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

SIGNpost 00823

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST

Post00823 EPI + Pain + Abstracts + News: 2 Outbreaks 07 October 2015

CONTENTS
1. RFP: Request for proposal for a Microneedle patch usability and
acceptability evaluation
2. WHO recommendations on reducing pain at the time of vaccination
3. 800+ resources on immunization information systems now in the TechNet
Resource Library
4. Abstract: A comprehensive hepatitis C virus risk factors meta-analysis
(1989-2013): do they differ in Egypt?
5. Abstract: Seroprevalence of hepatitis B virus infection and hepatitis B
surface antibody status among laboratory health care workers in
Isfahan, Iran
6. Abstract: Lymphocytic choriomeningitis virus infection induced by
percutaneous exposure
7. Abstract: Practices and challenges of infectious waste management: A
qualitative descriptive study from tertiary care hospitals in Pakistan
8. Abstract: An innovative national health care waste management system in
Kyrgyzstan
9. Abstract: Drug-device combination products in the twenty-first century:
epinephrine auto-injector development using human factors engineering
10. Abstract: Risk of Infection After Intra-articular Steroid Injection at
the Time of Ankle Arthroscopy in a Medicare Population
11. Abstract: The epidemiology of hepatitis C virus in Afghanistan:
Systematic review and meta-analysis
12. Abstract: Infectious disease, injection practices, and risky sexual
behavior among anabolic steroid users
13. Abstract: A Comparison of Continuous Subcutaneous Insulin Infusion vs.
Multiple Daily Insulin Injection in Children with Type I Diabetes in
Kuwait: Glycemic Control, Insulin Requirement, and BMI
14. Abstract: A randomised controlled trial examining the effectiveness of
cartoons as a distraction technique
15. Abstract: Cost-effectiveness of a hand hygiene program on health care-
associated infections in intensive care patients at a tertiary care
hospital in Vietnam
16. Abstract: Hand Hygiene: Knowledge and Attitudes of Fourth-Year
Clerkship Medical Students at Alfaisal University, College of
Medicine, Riyadh, Saudi Arabia
17. Abstract: A prospective observational study of needle handling
practices at a University Veterinary Teaching Hospital
18. Abstract: Septic arthritis of both knees following intra-articular
injection of petrol
19. No Abstract: Improving hand hygiene in hospitals–more is better
20. No Abstract: Emotional motivators might improve hand hygiene among
healthcare workers
21. No Abstract: Recognising design’s role in reducing HAIs
22. CDC updates and expands its vaccine safety website
23. News
– SINGAPORE: 4 deaths at renal ward could be linked to Hepatitis C: SGH
– NJ USA: Almost 70 patients tested for HIV and hepatitis after nurse is
caught REUSING a syringe while giving flu shots at New Jersey offices
– Singapore: SGH hepatitis C outbreak: Mystery of virus spread confounds
medical experts

The web edition of SIGNpost is online at:
http://signpostonline.info/archives/1914

More information follows at the end of this SIGNpost!

Please send your requests, notes on progress and activities, articles,
news, and other items for posting to: sign.moderator@gmail.com

Normally, items received by Tuesday will be posted in the Wednesday
edition.

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

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

Visit the SIGNpostOnline archives at: http://signpostonline.info

Like SIGNpost on Facebook at: https://www.facebook.com/SIGN.Moderator
and get updates on your device!
__________________________________________________________________
________________________________*_________________________________

1. RFP: Request for proposal for a Microneedle patch usability and
acceptability evaluation

Crossposted from Global Immunization News (GIN) with thanks
__________________________________________________________________
Request for proposal for a Microneedle patch usability and acceptability
evaluation

by Gitte Giersing, WHO HQ

WHO’s mission is to improve and increase vaccine coverage against
preventable diseases, as well as to accelerate development and approval
and uptake of new vaccines and delivery technologies. As such, the
Department of Vaccines and Biologicals is addressing these needs through
facilitating the development of innovative vaccine improve-ment and
delivery technologies that will improve coverage though easier
administration, enable the vaccine to re-main viable until the last mile,
and increase uptake by reducing vaccination costs and simplifying
logistics.

