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SIGN post 00667

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST *

Post00667 New SIGN Publications + Abstracts + News 19 September 2012

CONTENTS
1. New SIGN Publication: Summaries of injection safety country success stories
2. New SIGN Publication: Safe Injection Global Network: Advocacy booklet
3. Abstract: Sharps injuries and exposure to blood and bloodstained body
fluids involving medical waste handlers
4. Abstract: Study on status of needle-stick and other sharps injuries
among healthcare workers in a general hospital
5. Abstract: Registration of blood exposure accidents in the Netherlands by
a nationally operating call center
6. Abstract: Management of occupational blood exposures: a 4-year review
7. Abstract: Is universal HBV vaccination of healthcare workers a relevant
strategy in developing endemic countries? The case of a university
hospital in niger
8. Abstract: Sero-prevalence and associated risk factors on hepatitis C in
Maqiao township, Henan province of China
9. Abstract: Needle and syringe distribution trends in Western Australia,
1990 to 2009
10. Abstract: Filler augmentation, safe or unsafe: A case series of severe
complications of fillers
12. Abstract: Comparative Effectiveness of Injection Therapies in Lateral
Epicondylitis: A Systematic Review and Network Meta-analysis of
Randomized Controlled Trials
13. Abstract: Pilot study to measure cleaning effectiveness in health care
14. Abstract: Japanese professional nurses spend unnecessarily long time
doing nursing assistants’ tasks
15. Abstract: Prevalence of HBV infection in suspected population of
conflict-affected area of war against terrorism in North Waziristan
FATA Pakistan
16. Abstract: Healthcare-associated infections among pediatric oncology
patients in Pakistan: risk factors and outcome
17. Abstract: Efficacy of yeast-derived recombinant hepatitis B vaccine
after being used for 12 years in highly endemic areas in China
18. No Abstract: APIC strategic plan 2020
19. Kenya, Ghana, Nigeria, & South Africa: Mobile phone apps rescue medics
in fight against diseases, fake drugs
20. WHO Hand Hygiene Self-Assessment Framework: Hospital Performance in the
U.S. and Around the Globe
21. News
– USA: 1 more positive test in Hays for hepatitis C
– USA: Man Gets 30 Years in Hepatitis C Case
– Global South: Global South leads the way towards universal healthcare
coverage
– Risks of acupuncture range from stray needles to pneumothorax, finds
study

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__________________________________________________________________
________________________________*_________________________________

1. New SIGN Publication: Summaries of injection safety country success
stories
__________________________________________________________________
http://www.who.int/injection_safety/sign/country_success/en/index.html

Summaries of injection safety country success stories
Safe Injection Global Network

Publication details
Number of pages: 48
Publication date: 2011

Downloads: English pdf, 2.47Mb
www.who.int/entity/injection_safety/sign/success_story_summaries_regions.pdf

Introduction

This publication demonstrates intervention success stories that have
improved injection safety in both developed and developing countries,
proving that positive results are viable in different country settings.
Intervention strategies that target all these three core components
simultaneously have been shown to have the greatest positive effect on
improved injection safety:

behaviour change among patients and healthcare workers to decrease
injection overuse and achieve injection safety, availability of necessary
and of good quality injection devices and supplies, management of sharps
waste.
__________________________________________________________________
________________________________*_________________________________

2. New SIGN Publication: Safe Injection Global Network: Advocacy booklet
__________________________________________________________________
http://www.who.int/injection_safety/sign/advocacy_booklet/en/index.html

Safe Injection Global Network: Advocacy booklet

Publication details
Number of pages: 25
Publication date: 2011

Download English pdf, 1.75Mb
http://www.who.int/entity/injection_safety/sign/sign_advocacy_booklet.pdf

Introduction

Unsafe injection practices are an international issue. With an estimated 16
thousand million injections administered annually in developing and
transitional countries alone, the importance of promoting safe injection
practices is unprecedented. Over the past few decades failures to follow
safe injection practices have burdened many developing as well as developed
countries with outbreaks of infectious diseases.

Although the exact global burden of disease resulting from unsafe
injections is difficult to measure, 40% of all injections are believed to
be unsafe while in some countries the proportion is as high as 70%.
Globally, approximately 3-4 injections per person per year are
administered. As such, the danger of contaminated needles and syringes put
thousands of millions of people at risk of contracting bloodborne pathogens
including hepatitis B virus (HBV), hepatitis C virus (HCV), and human
immunodeficiency virus (HIV).
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Sharps injuries and exposure to blood and bloodstained body
fluids involving medical waste handlers
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22964471

Waste Manag Res. 2012 Sep 10.

Sharps injuries and exposure to blood and bloodstained body fluids
involving medical waste handlers.

Shiferaw Y, Abebe T, Mihret A.

Department of Medical Laboratory Science, University of Gondar, College of
Medicine & Health Science, Gondar, Ethiopia.

Exposure to healthcare waste can result in disease or injury. Though much
attention is paid to the safety of healthcare professionals and their
protection from sharps injury and exposure to blood and bloodstained body
fluids (BBFs), the welfare and safety of non-healthcare professionals who
are collecting, transporting and disposing waste has received very little
attention.

The objective of this study was to understand the incidence of sharps
injury and occupational BBF exposure of mucous membranes involving medical
waste handlers (MWHs).

A cross-sectional study was carried out using a self-administered
questionnaire, observation and interview. Data analysis was performed using
SPSS version 16. The ?(2) value was calculated and P <0.05 was considered
statistically significant.

One or more incidents of sharps injuries and BBF exposures to mucous
membranes occurred among 42.1% and 67.5% of MWHs respectively. None of the
respondents was immunized with hepatitis B vaccine owing to the high cost
of immunization and absence of free universal availability of the vaccine
for the adult population. Less than 50% of MWHs wore either gloves or boots
while performing their activities. Even though all knew about HIV, most of
the respondents demonstrated a lack of knowledge regarding viral hepatitis.

The risk of sharps injury and BBF exposure appeared high in MWHs. The
establishment of safe waste-management techniques and the appropriate use
of personnel protective equipment among MWHs in Addis Ababa is urgently
required.
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Study on status of needle-stick and other sharps injuries
among healthcare workers in a general hospital
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22470951

Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2011 Dec;29(12):939-43.

[Study on status of needle-stick and other sharps injuries among healthcare
workers in a general hospital].

