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SIGNpost 00707

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST *

Post00707  Interv Radiol IS Position + Abstracts + News  17 July 2013

CONTENTS
1. Society of Interventional Radiology position statement on injection
safety: improper use of single-dose/single-use vials
2. Updated Logistics Handbook: A Practical Guide for the Supply Chain
Management of Health Commodities
3. Abstract: Global control of hepatitis C: where challenge meets
opportunity
4. Abstract: KAP regarding HIV infection through accidental needlestick
injuries among dental students
5. Abstract: Healthcare worker safety: a vital component of surgical
capacity development in low-resource settings
6. Abstract: 30 Years on Selected Issues in the Prevention of HIV among
Persons Who Inject Drugs
7. Abstract: The trajectory of methadone maintenance treatment in Nepal
8. Abstract: Self-reported reasons for hand hygiene in 3 groups of health
care workers
9. Abstract: A randomized, controlled, blinded study of the safety and
immunogenicity of Haemophilus influenzae type b conjugate vaccine
injected at different intramuscular sites in Chinese infants
10. Abstract: The effect of injection duration and injection site on pain
and bruising of subcutaneous injection of heparin
11. Abstract: Safety of intra-articular hip injection of hyaluronic acid
products by ultrasound guidance: an open study from ANTIAGE register
12. Abstract: Update: Recommendations for Middle East Respiratory Syndrome
Coronavirus (MERS-CoV)
13. News
– USA: Another hepatitis B case is possibly linked to Tri-County Spinal
Care Center

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________________________________*_________________________________

1. Society of Interventional Radiology position statement on injection
safety: improper use of single-dose/single-use vials
__________________________________________________________________
J Vasc Interv Radiol. 2013 Jan;24(1):111-2.

Society of Interventional Radiology position statement on injection
safety: improper use of single-dose/single-use vials.

Silberzweig JE, Khorsandi AS, Dixon RG, Gross K, Nikolic B.

Department of Radiology, Beth Israel Medical Center, New York, NY 10003,
USA. jsilberzweig@chpnet.org

Free Full Text: http://www.jvir.org/article/S1051-0443(12)01020-2/fulltext

Abbreviations: CDC, Centers for Disease Control and Prevention, MDV,
multidose vial, SDV, single-dose vial, USP, United States Pharmacopeia

Efficient health care delivery includes expense reduction, distribution of
limited resources, and minimization of medical waste. These goals must be
achieved without patient safety compromise.

One challenging example is the administration of injectable medications.
Some common procedures may require injection of only a small quantity of
medication such as sodium tetradecyl sulfate (Sotradecol; AngioDynamics,
Queensbury, New York), onabotulinumtoxinA (BOTOX Cosmetic; Allergan,
Irvine, California), or radiocontrast agents for arthrography,
myelography, or percutaneous pain management procedures. In a busy
clinical setting, with several consecutive patients scheduled for similar
procedures, it may be tempting to purchase a medication in a large
“economy-size” container and split the doses into multiple syringes for
administration to multiple patients.

An essential feature of injection practice involves the safe
administration of a medication packaged in a single-dose vial (SDV) or
single-use vial. The Centers for Disease Control and Prevention (CDC) note
that improper use of a medication packaged in an SDV can place a patient
at increased risk for acquiring a health care–related infection (1).
Medication from an SDV is intended for parenteral administration for a
single patient during a single procedure. SDVs are labeled as such in the
manufacturer’s package insert. The CDC states that SDVs must not be used
for multiple patients. Even if an SDV contains more medication than is
needed for a single patient, that vial should not be used for more than
one patient nor stored for future use in the same patient.

