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SIGNpost 00733

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST *

Post00733 HC Waste Tools + SEDs + Abstracts + News 19 February 2014

CONTENTS
0. Moderators Note: Not optional
1. USAID | DELIVER PROJECT has developed several health care waste
management resources
2. Abstract: Use and activation of safety engineered sharps devices in a
sample of 5 Florida healthcare facilities
3. Abstract: Perceptions of home and self-injection of Sayana® Press in
Ethiopia: a qualitative study
4. Abstract: Needlestick injuries: causes, preventability and
psychological impact
5. Abstract: Interventions to prevent needle stick injuries among health
care workers
6. Abstract: Clinical and epidemiological features of hepatitis C virus
infection in South Korea: a prospective, multicenter cohort study
7. Abstract: Acute hepatitis B outbreaks in 2 skilled nursing facilities
and possible sources of transmission: North Carolina, 2009-2010
8. Abstract: Outbreak of Tsukamurella Species Bloodstream Infection among
Patients at an Oncology Clinic, West Virginia, 2011–2012
9. Abstract: Assessment of composition and generation rate of healthcare
wastes in selected public and private hospitals of Ethiopia
10. Abstract: Dental solid waste characterization and management in Iran:
A case study of Sistan and Baluchestan Province
11. Abstract: The impact of short-term topical gatifloxacin and
moxifloxacin on bacterial injection after hypodermic needle passage
through human conjunctiva
12. Abstract: Severe systemic Bacillus anthracis infection in an
intravenous drug user
13. Abstract: Outlier populations: individual and social network
correlates of solvent-using injection drug users
14. Abstract: The hepatitis B vaccine protects re-exposed health care
workers, but does not provide sterilizing immunity
15. Abstract: Has improved hand hygiene compliance reduced the risk of
hospital-acquired infections among hospitalized patients in Ontario?
Analysis of publicly reported patient safety data from 2008 to 2011
16. Abstract: Clostridium difficile Infection: A Worldwide Disease
17. Abstract: Susceptibility of high-risk human papillomavirus type 16 to
clinical disinfectants
18. No Abstract: Safety-engineered devices in 2012: the critical role of
healthcare workers in device selection
19. No Abstract: A request for an alliance in the battle for clean and
safe hospital surfaces
20. News
– Popular Disinfectants Do Not Kill HPV, Research Finds

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__________________________________________________________________
________________________________*_________________________________

0. Moderators Note: Not optional
__________________________________________________________________
Terry Grimmond, Director, Grimmond and Associates, Microbiology
Consultants, Hamilton New Zealand kindly posted the abstract of his recent
study below:

2. Abstract: Use and activation of safety engineered sharps devices in a
sample of 5 Florida healthcare facilities

As Terry points out:

” It is disturbing that 39.9% of conventional needles were capped prior to
discard and 42.5% of all devices were discarded as a ‘naked’ sharp. In
this small sampling it is of concern that 12 years after U.S. SED
legislation, 64.3% of healthcare professionals (HCP) placed themselves at
risk by recapping or discarding naked needles. Many non-activated
phlebotomy devices were visibly blood-contaminated.”

The continuation of needle recapping after so many years of regulation and
IEC effort is alarming.

Hello “Germ Theory of Disease” ! Not an option or an opinion.
__________________________________________________________________
________________________________*_________________________________

1. USAID | DELIVER PROJECT has developed several health care waste
management resources
__________________________________________________________________

The USAID | DELIVER PROJECT has developed several health care waste
management resources to support good practices for proper handling and
disposal of health care waste, covering topics such as minimization,
segregation, storage and transport, and treatment and disposal. The
resources include–

Guide to Health Care Waste Management for the Community Health Worker

This illustrated guide provides practical guidance for community health
workers on how to safely handle and dispose of hazardous waste.
http://bit.ly/1gFWJfZ

Logistics of Health Care Waste Management: Information and Approaches for
Developing Country Settings

This publication considers the reality of health care waste management
practices in resource-limited settings, and offers solutions based on
actual experience in developing countries. http://bit.ly/1c74L1I

Transporting, Storing, and Handling Malaria Rapid Diagnostic Tests at
Central and Peripheral Storage Facilities

Developed by the USAID | DELIVER PROJECT, Foundation for Innovative New
Diagnostics (FIND), World Health Organization-Western Pacific Regional
Office (WHO-WPRO), Roll Back Malaria Partnership, and UNICEF, this manual
is intended for staff at central and peripheral storage facilities that
use malaria rapid diagnostic tests (RDTs). http://bit.ly/1c75f7X

Ghana: Recycling Turns Environmental Risk into Community Benefit

This case study on the recycling of residual materials from the nationwide
distribution of long-lasting insecticide-treated bed nets (LLINs) in
Ghana. http://bit.ly/1gFYJoA

__________________________________________________________________
________________________________*_________________________________

2. Abstract: Use and activation of safety engineered sharps devices in a
sample of 5 Florida healthcare facilities
__________________________________________________________________
Use and activation of safety engineered sharps devices in a sample of 5
Florida healthcare facilities

Grimmond T. FASM, BAgrSc, GrDpAdEd

Director, Grimmond and Associates, Microbiology Consultants, Hamilton New
Zealand.

Introduction. The incidence of sharps injuries (SI) in U.S. fell
significantly with mandatory use of safety engineered devices (SED) in
2001 but has remained static since. More than half of SI from SED are due
to non-activation of devices and monitoring of activation is recommended.

