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

SIGNpost 00803

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST

Post00803 Note + IS:K2P + Abstracts + News 27 May 2015

CONTENTS
0. Moderators Note
1. Abstract: Knowledge, perception and practice of injection safety and
healthcare waste management among teaching hospital staff in south east
Nigeria: an intervention study
2. Abstract: Overview of sharps injuries among health-care workers
3. Abstract: Sharps injuries in the operating room
4. Abstract: MRI imaging and clinical features of sciatic nerve injection
injury
5. Abstract: Rate of infection and related risk factors on hepatitis C
virus in three counties of Jiangsu province
6. Abstract: An assessment of an HIV prevention intervention among people
who inject drugs in the states of Manipur and Nagaland, India
7. Abstract: Within-prison drug injection among HIV-infected Ukrainian
prisoners: prevalence and correlates of an extremely high-risk
behaviour
8. Abstract: Hepatitis C in European prisons: a call for an evidence-
informed response
10. Abstract: Syringe disposal among people who inject drugs in Los
Angeles: the role of sterile syringe source
11. Abstract: Prevalence and behavioural risks for HIV and HCV infections
in a population of drug users of Dakar, Senegal: the ANRS 12243 UDSEN
study
12. Abstract: Injection and sexual risk practices among young heroin users
in Hanoi, Vietnam
13. Abstract: The ‘My five moments for hand hygiene’ concept for the
overcrowded setting in resource-limited healthcare systems
14. Abstract: Comparison of adrenaline auto-injector devices: ease of use
and ability to recall use
15. Abstract: Analysis of Anaphylactic Shock Caused by 17 Types of
Traditional Chinese Medicine Injections Used to Treat Cardiovascular
and Cerebrovascular Diseases
16. Abstract: Microneedle patch delivery to the skin of virus-like
particles containing heterologous M2e extracellular domains of
influenza virus induces broad heterosubtypic cross-protection
17. News
– Philippines: Cabaero: ‘Ayaw’g puli-puli’
– India: ‘Auto Disposable Syringes Must be Widely Used’
– USA: Unsafe Injections Put Patients in Peril: Insist on best practices
before you’re stuck.

The web edition of SIGNpost is online at:
http://signpostonline.info/archives/1842

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!
__________________________________________________________________
________________________________*_________________________________

0. Moderators Note
__________________________________________________________________
The Moderator is traveling for 5 weeks.

SIGNpost will continue to be posted weekly, as travel and internet allows.

Please expect the next editon of SIGNpost in your inbox late in the week.

Normal SIGNposts will resume from 8 July 2015.

Thanks for your patience.

allan
__________________________________________________________________
________________________________*_________________________________

1. Abstract: Knowledge, perception and practice of injection safety and
healthcare waste management among teaching hospital staff in south east
Nigeria: an intervention study
__________________________________________________________________
Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4163175/
http://www.panafrican-med-journal.com/content/article/17/218/full/

Pan Afr Med J. 2014 Mar 19;17:218.

Knowledge, perception and practice of injection safety and healthcare
waste management among teaching hospital staff in south east Nigeria: an
intervention study.

Enwere OO1, Diwe KC2.

1Department of Internal Medicine, Faculty of Medicine, Imo State
University, Owerri, Nigeria.
2Department of Community Medicine, Faculty of Medicine, Imo State
University, Owerri, Nigeria.

INTRODUCTION: Health care workers are exposed to the risk of blood-borne
diseases such as HIV, Hepatitis B and C in their daily encounter with
infected patients and materials through unsafe injections. This study
determined the baseline and post-intervention knowledge and practice of
modern injection safety standards among health care workers.

METHODS: The study population was the healthcare workers in a teaching
hospital in southeastern Nigeria. Data was collected using a self-
administered 37-item structured questionnaire assessing their knowledge
and practice on injection safety. Collected data was analyzed using SPSS.

RESULTS: Nurses comprised 62.8% (98/156) of the population. While most had
heard of injection safety only 67.2% (84/125) had previously had any form
of training on it. Only 54% (81/150) had heard or seen color coded bins.
The standard needle and syringe is still widely used and 45% (65/145)
still recap needles on syringes after use irrespective of type of
personnel. Half (50.6% =78/154) of our respondents had had a previous
needle prick injury. Only 25.6% (20/78) with previous needle prick injury
had post-exposure prophylaxis. All doctors and laboratory scientists
always use gloves compared to 94.8% (91/96) nurses while handling patients
or materials. Following the intervention, a significantly high number
became aware of post-exposure prophylaxis and color coded bins and liners.

CONCLUSION: There is a need for healthcare workers to be regularly updated
on changing safety standards in their practice. Also hospitals must be
encouraged to acquire and use internationally accepted standard materials
in collection and disposal patient’s samples.

KEYWORDS: Needle prick; South Eastern Nigeria; colour coding; health
workers; post-exposure prophylaxis; teaching hospital

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4163175/
http://www.panafrican-med-journal.com/content/article/17/218/full/
__________________________________________________________________
________________________________*_________________________________

2. Abstract: Overview of sharps injuries among health-care workers
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25984621

Rev Med Inst Mex Seguro Soc. 2015 May-Jun;53(3):356-61.

[Overview of sharps injuries among health-care workers].

[Article in Spanish]

Gopar-Nieto R1, Juárez-Pérez CA, Cabello-López A, Haro-García LC, Aguilar-
Madrid G.

1Unidad de Investigación de Salud en el Trabajo, Centro Médico Nacional
Siglo XXI, Instituto Mexicano del Seguro Social, Distrito Federal, México.
gpeaguilarm@gmail.com.

Abstract in English, Spanish

Sharps injuries are one of the most frequent health-care related
accidents. It is estimated globally that 35 million workers are at risk;
in Mexico there is no data available for this type of injuries. They are
associated with lack of training, instrument and procedure risk, fatigue
and stress.

The occupational distribution is nurses 45 %, technicians 20 %, doctors 20
% and maintenance workers 5 %.

The most commonly associated procedures are injection, venipuncture,
suture, and insertion and manipulation of IV catheters.

Hepatitis B is the most commonly transmitted agent. Emotional distress is
huge as well as the cost of prophylaxis and follow-up.

More than half of the injuries are not notified. The most common reasons
for not reporting are: the belief that the exposure has low risk of
infection, the lack of knowledge of reporting systems and the assumption
that it is difficult to notify.

Many strategies have been created to reduce the incidence of sharps
injuries, such as: identifying the risk of blood exposure, the creation of
politics to minimize the risk, the education and training to create a safe
workplace, the enhancing of the reporting system, the use of double-
gloving and using safety- engineered sharps devices.

In many countries these politics have reduced the incidence of sharps
injuries as well as the economic burden.

KEYWORDS: Health facility environment; Health personnel; Needlestick
injuries; Occupational health
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Sharps injuries in the operating room
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25082440

Environ Health Prev Med. 2014 Sep;19(5):348-53.

