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SIGNpost 00709


Post00709  HCWM + Dentists + Hep C + Abstracts + News  31 July 2013
1. New 2nd Edition of” Safe management of wastes from health-care
2. Supply Chain Risk Management Toolkit
3. Abstract: Implementing a Sharps Injury Reduction Program at a Charity
Hospital in India
4. Abstract: Infection control practices in dental school: A patient
perspective from Saudi Arabia
5. Abstract: What are the costs and benefits of patient notification
exercises following poor infection control practices in dentistry?
6. Abstract: Compliance of Saudi dental students with infection control
7. Abstract: Knowledge, Attitude, Practice, and Status of Infection
Control among Iranian Dentists and Dental Students: A Systematic Review
8. Abstract: Epidemiology of hepatitis C virus infection in highly endemic
HBV areas in China
9. Abstract: Description of outbreaks of health-care-associated infections
related to compounding pharmacies, 2000-12
10. Abstract: Burden and prevention of viral hepatitis in the Arctic
region, Copenhagen, Denmark, 22-23 March 2012
11. Abstract: Tensions inherent in the evolving role of the infection
12. Abstract: Hand rub dose needed for a single disinfection varies
according to product: A bias in benchmarking using indirect hand
hygiene indicator
13. Abstract: The use of protective gloves by medical personnel
14. Abstract: Effectiveness of disinfectant wipes for decontamination of
bacteria on patients’ environmental and medical equipment surfaces at
Siriraj Hospital
15. Abstract: Use of safety scalpels and other safety practices to reduce
sharps injury in the operating room: What is the evidence?
16. Abstract: What about the surgeon?
17. Abstract: Universal screening versus universal precautions in the
context of preoperative screening for HIV, HBV, HCV in India
18. No Abstract: Building partnerships between law enforcement and harm
reduction programs
19. No Abstract: Infection control and management of hazardous materials
for the dental team, 5th edition
20. No Abstract: Eradication of hepatitis C infection: The importance of
targeting people who inject drugs
21. UK: Hepatitis C in the UK annual report
22. News
– Pakistan: Call to fight hepatitis
– Canada: Sask. hep C rate twice national average
– India: A crucial fight
– India: Infected injections, unsafe blood transfusions see Hepatitis
rising in India
– Georgia: Hepatitis C rages in Georgia
– USA: Six Recommended Measures to Prevent Hepatitis C for Young
Injection-Drug Users
– Australia: Hep C fears over needles
– India: Outbreak of hepatitis C at Barnala village
– Music may help lessen kids’ needle stress

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1. New 2nd Edition of” Safe management of wastes from health-care
From:Jan-Gerd Kühling <>
To: SIGN date: Jul 24 20-13

Dear Friends and Partners

I am glad to announce that finally the second edition of the book “Safe
management of wastes from health-care activities” (commonly known as the
Blue Book) is finalized and can be downloaded from the WHO server at:

I still remember: It was in 2006 and I was sitting with Yves and Bill in
the bus on the way to visit an hazardous waste incinerator near Rimini,
Italia ( Bill = William King Townend, the former chair of the ISWA
healthcare waste group and Yves Chartier from WHO). During this trip, we
discussed the need to update the Blue Book in the near future and decided,
that this should be a nice cooperation project of ISWA and WHO. In 2007,
we had the kick-off workshop.

As the Blue Book is the most important reference document in the
healthcare waste field, it took of course some time to review, update, re-
write and double and triple check it. I´m proud that we could contribute
to the second edition (Ute was the author of chapter 7 on logistics, I did
chapter 9 on waste water and Ute was also one of the Editors) and I feel
sad that Bill and Yves are not able to see the 2nd edition, but I trust
that they would be very satisfied with the final outcome.

Please get the word out that the new edition is available now! A lot of
people waited for this.

Best regards and happy reading


ETLog Health EnviroTech & Logistics GmbH Jan-Gerd Kühling Managing Partner
Kavalierstrasse 15 13187 Berlin Germany

Tel.: ++ 49 (0)30 / 44 31 87 – 41 Fax: ++ 49 (0)30 / 44 31 87 – 49 E-Mail: Skype-Username: etlog-jgk Web:

2. Supply Chain Risk Management Toolkit
From: Shega Shala <>
Date: Jul 25 2013

How can public health supply chain managers identify sources of risk
within their supply chains and develop robust responses to that risk?

The Risk Management Toolkit focuses on how to organize the logistics
activities of the supply chain to ensure that commodities needed for
health programs are continuously available, without disruption.

The USAID | DELIVER PROJECT developed the toolkit to introduce risk
management activities for health programs in developing countries.

In this toolkit, you will find—
•Risk Management for Public Health Supply Chains: Toolkit for Identifying,
Analyzing, and Responding to Supply Chain Risk in Developing Countries

•The Risk Assessment and Control Decision Support Tool (TRAC_DST) (Excel)
•Understanding and Managing Supply Chain Risks: Activity Session Notes

•Workshop: Developing a Risk Management Plan (PPT)

•Case Study: Supply Chain Risk Management, Project Monitoring at the SCMS
Project (PDF)

•Case Study: Supply Chain Risk Management, USAID | DELIVER PROJECT, Task
Order 5 (PDF)

Access the toolkit online at

3. Abstract: Implementing a Sharps Injury Reduction Program at a Charity
Hospital in India

Workplace Health Saf. 2013 Jul 23:339-345.

Implementing a Sharps Injury Reduction Program at a Charity Hospital in

Gramling JJ, Nachreiner N.

Health care workers in India are at high risk of developing bloodborne
infections from needlestick injuries. Indian hospitals often do not have
the resources to invest in safety devices and protective equipment to
decrease this risk.

In collaboration with hospital staff, the primary author implemented a
sharps injury prevention and biomedical waste program at an urban 60-bed
charity hospital in northern India. The program aligned with hospital
organizational objectives and was designed to be low-cost and sustainable.

Occupational health nurses working in international settings or with
international workers should be aware of employee and employer knowledge
and commitment to occupational health and safety.

Copyright 2013, SLACK Incorporated.

4. Abstract: Infection control practices in dental school: A patient
perspective from Saudi Arabia

Dent Res J (Isfahan). 2013 Jan;10(1):25-30.

Infection control practices in dental school: A patient perspective from
Saudi Arabia.

Baseer MA, Rahman G, Yassin MA.

Department of Community and Preventive Dentistry, Annamuthajiya Campus,
Riyadh Colleges of Dentistry and Pharmacy, Riyadh, Kingdom of Saudi

BACKGROUND: Routine use of gloves, masks and spectacles are important in
infection control. Aim of this study was to assess the knowledge and
attitudes of infection control measures among the patients attending
clinics of Riyadh Colleges of Dentistry and Pharmacy (RCsDP) in Saudi

MATERIAL AND METHODS: It was a cross-sectional descriptive study of a
convenient sample of dental patients attending dental clinics of RCsDP. A
structured, close ended, self-administered questionnaire was distributed
to 350 patients and a response rate of 86% was obtained.
Questionnaireconsisted of series of queries related to knowledge and
attitudes of patients towards infection control measures. Data analysis
included frequency distribution tables, Mann-Whitney and Kruskal-Wallis
tests. Level of significance was set at P < 0.05.

RESULTS: Final study sample included 301 patients (147 males and 154
females). Almost 99%, 93.7% and 82.7% of the patients agreed that dentist
should wear gloves, face mask and spectacles while providing treatment.
However, 60.1%, 30% of the patients said that HIV and hepatitis-B
infections can spread in dental clinics. Half of the patients felt that
they were likely to contract AIDS and 77.7% refused to attend clinics if
they knew that AIDS and Hepatitis-B patients treated there. Only 25.2%
said that autoclave is the best method of sterilization. A significantly
higher knowledge of infection control was observed among the previous
dental visitors compared to the first time visitors to the dental clinics
(P < 0.05).

