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SIGNpost 00770

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST

Post00770 SIGN meeting + Abstracts 15 October 2014

CONTENTS
1. Final dates of the SIGN meeting : 17-18 December 2014, Geneva
2. Abstract: Effect of preventive and curative interventions on hepatitis
C virus transmission in Egypt (ANRS 1211): a modelling study
3. Abstract: A serious complication due to liquid silicone injection in
the legs for cosmetic purpose
4. Abstract: Comparison of incidence of intravascular injections during
transforaminal epidural steroid injection using different needle types
5. Abstract: Prevalence of Hepatitis B Vaccination among Oral Health Care
Personnel in Mysore City, India
6. Abstract: Improved Hand Hygiene Compliance is Associated with the
Change of Perception toward Hand Hygiene among Medical Personnel
7. Abstract: Microneedle-based drug delivery systems for transdermal route
8. No Abstract: Introducing insulin pen needle safety devices in Australia
to protect nurses
9. No Abstract: HIV pandemic originated in Kinshasa around 1920, say
scientists

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1. Final dates of the SIGN meeting : 17-18 December 2014, Geneva
__________________________________________________________________
KHAMASSI, Selma <khamassis@who.int>
to: signmoderator@gmail.com
date: Mon, Oct 13, 2014
subject: Final dates of the SIGN meeting : 17-18 December 2014, Geneva

Dear SIGN partners

Many thanks to all those who responded to our enquiry about potential SIGN
meeting dates. Based on your responses, the proposed dates 17-18 December
were agreed by the vast majority of respondents . Thank you very much
indeed h for your flexibility .

Of course we will miss those of you who will not be able to make it but
since we are trying to make a democratic decision , we will follow the
opinion of the majority.

We will shortly post the tentative agenda of the meeting

Warm regards

Selma
________________________________

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: Effect of preventive and curative interventions on hepatitis
C virus transmission in Egypt (ANRS 1211): a modelling study
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25304421
Lancet Glob Health. 2014 Sep;2(9):e541-9.

Effect of preventive and curative interventions on hepatitis C virus
transmission in Egypt (ANRS 1211): a modelling study.

Breban R1, Arafa N2, Leroy S3, Mostafa A2, Bakr I2, Tondeur L3, Abdel-
Hamid M4, Doss W5, Esmat G5, Mohamed MK2, Fontanet A6.
Author information
1Institut Pasteur, Emerging Diseases Epidemiology Unit, Paris, France.
Electronic address: romulus.breban@pasteur.fr.
2Ain Shams University, Cairo, Egypt.
3Institut Pasteur, Emerging Diseases Epidemiology Unit, Paris, France.
4National Hepatology and Tropical Medicine Research Institute, Cairo,
Egypt; Minia University, Minia, Egypt.
5Cairo University, Cairo, Egypt.
6Institut Pasteur, Emerging Diseases Epidemiology Unit, Paris, France;
Conservatoire National des Arts et Métiers, Paris, France.

BACKGROUND: Most hepatitis C virus (HCV) transmission in Egypt is related
to medical injections and procedures. To control the spread of HCV, the
Egyptian Ministry of Health initiated awareness and education campaigns,
strengthened infection control in health-care facilities, and subsidised
anti-HCV treatment. We aimed to investigate the effect of these
interventions on the spread of HCV by mathematical modelling.

METHODS: We developed a mathematical model of HCV transmission in Zawyat
Razin, a typical rural community. Our model assumes that each individual
has two distinct types of medical procedures: injections and more invasive
medical procedures. To quantify the severity of the spread of HCV, we used
the notion of the basic reproduction number R0, a standard threshold
parameter signalling whether transmission of an infectious disease is
self-sustained and maintains an epidemic. If R0 is greater than 1, HCV is
self-sustained; if R0 is 1 or less, HCV transmission is not self-
sustained. We investigated whether heterogeneity in the rate of injection
or invasive medical procedures is the determinant factor for HCV
transmission and whether most iatrogenic transmission is caused by a small
group of individuals who receive health-care interventions frequently. We
then assessed whether interventions targeted at this group could reduce
the spread of HCV.

