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SIGNpost 00771

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST

Post00771  Ebola? + Waste + Abstracts + Ebola + News 22 October 2014

CONTENTS
0. Moderators note
1. Comment: SIGNpost is AWOL on the biggest issue of the day — the risk
for patients to get Ebola during health care
2. Editorial: Health care waste management: a multi speed development in
the sub-Sahara African region
3. Abstract: Immunization Practices of Pediatricians for Children Younger
Than Five Years in Coastal South India
4. Abstract: The impact of regulatory compliance behavior on hazardous
waste generation in European private healthcare facilities
5. Abstract: High incidence of occupational exposures among healthcare
workers in Erbil, Iraq
6. Abstract: Occupational exposure to blood and compliance with standard
precautions among health care workers in Beijing, China
7. Abstract: Most sharps pose safety risk to staff
8. Abstract: Potential risk of cross-infection by tourniquets: a need for
effective control practices in pakistan
9. Abstract: Sharps and high-pressure injection injuries in veterinary and
animal workers
10. Abstract: The risk of blood transfusion-associated Chikungunya fever
during the 2009 epidemic in Songkhla Province, Thailand
11. Abstract: Complications of intravitreal injections in patients with
diabetes
12. Abstract: Intramuscular ketorolac versus oral ibuprofen for pain
relief in first-trimester surgical abortion: a randomized clinical trial
13. Abstract: Would you tell everyone this? Facebook conversations as
health promotion interventions
14. Abstract: A Primer on Ebola for Clinicians
15. Ebola: Lessons From Ebola School: How To Draw Blood, Wipe Up Vomit
16. magpi: Advanced Mobile Data Collection Anywhere, On Any Device
17. News
– India: NGO raises alarm on rising hepatitis C cases among IDUs
– USA: Officer pricks hand on needle during pocket search
– USA: University of Cincinnati lands grant to attack hepatitis C among
needle users in 20 counties
– USA: Health care workers: Staying safe
– Kenya: NACC Raises Concerns Over HIV

The web edition of SIGNpost is online at:
http://signpostonline.info/archives/1758

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
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Visit the WHO injection safety website and the SIGN Alliance Secretariat
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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!
__________________________________________________________________
________________________________*_________________________________

0. Moderators note

SIGN Meeting 2014

The Safe Injection Global Network SIGN meeting will be held on 17-18
December 2014 at WHO Headquarters in 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.

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.
__________________________________________________________________
________________________________*_________________________________

1. Comment: SIGNpost is AWOL on the biggest issue of the day — the risk
for patients to get Ebola during health care
__________________________________________________________________
David Gisselquist <david_gisselquist@yahoo.com>

to: Sign Moderator <sign.moderator@gmail.com>
date: Wed, Oct 15, 2014
subject Re: Post00770 SIGN meeting + Abstracts

Hi Allan,

SIGNpost is AWOL on the biggest issue of the day — the risk for patients
to get Ebola during health care.

If that is not discussed publicly, seeking and welcoming the participation
of the West African public at risk — the evidence, the cases
acknowledged, the public warned about patients’ risks — we might very
well see infections doubling every month for the foreseeable future. Until
it is addressed.

Anyone with a job in healthcare could lose their job over this. A good way
to go.

David
__________________________________________________________________

Moderators reply
Hi David,

Thanks for your note. We have posted a few items related to Ebola xmission
in healthcare.

Today’s edition has something on phlebotomy / drawing blood for health
workers working with Ebola patients.

You might also note that all reports suggest that other than Ebola
treatment centres, most health services in Guinea, Sierra Leon and
Liberia have collapsed.

My understanding is that most EV transmission is now in households, rather
than in healthcare.

Reported EVD cases are doubling every 3 weeks, and may be accelerating as
all treatment facilities are overwhelmed and many or most infectious cases
remain in the community rather than in isolation

Please post something on the subject. Meanwhile I will post your note in
today’s SIGNpost.

regards and best wishes,
allan
__________________________________________________________________
________________________________*_________________________________

2. Editorial: Health care waste management: a multi speed development in
the sub-Sahara African region

Crossposted from the PanAfrican Medical Journal with thanks
__________________________________________________________________
http://www.panafrican-med-journal.com/content/article/17/305/full

Pan Afr Med J. 2014 Apr 22;17:305.

Health care waste management: a multi speed development in the sub-Sahara
African region.

Doumtsop JG.

Ministry of Public health, Cameroon.

Corresponding author Jean Gerard Tatou Doumtsop, Ministry of Public
Health, Cameroon

Editorial

Having visited many health care facilities in some countries of sub-Sahara
African region, I have come to notice that alongside often insurmountable
difficulties by health personnel per se such as water supply or
electricity supply lay an important rather more surmountable problem of
health care waste (HCW) management.

In 2002, WHO assessment in 22
developing countries showed that 18- 64% of Health care facilities do not
use proper waste disposal methods [1]. No doubt that the number of health
care facilities has increased significantly over the last decade due to
demographic development but mainly to global aid from international
commitment to eradicate and control many diseases ( Global funds, Clinton
Health Access Initiative, GAVI alliance, C2D etc.) making the issue a
serious rising problem. In my touring in different health facilities,
Countless time I have forked here and there in order to slip away heaps of
HCW within hospital enclosure from the top up reference hospital to the
top down health post. When I have sometimes asked how does it comes to be
like that, the most frequent answer has been that there is either no
incinerator or that the one existing is broken down! I have asked myself
about the common sense of health workers in our region. If we can say that
a nurse in a health post is not well trained to intuitively dispose HCW in
a safer manner, how does it come that even in some teaching hospital where
there are highly educated health personnel there is still little care
about safely disposal of HCW! Commonly, heaps of wastes are being burned
here and there but rarely completely burned! If 15 to 25% of total HCW
generated was potentially dangerous by the year 2000 [2], the rapid
scaling up of activities such as Expanded Program of Immunization and
other injection practices highly generator of potentially dangerous waste
have likely increased that percentage very well.

I noticed in approximate same conditions that some reference hospitals
either in the same country or between countries were performing better
than others and I suspected some hypothetical reasons: The overall
performance of the managing board; The overall concern of health workers
about public health issues; The poor motivation to care about public goods
as compare to private ones; The socio-economic standards of the catchment
area of the health care facility; The number of Non Governmental
Organisations working on health performing in the catchment area of the
health care facility.