This paper outlines the findings of a sharps container (SC) contents audit
conducted in Florida in September 2012.

Methods. Reusable, 22 liter sharps containers (Sharpsmart, Daniels
Sharpsmart Inc, Chicago IL) were randomly selected from 5 healthcare
facilities (HCF) in central Florida. Wearing protective apparel the
operator opened, decanted and enumerated all hollow bore needles and
sorted them into: conventional vs SED; capped vs uncapped; and activated
vs non- activated SED.

Results. 261L of sharps (40.3kg) from 18 sharps containers from 4
hospitals and one large family clinic were enumerated. 54.4% of the 1,987
devices were non-SED and 45.6% were SED. Of the SED, 21.6% (196/907) were
not activated. Of all devices 32.6% were “naked” conventional needles or
needle-syringes and 21.7% were capped needles or needle-syringes. Overall,
42.5% of devices were discarded “sharp”.

Discussion. It is disturbing that 39.9% of conventional needles were
capped prior to discard and 42.5% of all devices were discarded as a
‘naked’ sharp.

In this small sampling it is of concern that 12 years after U.S. SED
legislation, 64.3% of healthcare professionals (HCP) placed themselves at
risk by recapping or discarding naked needles. Many non- activated
phlebotomy devices were visibly blood-contaminated. The reasons for non-
activation of SED (ease of use, device preference, perception of patient
adverse event, training) need be addressed.

Conclusion. The high proportion of devices being capped or discarded with
an unprotected sharp may be a possible reason for the continued high SI
incidence in the United States. A new vigor encompassing competency
training, safety ownership and adoption of passive SED wherever possible
is needed to protect HCP.

——
The final definitive version of this article is published in the Journal
of the Association of Occupational Health Professionals in Healthcare
2014;34(1):13-15 (Winter Issue). Copies may be purchased by emailing
info@aohp.org. Full “Author copies” are available for personal research
purposes from tg@gandassoc.com.

http://www.aohp.org/aohp/HOME.aspx
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Perceptions of home and self-injection of Sayana® Press in
Ethiopia: a qualitative study
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24529492

Contraception. 2013 Dec 27. pii: S0010-7824(13)00753-1.

Perceptions of home and self-injection of Sayana® Press in Ethiopia: a
qualitative study.

Keith B1, Wood S2, Chapman C1, Alemu E1.

1PATH, Seattle, WA 98121, USA. 2PATH, Seattle, WA 98121, USA. Electronic
address: swood@path.org.

OBJECTIVE: Sayana® Press,1 a new subcutaneous formulation and presentation
of a popular injectable contraceptive, has the potential to expand non-
clinic access to contraception, including home and self-injection (HSI).
This study collected information from potential users and stakeholders on
their perceptions and preferences, the feasibility of an HSI of Sayana
Press program and key policy considerations.

STUDY DESIGN: PATH conducted 62 interviews and 7 focus groups with family
planning users, non-users, physicians, other health care providers and key
informants in the Oromia region of Ethiopia. Participants watched a
demonstration and tested the device on a model mid-interview. The study
did not involve product use in humans.

RESULTS: Women found the product easy to use, liked the simple design and
valued the time and expense that could be saved through HSI of Sayana
Press (HSI- SP). Of those with inhibitions about their ability to self-
inject, most shifted their opinion favorably after demonstration. The
majority of other stakeholders also supported HSI-SP and thought it could
increase contraceptive use in Ethiopia, and they suggested that any
successful program must include proper training and supervision,
particularly regarding product storage and waste management.

CONCLUSION: The data provide findings to stimulate further research and
support future planning. They suggest that HSI-SP may meet the needs of
many women if key requirements and challenges are met. It may also be
necessary to revise policies and guidelines to integrate the approach with
national family planning strategies.

IMPLICATIONS: This study provides the first available data on perceptions,
feasibility and requirements for HSI of Sayana Press in a low-resource
setting. Findings provide insights that may guide future implementation
strategies, strengthen non-clinic family planning access programs and
stimulate continued research.

Copyright © 2014 Elsevier Inc. All rights reserved.

KEYWORDS: Community health, Depot medroxyprogesterone acetate (DMPA),
Discreet users of contraception, Family planning, Injectable
contraception, Reproductive health, Uniject™
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Needlestick injuries: causes, preventability and
psychological impact
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24526576

Infection. 2014 Feb 14.

Needlestick injuries: causes, preventability and psychological impact.

Wicker S, Stirn AV, Rabenau HF, von Gierke L, Wutzler S, Stephan C.

Occupational Health Service, University Hospital Frankfurt, Theodor-Stern-
Kai 7, 60590, Frankfurt am Main, Germany, sabine.wicker@kgu.de.

Needlestick injuries (NSI) pose a significant health hazard among
healthcare personnel (HCP). The aim of our prospective observational study
was to evaluate the psychological impact of NSI and assess measures to
prevent NSI.

The target group was the medical staff and students of Frankfurt
University Hospital who had experienced a NSI (n = 370) during the 12-
month study period. Data were retrieved from accident insurance reports,
occupational follow-up examinations and a standardized anonymous
questionnaire sent to the affected HCP.

Analysis of the completed questionnaires (232/370) revealed that stress
(48.3 %) and tiredness (36.6 %) were common factors contributing to the
NSI and that >80 % of the respondents were concerned about the
consequences of the NSI.

