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SIGNpost 00777

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST

Post00777 Ebola Past + Abstracts + Waste + News 19 November 2014

CONTENTS
1. Ebola: learn from the past
2. Abstract: Sero-prevalence and factors associated with Hepatitis B and C
co-infection in pregnant Nigerian women living with HIV Infection
3. Abstract: Drug use, HIV, HCV and TB: major interlinked challenges in
Eastern Europe and Central Asia
4. Abstract: HIV Prevalence and Risk Behaviors Among People Who Inject
drugs in Two Serial Cross-Sectional Respondent-Driven Sampling Surveys,
Zanzibar 2007 and 2012
5. Abstract: HIV and STI Prevalence and Injection Behaviors Among People
Who Inject Drugs in Nairobi: Results from a 2011 Bio-behavioral Study
Using Respondent-Driven Sampling
6. Abstract: Does intra-articular steroid injection increase the rate of
infection in subsequent arthroplasty: grading the evidence through a
meta-analysis
7. Abstract: Risk factors for hepatitis B and C infection among blood
donors in five Chinese blood centers
8. Abstract: Back to basic: Bio-burden on hands of health care personnel
in tertiary teaching hospital in Malaysia
9. Abstract: The impact of injection anxiety on education of travelers
about common travel risks
10. News
– Waste USA: Taking Universal Precautions – Compliance with OSHA’s blood-
borne pathogens safety standards is vital
– UK: Hundreds get blood tests amid hygiene failures at dentist practice
– UK: Nottingham Dentist Has Potentially Infected 22,000 Patients With
HIV
– UK: Nottinghamshire Police probe dentist patient death
– UK: HIV and hepatitis scare: 22,000 patients recalled
– USA: Life in Houston should not be disposable
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1. Ebola: learn from the past

“The needles and syringes used at the hospital were shared with the
maternity ward. Equipment was, at best, rinsed with distilled water
between patients. Outpatients and pregnant women were infected by
injections; health workers were infected by blood and bodily fluids from
patients, and workers in turn infected family and community members. The
virus spread from that one index patient to 318 people, resulting in 280
deaths. The outbreak ended spontaneously, ironically hastened because the
hospital closed after workers became infected or fled their posts.”

Crossposted from Nature.com with thanks

Full Free Text
http://www.nature.com/news/ebola-learn-from-the-past-1.16117
__________________________________________________________________
Ebola: learn from the past

David L Heymann

09 October 2014

Drawing on his experiences in previous outbreaks, David L. Heymann calls
for rapid diagnosis, patient isolation, community engagement and clinical
trials.

The Ebola outbreak identified in Guinea in March this year has spread to
thousands of people across West Africa. Now, in crowded urban areas,
transmission has accelerated. The number of confirmed and suspected Ebola
cases reported in the week preceding 8 October (854) is more than twice
the total number of cases confirmed in the largest previous outbreak,
which lasted around four months, beginning in late 2000.

Past outbreaks of Ebola were stopped while they were still in rural areas.
Population density was lower, community ties were stronger and, arguably,
measures to prevent transmission were easier to implement.

Yet the lessons that I have learned in rural Africa since participating in
the investigation of the world’s first recorded outbreak of Ebola in 1976
still apply. People with fever and recent contact with an infected person
must be diagnosed as soon as possible, and those with Ebola must receive
care in isolation wards. Communities need the knowledge and the means to
prevent transmission, including safe ways to transport infected people to
isolation wards and to handle dead bodies respectfully.

The current outbreak demands all this and more. There is no proven
treatment for Ebola. Amid distrust and battered health-care systems,
affected countries and international workers are hoping to launch clinical
trials. This outbreak will go on for months yet, and it will not be the
last. It would be an injustice not to learn which of several experimental
treatments can be used to save lives.

History lessons

I was a member of the team that investigated the first known outbreak of
Ebola1. It was in the Democratic Republic of Congo (DRC, then called
Zaire) at the Yambuku Mission Hospital nearly four decades ago. By tracing
contacts and dates of infection, we searched for the first person infected
(possibly from the blood of a game animal butchered for food) who became a
source of infection for others. We concluded that this ‘index patient’ had
been treated at the mission clinic for a nosebleed, and for dysentery with
an injection. His visit was noted in an unremarkable entry on line 2,355
of an outpatient ledger.

The needles and syringes used at the hospital were shared with the
maternity ward. Equipment was, at best, rinsed with distilled water
between patients. Outpatients and pregnant women were infected by
injections; health workers were infected by blood and bodily fluids from
patients, and workers in turn infected family and community members. The
virus spread from that one index patient to 318 people, resulting in 280
deaths. The outbreak ended spontaneously, ironically hastened because the
hospital closed after workers became infected or fled their posts.

Ebola flared the next year at the Tandala Mission Hospital in the north of
the DRC, about 250 kilometres from Yambuku. I was based in Cameroon as an
epidemiologist for the US Centers for Disease Control and Prevention. A
colleague and I drove for two days across the Cameroon and Central African
Republicon unpaved roads through tropical rainforest to investigate.

Although the index case in that instance had also received care at a
poorly equipped hospital, a major outbreak did not occur2. The physician
in charge, a participant in the investigation at Yambuku, had suspected
Ebola and isolated the patient, a nine-year-old girl. Only one more
infection occurred — in the girl’s younger sister — and blood tests of
hospital workers and the patient’s contacts found that the physician
himself was carrying an antibody to Ebola, probably from a previous
infection.

These early investigations revealed patterns. The first sign is often a
cluster of people with diarrhoea or fever, lethargy and other symptoms
sometimes confused with typhoid fever. Ebola emerges in rural settings;
transmission occurs by contact with infected peoples’ blood and body
fluids. Its spread is amplified by poor hospital practices (such as re-
using needles) — health workers are at great risk of becoming infected and
spreading the virus within hospitals and into their communities. Isolation
can prevent hospital transmission, assuming that infection controls such
as protective equipment and safe disposal practices are in place.

“Survivor serum would not be in short supply.”
By 1995, when virologist Jean-Jacques Muyembe and I led the response to
the Ebola outbreak at Kikwit General Hospital in the DRC3, we knew that
rapid and robust action could stop spread, even along major transport
links. (Kikwit is 350 kilometres — 5 hours by road — from the capital
Kinshasa, where one patient travelled to and was rapidly identified and
isolated.) We also learned that communities clearly understood the risk of
infection, and could be persuaded to forego dangerous funeral rites, such
as washing out deceased relatives’ mouths or clipping their fingernails.

