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SIGNpost 00651

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

Post00651 Congo HCW BBV? + Abstracts + Review + RFP + News 30 May 2012

CONTENTS
1. Abstract: Practice of universal precautions and risk of occupational
blood-borne viral infection among Congolese health care workers
2. Abstract: Hepatitis C transmission due to contamination of multidose
medication vials: Summary of an outbreak and a call to action
3. Abstract: The potential clinical relevance of visible particles in
parenteral drugs
4. Abstract: Needlesticks injuries in dentistry
5. Abstract: Medical waste management at Oncology Institute of Vojvodina:
possibilities to successful implementation of medical waste regulation
in Serbia
6. Abstract: Infection control through the ages
7. Abstract: Budget impact analysis of insulin therapies and associated
delivery systems
8. Abstract: Defining and assessing evidence for the effectiveness of
technical assistance in furthering global health
9. Abstract: The development and characteristics of novel microneedle
arrays fabricated from hyaluronic acid, and their application in the
transdermal delivery of insulin
10. Abstract: Clinical pharmacology, uses, and adverse reactions of
iodinated contrast agents: a primer for the non-radiologist
11. Abstract: Intramuscular versus intravenous prophylactic oxytocin for
the third stage of labour
12. Abstract: Evidence-Based Knee Injections for the Management of
Arthritis
13. No Abstract: Disinfection requirements in punctures and injections: new
recommendation of the Robert Koch Institute
14. No Abstract: Formalin-induced iatrogenic cellulitis: a rare case of
dental negligence
15. No Abstract: Accidental injection of formalin into oral soft tissue:
are medications the only treatment?
16. No Abstract: Butterfly needles reduce the incidence of nerve injury
during phlebotomy
17. RFP: Visual cues on vaccine vials
18. Book Review: No Time to Lose: A Life in Pursuit of Deadly Viruses
19. News
– Calif. Veterans Affairs Health Care Facilities Hit with 30 Safety
Violations
– India: Beware the needle
– Body Art Training Group Approved as Provider of Bloodborne Pathogens
Training
– Viet Nam: HIV/AIDS cases decline: Ministry
– Kenya: Kenya drug addicts to get free needles, syringes
– For Those Who Fear Needles, an Air-Jet Alternative
– Pakistan: WHO to introduce new strategy to fight HIV/AIDS
– Kenya: Public forum to demystify needles
– Global: ‘Emergency plan’ to eradicate polio launched
– UK: Dental patients put at HIV risk by poor hygiene
– Buggy break rooms: Study reveals office ick
– USA: State Allows Pharmacies to Offer More Vaccines

The web edition of SIGNpost is online at:
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page at: http://facebook.com/SIGN.Moderator

Selected updates at: http://twitter.com/#!/signmoderator
__________________________________________________________________
________________________________*_________________________________

1. Abstract: Practice of universal precautions and risk of occupational
blood-borne viral infection among Congolese health care workers
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/21592618

Am J Infect Control. 2012 Feb;40(1):68-70.e1.

Practice of universal precautions and risk of occupational blood-borne
viral infection among Congolese health care workers.

Ngatu NR, Phillips EK, Wembonyama OS, Hirota R, Kaunge NJ, Mbutshu LH,
Perry J, Yoshikawa T, Jagger J, Suganuma N.

Department of Environmental Medicine, Kochi Medical School, Kochi
University, Nankoku, Japan.

The extent of occupational injuries among health care workers in central
Africa, particularly in the Democratic Republic of Congo, is not
documented. We sought to determine the incidence of percutaneous injury and
exposure to blood and other body fluids in Congolese urban and rural
hospitals in the previous year. Our data show high rates of percutaneous
injury and exposure to blood and other body fluids, reflecting poor safety
conditions for most Congolese health care workers.

Crown Copyright © 2012. Published by Mosby, Inc. All rights reserved.

Free Full text:
http://www.ajicjournal.org/article/S0196-6553(11)00169-6/fulltext
__________________________________________________________________
________________________________*_________________________________

2. Abstract: Hepatitis C transmission due to contamination of multidose
medication vials: Summary of an outbreak and a call to action
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/22632822

Am J Infect Control. 2012 May 25.

Hepatitis C transmission due to contamination of multidose medication
vials: Summary of an outbreak and a call to action.

Branch-Elliman W, Weiss D, Balter S, Bornschlegel K, Phillips M.

Divisions of Infectious Diseases and Infection Control/Hospital
Epidemiology, Beth Israel Deaconess Medical Center, Boston, MA.

In May 2001, The New York City Department of Health and Mental Hygiene was
informed of a cluster of 4 patients treated at an outpatient
gastroenterology center who developed acute hepatitis C virus infection.

An investigation identified a total of 12 clinic-associated hepatitis C
virus transmissions and the outbreak and was traced to unsafe handling of
multidose anesthetic vials and possible re-use of contaminated needles.

This report typifies the types of outbreaks that continue to occur despite
safe injection guidelines.

Copyright © 2012 Association for Professionals in Infection Control and
Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

3. Abstract: The potential clinical relevance of visible particles in
parenteral drugs
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22628244

J Pharm Sci. 2012 May 24. doi: 10.1002/jps.23217.

The potential clinical relevance of visible particles in parenteral drugs.

Doessegger L, Mahler HC, Szczesny P, Rockstroh H, Kallmeyer G, Langenkamp

A, Herrmann J, Famulare J.

Pharma Development Safety Risk Management, F. Hoffmann-La Roche AG, Basel,
Switzerland. lucette.doessegger@roche.com.

Visible particulates (VP) are one subclass of defects seen during the final
visual inspection of parenteral products and are currently one of the top
ten reasons for recalls 1,2.

The risk posed by particles is still unclear with limited experience
reported in humans but remains an important consideration during the
manufacture and use of parenteral products.

From the experimental and clinical knowledge of the distribution of
particulate matter in the body, clinical complications would include events
occurring around parenteral administration e.g., as a result of mechanical
pulmonary artery obstruction and injection site reaction, or sub-acute or
chronic events e.g., granuloma.

The challenge is to better understand the implication for patients of
single vials with VP and align the risk with the probabilistic detection
process used by manufacturers for accept/reject decisions of individual
units of product.

© 2012 Wiley Periodicals, Inc. and the American Pharmacists Association J
Pharm Sci.
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Needlesticks injuries in dentistry
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22609509

Kathmandu Univ Med J (KUMJ). 2011 Jul;9(35):208-12.

Needlesticks injuries in dentistry.

Gupta N, Tak J.

Department of Periodontics, Shree Bankey Bihari Dental College and Research
Centre.

Needlestick injuries and other sharps-related injuries which expose health
care professionals to bloodborne pathogens continue to be an important
public health concern. Dentists are at increased risk of exposure to
bloodborne pathogens, including Hepatitis B, Hepatitis C, and HIV.

This article presents comprehensive information on Needlestick injuries
(NSI), post exposure prophylaxis, precautions and suggestions for
prevention of NSI in dentistry.

