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SIGNpost 00821

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST

Post00821 Reminder Toolbox Review + Abstracts + News 23 September 2015

CONTENTS
0. Moderators Note: Reminder & Late Call: Injection Safety Toolbox Review
1. Abstract: Needlestick and occupational exposure to infections: a
compendium of current guidelines
2. Abstract: Nosocomial hepatitis C virus transmission from tampering with
injectable anesthetic opioids
3. Abstract: A survey on injuries among nurses and nursing students: a
descriptive epidemiologic analysis between 2002 and 2012 at a
University Hospital
4. Abstract: HIV-related knowledge, attitudes and practice among health
care workers in Montenegro
5. Abstract: Use of parenteral caffeinum natrio-benzoicum: an
underestimated risk factor for HCV transmission in China
6. Abstract: Using hepatitis C prevalence to estimate HIV epidemic
potential among people who inject drugs in the Middle East and North
Africa
7. Abstract: Risky behavior and correlates of HIV and Hepatitis C Virus
infection among people who inject drugs in three cities in Afghanistan
8. Abstract: Training students to use syringe pumps: an experimental
comparison of e-learning and classroom training
9. Abstract: Hand hygiene in reducing transient flora on the hands of
healthcare workers: an educational intervention
10. Abstract: Iranian healthcare workers’ perspective on hand hygiene: a
qualitative study
11. Abstract: Cutaneous cooling to manage botulinum toxin injection-
associated pain in patients with facial palsy: A randomised controlled
trial
12. Abstract: Short-term outcomes of platelet-rich plasma injection for
treatment of osteoarthritis of the knee
13. Abstract: Contamination of health care workers’ coats at the
University Teaching Hospital in Lusaka, Zambia: the nosocomial risk
14. No Abstract: Intravitreal injections and endophthalmitis
15. News
– UK: Streets Of Shame: Parts of Renfrewshire are becoming a deadly
dumping ground for hundreds of syringes

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__________________________________________________________________
________________________________*_________________________________

0. Moderators Note: Reminder & Late Call: Injection Safety Toolbox Review
__________________________________________________________________
Reminder & Late Call: Injection Safety Toolbox Review

Just in case you had some thought on this and had not got around to it –
one last chance!

The Injection Safety website and tools need some revision.

This is an open call for everyone, particularly experts to kindly visit
the Injection Safety Toolbox page at
http://www.who.int/injection_safety/toolbox/en/

Please review:

– the Policy Management tools

– the Technical Tools for Assessing, Planning, and Implementing injection
safety

– the Resources in the Document Centre with content spanning the period
from 1999 to the present

Please suggest which tools require revision

And if you see a need: What new tools should be developed?

Please reply to ALTAF, Arshad <altafa@who.int> by 20 September 2015
__________________________________________________________________
________________________________*_________________________________

1. Abstract: Needlestick and occupational exposure to infections: a
compendium of current guidelines
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23969653
Br Dent J. 2013 Aug;215(4):163-6. doi: 10.1038/sj.bdj.2013.791.

Needlestick and occupational exposure to infections: a compendium of
current guidelines.

Samaranayake L1, Scully C.
Author information

1The University of Hong Kong, 34 Hospital Road, Sai Ying Pun, Hong Kong.
lakshman@hku.hk

Needlestick and occupational exposure to infections is a constant threat
in dental practice.

Many blood-borne infections, including human immunodeficiency virus (HIV)
infection, hepatitis B and hepatitis C, may be contracted through this
route.

We provide here a useful compendium for dental practitioners on current
guidelines available to obviate such threats, as well as a simple
flowchart on prophylactic measures that could be taken after an accidental
exposure.
__________________________________________________________________
________________________________*_________________________________

2. Abstract: Nosocomial hepatitis C virus transmission from tampering with
injectable anesthetic opioids
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/25808284
Hepatology. 2015 Jul;62(1):101-10.

Nosocomial hepatitis C virus transmission from tampering with injectable
anesthetic opioids.

Hatia RI1, Dimitrova Z1, Skums P1, Teo EY2, Teo CG1.

1Division of Viral Hepatitis, Centers for Disease Control and Prevention,
Atlanta, GA.
2Department of Anesthesiology, Emory University School of Medicine,
Atlanta, GA.

The extent of provider-to-patient hepatitis C virus (HCV) transmission
from diversion, self-injection, and substitution (“tampering”) of
anesthetic opioids is unknown.

To quantify the contribution of opioid tampering to nosocomial HCV
outbreaks, data from health care-related HCV outbreaks occurring in
developed countries from 1990 to 2012 were collated, grouped, and
compared.

