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SIGNpost 00764

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST

Post00764 Devices + Policy + Yves Chartier Award + + 17 September 2014

CONTENTS
1. WHO Announcement @TEDMED: The new global initiative on Injection Safety
2. Global: WHO Mandates New Single-Use Syringe
3. The Yves Chartier Award 2014: Water, Sanitation–Toilets, Injection
Safety In the era of antimicrobial resistance and climate change
4. Guide to Health Care Waste Management for CHWs now available in French
5. Updated Guidelines for Warehousing Health Commodities
6. Abstract: Knowledge and practices about hospital waste disposal and
universal safety precautions in class IV employee
7. Abstract: Healthcare workers’ occupational exposure to bloodborne
pathogens: A 5-year observation in selected hospitals of the Malopolska
province
8. Abstract:Practice gaps in patient safety among dermatology residents
and their teachers: a survey study of dermatology residents
9. Abstract: Do community-based strategies reduce HIV risk among people
who inject drugs in China? A quasi-experimental study in Yunnan and
Guangxi provinces
10. Abstract: Risk Behaviors, Prevalence of HIV and Hepatitis C Virus
Infection and Population Size of Current Injection Drug Users in a
China-Myanmar Border City: Results from a Respondent-Driven Sampling
Survey in 2012
11. Abstract: Filtration of crushed tablet suspensions has potential to
reduce infection incidence in people who inject drugs
12. Abstract: Risk Factors for HCV Infection Among Young Adults in Rural
New York Who Inject Prescription Opioid Analgesics
13. Abstract: Temporal trends in mortality among people who use drugs
compared with the general Dutch population differ by hepatitis C virus
and HIV infection status
14. Abstract: Initial Experience and Evaluation of Reusable Insulin Pen
Devices Among Patients with Diabetes in Emerging Countries
15. Abstract: Nurses’ Perceptions and Satisfaction with the Use of Insulin
Pen Devices Compared with Insulin Vial and Syringes in an Inpatient
Setting
16. Abstract: Hospital hygiene – Where are we in the sixth year of
“Operation Clean Hands”?
17. Abstract: The issue of mandatory vaccination for healthcare workers in
Europe
18. Abstract: Do Intra-Articular Steroid Injections Increase Infection
Rates in Subsequent Arthroplasty? A Systematic Review and Meta-
Analysis of Comparative Studies
19. Abstract: Relationship Between Delayed Reactions to Dermal Fillers and
Biofilm: Facts and Considerations
20. Abstract: Elevated Lidocaine Serum Concentration After Subcutaneous
Lidocaine Administration Using a Needle-Free Device in Pediatric
Patients
21. No Abstract: Breaking the silence on viral hepatitis
22. News
– Indiana USA: Celina Police Department Issues Warning About Hypodermic
Needles
– WHO to Start New Global Health Initiative For Needle Safety
– Kentucky USA: Heroin epidemic fuels another scourge: hepatitis C:
Kentucky ranks No. 1 for the bloodborne virus
– U.S. air marshal in quarantine after suspected Ebola syringe attack at
Lagos airport

The web edition of SIGNpost is online at:
http://signpostonline.info/archives/1739

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__________________________________________________________________
________________________________*_________________________________

1. WHO Announcement @TEDMED: The new global initiative on Injection Safety
__________________________________________________________________
WHO Announcement at TEDMED

The new global initiative on Injection Safety

The World Health Organisation’s Deputy Director General, Dr Marie-Paule
Kieny announces a global initiative on injection safety


__________________________________________________________________
________________________________*_________________________________

2. Global: WHO Mandates New Single-Use Syringe
__________________________________________________________________
http://www.medscape.com/viewarticle/831604

Global: WHO Mandates New Single-Use Syringe

Marcia Frellick, Medscape Medical News [Edited] (12.09.14)

WASHINGTON, DC — Two innovations — a syringe that auto-disables so it
can’t be reused and a blood test that allows extensive results from a tiny
sample — are providing low-cost answers to some of the world’s most
confounding healthcare challenges.

British inventor Marc Koska created the K-1 (LifeSaver) syringe 20 years
ago, but until now, single-use needles were required by the World Health
Organization (WHO) only for immunizations, which represent 5% of the
global market. The other 95% pertained to the curative market, where there
is no global policy governing syringe use.

But that’s about to change.

Speaking to a TEDMED 2014 audience here, Koska played a video message from
Marie Paule Kieny, WHO assistant director general for health systems and
innovation, who said that by 2017, all health systems in the world will
have to switch to auto-disable syringes.

Koska said the directive is “only the third-ever global initiative that
the WHO has issued in their 66-year history.”

With a WHO mandate, “all parties involved in healthcare — manufacturers,
ministers, funders, as well as nurses and patients — will see the scourge
of iatrogenic infections end, and healthcare around the developing world
will be revolutionized,” Koska added in a news release.

He said WHO puts deaths from dirty needles at 1.3 million a year, twice
the number of deaths from malaria, making it the ninth leading cause of
deaths worldwide. Koska says he became aware of dirty needles’ role in
spreading AIDS, hepatitis, and other diseases when he was in his 20s and
decided to devote his life to inventing a syringe that couldn’t be reused.

Cutting Infection

“There is an incredible burden on healthcare workers in the developing
world when there aren’t the supplies that they need,” Koska said.

The K-1 syringe has a tiny locking ring in the barrel. When the plunger is
depressed, it passes the ring and can’t be pulled out to refill. Forced
extraction breaks the device.

Dr. Kieny said, “WHO’s new injection safety policy, combined with the work
of many partners in implementing the policy, in the next 2 years will
usher the world in a new era of safe, single-use syringes and needles for
all injections. This will finally bring an end to needless harm to
millions of healthcare workers and patients.”
__________________________________________________________________
________________________________*_________________________________

3. The Yves Chartier Award 2014: Water, Sanitation–Toilets, Injection
Safety In the era of antimicrobial resistance and climate change

Email your nominations to Safe Observer <garance@safeobserver.org>
__________________________________________________________________
The Yves Chartier Award 2014: “Water, Sanitation–Toilets, Injection Safety
In the era of antimicrobial resistance and climate change”

The Yves Chartier Award 2014 rewards an NGO, or an actor from civil
society, from an African country, who will have elaborated a campaign or
achieved an innovative project in the struggle against antimicrobial
resistance and climate change, relative to one of three specific domains
of intervention : Water – Sanitation & Toilets – Injection Safety. The
French engineer Yves Chartier who died in a mountain accident January 8,
2012, was an international functionary in the World Health Organization
(WHO) who had brought major contributions in these three domains of
intervention.

