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SIGNpost 00812

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST

Post00812 Global + Kids Shots + Dentists +  Abstracts + News  29 July 2015

CONTENTS
1. Hepatitis: Egypt, Uganda and India to take part in global injection
safety initiative campaign
2. World Hepatitis Day: WHO: Unsafe Injections Major Cause of Hepatitis
Death
3. Excerpt: WHO Guideline on the Use of Safety-Engineered Syringes for
Intramuscular, Intradermal and Subcutaneous Injections in Health-Care
Settings
4. Abstract: Hepatitis B and C status among health care workers in the
five main hospitals in eastern Libya
5. Abstract: Prevalence of hepatitis B surface antigen (HBsAg) and its
risk factors among individuals visiting Goba General Hospital, South
East Ethiopia, 2012
7. Abstract: Reuse of Insulin Pens Among Multiple Patients at 2 Veterans
Affairs Medical Centers
8. Abstract: Infection control: Knowledge and compliance among Saudi
undergraduate dental students
9. Abstract: Prevalence of blood-borne viruses among Iranian dentists:
Results of a national survey
10. Abstract: Post exposure prophylaxis to occupational injuries for
general dentist
11. Abstract: Gap Analysis of Infection Control Practices in Low- and
Middle-Income Countries
12. Abstract: Assessing future scenarios for health care waste management
using a multi-criteria decision analysis tool: A case study in the
Turkish West Black Sea Region
13. Abstract: Transition to injecting drug use in Iran: A systematic
review of qualitative and quantitative evidence
14. Abstract: Subcutaneous Injection of Percocet: A Case of Severe Soft
Tissue Loss
15. Abstract: Achieving Hand Hygiene Success With a Partnership Between
Graduate Medical Education, Hospital Leadership, and Physicians
16. Abstract: Nurses’ perceptions and satisfaction with the use of insulin
pen devices compared with insulin vial and syringes in an inpatient
setting
17. Abstract: Pharmacological and Combined Interventions to Reduce Vaccine
Injection Pain in Children and Adults: Systematic Review and Meta-
analysis
18. Abstract: Process Interventions for Vaccine Injections: Systematic
Review of Randomized Controlled Trials and Quasi-randomized Controlled
Trials
19. Abstract: Psychological Interventions for Vaccine Injections in Young
Children 0 to 3 Years: Systematic Review of Randomized Controlled
Trials and Quasi-Randomized Controlled Trials
20. No Abstract: Safety in practice: Sharps injuries
21. No Abstract: Medical students’ knowledge of infection control and
prevention: Factors associated with better results and room for
improvement
22. News
– Australia: World Hepatitis Day: Health experts warn Hep C epidemic
hitting Australia
– Pakistan: World Hepatitis Day – 2m people contract hepatitis from
unsafe injections: WHO
– India: WHO urges India to stick to safety guidelines for hepatitis
prevention
– Canada: Prince Albert health region tries new tactic to get used
needles off streets: Health expert fears Prince Albert Parkland health
region decision could lead to more cases of HIV
– Pakistan: Unsafe injections major cause of Hepatitis death: WHO
– WA USA Clallam County health services to distribute brochure on
collecting dirty needles
– India: WHO to launch campaign to combat hepatitis in India
– Northern Ireland UK: One in six Northern Irish drug users “share
needles”, survey claims

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1. Hepatitis: Egypt, Uganda and India to take part in global injection
safety initiative campaign
__________________________________________________________________
https://tinyurl.com/o3bscor

Hepatitis: Egypt, Uganda and India to take part in global injection safety
initiative campaign

Posted by Staff, Outbreak News Today (24.07.15)

The World Health Organization (WHO) announced today that it will
commemorate the fifth World Hepatitis Day next week with a global
injection safety initiative campaign in three pilot countries together
with the foundation arm of IKEA to combat the “silent epidemic” that kills
more than 1.4 million each year.

“Egypt, Uganda and India are three of the flagship countries that will be
taking on the first steps on this campaign,” Dr Edward Kelley, WHO’s
Director of Service Delivery and Safety told reporters in Geneva,
Switzerland.

The global campaign is designed to raise public awareness for safe
injections to combat Hepatitis B and C, ministry engagement for national
plans to deal with the infections and to engage the private sector,
including the syringe manufacturing community, Dr. Kelley said.

He also noted that the most frequent medical procedure in the world today
is administering of injections, “about 16 billion a year and the rate of
unsafe injections of those 16 billion – the estimate is up to 40 per
cent.”

At the press conference devoted to World Hepatitis Day, which falls on
July 28 – the birthday of the American scientist Baruch Blumberg who is
associated with his work on the hepatitis B – the UN health agency
highlighted the urgent need for countries to urgently enhance action to
prevent viral hepatitis infection and to ensure that people who have been
infected are diagnosed and offered treatment.

“We call hepatitis the ‘silent epidemic,’” said Dr. Stefan Wiktor, team
leader of WHO’s Global Hepatitis Programme. “It’s really underappreciated
– it’s level of importance as a cause of death and disease.”

“We estimate about 1.4 to 1.5 million deaths every year from all the
various types of hepatitis. That put it about the seventh leading cause of
death,” he said. WHO’s flagship event next week takes place in Egypt, a
country the health agency says has one of the world’s highest hepatitis
burdens.

“It is estimated that 10 per cent of the population between 15 and 59
years is chronically infected with hepatitis C,” WHO said in a fact sheet.
It adds that between 2007 and 2014, more than 350,000 people with
hepatitis C have been treated. Since the introduction of newer, more
effective medicines in 2014, the number of people being treated continues
to increase.

WHO emphasizes the need for all health services to reduce risks by using
only sterile equipment for injections and other medical procedures, to
test all donated blood and blood components for hepatitis B and C and to
promote the use of the hepatitis B vaccine. Safer sex practices, including
minimizing the number of partners and using barrier protective measures
(condoms), also protect against transmission.

The WHO officials also noted that the prices of medicines have come down
considerably in developing countries where generic drug manufacturers
being able to produce the drugs at lower costs but that the challenge
remained in middle-income countries such as Russia, China and Ukraine
where pharmaceutical companies were trying to make a profit by negotiating
country by country.

Both officials also stressed the importance of treating hepatitis
“comprehensively.”

“We have to push prevention and we have to push treatment,” Dr. Wiktor
said. “What we are really promoting is that countries address hepatitis
comprehensively.”
__________________________________________________________________
________________________________*_________________________________

2. World Hepatitis Day: WHO: Unsafe Injections Major Cause of Hepatitis
Death
__________________________________________________________________
https://tinyurl.com/qy3su36

WHO: Unsafe Injections Major Cause of Hepatitis Death

Lisa Schlein,VOA News (23.07.15)

GENEVA — In advance of World Hepatitis Day (July 28), the World Health
Organization is calling for urgent action to curb millions of infections
and deaths from viral hepatitis.

Hepatitis is a viral infection that attacks the liver and can cause acute
and chronic disease. It is often called a silent epidemic because the harm
it causes tends to be overlooked.

But WHO notes hepatitis is the seventh leading cause of death. It
estimates 240 million people are chronically infected with hepatitis B and
up to 150 million are infected with the hepatitis C virus. Together,
hepatitis B and C account for about 1.5 million deaths every year.

Preventing infection

WHO Global Hepatitis Program team leader Stefan Wiktor says all the tools
needed to prevent the infection and deaths are available. He says there is
a great vaccine for hepatitis B, good laboratory tests that can screen out
infection in the blood supply, and safe injection equipment.

“To prevent death there is treatment,” he said. “There is hepatitis
treatment for hepatitis B, which can control the disease or suppress the
virus, not cure it. Whereas, for hepatitis C. there is now drugs that can
cure almost everybody with hepatitis C. That has been the most dramatic
development in the last few years, that these new drugs that really
transform how we think about hepatitis and it is leading people to start
talking about elimination. Elimination of hepatitis as a public health
problem in the future.”

The cost of the so-called miracle drugs for Hepatitis C are out of reach
for most people around the world. A 12-week course of treatment costs
$84,000 in rich countries. But Egypt has successfully negotiated the price
down to $900 and the World Health Organization believes prices will
continue to fall in coming years.

The hepatitis B virus is transmitted through blood or other bodily fluids.
Most infections occur from mother to child. Hepatitis B prevalence is
highest in sub-Saharan Africa and East Asia.

The hepatitis C virus is a blood borne virus, which is most commonly
transmitted through injecting drug use. WHO Service Delivery and Safety
Department Director Edward Kelley says preventing unsafe injections is key
to curbing this epidemic.

“Unsafe injections account for 32 percent of hepatitis B infections, about
40 percent of hepatitis C… the most frequent medical procedure in the
world today are injections, 16 billion a year and the rate of unsafe
injections of those 16 billion, we estimate is about 40 percent,” she
said.

The World Health Organization is campaigning for the elimination of unsafe
injections by promoting the exclusive use of sterile syringes that are
specifically designed to prevent reuse.
__________________________________________________________________
________________________________*_________________________________

3. Excerpt: WHO Guideline on the Use of Safety-Engineered Syringes for
Intramuscular, Intradermal and Subcutaneous Injections in Health-Care
Settings

PDF Requires Adobe Acrobat Reader [620 KB] Available at
www.who.int/injection_safety/global-campaign/injection-safety_guidline.pdf
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26203487

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

Geneva: World Health Organization; 2015.

WHO Guidelines Approved by the Guidelines Review Committee.

