Lee C K, Wong H K, Ho P L, Tsoi W C, Lee K Y, Tsui G T F, Chua E, Leung J N S, Lin C K
Hong Kong Red Cross Blood Transfusion Service, Hong Kong SAR, China.
Transfus Med. 2012 Dec;22(6):404-8. doi: 10.1111/j.1365-3148.2012.01194.x. Epub 2012 Oct 5.
Significant efforts have been made towards bacterial risk minimization by limiting the chance of bacteria entering into collected blood, detecting its presence and eliminating them by pathogen reduction technology. Improved skin disinfection and the use of diversion pouch are effective upstream measures to reduce the risk of bacterial sepsis. Here we report on our experience with the use of blood bags with diversion pouch.
An observational study was performed to compare the bacterial contamination rate for two periods of time, i.e. before and after introduction of diversion pouch into blood bags. The incidence of bacterial contamination was monitored by the existing bacterial surveillance programme using pooled samples from 5 units of random donor platelets underwent aerobic culture in the BacT/ALERT 3D system.
Between 1 June 2004 and 31 May 2006 (blood bag without diversion pouch), 50 (0·0213%) out of 234,252 units of random donor platelets were found to have bacteria on culture whereas 15 (0·0057%) isolates out of 262,156 units were found from 1 June 2007 to 31 May 2009 (after diversion pouch was introduced). Overall, there was an 85% reduction in bacterial contaminated risk due to skin flora (P < 0·0001) but an increasing trend of detection of non skin flora such as Streptococcus bovis was noted.
Integration of diversion pouch into blood bags to divert the first 30 mL blood during blood collection on top of the current skin disinfection protocol can significantly reduce the risk of bacterial contamination.
通过限制细菌进入采集血液的机会、检测其存在并采用病原体灭活技术将其清除,已在最大程度降低细菌风险方面做出了重大努力。改进皮肤消毒和使用引流袋是降低细菌性败血症风险的有效上游措施。在此,我们报告使用带有引流袋的血袋的经验。
进行一项观察性研究,以比较两个时间段的细菌污染率,即在血袋中引入引流袋之前和之后。使用现有的细菌监测程序,通过对来自5个单位随机供体血小板的混合样本在BacT/ALERT 3D系统中进行需氧培养,监测细菌污染的发生率。
在2004年6月1日至2006年5月31日期间(无引流袋的血袋),在234,252单位随机供体血小板中,有50单位(0.0213%)培养发现有细菌,而在2007年6月1日至2009年5月31日期间(引入引流袋后),在262,156单位中有15单位(0.0057%)分离出细菌。总体而言,由于皮肤菌群导致的细菌污染风险降低了85%(P < 0.0001),但注意到诸如牛链球菌等非皮肤菌群的检测呈上升趋势。
在当前皮肤消毒方案的基础上,将引流袋整合到血袋中,在采血过程中引流最初的30 mL血液,可显著降低细菌污染风险。