Prevalence of transfusion-transmissible viral infections in first-time US blood donors by donation site

BACKGROUND: Understanding the donor base, infectious disease prevalence, and donation loss at various blood donation sites will help maximize blood collection efforts and blood availability. STUDY DESIGN AND METHODS: Using donation data collected at five US blood centers, the prevalence of HIV, HTLV, HBsAg, and HCV in first-time whole-blood donations at 10 donation sites was evaluated: military, education, religious, professional, industry, services, community, health care, government, and fixed sites. Donation loss from screening test reactivity at each donation site was also evaluated. RESULTS: During the study, 1.2 million first-time whole-blood donations were collected. Military and education sites had a low prevalence of all viral markers, except for HBsAg, which was highest at education sites. Variations in viral marker prevalence among donation sites were partially explained by donor demographic differences. Donation loss varied by donation site, ranging from 3.3 percent at education sites to 6.4 percent at industry sites, indicating differential efficiency of blood collection efforts. CONCLUSION: Different rates of positive viral test results and donation loss in first-time whole-blood donors were observed at various types of donation sites. This information may be useful in estimating the yield of usable units from specific blood drives and in allocating resources to meet blood center collection goals.     

Surveillance of risk profiles among new and repeat blood donors with transfusion-transmissible infections from 1995 through 2003 in the Netherlands

BACKGROUND: To evaluate the effectiveness of blood donor selection, this study reports risk profiles of donors with transfusion-transmissible infections as obtained by ongoing surveillance, 1995 through 2003, in the Netherlands. STUDY DESIGN AND METHODS: A surveillance program was installed to monitor risk profiles among new and repeat donors infected with human immunodeficiency virus (HIV), hepatitis C virus (HCV), hepatitis B virus (HBV), or human T-lymphotropic virus (HTLV), or positive for the presence of syphilis antibodies. At posttest counseling, a physician interviewed donors to clarify possible sources of infection. RESULTS: A total of 167 repeat donors and 404 new donors were interviewed: 33 with HIV, 123 with HCV, 279 with HBV, 21 with HTLV, and 112 with syphilis antibodies. Most HBV, HCV, and HTLV infections were among new donors (80, 85, and 67%), whereas most HIV infections were among repeat donors (79%). Nearly 25 percent of the donors did not report factors at screening that would have deferred them from donating blood. At posttest interviews, new donors with HCV often reported injecting drug use (19%). Repeat donors with HIV often reported male-to-male sex (8/26, 31%). CONCLUSION: A significant level of deferrable behavioral risks was found among donors with confirmed transfusion-transmissible infections that persist despite current donor selection. Reporting such behavior at initial donor selection would have eliminated a substantial part of the infections found. This study argues against relaxing the existing donor deferral of persons practicing male-to-male sex, given their significant proportion of HIV infections among repeat donors. Systematic surveillance of risk factors among infected blood donors provides ongoing information about the effectivity of donor selection and is recommended to evaluate and optimize blood policies.     

Reducing the risk of healthcare-acquired infection

Many patients experience increased hospital stays, poor health outcomes, or die each year, as a result of healthcare-acquired infections. Evonne Curran discusses the most common types of infection and suggests how nurses can minimise the risks of infection in clinical settings.     

Reducing the risk surgical site infection

Despite being largely preventable, surgical site infections continue to represent about a fifth of all healthcare-associated infections. This article examines the issues of detection and surveillance, and discusses the key interventions that can help to reduce the risk of these infections.ur     

Reducing the risk of catheter-related urinary tract infection

It is estimated that 10-12 per cent of hospital patients and four per cent of patients in the community have a urinary catheter at any one time (Stamm, 1998). Urinary tract infections (UTIs) account for almost half of all health care-associated infection (HAI), and a significant number of these infections are related to the insertion of urinary catheters (Pratt et al, 2001). Recent research has estimated that a patient who has a catheter for 20 days is almost certain to develop a catheter-related UTI and that the cost of treatment of UTI is estimated as being 1,327 pounds sterling per patient (Roadhouse and Wellsted, 2004). Plowman et al (1999) have estimated that a UTI can extend the length of a patient's stay in hospital by six days.     

Blood donor selection and screening: strategies to reduce recipient risk

Various measures are taken to ensure the safety of the blood supply. Donor selection begins with education of the public about transfusion-transmissible diseases. Potential donors must answer a questionnaire designed to identify specific risk factors for these infections. The questionnaire is the only line of protection against certain infections for which no testing is performed, such as malaria, babesiosis, leishmaniasis, and Chagas disease. All donations are tested for the presence of antibodies to HIV-1 and -2, HCV, HTLV and syphilis, the hepatitis B surface antigen (HbsAg), the p24 antigen (HIV), and also for HIV and HCV nucleic acids. The introduction of new and improved screening tests for transfusion-transmissible diseases has led to remarkable improvement in the safety of the blood supply, with substantial shortening of the window period for HIV, HCV, and HBV infections. The current challenge of the industry is to reduce even further the small but significant risk of bacterial contamination of platelet components. Finally, some safety measures are purely precautionary, such as the deferral of donors who have traveled to certain countries affected by the bovine spongiform encephalopathy (BSE).     

Efforts in minimizing risk of viral transmission through viral inactivation

The viral safety of blood and blood products has improved substantially over the last decade on account of the development of new viral screening and virucidal procedures. For nearly 15 years, virally inactivated blood derivatives, prepared by using advanced virucidal procedures, have amassed an extraordinary safety record with respect to hepatitis B and C and HIV. This record of safety has spawned the development of newer virucidal procedures designed to eliminate nonenveloped viruses from blood derivatives and viruses and other pathogens from blood components, including cellular components. Ongoing tests that include clinical studies will demonstrate how close we are to achieving a blood supply that is free of viruses, bacteria, and parasites.     