Excerpt

This guideline provides global, evidence-based recommendations on the use
of safety-engineered injection devices to prevent the reuse of syringes
and/or prevent needle-stick injuries in health-care workers. The ultimate
aim is to make injection practices safer for patients and health-care
workers and to prevent the injection-related transmission of deadly
viruses, particularly HIV, Hepatitis C and Hepatitis B.

The procedures covered are intramuscular (IM), intradermal (ID) and
subcutaneous (SC) injections including the syringes needed for the
reconstitution of medication or vaccines when required. Other procedures
e.g. intravenous injections and infusions, blood collection for laboratory
testing, and capillary blood sampling will be covered by another guideline
to be issued separately by WHO.

The policy recommendation aims to support Member States (MS) and
development partners in making informed decisions on the appropriateness
of introducing safety-engineered syringes for all injections in health-
care settings.

Copyright © World Health Organization 2015.

Sections
Acknowledgments
Abbreviations and acronyms
Executive summary
Scope and purpose
Target audience
Background
Methodology
Guideline development process
Management of conflicts of interest
Recommendations
Implications for future research
Considerations for the development of future guidelines
Dissemination, adaptation and implementation
Plans for updating this guideline
References
Appendix 1 WHO global burden of disease sub-regions
Appendix 2 Systematic reviews and evidence summaries report
Appendix 3 Systematic reviews on “Attitudes, values, preferences and
feasibility”
Appendix 4 Grade glossary
Appendix 5 Decision making tables
Appendix 6 Brochure containing the key policy recommendations for
dissemination

Free Books & DocumentsFree full text
http://www.ncbi.nlm.nih.gov/books/NBK305368/
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________________________________*_________________________________

4. Abstract: Hepatitis B and C status among health care workers in the
five main hospitals in eastern Libya
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25151657

J Infect Public Health. 2014 Nov-Dec;7(6):534-41.

Hepatitis B and C status among health care workers in the five main
hospitals in eastern Libya.

Elzouki AN1, Elgamay SM2, Zorgani A3, Elahmer O4.

1Department of Medicine, Hamad General Hospital, Hamad Medical
Corporation, Weill Cornell Medical College, Qatar. Electronic address:
nelzouki_1999@yahoo.com.
2Faculty of Medical Technology, Derna, Libya.
3Department of Microbiology and Immunology, Faculty of Medicine, Tripoli
University, Tripoli, Libya.
4National Center for Diseases Control, Tripoli, Libya.

The aim of the present study was to determine the frequency of hepatitis B
and C transmission to health care workers (HCWs) in five major hospitals
in eastern Libya and to analyze how the risk of these infections are
affected by the type of occupation, hospital work place and working
period.

From July 2008 to June 2009, 601 HCWs (mean age: 32.90 ± 8.85 years) were
tested for HBV and HCV markers using ELISA techniques. Polymerase chain
reaction (PCR) was performed on all positive samples of HBsAg and Anti-HCV
antibody to determine the level of HBV-DNA and HCV-RNA viremia,
respectively.

The overall frequency of HBsAg positivity was 1.8%. Anti-HBc, HBeAg and
Anti-HBe antibodies were found in 8.5%, 0.7% and 8.0% of samples,
respectively. The HBV-DNA level was positive in 55% of all HBsAg-positive
samples. Approximately half of the HCWs (51.4%) were Anti- HBs antibody
positive.

The overall positivity rate of Anti-HCV antibodies was 2.0%, and HCV-RNA
was positive in 33.3% of these samples. Overall, 52% of HCWs reported
receiving full vaccination doses (three doses) against HBV infection.

Among them, anti-HBs positivity was approximately 98.0%. 3.9% of those who
never received any HBV vaccination dose were HBsAg positive, compared to
1.3% HBsAg positive in those HCWs who had received one or two doses of
hepatitis B vaccine (p=0.01 for all comparisons).

Nurses and nurse-aides had the highest rates of both HBsAg and Anti-HCV
among the studied HCWs (HBsAg: 2.1% and 3.2%; Anti-HCV: 3.2% and 4.9%,
respectively). It is noteworthy that doctors also had a relatively high
prevalence rate of Anti-HCV (2.2%).

Obstetric wards, isolation room, dialysis units and dentist work places
had higher frequencies of HBV. HCV was found to be higher in the medical
and surgical wards (the prevalence varied between 3% and 5.6%).

There was no significant difference between HBsAg status and the work
period of HCWs.

In conclusion, universal precautions should be applied for the care of all
patients by all HCWs. Further, HBV vaccines should be more readily
available for Libyan HCWs by reinforcing current vaccination programs.

Copyright © 2014 King Saud Bin Abdulaziz University for Health Sciences.
Published by Elsevier Ltd. All rights reserved.

KEYWORDS: Health care workers; Hepatitis B; Hepatitis B vaccine; Hepatitis
C; Libya
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Prevalence of hepatitis B surface antigen (HBsAg) and its
risk factors among individuals visiting Goba General Hospital, South
East Ethiopia, 2012
__________________________________________________________________
http://www.biomedcentral.com/1756-0500/7/833

BMC Res Notes. 2014 Nov 24;7:833.

Prevalence of hepatitis B surface antigen (HBsAg) and its risk factors
among individuals visiting Goba General Hospital, South East Ethiopia,
2012.

Erena AN1, Tefera TB.

1Department of Medicine, Madawalabu University, College of Medicine and
Health Sciences, Bale-Goba, South East Ethiopia. asfneg@yahoo.com.

BACKGROUND: Hepatitis B virus infection is a significant health problem.
Approximately two billion people worldwide have chronic Hepatitis B virus
infection and over one million die annually. Hepatitis B virus infection
and Human Immunodeficiency Virus co-infection is an emerging concern in
the clinical management of patients because of shared routes of
transmission.

METHODS: Hospital based cross-sectional study was performed from January
to June, 2012 at Goba General Hospital. Socio-demographic and possible
risk factors data from study subjects were collected using pre-test and
structured questionnaire. Venous blood was collected and the serums were
tested for Hepatitis B surface antigen and Human Immune Deficiency Virus
using commercially available rapid test kits. Data were entered and
analyzed using the SPSS software package (version15). Binary and
multivariable logistic regressions were used to identify factors
associated factors. A p-value of <0.05 was considered statistical
significant.

RESULT: The prevalence of Hepatitis B surface Antigen in this study group
was 26 (7.4%). Prevalence of Hepatitis B Human Immune Deficiency Virus Co-
infection was about 9 (42.3%) and about 17 (5.1%) of Human Immuno
Deficiency Virus negative subjects were positive for Hepatitis B surface
Antigen. Risk factors like, hospital admission, multiple sexual partners,
HIV status, and unsafe drug injection were found to have significant
association with Hepatitis B surface Antigen on binary logistic
regression. However, multiple sexual partners and being positive for Human
Immuno Deficiency Virus infection were the only significantly associated
with Hepatitis B Virus on multivariable logistic regression.

CONCLUSION: Even though Hepatitis B surface Antigen prevalence is higher
among subjects who are Human Immuno Deficiency Virus positive, screening
program has to be started in the hospital for all clients regardless of
their disease status to prevent the potential spread of the infection.

Free Article http://www.biomedcentral.com/1756-0500/7/833
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Reuse of Insulin Pens Among Multiple Patients at 2 Veterans
Affairs Medical Centers
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26198627

Infect Control Hosp Epidemiol. 2015 Jul 22:1-9.

Reuse of Insulin Pens Among Multiple Patients at 2 Veterans Affairs
Medical Centers.

Schirmer P1, Winston CA1, Lucero-Obusan C1, Winters M2, Lesse A3, de
Comarmond C4, Oda G1, Martinello RA1, Holodniy M1.

11Office of Public Health,Department of Veterans Affairs,Washington,DC.
22Stanford University,Stanford,California.
33Veterans Affairs Western New York Healthcare System,Buffalo Medical
Center,Buffalo,New York.
45W. G. “Bill” Hefner Veterans Affairs Medical Center,Salisbury,North
Carolina.

OBJECTIVE To determine whether reuse of insulin pens among multiple
patients resulted in transmission of bloodborne pathogens (BBP). DESIGN
Retrospective cohort study.

SETTING Two Veterans Affairs medical centers.

PATIENTS Veterans who received insulin via insulin pens from 2010 to 2013.

METHODS Patients were identified through electronic health records,
notified of possible exposure, and serotested for human immunodeficiency
virus, hepatitis C virus (HCV), and hepatitis B virus. Newly discovered
case patients were assessed in relation to potential proximate patients to
determine viral strain relatedness by HCV envelope (env) gene sequencing.

RESULTS Of 1,791 hospitalized veterans who received insulin via insulin
pen, 1,155 were tested for at least 1 viral infection after exposure. Of
these, 67 patients were newly diagnosed with 1 or more viral BBPs. For
human immunodeficiency virus and hepatitis B virus no additional strain
testing of case or proximate patients was possible; 8 HCV cases and 45
proximates (40 unique patients; 5 patients were positive for 2 genotypes)
were identified as needing strain testing. Only 3 cases and their 19
proximates had samples available for further testing. None of the 26
remaining proximate patients had blood available for further testing.
Median genetic distance between the HCV env sequences of those available
for additional testing ranged from 14% to 24%, indicating nonrelatedness.