Sharps injuries in the operating room.

Lakbala P1, Sobhani G, Lakbala M, Inaloo KD, Mahmoodi H.

1Infectious and Tropical Diseases Research Center, Hormozgan University of
Medical Sciences, Bandar Abbas, Iran, parvin_lakbala@yahoo.com.

OBJECTIVES: We aimed to identify who sustains needlestick and sharps
injuries, under what circumstances and what actions are taken to minimize
the risk and in response to intraoperative NSSIs.

METHODS: The cross-sectional study was conducted in 2013 on 215 operation
room personnel in 14 hospitals of the Hormozgan province, Iran.

RESULTS: Two hundred and fifty appropriate responders completed the
questionnaire (86 %). Anaesthesia 59 (27.4 %) and operation room
technicians 55 (25.6 %) sustained the greatest numbers of NSSIs over the
past year. Awareness of local protocols was significantly worse in the
residents group. The commonest reasons for noncompliance with NSSIs local
protocols were not sure of the local protocols 44 (20.4 %) and prolonged
operation so unable to leave operation table 37 (17.3 %).

CONCLUSIONS: A revision of the local protocol to reduce the time it takes
to complete may improve compliance. Education is of paramount importance
in making health care workers aware of this issue. The application of
safety devices led to a reduction in NSSIs and reduces the risk of blood
borne infection as well.
__________________________________________________________________
________________________________*_________________________________

4. Abstract: MRI imaging and clinical features of sciatic nerve injection
injury
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26000913

Int J Neurosci. 2015 May 22:1-7.

MRI imaging and clinical features of sciatic nerve injection injury.

Ripellino P1, Mazzini L, Comi C, Perchinunno M, Stecco A, Cantello R.

1University of Eastern Piedmont, Department of Neurology , AOU Maggiore
della Carità , Novara.

A young patient with foot drop and inferior limb atrophy had a sciatic
nerve damage as a consequence of an unsafe intramuscular injection several
years before.

We show on video the clinical presentation, the core features of
electrodiagnostic studies, and the MRI images of the inflamed lumbosacral
plexus.

Treatment with oral steroids led to clinical and radiological improvement.

KEYWORDS: MRI; injury; lumbosacral plexus; plexopathy; sciatic nerve
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Rate of infection and related risk factors on hepatitis C
virus in three counties of Jiangsu province
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25598250

Zhonghua Liu Xing Bing Xue Za Zhi. 2014 Nov;35(11):1212-7.

[Rate of infection and related risk factors on hepatitis C virus in three
counties of Jiangsu province].

[Article in Chinese]

Xu K1, Zhu L2, Tang F1, Bao C1, Zhu Y1, Cao M3, Du G4, Xu J5, Peng H2,
Zhai X6.

1Department of Acute Infectious Disease Prevention and Control.
2Department of the National Major Science and Technology Projects, Jiangsu
Provincial Center for Disease Prevention and Control, Nanjing 210009,
Chin.
3Department of the National Major Science and Technology Projects, Taixing
Center for Disease Prevention and Control.
4Department of the National Major Science and Technology Projects,
Zhangjiagang Center for Disease Prevention and Control.
5Department of Acute Infectious Disease Prevention and Control, Danyang
Center for Disease Prevention and Control.
6Department of Acute Infectious Disease Prevention and Control; Department
of the National Major Science and Technology Projects, Jiangsu Provincial
Center for Disease Prevention and Control, Nanjing 210009, Chin. Email:
jszxj@jscdc.cn.

OBJECTIVE: To investigate the hepatitis C virus (HCV) infection rate among
general population in Jiangsu province and to analyze the main risk
factors for HCV infection.

METHODS: Subjects in 3 counties were surveyed by stratified cluster random
sampling in the National Major Science and Technology Projects
demonstration area in Jiangsu province. Interview was carried out with
uniformly- designed questionnaires. Blood samples were collected and anti-
HCV tested. Data were analysed under SPSS 13.0. Case-control study was
conducted on two groups with subjects under 1:4 matching by sex, age,
village of residence and status of HCV infection. Cox’s proportional
hazards regression analysis was then performed to analyze the risk factors
for HCV infection.

RESULTS: The positive rate of anti-HCV was higher in females (0.965%,
95%CI:0.899%-1.035%) than in males (0.572%, 95%CI:0.517%-0.632%).
Significant differences were noticed among the positive rates of anti-HCV
in the three counties (0.131%, 95%CI:0.103%-0.164%;0.316%, 95%CI:
0.268%-0.370%; 2.173% , 95% CI:2.039%-2.315% , respectively). Peak
prevalence of anti-HCV (1.577%, 95%CI:1.425%-1.740%) was observed among
persons at 50-59 years of age. Bottom rate (0.161%, 95%CI:0.125%-0.204%)
was observed below 30 years of age. High anti-HCV positive rate was
detected in people with lower education background or belonged to
‘floating population’.

Factors as having histories of hospitalization (OR = 3.049, 95%
CI:1.322-7.036), blood transfusion (OR = 14.319, 95%CI:2.318-88.459) or
sharing razor (OR = 3.604, 95%CI:1.096-11.851) were risk factors of HCV
infection in the area with the lowest anti-HCV positive rate.

In another county, factor as having histories of ‘blood products
transfusion’ (OR = 7.202, 95% CI:1.170-44.310) appeared important while in
the third county, having history of ‘blood donation’ (OR = 7.496,
95%CI:6.121- 9.180); ‘blood transfusion’ (OR = 2.305, 95%CI:1.578-3.369)
and ‘invasive physical examination’ (OR = 1.258, 95% CI:1.021-1.549)
appeared to be important.

Age seemed a risk factor for HCV infection. “Sharing razor” was a
specifically important risk factor among the 30- year-olds. “Having
received acupuncture” was noticed a risk factor only among people at 50-59
years of age while “Having received invasive physical examination” was
important in the 50-59 and 60-69 year-olds.

CONCLUSION: High anti-HCV positive rate was observed in people at middle
of aged population, as well as in those with poor education or under
‘floating’. Unsafe blood donation or having received blood-product
transfusion might be the risk factors in the last decades.

Factors as sharing razor, having received acupuncture or invasive
examination might be specifically risky in different populations.
__________________________________________________________________
________________________________*_________________________________

6. Abstract: An assessment of an HIV prevention intervention among people
who inject drugs in the states of Manipur and Nagaland, India
__________________________________________________________________
Open Access http://www.ijdp.org/article/S0955-3959(14)00092-9/fulltext

Int J Drug Policy. 2014 Sep;25(5):853-64.

An assessment of an HIV prevention intervention among people who inject
drugs in the states of Manipur and Nagaland, India.

Goswami P1, Medhi GK2, Armstrong G3, Setia MS4, Mathew S5, Thongamba G5,
Ramakrishnan L5, George B5, Singh RK5, Paranjape RS6, Mahanta J2.