[Article in Chinese]

Shi CL, Zhang M, Xie C.

National Institution for Occupational Health and Poison Control, China CDC,
Beijing 100050, China.

OBJECTIVE: To understand the prevalence of hospital healthcare workers
(HCWs) with needle-stick and other sharps injuries, and to provide the
basic data for intervention study.

METHODS: A retrospective investigation was conducted with questionnaires
for needle- stick and other sharps injuries from January 1- to December 31
of 2009 among 1201 healthcare workers in a general hospital.

RESULTS: The total number of needle-stick and other sharps injuries among
1201 healthcare workers in 2009 was 4320, the number of needle-stick and
other sharps injuries for each person was 3.58 and the incidence of needle-
stick and other sharps injuries was 78.85 %. The subjects with the high
risk of needle-stick and other sharps injuries were from the department of
gynecology and obstetrics, surgical department, intensive care unit and
emergency room, the incidences and the average numbers of episodes were
94.67% and 4.51 per person, 93.09% and 4.46 per person, 85.44% and 3.08 per
person, 76.62 % and 4.55 per person in 2009, respectively. The operations
resulting in the needle-stick and other sharps injuries were the breaking
glass preparation (ampoule or vial), withdrawing needles, preparing sharp
devices and performing an operation, the incidences were 46.96%, 30.97%,
25.73% and 14.49%, respectively. Needle-stick and other sharps injuries
were mainly caused by ampoules, winged steel needle, disposable syringes,
suture needles and scalpels, the incidences were 47.04%, 37.22%, 31.31%,
17.65% and 7.08%, respectively.

CONCLUSION: Healthcare worker are still at risk of needle- stick and other
sharps injuries, which was related to the profession, department, medical
manipulation and medical apparatus and instruments. Special and
comprehensive measurements for preventing the needle-stick and other sharps
injuries should be taken actively.
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Registration of blood exposure accidents in the Netherlands by
a nationally operating call center
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/22961021

Infect Control Hosp Epidemiol. 2012 Oct;33(10):1017-23.

Registration of blood exposure accidents in the Netherlands by a nationally
operating call center.

Schneeberger PM, Meiberg AE, Warmelts J, Leenders SC, van Wijk PT.

Department of Medical Microbiology and Infection Control, Jeroen Bosch
Hospital, ‘s-Hertogenbosch, The Netherlands.

Objective. Healthcare providers and other employees, especially those who
do not work in a hospital, may not easily find help after the occurrence of
a blood exposure accident. In 2006, a national call center was established
in the Netherlands to fill this gap.

Methods. All occupational blood exposure accidents reported to the 24-
hours-per-day, 7-days-per-week call center from 2007, 2008, and 2009 were
analyzed retrospectively for incidence rates, risk assessment, handling,
and preventive measures taken.

Results. A total of 2,927 accidents were reported. The highest incidence
rates were reported for private clinics and hospitals (68.5 and 54.3
accidents per 1,000 person-years, respectively). Dental practices started
reporting incidents frequently after the arrangement of a collective
financial agreement with the call center. Employees of ambulance services,
midwife practices, and private clinics reported mostly high-risk accidents,
whereas penitentiaries frequently reported low-risk accidents. Employees in
mental healthcare facilities, private clinics, and midwife practices
reported accidents relatively late. The extent of hepatitis B vaccination
in mental healthcare facilities, penitentiaries, occupational health
services, and cleaning services was low (<70%).

Conclusion. The national call center successfully organized the national
registration and handling of blood exposure accidents. The risk of blood
exposure accidents could be estimated on the basis of this information for
several occupational branches. Targeted preventive measures for healthcare
providers and other employees at risk can next be developed.
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Management of occupational blood exposures: a 4-year review
__________________________________________________________________
Br J Nurs. 2012 Jun 14-27;21(11):645-8.

Management of occupational blood exposures: a 4-year review.

Holland Flynn M, Reid A.

Tallaght Hospital, Dublin, Ireland.

In the healthcare setting, occupational blood exposure (OBE) is a well
recognised hazard. Following exposure, prompt and correct management is
required to prevent infection and minimise adverse psychological impact.

The aim of the study was to ascertain whether or not documentation of the
management and follow up of OBEs was appropriate and in line with best
practice.

Of the 134 cases reviewed, 65% of staff who reported an OBE attended for
management on the day of the injury. The instrument type was documented in
95% of cases, and degree of injury in 91%. However, the provision of first
aid was adequately documented for only 36% of exposure cases and the
provision of adequate information and advice was documented for just 33%.
Only approximately half of 23% of healthcare workers requiring follow up
completed this within the recommended time frame.

This study identified deficits in documentation, communication and follow
up. However, this will likely improve with the recommendations outlined in
this article.
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Is universal HBV vaccination of healthcare workers a relevant
strategy in developing endemic countries? The case of a university
hospital in niger
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22970218

PLoS One. 2012;7(9):e44442.

Is universal HBV vaccination of healthcare workers a relevant strategy in
developing endemic countries? The case of a university hospital in niger.

Pellissier G, Yazdanpanah Y, Adehossi E, Tosini W, Madougou B, Ibrahima K,
Lolom I, Legac S, Rouveix E, Champenois K, Rabaud C, Bouvet E.
Source

Groupe d’Etude sur le Risque d’Exposition des Soignants aux agents
infectieux (GERES), Faculté de Médecine Paris VII – Bichat, Paris, France.

BACKGROUND: Exposure to hepatitis B virus (HBV) remains a serious risk to
healthcare workers (HCWs) in endemic developing countries owing to the
strong prevalence of HBV in the general and hospital populations, and to
the high rate of occupational blood exposure. Routine HBV vaccination
programs targeted to high-risk groups and especially to HCWs are generally
considered as a key element of prevention strategies. However, the high
rate of natural immunization among adults in such countries where most
infections occur perinatally or during early childhood must be taken into
account.

METHODOLOGY/PRINCIPAL FINDINGS: We conducted a cross sectional study in 207
personnel of 4 occupational groups (medical, paramedical, cleaning staff,
and administrative) in Niamey’s National Hospital, Niger, in order to
assess the prevalence of HBV markers, to evaluate susceptibility to HBV
infection, and to identify personnel who might benefit from vaccination.
The proportion of those who declared a history of occupational blood
exposure ranged from 18.9% in the administrative staff to 46.9% in
paramedical staff. Only 7.2% had a history of vaccination against HBV with
at least 3 injections. Ninety two percent were anti-HBc positive. When we
focused on170 HCWs, only 12 (7.1%) showed no biological HBV contact. Twenty
six were HBsAg positive (15,3%; 95% confidence interval: 9.9%-20.7%) of
whom 8 (32%) had a viral load >2000 IU/ml.

