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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) 2 Public Health England: How to take a good quality blood spot sample

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? 3 Public Health England: How to take a good quality blood spot sample

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 4 Public Health England: How to take a good quality blood spot sample

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 5 Public Health England: How to take a good quality blood spot sample

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 6 Public Health England: How to take a good quality blood spot sample

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 7 Public Health England: How to take a good quality blood spot sample

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 8 Public Health England: How to take a good quality blood spot sample

How do I take a good quality sample? • Use an automated safety lancet, placed firmly against the infant’s heel • Preferred puncture site: 9 Public Health England: How to take a good quality blood spot sample

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 10 Public Health England: How to take a good quality blood spot sample

11 Public Health England: How to take a good quality blood spot sample

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) 12 Public Health England: How to take a good quality blood spot sample

Where can I find more information? • Neonatal Hepatitis B Immunisation Programme: https://www.gov.uk/government/uploads/system/uploads/attachment_data/fil e/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/G eneralInformationHepatitisB/hepbGeneralInfo/ • UK Newborn Screening Programme Centre Blood Spot Sampling Guidelines: www.newbornbloodspot.screening.nhs.uk/bloodspotsampling 13 Public Health England: How to take a good quality blood spot sample