online canadian pharmacy http://www.canadianpharmacy365.net/ pharmacy ratings phentermine no prescription

SIGNpost 00766

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST

Post00766 SIGN Meeting Postponed + Safety + Hepatitis 01 October 2014

CONTENTS
1. SIGN Meeting Postponed
2. Abstract:Viral Hepatitis — A Silent Pandemic; Let’s Get Going
3. Abstract: Assessment of knowledge and practices on injection safety
among service providers in east Godavari district of Andhra Pradesh
4. Abstract: Impact of intervention on healthcare waste management
practices in a tertiary care governmental hospital of Nepal
5. Abstract: Intramuscular injection technique: an evidence-based approach
6. Abstract: Medical graduates’ knowledge of bloodborne viruses and
occupational exposures
7. Abstract: Knowledge, attitude and practice of dentists towards
prophylaxis after exposure to blood and body fluids
8. Abstract: Hepatitis C, a silent threat to the community of Haryana,
India: a community-based study
9. Abstract: Prevention, treatment and care of hepatitis C virus infection
among people who inject drugs
10. Abstract: Policy responses to viral hepatitis B and C among people who
inject drugs in Member States of the WHO European region: a sub-
analysis of the WHO 2013 global hepatitis policy survey
11. Abstract: Hepatitis C in European prisons: a call for an evidence-
informed response
12. Abstract: Hepatitis C virus seroprevalence among people who inject
drugs and factors associated with infection in eight Russian cities
13. Abstract: Adverse reactions to injectable soft tissue fillers:
Memorable cases and their clinico-pathological overview
14. Abstract: Local Anesthetics: What’s New in Minimal Pain Injection and
Best Evidence in Pain Control
15. No Abstract: No strategy to meet the HCV epidemic
16. No Abstract: Epidural Steroid Injections Safety Recommendations by the
Multi-Society Pain Workgroup (MPW): More Regulations Without Evidence
or Clarification
17. No Abstract: Surface safety. Best practices in surface and medical
device disinfection
18. No Abstract: Mobile telephone in the hospital: so far an
underestimated source of pathogen transmission
19. BMC Supplement published: Viral Hepatitis and Drug Use in Europe
20. News
– Canada: Experts warn against use of multi-dose vials in wake of
hepatitis C outbreak at colonoscopy clinics
– Canada: Hepatitis C outbreaks at three Toronto colonoscopy clinics kept
secret
– Canada: Pain clinic doctor faces disciplinary hearing after outbreak
Anesthesiologist Dr. Stephen James accused of incompetence in infection
control and misconduct during probe
– Australia: Needle exchange: ACT Government pushes on with plan for jail
program

The web edition of SIGNpost is online at:
http://signpostonline.info/archives/1744

More information follows at the end of this SIGNpost!

Please send your requests, notes on progress and activities, articles,
news, and other items for posting to: sign.moderator@gmail.com

Normally, items received by Tuesday will be posted in the Wednesday
edition.

Subscribe or un-subscribe by email to: sign.moderator@gmail.com or to
sign@who.int

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

Visit the SIGNpostOnline archives at: http://signpostonline.info

Like SIGNpost on Facebook at: https://www.facebook.com/SIGN.Moderator
and get updates on your device!
__________________________________________________________________
________________________________*_________________________________

1. SIGN Meeting Postponed
__________________________________________________________________
SIGN Meeting Postponed

Dear SIGN partners,

Warm greetings from Geneva. I would like to thank very much all those who
have expressed interest in attending the SIGN meeting and the launch of
the new injection safety policy.

Unfortunately, in view of the urgent work and unforeseen commitments our
DG has with the Ebola outbreak, we have to postpone the SIGN meeting to
another date.

We are currently trying to identify with DGO another date our Director
General would be available to chair the SIGN meeting and launch the new
policy.

We will share with you this information as soon as a new date is agreed.

Best regards,
Selma

for the SIGN Secretariat
________________________________

Dr Selma Khamassi, MD, MPH
Injection Safety& Related Infection Control
Safe Injection Global Network (SIGN) Secretariat
HIS/SDS/PSQ
World Health Organization
20 Appia Avenue -CH 1211 Geneva 27 -Switzerland
Office 4175
Tel: +4122 7913431
Fax: +4122 79148 36
Email: khamassis@who.int
Website: http://www.who.int/injection_safety/en/
__________________________________________________________________
________________________________*_________________________________

2. Abstract:Viral Hepatitis — A Silent Pandemic; Let’s Get Going
__________________________________________________________________
http://www.iapsmupuk.org/journal/index.php/IJCH/article/view/681

Ind J Comm Health 2014;26(3):213-217.

Viral Hepatitis — A Silent Pandemic; Let’s Get Going

Om Prakash Kansal

Introduction: Viral Hepatitis is not drawing the attention from all levels
of stakeholders while the prevalence and incidence is silently growing. As
World Health Organization has adopted a resolution to raise the profile,
attention and resources towards fight against Hepatitis, this article
could help sensitize readers about the need and possible way forward in
their respective settings.

Aims: To Raise the profile of Hepatitis and draw attention of
Policymakers, Professional bodies and stakeholders from Public and Private
sector.

Methods and Material: This article is a review of the existing
information, basis the sources mentioned and author’s efforts in this
regard. Results: The adoption of resolution WHA 63.18 by the World Health
Assembly in 2010 and subsequent discussion in WHA 2014 offers immense
opportunity to understand the gaps in policy and practice and collate the
existing knowledge or generate new information, to excite policymakers and
guide them take informed decisions.

Conclusions: Hepatitis is a much serious issue than we all believe, only
concerted efforts by public health community could lead the way forward.
Key Message: Viral Hepatitis impacts all Health Care Professionals, being
a major occupational hazard. Thus, it is our community, which should lead
comprehensive approach to excite and guide policymakers take informed
decisions in fight against Viral Hepatitis.

Keywords Silent Pandemic; World Hepatitis Day; Comprehensive prevention
and control of Viral Hepatitis

Free Full Text [PDF]
http://www.iapsmupuk.org/journal/index.php/IJCH/article/view/681/pdf_57
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Assessment of knowledge and practices on injection safety
among service providers in east Godavari district of Andhra Pradesh
__________________________________________________________________
http://www.iapsmupuk.org/journal/index.php/IJCH/article/view/668

Ind J Comm Health 2014;26(3):259-263.

Assessment of knowledge and practices on injection safety among service
providers in east Godavari district of Andhra Pradesh

Sridevi Garapati, Sujatha Peethala

Objectives: To assess the Knowledge and Practices among service providers
regarding injection safety and its safe disposal in East Godavari District
of Andhra Pradesh.

Materials and Methods: Cross-Sectional study conducted in one year from
March 2010 to February 2011 among health care providers at all levels that
is Primary, Secondary and Tertiary levels of public sector selected
randomly in the five revenue divisions of East Godavari District with
sample size based on 4PQ/L2 formula found to be 300; Representing 30%
doctors (90), 30% staff nurses (90), 30% MPHW (F) (90) and 10% Lab-
Technicians(30) and data is obtained by semi- structured questionnaire;
Analyzed by using SPSS software version16.0.at p<0.05 significance level.

