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SIGNpost 00677

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST *

Post00677 Abstracts + Employment + News    28 November 2012

CONTENTS
1. Abstract: Changes to medication-use processes after overdose of U-500
regular insulin
2. Abstract: People who Inject Drugs, HIV Risk, and HIV Testing Uptake in
Sub-Saharan Africa
3. Abstract: Sexual transmission of HCV among monogamous heterosexual
couples: The HCV partners study
4. Abstract: Surgical site markers: potential source of infection
5. No Abstract: Unsafe injection procedures and staff training
6. No Abstract: Poor uptake of community based sexually transmissible
infection testing at an inner city needle and syringe program
7. Employment: Temporary Appointment: People that Deliver Executive
Manager, P4, Copenhagen, Denmark
8. News
– Thailand: Question marks over new approach to drug-users
– USA: Robert Metzler Colonoscopy Hepatitis C Lawsuit: South Florida
Veteran Awarded $1.25 Million
– Ireland: HSE Doctor Diagnosed with Hepatitis C Virus, Patients Are
Advised to Undergo Exams
– Vaccines: Breaking out of the cold chain
– Patients Forget How to Use EpiPen After 3 Months
– USA: Heroin Use Linked to Hepatitis C Increase

The web edition of SIGNpost is online at:
http://signpostonline.info/archives/1363

More information follows at the end of this SIGNpost!

Please send your requests, notes on progress and activities, articles,
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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. Abstract: Changes to medication-use processes after overdose of U-500
regular insulin
__________________________________________________________________
Am J Health Syst Pharm. 2012 Dec 1;69(23):2089-93.

Changes to medication-use processes after overdose of U-500 regular
insulin.

Monroe PS, Heck WD, Lavsa SM.

Purpose Modifications made to medication-use processes after an overdose of
U-500 regular insulin are described. Summary After a medication error
occurred with U-500 regular insulin, a multidisciplinary team of
physicians, nurses, advanced-practice nurses, and pharmacists was created
to review and improve the ordering, dispensing, and administration
processes associated with U-500 regular insulin. The group determined that
current safety practices for managing insulin were inadequate.

New safety processes specific to U-500 regular insulin were developed and
implemented. Vials of U-500 regular insulin are no longer dispensed to
nursing units and are stored only in the pharmacy and separated from other
insulins. The ordering of U-500 regular insulin is limited to the
endocrinology service, and all orders are written using a specialized U-500
regular insulin order set. The option for i.v. administration for U-500
regular insulin was removed from the pharmacy order-entry system; thus,
only the subcutaneous route is entered by the pharmacist.

In addition, patient-specific doses of U-500 regular insulin are prepared
in the pharmacy using only tuberculin syringes that require a double check
by two pharmacists. These syringes are delivered to patient care areas in a
bag distinguishing the medication as “high alert.” One last safety check
involving a two-nurse check at the bedside to confirm correct medication
administration is performed.

Lastly, patient education material specifically for U-500 regular insulin
is available online.

Conclusion A multidisciplinary team recommended modifications to the
medication-use system regarding U-500 regular insulin after review of a
medication error. No errors involving U-500 regular insulin have been
reported since implementation of the changes.
__________________________________________________________________
________________________________*_________________________________

2. Abstract: People who Inject Drugs, HIV Risk, and HIV Testing Uptake in
Sub-Saharan Africa
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23164598

J Assoc Nurses AIDS Care. 2012 Nov 17. pii: S1055-3290(12)00191-4.

People who Inject Drugs, HIV Risk, and HIV Testing Uptake in Sub-Saharan
Africa.

Asher AK, Hahn JA, Couture MC, Maher K, Page K.

Dramatic rises in injection drug use (IDU) in sub-Saharan Africa account
for increasingly more infections in a region already overwhelmed by the HIV
epidemic. There is no known estimate of the number of people who inject
drugs (PWID) in the region, or the associated HIV prevalence in PWID.

We reviewed literature with the goal of describing high-risk practices and
exposures in PWID in sub-Saharan Africa, as well as current HIV prevention
activities aimed at drug use. The literature search looked for articles
related to HIV risk, injection drug users, stigma, and HIV testing in sub-
Saharan Africa.

