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SIGNpost 00697

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST *

Post00697 World Hepatitis Day + eCourse + Abstracts + News 08 May 2013

CONTENTS
1. World Hepatitis Day 2013
2. PAHO/WHO offers virtual course on primary health care and management of
pharmaceutical services
3. Abstract: Association of the dominant hand and needle stick injuries for
Healthcare Workers in Taiwan
4. Abstract: Injectable administration privileges among pharmacists in the
United States
5. Abstract: Complications of injectable fillers, part I
6. Abstract: Significance of screening antibodies to hepatitis B virus core
antigen among Syrian blood donors
7. Abstract: Occult hepatitis B virus infection among Egyptian blood donors
8. Abstract: Dual HIV Risk: Receptive Syringe Sharing and Unprotected Sex
Among HIV-Negative Injection Drug Users in New York City
9. Abstract: Vaccine coverage of healthcare students in hospitals of the
Paris region in 2009: The Studyvax Survey
10. Abstract: Immunotherapy Safety: What Have We Learned from Surveillance
Surveys?
11. Abstract: Computer screen saver hand hygiene information curbs a
negative trend in hand hygiene behavior
12. Abstract: Update on hand hygiene
13. Abstract: Automated hand hygiene count devices may better measure
compliance than human observation
14. Case Report Abstract: Inadvertent injection of formalin mistaken for
local anesthetic agent: report of a case
15. Case Report Abstract: Primary inoculation skin tuberculosis by
accidental needle stick
16. Case Report Abstract: Allergen specific immunotherapy induced multi-
organ failure
17. Abstract: Combination injectable contraceptives for contraception
18. Abstract: Safety of Human Papillomavirus Vaccines: A Review
19. Abstract: Impact on Caesarean section rates following injections of
sterile water (ICARIS): a multicentre randomised controlled trial
20. Abstract: In vivo toxicological evaluation of polymeric nanocapsules
after intradermal administration
21. Abstract: Towards a realistic in vitro experience of epidural Tuohy
needle insertion
22. News
– Pakistan: Former KP govt responsible for vaccine scam, observes PHC’
– Las Vegas USA: Vegas jury asked to ignore hep C case ‘hysteria’
– USA: Dental Students Identified as Potential Infection Control Leaders
– UK: Portsmouth ‘rogue’ heroin claims sixth victim
– Oklahoma USA: Four new cases of hepatitis C identified in testing of
dentist’s patients
– UK: Needle dumping ground angers Third Street residents: More than 500
needles a day are discarded in safe disposal boxes located throughout
the city
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__________________________________________________________________
________________________________*_________________________________

1. World Hepatitis Day 2013
__________________________________________________________________
http://www.worldhepatitisalliance.org/WorldHepatitisDay/WHD2013.aspx

World Hepatitis Day 2013

Campaign Theme – This is Hepatitis – Know it. Confront it.

This year on the 28th July we will be celebrating our 6th World Hepatitis
Day, working in partnership with the World Health Organisation (WHO).

Our 2013 posters are now available to download here, and web banners will
be available soon. These materials should be all you need to set up a great
campaign anywhere in the world.

You will soon be able to customise these posters using our online
customisable tool to change the pictures, wording or language. This tool
will go live on our website in May.
www.worldhepatitisalliance.org/WorldHepatitisDay/CampaignMaterials.aspx

This year we are focusing on two main themes:

1. This is hepatitis. Know it. Confront it.: This theme has seen big
success since its launch in 2010, as it focuses on the real-life impact of
viral hepatitis. This year we are sure it will be just as popular!

2. See No Evil, Hear No Evil, Speak No Evil: The message from this theme is
that hepatitis is being ignored around the world, and we are calling for
that to change. The proverb is widely recognised, and we have two great
events to generate interest around it (see below)

We would love you to get involved and help us celebrate World Hepatitis
Day, either by downloading some of our campaign materials or by getting
involved in our global events to increase awareness of hepatitis.

Attempt to break the Guinness World Record

Celebrate World Hepatitis Day by helping break a Guinness World Record –
find out more here!
www.worldhepatitisalliance.org/WorldHepatitisDay/WHD2013/Guinness.aspx

Three Wise Monkeys Travel the World for Hepatitis Awareness

We’ve got our very own soft toy monkeys who will be travelling the world
this year to promote awareness about hepatitis. Learn more and order your
very own monkeys here!
www.worldhepatitisalliance.org/WorldHepatitisDay/WHD2013/ThreeWiseMonkeys.a
spx
__________________________________________________________________
________________________________*_________________________________

2. PAHO/WHO offers virtual course on primary health care and management of
pharmaceutical services
__________________________________________________________________
PAHO/WHO offers virtual course on primary health care and management of
pharmaceutical services

The Pan American Health Organization/World Health Organization (PAHO/WHO)
is sponsoring the 3rd Virtual Course on Primary Health Care–based
Pharmaceutical Services for Managers, aimed at developing the capacities of
pharmaceutical services leaders and managers through a client- and
community-centered approach.

The course will be offered from June 6th through October 17, 2013.
Registration is open through April 30, 2013.

PAHO Director Carissa F. Etienne announced the new course this week during
an official visit to Barbados.

The 190-hour, 19-week course is designed for professionals involved in
management, administration and technical activities in public sector
pharmaceutical services as well academics in public health and pharmacy
education, professionals involved in pharmacy service delivery, and those
involved in pharmaceutical delivery research.

The overarching goal of the course is to shift the focus of pharmaceutical
service management from “medicines as products” to “medicines for people”
in the community and their health-care needs.

Specific subjects will include:

* The role of pharmaceutical services in primary health care and health-
care delivery
* The influence of social determinants on the health of individuals and
communities
* Knowledge to help improve pharmaceutical services in individual countries
* Components and management structure of existing pharmaceutical services
* Formulation of plans for shifting pharmaceutical services from being
medicines-oriented to client/people-oriented
* Competencies required for implementing client-oriented strategies
* Designing interventional proposals for introducing renewed primary health
care.

The 3rd Virtual Course on Primary Health Care-based Pharmaceutical Services
for Managers – Version 2013 will be offered through the Virtual Campus for
Public Health in English and Portuguese.

PAHO/WHO is promoting access to medicines and technologies as one of the
six elements needed to strengthen health-care delivery systems and
universal health coverage.

For more information visit: http://www.campusvirtualsp.org/?q=en/welcome
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Association of the dominant hand and needle stick injuries for
Healthcare Workers in Taiwan
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23638275

Malawi Med J. 2012 Sep;24(3):56-60.

Association of the dominant hand and needle stick injuries for Healthcare
Workers in Taiwan.

Mbirimtengerenji N, Schaio J, Guo L, Muula A.

University of Malawi, Kamuzu College of Nursing, Private Bag 1 Lilongwe.
Malawi.

BACKGROUND: Healthcare workers face the risk of acquiring blood-borne
infections from patients through needle stick injuries. Understanding the
factors that are associated with increased risk, for example, the role of
the dominant hand, is important so that preventive measures can be focused.

METHODS: The EPINet (Exposure Prevention, Information Network-a trade mark
of Virginia University) questionnaire was used to collect the data. The
EPInet system started 2003 in Taiwan under C-MESH. When healthcare workers
sustain sharp injury, they complete the injury report form, and report to
infection control personnel, who then transmitted the data to EPINet
website monthly.