1FHI 360, New Delhi, India. Electronic address: pgoswami@fhi360.org.
2Regional Medical Research Centre, Dibrugarh, Assam, India.
3Nossal Institute of Global Health, University of Melbourne, Australia.
4Consultant Dermatologist and Epidemiologist, Mumbai, India; Consultant
Epidemiologist, MGM Institute of Health Sciences, India.
5FHI 360, New Delhi, India.
6National AIDS Research Institute, Pune, India.

BACKGROUND: The present study describes an assessment of a large-scale
intervention, “Avahan”, using an evaluation framework that assesses the
program coverage, changes in injection patterns, condom use, and STI and
HIV prevalence among People Who Inject Drugs (PWID) in two states of India
– Manipur and Nagaland.

METHODS: Program monitoring data and results from two rounds of a cross
sectional biological and behavioural surveys in 2006 (Round 1) and 2009
(Round 2) were used. The sample included 839 and 860 PWIDs from Manipur
and 821 and 829 PWIDs from Nagaland in Round 1 and Round 2 respectively
for current analysis. Bivariate and multivariate analyses were done to
measure the changes in behavioural and biological outcomes between the two
rounds and to examine the association between programme exposure and
behavioural outcomes.

RESULTS: In Manipur, about 77% of the PWIDs were contacted by the peer
educators/outreach workers every month and about 18% of the PWIDs visited
the clinic every month by March 2010. In Nagaland, however, the proportion
of PWIDs visiting the clinic monthly remained low (11% in March 2010).
PWIDs in both states were more likely to report ‘consistent safe injection
practice in the last six months’ in Round 2 compared to Round 1 (Manipur:
adjusted odds ratio (aOR): 1.88, 95% confidence intervals (CI): 1.46-2.43;
Nagaland: aOR: 2.35, 95% CI: 1.86-2.80) PWIDs were also more likely to
report consistent condom use with regular partners in Round 2. The
prevalence of Hepatitis B virus (HBV) increased in Round 2 in Manipur (11%
vs 6%, p<0.001) and Nagaland (8% vs 6%, p=0.05).

The prevalence of Hepatitis C virus (HCV) was high and did not change,
either in Manipur (67.3% vs 69.9%, p=0.42) and Nagaland (14.7% vs 15.1%,
p=0.82). Similarly, the prevalence of HIV did not change significantly
between the two Rounds either in Manipur (27.8% in Round 1 vs 29.2% in
Round 2, p=0.59) or in Nagaland (1.2% in Round 1 and 1.6% in Round 2 of
the IBBA, p=0.82).

CONCLUSION: Improvements in safe injection practices and consistent condom
use with regular partners suggest effectiveness of prevention efforts.
However, increase in HBV prevalence and non-decline in HCV and HIV
prevalence in both the states also underscore the need to continue and
intensify targeted interventions (such as Hepatitis B vaccination, needle
exchange programmes, condom distribution) for long term risk reduction
among PWID population.

Copyright © 2014 The Authors. Published by Elsevier B.V. All rights
reserved.

KEYWORDS: CMIS; Condom use; Cross sectional survey; HIV; HIV prevention
programme; Hepatitis B&C; Integrated behavioural and biological
assessment; Needle/syringe exchange programme; PWID; STI
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Within-prison drug injection among HIV-infected Ukrainian
prisoners: prevalence and correlates of an extremely high-risk
behaviour
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24951025

Int J Drug Policy. 2014 Sep;25(5):845-52.

Within-prison drug injection among HIV-infected Ukrainian prisoners:
prevalence and correlates of an extremely high-risk behaviour.

Izenberg JM1, Bachireddy C1, Wickersham JA1, Soule M1, Kiriazova T2,
Dvoriak S3, Altice FL4.

1Yale University School of Medicine, Section of Infectious Diseases, AIDS
Program, New Haven, CT, USA.
2Future Without AIDS Foundation, Odessa, Ukraine; Ukrainian Institute on
Public Health Policy, Kyiv, Ukraine.
3Ukrainian Institute on Public Health Policy, Kyiv, Ukraine.
4Yale University School of Medicine, Section of Infectious Diseases, AIDS
Program, New Haven, CT, USA; Yale University School of Public Health,
Division of Epidemiology of Microbial Diseases, New Haven, CT, USA.
Electronic address: frederick.altice@yale.edu.

BACKGROUND: In Ukraine, HIV-infection, injection drug use, and
incarceration are syndemic; however, few services are available to
incarcerated people who inject drugs (PWIDs). While data are limited
internationally, within- prison drug injection (WP-DI) appears widespread
and may pose significant challenges in countries like Ukraine, where PWIDs
contribute heavily to HIV incidence. To date, WP-DI has not been
specifically examined among HIV-infected prisoners, the only persons that
can transmit HIV.

METHODS: A convenience sample of 97 HIV-infected adults recently released
from prison within 1-12 months was recruited in two major Ukrainian
cities. Post-release surveys inquired about WP-DI and injection equipment
sharing, as well as current and prior drug use and injection, mental
health, and access to within-prison treatment for HIV and other
comorbidities. Logistic regression identified independent correlates of
WP-DI.

RESULTS: Complete data for WP-DI were available for 95 (97.9%)
respondents. Overall, 54 (56.8%) reported WP-DI, among whom 40 (74.1%)
shared injecting equipment with a mean of 4.4 (range 0-30) other injectors
per needle/syringe. Independent correlates of WP-DI were recruitment in
Kyiv (AOR 7.46, p=0.003), male gender (AOR 22.07, p=0.006), and active
pre- incarceration opioid use (AOR 8.66, p=0.005).

CONCLUSIONS: Among these recently released HIV-infected prisoners, WP-DI
and injection equipment sharing were frequent and involved many injecting
partners per needle/syringe. The overwhelming majority of respondents
reporting WP-DI used opioids both before and after incarceration,
suggesting that implementation of evidence-based harm reduction practices,
such as opioid substitution therapy and/or needle/syringe exchange
programmes within prison, is crucial to addressing continuing HIV
transmission among PWIDs within prison settings. The positive correlation
between Kyiv site and WP- DI suggests that additional structural
interventions may be useful.

Copyright © 2014 Elsevier B.V. All rights reserved.

KEYWORDS: HIV; Injecting drug use; Prison; Syringe exchange
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Hepatitis C in European prisons: a call for an evidence-
informed response
__________________________________________________________________
Open Access http://www.biomedcentral.com/1471-2334/14/S6/S17

BMC Infect Dis. 2014;14 Suppl 6:S17.

Hepatitis C in European prisons: a call for an evidence-informed response.

Arain A, Robaeys G, Stöver H.

Globally, over 10 million people are held in prisons and other places of
detention at any given time. People who inject drugs (PWID) comprise
10-48% of male and 30-60% of female prisoners.

