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SIGNpost 00740

 

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST *SAFE INJECTION GLOBAL NETWORK*

Post00740 Waste + Patients + NSI + IDU + Abstracts + News 09 April 2014

CONTENTS
1. Forecasting and Disposal of Unusable Health Commodities
2. New: Voluntary Medical Male Circumcision (VMMC) Health Care Waste
Management (HCWM) Toolkit
3. Abstract: Protecting patient safety in resource-poor settings
4. Abstract: A prospective look at the burden of sharps injuries and
splashes among trauma health care workers in developing countries: True
picture or tip of iceberg
5. Abstract: Relationship between nurse staffing levels and nurse outcomes
in community hospitals, Thailand
6. Abstract: Needlestick and sharps injuries among dental healthcare
workers at a university hospital
7. Abstract: Risk factors of hepatitis B transmission in northern
Palestine: a case – control study
8. Abstract: The Staying Safe Intervention: Training People Who Inject
Drugs in Strategies to Avoid Injection-Related HCV and HIV Infection
9. Abstract: High prevalence of HCV coinfection in HIV-infected
individuals in Shiraz, Islamic Republic of Iran
10. Abstract: Epidemiological Implications of HIV-Hepatitis C Co-Infection
in South and Southeast Asia
11. Abstract: Implementation of a nurse-delivered intravitreal injection
service
12. Abstract: Improving hospital staff compliance with environmental
cleaning behavior
13. Abstract: Hand sanitizer-dispensing door handles increase hand hygiene
compliance: A pilot study
14. Abstract: Complications of Injectable Fillers, Part 2: Vascular
Complications
15. Abstract: Suppression by Thimerosal of Ex-Vivo CD4+ T Cell Response to
Influenza Vaccine and Induction of Apoptosis in Primary Memory T Cells
16. No Abstract: OSHA-required and CDC-recommended workplace training
17. No Abstract: “Infectious” infection control
18. Ebola virus disease, West Africa – WHO update
19. News
– UK: NHS adviser calls for needle exchanges for steroid users
– Nigeria: ‘23m Nigerians Live With Hepatitis Unknowingly’
– USA: Girl, 2, stuck by ‘dirty needle’ – Second report of child stuck in
Rolla since February
– Scotland UK: Victims of contaminated blood products still demanding
justice

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__________________________________________________________________
________________________________*_________________________________

1. Forecasting and Disposal of Unusable Health Commodities

New Videos from the USAID | DELIVER PROJECT
__________________________________________________________________
Forecasting and Disposal of Unusable Health Commodities

New Videos from the USAID | DELIVER PROJECT

To help logisticians around the world build their professional capacities,
the USAID | DELIVER PROJECT has developed two new videos on technical
topics in supply chain management.

“Disposing of Unusable Health Commodities” discusses the importance of
following recommended practices when disposing of pharmaceutical waste.

“The Art and Science of Forecasting” provides an overview of the complex
task of forecasting health commodity needs for a country.

To view these videos, visit the USAID | DELIVER PROJECT website at
http://goo.gl/vHOCNg

Anne Marie Hvid, PMP
Knowledge Management Advisor
USAID | DELIVER PROJECT
John Snow, Inc.
1616 Fort Myer Drive, 16th floor
Arlington, VA 22209 USA
Phone: +1.703.310.5256
email: ahvid@jsi.com
http://deliver.jsi.com/
__________________________________________________________________
________________________________*_________________________________

2. New: Voluntary Medical Male Circumcision (VMMC) Health Care Waste
Management (HCWM) Toolkit
__________________________________________________________________
Scott Ackerson (03.04.14)

It is my great pleasure to announce the launch of the Voluntary Medical
Male Circumcision (VMMC) Health Care Waste Management (HCWM) Toolkit. This
toolkit was developed as a result of a request to the Supply Chain
Management System Project (SCMS) by USAID to assist program implementers
with the waste management challenges associated with VMMC programs.

The
toolkit contains guidance on the development of a waste management system
to support VMMC programs, standard operating procedures on waste disposal
and training tools for waste handlers and transporters. Based on South
African National Standards, International Best Practice and the SCMS
Health Care Waste Management Model, this comprehensive set of tools
provides guidance on building HCWM operational infrastructure, improves
staff capacity and aids stakeholders in managing the waste generated by
VMMC campaigns.

Additionally, the SCMS project has developed a guidebook and interactive
website to help program staff navigate through the tools and provide a
basic understanding of their purpose and their interdependence in
implementing the VMMC HCWM model. Each component is introduced in a
stand-alone section that includes an overview, timeline, useful tools and
guidance document.

The guidebook and all accompanying tools and resources are contained
within the interactive website and have been approved by the PEPFAR VMMC
Technical Working Group. The VMMC HCWM toolkit may now be accessed through
the following website: www.scms.pfscm.org/scms/hcwm_toolkit

A webinar providing a technical overview of the toolkit and related VMMC
commodities has been scheduled for April 22, 2014 from 9:00AM – 10:00AM
EST. Further information regarding this webinar will be provided in due
course.

In addition to the SCMS staff who worked on this toolkit, I would like to
thank the staff in following organizations for their involvement in
developing the materials for the VMMC Health Care Waste Management (HCWM)
Toolkit: Population Services International (PSI), JHPIEGO, Futures Group
and the Swaziland Ministry of Health – Environmental Health Department.
Finally, I request that you kindly disseminate this email to relevant
agency contacts or other stakeholder for their reference.

