Human herpesvirus 8 transfusion transmission in Ghana, an endemic region of West Africa

BACKGROUND: Human herpesvirus 8 (HHV‐8) seroprevalence ranges between less than 5% in Europe and North America and 50% to 70% in sub‐Saharan Africa. Evidence of HHV‐8 transfusion transmission is only indirect. We conducted a serologic (anti‐HHV‐8) and molecular (HHV‐8 DNA) study of samples from paired donor‐immunocompetent recipients transfused with whole blood. STUDY DESIGN AND METHODS: Samples from 252 donor‐recipient pairs were tested. Immunoglobulin G to HHV‐8 was detected with enzyme immunoassays and confirmed with an in‐house immunofluorescence assay. The cellular fraction from seroreactive donors and their recipients was tested for HHV‐8 DNA. RESULTS: Anti‐HHV‐8 was positive (reactive in two or more assays) in 28 (11%) patients and 16 (6%) donors. Of 12 seronegative recipients (at risk of transmission) receiving seropositive blood, one very likely transmission was identified (8.3% confidence interval, 0%‐23%). The donor blood contained HHV‐8 DNA and his and four other donors' sequences clustered separately from recorded genotypes with a 97% bootstrap constituting a distinct genotype. CONCLUSIONS: HHV‐8 is transmitted in Ghana but does not carry clinical consequences since most patients are immunocompetent. The clinical risk will increase with the availability of immunosuppressive drugs in sub‐Saharan Africa. We propose that a new genotype (HHV‐8‐G for Ghana) be added to the current nomenclature.     

Promoting safer blood transfusion practice in hospital

Results from a national comparative audit of bedside transfusion practice show that patients in the UK are at risk of misidentification and poor monitoring when undergoing a blood transfusion. A commonly identified reason for poor compliance with guidelines from the British Committee for Standards in Haematology (BCSH et al 1999) is a lack of awareness of good transfusion practice (National Blood Service (NBS) 2005). This article discusses the implications of the audit findings for the administration of blood at the bedside and examines initiatives to support hospital staff in their efforts to improve blood transfusion safety.     

Academic nursing practice in rural West Virginia

This exemplar highlights how a rural academic nursing practice has been effective in facilitating the integration of the tripartite academic role of education, research, and service for one university faculty member. The integration of students into the practice is described. The experience provided them with critical insights into rural academic practice during their delivery of prenatal care services to a vulnerable population of women in rural Appalachia. This exemplar also describes the use of the academic nursing practice as a laboratory both for studying the specific problems of this vulnerable population of women and their families, and testing interventions tailored to the needs of the community. Finally, the other ways the academic nursing practice benefits faculty and students, including integration of educational technology into the practice setting and opportunities for faculty leadership in rural community development, are discussed.     

Blood transfusion: crucial steps in maintaining safe practice

The transfusion of blood and blood products remains a highly effective and potentially life-saving treatment for many patients. However, blood is a living tissue and its transfusion, from one individual to another, is not without risk. Significant among these risks is the potential for human error and the subsequent transfusion of the incorrect blood component. Alarmingly, the number of errors would appear to be increasing, with the second annual report of the Serious Hazards of Transfusion (SHOT) Steering Group reporting a 36% increase in these cases (SHOT, 1999). Reversing this trend can only be achieved by adopting all inclusive and rigorous blood transfusion procedures. The registered nurse is central to such processes and therefore plays a crucial role in the safe administration of blood and blood products. This article considers the nurse's responsibilities and offers evidence-based guidelines for practice.     

Assessment of the clinical transfusion practice at a regional referral hospital in Uganda

The aim of this study was to determine the indications for transfusion, blood ordering practices and post‐transfusion complications, and to assess the clinical transfusion practice at Mbarara Regional Referral Hospital (MRRH) in Mbarara, Uganda. There are no guidelines on the appropriate use of blood at MRRH. Therefore, there was a need to assess the local clinical transfusion practice. Patients' hospital files were studied for evidence of blood transfusions in 2008. All five wards were reviewed and details on the transfusion process were recorded. A total of 1730 patients (median age, 19·0 years; range, 1 day to 88 years; female‐to‐male ratio, 1·4), for whom blood was cross‐matched, were studied. Of these, 1674 (96·8%) patients actually received transfusions, which were as whole blood in 58·4% of recipients. The mean number of units per recipient was 1·7 and the cross‐match‐to‐transfusion ratio was 1·3. The three most frequent indications for transfusion were malaria (38·8%), bleeding (27·1%) and other infections (16·1%). There were no records for pre‐transfusion haemoglobin, compatibility testing, transfusion start‐times and vital signs in 30·2, 51·8, 21·5 and 97·6% of the recipients, respectively. Transfusion reactions were recorded for 10 (0·6%) patients. Although there was no evidence of blood wastage, inadequacies were noted in the documentation of the transfusion process. There is a need to train staff in blood transfusion and to design a ‘blood transfusion form’ for easy monitoring and evaluation. A hospital transfusion committee and guidelines on the appropriate use of blood should be put in place at MRRH.     

