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SIGNpost 00666


Post00666  Health Logistics + IPC + Abstracts + News 12 September 2012

1. An Antenatal Counseling Guide to Fight Bloodborne HIV and Stigma
2. Logistics for Health Commodities Course Online at The Global Health
eLearning Center
3. Online Textbooks
4. Global Health Supply Chain Summit: Rwanda 14-16 November 2012
5. Abstract: Early diagnosis of hepatitis C transmission after needlestick
6. Abstract: Co-infection rate of HIV, HBV and Syphilis among HCV
seropositive identified blood donors in Kathmandu, Nepal
7. Abstract: Adverse drug reactions to local anesthetics: a systematic
8. Abstract: Nonsurgical interventions for low back pain
9. Abstract: Controlling HIV Epidemics among Injection Drug Users: Eight
Years of Cross-Border HIV Prevention Interventions in Vietnam and China
10. Abstract: HIV prevalence and risk behaviours among injecting drug users
in six Indonesian cities implications for future HIV prevention
11. Abstract: Association between harm reduction intervention uptake and
recent hepatitis C infection among people who inject drugs attending
sites that provide sterile injecting equipment in Scotland
12. Abstract: Linkage into specialist hepatitis C treatment services of
injecting drug users attending a needle syringe program-based primary
healthcare centre
13. Abstract: Evidence of high-risk sexual behaviors among injection drug
users in the Kenya PLACE study
14. Abstract: Methadone maintenance therapy outcomes in Iran
15. Abstract: Comparison of the robustness and functionality of three
adrenaline auto-injectors
16. Abstract: Safety of a novel microneedle device applied to facial skin:
a subject- and rater-blinded, sham-controlled, randomized trial
17. Abstract: The hospital pharmacist: an important contributor to improved
patient safety in the hospital
18. No Abstract: Investigation on health condition of medical waste
disposal workers in one province
19. News
– Wisconsin USA: Discarded Needles Found in Neighborhoods
– 8th Australasian Viral Hepatitis Conference: Un-edited statements from
the health sector and beyond
– UK: Heroin users warned after second anthrax death: Hospitals and walk-
in clinics across the UK warned to expect further cases after second
drug user dies in Blackpool
– UK: NHS spends £500,000 on users’ needles and swabs
– Australia: Jump in hospital staff risk
– Arizona USA: OPINIONS: Out of sight, out of mind
– UK: Nurse bailed in hospital deaths probe
– Tanzania: BD -Tanzania Government and Partners Launch Multi-Year
Training Program
– AZ inmates possibly exposed to Hepatitis C
– Arizona USA: Prison nurse tied to hepatitis C exposure

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1. An Antenatal Counseling Guide to Fight Bloodborne HIV and Stigma

A new post from John Balidawa, Bachi Medical Centre, Uganda, and David

John Balidawa, Bachi Medical Centre, and David Gisselquist

Public education about HIV transmission and acquisition risks in Africa
focuses almost exclusively on sexual risks. In African culture this results
into stigma to the HIV infected and affected because sex is a secret act.
It also prevents individuals from freely taking an HIV test as they will be
associated to having had a sexual act.

When a pregnant woman attends antenatal care, she is counseled
to take an HIV test. If this woman had no sexual risks and trusts her
husband should she take an HIV test? If she is HIV-positive, does it
mean her husband or herself had multiple sexual partners? What if
her husband tests HIV-negative?

Most women who go for antenatal care in Africa are encouraged to
get tested for HIV by the service providers and many test due pressure
from the health workers. An HIV-positive test contributes to reduce
the chances of mother to child transmission of HIV. But to do so – the
mother takes antiretroviral drugs during pregnancy, labour and after
deliver. The baby is also given antiretroviral drugs until three months
after breast feeding and breastfeeding is limited to a shorter period like
one year or less. It is hard for a mother to adhere to the prevention of
mother to child transmission of HIV guidelines from the health workers
without her partner knowing. Male partners are also expected to be
supportive to their HIV-positive women socially, physiologically and

Knowing who is infected is important information to plan the family’s
future and to protect whoever is not yet infected. But if people think all
HIV comes from sex, telling can be a problem. HIV testing and sharing
test results has always created family strife and stigma so the need to
remind people that there are other ways through which HIV can be
transmitted and acquired.

Bachi Medical Centre, Uganda, has introduced an Antenatal Counseling
Guide to give women information about blood borne risks for HIV that
they need to protect their families and also to counter the stigma, fear,
and sexual accusations that might follow HIV-positive test results. You
can find a link to this guide at: [458 kb PDF]

2. Logistics for Health Commodities Course Online at The Global Health
eLearning Center


Change is on the Way!

We asked, you responded, we listened! The Global Health eLearning Team
completed an in-depth evaluation of the Global Health eLearning (GHeL)
Center last year. Thank you to many learners across the world who
participated! Since then, we have been reviewing the feedback and using it
to create a new GHeL Center – one that will enhance your learning

There will not only be a fresh new design that better meets the needs of
learners and authors of courses, but we are also making the site simpler to
navigate, content easier to find, and the overall experience smoother and
more productive for learning and sharing.

The GHeL Center will contain the same excellent courses that you have
already completed, are in the process of completing, or have on your to-do-
list. In addition, the information contained in your user profile will

We will communicate specifics of the new site as the launch nears in

New and Improved Courses!

We are pleased to announce a new course on Long Acting and Permanent
Methods. LA/PMs: a Smart FP/RH Program Investment seeks to present the
rationale for making LA/PMs more widely available in the contraceptive
method mix of national FP programs and identifies key challenges as well as
proven and promising programs. The course presents a combination of
technical information, leadership and training strategies, and holistic
programming experiences from the field.

* Logistics for Health Commodities was recently revised and includes
cutting edge program examples and best practices managing logistics. In
this course you will learn about a wide range of logistics principles and
practices as well as the highlights each function of the logistics cycle,
including assessing stock status, inventory control, and monitoring and
evaluation. Complete this newly revised course to update your knowledge and
receive a new completion certificate.

Also, we’d like to share a new resource that might be of interest to Global
Health eLearning Center learners, the Global Health Journal…

New Global Health Journal Now Accepting Manuscripts
Global Health: Science and Practice, a new peer-reviewed, open access
online journal, is now accepting manuscripts that share best practices and
lessons learned, with an emphasis on articles that that detail how programs
can be implemented successfully.

GHSP is published by USAID in partnership with the Johns Hopkins Bloomberg
School of Public Health under the leadership of Editors-in-Chief James D.
Shelton, MD, MPH of USAID and Ron Waldman, MD, MPH of the Center for Global
Health at George Washington University.

Visit our website at to submit a manuscript, volunteer
to be a peer reviewer and subscribe to be notified when the first issue is
launched. GHSP will be offered free of charge to health professionals
worldwide. There also is no cost to authors to submit their manuscripts to
the journal for consideration. For additional information, contact Natalie
Culbertson Managing Editor

See you online,

The Global Health eLearning Center Team

3. Online Textbooks

Crossposted from In SafeHandS with thanks.
In SafeHandS, VOLUME 5, ISSUE 6, September 2012

This month we are featuring online textbooks

International Federation of Infection Control (IFIC)

Basic Concepts of Infection Control. 2nd edition. Revised 2011

This new edition of IFIC Basic Concepts of Infection Control builds on its
predecessors, enhancing and updating in a scientific way the knowledge
required as a foundation on which local policies and procedures can be

Most chapters have been reviewed and brought up-to-date by an international
panel of experts, and new ones have been added to ensure this new edition
provides a sound comprehensive knowledge base.

As before, we hope the infection prevention and control principles set out
in this book are applicable to all health care settings, especially in
these days of global limitation of resources, but particularly to areas
where infection prevention and control is still in its infancy.

International Labour Organization

Fundamental principles of occupational health and safety. Second edition.

This “is a practical guide to developing effective occupational safety and
health (OSH) policies and programmes based on the provisions defined in the
‘core’ ILO standards and instruments concerning OSH. It focuses on the key
topics essential to promoting and managing national and enterprise OSH
systems and presents a concise overview of the issues involved, together
with specific guidelines for policy design, implementation and management
at both national and enterprise levels. The operational aspects of meeting
health and safety requirements are also covered, with detailed sections on
legislation and enforcement, occupational health surveillance, and
preventive and protective measures, as well as health education and

University of California, San Francisco

HIVInsite Knowledge Base

“The HIV InSite Knowledge Base (HKB) is an online textbook of more than 100
chapters and resource pages covering an array of HIV clinical topics such
as the diagnosis and management of HIV, opportunistic infections, and AIDS-
related malignancies as well as HIV transmission, prevention, and public
policy. Chapters present state-of-the-art information from these topic
areas that is applicable to HIV care throughout the world.”