Microneedle patches (MNPs) are a novel vaccine delivery technology that
may offer many potential benefits for vaccine delivery in low- and middle-
income countries’ (LMIC) immunization programs, such as increased
thermostability, efficacy, ease of delivery, safety of disposal, and low
cost.

The acceptability and logistical fit of immunizing children with MNPs in
LMIC campaign settings has yet to be investigated, and is key to
evaluating the potential utilization of this technology beyond its
technical feasibility.

With this in mind, the WHO is announcing a Request for Proposals for a
MICRONEEDLE PATCH USABILITY & ACCEPTABILITY EVALUATION.

The closing date for proposals is 23 October 2015.

More information can be found at this link.
www.who.int/immunization/RFP_microneedles_patch_acceptability_study.pdf
__________________________________________________________________
________________________________*_________________________________

2. WHO recommendations on reducing pain at the time of vaccination

Crossposted from Global Immunization News (GIN) with thanks
__________________________________________________________________
WHO recommendations on reducing pain at the time of vaccination

By Hayatee Hasan, WHO HQ

In a new position paper published in today’s edition of the Weekly
Epidemiologi-cal Record, WHO provides recommendations that can be taken to
reduce pain and anxiety during vaccination which can be applied in all
countries worldwide.

Pain during vaccination sessions is manageable and managing pain does not
de-crease the efficacy of the vaccine. There are general effective,
feasible, non-costly, culturally acceptable, evidence-based strategies to
mitigate pain at the time of vaccination such as:

* Ensuring health-care personnel carrying out vaccination remain calm,
collabo-rative, well informed and avoid using language that increases
anxiety, and pro-motes distrust;

( Ensuring proper positioning of the vaccine recipient according to age,
for example infants and young children should be held by the caregiver and
for older children and adults to be sitting upright;

* When multiple vaccines are injected sequentially in the same session,
they should be administered in order of in-creasing painfulness.

In addition to the above general strategies, several specific
recommendations targeted at the different age groups were also identified
such as breast-feeding for infants or distractions using breathing
interventions for adults.

Read the position paper here.
www.who.int/immunization/policy/position_papers/reducing_pain_vaccination

Reducing pain at time of vaccination position paper

Position paper on reducing pain at time of vaccination (September 2015) –
Original English and French version
pdf, 531kb

Key references to the reducing pain at time of vaccination position paper
pdf, 132kb

Presentation: Summary of key points – WHO position paper on reducing pain
at time of vaccination
pdf, 115kb
__________________________________________________________________
________________________________*_________________________________

3. 800+ resources on immunization information systems now in the TechNet
Resource Library

Crossposted from Global Immunization News (GIN) with thanks
__________________________________________________________________
http://www.technet-21.org/en/resources/technet-resource-library
800+ resources on immunization information systems now in the TechNet
Resource Library

David Oh, WHO HQ consultant

The TechNet Resource Library (TRL), an online repository of useful journal
articles, documents, tools, websites, and other immunization resources,
has launched recently with more than 700 resources on immunization
information systems (IIS). Some of the subtopics within IIS include the
use of information and communication technologies (ICT) for logistics
management information systems, electronic immunization registries, and
immunization schedule reminder systems, with resources from a diverse
range of partners and stakeholders in the field of im-munization.

In addition to resources on new technologies and pilot projects, there is
a collection of historical resources on IIS systems from the 1980s and
beyond, giving insight into some of the progress that has been made since
then, but also some of the roadblocks that are yet to be overcome.

To help you stay updated on the most recent and relevant publications, a
collection of IIS resources will be posted every month on TechNet-21.
Resources from 2015 specifically on the use of ICT in IIS can be found at
this link.

The above collection displays one of the new features in the TRL called
“Favourites” that allows you to compile resources of particular interest
to you and group them into folders called “Collections”. You can choose to
keep these collections private, or share them with others. You can have as
many collections as you want, and as many resources per collection as you
like.

To create a collection, go to any of the resource pages and click Add to
Favourites ? Create new collection. You can also add resources to your
existing collections. To access your collections, simply go to the menu
bar at the top of the screen, and click on “Favourites” under Resources
tab ?TechNet Resource Library.