For further information regarding this or any other SCMS HCWM activities,
please contact Scott Ackerson, sackerson@pfscm.org or Tom Layloff,
tlayloff@pfscm.org.
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Protecting patient safety in resource-poor settings
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23642352

Best Pract Res Clin Obstet Gynaecol. 2013 Aug;27(4):497-508.

Protecting patient safety in resource-poor settings.

Galadanci HS.

Department of Obstetrics and Gynaecology, Aminu Kano Teaching Hospital,
No. 1, Zaria Road, PMB 3254, Kano, Nigeria. hgaladanci@yahoo.com

A crucial element in the delivery of high-quality health care is patient
safety. The rate of adverse events among hospital patients is an
indication of patient safety.

A systematic review of in-hospital adverse events revealed the median
incidence of adverse events as 9.2%; 7.4% were lethal and 43.5%
preventable. All the studies in the systemic review were from developed
countries, as research is lacking from developing countries.

In 2012, data from 10 developing countries reported adverse events ranging
from 2.5 to 18.4% per country; 30% were lethal and 83% preventable.

This study places patient safety as one of the major concerns of the
health policy agenda in developing countries. Human resources for health
deficits in developing countries constitute a major structural constraint
for ensuring patient safety.

The key to reducing adverse events in health care is system-based
interventions rather than clinical interventions or technologies.

Patient safety skills training, effective communication, and good team
work are essential in improving patient safety in developing countries.

Research on patient safety is needed to address the knowledge gap in
developing countries.

Copyright © 2013 Elsevier Ltd. All rights reserved.

KEYWORDS: adverse events, developing countries, drug adverse events,
healthcare acquired infections, patient safety, quality health care,
surgical adverse events
__________________________________________________________________
________________________________*_________________________________

4. Abstract: A prospective look at the burden of sharps injuries and
splashes among trauma health care workers in developing countries: True
picture or tip of iceberg
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24680470

Injury. 2014 Mar 11. pii: S0020-1383(14)00122-3.

A prospective look at the burden of sharps injuries and splashes among
trauma health care workers in developing countries: True picture or tip of
iceberg.

Rajkumari N1, Thanbuana BT2, John NV3, Gunjiyal J4, Mathur P5, Misra MC6.

1Department of Laboratory Medicine (Microbiology Division), Jai Prakash
Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New
Delhi 110029, India. Electronic address: nonika.raj@gmail.com.
2Hospital Infection Control, Jai Prakash Narayan Apex Trauma Centre, All
India Institute of Medical Sciences, New Delhi 110029, India. Electronic
address: SWEETBT123@gmail.com.
3Hospital Infection Control, Jai Prakash Narayan Apex Trauma Centre, All
India Institute of Medical Sciences, New Delhi 110029, India. Electronic
address: johnnibu@yahoo.com.
4Hospital Infection Control, Jai Prakash Narayan Apex Trauma Centre, All
India Institute of Medical Sciences, New Delhi 110029, India. Electronic
address: jacintagunjiyal@yahoo.co.in.
5Department of Laboratory Medicine (Microbiology Division), Jai Prakash
Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New
Delhi 110029, India. Electronic address: purvamathur@yahoo.co.in.
6Department of Surgery, Jai Prakash Narayan Apex Trauma Centre, All India
Institute of Medical Sciences, New Delhi 110029, India. Electronic
address: mcmisra@gmail.com.

OBJECTIVES: Health care workers (HCWs) face constant risk of exposure to
cuts and splashes as occupational hazard. Hence, a prospective
observational study was conducted to observe the exposure of HCWs to
various sharp injuries and splashes during health care and to work up a
baseline injury rate among HCWs for future comparison in trauma care set
ups.

METHODS: A 2 year and 5 month study was conducted among the voluntarily
reported exposed HCWs of the APEX trauma centre. Such reported cases were
actively followed for 6 months after testing for viral markers and
counselled. The outcomes of such exposed HCWs and rate of seroconversion
was noted. To form a future reference point, the injury rate in trauma
care HCWs based on certain defined parameters along with the rate of under
reporting were also analysed in this study.

RESULTS: In our study, doctors were found to have the highest exposure
(129, 36.2%), followed by nurses (52, 14.6%) and hospital waste disposal
staff (27, 7.6%). Of the source patients, a high number of them were HBV
positive (11, 3.1%), followed by HIV positive patients (8, 2.2%). No
seroconversion was seen in any of the exposed HCWs. Injuries by sharps
(303, 85.1%) outnumber those due to splashes (53, 14.9%) which were much
higher in those working in pressing situations. Underreporting was common,
being maximally prevalent in hospital waste disposal staff (182, 51.1%).

CONCLUSIONS: High rates of exposure to sharp injuries and splashes among
HCWs call for proper safety protocols. Proper methods to prevent it,
encouraging voluntary reporting and an active surveillance team are the
need of the hour.

Copyright © 2014 Elsevier Ltd. All rights reserved.

KEYWORDS: Blood borne viral infections, Health care workers, Injury rate,
Needlestick injury, Post-exposure prophylaxis, Splashes, Underreporting
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Relationship between nurse staffing levels and nurse outcomes
in community hospitals, Thailand
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24698300

Nurs Health Sci. 2014 Apr 4.

