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SIGNpost 00682

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST *

Post00682 Abstracts Abstracts Excerpt and News 16 January 2013

CONTENTS
1. Abstract: Assessment of the health care waste generation rates and its
management system in hospitals of Addis Ababa, Ethiopia, 2011
2. Abstract: The emergence of global attention to health systems
strengthening
3. Abstract: Best strategies for global HCV eradication
4. Abstract: Awareness and experience of needle stick injuries among dental
students at the University of Nairobi, Dental Hospital
5. Abstract: Acute Mycobacterial Flexor Tenosynovitis Following Accidental
Bacillus Calmette-Guérin Inoculation in a Health Care Worker: Case
Report
6. Abstract: Healthcare workers’ perceptions of occupational exposure to
blood-borne viruses and reporting barriers: a questionnaire-based study
7. Abstract: Model-based estimates of the risk of HCV transmission from
infected patients to gynaecologic and obstetric staff
8. Abstract: The role of the nurse in paediatric rheumatology
9. Abstract: The cost of harm and savings through safety: using simulated
patients for leadership decision support
10. Abstract: Detection of hepatitis C virus transmission using DNA mass
spectrometry
11. Abstract: Surveillance of adverse events following immunization in
Minhang district of Shanghai from 2007 to 2010
12. Abstract: Head-to-head comparison of an intradermal and a virosome
influenza vaccine in patients over the age of 60: Evaluation of
immunogenicity, cross-protection, safety and tolerability
13. Abstract: An investigation of three injections techniques in reducing
local injection pain with a human papillomavirus vaccine: A randomized
trial
14. Abstract: Evaluation of long-acting somatostatin analog injection
devices by nurses: a quantitative study
15. Abstract: Facial filler and neurotoxin complications
16. Abstract: Safety and Efficacy of Intradermal Injection of Botulinum
Toxin for the Treatment of Oily Skin
17. Abstract: Multilayered mucoadhesive hydrogel films based on thiolated
hyaluronic acid and polyvinylalcohol for insulin delivery
18. Abstract: Assessment of exposure to ethanol vapors released during use
of Alcohol-Based Hand Rubs by healthcare workers
19. No Abstract: Infection control: occupational infections and clinical
tests
20. No Abstract: Suggestions on strengthening the management of hospital
infection in acupuncture and moxibustion department
21. Excerpt: Screening for Hepatitis C Virus Infection in Adults [Internet]
22. News
– USA: Accidental Exposure: More Than 700 Patients May Have Been Exposed
To HIV, Hepatitis At Buffalo VA Hospital
– USA: Why Green Hospital Practices Could Make You Sick
– USA: 716 Patients at VA May Have Been Exposed to HIV
– USA: “Greed, ignorance, and laziness” are behind medical injection
dangers in US, says official
– Bioengineer developing needle-free “nanopatch” vaccines
– Uganda: Hepatitis B outbreak continues in Uganda
– Russia: Al Jazeera Examines HIV In Russia
– Uzbekistan: Is Tashkent Cooking Its HIV/AIDS Statistics?
– USA: Dirty medical needles put tens of thousands at risk in USA
– India: Study: Village in Kerala Tops in Hepatitis-B Cases

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__________________________________________________________________
________________________________*_________________________________

1. Abstract: Assessment of the health care waste generation rates and its
management system in hospitals of Addis Ababa, Ethiopia, 2011
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23311573

BMC Public Health. 2013 Jan 12;13(1):28.

Assessment of the health care waste generation rates and its management
system in hospitals of Addis Ababa, Ethiopia, 2011.

Debere MK, Gelaye KA, Alamdo AG, Trifa ZM.

BACKGROUND: Healthcare waste management options are varying in Ethiopia.
One of the first critical steps in the process of developing a reliable
waste management plan requires a widespread understanding of the amount and
the management system. This study aimed to assess the health care waste
generation rate and its management system in some selected hospitals
located in Addis Ababa, Ethiopia.

METHODS: Six hospitals in Addis Ababa, (three private and three public),
were selected using simple random sampling method for this work. Data was
recorded by using an appropriately designed questionnaire, which was
completed for the period of two months. The calculations were based on the
weights of the health care wastes that were regularly generated in the
selected hospitals over a one week period during the year 2011. Average
generation indexes were determined in relation to certain important
factors, like the type of hospitals (public vs private).

RESULTS: The median waste generation rate was found to be varied from
0.361- 0.669 kg/patient/day, comprised of 58.69% non-hazardous and 41.31%
hazardous wastes. The amount of waste generated was increased as the number
of patients flow increased (rs=1). Public hospitals generated high
proportion of total health care wastes (59.22%) in comparison with private
hospitals (40.48%). The median waste generation rate was significantly vary
between hospitals with Kruskal-Wallis test (X2=30.65, p=0.0001). The amount
of waste was positively correlated with the number of patients (p< 0.05).
The waste separation and treatment practices were very poor. Other
alternatives for waste treatment rather than incineration such as a locally
made autoclave should be evaluated and implemented.

CONCLUSION: These findings revealed that the management of health care
waste at hospitals in Addis Ababa city was poor.

Free full text http://www.ncbi.nlm.nih.gov/pubmed/23311573
__________________________________________________________________
________________________________*_________________________________

2. Abstract: The emergence of global attention to health systems
strengthening

Full free text: http://heapol.oxfordjournals.org/content/28/1/41.full
__________________________________________________________________
Health Policy Plan. (2013) 28 (1): 41-50.

The emergence of global attention to health systems strengthening

Tamara Hafner* and Jeremy Shiffman

+ Author Affiliations

Department of Public Administration and Policy, American University,
Washington, DC, USA

*Corresponding author. Department of Public Administration and Policy,
American University, 4400 Massachusetts Ave. NW, Washington, DC 20016, USA.
Tel: +1-202-885-6149. E-mail: hafner@american.edu

After a period of proliferation of disease-specific initiatives, over the
past decade and especially since 2005 many organizations involved in global
health have come to direct attention and resources to the issue of health
systems strengthening.

We explore how and why such attention emerged. A qualitative methodology,
process-tracing, was used to construct a case history and analyse the
factors shaping and inhibiting global political attention for health
systems strengthening. We find that the critical factors behind the recent
burst of attention include fears among global health actors that health
systems problems threaten the achievement of the health-related Millennium
Development Goals, concern about the adverse effects of global health
initiatives on national health systems, and the realization among global
health initiatives that weak health systems present bottlenecks to the
achievement of their organizational objectives.

While a variety of actors now embrace health systems strengthening, they do
not constitute a cohesive policy community. Moreover, the concept of health
systems strengthening remains vague and there is a weak evidence base for
informing policies and programmes for strengthening health systems.

There are several reasons to question the sustainability of the agenda.
Among these are the global financial crisis, the history of pendulum swings
in global health and the instrumental embrace of the issue by some actors.

KEY MESSAGES
Organizations involved in global health have paid increasing attention to
health systems strengthening over the past decade, driven by concerns over
slow progress on the health MDGs, and the impact of global health
initiatives on health systems.

There are several reasons to question the sustainability of this attention,
including a history of pendulum swings in global health, the global
financial crisis, a weak evidence base on solutions and the instrumental
embrace of the issue by some organizations.

Health systems strengthening is predominantly a national issue, but the
commitment of global actors is worth monitoring since they influence
financing, national priority and policy approaches.

Full free text: http://heapol.oxfordjournals.org/content/28/1/41.full
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Best strategies for global HCV eradication
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23286849

Liver Int. 2013 Feb;33 Suppl 1:68-79.

Best strategies for global HCV eradication.

Hagan LM, Schinazi RF.

Center for AIDS Research, Emory University School of Medicine and Veterans
Affairs Medical Center, Decatur, GA, USA.

Worldwide eradication of hepatitis C virus (HCV) is possible through a
combination of prevention education, universal clinical and targeted
community screening, effective linkage to care and treatment with promising
new direct-acting antiviral drug regimens.

Universal screening should be offered in all healthcare visits, and
parallel community screening efforts should prioritize high-prevalence,
high-transmission populations including injection drug users, prison
inmates and those with HIV/HCV co-infection.

Increasing awareness of HCV infection through screening, improving
treatment uptake and cure rates by providing linkage to care and more
effective treatment, and ultimately combining education efforts with
vaccination campaigns to prevent transmission and reinfection can slow and
eventually stop the ‘silent epidemic’.

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

4. Abstract: Awareness and experience of needle stick injuries among dental
students at the University of Nairobi, Dental Hospital
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23057284

East Afr Med J. 2010 May;87(5):211-4.

Awareness and experience of needle stick injuries among dental students at
the University of Nairobi, Dental Hospital.

Mungure EK, Gakonyo JM, Mamdani Z, Butt F.

Kenyatta National Hospital, P.O Box 38973-00623, Nairobi, Kenya.

