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Sánchez-Guzmán MDJ, Loyola-Cruz MÁ, López-Ornelas A, Cruz-Cruz C, Durán-Manuel EM, Bello-López JM. In situ and in vitro evaluation of two antiseptics for blood bank based on chlorhexidine gluconate/isopropyl alcohol and povidone-iodine. Transfus Apher Sci 2024; 63:103854. [PMID: 38061923 DOI: 10.1016/j.transci.2023.103854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 11/03/2023] [Accepted: 11/22/2023] [Indexed: 03/10/2024]
Abstract
BACKGROUND Poor disinfection is the main cause of blood contamination, so its elimination is key to limiting the entry of bacteria into the collection system. With the advancement of antiseptic technology, antiseptics with sterile, disposable applicators are now available. AIM To evaluate in situ two antiseptics (with and without applicators) for blood banks and to demonstrate in vitro antiseptic activity on bacterial biofilms of importance in transfusion medicine. METHODS Antiseptic A (2% sterile solution of chlorhexidine gluconate/70% isopropyl alcohol provided with applicator) and bulk antiseptic B (10% povidone-iodine) were evaluated. The deferred blood donor arms were subjected to disinfection with antiseptics A and B and the contralateral arms were cultured to determine the baseline bacterial load (control). Antiseptic activity was assessed by ANOVA and logaritmic reduction values (LRV) and percentage reduction values (PRV) were calculated. Finally, the in vitro activity of antiseptic A was analyzed by confocal laser scanning microscopy (CLSM) on biofilm models. RESULTS Prior to disinfection tests, commensal and clinically important bacteria were identified; antiseptic A showed post-disinfection bacterial growth rates of zero compared to controls (p < 0.0001). The frequency of bacterial growth with antiseptic B was 74%. A significant difference was identified between both antiseptics, where antiseptic A showed higher activity (p < 0.5468). LRV and PRV were 0.6-2.5/100% and 0.3-1.7/66.7-99.7% for antiseptics A and B, respectively. Through CLSM, disinfectant A (without applicator) showed lower in vitro antiseptic activity on the tested biofilms at the exposure times recommended by the manufacturer. CONCLUSIONS Sterile solution of chlorhexidine gluconate/isopropyl alcohol with applicator showed advantages disinfection in deferred blood donors over povidone-iodine.
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Affiliation(s)
- María de Jesús Sánchez-Guzmán
- División de Investigación, Hospital Juárez de México, Mexico City, Mexico; Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Mexico City, Mexico
| | | | | | - Clemente Cruz-Cruz
- División de Investigación, Hospital Juárez de México, Mexico City, Mexico; Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Mexico City, Mexico
| | - Emilio Mariano Durán-Manuel
- División de Investigación, Hospital Juárez de México, Mexico City, Mexico; Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Mexico City, Mexico
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Siddon AJ, Tormey CA, Snyder EL. Platelet Transfusion Medicine. Platelets 2019. [DOI: 10.1016/b978-0-12-813456-6.00064-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Cook IF. Sepsis, parenteral vaccination and skin disinfection. Hum Vaccin Immunother 2016; 12:2546-2559. [PMID: 27295449 PMCID: PMC5084982 DOI: 10.1080/21645515.2016.1190489] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 04/25/2016] [Accepted: 05/12/2016] [Indexed: 11/21/2022] Open
Abstract
ASBSTRACT Disinfection should be required for all skin penetrative procedures including parenteral administration of vaccines. This review analyses medically attended infectious events following parenteral vaccination in terms of their microbiological aetiology and pathogenesis. Like 'clean' surgical site infections, the major pathogens responsible for these events were Staphylococcal species, implicating endogenous con-tamination as a significant source of infection. As 70% isopropyl alcohol swabbing has been shown to effectively disinfect the skin, it would be medico-legally difficult to defend a case of sepsis with the omission of skin disinfection unless the very low risk of this event was adequately explained to the patient and documented prior to vaccination. There was a significant cost-benefit for skin disinfection and cellulitis. Skin disinfection in the context of parenteral vaccination represents a new paradigm of medical practice; the use of a low cost intervention to prevent an event of very low prevalence but of significant cost.
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Affiliation(s)
- Ian F. Cook
- University of Newcastle, Callaghan, New South Wales, Australia
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Cryopreservation in Closed Bag Systems as an Alternative to Clean Rooms for Preparations of Peripheral Blood Stem Cells. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 951:67-76. [PMID: 27837555 DOI: 10.1007/978-3-319-45457-3_6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Autologous and allogeneic stem cell transplantation (SCT) represents a therapeutic option widely used for hematopoietic malignancies. One important milestone in the development of this treatment strategy was the development of effective cryopreservation technologies resulting in a high quality with respect to cell viability as well as lack of contamination of the graft.Stem cell preparations have been initially performed within standard laboratories as it is routinely still the case in many countries. With the emergence of cleanrooms, manufacturing of stem cell preparations within these facilities has become a new standard mandatory in Europe. However, due to high costs and laborious procedures, novel developments recently emerged using closed bag systems as reliable alternatives to conventional cleanrooms. Several hurdles needed to be overcome including the addition of the cryoprotectant dimethylsulfoxide (DMSO) as a relevant manipulation. As a result of the development, closed bag systems proved to be comparable in terms of product quality and patient outcome to cleanroom products. They also comply with the strict regulations of good manufacturing practice.With closed systems being available, costs and efforts of a cleanroom facility may be substantially reduced in the future. The process can be easily extended for other cell preparations requiring minor modifications as donor lymphocyte preparations. Moreover, novel developments may provide solutions for the production of advanced-therapy medicinal products in closed systems.
