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SIGNpost 00647

 
*SAFE INJECTION GLOBAL NETWORK* SIGNPOST *SAFE INJECTION GLOBAL NETWORK*

Post00647 Lessons + Interest + Lives + Abstracts + News 9 May 2012

CONTENTS
1. Comment: Lessons from North American outbreaks – changing needles alone
is not enough
2. Call for Expressions of Interest: Health Policy and Systems Research in
the field of Access to Medicines in low- and middle-income countries
3. SAVE LIVES: Clean Your Hands – WHO’s global annual campaign
4. Summary Points: Does Development Assistance for Health Really Displace
Government Health Spending? Reassessing the Evidence
5. Abstract: The HIV Epidemic: High-Income Countries
6. Abstract: Infectious diseases in healthcare workers – an analysis of the
standardised data set of a German compensation board
7. Abstract: Prevalence of needle stick injuries among dental, nursing and
midwifery students in Shiraz, Iran
8. Abstract: A pooling analysis of occupational sharp injury on clinical
nurses in China
9. Abstract: Prevalence of hepatitis d virus infection among hepatitis B
virus infected patients in qom province, center of iran
10. Abstract: Factors associated with injection cessation, relapse and
initiation in a community-based cohort of injection drug users in
Chennai, India
11. Abstract: Are postoperative intravenous antibiotics necessary after
bimaxillary orthognathic surgery? A prospective, randomized, double-
blind, placebo-controlled clinical trial
12. Abstract: Association of Hepatitis C Virus Infection With Risk of ESRD:
A Population-Based Study
13. Abstract: HIV prevalence and sexual risk behaviour among non-injection
drug users in Tijuana, Mexico
14. Abstract: Effects of an online personal health record on medication
accuracy and safety: a cluster-randomized trial
15. Abstract: A national mapping assessment of blood collection and
transfusion service facilities in Afghanistan
16. Abstract: Sustained Reduction of Microbial Burden on Common Hospital
Surfaces Through The Introduction of Copper
17. Abstract: Health Professions and Risk of Sporadic Creutzfeldt-Jakob
Disease, 1965 To 2010
18. No Abstract: The need for continuous education in the prevention of
needlestick injuries
19. No Abstract: Will there be a vaccine to protect against the hepatitis C
virus?
20. News
– USA: Robot at work on disinfection at Virginia hospital
– USA: Board reprimands nurse who potentially exposed patients to
hepatitis, HIV
– UK: Hand hygiene campaign slashes hospital infection rates
– UK: Hepatitis C Cases Reach Record Levels in Lothians
– USA: Ambulance Company Accused Of Dumping Medical Waste
– USA: Boy undergoes HIV, hepatitis treatment after finding syringe at
Oakland playground
– Self-Destructing’ Syringes Force Safer Injection Practices

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__________________________________________________________________
________________________________*_________________________________

1. Comment: Lessons from North American outbreaks – changing needles alone
is not enough

Crossposted from the ‘Don’t Get Stuck With HIV’ Blog. with thanks.
__________________________________________________________________
Lessons from North American outbreaks – changing needles alone is not
enough
Stephen F. Minkin, Posted on http://dontgetstuck.wordpress.com/ (05.05.12)

Complete with graphics at: http://tinyurl.com/DGS-NoChangeNeedle-1

[DGS Note: (Stephen F Minkin <sfminkin[at]yahoo.com>) submitted the
following as a guest blog. Unsafe injections are a problem in North America
as well, but not nearly as much as in Africa and Asia. When unexplained
infections come to light, and when these can be traced to suspected
clinics, state or national governments in North America respond with
outbreak investigations, inviting thousands of patients who visited
suspected clinics to come for tests. Governments in sub-Saharan Africa have
not investigated unexpected infections, leaving patients with an unknown
burden of unnecessary — preventable — infections from health care.]
…………………………………………………………………

The CDC first reported on four large outbreaks of hepatitis B and hepatitis
C at outpatient medical facilities between 2000 and 2002. Two outbreaks
occurred in a private physician’s offices in New York, one at an Oklahoma
pain remediation center, and one at a hematology/oncology clinic in
Nebraska.[1] A total of 247 patients were known to have been infected at
these facilities.

In addition, unsafe practices were uncovered at a phlebotomy center in
California in 2001, where needles for drawing blood were reused. As a
result, 15,000 people had to be tested for HIV, hepatitis B, and hepatitis
C. [2]

Two more recent outbreaks discovered in Nevada and New York garnered
considerable media attention. In November 2007, reports surfaced that a New
York anesthesiologist reused syringes when withdrawing medicine from multi-
dose vials. In the process he potentially exposed thousands of patients to
blood-borne viruses. On December 14, 2007 the New York Department of Health
contacted approximately 8,500 patients exposed by this practice and urged
them to be tested for Hepatitis and HIV.

On February 29, 2008 health officials in Las Vegas closed the Endoscopy
Center of Southern Nevada after six patients were diagnosed with hepatitis
C. The outbreak was traced to nurse anesthetists reusing syringes to draw
up medicine from single use vials for multiple patients.

According to the CDC,

A clean needle and syringe were used to draw medication from a single-use
vial of propofol, a short acting intravenous anesthetic agent. The
medicine was injected directly through an intravenous catheter into the
patient’s arm. If a patient required more sedation, the needle was removed
from the syringe and replaced with a new needle; the new needle and old
syringe was used to draw more medication.

This was a “common practice” at this center for at least 4 years. As a
result 40,000 patients were potentially exposed to this risk of hepatitis
and HIV infections. [3]

The CDC suggests two possible ways the syringes could have been
contaminated.

Backflow from the patient’s intravenous catheter or from needle removal
might have contaminated the syringe with HCV (hepatitis C) and subsequently
contaminated the vial. Medication remaining in the vial was used to sedate
the next patient.

Investigators concluded that each of these outbreaks resulted from “unsafe
injection practices primarily the reuse of syringes and needles or
contamination of multiple-dose vials leading to patient to patient
transmission.”[4]

The changing of needles while reusing the syringe is very, very risky and
is not a WHO recommended practice. [5]

The 2002 Oklahoma outbreak was traced back to a nurse anesthetist
supervised by an anesthesiologist at a hospital outpatient clinic. In
response the American Association of Nurse Anesthetists (AANA) mailed
copies of the AANA Infection Control Guidelines to its members.

The organization also hired a research firm to conduct a random telephone
survey of Certified Registered Nurse Anesthetists (CRNAs) and
anesthesiologists “to learn more about practices and attitudes on needle
and syringe reuse.” A spokesperson termed the finding as “eye opening.”

Among the different categories of health professionals surveyed, 3 percent
of anesthesiologists who responded indicated they reuse needles and/or
syringes on multiple patients. CRNAs, other physicians, nurses and oral
surgeons reported reuse at 1 percent or less.

Extrapolating the survey findings – 3 percent of anesthesiologists plus 1
per cent of CRNAs – equated in 2002 to approximately 1,000 anesthesia
professionals who might have been exposing more than a million patients to
the risks of contaminated needles and syringes. [6]

They were forced to revisit the problem of the reuse because of the events
in New York and Nevada. On March 6, 2008, Dr. Wanda Wilson, the AANA
President, commented on the sad state of affairs.