CONCLUSIONS Our investigation revealed that exposure to insulin pen reuse
did not result in HCV transmission among patients who had viral genetic
analysis performed. Analysis for any additional potential transmission of
blood-borne pathogens was limited by the available samples.
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Infection control: Knowledge and compliance among Saudi
undergraduate dental students

Excerpt:

“Non-sterile occupational percutaneous injuries and splashes to the eye
were reported by around one-third of students (34.2%), with significant
differences between students in different years of study (p<0.001). Most
of the reported injuries were caused by anesthesia needles and endodontic
files (Figure 1 [Fig. 1]).”

Free full text at the Link
__________________________________________________________________
http://www.egms.de/static/en/journals/dgkh/2015-10/dgkh000253.shtml

Infection control: Knowledge and compliance among Saudi undergraduate
dental students.

GMS Hyg Infect Control. 2015 Jul 1;10:Doc10.

Al-Maweri SA1, Tarakji B2, Shugaa-Addin B2, Al-Shamiri HM2, Alaizari NA2,
AlMasri O3.

1Department of Oral and Maxillofacial Sciences, Al-Farabi Colleges of
Dentistry and Nursing, Riyadh, Saudi Arabia ; Department of Oral Medicine
and Diagnosis, Sana’a University, Sana’a, Yemen.
2Department of Oral and Maxillofacial Sciences, Al-Farabi Colleges of
Dentistry and Nursing, Riyadh, Saudi Arabia.
3Al-Farabi Colleges of Dentistry and Nursing, Riyadh, Saudi Arabia.

OBJECTIVE: This study aimed to assess the level of knowledge, attitudes,
and practices regarding infection control procedures among undergraduate
dental students.

METHODS: This was a questionnaire-based cross-sectional survey. A self-
administered questionnaire consisting of questions on students’
vaccination status as well as knowledge and attitudes regarding infection
control was sent to 600 undergraduate dental students in the fourth,
fifth, and sixth year of the Al-Farabi College for Dentistry and Nursing,
Riyadh, Saudi Arabia. The collected data were analyzed using SPSS
software. The significance level was set at P<0.05.

RESULTS: The response rate was 85% (512 out of 600). While the vast
majority of students (90%) had been vaccinated against hepatitis, only
37.4% have been assessed for anti-HBs. A total of 98.8% and 90.8% reported
always wearing gloves and masks, respectively, during dental procedures.
The use of protective eyewear was reported by only 29.2%. A significantly
higher proportion of sixth-year students showed a positive attitude toward
the treatment of patients with infectious diseases than other students of
lower academic years. Approximately one-third of students reported having
one or more occupational injuries while treating their patients.

CONCLUSION: Although the students had good knowledge and attitudes
regarding infection control, the compliance and practice levels regarding
the same were low. Such findings highlight the necessity of continued
infection-control education of Saudi dental students.

KEYWORDS: compliance; dental students; infection control; knowledge

Free full text
http://www.egms.de/static/en/journals/dgkh/2015-10/dgkh000253.shtml
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Prevalence of blood-borne viruses among Iranian dentists:
Results of a national survey
__________________________________________________________________
Free full text http://dx.doi.org/10.13075/ijomeh.1896.00324

Int J Occup Med Environ Health. 2015;28(3):593-602.

Prevalence of blood-borne viruses among Iranian dentists: Results of a
national survey.

Ahmad Akhoundi MS1, Momeni N1, Norouzi M2, Ghalichi L3, Shamshiri AR4,
Alavian SM5, Poortahmasebi V2, Jazayeri SM6.

1Tehran University of Medical Sciences, Tehran, Iran (Dental Research
Center, Dental Research Institute).
2Tehran University of Medical Sciences, Tehran, Iran (Department of
Virology, School of Public Health, Hepatitis B Molecular Laboratory).
3Iran University of Medical Sciences, Tehran, Iran (Department of
Epidemiology and Biostatistics, Mental Health Research Center).
4Tehran University of Medical Sciences, Tehran, Iran (Department of
Epidemiology and Biostatistics, Dental Research Center).
5Middle East Liver Diseases Center (MELD Centers), Tehran, Iran
(Department of Molecular Hepatology).
6Tehran University of Medical Sciences, Tehran, Iran (Department of
Virology, School of Public Health, Hepatitis B Molecular Laboratory).
jazayerism@tums.ac.ir.

OBJECTIVES: Health care workers, including dentists, are at the front line
for acquiring blood-borne virus infections. This study aimed to
investigate the prevalence of hepatitis B, hepatitis C and human
immunodeficiency viruses among Iranian dentists.

MATERIAL AND METHODS: The survey included 1628 dental health care workers
who attended the 51st annual Congress of the Iranian Dental Association.
Data on the risk of blood-borne virus transmission during health care and
infection control practices were gathered from self-administered
questionnaires. Sera were screened serologically by enzyme-linked
immunosorbent assay (ELISA). The positive samples were examined by
polymerase chain reaction (PRC) followed by direct sequencing.

RESULTS: Six (0.36%) and 81 (5.0%) were positive for hepatitis B surface
antigen (HBsAg) and (anti-hepatitis B virus core antigen (anti-HBc),
respectively. Only 1 (0.061%) was positive for anti-hepatitis C virus
(anti-HCV). No case was positive for anti-human immunodeficiency virus
(anti-HIV). One case was diagnosed as being occult hepatitis B virus (HBV)
infection. One thousand five hundred thirty-five (94.3%) of participants
had received at least 1 dose of HBV vaccine. One thousand three hundred
fifty-nine (88.5%) contained hepatitis B surface antibody (anti-HBs) > 10
IU/ml, of whom 55 (4.0%) were anti-HBc positive, suggesting that they had
been infected with HBV in the past. Anti-HBc positive cases had past
histories of hepatitis, either their own or their spouses’. Individuals
with inadequate anti-HBs levels (< 10 IU/ml) were significantly more
prevalent among anti-HBc positive cases (p < 0.001).

CONCLUSIONS: The prevalence of blood-borne viruses among dental HCWs found
in this study was lower than past reports from Iranian dentists and
general population. The implementation of HBV vaccination together with
improvement in infection control procedures has reduced the potential for
risk infection among Iranian dentists.

This work is available in Open Access model and licensed under a CC BY-NC
3.0 PL license.

KEYWORDS: HBV vaccine; blood-borne viruses; dentists; health care workers;
infection control; occult hepatitis B infection

Free full text http://dx.doi.org/10.13075/ijomeh.1896.00324
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Post exposure prophylaxis to occupational injuries for
general dentist
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26199484

J Indian Prosthodont Soc. 2014 Dec;14(Suppl 1):1-3.

Post exposure prophylaxis to occupational injuries for general dentist.

Utkarsha Lokesh1, Srinidhi D2, Sudhakara Reddy K3.

1Department of Oral Maxillofacial Surgery, Sri Rajivgandhi College of
Dental Sciences, Cholanagar, Hebbal post, Bangalore, India.
2Department of Oral Maxillofacial Surgery, Rajarajeshwari Dental College,
Bangalore, India.
3Department of Oral Maxillofacial Surgery, Sri Rajivgandhi College of
Dental Sciences, Bangalore, India.

Occupational injuries which expose health-care professionals to blood-
borne pathogens continue to be an important public health concern.
Especially, dentists are at increased risk of exposure to Hepatitis B,
Hepatitis C, and HIV.

Dentists should remember and apply many precautions
to prevent the broad spectrum of sharps and splash injuries that could
occur during the delivery of dental care.

This article updates and
consolidates recommendations for the management of dental health-care
personnel who have occupational exposure to blood and other body fluids.

KEYWORDS: Needle stick injury; Occupational injury; Post exposure
prophylaxis
__________________________________________________________________
________________________________*_________________________________

11. Abstract: Gap Analysis of Infection Control Practices in Low- and
Middle-Income Countries
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26198467

Infect Control Hosp Epidemiol. 2015 Jul 22:1-7.

Gap Analysis of Infection Control Practices in Low- and Middle-Income
Countries.

Weinshel K1, Dramowski A2, Hajdu Á3, Jacob S4, Khanal B5, Zoltán M6,
Mougkou K7, Phukan C8, Inés Staneloni M9, Singh N10.

11Society for Healthcare Epidemiology of America,Arlington,Virginia.
22Stellenbosch University,Cape Town,South Africa.
33National Center for Epidemiology,Budapest,Hungary.
44George Washington University,Washington,DC.
55B. P. Koirala Institute of Health Sciences,Nepal.
66Markhot Ferenc Teaching Hospital and Outpatient Clinic,Eger,Hungary.
77National Kapodistrian University,Athens School of
Medicine,Athens,Greece.
88Gauhati Medical College and Hospital,Guwahati,India.
99Hospital Italiano de Buenos Aires,Buenos Aires,Argentina.
1010Children’s National Medical Center,George Washington
University,Washington,DC.

BACKGROUND Healthcare-associated infection rates are higher in low- and
middle-income countries compared with high-income countries, resulting in
relatively larger incidence of patient mortality and disability and
additional healthcare costs.

OBJECTIVE To use the Infection Control Assessment Tool to assess gaps in
infection control (IC) practices in the participating countries.

METHODS Six international sites located in Argentina, Greece, Hungary,
India, Nepal, and South Africa provided information on the health facility
and the surgical modules relating to IC programs, surgical antibiotic use
and surgical equipment procedures, surgical area practices, sterilization
and disinfection of equipment and intravenous fluid, and hand hygiene.
Modules were scored for each country.