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Webster J, Bell-Syer SEM, Foxlee R. Skin preparation with alcohol versus alcohol followed by any antiseptic for preventing bacteraemia or contamination of blood for transfusion. Cochrane Database Syst Rev 2015; 2015:CD007948. [PMID: 25674776 PMCID: PMC7185566 DOI: 10.1002/14651858.cd007948.pub3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Blood for transfusion may become contaminated at any point between collection and transfusion and may result in bacteraemia (the presence of bacteria in the blood), severe illness or even death for the blood recipient. Donor arm skin is one potential source of blood contamination, so it is usual to cleanse the skin with an antiseptic before blood donation. One-step and two-step alcohol based antiseptic regimens are both commonly advocated but there is uncertainty as to which is most effective. OBJECTIVES To assess the effects of cleansing the skin of blood donors with alcohol in a one-step compared with alcohol in a two-step procedure to prevent contamination of collected blood or bacteraemia in the recipient. SEARCH METHODS In December 2014, for this third update, we searched the Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Library; Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL. SELECTION CRITERIA All randomised trials (RCTs) comparing alcohol based donor skin cleansing in a one-step versus a two-step process that includes alcohol and any other antiseptic for pre-venepuncture skin cleansing were considered. Quasi randomised trials were to have been considered in the absence of RCTs. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for inclusion. MAIN RESULTS No studies (RCTs or quasi RCTs) met the inclusion criteria. AUTHORS' CONCLUSIONS We did not identify any eligible studies for inclusion in this review. It is therefore unclear whether a two-step, alcohol followed by antiseptic skin cleansing process prior to blood donation confers any reduction in the risk of blood contamination or bacteraemia in blood recipients, or conversely whether a one-step process increases risk above that associated with a two-step process.
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Affiliation(s)
- Joan Webster
- Centre for Clinical Nursing, Royal Brisbane and Women's Hospital, Level 2, Building 34, Butterfield Street, Brisbane, Queensland, Australia, 4029. .
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Klausen SS, Hervig T, Seghatchian J, Reikvam H. Bacterial contamination of blood components: Norwegian strategies in identifying donors with higher risk of inducing septic transfusion reactions in recipients. Transfus Apher Sci 2014; 51:97-102. [DOI: 10.1016/j.transci.2014.08.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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7
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So BKL, Chu CCY, Ho PL, Chow KH, Leung JNS, Lee IYM, Lin CK, Lee CK. Evaluation of two chlorhexidine - alcohol-based skin disinfectants in blood donation setting. Vox Sang 2013; 106:316-21. [DOI: 10.1111/vox.12107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- B. K. L. So
- Hong Kong Red Cross Blood Transfusion Service; Hong Kong SAR China
| | - C. C. Y. Chu
- Hong Kong Red Cross Blood Transfusion Service; Hong Kong SAR China
| | - P. L. Ho
- Carol Yu Center for Infection and Department of Microbiology; the University of Hong Kong; Hong Kong SAR China
| | - K. H. Chow
- Carol Yu Center for Infection and Department of Microbiology; the University of Hong Kong; Hong Kong SAR China
| | - J. N. S. Leung
- Hong Kong Red Cross Blood Transfusion Service; Hong Kong SAR China
| | - I. Y. M. Lee
- Hong Kong Red Cross Blood Transfusion Service; Hong Kong SAR China
| | - C. K. Lin
- Hong Kong Red Cross Blood Transfusion Service; Hong Kong SAR China
| | - C. K. Lee
- Hong Kong Red Cross Blood Transfusion Service; Hong Kong SAR China
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Webster J, Bell-Syer SEM, Foxlee R. Skin preparation with alcohol versus alcohol followed by any antiseptic for preventing bacteraemia or contamination of blood for transfusion. Cochrane Database Syst Rev 2013:CD007948. [PMID: 23440821 DOI: 10.1002/14651858.cd007948.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Blood for transfusion may become contaminated at any point between collection and transfusion and may result in bacteraemia (the presence of bacteria in the blood), severe illness or even death for the blood recipient. Donor arm skin is one potential source of blood contamination, so it is usual to cleanse the skin with an antiseptic before blood donation. One-step and two-step alcohol based antiseptic regimens are both commonly advocated but there is uncertainty as to which is most effective. OBJECTIVES To assess the effects of cleansing the skin of blood donors with alcohol in a one-step compared with alcohol in a two-step procedure to prevent contamination of collected blood or bacteraemia in the recipient. SEARCH METHODS For this second update we searched the Cochrane Wounds Group Specialised Register (searched 20 November 2012); The Cochrane Central Register of Controlled Trials (CENTRAL) The Cochrane Library 2012, Issue 11; Ovid MEDLINE (20011 to November Week 2 2012); Ovid MEDLINE (In-Process & Other Non-Indexed Citations November 20, 2012); Ovid EMBASE ( 20011 to 2012 Week 46); and EBSCO CINAHL ( 2008 to 15 November 2012). SELECTION CRITERIA All randomised trials (RCTs) comparing alcohol based donor skin cleansing in a one-step versus a two-step process that includes alcohol and any other antiseptic for pre-venepuncture skin cleansing were considered. Quasi randomised trials were to have been considered in the absence of RCTs. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for inclusion. MAIN RESULTS No studies (RCTs or quasi RCTs) met the inclusion criteria. AUTHORS' CONCLUSIONS We did not identify any eligible studies for inclusion in this review. It is therefore unclear whether a two-step, alcohol followed by antiseptic skin cleansing process prior to blood donation confers any reduction in the risk of blood contamination or bacteraemia in blood recipients, or conversely whether a one-step process increases risk above that associated with a two-step process.
