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SIGNpost 00663

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST *

Post00663 WHO IDU Guide + Abstracts + News 22 August 2012

CONTENTS
1. WHO Guidance on prevention of viral hepatitis B and C among people who
inject drugs
2. Abstract: Disposal of syringes, needles, and lancets used by diabetic
patients in Pakistan
3. Abstract: Needlestick injury among interns and medical students in the
Occupied Palestinian Territory
4. Abstract: Disposal of sharps medical waste in the United States: impact
of recommendations and regulations, 1987-2007
5. Abstract: Performance improvement and implementation science: infection
prevention competencies for current and future role development
6. Abstract: Prevalence of hepatitis B & hepatitis C virus infections in
potential blood donors in rural Vietnam
7. Abstract: Are major reductions in new HIV infections possible with
people who inject drugs? The case for low dead-space syringes in highly
affected countries
8. Abstract: Viral Hepatitis and HIV Infection Among Injection Drug Users
in a Central Iranian City
9. Abstract: Drug-related arrest rates and spatial access to syringe
exchange programs in New York City health districts: combined effects on
the risk of injection-related infections among injectors
10. Abstract: Can intranasal drug use reduce HCV infection among injecting
drug users?
11. Abstract: Failed drug policies in the United States and the future of
AIDS: A perfect storm
12. Abstract: Testing of the World Health Organization recommended
formulations in their application as hygienic hand rubs and proposals
for increased efficacy
13. Abstract: Point-of-care hand hygiene: preventing infection behind the
curtain
14. Abstract: Patient-centered hand hygiene: the next step in infection
prevention
15. Abstract: Effectiveness of an audible reminder on hand hygiene
adherence
16. Abstract: Innovation and technology for global public health
17. No Abstract: Health care workers and vaccination
18. No Abstract: Punitive laws undermine HIV prevention, says report
19. News
– Australia: Hospitals act to cut dangerous waste
– Nigeria: Unsafe Injection, Bane Of Health Care Systems
– Indonesia: Hepatitis a Growing Public Health Threat in Indonesia:
Experts – Needle stick injuries heighten risk for hepatitis B and C
– USA: New Jersey Syringe Program Might Get Expansion
– Australia: Guards step up syringe action
– UK: Anthrax Drug User Death Caused by Suspected Heroin Contamination
– USA: Hepatitis C Outbreak Could Boost Regulation Bill
– USA: Safe in Common Urges Flu Vaccine Providers to Demand Syringes with
Needlestick Prevention Features
– Australia: Conviction politics: needle exchange established in ACT
prison
– Australia: Gallagher’s minimalist needle model may work
– New Hampshire USA: 32nd N.H. Patient Diagnosed with Hepatitis C
– USA: FDA Approves First Voice-Guided Epinephrine Injection

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__________________________________________________________________
________________________________*_________________________________

1. WHO Guidance on prevention of viral hepatitis B and C among people who
inject drugs
__________________________________________________________________

WHO Guidance on prevention of viral hepatitis B and C among people who
inject drugs

World Health Organization
HIV/AIDS Department
20, Avenue Appia
CH-1211 Geneva, 27 Switzerland

Guidance on prevention of viral hepatitis B and C among people who inject
drugs

Publication details

Editors: WHO
Publication date: July 2012
WHO reference number: WHO/HIV/2012.18

* Download: Guidance on prevention of viral hepatitis B and C among people
who inject drugs
http://apps.who.int/iris/bitstream/10665/75192/1/WHO_HIV_2012.18_eng.pdf

Overview

The guidance is the first step in the provision of comprehensive guidance
on viral hepatitis surveillance, prevention and treatment by the World
Health Organization. The following recommendations are based on systematic
reviews of scientific evidence, community values and preferences and
implementation issues.

Recommendation 1: It is suggested to offer people who inject drugs the
rapid hepatitis B vaccination regimen.

Recommendation 2: It is suggested to offer people who inject drugs
incentives to increase uptake and completion of the hepatitis B vaccine
schedule.

Recommendation 3: It is suggested that needle and syringe programs also
provide low dead-space syringes for distribution to people who inject
drugs.

Recommendation 4: Psychosocial interventions are not suggested for people
who inject drugs to reduce the incidence of viral hepatitis.

Recommendation 5: It is suggested to offer peer interventions to people who
inject drugs to reduce the incidence of viral hepatitis.

Other WHO Publications on Injecting drug use:
http://www.who.int/hiv/pub/idu/en/index.html
__________________________________________________________________
________________________________*_________________________________

2. Abstract: Disposal of syringes, needles, and lancets used by diabetic
patients in Pakistan
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22541266

J Infect Public Health. 2012 Apr;5(2):182-8.

Disposal of syringes, needles, and lancets used by diabetic patients in
Pakistan.

Ishtiaq O, Qadri AM, Mehar S, Gondal GM, Iqbal T, Ali S, Mati-ur-Rahman,
Janjua NZ.

Shifa International Hospital, Islamabad, Pakistan. osama@pakmedinet.com

OBJECTIVE: To assess the use, handling and disposal of insulin injection
equipment by diabetic patients in Pakistan.

METHODS: We conducted a cross-sectional study at diabetic clinics in five
tertiary centers in Pakistan. All diabetic patients (type 1/type 2) who
were on insulin for more than 1 month, were included. An Urdu (local
language)- translated questionnaire was used to collect information on
insulin administration equipment, the site and frequency of needle use,
insulin syringe/pen/lancet disposal, sharing of needles and knowledge about
diseases that are spread by sharing contaminated needles.

RESULTS: Of 375 patients, 58% were female. The mean (SD) duration of
diabetes was 12.3 (7.3) years, and the duration of insulin use was 4.4
(4.3) years. The majority of the patients used syringes (88.3%) for insulin
administration. Additionally, the majority of the patients disposed of used
devices (syringes, 92%; pens, 75%; and lancets, 91%) in the household
garbage collection bin. About half of the patients (n=185) reported being
educated by their physicians about the disposal of sharps. Those who were
educated by a physician (adjusted odds ratio (adjOR): 0.36; 95%CI:
0.16-0.81) or could read/write English (adjOR: 0.32; 95%CI: 0.11-0.92) were
less likely to dispose of syringes and needles in the household garbage.

CONCLUSION: The common disposal of sharps in the household garbage has
implications for disease transmission. Education on the safe disposal of
sharps may improve the disposal practices.

Copyright © 2012 King Saud Bin Abdulaziz University for Health Sciences.
Published by Elsevier Ltd. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Needlestick injury among interns and medical students in the
Occupied Palestinian Territory
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22891516

East Mediterr Health J. 2012 Jul;18(7):700-6.

Needlestick injury among interns and medical students in the Occupied
Palestinian Territory.

Al-Dabbas M, Abu-Rmeileh NM.

Department of Continuing Education, Al-Quds University Medical School,
jerusa alem, West Bank, Palestine. aldabbass@yahoo.com

The aim of this study was to determine the prevalence of needlestick injury
(NSI) among interns and medical students as well as their knowledge of,
attitude towards and their protective strategies against exposure to
bloodborne pathogens. A cross-sectional study was conducted among 272
participants using a self-administered questionnaire.

Just over 40% of the participants had experienced at least 1 NSI. Wound
suturing was the most common cause of injury (33.5%), and the highest
incidence (55.5%) was in the emergency room. Failure to report the injury
to health representatives was recorded for 48.6% of NSIs. Only 46.7% of the
interns had received the hepatitis B vaccine whereas most of the students
(76.8%) had completed their vaccination schedule (P < 0.001).

Participants were found to be at a high risk of NSIs and bloodborne
infections.
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Disposal of sharps medical waste in the United States: impact
of recommendations and regulations, 1987-2007
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/21824683

Am J Infect Control. 2012 May;40(4):354-8.

Disposal of sharps medical waste in the United States: impact of
recommendations and regulations, 1987-2007.

Perry J, Jagger J, Parker G, Phillips EK, Gomaa A.

International Healthcare Worker Safety Center, Division of Infectious
Diseases, Department of Medicine, University of Virginia Health System,
Charlottesville, USA. janeperry@virginia.edu

BACKGROUND: To gauge the impact of regulatory-driven improvements in sharps
disposal practices in the United States over the last 2 decades, we
analyzed percutaneous injury (PI) data from a national surveillance network
from 2 periods, 1993-1994 and 2006-2007, to see whether changes in
disposal-related injury patterns could be detected.

