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SIGNpost 00779

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST *SAFE INJECTION GLOBAL NETWORK*

Post00779 SIGN Reminder + Abstracts + Course + News 26 November 2014

CONTENTS
1. Reminder: Injection safety policy launch & SIGN meeting 23-24 February
2015
2. Abstract: Ebola virus disease cases among health care workers not
working in ebola treatment units – liberia, june-august, 2014
3. Abstract: What has been achieved in HIV prevention, treatment and care
for people who inject drugs, 2010-2012? A review of the six highest
burden countries
4. Abstract: Revitalizing the HIV response in Pakistan: a systematic
review and policy implications
5. Abstract: Syringe access, syringe sharing, and police encounters among
people who inject drugs in New York City: a community-level perspective
6. Abstract: Opioid substitution therapy protects against hepatitis C
virus acquisition in people who inject drugs: the HITS-c study
7. Abstract: Risk and vulnerability of key populations to HIV infection in
Iran; knowledge, attitude and practises of female sex workers, prison
inmates and people who inject drugs
8. Abstract: Hoigne syndrome following an intravenous injection of
ceftriaxone: a case report
9. Abstract: Blindness caused by cosmetic filler injection: a review of
cause and therapy
10. Abstract: Safety study of 38 503 intravitreal ranibizumab injections
performed mainly by physicians in training and nurses in a hospital
setting
11. Abstract: Hand Hygiene in Emergency Medical Services
12. Abstract: The Effects of an Injected Placebo on Endurance Running
Performance
13. Announcement: International Course Access to Medical Technologies –
Feb 02-06, 2015 Jaipur, India
14. News
– Canada: Abbotsford acupuncture patients advised to get tests for
hepatitis and HIV
– Canada: Media Release: Fraser Health Public Safety Advisory for clients
of the Acupuncture and Chinese Medicine Centre in Abbotsford

The web edition of SIGNpost is online at:
http://signpostonline.info/archives/1781

More information follows at the end of this SIGNpost!

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__________________________________________________________________
________________________________*_________________________________

1. Reminder: Injection safety policy launch & SIGN meeting 23-24 February
2015
__________________________________________________________________
Injection safety policy launch and SIGN meeting moved to 23-24 February
2015

Dr Marie-Paule Kieny
World Health Organization
Assistant Director-General – Health Systems and Innovation

Dear Colleagues,

As you know from previous messages, WHO is very pleased to be launching a
global campaign on injection safety. This is a critical issue in
protecting patients from infections caused by unsafe practices, such as
reusing syringes. The need to protect all cadres of health care workers is
clear and urgent, especially reducing their exposure to needle-stick
accidents during injections and in disposing of infected sharps waste.

Our policy launch was scheduled to take place 17-18 December 2014 but we
have made an important decision to postpone it to 23-24 February 2015.
WHO has devoted significant capacity to the Ebola outbreak, including the
deployment of many infection, prevention and control specialists to
perform training and give support to the front line responders in affected
countries. Dedicated partners and stakeholders have done the same. These
people and agencies need and deserve to be with us as we launch this
campaign and we ask for your understanding of this brief delay to
accommodate their full participation.

The policy launch by WHO’s Director General will now take place on 23
February 2015 , 10-12:00. SIGN meeting to continue 23 through 24 February.

An updated programme of work of the meeting will be shared with you soon

Please feel free to contact Drs Selma Khamassi or Ed Kelley if you have
questions.

Sincerely,

Dr Marie-Paule Kieny
ADG/HIS
__________________________________________________________________
________________________________*_________________________________

2. Abstract: Ebola virus disease cases among health care workers not
working in ebola treatment units – liberia, june-august, 2014
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25412067
MMWR Morb Mortal Wkly Rep. 2014 Nov 21;63(46):1077-81.

Ebola virus disease cases among health care workers not working in ebola
treatment units – liberia, june-august, 2014.

Matanock A, Arwady MA, Ayscue P, Forrester JD, Gaddis B, Hunter JC, Monroe
B, Pillai SK, Reed C, Schafer IJ, Massaquoi M, Dahn B, De Cock KM.

West Africa is experiencing the largest Ebola virus disease (Ebola)
epidemic in recorded history. Health care workers (HCWs) are at increased
risk for Ebola. In Liberia, as of August 14, 2014, a total of 810 cases of
Ebola had been reported, including 10 clusters of Ebola cases among HCWs
working in facilities that were not Ebola treatment units (non-ETUs).

The Liberian Ministry of Health and Social Welfare and CDC investigated
these clusters by reviewing surveillance data, interviewing county health
officials, HCWs, and contact tracers, and visiting health care facilities.
Ninety-seven cases of Ebola (12% of the estimated total) were identified
among HCWs; 62 HCW cases (64%) were part of 10 distinct clusters in non-
ETU health care facilities, primarily hospitals. Early recognition and
diagnosis of Ebola in patients who were the likely source of introduction
to the HCWs (i.e., source patients) was missed in four clusters.