We hope the 800+ IIS resources, the recent publications, and the
“Favourites” feature help immunization managers share their knowledge and
experiences with other partners for more productive collaborations. If you
have not joined TechNet but would like to, please go here. If you are
already on TechNet, make sure you check out the TRL and add your favourite
resources to the library!
__________________________________________________________________
________________________________*_________________________________

4. Abstract: A comprehensive hepatitis C virus risk factors meta-analysis
(1989-2013): do they differ in Egypt?
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24923487

Liver Int. 2015 Feb;35(2):489-501.

A comprehensive hepatitis C virus risk factors meta-analysis (1989-2013):
do they differ in Egypt?

El-Ghitany EM1, Abdel Wahab MM, Abd El-Wahab EW, Hassouna S, Farghaly AG.

1Tropical Health Department, High Institute of Public Health, Alexandria
University, Alexandria, Egypt.

BACKGROUND & AIMS: The prevention and control of HCV infection is complex
and challenging in terms of describing risk factors and modes of
transmission. This meta- analysis was conducted to summarize the best
available data on HCV risk factors worldwide and in Egypt.

METHODS: Through exhaustive literature searches (1989-2013) of HCV risk
factors, 357 original eligible articles were included in this study.

RESULTS: The highest detected risk was intravenous drug users (IDUs) (OR =
9.6) followed by HIV infection (OR = 4.9), having an IDU partner (OR =
4.1), HBV infection (OR = 3.5), Caesarean section (CS) (OR = 3.35), blood
transfusion (OR = 3.2) and having an HCV+ partner (OR = 3). Organ
transplantation, hospital admission, haemodialysis and having a sexually
transmitted infection carry 2.96, 2.4, 2.18 and 2 risks of having HCV
respectively. Other significant risk factors included poor education,
older age, sharing sharp or blunt objects, MSM, tattooing, hijama, body
piercing, minor operations and medical procedures. Some risks showed a
decrease over the previous decade, including blood transfusion, organ
transplantation, IDUs, IDU partner and CS. Others showed rising risks,
including having an HCV+ partner, MSM and suffering from STI. In Egypt,
male gender, rural residence, acupuncture and receiving parenteral
antischistosomal treatment were significant risks, while neither HIV nor
HBV were found to carry a risk of HCV infection.

CONCLUSION: Blood transfusion, organ transplantation, CS, IDUs,
haemodialysis, minor operations and medical procedures are established
risk factors. Attention and urgent intervention should be given to the
sexual route of transmission, as well as that through minor operations and
medical procedures.

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

KEYWORDS: Egypt and meta-analysis; HCV; risk factors
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Seroprevalence of hepatitis B virus infection and hepatitis B
surface antibody status among laboratory health care workers in
Isfahan, Iran
__________________________________________________________________
http://www.ajts.org/text.asp?2015/9/2/138/162701
Asian J Transfus Sci. 2015 Jul-Dec;9(2):138-40.

Seroprevalence of hepatitis B virus infection and hepatitis B surface
antibody status among laboratory health care workers in Isfahan, Iran.

Shoaei P1, Najafi S2, Lotfi N3, Vakili B1, Ataei B3, Yaran M2, Shafiei R3.

1Nosocomial Infection Research Center, Isfahan University of Medical
Sciences, Isfahan, Iran. 2Acquired Immunodeficiency Research Center,
Isfahan University of Medical Sciences, Isfahan, Iran. 3Infectious
Diseases Research Center, Isfahan University of Medical Sciences, Isfahan,
Iran.

BACKGROUND: Laboratory health care workers (HCWs) may become infected
through their occupation with blood-borne pathogens. The aims of this
study were determining the seroprevalence of hepatitis B virus (HBV) and
the protection offered by HBV vaccine in medical laboratory HCWs.

MATERIALS AND METHODS: A descriptive cross-sectional study was carried out
on 203 employers of clinical laboratories. Participant data were obtained
through a questionnaire, and the level of antigens and antibodies were
measured by enzyme-linked immunosorbent assay (ELISA).

RESULTS: All of the subjects were negative for HBV infection. Forty-seven
(23.2%) were not immune, 126 (62.0%) were relatively immune, and 30
(14.8%) were highly immune.