Results: In the present study knowledge of various service providers was
enquired into and practices were also observed in various aspects of
injection safety. Knowledge on washing hands before giving injection was
45.6% but when it comes to practice it was observed only among 18.2%;
Similarly knowledge on use of hub-cutter after giving injection was found
to be 33.9% but when practice of using hub-cutter was observed, it was
only 20.5%; Knowledge on safe disposal of used syringes was 53.8% but the
practice was found to be poor (21.7%). Similarly Knowledge on use of color
coded bags according to guidelines was 65.8% but when practice was
observed it is poor (20.6%). All these differences were statistically
significant with p<0.05.

Conclusion: In the present study Patient preference is the main indication
for injection; Knowledge of universal precautions, use of needle destroyer
after giving injection and correct method for final disposal of sharps was
less; whereas Knowledge of complications of unsafe injections, diseases
transmitted through needle stick injuries, importance of hepatitis B
immunization and Post Exposure Prophylaxis was good. Unsafe practices like
not washing hands, not wearing gloves, not cleaning the site of injection
and touching the needle while/ before giving injection were seen. Harmful
practices like recapping of needles, re-using of syringes were observed.
And also disposal of injection related waste was not according to
guidelines.

Keywords: Knowledge; Injection safety; Practices; Service providers; East
Godavari District.

Free Full Text:

HTML
http://www.iapsmupuk.org/journal/index.php/IJCH/article/view/668/html_54

PDF
http://www.iapsmupuk.org/journal/index.php/IJCH/article/view/668/pdf_63
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Impact of intervention on healthcare waste management
practices in a tertiary care governmental hospital of Nepal
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25261099

BMC Public Health. 2014 Sep 26;14(1):1005.

Impact of intervention on healthcare waste management practices in a
tertiary care governmental hospital of Nepal.

Sapkota B, Gupta GK, Mainali D.

BACKGROUND: Healthcare waste is produced from various therapeutic
procedures performed in hospitals, such as chemotherapy, dialysis,
surgery, delivery, resection of gangrenous organs, autopsy, biopsy,
injections, etc. These result in the production of non-hazardous waste
(75-95%) and hazardous waste (10-25%), such as sharps, infectious,
chemical, pharmaceutical, radioactive waste, and pressurized containers
(e.g., inhaler cans). Improper healthcare waste management may lead to the
transmission of hepatitis B, Staphylococcus aureus and Pseudomonas
aeruginosa.

METHODS: This evaluation of waste management practices was carried out at
gynaecology, obstetrics, paediatrics, medicine and orthopaedics wards at
Government of Nepal Civil Service Hospital, Kathmandu from February 12 to
October 15, 2013, with the permission from healthcare waste management
committee at the hospital. The Individualized Rapid Assessment tool
(IRAT), developed by the United Nations Development Program Global
Environment Facility project, was used to collect pre-interventional and
post-interventional performance scores concerning waste management. The
healthcare waste management committee was formed of representing various
departments. The study included responses from focal nurses and physicians
from the gynaecology, obstetrics, paediatrics, medicine and orthopaedics
wards, and waste handlers during the study period. Data included average
scores from 40 responders. Scores were based on compliance with the IRAT.

RESULTS: The waste management policy and standard operating procedure were
developed after interventions, and they were consistent with the national
and international laws and regulations. The committee developed a plan for
recycling or waste minimization. Health professionals, such as doctors,
nurses and waste handlers, were trained on waste management practices. The
programs included segregation, collection, handling, transportation,
treatment and disposal of waste, as well as occupational health and safety
issues. The committee developed a plan for treatment and disposal of
chemical and pharmaceutical waste. Pretest and posttest evaluation scores
were 26% and 86% respectively.

CONCLUSIONS: During the pre-intervention period, the hospital had no HCWM
Committee, policy, standard operating procedure or proper color coding
system for waste segregation, collection, transportation and storage and
the specific well-trained waste handlers. Doctors, nurses and waste
handlers were trained on HCWM practices, after interventions. Significant
improvements were observed between the pre- and post-intervention periods.

Free full text http://www.biomedcentral.com/1471-2458/14/1005/abstract
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Intramuscular injection technique: an evidence-based approach
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25249123

Nurs Stand. 2014 Sep 29;29(4):52-9.

Intramuscular injection technique: an evidence-based approach.

Ogston-Tuck S.

Institute of Health and Society, University of Worcester, Worcester.

Intramuscular injections require a thorough and meticulous approach to
patient assessment and injection technique.

This article, the second in a series of two, reviews the evidence base to
inform safer practice and to consider the evidence for nursing practice in
this area.

A framework for safe practice is included, identifying important points
for safe technique, patient care and clinical decision making.

It also highlights the ongoing debate in selection of intramuscular
injection sites, predominately the ventrogluteal and dorsogluteal muscles.

KEYWORDS: Injection; intramuscular injection technique; medication;
medicines management; patient assessment; patient safety
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Medical graduates’ knowledge of bloodborne viruses and
occupational exposures
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24360355

Am J Infect Control. 2014 Feb;42(2):203-5.

Medical graduates’ knowledge of bloodborne viruses and occupational
exposures.

Koehler N1, Vujovic O2, Dendle C3, McMenamin C4.

1Assessment and Learning Design, Deakin Learning Futures, Deakin
University, Burwood Campus, Burwood, VIC, Australia. Electronic address:
Nicole.Koehler@deakin.edu.au.
2Department of Infectious Diseases, The Alfred, Melbourne, VIC, Australia.
3Monash Infectious Diseases, Monash University, Clayton, VIC, Australia.
4Faculty of Medicine, Nursing and Health Sciences, Monash University,
Clayton Campus, Clayton, VIC, Australia.

A survey of medical graduates commencing employment as junior doctors was
performed to investigate knowledge of bloodborne viruses and occupational
exposure management, coupled with their experience of occupational
exposures.

There was a mismatch between general knowledge (excellent) and knowledge
of postexposure management (poor), and graduates had commonly experienced
an occupational exposure and not reported it.

The knowledge deficit regarding postexposure management and history of
poor practice (ie, nonreporting) following an exposure implies that the
transition period from student to junior doctor may be associated with
increased occupational health and safety risk.

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

KEYWORDS:
Needlestick injury; Occupational exposure management; Postexposure
prophylaxis
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Knowledge, attitude and practice of dentists towards
prophylaxis after exposure to blood and body fluids
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25027043

Int J Occup Environ Med. 2014 Jul;5(3):146-54.

Knowledge, attitude and practice of dentists towards prophylaxis after
exposure to blood and body fluids.

Shaghaghian S, Pardis S1, Mansoori Z.

1Department of Oral and Maxillofacial Pathology, School of dentistry,
Shiraz University of Medical Sciences, Shiraz, Iran.
soheilpardis7@gmail.com.