Inconsistent recognition and triage of cases of Ebola, overcrowding,
limitations in layout of physical spaces, lack of training in the use of
and adequate supply of personal protective equipment (PPE), and limited
supervision to ensure consistent adherence to infection control practices
all were observed.

Improving infection control infrastructure in non-ETUs is essential for
protecting HCWs. Since August, the Liberian Ministry of Health and Social
Welfare with a consortium of partners have undertaken collaborative
efforts to strengthen infection control infrastructure in non-ETU health
facilities.

Free full text
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6346a9.htm
__________________________________________________________________
________________________________*_________________________________

3. Abstract: What has been achieved in HIV prevention, treatment and care
for people who inject drugs, 2010-2012? A review of the six highest
burden countries
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24113623

Int J Drug Policy. 2014 Jan;25(1):53-60.

What has been achieved in HIV prevention, treatment and care for people
who inject drugs, 2010-2012? A review of the six highest burden countries.

Degenhardt L1, Mathers BM2, Wirtz AL3, Wolfe D4, Kamarulzaman A5, Carrieri
MP6, Strathdee SA7, Malinowska-Sempruch K8, Kazatchkine M9, Beyrer C3.

1National Drug and Alcohol Research Centre, University of New South Wales,
Sydney, New South Wales, Australia; School of Population and Global
Health, University of Melbourne, Melbourne, Victoria, Australia.
Electronic address: L.Degenhardt@unsw.edu.au.
2Kirby Institute, University of New South Wales, Sydney, New South Wales,
Australia.
3Center for Public Health and Human Rights, Johns Hopkins Bloomberg School
of Public Health, Baltimore, MD, United States.
4International Harm Reduction Development Program, Open Society
Foundations, New York, NY, United States.
5Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine,
University of Malaya, Kuala Lumpur, Malaysia.
6INSERM, U912 (SESSTIM), Marseille, France; Université Aix Marseille, IRD,
UMR-S912, Marseille, France; ORS PACA, Observatoire Régional de la Santé
Provence Alpes Côte d’Azur, Marseille, France.
7University of California, San Diego, Division of Global Public Health,
Department of Medicine, United States.
8Global Drug Policy Program, Open Society Foundations, Warsaw, Poland.
9UN Secretary-General special Envoy on HIV/AIDS in Eastern Europe and
Central Asia, Geneva, Switzerland.

OBJECTIVE: In 2010 the international HIV/AIDS community called on
countries to take action to prevent HIV transmission among people who
inject drugs (PWID). To set a baseline we proposed an “accountability
matrix”, focusing upon six countries accounting for half of the global
population of PWID: China, Malaysia, Russia, Ukraine, Vietnam and the USA.
Two years on, we review progress.

DESIGN: We searched peer-reviewed literature, conducted online searches,
and contacted experts for ‘grey’ literature. We limited searches to
documents published since December 2009 and used decision rules endorsed
in earlier reviews.

RESULTS: Policy shifts are increasing coverage of key interventions for
PWID in China, Malaysia, Vietnam and Ukraine. Increases in PWID receiving
antiretroviral treatment (ART) and opioid substitution treatment (OST) in
both Vietnam and China, and a shift in Malaysia from a punitive law
enforcement approach to evidence-based treatment are promising
developments. The USA and Russia have had no advances on PWID access to
needle and syringe programmes (NSP), OST or ART. There have also been
policy setbacks in these countries, with Russia reaffirming its stance
against OST and closing down access to information on methadone, and the
USA reinstituting its Congressional ban on Federal funding for NSPs.

CONCLUSIONS: Prevention of HIV infection and access to HIV treatment for
PWID is possible. Whether countries with concentrated epidemics among PWID
will meet goals of achieving universal access and eliminating new HIV
infections remains unknown. As long as law enforcement responses counter
public health responses, health-seeking behaviour and health service
delivery will be limited.

Copyright © 2013 Elsevier B.V. All rights reserved.

KEYWORDS: Injecting drug use, HIV, Needle and syringe programme; Opioid
substitution therapy, Antiretroviral therapy, Prevention

Free full text: http://www.ijdp.org/article/S0955-3959(13)00128-X/fulltext
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Revitalizing the HIV response in Pakistan: a systematic
review and policy implications
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23810289

Int J Drug Policy. 2014 Jan;25(1):26-33.

Revitalizing the HIV response in Pakistan: a systematic review and policy
implications.

Singh S1, Ambrosio M2, Semini I3, Tawil O4, Saleem M4, Imran M5, Beyrer
C2.

1Center for Public Health and Human Rights, Johns Hopkins Bloomberg School
of Public Health, Baltimore, MD, USA. Electronic address:
sosingh@jhsph.edu.
2Center for Public Health and Human Rights, Johns Hopkins Bloomberg School
of Public Health, Baltimore, MD, USA.
3Global HIV Program, The World Bank, Washington, DC, USA.
4Country Office Pakistan, UNAIDS, Pakistan.
5National AIDS Control Programme, Ministry of Inter-Provincial
Coordination, Pakistan.

BACKGROUND: We sought to describe the epidemiology of HIV in Pakistan and
prioritize interventions to improve the effectiveness and efficiency of
the response to HIV.