In contrast with an SDV, a multidose vial (MDV) of a medication contains
more than a single medication dose. MDVs are labeled as such by the
manufacturer and typically contain an antimicrobial preservative agent to
help prevent bacterial growth. The preservative agent has no effect on
viruses and does not protect against contamination when health care
personnel fail to follow safe injection practices. MDVs are discarded
within 28 days unless the manufacturer specifies a different (shorter or
longer) date for that opened vial. An MDV used for more than one patient
is required to be kept in a centralized medication area and not accessed
in the immediate patient treatment area (eg, procedure room, patient
room). If MDVs enter the treatment area, they should be dedicated for
single-patient use and discarded immediately after use (2).

A medication in an SDV can become contaminated and act as an infection
source if administered to multiple patients. The infection outbreak risk
is particularly increased with repeated SDV access with more than one
needle whenever an SDV is used for more than one patient. Since the CDC
safe injection guidelines were published in 2007, the CDC has reported 21
outbreaks associated with SDV medications administered for multiple
patients: seven outbreaks involved infections transmitted through
contamination by blood, and 14 involved bacterial infections 3, 4, 5, 6,
7. Two recently reported outbreaks of invasive Staphylococcus aureus
infection were confirmed in 10 patients being treated for pain in
outpatient clinics in Delaware and Arizona, in which SDVs were reused for
multiple patients (7). Transmission of life-threatening but preventable
bacterial infections by failing to follow safe-injection recommendations
can result in an infection outbreak that causes unnecessary morbidity and
draws attention of the media and regulatory agencies (8).

Concerns have been raised about whether these guidelines and related
policies contribute to drug shortages and increased medical costs to
health care providers. On May 2, 2012, the CDC restated its 2007 position
regarding the use of SDVs in response to “inaccuracies” being disseminated
to health care providers (9). The CDC recognized the problem of drug
shortages; however, such shortages are noted to be the result of
manufacturing, shipping, and other issues unrelated to the guidelines. The
CDC noted that lowering safety standards will not address the problem of
drug shortages (10).

Under certain conditions, however, such as during limited drug
availability, it is permissible for health care facilities to repackage
SDVs into smaller doses, each intended for a single patient use.
Repackaging is allowable if performed by qualified health care personnel
under specific conditions according to standards in United States
Pharmacopeia (USP) General Chapter 797, Pharmaceutical Compounding–Sterile
Preparations (11), as well as the manufacturer’s recommendations
pertaining to safe storage of that medication outside of its original
container (11). On June 15, 2012, CMS issued a memorandum that stated that
health care providers that do not comply with USP standards for SDVs may
be cited for deficiencies under applicable federal infection control
standards (12).

SVDs must never be used for multiple patients unless specific conditions
allow repackaging by qualified health care personnel under USP standards.
It is the responsibility of interventional radiologists and other licensed
personnel to adhere to best care practices for the safe performance of
minimally invasive treatments.

Article Outline
http://www.jvir.org/article/S1051-0443(12)01020-2/fulltext

References
http://www.jvir.org/article/S1051-0443(12)01020-2/fulltext

Copyright © 2013 SIR. Published by Elsevier Inc. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

2. Updated Logistics Handbook: A Practical Guide for the Supply Chain
Management of Health Commodities
__________________________________________________________________
Updated Logistics Handbook Now in French and Spanish

The USAID | DELIVER PROJECT has published French and Spanish translations
of the updated Logistics Handbook: A Practical Guide for the Supply Chain
Management of Health Commodities.

The Logistics Handbook, updated in 2011, offers practical guidance for
managing the supply chain, with an emphasis on health commodities.

It is intended to help program managers who design, manage, and assess
logistics systems for health programs.

In addition, policymakers, system stakeholders, and anyone working in
logistics will also find it helpful as a system overview and overall
approach.

Download the publications at http://j.mp/1bGfoaI
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Global control of hepatitis C: where challenge meets
opportunity
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23836235

Nat Med. 2013 Jul;19(7):850-8.

Global control of hepatitis C: where challenge meets opportunity.

Thomas DL.

Division of Infectious Diseases, Johns Hopkins School of Medicine,
Baltimore, Maryland, USA.

