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SIGNpost 00719

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST *

Post00719 Abstracts Catch-up 2 + Tools and News 30 October 2013

CONTENTS
1. Presentation: Study of Injecting Drug Users In Bahawalpur Pakistan
2. US CDC and Safe Injection Practices Coalition offer new infographic to
help clinicians properly use single and multiple-dose vaccine vials
3. New Costing Tools Will Help Policymakers Gather and Analyze
Critical Supply Chain Data
4. Risk of Blood-borne Viruses from Skin-piercing Beauty Treatments
5. Abstract: A practical approach to waste management
6. Abstract: Assessment of Reporting, Attitudes and Knowledge About the
Stab Incidents and Professional Risk of Viral Infection among Health
Care Professionals in Primary Health Care
7. Abstract: Hepatitis B virus transmissions associated with a portable
dental clinic, West Virginia, 2009
8. Abstract: Patient safety incident prevention and management among
Finnish dentists
9. Abstract: Incidence of needlestick injuries among medical students
after implementation of preventive training
10. Abstract: Assessment of knowledge, attitude and practices among
healthcare workers in a tertiary care hospital on needle stick injury
11. Abstract: How do university education and clinical experience
influence pre- registration nursing students’ infection control
practice? A descriptive, cross sectional survey
12. Abstract: Lessons learned in the multistate fungal infection outbreak
in the United States
13. Abstract: Clinical findings for fungal infections caused by
methylprednisolone injections
14. Abstract: An outbreak of fungal endophthalmitis after intravitreal
injection of compounded combined bevacizumab and triamcinolone
15. Abstract: Causes of Death and Characteristics of Decedents with Viral
Hepatitis, United States, 2010
16. Abstract: Less-Established Risk Factors Are Common in Asian Americans
with Hepatitis C Virus: A Case-Controlled Study
17. Abstract: Pharmacological Interventions Including Medical Injections
for Neck Pain: An Overview as Part of the ICON Project
18. Abstract: Increasing sharp safety device use in healthcare: a semi-
structured interview study
19. Abstract: The Dark Cloud of HIV Hangs Over Our IDUs
20. Abstract: Epidemiological characteristics of hepatitis C in China,
1997-2011
21. Abstract: Epidemiological characteristics of hepatitis C in Henan
province
22. Abstract: Epidemiology of hepatitis C virus infection and risk factor
analysis in the hebei province, china
23. Abstract: Harm reduction approach in Egypt: the insight of injecting
drug users
24. Abstract: “To share or not to share?” Serosorting by hepatitis C
status in the sharing of drug injection equipment among NHBS-IDU2
participants
25. Abstract: Effectiveness of Methadone Maintenance Treatment in
Prevention of Hepatitis C Virus Transmission among Injecting Drug
Users
26. Abstract: Extremely low and sustained HIV incidence among people who
inject drugs in a setting of harm reduction
27. Abstract: A qualitative study of the perceived effects of blue lights
in washrooms on people who use injection drugs
28. Abstract: Adherence to hand hygiene protocol by clinicians and medical
students at Queen Elizabeth Central Hospital, Blantyre-Malawi
29. Abstract: Hand hygiene behavior: translating behavioral research into
infection control practice
30. Abstract: Outbreak report: nosocomial transmission of measles through
an unvaccinated healthcare worker–implications for public health
31. News
– UK: Final report of bad blood inquiry delayed to 2014
– Nevada USA: Lawsuits filed against Sunrise Hospital and Medical Center
in child deaths

The web edition of SIGNpost is online at:
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Selected updates at: http://twitter.com/#!/signmoderator
__________________________________________________________________
________________________________*_________________________________

1. Presentation: Study of Injecting Drug Users In Bahawalpur Pakistan
__________________________________________________________________
from: zeeshan ayyaz <amitielwelfare[at]gmail.com>
to: Sign Moderator <sign.moderator[at]gmail.com>
date: Sun, Oct 27, 2013
subject: Research study Presentation

Sharing with you our presentation.

“Study of Injecting Drug Users In Bahawalpur Pakistan.”

Zeeshan Ayyaz and Dr. Kate Dolan
Amitiel Welfare Society Bahawalpur Pakistan

&

National Drug and Alcohol Research Centre University of
New South Wales Sydney, Australia

online web link is: http://tinyurl.com/PakistanIDUslides

http://www.slideshare.net/amitielwelfare/study-of-injecting-drug-users-in-
bahawalpur-pakistan-13714545

Best wishes,

Zeeshan Ayyaz
__________________________________________________________________
________________________________*_________________________________

2. US CDC and Safe Injection Practices Coalition offer new infographic to
help clinicians properly use single and multiple-dose vaccine vials
__________________________________________________________________
CDC and Safe Injection Practices Coalition offer new infographic to help
clinicians properly use single- and multiple-dose vaccine vials

Recent outbreaks associated with reuse of single-dose vials and misuse of
multiple-dose vials have resulted in patients suffering significant harm
and even death. CDC and the Safe Injection Practices Coalition urge all
healthcare professionals to use a new, dynamic infographic to learn the
differences between single-dose and multiple-dose vials and to understand
appropriate use of each. The infographic is an excellent resource for
clinicians, office/risk managers, and patients.

Learning how to properly identify the two vials will prevent infections
and can save lives. View the infographic in two user-friendly formats, a
web-based infographic or a printer-friendly PDF, and please share it with
your colleagues.

Web:
http://www.oneandonlycampaign.org/single-dose-multi-dose-vial-infographic

PDF: http://www.oneandonlycampaign.org/SDVMDV_PDF.pdf

The Safe Injection Practices Coalition (SIPC) is a partnership of
healthcare-related organizations that was formed to promote safe injection
practices in all U.S. healthcare settings. The SIPC has developed the One
& Only Campaign—a public health education and awareness campaign—aimed at
both healthcare providers and patients to advance and promote safe
injection practices.
__________________________________________________________________
________________________________*_________________________________

3. New Costing Tools Will Help Policymakers Gather and Analyze
Critical Supply Chain Data
__________________________________________________________________
Anne Marie Hvid <anne_marie_hvid@jsi.com>

subject: New Costing Tools Will Help Policymakers Gather and Analyze
Critical Supply Chain Data

To strengthen public health supply chains, policymakers, supply chain
managers, and development partners need to know the real costs of
delivering commodities. Identifying these costs and the sections of the
supply chain that are driving costs can give decisionmakers the data they
need to ensure adequate funding. However, this information is not always
readily available.

In response, the USAID | DELIVER PROJECT has developed a supply chain
costing approach and set of user-friendly tools. The Guide to Public
Health Supply Chain Costing: A Basic Methodology establishes a general
methodology for supply chain costing. The Excel-based Supply Chain Costing
Tool and supporting documents can be used to facilitate the data
collection, analysis, and report generation required for a supply chain
costing exercise.

To download these tools, visit http://j.mp/1aRtiV2
__________________________________________________________________
________________________________*_________________________________

4. Risk of Blood-borne Viruses from Skin-piercing Beauty Treatments
__________________________________________________________________
http://hivinkenya.blogspot.com.au/2013/09/risk-of-blood-borne-viruses-
from-skin.html

Risk of Blood-borne Viruses from Skin-piercing Beauty Treatments

Posted: 27 Sep 2013 10:38 PM PDT

[Crossposted from the Don’t Get Stuck With HIV site]

In the light of several recent news reports, the Don’t Get Stuck With HIV
site has created a new page on possible risks associated with use of skin-
piercing products such as Botox and Malanotan. Injection of anabolic
steroids and other performance enhancing drugs can carry similar risks,
especially if they are administered in an unsterile environment, and/or
administered by untrained or inexperienced providers. The UK Government
has issued a warning, saying that steroid users are at higher risk of HIV
and viral hepatitis. The Don’t Get Stuck With HIV page offers easy to
follow advice to people considering such treatments.

Similar information and advice on injections in general is available
throughout the Don’t Get Stuck With HIV site; healthcare risks aside from
injections are discussed here. There is also information on risks from
other cosmetic treatments, such as tattooing, ear and body piercing,
manicures and pedicures and hair styling and shaving. However, beauty
treatments that pierce the skin may be more risky than some of these other
cosmetic treatments because instruments such as needles go deeper below
the skin than tattoo needles, for example.

