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SIGNpost 00721

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST *

Post00721 Pakistan Law + IAPHL + Abstracts + News 20 November 2013

CONTENTS
1. Pakistan: The Sindh Disposable Syringe Act: putting the act together
2. New Website: International Association of Public Health Logisticians
3. Abstract: Healthcare-associated infections in sub-Saharan Africa
4. Abstract:Incidence rate of needlestick and sharps injuries in 67
Japanese hospitals: a national surveillance study
5. Abstract: Pediatric Intramuscular Injections: Guidelines for Best
Practice
6. Abstract: Occupational Exposure to Blood, Hepatitis B Vaccine Knowledge
and Uptake among Medical Students in Cameroon
7. Abstract: Decreasing central line infections and needlestick injury
rates: combining best practice and introducing a luer-activated
intravenous therapy system and antimicrobial intravenous connector
8. Abstract: Hepatitis C avoidance in injection drug users: a typology of
possible protective practices
9. Abstract: Cotton fever: an evanescent process mimicking sepsis in an
intravenous drug abuser
10. Abstract: Corticosteroid and platelet-rich plasma injection therapy in
tennis elbow (lateral epicondylalgia): a survey of current UK
specialist practice and a call for clinical guidelines
11. Abstract: Hepatitis B and C infection in international travelers
12. Abstract: Complications from toxins and fillers in the dermatology
clinic: recognition, prevention, and treatment
13. Abstract: Monitoring hand hygiene: meaningless, harmful, or helpful?
14. Abstract: Update on hand hygiene
15. Abstract: The crucial role of wiping in decontamination of high-touch
environmental surfaces: review of current status and directions for
the future
16. Abstract: Evidence that contaminated surfaces contribute to the
transmission of hospital pathogens and an overview of strategies to
address contaminated surfaces in hospital settings
17. Abstract: New technologies and trends in sterilization and
disinfection
18. Abstract: Monitoring and improving the effectiveness of cleaning
medical and surgical devices
19. Abstract: Self-disinfecting surfaces: review of current methodologies
and future prospects
20. Abstract: Immediate use steam sterilization: moving beyond current
policy
21. Abstract: Best practices in disinfection of noncritical surfaces in
the health care setting: creating a bundle for success
22. Abstract: Disinfection and sterilization: an overview
23. Abstract: Psychological interventions for needle-related procedural
pain and distress in children and adolescents
24. News
– Nagaland India: HEPATITIS C: A public health threat
– Michagan USA: Nov. 26 hearing set for pharmacy – Attorney general eyes
possible charges
– Australia: Our hidden epidemic: hepatitis in Australia
– Romania: Counterfeit syringes with serum against hepatitis found in
drugstores in Romania, police starts investigation
– Wyoming USA: Hepatitis C Outbreak in Wyoming
– Wisconsin USA: Center: Need for needles, Narcan
– Central Asia: HIV ‘Wave’ Feared in Central Asia
– Washington USA: Local botulism case points to toxic heroin

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________________________________*_________________________________

1. Pakistan: The Sindh Disposable Syringe Act: putting the act together
__________________________________________________________________

http://www.jpma.org.pk/full_article_text.php?article_id=5196

The Sindh Disposable Syringe Act: putting the act together

http://www.jpma.org.pk/full_article_text.php?article_id=5196

JPMA Vol. 63, No. 11, November 2013

Arshad Altaf ( Bridge Consultants Foundation, Karachi, Pakistan. )
Sonali Vaid ( USAID Health Care Improvement Project, University Research
Company, Bethesda, USA. )

The World Health Organization (WHO) is concerned that conventional
disposable syringes are being widely reused and that this practice has
contributed to the spread of blood-borne infections, such as hepatitis B,
hepatitis C and HIV.Research has shown that unless a physical barrier to
syringe reuse is introduced, economic drivers and cultural resistance to
waste lead to continued reuse in developing countries, regardless of
training, advocacy and regulatory factors.1 One of the main means to
address syringe reuse has been the introduction of syringes with reuse
prevention features http://tinyurl.com/ogg2jtq or
http://qdsyringe.wordpress.com/2011/11/13/safe-syringes-for-injection-
safety/ . This includes the auto disable (AD) syringes in which the
plunger gets locked after it is used once and certain types of syringes in
which the plunger additionally breaks, preventing any possibility of
reuse. AD syringes are routinely used in the immunization sector
worldwide, and in many countries they are by law used in the curative
sector.

Pakistan has one of the highest prevalence of hepatitis B and C in the
world. The nationwide prevalence of hepatitis B is 2.5% and of hepatitis C
is 4.9%.2 A number of studies have closely linked reuse of disposable
syringes by healthcare providers with spread of hepatitis B and C in
Pakistan. Two recent studies which had established strong association with
spread of hepatitis C in particular because of reuse of syringes are
referenced in this commentary here.3,4 To address the spread of these
life- threatening illnesses and stop the reuse of single use disposable
syringes, the Sindh Government passed a bill to regulate the use of
disposable syringes in 2011.

According to the Provincial Assembly of Sindh Notification of 24th
February, 2011 (No.PAS/Legis-B-25/2010) “The Sindh Regulation and Control
of Disposable Syringe Bill, 2010 having been passed by the Provincial
Assembly of Sindh on 12th January, 2011 and assented by the Governor of
Sindh on 17thFebruary, 2011 is hereby published as an Act of the
Legislature of Sindh.” It is further mentioned in the notification as
“Sindh Act No: IV of 2011.” The full Act is available at
http://www.pas.gov.pk/uploads/acts/Sindh%20Act%20No.IV%20of%202011.pdf,
the official website of Provincial Assembly of Sindh. The main clause of
this Act states that “no person shall manufacture, sell or use disposable
syringes other than auto lock, auto destruct or auto break for injection,
drawing of blood and other purposes.” It goes on to state that “all
directors, managers, secretaries or agents shall follow this Act and those
contravening will be punished with imprisonment for a term that may extend
to two years or fine which may extend to five hundred thousand rupees
(approximately US$ 5000) or with both.”

Despite the current legislation regulating the use of AD syringes, we have
noted several gaps in the “Sindh Act No: IV of 2011.” The first and
foremost gap in this bill is its lack of implementation. We checked with
the Hepatitis Control Program of Sindh which itself is only using AD
syringes for vaccination and treatment purposes. But the main tertiary
hospitals of Karachiare still using conventional disposable syringes for
therapeutic purposes. The heads of these hospitals and/or procurement
departments are violating this law and can face jail terms or huge fines
if any person from a law enforcement agency makes a simple visit and
inquires about this issue. We are quite sure that these and other
healthcare providers in the province are not even aware that such a law
even exists in the province.

The second gap in the Act is about selling and manufacturing AD syringes.
While it mentions that no person shall manufacture or sell syringes other
than AD, the Act clearly misses a key requirement which is that the
syringe should be compliant with ISO (International Organization for
Standardization) Standard 7886-4 and that the manufacturer should comply
with ISO Quality Systems Standards for Medical Devices Manufacturing ISO
13485. ISO compliance is essential to ensure that accepted international
quality standards are met in the manufacturing of the AD syringes. As the
Act stands right now, any supplier or manufacturer can provide any type of
AD syringes, and no one can legally question its quality or standard of
manufacturing. A study was supported by the World Health Organization and
conducted in provincial capitals of Pakistan in 2003-4 to assess the
quality of syringes available in the local market. Syringes were purchased
from 30 randomly selected pharmacies in the four provincial capitals. A
check list based on the ISO 7886 standard was developed and used to assess
the quality of syringes. The study found that 34% of the syringes sold in
the main cities of Pakistan was substandard, a significant proportion by
any means.5
Finally, the most important missing link is the reuse of syringes by
healthcare providers. This is a nationwide practice which is wreaking
havoc in patients\’ lives. Trained and untrained providers prescribe
unnecessary injections and reuse syringes for economic reasons. The
patient is often unaware of the life-threatening effect of this practice.
The roll-out of AD syringes alone will not be sufficient if this gap is
not addressed. The locking mechanism of the AD syringe has to be manually
operated, meaning the user has to push the plunger completely with a
little force after using the syringe in order to disable it and prevent
further reuse. It is thus still possible for someone with the intention to
reuse the AD syringe to circumvent its safety feature by not pressing the
plunger fully. Currently there is no legal deterrent to prevent healthcare
providers from reusing needles and syringes. Making unsafe injection
practice illegal under such an Act would have been the most logical place
to address this issue. However, that opportunity has also been missed. No
law exists in the province or country right now which would hold
healthcare providers accountable for reuse of syringes and needles.