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Affiliation(s)
- Joan Webster
- Centre for Clinical Nursing, Royal Brisbane andWomen’s Hospital, Brisbane,
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Lee C, Chan H, Ho P, Wong H, Leung J, Tsoi W, Lin C. Long-term clinical outcomes afterStreptococcus bovisisolation in asymptomatic blood donors in Hong Kong. Transfusion 2013; 53:2207-10. [DOI: 10.1111/trf.12087] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 11/17/2012] [Accepted: 11/18/2012] [Indexed: 12/24/2022]
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Platelet Transfusion Medicine. Platelets 2013. [DOI: 10.1016/b978-0-12-387837-3.00062-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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Lee CK, Wong HK, Ho PL, Tsoi WC, Lee KY, Tsui GTF, Chua E, Leung JNS, Lin CK. Significant bacterial contamination risk reduction with the use of diversion pouch. Transfus Med 2012; 22:404-8. [DOI: 10.1111/j.1365-3148.2012.01194.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 09/05/2012] [Accepted: 09/09/2012] [Indexed: 11/30/2022]
Affiliation(s)
- C. K. Lee
- Hong Kong Red Cross Blood Transfusion Service; Hong Kong; SAR; China
| | - H. K. Wong
- Hong Kong Red Cross Blood Transfusion Service; Hong Kong; SAR; China
| | - P. L. Ho
- Department of Microbiology; The University of Hong Kong; Hong Kong; SAR; China
| | - W. C. Tsoi
- Hong Kong Red Cross Blood Transfusion Service; Hong Kong; SAR; China
| | - K. Y. Lee
- Hong Kong Red Cross Blood Transfusion Service; Hong Kong; SAR; China
| | - G. T. F. Tsui
- Hong Kong Red Cross Blood Transfusion Service; Hong Kong; SAR; China
| | - E. Chua
- Hong Kong Red Cross Blood Transfusion Service; Hong Kong; SAR; China
| | - J. N. S. Leung
- Hong Kong Red Cross Blood Transfusion Service; Hong Kong; SAR; China
| | - C. K. Lin
- Hong Kong Red Cross Blood Transfusion Service; Hong Kong; SAR; China
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Patel TG, Shukla RV, Gupte SC. Impact of donor arm cleaning with different aseptic solutions for prevention of contamination in blood bags. Indian J Hematol Blood Transfus 2012; 29:17-20. [PMID: 24426327 DOI: 10.1007/s12288-011-0138-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 12/08/2011] [Indexed: 10/14/2022] Open
Abstract
Transfusion associated sepsis cases are encountered occasionally and bacterial transmission remains the major cause. The goal of our study was to compare the efficacy of disinfectants in phlebotomy site preparation. After selection of donor the antecubital fossa area of the arm was disinfected with different types of disinfectants namely sprit (70% isopropyl alcohol), povidone iodine (0.5% w/v available iodine in distilled water), savlon (1.5% v/v chlorhexidine gluconate solution and 3.0% cetrimide solution) and combination of sprit and povidone iodine. Swabs were collected from 20 donors using a sterile forceps, after cleaning with different antiseptic solutions. Swab was streaked on blood agar plate aseptically and the plate was incubated at 37°C for 24 h. Colonies were counted and a single colony was re-cultured by growing on nutrient and Mac-Conkey agar. The biochemical characteristics were determined by performing Gram staining, Motility, Catalase and Oxidase tests. The mean values of colonies were significantly higher with savlon compared to other three solutions. The difference was statistically significant by "t" test (t values 1.7-3.0; P < 0.05). Staphylococcus epidermidis, Staphylococcus sp., Streptococcus sp., Micrococcus sp., Bacillus megaterium and Bacillus cereus were the organisms identified. After completion of bleeding, samples from the bag were aseptically inoculated in aerobic and anaerobic culture bottles to be tested on BacT/Alert system. The bag containing donor's blood did not show any contamination when three cleanings were carried out using sprit, povidone iodine and spirit respectively.
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Affiliation(s)
- Tanvi G Patel
- Surat Raktadan Kendra & Research Centre, 1st Floor, Khatodara Health Centre, Besides Chosath Joganiyo Mata's Temple, Udhana Magdalla Road, Khatodara, Surat, 394 210 India
| | - Rinku V Shukla
- Surat Raktadan Kendra & Research Centre, 1st Floor, Khatodara Health Centre, Besides Chosath Joganiyo Mata's Temple, Udhana Magdalla Road, Khatodara, Surat, 394 210 India
| | - Snehalata C Gupte
- Surat Raktadan Kendra & Research Centre, 1st Floor, Khatodara Health Centre, Besides Chosath Joganiyo Mata's Temple, Udhana Magdalla Road, Khatodara, Surat, 394 210 India
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Celere MS, Ferreira O, Ubiali EMA, Julião FC, Fernandes AFT, de Andrade D, Segura-Muñoz SI. Antimicrobial activity of two techniques for arm skin disinfection of blood donors in Brazil. Transfus Med 2012; 22:116-21. [DOI: 10.1111/j.1365-3148.2012.01132.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- M S Celere
- Regional Blood Center of Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil
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McDonald CP. Interventions Implemented to Reduce the Risk of Transmission of Bacteria by Transfusion in the English National Blood Service. ACTA ACUST UNITED AC 2011; 38:255-258. [PMID: 22016696 DOI: 10.1159/000330474] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 06/30/2011] [Indexed: 11/19/2022]
Abstract
SUMMARY: BACKGROUND: Bacterial contamination remains a significant problem in transfusion medicine. A National Health Service Blood and Transplant (NHSBT) study and surveillance data indicated skin commensals derived from the skin of the donor are the major contaminants of blood components. NHSBT therefore explored two interventions: improved donor arm disinfection and diversion. METHODS: IMPROVED DONOR ARM DISINFECTION: Commercial and in-house methods of disinfection were evaluated. Swabs at the venepuncture site were taken before and after disinfection and the reduction in bioburden determined. Diversion: Special collection bags were manufactured to allow the initial volume of blood to flow into a pouch, representing the diversion pouch and then the next flow of blood into another pouch representing the collection bag. Pouches were screened for the presence of bacteria. The reduction in bacterial contamination was then determined. RESULTS: A two-step commercial procedure (Donor Prep Kit; DPK) consisting of 70% isopropyl alcohol followed by tincture of iodine was shown to be a best practice procedure (2-min procedure). A 99.79% reduction was obtained, and this method was 10 times more effective than current practice at that time. The DPK was shown in a field trial to increase donor waiting time. A second study was initiated to find a more rapid procedure. ChloraPrep®, consisting of 2% chlorhexidine gluconate and 70% isopropyl alcohol, was shown to have equivalent disinfection efficiency as the DPK, but only took 1 min to perform. In 2006, ChloraPrep was introduced as the national method of donor arm disinfection. Diversion was shown to give a 47% reduction in contamination and was introduced nationally in 2002. CONCLUSION: Improved donor arm disinfection and diversion are effective, low-cost interventions, but do not eliminate all bacterial transmissions. In 2011, bacterial screening of platelet components was introduced by NHSBT to further increase the safety of the blood supply.