CONCLUSIONS: Patients revealed adequate knowledge towards the use of
gloves, face mask and spectacles by dentist. However, their knowledge
regarding the spread of Hepatitis-B, HIV infection and use of autoclave
was poor. Previous visitor of dental clinics showed higher knowledge of
infection control as compared to the first time visitors. Many patients
expressed their negative attitudes towards dental care due to AIDS and
Hepatitis-B concerns.

KEYWORDS: Attitude, dental patients, infection control measures, knowledge

Free PMC Article

5. Abstract: What are the costs and benefits of patient notification
exercises following poor infection control practices in dentistry?

Public Health. 2013 Jul 20. pii: S0033-3506(13)00164-9.

What are the costs and benefits of patient notification exercises
following poor infection control practices in dentistry?

Close RM, Gray S, Bennett S, Appleby S, Khan F, Payne C, Oliver I.

Regional Epidemiology Unit, Health Protection Agency South West,
Gloucester, UK. Electronic address:

BACKGROUND: Allegations of serious failures in infection control practice
were made against a dentist practicing in the South West of England. The
dentist (who tested negative for Blood Borne Viruses (BBVs)) was
immediately suspended.

METHODS: Because inadequate infection control presents a potential risk of
transmitting BBVs between patients, a notification exercise was
undertaken. Of 7625 patients contacted, 2780 (37%) were tested.

RESULTS: Nine cases of Hepatitis B (HBV) and four cases of Hepatitis C
(HCV) were identified, of which seven were previously diagnosed. None of
these were children. All of the six newly diagnosed cases had recognized
risk factors for BBVs. The costs of the notification exercise were
estimated at £311,500 of which £165,000 was staff costs, (£51,916 per
newly diagnosed case).

CONCLUSION: This study did not demonstrate any patient-to-patient
transmission of blood-borne viruses but the response rate was relatively
low. There are significant costs associated with undertaking notification
exercises. These findings should inform future recommendations and
practice in this area.

Copyright © 2013 The Royal Society for Public Health. Published by
Elsevier Ltd. All rights reserved.

KEYWORDS: BBV, Blood borne viruses, Economic evaluation, Look back,
Notification exercise

6. Abstract: Compliance of Saudi dental students with infection control

Int Dent J. 2013 Aug;63(4):196-201. doi: 10.1111/idj.12030.

Compliance of Saudi dental students with infection control guidelines.

Ahmad IA, Rehan EA, Pani SC.

Restorative Dentistry Department, Riyadh Colleges of Dentistry and
Pharmacy, Riyadh, Saudi Arabia.

The aim of this study was to investigate compliance of dental students in
a Saudi dental school with recommended infection control protocols. A
pilot-tested questionnaire concerning various aspects of infection control
practices was distributed to 330 dental students.

The response rate was 93.9% (n = 311). About 99% of students recorded the
medical history of their patients and 80% were vaccinated against
hepatitis B. The highest compliance (100%) with recommended guidelines was
reported for wearing gloves and use of a new saliva ejector for each
patient. Over 90% of the respondents changed gloves between patients, wore
face masks, changed hand instruments, burs and handpieces between
patients, used a rubber dam in restorative procedures and discarded sharp
objects in special containers.

A lower usage rate was reported for changing face masks between patients
(81%), disinfecting impression materials (87%) and dental prosthesis (74%)
and wearing gowns (57%). Eye glasses and face shield were used by less
than one-third of the sample.

The majority of students were found to be in compliance with most of the
investigated infection control measures.

Nevertheless, further education is needed to improve some infection
control measures including vaccination for Hepatitis B virus (HBV),
wearing eye glasses, gowns and face shields and disinfecting impression
materials and dental prostheses.

© 2013 FDI World Dental Federation.

7. Abstract: Knowledge, Attitude, Practice, and Status of Infection
Control among Iranian Dentists and Dental Students: A Systematic Review

J Dent Res Dent Clin Dent Prospects. 2013;7(2):55-60.

Knowledge, Attitude, Practice, and Status of Infection Control among
Iranian Dentists and Dental Students: A Systematic Review.

Moradi Khanghahi B, Jamali Z, Pournaghi Azar F, Naghavi Behzad M, Azami-
Aghdash S.

Medical Philosophy and History Research Center, Tabriz University of
Medical Sciences, Tabriz, Iran.

BACKGROUND AND AIMS: Infection control is an important issue in dentistry,
and the dentists are primarily responsible for observing the relevant
procedures. Therefore, the present study evaluated knowledge, attitude,
practice, and status of infection control among Iranian dentists through
systematic review of published results.

MATERIALS AND METHODS: In this systematic review, the required data was
collected searching for keywords including infection, infection control,
behavior, performance, practice, attitude, knowledge, dent*, prevention,
Iran* and their Persian equivalents in PubMed, Science Direct, Iranmedex,
SID, Medlib, and Magiran databases with a time limit of 1985 to 2012. Out
of 698 articles, 15 completely related articles were finally considered
and the rest were excluded due to lake of relev-ance to the study goals.
The required data were extracted and summarized in an Extraction Table and
were analyzed ma- nually.

RESULTS: Evaluating the results of studies indicated inappropriate
knowledge, attitude, and practice regarding infection control among
Iranian dentists and dental students. Using personal protection devices
and observing measures required for infection control were not in
accordance with global standards.

CONCLUSION: The knowledge, attitudes, and practice of infection control in
Iranian dental settings were found to be inadequate. Therefore, dentists
should be educated more on the subject and special programs should be in
place to monitor the dental settings for observing infection control

KEYWORDS: Attitude, infection control, knowledge, practice, systematic

Free article:

8. Abstract: Epidemiology of hepatitis C virus infection in highly endemic
HBV areas in China

PLoS One. 2013;8(1):e54815.

Epidemiology of hepatitis C virus infection in highly endemic HBV areas in

Li D, Long Y, Wang T, Xiao D, Zhang J, Guo Z, Wang B, Yan Y.

Department of Epidemiology, and the Ministry of Education Key Lab of
Hazard Assessment and Control in Special Operational Environment, School
of Public Health, Fourth Military Medical University, Xi’an, China.

BACKGROUND: Wuwei City has the highest prevalence of hepatitis B virus
(HBV) in China. From 2007 to 2011, the average reported incidence rate of
hepatitis B was 634.56/100,000 people. However, studies assessing the
epidemic features and risk factors of HCV in the general population of
Wuwei City are limited.

METHODS: A total of 7189 people were interviewed and screened for HCV
antibodies. HCV RNA and HCV genotypes were analyzed by PCR. Relevant
information was obtained from the general population using a standardized
questionnaire, and association and logistic regression analyses were

RESULTS: The anti-HCV prevalence was 1.64% (118/7189), and HCV-RNA was
detected in 37.29% (44/118) of the anti-HCV positive samples. The current
HCV infection rate was 0.61% (44/7189) in the Wuwei general population.
Hepatitis C infection rate was generally higher in the plains regions
(?(2) = 27.54,P<0.05), and the most predominant HCV genotypes were 2a
(59.1%) and 1b (34.1%). The concurrent HCV and HBV infection rate was
1.37%, and a history of blood transfusion (OR = 17.9, 95% CI: 6.1 to 52.6,
p<0.001) was an independent risk factor for HCV positivity.

CONCLUSIONS: Although Wuwei is a highly endemic area for HBV, the anti-HCV
positive rate in the general population is low. More than one-third of
HCV-infected people were unaware of their infection; this may become an
important risk factor for hepatitis C prevalence in the general
population. Maintaining blood safety is important in order to help reduce
the burden of HCV infection in developing regions of China.

Free PMC Article

9. Abstract: Description of outbreaks of health-care-associated infections
related to compounding pharmacies, 2000-12

Am J Health Syst Pharm. 2013 Aug 1;70(15):1301-12.