Successful strategies
We had a three-pronged strategy. First, patients were identified and
isolated, and protective clothing was provided to health workers. Second,
contacts of all patients with Ebola were monitored, and their temperature
taken twice a day for three weeks. Those with fever were isolated until
diagnosis could be confirmed and those with Ebola were hospitalized.
Third, individuals were educated to protect themselves and their families.
In this and several other outbreaks, organizations such as the Red Cross
and the Red Crescent societies worked with village elders and chiefs to
distribute information tailored to local traditions. Red Cross workers in
protective gear provided transport for patients and burial services for
the dead. When the hospitals were full in Kikwit, some patients were
isolated in their homes. Their families were provided with protective
clothing and monitored daily.

Other strategies have been less successful. Attempts to block the disease
at Africa’s porous borders did not stop past outbreaks, and will not work
now. A cordon sanitaire was established by the DRC government around
Kikwit in 1995 and enforced through military roadblocks. But contacts
under fever surveillance travelled outside the cordon in dugout canoes.
The military patrolled roads, but not forest paths leading to the Kwilu
River.

Fast-forward to 2014. The quarantine of an urban slum of Monrovia,
Liberia’s capital, was lifted just days after its declaration; it had led
to armed clashes, even as residents reportedly moved in and out by
avoiding check points or bribing their way through.

Measures that were successful in stopping more than 20 major Ebola
outbreaks would have probably worked in March in rural Guinea. These
approaches are helping to contain another Ebola outbreak that began in
March this year in the DRC. Now, they must be adapted for the more
complex, difficult situation in urban, mobile societies. For example, city
wards may need to examine all fever cases daily, particularly where
contract tracing is ineffective.

Tough trials
The need for standard fluid replacement in patients is now urgent. Rich
countries have developed a few experimental vaccines and therapies,
spurred in part by fears of bioterrorism. In August, the World Health
Organization (WHO) reached a global consensus that it would be ethical for
clinical trials of these medicines to be carried out in affected
countries, even if the standard regulatory demonstrations of safety and
efficacy were not yet complete. Indeed, rigorous clinical trials for such
treatments are possible only during outbreaks, and are the only way to
learn what is effective.

In September, the Wellcome Trust, a biomedical-research charity in London,
pledged £3.2 million (US$5.2 million) to sponsor clinical trials. This is
a fraction of the funding needed, and other funders such as the Bill and
Melinda Gates Foundation are joining in. Even with recent undertakings
from the international community to send equipment and specialized staff,
and to train thousands of health workers, conducting clinical trials will
be difficult. The outbreak has closed or overwhelmed health-care
facilities, where infected patients have been turned away from hospitals
to die at home or in the streets.

Nonetheless, the Wellcome Trust and others are assessing sites for
clinical trials, and preparing potential protocols. They are likewise
discussing ethical issues such as whether experimental treatments should
be made available only in the context of randomized controlled trials, or
through other study methodologies that would permit more widespread use.

The number of infected patients far outstrips the limited supplies of
candidate vaccines, antivirals and other medicines. Again, experience from
history may prove useful. For ten weeks after the Yambuku outbreak in
1976, I stayed on in a ‘plasmapheresis’ programme. Thirteen Ebola
survivors voluntarily supplied their blood plasma, which contained
proteins that neutralize the Ebola virus. One of the plasma units was
given to a laboratory technician accidentally infected in the United
Kingdom; he survived4. Almost 20 years later, during the Kikwit outbreak
in 1995, eight patients received transfusions of whole blood from
survivors; seven lived5.

Whether these treatments work cannot be determined from this ad hoc
administration of survivor-blood products. Some scientists doubt that they
will work, suggesting that immune serum has been shown not to decrease the
amount of Ebola virus in the blood. But after reviewing the experimental
treatments available, an expert panel convened by the WHO recommended
clinical trials using survivors’ blood, as did the WHO Blood Regulators
Network. Compared with other experimental treatments, plasmapheresis
requires a complicated procedure and use of a potentially infectious
fluid. But even some rural clinics in sub-Saharan Africa regularly collect
blood (the first step in plasmapheresis) for transfusions, and screen out
donors who carry HIV or hepatitis.

Unlike the other experimental products, survivor serum would not be in
short supply. As results become available, trials could transition into
treatment if effectiveness is demonstrated (and health-care facilities re-
established). This could encourage patients and their families to agree to
hospitalization, and so help to isolate infected patients and stop the
spread of infection. For instance, hundreds of survivors in Sierra Leone,
which has so far seen around 2,700 cases of Ebola and about 880 deaths,
could supply a plasmapharesis trial enrolling large numbers of patients.
In the past, survivors have often been willing to provide blood to help
others — that will hopefully be the case again.

After the headlines

Research and development for vaccines and treatments must continue once
this terrible outbreak has passed. Eventually, as for all emerging
infections, attention must shift to prevention at the source — keeping the
Ebola virus from breaching the species barrier or using a future vaccine
to prevent human infection. Once transmission is fully understood,
communities can better prevent it.

For now, full international support must be focused on stopping this
outbreak through innovative and intensified patient isolation, contact
tracing and community empowerment.

Nature 514, 299–300 (16 October 2014) doi:10.1038/514299a

References

Breman, J. G. et al. in Ebola Virus Haemorrhagic Fever (ed. Pattyn, S. R.)
86–97 (Elsevier, 1977).

Heymann, D. L. et al. J. Infect. Dis. 142, 372–376 (1980).

Khan, A. S. et al. J. Infect. Dis. 179, S76–S86 (1999).

Emond, R. T. et al. Br. Med. J. 2, 541–544 (1977).

Mupapa, K. et al. J. Infect. Dis. 179, (Suppl. 1) S18–S23 (1999).

Affiliations

David L. Heymann is professor of infectious disease epidemiology at the
London School of Hygiene and Tropical Medicine, UK, and head of the Centre
on Global Health Security at Chatham House, London, UK.