Tampering was associated with 17% (8 of 46) of outbreaks, but 53% (438 of
833) of cases. Of the tampering outbreaks, six (75%) involved fentanyl,
five (63%) occurred in the United States, and one each in Australia,
Israel, and Spain. Case counts ranged from 5 to 275 in the tampering
outbreaks (mean, 54.8; median, 25), and 1-99 in the nontampering outbreaks
(mean, 10.4; median, 5); between them, the difference in mean ranks of
counts was significant (P?<?0.01). To estimate HCV transmission risks from
tampering, risk-assessment models were constructed, and these risks
compared with those from surgery.

HCV transmission risk from exposure to an opioid preparation tampered by a
provider of unknown HCV infection status who is a person who injects drugs
(PWID; 0.62%; standard error [SE]?=?0.38%) exceeds 16,757 times the risk
from surgery by a surgeon of unknown HCV infection status (0.000037%;
SE?=?0.000029%) and 135 times by an HCV-infected surgeon (0.0046%;
SE?=?0.0033%).

To pose a 50% patient transmission risk, an infected surgeon may take 30
years, compared to <1 year for a PWID tamperer, and weeks or days for a
PWID tamperer who intensifies access to opioids.

CONCLUSION: Disproportionately, many cases of HCV infection from
nosocomial outbreaks were attributable to provider tampering of anesthetic
opioids. Transmission risk from tampering is substantially higher than
from surgery.

© 2015 by the American Association for the Study of Liver Diseases. This
article has been contributed to by U.S. Government employees and their
work is in the public domain in the USA.
__________________________________________________________________
________________________________*_________________________________

3. Abstract: A survey on injuries among nurses and nursing students: a
descriptive epidemiologic analysis between 2002 and 2012 at a
University Hospital
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/25951867
Med Lav. 2015 May 4;106(3):216-29.

[A survey on injuries among nurses and nursing students: a descriptive
epidemiologic analysis between 2002 and 2012 at a University Hospital].

[Article in Italian]

Stefanati A1, Boschetto P, Previato S, Kuhdari P, De Paris P, Nardini M,
Gabutti G.

1Università degli studi di Ferrara-Sezione di Sanità Pubblica-
Dipartimento di Scienze Mediche. sta@unife.it.

BACKGROUND: Biological risk is the main occupational hazard in hospitals
(40-50% of the total). More than 130,000 injuries occur every year in
Italy and nurses are the most affected occupational category.

OBJECTIVES: This study evaluated the incidence of injuries related to
biological risk in nurses and nursing students in the University Hospital
of Ferrara, how they occur, the knowledge on the topic and on behaviour
during the department’s activity.

METHODS: A retrospective study involving a sample of 8 departments
(selected for the occurrence of more than 30 biological injuries between
1st January 2002 and 31 December 2012) recorded injuries related to
biological risk; subsequently a cross-sectional survey was carried out
through a questionnaire administered to nurses and nursing students.

RESULTS: 909 biological accidents were reported (81.18% in nurses and
18.82% in students). Blood was the main biological material involved
(83.72% of cases), mostly by percutaneous exposure (84.16%). According to
the questionnaire, 53% of subjects reported having had at least one injury
during their career, and 5.72% did not report it; 46% reported doing risky
procedures (re-capping needles) and 95.45% that they had been informed
about the correct use of PPE.

CONCLUSIONS: The lower percentage of injuries in students could be linked
to good university training and to less risky procedures being performed.
Re- capping needles remains one of the most dangerous manoeuvers
practised. Ongoing training on the correct use of PPE is essential to
train prepared and aware health professionals.
__________________________________________________________________
________________________________*_________________________________

4. Abstract: HIV-related knowledge, attitudes and practice among health
care workers in Montenegro
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/26040074
Coll Antropol. 2015 Mar;39(1):81-5.

HIV-related knowledge, attitudes and practice among health care workers in
Montenegro.

Gledovic Z, Rakocevic B, Mugoša B, Grgurevic A.

The objective of the present study was to assess HIV-related knowledge,
attitudes, and practice of health care workers (HCWs) in Montenegro. A
cross-sectional study was conducted in the University Clinical Centre of
Montenegro in Podgorica.

A self-administered anonymous questionnaire was used for data collecting.

Out of 526 HCWs, 422 were included in the survey and response rate was
80%.

An insufficient level of knowledge on HIV transmission and the risk after
exposure was observed generally, although the knowledge was better in
physicians compared to other HCWs categories.

A rather high proportion of HCWs showed inappropriate attitude regarding
the need of HIV testing of all hospitalized patients (64.7%) and
obligation of HIV+ patient to report his/her HIV status (88.9%) in order
to practice universal precaution. Additionally, 6.2% HCWs would refuse to
treat an HIV+ patient. More than a half (55.7%) of study participants were
educated in HIV/AIDS and 15.9% of them were HIV tested.

Majority of HCWs (67.5%) always applied universal precautions during their
daily work with patients. In spite of applying protective devices, number
of accidents was great.