Improving blood transfusion practice: role of a computerized hospital information system

The recent focus on medical risk and financial cost has prompted a need for better guidelines for prescribing the transfusion of blood components. In 1987, to respond to the issues of quality transfusion practice and accurate evaluation, LDS Hospital (Salt Lake City, UT) began using a computerized, knowledge-based blood-ordering system. Each transfusion request was reviewed and flagged by the computer when it did not meet the criteria established by the medical staff. The study reviewed the use of red cells, platelets, and fresh-frozen plasma in 13,082 transfusion orders for 5847 consecutive patients from July 1, 1988, through June 30, 1989. The evaluation assessed, first, the adherence of physicians to computerized criteria and, second, their adherence to the quality of transfusion practice. A high percentage of the blood units ordered met the established criteria: 91.2 percent for the red cell transfusions, 72.9 percent for platelets, and 81.7 percent for fresh-frozen plasma. From the July 1, 1987, implementation date through June 1989, the mean hematocrit of persons being transfused dropped from 28.6 to 27.7 percent (0.29 = 0.28) (p less than 0.005) and the number of orders requiring review by the quality assurance department dropped from 100 to 14 percent; moreover, there was a true-exception rate of only 0.37 percent. The use of the computer system effected the implementation of the following measures: 1) identification of the indications and establishment of clear clinical and biologic parameters for every transfusion, and 2) measurement and improvement of institutional transfusion practice. These results demonstrated the efficacy of a computerized hospital information system in implementing continuous quality improvement for transfusion practice.(ABSTRACT TRUNCATED AT 250 WORDS)     

Blood inventory management: hospital best practice

Blood is a perishable product, and hence good management of inventories is crucial. Blood inventory management is a trade-off between shortage and wastage. The challenge is to keep enough stock to ensure a 100% supply of blood while keeping time expiry losses at a minimum. This article focuses on inventory management of red blood cells in hospital transfusion laboratories to derive principles of best practice and makes recommendations that will ensure losses due to time expiry are kept to a minimum. The literature was reviewed to identify available models for perishable inventory management. Historical data from the UK blood supply chain was analyzed to identify hospitals with good inventory management practice and low wastage levels. Transfusion laboratory managers in the selected hospitals were interviewed in 7 case studies with the aim of identifying drivers for low wastage and good inventory management practice. The findings from the case studies were compared with the literature. The extant literature asserts that the drivers for good inventory performance are the use of complex inventory models and algorithms. This study has found this not to be the case. Instead, good performance is driven by the quality of transfusion laboratory staff, who must be skilled, regularly trained, and experienced. Electronic crossmatching, transparency of the inventory, and simple management procedures also facilitate good performance.     

Risk management in transfusion medicine: a hospital transfusion service perspective

The hospital transfusion service has always been at the heart of the blood component therapy chain. It has had the multiple roles of not only maintaining an inventory of a wide range of blood components, monitoring their storage conditions and ensuring compatibility when appropriate, but also being the source of expertise in transfusion medicine, and attempting to follow up any adverse consequences of transfusion. Hospital transfusion medicine has been seen essentially as a scientific and technical specialty with a minimal component of medical input. This is now changing and transfusion medicine is becoming an all embracing specialty where the hospital transfusion service still remains at the heart of transfusion medicine, but a much higher level of understanding is necessary at the clinical and consumer level.     

Help-seeking behaviours in childbearing women in Ghana, West Africa

FARNES C., BECKSTRAND R.L. & CALLISTER L.C. (2011) Help‐seeking behaviours in childbearing women in Ghana, West Africa. International Nursing Review 58 , 491–497 Aim: The purpose of this ethnographic study was to examine the health‐seeking behaviours of Ghanaian childbearing women. Background: The Ashanti consider pregnancy to be a vulnerable time when risk increases that women may be affected by witchcraft and develop sunsumyare. Preparation for positive birth outcomes include biomedical, ethnomedical and faith‐based interventions. Design: A sample of 42 childbearing Ghanaian women participated in audiotaped interviews. Transcribed interviews were coded and categorized into themes. Findings and discussion: The overriding theme was health seeking to ensure positive pregnancy outcomes. Subthemes included accessing multiple sources of care simultaneously, feeling vulnerable to spiritual illness, seeking spiritual protection and disclosing multiple sources of care. Conclusion: Childbearing is an essential part of the gender identity of Ashanti women. Witchcraft mentality provides a way for a woman to manage her life challenges. Implications for practice: Cultural beliefs and practices have profound effects on health‐seeking behaviours. It is becoming increasingly important that healthcare providers perform cultural and spiritual assessments and inquire about complementary sources of health care.