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

SIGNpost 00799

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST

Post00799 Jet Injectors + Waste Toolkit + Ebola + Abstracts 29 April 2015

WHO Guideline on the use of Safety-Engineered Syringes for Intramuscular,
Intradermal and Subcutaneous Injections in Health Care [PDF 620 KB]
www.who.int/injection_safety/global-campaign/injection-safety_guidline.pdf

CONTENTS
1. Survey: Your Perspective on Disposable-Syringe Jet Injectors
2. ToolKit for healthcare waste activities from UNDP / The Global Fund
3. Extract: From clinician to suspect case: my experience after a needle
stick in an Ebola treatment unit in Sierra Leone
4. Abstract: Rare, serious, and comprehensively described suspected
adverse drug reactions reported by surveyed healthcare professionals in
Uganda
5. Abstract: The epidemiology of blood-contaminated needlestick injuries
among veterinarians in portugal
6. Abstract: Reducing occupational risk for blood and body fluid exposure
among home care aides: an intervention effectiveness study
7. Abstract: Cost-effectiveness analysis of health care waste treatment
facilities in iran hospitals; a provider perspective
8. Abstract: Overcoming healthcare workers vaccine refusal–competition
between egoism and altruism
9. Abstract: Analysis on morbidity and mortality of viral hepatitis in
China, 2004-2013
10. Abstract: Transmission of Hepatitis C Virus among Prisoners,
Australia, 2005-2012
11. Abstract: Incidence and prevalence of hepatitis c virus infection
among persons who inject drugs in New York City: 2006-2013
13. Abstract: Parenteral pentazocine and diabetes mellitus: a double
whammy for cutaneous complication
14. Abstract: Incidence of endophthalmitis following intravitreal
Bevacizumab injection at a tertiary care hospital in Eastern Province
of Saudi Arabia
15. Abstract: Are Intravitreal Injections With Ultrathin 33-G Needles Less
Painful Than The Commonly Used 30-G Needles?
16. Abstract: Factors associated with reported pain on injection and
reactogenicity to an OMV meningococcal B vaccine in children and
adolescents
17. Abstract: Ebola infection control in Sierra Leonean health clinics: A
large cross-agency cooperative project

The web edition of SIGNpost is online at:
http://signpostonline.info/archives/1831

More information follows at the end of this SIGNpost!

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

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

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

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

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

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

1. Survey: Your Perspective on Disposable-Syringe Jet Injectors

Posted by Jody Garcia for PATH.

Please complete the survey at https://www.surveymonkey.com/s/629RM3C
__________________________________________________________________
Garcia, Jody (Consultant) <jgarcia@path.org>
to: “sign.moderator@gmail.com” <sign.moderator@gmail.com>
date: Tue, Apr 28, 2015
subject: Your Perspective on Disposable-Syringe Jet Injectors

Dear colleagues,

PATH is evaluating a new generation of needle-free jet injectors, known as
disposable-syringe jet injectors (DSJIs), for vaccine delivery in low and
middle-income countries.

We are writing to request your participation in a 15-minute survey
https://www.surveymonkey.com/s/629RM3C as we believe your input and
perspective will be extremely valuable in planning for impactful next
steps.

Thank you in advance.

With appreciation,

Jody Garcia
__________________________________________________________________
________________________________*_________________________________

2. ToolKit for healthcare waste activities from UNDP / The Global Fund

Many thanks to Jan-Gerd Kuehling at ETLog Health for this post:

“To help to reduce risks from the generation and disposal of HCW,
especially the disposal of unwanted or unused pharmaceuticals, potentially
infectious waste and other hazardous waste, UNDP currently develops a
toolkit consisting out of three parts”…….
__________________________________________________________________
Jan-Gerd Kuehling <kuehling@etlog-health.de>
sign.moderator@gmail.com
Wed, Apr 22, 2015 at 8:16 PM
UNDP / The Global Fund – healthcare waste activities

Dear Allan

The United Nations Development Programme (UNDP) is a strategic partner of
The Global Fund to Fight AIDS, Tuberculosis and Malaria (GF) and often
acts as interim Principal Recipient (PR) of last resort for countries in
which the GF cannot identify a national PR for its grants.

This partnership between UNDP and GF has enabled the prevention and
treatment of HIV, tuberculosis and malaria benefiting millions of people
in dozens of countries. However, GF programmes also require the
procurement and use of large volumes of goods and services which have a
potential negative environmental and public health impact.

To help to reduce risks from the generation and disposal of HCW,
especially the disposal of unwanted or unused pharmaceuticals, potentially
infectious waste and other hazardous waste, UNDP currently develops a
toolkit consisting out of three parts.

Part A of the toolkit will help decision makers to understand why
environmental safeguarding should be a standard in the planning and
execution of any GF programme.

Part B is intended to provide support in decision making on which waste
stream concept and strategy shall be applied, taking into account the
country context.