BACKGROUND: Post-exposure prophylaxis plays an important role in
prevention of bloodborne diseases after occupational exposures.

OBJECTIVE: To evaluate the knowledge, attitude and practice of dentists
towards post- exposure prophylaxis.

METHODS: In a cross-sectional study, 140 dentists in Shiraz were selected
through a systematic randomized sampling. They filled out a self-made
questionnaire including 30 knowledge, 4 attitude and 10 practice
questions. Mean of knowledge and percentage of various items of attitude
and practice were reported.

RESULTS: The mean±SD knowledge score of dentists was 18.5±6.2. Knowledge
had a significant relationship with the level of education (p<0.001),
attending infection control seminars (p<0.001), and working in public
clinics (p<0.001). A total of 63 (43%) dentists believed that immediate
washing of the exposed area has no effect on the prevention of hepatitis
and AIDS. Of the studied dentists, 13%, 11%, and 34% believed that
prophylaxis after exposure to patients’ blood had no effect on prevention
of human immunodeficiency virus (HIV), hepatitis B virus, and hepatitis C
virus infections, respectively. Only 170 (53%) exposed dentists
immediately washed the exposed area and only 43 (13.4%) of them evaluated
the source patient for risk factors of hepatitis and AIDS.

CONCLUSION: Knowledge, attitude and practice of dentists working in Shiraz
towards postexposure prophylaxis are not desirable. Interventions to raise
their awareness are therefore warranted.
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Hepatitis C, a silent threat to the community of Haryana,
India: a community-based study
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24567761

Australas Med J. 2014 Jan 31;7(1):11-6.

Hepatitis C, a silent threat to the community of Haryana, India: a
community-based study.

Verma R, Behera BK, Jain RB, Arora V, Chayal V, Gill PS.

Pt B D Sharma PGIMS, Rohtak, Haryana, India.

BACKGROUND: Hepatitis C is a global public health problem. As many as 12
million people may be chronically infected in India and most are unaware
of it.

AIMS: To determine the incidence of hepatitis C in the Ratia block of the
Fatehabad district, Haryana, India.

METHOD: This cross-sectional study was carried out by house-tohouse visits
over 2 weeks. After obtaining written consent, a blood sample was drawn
from suspected cases by a laboratory technician maintaining all necessary
safety precautions and sterilization.

RESULTS: Of the samples, 1,630 (22.3 per cent) were found to be positive
for hepatitis C by ELISA, 253 (15.5 per cent) patients were previously
hepatitis C positive, and adults (21-60 years) were affected maximally
(70.0 per cent).

CONCLUSION: The study emphasises the need for public awareness campaigns
at various levels and prevention of HCV infection. It also suggests the
need to develop and strengthen evaluation methodology for the Integrated
Disease Surveillance Project (IDSP).

KEYWORDS: HCV; Hepatitis C; community

Free Full Text Hepatitis C, a silent threat to the community of Haryana,
India: a community-based study

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3920471/
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Prevention, treatment and care of hepatitis C virus infection
among people who inject drugs
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25245939

Int J Drug Policy. 2014 Aug 30. pii: S0955-3959(14)00228-X.

Prevention, treatment and care of hepatitis C virus infection among people
who inject drugs.

Bruggmann P1, Grebely J2.

1Arud Centres for Addiction Medicine, Zurich, Switzerland. Electronic
address: p.bruggmann@arud.ch.
2The Kirby Institute, The University of New South Wales Australia, Sydney,
Australia.

People who inject drugs (PWID) represent the core of the hepatitis C virus
(HCV) epidemic in many countries. HCV transmission continues among PWID,
despite evidence demonstrating that high coverage of combined harm
reduction strategies, such as needle syringe programs (NSP) and opioid
substitution treatment (OST), can be effective in reducing the risk of HCV
transmission.

Among infected individuals, HCV-related morbidity and mortality continues
to grow and is accompanied by major public health, social and economic
burdens. Despite the high prevalence of HCV infection, the proportion of
PWID who have been tested, assessed and treated for HCV infection remains
unacceptably low, related to systems-, provider- and patient-related
barriers to care. This is despite compelling data demonstrating that with
the appropriate programs, HCV treatment is safe and successful among PWID.

The approaching era of interferon-free directly acting antiviral therapy
has the potential to provide one of the great advances in clinical
medicine. Simple, tolerable and highly effective therapy will likely
address many of these barriers, thereby enhancing the numbers of PWID
cured of HCV infection. However, the high cost of new HCV therapies will
be a barrier to implementation in many settings. This paper highlights
that restrictive national drug policy and law enforcement are key drivers
of the HCV epidemic among PWID.

This paper also calls for enhanced HCV treatment settings built on a
foundation of both prevention (e.g. NSP and OST) and improved access to
health care for PWID.

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

KEYWORDS: Hepatitis C; PWID
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Policy responses to viral hepatitis B and C among people who
inject drugs in Member States of the WHO European region: a sub-
analysis of the WHO 2013 global hepatitis policy survey
__________________________________________________________________
http://www.biomedcentral.com/1471-2334/14/S6/S15

BMC Infect Dis. 2014;14 Suppl 6:S15.

Policy responses to viral hepatitis B and C among people who inject drugs
in Member States of the WHO European region: a sub-analysis of the WHO
2013 global hepatitis policy survey.

Spina A, Eramova I, Lazarus JV.

BACKGROUND: Unsafe injections, through infectious bodily fluids, are a
major route of transmission for hepatitis B and C. Viral hepatitis burden
among people who inject drugs is particularly high in many Member States
of central and Eastern Europe while national capacity and willingness to
address it varies greatly.

METHODS: The initial survey included 43 questions covering awareness,
data, prevention, and screening and treatment. It was sent in five
languages to identified national focal points. This sub-analysis included
11 questions and 53 Member States in the WHO European Region. Descriptive
analyses of national activities are presented. As a secondary outcome
bivariate analyses of differences between Member States of the European
Union (EU) and European Free Trade Association (EFTA) compared to those
not in said grouping are presented.

RESULTS: Forty-four of the 53 Member States responded to the survey
(response rate of 83%). More than three-quarters reported offering
publicly-funded treatment for HBV or HCV (82% and 80%, respectively), with
a significantly higher proportion of EU/EFTA Member States (P=0.004 and P=
0.010, respectively). Half of Member States (53%) reported the existence
of a national policy for hepatitis prevention and control; however less
than one-third (27%) reported having written national strategies. Under
half of the responding Member States reported holding events for World
Hepatitis Day 2012. One-fifth reported offering hepatitis B and C testing
free of charge, with less than one-third reportedly conducting regular
serosurveys among people who inject drugs.

CONCLUSIONS: Findings highlight key gaps requiring attention in order to
improve national policies and programmes in the region and ensure an
adequate response to injection drug use-associated viral hepatitis.
Further studies are required to assess quality and impact of national
policies and services.