A continuous education is necessary to increase the level of knowledge of
HCWs about the risk of infection at the workplace. This would potentially
influence the modification of their attitudes regarding HIV patients and
improve prevention at the workplace.

Continuous research regarding the professional risk would provide better
health and safety among medical staff.
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Use of parenteral caffeinum natrio-benzoicum: an
underestimated risk factor for HCV transmission in China
__________________________________________________________________

Free full text http://www.biomedcentral.com/1471-2458/15/928
BMC Public Health. 2015 Sep 19;15(1):928.

Use of parenteral caffeinum natrio-benzoicum: an underestimated risk
factor for HCV transmission in China.

Xu H1,2, Yu G3, Sun H4, Lv J5, Wang M6, Kong F7, Zhang M8, Chi X9,10, Wang
X11,12, Wu R13,14, Gao X15,16, Zhong J17, Sun B18, Jiang J19, Pan Y20, Niu
J21,22,23.

BACKGROUND: Fuyu city in China has a high prevalence of hepatitis C virus
(HCV) infection resulting in a high morbidity and mortality from chronic
liver disease and hepatocellular carcinoma. This study was conducted to
identify the risk factors for HCV infection in Fuyu city.

METHODS: Recruitment of study subjects involved a cross-sectional survey
using non-random, convenience sampling. Information on demographic
variables, risk factors for HCV infection, clinical manifestations,
behavioral practices and family history was collected by administering a
questionnaire. Anti-HCV antibody was detected using Abbott ARCHITECT
i2000SR. HCV infection was confirmed by HCV-RNA testing by the Roche
Taqman HCV test. Univariate and multivariate analyses were performed to
identify the factors associated with HCV infection.

RESULTS: Out of 3,228 persons that participated in the survey, 3,219 were
enrolled in the study. The prevalence of HCV infection was 42.1 %
(1355/3219). Among 734 patients with chronic HCV infection whose HCV-RNA
genotyping was performed, genotype 1b was the most common (58.0 %),
followed by genotype 2a (40.2 %), while co-infection with genotypes 1b and
2a was detected in 1.8 % of the subjects.

On univariate analysis, male gender, older age, parenteral caffeinum
natrio-benzoicum and share syringes (PCNBSS), and nine other factors were
significantly associated with HCV infection.

After adjusting for potential confounders, male gender, old age, cigarette
smoking, lower education level, history of blood transfusion, blood
donation, prior dental surgery, and PCNBSS were found to be independently
associated with HCV infection.

CONCLUSIONS: The prevalence of HCV infection is likely to be high among
residents in Fuyu and we observed that genotypes 1b and 2a dominated in
the city. Our findings support the hypothesis that PCNBSS which became
endemic in Fuyu city during 1970s-1980s is strongly associated with HCV
positivity.
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Using hepatitis C prevalence to estimate HIV epidemic
potential among people who inject drugs in the Middle East and North
Africa
__________________________________________________________________

Open Access http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4541475/
AIDS. 2015 Aug 24;29(13):1701-10.

Using hepatitis C prevalence to estimate HIV epidemic potential among
people who inject drugs in the Middle East and North Africa.

Mumtaz GR1, Weiss HA, Vickerman P, Larke N, Abu-Raddad LJ.

1aInfectious Disease Epidemiology Group, Weill Cornell Medical College –
Qatar, Cornell University, Qatar Foundation – Education City, Doha, Qatar
bMRC Tropical Epidemiology Group, Department of Infectious Disease
Epidemiology, Faculty of Epidemiology and Population Health, London School
of Hygiene and Tropical Medicine, London cSchool of Social and Community
Medicine, University of Bristol, Bristol, UK dDepartment of Healthcare
Policy and Research, Weill Cornell Medical College, Cornell University,
Ithaca, New York eVaccine and Infectious Disease Institute, Fred
Hutchinson Cancer Research Center, Seattle, Washington, USA.

OBJECTIVES: The objective of this study is to understand the association
between HIV and hepatitis C virus (HCV) among people who inject drugs
(PWIDs) in the Middle East and North Africa (MENA), and to estimate HIV
epidemic potential among PWIDs using HCV prevalence.

DESIGN/METHODS: Using data from a systematic review of HIV and HCV among
PWID in MENA, we conducted two analyses, stratified by HIV epidemic state:
a meta-analysis of the risk ratio of HCV to HIV prevalence (RRHCV/HIV)
using DerSimonian- Laird random-effects models, and multivariable linear
regression predicting log HIV prevalence. The HCV-HIV association from
both analyses was used to estimate HIV prevalence at endemic equilibrium.
We compared predicted with current HIV prevalence to classify HIV epidemic
potential at country-level as low, medium or high, using predefined
criteria.