Dentists should remember and apply many precautions to prevent the broad
spectrum of sharps and splash injuries that could occur during the delivery
of dental care.
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Medical waste management at Oncology Institute of Vojvodina:
possibilities to successful implementation of medical waste regulation
in Serbia
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22617472

Waste Manag Res. 2012 May 21.

Medical waste management at Oncology Institute of Vojvodina: possibilities
to successful implementation of medical waste regulation in Serbia.

Gavrancic T, Simic A, Gavrancic B.

Blood Transfusion Institute, Novi Sad, Serbia.

Implementation of National waste management strategy, which included most
of Healthcare facilities (HCF) in Serbia, began in 2009. The present study
aimed to evaluate the medical waste management strategy protocol at
Oncology Institute of Vojvodina, which is the first institution in
Vojvodina and one of the first institutions in Serbia which has implemented
the recomended medical waste management protocol.

Segregation, storage, transportation and treatment were all evaluated and
that was all performed according to National strategy. Biohazard generation
rate was 0,17 kg/bed/day, which correspods with values in the HCF in
Eastern Europe.

The results show that the methods for safe management of medical waste are
acceptable, affordable, and economically justifable to accomplish the
reduction in the financial costs in HCF business, and can serve as
representative of proper medical waste management practice for other HCF.
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Infection control through the ages
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/21783278

Am J Infect Control. 2012 Feb;40(1):35-42.

Infection control through the ages.

Smith PW, Watkins K, Hewlett A.

Division of Infectious Diseases, Department of Internal Medicine,
University of Nebraska Medical Center, Omaha, NE 68198-5400, USA.
pwsmith@unmc.edu

To appreciate the current advances in the field of health care
epidemiology, it is important to understand the history of hospital
infection control.

Available historical sources were reviewed for 4 different historical time
periods: medieval, early modern, progressive, and post-World War II.

Hospital settings for the time periods are described, with particular
emphasis on the conditions related to hospital infections.

Copyright © 2012 Association for Professionals in Infection Control and
Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Budget impact analysis of insulin therapies and associated
delivery systems
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/22610028

Am J Health Syst Pharm. 2012 Jun 1;69(11):958-65.

Budget impact analysis of insulin therapies and associated delivery
systems.

Lee LJ, Smolen LJ, Klein TM, Foster SA, Whiteman D, Jorgenson JA, Hultgren
S.

Purpose A budget impact analysis of insulin therapies and associated
delivery systems is presented.

Methods Based on inputted procurement totals, per-item costs (based on 2011
average wholesale price), insulin distribution system (floor stock or
individual patient supply), waste, and treatment protocols for a specified
time frame, the budget impact model approximated the number of patients
treated with subcutaneous insulin, costs, utilization, waste, and injection
mechanism (pen safety needle or syringe) costs. To calculate net changes,
results of one-year 3-mL vial use were subtracted from one-year 10-mL vial
or 3-mL pen use.

Results Switching from a 10-mL vial to a 3-mL vial was associated with
reductions in both costs and waste. The net reductions in costs and waste
ranged from $15,482 and 120,000 IU, respectively, for floor-stock 10-mL
vial to floor-stock 3- mL vial conversion to $871,548 and 6,750,000 IU,
respectively, for individual patient supply 10-mL vial to floor-stock 3-mL
vial conversion. Switching from floor-stock 10-mL vials to individual
patient supply 3-mL vials increased costs and waste by $164,659 and
1,275,000 IU, respectively. Converting from individual patient supply 3-mL
pens to individual patient supply 3-mL vials reduced costs by $117,236 but
did not decrease waste.

Conclusion A budget impact analysis of the conversion of either 10-mL
insulin vials or 3-mL insulin pens to 3-mL insulin vials found reductions
in both cost and waste, except when converting from floor-stock 10-mL vials
to individual patient supply 3-mL vials.
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Defining and assessing evidence for the effectiveness of
technical assistance in furthering global health
__________________________________________________________________

Global Public Health: An International Journal for Research, Policy and
Practice

Defining and assessing evidence for the effectiveness of technical
assistance in furthering global health

DOI:10.1080/17441692.2012.682075

Gary R. Westa*, Sheila P. Clappa, E. Megan Davidson Averilla & Willard
Cates Jr.a

Available online: 21 May 2012

In an era when health resources are increasingly constrained, international
organisations are transitioning from directly managing health services to
providing technical assistance (TA) to in-country owners of public health
programmes.

We define TA as: ‘A dynamic, capacity-building process for designing or
improving the quality, effectiveness, and efficiency of specific
programmes, research, services, products, or systems’. TA can build
sustainable capacities, strengthen health systems and support country
ownership. However, our assessment of published evaluations found limited
evidence for its effectiveness.

We summarise socio-behavioural theories relevant to TA, review published
evaluations and describe skills required for TA providers.

We explore challenges to providing TA including cost effectiveness,
knowledge management and sustaining TA systems.

Lastly, we outline recommendations for structuring global TA systems.
Considering its important role in global health, more rigorous evaluations
of TA efforts should be given high priority.

Free Full Article – Open Access at:
http://www.tandfonline.com/doi/full/10.1080/17441692.2012.682075
__________________________________________________________________
________________________________*_________________________________

9. Abstract: The development and characteristics of novel microneedle
arrays fabricated from hyaluronic acid, and their application in the
transdermal delivery of insulin
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/22634072

J Control Release. 2012 May 22.

The development and characteristics of novel microneedle arrays fabricated
from hyaluronic acid, and their application in the transdermal delivery of
insulin.

Liu S, Jin MN, Quan YS, Kamiyama F, Katsumi H, Sakane T, Yamamoto A.

Department of Biopharmaceutics, Kyoto Pharmaceutical University, Misasagi,
Yamashina-ku, Kyoto 607-8414, Japan.

The aim of the present study was to develop novel insulin-loaded
microneedle arrays (MNs) fabricated from hyaluronic acid (HA), and
characterize their applicability in the transdermal delivery of insulin.

The shape of MNs was observed via scanning electron microscopy. The
characteristics of these novel insulin-loaded MNs, including hygroscopy,
stability, drug release profiles, and dissolution properties, were
evaluated from a clinical application point-of-view. Transepidermal water
loss (TEWL) was measured to investigate the piercing properties of MNs, and
the recovery of the skin barrier after the removal of MNs to confirm their
safety. Additionally, the transdermal absorption of insulin from MNs was
examined via an in vivo absorption study in diabetic rats. The length of
MNs was 800µm with a base diameter of 160µm and a tip diameter of 40µm. MNs
were found to maintain their skin piercing abilities for at least 1h, even
at a relative humidity of 75%.

After storing insulin-loaded MNs for a month at -40, 4, 20, and 40°C, more
than 90% of insulin remained in MNs at all temperatures, indicating that
insulin is highly stable in MNs at these storage conditions. It was also
found that insulin is rapidly released from MNs via an in vitro release
study. These findings were consistent with the complete dissolution of MNs
within 1h of application to rat skin in vivo. Therefore, the novel HA MNs
possess self-dissolving properties after their dermal application, and
insulin appears to be rapidly released from these MNs. A significant
increase in TEWL was observed after the application of MNs. However, this
parameter recovered back to baseline within 24h after the removal of MNs.