Free full text http://www.biomedcentral.com/1471-2334/14/S6/S15
__________________________________________________________________
________________________________*_________________________________

11. Abstract: Hepatitis C in European prisons: a call for an evidence-
informed response
__________________________________________________________________
http://www.biomedcentral.com/1471-2334/14/S6/S17

BMC Infect Dis. 2014;14 Suppl 6:S17.

Hepatitis C in European prisons: a call for an evidence-informed response.

Arain A, Robaeys G, Stöver H.

Globally, over 10 million people are held in prisons and other places of
detention at any given time. People who inject drugs (PWID) comprise
10-48% of male and 30-60% of female prisoners.

The spread of hepatitis C
in prisons is clearly driven by injection drug use, with many infected
prisoners unaware of their infection status.

Risk behaviour for
acquisition of hepatitis C via common use of injecting equipment is
widespread in many prison settings.

Free full text http://www.biomedcentral.com/1471-2334/14/S6/S17
__________________________________________________________________
________________________________*_________________________________

12. Abstract: Hepatitis C virus seroprevalence among people who inject
drugs and factors associated with infection in eight Russian cities
__________________________________________________________________
http://www.biomedcentral.com/1471-2334/14/S6/S12

BMC Infect Dis. 2014;14 Suppl 6:S12.

Hepatitis C virus seroprevalence among people who inject drugs and factors
associated with infection in eight Russian cities.

Heimer R, Eritsyan K, Barbour R, Levina OS.

BACKGROUND: Behavioural surveillance among people who inject drugs (PWID)
and testing for hepatitis C virus (HCV) and HIV is needed to understand
the scope of both epidemics in at-risk populations and to suggest steps to
improve their health.

METHODS: PWID were recruited using respondent-driven sampling (RDS) in
eight Russian cities. A standardized survey was administered to collect
sociodemographic and behavioral information. Blood specimens were obtained
for serological testing for HCV and HIV-1. Data across the eight sites
were pooled to identify individual-, network-, and city-level factors
associated with positive HCV serostatus.

RESULTS: Among 2,596 PWID participating in the study, 1,837 tested
positive for HCV (71%). The sample was 73% male and the mean age was 28.
Very few PWID reported regular contact with harm reduction programs.
Factors associated with testing positive for HCV were longer duration of
injection drug use, testing positive for HIV-1, sharing non-syringe
injection paraphernalia and water for rinsing syringes, and larger social
network size. Factors negatively associated with HCV-positive serostatus
were injecting with a used syringe and two city-level factors: longer mean
RDS recruitment chain in a city and higher levels of injecting stimulants.

CONCLUSIONS: HCV prevalence in all eight Russian cities is at the higher
end of the range of HCV prevalence among PWID in Europe, which provides
evidence that more resources, better prevention programs, and accelerated
treatment targeting PWID are needed to control the HCV epidemic.

Free full text http://www.biomedcentral.com/1471-2334/14/S6/S12
__________________________________________________________________
________________________________*_________________________________

13. Abstract: Adverse reactions to injectable soft tissue fillers:
Memorable cases and their clinico-pathological overview
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25260141

J Cosmet Laser Ther. 2014 Sep 26:1-22.

Adverse reactions to injectable soft tissue fillers: Memorable cases and
their clinico-pathological overview.

Lee SK, Kim SM, Cho SH, Lee JD, Kim HS.

Background: Filler injection is a minimally invasive procedure widely used
for soft tissue augmentation. Although the safety profile is favorable,
adverse events can occur, especially after illegal filler injection.

Objectives: The authors present memorable cases of filler complications
and review their clinico-pathological features and treatment strategies.

Patients and Methods: This is a retrospective, single-center case series.
The authors identified eight patients with significant complications
following filler injection. A medical record review was performed for
clinical history, histopathological studies and treatment.

Results: Six female and two male subjects presented with significant
filler complications. The time interval between filler injection and the
development of a complication varied greatly among cases (immediately
afterwards – 14 years following filler injection). Four of the patients
received illegal filler injection where the injected material was either
unknown (25%) or was told as paraffin (12.5%) and Vaseline® (12.5%).
Hyaluronic acid fillers were used in two patients (25%) and the rest were
injected with porcine atelocollagen (12.5%) and polyacrylamide hydrogel
(12.5%).

The complications were classified as an allergic reaction (25%), filler
material migration (12.5%), injection necrosis + embolism (25%) and
foreign body granuloma (37.5%), based on their clinic-pathological
features and were treated accordingly.

Conclusion: Adverse effects are not uncommon following filler injection.
Physicians should be aware of the potential side effects, recognize their
presentations and understand how to manage them.

KEYWORDS: Adverse reactions; memorable cases; soft tissue fillers

http://www.biomedcentral.com/1471-2334/14/S6/S15/abstract
__________________________________________________________________
________________________________*_________________________________

14. Abstract: Local Anesthetics: What’s New in Minimal Pain Injection and
Best Evidence in Pain Control
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25255006

Plast Reconstr Surg. 2014 Oct;134(4 Suppl 2):40S-9S.

Local Anesthetics: What’s New in Minimal Pain Injection and Best Evidence
in Pain Control.

Lalonde D1, Wong A.

1New Brunswick, Canada From the Division of Plastic Surgery, Dalhousie
University.

Local anesthesia in plastic surgery is undergoing a revolution. In the
last 10 years, significant improvements in technique have permitted
surgeons to do more and more under pure local anesthesia to increase
patient safety and convenience while maintaining total patient comfort
during the injection of the local anesthesia and while the procedure is
accomplished. Many procedures which used to require sedation are now being
performed without it.

This article explores some of the new advances in local anesthesia such as
painless blunt-tipped cannula local anesthetic infiltration, decreased
pain with sharp needle tip injection, and long- lasting local anesthetics
with delayed release from liposomal encapsulation.

This article also examines the best evidence of the last 10 years of
advances of pain control with local anesthesia.
__________________________________________________________________
________________________________*_________________________________

15. No Abstract: No strategy to meet the HCV epidemic
__________________________________________________________________
BMC Infectious Diseases 2014, 14(Suppl 6):S2

No strategy to meet the HCV epidemic

Olav Dalgard1* and Stefan Mauss2

* Corresponding author: Olav Dalgard

Author Affiliations
1 Department of Infectious Diseases, Akershus University Hospital,
Lørenskog Norway

2 Center for HIV and Hepatogastroenterology, Duesseldorf Germany

Open Access: The electronic version of this article is the complete one
and can be found online at:
http://www.biomedcentral.com/1471-2334/14/S6/S2

Published: 19 September 2014
© 2014 Dalgard and Mauss; licensee BioMed Central Ltd.
__________________________________________________________________
________________________________*_________________________________

16. No Abstract: Epidural Steroid Injections Safety Recommendations by the
Multi-Society Pain Workgroup (MPW): More Regulations Without Evidence
or Clarification
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/25247907

Pain Physician. 2014 Sep-Oct;17(5):E575-E588.