This initiative comes from civil society, in collaboration with the French
Ministry of Health, contributing the sum of five thousand euros, to honor
the memory of a man who devoted his life to «la santé publique à la
française » (The French concept of public health). This follows the 2012
event to honor his Memory at the World Health Assembly with an
International Journal for People’s Health, which includes the list of all
the Yves Chartier contributions while at WHO:
http://signpostonline.info/sign-links/peoples-health-movement-france.

The official call for candidacies was announced by Garance F. Upham,
President of Safe Observer International (SOI), at the WHO first world
conference on “Health and Climate Change” on Wednesday August 27th during
the plenary in the WHO headquarters. The call for candidacies will be
ongoing for two months. The winner to be selected early November, the
Award to be given end of November. The best five projects/campaigns to be
reported on in a brochure and presented at a press event.

Email nominations to Safe Observer <garance@safeobserver.org>

CANDIDACY FORM:

Name of the project or campaign:

Summary: (300 words maximum)

Description: (1500 words maximum)

Name of the Association, NGO, Network or Institute:

Country
Project officer Name, Firstname
Address
Telephone
E-mail
Web Site

Documentation about the project / the campaign

Add, in electronic format, any document that supports the application:
official documents, meeting reports, testimonies, press articles,
references on the Web…
__________________________________________________________________
________________________________*_________________________________

4. Guide to Health Care Waste Management for CHWs now available in French
__________________________________________________________________
Guide to Health Care Waste Management for CHWs now available in French

The USAID | DELIVER PROJECT has published a French language version of the
Guide to Health Care Waste Management for the Community Health Worker.
This illustrated guide is now available in French and English.

This publication provides practical guidance for community health workers
on how to safely handle and dispose of hazardous waste. It describes the
basic principles of waste management and offers solutions for managing the
waste generated from everyday activities carried out in the community.

Learn more at http://bit.ly/1pXyOeD

Anne Marie Hvid, PMP
Knowledge Management Advisor
USAID | DELIVER PROJECT
deliver.jsi.com
PHONE: 703.310.5256
WWW.JSI.COM
Anne Marie Hvid <anne_marie_hvid[at]jsi.com>
__________________________________________________________________
________________________________*_________________________________

5. Updated Guidelines for Warehousing Health Commodities
__________________________________________________________________
The USAID | DELIVER PROJECT has published an updated version of the
Guidelines for Warehousing Health Commodities. This publication
updates the 2005 warehousing guidelines and was written for anyone
trying to meet and solve the challenges of operating a warehouse
today.

The guidelines are an important reference tool for managers and staff,
whether they are constructing a new warehouse, implementing a new
warehouse system, or redesigning their current system. Guidelines for
Warehousing Health Commodities is for supply chain managers, logistics
advisors, and warehouse managers who want to improve and increase
efficiency in their current health commodity warehouse.

Learn more at http://bit.ly/1shM3Z9

Anne Marie Hvid, PMP
Knowledge Management Advisor
USAID | DELIVER PROJECT
deliver.jsi.com
PHONE: 703.310.5256
WWW.JSI.COM
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Knowledge and practices about hospital waste disposal and
universal safety precautions in class IV employee
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25141555

J Commun Dis. 2013 Mar-Jun;45(1-2):59-64.

Knowledge and practices about hospital waste disposal and universal safety
precautions in class IV employee.

Megha K, Daksha P.

Norms and guidelines are formed for safe disposal of hospital waste but
question is whether these guidelines are being followed and if so, to what
extent. Hence, this study was conducted with objective to study the
knowledge and practices about hospital waste disposal and universal safety
precautions in class IV employee and to study its relationship with
education, occupation and training.

A cross-sectional study was carried out in a teaching hospital in Mumbai
using semi-structured questionnaire in which Class IV employee were
included. Questionnaire was filled by face to face interview. Data were
analyzed using SPSS.

48.7% Class IV employee were not trained. More than 40% were following
correct practices about disinfection of infectious waste. None of the
respondents were using protective footwear while handling hospital waste.
Only 25.5% were vaccinated for hepatitis B. 16% had done HIV testing due
to contact with blood, body fluid, needle stick injury.

Knowledge and practices about hospital waste disposal and universal
precaution were statistically significant in trained respondents. Training
of employees should be given top priority; those already in service should
be given on the job training at the earliest.
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Healthcare workers’ occupational exposure to bloodborne
pathogens: A 5-year observation in selected hospitals of the Malopolska
province
__________________________________________________________________
Int J Occup Med Environ Health. 2014 Sep 10.

Healthcare workers’ occupational exposure to bloodborne pathogens: A 5-
year observation in selected hospitals of the Malopolska province.

Rózanska A1, Szczypta A, Baran M, Synowiec E, Bulanda M, Walaszek M.

1Chair of Microbiology, Jagiellonian University Medical College, Kraków,
Poland, rozanska@ifb.pl.

OBJECTIVES: The study presents data concerning occupational exposures
among the staff of 5 hospitals in the Malopolska province in 2008-2012,
taking into account the frequency and circumstances of exposure formation,
occupational groups of hospital workers, as well as diversification of the
reported rates in subsequent years between the hospitals and in each of
them. An additional objective of the analysis was to assess the practical
usefulness of the reported data for planning and evaluation of the
effectiveness of procedures serving to minimize the risk of healthcare
workers’ exposure to pathogens transmitted through blood.

MATERIAL AND METHODS: Data were derived from occupational exposure
registries kept by 5 hospitals of varying sizes and operational profiles
from the Malopolska province from the years 2008-2012.