A recent article on the BBC website draws attention to the concerns of a
health watchdog about the safety of Botox injections in the UK. They are
also questioning the safety of anabolic steroids, tanning agents and
dermal fillers. These treatments can be obtained in salons, or they can be
self administered. The article warns that sharing equipment can carry a
risk of infection with HIV, hepatitis or other blood borne diseases. The
UK’s National Institute for Health and Care Excellence (NICE) is currently
preparing guidelines on these issues.

Botox is a prescription only drug. However, an Australian news network ran
an article late last year about a ‘backyard botox’ clinic, a specific
clinic in Western Australia where infection control practices were found
to be lacking, highlighting some of the health risks involved. It is said
that the risk of infection with blood-borne diseases is small, but
nevertheless real. Some practitioners may offer such treatments in the
home, where conditions are likely to be unsuitable.

In 2008, the BBC reported that a growing number of people in the UK are
injecting themselves with an unlicensed hormonal tanning drug called
Melanotan. It is possible that this drug is being sold illegally online,
in salons, in gyms and in health and fitness centers.
__________________________________________________________________
________________________________*_________________________________

5. Abstract: A practical approach to waste management
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24137995

Health Estate. 2013 Sep;67(8):45-8.

A practical approach to waste management.

Budd S, Baker K.

SRCL.

In March 2013, the Department of Health (DH), in partnership with the
Department for Environment, Food and Rural Affairs (DEFRA) and the
Department of Transport, produced an updated version of Health Technical
Memorandum 07-01 (HTM 07-01), fully supported by the Environment Agency
(EA), the Health and Safety Executive (HSE), and the devolved
administrations.

Here, Stuart Budd, head of Environment, Safety and Health, and Keerti
Baker, PR and communications executive, at SRCL, one of the UK’s leading
healthcare waste specialists, look in some detail at the updated guidance,
with a particular focus on new developments in the area of clinical waste.
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Assessment of Reporting, Attitudes and Knowledge About the
Stab Incidents and Professional Risk of Viral Infection among Health
Care Professionals in Primary Health Care
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24082835

Mater Sociomed. 2013;25(2):113-7.

Assessment of Reporting, Attitudes and Knowledge About the Stab Incidents
and Professional Risk of Viral Infection among Health Care Professionals
in Primary Health Care.

Becirovic S, Pranjic N, Sarajlic-Spahic S, Ahmetagic S, Huseinagic S.

Department of Occupational Medicine, Faculty of Medicine, University of
Tuzla , Tuzla, Bosnia and Herzegovina ; , Department of Occupational
Pathology and Toxicology, Primary Health Care Centre Tuzla , Tuzla, Bosnia
and Herzegovina.

CONFLICT OF INTEREST: none declared.

GOAL: The goal of the research is to determine the relationship between
frequency and reporting of stab incidents, attitudes and knowledge about
stab incidents and occupational risk for transmission of viral infection
with HBV, HCV or HIV among health care professionals employed in primary
health care.

MATERIAL AND METHODS: Conducted is prospective, cross-section study by
questionnaires in 2012. The survey included health professionals in
Primary Health Care Center in Tuzla. The final sample has 131 respondents
(85% women). Statistical analysis was performed using the statistical
package SPSS version 20.0.

RESULTS: The prevalence rate of stab incidents throughout their career in
our study was 66%; while the rate of reported incidents was 4.83 ˜ 5 times
lower than the actual prevalence. In 49 out of 87 cases this was a case of
hollow needle prick. The most common causes of stab incidents are the time
pressure, unforeseen reactions of patients and lack of concentration.

CONCLUSION: Stab incidents are often not reported in in developing
countries. Training in order to raise awareness and knowledge about the
problem, proper procedures, good organization of work and anti-stress
program, safer disposal, conducting prophylaxis before and after exposure
monitored by the relevant institutions of occupational medicine should
contribute to solving this problem.

KEYWORDS: blood transmitted infections, incident, occupational risk

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3769157/
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Hepatitis B virus transmissions associated with a portable
dental clinic, West Virginia, 2009
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24080927

J Am Dent Assoc. 2013 Oct;144(10):1110-8.

Hepatitis B virus transmissions associated with a portable dental clinic,
West Virginia, 2009.

Radcliffe RA, Bixler D, Moorman A, Hogan VA, Greenfield VS, Gaviria DM,
Patel PR, Schaefer MK, Collins AS, Khudyakov YE, Drobeniuc J, Gooch BF,
Cleveland JL.

Dr. Radcliffe was with the Epidemic Intelligence Service, Centers for
Disease Control and Prevention, Atlanta, when the investigation described
in this article was conducted. She now is a program manager, Division of
Acute Disease Epidemiology, South Carolina Department of Health and
Environmental Control, Columbia.

BACKGROUND: Although hepatitis B virus (HBV) transmission in dental
settings is rare, in 2009 a cluster of acute HBV infections was reported
among attendees of a two-day portable dental clinic in West Virginia.

METHODS: The authors conducted a retrospective investigation by using
treatment records and volunteer logs, interviews of patients and
volunteers with acute HBV infection as well as of other clinic volunteers,
and molecular sequencing of the virus from those acutely infected.

RESULTS: The clinic was held under the auspices of a charitable
organization in a gymnasium staffed by 750 volunteers, including dental
care providers who treated 1,137 adults. Five acute HBV infections-
involving three patients and two volunteers-were identified by the local
and state health departments. Of four viral isolates available for
testing, all were genotype D. Three case patients underwent extractions;
one received restorations and one a dental prophylaxis. None shared a
treatment provider with any of the others. One case volunteer worked in
maintenance; the other directed patients from triage to the treatment
waiting area. Case patients reported no behavioral risk factors for HBV
infection. The investigation revealed numerous infection control breaches.

CONCLUSIONS: Transmission of HBV to three patients and two volunteers is
likely to have occurred at a portable dental clinic. Specific breaches in
infection control could not be linked to these HBV transmissions.
Practical Implications. All dental settings should adhere to recommended
infection control practices, including oversight; training in prevention
of bloodborne pathogens transmission; receipt of HBV vaccination for staff
who may come into contact with blood or body fluids; use of appropriate
personal protective equipment, sterilization and disinfection procedures;
and use of measures, such as high-volume suction, to minimize the spread
of blood.

KEYWORDS: Dentistry, hepatitis B virus, infection control, outbreak,
portable dental equipment
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Patient safety incident prevention and management among
Finnish dentists
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24087859

Acta Odontol Scand. 2013 May 13.

Patient safety incident prevention and management among Finnish dentists.

Hiivala N, Mussalo-Rauhamaa H, Murtomaa H.

Department of Oral Public Health, Institute of Dentistry, University of
Helsinki , Helsinki , Finland.

Objective. Assessing current patient safety incident (PSI) prevention
measures and risk management practices among Finnish dentists.

Materials and methods. A total of 1041 dentists practicing in the private
or public sectors in southern Finland completed an online questionnaire
concerning PSI prevention, PSI-reporting systems, feedback and knowledge
gained from device incidents and patient-generated safety information and
the knowledge of national PS-guidance. The answers were handled
anonymously. Statistical evaluations were performed using chi-square
analysis.

Results. Dentists suggested multiple methods for preventing PSIs related
to dental diagnostics, various treatments, equipment and devices,
medications, communication, infection control and general practice safety.
Preventive methods reported most frequently included working with caution
and forethought, keeping accurate patient records and the availability of
correct patient information. A special PSI-reporting system was used by
less than one third of respondents. Feedback received on PS-related data
and the utilization of guidebooks varied significantly between the studied
dentist groups.

Conclusions. Several PSI prevention techniques are already used in
Finland. However, wide variation exists in PSI prevention and risk
management practices among Finnish dentists. Systematic implementation of
available safety methods would probably prevent several PSIs.

The results indicate that the more dentists know about PS risks, the
easier it is for them to recognize situations possibly leading to patient
harm.

Anonymous PSI reports, patient complaints and claims data should,
therefore, be actively used for mutual learning. Increased PS education in
dentistry is also needed.
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Incidence of needlestick injuries among medical students
after implementation of preventive training
__________________________________________________________________
Singapore Med J. 2013 Sep;54(9):496-500.

Incidence of needlestick injuries among medical students after
implementation of preventive training.

Seng M, Lim JW, Sng J, Kong WY, Koh D.

National University Health System, 1E Kent Ridge Road, Singapore 119228.
melvin_yf_seng@nuhs.edu.sg.