BACKGROUND: Needle stick injuries (NSI) are the commonest route by which
blood borne viruses and/or infections such as HIV, Hepatitis B and C are
transmitted from patients to health care workers (HCW). Dental students are
also at risk of such infections and injuries due to accidental
contamination during their practical occupational exposure. There is hardly
any information regarding the knowledge and experiences of NSI among dental
students in Kenya.

OBJECTIVE: To determine the knowledge and experiences of NSI among dental
students at the University of Nairobi Dental Hospital (UONDH).

DESIGN: Descriptive cross-sectional study.

SETTING: University of Nairobi Dental Hospital premises. The population
included undergraduate and postgraduate dental students pursuing their
degrees at the university.

RESULTS: Seventy two questionnaires were issued and a response rate of 62
(81%) was achieved. The age of the respondents ranged from 21-35 years with
a mean age of 24 years (SD +/- 4.7) years. There were 33 (53%) males and 29
(47%) females. Most of the students were undergraduates (87%) while the
rest were postgraduate students (13%).

The majority (97%) of the respondents reported that NSI was a means of
cross-infection. Only 29% of the respondents had suffered NSI. Of those who
had suffered NSI, 36% of the incidents occurred when administering local
anaesthesia, while 23% were during scaling, 18% when recapping needles, 18%
while clearing up and 5% when suturing.

Only seven of those who had suffered NSI (39%) had reported of NSI. The
reasons for not reporting were: fear of stigmatisation (25%) or the fear of
consequences of cross-infection (38%). All the respondents who had
experienced NSI were undergraduates with no statistical significant
difference between the undergraduate and postgraduate students (chi2=3.758,
p=0.052). Among the respondents who had experienced NSI, nine were males
and nine were females with no statistical significance between the two
genders (chi2=0.106, p=0.481).

All the respondents recorded inadequate knowledge on the modes of
prevention of NSI. Less than half (27%) of the respondents had accurate
knowledge on the procedure followed in case of NSI.

Only 27% of the respondents had taken post-exposure prophylaxis (PEP) after
suffering NSI with no statistically significant difference between males
and females (chi2=44, p=0.108).

CONCLUSION: Although the level of knowledge on the risk of cross-infection
from NSI was high, there was decreased awareness on the means of prevention
and protocol.
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Acute Mycobacterial Flexor Tenosynovitis Following Accidental
Bacillus Calmette-Guérin Inoculation in a Health Care Worker: Case
Report
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23294648

J Hand Surg Am. 2013 Jan 4. pii: S0363-5023(12)01698-X.

Acute Mycobacterial Flexor Tenosynovitis Following Accidental Bacillus
Calmette-Guérin Inoculation in a Health Care Worker: Case Report.

Mundinger GS, Douglas KC, Higgins JP.

Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore,
Maryland.

Solutions containing bacillus Calmette-Guérin (BCG), a live attenuated form
of Mycobacterium bovis or Mycobacterium tuberculosis, commonly are injected
intravesically to treat tumors of the urinary bladder.

We report a case of acute mycobacterial flexor tenosynovitis in a health
care worker who inadvertently inoculated her finger via needlestick while
preparing BCG solution for intravesicular administration. She was treated
successfully with immediate operative intervention followed by 6 months of
antimycobacterial antibiotics.

Of 3 previous reports of hand infections following self-inoculation with
BCG solutions, this case is unique owing to rapid onset of acute
mycobacterial flexor tenosynovitis and positive intraoperative
mycobacterial cultures.

Needlesticks with BCG-containing solutions, especially into the flexor
tendon sheath, should be treated with timely surgical debridement and
appropriate antimycobacterial management.

Copyright © 2013 American Society for Surgery of the Hand. Published by
Elsevier Inc. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Healthcare workers’ perceptions of occupational exposure to
blood-borne viruses and reporting barriers: a questionnaire-based study
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22784489

J Hosp Infect. 2012 Sep;82(1):36-9.

Healthcare workers’ perceptions of occupational exposure to blood-borne
viruses and reporting barriers: a questionnaire-based study.

Winchester SA, Tomkins S, Cliffe S, Batty L, Ncube F, Zuckerman M.

South London Specialist Virology Centre, King’s College Hospital NHS
Foundation Trust, London, UK.

BACKGROUND: Healthcare workers (HCWs) are at significant risk of exposure
to blood-borne viruses (BBV).

AIM: To investigate HCW perceptions concerning occupational exposures to
BBV and possible barriers involved in reporting incidents.

METHODS: A total of 120 HCWs based at the Dental Institute, King’s College
Hospital NHS Foundation Trust, completed an anonymous questionnaire as part
of a multicentre study.

FINDINGS: Eighty-six percent (99/115) of respondents worried about
developing a BBV infection at work. Of those who feared hepatitis C virus
(HCV) the most, 69% (31/45) also believed that HCV posed the greatest risk
to their health, versus 53% (10/19) and 13% (5/40) with regard to hepatitis
B virus (HBV) and HIV infection, respectively (P < 0.001). Of respondents
with =21 years of health service experience, 75% (18/24) knew the risk of
HIV transmission versus 13% (2/16) of respondents with <5 years of health
service experience (P = 0.002). All (23/23) respondents with =21 years of
service were aware of HIV PEP versus 20% (12/60) with <21 years of service.
Ninety-two percent of respondents (104/113) agreed that it was important to
report all body fluid exposure incidents but only 58% (28/48) had reported
all their exposure incidents. Fifty-nine percent (60/102) agreed that an
electronic reporting system would improve reporting of such incidents.

CONCLUSIONS: This study identified a need to improve HCWs’ knowledge of BBV
infection risks and their management. Data gathered in this study will be
used to inform the development of a web-based system for the surveillance
of occupational exposures to BBV in the UK.

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

7. Abstract: Model-based estimates of the risk of HCV transmission from
infected patients to gynaecologic and obstetric staff
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23230714

Przegl Epidemiol. 2012;66(3):437-43.

[Model-based estimates of the risk of HCV transmission from infected
patients to gynaecologic and obstetric staff].

[Article in Polish]
Ganczak M, Szczeniowski A, Jurewicz A, Karakiewicz B, Szych Z.

Zaklad Zdrowia Publicznego, Pomorski Uniwersytet Medyczny, Szczecin.
mganczak@pum.edu.pl

The risk of acquiring the hepatitis C virus (HCV) through percutaneous
occupational exposure is dependent on three key variables: number of
injuries, probability of a percutaneous injury transmitting HCV and
prevalence of HCV infection in the patient population.

OBJECTIVE: To estimate the prevalence of HCV infection in the
gynaecological/obstetric patient population and thereafter estimate the
risk of HCV transmission to personnel through occupational exposure.

METHODS: The prevalence of anti-HCV was estimated through an anonymous
serosurvey of gynaecological/ obstetric patients in 15 randomly selected
hospitals in West Pomerania, Poland, from February 2008 to January 2009.
Using own published data on the percutaneous injuries during
gynaecological/obstetric surgeries and results obtained from serologic
survey, the risk of annual occupational transmission of HCV to personnel
was then derived with the use of a mathematical model.

RESULTS: The prevalence of anti-HCV infection for 528
gynaecological/obstetric patients, aged 18-83 (median 45), was 0.76%
(4/528; 95%CI: 0.29-1.93%). The estimated risk of HCV transmission from an
HCV infected patient to an uninfected staff member may vary over a wide
range (0.00007-0.1%), being dependent on the type of exposure; the average
risk for a midwife was 0.0038% per annum (0.15% risk over a 40 year
professional career). The estimated risk for a gynaecologist/obstetrician
was 0.0076% and 0.30% respectively.

CONCLUSIONS: The risk of an individual member of a gynaecological/obstetric
staff acquiring HCV through occupational exposure is low, however a
credible hazard still exists. One in 130 patients hospitalized at
gynaecological/obstetric wards showed markers of HCV infection. Therefore,
staff members should be encouraged to observe standard precautions
regarding sharps injury prevention and present themselves for post-exposure
management in case of need.
__________________________________________________________________
________________________________*_________________________________

8. Abstract: The role of the nurse in paediatric rheumatology
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23297593

Soins Pediatr Pueric. 2012 Nov-Dec;(269):25-6.

[The role of the nurse in paediatric rheumatology].

[Article in French]

Dorlé A.

Service de pédiatrie génerale, rhumatologie pédiatrique, Centre national de
référence des maladies auto-inflammatoires, CHU Bicêtre, Université de
Paris Sud, Le Kremlin-Bicêtre, France. etp.rhumatoped@bct.aphp.fr

With regard to the care of children with a rheumatic pathology, the nurse
is notably responsible for taking charge of patients and their family and
leading therapeutic education workshops for parents and children.

She teaches the parents or the child how to administer injections, respect
hygiene rules and use analgesic methods.
__________________________________________________________________
________________________________*_________________________________

9. Abstract: The cost of harm and savings through safety: using simulated
patients for leadership decision support
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22785347

J Patient Saf. 2012 Sep;8(3):89-96.