RESULTS: Seven hundred and seventy-five cases of exposure were found in a
group of 3165 potentially exposed workers in the analyzed period. Most
cases were observed in nurses (68%) and these were mainly various types of
needlestick injuries (78%). Exposure rates with respect to all workers
ranged from 2.6% to 8.3% in individual hospitals, but the differences in
their values registered in the hospitals in subsequent years did not bear
any statistical significance, in a way similar to the rates calculated
separately for each occupational group.

CONCLUSIONS: There was no upward or downward trend in the number of
reported cases of exposure to bloodborne pathogens in the studied period
in any of the hospitals. Statistically significant differences in the
percentages of exposures were reported between individual hospitals in
some years of the analyzed period, which confirms the need for registries
in individual units in order to plan and evaluate the effectiveness of
preventative measures.
__________________________________________________________________
________________________________*_________________________________

8. Abstract:Practice gaps in patient safety among dermatology residents
and their teachers: a survey study of dermatology residents
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24718731

JAMA Dermatol. 2014 Jul;150(7):738-42.

Practice gaps in patient safety among dermatology residents and their
teachers: a survey study of dermatology residents.

Swary JH, Stratman EJ.

Department of Dermatology, Marshfield Clinic, Marshfield, Wisconsin.
Abstract

IMPORTANCE: Curriculum and role modeling adjustments are necessary to
address patient safety gaps occurring during dermatology residency.

OBJECTIVE: To identify the source of clinical practices among dermatology
residents that affect patient safety and determine the best approach for
overcoming gaps in knowledge and practice patterns that contribute to
these practices.

DESIGN, SETTING, AND PARTICIPANTS: A survey-based study, performed at a
national medical dermatology meeting in Itasca, Illinois, in 2012,
included 142 dermatology residents from 44 residency programs in the
United States and Canada.

MAIN OUTCOMES AND MEASURES: Self-reported rates of dermatology residents
committing errors, identifying local systems errors, and identifying poor
patient safety role modeling.

RESULTS: Of surveyed dermatology residents, 45.2% have failed to report
needle-stick injuries incurred during procedures,

82.8% reported cutting and pasting a previous author’s patient history
information into a medical record without confirming its validity, 96.7%
reported right-left body part mislabeling during examination or biopsy,
and 29.4% reported not incorporating clinical photographs of lesions
sampled for biopsy in the medical record at their institution. Residents
variably perform a purposeful pause (“time-out”) when indicated to confirm
patient, procedure, and site before biopsy, with 20.0% always doing so. In
addition, 59.7% of residents work with at least 1 attending physician who
intimidates the residents, reducing the likelihood of reporting safety
issues they witness.

Finally, 78.3% have witnessed attending physicians purposefully
disregarding required safety steps.

CONCLUSIONS AND RELEVANCE: Our data reinforce the need for modified
curricula, systems, and teacher development to reduce injuries, improve
communication with patients and between physicians, residents, and other
members of the health care team, and create an environment free of
intimidation.
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Do community-based strategies reduce HIV risk among people
who inject drugs in China? A quasi-experimental study in Yunnan and
Guangxi provinces
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24885778

Harm Reduct J. 2014 May 6;11:15.

Do community-based strategies reduce HIV risk among people who inject
drugs in China? A quasi-experimental study in Yunnan and Guangxi
provinces.

Wang K1, Fu H, Longfield K, Modi S, Mundy G, Firestone R.

1PSI/China, 909-9 F, M2 Building, Harmonious Society, Xiaokang Rd, Hongyun
Community, Wuhua District, Kunming 650000, China. uangkai@gmail.com.

BACKGROUND: HIV transmission among people who inject drugs (PWID) is high
in Yunnan and Guangxi provinces in southwest China. To address this
epidemic, Population Services International (PSI) and four cooperating
agencies implemented a comprehensive harm reduction model delivered
through community-based drop-incenters (DiC) and peer-led outreach to
reduce HIV risk among PWID.

METHODS: We used 2012 behavioral survey data to evaluate the effectiveness
of this model for achieving changes in HIV risk, including never sharing
needles or syringes, always keeping a clean needle on hand, HIV testing
and counseling (HTC), and consistent condom use. We used respondent-driven
sampling to recruit respondents. We then used coarsened exact matching
(CEM) to match respondents during analysis to improve estimation of the
effects of exposure to both DiC and outreach, only DiC, and only outreach,
modeled using multivariable logistic regression.

RESULTS: We found a significant relationship between participating in both
peer-led DiC-based activities and outreach and having a new needle on hand
(odds ratio (OR) 1.53, p?<?.05) and consistent condom use (OR 3.31,
p?<?.001). We also found a significant relationship between exposure to
DiC activities and outreach and HIV testing in Kunming (OR 2.92, p?<?.01)
and exposure to peer-led outreach and HIV testing through referrals in
Gejiu, Nanning, and Luzhai (OR 3.63, p?<?.05).

CONCLUSIONS: A comprehensive harm reduction model delivered through peer-
led and community-based strategies reduced HIV risk among PWID in China.
Both DiC activities and outreach were effective in providing PWID behavior
change communications (BCC) and HTC. HTC is best offered in settings like
DiCs, where there is privacy for testing and receiving results. Outreach
coverage was low, especially in Guangxi province where the implementation
model required building the technical capacity of government partners and
grassroot organizations. Outreach appears to be most effective for
referring PWID into HTC, especially when DiC-based HTC is not available
and increasing awareness of DiCs where PWID can receive more intensive BCC
interventions.

Free Full Article http://www.harmreductionjournal.com/content/11/1/15
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Risk Behaviors, Prevalence of HIV and Hepatitis C Virus
Infection and Population Size of Current Injection Drug Users in a
China-Myanmar Border City: Results from a Respondent-Driven Sampling
Survey in 2012
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25203256

PLoS One. 2014 Sep 9;9(9):e106899.

Risk Behaviors, Prevalence of HIV and Hepatitis C Virus Infection and
Population Size of Current Injection Drug Users in a China-Myanmar Border
City: Results from a Respondent-Driven Sampling Survey in 2012.

Li L1, Assanangkornchai S2, Duo L3, McNeil E2, Li J4.

1Yunnan Institute of Drug Abuse, Kunming, Yunnan, P.R. China; Epidemiology
Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla,
Thailand.
2Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat
Yai, Songkla, Thailand.
3HIV/AIDS Asia Regional Program Yunnan Management Office, Kunming, Yunnan,
P.R. China.
4Yunnan Institute of Drug Abuse, Kunming, Yunnan, P.R. China.