RESULTS The 6 international sites completed 5 modules. Of 121 completed
sections, scores of less than 50% of the recommended IC practices were
received in 23 (19%) and scores from 50% to 75% were received in 43 (36%).
IC programs had various limitations in many sites and surveillance of
healthcare-associated infections was not consistently performed. Lack of
administration of perioperative antibiotics, inadequate sterilization and
disinfection of equipment, and paucity of hand hygiene were found even in
a high-income country. There was also a lack of clearly written defined
policies and procedures across many facilities.

CONCLUSIONS Our results indicate that adherence to recommended IC
practices is suboptimal. Opportunities for improvement of IC practices
exist in several areas, including hospital-wide IC programs and
surveillance, antibiotic stewardship, written and posted guidelines and
policies across a range of topics, surgical instrument sterilization
procedures, and improved hand hygiene.
__________________________________________________________________
________________________________*_________________________________

12. Abstract: Assessing future scenarios for health care waste management
using a multi-criteria decision analysis tool: A case study in the
Turkish West Black Sea Region
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26211633

J Air Waste Manag Assoc. 2015 Aug;65(8):919-29.

Assessing future scenarios for health care waste management using a multi-
criteria decision analysis tool: A case study in the Turkish West Black
Sea Region.

Ciplak N1.

1a Department of Environmental Engineering, Faculty of Engineering ,
University of Karabuk , Karabuk , Turkey.

The aim of this paper is to identify the best possible health care waste
management option in the West Black Sea Region by taking into account
economic, social, environmental, and technical aspects in the concept of
multi-criteria decision analysis. In the scope of this research, three
different health care waste management scenarios that consist of different
technology alternatives were developed and compared using a decision-
making computer software, called Right Choice, by identifying various
criteria, measuring them, and ranking their relative importance from the
point of key stakeholders.

The results of the study show that the decentralized autoclave technology
option coupled with the disposal through landfilling with energy recovery
has potential to be an optimum option for health care waste management
system, and an efficient health care waste segregation scheme should be
given more attention by the authorities in the region. Furthermore, the
discussion of the results points out multidisciplinary approach and the
equilibrium between social, environmental, economic, and technical
criteria. The methodology used in this research was developed in order to
enable the decision makers to gain an increased perception of a decision
problem.

In general, the results and remarks of this study can be used as a basis
of future planning and anticipation of needs for investment in the area of
health care waste management in the region and also in developing
countries that are dealing with the similar waste management problems.

IMPLICATIONS: Alternative technologies are not capable to treat some
categories of health care wastes, and Turkish practice has to be revised
urgently. In doing so, internal health care waste separation is critical
for determination of treatment technology. The author verified the
methodology in a decision-making framework for a real-world problem.
Results indicated that incinerating all health care wastes is not a
feasible option due to high cost.
__________________________________________________________________
________________________________*_________________________________

13. Abstract: Transition to injecting drug use in Iran: A systematic
review of qualitative and quantitative evidence
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26210009

Int J Drug Policy. 2015 May 12. pii: S0955-3959(15)00129-2.

Transition to injecting drug use in Iran: A systematic review of
qualitative and quantitative evidence.

Rahimi-Movaghar A1, Amin-Esmaeili M2, Shadloo B1, Noroozi A3, Malekinejad
M4.

1Iranian National Center for Addiction Studies (INCAS), Iranian Institute
for Reduction of High-Risk Behaviors, Tehran University of Medical
Sciences, No. 486, South Karegar Ave., Postal Code: 1336616357, Tehran,
Iran.
2Iranian Research Center for HIV/AIDS (IRCHA), Iranian Institute for
Reduction of High-Risk Behaviors, Tehran University of Medical Sciences,
Imam Khomeini Hospital, Keshavarz Blvd., Postal code: 14197-33141, Tehran,
Iran.
3Iranian National Center for Addiction Studies (INCAS), Iranian Institute
for Reduction of High-Risk Behaviors, Tehran University of Medical
Sciences, No. 486, South Karegar Ave., Postal Code: 1336616357, Tehran,
Iran; School of Advanced Technologies of Medicine, Tehran University of
Medical Sciences, Iran.
4Institute for Health Policy Studies and Global Health Sciences,
University of California San Francisco, 3333 California Street, Suite 265,
San Francisco, CA 94118, USA. Electronic address: MMalekinejad@ucsf.edu.

BACKGROUND: Injection drug use, a behavior associated with significant
adverse health effects, has been increasing over the past decade in Iran.
This study aims to systematically review the epidemiological and
qualitative evidence on factors that facilitate or protect the transition
to injection drug use in Iran.

METHODS: We conducted electronic searches in five international (Medline,
Web of Science, EMBASE, CINAHL, PsycINFO), one regional (IMEMR) and three
Iranian (Iranmedex, Iranpsych, IranDoc) databases, as well as contacting
experts in the field. Two trained researchers screened documents to
identify relevant studies and independently dual-extracted data following
pre- specified protocol. We applied principles of thematic analysis for
qualitative data and applied a random effect meta-analysis model for age
of first injection.

RESULTS: A total of 38 documents from 31 studies met eligibility criteria,
from which more than 50% were implemented from 2006 to 2008. The weighted
mean age of first injection was 25.8 (95% Confidence Interval: 25.3-26.2).
Between 1998 and 2011, the age of first injection was relatively stable.
Overall, drug users had used drugs for 6-7 years before they started
injection use. Heroin was the first drug of injection in the majority of
the cases. We identified factors influencing the initiation of or
transition to injection use at various levels, including: (1) individual
(pleasure-seeking behavior, curiosity and development of drug dependency
commonly reported), (2) social and environmental (role of peer drug users
in the first injection use, the economic efficiency associated with
injections and the wide availability of injectable form of drugs in the
market).

CONCLUSION: Harm reduction policies in Iran have almost exclusively
focused on drug injectors in Iran. However, given the extent of the non-
injection drug use epidemic, evidence from this study can provide insight
on points of interventions for the prevention of the transition to
injection use.

Copyright © 2015 Elsevier B.V. All rights reserved.

KEYWORDS: First injection episode; Harm reduction; Iran; Protective
factors for injecting; Risk factors for injecting; Substance use;
Systematic review
__________________________________________________________________
________________________________*_________________________________

14. Abstract: Subcutaneous Injection of Percocet: A Case of Severe Soft
Tissue Loss
__________________________________________________________________
Wounds. 2015 Jul;27(7):174-9.

Subcutaneous Injection of Percocet: A Case of Severe Soft Tissue Loss.

Baskin SM1, Abboud C1, Chen W2, Tolchin E3, Kelly RW3, Aballay AM4.

1Lake Erie College of Osteopathic Medicine, Erie, PA.
2University of Pittsburgh School of Medicine, Department of Plastic and
Reconstructive Surgery, Pittsburgh, PA.
3West Penn Burn Center, Western Pennsylvania Hospital, Pittsburgh, PA.
4West Penn Burn Center, Western Pennsylvania Hospital, Pittsburgh, PA;
email: AAballay@wpahs.org.

Prescription drug abuse ranks as the second most common class of illicit
drug use in the United States, and one mechanism of opiate abuse involves
intravenous injection of enteral narcotics such as oxycodone or
hydrocodone.

The authors describe a patient who sustained significant soft tissue
necrosis after intravenously injecting a solution made from crushed
enteral narcotics, with a focus on the operative course that resulted due
to a delay in initial definitive treatment.

The patient’s wounds encompassed 8% total body surface area and covered
247 cm2. A 55-year-old female was admitted to the burn unit (West Penn
Burn Center, Western Pennsylvania Hospital, Pittsburgh, PA) after she
initially presented with infection and cellulitis to her bilateral upper
extremities 3 weeks after intravenously injecting herself with crushed
oxycodone/acetaminophen.

She underwent numerous sequential operative repairs including initial
debridement, placement of dermal replacement templates, and several split-
thickness autografts and xenografts. Her total length of stay was 59 days,
broken into an initial 47-day stay, and a subsequent 12-day readmission
due to graft failure secondary to poor follow-up.

As the number of prescription drug abusers rises, it is possible that an
increase in attempts to intravenously abuse enteral narcotics may also
rise. As such, burn centers should be prepared for the extent of potential
limb necrosis and the operative treatment that may ensue.

Free full text https://tinyurl.com/or2w9u5
__________________________________________________________________
________________________________*_________________________________

15. Abstract: Achieving Hand Hygiene Success With a Partnership Between
Graduate Medical Education, Hospital Leadership, and Physicians
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26201665

Am J Med Qual. 2015 Jul 22. pii: 1062860615596567.

Achieving Hand Hygiene Success With a Partnership Between Graduate Medical
Education, Hospital Leadership, and Physicians.

Rosenbluth G1, Garritson S2, Green AL3, Milev D3, Vidyarthi AR4, Auerbach
AD3, Baron RB3.

1University of California, San Francisco, CA rosenbluthg@peds.ucsf.edu.
2UCSF Medical Center, San Francisco, CA.
3University of California, San Francisco, CA.
4Duke-NUS Graduate Medical School, Singapore Singapore General Hospital,
Singapore.

Engaging physicians in hand hygiene programs is a challenge faced by many
academic medical centers. Partnerships between education and academic
leaders present opportunities for effective collaboration and improvement.

The authors developed a robust hand hygiene quality improvement program,
with attention to rapid-cycle improvements, including all levels of staff
and health care providers. The program included a defined governance
structure, clear data collection process, educational interventions,
rapid-cycle improvements, and financial incentive for staff and physicians
(including residents and fellows).

Outcomes were measured on patients in all clinical areas. Run charts were
used to document compliance in aggregate and by subgroups throughout the
project duration.