The cost of harm and savings through safety: using simulated patients for
leadership decision support.

Denham CR, Guilloteau FR.

Texas Medical Institute of Technology, HCC Corporation, Austin, USA.
Charles_Denham@tmit1.org

OBJECTIVES: The ultimate objective of this program is to provide an
approach to understanding and communicating health-care harm and cost to
compel health-care provider leadership teams to vote “yes” to investments
in patient safety initiatives, with the confidence that clinical,
financial, and operational performance will be improved by such programs.

METHODS: Through a coordinated combination of literature evaluations,
careful mapping of high impact scenarios using simulated patients and
consensus review of clinical, operational, and financial factors, we
confirmed value in such approaches to decision support information for
hospital leadership teams to invest in patient safety projects.

RESULTS: The study resulted in the following preliminary findings:
·Communication between hospital quality and finance departments can be much
improved by direct collaborative relationships through regular meetings to
help both clarify direct costs, indirect costs, and the savings of waste
and harm to patients by avoidance of infections. ·Governance leaders and
the professional administrative leaders should consider establishing the
structures and systems necessary to act on risks and hazards as they evolve
to deploy resources to areas of harm and risk. ·

Quality and Infection Control Professionals can best wage their war on
healthcare waste and harm by keeping abreast of the latest literature
regarding the latest measures, standards, and safe practices for
healthcare-acquired infections and hospital-acquired conditions.

·Regular reviews of patients with health-care associated infections, with
direct attention to the attributable cost of treatment and how financial
waste and harm to patients may be avoided, may provide hospital leaders
with new insights for improvement. ·If hospitals developed their own risk
scenarios to determine impact of harm and waste from hospital-acquired
conditions in addition to impact scenarios for specific processes through
technology and process innovations, they would have more clear guidance for
improvement efforts. Tools such as impact calculators, performance models,
and simulated patient trajectories are no more tied to the reality of
running a hospital or treating a patient as jet simulator metrics are to
taking a real flight with real weather and real aircraftVthey provide a
view to enhance decision making but do NOT provide the answers.

CONCLUSIONS: The final result of this project was to demonstrate a
prototype leadership decision-support investment model approach that
addresses clinical, operational, and financial performance for typical
hospitals.

http://www.ncbi.nlm.nih.gov/pubmed/22785347
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Detection of hepatitis C virus transmission using DNA mass
spectrometry
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23300164

J Infect Dis. 2013 Jan 8.

Detection of hepatitis C virus transmission using DNA mass spectrometry.

Ganova-Raeva LM, Dimitrova ZE, Campo DS, Yulin L, Ramachandran S, Xia GL,
Honisch C, Cantor CR, Khudyakov YE.

Molecular Epidemiology and Bioinformatics Laboratory, Division of Viral
Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE,
MS A-33, Atlanta, Georgia 30329, USA.

The molecular detection of transmission of rapidly mutating pathogens such
as hepatitis C virus (HCV) is commonly achieved by assessing the genetic
relatedness of strains among infected patients. We describe the development
of a novel mass spectrometry (MS)-based approach to identification of HCV
transmissions. MS was used to detect products of base-specific cleavage of
RNA molecules obtained from HCV PCR fragments.

The MS-peak profiles (MSPs) were found to reflect variation in the HCV
genomic sequence and the intra-host composition of the HCV population.

Serum specimens (n=60) originating from case-patients of 14
epidemiologically confirmed outbreaks and unrelated controls (n=25) were
tested. Neighbor-joining trees constructed using MSP-based Hamming
distances showed 100% accuracy, and linkage networks constructed using a
threshold established from the Hamming distances between epidemiologically
unrelated cases showed 100% sensitivity and 99.93% specificity in
transmission detection.

The MS approach is rapid, robust, reproducible and cost-effective, and
applicable to investigating transmissions of other pathogens.
__________________________________________________________________
________________________________*_________________________________

11. Abstract: Surveillance of adverse events following immunization in
Minhang district of Shanghai from 2007 to 2010
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23302620

Zhonghua Er Ke Za Zhi. 2012 Nov;50(11):859-64.

[Surveillance of adverse events following immunization in Minhang district
of Shanghai from 2007 to 2010].

[Article in Chinese]

Zhang LP, Yu F, Jin BF, Wang Y, Xu HL, DU Y.

Expanded Program on Immunization, Minhang District Center for Disease
Control and Prevention, Shanghai 201101, China.

OBJECTIVE: To analyze the adverse events following immunization (AEFI) in
Minhang District of Shanghai from 2007 to 2010 and evaluate the safety of
vaccines.

METHOD: The data of AEFI cases were collected and reported by the Vaccine
Adverse Events Surveillance System (VAESS). The data were classified as
non-serious or serious reaction according to the symptoms and medical
records.

RESULT: From 2007 to 2010, 5088 AEFI cases were reported to the
surveillance system after 4.85 million doses of 24 kinds of vaccines (viral
vaccines, bacterial vaccine and non-vaccine product) use. A total of 5013
non-serious AEFI were reported with a rate of 103.24/100 000 doses. Among
the non-serious AEFIs, the majority were fever (3314 cases, 68.25/100 000
doses), followed by local reactions (1686 cases, 34.72/100 000 doses).

A total of 75 serious AEFIs were reported, with a rate of 1.54/100 000
doses. The anaphylaxis (26 cases, 0.54/100 000 doses) accounted for the
most among the serious AEFIs, followed by allergic rash (24 cases, 0.49/100
000 doses) and abscess at injection site (14 cases, 0.29/100 000 doses).

The susceptibility of data on AEFI rose year by year from 2007 to 2010, and
the reported rate rose from 40.48/100 000 in 2007 to 134.17/100 000 in
2010.

CONCLUSION: To maintain the sensitivity of AEFI surveillance is key to
detect rare serious adverse events. The sensitivity should be enhanced, at
the same time, pediatricians should treat the AEFI with standard methods,
so as to minimize the negative impacts of vaccination and to maintain the
confidence among the public.
__________________________________________________________________
________________________________*_________________________________

12. Abstract: Head-to-head comparison of an intradermal and a virosome
influenza vaccine in patients over the age of 60: Evaluation of
immunogenicity, cross-protection, safety and tolerability
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23295262

Hum Vaccin Immunother. 2013 Jan 7;9(3).

Head-to-head comparison of an intradermal and a virosome influenza vaccine
in patients over the age of 60: Evaluation of immunogenicity, cross-
protection, safety and tolerability.

Ansaldi F, Orsi A, de Florentiis D, Parodi V, Rappazzo E, Coppelli M,
Durando P, Icardi G.

I.R.C.C.S. “A.O.U. San Martino-IST”; Genoa, Italy; Department of Health
Sciences; University of Genoa; Genoa, Italy.

In the present study we first compare immunogenicity against vaccine and
heterologous circulating A(H1N1)pdm09 strains, tolerability and safety of
intradermal Intanza® 15 µg and of virosomal adjuvanted, intramuscularly
delivered influenza vaccine, Inflexal® V, in healthy elderly volunteers.
Five-hundred participants were enrolled in the study and randomly assigned
to the two vaccine groups to receive either one dose of Intanza® 15 µg or
Inflexal® V vaccine.

All subjects reported solicited local and systemic reactions occurred
within 7 d after vaccination and unsolicited adverse events up to 21 d
post-immunization and any serious adverse event appeared during the study.

A subset of 55 participants was randomly selected for immunogenicity and
cross-protection evaluations. Serum samples were collected before and 1 and
3 mo after immunization. Antibody responses were measured using
hemagglutination inhibition (HI) against all viruses used in the study and
neutralization (NT) assays against A(H1N1)pdm09 strains. At least one of
the CHMP criteria for influenza vaccine approval in the elderly was met by
virosomal vaccine against all the tested viruses; intradermal vaccine met
all criteria against all strains. Several parameters of immune response
against strains with a different antigenic pattern from that of vaccine
A/California/04/09(H1N1)pdm09 were significantly higher in the intradermal
vaccine group compared with the virosomal group.

Safety and systemic tolerability of both vaccines were excellent, but
injection site reactions occurred significantly more frequently in the
intradermal vaccination group. Immunogenicity of Intanza® 15 µg intradermal
vaccine tended to be higher than that of Inflexal® V against heterologous
strains in healthy elderly.
__________________________________________________________________
________________________________*_________________________________

13. Abstract: An investigation of three injections techniques in reducing
local injection pain with a human papillomavirus vaccine: A randomized
trial
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23306361

Vaccine. 2013 Jan 7. pii: S0264-410X(12)01851-8.

An investigation of three injections techniques in reducing local injection
pain with a human papillomavirus vaccine: A randomized trial.

Petousis-Harris H, Poole T, Stewart J, Turner N, Goodyear-Smith F, Coster
G, Lennon D.

