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Neuberger J, Brailsford SR, Mallinson G, Murphy MF, Simmonds P. Challenges for the maintaining the microbiological safety of the UK blood supply. Clin Med (Lond) 2023; 23:151-156. [PMID: 36806203 PMCID: PMC11046496 DOI: 10.7861/clinmed.2022-0401] [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] [Indexed: 02/22/2023]
Abstract
The supply of blood, blood products and components in the UK, as elsewhere, is safe, although there is no cause for complacency. Use of blood, blood products and components is not without risk of morbidity and mortality. Transfusion-transmitted infections (TTIs) continue to occur and may severely affect the health and welfare of recipients. As indicated by recent and current inquiries, public interest in these TTIs is huge. The risk of TTI can be mitigated but not abolished. Measures to reduce risk include screening of donors, testing of donations and, where appropriate, treatment of donations. The introduction of newer screening tests might identify some infectious donations but come at a cost, which could exceed a justifiable limit. Thus, the recognition, detection, reporting and investigation of cases of possible TTIs need to be improved. Recipients of blood should understand that, although transfusion in the UK is safe, it is not free of risk and so should be provided with full information so that properly informed consent can be given.
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Affiliation(s)
| | | | - Gary Mallinson
- Joint UK Blood Transfusion and Tissue Transplantation Services Professional Advisory Committee (JPAC), NHS Blood and Transplant, Bristol
| | - Michael F Murphy
- NHS Blood & Transplant, Oxford University Hospitals NHS Foundation Trust and University of Oxford, Oxford
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Ferguson E, Bowen S, Lawrence C, Starmer C, Barr A, Davison K, Reynolds C, Brailsford SR. Communicating the move to individualized donor selection policy: Framing messages focused on recipients and safety. Transfusion 2023; 63:171-181. [PMID: 36349898 PMCID: PMC10099824 DOI: 10.1111/trf.17175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/18/2022] [Accepted: 10/18/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Men-who-have-sex-with-men (MSM) have been deferred from donating blood. However, recent evidence supports the adoption of donor screening based on individuals' sexual behavior over population-based criteria. We explore how best to frame communications about adopting this change to minimize any potential negative consequences (e.g., reduced donor numbers). We examine the effectiveness of risk (emphasizing safety vs. emphasizing low risk), and focus (donor vs. recipient) frames on intentions to donate blood (approach) or feeling deterred from donating (avoid), and mechanisms linked to under-reporting sexual behavior. STUDY DESIGN AND METHODS We conducted a 2 (risk frame: risk vs. safety) by 3 (focus: donor vs. recipient vs. both) between-subjects online experiment (n = 2677). The main outcomes were intentions to donate and feelings of being put-off/deterred from donating (both for self and others). We also assessed the extent that forgetting, embarrassment/shame, and question irrelevance were perceived to be associated with under-reporting sexual behavior. RESULTS Frames that focused on safety or a recipient resulted in people reporting being less deterred from donating. Regardless of frame, people from ethnic minorities were more likely to feel deterred. Embarrassment/shame followed by forgetting and perceived irrelevance were the main reasons for under-reporting sexual behaviors, especially in ethnic minorities, and smartphones were perceived as an acceptable memory aid for sexual behavior. DISCUSSION Blood services moving to an individualized policy should frame donor selection in terms of safety and/or a recipient focus, explore sensitivities in ethnic minority communities, consider ways to normalize reporting sexual behavior, and use smartphones as a memory aid.
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Affiliation(s)
- Eamonn Ferguson
- School of Psychology, University of Nottingham, Nottingham, UK.,National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and Behaviour, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Sarah Bowen
- School of Economics, University of Nottingham, Nottingham, UK.,Behavioural Practice, KPUK, Westminster, London, UK
| | | | - Chris Starmer
- School of Economics, University of Nottingham, Nottingham, UK
| | - Abigail Barr
- School of Economics, University of Nottingham, Nottingham, UK
| | - Katy Davison
- NHS Blood and Transplant/UK Health Security Agency Epidemiology Unit, UK Health Security Agency London, London, UK
| | - Claire Reynolds
- NHS Blood and Transplant/UK Health Security Agency Epidemiology Unit, NHS Blood and Transplant, London, UK
| | - Susan R Brailsford
- NHS Blood and Transplant/UK Health Security Agency Epidemiology Unit, NHS Blood and Transplant, London, UK
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Neugebauer J, Hagen C, Brockmann C, Juhl D, Schuster SO, Steppat D, Görg S, Ziemann M. Completing the Donor History Questionnaire before the Donation Visit Can Improve Blood Safety. Transfus Med Hemother 2022; 49:306-314. [PMID: 37969867 PMCID: PMC10642529 DOI: 10.1159/000522101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/20/2022] [Indexed: 11/17/2023] Open
Abstract
Background and Objectives In Germany, the donor history questionnaire (DHQ) is traditionally filled in at the donation center to avoid any influence of others. Since March 2020, it has been suggested to donors to answer the DHQ already at home and to call if they have any concerns to reduce the number of ineligible donors on-site during the COVID-19 pandemic. Materials and Methods We evaluated the rate of ineligible donors before and after March 2020. Additionally, an anonymous online survey asking for the donors' attitude towards the DHQ was performed. It included questions on whether and for what reason the DHQ had been answered incorrectly in the past. Results The rate of ineligible donors decreased by 27% (from 7.1% to 5.2%). In total, 5,556 of 10,252 invited donors completed the survey (54.2%). 88.6% reported either going through the DHQ at home or knowing all questions from their previous donations. 444 donors (8.0%) had at least once postponed a donation after reading the DHQ at home. 68 donors (1.2%) admitted having intentionally provided false answers in the past (9 at home, 43 on-site, 14 both, 2 unknown). Not wanting to be rejected once arriving at the donation center was an important motivation for 42% of donors answering incorrectly on-site. Details on 46 incorrect answers were provided: only 17 had no influence on donor eligibility or product quality. In 5 cases, some blood products might have had impaired quality. Truthful answers to 17 questions would have led to deferral, mostly due to increased risk for unrecognized viral infections transmitted by sexual contacts. For a further 7 questions, there was insufficient information available to determine possible consequences. Asked about their general opinion, 753 (13.6%) of all donors estimated the risk of incorrect answers being greater on-site, while 239 (4.3%) presumed an increased risk at home. Conclusion Answering the DHQ prior to a donation visit prevented ineligible donors from visiting the donation center. Furthermore, it might improve honesty, as the discomfort of being deferred after arriving at the donation center was an important reason to answer incorrectly. Overall, there was no increased risk of donor or product safety, and potentially even a benefit.
