Challenges for quality control of institutional bone banking in developing countries

Abstract

To the Editor-To assess the contamination rate of retrieved bone allografts and the infection rate after bone allotransplantation, we performed the retrospective review of 2 audits to evaluate the quality of bone bank activities in the University hospital in Central Serbia using data from January 2007-December 2019.Institutional bone banks are the widely accepted source of allogenic bone grafts. They are liable for their harvesting, testing, and storage according to strict protocols. 1 Between 1% and 22% of the donated bone grafts are contaminated and thus rejected; disease transmission possible if the bone allograft is contaminated. [2][3][4] High-quality measures in the prevention of bone allograft contamination during retrieval and storage must be provided by any bone bank, particularly when sterilization procedures are not applied. 5 MethodsWe performed a retrospective observational cohort study involving 895 adult orthopedic inpatients at the University Clinical Center Kragujevac, in Kragujevac, Serbia, using data from January 2007-December 2019. The analysis of institutional bone banking was conducted after 2 audits including 562 donors and 333 recipients. The first audit was held from January 1, 2007, to May 31, 2013. During this period, fresh femoral head allografts were retrieved from 295 patients with femoral neck fracture or after primary total hip arthroplasty (THA). The second audit was conducted from June 1, 2013, to December 31, 2019, and 267 allografts were retrieved.Swab samples were sent to the hospital laboratory for microbiological evaluation. Two cultures of aerobic and anaerobic microorganisms in blood agar, MacConkey agar, and chocolate blood agar were analyzed. The donors were tested for hepatitis B (HBs antigen and anti-HBc-antibodies) and hepatitis C (HCV-antibodies and HCV-RNA), human immunodeficiency virus (HIV1/2 antibodies), and syphilis (VDRL) at donation and 6 months after surgery, according to the bone bank protocol. Acceptable bone

Detrimental Effects of the COVID-19 Pandemic on Elective Orthopedic Surgery and Institutional Bone Bank Activity

“…The leading cause of allograft rejection during the COVID-19 pandemic was the inability to perform serology retests due to underbudgeting, or donor refusal to perform serology retests, respectively. Our recent study showed that the overall discard rate of bone allografts following the past thirteen years was 26.86% (18). During the COVID-19 pandemic in 2020, the overall discard rate significantly increased to 80.76%.…”