Correspondence to: David L Heymann
__________________________________________________________________
________________________________*_________________________________

2. Abstract: Sero-prevalence and factors associated with Hepatitis B and C
co-infection in pregnant Nigerian women living with HIV Infection
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25396023

Pan Afr Med J. 2014 Mar 13;17:197.

Sero-prevalence and factors associated with Hepatitis B and C co-infection
in pregnant Nigerian women living with HIV Infection.

Ezechi OC1, Kalejaiye OO1, Gab-Okafor CV1, Oladele DA1, Oke BO1, Musa ZA1,
Ekama SO1, Ohwodo H1, Agahowa E1, Gbajabiamilla T1, Ezeobi PM1, Okwuraiwe
A2, Audu R RA2, Okoye RN3, David AN1, Odunukwe NN1, Onwujekwe DI1, Ujah
IA1.

1Clinical Sciences Division, Nigerian Institute of Medical Research, Yaba
Lagos Nigeria.
2Human Virology Laboratory, Nigerian Institute of Medical Research, Yaba
Lagos Nigeria.
3HIV Counseling and Testing Centre, Nigerian Institute of Medical
Research, Yaba Lagos Nigeria.

INTRODUCTION: Perinatal and horizontal transmission of Hepatitis B occur
in areas of high endemicity as most infections are acquired in the first 5
years of life. Unless Hepatitis B and C infected pregnant women
identified, and appropriate treatment provided, children born to these
women are at high risk of chronic Hepatitis B (and C) virus infection. The
objecive of this study was to determined the prevalence and the factors
associated with Hepatitis B and C Virus infection in pregnant HIV positive
Nigerians.

METHODS: A cross sectional study among HIV Positive pregnant women seen at
a large PMTCT clinic in Lagos Nigeria. The women were screened for
Hepatitis B and C Virus infection at enrollment. HIV viral load, CD4
count, liver transaminases and hemoglobin levels were also determined.
Data were managed with SPSS for windows version. Ethical approval was
obtained from the Institutions Ethical Review Board.

RESULTS: Of the 2391 studied subjects, 101(4.2%) and 37(1.5%) respectively
were seropositive for Hepatitis B and C Virus infection. Twowomen (0. 08%)
had triple infections. blood transfusion, (cOR: 2.3; 95% CI:1.1 – 4.6),
history of induced abortion (cOR:2. 2;95% CI:1.3 – 3.6), and elevated
baseline ALT (cOR:2. 2; 95%CI:2. 2;4.2) were significantly associated with
HBV. History of induced abortion was the only factor found to be
associated with HIV/ HCV (cOR: 1.9;95%CI:1. 3-3.9).

CONCLUSION: Hepatitis B Virus infection (4.2%) is relatively common in our
environment and associated with induced abortion, blood transfusion and
elevated baseline transaminase.

* Hepatitis C Virus infection (1.5%) is less common and associated with
only history of induced abortion.

KEYWORDS: HIV; Hepatitis B virus; Hepatitis C virus; pregnancy

Full Free Article
http://www.panafrican-med-journal.com/content/article/17/197/full/
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Drug use, HIV, HCV and TB: major interlinked challenges in
Eastern Europe and Central Asia
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25394010

J Int AIDS Soc. 2014 Nov 2;17(4 Suppl 3):19501.

Drug use, HIV, HCV and TB: major interlinked challenges in Eastern Europe
and Central Asia.

Kazatchkine M.

United Nations Special Envoy for HIV/AIDS in Eastern Europe and Central
Asia, Geneva, Switzerland.

Eastern Europe and Central Asia have the largest drug epidemic globally
and the fastest and still expanding HIV epidemic. The Russian Federation
and Ukraine together account for over 90% of the reported AIDS cases in
the region. If small in absolute numbers, the epidemics are however
significant in prevalence rate in most countries of Central Asia.

Most heroin and many of the new synthetic or home-made drugs are injected,
which has led to high prevalence levels (up to 90%) of HCV infection in
people who inject drugs (PWID). The two epidemics of HIV and HCV are in
turn interlinked with TB and MDR-TB that are highly prevalent among
marginalized populations in the region. Despite progress in the last two
years, access to antiretroviral treatment remains far below global levels
and increases more slowly than new reported cases of HIV.

Access to prevention is limited with low coverage of needle exchange
programs and very low or inexistent access to opioid substitutive therapy.
There are few exceptions to this situation, including Ukraine where harm
reduction programs are being scaled up together with significant peer
outreach programs for PWIDs. This is likely to be the reason why the
epidemic curves in the Russian Federation and Ukraine are now diverging.

The region faces many structural, cultural, societal and political
obstacles in responding to these quadruple epidemics. Without a
significantly expanded and strengthened response, these epidemics will
remain major causes of illness and premature deaths in the region.

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4224809/
__________________________________________________________________
________________________________*_________________________________

4. Abstract: HIV Prevalence and Risk Behaviors Among People Who Inject
drugs in Two Serial Cross-Sectional Respondent-Driven Sampling Surveys,
Zanzibar 2007 and 2012
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25399032

AIDS Behav. 2014 Nov 16.

HIV Prevalence and Risk Behaviors Among People Who Inject drugs in Two
Serial Cross-Sectional Respondent-Driven Sampling Surveys, Zanzibar 2007
and 2012.

Matiko E1, Khatib A, Khalid F, Welty S, Said C, Ali A, Othman A, Haji S,
Kibona M, Kim E, Broz D, Dahoma M.

1Division of Global HIV/AIDS, US Centers for Disease Control and
Prevention, CDC Tanzania, c/o US Embassy, 686 Old Bagamoyo Road, PO Box
9123, Dar Es Salaam, Tanzania, iyt9@cdc.gov.

People who inject drugs (PWID) are at higher risk of acquiring HIV due to
risky injection and sexual practices. We measured HIV prevalence and
behaviors related to acquisition and transmission risk at two time points
(2007 and 2012) in Zanzibar, Tanzania. We conducted two rounds of
behavioral and biological surveillance among PWID using respondent-driven
sampling, recruiting 499 and 408 PWID, respectively. Through faceto- face
interviews, we collected information on demographics as well as sexual and
injection practices. We obtained blood samples for biological testing. We
analyzed data using RDSAT and exported weights into STATA for multivariate
analysis.

