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SIGNpost 00643


Post00643 RFI + Abstracts + Global Research + 15th ICID + News 11 April 2012


1.Call for Information: Injections PerPersonPerYear & Equipment Reuse Rates
2006 to 2011
2. World Hepatitis Day 2012: 28 July 2012
3. Excerpt: Editorial: Nosocomial Hepatitis C: More of a Hidden Epidemic
4. Abstract: Needle stick injuries in nurses at a tertiary health care
5. Abstract: Changing practice for safe insulin administration
6. Abstract: Hepatitis B virus prevalence and vaccination response in
health care workers and students at the Federal University of Bahia,
7. Abstract: Dental students and bloodborne pathogens: occupational
exposures, knowledge, and attitudes
8. Abstract: Health care-associated hepatitis C virus infections attributed
to narcotic diversion
9. Abstract: Factors associated with history of drug use among female sex
workers (FSW) in a high HIV prevalence state of India
10. Abstract: Seroprevalence of HIV, syphilis, and hepatitis C virus in the
general population of the Liangshan Prefecture, Sichuan Province,
11. Abstract: Prevalence and correlates of HIV and HCV infection among
amphetamine-type stimulant users in six provinces in China
12. Abstract: Informal waste management system in Nigeria and barriers to
an inclusive modern waste management system: A review
13. Abstract: It’s not all about me: motivating hand hygiene among health
care professionals by focusing on patients
14. Abstract: Hospital privacy curtains are frequently and rapidly
contaminated with potentially pathogenic bacteria
15. Abstract: Dental perspective on biomedical waste and mercury
management: a knowledge, attitude, and practice survey
16. No Abstract: Study: Vast majority of C. difficile infections occur in
medical settings
17. No Abstract: Promoting an absolute culture of patient safety
18. Research and Development to Meet Health Needs in Developing Countries:
Strengthening Global Financing-Coordination
19. 15th International Congress on Infectious Diseases in June 2012
20. News
– India New contraceptive jab scares men
– USA: OP-ED: L.A. moves the needle
– USA: Patients Test Negative for Blood Infections From Poor Quality at
Shuttered Cancer Center
– UK: Staff catch hepatitis C from dirty needles while working at NHS
Greater Glasgow & Clyde
– USA: Kimberly Smedley Is Accused and Pleaded Guilty
– USA: FDA finds fake vials of cancer drug
– UK: Stepping Hill hospital subject of surprise inspection: Government
inspectors have carried out a surprise inspection at a hospital at the
centre of a police probe into insulin poisoning
– USA: No viral infections found in clinic’s patients
– Bacterial Contamination Found in Pharmacy Robots

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1.Call for Information: Injections PerPersonPerYear & Equipment Reuse Rates
2006 to 2011
From: KHAMASSI, Selma
date:Tue, Apr 10, 2012

Dear SIGN members

The WHO Injection Safety programme and the SIGN Secretariat are in the
process of updating information on the number of injections per person per
year as well as on reuse rates of injection equipment.

This will help to update the global burden of diseases from unsafe
injection practices from the 2000 data we have .

We need this information from 2006 to 2011. Except from DHS surveys, and
few other publications, no much information is available on this topic.

I would like to ask anyone of the network who has such information whether
it is at national level or from specific studies in hospitals to share this
information with me by sending the study to:

Selma Khamassi:

Your contribution will be acknowledged among the references used for this

Thank you very much for your collaboration in this work

Kind regards


2. World Hepatitis Day 2012: 28 July 2012

World Hepatitis Day is an annual event that each year provides
international focus for patient groups and people living with hepatitis B
and C. It is an opportunity around which interested groups can raise
awareness and influence real change in disease prevention and access to
testing and treatment.

The World Hepatitis Alliance first launched World Hepatitis Day in 2008,
and since then thousands of events have taken place around the world,
generating massive public and media interest. The Alliance has also
received support from governments worldwide, high-profile non-governmental
organizations (NGOs) and supranational bodies, such as Médecins Sans

Following the World Health Assembly in May 2010, it was agreed that World
Hepatitis Day would be recognized annually on 28 July.

For more information, E-mail:;
or visit:

3. Excerpt: Editorial: Nosocomial Hepatitis C: More of a Hidden Epidemic
Ann Intern Med. vol. 156 no. 7 534-535

Alfred DeMaria Jr., MD; and David R. Snydman, MD

From Massachusetts Department of Public Health, Boston, MA 02130, and Tufts
Medical Center, Boston, MA 02111.

Patient-to-patient transmission of hepatitis in health care settings has
been a notable problem over the past 35 years (1). Hepatitis B virus (HBV)
transmission was the focus of public health authorities until recently—with
the advent of vaccination of both providers and patients, HBV transmission
has become less common. Historically, identified outbreaks of nosocomial
hepatitis C were less common than those of hepatitis B (2) and were largely
limited to dialysis units (3).

However, reports in both Europe and the United States document that
hepatitis C virus (HCV) can be transmitted by chronically infected health
care providers to patients. Outbreaks due to hepatitis C transmission from
HCV-infected surgeons performing invasive procedures have occurred (4).
Patient-to-patient transmission has also occurred because of inappropriate
use and contamination of multidose vials, finger-stick devices, endoscopes,
and equipment used in gynecologic procedures (5). From a hospital
epidemiologist’s perspective, recognizing a cluster of HCV infections is
challenging, because most infections are silent and the prolonged
incubation period complicates identification of potential breaks in

Investigation of outbreaks of both HBV and HCV in various health care
settings has revealed how systematic breaches of infection control
procedures can result in transmission of infection (6). These outbreaks are
generally recognized by the temporal clustering of infected patients. Look-
back investigations may subsequently detect infection in others with the
common exposure. Drug diversion has been the source of transmission in
several previous reports (5, 7); in this issue, Hellinger and colleagues
(8) report …

This 100-word excerpt has been provided in the absence of an abstract.

4. Abstract: Needle stick injuries in nurses at a tertiary health care

J Ayub Med Coll Abbottabad. 2010 Jul-Sep;22(3):174-8.

Needle stick injuries in nurses at a tertiary health care facility.

Manzoor I, Daud S, Hashmi NR, Sardar H, Babar MS, Rahman A, Malik M.

Department of Community Medicine, Lahore Medical and Dental College,
Lahore, Pakistan.

BACKGROUND: Needle-stick injury (NSI) is a major occupational health and
safety issue faced by healthcare professionals globally. This study was
aimed to assess the frequency and factors associated with NSIs in nurses of
a tertiary health care facility in Lahore, Pakistan. It also focuses on
safety measures adopted by these nurses after a needle stick injury.

METHODS: This cross-sectional descriptive study was conducted in Ghurki
Trust Teaching Hospital, Lahore from October 2009 to January 2010. All
nurses have participated in the study with a response rate of 99%. These
responses were obtained via a pretested self-administered questionnaire.
The data was analysed using SPSS-16. Percentages of the categorical
variables were computed and represented in various statistical data
presentation forms, for analysis and comparison. Chi-square test was
applied as a test of significance with fixing the p-value of 0.05 as

RESULTS: Out of 77 nurses who participated in our study, only 33 (42%)
nurses were aware of the occupational hazards of their profession when they
joined nursing. Needle stick injury was reported by 40 (71.9%) of the
nurses in last one year. About 17 (31.5%) were injured at the time of
recapping the syringe. The availability of needle cutters in the hospital
was reported by 75 (97.4%) nurses while only 46 (60%) of them had
undertaken a sharp management training course. Approximately 50 (64.9%)
nurses failed to use gloves while administering injections. After getting
stuck by a contaminated needle 71 (92%) of the nurses cleaned the wound
with a spirit swab, 67 (87%) washed the area with soap and water and 58
(75%) applied a readily available bandage. Only 38 (49%) went on to inform
the higher officials about a needle stick injury. Fifty-seven (74%) of the
nurses were vaccinated against HBV, and 56 (72.2%) of needle stick injured
nurses proceeded for HBV screening, while 53 (68.6%) for HCV and 37(48.5%)
for HIV.