RESULTS: 93.5% of the healthcare workers reported being right handed and
only 6.5% reported being left handed. About two-thirds (65%) of the
reported injuries were by self, 30% injuries were by others and 5% were
reported as injured by unknown.There was an association between the
dominant hand injury and the needle stick original HCW user, p<0.0001.
There is a significant difference between the dominant hand and the
needlestick original HCW user. HCW whose dominant hand was the right hand
were most likely at risk to be injured by “others” than “self” or “unknown
HCW”; OR= 18.39; CI (0.42 ± 2.33).

CONCLUSION: Needlestick injuries among health care workers in Taiwan
continue to pose a serious occupational problem. Historically, prevention
has focused on the use of protective wear than assessment of which hand may
be at greater risk than the other. There is a greater need to prevent hand
injuries as the dominant hand remains the most used and injured in process
of patient care.

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3576832/
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Injectable administration privileges among pharmacists in the
United States
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23135568

Am J Health Syst Pharm. 2012 Nov 15;69(22):2002-5.

Injectable administration privileges among pharmacists in the United
States.

Oji V, McKoy-Beach Y, Pagan T, Matike B, Akiyode O.

Innovative Pharmaceuticalsand Consulting, Silver Spring, MD 20910, USA.
medgal8@gmail.com

PURPOSE: Privileges for administering nonvaccine injectable medications
among pharmacists in the United States were assessed.

METHODS: An e-mail inquiry on specific protocols for the administration of
injectables was sent to the state boards of pharmacy (BOPs) for all 50
states and the District of Columbia that had a valid e-mail address listed
on the National Association of Boards of Pharmacy website. Respondents were
encouraged to include in their response a link to state regulations so that
information from the BOP laws on privileges for administering injectables
could be closely reviewed. State guidelines were reviewed online for all
BOPs that did not respond to the first e-mail in order to complete the
study. A follow-up e-mail was sent only to those respondents whose states
granted pharmacists privileges for administering nonvaccine injectables in
order to clarify the specific drugs allowed to be injected by pharmacists.

RESULTS: Responses received included either links to state regulations or
explicit statements of the rules regarding pharmacists’ injectable
privileges. A total of 21 states currently grant pharmacists articulate
written information or rules pertaining to the privilege of administering
nonvaccine injectable products. Authority is provided through collaborative
practice agreements for most states. Products administered by pharmacists
vary by state.

CONCLUSION: Pharmacists in 21 states were found to have privileges for
administering injectable medications other than vaccines. Pharmacists were
authorized to administer these drugs through completion of training
approved by the Accreditation Council for Pharmacy Education, collaborative
practice agreements, valid prescription orders, board certification, or
other broad privileges as specified in state regulations.
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Complications of injectable fillers, part I
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23636629

Aesthet Surg J. 2013 May 1;33(4):561-75.

Complications of injectable fillers, part I.

Delorenzi C.

Dr DeLorenzi is a plastic surgeon in private practice in Kitchener,
Ontario, Canada.

Dermal filling has rapidly become one of the most common procedures
performed by clinicians worldwide. The vast majority of treatments are
successful and patient satisfaction is high. However, complications, both
mild and severe, have been reported and result from injection of many
different types of dermal fillers.

In this Continuing Medical Education review article, the author describes
common technical errors, the signs and symptoms of both common and rare
complications, and management of sequelae in clear, easily adaptable
treatment algorithms.

KEYWORDS: biofilms, dermal filler technique, filler complication, filler
infection, filler technique, hyaluronidase
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Significance of screening antibodies to hepatitis B virus core
antigen among Syrian blood donors
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23621787

Transfus Med. 2013 Apr 28.

Significance of screening antibodies to hepatitis B virus core antigen
among Syrian blood donors.

Muselmani W, Habbal W, Monem F.

Department of Biochemistry and Microbiology, Faculty of Pharmacy.

BACKGROUND: Hepatitis B virus (HBV) transmission via hepatitis B surface
antigen (HBsAg)-negative blood donors has been reported. While many
countries have implemented screening antibodies to hepatitis B core antigen
(anti-HBc) to further enhance transfusion safety, HBsAg is still the only
obligatory HBV screening test of blood donors in Syria.

OBJECTIVE: To evaluate the significance of screening anti-HBc to reduce the
risk of transfusion transmitted HBV infection in Syria.

METHODS/MATERIALS: A cohort cross-sectional prospective study included 1939
healthy blood donors assigned at the blood transfusion center of Damascus
University. All donors were tested for HBsAg and anti-HBc. HBsAg-negative,
anti-HBc- positive sera were further tested quantitatively for antibodies
to hepatitis B surface antigen (anti-HBs) and ‘anti-HBc alone’ sera were
considered for HBV quantitative real time polymerase chain reaction (qPCR).

RESULTS: Among 1913 HBsAg-negative donors, 215 (11·2%) were anti-HBc-
positive including 125 anti-HBs high-positive and 59 anti-HBs low-positive
donors. The remaining 31 donors were ‘anti-HBc alone’, five of which were
HBV DNA- positive.

CONCLUSION: Our results suggest including anti-HBc as an additional
screening test for blood donors in Syria to reduce the risk of HBV
transmission. As the most cost-effective measure, anti-HBc-positive donors
should be tested quantitatively for anti-HBs and only donors with no or low
(<100 IU?L-1 ) anti-HBs should be deferred.

© 2013 The Authors. Transfusion Medicine © 2013 British Blood Transfusion
Society.
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Occult hepatitis B virus infection among Egyptian blood donors
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23646231

World J Hepatol. 2013 Feb 27;5(2):64-73.

Occult hepatitis B virus infection among Egyptian blood donors.

Said ZN, Sayed MH, Salama II, Aboel-Magd EK, Mahmoud MH, Setouhy ME,
Mouftah F, Azzab MB, Goubran H, Bassili A, Esmat GE.

Zeinab N Said, Enas K Aboel-Magd, Microbiology and Immunology Department,
Faculty of Medicine (for Girls), Al-Azhar University, 11511 Cairo, Egypt.

AIM: To identify blood donors with occult hepatitis B virus (HBV) infection
(OBI) to promote safe blood donation.

METHODS: Descriptive cross sectional study was conducted on 3167 blood
donors negative for hepatitis B surface antigen (HBsAg), hepatitis C
antibody (HCV Ab) and human immunodeficiency virus Ab. They were subjected
to the detection of alanine aminotransferase (ALT) and aspartate
transaminase (AST) and screening for anti-HBV core antibodies (total) by
two different techniques; [Monoliza antibodies to hepatitis B core (Anti-
HBc) Plus-Bio- Rad] and (ARC-HBc total-ABBOT). Positive samples were
subjected to quantitative detection of antibodies to hepatitis B surface
(anti-HBs) (ETI-AB-AUK-3, Dia Sorin-Italy). Serum anti-HBs titers > 10 IU/L
was considered positive. Quantitative HBV DNA by real time polymerase chain
reaction (PCR) (QIAGEN-Germany) with 3.8 IU/mL detection limit was
estimated for blood units with negative serum anti-HBs and also for 32
whose anti-HBs serum titers were > 1000 IU/L. Also, 265 recipients were
included, 34 of whom were followed up for 3-6 mo. Recipients were
investigated for ALT and AST, HBV serological markers: HBsAg (ETI-MAK-4,
Dia Sorin-Italy), anti-HBc, quantitative detection of anti-HBs and HBV-DNA.