BACKGROUND: Injection drug use has been the major cause of HIV/AIDS in
China in the past two decades. We measured the prevalences of HIV and
hepatitis C virus (HCV) prevalence and their associated risk factors among
current injection drug users (IDUs) in Ruili city, a border region
connecting China with Myanmar that has been undergoing serious drug use
and HIV spread problems. An estimate of the number of current IDUs is also
presented.

METHODS: In 2012, Chinese IDUs who had injected within the past six months
and aged =18 years were recruited using a respondent-driven sampling (RDS)
technique. Participants underwent interviews and serological testing for
HIV, HBV, HCV and syphilis. Logistic regression indentified factors
associated with HIV and HCV infections. Multiplier method was used to
obtain an estimate of the size of the current IDU population via combining
available service data and findings from our survey.

RESULTS: Among 370 IDUs recruited, the prevalence of HIV and HCV was 18.3%
and 41.5%, respectively. 27.1% of participants had shared a needle/syringe
in their lifetime. Consistent condom use rates were low among both regular
(6.8%) and non-regular (30.4%) partners. Factors independently associated
with being HIV positive included HCV infection, having a longer history of
injection drug use and experience of needle/syringe sharing. Participants
with HCV infection were more likely to be HIV positive, have injected more
types of drugs, have shared other injection equipments and have
unprotected sex with regular sex partners. The estimated number of current
IDUs in Ruili city was 2,714 (95% CI: 1,617-5,846).

CONCLUSIONS: IDUs may continue to be a critical subpopulation for
transmission of HIV and other infections in this region because of the
increasing population and persistent high risk of injection and sexual
behaviours. Developing innovative strategies that can improve
accessibility of current harm reduction services and incorporate more
comprehensive contents is urgently needed.

Free Full Article
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0106899
__________________________________________________________________
________________________________*_________________________________

11. Abstract: Filtration of crushed tablet suspensions has potential to
reduce infection incidence in people who inject drugs
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25196921

Drug Alcohol Rev. 2014 Sep 6.

Filtration of crushed tablet suspensions has potential to reduce infection
incidence in people who inject drugs.

Ng H1, Patel RP, Bruno R, Latham R, Wanandy T, McLean S.

1Division of Pharmacy, School of Medicine, University of Tasmania, Hobart,
Australia.

INTRODUCTION AND AIMS: The medical complications of injecting preparations
from crushed tablets can be severe, and most can be attributed to the
injection of insoluble particles and micro-organisms. Previously we have
shown that most of the particles can be removed by filtration, but it was
not known whether bacteria could also be filtered in the presence of a
high particle load. This study aims to determine the feasibility of
filtration to remove bacteria from injections prepared from tablets.

DESIGN AND METHODS: Injections were prepared from crushed slow-release
morphine tablets, in mixed bacterial suspensions of Staphylococcus aureus,
Streptococcus pyogenes and Pseudomonas aeruginosa. The injection
suspensions were passed through syringe filters of porosity 0.45 or
0.20?µm, or combined 0.8 then 0.2?µm, and the bacterial load was counted.

RESULTS: Bacterial concentrations in unfiltered injections were
2.5-4.3?×?106 colony forming units mL-1 . Both the 0.20 and 0.45?µm
filters blocked unless a prefilter (cigarette filter) was used first. The
0.2?µm filter and the combined 0.8/0.2?µm filter reduced the bacteria to
the limit of detection (10 colony forming units mL-1 ) or below.
Filtration through a 0.45?µm filter was slightly less effective.

DISCUSSION AND CONCLUSIONS: Use of a 0.2?µm filter, together with other
injection hygiene measures, offers the prospect of greatly reducing the
medical complications of injecting crushed tablets and should be
considered as a highly effective harm reduction method. It is very likely
that these benefits would also apply to other illicit drug injections,
although validation studies are needed.

© 2014 Australasian Professional Society on Alcohol and other Drugs.

KEYWORDS: filtration; harm reduction; injecting drug use; micro-organism;
pharmaceutical opioid
__________________________________________________________________
________________________________*_________________________________

12. Abstract: Risk Factors for HCV Infection Among Young Adults in Rural
New York Who Inject Prescription Opioid Analgesics
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25211717

Am J Public Health. 2014 Sep 11:e1-e7.

Risk Factors for HCV Infection Among Young Adults in Rural New York Who
Inject Prescription Opioid Analgesics.

Zibbell JE1, Hart-Malloy R, Barry J, Fan L, Flanigan C.

1Jon E. Zibbell is with the Division of Viral Hepatitis, Centers for
Disease Control and Prevention, Atlanta, GA. Rachel Hart-Malloy and
Colleen Flanigan are with the AIDS Institute, New York State Department of
Health, Albany. Rachel Hart-Malloy is also with the Department of
Epidemiology and Biostatistics, University at Albany, State University of
New York. John Barry and Lillian Fan are with the Southern Tier AIDS
Program, Broome County, NY.

Objectives. We investigated a cluster of new hepatitis C cases in rural
New York among a cohort of young people who inject drugs (PWID) and misuse
prescription opioid analgesics (POA).

Methods. We recruited a purposive sample of PWID from Cortland County for
an in-person survey and HCV rapid antibody test (March-July 2012). We
examined sociodemographics, drugs currently injected, and lifetime and
recent injection behaviors to ascertain associations with HCV antibody
(anti-HCV) positivity.

Results. Of 123 PWID, 76 (61.8%) were younger than 30 years, and 100
(81.3%) received HCV rapid testing. Of those tested, 34 (34.0%) were
positive. Participants who reported injecting POA in the past 12 months
were 5 times more likely to be anti-HCV positive than those who injected
drugs other than POA, and participants who reported sharing injection
equipment in the past 12 months were roughly 4 times more likely to be
anti-HCV positive than those who did not.

Conclusions. Our analysis suggests people injecting POA may be at higher
risk for HCV infection than people who inject heroin or other drugs but
not POA.
__________________________________________________________________
________________________________*_________________________________

13. Abstract: Temporal trends in mortality among people who use drugs
compared with the general Dutch population differ by hepatitis C virus
and HIV infection status
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25211439

AIDS. 2014 Sep 10.