INTRODUCTION: Structured training for the prevention of needlestick
injuries (NSIs) among medical students was implemented in Singapore in
1998. In this study, we determined the incidence of NSIs and the knowledge
and practice of managing and reporting NSIs among first-year clinical
students in a medical school in Singapore, as well as the adequacy of the
training provided for these students, 14 years after preventive training
was instituted.

METHODS: All third-year medical students (n = 257) from the Yong Loo Lin
School of Medicine, National University of Singapore, Singapore, who had
completed their first clinical year posting were enrolled in this cross-
sectional study. A self-administered questionnaire was answered by the
students one month after completion of their last clinical posting.
Students who repeated their first clinical year were excluded from the
study.

RESULTS: 237 students completed the questionnaire. However, 9 of these
students were excluded because they repeated their first clinical year.
The response rate was 91.9%. Although 8 (3.5%) students reported one NSI
each, only 2 (25.0%) of these 8 students reported the incident to the
relevant authority. Among the students surveyed, 65.8% reported using
gloves at all times during venepuncture procedures, 48.7% felt that
improvements could be made to the current reporting system and procedures,
and 53.2% felt that the training provided before commencement of clinical
posting could be enhanced.

CONCLUSION: There was a decrease in the incidence of NSIs among medical
undergraduates in their first clinical year when compared to the
incidences reported in earlier studies conducted in the same centre (35.1%
in 1993 and 5.3% in 2004). The current reporting system could use a more
user-friendly platform, and training on NSIs could be improved to focus
more on real- life procedures and incident reporting.

Free full text http://www.sma.org.sg/UploadedImg/files/SMJ/5409/5409a4.pdf
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Assessment of knowledge, attitude and practices among
healthcare workers in a tertiary care hospital on needle stick injury
__________________________________________________________________
Int J Health Care Qual Assur. 2013;26(6):549-58.

Assessment of knowledge, attitude and practices among healthcare workers
in a tertiary care hospital on needle stick injury.

Bhargava A, Mishra B, Thakur A, Dogra V, Loomba P, Gupta S.

Department of Microbiology, G.B. Pant Hospital, New Delhi, India.
bhargavaaradhana@yahoo.com

PURPOSE: The study aims to assess healthcare workers’ needle-stick injury
(NSI) knowledge, attitudes and practices (KAP).

DESIGN/METHODOLOGY/APPROACH: A cross-sectional study was conducted in a
600-bedded hospital throughout six months. The data were collected using
an anonymous, self-reporting questionnaire. Participants were various
healthcare workers (HCW) drawn through stratified random sampling and
their knowledge, attitude and practice regarding NSI were assessed.

FINDINGS: There is significant difference in the mean knowledge, attitude
and practice scores among healthcare workers. Even though scores are
better for doctors and nurses, practice scores were better for technical
staff. Healthcare workers, who had better practice scores, had suffered
fewer NSIs. Since this study is a cross-sectional, the population’s NSI
incidence could not be calculated.

PRACTICAL IMPLICATIONS: This study emphasizes that applying knowledge to
practice is required to prevent NSIs. Various recommendations to help
prevent and deal with NSIs are made.

ORIGINALITY/VALUE: This study analyses healthcare workers’ NSI knowledge,
attitude and practices, and also assesses their correlation with NSI
incidence, which has not been done previously.
__________________________________________________________________
________________________________*_________________________________

11. Abstract: How do university education and clinical experience
influence pre- registration nursing students’ infection control
practice? A descriptive, cross sectional survey
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24090618

Nurse Educ Today. 2013 Sep 14. pii: S0260-6917(13)00332-8.

How do university education and clinical experience influence pre-
registration nursing students’ infection control practice? A descriptive,
cross sectional survey.

Hinkin J, Cutter J.

College of Human and Health Sciences, Swansea University, St David’s Park,
Carmarthen SA31 3HB, United Kingdom. Electronic address:
j.hinkin@swansea.ac.uk.

AIMS: This study aims to explore nursing students’ knowledge of infection
control and investigate how university education and clinical experience
influence their infection control practice.

BACKGROUND: In order to prevent and control healthcare associated
infections all healthcare staff must be knowledgeable about infection
control. However, knowledge and practice of infection control are often
sub-optimal. Education has had variable results in improving the infection
control knowledge of healthcare professionals yet, there have been few
studies examining this issue in relation to pre-registration nursing
students in the United Kingdom.

METHODS: This descriptive cross-sectional survey employed a questionnaire
composed of predominantly closed questions for data collection. A non-
probability, purposive sample of 354/444 (79.7%) nursing students from one
university participated in the study.

FINDINGS: Knowledge was generally adequate in questions related to
pathogen transmission, hand hygiene principles, glove use, immediate
action following sharps’ injuries, and risk reduction in relation to
sharps and waste management. Topics that received less positive results
related to the chain of infection, the use of alcohol gel and Clostridium
difficile and the definition of inoculation injury. University education
was the main influence on knowledge and practice (340/353, 96.3%), but
mentors (322/354, 91.2%), nurses (316/353, 89.3%), doctors (175/353,
49.4%) and other members of the multi-disciplinary team (213/352, 60.2%)
were also deemed influential. Workload, time, and availability of
facilities and equipment also contributed to the adoption of infection
control precautions. The findings illustrated the importance of both
theoretical and practical knowledge, supported by competent role models.

CONCLUSION: The study identified the complexities of knowledge acquisition
and application in a practice based discipline. The support of a competent
role model to assist in applying theory to practice is vital. The study
has identified that there are many variables that affect IPC practice,
both positively and negatively. © 2013.

KEYWORDS: Clinical practice, Education, Infection prevention and control,
Knowledge, Nursing students, Survey
__________________________________________________________________
________________________________*_________________________________

12. Abstract: Lessons learned in the multistate fungal infection outbreak
in the United States
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24152763
Curr Opin Infect Dis. 2013 Oct 22.

Lessons learned in the multistate fungal infection outbreak in the United
States.

Pappas PG.

Mycoses Study Group, Division of Infectious Diseases, University of
Alabama at Birmingham, Birmingham, Alabama, USA.

PURPOSE OF REVIEW: The recent outbreak of fungal meningitis related to
contaminated methylprednisolone acetate injections represents an important
cause of morbidity and continues to be a significant public health problem
in the United States.

RECENT FINDINGS: As of August 2013, there have been 749 cases and 63
deaths in 20 states associated with epidemic fungal meningitis, most of
these because of Exserohilum rostratum.

Clinical experience in managing these cases has grown dramatically in the
last several months; most patients require at least 6 months of antifungal
therapy for complicated disease. Most patients are treated with
voriconazole, with or without liposomal amphotericin B, for central
nervous system and paraspinal complications of the disease. For disease
involving the sacroiliac and peripheral joints, voriconazole alone has
been preferred. MRI spine imaging has identified several cases of
asymptomatic disease, suggesting an aggressive diagnostic approach to
exposed asymptomatic patients.

Mortality remains low (<10%), but morbidity relating to persistent
symptoms and treatment-associated toxicity is high.

SUMMARY: The ongoing fungal meningitis epidemic demonstrates an important
achievement for the public health community. Important questions remain
relating to the diagnosis, management, and long-term outcomes of these
patients. Important research questions pertaining to specific risks
influencing disease manifestations remain unanswered.
__________________________________________________________________
________________________________*_________________________________

13. Abstract: Clinical findings for fungal infections caused by
methylprednisolone injections
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24152260

N Engl J Med. 2013 Oct 24;369(17):1610-9.

Clinical findings for fungal infections caused by methylprednisolone
injections.

Chiller TM, Roy M, Nguyen D, Guh A, Malani AN, Latham R, Peglow S,
Kerkering T, Kaufman D, McFadden J, Collins J, Kainer M, Duwve J, Trump D,
Blackmore C, Tan C, Cleveland AA, MacCannell T, Muehlenbachs A, Zaki SR,
Brandt ME, Jernigan JA; Multistate Fungal Infection Clinical Investigation
Team.

The authors’ affiliations are listed in the Appendix.

BACKGROUND: Since September 18, 2012, public health officials have been
investigating a large outbreak of fungal meningitis and other infections
in patients who received epidural, paraspinal, or joint injections with
contaminated lots of methylprednisolone acetate. Little is known about
infections caused by Exserohilum rostratum, the predominant outbreak-
associated pathogen. We describe the early clinical course of outbreak-
associated infections.

METHODS: We reviewed medical records for outbreak cases reported to the
Centers for Disease Control and Prevention before November 19, 2012, from
the six states with the most reported cases (Florida, Indiana, Michigan,
New Jersey, Tennessee, and Virginia). Polymerase-chain-reaction assays and
immunohistochemical testing were performed on clinical isolates and tissue
specimens for pathogen identification.