RESULTS: 525/3167 (16.6%) of blood units were positive for total anti-HBc,
64% of those were anti-HBs positive. Confirmation by ARCHITECT anti-HBc
assay were carried out for 498/525 anti-HBc positive samples, where 451
(90.6%) confirmed positive. Reactivity for anti-HBc was considered
confirmed only if two positive results were obtained for each sample,
giving an overall prevalence of 451/3167 (14.2%) for total anti-HBc. HBV
DNA was quantified by real time PCR in 52/303 (17.2%) of anti-HBc positive
blood donors (viral load range: 5 to 3.5 x 10(5) IU/mL) with a median of
200 IU/mL (mean: 1.8 x 10(4) ± 5.1 x 10(4) IU/mL). Anti-HBc was the only
marker in 68.6% of donors.

Univariate and multivariate logistic analysis for identifying risk factors
associated with anti-HBc and HBV-DNA positivity among blood donors showed
that age above thirty and marriage were the most significant risk factors
for prediction of anti-HBc positivity with AOR 1.8 (1.4-2.4) and 1.4
(1.0-1.9) respectively. Other risk factors as gender, history of blood
transfusion, diabetes mellitus, frequent injections, tattooing, previous
surgery, hospitalization, Bilharziasis or positive family history of HBV or
HCV infections were not found to be associated with positive anti-HBc
antibodies. Among anti-HBc positive blood donors, age below thirty was the
most significant risk factor for prediction of HBV-DNA positivity with AOR
3.8 (1.8-7.9). According to HBV-DNA concentration, positive samples were
divided in two groups; group one with HBV-DNA = 200 IU/mL (n = 27) and
group two with HBV- DNA < 200 IU/mL (n = 26).

No significant difference was detected between both groups as regards mean
age, gender, liver enzymes or HBV markers. Serological profiles of all
followed up blood recipients showed that, all were negative for the studied
HBV markers. Also, HBV DNA was not detected among studied recipients, none
developed post-transfusion hepatitis (PTH) and the clinical outcome was
good.

CONCLUSION: OBI is prevalent among blood donors. Nucleic acid
amplification/HBV anti core screening should be considered for high risk
recipients to eliminate risk of unsafe blood donation.

KEYWORDS: Hepatitis B surface antigen, Hepatitis B virus, Hepatitis B
virus-DNA, Occult hepatitis B virus infection, Total anti-HBc
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Dual HIV Risk: Receptive Syringe Sharing and Unprotected Sex
Among HIV-Negative Injection Drug Users in New York City
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23640654

AIDS Behav. 2013 May 3.

Dual HIV Risk: Receptive Syringe Sharing and Unprotected Sex Among HIV-
Negative Injection Drug Users in New York City.

Neaigus A, Reilly KH, Jenness SM, Hagan H, Wendel T, Gelpi-Acosta C.

HIV/AIDS Epidemiology and Field Services Program, New York City Department
of Health and Mental Hygiene, Gotham Center, 42-09 28th Street, 22nd Floor,
New York, NY, 11101-4132, USA, aneaigus@health.nyc.gov.

HIV-negative injection drug users (IDUs) who engage in both receptive
syringe sharing and unprotected sex (“dual HIV risk”) are at high risk of
HIV infection. In a cross-sectional study conducted in New York City in
2009, active IDUs aged =18 years were recruited using respondent-driven
sampling, interviewed, and tested for HIV.

Participants who tested HIV- negative and did not self-report as positive
were analyzed (N = 439). Adjusted odds ratios (aOR) and 95 % confidence
intervals (95 % CI) were estimated using multinomial logistic regression.

The sample was: 77.7 % male; 54.4 % Hispanic, 36.9 % white, and 8.7 %
African-American/black. Dual risk was engaged in by 26.2 %, receptive
syringe sharing only by 3.2 %, unprotected sex only by 49.4 %, and neither
by 21.2 %. Variables independently associated with engaging in dual risk
versus neither included Hispanic ethnicity (vs. white) (aOR = 2.0, 95 % CI
= 1.0-4.0), married or cohabiting (aOR = 6.3, 95 % CI = 2.5-15.9),
homelessness (aOR = 3.4, 95 % CI = 1.6-7.1), =2 sex partners (aOR = 8.7, 95
% CI = 4.4-17.3), =2 injecting partners (aOR = 2.9, 95 % CI = 1.5-5.8), ***
and using only sterile syringe sources (protective) (aOR = 0.5, 95 % CI =
0.2-0.9).

A majority of
IDUs engaged in HIV risk behaviors, and a quarter in dual risk.
Interventions among IDUs should simultaneously promote the consistent use
of sterile syringes and of condoms.
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Vaccine coverage of healthcare students in hospitals of the
Paris region in 2009: The Studyvax Survey
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23623864

Vaccine. 2013 Apr 24. pii: S0264-410X(13)00423-4.

Vaccine coverage of healthcare students in hospitals of the Paris region in
2009: The Studyvax Survey.

Loulergue P, Fonteneau L, Armengaud JB, Momcilovic S, Levy-Brühl D, Launay
O, Guthmann JP; For the Studyvax survey group.

Université Paris Descartes, Faculté de Médecine, France; INSERM, CIC BT505,
France; Assistance Publique Hôpitaux de Paris (AP-HP), Groupe Hospitalier
Cochin Broca Hôtel Dieu, CIC de Vaccinologie Cochin-Pasteur, Paris, France.
Electronic address: pierre.loulergue@cch.aphp.frboth.

INTRODUCTION: Healthcare students should comply with the same vaccination
recommendations as employed healthcare professionals. Vaccination coverage
data for healthcare students are lacking MATERIALS AND METHODS: This cross-
sectional survey was carried out on medical, nursing and midwifery students
in 15 hospitals of the Assistance Publique – Hôpitaux de Paris with a
maternity ward. All midwifery students were surveyed, and a subset of
medical and nursing students were selected from 10 hospitals by three-stage
random sampling. Data were collected by face-to-face interviews and
verified from health records.

RESULTS: A total of 432 students were included in the study (178 medical,
147 nursing, 107 midwifery), of whom 376 (87%) had proof of vaccination.
The confirmed coverage for compulsory vaccinations was 96.9% for the
booster dose of diphtheria-tetanus-poliomyelitis vaccine, 93.6% for BCG and
91.8% for at least three doses of hepatitis B. The coverage for recommended
vaccinations confirmed by a vaccine booklet was 44% for pertussis (booster
at 11-13 or 16-18 years of age), and 79.3% and 49.6% for the first and
second doses of measles, respectively. The rate for influenza vaccination
was 39.6%, based on self-reported information. Of the 27 students without
any history of varicella infection, six had been vaccinated.

DISCUSSION: Vaccination coverage of healthcare students is high for
compulsory vaccinations, but largely insufficient for recommended
vaccinations. Increased awareness regarding the required vaccinations is
necessary in this population, as well as stronger enforcement prior to
initiating clinical work.

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

10. Abstract: Immunotherapy Safety: What Have We Learned from Surveillance
Surveys?
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23636820

Curr Allergy Asthma Rep. 2013 May 1.

Immunotherapy Safety: What Have We Learned from Surveillance Surveys?

Kannan JA, Epstein TG.

Department of Internal Medicine, University of Cincinnati College of
Medicine, Cincinnati, OH, USA.

