AIHA Blood Safety Toolkit

Welcome to the American International Health Allianceӳ Blood Safety Toolkit. Based on AIHA's experience in Georgia and Moldova, the Blood Safety Toolkit contains resources developed by AIHA and its partners as they worked together to improve the safety of blood and blood products. The development of this Toolkit was precipitated by requests from Kazakhstan, Russia, and other countries in Eastern Europe and Central Asia who expressed interest in improving their blood safety service and asked for technical assistance in key areas, including quality management, clinical effectiveness, and voluntary blood donation and recruitment. The Russian-language resources contained within the Blood Safety Toolkit can help blood transfusion services in the region strengthen their quality systems and operations, as well as their human resources capacity.

An Overview of Blood Safety in Eastern Europe and Central Asia

The quality of donated blood continues to be a public health concern in Eastern Europe and Central Asia. During the past decade, incidence of HIV and Hepatitis B & C has rapidly increased in the region. WHO and UNAIDS HIV/AIDS surveillance data in Europe indicates that most of these countries have a much higher HIV prevalence in donated blood units (more than 10 per 100,000 units) than the Western European and Central European countries (less than 5 per 100,000 units). Countries with rapid increases in prevalence among blood donors include Ukraine, Moldova, Georgia, Kazakhstan, Kyrgyzstan, and the Russian Federation. No such data is available for Tajikistan, Uzbekistan, and Turkmenistan.

The increasing HIV prevalence poses mounting concerns over donor selection. Developing a pool of regular, voluntary blood donors who exhibit low-risk behaviors is a key priority. Another major priority is developing effective blood screening policies and procedures. The high prevalence of HIV and Hepatitis has imposed mandatory screening for both these diseases in all countries in the region using proper screening technologies. However, some nations experience difficulties with ensuring that all collected blood is screened in a manner consistent with appropriate technologies and quality assurance standards. Such difficulties led to recent HIV transmission to patients in Kazakhstan and Kyrgyzstan, for example.

Another area that needs improvement is the utilization of blood components and products in the clinical field. Currently, there are no clear guidelines and indications in the region about when to use blood products. Instead, these decisions are generally left to each treating physician. In addition, blood products are usually provided free of charge to hospitals while transfusion alternatives must be purchased, which means there are economic incentives to administer blood components. National guidelines on appropriate and effective clinical use are necessary for an improved overall transfusion safety.

AIHAӳ Blood Safety Experience in Georgia and Moldova

AIHA has provided technical assistance in two of the countries in the region through blood safety projects supported by the United States Agency for International Development (USAID). Within USAIDӳ Ԑreventing HIV and Hepatitis ProjectԠin Moldova (PHHP), AIHA was a subcontractor to Emerging Markets Group (EMG) and collaborated with AABBئormerly known as the American Association of Blood Banksشo provide technical assistance to develop a blood safety service in line with international quality standards. Key elements of the blood safety service developed include:

• New standards and regulations consistent with international practices;
• New management information system;
• New guidelines for clinical effective use of blood and blood products;
• Concept for a new voluntary blood donation program; and
• Practitioner training in new quality management systems.

Recognizing the threat of blood borne infections through transfusions and blood products, AIHA established a modern blood bank in the Georgian capital of Tbilisi in 2000. The Jo Ann Medical Center Blood Bank was opened through the efforts of a USAID-supported partnership project between Global Healing in San Francisco and the Jo Ann Medical Center (JAMC) in Tbilisi.

During the funding period of 1999-2003, partners worked together to renovate and equip the JAMC Blood Bank, as well as train staff in initial operations both on-site in Georgia and in the United States. Partners also:

• Developed and implemented a computerized database for the blood bank;
• Conducted additional training in blood bank management and the preparation of various products;
• Introduced new laboratory methods for transfusion services;
• Piloted new donor recruitment strategies; and
• Customized standard operating procedures (SOPs) to fit the unique situation in Tbilisi.

In 2005, AIHA was awarded a Global Fund contract to replicate this successful blood bank model throughout Georgia. As part of this project, AIHA developed the National Donor Database and implemented SOPs at 16 new blood bank sites spanning Georgia.

In addition, AIHA started implementation of a nationwide media campaign targeted to recruit volunteer donors with the slogan "Give Blood - Safe Life." In 2007, regular media campaigns were conducted, including a large nationwide campaign devoted to World Blood Donor Day. Special educational materials such as posters, brochures, lectures, and seminars were developed to enroll volunteer donors. Individual donor cards were designed and distributed to all regional blood banks. Collaboration with the private sector was established in an effort to recruit more volunteer donors.

To use the Blood Safety Toolkit, simply select your area of interest to find materials on the following topics:

Quality Management
According to AABB, the most important quality management interventions are to develop and implement documents for three levels:
(a) Policy;
(b) Processes;
(c) Procedures.
Samples of such documents developed with support from AABB within USAIDӳ PHHP are included, along with training materials on how to develop standard operating procedures and process documents and training modules on SOP implementation in the area of hemotransmissible diseases laboratory

Promotion of Voluntary Blood Donors
To develop a new donor recruitment system, it is first necessary to evaluate the current knowledge, attitudes, and practices of the general population regarding blood donation. Then, based on the results, the blood service and other stakeholders can develop a national plan for donor recruitment that includes training personnel responsible for donor recruitment in modern methods of recruiting voluntary blood donors. A sample questionnaire for a KAP study, a sample national donor recruitment plan and a training module on donor recruitment developed through USAIDӳ PHHP are included in this section.

Effective Clinical Use
Effective clinical use interventions include developing national policy and guidelines on the clinical use of blood to inform the decisions of prescribers of blood and blood products about transfusion and related actions based on systematic, evidence-based research and protocols. This section includes a basic training module on indications for the appropriate use of blood components, adverse transfusion indications, best practices for laboratories and patient care, and a nationally adapted version of WHO generic guidelines, which were developed through USAIDӳ PHHP.

Monitoring and Evaluation
Effective monitoring and evaluation policies and procedures that are in keeping with accepted indicators and international reporting requirements are a key element of any successful blood safety service. Accurate data collection, analysis, and reporting help assure program quality and responsiveness to local and national needs. A detailed manual on monitoring and evaluation procedures developed through USAIDӳ PHHP is available in this section.

Blood Transfusion Law
Guidance on drafting new blood safety legislation in keeping with European Directives based on the efforts of USAID-supported efforts in Moldova conducted through the PHHP is available in this section.

Sample Standard Operating Procedures (SOPs) for Blood Banks
The guidelines included in this section were developed through a USAID-supported AIHA partnership linking San Francisco-based Global Healing with the Jo Ann Medical Center in Tbilisi, Georgia. These SOPs offer step-by-step practical advice related to the safety of blood and blood products.