Immunisation Advisory Centre, Department of General Practice and Primary
Health Care, Level 3, School of Population Health, University of Auckland,
Tamaki Campus, Morrin Road, Glen Innes, Private Bag 92019, Auckland 1072,
New Zealand. Electronic address: h.petousis-harris@auckland.ac.nz.

BACKGROUND: Previous research suggests vaccine injection technique can
influence local reactogenicity.

OBJECTIVE: To identify characteristics of vaccination technique and
individual vaccinees associated with frequency and severity of pain on
injection and local reactogenicity following immunisation with quadrivalent
human papillomavirus vaccine.

DESIGN: Randomised cross-over trial of three injection techniques. Data
were collected on health history, perceived stress and social support using
a 10 item perceived stress scale and a single item social support question.
Pain on injection was measured using a visual analogue scale and
reactogenicity data was collected using participant-held diaries.

SETTING: Clinic rooms at the University of Auckland.

PARTICIPANTS: Females aged 14-45 years and males aged 14-26 years recruited
to the study.

MAIN OUTCOME MEASURES: Primary outcome measures were perceived pain on
injection and the local injection site reactions pain, erythema, swelling
and induration.

RESULTS: The three injection techniques did not affect injection site
reactogenicity. Females tended to experience more reactogenicity. Perceived
stress, social support and atopy were not associated with reactogenicity
outcomes and exercise showed little effect. No variables, including
injection technique, were associated with wide variation in perceived pain
in injection. Case by case observational data suggest some variations in
anatomical site may be important.

CONCLUSIONS: Most injection site reactions in this study were mild. The
three injection techniques used in this study were equivalent in their
reactogenicity and pain profiles and could be recommended for use in this
population.

Copyright © 2013. Published by Elsevier Ltd.
__________________________________________________________________
________________________________*_________________________________

14. Abstract: Evaluation of long-acting somatostatin analog injection
devices by nurses: a quantitative study
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23293542

Med Devices (Auckl). 2012;5:103-9.

Evaluation of long-acting somatostatin analog injection devices by nurses:
a quantitative study.

Adelman DT, Burgess A, Davies PR.

Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.

The somatostatin analogs (SSAs) lanreotide Autogel/Depot and octreotide
long-acting release are used to treat acromegaly and neuroendocrine tumors.
The present study evaluated opinions on SSA injection devices, including a
recently approved lanreotide new device (lanreotide-ND), among nurses in
Europe and the USA.

Nurses injecting SSAs for at least three patients per year (n = 77) were
interviewed regarding SSA devices. Device attributes were rated via
questionnaire; nurses were then timed administering test injections with
lanreotide-ND and octreotide long-acting release. The most important
delivery system attributes were easy/convenient preparation and injection
(ranked in the top five by 70% of nurses), low clogging risk (58%), and
high product efficacy (55%). Compared with the octreotide long-acting
release device, lanreotide-ND scored higher on 15/16 attributes, had
shorter mean preparation and administration time (329 versus 66 seconds,
respectively; P = 0.01) and a higher overall preference score (70 versus
114, respectively; P = 0.01).

The five most important lanreotide-ND attributes were: prefilled device,
confidence a full dose was delivered, low clogging risk, easy/convenient
preparation and injection, and fast administration. These device features
could lead to improvements in clinical practice and benefit
patients/caregivers who administer SSAs at home.

PMID: 23293542 [PubMed] PMCID: PMC3534535 Free PMC Article

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3534535/
__________________________________________________________________
________________________________*_________________________________

15. Abstract: Facial filler and neurotoxin complications
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22723229

Facial Plast Surg. 2012 Jun;28(3):288-93.

Facial filler and neurotoxin complications.

Nettar K, Maas C.

Maas Clinic for Aesthetic and Facial Plastic Surgery, University of
California-San Francisco, CA, USA. Drnettar@maasclinic.com

Botulinum neuromodulators and injectable dermal fillers have become part of
the armamentarium in the treatment of facial aging. Their successful use
requires a fundamental knowledge of anatomy and physiology and a sound
understanding of their risks and complications.

Although neuromodulators and fillers continue to demonstrate a strong
record of safety, several notable risks exist.

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
__________________________________________________________________
________________________________*_________________________________

16. Abstract: Safety and Efficacy of Intradermal Injection of Botulinum
Toxin for the Treatment of Oily Skin
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23293895

Dermatol Surg. 2013 Jan 7.

Safety and Efficacy of Intradermal Injection of Botulinum Toxin for the
Treatment of Oily Skin.

Rose AE, Goldberg DJ.

Ronald O. Perelman Department of Dermatology, New York University School of
Medicine, New York, New York.

OBJECTIVE: To evaluate the safety and efficacy of intradermal injection of
abobotulinumtoxinA for the treatment of oily skin.

METHODS AND MATERIALS: Twenty-five patients with oily skin were treated in
the forehead region with intradermal injections of botulinum toxin.
Baseline and post-treatment sebum production was measured using a
sebometer. Photographs were taken. Patients were also asked to rate their
satisfaction with the treatment in terms of improvement in their oily skin.

RESULTS: Treatment with botulinum toxin resulted in significantly lower
sebum production at 1 week and 1, 2, and 3 months after injection (p <
.001, t-test). Twenty-three patients (91%) reported that they were
satisfied (50-75% improvement) with intradermal botulinum toxin as a
treatment for oily skin.

CONCLUSION: Intradermal injection of botulinum toxin significantly reduced
sebum production in the forehead region, with a high degree of patient
satisfaction. Intradermal botulinum toxin may be an effective treatment to
reduce sebum production in patients with oily skin. Larger, randomized,
blinded, placebo-controlled studies are warranted.

© 2012 by the American Society for Dermatologic Surgery, Inc. Published by
Wiley Periodicals, Inc.
__________________________________________________________________
________________________________*_________________________________

17. Abstract: Multilayered mucoadhesive hydrogel films based on thiolated
hyaluronic acid and polyvinylalcohol for insulin delivery
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22743112

Acta Biomater. 2012 Oct;8(10):3643-51.

Multilayered mucoadhesive hydrogel films based on thiolated hyaluronic acid
and polyvinylalcohol for insulin delivery.

Ding J, He R, Zhou G, Tang C, Yin C.

State Key Laboratory of Genetic Engineering, Department of Pharmaceutical
Sciences, School of Life Sciences, Fudan University, Shanghai 200433,
People’s Republic of China.

A multilayered hydrogel film system based on hyaluronic acid-cysteamine
(HA-Cym) and polyvinylalcohol (PVA) was fabricated. It contained a drug-
impermeable backing layer, a supporting layer preventing direct contact
between the loaded drug and the backing layer, a drug-loading layer and a
mucoadhesive layer. Scanning electron microscopy demonstrated the presence
of the distinct layers.

The composition and preparation procedure of the films influenced their
mucoadhesion, swelling, in vitro release of insulin and loaded insulin
stability. Vacuum drying and crosslinked PVA with glutaraldehyde might
reduce mucoadhesion, and they partially decreased the bioactivity of loaded
insulin. Lyophilized hydrogel film with uncrosslinked PVA as a mucoadhesive
layer possessed high mucoadhesion and showed no influence on the
bioactivity of loaded insulin.

The application of vacuum-dried PVA-crosslinked HA-Cym/PVA hydrogel film as
a drug-impermeable backing layer would provide a controllable
unidirectional insulin release. Therefore, such a multilayered hydrogel
film system could be a promising mucoadhesive delivery system for
controlled macromolecular drug release.

Copyright © 2012 Acta Materialia Inc. Published by Elsevier Ltd. All rights
reserved.
__________________________________________________________________
________________________________*_________________________________

18. Abstract: Assessment of exposure to ethanol vapors released during use
of Alcohol-Based Hand Rubs by healthcare workers
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23290089

J Infect Public Health. 2013 Feb;6(1):16-26.

Assessment of exposure to ethanol vapors released during use of Alcohol-
Based Hand Rubs by healthcare workers.

Hautemanière A, Cunat L, Ahmed-Lecheheb D, Hajjard F, Gerardin F, Morele Y,
Hartemann P.

Infection Prevention and Control, University Hospital of Nancy, France;
Department of Public Health and Environment, SERES, Faculté de Médecine de
Nancy, Lorraine University, France.

BACKGROUND: Despite the increasing use of Alcohol-Based Hand Rub solutions,
few studies have quantified the concentrations of inhaled ethanol.

OBJECTIVE: The aim of this study was to assess ethanol exposure during
hygienic and surgical hand disinfection practices.

METHOD: Ethanol concentrations were measured at the nose level of a wooden
dummy and human volunteers. Two systems were used in parallel to determine
short- term ethanol vapor exposures: activated charcoal tubes followed by
gas chromatography analysis and direct reading on a photoionization
detector (PID). Exposure was assessed for 4 different sequences (N=10)
reproducing hand rubs for simple surgery, nursing care, intensive care and
surgical scrub.

