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SIGNpost 00734

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST *

Post00734  Note + IS + HCWM + Devices + MDV + News 26 February 2014

CONTENTS
0. Moderators Note
1. Abstract: Injection safety practices in a main referral hospital in
northeastern Nigeria
2. Abstract: Audit of medication errors by anesthetists in North Western
Nigeria
3. Abstract: Current status of sharps waste management in the lower-level
health facilities in Tanzania
4. Abstract: Improving efficiency and safety for patients who are unable
to self-administer insulin
6. Abstract: HIV in Europe
7. Abstract: Hepatitis C among people who inject drugs in Tbilisi,
Georgia: An urgent need for prevention and treatment
8. Abstract: Hepatitis B virus prevalence, risk factors and genotype
distribution in HIV infected patients from West Java, Indonesia
9. Abstract: Knowledge about human immunodeficiency virus infection and
sexual behavior among drug users: a cross sectional study in Pokhara
submetropolitan city, Nepal
11. Abstract: POLYCLONAL OUTBREAK OF BLOODSTREAM INFECTIONS CAUSED BY
Burkholderia cepacia COMPLEX IN HEMATOLOGY AND BONE MARROW TRANSPLANT
OUTPATIENT UNITS
13. Abstract: Preparation and administration of injectable antibiotics: a
tool for nurses
14. No Abstract: New legislation provides greater protection from sharps
15. No Abstract: The sticking point: diabetic sharps disposal practices in
the community
16. News
– USA: Boy, 12, stuck by ‘dirty needle’
– USA: Dirty drug needle concern prompts school campaign
– Spain: Ten Alicante patients contract hepatitis through medical
negligence Same saline solution bag was used for several intravenous
transfusions

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__________________________________________________________________
________________________________*_________________________________

0. Moderators Note
__________________________________________________________________
Alarm Bells

Today’s lead abstract 1. “Injection safety practices in a main referral
hospital in northeastern Nigeria” concludes:

“This study depicts poor knowledge and a practice of injection
safety, inadequate injection safety supplies, and non-compliance to
injection safety policy and guidelines.”

download the full text or PDF Free at:
http://www.njcponline.com/text.asp?2014/17/2/134/127420

More follows below

best wishes,
allan
__________________________________________________________________
________________________________*_________________________________

1. Abstract: Injection safety practices in a main referral hospital in
northeastern Nigeria
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24553019

Niger J Clin Pract. 2014 Mar-Apr;17(2):134-9.

Injection safety practices in a main referral hospital in northeastern
Nigeria.

Gadzama GB1, Bawa SB, Ajinoma Z, Saidu MM, Umar AS.

1Department of Microbiology, University of Maiduguri, Maiduguri, Nigeria.

Background: No adherence of safe injection policies remains a major
challenge, and, worldwide, annually, it leads to 21 million new hepatitis
B cases and 260,000 HIV infection cases. This descriptive observational
survey was conducted to determine the level of adherence to universal
precaution for safe injection practices in the hospital.

Materials and Methods: The study units were selected using a simple random
sampling of injection services provider/phlebotomist in 27 units/wards of
the hospital. The study instruments were observation checklist and
interviewer administered questionnaires. EPI info (version 3.5.2) software
was used for data entry and generation of descriptive statistics was done
with units of analysis (units/wards) on injection safety practices of
health workers, availability of logistics and supplies, and disposal
methods.

Results: Only 33.3% of the units (95% CI, 16-54) had non-sharps infectious
healthcare waste of any type inside containers specific for non-sharps
infectious waste and 17 (77.3%) of the observed therapeutic injections
were prepared on a clean, dedicated table or tray, where contamination of
the equipment with blood, body fluids, or dirty swabs was unlikely.

Absence of recapping of needles was observed in 11 (50.0%) units giving
therapeutic injections. Only 7.4% of units surveyed had separate waste
containers for infectious non-sharps.

Conclusions: This study depicts poor knowledge and a practice of injection
safety, inadequate injection safety supplies, and non-compliance to
injection safety policy and guidelines.

Full Free Text Available from:
http://www.njcponline.com/text.asp?2014/17/2/134/127420
__________________________________________________________________
________________________________*_________________________________

2. Abstract: Audit of medication errors by anesthetists in North Western
Nigeria
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24553036

Niger J Clin Pract. 2014 Mar-Apr;17(2):226-31.

Audit of medication errors by anesthetists in North Western Nigeria.

Nwasor EO1, Sule ST, Mshelia DB.