The spread of hepatitis C in prisons is clearly driven by injection drug
use, with many infected prisoners unaware of their infection status. Risk
behaviour for acquisition of hepatitis C via common use of injecting
equipment is widespread in many prison settings.

In custodial settings, effective and efficient prevention models applied
in the community are very rarely implemented. Only approximately 60 out of
more than 10,000 prisons worldwide provide needle exchange. Thus, HCV
prevention is almost exclusively limited to verbal advice, leaflets and
other measures directed to cognitive behavioural change.

Although the outcome of HCV antiviral treatment is comparable to non-
substance users and substance users out of prison, the uptake for
antiviral treatment is extremely low.

Based on a literature review to assess the spread of hepatitis C among
prisoners and to learn more about the impact for the prison system,
recommendations regarding hepatitis C prevention, screening and treatment
in prisons have been formulated in this article.

Open Access http://www.biomedcentral.com/1471-2334/14/S6/S17
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Risk behaviors, prevalence of HIV and hepatitis C virus
infection and population size of current injection drug users in a
China-Myanmar border city: results from a Respondent-Driven Sampling
Survey in 2012
__________________________________________________________________
Free Open Access Article www.ncbi.nlm.nih.gov/pmc/articles/PMC4159231/

PLoS One. 2014 Sep 9;9(9):e106899.

Risk behaviors, prevalence of HIV and hepatitis C virus infection and
population size of current injection drug users in a China-Myanmar border
city: results from a Respondent-Driven Sampling Survey in 2012.

Li L1, Assanangkornchai S2, Duo L3, McNeil E2, Li J4.

1Yunnan Institute of Drug Abuse, Kunming, Yunnan, P.R. China; Epidemiology
Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla,
Thailand.
2Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat
Yai, Songkla, Thailand.
3HIV/AIDS Asia Regional Program Yunnan Management Office, Kunming, Yunnan,
P.R. China.
4Yunnan Institute of Drug Abuse, Kunming, Yunnan, P.R. China.

BACKGROUND: Injection drug use has been the major cause of HIV/AIDS in
China in the past two decades. We measured the prevalences of HIV and
hepatitis C virus (HCV) prevalence and their associated risk factors among
current injection drug users (IDUs) in Ruili city, a border region
connecting China with Myanmar that has been undergoing serious drug use
and HIV spread problems. An estimate of the number of current IDUs is also
presented.

METHODS: In 2012, Chinese IDUs who had injected within the past six months
and aged = 18 years were recruited using a respondent-driven sampling
(RDS) technique. Participants underwent interviews and serological testing
for HIV, HBV, HCV and syphilis. Logistic regression indentified factors
associated with HIV and HCV infections. Multiplier method was used to
obtain an estimate of the size of the current IDU population via combining
available service data and findings from our survey.

RESULTS: Among 370 IDUs recruited, the prevalence of HIV and HCV was 18.3%
and 41.5%, respectively. 27.1% of participants had shared a needle/syringe
in their lifetime. Consistent condom use rates were low among both regular
(6.8%) and non-regular (30.4%) partners. Factors independently associated
with being HIV positive included HCV infection, having a longer history of
injection drug use and experience of needle/syringe sharing. Participants
with HCV infection were more likely to be HIV positive, have injected more
types of drugs, have shared other injection equipments and have
unprotected sex with regular sex partners. The estimated number of current
IDUs in Ruili city was 2,714 (95% CI: 1,617-5,846).

CONCLUSIONS: IDUs may continue to be a critical subpopulation for
transmission of HIV and other infections in this region because of the
increasing population and persistent high risk of injection and sexual
behaviours. Developing innovative strategies that can improve
accessibility of current harm reduction services and incorporate more
comprehensive contents is urgently needed.

Free Open Access Article www.ncbi.nlm.nih.gov/pmc/articles/PMC4159231/
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Syringe disposal among people who inject drugs in Los
Angeles: the role of sterile syringe source
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24930425

Int J Drug Policy. 2014 Sep;25(5):905-10.

Syringe disposal among people who inject drugs in Los Angeles: the role of
sterile syringe source.

Quinn B1, Chu D2, Wenger L3, Bluthenthal RN2, Kral AH3.

1Centre for Population Health, Burnet Institute, 85 Commercial Road,
Melbourne, Victoria 3004, Australia. Electronic address:
brendanq@burnet.edu.au.
2Department of Preventive Medicine, Institute for Prevention Research,
Keck School of Medicine, University of Southern California, 2001 North
Soto Street, MC 9239, Los Angeles, CA 90033, United States.
3Urban Health Program, RTI International, 351 California Street (Suite
500), San Francisco, CA 94104, United States.

BACKGROUND: Few recent studies have investigated the prevalence of
improperly discarded syringes in community settings by people who inject
drugs (PWID). We examined whether syringe source was associated with the
act of improper syringe disposal and amount of syringes improperly
disposed of among PWID in Los Angeles, California.

METHODS: A cross-sectional sample of PWID (N=412) was recruited and
administered a structured questionnaire between July 2011 and April 2013.
Descriptive analyses investigated syringe access and disposal practices
among participants. Multivariate logistic regression analysis identified
adjusted associations between syringe source (syringe exchange program
[SEP] or pharmacy) and improper syringe disposal.

RESULTS: Most participants were male (69%), homeless (62%) and low-income
earners (64%). The majority (87%) of the sample received syringes from a
SEP in the past six months, with 26% having received syringes from
pharmacies and 36% from unauthorised sources (e.g., friend, drug dealer).
Of more than 30,000 used syringes reportedly disposed of by participants
during the past 30 days, 17% were disposed of improperly. Two percent of
participants disposed of any used syringes at pharmacies, compared to 68%
who used SEPs for syringe disposal. Having received sterile syringes from
a SEP was independently associated with lower odds of improper syringe
disposal; however, purchasing sterile syringes from pharmacies was
associated with significantly higher odds of improper syringe disposal.

CONCLUSION: In a city with both SEPs and pharmacies as syringe source and
disposal options for PWID, these findings suggest that while pharmacies
are selling syringes, they are not as readily involved in safe syringe
disposal. Given limits on SEP availability and the large geographic size
of Los Angeles County, augmenting current SEP services and providing other
community disposal sites, including pharmacy disposal, processes could
reduce improper syringe disposal among PWID in Los Angeles.

Copyright © 2014 Elsevier B.V. All rights reserved.

KEYWORDS: Pharmacy; Syringe access; Syringe exchange programs
__________________________________________________________________
________________________________*_________________________________

11. Abstract: Prevalence and behavioural risks for HIV and HCV infections
in a population of drug users of Dakar, Senegal: the ANRS 12243 UDSEN
study
__________________________________________________________________
Free full text http://www.jiasociety.org/index.php/jias/article/view/19888

J Int AIDS Soc. 2015 May 22;18(1):19888.