HIV prevalence among sampled PWID in Zanzibar was 16.0 % in 2007 and 11.3
% in 2012; 73.2 % had injected drugs for 7 years or more in 2007, while in
the 2012 sample this proportion was 36.9 %. In 2007, 53.6 % reported
having shared a needle in the past month, while in the 2012 sample, 29.1 %
reported having done so. While 13.3 % of PWID in 2007 reported having been
tested for HIV infection and received results in the past year, this
proportion was 38.0 % in 2012. Duration of injection drug use for 5 years
or more was associated with higher odds of HIV infection in both samples.

HIV prevalence and indicators of risk and preventive behaviors among PWID
in Zanzibar were generally more favorable in 2012 compared to 2007-a
period marked by the scale-up of prevention programs focusing on PWID.

While encouraging, causal interpretation needs to be cautious and consider
possible sample differences in these two cross-sectional surveys. HIV
prevalence and related risk behaviors persist at levels warranting
sustained and enhanced efforts of primary prevention and harm reduction.
__________________________________________________________________
________________________________*_________________________________

5. Abstract: HIV and STI Prevalence and Injection Behaviors Among People
Who Inject Drugs in Nairobi: Results from a 2011 Bio-behavioral Study
Using Respondent-Driven Sampling
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25398417

AIDS Behav. 2014 Nov 15.

HIV and STI Prevalence and Injection Behaviors Among People Who Inject
Drugs in Nairobi: Results from a 2011 Bio-behavioral Study Using
Respondent-Driven Sampling.

Tun W1, Sheehy M, Broz D, Okal J, Muraguri N, Raymond HF, Musyoki H, Kim
AA, Muthui M, Geibel S.

1HIV and AIDS Program, Population Council, 4301 Connecticut Avenue, NW,
Suite 280, Washington, DC, 20008, USA, wtun@popcouncil.org.

There is a dearth of evidence on injection drug use and associated HIV
infections in Kenya. To generate population-based estimates of
characteristics and HIV/STI prevalence among people who inject drugs
(PWID) in Nairobi, a cross-sectional study was conducted with 269 PWID
using respondent-driven sampling. PWID were predominantly male (92.5 %).
An estimated 67.3 % engaged in at least one risky injection practice in a
typical month. HIV prevalence was 18.7 % (95 % CI 12.3-26.7), while STI
prevalence was lower [syphilis: 1.7 % (95 % CI 0.2-6.0); gonorrhea: 1.5 %
(95 % CI 0.1-4.9); and Chlamydia: 4.2 % (95 % CI 1.2-7.8)]. HIV infection
was associated with being female (aOR, 3.5; p = 0.048), having first
injected drugs 5 or more years ago (aOR, 4.3; p = 0.002), and ever having
practiced receptive syringe sharing (aOR, 6.2; p = 0.001). Comprehensive
harm reduction programs tailored toward PWID and their sex partners must
be fully implemented as part of Kenya’s national HIV prevention strategy.
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Does intra-articular steroid injection increase the rate of
infection in subsequent arthroplasty: grading the evidence through a
meta-analysis
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25391629

J Orthop Surg Res. 2014 Nov 13;9(1):107.

Does intra-articular steroid injection increase the rate of infection in
subsequent arthroplasty: grading the evidence through a meta-analysis

Xing D, Yang Y, Ma X, Ma J, Ma B, Chen Y.

Background: Intraarticular steroid injections are widely used in joint
arthritis. However, the data regarding an association between an increased
risk for arthroplasty infection after an intraarticular steroid injection
are still conflicting. We conducted a meta-analysis to evaluate the
evidence from relevant studies that examine the relation between
intraarticular steroid injections and infection rates in subsequent joint
arthroplasty and to develop GRADE based recommendations for using the
steroid before arthroplasty.

Methods: A systematic search of all studies published through August 2014
was conducted using the MEDLINE, EMBASE, OVID, ScienceDirect and Cochrane
CENTRAL databases. The relevant studies that examined the relation between
intraarticular steroid injections and infection rates in subsequent joint
arthroplasty were identified. Demographic characteristics, infection rates
and clinical outcomes were manually extracted from all of the selected
studies. The evidence quality levels and recommendations were assessed
using the GRADE system.

Results: Eight studies looking at hip and knee arthroplasties were
included. Meta-analysis showed that patients with steroid injection before
arthroplasty had a higher deep infection rate than patients without
steroid injection (OR =2.13, 95%CI 1.02-4.45), but no significant effect
on superficial infection rate (OR =1.75, 95%CI 0.74-4.16). The overall
GRADE system evidence quality was very low, which lowers our confidence in
their recommendations.

Conclusions: Intraarticular steroid injections may lead to increased deep
infection rates of subsequent joint arthroplasty but not the superficial
infection rates. Due to the poor quality of the evidence currently
available, further studies are still required.

Free full text http://www.josr-online.com/content/9/1/107/abstract
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Risk factors for hepatitis B and C infection among blood
donors in five Chinese blood centers
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25382751

Transfusion. 2014 Nov 10.

Risk factors for hepatitis B and C infection among blood donors in five
Chinese blood centers.

Huang Y1, Guo N, Yu Q, Lv Y, Ma H, Yun Z, Yao F, Dong X, Zhu X, Wen X, Cao
R, Huang M, Bi X, Zhao M, Tiemuer MH, Li J, Zhou Z, He W, Liu J, Wright
DJ, Wang J, Ness P, Shan H; NHLBI Retrovirus Epidemiology Donor Study-II
(REDS-II), International Component.

1Institute of Blood Transfusion, Chinese Academy of Medical Sciences,
Chengdu, P.R. China.

Few studies were conducted on hepatitis B and C virus (HBV and HCV,
respectively) risk factors among Chinese blood donors in recent years
since voluntary donors replaced commercial donors.

STUDY DESIGN AND METHODS: A case-control survey was conducted in HBV- or
HCV-positive and -negative donors from five blood centers in China between
September 2009 and April 2011. Case status was defined by having a
reactive result on Monolisa HBsAg Ultra (Bio-Rad) for HBV and Ortho anti-
HCV EIA 3.0 (Johnson & Johnson) for HCV. Controls were randomly selected
qualified blood donors matched to cases by donation month and blood
center. Specific test- seeking, medical-related, and behavioral risk
factors were compared by HBV and HCV status using chi-square tests or
Fisher’s exact tests with Bonferroni correction.

