Labor de la enfermería española de hemovigilancia / The work of spanish haemovigilance nurses

Fundamentos: La finalidad de la Hemovigilancia es la prevención de eventos adversos relacionados con las transfusiones sanguíneas. Los informes de Hemovigilancia más recientes inciden en la tasa elevada de errores a la cabecera del paciente. La presencia de enfermeras de Hemovigilancia redunda en la prevención de los errores y el aumento de la seguridad transfusional. El objetivo de esta publicación es poner en conocimiento la labor de las enfermeras hemovigilantes.Métodos: Revisión bibliográfica sobre aspectos relacionados con las intervenciones de enfermería de Hemovigilancia a nivel nacional e internacional.Resultados: La presencia hospitalaria de enfermeras de Hemovigilancia está relacionada con la reducción de eventos no deseables y transforma las notificaciones en mayoritariamente casi-incidentes, su existencia favorece el incremento de registros de notificaciones y el seguimiento de trazabilidad en cada caso. Es capaz de detectar áreas de mejora al conocer todo el circuito transfusional y su figura permite el apoyo al resto de enfermeras asistenciales, especialmente en unidades con mayor tasa de incidencias.Conclusiones: La presencia de enfermeras de Hemovigilancia como figura experta dentro de una institución favorece el uso y consumo óptimo de hemocomponentes, incrementando así la seguridad y la sostenibilidad transfusional. (AU)

Fundamentals: The purpose of haemovigilance is the prevention of adverse events related to blood transfusions. Recent haemovigilance reports highlight the high rate of errors at the bedside. The presence of haemovigilance nurses has the potential to prevent errors and increase transfusion safety. The aim of this publication is to raise awareness of the work of Haemovigilance nurses.Methods: Literature review on national and international aspects of haemovigilance nursing interventions.Results: The presence of haemovigilance nurses in hospitals is related to the reduction of undesirable events and transforms notifications into near-misses, their existence favours the increase in notification records and the monitoring of traceability in each case. They are capable of detecting areas for improvement as they are familiar with the entire transfusion circuit and their role enables support to be given to the rest of the care nurses, especially in units with a higher rate of incidents.Conclusions: The presence of Haemovigilance nurses as an expert figure within an institution favours the optimal use and consumption of haemocomponents, thus increasing transfusion safety and sustainability. (AU)

Bacterial contamination and septic transfusion reaction rates associated with platelet components before and after introduction of primary culture: experience at a US Academic Medical Center 1991 through 2017.

BACKGROUND: The high incidence of septic transfusion reactions (STRs) led to testing being mandated by AABB from 2004. This was implemented by primary culture of single-donor apheresis platelets (APs) from 2004 and prestorage pooled platelets (PSPPs) from 2007. STUDY DESIGN/METHODS: Platelet (PLT) aliquots were cultured at issue and transfusion reactions evaluated at our hospital. Bacterial contamination and STR rates (shown as rates per million transfusions in Results) were evaluated before and after introduction of primary culture by blood centers that used a microbial detection system (BacT/ALERT, bioMerieux) or enhanced bacterial detection system (eBDS, Haemonetics). RESULTS: A total of 28,457 PLTs were cultured during pre-primary culture periods (44.7% APs; 55.3% at-issue pooled PLTs [AIPPs]) and 97,595 during post-primary culture periods (79.3% APs; 20.7% PSPPs). Forty-three contaminated units were identified in preculture and 34 in postculture periods (rates, 1511 vs. 348; p < 0.0001). Contamination rates of APs were significantly lower than AIPPs in the preculture (393 vs. 2415; p < 0.0001) but not postculture period compared to PSPPs (387 vs. 198; p = 0.9). STR rates (79 vs. 90; p = 0.98) were unchanged with APs but decreased considerably with pooled PLTs (826 vs. 50; p = 0.0006). Contamination (299 vs. 324; p = 0.84) and STR rates (25 vs. 116; p = 0.22) were similar for PLTs tested by BacT/ALERT and eBDS primary culture methods. A change in donor skin preparation method in 2012 was associated with decreased contamination and STR rates. CONCLUSION: Primary culture significantly reduced bacterial contamination and STR associated with pooled but not AP PLTs. Measures such as secondary testing near time of use or pathogen reduction are needed to further reduce STRs.

Efforts Toward Elimination of Infectious Agents in Blood Products.

The US blood supply has never been safer. This level of safety depends on a multifaceted approach including blood donor screening, sensitive infectious disease testing, and good manufacturing practice. However, risks remain for transfusion-transmitted infections due to bacterial contamination of platelets and emerging diseases. Thus, ongoing improvements in screening and testing are required. Newer pathogen reduction technologies have shown promise in further ameliorating the safety of the blood supply.

Serious hazards of transfusion - conference report: celebration of 20 years of UK haemovigilance.