We are entering an important new chapter in the story of hepatitis C virus
(HCV) infection. There are clear challenges and opportunities. On the one
hand, new HCV infections are still occurring, and an estimated 185 million
people are or have previously been infected worldwide.

Most HCV-infected persons are unaware of their status yet are at risk for
life-threatening diseases such as cirrhosis and hepatocellular carcinoma
(HCC), whose incidences are predicted to rise in the coming decade.

On the other hand, new HCV infections can be prevented, and those that
have already occurred can be detected and treated-viral eradication is
even possible.

How the story ends will largely be determined by the extent to which these
rapidly advancing opportunities overcome the growing challenges and by the
vigor of the public health response.

Requires subscription or payment
http://www.nature.com/nm/journal/v19/n7/full/nm.3184.html
__________________________________________________________________
________________________________*_________________________________

4. Abstract: KAP regarding HIV infection through accidental needlestick
injuries among dental students
__________________________________________________________________
Natl J Maxillofac Surg. 2012 Jul;3(2):238.

KAP regarding HIV infection through accidental needlestick injuries among
dental students.

Joob B, Wiwanitkit V.

Sanitation 1 Medical Academic Center, Bangkhae, Bangkok, Thailand.

Sir,

The recent report on “KAP regarding HIV infection through accidental
needlestick injuries among dental students” is quite interesting.[1]
Guruprasad and Chauhan reported that “There is a need of correcting the
existing misconceptions through education programs early in the course and
providing supportive and proper guidelines regarding needlestick injuries
and HIV infection”.[1] Indeed, the concern on medical personnel accidental
exposure and HIV infection risk has been talked for a long time. It is no
doubt that the students are the most vulnerable group with the highest
risk due to their lowest experience and knowledge. Of interest, the
accident and risk start as early as the start of clinical practice.[2]
However, it seems that the students are usually overlooked for their high
risk for getting accidents. Indeed, this group with the lowest clinical
experience should get the special mentoring and care.

It is totally agreed that there must be the program in the early course on
prevention of HIV and other blood-borne infections. However, another
important thing that should not be forgotten is the good training system
(good preventive tool, good place, good teacher, good post exposure
management, etc.) To manage the problem of accidental needlestick injuries
among dental students, the authors would like to raise these
recommendations.

1. It should be restated that accidental is a totally unwanted event that
occurs by chance and unpredictable.

2. The zero rate of accident has to be set as the benchmarking.

3. Correction and preventive action is required.

4. Quality control of clinical study process is needed. The safety has to
be an important aspect in quality control.

5. There must be the surveillance system for accident. Also, the incident
report has to be completely used.

6. There must be the good and effective post-exposure management system.

7. Before actual clinical practice, there must be prerequisite for passing
the assessment on safety practice.

8. The good preventive equipment has to be available for clinical practice
section.

9. The special training session on self-prevention behavior is suggested.
Also, the periodically repeatedly refreshment training is recommended.

10. Special care for clinical practice of the student is needed. Closed
observation by clinical mentor is the rule.

11. For each training session, introduction of safety before practice and
conclusion on safety after practice is recommended.

References
1. Guruprasad Y, Chauhan DS. Knowledge, attitude and practice regarding
risk of HIV infection through accidental needlestick injuries among dental
students of Raichur, India. Natl J Maxillofac Surg. 2011;2:152–5. [PMC
free article] [PubMed] www.ncbi.nlm.nih.gov/pmc/articles/PMC3343388/

2. Wiwanitkit V. Needle stick injuries during medical training among Thai
pre-clinical year medical students of the Faculty of Medicine,
Chulalongkorn University. J Med Assoc Thai. 2001;84:120–4. [PubMed]
www.ncbi.nlm.nih.gov/pubmed/11281490

Free PMC Article
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3700168/
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Healthcare worker safety: a vital component of surgical
capacity development in low-resource settings
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23433291

Int J Occup Environ Health. 2012 Oct-Dec;18(4):307-11.