This review found evidence demonstrating high rates of HIV in IDU
populations in sub-Saharan Africa, high-risk behaviors of the populations,
lack of knowledge regarding HIV, and low HIV testing uptake.

There is an urgent need for action to address IDU in order to maintain
recent decreases in the spread of HIV in sub-Saharan Africa.

Copyright © 2012 Association of Nurses in AIDS Care. Published by Elsevier
Inc. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Sexual transmission of HCV among monogamous heterosexual
couples: The HCV partners study
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23175457

Hepatology. 2012 Nov 23.

Sexual transmission of HCV among monogamous heterosexual couples: The HCV
partners study.

Terrault NA, Dodge JL, Murphy EL, Tavis JE, Kiss A, Levin TR, Gish R, Busch
M, Reingold AL, Alter MJ.

University of California San Francisco, Division of Gastroenterology, 513
Parnassus Ave, S357, Box 0538, San Francisco, CA, 94143.
Norah.Terrault@ucsf.edu.

BACKGROUND: The efficiency of hepatitis C virus (HCV) transmission by
sexual activity remains controversial. We conducted a cross-sectional study
of HCV-positive persons and their partners to estimate the risk for HCV
infection among monogamous heterosexual couples.

METHODS: 500 anti-HCV-positive, HIV-negative index persons and their long-
term heterosexual partners were studied. Couples were interviewed
separately for lifetime risk factors for HCV infection, within-couple
sexual practices and sharing of personal grooming items. Blood samples were
tested for anti-HCV, HCV RNA, and HCV genotype and serotype. Sequencing and
phylogenetic analysis determined the relatedness of virus isolates among
genotype- concordant couples.

RESULTS: HCV-positive index persons were mostly Non-Hispanic Whites, with
median age 49 years (range 26-79) and median 15 years (range 2-52) of
sexual activity with their partners. Overall, HCV prevalence among partners
was 4% (n=20), and 9 couples had concordant genotype/serotype. Viral
isolates in 3 couples (0.6%) were highly related, consistent with
transmission of virus within the couple. Based upon 8377 person-years of
follow-up, the maximum incidence rate of HCV transmission by sex was 0.07%
per year (95% CI: 0.01, 0.13) or ~1 per 190,000 sexual contacts. No
specific sexual practices were related to HCV-positivity among couples.

CONCLUSIONS: The results of this study provide quantifiable risk
information for counseling long-term monogamous heterosexual couples in
which one partner has chronic HCV infection. In addition to the extremely
low estimated risk for HCV infection in sexual partners, the lack of
association with specific sexual practices provides unambiguous and
reassuring counseling messages. (HEPATOLOGY 2012.).

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

4. Abstract: Surgical site markers: potential source of infection
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23168939

Orthop Nurs. 2012 Nov;31(6):344-7.

Surgical site markers: potential source of infection.

Driessche AM.

Ann Marie Driessche, BSN, RN, ONC, TNCC, Lead Preceptor of Perioperative
Services, Oakwood Annapolis Hospital, Wayne, Michigan.

Observing licensed independent practitioners mark surgical sites with all
types of marking pens is a concern related to the potential spread of
infections from patient to patient. The practice of using the same marking
pen to mark a surgical site has been questioned as a source of cross
contamination.

A literature review was done on recent studies and best practice
recommendations to determine whether marking pens can act as fomites for
nosocomial infections. The review indicated that surgical site markers, ink
pens, and aging permanent marking pens can be a source for cross-infection
with methicillin-resistant Staphylococcus aureus, other bacteria, fungus,
or virus.

The type of marking pens used and the act of using the same marking pen
from patient to patient could contribute to nosocomial infections. The
literature reviewed recommends a single time use of a surgical marking pen.

Interventions to prevent cross contamination and postoperative surgical
site infections are a major concern in the care of the orthopaedic patient.
__________________________________________________________________
________________________________*_________________________________

5. No Abstract: Unsafe injection procedures and staff training
__________________________________________________________________
http://www.jiph.org/article/S1876-0341(12)00087-1/abstract

J Infect Public Health. 2012 Oct;5(5):366-7.