“As an online textbook, the HKB not only makes its content widely available
free of charge, but also provides access to related materials, both within
HIV InSite and wherever else they may be available on the World Wide Web.
Many chapters link to a page of “Related Resources,” organized into
categories including guidelines, fact sheets, journal articles, and so on.”

HIV Treatments Directory

Comprehensive textbook on the immune system, HIV and HIV treatments
Department of Health, Victoria, Australia

Blue book – Guidelines for the control of infectious diseases

The blue book: guidelines for the control of infectious diseases has been
published by the Communicable Disease Prevention and Control Unit Victorian
Department of Health, to assist public health practitioners in the
prevention and control of infectious diseases.

4. Global Health Supply Chain Summit: Rwanda 14-16 November 2012

Crossposted from edrug with thanks.

Global Health Supply Chain Summit: Rwanda 14-16 November 2012

Dear Colleagues,

Please mark your calendar for the 2012 Global Health Supply Chain (GHSC)
Summit on November 14-16, 2012, in Kigali, Rwanda.

The Summit will feature two days of educational sessions on three key
topics: – understanding and managing risk in the supply chain, – taking
supply chain innovations to scale, and – benchmarking supply chain

A third day of the conference will be dedicated to “open space technology”
and discrete meetings, including educational content and networking for
members of the International Association for Public Health Logisticians

This is the first time the summit is held in Africa, and IAPHL will be
taking part as a sponsor and organizer.

We are currently raising money to sponsor IAPHL members to attend the
conference, and we encourage you to participate in our sponsorship program.

View sponsorship and event details at:

regards, Anne Marie Hvid JSI
A Call to Contribute to the 5th Global Health Supply Chain Summit –
bringing supply chain challenges forward from the field to the research
agenda “South to south cooperation is a visionary idea that is starting to
pay off today.

Due to their first-hand familiarity with the problems on the ground, actors
in South-South cooperation can be more efficient and effective in
identifying and implementing solutions.” —Rene Castro, Minister of Foreign
Affairs, Costa Rica1 The 5th Global Health Supply Chain Summit (GHSCS) will
connect academics and implementers on a platform of knowledge exchange and
global networking to foster South-to-South learning.

The Summit will offer numerous opportunities to learn individually, as well
as to come together as a global community of supply chain management
practitioners and researchers. Implementers, academics, and policymakers
will share information on country experiences, innovative practices,
challenges, and success stories to build knowledge across a globally
dispersed community. To maximize the opportunity for implementers in the
field to attend, the Summit will be held for the first time in Africa—over
three days in Kigali in November 2012.

Announcement details for the GHSCS are provided below.

As a collaborating sponsor of the Summit, the International Association of
Public Health Logisticians (IAPHL) is seeking sponsorship funding for
selected IAPHL members who would otherwise not have the opportunity to

The IAPHL has polled its members to identify those interested in attending
but lacking the financial resources to do so, largely implementers working
for public sector and NGO supply chains in Africa and the developing world.
IAPHL members will be selected to ensure a diversity of country attendance
and implementing experience. This will ensure richer interaction and
networking with implementing partners, academics, and commercial companies
to contribute to South-to-South knowledge exchanges, strengthening local
networks, and building a stronger global community for public health supply
chain management (PHSCM).

Started by MIT Zaragoza and then transitioned to the University of Sothern
California, the GHSCS has established itself as the premier forum for
public health supply chain implementers, academics, and commercial
organizations to meet, exchange views and experience, and learn from each
other. Unlike other similar conferences, it has maintained its focus on
routine public health supply chain strengthening.

5. Abstract: Early diagnosis of hepatitis C transmission after needlestick

Unfallchirurg. 2012 Sep 8.

[Early diagnosis of hepatitis C transmission after needlestick injury.]

[Article in German]

Himmelreich H, Sarrazin CM, Stephan C, Rabenau HF, Marzi I, Wicker S.

Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Klinikum der
Johann Wolfgang Goethe-Universität Frankfurt, Frankfurt am Main,

Occupational transmission of hepatitis C (HCV) is rare but has been
repeatedly described in the published literature. Early diagnosis and
therapy of acute hepatitis C is associated with an excellent chance of
permanent HCV elimination.

The majority of chronic HCV infections, however, lead to a slowly
progressive hepatitis with associated morbidity and risk of liver
cirrhosis. For this reason the need for antiviral therapy has to be
evaluated immediately.

6. Abstract: Co-infection rate of HIV, HBV and Syphilis among HCV
seropositive identified blood donors in Kathmandu, Nepal

Infect Ecol Epidemiol. 2012;2. doi: 10.3402/iee.v2i0.14835.

Co-infection rate of HIV, HBV and Syphilis among HCV seropositive
identified blood donors in Kathmandu, Nepal.

Shrestha AC, Ghimire P, Tiwari BR, Rajkarnikar M.

Department of Microbiology, Gandaki Medical College Teaching Hospital and
Research Centre, Kaski, Nepal.

BACKGROUND: HIV, HBV, Syphilis and HCV share common modes of transmission.

OBJECTIVE: The study was aimed to determine the co-infection rate of HIV,
HBV and Syphilis among HCV seropositive identified blood donors.

METHODS: The study was conducted on blood samples screened as HCV
seropositive at Nepal Red Cross Society, Central Blood Transfusion Service,
Kathmandu, Nepal. HCV seropositive samples were further tested for HIV, HBV
and Syphilis.

RESULTS: Eight co-infections were observed in 139 HCV seropositives with
total co-infection rate of 5.75% (95% CI=2.52-11.03).

CONCLUSION: Co-infection of HIV, HBV and Syphilis with HCV is prevalent in
the healthy looking blood donors of Kathmandu, Nepal.

7. Abstract: Adverse drug reactions to local anesthetics: a systematic

Oral Surg Oral Med Oral Pathol Oral Radiol. 2012 Sep 5.

Adverse drug reactions to local anesthetics: a systematic review.

Liu W, Yang X, Li C, Mo A.

State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China.

OBJECTIVE: The aim of this study was to analyze adverse drug reactions
(ADRs) associated with local anesthetics (LAs) and to characterize the
safety profile of LAs in clinical application.

STUDY DESIGN: Electronic databases were searched, and the data of the
included articles were extracted and analyzed.

RESULTS: A total of 922 articles were retrieved, and 101 of them,
containing 1,645 events, were included. Lidocaine (43.17%) and bupivacaine
(16.32%) were the most often involved LAs. Epinephrine (45.37%) was mostly
combined with LAs. Cardiovascular system reactions (27.83%) were the most
involved systematic ADRs of LAs. Among 7 death events (3.54%), 2 patients
died of intravascular injection. According to the meta-analysis, the risk
of using LA alone was lower than combined with epinephrine.

CONCLUSIONS: The present study demonstrated that the ADRs of LAs could not
be ignored, especially in oral and ophthalmologic treatments. Some ADRs
could be avoided by properly evaluating the conditions of patients and
correctly applying LAs.

Copyright © 2012 Elsevier Inc. All rights reserved.

8. Abstract: Nonsurgical interventions for low back pain

Prim Care. 2012 Sep;39(3):517-23.

Nonsurgical interventions for low back pain.

Grewal H, Grewal BS, Patel R.

Southern Regional AHEC, 1601 Owen Drive, Fayetteville, NC 28304, USA.

A variety of nonoperative interventions are available to treat back pain.
Careful assessment, discussion, and planning need to be performed to
individualize care to each patient.

This article discusses good to fair evidence from randomized controlled
trials that injection therapy, percutaneous intradiscal radiofrequency
thermocoagulation, intradiscal electrothermal therapy, and prolotherapy are
not effective.

Evidence is poor from randomized controlled trials regarding local
injections, Botox, and coblation nucleoplasty; however, with a focused
approach, the right treatment can be provided for the right patient.

To be more effective in management of back pain, further high-grade
randomized controlled trials on efficacy and safety are needed.

Copyright © 2012. Published by Elsevier Inc.

9. Abstract: Controlling HIV Epidemics among Injection Drug Users: Eight
Years of Cross-Border HIV Prevention Interventions in Vietnam and China

PLoS One. 2012;7(8):e43141.

Controlling HIV Epidemics among Injection Drug Users: Eight Years of Cross-
Border HIV Prevention Interventions in Vietnam and China.

Hammett TM, Des Jarlais DC, Kling R, Kieu BT, McNicholl JM, Wasinrapee P,
McDougal JS, Liu W, Chen Y, Meng D, Doan N, Huu Nguyen T, Ngoc Hoang Q, Van
Hoang T.

Abt Associates Inc., Cambridge, Massachusetts, United States of America.

INTRODUCTION: HIV in Vietnam and Southern China is driven by injection drug
use. We have implemented HIV prevention interventions for IDUs since
2002-2003 in Lang Son and Ha Giang Provinces, Vietnam and Ning Ming County
(Guangxi), China.

