1. Dried blood spot scheme for infants born to hepatitis B positive mothers How to take a good quality blood spot sample

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

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

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

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

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

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

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

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

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

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

13. 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 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 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/ 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/bloodspotsamplingwww.newbornbloodspot.screening.nhs.uk/bloodspotsampling 13Public Health England: How to take a good quality blood spot sample