METHODS: We conducted a systematic review of the epidemiology of HIV in
Pakistan. Data sources included PUBMED and EMBASE and unpublished reports
from public, non-governmental organizations and provincial and national
stakeholders. We focused on findings from the last 5 years and only
evaluated data before 2005 on at risk groups where there were insufficient
data published after 2005. A population attributable risk analysis was
conducted to estimate the burden of HIV among most at risk populations
(people who inject drugs, female sex workers, male sex workers, Hijra or
transgender sex workers and men who have sex with men).

RESULTS: Pakistan has a concentrated epidemic of HIV-1 among most at risk
populations with very low prevalence rates in the general population
(0.04%). The majority of current HIV infections are estimated to occur
among four at risk populations, despite their accounting for under 2% of
all adults. Injecting drug users accounted for 36.4% of HIV cases – the
largest share of infections in any one group. Female, male and transgender
sex workers accounted for 24%, 12% and 17.5% respectively, a cumulative
population attributable risk of 53.5% of all infections occurring among
sex workers.

CONCLUSION: Pakistan must continue to invest in targeted, evidence-based
interventions to prevent the spread of HIV and curb the epidemic
trajectory in Pakistan. A comprehensive range of services should include
needle and syringe exchange, opiate substitution therapy for people who
inject drugs, outreach and engagement with injecting drug users, Hijra’
community as well as male and female sex workers and their clients and
improved linkage between services and voluntary counseling, testing and
anti-retroviral therapy.

Copyright © 2013 Elsevier B.V. All rights reserved.

KEYWORDS: Concentrated epidemics; HIV; Pakistan; People who inject drugs
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Syringe access, syringe sharing, and police encounters among
people who inject drugs in New York City: a community-level perspective
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23916801

Int J Drug Policy. 2014 Jan;25(1):105-11.

Syringe access, syringe sharing, and police encounters among people who
inject drugs in New York City: a community-level perspective.

Beletsky L1, Heller D2, Jenness SM3, Neaigus A2, Gelpi-Acosta C4, Hagan
H5.

1Northeastern University School of Law and Bouvé College of Health
Sciences, 400 Huntington Avenue, Boston, MA 02115, USA; Division of Global
Public Health, UCSD School of Medicine, La Jolla, CA, USA. Electronic
address: leob@alumni.brown.edu.
2New York City Department of Health and Mental Hygiene, 125 Worth Street,
New York, NY 10013, USA.
3Department of Epidemiology, University of Washington, Box 357236,
Seattle, WA 98195, USA.
4National Development and Research Institutes, 71 West 23rd Street, New
York, NY 10010, USA.
5New York University College of Nursing, 726 Broadway, 10th Floor, New
York, NY 10003, USA.

BACKGROUND: Injection drug user (IDU) experience and perceptions of police
practices may alter syringe exchange program (SEP) use or influence risky
behaviour. Previously, no community-level data had been collected to
identify the prevalence or correlates of police encounters reported by
IDUs in the United States.

METHODS: New York City IDUs recruited through respondent-driven sampling
were asked about past-year police encounters and risk behaviours, as part
of the National HIV Behavioural Surveillance study. Data were analysed
using multiple logistic regression.

RESULTS: A majority (52%) of respondents (n=514) reported being stopped by
police officers; 10% reported syringe confiscation. In multivariate
modelling, IDUs reporting police stops were less likely to use SEPs
consistently (adjusted odds ratio [AOR]=0.59; 95% confidence interval
[CI]=0.40-0.89), and IDUs who had syringes confiscated may have been more
likely to share syringes (AOR=1.76; 95% CI=0.90-3.44), though the finding
did not reach statistical significance.

CONCLUSIONS: Findings suggest that police encounters may influence
consistent SEP use. The frequency of IDU-police encounters highlights the
importance of including contextual and structural measures in infectious
disease risk surveillance, and the need to develop approaches harmonizing
structural policing and public health.

Copyright © 2013 Elsevier B.V. All rights reserved.

KEYWORDS: Barriers; Injection drug use; Policing; Public health
surveillance; Structural factors; Syringe exchange programs
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Opioid substitution therapy protects against hepatitis C
virus acquisition in people who inject drugs: the HITS-c study
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25222455

Med J Aust. 2014 Sep 15;201(6):326-9.

Opioid substitution therapy protects against hepatitis C virus acquisition
in people who inject drugs: the HITS-c study.

White B1, Dore GJ2, Lloyd AR3, Rawlinson WD4, Maher L2.
Author information
1The Kirby Institute, University of New South Wales, Sydney, NSW,
Australia. lmaher@kirby.unsw.edu.au.
2The Kirby Institute, University of New South Wales, Sydney, NSW,
Australia.
3Inflammation and Infection Research Centre, University of New South
Wales, Sydney, NSW, Australia.
4Virology Division, SEALS Microbiology, Prince of Wales Hospital, Sydney,
NSW, Australia.

