A scoping review of interventions to improve blood culture sampling practices in hospital acute care settings

Background: Blood cultures (BCs) are the gold standard investigation for patients with suspected severe infection and sepsis. Yet, BCs are not consistently obtained prior to antibiotic administration, and sampling practices remain suboptimal. Optimizing BC sampling has important benefits, including reducing inappropriate antibiotic use and improving antimicrobial stewardship. Despite advances in sepsis recognition and management, a significant scope remains to improve BC sampling practices. This scoping review aimed to identify evidence on interventions used to improve BC sampling in higher economically developed countries. Methods: Database searches of MEDLINE, CINAHL, PubMed and BMJ Open Quality were conducted for studies published between January 2015 and January 2025. Included studies were mapped to the Behaviour Change Wheel (BCW) framework. Results: Searches identified 3746 records; 23 studies met the inclusion criteria, with two additional studies identified through reference screening. In total, 25 studies were analysed, identifying six intervention types. Common interventions included visual prompts, screening tools, education and training programmes and audit-and-feedback mechanisms. These interventions most frequently mapped to the BCW categories of Environmental Restructuring (32%), Education and Training (28%) and Enablement (25%). Outcome measures varied widely, with no consistent metrics used across studies. Conclusions: This review identified six intervention types used to improve BC sampling practices, with Environmental Restructuring, Education and Training, and Enablement most commonly employed. Interventions were associated with improvements in timely BC collection and reduced contamination rates. However, heterogeneity in outcome measures and gaps in intervention types highlight the need for standardized metrics and more robust evaluations to optimize BC sampling practices across healthcare settings.