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SIGNpost 00814

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST

Post00814  Smart Syringes + Abstracts + News 12 August 2015

CONTENTS
1. WHO calls for worldwide use of “smart” syringes
2. Abstract: Universal treatment success among healthcare workers
diagnosed with occupationally acquired acute hepatitis C
3. Abstract: Evaluation of knowledge, practices, and possible barriers
among healthcare providers regarding medical waste management in Dhaka,
Bangladesh
4. Abstract: Occupational exposure to bloodborne pathogens in a
specialized care service in Brazil [Extract]
5. Abstract: The poor children of the poor: Coping with diabetes control
in a resource-poor setting
6. Abstract: A Prospective Study for Introducing Insulin Pens and Safety
Needles in a Hospital Setting. The SANITHY Study
7. Abstract: Repeated vaccinations do not improve specific immune defenses
against Hepatitis B in non-responder health care workers
8. Abstract: Prevalence and Correlates of HIV and Hepatitis C Virus
Infections and Risk Behaviors among Malaysian Fishermen
9. Abstract: Intranasal naloxone administration for treatment of opioid
overdose
10. Abstract: Preoperative epidural injections are associated with
increased risk of infection after single level lumbar decompression
11. Abstract: Eighteen-year follow-up report of the surveillance and
prevention of an HIV/AIDS outbreak amongst plasma donors in Hebei
Province, China
12. Abstract: The estimation of prevalence and risk factors of hepatitis B
virus infection among blood donors in Chengdu, China
13. Abstract: Video observation of sharps handling and infection control
practices during routine companion animal appointments
14. Abstract: Efficacy of rehabilitation (lengthening) exercises,
platelet-rich plasma injections, and other conservative interventions
in acute hamstring injuries: an updated systematic review and meta-
analysis
15. Abstract: Understanding practice: factors that influence physician
hand hygiene compliance
16. Abstract: Implementation of the strategy “Clean Care is Safer Care” in
a third level hospital in Medellín, Colombia
17. Abstract: Touchless Technologies for Decontamination in the Hospital:
a Review of Hydrogen Peroxide and UV Devices
18. No Abstract: Transmission of a multidrug-resistant HIV-1 from an
occupational exposure, in São Paulo, Brazil
19. News
– Kentucky USA: Police say officer stuck by needle in pocket of man who
tested positive for Hepatitis C
– Canada: Hep C-positive attacker who stabbed store employee with dirty
needle gets 31 months’ jail
– USA: High numbers of hepatitis C infections found at urban ERs: Ten
percent of patients tested in a six-month period were infected with the
virus, and most had no idea
– Global: After Ebola Criticisms, WHO Plans for 4-Month Epidemic Response

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1. WHO calls for worldwide use of “smart” syringes

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

Making all injections safe brochure is an illustrated summary brochure for
the general public. pdf, 554kb [6 pages] free at
www.who.int/injection_safety/global-campaign/injection-safety_brochure.pdf
__________________________________________________________________
WHO calls for worldwide use of “smart” syringes

Press release

23 FEBRUARY 2015 | GENEVA – Use of the same syringe or needle to give
injections to more than one person is driving the spread of a number of
deadly infectious diseases worldwide. Millions of people could be
protected from infections acquired through unsafe injections if all
healthcare programmes switched to syringes that cannot be used more than
once. For these reasons, WHO is launching a new policy on injection safety
to help all countries tackle the pervasive issue of unsafe injections.*

A 2014 study sponsored by WHO, which focused on the most recent available
data, estimated that in 2010, up to 1.7 million people were infected with
hepatitis B virus, up to 315 000 with hepatitis C virus and as many as 33
800 with HIV through an unsafe injection. New WHO injection safety
guidelines and policy released today provide detailed recommendations
highlighting the value of safety features for syringes, including devices
that protect health workers against accidental needle injury and
consequent exposure to infection.

WHO also stresses the need to reduce the number of unnecessary injections
as a critical way of reducing risk. There are 16 billion injections
administered every year. Around 5% of these injections are for immunizing
children and adults, and 5% are for other procedures like blood
transfusions and injectable contraceptives. The remaining 90% of
injections are given into muscle (intramuscular route) or skin
(subcutaneous or intradermal route) to administer medicines. In many cases
these injections are unnecessary or could be replaced by oral medication.

“We know the reasons why this is happening,” says Dr Edward Kelley,
Director of the WHO Service Delivery and Safety Department. One reason is
that people in many countries expect to receive injections, believing they
represent the most effective treatment. Another is that for many health
workers in developing countries, giving injections in private practice
supplements salaries that may be inadequate to support their families.”

Transmission of infection through an unsafe injection occurs all over the
world. For example, a 2007 hepatitis C outbreak in the state of Nevada,
United States of America, was traced to the practices of a single
physician who injected an anaesthetic to a patient who had hepatitis C.
The doctor then used the same syringe to withdraw additional doses of the
anaesthetic from the same vial – which had become contaminated with
hepatitis C virus – and gave injections to a number of other patients. In
Cambodia, a group of more than 200 children and adults living near the
country’s second largest city, Battambang, tested positive for HIV in
December 2014. The outbreak has been since been attributed to unsafe
injection practices.

“Adoption of safety-engineered syringes is absolutely critical to
protecting people worldwide from becoming infected with HIV, hepatitis and
other diseases. This should be an urgent priority for all countries,” says
Dr Gottfried Hirnschall, Director of the WHO HIV/AIDS Department.

The new “smart” syringes WHO recommends for injections into the muscle or
skin have features that prevent re-use. Some models include a weak spot in
the plunger that causes it to break if the user attempts to pull back on
the plunger after the injection. Others have a metal clip that blocks the
plunger so it cannot be moved back, while in others the needle retracts
into the syringe barrel at the end of the injection.

Syringes are also being engineered with features to protect health workers
from “needle stick” injuries and resulting infections. A sheath or hood
slides over the needle after the injection is completed to protect the
user from being injured accidentally by the needle and potentially exposed
to an infection.

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. One
example is when a person is on an intravenous pump that uses a syringe.

The Organization is also calling for policies and standards for
procurement, safe use and safe disposal of syringes that have the
potential for re-use in situations where they remain necessary, including
in syringe programmes for people who inject drugs. Continued training of
health workers on injection safety – which has been supported by WHO for
decades – is another key recommended strategy. WHO is calling on
manufacturers to begin or expand production as soon as possible of ”smart”
syringes that meet the Organization’s standards for performance, quality
and safety.

“The new policy represents a decisive step in a long-term strategy to
improve injection safety by working with countries worldwide. We have
already seen considerable progress,” Dr Kelley says. Between 2000 and
2010, as injection safety campaigns picked up speed, re-use of injection
devices in developing countries decreased by a factor of 7. Over the same
period, unnecessary injections also fell: the average number of injections
per person in developing countries decreased from 3.4 to 2.9. In addition,
since 1999, when WHO and its partner organizations urged developing
countries to vaccinate children only using syringes that are automatically
disabled after a single use, the vast majority have switched to this
method.

Syringes without safety features cost US$ 0.03 to 0.04 when procured by a
UN agency for a developing country. The new “smart” syringes cost at least
twice that much. WHO is calling on donors to support the transition to
these devices, anticipating that prices will decline over time as demand
increases.
__________________________________________________________________
________________________________*_________________________________

2. Abstract: Universal treatment success among healthcare workers
diagnosed with occupationally acquired acute hepatitis C
__________________________________________________________________
Free Full Text
www.journalofhospitalinfection.com/article/S0195-6701(14)00301-6/fulltext

J Hosp Infect. 2015 Jan;89(1):69-71.