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Benjamin RJ, Dy B, Warren R, Lischka M, Eder AF. Skin disinfection with a single-step 2% chlorhexidine swab is more effective than a two-step povidone-iodine method in preventing bacterial contamination of apheresis platelets. Transfusion 2010; 51:531-8. [DOI: 10.1111/j.1537-2995.2010.02868.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Martínez F, Tarrand J, Lichtiger B. Impact on patient outcome following transfusion of bacterially contaminated platelets: the M.D. Anderson Cancer Center experience. Am J Clin Pathol 2010; 134:207-12. [PMID: 20660322 DOI: 10.1309/ajcps9yv7ytomrrh] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
This study examined the clinical outcome of every patient who received a bacterially contaminated unit of platelets at The University of Texas M.D. Anderson Cancer Center, Houston, during 2007. Samples of platelets were aerobically cultured and read for 1 day at 35 degrees C. Positive bottles were subcultured in the appropriate media. The effect of independent variables in the clinical outcome of patients infused with bacterially contaminated platelet units was analyzed. A total of 23,199 platelet units were transfused, 71 of which were bacterially contaminated units; 8 were apheresis platelets and 63 were whole blood platelets. Of the 71 units, 70 were contaminated with gram-positive bacteria and 1 with gram-negative bacteria. Only 1 patient developed fever, and coagulase-negative staphylococci were isolated from the transfused unit. Transfusion of fresh units and antibiotic therapy possibly explain the lack of clinical consequences in our patients.
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Ramirez-Arcos S, Goldman M. Skin disinfection methods: prospective evaluation and postimplementation results. Transfusion 2010; 50:59-64. [PMID: 19821950 DOI: 10.1111/j.1537-2995.2009.02434.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Optimal skin disinfection ensures blood safety. In this study, efficacies of the two-step skin disinfection methods used at Canadian Blood Services (CBS) and two one-step methods produced by different manufacturers were compared. STUDY DESIGN AND METHODS In each of the three phases of the study, two methods were compared by disinfection of the antecubital fossae of study subjects. The two-step methods were compared in Phase I: Method A (isopropyl alcohol scrub and iodine tincture ampule) and Method B (isopropyl alcohol and chlorhexidine scrub and isopropyl alcohol and chlorhexidine ampule). In Phases II and III, Method B was compared to two different one-step swab sticks containing isopropyl alcohol and chlorhexidine (Methods C and D). Contact plates were applied on each of the subjects before and after disinfection and incubated at 37 degrees C for 24 hours followed by colony counting. RESULTS In 99% of the subjects, colonies per plate were reduced from approximately 60 to less than 10 after disinfection using any method. Method B was superior to Method A (p < 0.05) but was not significantly different from Methods C and D. Method D was implemented for skin disinfection at CBS with no significant effects on blood product contamination. Skin reactions increased from approximately 0.02% to approximately 0.62% after implementation, which were subsequently reduced to approximately 0.04%. CONCLUSION In this study, isopropyl alcohol and chlorhexidine disinfectants were more efficacious than isopropyl alcohol and iodine. There was no difference in efficacy between one-step and two-step procedures or between methods of application. A one-step chlorhexidine and isopropyl alcohol kit has been successfully implemented at CBS.
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Monitoring bacterial contamination in equine platelet concentrates obtained by the tube method in a clean laboratory environment under three different technical conditions. Equine Vet J 2009; 42:63-7. [DOI: 10.2746/042516409x455221] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Zhu L, Xu J, Yang X, Shen Z, Wang Y, Zhu F, Lv H, Yan L. Detection of bacterial contamination of apheresis platelets in a Chinese Blood Center. Transfus Med 2009; 19:357-62. [DOI: 10.1111/j.1365-3148.2009.00948.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Webster J, Bell-Syer SE, Foxlee R. Skin preparation with alcohol versus alcohol followed by any antiseptic for preventing bacteraemia or contamination of blood for transfusion. Cochrane Database Syst Rev 2009:CD007948. [PMID: 19588446 DOI: 10.1002/14651858.cd007948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Blood for transfusion may become contaminated at any point between collection and transfusion and may result in bacteraemia (the presence of bacteria in the blood), severe illness or even death for the blood recipient. Donor arm skin is one potential source of blood contamination, so it is usual to cleanse the skin with an antiseptic before blood donation. One-step and two-step alcohol based antiseptic regimens are both commonly advocated but there is uncertainty as to which is most effective. OBJECTIVES To assess the effects of cleansing the skin of blood donors with alcohol in a one-step compared with alcohol in a two-step procedure to prevent contamination of collected blood or bacteraemia in the recipient. SEARCH STRATEGY We searched the Cochrane Wounds Group Specialised Register (March 10 2009); The Cochrane Central Register of Controlled Trials (CENTRAL) The Cochrane Library 2009, Issue 1; Ovid MEDLINE - (1950 to February Week 4 2009); Ovid EMBASE - (1980 to 2009 Week 9); and EBSCO CINAHL - (1982 to February Week 4 2009). We also searched the reference lists of key papers. SELECTION CRITERIA All randomised trials (RCTs) comparing alcohol based donor skin cleansing in a one-step versus a two-step process that includes alcohol and any other antiseptic for pre-venepuncture skin cleansing were considered. Quasi randomised trials were to have been considered in the absence of RCTs. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for inclusion. MAIN RESULTS No studies (RCTs or quasi RCTs) met the inclusion criteria. AUTHORS' CONCLUSIONS We did not identify any eligible studies for inclusion in this review. It is therefore unclear whether a two-step, alcohol followed by antiseptic skin cleansing process prior to blood donation confers any reduction in the risk of blood contamination or bacteraemia in blood recipients, or conversely whether a one-step process increases risk above that associated with a two-step process.