CONCLUSIONS/SIGNIFICANCE: The very small proportion of HCWs susceptible to
HBV infection in our study and other studies suggests that in a global
approach to prevent occupational infection by bloodborne pathogens, a
universal hepatitis B vaccination of HCWs is not priority in these
settings. The greatest impact on the risk will most likely be achieved by
focusing efforts on primary prevention strategies to reduce occupational
blood exposure. HBV screening in HCWs and treatment of those with chronic
HBV infection should be however considered.

Full Free Article
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0044442
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Sero-prevalence and associated risk factors on hepatitis C in
Maqiao township, Henan province of China
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22968024

Zhonghua Liu Xing Bing Xue Za Zhi. 2012 Jul;33(7):722-5.

[Sero-prevalence and associated risk factors on hepatitis C in Maqiao
township, Henan province of China].

[Article in Chinese]

Guo YH, Fan JX, Wang Z, Sun DY, Wang HF, Li ML, Liu J, Cui WG, Liu GH, Guo
WS.

Henan Provincial Center for Disease Control and Prevention, Zhengzhou
450016, China.

OBJECTIVE: To describe the prevalence and risk factors of hepatitis C virus
(HCV) occurred in Henan province, at the end of 2011.

METHODS: Five villages round Maqiao township, including 5187 residents,
were selected for the study. Five-milliliter-blood was drawn from every one
of the interviewee. Clinical data including age, gender and anti-HCV
antibody was recorded. Patients with positive antibodies against HCV were
tested for HCV RNA.

RESULTS: A total number of 5187 people from five villages were studied,
with age span from 1 to 97. The average age was 48 years and the sex ratio
was 1:1.34. The anti-HCV result showed that the prevalence was 2.27%, with
1-9 age group the lowest (1.55%) and the = 50 year-olds the highest
(4.93%). Different villages seemed to have significant differences on the
prevalence of HCV, with the highest as 8.68% and the lowest as 0.55%. Under
risk factors analysis and distance-infection rates linear regression
analysis, data showed that the prevalence might have correlated to the
behavior of a certain family-run clinic.

RESULTS: from multivariate analysis indicated that factors as intravenous
dropping, intravenous injection and the use of surgery/endoscope were
associated with the HCV infection in this village.

CONCLUSION: Although the public health care system had been developed for
more than ten years, iatrogenic infection was yet responsible for the
infection of HCV patients in the rural areas of China that called for
further attention paid to the system.
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Needle and syringe distribution trends in Western Australia,
1990 to 2009
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22963615

Drug Alcohol Rev. 2012 Sep 10.

Needle and syringe distribution trends in Western Australia, 1990 to 2009.

Lilley G, Mak DB, Fredericks T.

Sexual Health and Blood-borne Virus Program, Communicable Disease Control
Directorate, Department of Health, Perth, Australia.

INTRODUCTION AND AIMS: To describe needle and syringe distribution trends
of needle and syringe programs (NSP) between 1990 and 2009 in Western
Australia, and explore contributing factors within the national and state
strategic and legislative environment.

DESIGN AND METHODS: The number of needles and syringes distributed by each
of the four NSP types [needle and syringe exchange program (NSEP); health
service; pharmacy; vending machine] between 1990 and 2009 were stratified
by time period and geographic location using Microsoft Excel.

RESULTS: Total needle and syringe distribution over the 20-year period
increased by eight-fold. Regional areas experienced the highest growth: 20-
fold increase compared with seven-fold increase in metropolitan areas. The
proportion of needles and syringes distributed through NSEPs increased from
33% to 62% between 1990 and 2009, and through health services increased
from 3% to 8% between 1994 and 2009. The proportion distributed through
pharmacies decreased from 67% to 28% between 1990 and 2009, and through
vending machines from 7% to 1.3% between 1992 and 2009. National and state
HIV and hepatitis C strategies guided NSP provision at an early stage, and
expedited legislative amendments to allow for the operation of approved
NSPs.

DISCUSSION AND CONCLUSIONS: The majority of growth occurred through the
NSEPs and health service NSPs, which are publicly funded NSPs and provide
injecting equipment either on ‘exchange’ or free-of-charge respectively.
The Health Department of Western Australia recognises the increasing
reliance on publicly funded NSPs and the need to continue this cost-
effective public health program.

© 2012 Australasian Professional Society on Alcohol and other Drugs.
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Filler augmentation, safe or unsafe: A case series of severe
complications of fillers
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22973374

J Res Med Sci. 2011 Dec;16(12):1627-31.

Filler augmentation, safe or unsafe: A case series of severe complications
of fillers.

Omranifard M, Taheri S.

Associate Professor, Department of Surgery, School of Medicine, Isfahan
University of Medical Sciences, Isfahan, Iran.

BACKGROUND: The growing interest in filler injection requires a more
comprehensive knowledge about the complications of this procedure.

METHODS: A total of 5 cases with debilitating chronic complications
following filler injection referred to Al-Zahra hospital, Isfahan are
presented in this report.

RESULTS: The outcome of treatment for two of the cases was satisfactory. In
one case the treatment led to failure. A case committed suicide, the
remaining case had received vitamin E injection which caused severe
necrosis and scaring.

CONCLUSIONS: All fillers are considered foreign bodies and may provoke the
immune system to varying degrees. Most complications are, however, caused
by the technique of injection not the filler itself. Experience of
physicians along with adequate knowledge about fillers and their
complications can definitely guarantee a better outcome.

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3434907/
__________________________________________________________________
________________________________*_________________________________

12. Abstract: Comparative Effectiveness of Injection Therapies in Lateral
Epicondylitis: A Systematic Review and Network Meta-analysis of
Randomized Controlled Trials
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22972856

Am J Sports Med. 2012 Sep 12.

Comparative Effectiveness of Injection Therapies in Lateral Epicondylitis:
A Systematic Review and Network Meta-analysis of Randomized Controlled
Trials.

