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SIGNpost 00698

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST *

Post00698 AEFI + Abstracts + Jobs + News 15 May 2013

CONTENTS
1. Global Vaccine Safety New: Core Variables For Adverse Events Following
Immunization (AEFI) WHO
2. Abstract: Minimizing the risk of non-vertical, non-sexual HIV infection
in children–beyond mother to child transmission
3. Abstract: Strategies and challenges for safe injection practice in
developing countries
4. Abstract: Minimizing nurses’ risks for needlestick injuries in the
hospital setting
5. Abstract: Continued Non-Compliance with the American College of Surgeons
Recommendations To Decrease Infectious Exposure in the Operating Room:
Why?
6. Abstract: Work safety among Polish health care workers in respect of
exposure to bloodborne pathogens
7. Abstract: Prevalence of anti-HCV in an inmate population
8. Abstract: Reducing hospital associated infection: a role for social
marketing
9. Abstract: Prospective observational study to assess hand skin condition
after application of alcohol-based hand rub solutions
10. Abstract: Estimation of vaccine efficacy and critical vaccination
coverage in partially observed outbreaks
12. Abstract: Viral retinitis following intravitreal triamcinolone
injection
13. Abstract: Comparison of oral and intravenous Ibuprofen for medical
closure of patent ductus arteriosus: which one is better?
14. No Abstract: Reduce needlestick injury risk
15. No Abstract: APIC’s 2012 Heroes of Infection Prevention
16. Employment: UNDP needs PSM experts
17. News
– India: IAP launches SIE campaign; plans city based workshops across
India
– Pakistan: Risky shots
– USA: FDA Warns Drugs From Florida Compounding Shop May Be Contaminated
– Nevada USA: Vegas jury asked to ignore hep c case ‘hysteria’
– Vietnam: Vietnam suspends Quinvaxem vaccine following 9 deaths

The web edition of SIGNpost is online at:
http://signpostonline.info/archives/1458

More information follows at the end of this SIGNpost!

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

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

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

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

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

1. Global Vaccine Safety New: Core Variables For Adverse Events Following
Immunization (AEFI) WHO

Crossposted from WHO Global Immunization News with thanks
__________________________________________________________________
New: Core Variables For Adverse Events Following Immunization (AEFI)
WHO Global Immunization News, Geneva Switzerland (30.04.13)

From Madhava Ram Balakrishnan, Ahmed Bellah, Philipp Lambach, Christine
Maure, Patrick Zuber, WHO HQ

Optimal monitoring and meaningful analysis of Adverse Event Following
Immunization (AEFI) requires systematic and standardized collection of
critical parameters. A limited number of variables are required to properly
manage AEFI information. This includes a unique identification of the
report, the primary source of information, patient characteristics, details
of the event(s) and vaccine(s) concerned, and the possibility of collecting
additional information if needed.

Comparing AEFI reporting forms from a sample of emerging countries, a WHO
working group developed a core data set that was endorsed by the Global
Advisory Committee on Vaccine Safety (GACVS) in June 2012. This data set
includes 22 variables, ten of which have been identified as critical. This
simple structure is expected to provide countries with a harmonized
template that will simplify AEFI reporting and allow for comparisons and
pooling of essential information for action.
http://www.who.int/vaccine_safety/news/HL_1/en/index.html

A sample reporting form incorporating the core variables identified has
been developed. This form provides a template that countries could adapt to
suit the needs of their own immunization programmes. The core variables
will also enable countries to develop standard line lists. WHO is currently
using core variables to develop a computer-based application to collect
AEFI data that could be easily tailor-made to country specific requirements
and / or integrated with country’s existing Health Management Information
Systems.

Additional information or comments related to collection of AEFI data can
be requested or provided through this email. GVSI@WHO.int
__________________________________________________________________
________________________________*_________________________________

2. Abstract: Minimizing the risk of non-vertical, non-sexual HIV infection
in children–beyond mother to child transmission
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3500456/

J Int AIDS Soc. 2012 Nov 15;15(2):17377.

Minimizing the risk of non-vertical, non-sexual HIV infection in children–
beyond mother to child transmission.

Cotton MF, Marais BJ, Andersson MI, Eley B, Rabie H, Slogrove AL, Dramowski
A, Schaaf HS, Mehtar S.

Division of Paediatric Infectious Diseases, Tygerberg Children’s Hospital,
Stellenbosch University, Cape Town, South Africa. mcot@sun.ac.za

After witnessing an episode of poor injection safety in large numbers of
children in a rural under-resourced hospital in Uganda, we briefly review
our own experience and that of others in investigating HIV infection in
children considered unlikely to be through commonly identified routes such
as vertical transmission, sexual abuse or blood transfusion.

In the majority of cases, parents are HIV uninfected. The cumulative
experience suggests that the problem is real, but with relatively low
frequency. Vertical transmission is the major route for HIV to children.

However, factors such as poor injection safety, undocumented surrogate
breast feeding, an HIV-infected adult feeding premasticated food to a
weaning toddler, poor hygienic practice in the home and using unsterilised
equipment for minor surgical or traditional procedures are of cumulative
concern.

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3500456/
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Strategies and challenges for safe injection practice in
developing countries
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23662018

J Pharmacol Pharmacother. 2013 Jan;4(1):8-12.