Unsafe injection procedures and staff training.

Cope AD, Glenn LL.

College of Nursing, East Tennessee State University, P.O. Box 70658,
Johnson City, TN 37604, United States.

Higlights:

The study by Rehan et al. [1] was evaluated for support of the conclusion
was by the data. | The deviations from recommended practices were
infrequent and not shown to be clinically significant. | Although a strong
study, the conclusion that world-wide education programs are needed is not
warranted.
__________________________________________________________________
________________________________*_________________________________

6. No Abstract: Poor uptake of community based sexually transmissible
infection testing at an inner city needle and syringe program
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23158773

Sex Health. 2012 Nov 19. doi: 10.1071/SH12078.

Poor uptake of community based sexually transmissible infection testing at
an inner city needle and syringe program.

Martin L, Crawford S, Knight V, Bath N, McNulty A.
__________________________________________________________________
________________________________*_________________________________

7. Employment: Temporary Appointment: People that Deliver Executive
Manager, P4, Copenhagen, Denmark

Please submit a cover letter, CV, and signed P11 form to
dangsrecruit@unicef.org quoting “People that Deliver Executive Manager, P4,
TA” by 12 December 2012.
__________________________________________________________________
http://www.unicef.org/about/employ/index_66425.html

UNICEF EMPLOYMENT

Temporary Appointment: People that Deliver Executive Manager, P4,
Copenhagen, Denmark

If you are a passionate and committed professional and want to make a
lasting difference for children, the world’s leading children’s rights
organization would like to hear from you.

UNICEF, the world’s leading organization working for the rights of
children, seeks a Temporary Appointee, People that Deliver Executive
Manager, P-4, Copenhagen, Denmark.

Purpose:

Please see Terms of Reference http://tinyurl.com/d2vad4k or
http://www.unicef.org/about/employ/files/Advert_People_that_Deliver_Executi
ve_Manager_P4_8_month_TA_2012(1).docx

Qualification:

• First university degree from a recognised academic institution in one or
more of the following areas is preferred: Supply Chain Management, Business
Administration, Management, International Economics, Engineering,
International Development, Contract/Commercial Law, or areas directly
related to logistics operations or UNICEF programme areas. Demonstrated
professional work experience and understanding of relevant functions may be
considered in lieu of a university degree, preferably combined with
credited courses or certifications from relevant professional bodies in
supply chain management, procurement, contracting or logistics.

• Minimum eight years of relevant experience in human resource for health
systems, supply chain management and/or major health
partnerships/initiatives focused on developing countries health systems

• Proven conceptual understanding of and strong practical experience in
supporting institutionalization and sustainability within developing
country health programs – especially as related to supply chain management
and/or human resources

• Proven experience leading or managing multi-stakeholder initiatives,
preferably in early stages of development

• Experience in development programmes; a mix of field and headquarters
postings are advantageous

• Knowledgeable about relevant global health agencies (e.g., donors,
technical agencies, implementing partners and NGOs) working in supply chain
management and/or human resources for health

• Fluency in English. Second UN language is an advantage.

If you have got experience of working in a similar capacity and want to
make an active and lasting contribution to build a better world for
children, please submit a cover letter, CV, and signed P11 form to
dangsrecruit@unicef.org quoting “People that Deliver Executive Manager, P4,
TA” by 12 December 2012.

Only shortlisted candidates will be contacted.

UNICEF is committed to diversity and inclusion within its workforce, and
encourages qualified female and male candidates from all national,
religious and ethnic backgrounds, including persons living with
disabilities, to apply to become a part of the organization.

Updated: 23 November 2012

http://www.unicef.org/about/employ/index_66425.html
__________________________________________________________________
________________________________*_________________________________

8. News

– Thailand: Question marks over new approach to drug-users
– USA: Robert Metzler Colonoscopy Hepatitis C Lawsuit: South Florida
Veteran Awarded $1.25 Million
– Ireland: HSE Doctor Diagnosed with Hepatitis C Virus, Patients Are
Advised to Undergo Exams
– Vaccines: Breaking out of the cold chain
– Patients Forget How to Use EpiPen After 3 Months
– USA: Heroin Use Linked to Hepatitis C Increase

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/ckft3b3

Thailand: Question marks over new approach to drug-users
IRIN (23.11.12)

BANGKOK, 23 November 2012 (IRIN) – In September 2011, the government of
Thailand moved to try and decrease the number of drug-users by 80 percent
by adopting a more “softly, softly” approach, rather than sending people
straight to jail. Progress on drug addiction is being made, say experts,
but challenges remain.