OBJECTIVE: To estimate hepatitis C virus (HCV) incidence and identify
associated risk and protective factors among people who inject drugs
(PWID) in Sydney, New South Wales.

DESIGN, SETTING AND PARTICIPANTS: Community-based prospective
observational study of serologically confirmed HCV antibody-negative PWID
enrolled in six Sydney neighbourhoods located in three distinct regions
between 10 November 2008 and 31 October 2011.

MAIN OUTCOME MEASURES: Serologically confirmed HCV incidence per person-
years (py); and self- reported demographic and behavioural risk factors
for HCV infection.

RESULTS: The overall incidence of HCV infection was 7.9/100 py. Risk
factors independently associated with incident HCV infection were younger
age (adjusted hazard ratio [AHR] for age < 27 years, 5.66; 95% CI,
1.69-18.95; P = 0.005) and daily or more frequent injecting (AHR, 4.06;
95% CI, 1.15-14.30; P = 0.03). Opioid substitution therapy (OST) was
protective against HCV seroconversion and was associated with a reduced
risk of incident infection among those who mainly injected heroin or other
opioids (AHR for those not receiving OST while mainly injecting heroin or
other opioids, 5.64; 95% CI, 1.30-24.42; P = 0.02).

CONCLUSION: The observed HCV incidence was substantially lower than the
incidence of 30.8/100 py observed a decade earlier in a similar NSW-based
cohort, suggesting a decline in HCV incidence among PWID. This is likely
due to increased coverage of OST, combined with a probable decrease in the
population of PWID.

Free full text: http://tinyurl.com/nq4kwkt
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Risk and vulnerability of key populations to HIV infection in
Iran; knowledge, attitude and practises of female sex workers, prison
inmates and people who inject drugs
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25419677

Sex Health. 2014 Nov 24.

Risk and vulnerability of key populations to HIV infection in Iran;
knowledge, attitude and practises of female sex workers, prison inmates
and people who inject drugs.

Khajehkazemi R, Haghdoost A, Navadeh S, Setayesh H, Sajadi L, Osooli M,
Mostafavi E.

Background In this study data of three national surveys conducted among
female sex workers (FSW), prison inmates and people who inject drugs
(PWID) were presented and compared in relation to knowledge, attitude, and
practises.

Methods: The surveys were conducted in 2009 and 2010 and included 2546
PWID, 872 FSW and 5530 prison inmates. Knowledge, attitude and practises
towards HIV were measured through similar questions for each category.

Results: Over 90% of all participants had ever heard of HIV/AIDS, although
only approximately half of them perceived themselves at risk of
contracting HIV. More than 80% were able to correctly identify the ways of
preventing the sexual transmission of HIV; while more than two-thirds did
not use condom in their last sexual contact.

Approximately 20% of prisoners and FSW had a history of injecting drugs.
Among all participants who have injected drugs, prisoners had the highest
unsafe injecting behaviour at the last injection (61%), followed by FSW
(11%) and PWID (3%).

Conclusions: Despite major efforts to control the HIV epidemic in Iran,
the level of risk and vulnerability among prisoners, FSW and PWID is still
high. The level of comprehensive knowledge about HIV/AIDS is relatively
good; however, their risk perception of contracting HIV is low and high-
risk behaviours are prevalent.

Therefore, HIV prevention programs should be redesigned in a more
comprehensive way to identify the best venues to reach the largest number
of people at a higher risk of contracting HIV and decrease their risk
overlaps and vulnerability factors.
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Hoigne syndrome following an intravenous injection of
ceftriaxone: a case report
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23541140

Rev Med Interne. 2014 Mar;35(3):199-201.

[Hoigne syndrome following an intravenous injection of ceftriaxone: a case
report].

[Article in French]

Landais A1, Marty N2, Bessis D3, Pages M2, Blard JM2.

1Service de neurologie A, CHU Gui-de-Chauliac, Montpellier, France.
Electronic address: landais-anne@voila.fr.
2Service de neurologie A, CHU Gui-de-Chauliac, Montpellier, France.
3Service de dermatologie, CHU Gui-de-Chauliac, Montpellier, France.

INTRODUCTION: Hoigne’s syndrome is characterized by the development of
acute clinical manifestations which are mainly psycho-sensorial.
Classically, these features immediately follow the injection of procaine
penicillin G.

CASE REPORT: We report a 59-year-old man who presented with psycho-organic
manifestations that occurred just after the intravenous injection of
ceftriaxone; to our knowledge, this is the first case of Hoigne’s syndrome
reported after an injection of this antibiotic.

CONCLUSION: The pathophysiologic basis of this syndrome is still unknown.
It is important to keep in mind its clinical characteristics, which may
mimic immuno-allergic symptoms. It should be differentiated from
anaphylactic manifestations because Hoigne’s syndrome allows the
continuation of the treatment.

Copyright © 2013 Société nationale française de médecine interne (SNFMI).
Published by Elsevier SAS. All rights reserved.

KEYWORDS: Allergie; Allergy; Ceftriaxone; Hoigne’s syndrome; Syndrome de
Hoigné
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Blindness caused by cosmetic filler injection: a review of
cause and therapy
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25415089

Plast Reconstr Surg. 2014 Dec;134(6):1197-201.