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Affiliation(s)
| | | | | | | | | | | | | | - Malte Ziemann
- Institute for Transfusion Medicine, University Hospital of Schleswig-Holstein, Lübeck, Germany
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Uramatsu M, Maeda H, Mishima S, Takahashi M, Wada J, Amano K, Barach P, Miki T. Serious hazards of transfusion: evaluating the dangers of a wrong patient autologous salvaged blood in cardiac surgery. J Cardiothorac Surg 2022; 17:182. [PMID: 35974374 PMCID: PMC9382733 DOI: 10.1186/s13019-022-01931-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The past half century has seen the near eradication of transfusion-associated hazards. Intraoperative cell salvage while widely used still poses significant risks and hazards due to human error. We report on a case in which blood collected from a patient with lung cancer was mistakenly administered to a patient undergoing cardiac surgery who should have received his own collected blood. The initial investigation found that the cause of the patient harm was violations of procedures by hospital personnel. A detailed investigation revealed that not only violations were the cause, but also that the underlying causes included haphazard organizational policies, poor communication, workload and staffing deficiencies, human factors and cultural challenges. CASE PRESENTATION On August 14, 2019, a 72-year-old male was admitted to our hospital for angina pectoris and multivessel coronary artery disease. Cardiac surgery was performed using an autologous salvage blood collection system, and there were no major problems other than the prolonged operation time. During the night after the surgery, when the patient's blood pressure dropped, a nurse retrieved a blood bag from the ICU refrigerator that had been collected during the surgery and administered it at the physician's direction, but at this time neither the physician nor the nurse performed the required checking procedures. The blood administered was another patient's blood taken from another surgery the day before; an ABO mismatch transfusion occurred and the patient was diagnosed with DIC. The patient was discharged 65 days later after numerous interventions to support the patient. An accident investigation committee was convened to analyze the root causes and develop countermeasures to prevent a recurrence. CONCLUSION This adverse event occurred because the protocol for intraoperative blood salvage management was not clearly defined, and the procedure was different from the standard transfusion practices. We developed a new workflow based on a human factors grounded, systems-wide improvement strategy in which intraoperative blood collection would be administered before the patient leaves the operating room to completely prevent recurrence, instead of simply requiring front-line staff to do a double-check. Implementing strong systems processes can reduce the risk of errors, improve the reliability of the work processes and reduce the likelihood of patient harm occurring in the future.
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Affiliation(s)
- Masashi Uramatsu
- Department of Quality and Patient Safety, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan. .,Section of Medical Safety Management, Tokyo Medical University Hospital, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
| | - Hideyuki Maeda
- Department of Forensic Medicine, Graduate School of Medicine, Tokyo Medical University, 1-1-1 Shinjuku, Shinjuku-ku, Tokyo, 160-8402, Japan
| | - Shiro Mishima
- Department of Quality and Patient Safety, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.,Section of Medical Safety Management, Tokyo Medical University Hospital, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Megumi Takahashi
- Department of Quality and Patient Safety, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.,Section of Medical Safety Management, Tokyo Medical University Hospital, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Jun Wada
- Department of Quality and Patient Safety, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.,Section of Medical Safety Management, Tokyo Medical University Hospital, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Kagehiro Amano
- Department of Laboratory Medicine, Tokyo Medical University Hospital, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Paul Barach
- Thomas Jefferson University School of Medicine, Philadelphia, PA, USA.,University of Queensland School of Medicine, Brisbane, Australia.,Medical University of Graz, Graz, Austria
| | - Tamotsu Miki
- Department of Quality and Patient Safety, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
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Johns C, Simonson G, Hiwatig BM, Ross M. Actions and Attitudes of Men who have Sex with Men under Past, Current, and Hypothetical Future Blood Donation Deferral Policies. Transfus Med Rev 2022; 36:152-158. [DOI: 10.1016/j.tmrv.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/27/2022] [Accepted: 06/27/2022] [Indexed: 01/28/2023]
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