1Department of Anesthesia, Ahmadu Bello University Teaching Hospital,
Zaria, Nigeria.

Background: Safety issues are an important aspect of anesthesia practice.
The relevance of medication and drug administration errors in our everyday
practice is an important aspect of medical audit. Although there have been
few case reports of drug administration errors by anesthetists, there is
paucity of information regarding medication errors in anesthetic practice
in Nigeria.

We set out to study the incidence of medication errors among anesthesia
practitioners in Kaduna State, North Western Nigeria and to suggest ways
to minimize such errors.

Materials and Methods: A questionnaire-based study was conducted among
physician anesthetists and nurse anesthetists working in the major
secondary and tertiary hospitals in Kaduna State, North Western Nigeria.
The data obtained was analyzed using SPSS Version 17.0 and the data
presented in relevant charts and tables.

Results: A total of 43 persons responded to the questionnaire with a high
response rate of 86% and a male/female ratio of 2.3:1. Most of the
anesthetists (38 or 88%) work in tertiary government hospitals. Twenty-
four (56%) of them admitted to ever having a medication error, and 34
(79%) of them attributed the medication error to problems with drug
labeling from manufactures using similar labels for different drugs.
Untoward sequelae resulted in 44% of the patients that were affected by
these medication errors and these ranged from cardiac arrest to delayed
recovery from anesthesia.

[***] Majority of the respondents recommended vigilance, double checking
of drug labels, and color coding of syringes as ways to minimize
medication errors.

Conclusion: Medication errors do occur in the everyday practice of
anesthetists in Nigeria as in other countries and can lead to morbidity
and mortality in our patients. Routine audit and reporting of critical
incidents including errors in drug administration should be encouraged.
Reduction of medication errors is an important aspect of patient safety,
and vigilance remains the watchword.

Full Free Text: Available from:
http://www.njcponline.com/text.asp?2014/17/2/226/127563
__________________________________________________________________
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3. Abstract: Current status of sharps waste management in the lower-level
health facilities in Tanzania
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24409634

Tanzan J Health Res. 2010 Oct;12(4):266-73.

Current status of sharps waste management in the lower-level health
facilities in Tanzania.

Manyele SV1, Mujuni CM2.

1Department of Chemical & Mining Engineering, College of Engineering and
Technology, University of Dar es Salaam, PO. Box 35131, Dares Salaam,
Tanzania. smanyele@udsm.ac.tz
2Department of Chemical & Mining Engineering, College of Engineering and
Technology, University of Dar es Salaam, PO. Box 35131, Dares Salaam,
Tanzania.

Sharps waste is part of infectious medical waste, management of which is a
critical problem in Tanzanian health facilities. This study aimed at
assessing the current status of sharps waste management in lower level
health facilities (LLHFs) in Ilala Municipality in Tanzania.

In this study a sample of 135 LLHFs (103 dispensaries, 13 clinics, 11
laboratories, and 8 health centers) was involved.

The average number of workers per facility was 10, with positively skewed
probability density function (up to 80 workers). The average patient-to-
workers ratio was 5.87. About 59% of the LLHFs improvised sharps waste
containers (SWCs).

Sharps waste was transported by hands in 77% of LLHFs leading to high
risks of exposure to needle stick injuries. Boots, aprons and masks were
among the personal protective equipment (PPE) missing in most LLHFs, while
latex gloves that cannot protect workers from injuries caused by sharps
waste were readily available. Most facilities stored sharps waste for
about 72 hours (before treatment), which is beyond the recommended maximum
storage time of 24 hours.

About 39.3% of LLHFs utilized on-site single-chamber incinerators for
sharps waste treatment, which are of poor design, have rusted mechanical
parts, short and rusted chimneys, and without automatic flame ignition
burners.

It is concluded that sharps waste management in LLHFs is poor, which puts
workers, the public and the environment at risk of exposure to blood-borne
pathogens. It is, therefore, important that the municipality should
establish a waste processing center which will collect and incinerate all
sharps waste.

Free Full Text: http://www.ajol.info/index.php/thrb/article/view/53362
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________________________________*_________________________________

4. Abstract: Improving efficiency and safety for patients who are unable
to self-administer insulin
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24471213

Br J Community Nurs. 2013 Oct;18(10):476-81.

Improving efficiency and safety for patients who are unable to self-
administer insulin.

Livingstone C1, Wolper S2, Rogers T3.

1East and South East England NHS Specialist Pharmacy Services.
carina.livingstone@nhs.net
2Hounslow and Richmond Community Healthcare NHS Trust.
3East and South East England NHS Specialist Pharmacy Services.