RESULTS: Of 328 patients without peripheral-joint infection who were
included in this investigation, 265 (81%) had central nervous system (CNS)
infection and 63 (19%) had non-CNS infections only. Laboratory evidence of
E. rostratum was found in 96 of 268 patients (36%) for whom samples were
available. Among patients with CNS infections, strokes were associated
with an increased severity of abnormalities in cerebrospinal fluid
(P<0.001). Non-CNS infections were more frequent later in the course of
the outbreak (median interval from last injection to diagnosis, 39 days
for epidural abscess and 21 days for stroke; P<0.001), and such infections
developed in patients with and in those without meningitis.

CONCLUSIONS: The initial clinical findings from this outbreak suggest that
fungal infections caused by epidural and paraspinal injection of a
contaminated glucocorticoid product can result in a broad spectrum of
clinical disease, reflecting possible variations in the pathogenic
mechanism and in host and exposure risk factors. (Funded by the Centers
for Disease Control and Prevention.).

Full text:
http://www.nejm.org/doi/full/10.1056/NEJMoa1304879#t=articleResults
__________________________________________________________________
________________________________*_________________________________

14. Abstract: An outbreak of fungal endophthalmitis after intravitreal
injection of compounded combined bevacizumab and triamcinolone
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23640384
JAMA Ophthalmol. 2013 Jul;131(7):864-9.

An outbreak of fungal endophthalmitis after intravitreal injection of
compounded combined bevacizumab and triamcinolone.

Sheyman AT, Cohen BZ, Friedman AH, Ackert JM.

Department of Ophthalmology, Mount Sinai School of Medicine, New York, NY
10029, USA.

IMPORTANCE: Our experience may be useful to other practitioners using
compounded intravitreal agents, those suspecting infectious outbreaks, and
those managing fungal endophthalmitis.

OBJECTIVE: To describe a series of patients with fungal endophthalmitis
following intravitreal injection of combined bevacizumab and triamcinolone
acetonide prepared by the same compounding pharmacy.

DESIGN AND SETTING: Noncomparative case series.

PARTICIPANTS: Eight eyes of 8 patients who received an intravitreal
injection of compounded combined bevacizumab-triamcinolone in a period of
3 weeks had subtle, nonspecific findings that were later diagnosed as
fungal endophthalmitis.

MAIN OUTCOME MEASURES: Visual acuity, response to antimicrobial therapy,
and number of vitreoretinal surgical operations after diagnosis of fungal
endophthalmitis.

RESULTS: Eight patients developed endophthalmitis 41 to 97 days after
receiving the intravitreal injection, which was prepared by the same
compounding pharmacy. The injections occurred at the same location in New
York. Treatment was based on clinical examination findings and knowledge
of the etiology of the endophthalmitis. Eventually, all patients were
treated with oral voriconazole. Five of 8 patients were initially treated
with intravitreal antimicrobial agents. After 3 months of follow-up,
visual acuities ranged from 20/50 to hand motions. Local, state, and
federal health department officials were involved in investigating the
source of the outbreak.

CONCLUSIONS AND RELEVANCE: In the current study, we report a fungal
endophthalmitis outbreak after intravitreal injection of contaminated,
compounded combined bevacizumab- triamcinolone. In this series, Bipolaris
hawaiiensis was the identified causative agent.

The challenge of medical diagnosis, identification of the source of the
outbreak, and management experience are highlighted in our series. Our
experience may be useful to other practitioners using compounded
intravitreal agents, those suspecting infectious outbreaks, and those
managing fungal endophthalmitis.
__________________________________________________________________
________________________________*_________________________________

15. Abstract: Causes of Death and Characteristics of Decedents with Viral
Hepatitis, United States, 2010
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24065331

Clin Infect Dis. 2013 Sep 24.

Causes of Death and Characteristics of Decedents with Viral Hepatitis,
United States, 2010.

Ly KN, Xing J, Klevens RM, Jiles RB, Holmberg SD.

Division of Viral Hepatitis, Centers for Disease Control and Prevention,
Atlanta, GA.

Background. Previous research indicates that the mortality burden from
viral hepatitis is growing, particularly among middle-aged persons. In
order to monitor progress toward prevention goals, it is important to
continue to document characteristics and co-mortalities of these deaths.

This study sought to examine demographic characteristics and the most
frequent causes of death among decedents with a viral hepatitis-related
death.

Methods. A cross-sectional study was performed on approximately 2.4
million death records from 2010. We calculated 1) mortality rates for
decedents with and without hepatitis A, B, and C virus (HAV, HBV, and HCV)
and 2) relative risks for the most frequently cited conditions in
decedents with and without HBV and HCV. Results. In 2010, there were
18,473 (0.7%) deaths with HAV, HBV, and HCV listed among causes of death,
disproportionately in those aged 45-64 years.

Among the ten frequent causes of death, decedents listing HBV or HCV died,
on average, 22-23 years earlier than decedents not listing these
infections. HBV- and HCV- infected decedents aged 45-64 years had an
increased risk of having the following conditions reported than decedents
without these infections: cancer of liver and intrahepatic bile duct;
fibrosis, cirrhosis, and other liver diseases; alcohol-related liver
disease; gastrointestinal hemorrhage; HIV infection; acute and unspecified
renal failure; and septicemia (HCV only).

Conclusion. Decedents with other causes of death that include HBV or HCV
died 22-23 years earlier than decedents not listing these infections.

These data suggest and support the need for prevention, early
identification, and treatment of HBV and HCV.
__________________________________________________________________
________________________________*_________________________________

16. Abstract: Less-Established Risk Factors Are Common in Asian Americans
with Hepatitis C Virus: A Case-Controlled Study
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24081641

Dig Dis Sci. 2013 Oct 1.

Less-Established Risk Factors Are Common in Asian Americans with Hepatitis
C Virus: A Case-Controlled Study.

Kin KC, Lin B, Chaung KT, Ha NB, Trinh HN, Garcia RT, Nguyen HA, Nguyen
KK, Levitt BS, da Silveira EB, Nguyen MH.

Pacific Health Foundation, San Jose, CA, USA, kevin.kin@gmail.com.

BACKGROUND AND AIMS: The Centers for Disease Control and Prevention
recommend screening for hepatitis C virus (HCV) in patients with injection
drug use, blood transfusion before 1992, stigmata of liver disease, or
born between 1945 and 1965. The purpose of this study was to examine risk
factors for HCV acquisition in Asian Americans.

METHODS: This was a case-controlled study, with 471 consecutive patients
testing positive for anti-HCV between January 2001 and December 2008.
Controls included 471 patients with negative HCV matched at a one-to-one
ratio for sex, age (±5 years), and ethnicity.

RESULTS: For Asian patients, the most common risk factors were blood
transfusion and acupuncture or exposure to dirty needles (27 and 20 %,
respectively). On multiple logistic regression, potential predictors for a
positive anti- HCV test in Asians were acupuncture or exposure to dirty
needles (OR = 12.9, P < 0.0001), body tattoo (OR = 12.0, P = 0.001), and
history of blood transfusion (OR = 5.7, P < 0.0001).

DISCUSSION: Acupuncture and exposure to dirty needles are independent risk
factors of HCV infection. Asians coming from endemic areas should be
screened for HCV even when commonly-known risk factors for Western
patients are not present.
__________________________________________________________________
________________________________*_________________________________

17. Abstract: Pharmacological Interventions Including Medical Injections
for Neck Pain: An Overview as Part of the ICON Project
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24155805

Open Orthop J. 2013 Sep 20;7:473-93.

Pharmacological Interventions Including Medical Injections for Neck Pain:
An Overview as Part of the ICON Project.

Peloso PM, Khan M, Gross AR, Carlesso L, Santaguida L, Lowcock J,
Macdermid JC, Walton D, Goldsmith CH, Langevin P, Shi Q.

Merck & Co., Rahway, NJ, USA.

OBJECTIVES: To conduct an overview (review-of-reviews) on pharmacological
interventions for neck pain.

SEARCH STRATEGY: Computerized databases and grey literature were searched
from 2006 to 2012.

SELECTION CRITERIA: Systematic reviews of randomized controlled trials
(RCT) in adults with acute to chronic neck pain reporting effects of
pharmacological interventions including injections on pain,
function/disability, global perceived effect, quality of life and patient
satisfaction.

