Infection prevention in transfusion practice.

To the Editor—Contamination prevention of blood products is a challenge in transfusion practice. Contamination can occur at any point in the transfusion chain, including collection, processing, storage, issue, and administration. The objective of this communication is to describe strategies for preventing transfusion transmitted infections (TTIs) as practiced in a blood bank in a 167-bed oncology center in India. The blood bags used for collection comply with ISO 3826 standards. 1 We use bags with an attached diversion pouch for collection of the initial 20–25 mL of blood. This reduces bacterial contamination during collection by preventing the skin core from entering into the collection bag. The packet and blood bag are inspected for any evidence of visible contamination. Blood collection at our center is either for component preparation or as an apheresis (ie, single-donor platelets). The cleaning and disinfection methods before blood collection are followed as per World Health Organization guidelines. 2 This procedure consists of washing the donor's relevant arm with soapy water and disinfecting the anticubital fossa, initially with isopropyl alcohol for 30 seconds over a diameter of 8 cm in concentric manner, followed by application of 2.5% chlor-hexidine with 70% isopropyl alcohol. Until screening tests are completed, whole blood is stored between 2 and 6°C, and after component preparation, which is done within 1–2 hours of blood collection, platelets are stored at 22°C. Packed red blood cells (RBCs) are stored between 2 to 6°C, and plasma is stored at −40°C. The shelf-lives of stored products are defined as follows: 5 days for platelets, 1 year for plasma, and 6 weeks for RBCs. Blood components can potentially transmit several pathogens, and all donated units are screened for transfusion transmissible infections (TTIs). In India, mandatory testing for TTI is required for only 5 pathogens: human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), malaria, and syphilis. However, the list of potentially transmissible infections is large and includes other viruses: human T-lymphotropic virus In our center, the Vitros ECi system (Johnson & Johnson) is used to test for HBV surface antigen (HBsAg), anti-HCV antibodies, anti-HIV antibodies; immunochromatographic test (ie, a pan malaria card) is used to test for malaria (Plasmodium vivax and P. falciparum) antigen, and syphilis serology is performed using a card agglutination test (Rapid Plasma Reagin test). Blood units found to be serologically reactive for any of the markers (Table 1) are immediately identified, segregated, and …