METHODS: Interventions provide peer education and needle/syringe
distribution. Evaluation employed serial cross-sectional surveys of IDUs 26
waves from 2002 to 2011, including interviews and HIV testing. Outcomes
were HIV risk behaviors, HIV prevalence and incidence. HIV incidence
estimation used two methods: 1) among new injectors from prevalence data;
and 2) a capture enzyme immunoassay (BED testing) on all HIV+ samples.

RESULTS: We found significant declines in drug-related risk behaviors and
sharp reductions in HIV prevalence among IDUs (Lang Son from 46% to 23%
[p<0.001], Ning Ming: from 17% to 11% [p?=?0.003], and Ha Giang: from 51%
to 18% [p<0.001]), reductions not experienced in other provinces without
such interventions. There were significant declines in HIV incidence to low
levels among new injectors through 36-48 months, then some rebound,
particularly in Ning Ming, but BED-based estimates revealed significant
reductions in incidence through 96 months.

DISCUSSION: This is one of the longest studies of HIV prevention among IDUs
in Asia. The rebound in incidence among new injectors may reflect sexual
transmission. BED-based estimates may overstate incidence (because of
false-recent results in patients with long-term infection or on ARV
treatment) but adjustment for false-recent results and survey responses on
duration of infection generally confirm BED-based incidence trends.
Combined trends from the two estimation methods show sharp declines in
incidence to low levels. The significant downward trends in all primary
outcome measures indicate that the Cross-Border interventions played an
important role in bringing HIV epidemics among IDUs under control. The
Cross-Border project offers a model of HIV prevention for IDUs that should
be considered for large-scale replication.

Free Open Access Article:

10. Abstract: HIV prevalence and risk behaviours among injecting drug users
in six Indonesian cities implications for future HIV prevention

Harm Reduct J. 2012 Sep 3;9(1):37.

HIV prevalence and risk behaviours among injecting drug users in six
Indonesian cities implications for future HIV prevention programs.

Morineau G, Bollen L, Ika Syafitri R, Nurjannah N, Erti Mustikawati D,
Magnani R.

BACKGROUND: The HIV prevalence among injecting drug users (IDUs) in
Indonesia reached 50% in 2005. While drug use remains illegal in Indonesia,
a needle and syringe program (NSP) was implemented in 2006.

METHODS: In 2007, an integrated behavioural and biological surveillance
survey was conducted among IDUs in six cities. IDUs were selected via time-
location sampling and respondent-driven sampling. A questionnaire was
administered face-to-face. IDUs from four cities were tested for HIV,
syphilis, gonorrhoea and chlamydia. Factors associated with HIV were
assessed using generalized estimating equations. Risk for sexual
transmission of HIV was assessed among HIV-positive IDUs.

RESULTS: Among 1,404 IDUs, 70% were daily injectors and 31% reported
sharing needles in the past week. Most (76%) IDUs received injecting
equipment from NSP in the prior week; 26% always carried a needle and those
who didn’t, feared police arrest. STI prevalence was low (8%). HIV
prevalence was 52%; 27% among IDUs injecting less than 1 year, 35% among
those injecting for 1-3 years compared to 61% in long term injectors (p <
0.001). IDUs injecting for less than 3 years were more likely to have used
clean needles in the past week compared to long term injectors (p < 0.001).
HIV-positive status was associated with duration of injecting, ever been
imprisoned and injecting in public parks. Among HIV-infected IDUs,
consistent condom use last week with steady, casual and commercial sex
partners was reported by 13%, 24% and 32%, respectively.

CONCLUSIONS: Although NSP uptake has possibly reduced HIV transmission
among injectors with shorter injection history, the prevalence of HIV among
IDUs in Indonesia remains unacceptably high. Condom use is insufficient,
which advocates for strengthening prevention of sexual transmission
alongside harm reduction programs.

Free full text: The complete article is available as a provisional PDF. The
fully formatted PDF and HTML versions are in production.

11. Abstract: Association between harm reduction intervention uptake and
recent hepatitis C infection among people who inject drugs attending
sites that provide sterile injecting equipment in Scotland

Int J Drug Policy. 2012 Aug 31.

Association between harm reduction intervention uptake and recent hepatitis
C infection among people who inject drugs attending sites that provide
sterile injecting equipment in Scotland.

Allen EJ, Palmateer NE, Hutchinson SJ, Cameron S, Goldberg DJ, Taylor A.

Institute for Applied Social and Health Research, School of Social
Sciences, University of the West of Scotland, Paisley Campus, Paisley PA1
2BE, United Kingdom.

BACKGROUND: Prevalence of the hepatitis C virus (HCV) among people who
inject drugs (PWID) in Scotland is high. The Scottish Government has
invested significantly in harm reduction interventions with the goal of
reducing HCV transmission among PWID. In evaluating the effectiveness of
interventions, estimates of HCV incidence are essential.

METHODS: During 2008-2009, PWID were recruited from services providing
sterile injecting equipment across mainland Scotland, completed an
interviewer- administered questionnaire and provided a dried blood spot for
anonymous anti-HCV and HCV-RNA testing. Recent infections were defined as
anti-HCV negative and HCV-RNA positive. Logistic regression was undertaken
to examine associations between recent HCV infection and self-reported
uptake of methadone maintenance therapy (MMT) and injection equipment.

RESULTS: Fifty-four percent (1367/2555) of participants were anti-HCV
positive. We detected 24 recent HCV infections, yielding incidence rate
estimates ranging from 10.8 to 21.9 per 100 person-years. After adjustment
for confounders, those with high needle/syringe coverage had reduced odds
of recent infection (adjusted odds ratio [AOR] 0.32, 95% CI 0.10-1.00, p=
0.050). In the Greater Glasgow & Clyde region only, we observed a reduced
odds of recent infection among those currently receiving MMT, relative to
those on MMT in the last six months but not currently (AOR 0.04, 95% CI
0.001-1.07, p=0.055). The effect of combined uptake of MMT and high
needle/syringe coverage was only significant in unadjusted analyses (OR
0.34, 95% CI 0.12-0.97, p=0.043; AOR 0.48, 95% CI 0.16-1.48, p=0.203).

CONCLUSION: We report the first large-scale, national application of a
novel method designed to determine incidence of HCV among PWID using a
cross-sectional design. Subsequent sweeps of this survey will increase
statistical power and allow us to gauge the impact of preventive

Copyright © 2012 Elsevier B.V. All rights reserved.

12. Abstract: Linkage into specialist hepatitis C treatment services of
injecting drug users attending a needle syringe program-based primary
healthcare centre

J Subst Abuse Treat. 2012 Aug 29.

Linkage into specialist hepatitis C treatment services of injecting drug
users attending a needle syringe program-based primary healthcare centre.

Islam MM, Topp L, Conigrave KM, White A, Reid SE, Grummett S, Haber PS, Day

School of Public Health and Community Medicine, University of New South
Wales, Australia; Drug Health Service, Royal Prince Alfred Hospital,
Sydney, Australia.

Injecting drug users (IDUs), the key risk population for hepatitis C virus
(HCV) infection, constitute just a small proportion of HCV treatment
clients. This study describes an HCV treatment assessment model developed
by an inner-city IDU-targeted primary healthcare (PHC) facility and, using
a retrospective clinical audit, documents predictors of successful
referrals to a tertiary liver clinic. Between July 2006-December 2010, 479
clients attended the PHC, of whom 353 (74%) were screened for HCV antibody.
Sixty percent (212/353) tested positive, of whom 93% (197/212) were
screened for HCV-RNA with 73% (143/197) positive. Referrals to a tertiary
liver clinic were provided to 96 clients, of whom 68 (71%) attended. Eleven
clients commenced antiviral therapy (AVT), with seven achieving sustained
virological responses by December 2010. Clients who had not recently
injected drugs and those with elevated ALT levels were more likely to
attend the referrals, while those not prescribed psychiatric medications
were more likely to commence AVT.

The relatively high uptake of referrals, the number of individuals
commencing AVT and final treatment outcomes are reasonably encouraging,
highlighting the potential of targeted PHC services to facilitate
reductions in liver disease burden among IDUs.

Copyright © 2012. Published by Elsevier Inc.

13. Abstract: Evidence of high-risk sexual behaviors among injection drug
users in the Kenya PLACE study

Drug Alcohol Depend. 2011 Dec 1;119(1-2):138-41.

Evidence of high-risk sexual behaviors among injection drug users in the
Kenya PLACE study.

Brodish P, Singh K, Rinyuri A, Njeru C, Kingola N, Mureithi P, Sambisa W,
Weir S.

MEASURE Evaluation, Carolina Population Center, The University of North
Carolina at Chapel Hill, Chapel Hill, NC 27516-2524, USA.

BACKGROUND: Injection drug users (IDUs) in resource poor settings are at
high risk for HIV transmission through unsafe needle-sharing and sexual
practices. We report on the injecting and sexual behavior of a sample of
IDUs from Malindi, Kenya.