In conclusion, not only have the provisions of the Act not been
implemented at all,but the Act itself is not comprehensive enough and
overlooks key issues such as standards for AD syringes and reuse of
disposable needles and syringes. We all know that amending a law in
Pakistan is a daunting task. But this Act is critical to stopping the
scourge of Hepatitis B and C in the province. Prudent measures such as
forming a team of members of provincial assembly and technical public
health experts to address this issue should be the foremost priority of
Provincial Ministry of Health. However, efforts to amend the Act will be
meaningless if the law is not implemented and accountability for ensuring
implementation is not enforced. The problem of unsafe syringes and needles
needs to be addressed in a comprehensive manner with requisite technical
input from public health experts and in partnership with industry and
healthcare providers. This should include working with healthcare
establishments to ensure roll-out of AD syringes in the therapeutic sector
and with the injection manufacturing industry to ensure adequate
production to meet the needs at a feasible cost. We hope that the Sindh
Government will lead the country in being proactive and ensuring a
systematic process to strengthen the Sindh Regulation and Control of
Disposable Syringes Act, 2010 and in ensuring its implementation.

References
1. Lloyd JS, Milstien JB. Auto-disable syringes for immunization:Â issues
in technology transfer.  Bull World Health Organ 1999; 77: 1001-7.
2. Qureshi H, Bile KM, Jooma R, Alam SE, Afridi HU. Prevalence of
hepatitis B and C viral infections in Pakistan: findings of a national
survey for effective prevention and control measures. East Mediterr
Health J 2010; (16 Suppl): S15-S23.
3. Ver Hoeve E, Codlin AJ, Jawed F, Khan AJ, Samad L, Vatcheva KM, et al.
Persisting role of healthcare settings in hepatitis C transmission in
Pakistan: cause for concern. Epidemiol Infect 2013; 141: 1831-9.
4. Centers for Disease Control and Prevention (CDC). Establishment of a
viral hepatitis surveillance system – Pakistan, 2009-2011. MMWR Morb
Mortal Wkly Rep 2011; 60: 1385-90.
5. An Assessment of Quality of Syringes Available in Pakistan. External
Report Submitted to World Health Organization; 2004.
__________________________________________________________________
________________________________*_________________________________

2. New Website: International Association of Public Health Logisticians
__________________________________________________________________
International Association of Public Health Logisticians (IAPHL) ·

(11.11.13)

We are proud to announce IAPHL’s new & improved website at www.iaphl.org!

A few of the highlights of the new website include:

– A Resource Library for with easy-to-find technical briefs, guides, and
reports related to public health supply chain management.
http://iaphl.org/resource-library/

– The new IAPHL Blog summarizes discussions that have taken place on the
listserv, providing an easily searchable repository of past discussions
for easy reference. http://iaphl.org/resource-library/share-a-resource/

– Learn more about your fellow IAPHL members by visiting our membership
page. http://iaphl.org/membership/maps-and-stats/

– Stay up to date on News & Events happening in the supply chain world.
http://iaphl.org/news-events/
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Healthcare-associated infections in sub-Saharan Africa
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24209885

J Hosp Infect. 2013 Dec;85(4):257-67.

Healthcare-associated infections in sub-Saharan Africa.

Rothe C, Schlaich C, Thompson S.

University of Malawi, College of Medicine, Department of Medicine,
Blantyre, Malawi. Electronic address: camilla.rothe@web.de.

BACKGROUND: Healthcare-associated infections (HCAIs) are the most frequent
adverse consequences of healthcare worldwide, threatening the health of
both patients and healthcare workers (HCWs). The impact of HCAI is
particularly felt in resource-poor countries, with an already
overstretched health workforce and a high burden of community-acquired
infection.

AIM: To provide an overview of the current situation in sub-Saharan Africa
with regards to the spectrum of HCAI, antimicrobial resistance,
occupational exposure and infection prevention.

METHODS: We reviewed the literature published between 1995 and 2013 and
from other sources such as national and international agencies.

FINDINGS: Sparse data suggest that HCAIs are widespread in sub-Saharan
Africa, with surgical site being the dominant focus of infection.
Nosocomial transmission of multidrug-resistant tuberculosis is a
considerable concern, as is the prevalence of meticillin-resistant S.
aureus and resistant Enterobacteriaceae.

In HCWs, vaccination rates against vaccine- preventable occupational
hazards are low, as is reporting and subsequent human immunodeficiency
virus-testing after occupational exposure. HCWs have an increased risk of
tuberculosis relative to the general population. Compliance with hand
hygiene is highly variable within the region.

Injection safety in immunization programmes has improved over the past
decade, mainly due to the introduction of autodestruct syringes.

CONCLUSIONS: Despite the scarcity of data, the burden of HCAI in sub-
Saharan Africa appears to be high. There is evidence of some improvement
in infection prevention and control, though widespread surveillance data
are lacking. Overall, measures of infection prevention and occupational
safety are scarce. Copyright © 2013 The Healthcare Infection Society. All
rights reserved.

KEYWORDS: Antimicrobial resistance, Healthcare worker, Healthcare-
associated infection, Injection safety, Needlestick injury, Sub-Saharan
Africa
__________________________________________________________________
________________________________*_________________________________

4. Abstract:Incidence rate of needlestick and sharps injuries in 67
Japanese hospitals: a national surveillance study
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24204856

PLoS One. 2013 Oct 30;8(10):e77524.

Incidence rate of needlestick and sharps injuries in 67 Japanese
hospitals: a national surveillance study.

Yoshikawa T, Wada K, Lee JJ, Mitsuda T, Kidouchi K, Kurosu H, Morisawa Y,
Aminaka M, Okubo T, Kimura S, Moriya K.

Department of Research, The Institute for Science of Labour, Kawasaki,
Japan.

BACKGROUND: Determining incidence rates of needlestick and sharps injuries
(NSIs) using data from multiple hospitals may help hospitals to compare
their in- house data with national averages and thereby institute relevant
measures to minimize NSIs. We aimed to determine the incidence rate of
NSIs using the nationwide EPINet surveillance system.

METHODOLOGY/PRINCIPAL FINDINGS: Data were analyzed from 5,463 cases
collected between April 2009 and March 2011 from 67 Japanese HIV/AIDS
referral hospitals that participated in EPINet-Japan. The NSI incidence
rate was calculated as the annual number of cases with NSIs per 100
occupied beds, according to the demographic characteristics of the injured
person, place, timing, device, and the patients’ infectious status.

The NSI incidence rates according to hospital size were analyzed by a non-
parametric test of trend. The mean number of cases with NSIs per 100
occupied beds per year was 4.8 (95% confidence interval, 4.1-5.6) for 25
hospitals with 399 or fewer beds, 6.7 (5.9-7.4) for 24 hospitals with
400-799 beds, and 7.6 (6.7-8.5) for 18 hospitals with 800 or more beds (p-
trend<0.01).

NSIs frequently occurred in health care workers in their 20 s; the NSI
incidence rate for this age group was 2.1 (1.6-2.5) for hospitals having
399 or fewer beds, 3.5 (3.0-4.1) for hospitals with 400-799 beds, and 4.5
(3.9-5.0) for hospitals with 800 or more beds (p-trend<0.01).

CONCLUSIONS/SIGNIFICANCE: The incidence rate of NSIs tended to be higher
for larger hospitals and in workers aged less than 40 years; injury
occurrence was more likely to occur in places such as patient rooms and
operating rooms.