CONCLUSION: Needle stick injury is the most important occupational health
hazard in nurses with alarmingly high rates. Reporting to the concerned
authorities, screening of nurses after needle stick injury and promotion of
safety measures against it should be greatly encouraged.

5. Abstract: Changing practice for safe insulin administration

Nurs Times. 2012 Mar 6-12;108(10):22, 24, 26.

Changing practice for safe insulin administration.

Reid A.

Guy’s and St Thomas’ Foundation Trust, London.

Insulin is a life-saving medication but, if wrongly administered, it can
cause death or severe harm. Errors in insulin administration are common,
including the inappropriate use of intravenous syringes.

We surveyed all
clinical areas in our trust to identify types of syringes and needles
available and how these were stored and distinguished from IV syringes.

Based on these results, we developed recommendations to promote safety and
good practice and are standardising insulin syringes throughout the trust.

6. Abstract: Hepatitis B virus prevalence and vaccination response in
health care workers and students at the Federal University of Bahia,

Ann Hepatol. 2012 May;11(3):330-7.

Hepatitis B virus prevalence and vaccination response in health care
workers and students at the Federal University of Bahia, Brazil.

Carvalho P, Schinoni MI, Andrade J, Vasconcelos Rêgo MA, Marques P, Meyer
R, Araújo A, Menezes T, Oliveira C, Macêdo RS, Leal JC, Matos B, Schaer R,
Simones JM, Freire SM, Paraná R.

Graduate Program in Immunology (PPGIm-UFBA).

Background and rationale for the study. Hepatitis B (HB) is one of the most
prevalent occupational infections in health attendance environments.
According to the Brazil Ministry of Health, health professionals must be
vaccinated against the hepatitis B virus (HBV) and provide laboratory proof
of immunization.

Aims. To evaluate the seroprevalence of HBV infection and to analyze the
response to vaccine by measuring serum antibodies against HBV surface
antigen (anti-HBs) levels in a sample of students and health professionals
at the Federal University of Bahia.

Results. As part of this cross-sectional study, a campaign against
occupational HB was launched in 2007 and vaccination and blood samples were
collected for analysis of the following serological markers: HBV surface
antigen (HBsAg) and anti-HBs (measured by enzyme-linked immunoassay) and
total antibodies against HBV core antigen (anti-HBc).

The study sample comprised 766 people. Global seropositivity for HBV was
1.7%: 0.5% in the students and 8.8% in the professionals. In a group of
volunteers, a serological profile compatible with postvaccine immunity was
shown by 95% of volunteers with proof of vaccination and by 81.8% of
volunteers without proof of vaccination.

Conclusions. In conclusion, this study shows that it is important to
promote vaccination campaigns and improve knowledge and awareness about HB
among health care workers and higher education students.

7. Abstract: Dental students and bloodborne pathogens: occupational
exposures, knowledge, and attitudes

J Dent Educ. 2012 Apr;76(4):479-86.

Dental students and bloodborne pathogens: occupational exposures,
knowledge, and attitudes.

Myers JE, Myers R, Wheat ME, Yin MT.

Columbia University Medical Center, 630 West 168 Street, PH8-876, New York,
NY 10032;.

Dental professionals may be exposed to bloodborne pathogens in their work,
and dental students may be a particularly vulnerable group. Fear of
exposure has also been linked to discriminatory practices.

A cross- sectional survey of dental students was conducted at one U.S.
dental school to assess their knowledge about the transmission of
bloodborne pathogens and management of exposures; the frequency of their
bloodborne pathogen exposures (BBPEs); and associations among their prior
exposure, knowledge, perception of knowledge, and attitudes toward

Overall, 220 students (72.1 percent) responded to the survey, and 215 (70.5
percent) answered questions about exposures. The prevalence of BBPE was
19.1 percent and was greater among clinical than preclinical students

Percutaneous injuries occurred in 87.5 percent of those exposed. All
students (preclinical and clinical combined) answered more survey questions
correctly about transmission of bloodborne pathogens (66.7 percent) than
about post-exposure management (25.0 percent).

Fewer than half reported adequate knowledge of transmission and management
(47.5 percent and 37.3 percent, respectively). In this context, 8.2 percent
of the respondents acknowledged an unwillingness to perform procedures on
patients with HIV.

Since knowledge gaps may lead to failure to report incidents and delays in
appropriate exposure management and some negative attitudes towards
treating individuals with HIV persist, these findings justify improving
BBPE education at U.S. dental schools.

8. Abstract: Health care-associated hepatitis C virus infections attributed
to narcotic diversion

Ann Intern Med. 2012 Apr 3;156(7):477-82.

Health care-associated hepatitis C virus infections attributed to narcotic

Hellinger WC, Bacalis LP, Kay RS, Thompson ND, Xia GL, Lin Y, Khudyakov YE,
Perz JF.

Mayo Clinic, Jacksonville, Florida; Florida Department of Health,
Tallahassee, Florida.

Background: Three cases of genetically related hepatitis C virus (HCV)
infection that were unattributable to infection control breaches were
identified at a health care facility.

Objective: To investigate HCV transmission from an HCV-infected health care
worker to patients through drug diversion.

Design: Cluster and look-back investigations.

Setting: Acute care hospital and affiliated multispecialty clinic.

Patients: Inpatients and outpatients during the period of HCV transmission.

Measurements: Employee work and narcotic dispensing records, blood testing
for HCV antibody and RNA, and sequencing of the NS5B gene and the
hypervariable region 1 of the E2 gene.

Results: 21 employees were recorded as being at work or as retrieving a
narcotic from an automated dispensing cabinet in an area where a narcotic
was administered to each of the 3 case patients; all employees provided
blood samples for HCV testing. One employee was infected with HCV that had
more than 95% NS5B sequence homology with the HCV strains of the 3 case
patients. Quasi-species analysis showed close genetic relatedness with
variants from each of the case patients and more than 97.9% nucleotide
identity. The employee acknowledged parenteral opiate diversion.

An investigation identified 6132 patients at risk for exposure to HCV
because of the drug diversion. Of the 3929 living patients, 3444 (87.7%)
were screened for infection. Two additional cases of genetically related
HCV infection attributable to the employee were identified.

Limitation: Of the living patients at risk for HCV exposure, 12.3% were not

Conclusion: Five cases of HCV infection occurring over 3 to 4 years were
attributed to drug diversion by an HCV-infected health care worker. Studies
of drug diversion and assessments of strategies to prevent narcotics
tampering in all health care settings are needed.

Primary Funding Source: None.

9. Abstract: Factors associated with history of drug use among female sex
workers (FSW) in a high HIV prevalence state of India

BMC Public Health. 2012 Apr 5;12(1):273.

Factors associated with history of drug use among female sex workers (FSW)
in a high HIV prevalence state of India.

Medhi GK, Mahanta J, Kermode M, Paranjape RS, Adhikary R, Phukan SK, Ngully

BACKGROUND: The intersection between illicit drug use and female commercial
sex work has been identified as an important factor responsible for rising
HIV prevalence among female sex workers (FSW) in several northeastern
states of India. But, little is know about the factors associated with the
use of drugs among FSWs in this region. The objective of the paper was to
describe the factors associated with history of drug use among FSWs in
Dimapur, an important commercial hub of Nagaland, which is a high HIV
prevalence state of India.