Relationship between nurse staffing levels and nurse outcomes in community
hospitals, Thailand.

Nantsupawat A1, Nantsupawat R, Kulnaviktikul W, McHugh MD.

1Department of Nursing Administration, Chiang Mai University, ChiangMai,
Thailand.

A growing body of research has shown an association between nurse staffing
levels and a range of nurse outcomes. There is little empirical research
evaluating this relationship in Thailand.

This study evaluated the influence of nurse staffing levels on outcomes
among nurses. A cross- sectional survey design was conducted at 92
community hospitals using a stratified random sampling design across
Thailand during May and July 2012. Questionnaires included items focusing
on nurse staffing levels; job dissatisfaction and emotional exhaustion,
both related to nurse retention; and needlestick and sharps injuries. The
study sample comprised 1412 registered nurses who provided direct patient
care.

The findings showed that each additional patient per nurse was associated
with an additional 5% of nurses reporting dissatisfaction in their job; 8%
of nurses reporting high emotional exhaustion, and 4% of nurses reporting
needlestick and sharps injuries.

This study provides evidence of how nurse staffing levels result in nurse
outcomes. Nurses are significant healthcare providers that directly affect
quality of care and patient safety in hospitals. Improvement of nurse
staffing levels holds promise for improving nurse outcomes in Thailand.

© 2014 Wiley Publishing Asia Pty Ltd.

KEYWORDS: Thailand, burnout, job dissatisfaction, needlestick injuries,
nurse staffing levels, sharps injuries
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Needlestick and sharps injuries among dental healthcare
workers at a university hospital
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24685298

J Formos Med Assoc. 2014 Apr;113(4):227-33

Needlestick and sharps injuries among dental healthcare workers at a
university hospital.

Lee JJ1, Kok SH1, Cheng SJ1, Lin LD1, Lin CP2.

1Department of Dentistry, National Taiwan University Hospital, Taipei,
Taiwan; Department of Dentistry, School of Dentistry, National Taiwan
University College of Medicine, Taipei, Taiwan.
2Department of Dentistry, National Taiwan University Hospital, Taipei,
Taiwan; Department of Dentistry, School of Dentistry, National Taiwan
University College of Medicine, Taipei, Taiwan. Electronic address:
pinlin@ntu.edu.tw.

BACKGROUND/PURPOSE:
Needlestick/sharps injuries (NSI) are a major occupational hazard among
healthcare workers. Since needles and sharps are commonly used during
dental procedures, workers in the dental profession are especially prone
to sharps-related injuries. In this study, NSI among workers in the dental
department of National Taiwan University Hospital (NTUH) were analyzed to
find out the risk factors associated with NSI.

METHODS: NSI cases reported by the Department of Dentistry to NTUH from
2009 to 2011 were collected. Correlations between NSI and parameters
related to the events were analyzed.

RESULTS: A total of 56 NSI events including 31 occurring during surgical
treatment and 25 occurring during cleanup procedure were reported. The
annual incidence of NSI was 8.19% among all dental workers. NSI incidences
per person-year were 21.28% for interns, 7.50% for residents, 6.77% for
nursing staffs, 3.33% for clerks, and 0.85% for attending doctors (P <
0.001, chi-square test). NSI events occurred more frequently in the 3-
month period from July to September (20 cases), on Wednesday (18 cases) or
Friday (14 cases), and at the hours from 11:00 to 14:00 and after 16:00
(39 cases). Dental injection needle (19 cases) was the most common
instrument involved in NSI and 9 of these 19 needle injuries occurred
during need removal.

CONCLUSION: NSI events tend to occur in dental personnel (interns) with
lesser clinical skill and experience, in the period (from July to
September) when new interns and residents join the clinic, on the working
days in the middle (Wednesday) and end (Friday) of the week, and at the
hours close to lunch break (11:00 to 14:00) and getting off duty (after
16:00). In addition, establishment of standard operating procedure for
injection needle removal is necessary, because one-third of NSI are
needle-related. Copyright © 2012. Published by Elsevier B.V.

KEYWORDS: blood-borne diseases, dental healthcare workers, dental
injection needle, interns, needlestick, sharps injuries
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Risk factors of hepatitis B transmission in northern
Palestine: a case – control study
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24678920

BMC Res Notes. 2014 Mar 28;7(1):190.

Risk factors of hepatitis B transmission in northern Palestine: a case –
control study.

Nazzal Z1, Sobuh I.

1Assistant Professor in Community Medicine, Faculty of Medicine and Health
Sciences, An-Najah National University, Box 7,707, Nablus, Palestine.
znazzal@najah.edu.

BACKGROUND: The Hepatitis B (HB) infection is a significant health problem
in Palestine, which is categorized as an HB virus moderate endemic area,
with the HB carrier rate ranging from 2-6%. The aim of this study is to
determine the risk factors of Hepatitis transmission in the northern areas
of Palestine in order to help prevent and control this prevalent health
problem.

METHODS: A case-control study was implemented to achieve the study
objectives. One hundred HB virus seropositive cases and another 100
seronegative controls were included in the study. Univariate analysis and
a logistic regression model were performed to examine probable risk
factors of acquisition of HB infections.