Subcutaneous allergen immunotherapy (SCIT) is beneficial for the treatment
of allergic rhinitis, asthma, and in preventing stinging insect
anaphylaxis, but is not without risks.

Four retrospective surveillance surveys and one on-going national
prospective study have attempted to characterize the incidence and risk
factors for fatal and non-fatal SCIT reactions. These studies have
contributed significantly to currently recommended SCIT safety guidelines.

Recent surveillance studies indicate stable SR rates, and a possible
decline in the incidence of fatal reactions since the implementation of
evidence-based safety guidelines.

This review will provide a detailed summary of the evidence from
surveillance studies for risk factors associated with SCIT reactions,
including: uncontrolled asthma, prior systemic reactions, dosing during
peak pollen seasons, epinephrine being delayed or not given, dosing or
administration errors, inadequate waiting times, reactions occurring more
than 30 min after injections, injections given in medically unsupervised
settings, concomitant beta-blocker and angiotensin-converting enzyme
inhibitor (ACEi) use, and accelerated build-up regimens.
__________________________________________________________________
________________________________*_________________________________

11. Abstract: Computer screen saver hand hygiene information curbs a
negative trend in hand hygiene behavior
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22418603

Am J Infect Control. 2012 Dec;40(10):951-4.

Computer screen saver hand hygiene information curbs a negative trend in
hand hygiene behavior.

Helder OK, Weggelaar AM, Waarsenburg DC, Looman CW, van Goudoever JB, Brug
J, Kornelisse RF.

Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia
Children’s Hospital, Erasmus University Medical Center, Rotterdam, The
Netherlands. o.helder@erasmusmc.nl

BACKGROUND: Appropriate hand hygiene among health care workers is the most
important infection prevention measure; however, compliance is generally
low. Gain- framed messages (ie, messages that emphasize the benefits of
hand hygiene rather than the risks of noncompliance) may be most effective,
but have not been tested.

METHODS: The study was conducted in a 27-bed neonatal intensive care unit.
We performed an interrupted time series analysis of objectively measured
hand disinfection events. We used electronic devices in hand alcohol
dispensers, which continuously documented the frequency of hand
disinfection events. In addition, hand hygiene compliance before and after
the intervention period were directly observed.

RESULTS: The negative trend in hand hygiene events per patient-day before
the intervention (decrease by 2.3 [standard error, 0.5] per week) changed
to a significant positive trend (increase of 1.5 [0.5] per week) after the
intervention (P < .001). The direct observations confirmed these results,
showing a significant improvement in hand hygiene compliance from 193 of
303 (63.6%) observed hand hygiene events at pretest to 201 of 281 (71.5%)
at posttest.

CONCLUSIONS: We conclude that gain-framed messages concerning hand hygiene
presented on screen savers may improve hand hygiene compliance.

Copyright © 2012 Association for Professionals in Infection Control and
Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

12. Abstract: Update on hand hygiene
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23622758

Am J Infect Control. 2013 May;41(5 Suppl):S94-6.

Update on hand hygiene.

Boyce JM.

Hospital Epidemiology and Infection Control, Yale-New Haven Hospital, and
Yale University School of Medicine, New Haven, CT. Electronic address:
John.Boyce@ynhh.org.

Recent developments related to hand hygiene include new test methods for
evaluating hand hygiene products, improvements in alcohol-based hand rubs,
novel methods of hand antisepsis, and new strategies and technologies for
monitoring hand hygiene practices among health care personnel.

Copyright © 2013 Association for Professionals in Infection Control and
Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

13. Abstract: Automated hand hygiene count devices may better measure
compliance than human observation
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22633134

Am J Infect Control. 2012 Dec;40(10):955-9.

Automated hand hygiene count devices may better measure compliance than
human observation.

Morgan DJ, Pineles L, Shardell M, Young A, Ellingson K, Jernigan JA, Day
HR, Thom KA, Harris AD, Perencevich EN.

School of Medicine, University of Maryland, Baltimore, MD, USA.
dmorgan@epi.umaryland.edu

BACKGROUND: Hand hygiene is considered a critical factor in the prevention
of health care-associated infections, and there have been many studies on
ways to measure hand hygiene compliance.

OBJECTIVE: Our objective was to evaluate the utility of estimating hand
hygiene compliance using automated count technology versus direct human
observation before and after a feedback intervention. We used a before and
after quasi- experimental study over 30 weeks, in the setting of one 12-bed
neurocare intensive care unit (NCICU) and one 15-bed cardiac intensive care
unit (CCU) in a university, tertiary care hospital.

METHODS: We assessed hand hygiene through a quasi-experimental study
comparing estimated compliance using automated count technology and direct
observation by a secret shopper with a feedback intervention at month 3. We
used Poisson segmented regression and ?(2) tests to compare trends before
and after the intervention.

RESULTS: Over 30 weeks, we collected 424,682 dispenser counts and 338 hours
of human observations that included 1,783 room entries. Electronic hand
hygiene dispenser counts increased significantly in the post-intervention
period relative to the pre-intervention period (average count/patient-day
increased 22.7 in the NCICU and 7.3 in the CCU, both P < .001), but direct
observation of compliance did not change significantly (percent compliant
increased by 2.9% in the NCICU and decreased by 6.7% in the CCU, P = .47
and P = .07, respectively).

CONCLUSION: Passive electronic monitoring of hand hygiene dispenser counts
does not closely correlate with direct human observation and was more
responsive than observation to a feedback intervention.

Published by Mosby, Inc.
__________________________________________________________________
________________________________*_________________________________

14. Case Report Abstract: Inadvertent injection of formalin mistaken for
local anesthetic agent: report of a case
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22676982

Oral Surg Oral Med Oral Pathol Oral Radiol. 2012 May;113(5):581-2.

Inadvertent injection of formalin mistaken for local anesthetic agent:
report of a case.

Arakeri G, Brennan PA.

Peter Brennan’s Indian Academy of Craniofacial Research, Shahapur,
Karnataka, India. gururaj.arakeri@gmail.com

Chemical facial cellulitis, while commonly seen in domestic accidents or
attempted suicide, is uncommon in the dental office and hence rarely
addressed in the dental literature.

We present an unusual case of chemical facial cellulitis caused by
inadvertent injection of formalin into the soft tissues of the oral cavity,
which was mistaken for local anesthesia solution.

This report comprises the immediate symptoms, possible root cause, and
management of the difficult situation. We also provide some guidelines to
avoid such unfortunate events.

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

15. Case Report Abstract: Primary inoculation skin tuberculosis by
accidental needle stick
__________________________________________________________________

BMJ Case Rep. 2011 Jun 15;2011. pii: bcr1120103496.

Primary inoculation skin tuberculosis by accidental needle stick.

Belchior I, Seabra B, Duarte R.

Department of Pulmonology, Hospital de São João, Porto, Portugal.
inesbelchior@gmail.com

A 42-year-old female laboratory worker presented with a left index finger
skin lesion after an accidental prick while handling samples of a cultural
exam of Mycobacterium tuberculosis.

Surgical excision was performed and pathology analysis revealed a dermic
chronic inflammatory process with no granulomas.

Later, a non-painful lymphadenopathy appeared in the left axilla as well as
brownish indurated skin lesions in the lower limbs consistent with erythema
nodosum. Fine needle aspiration biopsy of the lymph node revealed
epithelioid granulomas, Langhans’ multinucleated giant cells and the
presence of acid-fast bacilli.