CONCLUSION: Hepatitis B infection is infrequent in laboratory HCWs in
Isfahan.

KEYWORDS: Health care worker; hepatitis B infection; occupational exposure

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4562132/
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Lymphocytic choriomeningitis virus infection induced by
percutaneous exposure
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26416845

Occup Med (Lond). 2015 Sep 28. pii: kqv156.

Lymphocytic choriomeningitis virus infection induced by percutaneous
exposure.

Aebischer O1, Meylan P2, Kunz S3, Lazor-Blanchet C4.

1Department of Internal Medicine, CHUV, 1011 Lausanne, Switzerland,
oriane.aebischer@chuv.ch.
2Department of Infectious Disease, CHUV, 1011 Lausanne, Switzerland.
3Department of Microbiology, CHUV, 1011 Lausanne, Switzerland.
4Department of Preventive and Occupational Medicine, CHUV, 1011 Lausanne,
Switzerland.

We report a case of acquired lymphocytic choriomeningitis virus (LCMV)
infection due to an accidental percutaneous inoculation of LCMV at work.

The injured worker developed a flu-like syndrome, followed by pericarditis
and meningoencephalitis. Seroconversion was confirmed by ELISA. The
patient made a complete recovery.

We review measures undertaken to prevent a similar event and propose a
follow-up protocol in the event of accidental LCMV exposure.

© The Author 2015. Published by Oxford University Press on behalf of the
Society of Occupational Medicine. All rights reserved. For Permissions,
please email: journals.permissions@oup.com.

KEYWORDS: Accidents; laboratory workers; needlestick injuries.
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Practices and challenges of infectious waste management: A
qualitative descriptive study from tertiary care hospitals in Pakistan
__________________________________________________________________
Open Access http://dx.doi.org/10.12669%2Fpjms.314.7988
Open Access PDF http://pjms.com.pk/index.php/pjms/article/view/7988/3470

Pak J Med Sci. 2015 Jul-Aug;31(4):795-8.
Practices and challenges of infectious waste management: A qualitative
descriptive study from tertiary care hospitals in Pakistan.

Kumar R1, Shaikh BT2, Somrongthong R3, Chapman RS4.

1Ramesh Kumar, PhD. Assistant Professor, Department of Health Systems and
Policy, Health Services Academy, Islamabad, Pakistan. College of Public
Health Sciences, Chulalongkorn University, Bangkok, Thailand.
2Babar Tasneem Shaikh, PhD., FRCP, Associate Professor, Department of
Health Systems and Policy, Health Services Academy, Islamabad, Pakistan.
3RatanaSomrongthong, PhD Associate Professor, College of Public Health
Sciences, Chulalongkorn University, Bangkok, Thailand.
4Robert S Chapman, MD Faculty, College of Public Health Sciences,
Chulalongkorn University, Bangkok, Thailand.

BACKGROUND AND OBJECTIVE: Infectious waste management practices among
health care workers in the tertiary care hospitals have been questionable.
The study intended to identify issues that impede a proper infectious
waste management.

METHODS: Besides direct observation, in-depths interviews were conducted
with the hospital administrators and senior management involved in
healthcare waste management during March 2014. We looked at the processes
related to segregation, collection, storage and disposal of hospital
waste, and identified variety of issues in all the steps.

RESULTS: Serious gaps and deficiencies were observed related to
segregation, collection, storage and disposal of the hospital wastes,
hence proving to be hazardous to the patients as well as the visitors.
Poor safety, insufficient budget, lack of trainings, weak monitoring and
supervision, and poor coordination has eventually resulted in improper
waste management in the tertiary hospitals of Rawalpindi.

CONCLUSION: Study has concluded that the poor resources and lack of
healthcare worker’s training in infectious waste results in poor waste
management at hospitals.

KEYWORDS: Healthcare personnel; Infectious waste management; Pakistan;
Tertiary care hospitals
__________________________________________________________________
________________________________*_________________________________

8. Abstract: An innovative national health care waste management system in
Kyrgyzstan
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25649402
Waste Manag Res. 2015 Feb;33(2):130-8.

An innovative national health care waste management system in Kyrgyzstan.