RESULTS: A total of 364 HBV cases, 174 HCV cases, and 689 controls
completed the survey; response rates were 66.2, 47.3, and 82%,
respectively. HCV- positive donors were significantly more likely to
report having a blood transfusion history (23.4% vs. 3.0%, p?<?0.0001) and
ever living with a person with illegal drug injection (6.0% vs. 0.5%,
p?<?0.0001) than controls. Having intravenous and intramuscular injections
in the past 12 months and ever having a tattoo are marginal risk factors
for HCV (p values?<?0.01). No specific risk factor for HBV was identified.

CONCLUSION: History of previous transfusion and living with illegal drug
users are risk factors for HCV infection among Chinese blood donors from
five regions. Test-seeking behavior is not associated with HBV or HCV
infections.

© 2014 AABB.
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Back to basic: Bio-burden on hands of health care personnel
in tertiary teaching hospital in Malaysia
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25382481

Trop Biomed. 2014 Sep;31(3):534-9.

Back to basic: Bio-burden on hands of health care personnel in tertiary
teaching hospital in Malaysia.

Wong JL1, Siti Azrin AH2, Narizan MI3, Norliah Y3, Noraida M3, Amanina A1,
Nabilah I1, Habsah H1, Siti Asma H1.

1Department of Medical Microbiology and Parasitology, School of Medical
Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan.
2Unit of Biostatistics and Research Methodology, School of Medical
Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan.
3Unit of Infection Control and Hospital Epidemiology, Hospital Universiti
Sains Malaysia.

Hands of Health Care Personnel (HCP) are one of the most common vehicles
for the transmission of infection. Microorganisms can survive well on the
hands of HCP for a certain duration. Therefore, the purpose of this study
is to bring awareness to HCP that their hands can actually be contaminated
with many microorganisms. These microbes on the hands of HCP can
potentially infect their patients if they do not comply with the proper
hand hygiene practice.

This cross-sectional study was conducted at a randomly selected Intensive
Care Unit (ICU) and general ward in a hospital. Twenty five HCP from each
ward were randomly selected and their hands were imprinted on blood
culture plates. Microorganism growth were quantified and identified. Data
were analyzed and presented as descriptive analysis.

One hundred blood agar plates were processed and analyzed. Majority (71%)
of the samples had more than 50 colony-forming units (CFU) and only 17% of
the samples had less than 25 CFU. Microorganisms identified include
Staphylococcus spp., Acinetobacter spp., Enterobacteriaceae, Pseudomonas
spp., Moraxella, Delftiaacidovorans and fungi. All isolated microorganisms
were antibiotic sensitive strain.

This study showed that the hands of HCP were contaminated with many
microorganisms. Therefore, it is imperative that HCP must practice proper
hand hygiene when taking care of their patients in the wards.
__________________________________________________________________
________________________________*_________________________________

9. Abstract: The impact of injection anxiety on education of travelers
about common travel risks
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24251652

J Travel Med. 2014 Mar-Apr;21(2):86-91.

The impact of injection anxiety on education of travelers about common
travel risks.

Noble LM1, Farquharson L, O’Dwyer NA, Behrens RH.

1UCL Medical School, University College London, London, UK.

BACKGROUND: Despite many travelers receiving at least one vaccination
during the pre-travel consultation, little is known about travelers’ fear
of injections and the impact this may have on educating travelers about
health risks associated with their trip. This study aimed to investigate:
(1) the prevalence of injection anxiety in travelers attending a pre-
travel consultation, (2) whether anxiety due to anticipating a vaccination
adversely affects recall of information and advice, and (3) whether
clinicians can recognize travelers’ anxiety, and how they respond to
anxious travelers.

METHODS: Consecutive adult travelers (N?=?105) attending one of two inner-
city travel clinics completed self-report measures of state anxiety,
injection anxiety, and symptoms of needle phobia immediately before and
after their pre-travel consultation. Clinicians were also asked to rate
travelers’ anxiety and report any anxiety management strategies.
Standardized information was presented during the consultation and recall
of information and advice was assessed immediately post-consultation.
Delayed recall (24?hours) was assessed for a subsample (20%) of
participants.

RESULTS: More than one third of travelers reported feeling nervous or
afraid when having an injection (39%). Travelers’ state anxiety was
related to their psychological and physiological reactions to needles, and
reduced significantly post-consultation. Recall of information and advice
varied, with failure of recall ranging from 2 to 70% across 15 items, and
delayed recall being significantly lower. No relationship was found
between recall and anxiety. Clinician-rated anxiety moderately correlated
with travelers’ self-reported anxiety.

CONCLUSIONS: A significant proportion of travelers experienced injection
anxiety when attending the pre-travel consultation, with some travelers
reporting symptoms consistent with criteria for Blood Injection Injury
phobia. There were important gaps in recall of information and advice
about common travel risks. Although no relationship was found between
recall and anxiety, this may have been due to the sample and setting.

© 2013 International Society of Travel Medicine.
__________________________________________________________________
________________________________*_________________________________

10. News

– Waste USA: Taking Universal Precautions – Compliance with OSHA’s blood-
borne pathogens safety standards is vital
– UK: Hundreds get blood tests amid hygiene failures at dentist practice
– UK: Nottingham Dentist Has Potentially Infected 22,000 Patients With
HIV
– UK: Nottinghamshire Police probe dentist patient death
– UK: HIV and hepatitis scare: 22,000 patients recalled
– USA: Life in Houston should not be disposable

Selected news items reprinted under the fair use doctrine of international
copyright law: http://www4.law.cornell.edu/uscode/17/107.html
__________________________________________________________________
http://waste360.com/safety/taking-universal-precautions

Waste USA: Taking Universal Precautions – Compliance with OSHA’s blood-
borne pathogens safety standards is vital.

By John Haudenshield, waste360, USA (14.11.14)

Contact with potentially contaminated bodily fluids during collection of
waste is a significant concern among waste and recycling personnel. While
the collection, transportation and disposal of regulated medical or “red
bag” waste is a specialized, highly-regulated segment within our industry,
inadvertent exposure to blood-borne pathogens in the general waste stream
is a potential occupational risk that should never be overlooked. We need
to raise workers’ awareness and prevent blood-borne pathogen exposure in
the waste and recycling industry, beginning with an overview of the U.S.
Occupational Safety & Health Administration (OSHA) standard and discussion
of the Center for Disease Control’s Universal Precautions.