Standard tuberculosis treatment resulted in regression of lesions and no
relapses occurred in the 2-year follow-up period.
__________________________________________________________________
________________________________*_________________________________

16. Case Report Abstract: Allergen specific immunotherapy induced multi-
organ failure
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23623947

Pulm Pharmacol Ther. 2013 Apr 26. pii: S1094-5539(13)00111-9. d

Allergen specific immunotherapy induced multi-organ failure.

Aissa S, Bensalem C, Khedher A, Azouzi A, Sehli J, Ben Saida I, Boussarsar
M.

Medical Intensive Care Unit, Farhat Hached Hospital, Sousse, Tunisia.

Allergen specific immunotherapy (ASI) is a well-documented treatment for
allergic asthma, rhinitis and allergy to bee venoms. Immunotherapy with
subcutaneous injections of allergens extracts has proved beneficial in
reducing symptoms of allergic rhinitis and asthma.

Side effects due to specific immunotherapy in short term have been largely
documented. These effects were various but were usually mild. Fatal
reactions are less frequent.

We reported a case of a woman, with a history of allergic asthma under
specific desensitization protocol, who developed an acute multi-organ
failure (MOF) consecutive to administration of ASI (Alustal® Stallergenes
SA, France). This type of fatal reaction has not been described as adverse
event of specific immunotherapy.

We aimed to describe this dramatic reaction, expose the arguments to define
the relationship between the administration of allergen extract and the
occurrence of this fatal reaction.

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

17. Abstract: Combination injectable contraceptives for contraception
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23641480

Cochrane Database Syst Rev. 2013;3:CD004568.

Combination injectable contraceptives for contraception.

Gallo MF, Grimes DA, Lopez LM, Schulz KF, d’Arcangues C.

Division of Reproductive Health, Centers for Disease Control and
Prevention, Atlanta, Georgia, USA.

BACKGROUND: Combination injectable contraceptives (CICs) provide a highly
effective, reversible method of preventing pregnancy, and they do not
require daily administration or use at the time of coitus. Although they
are used in many countries, their acceptability could be limited by method
characteristics, such as the need to obtain a monthly injection or bleeding
pattern changes.

OBJECTIVES: To assess the contraceptive efficacy, bleeding patterns,
discontinuation, user preferences, and side effects of CICs.

SEARCH METHODS: In January and February 2013, we searched for randomized
controlled trials (RCTs) of combination injectable contraceptives.Databases
include MEDLINE, POPLINE, CENTRAL, EMBASE, and LILACS.We searched for
current trials in ClinicalTrials.gov and ICTRP.Earlier searches also
included AIM and IMEMR. For the initial review, we also assessed the
references listed in review articles and in the eligible trial reports.

SELECTION CRITERIA: RCTs were eligible if they compared a combination
injectable contraceptive with any other contraceptive method (e.g., a
second CIC,a progestin-only injectable contraceptive, another hormonal
contraceptive or a barrier method) or a placebo. We limited the review to
marketed CICs.

DATA COLLECTION AND ANALYSIS: Two authors independently extracted data on
contraceptive efficacy, bleeding patterns, continuation, and side effects.
We calculated the Peto odds ratio or mean difference with 95% confidence
interval for dichotomous or continuous outcome, respectively. Survival
analysis estimates for method discontinuation were presented where
available.

MAIN RESULTS: Twelve trials met the inclusion criteria. Combination
injectable contraceptives include depot medroxyprogesterone acetate (DMPA)
25 mg plus estradiol cypionate (E(2)C) 5 mg, as well as norethisterone
enanthate (NET- EN) 50 mg plus estradiol valerate (E(2)V) 5mg. These
contraceptives resulted in lower rates of early study discontinuation due
to amenorrhea or other bleeding problems than progestin-only
contraceptives. However, rates were higher for overall discontinuation and
discontinuation due to other medical reasons.Acceptability results favored
the CIC in one study and the progestin-only in another.Studies comparing
two CICs found that NET-EN 50 mg plus E(2)V (5)mg resulted in less overall
discontinuation and less discontinuation due to amenorrhea or prolonged
bleeding than DMPA 25 mg plus E(2)C 5 mg. However, these differences were
not detected in all trials.The NET-EN plus E (2) V group also had more
regular bleeding and fewer prolonged bleeding reference periods than the
DMPA plus E(2)C group. The groups did not differ in their amenorrhea rates.

AUTHORS’ CONCLUSIONS: While discontinuation rates can be viewed as a
measure of method acceptability, the findings should be interpreted with
caution since discontinuation depends on many factors. Future research
should be directed toward improving the acceptability of combination
injectable contraceptives, such as providing injections in settings more
convenient than clinics, methods for women to administer their own
injections, and counseling about possible bleeding pattern changes.

Update of Cochrane Database Syst Rev. 2008;(4):CD004568.
__________________________________________________________________
________________________________*_________________________________

18. Abstract: Safety of Human Papillomavirus Vaccines: A Review
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23637071
Drug Saf. 2013 May 1.

Safety of Human Papillomavirus Vaccines: A Review.

Macartney KK, Chiu C, Georgousakis M, Brotherton JM.

National Centre for Immunisation Research and Surveillance (NCIRS), Kids
Research Institute, The Children’s Hospital at Westmead, Cnr Hawkesbury
Road and Hainsworth Street, Westmead Locked Bag 4001, Westmead, NSW, 2145,
Australia, kristine.macartney@health.nsw.gov.au.

Vaccination to prevent human papillomavirus (HPV)-related infection leading
to cancer, particularly cervical cancer, is a major public health
breakthrough. There are currently two licensed HPV vaccines, both of which
contain recombinant virus-like particles of HPV types 16 and 18 (which
account for approximately 70 % of cervical cancer). One vaccine also
protects against HPV types 6 and 11, which cause genital warts. The safety
profile of both vaccines was assessed extensively in randomised controlled
clinical trials conducted prior to licensure and has been further
elucidated following licensure from surveillance and specific studies in
large populations.

This review aims to examine current evidence regarding the safety of HPV
vaccines. In summary, both vaccines are associated with relatively high
rates of injection site reactions, particularly pain, but this is usually
of short duration and resolves spontaneously. Systemic reactions have
generally been mild and self-limited. Post vaccination syncope has
occurred, but can be avoided with appropriate care. Serious vaccine-
attributable adverse events, such as anaphylaxis, are rare, and although
not recommended for use in pregnancy, abnormal pregnancy outcomes following
inadvertent administration do not appear to be associated with vaccination.

HPV vaccines are used in a three-dose schedule predominantly in adolescent
females: as such case reports linking vaccination with a range of new onset
chronic conditions, including autoimmune diseases, have been made. However,
well-conducted population-based studies show no association between HPV
vaccine and a range of such conditions.

Whilst this reassuring safety profile affirms the positive risk benefit of
vaccination, as HPV vaccine use expands into more diverse populations,
including males, ongoing safety assessment using well-conducted studies is
appropriate.
__________________________________________________________________
________________________________*_________________________________

19. Abstract: Impact on Caesarean section rates following injections of
sterile water (ICARIS): a multicentre randomised controlled trial
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23642147

BMC Pregnancy Childbirth. 2013 May 3;13(1):105.