Strategies and challenges for safe injection practice in developing
countries.

Gyawali S, Rathore DS, Shankar PR, Kumar KV.

Department of Pharmacology, Manipal College of Medical Sciences (MCOMS),
Pokhara, Nepal ; PhD Scholar, Suresh GyanVihar University, Jaipur, India.

Injection is one of the important health care procedures used globally to
administer drugs. Its unsafe use can transmit various blood borne
pathogens. This article aims to review the history and status of injection
practices, its importance, interventions and the challenges for safe
injection practice in developing countries.

The history of injections started with the discovery of syringe in the
early nineteenth century.

Safe injection practice in developed countries was initiated in the early
twentieth century but has not received adequate attention in developing
countries.

The establishment of “Safe Injection Global Network (SIGN)” was an
milestone towards safe injection practice globally. In developing
countries, people perceive injection as a powerful healing tool and do not
hesitate to pay more for injections. Unsafe disposal and reuse of
contaminated syringe is common.

Ensuring safe injection practice is one of the greatest challenges for
healthcare system in developing countries. To address the problem,
interventions with active involvement of a number of stakeholders is
essential.

A combination of educational, managerial and regulatory strategies is found
to be effective and economically viable. Rational and safe use of
injections can save many lives but unsafe practice threatens life. Safe
injection practice is crucial in developing countries.

Evidence based interventions, with honest commitment and participation from
the service provider, recipient and community with aid of policy makers are
required to ensure safe injection practice.

KEYWORDS: Injection, injection providers, interventions, sharp waste,
strategies
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Minimizing nurses’ risks for needlestick injuries in the
hospital setting
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23650894

Workplace Health Saf. 2013 May;61(5):197-202.

Minimizing nurses’ risks for needlestick injuries in the hospital setting.

Rohde KA, Dupler AE, Postma J, Sanders A.

Despite advances in safety mechanisms for sharps, nurses continue to be at
high risk for needlestick injuries, with more than half of all nurses
experiencing at least one needlestick injury during their careers.
Needlestick injury risk appears to be the result of three incident factors:
nurses’ sense of urgency, variable shift work, and lower skill level
related to years of experience, academic degree, and younger age. This
article synthesizes the evidence related to these risk factors among nurses
in the hospital setting.

Evidence linking needlestick injury risk with both variable shift work and
lower skill level is demonstrated. The evidence supporting a relationship
between needlestick injury risk and nurses’ sense of urgency is
conflicting.

It is the authors’ goal to reduce needlestick injury risk for nurses;
therefore, specific changes to hospital nursing practice are recommended
based on the evidence identified.

Copyright 2013, SLACK Incorporated.
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Continued Non-Compliance with the American College of Surgeons
Recommendations To Decrease Infectious Exposure in the Operating Room:
Why?
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23641753

Surg Infect (Larchmt). 2013 May 3.

Continued Non-Compliance with the American College of Surgeons
Recommendations To Decrease Infectious Exposure in the Operating Room: Why?

Welc CM, Nassiry A, Elam K, Sanogo K, Zuelzer W, Duane T, Stevens MP,
Edmond M, Bearman G.

1 Department of Internal Medicine, Division of Infectious Diseases,
Virginia Commonwealth University , Richmond, Virginia.

Abstract Background: The American College of Surgeons (ACS) Statement on
Sharps Safety recommends the use of double gloving (DG), hands-free zone
(HFZ), and blunt-tip suture needles (BTSN) in the operating room to
decrease needlestick injuries.

Despite this endorsement, compliance is low. This survey determined the
perceptions, attitudes, and barriers to compliance with these guidelines.

Methods: A survey using a voluntary convenience sample of surgical staff
members in which queries related to understanding of the ACS
recommendations were posed. A total of 107 of the 324 surveys were
completed and returned, for a response rate of 33%. Most respondents were
residents (64%) or attending surgeons (29%).

Results: Respondents were most familiar with recommendations for DG (58% of
residents and 68% of attendings) and HFZ (61% for both groups) but less so
for BTSN (48% of residents and 52% of attendings). More than 50% of the
staff believed that DG decreased the risk of needlesticks, yet fewer than
half used DG more than 75% of the time. Half believed that HFZ protected
from sticks, yet fewer than 10% used it at least 75% of the time. Fewer
than 50% believed that BTSN minimizes the risk of injury, with fewer than
10% of respondents using them at least 75% of the time. Reasons for non-
compliance included decreased tactile sensation with DG, lack of training
with HFZ, and lack of availability of BTSN.

Conclusions: To improve compliance with the ACS recommendations,
institutions must improve awareness of the guidelines and the benefits
associated with compliance and remove barriers to their incorporation into
standard practice.
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Work safety among Polish health care workers in respect of
exposure to bloodborne pathogens
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23650763

Med Pr. 2013;64(1):1-10.

Work safety among Polish health care workers in respect of exposure to
bloodborne pathogens.

Rybacki M, Piekarska A, Wiszniewska M, Walusiak-Skorupa J.