Higher levels of anxiety were reported when the patient was known to have
a chronic virus infection. Stressful working conditions, lack of adequate
protective medical/technical equipment and poor work routines were
suggested as factors contributing to NSI.
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Interventions to prevent needle stick injuries among health
care workers
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22317004

Work. 2012;41 Suppl 1:1969-71.

Interventions to prevent needle stick injuries among health care workers.

Van der Molen HF, Zwinderman KA, Sluiter JK, Frings-Dresen MH.

Coronel Institute of Occupational Health, Academic Medical Center,
University of Amsterdam, PO Box 22700, 1100 DE Amsterdam, Netherlands.

Needle stick injuries (NSIs) are frequently reported as occupational
injuries among health care workers. The health effects of a NSI can be
significant when blood-to-blood contact occurs from patient to health care
worker.

The objective of this study was to evaluate whether the number of NSIs
decreased among health care workers at risk in one Dutch academic hospital
after introduction of injection needles with safety devices in combination
with an interactive workshop.

In a cluster three-armed randomized controlled trial, 23 hospital
divisions (n=796 health care workers) were randomly assigned to a group
that was subjected to the use of a ‘safety device plus workshop’, to a
group that was subjected to a ‘workshop only’ or to a control group with
no intervention.

The combined intervention of the introduction of needle safety devices and
an interactive workshop led to the highest reduction in the number of
self- reported NSIs compared to a workshop alone or no intervention.

For practice, the use of relatively simple protective needle safety
devices and interactive communication are effective measures for reducing
NSI’s.
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Clinical and epidemiological features of hepatitis C virus
infection in South Korea: a prospective, multicenter cohort study
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23813472

J Med Virol. 2013 Oct;85(10):1724-33.

Clinical and epidemiological features of hepatitis C virus infection in
South Korea: a prospective, multicenter cohort study.

Seong MH, Kil H, Kim YS, Bae SH, Lee YJ, Lee HC, Kang BH, Jeong SH.

Department of Internal Medicine, Seoul National University Bundang
Hospital, Seongnam, Republic of Korea.

The epidemiological and clinical features of hepatitis C virus (HCV)
infection in South Korea were examined in a prospective, multicenter
cohort study that included 1,173 adult patients with positive results for
anti-HCV antibody who completed a questionnaire survey on the risk factors
for HCV infection from January 2007 to December 2011 at five university
hospitals.

The HCV cohort had a mean age of 55.4 years with 48.3% men, and diagnostic
categories of acute hepatitis (n?=?63, 5.3%), past infection (n?=?37,
3.2%), chronic hepatitis (n?=?777, 66.2%), cirrhosis of the liver
(n?=?179, 15.3%), and hepatocellular carcinoma (n?=?117, 10.0%). The major
HCV genotypes were genotype 1 (52.7%) and genotype 2 (45.3%). Liver biopsy
was performed in 301 patients (25.7%), and 42.8% of the subjects received
antiviral therapy against HCV.

The behavioral risk factors possibly related to HCV infection were
intravenous drug use (5%), needle stick injury (7%), blood transfusion
before 1995 (19%), sexual relationship with more than three partners
(28%), piercings (35%), tattoos (36%), surgery (43%), acupuncture (83%),
diagnostic endoscopy (85%), and dental procedures (93%).

Age, intravenous drug use, needle stick injury, transfusion before 1995,
and tattoos were the independent risk factors of HCV infection.

Copyright © 2013 Wiley Periodicals, Inc.

KEYWORDS: Korea, epidemiology, genotype, hepatitis C virus, treatment
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Acute hepatitis B outbreaks in 2 skilled nursing facilities
and possible sources of transmission: North Carolina, 2009-2010
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23739075

Infect Control Hosp Epidemiol. 2013 Jul;34(7):709-16.

Acute hepatitis B outbreaks in 2 skilled nursing facilities and possible
sources of transmission: North Carolina, 2009-2010.

Seña AC, Moorman A, Njord L, Williams RE, Colborn J, Khudyakov Y,
Drobenuic J, Xia GL, Wood H, Moore Z.

Durham County Department of Public Health, Durham, North Carolina, USA.
idrod@med.unc.edu

OBJECTIVE: Acute hepatitis B virus (HBV) infections have been reported in
long-term care facilities (LTCFs), primarily associated with infection
control breaks during assisted blood glucose monitoring. We investigated
HBV outbreaks that occurred in separate skilled nursing facilities (SNFs)
to determine factors associated with transmission.

DESIGN: Outbreak investigation with case-control studies.

SETTING: Two SNFs (facilities A and B) in Durham, North Carolina, during
2009-2010.

PATIENTS: Residents with acute HBV infection and controls randomly
selected from HBV-susceptible residents during the outbreak period.

METHODS: After initial cases were identified, screening was offered to all
residents, with repeat testing 3 months later for HBV-susceptible
residents. Molecular testing was performed to assess viral relatedness.
Infection control practices were observed. Case-control studies were
conducted to evaluate associations between exposures and acute HBV
infection in each facility.

RESULTS: Six acute HBV cases were identified in each SNF. Viral
phylogenetic analysis revealed a high degree of HBV relatedness within,
but not between, facilities. No evaluated exposures were significantly
associated with acute HBV infection in facility A; those associated with
infection in facility B (all odds ratios >20) included injections,
hospital or emergency room visits, and daily blood glucose monitoring.