Impact on Caesarean section rates following injections of sterile water
(ICARIS): a multicentre randomised controlled trial.

Lee N, Mårtensson LB, Homer C, Webster J, Gibbons K, Stapleton H, Dos
Santos N, Beckmann M, Gao Y, Kildea S.

BACKGROUND: Sterile water injections have been used as an effective
intervention for the management of back pain during labour. The objective
of the current research is to determine if sterile water injections, as an
intervention for back pain in labour, will reduce the intrapartum caesarean
section rate.Methods/design

DESIGN: A double blind randomised placebo controlled trial

Setting: Maternity hospitals in AustraliaParticipants: 1866 women in
labour, >=18 years of age who have a singleton pregnancy with a fetus in a
cephalic presentation at term (between 37 + 0 and 41 + 6 weeks gestation),
who assess their back pain as equal to or greater than seven on a visual
analogue scale when requesting analgesia and able to provide informed
consent.

Intervention: Participants will be randomised to receive either 0.1 to 0.3
millilitres of sterile water or a normal saline placebo via four
intradermal injections into four anatomical points surrounding the
Michaelis’ rhomboid over the sacral area. Two injections will be
administered over the posterior superior iliac spine (PSIS) and the
remaining two at two centimetres posterior, and one centimetre medial to
the PSIS respectively.

Main outcome measure: Proportion of women who have a caesarean section in
labour

Randomisation: Permuted blocks stratified by research site.Blinding
(masking): Double-blind trial in which participants, clinicians and
research staff blinded to group assignment.

Funding: Funded by the National Health and Medical Research CouncilTrial
registration: Australian New Zealand Clinical Trials Registry (No
ACTRN12611000221954).

DISCUSSION: Sterile water injections, which may have a positive effect on
reducing the CS rate, have been shown to be a safe and simple analgesic
suitable for most maternity settings.

A procedure that could reduce intervention rates without adversely
affecting safety for mother and baby would benefit Australian families and
taxpayers and would reduce requirements for maternal operating theatre
time.

Results will have external validity, as the technique may be easily applied
to maternity populations outside Australia.

In summary, the results of this trial will contribute High level evidence
on the impact of SWI on intrapartum CS rates and provide evidence of the
analgesic effect of SWI on back pain.
__________________________________________________________________
________________________________*_________________________________

20. Abstract: In vivo toxicological evaluation of polymeric nanocapsules
after intradermal administration
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23643792

Eur J Pharm Biopharm. 2013 May 2. pii: S0939-6411(13)00123-9.

In vivo toxicological evaluation of polymeric nanocapsules after
intradermal administration.

Bulcão RP, de Freitas FA, Dallegrave E, Venturini CG, Baierle M, Durgante
J, Sauer E, Cassini C, Cerski CT, Zielinsky P, Salvador M, Pohlmann AR,
Guterres SS, Garcia SC.

Programa de Pós-Graduação em Ciências Farmacêuticas, Departamento de
Análises, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul,
90610-000 Porto Alegre, Brazil; Laboratório de Toxicologia (LATOX),
Universidade Federal do Rio Grande do Sul, 90610-000 Porto Alegre, Brazil.

Polymeric nanocarriers have shown great promise as delivery systems. An
alternative strategy has been to explore new delivery routes, such as
intradermal (i.d.) that can be used for vaccines and patch-based drug
delivery. Despite their many advantages, there are few toxicity studies,
especially in vivo.

We report a safety assessment of biodegradable poly(- caprolactone) lipid-
core nanocapsules (LNC) with a mean size of 245 ± 10 nm following single
and repeated intradermal injections to Wistar rats. Suspensions were
prepared by interfacial deposition of polymer. The animals (n = 6/group)
received a single dose of saline solution (1.2 ml/kg) or LNC (7.2 × 1012
LNC/kg), or repeated doses of two controls, saline solution or Tween 80
(0.9 ml/kg), or three different concentrations of LNC (1.8, 3.6, and 5.4 ×
1012 LNC/kg) for 28 consecutive days. Clinical and physiological signs and
mortality were observed. Samples of urine, blood, and tissue were used to
perform toxicological evaluation.

There were no clinical signs of toxicity or mortality, but there was a
slight decrease in the relative body weights in the Tween 80-treated group
(p < 0.01) after repeated administration. No histopathological alterations
were observed in tissues or significant changes in blood and urinary
biomarkers for tissue damage. Mild alterations in white blood cells count
with increases in granulocytes in the Tween-80 group (p < 0.05) were found.
Genotoxicity was evaluated through the comet assay and no statistical
difference was observed among the groups.

Therefore, we conclude that, under the conditions of these experiments,
biodegradable LNC did not present appreciable toxicity after 28 consecutive
days of intradermal administration and is promising for its future
application in vaccines and patch-based devices for enhancing the delivery
of drugs.

Copyright © 2013 Elsevier B.V. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

21. Abstract: Towards a realistic in vitro experience of epidural Tuohy
needle insertion
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23636758

Proc Inst Mech Eng H. 2013 Apr 4.

Towards a realistic in vitro experience of epidural Tuohy needle insertion.

Vaughan N, Dubey VN, Wee MY, Isaacs R.

School of Design, Engineering & Computing, Bournemouth University, Poole,
UK.

The amount of pressure exerted on the syringe and the depth of needle
insertion are the two key factors for successfully carrying out epidural
procedure. The force feedback from the syringe plunger is helpful in
judging the loss of pressure, and the depth of the needle insertion is
crucial in identifying when the needle is precisely placed in the epidural
space.

This article presents the development of two novel wireless devices to
measure these parameters to precisely guide the needle placement in the
epidural space.

These techniques can be directly used on patients or implemented in a
simulator for improving the safety of procedure. A pilot trial has been
conducted to collect depth and pressure data with the devices on a porcine
cadaver.

These measurements are then combined to accurately configure a haptic
device for creating a realistic in vitro experience of epidural needle
insertion.
__________________________________________________________________
________________________________*_________________________________

22. News

– Pakistan: Former KP govt responsible for vaccine scam, observes PHC’
– Las Vegas USA: Vegas jury asked to ignore hep C case ‘hysteria’
– USA: Dental Students Identified as Potential Infection Control Leaders
– UK: Portsmouth ‘rogue’ heroin claims sixth victim
– Oklahoma USA: Four new cases of hepatitis C identified in testing of
dentist’s patients
– UK: Needle dumping ground angers Third Street residents: More than 500
needles a day are discarded in safe disposal boxes located throughout
the city

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

 

Pakistan: Former KP govt responsible for vaccine scam, observes PHC’
Akhtar Aminm, The News International, Pakistan (07.05.13)

PESHAWAR: Peshawar High Court (PHC) Chief Justice Dost Muhammad Khan
observed on Monday that the former provincial government had committed a
massive corruption in the purchase of substandard Hepatitis-C vaccines and
many of the patients died due to the vaccines.

He made the observation while hearing bail petitions of a man arrested and
charged with possessing fake medicines in a medical store. The chief
justice said supply of spurious drugs to Khyber Pakhtunkhwa from Punjab
continued. The chief justice said that there were many industries in
different areas of Punjab producing fake medicines, including Bhakar,
Bhalwal, Muzaffarghar, Multan, Khushab and Lahore.

