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SIGNpost 00804

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST

Post00804 Note + Warehouse Guide in French + Abstracts   04 June 2015

CONTENTS
0. Moderators Note
1. New French Edition: “Guidelines for Warehousing Health Commodities”
2. Abstract: An Outbreak of Joint and Cutaneous Infections Caused by
Nontuberculous Mycobacteria after Corticosteroid Injection
3. Mercury and other biomedical waste management practices among dental
practitioners in India
4. Abstract: Staff perception on biomedical or health care waste
management: a qualitative study in a rural tertiary care hospital in
India
5. Abstract: Blood-borne infections in healthcare workers in South Africa
6. Abstract: PREVALENCE OF THE HEPATITIS C VIRUS AMONG UNIVERSITY
EMPLOYEES IN SÃO PAULO, SOUTHEASTERN BRAZIL: predictive factors and
geoprocessing spatial analysis
7. Abstract: Prevalence and behavioural risks for HIV and HCV infections
in a population of drug users of Dakar, Senegal: the ANRS 12243 UDSEN
study
8. No Abstract: WHO urges introduction of single use syringes
9. New WHO Injection Safety Guidelines

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0. Moderators Note
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The Moderator is traveling.

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

Normal SIGNposts will resume from 8 July 2015.

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1. New French Edition: “Guidelines for Warehousing Health Commodities”

Get > Lignes directrices pour le stockage des produits de santé < at the
link http://bit.ly/1Jrc5W4

From Anne Marie Hvid, PMP, Knowledge Management Advisor
USAID | DELIVER PROJECT deliver.jsi.com
__________________________________________________________________
A French version of Guidelines for Warehousing Health Commodities
(Lignes directrices pour le stockage des produits de santé) is now
available.

Written for anyone trying to meet and solve the challenges of
operating a warehouse today, these guidelines are an important
reference tool for managers and staff, whether they are constructing a
new warehouse, implementing a new warehouse system, or redesigning
their current system.

The guide is designed to be interactive, with each specific topic
accessible as needed, and it includes case studies to give real-life
examples that illustrate the importance of improving warehouse
operations.

Download Lignes directrices pour le stockage des produits de santé at
http://bit.ly/1Jrc5W4
________________________________*_________________________________

2. Abstract: An Outbreak of Joint and Cutaneous Infections Caused by
Nontuberculous Mycobacteria after Corticosteroid Injection
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Open Access www.ijidonline.com/article/S1201-9712(15)00126-5/abstract

Int J Infect Dis. 2015 May 27. pii: S1201-9712(15)00126-5.

An Outbreak of Joint and Cutaneous Infections Caused by Nontuberculous
Mycobacteria after Corticosteroid Injection.

Jung SY1, Kim BG1, Kwon D2, Park JH3, Youn SK2, Jeon S4, Um HY1, Kwon KE1,
Kim HJ1, Jung HJ1, Choi E1, Park BJ5.

1Korea Institute of Drug Safety and Risk Management (KIDS). 2Division of
Epidemic Intelligence Service, Korea Centers for Disease Control and
Prevention (KCDC). 3Department of Preventive Medicine, Dongguk University
College of Medicine. 4Division of Tuberculosis and Bacterial Respiratory
Infection, Center for Infectious Diseases, Korea National Institute of
Health (KNIH). 5Korea Institute of Drug Safety and Risk Management (KIDS);
Department of Preventive Medicine, Seoul National University College of
Medicine. Electronic address: bjpark@snu.ac.kr.

OBJECTIVES: We investigated an outbreak of joint and cutaneous infections
among the patients who were injected at a single clinic in South Korea.

METHODS: In this retrospective case-control study, 61 cases were diagnosed
based on symptoms and signs of septic arthritis or cutaneous infection
that developed after injections at the clinic from April to September in
2012, and 64 controls were investigated by administering questionnaires on
risk factors, and analyzing medical records from the clinic. An
environmental investigation was performed, and clinical specimens of the
cases were analyzed by pulsed-field gel electrophoresis.

RESULTS: All cases were injected with triamcinolone. A greater number of
triamcinolone injections (adjusted odds ratio 4.3, 95% confidence interval
1.5-12.1 for 6 or more visits, compared with 1-2 visits) was associated
with the development of an infection. In the clinic, only triamcinolone
injection was prepared by mixing with lidocaine and normal saline, and an
alcohol swab was prepared using boiled tap water by the clinic’s staff
members. Although injected medications and environmental cultures were not
found to be responsible, a single strain of M. massiliense was isolated
from affected sites of 16 cases.