Observations revealed absence of trained infection control staff at
facility A and suboptimal hand hygiene practices during blood glucose
monitoring and insulin injections at facility B.

CONCLUSIONS: These outbreaks underscore the vulnerability of LTCF
residents to acute HBV infection, the importance of surveillance and
prompt investigation of incident cases, and the need for improved
infection control education to prevent transmission.
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Outbreak of Tsukamurella Species Bloodstream Infection among
Patients at an Oncology Clinic, West Virginia, 2011–2012
__________________________________________________________________
Infection Control and Hospital Epidemiology , Vol.35, No.3 (March 2014),
pp. 300-306

The University of Chicago Press on behalf of The Society for Healthcare
Epidemiology of America

http://www.jstor.org/stable/10.1086/675282

Outbreak of Tsukamurella Species Bloodstream Infection among Patients at
an Oncology Clinic, West Virginia, 2011–2012

Isaac See, MD,1,2 Duc B. Nguyen, MD,1,2 Somu Chatterjee, MD, MPH,3 Thein
Shwe, MPH, MS, MBBS,3 Melissa Scott, RN,3 Sherif Ibrahim, MD, MPH,3
Heather Moulton-Meissner, PhD,2 Steven McNulty, BS,4 Judith Noble-Wang,
PhD,2 Cindy Price, RN, BSN, CIC,5 Kim Schramm, MT(ASCP),6 Danae Bixler,
MD, MPH,3 and Alice Y. Guh, MD, MPH2

1. Epidemic Intelligence Service, Centers for Disease Control and
Prevention, Atlanta, Georgia
2. Division of Healthcare Quality Promotion, Centers for Disease Control
and Prevention, Atlanta, Georgia
3. Division of Infectious Disease Epidemiology, West Virginia Bureau for
Public Health, Charleston, West Virginia
4. Department of Microbiology, University of Texas Health Science Center,
Tyler, Texas
5. Department of Infection Control, Ohio Valley Medical Center, Wheeling,
West Virginia
6. Department of Microbiology, Ohio Valley Medical Center, Wheeling, West
Virginia
Address correspondence to Isaac See, MD, Centers for Disease Control and
Prevention, 1600 Clifton Road NE, Mailstop A-24, Atlanta, GA 30333
(isee@cdc.gov).

Objective. To determine the source and identify control measures of an
outbreak of Tsukamurella species bloodstream infections at an outpatient
oncology facility.

Design. Epidemiologic investigation of the outbreak with a case-control
study.

Methods. A case was an infection in which Tsukamurella species was
isolated from a blood or catheter tip culture during the period January
2011 through June 2012 from a patient of the oncology clinic. Laboratory
records of area hospitals and patient charts were reviewed. A case-control
study was conducted among clinic patients to identify risk factors for
Tsukamurella species bloodstream infection. Clinic staff were interviewed,
and infection control practices were assessed.

Results. Fifteen cases of Tsukamurella (Tsukamurella pulmonis or
Tsukamurella tyrosinosolvens) bloodstream infection were identified, all
in patients with underlying malignancy and indwelling central lines. The
median age of case patients was 68 years; 47% were male. The only
significant risk factor for infection was receipt of saline flush from the
clinic during the period September–October 2011 (P = .03), when the clinic
had been preparing saline flush from a common-source bag of saline. Other
infection control deficiencies that were identified at the clinic included
suboptimal procedures for central line access and preparation of
chemotherapy.

Conclusion. Although multiple infection control lapses were identified,
the outbreak was likely caused by improper preparation of saline flush
syringes by the clinic. The outbreak demonstrates that bloodstream
infections among oncology patients can result from improper infection
control practices and highlights the critical need for increased attention
to and oversight of infection control in outpatient oncology settings.

Free full text: http://www.jstor.org/stable/full/10.1086/675282
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Assessment of composition and generation rate of healthcare
wastes in selected public and private hospitals of Ethiopia
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24525670

Waste Manag Res. 2014 Feb 13.

Assessment of composition and generation rate of healthcare wastes in
selected public and private hospitals of Ethiopia.

Tesfahun E, Kumie A, Legesse W, Kloos H, Beyene A.

School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia

In many developing countries, the inadequacy of data regarding the
quantity and composition of healthcare waste is one of the major reasons
for improper healthcare waste management. We investigated the generation
rate and composition of healthcare wastes in six public and three private
hospitals.

We conducted healthcare waste composition and characterization
measurements for seven consecutive days in the selected hospitals
following the protocol described by the World Health Organization (WHO).

The results revealed that the total generation rate of healthcare wastes
of hospitals ranged from 0.25 to 2.77 kg/bed/day with a median value of
1.67 kg/bed/day for inpatients to 0.21-0.65 in kg/patient/day with a
median value of 0.31 kg/patient/day for outpatients.

The waste generation rate in private hospitals (median 3.9 kg/bed/day) was
significantly greater (Kruskal-Wallis test, P < 0.05) than in government
hospitals (median 1.5 kg/bed/day).

The median values of percent hazardous waste estimated for private and
government hospitals were 63.4% and 52.2%, respectively.

These figures are about three times greater than the threshold values
recommended by the WHO.

This situation might be attributed to the improper practice of healthcare
waste segregation by health professionals and auxiliary health workers due
to inadequate risk perception and lack of enforced public health
regulations.