It is astounding that in this day and age there are still nurse
anesthetists, anesthesiologists and other health professionals who still
risk using needles and syringes on more than one patient, or know of such
activities and don’t report them. Published standards and guidelines
dictate that single-use and disposal of these products is the best way to
ensure patient safety. Patient safety is our primary focus – not cost
savings, time savings, or any other factor

If the hepatitis C outbreaks in New York and Nevada demonstrated anything,
it was that such incidents occur regardless of a provider’s degree,
credentials, or title. For any group to suggest otherwise is to put its
collective head in the sand-it is irresponsible, negligent, and a sure
invitation for yet another Nevada or New York situation to occur.[7]

A 1990 study by Canadian researchers experimentally examined the risk of
cross infection related to the multiple use of disposable syringes
connected to IV tubing during anesthesia. The authors were motivated
because “the practice of reusing disposable plastic syringes for several
patients is still prevalent in North American operating rooms despite
warnings about possible hazards. ”

In some operating rooms, the usual practice is to reuse disposable syringes
while changing needles. This practice is based on the assumption, that
since only needles enter the injection site, it is the only part that can
be contaminated. A high proportion of reused syringes were contaminated
even if only the needle had contact with blood. The probable mechanism of
contamination is by aspiration into the syringe of blood remaining in the
needle because of the negative pressure generated while removing the
needle.

In view of these finding the authors emphasized that “changing needles
alone is a useless procedure to prevent contamination.”[8]

[1] CDC MMWR Weekly, “Transmission of Hepatitis B and C Viruses in
Outpatient Settings-New York, Oklahoma and Nebraska, 2000-2002,” September
26, 2003 /52 (38); 901-906.

[2] Porco TC et al., “Risk of infection from needle reuse at a phlebotomy
center,” Am J Public Health, 2001, 91: 636-8.

[3] CDC, “Acute Hepatitis C Virus Infections Attributed to Unsafe
Injection Practices at an Endoscopy Clinic – Nevada,” 2007 MMWR May
16,2008.

[4] Ibid. p 901.

[5] BD Email dated 10/12/2007 attaching PATH Report, “Evaluation of a
Retractable Syringe in South Africa” p. 35 (Sept. 2007)

[6] AANA press release, AANA condemns unsafe injection practices, March
6,2008.

[7] AANA press release, “AANA condemns unsafe injection practices,” March
6,2008.

[8] Trepanier et al, “Risk of cross infection related to the multiple use
of disposable syringes,” Can J Anaesth 1990/37:2/pp 156-159.
__________________________________________________________________
________________________________*_________________________________

2. Call for Expressions of Interest: Health Policy and Systems Research in
the field of Access to Medicines in low- and middle-income countries

The deadline for submission of the Expression of Interest is 18 June 2012.

Crossposted from the PAHO/WHO Equity Listserve with thanks.
http://listserv.paho.org/Archives/equidad.html
Twitter http://twitter.com/eqpaho
__________________________________________________________________

Call for Expressions of Interest:

Health Policy and Systems Research in the field of Access to Medicines in
low- and middle-income countries.

This call aims to explore the connections between medicines and three other
functions of health systems: health financing, governance and health
information.

The results from the recent priority-setting exercise performed by the
Alliance identified research questions in access to medicines that
demonstrate the need to explore the relationships between medicines and the
other building blocks of the health system and analyse the health system
determinants of access to medicines.

The deadline for submission of the Expression of Interest is 18 June 2012.

Description: http://bit.ly/KCWZke

Grant application submission: http://bit.ly/IISZ0k
__________________________________________________________________
________________________________*_________________________________

3. SAVE LIVES: Clean Your Hands – WHO’s global annual campaign
__________________________________________________________________

Clean Care is Safer Care

Save Lives: Clean Your Hands

Five steps to 5 May 2012 – What’s YOUR plan?

Our 2012 call to action was “create your action plan based on your
facility’s results using the WHO Hand Hygiene Self-Assessment Framework”.
Congratulations to everyone who has worked hard to be part of the
celebrations for the fourth year of WHO SAVE LIVES: Clean Your Hands. The
commitment again has been overwhelming and demonstrates that there is truly
a global momentum for improving patient safety through clean hands year on
year.

http://www.who.int/gpsc/5may/en/

SAVE LIVES: Clean Your Hands promotional video: for download [2.5Mb]
Arabic Chinese English French Russian Spanish

http://www.who.int/gpsc/5may/video/en/index.html
__________________________________________________________________
________________________________*_________________________________

4. Summary Points: Does Development Assistance for Health Really Displace
Government Health Spending? Reassessing the Evidence
__________________________________________________________________
http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001214

PLoS Med 9(5): e1001214.

Does Development Assistance for Health Really Displace Government Health
Spending? Reassessing the Evidence

Rajaie Batniji*, Eran Bendavid

Stanford University, Stanford, California, United States of America
Citation: Batniji R, Bendavid E (2012) Does Development Assistance for
Health Really Displace Government Health Spending? Reassessing the
Evidence. PLoS Med 9(5): e1001214. doi:10.1371/journal.pmed.1001214

Published: May 8, 2012

Copyright: © 2012 Batniji, Bendavid.
Funding: Funding from the Stanford University Freeman Spogli Institute’s
‘Global Underdevelopment Action Fund’ supported this work.

* E-mail: batniji@stanford.edu

Provenance: Not commissioned; externally peer reviewed.

Summary Points

At the core of the current aid debate is the question of whether
development assistance for health provided to developing country
governments increases health expenditures.

It has recently been suggested that development assistance for health to
governments leads to a displacement of government spending, reinforcing
skepticism about health aid.

Here we examine a database of public financing for health from 1995 to 2006
and demonstrate that prior conclusions drawn from these data are unstable
and driven by outliers.

* While government spending may be displaced by development assistance for
health in some settings, the evidence is not robust and is highly variable
across countries. We recommend that current evidence about aid displacement
cannot be used to guide policy.

Open access article:
http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001214

This is an open-access article distributed under the terms of the Creative
Commons Attribution License, which permits unrestricted use, distribution,
and reproduction in any medium, provided the original author and source are
credited.
__________________________________________________________________
________________________________*_________________________________

5. Abstract: The HIV Epidemic: High-Income Countries
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22553497

Cold Spring Harb Perspect Med. 2012 May;2(5):a007195.

The HIV Epidemic: High-Income Countries.

Vermund SH, Leigh-Brown AJ.

Institute for Global Health and Department of Pediatrics, Vanderbilt
University School of Medicine, Nashville, Tennessee 37203.

The HIV epidemic in higher-income nations is driven by receptive anal
intercourse, injection drug use through needle/syringe sharing, and, less
efficiently, vaginal intercourse. Alcohol and noninjecting drug use
increase sexual HIV vulnerability.

Appropriate diagnostic screening has nearly eliminated blood/blood product-
related transmissions and, with antiretroviral therapy, has reduced mother-
to-child transmission radically. Affected subgroups have changed over time
(e.g., increasing numbers of Black and minority ethnic men who have sex
with men).

Molecular phylogenetic approaches have established historical links between
HIV strains from central Africa to those in the United States and thence to
Europe. However, Europe did not just receive virus from the United States,
as it was also imported from Africa directly.

Initial introductions led to epidemics in different risk groups in Western
Europe distinguished by viral clades/sequences, and likewise, more recent
explosive epidemics linked to injection drug use in Eastern Europe are
associated with specific strains.

Recent developments in phylodynamic approaches have made it possible to
obtain estimates of sequence evolution rates and network parameters for
epidemics.

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3331688/
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Infectious diseases in healthcare workers – an analysis of the
standardised data set of a German compensation board
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22553942

J Occup Med Toxicol. 2012 May 3;7(1):8.

Infectious diseases in healthcare workers – an analysis of the standardised
data set of a German compensation board.

Nienhaus A, Kesavachandran C, Wendeler D, Haamann F, Dulon M.

