REFERENCES:

CONCLUSION:

INTRODUCTION:

Haemovigilance, the term derived by amalgamation of Greek word ‘haema’ means blood and a Latin word, ‘vigil’ means watchful. The concept of haemovigilance first came into existence in France in 1990, almost with same ideas and vision of pharmacovigilance¹.

As per International Haemovigilance Network (IHN) and International Society of Blood Transfusion (ISBT), haemovigilance is described as an assembly of surveillance strategies covering the complete transfusion

sequence from the collection of blood and its components to the follow up of its recipients, designed to collect and appraise information on unexpected or undesirable reactions resulting from the therapeutic use of blood products, and to avoid their occurrence and recurrence. So, haemovigilance is an organised system that incorporates monitoring, identification, reporting, investigating and analysis of adverse episode near-misses and reactions pertinent to transfusion and manufacturing blood products.

However, there are risks of adverse events associated with the transfusion of blood and blood products to patients. The concept of safe blood transfusion gained attention in Europe aftermath of public outcry following the contaminated blood scandals and legal cases of the 1980s and 1990s. This created an immediate need for developing a surveillance system for transfusion safety. Now this surveillance system is commonly known by the name of Haemovigilance.²

Haemovigilance is a set of monitoring procedures that includes the whole blood cycle, with the purpose of obtaining information about adverse effects occurring at different stages and making it available, to try to prevent the emergence or recurrence of adverse effects and to improve the safety of both the donor and the receptor.³

Transfusion of blood products is a double-edged sword and should be used judiciously. Improvements in donor screening and transfusion transmissible diseases testing procedures have led to a decrease in the hazards and risks that are associated with transmission of the infectious diseases associated with blood transfusion. However, the risks of non-infectious complications have become more apparent. These non-infectious complications called as adverse transfusion reactions (ATRs) can either be acute in nature or follow a delayed course.

The primary aim of Hemovigilance Programmes in India is to improve the transfusion safety and quality by collecting, analysing and disseminating information on a common arena of serious adverse reactions due to transfusion of blood and blood products. It is also a continuous process of data collection and analysis of blood transfusion related adverse reaction to investigate their cause and outcome and prevent their occurrence or recurrence.^4,6

Haemovigilance gives insight into the current ongoing practices and helps in identifying areas for improvement and standardization. Education of nursing staff, resident doctors, and interns in the handling, administration, and storage of blood components and also signs and symptoms of transfusion reactions will help in diagnosing and reporting of more transfusion reactions. Strict adherence to the blood bank standard operating procedure by technical staff will be helpful in reducing newer events such as ABO incompatible HTR.^5,7

Nine years have passed since haemovigilance programme launched, though there is a continuous increase in Blood Bank participation in the program, it is an alarming need of an hour to increase the awareness regarding reporting of haemovigilance as a step towards safe blood transfusion and patient safety.⁸

The blood transfusion process is a risk related operations which could easily affect the quality of blood and its components by contaminating the external factors and errors. In recent years there were many controversies and issues involved in Blood transfusion, like incorrect and infected blood was transfused to the patient, which has caused harmful effects to the patients with life-threatening diseases or even sometimes death.

In most of the developed countries, a successful Haemovigilance was implemented by developing and collaborating with standard network on International Haemovigilance Network (IHN) and International Society on Blood transfusion (ISBT), which is a major working committee.⁹

In hospitals nurses play a significant role in identification of transfusion risks such as transmission of serious blood borne infections and potentially fatal immunologic and non-immunologic reactions. So, they need to have a thorough knowledge of pathophysiology of transfusion reactions and presenting symptoms and treatment necessary to monitor transfusion safety. Through meticulous nursing assessment, detection and proper planning of interventions, nurses could prevent and minimize morbidity and mortality in patients receiving blood transfusion.¹⁰

Adverse drug reactions are also known as side effects. Adverse drugs reactions (Adrs), are toxic, unintended, and undesirable impacts which might occur as result of drug treatment. These reactions occur due to self-medication or due to intake of over dose of medicines without prescription. Such reactions might cause blood contamination due to toxicities. The prescribed drugs may produce undesirable effects along with main effect which leads to adverse drug reactions. Most of the adverse drug reactions are preventable. Hence, in order to avoid adverse drug reactions one should take only properly prescribed drugs.¹¹

