infection control standards in blood transfusion
TRANSCRIPT
>> 0 >> 1 >> 2 >> 3 >> 4 >>
INFECTION CONTROL
Feah A. Altura, RNInfection Prevention and Control
Nurse
>> 0 >> 1 >> 2 >> 3 >> 4 >>
Question:How does a
Full Glass of WaterWeigh?
>> 0 >> 1 >> 2 >> 3 >> 4 >>
>> 0 >> 1 >> 2 >> 3 >> 4 >>
>> 0 >> 1 >> 2 >> 3 >> 4 >>
>> 0 >> 1 >> 2 >> 3 >> 4 >>
Infection Control Standards in Blood Transfusion
>> 0 >> 1 >> 2 >> 3 >> 4 >>
Anne ClaireThis is a case of a 25 wks
AOG pregnant patient who had continuous
contractions and later prematurely gave birth to
Anne Claire…
Since, she is a PRETERM Baby she needed
FREQUENT BLOOD TRANSFUSIONS.
>> 0 >> 1 >> 2 >> 3 >> 4 >>
>> 0 >> 1 >> 2 >> 3 >> 4 >>
In the early 1980s, a number of hemophiliacs contracted HIV through blood transfusions. Since then, public concern about infections transmitted
through blood transfusions has increased.
>> 0 >> 1 >> 2 >> 3 >> 4 >>
Infectious Agents identified in the Blood of Donors:
• Hepatitis A, B, and C • Malaria • Syphilis • Cytomegalovirus • Herpesviruses • Epstein-Barr virus • Creutzfeldt-Jacob virus (which causes the
human form of "mad cow" disease) • West Nile virus
>> 0 >> 1 >> 2 >> 3 >> 4 >>
Risk for Allogeneic Blood TransfusionTransfusion transmitted infections reported to Serious Hazards Of Transmission
Scotland
1995 1996 1997 1998 1999 Total
Hepatitis A - 1 - - - 1
Hepatitis B 1 1 - 2 1 5
Hepatitis C - 1 - 1 1 3
HIV - 3 - - - 3
Bacteria 1 1 3 1 5 11
Malaria - - 1
>> 0 >> 1 >> 2 >> 3 >> 4 >>
>> 0 >> 1 >> 2 >> 3 >> 4 >>
Sources of Blood Transfusion
a. Homologous Donation
b. Autologous Donation
c. Direct Donation
d. Blood Salvage
>> 0 >> 1 >> 2 >> 3 >> 4 >>
Autologous Donation• Donation of a client’s own blood for hospitalization. • Preoperative donation collected 4-6 hours before surgery• Iron supplements may be ordered• Benefits:
– Prevention of viral infection from donated blood– Used for client with history of blood transfusion reaction– Rare blood type
• Contraindication– Acute Infection– Chronic Disease– Hemoglobin <11g/L, Hematocrit <33%– Cerebrovascular Disease– Cardiovascular Disease
• Kaplan, 2006
>> 0 >> 1 >> 2 >> 3 >> 4 >>
BLOOD TRANSFUSION REACTION:BACTERIAL REACTION
It is possible for blood, especially platelets, to become contaminated with bacteria during or
after donation. Transfusion with blood that has bacteria can result in a systemic bacterial
infection. Because of the precautions taken in drawing and handling donated blood, this risk is
small. There is a greater risk for bacterial infection from transfusions with platelets. Unlike
most other blood components, platelets are stored at room temperature. If any bacteria are present, they will grow and cause an infection when the platelets are used for transfusion.