RESULTS: The ethanol concentrations measured were of a similar order
between the dummy and volunteers. The concentrations obtained by PID were
higher than the gas chromatography values for the simple care (45%) and
nursing care (27%) sequences and reflected specific exposure peaks of
ethanol, whereas ethanol concentrations were continuously high for
intensive care (440mgm(-3)) or surgical scrub (650mgm(-3)).

CONCLUSION: Ethanol concentrations were similar for these two exposure
assessment methods and demonstrated a relationship between handled doses
and inhaled doses. However, the ethanol vapors released during hand
disinfection were safe for the healthcare workers.

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

19. No Abstract: Infection control: occupational infections and clinical
tests
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22685778

Rinsho Byori. 2009 Aug;Suppl 144:77-9.

[Infection control: occupational infections and clinical tests].
[Article in Japanese]

Haruki K.
__________________________________________________________________
________________________________*_________________________________

20. No Abstract: Suggestions on strengthening the management of hospital
infection in acupuncture and moxibustion department
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23227691

Zhongguo Zhen Jiu. 2012 Sep;32(9):818.

[Suggestions on strengthening the management of hospital infection in
acupuncture and moxibustion department].

[Article in Chinese]

Yu DY, Zhao YP.

yudingyuan19@126.com
__________________________________________________________________
________________________________*_________________________________

21. Excerpt: Screening for Hepatitis C Virus Infection in Adults [Internet]

Free full text http://www.ncbi.nlm.nih.gov/books/NBK115423/
__________________________________________________________________
Screening for Hepatitis C Virus Infection in Adults [Internet].

Editors: Chou R, Cottrell EB, Wasson N, Rahman B, Guise JM.

Rockville (MD): Agency for Healthcare Research and Quality (US); 2012 Nov.
Report No.: 12(13)-EHC090-EF.

AHRQ Comparative Effectiveness Reviews.

OBJECTIVES: Many patients with chronic hepatitis C virus (HCV) infection
are unaware of their status. Screening could identify patients at earlier
stages of disease, when interventions might be effective in improving
clinical outcomes or reducing transmission risk. The purpose of this report
is to systematically review the evidence on screening for HCV infection in
asymptomatic adults without known liver enzyme abnormalities, including
pregnant women. This review focuses on research gaps identified in the 2004
United States Preventive Services Task Force (USPSTF) review and new
studies published since that review, and it reviews evidence on prenatal
HCV screening not included in the 2004 USPSTF review. This report examines
both direct evidence on the effects of screening for HCV infection compared
to no screening on clinical outcomes, as well as the indirect chain of
evidence (diagnosis, workup, and treatment) needed to understand effects of
screening on clinical outcomes. Treatments evaluated included
immunizations, counseling, and interventions to potentially reduce risk of
mother-to-child transmission. To complement this review of screening for
HCV, the Agency for Healthcare Research and Quality (AHRQ) commissioned a
separate review on effectiveness of antiviral treatments.

DATA SOURCES: Articles were identified from searches (from 1947 to May
2012) of the Cochrane Database of Systematic Reviews, the Cochrane Central
Register of Controlled Trials, EBM Reviews, and Ovid MEDLINE®. The searches
were supplemented by reviewing reference lists and searching clinical trial
registries.

REVIEW METHODS: We used predefined criteria to determine study eligibility.
We selected randomized trials and observational studies that evaluated
effects of screening, counseling interventions, and immunizations on
clinical and intermediate outcomes. We also selected studies that evaluated
effects of labor and delivery practices and breastfeeding on mother-to-
child transmission of HCV infection. We selected studies that evaluated the
diagnostic accuracy of noninvasive tests compared to liver biopsy for
diagnosing fibrosis or cirrhosis in patients with chronic HCV infection.
The quality of included studies was assessed, data were extracted, and
results were summarized.

RESULTS: Of the 10,786 citations identified at the title and abstract
level, we screened and reviewed 808 full-length articles. A total of 182
studies were included. There was no direct evidence on clinical benefits
associated with screening compared with no screening (or comparing
different screening approaches) in nonpregnant or pregnant adults.
Retrospective studies found that screening strategies targeting multiple
risk factors were associated with sensitivities of over 90 percent and
numbers needed to screen to identify one case of HCV infection of less than
20. Narrowly targeted screening strategies based on history of intravenous
drug use were associated with numbers needed to screen of less than two,
but missed up to two-thirds of infected people. Data on harms of screening
(such as labeling and anxiety) were sparse. Compared with liver biopsy, a
number of indices based on panels of blood tests were associated with a
median area under the receiver operating characteristic curve (AUROC) of
0.75 to 0.86 for diagnosing fibrosis and a median AUROC of 0.80 to 0.91 for
diagnosing cirrhosis, but there was insufficient evidence to determine
clinical outcomes associated with strategies incorporating noninvasive
tests for evaluating patients with HCV infection. Limited evidence
suggested that knowledge of HCV status and counseling interventions may
reduce alcohol use and risky injection drug use behaviors, but more
evidence is needed to demonstrate long-term sustainability and to
understand effects on clinical outcomes and transmission risk. In pregnant
women, cohort studies found no clear association between mode of delivery
and risk of vertical transmission of HCV infection and consistently found
no association between breastfeeding and transmission risk. Evidence on the
association between other labor and delivery management practices and risk
of vertical transmission of HCV infection was sparse, but suggested that
prolonged rupture of membranes is associated with increased risk.

CONCLUSIONS: Although screening tests can accurately identify adults with
chronic HCV infection, targeted screening strategies based on the presence
of risk factors miss some patients with HCV infection. As a result, more
research is needed to understand the effects of different screening
strategies on clinical outcomes. Evidence on effects of knowledge of HCV
status and counseling and immunizations on clinical and intermediate
outcomes in patients diagnosed with HCV infection remains sparse and more
research is needed to understand effective interventions for preventing
vertical transmission. A complete assessment of benefits and harms of
screening requires consideration of the effectiveness of antiviral
regimens, which are the subject of a complementary review.

Sections
Preface
Acknowledgments
Key Informants
Technical Expert Panel
Peer Reviewers
Executive Summary
Introduction
Methods
Results
Discussion
References
Abbreviations and Acronyms
Appendix A Exact Search Strategy
Appendix B Hepatitis C Screening: Inclusion Criteria by Key Question
Appendix C Included Studies
Appendix D Excluded Studies
Appendix E Quality Assessment Methods
Appendix F Overall Strength of Evidence: Summary of Grading Domains
Appendix G Evidence Tables and Overall Quality Ratings
PMID: 23304739 [PubMed] Books & Documents

Free full text http://www.ncbi.nlm.nih.gov/books/NBK115423/
__________________________________________________________________
________________________________*_________________________________

22. News

– USA: Accidental Exposure: More Than 700 Patients May Have Been Exposed
To HIV, Hepatitis At Buffalo VA Hospital
– USA: Why Green Hospital Practices Could Make You Sick
– USA: 716 Patients at VA May Have Been Exposed to HIV
– USA: “Greed, ignorance, and laziness” are behind medical injection
dangers in US, says official
– Bioengineer developing needle-free “nanopatch” vaccines
– Uganda: Hepatitis B outbreak continues in Uganda
– Russia: Al Jazeera Examines HIV In Russia
– Uzbekistan: Is Tashkent Cooking Its HIV/AIDS Statistics?
– USA: Dirty medical needles put tens of thousands at risk in USA
– India: Study: Village in Kerala Tops in Hepatitis-B Cases

Selected news items reprinted under the fair use doctrine of international
copyright law: http://www4.law.cornell.edu/uscode/17/107.html
__________________________________________________________________
USA: Accidental Exposure: More Than 700 Patients May Have Been Exposed To
HIV, Hepatitis At Buffalo VA Hospital
By Carolyn Thompson, Associated Press, USA (14.01.13)

BUFFALO, N.Y. — Federal authorities warned against the infection risks of
using insulin pens on more than one patient, and officials on Monday asked
why a Buffalo veterans hospital may have used the pens on many patients,
causing an HIV scare.

More than 700 patients admitted to the Veterans Affairs Western New York
Healthcare System over a two-year period may have been exposed to HIV,
hepatitis B and hepatitis C, officials said following a review that found
that multi-dose pens intended for use by a single patient may have been
used on more than one person.

Although the needles were changed, the stored insulin could have been
contaminated by a back flow of blood with each use, experts said.

On Monday, members of the region’s congressional delegation sought an
investigation.

“Is this situation isolated to the VA Medical Center in Buffalo or is it
reflective of a systemic problem in patient labeling that has endangered
veterans throughout the VA healthcare system?” Rep. Brian Higgins, D-N.Y.,
asked in a letter to Veterans Affairs Secretary Eric Shinseki.

The hospital, in a statement to The Associated Press, said only inpatients
in Buffalo were affected.

Federal health agencies have been warning against sharing insulin pens for
several years. The Food and Drug Administration issued an alert in March
2009 after learning that more than 2,000 patients may have been exposed at
a Texas hospital between 2007 and 2009.