Blindness caused by cosmetic filler injection: a review of cause and
therapy.

Carruthers JD1, Fagien S, Rohrich RJ, Weinkle S, Carruthers A.

1Vancouver, British Columbia, Canada From the University of British
Columbia.

Vascular occlusion causing blindness is a rare yet greatly feared
complication of the use of facial aesthetic fillers.

The authors performed a review of the aesthetic literature to ascertain
the reported cases of blindness and the literature reporting variations in
the vascular anatomy of the human face.

The authors suggest a small but potentially helpful addition to the
accepted management of the acute case. Cases of blindness, mostly
irreversible, from aesthetic filler injections have been reported from
Asia, Europe, and North America.

Autologous fat appears to be the most frequent filler causing blindness.
Some cases of partial visual recovery have been reported with hyaluronic
acid and calcium hydroxylapatite fillers.

The sudden profusion of new medical and nonmedical aesthetic filler
injectors raises a new cause for alarm about patient safety. The published
reports in the medical literature are made by experienced aesthetic
surgeons and thus the actual incidence may be even higher. Also, newer
injectors may not be aware of the variations in the pattern of facial
vascular arborization.

The authors present a summary of the relevant literature to date and a
suggested helpful addition to the protocols for urgent management.
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Safety study of 38 503 intravitreal ranibizumab injections
performed mainly by physicians in training and nurses in a hospital
setting
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25403735

Acta Ophthalmol. 2014 Nov 17.

Safety study of 38 503 intravitreal ranibizumab injections performed
mainly by physicians in training and nurses in a hospital setting.

Hasler PW1, Brandi Bloch S, Villumsen J, Fuchs J, Lund-Andersen H, Larsen
M.

1Department of Ophthalmology, University Hospital Basel, Basel,
Switzerland.

PURPOSE: To evaluate and to compare the safety of intravitreal ranibizumab
injections performed by physicians and nurses at a single large hospital
clinic in Denmark during 5 years.

DESIGN: Retrospective, interventional, non-comparative study.

METHODS: Setting: All eyes that underwent a protocolized ranibizumab
injection procedure performed in an operating room mainly by nurses and
physicians in their first year of ophthalmology training. Study
population: A total of 4623 eyes in 3679 patients with subretinal
neovascularization secondary to a variety of retinal diseases, mainly
neovascular AMD treated with intravitreal therapy (IVT) at the Glostrup
Hospital from January 1, 2007 to December 31, 2011 with a mean follow-up
of 12.2 months (95% confidence interval: 11.9-12.6). Main outcome
measures: Frequency of endophthalmitis, traumatic cataract, intraocular
haemorrhage and retinal detachment from 2007 to 2012.

RESULTS: Overall, 38 503 intravitreal ranibizumab injections were
performed in 4623 eyes. Injections were performed by nurses (32.5%),
ophthalmology residents (61.3%) and vitreoretinal surgeons (6.2%). Severe
complications to treatment were observed in 17 eyes: Endophthalmitis (14
eyes, 0.36 ‰ of injections whereof seven cases were culture-positive),
anterior uveitis (one eye, 0.026 ‰), traumatic cataract (one eye, 0.026 ‰)
and rhegmatogenous retinal detachment (one eye, 0.026 ‰). Retinal pigment
epithelial tears were registered in 14 eyes in 14 subjects within the
first year of treatment with ranibizumab. Of the 14 cases of
endophthalmitis, seven occurred within a period of 5 weeks in 2010 when
occasionally abnormal needle outflow resistance prompted the needle
replacement in the operating room. No drug-related adverse events were
recorded.

CONCLUSIONS: Intravitreal ranibizumab injection performed by nurses and
physicians without preinjection topical antibiotics was associated with a
rate of injection-related adverse events of 0.44 ‰.

© 2014 Acta Ophthalmologica Scandinavica Foundation. Published by John
Wiley & Sons Ltd.
__________________________________________________________________
________________________________*_________________________________

11. Abstract: Hand Hygiene in Emergency Medical Services
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25415186

Prehosp Emerg Care. 2014 Nov 21.

Hand Hygiene in Emergency Medical Services.

Teter J, Millin MG, Bissell R.

Background. Hospital-acquired infections (HAIs) affect millions of
patients annually (World Health Organization. Guidelines on Hand Hygiene
in Healthcare. Geneva: WHO Press; 2009). Hand hygiene compliance of
clinical staff has been identified by numerous studies as a major
contributing factor to HAIs around the world. Infection control and hand
hygiene in the prehospital environment can also contribute to patient harm
and spread of infections. Emergency medical services (EMS) practitioners
are not monitored as closely as hospital personnel in terms of hand
hygiene training and compliance. Their ever-changing work environment is
less favorable to traditional hospital-based aseptic techniques and
education.