RESULTS: The review identified 88 HCV prevalence measures among PWID in
MENA, of which 54 had a paired HIV prevalence measure. The pooled
RRHCV/HIV were 16, 4 and 3 in low-level, emerging and established HIV
epidemics, respectively. There was a significant linear relationship
between HCV and HIV at endemic equilibrium (P?=?0.002). The predicted
endemic HIV prevalence ranged between 8% (Tunisia) and 22% (Pakistan). Of
the nine countries with data, five have high and three medium HIV epidemic
potential. Only one country, Pakistan, appears to have reached saturation.

CONCLUSION: HCV prevalence could be a predictor of future endemic HIV
prevalence. In MENA, we predict that there will be further HIV epidemic
growth among PWID. The proposed methodology can identify PWID populations
that should be prioritized for HIV prevention interventions.

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4541475/
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Risky behavior and correlates of HIV and Hepatitis C Virus
infection among people who inject drugs in three cities in Afghanistan
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/25131717
Drug Alcohol Depend. 2014 Oct 1;143:127-33.

Risky behavior and correlates of HIV and Hepatitis C Virus infection among
people who inject drugs in three cities in Afghanistan.

Ruiseñor-Escudero H1, Wirtz AL2, Berry M3, Mfochive-Njindan I4, Paikan F5,
Yousufi HA5, Yadav RS6, Burnham G4, Vu A7.

1Department of Psychiatry, Michigan State University, 965 E Fee Hall Suite
A227, East Lansing, MI, 48824, USA; Department of International Health,
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205,
USA. Electronic address: horaciore@gmail.com.
2Department of Emergency Medicine, Johns Hopkins Medical Institution,
Baltimore, MD, 21205, USA; Center for Public Health and Human Rights,
Department of Epidemiology, Johns Hopkins Bloomberg School of Public
Health, Baltimore, MD, 21205, USA.
3Centers for Disease Control and Prevention, Atlanta, GA, USA.
4Department of International Health, Johns Hopkins Bloomberg School of
Public Health, Baltimore, MD, 21205, USA.
5National AIDS Control Program, Ministry of Public Health, Kabul,
Afghanistan.
6ChildFund, New Delhi, 110048, India.
7Department of Emergency Medicine, Johns Hopkins Medical Institution,
Baltimore, MD, 21205, USA; Department of International Health, Johns
Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.

BACKGROUND: Injecting drug use is the primary mode of HIV transmission and
acquisition in Afghanistan. People who inject drugs (PWID) in the country
have been characterized by high risk injecting behavior and a high burden
of HCV infection. We aimed to estimate the burden of HIV, HCV, and other
infectious diseases and to identify the correlates of HIV and HCV
infection among PWID living in three major Afghan cities in 2009.

METHODS: Epidemiologic data was collected among PWID for the integrated
biological and behavioral surveillance (IBBS) survey between May and
August, 2009 in three Afghan cities. Data were collected using a
structured questionnaire and biologic specimens to screen for HIV, HBV,
HCV, syphilis, and HSV-2 using rapid testing kits. Multiple logistic
regression models were constructed to identify correlates of infection.

RESULTS: Among 548 participants, pooled HIV prevalence was 7.1% (Mazar-i-
Sharif: 1.0%, Kabul: 3.1%, Herat: 18.4%) and HCV prevalence was 40.3%.
Almost all participants with HIV infection were co-infected with HCV
(94.9%). Pooled prevalence estimates for other diseases included 7.1% for
HBV, 5.5% for syphilis; and 9.3% for HSV-2. Living in Herat, ever in
prison and time injecting were independently associated with HIV
infection. Living in Kabul, Herat and time injecting were independently
associated with HCV infection.

CONCLUSIONS: There is a high and heterogeneous burden of HIV and HCV among
PWID in Afghan cities. Provision of comprehensive harm reduction services
to PWID in Afghanistan is warranted to reduce exposures associated with
HIV and HCV infection, especially in the city of Herat.

Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

KEYWORDS: Afghanistan; HBV; HCV; HIV; HSV; PWID
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Training students to use syringe pumps: an experimental
comparison of e-learning and classroom training
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/26368041
Biomed Tech (Berl). 2015 Sep 12.
pii: /j/bmte.ahead-of-print/bmt-2014-0116/bmt-2014-0116.xml.

Training students to use syringe pumps: an experimental comparison of e-
learning and classroom training.

Grundgeiger T, Kolb L, Korb MO, Mengelkamp C, Held V.

The inadequate use of syringe pumps can jeopardize patient safety, and
syringe pump trainings are conducted to manage this risk.

A critical step in this risk management process is the learning success of
trainees. In the present paper, we compared an e-learning approach with
standard classroom training in learning success effectives, trainees’
opinion on the trainings, and investigated the relation between
technological affinity and learning success.

The results showed that e-learning was as effective as classroom training
but nursing students’ confidence in using the pump and satisfaction with
the training was decreased for e-learning compared with classroom
training. We discuss the results in context of the nursing e-learning
literature.