Part C will provide support for the planning and implementation of
safeguard strategies for GF grant practitioners including the budgeting
for waste management as a standard component for each grant. The findings
of four country assessments of UNDP administered GF grants in Bosnia and
Herzegovina, Tajikistan, Uzbekistan and Zimbabwe were used as base for
this toolkit. The assessments included several site visits and interviews
with relevant stakeholders from sub-recipients, different governmental
authorities, environmental experts and from other UN organizations.

Part A and Part B of the toolkit, as well as the four country reports, are
now available on the internet:
http://www.eurasia.undp.org/content/rbec/en/home/library/hiv_aids/rapid-
assessment-healthcare-waste-global-fund/

It is hoped that this series of documents will contribute to reduce the
ecological footprint of healthcare sector.

Best regards

Jan
__________________________________________________________________
ETLog Health EnviroTech & Logistics GmbH

Jan-Gerd Kühling
Managing Partner
Kavalierstrasse 15
13187 Berlin
Germany

Tel.: ++ 49 (0)30 / 44 31 87 – 41
Fax: ++ 49 (0)30 / 44 31 87 – 49
E-Mail: kuehling@etlog-health.de
Skype-Username: etlog-jgk
Web: www.etlog-health.com
__________________________________________________________________
________________________________*_________________________________

3. Extract: From clinician to suspect case: my experience after a needle
stick in an Ebola treatment unit in Sierra Leone
__________________________________________________________________
Open Access Article http://www.ajtmh.org/content/92/2/225

Am J Trop Med Hyg. 2015 Feb;92(2):225-6.

From clinician to suspect case: my experience after a needle stick in an
Ebola treatment unit in Sierra Leone.

Rubinson L1.

1R. Adams Cowley Shock Trauma Center, University of Maryland School of
Medicine, Baltimore, Maryland lrubinson@umm.edu.

Open Access Article http://www.ajtmh.org/content/92/2/225
__________________________________________________________________

Extract Extract Extract Extract Extract Extract

From Clinician to Suspect Case: My Experience After a Needle Stick in an
Ebola Treatment Unit in Sierra Leone

Lewis Rubinson*
R. Adams Cowley Shock Trauma Center, University of Maryland School of
Medicine, Baltimore, Maryland

* Address correspondence to Lewis Rubinson, R. Adams Cowley Shock Trauma
Center, University of Maryland School of Medicine, 22 South Greene Street,
Baltimore, MD 21210. E-mail: lrubinson@umm.edu

While providing clinical care in the confirmed ward of the Ebola Treatment
Unit (ETU) at the Kenema Government Hospital (KGH) in Kenema, Sierra
Leone, I accidentally stuck an 18-gauge hollow-bore needle deep into my
left thumb. I could immediately feel some blood oozing under my gloves,
and I squeezed the area of penetration to try to promote additional
bleeding. I rinsed the outside of my gloves with the only available
option—0.5% bleach. In an ETU, one cannot simply remove one’s gloves and
clean one’s hands with soap and water as one would with a needle stick in
other clinical environments. After the momentary shock and embarrassment
subsided, I notified my clinical partner about what transpired and then
called by radio to have an urgent egress from the ETU.

When I arrived in the personal protective equipment (PPE) doffing area,
Dario Gramuglia, chief of logistics for the World Health Organization
(WHO) at Kenema, maintained full discipline, and we adhered to the
stringent protocol of proper PPE removal without deviation; in all
honesty, I was quite anxious to examine the needle stick and clean it
properly as soon as possible. When my inner glove was removed, I had blood
on my thumb and thenar eminence. I now was able to confirm that it was a
fairly deep penetration. I first cleaned the wound with water and had
trouble finding soap, because 0.05% bleach was frequently used for
handwashing. Ultimately, I had to make do with 2% chlorhexidine gluconate
swabs to clean the wound.

As I walked up the hill from the doffing station toward the WHO office, I
now had time to begin contemplating what my risks were of exposure to
Ebola virus disease (EVD) and other blood-borne pathogens. The needle had
been stuck in the side of a plastic intravenous (IV) bottle, a practice
some local nursing staff used to extract crystalloid fluid into syringes
to create flushes. Usually, clean needles were used for such practices,
but the IV for this particular patient had been started at a different
isolation unit before her arrival in Kenema; therefore, the needle’s
history was unknown, meaning it was uncertain whether the needle had been
used to draw blood from any patient. Still, as I considered the risk from
the needle itself then and over the following days, I always considered it
to be fairly low. The real risk in my mind, which was confirmed by other
consultants, was whether the needle carried infectious materials from the
outside of my glove into my thumb.