Epidural Steroid Injections Safety Recommendations by the Multi-Society
Pain Workgroup (MPW): More Regulations Without Evidence or Clarification.

Manchikanti L1, Falco FJ, Benyamin RM, Gharibo CG, Candido KD, Hirsch JA.

1Pain Management Center of Paducah, Paducah, KY, and University of
Louisville, Louisville, KY; Mid Atlantic Spine & Pain Physicians, Newark,
DE, and Temple University Hospital, Philadelphia, PA; Millennium Pain
Center, Bloomington, IL, and University of Il.
Abstract

Free full text [PDF]

http://tinyurl.com/k9s5q7r
__________________________________________________________________
________________________________*_________________________________

17. No Abstract: Surface safety. Best practices in surface and medical
device disinfection
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25137977

Health Facil Manage. 2014 Jun;27(6):2 p preceding 41.

Surface safety. Best practices in surface and medical device disinfection.

Kehoe B.
__________________________________________________________________
________________________________*_________________________________

18. No Abstract: Mobile telephone in the hospital: so far an
underestimated source of pathogen transmission
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25147895

Kinderkrankenschwester. 2014 Jul;33(7):288-9.

[Mobile telephone in the hospital: so far an underestimated source of
pathogen transmission].

[Article in German]

Panknin HT.
__________________________________________________________________
________________________________*_________________________________

19. BMC Supplement published: Viral Hepatitis and Drug Use in Europe
__________________________________________________________________
http://www.biomedcentral.com/bmcinfectdis/supplements/14/S6

Volume 14 Supplement 6

Viral Hepatitis and Drug Use in Europe

Research and Commentaries

Edited by Jeffrey V Lazarus and Kevin A Fenton
This publication has been produced with the financial support of the Drug
Prevention and Information Programme (DPIP) of the European Union.

BMC Infectious Diseases publishes selected collections of research
articles, conference proceedings, reviews and reports as supplements,
which are free to access online.

All articles published in supplements are subject to peer review; meeting
abstracts undergo review and selection by the conference.

__________________________________________________________________

http://www.biomedcentral.com/1471-2334/14/S6/S1

Introduction [Extract]

Hepatitis – a devastating epidemic in Europe
Jeffrey V Lazarus1* and Kevin A Fenton2

* Corresponding author: Jeffrey V Lazarus jeffrey.lazarus@regionh.dk

Author Affiliations
1 CHIP, Centre for Health and Infectious Disease Research and WHO
Collaborating Centre on HIV and Viral Hepatitis, Rigshospitalet,
University of Copenhagen, Copenhagen, Denmark

2 Public Health England, London, United Kingdom

BMC Infectious Diseases 2014, 14(Suppl 6):S1 doi:10.1186/1471-2334-14-S6-
S1

Open Access: The electronic version of this article is the complete one
and can be found online at:
http://www.biomedcentral.com/1471-2334/14/S6/S1

Published: 19 September 2014

© 2014 Lazarus and Fenton; licensee BioMed Central Ltd.

This is an Open Access article distributed under the terms of the Creative
Commons Attribution License http://creativecommons.org/licenses/by/4.0

Introduction

With hepatitis B and C, the European region is confronting a devastating
epidemic that seemingly has emerged in silence. The major driver of
hepatitis B and C in Europe is now injecting drug use. Yet it would be a
mistake to think of these diseases as a problem primarily for people who
inject drugs (PWID). They are a problem for governments, health systems,
communities, families and all who care about the rights and dignity of the
most marginalised members of our society.

The first European Conference on Hepatitis C and Drug Use, slated for
23-24 October 2014, may well be seen in retrospect as a landmark event
spurring the emergence of the broad-based movement that is needed to alter
the course of the region’s hepatitis epidemic. The conference’s
international organising partner, the Correlation Network’s Hepatitis C
Initiative, has utilised financial support from the Drug Prevention and
Information Programme of the European Union to publish a journal
supplement in conjunction with the conference. We, the editors of the
supplement, are proud to have had this opportunity to bring together
information and viewpoints about some of the most important issues on the
conference agenda. We trust that the publication will both inform the
current dialogue around key issues and also find a place as a core
resource for the many additional people who will surely be drawn to this
work in the years to come.

The European Conference on Hepatitis C and Drug Use takes place at a
pivotal time. The first-ever World Health Assembly resolution on viral
hepatitis in 2010 [1] generated momentum in relation to key strategy and
policy issues at the global level, as reflected in the viral hepatitis
strategic framework announced by the World Health Organization (WHO) in
2012 [2]. In 2013, WHO followed up by asking Member States to report on
existing national policies and practices in relation to the four axes of
the strategic framework. The resulting Global Policy Report on the
Prevention and Control of Viral Hepatitis in WHO Member States [3]
provides a benchmark for measuring progress on a number of critical
issues.

In the spring of 2014, WHO’s hepatitis programme convened its first-ever
“global partners meeting,” and the resulting “Call to Action to Scale Up
Global Hepatitis Response” captured the major concerns of the many civil
society organisations that attended the meeting [4]. Not long afterwards,
strong civil society engagement helped to ensure passage of a new World
Health Assembly resolution [5] that obligates governments to take more
concrete measures in response to viral hepatitis. Civil society again came
together to contribute to the first Global Community Hepatitis Policy
Report, released by the World Hepatitis Alliance on World Hepatitis Day
2014 [6].

The importance of addressing the viral hepatitis prevention and treatment
needs of people who inject drugs has been a strand running through all of
these developments. Indeed, one of the key advocacy victories associated
with the new World Health Assembly resolution is the inclusion of
commitments relating to people who inject drugs. The resolution calls on
WHO Member States to “ implement comprehensive hepatitis prevention,
diagnosis and treatment programmes for people who inject drugs.” Footnoted
text names nine key interventions, including needle and syringe
programmes; opioid substitution therapy and other drug dependence
treatment; and targeted information, education and communication for
people who inject drugs and their sexual partners.

In short, this is an opportune time to bring PWID issues to the forefront
in discussions about how to rein in hepatitis B and C in Europe and
globally.

The discussions underway in policy, advocacy and research circles are by
necessity very broadly focused. Viral hepatitis prevention efforts must
overcome immense obstacles associated with low public awareness and
misconceptions about the nature of the threat. The same factors hinder
health systems from identifying a vast number of infected but currently
asymptomatic and undiagnosed people who might benefit from treatment.
There is also much to be resolved around fundamental matters such as
uniform disease surveillance standards and treatment initiation criteria.
The hepatitis C treatment cascade needs to be more clearly conceptualised
so that vital questions can be pursued regarding how to engage, retain and
successfully treat far more people.

PWID issues are not an “add-on” to this already daunting agenda. They are
cross-cutting throughout the agenda, for the simple reason that people who
inject drugs are commonly the human face of the hepatitis B and C
epidemics in many countries, including a large number of countries in
Europe. Successfully engaging these individuals in prevention and
treatment efforts means addressing a complex public health threat within
the context of other equally complex threats – such as addiction, mental
illness, financial instability and the stigmatisation and criminalisation
of drug users.