Institutional targets were achieved and then exceeded, with sustained hand
hygiene compliance >90%. Physician compliance lagged behind aggregate
compliance but ultimately was sustained at a level exceeding the target.

Successfully achieving the institutional goal required collaboration among
all stakeholders. Physician-specific data and physician champions were
essential to drive improvement.

© The Author(s) 2015.

KEYWORDS: hand hygiene; infection control; quality improvement; residents
and fellows
__________________________________________________________________
________________________________*_________________________________

16. Abstract: Nurses’ perceptions and satisfaction with the use of insulin
pen devices compared with insulin vial and syringes in an inpatient
setting
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25198537

Diabetes Technol Ther. 2014 Nov;16(11):742-6.

Nurses’ perceptions and satisfaction with the use of insulin pen devices
compared with insulin vial and syringes in an inpatient setting.

Shogbon AO1, Ngo D, Jacob B, Kimble LP, Ryan G.

11 Mercer University College of Pharmacy , Atlanta, Georgia .

BACKGROUND: The purpose of this study was to compare nurses’ perceptions
and satisfaction with the use of insulin pen devices versus vial and
syringes for insulin delivery in an inpatient setting.

MATERIALS AND METHODS: The study used a descriptive design using self-
report surveys. Nurses rated their perceptions on a 4-point Likert scale
(from 1=strongly disagree to 4=strongly agree) on the ease of use, ease to
teach patients, confidence and comfort in use, perceived time efficiency,
safety of use, risk of needle sticks, and overall satisfaction and
preference with use of each insulin delivery device.

RESULTS: In total, 139 (95%) nurses from nine nursing units at one
hospital participated in this study. Compared with vial and syringe,
nurses felt insulin pens were easier to use to measure insulin dose
(mean±SD, 3.7±0.5 vs. 3.1±0.7; P<0.001), were easier to teach patients to
use (3.5±0.6 vs. 2.8±0.7; P<0.001), provided more confidence in measuring
insulin dose (3.7±0.5 vs. 3.4±0.6, P<0.001), saved on administration and
preparation time (3.6±0.5 vs. 2.3±0.8; P<0.001), reduced the risk of
giving a wrong dose of insulin (3.2±0.8 vs. 2.2±0.7; P<0.001), and reduced
the risk of needle sticks (3.5±0.7 vs. 2.1±0.8; P<0.001). Overall, a
majority of nurses preferred the use of insulin pens to vial and syringes
in an inpatient setting (83% vs. 15%; P<0.05).

CONCLUSIONS: Nurses felt more comfortable and confident with the use of
insulin pens compared with vial and syringes and perceived insulin pens to
be a safer alternative for both patients and themselves.
__________________________________________________________________
________________________________*_________________________________

17. Abstract: Pharmacological and Combined Interventions to Reduce Vaccine
Injection Pain in Children and Adults: Systematic Review and Meta-
analysis
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26201016

Clin J Pain. 2015 Jul 21.

Pharmacological and Combined Interventions to Reduce Vaccine Injection
Pain in Children and Adults: Systematic Review and Meta-analysis.

Shah V1, Taddio A, McMurtry CM, Halperin SA, Noel M, Riddell RP, Chambers
CT; HELPinKIDS Team.

1*Neonatologist, Mount Sinai Hospital and Associate Professor, Faculty of
Medicine, University of Toronto †Leslie Dan Faculty of Pharmacy,
University of Toronto and Senior Associate Scientist, The Hospital for
Sick Children ‡Department of Psychology, University of Guelph, Associate
Scientist, Children’s Health Research Institute, and Adjunct Researcher,
Department of Paediatrics, Western University, London, Ontario
§Departments of Pediatrics and Microbiology and Immunology, Dalhousie
University, IWK Health Centre, Halifax, Nova Scotia ?Center for Child
Health, Behavior and Development, Seattle Children’s Research Institute,
Seattle, WA ¶York University and Adjunct Scientist, The Hospital for Sick
Children #Department of Pediatrics and Psychology, Faculty of Science,
Dalhousie University, IWK Health Centre, Nova Scotia.

BACKGROUND: This systematic review assessed the effectiveness and safety
of pharmacotherapy and combined interventions for reducing vaccine
injection pain in individuals across the lifespan.

DESIGN/METHODS: Electronic databases were searched for relevant randomized
and quasi- randomized controlled trials. Self-reported pain and fear as
well as observer-rated distress were critically important outcomes. Data
were combined using standardized mean difference (SMD) or relative risk
(RR) with 95% confidence intervals (CI).

RESULTS: Fifty-Five studies that examined breastfeeding (which combines
sweet- tasting solution, holding and sucking), topical anesthetics, sweet-
tasting solutions (sucrose, glucose), vapocoolants, oral analgesics, and
combination of two versus one intervention were included.

The following results report findings of analyses of critical outcomes
with the largest number of participants. Compared to control, acute
distress was lower for infants breastfed during vaccination (n=792): SMD
-1.78 (CI: -2.35, -1.22) and before vaccination (n=100): SMD -1.43 (CI:
-2.14, -0.72).

Compared to control/placebo, topical anesthetics showed benefit on acute
distress in children (n=1424): SMD -0.91, (CI: -1.36, -0.47) and self-
reported pain in adults (n=60): SMD -0.85 (CI: -1.38, -0.32). Acute and
recovery distress was lower for children who received sucrose (n=2071):
SMD -0.76, (CI: -1.19, -0.34) or glucose (n=818): [SMD: -0.69, (CI: -1.03,
-0.35)] compared to placebo/no treatment. Vapocoolants reduced acute pain
in adults [(n=185) SMD -0.78, (CI: -1.08, -0.48)] but not children.

Evidence from other needle procedures showed no benefit of acetaminophen
or ibuprofen. The administration of topical anesthetics before and
breastfeeding during vaccine injections showed mixed results when compared
to topical anesthetics alone.

There were no additive benefits of combining glucose and non-nutritive
sucking (pacifier) compared to glucose or non- nutritive sucking
(pacifier) alone or breastfeeding and sucrose compared to breastfeeding or
sucrose alone.

CONCLUSIONS: Breastfeeding, topical anesthetics, sweet-tasting solutions
and the combination of topical anesthetics and breastfeeding are effective
in reducing vaccine injection pain in infants and children and its use
should become the standard of care. In adults, limited data demonstrate
some benefit of topical anesthetics and vapocoolants.

This is an open-access article distributed under the terms of the Creative
Commons Attribution- Non Commercial-No Derivatives License 4.0 (CCBY-NC-
ND), where it is permissible to download and share the work provided it is
properly cited.

The work cannot be changed in any way or used commercially.
http://creativecommons.org/licenses/by-nc-nd/4.0.

Free Full Text: https://tinyurl.com/nh3g3x3
__________________________________________________________________
________________________________*_________________________________

18. Abstract: Process Interventions for Vaccine Injections: Systematic
Review of Randomized Controlled Trials and Quasi-randomized Controlled
Trials
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26201015

Clin J Pain. 2015 Jul 21.

Process Interventions for Vaccine Injections: Systematic Review of
Randomized Controlled Trials and Quasi-randomized Controlled Trials.

Pillai Riddell R1, Anna T, McMurtry CM, Vibhuti S, Melanie N, Chambers CT;
HELPinKIDS&Adults Team.

1*York University and Adjunct Scientist, The Hospital for Sick Children,
Toronto, Ontario †Leslie Dan Faculty of Pharmacy, University of Toronto
and Senior Associate Scientist, The Hospital for Sick Children, Toronto,
Ontario ‡Department of Psychology, University of Guelph, Associate
Scientist, Children’s Health Research Institute, and Adjunct Researcher,
Department of Paediatrics, Western University, London, Ontario §Mount
Sinai Hospital and Associate Professor, Faculty of Medicine, University of
Toronto, Toronto, Ontario ?Center for Child Health, Behavior and
Development, Seattle Children’s Research Institute, Seattle, Washington
¶Department of Pediatrics and Psychology, Faculty of Science, Dalhousie
University, IWK Health Centre, Halifax, Nova Scotia.

BACKGROUND: This systematic review evaluated the effectiveness of process
interventions (education for clinicians, parent presence, education of
parents [before and on day of vaccination], and education of patients on
day of vaccination) on reducing vaccination pain, fear, and distress and
increasing the use of interventions during vaccination.

DESIGN/METHODS: Databases were searched using a broad search strategy to
identify relevant randomized and quasi-randomized controlled trials.
Critical outcomes were pain, fear, distress [when applicable], and use of
pain management interventions. Data were extracted according to procedure
phase (pre-procedure, acute, recovery, combinations of these) and pooled
using established methods. Analyses were conducted using Standardized Mean
Differences (SMD) and Risk Ratios (RR).

RESULTS: Thirteen studies were included. Results were generally mixed.
Based on low to very low quality evidence, the following specific critical
outcomes showed significant effects suggesting: (1) Clinicians should be
educated about vaccine injection pain management [Use of interventions:
SMD 0.66 (95% Confidence Interval [CI] 0.47, 0.85)]; (2) Parents should be
present [Distress Pre-procedure: SMD -0.85 (95% CI -1.35, -0.35]; (3)
Parents should be educated prior to the vaccination day [Use of
Intervention pre-procedure: SMD 0.83 (95% CI 0.25, 1.41) and RR 2.08 (95%
CI 1.51, 2.86); Distress Acute: SMD -0.35 (95% CI -0.57, -0.13)]; (4)
Parents should be educated on the vaccination day [Use of interventions:
1.02 SMD (95% CI 0.22, 1.83) and RR 2.42 (1.47, 3.99); Distress Pre-
Procedure+Acute+Recovery: -0.48 (95% CI -0.82, -0.15)]; and (5)
Individuals 3 years of age and older should be educated on the day of
vaccination [Fear pre-procedure: -0.67 SMD (95% CI -1.28, -0.07)].