He said the industries were supplying fake medicines to Khyber Pakhtunkhwa
in large numbers and thus playing with the lives of people. A single bench
of chief justice directed the PHC Human Rights Directorate to prepare a
comprehensive report of the use of fake medicines in the provincial capital
and produce it before the court on next hearing.

The bench also adjourned bail petitions of director general Health
Department Dr Mohammad Sharif, chief of the Provincial Hepatitis Control
Programme Dr Ghulam Subhani and assistant junior clerk Mubarak Shah in the
case till May 13.

The Khyber Pakhtunkhwa Anti-Corruption Establishment (ACE) had arrested
them for their alleged involvement in purchase and distribution of
substandard Hepatitis-C vaccines.The officials were accused of purchasing
1.6 million substandard interferon vials worth around Rs150 million for
onward distribution in different hospitals of the province for hepatitis-C
patients. The bench also directed the director ACE to produce a complete
report regarding purchase of the vaccines and all officials and other
persons involved in the purchase of fake hepatitis-C vaccines.

Interferon vial purchased under the Benazir Health Support Programme number
1,698,997. The number of vials issued to various districts by the project
director, as per stock register entries, is 962,280 and as of February 15,
2013 the missing vials stand at 736,967. All in all, 1,508,699 interferon
vials are still unaccounted for.
__________________________________________________________________
__________________________________________________________________
Las Vegas USA: Vegas jury asked to ignore hep C case ‘hysteria’
By Ken Ritter, Associated Press, USA (07.05.13)

Jurors will have to decide if a former endoscopy clinic owner and employees
knew they were committing a crime, or if they simply made mistakes when
seven of their patients became infected with incurable hepatitis C in 2007
– including one patient who later died, defense attorneys said Tuesday.

LAS VEGAS — Jurors will have to decide if a former endoscopy clinic owner
and employees knew they were committing a crime, or if they simply made
mistakes when seven of their patients became infected with incurable
hepatitis C in 2007 – including one patient who later died, defense
attorneys said Tuesday.

The defense used opening statements to cast the trial of former Dr. Dipak
Desai as complicated and his client as the underdog against state court
prosecutors in a community shocked when health officials in February 2008
notified 63,000 former Desai patients to get tested for potentially fatal
blood-borne diseases.

“Set aside the publicity. Set aside the mass hysteria,” defense attorney
Frederick Santacroce said during opening statements as he pleaded for a
fair and impartial trial for his client, former nurse-anesthetist Ronald
Lakeman, and former clinic owner Dipak Desai.

“You are going to be the truth-finders,” Santacroce told the jury seated
Monday for a criminal trial expected to take six weeks or more. “You are
going to have to be independent and strong and listen to all the evidence.”

Desai attorney Richard Wright used his opening statements to cast the case
as complicated and Desai as the underdog in community shocked when health
officials in February 2008 notified 63,000 former Desai patients to get
tested for potentially fatal blood-borne diseases.

Just reading the indictment on Monday against the two men took 90 minutes,
and Wright on Tuesday told the jury that prosecutors wouldn’t be able to
prove the case beyond a reasonable doubt.

Prosecutor Michael Staudaher told jurors Monday that greed was the motive
for the crimes, and reusing contaminated anesthetic was just one of several
ways Desai pinched pennies at clinics where patients were rushed through
like cattle.

Wright described Desai and employees at Desai’s three busy Las Vegas
clinics – the Endoscopy Center of Nevada, Gastroenterology Center of Nevada
and Desert Shadow Endoscopy Center – as cooperative when health
investigators arrived in late 2007 to try to pinpoint the source of the
community hepatitis C cluster.

Desai, a former prominent Las Vegas gastroenterologist and state medical
board member, didn’t want to shut his clinics down without evidence that
they were the source of the community outbreak, his lawyer said, so
practitioners willingly let investigators from the Southern Nevada Health
District and the federal Centers for Disease Control in Atlanta come in and
watch what they were doing.

“Did they perceive they were knowingly, consciously doing something wrong?”
Wright asked. “I think the evidence is going to be such that every single
one of those employees, every practitioner in there, did not know they were
engaging in risky behavior when they did what they did.”

Health investigators reported genetically linking hepatitis C infections of
nine people to procedures conducted in 2007 at Desai clinics. Authorities
said that although hepatitis C was found in another 105 patients, the cases
weren’t conclusively linked. The outbreak was blamed on unsafe clinic
practices on two dates in 2007, and the reuse of large vials of the
anesthetic propofol contaminated during reuse between patients.

Insurance companies were billed for more time than procedures took,
syringes and disposable equipment were also reused, and Desai even ordered
employees to limit the amount of lubricant used on patients during
colonoscopies and endoscopies, Staudaher said.

Desai and Lakeman have each pleaded not guilty to 28 charges, including
criminal neglect of patients, reckless disregard of persons, theft,
obtaining money under false pretenses, insurance fraud and murder. If
convicted, each spend the rest of his life in prison.

The murder charge was added last year after infected former patient Rodolfo
Meana died in the Philippines at age 77.

A former co-defendant, Keith Mathahs, 77, pleaded guilty last December to
five felony charges including criminal neglect of patients resulting in
death, insurance fraud and racketeering in a plea deal that will have him
testify against Desai and Lakeman. Mathahs could get probation or up to 72
months in state prison at sentencing.

Santacroce said that while prosecutors can show Desai and Mathahs treated
Meana, Lakeman never did.

Wright never referred during his opening statement to strokes and other
physical ailments that he maintains so incapacitate Desai that he can’t
assist in his defense. Desai has also declared bankruptcy and surrendered
his medical license.

Desai, 63, walks in and out of the courtroom with his wife and family
members, and sits silently at the defense table staring straight ahead
during proceedings.

The hepatitis outbreak at his clinics also spawned hundreds of separate
civil negligence lawsuits including one that led a jury in Las Vegas to
order the state’s largest health management organization to pay $500
million in punitive damages to three plaintiffs.

In 2011, juries also awarded hundreds of millions of dollars in civil
judgments against pharmaceutical companies that plaintiffs blamed for
supplying large vials of propofol to Desai clinics.
__________________________________________________________________
__________________________________________________________________
USA: Dental Students Identified as Potential Infection Control Leaders
Infection Control Today, USA (06.05.13)

Alleged breaches of infection control practices by an Arkansas dentist who
recently may have sedated about 100 patients with a drug possibly
contaminated with infectious material and an Oklahoma oral surgeon who
potentially exposed thousands of patients to bloodborne viruses, are
reinforcing national efforts to better prepare the next generation of
infection control experts.

In an effort to engage dental and dental hygiene students early in their
careers, the Organization for Safety, Asepsis and Prevention (OSAP) is
awarding University of Louisville dental hygiene student Hollie Brookman
and dental student Tyler Jury scholarships to attend the Annual Infection
Prevention & Safety Symposium June 13-15, 2013 in San Diego.

OSAP executive director Therese Long, MBA, CAE, said the organization chose
the UofL School of Dentistry (ULSD) for its inaugural student awards
because of UofL administration and faculty support in the area of teaching
infection control and prevention. “One of our strategic goals is to foster
and identify leadership regarding the future of infection prevention. It is
critical for OSAP to do what it can to promote education, and these two
awards represent an important step forward in connecting with dental
education,” Long says. “Our goal is to prevent breaches like the ones that
occurred in Oklahoma and Arkansas.”