The concern about biomedical waste management was seriously considered by
WHO in 2000 and grounds for good management laid down [3], but over the
following decade the scale of the phenomenon in our sub-Sahara African
region has not been really evaluated! The little concern of public health
operational researchers in Africa may be due to the sensibility of the
issue thus impairing them to easily obtain ethical clearance from decision
makers, these latter, somehow more concerned with their reputation.

Principles and methods from the simplest to the more sophisticated ones
for biomedical waste management are well established and continue to be
updated by interested organisations [4], but I still believe that for our
very low income region, the challenge should be first what to do and how
to do before what to use and how to use given our very low capacity to
sustain a rapidly growing technology. As long as I remember that the
problem was never mentioned about during our medical training period I
also strongly believe that the best way to promote best practices in the
long run is to include the matter in the training program in health
schools. By the time they become health workers, their awareness about HCW
management will certainly be better raised and they could intuitively
apply corresponding best practices to their working setting. However, as
developed by WHO [5], good HCW management definitely depends on a
dedicated waste management team, good administration, careful planning,
sound organisation underpinning legislation, adequate financing, and full
participation by trained staff.

Competing interests: The author declares no competing interests.

References

World Health Organization. Management of Waste from Hospital and other
Health Care Establishment, Geneva 2000; 94-96. Google Scholar

Glenn, McR, Garwal R. Clinical waste in Developing Countries. An analysis
with a Case Study of India and a critique of the Basle-TWG Guidelines.
1999. Google Scholar

Best practices in Health care waste management. Examples from four
Philippine Hospitals. Health Care Without Harm Asia, 2007.

Manuel de gestion des déchets biomédicaux. CICR, Mai 2011.

Diaz LF, Fisher S; World Health Organization; Health Care Without Harm.
Management of health care wastes. Waste Manag. 2005;25(6):567-74. PubMed |
Google Scholar

Free full text Permanent link:
http://www.panafrican-med-journal.com/content/article/17/305/full

doi:10.11604/pamj.2014.17.305.3965 Cite or link using DOI

Key words: Health care, waste management, Africa

© Jean Gerard Tatou Doumtsop et al.

The Pan African Medical Journal – ISSN 1937-8688. This is an Open Access
article distributed under the terms of the Creative Commons Attribution
License (http://creativecommons.org/licenses/by/2.0), which permits
unrestricted use, distribution, and reproduction in any medium, provided
the original work is properly cited.
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Immunization Practices of Pediatricians for Children Younger
Than Five Years in Coastal South India
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25318472

J Prim Care Community Health. 2014 Oct 15. pii: 2150131914554455.

Immunization Practices of Pediatricians for Children Younger Than Five
Years in Coastal South India.

Mithra P P1, Unnikrishnan B2, T R2, Kumar N2, Chatterjee PK2, Holla R2.

1Kasturba Medical College (Manipal University), Mangalore, India
prasanna.mithra@manipal.edu ppmithra@gmail.com.
2Kasturba Medical College (Manipal University), Mangalore, India.

CONTEXT: Immunization helps in controlling infectious diseases. Child
immunization is an important component of child survival programs in
India, which mainly follows the National Immunization Schedule. Also, many
of the injection practices followed are not safe.

AIMS: To study the practices of pediatricians toward the immunization of
children younger than 5 years and injection-related waste management.

SETTINGS AND DESIGN: Cross-sectional study carried out in the city of
Mangalore, a rapidly developing city in southern India.

METHODS AND MATERIAL: All the practicing pediatricians were included in
the study and an interview was done on prior appointment using pretested
interview schedule in March 2012, after obtaining clearance from the
institutional ethics committee. Data were analyzed using the Statistical
Package for Social Sciences version 11.5.

RESULTS: Among the 54 practicing pediatricians in Mangalore, 42 were
included in this study after exclusion criteria were applied. Among them,
71.4% were following the National Immunization Schedule, 5% did not prefer
to give combination vaccines, 17% reported vaccine failure at least once
in their practice, and 85.7% motivated the parents for future doses.
Distance to the clinic and affordability were the major reasons for loss
of follow-up.

Only 38.1% used auto-disabled syringes, 11.9% did not
observe the children following the immunization, and 45.2% did not use
color coding for disposal of injection-related wastes. Mechanical hub
cutters were preferred by 41% of the respondents.

CONCLUSION: The study showed the diversity in immunization practices. The
National Immunization Schedule is the most commonly followed schedule.
However, the safety of the injection practices was limited.

© The Author(s) 2014.

KEYWORDS: children younger than 5 years; immunization; pediatricians;
south India
__________________________________________________________________
________________________________*_________________________________

4. Abstract: The impact of regulatory compliance behavior on hazardous
waste generation in European private healthcare facilities
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23831780

Waste Manag Res. 2013 Oct;31(10):996-1001.

The impact of regulatory compliance behavior on hazardous waste generation
in European private healthcare facilities.

Botelho A.

University of Minho and NIMA, Braga, Portugal.

This study empirically evaluates whether the increasingly large numbers of
private outpatient healthcare facilities (HCFs) within the European Union
(EU) countries comply with the existing European waste legislation, and
whether compliance with such legislation affects the fraction of
healthcare waste (HCW) classified as hazardous.

To that end, this study uses data collected by a large survey of more than
700 small private HCFs distributed throughout Portugal, a full member of
the EU since 1986, where 50% of outpatient care is currently dominated by
private operators. The collected data are then used to estimate a hurdle
model, i.e. a statistical specification in which there are two processes:
one is the process by which some HCFs generate zero or some positive
fraction of hazardous HCW, and another is the process by which HCFs
generate a specific positive fraction of hazardous HCW conditional on
producing any.

Taken together, the results show that although compliance with the law is
far from ideal, it is the strongest factor influencing hazardous waste
generation. In particular, it is found that higher compliance has a small
and insignificant effect on the probability of generating (or reporting)
positive amounts of hazardous waste, but it does have a large and
significant effect on the fraction of hazardous waste produced,
conditional on producing any, with a unit increase in the compliance rate
leading to an estimated decrease in the fraction of hazardous HCW by 16.3
percentage points.

KEYWORDS: Healthcare waste; compliance; hazardous waste; regulation
__________________________________________________________________
________________________________*_________________________________

5. Abstract: High incidence of occupational exposures among healthcare
workers in Erbil, Iraq
__________________________________________________________________
http://www.jidc.org/index.php/journal/article/view/25313611

J Infect Dev Ctries. 2014 Oct 15;8(10):1328-33.