METHODS: FSWs were recruited using respondent driven sampling (RDS), and
were interviewed to collect data on socio-demographic characteristics and
HIV risk behaviours. Biological samples were tested for HIV, syphilis
gonorrhea and Chlamydia. Logistic regression analysis was performed to
identify factors associated with drug use.

RESULTS: Among the 426 FSWs in the study, about 25% (n = 107) reported
having ever used illicit drugs. Among 107 illicit drug users, 83 (77.6%)
were non- injecting and 24 (22.4%) were injecting drug users. Drug-using
FSWs were significantly more likely to test positive for one or more STIs
(59% vs. 33.5%), active syphilis (27.1% vs. 11.4%) and Chlamydia infection
(30% vs. 19.9%) compared to their non-drug using peers. Drug-using FSWs
were also significantly more likely to be currently married, widowed or
separated compared with nondrug- using FSWs. In multiple logistic
regression analysis, being an alcohol user, being married, having a larger
volume of clients, and having sexual partners who have ever used or shared
injecting drugs were found to be independently associated with illicit drug

CONCLUSIONS: Drug-using FSWs were more vulnerable to STIs including HIV
compared to their non-drug using peers. Several important factors
associated with being an FSW who uses drugs were identified in this study
and this knowledge can be used to plan more effectively targeted harm
reduction strategies and programs.

Free full text

10. Abstract: Seroprevalence of HIV, syphilis, and hepatitis C virus in the
general population of the Liangshan Prefecture, Sichuan Province,

J Med Virol. 2012 Jan;84(1):1-5.

Seroprevalence of HIV, syphilis, and hepatitis C virus in the general
population of the Liangshan Prefecture, Sichuan Province, China.

Dai S, Shen Z, Zha Z, Leng R, Qin W, Wang C, Chen L, Tian M, Huang Z, Chen
G, Cen H, Xue L, Wang J, Lu Y, Cao B, Ye D.

Department of Epidemiology and Biostatistics, School of Public Health,
Anhui Medical University, Hefei, Anhui, China.

This study aimed at understanding the HIV prevalence, distribution of HIV
risk factors and whether the HIV has spread from high-risk groups to the
general population in the Yanyuan and Muli counties, Liangshan Prefecture,
Sichuan Province, China.

A multistage probability method was used to select a representative sample
of villages in each county, with stratification by risk employed in the
sampling for the Yanyuan county. A real-name registration and confidential
method were adopted to collect the information of the participants.

Blood specimens were tested for HIV, syphilis, and hepatitis C virus.

A total of 4,950 subjects participated in the study. Of the participants
aged?=?15 years, 0.12% self-reported being drug users and 40% were
injection drug users; 0.46% had multiple sex partners and the condom use
rate was only 26.3% during the last sexual intercourse. HIV, syphilis, and
HCV prevalence of Yanyuan county were 0.06% (95% CI: 0-0.142), 0.06% (95%
CI: 0-0.142), and 0.15% (95% CI: 0.020-0.280), respectively. HCV prevalence
of Muli county was 0.06% (95% CI: 0-0.191), and none was found to be HIV or
syphilis positive. Therefore, the rate of HIV infection in Yanyuan and Muli
counties is at a low level currently.

The Yanyuan county HIV infection rate is similar to the average rate in all
of China, and the Muli county rate is below China’s average. The HIV
epidemic has not spread from high-risk groups to the general population in
these two counties.

Copyright © 2011 Wiley Periodcals, Inc.

11. Abstract: Prevalence and correlates of HIV and HCV infection among
amphetamine-type stimulant users in six provinces in China

J Acquir Immune Defic Syndr. 2012 Apr 4.

Prevalence and correlates of HIV and HCV infection among amphetamine-type
stimulant users in six provinces in China.

Bao YP, Liu ZM, Lian Z, Li JH, Zhang RM, Zhang CB, Hao W, Wang XY, Zhao M,
Jiang HF, Yan SY, Wang QL, Qu Z, Zhang HR, Wu P, Shi J, Lu L.

aNational Institute on Drug Dependence, Peking University, Beijing, 100191,
China bYunnan Institute for Drug Abuse, Xi Hua Yuan, Kunming, Yunnan,
650228, China cMental Health Institute, The Second Xiangya Hospital,
Central South University, Hunan, 410011, China dShanghai Mental Health
Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030,

BACKGROUND: China has experienced an epidemic of amphetamine-type stimulant
(ATS) use in recent years. The present study explored the status and
correlates of human immunodeficiency virus (HIV) and hepatitis C virus
(HCV) infection among ATS users in China.

METHODS: A multicenter cross-sectional study of HIV and HCV status and
associated behaviors among ATS users was conducted in six provinces from
September 2009 to December 2010. Socioeconomic/behavioral risk factors were
measured. Blood samples were collected to test for HIV and HCV antibodies.

RESULTS: Of the 1327 ATS users, the prevalence of HIV and exposure to HCV
were 4.5% and 43.5%, respectively, with large geographic variations
(0-20.3% and 8.6%-67.1%, respectively). HIV infection was independently
associated with living in Yunnan Province (adjusted odds ratio [AOR] =
15.8; 95% confidence interval [CI]: 2.0-125.1), polydrug use (AOR = 2.6;
95% CI: 1.3-5.4), increased frequency of sexual behavior (AOR = 2.0; 95%
CI: 1.1-4.1), history of sex with sexually transmitted infection-positive
persons (AOR = 11.4; 95% CI: 1.3-98.9), and HCV infection (AOR = 2.8; 95%
CI: 1.2-6.7). HCV was associated with study site, marital status,
unemployment (AOR = 1.8; 95% CI: 1.3-2.4), a longer duration of ATS use,
and history of injection use of ATS (AOR = 13.3; 95% CI: 1.5-116.1).

CONCLUSIONS: The prevalence of HIV was high among ATS users in Yunnan
Province but quite rare elsewhere, and the prevalence of exposure to HCV
was high in six provinces. Risk factors emphasize the need for new
prevention strategies toward this population at risk in China.

12. Abstract: Informal waste management system in Nigeria and barriers to
an inclusive modern waste management system: A review

Public Health. 2012 Apr 3.

Informal waste management system in Nigeria and barriers to an inclusive
modern waste management system: A review.

Oguntoyinbo OO.

Public Health, School of Health and Social Care, Bournemouth University,
Royal London House, Christchurch Road, Bournemouth BH1 3LT, UK.

OBJECTIVES: To explore the activities of the informal waste management
sector in Nigeria, and barriers to integrating them in an inclusive waste
management system.

STUDY DESIGN: Literature review.

METHODS: A literature review was undertaken to evaluate the informal waste
management system and formal waste management system in Nigeria and other
developing countries with similar settings. Nine databases were searched
and 34 studies met the following inclusion criteria: evaluation of the role
of informal waste collectors, recycling and solid waste management in
developing countries.

RESULTS: Most of the evaluated studies (97%, n = 33) acknowledged the
significant environmental and socio-economic roles played by the informal
waste collectors and scavengers in developing countries. The studies
identified the following as barriers to inclusive waste management in
Nigeria: repressive policy, unhygienic waste collection methods, lack of
evidence to support activity, and low quality and quantity of secondary

CONCLUSIONS: Scavengers and other groups of informal recyclers see waste as
a source of income and livelihood, whilst the general public see it as an
aesthetic problem and see the people engaged in resource recovery as a
social nuisance. Integrating their informal services with the formal waste
management system is a potential tool to empower these people to increase
their skills in resource recovery and improve their working and living

Inclusive waste management is a process, and observable changes are taking
place in some developing countries where waste pickers and informal waste
collectors have become environmental agents. A major limitation to the
integration of informal waste collectors and scavengers is the social
acceptance of their activity as a viable source of income, and of
themselves as environmental agents in the sustainability of virgin

Copyright © 2012 The Royal Society for Public Health. Published by Elsevier
Ltd. All rights reserved.