Healthcare worker safety: a vital component of surgical capacity
development in low-resource settings.

Petroze RT, Phillips EK, Nzayisenga A, Ntakiyiruta G, Forrest Calland J.

Department of Surgery, University of Virginia, Charlottesville, VA, USA.

INTRODUCTION: A disparate number of occupational exposures to bloodborne
pathogens occur in low-income countries where disease prevalence is high
and healthcare provider-per-population ratios are low.

METHODS: In an effort to highlight the important role of healthcare worker
safety in surgical capacity building in Rwanda, we measured self-reported
presence of safety materials and compliance with personal protective
equipment in the operating theatre as part of a nationwide survey to
characterize emergency and essential surgical capacity in all government
hospitals.

RESULTS: We surveyed 44 hospitals. While staff report general availability
of safe disposal of sharps and hazardous waste, presence of and compliance
with eye protection was lacking. Staff were cognizant of prevention
measures such as double-gloving and ‘safe receptacles’, as well as
hospital policies for post-exposure prophylaxis for HIV following
needlesticks, but there was little awareness of hepatitis exposure.

CONCLUSIONS: Healthcare worker safety should be a key component of
hospital-level surgical capacity.
__________________________________________________________________
________________________________*_________________________________

6. Abstract: 30 Years on Selected Issues in the Prevention of HIV among
Persons Who Inject Drugs
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23840957

Adv Prev Med. 2013;2013:346372.

30 Years on Selected Issues in the Prevention of HIV among Persons Who
Inject Drugs.

Des Jarlais DC, Pinkerton S, Hagan H, Guardino V, Feelemyer J, Cooper H,
Hatzatkis A, Uuskula A.

The Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel
Medical Center, 160 Water Street, FL 24, New York, NY 10038, USA.

After 30 years of extensive research on human immunodeficiency virus (HIV)
among persons who inject drugs (PWID), we now have a good understanding of
the critical issues involved. Following the discovery of HIV in 1981,
epidemics among PWID were noted in many countries, and consensus
recommendations for interventions for reducing injection related HIV
transmission have been developed.

While high-income countries have continued to develop and implement new
Harm Reduction programs, most low-/middle-income countries have
implemented Harm Reduction at very low levels.

Modeling of combined prevention programming including needle exchange
(NSP) and antiretroviral therapy (ARV) suggests that NSP be given the
highest priority. Future HIV prevention programming should continue to
provide Harm Reduction programs for PWID coupled with interventions aimed
at reducing sexual transmission.

As HIV continues to spread in low- and middle-income countries, it is
important to achieve and maintain high coverage of Harm Reduction programs
in these locations. As PWID almost always experience multiple health
problems, it will be important to address these multiple problems within a
comprehensive approach grounded in a human rights perspective.

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3694369/
__________________________________________________________________
________________________________*_________________________________

7. Abstract: The trajectory of methadone maintenance treatment in Nepal
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23845916

Int J Drug Policy. 2013 Jul 8. pii: S0955-3959(13)00094-7.

The trajectory of methadone maintenance treatment in Nepal.

Ambekar A, Rao R, Pun A, Kumar S, Kishore K.

National Drug Dependence Treatment Centre, All India Institute of Medical
Sciences, New Delhi 110029, India. Electronic address:
atul.ambekar@gmail.com.

There are about 28,500 people who inject drugs (PWID) in Nepal and HIV
prevalence among this group is high. Nepal introduced harm reduction
services for PWID much earlier than other countries in South Asia.
Methadone maintenance treatment (MMT) was first introduced in Nepal in
1994.

This initial small scale MMT programme was closed in 2002 but reopened in
2007 as an emergency HIV prevention response. It has since been scaled up
to include three MMT clinics and continuation of MMT is supported by the
Ministry of Home Affairs (MOHA; the nodal ministry for drug supply
reduction activities) and has been endorsed in the recent National
Narcotics policy. Pressure from drug user groups has also helped its
reintroduction.