Application of the NSI incidence rates by hospital size, as a benchmark,
could allow individual hospitals to compare their NSI incidence rates with
those of other institutions, which could facilitate the development of
adequate control strategies.

Open Access: Full text [Free]
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0077524
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Pediatric Intramuscular Injections: Guidelines for Best
Practice
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24201242

MCN Am J Matern Child Nurs. 2013 Nov 6.

Pediatric Intramuscular Injections: Guidelines for Best Practice.

Kaniaris A.

Abigail Kaniaris is a Registered Nurse, Pediatric Meduflex Team, a Doctor
of Nursing Practice student, College of Nursing, The Medical University of
South Carolina, Charleston, SC. She can be reached via e-mail at
Kaniaris@musc.edu.

The administration of injections is a fundamental nursing skill; however,
it is not without risk. Children receive numerous vaccines, and pediatric
nurses administer the majority of these vaccines via the intramuscular
route, and thus must be knowledgeable about safe and evidence-based
immunization programs.

Nurses may not be aware of the potential consequences associated with poor
injection practices, and historically have relied on their basic nursing
training or the advice of colleagues as a substitute for newer evidence
about how to administer injections today.

Evidence-based nursing practice requires pediatric nurses to review
current literature to establish best practices and thus improved patient
outcomes.
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Occupational Exposure to Blood, Hepatitis B Vaccine Knowledge
and Uptake among Medical Students in Cameroon
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24200149

BMC Med Educ. 2013 Nov 8;13(1):148.

Occupational Exposure to Blood, Hepatitis B Vaccine Knowledge and Uptake
among Medical Students in Cameroon.

Noubiap JJ, Nansseu JR, Kengne KK, Tchokfe S, Agyingi LA.

BACKGROUND: Hepatitis B virus (HBV) is the most contagious blood borne
pathogen. The risk of occupational exposure to HBV among health care
workers is a major concern, especially medical trainees. In this study we
describe the knowledge of risk factors for HBV infection, history of
accidental exposure to blood, awareness of HBV vaccine and the vaccination
status among medical students in Cameroon.

Methods/Findings: A cross-sectional survey was carried out using an
anonymous self-administered questionnaire among 111 medical students.

Sixty-two (55.9%) had had at least one accidental exposure to blood since
the beginning of their medical training, with a median of 2 (IQR, 1-3)
exposures.

There was a good knowledge of the risk factors for HBV infection and
awareness of HBV vaccine among participants. However, only 20 (18%)
participants had completed the three doses of primary HBV vaccination.
Furthermore, only 2 of the 20 (10%) adequately vaccinated participants had
a post-vaccination test to confirm a good immune response and thus an
effective protection against HBV infection.

The main reason for not being vaccinated was lack of money to pay for the
vaccine (45.6%). Forty seven (42.3%) participants had been sensitized by
their training institutions about the importance of HBV vaccination. These
were more likely to be vaccinated compared to those who had not been
sensitized (p<0,001).

CONCLUSION: There is a high rate of accidental exposure to blood and a
very low HBV vaccination uptake in medical students in Cameroon, leading
to a high occupational risk of HBV infection. HBV vaccination should be
strongly recommended for medical students and the vaccine made available
free of charge at the beginning of their training.

Open Access from http://www.biomedcentral.com/1472-6920/13/148/abstract

or the complete article is available as a provisional PDF.
http://www.biomedcentral.com/content/pdf/1472-6920-13-148.pdf

The fully formatted PDF and HTML versions are in production.
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Decreasing central line infections and needlestick injury
rates: combining best practice and introducing a luer-activated
intravenous therapy system and antimicrobial intravenous connector
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23132085

J Infus Nurs. 2012 Nov-Dec;35(6):370-5.

Decreasing central line infections and needlestick injury rates: combining
best practice and introducing a luer-activated intravenous therapy system
and antimicrobial intravenous connector.

Charron K.

Regional Referral Center/Day Unit, University of Ottawa Heart Institute,
Ottawa, Ontario, Canada. kacharron@ottawahospital.on.ca

The purpose of this study was to evaluate the impact of practice and
intravenous (IV) therapy product changes on central line infections (CLIs)
and needlestick injuries.

Data were collected in 2009 and 2010 for 1 year before and after
implementation of practice and product changes. Statistical significance
was noted when comparing CLIs before and after implementation of an
antimicrobial IV connector.

The number of needlestick injuries also decreased by 12% during this time.

Study results support ongoing clinical practice monitoring and education
as well as the use of a luer-activated IV therapy system and an
antimicrobial IV connector.
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Hepatitis C avoidance in injection drug users: a typology of
possible protective practices
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24194855

PLoS One. 2013 Oct 23;8(10):e77038.

Hepatitis C avoidance in injection drug users: a typology of possible
protective practices.

McGowan C, Harris M, Rhodes T.

Department of Social and Environmental Health Research, London School of
Hygiene & Tropical Medicine, London, United Kingdom.

INTRODUCTION: Hepatitis C virus (HCV) represents a serious public health
concern. People who inject drugs (PWID) are at particular risk and nearly
half (45%) of PWID in England may be infected. HCV prevention
interventions have only had moderate impact on the prevalence of HCV in
this population. Using qualitative methods, we sought to detail the
protective practices potentially linked to HCV avoidance among PWID, and
explore the motivations for these.

METHODS: The study used a life history approach allowing participants to
detail their lived experience both before and during the course of their
injecting careers. Thirty-seven participants were recruited from drug
services in London, and from referrals within local injecting networks. A
baseline and follow-up in-depth qualitative interview was carried out with
each participant, and for half, a third interview was also undertaken. All
underwent testing for HCV antibody. Analyses focused on developing a
descriptive typology of protective practices potentially linked to HCV
avoidance.

RESULTS: Practices were deemed to be protective against HCV if they could
be expected a priori to reduce the number of overall injections and/or the
number of injections using shared injecting equipment. Participants
reported engaging in various protective practices which fell into three
categories identified through thematic analysis: principles about
injecting, preparedness, and flexibility.

CONCLUSIONS: All participants engaged in protective practices irrespective
of serostatus. It is important to consider the relative importance of
different motivations framing protective practices in order to formulate
harm reduction interventions which appeal to the situated concerns of
PWID, especially given that these protective practices may also help
protect against HIV and other blood borne infections.

Free full text
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0077038
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Cotton fever: an evanescent process mimicking sepsis in an
intravenous drug abuser
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23528959

J Emerg Med. 2013 Jun;44(6):e385-7.

Cotton fever: an evanescent process mimicking sepsis in an intravenous
drug abuser.

Torka P, Gill S.

Department of Internal Medicine, SUNY Upstate Medical University,
Syracuse, NY 13202, USA.

BACKGROUND: Although many complications of intravenous drug abuse are well
described, “cotton fever” has had little mention in recent medical
literature. Cotton fever is street terminology for the post-injection
fever experienced by many drug users after “shooting up” with heroin
reclaimed from a previously used cotton filter.

CASE REPORT: We report on a 22-year-old man with a history of intravenous
drug abuse with fever 30 min after injecting heroin. He was intensely
diaphoretic, tachycardic, and febrile. His workup was negative for any
infectious etiology and he later admitted to reusing the same cotton balls
for heroin filtration several times over in order to preserve more of the
drug.

CONCLUSIONS: Although it is usually a benign situation, cotton fever can
have a dramatic clinical and hematologic course. We present a typical case
of cotton fever followed by a description of the pathophysiology and
clinical presentation of this entity.

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

10. Abstract: Corticosteroid and platelet-rich plasma injection therapy in
tennis elbow (lateral epicondylalgia): a survey of current UK
specialist practice and a call for clinical guidelines
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24195919

Br J Sports Med. 2013 Nov 6. doi: 10.1136/bjsports-2013-092674.

Corticosteroid and platelet-rich plasma injection therapy in tennis elbow
(lateral epicondylalgia): a survey of current UK specialist practice and a
call for clinical guidelines.

Titchener AG, Booker SJ, Bhamber NS, Tambe AA, Clark DI.

