Strategies adopted to overcome dengue crisis at a hospital based blood bank.

Sir,

The episodic surge in cases of thrombocytopenia due to dengue, malaria or other infections creates a disaster like situation in most hospitals and blood banks. It becomes difficult to handle such increased workloads unless specific measures are taken. Our hospital which is a tertiary care centre at Uttarakhand, witnessed a similar situation with the demand for platelets increasing many fold due to a great increase in cases of dengue suddenly in the month of September 2010 when 734 units of platelets were supplied. In the month of October 2470 units were supplied. This was in absolute contrast to the routine monthly average of 80 units per month. Various strategies were planned to handle the situation. The problems faced and steps taken are enumerated.

With such a sudden increase in workload, it was not easy to be able to immediately recruit new staff with the primary issue being availability and secondly an apprehension whether would new staff actually be able to help in the immediate phase of the current disaster. Plans were made listing the problems at hand and then finding ways around them. We thought of taking help from other departments. All areas were overworked. Areas like phlebotomy, Crossmatch, Component sections could only be handled by trained people. It was decided that areas like reception and infectious disease lab could be considered for outside help.

A plan of action was prepared which was as follows:

Upon request, security and public relations department staff was mobilized to the reception.

The work of infectious disease lab was handed over to the microbiology department.

Lab technicians from other labs were called in to assist in blood grouping

The Officials at Rural Development institute of our hospital which has access to the local population also assisted in spreading word about the need of voluntary blood donation.

Nursing staff assisted in phlebotomy and refreshments.

The staff had to do extra duties and for this they were paid incentives.

The Material management department was instructed to procure enough supplies of consumables.

The staff instructed to be polite and understanding.

It was felt by us that a system of sharing responsibility among departments in times of need does work in a hospital based blood bank.

There is scarce data in literature on crisis management in blood banks in situations that cause greatly increased blood demand. It has been suggested that there should be establishment of nationally coordinated bloodbank operations in time of a crisis.[12] An inventory of personnel should be maintained and mechanism for blood reception, pretransfusion testing and transfusion should be defined and simulation exercise should be organised.[1] A network of mobile blood banks having a good stock of safe blood, equipment and technical staff can provide effective Blood Transfusion service.[2] A key contact list should be periodically updated and maintained for departments that require communication during an emergency.[3] Flowcharts that list various options, can be developed for emergency operation.[4] Disaster committees should be appointed in hospitals.[5]

Recommendations

Disaster committees should be set up at National, State and individual hospital level to -

Recognize needs of increased demand of blood or its products.

Maintain flowcharts that determine the in blood banks that need assistance.

Identify neighbouring areas whose blood banks can assist.

Ensure sufficient supply of commodities like Blood bags and reagents.

Assist general administration in the concerned blood bank.

Keep updated records on personnel in various departments