Background: Bacterial sepsis after apheresis platelet transfusion is still reported with approximately 1 in 109,000 distributed components, despite current preventive measures. Bacteria commonly found on healthy skin that escape detection with culture-based quality control tests are most often implicated in septic reactions. Consequently, we sought to evaluate the efficacy of a 1-step, 2% chlorhexidine-based swab compared to our current 2-step method with povidone iodine for skin disinfection before apheresis platelet collection. Methods: Three regional blood centers in a large blood system used a 1-step method with 2% chlorhexidine/70% isopropyl alcohol (ChloraPrep 1 One-Step Swabstick, Cardinal Healthcare) as the primary method for skin disinfection during the study period (trial group); the remaining 32 centers (control group) used the standard 2-step method with 0.75%/1.0% povidone iodine. Donors who developed skin irritation or allergic reaction to chlorhexidine during the trial were switched to the standard povidone-iodine scrub. Bacterial culture results under aerobic conditions for all plateletpheresis donations in the trial group were compared to the control group during a 7-month study period in 2009 or to the same baseline period in previous year. Initial positive culture results were included in the analysis if bacteria were isolated from the aerobic bottle. Results: The rate of initial positive culture results was significantly lower in the trial group compared to the control group during the seven-month study period in 2009 [11.0 vs 32.9 per 100,000 donations, OR (95% CI) 0.33 (0.13-0.73)]. A significant decrease in bacterial contamination in both the trial and control regions was also apparent during the study period compared to baseline in the previous year, but the decrease was more pronounced in the trial regions (Table 1). There was a trend in a reduction of confirmedpositive bacterial culture results from skin contaminants, although the total number of observations was small (data not shown). Aller-gic reactions reported by the trial regions during the study period significantly increased compared to the control regions (17.4 vs. 0.8 per 10,000 donations, p < 0.05). Approximately 1% of donors who participated in the trial had skin irritation or allergy that required switching to the standard arm scrub. Conclusion: A chlorhexidine-based skin disinfection method was more efficacious than the standard method with povidone-iodine in preventing bacterial contamination of apheresis platelet donations. The use of chlorhexidine was associated with reports of skin irritation, which required switching back to the standard arm preparation for some donors. The potential benefit of reducing bacterial contamination could translate to improved transfusion safety and increased availability of apheresis platelet components for transfusion.
A.F. Eder, None.