The Annual SHOT Report for incidents in 2016 was published on July 12 and celebrated of 20 years of UK haemovigilance. Components are very safe, related in part to risk-reduction measures triggered by SHOT reporting. Transfusion-related acute lung injury is now very rare (all plasma components are provided from male donors), and infection transmission is also uncommon - a single transmission of hepatitis E in 2016 and no bacterial transmissions. Human factors (errors) account for 87% of all reports. Deaths and major morbidity most often result from transfusion-associated circulatory overload. Wrong transfusions and deaths from ABO-incompatible transfusion can be reduced by correct bedside checks. It is notable that information technology systems may not be safe. Standardisation is required for flags and alerts. SHOT key recommendations include: assess patients for transfusion-associated circulatory overload prior to transfusion. Be like a pilot - use a bedside checklist when setting up the transfusion.

Blood transfusion in the Caribbean: a case study of Trinidad and Tobago.

The Caribbean islands form an archipelago connecting North and South America. They have all been colonised by European countries and share strong historical, social, economic and diplomatic links with North America. However, their blood transfusion services have evolved differently, using predominantly family/replacement rather than voluntary non-remunerated donors as has been the practice in England and America since 1926 and 1970, respectively. This article uses the case of Trinidad and Tobago to examine the history and current state of blood transfusion services in the Caribbean and to present early results of an initiative for improving blood safety and adequacy in the region.

The History and Challenges of Blood Donor Screening in China.

Since the establishment of People's Republic of China in 1949, the Chinese government has encountered several catastrophes related to transfusion transmitted diseases. The government's increasing attention to blood safety has prompted the initiation of a series of policies and measures that have enhanced the level of safety for the blood supply and met the basic clinical demands of blood for 1.3 billion people in the country. Blood donation screening strategies in China predominantly comprise donor screening and donor testing. Donor screening includes selection of low-risk blood donors by the use of a donor history questionnaire, predonation physical examination, and initial rapid donor testing. Donor testing includes direct pathogen detection and serology tests. The year 1998 marked the most transformative change in blood donor selection and screening policies in China. Before 1998, paid donation was the predominant mode of blood donation. Donor screening and donor testing were conducted before donation, and only those who were eligible were allowed to donate. To ensure the safety of blood, donor testing was performed again after donation. After the implementation of the Blood Donation Law in 1998, to promote voluntary and unpaid donation, predonation donor testing was eliminated to reduce the amount of waiting time and to provide a more convenient donation experience for blood donors. However, it is the national requirement that donated blood should undergo 2 rounds of testing using different equipment or reagents, conducted by different personnel. Donor selection has transitioned from paid donation and obligatory donation to voluntary donation with fixed volunteer groups, as the latter mode of donation provides the lowest risks. Donations are currently screened for syphilis, hepatitis C virus, HIV, and hepatitis B virus (HBV). Units, previously typed only for ABO, are now routinely tested for both ABO and Rh(D). Innovations in testing technologies and methods have also brought changes to screening parameters. For instance, screening for HBV pathogens evolved from the early use of hemagglutination method to the later use of radioimmunoassay, independent enzyme-linked immunosorbent assay, and now the widespread application of nucleic acid test (NAT). Since 2010, the Chinese government has established NAT capacity in several blood centers; and in 2015, the government invested 900 million RMB on the nationwide expansion of NAT. Although the Chinese government has worked to enhance blood safety, many challenges remain. Concern exists for rising rates of HIV infection. The existence of occult HBV infection and the transmission of emerging blood-borne diseases continue to challenge the safety of the blood supply.

[Jean-Jacques Lefrère: A miscarried ambition for blood safety in francophone Africa]. / Jean-Jacques Lefrère: une ambition fauchée pour la sécurité transfusionnelle en Afrique francophone.

The announcement of the death of Professor Jean-Jacques Lefrère caused considerable emotion and surprise within the francophone Africa blood transfusion research network. The group was created in 2007 in Paris. Each member that works within this group wanted to pay their last respects through dedicated publication for a brilliant researcher and writer. The tribute describes the creation of the group, its goals, its operations, its achievements and the prospects of its activities while emphasizing the essential role that Professor Lefrère played within the group.

History of blood transfusion in sub-saharan Africa.

The adequacy and safety of blood transfusion in sub-Saharan Africa is the subject of much concern, yet there have been very few studies of its history. An overview of that record finds that transfusions were first reported in Africa (sub-Saharan and excluding South Africa) in the early 1920s, and organized transfusion practices were established before the Second World War. Blood transfusion grew rapidly after 1945, along with the construction of new hospitals and expanded health services in Africa. Significant differences existed between colonial powers in the organization of transfusion services, but these converged after independence as their use continued to grow and decentralized and hospital-based practices were adopted. It was only after the oil crisis in the mid-1970s that health spending declined and the collection, testing, and transfusion of blood began to level off. Thus, when the AIDS crisis hit transfusion services, they were already struggling to meet the needs of patients. At this time, foreign assistance as well as the World Health Organization and the League of Red Cross Societies helped respond to both the immediate problem of testing blood, and for some countries, support existed for the broader reorganization of transfusion. Overall, the history shows that transfusion was adopted widely and quickly, limited mainly by the availability of knowledgeable doctors and hospital facilities. There was less resistance than expected by Africans to receive transfusions, and the record shows a remarkable flexibility in obtaining blood. The dangers of disease transmission were recognized from an early date but were balanced against the potential lifesaving benefits of transfusion.