METHODS: Data were derived from the EPINet Sharps Injury Surveillance
Research Group, established in 1993 and coordinated by the International
Healthcare Worker Safety Center at the University of Virginia. For the
period 1993-1994, 69 hospitals contributed data; the combined average daily
census for the 2 years was 24,495, and the total number of PIs reported was
7,854. For the period 2006-2007, 33 hospitals contributed data; the
combined average daily census was 6,800, and the total number of PIs
reported was 1901.

RESULTS: In 1992-1993, 36.8% of PIs reported were related to disposal of
sharp devices. In 2006-2007, this proportion was 19.3%, a 53% decline.

CONCLUSIONS: This comparison provides evidence that implementation of
point-of-use, puncture-resistant sharps disposal containers, combined with
large-scale use of safety-engineered sharp devices, has resulted in a
marked decline in sharps disposal-related injury rates in the United
States. The protocol for removing and replacing full sharps disposal
containers remains a critical part of disposal safety.

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

5. Abstract: Performance improvement and implementation science: infection
prevention competencies for current and future role development
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22541853

Am J Infect Control. 2012 May;40(4):304-8.

Performance improvement and implementation science: infection prevention
competencies for current and future role development.

Hanchett M.

Association for Professionals in Infection Control and Epidemiology, Inc,
Washington, DC, USA. mhanchett@apic.org

The Association for Professionals in Infection Control and Epidemiology,
Inc, developed its first model of infection preventionist (IP) competency
in 2011. The model is based on the principles of patient safety,
professional and practice standards, and core competencies identified
through research conducted by the Certification Board of Infection Control
and Epidemiology, Inc. In addition, the model highlights 4 domains that are
predicted to be key areas for future competency development.

Performance improvement (PI) and implementation represent 1 of the 4
forward-focused domains. Concurrently, the inclusion of implementation
science (IS) in the competency model is consistent with the research goals
established by the Association for Professionals in Infection Control and
Epidemiology, Inc, in its 2020 strategic plan.

This article explains the importance of PI and IS and describes their
relevance to the current and future IP role development. Significant
challenges such as role delineation and compression are discussed.

The need for the IP to acquire new competencies at integrating, as well as
differentiating, PI and IS are explored in terms of emerging issues and
trends.

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

Full text [ Appears to be Open Access ]
http://www.ajicjournal.org/article/S0196-6553(12)00167-8/fulltext
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Prevalence of hepatitis B & hepatitis C virus infections in
potential blood donors in rural Vietnam
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/22885267

Indian J Med Res. 2012 Jul;136(1):74-81.

Prevalence of hepatitis B & hepatitis C virus infections in potential blood
donors in rural Vietnam.

Viet L, Lan NT, Ty PX, Björkvoll B, Hoel H, Gutteberg T, Husebekk A, Larsen
S, Skjerve E, Husum H.

Tromsoe Mine Victim Resource Centre, University Hospital North Norway,
Tromsoe; Faculty of Health Sciences, University of Tromsoe, Norway, .

Background & objectives: Safe blood and blood products should be offered to
all patients in need for blood transfusion. The objectives of the present
study were to establish prevalence estimates for hepatitis B and hepatitis
C virus infections as a foundation for safe blood transfusion in rural
Vietnam, and to check the accuracy of the laboratory analysis used for
hepatitis testing of blood donors in Vietnam.

Methods: A cross-sectional study was conducted in two rural communities in
Quang Tri, Vietnam. A total of 1,200 blood samples collected from potential
blood donors were tested by an enzyme immunoassay technique (EIA) for
detection of hepatitis surface antigen (HBsAg), antibodies to hepatitis B
core antigen (anti-HBc), and antibodies to hepatitis C antigen (anti-HCV).
The EIA test outcome was validated by a chemiluminescent micro particle
immunoassay technique (CMIA).

Results: The prevalence of HBsAg and anti-HBc in the study population was
11.4 per cent (95% CI 9.6 – 13.2) and 51.7 per cent (95% CI 48.8 – 54.5),
respectively, the prevalences being higher in males than females. The
prevalence of anti-HCV was 0.17 per cent. The test agreement between the
EIA and CMIA techniques was high both for HBsAg detection (? = 0.91; 95%
CI: 0.83 – 0.99) and for anti-HBc detection (? = 0.89; 95% CI 0.81 – 0.97).
Compared to CMIA results, the positive and negative predictive values of
the EIA tests were found to be 94.9 per cent (95% CI 87.5 – 98.6) and 97.5
per cent (95% CI 86.8 – 99.9) for HBsAg, and 92.4 per cent (95% CI 84.2 –
97.2) and 100 per cent (95% CI 91.2 – 100) for anti- HBc.

Interpretation & conclusions: The study shows that hepatitis B virus
infection is endemic in rural areas of Vietnam and that almost half of the
population is or has been infected. Hepatitis C infection is rare, but
false negative test results cannot be ruled out.

Also, the results indicate that the EIA performance in blood donor
screening in Vietnam may be sub- optimal, missing 2.5 per cent of hepatitis
B virus carriers and falsely excluding more than 7 per cent of blood
donors.

As the prevalence of hepatitis B infection is high, occult hepatitis B
infection may represent a threat to safe blood transfusion. Therefore,
nucleic acid amplification testing for HBV should be considered for blood
donor screening in Vietnam.

Free full text: http://www.ijmr.org.in/text.asp?2012/136/1/74/99578
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Are major reductions in new HIV infections possible with
people who inject drugs? The case for low dead-space syringes in highly
affected countries
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22884539

Int J Drug Policy. 2012 Aug 9.

Are major reductions in new HIV infections possible with people who inject
drugs? The case for low dead-space syringes in highly affected countries.

Zule WA, Cross HE, Stover J, Pretorius C.

Substance Abuse, Treatment, Evaluations and Interventions Program, RTI
International, 3040 Cornwallis Road, Research Triangle Park, NC 27709-2194,
United States.

Circumstantial evidence from laboratory studies, mathematical models,
ecological studies and bio behavioural surveys, suggests that injection-
related HIV epidemics may be averted or reversed if people who inject drugs
(PWID) switch from using high dead-space to using low dead-space syringes.
In laboratory experiments that simulated the injection process and rinsing
with water, low dead space syringes retained 1000 times less blood than
high dead space syringes. In mathematical models, switching PWID from high
dead space to low dead space syringes prevents or reverses injection-
related HIV epidemics.

No one knows if such an intervention is feasible or what effect it would
have on HIV transmission among PWID. Feasibility studies and randomized
controlled trials (RCTs) will be needed to answer these questions
definitively, but these studies will be very expensive and take years to
complete. Rather than waiting for them to be completed, we argue for an
approach similar to that used with needle and syringe programs (NSP), which
were promoted and implemented before being tested more rigorously. Before
implementation, rapid assessments that involve PWID will need to be
conducted to ensure buy-in from PWID and other local stakeholders.

This commentary summarizes the existing evidence regarding the protective
effects of low dead space syringes and estimates potential impacts on HIV
transmission; it describes potential barriers to transitioning PWID from
high dead space to low dead space needles and syringes; and it presents
strategies for overcoming these barriers.

Copyright © 2012 Elsevier B.V. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Viral Hepatitis and HIV Infection Among Injection Drug Users
in a Central Iranian City
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22895463

J Addict Med. 2012 Aug 14.

Viral Hepatitis and HIV Infection Among Injection Drug Users in a Central
Iranian City.

Sofian M, Aghakhani A, Banifazl M, Azadmanesh K, Farazi AA, McFarland W,
Eslamifar A, Ramezani A.

From the Arak University of Medical Sciences (MS and A-AF), Arak, Iran;
Clinical Research Department (AA, AE, and AR), Pasteur Institute of Iran,
Tehran, Iran; Iranian Society for Support of Patients with Infectious
Diseases (MB), Tehran, Iran; Virology Department (KA), Pasteur Institute of
Iran, Tehran, Iran; and Epidemiology Section (WM), San Francisco Department
of Public Health, San Francisco, CA.

OBJECTIVE: This study aimed to determine the prevalence of serological
markers for hepatitis B virus (HBV), hepatitis C virus (HCV), human
immunodeficiency virus (HIV), and occult HBV infection among injection drug
users (IDUs) with isolated anti-hepatitis B core (anti-HBc).