Prevalence and behavioural risks for HIV and HCV infections in a
population of drug users of Dakar, Senegal: the ANRS 12243 UDSEN study.

Leprêtre A1, Ba I2, Lacombe K3,4,5, Maynart M6, Toufik A7, Ndiaye O6, Kane
CT8, Gozlan J3,9, Tine J6, Ndoye I6, Raguin G10,4, Girard PM3,4,11.

1Institut Médecine Epidémiologie Appliquée, Université Xavier Bichat,
Paris, France; anlepretre@gmail.com.
2Hôpital Psychiatrique de Thiaroye, Dakar, Senegal.
3Sorbonne-Universités, Paris, France.
4Service de Maladies Infectieuses et Tropicales, Hôpitaux Universitaires
de l’Est Parisien, Hôpital Saint-Antoine, Paris, France.
5Inserm UMR-S1136, Institut Pierre-Louis de Santé Publique, Paris, France;
karine.lacombe@sat.aphp.fr.
6Centre Régional de Recherche et de Formation à la Prise en Charge
Clinique (CRCF), Service des Maladies Infectieuses, Centre Hospitalier
Universitaire de Fann, Dakar, Sénégal.
7Institut Médecine Epidémiologie Appliquée, Université Xavier Bichat,
Paris, France.
8Laboratoire de Bacterio-virologie, Hôpital Le Dantec, Dakar, Senegal.
9Laboratoire de Virologie, Hôpitaux Universitaires de l’Est Parisien,
Hôpital Saint-Antoine, Paris, France.
10Département Santé, Expertise France, Paris, France.
11Inserm UMR-S1136, Institut Pierre-Louis de Santé Publique, Paris,
France.

OBJECTIVES: Data on the extent of drug use and associated HIV, hepatitis C
and hepatitis B infection in West Africa are lacking. The objectives of
ANRS12244 UDSEN study were to estimate the size of the heroin and/or
cocaine drug user (DU) population living in the Dakar area (Senegal), and
assess the prevalence and risk factors of HIV, hepatitis C virus (HCV) and
hepatitis B virus (HBV), including behavioural determinants in this
population, in order to set up an integrated prevention and treatment
programme for DUs.

DESIGN AND METHODS: A capture-recapture method was applied for population
size estimation, whereas the respondent-driven sampling (RDS) method was
used to recruit a sample of DUs living in the Dakar area and determine
HIV, HBV and HCV prevalence. Behavioural data were gathered during face-
to-face interviews, and blood samples were collected on dried blood spots
for analysis in a central laboratory. Data analysis was performed using
the RDS analysis tool, and risk factors were determined by logistic
regression. Access to laboratory results was organized for the
participants.

RESULTS: The size of the DU population in the Dakar area was estimated to
reach 1324 (95% confidence interval (95% CI: 1281-1367)). Based on the 506
DUs included in the study, the HIV, HCV and HBV prevalence were 5.2% (95%
CI: 3.8-6.3), 23.3% (95% CI: 21.2-25.2) and 7.9% (95% CI: 5.2-11.1),
respectively. In people who inject drugs (PWID), prevalence levels
increased to 9.4% for HIV and 38.9% for HCV (p=0.001 when compared to
those who never injected). Women were more at risk of being HIV infected
(prevalence: 13.04% versus 2.97% in males, p=0.001). Being PWID was a risk
factor for HCV and HIV infection (odds ratio, OR: 2.7, 95% CI: 1.7-4.3,
and OR: 4.3, 95% CI: 1.7-10.7, respectively), whereas older age and female
sex were additional risk factors for HIV infection (10% increase per year
of age, p=0.03 and OR: 4.9, 95% CI: 1.6-156, respectively). No specific
determinant was associated with the risk of HBV infection.

CONCLUSIONS: High HIV and HCV prevalence were estimated in this population
of DUs (including non-injectors) living in the Dakar area, Senegal,
whereas HBV prevalence was close to that of the global Senegalese
population, reflecting a risk of infection independent of drug use. Women
seem to be highly vulnerable and deserve targeted interventions for
decreasing exposure to HIV, while behavioural risk factors for HIV and HCV
include the use of unsafe injections, reflecting the urgent need for
developing harm reduction interventions and access to opioid substitution
therapy services.

KEYWORDS: Senegal; drug use; hepatitis B virus; hepatitis C virus; human
immunodeficiency virus; respondent-driven sampling

Free full text http://www.jiasociety.org/index.php/jias/article/view/19888
__________________________________________________________________
________________________________*_________________________________

12. Abstract: Injection and sexual risk practices among young heroin users
in Hanoi, Vietnam
__________________________________________________________________
Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4435536/

Drugs (Abingdon Engl). 2015 Apr;22(2):166-172.

Injection and sexual risk practices among young heroin users in Hanoi,
Vietnam.

Goldsamt LA1, Clatts MC2, Le G3, Yu G1.

1College of Nursing, New York University, New York, NY, USA.
2School of Public Health, University of Puerto Rico, San Juan, Puerto
Rico.
3Center for Research and Training on HIV/AIDS, Hanoi Medical University,
Hanoi, Vietnam.

Epidemiological data in Vietnam shows high HIV prevalence rates among
injection drug users, especially in urban centres. However, there are
limited data on specific practices used to prepare and inject drugs or on
sexual practices among Vietnamese injectors.

A street-based cross- sectional interview was conducted with 862 heroin
injectors in Hanoi, Vietnam, to collect such data.

Variability was seen in both injection and sexual risk, with 12.9% of
current injectors reporting at least one unsafe method of drug sharing and
57.1% reporting unsafe sex in the past 30 days.

These risks were strongly associated with those who engaged in unsafe
injection significantly more likely to engage in unsafe sex (69.4% vs.
55.3%) and those engaging in unsafe sex significantly more likely to
engage in unsafe injection (15.7% vs. 9.2%).

These findings highlight the overlap of injection and sexual risk
practices among Vietnamese heroin users and suggest the need for strong,
broadly targeted HIV prevention activities among this population.

KEYWORDS: Heroin; injection drug use; sexual risk; youth

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4435536/
__________________________________________________________________
________________________________*_________________________________

13. Abstract: The ‘My five moments for hand hygiene’ concept for the
overcrowded setting in resource-limited healthcare systems
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25997803

J Hosp Infect. 2015 May 1. pii: S0195-6701(15)00183-8.

The ‘My five moments for hand hygiene’ concept for the overcrowded setting
in resource-limited healthcare systems.

Salmon S1, Pittet D2, Sax H3, McLaws ML4.

1School of Public Health and Community Medicine, UNSW Medicine, UNSW,
Sydney, Australia.
2Infection Control Program and WHO Collaborating Centre on Patient Safety,
University of Geneva Hospitals and Faculty of Medicine, Geneva,
Switzerland.
3Division of Infectious Diseases and Infection Control, University and
University Hospital Zurich, Switzerland.
4School of Public Health and Community Medicine, UNSW Medicine, UNSW,
Sydney, Australia. Electronic address: m.mclaws@unsw.edu.au.