Department of Trauma and Orthopaedics, Royal Derby Hospital, Derby, UK.

BACKGROUND: Tennis elbow is a common condition with a variety of treatment
options, but little is known about which of these options specialists
choose most commonly. Corticosteroid injections in tennis elbow may reduce
pain in the short-term but delay long-term recovery. We have undertaken a
UK-wide survey of upper limb specialists to assess current practice.

METHODS: Cross-sectional electronic survey of current members of the
British Elbow and Shoulder Society (BESS) and the British Society for
Surgery of the Hand (BSSH).

RESULTS: 271 of 1047 eligible members responded (25.9%); consultant
surgeons constituted the largest group (232/271, 85%). 131 respondents
(48%) use corticosteroid injections as their first-line treatment for
tennis elbow. 206 respondents (77%) believed that corticosteroid
injections are not potentially harmful in the treatment of tennis elbow,
while 31 (11%) did not use them in their current practice. In light of
recent evidence of the potential harmful effects of corticosteroid
therapy, 136 (50%) had not changed their practice while 108 (40.1%) had
reduced or discontinued their use. 43 respondents (16%) reported having
used platelet-rich plasma injections.

CONCLUSIONS: Recent high-quality evidence that corticosteroids may delay
recovery in tennis elbow appears to have had a limited effect on current
practice. Treatment is not uniform among specialists and a proportion of
them use platelet-rich plasma injections.

KEYWORDS: Tendons
__________________________________________________________________
________________________________*_________________________________

11. Abstract: Hepatitis B and C infection in international travelers
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23577866

J Travel Med. 2013 May-Jun;20(3):194-202.

Hepatitis B and C infection in international travelers.

Johnson DF, Leder K, Torresi J.

Department of Infectious Diseases, Austin Hospital, University of
Melbourne, Heidelberg, Victoria, Australia.

BACKGROUND: Hepatitis B and C virus (HBV and HCV) cause significant
morbidity and mortality worldwide. With the rise in international travel
over the last three decades, many travelers are at risk of HBV and HCV
infection.

METHODS: This review focuses on the epidemiology of HBV and HCV in
international travelers, the modes of transmission, and the prevention of
infection in travelers.

RESULTS: The risk of HBV and HCV infection varies widely and depends on
the prevalence of the destination country, the duration of travel, and the
activities undertaken while abroad. Travelers commonly undertake high-risk
activities that place them at risk of both HBV and HCV infection. Poor
uptake of preventative health measures and poor adherence to health
recommendations are also common.

The monthly incidence of HBV infection for long-term travelers to endemic
countries ranges from 25 to 420 per 100,000 travelers. HBV infection can
be prevented through timely vaccination of travelers. HBV vaccination is
safe and efficacious with protective levels of antibodies achieved in >90%
of recipients. Information regarding the risk of HCV acquisition is scarce
and until recently was limited to case reports following medical
interventions.

CONCLUSIONS: This review demonstrates international travelers are at risk
of HBV and HCV infection and provides evidence-based information enabling
health practitioners to provide more appropriate pre-travel advice. HBV
vaccination should be considered in all travelers to countries with a
moderate to high HBV prevalence (HBsAg = 2%) and the risk and benefits
discussed with the individuals in consultation with the health
practitioner.

There is no duration of travel without risk of HBV infection. However, it
is apparent that those travelers with a longer duration of travel are at
greatest risk of HBV infection (ie, expatriates).

Travelers should also receive advice regarding the modes of transmission
and the activities that place them at risk of both HBV and HCV infection.

© 2013 International Society of Travel Medicine.
__________________________________________________________________
________________________________*_________________________________

12. Abstract: Complications from toxins and fillers in the dermatology
clinic: recognition, prevention, and treatment
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24200384

Facial Plast Surg Clin North Am. 2013 Nov;21(4):663-73.

Complications from toxins and fillers in the dermatology clinic:
recognition, prevention, and treatment.

Dayan SH.

Chicago Center for Facial Plastic Surgery, Chicago, IL, USA; DeNova
Research, Chicago, IL, USA; Department of Otolaryngology, University of
Illinois at Chicago, Chicago, IL, USA. Electronic address:
SDayan@DrDayan.com.

Adverse reactions and unintended effects can occasionally occur with
toxins for cosmetic use, even although they generally have an outstanding
safety profile.

As the use of fillers becomes increasingly more common, adverse events can
be expected to increase as well.

This article discusses complication avoidance, addressing appropriate
training and proper injection techniques, along with patient selection and
patient considerations.

In addition to complications, avoidance or amelioration of common adverse
events is discussed.

Copyright © 2013 Elsevier Inc. All rights reserved.

KEYWORDS: Cosmetic surgery complications, Cosmetic surgery safety, Filler
complications, Toxin complications
__________________________________________________________________
________________________________*_________________________________

13. Abstract: Monitoring hand hygiene: meaningless, harmful, or helpful?
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23622747
Am J Infect Control. 2013 May;41(5 Suppl):S42-5.

Monitoring hand hygiene: meaningless, harmful, or helpful?

Larson E.

School of Nursing, and Professor of Epidemiology, Mailman School of Public
Health, Columbia University, New York, NY 10032, USA. Ell23@columbia.edu

Whereas monitoring adherence to hand hygiene (HH) guidelines is standard
practice in most acute care facilities, practice improvement has been
slow.

In hospitals primarily concerned with reputation, incentives to report
high HH rates may create negative consequences. Practice change will
require increased staff engagement and more sustainable methods to monitor
HH and provide feedback.

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

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

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

Update on hand hygiene.

Boyce JM.

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

Recent developments related to hand hygiene include new test methods for
evaluating hand hygiene products, improvements in alcohol-based hand rubs,
novel methods of hand antisepsis, and new strategies and technologies for
monitoring hand hygiene practices among health care personnel.
Copyright © 2013 Association for Professionals in Infection Control and
Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

15. Abstract: The crucial role of wiping in decontamination of high-touch
environmental surfaces: review of current status and directions for
the future
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23622759

Am J Infect Control. 2013 May;41(5 Suppl):S97-104.

The crucial role of wiping in decontamination of high-touch environmental
surfaces: review of current status and directions for the future.

Sattar SA, Maillard JY.

Centre for Research on Environmental Microbiology, Faculty of Medicine,
University of Ottawa, Ottawa, Ontario, Canada. ssattar@uottawa.ca

The testing and label claims of disinfectants to wipe high-touch
environmental surfaces rarely reflect their field use where contact times
are in seconds with only microliters of the disinfectant deposited on a
unit surface area.

Therefore, such products must be properly assessed with
mechanical/chemical action combined.

We critically review current wipe test methods and propose future
approaches.

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

16. Abstract: Evidence that contaminated surfaces contribute to the
transmission of hospital pathogens and an overview of strategies to
address contaminated surfaces in hospital settings
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23622751

Am J Infect Control. 2013 May;41(5 Suppl):S6-11.

Evidence that contaminated surfaces contribute to the transmission of
hospital pathogens and an overview of strategies to address contaminated
surfaces in hospital settings.

Otter JA, Yezli S, Salkeld JA, French GL.

Centre for Clinical Infection and Diagnostics Research, Department of
Infectious Diseases, King’s College London & Guy’s and St Thomas’ NHS
Foundation Trust, London, UK. jonathan.otter@kcl.ac.uk

Evidence that contaminated surfaces contribute to the transmission of
hospital pathogens comes from studies modeling transmission routes,
microbiologic studies, observational epidemiologic studies, intervention
studies, and outbreak reports.

This review presents evidence that contaminated surfaces contribute to
transmission and discusses the various strategies currently available to
address environmental contamination in hospitals.

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

17. Abstract: New technologies and trends in sterilization and
disinfection
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23622756

Am J Infect Control. 2013 May;41(5 Suppl):S81-6.

New technologies and trends in sterilization and disinfection.

Schneider PM.

LexaMed, Toledo, OH 43605, USA. pmschneider11@yahoo.com

Continued improvements in low-temperature sterilization systems have
resulted in reduced processing times and expanded capabilities for
instrument reprocessing.