Department of Occupational Diseases and Toxicology, Nofer Institute of
Occupational Medicine, Lódz, Poland. mrybacki@imp.lodz.pl

OBJECTIVES: Viral hepatitis is the second most often identified infectious
illness acquired at work and it is mostly registered among health care
personnel. This group of workers is at greater risk of exposure to blood
and bloodborne pathogens, including hepatitis B and C viruses. The aims of
this study were to evaluate the efficacy of methods promoting work safety
in healthcare settings, to assess the frequency of exposures in the last 12
months prior to the study and to determine a rate of reporting them to
appropriate authorities.

METHODS: A total of 1138 Polish healthcare workers were interviewed during
the study period (between 2009 and 2010).

RESULTS: Sustaining accidental occupational percutaneous exposure during
last 12 months was declared by 242 workers (21% of the whole group). Only
in 146 cases these incidents were reported to authorities. Exposure
incidents were associated with self-perception of high risk of exposure (OR
= 3.69, p = 0.0027), employment in out-patient (vs. hospital-based)
healthcare setting (OR = 1.71, p = 0.0089), conviction that the level of
information about bloodborne infections conveyed at work was insufficient,
lack of both exposure reporting system and knowledge about the ways of
reporting.

CONCLUSIONS: Despite the different established proposals of the post-
exposure procedures, it turns out that particularly in small, not providing
24 hours service healthcare settings these procedures are not known or are
not respected. More attention should be given to education, especially in
regard to the risk of infection, advantages of post-exposure prophylaxis
and reporting exposure incidents.
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Prevalence of anti-HCV in an inmate population
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23090226

Rev Assoc Med Bras. 2012 Oct;58(5):557-60.

Prevalence of anti-HCV in an inmate population.

[Article in English, Portuguese]

Rosa Fd, Carneiro M, Duro LN, Valim AR, Reuter CP, Burgos MS, Possuelo L.

Pharmacy Course, Universidade de Santa Cruz do Sul (UNISC), Santa Cruz do
Sul, RS, Brazil.

OBJECTIVE: To estimate the prevalence of hepatitis C using a rapid
hepatitis C virus (HCV) test in an inmate population from the countryside
of Rio Grande do Sul, Brazil.

METHODS: Through a descriptive study, 195 inmates were evaluated by random
sampling.

RESULTS: A total of 9.7% of the inmates were positive. In this analysis,
the variable injectable drug use was predictive of HCV infection.

CONCLUSION: The high prevalence of positive serology for HCV observed among
the inmates is of particular concern, as it is much higher than in the
general population. Therefore, it is necessary to conduct specific approach
campaigns to gather more information on infectious diseases in prison
settings, as well as to provide appropriate treatment to prevent viral
dissemination.

Free full text http://dx.doi.org/10.1590/S0104-42302012000500012
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Reducing hospital associated infection: a role for social
marketing
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23534148

Int J Health Care Qual Assur. 2013;26(2):118-34.

Reducing hospital associated infection: a role for social marketing.

Conway T, Langley S.

Salford Business School, University of Salford, Manchester, UK.
a.conway@salford.ac.uk

PURPOSE: Although hand hygiene is seen as the most important method to
prevent the transmission of hospital associated infection in the UK, hand
hygiene compliance rates appear to remain poor. This research aims to
assess the degree to which social marketing methodology can be adopted by a
particular organisation to promote hand hygiene compliance.

DESIGN/METHODOLOGY/APPROACH: The research design is based on a conceptual
framework developed from analysis of social marketing literature. Data
collection involved taped interviews given by nursing staff working within
a specific Hospital Directorate in Manchester, England. Supplementary data
were obtained from archival records of the hand hygiene compliance rates.

FINDINGS: Findings highlighted gaps in the Directorate’s approach to the
promotion of hand hygiene compared to what could be using social marketing
methodology. Respondents highlighted how the Directorate failed to fully
optimise resources required to endorse hand hygiene practice and this
resulted in poorer compliance.

PRACTICAL IMPLICATIONS: From the experiences and events documented, the
study suggests how the emergent phenomena could be utilised by the
Directorate to apply a social marketing approach which could positively
influence hand hygiene compliance.

ORIGINALITY/VALUE: The paper seeks to explore the use of social marketing
in nursing to promote hand hygiene compliance and offer a conceptual
framework that provides a way of measuring the strength of the impact that
social marketing methodology could have.
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Prospective observational study to assess hand skin condition
after application of alcohol-based hand rub solutions
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/21839542

Am J Infect Control. 2012 Mar;40(2):160-4.

Prospective observational study to assess hand skin condition after
application of alcohol-based hand rub solutions.

Ahmed-Lecheheb D, Cunat L, Hartemann P, Hautemanière A.

Department of Public Health and Environment, School of Medicine, Nancy,
France. djihane.lecheheb-ahmed@medecine.uhp-nancy.fr

BACKGROUND: The use of alcohol-based hand rub solutions (ABHRSs) in health
care settings has been associated with increased hand hygiene compliance
and reduced rates of nosocomial infection. Deterioration in hand skin
condition leads to impaired barrier function, changes in skin flora, and
increased bacterial shedding. Thus, poor skin condition can increase the
risk of infection. This study evaluated the hand skin condition and dermal
tolerance among health care workers (HCWs) after ABHRS application.

METHODS: The study group comprised 231 HCWs (34% nurses, 22% nurse
assistants, and 15% hospital cleaners). The mean participant age was 40
years. Stratum corneum hydration and superficial sebum content and surface
pH of the skin were measured on the back and palm of each participant’s
dominant hand before and after ABHRS use. A self-assessment questionnaire
was administered to collect information about the participants, their skin
problems, and their perception of the ABHRS.