Before the needle stick, I had been assisting a confused person with EVD
to return to the confirmed ward, and then shortly afterward, I was
examining and providing parenteral crystalloid therapy to several severely
ill persons with EVD. My gloves did not have visible blood on the outside
before the needle stick, because if so, I would have disinfected with 0.5%
bleach whenever such a circumstance was noted. Had there been blood on my
glove, I would have been fairly concerned, but I also would have been
partially reassured; in a past investigation, blood on a healthcare
worker’s glove only yielded Ebola RNA, and infectious virus could not be
cultured.1 Still, those data were limited. This event would be considered
a high-risk exposure.2 The public health definition of high-risk exposure
does not necessarily equate with high probability of sequelae. As I
digested the event, I believed that my risk of becoming ill with EVD was
low but not zero. Nevertheless, it was much more likely I would never get
ill. Because I met the definition for a high-risk exposure, I was to be
medically evacuated from Sierra Leone back to the United States.

[Continues at the link: http://www.ajtmh.org/content/92/2/225 ]
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Rare, serious, and comprehensively described suspected
adverse drug reactions reported by surveyed healthcare professionals in
Uganda
__________________________________________________________________
Open Access
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0123974

PLoS One. 2015 Apr 23;10(4):e0123974.

Rare, serious, and comprehensively described suspected adverse drug
reactions reported by surveyed healthcare professionals in Uganda.

Kiguba R1, Karamagi C2, Waako P1, Ndagije HB3, Bird SM4.

1Department of Pharmacology and Therapeutics, Makerere University College
of Health Sciences, Kampala, Uganda.
2Clinical Epidemiology Unit, Makerere University College of Health
Sciences, Kampala, Uganda.
3National Pharmacovigilance Centre, National Drug Authority, Kampala,
Uganda.
4Medical Research Council Biostatistics Unit, Cambridge, United Kingdom.

BACKGROUND: Lack of adequate detail compromises analysis of reported
suspected adverse drug reactions (ADRs). We investigated how
comprehensively Ugandan healthcare professionals (HCPs) described their
most recent previous-month suspected ADR, and determined the
characteristics of HCPs who provided comprehensive ADR descriptions. We
also identified rare, serious, and unanticipated suspected ADR
descriptions with medication safety-alerting potential.

METHODS: During 2012/13, this survey was conducted in purposively selected
Ugandan health facilities (public/private) including the national referral
and six regional referral hospitals representative of all regions.
District hospitals, health centres II to IV, and private health facilities
in the catchment areas of the regional referral hospitals were
conveniently selected. Healthcare professionals involved in prescribing,
transcribing, dispensing, and administration of medications were
approached and invited to self-complete a questionnaire on ADR reporting.
Two-thirds of issued questionnaires (1,345/2,000) were returned.

RESULTS: Ninety per cent (241/268) of HCPs who suspected ADRs in the
previous month provided information on five higher-level descriptors as
follows: body site (206), drug class (203), route of administration (127),
patient age (133), and ADR severity (128). Comprehensiveness (explicit
provision of at least four higher-level descriptors) was achieved by at
least two-fifths (46%, 124/268) of HCPs. Received descriptions were more
likely to be comprehensive from HCPs in private health facilities, regions
other than central, and those not involved in teaching medical students.

Overall, 106 serious and 51 rare previous-month suspected ADRs were
described. The commonest serious and rare ADR was Stevens-Johnson syndrome
(SJS); mostly associated with oral nevirapine or cotrimoxazole, but
haemoptysis after diclofenac analgesia and paralysis after quinine
injection were also described.

CONCLUSION: Surveyed Ugandan HCPs who had suspected at least one ADR in
the previous month competently provided comprehensive ADR descriptions:
more, indeed, than are received per annum nationally. Properly analyzed,
and with local feed-back, voluntary ADR reports by HCPs could be an
essential alerting tool for identifying rare and serious suspected ADRs in
Uganda.

Free full text
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0123974
__________________________________________________________________
________________________________*_________________________________

5. Abstract: The epidemiology of blood-contaminated needlestick injuries
among veterinarians in portugal
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25906274

J Agromedicine. 2015;20(2):160-6.

The epidemiology of blood-contaminated needlestick injuries among
veterinarians in portugal.

Mesquita JR1, Sousa SI, Vala H, Nascimento MS.

1a Instituto Politécnico de Viseu , Escola Superior Agrária , Viseu ,
Portugal.

Needlestick injuries (NIs) are considered a substantial occupational
health and safety hazard in contemporary health care practice. Unlike
human medicine where much effort has been devoted to reduce the incidence
of these events, the same aggressive approach has not been used in
veterinary medicine.

This study investigated the occurrence of blood- contaminated NIs in
Portuguese veterinarians. Participants of a veterinary meeting were asked
to complete a questionnaire-based survey. Univariate and multivariate
logistic regression analyses were performed to produce predicted
probabilities for NI episodes in veterinarians.

From the total of 373 enrolled veterinarians, 293 (78.5%) reported having
had at least one NI during their professional life. Veterinarians working
with dogs were more likely to have experienced a NI (adjusted odds ratio
[aOR]: 145.74, P < .001).