13. Abstract: It’s not all about me: motivating hand hygiene among health
care professionals by focusing on patients

Psychol Sci. 2011 Dec;22(12):1494-9.

It’s not all about me: motivating hand hygiene among health care
professionals by focusing on patients.

Grant AM, Hofmann DA.

Management Department, The Wharton School, University of Pennsylvania,
Philadelphia, PA 19104-6370, USA.

Diseases often spread in hospitals because health care professionals fail
to wash their hands. Research suggests that to increase health and safety
behaviors, it is important to highlight the personal consequences for the
actor. However, because people (and health care professionals in
particular) tend to be overconfident about personal immunity, the most
effective messages about hand hygiene may be those that highlight its
consequences for other people.

In two field experiments in a hospital, we compared the effectiveness of
signs about hand hygiene that emphasized personal safety (“Hand hygiene
prevents you from catching diseases”) or patient safety (“Hand hygiene
prevents patients from catching diseases”). We assessed hand hygiene by
measuring the amount of soap and hand- sanitizing gel used from dispensers
(Experiment 1) and conducting covert, independent observations of health
care professionals’ hand-hygiene behaviors (Experiment 2).

Results showed that changing a single word in messages motivated meaningful
changes in behavior: The hand hygiene of health care professionals
increased significantly when they were reminded of the implications for
patients but not when they were reminded of the implications for

14. Abstract: Hospital privacy curtains are frequently and rapidly
contaminated with potentially pathogenic bacteria
PII: S0196-6553(12)00070-3 doi:10.1016/j.ajic.2011.12.017

AJIC: American Journal of Infection Control

Article in Press

Hospital privacy curtains are frequently and rapidly contaminated with
potentially pathogenic bacteria

Michael Ohl, MD, MSPH, Marin Schweizer, PhD, Maggie Graham, MS, Kristopher
Heilmann, BS, Linda Boyken, BS, Daniel Diekema, MD

Background: Privacy curtains are a potentially important site of bacterial
contamination in hospitals. We performed a longitudinal study to determine
the prevalence and time course of bacterial contamination on privacy

Methods: Over a 3-week period, swab cultures (n = 180) were obtained twice
weekly from the leading edge of 43 curtains in 30 rooms in 2 intensive care
units and a medical ward. Curtains were marked to determine when they were
changed. Contamination with Staphylococcus aureus, methicillin-resistant S
aureus (MRSA), Enterococcus spp, vancomycin-resistant enterococcus (VRE),
or aerobic gram-negative rods was determined by standard microbiologic
methods. To distinguish persistence of pathogens on curtains from
recontamination, all VRE and MRSA were typed using pulsed-field gel

Results: Twelve of 13 curtains (92%) placed during the study showed
contamination within 1 week. Forty-one of 43 curtains (95%) demonstrated
contamination on at least 1 occasion, including 21% with MRSA and 42% with
VRE. Eight curtains yielded VRE at multiple time points: 3 with persistence
of a single isolate type and 5 with different types, suggesting frequent

Conclusion: Privacy curtains are rapidly contaminated with potentially
pathogenic bacteria. Further studies should investigate the role of privacy
curtains in pathogen transmission and provide interventions to reduce
curtain contamination.

Supported by an unrestricted grant from PurThread, a maker of antimicrobial

Key Words: Environmental contamination, Resistant pathogens

Published by Elsevier Inc.

15. Abstract: Dental perspective on biomedical waste and mercury
management: a knowledge, attitude, and practice survey

Indian J Dent Res. 2011 May-Jun;22(3):371-5.

Dental perspective on biomedical waste and mercury management: a knowledge,
attitude, and practice survey.

Sood AG, Sood A.

Department of Conservative Dentistry and Endodontics, Sudha Rustagi College
of Dental Sciences and Research, Faridabad, India.

CONTEXT: Management of waste generated in any health-care facility is a
critical issue as it poses a direct threat to human health as well as to
the environment. The biomedical waste generated in the dental scenario
includes sharps, used disposable items, infectious waste (blood-soaked
cotton, gauze, etc.), hazardous waste (mercury, lead), and chemical waste
(such as spent film developers, fixers, and disinfectants). A major concern
in our field is management and disposal of mercury.

AIMS: To obtain information about the knowledge, attitude, and practices of
dental institutions and dental practitioners in the disposal of waste.

SETTINGS AND DESIGN: A self-administered questionnaire, composed of 50
questions was designed.

MATERIALS AND METHODS: The questionnaire was distributed among the
participants, chosen randomly, including dental students, faculty from
dental colleges and private practitioners in and around Delhi, India.
Statistical analysis used: The percentage response for each question from
all the participants was obtained and the data was calculated.

RESULTS: Many dentists have knowledge about the waste management but they
lack in the attitude and practice. Conclusions: There is need for education
regarding hazards associated with improper waste disposal at all levels of
dental personnel. It is imperative that waste should be segregated and
disposed off in a safe manner to protect the environment as well as human

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16. No Abstract: Study: Vast majority of C. difficile infections occur in
medical settings

JAMA. 2012 Apr 4;307(13):1356.

Study: Vast majority of C. difficile infections occur in medical settings.

Voelker R.

17. No Abstract: Promoting an absolute culture of patient safety

Rev Infirm. 2012 Jan;(177):4.

[Promoting an absolute culture of patient safety].

[Article in French]

Chevillotte J.

18. Research and Development to Meet Health Needs in Developing Countries:
Strengthening Global Financing-Coordination

Crossposted from the PAHO/WHO Equity List with thanks.
Research and Development to Meet Health Needs in Developing Countries:
Strengthening Global Financing-Coordination

WHO – Report of the Consultative Expert Working Group –EWG – on:
Research and Development: Financing and Coordination

Available online PDF file [226p.] at:

5 April 2012 | Geneva – New sources of funding are needed to stimulate
health research specifically for diseases that affect people in developing
countries, according to a report published today by an international expert
group convened by WHO.

The Consultative Expert Working Group on Research and Development:
Financing and Coordination (CEWG) has called for increased global
commitment to funding and coordinating health research to meet the specific
needs of developing countries. The group proposes a package of changes that
includes utilizing open knowledge innovation and prizes as incentives,
mandatory government commitments, pooling of funding and an international
binding convention on global health research.

Recommendations to improve global financing

* Research outputs that address health needs of developing
countries should be in the public domain or made available through open
* Patent pools should be used to increase sharing of research
* Pooled funding mechanisms should coordinate financial resources
and some of the funds should be used for capacity building in developing
countries including direct grants to companies that can help promote
technology transfer.
* WHO should play a central coordinating role in global health
* Increased funding is needed from governments and philanthropic
sources in the light of market failures of private investments.
* All countries should commit to spend at least 0.01% of gross
domestic product on research to develop health technologies for use in
developing countries.
Discussion on the recommendations will take place at the 65th World Health
Assembly (WHA) in May 2012….”