Methods. This study aimed to determine the current state of hand hygiene
practices among EMS providers and to provide recommendations for improving
practices in the emergency health services environment. This study was a
prospective, observational prevalence study and survey, conducted over a
2-month period. We selected participants from visits to three selected
hospital emergency departments in the mid-Atlantic region. There were two
data components to the study: a participant survey and hand swabs for
pathogenic cultures.

Results. This study recruited a total sample of 62 participants. Overall,
the study revealed that a significant number of EMS providers (77%) have a
heavy bacterial load on their hands after patient care. All levels of
providers had a similar distribution of bacterial load. Survey results
revealed that few providers perform hand hygiene before (34%) or in
between patients (24%), as recommended by the Centers for Disease Control
and Prevention guidelines.

Conclusion. This study demonstrates that EMS providers are potential
vectors of microorganisms if proper hand hygiene is not performed
properly. Since EMS providers treat a variety of patients and operate in a
variety of environments, providers may be exposed to potentially
pathogenic organisms, serving as vectors for the exposure of their
patients to these same organisms. Proper application of accepted standards
for hand hygiene can help reduce the presence of microbes on provider
hands and subsequent transmission to patients and the environment.

KEYWORDS: hand hygiene; hand washing; infection; infection control;
patient safety
__________________________________________________________________
________________________________*_________________________________

12. Abstract: The Effects of an Injected Placebo on Endurance Running
Performance
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25412293

Med Sci Sports Exerc. 2014 Nov 19.

The Effects of an Injected Placebo on Endurance Running Performance.

Ross R1, Gray CM, Gill JM.

11Institute of Cardiovascular and Medical Sciences, College of Medical,
Veterinary and Life Sciences, University of Glasgow, Glasgow, United
Kingdom; 2Institute of Health and Wellbeing, College of Social Sciences,
University of Glasgow, Glasgow, United Kingdom.

PURPOSE: To quantify the placebo effect magnitude on endurance running
performance, in ‘real-world’ field-based head-to-head competition
settings, of an injected placebo (‘OxyRBX’) purporting to have similar
effects to recombinant human erythropoietin (r-HuEPO).

METHODS: 15 endurance-trained club-level men (age: 27.5±6.8 years, BMI:
22.9±2.0 kg·m), with personal best 10 km times of 39.3±4.4 min (mean±SD),
completed the randomised cross-over study design of 3 km races before and
after 7-day ‘control’ and ‘placebo’ phases. During the placebo phase
participants self-administered subcutaneous saline injections daily,
believing it to be OxyRBX, with no intervention during the control phase.
At the start and end of each 7-day phase 3 km running performance was
assessed. Qualitative assessments of participants’ perceptions and
experiences were recorded throughout and in semi-structured interviews on
completion.

RESULTS: Race time improved significantly more in response to the placebo
intervention (9.73±1.96 s faster, P=0.0005), than in response to control
(1.82±1.94 s faster, P=0.41) (P interaction = 0.02). In response to the
placebo, participants reported reductions in physical effort, increased
potential motivation and improved recovery. Beliefs and congruence between
positive expectations of the effects of the placebo and perceptions of
physical change during training also appeared to impact on competitive
performance.

CONCLUSIONS: Compared to control, the injected placebo improved 3 km race
time by 1.2%. This change is of clear sporting relevance, but is smaller
than the performance improvement elicited by r-HuEPO administration. The
qualitative data suggest that placebo may have improved performance by
both reducing perception of effort and increasing potential motivation, in
accord with the psychobiological model for exercise performance, and that
cognitive and non-cognitive processes appear to have influenced placebo
response.
__________________________________________________________________
________________________________*_________________________________

13. Announcement: International Course Access to Medical Technologies –
Feb 02-06, 2015 Jaipur, India

Crossposted from E-DRUG with thanks.
http://list.healthnet.org/mailman/listinfo/e-drug
__________________________________________________________________
Date: Wed, 19 Nov 2014
From: “abhishek dadhich” <apanabhi@gmail.com>

E-DRUG: International Course Access to Medical Technologies – Feb 02-06,
2015 Jaipur, India

Announcement of the International Course on Access to Medical Technologies
and Innovations ‘Balancing between Public Health and Intellectual Property
Law’ – from February 02-06, 2015 at IIHMR, Jaipur, India

BACKGROUND

WHO estimates that 10 million people die from failure to access to
medicines and healthcare technologies. Reasons behind the cause of this
incidence is that people die from diseases like AIDS, TB, Malaria and
other tropical diseases due to non availability of medical technologies
due to financially expensive and scarcity of new research and development
in healthcare innovations. Access to treatments for non-communicable
disease, including expensive cancer treatments in middle-income countries
is also another future challenge among healthcare burden.

It’s a need of the hour to address these issues and well advance, tangible
policies should be framed so that availability and affordability of
essential medicines & healthcare technologies would be made regularly
without any interruption, especially in countries with low resource
settings. It also requires paying attention on regulation of medical
technologies addresses essential health policy objectives like products
must be safe, efficacious and of adequate quality. Yet, regulation also
shapes the landscape for access and innovation: a higher safety standard
requires the generation of more data and thus increases the cost of
innovation. Unjustified regulatory barriers and lengthy marketing
authorization processes delay access to needed medical technologies.