The study revealed that the generation rate and proportion of hazardous
waste significantly varies between public and private hospitals and number
of patients treated per day.
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Dental solid waste characterization and management in Iran:
A case study of Sistan and Baluchestan Province
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24519230

Waste Manag Res. 2014 Feb;32(2):157-64.

Dental solid waste characterization and management in Iran: A case study
of Sistan and Baluchestan Province.

Bazrafshan E, Mohammadi L, Mostafapour FK, Moghaddam AA.

1Department of Rheumatology, Baqiyatallah University of Medical Sciences,
Tehran, Iran.
2Department of Infection Disease, Baqiyatallah Research Center for
Gastroenterology and Liver Disease, Baqiyatallah University of Medical
Sciences, Tehran.
3Department of Rheumatology, Sina Hospital, Tehran University of Medical
Sciences, Tehran, Iran.

The management of dental solid waste continues to be a major challenge,
particularly in most healthcare facilities of the developing world. In
Iran, few studies on management of dental solid waste and its composition
are available. An effort has been made through this study to evaluate the
hazardous and infectious status of dental solid waste, keeping in mind its
possible role in cross-infection chain.

For this study, 123 private dental centres and 36 public dental centres
were selected and the composition and generation rate of dental solid
waste produced were measured. Dental solid waste was classified to four
main categories: (i) domestic-type; (ii) potentially infectious; (iii)
chemical and pharmaceutical; and (iv) toxic, which constituted 11.7, 80.3,
6.3, and 1.7%, respectively, of the total. Also, the results indicated
that the dental solid waste per patient per day generation rate for total,
domestic-type, potentially infectious, chemical and pharmaceutical, and
toxic wastes were 169.9, 8.6, 153.3, 11.2, and 3.3 g/patient/d,
respectively.

Furthermore, the per day generation rates for total, domestic-type,
potentially infectious, chemical and pharmaceutical, and toxic wastes were
194.5, 22.6, 156.1, 12.3, and 3.4 kg/d, respectively.

According to findings of this study, for best management of dental waste
it is suggested that source reduction, separation, reuse, and recycling
programmes be implemented and each section of dental waste be collected
and disposed of separately and in accordance with related criteria.

KEYWORDS: Chemical waste, dental solid waste, hazardous waste, healthcare
waste,infectious waste
__________________________________________________________________
________________________________*_________________________________

11. Abstract: The impact of short-term topical gatifloxacin and
moxifloxacin on bacterial injection after hypodermic needle passage
through human conjunctiva
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23425429

J Ocul Pharmacol Ther. 2013 Jun;29(5):450-5.

The impact of short-term topical gatifloxacin and moxifloxacin on
bacterial injection after hypodermic needle passage through human
conjunctiva.

Pettey JH, Mifflin MD, Kamae K, McEntire MW, Pettey DH, Callegan MC, Brown
H, Olson RJ.

John A. Moran Eye Center, University of Utah , Salt Lake City, Utah 84132,
USA.

PURPOSE: To determine the bacterial contamination rate of a 27-gauge
needle bore during conjunctival penetration in donor eye bank eyes and the
effect of short-term use of topical 0.3% gatifloxacin and 0.5%
moxifloxacin.

METHODS: One hundred consecutive human donors had 10 conjunctival
penetrations per 10 syringes per eye before antibiotic placement; this was
repeated 15 min after antibiotic use. Samples were cultured by expressing
0.3 mL of saline through the needle. Positive cultures were speciated.

RESULTS: There were 1,033 positive cultures (25.8% of all cultures); 568
(28.4%) pre-antibiotics, 249 (24.9%) after gatifloxacin (P=0.04, compared
to the pre-antibiotic rate), and 216 (21.6%) after moxifloxacin (P<0.001).
The most common organism was Staphylococcus epidermidis [334 positive
cultures (8.4%)]. No antibiotic effect was seen on this or other organisms
except S. aureus [4.6% pre-antibiotic, 2.8% after gatifloxacin (P=0.02),
and 1.8% after moxifloxacin (P<0.001)] and other Staphylococcus species
[5.3% pre- antibiotic, 3.6% after gatifloxacin (P=0.04), and 3.2% after
moxifloxacin (P=0.01)].

CONCLUSIONS: Transconjunctival penetration often results in needle bore
contamination; bacteria are included in an injected solution. Fifteen
minutes of exposure to 2 topical antibiotics had a minimal effect on
bacterial contamination and no significant effect on many common
pathogens.
__________________________________________________________________
________________________________*_________________________________

12. Abstract: Severe systemic Bacillus anthracis infection in an
intravenous drug user
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24526196

BMJ Case Rep. 2014 Feb 13;2014. pii: bcr2013201921.

Severe systemic Bacillus anthracis infection in an intravenous drug user.

Veitch J, Kansara A, Bailey D, Kustos I.

Countess of Chester NHS Foundation Trust, Chester, UK.

There has recently been an outbreak of injectional anthrax infection
secondary to contaminated heroin use in the UK and Europe.

We present a case of a 37-year-old man presenting with pain and swelling
in the groin following injection of heroin into the area.

He was initially treated for severe cellulitis, however, he failed to
respond to appropriate antimicrobial therapy. He went onto develop a
widespread rash; it was then that a diagnosis of injectional anthrax
infection was considered. Appropriate investigations were initiated
including serum sample and tissue biopsy, and the diagnosis was confirmed.
Management included extensive surgical debridement and a prolonged course
of combination antibiotic therapy.