RESULTS: Univariate analysis showed that HB case-patients were more likely
to report having a history of blood transfusion, dental visits,
hospitalization, Hejamat, sharing shaving equipments, intravenous drug
use, or living abroad than controls were. The logistic regression model
revealed a history of dental visits to be the most significant risk
factor, (P value <0.001, OR 5.6; 95% CI 2.8-11.1).

CONCLUSION: The presence of these risk factors emphasizes the need for
both increasing the uptake of HB vaccine and implementing risk-targeted
public health education. Development and enforcement of appropriate
infection control guidelines for dental care services are important to
prevent HB virus transmission as well.

Free full text http://www.biomedcentral.com/1756-0500/7/190
__________________________________________________________________
________________________________*_________________________________

8. Abstract: The Staying Safe Intervention: Training People Who Inject
Drugs in Strategies to Avoid Injection-Related HCV and HIV Infection
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24694328

AIDS Educ Prev. 2014 Apr;26(2):144-57.

The Staying Safe Intervention: Training People Who Inject Drugs in
Strategies to Avoid Injection-Related HCV and HIV Infection.

Mateu-Gelabert P, Gwadz MV, Guarino H, Sandoval M, Cleland CM, Jordan A,
Hagan H, Lune H, Friedman SR.

This pilot study explores the feasibility and preliminary efficacy of the
Staying Safe Intervention, an innovative, strengths-based program to
facilitate prevention of infection with the human immunodeficiency virus
and with the hepatitis C virus among people who inject drugs (PWID).

The authors explored changes in the intervention’s two primary endpoints:
(a) frequency and amount of drug intake, and (b) frequency of risky
injection practices.

We also explored changes in hypothesized mediators of intervention
efficacy: planning skills, motivation/self-efficacy to inject safely,
skills to avoid PWID-associated stigma, social support, drug- related
withdrawal symptoms, and injection network size and risk norms. A 1-week,
fivesession intervention (10 hours total) was evaluated using a pre-
versus 3-month posttest design. Fifty-one participants completed pre- and
posttest assessments.

Participants reported significant reductions in drug intake and injection-
related risk behavior. Participants also reported significant increases in
planning skills, motivation/self- efficacy, and stigma management
strategies, while reducing their exposure to drug withdrawal episodes and
risky injection networks.
__________________________________________________________________
________________________________*_________________________________

9. Abstract: High prevalence of HCV coinfection in HIV-infected
individuals in Shiraz, Islamic Republic of Iran
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24684094

East Mediterr Health J. 2013 Dec;19(12):975-81.

High prevalence of HCV coinfection in HIV-infected individuals in Shiraz,
Islamic Republic of Iran.

Alipour A, Rezaianzadeh A, Hasanzadeh J, Rajaeefard A, Davarpanah MA,
Hasanabadi M.

We carried out a cross-sectional survey in Shiraz to determine the
prevalence of hepatitis C virus (HCV) in 1 444 individuals infected with
human immunodeficiency virus (HIV). We also determined the risk factors
for this coinfection. Demographic and behavioural data were obtained using
a standard questionnaire. The prevalence of HIV-HCV coinfection was 78.4%
(95% CI: 76.3-80.5).

Intravenous drug use (OR = 7.2; 95% CI: 4.9-10.6), imprisonment (OR = 6.9;
95% CI: 4.6-10.4), tattooing in prison (OR = 2.61; 95% CI: 1.4-4.8),
tattooing out of prison (OR = 2.0; 95% CI: 1.3-3.1) and age (OR = 1.02
with increasing each year of life; 95% CI: 1.0-1.04) were significantly
associated with HCV-HIV coinfection.

Prevalence of HCV-HIV coinfection is high in Shiraz. Intravenous drug use
and imprisonment are the main risk factors for this coinfection.

Therefore, serious implementation of HIV and HCV testing, education,
prevention, care and treatment programmes and evaluation of harm reduction
programmes in prisons are very important.
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Epidemiological Implications of HIV-Hepatitis C Co-Infection
in South and Southeast Asia
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24682917

Curr HIV/AIDS Rep. 2014 Mar 29.

Epidemiological Implications of HIV-Hepatitis C Co-Infection in South and
Southeast Asia.

Ye S1, Pang L, Wang X, Liu Z.

1National Center for AIDS/STD Control and Prevention, China Center for
Disease Control and Prevention, 155 Changbai Road, Changping District,
Beijing, 102206, People’s Republic of China, yeshaodong@chinaaids.cn.

We sought to profile the epidemiological implication of human
immunodeficiency virus (HIV) and hepatitis C virus (HCV) co-infection from
South and Southeast Asia by reviewing original studies reporting
prevalence of HIV-HCV co-infection and their risk factors. Thirteen papers
cited in the PubMed database and published in 2012 and 2013 were reviewed.

The overall HCV co-infection prevalence ranged broadly from 1.2 % to 98.5
% among HIV-positive people in South and Southeast Asia. Among HCV
seropositive blood donors in Nepal, 5.75 % had HIV co-infection.

Injecting drug use (IDU) was one of the key risk factors of co-infection,
with HCV infection reaching 89.8 % and 98.5 % among HIV-positive injecting
drug users in Vietnam.

The most recent data from South and Southeast Asia suggest the urgency of
implementation of comprehensive prevention and control strategies of HIV-
HCV co-infection.