High incidence of occupational exposures among healthcare workers in
Erbil, Iraq.

Hosoglu S1, Ahmad Z, Tahseen MS, Diyar Z, Selbes S, Colak A.

1Dicle University Hospital, Diyarbakir, Turkey. hosoglu@hotmail.com.

INTRODUCTION: The current status of percutaneous injury and mucous
exposures (PMEs) of hospital workers and factors associated with the
injuries have not been studied in Iraq. This study aimed to evaluate the
epidemiology of PMEs with blood or body fluids that leads serious risks
for healthcare workers (HCWs).

METHODOLOGY: An analytic, cross-sectional survey study was conducted among
HCWs in Erbil city center, Iraq. The study was performed at
sevenhospitals, and 177 participants were included. The dependent variable
was the occurrence of PMEs in the last year, and the independent variables
were age, sex, occupation of HCWs, working site, and work duration.

RESULTS: A total of 177 HCW participants included 57 nurses/midwives
(32.2%), 59 doctors (33.3%), 27 laboratory workers (15.3%), and 34
paramedics/multipurpose workers (19.2%) from seven hospitals. The study
concluded that 67.8% of the participants reported at least one
occupational PME in the last year. In all, 13.3/person/year PME incidents
were reported for nurses, 9.74/person/year for paramedics/multipurpose
workers, 6.71/person/year for doctors, and 3.37/person/year laboratory
workers. The mean number of PME incidents was 8.91/person/year. HCWs
showed 85.0% compliance with wearing mask in risky situations. The most
dangerous action for occupational exposure was blood taking (39.0%). In
the univariate analysis, none of the investigated variables were found to
be significantly related to PME.

CONCLUSIONS: Occupational injuries and exposures in Iraqi HCWs are
extremely common; awareness about protection is not sufficient. Nurses
were found to be the highest risk group among HCWs. Preventive actions
should be taken to avoid infection.

Free full text http://www.jidc.org/index.php/journal/article/view/25313611
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Occupational exposure to blood and compliance with standard
precautions among health care workers in Beijing, China
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24581027

Am J Infect Control. 2014 Mar;42(3):e37-8.

Occupational exposure to blood and compliance with standard precautions
among health care workers in Beijing, China.

Liu XN1, Sun XY2, van Genugten L3, Shi YH2, Wang YL2, Niu WY4, Richardus
JH3.

1Department of Social Medicine and Health Education, School of Public
Health, Peking University, Beijing, China; Department of Public Health,
Erasmus MC, University Medical Center Rotterdam, Rotterdam, The
Netherlands.
2Department of Social Medicine and Health Education, School of Public
Health, Peking University, Beijing, China.
3Department of Public Health, Erasmus MC, University Medical Center
Rotterdam, Rotterdam, The Netherlands.
4Department of Social Medicine and Health Education, School of Public
Health, Peking University, Beijing, China. Electronic address:
Health1956@163.com.

This cross-sectional survey assessed both risk and prevention of health
care workers to bloodborne virus transmission in 2 hospitals in Beijing.

The identified discrepancy between the high level of occupational blood
exposure and suboptimal compliance with standard precautions underscores
the urgent need for interventions to enhance occupational safety of health
care workers in China.

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

KEYWORDS: Caregivers; Guidelines; Infection control; Occupational injuries
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Most sharps pose safety risk to staff
__________________________________________________________________
Nurs Stand. 2014 Oct 15;29(7):10.

Most sharps pose safety risk to staff.

[No authors listed]

Nearly three quarters of sharps purchased by trusts in England in 2014 do
not have safety mechanisms designed to prevent needlestick injuries,
research by Unison suggests.
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Potential risk of cross-infection by tourniquets: a need for
effective control practices in pakistan
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25317294

Int J Prev Med. 2014 Sep;5(9):1119-24.

Potential risk of cross-infection by tourniquets: a need for effective
control practices in pakistan.

Mehmood Z1, Mubeen SM2, Afzal MS1, Hussain Z1.

1Hamdard College of Medicine and Dentistry, Karachi, Pakistan.
2Department of Community Health Sciences, Hamdard College of Medicine and
Dentistry, Karachi, Pakistan.

BACKGROUND: Tourniquets used repeatedly on patients for blood sampling are
a potential source of nosocomial infections. They harbor numerous
microorganisms, including methicillin-resistant Staphylococcus aureus
(MRSA). The aim of this study was to investigate tourniquets for the
presence of microorganisms and to ascertain the infection control
practices of health care workers.

METHODS: A cross-sectional study was carried out in 2012 on 100 samples of
tourniquets collected from public and private sector hospitals in Karachi,
Pakistan. The samples were cultured, and pathogenic microorganisms were
identified and tested for methicillin resistance. A questionnaire was
administered simultaneously to 100 health care workers who had used the
tourniquets. Descriptive data are represented as frequencies and
percentages. Ethical considerations were taken into account.

RESULTS: The total colonization rate was 51%, with no bacterial growth in
17/40 and 32/60 samples from public and private sector hospitals,
respectively. S. aureus was isolated from 12 (42%) private sector hospital
samples and 10 (43%) public sector hospital samples. Although MRSA was
found in more samples from public than private sector hospitals, the
difference was not statistically significant. Nevertheless, 90% of all
elastic and 41% of all rubber tourniquets harbored microorganisms (P <
0.001). Although 96% of health care workers agreed that hospital staff and
fomites can transmit infection, none identified tourniquets as a potential
source. When asked whether tourniquets appeared clean before use, 66%
agreed, and only 25% considered that tourniquets should be washed or
cleaned before use.

CONCLUSIONS: Tourniquets are a potential reservoir and vehicle for the
spread of nosocomial infections, including MRSA. Health care workers have
inadequate knowledge about infection control procedures and personal
hygiene for disinfecting reusable items.

KEYWORDS: Fomite; health care worker; infection; nosocomial infection;
tourniquet

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4192773/
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Sharps and high-pressure injection injuries in veterinary and
animal workers
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25325410

Eur J Emerg Med. 2014 Oct 16.

Sharps and high-pressure injection injuries in veterinary and animal
workers.

Robertson CE1, Ackerman NA, Burke FD, Reilly WJ.

