Blood donation. “Hospitals should start using diversion pouches — small bags that collect the first few millilitres of blood, which often carry skin bacteria. These should be discarded before the main collection begins.”
Collince Ogolla was 28 years old when, as a laboratory
technologist, he was assigned to a Regional Blood Transfusion Centre during the
Covid-19 pandemic. Like the other 54 professionals in his cohort, he arrived
with hope, proud to serve the country at a time of crisis.
But it didn’t take long for his excitement to give way to
unease.
He handled bags of donated blood every day — matching
types, processing samples, and preparing them for transfusion. But there was one
thing no one ever talked about, and no one ever tested for.
“We tested for viruses, yes: HIV, hepatitis, syphilis,” he
says. But they never checked for bacterial contamination. Not once.
Especially for platelets. They are stored at room
temperature and are known globally to carry the highest risk of bacterial
contamination.
“I developed a deep concern regarding certain critical gaps
in blood safety practices, particularly the absence of routine bacterial
screening for donated blood products, including platelets,” Ogolla recalls. “These
blood components were frequently issued to recipients without bacterial
contamination screening, including platelets, which normally pose the highest
risk of bacterial contamination.”
It felt wrong. It is this quiet discomfort that pushed him to dig more, through a study at a level 5 hospital in the country.
What he discovered was worse than he feared: more than one
in five ready-to-transfuse blood units were contaminated with bacteria that could kill.
The research, which he conducted at Kisii Teaching and
Referral Hospital in 2022-2023, revealed that 21.3 per cent of blood meant for
transfusion carried bacteria that could cause severe illness, and even death,
if transfused into patients.
“A contamination rate of this level is alarmingly high and
exceeds global safety thresholds, indicating an urgent need for intervention,”
he told The Star. “Such contaminated blood can lead to infections ranging from
fever and sepsis to multi-organ failure and death, especially in patients with
weakened immune systems.”
The findings of the study, which he co-authored with Dr
Rodgers Demba, have been published in Advances in Hematology, under the title:
“Evaluation of Bacterial Contamination in Donated Blood for Transfusion
Purposes at Kisii Teaching and Referral Hospital.”
Dr Demba chairs the Department of Medical Laboratory Science, School of Medicine, at Maseno University.
“This isn’t just a Kisii [Hospital] issue,” Ogolla says. “Blood collection procedures are generally standard across Kenya. So if we
found this level of contamination in one hospital, we have to assume other
centres may face the same risk, or worse.”
They found the most common contaminants were Staphylococcus epidermidis, S. aureus, E. coli, and Bacillus species, all bacteria commonly
found on the skin or in the environment. While harmless in other parts of the
body, they become dangerous when introduced directly into the bloodstream.
Kenya’s blood safety efforts have mainly focused on
screening for viruses such as HIV and hepatitis. But bacterial contamination,
often caused by poor collection practices or lack of proper screening, has
received far less attention.
Ogolla says that must change.
“There is currently no routine bacterial screening in many
of Kenya’s blood transfusion centres,” he said. “We issue blood, including
platelets, without confirming whether it is bacterially safe. That’s a serious
gap in our system.”
Collince Ogolla. He says there should be routine bacterial screening, especially for high-risk products like platelets.
In developed countries such as the United States and France,
bacterial contamination of donated blood is estimated at just 0.1 to 0.2 percent. In contrast, a 2018 Kenyan study recorded a contamination rate of 18 per cent. That was already high by global standards.
But the new finding of 21.3 per cent contamination at a
major referral hospital suggests the problem may be far worse and more
widespread than previously known.
Ogolla now wants to expand his research to include other
blood banks across the country and even the wider East African region.
The study also found that blood from donors aged 21–30
years, and those with blood group A-positive, were more likely to be
contaminated. The reasons for this are still unclear, but Ogolla suspects it
may be linked to the frequency of donations or how collection procedures are
handled for these groups.
He recommends several simple but effective interventions to
fix the problem.
“First, proper disinfection of the donor’s skin before
drawing blood is essential,” he says. “You need to use alcohol-iodine
antiseptics and allow them to dry for at least 30 seconds before inserting the
needle.”
“Second, we need to train and retrain phlebotomists and laboratory
staff on aseptic techniques.”
“Third, hospitals should start using diversion pouches —
small bags that collect the first few millilitres of blood, which often carry
skin bacteria. These should be discarded before the main collection begins.”
“And lastly, there should be routine bacterial screening,
especially for high-risk products like platelets. We already have the
technology, such as the BD BACTEC system, which can be standardised across the
country.”
He also recommends that the Ministry of Health and the Kenya
Tissue and Transplant Authority (successor of the Kenya National Blood
Transfusion Service) review national protocols and set mandatory safety
benchmarks for all blood banks.
“Kenya urgently needs a national conversation around blood
safety,” Ogolla said. “Lives are at stake, and the public trusts our health
system to protect them. That trust must be earned through action.”
If funding becomes available, Ogolla hopes to carry out a
nationwide audit of bacterial safety in blood donations and work with
policymakers to strengthen regulation, staff training, and monitoring.
In the 2024 performance audit on the management of blood
transfusion services, the Auditor General also flagged serious shortcomings in
Kenya’s national blood service system.
The audit found that blood safety protocols were
inconsistently implemented, with inadequate screening, testing, and quality
assurance at many transfusion centres.
The report said regional centres lacked standardised
protocols for bacterial screening, diversion pouch use, or aseptic collection
techniques, leaving national guidelines unimplemented. These governance gaps
were marked as high risk, given their potential to result in unsafe
transfusions and patient harm.
“KNBTS has inefficiencies in blood collection, testing,
processing and transfusion, which may affect the quality and safety of blood.
Further, KNBTS is not leveraging modern technology to maximise utilisation of the available blood units,” said the report, titled Performance Audit Report On Management of Blood Transfusion Services by the Kenya
National Blood Transfusion Service-Predecessor To Kenya Tissue And Transplant
Authority.