A clinical alert from the Centers for Disease Control last year came amid
continued reports of the practice.

“This just shouldn’t happen, but it does,” Dr. Melissa Schaefer of the CDC
said Monday, “and I think the incidents we hear about are likely
underreported.

“Reuse of insulin pens for more than one patient essentially is akin to
syringe reuse,” she said. “You can get back flow of blood into that syringe
or cartridge that contains the insulin and then you potentially expose
others patients. And changing the needle wouldn’t make it safe for multi-
patient use.”

Ignorance of the danger may be a factor, experts said, with hospital
employees mistakenly viewing the pens like multi-dose drug vials that are
meant to safely supply more than one patient if each dose is drawn with a
new needle.

“As we get new technology, it’s just re-educating personnel,” Schaefer
said.

The Buffalo hospital said it began using insulin pens in October 2010. An
inspection in November 2012 led to the discovery of pens in medication
carts without patient labels and the likelihood they may have been used on
more than one patient.

“There is a very small chance that some patients could have been exposed to
the hepatitis B virus, the hepatitis C virus or HIV, based on practices
identified at the facility,” a Friday memo from the VA to the region’s
congressional representatives said.

Rep. Chris Collins, R-N.Y., spoke with the undersecretary for health at the
Department of Veterans Affairs, spokesman Grant Loomis said, and was told
veterans would be contacted beginning Monday.

The VA said it was establishing a nurse-staffed call center to notify and
respond to veterans’ questions and arrange blood tests and any necessary
follow-up care. Employees would also receive educational material on the
appropriate use of insulin pens, the agency said.

“Once this was identified, immediate action was taken to ensure the insulin
pens were labeled and only used according to pharmaceutical guidelines,”
the hospital’s statement said.

The VA’s National Center for Patient Safety, meanwhile, has been asked to
prepare a safety alert for all VA facilities, spokesman Josh Taylor said.
The notices are designed to reinforce best practices for patient care.

In 2009, Fort Polk’s Bayne-Jones Army Community Hospital contacted and
tested 15 patients who might have been injected with insulin from a pen
first used on another patient. Hospital records don’t indicate that any
became ill because of those injections, spokeswoman Kathy Ports said
Monday.
___

Associated Press writers Janet McConnaughey in New Orleans and Kevin
Freking in Washington contributed to this report.
__________________________________________________________________
__________________________________________________________________
http://tinyurl.com/cdkmbhk

USA: Why Green Hospital Practices Could Make You Sick
Kent Sepkowitz, Newsweek, USA (14.01.13)

[Moderators Note: This is a muddled piece conflating numerous issues.
Reader beware]

The u.s. centers for Disease Control and Prevention recently launched the
One and Only Campaign, an endeavor aimed not—as the name might suggest—at
promoting marital monogamy, but ­rather at reducing the improper reuse of
certain medical devices. By its estimate, well over 100,000 Americans in
the last decade have been exposed to infections such as hepatitis and HIV
because of unsafe injections, such as reused needles or vials of medicine
that have been dipped into more than once. These exposures have resulted in
dozens of increasingly well-publicized outbreaks, such as the 21 cases of
hepatitis C spread from one dialysis center in New Jersey. Indeed, the CDC
now has a website to keep the public informed of the latest trouble.

To limit possible risk, the CDC, in its new campaign, has suggested a
simple approach to injections: “one needle, one syringe, only one time.”
Seems like a straightforward initiative without a countervailing point of
view, right?

Maybe not. Meet the green health-care crowd, a serious and longsighted
group who frets over the staggering amount of medical waste produced—about
7,000 tons a day, or 2.5 million tons annually, enough to spawn a $3
billion health-care-waste-management industry. While they aren’t pushing
the reuse of needles, they believe that recycling as much medical equipment
as is safely possible is the best way to reduce the landfills of hospital
waste and prevent boats loaded with medical trash from drifting port to
port in search of a willing or financially strapped country to accept our
discards.

Recycling by resterilization has a longstanding precedent in health care,
and none of the outbreaks reported thus far has been related to properly
recycled medical equipment. High-ticket items like bronchoscopes and
endoscopes that cost far too much to toss out after every use are
reprocessed through carefully prescribed, heavily regulated steps. Building
on this approach, current medical-waste recyclers are looking to put other
invasive equipment—not needles or syringes, but certain types of surgical
tools—back into circulation after a good scrubbing. Plus, by picking
cheaper equipment to rework—stuff that can be disassembled, sterilized, and
reassembled or else tossed away if too messy—they can throw it out if they
can’t get it right. That way, they are less likely to stumble over a
problem faced by U.S. Veterans Affairs hospitals that recently were
investigated because of possible spread of HIV and hepatitis related to
improperly cleaned endoscopes.

Inevitably the two initiatives—clean and green—will collide, even though
both are acting on behalf of protecting the public’s health. It’s a debate
between those seeking immediate reward (don’t give me a dangerous
infection) and those with a longer view (please leave some of the earth
inhabitable). Current methods appear adequate to guarantee sterility for
the shortlist of items already put onto the recycling merry-go-round. The
trick will be to maintain the same caution and sober, deliberate science as
the list lengthens. Because unlike glass bottles and mounds of flattened
cardboard, in this corner of the recycling market, there is no margin for
error.

Dr. Kent Sepkowitz is an infectious-disease specialist in New York City.
__________________________________________________________________
__________________________________________________________________
USA: 716 Patients at VA May Have Been Exposed to HIV
Jerry Zremski, Buffalo News, New York USA (12.01.13)

The US Department of Veterans Affairs (VA) has informed local lawmakers and
members of Congress that 716 patients at the Buffalo VA Medical Center may
have been exposed to HIV, hepatitis B, or hepatitis C because of the
inadvertent reuse of insulin pens that were intended for one-time use. The
VA says that 570 of those patients are still alive. The possible reuse of
the insulin pens happened between October 19, 2010, and November 1, 2012,
according to the VA memo sent on January 11. The memo states that health
officials discovered the problem during a routine pharmacy inspection last
November 1 when they found insulin pens without patient labels attached to
them in supply carts, thus revealing the possible reuse of the insulin
pens. Hospital spokeswoman Evangeline Conley explained that once officials
detected the problem, the hospital immediately took action to ensure that
the insulin pens were used according to pharmaceutical guidelines, that the
insulin pens were labeled, and that the hospital changed its procedure to
prevent the reuse of insulin pens.

The VA plans to send a letter to every veteran who may have been infected,
and is also establishing a nurse-staffed call center to handle calls from
concerned veterans. Rep. Chris Collins (R-N.Y.), after speaking with VA
Undersecretary for Health Dr. Robert A. Petzel, stated that “[Petzel’s]
thought was that it’s a very, very low chance of passing infection, but
it’s not out of the realm of possibility, and that’s why they’re testing
everyone.” So far, the VA has not found any patients who were infected at
the Buffalo VA Medical Center; the VA is carrying out an analysis of the
cause of the problem and developing an action plan based upon the analysis.
The VA National Center for Patient Safety is developing a patient safety
alert for other VA medical facilities to ensure that this error does not
occur anywhere else. Collins notes that the VA is being “open and
transparent” about the problem; however, he states, “It doesn’t diminish
the fact that it did go on for two years here.”

Sen. Charles E. Schumer (D-N.Y.), stunned after hearing of the reuse of the
insulin delivery pens, declared, “What has happened can only be described
as the grossest of irresponsible and dangerous behavior.” He urges the VA
to deal immediately with the health of those who were victimized and launch
a thorough investigation to let everyone know what will be done to prevent
this problem from happening in Buffalo or anywhere else in the country
again.
__________________________________________________________________
__________________________________________________________________
http://dx.doi.org/10.1136/bmj.f176

USA: “Greed, ignorance, and laziness” are behind medical injection dangers
in US, says official

By Jeanne Lenzer, BMJ, UK BMJ 2013; 346 (10.01.13)

Dangerous injection practices by healthcare providers in the United States
have caused at least 49 infectious outbreaks since 2001, a new report has
found, putting 150?000 people at risk of diseases ranging from HIV to
hepatitis and drug resistant Staphylococcus aureus. Two thirds of the
dangerous injections were given in just the past four years, it says.

The findings, published by the newspaper USA Today,1 come on the heels of a
nationwide outbreak of more than 650 fungal infections related to tainted
drugs used across 19 states, resulting in 372 cases of meningitis and 39
deaths.

Officials at the Centers for Disease Control and Prevention (CDC), which
provided the data to USA Today, said that the numbers in the …

Requires subscription or payment
__________________________________________________________________
__________________________________________________________________
Bioengineer developing needle-free “nanopatch” vaccines
By Kate Kelland, Reuters Health and Science Correspondent (10.01.13)

LONDON | (Reuters) – When it comes to protecting millions of people from
deadly infectious diseases, Mark Kendall thinks a fingertip-sized patch
covered in thousands of vaccine-coated microscopic spikes is the future.