Toktobaev N1, Emmanuel J2, Djumalieva G3, Kravtsov A3, Schüth T4.

1Health Care Waste Management Project, financed by the Swiss Agency for
Development and Cooperation (SDC) and implemented by the Swiss Red Cross,
Bishkek, Kyrgyz Republic nurjan.toktobaev@gmail.com.
2E & ER Group, Hercules, CA, USA.
3Republican Centre for Infection Control, Ministry of Health of the Kyrgyz
Republic, Bishkek, Kyrgyzstan.
4Health Care Waste Management Project, financed by the Swiss Agency for
Development and Cooperation (SDC) and implemented by the Swiss Red Cross,
Bishkek, Kyrgyz Republic.

A novel low-cost health care waste management system was implemented in
all rural hospitals in Kyrgyzstan. The components of the Kyrgyz model
include mechanical needle removers, segregation using autoclavable
containers, safe transport and storage, autoclave treatment,
documentation, recycling of sterilized plastic and metal parts, cement
pits for anatomical waste, composting of garden wastes, training,
equipment maintenance, and management by safety and quality committees.
The gravity-displacement autoclaves were fitted with filters to remove
pathogens from the air exhaust. Operating parameters for the autoclaves
were determined by thermal and biological tests. A hospital survey showed
an average 33% annual cost savings compared to previous costs for waste
management. All general hospitals with >25 beds except in the capital
Bishkek use the new system, corresponding to 67.3% of all hospital beds.
The investment amounted to US$0.61 per capita covered. Acceptance of the
new system by the staff, cost savings, revenues from recycled materials,
documented improvements in occupational safety, capacity building, and
institutionalization enhance the sustainability of the Kyrgyz health care
waste management system.

© The Author(s) 2015.

KEYWORDS: Hospital/medical waste; Kyrgyzstan; autoclave treatment; cost
survey; recycling; sustainable healthcare waste management
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Drug-device combination products in the twenty-first century:
epinephrine auto-injector development using human factors engineering
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25435244

Expert Opin Drug Deliv. 2015 May;12(5):751-62.

Drug-device combination products in the twenty-first century: epinephrine
auto-injector development using human factors engineering.

Edwards ES1, Edwards ET, Simons FE, North R.

1Kaléo, Inc. , 111 Virginia Street, Ste. 300, Richmond, VA 23219 , USA ;
+1 804 545 6374 , +1 804 545 6219 , eric.edwards@kaleopharma.com.

INTRODUCTION: The systematic application of human factors engineering
(HFE) principles to the development of drug-device combination products,
including epinephrine auto-injectors (EAIs), has the potential to improve
the effectiveness and safety of drug administration.

AREAS COVERED: A PubMed search was performed to assess the role of HFE in
the development of drug-device combination products. The following
keywords were used in different combinations: ‘human factors engineering,’
‘human factors,’ ‘medical products,’ ‘epinephrine/adrenaline auto-
injector,’ ‘healthcare’ and ‘patient safety.’ This review provides a
summary of HFE principles and their application to the development of
drug-device combination products as advised by the US FDA. It also
describes the HFE process that was applied to the development of Auvi-Q, a
novel EAI, highlighting specific steps that occurred during the product-
development program.

EXPERT OPINION: For drug-device combination products, device labeling and
usability are critical and have the potential to impact clinical outcomes.
Application of HFE principles to the development of drug-delivery devices
has the potential to improve product quality and reliability, reduce risk
and improve patient safety when applied early in the development process.
Additional clinical and real-world studies will confirm whether the
application of HFE has helped to develop an EAI that better meets the
needs of patients at risk of anaphylaxis.

KEYWORDS: adrenaline auto-injector; combination products; epinephrine
auto-injector; human factors engineering; risk reduction; safety
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Risk of Infection After Intra-articular Steroid Injection at
the Time of Ankle Arthroscopy in a Medicare Population
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26422706

Arthroscopy. 2015 Sep 25. pii: S0749-8063(15)00656-8.

Risk of Infection After Intra-articular Steroid Injection at the Time of
Ankle Arthroscopy in a Medicare Population.

Werner BC1, Cancienne JM2, Burrus MT2, Park JS2, Perumal V2, Cooper MT2.