The high level of NIs observed in these professionals shows that NIs are a
potential occupational health problem in Portuguese veterinarians, with
the possibility for transmission of haematogenous zoonosis.
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Reducing occupational risk for blood and body fluid exposure
among home care aides: an intervention effectiveness study
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24372476

Home Health Care Serv Q. 2013;32(4):234-48.

Reducing occupational risk for blood and body fluid exposure among home
care aides: an intervention effectiveness study.

Amuwo S1, Lipscomb J, McPhaul K, Sokas RK.

1a University of Illinois at Chicago School of Public Health , Chicago ,
Illinois , USA.

The purpose of this quasi-experimental pretest/posttest research study was
to examine the effectiveness of an intervention designed through a
participatory process to reduce blood and body fluid exposure among home
care aides.

Employer A, the intervention site, was a large agency with approximately
1,200 unionized home care aides. Employer B, the comparison group, was a
medium-sized agency with approximately 200 home care aides.

The intervention was developed in partnership with labor and management
and included a 1-day educational session utilizing peer educators and
active learning methods to increase awareness about the risks for
occupational exposure to blood and body fluids among home care aides and a
follow-up session introducing materials to facilitate communication with
clients about safe sharps disposal.

Self-administered preintervention and postintervention questionnaires
identifying knowledge about and self-reported practices to reduce
bloodborne pathogen exposure were completed in person during mandatory
training sessions 18 months apart.

Home care aides in the intervention group for whom the preintervention and
postintervention questionnaires could be directly matched reported an
increase in their clients’ use of proper sharps containers (31.9% pre to
52.2% post; p = .033).

At follow-up, the intervention group as a whole also reported increased
use of sharps containers among their clients when compared to controls (p
= .041).
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Cost-effectiveness analysis of health care waste treatment
facilities in iran hospitals; a provider perspective
__________________________________________________________________
Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4402413/

Iran J Public Health. 2015 Mar;44(3):352-60.

Cost-effectiveness analysis of health care waste treatment facilities in
iran hospitals; a provider perspective.

Rashidian A1, Alinia C1, Majdzadeh R2.

1Dept. of Health Management and Economics, School of Public Health, Tehran
University of Medical Sciences, Tehran, Iran.
2Knowledge Utilization Research Center (KURC), Center for Community-Based,
Tehran University of Medical Sciences, Tehran, Iran.

BACKGROUND: Our aim was to make right and informative decision about
choosing the most cost-effectiveness heterogeneous infectious waste
treatment methods and devices.

METHODS: In this descriptive study, decision tree analysis, with 10-yr
time horizon in bottom-up approach was used to estimate the costs and
effectiveness criteria of the employed devices at provider perspective in
Iranian hospitals. We used the one-way and scenario sensitivity analysis
to measure the effects of variables with uncertainty. The resources of
data were national Environmental and Occupational Health Center Survey
(EOHCS) in 2012, field observation and completing questionnaire by
relevant authorities in mentioned centers.

RESULTS: Devices called Saray 2, Autoclave based, and Newster 10,
Hydroclave based, with 92032.4 (±12005) and 6786322.9 (±826453) Dollars
had the lowest and highest costs respectively in studied time period and
given the 5-10% discount rate. Depending on effectiveness factor type,
Newster 10 with Ecodas products and Saray products respectively had the
highest and lowest effectiveness. In most considered scenarios, Caspian-
Alborz device was the most cost-effectiveness alternative, so for the
treatment of each adjusted unit of volume and weight of infectious waste
in a 10 year period and in different conditions, between 39.4 (±5.1) to
915 (±111.4) dollars must be spent.

CONCLUSION: The findings indicate the inefficiency and waste of resources,
so in order to efficient resource allocation and to encourage further cost
containment in infectious waste management we introduce policy
recommendation that be taken in three levels.

KEYWORDS: Cost-effectiveness analysis; Economic evaluation; Infectious
waste; Sensitivity analysis; Treatment devices

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4402413/
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Overcoming healthcare workers vaccine refusal–competition
between egoism and altruism
__________________________________________________________________
http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20979

Euro Surveill. 2014 Dec 4;19(48):20979.

Overcoming healthcare workers vaccine refusal–competition between egoism
and altruism.

Betsch C1.

Author information

1University of Erfurt, Erfurt, Germany.

Vaccination reduces the risk of becoming infected with and transmitting
pathogens. The role of healthcare workers (HCWs) in controlling and
limiting nosocomial infections has been stressed repeatedly. This has also
been recognised at a political level, leading the European Council of
Ministers in 2009 to encourage coverage of 75% seasonal influenza vaccine
in HCWs.

Although there are policies, recommendations and well-tolerated vaccines,
still many HCWs refuse to get vaccinated. This article uses literature
from psychology and behavioural economics to understand vaccination
decisions and the specific situation of HCWs. HCWs are expected to be
highly motivated to protect others. However, their individual vaccination
decisions follow the same principles (of weighting individual risks) as
everyone else’s vaccination decisions. This will lead to decisional
conflict in a typical social dilemma situation, in which individual
interests are at odds with collective interests. Failure to get vaccinated
may be the result.