The authors summarise the important steps in diagnosis and the management
options in patients presenting with this life-threatening infection.
__________________________________________________________________
________________________________*_________________________________

13. Abstract: Outlier populations: individual and social network
correlates of solvent-using injection drug users
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24523923

PLoS One. 2014 Feb 11;9(2):e88623.

Outlier populations: individual and social network correlates of solvent-
using injection drug users.

Shaw SY1, Jolly AM2, Wylie JL3.

1Department of Community Health Sciences, University of Manitoba,
Winnipeg, Manitoba, Canada.
2Public Health Agency of Canada, Ottawa, Ontario, Canada ; Dalla Lana
School of Public Health, University of Toronto, Toronto, Ontario, Canada.
3Department of Community Health Sciences, University of Manitoba,
Winnipeg, Manitoba, Canada ; Cadham Provincial Laboratory, Winnipeg,
Manitoba, Canada ; Department of Medical Microbiology, University of
Manitoba, Winnipeg, Manitoba, Canada.

OBJECTIVE: We previously identified a high prevalence of Hepatitis C (HCV)
amongst solvent-using injection drug users (S-IDU) relative to other
injection drug users within the same locality. Here we incorporated social
network variables to better characterize some of the behavioural
characteristics that may be putting this specific subgroup of IDU at
elevated disease risk.

METHODS: A cross-sectional survey of at-risk populations was carried out
in Winnipeg, Canada in 2009. Individuals reporting any history of
injection drug and/or solvent use were included in the study. Associations
between subgroup membership, infection with HCV and HIV and individual and
social network variables were examined.

RESULTS: In relation to other IDU, S-IDU were more likely to be infected
with HCV, to report ever having shared a syringe, and to associate with
other IDU. They were further differentiated in terms of their self-
reported sexual orientation, ethnicity and in the injection drugs
typically used.

CONCLUSION: Solvent use stands as a proxy measure of numerous other
characteristics that put this group of IDU at higher risk of infection.
Provision of adequate services to ostracized subpopulations may result in
wider population-level benefits.

Free Full Text Article
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0088623
__________________________________________________________________
________________________________*_________________________________

14. Abstract: The hepatitis B vaccine protects re-exposed health care
workers, but does not provide sterilizing immunity
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23916846

Gastroenterology. 2013 Nov;145(5):1026-34.

The hepatitis B vaccine protects re-exposed health care workers, but does
not provide sterilizing immunity.

Werner JM, Abdalla A, Gara N, Ghany MG, Rehermann B.

Immunology Section, National Institute of Diabetes and Digestive and
Kidney Diseases, National Institutes of Health, Department of Health and
Human Services, Bethesda, Maryland; Liver Diseases Branch, National
Institute of Diabetes and Digestive and Kidney Diseases, National
Institutes of Health, Department of Health and Human Services, Bethesda,
Maryland.

BACKGROUND & AIMS: Infection with hepatitis B virus (HBV) can be prevented
by vaccination with HB surface (HBs) antigen, which induces HBs-specific
antibodies and T cells. However, the duration of vaccine-induced
protective immunity is poorly defined for health care workers who were
vaccinated as adults.

METHODS: We investigated the immune mechanisms (antibody and T-cell
responses) of long-term protection by the HBV vaccine in 90 health care
workers with or without occupational exposure to HBV, 10-28 years after
vaccination.

RESULTS: Fifty-nine of 90 health care workers (65%) had levels of
antibodies to HBs antigen above the cut-off (>12 mIU/mL) and 30 of 90
(33%) had HBs-specific T cells that produced interferon-gamma. Titers of
antibodies to HBs antigen correlated with numbers of HBs-specific
interferon-gamma-producing T cells, but not with time after vaccination.
Although occupational exposure to HBV after vaccination did not induce
antibodies to the HBV core protein (HBcore), the standard biomarker for
HBV infection, CD4(+) and CD8(+) T cells against HBcore and polymerase
antigens were detected. Similar numbers of HBcore- and polymerase-specific
CD4(+) and CD8(+) T cells were detected in health care workers with
occupational exposure to HBV and in patients who acquired immunity via HBV
infection. Most of the HBcore- and polymerase-specific T cells were
CD45RO(+)CCR7(-)CD127(-) effector memory cells in exposed health care
workers and in patients with acquired immunity. In contrast, most of the
vaccine-induced HBs-specific T cells were CD45RO(-)CCR7(-)CD127(-)
terminally differentiated cells.

CONCLUSIONS: HBs antigen vaccine-induced immunity protects against future
infection but does not provide sterilizing immunity, as evidenced by
HBcore- and polymerase-specific CD8(+) T cells in vaccinated health care
workers with occupational exposure to HBV. The presence of HBcore- and HBV
polymerase- specific T-cell responses is a more sensitive indicator of HBV
exposure than detection of HBcore-specific antibodies.

Copyright © 2013 AGA Institute. Published by Elsevier Inc. All rights
reserved.

KEYWORDS: DMSO, FCS, HBV, HBV core protein, HBV polymerase, HBVpol,
HBcore, HBsAg, HDV, IFN, Immune Response, Immunization, PBMC, PBS, PE,
PHA-M, T Cell, Virus, anti-HBs, antibody to hepatitis B surface antigen,
dimethyl sulfoxide, fetal calf serum, hepatitis B surface antigen,
hepatitis B virus, hepatitis D virus, interferon, peripheral blood
mononuclear cells, phosphate-buffered saline, phycoerythrin,
phytohemagglutinin
__________________________________________________________________
________________________________*_________________________________

15. Abstract: Has improved hand hygiene compliance reduced the risk of
hospital-acquired infections among hospitalized patients in Ontario?
Analysis of publicly reported patient safety data from 2008 to 2011
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23651891

Infect Control Hosp Epidemiol. 2013 Jun;34(6):605-10.