Hand hygiene is a core activity of patient safety for the prevention of
healthcare-associated infections (HCAIs).

To standardize hand hygiene practices globally the World Health
Organization (WHO) released Guidelines on Hand Hygiene in Health Care and
introduced the ‘My five moments for hand hygiene’ concept to define
indications for hand hygiene rooted in an evidence-based model for
transmission of micro-organisms by healthcare workers’ (HCWs) hands.

Central to the concept is the division of the healthcare environment into
two geographical care zones, the patient zone and the healthcare zone,
that requires the HCW to comply with specific hand hygiene moments. In
resource-limited, overcrowded healthcare settings inadequate or no spatial
separation between beds occurs frequently. These conditions challenge the
HCW’s ability to visualize and delineate patient zones.

The ‘My five moments for hand hygiene’ concept has been adapted for these
conditions with the aim of assisting hand hygiene educators, auditors, and
HCWs to minimize ambiguity regarding shared patient zones and achieve the
ultimate goal set by the WHO Guidelines – the reduction of infectious
risks.

Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

KEYWORDS: Alcohol-based hand rub; Hand hygiene; Healthcare workers;
Healthcare- associated infections; My five moments for hand hygiene;
Overcrowding; Patient zone
_____________________________________________________________
________________________________*_________________________________

14. Abstract: Comparison of adrenaline auto-injector devices: ease of use
and ability to recall use
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25041111

Pediatr Allergy Immunol. 2014 Aug;25(5):462-7.

Comparison of adrenaline auto-injector devices: ease of use and ability to
recall use.

Robinson MN1, Dharmage SC, Tang ML.

1Department of Allergy and Immunology, Royal Children’s Hospital,
Melbourne, Vic., Australia; Allergy and Immune Disorders, Murdoch
Children’s Research Institute, Melbourne, Vic., Australia.

BACKGROUND: A limited number of adrenaline auto-injectors are currently
available. Epipen and Anapen are available in Australia, New Zealand, UK
and parts of Europe and Asia. Few studies have compared the performance of
these devices.

OBJECTIVE: To compare the intuitiveness of use of these devices. A
secondary aim was to compare the ability to recall the use of each device
after a period of 3 months.

METHOD: A random sample of 100 subjects naïve to both the EpiPen and
Anapen were recruited from staff and families attending Royal Children’s
Hospital, Melbourne Australia. Subjects were randomized to Anapen (n = 53)
or EpiPen (n = 47) and asked to demonstrate use of a ‘trainer’ device (i)
prior to and (ii) after receiving training in its correct use. A subset (n
= 32) participated in a follow-up study to evaluate (iii) the ability to
recall correct use of each device.

RESULTS: Most subjects correctly demonstrated all steps in use of the
EpiPen and Anapen both prior to (89% vs. 79%, p = 0.17) and after training
on use (100% vs. 100%). However, after 3 months, significantly more
participants correctly demonstrated use of EpiPen (87%) compared to Anapen
(35%) (p = 0.003) and critical errors that would likely result in failure
to administer adrenaline were more common with Anapen (59% vs. 13%, p =
0.01).

CONCLUSION: Most study participants correctly demonstrated the use of both
devices without prior training. There was greater attrition in correct use
of Anapen compared to EpiPen over time. Critical errors in administration
were more likely with Anapen than EpiPen.

© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

KEYWORDS: Anapen; EpiPen; adrenaline auto-injector; anaphylaxis
__________________________________________________________________
________________________________*_________________________________

15. Abstract: Analysis of Anaphylactic Shock Caused by 17 Types of
Traditional Chinese Medicine Injections Used to Treat Cardiovascular
and Cerebrovascular Diseases
__________________________________________________________________
Free Article http://www.hindawi.com/journals/bmri/2015/420607/

Biomed Res Int. 2015;2015:420607.

Analysis of Anaphylactic Shock Caused by 17 Types of Traditional Chinese
Medicine Injections Used to Treat Cardiovascular and Cerebrovascular
Diseases.

Guo YJ1, Wang W1, Meng L1, Wang YQ1.

1Department of Pharmacology, The First Affiliate Hospital of Nanjing
Medical University, Nanjing, Jiangsu, China.

Several reports describing anaphylactic shock following treatment of
cardiovascular and cerebrovascular diseases with Chinese herbal injections
were described.

Our analysis of these reports showed that anaphylactic shock caused by
traditional Chinese medicine (TCM) injections for the treatment of
cardiovascular and cerebrovascular diseases is common but also sometimes
fatal. Therefore, we proposed the following four suggestions for improving
the clinical safety of delivering Chinese herbal injections and reducing
the occurrence of allergic shock.

First, patients with cardiovascular and cerebrovascular diseases are at
high risk, so they should only be given TCM injections after a doctor’s
diagnosis and approval.

Second, people in allergic groups can suffer anaphylactic shock, so
vigilance is important in the treatment of all age groups, although even
more caution should be exercised when treating children or elderly people.
In fact, TCM injections may not be appropriate for those age groups, so
that they should be carefully considered before treatment.

Third, no significant gender differences have been noted in patients with
anaphylactic shock, so all patients should be carefully monitored,
irrespective of gender.

Fourth, the timeframe in which different drugs cause anaphylactic shock
varies; thus, patients should be observed as long as possible.

Free Article http://www.hindawi.com/journals/bmri/2015/420607/
__________________________________________________________________
________________________________*_________________________________

16. Abstract: Microneedle patch delivery to the skin of virus-like
particles containing heterologous M2e extracellular domains of
influenza virus induces broad heterosubtypic cross-protection
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26003039

J Control Release. 2015 May 20. pii: S0168-3659(15)00577-5.

Microneedle patch delivery to the skin of virus-like particles containing
heterologous M2e extracellular domains of influenza virus induces broad
heterosubtypic cross-protection.

Kim MC1, Lee JW2, Choi HJ3, Lee YN4, Hwang HS4, Lee J5, Kim C5, Lee JS6,
Montemagno C3, Prausnitz MR2, Kang SM7.

1Center for Inflammation, Immunity & Infection, Institute for Biomedical
Sciences, Georgia State University, Atlanta, GA 30303, USA; Animal and
Plant Quarantine Agency, 175 Anyangro, Anyang, Gyeonggido 430-757, South
Korea.
2School of Chemical and Biomolecular Engineering, Georgia Institute of
Technology, Atlanta, GA 30332, USA.
3Department of Chemical and Materials Engineering, University of Alberta,
AB T6G 2M9, Canada.
4Center for Inflammation, Immunity & Infection, Institute for Biomedical
Sciences, Georgia State University, Atlanta, GA 30303, USA.
5BEAMS Biotechnology Co. Ltd., Seongnam, Gyeonggido, South Korea.
6National Institute of Biological Resources, Incheon 404-708, South Korea.
7Center for Inflammation, Immunity & Infection, Institute for Biomedical
Sciences, Georgia State University, Atlanta, GA 30303, USA. Electronic
address: skang24@gsu.edu.