DATA COLLECTION & ANALYSIS: Two independent authors selected articles,
assessed risk of bias and extracted data The GRADE tool was used to
evaluate the body of evidence and an external panel provided critical
review.

MAIN RESULTS: We found 26 reviews reporting on 47 RCTs. Most
pharmacological interventions had low to very low quality methodologic
evidence with three exceptions. For chronic neck pain, there was evidence
of: a small immediate benefit for eperison hydrochloride (moderate GRADE,
1 trial, 157 participants);no short-term pain relieving benefit for
botulinum toxin-A compared to saline (strong GRADE; 5 trial meta-analysis,
258 participants) nor for subacute/chronic whiplash (moderate GRADE; 4
trial meta-analysis, 183 participants) including reduced pain, disability
or global perceived effect; andno long-term benefit for medial branch
block of facet joints with steroids (moderate GRADE; 1 trial, 120
participants) over placebo to reduce pain or disability;

REVIEWERS’ CONCLUSIONS: While in general there is a lack of evidence for
most pharmacological interventions, current evidence is against botulinum
toxin-A for chronic neck pain or subacute/chronic whiplash; against medial
branch block with steroids for chronic facet joint pain; but in favour of
the muscle relaxant eperison hydrochloride for chronic neck pain.

KEYWORDS: Neck pain, medical injections, pharmacological interventions,
review of reviews.

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3802125/
__________________________________________________________________
________________________________*_________________________________

18. Abstract: Increasing sharp safety device use in healthcare: a semi-
structured interview study
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23869499

Contemp Nurse. 2013 Jun;44(2):144-55.

Increasing sharp safety device use in healthcare: a semi-structured
interview study.

Stringer B, Astrakianakis G, Haines T.

Simon Fraser University, Blusson Hall, Burnaby, BC, Canada.

The use of sharp safety devices in healthcare is considered the most
important means of preventing occupational percutaneous injuries and has
been mandated for use in most hospitals in industrialized countries
including in Canada. However, clinical personnel’s perceptions on the use
of safety devices needs further characterization to improve compliance.

This study’s objective was to identify healthcare provider perspectives on
different aspects of sharp safety device use and on how use could be
increased.

Using a constant comparison approach, data from semi-structured interviews
with 39 nurses, physicians and phlebotomists providing direct patient
care, and six nurses acting as the interface between clinical personnel
and purchasing departments, were analyzed.

Study participants were from three of the six health authorities in
British Columbia. The four major categories that emerged from the data
were: selection processes; identification and replacement; training; and
multi-level barriers and facilitators.

Findings highlighted the importance of including personnel regularly using
safety devices at each stage of their selection including when they are
being considered for replacement with superior devices, as well as the
need for appropriate initial and refresher training, and how practices at
the hospital, ward and individual level facilitate safety device use.
__________________________________________________________________
________________________________*_________________________________

19. Abstract: The Dark Cloud of HIV Hangs Over Our IDUs

This is a contributed abstract of the presentation available at:
http://tinyurl.com/PakistanIDUslides
__________________________________________________________________
The Dark Cloud of HIV Hangs Over Our IDUs

Zeeshan Ayyaz (1), Kate Dolan (2)

1. Amitiel Welfare Society, Pakistan.
amitielwelfare@gmail.com
2. Program of International Research and Training, NDARC, UNSW Australia.
K.dolan@unsw.edu.au

Over 7000 people are infected with HIV daily. Of the 13 .2 million IDU
worldwide, 3.3 million are in South and South-east Asia and 91,000 in
Pakistan. Syringes are cheap (10 c), but costly for IDUs who share
routinely. Our Society provides NSP, condoms and medical care for IDUs in
Bahawalpur, Pakistan.

In 2012, we visited 5 drug hotspots and recruited 50 IDU participants. We
examined their drug use, sexual risk behaviour, attitudes and HIV testing
experience.

They were mostly males (98%), with a mean age of 24.4 yrs (R: 15 – 54 yr),
Muslim (88%) and mostly illiterate (60%). All were local Bahawalpur IDUs
(100%), who slept on the streets (84%) and their source of income was
scavenging from garbage (82%). IDUs thought their family (67%) and the
community (62%) hated them. Their first use of drugs was at a mean age
18.7 yrs (R: 15 – 54 yrs).

All injected Morphine tablets, Pheniramine and Diazepam liquid (100%) and
many shared syringes (82%). Most have had sexual intercourse (94%), with
sex workers (40%), had a sexual preference for females (86%), but few used
condoms (16%) or knew about safe sex (16%), or STDs (24%). Over half had
genital itch (54%).

Disturbingly few IDUs knew about HIV (12%), none had been tested for HIV
(0%), yet many were interested in being tested for HIV (90%).

Pakistani IDUs experience significant stigma, harms from injecting, have a
low awareness of HIV and no experience with HIV testing. More funding is
urgently needed for NSP, HIV education, safe sex promotion and drug
treatment to reduce these harms and thwart the impending epidemic of HIV
transmission in our IDU community as Pakistan recently moved into a
concentrated phase of its HIV epidemic.
__________________________________________________________________
________________________________*_________________________________

20. Abstract: Epidemiological characteristics of hepatitis C in China,
1997-2011
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24125600

Zhonghua Liu Xing Bing Xue Za Zhi. 2013 Jun;34(6):548-51.

[Epidemiological characteristics of hepatitis C in China, 1997-2011].

[Article in Chinese]
Qin QQ, Guo W, Wang LY, Yan RX, Ge L, Wang L, Cui Y.

National Center for AIDS/STD Control and Prevention, Chinese Center for
Disease Control and Prevention, Beijing 102206, China.

OBJECTIVE: To analyze the epidemiological characteristics and changing
trend as well as the related affecting factors of hepatitis C in China.

METHODS: Data analysis was performed based on the case-reporting data of
hepatitis C from 1997 to 2011, using SPSS 19.0.

RESULTS: The number of reported cases and incidence of hepatitis C had
been increasing annually since 1997, especially in 2004. The hepatitis C
reported incidence increased from 3.03 per 100 000 in 2004, to 12.97 per
100 000 in 2011.

The 15 to 49 age group accounted for more than 50% of all the reported
cases, seen in every year. The number and proportion of hepatitis C
reported cases among those over 50 year-olds had an annually increase.
From 2005 to 2011, the number of cases in both urban areas and rural areas
increased annually, while the urban-rural ratio decreased from 1.47 in
2005 to 0.99 in 2011.

There appeared an increasing trend of hepatitis C reported incidence in
China, with most of the high reported incidence of hepatitis C fell in the
northern parts of China. 74.8% of the HCV/HIV co-infected cases had
histories of intravenous drug use, plasma donation, blood transfusion or
surgical operation.

CONCLUSION: The reported number and incidence of HCV infection had been
increasing annually. To develop a more realistic control measures for
hepatitisv C, it is necessary to strengthen the monitoring program and
carrying out specific epidemiological study among target groups and key
areas.
__________________________________________________________________
________________________________*_________________________________

21. Abstract: Epidemiological characteristics of hepatitis C in Henan
province
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24125602

Zhonghua Liu Xing Bing Xue Za Zhi. 2013 Jun;34(6):557-9.

[Epidemiological characteristics of hepatitis C in Henan province].

[Article in Chinese]

Fan PY, Sun DY, Ma YM, Sun GQ, Cui WG, Zhu Q, He JY, Zhou G, Xu J, Wang Z.

Henan Provincial Centre for Disease Control and Prevention, Zhengzhou
450016, China.

OBJECTIVE: To understand the epidemiological characteristics of hepatitis
C in Henan province.

METHODS: Multistage sampling was used to investigate a group of 1-75 year-
old general population, living in 30 districts of 18 cities, Henan
province. Blood samples were collected and tested for anti-HCV and
hepatitis C virus(HCV), from April to July 2012.

RESULTS: 32 203 persons were investigated. Among the general population
aged 1 to 75 years old, the overall prevalence rates of anti-HCV and HCV
RNA were 0.64% and 0.35% respectively. The prevalence rates of anti-HCV
among males and females were 0.60%, and 0.68% respectively, with the rates
of HCV RNA as 0.37%, and 0.33% respectively. The prevalence rates of anti-
HCV and HCV RNA were increasing with age. The prevalence rates of anti-HCV
and HCV RNA in urban area were 0.58% and 0.32%, and in rural area as
0.41%, and 0.19% respectively.