METHODS: A Priority for Local AIDS Control Efforts (PLACE) study was
conducted from April to May 2010 to identify areas where HIV transmission
is most likely to occur and specific venues where people meet new sexual
partners. Community informants (n=202) listed 157 unique venues from which
29 were randomly selected using a systematic fixed interval sampling
strategy with probability of selection proportional to venue size. Twenty
patrons and four workers were interviewed at each venue. Drug use practices
were elicited in a staff-administered interview.

RESULTS: Between 40% and 50% of IDUs reported needle-sharing, taking drugs
from a common reservoir, using a ready-made solution without boiling, and
not exchanging a used for a new syringe in the past month. Most could
inconsistently or never get new syringes. In multivariate logistic
regression models controlling for age, education, residence, and poverty
status, IDUs were twice as likely as non-IDUs to report multiple partners
in the past year (OR 1.94, 95% CI 1.26-3.00, p<.01) and multiple new
partners in the past year (OR 2.11, 95% CI 1.30-3.42, p<.01).

CONCLUSIONS: High prevalence of multiple sexual partnerships and risky
injecting behaviors among IDUs and unavailability of new injecting needles
are likely facilitating HIV transmission in Malindi, Kenya.

Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

14. Abstract: Methadone maintenance therapy outcomes in Iran

Subst Use Misuse. 2012 Jun;47(7):767-73.

Methadone maintenance therapy outcomes in Iran.

Noori R, Narenjiha H, Aghabakhshi H, Habibi G, Khoshkrood Mansoori B.

Dariush Institute, Research Center of Substance Abuse and Dependency,
Tehran, Iran. swt

INTRODUCTION: Because of the increasing number of injecting drug users
(IDUs) in Iran and the risk of the spread of HIV infection, harm reduction
programs have been considered for conventional law enforcement measures.
The aim of this study was to evaluate the efficacy of methadone maintenance
therapy (MMT) in IDUs and the associated health and social outcomes.

MATERIAL AND METHODS: This case-control study was conducted at the
Persepolis Harm Reduction Center in Tehran during the year 2006. Data were
gathered from two groups of randomly chosen patients. The first group
consisted of 75 IDU patients who had undergone at least 6 months of
methadone treatment (the MMT group), and second group consisted of 75 newly
admitted clients (the control group). Participants were assessed on their
dangerous injection and sexual behaviors, social well-being, and patterns
of drug use. The results were compared between the two groups.

RESULTS: The mean age of participants in the two groups was almost the same
(34.28 years in the control group and 35.68 years in the MMT group, p
>.05). Prevalence of drug injection in the MMT group was less than that in
the control group (16% vs. 100%). There was also a dramatic difference in
needle and syringe sharing (40% in the control group vs. 4% in the MMT
group) but not in crimes and arrests (p = .4). Those in the MMT group had a
better relationship with their families, partners, coworkers, and neighbors
compared with controls. There was no considerable difference in dangerous
sexual behaviors between the two groups.

CONCLUSIONS: Given the large number of HIV-positive cases among IDUs and
considering that injection drug use is the main spreading factor for HIV,
MMT would play a major role in controlling the HIV epidemic through
reduction of heroin injection and the risk behaviors related to it. High
inflation rate, lack of interorganization coordination, budget limitation,
and no follow-up were the most important limitations of this study.

15. Abstract: Comparison of the robustness and functionality of three
adrenaline auto-injectors

J Asthma Allergy. 2012;5:39-49.

Comparison of the robustness and functionality of three adrenaline auto-

Schwirtz A, Seeger H.

Pharma Consult GmbH, Vienna, Austria.

BACKGROUND: Anaphylaxis is a medical emergency that requires the
intramuscular injection of adrenaline using an adrenaline auto-injector
(AAI). This study compared the robustness and performance characteristics
of three AAIs available in Europe.

METHODS: Three AAIs (Jext(®), EpiPen(®), and Anapen(®)) were tested in
terms of the force needed to activate the AAIs, exposed needle length,
injection volume, and injection time. Three conditions were used to assess
robustness: base conditions, after three successive free-fall drops from
1.5 m, and after a 40 kg static load challenge. The injection depth and
estimated volume of solution delivered into ballistic gelatin were also

RESULTS: Less force was required to remove the safety cap from Jext and
EpiPen than from Anapen under base conditions. The required force was
unaffected by free-fall drop tests, whereas the static load test
significantly increased the force required to remove the safety cap from
Jext (difference from base value 7.7 N; P < 0.001) and from EpiPen (
difference from base value 30.3 N; P < 0.001). Two Anapens could not be
activated after the free-fall and static load tests. The mean exposed
needle length was 15.36 mm (standard error [SE] 0.04) for Jext, 15.02 mm
(SE 0.05) for EpiPen, and 7.49 mm (SE 0.15) for Anapen. The mean maximum
injection depth in gelatin within 10 seconds was 28.87 mm (standard
deviation [SD] 0.73) for Jext, 29.68 mm (SD 2.08) for EpiPen, and 18.74 mm
(SD 1.25) for Anapen.

CONCLUSION: A comparison of the robustness and performance characteristics
of the three AAIs showed that cartridge-based devices (Jext and EpiPen)
appeared to be significantly more robust and capable of rapidly and
consistently delivering the correct dose of adrenaline to the correct
tissue compartment than the syringe-based Anapen. Overall, Jext performed
better than EpiPen or Anapen following mechanical stress designed to mimic
real-world use.

Free Open Access Article

16. Abstract: Safety of a novel microneedle device applied to facial skin:
a subject- and rater-blinded, sham-controlled, randomized trial

Arch Dermatol. 2012 Jun;148(6):711-7.

Safety of a novel microneedle device applied to facial skin: a subject- and
rater-blinded, sham-controlled, randomized trial.

Hoesly FJ, Borovicka J, Gordon J, Nardone B, Holbrook JS, Pace N, Ibrahim
O, Bolotin D, Warycha M, Kwasny M, West D, Alam M.

Department of Dermatology, Feinberg School of Medicine, Northwestern
University, Chicago, Illinois, USA.

OBJECTIVE: To assess the safety of a novel microneedle device on facial
skin of healthy individuals of all Fitzpatrick skin types.

DESIGN: Subject- and live rater–blinded, sham-controlled, randomized trial.

SETTING: University-based ambulatory dermatology service providing both
primary and referral care.

PARTICIPANTS: Healthy adults recruited from postings.

INTERVENTION: Device or sham applied with finger pressure to the right or
left sides, respectively, of the participants’ lateral forehead, temple,
and nasolabial fold. At the 24-hour visit, a larger area (3 × 3 matrix) at
the central forehead was treated with the device, and the participants
applied the device to their chins.

MAIN OUTCOME MEASURE: Live blinded rater determination of local skin
reaction scores (SRSs).

RESULTS: At the 5-minute skin assessment, the median SRS was 1 for all skin
type and age groups. There was no median pain score higher than 1 for any
age or skin type group. For the sham device, median SRSs were 0 at all time
points for all age and skin type groups. Mean SRSs for the device and sham
were significantly different only for the lateral forehead at 5 and 30
minutes (P = .04).

CONCLUSIONS: The microneedle device appears to be safe and well tolerated
in both sexes and various skin types and ages. Facial skin application of
the device elicits mild, self-limited, and rapidly resolving erythema
marginally greater than that associated with the sham control.

17. Abstract: The hospital pharmacist: an important contributor to improved
patient safety in the hospital

Chimia (Aarau). 2012;66(5):300-3.

The hospital pharmacist: an important contributor to improved patient
safety in the hospital.

Berthouzoz S, Berger L, Bonnabry P, Pannatier A.

Department of Pharmacy, University Hospital Lausanne University Hospital
Rue du Bugnon 46, CH-1011 Lausanne, Switzerland.

Injectable drugs are high-risk products and their reconstitution in
hospital wards is a potential source of errors. Thus, in order to secure
the reconstitution process and thereby improve safety, the pharmacy
department of Lausanne University Hospital is focusing on developing ready-
to-use forms (CIVAS).

These preparations are compounded in controlled clean rooms and are
analyzed prior to release. In the intensive care unit, amiodarone 12.5
mg/mL in glucose 5% is one of the high-risk preparations, which has led the
pharmacy to develop a ready-to-use solution.

To this end, a one-year stability study was initiated, and the preliminary
results (after six months) are illustrated here. A stability-indicating
HPLC method was developed and validated for monitoring the concentration of
amiodarone. Batches were stored at 5 °C and 30 °C, which were analyzed
immediately after preparation, after one, two, four and six months of
storage. The pH and osmolality values were monitored at the respective time

It was observed that after six months, all the results were within
specifications. However, the pH values started to decrease after two months
when amiodarone was stored at 30 °C. After six months, a degradation peak
appeared on the chromatogram of these solutions, which suggested that
amiodarone is more stable at 5 °C.