The WHO European region has an estimated 15 million people living with
hepatitis C, of whom an estimated two million are current drug injectors
[7]. At the same time, only 30% of European countries submitting
information to WHO for the 2013 policy report indicated that they have
comprehensive national viral hepatitis strategies or plans. Seventy
percent told WHO that they have hepatitis prevention policies targeting
PWID. With such large gaps in national leadership, it is no wonder that
the overall public health response to the viral hepatitis epidemic among
PWID appears to be so fragmented.

Yet the lack of a high-profile discourse regarding how to elaborate the
strategies suggested by the WHO framework should not be interpreted as a
lack of interest in hepatitis and PWID. As the contributions to this
supplement suggest, a vast array of people and organisations have been
quietly forging ahead in their own communities and peer networks. The
collective wisdom accruing through these efforts must be shared more
widely, and it must be shared as quickly as possible – there is absolutely
no time to lose.

In this context, the supplement editors hope that the publication and
conference together help usher in a new era of knowledge-sharing among
those who are committed to preventing and treating hepatitis B and C among
people who inject drugs. We are pleased to note that the supplement
presents no less than ten commentaries about crucial issues in this realm,
and we are equally pleased about the diversity of experiences represented
in the contributions. To illustrate:

• In “No Strategy to Meet the HCV Epidemic,” Olav Dalgard and Stefan Mauss
of the European Association for the Study of the Liver discuss some of the
vast implications of the changing hepatitis C treatment paradigm,
including the opportunity to raise awareness about prevention.

• Achim Kautz and colleagues at the European Liver Patients Association
broadly outline key strategic considerations in relation to improving
hepatitis C screening and treatment for PWID in Europe.

• Chris Ford and Juliet Bressan, United Kingdom-based physicians with a
wealth of knowledge about addiction services, argue forcefully for the
decriminalisation of people who use drugs as a strategic element of the
hepatitis C response.

• In “A Treatment Revolution for Those Who Can Afford It?” Maria Phelan
and Catherine Cook of Harm Reduction International capture some of the
central issues being raised by the extremely high price of new direct-
acting antiviral drugs and call attention to what this means for PWID in
Europe.

• Slovenia’s exemplary national multidisciplinary healthcare network for
treating hepatitis C in people who inject drugs is described by physician
Mojca Maticic, a hepatitis expert who has played a major role in helping
to develop the Slovenian model.

• Leon Wylie of Hepatitis Scotland and other key actors involved in the
Scottish Hepatitis C Action Plan identify ways in which the acclaimed
Scottish approach can serve as a valuable example for others seeking to
develop effective national and pan-European responses to hepatitis C.

• Astrid Leicht of Fixpunkt, a German nongovernmental organisation working
to promote the health of people who use drugs, demonstrates the expertise
that those working at the community level are ready to contribute in
“Improving the Quality of Needle and Syringe Programmes: an Overlooked
Strategy for Preventing Hepatitis C among People Who Inject Drugs.”

• Ricardo Baptista Leite, a physician and Member of Parliament in
Portugal, explains the process that led to the strategic consensus for the
integrated management of hepatitis C in Portugal and highlights primary
recommendations.

• Two contributions from Spain both look critically at ECDC and EMCDDA
Guidance: Prevention and Control of Infectious Diseases among People Who
Inject Drugs [8]. Antonio Corbacho and co-authors representing five
Spanish drug user organisations share insights about what this landmark
guidance document means for their constituencies, as well as identifying
shortcomings and proposing addenda that reflect drug users’ concerns. In a
similar vein but from a quite different vantage point, Joan Colom i Farran
of the Public Health Agency of Catalonia offers a policy-maker’s
perspective on ECDC and EMCDDA Guidance, and in doing so draws out
elements of the guidance that warrant more careful consideration.

The publication also contains five research articles and a discussion
article that collectively demonstrate the potential for smart research to
help transform the political and public health response to hepatitis C in
Europe. Robert Heimer and colleagues present findings from a bio-
behavioural study on hepatitis C among PWID in eight Russian cities,
calling attention to the advanced epidemic there. In “HIV and hepatitis C
Co-infection in Europe, Israel and Argentina: a EuroSIDA Perspective,”
Lars Peters and colleagues examine the nested hepatitis cohort in one of
the world’s major HIV cohort studies. Mojca Maticic and colleagues present
findings that will be valuable to advocates and policy-makers in their
article, “Are There National Strategies, Plans and Guidelines for the
Treatment of Hepatitis C in People who Inject Drugs? A Survey of 33
European Countries.”

Alexander Spina and colleagues focus on the PWID findings from the
aforementioned first WHO global hepatitis policy report in “Policy
Responses to Viral Hepatitis B and C among People Who Inject Drugs in
Member States of the WHO European Region: a Sub-analysis of the WHO 2013
Global Hepatitis Policy Survey.” Jeffrey V Lazarus and colleagues report
worrisome findings about low treatment levels in “A Systematic Review of
Hepatitis C Virus Treatment Uptake among People Who Inject Drugs in the
European Region,” while Amber Arain and colleagues provide recommendations
regarding hepatitis C prevention, screening and treatment in prisons, a
highly neglected setting.

Finally, the supplement presents a timely roundtable discussion entitled
“How Lessons Learned from HIV can Inform the Global Response to Viral
Hepatitis”” with patient, physician, epidemiologist, qualitative
researcher and grassroots advocate perspectives.
__________________________________________________________________
________________________________*_________________________________

20. News

– Canada: Experts warn against use of multi-dose vials in wake of
hepatitis C outbreak at colonoscopy clinics
– Canada: Hepatitis C outbreaks at three Toronto colonoscopy clinics kept
secret
– Canada: Pain clinic doctor faces disciplinary hearing after outbreak
Anesthesiologist Dr. Stephen James accused of incompetence in infection
control and misconduct during probe
– Australia: Needle exchange: ACT Government pushes on with plan for jail
program

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/nupus8a

Canada: Experts warn against use of multi-dose vials in wake of hepatitis
C outbreak at colonoscopy clinics

By Theresa Boyle, Toronto Star, Toronto Canada (30.09.14)

Practice of giving more than one dose from a larger bottle may play a
bigger role in infections than some health-care professionals think.

Vials of injectable medication meant for more than one patient pose an
infection risk and should no longer be used, says a leading Ontario
infection control expert.

“Don’t get me started on multi-dose vials. We should not be using multi-
dose vials in this day and age,” said Dr. Allison McGeer, director of
infectious disease control at Mount Sinai Hospital.

The Star reported on Saturday that 11 patients contracted hepatitis C
during separate outbreaks at three Toronto colonoscopy clinics between
2011 and 2013.

Toronto Public Health said it is “possible” that use of multi-dose vials
was the cause.

Multi-dose vials are small glass or plastic bottles that contain more than
one dose of liquid medication. They are used in conjunction with needles
and syringes.