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Affiliation(s)
- Joan Webster
- Centre for Clinical Nursing, Royal Brisbane and Women's Hospital, Level 2, Building 34, Butterfield Street, Herston, QLD, Australia, 4029
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Lee C, Ho P, Lee K, Tsui G, Chua E, Tsoi W, Lin C. Value of anaerobic culture in bacterial surveillance program for platelet concentrates. Transfusion 2008; 48:2606-11. [DOI: 10.1111/j.1537-2995.2008.01887.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Reesink HW, Mohammadi T, Pietersz RN, Savelkoul PH. Rapid screening by real-time 16S rDNA PCR for bacterial contamination of blood products. Clin Chem Lab Med 2008; 46:954-62. [DOI: 10.1515/cclm.2008.155] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Schrezenmeier H, Walther-Wenke G, Müller TH, Weinauer F, Younis A, Holland-Letz T, Geis G, Asmus J, Bauerfeind U, Burkhart J, Deitenbeck R, Förstemann E, Gebauer W, Höchsmann B, Karakassopoulos A, Liebscher UM, Sänger W, Schmidt M, Schunter F, Sireis W, Seifried E. Bacterial contamination of platelet concentrates: results of a prospective multicenter study comparing pooled whole blood-derived platelets and apheresis platelets. Transfusion 2007; 47:644-52. [PMID: 17381623 DOI: 10.1111/j.1537-2995.2007.01166.x] [Citation(s) in RCA: 144] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The GERMS Group initiated a prospective multicenter study to assess prevalence and nature of bacterial contamination of pooled buffy-coat platelet concentrates (PPCs) and apheresis platelet concentrates (APCs) by routine screening with a bacterial culture system. STUDY DESIGN AND METHODS In nine centers overall, 52,243 platelet (PLT) concentrates (15,198 APCs, 37,045 PPCs) were analyzed by aerobic and anaerobic cultures (BacT/ALERT, bioMérieux). RESULTS In 135 PLT concentrates (PCs; 0.26%), bacteria could be identified in the first culture (0.4% for APCs vs. 0.2% for PPCs; p < 0.001). In 37 (0.07%) of these PC units, the same bacteria strain could be identified in a second culture from the sample bag and/or the PC unit. The rate of confirmed-positive units did not differ significantly between APC (0.09%; 1/1169) and PPC units (0.06%; 1/1544). Bacteria from skin flora (Propionibacterium acnes, Staphylococcus epidermidis) were the most prevalent contaminants. Median times to first positive culture from start of incubation were 0.7 and 3.7 days in aerobic and anaerobic cultures for confirmed-positive units. With a "negative-to-date" issue strategy, most PC units (55%) had already been issued by time of the first positive culture. CONCLUSION The rate of confirmed bacterial contamination of PC units was low. Nevertheless, clinicians must be aware of this risk. The risk of bacterial contamination does not warrant universal preference of APCs. It must be questioned whether routine bacterial screening by a culture method can sufficiently prevent contaminated products from being transfused due to the delay until a positive signal in the culture system and due to false-negative results.
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Affiliation(s)
- Hubert Schrezenmeier
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, Red Cross Blood Donor Service Baden-Württemberg-Hessia, and Institute of Transfusion Medicine, University of Ulm, Ulm, Germany.
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Bihl F, Castelli D, Marincola F, Dodd RY, Brander C. Transfusion-transmitted infections. J Transl Med 2007; 5:25. [PMID: 17553144 PMCID: PMC1904179 DOI: 10.1186/1479-5876-5-25] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2007] [Accepted: 06/06/2007] [Indexed: 12/15/2022] Open
Abstract
Although the risk of transfusion-transmitted infections today is lower than ever, the supply of safe blood products remains subject to contamination with known and yet to be identified human pathogens. Only continuous improvement and implementation of donor selection, sensitive screening tests and effective inactivation procedures can ensure the elimination, or at least reduction, of the risk of acquiring transfusion transmitted infections. In addition, ongoing education and up-to-date information regarding infectious agents that are potentially transmitted via blood components is necessary to promote the reporting of adverse events, an important component of transfusion transmitted disease surveillance. Thus, the collaboration of all parties involved in transfusion medicine, including national haemovigilance systems, is crucial for protecting a secure blood product supply from known and emerging blood-borne pathogens.
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Affiliation(s)
- Florian Bihl
- Partners AIDS Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Damiano Castelli
- Swiss Red Cross Blood Transfusion Service of Southern Switzerland, Lugano, Switzerland
| | | | - Roger Y Dodd
- American Red Cross, Holland Laboratory, Rockville, MD, USA
| | - Christian Brander
- Partners AIDS Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Fehri S, Tazi I, Loukhmass L, Benchemsi N. [New container of sample: role in the reduction of bacterial contamination of standard platelet units]. Transfus Clin Biol 2007; 13:335-40. [PMID: 17306583 DOI: 10.1016/j.tracli.2006.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2006] [Accepted: 12/29/2006] [Indexed: 11/25/2022]
Abstract
BACKGROUND Bacterial contamination of unstable blood products constitutes today the most frequent infectious risk transmitted by blood transfusion. Platelet concentrates are often incrimineted. As responsible germs are in general of cutaneous origin, a sample procedure with diversion of the first 20 ml during blood donation is studied. The aim of this study is to evaluate the results of this technique on bacterial contamination rate of standard platelet units prepared at the regional blood transfusion center in Casablanca. STUDY DESIGN AND METHODS A comparative study of two types of sample pockets is made: 500 Standard Platelet concentrates (CPS) are prepared after collection using standard triple bags (Baxter) (group 1) and 560 pockets of CPS were prepared after collection using triple bags with Sample Diversion Pouch sampling system for elimination of the first 20 ml of donation (Macopharma and Terumo) (group 2). The skin was disinfected in two times with alcohol 70%. The bacteriological study was made in the two groups at the third day of conservation. RESULTS Six CPS of group 1 were contaminated, of which five were staphylococci coagulase negative and one bacillus sp. Six CPS of group 2 were contaminated, of which five were staphylococci coagulase negative and one staphylococcus aureus. The bacteria isolated were those of cutaneous flora at 100%. Diversion of first 20 ml of blood donation results in a 16.6% reduction in bacterial contamination of CPS (P>0.05). CONCLUSION The non-significant reduction in the prevalence of the bacterial infection of CP formulates the problem of the indication of the sampling devices with derivation of first 20 ml during blood collection.