The preliminary results obtained in this study indicated that injectable
amiodarone solutions are stable for six months under refrigerated storage
conditions. The study is ongoing.

18. No Abstract: Investigation on health condition of medical waste
disposal workers in one province

Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2010 Sep;28(9):682-3.

[Investigation on health condition of medical waste disposal workers in one

[Article in Chinese]

Li Q, Liu ZD, Zheng CB.

19. News

– Wisconsin USA: Discarded Needles Found in Neighborhoods
– 8th Australasian Viral Hepatitis Conference: Un-edited statements from
the health sector and beyond
– UK: Heroin users warned after second anthrax death: Hospitals and walk-
in clinics across the UK warned to expect further cases after second
drug user dies in Blackpool
– UK: NHS spends £500,000 on users’ needles and swabs
– Australia: Jump in hospital staff risk
– Arizona USA: OPINIONS: Out of sight, out of mind
– UK: Nurse bailed in hospital deaths probe
– Tanzania: BD -Tanzania Government and Partners Launch Multi-Year
Training Program
– AZ inmates possibly exposed to Hepatitis C
– Arizona USA: Prison nurse tied to hepatitis C exposure

Selected news items reprinted under the fair use doctrine of international
copyright law:
Wisconsin USA: Discarded Needles Found in Neighborhoods
By Tony Ullrich, WBAY, Wisconsin USA (11.09.12)

The Town of Menasha Police Department says it is getting reports of used
medical needles being found on the ground in neighborhoods.

In the past three weeks, police say there have been three instances where
people reported discarded needles in streets and parking lots on the town’s
west side near homes on Jacobsen Road and West American Drive.

“We have no idea where these needles are coming from, if they’re needles
that are used for legitimate medical purposes or if they’re used for
illegal drugs,” said Jason Weber, Town of Menasha police community liaison

Weber says there’s a possibility that the needles were used for illegal
drugs like heroin. Because the needles may be contaminated, police are
disposing of them.

“We were worried basically worried about kids, you know, coming in contact
with these needles. We wanted parents to be aware of this and let their
kids know,” he said.

Winnebago County Health department officials say needles show up on the
ground from time-to-time and people are at-risk of disease or infection if
they aren’t handled properly.

“Needles that are part of trash are probably less likely to be biological,
you know, sources of exposure such as needle sharing, but still can carry
organisms that can cause disease including hepatitis or tetanus or other
organisms in the environment that could cause a nasty infection,” said Doug
Gieryn, Winnebago County Health department.

Weber says people can throw away their old needles at drop-off locations
including pharmacies and hospitals.

8th Australasian Viral Hepatitis Conference: Un-edited statements from the
health sector and beyond
By Health minister Tony Ryall, New Zealand Doctor Online (10.09.12)

Speech from New Zee land Health Minister Tony Ryall

Welcome everyone to Auckland, New Zealand, to the 8th Australasian Viral
Hepatitis Conference. The significant attendance at this conference shows
viral hepatitis as a global health issue, with Asia Pacific the most
affected region.

It’s a great privilege for me to be here to open your conference,
particularly for reasons you’ll understand later on. I would like to
acknowledge Ngati Whatua kaumatua Pita Pou and Dave Hillman, and the Chairs
of the conference; Professor Ed Gane and Mr John Hornell.

World Hepatitis Day was marked recently at an event with the New Zealand
Hepatitis Foundation at Parliament with the theme: let’s know about it,
let’s increase testing, and let’s treat hepatitis.


The prevalence of hepatitis on a global scale is staggering.

The burden of the hepatitis spectrum is immense. The sheer numbers of cases
are large, the end diseases are severe and chronic and affect years of
life. The treatments can be very expensive, and for many patients the early
infection stages of hepatitis disease are silent and ill-recognised. In
essence, the challenge represented by hepatitis is formidable.

One in 12 people in the world live with either Hepatitis B (HBV) or
Hepatitis C (HCV) – and the life-long health risks of liver cancer or liver
failure. An estimated two million people die every year from hepatitis,
while many more struggle with reduced quality of life from chronic liver

Here in New Zealand, 150,000 people live with HBV or HCV – in Australia
it’s estimated around 450,000 do. What’s startling – as you know – is that
most of these people don’t realise they have the virus. It’s estimated
around 300 people die of hepatitis in this country each year.

That is why some of the most important work around this communicable
disease is happening in our part of the world. Including my part of the
world …in the Bay of Plenty on New Zealand’s east coast. Bay of Plenty
Hepatitis Foundation Kawerau Screening New Zealand has pioneered work with
the Hepatitis B Virus.

In the mid-1980s, local researchers carried out ground breaking population
screening for HBV in Kawerau in the Eastern Bay of Plenty where I was
brought up and went to school. They had noticed that many children coming
into Whakatane Hospital were jaundiced.

At the same time, an “Assay” test that identified the disease had become

The team – which was to become the Hepatitis B Foundation – proceeded to
screen 90 per cent of the population of Kawerau – looking for HBV.
They found almost 600 people with HBV in Kawerau… a town of around 8,000
people. A number of those people have remained in long term follow up. Some
of whom I know personally. Last year Professor Ed Gane, Professor Chris
Cunningham, and the Hepatitis Foundation won a New Zealand Health Research
Council grant to go back to Kawerau, 28 years later, and retest the almost
600. They’re looking for markers identifying which HBV patients are more at
risk. …Why one person with HBV gets liver cancer and another doesn’t.

This will be a significant long term study which should greatly add to our
knowledge of this disease.


New Zealand was only the second country in the world, after Taiwan, to
introduce a universal neonatal vaccination programme against HBV.
Vaccinating babies against Hepatitis B is one of the most important
preventative tools we have. Neonatal vaccination remains one of the most
cost effective health interventions introduced, and as such it could be
possible to eradicate HBV within the next 50 years.

Childhood immunisation is one of the Government’s six national health
targets. Over the past four years, completed immunisation rates for two
year olds have gone from 67% to 93%… with today no difference between
ethnic groups. This is a significant public health achievement. We are now
bringing the focus and effort of the immunisation target down from two year
olds to eight month olds to improve the timeliness and coverage of neonatal
vaccinations. Currently 80% of newborns have received the appropriate
vaccinations – including for the three for HBV – by eight months, and we
are determined to be at 95% by this time in 2014.

Meantime we must do more to manage the tens of thousands of people with
hepatitis coming down the pipeline.

Focus on Long Term Conditions

This Government continues to build on services already in place to reduce
the spread of viral hepatitis.

There is the Needle and Syringe Exchange Programme and the National HBV
Surveillance programme. This latter programme is now the largest HBV
surveillance programme in the world, with over 13,500 people enrolled.
Regular blood testing enables complications such as liver inflammation and
cancer to be detected early.

But to be even more effective, health services need to improve early
diagnosis and treatment. We need to ensure an integrated approach to
hepatitis – a similar integrated, community based approach best suited to
managing most long term chronic conditions.

Increasingly in New Zealand we are seeing health resources move to better
support the desire of patients to receive care closer to home, and often
manage their conditions themselves. Community and hospital clinicians are
sharing expertise, information and resources to ensure patients don’t have
to worry about navigating between multiple services, providers and
settings. Finances are too tight…and patients too savvy…to permit silos and
uncoordinated care to remain.


Successfully managing the Hepatitis B and C viruses in the future will
depend on just this sort of integration.

Too may HBV and HCV carriers don’t know they have the virus. They don’t
know that they can live longer and healthier lives with the right support
and treatment for their condition. HBV and HCV are diseases that are
asymptomatic for years, so it’s important there is increased identification
and diagnosis. HBV and HCV can both be successfully managed in the
community if caught early. The Hepatitis Foundation of New Zealand, with
$5m from this Government, is building on its already successful HBV
surveillance programme by implementing an integrated healthcare approach to
the hepatitis C virus.

They’ve begun one integrated community-based pilot in the Bay of Plenty and
will soon start the second in Wellington-Hutt Valley-Wairarapa.
In the Bay of Plenty, a committed HCV nurse will work with all providers
involved in health care likely to care for patients with Hepatitis C;
general practice, community care agencies, hospitals and people living with

The aim is to increase public awareness, and to seek out and identify HCV
patients, and then prioritise helping those people to manage their
conditions with the appropriate care. …supporting the most affected
patients into secondary care, avoiding unnecessary waiting, and supporting
the rest in the community with education and lifestyle advice.

The project will also seek to reduce the stigma some people experience with
having hepatitis C, and ensuring there’s information available about how to
avoid infection in the first place. In the Wellington area, two HCV nurses
will work with the Department of Corrections, running programmes with
prisoners who’ve agreed to be involved.