These findings indicate that the transdermal transport pathway of insulin,
which was created by the MNs, disappeared within 24h, and that the skin
damage induced by the MNs was reversible. Furthermore, a dose-dependent
hypoglycemic effect and transdermal delivery of insulin were observed after
a dermal treatment with insulin-loaded MNs in vivo. A continuous
hypoglycemic effect was observed after 0.25IU of insulin was administered
to skin via MNs.

Additionally, lower peak plasma insulin levels, but higher plasma insulin
concentrations after 2h, were achieved with 0.25IU of insulin administered
via MNs as compared to the subcutaneous administration of insulin of the
same dose. Pharmacodynamic and pharmacokinetic parameters indicated that
insulin administered via MNs was almost completely absorbed from the skin
into the systemic circulation, and that the hypoglycemic effect of insulin-
loaded MNs was almost similar to that of the subcutaneous injection of
insulin.

These findings indicate that the novel insulin-loaded MNs fabricated from
HA are a very useful alternative method of delivering insulin via the skin
into the systemic circulation without inducing serious skin damage.
Therefore, HA MNs may be an effective and safe method of transdermal
insulin delivery in the clinic.

Copyright © 2012. Published by Elsevier B.V.
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Clinical pharmacology, uses, and adverse reactions of
iodinated contrast agents: a primer for the non-radiologist
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/22469351

Mayo Clin Proc. 2012 Apr;87(4):390-402.

Clinical pharmacology, uses, and adverse reactions of iodinated contrast
agents: a primer for the non-radiologist.

Pasternak JJ, Williamson EE.

Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, USA.

Pasternak.jeffrey@mayo.edu

Iodinated contrast agents have been in use since the 1950s to facilitate
radiographic imaging modalities. Physicians in almost all specialties will
either administer these agents or care for patients who have received these
drugs.

Different iodinated contrast agents vary greatly in their properties, uses,
and toxic effects. Therefore, clinicians should be at least superficially
familiar with the clinical pharmacology, administration, risks, and adverse
effects associated with iodinated contrast agents.

This primer offers the non-radiologist physician the opportunity to gain
insight into the use of this class of drugs. Copyright © 2012 Mayo
Foundation for Medical Education and Research.

Published by Elsevier Inc. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

11. Abstract: Intramuscular versus intravenous prophylactic oxytocin for
the third stage of labour
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22336865

Cochrane Database Syst Rev. 2012 Feb 15;2:CD009332.

Intramuscular versus intravenous prophylactic oxytocin for the third stage
of labour.

Oladapo OT, Okusanya BO, Abalos E.

Maternal and Fetal Health Research Unit, Department of Obstetrics and
Gynaecology, Obafemi Awolowo College of Health Sciences,Olabisi Onabanjo
University, Sagamu, Nigeria. tixon y2k@hotmail.com.

BACKGROUND: There is a general agreement that oxytocin given either through
the intramuscular or intravenous route is effective in reducing postpartum
blood loss. However, it is unclear whether the subtle differences between
the mode of action of these routes have any effect on maternal and infant
outcomes.

OBJECTIVES: To determine the comparative effectiveness and safety of
oxytocin administered intramuscularly or intravenously for prophylactic
management of the third stage of labour after vaginal birth.

SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group’s
Trials Register (31 December 2011).

SELECTION CRITERIA: Randomised trials comparing intramuscular with
intravenous oxytocin for prophylactic management of the third stage of
labour after vaginal birth. We excluded quasi-randomised trials.

DATA COLLECTION AND ANALYSIS: Two review authors planned to independently
assess trials for inclusion, assess risk of bias and extract data.

MAIN RESULTS: The search strategies identified no trials for consideration
but we identified one ongoing study.

AUTHORS’ CONCLUSIONS: There is no evidence from randomised trials to
evaluate the comparative benefits and risks of intramuscular and
intravenous oxytocin when given to prevent excessive blood loss after
vaginal birth. Randomised trials with adequate design and sample sizes are
needed to assess whether the route of prophylactic oxytocin after vaginal
birth affects maternal or infant outcomes. Such trials should be large
enough to detect clinically important differences in major side effects
reported in observational studies and also to consider the acceptability of
the intervention to mothers and providers as important outcomes.

Full Article: Free Open Access at:
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD009332.pub2/full
__________________________________________________________________
________________________________*_________________________________

12. Abstract: Evidence-Based Knee Injections for the Management of
Arthritis
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/22621287

Pain Med. 2012 May 23.

Evidence-Based Knee Injections for the Management of Arthritis.

Cheng OT, Souzdalnitski D, Vrooman B, Cheng J.

Department of Pain Management, Cleveland Clinic, Cleveland, Ohio, USA.

Objective. Arthritis of the knee affects 46 million Americans. We aimed to
determine the level of evidence of intraarticular knee injections in the
management of arthritic knee pain.

Methods. We systematically searched PUBMED/MEDLINE and the Cochrane
databases for articles published on knee injections and evaluated their
level of evidence and recommendations according to established criteria.

Results. The evidence supports the use of intraarticular corticosteroid
injections for rheumatoid arthritis (1A+ Level), osteoarthritis (1A+
Level), and juvenile idiopathic arthritis (2C+ Level). Pain relief and
functional improvement are significant for months up to 1 year after the
injection. Triamcinolone hexacetonide offers an advantage over
triamcinolone acetonide and should be the intraarticular steroid of choice
(2B+ Level).

Intraarticular injection of hyaluronate may provide longer pain relief than
steroid injection in osteoarthritis (2B+ Level). It can also be effective
for rheumatoid arthritis knee pain (1A+ Level). However, it is only
recommended for patients with significant surgical risk factors and for
patients with mild radiographic disease in whom conservative treatment has
failed (2B± Level). Botulinum toxin type A injection is effective in
reducing arthritic knee pain (2B+ Level), and so is tropisetron (2B+ Level)
and tanezumab (2B+ Level). T

he new agents, such as rAAV2-TNFR:Fc, SB-210396/CE 9.1, and various
radioisotopes have provided various degrees of success, but their long-term
safety and efficacy remains to be determined.

Conclusions. We conclude that strong evidence supports the use of
intraarticular knee injection as a valuable intervention in the continuum
of management of arthritis between conservative treatment and knee
surgeries.

Wiley Periodicals, Inc
__________________________________________________________________
________________________________*_________________________________

13. No Abstract: Disinfection requirements in punctures and injections: new
recommendation of the Robert Koch Institute
__________________________________________________________________
Kinderkrankenschwester. 2012 Mar;31(3):97-8.

[Disinfection requirements in punctures and injections: new recommendation
of the Robert Koch Institute].