“This is a unique opportunity for our students to become involved before
they graduate, and it is important to seek out leaders who will move the
science of prevention forward. We look for practical applications in our
teaching approach, and the expectation is that our students will practice
in a similar manner,” says Theresa Mayfield, associate dean for clinical
affairs, UofL School of Dentistry.

“Technology has changed drastically over the past 20 years in how
practitioners receive information and communicate it to patients; we hope
our students will help pave the way in making infection prevention
information more applicable to patients,” says Patty Bonasso Byrd, RDH, BS,
director of infection control, UofL School of Dentistry.

After learning about the new scholarships, UofL School of Dentistry alumnae
Sharon Baker, DMD, has decided to join the effort in bringing more
attention to patient safety and increased awareness of OSAP by donating the
cost of OSAP memberships for several UofL students.

Infection prevention curriculum is incorporated in multiple courses for
dental health profession students including microbiology, oral pathology,
oral radiology, and periodontics, to name a few. ULSD also evaluates
written preclinical, clinical and laboratory protocols to ensure adequate
asepsis, infection and hazard control and hazardous waste disposal.

UofL dental school faculty, students and staff receive training on
Occupational Safety and Health Administration (OSHA) bloodborne pathogens
standards, OSHA hazard communication standards, Centers for Disease Control
guidelines for the dental setting, Environmental Protection Agency and
Kentucky Board of Dentistry infection control requirements, and other state
and local waste management regulations.

Source: Organization for Safety, Asepsis and Prevention (OSAP)
__________________________________________________________________
__________________________________________________________________
http://www.bbc.co.uk/news/uk-england-hampshire-22411375

UK: Portsmouth ‘rogue’ heroin claims sixth victim
BBC, UK (04.05.13)

A suspected contaminated batch of heroin in the Portsmouth area has been
blamed for a sixth person falling ill.

The woman was hospitalised on Friday after using the drug. She was
discovered by a member of the public who called an ambulance.

Two men aged 33 and 36 have died and three others have been taken ill since
Tuesday.

Detectives are making inquiries into the suspected link between all the
people and the same batch of heroin.

Police said she may have died if she had not been treated.

The 33-year-old man from Fareham, who had been in a critical condition in
hospital, died on Thursday.

On Wednesday a 36-year-old man who had been taken ill at an address in
Paulsgrove also died.

Two men aged 32 and 48 have been arrested on suspicion of supplying a
class-A drugs, a police spokesman said on Friday.
__________________________________________________________________
__________________________________________________________________
Oklahoma USA: Four new cases of hepatitis C identified in testing of
dentist’s patients
TheCollinsvilleNews.com, Collinsville, OK, USA (02.05.13)

As testing continues for patients of W. Scott Harrington’s dental surgical
practice, the Oklahoma State Department of Health (OSDH) and Tulsa Health
Department (THD) have a third round of results to report.
Four new cases of hepatitis C have been identified since the last situation
update, for a cumulative total of 69 individuals who have tested positive
for hepatitis C. One new case of hepatitis B has been identified, for a
cumulative total of four individuals who have tested positive for hepatitis
B. There have been fewer than three positive HIV infections identified thus
far.

From staff reports, Oklahoma Health Dept.
__________________________________________________________________
__________________________________________________________________
http://tinyurl.com/d4zeqc8

UK: Needle dumping ground angers Third Street residents: More than 500
needles a day are discarded in safe disposal boxes located throughout the
city
By Craig Gilbert, London Community News, London UK (02.05.13)

If you can find a vein, you can find a garbage can.

That’s the message from two longtime East London residents who are fed up
with finding discarded drug syringes in parks and along streets where
hundreds of children walk to and from school every day.

Collette Filazzola is a lifelong resident of the Third Street area. Now 36
and a mother of three, she is raising the alarm on a sharp increase in the
number of needles left on the ground along a railway corridor used as a
shortcut by many area residents and in a park popular with dog owners.

She got a shock on Earth Day when she and her children found several
needles along the banks of a creek in the nearby park. She said last week
she found one leaning against the maple tree in her front yard.

Filazzola and “John,” another longtime resident of the area who asked to
remain anonymous, are concerned for the safety of their children and pets.
Both have two children under the age of nine.

“There’s a school here,” Filazzola said. “People’s problems are becoming
our little children’s problems.”

They said three separate school bus routes pick up and drop off students
within a stone’s throw of the needle dumping ground.

John’s seven-year-old daughter pointed out the drug paraphernalia while
walking near the railroad tracks.

“She said ‘watch out daddy,’ and I looked down and as soon as I took one
step on the gravel I was surrounded by needles.”

On Wednesday morning (May 1) there were more than 50 used needles and empty
sterile water ampoules, used to mix with the drugs before injection, strewn
about the grass on the south side of the rail line at Third Street, several
just inches from the sidewalk. Some were floating in a puddle, others
embedded in the thatch alongside the tracks and still more sitting in plain
sight between the rail ties.

Two unsealed pop bottles, about 30 feet from the road, contained dozens
more.

Several needles still had the metal tip attached. One appeared to be full
of a liquid, its metal tip and safety cap still intact.

The site is a one-minute walk from the Gibraltar Flea Market and less than
a kilometre from Franklin D. Roosevelt Public School.

Filazzola wants the city to install a stationary needle drop box near the
tracks like the 12 placed in the downtown core and other high-use areas.

“I’ll clean up cigarette butts, but I’m not dealing with this.”

According to Jan Richardson, manager of homelessness, hostels and special
populations for the City of London, 186,000 used syringes were collected
through those safe disposal boxes in 2012, a “significant increase” from
2011, when 130,000 were collected through the bins and site clean-ups.

That’s more than 500 a day.

She said the increase can’t be tied directly to more intravenous drug use,
but is more likely an indication of a wider awareness and acceptance of the
bins.

The city can install disposal bins at the request of a concerned resident,
but they try to coordinate with the business improvement association or
neighbourhood group whose “turf” the location falls within.

That’s a lengthy process so in the meantime, she urges residents to report
concerns to the Regional HIV/AIDS Connection (519-434-1601) or London CAReS
(519-667-2273).

This type of notification allows the Regional HIV/AIDS Connection to
quickly dispatch a team from its peer engagement program to clean the
needles, and to add the location to a list of high priority areas they
target for regular sweeps.

“They become good neighbours in promoting the importance of putting a
needle bin there,” Richardson said. “And they help us by being our eyes on
the street.”

She added there are instructions online for how to safety dispose of a
syringe on the websites of London CAReS, the Regional HIV/AIDS Connection
and the Middlesex-London Health Unit (MLHU).

As of May 1, the Third Street rail crossing hadn’t been identified as a hot
spot.

Richardson said that now the snow is gone, the discovery of batches of
needles may be an unwelcome but expected sight.

“We have a number of activities during clean-up week that help to identify
spots that were vacant over the winter but are now exposed.”

Brian Lester is the executive director of the Regional HIV/AIDS Connection.
He said lately the program’s Injection Drug User outreach officer has been
bringing back more used syringes than the number of clean ones he
distributes.

“London certainly has a significant issue with addiction and a high level
of injection drug users,” he said. “We do a lot of education to remind
individuals to safely dispose of their needles.”

He said the program is “diligent” in doing what it can to protect the
health and safety of all members of the community, including the
marginalized who turn to drugs.

“We are paying attention.”
__________________________________________________________________
________________________________*_________________________________
* 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

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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
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