Progress in technology and pharmaceuticals will also make a difference to
people living with hepatitis. The introduction of Fibroscan machines in
Australia and New Zealand has provided a safe alternative to liver biopsy.
Earlier this year Medsafe approved the first generation of protease
inhibitors for HCV treatment in New Zealand. Pharmac is currently
evaluating a proposal to fund them.

These and other new oral antiviral drugs could increase both the
effectiveness and safety of antiviral therapy and should encourage more
people to start treatment.

And I’d also like to acknowledge the superb work and leadership of the
Liver Transplant Unit at Auckland City Hospital. This is indeed an
important national service with world class clinicians.


Your conference brings together more than 600 eminent thinkers,
researchers, community leaders and practitioners from throughout Australia,
New Zealand, Asia, the Pacific, Europe and North America.

It’s a great honour to host you here in New Zealand.

The solutions to the issues raised by the various forms of hepatitis will
be found by advances in all the areas I have mentioned this morning –
research, technology, vaccination, drugs, and targeted intervention in
society and with individuals. However there is one more essential
ingredient and this is what this conference is all about.

This element is a mix of collaboration, discussion, dissemination of
important information and identification through networking of the best
ways ahead. Your presence here and your scientific engagement is important
work. It makes a difference in the lives of so many.

I wish you well with the 8th Australasian Viral Hepatitis Conference.
UK: Heroin users warned after second anthrax death: Hospitals and walk-in
clinics across the UK warned to expect further cases after second drug user
dies in Blackpool
Amelia Hill, The Guardian, (10.09.12)

Anthrax bacteria: drug users may become infected when injecting, smoking or
snorting heroin contaminated with spores. Photograph: Smc Images/Getty
A second person has died from an anthrax infection after injecting heroin,
causing health experts to warn hospitals and walk-in clinics across the UK
to expect more cases.

The death comes three weeks after another heroin user died after
contracting the disease from what is assumed to be a batch of contaminated

Both fatalities were in Blackpool but two further cases of infection have
been reported in Scotland and Wales since early June.

The deaths are part of a European-wide outbreak of anthrax among people who
inject drugs: there have been 10 cases across Germany, Denmark and France
in recent months.

The European Centre for Disease Prevention and Control and the European
Monitoring Centre for Drugs and Drug Addiction have issued warnings that
heroin users in Europe are at risk of exposure to anthrax and warned there
may be further cases.

“Anthrax can be cured with antibiotics, if treatment is started early. It
is therefore important for medical professionals to know the signs and
symptoms to look for, so that there will be no delays in providing
treatment,” said Dr Fortune Ncube, an expert in blood-borne viruses with
the Health Protection Agency (HPA).

“It’s likely that further cases among people who inject heroin will be
identified as part of the ongoing outbreak in EU countries,” he added. “The
Department of Health has alerted the NHS of the possibility of people who
inject drugs presenting to emergency departments and walk-in clinics, with
symptoms suggestive of anthrax.”

Local drug services throughout the UK have been alerted and the National
Treatment Agency has circulated posters and leaflets about anthrax
contamination aimed at heroin users.

Drug users may become infected with anthrax when heroin is contaminated
with anthrax spores. This could be a source of infection if injected,
smoked or snorted.

Ncube said there was no safe route for consuming heroin or other drugs that
may be contaminated with anthrax spores.

“The HPA is warning people who use heroin that they could be risking
anthrax infection,” he said Ncube. “We urge all heroin users to seek urgent
medical advice if they experience signs of infection such as redness or
excessive swelling at or near an injection site, or other symptoms of
general illness such a high temperature, chills, severe headaches or
breathing difficulties. Early treatment with antibiotics is essential for a
successful recovery.”
UK: NHS spends £500,000 on users’ needles and swabs
Edinburgh Evening News, Scotland UK (10.09.12)

SUBSTANCE abusers in the Lothians have been handed millions of items of
drug paraphernalia at a cost of more than £500,000 in less than three-and-a
half years.

Under a Scottish Government strategy aimed at reducing the spread of
infection among drug users, NHS Lothian has given out almost two million
needles and syringes, along with more than one million swabs and over 1.3
million packs of vitamin C or citric acid, used by addicts to dissolve

The equipment, which is supplied free to drug users, has cost NHS Lothian
£516,284 since April 2009 – with nearly £50,000 being spent on drug
paraphernalia already between April and July this year. Almost 60,000
sharps bins, used to safely dispose of needles, were also distributed over
the 36-month period.

The Scottish Government and NHS Lothian moved to defend the practice of
giving out paraphernalia, saying it was crucial in reducing the
transmission of deadly viruses and reduced the long-term financial burden
on the NHS, with standard hepatitis C treatment costing £7000 per patient,
or £28,000 if they have a more severe version of the virus.

But MSP Jackson Carlaw, (pictured) the Scottish Conservatives’ health
spokesperson, branded the policy “crazy”.

He said: “People will be quite stunned to see the extent to which to SNP
and our health boards go to help addicts indulge in drug use. That in turn
will only increase crime rates in the area, because they have to pay for
the drugs somehow. NHS budgets are tight, and pouring away tens of
thousands of pounds on drug paraphernalia when nursing posts are being
reduced is a crazy approach.”

However, Grant Sugden, director of the Edinburgh-based Waverley Care
charity which works to prevent the spread of HIV and Hapatitis C, insisted
the policy offered value for money. He said: “There’s a lot of evidence
that providing this equipment does work. Treating people with HIV for life
comes at a huge cost, and while hepatitis C can be cured, it’s still

“We all want to see people coming off drugs, but at the same time we want
people who are using to do it more safely. It’s ridiculous to say having
injecting equipment available encourages people to take drugs.”

While the majority of those making use of the free equipment are heroin
addicts, those using image-enhancing drugs such as steroids also take
advantage of free injecting equipment.

The syringe barrels and needles provided come in a wide range of shapes and
sizes. Packs of 100 basic needles are purchased at a cost of £1.40, while
more expensive 1ml “never-share” syringes, which are designed specifically
for drug users, cost £37.50 for 500.

Hilda Stiven, co-ordinator for the Lothian Hepatitis Managed Care Network,
said the programmes had the added benefit of bringing drug users into
contact with NHS staff who could then offer support, and had contributed to
Lothian having one of the lowest rates of Hepatitis C among drug users in

She added: “These services play a major role in bringing about more
integrated care for injecting drug users, providing educational
interventions, identifying those infected with hepatitis C and linking
people in to clinical care and support.”

A Scottish Government spokesperson said: “Increasing the quantity, quality
and nature of injecting equipment provided is critical to our efforts to
reduce transmission of hepatitis C and other blood-borne viruses – notably
HIV – and in turn, to reduce the long- term burden on the NHS from treating
and managing those infected.”

Australia: Jump in hospital staff risk
Ewa Kretowicz, The Canberra Times, Australia (09.09.12)

THE number of Canberra Hospital staff put at risk from blood or bodily
fluid contamination jumped by 34 per cent last year.

Of almost 200 nurses and doctors who were exposed, 18 incidents involved
patients with either hepatitis B, C or HIV.

In one instance, a nurse attempting to insert an intravenous line in a
wriggling baby, slipped and pierced her thumb while another nurse disposing
of a wet pad flicked its contents on to her skin and a third staff member
was scratched by an agitated patient. But the most common incidents involve
patients vomiting, bleeding, urinating or defecating on staff.

The hospital’s occupational risk exposure protocols require staff to report
any incidents immediately and undergo a blood test, but secretary of the
ACT Nursing Federation Jenny Miragaya said she was concerned not all staff
were reporting incidents.

A spokesman from ACT Health said no staff at the Canberra Hospital had been
infected with a blood-borne virus through contact with a patient in the
past decade.

”Staff are informed of blood results within 24 hours and follow-up
appointments in the OMU [Occupational Medicine Unit] are arranged,” he

”While waiting for test results, the staff member is advised to follow
standard precautions for reducing transmission of blood-borne viruses such
as safe sex, not sharing personal items or donating blood for 12 months.”

In 2010, 143 exposure incidents were recorded, seven involved patients with
either hepatitis B, C or HIV.

Ms Miragaya said the hospital had standard infection control programs but
she did not know why the number of incidents had increased.

”Is it an increase in reporting or incidents?” Ms Miragaya said.

”My understanding is that if you have a needlestick injury or blood
splatter you are required to report it. I would be concerned if there is
any increase but it may be a reflection of the busyness of the hospital.”

Calvary Hospital refused to provide information about contamination
incidents. Chief executive Ray Dennis said there were concerns about

Arizona USA: OPINIONS: Out of sight, out of mind
The Republic | (08.09.12)

On Aug. 27, a nurse working for a company called Wexford Health Sources
Inc. administered a dose of insulin to a diabetic patient who has hepatitis
C, a deadly and extremely infectious liver disease.

The nurse then inserted the needle into another vial of insulin to draw
still more of the drug for the patient. She put that second vial, and the
remainder of its contents, onto a shelf with other vials of insulin.