Interestingly, these developments have taken place during a period of
political instability in Nepal, with the help of strong advocacy from
multiple stakeholders. The MMT programme has also had to face resistance
from those who were running drug treatment centres.

Despite overcoming such troubles, the MMT programme faces a number of
challenges. Coverage of MMT is low and high-risk injecting and sexual
behaviour among PWID continues. The finance for MMT is largely from
external donors and these donations have become scarce with the current
global economic problems. With a multitude of developmental challenges for
Nepal, the position of MMT in the national priority list is uncertain.
Ownership of the programme by government, a cost-effective national MMT
scale up plan and rigorous monitoring of its implementation is needed.

Copyright © 2013 Elsevier B.V. All rights reserved.

KEYWORDS: HIV prevention, Opioid substitution treatment, People who inject
drugs
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Self-reported reasons for hand hygiene in 3 groups of health
care workers
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22264745

Am J Infect Control. 2012 Sep;40(7):653-8.

Self-reported reasons for hand hygiene in 3 groups of health care workers.
McLaughlin AC, Walsh F.

Department of Psychology, North Carolina State University, Raleigh, NC
27695, USA. Anne_McLaughlin@ncsu.edu

BACKGROUND: The hands of health care workers continue to be the main
vector for nosocomial infection in hospitals. The purpose of the current
research was to capture the health beliefs and self-reported behaviors of
US health care workers to better understand why workers avoid hand hygiene
and what prompts them to wash.

METHODS: An online survey of health care workers assessed their reasons
for washing their hands, reasons for not washing, and what cues prompted
the decision to wash or not wash in a variety of locations.

RESULTS: The findings were that hand hygiene could be cued by an external
situation but tended to be motivated internally. Hand hygiene was avoided
because of situational barriers.

CONCLUSION: The reasons for performing hand hygiene can be situated in the
internally motivated Theory of Planned Behavior; however, the reasons for
not performing hand hygiene tend to be situational and affected by the
environment. The results may be used to design programs, products, and
systems that promote appropriate hand hygiene practices. Principles for
design of these programs and products are provided.

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

9. Abstract: A randomized, controlled, blinded study of the safety and
immunogenicity of Haemophilus influenzae type b conjugate vaccine
injected at different intramuscular sites in Chinese infants
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23842003

Hum Vaccin Immunother. 2013 Jul 10;9(11).

A randomized, controlled, blinded study of the safety and immunogenicity
of Haemophilus influenzae type b conjugate vaccine injected at different
intramuscular sites in Chinese infants.

Luo F, Li L, Zheng D, Zhang Z, Wang Z, Yang L, Liu Z, Ai X, Bai Y, Lu Q,
Shi N.

Chaoyang Diseases Control and Prevention Center; Beijing, PR China.

To compare the safety and immunogenicity of Haemophilus influenzae type b
(Hib) conjugate vaccine administered via the vastus lateralis and deltoid
muscles, 320 healthy Chinese infants < 12 mo of age were enrolled in a
randomized, controlled, blinded study and divided into 2 age groups: 2-5
mo and 6-12 mo.

Each age group was then randomized (1:1) to either the vastus lateralis
(experimental) group who received Hib vaccination into this muscle 2 or 3
times at monthly intervals, or the deltoid (control) group who received
Hib vaccination into this muscle either 3 times (2-5 mo group) or twice
(6-12 mo group) at monthly intervals.

Local and systemic adverse reactions after each vaccine dose were
recorded, and Hib-PRP antibody concentrations were determined by ELISA at
28 d after completion of the immunization schedule.

There were no significant differences in the proportions of subjects with
post-immunization Hib-PRP antibody concentrations = 1.0 µg/mL or = 0.15
µg/mL with the two injection sites for either age group, or in the post-
immunization Hib-PRP antibody concentrations achieved (p > 0.05).

