1.1
Kurin Lock can be used in the NHS to reduce contamination in blood culture collection in emergency departments with high blood culture contamination rates while more evidence is generated.
Guidance
1 Recommendations
Evidence generation
1.2
Evidence should be generated on:
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the resource impact of blood culture test results, including data on length of hospital stay, antibiotic use, further microbiological investigations and medical interventions
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staff adherence to blood culture collection methods
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baseline blood culture contamination rates, and any change in these rates from using Kurin Lock.
What this means in practice
NICE has made this recommendation because although there is uncertainty around the evidence of cost effectiveness for Kurin Lock, antimicrobial resistance is an area of high unmet need in the NHS.
Adopting Kurin Lock would need no change to standard practice. Clinical experts report that it is easy to use and needs minimal training compared with other methods to reduce contamination.
Evidence generation alongside using Kurin Lock in the NHS should give an opportunity to collect resource impact data to inform the economic modelling.
These recommendations will be reviewed within 3 years, or sooner if new evidence becomes available. Take this and the uncertainty around pricing into account when negotiating lengths of contracts.
This guidance is not accompanied by an evidence generation plan, but details of the types of evidence that should be generated are included in section 4.10.
Why the committee made these recommendations
Clinical trial evidence suggests that Kurin Lock is a safe and effective way of reducing blood culture contamination rates, compared with standard blood culture collection. It is not clear how it affects other outcomes, like length of hospital stay and antibiotic use, because the clinical trials did not formally record these outcomes.
The economic modelling is also uncertain, and it is unclear if Kurin Lock is cost incurring or cost saving. Kurin Lock costs much more than standard blood culture collection. So, it is more likely that Kurin Lock is cost saving when it is used in emergency departments with high rates of blood culture contamination. The external assessment group (EAG) estimated that if Kurin Lock reduces length of stay by only 0.5 days, and the baseline contamination rate in the department is 8%, the cost of a Kurin Lock device would need to be £10 rather than £19.50 to be cost neutral.
Evidence generation would help address uncertainties in the cost-effectiveness evidence. So, Kurin Lock is recommended for use in emergency departments with high blood culture contamination rates while evidence is generated.
The UK Government has developed a 5‑year national action plan to tackle antimicrobial resistance. This aims to contain and control antimicrobial resistance by 2040 by optimising antimicrobial use and reducing the need for and unintentional exposure to antibiotics. Kurin Lock may help to address this in emergency departments.