As the relationship of environmental surface contamination and health
care-associated infections has become more defined, area disinfection
systems and antimicrobial surface technologies have emerged as new
strategies for disinfection of surfaces.

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

18. Abstract: Monitoring and improving the effectiveness of cleaning
medical and surgical devices
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23622750

Am J Infect Control. 2013 May;41(5 Suppl):S56-9.

Monitoring and improving the effectiveness of cleaning medical and
surgical devices.

Alfa MJ.

Diagnostic Services of Manitoba, and the University of Manitoba, Winnipeg,
MB, Canada. malfa@dsmanitoba.ca

The overall risk of infection from medical devices is very low, but high
infection transmission rates have been related to inadequate reprocessing
of arthroscopic shavers and flexible duodenoscopes.

Monitoring of manual and automated cleaning is needed to ensure that
inadequately cleaned medical devices are recleaned prior to disinfection
or sterilization.

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

19. Abstract: Self-disinfecting surfaces: review of current methodologies
and future prospects
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23622745

Am J Infect Control. 2013 May;41(5 Suppl):S31-5.

Self-disinfecting surfaces: review of current methodologies and future
prospects.

Weber DJ, Rutala WA.

Department of Medicine, University of North Carolina at Chapel Hill,
Chapel Hill, NC, USA. dweber@unch.unc.edu

Methods to improve disinfection of environmental surfaces in hospital
rooms include improving cleaning/disinfection by environmental service
workers through education and feedback on cleaning effectiveness (eg, use
of fluorescent dyes), “no-touch” methods (eg, UV-C light), and self-
disinfecting surfaces.

Self-disinfecting surfaces can be created by impregnating or coating
surfaces with heavy metals (eg, silver or copper), germicides (eg,
triclosan), or miscellaneous methods (eg, light-activated antimicrobials).

These methods are under active investigation but to date have not been
assessed for their ability to reduce health care-associated infections.

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

20. Abstract: Immediate use steam sterilization: moving beyond current
policy
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23622748

Am J Infect Control. 2013 May;41(5 Suppl):S46-8.

Immediate use steam sterilization: moving beyond current policy.

Seavey R.

Seavey Healthcare Consulting, LLC, Arvada, CO 80002, USA.
rose@seaveyhealthcareconsulting.com

Immediate-use steam sterilization (IUSS) is steam sterilization intended
for immediate use. IUSS may cause an increased risk of infection to
patients because of stress and time constraints placed on staff.

When IUSS is used, it is vital to properly carry out the complete
multistep process according to the manufacturer’s written validated
instructions for use.

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

21. Abstract: Best practices in disinfection of noncritical surfaces in
the health care setting: creating a bundle for success
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23622744
Am J Infect Control. 2013 May;41(5 Suppl):S26-30.

Best practices in disinfection of noncritical surfaces in the health care
setting: creating a bundle for success.

Havill NL.

Quality Improvement Support Services, Yale New Haven Hospital, New Haven,
CT, USA. Nancy.Havill@ynhh.org

Because increasing evidence suggests that the environment plays a role in
transmission of health care-associated infections, more attention is
focusing on environmental cleaning and improving its efficacy.

Creating and sustaining a successful cleaning and disinfection program
should include several key components using a bundle approach and requires
ongoing commitment within the institution.

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

22. Abstract: Disinfection and sterilization: an overview
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23622742

Am J Infect Control. 2013 May;41(5 Suppl):S2-5.

Disinfection and sterilization: an overview.

Rutala WA, Weber DJ.

Hospital Epidemiology, University of North Carolina Health Care System,
Chapel Hill, NC 27599-7030, USA. brutala@unch.unc.edu

All invasive procedures involve contact by a medical device or surgical
instrument with a patient’s sterile tissue or mucous membranes.

The level of disinfection or sterilization is dependent on the intended
use of the object: critical (items that contact sterile tissue such as
surgical instruments), semicritical (items that contact mucous membrane
such as endoscopes), and noncritical (devices that contact only intact
skin such as stethoscopes) items require sterilization, high-level
disinfection, and low-level disinfection, respectively.

Cleaning must always precede high- level disinfection and sterilization.

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

23. Abstract: Psychological interventions for needle-related procedural
pain and distress in children and adolescents
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24108531

Cochrane Database Syst Rev. 2013 Oct 10;10:CD005179.

Psychological interventions for needle-related procedural pain and
distress in children and adolescents.

Uman LS, Birnie KA, Noel M, Parker JA, Chambers CT, McGrath PJ, Kisely SR.

IWK Health Centre & Dalhousie University, Halifax, Nova Scotia, Canada.

BACKGROUND: This review is an updated version of the original Cochrane
review published in Issue 4, 2006. Needle-related procedures are a common
source of pain and distress for children. Our previous review on this
topic indicated that a number of psychological interventions were
efficacious in managing pediatric needle pain, including distraction,
hypnosis, and combined cognitive behavioural interventions. Considerable
additional research in the area has been published since that time.

OBJECTIVES: To provide an update to our 2006 review assessing the efficacy
of psychological interventions for needle-related procedural pain and
distress in children and adolescents.

SEARCH METHODS: Searches of the following databases were conducted for
relevant randomized controlled trials (RCTs): Cochrane Central Register of
Controlled Trials (CENTRAL); MEDLINE; EMBASE; PsycINFO; the Cumulative
Index to Nursing and Allied Health Literature (CINAHL); and Web of
Science. Requests for relevant studies were also posted on various
electronic list servers. We ran an updated search in March 2012, and again
in March 2013.

SELECTION CRITERIA: Participants included children and adolescents aged
two to 19 years undergoing needle-related procedures. Only RCTs with at
least five participants in each study arm comparing a psychological
intervention group with a control or comparison group were eligible for
inclusion.

DATA COLLECTION AND ANALYSIS: Two review authors extracted data and
assessed trial quality and a third author helped with data extraction and
coding for one non-English study. Included studies were coded for quality
using the Cochrane Risk of bias tool. Standardized mean differences with
95% confidence intervals were computed for all analyses using Review
Manager 5.2 software.

MAIN RESULTS: Thirty-nine trials with 3394 participants were included. The
most commonly studied needle procedures were venipuncture, intravenous
(IV) line insertion, and immunization. Studies included children aged two
to 19 years, with the most evidence available for children under 12 years
of age. Consistent with the original review, the most commonly studied
psychological interventions for needle procedures were distraction,
hypnosis, and cognitive behavioural therapy (CBT).

The majority of included studies (19 of 39) examined distraction only. The
additional studies from this review update continued to provide strong
evidence for the efficacy of distraction and hypnosis.

No evidence was available to support the efficacy of preparation and
information, combined CBT (at least two or more cognitive or behavioural
strategies combined), parent coaching plus distraction, suggestion, or
virtual reality for reducing children’s pain and distress.

No conclusions could be drawn about interventions of memory alteration,
parent positioning plus distraction, blowing out air, or distraction plus
suggestion, as evidence was available from single studies only.

In addition, the Risk of bias scores indicated several domains with high
or unclear bias scores (for example, selection, detection, and performance
bias) suggesting that the methodological rigour and reporting of RCTs of
psychological interventions continue to have considerable room for
improvement.

AUTHORS’ CONCLUSIONS: Overall, there is strong evidence supporting the
efficacy of distraction and hypnosis for needle-related pain and distress
in children and adolescents, with no evidence currently available for
preparation and information or both, combined CBT, parent coaching plus
distraction, suggestion, or virtual reality.