Universal treatment success among healthcare workers diagnosed with
occupationally acquired acute hepatitis C.

Tomkins SE1, Rice BD2, Roy K3, Cullen B3, Ncube FM1.

1Centre for Infectious Disease Surveillance and Control, Public Health
England, London, UK.
2Centre for Infectious Disease Surveillance and Control, Public Health
England, London, UK. Electronic address: brian.rice@phe.gov.uk.
3Health Protection Scotland, NHS National Services Scotland, Glasgow, UK.

Healthcare workers (HCWs) are at risk of occupationally acquired hepatitis
C. In the UK, 17 HCWs were diagnosed with occupationally acquired acute
hepatitis C between 2002 and 2011.

All 17 cases involved percutaneous injuries from hollowbore needles, 16
known to be contaminated with blood. Of these 17 HCWs, 15 received
antiviral therapy and 14 are known to have achieved viral clearance.

Treatment success was irrespective of genotype. The successful treatment
of HCWs emphasizes the need for UK guidelines on the management of
occupationally acquired acute hepatitis C.

Copyright © 2014 The Healthcare Infection Society. Published by Elsevier
Ltd. All rights reserved.

KEYWORDS: Acute hepatitis C; Healthcare worker; Occupational infection;
Treatment

Free Full Text
www.journalofhospitalinfection.com/article/S0195-6701(14)00301-6/fulltext
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Evaluation of knowledge, practices, and possible barriers
among healthcare providers regarding medical waste management in Dhaka,
Bangladesh
__________________________________________________________________
Full Open Access http://www.medscimonit.com/download/index/idArt/890904

Med Sci Monit. 2014 Dec 9;20:2590-7.

Evaluation of knowledge, practices, and possible barriers among healthcare
providers regarding medical waste management in Dhaka, Bangladesh.

Sarker MA1, Harun-Or-Rashid M2, Hirosawa T1, Abdul Hai MS3, Siddique MR4,
Sakamoto J5, Hamajima N1.

1Department of Healthcare Administration, Nagoya University Graduate
School of Medicine, Nagoya, Japan.
2Drug Administration, Institute of Public Health, Dhaka, Bangladesh.
3Department of OEH, National Institute of Preventive and Social Medicine,
Dhaka, Bangladesh.
4Department of Administration, Directorate General of Health Services,
Dhaka, Bangladesh.
5Director, Tokai Central Hospital, Tokai, Japan.

BACKGROUND: Improper handling of medical wastes, which is common in
Bangladesh, could adversely affect the hospital environment and community
at large, and poses a serious threat to public health. We aimed to assess
the knowledge and practices regarding medical waste management (MWM) among
healthcare providers (HCPs) and to identify possible barriers related to
it.

MATERIAL AND METHODS: A cross-sectional study was carried out during June
to September, 2012 including 1 tertiary, 3 secondary, and 3 primary level
hospitals in Dhaka division, Bangladesh through 2-stage cluster sampling.
Data were collected from 625 HCPs, including 245 medical doctors, 220
nurses, 44 technologists, and 116 cleaning staff who were directly
involved in MWM using a self-administered (researcher-administered for
cleaning staff), semi-structured questionnaire.

RESULTS: Nearly one-third of medical doctors and nurses and two-thirds of
technologists and cleaning staff had inadequate knowledge, and about half
of medical doctors (44.0%) and cleaning staff (56.0%) had poor practices.
HCPs without prior training on MWM were more likely to have poor practices
compared to those who had training. Lack of personal protective equipment,
equipment for final disposal, MWM-related staff, proper policy/guideline,
and lack of incinerator were identified as the top 5 barriers.

CONCLUSIONS: Strengthening and expansion of ongoing educational
programs/training is necessary to improve knowledge and practices
regarding MWM. The government should take necessary steps and provide
financial support to eliminate the possible barriers related to proper
MWM.

Free Article http://www.medscimonit.com/download/index/idArt/890904
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Occupational exposure to bloodborne pathogens in a
specialized care service in Brazil [Extract]

Extract below the abstract Free Open Access Article
__________________________________________________________________
http://www.ajicjournal.org/article/S0196-6553(15)00619-7/fulltext

Am J Infect Control. 2015 Aug 1;43(8):e39-41.

Occupational exposure to bloodborne pathogens in a specialized care
service in Brazil.

Khalil Sda S1, Khalil OA2, Lopes-Júnior LC3, Cabral DB4, Bomfim Ede O4,
Landucci LF5, Santos Mde L6.

1Faculty of Health Sciences, Graduate Program in Nursing, University of
Brasília (UnB), Brasília, Federal District, Brazil.
2Federal Institute of Education, Science and Technology of Paraná (IFPR),
Londrina, Paraná, Brazil. Electronic address: omar.khalil@ifpr.edu.br.
3Department Maternal-Infant Nursing and Public Health, Who Collaborating
Centre for Nursing Research Development, São Paulo, Brazil.
4Department General and Specialized Nursing, Who Collaborating Centre for
Nursing Research Development, São Paulo, Brazil.
5Rio Preto University Center (UNIRP), Department of Dentistry, São José do
Rio Preto, São Paulo, Brazil.
6Faculty of Medicine of São José do Rio Preto (FAMERP), Department of
Nursing, São José do Rio Preto, São Paulo, Brazil.

In a retrospective study about the epidemiology of exposure to bloodborne
pathogens among health care providers, 71.10% of the analyzed events
occurred among health professionals, mainly auxiliary nurses. Percutaneous
exposure (83.04%) was the most frequent.

Greater advances are necessary in the development of public policies for
this issue in terms of inspection of regulatory norms and raising the
professionals’ awareness through policy and education.

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

KEYWORDS: Exposure of body fluids to mucosal membranes; Health care
providers; Percutaneous injuries

Free Open Access Article:
http://www.ajicjournal.org/article/S0196-6553(15)00619-7/fulltext
__________________________________________________________________

Extract Extract Extract Extract Extract Extract Extract Extract Extract
__________________________________________________________________

” Discussion ”

” The data demonstrated a greater occurrence of occupational accidents
among health professionals who were women (75.19%), with prevalence in the
area of nursing. These results are similar to those found in other works
which researched this issue, which indicated that approximately 90% of
nursing professionals are women.1, 4 ”

” It is well known that the nursing staff represents a group that is
particularly vulnerable to biologic risks because of the specific
characteristics of their work activities, which involve direct and
continuous care to patients.5 ”

” Among the main recommendations for preventing accidents, emphasis is
placed on maximum attention while undertaking procedures, not using the
finger as a buffer, not resheathing needles, not bending or removing
needles with the hands, and finally, placing sharp materials in a lidded
receptacle that is puncture-resistant.6 ”

“The resheathing of needles and instruments was the cause of accidents in
approximately 6.49% of the professionals analyzed. ”
__________________________________________________________________
________________________________*_________________________________

5. Abstract: The poor children of the poor: Coping with diabetes control
in a resource-poor setting
__________________________________________________________________
Free Full Text PDF http://hmpg.co.za/index.php/samj/article/view/7401/9141

S Afr Med J. 2015 Apr 7;105(5):7401.

