title: Diversion of initial blood flow to prevent whole-blood contamination by skin surface bacteria: an in vitro model.
abstract: BACKGROUND
  Sepsis arising from the transfusion of bacterially contaminated platelet components continues to be an infrequent, yet serious transfusion complication. Skin organisms are implicated in a number of these septic episodes. A model system was used to investigate if a skin organism's bioburden in blood components could be reduced by diverting the first few mL of whole blood away from the primary container.
  
  
  METHODS
  A sterile medication site was inserted into a bag containing sterile saline or whole blood; the site was deliberately contaminated with Staphylococcus aureus and allowed to dry. After needle puncture of the contaminated medication site, bacteria levels were measured 1) in successive 7-mL tubes of blood or saline drawn through a diversion arm, 2) in 40 mL of a connected transfer pack, and 3) in blood or saline from a needle puncture of the original container via another sterile medication port.
  
  
  RESULTS
  Diverting the first 21 to 42 mL of saline or whole blood reduces the downstream bioburden of deliberately introduced surface S. aureus by approximately 1 log.
  
  
  CONCLUSIONS
  Development of a diversion system for collection of whole blood in sample tubes before filling the primary container may reduce the bioburden of subsequently prepared components and thereby the frequency of sepsis due to skin organisms.
authors.affiliation: Product Development Department, Holland Laboratory for the Biomedical Sciences, American Red Cross Biomedical Services, Rockville, MD 20855, USA. wagners@usa.redcross.org
authors.forename: S J
authors.initials: SJ
authors.lastname: Wagner
authors.forename: D
authors.initials: D
authors.lastname: Robinette
authors.forename: L I
authors.initials: LI
authors.lastname: Friedman
authors.forename: J
authors.initials: J
authors.lastname: Miripol
mesh_terms: D001769:Blood / Q000382:microbiology; D001782:Blood Donors; D006801:Humans; D008954:Models, Biological; D018805:Sepsis / Q000209:etiology; D012867:Skin / Q000382:microbiology*; D013211:Staphylococcus aureus / Q000302:isolation & purification; D065227:Transfusion Reaction