METHODS: A total of 153 male IDUs were tested for anti-hepatitis B surface
(anti- HBs), hepatitis B surface antigen (HBsAg), anti-HBc, anti-HCV, and
anti- HIV. The presence of HBV-DNA was determined in plasma samples of
individuals with isolated anti-HBc (HBsAg negative, anti-HBs negative, and
anti-HBc positive) by polymerase chain reaction (PCR).

RESULTS: The prevalence of markers for viral hepatitis and HIV infections
was 59.5% for anti-HCV, 44.4% for anti-HBs, 22.9% for anti-HBc, 7.2% for
HBsAg, and 5.9% for anti-HIV. Several markers for coinfection, including
HBV-HCV (5.9%), HCV-HIV (5.2%), HBV-HIV (2.0%), and HBV-HCV-HIV (1.3%),
were present. Of the 7.2% of IDUs with isolated anti-HBc, all were anti-HCV
positive and 18.2% were anti-HIV positive; however, no cases had detectable
HBV-DNA as a marker of occult infection.

CONCLUSIONS: Markers for HCV, HBV, HIV, and combinations of these
infections were common among IDUs in a city of central Iran. Isolated anti-
HBc was associated with HCV but not with occult HBV infection in this
sample. The 10-fold higher prevalence of HCV than HIV infection may be a
harbinger of increasing HIV among IDUs in this area.

http://www.ncbi.nlm.nih.gov/pubmed/22895463
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Drug-related arrest rates and spatial access to syringe
exchange programs in New York City health districts: combined effects on
the risk of injection-related infections among injectors
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22047790

Health Place. 2012 Mar;18(2):218-28.

Drug-related arrest rates and spatial access to syringe exchange programs
in New York City health districts: combined effects on the risk of
injection-related infections among injectors.

Cooper HL, Des Jarlais DC, Tempalski B, Bossak BH, Ross Z, Friedman SR.

Department of Behavioral Sciences and Health Education, Rollins School of
Public Health at Emory University, 1518 Clifton Road NE, Room 526, Atlanta,
GA 30322, USA. hcoope3@emory.edu

Drug-related law enforcement activities may undermine the protective
effects of syringe exchange programs (SEPs) on local injectors’ risk of
injection-related infections. We explored the spatial overlap of drug-
related arrest rates and access to SEPs over time (1995-2006) in New York
City health districts, and used multilevel models to investigate the
relationship of these two district-level exposures to the odds of injecting
with an unsterile syringe.

Districts with better SEP access had higher
arrest rates, and arrest rates undermined SEPs’ protective relationship
with unsterile injecting.

Drug-related enforcement strategies targeting
drug users should be de-emphasized in areas surrounding SEPs.

Copyright © 2011 Elsevier Ltd. All rights reserved.

http://www.ncbi.nlm.nih.gov/pubmed/22047790
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Can intranasal drug use reduce HCV infection among injecting
drug users?
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/21794991

Drug Alcohol Depend. 2011 Dec 15;119(3):201-6.

Can intranasal drug use reduce HCV infection among injecting drug users?

Des Jarlais DC, Hagan H, Arasteh K, McKnight C, Semaan S, Perlman DC.

Beth Israel Medical Center, New York, NY 10038, USA. dcdesjarla@aol.com

BACKGROUND: Preventing HCV infection among people who inject drugs is a
difficult public health challenge. We examined the potential role of
intranasal drug use in reducing HCV acquisition.

METHODS: Subjects were recruited from IDUs entering the Beth Israel drug
detoxification program from 2005 to 2010. A structured interview was
administered and serum samples were collected for HCV testing.

RESULTS: 726 active injecting drug users were recruited from 2005 to 2010.
HCV prevalence was 71%, 90% reported recent heroin injection and 44%
reported recent intranasal heroin use. In a multiple logistic regression
analysis, being HCV seropositive was associated with more years injecting,
Latino ethnicity, previous testing for HCV, and recent injection of
speedball, and negatively associated with recent intranasal use of heroin
(AOR=0.52, 95% CI 0.33-0.82) and intranasal use of speedball (AOR=0.41, 95%
CI 0.31-0.80). The association between intranasal heroin use and lower HCV
seroprevalance was observed among both new injectors and persons with long
injecting histories (16+ years since first injection).

CONCLUSION: Encouraging intranasal use as an alternative to injection among
persons currently injecting drugs may be a viable strategy for reducing HCV
transmission.

Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

11. Abstract: Failed drug policies in the United States and the future of
AIDS: A perfect storm
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22895500

J Public Health Policy. 2012 Aug;33(3):309-16.

Failed drug policies in the United States and the future of AIDS: A perfect
storm.

Drucker E.

Department of Epidemiology, Mailman School of Public Health, Columbia
University, 722 West 168th Street, New York, NY 10032, USA.

How much could US policies have reduced the initial growth of the epidemic
had we moved earlier to institute Harm Reduction drug policies such as
needle exchange programs for injecting drug users?

The US Centers for Disease Control estimates 50?000 HIV infections annually
in the United States (156 per million population), but the more populous
European Union estimates 5000 (less that 10 per cent of the US incidence) –
a measure of the failure of US prevention policies for HIV. The earliest
official responses to AIDS in the United States expressed official fear and
condemnation of victims and denial of the magnitude and seriousness of the
population risks in the epidemic’s early stages.

These failures with AIDS prefigure current US crises in general health
policies and interfere with efforts to successfully inform public
understanding of the meaning and value of scientific evidence about health
have diminished public confidence in credibility and trustworthiness of
professional and political leadership for US health polices.
__________________________________________________________________
________________________________*_________________________________

12. Abstract: Testing of the World Health Organization recommended
formulations in their application as hygienic hand rubs and proposals
for increased efficacy
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22134012

Am J Infect Control. 2012 May;40(4):328-31.

Testing of the World Health Organization recommended formulations in their
application as hygienic hand rubs and proposals for increased efficacy.

Suchomel M, Kundi M, Pittet D, Weinlich M, Rotter ML.

Institute of Hygiene and Applied Immunology, Medical University of Vienna,
Austria. miranda.suchomel@meduniwien.ac.at

BACKGROUND: In Central Europe, alcohol-based hand rubs have been the
preferred choice for hand hygiene, whereas, in other countries, other
preparations have been used that are based on other active agents.
Recently, a move towards alcohol-based hand rubs has begun, but they may be
costly and unaffordable to some. Therefore, the World Health Organization
(WHO) has recommended 2 hand rub formulations (WHO I and WHO II) for local
production in health care settings where commercial products are not
available or are too expensive.

OBJECTIVES: WHO I, based on ethanol 80% (vol/vol), and WHO II, based on
isopropanol 75% (vol/vol), were investigated for their bactericidal
efficacy in their application as hygienic hand rubs.

METHODS: The investigation took place at the Institute for Hygiene and
Applied Immunology, Medical University Vienna, Austria, as a prospective,
randomized, in vivo laboratory study, comparative in crossover design. Both
formulations were tested according to the European Standard EN 1500 in 2
applications (1 × 3 mL/30 seconds or 2 × 3 mL/2 × 30 seconds).
Additionally, modifications with increased alcohol concentrations (weight
instead of volume percent) were tested in the short application.
Bactericidal efficacies were compared with those of the respective
reference procedure “R,” ie, rubbing 2 × 3 mL 60% vol/vol isopropanol for 2
× 30 seconds onto hands artificially contaminated with Escherichia coli
K12.

RESULTS: The short application of either WHO formulation resulted in
bacterial reductions significantly inferior to the respective ones of R.
However, prolonging the contact time to 60 seconds or increasing the
alcohol content produced reductions similar to those of R.

CONCLUSION: Both WHO-recommended formulations meet the efficacy
requirements of EN 1500 within 60 seconds but not within 30 seconds.
Increasing the respective alcohol concentrations from 80% vol/vol to 80%
wt/wt and 75% vol/vol to 75% wt/wt renders the formulations sufficiently
active to conform to the norm also within 30 sections.

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

13. Abstract: Point-of-care hand hygiene: preventing infection behind the
curtain
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22546271

Am J Infect Control. 2012 May;40(4 Suppl 1):S3-10.