Has improved hand hygiene compliance reduced the risk of hospital-acquired
infections among hospitalized patients in Ontario? Analysis of publicly
reported patient safety data from 2008 to 2011.

DiDiodato G.

Department of Critical Care, Royal Victoria Hospital, Barrie, Ontario,
Canada. gdidiodato@gmail.com

DESIGN: Prospective, observational, ecological, time series, cross-
sectional study examining the association between hand hygiene compliance
(HHC) rates and the incidence of hospital-acquired infections.

SETTING: Acute care hospitals (N = 166) located in the province of
Ontario, Canada.

METHODS: All data were extracted from the Ontario patient safety indicator
database ( http://www.hqontario.ca/public-reporting/patient-safety).
Complete data were available for 166 acute care hospitals from October 1,
2008, to December 31, 2011. The rates of Clostridium difficile infection
(CDI) are reported monthly, methicillin-resistant Staphylococcus aureus
(MRSA) bacteremia quarterly, and HHC rates yearly. Trends and associations
for each indicator were evaluated by ordinary least squares regression
(HHC), zero-inflated Poisson regression (MRSA bacteremia), or Poisson
regression (CDI). Dependent variables included in the regression analyses
were extracted from the same database and included year, healthcare
region, and type of hospital (teaching or small or large community).

RESULTS: Compared to those in 2008, reported HHC rates improved every year
both before and after environment/patient contact (range, 10.6%-25.3%).
Compared to those in 2008, there was no corresponding change in the rates
of MRSA bacteremia; however, the rates of CDI decreased in 2009 but were
not statistically significantly decreased from baseline in either 2010 or
2011. No consistent association was demonstrated between changes in the
rates of HHC and these two healthcare-associated infections (HAIs).

CONCLUSIONS: Despite significant improvements in reported rates of HHC
among healthcare personnel in Ontario’s hospitals, we could not
demonstrate a positive ecological impact on rates of these two HAIs
__________________________________________________________________
________________________________*_________________________________

16. Abstract: Clostridium difficile Infection: A Worldwide Disease
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24516694

Gut Liver. 2014 Jan;8(1):1-6.

Clostridium difficile Infection: A Worldwide Disease.

Burke KE, Lamont JT.

Division of Gastroenterology, Beth Israel Deaconess Medical Center,
Boston, MA, USA.

Clostridium difficile, an anaerobic toxigenic bacterium, causes a severe
infectious colitis that leads to significant morbidity and mortality
worldwide. Both enhanced bacterial toxins and diminished host immune
response contribute to symptomatic disease. C. difficile has been a well-
established pathogen in North America and Europe for decades, but is just
emerging in Asia.

This article reviews the epidemiology, microbiology, pathophysiology, and
clinical management of C. difficile. Prompt recognition of C. difficile is
necessary to implement appropriate infection control practices.

KEYWORDS: Asia, Clostridium difficile, Epidemiology, Review

Free Full Article
http://synapse.koreamed.org/DOIx.php?id=10.5009/gnl.2014.8.1.1
__________________________________________________________________
________________________________*_________________________________

17. Abstract: Susceptibility of high-risk human papillomavirus type 16 to
clinical disinfectants
__________________________________________________________________
http://jac.oxfordjournals.org/content/early/2014/02/04/jac.dku006.abstract

Susceptibility of high-risk human papillomavirus type 16 to clinical
disinfectants

Jordan Meyers1,†‡, Eric Ryndock2,†, Michael J. Conway2,§, Craig Meyers2,*
and Richard Robison1

+ Author Affiliations

1Department of Microbiology and Molecular Biology, Brigham Young
University, Provo, UT 84602, USA
2Department of Microbiology and Immunology, Pennsylvania State College of
Medicine, Hershey, PA 17033, USA
?*Corresponding author. Tel: +1-717-531-6240; Fax: +1-717-531-4600; E-
mail: cmm10@psu.edu

Objectives: Little to nothing is known about human papillomavirus (HPV)
susceptibility to disinfection. HPV is estimated to be among the most
common sexually transmitted diseases in humans. HPV is also the causative
agent of cervical cancers and other anogenital cancers and is responsible
for a significant portion of oropharyngeal cancers. While sexual
transmission is well documented, vertical and non-sexual transmission may
also be important.

Methods: Using recombinant HPV16 particles (quasivirions) and authentic
HPV16 grown in three-dimensional organotypic human epithelial culture, we
tested the susceptibility of high-risk HPV to clinical disinfectants.
Infectious viral particles were incubated with 11 common clinical
disinfectants, appropriate neutralizers were added to inactivate the
disinfectant and solutions were filter centrifuged. Changes in the
infectivity titres of the disinfectant-treated virus were measured
compared with untreated virus.

Result: HPV16 is a highly resistant virus; more so than other non-
enveloped viruses previously tested. The HPV16 quasivirions showed similar
resistance to native virions, except for being susceptible to isopropanol,
the triple phenolic and the lower concentration peracetic acid-silver
(PAA-silver)-based disinfectant. Authentic virus and quasivirus were
resistant to glutaraldehyde and ortho-phthalaldehyde and susceptible to
hypochlorite and the higher concentration PAA-silver-based disinfectant.