Additional research is needed to further assess interventions that have
only been investigated in one RCT to date (that is, memory alteration,
parent positioning plus distraction, blowing out air, and distraction plus
suggestion). There are continuing issues with the quality of trials
examining psychological interventions for needle-related pain and
distress.
__________________________________________________________________
________________________________*_________________________________

24. News

– Nagaland India: HEPATITIS C: A public health threat
– Michagan USA: Nov. 26 hearing set for pharmacy – Attorney general eyes
possible charges
– Australia: Our hidden epidemic: hepatitis in Australia
– Romania: Counterfeit syringes with serum against hepatitis found in
drugstores in Romania, police starts investigation
– Wyoming USA: Hepatitis C Outbreak in Wyoming
– Wisconsin USA: Center: Need for needles, Narcan
– Central Asia: HIV ‘Wave’ Feared in Central Asia
– Washington USA: Local botulism case points to toxic heroin

Selected news items reprinted under the fair use doctrine of international
copyright law: http://www4.law.cornell.edu/uscode/17/107.html
__________________________________________________________________
http://www.morungexpress.com/frontpage/106496.html

Nagaland India: HEPATITIS C: A public health threat

MorungExpress, India, Kohima (12.11.13)

‘If this situation is not addressed now, there will be a huge burden on
healthcare’

The prevalence rate of Hepatitis C among people who inject drugs in
Nagaland is 20.8 percent, as documented by the Indian Council of Medical
Research (ICMR), through the Integrated Bio-Behavioral Assessment study.
“If this situation is not addressed now, there will be a huge burden on
healthcare in the years to come,” stated Abou Mere, Convenor of NepCoN
during the culmination programme of the Hepatitis C signature campaign at
DUDA Guest House, Kohima on November 12. The event was conducted by the
Kohima Users Network (KUN) along with HepCoN.

Commissioner and Secretary for Health and Family Welfare, Sentiyanger,
stressed on the need to spread Hepatitis C awareness, particularly in the
villages. He further called for KUN and HepCoN to immediately write to the
project director, Nagaland State AIDS Control Society, so that it would be
one of the agendas in the next meeting.

Sharing the overview of the signature campaign, Ketholelie Angami informed
that the Integrated Bio-Behavioral Assessment (IBBA Round 1 and 2) done by
the ICMR showed an increasing trend of HCV among Injecting Drug Users
(IDUs) from Phek and Wokha (5.4% to 8.7% and 16.7% to 20.8 %
respectively.)

However, he stated, in recent years, not much has been done by the state
government, civil organizations nor the NGOs working in the field of
HIV/AIDS and other health sectors, whereas the epidemic continues to
spread rapidly and at an alarmingly rate.

He said that the signature campaign, which started on September 14, aims
to provide information on how Hepatitis C Virus (HCV) is transmitted. HCV
is transmitted through contact with an infected person’s blood while
sharing razor or toothbrush, sharing needles/syringes and other injecting
paraphernalia with someone infected with Hepatitis C, having unprotected
sex with someone with Hepatitis C, accidental prick by a needle infected
with Hepatitis C, skin piercing, tattoo (with contaminated ink or needle),
receiving infected blood products for hemophilia, receiving unscreened
blood & blood product etc.

The objective is to educate the people who use drugs (PUDs) on HCV by
reaching out to them at the various IDU intervention projects and service
providers. He added that the drop-in-centre serves as a hub for many IDUs
to congregate and where optimum information of HCV can be imparted with
minimal resource utility.

Hepatitis C is curable and the treatment lasts from 6 months to 1 year.
However, people continue to die because the treatment is very expensive
and the diagnostics for screening and monitoring the treatment is not
accessible. Abou Mere stated that the central and state government has not
responded to the epidemic as yet.

Mere informed that government employees can claim reimbursement for the
treatment of Hepatitis C; however, people without government employment
continue to die because they cannot afford or access the medicines. He
appreciated the initiative of Naga Hospital Authority Kohima in
collaboration with Merck to provide free diagnostics and preferential
pricing for the treatment of the infection. “Yet, even the so called
preferential pricing is out of question for many Nagas, especially from
marginalized community like people living with HIV or people who use
drugs. They have no option but to accept that they will have to live and
die with Hepatitis C,” he said.

He urged the Commissioner of Health, medical doctor’s fraternity, civil
society and community activist to work together, recognize Hepatitis C as
a public health threat to Naga society and work towards access to
treatment and further reduction of pegylated interferon- which is
considered as the current standard of care.
__________________________________________________________________
__________________________________________________________________
http://tinyurl.com/n2za573

Michagan USA: Nov. 26 hearing set for pharmacy – Attorney general eyes
possible charges

by Christopher Behnan, Livingston Daily, Daily Press & Argus (12.11.13)

An administrative law judge this month will determine whether a South Lyon
business illegally mass-produced compounded drugs for hospitals and
clinics.

State Attorney General Bill Schuette last month obtained the suspension of
Specialty Medicine Compounding Pharmacy’s license after fungi were
discovered in one of its injected products at Henry Ford Hospital in
Detroit.

A Nov. 26 hearing in Detroit will determine whether the license
suspensions of the pharmacy and pharmacist-owner Kenny Walkup Jr. will be
rescinded or stay in place. The state Pharmacy Disciplinary Subcommittee
will make a final ruling based on the judge’s recommendation.

Schuette alleges the pharmacy “acted as a drug manufacturer by
distributing large amounts of medication” to Michigan hospitals and
clinics.

Walkup was only licensed to fill individual prescriptions for Michigan
patients, Schuette maintains.

The formal complaint against the pharmacy and Walkup claims none of the
compounded drugs were prepared based on individual prescriptions.

“It appears medications were prepared in bulk without appropriate
labeling. Furthermore, the sterility of respondent’s facility is called
into question based on the contaminated product produced,” the complaint
states.

Schuette’s spokeswoman Joy Yearout said the drug manufacturing allegation
will be proven as the case is processed.

Compounding pharmacies combine two or more drug elements for individual
patients and are overseen by state boards of pharmacy, rather than the
U.S. Food and Drug Administration.

A spokesman for the business wouldn’t say whether the pharmacy delivers
shipments of compounded drugs to facilities or strictly fills
prescriptions for individual patients.

“Due to the state’s pending licensing action, Specialty Medicine
Compounding Pharmacy cannot comment on the allegations made by the
attorney general at this point. However, the pharmacy will respond to the
attorney general in its formal filings in the course of the administrative
action,” said David Ball, spokesman for the pharmacy

“Given that this is an open licensing issue with the state, the pharmacy
is not going to comment further at this time,” Ball added.

Schuette is separately reviewing possible charges against the pharmacy for
dispensing two contaminated vials of D50, a dextrose-based intravenous
solution, to the Detroit hospital and possibly other hospitals and
clinics.

A Henry Ford pharmacy technician discovered fungal contamination in two
vials. Tests showed one vial had penicillium fungus and another contained
aspergillus fungus.

Penicillium, which in some cases produces the antibiotic penicillin,
rarely causes illness. The identity of the penicillium species in D50 has
not been identified, Henry Ford officials said.

Aspergillus is known to occasionally cause illness, especially in those
with weakened immune systems.

No cases of illness have been reported.

“Further investigation is being done by the state into the issue of
contaminated products,” Yearout said.

Once the contamination was discovered, the South Lyon pharmacy recalled
its other sterile products, none of which were believed to be
contaminated.

A similar manufacturing allegation has been made by Schuette against New
England Compounding Center for shipping tainted products across state
lines into Michigan, resulting in 264 cases of illness, including 19
deaths.

A 13-member grand jury, which includes four Livingston County members,
will determine whether the NECC violated state law by selling or
manufacturing an “adulterated drug.”

NECC, like the South Lyon pharmacy, was not licensed to manufacture drugs,
__________________________________________________________________
__________________________________________________________________
http://tinyurl.com/la6au8f

Australia: Our hidden epidemic: hepatitis in Australia

By Serkan Ozturk, Star Observer, Australia(10.11.13)

Nearly half of the estimated 207,000 people living with chronic hepatitis
B in Australia continue to remain undiagnosed while 15 percent of people
living with chronic hepatitis C in Australia have not yet been diagnosed,
according to official figures released late last month.

The statistics were revealed in the Kirby Institute’s Annual Surveillance
Report 2013 released at the Australasian HIV&AIDS Conference in Darwin on
October 21.

The report found that almost 400 deaths in 2012 were related to hepatitis
B-related liver disease despite the rate of diagnosis of newly acquired
hepatitis B infection declining among those aged 30 years or older as well
as reducing substantially among people aged 15 -29 since 2003. In 2012,
NSW had the highest number of diagnoses of hepatitis B infection, with
34.7 percent of the national total.