In addition, there were no significant differences in the rates of local
and systemic reactions after the first and second vaccinations between the
2 injection sites for either age group (p > 0.05), but the rate of
systemic reactions in the 2-5 mo group after the third vaccination via the
vastus lateralis muscle was significantly lower than after deltoid
vaccination (0% vs 8.57%; p < 0.05). Thus, administration via the vastus
lateralis muscle is worth considering for Hib vaccination.

KEYWORDS: Haemophilus influenzaetype b vaccine, deltoid, immunogenicity,
safety, vaccination site, vastus lateralis
__________________________________________________________________
________________________________*_________________________________

10. Abstract: The effect of injection duration and injection site on pain
and bruising of subcutaneous injection of heparin
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23844561

J Clin Nurs. 2013 Jul 12.

The effect of injection duration and injection site on pain and bruising
of subcutaneous injection of heparin.

Pourghaznein T, Azimi AV, Jafarabadi MA.

Department of Medical-Surgical, School of Nursing and Midwifery, Mashhad
University of Medical Sciences, Mashhad, Iran.

AIMS AND OBJECTIVES:
To determine and compare the effects of four methods of subcutaneous
heparin injection on pain and bruising in abdomen and thighs.

BACKGROUND: Subcutaneous heparin injection is a common nursing clinical
intervention. Nurses frequently inject heparin subcutaneously and this
action often results in some complications such as bruising, haematoma,
pain and induration in the injection site. There are also some other
factors inducing complications associated with heparin injection,
including the injection site and the injection duration.

DESIGN: A quasi-experimental within-subject design.

METHODS: This study was conducted on 90 patients with COPD hospitalised in
two ICU wards at two teaching hospitals in urban areas of Iran. They were
administered heparin subcutaneously, 4000 units every 12 hours. Each
patient received four injections in their abdomen and thighs, using four
different methods. The number and size of bruising at the injection site
were measured through a flexible millimetre ruler, 48 hours after each
injection. The severity of pain was measured through pain visual analogue
scale immediately after each injection. Collected data were analysed by
descriptive and analytical statistics using spss 11.5 software.

RESULTS: In the method 15 seconds injection duration and waiting for 5
seconds before withdrawing the needle, the number of bruising was
significantly lower and size of bruising was significantly smaller, but no
significant difference was found in the severity of pain. However, in
other methods, the severity of pain in thighs was significantly higher
than in abdomen, but no statistically significant difference was reported
between the size and number of bruising in abdomen and thighs.

CONCLUSIONS: The method 15 seconds injection duration and waiting for 5
seconds before withdrawing the needle is recommended to be used for
subcutaneous heparin injection by clinical nurses. As to the results, the
severity of pain in abdomen was lower than in thighs.

RELEVANCE TO CLINICAL PRACTICE: This study proposed a suitable method for
subcutaneous heparin injection in order to reduce pain and bruising.

© 2013 John Wiley & Sons Ltd.

KEYWORDS: bruising, heparin, injection duration, injection site, pain,
subcutaneous injection
__________________________________________________________________
________________________________*_________________________________

11. Abstract: Safety of intra-articular hip injection of hyaluronic acid
products by ultrasound guidance: an open study from ANTIAGE register
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23852899

Eur Rev Med Pharmacol Sci. 2013 Jul;17(13):1752-9.

Safety of intra-articular hip injection of hyaluronic acid products by
ultrasound guidance: an open study from ANTIAGE register.

Migliore A, Tormenta S, Laganà B, Piscitelli P, Granata M, Bizzi E,
Massafra U, Giovannangeli F, Maggi C, De Chiara R, Iannessi F, Sanfilippo
A, Camminiti M, Pagano MG, Bagnato G, Iolascon G.