If we understand the motivations and mechanisms of HCWs’ vaccine refusal,
interventions and campaigns may be designed more effectively. Strategies
to increase HCWs’ vaccine uptake should be directed towards correcting
skewed risk perceptions and activating pro-social motivation in HCWs.

Comment in

Author’s reply: vaccinating healthcare workers: ethics and strategic
behaviour. [Euro Surveill. 2015]

Letter to the editor: vaccinating healthcare workers: evidence and ethics.
[Euro Surveill. 2015]

Free full text
http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20979
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Analysis on morbidity and mortality of viral hepatitis in
China, 2004-2013
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25907724

Zhonghua Liu Xing Bing Xue Za Zhi. 2015 Feb;36(2):144-7.

[Analysis on morbidity and mortality of viral hepatitis in China,
2004-2013].

[Article in Chinese]

Zhang M1, Yuan Y2, Mao P3, Zhuang Y4.

1Medical School of Chinese People’s Liberation Army, Beijing 100853,
China; Center of Therapeutic Research for Hepatocellular Carcinoma.
2Department of Nosocomial Infection Control.
3Medical School of Chinese People’s Liberation Army, Beijing 100853,
China; Experimental Technology Support and Research Center, 302 Hospital
of Chinese People’s Liberation Army. Email: maopy302@163.com.
4Department of Nosocomial Infection Control. Email:
yingjiezhuang@sina.com.

OBJECTIVE: To understand the incidence and death patterns of viral
hepatitis in China and provide evidence for the prevention and control of
viral hepatitis. METHODS:

The analysis was conducted on the incidence and death data of viral
hepatitis published by National Health and Family Planning Commission
during 2004-2013.

RESULTS: The incidences of viral hepatitis in Guizhou,Yunnan, Tibet,
Gansu, Qinghai,Ningxia and Xinjiang provinces (autonomous region) were
high. The major forms were hepatitis B (80.63/100 000) and hepatitis C
(9.68/100 000), accounting for 80.90% and 9.25% of the total reported
viral hepatitis cases respectively. The incidences of hepatitis A and
unidentified hepatitis decreased and the incidence of hepatitis B, C and E
increased during this period. During the 10 years, 10 008 deaths caused by
viral hepatitis were reported (1 001 deaths per year). The reported deaths
caused by hepatitis A, hepatitis E and unidentified hepatitis decreased
during this period.

The reported deaths caused by hepatitis B were in a downward trend, but
the constituent in total cases remained high. The reported deaths caused
by hepatitis C were in an upward trend.

CONCLUSION: During 2004-2013, the overall incidence of viral hepatitis
showed no downward trend in China. The incidence of hepatitis B remained
high, and the incidence of hepatitis C showed an obvious upward trend. The
overall death rate and case fatality rate of viral hepatitis showed a
downward trend, but hepatitis B remained the main cause of viral hepatitis
related death, and the death caused by hepatitis C was in increase.
Hepatitis B and hepatitis C are the major targets in the prevention and
treatment of viral hepatitis in China, and the 7 western provinces
(autonomous region) with high incidences are the key regions of the
prevention and control.
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Transmission of Hepatitis C Virus among Prisoners,
Australia, 2005-2012
__________________________________________________________________
http://wwwnc.cdc.gov/eid/article/21/5/14-1832_article

Emerg Infect Dis. 2015 May;21(5):765-74.

Transmission of Hepatitis C Virus among Prisoners, Australia, 2005-2012.

Bretaña NA, Boelen L, Bull R, Teutsch S, White PA, Lloyd AR, Luciani F;
HITS-p investigators.

Hepatitis C virus (HCV) is predominantly transmitted between persons who
inject drugs. For this population, global prevalence of HCV infection is
high and incarceration is common and an independent risk factor for HCV
acquisition.

To explore HCV transmission dynamics in incarcerated populations, we
integrated virus sequences with risk behavior and spatiotemporal data and
analyzed transmission clusters among prisoners in Australia.

We detected 3 clusters of recent HCV transmission consisting of 4 likely
in-custody transmission events involving source/recipient pairs located in
the same prison at the same time. Of these 4 events, 3 were associated
with drug injecting and equipment sharing.

Despite a large population of prisoners with chronic HCV, recent
transmission events were identified in the prison setting. This ongoing
HCV transmission among high-risk prisoners argues for expansion of
prevention programs to reduce HCV transmission in prisons.

KEYWORDS: Australia; clustering; hepatitis C virus; injection drug use;
phylogenetics; prisons; transmission; viruses

Free full text http://wwwnc.cdc.gov/eid/article/21/5/14-1832_article
__________________________________________________________________
________________________________*_________________________________

11. Abstract: Incidence and prevalence of hepatitis c virus infection
among persons who inject drugs in New York City: 2006-2013
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25891230

Drug Alcohol Depend. 2015 Apr 13. pii: S0376-8716(15)00195-7.