CONCLUSIONS: Repeated injection of triamcinolone contaminated with NTM
from the clinic’s environment may have caused the post-injection outbreak.
Copyright © 2015. Published by Elsevier Ltd.

KEYWORDS: Corticosteroid; Epidemiology; Injection; Nontuberculous
Mycobacteria; Outbreak

Free full text
http://www.ijidonline.com/article/S1201-9712(15)00126-5/abstract
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3. Mercury and other biomedical waste management practices among dental
practitioners in India
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Biomed Res Int. 2014;2014:272750.

Mercury and other biomedical waste management practices among dental
practitioners in India.

Singh RD1, Jurel SK1, Tripathi S1, Agrawal KK1, Kumari R2.

1Department of Prosthodontics, Faculty of Dental Sciences, King George’s
Medical University, Lucknow, Uttar Pradesh, India.
2Department of Community Medicine & Public Health, King George’s Medical
University, Lucknow, Uttar Pradesh, India.

OBJECTIVES: The objective of the study was to assess the awareness and
performance towards dental waste including mercury management policy and
practices among the dental practitioners in North India.

MATERIALS AND METHODS: An epidemiologic survey was conducted among 200
private dental practitioners. The survey form was composed of 29 self-
administered questions frame based on knowledge, attitude, and those
regarding the practices of dentists in relation to dental health-care
waste management. The resulting data were coded and a statistical analysis
was done.

RESULTS AND DISCUSSION: About 63.7% of the dentists were not aware of the
different categories of biomedical waste generated in their clinics. Only
31.9% of the dentists correctly said that outdated and contaminated drugs
come under cytotoxic waste.

>>> 46.2% said they break the needle and dispose of it and only 21.9% use
needle burner to destroy it. <<<

45.0% of the dentists dispose of the developer and fixer solutions by
letting them into the sewer, 49.4% of them dilute the solutions and let
them into sewer and only 5.6% return them to the supplier. About 40.6% of
the dentists dispose of excess silver amalgam by throwing it into common
bin.

CONCLUSION: It was concluded that not all dentists were aware of the risks
they were exposed to and only half of them observe infection control
practices.

Free PMC Article http://www.hindawi.com/journals/bmri/2014/272750/
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4. Abstract: Staff perception on biomedical or health care waste
management: a qualitative study in a rural tertiary care hospital in
India
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Free Open Access Text

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0128383

PLoS One. 2015 May 29;10(5):e0128383.

Staff perception on biomedical or health care waste management: a
qualitative study in a rural tertiary care hospital in India.

Joshi SC1, Diwan V2, Tamhankar AJ3, Joshi R4, Shah H4, Sharma M5, Pathak
A6, Macaden R7, Stålsby Lundborg C8.

1Department of Community Medicine, R.D. Gardi Medical College, Ujjain,
India.
2Department of Public Health and Environment, R.D. Gardi Medical College,
Ujjain, India; International Center for Health Research, R.D. Gardi
Medical College, Ujjain, India; Department of Public Health Sciences,
Karolinska Institutet, Stockholm, Sweden.
3Department of Public Health Sciences, Karolinska Institutet, Stockholm,
Sweden; Indian Initiative for Management of Antibiotic Resistance,
Department of Environmental Medicine, R.D. Gardi Medical College, Ujjain,
India.
4Department of Microbiology, R.D. Gardi Medical College, Ujjain, India.
5Department of Public Health Sciences, Karolinska Institutet, Stockholm,
Sweden; Department of Pharmacology, R.D. Gardi Medical College, Ujjain,
India.
6Department of Public Health Sciences, Karolinska Institutet, Stockholm,
Sweden; Department of Pediatrics, R.D. Gardi Medical College, Ujjain,
India; Department of Women and Children’s Health, International Maternal
and Child Health Unit, Uppsala University, Uppsala, Sweden.
7St. Johns Research Institute, Bangalore, India.
8Department of Public Health Sciences, Karolinska Institutet, Stockholm,
Sweden.

BACKGROUND: Health care or biomedical waste, if not managed properly, can
be of high risk to the hospital staff, the patients, the community, public
health and the environment, especially in low and middle income settings
where proper disposal norms are often not followed. Our aim was to explore
perceptions of staff of an Indian rural tertiary care teaching hospital on
hospital waste management.

METHOD: A qualitative study was conducted using 10 focus group discussions
(FGDs), with different professional groups, cleaning staff, nurses,
medical students, doctors and administrators. The FGD guide included the
following topics: (i) role of Health Care Waste Management (HCWM) in
prevention of health care associated infections, (ii) awareness of and
views about HCWM- related guidelines/legislation, (iii) current HCWM
practices, (iv) perception and preparedness related to improvements of the
current practices, and (v) proper implementation of the available
guidelines/legislation. The FGDs were recorded, transcribed verbatim,
translated to English (when conducted in Hindi) and analysed using content
analysis.