The poor children of the poor: Coping with diabetes control in a resource-
poor setting.

De Villiers FP1.

1Department of Paediatrics and Child Health, MEDUNSA Campus, Sefako
Makgatho Health Sciences University, Pretoria. alfafrancois@yahoo.co.uk.

BACKGROUND: Coping with diabetes control is difficult for newly diagnosed
and experienced patients alike. Children with diabetes face severe
challenges, as they may not yet have attained the necessary cognitive,
fine motor or psychosocial skills required for performance of the tasks
required from the diabetic patient. Most therefore require some adult
assistance.

OBJECTIVES: To establish whether paediatric diabetic patients are
adequately supported by their families in terms of giving insulin
injections and doing home blood glucose monitoring (HBGM), and whether
insulin and the necessary equipment are appropriately stored in their
homes.

METHODS: Patients attending a paediatric diabetes clinic were interviewed.
The data collected included demographic variables, type of insulin,
measurement of insulin doses, administration of insulin, and blood glucose
monitoring tests.

RESULTS: Twenty-five subjects were interviewed: 18 measured the insulin
themselves, five mothers and one aunt did so, and in one case the mother
and patient did so together. The four children aged =10 years had their
insulin measured by their mothers, but one had to administer the injection
himself. Eight of the nine children aged 11 – 15 years measured and
administered the insulin themselves; in four cases the doses were checked
by an adult. The mothers of four children did the fingerpricks, and eight
children were helped with measuring the results. Only two children aged 11
– 15 years had their doses checked by an adult.

CONCLUSION: Adult assistance with regard to both insulin injections and
HBGM is rarely forthcoming. The children seem not to be sufficiently
supported by their families.

Free Full Text PDF http://hmpg.co.za/index.php/samj/article/view/7401/9141
__________________________________________________________________
________________________________*_________________________________

6. Abstract: A Prospective Study for Introducing Insulin Pens and Safety
Needles in a Hospital Setting. The SANITHY Study
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26245310

Curr Diabetes Rev. 2015 Aug 6.

A Prospective Study for Introducing Insulin Pens and Safety Needles in a
Hospital Setting. The SANITHY Study.

Bossi AC1, Veronesi G, Poerio CS, Braus A, Madaschi S, Destro M, Ferraro
B, Gilberti L, Sganzerla P, Davis EM.

1Metabolic Diseases and Diabetes Unit, Treviglio General Hospital, P.le
Ospedale, 1 – 24047 Treviglio – BG – Italy.
antonio_bossi@ospedale.treviglio.bg.it.

BACKGROUND: to assess costs and safety of insulin pen devices and safety
needles as compared to vial/syringes in hospitalized patients requiring
insulin therapy in a General Hospital in Northern Italy.

MATERIALS AND METHODS: in a prospective 9-month study, consecutive
patients admitted to three Hospital Units received insulin therapy through
either a traditional disposable syringe method, or pen/safety needles with
dual-ended protection, or disposable safety syringes. We compared the
median direct (insulin and devices) and indirect (insulin supply at
discharge, insulin wastage) costs of a 10-day in-hospital insulin
treatment in the 3 study groups, additionally accounting for the costs
related to the observed needlestick injury rate. Patients’ safety during
in-hospital stay (hypo- and hyperglycemia episodes) and satisfaction were
also assessed.

RESULTS: N=360 patients (55% men, mean age 75.6 years, 57% with DM since =
10 years) were recruited in the study. Insulin pens had higher median
direct cost than both traditional syringes (43 vs. 18 €/patient, p<.0001)
and safety syringes (21.5 €/patient, p<.0001). However, when also indirect
and injuries costs were taken into account, the estimated savings for
using pens over traditional syringes were as high as 32 €/patient (45.8
vs. 77.6 €/patient, p-value <.0001). No differences in patients’ safety
were observed. 74% and 12% of patients using pens and syringes would like
to continue the method at home, respectively (p<0.0001).

DISCUSSION: a selective use of individual pre-filled pens/safety needles
for patients who are likely to continue insulin therapy at home may
strongly reduce hospital diabetes treatment related costs.
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Repeated vaccinations do not improve specific immune defenses
against Hepatitis B in non-responder health care workers
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25444815

Vaccine. 2014 Dec 5;32(51):6902-10.

Repeated vaccinations do not improve specific immune defenses against
Hepatitis B in non-responder health care workers.

Zaffina S1, Marcellini V2, Santoro AP1, Scarsella M2, Camisa V1, Vinci
MR1, Musolino AM3, Nicolosi L4, Rosado MM5, Carsetti R6.
Author information
1Health Technology Assessment & Safety Research Unit and Occupational
Medicine Service, Department of Laboratories, Ospedale Pediatrico Bambino
Gesù, IRCSS, Piazza S. Onofrio 4, 00165 Roma, Italy.
2Immunology Unit, Immunology and Pharmacotherapy Research Area, Ospedale
Pediatrico Bambino Gesù, IRCSS, Piazza S. Onofrio 4, 00165 Roma, Italy.
3Paediatric Emergency Department, Department of Laboratories, Ospedale
Pediatrico Bambino Gesù, IRCSS, Piazza S. Onofrio 4, 00165 Roma, Italy.
4Department of Pediatrics, Department of Laboratories, Ospedale Pediatrico
Bambino Gesù, IRCSS, Piazza S. Onofrio 4, 00165 Roma, Italy.
5Immunology Unit, Immunology and Pharmacotherapy Research Area, Ospedale
Pediatrico Bambino Gesù, IRCSS, Piazza S. Onofrio 4, 00165 Roma, Italy.
Electronic address: manuelaanjosm.rosado@gmail.com.
6Immunology Unit, Immunology and Pharmacotherapy Research Area, Ospedale
Pediatrico Bambino Gesù, IRCSS, Piazza S. Onofrio 4, 00165 Roma, Italy;
Diagnostic Immunology Unit, Department of Laboratories, Ospedale
Pediatrico Bambino Gesù, IRCSS, Piazza S. Onofrio 4, 00165 Roma, Italy.
Electronic address: rita.carsetti@opbg.net.

Hepatitis B is a major infectious occupational hazard for health care
workers and can be prevented with a safe and effective vaccine.

The serum titer of anti-HBsAg antibodies is the most commonly used
correlate of protection and post-vaccination anti-HBsAg concentrations of
= 10 mIU/ml are considered protective. Subjects with post-vaccination
anti-HBsAg titers of <10 mIU/ml 1-6 months post-vaccination, who tested
negative for HBsAg and anti-HBc, are defined as non-responders.

The question of whether non-responders should be repeatedly vaccinated is
still open.

The aim of the study was to (i) evaluate the distribution of lymphocyte
subpopulations and the percentage of HBsAg-specific memory B cells in
responders and non-responders (ii) assess whether non-responders can be
induced to produce antibodies after administration of a booster dose of
vaccine (iii) determine whether booster vaccination increases the number
of specific memory B cells in non-responders. Combining flow-cytometry,
ELISPOT and serology we tested the integrity and function of the immune
system in 24 health care workers, confirmed to be non-responders after at
least three vaccine injections.

We compared the results with those obtained in 21 responders working in
the same institution.

We found that the great majority of the non-responders had a functional
immune system and a preserved ability to respond to other conventional
antigens.

