online canadian pharmacy http://www.canadianpharmacy365.net/ pharmacy ratings phentermine no prescription

SIGN00668

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST *

Post00668 ICAN 2012 + Abstracts + Supply Summit + News 26 September 2012

CONTENTS
1. Reminder: ICAN 2012, 27 – 29 November, The Pavilion, V & A Waterfront,
Cape Town, South Africa
2. Abstract: Survey of sharp waste disposal system in clinics of New
Karachi
3. Abstract: Socio-demographic characteristics of health care workers and
hepatitis B virus (HBV) infection in public teaching hospitals in
khartoum state, Sudan
4. Abstract: Occupational Exposure to Blood and Body Fluids among Health
Care Workers in Teaching Hospitals in Tehran, Iran
5. Abstract: Longer years of practice and higher education levels promote
infection control in Iranian dental practitioners
6. Abstract: Assessment of infection control practices for interventional
techniques: a best evidence synthesis of safe injection practices and
use of single-dose medication vials
7. Abstract: An observational study to evaluate the efficiency and safety
of ioversol pre-filled syringes compared with ioversol bottles in
contrast-enhanced examinations
8. Abstract: Smart pump alerts: all that glitters is not gold
9. Abstract: Specific immunotherapy can greatly reduce the need for
systemic steroids in allergic rhinitis
10. Abstract: Hand sanitizer dispensers and associated hospital-acquired
infections: friend or fomite?
11. Abstract: Ultraviolet powder versus ultraviolet gel for assessing
environmental cleaning
12. Abstract: Dating the origin and dispersal of hepatitis B virus
infection in humans and primates
13. Abstract: Anti-hepatitis B surface antigen titres in vaccinated
dentistry students at Damascus University
14. No Abstract: A simple method to improve safety of epinephrine auto-
injectors
15. The 5th Global Health Supply Chain Summit
16. News
– VIDEO: Mum’s horror over needle on beach
– Canada: Ex-convict, HIV/AIDS advocacy groups ask court for prison needle
exchanges
– Canada: Ottawa Sued Over ‘Failure’ to Provide Needle-Exchange Programs
in Prisons
– USA: Roseburg woman frustrated after finding dirty needle on ground
– USA: Class-Action Lawsuit Eyed in Hepatitis C Cases
– USA: Accused Hepatitis C Infector May Have Spread Virus 2 Years Earlier
Than Previously Reported

The web edition of SIGNpost is online at:
http://signpostonline.info/archives/1296

More information follows at the end of this SIGNpost!

Please send your requests, notes on progress and activities, articles,
news, and other items for posting to: sign@lists.uq.edu.au

Normally, items received by Tuesday will be posted in the Wednesday
edition.

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

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

Visit the SIGNpostOnline archives at: http://signpostonline.info

Selected updates and breaking news items on the SIGN Moderator Facebook
page at: http://facebook.com/SIGN.Moderator

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

1. Reminder: ICAN 2012, 27 – 29 November, The Pavilion, V & A Waterfront,
Cape Town, South Africa
__________________________________________________________________
Fourth ICAN African Conference to be held at the Waterfront in Cape Town,
South Africa from the 27th to 29th November, 2012.

Web-site : www.icanetwork.co.za
e-mail: ican@sun.ac.za

ICAN 2012, 27 – 29 November, The Pavilion, V & A Waterfront, Cape Town,
South Africa

Keynote speakers

Dr David Livermore, UK
Ginny Lipke, USA
Dr Michael Tapper, USA
Prof Nancy Gibson, Canada

Bursaries: Closing date, 1 September 2012
Visit our website for more information

Important dates:
Early Registration closes:
28 September 2012
Accommodation reservations:
28 September 2012
__________________________________________________________________
________________________________*_________________________________

2. Abstract: Survey of sharp waste disposal system in clinics of New
Karachi
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22755380

J Pak Med Assoc. 2012 Feb;62(2):163-4.

Survey of sharp waste disposal system in clinics of New Karachi.

Qaiser S.

The Health Foundation, S.I.T.E, Karachi.

The World Health Organization (WHO) estimates that there are 350 million
people with chronic HBV infection and 170 million people with chronic HCV
infection worldwide. Hepatitis B is estimated to result in 563, 000 deaths
and hepatitis C in 366, 000 deaths annually. Given its large population
(180 million) and intermediate to high rates of infection, Pakistan is
among the worst afflicted nations.

The reuse of syringes and needles was a major factor contributing towards
increased HCV prevalence. It was reported that there are several small
groups involved in recycling and repacking of used unsterilized syringes,
which were available in various drug stores. It was difficult for the
public to differentiate between new sterilized syringes and recycled
unsterilized syringes

In Pakistan, the number of estimated injections per person per year ranged
from 8.2 to 13.6, which was the highest among developing countries, out of
which 94.2% were unnecessary.

In 2000, the WHO recommended that countries should implement strategies to
change the behaviour of health care workers and patients in order to
decrease the over-use of injections, to ensure the practice of sterile
syringes and needles, and to properly destroy sharp waste after use.
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Socio-demographic characteristics of health care workers and
hepatitis B virus (HBV) infection in public teaching hospitals in
khartoum state, Sudan
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22980339

Glob J Health Sci. 2012 May 21;4(4):37-41.

Socio-demographic characteristics of health care workers and hepatitis B
virus (HBV) infection in public teaching hospitals in khartoum state,
Sudan.

Ahmed Elmukashfi T, Ali Ibrahim O, Elkhidir IM, Ali Bashir A, Ali Awad
Elkarim M. tahamukashfi@hotmail.com.