You can well imagine where this health-horror story is going: More than 100
other diabetes patients who later were given insulin treatments may have
been infected with hepatitis C.

Mistakes happen. Including potentially tragic ones like this. But there is
a bit more to this story.

Wexford is a private company that just this spring won a $349 million,
three-year contract to provide health services to Arizona’s nearly 40,000
prison inmates. The nurse, who already was under investigation for
providing slipshod care, worked for Wexford at the Arizona state prison at

State rules require health-care providers, including those working out of
prisons, to alert county and state health authorities about a potential
outbreak of an infectious disease within five business days.

Wexford alerted public health officials of the incident on Sept. 4, more
than a week afterward — and only after Wendy Halloran of 12 News learned
what happened from an inmate’s family and The Republic’s Craig Harris broke
the story online.

In Arizona’s seemingly inexorable march toward privatizing ever more of its
prison system, this incident is but one more red flag about the pitfalls of
that policy.

Sure, it was an accident. Accidents happen. But are more such accidents
occurring at prisons whose profit motives tempt supervisors to cut corners?

Corner-cutting appears to have been a factor in the escape of three
prisoners on July 30, 2010, from a Kingman prison operated by Management &
Training Corp. A faulty alarm system appears to have contributed to the
incident, during which the escapees murdered a New Mexico couple.

Another private contractor hired by Arizona, GEO Group Inc., has lost at
least 27 of its prisoners around the country since 2004, including one from
a facility in Florence, albeit from mostly low-security facilities.

The Wexford incident, however, raises a still more unsettling concern: Are
there more accidents and incidents than we know about? Is Wexford’s slow-mo
reaction to following established protocol evidence of other incidents
being swept under the rug?

The state Legislature’s most ardent Republican critic of private prisons,
Mesa Rep. Cecil Ash, argues that private prisons “are the wrong business
model” for exactly that reason: “They are out of sight, out of mind.”

If private-prison operations were cheaper to operate, that might mitigate
the more minor operational concerns. But they are nearly 10 percent more
expensive to operate. Lawmakers like them because of the up-front cost
savings on construction, which the private firms often bear.

Legislators need to take this Wexford incident for what it is: stark
evidence that transparency is a serious issue with private prisons.

Prisons are out of sight, out of mind, at our peril.
UK: Nurse bailed in hospital deaths probe
Pat Hurst, The Independent, UK (06.09.12)

A Filipino nurse arrested in connection with poisoning deaths at a hospital
has had his bail extended, police said today.

Victorino Chua, 46, was initially held in January on suspicion of tampering
with medical records at Stepping Hill Hospital in Stockport, Cheshire.

He was further arrested on suspicion of three counts of murder and 18
counts of causing grievous bodily harm. Chua has not been charged.

Chua was bailed until next Monday but had his bail extended today until
January 31 next year, Greater Manchester Police said.

The Force is investigating the contamination of various products with
insulin between June 1 and July 15 last year at the hospital.

Twenty-two people were subsequently poisoned by the contaminated products,
seven of whom have since died. They are Tracey Arden, 44, Arnold Lancaster,
71, Derek Weaver, 83, William Dickson, known as Bill, 82, Linda McDonagh,
60, John Beeley, known as Jack, 73, and Beryl Hope, 70.

Staff at Stepping Hill Hospital first raised the alarm after noticing
“unexplained” low blood sugar levels in patients.

Police later found a number of saline drips had been deliberately
contaminated, between June 1 and July 15 last year.

Detectives are now reviewing and analysing each of the hundreds of
interactions all those patients had with a member of staff or visitor
during their time at Stepping Hill.

More than 650 statements have been taken and 800 members of staff have been
spoken to.

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

Another Stepping Hill nurse, Rebecca Leighton, 28, from Heaviley,
Stockport, spent six weeks in jail after being held over allegations she
had tampered with the saline bags.

She was then released and cleared of any wrongdoing last September when
prosecutors said there was not enough evidence against her, but she was
subsequently sacked for theft by bosses.

Tanzania: BD -Tanzania Government and Partners Launch Multi-Year Training
M2 Communications, ENP Newswire, UK (06.09.12) Press Release (05.09.12)

Dar es salaam, Tanzania – Tanzania healthcare workers will learn improved
phlebotomy and blood drawing practices through a new initiative led by the
Tanzanian Ministry of Health and Social Welfare in partnership with the
U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S.
Department of Health and Human Services’ Centers for Disease Control and
Prevention (CDC) and BD (Becton, Dickinson and Company).

Jhpiego, a technical assistance partner for the MoHSW, will join in the
efforts to manage and scale up these improved services.

The Tanzania Initiative for Blood-Drawing Applications (TIBA) aims to
improve overall healthcare and laboratory services in health facilities,
especially those in the regions with a high burden of HIV/AIDS. Drawing
blood from patients’ veins using a needle and syringe is one of the most
commonly performed medical procedures in hospitals and clinics, though
there are risks associated with this procedure. A 2008 survey conducted in
14 Tanzanian health institutions foundthat needle pricks (52.9 percent) and
splash of blood from patients (21.7 percent) were common among healthcare
workers. Given the prevalence of the blood-drawing procedure –
approximately 1,500,000 drawings per year in Tanzania – it is vital that
clinicians take the necessary steps to protect themselves and their
patients from blood borne infections, such as HIV, resulting from
accidental pricking, stabbing or scratching with equipment that has been
used to collect blood.

Under this two-year program, BD will provide training on blood-drawing
practices, specimen handling and safety measures to prevent needle stick
injuries, thereby improving safety for both patients and health workers.

Elements of the program include:

.BD associates will train 20 local health workers as master trainers in
safe blood drawing practices. These master trainers will then lead
trainings in regions throughout the country. The program ultimately aims to
train at least 500 healthcare workers in Tanzania.

.Helping ensure specimen quality and minimize exposure to the HIV virus
among health workers by providing treatment in case of accidental

.Helping prevent needle stick injuries by establishing needle stick injury
surveillance, which helps to identify people in need of life-saving, post-
exposure prophylaxis.

.Correct practices that pose risk to health workers and patients.

Participating sites include Amana Regional Referral Hospital, Bugando
Consultant Hospital, Iringa Regional Referral Hospital, Lindi Regional
Referral Hospital, Mbeya Consultant Hospital, Muhimbili Orthopedic
Institute, Singida Regional Referral Hospital, Tabora Regional Referral
Hospital, Bombo Tanga Regional Referral Hospital and Kilimanjaro Christian
Medical Centre.

‘This collaboration comes at an appropriate time as the Quality Assurance
Directorate of the Tanzania Ministry of Health and Social Welfare, through
the Health Services Inspectorate and Quality Assurance Section, is
finalizing the National Phlebotomy Guidelines for Quality and Safe Health
Care Services and the National Injection Safety Devices Policy Guidelines,’
said Minister of Health and Social Welfare Hon. Dr. Hussein A. Mwinyi.
‘Safe blood drawing is an area that requires much improvement and BD will
help strengthen our efforts by developing phlebotomy curriculum and

‘The PEPFAR partnership has demonstrated much success in Kenya and Zambia
to date,’ said Dr. Koku Kazaura, Acting HIV-Prevention Branch Chief of CDC.
‘After our team experienced the trainings first hand in Kenya, we were very
eager to engage in this partnership to create a program that addresses our
own country’s needs.’

‘Safe blood sample procedures are important for accurate diagnosis and
treatment of illnesses and diseases,’ said Renuka Gadde, Vice President,
Global Health, BD. ‘BD’s training efforts in Tanzania will help healthcare
workers protect themselves against unnecessary needle stick injuries and
possible disease exposure while also helping improve the blood samples. We
look forward to working with the Tanzanian government in developing
standards and processes that will help protect healthcare workers and
improve patient outcomes.’

‘As the number of healthcare services increases in Tanzania,’ added Natalie
Hendler, Infection Project Director, Jhpiego Tanzania, ‘we need to ensure
that quality is maintained. This initiative will help guarantee that blood
draws and phlebotomy are being done in a standardized and high-quality
manner across Tanzania.’

‘It is critical that these programs support the master trainers to develop
a cadre of fully-skilled healthcare workers capable of safe blood drawing
practices,’ said Brian Rettmann, PEPFAR-Tanzania Country Coordinator.
‘PEPFAR recognizes that human resources are vital to creating sustainable,
country-owned systems.’

Over the past several years, safe blood collection has become increasingly
important in sub-Saharan nations and other developing countries with high
incidences of HIV/AIDS. Access to HIV treatment in these nations has also
expanded significantly during this time. This has led to a substantial
increase in the number of blood collections for HIV screening and
monitoring tests.

