Snake in the grass: A case report of transfusion reactions due to contaminated donor arm disinfectant

Abstract

Bacterial contamination of blood components remains an on-going challenge. In the majority of cases, organisms contaminating the blood components are a part of normal skin flora. Here, we report a case of bacterial contamination of blood units through contaminated donor arm disinfectant. There was a series of reactions due to random donor platelet (RDP) transfusion. The patients had features of septic transfusion reactions. On root cause analysis, spirit swabs used for disinfection of donors’ arm were identified as the culprit and presence of Clostridium difficile was established. All the blood components prepared on the dates of implicated RDP units were removed from the stock and we replaced the existing 70% alcohol disinfectant with chlorhexidine-alcohol-based antiseptic rub. Further, no such transfusion reactions were reported. Implementation of good donor arm disinfection technique in addition to the use of blood bags with diversion pouch is proposed to be best preventive strategy for resource-poor settings.

Retrospective Study of the Prevalence of Bacterial Contamination of Platelet Concentrates in Morocco

“…These two bacteria types are responsible for the increased incidence of severe sepsis and septic shock as reported by (Babu M, et al) 13 The isolated bacteria in this study, as found in other research were part of the skin flora. 3 Similar bacteria on the antecubital fossa of potential blood donors were found in an early study by our group (Article in press). With the exception of Staphylococcus aureus which can causing a serious problems, 14 most of the time, these bacterial species found in this study are generally associated with non-fatal septic transfusion reactions.…”

“…At the CHU laboratory, every PCs are disinfected for at least one minute with a disinfectant (70% concentrated Alcohol), 3 the bacterial culture was done aseptically from PCs samples following the World Health Organization (WHO) recommendations. 11 The bacterial cultures broths were incubated in aerobic atmosphere at 37°C for 7 days and were daily controlled for any possible signs of bacterial growth (turbidity, color, voile…).…”

“…1 The prevalence of bacterial contamination of blood was found to be between 0.2% and 4 %. 2,3 The clinical consequences of transfusing bacterially contaminated blood range from minimal or no reaction to fatal septic shock and death. The platelet concentrates (PCs) were found to be the most contaminated.…”

Blood Donor Arm Cleaning–Another Step towards Preventing the Contamination of Blood Products for Transfusion Purposes

“…The uppermost layer and deeper layers of the skin harbour many resident and transient bacteria [24]. Apart from causing diseases when transmitted from one person to another, they run the risk of contaminating blood products if proper cleaning of the antecubital fossa is not carried out [25]. Cleaning the skin with soap and water is more effective than washing the skin with just water or no hand washing at all [26].…”

Analysis of Bacterial Contamination in Blood Bank: Comparison of Two Different Donor Arm Disinfectant

“…A Blood &Transplant study conducted by NHS revealed reduction in contamination of blood products by 57% using improved disinfection strategies [13] .…”