CONCLUSION: After the implementation of comprehensive measures for HCV
control and prevention, Henan province became low prevalent for HCV
infection. Our data revealed that the overall prevalence remained low, but
the epidemic was severe in some geographical regions in Henan province.
__________________________________________________________________
________________________________*_________________________________

22. Abstract: Epidemiology of hepatitis C virus infection and risk factor
analysis in the hebei province, china
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24069430

PLoS One. 2013 Sep 19;8(9):e75586.

Epidemiology of hepatitis C virus infection and risk factor analysis in
the hebei province, china.

Zhao Y, Shen L, Ma J, Gao Z, Han X, Qi S, Li Q.

Center for Disease Control and Prevention of Hebei Province, Shijiazhuang,
China.

BACKGROUND: In 1985, a hepatitis C virus (HCV) outbreak caused by
plasmapheresis donation was reported in the Hebei Province, China.
However, studies assessing the epidemic features and risk factors of HCV
in the general population of Hebei have been limited until now.

METHODS: The multicenter cluster sampling method was used to collect
samples. The participants were interviewed. Relevant information was
obtained from the general population using a standardized questionnaire,
and association and logistic regression analyses were conducted. Serum
samples were taken to test anti-HCV by enzyme immunoassays.

RESULTS: A total of 4562 participants from 11 cities of the Hebei Province
were enrolled. The average anti-HCV positive rate was 0.62% (29/4562),
which was 1.07% in the rural population, compared with 0.22% in the urban
population. The anti-HCV positive rate in the 40-59-year age group was
higher than in those aged <40 years. History of blood transfusion and
transmission in families were the main risk factors for HCV infection in
this area.

CONCLUSION: The anti-HCV positive rate in Hebei has decreased
significantly from that two decades ago. Safety of blood products and
health education about HCV still need to be improved.

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3777954/
__________________________________________________________________
________________________________*_________________________________

23. Abstract: Harm reduction approach in Egypt: the insight of injecting
drug users
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/24083418

Harm Reduct J. 2013 Oct 1;10(1):17.

Harm reduction approach in Egypt: the insight of injecting drug users.

Oraby D.

BACKGROUND: Egypt has low HIV prevalence (below 0[bullet operator]02 %)
among the general population, mostly attributed to the conservative
culture. The 2010 second round biological/behavioral surveillance survey
(Bio-BSS) conducted in some governorates revealed concentrated epidemic
among male injecting drug users (IDUs).

METHODS: The current study aimed at exploring the perspective of IDUs
regarding the HIV preventive efforts targeting them to provide relevant
evidence based policy recommendations. The study included desk review, in-
depth interviews with service providers and focus group discussions with
IDUs of both sexes.

RESULTS: The study described the current harm reduction interventions in
Egypt and highlighted the insights of active IDUs and service providers
interacting with them as regards their ability to address their needs and
what they miss in these interventions and how IDUs perceive these
interventions.

CONCLUSION: The epidemiological reality of HIV infection in Egypt favors
prioritizing efforts to the high risk groups rather than the general
population. Hence, harm reduction should be at the core of interventions
targeting HIV. The current study revealed that there is still a long way
to go to enhance the role of these interventions in influencing a
significant behavior change among target group.

Free full text http://www.harmreductionjournal.com/content/10/1/17
__________________________________________________________________
________________________________*_________________________________

24. Abstract: “To share or not to share?” Serosorting by hepatitis C
status in the sharing of drug injection equipment among NHBS-IDU2
participants
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24136794

J Infect Dis. 2013 Oct 16.

“To share or not to share?” Serosorting by hepatitis C status in the
sharing of drug injection equipment among NHBS-IDU2 participants.

Smith BD, Jewett A, Burt RD, Zibbell JE, Yartel AK, Dinenno E.

Centers for Disease Control and Prevention, Division of Viral Hepatitis,
Atlanta, Georgia 30333.

Background. Persons who inject drugs (PWID) are at high risk for acquiring
hepatitis C virus (HCV) infection. CDC estimates there are 17,000 new
infections per year, mainly among PWID. This study examines injection
equipment serosorting – considering HCV serostatus when deciding whether
and with whom to share injection equipment.

Objective. To examine whether injection equipment serosorting is occurring
among PWID in selected cities.Methods. Using data from the National HIV
Behavioral Surveillance System-Injection Drug Users (NHBS-IDU2, 2009), we
developed multivariate logistic regression models to examine the extent to
which participants’ self-reported HCV status is associated with their
injection equipment serosorting behavior and knowledge of last injecting
partner’s HCV status.

Results. Participants who knew their HCV status were more likely to know
the HCV status of their last injecting partner, compared to those who did
not know their status (HCV+: aOR 4.1, 95%CI 3.4-4.9; HCV-: aOR 2.5, 95%CI
2.0-3.0). Participants who reported being HCV+, relative to those of
unknown HCV status, were five times more likely to share injection
equipment with a partner of HCV-positive status (aOR 4.8, 95%CI 3.9-6.0).

Conclusion. Our analysis suggests PWID are more likely to share injection
equipment with persons of concordant HCV status.
__________________________________________________________________
________________________________*_________________________________

25. Abstract: Effectiveness of Methadone Maintenance Treatment in
Prevention of Hepatitis C Virus Transmission among Injecting Drug
Users
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24069039

Hepat Mon. 2013 Aug 17;13(8):e12411.

Effectiveness of Methadone Maintenance Treatment in Prevention of
Hepatitis C Virus Transmission among Injecting Drug Users.

Alavian SM, Mirahmadizadeh A, Javanbakht M, Keshtkaran A, Heidari A,
Mashayekhi A, Salimi S, Hadian M.

Baqiatallah Research Center for Gastrointestinal and Liver Diseases,
Baqiatallah University of Medical Sciences, Tehran, IR Iran ; Middle East
Liver Disease Center, Tehran, IR Iran.

BACKGROUND: Injecting drug users (IDUs) are a major and most important
risk factor for rising hepatitis C virus (HCV) prevalence in Iran.

OBJECTIVES: The objective of this study was to determine the effectiveness
of methadone maintenance treatment (MMT) in prevention of HCV infection
transmission among IDUs.

PATIENTS AND METHODS: A mathematical modeling has been used to estimate
number of HCV infections averted. The input parameters used in the model
were collected by self- reported method from 259 IDUs before registering
and one year after MMT. Nonparametric statistical tests have been used to
compare risky injecting and sexual behaviors among IDUs before and after
participating in MMT program. Deterministic sensitivity analyses were done
to show the effects of parameters’ uncertainty on outcome.

RESULTS: Of the 259 participants, 98.4% (255) were men, the mean age ± SD
was 33.1 ± 7.58 years and HCV prevalence was 50%. The studied IDUs
reported lower rate of risky injecting and sexual behavior after
participation in MMT program. The cumulative incidence of HCV per 100 IDUs
due to sharing injection and unsafe sexual contact with MMT program were
13.84 (95% CI: 6.17 -21.51), 0.0003 (0.0001 – 0.0005) and without it 36.48
(25.84 – 47.11) and 0.0004 (0.0002-0.0006) respectively.

CONCLUSIONS: The MMT program is an effective intervention to prevent HCV
infection transmission, although it is essential to compare its
effectiveness with other interventions before implementing it in
nationwide.

KEYWORDS: Effectiveness, Hepatitis C, Incidence, Iran, Maintenance,
Methadone

Free PMC Article

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3782738/
__________________________________________________________________
________________________________*_________________________________

26. Abstract: Extremely low and sustained HIV incidence among people who
inject drugs in a setting of harm reduction
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24056070

AIDS. 2013 Sep 19.

Extremely low and sustained HIV incidence among people who inject drugs in
a setting of harm reduction.

Iversen J, Wand H, Topp L, Kaldor J, Maher L.

aViral Hepatitis Epidemiology and Prevention Program bBiostatistics and
Databases Program, The Kirby Institute, University of New South Wales
cResearch Strategy Unit, Cancer Council NSW dPublic Health Interventions
Research Group, The Kirby Institute, University of New South Wales,
Sydney, New South Wales, Australia.

This study created a retrospective cohort by linking repeat respondents in
a large, national, annual cross-sectional sero-survey to estimate HIV
incidence among people who inject drugs (PWIDs) in Australia.

Results indicate extremely low and sustained rates of HIV incidence (0.11
per 100 person-years) over almost two decades (1995-2012).