A biomedical engineer with a fascination for problem solving, he has
developed the so-called “nanopatch” to try to transform delivery of life-
saving vaccines against potential killers like flu and the HPV virus that
causes cervical cancer.

After 160 years of using needles and syringes for immunization, he says,
at-risk people – especially those living in poorer, tropical, remote
countries – need something simpler, stabler and easier to use. And he
thinks he has the answer.

“Most current vaccines are delivered via the needle and syringe system that
was developed in 1853,” the scientist said in an interview from his
laboratory in Australia. “It’s effective on many levels but it also has
many downsides.”

Kendall’s nanopatch has yet to prove itself in human clinical trials, but
has had impressive results in animal tests.

Those have been enough to persuade U.S. pharmaceutical giant Merck, maker
of many of the world’s top-selling vaccines, to give Kendall a three-year
research grant to take the device into human trials.

NO COLD CHAIN

The nanopatch is designed to place a tiny amount of vaccine just under the
skin without the need for a needle jab. Because it delivers the active
ingredient right to where it is needed, tests have shown it can generate
same immune response with only a fraction of the dose needed in a
conventional vaccine.

And because it uses the vaccine in dried form, it does not need cold-chain
refrigeration or trained staff to deliver it.

Kendall says one key limitation of needle and syringe vaccines, beside
needing expensive cold-chains and specialist staff to deliver them, is that
the needle puts the vaccine into muscle, which has relatively few immune
cells.

In the last 30 years or so, immunologists have discovered that skin, unlike
muscle, is rammed full of immune cells, making it a far more effective
place to apply vaccines. “You could argue the skin is our immune sweet
spot,” Kendall said.

So far, Kendall’s research team at the University of Queensland’s Institute
for Biotechnology and Nanotechnology have tested the nanopatch on mice
using various inoculations – including against flu, the human
papillomavirus (HPV) that causes cervical cancer, and even with a potential
new vaccine against mosquito-borne viral disease chikungunya.

“We demonstrated that you need only a tiny fraction of the dose, perhaps a
hundredfold less” to get the same immune response, Kendall said.

Among other potential advantages of the nanopatch are that it is pain free,
low cost – it could be made for under $1 a dose compared with more than $50
for many current vaccines – and easily transportable. Kendall even ponders
whether it might be mailed to remote places for people to administer it
themselves.

PATCHY HISTORY

But he also recognizes there is a long way to go to bring what is still an
experimental device to market – and he is aware of previous attempts at
vaccine patches that had little success.

The Austrian biotech firm Intercell, now owned by France’s Vivalis, saw its
share price slump in 2010 after its experimental vaccine enhancement patch
(VEP) system against pandemic flu failed in a mid-stage trial.

Kendall says, however, that Intercell’s VEP system had a very different
mode of action. The patch was applied after a needle vaccination and
designed to boost the jab’s effect by putting an adjuvant, or booster, into
the skin.

His nanopatch applies the vaccine direct, with no adjuvant. “We apply the
patch against the skin with an applicator … and we have a high level of
control of the antigen delivered.”

Kendall is keen to ensure that if his patch does make it to market, it will
not follow the pattern of many previous vaccine developments, which have
seen life-saving shots go first to people in the wealthy world and only
after several years start to reach those who need them in poorer countries.

There are still 17 million deaths a year from infectious diseases, mostly
in poor countries that often cannot afford the pricey vaccines that could
prevent them.

Kendall has just returned from a feasibility study using prototypes of the
nanopatch in Papua New Guinea, which has one of the world’s highest rates
of infection with HPV – a virus that can lead to cervical cancer, the
biggest cause of death in young women in developing countries.

He travelled in daytime temperatures of 30 to 40 degrees Celsius and up to
100 percent humidity “and when we got back and tested the patches we found
there had been no loss in activity”.

This success means Kendall now wants to push on to full clinical trials on
humans, starting this year in Australia and followed swiftly with parallel
trials in Papua New Guinea. An enterprise award of $100,000 from the luxury
watchmaker Rolex is helping him along that path.

“This could potentially change the world of vaccinations. But we still have
a very long way to go,” he says.

(Editing by Louise Ireland)
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http://tinyurl.com/cbp2vr7

Uganda: Hepatitis B outbreak continues in Uganda
by Jeffrey Bigongiari, vaccine news daily

Hepatitis B

Public health officials in Uganda’s West Nile region have expressed concern
about persistent outbreak of Hepatitis B that has caused the deaths of at
least 29 people.

The officials said the illness is concentrated in the northwestern
districts of Moyo and Adjumani and the number of cases appears to be on the
rise. Most of the health facilities in the region lack the required
vaccines and equipment needed to combat the illness, according to
Monitor.co.ug.

Local residents have complained that a complete dose of the Hepatitis B
vaccine remains too expensive at area private clinics.

Surveillance teams said the number of fatalities might be higher than 29
because many residents are forgoing treatment at public health facilities
in favor of private ones that are not fully reporting the extent of
infections.

Dr. Dr Dominic Drametu, the medical superintendent of Adjumani, said the
district hospital has treated approximately 90 cases of the illness in the
last three years.

“On average at least the hospital handles at least two cases of Hepatitis B
every month but our challenge is the facility lacks the required drugs,”
Drametu said, Monitor.co.ug reports.

Hepatitis B is a viral infection that predominantly affects the liver. It
can vary in severity, lasting a few weeks or resulting in life-long health
problems, according to the U.S. Centers for Disease Control and Prevention.
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www.aljazeera.com/programmes/insidestory/2013/01/20131410010949738.html

Russia: Al Jazeera Examines HIV In Russia
Kaiser Daily Global Health Policy Report (07.01.13)Monday, January 07, 2013

Al Jazeera continues its coverage of HIV in Russia, where “[t]he latest
official figures show that about 200 new cases are being recorded every
single day.” The news service writes, “HIV is spreading five times faster
in Russia than the global average, with Ukraine and Russia accounting for
90 percent of the region’s cases,” adding, “The main source for 60 percent
of new infections is dirty needles used to inject drugs.”

However, the country has “resisted so-called harm reduction strategies
including funding needle exchange programs, angering health workers and
global HIV prevention groups,” Al Jazeera writes, noting, “Activists say
social stigma is impeding the fight against HIV in Russia.” An accompanying
“Inside Story” video report examines how Russia “plan[s] to stem the rise
in HIV” (1/4).
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http://www.ipsnews.net/2013/01/is-tashkent-cooking-its-hivaids-statistics/

Uzbekistan: Is Tashkent Cooking Its HIV/AIDS Statistics?
By EurasiaNet Correspondents, Tashkent Uzbekistan EurasiaNet (02.01.13)

TASHKENT, Jan 2 2013 (EurasiaNet) – Uzbekistan is facing a public health
time bomb, experts are warning. Authorities contend they are making gains
in the battle to contain the spread of HIV/AIDS, but independent
specialists say such claims are built on twisted figures and deceptive
methodology.

At a late-November speech to mark World AIDS Day, the director of
Uzbekistan’s National AIDS Centre, Nurmat Atabekov, said Tashkent is making
progress in its fight against HIV/AIDS and that the number of new
infections in the country is falling, local media reported.

In 2011, Atabekov said, Uzbekistan saw an 11-percent decline in the number
of new infections compared with the previous year; that followed a 5.5
percent decline in 2010. This year, the country should see another drop.
The total number of infected people continues to rise – to 24,539 as of
Nov. 1 – but the number of new infections per year peaked in 2009, he said.

“We now test over two million people a year and the rate of occurrence
(this year) is 0.19 cases per 100,000 people,” Atabekov said. “For
comparison, it was 0.43 in 2008.”

That sounds like very good news. But independent experts say Atabekov and
his office came up with the rosy numbers by design. Of course, it would not
be the first time an Uzbek official has massaged statistics. Since the
Soviet days when Uzbek planners reported inflated cotton harvests to
Moscow, Tashkent has often distributed misleading numbers.

The U.S. State Department regularly cautions that Uzbek government
statistics on everything from economic growth to domestic violence are “not
consistently reliable”. In some cases, authorities go to great lengths to
conceal facts. For example, from 2007-10, officials tried to cover up a
hospital scandal involving the spread of HIV that left 147 children
infected in the eastern city of Namangan.

EurasiaNet.org tried to follow up with Atabekov, but he would not take our
calls and his staff would not share a copy of his presentation. But his
deputy, Gulyam Radjabov, did speak with us briefly and confirmed that
though Uzbekistan is testing more people each year, “less and less cases of
infected people are being found.”

The key to the decrease, on paper, seems not to be that two million people
were screened last year (out of a population of roughly 30 million), but
rather who was screened. Several HIV experts familiar with Uzbekistan said
the infection rate is dropping because officials are testing people who are
at low risk of contracting the virus.