Executive summary .
Chapter 1: Introduction

Chapter 2: Setting the scene: the issues
The need for action
Trends in R&D in the pharmaceutical industry
Research and development relevant to developing countries
Expenditure Estimates and Sources of Funding
Research Outcomes
Research and development and access .
Research and development financing
Research and development coordination

Chapter 3: Review of proposals
Chapter 4: Strengthening global financing of health research and
Chapter 5: Strengthening global coordination in health research and
Chapter 6: Implementation: a binding instrument

Annex 1: Inception report

Annex 2: Mapping of EWG and CEWG processes
The EWG‘s grouping of R&D financing and coordination proposals
The first step: creation of an inventory of 109 proposals
The second step: from 109 proposals to 91 proposals
The third step: from 91 to 22 grouped proposals
CEWG grouping of R&D financing and coordination proposals
The inventory of R&D financing and coordination proposals considered by
The new landscape of proposals: 15 assessments and chapters on financing
and coordination

Annex 3: Assessments of proposals . .
Global Framework on Research and Development . .
Removal of data exclusivity . .
Direct grants to companies
Green intellectual property
Health Impact Fund
Orphan drug legislation
Patent pools
Pooled funds
Open approaches to research and development and innovation
Milestone prizes and end prizes
Purchase or procurement agreements
Priority review voucher
Regulatory harmonization
Tax breaks for companies
Transferable intellectual property rights

ANNEX 4: Regional consultation meetings

19. 15th International Congress on Infectious Diseases in June 2012

15th ICID • Bangkok, Thailand • June 13-16, 2012
Centara Grand & Bangkok Convention Centre at Central World

Scientific Sessions


Welcome to the 15th ICID Website!

Dear Members, Colleagues, Sponsors and Friends:

I am delighted to announce that Bangkok has been selected by the
International Society for Infectious Diseases (ISID) as the venue for the
15th International Congress on Infectious Diseases (15th ICID) in June

ISID exists to encourage collaboration between leaders as well as students
to find new solutions to the world’s infectious diseases. ISID promotes
this by bringing together clinicians, researchers, microbiologists and
epidemiologists of infectious diseases from all countries of the world to
share their commitment and expertise. The end result will be new
partnerships, new preventive methods and new therapeutics.

ISID’s most successful collaborative program is ProMED-mail, the global
electronic surveillance and communication network reporting potential
outbreaks affecting humans, animals and plants around the world. ProMED-
mail communicates immediate information about disease outbreaks to >50,000
subscribers. Outbreak reports are created by a staff of 40 international
experts, in multiple languages, on a daily basis, for free.

The 15th ICID will be a chance for ongoing collaborative efforts, as well
as for individuals, to present and share their experiences fighting
infectious diseases. To commemorate the 30th year of our Society we are
keen to provide attendees in Bangkok with an outstanding scientific program
that will run the spectrum from cutting edge research with clinical
implications, to state of the art practices in infectious diseases by a
truly international faculty composed of world leaders in their areas. ISID
looks forward to working together with our collaborator in Thailand, the
Infectious Disease Association of Thailand (IDAT), as well as other
organizations to develop 15th ICID.

Thailand is bordered by Myanmar, Laos, Malaysia and Cambodia, countries
where many infectious diseases are endemic, and the choice of Bangkok
reflects the commitment of ISID to host meetings in areas where healthcare,
education and training in infectious diseases are important issues.

Bangkok, the capital of Thailand, has the ideal congress infrastructure and
is an optimal hub site to welcome Asian and worldwide participants to our
scientific meeting. Attendees will be able to visit historical sites,
immerse in art and culture, taste special foods as well as travel to exotic
and beautiful areas outside of the city.

We look forward to your participation at the 15th ICID and to meeting you
in Bangkok, June 2012.
Daniel Lew, MD
President, International Society for Infectious Diseases

International Society for Infectious Diseases
9 Babcock Street, Unit 3, Brookline MA 02446-5903 · USA
Phone: (617) 277-0551 · Fax: (617) 278-9113 ·

©2001-2010 International Society for Infectious Diseases. All Rights

20. News

– India New contraceptive jab scares men
– USA: OP-ED: L.A. moves the needle
– USA: Patients Test Negative for Blood Infections From Poor Quality at
Shuttered Cancer Center
– UK: Staff catch hepatitis C from dirty needles while working at NHS
Greater Glasgow & Clyde
– USA: Kimberly Smedley Is Accused and Pleaded Guilty
– USA: FDA finds fake vials of cancer drug
– UK: Stepping Hill hospital subject of surprise inspection: Government
inspectors have carried out a surprise inspection at a hospital at the
centre of a police probe into insulin poisoning
– USA: No viral infections found in clinic’s patients
– Bacterial Contamination Found in Pharmacy Robots

Selected news items reprinted under the fair use doctrine of international
copyright law:
India New contraceptive jab scares men
Darinia Khongwir, TNN,Times of India (10.04.12)

A new method of contraception involves men getting an injection in their
private parts. Will there be any takers?

Family planning has hitherto been primarily about female contraception – be
it the pill, non-hormonal intra uterine devices or surgical sterilization.
For the men, the choices were either surgical procedures or the use of
condoms, both of which are not very popular.

Over the next three years, though, this scenario might change, with a new
contraceptive method for men being developed. The process is fairly simple
– if you do not swoon every time you see a syringe.

The reversible procedure, which is currently in its advanced clinical
trials in India, will involve a medical practitioner injecting a polymer
gel into a man’s private parts. The gel will break apart the sperm and
prevent fertilization. Though the method is still in its nascent stage, BT
asked men in the city if they would opt for it, should the technology be
made available here. Interestingly, most respondents thought it was a great
idea, but were scared to try it themselves.

“The concept sounds painful, but is innovative. My first concern, though,
is safety. Unlike traditional contraceptive methods like using a condom,
which protects you from STDs and HIV, an injection can leave you
susceptible to a host of diseases. The injection is a good contraceptive
option for married couples,” says Gul Md Akhbar, fitness expert.

A leading Kannada actor echoes Gul’s sentiment that this form of
contraception works best for a couple. “This sort of contraception will be
easier on women. It is also a good option for couples who want to defer
having children. It should work as long as all parties are comfortable with
it,” he says on condition of anonymity.

The fear of needles apart, there is also apprehension about whether the
effect of the gel is reversible. “What if an injection to reverse the
effects of the gel does not work? If sperm is broken apart by a pill
instead of an injectable gel, I think more men would be willing to opt for
contraception,” says Zoheb Yusuf, model.

There are however, voices of dissent. “I would never opt for it because I
am spooked by the idea of it all. I think condoms are the best – they are
cheap, readily available and offer protection. So why go for an injection
when there are easier options?” asks model Karan Medappa. Agrees model
Carun Carumbiah, who also advocates greater self-control for men as a
contraceptive method. “Condoms are effective and this form of contraception
suffices for men. A man must exercise control and know when to stop,” he

And while men continue to debate whether or not to take the jab, actor
Sanjjanaa is all for having a man undergo the procedure. “It is a very good
option. Why should only women have to use contraception? We already endure
so much pain with the menstrual cycle, pregnancy and childbirth. Men also
need to contribute to the relationship and this could be their way of doing
so. It is, after all, just an injection with temporary effects,” she says.

Women|syringe|sterilization|sperm|privateparts|Men|Echoes|Contraceptive jab
USA: OP-ED: L.A. moves the needle
By Shoshanna Scholar, Los Angeles Times, USA (10.04.12)

The city’s early action in AIDS/HIV prevention by providing a needle
exchange program proved to be prescient. Now is no time to back off.

The first cases of HIV identified anywhere in the world are widely thought
to have been in Los Angeles in 1981. Since then, 45,000 Angelenos have
contracted HIV and nearly half have died due to the disease.