Preventing transfusion-transmitted babesiosis: preliminary experience of the first laboratory-based blood donor screening program

BACKGROUND: Babesiosis is the most common transfusion‐transmitted infection reported to the Food and Drug Administration (FDA). We developed and implemented the first laboratory‐based blood donor screening program for Babesia microti to help reduce and prevent transfusion‐transmitted babesiosis (TTB) and report results for the initial year. STUDY DESIGN AND METHODS: Selective B. microti donor screening was performed using real‐time polymerase chain reaction (PCR) and indirect immunofluorescence assay (IFA) to reduce the incidence of TTB in neonates and pediatric sickle cell and thalassemia patients under an FDA‐approved investigational new drug application. We compared the reports of TTB in these patients in the first 12 months of the study with those of patients who received unscreened blood from 2005 to 2010. RESULTS: There were 2113 units tested with 2086 negative results, 26 positive IFA results (1.23%), and one indeterminate PCR result (0.05%). No reported case of TTB occurred with any B. microti–screened unit transfused to the targeted patients (0/787 units) or to any patient who received the screened units (0/2086 units). Before screening, there were seven cases of TTB in neonates, sickle cell, and thalassemia patients from 6500 unscreened units (one case/929 units) and 24 cases in the total transfused population from 496,545 units distributed (one case/20,686 units). CONCLUSION: Implementation of B. microti IFA and PCR screening is compatible with blood center operations to provide tested units. While the results after 1 year are not powered to demonstrate a change in the rate of TTB after testing, they are encouraging.     

Rapid random-donor screening for the selection of viral antibody-containing blood donations

We describe a 3 1/2 year trial in which we used immunofluorescence to detect and titrate antibody to six common viruses in normal healthy blood donors drawn at random from West and South East Scotland. The trial was designed to allow selection of blood donations rich in specific antiviral antibody for inclusion in the plasma pool which would, in turn, be used for the preparation of specific antiviral immunoglobulin. The results show the natural frequency of occurrence of antibody to different viruses in healthy adult blood donors.     

Reducing the risk of ventilator-acquired pneumonia through head of bed elevation

Background: It has been suggested that placing critically ill ventilated patients in a semirecumbent position minimizes the likelihood of nosocomial pneumonia. Aim: This pilot study explores whether the incidence of ventilator‐acquired pneumonia (VAP) can be reduced by elevating the head of the bed to 45°. Methods: The design is quantitative in nature, using a randomized controlled trial. The method involves adult ventilated patients being randomly assigned to one of two positions, i.e. 45° raised head of bed (treatment group) or 25° raised head of bed (control group). Data collection relied upon the diagnosis of clinically suspected and microbiologically confirmed pneumonia defined by the Consensus Conference on VAP. Results: Thirty patients were included in the study – 17 in the treatment group and 13 in the control group. Results showed that 29% (five) in the treatment group and 54% (seven) in the control group contracted VAP (P < 0·176). Conclusions: There was a trend towards a reduction in VAP in the patients nursed at 45°. However, because of the sample size this difference did not reach statistical significance.     

Analysis of HBV infection after blood transfusion in Japan through investigation of a comprehensive donor specimen repository

BACKGROUND: To understand the risk of transfusion-transmitted viral infection, it is important to precisely assess cases of infection that follow transfusion. STUDY DESIGN AND METHODS: HBV infections noted after transfusion in 1997, 1998, and 1999 were analyzed. Transfusion in all these cases was performed before NAT was adopted for donor screening. To detect viral infection, PCR and serologic tests for HBV were performed retrospectively on all blood samples from implicated donors that had been stored in a frozen state after each donation. The concentration of HBV genome was measured in HBV-positive blood samples. RESULTS: One hundred three cases of HBV infection were analyzed; of these, only 16, including at least 10 infections due to window-period (HBsAg-positive by reverse particle hemagglutination assay) donations, were confirmed by further testing to be related to transfusion. The concentrations of HBV genome were very low in four blood samples (<50, 400, 500, and 800 genome equivalents/mL of plasma). CONCLUSIONS: The remaining risk of transfusion transmission of HBV infection before the adoption of NAT was mainly due to window-period donations, including one that was made before the HBV genome was detectable by PCR. However, it was determined that transfusion was not responsible in many cases for HBV infection after transfusion.     

Temporal trends in the prevalence of HIV and other transfusion-transmissible infections among blood donors in northern Thailand, 1990 through 2001

BACKGROUND: Thailand's epidemic of HIV infection, which began in 1988, has primarily involved heterosexual transmission of the virus. This study describes changes in prevalence of HIV and other infectious diseases among blood donors in northern Thailand from 1990 through 2001. STUDY DESIGN AND METHODS: Serologic screening results and demographic data were analyzed from 276,066 donors screened at two blood collection facilities in Chiang Mai, Thailand, from 1990 through 2001. RESULTS: The HIV prevalence peaked in 1991 to 1993 at 4.04 percent and then declined to 0.38 percent in 2001. The overall prevalence of HIV infection was 2.16 percent; HIV prevalence was higher among male (2.24%) than among female (0.64%) donors, in first-time donors, and in replacement volunteer donors. The majority of the donors were men and first-time donors throughout this study. The prevalence of antibodies to syphilis decreased significantly in both men and women. However, the prevalence of antibodies to HCV and HBsAg were stable. CONCLUSIONS: The declining HIV prevalence from 1990 through 2001 among blood donors in two large blood banks in northern Thailand indicates significant progress toward recruitment of a safer donor population in a developing country despite a major HIV and AIDS epidemic involving the general population.