1Department of Orthopaedic Surgery, University of Virginia Health System,
Charlottesville, Virginia, U.S.A.. Electronic address: bcw4x@virginia.edu.
2Department of Orthopaedic Surgery, University of Virginia Health System,
Charlottesville, Virginia, U.S.A.

PURPOSE: To employ a national database to evaluate the association between
intraoperative corticosteroid injection at the time of ankle arthroscopy
and postoperative infection rates in Medicare patients.

METHODS: A national insurance database was queried for Medicare patients
who underwent ankle arthroscopy, including arthroscopic removal of loose
body, synovectomy, and limited or extensive debridement. Two groups were
created: ankle arthroscopy with concomitant local steroid injection (n =
459) and a control group of patients who underwent ankle arthroscopy
without intraoperative local steroid injection (n = 9,327). The
demographics and Charlson Comorbidity Index of each group were compared.
Infection rates within 6 months postoperatively were assessed using
International Classification of Diseases, 9th revision, and Current
Procedural Terminology codes and compared between groups using ?2-tests.

RESULTS: A total of 9,786 unique patients who underwent ankle arthroscopy
were included in the study. There were no statistically significant
differences between the steroid injection study group and controls for the
assessed infection-related variables, including gender, age group,
obesity, smoking, and average Charlson Comorbidity Index. The infection
rate for patients who had a local steroid injection at the time of surgery
was 3.9% (18/459 patients), compared with 1.8% (168/9,327 patients) in the
control group (odds ratio, 2.2; 95% confidence interval, 1.4 to 3.7; P =
.002.) The majority of this difference was noted between the 65 and 79
years age groups.

CONCLUSIONS: The use of intraoperative intraarticular corticosteroid
injection at the time of ankle arthroscopy in Medicare patients is
associated with significantly increased rates of postoperative infection
compared with controls without intraoperative steroid injections.

LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Copyright © 2015 Arthroscopy Association of North America. Published by
Elsevier Inc. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

11. Abstract: The epidemiology of hepatitis C virus in Afghanistan:
Systematic review and meta-analysis
__________________________________________________________________
Free Full Text Open Access http://dx.doi.org/10.1016/j.ijid.2015.09.011

http://www.ncbi.nlm.nih.gov/pubmed/26417880

Int J Infect Dis. 2015 Sep 25. pii: S1201-9712(15)00221-0.

The epidemiology of hepatitis C virus in Afghanistan: Systematic review
and meta-analysis.

Chemaitelly H1, Mahmud S2, Rahmani AM3, Abu-Raddad LJ4.

1Infectious Disease Epidemiology Group, Weill Cornell Medical College in
Qatar, Cornell University, Qatar Foundation – Education City, Doha, Qatar.
Electronic address: hsc2001@qatar-med.cornell.edu.
2Infectious Disease Epidemiology Group, Weill Cornell Medical College in
Qatar, Cornell University, Qatar Foundation – Education City, Doha, Qatar.
3Afghanistan National Blood Safety and Transfusion Services, Kabul,
Afghanistan.
4Infectious Disease Epidemiology Group, Weill Cornell Medical College in
Qatar, Cornell University, Qatar Foundation – Education City, Doha, Qatar;
Department of Healthcare Policy & Research, Weill Cornell Medical College,
Cornell University, New York, USA.

OBJECTIVES: To characterize hepatitis C virus (HCV) epidemiology and
inform public health research, policy, and programming priorities in
Afghanistan.

METHODS: We systematically reviewed and synthesized records of HCV
incidence and prevalence following PRISMA guidelines. Meta-analyses were
implemented using a DerSimonian-Laird random effects model with inverse
variance weighting to estimate HCV prevalence among various at risk
populations. A risk of bias assessment was incorporated.

RESULTS: Our search identified one HCV incidence and 76 HCV prevalence
measures. HCV incidence was only assessed among people who inject drugs
(PWID), and was reported at 66.7 per 100 person-years. Our meta-analyses
estimated HCV prevalence at 0.7% among the general population (range:
0-9.1%; 95% CI: 0.5-0.9%), 32.6% among PWID (range: 9.5-70.0%; 95% CI:
24.5-41.3%), and 2.3% among populations at intermediate risk (range:
0.0-8.3%; 95% CI: 1.3-3.7%). No data was available for other high risk
populations such as hemodialysis, thalassemia, and hemophilia patients.