Temporal trends in mortality among people who use drugs compared with the
general Dutch population differ by hepatitis C virus and HIV infection
status.

Van Santen DK1, Van Der Helm JJ, Grady BP, de Vos AS, Kretzschmar ME,
Stolte IG, Prins M.

1aDepartment of Research, Cluster Infectious Diseases, Public Health
Service Amsterdam, Amsterdam bJulius Center, University Medical Center
Utrecht, Utrecht cDepartment of Infectious Diseases, Center for Infection
and Immunology Amsterdam (CINIMA), Academic Medical Center (AMC),
Amsterdam dCentre for Infectious Disease Control, National Institute of
Public Health and the Environment, Bilthoven, the Netherlands.

OBJECTIVES:: We aimed to identify temporal trends in all-cause and cause-
specific mortality rates among people who use drugs (PWUD) compared with
the general Dutch population and to determine whether mortality trends
differed by hepatitis C virus (HCV)/HIV status.

DESIGN:: Longitudinal cohort study.

METHODS:: Using data from the Amsterdam Cohort Studies among 1254 PWUD
(1985-2012), all-cause and cause-specific standardized mortality ratios
(SMRs) were calculated; SMRs were stratified by serological group
(HCV/HIV-uninfected, HCV-monoinfected, and HCV/HIV-coinfected) and
calendar period. Temporal trends were estimated using Poisson regression.

RESULTS:: The overall all-cause SMR was 13.9 (95% confidence interval
12.6-15.3). The SMR significantly declined after 1996, especially due to a
decline among women (P?<?0.001). The highest SMR was observed among
HCV/HIV- coinfected individuals during 1990-1996 (SMR 61.9, 95% confidence
interval 50.4-76.0), which significantly declined after this period among
women (P?=?0.001). In contrast, SMR for HCV-monoinfected, and HCV/HIV-
uninfected PWUD did not significantly change over time. The SMR for non-
natural deaths significantly declined (P?=?0.007), whereas the SMR for
HIV-related deaths was the highest during all calendar periods.

CONCLUSIONS:: We found evidence for declining all-cause mortality among
PWUD compared with the general population rates. Those with HCV/HIV-
coinfection showed the highest SMR. The decline in the SMR seems to be
attributable to the decline in mortality among women. Mortality rates due
to non-natural deaths came closer to those of the general population over
time. However, HIV-related deaths remain an important cause of mortality
among PWUD when compared with the general Dutch population. This study
reinforces the importance of harm-reduction interventions and HCV/HIV
treatment to reduce mortality among PWUD.
__________________________________________________________________
________________________________*_________________________________

14. Abstract: Initial Experience and Evaluation of Reusable Insulin Pen
Devices Among Patients with Diabetes in Emerging Countries
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25213801

Diabetes Ther. 2014 Sep 12.

Initial Experience and Evaluation of Reusable Insulin Pen Devices Among
Patients with Diabetes in Emerging Countries.

Tschiedel B1, Almeida O, Redfearn J, Flacke F.

1Institute for Children with Diabetes, R. Alvares Cabral, 529, Porto
Alegre, RS, 91350-250, Brazil, badutsch@gmail.com.

BACKGROUND: Many individuals with type 2 diabetes in emerging countries
are transitioning from vial-and-syringe insulin delivery to that of
insulin pens (disposable or reusable). As with all insulin delivery
methods, patient preferences and comfort are of utmost importance to
optimize adherence to treatment. Patient-preferred characteristics for
reusable insulin pens and barriers to appropriate injection, particularly
in these regions, have not been widely reported in the clinical
literature, highlighting a key information gap for clinicians considering
these methods as part of a comprehensive diabetes management approach.

METHODS: Face-to-face interviews were conducted with people with type 1/2
diabetes, including insulin-naïve and established insulin users. After
moderator demonstration, participants were evaluated on their ability to
perform a six-step process to inject a 10-unit dose into a pad with the
AllStar® (AS; Sanofi, Mumbai, India), HumaPen Ergo II® (HE2; Eli Lilly,
Indianapolis, USA), and NovoPen 4® (NP4; Novo Nordisk, Bagsværd, Denmark)
pens. Local pens were also tested in India, China and Brazil.

RESULTS: A total of 503 people from India, Malaysia, Brazil, Egypt, and
China participated. Participants completed the six-step process in an
average, 2-3 min per pen. Participants ranked ease of overall use and ease
of self-injection and dialing/reading dose as most important features for
new insulin pens. When using the pens, the most difficult step was
priming/safety testing, with 7-12% failing and 28-40% having difficulty;
6%, 18%, and 22% failed to hold the injection button down for the required
period of time using AS, NP4, and HE2, respectively. Participants ranked
AS significantly higher for nine of 12 ease-of-use features including
three of the top four features considered the most important for reusable
pens, while HE2 was ranked higher for two features. Local pens were ranked
lowest.

CONCLUSIONS: Priming the pen and injecting the dose imparted most
difficulty for people with diabetes in emerging countries. Most
participants found AS easiest to use overall, with differences noted
between pens for individual steps of dose delivery. Identifying
characteristics most preferred by patients may assist in improving
adherence to insulin therapy.
__________________________________________________________________
________________________________*_________________________________

15. Abstract: Nurses’ Perceptions and Satisfaction with the Use of Insulin
Pen Devices Compared with Insulin Vial and Syringes in an Inpatient
Setting
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25198537

Diabetes Technol Ther. 2014 Sep 8.

Nurses’ Perceptions and Satisfaction with the Use of Insulin Pen Devices
Compared with Insulin Vial and Syringes in an Inpatient Setting.

Shogbon AO1, Ngo D, Jacob B, Kimble LP, Ryan G.

11 Mercer University College of Pharmacy , Atlanta, Georgia .

Background: The purpose of this study was to compare nurses’ perceptions
and satisfaction with the use of insulin pen devices versus vial and
syringes for insulin delivery in an inpatient setting. Materials and

Methods: The study used a descriptive design using self-report surveys.
Nurses rated their perceptions on a 4-point Likert scale (from 1=strongly
disagree to 4=strongly agree) on the ease of use, ease to teach patients,
confidence and comfort in use, perceived time efficiency, safety of use,
risk of needle sticks, and overall satisfaction and preference with use of
each insulin delivery device.