A vial can become contaminated if the same syringe or needle is used for
multiple patients.

Public Health Ontario, on its website, states that “unsafe injection
practices” involving the vials can cause disease transmission. When a
patient infected with hepatitis C is injected with medication, for
example, backflow of traces of blood can contaminate the syringe.

When additional medication is then drawn from the vial and given to the
same patient, the needle is often replaced, but the same syringe is used.
The vial gets contaminated from the syringe, and the next patient to be
injected with medication from it is then placed at risk.

The problem of health-care professionals inadvertently spreading infection
has been underestimated, McGeer said.

“I think that it is only recently that we’ve started taking seriously the
possibility that medical procedures are a potential risk for hepatitis, so
most physicians, nurses, etc., think it doesn’t happen. But in truth, this
has been happening on an ongoing basis. We need to be doing better to
prevent it,” she warned.

According to TPH, three patients were infected with hepatitis C at the
Downsview Endoscopy Clinic in 2011, three at the North Scarborough
Endoscopy Clinic in 2012 and five at the Ontario Endoscopy Clinic in 2013.
Other places around the world have experienced outbreaks related to multi-
use vials.

“You walk into any endoscopy unit or any pain clinic or any of the places
where people use intravenous medication, and there will be deficiencies
with multi-dose vials. I guarantee it. There is nobody who is using them
properly. I hope we are finally going to move on it,” McGeer said.

The microbiologist, who said she has been on a “multi-dose-vial mission
for 20 years,” noted the ampoules continue to be used in Ontario clinics,
hospitals and outpatient offices. They are cheaper than single-dose vials
and easier to store.

“We should be using single-dose vials of (injectable) medication, for the
same reason that you have to have your foot on the brake when you put your
car in gear, and you have ground-fault interrupters in bathroom electrical
sockets, and you have railings on decks more than three feet above the
ground, and there are automatic shut-off valves in car gas tanks so they
don’t overflow,” she said.

“These are all examples of situations in which we force safety functions
because we know that people are likely to make mistakes,” she continued.
Despite Garber’s assertion that the vials can be used safely, a Public
Health Ontario committee steers clinicians away from using them. A best-
practices guide from the Provincial Infectious Diseases Advisory Committee
states: “Outbreaks associated with the use of multi-dose vials in
outpatient settings are a frequent and a recurring problem. The use of
multi-dose vials should be avoided whenever possible.”

But Dr. Gary Garber, medical director of infection prevention and control
for Public Health Ontario, defended the use of the vials.

“Multi-dose vials can be used safely if the appropriate procedures are
used,” he said, explaining, for example, that clinicians should wash their
hands and never re-enter a vial with a used needle.

“If you want to look at the number of injections that go on every day in
any given hospital or in any given city or health department, and then you
look at the occasional infection that has happened, it is minuscule,”
Garber said.
__________________________________________________________________
__________________________________________________________________
http://tinyurl.com/kzoodbc

Canada: Hepatitis C outbreaks at three Toronto colonoscopy clinics kept
secret

By: Theresa Boyle, Toronto Star, Toronto Canada (27.09.14)

Toronto Public Health, which revealed the outbreaks when pressed by the
Star, said 11 patients were infected and tainted sedative injections were
the “possible” cause in all cases.

The NDP is calling on the province to remove the College of Physicians and
Surgeons as the regulator of out-of-hospital clinics, after the college
kept three hepatitis C outbreaks in Toronto a secret. MPP France Gélinas
charged that the outbreaks show the organization is failing in its duties
to uphold quality of care and to be transparent.VIEW 2 PHOTOSzoom RICK
MADONIK / TORONTO STAR FILE PHOTO

The NDP is calling on the province to remove the College of Physicians and
Surgeons as the regulator of out-of-hospital clinics, after the college
kept three hepatitis C outbreaks in Toronto a secret. MPP France Gélinas
charged that the outbreaks show the organization is failing in its duties
to uphold quality of care and to be transparent.

Three Toronto colonoscopy clinics have had hepatitis C outbreaks since
2011, the Star has learned.

Toronto Public Health, which revealed the outbreaks when pressed by the
Star, says 11 patients were infected and that tainted sedative injections
were the “possible” cause in all cases.

The authorities responsible for investigating the spread of infection and
inspecting the clinics — TPH and the College of Physicians and Surgeons of
Ontario, respectively — kept the outbreaks secret.

NDP health critic France Gélinas said public awareness of the first
outbreak might have prevented the next two.

“It has gone beyond appalling that the same mistakes are being repeated
and are not being reported,” she said.

She is calling on the province to remove the CPSO as regulator of such
clinics — known as “out-of-hospital premises” — charging that the
outbreaks show the organization is failing in its duties to uphold quality
of care and to be transparent, and is placing patients at risk.

The MPP for Nickel Belt also wants the province to suspend the downloading
of hospital services into the community and place a moratorium on the
creation of any new clinics until a new oversight body is created to
ensure public safety.

“The minister of health has to realize that this push into the community
is not safe. It won’t be safe until we have in place much more robust
oversight,” she said.

Health Minister Eric Hoskins said he is seeking advice on ways to
strengthen outbreak protocols and inspection programs to ensure patient
safety in clinics outside of hospitals.

“We will work to identify new tools that can help us continue to protect
patient safety no matter where (patients) are receiving treatment.
Ontarians have my commitment as minister that we will do whatever is
necessary to protect the safety of patients,” he said.

TPH told the Star 11 patients contracted the liver-damaging virus during
three outbreaks over the last three years: three were infected at the
Downsview Endoscopy Clinic on Dec. 7, 2011, three at the North Scarborough
Endoscopy Clinic on Oct. 17, 2012, and five at the Finch Ave. W. site of
the Ontario Endoscopy Clinic on March 15, 2013.

Nine of the 11 infected patients have gone on to develop chronic hepatitis
C, meaning the virus has remained in their bodies, placing them at risk of
serious, long-term problems, including cirrhosis of the liver and liver
cancer.

None of the clinics offered up anyone to be interviewed, but all three
provided written statements. They all expressed concern for the health and
recovery of the patients, said they co-operated fully with investigations
and emphasized that they are committed to ensuring outbreaks never occur
again.

The Downsview Endoscopy Clinic also said it no longer uses multi-dose
vials.

Dr. Michael Finkelstein, associate medical officer of health for Toronto,
told the Star while no definitive cause of the outbreaks was determined,
it’s possible that the virus spread the same way at the three clinics.

Vials of liquid sedative medication, each used on more than one patient
undergoing endoscopic procedures such as colonoscopies, may have become
contaminated.

“In all three investigations, the clinics were using multi-dose medication
vials for anesthetic and pain management to sedate patients undergoing
endoscopic procedures. It is possible that a vial of multi-dose medication
used during the procedures became contaminated,” he said.

“There are examples in the medical literature of (hepatitis C) being
transmitted between patients in this type of setting when a multi-dose
vial of medication becomes contaminated with the blood of an infected
patient. In all three cases, TPH ruled out contamination of the endoscopes
as a possible source of . . . transmission,” he continued.