FINDINGS: The R0 of the spread of HCV without treatment was 3·54 (95% CI
1·28-6·18), suggesting a self-sustained spread. Furthermore, the present
national treatment programme only decreased R0 from 3·54 to 3·03 (95% CI
1·10-5·25). Individuals with high rates of medical injections seem to be
responsible for the spread of HCV in Egypt; the R0 of the spread of HCV
without treatment would be 0·64 (95% CI 0·41-0·93) if everybody followed
the average behaviour. The effect of treatment on HCV transmission is
greatly enhanced if treatment is provided a mean of 2·5 years (95% CI
0·1-9·2) after chronic infection and with drug regimens with more than 80%
efficacy. With these treatment parameters, preventive and curative
interventions targeting individuals with high rates of medical injections
might decrease R0 below 1 for treatment coverage lower than 5%.

INTERPRETATION: Targeting preventive and curative interventions to
individuals with high rates of medical injections in Egypt would result in
a greater reduction the spread of HCV than would untargeted allocation.
Such an approach might prove beneficial in other resource-limited
countries with health-care- driven epidemics.

FUNDING: Agence Nationale de Recherche sur le SIDA et les Hépatites
Virales (ANRS 1211), ANR grant Labex Integrative Biology of Emerging
Infectious Diseases.

Copyright © 2014 Breban et al. Open Access article distributed under the
terms of CC BY-NC-ND. Published by .. All rights reserved.

Free full text

http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(14)
70188-3/fulltext
__________________________________________________________________
________________________________*_________________________________

3. Abstract: A serious complication due to liquid silicone injection in
the legs for cosmetic purpose
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24217838

Clin Ter. 2013;164(5):e377-9. doi: 10.7417/CT.2013.1616.

[A serious complication due to liquid silicone injection in the legs for
cosmetic purpose].

[Article in Italian]

Fumo G1, Ferreli F, Murgia S, Galletti R, Pau M.

1Clinica Dermatologica. Azienda Ospedaliera Universitaria di Cagliari,
Italia.

Liquid injectable silicone has been used to increase volume in determined
cutaneous districts, particularly in aesthetical reconstructive surgery.

Although considered biologically inert for a long time this substance
produced various complications as granulomatous foreign body reaction
(siliconomas), secondary limphedema, tissue destruction and lethal
embolism.

A 35-year-old Caucasian woman came to our department with erithema and
edema on the right leg, fever and chills. A thorough examination of the
patient’s history revealed injection of liquid silicone 7 years before for
cosmetic volume increase of both legs. A closer observation revealed a
small fistulous element from which came out white- yellow puruloid
material.

Antibiotic therapy and drainage of the abscess were undertaken. Within few
days of treatment erithema and swelling essentially improved and the
patient was discharged. After two months she came back to our department
due to the same disease on her left leg that we treated with the therapy
previously used.

We highlight the long time, 7 years, elapsed between liquid silicone
injection and onset of cutaneous symptoms.
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Comparison of incidence of intravascular injections during
transforaminal epidural steroid injection using different needle types
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25302096

Korean J Anesthesiol. 2014 Sep;67(3):193-7.

Comparison of incidence of intravascular injections during transforaminal
epidural steroid injection using different needle types.

Hong JH, Lee YH.

Department of Anesthesiology and Pain Medicine, Keimyung University
Dongsan Hospital, Daegu, Korea.

BACKGROUND: Infrequent but serious complications of transforaminal
epidural steroid injection (TFESI) occur due to inadvertent intravascular
injections. A few studies reported that the different needle types can
influence on the occurrences of intravascular incidence in TFESI. This
study prospectively evaluated whether short-bevel needle can reduce the
incidences of intravascular injection of TFESI compared to long-bevel
needles.

METHODS: From March 2013 to December 2013, 239 consecutive patients were
enrolled and received 249 fluoroscopically guided TFESI using the classic
technique. Confirmation of intravascular spread was done initially with
real time fluoroscopy and then with digital subtraction angiography method
in a same patient. Injection technique for TFESI was the same for both
short-bevel and long-bevel needle types.

