We are just completing a week of hosting The Joint Commission and I have a question. The inspector was not pleased that our two hospitals were issuing donor units for transfusion without placing the donor units in individual plastic zip lock bags and I understand that this will be a formal finding and that they are recommending a risk assessment. I know of no requlatory requirement do to issue in a plastic bag. I have seen this practice in some facilities, but know of nothing that would drive this. We do realize that there is a concern if the unit were to be dropped and it burst. Thoughts please? Thanks in advance!

Not sure about this either but you will eventually have a standard sited by JCAHO.  I would appreciate it if you could let me know here what it is.

 

Thanks, Scott

Occasionally I have a nurse that requests a transport bag, but otherwise NO bag.

• We have always issued individual units in plastic biohazard bags---multiples for the OR go in coolers......we've never been cited by the JC for it, but we are entering our window for the next inspection so I too, would be interested in knowing what regulation is cited.

I know of no standard requiring the issue of components in plastic bags. The courier must be wearing gloves though if no other protective device is used. If plastic bags are used they DO NOT have to be biohazard bags.

I don't know of a standard requiring that blood products be issued in a plastic bag. If Joint Commission sites you with a deficiency, I believe they will cite the standard that they feel you are violating.

I had a Joint Commission inspection last July and we do not issue blood products in plastic bags and we were not cited. In fact, the inspector did not even ask about it, even though she witnessed blood being dispensed and she watched a transfusion.

We issue products in paper bags, but that is only for esthetics.and patient privacy. I don't know of any standard, although I have never actually been inspected by Joint Commission (except as part of a tracer) because we are CAP and AABB accredited.

OSHA considers tested donor blood not a biohazard.  The only biohazardous blood units are autologous that are so labeled.  There is another thread on this site on the topic.  I believe one place had to start issuing in opaque bags because a visitor saw the unit of blood, passed out and hit her head.  We issue in a clear plastic bag for aesthetics and to avoid explaining that it isn't biohazard.  Definitely a mess if it drops and breaks.

we use plastic bag...not ziplock, not biohazard..

I don't know of a standard. However the issuing Blood Establishment issues packed cells in plastic bag overwraps. They ask that these be maintained until the units are hung, so we comply with ther request. I think it is because of a decrease in surface contamination of the bag. However I don't know of any studies to support this.

We have Joint Commission again next year, so could be interesting.

On the privacy side, hand transportd blood or products are carried in a small red  insulated box - so is not visible until at the patient bedside.

Cheers

Eoin

We issue in a clear ziplock (not biohazard).  I was told that this is an OSHA reg but have never seen documentation to back that up.  However, the reasoning that It would minimize the mess due to accidental breakage and that it limits   surface contamination both make sense to me.  Also, we had a child pass out on "take your child to work day" after seeing a unit of blood, so issuing in an opaque container also has its advantages. 

Firstly,  I will say that at both hospitals I worked we used ziplock bags for transport.  The AABB technical manual does mention that  "it is prudent to place the unit in a protective container to contain any spilliage if the bag should break"  (that is under dispensing and transport) however, I realize that isn't exactly a regulation.

 

Let me tell you about this one time.....

 

 

  At the current hospital I am at.. a unit of blood was issued and must have had a pinhole or been damaged somehow but in any case it leaked in the tube system.  Apparently someone didnt seal the bag properly and it created a bit of a mess (yuck).  We do visually inspect the units- so I am not sure how this happened but let me tell you...the Engineering department wasn't thrilled

Except for units sent in a cooler, we send blood to the floors via pneumatic tube. We double bag them in zip lock bags per request of our Infection Control folks. (I sometimes wonder if the ziplocks, often prepared by folks who, like my wife, are baffled by the complexities of ziplock technology and just can't seal the damned things, really offer additional protection to a bag designed to withstand the stresses of centrifugation and getting squeezed in a vise to extract the plasma.) I don't know of specific regulations governing the practice. I like the idea of opaque bags or cartons in public areas, not just to avoid pass-outs but there's the possibility of someone seeing patient ID on the accompanying paperwork as well.