Description of outbreaks of health-care-associated infections related to
compounding pharmacies, 2000-12.

Staes C, Jacobs J, Mayer J, Allen J.

Catherine Staes, B.S.N., M.P.H., Ph.D., is Assistant Professor; and Jason
Jacobs is a doctoral student, Department of Biomedical Informatics,
University of Utah, Salt Lake City. Jeanmarie Mayer, M.D., is Hospital
Epidemiologist, Department of Medicine, University of Utah Health Care
Hospital and Clinics, Salt Lake City. Jill Allen, Pharm.D., BCPS, is Drug
Information Consultant, Pin Oak Associates, Salt Lake City.

PURPOSE: Outbreaks of health-care-associated infections related to
compounding pharmacies from 2000 through 2012 are described.

METHODS: PubMed and the websites for the Centers for Disease Control and
Prevention and the Food and Drug Administration were searched to identify
infectious outbreaks associated with compounding pharmacies outside the
hospital setting between January 2000 and November 2012.

RESULTS: Between January 2000 and before the 2012 fungal meningitis
outbreak, 11 outbreaks were identified, involving 207 infected patients
and 17 deaths after exposure to contaminated compounded drugs. The 2012
meningitis outbreak had a similar mortality rate but increased these
totals almost fivefold. Half of the outbreaks involved patients in more
than one state. Three outbreaks involved ophthalmic drugs. The remaining
outbreaks involved corticosteroids, heparin flush solutions, cardioplegia
solution, i.v. magnesium sulfate, total parenteral nutrition, and
fentanyl. The outbreaks were caused by pathogens commonly associated with
health-care-associated infections, common skin commensals, and organisms
that rarely cause infection. Morbidity was substantial, including vision
loss. Half the outbreaks resulted in recall of all sterile drugs from the
pharmacy due to systemic problems with sterile procedures.

CONCLUSION: Before the nationwide 2012 fungal meningitis outbreak, drugs
produced by compounding pharmacies were associated with 11 other smaller,
but equally serious, outbreaks that occurred sporadically over the past 12
years. Lapses in sterile compounding procedures led to contamination of
compounded drugs, exposure to patients, and a threat to public health in
these outbreaks. Recognition and subsequent public health investigation
were usually triggered by the occurrence of illness among multiple
patients in a single health care setting.

10. Abstract: Burden and prevention of viral hepatitis in the Arctic
region, Copenhagen, Denmark, 22-23 March 2012

Int J Circumpolar Health 2013, 72: 21163

Burden and prevention of viral hepatitis in the Arctic region, Copenhagen,
Denmark, 22-23 March 2012

David FitzSimons, Brian McMahon, Greet Hendrickx, Alex Vorsters, Pierre
Van Damme

The Viral Hepatitis Prevention Board (VHPB), in collaboration with the WHO
Regional Office for Europe, organized a meeting in Copenhagen in March
2012 on the burden and prevention of viral hepatitis in the Arctic
regions, with the following aims: to provide an overview of surveillance
systems for infectious diseases, to review the epidemiological situation
and explain the high prevalence of viral hepatitis, to give an overview of
the current prevention and control measures for viral hepatitis, to
discuss the progress achieved in prevention, to review the possible
implementation of new prevention strategies, control measures and
monitoring systems, and to discuss the successes, issues and barriers to
overcome, and the way forward.

The focus of the discussions was the indigenous populations of the Arctic
and subarctic regions. This report summarizes the background context, the
health systems, surveillance and epidemiology of viral hepatitis in the
region, the lessons learnt and matters for consideration, as well as
possible future activities.

Full Text: PDF HTML EPUB XML At the link

11. Abstract: Tensions inherent in the evolving role of the infection

Am J Infect Control. 2013 Jul 20. pii: S0196-6553(13)00849-3.

Tensions inherent in the evolving role of the infection preventionist.

Conway LJ, Raveis VH, Pogorzelska-Maziarz M, Uchida M, Stone PW, Larson

Columbia University School of Nursing, New York, NY. Electronic address:

BACKGROUND: The role of infection preventionists (IPs) is expanding in
response to demands for quality and transparency in health care. Practice
analyses and survey research have demonstrated that IPs spend a majority
of their time on surveillance and are increasingly responsible for
prevention activities and management; however, deeper qualitative aspects
of the IP role have rarely been explored.

METHODS: We conducted a qualitative content analysis of in-depth
interviews with 19 IPs at hospitals throughout the United States to
describe the current IP role, specifically the ways that IPs effect
improvements and the facilitators and barriers they face.

RESULTS: The narratives document that the IP role is evolving in response
to recent changes in the health care landscape and reveal that this
progression is associated with friction and uncertainty. Tensions inherent
in the evolving role of the IP emerged from the interviews as 4 broad
themes: (1) expanding responsibilities outstrip resources, (2) shifting
role boundaries create uncertainty, (3) evolving mechanisms of influence
involve trade-offs, and (4) the stress of constant change is compounded by
chronic recurring challenges.

CONCLUSION: Advances in implementation science, data standardization, and
training in leadership skills are needed to support IPs in their evolving
role. Copyright © 2013 Association for Professionals in Infection Control
and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

KEYWORDS: Infection control, Infection preventionist, Professional role,
Qualitative research

12. Abstract: Hand rub dose needed for a single disinfection varies
according to product: A bias in benchmarking using indirect hand
hygiene indicator

J Epidemiol Glob Health. 2012 Dec;2(4):193-8.

Hand rub dose needed for a single disinfection varies according to
product: A bias in benchmarking using indirect hand hygiene indicator.

Girard R, Aupee M, Erb M, Bettinger A, Jouve A.

Unité d’Hygiène et Epidémiologie, Groupement Hospitalier Sud Hospices
Civils de Lyon, France. Electronic address:

BACKGROUND: The 3ml volume currently used as the hand hygiene (HH) measure
has been explored as the pertinent dose for an indirect indicator of HH
compliance. A multicenter study was conducted in order to ascertain the
required dose using different products.

METHOD: The average contact duration before drying was measured and
compared with references. Effective hand coverage had to include the whole
hand and the wrist. Two durations were chosen as points of reference: 30s,
as given by guidelines, and the duration validated by the European
standard EN 1500. Each product was to be tested, using standardized
procedures, by three nosocomial infection prevention teams, for three
different doses (3, 2 and 1.5ml).

RESULTS: Data from 27 products and 1706 tests were analyzed. Depending on
the product, the dose needed to ensure a 30-s contact duration in 75% of
tests ranging from 2ml to more than 3ml, and to ensure a contact duration
exceeding the EN 1500 times in 75% of tests ranging from 1.5ml to more
than 3ml.

The aftermath interpretation is the following: if different products are
used, the volume utilized does not give an unbiased estimation of the HH
compliance. Other compliance evaluation methods remain necessary for
efficient benchmarking.

Copyright © 2012 Ministry of Health, Saudi Arabia. Published by Elsevier
Ltd. All rights reserved.

KEYWORDS: Benchmarking, Compliance, Hand hygiene, Hand rub

13. Abstract: The use of protective gloves by medical personnel

Int J Occup Med Environ Health. 2013 Jul 15.

The use of protective gloves by medical personnel.

Garus-Pakowska A, Sobala W, Szatko F.

Department of Hygiene and Health Promotion, Department of Hygiene and
Epidemiology, Medical University of Lodz, Lódz, Poland, anna.garus-

INTRODUCTION: To minimize the risk of cross-infection between the patient
and the medical staff, it is necessary to use individual protective
measures such as gloves. According to the recommendations of the Centers
for Disease Control and Prevention (CDC) and the World Health Organization
(WHO), protective gloves should always be used upon contact with blood,
mucosa, injured skin or other potentially infectious material.

MATERIALS AND METHODS: The aim of the study was to evaluate, through
quasi-observation, the use of protective gloves by medical staff according
to the guidelines issued by the CDC and WHO. The results were subject to
statistical analysis (p < 0.05).