Under the new approach, groups of drug-users are offered voluntary
treatment, without prosecution, for a specific period of time, typically
15-90 days, with follow-up as needed.

According to the treatment division at the Thai government’s Office of
Narcotics Control Board (ONCB), nearly half a million drug-users
voluntarily registered for rehabilitation in the past year. Some 100,000
overcame their addiction problems.

Previously only 40,000-60,000 drug-users received free treatment in
government-run hospitals per year, with many more filling up the prisons.

“The government’s intention to help the drug-users to quit drugs is good.
However, as the success of drug treatment is mainly due to the readiness
and willingness of drug-users, the approach of the treatment in large
groups within a certain period of time is not appropriate and has little
chance of succeeding,” Petsri Siriniran, director of the National AIDS
Management Centre in the Public Health Ministry’s Department of Disease
Control, told IRIN.

Over the past year the government has set up nearly 1,000 newly modified
community health centres and rehabilitation facilities across the kingdom.
They provide largely free services.

The Ministry of Public Health estimates there was a three-fold increase in
the number of drug addicts from nearly half a million in 2007 to 1.4
million in 2011.

The sharp increase is partly due to the ready availability of drugs:
neighbouring Myanmar’s opium output has risen for the sixth consecutive
year, according to the UN Office of Drugs and Crime (UNODC).

Activists concerned

Civil society groups and health activists, meanwhile, have expressed
concern over the quality of treatment on offer, saying that Thailand’s
initiative on drug-users could seriously hamper large-scale efforts to
reduce drug-related problems.

“The [existing] treatment system is not the answer. Harm reduction should
be [the] government’s priority,” said Lavan Sarovat, the coordinator at
12D, a network of 12 civil society groups working on harm reduction in
Thailand.

HIV prevalence among injecting drug-users (IDUs) dropped to 22 percent in
2010 from over 40 percent in 2008 and 2009. However, this rate is still
among the highest in the region, according to the Global AIDS response
progress reports submitted by governments to the Joint UN Programme on
HIV/AIDS (UNAIDS).

“IDUs are a driver of HIV infection in Thailand. Any comprehensive health
response to drugs must include a comprehensive package to prevent HIV
transmission,” said Gary Lewis, the regional representative at UNODC.

The World Health Organization estimates there are nearly 40,000 IDUs in
Thailand.

“We haven’t been able to clean the country. Drugs are still everywhere. The
government should realize it’s time and spend budget to develop [its drug
treatment programme] with the involvement of drug-users and community
networks to design how it should look like,” Sarovat said.

Lewis stressed the importance of voluntary, evidence- and community-based
treatment, and care for people with drug dependence.

“We stand ready to support the Royal Government of Thailand to develop a
cost-effective, evidence- and rights-based system that addresses the
separate issues of drug use and drug dependence,” he said.

According to the 2012 UNODC World Drug Report, apart from cannabis, the use
of opioids (especially heroin) and amphetamine-type stimulants (mainly
methamphetamine), are the primary concerns in Southeast Asia.

rg/ds/cb Copyright © IRIN 2012. All rights reserved. This material comes to
you via IRIN, the humanitarian news and analysis service of the UN Office
for the Coordination of Humanitarian Affairs

http://tinyurl.com/ckft3b3
__________________________________________________________________
__________________________________________________________________
USA: Robert Metzler Colonoscopy Hepatitis C Lawsuit: South Florida Veteran
Awarded $1.25 Million
WPTV.com, Palm Beach Florida USA (23.11.12)

A 70-year-old Air Force veteran and his wife have won a $1.25 million
lawsuit against the US government because it is likely that he contracted
hepatitis C at the Miami Veterans Administration Medical Center.