[Article in German]

Panknin HT.

ht.panknin@berlin.de
__________________________________________________________________
________________________________*_________________________________

14. No Abstract: Formalin-induced iatrogenic cellulitis: a rare case of
dental negligence
__________________________________________________________________
J Oral Maxillofac Surg. 2011 Dec;69(12):e525-7.

Formalin-induced iatrogenic cellulitis: a rare case of dental negligence.

Gupta DS, Srivastava S, Tandon PN, Jurel S, Sharma S, Singh S Jr.

Senior Lecturer, Department of Oral & Maxillofacial Surgery, Teerthanker
Mahaveer Dental College & Research Centre, Moradabad, India.
drdsgupta@gmail.com
Comment in
__________________________________________________________________
________________________________*_________________________________

15. No Abstract: Accidental injection of formalin into oral soft tissue:
are medications the only treatment?
__________________________________________________________________
J Oral Maxillofac Surg. 2012 Apr;70(4):755-6.

Accidental injection of formalin into oral soft tissue: are medications the
only treatment?

Arakeri G, Brennan PA.

Comment on J Oral Maxillofac Surg. 2011 Dec;69(12):e525-7.
__________________________________________________________________
________________________________*_________________________________

16. No Abstract: Butterfly needles reduce the incidence of nerve injury
during phlebotomy
__________________________________________________________________
Arch Pathol Lab Med. 2012 Apr;136(4):352.

Butterfly needles reduce the incidence of nerve injury during phlebotomy.

Ohnishi H, Watanabe M, Watanabe T.

http://www.archivesofpathology.org/doi/full/10.5858/arpa.2011-0431-LE

Open Access
__________________________________________________________________
________________________________*_________________________________

17. RFP: Visual cues on vaccine vials

Crossposted from TECHNET21 with thanks.
__________________________________________________________________
RFP: Visual cues on vaccine vials

The Immunization Practices Advisory Committee (IPAC), and the Technology
and Logistics Advisory Committee (TLAC) previously, has been guiding WHO in
the development and testing of appropriate visual cues. Two types of
visual cues were tested: one indicating to health workers which vaccines
are appropriate to discard six hours after opening, and the second which
vaccines can be kept under certain conditions for up to 28 days, in
accordance with the MDVP. IPAC has recommended a preferred set of visual
cues that are now ready for final field testing in a pilot country.

* The visual cues were designed to reinforce the compliance of health
workers behaviour to the MDVP. Previously, health workers would use the
fact that a multi-dose vial was a liquid formulation as an indicator that
the vial could be kept open for subsequent sessions.

The piloting is directed at assessing the processes involved in the
introduction of visual cues, including whether they successfully reinforce
the correct behaviour in health workers, even in the context where the
previous policy training (liquid vaccine means “keep for subsequent
sessions”) is no longer valid.

Objectives

The objectives of this proposal are:
• to describe the implementation processes involved in adopting vaccines
with visual cues at peripheral, intermediate, and central levels of the
system; identifying facilitating and limiting factors; and including
stakeholder roles and costs (e.g. changes in vaccines costs, supporting
interventions such as training and supervision, costs due to vaccine
wastage);
• to develop (or adapt where available), review, implement and evaluate
training initiatives linked to the adoption of visual cues in the selected
setting, both for facilitators and participants;
• to assess the health worker’s understanding of the meaning and practices
associated with the visual cue (including the writing of the date of
opening on the vial); and
• to describe the level of compliance of the MDVP criteria based on the
observed behaviour of health workers.

The closing date for the RFP is 13 June 2012.

An electronic copy of the proposal in English should be submitted to Dr
Rudi Eggers: eggersr@who.int

Please see attached document for more details.
RFP-Visual-cue-pilot-vf2.pdf http://tinyurl.com/7rmykkl
__________________________________________________________________
________________________________*_________________________________

18. Book Review: No Time to Lose: A Life in Pursuit of Deadly Viruses
__________________________________________________________________
Review: The sea is full of sharks
By Laurie Garrett, The Lancet, doi:10.1016/S0140-6736(12)60844-7 (6.05.12)

No Time to Lose: A Life in Pursuit of Deadly Viruses
Peter Piot
WW Norton & Company Ltd, 2012
Pp 304. US$28·95 ISBN-9780393063165

As a child of the 1950s growing up in the Flemish village of Keerbergen,
Peter Piot dreamed of two Belgian characters that would shape his life:
Tintin and Father Damien. From Tintin, Piot gained a carnivorous hunger for
adventure and travel. But Father Damien’s great sacrifice for the 19th-
century Hawaiian victims of leprosy held a special resonance for the young
Catholic boy, as the missionary came from nearby Tremelo, where Piot would
stare at Damien’s town square statue. The part of Piot’s character that
devoured Tintin spawned a 27-year-old doctor, still in training in
microbiology, who eagerly flew to Zaire without a valid passport and little
support from his own country to jump into a mysterious 1976 epidemic. But
the soul that was enthralled with Father Damien pushed adventure aside in
favour of outrage over the conditions he found in a Catholic mission in
Yambuku, where the terrifying epidemic of what would be dubbed Ebola was
spawned.

The ideals of adventure, travel, and medicine form a thread that weaves
through Piot’s No Time To Lose: A Life in Pursuit of Deadly Viruses, making
it a riveting read. But the sobriety and sacrifice of Damien form a second,
more interesting arc from 1976 Zaire to Dec 26, 2008, when Piot stepped for
the last time out of his office as Executive Director of the United Nations
AIDS Programme (UNAIDS): a coupling of indignation and discovery. Whether
it came from staring at the Tremelo statue, the natural proclivities of
small town Flemish folk, his father’s economist pragmatism, or his mother’s
no-nonsense office management skills, Piot seems to have approached every
issue in his life, first, with a recognition of a basis for his
indignation; and, second, with concrete, logical problem-solving. That
paired indignation and problem-solving has made his journey through life
have meaning, not only for Piot, but ultimately for millions of people
infected with HIV.

Throughout No Time to Lose, Piot devours so energetically opportunities,
meals, wine, and instant friendships, from beers drunk in the humid heat of
Yambuku with Father Carlos to mojitos sipped with Fidel Castro, that the
reader savours the moments, and insights, alongside him. But the reader is
also at Piot’s side when he watches Ukrainian intravenous drug users inject
heroin between their toes or listens in astonishment to whiskey-sipping
South African President Thabo Mbeki, as he weaves a dark conspiracy in
which western pharmaceutical companies invent a false disease (AIDS) to
force poor countries to buy their drugs.
Ultimately the hunger for adventure is also one for knowledge, and Piot’s
fervour to learn, grow, and adapt consistently served him. I suspect
students of science and public health will benefit from the methods Piot
deployed in analysing and solving problems, from the epidemiological
features of AIDS during the 1980s to the Chinese Government’s refusal to
confront HIV 15 years later. By the time the final page is reached Piot
has, to name but a few deeds, been on a plane captured by terrorists; spent
2 days inside Renaissance hallways of the Vatican arguing about condoms;
isolated a new form of penicillin-resistant gonorrhoea; carried the
bloated, redolent bodies of dead helicopter pilots through the jungles of
Zaire; treated what was probably the first case of AIDS in Belgium; run
successfully for election to leadership of UNAIDS and unsuccessfully for
Director-General of WHO; confronted the President of Zambia when Chiluba
asserted AIDS was “punishment for fornication”; berated Fidel Castro for
imposing mandatory quarantine on Cubans infected with HIV; sneered at
Suzanne Mubarak, First Lady of Egypt, when she stated that no tree is high
enough to hang all homosexuals; and survived dozens of death threats,
mostly from AIDS activists.