A broadly cross-protective influenza vaccine that can be administrated by
a painless self-immunization method would be a value as a potential
universal mass vaccination strategy.

This study developed a minimally- invasive microneedle (MN) patch for skin
vaccination with virus-like particles containing influenza virus
heterologous M2 extracellular (M2e) domains (M2e5x VLPs) as a universal
vaccine candidate without adjuvants.

The stability of M2e5x VLP-coated microneedles was maintained for 8weeks
at room temperature without losing M2e antigenicity and immunogenicity.

MN skin immunization induced strong humoral and mucosal M2e antibody
responses and conferred cross-protection against heterosubtypic H1N1,
H3N2, and H5N1 influenza virus challenges. In addition, M2e5x VLP MN skin
vaccination induced T-helper type 1 responses such as IgG2a isotype
antibodies and IFN-? producing cells at higher levels than those by
conventional intramuscular injection.

These potential immunological and logistic advantages for skin delivery of
M2e5x VLP MN vaccines could offer a promising approach to develop an easy-
to-administer universal influenza vaccine.

Copyright © 2015. Published by Elsevier B.V.

KEYWORDS: Cross-protection; Influenza universal vaccine; M2e5x VLPs;
Microneedles
__________________________________________________________________
________________________________*_________________________________

17. News

– Philippines: Cabaero: ‘Ayaw’g puli-puli’
– India: ‘Auto Disposable Syringes Must be Widely Used’
– USA: Unsafe Injections Put Patients in Peril: Insist on best practices
before you’re stuck.

Selected news items reprinted under the fair use doctrine of international
copyright law: http://www4.law.cornell.edu/uscode/17/107.html
__________________________________________________________________
www.sunstar.com.ph/cebu/opinion/2015/05/25/cabaero-ayawg-puli-puli-409446

Philippines: Cabaero: ‘Ayaw’g puli-puli’

By Nini B. Cabaero, Sun.Star, Cebu Philippines (25.05.15)

THE writing’s on the wall, in bold letters and with a yellow background,
but the message is being misunderstood.

Painted on some walls of Cebu City barangays is a poster with the message
–AYAW’G PULI2x

It’s in all caps, with a yellow background and a splattering of red that
looks like blood. At the bottom is a crude drawing of a needle, except
this part is not noticed right away unless you know what the poster is
saying.

The Sun.Star website at www.sunstar.com.ph recently investigated what the
writing on the wall was all about and came out with a video report that
started with how people misunderstood the message. The video report titled
“Unsa’y pasabot sa ‘Ayaw’g puli-puli’?” was uploaded last May 13 and
focused on a little-known campaign.

We’re not satisfied with what we have, so we replace or we change it, one
person who was interviewed said. Even comments on Facebook when the video
report was posted had the same take. Stick to one partner. Do not change
partners. Do not have multiple sexual partners.

The message was actually part of a campaign to stop the spread of the
human immunodeficiency virus (HIV) among people who inject drugs by
telling them not to share needles. The HIV causes Aids or the acquired
immunodeficiency syndrome.

Remberto Generalao Jr., Romp project officer, said the sign is a reminder
to drug users to have their own syringe and not share needles with
injecting partners because it is a way to get HIV. The Reaching Out to the
Most-at-Risk Populations (Romp) is a United States Agency for
International Development program that covers Cebu, Mandaue and Lapu-lapu.

Generalao said that using contaminated needles is the fastest way of
getting HIV. In Cebu City, 74 percent of persons with HIV got the virus
from sharing needles. This percentage is higher than the fraction that got
the virus through sexual contact, Dr. Ilya Tac-an, of the Cebu City health
department’s HIV/Aids detection unit, said.

Unlike in other cities where men having sex with men is the number one
mode of HIV transmission, Cebu clients of the health department got HIV
from needle use.

Chances of transmission are higher with sharing needles compared to having
sexual contact because, in one use of a contaminated needle, the virus
could be transmitted.

It’s not about changing partners or being unfaithful to your spouse. It’s
about heeding the warning that risky behavior has consequences.
The Sun.Star video report was made by journalism interns Bb Girl Grace Ann
Gonzales of the Negros Oriental State University, and Pia Bilar and
Ojharra Catherine Manlosa of Cebu Normal University.
__________________________________________________________________
__________________________________________________________________
https://tinyurl.com/poecax9

India: ‘Auto Disposable Syringes Must be Widely Used’

By Express News Service, Hyderabad India (24.05.15)

In spite of advances in medical care and health education, used syringes
are still widely used posing severe threat to public health, regrets
Niloufer Hospital superintendent Dr K Devaraj.

For instance, 70 per cent of Hepatitis B and Hepatitis C cases are caused
due to used needle pricks.

Dr Devaraj explains the importance of safe injection practices in a free-
wheeling chat with Express.

Excerpts

Dr K Devaraj

Are used syringes and needles still being used?

All good hospitals dispose of syringes after using once and follow safe
injection practices. But even today, in most of the rural areas and
clinics run by rural medical practitioners, unsafe injection practices are
followed. Either out of ignorance or greed, the same injection is used
many times. This is a very unhealthy practice which can pose severe
dangers.

What are the risks of reused syringes?

Hepatitis B and Hepatitis C are the two major problems which occur due to
unsafe injection practices. For instance, 60-70 per cent of Hepatitis B
and Hepatitis C cases occur due to unsafe needle pricks. AIDS is another
problem which occurs due to the use of reused syringes.

How can we prevent this problem?

Auto disposable syringes are the best option. If auto disposable syringes
are used, the hole of the needle automatically gets blocked after
injecting. As a result, a medical practitioner cannot reuse it. There are
also pre-filled syringes in which medicine is already filled. As soon as
the injection is given, it has to be disposed of.

Are auto disposable syringes affordable?

The difference between auto disposable syringes and normal syringes will
be just about one rupee. But when compared with the cost of treating
blood-borne infections and accidental injuries due to needle pricks, it is
worth investing in them. Already auto disposable syringes are used in
immunisation programme.

What are the other safe injection practices?

Switching to injection devices with sharps (syringes, injection and
blades) injury protection feature (SIPs), as opposed to devices without a
sharps injury protection feature is another measure which we need to take
as many people are suffering due to unsafe needle pricks. Caution should
also be taken about overuse of injections for health conditions where oral
formulations are available and recommended as the first line treatment.
__________________________________________________________________
__________________________________________________________________
https://tinyurl.com/ojb68wq

USA: Unsafe Injections Put Patients in Peril: Insist on best practices
before you’re stuck.

By Michael O. Schroeder, U.S. News & World Report, USA (21.05.15)

More than 150,000 people have been notified that they were potentially
exposed to unsafe injection practices.