A one-day ‘snapshot’ study was conducted to determine the nature and
extent of specific safety issues faced by community nurses who care for
patients unable to self-administer insulin.

Community teams from 19 NHS trusts reported 607 patients requiring support
with insulin administration. In total, 15.1% of insulin administration
documents had an abbreviation for the word ‘units’, which is a serious
safety hazard where any resulting serious harm would be classed as a
‘never event’. Pens or disposable devices were used for 52.9% of all
administrations, with 16.7% using an insulin device without any previous
device-specific training.

Major differences were discovered between trusts in many aspects of
practice and insulin use, and comparative data can be used to benchmark
activity and drive safety and cost improvement For example, 50.9% of
patients had insulin administered more than once a day, but individual
trusts reported figures ranging from 25.9% to 66.7%.

If it were possible for all 19 trusts to manage 60% of patients on once-
daily regimens, total annual service costs could be reduced by about
pounds 200,000, or by pounds 3.5 million across the U.K.s.
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Anaphylaxis treatment: ergonomics of epinephrine autoinjector
design
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24384133

Am J Med. 2014 Jan;127(1 Suppl):S12-6.

Anaphylaxis treatment: ergonomics of epinephrine autoinjector design.

Dennerlein JT.

Northeastern University, Boston, Mass; Harvard School of Public Health,
Boston, Mass. Electronic address: j.dennerlein@neu.edu.

Epinephrine administration is a critical component of individualized
emergency action plans for patients at risk for anaphylaxis. Fundamental
ergonomic principles can be used to facilitate rapid and effective use of
an epinephrine autoinjector when appropriate. Specific patient
characteristics, including age and strength, that impact physical and
cognitive capabilities, should be considered when choosing an epinephrine
autoinjector.

Considerations in the optimal functioning of an autoinjector include the
device being portable, identifiable, safe, and effective. Size, shape,
coloring, and labeling of the device all contribute to the device being
portable and identifiable. Trigger-lock features, designs resistant to
physical perturbations, and safety technology to prevent injury after use
contribute to safety and reliability. Optimal grip designs, tailored in
size and/or shape to specific patient types, contribute to reliability and
effectiveness.

After selection of the most appropriate autoinjector, hands-on training,
practice, and drills should be implemented.

Copyright © 2014 Elsevier Inc. All rights reserved.

KEYWORDS: Allergy, Anaphylaxis, Autoinjector design, Emergency action
plan, Epinephrine, Ergonomics, Grip design

Full text http://www.amjmed.com/article/S0002-9343(13)00832-2/fulltext
__________________________________________________________________
________________________________*_________________________________

6. Abstract: HIV in Europe
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24559564

Clin Dermatol. 2014 Mar-Apr;32(2):282-5.

HIV in Europe.

Põder A1, Haldre M2.

1Tartu University Clinics Foundation, Clinic of Dermatovenerology, Raja
31, Tartu, Estonia. Electronic address: airi@std.ee.
2University of Tartu, Faculty of Medicine.

In 2011, the estimated number of people living with HIV in Europe and
Central Asia was 2.3 million. This is more than twice the 2001 figure. At
the same time, approximately 50% of the infected people may not know their
HIV status. The Europe/Central Asia region is one of only two regions in
which HIV infections continue to increase.

The estimated prevalence rate in the west and center of the region,
however, has remained stable at 0.2%. The HIV epidemics in Eastern Europe
and Central Asia are typically driven by unsafe drug injection and by
onward transmission to the sexual partners of people who inject drugs. In
the western part of the region, the epidemic remains concentrated among
men who have sex with men and migrants from countries with generalized
epidemics.

Means of preventing and fighting HIV should, first and foremost, be
directed to those parts of the population that are most exposed to the
risk of the infection. Proceeding from the data presented, recommendations
are given for ways of decreasing HIV prevalence in the region, such as
promoting dialogue and awareness among multistakeholders, including policy
makers, donors, and population groups most exposed to the infection.

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

7. Abstract: Hepatitis C among people who inject drugs in Tbilisi,
Georgia: An urgent need for prevention and treatment
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24529802

Int J Drug Policy. 2014 Jan 23. pii: S0955-3959(14)00010-3.

Hepatitis C among people who inject drugs in Tbilisi, Georgia: An urgent
need for prevention and treatment.

Bouscaillou J1, Champagnat J2, Luhmann N2, Avril E2, Inaridze I3, Miollany
V3, Labartkava K4, Kirtadze I5, Butsashvili M6, Kamkamidze G6, Pataut D2.