For example, the number of Uzbeks tested has more than doubled since 2009,
when HIV testing for pregnant women became mandatory. Couples require a
test to obtain a marriage certificate, too. While that is a good practice,
HIV experts say, these are low-risk populations and screening them allows
Tashkent to trumpet a drop in the overall infection rate.

But are vulnerable groups – specifically injecting drug users and gay men –
getting tested? Experts worry that official statistics underestimate the
absolute number of infections by as much as a factor of three because
Uzbekistan’s conservative society (where homosexuality is illegal)
stigmatises these most vulnerable populations, and thus they eschew
testing.

Getting HIV data for Uzbekistan is a chore. UNAIDS does not publish basic
epidemiological statistics for the country, and the World Health
Organization’s latest online data for Uzbekistan, which is full of holes,
was published in 2008.

Because of the sensitivity of the issue in Uzbekistan – where most western
NGOs have been forced to close by the government, foreigners are routinely
denied visas, and a local activist was jailed in 2009 for passing out
literature on how to prevent HIV – knowledgeable regional experts would
speak only on the strictest terms of anonymity.

Several suggested that authorities are deliberately hiding new infections
in order to report numbers that will burnish Uzbekistan’s image. Just a few
years ago new infection rates were exploding. Between 2001 and 2005, when
international organisations were helping to introduce testing, annual newly
registered cases grew by 300 percent.

Atabekov pointed to migrant workers as a particular problem. On this point,
experts concur. An estimated three million Uzbeks work in Russia, where the
virus is out of control. As in Uzbekistan, social stigma among high-risk
populations in Russia discourages testing.

Migrants traveling to Russia from Uzbekistan routinely pay for sex (one
2009 study found 93 percent had) and show little knowledge of how to
prevent HIV. In 2010, the Central Asia AIDS Control Project found that only
12.9 percent of Uzbek migrants knew that a condom could prevent the virus.
Men seem to be traveling to Russia, picking up HIV from prostitutes, and
later passing the virus onto their wives at home.

But there the consensus ends. A Western HIV expert with years of Central
Asia experience flagged two additional concerns with the Uzbek National
AIDS Center’s statistics.

For one, tests are coming back with false negatives, she said, because
samples are not properly refrigerated, especially in rural areas.

If sending HIV-positive people back into the population convinced they are
not carriers is not worrying enough, the expert expressed concern that
officials deliberately fix infection numbers to show a decline: “The
government is artificially keeping (low) the rate of infections by freezing
the blood at the point when the (nationwide) infection level reaches a
certain (quota) and testing that blood the following year. So if you look
at the statistics for each year, most of the infections will be recorded in
the first quarter. And the show goes on,” she said.

*This story originally appeared on Eurasianet.org
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http://www.usatoday.com/story/news/nation/2012/12/26/infections-needles-
mrsa-hospitals/1780335/

USA: Dirty medical needles put tens of thousands at risk in USA
Peter Eisler, USA TODAY (28.12.12)

As drug-resistant superbugs and increasingly virulent viruses menace the
medical world, patients face a threat that was supposed to die with the
advent of the disposable syringe more than 50 years ago: dirty needles.

STORY HIGHLIGHTS
– More than 150,000 patients received unsafe injections since 2001
– More than 5% of clinicians don’t follow safety standards
– Dirty syringes can infect multiple patients

When seven people arrived at a Delaware hospital in March with drug-
resistant MRSA infections, the similarities were alarming.

All of the patients had the same strain of MRSA, all had the infections in
joints, and all had gotten injections in those joints at the same
orthopedic clinic in a three-day span. State health officials found that
the clinic had injected multiple patients with medication from a vial that
was meant to be used only once, spreading the MRSA bacteria to a new
patient with each shot.

A month later, three patients in Arizona were hospitalized with MRSA
infections, also following shots at a pain clinic. Again, state and county
health officials tied the cases to the injection of multiple patients from
a single-dose vial. A fourth shot recipient died; investigators noted that
MRSA “could not be ruled out” as a cause.

In July, more than 8,000 patients of an oral surgeon in Colorado were
advised to get tested for HIV, the virus that causes AIDS, and hepatitis
after state health investigators found that his office reused syringes to
inject medication through patients’ IV lines. Six patients have tested
positive for one of the diseases.

As drug-resistant superbugs and increasingly virulent viruses menace the
medical community, health officials still face a quiet threat that was
supposed to die with the advent of the disposable syringe more than 50
years ago: dirty needles.

Since 2001, more than 150,000 patients nationwide have been victims of
unsafe injection practices, and two-thirds of those risky shots were
administered in just the past four years, according to data from the U.S.
Centers for Disease Control and Prevention. The errors led to at least 49
disease outbreaks, a USA TODAY examination shows, and a trail of victims
suffering with potentially life-threatening bacterial infections, such as
MRSA, and sometimes fatal viruses, such as hepatitis.

“You just feel betrayed, vulnerable,” says Evelyn McKnight, 57, who
contracted hepatitis C a decade ago while being treated for cancer at a
Nebraska oncology clinic. The virus required six months of debilitating
drug treatment on top of her chemotherapy, and it could re-emerge at any
time.

“People think, ‘This can’t happen in the United States; this is a Third
World thing,’ ” adds McKnight, who heads HONOReform, a foundation that
advocates safe injection practices. “Unfortunately, it happens on a regular
basis, and it affects a lot of people, families, communities.”

Without question, the overwhelming majority of the hundreds of millions of
injections administered annually in hospitals, nursing homes, clinics and
doctors’ offices are done safely and without incident. But a significant
percentage of clinicians — some studies suggest more than 5% — don’t
follow accepted safety standards.

That translates into a lot of bad shots.

“It’s a huge issue. … It makes us crazy,” says Michael Bell, the CDC’s
associate director for infection control. “We’re trying to eliminate a
range of harms in health care — high-level, complex challenges — and we
look behind us and these basic, obvious, completely preventable problems
are still occurring. … It really comes down to a matter of greed,
ignorance or laziness.”

USA TODAY reviewed state and federal outbreak reports, regulatory records
and court documents to gauge the scope and impact of unsafe injection
practices. The newspaper also interviewed public health officials, doctors
and nurses — and victims. Key findings:

• The CDC’s official tally of 150,000 people who were affected by unsafe
injections likely represents a fraction of all cases. Although that figure
comprises all of the patients who got bad shots — including those who
weren’t sickened — it’s ??based only on incidents that are reported, and
many are not. Symptoms from injection-related illnesses, such as hepatitis,
can take years to emerge, so many cases are not traced back to their true
cause.

• Federal and state data show that unsafe injections are more common in
clinics, smaller outpatient facilities and long-term care centers than in
acute care hospitals. Some of the biggest illness outbreaks linked to reuse
of syringes or the injection of multiple patients from single-use vials
have occurred at stand-alone clinics, such as oncology and endoscopy
facilities, or outpatient surgical settings.

• Many clinics and other outpatient facilities with suspect injection
records operate in a regulatory gray area with little oversight. Concerns
about injection practices in those settings often are the purview of state
medical boards, which generally lack the regulatory authority or
investigative resources of health departments. Few states have passed laws
to address concerns about injection practices in such facilities.

“The volume of poor (injection) practice is very large and unmonitored, and
I really do think it’s a huge problem that the country is facing,” says
Neil Fishman, an infectious-disease specialist and associate chief medical
officer at the University of Pennsylvania Health System. “It is, in some
respects, a hidden epidemic … (and) the oversight is very weak.”

Unwitting victims…

Article continues at http://tinyurl.com/cokjcws
www.usatoday.com/story/news/nation/2012/12/26/infections-needles-mrsa-
hospitals/1780335/
__________________________________________________________________
__________________________________________________________________
India: Study: Village in Kerala Tops in Hepatitis-B Cases
M.V. Pavan, Times of India, India (18.12.12)

The Indian Council of Medical Research identified 348 hepatitis B-infected
persons in a survey of the 2,017 residents in the village of Ooramana in
the Ernakulum District. The cases in Ooramana represent 17 percent of all
hepatitis B cases in India, according to the Manipal Centre for Virus
Research (MCVR). About seven percent of India’s population has hepatitis B,
stated G. Arun Kumar, head of MCVR.

Hepatitis B is typically spread among persons living together in one house.
In contrast, the MCVR investigative team identified a high level of
“horizontal” transmission in Ooramana, where hepatitis B-infected
individuals transmit the virus to people outside the family. The two
primary means of horizontal transmission in Ooramana are infected syringes
and four barbershops that serve the village, reported Kumar.

The MCVR conducted the studies in Ooramana during the months of October and
November 2012.
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________________________________*_________________________________
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Facsimile: +41 22 791 4836 E- mail: sign@who.int
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SIGN meets annually to aid collaboration and synergy among SIGN network
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The 2010 annual Safe Injection Global Network meeting was held from 9
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The SIGN 2010 meeting report pdf, 1.36Mb is available on line at:
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