INTRODUCTION: Healthcare workers (HCW) are exposed to infectious agents.
Disease surveillance is therefore needed in order to foster prevention.

METHODS: The data of the compensation board that covers HCWs of non-
governmental healthcare providers was analysed for a five-year period. For
hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, the period
analysed was extended to the last 15 years. The annual rate of occupational
infectious diseases (OIDs) per 100,000 employees was calculated. For NSIs a
rate per 1,000 employees was calculated.

RESULTS: Within the five years from 2005 to 2009 a total of 384 HCV
infections were recognised as OIDs (1.5/100,000 employees). Active TB was
the second most frequent cause of an OID. While the numbers of HBV and HCV
infections decreased, the numbers for active TB did not follow a clear
pattern. Needlestick injuries (NSIs) are still frequent even though their
number declined for the first time in 2009 by 3.5%. NSIs were especially
often reported at hospitals (29.8/1,000 versus 7.4/1,000 employees for all
other HCWs).

CONCLUSION: Although they are declining, HCV infections remain frequent in
HCWs, as do NSIs. Whether the reinforcement of the recommendations for the
use of safety devices in Germany will prevent NSIs and therefore HCV
infections should be closely observed.

Free full text: http://www.occup-med.com/content/7/1/8/abstract
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Prevalence of needle stick injuries among dental, nursing and
midwifery students in Shiraz, Iran
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22558039

GMS Krankenhhyg Interdiszip. 2012;7(1):Doc05.

Prevalence of needle stick injuries among dental, nursing and midwifery
students in Shiraz, Iran.

Askarian M, Malekmakan L, Memish ZA, Assadian O.

Department of Community Medicine, Medicinal & Natural Products Chemistry
research center, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: The risk of occupational exposure to blood borne pathogens
(including hepatitis B, hepatitis C and HIV) via sharp injuries such as
needle stick injuries (NSIs) among health care workers, especially dental,
nursing and midwifery students is a challenging issue. Inadequate staff,
lack of experience, insufficient training, duty overload and fatigue may
lead to occupational sharp injuries.

The aim of this prospective cross- sectional study was to evaluate the
frequency of NSIs in Iranian dental, nursing, and midwifery students and
their knowledge, attitude and practices regarding prevention of NSIs.

Methods: A questionnaire was provided to 264 dental and 435 nursing and
midwifery students during their under graduate clinical training. 52% of
dental students and 48% of nursing and midwifery students responded to the
questionnaire. The questionnaire was pre-tested for reliability on 9.2% of
the 55 sample population and found to have a high (r=0.812) test-retest
reliability.

Results: 73% of students reported at least one NSI during the past year.
Activities most frequently associated with injuries involved use of a
hollow-bore needle during venous sampling or IV injection in both groups,
followed by wound suturing in nursing and midwifery students and recapping
in dental students.

NSIs and non-reporting of NSIs were highly prevalent in these participants.
The reason for not reporting injuries included not knowing the reporting
mechanism or not knowing to whom to report.

Conclusion: Education about transmission of blood borne infections,
standard precaution and increasing availability of protective strategies
must be enforced. Furthermore, an optimization of the management for
reporting is warranted.
__________________________________________________________________
________________________________*_________________________________

8. Abstract: A pooling analysis of occupational sharp injury on clinical
nurses in China
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/19351466

Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2009 Feb;27(2):65-70.

[A pooling analysis of occupational sharp injury on clinical nurses in
China].

[Article in Chinese]

Wang HQ, Zhang M, Li T, Du XY.

National Institute of Occupational Health and Poison Control, Chinese
Center for Disease Control and Prevention, Beijing 100050, China.

OBJECTIVE: To estimate the occupational sharp injury incidence and the
diversity of the injury and the preventive control methods between the
different levels of hospitals and the different areas of hospitals among
nurses in China.

METHODS: An electronic search of relevant online databases was undertaken.
Twenty six retrospective investigation reports were identified from 209
reports based on the filter standards after a systematic review of them.
The data were pooled for analysis.

RESULTS: 19 171 clinical nurses recalled the sharp injuries in the past
year which came from 229 hospitals in 23 cities in China. 81.37% had
sustained at least one sharp injury. The polled average number of episodes
of occupational sharp injuries and needle stick and contaminated needle
stick were 8.68, 4.17 and 2.68 episode per person per year before 2004 and
fell to 3.42, 2.54 and 1.58 episode per person per year after 2005,
respectively. The needle stick injuries and broken glass injuries accounted
for 54.31% and 38.31%, respectively. The needle stick injuries mainly
occurred in collecting or sorting of used sharps instrument (24.90%),
withdrawing needle or separating it from container (22.62%), during use of
the item such as inserting needle or draw a blood sample or puncturing or
inject drug (21.01%), recapping used needles (15.62%). 9.42% of the
episodes were reported, 19.22% of the nurses wore gloves while doing
procedures on patients, 40.66% of the nurses accepted work safety training
and 66.67% of them were immunized with Hepatitis B vaccine.

CONCLUSION: The sharp injuries are correlated with work load, the making
and implementation of the rules, the levels and districts of the hospitals.
The prevention control methods on sharp injury should be strengthened and
the key point is to issue and publicize the guideline of prevention and
control for occupational exposure to bloodborne pathogen.
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Prevalence of hepatitis d virus infection among hepatitis B
virus infected patients in qom province, center of iran
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22550529

Hepat Mon. 2012 Mar;12(3):205-8.

Prevalence of hepatitis d virus infection among hepatitis B virus infected
patients in qom province, center of iran.

Ghadir MR, Belbasi M, Heidari A, Sarkeshikian SS, Kabiri A, Ghanooni AH,
Iranikhah A, Vaez-Javadi M, Alavian SM.

Gastroenterology Section, Department of Internal Medicine, Faculty of
Medicine, Qom University of Medical Sciences, Qom, IR Iran.

BACKGROUND: Hepatitis D virus (HDV) is a defective RNA virus that depends
on the hepatitis B surface antigen (HBsAg) of hepatitis B virus for its
replication, developing exclusively in patients with acute or chronic
hepatitis B. There are little data regarding the routes of HDV transmission
in Iran. The risk factors for HDV infection in Iran are blood transfusion,
surgery, family history, Hejamat wet cupping (traditional phlebotomy),
tattooing, war injury, dental interventions, and endoscopy.

OBJECTIVES: We performed this study to determine the prevalence of
hepatitis D in the general population of Qom province and the potential
risk factors for acquiring HDV.

PATIENTS AND METHODS: This cross-sectional study collected 3690 samples
from 7 rural clusters and 116 urban clusters. HBs antigen was measured, and
if the test was positive, anti-HDV was measured. Ten teams, each consisting
of 2 trained members, were assigned to conduct the sampling and administer
the questionnaires. The data were analyzed using SPSS.

RESULTS: Forty-eight subjects (1.3%) suffered from hepatitis B, and 1
HBsAg-positive case had HDV infection. The prevalence of hepatitis D
infection in Qom Province was 0.03%. The prevalence of hepatitis D
infection in HBsAg- positive cases was 2%. Our anti-HDV-positive case had a
history of tattooing, surgery, and dental surgery. There was no significant
relationship between tattooing, surgery history, or dental surgery and
hepatitis D infection.

CONCLUSIONS: The prevalence of hepatitis D in Qom is the the lowest in
Iran, similar to a study in Babol (north of Iran).
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Factors associated with injection cessation, relapse and
initiation in a community-based cohort of injection drug users in
Chennai, India
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/21815960

Addiction. 2012 Feb;107(2):349-58.

Factors associated with injection cessation, relapse and initiation in a
community-based cohort of injection drug users in Chennai, India.