>> 0 >> 1 >> 2 >> 3 >> 4 >>
BLOOD TRANSFUSION REACTIONS
• Bacterial contamination: – Rarely, blood becomes contaminated with tiny
amounts of skin bacteria during donation. – Platelets must be stored at room temperature,
these bacteria can grow rapidly – This affects about 1 in 1000-3000 units of
platelets– Patients receiving these platelets may
develop serious illness within minutes or hours after the transfusion is started
>> 0 >> 1 >> 2 >> 3 >> 4 >>
Blood Safety
The Precautions taken to ensure that blood-borne pathogens are not transmitted via donated
blood includes the ff:1. Rejection of potential donors whose medical
history shows evidence of viral hepatitis, drug addiction or recent blood transfusion or tattoos
2. Laboratory testing of all donated blood for the presence of Hepatitis B and C, Syphilis and the HIV-1 antibody
* www.answers.com
>> 0 >> 1 >> 2 >> 3 >> 4 >>
Processing of blood prior to transfusion
• Donated blood is sometimes subjected to processing after it is collected, to make it suitable for use in specific patient populations. Examples include:
• Leukoreduction, or the removal of stray white blood cells from the blood product by filtration. Leukoreduced blood is less likely to cause alloimmunization (development of antibodies against specific blood types), and less likely to cause febrile transfusion reactions. Also, leukoreduction greatly reduces the chance of cytomegalovirus (CMV) transmission. Leukoreduced blood is appropriate for:– Chronically transfused patients – Potential transplant recipients – Patients with previous febrile nonhemolytic transfusion reactions – CMV seronegative at-risk patients for whom seronegative
components are not available
>> 0 >> 1 >> 2 >> 3 >> 4 >>
• Irradiation. In patients who are severely immunosuppressed and at risk for transfusion-associated graft-versus-host disease, transfused red cells may be subjected to irradiation with at least 25 Gy to prevent the donor T lymphocytes from dividing in the recipient. Irradiated blood products are appropriate for: – Patients with hereditary immune deficiencies – Patients receiving blood transfusions from relatives in directed-donation
programs – Patients receiving large doses of chemotherapy, undergoing
stem cell transplantation, or with AIDS (controversial).
>> 0 >> 1 >> 2 >> 3 >> 4 >>
• CMV screening. Cytomegalovirus, or CMV, is a virus which infects white blood cells. Many people are asymptomatic carriers. In patients with significant immune suppression (e.g. recipients of stem cell transplants) who have not previously been exposed to CMV, blood products that are CMV-negative are preferred. Leukoreduced blood products can substitute for CMV-negative products, since the complete removal of white blood cells removes the source of CMV transmission.
>> 0 >> 1 >> 2 >> 3 >> 4 >>
BLOODBORNE PATHOGENHEPATITIS B VIRUS
• Hepatitis B Virus (HBV) causes serious liver disease
• Half of the people infected with Hepatitis B have no symptoms.
• Those with symptoms may experience jaundice, fatigue, abdominal pain, loss of appetite, occasional nausea or vomiting
>> 0 >> 1 >> 2 >> 3 >> 4 >>
BLOODBORNE PATHOGENHEPATITIS C VIRUS
• Hepatitis C Virus (HBC) causes serious liver disease• While 85% of people infected with HCv have chronic
infections, only about 10% of those infected with HBV are chronically infected.
• People chronically infected with Hepatitis C may have no symptoms for up to 30 years, yet during that time the infection may be slowly damaging the liver
• HEPATITIS C IS THE LEADING INDICATOR FOR LIVER TRANSPLANT
• THERE IS NO VACCINE TO PREVENT HEPATITIS C
>> 0 >> 1 >> 2 >> 3 >> 4 >>
BLOODBORNE PATHOGENHUMAN IMMUNODEFICIENCY VIRUS
(HIV)• HIV attacks a person’s immune system and causes it to
break down• Like HCV, HIV can live in a person for years with no
obvious symptoms• Damage can be observed in blood test – lowered T-cell
counts before actual symptoms are experienced.• If T-cell count drops below 200, the infected person is
diagnosed with AIDS• Transmission: Primarily through SEXUAL CONTACT
WITH AN INFECTED PARTNER OR SHARING CONTAMINATED NEEDLES AND/OR SYRINGES