Krogh TP, Bartels EM, Ellingsen T, Stengaard-Pedersen K, Buchbinder R,
Fredberg U, Bliddal H, Christensen R.

Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark.

BACKGROUND: Injection therapy with glucocorticoids has been used since the
1950s as a treatment strategy for lateral epicondylitis (tennis elbow).
Lately, several novel injection therapies have become available.

PURPOSE: To assess the comparative effectiveness and safety of injection
therapies in patients with lateral epicondylitis.

STUDY DESIGN: Systematic review and meta-analysis.

METHODS: Randomized controlled trials comparing different injection
therapies for lateral epicondylitis were included provided they contained
data for change in pain intensity (primary outcome). Trials were assessed
using the Cochrane risk of bias tool. Network (random effects) meta-
analysis was applied to combine direct and indirect evidence within and
across trial data using the final end point reported in the trials, and
results for the arm-based network analyses are reported as standardized
mean differences (SMDs).

RESULTS: Seventeen trials (1381 participants; 3 [18%] at low risk of bias)
assessing injection with 8 different treatments-glucocorticoid (10 trials),
botulinum toxin (4 trials), autologous blood (3 trials), platelet-rich
plasma (2 trials), and polidocanol, glycosaminoglycan, prolotherapy, and
hyaluronic acid (1 trial each)-were included. Pooled results (SMD [95%
confidence interval]) showed that beyond 8 weeks, glucocorticoid injection
was no more effective than placebo (-0.04 [-0.45 to 0.35]), but only 1
trial (which did not include a placebo arm) was at low risk of bias.
Although botulinum toxin showed marginal benefit (-0.50 [-0.91 to -0.08]),
it caused temporary paresis of finger extension, and all trials were at
high risk of bias. Both autologous blood (-1.43 [-2.15 to -0.71]) and
platelet-rich plasma (-1.13 [-1.77 to -0.49]) were also statistically
superior to placebo, but only 1 trial was at low risk of bias. Prolotherapy
(-2.71 [-4.60 to -0.82]) and hyaluronic acid (-5.58 [-6.35 to -4.82]) were
both more efficacious than placebo, whereas polidocanol (0.39 [-0.42 to
1.20]) and glycosaminoglycan (-0.32 [-1.02 to 0.38]) showed no effect
compared with placebo. The criteria for low risk of bias were only met by
the prolotherapy and polidocanol trials.

CONCLUSION: This systematic review and network meta-analysis of randomized
controlled trials found a paucity of evidence from unbiased trials on which
to base treatment recommendations regarding injection therapies for lateral
epicondylitis.
__________________________________________________________________
________________________________*_________________________________

13. Abstract: Pilot study to measure cleaning effectiveness in health care
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/21937146

Am J Infect Control. 2012 Jun;40(5):477-8.

Pilot study to measure cleaning effectiveness in health care.

Gillespie EE, Scott C, Wilson J, Stuart R.

Infection Control and Epidemiology Unit, Southern Health, Clayton,
Victoria, Australia. elizabeth.gillespie@southernhealth.org.au

Environmental surfaces are likely to contribute to the transmission of
health care-associated pathogens. The present study aimed to determine the
most effective regimen or product for removing bioburden. An adenosine
triphosphate assessment technique was used to compare cleaning methods and
products for removing bioburden from soiled surfaces.

Of the regimens or products tested, 2-step cleaning most thoroughly removed
bioburden. The 2- in-1 products were no more effective in removing
bioburden than a 1-step clean using a neutral detergent.

Crown Copyright © 2012. Published by Mosby, Inc. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

14. Abstract: Japanese professional nurses spend unnecessarily long time
doing nursing assistants’ tasks
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22976342

Tohoku J Exp Med. 2012;228(1):59-67.

Japanese professional nurses spend unnecessarily long time doing nursing
assistants’ tasks.

Kudo Y, Yoshimura E, Taruzuka Shahzad M, Shibuya A, Aizawa Y.

Department of Health Care Management, Kitasato University School of
Medicine.

In environments in which professional nurses do simple tasks, e.g.,
laundry, cleaning, and waste disposal, they cannot concentrate on technical
jobs by utilizing their expertise to its fullest benefit. Particularly, in
Japan, the nursing shortage is a serious problem. If professional nurses
take their time to do any of these simple tasks, the tasks should be
preferentially allocated to nursing assistants. Because there has been no
descriptive study to investigate the amount of time Japanese professional
nurses spent doing such simple tasks during their working time, their
actual conditions remain unclear.

Professional nurses recorded their total working time and the time they
spent doing such simple tasks during the week of the survey period. The
time an individual respondent spent doing one or more simple tasks during
that week was summed up, as was their working time. Subsequently, the
percentage of the summed time he or she spent doing any of those tasks in
his or her summed working time was calculated.

A total of 1,086 respondents in 19 hospitals that had 87 to 376 beds were
analyzed (response rate: 53.3%).

The average time (SD) that respondents spent doing those simple tasks and
their total working time were 2.24 (3.35) hours and 37.48 (10.88) hours,
respectively. The average percentage (SD) of the time they spent doing the
simple tasks in their working time was 6.00% (8.39). Hospital
administrators must decrease this percentage.

Proper working environments in which professional nurses can concentrate
more on their technical jobs must be created.

Free full text
https://www.jstage.jst.go.jp/article/tjem/228/1/228_59/_article
__________________________________________________________________
________________________________*_________________________________

15. Abstract: Prevalence of HBV infection in suspected population of
conflict-affected area of war against terrorism in North Waziristan
FATA Pakistan
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22960542

Infect Genet Evol. 2012 Aug 30.

Prevalence of HBV infection in suspected population of conflict-affected
area of war against terrorism in North Waziristan FATA Pakistan.

Ali A, Nisar M, Idrees M, Ahmad H, Hussain A, Rafiq S, Sabri S, Rehman HU,
Ali L, Wazir S, Khan T.

Department of Biotechnology University of Malakand, Chakdara, Khyber
Pakhtoonkhaw, Pakistan.

BACKGROUND: Hepatitis B virus (HBV) infection is a major cause of severe
liver diseases including fibrosis, hepatocellular carcinoma (HCC) and
cirrhosis related end stage liver diseases (ESLD) in mankind. It is a
common belief that infectious diseases have historically been responsible
for the massiveness of war-related deaths, so the aim of this study was to
estimate the prevalence of HBV infection and to demonstrate the various
socio-economic, demographic and possible risk factors related to HBV
infection among the conflict-affected peoples due to war against terrorism
in North Waziristan.