Mehta SH, Sudarshi D, Srikrishnan AK, Celentano DD, Vasudevan CK, Anand S,

Kumar MS, Latkin C, Solomon S, Solomon SS.

Department of Epidemiology, Johns Hopkins Bloomberg School of Public
Health, Baltimore, MD 21205, USA. shmehta@jhsph.edu

AIMS: To characterize factors associated with injection cessation, relapse
and initiation.

DESIGN: The Madras Injection Drug User and AIDS Cohort Study (MIDACS) is a
prospective cohort of injection drug users (IDUs) recruited in 2005-06 with
semi-annual follow-up to 2009. Discrete-time survival models were used to
characterize predictors of time to first injection cessation and relapse.

SETTING: Chennai, India.

PARTICIPANTS: A total of 855 IDUs who reported injecting in the 6 months
prior to baseline and had >1 follow-up visit.

MEASUREMENTS: Cessation was defined as the first visit where no injection
drug use was reported (prior 6 months) and relapse as the first visit where
drug injection (prior 6 months) was reported after first cessation.

FINDINGS: All participants were male; median age was 35 years. Over 3
years, 92.7% reported cessation [incidence rate (IR): 117 per 100 person-
years]. Factors associated positively with cessation included daily
injection and incarceration and factors associated negatively with
cessation included marriage, alcohol and homelessness. Of those who
reported cessation, 23.6% relapsed (IR: 19.7 per 100 person-years). Factors
associated positively with relapse included any education, injection in the
month prior to baseline, sex with a casual partner, non-injection drug use,
incarceration and homelessness. Alcohol was associated negatively with
relapse. The primary reasons for cessation were medical conditions (37%)
and family pressure (22%). The majority initiated with non-injection drugs,
transitioning to injection after a median 4 years.

CONCLUSIONS: Injection drug users in southern India demonstrate a high rate
of injection cessation over 3 years, but relapse is not uncommon.
Compensatory increases in alcohol use indicate that cessation of injection
does not mean cessation of all substance use. Family pressure, concerns
about general health, fear of human immunodeficiency virus infection and a
history of non-injection drug use are important correlates of cessation.

© 2011 The Authors, Addiction © 2011 Society for the Study of Addiction.

Comment in: Addiction. 2012 Feb;107(2):359-60.
__________________________________________________________________
________________________________*_________________________________

11. Abstract: Are postoperative intravenous antibiotics necessary after
bimaxillary orthognathic surgery? A prospective, randomized, double-
blind, placebo-controlled clinical trial
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/21871782

Int J Oral Maxillofac Surg. 2011 Dec;40(12):1363-8.

Are postoperative intravenous antibiotics necessary after bimaxillary
orthognathic surgery? A prospective, randomized, double-blind, placebo-
controlled clinical trial.

Tan SK, Lo J, Zwahlen RA.

Dept. of Oral & Maxillofacial Surgery, The University of Hong Kong, Hong
Kong SAR, PR China.

Postoperative antibiotic prophylaxis is often administered intravenously,
despite an increased morbidity rate compared with oral application. This
study investigates whether a postoperative oral antibiotic regimen is as
effective as incorporation of intravenous antibiotics after bimaxillary
orthognathic surgery.

42 patients who underwent bimaxillary orthognathic surgery between December
2008 and May 2010 were randomly allocated to 2 placebo-controlled
postoperative antibiotic prophylaxis groups. Group 1 received oral
amoxicillin 500mg three times daily; group 2 received intravenous
ampicillin 1g four times daily, during the first two postoperative days.
Both groups subsequently took oral amoxicillin for three more days.

Clinically, the infection rate was assessed in both study groups for a
period of 6 weeks after the surgery. 9 patients (21.4%) developed
infection. No adverse drug event was detected. No significant difference
(p=0.45) was detected in the infection rate between group 1 (3/21) and
group 2 (6/21). Age, type of surgical procedures, duration of the operative
procedure, surgical procedure-related events, blood loss, and blood
transfusion were all found not related to infection (p>0.05).

Administration of more cost-effective oral antibiotic prophylaxis, which
causes less comorbidity, can be considered to be safe in bimaxillary
orthognathic surgery with segmentalizations.

Copyright © 2011 International Association of Oral and Maxillofacial
Surgeons. Published by Elsevier Ltd. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

12. Abstract: Association of Hepatitis C Virus Infection With Risk of ESRD:
A Population-Based Study
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22554802

Am J Kidney Dis. 2012 May 2.

Association of Hepatitis C Virus Infection With Risk of ESRD: A Population-
Based Study.

Su FH, Su CT, Chang SN, Chen PC, Sung FC, Lin CC, Yeh CC.

School of Public Health, College of Public Health and Nutrition, Taipei
Medical University, Taipei, Taiwan; Department of Family Medicine, Taipei
Medical University Hospital, Taipei, Taiwan.

BACKGROUND: The association between chronic hepatitis C virus (HCV)
infection and end- stage renal disease (ESRD) has been widely debated.

STUDY DESIGN: National population-based cohort study.

SETTING & PARTICIPANTS: Insurance claims data from the Taiwan National
Health Insurance Research Database in 2000-2005.

PREDICTOR: Chronic HCV infection as defined by the International
Classification of Diseases, Ninth Revision, Clinical Modification.

OUTCOMES: ESRD as defined by the International Classification of Diseases,
Ninth Revision, Clinical Modification.

RESULTS: We identified 6,291 adults with chronic HCV infection. The control
group included 31,455 sex- and age-matched individuals without evidence of
chronic hepatitis. The incidence of ESRD was 2.14-fold higher in patients
with chronic HCV infection (HR, 1.53; 95% CI, 1.17-2.01; P = 0.002) than in
patients without HCV infection. Age stratification analysis showed that
patients aged 50-59 years with chronic HCV infection (HR, 7.77; 95% CI,
4.23-14.3; P < 0.001) had the highest risk of developing ESRD relative to
patients aged 20-49 years without chronic HCV infection (interaction P <
0.001).

LIMITATIONS: Lack of clinical data.

CONCLUSIONS: Patients with chronic HCV infection are at greater risk of
developing ESRD than individuals without chronic HCV infection. In
addition, the risk of developing ESRD is highest in younger patients with
HCV infection. Early renal screening programs should be initiated for this
high-risk group of young individuals with chronic HCV infection.

Copyright © 2012 National Kidney Foundation, Inc. Published by Elsevier
Inc. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

13. Abstract: HIV prevalence and sexual risk behaviour among non-injection
drug users in Tijuana, Mexico
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/21390967

Glob Public Health. 2012;7(2):175-83.

HIV prevalence and sexual risk behaviour among non-injection drug users in
Tijuana, Mexico.

Deiss RG, Lozada RM, Burgos JL, Strathdee SA, Gallardo M, Cuevas J, Garfein
RS.

Division of Global Public Health, School of Medicine, University of
California San Diego, La Jolla, CA 92093, USA.

Prior studies estimate HIV prevalence of 4% among injection drug users
(IDUs), compared with 0.8% in the general population of Tijuana, Mexico.
However, data on HIV prevalence and correlates among non-injecting drug
users (NIDUs) are sparse.

Individuals were recruited through street outreach for HIV testing and
behavioural risk assessment interviews to estimate HIV prevalence and
identify associated sexual risk behaviours among NIDUs in Tijuana.
Descriptive statistics were used to characterise ‘low-risk’ NIDUs (drug
users who were not commercial sex workers or men who have sex with men).