RESULTS: During 1544 hours of observations, 3498 situations were recorded
in which wearing protective gloves is demanded from the medical staff. The
overall percentage of the observance of using gloves was 50%. The use of
gloves depended significantly on the type of ward, profession, performed
activity, number of situations that require wearing gloves during the
observation unit and the real workload. During the entire study, as many
as 718 contacts with patients were observed in which the same gloves were
used several times.

CONCLUSION: Wearing disposable protective gloves by the medical staff is

14. Abstract: Effectiveness of disinfectant wipes for decontamination of
bacteria on patients’ environmental and medical equipment surfaces at
Siriraj Hospital

J Med Assoc Thai. 2013 Feb;96 Suppl 2:S111-6.

Effectiveness of disinfectant wipes for decontamination of bacteria on
patients’ environmental and medical equipment surfaces at Siriraj

Seenama C, Tachasirinugune P, Jintanothaitavorn D, Kachintorn K,
Thamlikitkul V.

Division of Infectious Diseases and Tropical Medicine, Department of
Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University
Bangkok, Thailand.

OBJECTIVE: To determine the effectiveness of Virusolve+ disinfectant wipes
and PAL disinfectant wipes for decontamination of inoculated bacteria on
patients’ environmental and medical equipment surfaces at Siriraj

MATERIAL AND METHOD: Tryptic soy broths containing MRSA and XDR A.
baumannii were painted onto the surfaces of patient’s stainless steel bed
rail, patient’s fiber footboard, control panel of infusion pump machine
and control panel of respirator. The contaminated surfaces were cleaned by
either tap water, tap water containing detergent, Virusolve+ disinfectant
wipes or PAL disinfectant wipes. The surfaces without any cleaning
procedures served as the control surface. The contaminated surfaces
cleaned with the aforementioned procedures and control surfaces were
swabbed with cotton swabs. The swabs were streaked on agar plates to
determine the presence of MRSA and XDR A. baumannii.

RESULTS: MRSA and XDR A. baumannii were recovered from all control
surfaces. All surfaces cleaned with tap water or tap water containing
detergent revealed presence of both MRSA and XDR A. baumannii. However the
amounts of bacteria on the surfaces cleaned with tap water containing
detergent were less than those cleaned with tap water alone. All surfaces
cleaned with PAL disinfectant wipes also revealed presence of both MRSA
and XDR A. baumannii. However the amounts of bacteria on the surfaces
cleaned with PAL disinfectant wipes were less than those cleaned with tap
water containing detergent. No bacteria were recovered from all surfaces
cleaned with Virusolve+ disinfectant wipes.

CONCLUSION: Virusolve+ disinfectant wipes were more effective than tap
water; tap water containing detergent and PAL disinfectant wipes for
decontamination of bacteria inoculated on patients environmental and
medical equipment surfaces at Siriraj Hospital.

15. Abstract: Use of safety scalpels and other safety practices to reduce
sharps injury in the operating room: What is the evidence?

Can J Surg. 2013 Aug;56(4):263-9.

Use of safety scalpels and other safety practices to reduce sharps injury
in the operating room: What is the evidence?

Degirolamo KM, Courtemanche DJ, Hill WD, Kennedy A, Skarsgard ED.

Department of Surgery, University of British Columbia, Vancouver, BC.

BACKGROUND: The occupational hazard associated with percutaneous injury in
the operating room (OR) has encouraged harm reduction through behaviour
change and the use of safety-engineered surgical sharps. Some Canadian
regulatory agencies have mandated the use of “safety scalpels.” Our
primary objective was to determine whether safety scalpels reduce the risk
of percutaneous injury in the OR, while a secondary objective was to
evaluate risk reduction associated with other safety practices.

METHODS: We used evidence review methods described by the International
Liaison Committee on Resuscitation and conducted a systematic, English-
language search of Ovid, MEDLINE and EMBASE using the following search
terms: “safety-engineered scalpel,” “mistake proofing device,”
“retractable/removable blade/scalpel,” “pass tray,” “hands free passing,”
“neutral zone,” “sharpless surgery,” “double/cutproof gloving” and “blunt
suture needles.” Included articles were scored according to level of
evidence; quality; and whether they were supportive, opposed or neutral to
the study question(s).

RESULTS: Of 72 included citations, none was supportive of the use of
safety scalpels. There was high-level/quality evidence (Cochrane reviews)
in support of risk reduction through double-gloving and use of blunt
suture needles, with additional evidence supporting a pass tray/neutral
zone for sharps handling (4 of 5 articles supportive) and use of suturing
adjuncts (1 article supportive).

CONCLUSION: There is insufficient evidence to support regulated use of
safety scalpels. Injury-reduction strategies should emphasize proven
methods, including double-gloving, blunt suture needles and use of hands-
free sharps transfer.

Free full text

16. Abstract: What about the surgeon?

Int J Surg. 2013;11(1):18-21.

What about the surgeon?

Khajuria A, Maruthappu M, Nagendran M, Shalhoub J.

Imperial College London School of Medicine, London SW7 2AZ, UK.

The safety of the patient and its importance in a surgical setting is well
recognised. However, in the literature far less emphasis is placed upon
the safety of the surgeon and his/her team.

This review discusses the risks to which a surgeon is exposed, including
blood-borne pathogens, radiation exposure, biomechanical stresses and
fatigue, and the adverse effects of diathermy fumes.

Strategies addressing these risks are presented and recommendations to
improve surgical team safety are offered.

Copyright © 2012 Surgical Associates Ltd. Published by Elsevier Ltd. All
rights reserved.

17. Abstract: Universal screening versus universal precautions in the
context of preoperative screening for HIV, HBV, HCV in India

Indian J Med Microbiol. 2013 Jul-Sep;31(3):219-25.

Universal screening versus universal precautions in the context of
preoperative screening for HIV, HBV, HCV in India.

Ahmed R, Bhattacharya S.

Tata Medical Centre, Rajarhat, Kolkata , West Bengal, India.

In the Indian context, there is a convention of doing pre-operative
screening for HIV, hepatitis B virus and hepatitis C viruses for all
patients as a routine pre-intervention investigation.

This approach is justified in some instances in the best interest of the
patient. However, as routine screening is not the standard care
internationally and as there is a significant divergence of views about
the merits and demerits of this practice, this issue needs to be debated
in a rational manner with an evidence-based approach.

The present article is authored by a surgeon and a microbiologist from a
new cancer care centre in eastern India, who has attempted to address this
contentious issue.

The various available options have been explored, and advantages and
disadvantages of the different approach have been discussed.

An algorithm for infection prevention and control has been presented so
that surgeons and medical microbiologists could manage infection control
challenges satisfactorily.

18. No Abstract: Building partnerships between law enforcement and harm
reduction programs
Int J Drug Policy. 2013 Jul 15. pii: S0955-3959(13)00099-6.

Building partnerships between law enforcement and harm reduction programs.

Jardine M.

Law Enforcement and HIV Network, Nossal Institute for Global Health, The
University of Melbourne, 161 Barry Street, Carlton, Vic 3010, Australia.
Electronic address:

19. No Abstract: Infection control and management of hazardous materials
for the dental team, 5th edition

Br Dent J. 2013 Jul 26;215(2):99-100.

Infection control and management of hazardous materials for the dental
team, 5th edition.

Porter C.

20. No Abstract: Eradication of hepatitis C infection: The importance of
targeting people who inject drugs

Hepatology. 2013 Jul 19. doi: 10.1002/hep.26623. [

Eradication of hepatitis C infection: The importance of targeting people
who inject drugs.

Hellard M, Doyle JS, Sacks-Davis R, Thompson AJ, McBryde E.