1Médecins du Monde, France. Electronic address:
Julie.bouscaillou@medecinsdumonde.net.
2Médecins du Monde, France.
3Médecins du Monde, Georgia.
4New Vector, Georgia.
5Addiction Research Center, Alternative Georgia, Tbilisi, Georgia.
6Neolab, Georgia.

BACKGROUND: Drug use and hepatitis C virus (HCV) are both major public
health issues in Georgia. However, the access to HCV prevention and care
is still very limited in the country. This study was conducted to examine
the HCV epidemic among people who inject drugs (PWID) in Tbilisi and to
assess the treatment needs of this most-at-risk population.

METHODS: Respondent-driven-sampling was used to obtain a sample of PWID in
Tbilisi. Each participant was interviewed face-to-face and underwent an
HCV antibody-based rapid diagnostic test. If a test was positive, a
further evaluation was performed, including direct detection of HCV by
PCR, genotyping and liver fibrosis assessment by transient elastography.
People needing urgent treatment were defined as those who were currently
infected and had severe liver fibrosis (liver stiffness above 10kPa).
Prevalences were calculated crude and then weighted to adjust for the
sampling method. Risk factors for liver fibrosis were studied using
generalized linear models.

RESULTS: A total of 216 PWID were recruited in October 2012. The mean age
was 39.6 and 7.9% were female. HCV antibodies were found in 91.9% of the
participants and 82.0% had a chronic infection. Among the chronically
infected participants, genotype 3 was predominant (66.9%) and 10.4% had
viruses from two different genotypes. Severe liver fibrosis was found in
24.2% of the infected participants (only in men) and was significantly
associated with the duration of drug use and coinfection with hepatitis B.

CONCLUSION: Georgian PWID are very exposed to HCV and have high levels of
severe liver fibrosis. Hence, harm reduction services should be scaled-up
in Georgia and HCV treatment programmes should be implemented straight
away and should include active drug users. Other risk factors for liver
fibrosis, such as hepatitis B, should be specifically addressed in this
population.

Copyright © 2014 Elsevier B.V. All rights reserved.

KEYWORDS: Drug users, Hepatitis C, Liver fibrosis, Respondent-driven
sampling, Treatment needs
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Hepatitis B virus prevalence, risk factors and genotype
distribution in HIV infected patients from West Java, Indonesia
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24529845

J Clin Virol. 2014 Jan 26. pii: S1386-6532(14)00032-8.

Hepatitis B virus prevalence, risk factors and genotype distribution in
HIV infected patients from West Java, Indonesia.

Fibriani A1, Wisaksana R2, Alisjahbana B2, Indrati A3, Schutten M4, van
Crevel R5, van der Ven A5, Boucher CA4.

1Department of Virology, Erasmus Medical Centre, Erasmus University
Rotterdam, The Netherlands; School of Life Science and Technology,
Institut Teknologi Bandung, Indonesia. Electronic address:
a.fibriani@erasmusmc.nl.
2Internal Medicine Department, Hasan Sadikin Hospital-Medical Faculty,
Universitas Padjadjaran Bandung, Indonesia.
3Clinical Pathology Department, Hasan Sadikin Hospital-Medical Faculty,
Universitas Padjadjaran Bandung, Indonesia.
4Department of Virology, Erasmus Medical Centre, Erasmus University
Rotterdam, The Netherlands.
5Department of General Internal Medicine, Radboud University Medical
Centre, Nijmegen, The Netherlands.

BACKGROUND: Indonesia currently faces both an increasing HIV incidence and
a high hepatitis B virus (HBV) burden.

OBJECTIVE: The objective of our study is to examine the prevalence, risk
factors, and genotypic distribution of HBV infection among HIV infected
patients in West Java, Indonesia.

STUDY DESIGN: A cross sectional study was conducted among a cohort of HIV
infected patients in 2008. Demographic and disease related variables were
compared between HBV negative and positive patients. Logistic regression
was applied to determine risk factors for HBV co-infection. HBV and HIV
genotyping was performed in co-infected patients.

RESULTS: Of 636 HIV-infected patients, the rate of HBV co-infection was
7%. The proportion of males was higher in HBV/HIV co-infected patients
than in HIV mono-infected patients (93% vs. 72%, P=0.001). A history of
injecting drug use (IDU), but not tattooing, was associated with HBV co-
infection [P=0.035 OR 2.41 (95% CI 1.06-5.47)]. In the HIV and HBV
treatment naive patients, CD4 cells counts <50cells/mm3, HIV-RNA plasma =
10,000copies/ml and AST level above normal were more often found in
patients with high HBV-DNA levels (=20,000IU/ml) as compared to those with
low HBV DNA (<20.000IU/ml) (P<0.05). As in the general population, B3 was
the dominant subtype in HBV co-infected patients.

