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ElinF

Units being returned from isolated patients

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How do you handle units being returned (within the appropriate temperature and time frame) from a patient who is isolated (and units not in a cooler- but it was in a biohazard bag- did they take it out of the bag? I don't know).  We don't have very many returned units, but this past weekend we had a patient under precautions for COVID-19 and her unit was returned to us.  You can't sterilize a unit...so then I got to thinking, what about other isolated patients.  The patient actually has Flu B. So is it ok for this unit to be used for someone else?  I have never actually had this problem that I know of. 

 

 

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Blood products that were taken into isolation are never returned to us.    If they are not used, they are discarded in the room.

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10 hours ago, John C. Staley said:

I'm curious, why was blood requested for a patient with covid19/flu like symptoms??  :coffeecup:

 

She an oncology patient who gets regular transfusions. She was just unfortunate to get Flu B this year.  We have been transfusing her for years. 

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What about any coolers that might have been taken into the isolation room? Who is responsible for cleaning the cooler prior to it's return? Plus if it has been in an isolation room with COVID-19, who is going to go into the isolation room and retrieve the cooler and clean it appropriately prior to it being carried thru the hospital halls?

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I wondered the same thing, both about units and the samples from the patients. The only related thing I could think of are policies regarding CJD/vCJD, and those only covered samples. Besides following universal precautions and wearing the necessary PPE, seems to me the only difference is vigorous cleaning of non-disposable equipment with bleach after testing and that samples sent to micro are handled under BSL-3.

Another point, you don't know the status of every single patient getting blood products, so do you even know who had Flu B before all this madness?

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2 hours ago, PerkinsSutton said:

Can you not wipe the bag down once returned?

The bags are engineered with a sort of "breathable" membrane, so you could, in a way, poison the product.

We have found floors trying to wipe down units with bleach before they come back to the Blood Bank, which totally isn't okay !!!! but, they wouldn't know otherwise. The products would have to be discarded,

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We decontaminate our coolers daily because they go into the OR.  If a cooler came back from an isolation room, we would decontaminate (wipe down with a bleach wipe).  Units returned are also rare because it is difficult to have the RN staff to return blood in a timely manner to ensure it is still 10C or less.  Consequently this is not an issue.  It would be interesting to hear the lessons learned on this subject from the Medical Centers in NYC.

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Is there any FDA approved disinfectants for cleaning the bags?  I have an ID doc who said if I have the IFU for the product I should be able to see any approved disinfectants.  The only issue is, they are not my bags and I don't necessarily have the manufacturer's information.  Any thoughts?

 

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Most bag manufacturers suggest a diluted bleach solution for RBC bag surfaces. Not sure about platelet bags since they are semi-permeable. 

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At our facility we wipe the coolers down upon return from each patient.  Inside, outside, ice...

We also started wiping all products returned with 70% isopropyl alcohol or 70% ethanol.

We do this for all coolers and all products as we have no idea what the diagnosis is of the patient.

Here's one reference: https://www.sciencedirect.com/science/article/pii/S1743919105001147

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At our facilities last week, we implemented a temporary "no return" policy during this COVID crisis. Only exceptions are those issued in ice chest to O.R., massive transfusion, or ECHMO, provided they are not COVID patients or patients under investigation. The nurses have become much more compliant with completing the pre-transfusion checklist before picking up the unit as a result.

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You should contact the bag manufacturer. It's on the bag and google will get you a contact.  You may be destroying the plastic or leaching it into the blood product.  Assuming bleach or alcohol is safe is a huge mistake.  Our manufacturer is recommending distilled water ONLY on platelet bags.
Coolers SHOULD NOT GO IN ISOLATION ROOMS. Period.

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On 4/1/2020 at 11:57 AM, Johnv said:

We decontaminate our coolers daily because they go into the OR.  If a cooler came back from an isolation room, we would decontaminate (wipe down with a bleach wipe).  Units returned are also rare because it is difficult to have the RN staff to return blood in a timely manner to ensure it is still 10C or less.  Consequently this is not an issue.  It would be interesting to hear the lessons learned on this subject from the Medical Centers in NYC.

Whatever units you issue, do you just assume they're not coming back then? You treat it as "once theyre gone theyre gone" ?

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On 4/13/2020 at 11:14 AM, Smarty pants said:

You should contact the bag manufacturer. It's on the bag and google will get you a contact.  You may be destroying the plastic or leaching it into the blood product.  Assuming bleach or alcohol is safe is a huge mistake.  Our manufacturer is recommending distilled water ONLY on platelet bags.
Coolers SHOULD NOT GO IN ISOLATION ROOMS. Period.

Coolers can still go... I think the units in the cooler are more of the issue, but it seems by the responses above that facilities have created their own workarounds. 

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We assume that every patient is a COVID patient. We place each unit in a zip lock bag with the unit tag placed along the back of the bag, seal the zip lock and place a label across the top of the seal warning that if the seal is broken the unit will be discarded. We do this for every unit.

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This came up at our facilities during the Covid-19 pandemic.  Infection control advice was to handle blood units as per usual precautions, given that PPE would be worn by anyone handling the blood units and hand hygiene performed before initiating transfusion.  All coolers returned to the blood bank are disinfected at our facilities regardless of patient isolation status. 

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