1aThe Veterinary Hospital Group Ltd, Plymouth bDepartment of Hand Surgery,
Pulvertaft Hand Centre, Derby cDepartment of Veterinary Pathology,
University of Glasgow, Chair, Veterinary Products Committee, Glasgow
dDepartment of Emergency Medicine, University of Edinburgh, Edinburgh, UK.

Needlestick and ‘sharps’ injuries among those working with animals are a
significant, under-reported and often ill-understood problem. Many
patients present initially to Emergency Departments, where their potential
to cause local and systemic infections and injury, zoonoses, allergic or
anaphylactic reactions and death may be unrecognized.

Increased awareness of the possibility of adverse effects and the
consequences of these specific injuries is essential.
__________________________________________________________________
________________________________*_________________________________

10. Abstract: The risk of blood transfusion-associated Chikungunya fever
during the 2009 epidemic in Songkhla Province, Thailand
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24527811

Transfusion. 2014 Aug;54(8):1945-52.

The risk of blood transfusion-associated Chikungunya fever during the 2009
epidemic in Songkhla Province, Thailand.

Appassakij H1, Promwong C, Rujirojindakul P, Wutthanarungsan R,
Silpapojakul K.

1Department of Pathology, Faculty of Medicine, Prince of Songkla
University, Hat Yai, Songkhla, Thailand.

BACKGROUND: Asymptomatic Chikungunya fever (CHIKF)-viremic blood donors
could be a potential threat of spreading the disease unwittingly through
contaminated blood transfusions. The relatively low prevalence of
Chikungunya virus antibodies in the population and the records of more
than 9000 suspected CHIKF cases raised concern about the potential
transfusion-associated CHIKF during the 2009 epidemic. This study assessed
the potential transfusion risk for CHIKF and the implementation of blood
safety measures to mitigate this risk.

STUDY DESIGN AND METHODS: A probabilistic model using key variables
obtained from local information was used to estimate the weekly risk of
transfusion-associated CHIKF during the 2009 epidemic. In addition, other
blood safety measure-based strategies involving screening for donors at
risk, donor tracing, and a 7- day quarantine of blood components at risk
were implemented at the time of the epidemic.

RESULTS: The risk of viremic donations per 100,000 ranged from 38.2 (95%
confidence interval [CI], 36.5-39.8) to 52.3 (95% CI, 50.4-54.2). The
potential risk of transfusion-associated CHIKF per 100,000 was estimated
to be 1 in 2429 (0.04%; 95% CI, 1 in 6681 [0.02%]-1 in 1572 [0.06%]) to 1
in 1781 (0.06%; 95% CI, 1 in 3817 [0.03%]-1 in 1214 (0.08%]) donations.
Among 26,722 donations, 11 (95% CI, 4-17) to 15 (95% CI, 7-22) donations
were predicted to associate with transfusion risk. The implementation of
blood safety measure-based strategies for this epidemic period suggested
to deter 11 blood donations of transfusion risk.

CONCLUSION: The interventions for blood safety measures applied in this
study had mitigated the potential transfusion-associated CHIKF during the
2009 epidemic.

© 2014 AABB.

Comment in
Chikungunya virus: new risk to transfusion safety in the Americas.
[Transfusion. 2014]
__________________________________________________________________
________________________________*_________________________________

11. Abstract: Complications of intravitreal injections in patients with
diabetes
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25325853

Semin Ophthalmol. 2014 Nov;29(5-6):276-89.

Complications of intravitreal injections in patients with diabetes.

Shikari H1, Silva PS, Sun JK.

1Beetham Eye Institute, Joslin Diabetes Center , Boston, Massachusetts ,
USA and.

Intravitreal injections for the treatment of retinal disorders and
intraocular infection have become a common ophthalmic procedure, and
injections of anti-vascular endothelial growth factor agents or steroids
are frequently performed for the treatment of diabetic macular edema or
other diabetic vascular pathology.

Diabetic patients may be at higher risk of adverse events than non-
diabetic individuals given frequent systemic co-morbidities, such as
cardiovascular and renal disease, susceptibility to infection, and unique
ocular pathology that includes fibrovascular proliferation. Fortunately,
many associated complications, including endophthalmitis, are related to
the injection procedure and can therefore be circumvented by careful
attention to injection techniques.

This review highlights the safety profile of intravitreal injections in
patients with diabetes. Although diabetic patients may theoretically be at
higher risk than non-diabetic patients for complications, a comprehensive
review of the literature does not demonstrate substantial increased risk
of intravitreal injections in patients with diabetes.

KEYWORDS: Aflibercept; bevacizumab; complications; diabetes; diabetic
macula edema; diabetic retinopathy; intravitreal injections; ranibizumab
__________________________________________________________________
________________________________*_________________________________

12. Abstract: Intramuscular ketorolac versus oral ibuprofen for pain
relief in first-trimester surgical abortion: a randomized clinical
trial
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24309219

Contraception. 2014 Feb;89(2):116-21.

Intramuscular ketorolac versus oral ibuprofen for pain relief in first-
trimester surgical abortion: a randomized clinical trial.

Braaten KP1, Hurwitz S2, Fortin J3, Goldberg AB4.

1Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham
and Women’s Hospital, Boston, MA 02115, USA; Planned Parenthood League of
Massachusetts, Boston, MA 02215, USA. Electronic address:
kpbraaten@partners.org.
2Center for Clinical Investigation, Department of Medicine, Brigham and
Women’s Hospital, Boston, MA 02115, USA.
3Planned Parenthood League of Massachusetts, Boston, MA 02215, USA.
4Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham
and Women’s Hospital, Boston, MA 02115, USA; Planned Parenthood League of
Massachusetts, Boston, MA 02215, USA.

OBJECTIVE: Oral nonsteroidal antiinflammatory medications (NSAIDs) have
been shown to reduce pain with first-trimester surgical abortion compared
to placebo, but it is unclear if one NSAID is better than another. Some
providers administer intramuscular ketorolac, though data regarding its
efficacy in abortion are limited. This study was designed to compare oral
ibuprofen to intramuscular ketorolac for pain management during first-
trimester surgical abortion.

STUDY DESIGN: This was a randomized, double-blind, controlled trial. Women
undergoing first-trimester surgical abortion with local anesthesia were
randomized to preprocedural oral ibuprofen, 800 mg given 60-90 min
preprocedure, or intramuscular ketorolac, 60 mg given 30-60 min
preprocedure. The primary outcome was pain with uterine aspiration on a
21-point, 0-100, numerical rating scale. Secondary outcomes included pain
with cervical dilation, postoperative pain and patient satisfaction.