Results showed that HIV prevalence was 3.7% among low-risk NIDUs. During
the prior six months, 52% of NIDUs reported having >1 casual partner; 35%
reported always using condoms with a casual partner; and 13% and 15%,
respectively, reported giving or receiving something in exchange for sex.
Women were significantly more likely than men to have unprotected sex with
an IDU (p<0.01).

Conclusions: The finding that HIV prevalence among NIDUs was similar to
that of IDUs suggests that HIV transmission has occurred outside of
traditional core groups in Tijuana. Broad interventions including HIV
testing, condom promotion and sexual risk reduction should be offered to
all drug users in Tijuana.
__________________________________________________________________
________________________________*_________________________________

14. Abstract: Effects of an online personal health record on medication
accuracy and safety: a cluster-randomized trial
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/22556186

J Am Med Inform Assoc. 2012 May 3.

Effects of an online personal health record on medication accuracy and
safety: a cluster-randomized trial.

Schnipper JL, Gandhi TK, Wald JS, Grant RW, Poon EG, Volk LA, Businger A,
Williams DH, Siteman E, Buckel L, Middleton B.

Division of General Medicine and Primary Care, Brigham and Women’s
Hospital, Boston, Massachusetts, USA.

ObjectiveTo determine the effects of a personal health record (PHR)-linked
medications module on medication accuracy and safety.

Design: From September 2005 to March 2007, we conducted an on-treatment
sub-study within a cluster-randomized trial involving 11 primary care
practices that used the same PHR. Intervention practices received access to
a medications module prompting patients to review their documented
medications and identify discrepancies, generating ‘eJournals’ that enabled
rapid updating of medication lists during subsequent clinical visits.

Measurements: A sample of 267 patients who submitted medications eJournals
was contacted by phone 3 weeks after an eligible visit and compared with a
matched sample of 274 patients in control practices that received a
different PHR-linked intervention. Two blinded physician adjudicators
determined unexplained discrepancies between documented and patient-
reported medication regimens. The primary outcome was proportion of
medications per patient with unexplained discrepancies.

Results: Among 121?046 patients in eligible practices, 3979 participated in
the main trial and 541 participated in the sub-study. The proportion of
medications per patient with unexplained discrepancies was 42% in the
intervention arm and 51% in the control arm (adjusted OR 0.71, 95% CI 0.54
to 0.94, p=0.01). The number of unexplained discrepancies per patient with
potential for severe harm was 0.03 in the intervention arm and 0.08 in the
control arm (adjusted RR 0.31, 95% CI 0.10 to 0.92, p=0.04).

Conclusions: When used, concordance between documented and patient-reported
medication regimens and reduction in potentially harmful medication
discrepancies can be improved with a PHR medication review tool linked to
the provider’s medical record.

Trial registration number” This study was registered at ClinicalTrials.gov
(NCT00251875).
__________________________________________________________________
________________________________*_________________________________

15. Abstract: A national mapping assessment of blood collection and
transfusion service facilities in Afghanistan
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22554200

Transfusion. 2012 May 3.

A national mapping assessment of blood collection and transfusion service
facilities in Afghanistan.

Mansoor GF, Rahmani AM, Kakar MA, Hashimy P, Abrahimi P, Scott PT, Peel SA,
Rentas FJ, Todd CS.

From the Health Protection and Research Organisation; the Afghan National
Blood Safety and Transfusions Services, Ministry of Public Health, Kabul,
Islamic Republic of Afghanistan; the School of Medicine, Yale University,
New Haven, Connecticut; the United States Military HIV Research Program,
Walter Reed Army Institute of Research, Bethesda, Maryland; the Armed
Services Blood Program Office, United States Department of Defense, Falls
Church, Virginia; and the Department of Obstetrics & Gynecology, Columbia
University, New York, New York.

BACKGROUND: The purpose of this study was to assess functionality and
resources of facilities providing blood collection and transfusion services
in Afghanistan.

STUDY DESIGN AND METHODS: This national cross-sectional assessment included
facilities collecting or transfusing blood identified through official data
sources and private key informants. At each facility, study representatives
completed a standardized instrument assessing presence of records logbook,
electricity, refrigeration, and required transfusion-transmitted infection
(TTI; human immunodeficiency virus, syphilis, and hepatitis B and C) test
kits. Descriptive statistics were generated, with differences analyzed
using chi- square or Fisher’s exact tests.

RESULTS: Between August and November 2010, a total of 243 facilities were
surveyed with public (52.3%, n = 127) and private (43.2%, n = 105) sector
comprising the majority. Most (63%) facilities were urban, with 23.5%
located in Kabul province. Of 92,682 units collected nationally in the 12
months before evaluation, 7.5% (n = 6952) had no disposition record. Many
(62%, n = 151) facilities had an established recordkeeping system; the
remainder provided estimates. Half of surveyed facilities had regular power
supply (57.8%), refrigerators for storing blood (52.3%), or all necessary
TTI test kits (62.1%). Military (83.3%) and public (74.8%) facilities were
more likely to have all TTI test kits present compared to private (46.7%, p
< 0.01) but not nongovernmental organization (40.0%, p = 0.37) facilities.

CONCLUSION: In Afghanistan, blood donation and transfusion occur with
substantial differences in data recording and TTI test availability, with
private facilities less likely to have these resources. Efforts are needed
to improve available resources and ensure that facilities are in compliance
with national standards for donor screening. © 2012 American Association of
Blood Banks.
__________________________________________________________________
________________________________*_________________________________

16. Abstract: Sustained Reduction of Microbial Burden on Common Hospital
Surfaces Through The Introduction of Copper
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/22553242

J Clin Microbiol. 2012 May 2.

Sustained Reduction of Microbial Burden on Common Hospital Surfaces Through
The Introduction of Copper.

Schmidt MG, Attaway HH, Sharpe PA, John J Jr, Sepkowitz KA, Morgan A,
Fairey SE, Singh S, Steed LL, Cantey JR, Freeman KD, Michels HT, Salgado
CD.

Medical University of South Carolina, Department of Microbiology and
Immunology, Charleston, SC.

Background: The contribution of environmental surface contamination with
pathogenic organisms to the development of healthcare-associated infections
(HAI) has not been well defined.

Methods: The microbial burden (MB) associated with commonly touched
surfaces in intensive care units (ICUs) was determined by sampling six
objects in 16 rooms from ICUs in three hospitals over 43 months. At month
23, copper-alloy surfaces, with inherent antimicrobial properties, were
installed onto six monitored objects in 8 of 16 rooms and the effect that
this application had on the intrinsic MB present on the six objects was
assessed. Census continued in rooms with and without copper for an
additional 21 months.

Results: In concert with routine infection control practices, the average
MB found for the six objects assessed in the clinical environment during
the pre-intervention phase was 28 times higher (6,985 cfu/100 cm(2), n=3977
objects sampled) than levels proposed as benign immediately after terminal
cleaning, <250 cfu/100cm(2). During the intervention phase the MB was found
to be significantly lower for both the control and copper surfaced objects.
Copper was found to exert a significant 83% reduction to the average MB
found on the objects (465 cfu/100cm(2), n=2714 objects) as compared to the
controls (2,674 cfu/100cm(2), n=2,831 objects, p<0.0001).