Results: In total, 139 (95%) nurses from nine nursing units at one
hospital participated in this study. Compared with vial and syringe,
nurses felt insulin pens were easier to use to measure insulin dose
(mean±SD, 3.7±0.5 vs. 3.1±0.7; P<0.001), were easier to teach patients to
use (3.5±0.6 vs. 2.8±0.7; P<0.001), provided more confidence in measuring
insulin dose (3.7±0.5 vs. 3.4±0.6, P<0.001), saved on administration and
preparation time (3.6±0.5 vs. 2.3±0.8; P<0.001), reduced the risk of
giving a wrong dose of insulin (3.2±0.8 vs. 2.2±0.7; P<0.001), and reduced
the risk of needle sticks (3.5±0.7 vs. 2.1±0.8; P<0.001).

Overall, a majority of nurses preferred the use of insulin pens to vial
and syringes in an inpatient setting (83% vs. 15%; P<0.05).

Conclusions: Nurses felt more comfortable and confident with the use of
insulin pens compared with vial and syringes and perceived insulin pens to
be a safer alternative for both patients and themselves.
__________________________________________________________________
________________________________*_________________________________

16. Abstract: Hospital hygiene – Where are we in the sixth year of
“Operation Clean Hands”?
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24446006

Anasthesiol Intensivmed Notfallmed Schmerzther. 2014 Jan;49(1):30-4.

[Hospital hygiene – Where are we in the sixth year of “Operation Clean
Hands”?].

[Article in German]

Reichardt C1, Bunte-Schönberger K1, Behnke M2, Clausmeyer JO2, Gastmeier
P1.

1Institut für Hygiene und Umweltmedizin / Charité – Universitätsmedizin
Berlin.
2Referenzzentrum für Surveillance von nosokomialen Infektionen / Charité –
Universitätsmedizin Berlin.

The national German hand hygiene campaign is implementing the WHO patient
safety initiative “Clean Care is Safer Care”. After 6 years over 1400
health care institutions are participating in the campaign on a voluntary
basis.

The implementation of the multimodal intervention concept including
improvement of alcohol based hand rub availability, the introduction of 2
surveillance methods and of the WHO “My 5 Moments of Hand Hygiene Model”
in those health care facilities, participating for several years,
increased median hand hygiene compliance by 11% and alcohol based hand rub
availability by 61%.

© Georg Thieme Verlag Stuttgart · New York.
__________________________________________________________________
________________________________*_________________________________

17. Abstract: The issue of mandatory vaccination for healthcare workers in
Europe
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24350731

Expert Rev Vaccines. 2014 Feb;13(2):277-83.

The issue of mandatory vaccination for healthcare workers in Europe.

Galanakis E1, D’Ancona F, Jansen A, Lopalco PL; VENICE (Vaccine European
New Integrated Collaboration Effort) National Gatekeepers, Contact Points.
Collaborators (35)
Kanitz E, Schmid D, Sabbe M, Van Damme P, Kojouharova M, Soteriou S, Kriz
B, Valentiner-Branth P, Filippova I, Kerbo N, Leino T, Nohynek H, Lévy-
Bruhl D, Wichmann O, Stavrou T, Molnàr Z, Gudnason T, Cotter S, D’Ancona
F, Perevoscikovs J, Lileikyte A, Berthet F, Fenech TM, de Melker H,
Feiring B, Paradowska-Stankiewicz I, Fernandes TM, Valente P, Gratiana C,
Hudecová H, Zampachova A, Kraigher A, Limia A, Uhnoo I, Pebody R.
Author information
1Department of Paediatrics and Interfaculty Graduate Programme in
Bioethics, University of Crete, Heraklion 710 03, Greece.

Mandatory policies have occasionally been implemented, targeting optimal
vaccination uptake among healthcare workers (HCWs). Herein, we analyze the
existing recommendations in European countries and discuss the feasibility
of implementing mandatory vaccination for HCWs.

As reflected by a survey among vaccine experts from 29 European countries,
guidelines on HCW vaccination were issued in all countries, though with
substantial differences in targeted diseases, HCW groups and type of
recommendation. Mandatory policies were only exceptionally implemented.
Results from a second survey suggested that such policies would not become
easily adopted, and recommendations might work better if focusing on
specific HCW groups and appropriate diseases such as hepatitis B,
influenza and measles.

In conclusion, guidelines for HCW vaccination, but not mandatory policies,
are widely adopted in Europe. Recommendations targeting specific HCW
groups and diseases might be better accepted and facilitate higher vaccine
uptake than policies vaguely targeting all HCW groups.
__________________________________________________________________
________________________________*_________________________________

18. Abstract: Do Intra-Articular Steroid Injections Increase Infection
Rates in Subsequent Arthroplasty? A Systematic Review and Meta-
Analysis of Comparative Studies
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25201257

J Arthroplasty. 2014 Aug 2. pii: S0883-5403(14)00479-3.

Do Intra-Articular Steroid Injections Increase Infection Rates in
Subsequent Arthroplasty? A Systematic Review and Meta-Analysis of
Comparative Studies.

Charalambous CP1, Prodromidis AD2, Kwaees TA2.

1Faculty of Medicine and Dentistry of University of Central Lancashire,
Preston, PR1 2HE, and Blackpool Victoria Hospital, Whinney Heys Road,
Blackpool, Lancashire, FY3 8NR, UK.
2Blackpool Victoria Hospital, Lancashire, FY3 8NR, UK.

Intra-articular steroid injections are widely used in joint arthritis. The
safety of such injections has been questioned as they may increase
infection rates in subsequent arthroplasty.

We carried out a meta-analysis of studies examining the relation between
intra-articular steroid injections and infection rates in subsequent joint
arthroplasty. A literature search was undertaken. Eight studies looking at
hip and knee arthroplasties were analyzed.

