Should blood banks store autologous bone flaps in their freezer? Page 2

ADDENDA Oct. 9, 2006

17. An Infection Control Coordinator at a hospital in the Northern USA reports that for the first time in anyone's memory during a neurosurgical re-implantation procedure, an autologous cranial bone flap (about 2 x 2 inches in dimension) was dropped on the floor in the operating room (OR). Normally, such a bone flap is stored in a sterile plastic container at less than 0 degrees Fahrenheit in a freezer that is located in the OR. The bone flap is usually re-implanted within a few months. The inquiring Infection Control Coordinator wonders if there is any guidance on what should be done to clean/disinfect the dropped flap for safe use for the patient? She acknowledges that her hospital is also interested to know if others feel that they need to be more formal about logging and tracking the autologous bone flaps. They are also considering storing the bone flaps in a "double" sterile container (one inside another) at -80 degree Fahrenheit in a blood bank freezer. No testing or attempt at processing bone flaps is done at the present time, except perhaps for an initial cleansing in sterile water in the OR.

ADDENDA Oct. 13, 2006

18. Dr. Judith E. Woll, Clinical Professor of Pathology and Internal Medicine at Wright State University School of Medicine and CEO of Community Blood Center/Community Tissue Services in Dayton, Ohio (attribution used with permission) addresses maintenance of autologous tissue and management of a dropped flap. According to Dr. Woll: "The American Association of Tissue Banks Standards (www.aatb.org) has detailed requirements for proper management of autologous tissue. In summary, AATB allows bone tissue, if stored for six months or less, to be kept at minus 20° C to minus 40° C. If longer storage is required, then the temperature requirement is minus 40° C or colder. Bone tissue can be kept for no longer than 5 days from recovery at refrigerated temperatures between 1-10° C. At the time of recovery, the flap should be cultured and placed in a sterile container. The tissue should be individually and aseptically wrapped in a manner to prevent contamination of the contents, and allow for aseptic delivery of the specimen for storage and/or reimplantation. The receptacle shall be labeled immediately with the donor's name, age, sex, hospital medical record number and/or SSN, and institution name. It should also be prominently labeled 'FOR AUTOLOGOUS USE ONLY'. Retrieval records shall include: name and address of the institution in which the autograft was retrieved, date and time the autograft was collected, name of the physician recovering the autograft, donor name, age, sex, hospital medical record number/or SSN, and type of tissue recovered. A log should be kept that establishes complete tracking of the graft and storage situations. The graft should be kept in a quarantined setting in a freezer that is continuously monitored. There are also JCAHO requirements for handling of tissue grafts in the hospital setting. A similar discussion is on the AORN website and in the September/October AABB News."
    
    As far as methods of disinfection for a skull flap, Dr. Woll offers several options. "Tissue banks frequently gamma irradiate potentially contaminated grafts at 15-25 kGy (1.5-2.5 MRads). This usually takes several days lead time before implantation. The hospital may have other methods to disinfect the grafts as well."
    
    Finally, Dr. Woll concludes saying that "If your local tissue bank does not have an autologous tissue program, Community Tissue Services™ would be happy to help."

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