Our most important findings are that the frequency of HBsAg-specific
memory B cells is comparable in non-responders and controls and that
booster immunization does not lead either to antibody production or memory
B cell increase in non-responders.

Copyright © 2014 Elsevier Ltd. All rights reserved.

KEYWORDS: Anti-HBsAg specific antibodies; Hepatitis B vaccine; Memory B
cells; Non- responders
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Prevalence and Correlates of HIV and Hepatitis C Virus
Infections and Risk Behaviors among Malaysian Fishermen
__________________________________________________________________
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0118422

PLoS One. 2015 Aug 5;10(8):e0118422.

Prevalence and Correlates of HIV and Hepatitis C Virus Infections and Risk
Behaviors among Malaysian Fishermen.

Choo MK1, El-Bassel N2, Adam PC3, Gilbert L2, Wu E2, West BS2, Bazazi AR4,
De Wit JB3, Ismail R1, Kamarulzaman A1.

1Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine,
University of Malaya, Kuala Lumpur, Malaysia.
2Social Intervention Group, Columbia University School of Social Work, New
York, New York, United States of America.
3Centre for Social Research in Health, Faculty of Arts and Social
Sciences, UNSW Australia, Sydney, Australia.
4Department of Epidemiology of Microbial Diseases, Yale School of Public
Health, New Haven, Connecticut, United States of America.

Fishermen in Southeast Asia have been found to be highly vulnerable to
HIV, with research evidence highlighting the role of sexual risk
behaviors. This study aims to estimate the rate of HIV as well as
hepatitis C virus (HCV) infections among Malaysian fishermen, and the
risky sexual and injection drug use behaviors that may contribute to these
infections.

The study also includes an assessment of socio-demographic, occupational
and behavioral correlates of testing positive for HIV or HCV, and socio-
demographic and occupational correlates of risk behaviors.

The study had a cross-sectional design and recruited 406 fishermen through
respondent-driven sampling (RDS). Participants self-completed a
questionnaire and provided biological specimens for HIV and HCV testing.
We conducted and compared results of analyses of both unweighted data and
data weighted with the Respondent-Driven Sampling Analysis Tool (RDSAT).

Of the participating fishermen, 12.4% were HIV positive and 48.6% had HCV
infection. Contrary to expectations and findings from previous research,
most fishermen (77.1%) were not sexually active. More than a third had a
history of injection drug use, which often occurred during fishing trips
on commercial vessels and during longer stays at sea. Of the fishermen who
injected drugs, 42.5% reported unsafe injection practices in the past
month.

Reporting a history of injection drug use increased the odds of testing
HIV positive by more than 6 times (AOR = 6.22, 95% CIs [2.74, 14.13]).
Most fishermen who injected drugs tested positive for HCV. HCV infection
was significantly associated with injection drug use, being older than 25
years, working on a commercial vessel and spending four or more days at
sea per fishing trip.

There is an urgent need to strengthen current harm reduction and drug
treatment programs for Malaysian fishermen who inject drugs, especially
among fishermen who work on commercial vessels and engage in deep-sea
fishing.

Free full text
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0118422
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Intranasal naloxone administration for treatment of opioid
overdose
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25465584

Am J Health Syst Pharm. 2014 Dec 15;71(24):2129-35.

Intranasal naloxone administration for treatment of opioid overdose.

Robinson A1, Wermeling DP2.

1Amanda Robinson is a Pharm.D. student; and Daniel P. Wermeling, Pharm.D.,
FASHP, FCCP, is Professor of Pharmacy, University of Kentucky College of
Pharmacy, Lexington.
2Amanda Robinson is a Pharm.D. student; and Daniel P. Wermeling, Pharm.D.,
FASHP, FCCP, is Professor of Pharmacy, University of Kentucky College of
Pharmacy, Lexington. dwermel@uky.edu.

PURPOSE: The pharmacology, pharmaco-kinetic properties, and clinical
efficacy of naloxone injection administered intranasally for the reversal
of opioid overdose are reviewed.

SUMMARY: Naloxone is an opioid-receptor antagonist that is used in the
treatment of opioid overdose to reverse the respiratory and central
nervous system-depressant effects of the opioid. Naloxone injection is
traditionally given by intravenous, intramuscular, and subcutaneous
routes.

Paramedics also administer naloxone injection intranasally in the
prehospital setting to treat suspected opioid overdose. The nasal mucosa
has a rich blood supply that allows for efficient drug absorption and the
avoidance of first-pass hepatic metabolism that would be seen with oral
administration.

Obtaining vascular access can be difficult in known drug users, prolonging
the time required to administer the antidote. Patients awakening from an
overdose may be agitated, confused, and even combative, thus increasing
the risk of needle-stick injury to first responders.

The intranasal route avoids the need for establishing vascular access and
can be associated with speedier patient recovery. In two randomized
controlled trials, intranasal naloxone alone was shown to be sufficient
for reversing opioid-induced respiratory depression in 74% and 72% of the
respective study populations of patients experiencing opioid overdose. In
addition, the safety profile of intranasal naloxone appears to be no
different than that of naloxone injection in the treatment of opioid
overdose in the prehospital setting.

CONCLUSION: Intranasal administration of naloxone appears to be effective
in treatment of opioid overdose when i.v. administration is impossible or
undesirable.

Copyright © 2014 by the American Society of Health-System Pharmacists,
Inc. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Preoperative epidural injections are associated with
increased risk of infection after single level lumbar decompression
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26235469

Spine J. 2015 Jul 30. pii: S1529-9430(15)01147-X.

Preoperative epidural injections are associated with increased risk of
infection after single level lumbar decompression.

Yang S1, Werner BC1, Cancienne JM1, Hassanzadeh H1, Shimer AL1, Shen FH1,
Singla A2.

1University of Virginia Health System, Department of Orthopaedic Surgery,
400 Ray C. Hunt Dr, Suite 330, Charlottesville VA, 22903.
2University of Virginia Health System, Department of Orthopaedic Surgery,
400 Ray C. Hunt Dr, Suite 330, Charlottesville VA, 22903. Electronic
address: anujrajsingla@gmail.com.

Background context Lumbar epidural steroid injections (LESI) are often
performed as a treatment option for lumbar stenosis and radiculopathy
prior to lumbar decompression surgery. Several case series have reported
spinal infections after LESIs. There is lack of literature regarding the
rate of postoperative infections after lumbar decompression in patients
who had prior LESIs.

Purpose The goal of the present study is to employ a large national
database to determine if there is an association of preoperative LESIs at
various time intervals before lumbar decompression on the incidence of
postoperative infection.

Study Design/Setting Retrospective case control database study, Level III
Patient Sample Medicare patients over age 65 years who had a LESI within
one year of single level lumbar decompression surgery.

Outcome Measures ICD-9 diagnosis codes for postoperative infection. CPT
procedure codes for treatment of postoperative infection.

Methods The PearlDiver Patient Records Database, an insurance-based
database of patient records, was utilized for this study. The database was
queried for LESI and single- level lumbar decompression procedures using
CPT codes. These study patients were then divided into four separate
cohorts: (1) lumbar decompression within 1 month following LESI, (2)
lumbar decompression between 1 and 3 months following LESI, (3) lumbar
decompression between 3 and 6 months following LESI, and (4) lumbar
decompression between 6 and 12 months following LESI. Unique control
groups for each study cohort were created with patients who underwent
single level lumbar decompression without previous LESI and matched for
major risk factors for infection, including age, sex, smoking status,
diabetes and obesity.