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Affiliation(s)
- S Fehri
- Centre régional de transfusion sanguine de Casablanca, rue Faidouzi, BP 5338 Maarif Casablanca, Maroc.
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McDonald CP. Bacterial risk reduction by improved donor arm disinfection, diversion and bacterial screening. Transfus Med 2007; 16:381-96. [PMID: 17163869 DOI: 10.1111/j.1365-3148.2006.00697.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The Interventions of improved donor arm disinfection, diversion and bacterial screening have been implemented by blood services and shown to have substantial benefit. The major source of bacterial contamination is donor arm derived. Blood services are now introducing best practice donor arm disinfection techniques. Diversion has been shown to substantially reduce bacterial contamination in the order of 40-88%. Diversion, together with improved donor arm disinfection, has shown to improve the percentage of reduction in contamination from 47% to 77%. Residual contamination levels after the Introduction of diversion and improved donor arm disinfection may be in the order of 30-40%. Numerous countries have now implemented screen testing programmes for platelet concentrates, which are the major source of bacterial transfusion transmission. Pathogen reduction systems have been developed and are under development. At present, concerns remain with these systems regarding cost, process control, ability to inactivate high titres of viruses, killing of bacterial spores, product damage, genotoxicity and mutagenicity. The interventions of diversion, improved donor arm disinfection and bacterial screen testing are currently available, As such they can be implemented now to increase blood safety with no associated patient risk.
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Affiliation(s)
- C P McDonald
- National Bacteriology Laboratory, National Blood Service, Colindale, London, UK.
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30
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Platelet Storage and Transfusion. Platelets 2007. [DOI: 10.1016/b978-012369367-9/50831-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Mohr H, Bayer A, Gravemann U, Müller TH. Elimination and multiplication of bacteria during preparation and storage of buffy coat-derived platelet concentrates. Transfusion 2006; 46:949-55. [PMID: 16734811 DOI: 10.1111/j.1537-2995.2006.00827.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The prevalence of bacterial contamination of random-donor platelet concentrates (PCs) is considerably lower than that of blood donations. Which key steps of the preparation procedure contribute to the elimination of bacteria was investigated. STUDY DESIGN AND METHODS Ten bacteria species were used. Blood donations were spiked with bacteria and stored at 22 degrees C for 8 hours. The buffy coats were kept for 6 hours. PCs were prepared from pools of 4 buffy coats. At each preparation step and during PC storage, bacteria contents were measured. In additional experiments, the titers of spiked blood and buffy coats were determined after storage at 20, 22, or 24 degrees C for 8 and up to 24 hours, respectively. RESULTS Enterobacter cloacae, Escherichia coli, Pseudomonas aeruginosa, Serratia marcescens, and Yersinia enterocolitica were completely inactivated during storage in blood or buffy coats. Titer reduction was between 3.32 and 4.62 log. Bacillus cereus, Propionibacterium acnes, Staphylococcus aureus, and Staphylococcus epidermidis did not multiply. Compared with their values in spiked blood the titers in the PCs were reduced by 1.7 to 2.8 log. Klebsiella pneumoniae was the only species that grew in blood. With the exception of P. acnes, those species that were not removed by the preparation process multiplied in the PCs. Remarkable donor-to-donor variations of the bactericidal activities of buffy coats were detected when the storage time was prolonged to 24 hours. CONCLUSIONS Bacteria are significantly eliminated by the preparation procedure for random donor PCs. Also, blood and buffy coats are bactericidal for most species. When buffy-coat storage is prolonged, it cannot, however, be predicted whether specific strains vanish or multiply.
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Affiliation(s)
- Harald Mohr
- Blood Center of the German Red Cross Chapters of NSTOB, Institutes Springe and Gera, Springe, Germany.
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32
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de Korte D, Curvers J, de Kort WLAM, Hoekstra T, van der Poel CL, Beckers EAM, Marcelis JH. Effects of skin disinfection method, deviation bag, and bacterial screening on clinical safety of platelet transfusions in the Netherlands. Transfusion 2006; 46:476-85. [PMID: 16533293 DOI: 10.1111/j.1537-2995.2006.00746.x] [Citation(s) in RCA: 133] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Bacterial contamination of blood products is a great hazard for development of fatal transfusion reactions. Bacterial screening of platelet concentrates (PC) by aerobic and anaerobic culturing (BacT/ALERT, bioMérieux) was introduced in the Netherlands in October 2001. STUDY DESIGN AND METHODS In November 2002, a nationwide, uniform skin cleansing method was introduced with a double-swab disinfection with 70 percent isopropyl alcohol. One location routinely used an integrated diversion bag to collect the first 20 to 30 mL. RESULTS Over the calendar years 2002 and 2003, in total 113,093 PCs derived from pooled buffy coats were screened. After introduction of the new disinfection method, 0.85 percent were initially positive. This was a small reduction compared to the previous disinfection methods under which 0.95 percent were initially positive. The location with use of the diversion bag showed a significantly lower frequency of bacterial contamination, with 0.50 percent before and 0.37 percent after introduction of 70 percent isopropyl alcohol. In addition 8000 apheresis PCs were also screened, showing 24 initially positive samples (0.30%). CONCLUSION The use of the diversion bag and, to a lesser extent, the use of double swabs with 70 percent isopropyl alcohol, led to a reduction of contamination. As expected, predominant contamination with resident skin bacteria was reduced. The combination of diversion bag and new disinfection led to a frequency of initial positive results for pooled five-donor PCs, which is similar to that of single-donor apheresis PCs. Furthermore, the bacterial detection system and associated product recall procedures have been shown to be effective in preventing transfusion of contaminated PCs and/or related red cells, especially for rapidly growing bacteria.