Incidence and prevalence of hepatitis c virus infection among persons who
inject drugs in New York City: 2006-2013.

Jordan AE1, Des Jarlais DC2, Arasteh K2, McKnight C2, Nash D3, Perlman
DC4.

1The Graduate Center at the City University of New York, 365 Fifth Avenue,
New York, NY 10016, USA; Center for Drug Use and HIV Research, New York,
NY, USA. Electronic address: ae.jordan@nyu.edu.
2Center for Drug Use and HIV Research, New York, NY, USA; Mount Sinai Beth
Israel, Baron Edmond de Rothschild Chemical Dependency Institute, 120
Water St, Floor 24, New York, NY 10038, USA.
3City University of New York, Hunter College, 2180 Third Avenue, New York,
NY 10035, USA.
4Center for Drug Use and HIV Research, New York, NY, USA; Mount Sinai Beth
Israel, 120 East 16th Street, New York, NY 10003, USA.

BACKGROUND: Hepatitis C virus infection is a source of significant
preventable morbidity and mortality among persons who inject drugs (PWID).
We sought to assess trends in hepatitis C virus (HCV) infection among PWID
from 2006 to 2013 in New York City (NYC).

METHODS: Annual cross-sectional surveys of PWID entering a large drug
abuse treatment program were performed. Risk behavior questionnaires were
administered, and HIV and HCV testing were conducted. Comparisons were
made with prior prevalence and incidence estimates in 1990-1991 and
2000-2001 reflecting different periods of combined prevention and
treatment efforts.

RESULTS: HCV prevalence among PWID (N: 1535) was 67% (95% CI: 66-70%)
during the study period, and was not significantly different from that
observed in 2000-2001. The estimated HCV incidence among new injectors
(persons injecting for =6 years) during 2006-2013 was 19.5/100 PYO (95%
CI: 17-23) and did not differ from that observed in 2000-2001 (18/100 PYO,
95% CI: 14-23/100).

CONCLUSIONS: Despite the expansion of combined prevention programming
between 2000-2001 and 2006-2013, HCV prevalence remained high. Estimated
HCV incidence among new injectors also remained high, and not
significantly lower than in 2000-2001, indicating that expanded combined
prevention efforts are needed to control the HCV epidemic among PWID in
NYC.

Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

KEYWORDS: Hepatitis C virus infection; Medication assisted treatment;
Methadone maintenance treatment; Needle/syringe exchange program; People
who inject drugs
__________________________________________________________________
________________________________*_________________________________

12. Abstract: Human factors engineering and design validation for the
redesigned follitropin alfa pen injection device
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25895897

Expert Opin Drug Deliv. 2015 May;12(5):715-25.

Human factors engineering and design validation for the redesigned
follitropin alfa pen injection device.

Mahony MC1, Patterson P, Hayward B, North R, Green D.

1EMD Serono, Inc. , One Technology Place, Rockland, MA 02370 , USA +1 781
681 2438 ; +1 781 681 2900 ; mary.mahony@emdserono.com.

OBJECTIVES: To demonstrate, using human factors engineering (HFE), that a
redesigned, pre-filled, ready-to-use, pre-asembled follitropin alfa pen
can be used to administer prescribed follitropin alfa doses safely and
accurately.

METHODS: A failure modes and effects analysis identified hazards and harms
potentially caused by use errors; risk-control measures were implemented
to ensure acceptable device use risk management. Participants were women
with infertility, their significant others, and fertility nurse (FN)
professionals. Preliminary testing included ‘Instructions for Use’ (IFU)
and pre-validation studies. Validation studies used simulated injections
in a representative use environment; participants received prior training
on pen use.

RESULTS: User performance in preliminary testing led to IFU revisions and
a change to outer needle cap design to mitigate needle stick potential. In
the first validation study (49 users, 343 simulated injections), in the FN
group, one observed critical use error resulted in a device design
modification and another in an IFU change. A second validation study
tested the mitigation strategies; previously reported use errors were not
repeated.

CONCLUSIONS: Through an iterative process involving a series of studies,
modifications were made to the pen design and IFU. Simulated-use testing
demonstrated that the redesigned pen can be used to administer follitropin
alfa effectively and safely.

KEYWORDS: failure modes and effects analysis; follitropin alfa pen; human
factors engineering; usability; validation testing
__________________________________________________________________
________________________________*_________________________________

13. Abstract: Parenteral pentazocine and diabetes mellitus: a double
whammy for cutaneous complication
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25906524

J Assoc Physicians India. 2014 Oct;62(10):52-4.

Parenteral pentazocine and diabetes mellitus: a double whammy for
cutaneous complication.

Phaujdar S, Sarkar RN, Bhattacharyya K.

Pentazocine, a non-narcotic analgesic, though has no addictive potential
but abused frequently via parenteral route for its psychological
dependence.