RESULTS: Two themes were identified: Theme (A), ‘Challenges in integration
of HCWM in organizational practice,’ with the categories (I) Awareness and
views about HCWM, (II) Organizational practices regarding HCWM, and (III)
Challenges in Implementation of HCWM; and Theme (B), ‘Interventions to
improve HCWM,’ with three categories, (I) Educational and motivational
interventions, (II) Organizational culture change, and (III) Policy-
related interventions.

CONCLUSION: A gap between knowledge and actual practice regarding HCWM was
highlighted in the perception of the hospital staff. The participants
suggested organizational changes, training and monitoring to address this.
The information generated is relevant not merely to the microsystem
studied but to other institutions in similar settings.

Free full text
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0128383
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5. Abstract: Blood-borne infections in healthcare workers in South Africa
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http://www.ncbi.nlm.nih.gov/pubmed/25909108

S Afr Med J. 2014 Nov;104(11):732-5.

Blood-borne infections in healthcare workers in South Africa.

Rossouw TM, van Rooyen M, Louw JM, Richter KL.

The risks associated with infection of healthcare workers and students
with blood-borne pathogens, specifically HIV, hepatitis B virus and
hepatitis C virus, are often neglected.

South Africa (SA) currently has no official policies or guidelines in
place for the prevention and management of these infections.

This article reviews the available data and international guidelines with
regard to infected healthcare practitioners and makes minimum
recommendations for the SA setting.

Full Text http://www.samj.org.za/index.php/samj/article/view/8518
__________________________________________________________________
________________________________*_________________________________

6. Abstract: PREVALENCE OF THE HEPATITIS C VIRUS AMONG UNIVERSITY
EMPLOYEES IN SÃO PAULO, SOUTHEASTERN BRAZIL: predictive factors and
geoprocessing spatial analysis
__________________________________________________________________
http://dx.doi.org/10.1590/S0004-28032015000100003

Arq Gastroenterol. 2015 Jan-Mar;52(1):9-13.

PREVALENCE OF THE HEPATITIS C VIRUS AMONG UNIVERSITY EMPLOYEES IN SÃO
PAULO, SOUTHEASTERN BRAZIL: predictive factors and geoprocessing spatial
analysis.

Oliveira CV1, Barbosa WF1, Silveira LV1, Menezes J1, Machado FS1, Silva
GF1.

1Departamento de Medicina Interna, Divisão de Gastroenterologia, Faculdade
de Madicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP,
Brasil.

Background There are limited studies on the prevalence and risk factors
associated with hepatitis C virus (HCV) infection.

Objective Identify the prevalence and risk factors for HCV infection in
university employees of the state of São Paulo, Brazil.

Methods Digital serological tests for anti-HCV have been performed in 3153
volunteers. For the application of digital testing was necessary to
withdraw a drop of blood through a needlestick. The positive cases were
performed for genotyping and RNA. Chi-square and Fisher’s exact test were
used, with P-value <0.05 indicating statistical significance. Univariate
and multivariate logistic regression were also used.

Results Prevalence of anti-HCV was 0.7%. The risk factors associated with
HCV infection were: age >40 years, blood transfusion, injectable drugs,
inhalable drugs (InDU), injectable Gluconergam®, glass syringes, tattoos,
hemodialysis and sexual promiscuity. Age (P=0.01, OR 5.6, CI 1.4 to 22.8),
InDU (P<0.0001, OR=96.8, CI 24.1 to 388.2), Gluconergam® (P=0.0009, OR=
44.4, CI 4.7 to 412.7) and hemodialysis (P=0.0004, OR=90.1, CI 7.5 –
407.1) were independent predictors. Spatial analysis of the prevalence
with socioeconomic indices, Gross Domestic Product and Human Development
Index by the geoprocessing technique showed no positive correlation.

Conclusions The prevalence of HCV infection was 0.7%. The independent risk
factors for HCV infection were age, InDU, Gluconergan® and hemodialysis.
There was no spatial correlation of HCV prevalence with local economic
factors.

Free full text http://dx.doi.org/10.1590/S0004-28032015000100003
__________________________________________________________________
________________________________*_________________________________

7. 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 PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4442125/

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 PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4442125/
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8. No Abstract: WHO urges introduction of single use syringes
__________________________________________________________________
BMJ. 2015 Feb 24;350:h1055.

WHO urges introduction of single use syringes.

Gulland A1.

1London.
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9. 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]
__________________________________________________________________
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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
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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
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