Far from a healthy shot in the arm, some injections carry more than
medicine into the veins and bodies of patients.

To date, more than 150,000 people have received letters after going to
outpatient centers and other health care providers notifying them they
were potentially exposed to unsafe injection practices, and, as a result,
diseases such as hepatitis C, an infection of the liver that commonly
becomes chronic, as well as bacterial infections. That’s according to the
latest figures from the Centers for Disease Control and Prevention, which
began keeping statistics on the problem in 2001.

Through 2011, the most recent year for which data are available,
dangerously negligent practices such as reusing single-use syringes or
drawing from single-use medication vials to administer injections to
multiple individuals have led to more than 40 outbreaks nationwide.

Health officials say the findings punctuate a need to raise awareness and
improve safety education among providers and patients in the U.S.

“I think it was realizing that this was not just a developing world
problem,” says CDC health care epidemiologist Dr. Joseph Perz. “CDC was
supporting the World Health Organization, and its Safe Injection Global
Network activities – that’s something that CDC helped found in the late
1990s – and what we realized by the early 2000s is that we had a lot more
outbreak activity here in the U.S. than we’d anticipated.”

Perz and his CDC colleagues say problems persist today.

Earlier this month, Tonya Rushing, the former chief operating officer of a
Las Vegas medical clinic involved in a 2007 hepatitis C outbreak tied to
unsafe injection practices, pleaded guilty to conspiracy to commit health
care fraud for inflated billing practices and received a sentence of one
year and one day in federal prison. Rushing had served under the physician
owner of the Endoscopy Center of Southern Nevada, Dr. Dipak Kantila Desai.

For his part, Dr. Desai is serving a life sentence for second-degree
murder, related to the death of a 77-year-old patient infected with
hepatitis C.

“What made this outbreak different is that this wasn’t just a bad day. It
was the routine practice in the clinic,” Perz says. Nurse anesthetists,
who also faced prosecution in the case, were found to have routinely
reused syringes, against proper single-use protocol, repeatedly dipping
into vials containing the sedative propofol, which were apparently
contaminated with hepatitis C. Perz called the outbreak a “tipping point”
for stepped-up efforts to raise public awareness about unsafe infection
practices.

While the CDC says most providers follow safe injection practices, he and
others at the agency stress that recent outbreaks highlight the need for
patients to remain vigilant. That includes an ongoing investigation into a
Santa Barbara, California, doctor’s office where unsafe injection
practices were implicated in at least five patients testing positive for
hepatitis C.

“There’s been a lot of real patient harm – life-threatening diseases, not
limited to but including hepatitis C, multiple-drug resistant staph
aureus, a long list of fairly serious infections,” Perz says. Among them:
HIV and spinal meningitis.

One unsafe injection practice that gets less recognition, he says,
involves a health provider’s failure to wear a face mask – as they should
– while administering a spinal injection.

“That is a way of spreading bacteria to one of your protected, sterile
immune sites, anatomically. You can imagine that if bacteria are
inadvertently introduced into your spine that the outcome could be very
bad,” he says. “There’s a number of outbreaks involving spinal meningitis
that have occurred from, most likely, the simple failure to wear a face
mask as recommended in that situation.”

Injecting patients safely also requires keeping up with the times and
changing health care technology.

Insulin pens created for convenient use by one individual have been
misused in health care settings. “We’ve had a number of situations – not
outbreaks, per se, but situations – where somebody in a hospital, a nurse,
uses that insulin pen for more than one patient,” Perz says. “We’ve had
thousands of patients who’ve had to get letters and go through the anxiety
of testing. We’ve not documented an outbreak, thank goodness.” But, he
says, it raises concern as pre-filled, self-injection pens are becoming
more prevalent.

“The technology is moving. That’s good for patients who are managing their
own disease process, but we have to be very careful when that technology
is introduced into a health care setting and we don’t have all the
safeguards and training in place,” Perz adds. “So that’s something the
[CDC] campaign has tried to bring attention to as well.”

Outspoken patient advocate Evelyn McKnight, the victim of unsafe injection
practices, encourages patients to talk openly with providers about
injection safety.

“Certainly when you’re going to be given an injection, ask, ‘Is this going
to be one needle, one syringe, only for me, only used one time?’ You might
ask to see them open the needle in front of you,” she says.

That’s central to the CDC’s “One & Only” public awareness campaign, which
aims to educate providers and patients, and facilitate dialogue on safe
injection practices.

“It’s a little bit technical for a patient to start to ask providers
questions about if they’re using a single-dose vial versus a multiple-dose
vial, and how much of which, and which equipment that they’re using,” says
campaign director Jennifer Mitchell. “So we try on our website to provide
introductory level questions so that patients feel empowered in being able
to have this type of conversation if they’re concerned about their safety
and their environment.”

The CDC recommends patients ask health care providers the following
questions before receiving an injection:

• Will a new needle, new syringe and a new vial be used for this procedure
or injection?

• Can you tell me how you prevent the spread of infections in your
facility?

• What steps are you taking to keep me safe?

Mitchell and others want patients to realize these questions are far from
an extraneous add-on to health care conversations; rather they fit into
broader discussion about infection control that CDC recommends patients
routinely have with providers. The agency insists, for example, that
patients not be bashful about asking doctors or other providers to wash
their hands – an infection-control measure as powerful as it is simple,
and one that studies show frequently gets skipped.

For backup – and to guide the safe-injection-practices discussion –
Mitchell recommends patients download and print out a health care provider
brochure and separate pocket card with injection safety information from
the One & Only website and take it with them to share with health care
providers.

McKnight says providers should, in turn, be open to having injection
safety conversations. She knows all too well the stakes for patients.

In 2001, McKnight contracted hepatitis C while being treated for a
recurrence of breast cancer at a clinic in Fremont, Nebraska, where she
lives. Under her oncologist’s direction, nurses had reused syringes to
draw contaminated saline from a vial used for multiple patients, infecting
McKnight and 98 patients with hepatitis C in what remains one of the
largest health care outbreaks in U.S. history.

“It was such suffering for all of our community,” McKnight says. “I mean
99 people. There was such sorrow and grief and difficulty. Lives were
lost. Six people died from hepatitis C, not from cancer. It’s also
completely preventable.”

McKnight went on to co-found HONOReform, a public policy organization,
along with the nonprofit HONOReform Foundation, focused on developing
programs to prevent future outbreaks, like promoting safe injection
practices, and she has encouraged the CDC’s public awareness efforts.

“I am fortunate: I cleared the virus,” says McKnight, who is also cancer
free. “I think when you go through a crisis, a trauma like this, the only
solace you can take is [that] what happened to us can be used to prevent
it from happening to anybody else.”

TAGS: hepatitis AIDS/ HIV death health patients patient safety doctors
health care patient advice CDC
__________________________________________________________________
________________________________*_________________________________

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.