As terrible as that statistic is, we can look back over the last 30 years
with considerable pride because Los Angeles’ courageous response to the
epidemic also saved many lives. We now know how much worse things would
have been had local elected leaders not braved controversy to support one
of the most effective HIV prevention tools we have: needle exchange.

How much worse? Consider some comparative data — needle exchange isn’t
solely responsible for the differences in these statistics, but it plays an
important role.

In 1992 in Los Angeles, where needle exchanges were already in effect, the
rate of HIV among those who injected drugs was 8.4%. In 1993, the HIV rate
in Miami for that population was the highest in the country: 48%. Although
Miami put into place HIV-prevention programs, there has never been a large-
scale needle exchange program there. Today the rate of HIV among injection
drug users in Miami is 16%. In Los Angeles, the rate stayed low, and as of
2009, the most recent data available, it was 5%.

These facts have important consequences. Extrapolating from county data,
it’s believed that about 34,000 Los Angeles residents are injection drug
users. The California Department of Public Health calculates the lifetime
costs of treating one person with HIV at $385,200. If those 34,000
Angelenos had an HIV rate of 16% rather than 5%, we’d be spending an
additional $1.4 billion in treatment costs.

People affected by HIV/AIDS in the late 1980s and early 1990s faced all
kinds of discrimination. Our civic leaders displayed wisdom and guts with a
series of early actions in response to the epidemic, beginning with the
country’s first AIDS anti-discrimination law in 1985.

Four years later, L.A. put in place an AIDS coordinator, Fred Eggan, who
provided a structure for the city to partner with community organizations
to raise public awareness, prevent new HIV infections and support those
affected by HIV/AIDS.

Needle exchange came next. It was highly controversial at first. Activists
and volunteers, including the founder of my program, Renee Edgington, began
the exchange underground in the late 1980s; it was formally established in
1992. They faced protesters, prosecution, conflicts with private security,
law enforcement, even citizen’s arrest.

Critics objected: Why give people who inject drugs the tools they need to
break the law? It seemed to many observers that swapping sterile needles
for used needles would only make things worse. But city leaders held firm,
and decades of research have now vindicated decisions by the city and later
county leaders who bet on needle exchange. In fact, more than 200 studies
from the U.S. and abroad agree: Needle exchange programs not only prevent
HIV, but people who use them are also more likely to enter drug treatment
and get off drugs.

People who inject drugs will keep doing it with or without access to clean
needles. Reusing old syringes greatly increases the risk of staph infection
or the antibiotic resistant MRSA; sharing syringes leads to HIV and
hepatitis C infection.

Ask anyone who’s ever injected drugs how difficult it is to get sterile
syringes without exchange. In California, some pharmacies sell syringes
without a prescription, but they are few and far between. Most don’t offer
disposal or referrals to badly needed wraparound and referral services such
as medical care and access to drug treatment. Outside of

the participating pharmacies and needle exchange programs, there are few
options other than buying them on the street.

Earlier this year, Stephen Simon, the city’s fifth AIDS coordinator, left
the job for the private sector. Stephen was a tenacious champion of the
city’s exchange programs and syringe access in California.

“It’s been a tough political challenge,” Simon told the City Council as he
left, but “we removed more than a million dirty needles from the streets of
Los Angeles each year…. That’s the kind of tough political decisions that
you all have made here.” Council members Bill Rosendahl, Eric Garcetti, Tom
LaBonge, Paul Koretz, Dennis Zine and Ed Reyes all spoke with gratitude of
Simon’s tenacity and creativity in guiding the city’s fight to reduce HIV
and AIDS.

So far, however, Simon’s job hasn’t been filled. And yet the HIV epidemic
is still with us, and we still need city and county help to protect the
progress we’ve made so far. We still need local government to stand up
against continuing and misguided opposition to needle exchange.

In a time of polarized political conversation and a distressed economy, it
may be tough to remember how important L.A.’s pioneering prevention
strategy has been. We can’t afford to throw away people, or money, on
treating those whose illnesses we could prevent. Not in times like these.
L.A. needs to keep supporting needle exchange programs, and it needs to
advocate for and coordinate with those programs.

Shoshanna Scholar has served as the executive director of Clean Needles
Now/Harm Reduction Central in Los Angeles since 2003.

Copyright © 2012, Los Angeles Times
USA: Patients Test Negative for Blood Infections From Poor Quality at
Shuttered Cancer Center
by Jaimie Oh, Becker’s Hospital Review (09.04.12)

Tags: bloodborne infections | infection control | MississippiOfficials from
the Mississippi Health Department said 300 patients tested negative for
blood infections, such as HIV, due to substandard care at the now-shuttered
Rose Cancer Center in Summit, according to a New England Cable News report.

State health officials shut down the Rose Cancer Center after 11 patients
were hospitalized from bacterial infections. They determined the center
demonstrated “unsafe infection control practices,” including diluting
chemotherapy drugs and using old needles, according to the report.
Following the hospitalizations, the health department alerted former
patients to undergo testing for bloodborne infections.

Although all patients thus far have tested negative for infections, the
department will continue to offer testing for future concerned patients. In
addition to substandard quality care, the center was under fire for alleged
healthcare fraud.
UK: Staff catch hepatitis C from dirty needles while working at NHS Greater
Glasgow & Clyde
by Kevin O’Sullivan, Scottish Daily Record (08.04.12)

THREE medical workers have caught deadly hepatitis C after ­jagging
­themselves on dirty needles.

They were infected with the virus – which can cause liver ­disease and
cancer – while ­working at NHS Greater Glasgow & Clyde.

A Sunday Mail investigation discovered there have been more than 7000
“sharps” injuries recorded at Scottish hospitals in the past five years –
including the three hep C infections.

Dr Jean Turner, of Scotland’s Patients’ Association, said: “These incidents
are horrifying. ­Hepatitis C is very serious. It can cause ­enormous damage
to the liver and can be easily transmitted if ­careless mistakes are made.

“It is worrying these incidents have occurred and we are only just finding
out about them now. I hope the affected staff are no longer in ­contact
with patients.

“Health boards should be open and ­transparent and volunteer ­figures on
needle injuries – ­keeping it secret is a bad idea.”

There were 7458 injuries caused by sharps – which include ­needles,
scalpels and scissors – in hospitals and clinics since 2007.

The highest number was at NHS Greater Glasgow & Clyde, with 1404, followed
by NHS Grampian on 1193 and NHS Lothian on 1111.

NHS Greater Glasgow & Clyde confirmed three staff caught hep C.
A spokesman said the board was prevented from releasing case details
because of “data protection” laws, adding: “There is absolutely no risk to

“The three staff members, one of whom has now left, did not require to have
their duties restricted as they already worked in environments where they
posed no risk.”
USA: Kimberly Smedley Is Accused and Pleaded Guilty
by Jasmineparker, (08.04.12)

A 45-year-old Kimberly Smedley is accused of injecting women’s buttocks
illegally with non-approved FDA commercial grade silicone. Smedley of
Atlanta pleaded guilty in U.S District Court in Baltimore to charges that
could send her to jail for 5 years.

Smedley has been administering the illegal injections in different cities
like New York, Washington D.C and Baltimore. Her clients paid her an amount
ranging from $500 and $1,600 cash for unsafe butt boosters. The report said
that the liquid used by Smedley was made of silicone, which commonly found
in paint or furnish polish.

Officials found that Smedley is not a licensed practitioner neither a
doctor and the materials she used for the injections do not meet safety and
approval of FDA.

In U.S. District Court in Baltimore, she pleaded guilty for conspiracy of
introducing and delivering illegally the adulterated and mistrusted brands
of devices in injecting buttocks of women for butt boosters. With these,
she is facing a maximum of 5 years in jail with a fine of $250,000.