RESULTS: Ninety-four women were enrolled; 47 were randomized to ibuprofen
and 47 to ketorolac. The groups did not differ with regards to
demographics, reproductive history or Depression Anxiety Stress Scale
scores. Mean pain scores for suction curettage did not differ between
groups (52.3 vs. 56.2, p=.53). There was also no difference in pain with
cervical dilation (41.6 vs. 45.4, p=0.48) or postoperative pain (22.3 vs.
15.0 p=.076), though patients in the ketorolac group experienced
significantly greater arm pain than those who received a placebo injection
(30.4 vs. 15.6, p<.001). Satisfaction with pain control did not differ
significantly by group.

CONCLUSIONS: Intramuscular ketorolac does not offer superior pain control
compared to oral ibuprofen for first-trimester surgical abortion.

IMPLICATIONS: Intramuscular ketorolac does not offer superior pain control
over oral ibuprofen during first-trimester surgical abortion, is more
expensive and causes patients significant arm discomfort. Its use should
therefore be reserved for patients who cannot tolerate oral NSAIDs.

© 2014.

KEYWORDS: Ibuprofen; Ketorolac; NSAIDs; Pain control; Surgical abortion
__________________________________________________________________
________________________________*_________________________________

13. Abstract: Would you tell everyone this? Facebook conversations as
health promotion interventions
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24727742

J Med Internet Res. 2014 Apr 11;16(4):e108.

Would you tell everyone this? Facebook conversations as health promotion
interventions.

Syred J1, Naidoo C, Woodhall SC, Baraitser P.

1HIV & Sexual Health Research Group, King’s College London, London, United
Kingdom.

BACKGROUND: Health promotion interventions on social networking sites can
communicate individually tailored content to a large audience. User-
generated content helps to maximize engagement, but health promotion
websites have had variable success in supporting user engagement.

OBJECTIVE: The aim of our study was to examine which elements of moderator
and participant behavior stimulated and maintained interaction with a
sexual health promotion site on Facebook.

METHODS: We examined the pattern and content of posts on a Facebook page.
Google analytics was used to describe the number of people using the page
and viewing patterns. A qualitative, thematic approach was used to analyze
content.

RESULTS: During the study period (January 18, 2010, to June 27, 2010), 576
users interacted 888 times with the site through 508 posts and 380
comments with 93% of content generated by users. The user-generated
conversation continued while new participants were driven to the site by
advertising, but interaction with the site ceased rapidly after the
advertising stopped. Conversations covered key issues on chlamydia and
chlamydia testing. Users endorsed testing, celebrated their negative
results, and modified and questioned key messages. There was variation in
user approach to the site from sharing of personal experience and
requesting help to joking about sexually transmitted infection. The
moderator voice was reactive, unengaged, tolerant, simplistic, and was
professional in tone. There was no change in the moderator approach
throughout the period studied.

CONCLUSIONS: Our findings suggest this health promotion site provided a
space for single user posts but not a self-sustaining conversation.
Possible explanations for this include little new content from the
moderator, a definition of content too narrow to hold the interest of
participants, and limited responsiveness to user needs. Implications for
health promotion practice include the need to consider a life cycle
approach to online community development for health promotion and the need
for a developing moderator strategy to reflect this.

This strategy should reflect two facets of moderation for online health
promotion interventions: (1) unengaged and professional oversight to
provide a safe space for discussion and to maintain information quality,
and (2) a more engaged and interactive presence designed to maintain
interest that generates new material for discussion and is responsive to
user requests.

KEYWORDS:
chlamydia; health promotion; social media

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4042608/
__________________________________________________________________
________________________________*_________________________________

14. Abstract: A Primer on Ebola for Clinicians
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25325294

Disaster Med Public Health Prep. 2014 Oct 17:1-5.

A Primer on Ebola for Clinicians.

Toner E, Adalja A, Inglesby T.

1UPMC Center for Health Security,Baltimore,Maryland.

The size of the world’s largest Ebola outbreak now ongoing in West Africa
makes clear that further exportation of Ebola virus disease to other parts
of the world will remain a real possibility for the indefinite future.
Clinicians outside of West Africa, particularly those who work in
emergency medicine, critical care, infectious diseases, and infection
control, should be familiar with the fundamentals of Ebola virus disease,
including its diagnosis, treatment, and control. In this article we
provide basic information on the Ebola virus and its epidemiology and
microbiology. We also describe previous outbreaks and draw comparisons to
the current outbreak with a focus on the public health measures that have
controlled past outbreaks. We review the pathophysiology and clinical
features of the disease, highlighting diagnosis, treatment, and hospital
infection control issues that are relevant to practicing clinicians. We
reference official guidance and point out where important uncertainty or
controversy exists. (Disaster Med Public Health Preparedness. 2014;0:1-5).
__________________________________________________________________
________________________________*_________________________________

15. Ebola: Lessons From Ebola School: How To Draw Blood, Wipe Up Vomit
__________________________________________________________________
http://tinyurl.com/nf93r76

Ebola: Lessons From Ebola School: How To Draw Blood, Wipe Up Vomit

by Nurith Aizenman, NPR, USA (16.10.14)

How can health workers stay safe while treating an Ebola patient?

The CDC is embroiled in a controversy over that very question. After the
infection of two nurses at a Dallas hospital, the agency is facing
criticism about whether initial guidelines provided to U.S. facilities
were stringent enough.

Yet the Centers for Disease Control and Prevention adopted the strictest
possible standard when developing a training program for clinicians headed
to West Africa, consulting closely with the aid group Doctors Without
Borders.

The course runs three days every week through January with about 35
students per session.

The venue is a former U.S. Army base in Alabama that’s been rigged to look
just like an Ebola treatment center in West Africa. They’ve got the same
orange mesh fencing used to mark off high-risk areas, barrels of
disinfectant solution, and, to stand in for patients, plastic mannequins
laid out on cots. One of them is posed to look as if he’s vomiting into a
bucket.

And the curriculum? Lots of detailed instructions on how to put on and
take off the personal protective gear medical workers must wear, of
course.