Hepatitis NSW CEO, Stuart Loveday, said if not diagnosed and managed
properly, hepatitis B infection can lead to cirrhosis, liver cancer or
liver failure.

“Deaths from primary liver cancer are climbing faster than any other cause
of cancer death in Australia and untreated chronic hepatitis B is a major
contributor,” Loveday said.

“An estimated 383 deaths in 2012 were attributable to hepatitis B-related
liver disease.

“It is important to remember that many people with hepatitis B don’t
experience any symptoms at all so getting tested is critical.”

Professor of Gastroenterology and Hepatology at Australian National
University, Narci Teoh, said treatments currently available for hepatitis
B were highly effective, well tolerated and very simple to administer.

“We can tailor and individualise those treatments to people,” Professor
Teoh said.

“It is critical for people with hepatitis B to be informed and start a
conversation with their doctor in order to understand what this virus does
and how to look after themselves and their liver.”

Loveday said vaccination was the simplest way to prevent contracting
hepatitis B.

“While most children born in Australia have been vaccinated, if you think
you might be at risk of contracting hepatitis B, consult your doctor about
getting vaccinated,” he said.

The Annual Surveillance Report also found that an estimated 310,000 people
living in Australia in 2012 had been exposed to hepatitis C with it
thought 173,500 had chronic hepatitis C infection and early liver disease,
51,500 had chronic hepatitis C infection and moderate liver disease and
6,500 were living with hepatitis C related cirrhosis.

The other 80,000 people believed to have to have been exposed have cleared
their infection.

The Kirby Institute estimates that almost 80 percent of all infections for
hepatitis C occur among people who inject drugs, with only one percent of
those people currently receiving treatment. Unlike other types of
hepatitis, there is currently no vaccine to prevent hepatitis C and
medication is the only way to manage the disease.

In February, the previous Labor federal government announced it will
provide more than $220 million over five years to subsidise hepatitis C
medications boceprevir (Victrelis) and telaprevir (Incivo) through the
Pharmaceutical Benefits Scheme (PBS).?It is believed that 10-15 percent of
all people living with HIV in Australia may also have hepatitis C and that
co-infection remains a serious issue.

© Star Observer 2013
__________________________________________________________________
__________________________________________________________________
http://tinyurl.com/jwa8cxj

Romania: Counterfeit syringes with serum against hepatitis found in
drugstores in Romania, police starts investigation

by Irina Popescu, romania-insider.com, Romania (08.11.13)

The Romanian police, together with the National agency for Medicines (ANM)
have started an investigation after counterfeit syringes with serum
against hepatitis were found in three drugstores in Romania.

Two of the drugstores are located in Pitesti, while the third one is in
Ialomita country, Police sources told local news agency Mediafax.

“We’re talking about the Pegasys medicine. There were found dozens of
boxes containing syringes, which are bad fakes,” Mediafax reports, quoting
sources from the investigation.

“The serum is actually water mixed with glucose, instead of the solution
of active substance peginterferon alfa-2a, while the syringes are made of
plastic and have white pistons, although the originals are made of glass
with red pistons”.

The Romanian ministry of Health recommends patients using Pegasys to
immediately see their doctors if they’ve purchased the medicine in the
last two weeks.

The investigation started following complaints received from patients.

Roche Romania, the company that sells the medicine, said it informed the
National Agency of Medicine in September about a counterfeit box of
Pegasys found in Germany.
__________________________________________________________________
__________________________________________________________________
http://www.kulr8.com/story/23910220/hepatitis-c-outbreak-in-wyoming

Wyoming USA: Hepatitis C Outbreak in Wyoming

By Alan Wagmeister, KULR 8 News, Wyoming USA (08.11.13)

POWELL, WYOMING – Northern Wyoming is dealing with an outbreak of
Hepatitis C.

KULR 8’s Penny Preston was in Powell to find out what officials believe
may be the cause.

Hepatitis C, an incurable and sometimes fatal disease which affects the
liver, is on the rise in Powell and Cody Wyoming.

“The yellow line here are the Wyoming rates. They stayed pretty
consistent. And the blue line are the Park County rates,” says Ashley
Grajczyk of the Wyoming Health Department.

The line goes off the chart. Wyoming Health Department representative
Ashley Grajczyk says the number of cases in Park County tripled from 2011
to 2012. In 2012, they were double the state rate.

Furthermore, the disease is showing up primarily in people 30 years and
younger. How is Hepatitis C transmitted from one person to another? In
Park County, mostly injected drug use.

“We’re talking about Hepatitis C here, but in reality it is at risk kids
15 to 30 who are doing all kinds of things maybe we don’t want to
acknowledge, or we know about, or don’t know what to do about,” says Bill
Crampton, Park County Public Health.

The health officials pointed out the people who are getting the disease
are most often uninsured, as well. So they asked the members of the Park
County health coalition to help them find a doctor, hospital, or clinic
that would take on the expensive testing and treatment.

They also discussed possible solutions, including clean needle exchanges,
but that is illegal in Wyoming. Park County Attorney Bryan Skoric has long
campaigned against prescription drug abuse and does not support clean
needle exchanges.

“I’d say we’re seeing more drug use. Certainly. Do we believe more people
are injecting legal controlled substances, i.e. pills they obtain from
physicians more? Yes, we believe that is happening,” says Bryan Skoric,
Park County Attorney. Skoric says doctors are prescribing too many pain
killers. “In my opinion, the state’s not doing enough to address that.”

Skoric thinks the lawmakers should compel doctors to check patient records
for doctor shopping. Until something changes here, drug abuse will have
more than intended consequences. From Powell, Penny Preston, KULR 8 News.

Health officials also noted an increase in Hepatitis C cases in Natrona
County, but chalked that up to better reporting.
__________________________________________________________________
__________________________________________________________________
Wisconsin USA: Center: Need for needles, Narcan

By Anne Jungen, La Crosse Tribune, Wisconsin USA (08.11.13)

A nonprofit organization in La Crosse has distributed 74,424 clean needles
to drug users so far this year.

While criticized as enabling drug use, the needle-exchange program at the
AIDS Resource Center is the most effective prevention against the spread
of HIV and Hepatitis C, prevention supervisor Laura Runchey told La Crosse
County’s Heroin and Illicit Drug Task Force on Thursday.

“The needle exchange does not encourage drug use,” she said.

Users picked up more than 1.5 million needles statewide in 2011 and about
2 million last year, Runchey said.

The numbers in La Crosse are climbing, with the local center providing
68,765 needles to anonymous users last year, a 510 percent hike from 2008.

While users are supposed to exchange needles, La Crosse firefighters are
cleaning up dirty needles from city stairwells, including in the
department’s training tower on Isle La Plume, fire Chief Gregg Cleveland
said.

“We’ve picked them up in front of schools,” he said.

The AIDS Resource Center also teaches users how to respond to an overdose
and administer Narcan, the antidote to a heroin overdose. Those who
complete the program get a prescription for five doses, which the center
obtains for 50 cents each.

The center trained 30 people in 2011, 44 in 2012 and 43 people this year.
They reported using Narcan 15 times in 2011, 26 times in 2012 and 32 times
already this year, center officials said.

Eighty-five percent of drug overdoses have witnesses, said Scott Stokes,
the agency’s director of prevention.

Equipping more people with Narcan “is a huge opportunity to respond to
people who find themselves in trouble,” Stokes said.

“And drug users will respond,” he said.

The city has had three heroin deaths this year, down from 10 in 2012 and
eight in 2011, La Crosse police Lt. Dan Kloss said.

“I think that’s because of the Narcan use,” he said.

But cost of the highly effective drug is expected to skyrocket next year,
Stokes said.

The AIDS Resources Center supports pending legislation that grants limited
immunity to those who alert authorities to an overdose.

“Drug users are afraid to call 911,” Stokes said. “They’re afraid they’re
going to be arrested.”

