Dried blood spot scheme for infants born to hepatitis B positive mothers

How to take a good quality blood spot sample

Purpose

• This presentation has been written by Public Health England’s Immunisation Department, to support The National Dried Blood Spot Testing Scheme for Infants of Hepatitis B Positive Mothers

• It was adapted from the UK Newborn Screening Programme Centre’s (UKNSPC) presentation which supports the updated Guidelines for Newborn Blood Spot Sampling (2012)

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Overview• Why is it important to take a good quality blood spot sample?

• How do I prepare for taking a blood spot?

• How do I take a good quality sample?

• What do I do after taking the sample?

• Where can I find more information?

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Why is it important to take a good quality blood spot sample?• Facilitates referral of an infected child to a specialist as needed

• Reassurance to family that transmission has been avoided if negative

• Included in the NHS Commissioning Board service specification for the neonatal hepatitis B vaccination programme

• Monitor delivery of immunisation programme

• Recommended by NICE (2009)

• Recommendation to immunise and test babies since 2000 (HSC 1998/127)

• Inadequate samples = requests for repeats = costly delays

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How do I prepare for taking a blood spot?• The blood spot should be taken at 12 months. The test is recommended at

the same visit as the fourth dose of hepatitis B vaccine

• At this visit, discuss screening with parent(s)

• Provide information (Q&A leaflet)

• Record discussion and leaflet provision

• Record parents’ choice

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How do I prepare for taking a blood spot?• Hepatitis B Dried Blood Spot Testing kit which includes: request form, clear

bag, alcohol wipe, instruction sheet, reply-paid specimen bag, automated safety lancet, Dried Blood Spot card

• Infant’s NHS number

• Child health record

• Non-sterile protective gloves

• Sharps box

• Cotton wool / gauze

• Hypoallergenic spot plaster

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How do I take a good quality sample?• Check the expiry date of the blood spot card and place on a clean surface

• The infant’s NHS number on the card is mandatory in England

• Complete all fields

• Fill in request form with demographic details, hepatitis B vaccine history, maternal hepatitis history and GP details

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How do I take a good quality sample?• Recommend comfort measures for the infant

• Clean the heel with the alcohol wipe

• Allow the heel to dry completely

• Wash hands and apply gloves

• Ensure the infant is warm and comfortable

• Additional warming of the foot is not required

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How do I take a good quality sample?• Use an automated safety lancet, placed firmly against the infant’s heel

• Preferred puncture site:

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How do I take a good quality sample?• The aim is to fill each circle on the card with a single drop of blood

• Wait for the blood to flow – do not squeeze the foot

• Allow the blood to fill each circle by natural flow and seep through from front to back

• Do not layer the blood

• Do not compress the blood spot

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What do I do after taking the sample?• Wipe excess blood from the heel and apply gentle pressure with cotton wool

/ gauze

• Apply a spot plaster if necessary

• Allow spots to air-dry away from direct sunlight or heat before placing in glassine envelope

• Send the card within 24 hours

• Record taking the blood spots in the infant’s Red Book and in GP notes (if applicable)

• Inform parents from whom they should expect the results (e.g. GP, hospital, local coordinator)

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Where can I find more information?• Neonatal Hepatitis B Immunisation Programme:

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213173/01-Neonatal-hepatitis-B-immunisation-programme.pdf

• British Liver Trust information on hepatitis B: http://79.170.44.126/britishlivertrust.org.uk/wp-content/uploads/2012/12/Hepatitis-B-Low-Res-PDF1.pdf

• PHE information on hepatitis B: http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/HepatitisB/GeneralInformationHepatitisB/hepbGeneralInfo/

• UK Newborn Screening Programme Centre Blood Spot Sampling Guidelines: www.newbornbloodspot.screening.nhs.uk/bloodspotsampling

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