RESULTS: The study group was 83% females. Skin hydration at the 2
assessment sites was markedly increased after ABHRS use (P < .0001). The
mean pH value did not change significantly on the back of the hand, but did
change significantly on the palm (P = .012). The superficial sebum content
decreased significantly on the palm (P < .0001), but not on the back of the
hand. HCWs reported excellent or good skin tolerance of ABHRS in 73% of
cases.

CONCLUSION: ABHRSs are well tolerated and do not dry the skin. pH and
superficial sebum values decreased slightly, but these decreases did not
affect skin barrier function. Values remained within the physiological
range.

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

10. Abstract: Estimation of vaccine efficacy and critical vaccination
coverage in partially observed outbreaks
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23658512

PLoS Comput Biol. 2013 May;9(5):e1003061.

Estimation of vaccine efficacy and critical vaccination coverage in
partially observed outbreaks.

van Boven M, Ruijs WL, Wallinga J, O’Neill PD, Hahné S.

Centre for Infectious Disease Control, National Institute for Public Health
and the Environment, Bilthoven, The Netherlands.

Classical approaches to estimate vaccine efficacy are based on the
assumption that a person’s risk of infection does not depend on the
infection status of others. This assumption is untenable for infectious
disease data where such dependencies abound. We present a novel approach to
estimating vaccine efficacy in a Bayesian framework using disease
transmission models.

The methodology is applied to outbreaks of mumps in primary schools in the
Netherlands. The total study population consisted of 2,493 children in ten
primary schools, of which 510 (20%) were known to have been infected, and
832 (33%) had unknown infection status. The apparent vaccination coverage
ranged from 12% to 93%, and the apparent infection attack rate varied from
1% to 76%.

Our analyses show that vaccination reduces the probability of infection per
contact substantially but not perfectly ([Formula: see text]?=?0.933;
95CrI: 0.908-0.954). Mumps virus appears to be moderately transmissible in
the school setting, with each case yielding an estimated 2.5 secondary
cases in an unvaccinated population ([Formula: see text]?=?2.49; 95%CrI:
2.36-2.63), resulting in moderate estimates of the critical vaccination
coverage (64.2%; 95%CrI: 61.7-66.7%).

The indirect benefits of vaccination are highest in populations with
vaccination coverage just below the critical vaccination coverage. In these
populations, it is estimated that almost two infections can be prevented
per vaccination.

We discuss the implications for the optimal control of mumps in
heterogeneously vaccinated populations.

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3642050/
__________________________________________________________________
________________________________*_________________________________

11. Abstract: The risks of epidural and transforaminal steroid injections
in the Spine: Commentary and a comprehensive review of the literature
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23646278

Surg Neurol Int. 2013 Mar 22;4(Suppl 2):S74-93.

The risks of epidural and transforaminal steroid injections in the Spine:
Commentary and a comprehensive review of the literature.

Epstein NE.

The Albert Einstein College of Medicine, Bronx, 10461, and Chief of
Neurosurgical Spine and Education, Department of Neuroscience, Winthrop
University Hospital, Mineola, NY, 11501, USA.

BACKGROUND: Multiple type of spinal injections, whether
epidural/translaminar or transforaminal, facet injections, are offered to
patients with/without surgical spinal lesions by pain management
specialists (radiologists, physiatrists, and anesthesiologists). Although
not approved by the Food and Drug Administration (FDA), injections are
being performed with an increased frequency (160%), are typically short-
acting and ineffective over the longer-term, while exposing patients to
major risks/complications.

METHODS: For many patients with spinal pain alone and no surgical lesions,
the “success” of epidural injections may simply reflect the self-limited
course of the disease. Alternatively, although those with surgical
pathology may experience transient or no pain relief, undergoing these
injections (typically administered in a series of three) unnecessarily
exposes them to the inherent risks, while also delaying surgery and
potentially exposing them to more severe/permanent neurological deficits.

RESULTS: Multiple recent reports cite contaminated epidural steroid
injections resulting in meningitis, stroke, paralysis, and death. The
Center for Disease Control (CDC) specifically identified 25 deaths (many
due to Aspergillosis), 337 patients sickened, and 14,000 exposed to
contaminated steroids. Nevertheless, many other patients develop other
complications that go unreported/underreported: Other life-threatening
infections, spinal fluid leaks (0.4-6%), positional headaches (28%),
adhesive arachnoiditis (6-16%), hydrocephalus, air embolism, urinary
retention, allergic reactions, intravascular injections (7.9-11.6%),
stroke, blindness, neurological deficits/paralysis, hematomas, seizures,
and death.

CONCLUSIONS: Although the benefits for epidural steroid injections may
include transient pain relief for those with/without surgical disease, the
multitude of risks attributed to these injections outweighs the benefits.

KEYWORDS: Complications, epidural spinal injections, infection, spinal
fluid leaks
__________________________________________________________________
________________________________*_________________________________

12. Abstract: Viral retinitis following intravitreal triamcinolone
injection
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23648134

J Fr Ophtalmol. 2013 May 3. pii: S0181-5512(13)00115-0.

[Viral retinitis following intravitreal triamcinolone injection.]