Meta-analysis showed that steroid injection had no significant effect on
either deep (risk ratio = 1.87; 95% CI 0.80-4.35; P = 0.15) or superficial
infection rates (risk ratio = 1.75; 95% CI 0.76-4.04; P = 0.19) of
subsequent arthroplasty.

Further large cohort studies would be of value in further examining
whether steroid injections close to the time of arthroplasty are safe.

Copyright © 2014. Published by Elsevier Inc.

KEYWORDS: arthroplasty; infection; injections; intra-articular; steroid
__________________________________________________________________
________________________________*_________________________________

19. Abstract: Relationship Between Delayed Reactions to Dermal Fillers and
Biofilm: Facts and Considerations
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25207761

Dermatol Surg. 2014 Sep 9.

Relationship Between Delayed Reactions to Dermal Fillers and Biofilm:
Facts and Considerations.

Beer K1, Avelar R.

1*General Surgical and Aesthetic Dermatology, University of Miami, Miami,
Florida; †Allergan Medical, Santa Barbara, California.

BACKGROUND: Delayed reactions associated with dermal fillers have often
been attributed to hypersensitivity reactions; however, the evolving
literature suggests that biofilms may represent an underrecognized cause
and a difficult diagnosis to establish. As implanted devices become more
popular, biofilms present an increasing risk to patients.

OBJECTIVE: The mechanism of action for biofilm formation, diagnostic
challenges, and methods to recognize biofilms will be reviewed. These are
increasingly important for physicians who implant these devices and for
those who see patients with implanted devices.

METHODS: We review the relevant literature and explore some of these
issues.

CONCLUSION: Preventative measures may decrease delayed reactions and
biofilm formation after injection of dermal fillers. Infection through
biofilms should be considered and carefully evaluated to ensure timely
treatment.
__________________________________________________________________
________________________________*_________________________________

20. Abstract: Elevated Lidocaine Serum Concentration After Subcutaneous
Lidocaine Administration Using a Needle-Free Device in Pediatric
Patients
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25198765

Pediatr Emerg Care. 2014 Sep 5.

Elevated Lidocaine Serum Concentration After Subcutaneous Lidocaine
Administration Using a Needle-Free Device in Pediatric Patients.

Gulur P1, Cohen AR, Watt L, Lau ME, El Saleeby C.

1From the *Department of Anesthesia, Critical Care, and Pain Medicine,
Massachusetts General Hospital; †Harvard Medical School; and Departments
of ‡Emergency Medicine, and §Pediatrics, Massachusetts General Hospital,
Boston, MA.

We report several cases in which pediatric patients at our institution
have elevated lidocaine levels in toxicology screens after subcutaneous
injection of lidocaine using a needle-free device.

The purpose of this article is to report 4 cases in which pediatric
patients have elevated lidocaine levels in toxicology screens after J-Tip
administration. In particular, the article highlights 2 cases in which
children younger than 3 years had lidocaine levels in the toxic range.

Although the literature has reported the device to be effective with no
significant untoward effects in children as young as 3 years, it seems
that no information is available for children younger than 3 years.

From a quality assurance/safety perspective, a summary is provided as our
institutional response to concerns raised over what is typically thought
to be a benign and beneficial intervention in children.
__________________________________________________________________
________________________________*_________________________________

21. No Abstract: Breaking the silence on viral hepatitis
__________________________________________________________________
Ann Intern Med. 2014 Jul 15;161(2):147-8.

Breaking the silence on viral hepatitis.

Valdiserri RO, Koh HK.

First page preview [Free] at
http://annals.org/article.aspx?articleid=1865264
__________________________________________________________________
________________________________*_________________________________

22. News

– Indiana USA: Celina Police Department Issues Warning About Hypodermic
Needles
– WHO to Start New Global Health Initiative For Needle Safety
– Kentucky USA: Heroin epidemic fuels another scourge: hepatitis C:
Kentucky ranks No. 1 for the bloodborne virus
– U.S. air marshal in quarantine after suspected Ebola syringe attack at
Lagos airport

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/pl4l7a2

Indiana USA: Celina Police Department Issues Warning About Hypodermic
Needles

By Ian Hoover & Paula Hinton, Indiana’s NewsCenter, Indiana USA (12.09.14)

CELINA, OH (21Alive) — The Celina Police Department has issued a warning
to residents: If you see a hypodermic syringe, don’t pick it up.

Police say over the past several months the department has received
reports of syringes found in the area, usually in gutters, storm drains,
yards and other outside locations.

Just this morning, a used syringe was jammed int a Fedex drop box, and
found in a position that could have injured a person attempting to use the
box.

These syringes or “needles” pose serious health risks if an unsuspecting
person gets pricked by the needle. Hepatitis C and other bloodborne
diseases and bacteria can be passed on.

If you find a needle, you are urged to call police.
__________________________________________________________________
__________________________________________________________________
WHO to Start New Global Health Initiative For Needle Safety

Alexandra Sifferlin , TIME, USA (11.09.14)

At the TEDMED conference in Washington, DC, Dr. Marie-Paule Kieny,
assistant director general of the World Health Organization (WHO),
revealed that the organization will announce its third-ever global health
initiative and policy in October. The initiative this time is around
needle safety.

The announcement came during a TEDMED presentation by British inventor
Marc Koska, who spent his early 20s creating the K-1 syringe: the first
syringe to automatically disable once it’s used, making it impossible to
use again. A small ring inside of the barrel of the syringe allows the
plunger to move in one direction and not the other, so after an injection,
the plunger is locked in place and will break if forced.

The hope is that the WHO mandate, which will encourage the use of non-
reusable syringes, will become a worldwide health safety standard.

In Koska’s TEDMED presentation, viewers watched a hidden camera video of a
nurse administering an injection to a child, then using the same needle on
a man with HIV, then using the same needle one more time on a baby. There
are 1.3 million deaths every year due to dirty needles and millions of
dollars lost to treating unnecessary illness caused by infections from
shared needles. Unsafe injections cause 23 million cases of hepatitis
worldwide; in Africa, an estimated 20 million medical injections
contaminated with blood from an HIV-positive patient are administered
every year.