Results Overall, the rate of postoperative infection after single level
lumbar decompression after LESI remained relatively low ranging between
0.8-1.7%.

The incidence of 90-day postoperative infection after lumbar decompression
was significantly higher than matched controls in groups with LESI within
1 month (OR=3.2, p<0.0001) and 1-3 months prior to surgery (OR=1.8,
p<0.0001).

The incidence of 90-day postoperative infection was not significantly
different than matched controls in groups with LESI between 3-6 months (OR
= 1.3, p=0.15) and 6-12 months prior to (OR = 1.3, p=0.18)

Conclusions Single level lumbar decompression within 3 months after LESI
may be associated with an increased rate of postoperative infection.
Increasing the time interval between LESI and single level lumbar
decompression surgery to at least 3 months may decrease postoperative
infection rates.

Copyright © 2015 Elsevier Inc. All rights reserved.

KEYWORDS: Spine surgery, Complications; epidural injection; lumbar
decompression; postoperative infection; spinal infection
__________________________________________________________________
________________________________*_________________________________

11. Abstract: Eighteen-year follow-up report of the surveillance and
prevention of an HIV/AIDS outbreak amongst plasma donors in Hebei
Province, China
__________________________________________________________________
Free Open Access Article http://www.biomedcentral.com/1471-2334/15/316

BMC Infect Dis. 2015 Aug 6;15:316.

Eighteen-year follow-up report of the surveillance and prevention of an
HIV/AIDS outbreak amongst plasma donors in Hebei Province, China.

Chen S1, Zhao H2, Zhao C3, Zhang Y4, Li B5, Bai G6, Liang L7, Lu X8.
Author information
1Hebei Province Center for Disease Control and Prevention, 97 Huaian East
Road, Yuhua District, Shijiazhuang, 050021, China. hebeicdc2013@sina.com.
2Hebei Province Center for Disease Control and Prevention, 97 Huaian East
Road, Yuhua District, Shijiazhuang, 050021, China. sunline6666@sina.com.
3Hebei Province Center for Disease Control and Prevention, 97 Huaian East
Road, Yuhua District, Shijiazhuang, 050021, China.
zhaocuiying906@sina.com.
4Hebei Province Center for Disease Control and Prevention, 97 Huaian East
Road, Yuhua District, Shijiazhuang, 050021, China. hivstd@126.com.
5Hebei Province Center for Disease Control and Prevention, 97 Huaian East
Road, Yuhua District, Shijiazhuang, 050021, China. lxli0124@163.com.
6Hebei Province Center for Disease Control and Prevention, 97 Huaian East
Road, Yuhua District, Shijiazhuang, 050021, China. baiguangyi@sohu.com.
7Hebei Province Center for Disease Control and Prevention, 97 Huaian East
Road, Yuhua District, Shijiazhuang, 050021, China. lianglianghiv@126.com.
8Hebei Province Center for Disease Control and Prevention, 97 Huaian East
Road, Yuhua District, Shijiazhuang, 050021, China. lxlii2009@163.com.

BACKGROUND: There has been a clear increase in HIV-1 infection cases in
recent years in Hebei Province, China, and transmission via blood is one
of the risk factors in the early. This article aimed to investigate the
HIV infection rate and control efficiency among the paid blood donor
population over a period of 18 years.

METHODS: From 1995-2013, HIV/AIDS cases among former blood donors in Hebei
Province were registered and closely monitored to collect data of all-
cause mortality, intervention measures to prevent family transmission,
disease transmission between couples as well as between mothers and
infants, and HAART therapy outcomes.

RESULTS: A total of 326 cases were identified as directly infected with
HIV/AIDS during plasma donation in Hebei Province. Of these, 146 cases
(44.8 %) were identified in the same year as infection; 180 cases (55.2 %)
were identified 1-18 years after infection because they did not
participate in the 1995 screening. The final case was identified in
February 2012.

By 2013, the mortality rate and survival rate of plasma donor-related
HIV/AIDS was 54.9 % and 45.1 %, respectively. The identified transmission
rate between couples was 11.3 % (8/71); this rate during the same year as
infection was 3.3 % (1/30), and the rate 4-17 years after HIV infection
was 17.1 % (7/41). Approximately 91.2 % (145/159) of married women of
childbearing age did not have children after being informed of HIV
infection. Only 8.8 % (14/159) of these women had children after being
informed of HIV infection. The mother-to-infant transmission rate was 38.5
% (5/13). The HAART coverage rate has increased from 10.1 % (16/159) in
2003 to 83.6 % (127/152) in 2013. Since 1999, the HIV mortality rate has
trended up; by 2013, the cumulative mortality rate reached 54.9 %
(179/326).

After HAART was initiated in China, the death rate decreased to some
extent.

Second generation transmission (via couple or mother-to- infant
transmission) among blood donor-related HIV cases accounted for
approximately 4.0 % (13/326). All first- or second-generation cases were
infected with HIV-1 subtype B.

CONCLUSIONS: In this accident of HIV-infection among plasma donors in
Hebei Province, a total of 339 direct and second-generation cases have
been identified over 18 years of monitoring. Favorable clinical results
have been achieved using intervention measurements and antiviral therapy.

Free Open Access Article http://www.biomedcentral.com/1471-2334/15/316
__________________________________________________________________
________________________________*_________________________________

12. Abstract: The estimation of prevalence and risk factors of hepatitis B
virus infection among blood donors in Chengdu, China
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26241150

J Med Virol. 2015 Aug 4.

The estimation of prevalence and risk factors of hepatitis B virus
infection among blood donors in Chengdu, China.

Zhong L1, Xi G2, Zhang L3, Liu S4, Wan L5, Yu L6, Zhou M6, Zhang J7, He
Y1.
Author information
1Department of Quality Control, Chengdu Blood Center, Chengdu, China.
2Department of Blood Supply, Chengdu Blood Center, Chengdu, China.
3Department of Blood Screening, Chengdu Blood Center, Chengdu, China.
4Department of Blood Collection, Chengdu Blood Center, Chengdu, China.
5Department of Blood Preparation, Chengdu Blood Center, Chengdu, China.
6Department of Donor Service, Chengdu Blood Center, Chengdu, China.
7Department of Administration Office, Chengdu Blood Center, Chengdu,
China.

The reported positive rates of hepatitis B virus surface antigen (HBsAg)
among Chinese blood donors generally do not include data from pre-donation
rapid tests. The aim of this study was to estimate the prevalence of
serologic markers for HBsAg and risk factors among blood donors from
Chengdu, China.

From April 2010 to March 2011, a total of 16,875 blood donors were
enrolled. Data from HBsAg tests before and after donations were collected
to estimate the prevalence of HBsAg. A case-control study was conducted in
265 unique HBsAg-positive blood donors and 530 seronegative donors between
January 2011 and October 2012. The odds ratio (OR) and 95% confidence
interval (CI) were calculated using conditional logistic regression. The
population attributable risk (PAR) was estimated.