Equitable access to quality medicines and healthcare technologies is an
essential component of health system and to strengthen the proper
healthcare system; rationalizing between public health and IPR trade law,
fair competition policy, appropriate licensing of patents and capacity
building under access to medical technologies and innovations build on
Government willingness, involvement of healthcare stakeholders and
community participation can effectively facilitate availability of
essential medicines and healthcare innovations in their nations.

ABOUT THE INSTITUTE

The Institute of Health Management Research (IIHMR University), Jaipur (
www.iihmr.org) has been contributing towards this very topical issue of
international importance through its flagship yearly WHO sponsored
International Courses in Promoting Rational Drug Use in Communities
(PRDUC) for last 10 years. To addresses the issues related to availability
and affordability of essential medicines, a Management Development Program
on Access to Medical Technologies and Innovation is being organized at
IIHMR from Feb. 02-06, 2015.

In addition, to various international courses on Anti retrovirals and
Related Drug Supply Chain Management in Low Resource Settings one
International Course on Rational Use of Medicines – A Focus on HIV TB and
Malaria and one Management Development Program on Pharmaceutical
Management in Hospitals have already been organized by the institute.

To address, the issues related to Accessibility of Medical Technologies in
developing countries, an International Training Program on Access to
Medical Technologies and Innovations ‘Balancing between Public Health and
Intellectual Property Law’ is being organized at IIHMR from February
02-06, 2015.

*COURSE OBJECTIVES*

The specific objectives of the program are:

1. To enable participants understand the concepts and principles of
access to essential medicine and medical devices.
2. To understand the components of public health and medical
technologies.
3. To discuss the public health policy and Intellectual property, trade
policies dimensions.
4. To discuss the different aspects of medical technologies in term of
innovations and accessibility.

*COURSE CONTENTS*

1. The basics of medical technologies and their cooperating agencies
2. The global burden of disease and global health risks.
3. Balancing between law and policy for innovation and access to
medical
technologies.
4. Public health policy and Intellectual property, trade.
5. R&D landscape in Medical technologies and innovation dimensions.
6. Intellectual property rights in the innovation cycle.
7. Generic medicines policies and IP-related determinants for access to
medical technologies.

*WHO SHOULD PARTICIPATE?*

The program is meant for the policy makers, doctors, pharmacists and other
public health professionals/officials/management staff from
Ministries/Departments of Medicine & amp; Health, government hospitals,
development aid agencies, social scientists, NGOs interested in improving
accessibility of medical technologies and innovations.

*TRAINING APPROACH*

The program will use a mix of lecture by resource persons to introduce the
lead concept and encourage active interaction by the participants through
classroom discussions, group work and presentations. The course will be
conducted in English.

*DURATION AND VENUE*

The program is of 5-day duration. The program will start at 10.00 am on
Monday, 2 Feb 2015 and conclude at 5.00 pm on Friday, 06 Feb 2015. The
program will be held at the Institute of Health Management Research, IIHMR
University, Jaipur.

*PROGRAM FEE*

The program fee USD 600 per participant + 12.36% service tax covers
twin-shared air-conditioned accommodation at the Institute Guest House,
tuition, course materials, field visit, and airport pickup, with
breakfast,
lunch, dinner and tea/coffee during the program. For accommodation on
single occupancy basis USD 20 per day will be charged extra.

*APPLICATION*

Interested candidates may apply on CV Template which can be obtained from
the Course Coordinator by sending a request email at abhishek@iihmr.org

or by post to Indian Institute of Health Management Research,
IIHMR University, 1, Prabhu Dayal Marg, Sanganer Airport,
JAIPUR – 302 011 (India),

or by Fax at +91 141 3924738.

Completed CV Template must reach the Course Coordinator by January 15,
2015,
to facilitate timely finalization of sending invitations for participation
along with visa support letters.

*CERTIFICATION*

A certificate of participation on completion of the program will be issued
by Institute of Health Management Research, Jaipur.

*COURSE COORDINATOR*

Prof. Abhishek Dadhich
Institute of Health Management Research
1, Prabhu Dayal Marg, Sanganer Airport
Jaipur – 302 029, INDIA
Phone: 0141-3924700 (30 Lines); Fax: 0141-3924738 Mob: +91 9460458501
Email: abhishek@iihmr.org ,
apanabhi@gmail.com
__________________________________________________________________
________________________________*_________________________________

14. News

– Canada: Abbotsford acupuncture patients advised to get tests for
hepatitis and HIV
– Canada: Media Release: Fraser Health Public Safety Advisory for clients
of the Acupuncture and Chinese Medicine Centre in Abbotsford

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/l2hc783

Canada: Abbotsford acupuncture patients advised to get tests for hepatitis
and HIV

By Erin Elli, Vancouver Sun, Canada (21.11.14)

Patients of an Abbotsford acupuncture centre are being advised to get
tested because they may have been exposed to HIV and Hepatitis B and C.
Photograph by: Handout , bioLytical Laboratories Inc.
METRO VANCOUVER – Looking for the source of a hepatitis B infection led
officials from the Fraser Health Authority to an established acupuncturist
in Abbotsford who has now had her licence suspended.