CONCLUSIONS: HCV prevalence among the general population in Afghanistan is
comparable to global levels. Data are needed for the level of infection
among key clinical populations at high risk of infection. There is also an
immediate need for expansion of harm reduction programs among PWID and
prisoners.

Copyright © 2015. Published by Elsevier Ltd. Open access funded by the
Author(s)

KEYWORDS: Afghanistan; Epidemiology; Hepatitis C virus; Middle East;
Prevalence; Systematic review.
__________________________________________________________________
________________________________*_________________________________

12. Abstract: Infectious disease, injection practices, and risky sexual
behavior among anabolic steroid users
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26422090

AIDS Care. 2015 Sep 30:1-6.
Infectious disease, injection practices, and risky sexual behavior among
anabolic steroid users.

Ip EJ1, Yadao MA1, Shah BM2, Lau B3,4.

1a Department of Clinical Sciences , Touro University California College
of Pharmacy , Vallejo , CA , USA.
2b Department of Social , Behavioral, and Administrative Sciences, Touro
University California College of Pharmacy , Vallejo , CA , USA.
3c Department of Emergency Medicine , Kaiser Permanente Santa Clara
Medical Center , Santa Clara , CA , USA.
4d Division of Emergency Medicine , Stanford University School of Medicine
, Palo Alto , CA , USA.

Anabolic-androgenic steroids (AAS) and other performance-enhancing drugs
(PEDs) are commonly misused to increase muscle size and strength, as well
as improve physical appearance.

Many AAS and certain PEDs are administered via injection and therefore
pose a risk for transmission of infectious diseases such as human
immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus
(HCV), and skin and soft tissue infections (SSTIs). Further, AAS users may
be more likely to take part in high-risk sexual behaviors than non-AAS
users.

This review explores the prevalence of infectious diseases as well as
risky injection practices and sexual behaviors of AAS users in the current
literature.

A comprehensive MEDLINE search (1984-17 April 2015) for English language
reports was performed on AAS users. Ten studies analyzed the prevalence of
HIV infection, 6 studies analyzed HBV infection, and 6 studies analyzed
HCV infection; 20 studies analyzed injection practices and 7 studies
analyzed high-risk sexual behaviors of AAS users.

HIV, HBV, HCV, and SSTIs have been associated with AAS users. In
particular, HIV infection seems much higher among homosexual male AAS
users. AAS users also take part in high-risk injection practices but to a
much lower extent than intravenous drug users. AAS users are also more
likely to engage in high-risk sexual behaviors than the general
population.

Clinicians and health-policy leaders may utilize these findings to
implement strategies to decrease the spread of infectious diseases.

KEYWORDS: Anabolic steroids; HIV; infectious disease; injecting risk;
sexual behavior
__________________________________________________________________
________________________________*_________________________________

13. Abstract: A Comparison of Continuous Subcutaneous Insulin Infusion vs.
Multiple Daily Insulin Injection in Children with Type I Diabetes in
Kuwait: Glycemic Control, Insulin Requirement, and BMI
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26421114
Oman Med J. 2015 Sep;30(5):336-43. doi: 10.5001/omj.2015.69.

A Comparison of Continuous Subcutaneous Insulin Infusion vs. Multiple
Daily Insulin Injection in Children with Type I Diabetes in Kuwait:
Glycemic Control, Insulin Requirement, and BMI.

Majedah M. AbdulRasoul, Mousa M1, Al-Mahdi M2, Al-Sanaa H3; Dalia Al-
AbdulRazzaq, Al-Kandari H4.

1Department of Community Medicine, Kuwait University, Jabriya City,
Kuwait.
2Department of Pediatrics, Adan Hospital, AlAhmadi City, Kuwait.
3Department of Pediatrics, Amiri Hospital, Kuwait city, Kuwait.
4Department of Pediatrics, Farwania Hospital, Farwaniya City, Kuwait.