>> 0 >> 1 >> 2 >> 3 >> 4 >>
Transmission• Hepatitis B, Hepatitis C and HIV spread most easily
through contact with blood• Contact with Other Potentially Infected Materials (OPIM)
– Semen– Vaginal Fluid– Other body fluid or tissue containing visible blood– CSF– Synovial fluid– Pleural Fluid– Peritoneal Fluid– Pericardial Fluid– Amniotic Fluid– Saliva in Dental Procedures
>> 0 >> 1 >> 2 >> 3 >> 4 >>
Means of Transmission
• An accidental injury by a sharp object contaminated with infectious material
• Open cuts, nicks and skin abrasions, even dermatitis and acne, as well as the mucous membranes of your mouth, eyes or nose
• Indirect Transmission
>> 0 >> 1 >> 2 >> 3 >> 4 >>
Work Practice Control
• HANDWASHING
• STANDARD PRECAUTIONS
• SHARPS SAFETY
• PERSONAL PROTECTIVE EQUIPMENT
• GOOD HOUSEKEEPING
>> 0 >> 1 >> 2 >> 3 >> 4 >>
STANDARD PRECAUTIONS
Treat all blood and body fluids, excretions and secretions, non-intact skin and mucous membranes as if infectious
>> 0 >> 1 >> 2 >> 3 >> 4 >>
PERSONAL PROTECTIVE EQUIPMENTS
• Use protective barriers
• Use gloves to protect hands from contamination
• Use gowns to protect skin and clothing from exposure
• Use fluid-resistant gowns when exposed to large amounts of blood and body fluids
>> 0 >> 1 >> 2 >> 3 >> 4 >>
• Wash with soap and running water when hands are visibly soiled or contaminated by blood or other body substances
• To wash, wet hands and apply soap, rubbing vigourously for at least fifteen seconds over all surfaces
• Rinse thouroughly and dry with a disposable towel, then use a dry towel to turn off the faucet
HAND HYGIENE
>> 0 >> 1 >> 2 >> 3 >> 4 >>
>> 0 >> 1 >> 2 >> 3 >> 4 >>
HOUSEKEEPING• Keep work surfaces and equipment clean• Do not allow equipment contaminated with blood
or body fluids to touch skin or mucous membranes of a client or a staff member
• Discard single-use equipment• Clean and disinfect contaminated, non-
disposable equipment immediately• Place blood and other medical waste in closed,
leakproof containers, labeled with colored warning signs to alert others to the contents
>> 0 >> 1 >> 2 >> 3 >> 4 >>
SHARPS SAFETY• Dispose of needles and other sharp instruments
immediately in specially labeled, puncture resistant containers located close to the area where sharps are used and mounted slightly below eye level
• Never reach into a container of contaminated sharps• Replace sharps containers before they overfill, or when
¾ full• Use a broom or dustpan, or forceps or tongs to pick up
broken glass – NOT HANDS• Transport specimens or other potentially infectious
materials in closed, leakproof containers and watch your step
>> 0 >> 1 >> 2 >> 3 >> 4 >>
Bloodless Medicine
>> 0 >> 1 >> 2 >> 3 >> 4 >>
Reminders• Blood must be hung within 30 minutes of arriving at the
unit• Maintain Standard Precautions when handling blood or
Intravenous equipment; Assure client that risk for AIDS is minimal because blood is screened
• Clean IV Port with Alcohol Swab or 70% Isopropyl Alcohol before Piggyback of BT
• Strict Vital Signs Monitoring– Hemolytic Reaction within first 10-15 minutes– Febrile Reaction within 30 minutes– Allergic Reaction anytime during or after transfusion
• Mosby, 1999
>> 0 >> 1 >> 2 >> 3 >> 4 >>
>> 0 >> 1 >> 2 >> 3 >> 4 >>
QUIZ: DEAL OR NO DEAL
You are covered by the standard precaution only if you are a surgical doctor or nurse?
>> 0 >> 1 >> 2 >> 3 >> 4 >>
NO DEAL
AS LONG AS U R WORKING IN THE HOSPITAL U
SHOULD USE STANDARD PRECAUTIONS
>> 0 >> 1 >> 2 >> 3 >> 4 >>
QUIZ: DEAL OR NO DEAL
HIV and HBV are the only bloodborne pathogens you
face
>> 0 >> 1 >> 2 >> 3 >> 4 >>
NO DEALTHERE ARE NUMEROUS INFECTIONS ASSOCIATED WITH BLOOD INCLUDING
HEPATITIS C
>> 0 >> 1 >> 2 >> 3 >> 4 >>
QUIZ: DEAL OR NO DEAL
Standard precautions means treating all blood and body
fluids as potentially infectious?
>> 0 >> 1 >> 2 >> 3 >> 4 >>
OF COURSE
DEAL
>> 0 >> 1 >> 2 >> 3 >> 4 >>
QUIZ: DEAL OR NO DEAL
YOU SHOULD BEND ALL UR NEEDLES BEFORE PUTTING
THEM IN THE SHARPS CONTAINER?
>> 0 >> 1 >> 2 >> 3 >> 4 >>
NO DEALCGE! ITRY NINYO! AY SHA!
MADADAGDAGAN ANG STATISTICS KO NITO!!!
>> 0 >> 1 >> 2 >> 3 >> 4 >>