BACKGROUND: HBV is second to tobacco as a known human carcinogen and the
10th leading cause of death worldwide.

OBJECTIVES: To examine the socio-demographic characteristics of health care
workers and hepatitis B virus in Public Teaching Hospitals in Khartoum
State, Sudan, in 2004.

METHODS: It was an observational, cross sectional, facility-based study. A
total of 843 subjects were selected. It was conducted through multistage
cluster sampling. The clustering was based on: type of hospital (Federal or
State) and degree of exposure (type of department). For the analysis, Z-
test for single proportion and some non-parametric tests such as Chi-Square
test were used.

RESULTS: Among the 843 subjects tested for HBV markers (Anti-HBc, HBsAg,
HBsAb, and HBeAg), the prevalence of Anti-HBc, HBsAg, HBsAb, and HBeAg was
found to be 57%, 6%, 37% and 9% respectively. Seroprevalence of all HBV
markers was found to be statistically significant with demographic factors
(P<0.05).

CONCLUSION: Infection rate, carrier rate and a profile of high infectivity
rate were found to be high. The immunity rate was low. There is a
significant association between HBV markers and socio-demographic
characteristics. Highest rate of infection was found in State Hospitals,
South and West regions, married HCWs and HCWs of age group 30-49.
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Occupational Exposure to Blood and Body Fluids among Health
Care Workers in Teaching Hospitals in Tehran, Iran
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3438432/

Iran Red Crescent Med J. 2012 Jul;14(7):402-7.

Occupational Exposure to Blood and Body Fluids among Health Care Workers in
Teaching Hospitals in Tehran, Iran.

Shokuhi Sh, Gachkar L, Alavi-Darazam I, Yuhanaee P, Sajadi M.

Department of Infectious Disease, Loghman Hospital, Shahid Beheshti
University of Medical Sciences, Tehran, Iran.

BACKGROUND: Health care workers (HCWs) are vulnerable populations for
infection with blood borne pathogens. This study was conducted to determine
occupational exposure to blood and body fluids among HCWs in teaching
hospitals in Tehran, Iran.

METHODS: A self-structures questionnaire was used to study 650 HCWs during
2006 -2007 in some teaching hospitals in Tehran, Iran.

RESULTS: occupational exposure to blood and body fluids to blood and body
fluids of patients was noticed in 53.4%. Recapping was the most common
cause of niddle stick injuries (26.5%) and 19.9% of HCWs with a history of
needlestick or mucosal exposure had sought medical advice from a
specialist, 79.4% of these visited a doctor in the first 24 hours after
exposure. Twenty percent of people with a history of needlestick or mucosal
exposure to human immune deficiency virus positive (HIV(+)) patients
received post-exposure prophylaxis and 46.7% tested themselves for
seroconversion. 25.8% of HCWs with a history of needlestick or mucosal
exposure with HBsAg(+) patients received hepatitis B immunoglobuline
(HBIG), all of these had received it in the first 72 hours after exposure.
History of vaccination, and reassurance about the effective serum antibody
titer was the most frequent reason mentioned in case the individuals did
not receive HBIG (56.5%).

CONCLUSION: There is a need for further research to investigate why many
HCWs do not take prophylactic and essential actions after needle stick or
mucosal exposure to body fluids of infected patients.

Free full text: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3438432/
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Longer years of practice and higher education levels promote
infection control in Iranian dental practitioners
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3438435/

Iran Red Crescent Med J. 2012 Jul;14(7):422-9.

Longer years of practice and higher education levels promote infection
control in Iranian dental practitioners.

Ebrahimi M, Ajami BM, Rezaeian A.

Department of Pediatric Dentistry, Dental Research Center, Dental School,
Mashhad University of Medical Sciences, Mashhad, Iran.

BACKGROUNDS: Infection control is one of the primary responsibilities of
dental health care personnel. The purpose of this study was to evaluate
whether the infection control practices of Iranian dentists and dental
nurses working in governmental dental health care centers were influenced
by their educational level and years of practice.

METHODS: This cross-sectional analytical study was completed in 2009, and
it included 63 Iranian dental practitioners. Infection control knowledge
was evaluated with a self-administered questionnaire, and infection control
practices were evaluated with a checklist of questions by observation with
one researcher.

RESULTS: The dental practitioners in Mashad had a low level of infection
control knowledge. Dental personnel with a higher educational level had
significantly greater knowledge than those with less education.
Additionally, dental personnel who had more years of practice had a greater
knowledge of infection control.

CONCLUSION: Since dental practitioners working in Mashad governmental
dental health care centers with fewer years of practice and less
educational level had a low level of infection control knowledge, we
recommend a continuing educational program for this group and dental
nurses.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3438435/
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Assessment of infection control practices for interventional
techniques: a best evidence synthesis of safe injection practices and
use of single-dose medication vials
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22996856

Pain Physician. 2012 Sep;15(5):E573-614.

Assessment of infection control practices for interventional techniques: a
best evidence synthesis of safe injection practices and use of single-dose
medication vials.

Manchikanti L, Falco FJ, Benyamin RM, Caraway DL, Helm Ii S, Wargo BW,
Hansen H, Parr AT, Singh V, Hirsch JA.

Pain Management Center of Paducah, Paducah, KY, and University of
Louisville, Louisville, KY; Mid Atlantic Spine & Pain Physicians of Newark,
Newark, DE, and Temple University Hospital, Philadelphia, PA.