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McDonald CP, Pearce S, Wilkins K, Colvin J, Robbins S, Colley L, Taylor J, Barbara JAJ. Pall eBDS: an enhanced bacterial detection system for screening platelet concentrates. Transfus Med 2005; 15:259-68. [PMID: 16101803 DOI: 10.1111/j.0958-7578.2005.00587.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Bacterial contamination of blood components remains a significant problem in transfusion medicine. The Pall enhanced bacterial detection system (Pall eBDS) detects the presence of bacteria in leucodepleted platelet concentrates by measuring the reduction of oxygen in the sample, due to aerobic bacterial growth. Pooled platelet concentrates were spiked at 10 cfu mL(-1) with 10 organisms (one species per bag). Pall eBDS pouches were inoculated with the spiked platelet concentrates. After 24 and 30 h of incubation, the oxygen level was measured. A further set of pouches were taken from the inoculated platelet concentrates at 24 h. Incubation and reading intervals were as for the initial set of pouches. A sensitivity study was also performed comparing the Pall eBDS with the BacT/ALERT system. Spiking at 10 cfu mL(-1) and immediately sampling into Pall eBDS pouches resulted in 97.6 and 100% detection after an incubation period of 24 and 30 h, respectively. After 24 h of incubation of the spiked platelet concentrates and then sampling into Pall eBDS pouches, 99.1% detection was obtained after incubation for both 24 and 30 h. The sensitivity of the Pall eBDS and BacT/ALERT is similar and in the order of 1 cfu mL(-1). Implementation of either BacT/ALERT or Pall eBDS for routine screening of platelet concentrates has the potential to further increase the safety of the blood supply.
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Castro E, Bueno JL, Barea L, González R. Feasibility of implementing an automated culture system for bacteria screening in platelets in the blood bank routine. Transfus Med 2005; 15:185-95. [PMID: 15943703 DOI: 10.1111/j.1365-3148.2005.00571.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Bacterial contamination of blood components is the principal infectious complication linked to transfusion. The aim of the study was to evaluate the applicability of an automated culture system for platelets. 10 141 platelet concentrates were cultured individually and in pools of five on storage days 1 and 7 using Bact/Alert system aerobic bottles. A modified collection bag was used for improved sampling. Five-millilitre samples were cultured at 37 degrees C for 7 days. Only those samples where the same bacteria were identified in reculture were considered true positives (TP). Homogeneity of proportions was tested by Fisher's exact test. The rate of TP was 30 per 100 000 (95% CI, 6.1-86.4) sampling on day 1; 33 per 100 000 (95% CI, 7-96) on day 7; and 40 per 100 000 (95% CI, 1.28-122.4) if the screening was based on taking both samples (day 1 and 7). Only one TP was detected in the pool testing. The time for detection among TPs on day 1 ranged between 30 and 134 h. The system is not considered practical for use as a routine screening method, as the time for detection is too long. Pool testing is insensitive. Faster screening methods or pathogen-inactivation systems are needed.
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Affiliation(s)
- E Castro
- Centro de Donación de Sangre Cruz Roja Española, Madrid, Spain.
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36
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Buchta C, Dettke M, Funovics PT, Hirschl AM, Macher M, Worel N, Höcker P. Impact of manufacturing, irradiation and filtration steps to bacterial contamination of autologous fibrin sealant. Biologicals 2005; 32:165-9. [PMID: 15536048 DOI: 10.1016/j.biologicals.2004.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2003] [Accepted: 03/09/2004] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Preoperative production of autologous fibrin sealant has become a routine procedure during the last years. As a certain percentage of blood products is contaminated with bacteria, contamination of plasma used for the production of fibrin sealant cannot be excluded. Especially in the orthopaedic setting, application of contaminated fibrin sealant can cause severe infections. MATERIALS AND METHODS We contaminated plasma with Staphylococcus epidermidis, Corynebacterium striatum, Bacillus subtilis or Escherichia coli and produced fibrin sealant by cryoprecipitation and alcohol precipitation. Additionally, the products were gamma-irradiated at a dose of 30 Gy, frozen at -55 degrees C and filtered through a 0.2 microm filter after thawing. After each preparation step, samples were drawn and numbers of colony forming units were counted after incubation on agar plates. RESULTS Cryoprecipitation, irradiation, freezing at -55 degrees C, and alcohol precipitation have only little impact on numbers of colony forming units. Filtration through a bacterial filter results in a sterile product. CONCLUSION Bacteria in plasma as a starting material for production of fibrin sealant survive all routine steps of production, including gamma irradiation and freezing. Filtration of the product through a qualified bacterial filter is the only safe means to provide a sterile product.
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Affiliation(s)
- Christoph Buchta
- Department for Blood Group Serology and Transfusion Medicine, Vienna Medical University, Vienna, Austria.
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37
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38
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Wong PY, Colville VL, White V, Walker HM, Morris RA. Validation and assessment of a blood-donor arm disinfectant containing chlorhexidine and alcohol. Transfusion 2004; 44:1238-42. [PMID: 15265130 DOI: 10.1111/j.1537-2995.2004.03362.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND To minimize the bacterial contamination rate in blood collected from donors, a study was designed to evaluate the suitability of a single-use chlorhexidine-alcohol antiseptic for donor arm preparation at all blood collection venues in Australia. STUDY DESIGN AND METHODS A prospective study of bacterial load on the skin was performed on 616 blood donors' arms before and after disinfection using a direct swabbing and plating technique. Disinfection was achieved with a swab containing 1 percent chlorhexidine gluconate with 75 percent alcohol, which was applied to the skin in a prescribed method. Feedback from blood donors and staff was obtained using questionnaires. RESULTS After disinfection, 99 percent of donor arms had bacterial counts of 5 cfu per plate or less, and 99.5 percent had counts of 10 cfu per plate or less, respectively. The mean colony count for all donors after disinfection was 0.39, and the percentage reduction was 99 compared to predisinfection. Sixteen donors (3%) noted transient skin irritation. The majority of staff (64%) preferred not to use the new disinfectant due to the difficulty opening the packaging and an excessive amount of antiseptic solution per pack. CONCLUSION The bacteriologic study showed that the disinfectant satisfied the requirements of the Australian Red Cross Blood Service for use to prepare blood-donor arms before venesection. An improvement to the packaging was required before it could be acceptable to all staff.