His Flemish grandmother berated young Peter that, “your ass can’t sit
still”, and several times in his memoir Piot says he was, “basically
running around like crazy”. Indeed, the pace of this life seems impossibly
fast. And when Jonathan Mann, the original leader of the global fight
against HIV/AIDS, died in a Swissair crash in 1998, Piot found alarming
reason to work even harder: “It gave me an incredible sense of urgency: I
need to do so much before that happens to me too.”

By the time Piot walks out of his UNAIDS office, all he can do (at Kofi
Annan’s suggestion, no less) is sleep, as “every cell in my body had
accumulated a decade of regular lack of sleep and constant jet lag”. His
admiration for former UN Secretary-General Annan began in 1995 when he
pulled the new UNAIDS leader aside and whispered, “The sea is full of
sharks.” It’s the apt kick-off to Piot’s years at the UN, fighting off
bureaucrats, donors, activists, bigoted world leaders, incompetent global
health maestros, and what he characterises as troublesome journalists.
(Piot’s disdain for the media is surprisingly tough. Conversely, his praise
for well over 300 colleagues will send readers to the index to look
themselves up. Here’s a clue: if Piot liked working with you, your name is
preceded by positive adjectives. If not, well, it’s just your name.)
Piot’s analysis of inherent failures in the UN system will resonate with
anybody who has ever worked for a UN agency. Of wealthy-nation donors Piot
summarises: “I preferred by far the tough love of the UK and the US to the
lip service of some other countries who were long on words, but short on
cash.” Parsimonious France, he tells us, was “always pushing to recruit
French nationals”, and when Piot ran for leadership of WHO, the Italians
“unashamedly gave me the CVs of five fairly junior Italian officials as a
condition for their vote for me”.

He reserves special disdain for western AIDS advocates, noting there was
“simply zero tolerance among some for anything other than advocating for
more money”, and pushing policies that blurred, “the lines between
scientific evidence, professional institutional loyalty, and activism”.
Piot denounces the idea that amounts of money raised should serve as the
primary metric of global health achievement: “The only real measure of our
success would be in lives saved.” Ultimately reflecting on the emphasis
placed on HIV treatment, versus the controversies that have shrouded every
infection prevention effort, he sadly concludes, “Even if we could stop
AIDS today—stop it cold—in terms of new transmissions, it would still have
a massive impact on generations to come.” By 2008 Piot can justifiably
claim at least partial credit for the nearly 7 million people outside of
the wealthy world receiving HIV treatment and the huge global health
enterprise that arose during his tenure at UNAIDS, but he remains wistful.
More than once he reflects “The question that haunts me until today is
whether we could have done it earlier, faster.”

Full Text: http://www.cfr.org/global-health/sea-full-sharks/p28363
@ The Lancet: may require registration http://bit.ly/N5PmQM
__________________________________________________________________
________________________________*_________________________________

19. News

– Calif. Veterans Affairs Health Care Facilities Hit with 30 Safety
Violations
– India: Beware the needle
– Body Art Training Group Approved as Provider of Bloodborne Pathogens
Training
– Viet Nam: HIV/AIDS cases decline: Ministry
– Kenya: Kenya drug addicts to get free needles, syringes
– For Those Who Fear Needles, an Air-Jet Alternative
– Pakistan: WHO to introduce new strategy to fight HIV/AIDS
– Kenya: Public forum to demystify needles
– Global: ‘Emergency plan’ to eradicate polio launched
– UK: Dental patients put at HIV risk by poor hygiene
– Buggy break rooms: Study reveals office ick
– USA: State Allows Pharmacies to Offer More Vaccines

Selected news items reprinted under the fair use doctrine of international
copyright law: http://www4.law.cornell.edu/uscode/17/107.html
__________________________________________________________________
http://tinyurl.com/7otx9yg

Calif. Veterans Affairs Health Care Facilities Hit with 30 Safety
Violations
Occupational Health and Safety Online, USA (28.05,12)

* OSHA issued notices for serious violations involving blocked emergency
exit doors and routes, multiple electrical hazards, a lack of proper
machine guarding, and exposure to contaminated needles.

OSHA has issued 30 notices of unsafe and unhealthful working conditions for
violations found during inspections of four U.S. Department of Veterans
Affairs medical facilities. OSHA began the inspections in November 2011 at
the VA hospital in Mather and at outpatient clinics in Martinez, Fairfield,
and Oakland. All are part of the VA’s Northern California Health Care
System.

“The safety hazards identified at these four clinics demonstrate a need for
a renewed commitment by the Department of Veterans Affairs to provide a
safe workplace for the VA employees who care for our nation’s wounded and
aging soldiers,” said David Shiraishi, director of OSHA’s Oakland Area
Office.

OSHA issued notices for 25 serious violations involving blocked emergency
exit doors and routes, multiple electrical hazards, a lack of proper
machine guarding, and exposure to contaminated needles.

A notice also has been issued for a repeat violation involving the improper
storage of biological hazardous waste. A notice for a similar violation at
the Mather hospital was issued in 2007.

OSHA also has issued notices for four other-than-serious violations
involving an incomplete written hazard communication program and failing to
identify exit doors.

Under Executive Order 12196, federal agencies must comply with the same
safety and health standards as private sector employers covered under the
Occupational Safety and Health Act. The federal agency equivalent to a
private sector citation is the Notice of Unsafe or Unhealthful Working
Conditions.

OSHA cannot propose monetary penalties against another federal agency for
failure to comply with OSHA standards.

Copyright 2010 1105 Media Inc.
__________________________________________________________________
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http://www.thehindu.com/health/article3462223.ece

India: Beware the needle
AARTI DHAR. The Hindu, India (27.05.12)

* Paediatricians release guidelines to prevent hospital associated
infections

Concerned over unhealthy practices followed by health care givers that can
be potential threats to the patients and the community, the Indian Academy
of Paediatrics (IAP) has released a manual, ‘IAP Guidelines on Safe
Injection Practices’.

Drafted in association with BD, a global medical technology company, the
guidelines would help to standardize safe injection practices and
prevention of infection in healthcare settings.

