Blood donations by individuals who are allergic to disinfectants used in arm preps

A dedicated apheresis platelet donor in Washington State is allergic to Betadine swabs. Waiting two weeks between donations has not been enough time for the skin at the venipuncture site to recover; once it took 8 weeks. The donor's dermatological allergies to chemicals became apparent in the mid-1950s while she was working as a newspaper photographer at her high school, and reappeared when she was discharged home with her first baby and a large bottle of pHisoHex®. Consequently, she is not willing to have anyone come near her with "green soap." She and her blood center have developed a procedure that usually keeps her donations on schedule. The phlebotomists alternate alcohol and Betadine swabs every other donation. As soon as the donor is 'unhooked' from the machine, she goes to the bathroom and cleans her arm thoroughly with soap that she brings from home. When dry, a technician wraps her arm and the donor goes home. After 4 hours, the donor unwraps her arm, washes it thoroughly again, and applies a lotion which contains Vitamin E and Aloe. She reports not having had an allergic reaction since last March and concludes saying: "Yes, mine is an unusual case, but i present the information for your possible future use."

The Editors think that the prior discussions below are germane to this donor's feedback.

• Managing Donors with Iodine Sensitivity
• What studies should be done to validate a new antiseptic before using it for arm preparation of blood donors?

The following comments have been received in response.

ADDENDA Feb. 21, 2010

1. A very experienced transfusion medicine physician located in a sunbelt state reports that few recent publications address the efficacy of the chlorhexidine-alcohol method. This method has been implemented successfully at large blood collection facilities in North America and Europe; and certainly is acceptable to use for donors who have iodine allergy. The responding physician points out that use of green soap is suboptimal and is considered unacceptable for skin preparation of blood donors. He has provided the following references:
   • Darouiche RO, Wall MJ Jr, Itani KMF, et al. Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis. N Engl J Med. 2010 Jan 7;362(1):18-26.
   • McDonald C, McGuane S, Thomas J, et al. A novel rapid and effective donor arm disinfection method. Transfusion. 2010 January. 50(1):53-58.
   • Ramirez-Arcos S, Goldman, M. Skin disinfection methods: prospective evaluation and postimplementation results. Transfusion. 2010 January. 50(1):59-64.
   • Bueno J. Skin disinfection and bacterial contamination of blood components: be simple. Transfusion. 2010 January. 50(1):5-8. (Editorial- no abstract available)
2. A transfusion medicine physician at a community blood collection center in Washington state remarks that "This is an interesting comment from a donor! (We first polled all our donor team supervisors to find out if this was one of our donors. As far as we can determine, no!)" The responding physician's center uses Chloroaprep® as their primary skin disinfection routine and have Betadine as a backup method in case the donor cannot tolerate the primary one. As both are "industry standards", they have not performed an independent assessment of microbiologic killing capacity of these techniques but instead rely on the published literature. Before implementing any other techniques (which they have not done), they would again defer to the scientific literature to ensure equivalent antiseptic capability or perform such work themselves. However, they have not been forced to do that to maintain their donors' participation. He concludes by saying that "In any case, green soap is definitely a "no-no" now!"
   
   
3. Editors' Note: Readers of this discussion should note that AABB Standard 5.6.2 Protection Against Contamination reads "The venipuncture site shall be prepared so as to minimize risk of bacterial contamination. Green soap (USP) shall not be used." (AABB Standards for Blood Banks and Transfusion Services, 26th edition, 2009).

ADDENDA Mar. 26, 2010

4. A transfusion medicine physician with years of experience in blood donor collection comments that two articles:
   • McDonald C, McGuane S, Thomas J, et al. A novel rapid and effective donor arm disinfection method. Transfusion. 2010 January. 50(1):53-5.
   • Ramirez-Arcos S, Goldman, M. Skin disinfection methods: prospective evaluation and postimplementation results. Transfusion. 2010 January. 50(1):59-64.

   and an editorial

   • Bueno J. Skin disinfection and bacterial contamination of blood components: be simple. Transfusion. 2010 January. 50(1):5-8. (Editorial- no abstract available)

   in the January 2010 issue of Transfusion address the topic under discussion. The responding physician adds that his blood collection center has seen only minor reactions with chlorhexidine during the past few years, which responded to moisturizer application.

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Ira A. Shulman, MD
CBBS e-Network Forum Senior Editor & Moderator

W. Tait Stevens, MD
CBBS e-Network Forum Editor & Moderator

Elizabeth M. St. Lezin, MD
CBBS e-Network Forum Associate Editor & Moderator