But when I visited, I also saw how the instructors spend lots of time
teaching students how to do ordinary medical tasks in the extraordinary
circumstances of an Ebola hospital. They break the tasks up into three
days of lessons.

Here’s a sampling.

Day 1: How to draw blood from a suspected Ebola patient so you can test
for the disease

This activity is especially dangerous, so precautions are key, says Dr.
Michael Jhung, the CDC medical officer heading up the course: “It’s a very
simple medical procedure and something every clinician knows how to do and
has probably done tens if not hundreds of times. But it gets complicated
with an Ebola patient because [contact with blood] is one way the virus
can get transmitted to a health care worker.” Like other bodily fluids
from an Ebola patient such as vomit and waste, blood can have very high
levels of the virus. “The consequences can be severe if there’s an error
or lapse in procedures,” he says.

1) Make sure you have all the materials you’ll need before you put on your
protective suit. And there are quite a number of materials: syringe, vial,
Band-Aid, etc. In a regular medical setting like a doctor’s office, you
can always leave the room to get a missing item. But in an Ebola ward, if
you realize you left a tool in the low-risk area, you’ll lose a total of
30 minutes just taking the suit off to leave, then suiting up again to get
back in.

2) Always work in pairs. You and your partner are responsible for
continuously monitoring each other — for exposed skin the other person
might not notice, for instance, or for slip-ups in procedure. And you’ll
often need two people to carry out the extra precautionary steps required
when working with Ebola patients.

3) Assess the patient’s ability to sit still. “Your suit won’t protect you
from a needle-stick injury. You can wear three or four or even 10 pairs of
gloves, but a needle will go through all of them,” Jhung explains. “So if
you think the patient is going to be moving around too much, perhaps
because they’re undergoing a seizure or they’re in so much pain, you might
choose not to draw blood at that time.”

4) Dispose of the syringe immediately. The minute you’ve pulled it out of
the patient, drop it into the sealed disposal container. This is standard
practice in any setting, says Jhung, “But if you’ve done it 500 times, you
might get a little nonchalant. So we really emphasize it. Not disposing of
a sharp” — that’s medical shorthand for pointy objects like needles —
“immediately is one of those small errors that could be catastrophic in
this case.”

5) Wash your gloved hands under 0.5 percent chlorine solution. That’s the
percentage aid groups working in West Africa have settled on as
sufficient. The washing should take place right after you’ve put the Band-
Aid on the patient. You don’t need to wash for that long — the chlorine
solution kills the virus on contact. But you do need to make sure the
solution reaches every part of your gloved hand, including in between
fingers to get at any blood that may have spattered on your hands as you
pierced the patient’s skin or bandaged it.

6) Label and spray. With a water-resistant marker, write identifying
information on the tube of blood you’ve just drawn, then hold it out so
your partner can spray the vial with chlorine solution. Spraying must
always be done close to the ground, to ensure contaminated fluids hit by
the spray don’t dislodge and fly into anyone’s face.

7) Drop the tube in a bag. Your partner will hold open a plastic bag. Drop
the tube of blood into it.

8) Spray the outside of that bag. In theory it should be free of the
virus. But the entire high-risk area is considered to be potentially
contaminated — particles of a patient’s vomit or blood may have landed on
the box of trash bags and gone unnoticed, for instance. And the gloves
that you or your partner are wearing may still have some bodily fluids on
them. So you can’t be too careful.

9) Bag it again, spray it again. Take a second plastic bag, and spray the
inside — just in case that first bag wasn’t sprayed as thoroughly as
necessary. Then drop the first bag into the second bag.

10) Spray the outside of the second bag.

11) Walk to the laboratory area of the hospital.

12) Just before you hand off the bag, spray it one more time. That’s a
precaution in case it came into contact with contaminated fluids as you
were walking the bag to the lab. “Possibly along the way to the lab
someone could set the bag down to take care of a patient in an emergency
situation, or they could bump up against a patient,” says Jhung. So
spraying the bag one last time before handing it over to the lab is “just
a good practice to get into.”

13) Bag it again for safety’s sake. A lab worker will hold open a third
bag for you to drop the second bag into.

Day 2: Cleaning up vomit or stool

Technically, a sanitation or hygiene worker performs this task, not a
clinician. But clinicians need to know the basics in case they need to
pitch in — and so they can tell if the facility they’re working in is
following proper safety procedures.

1) Chlorine is your friend. That’s a phrase that CDC instructors tell
their students to remember. “The take-home point is that if there’s any
doubt about what you should do about a spill, you should put chlorine
solution on it,” says Jhung. But he adds that it’s important not to use
too powerful a spray — you don’t want to send fluids flying around. Better
to gently pour or spritz the chlorine solution onto the affected area.
This is the first step to take regardless of where the vomit has landed:
floor, bed linens, etc. After about 10 to 15 minutes, the liquid portion
of the waste should be decontaminated.

2) Wear thick dishwashing gloves. They allow for less fine motor movements
than the exam and surgical gloves worn during medical procedures. But
dishwashing gloves are stronger and less likely to tear.

3) Deal with any solid bits in the fluid by using a “chuck.” Jhung
describes a chuck as a large cloth with the consistency of a diaper. First
moisten it with chlorine solution, then lay it on top of the solid waste.
Wait 10 to 15 minutes so that some disinfection can take place

4) Pick up the chuck and the solid bits it’s covering. Put the cloth, with
the bits, in a plastic disposal bag.

5) Spray or pour chlorine solution into that bag.

6) Put the bag in another bag. Close the first bag, spray the outside, and
place it in a second bag.

7) Spray and dispose. Spray the outside of the second bag with chlorine
solution and walk it over to the hospital’s waste disposal area — often an
incinerator.

8) Tackle the remaining liquid. The liquid portion of the waste can now be
mopped up with paper towels — as long as the liquid has been thoroughly
covered with chlorine solution for 15 minutes, any virus in it will have
been killed.

9) Dispose of materials. Any paper towels used should be placed in a
plastic disposal bag and taken to the waste disposal area.

Day 3: How to admit a suspected Ebola patient into the ward

1) Gear up. Interviewing a patient requires less protective gear than
treating a patient. Eyes need to be covered with goggles or a clear mask,
and you’ll need to wear gloves. But a head-to-toe suit is not required as
long as you can remain at least 3 feet away from the patient.

2) Suit up if necessary. If the patient’s symptoms and history suggest
Ebola, you need to suit up fully before escorting the individual into the
suspect case area. As with cleanups, dishwashing gloves should be worn for
this job.