Findings demonstrate that sustained prevention of HIV transmission among
PWID is possible and suggest that the early establishment and rapid scale-
up of needle and syringe programmes (NSP), at a time when background
prevalence was low, likely contributed to the prevention of an HIV
epidemic among Australian PWID.
__________________________________________________________________
________________________________*_________________________________

27. Abstract: A qualitative study of the perceived effects of blue lights
in washrooms on people who use injection drugs
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24099145

Harm Reduct J. 2013 Oct 8;10(1):22.

A qualitative study of the perceived effects of blue lights in washrooms
on people who use injection drugs.

Crabtree A, Mercer G, Horan R, Grant S, Tan T, Buxton J.

BACKGROUND: Blue lights are sometimes placed in public washrooms to
discourage injection drug use. Their effectiveness has been questioned and
concerns raised that they are harmful but formal research on the issue is
limited to a single study. We gathered perceptions of people who use
injection drugs on the effects of blue lights with the aim of informing
harm reduction practice.

METHODS: We interviewed 18 people in two Canadian cities who currently or
previously used injection drugs to better understand their perceptions of
the rationale for and consequences of blue lights in public washrooms.

RESULTS: Participants described a preference for private places to use
injection drugs, but explained that the need for an immediate solution
would often override other considerations. While public washrooms were in
many cases not preferred, their accessibility and relative privacy appear
to make them reasonable compromises in situations involving urgent
injecting. Participants understood the aim of blue lights to be to deter
drug use. The majority had attempted to inject in a blue-lit washroom.
While there was general agreement that blue lights do make injecting more
difficult, a small number of participants were entirely undeterred by
them, and half would use a blue-lit washroom if they needed somewhere to
inject urgently. Participants perceived that, by making veins less
visible, blue lights make injecting more dangerous. By dispersing public
injection drug use to places where it is more visible, they also make it
more stigmatizing. Despite recognizing these harms, more than half of the
participants were not opposed to the continued use of blue lights.

CONCLUSIONS: Blue lights are unlikely to deter injection drugs use in
public washrooms, and may increase drug use-related harms. Despite
recognizing these negative effects, people who use injection drugs may be
reluctant to advocate against their use. We attempt to reconcile this
apparent contradiction by interpreting blue lights as a form of symbolic
violence and suggest a parallel with other emancipatory movements for
inspiration in advocating against this and other oppressive interventions.

Free full text http://www.harmreductionjournal.com/content/10/1/22
__________________________________________________________________
________________________________*_________________________________

28. Abstract: Adherence to hand hygiene protocol by clinicians and medical
students at Queen Elizabeth Central Hospital, Blantyre-Malawi
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24098831

Malawi Med J. 2013 Jun;25(2):50-2.

Adherence to hand hygiene protocol by clinicians and medical students at
Queen Elizabeth Central Hospital, Blantyre-Malawi.

Kalata NL, Kamange L, Muula AS.

Dept of Community Health College of Medicine, University of Malawi.

BACKGROUND: While communicable diseases are the leading causes of
morbidity and mortality in Malawi, the contribution of nosocomial or
hospital-acquired infections (HAIs) is unknown but could be substantial.
The single most important method of preventing nosocomial infections is
hand hygiene. We report a study which was conducted in 2011 to investigate
adherence to hand hygiene protocols by clinicians and medical students
working at Queen Elizabeth Central Hospital in Blantyre, Malawi.

METHODS: There were two parts to the study: a single blinded arm in which
participants were observed without their knowledge by trained nurses; and
a second arm which included self-completion of questionnaire after
participant consent was obtained. The 2009 World Health Organization hand
hygiene technique and recommendations which were adopted by Queen
Elizabeth Central Hospital were used to define an opportunity for hand
washing and effectiveness of hand washing. Hand hygiene effectiveness was
defined as adherence to at least 6 out of 7 steps (80%) of the hand
hygiene technique when using alcohol-based formulation or at least 8 out
of 10 steps (80%) of the hand hygiene technique when using water and soap
formulation before and after having direct contact with patients or their
immediate surroundings.

RESULTS: Clinicians were found to have disinfected their hands more than
medical students (p<0.05) but effectiveness was similar and very low
between the two groups (p=0.2). No association was also found between
having a personal hand sanitizer and hand hygiene practice (p=0.3).
Adherence to hand hygiene was found to be 23%. Most of the participants
mentioned infection transmission prevention as a reason for disinfecting
their hands. Other reasons mentioned included: a routine personal hand
hygiene behaviour and discomfort if not washing hands. The top three
reasons why they did not disinfect hands were forgetfulness,
unavailability of sanitizers and negligence.

CONCLUSION: Adherence to hand hygiene practice was found to be low, with
forgetfulness and negligence being the major contributing factors. A
hospital-wide multifaceted program aiming at clinicians and students
education, adoption of alcohol based hand rubs as a primary formulation,
production of colored poster reminders and encouraging role modeling of
junior practitioners by senior practitioners can help improve compliance
to hand hygiene.

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3784937/
__________________________________________________________________
________________________________*_________________________________

29. Abstract: Hand hygiene behavior: translating behavioral research into
infection control practice
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/24113596

Infect Control Hosp Epidemiol. 2013 Nov;34(11):1137-45.

Hand hygiene behavior: translating behavioral research into infection
control practice.

Eiamsitrakoon T, Apisarnthanarak A, Nuallaong W, Khawcharoenporn T, Mundy
LM.

Thammasat University Hospital, Pathumthani, Thailand.

Background. In 2009, the World Health Organization (WHO) recommended “My
Five Moments for Hand Hygiene” (5MHH) to optimize hand hygiene (HH).
Uptake of these recommendations by healthcare workers (HCWs) remains
uncertain.

Methods. We prospectively observed HCW compliance to 5MHH. After
observations, eligible HCWs who consented to interviews completed surveys
on factors associated with HH compliance based on constructs from the
transtheoretical model of behavioral change (TTM) and the theory of
planned behavior (TPB). Survey results were compared with observed HCW
behaviors.

Results. There were 968 observations among 123 HCWs, of whom 110 (89.4%)
were female and 63 (51.3%) were nurses. The mean HH compliance for all
5MHH was 23.2% (95% confidence interval [CI], 18.1%-28.3%) by direct
observation versus 82.4% (95% CI, 79.9%-84.9%) by self report. The HCW
5MHH compliance was associated with critical care unit encounters
([Formula: see text]), medicine unit encounters ([Formula: see text],
[Formula: see text]), immunocompromised patient encounters ([Formula: see
text]), and HCW prioritized patient advocacy ([Formula: see text]). Self-
reported TTM stages of action or maintenance ([Formula: see text]) and the
total TPB behavior score correlated with observed 5MHH ([Formula: see
text], [Formula: see text]) and with self-reported 5MHH compliance
([Formula: see text], [Formula: see text]).

Conclusion. Observed HCW compliance to 5MHH was associated with the type
of hospital unit, type of provider-patient encounter, and theory-based
behavioral measures of 5MHH commitment.
__________________________________________________________________
________________________________*_________________________________

30. Abstract: Outbreak report: nosocomial transmission of measles through
an unvaccinated healthcare worker–implications for public health
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/24099734

J Public Health (Oxf). 2013 Oct 6.

Outbreak report: nosocomial transmission of measles through an
unvaccinated healthcare worker–implications for public health.

Baxi R, Mytton OT, Abid M, Maduma-Butshe A, Iyer S, Ephraim A, Brown KE,
O’Moore E.

Department of Public Health, University of Oxford, Old Road Campus,
Headington, Oxford OX3 7LG, UK.

BACKGROUND: Nosocomial transmission of measles is a near avoidable event
with the potential for serious sequelae. Those who acquire infection in
hospitals may be particularly susceptible to serious disease. UK guidance
recommends measles, mumps, rubella vaccine (MMR) vaccination for
healthcare workers (HCWs) as a key preventative measure against nosocomial
transmission. We report an incident of transmission of measles from a
patient to an unvaccinated HCW, with subsequent onward transmission to a
patient in a paediatric unit.

METHODS: Response to the incident was undertaken in accordance with
guidance from the Health Protection Agency (now Public Health England) and
UK Department of Health.

RESULTS: The index case had travelled to France, where there was an
ongoing outbreak. There were 110 contacts identified for this HCW, of whom
61 were advised to have MMR and 5 were given immunoglobulin. All three
cases were found to have the same D4 genotype.

