Dear Sir,
As described in depth in the two editorials published in the previous number of Blood Transfusion, the COVID-19 outbreak raises the issue of workers’, donors’ and patients’ safety in Transfusion Medicine Centres (TMC)1,2. Below is an example of a multimodal response and action taken in our TMC’s activities, after estimating and evaluating processes connected to hazards (Figure 1)3–4.
Figure 1.
Response actions for the re-organisation of the activities of Turin’s TMC during COVID-19 outbreak to prevent transmission of SARS-CoV-2 between personnel, donors and patients
PPE: personal protection equipment; TMC: Transfusion Medicine Centres.
Raise awareness about the transmission routes of SARS-CoV-2: surgical mask, alcohol-based hand sanitizer and gloves provided to nurses and doctors interfacing with donors and patients.
Strengthen training on the correct use of personal protective equipment (PPE), including the correct sequence for putting on and removing PPE.
Re-define patient/donor appointments criteria: restrict access to patients for emergency treatments only, while keeping Patient Blood Management (PBM) procedures in place for planned major oncological surgery because of a possible shortage in the blood supply; use of a questionnaire triage to investigate any contact with persons at risk and symptoms, and tympanic temperature measurement (<37.5 °C); hand sanitizer to be used before entering the ward; reorganisation of waiting rooms to permit safe distancing, and to ensure these areas are aired every 30 minutes.
Create a dedicated workflow for biological samples from COVID-19+ wards with: a dedicated centrifuge with an anti-aerosol shield and 3 minutes waiting time after centrifugation; a dedicated immunohaematology instrument: a separate storage area. Double bagging procedures should be implemented for all samples. Improve biosafety protection for lab personnel: surgical masks and gloves during working hours for all, double pairs of gloves for those assigned to receive samples, FFP2 respirators, face shield protection, long-sleeved, water-resistant gowns and double pairs of gloves for all personnel handling samples, instruments and waste because of the risk of aerosol transmission (manually uncap/recap tubes, empty dilution tubes and cards).
Intensify disinfection procedures: twice daily decontamination of lab-dedicated instruments and surfaces with 1:100 chlorine solution and of shared devices (i.e. computers and telephones) with a 70% ethanol solution.
Application of a strict “SINGLE UNIT” policy to all COVID-19+ wards to reduce the return of possibly contaminated blood bags.
Implement a procedure for sanitizing blood bags in case of restitution from a COVID-19+ ward using a 1:100 chlorine solution followed by 70% ethanol.
We are continuously registering the number of SARS-CoV-2+ samples processed and of treated patients and donors who retrospectively are confirmed positive. We then compare these to the number of cases of confirmed positive infection amongst contacts in the TMC (other donors, patients and workers) to see whether our new operating instructions are efficient in preventing transmission of infection to subjects that attend our TMC2,4.
Footnotes
The Authors declare no conflicts of interest.
REFERENCES
- 1.Mascaretti L, De Angelis V, Berti P. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic and Transfusion Medicine: reflections from Italy. Blood Transf. 2020;18:77–8. doi: 10.2450/2020.0071-20. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Cai X, Ren M, Chen F, et al. Blood Transfusion during the COVID-19 outbreak. Blood Transf. 2020;18:79–82. doi: 10.2450/2020.0076-20. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.She J, Jiang J, Ye L, et al. 2019 novel Coronavirus of pneumonia in Wuhan, China: emerging attack and management strategies. Clin Trans Med. 2020;9:19. doi: 10.1186/s40169-020-00271-z. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.European Centre for Disease Prevention and Control. Infection prevention and control for COVID-19 in healthcare settings – Third update. 31 March 2020. ECDC; Stockholm: 2020. [Accessed on 05/04/2020]. Available at: https://www.ecdc.europa.eu/sites/default/files/documents/Infection-prevention-control-for-the-care-of-patients-with-2019-nCoV-healthcare-settings_update-31-March-2020.pdf. [Google Scholar]