CONCLUSIONS: Educating individuals involved in the vaccination procedure
(clinicians, parents of children being vaccinated; individuals older than
3 y of age) is beneficial to increase use of pain management strategies,
reduce distress surrounding with vaccination, and to reduce fear. When
possible, parent presence is also recommended for children undergoing
vaccination.

This is an open-access article distributed under the terms of the Creative
Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-
ND), where it is permissible to download and share the work provided it is
properly cited. The work cannot be changed in any way or used
commercially. http://creativecommons.org/licenses/by-nc-nd/4.0.

Free Full Text: https://tinyurl.com/qbryd4f
__________________________________________________________________
________________________________*_________________________________

19. Abstract: Psychological Interventions for Vaccine Injections in Young
Children 0 to 3 Years: Systematic Review of Randomized Controlled
Trials and Quasi-Randomized Controlled Trials
__________________________________________________________________
https://tinyurl.com/oa59b9t

Clin J Pain. 2015 Jul 21.

Psychological Interventions for Vaccine Injections in Young Children 0 to
3 Years: Systematic Review of Randomized Controlled Trials and Quasi-
Randomized Controlled Trials.

Riddell RP1, Taddio A, McMurtry CM, Chambers CT, Shah V, Noel M;
HELPinKIDS Team.

1*York University; Scientific Staff, The Hospital for Sick Children;
Adjunct Associate Professor, University of Toronto; Toronto, Ontario
†Leslie Dan Faculty of Pharmacy, University of Toronto and Senior
Associate Scientist, The Hospital for Sick Children, Toronto, Ontario
‡Department of Psychology, University of Guelph, Associate Scientist,
Children’s Health Research Institute, and Adjunct Researcher, Department
of Paediatrics, Western University, London, Ontario §Department of
Pediatrics and Psychology, Dalhousie University, Centre for Pediatric Pain
Research, IWK Health Centre, Halifax, Nova Scotia ?Mount Sinai Hospital
and Associate Professor, Faculty of Medicine, University of Toronto,
Toronto, Ontario ¶Center for Child Health, Behavior and Development,
Seattle Children’s Research Institute, Seattle, Washington.

BACKGROUND: This systematic review evaluated the effectiveness of
distraction for reducing infant distress during vaccinations in young
children aged 0 to 3 years.

DESIGN/METHODS: Database searches identified relevant randomized and
quasi-randomized controlled trials. Three separate clinical questions
related to variants of the psychological strategy of distraction (directed
video; directed toy; non-directed toy) were pursued. Distress was
identified as the critical outcome to assess the benefits of distraction
and extracted from relevant trials. Distress was analyzed by phase of
procedure (distress pre-procedure; distress acute; distress recovery;
idiosyncratic phases based on some or all of the three aforementioned
phases).

RESULTS: Ten studies were included in the review. Significant results are
presented herein. For directed video distraction, moderate quality
evidence suggested distress was lowered in the treatment group (SMD 0.68
lower [95% CI -1.04, -0.32]) for the acute+recovery phase as well as the
pre- procedure phase (SMD 0.49 lower [95% CI -76, -0.22]). For directed
toy distraction, the analysis of low quality evidence for a combined pre-
procedure+acute+recovery phase of distress (analysis n=81), suggested
distress was lowered in the treatment group (SMD 0.47 lower [95% CI -0.91,
-0.02]). An effect for non-directed toy distraction was also seen,
analyzing very low quality evidence, for the acute distress phase (n=290;
SMD 0.93 lower, [95% CI -1.86, 0.00]).

CONCLUSIONS: Generally low to very low quality evidence suggests that
there may be an effect of directed (toy and video) and non-directed toy
distraction for children aged 0 to 3, for certain phases of the
vaccination.

This is an open-access article distributed under the terms of the Creative
Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-
ND), where it is permissible to download and share the work provided it is
properly cited. The work cannot be changed in any way or used
commercially. http://creativecommons.org/licenses/by-nc-nd/4.0.

Free Full Text: https://tinyurl.com/oa59b9t
__________________________________________________________________
________________________________*_________________________________

20. No Abstract: Safety in practice: Sharps injuries
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25998331

Br Dent J. 2015 May 22;218(10):556.

Safety in practice: Sharps injuries.

Scully C, Samaranayake L.

Comment on

‘Needle-stick injuries and transmission of HIV to HCWs’. [Br Dent J. 1994]
__________________________________________________________________
________________________________*_________________________________

21. No Abstract: Medical students’ knowledge of infection control and
prevention: Factors associated with better results and room for
improvement
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26190384

Am J Infect Control. 2015 Jul 16. pii: S0196-6553(15)00658-6.

Medical students’ knowledge of infection control and prevention: Factors
associated with better results and room for improvement.

Legeay C1, Thépot-Seegers V2, Groh M3, Pilmis B3, Zahar JR4.

1Unité de Prévention et de Lutte contre les Infections Nosocomiales, CHU
d’Angers, Université d’Angers, Angers, France.
2Service d’Information Médicale, CHU d’Angers, Université d’Angers,
Angers, France.
3Infection Control Unit, Assistance Publique Hôpitaux de Paris, CHU Necker
Enfants Malades, Paris, France.
4Unité de Prévention et de Lutte contre les Infections Nosocomiales, CHU
d’Angers, Université d’Angers, Angers, France. Electronic address:
jeanralph.zahar@chu-angers.fr.
__________________________________________________________________
________________________________*_________________________________

22. News

– Australia: World Hepatitis Day: Health experts warn Hep C epidemic
hitting Australia
– Pakistan: World Hepatitis Day – 2m people contract hepatitis from
unsafe injections: WHO
– India: WHO urges India to stick to safety guidelines for hepatitis
prevention
– Canada: Prince Albert health region tries new tactic to get used
needles off streets: Health expert fears Prince Albert Parkland health
region decision could lead to more cases of HIV
– Pakistan: Unsafe injections major cause of Hepatitis death: WHO
– WA USA Clallam County health services to distribute brochure on
collecting dirty needles
– India: WHO to launch campaign to combat hepatitis in India
– Northern Ireland UK: One in six Northern Irish drug users “share
needles”, survey claims

Selected news items reprinted under the fair use doctrine of international
copyright law: http://www4.law.cornell.edu/uscode/17/107.html
__________________________________________________________________
https://tinyurl.com/qasgjr3

Australia: World Hepatitis Day: Health experts warn Hep C epidemic hitting
Australia

PM By Elise Worthington,ABC Online, ABC News Australia (28.07.15)

Public health experts are warning Australia is in the midst of a Hepatitis
C epidemic with almost a quarter of a million people suffering from the
blood-borne virus.

Around 90 per cent of new infections are among people who inject drugs and
research shows the prevalence of Hepatitis C among those using needle
exchange programs is rising despite increased access to clean syringes.

Hepatitis C is the most prevalent blood-borne virus in Australia and
because of a lack of symptoms, it can go undetected for years.

If left untreated, the infectious disease attacks the liver and can lead
to cirrhosis, end-stage liver disease and liver cancer.

Fiona has been volunteering at the peer-based New South Wales Users and
Aids Association (NUAA) needle exchange clinic in Sydney for years.

She contracted Hepatitis C in the mid 1980s while sharing syringes.

“I’m 50 now. I’ve been using for many years, probably over 30,” she said.

“So there was that intense guilt around that, it’s alright for me to get
it but it’s not OK for me to give it, and I knew nothing, I didn’t know if
I was going to live or die.”

The NUAA needle exchange service is the only peer-based service in the
state that allows clients to come in, take what they need and get advice
from other drug users.

Fiona said while Hepatitis C education and access to syringes had
improved, many people were still sharing, some due to the stigma involved
in getting clean gear.

“For some people sharing is part of their routine of drug use, it might be
with their partner,” she said.

“It’s also very hard for some people if you are asked to give someone a
syringe and you’ve used it and if they are begging you to use that what do
you do?

“You don’t want them to be sick or hang out because you understand that
feeling, but you don’t want to give them a virus.

“If someone is begging you for that syringe it’s really hard not to.

“It puts you in a real ethical dilemma I suppose.”

Multi-coloured syringes handed out

Today is World Hepatitis Day and among T-shirts and pens reminding clients
of the risks of Hepatitis C, Fiona is unpacking a box of multi-coloured
syringes, specially designed to stop users from sharing when injecting in
a group.

Fellow volunteer James is tallying up the number of syringes he has given
out today.

“I just feel like I’m making a difference and yeah if it wasn’t for people
doing this, we’d be back in the dark old days which weren’t good,” he
said.

“A lot of people got Hep C and when they haven’t got drugs they drink …
I’ve seen friends of mine die.”

James, who has also contracted Hepatitis C, said he was now educated on
how to prevent the virus.

“As an injecting drug user am I concerned? Not anymore, because it’s all
clean if you do the right thing and follow the rules which are quite
straight, you can’t go wrong,” he said.

The problem public health authorities are facing is that many people are
not following those rules.

Research on people accessing needle and syringe programs in Australia has
shown there has been a significant increase in Hepatitis C prevalence
among clients in 2014.