Finally, we discuss the literature for risk identification, risk analysis,
risk treatment, and risk monitoring and control in the context of syringe
pump training and add the lessons learned from the evaluated e-learning
program.
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Hand hygiene in reducing transient flora on the hands of
healthcare workers: an educational intervention
__________________________________________________________________

Free Full Text http://www.ijmm.org/text.asp?2015/33/1/125/148409
Indian J Med Microbiol. 2015 Jan-Mar;33(1):125-8.

Hand hygiene in reducing transient flora on the hands of healthcare
workers: an educational intervention.

Kapil R, Bhavsar HK1, Madan M.

1Cancer Society Medical College, Ahmedabad, Gujarat, India.

AIM: Hand hygiene has now been recognised as one of the most effective
intervention to control the transmission of infections in a hospital and
education is an important tool to ensure its implementation. In order to
convince the users and as a part of education, it is important to generate
evidence on the role of hand hygiene in reducing the bacterial flora on
their hands. The present study was undertaken in a tertiary care hospital
to demonstrate the presence of bacterial flora on the hands of healthcare
workers (HCW) in different categories, to teach them proper hand hygiene
technique using alcohol-based hand rub and determine the outcome for
reduction of bacteria.

MATERIALS AND METHODS: A total sample size of 60 subjects including
resident doctors, medical students, nurses and hospital attendants were
included in the study after obtaining informed consent. Each person was
educated on the technique of hand hygiene with alcohol-based hand rub and
hand impressions were cultured before and after hand hygiene. All the
subjects were also given a questionnaire to assess their perception on
hand hygiene. The WHO posters on proper hand hygiene were displayed in the
appropriate areas of the hospital in addition, as an educational tool.

RESULTS: Majority (42 out of 60) of the HCWs had bacterial count up to 100
colonies or more on both hands before the application of hand rub while
working in the hospital. After use of alcohol hand rub with a proper hand
hygiene technique, it was found that the percentage reduction was 95-99%
among doctors and nurses, 70% among hospital attendants and 50% among
sanitary attendants. Staphylococcus aureus was present on the hands of
eight persons of which three were methicillin-resistant Staphylococcus
aureus.

CONCLUSIONS: The study demonstrates that transient bacteria are present on
the hands of HCWs but majority could be removed by proper hand hygiene,
which needs continuous education to be effective. It also shows that
active education by demonstrating the proper hand hygiene technique and
direct observation of the practices, though demanding, are ideal to
understand the attitudes and practices of HCWs and helps in planning
implementation strategies.

Free full text http://www.ijmm.org/text.asp?2015/33/1/125/148409
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Iranian healthcare workers’ perspective on hand hygiene: a
qualitative study
__________________________________________________________________

Free Full Text http://www.jiph.org/article/S1876-0341(14)00077-X/fulltext
J Infect Public Health. 2015 Jan-Feb;8(1):72-9.

Iranian healthcare workers’ perspective on hand hygiene: a qualitative
study.

McLaws ML1, Farahangiz S2, Palenik CJ3, Askarian M4.

1School of Public Health & Community Medicine, UNSW Medicine, UNSW
Australia, Sydney, Australia. Electronic address: M.mclaws@unsw.edu.au.
2Student Research Committee, Shiraz University of Medical Sciences,
Shiraz, Iran. Electronic address: farahangiz@sums.ac.ir.
3Department of Oral Biology, Infection Control Research and Services,
Indiana University School of Dentistry, Indianapolis, IN, USA.
4Department of Community Medicine, Shiraz Anesthesiology and Critical Care
Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Electronic address: askariam@sums.ac.ir.

BACKGROUND: Hand hygiene (HH) has been identified as one of the simplest,
but most important, methods to prevent cross-infection in healthcare
facilities. In spite of this fact, the HH compliance rate remains low
among healthcare workers (HCWs). Several factors may affect HH behavior.
In this study, we aimed to assess various aspects of HH from the
perspective of HCWs.

METHOD: This qualitative study was conducted in two hospital settings in
Shiraz, Iran. Eight focus group discussions (FGDs) and six in-depth
interview sessions were held with ICU and surgical ward nurses, attending
physicians, medical and nursing students and supporting staff. Each FGD
and interview was transcribed verbatim, open codes were extracted, and
thematic analysis was conducted.

RESULTS: Three themes emerged from the thematic analysis including: “the
relationship between personal factors and HH compliance,” “the
relationship between environmental factors and HH compliance” and “the
impact of the health system on HH adherence, including the role of
adequate health systems, administrative obligations and the effect of
surveillance systems.”

CONCLUSION: Several factors played a significant role in improving HCWs HH
compliance, such as the regular adherence to health system tenets. HH
compliance may be improved through application of realistic policies and
better supervision. In addition, appropriate education may positively
affect HH behavior and attitudes.