CONCLUSIONS: The report highlights the large number of potential contacts
in a hospital setting and the time and resource implications involved to
prevent further cases. It also highlights the importance of timely
identification of measles, early public health notification and complete
contact tracing. Such incidents are nearly avoidable given the
availability of an efficacious vaccine.

KEYWORDS: MMR, healthcare worker, measles, nosocomial infection, outbreak,
vaccination
__________________________________________________________________
________________________________*_________________________________

31. News

– UK: Final report of bad blood inquiry delayed to 2014
– Nevada USA: Lawsuits filed against Sunrise Hospital and Medical Center
in child deaths

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

www.heraldscotland.com/news/health/final-report-of-bad-blood-inquiry-
delayed-to-2014-x.22524883

UK: Final report of bad blood inquiry delayed to 2014

By Judith Duffy, Herald Scotland, U.K. (26.10.13)

THE final report of a long-running public inquiry into how people were
infected with hepatitis C and HIV through contaminated blood products will
not be published until spring next year, the Sunday Herald can reveal.

The findings of the inquiry chaired by Lord Penrose – which had been due
to be released this year – are now to be made public in March 2014, more
than six years after the pledge to hold an investigation was made by the
Scottish Government.

The delay will increase the overall cost of the inquiry, which to date has
cost more than £9 million.

The delay has been caused by a decision to seek further written evidence
from witnesses on the issue of trying to establish exactly how many NHS
patients were affected, according to an inquiry spokeswoman.

This is the second major public inquiry to be delayed this month, as it
was also revealed that the report from a public inquiry into the deaths
from clostridium difficile at the Vale of Leven Hospital in West
Dunbartonshire had been put back for a fourth time.

The Vale of Leven inquiry was originally due to be published by the end of
May 2011, but it too is expected to report by the end of March next year.

Health Secretary Alex Neil said the chairman of the Vale of Leven inquiry
Lord MacLean, who was struck by illness last year, required extra time in
order to fully consider all evidence to ensure a robust report.

However, opposition politicians yesterday raised concerns about the delays
affecting both inquiries.

Neil Findlay, health spokesman for Scottish Labour, said: “The people
affected deserve to know what went wrong and it’s unfair to make them wait
this long while they have to live each day with the consequences of what
happened to them.

“Public inquiries should bring closure to those affected and also bring
forward recommendations to improve our systems.

“Questions must be asked of Alex Neil on why he hasn’t pushed for both the
Penrose and Vale of Leven inquiries to report sooner. The public need to
know what is holding up these vital inquiries.”

Scottish Conservative health spokesman Jackson Carlaw said: “As a party we
believe that public inquiries, given their gravity and their expense,
should only be established in the most deserving of situations.

“So when they are launched, it’s important timescales are adhered to. Many
were affected by these tragedies and are placing considerable store on the
respective inquiry outcomes. Delaying them further can only extend
distress and fuel suspicions.”

The Penrose inquiry was set up to examine how hundreds of haemophiliacs
and other patients were infected with HIV and hepatitis C through “bad
blood” products during the 1970s and 1980s.

Bernard Manson, chair of the Haemophilia Society, said: “Those whose lives
have been directly impacted by contaminated blood, who have waited 30
years for a public inquiry, will wish to see the report as soon as is
practical.

“However, we understand why, with the large amount of evidence coming
before the inquiry, Lord Penrose has felt it necessary to extend the time
to produce his report beyond his original estimate.

“We look forward to the report and to the response of the Scottish
Government.”

Campaigner Bruce Norval, a haemophiliac who contracted hepatitis C from
infected blood products, said he was “not happy” about any delay. However,
he added: “If those delays are going to result in a proper, measured
conclusion to this then I will tolerate them.”

A spokeswoman for the Penrose Inquiry said: “Following the final
procedural hearing held in October 2012, further work on statistics has
led to an extended timescale for completion of the Penrose Inquiry’s final
report. However, it is now in its concluding stage.

“Subject to the length of time required for the warning letters process
and the time to print the final document, it is anticipated that the final
report will be published in March 2014.”

A spokeswoman for the Scottish Government said: “The Penrose Inquiry is
independent of Scottish ministers, and it is a matter for the chairman,
Lord Penrose, to decide on how he wishes to progress the inquiry within
the terms of reference.”

The spokeswoman added that there was an intention to review the existing
financial support provisions for people who contracted hepatitis C from
NHS contaminated blood following the final report and recommendations of
the inquiry.
__________________________________________________________________
__________________________________________________________________
Nevada USA: Lawsuits filed against Sunrise Hospital and Medical Center in
child deaths

By Paul Harasim, Las Vegas Review-Journal, Nevada USA (21.10.13)

Sunrise Hospital and Medical Center and its director of pharmacy, Wilson
Chu, purchased a contaminated cardiac drug from an unaccredited
compounding pharmacy that ultimately led to the 2012 deaths of two Las
Vegas children, two lawsuits filed in U.S. District Court allege.

They did so, according to the suit filed last week, largely because the
pharmacy offered cheaper prices.

The suit also contends Sunrise did not follow recognized standards to
confirm the drug’s safety.

Filed on behalf of the families of 6-year-old Zacharie Nicholas Rood-
Sucharzewski and 4-year-old Ari Thomas Gomez, the lawsuits charge that
Sunrise bought contaminated cardioplegia solution in bulk from the New
England Compounding Center (NECC), an unaccredited compounding pharmacy
responsible last year for an outbreak of fungal meningitis in the United
States that the federal Centers for Disease Control and Prevention says
has caused 64 deaths. The two youngsters underwent open heart surgery at
Sunrise.

John Thornton, a California lawyer handling the cases along with attorney
Peter Wetherall of Las Vegas, charged: “Hospitals that chose to outsource
their drugs from NECC would have discovered irregularities had they
followed recognized standards to confirm sterility.”

Spokesman Brendan Bussmann explained Sunrise’s position:

“As soon as Sunrise Hospital and Medical Center learned some New England
Compounding Center products had been recalled, we immediately pulled all
NECC products from our inventory. However, a small number of our patients
had already received doses of medication from NECC. To the best of our
knowledge, the medications have not currently been confirmed as causing
infections and authorities believe the risk is very low. Because of
Sunrise’s commitment to quality care and the safety of its patients, we
notified these patients out of an abundance of caution as advised by U.S.
Food and Drug Administration.”

Both Katrina Eldeth, Ari’s mother, and Alan Zucharzewski, Zacharie’s
father, learned in letters dated Oct. 18, 2012 from Sunrise that the drug
given their sons on the days of their 2012 operations had been recalled.
In October 2012, the FDA issued a warning that cardioplegia may be
contaminated.

Both lawsuits allege that the boys developed serious infections from the
cardioplegia solution and that they spent more than a month in critical
condition before dying.

Neither parent agreed to be interviewed.

Until now, the primary focus of lawsuits against NECC nationwide has been
on contaminated steroid injections doctors administer for lower back pain.
According to the CDC, 750 people from 20 states are now being treated for
infections from those tainted spinal injections, but none of them are from
Nevada. NECC is also the target of state and federal criminal probes.

The lawsuits filed on behalf of the young boys, which also name the owners
of NECC as defendants, are the first relating to injuries from a
contaminated heart drug.

Cardioplegia solution is used during complicated heart surgeries to
suspend cardiac activity. The lawsuit states that the solution used during
the boys’ operations was recalled by NECC after authorities discovered
widespread bacterial and fungal contamination throughout NECC’s
facilities.

Sunrise should have known the danger of using drugs that were not from
FDA-approved manufacturers, the lawsuits state. According to the suits,
“Cheaper prices … was one of the factors prompting” Sunrise to purchase
NECC’s cardioplegia solution.

Chu and Sunrise also didn’t take investigative steps necessary to
determine if NECC could provide a safe drug for open heart surgery
procedures, the lawsuit states.

The suits also charge that Sunrise knowingly submitted false names in lieu
of valid, actual patient names on NECC’s prescription order forms in
violation of Massachusetts law — a tactic, the suit alleges, that allowed
Sunrise to “illegally obtain compounded drugs from NECC in bulk.”

According to the suit, Sunrise and Chu are guilty of a violation of
Nevada’s public health and safety prescription fraud law, which provides
that any person “who knowingly or intentionally obtains” a drug through
“misrepresentation” is guilty of a category E felony.
__________________________________________________________________
________________________________*_________________________________
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The 2010 annual Safe Injection Global Network meeting to aid collaboration
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The SIGN 2010 meeting report pdf, 1.36Mb is available on line at:
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