A parliamentary inquiry into the virus has heard it is estimated 10,000
people a year contract Hepatitis C and 700 people a year die from
Hepatitis C-associated liver disease.

Australian Injecting and Illicit Drug Users League (AIVL) executive
officer Annie Madden said a large part of the problem was the stigma and
discrimination faced by those trying to access clean equipment.

“People must be able to get access to the amounts and types of injecting
equipment they need, when they need it,” she said.

I get pain in my right hand side where I know it’s about my liver, having
issues with my kidneys where it’s related to my liver so physically
tiredness, depression and those kind of things.

Fiona, drug user and volunteer at New South Wales Users and Aids
Association

“That means, as a minimum, providing more access points, after-hours
access, increased peer education and removing legal barriers to peer
distribution of injecting equipment,” she said.

Candice was also a client at the clinic before starting to volunteer at
the service.

“I first contracted Hepatitis C at 19. I’d been using for a year and a
half by then and I had a partner I introduced to needle administration as
well,” she said.

“We would share with each other and he one day went off and without my
knowledge went and shared with people and contracted Hep C.”

Candice said she only found out her partner was positive when he went to
jail and was tested for the virus.

While newer and more effective treatments are becoming more widely
available they are still expensive and many people are afraid of the side
effects.

Many of those who have been living with the virus for decades have watched
friends suffer and die and chronic hepatitis infection is now the leading
reason for liver transplantation in Australia.

Fiona said the impacts of the virus on her body were only just becoming
more obvious now she was getting older.

She is waiting for newer generation Hepatitis C drugs to become available
on the PBS.

“I get pain in my right hand side where I know it’s about my liver, having
issues with my kidneys where it’s related to my liver so physically
tiredness, depression and those kind of things,” she said.

“Heaps of people I know and work with, or are part of my social network,
have Hep C and too many have died of liver-related cancer and the like and
it’s always really sad and horrible.”
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https://tinyurl.com/ne6j7yr

Pakistan: World Hepatitis Day – 2m people contract hepatitis from unsafe
injections: WHO

By Our Staff Reporter, Dental News Pakistan, Pakistan (27.07.15)

GENEVA – World Health Organization (WHO), an international organization
that aims to fight and control disease, has alerted people to the risks of
contracting hepatitis from unsafe blood, unsafe injections, and sharing
drug-injection equipment, saying some 11 million people, who inject drugs,
have hepatitis B or C infection.

Highlighting the urgent need for enhancing action to prevent viral
hepatitis infection, WHO urged countries to ensure infected people are
diagnosed and offered treatment.

A WHO press release issued on the eve of World Hepatitis Day said that
this year it was focusing, particularly on hepatitis B and C, which
together cause around 80 per cent of all liver cancer deaths and kill
close to 1.4 million people every year.

It cautioned that children born to mothers with hepatitis B or C and sex
partners of people with hepatitis are also at risk of becoming infected.

The world health body emphasized the need for all health services to
reduce risks by using only sterile equipment for injections and other
medical procedures, to test all donated blood and blood components for
hepatitis B and C (as well as HIV and syphilis) and to promote the use of
the hepatitis B vaccine. Safer sex practices, including minimizing the
number of partners and using barrier protective measures (condoms), also
protect against transmission, it said.

Approximately, two million people contract hepatitis from unsafe
injections each year but these infections could be averted by using
sterile syringes that are specifically designed to prevent reuse.

INJECTIONS: Two million people contract hepatitis from unsafe injections
each year which could be prevented with sterile syringes.

Suggesting that oral medications could be used, WHO said that injections
are not the first recommended course of treatment for many diseases.

In this regard, the world body pointed out that of the total 16 billion
injections administered every year, around 5pc of them are for
immunization, a further 5pc for procedures like blood transfusions and
injectable contraceptives, and the remaining 90pc to administer medicines.

WHO recommended vaccinating all children against hepatitis B infection,
from which approximately 780,000 people die each year. A safe and
effective vaccine could protect from hepatitis B infection for life.
Ideally, the vaccine should be given as soon as possible after birth,
preferably within 24 hours. The birth dose should be followed by 2 or 3
doses to complete the vaccine series.

Recommending vaccinating adults who are at increased risk of acquiring
hepatitis B, the organization said that these include people who
frequently require blood or blood products (for example dialysis
patients), health-care workers, people who inject drugs, household and
sexual contacts of people with chronic hepatitis B, and people with
multiple sexual partners.

It is since 1982, over one billion doses of hepatitis B vaccine have been
used worldwide and millions of future deaths from liver cancer and
cirrhosis have been prevented. In a number of countries where around one
in 10 children used to become chronically infected with the hepatitis B
virus, vaccination has reduced the rate of chronic infection to less than
one in 100 among immunized children.

Though no vaccine is available against hepatitis C to-date, medicines are
now available that could cure most people with hepatitis C and control
hepatitis B infection. People who receive these medicines are much less
likely to die from liver cancer and cirrhosis and much less likely to
transmit the virus to others. WHO, therefore, urged people who think they
might have been exposed to hepatitis to get tested so they can find out
whether they required treatment to improve their own health and reduce the
risk of transmission.

Earlier this year, the WHO’s new guidelines for treatment of hepatitis B
infection, recommended use of simple non- invasive tests to assess the
stage of liver disease to help identify who required treatment.

WHO also called for prioritizing treatment of those with cirrhosis, the
most advanced stage of liver disease, and for the use of two safe and
highly effective medicines – tenofovir or entecavir. Continued monitoring
of using simple tests is important to assess whether treatment is working,
and if it can be stopped.

In 2014, WHO issued guidance for testing and treatment of hepatitis C
infection whereby it recommended providing testing for people considered
at high risk of infection and ensuring treatment for those, who have the
virus, with several effective medicines, including new regimens that use
only oral medicines.

WHO will update recommendations on drug treatments periodically as and
when new anti-viral medicines become available and new evidence emerges,
the release concluded.
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https://tinyurl.com/nf65xks

India: WHO urges India to stick to safety guidelines for hepatitis
prevention

Economic Times, By PTI, India (27.07.15)

NEW DELHI: Ahead of World Hepatitis Day tomorrow, the World Health
Organisation has urged India to strictly adhere to the WHO injection
safety guidelines for hepatitis prevention.

“The health sector needs to strengthen disease surveillance systems,
ensure injection and patient safety, screen all blood products and ensure
strict adherence to the new WHO injection safety guidelines while
improving infant vaccination rates including birth dose of hepatitis B
within first 24 hours of first 24 hours of delivery,” Dr Poonam Khetrapal
Singh, Regional Director of WHO for South-East Asia Region said today.

Around 40 million people live with chronic hepatitis B infection in India
alone and 60 per cent living with HIV co-infected with hepatitis run the
greater risk of complications and deaths.

“The responsibility also lies with individuals. Health promotion
initiatives need to be strengthened and people made aware of how they risk
getting hepatitis and what they need to do to protect themselv ..

Read more at:
http://economictimes.indiatimes.com/articleshow/48240541.cms?utm_source=
contentofinterest&utm_medium=text&utm_campaign=cppst
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https://tinyurl.com/np3op2r

Canada: Prince Albert health region tries new tactic to get used needles
off streets: Health expert fears Prince Albert Parkland health region
decision could lead to more cases of HIV

by Angela Hill, News Talk 650 CKOM, Saskatchewan Canada (25.07.15)

A Saskatchewan health region is changing how it hands needles out in an
effort to get more of them off the street.

“We had quite a large number of people who never brought anything back
in,” said Brett Enns, vice-president of primary and community care with
the Prince Albert Parkland Health Region.

Around 200 people, representing 28 per cent of those who use the needle
exchange at Access Place, never returned their used equipment.

“We tried to continue to educate folks and we tried to ask them to just
pick up a couple. We don’t want a one-for-one exchange, and it’s never
going to be that, ‘but if you can do your part and bring a few in as you
come that would be helpful and that would help with our program,’” Enns
said.

“Now we’ve said to folks okay, here are a pack of needles, please bring
back some and if you’re not going to bring back some; it’s not that were
not going to give you needles, but there might be a reduction in the
number of needles that we give you at any given time.”

The reduction of clean needles being handed out concerns Dr. Mark Tyndall,
the medical director of the British Columbia Centre of Disease Control.

He was in Vancouver during the HIV and AIDS crisis in the 1990s and early
2000s and said it was restrictive policies with the distribution of
needles that was partially to blame for the increased HIV transmission and
AIDS deaths.

“So we’ve been down this route before and there’s really no, no room for
an enforced exchange. The implications of messing around with something we
know very well about, the downside can be quite catastrophic for an
individual,” Tyndall said.

“It’s hard to be really critical of people who are really trying to do
their best, but I think this is just an ill-advised experiment and the
potential downside is that there will be another two cases of HIV that
were really unnecessary.”

Enns said personal responsibility is an important piece.

“I think through the work that we have done in terms of education, that
individuals do understand their role, they do understand what it means to
be a part of the program, and they certainly know the benefit of clean
needles and using clean needles, and they do their best to ensure that
they get clean needles. This is about the choice of participating in a
program for their benefit,” he said.

“I know from anecdotal evidence that it’s a bit of a power-and-control
piece that ‘nobody is going to tell me what to do or what not to do,’ and
that makes it kind of difficult,”

The health region has a 95 per cent return rate, but last year calculated
56,298 needles weren’t returned. Enns said taking into account the amount
of needles these roughly 200 people use, the numbers pretty much match up.

The 200 people in questions are regulars who have used the exchange for
several years, Enns said.