Centre for Population Health, Burnet Institute, Melbourne, Victoria,
Australia; Infectious Diseases Unit, The Alfred Hospital, Melbourne,
Victoria, Australia; Department of Epidemiology and Preventative Medicine,
Monash University, Melbourne, Victoria, Australia.

KEYWORDS: HCV, PWID, direct acting antiviral treatment, people who inject

Access the article free at:

21. UK: Hepatitis C in the UK annual report

Hepatitis C in the UK annual report
Health Protection Report Volume 7 No 30; 26 July 2013, U.K. (26.07.13)

Laboratory-confirmed new diagnoses of hepatitis C infection (HCV) reported
in England rose to 10,873 cases in 2012, up by more than one third from
the 7,882 cases reported in 2010 – when statutory notification by
diagnostic laboratories was first introduced. London accounted for 26 per
cent of all cases reported in England in 2012, almost treble – at 2,844
cases – the 954 reported in London in 2010. These are among the
conclusions of the annual hepatitis C report published by Public Health
England (PHE) ahead of World Hepatitis Day on Sunday 28 July [1,2].

The report is the eighth for England, and the fifth also to present
consolidated data for the UK as a whole. The main chapters describe: the
scale of the UK problem; prevention; diagnosis, testing and awareness of
infection; and treatment and care in England, Scotland, Wales and Northern
Ireland, respectively. Data are also presented on testing and diagnosis in
respect of particular groups (people who inject drugs, prison populations,
black and minority ethnic populations and blood donors).

Across the UK more than 215,000 individuals are thought to be chronically
infected with hepatitis C. In England, around 160,000 people are living
with chronic infection, the report confirms, many of whom are unaware of
their infection. Over the past 15 years, hospital admissions for hepatitis
C-related end stage liver disease and liver cancer in England have
increased from 574 in 1998 to 2,266 in 2012, while deaths have risen from
115 in 1998 to 326 in 2012.

Antiviral therapies exist that will clear the virus in most cases, yet
only around three per cent of the chronically infected population in
England access them each year. Preliminary results from statistical models
presented in the report suggest that cases of hepatitis C-related, end-
stage liver disease, and the number of liver cancer patients, could be
substantially reduced by increasing access to treatment.

The greatest risk of hepatitis C infection is associated with sharing
equipment for injecting drugs. Data from the Unlinked Anonymous Monitoring
(UAM) survey of people who inject drugs suggest that levels of infection
in this group remained high in 2012, with around half of those surveyed in
England being infected [3].

PHE is encouraging local authorities and NHS colleagues to absorb the
recommendations in this report and take local action to drive improvements
in the prevention, diagnosis and treatment of hepatitis C infection.

1. PHE, HP Scotland PH Wales, HSC (Northern Ireland), July 2012. Hepatitis
in the UK (2013 report). Downloadable from the legacy HPA website:
Publications › Infectious diseases › Bloodborne infections › Hepatitis C
in the UK › Hepatitis C in the UK: 2013 report.

2. “Hepatitis C diagnoses rise by a third in England”, PHE news release,
25 July 2013.

3. Unlinked anonymous HIV and viral hepatitis monitoring among PWID: 2013
report, HPR 7(29).

22. News

– Pakistan: Call to fight hepatitis
– Canada: Sask. hep C rate twice national average
– India: A crucial fight
– India: Infected injections, unsafe blood transfusions see Hepatitis
rising in India
– Georgia: Hepatitis C rages in Georgia
– USA: Six Recommended Measures to Prevent Hepatitis C for Young
Injection-Drug Users
– Australia: Hep C fears over needles
– India: Outbreak of hepatitis C at Barnala village
– Music may help lessen kids’ needle stress

Selected news items reprinted under the fair use doctrine of international
copyright law:

Pakistan: Call to fight hepatitis
The Nation, Pakistan (29.07.13)

LAHORE/KARACHI – Like other parts of the globe, the World Hepatitis Day
was observed across the country on Sunday to raise awareness about viral
hepatitis, precautionary measures and treatment.

In Lahore, with the day falling on a holiday, public sector and private
health institutions carried out the rituals of holding seminars, workshops
and free camps on Saturday. As such no institution organised any event on
the day designated by WHO to raise public awareness about the menace of
viral hepatitis.

According to reports, Pakistan is facing an epidemic of Hepatitis.
National prevalence of Hepatitis B is 2.4 percent and Hepatitis C is 4.9
percent. Currently, there are an estimated 16 million persons infected by
this disease. Main reasons for the spread of this disease are frequent use
of therapeutic injections, reuse of syringes, inappropriate sterilisation
practices and hospital waste management system. Pakistan Medical and
Research Council conducted a national population survey to find actual
prevalence of Hepatitis B and Hepatitis C in Pakistan in 2007.

In survey about 47,043 persons screened, of whom the Hepatitis B
prevalence came as 2.4% and Hepatitis C at 4.9%, making an aggregate of
7.4%. This comes to an estimated number of exposures to the population of
12 million.

If we look at provincial situations then Hepatitis B prevalence comes to
2.5%, 2.4%, 1.3% and 4.3% in Sindh, Punjab, KPK and Balochistan
respectively. While figures for Hepatitis C were 5%, 6.7%, 1.1% and 1.5%
in Sindh, Punjab, KPK and Balochistan respectively. The prevalence varied
greatly in between the districts of each province with some districts
showing high Hepatitis B figures while others showed high Hepatitis C

Frequent use of injections (30% population taking more than 10 injections
per person per year) and reuse of syringes, showed strong association of
Hepatitis C infections. Using scientific tools, WHO identified a total of
30 districts showing very high prevalence for Hepatitis B and C. These are
the districts where WHO in collaboration with the Provincial Hepatitis
Control Programmes will work to stop the spread of this infection.

High number of injections has been found to be the commonest source of
spreading the disease apart from reuse of syringes. Improper sterilisation
and unsafe blood transfusion also stood out as the common sources of
disease spread.

In Karachi, Sindh Institute of Urology and Transplantation (SIUT) Director
Prof Adib Rizvi has said there are about 15 million people suffering from
Hepatitis B and C in Pakistan. He was speaking at a health awareness
seminar regarding Hepatitis B at SIUT on Sunday.

Dr Rizvi said the prevalence of Hepatitis B and C is around 2.5 percent
and 4.8 percent respectively. He stressed a comprehensive effort by the
government is urgently required to prevent death of millions. Dr Zaigham
Abbass of Gastroenterology Department presented the mode of spread of
viral Hepatitis. The Hepatitis refers to group of diseases caused by
infection from one of the five viruses – Hepatitis A, B, C, D, E.
The experts highlighted the need to spread awareness among people,
preventive measures and timely treatment of the disease.

Hepatitis A and E are spread by oral fecal route while B and C are spread
by blood. The usual mode of transmission of Hepatitis B and C is high due
to getting treatment by injections and drips. The equipments are not
properly sterilised and reuse of syringes by quakes is also a major issue.
Justice (r) Rana Bhagwan Das was the chief guest while Faisal Edhi also
addressed the occasion. They stressed on the need to involve the community
by raising awareness, promoting partnership and mobilising resources.

Agha Khan University’s Dr Saeed Hamid said although there are vaccines for
Hepatitis B and a new treatment for Hepatitis C is also available that
would save millions of lives but the government is not seeming tending to
avail them. “The government of Sindh is making effort to deal with this
problem by implementing Hepatitis control programmes,” stated Project
Manager of Hepatitis Prevention Dr Ayaz Ali Memon.

The theme of World Hepatitis Day was ‘See No Evil, Hear No Evil, Speak No
Evil’. The message imparted from the theme is that Hepatitis is being
ignored around the world and there is need for change.