RESULTS: The incidences of intravascular injections with the long-bevel
and short- bevel needles were 15.0% (21/140) and 9.2% (4/140),
respectively. More than half of intravascular injections occurred
simultaneously with epidural injections (8.0%, 20/249). There were no
statistically significant differences between the long-bevel and the
short-bevel needles in the rates of intravascular injections (P = 0.17).

CONCLUSIONS: Short-bevel needles did not demonstrate any benefits in
reducing the incidence of intravascular injection.

KEYWORDS: Intravascular; Long-bevel; Short-bevel; Transforaminal epidural
steroid injection

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4188765/
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Prevalence of Hepatitis B Vaccination among Oral Health Care
Personnel in Mysore City, India
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25284530

Oral Health Dent Manag. 2014 Sep;13(3):652-5.

Prevalence of Hepatitis B Vaccination among Oral Health Care Personnel in
Mysore City, India.

Reddy V, Bennadi D1, Kshetrimayum N, Reddy CV, Satish G, Kura U, Yadavalli
G.

1Department of Public Health Dentistry, Sree Siddhartha Dental College and
Hospital, Tumkur, India; Tel: +91-9164984840; e-mail: darmadhu@yahoo.com.

BACKGROUND: The transmission of blood borne virus in health care workers
is a potential occupational hazard to patients as well as to the Oral
Health Care Personnel (OHCP). Hepatitis B remains a serious threat to
dental team.

PATIENTS AND METHODS: To assess the vaccination status and post
vaccination antibody status of oral health care personnel against
Hepatitis B Virus (HBV) infection. Descriptive Cross-sectional
questionnaire study was conducted among the oral health care personnel of
Mysore city.

RESULTS: Out of 300 oral health care personnel 256 (85.4%) were vaccinated
for HBV infection and 44 (14.6%) had not taken vaccination. Highest
frequency of vaccination was seen among dentists and least amongst dental
lab technicians and other workers. This difference was highly significant
among the different occupation groups (p= 0.001).

CONCLUSION: Majority of the OHCP of Mysore city have been vaccinated.
Among them, dentists formed the majority group of vaccinated. But there
was ignorance and less awareness regarding Hepatitis B vaccination among
dental lab technicians and other workers like dental assistants and
cleaning staff. Awareness amongst OHCPS against Hepatitis B vaccination
has increased significantly over the years, but there are few who do not
intend to get vaccinated.
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Improved Hand Hygiene Compliance is Associated with the
Change of Perception toward Hand Hygiene among Medical Personnel
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25298905

Infect Chemother. 2014 Sep;46(3):165-71.

Improved Hand Hygiene Compliance is Associated with the Change of
Perception toward Hand Hygiene among Medical Personnel.

Lee SS1, Park SJ2, Chung MJ2, Lee JH2, Kang HJ2, Lee JA1, Kim YK1.

1Division of Infectious Diseases, Department of Internal Medicine, Hallym
University Sacred Heart Hospital, Hallym University College of Medicine,
Anyang, Korea.
2Department of Infection Control, Hallym University Sacred Heart Hospital,
Hallym University College of Medicine, Anyang, Korea.

BACKGROUND: Hand hygiene compliance has improved significantly through
hand hygiene promotion programs that have included poster campaign,
monitoring and performance feedback, and education with special attentions
to perceived subjective norms. We investigated factors associated with
improved hand hygiene compliance, focusing on whether the improvement of
hand hygiene compliance is associated with changed perception toward hand
hygiene among medical personnel.

MATERIALS AND METHODS: Hand hygiene compliance and perceptions toward hand
hygiene among medical personnel were compared between the second quarter
of 2009 (before the start of a hand hygiene promotion program) and the
second quarter of 2012. We assessed adherence to hand hygiene among
medical personnel quarterly according to the WHO recommended method for
direct observation. Also, we used a modified self-report questionnaire to
collect perception data.