The prevalence of HBsAg was 3.17% (95% CI, 2.91-3.43%). The following risk
factors were associated with HBV infection: non-vaccination for HBV
(OR?=?4.236; 95% CI, 2.72-6.60%), razor sharing (OR?=?2.370; 95% CI,
1.46-3.84%), dental treatment (OR?=?1.714; 95% CI, 1.21-2.43%),
acupuncture (OR?=?1.983; 95% CI, 1.20-3.28%), a family history of HBV
infection (OR?=?2.257; 95% CI, 1.32-3.86%), and endoscopy (OR?=?2.17; 95%
CI, 1.04-4.51%). The PAR values of the risk factors were 42.77%, 31.78%,
13.68%, 6.18%, 6.09% and 2.85%, respectively, and the total PAR was
68.78%.

The prevalence of HBsAg among Chinese blood donors is still high.

HBV vaccinations can provide protection. Blood contact from sharing
instruments is still a high risk route of transmission for HBV.
Immunization programs and behavioral interventions should be used to
prevent blood donation infections and improve blood safety.

This article is protected by copyright. All rights reserved.

KEYWORDS: blood donor; hepatitis B; population attributable risk;
prevalence; razor sharing; vaccine
__________________________________________________________________
________________________________*_________________________________

13. Abstract: Video observation of sharps handling and infection control
practices during routine companion animal appointments
__________________________________________________________________
Free Full Article http://www.biomedcentral.com/1746-6148/11/185

BMC Vet Res. 2015 Aug 6;11:185.

Video observation of sharps handling and infection control practices
during routine companion animal appointments.

Anderson ME1, Weese JS2.

1Ontario Ministry of Agriculture, Food & Rural Affairs, Guelph, ON,
Canada. maureen.e.c.anderson@ontario.ca.
2Department of Pathobiology, University of Guelph, Guelph, ON, Canada.
jsweese@uoguelph.ca.

BACKGROUND: Infection control in veterinary clinics is important for
preventing pathogen spread between patients, staff and the public. There
has been no direct evaluation of the use of many basic infection control
practices, including sharps handling, environmental cleaning, and personal
protective clothing (PPC), in companion animal clinics. The objective of
this study was to describe these and other infection control practices
associated with routine companion animal appointments in veterinary
clinics in Ontario.

RESULTS: Video observation of practices was performed in 51 clinics for
approximately 3 weeks each as part of another study evaluating the effect
of a poster campaign on hand hygiene compliance. Two small wireless
surveillance cameras were used: one in an exam room, one in what was
considered the most likely location for hand hygiene to be performed
outside the exam room following an appointment. Video footage was coded
and analyzed for 47 clinics, including 2713 appointments and 4903
individual staff-animal contacts.

Recapping of a needle was seen in 84% (1137/1353) of appointments in which
use was observed. Only one apparent needlestick injury (NSI) was seen,
during recapping.

Exam tables were cleaned and floors were mopped following 76% (2015/2646)
and 7% (174/2643) of appointments, respectively. Contact time with spray
used to clean the exam table ranged from 0-4611 s (mean 39 s, median 9 s).
Appropriate PPC was worn for 72% (3518/4903) of staff-animal contacts.

CONCLUSIONS: Although there was significant room for improvement in sharps
handling behaviours in participating clinics, the number of observed NSIs
was low. Contact time with environmental disinfectants and use of PPC
could also be improved, as well as other basic infection control
practices. Education and motivation of veterinary staff to use these
simple measures more effectively could potentially have a significant
impact on infection control in veterinary clinics for relatively little
cost.

Free Full Article http://www.biomedcentral.com/1746-6148/11/185
__________________________________________________________________
________________________________*_________________________________

14. Abstract: Efficacy of rehabilitation (lengthening) exercises,
platelet-rich plasma injections, and other conservative interventions
in acute hamstring injuries: an updated systematic review and meta-
analysis
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26198389

Br J Sports Med. 2015 Jul 21. pii: bjsports-2015-094879.

Efficacy of rehabilitation (lengthening) exercises, platelet-rich plasma
injections, and other conservative interventions in acute hamstring
injuries: an updated systematic review and meta-analysis.

Pas HI1, Reurink G2, Tol JL3, Weir A4, Winters M5, Moen MH6.

1The Sports Physician Group, Department of Sports Medicine, St Lucas
Andreas Hospital, Amsterdam, The Netherlands Department of Cardiology,
Alrijne Hospital Leiden, Leiden, The Netherlands.
2The Sports Physician Group, Department of Sports Medicine, St Lucas
Andreas Hospital, Amsterdam, The Netherlands Department of Orthopaedics,
Erasmus Medical Centre, Rotterdam, The Netherlands Department of
Orthopaedic Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
3The Sports Physician Group, Department of Sports Medicine, St Lucas
Andreas Hospital, Amsterdam, The Netherlands Aspetar, Orthopedic and
Sports Medicine Hospital, Doha, Qatar Amsterdam Center of Evidence Based
Sports Medicine, Academic Medical Center, Amsterdam, The Netherlands.
4Department of Orthopaedic Surgery, Academic Medical Centre, Amsterdam,
The Netherlands.
5Department of Rehabilitation, Nursing Science & Sports, University
Medical Centre Utrecht, Utrecht, The Netherlands.
6The Sports Physician Group, Department of Sports Medicine, St Lucas
Andreas Hospital, Amsterdam, The Netherlands Bergman Clinics, Naarden, The
Netherlands.

BACKGROUND: Our 2012 review on therapeutic interventions for acute
hamstring injuries found a lack of high-quality studies. The publication
of new studies warranted an update.

OBJECTIVES: To update and reanalyse the efficacy of conservative
treatments for hamstring injury.

DATA SOURCES: PubMed, EMBASE, Web of Science, Cochrane library, CINAHL and
SPORTDiscus were searched till mid-February 2015.

STUDY ELIGIBILITY CRITERIA: Randomised controlled trials (RCTs) on the
effect of conservative interventions versus a control group or other
intervention for hamstring injuries (HI) were included.

DATA ANALYSIS: The search results were screened independently by two
authors. Risk of bias assessment was performed using a modified Downs and
Black scale with a maximum score of 28. Meta-analysis was performed, where
possible.

MAIN RESULTS: 10 RCTs (526 participants), including 6 new RCTs, were
identified. Two RCTs were of good/excellent quality, the rest were fair or
poor (median Downs and Black score 16 (IQR 9)). Meta-analysis of two
studies on rehabilitation (lengthening) exercises showed a significantly
reduced time to return to play (HR 3.22 (95% CI 2.17 to 4.77), p<0.0001)
but no difference in risk of re-injury. Meta-analysis of three studies
investigating platelet-rich plasma (PRP) showed no effect when compared to
control (HR 1.03 (95% CI 0.87 to 1.22), p=0.73). Limited evidence was
found that progressive agility and trunk stability training may reduce re-
injury rates.

CONCLUSIONS: Meta-analysis showed superior efficacy for rehabilitation
exercises. PRP injection had no effect on acute hamstring injury. Limited
evidence was found that agility and trunk stabilisation may reduce re-
injury rates. The limitations identified in the majority of RCTs should
improve the design of new hamstring RCTs.

Published by the BMJ Publishing Group Limited.

KEYWORDS: Hamstring; Injuries; Physiotherapy; Platelet-Rich Plasma; Review
__________________________________________________________________
________________________________*_________________________________

15. Abstract: Understanding practice: factors that influence physician
hand hygiene compliance
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25419774

Infect Control Hosp Epidemiol. 2014 Dec;35(12):1511-20.

Understanding practice: factors that influence physician hand hygiene
compliance.