BACKGROUND: It is universally accepted that transmission of bloodborne
pathogens during health care procedures continues to occur because of the
use of unsafe and improper injection, infusion, and medication
administration practices by health care professionals in various clinical
settings. This resulted in development of multiple guidelines based on case
reports; however, these case reports are confounded by multiple factors
without causal relationship to a single factor. Even then, single-dose
vials used for multiple patients have been singled out and became the focus
of infection control policies resulting in inordinate expenses for
practices without improving patient safety. The cost of implementation of
single dose vial policy in Interventional Pain Management for drugs alone
may cost $750 million, whereas with single use radional gloves may exceed
$1 billion per year.

STUDY DESIGN: Best evidence synthesis.

OBJECTIVE: To critically appraise and synthesize the literature on
infection control practices for interventional techniques, including safe
injection and medication vial utilization.

METHODS: The available literature on infection control practices was
reviewed. Due to the nature of the studies involved, with the majority
being case reports, and a few prospective evaluations, quality assessment
and clinical relevance criteria were not applied. Data sources included
relevant literature identified through searches of PubMed and EMBASE from
1966 through June 2012, literature from the Centers for Disease Control and
Prevention (CDC), the U.S. Food and Drug Administration (FDA), and manual
searches of the bibliographies of known primary and review articles.

OUTCOME MEASURES: The primary outcome measure was correlating infection to
a breach of standards in infection control practices. The secondary
objective was to assess the contribution of single-dose vials independently
for infection.

RESULTS: A total of 60 reports met inclusion criteria, with 16 reports
related to pain management and other procedures, of which 9 reports were
attributed to issues related to interventional techniques. Based on an
estimated 37 infections occurring during 200 million interventional
techniques from 1997 through 2011, the rate of infection is speculated to
be one infection for every 5 million interventional pain management
procedures. However, if 10 times more infections are estimated, the
infection rate appears to be one infection for every 500,000 interventional
pain management procedures.

The evidence is good for infection related to a breach of infection control
practices.

There is good evidence that contamination of multi-dose or single-dose
vials can contribute to infection. There was poor evidence that the use of
single-dose vials on multiple patients with appropriate infection control
practices cause infection in interventional pain management.

LIMITATIONS: The limitations of this comprehensive best evidence synthesis
include the paucity of literature and dependence of governmental agencies
on their literature without applying Institute of Medicine (IOM) criteria
for guideline synthesis.

CONCLUSION: There is good evidence that any breach of sterile practice may
result in serious and life threatening infections. There is poor evidence
for single- dose vials as a sole factor causing infections when used in
multiple patients in interventional pain management settings.

Free full text:
http://www.painphysicianjournal.com/2012/september/2012;15;E573-E614.pdf
__________________________________________________________________
________________________________*_________________________________

7. Abstract: An observational study to evaluate the efficiency and safety
of ioversol pre-filled syringes compared with ioversol bottles in
contrast-enhanced examinations
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22983259

Acta Radiol. 2012 Sep 14.

An observational study to evaluate the efficiency and safety of ioversol
pre-filled syringes compared with ioversol bottles in contrast-enhanced
examinations.

Vogl TJ, Wessling J, Buerke B.

Department of Diagnostic and Interventional Radiology, Johann Wolfgang
Goethe University Frankfurt.

Background The use of pre-filled syringes for contrast media (CM)
administration allows efficient and optimized workflow during radiologic
diagnostic procedures, and reduces the risk of contamination, providing
benefits for both patients and healthcare workers.PurposeTo compare the
efficiency and safety of ioversol (Optiray(TM)) bottles and pre-filled
syringes in clinical practice.

Material and Methods This was an observational, non-interventional,
prospective, multicenter study conducted at 72 centers in Germany. Patients
undergoing contrast-enhanced computed tomography (CT) examinations with
ioversol were enrolled. The use of ioversol bottles and pre-filled syringes
in the diagnostic procedure was recorded in terms of efficiency (residual
volume, re-use of CM) and safety (adverse events [AEs]).

Results A total of 10,836 patients were enrolled and included in this
study. Ioversol bottles and syringes were used in 72% and 28% of cases,
respectively. Analysis of the volume of CM in bottles before and after
examinations, together with the volume used during the examination,
suggested that in 22.5% of cases a new bottle was connected during the
procedure.

Further analysis revealed that in 80.2% of cases, the remaining volume of
CM in the bottles could potentially be used for subsequent investigations,
compared with <1% of cases for pre-filled syringes.

For the total study population, AEs and serious AEs were reported in 30
(0.28%) and four (0.037%) patients, respectively, with no significant
difference observed between ioversol bottles and syringes.

ConclusionAdministration of ioversol for contrast-enhanced CT examinations
is associated with a low incidence of AEs and is generally safe and well
tolerated. Ioversol pre-filled syringes were associated with lower residual
volumes and less potential re-use compared with bottles.
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Smart pump alerts: all that glitters is not gold
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22078107

Int J Med Inform. 2012 May;81(5):344-50.

Smart pump alerts: all that glitters is not gold.

Manrique-Rodríguez S, Sánchez-Galindo A, Fernández-Llamazares CM, López-
Herce J, Echarri-Martínez L, Escudero-Vilaplana V, Sanjuro-Sáez M,
Carrillo-Álvarez A.