Based on the documents reported to the court, one of Smedley’s clients, an
exotic dancer in Baltimore, had experienced shortness of breathing right
when she received the injections from Smedley. The dancer was found with
fluids in her lungs, diagnosed andtreated with pneumonia.

In a hotel in Washington D.C. police arrested Smedley and caught her with
the possession of three 18 gauge medical needles.

By injecting customers with commercial silicone, Smedley causes danger to
the lives of her customers. At least one of her customers suffer from lung
damage which caused by unapproved substance she uses. No one should
practice any medical procedures in a hotel room, according to a statement
made by U.S. Attorney Rod J. Rosenstein to a report.

There are some butt-booster horror stories hit the news headlines in the
country. Among of them is Smedley’s illegal medical practice.

In Florida, a 30-year-old man named Oneal Ron Morris was arrested in
November after allegedly practicing buttock booster injections in at least
a single person with a combination of glue, cement and tire sealant.

Just a year ago in February, Claudia Aderotimi, a british tourist passed
away after receiving injection of cosmetic buttocks at a hotel in Southwest

More than 140 percent of women between 2000 and 2010 underwent legal
buttocks procedures according to the American Society of Plastic Surgeons.
USA: FDA finds fake vials of cancer drug
Ishton W. Morton, Cincinnati Public Policy Examiner, USA (08.04.12)

The Food and Drug Administration (FDA) is warning doctors that a second
counterfeit version of the best-selling cancer drug Avastin has been found
in the U.S., packaged as the Turkish brand of the medication.

Since counterfeits drugs continues to be a problem for the United States,
it seems that FDA should be pushing Congress to make law condemning or
holding individuals, organizations, companies and countries accountable
and labeled them as terrorist for becoming involved in the process of
distributing and trafficking known that drugs these will be deadly when
used for their intended purpose.

A spokesperson for FDA said this particular counterfeits does not contain
the active ingredient in Avastin, which is used to treat cancers of the
colon, lung, kidney and brain. The vials are packaged as Altuzan, the
Turkish version of Avastin that is not approved for use in the U.S.

However, in the international community, terrorism has no universally
agreed, legally binding, criminal law definition. In this case
counterfeiting drugs seems to presents systematic acts that can be
considered as terrorism since they are used terror, especially as a means
of coercion.

This concept of terrorism may itself be controversial. However, common
definitions of terrorism refer only to those violent acts which are
intended to create fear terror, are perpetrated for a religious, political
or, ideological goal; and deliberately target or disregard the safety of
non-combatants civilians.

By distributing with a the false hope of treatment for cancers of the
colon, lung, kidney and brain when knowing that they will not work suggest
these acts could be considered as act of terrorism. These acts are being
directed towards non-combatants civilians.

A spokesperson for the agency send out information stating any packages or
vials labeled with the lot number B6021 must be considered counterfeit.

It is believe that doctors have bought the counterfeits through Richards
Pharma, a U.K.-licensed distributor that does business as Richards
Services, Warwick Healthcare Solutions and Ban Dune Marketing Inc. If
doctors have prior knowledge that these drugs are counterfeits they should
be held accountable.

However, according to British regulators Richards Pharma imported 120 packs
of the fake Altuzan from Turkey. Thirty-eight packets were shipped directly
to the U.S., while the rest were sold to another U.K. distributor who then
shipped them to the U.S. U.K. authorities were notified of the fake product
by the FDA on March 28th, 2012 according to a statement from the country’s
Medicines and Healthcare Products Regulatory Agency.

The Food and Drug Administration is advising doctors to stop using any
drugs acquired from the network. No deaths have been reported in connection
with the counterfeits.

Some definitions of terrorism includes acts of unlawful violence and war.
Quite frankly similar tactics or definitions criminalizing individuals,
organizations, companies and countries who are involved in this process.

In February the FDA announced an investigation into a different batch of
fake Avastin distributed to doctors in several states. Those counterfeits
appeared to have moved through a different network of distributors.

According to European regulators traced the packages through Britain,
Denmark, Switzerland and the Middle East. The original country of origin
remains unclear.

It is believe that Roche sells Avastin in 120 countries and manufactures
and packages the drug at eight sites worldwide. The company is
headquartered in Switzerland.

However, a spokeswoman for Roche’s Genentech unit said authentic Altuzan
packaging has text in Turkish, while the counterfeit packages obtained by
the FDA have English text. She added that importing even authentic Altuzan
into the U.S. is illegal.

According to Charlotte Arnold who said in a statement; “The only Avastin
that can be legally purchased by wholesalers in the United States is FDA-
approved Avastin manufactured by Genentech.”

The United States is vast and highly populated. Incidents of counterfeiting
reported by drugmakers have increased steadily over the decade to more than
1,700 worldwide last year. Only 6% of those were in the U.S. The rise in
counterfeiting comes as pharmaceutical supply chains increasingly stretch
across continents.

Unfortunately, it is believed that more than 80% of the active ingredients
used in U.S. pharmaceuticals are now manufactured overseas, according to a
recent congressional report.

Terrorism has been practiced by both right-wing and left-wing political
parties, nationalistic groups, religious groups, revolutionaries, and
ruling governments. An abiding characteristic is the indiscriminate use of
violence against noncombatants for the purpose of gaining publicity for a
group, cause, or individual. As we protect our water and other natural
resources, so we must protect our medication.
UK: Stepping Hill hospital subject of surprise inspection: Government
inspectors have carried out a surprise inspection at a hospital at the
centre of a police probe into insulin poisoning, U.K. (08.04.12)

Experts from health watchdog the Care Quality Commission (CQC) carried out
the inspection at Stepping Hill Hospital in Stockport, Greater Manchester,
last month.

Detectives believe somebody at the hospital injected saline with insulin,
poisoning 22 patients.

The contamination was discovered in July last year.

A CQC spokesperson said: “The CQC carried out an unannounced inspection at
Stepping Hill Hospital on Monday, March 26, where inspectors focused on
standards relating to patient care and welfare, medicines management and
the internal assessments in place to monitor service provision.

“The CQC will publish full details of the inspectors’ findings from this
visit in a review of compliance on its website in the near future.”

Hospital bosses say safety procedures have been reviewed since the
contamination was discovered.

They include keeping saline locked away.

A hospital spokeswoman said: “We can confirm that we have had a visit from
the Care Quality Commission (CQC) and are currently awaiting their report.
“This visit was part of the CQC’s annual programme of inspections which are
carried out nationally.

“Our services and care are constantly reviewed, but it is always helpful to
have others assess these areas. This helps us to keep improving what we do
and ensure we provide the highest quality care.”

Earlier this month Beryl Hope, 70, was revealed to be the latest patient
believed to have been poisoned.

She died last August and detectives “recategorised” her case after a
thorough review with medical specialists.

However, it is not known whether the poisoning contributed to her death.
Detectives are continuing to investigate and review the cases of 21 other
patients, including six others who have died: Tracey Arden, Arnold
Lancaster, Derek Weaver, William Dickson (known as Bill), Linda McDonagh
and John Beeley (known as Jack).

Greater Manchester Police said they were “continually getting new
information and data, all of which is under constant review and scrutiny”.
A male nurse arrested in connection with poisoning deaths at Stepping Hill
was rebailed in March pending further inquiries.

Filipino-born Victorino Chua, 46, was arrested in January on suspicion of
tampering with medical records at the hospital and was further arrested on
suspicion of three counts of murder and 18 counts of causing grievous
bodily harm.