Blood donation can save millions of lives. Donation of blood is a behavioural phenomenon and is always considered a humanitarian act. Nowadays, blood transfusion is still one of the main components of care and treatment to patients with serious haemorrhagic conditions such as trauma, major surgeries, chemotherapy, and patients in need of long-term therapies.¹²

Central venous catheters (CVCs) are being used increasingly in inpatient and outpatient settings to provide long-term venous access. CVCs disrupt skin integrity making infections possible. Infection may spread to the bloodstream and hemodynamic changes and organ dysfunction (severe sepsis) may results, possibly leading to death. (Mark. E, Rupp and Rita, 2004) Infection control Hospital Epidemol (2003) reported that central line-associated bloodstream infections are considered to be an avoidable complication of health care delivery.¹³

The blood-borne diseases include a broad spectrum of infectious conditions that reach their target tissue through the circulation of blood. Health care workers, emergency response and public safety personnel, barbers and other workers can be exposed to blood through needle stick and other sharps injuries, mucous membrane, and skin exposures.¹⁴

Petrol (gasoline) is a complex mixture of low-molecular weight compounds, mainly paraffins, naphthene’s, olefins, aromatic and polycyclic hydrocarbon have been found in blood oh humans. Investigations indicated that, engine room personnel on ships are exposed to polycyclic aromatic hydrocarbons (PAH) from oil and oil products. The International Agency for Research on Cancer (IARC) has classified several PAH compounds into probable (2A) or possible (2B) human carcinogens.¹⁵

There are numerous ways by which germs and pathogens could enter the body and cause diseases. A blood-borne disease is one that is transmitted from one person's blood to another's and that manifests itself prominently in the blood elements. These include a broad spectrum of infectious conditions that reach their target tissue through the circulation of blood. The most common examples are HIV, hepatitis B and hepatitis C. Health care workers are at high risk of acquiring Blood-borne diseases, because they are exposing to blood and body fluids in their day-to-day duties. Needle stick injury to hospital staff, especially among housekeeping staff, is quite frequent and can result in infections and blood-borne diseases, but staff frequently does not report the injury due to lack of awareness.¹⁶

Individuals with severe thalassemia might require blood transfusion, drug therapy i.e. deferoxamine, deferasirox, deferiprone, and also bone marrow transplant. Bone Marrow Transplant (BMT) is still remains the only definitive cure available for patients with Thalassemia.¹⁷

In hospitals environments especially in developing countries the emergence of multidrug resistant bacteria is an increasing infection control problem lead to difficult to treat inpatients infected with different infections because of increased antibiotic resistance rate.¹⁸Haemovigilance has developed and will continue to develop in response to the safety needs and such active influences need to be encouraged and fostered. Without haemovigilance, it is impossible to definitively weigh the risk associated with transfusion and consequently difficult for healthcare professionals to assess the benefit/risk ratio and counsel pre-transfusion patients accordingly. In order to improve the reporting rate, it is important to improve the knowledge, attitude and practice of the healthcare professionals with regard to the adverse transfusion reaction reporting and the haemovigilance. In this context we planned to conduct a study entitled “Knowledge, Attitude and Practice of Haemovigilance Amongst Healthcare Professionals in North Karnataka” With an objective of analysing the factors of underreporting of Acute transfusion reactions among Healthcare Professionals.

MATERIALS AND METHOD:

A prospective study was carried out in a tertiary care hospital among healthcare professionals for the period of three months using a pre structured validated questionnaire.

Healthcare professional who are working in medical and paramedical hospital and who are willing to participate were included in the study.

A total of 100 health care professionals took part in the study.

Ethical clearance certificate was obtained from the ethical clearance committee.

Data was analysed using descriptive statistics namely total numbers, percentage and Microsoft word and Excel sheets have been used to generate graphs, tables etc.