Point-of-care hand hygiene: preventing infection behind the curtain.

Kendall A, Landers T, Kirk J, Young E.

University Health Network, Toronto, Ontario, Canada. anson.kendall@uhn.ca

Best practices for hand hygiene provide indications for performance of hand
hygiene at specific points in time during patient care. For hand hygiene to
prevent infections, hand hygiene resources must be readily available to
health care workers whenever required.

This article reviews practices and recommendations intended to facilitate
hand hygiene behavior at the point of care (POC) within the health care
setting.

Key aspects of POC hand hygiene include the provision of alcohol-based hand
rub products, integration of dispensing solutions within the patient zone,
consideration of patient care workflow, and dispenser designs that optimize
acceptance and usage.

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

14. Abstract: Patient-centered hand hygiene: the next step in infection
prevention
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22546268

Am J Infect Control. 2012 May;40(4 Suppl 1):S11-7.

Patient-centered hand hygiene: the next step in infection prevention.

Landers T, Abusalem S, Coty MB, Bingham J.

College of Nursing, The Ohio State University, 1585 Neil Avenue, Columbus,
OH 43210-1216, USA. tlanders@con.ohio-state.edu

Hand hygiene has been recognized as the most important means of preventing
the transmission of infection, and great emphasis has been placed on ways
to improve hand hygiene compliance by health care workers (HCWs). Despite
increasing evidence that patients’ flora and the hospital environment are
the primary source of many infections, little effort has been directed
toward involving patients in their own hand hygiene. Most previous work
involving patients has included patients as monitors or auditors of hand
hygiene practices by their HCWs.

This article reviews the evidence on the benefits of including patients
more directly in hand hygiene initiatives, and uses the framework of
patient-centered safety initiatives to provide recommendations for the
timing and implementation of patient hand hygiene protocols. It also
addresses key areas for further research, practice guideline development,
and implications for training of HCWs.

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

15. Abstract: Effectiveness of an audible reminder on hand hygiene
adherence
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/21917355

Am J Infect Control. 2012 May;40(4):320-3.

Effectiveness of an audible reminder on hand hygiene adherence.

Fakhry M, Hanna GB, Anderson O, Holmes A, Nathwani D.

Department of Surgery and Cancer, Imperial College London, UK.

BACKGROUND: Multimodal interventions aim to improve health care workers’
adherence to hand hygiene guidelines. Visitors are not primarily targeted,
but may spread epidemic infections. Effective interventions that improve
the adherence of visitors to hand hygiene guidelines are needed to prevent
the transmission of epidemic infections to or from health care
environments.

METHODS: An electronic motion sensor-triggered audible hand hygiene
reminder was installed at hospital ward entrances. An 8-month
preinterventional and postinterventional study was carried out to measure
the adherence of hospital visitors and staff to hand hygiene guidelines.

RESULTS: Overall hand hygiene adherence increased from 7.6% to 49.9% (P <
.001). The adherence of visitors and nonclinical staff increased
immediately from 10.6% to 63.7% and from 5.3% to 34.8%, respectively (P <
.001). Adherence of doctors, nurses, and physiotherapists increased
gradually from 4.5% to 38.3%, from 5.4% to 43.4%, and from 8.7% to 49.5%,
respectively (P < .001). Improved adherence was sustained among visitors
and clinical staff (P < .001), but not among nonclinical staff (P = .341).

CONCLUSIONS: The electronic motion sensor-triggered audible reminder
immediately and significantly improved and sustained greater adherence of
hospital visitors and clinical staff to hand hygiene guidelines. This is an
effective addition to multimodal hand hygiene interventions and may help
control epidemic infections.

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

16. Abstract: Innovation and technology for global public health
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22780442

Glob Public Health. 2012 Jul 10.

Innovation and technology for global public health.

Piot P.

a Office of the Director , London School of Hygiene and Tropical Medicine ,
London , UK.

Recent decades have been marked by the explosive development of innovative
scientific, technological and business products and processes. Despite
their immense impact on health globally, little has been accomplished in
the field of global public health to incorporate, address and harness such
innovations in practice.

In order to meet the world’s growing health needs, it is essential that
global public health accepts and adapts to these innovations. Moreover,
such innovations must be implemented equitably in ways that will best serve
their intended recipients, without deepening health- and access-related
disparities.

This article will briefly discuss the wide array of technologies in the
pipeline that will affect global public health practice, their impact on
the field and on populations and the issues facing the field in adopting
these innovations
__________________________________________________________________
________________________________*_________________________________

17. No Abstract: Health care workers and vaccination
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22616296

Aust Nurs J. 2012 Apr;19(9):21.

Health care workers and vaccination.

Foley E.
__________________________________________________________________
________________________________*_________________________________

18. No Abstract: Punitive laws undermine HIV prevention, says report
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22893149

AMA. 2012 Aug 15;308(7):661.

Punitive laws undermine HIV prevention, says report.

Voelker R.
__________________________________________________________________
________________________________*_________________________________

19. News

– Australia: Hospitals act to cut dangerous waste
– Nigeria: Unsafe Injection, Bane Of Health Care Systems
– Indonesia: Hepatitis a Growing Public Health Threat in Indonesia:
Experts – Needle stick injuries heighten risk for hepatitis B and C
– USA: New Jersey Syringe Program Might Get Expansion
– Australia: Guards step up syringe action
– UK: Anthrax Drug User Death Caused by Suspected Heroin Contamination
– USA: Hepatitis C Outbreak Could Boost Regulation Bill
– USA: Safe in Common Urges Flu Vaccine Providers to Demand Syringes with
Needlestick Prevention Features
– Australia: Conviction politics: needle exchange established in ACT
prison
– Australia: Gallagher’s minimalist needle model may work
– New Hampshire USA: 32nd N.H. Patient Diagnosed with Hepatitis C
– USA: FDA Approves First Voice-Guided Epinephrine Injection

Selected news items reprinted under the fair use doctrine of international
copyright law: http://www4.law.cornell.edu/uscode/17/107.html
__________________________________________________________________
Australia: Hospitals act to cut dangerous waste
Mark Metherell, Sydney Morning Herald, Australia (22.08.12)

AUSTRALIA’S hospitals, the effluents from which can range from drug-
resistant pathogens to infected medical waste, are joining an international
”green hospital” movement to promote environmental health.

The Australian Healthcare and Hospitals Association signs today on to a
5000-strong global network aimed at reducing hospital waste and minimising
use of harmful chemicals.

The Global Green and Healthy Hospitals Agenda seeks to build on worldwide
developments to make health systems more sustainable, lowering hospitals’
waste production and their use of energy, water and chemicals.

The agenda document said paradoxically the health sector contributed to the
environmental health problems flowing from climate change, chemical
contamination and unsustainable resource use.

It proposed numerous initiatives to make hospitals healthier for patients
and the environment. Hospitals are estimated to consume about twice as much
energy per square metre as a typical office building, because of their
power-hungry equipment and 24/7 operation.

Countries including Australia have demonstrated how basic measures can cut
energy consumption, said the agenda document, which supported solar and
wind generation.
__________________________________________________________________
__________________________________________________________________
http://tinyurl.com/ctgwocc

Nigeria: Unsafe Injection, Bane Of Health Care Systems
By Winifred Ogbebo, Leadership Newspapers, Abuja Nigeria (20.08.12)

Each year, at least 16 billion injections are administered in developing
and transitional countries, says the World Health Organisation.

Injection is one of the most common health care procedures and the vast
majority, around 95 per cent is given in curative care.

According to WHO definition, injections are a skin puncturing procedure
performed with a syringe and needle to introduce a substance for
prophylactic, curative, or recreational purposes.

Injections can be given intravenously, intramuscularly, intradermally, or
subcutaneously. Injections are among the most frequently used medical
procedures, with an estimated 20 billion injections administered each year
world-wide.

A large majority (more than 90 per cent) of these injections are
administered for curative purposes (for every vaccination injection, 20
curative injections are administered. Immunization accounts for around 3
per cent of all injections, with the remainder for other indications,
including use of injections for transfusion of blood and blood products and
contraceptives.

However, the health body observed that in certain regions of the world, use
of injections has completely overtaken the real need, reaching proportions
no longer based on rational medical practice. In some situations, as many
as nine out of 10 patients presenting in a primary healthcare provider
receive an injection, over 70% of which are unnecessary or could be given
in an oral formulation.