Open Access Full Free Text
http://link.springer.com/article/10.1007%2Fs11904-014-0206-z
__________________________________________________________________
________________________________*_________________________________

11. Abstract: Implementation of a nurse-delivered intravitreal injection
service
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24699166

Eye (Lond). 2014 Apr 4.

Implementation of a nurse-delivered intravitreal injection service.

Dacosta J, Hamilton R, Nago J, Mapani A, Kennedy E, Luckett T, Pavesio C,
Flanagan D.

Medical Retina Service, Moorfields Eye Hospital, London, UK.

Purpose: The purpose of this study was to introduce nurse-delivered
intravitreal injections to increase medical retina treatment capacity.

Methods: Indemnity, clinical governance, training, planning, and
implementation issues were addressed. The outcome measures were patient
safety, patient experience, and clinic capacity.

Results: No serious vision- threatening complications were recorded in a
consecutive series of 4000 nurse-delivered intravitreal injections. A
Mann-Whitney test showed a significant increase in intravitreal injections
(P=0.003) in the medical retina service after introduction of nurse-
delivered intravitreal injections. The majority of patients accepted and
were satisfied with a nurse-delivered intravitreal injection.

Discussion: Nurse-delivered intravitreal injections appear safe,
acceptable to patients, and are an effective means to increase
intravitreal injection capacity in medical retina clinics.
__________________________________________________________________
________________________________*_________________________________

12. Abstract: Improving hospital staff compliance with environmental
cleaning behavior
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24688183

Proc (Bayl Univ Med Cent). 2014 Apr;27(2):88-91.

Improving hospital staff compliance with environmental cleaning behavior.

Ramphal L, Suzuki S, McCracken IM, Addai A.

Cook Children’s Hospital, Fort Worth, Texas (Ramphal); and the Departments
of Environmental Health (Ramphal, Addai) and Biostatistics (Suzuki,
McCracken), the University of North Texas School of Public Health. Dr.
Ramphal is now with Blue Cross Blue Shield.

Reducing the incidence of healthcare-associated infections requires proper
environmental cleanliness of frequently touched objects within the
hospital environment.

An intervention was launched in June 2012 and repeated in February 2013
and August 2013 to increase hospital room cleanliness with repeated
education and training of nursing and environmental services staff to
reduce healthcare-associated infections at Cook Children’s Medical Center.

Random rooms were tested, staff were trained about proper cleaning, rooms
were retested for surface cleanliness, and preintervention and
postintervention values were compared.

The percentage of cleaned surfaces improved incrementally between the
three trials-with values of 20%, 49%, and 82% showing that repeat training
favorably changed behavior in the staff (P = 0.007). During the study
period, during which other infection control interventions were also
introduced, there was a decline from 0.27 to 0.21 per 1000 patient days
for Clostridium difficile infection, 0.43 to 0.21 per 1000 patient days
for ventilator-associated infections, 1.8% to 1.2% for surgical site
infections, and 1.2 to 0.7 per 1000 central venous line days for central
line-associated bloodstream infections.

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3954653/
__________________________________________________________________
________________________________*_________________________________

13. Abstract: Hand sanitizer-dispensing door handles increase hand hygiene
compliance: A pilot study
__________________________________________________________________
Am J Infect Control. 2014 Apr;42(4):443-5.

Hand sanitizer-dispensing door handles increase hand hygiene compliance: A
pilot study.

Babiarz LS1, Savoie B2, McGuire M2, McConnell L3, Nagy P2.

1The Russell H. Morgan Department of Radiology and Radiological Sciences,
The Johns Hopkins Medical Institutions, Baltimore, MD. Electronic address:
lbabiar1@jhmi.edu.
2The Russell H. Morgan Department of Radiology and Radiological Sciences,
The Johns Hopkins Medical Institutions, Baltimore, MD.
3The Johns Hopkins Hospital, The Johns Hopkins Medical Institutions,
Baltimore, MD.

Improving rates of hand hygiene compliance (HHC) has been shown to reduce
nosocomial disease.

We compared the HHC for a traditional wall-mounted unit and a novel
sanitizer-dispensing door handle device in a hospital inpatient ultrasound
area. HHC increased 24.5%-77.1% (P < .001) for the exam room with the
sanitizer-dispensing door handle, whereas it remained unchanged for the
other rooms.

Technical improvements like a sanitizer- dispensing door handle can
improve hospital HHC.

Copyright © 2014 Association for Professionals in Infection Control and
Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

KEYWORDS: Handwashing, Infection control, Nosocomial disease
__________________________________________________________________
________________________________*_________________________________

14. Abstract: Complications of Injectable Fillers, Part 2: Vascular
Complications
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24692598

Aesthet Surg J. 2014 Apr 1.

Complications of Injectable Fillers, Part 2: Vascular Complications.

Delorenzi C.

Dr DeLorenzi is a plastic surgeon in private practice in Kitchener,
Ontario, Canada.

Accidental intra-arterial filler injection may cause significant tissue
injury and necrosis. Hyaluronic acid (HA) fillers, currently the most
popular, are the focus of this article, which highlights complications and
their symptoms, risk factors, and possible treatment strategies. Although
ischemic events do happen and are therefore important to discuss, they
seem to be exceptionally rare and represent a small percentage of
complications in individual clinical practices. However, the true
incidence of this complication is unknown because of underreporting by
clinicians.