Duan (Deborah) Hu cannot practise at the Acupuncture and Chinese Medicine
Centre on McCallum Road pending an investigation.

Medical health officer Dr. Michelle Murti said Friday while it’s unusual
for the health authority to be involved in action against an acupuncture
clinic, it’s responsible for tracking communicable diseases, including
blood-borne illnesses that can be spread by unsanitary practices in
acupuncture, tattooing or surgery.

“The used needles were being stored in an open bowl receptacle. While we
don’t have direct evidence, because of the way they were being stored
there was potential for them to be used from one person to the next,”
Murti says.

Acupuncture needles should not be used for more than one patient and
should be discarded in a closed, tamper-proof container, she said.

Although ultrafine acupuncture needles typically do not draw blood, there
is a chance that a small amount could end up on a needle if it punctures a
capillary near the surface of the skin.

The health authority is warning anyone who had acupuncture at the centre
to be tested for hepatitis B, C and HIV because all can be spread through
blood. Although there are no known examples of this happening in B.C.,
Murti says international health officials report its occurrence in other
countries.

Hu has been practising in Abbotsford since 2001 at this and a previous
location, according to Fraser Health. Letters are being sent to all her
known patients, but spotty record-keeping at the clinic makes it
impossible to reach all former patients so, the Health Authority decided
to issue a public alert.

The College of Traditional Chinese Medicine Practitioners and
Acupuncturists of B.C., which licensed Hu, immediately suspended her and
launched an investigation by a committee of the college.

“The committee determined that it was necessary to take immediate action
to protect the public because of the unsanitary and unsafe condition of
the practice and clinic operations,” according to a news release from the
organization.

No one from the college was available to speak to a reporter Friday.

While the duty of the CTCMA is to “establish, monitor and enforce
standards of practice,” Hu’s suspected transgressions where brought to
light by the health authority.
__________________________________________________________________
__________________________________________________________________
http://www.wireservice.ca/index.php?module=News&func=display&sid=13431

Canada: Media Release: Fraser Health Public Safety Advisory for clients of
the Acupuncture and Chinese Medicine Centre in Abbotsford

Wire Service Canada (press release) (21.11.14)

British Columbia

Fraser Health is issuing an advisory for individuals who received
acupuncture services at the Acupuncture and Chinese Medicine Centre,
located at #11 – 2168 McCallum Road in Abbotsford. Acupuncture services
offered at this facility by Duan (Deborah) Hu did not meet infection
prevention and control standards and posed a health hazard to patients of
the Centre.

WireService.ca Media Release (11/20/2014) Abbotsford, BC – Clients who
received acupuncture services at the Acupuncture and Chinese Medicine
Centre in Abbotsford, are being recommended to follow up with their health
care provider, and be tested for Hepatitis B, C and HIV. More information
on the health risks and the recommended testing is available on at
www.fraserhealth.ca/acupuncturist.

Fraser Health Public Health routinely follows-up cases of reportable
communicable diseases, and their potential sources, to prevent
transmission and reduce risks to the public. These sources can include
acupuncture clinics, and other forms of blood borne exposures.

During a recent investigation the Centre was identified and inspected by
Fraser Health Public Health. Results of the inspection identified a number
of inadequate infection control practices that could increase the risk of
transmission of blood borne infections.

“We were notified of a concern about inadequate infection control measures
at the Centre. Our Environmental Health Officers immediately investigated
the clinic,” says Fraser Health Medical Health Officer, Dr. Michelle
Murti. “Based on the investigation of the Centre, we are alerting clients
of Ms. Hu that they may be at increased risk of exposure to blood borne
infections that can be transmitted by improper and unsanitary acupuncture
techniques.”
__________________________________________________________________
________________________________*_________________________________

SIGN Meeting 2015

The Safe Injection Global Network SIGN meeting is 23-24 February 2015 at
WHO Headquarters in Geneva Switzerland

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.
__________________________________________________________________
________________________________*_________________________________
* SAFETY OF INJECTIONS brief yourself at: www.injectionsafety.org

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

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

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

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

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

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

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

The 2010 annual Safe Injection Global Network meeting to aid collaboration
and synergy among SIGN network participants worldwide was held from 9
to 11 November 2010 in Dubai, The United Arab Emirates.

The SIGN 2010 meeting report pdf, 1.36Mb is available on line at:
http://www.who.int/injection_safety/toolbox/sign2010_meeting.pdf

The report is navigable using bookmarks and is searchable. Viewing
requires the free Adobe Acrobat Reader at: http://get.adobe.com/reader/

Translation tools are available at: http://www.google.com/language_tools
or http://www.freetranslation.com
__________________________________________________________________
________________________________*_________________________________
All members of the SIGN Forum are invited to submit messages, comment on
any posting, or to use the forum to request technical information in
relation to injection safety.

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

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

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

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

The SIGNpost Website is http://SIGNpostOnline.info

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

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

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

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

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

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

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