Leaderboard

I'm going to be blunt. This is ridiculous!! You have the potential of causing far more problems by removing the cubes from their protective container.

We got the same song and dance from our infection department some years ago. Our manager told them the instruments would not work correctly if the saline/reagents were not in the manufacturer's container, the interior plastic bag would droop and possibly break without the cardboard support to contain it. The solution/compromise was to make a notebook of "acceptable" cardboard containers, e.g. saline/reagent cubes. If an inspector questioned, we would show them the book with pictures of what had to be in cardboard to maintain lot numbers or integrity of the reagent. I agree, the rule is to reduce incoming exterior dirt and insect infestation for patient areas but the lab is not a patient care area. Some committees make a mountain out of a molehill and go too far.

I think you should invite members of that committee to remove a bag from its cube, try to label it sufficiently (substance, lot #, expiration, etc.), attach that label in such a way that it will stay attached when the bag 'collapses' as it's emptied, hoist the bag up to the level of a cell washer without the aid of the box (especially this part), and suggest ways to keep the collapsed bag at an angle that will ensure all the contents are used. I'm willing to bet they'll come around.

We had an over zealous infection control team (made up of 100% nurses) come to our lab last year making the same demand. We told them, in essence, we will not comply because the risk of injury from handling those containers were greater than the risk they were trying to alleviate. Furthermore, the risk of accidently confusing saline with formalin, whose containers look exactly alike, was to high when removing from the cardboard containers. In addition to that, we told them the man hours required to keep up with that would require additional FTE's, which would not be approved. They conceded and we continued on, business as usual. TJC does not really inspect labs that are CAP, AABB, or CLIA certified. Those organizations understand the logistics of the cubes and do not have a problem with it. Most infection control officers are nurses and think from the nursing perspective only.

We've never been cited by CAP, the FDA or TJC. TJC does come into Blood Bank because we handle the frozen/refrigerated tissue grafts and never a word said. Our saline in use is quite visible to anyone who walks into the department. That request is overboard and made by people that have never worked in the lab. Agree with the comments about safely handling the plastic blob, utilizing the reagent w/o waste, proper labeling w/ lot, etc. and the fact that it would look just like formalin and some of the reagents hemo uses.

I would recommend getting the LIS. It will provide a level of patient safety that you can't get with paper. It improves workflow, especially if you are using automation. Decreases documentation errors and omissions. It will simplify billing. It will vastly reduce the piles of paper documentation that you would otherwise be storing for years - patient, donor and potentially QC (depending on the software). It simplifies inventory management, especially when you get look-backs and recalls from your blood supplier years down the road. We are a smaller hospital that went to an LIS just a few years ago. I can't imagine ever going back to paper (gives me nightmares actually!). It has definitely reduced my workload in terms of all the record keeping, reporting, etc. that is required. I am filling out fewer error reports and deviations from SOP. With staffing issues a 'normal' thing now, I need all the time I can find to do all the other things I need to get done, including working on the bench. Are you going to do the reaction workups or refer those?

Finer the sand the better. Cat sand should be ok as long as not used

Wow. This is one of the reasons why our automated temperature monitoring system has an alarm point and computer access to monitoring directly in the blood bank. If an alarm goes off it starts playing Rock and Roll by Led Zeppelin (clicked all the way to 11).

I've never had a problem w BB reagents not working (except when I set them up to fail). I have seen problems with reactivity not on par with usual results. Contacting vendor discovered a change in the formula at production.

When temp increases to the threshold set point (usually 0.5’C off limit), everything gets moved to a different freezer or shipping containers with dry ice. If you get dry ice from your blood supplier your set point may need to be lower to give a transport buffer. If using containers the temp is monitored every four hours. In other words everything is moved before it goes out of temp so nothing is thrown out.

Visual inspection, review package insert for changes, log-in and QC when opened

Request new safety committee to audit the trail the saline boxes take from the manufacturer to the blood bank to ascertain where this "dirt" is coming from. Or to put it another way show the manufacturer for this product is required to maintain a level of cleanliness to prevent roaches etc., the couriers the same. As mentioned above this is ridiculous

I QC reagents before I put them into use; usually not upon receipt.

Here is a follow up. The baby had tested with anti-A on 27, April and transfused with O washed cells the same day, but on 10, May she had no anti-A and received A type packed red cells with no transfusion reaction. She has stoped feeding on her mother's milk for 14 days. I tried to persuade her mother to do some tests. The results came out and she has no anemia, with normal reticulocyte count and percentage. Her bilirubin and LDH are normal too. But she has not tested her haptoglobin. She has not received any blood transfusion and IVIG. She just diagnosed with slight anemia during pregnancy and after birth. She had taken iron supplements during pregnancy,. This is her eventh pregnancies and the third baby, she had several miscarriages. She told me her case seems like a mystery both to her and the doctors she know. She just want to know if she is ok and the baby will be healthy in the future.

Here is an interesting paper showing that antibodies to red cell/platelet... may be transmitted via breast milk indeed, causing prolonged HDFN. Milk contains mostly IgA but IgM and IgG may be present of course and IgGs can cross the different barriers up to blood circulation (not on the same model - not actively - as the placenta though). The surprizing part here is the mother and baby are group A, A antigen is ubiquitous so the anti-A titer in breast milk should high enough to interfer with reverse group despite the adsorption of anti-A on various tissues. https://pubmed.ncbi.nlm.nih.gov/30720868/

You would only need to file a BPD with the FDA if you distribute any of these products for transfusion or transfer. Just because you had that event is not cause to report.

I have never used plasma to validate a freezer. I have validated that alarms work, temp is accurate, plugged into proper receptacle, chart works, door seals properly, unit maintains temp etc.

We have a new safety committee in our laboratory, and they are saying that we need to remove our saline from the 10L cube cardboard boxes and store the 10L bags in another plastic box that we relabel. They are using the "no shipping boxes" as the basis for this decision. We've never heard of anyone in blood bank doing this. Our arguement is that we are not a patient care area, so the cardboard shouldn't be a problem. The committee is saying since phlebotomists come in and out of the lab, it counts as patient care......they do not come and hang out in the blood bank storerooom. Having a hard time convincing the committee that we are not going to be taking saline out of the box.....HELP!