RESUMO
BACKGROUND: Pathogen reduction treatment (PRT) reduces the risk of transfusion-transmitted infections from established and emerging organisms. Manufacturing, however, is complex. In our university health system, we phased in pathogen-reduced platelets (PR PLTs) by patient population. We then assessed the implementation strategy and investigated factors in the supply chain that prevented us from meeting the goal of providing greater than 90% PR PLTs within 6 months. STUDY DESIGN AND METHODS: In Phase 1, PR PLTs were provided in the outpatient cancer center. Phase 2 added inpatients undergoing bone marrow transplantation, and Phase 3 included all patients. In Phase 4, the blood center implemented manufacturing optimization strategies. Product supply and usage during the first 23 months after implementation were evaluated. Investigation of the supply chain included analysis of (1) the number of in-state hospitals receiving PR PLTs; (2) the fraction of products eligible for PRT before and after manufacturing improvements. RESULTS: During Phases 1 and 2, PR products comprised 44% and 53% of PLTs transfused in the phased-in areas. At 6 months, 41% of PLTs were PR, and at 23 months, 92%. The fraction of PR PLTs transfused in our system correlated logarithmically with the number of in-state hospitals receiving them (R2 = 0.71) and the number of PR PLTs sold to those hospitals (R2 = 0.80). CONCLUSION: Phased implementation is a practical and ethical way to introduce PR PLTs in a health system and facilitates scalability at the blood center. Widespread availability of PR products may require collective action and can be increased by optimization strategies during manufacturing.