Typical clinical findings include skin blanching, livedo reticularis, slow
capillary refill, and dusky blue-red discoloration, followed a few days
later by blister formation and finally tissue slough. Mainstays of
treatment (apart from avoidance by meticulous technique) are prompt
recognition, immediate treatment with hyaluronidase, topical nitropaste
under occlusion, oral acetylsalicylic acid (aspirin), warm compresses, and
vigorous massage. Secondary lines of treatment may involve intra-arterial
hyaluronidase, hyperbaric oxygen therapy, and ancillary vasodilating
agents such as prostaglandin E1.

Emergency preparedness (a “filler crash cart”) is emphasized, since early
intervention is likely to significantly reduce morbidity. A clinical
summary chart is provided, organized by complication presentation.

KEYWORDS: Freudenthal syndrome, HA filler, Nicolau syndrome, cosmetic
medicine, dermal fillers, embolia cutis medicamentosa, hyaluronic acid,
hyaluronic acid complications, hyaluronidase (HYAL), intravascular
injections, soft tissue filler, vascular complications
__________________________________________________________________
________________________________*_________________________________

15. Abstract: Suppression by Thimerosal of Ex-Vivo CD4+ T Cell Response to
Influenza Vaccine and Induction of Apoptosis in Primary Memory T Cells
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24690681

PLoS One. 2014 Apr 1;9(4):e92705.

Suppression by Thimerosal of Ex-Vivo CD4+ T Cell Response to Influenza
Vaccine and Induction of Apoptosis in Primary Memory T Cells.

Loison E1, Poirier-Beaudouin B1, Seffer V1, Paoletti A2, Abitbol V3,
Tartour E4, Launay O5, Gougeon ML1.

1Antiviral Immunity Biotherapy and Vaccine Unit, Institut Pasteur, Paris,
France.
2Inserm U1030, Institut Gustave Roussy, Villejuif, France.
3Gastroenterology Department, Hôpital Cochin, AP-HP, Paris, France.
4Inserm U970, Université Paris Descartes, PARCC/HEGP, Paris, France.
5Centre d’Investigation Clinique BT-505, Hôpital Cochin, AP-HP, Paris,
France.

Thimerosal is a preservative used widely in vaccine formulations to
prevent bacterial and fungal contamination in multidose vials of vaccine.

Thimerosal was included in the multidose non-adjuvanted pandemic 2009 H1N1
vaccine Panenza.

In the context of the analysis of the ex-vivo T cell responses directed
against influenza vaccine, we discovered the in vitro toxicity Panenza,
due to its content in thimerosal. Because thimerosal may skew the immune
response to vaccines, we investigated in detail the ex- vivo effects of
thimerosal on the fate and functions of T cells in response to TCR
ligation.

We report that ex-vivo exposure of quiescent or TCR-activated primary
human T cells to thimerosal induced a dose-dependent apoptotic cell death
associated with depolarization of mitochondrial membrane, generation of
reactive oxygen species, cytochrome c release from the mitochondria and
caspase-3 activation. Moreover, exposure to non-toxic concentrations of
thimerosal induced cell cycle arrest in G0/G1 phase of TCR-activated T
cells, and inhibition of the release of proinflammatory cytokines such as
IFN gamma, IL-1 beta, TNF alpha, IL-2, as well as the chemokine MCP1. No
shift towards Th2 or Th17 cells was detected.

Overall these results underline the proapoptotic effect of thimerosal on
primary human lymphocytes at concentrations 100 times less to those
contained in the multidose vaccine, and they reveal the inhibitory effect
of this preservative on T-cell proliferation and functions at nanomolar
concentrations.

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3972181/
__________________________________________________________________
________________________________*_________________________________

16. No Abstract: OSHA-required and CDC-recommended workplace training
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24579263

Dent Assist. 2013 Nov-Dec;82(6):14.

OSHA-required and CDC-recommended workplace training.

[No authors listed]
__________________________________________________________________
________________________________*_________________________________

17. No Abstract: “Infectious” infection control
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24579261

Dent Assist. 2013 Nov-Dec;82(6):6, 8.

“Infectious” infection control.

Henjes KD.

39th Medical Operations Squadron, 39th Dental Clinic, Incirlik Air Base,
Turkey.
__________________________________________________________________
________________________________*_________________________________

18. Ebola virus disease, West Africa – WHO update
__________________________________________________________________
http://www.who.int/csr/don/2014_04_07_ebola/en/

Ebola virus disease, West Africa – update (07.04.14)

WHO Disease Outbreak News

7 APRIL 2014 – As of 7 April, a cumulative total of 151 clinically
compatible cases, including 95 deaths had officially been reported from
Guinea. Laboratory investigations continue at the Institut Pasteur (IP)
Dakar laboratory in Conakry (65 samples tested, of which 34 are positive
by PCR for ebolavirus) and at the European Union Mobile Laboratory (EMLab)
team in Guekedou (36 samples tested/20 positive). Medical observation is
continuing for 535 contacts. There have been no new cases in health-care
workers since the last report and no new areas are affected.

As of 7 April, the Ministry of Health and Social Welfare (MOHSW) of
Liberia has reported a cumulative total of 5 laboratory confirmed cases
and 16 suspected and probable cases of Ebola virus disease (EVD),
including 10 deaths. All 5 laboratory confirmed cases have died. The most
recent death is in a probable case of EVD from Montserrado. Three cases
have occurred in health-care workers, all of whom have died. The date of
onset of the most recent confirmed case is 6 April, with 6 patients
currently hospitalised. At present 28 contacts remain under medical
observation.