Preventing exposures to blood-borne pathogens begins with the effective
implementation of OSHA standard 40 CFR 1910.1030. This standard applies to
all occupational exposures to blood or other potentially infectious
materials (OPIM), defined as human body fluids such as semen, vaginal
secretions, cerebrospinal fluid, amniotic fluid or any body fluid that is
visibly contaminated with blood. Applying the OSHA blood-borne pathogens
standard begins with developing an Exposure Control Plan (ECP), a
mandated, written document designed to identify potential sources of
exposures and establish actions and behaviors to eliminate or minimize
employee exposures.

The ECP must be reviewed and updated annually to include changes to your
business processes or procedures as well as the documented consideration
or implementation of new technology. Its main elements are:

1. Exposure determination. This is a list of employee classifications, job
tasks and procedures in which occupational exposure may occur. The risk
assessments are made without regard to personal protective equipment or
work practice/operational controls. That can be a standalone assessment or
part of a broader, integrated risk assessment of your facilities and
operations.

2. Communication of hazards to employees. It is paramount that every
employee has documented training and a solid understanding of which fluids
present infection hazards and the risks and controls associated with their
job, including volunteer first responders. Understand the avenues of
potential exposure through the skin and mucous membranes (nose, mouth and
eyes) and via punctures from needle sticks, cuts, abrasions or similar
injuries. The training puzzle’s final piece is knowing how to protect
against such exposures.

3. Following methods of compliance. This includes universal precautions,
engineering and administrative controls, personal protective equipment and
housekeeping, especially waste handling. Other ECP elements address the
Hepatitis B vaccination and post-exposure evaluation.

The golden rule of preventing exposures is the foundation of universal
precautions. First and foremost, all blood and OPIM are considered
infectious. You must prevent contact by recognizing potential hazards,
sound operating procedures and engineering controls and through the use of
appropriate personal protective equipment to create barriers between the
fluids of concern and routes of exposure.

* Examine what you are picking up before grabbing it.

* Do not use your body to compress a trash bag or cardboard box.

* Do not pick up red bag waste, sharps containers, biohazard-labeled
containers and/or needles. If you encounter these items, stop and notify
your supervisor.

* Use tools to pick up/clean up broken glass, knives, razor blades and
other sharp objects. Do not handle these objects if they appear to be
contaminated with blood or bodily fluids. Notify your supervisor.

* Wear puncture-resistant gloves and safety glasses while working.

Employers are required to offer a Hepatitis B Vaccination, at no cost, to
any employee involved in an incident where they were exposed to blood or
other potentially infectious materials.

4. Recordkeeping. Employers are required to maintain confidential medical
records, including written acceptance or declination by the employee of a
post-exposure Hepatitis B vaccine. Also, training records and a sharps
injury log must be maintained.

Waste collection personnel face many challenges throughout the day. Using
universal precautions simplifies incidents by categorizing all blood and
bodily fluids as potentially infectious. Being able to recognize hazards,
follow proper procedures and use appropriate personal protective equipment
will help you safely address whatever you encounter. If you have further
questions, contact the National Waste & Recycling Association
(wasterecycling.org). If your company handles regulated medical waste,
consider joining NW&RA’s Healthcare Waste Institute.

John Haudenshield is the safety director for the National Waste &
Recycling Association and may be reached at (540) 589-2975 or
JHaudenshield@wasterecycling.org.
__________________________________________________________________
__________________________________________________________________
http://tinyurl.com/lvk2uyh

UK: Hundreds get blood tests amid hygiene failures at dentist practice

More than 22,000 former patients of banned dentist Desmond D’Mello
recalled to check for possible infections

By James Meikle, The Guardian, UK (13.11.14)

More than 450 people have had blood tests to establish whether they
developed infections due to poor hygiene practices of a dentist who has
caused a health scare involving an estimated 22,000 former patients.

About a further 1,500 sought advice either at a specially set-up clinic or
from a helpline within hours of health chiefs announcing they were
investigating failures by Desmond D’Mello. He was suspended from NHS work
in June and barred from practising altogether in August pending inquiries
by the NHS, the coroner and his professional disciplinary body.

A plea for all those treated by D’Mello at the Daybrook dental centre in
Arnold, Nottinghamshire, over 32 years to contact the authorities on
Wednesday morning prompted an enormous response to one of the biggest
recalls in NHS history. It was needed because the age of the records at
his practice meant it was not possible to write to all those possibly
affected.

More than 600 people attended a temporary clinic in the town, with 452
being tested and more than 150 taking away information before making a
decision. Another 1,333 people used the 8am to 8pm hotline.

The death of one of D’Mello’s patients, 23-year-old Amy Duffield in August
2013 from viral acute myocarditis – a heart infection – is being
investigated on behalf of coroner Mairin Casey. Amy’s mother, Sharon, said
on Wednesday: “Amy was my life. She was unique – my best friend as well as
my daughter. Of course I miss her terribly, having lost her at such a
young age with so much of her life in front of her.

“I have nothing but admiration for the superb care given to Amy by the NHS
in the last days of her life. They did their very best to save her, but it
wasn’t to be. We will of course be interested in the findings of the
investigation, whatever the outcome, but it won’t bring Amy back.”

The tests are to determine whether any of D’Mello’s patients might have
contracted blood-borne viruses, especially HIV, hepatitis B or hepatitis
C, which can take many years to result in obvious symptoms, because of
unsafe practices at his surgery. Health officials say the risk is low but
want to be sure after the discovery of apparent multiple failures in
infection control.

D’Mello has been tested and found clear of blood-borne viruses so there
was no risk of infection for him, they say. His former clinic has
different owners, which are in no way connected with the incident.

The helpline number is 03330 142479.
__________________________________________________________________
__________________________________________________________________
Moderators note: This is an advertisement for legal services related to
the case of infection alleged to have been caused by poor practices and is
posted for an example of infection control breach sequelae.

http://www.webwire.com/ViewPressRel.asp?aId=192847

UK: Nottingham Dentist Has Potentially Infected 22,000 Patients With HIV

WEBWIRE – UK (13.11.14)

In a case of dental negligence that can only be described as shocking, a
dentist in Nottingham has seemingly failed to take the most basic of
precautions to prevent cross infection over a period of 32 years thus
endangering the lives of thousands.