Dr Farina Hanif of SIUT explained the theme of World Hepatitis Day. “It
refers to those who deal with the problem by refusing to acknowledge them.
This theme was chosen to highlight that Hepatitis is being ignored around
the world. The SIUT participated in an attempt to break the world record.
Around 200 people gathered on DFMC roof top and joined the global effort
to spread the Hepatitis awareness by performing the the message of the
awareness drive. The event was led by Dr Syed Mujahid Hassan.
Canada: Sask. hep C rate twice national average

By Iryn Tushabe, Regina Leader-Post, Canada (29.07.13)

Saskatchewan has one of the highest rates of hepatitis C infection in
Canada, according to Dr. Saqib Shahab, the province’s chief medical health

“Our rates are twice the national average,” he said.

In Saskatchewan, there are 60 cases of hep C per 100,000 people, whereas
the national rate is 30.

Shahab said between 600 and 700 people seek treatment for hep C in the
province, but some people, unaware of their status, seek no medical help.

Hepatitis is inflammation of the liver, which can result in injury or
destruction of the liver cells.

“If you have recently had unprotected sex or shared a needle, we do
encourage that you get yourself screened for hep B, hep C and HIV,” said
Shahab, adding that hep C doesn’t always cause an acute infection
immediately after exposure.

Hepatitis C is transmitted by an exchange of bodily fluids with an
infected person through unprotected sex or sharing of needles by
intravenous (IV) drug users.

While there are up to five classifications of hepatitis ranging from hep A
to hep G, only hep B and C are of concern in Saskatchewan.

As there is an effective vaccine for hepatitis B, it is no longer a
serious issue countrywide.

But hep C remains a big problem.

There is no vaccine for the virus that causes it and while it’s treatable,
the resulting side effects are many. Flu-like symptoms including body
aches, chills, as well as mood and sleep disturbances, are a few of the
side effects which make treatment unappealing to sufferers, according to
Pam Thompson, a nurse at the Regina Urban Care Centre – a clinic which
treats patients with hep C. Thompson is hopeful that new treatments with
improved outcomes will soon be available.

According to Thompson, the number of people seeking hepatitis C treatment
has been increasing since the clinic opened its doors in 2011.

“More and more people are being tested and they find out that they have
hep C,” said Thompson.

The majority of patients treated at the clinic acquire the infection
through IV drug use and needle sharing.

“I’ve rarely treated anybody that didn’t get hep C from some type of
needle use, whether it be sharing needles or snorting or something of that
nature,” Thompson said.

According to Shahab, for every 100 IV drug users, about 80 will be
positive for hep C. And drug users usually acquire the infection within
one to two years of IV drug use.

As the struggle with hepatitis is a global one, the World Health
Organization has declared July 28 World Hepatitis Day (WHD).

In Canada, this year’s theme – Know your status? Get tested – is meant to
encourage more people to get tested.

An estimated 550,000 Canadians have viral hepatitis – many unaware of
their status.

© Copyright (c) The Regina Leader-Post

India: A crucial fight

DR. NARESH BHAT, The Hindu, India (27.07.13)

On World Hepatitis Day, what we need is more awareness, mass vaccination
and enforcement of safe injection practices to shield people from this
easily preventable disease.

After becoming the diabetes and chronic kidney disease capital of the
world, India is on its way to claiming the dubious honour for yet another
disease: hepatitis. Its incidence is rising rapidly, with 1.1 million
Indians suffering from hepatitis B, leading to 240,000 deaths each year,
according to WHO figures. Hepatitis C claims another 96,000 Indians

Pratibha (name changed), a 17-year-old girl from Punjab, was horrified
when she was diagnosed for hepatitis B after undertaking a blood test
during a dental procedure. Pratibha is not an isolated case. Millions of
people in India haplessly encounter this reality in their lives
unknowingly. In an age when heart ailments hog print space, people
overlook the fact that liver diseases can be contracted easily.

Hepatitis is inflammation (irritation or swelling) of the liver mostly
caused by a viral infection. Symptoms include jaundice, dark urine,
fatigue, vomiting, and stomach pain. But sometimes, patients show no
symptoms at all, making it hard to detect without proper tests.

The burden of blood-borne diseases like hepatitis B, C and D and HIV/AIDS
can be substantially reduced by the simple but very effective measure of
banning the reuse of injections. Worldwide, 33 per cent of new cases of
hepatitis B and 42 per cent of hepatitis C every year are caused by unsafe
injections, according to WHO figures.

In India, as repeated outbreaks of Hepatitis B and C have shown, a major
danger arises from unsafe injection practices and the reuse of needles.
Given India’s endemic risk factors, it is imperative to spread awareness
about the dangers of unsafe injection practices. This needs to be backed
by strict enforcement of norms to make certain that accidental
transmission of disease is prevented altogether or reduced to the minimum.

Hepatitis cases are rising in India because most people don’t know what it
is and how it can be prevented. This is unfortunate as hepatitis is the
second biggest preventable cause of cancer after tobacco, say medical
experts. The Government needs to organise a countrywide education campaign
among health workers about the importance of injection safety.

Children and adults alike have to be encouraged to get vaccinated against
hepatitis A and B, the two strains for which vaccines are available.
Healthcare workers face the prospects of contracting hepatitis B and C due
to occupational exposure to blood and other body fluids. The most common
way in which they contract hepatitis is by needle stick injuries,
especially those involving hollow needles. Some areas like surgery,
gynecology and orthopedic services pose a higher risk. Vaccination and
adherence to universal standard precautions are the only way for
healthcare workers to protect themselves from hepatitis.

Reducing the exposure of people to the viruses still remains the best bet
to decrease the disease burden. Treatment is very expensive. Worse, many
patients don’t even get to know they have hepatitis until it is too late.
We need more awareness, mass vaccination and strict enforcement of safe
injection practices to shield people from this easily preventable disease.

Keywords: hepatitis, World Hepatitis Day, Hepatitis B, Hepatitis C

India: Infected injections, unsafe blood transfusions see Hepatitis rising
in India

Times of India, IANS India (27.07.13)

Tags: World Health Organization|Hepatitis C|hepatitis B|hepatitis

NEW DELHI: India’s Hepatitis burden is rising due to the use of infected
injections and unsterilised medical equipment as well as unsafe blood

In India, nearly two-thirds of the injections being used are unsafe,
posing health hazards for the recipients. Unhygienic use of needles in
acupuncture and tattooing also has a significant role in spreading
hepatitis, according to experts.

There are five main Hepatitis viruses, referred to as types A, B, C, D and
E. Hepatitis A and E are typically caused by ingestion of contaminated
food or water. Hepatitis B, C and D usually occurs as a result of
parenteral contact with infected body fluids. Hepatitis B is also
transmitted by sexual contact.

“Hepatitis B (HBV) and Hepatitis C (HCV) infections are silent diseases
that remain asymptomatic for decades. Due to lower awareness, more than 80
percent HCV patients and over 60 percent patients with HBV are diagnosed
at a stage when the disease is irreversible,” Anil Arora, chairman and
head of the Department of Gastroenterology and Hepatology, Sir Ganga Ram
Hospital, New Delhi said.

Ajay Kumar, senior consultant gasteroenterology Indraprastha Apollo
Hospitals said: “Transmission of Hepatitis through infected syringes and
blood is a significant problem in India.”

“Most patients in India get the Hepatitis B and C forms in childhood
either through mother to child transmission or contact with other
siblings,” he said adding, many times after being infected the problem
becomes chronic and they become permanent carriers of the virus.

He added that there was much need to organize a countrywide education
campaign among health workers, patients and the community, especially in
the rural areas.

Anupam Sibal group medical director and senior gasteroenterologist at
Apollo, who specialises in paediatric Hepatitis, said immunisation against
the disease is an effective prevention method.

Under the Universal Immunization Programme (UIP), the government provides
Hepatitis B vaccine and the operational cost of vaccination to states and
union territories for preventing Hepatitis B infection.

Since April 2005, the government has also introduced auto-disabled (AD)
syringes for all vaccinations under UIP in all states. AD syringes are
single use, self-locking syringes that cannot be used more than once.