According to findings by the WHO, patients tend to prefer injections
because they believe them to be stronger and faster medications. They also
believe that doctors regard injections to be the best treatment. In turn,
doctors over-prescribe injections because they believe that this best
satisfies patients, even though patients are often open to alternatives. In
addition, prescription of an injection sometimes allows the charging of a
higher fee for service.

During her tenure as Director- General of the National Agency for Food and
Drug Administration and Control (NAFDAC), Prof Dora Akunyili was in the
vanguard of campaign against over- reliance on injections.

Apart from the dangers involved in unsafe injection, she held that drugs or
medications also serve the same purpose if not more efficient.

At the flag off of the National Sensitisation Campaign on Injection Safety
last year, the Director General, NAFDAC, Dr Paul Orhii, said that some of
the 20 billion injections given annually worldwide are unnecessary and
unsafe.

He averred that unsafe injections pose a threat to the patient, health
workers and the community.

His words; “It exposes patients to pathogens either directly via
contaminated equipment or indirectly via contaminated medication vials.
Poor injection safety practices arise when unsterilized needles are used,
dirty needles are mishandled and from inadequate sharp disposal practice”

However, Orhii said that the risk posed by patient to patient transmission
of infection due to reuse of syringes or by patient to health worker
transmission due to needle stick pricks can be brought to the barest
minimum if all elements of injection safety are in force.

He described a safe injection as one that does not harm the recipient, does
not expose the provider to any avoidable risks and does not result in waste
that is dangerous to the community.

The General Manager, First Medical and Sterile Products, Dr Isaac Nnamdi,
said there was need to activate the urgency in joining the fight with the
rest of the world against unhealthy use of injection as there are so many
recorded deaths in the country through injection use which could have been
avoided.

Similarly, the Health Minister, Prof Onyebuchi Chukwu, maintained that
because of the increasing dangers posed by unwholesome use of injection,
there was need for awareness.

He said though injections are useful, they are unnecessary, saying, “A lot
more needs to be done because the problems are monumental”

To prevent injection overuse in the curative sector, WHO urged countries’
national drug policies to promote the rational use of therapeutic
injections. This may include removing unnecessary injectable medicines from
the national essential medicines list.

Similarly, the minister of Health has directed all federal government-
owned health institutions to phase out conventional syringes by October 1st
this year.

He issued this deadline at the signing of a memorandum of understanding
(MoU) between the federal government and the Rivers State Government for
bulk purchase of auto-disable syringes.

Chukwu said the migration from conventional to auto-disable syringes was in
line with the National Health Policy, adding that this was affirmed by the
highest decision making body on health in this country, the National
Council on Health (NCH).

He said: ‘’ It is important for us to move away from conventional syringes
to auto-disable syringes as a strategy to reduce transmission of infections
particularly infections such as Hepatitis B, HIV and so many diseases that
are blood borne.”

Prof. Chukwu urged all State Governments to begin to implement the decision
of the National Council on Health regarding this issue, explaining that the
National Council on Health is a forum where federal and state governments
sit down and take decisions on matters that border on healthcare delivery
in the country.

He also called on the private sector to buy into this decision to conform
with international best practices and also enjoined other manufacturing
companies to move from manufacturing conventional syringes to auto-disable
syringes.

A safe injection does no harm. However, when safety control practices are
not respected, severe infections can result, putting human lives at risk.

Reuse of syringes and needles in the absence of sterilization exposes
millions of people to infections. Assessments carried out in numerous
countries have revealed that syringes and needles are often just rinsed in
a pot of tepid water between injections.

Worldwide, up to 40% of injections are given with syringes and needles
reused without sterilization and in some countries this proportion is as
high as 70%.

The WHO puts other unsafe practices, such as poor collection and disposal
of dirty injection equipment, expose healthcare workers and the community
to the risk of needle stick injuries. In some countries unsafe disposal can
lead to re-sale of used equipment on the black market. The proportion of
non industrialized countries still reporting that they use open burning of
syringes (considered unacceptable by WHO) was 50% in 2004.

According to the WHO, the most recent study indicates that each year,
unsafe injections cause an estimated 1.3 million early deaths, a loss of 26
million years of life, and an annual burden of USD 535 million in direct
medical costs.

Unsafe injection practices are a powerful engine to transmit blood-borne
pathogens, including hepatitis B virus (HBV), hepatitis C virus (HCV) and
human immunodeficiency virus (HIV). Because infection with these viruses
initially presents no symptoms, it is a silent epidemic. However, the
consequences of this are increasingly recognized.

Hepatitis B virus: HBV is highly infectious and causes the highest number
of infections: in developing and transitional countries 21.7 million people
become infected each year, representing 33% of new HBV infections worldwide

Hepatitis C virus: Unsafe injections are the most common cause of HCV
infection in developing and transitional countries, causing two million new
infections each year and accounting for 42% of cases.

Human immunodeficiency virus: Globally, nearly 2% of all new HIV infections
are caused by unsafe injections. In South Asia up to 9% of new cases may be
caused in this way. Such proportions can no longer be ignored.

HBV, HCV, and HIV cause chronic infections that lead to disease,
disability and death, a number of years after the unsafe injection. Those
infected with hepatitis B virus in childhood will typically present with
chronic liver disease by the age of 30 years, at the prime of their life.
This has a dramatic effect on national economies.
__________________________________________________________________
__________________________________________________________________
Indonesia: Hepatitis a Growing Public Health Threat in Indonesia: Experts –
Needle stick injuries heighten risk for hepatitis B and C
The Jakarta Globe , Jakarta Indonesia (Source: IRIN) (20.08.12)

Poor awareness about hepatitis infections and a lack of treatment have made
the disease a growing public health threat in Indonesia, experts say.

An estimated 25 million Indonesians have either had hepatitis B or C, but
only about 20 percent of them know, said Rino Gani, the chairman of the
Indonesian Liver Research Association.

Hepatitis is a viral infection with latent symptoms that can take decades
to discover while it damages the liver. Impaired liver function makes it
hard for the body to excrete waste or for blood to clot properly, which can
be fatal in an accident or a complication from surgery.

“We don’t have hard figures for deaths caused by hepatitis, but 30 percent
of people who have hepatitis B and C develop chronic heart problems, which
in turn develop into cirrhosis [irreversible scarring of the liver] or
liver cancer,” Gani said.

Seven types of virus can cause hepatitis, called hepatitis A to G.
Hepatitis A, B, C and E are the most common, causing symptoms such as
yellowing of the skin and eyes (jaundice), dark urine, extreme fatigue, and
abdominal pain, according to the World Health Organization.

People can go for years, even decades, without symptoms. “The cost of
treatment is high and some people think the disease is not serious enough —
it can take 20 years for hepatitis B and C to cause cancer or cirrhosis,”
said Gani.

In 2010 an estimated one million people in Indonesia had cancer of all
types, according to the Indonesian Association of Internists.

Anti-vaccination

In 1997 the government started vaccinating children aged under 5 against
hepatitis B, reaching 82 percent of the under-5 population by 2009, said
Mohamad Subuh, director of the communicable diseases department of the
Health Ministry. There is no vaccine available for hepatitis C.

But some groups in Indonesia have campaigned against vaccination, saying
there is no proof that vaccines can protect children from diseases, and
that they could even be dangerous to health.

A coalition of hard-line Islamic groups — Sharia4Indonesia — says
vaccination is a Western conspiracy to weaken children in developing
countries so as to create a “new world order”.

The groups organized a rally in Jakarta in 2011, staging a performance
about “the dangers of vaccines”. Their leaflets quote experts such as a
former director of the National Institutes of Health in the United States,
James R. Shannon, as saying: “The only safe vaccine is one that is never
used.”

Health Minister Nafsiah Mboi said that without vaccination, millions of
lives are in danger. “I’m restless because [of] this anti-vaccine
movement,” the minister said. “With immunization, we can save millions of
children in Indonesia from being infected with hepatitis B and C.”

Treatment

“Our efforts have focused on prevention, but we also continue to provide
better access to treatment for people with hepatitis,” said the Health
Ministry’s Subuh.

The government set up a unit in the Health Ministry in 2010 to focus on
hepatitis, which is preparing treatment and prevention guidelines, and
conducting early-detection trials in high-risk populations, including
health care workers and injecting drug users.