Copyright © 2014 King Saud Bin Abdulaziz University for Health Sciences.
All rights reserved.

KEYWORDS: Hand hygiene; Healthcare workers; Iran; Qualitative study
__________________________________________________________________
________________________________*_________________________________

11. Abstract: Cutaneous cooling to manage botulinum toxin injection-
associated pain in patients with facial palsy: A randomised controlled
trial
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/26385134
J Plast Reconstr Aesthet Surg. 2015 Aug 19. pii: S1748-6815(15)00384-8.

Cutaneous cooling to manage botulinum toxin injection-associated pain in
patients with facial palsy: A randomised controlled trial.

Pucks N1, Thomas A2, Hallam MJ3, Venables V4, Neville C4, Nduka C4.

1Department of Acute General Medicine, John Radcliffe Hospital, Headley
Way, Oxford, UK.
2Division of Surgery, Imperial College London, 10th Floor QEQM Building,
London, UK; Facial Palsy Team, Department of Plastic Surgery, Queen
Victoria NHS Foundation Trust, Holtye Road, East Grinstead, West Sussex,
UK. Electronic address: Dralexisthomas@gmail.com.
3Department of Plastic Surgery, Aberdeen Royal Infirmary, Foresterhill
Road, Aberdeen, UK.
4Facial Palsy Team, Department of Plastic Surgery, Queen Victoria NHS
Foundation Trust, Holtye Road, East Grinstead, West Sussex, UK.

INTRODUCTION: Botulinum toxin injections are an effective, well-
established treatment to manage synkinesis secondary to chronic facial
palsy, but they entail painful injections at multiple sites on the face up
to four times per year. Cutaneous cooling has long been recognised to
provide an analgesic effect for cutaneous procedures, but evidence to date
has been anecdotal or weak. This randomised controlled trial aims to
assess the analgesic efficacy of cutaneous cooling using a cold gel pack
versus a room-temperature Control.

MATERIAL AND METHODS: The analgesic efficacy of a 1-min application of a
Treatment cold (3-5 °C) gel pack versus a Control (room-temperature (20
°C)) gel pack prior to botulinum toxin injection into the platysma was
assessed via visual analogue scale (VAS) ratings of pain before, during
and after the procedure.

RESULTS: Thirty-five patients received both trial arms during two separate
clinic appointments. Cold gel packs provided a statistically significant
reduction in pain compared with a room-temperature Control (from 26.4- to
10.2-mm VAS improvement (p < 0.001)), with no variance noted secondary to
age, the hemi-facial side injected or the order in which the Treatment or
Control gel packs were applied.

CONCLUSION: Cryoanalgesia using a fridge-cooled gel pack provides an
effective, safe and cheap method for reducing pain at the botulinum toxin
injection site in patients with facial palsy.

Copyright © 2015 British Association of Plastic, Reconstructive and
Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

KEYWORDS: Analgesia; Botulinum toxin; Cryoanalgesia; Facial nerve palsy;
Pain; Synkinesis
__________________________________________________________________
________________________________*_________________________________

12. Abstract: Short-term outcomes of platelet-rich plasma injection for
treatment of osteoarthritis of the knee
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/26387122
Knee Surg Sports Traumatol Arthrosc. 2015 Sep 19.

Short-term outcomes of platelet-rich plasma injection for treatment of
osteoarthritis of the knee.

Kanchanatawan W1, Arirachakaran A2, Chaijenkij K3, Prasathaporn N4,
Boonard M5, Piyapittayanun P6, Kongtharvonskul J7.

1Orthopedics Department, Lerdsin General Hospital, Bangkok, Thailand.
Wichanmd@yahoo.com.
2Orthopedics Department, Police General Hospital, Bangkok, Thailand.
amy.alisara@gmail.com.
3Orthopedics Department, College of Sports Science and Technology, Mahidol
University, Bangkok, Thailand. kornortho@gmail.com.
4Orthopedics Department, Queen Savang Vadhana Memorial Hospital, Bangkok,
Thailand. Khakainiti@gmail.com.
5Orthopedics Department, Srinakarin Hospital, Khonkaen, Thailand.
mboonard@gmail.com.
6Orthopedics Department, Police General Hospital, Bangkok, Thailand.
Ppiyapittayanun@yahoo.com.
7Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine,
Ramathibodi Hospital, Rama VI Road, Rachatevi, Bangkok, 10400, Thailand.
Jatupon_kong@hotmail.com.

PURPOSE: To compare the clinical outcomes of osteoarthritis indices (WOMAC
and Lequesne scores) and adverse events in the treatment of osteoarthritis
(OA) of the knee with platelet-rich plasma (PRP) versus hyaluronic acid
(HA) or placebo.

METHODS: A systematic review and meta-regression were performed to compare
outcomes between PRP injections versus HA or placebo. Relevant randomized
control trials were identified from Medline and Scopus from date of
inception to 13 August 2015.