It causes local sclerosis resulting in non-healing ulcer at injection
sites. Diabetes mellitus suppress host immunity, making them vulnerable to
various bacterial skin and soft tissue infection among which mkethicillin
resistant staphylococcus aureus (MRSA) infection are predominant.

We report a case, a 50-year-old shopkeeper who used to inject pentazocine
primarily as analgesic, later became addicted to it. Blindly injecting the
drug in any approachable soft tissue resulted in woody induration of local
skin with multiple ulcers in his both arms. He later developed type 2
Diabetes mellitus which made the scenario even worser.
__________________________________________________________________
________________________________*_________________________________

14. Abstract: Incidence of endophthalmitis following intravitreal
Bevacizumab injection at a tertiary care hospital in Eastern Province
of Saudi Arabia
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25892933

Saudi J Ophthalmol. 2015 Apr-Jun;29(2):135-6.

Incidence of endophthalmitis following intravitreal Bevacizumab injection
at a tertiary care hospital in Eastern Province of Saudi Arabia.

Cheema RA1, Alshihry AM2, Cheema HR3.

1Vitreo-Retinal Service, Dhahran Eye Specialist Hospital, Dhahran, Saudi
Arabia.
2Epidemiology and Infection Control Department, Dhahran Eye Specialist
Hospital, Dhahran, Saudi Arabia.
3Royal College of Surgeons in Ireland, Dublin, Ireland.

The aim of this communication is to report the incidence of
endophthalmitis following the use of intravitreal Bevacizumab (IVB) at a
tertiary care hospital in the Eastern province of Saudi Arabia.

A total of 2769 intravitreal Bevacizumab injections were carried out
between January 2009 and April 2014. During this period, one case of
endophthalmitis following IVB injection occurred. The overall incidence of
clinical endophthalmitis was 0.036% (1/2769; 95% confidence interval:
0.0001-0.002%).

This compares favorably with studies reported from other parts of the
world.

KEYWORDS: Avastin; Endophthalmitis; Intravitreal Bevacizumab; Saudi Arabia

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4398804/
__________________________________________________________________
________________________________*_________________________________

15. Abstract: Are Intravitreal Injections With Ultrathin 33-G Needles Less
Painful Than The Commonly Used 30-G Needles?
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25901838

Retina. 2015 Apr 20.

Are Intravitreal Injections With Ultrathin 33-G Needles Less Painful Than
The Commonly Used 30-G Needles?

van Asten F1, van Middendorp H, Verkerk S, Breukink MB, Lomme RM, Hoyng
CB, Evers AW, Klevering BJ.

1*Department of Ophthalmology, Radboud University Medical Center,
Nijmegen, the Netherlands; †Health, Medical and Neuropsychology Unit,
Institute of Psychology, Leiden University, Leiden, the Netherlands; and
Departments of ‡Medical Psychology, and §Surgery, Radboud University
Medical Center, Nijmegen, the Netherlands.

PURPOSE: This study investigated whether pain from intravitreal injections
(IVIs) can be reduced by injecting with a 33-G needle instead of the
commonly used 30-G needle. Additionally, several pain-related
psychological factors were explored as predictors of outcome.

METHODS: This randomized crossover trial included 36 patients who received
injections with both needles in randomized order. After the injection,
patients rated IVI pain on a 0 to 10 scale. Before injection, distress and
pain expectations were assessed. Afterward, patients rated the IVI
procedure and anticipated consequences. In addition, we assessed the force
necessary to penetrate the sclera for both needles in porcine eyes.

RESULTS: The 33-G needle did not result in lower IVI pain (2.8 vs. 3.1, P
= 0.758) but tended to cause less vitreal reflux (0 vs. 5 times, P =
0.054). Factors related to more pain were distress, expecting IVI pain and
discomfort, dissatisfaction with the preparation procedure, anticipating
negative consequences, and female gender. Patients regarded povidone-
iodine disinfection as particularly unpleasant. Exploration of the
needles’ mechanical properties showed that 33-G needles penetrate the
sclera more easily.

CONCLUSION: The thinner 33-G needle does not reduce IVI pain but may limit
scleral damage. Future efforts could be aimed at optimizing patient
information, reducing distress, and the use of better tolerable
disinfectants.
__________________________________________________________________
________________________________*_________________________________

16. Abstract: Factors associated with reported pain on injection and
reactogenicity to an OMV meningococcal B vaccine in children and
adolescents
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25905795

Hum Vaccin Immunother. 2015 Apr 23:0.

Factors associated with reported pain on injection and reactogenicity to
an OMV meningococcal B vaccine in children and adolescents.

Petousis-Harris H1, Jackson C, Stewart J, Coster G, Turner N, Lennon D.

1a General Practice & Primary Health Care ; University of Auckland ;
Auckland , New Zealand.

Pain on vaccine injection and subsequent site reactions of pain and
swelling may influence confidence in vaccines and their uptake.