On
November 21, U.S. District Judge Adalberto Jordan ruled that the Medical
Center’s staff did not properly clean colonoscopy equipment, which probably
caused the patient’s infection.

He received his colonoscopy in 2007 and had
tested negative for hepatitis C in the previous year, but tested positive
in 2009. A VA investigation found that more than 11,000 veterans received
colonoscopies with equipment that had not been cleaned properly between
2004 and 2009 at VA hospitals in Miami; Murfreesboro, Tenn.; and Augusta,
Ga. Rather than sterilizing the equipment with steam and chemicals as
recommended by the manufacturer, the hospitals had been rinsing the
equipment.

Investigators who took apart water tubes that were supposed to
be ready for use also found “discolored liquid and debris.” Dr. David
Nelson, a board-certified internist, testified that “there is a less than
zero percent chance” that the veteran contracted hepatitis through his
colonoscopy, but according to the judge, the veteran had no other risks
associated with contracting the virus.
__________________________________________________________________
__________________________________________________________________
Ireland: HSE Doctor Diagnosed with Hepatitis C Virus, Patients Are Advised
to Undergo Exams
StudentNews.ie , Ireland (21.11.12)

A female doctor employed with Ireland’s Health Service Executive (HSE) has
been diagnosed with hepatitis C, which is an infectious and deadly virus.
Hundreds of the doctor’s female patients may have contracted the virus as
well. HSE has refused to reveal the names of the 10 hospitals where the
doctor worked; however, health officials have notified these hospitals and
advised them to trace every patient with whom the HSE doctor had contact.
HSE wants any patients who did contract hepatitis C to be re-examined for
health security purposes.

The doctor has been a registered obstetrician in the Republic of Ireland
since October 2008. HSE hired her as a substitute and discovered only
recently that the doctor was carrying the virus. The agency will examine
staff at hospitals where the doctor worked, as well as examine its own
staff, especially those who have had direct contact with her.

Hepatitis C is difficult to determine as it provides no clear symptoms
until it has already caused major damage to organs inside the human body.
Although the chance of a health worker acquiring HCV is minimal, HSE has
warned hospitals to review patients’ files and provide women free hepatitis
C tests, particularly the women on whom the doctor performed surgery or saw
as patients. HSE will notify them of their test results as quickly as
possible.

Dr. Kevin Kelleher, HSE Assistant National Director of Health Protection,
also warned all hospitals to ban the doctor from being employed, as
patients risk being infected.
__________________________________________________________________
__________________________________________________________________
http://www.irinnews.org/Report/96827/HEALTH-Breaking-out-of-the-cold-chain

Vaccines: Breaking out of the cold chain
IRIN (20.11.12)

DAKAR, 20 November 2012 (IRIN) – Health workers currently immunizing
thousands of children and young adults against Meningitis A in Benin are
currently doing so without having to spend days preparing ice packs and
sourcing generators and fridges to load on trucks because the vaccine has
now won approval for being kept at up to 40 degrees Celsius for as long as
four days.

Before, like almost all vaccines, the Meningitis A vaccine (marketed in
Africa as MenAfricVac) was only licensed for use if kept at temperatures of
2-8 degrees Celsius.

The breakthrough follows years of rigorous testing of the effect of heat on
the vaccine by the regulator Drugs Controller General of India, Health
Canada, and the World Health Organization (WHO) Vaccines pre-qualification
programme.

As a result, very remote populations will access the vaccine more easily,
the logistics of vaccine campaigns will be simpler, and vaccine campaign
costs will drop both for partners and for national governments, said Michel
Zaffran, coordinator of WHO’s Expanded Programme on Immunization (EPI), and
Marie-Pierre Preziosi, director of the meningitis Vaccine Project, a
partnership between international NGO PATH and WHO.

Costs will not drop significantly immediately, but will diminish as more
vaccines are relicensed, says WHO. Cost implication studies are under way
in northern Benin and Chad.

While cold chain limitations do not tend to limit coverage, they do
overburden health workers, says WHO.

Even industrialized country vaccine campaigns have trouble sticking to the
cold chain, and each year thousands of vaccines are thrown away due to cold
chain failure, even if the vaccine might still have been unaffected,
according to WHO.