METHODS: Blood samples were collected from total 790 suspected individuals
from the conflict-affected population of North Waziristan and were analyzed
initially tested for the presence of HBsAg, HBeAg antigens, Anti-HBc and
Anti-HBs antibodies using ELISA methods. All the positive samples were
tested by real time PCR to confirm the presence of HBV DNA in ELISA
positive specimens.

RESULTS: Total of 126 (15.94%) samples were found positive for HBV DNA by
real-time PCR. Among these positive subjects, 95 (75.5%) were males while
31 (24.5%) were females in a ratio of approximately 3:1. High HBV
prevalence (41.26%) was observed among the subjects of subdivision Miran
Shah relating to the high frequency of military activities against
terrorism as compared to Mir Ali subdivision (35.7%) and Razmak subdivision
(19.8%). Among the age groups, high prevalence (38.88%) was observed in age
group 21-30 as compared to children and in older age groups. The modes of
HBV transmission in this area was associated with re-uses of contaminated
needles/syringes in medical care, barbers shops, sexual exposure and
tattooing are the principal causal risks factors. Furthermore HBV infection
was significantly higher in people with low socioeconomic status, in
illiterate persons and in drivers.

CONCLUSION: Our results indicate high prevalence rate of HBV infection in
young subjects obviously confirms the entire absence of any program to
fight HBV. Mass Immunization programs, awareness campaigns and education
efforts should be practiced immediately to reduce HBV transmission among
young peoples of this conflict zone.

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

16. Abstract: Healthcare-associated infections among pediatric oncology
patients in Pakistan: risk factors and outcome
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22610708

J Infect Dev Ctries. 2012 May 14;6(5):416-21.

Healthcare-associated infections among pediatric oncology patients in
Pakistan: risk factors and outcome.

Siddiqui NU, Wali R, Haque AU, Fadoo Z.

Department of Pediatric and Child Health, Aga Khan University Hospital,
Karachi 74800, Pakistan. naveed.rehman@aku.edu

INTRODUCTION: Pediatric oncology patients are at increased risk of
contracting healthcare-associated infections (HAIs), which are responsible
for increased morbidity and mortality rates as well as treatment costs.
This study aimed to identify the frequency of HAIs among pediatric oncology
patients and their outcome.

METHODOLOGY: Pediatric oncology patients admitted between January 2009 and
June 2010 in a pediatric ward at Aga Khan University Hospital, Karachi,
Pakistan, who developed HAIs, were analyzed.

RESULTS: A total of 90 HAIs were identified in 32 patients in 70
admissions. The HAI rate among pediatric oncology patients was 3.1/100
admission episodes. Bloodstream infections (63 episodes, 90.0%) were the
most common, followed by urinary tract infection (two episodes, 2.9%).
Gram-positive infections were seen in 54 (60%) patients, followed by Gram-
negative infection in 34 (37.8%), and fungi in 2 (2.8%) cases. Coagulase
negative staphylococci was the most common Gram-positive and Escherichia
coli and Pseudomonas aeruginosa were most common Gram-negative infections.
Mortality rate among pediatric oncology patients who developed HAIs was
12.5% (4/32).

Total parental nutrition use and length of stay longer than 30 days were
the identified risk factors associated with increased mortality among
pediatric oncology patients who developed HAIs.

CONCLUSION: We report an HAI rate among pediatric oncology patients of
3.1/100 admission episodes with a mortality rate of 12.5% in Pakistan.
Further studies should be done, especially in the developing world, to
identify the risk factors associated with increased mortality among
pediatric oncology patients so that adequate measures can be taken to
reduce the mortality among these patients.

Free full text http://www.jidc.org/index.php/journal/article/view/22610708
__________________________________________________________________
________________________________*_________________________________

17. Abstract: Efficacy of yeast-derived recombinant hepatitis B vaccine
after being used for 12 years in highly endemic areas in China
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22959987

Vaccine. 2012 Sep 6.

Efficacy of yeast-derived recombinant hepatitis B vaccine after being used
for 12 years in highly endemic areas in China.

Shen L, Wang F, Wang F, Cui F, Zhang S, Zheng H, Zhang Y, Liang X, Bi S.

Institute for Viral Disease Control and Prevention, Chinese Center for
Disease Control and Prevention, Beijing 102206, China.

OBJECTIVE: To evaluate the long-term efficacy and duration of yeast-derived
recombinant hepatitis B vaccine in hepatitis B virus (HBV)-endemic areas.

METHOD: A cross-sectional investigation was carried out in five HBV-endemic
areas. Children who were born between 1997 and 2008 and vaccinated with
yeast- derived recombinant hepatitis B vaccine were selected. Serum samples
were taken to test HBV infection markers by microparticle enzyme
immunoassay, and the results were compared to those before vaccination.

RESULTS: 7066 subjects were enrolled. The average adjusted hepatitis B
surface antigen (HBsAg) prevalence was 1.02%. HBV core antibody (anti-HBc)
prevalence was 3.54%. The overall percentage of HBsAg(-)&Anti-HBc(-)&Anti-
HBs(+) was 61.34%. With time after immunization, the percentage annually
decreases from 86.11% in 2008 to 49.80% in 1997. Geometric mean
concentration (GMC) of anti-HBs decreased significantly annually. The
portion of GMC=100-999.9mIU/ml was 48.0% in 2008, and decreased to 16.7% in
1997.

CONCLUSION: HBsAg prevalence decreased dramatically. This shows that the
yeast-derived recombinant hepatitis B vaccine is effective and stable after
being used for 12 years in HBV-endemic areas. It is not suggested to carry
out booster immunization.

Copyright © 2012. Published by Elsevier Ltd.
__________________________________________________________________
________________________________*_________________________________

18. No Abstract: APIC strategic plan 2020

Free full text:
http://www.ajicjournal.org/article/S0196-6553(12)00170-8/fulltext
__________________________________________________________________
Am J Infect Control. 2012 Jun;40(5):391.

APIC strategic plan 2020.