RESULTS AND DISCUSSION:

A prospective observational study was carried out by collecting the data from Healthcare professionalsusing a predesigned questionnaire to assess their Knowledge, Attitude and Practice towards Haemovigilance among Health Care Professionals in North Karnataka. A total of 100 participants were involved in the study most of them were in the age group of 20-30 years i.e. 64% followed by 31-40 years i.e 20%, 41-50 years i.e. 12%, 51-60 years i.e. 3% and the least study participants were in the age group of 61-70 years.

A total of 100 participants were involved in the study most of them were Physicians (36%) followed by Pharmacists (34%), Nurses(27%) and Pathologists(3%) as depicted in table 1.

Table 1: Profession wise Distribution of Healthcare professionals

(n=100)

S. No	Profession	No. of participants	Percentage (%)
1	Physicians	36	36
2	Pharmacists	34	34
3	Nurses	27	27
4	Pathologist	3	3

Total of 100 participants were involved in the study among which 67% were aware about haemovigilance programme and 33% were unaware, 20% attended seminar/workshop on haemovigilance and 80% did not attend any seminar/workshop on haemovigilance, 80% have Knowledge about transfusion reaction and 20% do not have knowledge about transfusion reaction, 64% have knowledge about patient preparation before the blood bank collection and 36% did not have knowledge, 78% have knowledge about blood storage that has to be transfused and 22% did not have knowledge, 50% have knowledge about privacy and security of data sent through haemovigilance and 50% did not have any knowledge, 11% have knowledge about haemovigil software and 89% wew not aware about haemovigil software, 36% have knowledge on how to report transfusion blood related adverse events and 64% did not have knowledge on how to report transfusion blood related adverse events, 41% have knowledge about risks to donors caused during blood transfusion and 59% did not have knowledge, 17% have knowledge about the form which is used to report haemovigilance and 83% did not have knowledge about the form which is used to report haemovigilance. This results are shown in table 2.

Table 2: Knowledge on Haemovigilance among Healthcare professionals(n=100)

S. No	Questionnaire	Yes (%)	No (%)
1	Aware about haemovigliance programme.	67	33
2	Attended any seminar/workshop on haemovigilance.	20	80
3	Knowledge about transfusion reaction.	80	20
4	Knowledge about the patient preparation before the blood bag collection.	64	36
5	Knowledge about blood storage that has to be transfused.	78	22
6	Knowledge about privacy and security of data sent through haemovigilance	50	50
7	Knowledge about haemovigil software.	11	89
8	Knowledge on how to report transfusion related adverse event.	36	64
9	Knowledge on risk to donors caused during Blood transfusion.	41	59
10	Knowledge on form which is used to report haemovigilance.	17	83

The results shows that 73% strongly agree the blood transfusion is useful in Health condition, 56%

Agree that blood transfusion is risk to patients where 19% strongly agree about this and 22% disagree related to risk to patients followed by 3% who strongly disagree to blood transfusion is risk to patients, 25% of participants have witnessed a transfusion reactions and 26% did not witnessed any transfusion reactions.

Reporting of transfusion reaction essential, 53% of participants have strongly agreed to this statement and 28% only agreed, 2% strongly disagreed, 12% disagree and 5% were Undecided about this.

Almost 58% strongly agree that transfusion reaction benefits patients, where 34% only agree and 4% disagree and 3% were undecided and only 1% were strongly disagree that transfusion reaction reporting benefits to patients as shown in table 3.

Table 3: Attitude towards Haemovigilance among Healthcare professionals(n=100)

Table 4: Practice of Haemovigilance among Healthcare professionals(n=100)

S. No.	Questionnaires	Yes (%)	No (%)
1	Have you documented any transfusion reactions?	44	56
2	Have you pricked yourself with needles while collecting blood?	41	59
3	Have you suspected any donor which has been tested for HIV?	13	87
4	Have you ever faced some issues like giving the wrong blood group to a patient in a ward and you noticed it next day?	12	88
5	Do you face some situations like the ward staff return the blood bank complaining to transfusion reactions?	23	77

Questionnaires based on practice on haemovigilance among study participants where participants were involved in the study among which 44% have documented a transfusion reaction and 56% didn’t documented transfusion reaction, 41% pricked themselves with needle while collecting blood and 59% didn’t prick themselves, 13% have suspected a donor which has been tested for HIV where as 87% didn’t observe any donor having HIV, 12% have faced some situations like giving wrong blood group to patient in a ward and noticed it next day followed by 88% didn’t faced any situations like this, 23% faced some situations like the ward staff return the blood bank complaining to transfusion reactions and 77% didn’t face this type of situations. All this results are shown in Table 4.