Pharmacy Service, Hospital General Universitario Gregorio Marañón, Spain.
smanrique.hgugm@salud.madrid.org

INTRODUCTION: The implementation of smart pump technology can reduce the
incidence of errors in the administration of intravenous drugs. This
approach involves developing drug libraries for specific units and setting
hard and soft limits for each drug. If a programming error occurs and these
limits are exceeded, an alarm sounds and the infusion can be blocked. A
detailed analysis of these alarms is essential in order not to bias the
results in favor of a positive impact of this technology.

PURPOSE: To evaluate the results of the first analysis of the use of smart
infusion pumps and to assess the significance and practical implications of
the alarms sounded.

METHODS: The study was performed by a multidisciplinary team that consisted
of a clinical pharmacist, a pediatrician from the pediatric intensive care
unit (PICU), and the chief nurse of the unit. A library of 108 drugs was
developed over a 7-month period and introduced into 40 syringe pumps and 12
volumetric pumps (Alaris(®) with Plus software) before being applied in 6
of the 11 beds in the PICU. After four month’s use, data were analyzed
using the Guardrails(®) CQI v4.1 Event Reporter program.

RESULTS: Following the first four months of implementation, compliance with
the drug library was 87%. By analyzing the alerts triggered, we were able
to detect problems such as the need to increase user training, readjust
limits that did not correspond to clinical practice, correct errors in the
editing of the drug library and including a training profile.

CONCLUSION: It is difficult to obtain accurate data on the true impact of
this technology in the early stages of its implementation. This preliminary
analysis allowed us to identify improvement measures to distinguish, in
future evaluations, the alarms triggered by a real programming error from
those caused by incorrect use.

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

9. Abstract: Specific immunotherapy can greatly reduce the need for
systemic steroids in allergic rhinitis
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22984787

Allergy. 2012 Sep 17.

Specific immunotherapy can greatly reduce the need for systemic steroids in
allergic rhinitis.

Aasbjerg K, Torp-Pedersen C, Backer V.

Respiratory Research Unit, Bispebjerg University Hospital, Copenhagen,
Denmark.

BACKGROUND: Worldwide, more than 400 million individuals have allergic
rhinitis, which has a significant impact on the individual’s general
health. Most patients self-medicate with over-the-counter drugs, but severe
cases need treatment with topical corticosteroids and/or immunotherapy
(SCIT). Although the ARIA guidelines discourage the use of systemic
corticosteroids, this treatment is often used by general practitioners.

AIMS: To investigate the use of systemic steroids to treat allergic
rhinitis in Denmark and the role of SCIT as an alternative.

METHODS: A retrospective study based on Danish National Registry databases
1995-2009. Steroid use was defined as a minimum of one steroid injection
during April-July for at least three consecutive years. SCIT treatment
against grass (Phleum pratense), birch (Betula verrucosa) or both was
included.

RESULTS: Overall, 39 173 individuals were treated with either SCIT or
steroids; 93.1% received only steroids, and 6.9% received SCIT and/or
steroids. The steroid-to-SCIT ratio was 14 : 1 (P < 0.0001).

The mean annual steroid injections were 1.6 in the steroid-only group and
1.0 in the SCIT group (P < 0.0001). Of the SCIT-treated individuals, 84%
did not need steroids after SCIT treatment (P < 0.0001).

The hazard ratios of receiving steroids after SCIT against grass, birch or
both were 0.65, 0.83 and 0.72, respectively (P < 0.0001), when compared
with the steroids-only group. The maximum hazard reduction was obtained if
patients responded well to SCIT treatment after one to 3 years.

CONCLUSIONS: Systemic steroid injections are still widely used to treat
pollen allergy. Specific immunotherapy can greatly reduce the need for
steroids.

© 2012 John Wiley & Sons A/S.
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Hand sanitizer dispensers and associated hospital-acquired
infections: friend or fomite?
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22568918

Surg Infect (Larchmt). 2012 Jun;13(3):137-40.

Hand sanitizer dispensers and associated hospital-acquired infections:
friend or fomite?

Eiref SD, Leitman IM, Riley W.

Department of Surgery, Albert Einstein College of Medicine-Beth Israel
Medical Center, New York, New York 10003, USA. seiref@chpnet.org

BACKGROUND: Waterless alcohol-based hand sanitizers are an increasingly
popular method of hand hygiene and help prevent hospital-acquired infection
(HAI). Whether hand sanitizer dispensers (HSDs) may themselves harbor
pathogens or act as fomites has not been reported.

METHODS: All HSDs in the surgical intensive care unit of an urban teaching
hospital were cultured at three sites: The dispenser lever, the rear
underside, and the area surrounding the dispensing nozzle.

RESULTS: All HSDs yielded one or more bacterial species, including
commensal skin flora and enteric gram-negative bacilli. Colonization was
greatest on the lever, where there is direct hand contact.

CONCLUSION: Hand sanitizer dispensers can become contaminated with
pathogens that cause HAI and thus are potential fomites.
__________________________________________________________________
________________________________*_________________________________

11. Abstract: Ultraviolet powder versus ultraviolet gel for assessing
environmental cleaning
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22227990

Infect Control Hosp Epidemiol. 2012 Feb;33(2):192-5.

Ultraviolet powder versus ultraviolet gel for assessing environmental
cleaning.

Munoz-Price LS, Fajardo-Aquino Y, Arheart KL.

Division of Infectious Diseases, Department of Medicine, University of
Miami, Miami, Florida, USA. smunozprice@med.miami.edu

We compared cleaning rates associated with use of a white ultraviolet (UV)
powder versus a transparent UV gel among units with various degrees of
previous experience with UV powder.

The study outcome was the presence of discordant cleaning (removal of
powder without the removal of gel, or vice versa).