[No authors listed]

Free full text:
http://www.ajicjournal.org/article/S0196-6553(12)00170-8/fulltext
__________________________________________________________________
________________________________*_________________________________

19. Kenya, Ghana, Nigeria, & South Africa: Mobile phone apps rescue medics
in fight against diseases, fake drugs
__________________________________________________________________
Kenya, Ghana, Nigeria, & South Africa: Mobile phone apps rescue medics in
fight against diseases, fake drugs

By Fredrick Obura, The Standard Digital News, Nairobi Kenya (17.09.12)

A group of doctors from Kenya, Ghana, Nigeria, and South Africa have come
up with a simple technology to improve knowledge among Kenyans.

The mobile phone application known as iafya is a platform that contains
health information simplified to make understanding easy.

“Whether you want to look up medical conditions, browse medical procedures,
check treatment options or need basic first aid; the iAfya application
offers the answers for free.” said Dr Allan Makenzi (pictured), founder
iAfya Health Information.

Doctors say lack of awareness on serious health complications is causing
deaths from preventable diseases such as malaria, cholera, and cancer now
claiming thousands of people annually. Widespread cause of deaths in the
third world countries could be attributed to inaccessible information.

Recently at a Mobile West Conference in Nairobi, the application was voted
best, a position, which earned it space at the Blackberry App World. “After
my masters study in health economics from Cape Town University, I had a
stint at the Agakhan hospital in Nairobi,” said Dr Makenzi.

Dealing with diseases

“My interaction with patients’ revealed lack of precise information in
dealing with diseases, the knowledge gap is causing many their lives from
diseases which can easily be dealt with at earlier stages,” he says. “I
also learnt that many especially those from rural parts of the country
relies on traditional methods in curing diseases, a cow dung for instance
is used in curing wounds,” he says.

“This is not hygienic, it only worsens the situation by exposing one to
other diseases,” he said. Two years ago at a conference attended by
delegates from other parts of Africa, he realised the situation was the
same. “Patients die elsewhere as in Kenya due to lack of information,” he
notes. “I teamed up with like-minded doctors from Ghana, Nigeria, and South
Africa on how to avail basic information on prevalent cases such as
malaria, HIV, cancer, diarrhea to majority if not all,” he says. “We
settled on mobile phones as a medium of reach because of its wide adoption
in Kenya and beyond.”

“The application can be accessed on Internet enabled phones, users can
access medical conditions and procedures in text and in illustration
formats on over 5000 different diseases available in the application,” he
says. The number of mobile subscribers in the country has increased to 29.2
million between January and March 2012 up from 28.08 million in December
last year.

According to the 3rd quarter sector statistics for the financial year
2011/2012 released by the Communicatons Commission of Kenya, 89.10 per cent
of the population has access to mobile phones.

Access to health

The past two years has seen enterprises capitalising on the development to
improve health access in the country. This is in line with Millennium
Development Goals, which advocates for better health in the third world
countries. Telekom Kenya, Safaricom, and Airtel have so far launched health
initiatives targeting widespread mobile phones in the country. In October
last year, Orange Kenya launched Mpedigree; an SMS based system to fight
against counterfeit drugs. The programme is intended to fight counterfeit
drugs in Kenya and Cameroon where up to 30 per cent of the drugs are
potentially affected. Medical Services minister Prof Anyang’ Nyong’o says
one out of 174 drugs are counterfeits, hence the need to be vigilant to
fight the menace using technology.

“Such innovations have potential in improving health standards in our
country,” he said during the launch. In an interview with Tech Insight, Dr
Makenzi said technology had a potential of helping Kenya achieve Millennium
Development goals in health.

“We are in talks with the ministry of Health, and a telecommunication
operator to upscale adoption of e-health in the country.”

GLANCE FACTS

iafya Health Initiative

BlackBerry teamed up with Avallain and produced a super health application
for the people of Kenya. The iAfya app for BlackBerry Smartphones gives
BlackBerry subscribers fingertip access to a broad range of health
information.

Designed especially for the BlackBerry platform the application entails
various sections including basic first aid, frequently asked questions,
contact a health worker, look up medical conditions, look up medical
procedures, news and even an illustrated section which has a sort of
cartoon vibe.

With to switch between English and Swahili, the app will give freedom to
make the most of discovering health information and helping them with
seeking assistance. iAfya works on all BlackBerry 7 devices and is free to
download from BlackBerry App World now.
__________________________________________________________________
________________________________*_________________________________

20. WHO Hand Hygiene Self-Assessment Framework: Hospital Performance in the
U.S. and Around the Globe
__________________________________________________________________
http://tinyurl.com/8qeshgo

WHO Hand Hygiene Self-Assessment Framework: Hospital Performance in the
U.S. and Around the Globe
By Kelly M. Pyrek, Infection Control Today, USA (15.09.12)

For a slide show containing highlights from this article, CLICK HERE:
www.infectioncontroltoday.com/galleries/2012/09/hand-hygiene-
assessment.aspx

The World Health Organization (WHO) taught the global healthcare community
that there are five critical moments in hand hygiene that can make or break
infection prevention efforts. Now, using a framework provided by the WHO,
hospitals around the world can conduct assessments of their hand hygiene
compliance efforts within the context of the larger issues of institutional
cultures of safety and other key measures impacting patient outcomes. A
recent survey of U.S. healthcare facilities reveals that while great
strides are being made, there is much more work to be done to boost hand
hygiene monitoring and self-assessment.

The survey was undertaken by Laurie J. Conway, RN, MS, CIC, a graduate
student at the Columbia School of Nursing, and colleagues Benedetta
Allegranzi, MD, (first author of the study) of the World Health
Organization World Alliance for Patient Safety; Didier Pittet, MD, MS, of
the University of Geneva Hospitals; Katherine Ellingson, PhD, of the
Centers for Disease Control and Prevention (CDC); and Elaine Larson, PhD,
RN, CIC, of Columbia University School of Nursing. It surveyed hospitals
participating in the World Health Organization (WHO) SAVE LIVES: Clean Your
Hands campaign, and Conway presented preliminary results from this project
at the 2012 annual conference of the Association for Professionals in
Infection Control and Epidemiology (APIC) held in June.

In the preface to the World Health Organization (WHO) Guidelines on Hand
Hygiene in Health Care, Pittet, special advisor for the WHO First Global
Patient Safety Challenge Clean Care is Safer Care, observes, “By their very
nature, infections are caused by many different factors related to systems
and processes of care provision as well as to human behavior that is
conditioned by education, political and economic constraints on systems and
countries, and often on societal norms and beliefs. Most infections,
however, are preventable. Hand hygiene is the primary measure to reduce
infections. A simple action, perhaps, but the lack of compliance among
healthcare providers is problematic worldwide.”

