How Philly area hospitals are dealing with a national shortage of blood culture bottles

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Hospitals in the Philadelphia region are dealing with the fallout from a shortage of blood culture bottles. A few weeks ago, the Food and Drug Administration and the Centers for Disease Control and Prevention sent out alerts about the nationwide shortage.

Health care providers and labs routinely use these bottles to test for infections in patients’ blood. They contain a solution that helps bacteria grow. The manufacturer estimates the shortage will continue for at least a few more weeks, stating that the problem is due to issues with the supply of plastic. It’s serious enough that some doctors have discussed using expired bottles.

As the chief of infectious diseases and preventive medicine for Main Line Health, which has five hospitals in southeastern Pennsylvania, Brett Gilbert oversees infection control.

“It’s a rapidly evolving issue because we don’t know week to week necessarily what our supply is going to be,” he said.

These blood culture bottles are designed to work in a specific testing machine, which many hospitals around the country use. That is also why it is challenging to just replace them.

Gilbert said that since Main Line Health heard about this problem, they have been conserving these bottles. For example, they save them for people who could have serious infections and need these tests the most. For instance, Gilbert said that in the past, they might have ordered blood cultures for patients who have uncomplicated urinary tract infections or cellulitis, a common bacterial skin infection. However, it’s unlikely these patients would have infections in their blood, so during this shortage, doctors may not order blood cultures for those patients.

“It can potentially impact care and that’s why we’ve tried to come up with these mitigation strategies,” he added, explaining that the standards for what kind of patient gets a blood culture can change as the supply of these bottles changes.

He said Main Line Health is also ensuring that medical staff collect enough blood for every bottle so that no bottle is wasted. He said he has not seen such a serious shortage of these bottles in his 25 years of practicing medicine.

Other hospitals in the region also have to make difficult decisions during the shortage.

“They’re never easy; if they’re easy, we would have them in place already,” said Jonathan Bakst, vice president of laboratory operations at Temple Health.

He said that similar to Main Line Health, they have added procedures to reduce the number of bottles the health system goes through. For instance, they no longer routinely take two sets to rule out false positives. Instead, they take extra steps to prevent contamination in the samples and collect enough blood, making false positives less likely. He said that they have already used 40 to 50 percent fewer bottles in the past two weeks.

However, Bakst said they have also started planning for what they would do if they ran out of these bottles entirely – which would also mean that they can no longer use the instruments that help grow the bacteria.

“The instrumentation has been around for four decades or so, so going back, we’re taking a step back to the 70s and to the 80s,” he said.

He explained that would mean using other bottles to collect blood samples and, if needed, making their own solution to grow the bacteria samples. However, they must first ensure those procedures produce accurate results, and laboratory staff will have to check on those samples at least twice a day manually.

On a call hosted by the CDC and the Infectious Diseases Society of America, clinicians discussed possibly using expired blood culture bottles, discussing research that showed the bottles still worked a few months after the expiration date. Main Line Health, Temple Health, Jefferson Health, and the Children’s Hospital of Philadelphia all said they are not considering that as an option at the moment.

Jefferson Health still has a large enough supply at the moment, and they are conserving the bottles and not rationing them, said Bryan Hess, an infectious disease physician at Thomas Jefferson University Hospital. He said they have plans to ration bottles if supplies dwindle, but right now, they are focused on telling their medical staff about best practices to avoid collecting blood cultures that are unlikely to have an impact on patient care. But when they do collect blood cultures, they are still repeating them. He said some of these practices could continue even if there is no shortage of bottles.

“It has kind of forced our clinicians to … be a little more thoughtful and judicious in ordering tests. I think that’s something that can apply to a lot of tests and studies that we order,” he said. “There’s been no negative impact on patient care.”

The manufacturer, BD Life Sciences, said they hope to have glass bottles available in the U.S. by early September. Bakst said laboratories have used glass bottles in the past but moved away from those because they could sometimes break while in transit.