[Article in French]

Zghal I, Malek I, Amel C, Soumaya O, Bouguila H, Nacef L.

Service d’ophtalmologie A, institut « Hédi Raies » d’ophtalmologie,
boulevard 9-Avril, Bab Saadoun, 1006 Tunis, Tunisie.

Necrotizing viral retinitis is associated with infection by the Herpes
family of viruses, especially herpes simplex virus (HSV), varicella zoster
virus (VZV) and occasionally cytomegalovirus (CMV). When the diagnosis is
suspected clinically, antiviral therapy must be instituted immediately.

We report the case of a patient presenting with necrotizing viral retinitis
3 months following intravitreal injection of triamcinolone acetonide for
diabetic macular edema. Fluorescein angiography demonstrated a superior
temporal occlusive vasculitis. A diagnostic anterior chamber paracentesis
was performed to obtain deoxyribo-nucleic acid (DNA) for a polymerase chain
reaction (PCR) test for viral retinitis. PCR was positive for CMV. The
patient was placed on intravenous ganciclovir.

CMV retinitis is exceedingly rare in immunocompetent patients; however, it
remains the most common cause of posterior uveitis in immunocompromised
patients. The incidence of this entity remains unknown. Local
immunosuppression, the dose and the frequency of injections may explain the
occurrence of this severe retinitis.

Copyright © 2013. Published by Elsevier Masson SAS.
__________________________________________________________________
________________________________*_________________________________

13. Abstract: Comparison of oral and intravenous Ibuprofen for medical
closure of patent ductus arteriosus: which one is better?
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22613269

Congenit Heart Dis. 2012 Nov-Dec;7(6):534-43.

Comparison of oral and intravenous Ibuprofen for medical closure of patent
ductus arteriosus: which one is better?

Olukman O, Calkavur S, Ercan G, Atlihan F, Oner T, Tavli V, Kultursay N.

Neonatal Intensive Care Unit, Dr. Behcet Uz Children’s Hospital, Izmir,
Turkey. drolukman2002@yahoo.com

OBJECTIVE: Intravenous ibuprofen is an expensive drug that is being used
currently for treating and preventing patent ductus arteriosus. Although
oral ibuprofen is much cheaper, there is limited data published about its
safety and efficacy. The aim of this study was to compare two forms of
ibuprofen in terms of safety and efficacy in closure of patent ductus
arteriosus.

DESIGN: This is a single-center retrospective study.

SETTING: Data were collected from patients’ files of preterm infants who
were hospitalized at the Neonatal Intensive Care Unit of Dr. Behcet Uz
Children’s Hospital between April 2009 and June 2010.

PATIENTS: Six hundred sixty infants were evaluated by echocardiography
between 24 and 48 postnatal hours. Clinically and hemodynamically
significant ductus arteriosus was defined in 66 infants with gestational
age less than 32 weeks and birth weight less than 1500 g.

INTERVENTIONS: Oral or intravenous ibuprofen (loading dose: 10 mg/kg on day
1, followed by maintenance dose: 5 mg/kg on days 2 and 3) was administered.

OUTCOME MEASURES: Treatment success was defined as a completely closed duct
without reopening on follow-up. Drug-associated renal, gastrointestinal,
cerebral, hematological, and metabolic side effects were monitored and
compared between treatment groups.

RESULTS: Ductal closure rates were 100% and 97.6%, respectively, in the
oral and intravenous groups. Hypernatremia was the remarkable side effect
in the intravenous group, whereas bronchopulmonary dysplasia and septicemia
were prominent in the oral group. No statistically significant difference
could be demonstrated between the groups in terms of mortality rates.

CONCLUSION: Oral ibuprofen therapy is as efficacious as intravenous
ibuprofen with some concerns about increased sepsis and bronchopulmonary
dysplasia incidence. However, comprehensive and large-scale pharmacokinetic
studies are required in order to prove this efficacy. On the other hand,
intravenous ibuprofen still remains to be the drug of choice for patent
ductus arteriosus but only with meticulous control of serum sodium levels
in smaller infants.

© 2012 Wiley Periodicals, Inc.
__________________________________________________________________
________________________________*_________________________________

14. No Abstract: Reduce needlestick injury risk
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23660916

Br Dent J. 2013 May 10;214(9):477.

Reduce needlestick injury risk.

[No authors listed]
__________________________________________________________________
________________________________*_________________________________

15. No Abstract: APIC’s 2012 Heroes of Infection Prevention
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22854375

Am J Infect Control. 2012 Aug;40(6):485.

APIC’s 2012 Heroes of Infection Prevention.

Association for Professionals in Infection Control and Epidemiology.
__________________________________________________________________
________________________________*_________________________________

16. Employment: UNDP needs PSM experts

Crossposted from the e-drug mailing list with thanks
http://list.healthnet.org/mailman/listinfo/e-drug
__________________________________________________________________

Date: Fri, 10 May 2013 14:10:48 +0000
From: “Guy Rino Meyers” <guy.rino.meyers[at]undp.org>
Subject: UNDP needs PSM experts

UNDP needs PSM experts

Dear All,

UNDP is looking for PSM experts to support the CO in their role as PR for
GF grants.

You will find an announcement for a short term support role below and an
announcement for a longer term position will follow soon.