Squires JE1, Linklater S, Grimshaw JM, Graham ID, Sullivan K, Bruce N,
Gartke K, Karovitch A, Roth V, Stockton K, Trickett J, Worthington J, Suh
KN.

1School of Nursing, Faculty of Health Sciences, University of Ottawa,
Ottawa, Ontario, Canada.

OBJECTIVE: To identify the behavioral determinants–both barriers and
enablers–that may impact physician hand hygiene compliance.

DESIGN: A qualitative study involving semistructured key informant
interviews with staff physicians and residents.

SETTING: An urban, 1,100-bed multisite tertiary care Canadian hospital.

PARTICIPANTS: A total of 42 staff physicians and residents in internal
medicine and surgery.

METHODS: Semistructured interviews were conducted using an interview guide
that was based on the theoretical domains framework (TDF), a behavior
change framework comprised of 14 theoretical domains that explain health-
related behavior change. Interview transcripts were analyzed using
thematic content analysis involving a systematic 3-step approach: coding,
generation of specific beliefs, and identification of relevant TDF
domains.

RESULTS: Similar determinants were reported by staff physicians and
residents and between medicine and surgery. A total of 53 specific beliefs
from 9 theoretical domains were identified as relevant to physician hand
hygiene compliance. The 9 relevant domains were knowledge; skills; beliefs
about capabilities; beliefs about consequences; goals; memory, attention,
and decision processes; environmental context and resources; social
professional role and identity; and social influences.

CONCLUSIONS: We identified several key determinants that physicians
believe influence whether and when they practice hand hygiene at work.
These beliefs identify potential individual, team, and organization
targets for behavior change interventions to improve physician hand
hygiene compliance.
__________________________________________________________________
________________________________*_________________________________

16. Abstract: Implementation of the strategy “Clean Care is Safer Care” in
a third level hospital in Medellín, Colombia
__________________________________________________________________
Rev Chilena Infectol. 2014 Jun;31(3):280-6.

[Implementation of the strategy “Clean Care is Safer Care” in a third
level hospital in Medellín, Colombia].

[Article in Spanish]

Restrepo AV, Valderrama MP, Correa AL, Mazo LM, González NE, Jaimes F.

INTRODUCTION: Hand hygiene is the most cost-effective and simple measure
of preventing healthcare associated infections (HAI). The approach to
improve low compliance must be through multimodal interventions such as
the “Clean Care is Safer Care” strategy (WHO).

AIM: To estimate the efficacy of a multimodal strategy in improving hand
hygiene in five wards of a tertiary care hospital in Medellín, Colombia
(2008-2010).

METHODS: Quasi-experimental before-after study.

RESULTS: Hand hygiene compliance significantly increased after the
intervention (82 to 89%, p = 0.007). The knowledge score increased from a
median of 26 (IQR=22-28) to 30 (IQR=26-32, p = 0.001). Alcohol-based hand
rub consumption increased significantly from 10.5 liters to 58.1 liters
per 1000 patient-days [incidence ratio (IR) = 2.39, 95% CI = 1.99; 2.88].
Monthly HAI rates showed no significant variations during the same period
[IR = 0.90, 95% CI = 0.71; 1.13].

DISCUSSION: This and other recent studies demonstrate that implementing a
multimodal strategy for hand hygiene significantly increases compliance
with this measure, irrespective of type of health worker or hospital
department.

CONCLUSIONS: Implementing a multimodal strategy we achieved significant
increases in hand hygiene compliance but mild or no significant variations
in monthly HAI rates.

Free full text http://dx.doi.org/10.4067/S0716-10182014000300005
__________________________________________________________________
________________________________*_________________________________

17. Abstract: Touchless Technologies for Decontamination in the Hospital:
a Review of Hydrogen Peroxide and UV Devices
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26252970

Curr Infect Dis Rep. 2015 Sep;17(9):498.

Touchless Technologies for Decontamination in the Hospital: a Review of
Hydrogen Peroxide and UV Devices.

Doll M1, Morgan DJ, Anderson D, Bearman G.

1Division of Infectious Disease, University of Maryland Medical Center,
725 Lombard Street, Room N550, Baltimore, MD, 21201, USA, mdoll@umm.edu.

Reduction of microbial contamination of the hospital environment is a
challenge, yet has potential impacts on infection prevention efforts.

Fumigation and UV light devices for environmental cleaning have expanded
into the health care setting with the goal of decontamination of difficult
to clean or overlooked surfaces.

In an era of increased scrutiny of hospital-acquired infections,
increasingly, health care centers are adopting these “touchless” cleaning
techniques as adjuncts to traditional manual cleaning.

The evidence for improved clinical outcomes is lacking; yet, the
experience with these devices continues to accumulate in the literature.

We review the recently published data related to the use of hydrogen
peroxide and UV light-based decontamination systems for cleaning of
hospital rooms.

Touchless cleaning technologies may provide an incremental benefit to
standard practices by limiting cross-transmission of pathogens via
environmental surfaces, though evidence of prevention of infections
remains limited.
__________________________________________________________________
________________________________*_________________________________

18. No Abstract: Transmission of a multidrug-resistant HIV-1 from an
occupational exposure, in São Paulo, Brazil
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26244399

AIDS. 2015 Jul 31;29(12):1580-3.

Transmission of a multidrug-resistant HIV-1 from an occupational exposure,
in São Paulo, Brazil.

Lopes GI1, Coelho LP, Hornke L, Volpato AP, Lopércio AP, Cabral GB,
Ferreira JL, Domingues CS, Brígido LF.

1aRetrovirus Laboratory, Virology Center, Adolfo Lutz Institute, São
Paulo/SP bSpecialized Healthcare Service, SEA Barueri/SP cEpidemiological
Surveillance, Department of the São Paulo State Program for STDs and AIDS
STD/AIDS, São Paulo/SP, Brazil.
__________________________________________________________________
________________________________*_________________________________

19. News

– Kentucky USA: Police say officer stuck by needle in pocket of man who
tested positive for Hepatitis C
– Canada: Hep C-positive attacker who stabbed store employee with dirty
needle gets 31 months’ jail
– USA: High numbers of hepatitis C infections found at urban ERs: Ten
percent of patients tested in a six-month period were infected with the
virus, and most had no idea
– Global: After Ebola Criticisms, WHO Plans for 4-Month Epidemic Response

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/nnogkbs

Kentucky USA: Police say officer stuck by needle in pocket of man who
tested positive for Hepatitis C

By Danielle Lama, WDRB, Kentucky USA (12.08.15)

LOUISVILLE, Ky. (WDRB) — Police say an LMPD officer was stuck by a needle
while searching a suspect and exposed to Hepatitis C.

It happened on Aug. 2 when fast food employees along Dixie Highway
contacted police about 26-year-old James Smith. When an officer arrived,
he found Smith at the KFC.

An arrest warrant says Smith was intoxicated, unsteady on his feet and
incoherent and as the officer searched Smith, he was stuck with a needle.
Police say Smith was taken to the hospital and tested positive for
Hepatitis C.

“A needle stick is a high risk exposure because it can take that viral
particle and stick it deep under the skin,” said Dr. Bill Smock, LMPD
police surgeon.

Smock says as heroin use rises, more people have syringes on them.

According to the police department, 13 officers were stuck by needles in
2013. Eight officers were stuck by needles the next year. So far this
year, nine officers have been stuck by needles. It’s led to a new protocol
within the department giving officers access to a drug that prevents HIV.