We found higher frequency of discordance in high-experience units (31%)
than in no-experience units (8%) (P < .001). In 92% of discordant findings,
the powder was removed but not the gel (P < .001).

These findings suggest preferential cleaning of visible UV targets among
units with high levels of previous experience with powder.
__________________________________________________________________
________________________________*_________________________________

12. Abstract: Dating the origin and dispersal of hepatitis B virus
infection in humans and primates
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22987324

Hepatology. 2012 Sep 17.

Dating the origin and dispersal of hepatitis B virus infection in humans
and primates.

Paraskevis D, Magiorkinis G, Magiorkinis E, Ho SY, Belshaw R, Allain JP,
Hatzakis A.

Department of Hygiene, Epidemiology and Medical Statistics, Medical School,
University of Athens, Athens, Greece. dparask@med.uoa.gr.

The origin of hepatitis B virus (HBV) infection in humans and other apes
remains largely unresolved. Understanding the origin of HBV is crucial
because it provides a framework for studying the burden, and subsequently
the evolution, of HBV pathogenicity with respect to changes in human
population size and life expectancy.

To investigate this controversy,we examined the relationship between HBV
phylogeny and genetic diversity of modern humans,investigated the timescale
of global HBV dispersal and tested the hypothesis of HBV-human co-
divergence.

We find that the global distribution of HBV genotypes and subgenotypes are
consistent with the major prehistoric modern human migrations. We calibrate
the HBV molecular clock using the divergencetimesofdifferent indigenous
human populations based on archaeological and genetic evidence,and
showthatHBVjumped into humans around 33,600; 95% Higher Posterior Density:
22,000-47,100 years ago (estimated substitution rate: 2.2?10(-6) ; 95%
Higher Posterior Density: 1.5-3.0?10(-6) substitutions/site/year). This
coincides with the origin of modern non-African humans. Crucially, the most
pronounced increase in the HBV pandemic correlates with the global
population increase over the last 5,000 years.

We also show that the non-human HBV clades in orang-utans and gibbons
resulted from cross-species transmission events from humans that occurred
no earlier than 6,100 years ago

Conclusion: Our study provides, for the first time, an estimated timescale
for the HBV epidemicthat closely coincides withdates of human dispersals,
supporting the hypothesis that HBV has been co-expanding and co-migrating
with human populations for the last 40,000 years. (HEPATOLOGY 2012.)

Copyright © 2012 American Association for the Study of Liver Diseases.
__________________________________________________________________
________________________________*_________________________________

13. Abstract: Anti-hepatitis B surface antigen titres in vaccinated
dentistry students at Damascus University
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22888621

East Mediterr Health J. 2012 Jun;18(6):630-4.

[Anti-hepatitis B surface antigen titres in vaccinated dentistry students
at Damascus University].

[Article in Arabic]

Srour IH, Mashlah A.

Department of Oral Medicine, Faculty of Dentistry, Damascus University,
Damascus, Syrian Arab Republic. hadisrour@gmail.com

Dental practice carries considerable danger for acquiring bloodborne
pathogens such as hepatitis B virus (HBV). Vaccination against this virus
is an important approach to reducing the infection. Post-vaccination test
to confirm the seroconversion is important also.

Over the period 1 March-31 May 2010, we assessed the efficacy of HBV
vaccination among 91 fourth-year dental students at Damascus University,
who were vaccinated under the mandatory Faculty of Dentistry programme.
Anti-HBsAg antibody titres were determined in the blood samples using an
enzyme immunoassay to measure; > or = 10 IU/mm was considered an adequate
response titer. Seven of the 91 dentistry students (7.7%) had anti-HBs
antibody titre < 10 mlU/mL. The frequency of unresponsiveness was
significantly higherwith smoking (P = 0.012) and alcohol consumption (P =
0.014).

Anti-HBs test should be included in routine immunization services of the
School of Dentistry at Damascus University.
__________________________________________________________________
________________________________*_________________________________

14. No Abstract: A simple method to improve safety of epinephrine auto-
injectors
__________________________________________________________________
Pediatr Allergy Immunol. 2012 Jun;23(4):399-400.

A simple method to improve safety of epinephrine auto-injectors.

Kränke B, Schuster C, Wiednig M, Reiter H.
__________________________________________________________________
________________________________*_________________________________

15. The 5th Global Health Supply Chain Summit

Crossposted from http://www.ghsc-2012.com/ghsc_2012/homepart.php with
thanks
__________________________________________________________________

GHSC Summit 2012

“Fostering interaction between implementers and academics to build
knowledge and learning – bringing supply chain challenges forward from the
field to the research agenda”

The 5th Global Health Supply Chain Summit (GHSCS) a collaboration between
the International Association of Public Health Logisticians (IAPHL),
University of Southern California, and London School Of Business 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. To maximize the opportunity for implementers in the
field to attend, the Summit will be held for the first time in Africa.

Implementers will gain access to current information about the supply
chains they support, the operating environments, as well as networks and
solutions to leverage; academics will hear implementers’ in-country
experiences for relevant topics to advance the research agenda in supply
chain management. The Summit will provide a forum for speakers and
attendees alike to access the global supply chain communities’ technical
expertise and relevant in-country field experiences.

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 performance. A
third day of the conference will be dedicated to “open space technology”
and discrete meetings, including educational content and networking for
IAPHL members.

Should you require an invitation letter (for applying for a visa or
funding) please don´t hesitate to contact Dr. Yehuda Bassok at
ybassok@marshall.usc.edu.