Hepatitis B is transmitted through contact with blood or other bodily
fluids, while hepatitis C is passed from one person to another by blood-to-
blood contact.

Gani said many people who have hepatitis cannot afford treatment and choose
to ignore it. Hepatitis is covered under government health waivers for the
poor, known as Jamkesmas, but patients either do not know about these
subsidies or do not qualify for them.

Treatment for hepatitis B and C that lasts longer than six months involves
injecting costly “interferon” disease-fighting proteins.

In Southeast Asia, around 100 million people are infected with hepatitis B,
according to WHO.

Every year there are nearly nine million cases of hepatitis in Southeast
Asia, and nearly 600,000 deaths resulting from hepatitis B and C
complications.

IRIN
__________________________________________________________________
__________________________________________________________________
USA: New Jersey Syringe Program Might Get Expansion
Kathryn Brenzel, Star-Ledger, Newark New Jersey (08.19.12)

A bill to establish permanent statewide needle-exchange programs (NEPs)
awaits review in the New Jersey Assembly Health and Senior Services
Committee. The state launched syringe access sites in 2006 as a pilot
program under the Blood-Borne Disease Reduction Act. Currently Newark,
Camden, Jersey City, Trenton, and Paterson host programs.

A report by the New Jersey Department of Health and Senior Services says
the pilot program has helped curb the number of used needles in
circulation. Data from 2007-09 indicated that 4,482 participants were
enrolled, and 998 were receiving drug treatment.

The Newark NEP has served 2,8000 unique clients since its inception,
according to Brian McGovern, executive director of the North Jersey
Community Research Initiative. He said the state would benefit from making
NEPs available beyond urban areas.

Roseanne Scotti, New Jersey director for the Drug Policy Alliance, said it
makes “good moral and good financial sense” for the state to further fund
the existing programs and make them permanent. The bill being proposed
appropriates $95,000 toward this effort.

The bill is controversial, however, and most of Warren and Hunterdon
counties’ senators voted against it last month. “I think it sends the wrong
message to society,” Sen. Michael Doherty (R-Warren/Hunterdon) said. “On
the one hand, you’re saying, ‘Drugs are bad,’ then providing needles to
facilitate drug use.” Although the programs offer other services, Doherty
said there are other, better means for drug users to seek treatment.

In January, Gov. Chris Christie signed a bill that allows pharmacies to
sell up to 10 hypodermic syringes without a prescription to people older
than 18.
__________________________________________________________________
__________________________________________________________________
Australia: Guards step up syringe action
Christopher Knaus, The Canberra Times, Canberra Australia (17.08.12)

The brawl over the government’s planned prison needle exchange will heat up
dramatically today, as the guards’ union seeks to take Chief Minister Katy
Gallagher to the industrial relations tribunal.

The government announced a plan this week to trial a needle and syringe
program in Canberra’s jail as early as next year, drawing praise from
Australia’s public health experts who applauded the ”brave” effort to
stem the spread of hepatitis C and other blood borne disease.

But the Community and Public Sector Union, which represents guards, say
they were shocked by Wednesday’s announcement, and have reaffirmed their
adamant opposition to any needle exchange that puts their members at risk.

This morning, the union will up the stakes, putting in a notification of
dispute with Fair Work Australia over the government’s approach to
implementing the needle exchange.

The crux of the dispute relies on a clause in the guards’ enterprise
agreement that states the union must be properly consulted with, and also
give consent, before a needle exchange can go ahead.

CPSU regional director Vince McDevitt said the government had not consulted
in good faith, and already had a pre-determined outcome to set up the
needle exchange.

The union will seek to have conciliation hearings in the tribunal on those
grounds.

The move comes as the needle exchange, which would be the first in the
English-speaking world, failed to garner support from other state and
territory governments.

All other state governments, contacted by The Canberra Times yesterday,
said they still had no plans to introduce needle exchanges in their jails.

NSW, South Australia, and Queensland said the handing out of needles put
guards and prisoners in too much danger, while the Victorian and West
Australian governments said it would undermine their zero tolerance
approach to drug use in jails.

The Tasmanian Corrections Minister, Greens leader Nick McKim, was slightly
more positive, saying the state had no current plans for a prison-based
needle exchange, but would watch any trial in the ACT with great interest.

The lack of interstate support has not deterred Ms Gallagher, who was
described on Wednesday as a politician ”with spine” by public health
advocates.

She said she’s not surprised by the nation’s reluctance to follow the ACT’s
lead on a prison-based needle exchange. ”These are controversial subjects
and it’s easier not to have the discussion than to have it,” Ms Gallagher
said.

”I’ve thought about that too, the fact that no one else is doing it, is
that a reason not to explore it here?” she asked.

”And I reached the view at the end that, based on the information that I
have about our jail, what other jurisdictions were doing really wasn’t
relevant.”

Needle exchanges are operating at prisons across Europe, including Germany,
Switzerland, Belarus and Moldova, and also in Iran.

National Drug and Alcohol Research Centre Professor Kate Dolan, an expert
in the area of prison health, has seen many of those needle exchanges first
hand.

Professor Dolan said Australia was well behind the jails in Europe, where
needle exchanges were first seen in the early 1990s.

She said foreign needle exchanges had not seen problems with prisoner and
guard safety, but had seen dramatic reductions in both drug use and blood
borne disease.

”The research from overseas is very promising,” Professor Dolan said.

Read more:
http://www.canberratimes.com.au/act-news/guards-step-up-syringe-
action-20120816-24bs8.html#ixzz24FAtoUsT
__________________________________________________________________
__________________________________________________________________
UK: Anthrax Drug User Death Caused by Suspected Heroin Contamination
By Kristen Hallam and Mehreen Khan, Bloomberg News (17.08.12

An injecting drug user in England who died in the hospital had a confirmed
case of anthrax in a growing instance of the condition from contaminated
drugs, the Health Protection Agency said today.

The fatality in Blackpool, northwest England follows the identification of
seven anthrax cases since June in Scotland, Germany, Denmark and France,
with the source presumed to be contaminated heroin, said the HPA in an e-
mailed statement. There was a similar fatality in Blackpool from anthrax
through drug injection in February 2010.

Drug injectors, who are vulnerable to a range of infectious diseases, may
become infected with the anthrax bacteria when heroin is contaminated with
anthrax spores causing an infection, according to the HPA. The condition
can be cured if treatment starts at an early stage and is rarely passed
from human to human.

“Anthrax can be cured with antibiotics, if treatment is started early,”
said Dilys Morgan, a doctor specialized in infectious diseases at the HPA.
“It is therefore important for medical professionals to know the signs and
symptoms to look for, so that there are no delays in providing the
necessary treatment.”

Redness and swelling occur at the point of injection among drug users who
have anthrax, while fever and flu-like symptoms develop if the drug is
smoked, the HPA said.

An outbreak of anthrax among heroin users in Scotland was reported in 2009
and 2010, infecting 47 people, 14 of whom died. Before 2009, only one case
of drug-related anthrax was found — in Norway in 2000, the London-based
agency said.

Anthrax bacteria, known as Bacillus anthracis, occurs most commonly in
cattle, sheep and goats and can produce poisons lethal to humans.
__________________________________________________________________
__________________________________________________________________
USA: Hepatitis C Outbreak Could Boost Regulation Bill
Holly Ramer, Associated Press (16.08.12)

The recent case of a medical technologist accused of infecting patients
with hepatitis C at a New Hampshire hospital could build support for the
creation of consistent national standards for such workers, advocates say.

Arrested in July, cardiovascular technologist David Kwiatkowski is accused
of a drug-diversion scheme that contaminated syringes used on patients at
Exeter Hospital. Before his arrest, Kwiatkowski worked at 18 hospitals in
seven other states, moving from job to job despite being fired twice for
allegations of drug use and theft. Lack of regulation, poor communication,
and deception helped cover his trail.

“Unbelievable,” said US Rep. John Barrow (D-Ga.), lead sponsor of a bill
that would require medical imaging and radiation workers to meet uniform
national standards in order for employing hospitals to receive Medicare
funding.