The WHO Self-Assessment Framework is just one of the many components of the
global organization’s platform of strategies for hand hygiene promotion and
improvement, including the WHO First Global Patient Safety Challenge,
“Clean Care is Safer Care,” which is focusing part of its attention on
improving hand hygiene standards and practices in healthcare, along with
implementing successful interventions.

Healthcare facilities can track their progress in hand hygiene resources,
promotion and activities, plan their actions and aim for improvement and
sustainability through the use of the WHO Hand Hygiene Self-Assessment
Framework. The Framework is a tool with which to obtain a situation
analysis of hand hygiene promotion and practices within an individual
healthcare facility, according to a set of indicators. While providing an
opportunity to reflect on existing resources and achievements, the Hand
Hygiene Self-Assessment Framework also helps to focus on future plans and
challenges. In particular, it acts as a diagnostic tool, identifying key
issues requiring attention and improvement. The results can be used to
facilitate development of an action plan for the facility’s hand hygiene
promotion program. Repeated use of the Hand Hygiene Self-Assessment
Framework will also allow documentation of progress with time. The WHO says
this tool should be a catalyst for implementing and sustaining a
comprehensive hand hygiene program within a healthcare facility.

This tool should be used by professionals in charge of implementing a
strategy to improve hand hygiene within a healthcare facility. If no
strategy is being implemented yet, then it can also be used by
professionals in charge of infection control or senior managers at the
facility directorate. The framework can be used globally, by healthcare
facilities at any level of progress as far as hand hygiene promotion is
concerned.

The Hand Hygiene Self-Assessment Framework is divided into five components
and 27 indicators. The five components — system change, education and
training, evaluation and feedback, reminders in the workplace, and
institutional safety climate — reflect the five elements of the WHO
Multimodal Hand Hygiene Improvement Strategy
http://www.who.int/gpsc/5may/tools/en/index.html and the indicators have
been selected to represent the key elements of each component. These
indicators are based on evidence and expert consensus and have been framed
as questions with defined answers (either “Yes/No” or multiple options) to
facilitate self-assessment. Based on the score achieved for the five
components, the facility is assigned to one of four levels of hand hygiene
promotion and practice: inadequate, basic, intermediate and advanced:

– Inadequate: hand hygiene practices and hand hygiene promotion are
deficient. Significant improvement is required.

– Basic: some measures are in place, but not to a satisfactory standard.
Further improvement is required.

– Intermediate: an appropriate hand hygiene promotion strategy is in place
and hand hygiene practices have improved. It is now crucial to develop
long-term plans to ensure that improvement is sustained and progresses.

– Advanced: hand hygiene promotion and optimal hand hygiene practices have
been sustained and/or improved, helping to embed a culture of safety in the
healthcare setting.

Infection preventionists using the WHO Hand Hygiene Self-Assessment
Framework circle the answer appropriate to their facility for each
question. Each answer is associated with a score. After completing a
component, the scores are added up for the answers selected to give a
subtotal for that component. During the interpretation process these
subtotals are then added up to calculate the overall score to identify the
hand hygiene level to which the participant’s healthcare facility is
assigned. Within the Framework is a list of WHO implementation tools
available from the WHO First Global Patient Safety Challenge to facilitate
the implementation of the WHO Multimodal Hand Hygiene Improvement Strategy
(http://www.who.int/gpsc/5may/tools/en/index.html). These tools are listed
in relation to the relevant indicators included in the Framework and may be
useful when developing an action plan to address areas identified as
needing improvement.

To access the framework tool, visit:
http://www.who.int/gpsc/country_work/hhsa_framework_October_2010.pdf

[ Mod: Article continues aT http://tinyurl.com/8qeshgo ]
__________________________________________________________________
________________________________*_________________________________

21. News

– USA: 1 more positive test in Hays for hepatitis C
– USA: Man Gets 30 Years in Hepatitis C Case
– Global South: Global South leads the way towards universal healthcare
coverage
– Risks of acupuncture range from stray needles to pneumothorax, finds
study

Selected news items reprinted under the fair use doctrine of international
copyright law: http://www4.law.cornell.edu/uscode/17/107.html
__________________________________________________________________
USA: 1 more positive test in Hays for hepatitis C
The Associated Press USA (15.09.12)

TOPEKA, Kan. — Kansas officials say a fourth former patient at Hays
Medical Center has tested positive for a strain of hepatitis C linked to a
cluster of New Hampshire cases traced to a traveling hospital technician.

The Kansas Department of Health and Environment announced the latest
positive test Friday. The other three positive tests were reported last
month.

The KDHE says 474 people were potentially exposed to hepatitis C when David
Kwiatkowksi worked at the Hays hospital’s cardiac catheterization lab from
May 24 to Sept. 22, 2010.

The Hays Daily News (http://bit.ly/QhGHOE) reported that some specimens
still are being processed.

Kwiatkowski has denied allegations that he stole drugs from a New Hampshire
hospital, injected himself and contaminated syringes later used on
patients. He previously worked in seven other states, including Kansas.
__________________________________________________________________
__________________________________________________________________

USA: Man Gets 30 Years in Hepatitis C Case
Associated Press (11.09.12)

A 49-year old radiology technician in Jacksonville, Florida, was sentenced
to 30 years in federal prison after pleading guilty to stealing syringes of
painkillers meant for patients’ procedures. He had replaced the syringes
with syringes of saline contaminated with Hepatitis C virus, which
subsequently caused a patient’s death.

The technician tampered with the syringes from 2006-2008, while employed at
the Mayo Clinic branch in Jacksonville. A three-year investigation finally
linked the hepatitis C outbreak to the technician who was then fired and
reported to the police.
__________________________________________________________________
__________________________________________________________________

Global South: Global South leads the way towards universal healthcare
coverage
IRIN, UN Office for the Coordination of Humanitarian Affairs (11.09.12)

JOHANNESBURG, 11 September 2012 (IRIN) – An increasing number of developing
countries are introducing universal healthcare coverage – and creating new
models to do it – according to research published in The Lancet. Lessons
learned from countries like Ghana, India and Rwanda are already shaping the
way countries like South Africa are beginning to pilot their own bids for
universal coverage.