On a slight tangent, I have never seen a blood bag that could be broken by simply dropping it.  At one facility we bagged them in paper sacks.  The administration thought that friends and family of patients might be disturbed at the sight of units of blood being carried through the hospital! 

 

I have, however seen one explode,  I was packing a unit of whole blood in one of the old spring loaded presses.  As I was slowly rasing the lever I was distracted and the lever slipped out of my hand at the beginning of the process.  The plate that, normally, gently squeezes the blood bag slammed into the unit with such force it ruptured the top seam and blood covered the walls as well as myself.  We had most of it cleaned up when a new house keeper arrived.  She took one look at the blood dripping from the ceiling and running down the walls, turned into the closest bath room, threw up repeatedly and then left.  No one ever saw her again. 

I remember once dropping a bottle of 250mL Human Albumin Solution in a Laboratory in which I worked.  You would be amazed how far the HAS oozed (I won't say flowed) and just how much of the ooze made straight for underneath a very old, very, very heavy fridge!

On a slight tangent, I have never seen a blood bag that could be broken by simply dropping it. 

 

Oh, I have seen many RBCs break when dropped on the floor.  It usually happens when they land flat on their front/back after falling off a counter or a cart.  The RBCs will burst along the seam and splatter across a room. 

Yes I had seen 2-3 one every month when one of the oldtimer dropped them the cart he was working on.

I had to discuss during staff meeting to make sure that staff does not put too many bags on the cart.

All that I have seen break have "pancaked" when they hit the floor and broke at a seam.  Quite the mess.  Seems to happen once every few years where I've been. I learned quickly to juggle any dropped unit down my leg to break its fall.

Apparently the bags I saw dropped were tougher than most.  Or they just don't make them like they used to.  (Now I am sounding my age!) 

We were inspected by HFAP this year and one of the STRONG suggestions made by the inspector was to issue units in a plastic bag with a biohazard sticker.  The reason given was the possibility of a ruptured unit if dropped during handling.  This was easier to "just do it" than to argue the lack of regulation especially since it makes practical sense to me.

We use opaque red ziplock bags that do NOT have biohazard printed on them.  Why opaque? So people in the hallway don't freak out.  Why red? So that the nurses will know that it is important and it stands out if someone leaves it on the counter. 

I am ambivalent about the biohazard symbol on the plastic bags we issue our blood products within. If I was a patient and saw the bag I would want to know why they were administering a biohazardous transfusion to me.

UPDATE: The results are in - and it is not what we hoped. Not issuing blood products in a plastic bag (when not issued in a cooler) was an indirect finding when we received our final Joint Commission report. They referred to:

TJC Standard: IC.01.03.01

Primary Priority Focus Area: Infection Control: hospital identifies risks for acquiring and transmitting infections.

So needless to say, we are now issuing all our blood products in a cooler or in plastic bags. We are using a clear plastic bag at this time. It is not opaque and it is not labeled as "Biohazard".

 

A huge "Thank you!" to those have have responded.

Beth Polstra, Transfusion Mgr.,  Children's Healthcare of Atlanta 

On a slight tangent, I have never seen a blood bag that could be broken by simply dropping it.  At one facility we bagged them in paper sacks.  The administration thought that friends and family of patients might be disturbed at the sight of units of blood being carried through the hospital! 

 

I have, however seen one explode,  I was packing a unit of whole blood in one of the old spring loaded presses.  As I was slowly rasing the lever I was distracted and the lever slipped out of my hand at the beginning of the process.  The plate that, normally, gently squeezes the blood bag slammed into the unit with such force it ruptured the top seam and blood covered the walls as well as myself.  We had most of it cleaned up when a new house keeper arrived.  She took one look at the blood dripping from the ceiling and running down the walls, turned into the closest bath room, threw up repeatedly and then left.  No one ever saw her again. 

 Well, let me tell you, I have!  I don't know what it is with me but just about everytime I drop one it bursts into a  red, yucky pile.  The bags we get from our donor center seem to have weak corners or something.  If you drop it just right, it will explode.  I seem to have perfected the "just right"

i have seen a unit explode when dropped...of course it was the unit antigen matched for the patient with six antibodies.  Needless to say I was sick but not from the sight of blood on the floor.