Donor Notification of Testing and Arm Prep

[Tim West]

We had our AABB assessment last week and two issues came up that I'd like some feedback on.

1. Standard 5.2.2.1: Informing donors of circumstances when infectious disease testing is not performed. Our consent states that testing will be conducted based on our ability to prepare a usable product from the donation. It was felt that this statement is not sufficient given the fact that the average donor is not aware that testing is not performed on low volume (short) units. How do other blood banks address this issue?

2. After the 2nd arm prep we position a sterile gauze pad over the site exerting enough pressure to make sure the pad sticks to the prepped site. The question was raised as to whether we should be putting any pressure on the edges of the gauze when it is placed. The suggestion was made that we just allow the prep to air dry and not use a gauze pad at all. When are other locations doing?

Thank you!

[rcurrie]

I am the quality assurance officer for our donor center, processing lab, testing lab, and transfusion service. Here are my views:

1. You may choose to notify donors in the donor consent that testing may not be performed. Our wording addressing this issue: "I understand that there may be unexpected circumstances where infectious disease tests cannot be performed." This meets all tests, including the FDA regs. You may choose to state that no disease testing will be performed unless a full unit is obtained from a qualified donor.

2. Pressing down on the gauze is bad practice. The gauze should simply be placed over the site without any pressure being applied. It is better to use the gauze than to not use it, as bacteria and fungi are ubiquitous in the air, and the uncovered site will just be recontaminated if there is a delay in venipuncture. If, however, you are ready to immediately insert the needle, then no gauze is needed until the needle has been inserted and anchored.

BC

[ncehall]

We added a statement to our Educational Materials that donors must read:

What happens after your donation:

To protect patients, your blood is tested for hepatitis B and C, HIV, certain other viruses, and syphilis. If your blood tests positive it will not be given to a patient. You will be notified about test results that may disqualify you from donating in the future. There are some circumstances in which we cannot perform these tests (such as when we do not collect enough blood or the blood tubes are broken). Please do not donate to get tested for HIV, hepatitis, or any other infections!

I agree with BC that gauze should be used, but never pressed down upon.

[OPUS104]

Checking on our wording for the testing, but I asked one of our pleb. and she said 30 sec. air dry then lay a piece of guaze on site if not sticking immed. (no pressing allowed)

[rcurrie]

Checking on our wording for the testing, but I asked one of our pleb. and she said 30 sec. air dry then lay a piece of guaze on site if not sticking immed. (no pressing allowed)

Yep. That's standard practice. See Method 6.2. Arm Preparation for Blood Collection, in the Tech Manual. The operative instructions here are, ". . . let it stand for 30 seconds or as indicated by the manufacturer. Cover the area with dry, sterile gauze until the time of the venipuncture."

Tim, your inspector must have seen something that caused an alarm to go off, such as pressure being placed on the intended venipuncture site through the gauze. I always tell the phlebotomists to have two gauze pads ready in case one falls off on the floor. They can then open the second one and cover the prepped arm.

BC

[OPUS104]

I must say I'm not surprised that our proc. is straight out of the standards..... our QA dept. is awsome. I feel blessed not to have to know all of the details like you do. Thanks for the info.