CONCLUSION: The prevalence of active HBV infection and the genotype
distribution among HIV infected individuals is similar to the overall
population in Java. However, an increased prevalence was observed in men
with a history of IDU, underlining the need for routine HBV screening and
monitoring.

Copyright © 2014 Elsevier B.V. All rights reserved.

KEYWORDS: HBV, HIV, Indonesia
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Knowledge about human immunodeficiency virus infection and
sexual behavior among drug users: a cross sectional study in Pokhara
submetropolitan city, Nepal
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24550681

HIV AIDS (Auckl). 2014 Feb 12;6:1-7.

Knowledge about human immunodeficiency virus infection and sexual behavior
among drug users: a cross sectional study in Pokhara submetropolitan city,
Nepal.

Neupane SR, Mishra SR.

Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal.

Drug abuse is one of the public health problems in Nepal. Only limited
research has been done to explore knowledge and sexual behaviors of
injection drug users in Nepal.

The objective of this research was to explore knowledge about human
immunodeficiency virus (HIV) infection and sexual behavior among drug
users in Nepal.

More than 90% of participants had heard of HIV. Almost all participants
who had heard of HIV knew that HIV is transmitted through unsafe sexual
intercourse and through syringe use. In comparison to that, a small
percentage of participants knew of infected blood and mother to child as
modes of transmission of HIV. Injection drug users were less likely to use
condoms during sexual intercourse with their wives.

Awareness programs and behavior-change communication to alert drug users
to the risks of sharing syringes need to be conducted, in addition to
promoting the use of condoms during sexual intercourse with other women as
well as with their wives.

KEYWORDS: HIV, Nepal, drug use, sexual behavior

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3926783/
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Policies and politics that promote HIV infection in the
Southern United States
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24556871

AIDS. 2014 Feb 19.

Policies and politics that promote HIV infection in the Southern United
States.

Adimora AA1, Ramirez C, Schoenbach VJ, Cohen MS.

1aSchool of Medicine bUNC Gillings School of Global Public Health, The
University of North Carolina, Chapel Hill, North Carolina, USA.

The South has the highest rates of HIV infection, HIV-related mortality,
and many other adverse health outcomes in the United States. A number of
social, structural, and policy factors drive the poorer health and HIV
status of Southerners relative to other Americans. The South’s worse
health partly reflects its larger proportion of African Americans, who
experience disadvantages in health in all US regions, due to poverty and
racial discrimination. But after adjustment for race/ethnicity, HIV case-
fatality rates for nearly all Southern states are double those of the
state with the lowest rate.

Challenges to HIV prevention and care in the region include its large
rural population combined with a shortage of providers with expertise in
HIV treatment, lingering distrust of the healthcare system, homophobia,
and stigma toward people with HIV infection. Moreover, government
policies, facilitated by restrictions on voting, often reduce access to
HIV prevention and care through Medicaid, antiretroviral drugs, sex
education, and syringe exchange programs.

Many Southern states have pursued – and continue to pursue – policies that
impede earlier detection and treatment. These policies directly and
indirectly fuel the increased HIV incidence, morbidity, and mortality that
characterize the region and arguably represent a human rights violation.
__________________________________________________________________
________________________________*_________________________________

11. Abstract: POLYCLONAL OUTBREAK OF BLOODSTREAM INFECTIONS CAUSED BY
Burkholderia cepacia COMPLEX IN HEMATOLOGY AND BONE MARROW TRANSPLANT
OUTPATIENT UNITS
__________________________________________________________________
Rev Inst Med Trop Sao Paulo. 2014 Jan-Feb;56(1):71-6.

POLYCLONAL OUTBREAK OF BLOODSTREAM INFECTIONS CAUSED BY Burkholderia
cepacia COMPLEX IN HEMATOLOGY AND BONE MARROW TRANSPLANT OUTPATIENT UNITS.

Boszczowski I1, Prado GV1, Dalben MF1, Telles RC2, Freire MP1, Guimarães
T1, Oliveira MS1, Rosa JF2, Soares RE2, Llacer PE3, Dulley FL4, Costa SF2,
Levin AS1.