“This is a breakthrough,” said Zaffran. “It is the first vaccination ever
to be licensed for use in a developing country with the flexibility to take
us out of the rigid temperature structure. It is a great simplification of
logistics. And it opens the door for other manufacturers to follow suit.”

Why so long?

But the vaccine is nothing new – merely the license has changed following
analysis of years of data on the vaccine’s stability – that is, how well it
can withstand temperature rises and other conditions.

“The potential for some vaccines to remain safely outside the cold chain
for short periods of time has been widely known for over 20 years,” said
Zaffran in a recent communiqué. “But this is the first time a vaccine
intended for use in Africa has been tested and submitted to regulatory
review and approved for this type of use.”

The Meningitis Belt

It took decades to get here because agencies got stuck in a mindset, said
Zaffran. The EPI was set up in the 1970s to immunize as many children
against diseases as quickly as possible, and put in place simple rigid
rules to avoid risk: one of which was to keep vaccines cold. “It was quite
difficult to move away from this mentality,” said Zaffran.

Regulators and manufacturers are “very conservative in order to protect the
population,” said Preziosi. “It took a while for all the documentation to
be gathered to convince them to go ahead.”

Strict controls remain: “This is not a “green light to do anything with a
vaccine – it still needs to be kept… at no more than 40 degrees, for any
more than four days,” stressed Zaffran.

Hepatitis B next?

“The momentum is there. I am quite confident that within the next year or
two, we’ll have one or two more re-licensed in this way,” he said.

Analysis on the heat stability of Hepatitis B and HPV (human
papillomavirus) vaccines is under way; next on the list are yellow fever,
rotavirus and pneumococcal disease.

Even the oral polio vaccine – one of the most heat-sensitive vaccines – was
shown to be stable when the cold chain broke down in a part of Chad,
according to a recent study though WHO was emphatic that rather than
licensing the vaccine it will gradually be phased out as progress towards
eradication inches along.

Meningitis progress

The MenAfricVac, which costs just under 50 US cents per dose, was designed
for use in the 26 countries that span the African meningitis belt, from
Senegal to Ethiopia.

Some 100 million people aged 1-29 across 10 countries have been vaccinated
thus far; a further 16 countries are planned between now and 2016.

Early results have been very positive: Burkina Faso has had the lowest
level of epidemic meningitis in 15 years, and the campaign is achieving
“herd immunity” – that is, those either too old or too young to have
received the vaccine have also been shown to be clear of the bacteria.

Meningitis A could be eliminated in the meningitis belt if the mass
campaign continues, says Preziosi, and if governments then incorporate it
in their routine immunization programmes.

But more funding beyond the US$160 million from the GAVI Alliance, and
contributions from national governments, will be needed to complete the
campaign, she warns.

aj/cb Copyright © IRIN 2012. All rights reserved. This material comes to
you via IRIN, the humanitarian news and analysis service of the UN Office
for the Coordination of Humanitarian Affairs

http://www.irinnews.org/Report/96827/HEALTH-Breaking-out-of-the-cold-chain
__________________________________________________________________
__________________________________________________________________
http://www.medscape.com/viewarticle/774843

Patients Forget How to Use EpiPen After 3 Months
Fran Lowry, Medscape Medical News (20.11.12)

ANAHEIM, California — Patients with a history of anaphylaxis who have been
prescribed epinephrine auto-injectors forget how to use them after
approximately 3 months and need frequent retraining, researchers reported
in an oral session here at the American College of Allergy, Asthma &
Immunology 2012 Annual Scientific Meeting.

Rabia Q. Chaudhry, MD, from the University of Medicine and Dentistry of New
Jersey in Newark, presented data showing that most patients thought they
knew how to use their EpiPen, but none of them knew they had to rub the
site immediately after the injection, and most had a problem figuring out
what side of the pen to use.

“The EpiPen is a life-saving device; it is extremely important that our
patients know how to use it properly,” Dr. Chaudhry told Medscape Medical
News.

“In this study, we wanted to determine how well they knew how to use it. We
devised a quality-assurance questionnaire to help us figure out how
effective our training was,” she explained.