Tanzania is the third country to participate in this global public-private
partnership, first launched in Kenya in June 2010 followed by Zambia in
2011. Since 2010, the program has reached over 2,000 additional health
workers in over 30 health facilities throughout sub-Saharan Africa. Results
to-date show greatly improved blood-drawing knowledge and skills,
reductions in improper practices and higher levels of healthcare worker

The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) is the U.S.
Government initiative to support partner nations around the world in
responding to HIV/AIDS. It was launched in 2003, and is the largest
commitment by any nation to combat a single disease internationally in
history. Through PEPFAR, the U.S. Gov-ernment has committed approximately
$46 billion to bilateral HIV/AIDS programs, the Global Fund to Fight
HIV/AIDS, Tuberculosis and Malaria, and bilateral TB programs through
Fiscal Year 2012. This Initiative supports partner countries in improving
health outcomes through strengthened health systems, with a particular
focus on improving the health of women, newborns and children through
programs that address a range of health issues. For more information,
please visit

About CDC
The U.S. Centers for Disease Control and Prevention (CDC) is America’s
premier health promotion, prevention, and preparedness agency and a global
leader in public health. CDC is at the forefront of public health efforts
to prevent and control infectious and chronic diseases, injuries, workplace
hazards, disabilities, and environmental health threats. The agency is
globally recognized for conducting research and investigations and for its
action-oriented approach to public health. CDC’s Division of Global
HIV/AIDS (DGHA) provides critical leadership in the fight against HIV/AIDS
in resource-constrained countries by assisting partner governments to
strengthen laboratory, epidemiology, surveillance, public health evaluation
and workforce capacity-essential components for strong sustainable public
health systems. For more information, please visit

About BD
BD is a leading global medical technology company that develops,
manufactures and sells medical devices, instrument systems and reagents.
The Company is dedicated to improving people’s health throughout the world.
BD is focused on improving drug delivery, enhancing the quality and speed
of diagnosing infectious diseases and cancers, and advancing research,
discovery and production of new drugs and vaccines. BD’s capabilities are
instrumental in combating many of the world’s most pressing diseases.
Founded in 1897 and headquartered in Franklin Lakes, New Jersey, BD employs
approximately 29,000 associates in more than 50 countries throughout the
world. The Company serves healthcare institutions, life science
researchers, clinical laboratories, the pharmaceutical industry and the
general public. For more information, please visit

About Jhpiego
Jhpiego (pronounced ‘ja-pie-go’), is an international non-profit health
organization affiliated with Johns Hopkins University. For 40 years,
Jhpiego has empowered front-line health workers by designing and
implementing effective, low-cost, hands-on solutions to strengthen the
delivery of health care services for women and their families. Jhpiego
works to break down barriers to high-quality health care for the world’s
most vulnerable populations. For more information, go to

AZ inmates possibly exposed to Hepatitis C
By Phil Benson, CBS 5, AP (05.09.12)

PHOENIX – As many as 105 inmates at the state prison west of Phoenix may
have been exposed to Hepatitis C because medication was administered with a
dirty needle.

Wexford Health Sources said a contracted nurse violated the basic
infection-control protocols.

Prison officials said inmates at the Arizona State Prison Complex-Lewis in
Buckeye who were exposed have been notified and are currently being
screened for infectious diseases.

Hepatitis C is a viral disease that leads to inflammation of the liver.

The nurse, who was not a Wexford Health employee, had been assigned to work
at the prison complex by a local staffing agency.

A statement issued by Wexford Health Sources said, “In addition to
suspending the individual, Wexford Health has banned the nurse from working
under any of its contracts in the future. Wexford also reported the nurse
to the state nursing board for investigation; and has requested that the
staffing agency employing the nurse do the same.”

Wexford Health said, “at no time was the same syringe used on more than one
patient. No staff members were exposed as a result of the incident.”

An independent laboratory will provide continued medical monitoring and
testing of these potentially exposed inmates over the next several months,
officials with Wexford Health Sources said.

Copyright 2012 CBS 5 (Meredith Corporation). The Associated Press
contributed to this report.
Arizona USA: Prison nurse tied to hepatitis C exposure
by Craig Harris, The Republic | (04.09.12)

A nurse for the new medical provider for Arizona prisons may have exposed
103 inmates at the Buckeye state prison to hepatitis C by contaminating the
prison’s insulin supply, and state and local health officials were not
alerted for more than a week.

Officials with the state and Maricopa County health departments, who
confirmed to The Arizona Republic on Tuesday that they had not been
informed by Wexford Health Sources Inc. of the problem, said they will
launch investigations into the incident.

Official notification of the Aug. 27 error only came late Tuesday
afternoon, hours after an inmate’s family member had told 12 News of the
potential health risk.

State rules require health-care providers and correctional facilities to
notify health departments within five business days of a hepatitis C
diagnosis, treatment or detection.

Wexford said it suspended the nurse on Aug. 27, immediately after learning
the person “had violated basic infection-control protocols while
administering medication that day.”

“In talking with the Department of Health Services, they believe it should
have been reported first to the county,” Corrections Director Charles Ryan
said late Tuesday. “That is a question we will have of Wexford — as to the
lack of notification or an explanation as to why that did not occur.

“The department has concerns about this issue, and we will be having
further discussions with Wexford in terms of this requirement and some
other issues as well.”

Ryan said the incident occurred when a diabetic inmate who also has
hepatitis C was administered a routine dose of insulin by the nurse on Aug.
27. The needle used on that inmate was inserted into another vial to draw
more insulin for the same inmate.

Ryan said the contaminated needle was inserted into a vial which was then
put back among other vials in the prison’s medication refrigerator. It got
mixed up with other vials used throughout that day to administer insulin
injections to more than 100 other diabetic inmates. Later that day, Ryan
said, officials realized that the vial that potentially had been tainted
with hepatitis C may have been used to dose other inmates.

At that point, the nurse in question was suspended and prison officials
sought to determine how many inmates may have been exposed.

All the vials of medicine were destroyed after the discovery.

Wexford spokesman Larry Pike on Tuesday minimized the potential exposure of
other inmates. He said that the company acted “expeditiously” to identify
those who were potentially affected and that the company believes the
potential for their exposure was small.

Though corrections officials and Wexford declined to name the nurse, the
Arizona State Board of Nursing identified her as Nwadiuto Jane Nwaohia. She
has been under state investigation since June 2012 for unsafe practice or
substandard care, but the board would not provide additional information on
the nature of the previous problem.

Corrections officials first acknowledged the matter Tuesday morning after
12 News asked about the incident at the Arizona State Prison Complex-Lewis,
which houses 5,382 inmates in minimum- to maximum-security facilities.

Hepatitis C is the leading cause of liver transplants and causes liver
cancer. Seventy-five to 85 percent of people with hepatitis C develop a
chronic infection, according to the U.S. Centers for Disease Control and

Shoana Anderson, head of the state Office of Infectious Disease Services,
said one of the biggest dangers for those infected with hepatitis C is “it
sits in the liver quietly, and 20 years later, a person can develop severe
liver disease.”

Anderson and Jeanene Fowler, a spokeswoman for the Maricopa County
Department of Public Health, said Wexford should have notified them of the

“It’s extremely disturbing that something like this could happen. It calls
for a thorough investigation to determine all of the surrounding causes of
the mistake or the negligence,” said Don Specter of the Prison Law Office,
a prison watchdog group based in Berkeley, Calif.

Ken Kopczynski, executive director of the Private Corrections Working Group
in Tallahassee, Fla., called the incident “scary” and said it shows a lack
of oversight by corrections officials.

“This is a problem with privatization,” Kopczynski said. “They are just
accepting who Wexford will hire.”

Wexford, which has previously lost contracts for poor service in other
jurisdictions, this spring won a $349 million, three-year contract to
provide health care for Arizona inmates. The company began providing
services for nearly 40,000 Arizona inmates on July 1.

In a written statement, the Pittsburgh-based company said it suspended the
nurse immediately upon learning she “may have compromised a vial of
medication by placing it in contact with a previously used syringe.”

Wexford, in its statement, said a local staffing agency assigned the nurse
to the prison complex. The company said that at no time was the same
syringe and needle used on more than one patient and that no staff members
were exposed.

Wexford said it reported the nurse to the state nursing board for
investigation, but that did not occur until late Tuesday afternoon, after
the news had been reported. The company also banned the nurse from working
under any of its contracts in the future. Wexford provides health-care
services nationwide to roughly 124,000 inmates and other residents at more
than 100 institutions.

The state said inmates exposed were notified and are being screened for
infectious diseases. An independent laboratory under contract with Wexford
will provide continuing medical monitoring and testing of the potentially
exposed inmates over the next several months, the state said. All patients
will be informed of their results, though Ryan noted that some inmates may
previously have been exposed to hepatitis C.

Before the problem at the Buckeye prison, Wexford had issues in other
states. Clark County, Wash., declined to renew a contract with Wexford in
2009 at its county jail and juvenile-detention center after complaints that
Wexford was not dispensing medications to inmates in a timely fashion.
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