B L O O D D O N O R S A N D B L O O D C O L L E C T I O N
A novel rapid and effective donor arm disinfection method_02332 53..58
Carl McDonald, Siobhan McGuane, Julia Thomas, Stephen Hartley, Steve Robbins, Anjana Roy,
Neville Verlander, and John Barbara
BACKGROUND: The aim of the study was to derive a
donor arm disinfection technique that was rapid, but
with a disinfection efficacy equivalent to a previous
“best-practice” technique. This method consisted of a
two-stage procedure with an initial application of 70%
isopropyl alcohol and then 2% tincture of iodine (IATI).
The total time for the IATI method was 2 minutes in
duration. A rapid technique (1 min in duration) was
needed to obviate potential problems due to increased
donor waiting time, had the IATI method been imple-
mented at blood donation sessions.
STUDY DESIGN AND METHODS: A direct swabbing
and plating technique was used to enumerate bacteria
present before and after disinfection. In total, seven
methods were evaluated.
RESULTS: The chlorhexidine/alcohol applicator (CAA)
disinfection device containing 1.5 mL of 2% chlorhexi-
dine gluconate and 70% isopropyl alcohol (99.91%
reduction; confidence limits, 99.55%, 99.98%) was
shown to have equivalent disinfection efficacy as the
IATI method (99.89% reduction; confidence limits,
99.36%, 99.98%; p = 0.86). Procedural time for the
1.5-mL CAA method was 1 minute thereby avoiding
potential problems of increased donor waiting time,
inherent in the IATI 2-minute procedure at blood dona-
CONCLUSIONS: The 1.5-mL CAA disinfection method
offers blood services a rapid and effective donor arm
disinfection procedure. In 2006, the 1.5-mL CAA proce-
dure was implemented throughout the entire English
blood service for all donations.
sion (SHOT) Surveillance System.1In the period 2001
nation were reported in the United States, comprising
14.1% of all transfusion-associated mortality.2
The major source of bacterial contamination is donor
arm derived.3,4Skin flora including coagulase-negative
staphylococci, Staphylococcus aureus, Corynebacterium
spp., Propionibacterium acnes, and Bacillus spp. are the
most commonly detected organisms in screening and
monitoring studies.5-8In the US Bacterial Contamination
of Blood (BaCon), UK SHOT, and French Haemovigilance
System studies, resident skin flora potentially account for
57% of platelet (PLT) concentrate and 37% of red blood
cell (RBC)-associated transmissions.9-11In total, skin-
derived organisms (resident and transient), account for
over 90% of PLT concentrate and 70% of RBC-associated
bacterial transmissions cited in these studies.
An initial study on the effectiveness of donor arm dis-
infection techniques was undertaken by National Health
Service Blood and Transplant (NHSBT), National Bacteri-
ology Laboratory (NBL) in 1999 to find a “best-practice”
ransmission of bacteria by transfusion remains
a significant problem in transfusion medicine.
To date, there have been 38 cases (10 deaths)
reported from the Serious Hazards of Transfu-
ABBREVIATIONS: CAA = chlorhexidine/alcohol applicator;
IAA = 70% isopropyl alcohol applicator; IAS = 70% isopropyl
alcohol swab; IATI = 70% isopropyl alcohol, followed by 2% tinc-
ture of iodine; NBL = National Bacteriology Laboratory;
NHSBT = National Health Service Blood and Transplant.
From the National Bacteriology Laboratory, NHS Blood and
Transplant; and the Statistics, Modelling and Bioinformatics
Department, Health Protection Agency, Centre for Infections,
Address reprint requests to: Carl P. McDonald, Head of Bac-
teriology, National Bacteriology Laboratory, NHS Blood and
Transplant, Colindale Avenue, Colindale, London NW9 5BG, UK;
Received for publication February 6, 2009; revision
received May 19, 2009, and accepted May 24, 2009.
Volume 50, January 2010
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MCDONALD ET AL.
Volume 50, January 2010