The researchers questioned 11 patients during routine follow-up visits
after they had been prescribed the auto-injectors.

They asked the patients if they thought they knew how to correctly use
their EpiPen and recorded their last date of training.

Then, using an EpiPen demonstrator, the patients were evaluated on the
following items for proper use: removing the safety cap, using the correct
side of the injector, injecting the lateral thigh, holding for 10 seconds,
rubbing the area after injection, calling 911, and carrying a second
EpiPen.

Before they were tested, 91% of the patients believed they knew how to use
their EpiPen correctly. One of the 11 test patients had received no
previous training.

The study showed that up to 3 months after training, the patients were able
to do 71% to 86% of the steps correctly; however, this fell to 29% to 57%
after 3 months.

“None of the patients knew to rub the site after injection, but we feel
that this is probably our fault as physicians for not teaching them
properly,” Dr. Chaudhry said. “The manufacturer says to do it, and it must
have a reason, but we haven’t been stressing this.”

The most serious issue was failure to use the correct side of the injector,
she added.

“On one side, you have to remove the safety; the needle actually comes out
on the other side. If they grasp the injector the wrong way, they could
inject their thumb. There actually have been case reports of people losing
a thumb that way,” Dr. Chaudhry said.

“We human beings can only remember things for so long, and then our
memories tend to fade,” Jay M. Portnoy, MD, professor of pediatrics at
University of Missouri and Mercy Children’s Hospital, both in Kansas City,
told Medscape Medical News.

“Something as important as using your EpiPen, which is potentially
lifesaving, needs to be refreshed,” said Dr. Portnoy, who comoderated the
session.

Jane Purser, MD, volunteer faculty at Oklahoma University and Oklahoma
State University, and an allergist in private practice in Tulsa, told
Medscape Medical News that she asks her patients to teach someone else to
use an EpiPen each time they come for their visit.

“I do this at every visit. I ask them how to use it and then I ask them to
teach another person, whether it’s a sibling, parent, one of my residents
or, if nobody is there, me. I ask them to explain what they are doing at
each step and to explain the rationale and the significance of what they
are doing,” said Dr. Purser, who was not involved in the study.

“I find that if you have to teach someone else, you tend to know the
material better. Also, when my patients have to use their own words and
hear themselves, it tells me what they actually don’t know.”

Dr. Chaudhry, Dr. Portnoy, and Dr. Purser have disclosed no relevant
financial relationships.

American College of Allergy, Asthma & Immunology (ACAAI) 2012 Annual
Scientific Meeting: Abstract 59. Presented November 12, 2012.
__________________________________________________________________
__________________________________________________________________
USA: Heroin Use Linked to Hepatitis C Increase
Wisconsin Rapids Daily Tribune, Wisconsin USA (18.11.12)

The increase in the number of persons infected with the hepatitis C virus
(HCV) in central Wisconsin is attributed to the growing popularity of the
drug heroin. In the year 2000, when the state began tracking HCV
infections, there were 24 cases of HCV infection in Langlade, Oneida, and
Lincoln counties. At present, there are 50 confirmed cases in two
counties—Marathon and Portage. A 2011 study by CDC and the Wisconsin
Division of Public Health, with assistance from local county health
departments, indicated that the primary cause of hepatitis C infection was
sharing needles to inject heroin.

Jim Cramm, a Marshfield police department detective who investigates drug
crime in Wisconsin, stated that heroin has become more common, as it is
cheaper than prescription opioid drugs. Cramm also said that after drugs in
the opioid oxycodone family were reformulated in 2010 to prevent abuse,
users turned to heroin, which has similar effects. He explained how it is
brought through Chicago into Wisconsin’s smaller communities.

Melanie Baehr, Portage County’s Health Department nursing supervisor,
stated that the problem of HCV is further complicated by the fact that that
approximately 75 percent of persons with HCV infection are unaware of it,
as there usually are no symptoms in the early stages of the disease. She
suggests that preventing transmission of hepatitis C involves counseling
those who are infected about risks and prevention methods.
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* 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 Health Systems Policies and
Workforce, WHO, Avenue Appia 20, CH-1211 Geneva 27, Switzerland.
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
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