There are no registration fees for the 5th Global Supply Chain Summit.

We hope that you will be able to participate in this exciting summit.

Click here to register
http://www.ghsc-2012.com/ghsc_2012/RegistrationPart.php

Please check the Participant resources page for more details.
http://www.ghsc-2012.com/ghsc_2012/ParticipantPart.php

Agenda
http://www.ghsc-2012.com/ghsc_2012/AgendaPart.php
__________________________________________________________________
________________________________*_________________________________

16. News

– VIDEO: Mum’s horror over needle on beach
– Canada: Ex-convict, HIV/AIDS advocacy groups ask court for prison needle
exchanges
– Canada: Ottawa Sued Over ‘Failure’ to Provide Needle-Exchange Programs
in Prisons
– USA: Roseburg woman frustrated after finding dirty needle on ground
– USA: Class-Action Lawsuit Eyed in Hepatitis C Cases
– USA: Accused Hepatitis C Infector May Have Spread Virus 2 Years Earlier
Than Previously Reported

Selected news items reprinted under the fair use doctrine of international
copyright law: http://www4.law.cornell.edu/uscode/17/107.html
__________________________________________________________________
http://tinyurl.com/8wjotc9

VIDEO: Mum’s horror over needle on beach
Shields Gazette, UK (19.09.12)

A FURIOUS mum has sounded a warning after her little boy came within inches
of picking up a used needle on a South Tyneside beach.

Two-year-old Lucas Bain had no idea of the potential danger he was putting
himself in when he reached out to pick up the discarded needle.

The toddler had been running in front of his mum, Rochelle Spiller, during
a trip to Little Haven Beach in South Shields last Thursday, when he came
across the syringe lying on dry sand.

Luckily, his 23-year-old mum was quick to react and managed to pick her son
up before he had the chance to touch it. “I hate to think what would have
happened if he had picked it up,” said Miss Spiller, from Caer Urfa Close,
South Shields.

“He could have quite easily been facing a life sentence. “My cousin was
pricked by a needle, and it was a horrendous wait to see if he had been
infected with diseases. “It’s just absolutely disgusting and dangerous.
“It’s not the first time I have found needles on the beach. Last year, I
managed to fill a bag of them.”

Miss Spiller carried the needle off the beach and disposed of it, but says
she came across another one when she returned to the beach on Monday.
Again, she took it home and disposed of it.

Her concerns come after the Gazette was sent a photograph from another
visitor to the beach, who came across 10 needles lying on the sand.

Miss Spiller said: “I was terrified in case anyone stood on the needle. “I
just wanted to get it off the beach straight away. There is all sorts of
rubbish lying on the beach. The council needs to be doing more to make sure
the beaches are clean.”

The NHS website – www.nhs.uk – warns that those pricked by a used needle
can be left exposed to diseases including hepatitis B, hepatitis C or HIV.
The site advises anyone who is pricked by a needle to seek emergency
medical help.

A South Tyneside Council spokesman said: “We take great pride in keeping
our award-winning beaches clean and tidy. “Reports of potentially hazardous
waste are always responded to swiftly, regardless of season.

“On this occasion a member of the public alerted us about a needle he had
found on Little Haven Beach, and council workers disposed of it immediately
and safely. We’d like to thank him for informing us.”
__________________________________________________________________
__________________________________________________________________
Canada: Ex-convict, HIV/AIDS advocacy groups ask court for prison needle
exchanges
Bruce Cheadle, Global Edmonton, Tuesday, September 25, 2012 4:47 PM

OTTAWA – A former prisoner infected with hepatitis C is suing the federal
government over its refusal to allow clean-needle exchanges inside prisons.

Steven Simons, who served 12 years behind bars, has the backing of several
HIV/AIDS advocacy organizations in a suit that names Public Safety Minister
Vic Toews, the Correctional Service of Canada and its commissioner.

The lawsuit, filed Tuesday in the Ontario Superior Court of Justice, argues
the government has arbitrarily disregarded the health evidence on needle
exchanges in prisons.

“The absolute prohibition on sterile injection equipment is arbitrary, over
broad and grossly disproportionate to the legitimate objective of
curtailing the use of illicit drugs within the correctional system,” says
the 13-page application.

It says the policy disproportionately jeopardizes the liberty and health of
the disabled — in this case people suffering from drug addiction.

And it wants a court injunction forcing the creation of a needle exchange
program in Canada’s prisons.

Toews and his officials quickly dismissed the lawsuit, while stating for
the record that they could not comment on a specific case before the
courts.

“Our government has a zero tolerance policy for drugs in our institutions,”
Toews told the House of Commons in response to a friendly Conservative
question on the lawsuit.

“That is why we made a commitment during the last election to develop drug-
free prisons. Drug use among prisoners dramatically reduces their chances
of successful rehabilitation.”

His spokeswoman, Julie Carmichael, had earlier said by email that “our
government will never consider putting weapons, such as needles, in the
hands of potentially violent prisoners.”

The lawsuit makes the case that drugs remain prevalent in Canadian prisons
and that authorities have acknowledged they cannot completely eliminate
prisoner drug abuse.

Moreover, prisons in other jurisdictions have been providing clean needles
since 1992 and “the available evidence indicates that such programs can
operate consistently with interdiction against drug use in prisons,” it
says.

The application states government policy ignores years of study and
experience and that the correctional service and Public Safety Canada “have
not provided any evidence on which they claim to base this decision, simply
asserting that it is their policy to approach the problems posed by drugs
in prisons with ‘zero tolerance’ for drugs.”