The short term work will be partially home based and partially on site
after a short briefing in Geneva.

We need senior expertise and energetic approaches for the following
interesting and challenging tasks:

Under the overall supervision of the Senior Procurement and Supply
Management Specialist, the Consultant will be responsible for:

Specific Deliverables:

Advisory and support services to country offices acting as interim
Principal Recipients and providing capacity support to national entities on
procurement and supply chain management issues.

Advise Country Offices on best procurement and supply chain management
practices.

Provide technical support to Country Offices in the transition to the
interim Principal Recipient role including development of Terms of

Reference and recruitment process of procurement staff.

Provide technical support to Country Office in preparing for periodic
reviews and grant closure activities in line with UNDP and Global Fund
policies and rules.

Provide technical assistance to Country Office in the formulation and
revision of Procurement and Supply Management Plans and Quality Assurance
Plans in line with UNDP and Global Fund policies and rules.

Ensure systematic knowledge sharing on procurement with Country Offices by
assisting the Senior Procurement Advisor in the organization of training
workshops and in the development of knowledge tools.

Actively participate in UNDP and other relevant external networks to
promote capacity development in procurement and supply chain management and
asset management.

Supports Country Offices in the fulfillment of audit recommendations and
action plans.

Supports the process of contracting of Sub-recipients and Best Value for
Money reviews.

Undertakes risk management assessments related to Procurement and Supply
Management for Country Office(s) currently in the Principal Recipient role
and for capacity support roles.

Provides information and communicates with UNDP GF Partnership Team (BDP)
on PSM related issues and provides data to the Senior Procurement and
Supply Management Specialist for communication with the Global Fund and
external partners and provides clarification and responses in timely
manner.

Expected Outputs: At the end of the assignment period, the consultant will
have delivered as follows:

PSM Plan(s) approved by UNDP and Global Fund for UNDP Country Offices
acting in the interim Principal Recipient role.

Quality Assurance Plan(s) approved by UNDP and Global Fund for three UNDP
Country Offices acting in the interim Principal Recipient role.

Risk Management Assessment(s) and Capacity Development Plan(s) for PSM
completed for UNDP Country Offices acting in the interim Principal
Recipient role.

Risk Management Assessment and Discussion Paper for UNDP Country Offices
providing support to national entities implementing Global Fund programmes.

Action Plan(s) PSM audit recommendations developed and agreed with UNDP
Country Offices acting in the interim Principal Recipient role.

Best Value for Money Assessments approved for UNDP Country Offices acting
in the inerim Principal Recipient role.

Monthly Progress reports and final reports prepared and shared with Senior
Procurement and Supply Management Specialist.

Reporting: The Procurement and Supply Management Consultant will regularly
evaluate progress in meeting the specific deliverables with the Senior
Procurement and Supply Management Specialist.

Travel: In the case of unforeseeable travel, payment of travel costs
including tickets, lodging and terminal expenses should be agreed upon,
between the respective business unit and HIV, Health and Development Group,
Geneva. The period is expected to be for a total of 60 days from May/August
2013 with a possible extension of 60 days.

Evaluation Applicants will be screened against qualifications and
competencies specified below through a desk review or an interview process.
Those selected for the next stage of the selection process will be reviewed
based on cumulative analysis based on a combination of the Technical and
Financial Scores.

Follow the link below and apply before 20 May:
http://unjobs.org/vacancies/1367989930886

Rino Guy Meyers
Senior Procurement Adviser

Partnership with The Global Fund to Fight AIDS, Tuberculosis and Malaria
HIV, Health and Development Group
Bureau for Development Policy
United Nations Development Programme – Geneva Office
Tel: +41 22 91 78714
Mobile: +41 (0)79 173 24 14
Fax: +41 22 917 8001
E-mail: Guy.rino.meyers@undp.org
Skype : Rino_Guy_Meyers

Mail: UNDP, Palais des Nations, CH-1211 Geneva 10
Office: 11-13 Chemin des Anémones, Châtelaine, CH-1219 Geneva, Switzerland
__________________________________________________________________
________________________________*_________________________________

17. News

– India: IAP launches SIE campaign; plans city based workshops across
India
– Pakistan: Risky shots
– USA: FDA Warns Drugs From Florida Compounding Shop May Be Contaminated
– Nevada USA: Vegas jury asked to ignore hep c case ‘hysteria’
– Vietnam: Vietnam suspends Quinvaxem vaccine following 9 deaths

Selected news items reprinted under the fair use doctrine of international
copyright law: http://www4.law.cornell.edu/uscode/17/107.html
__________________________________________________________________
http://www.pharmabiz.com/NewsDetails.aspx?aid=75316&sid=2

India: IAP launches SIE campaign; plans city based workshops across India
Our Bureau, Bengaluru India, pharmabiz.com (13.05.13)

The Indian Academy of Paediatrics (IAP) is launching a nationwide Safe
Injection Environment (SIE) Campaign to train paediatricians. The campaign
intends to train over 500 paediatricians and health professionals with the
objective of protecting children from infections caused by unsafe
injections.