In the early 20th century, two models of universal healthcare coverage
emerged in the United Kingdom and Germany. The UK uses general taxes to
fund publicly provided healthcare in its one risk pool model, while
Germany’s multiple risk pool model relies on household premiums and payroll
taxes, and relies on private healthcare providers. Industrialized countries
like Japan, Canada and France have all implemented variations of these two
models.

But countries from the global South are creating their own models,
according to research by the Results for Development Institute and others,
published in The Lancet as part of its universal healthcare coverage
series.

The research, which surveyed nine developing countries in Africa and Asia
(which are now part of a joint learning network on the issue) found that
the new models vary considerably but have several common characteristics,
including increased revenue and health budgets, larger risk pools and use
of the private sector.

The rationale for moving to universal healthcare is also largely the same,
according to lead author Gina Lagomarsino, a managing director at the
Results for Development Institute. “In most cases, the move to universal
coverage is a response to people feeling like they’re paying too much out
of pocket for healthcare that they can’t afford or can’t even get because
it’s too expensive,” she told IRIN/PlusNews.

Finding the funds

Nigeria used revenue freed up by debt relief to fund pilot universal
coverage programmes for expecting mothers and children, while Ghana
increased value-added taxes by about 3 percent in 2003 to fund its
programme. Ghanaian policy makers noted that earmarking the increase for
health expenditures made it an easier sell to voters.

“For Ghana, it became a major issue in the [2004] elections,” Lagomarsino
said. “People were tired of what, in Ghana, had come to be known as the
‘cash and carry’ system of healthcare where people had to pay a lot out of
pocket, so it became very political to create a system where everyone could
have access.”

On average, countries had to increase government spending on health by as
much as 11 percent to fund universal coverage efforts. Only in the
Philippines did the government decrease spending, according to the
research.

International aid accounted for more than a quarter of funding in only
three countries – Mali, Kenya and Rwanda – where almost half of universal
healthcare coverage was donor-funded, according to the research.

However, authors in an accompanying paper caution that increases in revenue
have to be accompanied by better governance and population targeting to
make a real difference.

Bigger pools and the public-private mix

While two-thirds of countries surveyed had multiple risk pools, which some
argue foster inequality and increase administration costs, researchers
found many countries were consolidating these pools into larger ones.

“Successful countries have been moving towards broader, larger risk pools
where you have more of the population under one system rather than a
fragmented one that, for instance, has separated pools for civil servants,
the formal sector, the poor,” Lagomarsino said.

“Bringing everyone into one pool can make healthcare more equitable because
everyone is entitled to the same set of benefits.”

For Ghana it became a major issue in the [2004] elections. People were
tired of what, in Ghana, had come to be known as the ‘cash and carry’
system of healthcare where people had to pay a lot out of pocket, so it
became very political to create a system where everyone could have
accessMost countries are also choosing to include the private sector. Of
the nine countries surveyed, only Rwanda and Vietnam rely solely on public
health providers. The majority of countries surveyed purchase health
services from public and private service providers, allowing for varying
degrees of patient choice in providers. Most reliant on the private sector
is federalist India, where private health insurers bid to implement state
health coverage. These companies are then tasked with enrolling people in
healthcare plans, receiving state money based on the number of people
enrolled.

According to Lagomarsino, advocates of the controversial system argue that
because companies are paid per enrolled member, they are motivated to reach
out to the previously uninsured in poor and rural communities. Detractors
argue that it may also create a perverse incentive to poorly educate people
on the package of services they are entitled to, ensuring that services
remain underutilized and that companies’ payments to healthcare providers
are limited.

Lagomarsino and her co-authors warn against the total exclusion of the
private sector insurance in universal healthcare coverage, arguing that
this can lead to two-tiered systems, in which poor people go to public
facilities perceived to be of lower quality and those who can pay use
private care. A mixed public-private system, by contrast, can use subsidies
or other mechanisms to extend private care to the poor.

Although not included in the study, South Africa provides one of the
world’s best examples of such a two-tiered system, Lagomarsino told
IRIN/PlusNews. According to the Democratic Nursing Organisation of South
Africa, 8.1 million South Africans pay to utilize the better resourced
private sector while about 41 million rely solely on the public healthcare
system in which some treatments, like renal dialysis, are rationed.

Brian Ruff, CEO of South Africa’s largest private health insurance,
Discovery Health, co-authored a commentary on inequalities in South
Africa’s health system in 2011. In it, he and his co-authors characterized
the health system as deeply divided, with stark and growing differences in
access and quality between public and private care – mirroring the
inequalities between rich and poor in almost every aspect of South African
life.

South Africa latest to join expanding club

But measures are underway to change this. Shortly after his 2009
inauguration as South African Health Minister, Aaron Motsoaledi began to
move the country toward universal healthcare coverage through a national
health insurance (NHI), convening a ministerial advisory committee of
health experts on the matter. In 2011, the country issued its first draft
policy document on the NHI, and in April 2012 launched the initiative in
ten pilot districts nationally. While these pilot sites have been funded
through a conditional grant, the NHI will eventually be funded through a
dedicated fund.

South Africa’s Treasury Department had promised to release a policy paper
in April of this year, outlining how the NHI would be funded, but it has
yet to do so. In this paper’s absence, speculation remains rife as to how
the government will fund its move to universal coverage.

llg/kn/rz

Copyright © IRIN 2012. This material comes to you via IRIN, the
humanitarian news and analysis service of the UN Office for the
Coordination of Humanitarian Affairs. This report does not necessarily
reflect the views of the United Nations
__________________________________________________________________
__________________________________________________________________
Risks of acupuncture range from stray needles to pneumothorax, finds study
Zosia Kmietowicz, BMJ BMJ 2012;345:e6060 (07.09.12)

About 100 patients a year in England and Wales experience adverse events
after acupuncture delivered by the NHS, ranging from having needles left on
their body to pneumothorax, a study has found.1

Although most incidents aren’t harmful, it is likely that the total figure
is an underestimate because of under-reporting, say the researchers. They
recommend a number of practices that can improve the safety of acupuncture.

The researchers searched the database of the national reporting and
learning system run …

Access to the full text of this article requires a subscription or payment
http://www.bmj.com/content/345/bmj.e6060
__________________________________________________________________
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