If you have been exposed to life threatening blood borne infections due to
this shocking instance of dental negligence act now and get the
compensation you deserve.

Dentist Desmond D’Mello of Daybrook Dental Practice in Nottingham worked
on 22,000 patients over his 32 years of practice, but appears not to have
taken the most basic precautions to prevent the spread of blood borne
infections between patients putting thousands of dental patients at
serious risk of contracting life threatening diseases such as HIV,
Hepatitis and other serious infections. Unfortunately, thousands of
D’Mello’s patients treated at Daybrook will now need to have blood tests
and face the anguish of a wait for results and possible findings of
infection.

David Corless-Smith whom has been offering victims legal advice adds “We
have looked at the timeline of regulation of Dr Desmond D’Mello’s practice
and have discovered that he was not suspended by the dentists’ regulator
the General Dental Council (GDC) until late August 2014 despite a video
being taken of his poor cross infection practices and supplied to NHS
England in June 2014. Questions will need to be asked why it took 2 months
for the GDC to suspend him when the evidence was clear that he was danger
to patients.”

The Dental Law Partnership also feel that the Care Quality Commission also
have other important questions to answer as the CGC visited Daybrook
Dental Practice where D’Mello worked as part of their planned dental
practice inspection visits in Nov 2013, and reviewed it again in Feb 2014,
yet somehow declared that they had no concerns about Desmond D’Mello’s
cleanliness and infection control.

Unfortunately for patients, the CQC report appears completely inaccurate,
potentially endangering the lives of thousands. D’Mello had seemingly
deceived inspectors as he was made aware of the CQC’s intentions to visit
and inspect his practice, allowing him the time to ‘clean up his act’
before CQC inspectors arrived. This apparent deception has endangered the
lives of thousands of patients as they were continuously exposed to the
risk of infection.

To prevent this happening in the future and to protect dental patients,
the Dental Law Partnership, expert dental negligence solicitors are
calling for unannounced surprise practice inspections by CQC to be made
mandatory for all dental practices.

Solicitors at the Dental Law Partnership are urging patients of the
Daybrook Dental Practice in Nottingham and those whom have been treated by
Desmond D’Mello to come forward.

Specialising in dental negligence compensation claims, the expert
solicitors at the Dental Law Partnership can help you get the compensation
you deserve. If you have been exposed to life threatening blood borne
infections due to this shocking instance of dental negligence act now and
get the compensation you deserve.

For more information, visit www.dentallaw.co.uk or phone 0800 0853 823
today and get the compensation you deserve.

WebWireID192847
__________________________________________________________________
__________________________________________________________________
http://www.bbc.com/news/uk-england-nottinghamshire-30005682

UK: Nottinghamshire Police probe dentist patient death

BBC News, Nottingham, UK (12.11.14)

Police are investigating after a woman died the same month she was treated
by a dentist, currently under review for poor infection control practices.

Amy Duffield died in August 2013 shortly after treatment at the practice
in Daybrook, Nottinghamshire.

Desmond D’Mello has been suspended by the General Dental Council and up to
22,000 former patients may have to be tested for blood-borne viruses.

It is said he did not wash his hands or sterilise equipment between
patients.

Experts said the risk of infection was believed to be low but thousands of
people who used the practice in the Nottingham suburb are to be recalled
and offered tests for HIV and hepatitis.

Miss Duffield, a Leeds University graduate, died in hospital in August
2013 of viral acute myocarditis after suffering palpitations, her family
said.

Mother Sharon Duffield said: “Amy was my life. She was unique – my best
friend as well as my daughter. Of course I miss her terribly, having lost
her at such a young age with so much of her life in front of her.

“I have nothing but admiration for the superb care given to Amy by the NHS
in the last days of her life. They did their very best to save her, but it
wasn’t to be.

“We will of course be interested in the findings of the investigation,
whatever the outcome, but it won’t bring Amy back.”

Nottinghamshire Police was asked by the coroner to investigate Miss
Duffield’s death and that of a second woman, aged 29, who died the same
month.

Detectives ruled out a link between the 29-year-old woman’s death and her
treatment but continue to investigate Ms Duffield’s case.

The hygiene concerns came to light when a whistleblower contacted health
authorities after filming covertly at the practice.

Mr D’Mello had been tested and was clear of all diseases, NHS England
said.

The leaflet

A leaflet about the risks posed to patients has been handed out at
Daybrook Dental Practice

“Patients seen by Mr D’Mello appear to have been placed at a possible low
risk of infection from blood-borne infections, due to multiple failures in
cross-infection control measures,” a spokesman said.

NHS England said it appeared Mr D’Mello failed to wash his hands and used
the same instruments for more than one patient without sterilising them
between appointments.

Two nurses who were filmed are also being investigated, but another
dentist, who worked with Mr D’Mello at the time, is not under any
suspicion.

A Care Quality Commission inspection in July also raised concerns about
the possibility of cross-contamination at the practice.

The report said the staff toilet and another room were being used as store
rooms for equipment.

“This posed a risk of these items coming into contact with body fluids
which may be contaminated,” the report said.

However, inspectors who had visited the clinic in November last year gave
it a clean bill of health.

The new owners of the practice have renovated the property and addressed
all the concerns, the inspectors said.

Patient reaction

Nigel Shearing, from Huthwaite in Nottinghamshire, said: “I was his first
patient when he came out of dental school and set up his practice. I’ve
been seeing him for nearly 30 years.

“He was a true professional, always spot on. He was one of the best
dentists I’ve ever had.

“I have absolutely zero concerns. I’m sure it’s all nothing. If he
practised again, I’d continue to see him.”

Beth Parsons, from Daybrook, who was a patient for 30 years, said: “I am
in a state of shock… absolutely amazed. We knew he was suspended but we
didn’t know why until this morning.”

Doug Black of NHS England said: “We are extremely sorry for the undoubted
worry and concern that people may feel on hearing this news.

“I would like to stress again that the risk is low but would encourage
anyone affected to contact the advice line,” Dr Black said.