There has been no change in the epidemiological situation of EVD in Sierra
Leone. The Ministry of Health and Sanitation of Sierra Leone has confirmed
that 2 suspected cases of viral haemorrhagic fever are laboratory
confirmed as Lassa fever which is endemic in Sierra Leone.

The Ministry of Health of Mali has reported a cumulative total of 6
suspected cases as of 7 April, 2 of which have tested negative for
ebolavirus infection and other viral haemorrhagic fever viruses in assays
conducted by the U.S. Centers for Disease Control and Prevention (CDC) in
Atlanta. Samples from the 4 remaining suspected cases have today been sent
to CDC and the Institut Pasteur, Dakar, for testing.

The Ministry of Health of Ghana has excluded EVD in a 12 year-old girl who
died of an acute febrile illness in Kumasi City and who was reported in
the media as a suspected case of ebolavirus infection. Laboratory testing
of her clinical samples was conducted at the Noguchi Memorial Institute
for Medical Research, University of Ghana in Accra.

As this is a rapidly changing situation, the number of reported cases and
deaths, contacts under medical observation and the number of laboratory
results are subject to daily changes due to consolidation of case, contact
and laboratory data, enhanced surveillance and contact tracing activities
and ongoing laboratory investigations.

WHO does not recommend that any travel or trade restrictions be applied to
Guinea, Liberia, Mali or Sierra Leone based on the current information
available for this event.

This update has also been posted on the regional website of the WHO
African Regional Office
__________________________________________________________________
________________________________*_________________________________

19. News

– UK: NHS adviser calls for needle exchanges for steroid users
– Nigeria: ‘23m Nigerians Live With Hepatitis Unknowingly’
– USA: Girl, 2, stuck by ‘dirty needle’ – Second report of child stuck in
Rolla since February
– Scotland UK: Victims of contaminated blood products still demanding
justice

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/nddlcqg

UK: NHS adviser calls for needle exchanges for steroid users

By Sarah Boseley and Haroon Siddique, theguardian.com (09.04.14)

Nice says NHS should provide services at gyms and develop policies to help
young people who inject performance drugs

Needle exchange centres should be set up all over England to help protect
the growing numbers of young people injecting steroids and other
performance drugs, say NHS advisers.

Heroin addicts are no longer the only people in danger of contracting HIV
and hepatitis C from reusing needles and syringes, says the National
Institute for Health and Care Excellence.

Clinics are seeing increasing numbers of body-conscious young men, as well
as young people of both sexes who are injecting new psychoactive
substances for a bigger and cheaper hit. About 60,000 people, at a
conservative estimate, injected anabolic steroids last year, says Nice.

Needle exchange programmes were set up in the 1980s and 90s when the Aids
epidemic took off to cope with what was at the time the new and lethal
threat of HIV infection. Now they are facing a new challenge with the
emergence of a different kind of drug injector.

Nice recommends that the NHS should provide services at gyms and outside
working hours and develop policies to help people aged under 18 – and even
under 16 – who are injecting.

Separately, a study published by the Lancet medical journal has found that
offering heroin addicts £30 in shopping vouchers incentivises them to have
the three successive vaccinations to protect themselves against hepatitis
B, a cause of cirrhosis and liver cancer.

Only 9% of those offered advice to have the vaccination completed the
course on time, compared with over 45% of those who received vouchers as a
reward.

Harm reduction clinics offering clean needles and syringes have for some
time been seeing a new category of clientele alongside heroin users. David
Rourke, from CRI’s Arundel Street Project, a harm reduction programme in
Sheffield, said they had started with a fortnightly clinic for steroid
users, which became weekly, and they had people coming through the door
seven days a week.

“We know there are many more people out there who are using needle and
syringe programmes because this group of users do not see themselves as
drug users,” he said. “Traditionally they are more sexually active than
users of heroin or crack, so there is more potential for the spread on
infections through sex.”

He said young people were also injecting new psychoactive substances –
“any of the legal highs”. These include mephedrone, known as MCAT or Meow
Meow; methoxetamine, called mexxy or MXE; and ketamine, or ket. “We’re
hearing of people trying to inject pretty much any of them,” he said.
Price was one reason – they could get a bigger hit with a smaller quantity
compared with other drugs.

Competitive bodybuilders were not the only people injecting steroids,
Rourke said. There were also “people who want to look good to go out on a
Friday night, those who work on construction sites and even people who
work in emergency services.” They all wanted to feel at peak physical
capacity, he said.

The study on shopping voucher incentives for hepatitis B vaccinations was
carried out in 12 NHS centres countrywide by experts from King’s College,
Imperial College and University College in London. Professor John Strang,
from King’s National Addiction Centre, who led the study, called it a
“definitive trial”, which should lead to financial incentives for drug
users being adopted in the NHS.

About 15-25% of people with chronic hepatits B die of liver disease.
Vaccination would save lives and save the NHS money that would be spent in
treatment. A further trial of offering cocaine addicts vouchers to quit is
under way. Financial incentives for breastfeeding and attending for
cervical cancer smears have also been considered.
__________________________________________________________________
__________________________________________________________________
http://leadership.ng/news/363766/23m-nigerians-live-hepatitis-unknowingly

Nigeria: ‘23m Nigerians Live With Hepatitis Unknowingly’

By Patrick Ochoga, Leadership, Nigeria (07.04.14)

Over 23million Nigerians are living with the dreaded Hepatitis disease
without even knowing it, according to Clem Agba Foundation (TCAF) saddled
with the responsibility of raising awareness aimed at tackling the
scourge.