Conclusion: The introduction of copper surfaces to objects formerly covered
with plastic, wood, stainless steel and other materials found in the
patient care environment significantly reduced the overall MB on a
continuous basis thereby providing a potentially safer environment for
hospital patients, HCWs and visitors.
__________________________________________________________________
________________________________*_________________________________

17. Abstract: Health Professions and Risk of Sporadic Creutzfeldt-Jakob
Disease, 1965 To 2010
__________________________________________________________________

Eurosurveillance, Volume 17, Issue 15, 12 April 2012

Health Professions and Risk of Sporadic Creutzfeldt-Jakob Disease, 1965 To
2010

E Alcalde-Cabero1, J Almazán-Isla1, J P Brandel2, M Breithaupt3, J
Catarino4, S Collins5, J Haybäck6, R Höftberger7, E Kahana8, G G Kovacs7,9,
A Ladogana10, E Mitrova11, A Molesworth12, Y Nakamura13, M Pocchiari10, M
Popovic14, M Ruiz-Tovar1, A L Taratuto15, C van Duijn16, M Yamada17, R G
Will12, I Zerr3, J de Pedro Cuesta ()1
National Centre of Epidemiology – Consortium for Biomedical Research in
Neurodegenerative Diseases (Centro de Investigación Biomédica en Red sobre
Enfermedades Neurodegenerativas – CIBERNED), Carlos III Institute of
Health, Madrid, Spain
Institut National de la Santé et de la Recherche Médicale (INSERM) UMRS
975, National CJD Surveillance Network, Assistance publique – Hôpitaux de
Paris (APHP), National Reference Centre for CJD, Pitié-Salpêtrière Hospital
Group, Paris, France
Department of Neurology, National Reference Centre for TSE, Georg-August
University, Göttingen, Germany
Alameda Epidemiology and Health Statistics Department, Lisbon, Portugal
Department of Pathology, University of Melbourne, Melbourne, Australia
Institute of Neuropathology, Zurich University Hospital, Zurich,
Switzerland
Institute of Neurology, Vienna Medical University, Vienna, Austria
Department of Neurology, Barzilai Medical Centre, Ashkelon, Israel
National Reference Centre for Human Prion Diseases, Semmelweis University,
Budapest, Hungary
Department of Cell Biology and Neurosciences, Health Institute, Rome, Italy
Department of Prion Diseases, Slovak Medical University Research Base,
Bratislava, Slovakia
National CJD Research and Surveillance Unit, Western General Hospital,
Edinburgh, United Kingdom
Department of Public Health, Jichi Medical University, Shimotsuke, Japan
Institute of Pathology, Medical Faculty, University of Ljubljana,
Ljubljana, Slovenia
Department of Neuropathology/FLENI, Referral Centre for CJD and other TSEs,
Institute for Neurological Research, Buenos Aires, Argentina
National Surveillance of CJD, Erasmus MC, Rotterdam, The Netherlands
Neurology Department, Kanazawa University Hospital, Kanazawa, Japan

In 2009, a pathologist with sporadic Creutzfeldt-Jakob Disease (sCJD) was
reported to the Spanish registry. This case prompted a request for
information on health-related occupation in sCJD cases from countries
participating in the European Creutzfeldt Jakob Disease Surveillance
network (EuroCJD).

Responses from registries in 21 countries revealed that of 8,321 registered
cases, 65 physicians or dentists, two of whom were pathologists, and
another 137 healthcare workers had been identified with sCJD. Five
countries reported 15 physicians and 68 other health professionals among
2,968 controls or non-cases, suggesting no relative excess of sCJD among
healthcare professionals.

A literature review revealed: (i) 12 case or small case-series reports of
66 health professionals with sCJD, and (ii) five analytical studies on
health-related occupation and sCJD, where statistically significant
findings were solely observed for persons working at physicians’ offices
(odds ratio: 4.6 (95 CI: 1.2-17.6)).

We conclude that a wide spectrum of medical specialities and health
professions are represented in sCJD cases and that the data analysed do not
support any overall increased occupational risk for health professionals.

Nevertheless, there may be a specific risk in some professions associated
with direct contact with high human-infectivity tissue.

Free article at:
http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20144
__________________________________________________________________
________________________________*_________________________________

18. No Abstract: The need for continuous education in the prevention of
needlestick injuries
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22551432

Contemp Nurse. 2011 Oct;39(2):194-205.

The need for continuous education in the prevention of needlestick
injuries.

Fourie WJ, Keogh JJ.

Head of Department, School of Nursing and Health Studies, Manukau Institute
of Technology, Manukau, New Zealand.
__________________________________________________________________
________________________________*_________________________________

19. No Abstract: Will there be a vaccine to protect against the hepatitis C
virus?
__________________________________________________________________
Gastroenterology. 2012 May;142(6):1384-7.

Will there be a vaccine to protect against the hepatitis C virus?

Callendret B, Walker CM.

The Research Institute at Nationwide Children’s Hospital and Department of
Pediatrics, College of Medicine, The Ohio State University.
__________________________________________________________________
________________________________*_________________________________

20. News

– USA: Robot at work on disinfection at Virginia hospital
– USA: Board reprimands nurse who potentially exposed patients to
hepatitis, HIV
– UK: Hand hygiene campaign slashes hospital infection rates
– UK: Hepatitis C Cases Reach Record Levels in Lothians
– USA: Ambulance Company Accused Of Dumping Medical Waste
– USA: Boy undergoes HIV, hepatitis treatment after finding syringe at
Oakland playground
– Self-Destructing’ Syringes Force Safer Injection Practices

Selected news items reprinted under the fair use doctrine of international
copyright law: http://www4.law.cornell.edu/uscode/17/107.html
__________________________________________________________________
www.healthcareitnews.com/news/robot-work-disinfection-virginia-hospital

USA: Robot at work on disinfection at Virginia hospital
Bernie Monegain, Editor, Healthcare IT News (07.05.12)

CHESAPEAKE, VA – Chesapeake Regional Medical Center has rolled out a five-
foot, automated disinfection robot named Tru-D (Total Room Ultraviolet
Disinfection), part of a $2 million CDC grant awarded to Duke University
for the prevention of healthcare-associated infections (HAIs).

CDC funding and technology selection was highly competitive. Chesapeake
Regional was one of nine facilities chosen by Duke Infection Control
Outreach Network (DICON) to implement Tru-D disinfection.

“We selected Tru-D because its automated system is proven to significantly
reduce environmental pathogens and eliminate human error in the
disinfection process,” said DICON Medical Director Daniel Sexton, MD.

U.S. Department of Health and Human Services (HHS) data reveals that one in
20 inpatients will fight an infection associated with their hospital care,
contributing to nearly 100,000 fatalities annually.

Government estimates peg annual costs for preventable infections at $33
billion, increasing hospital costs in an already tight marketplace.
Contributing to escalating costs, Medicare and Medicaid no longer reimburse
for many types of infections, leaving hospitals to foot the bill.
Integrating advanced technology like Tru-D SmartUVC into daily cleaning
protocols “would be worth it, to prevent infection,” said Billy Richmond,
MD, Chesapeake Regional’s director of infection control.

Clinical studies that link environmental surface contamination to patient
infection have resulted in strenuous hand-washing requirements for
healthcare workers. But according to Richmond, “It is not enough … as we
approach 100 percent compliance with hand-washing, we still have
infections.”

So, the focus now is to target contaminated, high-touch surfaces in a
patient’s room. “Even if you have 100 percent hand-washing, if you go into
a room and touch a contaminated surface, then you contaminate your hand,”
Richmond said.

Research indicates that three specific disinfection technologies –
accurately dosed ultraviolet light treatment, bleach and quaternary
ammonium – all show a significant reduction of environmental biological
contamination. Through this CDC-funded study, researchers will document
HAI-reduction specific to each technology, and determine if a combination
of these technologies might do a better job killing the infectious
pathogens that cause healthcare associated infections, or HAIs.