Multi-dose vials are often used in hospitals and community clinics because
they are cheaper and easier to store than single-dose vials.

According to the Provincial Infectious Diseases Advisory Committee, clinic
outbreaks caused by mishandling of multi-dose vials are an ongoing
problem: “Outbreaks associated with multi-dose vials in outpatient
settings are frequent and recurring. Multi-dose vials should be avoided
when possible.”

Public Health Ontario, on its website, states “unsafe injection practices”
involving the vials can cause disease transmission. When a patient
infected with hepatitis C is injected with medication, backflow of traces
of blood can contaminate the syringe.

When additional medication is then drawn from the vial and given to the
same patient, the needle is often replaced, but the same syringe is used.
The vial gets contaminated from the syringe, and the next patient to be
injected with medication from it is then placed at risk.

A copy of an August 2014 interim report on the investigation into the
outbreak at the North Scarborough Endoscopy Clinic obtained by the Star
states: “It is possible that a vial of medication, most likely Xylocaine,
became contaminated.”

Xylocaine is a local anesthetic.

The report suggests TPH began investigating the clinic after learning a
51-year-old man tested positive for hepatitis C on Dec. 14, 2012, two
months after undergoing a colonoscopy there.

In the preceding weeks, he had come down with symptoms of the disease,
including jaundice, pale stools, loss of appetite, fatigue, nausea and
dark urine.

TPH and Public Health Ontario got a list of patients who had been to the
clinic in the days immediately before and after the man’s Oct. 17, 2012
visit. On that list, they found a patient who was known to have already
had hepatitis. It turned out this man had also visited the clinic on Oct.
17, just prior to the 51-year-old man.

To determine if anyone else had contracted the virus, letters were sent to
other patients who had procedures done at the clinic on Oct. 17, 18 and
19. They were advised to get tested for the virus. This resulted in two
other infected patients being identified. Both had been to the clinic on
Oct. 17.

States the report: “The chances of inadvertent contamination increase with
the use of multi-dose medication containers and rapid turnover between
patients. Best practices for injection medication dictate use of single-
use vials that are discarded after each procedure and in between
patients.”
__________________________________________________________________
__________________________________________________________________
http://tinyurl.com/og2ddmw

Canada: Pain clinic doctor faces disciplinary hearing after outbreak
Anesthesiologist Dr. Stephen James accused of incompetence in infection
control and misconduct during probe.

By Theresa Boyle, Toronto Star, Toronto Canada (25.09.14)

An anesthesiologist alleged to have infected patients during an outbreak
at a Toronto pain clinic that was kept secret from the public has been
ordered by the College of Physicians and Surgeons of Ontario to face a
disciplinary hearing.

The move comes as Toronto Public Health begins exploring ways to let the
public know more about outbreaks at clinics and as Health Minister Eric
Hoskins urges the physician watchdog to do the same.

Meantime, a proposed multimillion-dollar class-action lawsuit has been
launched on behalf of patients who developed serious infections after
being treated at the Rothbart Centre for Pain Care. It charges that the
clinic and anesthesiologist Dr. Stephen James failed to maintain adequate
infection-control procedures.

James told the Star in an email it would be inappropriate to comment on
any litigation, adding, “I take very seriously the physician-patient
relationship and the responsibilities that derive from that relationship.
I sincerely regret that any of my patients experienced health
complications. My primary goal as a physician is to improve quality of
life.”

The clinic’s medical director, Dr. Peter Rothbart, did not respond to a
request for comment.

The actions follow publication of a Star story about nine patients who
developed meningitis and epidural abscesses during a 2012 outbreak at the
Dufferin St. clinic.
__________________________________________________________________
__________________________________________________________________
http://tinyurl.com/nqpwfgh

Australia: Needle exchange: ACT Government pushes on with plan for jail
program

By Lisa Mosley and Jonathon Gul, ABC News Australia
Updated 24 Sep 2014, 5:00pmWed 24 Sep 2014, 5:00pm

The ACT Opposition has failed to convince the Government to abandon its
plan to implement a needle-exchange program in Canberra’s jail.

The Government plans to introduce a needle and syringe exchange program to
stop the spread of blood-borne viruses among drug users at the jail.

The Liberals moved a motion in the Legislative Assembly calling on the
Government to abandon the policy.

It failed to attract any support from Labor or the Greens, and was
defeated.

Prison staff have vigorously opposed the plan, citing concerns over safety
at the Alexander Maconochie Centre.

Liberals spokesman Andrew Wall said the Government was failing to consider
the views of jail staff.

“They are the ones that have an intimate knowledge of how the prison
environment works,” he said.

“They are all too aware that a blood-filled syringe would most likely
become the weapon of choice, and the staff would be be almost powerless in
combating these incidents.”

Corrections Minister Shane Rattenbury said he remained committed to
implementing the needle-exchange program.

He said the Liberals should consider the facts and the health of the
prison population.

“Detainees in Australian prisons experience among the highest prevalence
of hepatitis C virus infection in the world, and extremely high rates of
hepatitis C transmission,” he said.

Topics: law-crime-and-justice, prisons-and-punishment, drugs-and-
substance-abuse, community-and-society, drug-offences, crime, act,
canberra-2600
__________________________________________________________________
________________________________*_________________________________
* 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
__________________________________________________________________
________________________________*_________________________________

SIGN Meeting Postponed

The previously announced Safe Injection Global Network SIGN meeting for
October 2014 has been postponed.

A new announcement will be posted as soon as poossible.

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

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.
__________________________________________________________________

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
__________________________________________________________________
________________________________*_________________________________
All members of the SIGN Forum are invited to submit messages, comment on
any posting, or to use the forum to request technical information in
relation to injection safety.

The comments made in this forum are the sole responsibility of the writers
and does not in any way mean that they are endorsed by any of the
organizations and agencies to which the authors may belong.

Use of trade names and commercial sources is for identification only and
does not imply endorsement.

The SIGN Forum welcomes new subscribers who are involved in injection
safety.

* Subscribe or un-subscribe by email to: sign.moderator@gmail.com, or to
sign@who.int

The SIGNpost Website is http://SIGNpostOnline.info

The SIGNpost website provides an archive of all SIGNposts, meeting
reports, field reports, documents, images such as photographs, posters,
signs and symbols, and video.

We would like your help in building this archive. Please send your old
reports, studies, articles, photographs, tools, and resources for posting.

Email mailto:sign.moderator@gmail.com
__________________________________________________________________
________________________________*_________________________________

The SIGN Internet Forum was established at the initiative of the World
Health Organization’s Department of Essential Health Technologies.

The SIGN Secretariat home is the Department of Health Systems Policies and
Workforce, Geneva Switzerland.

The SIGN Forum is moderated by Allan Bass and is hosted on the University
of Queensland computer network. http://www.uq.edu.au
__________________________________________________________________

Comments are closed.