The reality is drug overdose investigations are complex and time-
consuming, Kloss said. Witnesses are reluctant to work with police and
often aren’t credible, he said. One case could take an investigator up to
10 days’ worth of work.
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http://www.ipsnews.net/2013/11/hiv-wave-feared-in-central-asia/

Central Asia: HIV ‘Wave’ Feared in Central Asia

By Pavol Stracansky, IPS Inter Press Service, Italy (04.11.13)

MOSCOW, Nov 4 2013 (IPS) – Healthcare systems in Eastern Europe and
Central Asia remain woefully unable to cope with HIV/AIDS as the region’s
raging epidemic – the fastest growing in the world – takes on a new
dimension, a senior UN official has told IPS.

Until now the Eastern Europe and Central Asia (EECA) epidemic had been
driven by injection drug use. But data and anecdotal evidence has shown a
strong rise in the spread of the disease through heterosexual transmission
as well as via men who have sex with men – potentially throwing up a new
set of challenges for governments and healthcare ministers.

But, says the UN Secretary General’s Special Envoy on HIV/AIDS in Eastern
Europe and Central Asia, Michel Kazatchkine, until a new approach to
treating the disease is taken in countries worst affected by it, the
response to the epidemic will continue to be poor and largely ineffective.

“In some countries it will probably take a wave of deaths, or the death of
someone famous or a prominent member of the Church for anything to
change.”

He told IPS: “HIV/AIDS in Eastern Europe and Central Asia needs to be
taken out of the medical ghetto which it is in at the moment.

“Regardless of whether it is driven by heterosexual transmission or drug-
injection, I am afraid that until the disease gets visibility and health
systems get geared up to take it on, it will not be dealt with properly.
In some countries it will probably take a wave of deaths, or the death of
someone famous or a prominent member of the Church for anything to
change.”

For many years Eastern Europe and Central Asia has had the world’s fastest
growing HIV/AIDS epidemic. The estimated number of people with HIV has
grown by 140 percent in the past ten years, according to UN figures.
Russia has 70 percent of all people living with HIV in the region and
together with the Ukraine accounts for 90 percent of the region’s HIV
infection cases.

The epidemic remains primarily linked with injection drug use with over 35
percent of case reports in the region associated with drug use.

But in the last five years, there has been a marked increase in
heterosexual transmission which now accounts for 30 percent of reported
cases, according to Kazatchkine. Much of this is believed to be between
male drug users and women.

However, the exposure route of 40 percent of infections in the region is
classified as ‘unknown’. It is thought that most of these are among men
who have sex with men.

Discrimination, persecution and stigmatisation of homosexuals, drug users
and people with HIV/AIDS means that it is impossible to collect accurate
data on the spread of the disease.

Gay men are often fearful of admitting to doctors how they became infected
and instead say that they contracted it through heterosexual sex. Drug
users, who can face long prison sentences in some countries in the region,
do the same.

Recent legislation banning the promotion of same sex partnerships and
long-standing travel restrictions in some parts of the region for people
with HIV have only further marginalised groups in which the disease is
spreading rapidly.

This presents a major problem in effectively dealing with the epidemic,
say doctors, as it adds to existing barriers to the prevention and
treatment of the disease.

Prof. Jens Lundgren of the European Aids Clinical Society (EACS) told IPS:

“What we know is that any policies, anywhere in the world, which are
introduced and which marginalise or stigmatise people with HIV are
counter-productive to treating the disease.

“A good, rational health policy is one that involves a clear view of a
disease’s epidemiology – where, in what communities and how it is being
spread.”

This comes on top of what has been repeatedly criticised by international
bodies as a continuingly poor healthcare response to the disease in many
countries.

Access to anti-retroviral treatment is very low – with as little as eight
percent of all those in need of it being able to obtain it in Russia, for
example.

Systematic care of those diagnosed with the disease is also inadequate.

“One of the problems in Russia is that there is no integration of a
patient with HIV into the primary health care system,” said Kazatchkine.
“When someone is diagnosed they are simply referred to a special centre
and passed on. It is as if they are something to be got rid of. No one
follows up on them and they are essentially forgotten.”

There are fears that news of the changing nature of the epidemic’s spread
could be used by some authorities to push their own political agendas on
how to deal with the epidemic.

International bodies have urged countries in the region to adopt harm
reduction programmes, including needle exchanges and drug substitution
therapy, which are recommended best practice in the West as a front-line
measure to help prevent the spread of the disease.

While some countries, notably the Ukraine, have had some success in
rolling out these programmes and helping bring down new infection rates,
others, such as Russia, are apathetic or even hostile to harm reduction.

Drug substitution therapy is illegal in Russia as political and medical
authorities refuse to sanction it and there are no state needle exchange
programmes.

The vast majority of funding for prevention programmes has come from
foreign organisations, but some of these have left the country as its
regime has become more authoritarian.

Some of the few organisations in Russia offering harm reduction services,
such as the Humanitarian Action NGO in St Petersburg, have told IPS of the
problems drug users face in accessing harm reduction programmes and of the
difficulties they have in providing them, from almost absent funding to
hostile police and societal attitudes.

That the disease is being spread more and more by sexual behaviour could
provide ammunition to those who argue harm reduction programmes are a
waste of resources.

“There are some authorities in the region which take every opportunity to
use something that takes attention away from the need for continued harm
reduction strategies and programmes and I fear the fact there is a rising
heterosexual spread of the disease could be instrumentalised to attack
harm reduction programmes among drug users,” Kazatchkine told IPS.

This would further hamper efforts to combat the epidemic as injection drug
use is expected to remain the main route of transmission of HIV in the
region for some time to come.

“There will continue to be an increase in sexual transmission while the
epidemic among drug users will not slow down,” said Kazatchkine.
__________________________________________________________________
__________________________________________________________________
http://tinyurl.com/l4e3vp2

Washington USA: Local botulism case points to toxic heroin

by Jefferson Robbins, Wenatchee World, Washington USA (04.11.13)

WENATCHEE — A patient was diagnosed in a Chelan County hospital with wound
botulism, a paralyzing toxic reaction believed to derive from injecting
tainted heroin.

Chelan-Douglas Health District spokeswoman Mary Small said her agency was
alerted Wednesday to the botulin poisoning, which poses no wider risk to
the general public. The health district gave notice of the health case
Thursday to local health providers and police, in case more such
poisonings emerge, Small said.

“We just wanted to put out an awareness to people who provide service and
work with people who are using drugs,” she said.

Botulism is a potentially fatal bacteria-related poisoning that can occur
from eating tainted food or, in the case of wound botulism, introducing
botulin-producing bacteria through the skin. It is not communicable from
person to person.

Small could not give the name of the patient due to federal privacy laws,
and did not know the patient’s condition. She said a photograph
distributed with her alert, which shows a patient’s bare legs with several
open sores, was meant as illustration and was not a photo of the Chelan
County victim. Open sores are associated with IV drug injection but are
not necessarily a symptom of botulin poisoning.

Early symptoms of botulism — presenting anywhere from one day to two weeks
after exposure — include weakness and drooping eyelids, blurred or double
vision, extreme dry mouth and sore throat, trouble swallowing or speaking,
and shortness of breath or other breathing trouble. Left untreated, it can
paralyze the muscles involved in breathing, leading to death.

There are about 145 cases of botulism reported each year according to the
Centers for Disease Control and Prevention. About 20 percent of all cases
stem from wound infections, and most wound botulism cases are associated
with the injection of black tar heroin.

The toxic bacterium is believed to live within diluting agents —
“dextrose, burned cornstarch, instant coffee, and sometimes even dirt,”
according to a 2004 medical study— introduced while processing the heroin.
This means disinfected needles and clean injection points can’t prevent
infection.

Ten Americans have died of wound botulism since 2001. Cases have been
reported over the last decade among IV drug users in the Yakima area,
including two in 2010, one in 2007 and four others in 2003, but Small said
this appears to be the first such instance in the Wenatchee Valley.

“We’re hoping not to see any more cases in our area,” Small said.
__________________________________________________________________
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