The tampering affected patients on wards A1, A2 or A3 – acute care wards
for seriously-ill patients.

Detectives still do not know for sure if insulin poisoning caused any of
the deaths.

Comprehensive scientific testing is still going on in the lengthy police
investigation involving the interviewing of more than 650 people.
Another Stepping Hill nurse, Rebecca Leighton, 28, from Heaviley,
Stockport, spent six weeks in jail after being held over allegations she
had tampered with the saline bags.

She was then released and cleared of any wrongdoing last September when
prosecutors said there was not enough evidence against her, but she was
subsequently sacked for theft by bosses.
USA: No viral infections found in clinic’s patients
By Holbrook Mohr, Associated Press, (05.04.12)

JACKSON, Miss. — Mississippi health officials say none of the nearly 300
cancer patients they tested from a defunct clinic have contracted viral
blood infections such as HIV because of care at the facility, which is
suspected of diluting chemotherapy drugs and using old needles.

The Mississippi Health Department closed Rose Cancer Center in Summit in
July because of “unsafe infection control practices” after 11 patients were
hospitalized with the same bacterial infection.

Health Department spokeswoman Liz Sharlot told The Associated Press that
the department sent out two rounds of letters to former patients advising
them they could come in for tests. She said none of the patients tested had
blood-borne viral infections related to the clinic’s care.

Sharlot said the last tests were done in February, but the department would
test additional patients if they ask for a screening.

A lawsuit claims at least one patient died from HIV around the time the
clinic was closed.

The clinic’s founder, Dr. Meera Sachdeva, and two others have been indicted
on federal charges accusing them of participating in multimillion dollar
fraud that included using old needles and diluting chemotherapy medicine.
Sachdeva, Brittany McCoskey and Monica Weeks are charged with offenses
including conspiracy, fraud and witness tampering. They have pleaded not

Federal prosecutors said in a recent court filing that more charges are

Authorities say the clinic made millions of dollars while diluting drugs
and billing Medicaid, Medicare and insurance companies for more
chemotherapy that patients received. The clinic also used old syringes on
multiple patients while billing for new ones, court records said.

Sachdeva established the clinic in south Mississippi in 2005 and billed
Medicaid and Medicare for about $15.1 million during the alleged scheme.
She has been held without bond since August because authorities consider
her a flight risk.

She is a naturalized U.S. citizen from India. Prosecutors said she often
traveled overseas and has considerable assets, including bank accounts, in
her native country, despite the seizure of about $6 million.

McCoskey and Weeks are free on bond. Prosecutors say Weeks did billing for
the clinic. McCoskey was a receptionist and later the office manager,
prosecutors have said.

One of several lawsuits related to the clinic claims James Ralph Patterson
Sr. went there for treatment of his brain and lung cancer but ended up
getting watered-down drugs and was infected with HIV by an old needle.

Patterson died July 3 at the age of 61.

The lawsuit is filed on behalf of Patterson’s son, and it’s is one of
several suits filed in Pike County.

Read more here:
Bacterial Contamination Found in Pharmacy Robots
ScienceDaily, USA (04.04.12)

ScienceDaily (Apr. 4, 2012) — Drug dispensing robots designed to quickly
prepare intravenous medications in a sterile environment can harbor
dangerous bacteria, according to a report in Infection Control and Hospital
Epidemiology, the journal of the Society for Healthcare Epidemiology of

During a routine screening in 2010, personnel at Wake Forest Baptist
Medical Center in North Carolina discovered Bacillus cereusbacteria in
samples dispensed by their machine, the Intellifill IV. “To our knowledge,
this is the first published report of a pharmacy robot being contaminated
with Bacillus with resultant contamination of intravenous drug product,”
the report’s authors write.

Bacillus is a potentially harmful bacterium that is resistant to many
commonly used disinfectants, including alcohol. Personnel discovered the
contamination through quality assurance measures recommended by the
manufacturer before any patients were harmed by the contaminated drugs. The
implications of contaminated intravenous products can be serious, including
potentially life-threatening bloodstream infections. While any adverse
events were avoided, the investigation into how the machine became
contaminated suggests that the current cleaning and maintenance
recommendations may need to be strengthened.

The investigators traced the contamination to the machine’s washing station
and the tubing associated with it. Because this area is not considered a
sterile part of the robot, the manufacturer does not specify a cleaning
procedure for these parts beyond regular “fogging” with alcohol, using a
spray bottle to clean inaccessible parts.

“To prevent other users of Intellifill IV from experiencing the same
problem, the manufacturer should consider establishing a formal procedure
for cleaning and maintaining the washing station, with more detailed
recommendations to change the drain tube, the container, and possibly the
washing station itself,” the authors write. “In addition, it is reasonable
to expand existing quality assurance recommendations to include surface
testing of the washing station and air sampling in the center of the
compartment. Last, using the robot in the pharmacy’s clean room could
further decrease the risk of contamination.”

The findings stress the importance of routine screening of medication
prepared by robotic dispensers, which are increasingly used in hospitals.
“Quality assurance methods are critical to ensure ongoing patient safety,”
the authors write.

The above story is reprinted from materials provided by Society for
Healthcare Epidemiology of America.

Journal Reference: David Cluck, John C. Williamson, Marty Glasgo, Daniel
Diekema, Robert Sherertz. Bacterial Contamination of an Automated Pharmacy
Robot Used for Intravenous Medication Preparation. Infection Control and
Hospital Epidemiology, 2012; 33 (5): 517 DOI: 10.1086/665316

Society for Healthcare Epidemiology of America (2012, April 4). Bacterial
contamination found in pharmacy robots. ScienceDaily. Retrieved April 11,
2012, from­ /releases/2012/04/120404125223.htm
* SAFETY OF INJECTIONS brief yourself at:

A fact sheet on injection safety is available at:

* Visit the WHO injection safety website and the SIGN Alliance Secretariat

* Download the WHO Best Practices for Injections and Related Procedures
Toolkit March 2010 [pdf 2.47Mb]:

Use the Toolbox at:

Get SIGN files on the web at:
get SIGNpost archives at:


The SIGN Secretariat, the Department of Essential Health Technologies,
WHO, Avenue Appia 20, CH-1211 Geneva 27, Switzerland. Telephone: +41 22
791 3680, Facsimile: +41 22 791 4836, E- mail:

SIGN meets annually to aid collaboration and synergy among SIGN network
participants worldwide.

The 2010 annual Safe Injection Global Network meeting was held from 9
to 11 November 2010 in Dubai, The United Arab Emirates.

The SIGN 2010 meeting report pdf, 1.36Mb is available on line at:

The report is navigable using bookmarks and is searchable. Viewing
requires the free Adobe Acrobat Reader at:

Translation tools are available at:
All members of the SIGN Forum are invited to submit messages, comment on
any posting, or to use the forum to request technical information in
relation to injection safety.

The comments made in this forum are the sole responsibility of the writers
and does not in any way mean that they are endorsed by any of the
organizations and agencies to which the authors may belong.

Use of trade names and commercial sources is for identification only and
does not imply endorsement.

The SIGN Forum welcomes new subscribers who are involved in injection

* Subscribe or un-subscribe by email to:, or to

SIGNpost Website

The new website is a work in progress and will
grow to provide an archive of all SIGNposts, meeting reports, field
reports, documents, images such as photographs, posters, signs and symbols,
and video.

We would like your help in building this archive. Please send your old
reports, studies, articles, photographs, tools, and resources for


The SIGN Internet Forum was established at the initiative of the World
Health Organization’s Department of Essential Health Technologies. The
SIGN Forum is moderated by Allan Bass and is hosted on the University of
Queensland computer network.

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