This prevents misuse and contamination and cross- infection through
repeated use of unsterile injection or equipment. Routine screening of
blood units for Hepatitis B and C has been made mandatory for all blood
banks to detect and discard contaminated blood units, a senior health
ministry official said.

Hepatitis viruses are estimated to be among the top 10 causes of death in
India. According to the World Health Organization, 240 million people
globally are chronically infected with Hepatitis B and around 150 million
are chronically infected with Hepatitis C.

Approximately 500 million people worldwide are living with either
hepatitis B or hepatitis C. This means 1 in 12 people suffer from this
deadly disease.

As for Hepatitis C, one out of every 100 in India may be chronically
infected by the virus and most among these 12 million people do not know
they are infected.

According to government figures, prevalence of Hepatitis C has been
observed to be relatively higher in Punjab, Andhra Pradesh, Puducherry,
Arunachal Pradesh and Mizoram.

Interestingly, several studies conducted in these states have highlighted
different risk factors which are believed to have led to the relatively
higher prevalence of the condition.

“Hepatitis C usually affects people in the age group of 20 to 60 years
while Hepatitis B is most common in the age groups 10 to 60 years,”
Kaushal Madan, senior consultant Hepatologist and Gastroenterologist,
Medanta – The Medicity Hospital, Gurgaon said.

Georgia: Hepatitis C rages in Georgia

By Sabina Idayatova, Azer News, Azerbaijan (24.07.130

According to official statistics, hepatitis C levels in Georgia have hit
record levels, with 200,000 people currently infected, which is
approximately 6.7 percent of the population, and 2,000 new cases emerge

According to experts, the death rate is also high, as the treatment of the
disease is expensive. Moreover, there is no state program for the
prevention, diagnosis and treatment of hepatitis C. Official figures
indicate that only 10 percent of the infected can afford treatment.

Georgian Public Broadcaster reported on July 22 that Georgia has the
highest number of people infected with hepatitis C in the South Caucasus

According to a report of the joint program officer for the International
Harm Reduction Development Program and Access to Essential Medicines
Initiative, Azadeh Momenghalibaf, published on July 10, the vast majority
of the estimated 185 million people living with hepatitis C worldwide
reside in lower- and middle-income countries like Georgia, where there is
virtually no access to treatment and no government response.

“Much of this has to do with the fact that hepatitis C is a hidden
epidemic: most people don’t know they’re infected as a result of lack of
access to both diagnostics and treatment.

“For two years, Georgian advocates have been raising the profile of
hepatitis C in the country through mass events, protests, and campaigns,
and have mobilized thousands of patient voices to demand action by their
government. Hepatitis C simply became a problem that the government could
no longer ignore,” Momenghalibaf said in the report.

Momenghalibaf cited the exorbitant price of roughly $18,000 for a 48-week
course of Pegylated-Interferon produced and patented by pharmaceutical
giants Roche and Merck; the backbone medicine of hepatitis C treatment,
which is currently inaccessible for patients who have to pay for it out of
their pocket, and unaffordable for the government.

In February, Georgian Health Minister David Sergeenko acknowledged that
the government does not have enough money to cover treatment costs for
such a large portion of the population, website
reported. He said estimates show that 1,000 people need liver transplants,
which would have to be done abroad at an extremely high cost.

Sergeenko said that even if the country spent its entire healthcare budget
on treating HCV infection it would still not meet its basic needs.
Furthermore, some Georgian doctors claim that current statistics are most
likely low because they are based on data from 2004, and that the true
number is actually much higher. Georgia receives some international aid
for HCV healthcare, but it usually applies only to patients with HIV

Nevertheless, Momenghalibaf said that backed by Georgian civil society and
patient groups putting pressure on Roche and Merck to reduce their prices,
the Georgian government will fiercely negotiate with these companies to
reach a price that will ensure their goal of universal coverage can be

According to Momenghalibaf, the price Georgia secures will not only
represent a victory for the country, but for the global access to
hepatitis C treatment movement, a movement consisting of patients and
their advocates fighting to gain access to these lifesaving medicines, and
urging governments and pharmaceutical companies to put lives before

USA: Six Recommended Measures to Prevent Hepatitis C for Young Injection-
Drug Users

By Jeff Sheehy, University of California, San Francisco (24.07.13)

UC San Francisco researchers are recommending a combination of six
comprehensive measures to prevent the spread of hepatitis C, in an effort
to address the estimated 31,000 young people who may be newly infected
each year in the United States due to injection-drug use.

The measures, which stem from a 16-year UCSF research project with
injection-drug users, known as the “U Find Out” or UFO Study, build upon
the successes of clean syringe programs and similar efforts, while
recommending greater focus on the social issues behind drug use and
further integration of the multiple approaches to combating hepatitis C.

In February, the U.S. Department of Health and Human Services (HHS) noted
the rising epidemic of hepatitis C virus among young people aged 15-30 who
inject drugs, calling attention to an increasingly serious issue

While data on hepatitis C are limited, the HHS estimates that as many as
3.9 million people in the United States are living with a chronic form of
the disease, which the researchers said is at least 10 times more
infectious than HIV. In 2007, the number of U.S. deaths associated with
hepatitis C surpassed those from HIV for the first time.

“Based on our UFO Study here in San Francisco, we have accumulated data
that identify key strategies that, when scaled up, could substantially
reduce the rate of new hepatitis C infections among young people who
inject drugs,” said the study’s lead investigator, Kimberly Page, PhD,
MPH, a professor in the UCSF Department of Epidemiology and Biostatistics,
and in UCSF Global Health Sciences.

The research team examined several data sources to arrive at the new
estimate of 31,000 new cases per year and identified six areas where
prevention efforts should be focused. Findings appear online July 24 in a
special supplement titled, “Prevention and Management of Hepatitis C Virus
among People Who Inject Drugs: Moving the Agenda Forward,” in the journal
Clinical Infectious Diseases. The publication coincides with World
Hepatitis Week, July 21 to 28.

Beyond Syringe Exchange Programs
First, while syringe-exchange programs have long been recognized as an
absolutely essential element in disease prevention, giving injectors
access to clean needles and syringes, the UFO Study team discovered that
up to 40 percent of infections occurred from exposures to shared drug
preparation containers, filters and rinse water.

“The hepatitis C virus lives a long time on surfaces and can easily
contaminate various types of injecting equipment, so while expanding
needle exchanges throughout the country is essential, one of our critical
recommendations is that existing and newly established exchanges provide
clean ancillary equipment along with needles and syringes,” said Page.

The “U Find Out” Study, which began in September 1997, is a constellation
of research studies and projects focusing primarily on viral hepatitis,
particularly hepatitis C virus, among young injection drug users in San

Read more about their work.

Additional strategies identified in the paper include hepatitis C virus
screening, testing and counseling; targeting interventions to address the
social and relational contexts of injecting; injection cessation
interventions to reduce risks of exposure; development of models to guide
roll out of new hepatitis C treatments and vaccines; and the
implementation of robust, scaled interventions in combination to synergize
the effectiveness of individual interventions.

“A new rapid test for hepatitis C has become available that can be
delivered at the point of care with results in 20 minutes, so making that
widely available can significantly improve screening, testing and
counseling,” said Page. “Also, our research identified the value of
‘taking breaks’ for both reducing the risks of exposure to the virus and
helping end injection drug use.”

The UFO Study looked at the behaviors associated with attempts by
injectors to complete various injection cessation programs, such as 12-
step or opiate substitution programs. While in these programs, exposure
risks disappeared.

However, while injectors frequently fail cessation programs, the UFO Study
showed that the more injectors try to quit, or “take breaks” from drugs,
the more likely they eventually are to succeed. That new data could inform
how these and other treatment programs handle relapses in the future.

“Often these programs are very unforgiving and relapses can lead to
permanent bans,” Page said. “This is likely not the best tactic for
reducing disease exposure risks and also may not be optimal for helping
injectors end injection drug use.”