RESULTS: Nine of 551 studies were eligible; 6, 5, 5, 5, 2, 2, 2 and 7
studies were included in pooling of WOMAC total, pain, stiffness and
function scores, Lequesne score, IKDC score, EQ-VAS score and adverse
events in OA knee patients, respectively. The PRP injections had -15.4 (95
% CI -28.6, -2.3, p = 0.021), lower mean WOMAC total scores, and 8.83 (95
% CI 5.88, 11.78, p < 0.001), 7.37 (95 % CI 4.33, 10.05, p = 0.021) higher
mean IKDC and EQ- VAS scores when compared to HA injections. However, PRP
injections had no significant differences in WOMAC pain, stiffness and
function scores, as well as Lequesne score and adverse events when
compared to HA or placebo.

CONCLUSION: In short-term outcomes (=1 year), PRP injection has improved
functional outcomes (WOMAC total scores, IKDC score and EQ-VAS) when
compared to HA and placebo, but has no statistically significant
difference in adverse events when compared to HA and placebo. This study
suggests that PRP injection is more efficacious than HA injection and
placebo in reducing symptoms and improving function and quality of life.
It has the potential to be the treatment of choice in patients with mild-
to-moderate OA of the knee who have not responded to conventional
treatment.

LEVEL OF EVIDENCE: I.

KEYWORDS: HA; Hyaluronic acid; Meta-analysis; Osteoarthritis; PRP;
Platelet-rich plasma
__________________________________________________________________
________________________________*_________________________________

13. Abstract: Contamination of health care workers’ coats at the
University Teaching Hospital in Lusaka, Zambia: the nosocomial risk
__________________________________________________________________

Free Open Access http://www.occup-med.com/content/10/1/34
J Occup Med Toxicol. 2015 Sep 16;10:34.

Contamination of health care workers’ coats at the University Teaching
Hospital in Lusaka, Zambia: the nosocomial risk.

Mwamungule S1, Chimana HM1, Malama S2, Mainda G3, Kwenda G1, Muma JB3.

1Department of Biomedical Sciences, School of Medicine, University of
Zambia, Lusaka, Zambia.
2Health Promotions Unit, Institute of Economic and Social Research,
University of Zambia, Lusaka, Zambia.
3Department of Disease Control, School of Veterinary Medicine, University
of Zambia, Lusaka, Zambia.

BACKGROUND: Health care Associated Infections (HAIs) are a major public
health problem in both developed and developing countries. They pose a
severe impact in resource-poor settings, where the rate of infection is
estimated to be relatively high. Therefore, this study was conducted to
establish empirical evidence related to HAIs in Zambia.

METHOD: This was a prospective cross-sectional study conducted from
October, 2013 to May 2014 at the University Teaching Hospital (UTH) in
Lusaka. A total of 107 white coats worn by health care-workers at UTH were
sampled for possible bacteriological contamination.

RESULTS: Of the 107 white coats screened, 94 (72.8 %) were contaminated
with bacteria. There was no difference in the contamination levels between
white coats worn for more than 60 min (47.8 %) compared to those worn for
30-60 min (46.7 %) (p?=?0.612). Further, the antibiotic sensitivity tests
indicated that the bacterial isolates were resistant to some of the
antibiotics assessed. Isolates of Staphylococcus aureus and Klebsiella
pnumoniae exhibited the highest resistance to most of the antibiotics
assessed.

CONCLUSION: This study has shown that white coats worn by health care-
workers at the University Teaching Hospital generally have high microbial
contaminations and hence pose a nosocomial risk. It is therefore,
recommended that white coats be regularly sanitized, and health care
workers also be sensitized on public health risk of HAIs associated with
contaminated coats.

KEYWORDS: Antibiotic- resistance; Bacteria; Health-worker; Nosocomial;
Zambia

Free Article http://www.occup-med.com/content/10/1/34
__________________________________________________________________
________________________________*_________________________________

14. No Abstract: Intravitreal injections and endophthalmitis
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/25730615
Int Ophthalmol Clin. 2015 Spring;55(2):1-10.

Intravitreal injections and endophthalmitis.

Kim SJ.
__________________________________________________________________
________________________________*_________________________________

15. News

– UK: Streets Of Shame: Parts of Renfrewshire are becoming a deadly
dumping ground for hundreds of syringes

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/p9vjms3
UK: Streets Of Shame: Parts of Renfrewshire are becoming a deadly dumping
ground for hundreds of syringes

By Chris Taylor, Scottish Daily Record, Scotland UK (22.09.15)

Drug addicts are dumping hundreds of dirty needles in Renfrewshire
streets, including outside schools.

Council teams have been alerted 634 times in the last five years to pick
up dirty syringes.

Despite the substantial number of call-outs, local authority chiefs admit
they do not log the number of sharps found, which is estimated to be
significantly higher.