Education and certification standards vary in the 45 states that regulate
at least one type of job involving medical imaging or radiation therapy.
The American Society of Radiologic Technologists for years has lobbied for
federal legislation like the bill under consideration. Sens. Mike Enzi (R-
Wyo.) and Tom Harkin (D-Iowa) introduced their version in July, with Barrow
one of 130 House co-sponsors. Congress has failed to pass any previous
versions, despite no significant opposition, said Christine Lung, ASRT’s
vice president of government relations.

“I think it’s going to take situations like Mr. Kwiatkowski … to really
make the public sit up and take notice,” Lung said.

“While medical licensing laws and regulations have traditionally been
developed at the state level, Congress has an important oversight role in
ensuring patient safety across the nation,” said John Billings, chief of
staff for Rep. Charles Bass (R-N.H.). Sen. Kelly Ayotte (R-N.H.) said she
would consider legislative remedies, but that hospitals bear the ultimate
responsibility to prevent such incidents by conducting thorough background
checks and strictly controlling access to narcotics.
__________________________________________________________________
__________________________________________________________________
USA: Safe in Common Urges Flu Vaccine Providers to Demand Syringes with
Needlestick Prevention Features
Infection Control Today (16.08.12)

This fall and winter, approximately 150 million doses of flu vaccine will
be administered across the U.S during the influenza season – which means
one injection will be given to almost 1 in every 2 U.S. citizens. Safe in
Common, a non-profit organization established to promote needlestick safety
and build a community of healthcare safety advocates, today issued a
reminder to healthcare facilities and other public sites that will
administer the flu vaccine to use syringes with safety features that can
protect providers from the risk needlestick injuries.

The Centers for Disease Control and Prevention (CDC) recommends everyone
who is at least six months of age get a flu vaccine before the flu season,
which the CDC tracks from October 2012 to May 2013. Administration of the
flu vaccine will occur in both controlled environments, such as hospitals
and physician’s offices, as well as shopping malls, drug stores and other
public areas.

The majority of flu vaccine doses will be administered to patients in
either a prefilled or hypodermic syringe. To comply with the Occupational
Safety and Health Administration (OSHA)’s Bloodborne Pathogens Standard,
employers are required to use syringes with safety-engineered equipment,
where commercially available, to help protect healthcare personnel and
others at potential risk of infection from HIV, hepatitis C and other modes
via needlestick injuries. Employers who fail to comply with the
requirements of the Bloodborne Pathogens Standard risk being issued with
citations and financial penalties by OSHA.

According to Mary Foley, PhD, RN, chairperson of Safe in Common, healthcare
personnel and other employees engaged in the administration of a flu
vaccine are among those at greatest risk of needlestick injury.

“The hectic environments where flu vaccines are often given, as well as
safety deficiencies in the syringes typically used for these injections,
can put healthcare personnel at significant risk of incurring a needlestick
injury. Safe in Common is calling for all providers of the flu vaccine to
stock sufficient supplies of safety-engineered equipment and appropriate
disposal systems to cover every flu vaccine that will be given at their
site,” Foley says.

Because flu vaccines are typically administered by intramuscular injection,
it is routine procedure for syringes to be supplied without needles so that
healthcare personnel can select a needle of appropriate length to
accommodate the needs of each target patient. Foley says the safety needles
that are commonly used for intramuscular injections provided healthcare
personnel with sub-optimal levels of protection.

“The goal for every injection where there is risk of a needlestick injury
should be the removal of harm as quickly as possible. All too often, flu
vaccinations are given with syringes that are attached with standard luer
needles. This is no longer acceptable practice within U.S. healthcare
facilities, and we encourage people to speak up when they see syringes
without safety features being used.

“But even where a safety product such as a needle guard is utilized, an
operator must first remove the used syringe from the body of the patient
before manually engaging the needlestick prevention mechanism. Needlestick
injuries often occur either before or during the activation of these manual
safety products, or because the operator elects not to engage the safety
mechanism at all. We encourage pharmaceutical manufacturers to provide
their flu vaccines prefilled with products with integrated and automatic
safety features that can deliver optimal levels of protection to healthcare
personnel. We also want to let healthcare personnel know that if these
devices are not available currently, they have the right to demand them.
It is their health that is at risk,” Foley adds.

OSHA estimates that 5.6 million workers in the U.S. healthcare industry are
at risk of occupational exposure to bloodborne pathogens via needlestick
injuries and other sharps-related injuries and the CDC reports that 385,000
needlestick injuries and other sharps-related injuries are sustained
annually by hospital-based healthcare personnel.

Safe in Common works to eradicate needlestick and sharps related injuries
and to promote the adoption of safer engineering controls in healthcare
settings through education and training. Backed by a community of thousands
of healthcare personnel, SIC is raising awareness of Needlestick injury
prevention and gathering signatures for the organization’s Needlestick
Safety Pledge as a step toward prevention.

For more information about Safe in Common or to learn about partnership
opportunities and the Organization’s ongoing work to promote utilizing
safer engineering controls that protect healthcare workers from unnecessary
needlestick and sharps related injuries, visit http://www.safeincommon.org.
__________________________________________________________________
__________________________________________________________________

http://theconversation.edu.au/conviction-politics-needle-exchange-
established-in-act-prison-8857

http://tinyurl.com/csfekvh

Australia: Conviction politics: needle exchange established in ACT prison
By Alex Wodak, The Conversation, Australia (16.08.12)

The announcement yesterday by Chief Minister Katy Gallagher to establish a
needle exchange in the ACT’s Alexander Maconochie Prison is historic.
Politicians need votes like the rest of us need oxygen. And they know that
there are no votes in prisons. But prisoners are a major concern for public
health and human rights.

Despite prison authorities all over the world doing everything in their
power to stop drugs entering prisons, they still get in. And they always
will. Charles Manson, the most closely-guarded prisoner in the Western
world, was still able to obtain illicit drugs behind bars.

But why do prison inmates take drugs despite the huge risks they run? A
prisoner once explained to me that “a day off your face is a day off your
sentence”. Last year, an inmate in a Jakarta jail told me that drugs were
sometimes cheaper in his prison than in the community.

Less than 1% of the community injects drugs. But those who do inject about
two to three times a day (or about 60 to 100 times a month). These days
people injecting in the community are likely to share needles and syringes
with about half a dozen close friends each year. Most of the time, they
inject using brand new sterile needles and syringes. Other harm reduction
measures are generally readily available. In the community HIV infections,
but not hepatitis C infections, are rare.

That’s quite a contrast with the situation in prisons. Up to 25% of
prisoners will inject drugs while they are behind bars. Prisoners who
inject drugs do so much less frequently than their counterparts in the
community – perhaps only half a dozen times a month. But they will often
share each needle and syringe with between six and ten other inmates. The
needles and syringes used in prison are cut down and will have been used
previously, perhaps hundreds of times. They are perfect and efficient
vehicles for transmitting viral infections.

Most HIV and hepatitis C infections that occur in prisons are only detected
when the former inmate is back in the community. By then it’s almost
impossible to prove where the infection was contracted. People who use
drugs often serve frequent but short prison sentences and so often move
between the community and prison.

It’s difficult explaining this situation to the community. More draconian
approaches to prison are always expensive, rarely effective and often have
severe unintended negative consequences. But draconian approaches are
political viagra while pragmatic and effective approaches are often
considered politically suicidal.

That’s why it’s taken more than 20 years before any politician in the
English-speaking world has done what Katy Gallagher has had the courage to
do. Politicians who stand up for important principles deserve to be
strongly supported. Katy Gallagher will be greatly admired for the rest of
her life by people who understand that protecting public health and human
rights is critical.

Sooner or later, a prisoner or former prisoner who can prove that they
acquired HIV or hepatitis C in a correctional system elsewhere in Australia
will sue the prison authority for failure to provide duty of care to the
level provided in the community for the last quarter century.

A court will then award them a large sum of money. One by one, correctional
authorities in other jurisdictions will act either before or after such a
court case. But the experience with the introduction of community needle
syringe programs in Australia in the late 1980s suggests that it will still
be a difficult and protracted battle extending this decision to the rest of
the country.

This is a great moment for public health and human rights. The ACT
government’s decision reminds us that offenders get sent to prison as
punishment, not for punishment. They’re certainly not sent to prison to
acquire dangerous infections and then spread them to their loved ones and
friends in the community.