Co-authors include Meghan Morris and Judith A. Hahn, PhD, from UCSF; Lisa
Maher from the Kirby Institute in Sydney, Australia; and Maria Prins from
the Public Health Service in Amsterdam, The Netherlands.

The UFO Study is funded by the U.S. National Institute on Drug Abuse and
the Australian Government Department of Health and Ageing.

UCSF Global Health Sciences is affiliated with the AIDS Research Institute
(ARI) at UCSF. UCSF ARI houses hundreds of scientists and dozens of
programs throughout UCSF and affiliated labs and institutions, making ARI
one of the largest AIDS research entities in the world.

UCSF is a leading university dedicated to advancing health worldwide
through advanced biomedical research, graduate-level education in the life
sciences and health professions, and excellence in patient care.

Australia: Hep C fears over needles
Jennifer Crawley, The Mercury, Tasmania, Australia (23.07.13)

TASMANIA’S leading drug authority has called on the State Government to
fund more needle vending machines to reduce the incidence of hepatitis C
in the community.

The Alcohol Tobacco and other Drugs Council said injecting drug users were
reusing needles and syringes because needle outlets were closed or too far

There are six NSPs needle and syringe programs at Devonport, Launceston
Bridgewater, Glenorchy, Hobart and Claremont.

There are three vending machines in Tasmania that dispense needle packs,
but only two are open 24 hours – at Anglicare in Watchorn St, Hobart, and
at the Salvation Army in Launceston.

The Devonport machine is open from 8am-6pm, but users can access equipment
24 hours at the North West Regional Hospital.

ATODC chief Jann Smith said a recent budget cut meant ampoules of sterile
water were no longer free.

Ms Smith said it was “absolutely important” for drug users to have easy
access to sterile equipment, but it was not cost-effective to open the
NSPs 24 hours.

She said vending machines were a viable alternative and people were
comfortable using them.

Department of Health and Human Services population health director Siobhan
Harpur said funding had not been reduced to the NSP program and the
availability of machines was determined by the organisations.

India: Outbreak of hepatitis C at Barnala village
BB Goyal, Hindustan Times, India (22.07.13)

Barnala: Fear and anguish prevails at nearby Kalala village with the
outbreak of hepatitis C as a majority of people have tested positive for
the hepatitis C virus (HCV). The village has a population of 2,358 living
in 428 houses. The health department has taken 41 samples of which 28 have
been found positive.

In December 2012, in a medical camp, 370 people out of 870 were found
hepatitis C positive. Going by that ratio, the actual number of infected
persons might be in the range of 800 to 1,000. HCV has taken the lives of
25 people of the village. The village has no clinical laboratory or
government dispensary. Health facilities are virtually non-existent in the

Most of the newly elected panchayat members are victims of the dreaded
disease. Three panches — Surjit Singh, Santokh Singh and Harbhajan Singh
— are HCV positive. Sarpanch Ranjit Singh Rana was also HCV positive, but
he got himself treated.

Recently a blood donation camp was organised in the village by Dayanand
Medical College and Hospital, Ludhiana. Ninety units were donated by
villagers. Of this, 28 units were found to be hepatitis C positive.

Villager Kuldeep Singh, 24, said he had lost his grandfather, father and
uncle to HCV. Now he, his sister and cousin are infected. The treatment
cost is over Rs. 2 lakh, so all cannot afford that.

Hepatitis C virus was identified in 1989. World Health Organization (WHO)
compares HCV to a ‘viral time bomb’. HCV is responsible for 50-76% of all
liver cancer cases worldwide.

The health authorities have not taken the matter with seriousness. Even in
2010, 98 hepatitis C cases were reported from Kalala, Chananwal, Chinniwal
and Sehjra villages. Recently, 13 cases have been reported from Kube
village. These villages are in close proximity. The villagers still say
unhygienic water is responsible for the epidemic. Health authorities have
not made villagers aware on not to use contaminated and unsterilised
needles, the main cause of HCV.

Civil surgeon Dr Renu passed the buck on to unregistered RMPs, holding
them responsible for re-using syringes, making people vulnerable to
infections. However, she failed to answer as to why her department had not
taken action against such RMPs so far.

Such outbreaks are required to be notified to the Integrated Disease
Surveillance Project immediately by the health department.

The civil surgeon said she was not aware of the previous outbreaks since
she joined only four months ago.

“We are instructing the civil surgeon to take effective steps and refer
patients to Government Medical College, Patiala, and the PGI, Chandigarh.
The civil surgeon is also being asked to take action against unregistered
RMPs,” said deputy commissioner Indu Malhotra.

Music may help lessen kids’ needle stress

By Andrew M. Seaman, Reuters Health (18.07.13)

NEW YORK (Reuters Health) – Children who listened to music while an IV
needle was inserted into their arms were less stressed than kids who
didn’t listen to music, in a new study from Canada.

“We were really looking to see if music could reduce the distress in
children,” said Lisa Hartling, the study’s lead author from University of
Alberta in Edmonton.

Aside from pain medication, other ways to help control pain in the
emergency department (ED) include distractions such as audio, video,
stories, imagery and concentrated breathing exercises, Hartling and her
colleagues say.

“One of the features of music is that it’s a very powerful distracter,”
said Linda Chlan, who has studied music therapy but was not involved in
the new study.

Past research has shown that music significantly reduces pain and anxiety
during medical procedures.

For the new study, conducted at Stollery Children’s Hospital in Edmonton
between January 2009 and March 2010, Hartling and her colleagues randomly
assigned 42 children to either listen to music playing out loud in the
room, or not, while intravenous (IV) needles were inserted into their arm
in the ED. The same music recordings were played for each child.

The children also received the usual treatments to help make the
procedures less painful, including pain relievers applied to the skin, and
comforting, supportive words from the medical staff.

Reviewers watched a video recording of each IV insertion to measure the
children’s stress before and immediately after the procedure on a scale
from 0 to 23.5 – with higher scores representing more distress. The
reviewers did not know which children were listening to music, according
to a report of the study published in the medical journal JAMA Pediatrics.

The children, who were all between three and 11 years old, were also asked
about the amount of pain they experienced during the procedure.

Overall, the researchers didn’t find a difference between the music and
non-music groups in the amount of distress experienced by children
immediately before and after the procedures.

However, after they excluded the 10 kids who didn’t stress at all during
the IV insertion, the researchers found the distress level in children who
listened to music rose less than it did in kids who didn’t have music
playing during the procedure.

They found the distress level of the children in the non-music group
increased 2.2 points on the scale, compared to a 1.1 point increase in
music-group kids.

That difference would be noticeable, according to the researchers.

What’s more, children in the non-music group said their pain increased by
about two points on a scale from 0 to 10 – with higher numbers indicating
more pain. Children in the music group, in contrast, reported no increase
in pain.

Healthcare providers were also more likely to say the IV insertion
procedure was “very easy” in the music group than in the non-music group.

“Based on the research I’ve seen, the review of the literature we’ve done
and our study, music has the potential to benefit and – at worse – won’t
do any harm,” Hartling told Reuters Health.

Chlan, Distinguished Professor of Symptom Management Research at The Ohio
State University College of Nursing in Columbus, said the study shows that
the practice holds potential, but she’d like to see a study that includes
a group of kids wearing headphones to eliminate distractions in the non-
music group.

“I think this opens the door that this is a safe intervention, and kids
and parents like it. Those are two of the main concerns for healthcare
providers,” she said.

The method is also appealing because it’s cheap and easy to employ, said
Joke Bradt, an associate professor in the Creative Arts Therapies
Department at Drexel University College of Nursing and Health Professions
in Philadelphia.

“I hope as more studies like this get published it becomes more
mainstream,” said Bradt, who wasn’t involved in the new study.

SOURCE: JAMA Pediatrics, online July 16, 2013.
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