Handling fully tested labeled blood products without wearing gloves

A California blood banker indicated that at a recent external unscheduled accreditation inspection, the assessors (inspectors) expressed concern that the blood bank staff members were handling fully tested labeled blood products without wearing gloves. The assessors were asked for clarification as to why they were concerned because the facility only requires gloves to be worn for handling untested donor units; when staff handle fully tested labeled blood products, glove use is optional. The assessors suggested that the inquiring colleague "look into their policy" because at the assessors' facilities, (a transfusion service and a military blood center), glove use is mandatory even when handling fully tested labeled blood products. The inquiring colleague wonders what is the practice at other institutions.

For instance, in a previous discussion by the e-Network Forum, it states that according to California Code of Regulations (CCR) Title 8 Section 5193(d)(4)(G)4, if an employer in a volunteer blood donation center judges that routine gloving for all phlebotomies is not necessary then the employer shall:

• Periodically reevaluate this policy;
• Make gloves available to all employees who wish to use them for phlebotomy;
• Not discourage the use of gloves for phlebotomy; and
• Require that gloves be used for phlebotomy in the following circumstances:
  • When the employee has cuts, scratches, or other breaks in his or her skin;
  • When the employee judges that hand contamination with blood may occur, for example, when performing phlebotomy on an uncooperative source individual; and
  • When the employee is receiving training in phlebotomy.

The following comments have been received in response.

ADDENDA August 6, 2010

1. Dr. Paul Holland, a senior California blood banker/transfusion medicine specialist in California (attribution used with permission) reaffirms his earlier opinion that there is no reason to wear gloves when handling blood bags from qualified donors since there is no requirement to wear them when phlebotomizing the donor, assuming the donor is not a patient or an autologous donor. In Dr. Holland's opinion, the points in the California Code of Regulations, cited in the query above, have it right. The risk of handling a unit of blood, assuming it is not broken or leaking, is negligible. To wear gloves is unnecessary and carries its own risk for some people, plus gives the impression that the unit of blood, like the donor it came from, is inherently unsafe. He adds that a reference to the safely/risk of phlebotomizing qualified, volunteer, non-remunerated blood and apheresis donors, can be found in the following publication: Holland PV. Safety in the blood bank In: Nance ST ed. Blood supply: Risks, perceptions and prospects for the future. Bethesda, MD AABB 1994;61-78. Finally, he says that with the additional measures we now have in place, like NAT, that handling a fully tested unit of blood is even safer today.

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