A 2005 study to assess injection practices showed that nationwide, 62 per
cent of all injections were unsafe due to improper sterilization, reuse or
faulty administration, making them a leading cause of healthcare or
hospital-associated infections (HAIs). The HAIs are infections that a
patient acquires while undergoing treatment from a healthcare facility for
a different medical problem. In the last 20 years, emerging diseases like
HIV, Hepatitis have intensified severity of risks from unsafe injections
and unsafe waste disposal. The World Health Organization (WHO) estimates
that globally about 1.3 m people die of infections caused by reuse of
syringes per year, of which estimated 300,000 are in India. The IAP
Guidelines provide an analysis of the problem of unsafe injections and
provide technical specifications on safe injection techniques. A safe
injection environment (SIE) is defined by a set of conditions in which
required medication is delivered in all settings without potential harm to
the patient, to the service provider, or to the community. The creation of
SIE calls for integration over the spectrum of patient care and also
throughout the lifecycle of the devices used from source materials and
manufacturing through use and disposal.

“We are committed to improving the health and well being of all people who
receive injections,” said Rohit C. Agrawal, National IAP President.

Keywords: hospital infections, Indian Academy of Paediatrics, guidelines
__________________________________________________________________
__________________________________________________________________
http://www.pr.com/press-release/416010

Body Art Training Group Approved as Provider of Bloodborne Pathogens
Training
PR.com, USA (27.05.12)

The Health Care Agency, County of Orange, California has designated the
Body Art Training Group as an approved provider of bloodborne pathogen
exposure control training for tattoo artists, body piercers, and permanent
cosmetics technicians.

Santa Ana, CA, May 27, 2012 –(PR.com)– The Body Art Training Group
announced today that it has been designated as an Approved Provider of
Bloodborne Pathogen Exposure Control Training by the Health Care Agency,
County of Orange, California. This approval is for both online and
classroom training.

The County of Orange requires all body art practitioners to take bloodborne
pathogens training. Tattoo artists, body piercers, and permanent cosmetics
technicians can now satisfy this requirement by taking the Body Art
Training Group’s online course “Bloodborne Pathogens Training and Infection
Control for Body Art Professionals.”

This course also complies with OSHA’s initial and annual bloodborne
pathogens training requirements. After successful completion of this
course, a Certificate of Completion can be immediately printed.

In person classes are also available. Kathy Hartman, an instructor at the
Body Art Training Group, gives in-shop classes on bloodborne pathogens and
on developing a body art shop Exposure Control and Infection Prevention
Plan.

Since 2008, the Body Art Training Group,
http://www.bodyarttraininggroup.com, has offered on-site bloodborne
pathogens training for body art professionals. These courses provide
training as required by OSHA’s Bloodborne Pathogens Standard 29 CFR
1910.1030 and California’s Safe Body Art Act (AB 300).

In 2010, the Body Art Training Group began offering classes online.

These online classes are specifically designed for the body art industry
and are suitable for all types of body art professionals: tattoo artists,
body piercers, permanent cosmetics technicians, electrologists, and body
modification practitioners.
__________________________________________________________________
__________________________________________________________________
Viet Nam: HIV/AIDS cases decline: Ministry
Viet Nam News VNS (26.05.12)

HA NOI — Viet Nam has seen a downward trend in the number of HIV cases but
at a slowing pace in recent years, according to the Ministry of Health’s
Viet Nam Administration of HIV/AIDS Control.

In 2011, nearly 14,200 people were tested positive for HIV, a decrease by
nearly 150 compared to the year 2010, according to statistics released
yesterday.

Whereas the number in 2010 decreased by 1,800 compared with 2009, which
also saw more than 4,000 down from the previous year.

“The decreasing rate gets slower because the number of prostitutes using
condoms tends to go down while that of heroin addicts sharing injection
needles went up despite the police and community efforts,” said Le Hai Son,
deputy head of the administration’s Supervision and Evaluation Division.
In Ha Noi, 22 per cent of prostitutes were tested positive for HIV, but
only 24.5 per cent of them use condoms regularly. * Meanwhile, more than 20
per cent of heroin addicts in cities and provinces sharing injection
needles have been infected.

Nearly 200,000 people in the country suffered from HIV by the end of March
this year.

More than 49,300 of them are currently living with AIDS with more than
52,600 having died of the disease.

As many as 90 per cent of HIV patients are between 20 and 49 years old.
It is forecast that this year the number of HIV patients can re-increase in
some cities and provinces such as Ha Noi, HCM City, Son La, Thai Nguyen,
Dien Bien and Nghe An, he said.

“People facing a high risk include heroin addicts and ethnic minority women
whose awareness on the disease was low,” Son said.

To improve HIV/AIDS prevention, Prime Minister Nguyen Tan Dung on Tuesday
signed an instruction, asking the Ministry of Health to preside over the
National Strategy on HIV/AIDS Prevention and Control to 2020 with a vision
to 2030. The targets of the strategy is the vision of zero new infections,
zero discrimination and zero AIDS-related deaths.

The peak month for mother-to-child HIV transmission prevention 2012 will be
launched nation-wide from June 1 to 30.

Chu Quoc An, deputy director of the administration, said, “This is a chance
to further raise awareness among people in general, women of child-bearing
age and pregnant women in particular, of mother-to-child HIV transmission
prevention and create opportunities for pregnant women to have early access
to mother-to-child HIV transmission prevention services.”
__________________________________________________________________
__________________________________________________________________

www.capitalfm.co.ke/news/2012/05/drug-addicts-to-get-free-needles-syringes/

Kenya: Kenya drug addicts to get free needles, syringes
Capital FM Kenya, Kenya (25.05.12)

MOMBASA, Kenya, May 25 – The government has purchased eight million needles
and syringes to be distributed to over 46,000 people addicted to drugs.

Coast Provincial Director of Public Health and Sanitation Anisa Omar said
the consignment has already been shipped and the distribution exercise is
expected to start next week in Nairobi and Mombasa.

Anisa said the Coast region was leading in drug addicts were 26,667 have be
identified, with Nairobi having 22,500 addicts.

Anisa said the distribution would be coordinated by the Ministry of Public
Health and Sanitation through several NGOs.

The first phase of the distribution will run for a year.

Addressing a press conference during the project launch at a Mombasa hotel,
Anisa said there was need for the government to collaborate with NGOs to
address the alarming number of new HIV infections associated with sharing
of needles and syringes.

According to the National Aids and STI Control Programme, Anisa said about
one in every five people who inject drugs in Nairobi and Coast are living
with HIV, adding that one in every 16 new HIV infections in the two cities
are attributed to injecting drugs.

She said there was enough evidence worldwide that the needle and syringe
programme reduces cases of HIV and other blood transmitted infections among
people who inject drugs.

Nacada Director Sheikh Juma Ngao said the government was doing its best to
fight drug abuse.

“The government is committed to fighting drug trafficking and I call upon
for close surveillance of all our boarders to ensure no drugs found their
way into the country,” said Sheikh Ngao.
__________________________________________________________________
__________________________________________________________________
For Those Who Fear Needles, an Air-Jet Alternative
BY Molly Oswaks, GIZMODO (25.05.12)

Needle-less technology for injecting medicine is nothing new. But, until
now, it’s relied on compressed air or gas cartridges to breach the skin and
deliver the dosage.