Participants were involved in the study among which most of the participants think about how and where to report the reaction is the main factor for discouraging transfusion reaction reporting i.e. 65% followed by 58% selected fear of consequences, 57% selected lack of time to report, 51% opted legal liabilities issues, 44% selected only blood bank can report, 38% selected reporting of known reaction is not required, 35% selected that report may be wrong, 29% selected that it is difficult to assess transfusion reaction has occurred or not, 28% selected single reported case may not affect the database, and only 12% selected no remuneration for reporting. All this results are depicted in table 5.

Table 5: Factors Discouraging Transfusion Reaction Reporting according to Healthcare professionals (n=100)

S. No	Factors	Percentage (%)
1	How and where to report the reaction	65
2	Difficult to assess transfusion reaction has occurred or not	29
3	Only blood bank can report	44
4	Reporting of known reaction is not required	38
5	Single reported case may not affect the database	28
6	Lack of time to report	57
7	Legal liability issues	51
8	Fear of consequences	58
9	Concern that report may be wrong	35
10	No remuneration for reporting	12

Participants involved in the study have selected the factors which can improve the reporting. Most of the participants i.e. 86% selected that health care professionals should be trained in reporting, 77% selected that reporting should be made compulsory, 75% selected that transfusion form should be made available in the hospital wards, 73% selected that transfusion reaction reporting form should be made easier, 73% selected that development of mobile applications should be made, 68% selected that toll free number should be launched, 65% selected that CME’s/workshop/seminars should be conducted and 20% selected that remuneration for transfusion reaction reporting should be there. All these results are shown in table 6.

Table 6: Possible ways to Improve Reporting of Transfusion according to Healthcare professionals(n=100)

S. No.	Possible ways to improve Reporting of transfusion	Percentage (%)
1	Health professional should be trained in reporting	86
2	Keep the availability of transfusion reporting forms in the wards	75
3	Make transfusion reaction reporting form easier	73
4	Remuneration of transfusion reaction reporting	20
5	CMEs/workshops/seminars	65
6	Making reporting compulsory	77
7	Launching of toll free offline number	68
8	Development of mobile application	73

Blood transfusion is a lifesaving procedure but carry inherent risk of adverse reaction. The reporting of these events is primarily carried out by the health-care professionals. However, still there is underreporting of these events. Therefore, in the present study, the KAP and causes of under reporting of haemovigilance were studied among 100 health-care professionals comprised doctors, nurses and pharmacists. Maximum number of the participants had awareness of haemovigilance program and also showed fairly positive attitude. However, in spite good knowledge, attitude and practice was found lacking. Outcome of the study suggests that though the knowledge and attitude regarding hemovigilance was fairly high but still the score on practice was low. There is a need for encouraging the Healthcare Professionals regarding reporting of acute transfusion reactions. Further Educational interventions like CME_s,CPE_s of haemovigilance program may also enhance reporting rate.

CONFLICT OF INTEREST:

The authors declare that there are no conflicts of interest.

ACKNOWLEDGEMENT:

The Authors would like to acknowledge Medical Superintendent, physicians, nurses and all other Healthcare professionals of study hospital for their valuable suggestions and support.

Questionnaires

Strongly agree (%)

Agree (%)

strongly disagree (%)

Disagree (%)

Undecided (%)

Is blood transfusion useful in health conditions?

Is blood transfusion is risk to patients?

Have you witnessed a transfusion reactions?

Is reporting of transfusion reaction essential ?

Does transfusion reaction reporting benefits patients?

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Received on 16.03.2022 Modified on 02.06.2022

Asian J. Pharm. Res. 2022; 12(4):287-292.

DOI: 10.52711/2231-5691.2022.00046