Hospitals face shortage of bottles for blood cultures, and it’s a big problem

Hospitals across the country are wrestling with a shortage of bottles used for blood cultures.

Hospitals are facing a shortage of bottles used for blood cultures, which are essential for identifying infections. Hospitals are planning to conserve supplies and limit orders of blood cultures.

While it may not seem serious at first blush, hospitals utilize blood cultures to determine the source of infections and if patients have serious conditions such as sepsis. The blood culture bottles are indispensable for hospitals, and providers are looking at shortages that are expected to run into the early fall, at least.

The Centers for Disease Control and Prevention sent an advisory this week warning of a “critical shortage” of blood culture vials.

“This shortage has the potential to disrupt patient care by leading to delays in diagnosis, misdiagnosis, or other challenges in the clinical management of patients with certain infectious diseases,” the CDC said.

Nancy Foster, vice president for quality and patient safety at the American Hospital Association, tells Chief Healthcare Executive® that health systems are taking steps to conserve the bottles. “They don't know exactly when the situation is going to turn around,” Foster says.

Hospitals are expecting a shortage of blood culture bottles for the next several weeks, but have been advised supplies could improve in early September, Foster says.

“People are nervous,” she says.

‘A real challenge’

The shortage involves Becton Dickinson BACTEC™ blood culture media bottles, the CDC says. Becton Dickinson, a company based in Franklin Lakes, N.J., supplies blood culture bottles to hospitals in America and around the world.

The company said in a message online that it is seeing “reduced availability of blood culture vials from our supplier.”

Chris Beddard, vice president of microbiology at BD Life Sciences, updated clinicians during a webinar held by the Infectious Diseases Society of America this week. Beddard said the company initially expected the shortage from the supplier would be temporary.

“After multiple discussions and investigation analysis, the issues are more complex than were originally communicated to us, and this will limit our ability to supply the blood culture vials within the U.S, but also globally,” Beddard said during the webinar.

The company is moving to glass files for one type of media, and expects to see improvements in supplies by September 2024, Beddard said.

Hospitals are hoping for relief sooner than later, Foster says.

“The longer it lasts, certainly the harder it will be to ensure that every patient who needs a blood culture gets one,” Foster says. “The clinical leaders inside of each institution are thinking about how, if this gets worse, how will we have to manage supply? How will we even further restrict what we allow people to order, when we allow them to order applied culture? That will be a real challenge going forward.”

In its webinar, the Infectious Diseases Society of America featured physicians and leaders at prominent health systems talking about the impact of the shortage.

Romney M. Humphries, director of The Division of Laboratory Medicine at Vanderbilt University Medical Center, said during the webinar that the organization was expecting to receive a smaller supply of bottles earlier this month. But even with adjusted expectations, the medical center received far less than expected.

Since the beginning of July, “we’ve received less than 1% of the AEROBIC bottle orders from our distributor,” Humprhies said.

Vanderbilt secured more bottles from BD. Still, Humprhies said the medical center developed plans to avoid running out of blood culture bottles “which for us was a very real possibility.”

What hospitals can do

Clinicians during the Infectious Diseases Society of America webinar shared strategies and guidance to help conserve the dwindling supply of blood culture vials.

Some pointed to the need to examine the use of blood cultures across the organization, to ensure some clinicians aren’t asking for cultures when they aren’t always necessary. Hospitals should identify areas with higher orders of blood cultures and assess if some are being ordered unnecessarily.

Aaron M. Milstone, MD, professor of pediatric infectious diseases and epidemiology at Johns Hopkins Medicine, said hospitals can conserve supplies by being more judicious in ordering blood cultures.

“We always remind people that if you're concerned that your patient has bacterial sepsis, you should get a blood culture. But a lot of people get blood cultures for other reasons, and people have symptoms that are likely due to other things. So I think there's often low-hanging fruit that can be tackled right away,” Milstone said.

Jake D. Bunn, a clinical laboratory scientist at the CDC, said hospitals should be especially mindful to avoid contaminating blood cultures with low supplies of bottles.

“It's important to emphasize that those who collect blood culture should be performing routine skin disinfection prior to collection to minimize the risk of contamination of the blood culture and the need to recollect additional blood cultures,” Bunn said during the webinar. “You should also ensure the proper blood volume is collected to avoid a need to recollect additional blood cultures.

“These considerations do not make more blood culture bottles show up on your loading box, but will help to ensure if a blood culture is indicated, they are collected appropriately to help the supply management,” he said.

Sarah Turbett, MD, the associate director of clinical microbiology laboratories at Massachusetts General Hospital, said hospitals must develop teams to tackle the shortage, including those in clinical leadership, top executives, information technology and emergency preparedness.

Hospitals need to develop conservation strategies, she said.

“I think we all know, though, that despite the conservation efforts in a lot of situations, it's just not going to be enough, and we're going to have to think about moving to rationing, and I really hope not severe rationing efforts,” Turbett said. “And the reality of the situation is that some hospitals have already had to move into that.”

Supply chain headaches

Foster credits Becton Dickinson for updating providers on the issue and holding calls with clinicians to discuss the situation. But she said the company’s shortage could have a wide impact since it’s a major supplier of blood culture bottles.

And it’s not as simple as turning to another supplier for bottles, Foster said. Becton Dickinson’s analyzers that are used to examine blood cultures are designed to work with the company’s own bottles, so vials from another company won’t fit.

Hospitals have faced a host of supply chain interruptions in recent years, particularly during the heart of the COVID-19 pandemic. In 2022, hospitals dealt with shortages of contrast dye used in medical imaging, due to a shutdown of a key plant in Shanghai.

In April, the American Society of Hospital Pharmacists reported a record of 323 active drug shortages in the first quarter of 2024. The ASHP says shortages included life-saving medications, such as cancer drugs.

“Unfortunately we've had a number of supply shortages throughout the pandemic, and then continuing after the pandemic,” Foster says. “So it's not something unfamiliar to us.”