3) Get a stretcher if needed. If the person cannot walk on his or her own
power, you will need four people and a stretcher. The team will lift the
patient onto the stretcher.

4) Spray the ground. Use a chlorine solution to spray the area where the
patient was standing or lying as thoroughly as possible so as to cover any
bodily fluids that may have run off of them.

5) Carry the patient into the ward on the stretcher. Then immediately hand
the stretcher over to hygiene workers, who will need to decontaminate it
with chlorine spray before it can be used again.

6) Check for any breaches in your protective gear. Jhung says you are most
likely to dislodge gear and expose skin when you are carrying a person or
helping him onto a bed. Even if you have no reason to think you touched an
Ebola patient’s fluids, if you notice any skin showing or any tears in
your suit or gear at any time while you are in the high-risk area, you and
your partner must immediately exit the high-risk area and take off your
suit in accordance with the usual careful removal procedures taught in the
course.

Protective gear runs from goggles and head covering to gloves and boots.

Jhung stresses that this class is just an introduction to the basics. Aid
groups that run Ebola treatment units, like Doctors Without Borders and
International Medical Corps, require clinicians to work under the close
supervision of a mentor at a real facility for several weeks before they
are considered fully trained.
__________________________________________________________________
________________________________*_________________________________

16. magpi: Advanced Mobile Data Collection Anywhere, On Any Device
__________________________________________________________________
magpi ADVANCED MOBILE DATA COLLECTION ANYWHERE, ON ANY DEVICE

Magpi mobile technology makes data collection, collaboration and
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mobile data collection and communication with more than 33,000 users
around the globe.

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MAGPI MOBILITY CONNECTING THE WORLD

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in minutes with Magpi. Simply create a form using our web dashboard,
deploy it to any mobile device, and start collecting and syncing data in a
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With Magpi, your organization can experience the full bene?ts of mobility:
real-time data collection and syncing, dramatic time savings, and improved
data quality, all while removing paper from the process. Tens of thousands
of ?eld workers in more than 170 countries already use Magpi to create
multi-device mobile apps for inspections, surveys, and geo-data
information collection—all in real-time. From tracking vaccinations in
remote villages to responding to natural disasters to ensuring that oil
and gas pipelines meet regulatory compliance standards, Magpi enables
mobile data collection anywhere and anytime.

mobile-app-suite

Magpi 2.0 features include:

* Compatibility with iOS, Android and Symbian systems
* SMS and web-entry data collection
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* Form sharing via email and SMS
* Multiple question types (text, numbers, multiple choice, geo-
location, and subforms)
* Instant data analysis and publishing of data sets and maps
* Import/export of forms, data and contacts
* Forward/backward movement through questionnaire
* Forms in any language in any alphabet
* Integrated Geographic Information System (GIS)
* Audit log
* Form export in codebook and field-ready format
* Logical checks
* Automatic calculations
* Customizable form roles and privileges

SIGN UP FOR FREE http://home.magpi.com/mobile-data-collection/
__________________________________________________________________
________________________________*_________________________________

17. News

– India: NGO raises alarm on rising hepatitis C cases among IDUs
– USA: Officer pricks hand on needle during pocket search
– USA: University of Cincinnati lands grant to attack hepatitis C among
needle users in 20 counties
– USA: Health care workers: Staying safe
– Kenya: NACC Raises Concerns Over HIV

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/pferkc9

India: NGO raises alarm on rising hepatitis C cases among IDUs

Bindiya Chari, Times of India, TNN (17.10.14)

PANAJI: Forty-three cases of hepatitis C have been detected among 700-odd
injecting drug users, also called IDUs, in Goa. NGO, Positive People, who
works with IDUs, started testing for the disease two years ago and members
say they come across at least one case of hepatitis C every month.

In August, the NGO intimated the directorate of health services as well as
the Goa State AIDS Control Society (GSACS) about the worrying trend, but,
there has allegedly been no response from either authority. To make
matters worse, hepatitis C testing kits are currently in short supply.

When contacted, Dr Vandana Patankar, project director, GSACS, told TOI
that they have written to the National Aids Control Organization (NACO)
and are coordinating with NACO as they “understand the seriousness of the
problem”. She admitted there is a shortage of hepatitis C testing kits as
only blood banks are supplied the same.

Dr Jose D’Sa, deputy director, health services, said the department has
not received any correspondence on this issue. “Maybe they (Positive
People) have approached the Candolim primary health centre. We have not
received anything,” he said.

Hepatitis C is caused by the hepatitis C virus (HCV) that swells up the
liver, preventing it from working well. The disease has no vaccine and its
treatment, according to doctors, is both expensive and has severe side-
effects.

Godwin Fernandes, IDU project manager, Positive People, North Goa, said
the NGO has informed both government bodies in writing about hepatitis C
cases but has not received any feedback till date. “For the last two years
the growing number of our clients testing positive for HCV is a major
concern for our organization. We have close to 700-odd registered IDUs in
Goa,” said Fernandes.

He said the world over hepatitis C infection among IDUs is very common
because of their tendency to use contaminated injections. “If a used
injection is left in the open even for some time and used subsequently
without sterilization there is risk of the second user catching the
infection,” he explained. The NGO runs a needle exchange programme where
IDUs are given a fresh needle in exchange of an old one.
__________________________________________________________________
__________________________________________________________________
USA: Officer pricks hand on needle during pocket search

Associated Press, USA (17.10.14)

BETHLEHEM, Pa. (AP) – A car thief with hepatitis is going to jail after he
let a Bethlehem police officer search his pocket and prick his hand on a
needle.

Miguel Ortiz Jr. says he failed to warn the officer because he only heard
him ask about weapons.

He’s been sentenced to nine to 21 months in prison for aggravated assault
and receiving stolen property.

The search came after the 23-year-old Ortiz crashed a stolen car into a
cigar store.

The officer has been undergoing tests and taking large doses of medicine
as he waits to learn if he has contracted hepatitis.

Ortiz has apologized at a court hearing Thursday. He told the judge he
stole the car after using heroin.

Copyright 2014 The Associated Press.
__________________________________________________________________
__________________________________________________________________
http://tinyurl.com/l5l9lrz

USA: University of Cincinnati lands grant to attack hepatitis C among
needle users in 20 counties

Christine Charlson, WCPO, Cincinnati Ohio USA (16.10.14)

A team of researchers from the University of Cincinnati will turn its
attention to the heartland of the heroin epidemic in Ohio to combat the
spread of hepatitis C among drug users.