1Infection Control Department, Hospital das Clinicas, Universidade de São
Paulo, SP, Brazil, Infection Control Department, Hospital das Clinicas,
Universidade de São Paulo, SP, Brazil.
2Department of Infectious Diseases and LIM-54, University of São Paulo,
São PauloSP, Brazil, Department of Infectious Diseases and LIM-54,
University of São Paulo, São Paulo, SP, Brazil.
3Hematology Unit, Hospital das Clínicas, University of São Paulo, São
PauloSP, Brazil, Hematology Unit, Hospital das Clínicas, University of São
Paulo, São Paulo, SP, Brazil.
4Chief of Bone Marrow Transplant Unit, Hospital das Clínicas, University
of São Paulo, São PauloSP, Brazil, Chief of Bone Marrow Transplant Unit,
Hospital das Clínicas, University of São Paulo, São Paulo, SP, Brazil.

Aim: The objective was to describe an outbreak of bloodstream infections
by Burkholderia cepacia complex (Bcc) in bone marrow transplant and
hematology outpatients.

Methods: On February 15, 2008 a Bcc outbreak was suspected. 24 cases were
identified. Demographic and clinical data were evaluated. Environment and
healthcare workers’ (HCW) hands were cultured. Species were determined and
typed.

Reinforcement of hand hygiene, central venous catheter (CVC) care,
infusion therapy, and maintenance of laminar flow cabinet were undertaken.

16 different HCWs had cared for the CVCs. Multi-dose heparin and saline
were prepared on counter common to both units.

Findings: 14 patients had B. multivorans (one patient had also B.
cenopacia), six non-multivorans Bcc and one did not belong to Bcc. Clone A
B. multivorans occurred in 12 patients (from Hematology); in 10 their CVC
had been used on February 11/12. Environmental and HCW cultures were
negative. All patients were treated with meropenem, and ceftazidime lock-
therapy. Eight patients (30%) were hospitalized. No deaths occurred.

After control measures (multidose vial for single patient; CVC lock with
ceftazidime; cleaning of laminar flow cabinet; hand hygiene improvement;
use of cabinet to store prepared medication), no new cases occurred.

Conclusions: This polyclonal outbreak may be explained by a common source
containing multiple species of Bcc, maybe the laminar flow cabinet common
to both units.

[**] There may have been contamination by B. multivorans (clone A) of
multi-dose vials.

Free full text http://tinyurl.com/mgcgtlo
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________________________________*_________________________________

12. Abstract: Percutaneous injuries amongst Greek endodontists: a national
questionnaire survey
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23013210

Int Endod J. 2013 Mar;46(3):264-74.

Percutaneous injuries amongst Greek endodontists: a national questionnaire
survey.

Zarra T1, Lambrianidis T.

1Department of Endodontology, Dental School, Aristotle University of
Thessaloniki, Thessaloniki, Greece. theozarra@gmail.com

AIM: To investigate amongst Greek endodontists the incidence of
percutaneous injuries, the circumstances associated with them, the
therapeutic measures taken after the injuries and their compliance with
infection control measures.

METHODOLOGY: One hundred and forty-seven endodontists met the inclusion
criteria and were invited to participate in the survey. Personal and
professional data, information on percutaneous injuries in the past 5
years and on infection control practices were gathered through interviews
based on a questionnaire. Data were analysed using chi-square test,
independent samples t-test, one-way anova and Pearson’s correlation
coefficient. The level of significance was set at P = 0.05.

RESULTS: The response rate was 84%. The injury rate was estimated at 1.35
per endodontist per year. Endodontic files were associated with 37% of the
injuries and fingers were injured in 75% of the most recent cases. Medical
assistance was sought in 36% of the most recent injuries. Endodontists who
always or usually practiced 4-handed endodontics (P = 0.007) as well as
those not performing surgical endodontics (P = 0.007) reported
significantly fewer injuries. In 91% of the participants, a complete
hepatitis B virus vaccination was reported. Gloves, masks, rubber dam
isolation and puncture-resistant containers for disposal of sharp
instruments were always used by 98%, 94%, 100% and 81% of the respondents,
respectively.

CONCLUSIONS: The injury rate was low. The practice of four-handed
endodontics was associated with a reduced number of percutaneous injuries;
the performance of surgical endodontics increased their incidence. Greek
endodontists showed a high level of compliance with infection control
measures.

© 2012 International Endodontic Journal.
__________________________________________________________________
________________________________*_________________________________

13. Abstract: Preparation and administration of injectable antibiotics: a
tool for nurses
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24427920

Rev Infirm. 2013 Dec;196:38-40.

[Preparation and administration of injectable antibiotics: a tool for
nurses].