Infections are rare at Chesapeake Regional, with 72 HAIs and no fatalities
reported out of 15,604 admissions over the last 12 months, according to
hospital officials.

The Tru-D used by Chesapeake Regional emits a narrow-band of specifically
dosed UV germicidal light to kill the environmental pathogens that commonly
cause infections acquired at hospitals.

Tru-D SmartUVC is the only portable UV disinfection system that precisely
measures reflected UVC emissions with Sensor360 technology to automatically
calculate the pathogen-lethal UV dose required for each room, dynamically
compensating for room size, shape and other dose altering variables such as
the position of contents, windows, blinds and doors.
__________________________________________________________________
__________________________________________________________________
USA: Board reprimands nurse who potentially exposed patients to hepatitis,
HIV
David Wahlberg, The Wisconsin State Journal, Wisconsin USA (04.05.12)

The Wisconsin Board of Nursing on Thursday reprimanded Stacey Anderson, a
former diabetes nurse educator at Dean Health System who potentially
exposed more than 2,000 patients to hepatitis or HIV over five years.

The board also fined Anderson $450 and made her pay to take classes on
medical errors, infection control and exposure to blood-borne pathogens.
Reprimands go on health professionals’ permanent records.

Dean officials announced in August that a nurse mistakenly reused insulin
demonstration pens and finger stick devices, possibly exposing 2,345
patients to hepatitis B or C, or HIV, from 2006 to Aug. 10, 2011.

Anderson’s “conduct in these situations increased the risk of blood-borne
pathogens from one patient to another,” the nursing board said in its
disciplinary order approved unanimously Thursday.

Anderson, 39, of Madison, told the board she let some patients give
themselves a “dry stick” with the demonstration pens. Health officials say
the pens are supposed to be used on oranges or pillows, not people.

Some of the devices used by Anderson had labels stating “not for human
use,” the nursing board said.

Anderson said she replaced the needle mechanism of the pen and cleaned the
pen with alcohol between patients, but she sometimes let patients
administer saline out of the same cartridge.

Anderson, who was fired from Dean, will have to provide the order to any
prospective employer for two years, the nursing board said.

Anderson and her attorney couldn’t be reached for comment Thursday.

More than 1,500 patients have been tested for the viruses, Dean spokeswoman
Kim Sveum said, but Dean hasn’t publicly released testing results. Nearly
700 patients were found not to need testing because they had no contact
with the devices, Sveum said.

In January, a Monona man sued Dean, saying he contracted hepatitis C after
seeing Anderson “on or before” Sept. 16, 2009.

Keith Steffen, 55, also named Dean’s insurer, Midwest Medical Insurance
Co., and Wisconsin’s Injured Patients and Families Compensation Fund, which
covers payments of more than $1 million.

Steffen also sued the Dane County Department of Human Services because it
covered his state BadgerCare health benefits.
__________________________________________________________________
__________________________________________________________________
www.onmedica.com/newsarticle.aspx?id=06d6203c-8a0d-4006-8482-13a6a54a2f79

UK: Hand hygiene campaign slashes hospital infection rates

Adrian O’Dowd, OnMedica, UK (04.05.12)

A national hand hygiene campaign designed to reduce healthcare associated
infections in hospitals across England and Wales has been highly
successful, concludes a study published online today by the BMJ.

The CleanYourHands campaign has played an important role in almost halving
rates of MRSA and C difficile infections between 2005 and 2009 and was the
first such campaign in the world to be rolled out nationally.

The government campaign was rolled out from January 2005 to all acute NHS
trusts in England and Wales following concern over high levels of
infections and low levels of hand hygiene in hospitals.

The main aim was to reduce high levels of Staphylococcus aureus infection –
meticillin resistant (MRSA) and meticillin sensitive (MSSA) – and
Clostridium difficile infection that spread through contamination of
healthcare workers hands.

As part of the campaign, alcohol hand rub was provided at each hospital
bedside, posters were distributed, regular audits and feedback took place,
and materials were given to patients to remind healthcare workers to clean
their hands. Every trust had to order soap and alcohol hand rub from
central NHS supply agencies, to ensure products met high standards.

Researchers from the Royal Free Campus, University College London Medical
School and the Health Protection Agency, set out to evaluate the impact of
the CleanYourHands campaign on rates of hospital procurement of alcohol
hand rub and soap and its association with infection rates. These were
measured every three months across all 187 acute NHS hospital trusts
between 2005 and 2009.

Results showed that the amount of soap and alcohol hand rub being bought
and used tripled from 21.8 to 59.8 ml per patient bed day.

Over the study period, rates of MRSA infections more than halved from 1.88
to 0.91 cases per 10,000 bed days while C difficile infections fell by more
than 40% from 16.75 to 9.49 cases. MSSA infection rates did not fall.

The authors found that increased procurement of soap was independently
associated with reduced C difficile infection throughout the study, while
more procurement of alcohol hand rub was independently associated with
reduced MRSA infection, but only in the last year of the study. These
strong and independent associations remained after taking account of all
other interventions.

Increasing procurement was not the only reason for these reductions, and
the authors stressed that there were other factors involved such as the
publication of the Health Act 2006 and visits by Department of Health
improvement teams.

The authors concluded: “The study suggests that national infection control
interventions, including a hand hygiene campaign, undertaken in the context
of a high profile political drive, can successfully reduce selected
healthcare associated infections.”

A Department of Health spokesperson said: “Real progress has been made by
this government on this. MRSA bloodstream infection has dropped by 41% and
C. difficile by 30% across the NHS in England since 2009-10.

“The CleanYourHands campaign was successful in its aim to highlight the
importance of good hand hygiene practice across the NHS. We know this has
been successful. We want to make sure the NHS continues the good practice
highlighted in the campaign.”
__________________________________________________________________
__________________________________________________________________
UK: Hepatitis C Cases Reach Record Levels in Lothians
The Scotsman, UK (03.05.12) [Edited]

Hepatitis C diagnoses in the Lothians hit a record high last year, though
health experts say this indicates that government-led awareness and testing
efforts are effective.

“We welcome the increase, because it shows that the action plan is
working,” said Petra Wright, Scottish officer for the Hepatitis C Trust.

Wright noted that in 2009, testing was introduced at drug outreach
facilities. And in 2011, the Scottish government implemented the Sexual
Health and Blood-Borne Viruses Framework. Last summer, posters went up in
pubs and clubs across the Capital warning of hepatitis C, explaining how
the disease is transmitted, and promoting support groups.

In 2011, 333 hepatitis C infections were diagnosed, up from 276 in 2010 and
202 in 2009. Last year’s diagnoses represent a two-fold increase over a
decade ago.

Some 3,700 people in the Lothians are known to be infected with hepatitis
C, but Wright said the true figure is likely two times as high. The virus
can remain symptomless for up to a decade, while early symptoms – including
depression, fatigue, skin problems, insomnia, digestive issues, and pain –
are often mistaken for other conditions. The greatest risk factor for
infection is injecting drug use, though steroid users and those who have
received tattoos from unlicensed providers or abroad also are at risk.
__________________________________________________________________
__________________________________________________________________
USA: Ambulance Company Accused Of Dumping Medical Waste
WRGB, Albany New Your, USA (03.05.12)

ALBANY — A local ambulance company is in hot water and is being told to
clean up its act.

The Capital District Ambulance Service is accused of dumping medical waste
in abandoned ambulances. CBS6 has learned that DGS workers who were
performing routine maintenance found bags of blood-soaked rags and dirty
needles in a lot at 86 West Street.

Albany Fire Chief Bob Forezzi said that firefighters were called in to
investigate, but he said that he didn’t want to put his firefighters at
risk so he turned it over to the Department of Environmental Conservation.