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Affiliation(s)
- P-Y Wong
- Australian Red Cross Blood Service-Victoria, South Melbourne, Victoria, Australia.
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39
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Munksgaard L, Albjerg L, Lillevang ST, Gahrn-Hansen B, Georgsen J. Detection of bacterial contamination of platelet components: six years’ experience with the BacT/ALERT system. Transfusion 2004; 44:1166-73. [PMID: 15265120 DOI: 10.1111/j.1537-2995.2004.04019.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hemovigilance has shown that bacteria cause more fatalities than other infections together. Surveillance for detection of bacteria in platelets (PLTs) was initiated. Concomitantly, the storage period for PLTs was extended from 5 to 7 days to reduce cost. STUDY DESIGN AND METHODS Analysis was performed of all cases of a positive signal in a screening procedure for contaminated PLTs taking into account results of confirmative cultures and results of culture from blood components including bacteria strains. Records were assessed from patients transfused with blood components issued before the screening culture became positive. RESULTS Samples were collected from 22,057 PLT units. An initial reaction was seen in 84 (0.38%). Growth was confirmed in 70 of these. Of the associated PLT units, 26 had been issued or outdated at the time when the culture was found to be reactive, in 27 bacteria were found, and in 17 cultures were negative. The bacteria found were mainly from normal skin flora. Sixty-six patients received 75 blood components issued before the screening system alarmed. None of these patients had a transfusion reaction reported. The outdating fell to less than 5 percent. CONCLUSION A screening system for detection of bacterial contamination was implemented without increase in cost owing to extension of storage time to 7 days. Transfusion of several contaminated blood components was prevented.
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Affiliation(s)
- Lars Munksgaard
- County of Funen Transfusion Service, Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
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40
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Affiliation(s)
- Roslyn Yomtovian
- Department of Pathology, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
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41
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Ritter M, Schwedler J, Beyer J, Movassaghi K, Mutters R, Neubauer A, Schwella N. Bacterial contamination of ex vivo processed PBPC products under clean room conditions. Transfusion 2003; 43:1587-95. [PMID: 14617319 DOI: 10.1046/j.1537-2995.2003.00573.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Patients undergoing high-dose radio- and/or chemotherapy and autologous or allogeneic PBPC transplantation are at high risk for infections owing to profound immunosuppression. In this study, the rate of microbial contamination of ex vivo processed PBPC products was analyzed, comparing preparation under clean room conditions to standard laboratory conditions. STUDY DESIGN AND METHODS After implementation of good manufacturing practice conditions in the two participating institutions, the microbial contamination rate of 366 PBPC harvests from 198 patients was determined under certified clean room conditions (Group A) from 2000 until 2002. To investigate influence of improved environmental conditions along with other parameters, this set of samples was compared with a historical control set of 1413 PBPC products, which have been processed ex vivo under a clean bench in a regular laboratory room and were harvested from 626 patients (Group B) from 1989 until 2000. RESULTS In Group B microbial contamination was found in 74 PBPC products (5.2%) from 57 patients. In Group A microbial growth was detected in 3 leukapheresis products (0.8%) from 3 patients. After exclusion of PBPC products, which were probably contaminated before manipulation, statistical analysis showed a significant difference (chi2= 10.339; p < 0.001). CONCLUSION These data suggest an impact of clean room conditions on the bacterial contamination rate of PBPC products. To identify confounding variables, variables like technique of leukapheresis, culture methodology, and microbial colonization of central venous catheters were taken into account. Further variables might be identified in following studies.
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Affiliation(s)
- Markus Ritter
- Department of Haematology, Oncology and Immunology, Philipps-University Hospital, Marburg, Germany.
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Lee CK, Ho PL, Lee KY, Cheng WW, Chan NK, Tsoi WC, Lin CK. Estimation of bacterial risk in extending the shelf life of PLT concentrates from 5 to 7 days. Transfusion 2003; 43:1047-52. [PMID: 12869109 DOI: 10.1046/j.1537-2995.2003.00456.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The use of bacterial culture to prevent bacterial contamination of blood components has renewed interest for extending the shelf life of PLT concentrates to 7 days after collection. STUDY DESIGN AND METHODS This study was therefore conducted to determine the residual risk of bacterial contamination in PLT concentrates at the end of 5 and 7 days after collection in a center where all PLT concentrates are routinely screened by taking samples on Day 2 for culture. PLT units with no growth after 48 hours were sampled a second time on Day 5 or Day 7 after collection, followed by inoculation into aerobic culture bottles. The inoculated bottles were then monitored for up to 7 days at 35 degrees C in an automatic monitoring and detection system. RESULTS During a 16-month study period, a total of 6020 PLT concentrates were tested 5 days (Group A, n=3010) and 7 days (Group B, n=3010) after collection. Four units in each group (0.133%) were found to be contaminated. In 6 units, bacteria were seen on direct Gram stain. In addition, 5 of the associated RBC units grew the same organisms on culture. The organisms include three coagulase-negative staphylococci and five Propionibacterium acnes. The positive rate of routine short-term bacterial culture was 0.035 percent during the same study period. CONCLUSION Despite routine short-term bacterial culture, a significant risk of bacterial contamination remains at 5 and 7 days after collection. For now, the shelf life of PLT concentrates should remain 5 days.
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Affiliation(s)
- C K Lee
- Hong Kong Red Cross Blood Transfusion Service and Center of Infection and Department of Microbiology, the University of Hong Kong, Hong Kong.
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