“They are folks that have been engaged in our program for a number of
years, and so it’s just helping them kind of move along that journey and
trying to encourage them to help out with the safe disposal,” he said.

Tyndall said the medical evidence around the prevention of the spread of
HIV and AIDS in the injection drug user population says something
different.

“The very critical thing that we know from many, many studies and much
evidence is that the distribution of needles is much more important than
exchange,” he said. “If we see situations where people go to get clean
needles and they are told to go away and come back when they can bring
their old ones back. I just find that from what we know now, that is
totally inexcusable behaviour… We have trouble enough getting people to
come and get clean needles sometimes, so I think anything we do to make a
barrier to that is unacceptable.”

Tyndall said 28 per cent of people not returning used needles is more than
he would have expected, but the best policy would be encouragement and
creating incentives for return.

Prince Albert has seen its share of controversy around exchange, including
a mayor who wanted to pay people to pick up and return needles, but Enns
said this plan has nothing to do with community conversation.

“This isn’t a response to community pressure; it’s about being good
stewards and being invested in the program,” he said.

The region is trialling the idea and will review it in the fall to see if
it has made any improvements in returns, engaging clients, or if there is
a change in accessing services.
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www.aaj.tv/2015/07/unsafe-injections-major-cause-of-hepatitis-death-who/

Pakistan: Unsafe injections major cause of Hepatitis death: WHO

Aaj News, AAP, Pakistan (24.07.15)

ISLAMABAD: In advance of World Hepatitis Day (July 28), the World Health
Organization is calling for urgent action to curb millions of infections
and deaths from viral hepatitis.

Hepatitis is a viral infection that attacks the liver and can cause acute
and chronic disease. It is often called a silent epidemic because the harm
it causes tends to be overlooked.

But WHO notes hepatitis is the seventh leading cause of death. It
estimates 240 million people are chronically infected with hepatitis B and
up to 150 million are infected with the hepatitis C virus, Voice of
America reported.

Together, hepatitis B and C account for about 1.5 million deaths every
year. WHO Global Hepatitis Program team leader Stefan Wiktor says all the
tools needed to prevent the infection and deaths are available.

He says there is a great vaccine for hepatitis B, good laboratory tests
that can screen out infection in the blood supply, and safe injection
equipment.

“To prevent death there is treatment,” he said. “There is hepatitis
treatment for hepatitis B, which can control the disease or suppress the
virus,not cure it.

Whereas, for hepatitis C. there is now drugs that can cure almost
everybody with hepatitis C. That has been the most dramatic development in
the last few years, that these new drugs that really transform how we
think about hepatitis and it is leading people to start talking about
elimination.

Elimination of hepatitis as a public health problem in the future.”

The cost of the so-called miracle drugs for Hepatitis C are out of reach
for most people around the world.

A 12-week course of treatment costs $84,000 in rich countries. But Egypt
has successfully negotiated the price down to $900 and the World Health
Organization believes prices will continue to fall in coming years.

The hepatitis B virus is transmitted through blood or other bodily fluids.
Most infections occur from mother to child. Hepatitis B prevalence is
highest in sub-Saharan Africa and East Asia.

The hepatitis C virus is a blood borne virus, which is most commonly
transmitted through injecting drug use. WHO Service Delivery and Safety
Department Director Edward Kelley says preventing unsafe injections is key
to curbing this epidemic.

“Unsafe injections account for 32 percent of hepatitis B infections, about
40 percent of hepatitis C the most frequent medical procedure in the world
today are injections, 16 billion a year and the rate of unsafe injections
of those 16 billion, we estimate is about 40 percent,” she said.

The World Health Organization is campaigning for the elimination of unsafe
injections by promoting the exclusive use of sterile syringes that are
specifically designed to prevent reuse.

APP
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https://tinyurl.com/pol8946

WA USA Clallam County health services to distribute brochure on collecting
dirty needles

By Diane Urbani de la Paz , Peninsula Daily News, WA USA (23.07.15)

PORT ANGELES — When you see a syringe with a needle on the ground, take
care to dispose of it safely.

That’s the message from Clallam County Health and Human Services, which
now has a brochure, titled “Get the Point,” with instructions for picking
up syringes that can carry blood-borne pathogens such as HIV and
hepatitis.

¦ Wearing gloves, pick up the syringes one at a time, by the plunger end.

¦ Drop the syringe point-first into a plastic bottle such as a 2-liter
soda container.

¦ Put a lid on the bottle.

¦ Wash your hands immediately.

Capping the bottle and placing it in the trash — not in a recycling bin —
is key, since “one of the biggest hazards of being a sanitation worker is
the possibility of being stuck with a hypodermic needle,” the brochure
reads.

The county health department also urges labeling the bottles with
“Warning: Syringes. Do not recycle.”

Don’t fill the plastic container to the top, it reads; leave 2 or 3 inches
between the syringes and the neck of the bottle. Using tape to seal the
cap is also a good idea.

The “Get the Point” brochure will be distributed at this Saturday’s
Revitalize Port Angeles parks cleanup, which will cover Erickson Playfield
and Jessie Webster, Francis Street and Lincoln parks from 9 a.m. to noon.
Volunteers are welcome to gather at the park of their choice and visit
www.RevitalizePortAngeles.org for information.

The brochures and bottle labels are also available free at the Clallam
County Public Health Department, 111 E. Third St., or online at
http://tinyurl.com/pdn-syringeservices.

The department also runs a free syringe exchange service where intravenous
drug users can turn in used needles and obtain sterile ones. In the first
six months of this year, the service took in 152,000 syringes, said public
health program manager Christina Hurst.

For information about the service, phone 360-417-2274.
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https://tinyurl.com/nf65xks

India: WHO to launch campaign to combat hepatitis in India

Economic Times, PTI, India (23.07.15)

GENEVA: The WHO today said it will launch a new pilot campaign in India,
Egypt and Uganda to combat hepatitis which affects over two million people
globally through the use of unsafe injections.

The Global Injection Safety Initiative, to focus on Hepatitis B and C
which cause approximately 80 per cent of liver cancer deaths counting to
about 1.4 million people every year, is part of the World Health
Organisation’s global patient safety programme.

The campaign will raise public awareness for safe injections to combat
Hepatitis B and C, ministry engagement for national plans to deal with the
infections and engage the private sector, including the syringe
manufacturing community, to transition to exclusive production of safe
syringes, the WHO said.

“Egypt, Uganda and India are three of the flagship countries that will be
taking on the first steps on this campaign,” said Dr Edward Kelley,
Director, Service Delivery and Safety at WHO.

“In India, the discussion is essentially focusing on two states as a
potential start but we haven’t had the final discussions with the ministry
as to how exactly they would like to roll that out. In September, there
will be a team going out to do assessments.

“Our work on preventing the infection before they happen will be key to
controlling the potential elimination of hepatitis globally,” Kelley said.

Unsafe injections account for 32 per cent of Hepatitis B – 1.7 million
infections – and 40 per cent of Hepatitis C – 315,000 infections –
globally.

The most frequent medical procedure in the world today is administering of
injections, about 16 billion a year, Kelly said, adding: “And the rate of
unsafe injections of those 16 billion – the estimate is up to 40 per
cent.”

Around 130 to 150 million people globally have chronic Hepatitis C
infection and an estimated 240 million people are affected with chronic
Hepatitis B.

“We call Hepatitis, the silent epidemic. It is really under-appreciated —
its level of importance as a cause of death,” said Dr Stefan Wiktor, Team
Leader, Global hepatitis Program of WHO.

The UN agency is also planning to combat the problem of excessive use of
injections as part of its campaign.

Gilead, one of the three companies with Hepatitis C treatment, has given
voluntary licensing to 11 Indian generic drug manufacturers for use in 91
countries after a huge furore caused by its USD 1,000 a pill price tag for
treatment.

“In the last few months, the first generic came out,” Dr Wiktor said.

The World Hepatitis Day is on July 28.
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www.belfastlive.co.uk/news/health/one-six-northern-irish-drug-9706664

Northern Ireland UK: One in six Northern Irish drug users “share needles”,
survey claims

By Rob Grant, Belfast Live (22.07.15)

Public Health England ran a survey on the health of people who inject
drugs such as crack cocaine and heroin in England, Wales and Northern
Ireland

Just over one in six drug users report sharing needles in Northern
Ireland.

Some 17 per cent of people who had injected drugs in the previous four
weeks in the region said they had shared needles or syringes – a risky
practice that can pass on viruses such as hepatitis and HIV.

Public Health England ran a survey on the health of people who inject
drugs such as crack cocaine and heroin in England, Wales and Northern
Ireland.

It found that 33% of people in Northern Ireland who had injected drugs in
the past year reported some symptoms of an infection at the part of their
body where they stuck the needle.

These kinds of symptoms can include open wounds and sores.

Needle drug users in Northern Ireland did not use condoms very regularly,
the survey found.

Only 28% of those with two or more sexual partners in the past year said
they always used condoms when they had sex.

The figure for England, Wales and Northern Ireland combined was 22%.

Hepatitis B and C are serious health hazards for people who inject drugs.

The diseases are passed by contact with bodily fluids and can cause liver
cancer.

Blood tests showed that 23% of needle drug users in Northern Ireland had
antibodies for Hepatitis C and 7% for Hepatitis B – indicators that they
are or have been infected with the viruses.

Across England, 16% of needle drug users reported sharing needles or
syringes over the past four weeks.
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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
__________________________________________________________________
________________________________*_________________________________
* 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
__________________________________________________________________

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