Injections are the most commonly administered procedure in the world with
over 16 billion administered annually. A child’s journey for injections
starts in his first few months through preventive immunization. While
preventive immunization constitutes only about 5%, the rest of 95% are for
therapeutic reasons. Healthcare professionals often reuse syringe/s or
needle/s assuming that they are safe; they also recap the needles after use
and throw the plastic and sharps waste in a single container. Suchwrong
practices need to be corrected through sanitization and training the best
practices on Safe Injections. WHO has estimated that 42% of the Hepatitis C
and 33% of Hepatitis B cases can be attributed to unsafe injections.

Under the SIE campaign, IAP will be conducting city-based training
workshops in 12 locations across India such as Kolkata, Bhubaneswar,
Jaipur, Delhi, Chandigarh, Lucknow, Gwalior, Nagpur and Hyderabad. The
India-wide campaign will represent IAP members from five zones – East,
West, North, South and Central. IAP will be engaging with the local
government officials to leverage them as key influencers for the training
programs.

According to a 2004 INCLEN study on injection practices, about 63% of all
injections administered in India are unsafe. Unsafe injection practices are
an important cause behind the spread of various diseases such as hepatitis.
When it comes to the health of children, the importance of safe injections
cannot be overemphasized. There is an urgent need to train Indian
healthcare providers in safe injection practices and the campaign for
paediatricians will be very effective in promoting the same in India,
especially for children,” Dr. Sailesh Gupta, Secretary General, IAP.

IAP recently released the Safe Injection Guidelines which provides a
comprehensive view about the current situation analysis, science behind
injection techniques, dos and donts to ensure Safe Injection Practices.

Through these workshops, IAP seeks to ensure that their members at
clinics/nursing home follow safe injection practices and thus protect
patients, healthcare workers, communities and the environment from risks
associated with unnecessary and unsafe injections, as well as improper
disposal of medical waste.

The SIE workshops will be conducted by IAP and BD India and will provide
details on the current situation and policies of the government, best
practices and Safe Infusion, health care worker safety and needle stick
injury surveillance.
__________________________________________________________________
__________________________________________________________________
http://dawn.com/2013/05/12/risky-shots/

Pakistan: Risky shots
Dawn, Pakistan, From InpaperMagzine (12.05.13)

Till the use, reuse and misuse of syringes continues, Dr Quaid Saeed, at
the World Health Organisation (WHO), does not see the government or health
specialists winning the battle against the spread of hepatitis C virus in
Pakistan. Of Pakistan’s 180 million, an estimated 12 to 15m are infected
with various forms of hepatitis viruses. The country also has the highest
number of patients with chronic liver disease in the world, said Saeed, who
is national programme officer on HIV/AIDS and hepatitis at the WHO.

Nine out of 10 injections administered in the country are unnecessary, said
Dr Arshad Altaf, of the Safety Injection Global Network (SIGN) Pakistan, a
coalition of volunteers aiming to achieve safe and appropriate use of
injections throughout the world. “All evidence for the spread of HCV points
to use of non-sterile syringes in Pakistan”, Altaf told Dawn.

The same is confirmed by Dr Aftab Mohsin, former national programme manager
of the Prime Minister’s Programme for Prevention and Control of Hepatitis
(which has now been devolved to the provinces).

“It’s not just quacks, I hold qualified dentists and medical practitioners
responsible for unsafe practices of administering unnecessary injections,
and using non-sterile syringes or needles”, said Mohsin, who is also one of
Pakistan’s leading liver and gastroenterology physicians.

“Unfortunately, there is no legislation in place to ban reuse and misuse of
syringes”, said Mohsin, to which WHO’s Saeed added, that there was “no law
to date that prohibits quacks from practising”.

Coupled with poverty and illiteracy, other reasons for the spread of what
is known as a silent epidemic (as the symptoms do not show until 15 to 20
years later), said Saeed, are use of non-sterilised dental instruments by
roadside dentists and contaminated blood transfusions.

While there is a Safe Blood Transfusion Act, enacted in 2002, Saeed said it
has yet to be fully implemented. “Every year 1.2 million pints of blood is
transfused of which only 60pc is screened for hepatitis and HIV, the
remaining 40pc is transfused unchecked.

However, Mohsin added, the legislation was “very assiduously implemented in
thousands of blood banks across Punjab”, but the same cannot be said about
blood banks in the other three provinces.

Hepatitis is an inflammation of the liver commonly caused by a viral
infection. hepatitis viruses are classified as types A, B, C, D, and E.
While hepatitis A and E are generally caused by food or water
contamination. Hepatitis B, C and D are acquired through contact with
infected body fluids, particularly blood. For those infected with hepatitis
B, said Saeed, 80pc of the patients recover naturally and may not suffer
from liver damage and out of those infected with hepatitis C, 80pc may
become chronic carriers”.

Liver transplant is usually the only treatment option for patients with
end-stage liver disease. Unfortunately, there is no vaccine to prevent
spread of hepatitis C. But for the HCV genotype 3 prevalent among most
patients in Pakistan, an antiviral therapy using conventional Interferon is
used to treat the patients.

“Our practices are terrible and our treatment is far worse,” pointed out
Mohsin, recommending pegylated interferon to the conventional one.

Anywhere between 2 to 3pc of Pakistanis are carriers of hepatitis B and 4
to 5pc of hepatitis C. However, the number of those with hepatitis B or C
could be significantly higher, said Saeed, if the entire population was
screened for the disease.