[Article in French]

Guillaudin M1, Griveaux A2, Te Bonle F2, Jandard V2, Paillet M2, Camus G2,
Galvez O2, Bohand X2.

1Hôpital d’Instruction des Armies Percy, 101 avenue Henry Barbusse, 92140
Clamart, France. morgane.guillaudin@wanadoo.fr 2Hôpital d’Instruction des
Armies Percy, 101 avenue Henry Barbusse, 92140 Clamart, France.

Nurses, the main caregivers to administer medications, often find
themselves lacking the information which is nevertheless essential for the
preparation of injectable antibiotics.

This problem, frequent in hospitals, impacts on patient safety. On the
initiative of the pharmacy and nursing staff, a tool has been created in
the Percy Army Teaching Hospital in Clamart.
__________________________________________________________________
________________________________*_________________________________

14. No Abstract: New legislation provides greater protection from sharps
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24427828

Qld Nurse. 2013 Aug;32(4):46.

New legislation provides greater protection from sharps.

[No authors listed]
__________________________________________________________________
________________________________*_________________________________

15. No Abstract: The sticking point: diabetic sharps disposal practices in
the community
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23377844

J Gen Intern Med. 2013 Jul;28(7):868-9.

The sticking point: diabetic sharps disposal practices in the community.

Costello J1, Parikh A.

1Internal Medicine Faculty Practice, Saint Barnabas Medical Center, 94 Old
Short Hills Road, Livingston, NJ, 07039, USA. jcostello@barnabashealth.org

PMC3682034 [Available on 2014/7/1]
__________________________________________________________________
________________________________*_________________________________

16. News

– USA: Boy, 12, stuck by ‘dirty needle’
– USA: Dirty drug needle concern prompts school campaign
– Spain: Ten Alicante patients contract hepatitis through medical
negligence Same saline solution bag was used for several intravenous
transfusions

Selected news items reprinted under the fair use doctrine of international
copyright law: http://www4.law.cornell.edu/uscode/17/107.html
__________________________________________________________________
http://www.therolladailynews.com/article/20140224/NEWS/140229323/1001/NEWS

USA: Boy, 12, stuck by ‘dirty needle’

By Paul Hackbarth,The Rolla Daily News, Rolla MO USA (24.02.14)

Rolla police say a 12-year-old boy was stuck by a “dirty needle” after he
and another 12-year-old boy started playing with several used hypodermic
syringes they found Friday afternoon, Feb. 21.

According to a news release by the Rolla Police Department, the two boys
found the syringes near the road in the 1000 block of Laguille Court
between Mark Twain Elementary School and Rolla Middle School.

Police say while the two boys were playing with the syringes, one of the
boys was stuck in the arm with one of the needles.

The parent of that boy learned about the incident and contacted
authorities Monday morning, Feb. 24.

The parent was directed to take the child to the emergency room.
Rolla Police Chief Mark Kearse said Tuesday he did not know the status of
the boy, saying testing takes some time.

The syringes found also will be tested.

Kearse said there are not that many labs available in Missouri, so testing
the syringes for fingerprints would be difficult and timely. Kearse also
said the RPD has no database to compare to any potential prints found.
Some dangers associated with getting stuck by a used syringe include what
potential drugs or chemicals the syringe had in it and whether the person
who used the syringe has any diseases.

According to the RPD, in the past year alone, used syringes have been
found in public parks, near schools and at school bus stops. One
individual even found a used syringe in her fenced backyard where her
toddler plays.

Parents should remind their children not to touch hypodermic syringes,
according the police. If children find a hypodermic syringe, they should
immediately show their parent, guardian or trusted adult where it is so it
can be reported to the RPD.

An officer will respond and will safely recover and dispose of the syringe

Read more:
www.therolladailynews.com/article/20140224/News/140229323#ixzz2uOflyK9e
__________________________________________________________________
__________________________________________________________________
http://tinyurl.com/m3k35up

USA: Dirty drug needle concern prompts school campaign

by ZAHID ARAB, KING 5 News, Washington USA (21.02.14)

OLYMPIA, Wash. — Concern over dirty drug needles found on Olympia’s
Madison Elementary campus has prompted the school to take action.
While the school was closed for construction this fall, parents say it
became a hangout for the homeless with the area littered with dirty drug
needles.

“You have to be concerned, I’ve got three little kids,” said Nathan Allan,
a parent.

Allan along with other parents from the group “Concerned Olympians”
brought the issue to the attention of Principal Domenico Spatola-Knoll,
who took swift action. To raise awareness and protect students, the school
created the “Stop! Don’t Touch! Get an Adult!”Campaign.