A team of medical and mechanical engineering researchers from MIT has
developed a new technology for needle-less injection that relies on not
compressed molecules but magnetic energy.

The device uses something called a “Lorentz-force actuator” (a small,
powerful magnet surrounded by a coil of wire that’s attached to a piston
inside the drug ampoule) that, powered by an electrical current, creates an
adjustable high-pressure jet and ejects it out of a microscopically narrow
nozzle. This needle-thin stream of air penetrates the skin to deliver
highly controlled doses at different depths.

At nearly the speed of sound, the device is capable of injecting a drug in
high pressure doses of up to 100 megapascals, in under a millisecond. It is
so sensitive, mid-way through the injection the velocity of the injection
can be adjusted by altering the electrical current—higher velocity to break
the skin’s surface, slightly lower to mete the drug into the bloodstream
and surrounding tissue.

The benefits of this “needle-less needle” are seemingly endless: Of course,
those with an aversion to needles will be soothed by the alternative
injection, especially people like diabetics, who routinely must administer
self-injections. But also the chance of needle-stick injuries will be
mitigated, as will the risk of contracting a disease off a contaminated
needle.

Ian Hunter, the Professor of Mechanical Engineering who led the research
team, explains that because the device can also take a drug in powdered
form—it vibrates at such a rate that the drug behaves as though it were a
liquid being injected through the skin—administering injections in
developing countries will be easier, as powders require no refrigeration or
cooling.

Not yet available, though hopefully soon, further development of the jet-
injection device is currently underway. [GizMag – Image via Tatiana
Popova/Shutterstock]

Video: http://www.youtube.com/watch?feature=player_embedded&v=M09LyLqb5qw
__________________________________________________________________
__________________________________________________________________
Pakistan: WHO to introduce new strategy to fight HIV/AIDS
By Ashfaq Yusufzai, Central Asia Online (24.05.12)

PESHAWAR – The World Health Organisation (WHO) has called for implementing
a needle exchange policy to reduce the incidence of HIV/AIDS among
injection drug users (IDUs) in Peshawar, WHO official Dr. Muhammad
Ikramullah told Central Asia Online May 23.

In April, the Khyber Pakhtunkhwa (KP) social welfare department took 22
IDUs to a rehab centre, where 11 of them tested positive for HIV/AIDS, he
said. The WHO is asking the KP government to make arrangements for treating
the HIV patients while it works to implement a needle exchange programme in
KP.

The programme would provide new, sterile needles to IDUs, he said, adding
that a survey conducted in Pakistan last year showed 20% of IDUs had
HIV/AIDS.
__________________________________________________________________
__________________________________________________________________
Kenya: Public forum to demystify needles
By Brian Otieno, The Star, Kenya (24.05.12)

Five organisations dealing with drugs at the Coast will today meet with the
public to dispel claims that they are promoting drug abuse in the region.
The Muslim Education Welfare Association, Reach Out, Omari Project from
Malindi, Nocet from Nairobi and Teens Watch from Ukunda will hold a session
at Pride Inn hotel on Haile Selasie Avenue where a panel of five experts
will answer questions from the public.

A programme that will involve the government distributing about eight
million needles and syringes to people who inject themselves with drugs has
been met with fierce resistance from local communities. The Needle and
Syringe Programme is meant to reduce the spread of blood-borne infections
such as HIV and hepatitis. It is set to be rolled out later this month both
at the Coast and in Nairobi. “There has been a misconception about the
programme leading to the resistance of the project and that is why there
will be the experts to explain to them the aim of this programme and how it
will work,” said Fatma Jeneby an organiser of the forum.

The experts at the forum will include provincial director of public health
and sanitation Anisa Omar, Nacada director Sheikh Juma Ngao, consultant
psychiatrist Fred Owiti, community policing chairman Mohammed Ali and Lamu
East councillor Hussein Taib. “The meeting will bring together the
government, doctors, religious leaders, people who inject drugs and civil
societies. “The need for new interventions in addressing the alarming
number of new HIV infections associated with sharing of needles and
syringes will be addressed,” said Jeneby. According to the National Aids
and STI Control Programme about one in every five people who inject drugs
in Nairobi and Coast are living with HIV.
__________________________________________________________________
__________________________________________________________________
http://www.bbc.co.uk/news/health-18186393

Global: ‘Emergency plan’ to eradicate polio launched
BBC News, UK (24.05.12)

Tackling polio has entered “emergency mode” according to the Global Polio
Eradication Initiative after “explosive” outbreaks in countries previously
free of the disease.

It has launched a plan to boost vaccination in Nigeria, Pakistan and
Afghanistan, the only countries where the disease is still endemic.

Experts fear the disease could “come back with a vengeance”.

The World Health Organization says polio is “at a tipping point”.

There have been large outbreaks of the virus in Africa, Tajikistan and
China has had its first cases for more than a decade.

‘Relentless’

Bruce Aylward, head of the WHO’s polio eradication campaign, said: “Over
the last 24 months on three continents – in Europe, in Africa and in Asia –
we have seen horrific explosive outbreaks of the disease that affected
adults, and in some cases 50% of them died.

“What it reminded people is that, if eradication fails, we are going to see
an huge and vicious upsurge of this disease with consequences that it is
very difficult even to foresee right now.”

He said the initiative was “now on an emergency footing” which would result
in a “big shift” in the way the virus is tackled.

The strategy has been summarised as the “relentless pursuit of the
unvaccinated child”.

However, Dr Aylward also cautioned that there was a $950m shortfall in
funding and admitted they had been forced into “cutting corners” with
vaccination campaigns being stopped in some countries.

‘Will’

India, once regarded as one of the most challenging countries, was declared
free of the disease in February.

Kalyan Banerjee, the president of Rotary International, said: “We know
polio can be eradicated, and our success in India proves it.

“It is now a question of political and societal will.

“Do we choose to deliver a polio-free world to future generations, or do we
choose to allow 55 cases this year to turn into 200,000 children paralyzed
for life, every single year?”

The Global Polio Eradication Initiative is a partnership between
governments, the World Health Organization (WHO), Rotary International, the
US Centers for Disease Control and Prevention and the United Nations
Children’s Fund.

Members of the WHO, meeting in Geneva, will vote this week on whether to
declare polio eradication an “emergency for public health” in the three
countries where it is still endemic.

The WHO estimates that failure to act could lead to as many as 200,000
paralyzed children a year worldwide within a decade.

The WHO originally set the year 2000 as its target for polio eradication.
Dr Margaret Chan, director-general of the WHO, said the organisation was
now working “in emergency mode”.

The BBC’s Imogen Foulkes in Geneva says the programme has claimed some
remarkable successes, most notably India, which was declared polio-free in
February.

She says the WHO hopes to shake donor countries out of their complacency
and support one last effort at eradication. The WHO believes that with one
last push, the disease could be eradicated globally, she says.

It is thought conflict and a lack of trust in vaccinations mean fewer
children are being immunized.

Polio is a highly infectious disease caused by a virus. It invades the
nervous system, and can cause total paralysis in a matter of hours.