RESULTS: Hand hygiene compliance among physicians and nurses improved
significantly from 19.0% in 2009 to 74.5% in 2012 (P < 0001), and from
52.3% to 91.2% (P < 0.001), respectively. These improvements were observed
in all professional status or all medical specialties that were compared
between two periods, regardless of the level of the risk for cross-
transmission. Hand hygiene compliance among the medical personnel
continued to improve, with a slight decline in 2013. Perceptions toward
hand hygiene improved significantly between 2009 and 2012. Specifically,
improvements were evident in intention to adhere to hand hygiene,
knowledge about hand hygiene methods, knowledge about hand hygiene
indications including care of a dirty and a clean body site on the same
patient, perceived behavioral and subjective norms, positive attitude
toward hand hygiene promotion campaign, perception of difficulty in
adhering to hand hygiene, and motivation to improve adherence to hand
hygiene.

CONCLUSIONS: The examined hand hygiene promotion program resulted in
improved hand hygiene compliance and perception toward hand hygiene among
medical personnel. The improved perception increased hand hygiene
compliance. Especially, the perception of being a role model for other
colleagues is very important to improve hand hygiene compliance among
clinicians.

KEYWORDS: Hand Hygiene; Health personnel; Quality Improvement

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4189144/
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Microneedle-based drug delivery systems for transdermal route
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24144208

Curr Drug Targets. 2014 Mar;15(3):281-91.

Microneedle-based drug delivery systems for transdermal route.

Pierre MB, Rossetti FC1.

1Faculdade de Farmacia, Laboratorio de Pesquisa e Desenvolvimento
Farmacotecnico, Departamento de Medicamentos, Universidade Federal do Rio
de Janeiro, Brasil, Av. Carlos Chagas Filho, 373, 21.941.590, Rio de
Janeiro, Brazil. bernadete@pharma.ufrj.br.

Transdermal delivery offers an attractive, noninvasive administration
route but it is limited by the skin’s barrier to penetration. Minimally
invasive techniques, such as the use of microneedles (MNs), bypass the
stratum corneum (SC) barrier to permit the drug’s direct access to the
viable epidermis.

These novel micro devices have been developed to puncture the skin for the
transdermal delivery of hydrophilic drugs and macromolecules, including
peptides, DNA and other molecules, that would otherwise have difficulty
passing the outermost layer of the skin, the SC. Using the tools of the
microelectronics industry, MNs have been fabricated with a range of sizes,
shapes and materials. MNs have been shown to be robust enough to penetrate
the skin and dramatically increase the skin permeability of several drugs.
Moreover, MNs have reduced needle insertion pain and tissue trauma and
provided controlled delivery across the skin.

This review focuses on the current state of the art in the transdermal
delivery of drugs using various types of MNs and developments in the field
of microscale devices, as well as examples of their uses and clinical
safety.
__________________________________________________________________
________________________________*_________________________________

8. No Abstract: Introducing insulin pen needle safety devices in Australia
to protect nurses
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25090881

Aust Nurs Midwifery J. 2014 Jul;22(1):30-3.

Introducing insulin pen needle safety devices in Australia to protect
nurses.

Gillespie E, Canning E.
__________________________________________________________________
________________________________*_________________________________

9. No Abstract: HIV pandemic originated in Kinshasa around 1920, say
scientists
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25281683

BMJ. 2014 Oct 3;349:g5967.

HIV pandemic originated in Kinshasa around 1920, say scientists.

Wise J.

London.

Extract

The current HIV pandemic almost certainly originated in Kinshasa in the
Democratic Republic of the Congo around 1920, a new analysis has
concluded.

The city’s transport links, particularly its railways, made Kinshasa one
of the best connected of all central African cities and contributed to the
spread of the virus, said a report published in Science. By the end of
the 1940s over a million people were travelling through Kinshasa on these
railways each year.

HIV is known …

Full text requires payment or subscription
http://www.bmj.com/content/349/bmj.g5967.long
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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 possible.

The main topic of the meeting is 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

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requires the free Adobe Acrobat Reader at: http://get.adobe.com/reader/

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or http://www.freetranslation.com
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