Conclusions: We present the first disinfectant susceptibility data on
HPV16 native virions, which show that commonly used clinical
disinfectants, including those used as sterilants in medical and dental
healthcare facilities, have no effect on HPV16 infectivity. Policy changes
concerning disinfectant use are needed. The unusually high resistance of
HPV16 to disinfection supports other data suggesting the possibility of
fomite or non-sexual transmission of HPV16.

Key words: hospital sterilants papillomavirus cancer glutaraldehydes
ortho- phthalaldehydes

© The Author 2014. Published by Oxford University Press on behalf of the
British Society for Antimicrobial Chemotherapy. All rights reserved. For
Permissions, please e-mail: journals.permissions@oup.com
__________________________________________________________________
________________________________*_________________________________

18. No Abstract: Safety-engineered devices in 2012: the critical role of
healthcare workers in device selection
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23651893

Infect Control Hosp Epidemiol. 2013 Jun;34(6):615-8.

Safety-engineered devices in 2012: the critical role of healthcare workers
in device selection.

Jagger J, Perry J.

International Healthcare Worker Safety Center, Division of Infectious
Diseases, Department of Medicine, University of Virginia School of
Medicine, Charlottesville, Virginia, USA. jcj@virginia.edu
__________________________________________________________________
________________________________*_________________________________

19. No Abstract: A request for an alliance in the battle for clean and
safe hospital surfaces
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23806837

J Hosp Infect. 2013 Aug;84(4):341-2.

A request for an alliance in the battle for clean and safe hospital
surfaces.

Otter JA, Yezli S, Perl TM, Barbut F, French GL.

Comment on
The role of ‘no-touch’ automated room disinfection systems in infection
prevention and control. [J Hosp Infect. 2013]

Floor wars: the battle for ‘clean’ surfaces. [J Hosp Infect. 2013]

The need for clinically relevant studies of non-touch disinfecting
systems. [J Hosp Infect. 2013]
__________________________________________________________________
________________________________*_________________________________

20. News

– Popular Disinfectants Do Not Kill HPV, Research Finds

Selected news items reprinted under the fair use doctrine of international
copyright law: http://www4.law.cornell.edu/uscode/17/107.html
__________________________________________________________________
http://tinyurl.com/oczr3f9

Popular Disinfectants Do Not Kill HPV, Research Finds

Infection Control Today (13.02.14)

Commonly used disinfectants do not kill human papillomavirus (HPV) that
makes possible non-sexual transmission of the virus, thus creating a need
for hospital policy changes, according to researchers from Penn State
College of Medicine and Brigham Young University.

“Because it is difficult to produce infectious HPV particles for research,
little has been known about HPV susceptibility to disinfection,” says
Craig Meyers, the Distinguished Professor of Microbiology and Immunology
at Penn State College of Medicine.

Use of disinfectants on HPV in healthcare settings has been based on what
works on other viruses or what is thought should be effective.

Meyers collaborated with Richard Robison, an expert in microbial
disinfectants at Brigham Young University.

HPV is estimated to be among the most common sexually transmitted diseases
and is linked to cervical cancers. For this study, researchers grew HPV16,
a specific strain that is responsible for up to 60 percent of all HPV-
associated cancers. They then used 11 common disinfectants on the virus.

These disinfectants included ones made of ethanol and isopropanol because
these are common ingredients in surface disinfectants and hand sanitizers
used in both public and health care settings. Study of these hand
sanitizers is important because other research has shown high levels of
HPV DNA on fingers of patients with current genital infections. While HPV
is susceptible to certain disinfectants, including hypochlorite and
peracetic acid, it is resistant to alcohol-based disinfectants.

“Chemical disinfectants in hand sanitizer are commonly used in the general
population to prevent the spread of infectious diseases,” Meyers says.
“For flu or cold viruses they are very effective. But the data shows that
they do nothing for preventing the spread of human papillomavirus.”

They also tested other common disinfectants, including glutaraldehyde,
which is used for sterilization in medical and dental facilities. Results
show that glutaraldehyde is not effective at inactivating the HPV virus.

Results were published in the Journal of Antimicrobial Chemotherapy.

Other research has suggested that HPV could be transmitted non-sexually.
The current study shows that medical instruments considered sterile could
pose a risk for transmission.

“Chemical disinfectants used in the hospitals and other healthcare
settings have absolutely no effect on killing human papillomavirus,”
Meyers says. “So unless bleach or autoclaving is used in the hospital
setting, human papillomavirus is not being killed and there is a potential
spread of HPV through hospital acquired or instrument or tool infection.”

Meyers said the results suggest a need for a change in disinfectant use
policies.

Other scientists on this project were Jordan Meyers, Brigham and Woman’s
Hospital, formerly of Brigham Young University; and Eric Ryndock and
Michael J. Conway, Department of Microbiology and Immunology, Penn State
College of Medicine.

The National Institute of Allergy and Infectious Disease of the National
Institutes of Health and the BYU Mentoring Environment Grant program
funded this research.

The full report, “Susceptibility of High-Risk Human Papillomavirus Type 16
to Clinical Disinfectants,” was published online in the Journal of
Antimicrobial Chemotherapy (2014; doi: 10.1093/jac/dku006)
__________________________________________________________________
________________________________*_________________________________
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