WHO defines the risk as ‘high’ if the disease is prevalent in more than 8pc
of the population, ‘intermediate’ as 2-8 pc, and ‘low’ if less than 2pc.
__________________________________________________________________
__________________________________________________________________
USA: FDA Warns Drugs From Florida Compounding Shop May Be Contaminated
Written by Heather Linder, Becker’s Hospital Review (10.05.13)

Based on a recent inspection, the FDA is warning providers and hospital
supply managers that drugs produced and distributed by The Compounding Shop
in St. Petersburg, Fla., may not be sterile, according to the American
Society of Anesthesiologists.

No products from this compounder that are marked as sterile should be
administered to patients, as microbial contamination can put patients at
risk for severe infections.

Hospitals and healthcare providers should quarantine any such products and
await further instructions, according to the release.
__________________________________________________________________
__________________________________________________________________
Nevada USA: Vegas jury asked to ignore hep c case ‘hysteria’
KSNV MyNews3 (07.05.13)

Opening statements wrapped up today in the criminal trial of Dr. Dipak
Desai, the man at the center of a hepatitis c outbreak in Las Vegas in
2007. Yesterday we heard from prosecutors and today the defense laid out
its case. News 3’s Elizabeth Donatelli joins from the Regional Justice
Center with the report.

LAS VEGAS (AP) — 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.

©2013 Associated Press. All rights reserved. This material may not be
published, broadcast, rewritten, or redistributed.
__________________________________________________________________
__________________________________________________________________
Vietnam: Vietnam suspends Quinvaxem vaccine following 9 deaths
TUOI TRE News, VietNam(06.05.13)

The Ministry of Health decided on May 4 to suspend the use of Quinvaxem,
the made-in-Korea vaccine against five childhood deadly diseases, after
nine deaths and dozens of cases of severe allergic reactions among local
infants were reported over the past six months.

Since last November, nine newborns from different provinces died after
being vaccinated with Quinvaxem, which is meant to prevent five common,
potentially fatal childhood diseases: diphtheria (D), tetanus (T),
pertussis (P, whooping cough), hepatitis B (HepB), and Haemophilus
influenza type b (Hib).

All of the babies who died were in good health, but hours after receiving
the vaccine they began wailing loudly, convulsed, and had serious trouble
breathing, before passing away shortly after.

Despite several tests, no scientific evidence directly connecting the
vaccine with the deaths or severe allergies has been provided, while health
officials stressed that the vaccine batches involved were good quality and
met all technical requirements.

However, no evidence has been produced to exclude the vaccine as a reason
either.

According to Trinh Quang Huan, former deputy health minister, out of the 42
batches of Quinvaxem vaccine imported by Vietnam, over 20 resulted in minor
to severe allergic post-injection reactions.

Huan also noted that whole-cell pertussis vaccines, like Quinvaxem, are
among those that cause the most allergic reactions.

After severe reactions were reported in different provinces after
immunization with Quinvaxem, provincial health departments halted the use
of the vaccine.

Nguyen Nhat Cam, head of the Hanoi Preventive Health Center under the
Ministry of Health, said that though tests on the vaccine batches suspected
to have something to do with the deaths last January proved that the
vaccine involved was fine and stored correctly, his center still halted the
use of the vaccine, with some 3,000 remaining doses.

Replacement
According to the ministry, Vietnam uses up to 4.5 million doses of
Quinvaxem vaccine a year to immunize 1.5 million children younger than one
year against the five said diseases.

The ministry has yet to provide guidance on which vaccines can serve as a
substitute for Quinvaxem. Meanwhile, the Drug Administration Office
suggested that the substitutes could be Hepatitis B, and Haemophilus
influenza type b vaccines as separate ones and a three-in-one vaccine to
immunize against diphtheria, pertussis and tetanus.

The office said it is ready to import substitute vaccines on the ministry’s
request.

Cam also urged the ministry to provide guidance on the replacment vaccines
soon, as Quinvaxem is used for babies while the three-in-one vaccine is for
1.5-year-old infants.

He also stressed that, regarding the fatal risk of the five diseases, the
lack of vaccines in the long term may cause vaccination loopholes.

Meanwhile, Huan urged the government to provide funds or seek sponsorship
to acquire five-in-one or six-in-one substitutes.

According to Tran Phu Manh Sieu, head of the Ho Chi Minh City Preventive
Health Center, in case that the suspense of Quinvaxem and lack of official
substitutes lasts more than 15 days, parents can take their newborns for
serviced vaccinations at local hospitals and health centers, where other
vaccines to immunize against these five disease are readily available.
__________________________________________________________________

According to the World Health Organization several countries including Sri
Lanka and Pakistan have ordered the withdrawal of Quinvaxem, produced by
South Korea’s Berna Biotech Group since 2006, from their markets following
multiple deaths and severe allergic reactions among local infants.

Local governments have investigated the issue with the assistance of WHO,
but they failed to prove the connection between the use of the vaccine with
the deaths or severe reactions.

Around 429 million doses of Quinvaxem vaccine have been used in over 30
nations since 2006.

Every year, Vietnam consumes 4.5 million doses of Quinvaxem since 2010.
__________________________________________________________________
________________________________*_________________________________
* SAFETY OF INJECTIONS brief yourself at: www.injectionsafety.org

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The SIGNpost Website is http://SIGNpostOnline.info

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

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

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

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

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