DEC spokesman Rick Georgeson told CBS6 that the ambulance company complied
with an order to clean up the mess, and the waste is now secured at their
facility. Georgeson said that anyone could have had access to the medical
waste.

The Capital District Ambulance Service is now facing two misdemeanor
charges that each carry up to one year in jail for the company manager, and
a fine ranging from $1,000 to $10,000.
__________________________________________________________________
__________________________________________________________________
USA: Boy undergoes HIV, hepatitis treatment after finding syringe at
Oakland playground
FoxReno.com (02.05.21)

OAKLAND, Calif. – A young boy who pricked his finger after finding a used
syringe in an Oakland schoolyard last week is undergoing preventive
treatment for HIV and hepatitis as a precaution.

Seven-year-old Miklo Santiago was in the Highland Children’s Center
playground doing what boys do last Wednesday — digging in the dirt during
recess — when he found a used syringe.

That afternoon, the first grader’s mother Elaine Cruz picked him up from
his after-school program and learned about his discovery in shocking
fashion.

“My son has a syringe in his pocket, pulls it out and says look ‘Mommy,
look what I found.'” said Elaine Cruz. “My heart just dropped.” Worried,
Cruz rushed her son to Children’s Hospital Oakland. Once there, a blood
sample was taken.

As a precaution, doctors prescribed two medications to prevent HIV and
Hepatitis B and C.

“They told us for the next six months, we wouldn’t really know if he
contracted anything, because that’s how long it takes, ” said Cruz. “In the
meantime, they can just test his blood to make sure that he has enough
immunity to fight off whatever could be in that needle. ”

Cruz and the boy’s father, Kenny Santiago, said the next six months will be
filled with lots of prayers. “I’m scared. And my son is scared,” said
Santiago. “He asked us the other day is he going to die. And we were like,
‘No son, you’re going to be alright.'”

School District spokesman Troy Flint apologized for the incident and
promised there would be more thorough cleanings of the play area more
often. “We have made sure to reinforce that there be a daily sweep of the
grounds by custodial staff,” said Flint.

Miklo’s parents were understandably angry with the school about the
incident. “You think when you send your kids to school that you are sending
them to a safe place. A clean place where they are well supervised,” says
Santiago. “For something like that to happen at a school is really
unacceptable.”

Cruz and Santiago also criticized the district for not informing the
families of the 100 students who attend the Highland Children’s Center
program about the needle discovery.

Flint said a letter is set to go out on Thursday, more than a week after
the incident.
__________________________________________________________________
__________________________________________________________________
‘Self-Destructing’ Syringes Force Safer Injection Practices
By: Talea Miller, PBS NewsHour USA (02.11.11)

A nurse injects a patient with a syringe of antibiotics, reloads and moves
on to the next patient in line. The syringe isn’t sterilized, the needle is
not replaced, and the patient is at risk of contracting a disease from the
very shot that is supposed to cure him.

It’s a disturbing scenario, and one that plays out each day in many poor
countries. About 40 percent of all injections are given with unsterilized,
reused syringes and needles, reports the World Health Organization. An
estimated 1.3 million deaths — and 21.7 million new Hepatitis B infections
— occur each year as a result of the unsafe practice.

To prevent this from happening, organizations like UNICEF and the WHO have
moved to syringes that “self destruct” after one use to protect patients
from contracting blood-borne diseases. The devices, called auto-disable
syringes, jam up after one injection and can’t be reused. The casing is
engineered to break if someone tries to forcefully refill it.

View a diagram of one auto-disable model below, which locks the plunger
after one use with a metal clip. Other models feature a breaking plunger,
which cracks the syringe once it is used.

Now, Tanzania has committed to becoming the first country to exclusively
use auto-disable syringes.

Edward Hoekstra, a senior health and measles vaccine specialist at UNICEF,
welcomed the news from Tanzania, but said the problem is still widespread.
UNICEF has been using only auto-disable syringes for all its preventative
child immunizations, but the vast majority of injections each year are for
treatment of disease and are harder for governments to regulate.

Hoekstra recalls watching a line of 20 children vaccinated with a
disposable syringe and needle in a rural health clinic in China prior to
the switch to auto-disable child vaccines.

“In developing countries, you only pay 5 cents for a syringe but their
incomes might be 1 dollar a day. So if you have 20 kids that you vaccinate
with one syringe then you have a doubling of your income,” he said. “It’s
dubious if people will make the right decision.”

Regular disposable syringes can also make their way back into the
marketplace after being used. People will take syringes from a health
clinic’s trash, wash them and repackage them for resale.

“You can find in a market a perfectly well packed syringe, then you look
closely and you can still see some blood in the syringe from the last
person,” he said.

An investigation in India in 2009, reported in the Lancet, found warehouses
filled with syringes and needles recovered by waste-pickers and repackaged
to be sold on the black market.

Most modern syringes are made of plastic, and even if the needle is
replaced, bits of blood can be retracted into the syringe and passed on to
other patients. The syringe itself can’t be sterilized and is intended to
be disposed.

By eliminating the ability to reuse the syringe, a used auto-disable
syringe can’t be resold. But concerns have been raised about the amount of
medical waste generated by auto-disable syringes, and the need for safe
waste removal plans. Hoekstra said vaccines in general generate a huge
quantity of medical waste from the millions of children immunized in
countries around the globe each year. Waste boxes are distributed with all
auto-disable vaccines, and the syringes are usually incinerated or dropped
in strong sterilization chemicals, depending on the location.

He points to innovation in the engineering of the syringes as one of the
solutions, the next evolution in products designed to solve this health
dilemma. New auto-disable syringes are being designed to use less
materials, create less waste and fit more vaccines into each shipment.
Manufacturers save money on materials, and are offering the devices at no
extra cost.

“It is a win-win situation,” he said.
__________________________________________________________________
________________________________*_________________________________
* SAFETY OF INJECTIONS brief yourself at: www.injectionsafety.org

A fact sheet on injection safety is available at:
http://www.who.int/mediacentre/factsheets/fs231/en/index.html

* Visit the WHO injection safety website and the SIGN Alliance Secretariat
at: http://www.who.int/injection_safety/en/

* Download the WHO Best Practices for Injections and Related Procedures
Toolkit March 2010 [pdf 2.47Mb]:
http://whqlibdoc.who.int/publications/2010/9789241599252_eng.pdf

Use the Toolbox at: http://www.who.int/injection_safety/toolbox/en/

Get SIGN files on the web at: http://signpostonline.info/signfiles-2
get SIGNpost archives at: http://signpostonline.info/archives-by-year

Like on Facebook: http://facebook.com/SIGN.Moderator

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@who.int
__________________________________________________________________
________________________________*_________________________________

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:
http://www.who.int/entity/injection_safety/toolbox/sign2010_meeting.pdf

The report is navigable using bookmarks and is searchable. Viewing
requires the free Adobe Acrobat Reader at: http://get.adobe.com/reader/

Translation tools are available at: http://www.google.com/language_tools
or http://www.freetranslation.com
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The comments made in this forum are the sole responsibility of the writers
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Use of trade names and commercial sources is for identification only and
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The SIGN Forum welcomes new subscribers who are involved in injection
safety.

* Subscribe or un-subscribe by email to: sign.moderator@gmail.com, or to
sign@who.int

SIGNpost Website

The new website http://SIGNpostOnline.info is a work in progress and will
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We would like your help in building this archive. Please send your old
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The SIGN Internet Forum was established at the initiative of the World
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SIGN Forum is moderated by Allan Bass and is hosted on the University of
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