Operative Unit of Rheumatology, S. Pietro Fatebenefratelli Hospital, Rome,
Italy. migliore.alberto60@gmail.com

OBJECTIVE: We developed a standardized technique for ultrasound guided
intra- articular injection of the hip joint with the purpose of extending
routine intra-articular injection of hyaluronans and steroids to the hip,
as commonly used in the knee. In this article we report the safety of this
technique in an extended series of patients.

PATIENTS AND METHODS: Patients were injected supine with an anterosuperior
approach under ultrasound guidance. The Us probe is applied with a target
device for biopsy.

RESULTS: The standardised technique was used to inject 1906 patients with
4002 injections of hyaluronan products over a four-year period. The
treatment was well tolerated with few, and exclusively local, side
effects.

CONCLUSIONS: The administration of hyaluronans under ultrasound-guided
intra-articular injection is a safe technique for treatment of rheumatic
diseases of the hip.
__________________________________________________________________
________________________________*_________________________________

12. Abstract: Update: Recommendations for Middle East Respiratory Syndrome
Coronavirus (MERS-CoV)
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23842446

MMWR Morb Mortal Wkly Rep. 2013 Jul 12;62(27):557.

Update: Recommendations for Middle East Respiratory Syndrome Coronavirus
(MERS-CoV).

Centers for Disease Control and Prevention (CDC).

On June 11, 2013, CDC issued interim infection prevention and control
recommendations for hospitalized patients with known or suspected Middle
East respiratory syndrome coronavirus (MERS-CoV) infection in U.S.
hospitals. To date, no MERS-CoV cases have been reported in the United
States; however, cases have been reported in eight other countries.

Recent published reports have described limited health-care transmission
of MERS-CoV, including cases among health-care personnel in international
settings.

These published reports highlight the need for rapid detection of
infectious patients and adherence to correct infection prevention measures
to prevent transmission of the virus among patients, health-care
personnel, and visitors.

Free full text
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6227a4.htm
__________________________________________________________________
________________________________*_________________________________

13. News

– USA: Another hepatitis B case is possibly linked to Tri-County Spinal
Care Center

Selected news items reprinted under the fair use doctrine of international
copyright law: http://www4.law.cornell.edu/uscode/17/107.html
__________________________________________________________________
USA: Another hepatitis B case is possibly linked to Tri-County Spinal Care
Center
Lauren Sausser, The Post and Courier, North Caroline USA (09.07.13)

Another person has tested positive for hepatitis B since the state health
department started investigating a medical clinic in North Charleston in
May, the Department of Health and Environmental Control confirmed.

It brings the total number of Tri-County Spinal Care Center patients who
have tested positive for the infectious disease to 19.

DHEC launched an investigation into Tri-County Spinal Care Center this
spring when three patients who received similar injections on the same
days in February were diagnosed with hepatitis B.

To date, DHEC has notified about 600 other current and former patients
that they should be tested too.

“We identified breaches in infection control practices that could have
resulted in the contamination of medication that was administered to
multiple patients and served as a possible source of infection,” said DHEC
spokesman Jim Beasley.

Still, it’s virtually impossible to confirm that the clinic is the source
of these 19 infections, he said.

Hepatitis B affects the liver. Sometimes the disease clears on its own; in
other cases it develops into a lifelong condition and can cause liver
cancer.

More than half of these 19 hepatitis B cases already have cleared, Beasley
said. Only one patient has developed chronic hepatitis B.

A message left for Tri-County Spinal Care Center owner Cameron Wills was
not returned.
__________________________________________________________________
________________________________*_________________________________
* 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
__________________________________________________________________
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The 2010 annual Safe Injection Global Network meeting to aid collaboration
and synergy among SIGN network participants worldwide 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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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
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The SIGN Internet Forum was established at the initiative of the World
Health Organization’s Department of Essential Health Technologies.

The SIGN Secretariat home is the Department of Health Systems Policies and
Workforce, Geneva Switzerland.

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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