“Without safety, we really can’t do our job educating kids,” he said.
Through the help of the Thurston County Health Department, Spatola-Knoll
and all staff members received training on how to spot and discard unsafe
materials. Custodians also do an extensive sweep of the campus throughout
the day.

“It’s our job to help them understand that things on the ground might be
dangerous, might be sharp, help them recognize things they shouldn’t
touch,” said Spatola-Knoll.

Allan says what could carry HIV or Hepatitis may look like treasure to
young kids.

“It’s different. You don’t see a needle every day,” said Allan.
The school has now placed a needle collection bin in the nurse’s office
and hung posters addressing the issue all over campus.

In his community, Allan says it’s a lesson kids need to learn.

“We live in a great neighborhood; the reality is not everyone is a good
person. It gives you peace of mind; you want to know that you’re sending
your kid to a safe place,” said Allan.

An exact number of how many items have been picked up at Madison
Elementary was not available.
__________________________________________________________________
__________________________________________________________________
http://elpais.com/elpais/2014/02/20/inenglish/1392899253_764004.html

Spain: Ten Alicante patients contract hepatitis through medical negligence
Same saline solution bag was used for several intravenous transfusions

By Jaime Prats, El Pais, Spain (20.02.14)

Ten patients at Marina Baixa Hospital, in Villajoyosa (Alicante province),
were infected with hepatitis C due to medical negligence, an official
report shows. The case was uncovered when a 35-year-old woman filed a
complaint after a routine checkup found her to have contracted the disease
during her stay at this public health center in December 2011.

An internal investigation found that nine other patients were infected
around the same time, probably due to the use of the same saline solution
bag for intravenous transfusions on several patients, instead of
individual bags as recommended by good practice guidelines.

The report by the epidemiology section of the Valencian health service is
dated August 30, 2013, but was not released until this week. On Monday,
the Patient Ombudsman association said it had filed a complaint with the
Valencian Health Agency over the case of the 35-year-old woman who was the
first to realize that her sudden infection was linked to her surgery at
Marina Baixa Hospital in late 2011.

My client panics about the possibility of infecting her husband as well”
“She is emotionally distraught; they’ve ruined her life,” says her lawyer,
Ignacio Martínez. “She panics about the possibility of infecting her
husband as well. She’s afraid of having sexual relations.”

Sources at the Valencian government admitted the facts and said there are
seven legal and administrative proceedings underway following complaints
by other affected patients. The report notes that there might have been
even more cases, but 13 other target patients were dead by the time the
study was conducted, while investigators were unable to locate a British
national who was also hospitalized at the center on December 1, 2011.

The study concludes that “the date of exposure was probably between
November 30 and December 1.” Investigators feel that the most likely
culprit is a bag of saline solution used originally on a patient who had
the virus, then on the others.

On the night of December 29, the original hepatitis C carrier suffered a
digestive hemorrhage. Health workers opened up a second intravenous line
for an emergency transfusion. It is possible, the report says, that
stabilizing the patient required using the saline solution several times
via a process that involves extracting the liquid with a needle and
injecting it into the patient’s catheter. “If, during this process, the
same needle were inadvertently used, the multidosage saline solution bag
would have been contaminated.”

Of the 10 patients who were infected, as of the report’s drafting three
had already required medical treatment, and a fourth was about to embark
on it. One more had died because of an unrelated pathology. Regional
health authorities told EL PAÍS that multidosage bags are no longer being
used.

“These cases are very rare,” says Rafael Cantón, vice-president of the
Spanish Society for Infectious Diseases and Clinical Microbiology.
“Hospital infection rates have dropped very significantly in Spain.”

Hepatitis C may be present in the body without any symptoms, which creates
the long-term risk of liver damage in the shape of cirrhosis or liver
cancer. In 20-25 percent of people who have been in contact with the
virus, the pathogen disappears spontaneously. For the rest, the sooner
treatment begins, the greater the possibilities of eradicating the
infection, notes Enrique Ortega, head of the infectious disease unit at
the Valencia General Hospital. Treating patients with ribavirin and
interferon during the six months following infection raises the chances of
success to 90 percent.

After a six-month treatment, the 35-year-old woman who denounced her case
now has a very low viral content in her body, says her lawyer. “But she is
still devastated.”
__________________________________________________________________
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The 2010 annual Safe Injection Global Network meeting to aid collaboration
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The SIGN 2010 meeting report pdf, 1.36Mb is available on line at:
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