NDP Leader Tom Mulcair said the government policy follows the same pattern
as Insite, the safe injection site in Vancouver that the Harper government
tried to shut down. The Supreme Court of Canada — citing Insite’s health
benefits — ruled unanimously last year that using drug laws to close the
facility would violate the Charter of Rights and Freedoms.

“As the Supreme Court reminded us in the Insite case, we’ve got to make
these decisions based on evidence and not based on superstition,” said
Mulcair.

“I think we have to protect human lives, whether it be the people who are
working in those prisons who come in contact with those prisoners or
otherwise.”

In a news release, the Canadian HIV/AIDS Legal Network says Canada’s prison
population faces HIV rates 10 times the national average, and hepatitis C
infections that are 30 times the national average.

The cost of treating these prisoners then falls to taxpayers, and the
public bears the cost of further infections once prisoners serve their
sentences and are released, said the release.

“Prison health is public health,” said Sandra Ka Hon Chu, the legal
network’s senior policy analyst.

The advocacy group claims the latest Conservative omnibus crime bill passed
last spring will only make matters worse “as more and more people are
incarcerated for non-violent drug offences.”

© The Canadian Press, 2012
__________________________________________________________________
__________________________________________________________________
Canada: Ottawa Sued Over ‘Failure’ to Provide Needle-Exchange Programs in
Prisons
CTV.ca , Canada (25.09.12)

The federal government of Canada is being sued by a former prisoner and
several advocacy groups for endangering prisoners’ health by not providing
needle-exchange programs for inmates. The former prisoner, the Canadian
HIV/AIDS Legal Network, Prisoners with HIV/AIDS Support Action Network, the
Canadian AIDS Treatment Information Exchange (CATIE), and the Canadian
Aboriginal AIDS Network have launched the lawsuit, which will be filed in
Ontario’s Superior Court of Justice. The suit alleges that the federal
government failed to protect the health of inmates because of its ongoing
refusal to implement clean needle and syringe programs.

The inmate was incarcerated at Ontario’s Warkworth Institution from 1998 to
2010. He was infected with hepatitis C after sharing his drug injecting
equipment with another prisoner. The former prisoner asserts that if the
prison had a needle-exchange program he would not have had to use homemade,
shared equipment, and may not have been infected.

The former prisoner stated that his motivation was to see that other drug-
addicted prisoners are not forced to do the same and become infected. The
lawsuit does not ask for financial compensation, but seeks a court
injunction that would require the federal government to begin needle
exchange programs in prisons across the country. It claims that prisoners
are entitled to a needle exchange program under the Charter of Rights and
Freedoms. Some communities in Canada have needle-exchange programs in place
for the population, but no Canadian prison offers a needle-exchange
program.

Vic Toews, Minister of Public Safety; Rob Nicholson, attorney general; and
Don Head, commissioner of the Correctional Service of Canada are
specifically named in the lawsuit.
__________________________________________________________________
__________________________________________________________________
http://www.nrtoday.com/news/2596935-113/needle-hicks-needles-dirty

USA: Roseburg woman frustrated after finding dirty needle on ground
Michael Sullivan, The News-Review, Oregon USA (25.09.12)

Ashley Hicks of Roseburg stands near the spot where she found a discarded
hypodermic needle on Sept. 19 near J & J Market and Deli in Roseburg
Friday.

Ashley Hicks pulled into the parking lot of the J&J Market on Southeast
Stephens Street in Roseburg last week and as she stepped out of her car,
she saw a hypodermic needle on the pavement.

Hicks said she couldn’t just ignore a dirty needle that could spread
hepatitis C, the HIV virus or other diseases, “I didn’t want to leave it
and have someone else step on it,” she said.

Hicks called an emergency dispatcher and requested an officer come and
properly dispose of the needle. The dispatcher asked Hicks whether she
could get a soda pop cup from the store and use a plastic lid to scoop the
needle into the cup.

“I told her, ‘No, ma’am. I will not do that.’ I’m not trained. I don’t have
gloves,” Hicks recalled. Hicks was confronted with the same problem not
uncommonly faced by residents. What to do about a dirty needle endangering
the public? Dispatchers typically receive several calls a day from people
who have found dirty needles, the supervisor of the Douglas County dispatch
center, Katy Stall, said. “It’s a big problem,” she said.

Dispatchers ask whether the person is comfortable scooping the needle into
a container, she said. If not, an officer is sent to deal with it.

Hicks said she waited outside the store for nearly an hour but no officer
came. Stall said an officer was sent to the scene but was diverted to a
higher-priority call. Hicks, a member of a south Roseburg neighborhood
group committed to cleaning up the area, called several times, including
calls to the emergency 911 line. Stall said residents should call
nonemergency numbers to report needles, but not 911 unless there’s an
actual emergency.

When an officer didn’t come, J&J store clerk Summer Payne grabbed a broom
and swept the needle into a dustpan. She then placed everything into a
Dumpster. “I wasn’t sure what to do, so I threw it all away: the needle,
the broom and the dustpan,” Payne said.

It turns out that it’s illegal under Oregon law to throw needles and other
medical waste into the trash. Those items could place trash haulers,
landfill workers or people going through a trash bin at risk.

“Having the store clerk sweep it up was probably the best solution, but
throwing it out in the Dumpster wasn’t,” said Marilyn Carter, Douglas
County Public Health promotion program manager. “We probably need to do a
better job of educating people how to dispose of those things properly.”