“We will have medication pre-staged in each of the divisions around the
county so that if an officer on Dixie Highway has a needle stick and
exposure they can be administered the medication hopefully within 10 to 15
minutes of the exposure,” Smock told WDRB News.

There is no preventative drug for Hepatitis C but there is treatment,
according to Smock. He says the officer will now have to undergo months of
testing as doctors monitor whether he contracts the virus.

“This is a very traumatic event, not only for the officer, but for their
family,” Smock said.

Police say the officer in this case asked Smith if he had anything on him
that could stick him. According to an arrest warrant, Smith denied having
anything. He’s been charged with wanton endangerment and possession of
drug paraphernalia.

Dr. Smock says to date, no LMPD officers have contracted HIV or Hepatitis
C through exposure at work.

Copyright 2015 WDRB News. All rights reserved.
__________________________________________________________________
__________________________________________________________________
https://tinyurl.com/okdkq9y

Canada: Hep C-positive attacker who stabbed store employee with dirty
needle gets 31 months’ jail

By Tim Petruk, The Province, B.C. Canada (11.08.15)

KAMLOOPS, B.C. — Stabbing a store employee with a dirty needle has cost a
Kamloops man with hepatitis C more than two years of freedom.

Jonathon Fernandez was sentenced in B.C. Supreme Court on Monday to 31
months in jail after being found guilty of aggravated assault.

The 42-year-old was charged after an incident at Extra Foods in north
Kamloops on March 27.

Court heard a loss-prevention officer spotted Fernandez trying to steal
Lakota back cream and followed him out of the store.

When confronted, Fernandez pulled a needle on the worker and started
swinging.

The worker was struck in his left palm and the needle became embedded in
his hand.

Fernandez was eventually subdued and arrested by police.

Crown prosecutor Joel Gold said the victim underwent 28 days of medication
and is still being regularly monitored by doctors.

“You’ve got the potential of transference of life-threatening diseases,
you’ve got the anxiety of the victim,” Gold said.

“The good news is that he’s so far clear and the hope is that will
continue to be the case.”

Court heard Fernandez has a lengthy criminal history with more than 40
convictions, seven of which have been for violent offences.

B.C. Supreme Court Justice Dev Dley handed Fernandez a 31-month sentence
in a federal penitentiary, to be followed by one year of probation.

“I’m terrified of going to a federal penitentiary,” Fernandez said in
court. “I’ve heard stories of what goes on in there. I’m scared to death
but, at the same time, I’m a God-fearing man and I’ll go down whatever
road the Lord has chosen for me.”

Fernandez was also ordered to submit a sample of his DNA to a national
criminal database.

© Copyright (c) The Province
__________________________________________________________________
__________________________________________________________________
https://tinyurl.com/orcpps4

USA: High numbers of hepatitis C infections found at urban ERs: Ten
percent of patients tested in a six-month period were infected with the
virus, and most had no idea

By Stephen Feller, UPI USA (07.08.15)

WASHINGTON, Aug. 7 (UPI) — Three-quarters of people who tested positive
for the hepatitis C virus in a study of patients at emergency rooms had no
idea they were infected with it.

Hepatitis C, a blood-borne infection that can cause liver disease and
liver cancer, affects about 3 million people in the United States, about
75 percent of whom are part of the Baby Boom generation.

“In addition to the myriad public health functions they already perform,
urban emergency departments may play an important role as safety net
providers for HCV screening,” said Dr. Douglas White, a researcher and
emergency physician at Highland Hospital in Oakland, Calif., in a press
release. “We have a better than even chance of reaching many of the three
million people who are infected since they tend to be heavy emergency
department users already. It gives us a chance to connect these people to
ongoing care at HCV clinics or elsewhere in the health care system.”

Researchers analyzed patient data on 26,639 adult patients over the age of
18 collected during a six-month study at Highland Hospital in Oakland.
Just under 10 percent of those patients, 2,581, completed either virus
screening or diagnostic testing as part of program set up in the
hospital’s emergency room to gauge the prevalence of hepatitis C in the
community.

Patients were selected either because they are members of the Baby Boom
generation, who are born between 1945 and 1965, or had reported ever using
injectible drugs.

Among the group that was tested, 10.3 percent, or 267 people, tested
positive for the virus. Researchers classified 70 percent of those as
“chronically infected.” Only 24 percent of patients were aware they had
the virus before being tested at the hospital.

About two-thirds of the patients were not informed of their test results
before being discharged from the hospital, requiring staff to track them
down — which researchers said was difficult — and 76 percent did not
show up for follow-up appointments.

“Given skyrocketing rates of injection heroin use around the country, we
expect the already high rates of hepatitis C infection to explode,” said
lead study author Douglas White, MD, of Highland Hospital, Alameda Health
System in Oakland, Calif. “Intervention by emergency departments, in the
form of screening and referral for treatment, could help slow the spread
of this potentially deadly, communicable disease.”

The study is published in the Annals of Emergency Medicine.
__________________________________________________________________
__________________________________________________________________
www.reuters.com/article/2015/07/31/health-ebola-who-idUSL5N10B3XQ20150731

Global: After Ebola Criticisms, WHO Plans for 4-Month Epidemic Response

By Tom Miles, Reuters Health Information (31.07.15)

GENEVA (Reuters) – The World Health Organization is creating a “blueprint”
to improve the medical response to major outbreaks of diseases, after it
was accused of reacting too slowly to West Africa’s Ebola epidemic, it
said on Friday.

“The goal is to reduce the time from recognition of an outbreak to the
availability of new medical tools to four months or less,” WHO Director-
General Margaret Chan told a news conference in Geneva.

“Doing so, I believe, will leave the world better prepared for the next
inevitable medical emergency. No one wants to see clinicians, doctors,
left empty handed again.”

The plan is likely to cover influenza strains such as H5N1 and could help
prepare for a worsening spread of Middle East Respiratory Syndrome (MERS),
among other diseases, WHO officials said.

The proposal is part of a swathe of reforms designed to avoid a repetition
of the U.N. health agency’s slow response to the Ebola epidemic, which has
killed 11,294 people and has yet to be fully snuffed out in Sierra Leone,
Liberia and Guinea.

The WHO is hoping to learn from the development of an Ebola vaccine, which
has proceeded at lightning speed compared to normal drug development but
only really took off once the Ebola outbreak was already at crisis point.

One potential Ebola vaccine has been shown to be 100% effective, according
to trial data reported in the Lancet July 31. (http://bit.ly/1fOPMOZ)

When the next epidemic comes, the WHO wants the tools to tackle it much
more quickly. It plans to analyse diagnostics, vaccines, drugs and other
medical equipment, and wants to take research far enough so that the
products could reach the final phase of efficacy testing within four
months of an outbreak.

“Based on our experience of Ebola and our earlier experience of pandemic
influenza, in some diseases it’s very difficult to develop innovations,
especially from scratch, in four months,” Chan said.

WHO Assistant-Director-General Marie-Paule Kieny said: “What we have
started to work on … is to see what should be done for other diseases of
epidemic potential, prior to any epidemic starting.”

The plan will set up “step-by-step procedures, protocols, collaborative
agreements, codes of conduct, and ideal product profiles that can be put
in place in advance,” Chan said.

The blueprint is expected to be presented to the WHO’s annual conference
of health ministers, the World Health Assembly, in 2016, Kieny said.
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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
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* 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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