Koska said that once WHO officially launches its initiative, his next step
is to ensure that manufacturers convert to the safer needles. The cost is
no more than standard needle production, but “the policy is a monumental
step,” he said.
__________________________________________________________________
__________________________________________________________________
http://tinyurl.com/luc664b

Kentucky USA: Heroin epidemic fuels another scourge: hepatitis C: Kentucky
ranks No. 1 for the bloodborne virus

Jessica Noll, WCPO, Cincinnati Ohio USA (11.09.14)

“It wouldn’t matter if you had AIDS. If you had dope, I wanted your
needle. I didn’t care.”

22-year-old Sara Messer, Rabbit Hash, Ky.

FLORENCE, Ky. – Sara Messer is a recovering heroin addict diagnosed with
hepatitis C after sharing a needle with a friend, a friend she knew had
the virus.

Messer, now living at the Brighton Recovery Center for Women in Florence,
is one of at least 264 people infected with hepatitis C in Northern
Kentucky, and an example of why Northern Kentucky leads the country in
infection rates for the bloodborne pathogen.

The state of Kentucky is No. 1 in the nation with 4.1 hepatitis C cases
per 100,000 residents, according to the U.S. Centers for Disease Control.
That rate far surpasses the national average of 0.6 people per 100,000.
And in Northern Kentucky, the rate is off the chart: 13 per 100,000,
according to the Northern Kentucky Health Department.

With the ongoing surge of heroin users, the wave of hepatitis C patients
is mounting, many of them undiagnosed. Since 2010, hepatitis C cases have
increased by more than 80 percent in Northern Kentucky, with 23 cases
reported in 2010, 42 cases in 2011 and 52 in 2012.

Become a WCPO Insider and see what health officials want to do to prevent
the spread of hepatitis C, how the number is soaring and what you need to
know before getting tested.

Copyright 2014 Scripps Media, Inc.
__________________________________________________________________
__________________________________________________________________
http://tinyurl.com/HS-Ebola-1

U.S. air marshal in quarantine after suspected Ebola syringe attack at
Lagos airport

Homeland Security Newswire, USA (09.09.14)

An American federal air marshal was placed in quarantine in Houston, Texas
yesterday after being attacked Sunday night at the Lagos, Nigeria airport.
The assailant wielded a syringe which contained an unknown substance, and
was able to inject an unknown substance into the back of one of the air
marshal’s arms. The marshal was able to board the United Airlines flight
to Houston, where he was met by FBI agents and health workers from the
Centers for Disease Control (CDC).

An American federal air marshal was placed in quarantine in Houston, Texas
yesterday after being attacked Sunday night at the Lagos, Nigeria airport.
The assailant wielded a syringe which contained an unknown substance, and
was able to inject an unknown substance into the back of one of the air
marshal’s arms. ABC News reports that the air marshal, who was in Nigeria
with a team of other marshals, was attacked when the group was in an
unsecured area of the airport terminal in Lagos.

The marshal was able to board the United Airlines flight to Houston, where
he was met by FBI agents and health workers from the Centers for Disease
Control (CDC).

Fearing the syringe contained liquid contaminated with the Ebola virus,
the authorities in Houston immediately put him into quarantine. The FBI
said he was screened “on-scene… out of an abundance of caution.”

An FBI spokesperson said, “The victim did not exhibit any signs of illness
during the flight and was transported to a hospital upon landing for
further testing. None of the testing conducted has indicated a danger to
other passengers.”

The infectious agents would not immediately manifest or make the patient
contagious.

ABC News also reports that while the unknown assailant escaped, Nigerian
officials said the other air marshals on the team secured the needle and
brought it on the flight for testing in the United States.

Officials noted that U.S. air marshals travel undercover in plain clothes
and an attacker would not be able to identify his target as an American
law enforcement agent.

“While there is no immediate intelligence to confirm this was a targeted
attack, this is our reminder that international cowards will attempt to
take sneaky lethal shots at our honorable men and women abroad,” said Jon
Adler, the national president of the Federal Law Enforcement Officers
Association.

The Lagos airport has been considered a possible target for the Islamist
group Boko Haram.
__________________________________________________________________
________________________________*_________________________________
* SAFETY OF INJECTIONS brief yourself at: www.injectionsafety.org

A fact sheet on injection safety is available at:
http://www.who.int/mediacentre/factsheets/fs231/en/index.html

* Visit the WHO injection safety website and the SIGN Alliance Secretariat
at: http://www.who.int/injection_safety/en/

* Download the WHO Best Practices for Injections and Related Procedures
Toolkit March 2010 [pdf 2.47Mb]:
http://whqlibdoc.who.int/publications/2010/9789241599252_eng.pdf

Use the Toolbox at: http://www.who.int/injection_safety/toolbox/en/

Get SIGN files on the web at: http://signpostonline.info/signfiles-2
get SIGNpost archives at: http://signpostonline.info/archives-by-year

Like on Facebook: http://facebook.com/SIGN.Moderator

The SIGN Secretariat, the Department of Health Systems Policies and
Workforce, WHO, Avenue Appia 20, CH-1211 Geneva 27, Switzerland.
Facsimile: +41 22 791 4836 E- mail: sign@who.int
__________________________________________________________________
________________________________*_________________________________

The Safe Injection Global Network SIGN meeting will be held on 30-31
October 2014 at WHO/HQ Geneva Switzerland

The main topic of the meeting is the new injection safety policy
recommendation and developing the appropriate strategies for
implementation in countries worldwide.

This policy follows on from the key 1999 policy on the use of Auto-Disable
Syringes.

The Keynote speaker will be Dr Margaret Chan, the Director-General of WHO.

Dr. Chan will launch the new IS policy which recommends the use of safety
engineered injection devices for reuse prevention and sharps injury
protection.

* All SIGN members are welcome to attend this meeting.

Please submit your expressions of interest in participating in this
important meeting to Dr. Selma Khamassi, at the SIGN Secretariat at WHO.

Contact Information

Dr. Selma Khamassi
SIGN Secretariat
Department of Health Systems Policies and Workforce
20 Avenue Appia
1211,Geneva 21
Switzerland

Email: KHAMASSI, Selma <KhamassiS@who.int>
Fax: +41 22 791 4836
__________________________________________________________________

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/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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We would like your help in building this archive. Please send your old
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__________________________________________________________________
________________________________*_________________________________

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