This study aimed to identify factors associated with reported pain on
injection and reactogenicity following administration of a strain specific
meningococcal B outer membrane vesicle vaccine.

A retrospective analysis of data was conducted from a phase II single
center randomized observer-blind study that evaluated the safety,
reactogenicity and immunogenicity of this vaccine in two cohorts of
healthy eight to 12 year old children.

Vaccine administration technique was observed by an unblinded team member
and the vaccine administrator instructed on standardized administration.
Participants kept a daily diary to record local reactions (erythema,
induration and swelling) and pain for seven days following receipt of the
vaccine.

Explanatory variables were cohort, vaccine, age, gender, ethnicity, body
mass index, atopic history, history of frequent infections, history of
drug reactions, pain on injection, vaccinator, school population
socioeconomic status, serum bactericidal antibody titer against the
vaccine strain NZ98/254, and total IgG. Univariate and multivariable
analyses were conducted using ordinal logistic regression for factors
relating to pain on injection and reactogenicity.

Perceived pain on injection was related to vaccine formulation, vaccine
administrator and ethnicity. Reactogenicity outcomes varied with ethnicity
and vaccine administrator.

Maintaining community and parental confidence in vaccine safety without
drawing attention to differences between individuals and groups is likely
to become increasingly difficult. Vaccine administration technique alone
has the potential to significantly reduce pain experienced on injection
and local vaccine reactions.

KEYWORDS: Ethnic groups; Immunization; Injections; Reactogenicity;
Vaccines; intramuscular
__________________________________________________________________
________________________________*_________________________________

17. Abstract: Ebola infection control in Sierra Leonean health clinics: A
large cross-agency cooperative project
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25891979

Am J Infect Control. 2015 Apr 17. pii: S0196-6553(15)00181-9.

Ebola infection control in Sierra Leonean health clinics: A large cross-
agency cooperative project.

Levy B1, Rao CY2, Miller L3, Kennedy N4, Adams M5, Davis R6, Hastings L6,
Kabano A4, Bennett SD7, Sesay M8.

1Epidemic Intelligence Service, Centers for Disease Control and
Prevention, Atlanta, GA. Electronic address: xew6@cdc.gov.
2Division of Global Health Protection, Centers for Disease Control and
Prevention, Beijing, People’s Republic of China.
3International Rescue Committee, New York, NY.
4UNICEF, Freetown, Sierra Leone.
5Epidemic Intelligence Service, Centers for Disease Control and
Prevention, Atlanta, GA.
6Concern Worldwide, Dublin, Ireland.
7Division of Foodborne, Waterborne, and Environmental Diseases, Centers
for Disease Control and Prevention, Atlanta, GA.
8Ministry of Health and Sanitation, Freetown, Sierra Leone.

The Ebola virus disease outbreak occurring in West Africa has resulted in
at least 199 cases of Ebola in Sierra Leonean health care workers, many as
a result of transmission occurring in health facilities. The Ministry of
Health and Sanitation of Sierra Leone recognized that improvements in
infection prevention and control (IPC) were necessary at all levels of
health care delivery. To this end, the U.S. Centers for Disease Control
and Prevention, United Nations Children’s Fund, and multiple
nongovernmental organizations implemented a national IPC training program
in 1,200 peripheral health units (PHUs) in Sierra Leone. A tiered training
of trainers program was used.

Trainers conducted multiday trainings at PHUs and coordinated the delivery
of personal protective equipment (gloves, gowns, masks, boots) and
infection control supplies (chlorine, buckets, disposable rags, etc) to
all PHU staff. Under the ongoing project, 4,264 health workers have
already been trained, and 98% of PHUs have received their first shipment
of supplies.

Copyright © 2015 Association for Professionals in Infection Control and
Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

KEYWORDS: Health care workers; Health clinic; Health education; Infection
control; Occupational health; Primary health care
__________________________________________________________________
________________________________*_________________________________
New WHO Injection Safety Guidelines

WHO is urging countries to transition, by 2020, to the exclusive use of
the new “smart” syringes, except in a few circumstances in which a syringe
that blocks after a single use would interfere with the procedure.

The new guideline is:

WHO Guideline on the use of Safety-Engineered Syringes for Intramuscular,
Intradermal and Subcutaneous Injections in Health Care

It is available for free download or viewing at this link:
www.who.int/injection_safety/global-campaign/injection-safety_guidline.pdf

PDF Requires Adobe Acrobat Reader [620 KB]
__________________________________________________________________
________________________________*_________________________________
Making all injections safe brochure

This is an illustrated summary brochure for the general public.

pdf, 554kb [6 pages]

www.who.int/injection_safety/global-campaign/injection-safety_brochure.pdf
__________________________________________________________________
________________________________*_________________________________

SIGN Meeting 2015

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

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

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

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

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

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

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

The SIGNpost Website is http://SIGNpostOnline.info

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

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

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

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

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

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

Comments are closed.