The foundation also lamented the low level of awareness and urged relevant
government agencies and departments to do more in the area of awareness
creation.

Founder of the foundation, Mr Clem Agba made the call when he formally
launched the foundation to mark his 50th birthday. He had earlier embarked
on free medical tests and treatments in Edo North Senatorial District.

Speaking at the ceremony, the Edo State commissioner for environment said
he decided to set up the foundation with special focus on Hepatitis
largely because he lost two close relatives, his mother, Mrs Philomena
Agba and brother-in-law, Victor Okpako, whom he said both succumbed to
cancer which was caused by Hepatitis C and B respectively.

Explaining reasons for his mission, he stated “It is about creating
awareness about the neglected killer, hepatitis, and instituting a
foundation to engage in public awareness campaigns, evidence-based data
for action, prevention of the causative virus’ transmission, as well as
screening, counselling, care and providing further treatment.”

“Hepatitis is a silent global epidemic that has infected 370million people
and is responsible for almost 1million deaths annually.

“Recent statistics indicate that not less than 23million Nigerians are
estimated to be infected with the Hepatitis B virus (HBV), making Nigeria
one of the countries with the highest incidence of HBV infection in the
world. Most of the people who are infected are unaware of their infection
and this has resulted in the hepatitis infection becoming one of the
biggest threats to the health of the world.

He added that the foundation would help those who may not be able to
access government provisions in the health sector.
__________________________________________________________________
__________________________________________________________________
http://www.therolladailynews.com/article/20140407/NEWS/140408881/-1/news

USA: Girl, 2, stuck by ‘dirty needle’ – Second report of child stuck in
Rolla since February

By Paul Hackbarth, The Rolla Daily News, Missouri USA (07.04.14)

A 2-year-old girl became the second child reported to be stuck by a “dirty
needle” in Rolla in the last seven weeks.

According to the Rolla Police Department’s daily media log, an entry for
Sunday, April 6, stated that the girl was “stuck in her left palm with a
‘dirty needle’ while playing in her front yard” in the 900 block of Fourth
Street.

According to Rolla police, a 12-year-old boy was stuck in the arm by a
“dirty needle” after he and another 12-year-old boy started playing with
several used hypodermic syringes they found Feb. 21 in the 1000 block of
Laguille Court near Mark Twain Elementary School.

Lt. Doug James, of the RPD, said Monday that these two children were the
only ones he knew of that had been stuck by the used syringes.

There have been several other reports over the last few months of used
syringes found in Rolla, including 12 used syringes found on the East
Central?College/Rolla Technical Center campus on Forum Drive on March
12-13.

James said he was unsure why there seemed to be an increased number of
reports of used syringes found. “It could be that the public is just more
aware,” James said.

A post from Sunday on the police department’s Facebook page states that
“drug users (who also carry communicable diseases) would rather throw
their used contaminated needles in conspicuous places so they don’t get
busted by the police for being in ‘possession of drug paraphernalia.’ The
problem is when we have heavy rains like we had a few days ago those
needles float out of those places and into places where children can find
them.”

Parents should remind their children not to touch hypodermic syringes,
according the police. If somebody finds a hypodermic syringe, they should
immediately report it to the RPD, and an officer will respond to safely
recover and dispose of the syringe.
__________________________________________________________________
__________________________________________________________________
http://tinyurl.com/nosnb3c

Scotland UK: Victims of contaminated blood products still demanding
justice

STV, Scotland UK (04.04.14)

People infected with Hepatitis C from contaminated blood products say
they’re still being denied justice after ten years.

A decade ago a judge recommended damages and more support for victims and
their families.

But campaigners say little progress has been made on providing adequate
compensation and other help for those infected in the 1970s and 80s.

The plight of those infected by contaminated blood in the 1970s and 80s,
has been the focus of petitions, committees and expert panels.

Campaigners say they’re still waiting for the recommendations issued a
decade ago by another judge, Lord Ross to be fully implemented.

The Ross Report called for multi-million damages, specialist care and more
action to find possible victims.

The Scottish government say from 1995, all reasonable measures were taken
to trace those affected.

A spokesperson added that ministers intend to review the financial support
for victims after the Penrose Inquiry reports back. This may now be
delayed until after the independence referendum.
__________________________________________________________________
________________________________*_________________________________
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Facsimile: +41 22 791 4836 E- mail: sign@who.int
__________________________________________________________________
________________________________*_________________________________

The 2010 annual Safe Injection Global Network meeting to aid collaboration
and synergy among SIGN network participants worldwide was held from 9
to 11 November 2010 in Dubai, The United Arab Emirates.

The SIGN 2010 meeting report pdf, 1.36Mb is available on line at:
http://www.who.int/entity/injection_safety/toolbox/sign2010_meeting.pdf

The report is navigable using bookmarks and is searchable. Viewing
requires the free Adobe Acrobat Reader at: http://get.adobe.com/reader/

Translation tools are available at: http://www.google.com/language_tools
or http://www.freetranslation.com
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