Loose needles in trash are a concern for Roseburg Disposal Co. employees,
General Manager Dori John said. Needles can poke through plastic or paper
bags and stick workers handling them, she said. “We will refuse to dump a
container if we know there are needles in it,” John said.

In picking up a needle, gloves should be worn and the needle picked up away
from the sharp end. The needle should then be placed for temporary storage
in a clear plastic bottle with a lid.

To be disposed of properly, needles must be placed in an approved red
container made of rigid plastic and containing a biohazard symbol.
Containers may be obtained at any of the county garbage transfer stations
at no charge. When full, the container may be exchanged for a new one,
again at no charge.

Individual needles may be deposited in a drop box outside the Douglas
County Health Department, 621 W. Madrone St. “We encourage people to use
that drop box,” Carter said.
__________________________________________________________________
__________________________________________________________________
USA: Class-Action Lawsuit Eyed in Hepatitis C Cases
Doug Alden, Union Leader, Manchester, New Hampshire USA (24.09.12)

Attorney Peter McGrath seeks a class-action lawsuit against Exeter
Hospital, New Hampshire, in connection with a hepatitis C outbreak. McGrath
claims a client list of 169 persons, including 11 patients who acquired
hepatitis C at Exeter Hospital, from a former medical technician who
allegedly injected himself with pain killers meant for patients and
replaced the syringes, thus contaminating syringes that were unknowingly
used on patients.

According to McGrath, some of his clients tested negative for the disease,
but they had to endure the difficulty of fearing they were exposed and not
knowing if they had contracted the disease. Many of them are in counseling
and other kinds of treatment resulting from the knowledge that they may
have been exposed to the life-threatening disease. McGrath expects to
present his request for class action status in November 2012. He filed a
complaint in Rockingham County Superior Court against the hospital in June
and has now added the Nebraska-based Triage Staffing Inc., the health care
company that hired and placed the technician, to the suit.

So far, the N.H. Department of Health and Human Services has linked 32
cases to the hospital and the former traveling medical technician. Dr. Jose
Montero, Public Health Director for New Hampshire, reported that the state
is waiting for the Centers for Disease Control and Prevention to confirm
test results for 10 additional former Exeter hospital patients. Since the
beginning of the outbreak, the state has tested 3,798 former Exeter
hospital patients and workers.
__________________________________________________________________
__________________________________________________________________
USA: Accused Hepatitis C Infector May Have Spread Virus 2 Years Earlier
Than Previously Reported
CBS News, USA (10.09.12)

A 65-year-old veteran of the Vietnam war appears to be an early victim of
the 33-year-old former medical technician accused of infecting patients
with hepatitis C. The veteran was infected in 2008 at the Baltimore VA
Medical Center – two years earlier than investigators allege he began
spreading the disease. The earliest evidence that the technician tested
positive for hepatitis C was in 2010.

According to the veteran’s attorney, Michael Rainboth of Portsmouth, N.H.,
the hospital admitted that the technician was present at both procedures
for the veteran, and it is accepting responsibility. The hospital’s web
site lists 168 patients as having had procedures involving the technician
in 2008, and indicates that hepatitis tests have been offered to 51 of
them.

The technician is accused of injecting himself with painkillers meant for
patients and replacing the used needles filled with another solution. The
contaminated syringes were then used on patients. He has been indicted by
federal prosecutors. Hepatitis C testing is continuing at hospitals in
other states where the traveling hospital technician had worked.
__________________________________________________________________
________________________________*_________________________________
* SAFETY OF INJECTIONS brief yourself at: www.injectionsafety.org

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

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

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

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

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

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

The SIGN Secretariat, the Department of Essential Health Technologies,
WHO, Avenue Appia 20, CH-1211 Geneva 27, Switzerland. Telephone: +41 22
791 3680, Facsimile: +41 22 791 4836, E- mail: sign@who.int
__________________________________________________________________
________________________________*_________________________________

SIGN meets annually to aid collaboration and synergy among SIGN network
participants worldwide.

The 2010 annual Safe Injection Global Network meeting was held from 9
to 11 November 2010 in Dubai, The United Arab Emirates.

The SIGN 2010 meeting report pdf, 1.36Mb is available on line at:
http://www.who.int/entity/injection_safety/toolbox/sign2010_meeting.pdf

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

Translation tools are available at: http://www.google.com/language_tools
or http://www.freetranslation.com
__________________________________________________________________
________________________________*_________________________________
All members of the SIGN Forum are invited to submit messages, comment on
any posting, or to use the forum to request technical information in
relation to injection safety.

The comments made in this forum are the sole responsibility of the writers
and does not in any way mean that they are endorsed by any of the
organizations and agencies to which the authors may belong.

Use of trade names and commercial sources is for identification only and
does not imply endorsement.

The SIGN Forum welcomes new subscribers who are involved in injection
safety.

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

The SIGNpost Website is http://SIGNpostOnline.info

The new website is a work in progress and will grow to provide an archive
of all SIGNposts, meeting reports, field reports, documents, images such as
photographs, posters, signs and symbols, and video.

We would like your help in building this archive. Please send your old
reports, studies, articles, photographs, tools, and resources for

Email mailto:sign.moderator@gmail.com
__________________________________________________________________
________________________________*_________________________________

The SIGN Internet Forum was established at the initiative of the World
Health Organization’s Department of Essential Health Technologies. The
SIGN Forum is moderated by Allan Bass and is hosted on the University of
Queensland computer network. http://www.uq.edu.au
__________________________________________________________________

Comments are closed.