The U.S. Centers for Disease Control and Prevention (CDC) has awarded a
$900,000 grant to study the 20 rural counties hardest hit by the disease.
The counties include five in Southwest Ohio: Adams, Brown, Butler,
Clermont and Warren.

The full list of counties involved in the study: Athens, Brown, Butler,
Clermont, Clinton, Fayette, Gallia, Green, Highland, Hocking, Jackson,
Lawrence, Meigs, Montgomery, Pike, Preble, Ross, Scioto, Vinton and
Warren.

The project, known as the Southern Ohio Prevents Hepatitis Project
(StOPHeP), will identify and provide outreach and treatment options for
those most at risk.

Principal investigator Dr. Judith Feinberg, professor of internal medicine
at University of Cincinnati, explained the study will focus on the heroin
epidemic that has touched many relatives, friends, neighbors and co-
workers.

“This new injection epidemic is highly concentrated in young people
between the ages of 18 and 30, and it’s primarily a suburban and rural
problem,” Feinberg said. “Not to say that there isn’t any of this going on
in cities, but it’s remarkable how much is happening outside of city
centers.”

…. subscription required for the complete article
__________________________________________________________________
__________________________________________________________________
http://www.carolinalive.com/news/story.aspx?id=1110173

USA: Health care workers: Staying safe

by Courtney Griffin, WPDE, CarolinaLive, USA (15.10.14)

Courtney is the anchor for the new weekend Good Morning Carolinas show,
and is a reporter during the week.

The Centers for Disease Control estimates that each year 385,000 hospital-
based healthcare workers sustain needlesticks and other related injuries,
an average of 1,000 injuries per day.

Each profession has its fair share of risks, but one profession in
particular, phlebotomist, takes those risks to another level.

If a healthcare worker is stuck with a patient’s dirty needle, they can be
exposed to viruses like Hepatitis B and C and even HIV.

“If an employee has a needlestick they immediately go to the emergency
room, they’re monitored through infection control and they can have
counseling if they need,” said Rhonda Williamson, phlebotomy supervisor at
Grand Strand Regional Medical Center.

Williamson’s been drawing blood for 27 years and says she knows of fewer
than 10 cases where a worker was stuck by a needle.

She said she has only been stuck once, when she first started her career,
and in that case she says the patient jumped.

“It’s not very easy, usually if it happens maybe the patient has jumped,
something unexpected has happened,” she said.

The needles they use have a safety guard that snaps over the needle,
securing it, she said.

However, if a needlestick injury does happen, the center is prepared.

“We’ve had needlesticks here but we always take the precautions and have
them tested and follow up,” Williamson said.

She said the worker’s blood is be tested for months following the
incident.

“Always monitored, and the patient gets drawn as well. They’re tested for
HIV, Hepatitis and RPR,” she said.

According to the CDC, if a healthcare worker is stuck by a needle from a
patient who has HIV, the worker has a 1 in 300 chance that she or he will
be infected with HIV.

The CDC reports 50 percent of healthcare workers who experience a
needlestick injury don’t report it.
__________________________________________________________________
__________________________________________________________________
Kenya: NACC Raises Concerns Over HIV

By Martin Mwita, The Star, Nairobi Kenya (15.10.15)

THE National Aids Control Council has raised concern over an increase on
HIV-Aids prevalence among Injection Drug Users in Mombasa county.

The agency says 18 per cent of IDUs in the country’s drug dens, majority
in Mombasa, are currently HIV positive.

The number is feared to increase by six percent in Mombasa alone by the
end this year.

The statistics have also been captured in the Kenya HIV Prevention
Revolution Report, 2014, by the Ministry of Health.

Currently, IDU’s in Mombasa are estimated at 18,000 persons, according to
Reachout Centre Trust, an NGO running rehabilitation programmes at the
Coast.

NACC Mombasa county coordinator Julius Koome said persons injecting and
abusing heroin in Mombasa could hit over 20,000.

Speaking to the Star on phone Yyesterday, Koome said IDU’s remain exposed
to HIV infection as a result of sharing needles.

“Majority of them share needles and this exposes them to infections,”
Koome said.

He said treatment default for the addicts suffering from HIV, TB and even
Hepatitis is also high, where 30 per cent for HIV patients default
treatment.

Koome said a Needle and Syringe Programme currently underway in Mombasa
and Ukunda could reduce HIV infection among IDU’s.

Reach-out Centre is among stakeholders in the programme.

The trust’s executive director Taib Abdulrahman said the response has been
good.

The programme involves distribution of syringes and needles to IDU’s, to
avoid sharing of needles, which expose them to infection.

“We give a packet of three or six needles and syringes according to the
times the person injects. We however don’t give the needles to anybody,”
Abdulrahman told the Star on the phone.

He said the IDU’s must be registered to benefit from the projects where
they are required to return the needles for fresh supply.

“The program has picked on well and currently we have a good return rate
of between 80-85 per cent,” said Abdulrahman.

Among notorious areas in Mombasa with high numbers of IDU’s include the
Old Town, Mwembe Tayari, Go-downs in Docks area, Kisauni, Bombolulu,
Mshomoroni, Likoni, Mtongwe and Mwenza among others.

Copyright © 2014 The Star. All rights reserved. Distributed by AllAfrica
Global Media (allAfrica.com).
__________________________________________________________________
________________________________*_________________________________
* 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/

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Facsimile: +41 22 791 4836 E- mail: sign@who.int
__________________________________________________________________
________________________________*_________________________________

SIGN Meeting 2014

The Safe Injection Global Network SIGN meeting will be held on 17-18
December 2014 at WHO Headquarters in 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.

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
__________________________________________________________________
________________________________*_________________________________
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* Subscribe or un-subscribe by email to: sign.moderator@gmail.com, or to
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The SIGNpost Website is http://SIGNpostOnline.info

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We would like your help in building this archive. Please send your old
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Email mailto:sign.moderator@gmail.com
__________________________________________________________________
________________________________*_________________________________

The SIGN Internet Forum was established at the initiative of the World
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The SIGN Secretariat home is the Department of Health Systems Policies and
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The SIGN Forum is moderated by Allan Bass and is hosted on the University
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