reprovision programmes in Britain, provided that these are well planned and well resourced. ConclusionOur findings dispel some of the common concerns and myths associated with "care in the community" patients and provide robust evidence that community care has worked well for the former patients of psychiatric hospitals, most of whom are currently living in the community and posing minimal risk to themselves and the public. In light of this, a change towards institutional care is not a rational policy.We thank the research workers who have contributed to the collection of the data, the patients, and the hospital and community staff. This paper is designated the TAPS project 45.Contributors: NT participated in data collection, analysis, interpretation, and drafting the paper. JL conceived and designed the Team for the Assessment of Psychiatric Services (TAPS) project and has been the director of the research team for the past 13 years. He helped to draft and edit this paper. GG participated in the analysis and interpretation of the mortality data. He also computerised the assessment tools used by TAPS. NT and JL will act as guarantors for the paper.Funding: The Team for the Assessment of Psychiatric Services (TAPS) is funded by the Department of Health, North Thames Regional Health Authority, and the Gatsby Foundation. It is administered through the Department of Psychiatry and Behavioural Sciences, Royal Free and University College Medical School, London.Competing interests: The TAPS project was largely funded by the Department of Health. This, and previous TAPS papers, were sent for comments to the Department of Health before submission. However, all papers, including this one, were drafted without administrative intervention or scrutiny of any kind. The opinions expressed do not necessarily reflect the policy of the Department of Health. AbstractObjective To receive and collate reports of death or major complications of transfusion of blood or components.

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The risks of HBV-, HCV- or HIV-infectious donations entering the blood supply in England are very low, and have decreased since 1993. Although the accuracy of these estimates is imperfect, mainly owing to uncertainty in some assumptions and to small numbers of infections, they provide some quantification of the risk of HBV, HCV or HIV transmission by transfusion, and allow comparison of the magnitude of these risks for each infection and over time. The methods we have used have been developed and improved from previously published methods.

The study validates diversion and an improved donor-arm disinfection procedure. In combination, these two interventions produced a substantial reduction in contamination. These procedures are to be introduced by the English National Blood Service to enhance the safety of the blood supply.

A male patient with acute myeloid leukaemia received a pooled platelet preparation prepared by Optipress system on the last day of its shelf life. The patient collapsed after two-thirds of the contents had been transfused. Clostridium perfringens was isolated from the platelet bag within 18 h of the acute event. Metronidazole, gentamicin and Clostridium antiserum were then administered in addition to the broad spectrum antibiotics started previously. However, the patient died 4 days after the platelets were transfused. The cause of death was given as cardiovascular shock, entirely compatible with an overwhelming bacteraemic and septic episode. A coroner's verdict of accidental death due to transfusion of a contaminated unit of platelets was recorded. On subsequent investigation Cl. perfringens type A serotype PS68,PS80 (identical to that found in the platelet bag) was cultured from the venepuncture site of the arm of one of the donors who contributed towards the platelet pool. The donor had two young children and frequently changed nappies. Faecal contamination of the venepuncture site was the suspected source for the transmission of Cl. perfringens, an organism commonly found in the soil and intestinal tract of humans. This case dramatically highlights the consequences of transfusing a bacterially contaminated unit. It is vital that such incidents are investigated and reported so that the extent of transfusion-associated bacterial transmission can be monitored and preventative measures taken if possible.