One in 200 infections leads to irreversible paralysis, usually in the legs.
Among those paralysed, 5% to 10% die when their breathing muscles become
immobilized.

Unicef executive director Anthony Lake said: “All our efforts are at risk
until all children are fully immunized against polio – and that means fully
funding the global eradication effort and reaching the children we have not
yet reached

“We have come so far in the battle against this crippling disease. We can
now make history – or later be condemned by history for failing.”

WHO Polio Fact Sheet: http://www.who.int/mediacentre/factsheets/fs114/en/
__________________________________________________________________
__________________________________________________________________
http://www.dentistryiq.com/index/display/news-display/1671678107.html

UK: Dental patients put at HIV risk by poor hygiene
Rod Mills, Scottish Express, Scotlina U.K. (23.05.12)

A DENTAL clinic put patients at risk of deadly diseases such as HIV and
hepatitis because of poor hygiene, it emerged yesterday.

Letters have been sent to patients of the practice warning them of
unsatisfactory infection control measures.

About 900 people have been alerted to a potential risk of blood-borne
infections at the practice in Aberdeen.

But the level of risk has been described as low.

The private Bridge of Don Dental Clinic and Research Centre opened in
January.

The failure to meet national standards of infection control was found by an
NHS Grampian inspection in March.

Helpline Concerns were raised that dental instruments were not sterilised
properly.

Yesterday, Dr Maria Rossi, consultant in Public Health Medicine at NHS
Grampian, said a helpline had been set up for concerned patients.

She said: “We are working closely with local and national experts and have
concluded there is a low risk of infection to patients. As our priority is
always for the safety and welfare of patients, we felt it was important to
write to inform them of this incident.

“The letter emphasises that no action is required by the patient but tests
will be available if anyone remains concerned having read the letter and
after calling the helpline.”

The letters to patients said a follow-up inspection on April 10 found an
improvement.

New rules for cleaning and decontamination procedures were set for dental
practices in Scotland in 2007. It is the responsibility of each registered
dentist to ensure clinical standards are maintained for all patient care.

Dentists who fail to follow the correct procedures place patients at risk
from blood-borne viruses.

NHS Grampian said Dr Xenofon Gkouzis was the only dentist now working at
the Silverburn Crescent practice and the incident did not relate to him.

Ray Watkins, consultant in Dental Public Health at NHS Grampian, said:
“While this is an independent practice, it is expected to comply with
national infection control standards. We are unable to confirm these
standards were adhered to prior to April 10.

“At a follow-up visit, procedures were found to be satisfactory. The
practice has co-operated with the investigation and will continue to be
monitored.”

Patients can contact the NHS 24 helpline on 08000 28 28 16 between 8am and
10pm if they would like further advice.

Copyright 2012 Express NewspapersAll Rights Reserved Scottish Express
__________________________________________________________________
__________________________________________________________________
Buggy break rooms: Study reveals office ick
By Brian Alexander, Vitals, MSNBC.MSM.com (23.05.12)

Your co-workers may seem friendly but, if a study released today is any
indication, they could be aircraft carriers for germs.

According to University of Arizona microbiologist Charles Gerba, who
researches the environmental presence of infectious bacteria and viruses,
employees in offices arrive in the morning, “put their stuff on their
desks” where, he says, the germ payload is often more than you’d find on
the typical toilet seat, “and then go to break rooms to get coffee. The two
things you spread in a break room are office gossip and germs.”

Gerba consulted on the new study, conducted by a division of the Kimberly-
Clark Corporation (which manufactures and sells cleaning and disinfectant
supplies to businesses). For the study, researchers collected nearly 5,000
swabs from office buildings containing almost 3,000 employees over the
course of two years to measure traces of possible contamination on office
surfaces.

The study, which focused on office break rooms, found that 75 percent of
break room faucet handles displayed a high degree of contamination as did
nearly half of microwave oven handles, and a quarter of refrigerator door
handles.

“The break room is really the center of germ transfer in the office rather
than the individual cubicle,” said Gerba. “Everything is shared in the
break room.”

For example, he pointed out, many people rinse their coffee cups and push a
sponge around the inside. Those sponges can be loaded with E. coli, “so
you’re really wiping your mug with E. coli,” he said.

The second big break room habit that spreads germs is greeting co-workers.
“Actually,” Gerba, explained, from a pathogen-transfer perspective, “you’d
be better off kissing each other than shaking hands” because people cough
or sneeze into their hands and transfer the germs when shaking.

In earlier work, Gerba documented that each person’s desktop environment is
rife with germs like norovirus (which can cause diarrhea), parainfluenza
(respiratory tract infections), and drug-resistant staph (MRSA).

The Kimberly-Clark study did not measure viruses and bacteria directly. It
measured ATP, adenosine triphosphate, present in all organic matter. The
presence of ATP means a surface contains some form of organic material,
which could indicate either the presence of bacteria and viruses, or that
something such as food residue is present that could provide a welcoming
environment for germs.

The company has an obvious incentive to make workplaces sound germy, but,
according to Gerba, they really are. “Those break rooms are as bad as we
thought they were,” he said.

This doesn’t mean your office break room is necessarily a biohazard zone,
or that you’re bound to get sick if you use it. It just means that any
surfaces people touch are likely to be contaminated with something.
A simple solution, Gerba pointed out, is for companies to clean more
carefully, and for employees to wash their hands, or use a hand sanitizer,
more often.
__________________________________________________________________
__________________________________________________________________
USA: State Allows Pharmacies to Offer More Vaccines
Kay Lazar, Boston Globe, Boston MA USA (21.05.12)

Massachusetts currently allows pharmacists to administer annual flu shots,
but a new state health policy will expand that authority to include giving
vaccinations for hepatitis A and B; human papillomavirus; measles, mumps
and rubella; tetanus, diphtheria, and whooping cough; shingles; pneumonia;
chickenpox; and meningitis.

Kevin Cranston, director of the Department of Public Health (DPH) Bureau of
Infectious Disease, said the move by regulators is designed to make
vaccination more convenient and cost-effective. An office visit to or a
prescription from a primary care provider is not necessary, which in turn
lowers the work load of physicians, he said.

David Johnson, executive vice president of the Massachusetts Pharmacists
Association, said consumers who face transportation and time constraints
likely will benefit most from the policy. But Dr. Lynda Young, president of
the Massachusetts Medical Society, worries it will make the task of
tracking what vaccines a patient has had and when more difficult for
physicians.

A 2010 Massachusetts law established, but did not fund, a state vaccine
registry. DPH has used federal money to launch pilot registries at several
sites; officials said last fall that a statewide rollout was planned for
2012.

Massachusetts has often led the nation in childhood immunization rates, but
adult rates have lagged. Under the policy, finalized last month,
pharmacists must undergo training that meets state standards for vaccine
administration.
__________________________________________________________________
________________________________*_________________________________
* 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

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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
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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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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
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
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

Email mailto:sign.moderator@gmail.com
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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. http://www.uq.edu.au
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