The NHS has written separately to the 166 patients who were captured on
camera in the secret filming to explain what has happened.

A hotline and a community clinic have been set up in Nottingham to handle
any questions.
__________________________________________________________________
__________________________________________________________________
http://tinyurl.com/kyed2dr

UK: HIV and hepatitis scare: 22,000 patients recalled

By Keith Perry, Telegraph.co.uk, UK (12.11.14)

Patient recall over HIV fears linked to contaminated dental equipment, it
is reported as Public Health England prepare to issue warning

Health chiefs are recalling up to 22,000 patients at a dental practice in
Nottingham over fears they could have been infected with blood-borne
viruses as a result of contaminated equipment.

Patients are to undergo tests over risks they could have been treated with
contaminated dental equipment over three decades.

They will be tested for viruses including HIV, hepatitis B and C. A
dentist was suspended in June after a whistleblower filmed him allegedly
breaching infection-control standards, the Mirror reported.

Health chiefs launched an investigation after reviewing the footage, and
called in officials from Public Health England.

A clinical risk assessment concluded that patients may have been placed at
risk of infection from blood-borne viruses.

Sources said more than 160 patients were recorded as being put at “serious
risk” from infection.

They also said the dentist was allegedly responsible for multiple failures
in cross-infection control standards that left health experts “horrified”.
He worked at the practice for 32 years and treated about 22,000 patients.
NHS England is trying to contact all of his former patients after health
experts made an unprecedented recommendation that they should be screened.
An emergency walk-in centre is being set up in Nottinghamshire to deal
with patients.

A separate hotline, open seven days a week, is also being set up to advise
people who were treated at the practice.

The dentist was given an interim 18-month suspension by the General Dental
Council in August, pending an investigation.

NHS England will make a public appeal on Wednesday in what could by the
biggest recalls in NHS history. The investigators’ task has been
complicated by the huge number of patients involved and because some were
treated as long ago as 1982.
__________________________________________________________________
__________________________________________________________________
http://tinyurl.com/n5zdzmn

USA: Life in Houston should not be disposable

By Irma Vejo, Your Houston News, Houston Texas USA (11.11.14)

Houston, we have a serious problem. This city of ours is one of the few
metropolitan areas that does still not have a needle exchange program. One
might wonder where the problem lies and if it is a question of
misinformation? Well, it is to a certain extent. Are there people in
Houston believing that establishing a needle exchange program would
increase drug use, despite data showing that the opposite is true?
Absolutely. Is there stigma associated with drug use? Absolutely. Are
there individuals believing that drug addiction is a choice and that the
victim should be blamed for his/her poor choice? Yes, unfortunately, there
are.

The first step to clearing up some of these misconceptions about needle
exchange programs, that would also lead to harm reduction, would be
establishing actual needle exchange programs, which are currently illegal
in Texas. The goal of harm reduction is to promote safer use and with that
decrease harmful effects of drug use. Although not required, injection
drug users would be encouraged to bring their used needles to a syringe
exchange site in exchange for new needles. Needle exchange site staff
would then safely dispose of the used syringes. Besides offering unused
needles; needle exchange sites offer referrals to drug treatment centers
and HIV testing; oftentimes reaching difficult to reach and homeless
clients that otherwise would not get treatment services.

Texas has the fourth highest HIV/AIDS rate in the nation, and AIDS and
Hepatitis C infections have particularly devastated the African American
community in our city. In the United States, needle-sharing accounts to at
least 25 % of all AIDS cases, as sharing needles significantly increases
the user’s chances of contriving HIV and Hepatitis C. As life-long
treatment for AIDS can cost up to $300, 000 for one person, and the
average cost for a needle distributed is $ 0.97; it is evident that we
simply cannot afford not to have a needle exchange program in Houston.

According to the Coalition for Safe Community Needle Disposal in Houston,
needle sticks can lead to serious health problems and infections. The
Coalition estimates that 7.8 billion needles are discarded in garbage
dumpsters each year; a large percentage of this number were needles used
to inject illegal drugs . This puts all of us in potential danger of being
stuck by a possibly infected needle; something a 47-year old Houston
woman, who was stuck by a used needle while shopping at Kohl’s recently,
knows all too well. Although there has been a lot of talk about passing
legislation that would allow the establishment of needle-exchange
programs, so far pleads from citizens and police officers have been
ignored.

Police officers, when on duty, are especially at risk of getting stuck by
contaminated needles, particularly when working on a drug bust. This has
created an additional layer of danger for the police force in Houston. We
need to consider that Houstonian children, garbage collectors, and
paramedics very often find improperly discarded syringes . Elections often
mean change, and Texas law would need to change before Houston can have a
needle exchange program. One of the ways everybody can get involved would
be to write a letter to the new Texas governor; expressing support for
much needed needle exchange programs in Texas.

We must recognize that there are ways to make drug use significantly
safer, while taking into consideration that drug use happens for various
reasons and that poverty, mental disorders, childhood trauma, and many
other things can contribute to drug abuse. It is of outermost importance
for us to accept that drugs are not going to go away, and it is important
to meet users where they are; instead of shaming, judging, and ignoring
them. We need to hear from and ensure that those affected by this disease
the most, the users themselves, have a voice in establishing programs and
policies that would be beneficial to them and society at large. While
recognizing the hazard of illicit drug use, we must support and make drug
users part of the solution; as they can help reduce further damages of
drug use by sharing needle-exchange information with other users. The fact
that needle exchange programs are illegal in our city sends the message to
our drug addicted citizens that their lives are somehow unimportant,
insignificant, and disposable. It is time to send a message more congruent
with our city; a message of non-judgment, acceptance, recognition, and
hope.

Irma Vejo is a MSW student at the University of Houston Graduate College
of (Political) Social Work.
__________________________________________________________________
________________________________*_________________________________
* 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 2015

The Safe Injection Global Network SIGN meeting has been postponed until
early 2015. Details will be announced as soon as possible.

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
__________________________________________________________________
________________________________*_________________________________
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The comments made in this forum are the sole responsibility of the writers
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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
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The SIGNpost Website is http://SIGNpostOnline.info

The SIGNpost website provides an archive of all SIGNposts, meeting
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We would like your help in building this archive. Please send your old
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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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