Those who like to demonise all politicians should think about Katy
Gallagher and the ACT government courageously acting in the best interests
of the community. We should remember with gratitude how politicians from
all parties in the early years of HIV excelled themselves by ranking the
national interest above their short-term political interests. Katy
Gallagher is following in this great tradition.
—————————————————————————
AUTHOR: Alex Wodak
Director, Alcohol and Drug Service, St Vincent’s Hospital at St Vincent’s
Hospital, Darlinghurst
DISCLOSURE STATEMENT

Alex Wodak is the president of the Australian Drug Law Reform Foundation.
He has been involved with prison health meetings with UN Office Drugs and
Crime.

The Conversation provides independent analysis and commentary from
academics and researchers.

We are funded by CSIRO, Melbourne, Monash, RMIT, UTS, UWA, Deakin,
Flinders, Griffith, La Trobe, Murdoch, QUT, Swinburne, UniSA, UTAS, UWS and
VU.
__________________________________________________________________
__________________________________________________________________
http://tinyurl.com/clgfbeg

Australia: Gallagher’s minimalist needle model may work
John Ryan, Canberra Times, Canberra Australia (16.08.12)

This pragmatic and sensible approach has much in its favour, JOHN RYAN
writes

The ”minimalist” model of sterile injecting equipment provision in prison
proposed by Chief Minister Katy Gallagher yesterday is so pragmatically
sensible that it may work, in a number of ways.

The framework for managing blood-borne viruses in the Alexander Maconochie
Centre is comprehensive. It stresses drug control and drug treatment while
offering a doctor-supervised system where inmates can swap an existing
dirty needle for a sterile one.

First and foremost, the proposal provides an opportunity for people at risk
of catching HIV or hepatitis C/B to access a proven prevention method so
that they can avoid infection and passing the virus to others upon their
release back to the community.

Injection already occurs within the AMC and as the confirmation of at least
nine hepatitis C infections among detainees shows, the inability to access
the option of sterile equipment by prisoners is almost certainly in breach
of the Corrections Management Act.

A second way in which the announcement of a possible ”one-for-one”
exchange is astute is to side-step the possibility of a successful legal
challenge by a person claiming that continued denial of safer injection
options breached principles of healthcare equivalence.

Potential for a legal challenge is not hypothetical. A strong body of legal
opinion has been assembled.

Last month the International Labour Organisation, which represents workers’
interests within United Nations processes, broke new and interesting ground
by weighing into the discussion. This is relevant to the third way in which
Gallagher’s sensible approach is likely to be ultimately successful.

The reality is that the AMC would already have a form of controlled needle
exchange,

and some infections in and outside the prison would have been averted, if
not for opposition by the Community and Public Sector Union.

Despite international evidence to the contrary, the union continues to trot
out the line that a carefully controlled program could lead to needles
being used as weapons. This is the same line that was used against condoms
being introduced.

The ILO policy guidelines, aimed squarely at governments, prison
authorities and workforce representatives, lists 15 recommended
interventions as part of a ”comprehensive” suite of drug-related health
interventions.

One was: ”Prisoners who inject drugs should have easy and confidential
access to sterile drug injecting equipment, syringes and paraphernalia, and
should receive information about the programs.”

Gallagher’s administration is the first government to act in accordance
with these new recommendations. Her announcement reflects those ILO
sentiments.

Importantly, the guidelines rightly consider the interests of prison
officers. With the nitty-gritty of implementation still ahead, the ILO
suggests: ”Occupational safety and health procedures on HIV, viral
hepatitis and tuberculosis should be established for employees. Prison
staff and workers in prisons should receive information, education and
training by labour inspectors and specialists in medicine and public health
enabling them to perform their duties in a healthy and safe manner.”

So there it is: the workers’ voice within the UN urges prison officer
education and involvement in BBV prevention that must include needle and
syringe programs. This is where the shrewd ”minimalist” model
pragmatically suggested by the Chief Minister is most significant.

CPSU secretary Vince McDevitt has previously pushed a ”needles in guards
out” position. But, putting management of one-for-one exchange in the
hands of respected doctors makes it more palatable to CPSU officials
representing any oppositionalist prison guards.

A one-for-one model can become the Nauru option, for both the CPSU and the
Liberal Party Leader, Zed Seselja. Respect expert advice and shift policy
in accordance with evidence in support of people’s welfare.

McDevitt yesterday recognised that decisions concerning sterile needle
access should be in the hands of ”doctors, not politicians”. Therefore,
he should be telling his members that decisions need to be in the hands of
doctors rather than prison guards.

The ACT branch of the Australian Nurses Federation has supported in-prison
sterile needle provision in principle, but couldn’t endorse models that had
previously been canvassed. A one-for-one option in the hands of the doctors
as part of an improved overall health approach should almost certainly be
acceptable to the ANF membership.

When the ”one-for-one” exchange accompanied by effective workforce
training becomes accepted, as I think it will, it is less likely that in
the event of forming government, Seselja could reasonably unwind it. The
legal and moral arguments concerning healthcare equivalence would likely
carry even more weight. There is no cure for HIV, no vaccine for hepatitis
C and science still can’t solve widespread drug dependence. That’s why
community programs exist to help prevent disease among injectors. ”

John Ryan is chief executive officer of Anex Australia, an independent not-
for-profit public health organisation committed to the prevention of drug-
related harm.

Read more: http://tinyurl.com/clgfbeg
__________________________________________________________________
__________________________________________________________________
New Hampshire USA: 32nd N.H. Patient Diagnosed with Hepatitis C
Associated Press (15.08.12)

Another Exeter Hospital patient has been diagnosed with the same strain of
hepatitis C virus carried by David Kwiatkowski, a former medical
technologist who is accused of a drug-theft scheme that contaminated
syringes and infected patients.

This brings to 32 the number of former Exeter Hospital patients diagnosed
with HCV since May, when the investigation began.

The most recently diagnosed patient was treated at Exeter’s cardiac lab
before Kwiatkowski’s reported start date in April 2011; however, public
health officials said the patient was still hospitalized when the
technologist began working.

To rule out other staffers, the state is recommending that certain
additional workers be tested.
__________________________________________________________________
__________________________________________________________________
http://www.medscape.com/viewarticle/769084?src=mpnews

USA: FDA Approves First Voice-Guided Epinephrine Injection
Emma Hitt, PhD, Medscape Today (13.08.12)

August 13, 2012 — The first voice-guided epinephrine auto-injector (Auvi-Q,
sanofi US) has been approved for use by the US Food and Drug Administration
(FDA).

According to the manufacturer, this is the first auto-injector device with
both audio and visual cues to guide patients through the injection process.
The product will be commercially available sometime after November 15, Lori
Lukus, director of product communications with sanofi US, told Medscape
Medical News.

The auto-injector is indicated for the emergency treatment of life-
threatening allergic reactions that may occur as a result of the ingestion
of allergens, including nuts and eggs, and insect bites and stings.

Auvi-Q

Auvi-Q is about the size of a credit card and the thickness of a cellular
telephone. It has a retractable needle mechanism designed to help prevent
accidental needle sticks after injection, the manufacturer states.

The device is available in 2 different doses: 0.3 mg epinephrine injection
for patients who weigh 66 pounds or more and 0.15 mg epinephrine injection
for patients who weigh between 33 and 66 pounds. The device has not been
studied in patients weighing less than 33 pounds.

In a telephone interview with Medscape Medical News, independent
commentator Clifford Bassett, MD, said that this new device is “very
exciting” because any time a device can be made “easier, simpler and more
pleasant, and even cooler, then we will increase the likelihood that
patients will keep it available during an emergency.”

According to the manufacturer, approximately two thirds of patients and
caregivers do not always carry their epinephrine auto-injector as
recommended, and nearly half worry that others will not know how to use
their device during an emergency.

“The audio feature of this device is certainly unique,” Dr. Bassett added.
“We are really looking forward to such a device in the allergy community.
My hope is that the device will penetrate into the market of those
individuals who do not currently carry an auto-injector with them.”

Dr. Bassett is a spokesperson for the American College of Allergy, Asthma
and Immunology and allergist with Allergy & Asthma Care of New York.

Sanofi US licensed the North American commercialization rights to Auvi-Q
from Intelliject Inc, which has retained commercialization rights for the
rest of the world.

Dr. Bassett has disclosed no relevant financial relationships.
__________________________________________________________________
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