St Fergus’ Primary, in Ferguslie Park, Paisley, has been visited FOUR
times during the period to deal with needles, while more were found
outside nearby Glencoats Lodge Nursery.

Councillor Mags MacLaren, who represents families in Paisley North West,
has slammed the figures as “shocking”. She told the Paisley Daily Express:
“It’s terrible to discover needles have been left outside schools and
nurseries. “It’s incredibly sad that children should have to be taught
about the dangers syringes present at such a young age. “The thought of a
youngster getting their hands on one of these and injuring themselves
doesn’t bear thinking about. “There are so many good people in the area
dedicated to improving the west end and this is making their work even
harder.”

Paisley tops the region’s table of shame, with the most call-outs to roads
in the town’s west end. Well Street, Broomlands Street, Clavering Street
East and Douglas Street all make the top 10 of sites facing the biggest
problem. Ferguslie Park has the worst affected schools in the district,
with safety teams being called to deal with needles outside St Fergus’s
with at least one visit each to St Mary’s Primary and Glencoats Nursery.

Syringes have also been found outside the area’s Tannahill Centre
community hub.

A mum, who asked not to be named, told how she would now reconsider
letting her 12-year-old daughter walk to class at St Fergus’. She said:
“Parents keep getting told that we should encourage our children to walk
or cycle to school, but this changes all of that. “My girl walks with her
pals and it’s not far to go, but I really will have to reconsider letting
them walk now. “The thought of them pricking themselves on something a
junkie has left behind makes me sick. “What goes on in some people’s
heads?”

Contaminated syringes can pass on deadly hepatitis or HIV if the finder
comes into contact with infected blood or if their skin is pierced by a
needle.

Derek Robertson, chief executive of Keep Scotland Beautiful, says
discarded drug paraphernalia is a problem. He said: “All around us on an
everyday basis we see confirmation of the scale of Scotland’s litter
problem. “The information released today shows the scale of the problem,
and how dangerous some kinds of litter are. “We all need to take more
personal responsibility for the problem, and ensure that nothing is
disposed of irresponsibly.

“Further, anyone discarding syringes is showing a callous disregard for
the safety of others. “We would encourage anyone finding dangerous litter
to report their finding to their local authority who will ensure it is
collected and disposed of safely.”

Renfrewshire Council says nine call-outs have been made to public parks to
deal with syringes since 2010, with several visits also occurring at
community centres, used by families and the elderly.

Teams have been forced to visit Beechwood Community Centre, in the north
of Paisley, and Foxbar Youth Drop-In and the Tannahill Community Centre to
dispose of dirty needles.

Councillor Eddie Devine, convener of Renfrewshire Council’s Environment
Policy Board, says efforts are made to remove syringes as soon as they are
reported. He said: “We work hard to encourage intravenous drug users to
dispose of their needles responsibly through the Needle Exchange Service.
“The council is also a member of the Renfrewshire Alcohol and Drug
Partnership which works to tackle the root causes of substance misuse and
help addicts to recover. “We also take rapid, direct action to clear up
used needles. “The Renfrewshire Wardens collect needles from public places
if they represent a hazard.”
__________________________________________________________________
________________________________*_________________________________

New WHO Injection Safety Guidelines

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

The new guideline is:

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

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

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

This is an illustrated summary brochure for the general public.

pdf, 554kb [6 pages]

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

SIGN Meeting 2015

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

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

A report of the meeting will be posted ASAP
__________________________________________________________________
________________________________*_________________________________
* SAFETY OF INJECTIONS brief yourself at: www.injectionsafety.org

A fact sheet on injection safety is available at:
http://www.who.int/mediacentre/factsheets/fs231/en/index.html

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

* Download the WHO Best Practices for Injections and Related Procedures
Toolkit March 2010 [pdf 2.47Mb]:
http://whqlibdoc.who.int/publications/2010/9789241599252_eng.pdf

Use the Toolbox at: http://www.who.int/injection_safety/toolbox/en/

Get SIGN files on the web at: http://signpostonline.info/signfiles-2
get SIGNpost archives at: http://signpostonline.info/archives-by-year

Like on Facebook: http://facebook.com/SIGN.Moderator

The SIGN Secretariat, the Department of Health Systems Policies and
Workforce, WHO, Avenue Appia 20, CH-1211 Geneva 27, Switzerland.
Facsimile: +41 22 791 4836 E- mail: sign@who.int
__________________________________________________________________
________________________________*_________________________________
All members of the SIGN Forum are invited to submit messages, comment on
any posting, or to use the forum to request technical information in
relation to injection safety.

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

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

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

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

The SIGNpost Website is http://SIGNpostOnline.info

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

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

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

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

The SIGN Secretariat home is the Service Delivery and Safety (SDS)
Health Systems and Innovation (HIS) at WHO HQ, 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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