OBJECTIVE: Continuous subcutaneous insulin infusion (CSII) and multiple
daily insulin injections (MDI) are two methods currently used to manage
type I diabetes mellitus (T1DM). Here we compare our experiences with CSII
and MDI in a large cohort of pediatric patients in Kuwait.

METHODS: Data on 326 patients with T1DM who were started on CSII between
2007 and 2012 were retrospectively compared with those of 326 patients on
MDI. They were matched for sex, age at diagnosis, T1DM duration, glycemic
control, insulin requirement, and body mass index (BMI). Data were
collected at baseline and every three months and included glycated
hemoglobin (HbA1c), insulin dose, and adverse events (severe hypoglycemia,
diabetic ketoacidosis, and skin problems).

RESULTS: The main reason for switching to CSII was to achieve better
glycemic control (37%), followed by reducing hypoglycemia, and improving
the quality of life (13.3% each). Although HbA1c decrease was most
significant in the first year, it continued to be significantly lower in
the CSII group compared to the MDI throughout the study period. Total
daily insulin requirements were significantly lower in the CSII group. BMI
increased in both groups, but the difference was significant only at the
end of the fifth year. There was no significant change in the rate of
diabetic ketoacidosis in either group. The CSII patients had more severe
hypoglycemic episodes at baseline; however, it significantly decreased
throughout the study period. Only five patients discontinued CSII therapy
and two of these restarted within three months.

CONCLUSION: CSII is a safe intensive insulin therapy in youngsters with
T1DM and achieved markedly fewer severe hypoglycemic episodes and lower
daily insulin requirements.

KEYWORDS: Adolescent; Body Mass Index; Child; Diabetes Mellitus, Type I;
Hemoglobin A, Glycosylated; Insulin Infusion Systems

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4576387/
__________________________________________________________________
________________________________*_________________________________

14. Abstract: A randomised controlled trial examining the effectiveness of
cartoons as a distraction technique
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25858408
Nurs Child Young People. 2015 Apr;27(3):28-33.

A randomised controlled trial examining the effectiveness of cartoons as a
distraction technique.

Cerne D1, Sannino L, Petean M.

1Local Health Unit 2, Bassa Friulana-Isontina, Gorizia and Trieste
University, Italy.

AIM: Distress and pain associated with immunisation are significant
problems for children, carers and healthcare professionals. This study was
designed to determine whether distraction by watching cartoons during
immunisation could reduce the distress and pain perceived by the children.

METHODS: A sample of 35 six year olds was randomly assigned to one of two
groups: the first was distracted by standard techniques during
immunisation, the second by watching cartoons. Levels of distress were
measured with the amended observation scale of behavioural distress, and
of pain by the Wong-Baker FACES pain rating scale.

RESULTS: The levels of distress were significantly lower in the group
distracted by cartoons compared with children who received traditional
distraction techniques during immunisation.

CONCLUSION: By using an easy, cheap intervention, children’s first
introduction to health services can be made a positive experience which
will decrease the number developing pre-procedural anxiety or a fear of
needles.

KEYWORDS: Anxiety; cartoons; child distress; child health; childhood
immunisations; distraction techniques; pain
__________________________________________________________________
________________________________*_________________________________

15. Abstract: Cost-effectiveness of a hand hygiene program on health care-
associated infections in intensive care patients at a tertiary care
hospital in Vietnam
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26432185

Am J Infect Control. 2015 Sep 29. pii: S0196-6553(15)00879-2.

Cost-effectiveness of a hand hygiene program on health care-associated
infections in intensive care patients at a tertiary care hospital in
Vietnam.

Thi Anh Thu L1, Thi Hong Thoa V2, Thi Van Trang D2, Phuc Tien N2, Thuy Van
D2, Thi Kim Anh L2, Wertheim HF3, Truong Son N2.

1Cho Ray Hospital, Ho Chi Minh City, Vietnam. Electronic address:
letathu@gmail.com.
2Cho Ray Hospital, Ho Chi Minh City, Vietnam.
3Oxford University Clinical Research Unit, Hanoi, Vietnam, Nuffield
Department of Clinical Medicine, University of Oxford, Oxford, United
Kingdom; Department of Clinical Microbiology, Radboudumc, Nijmegen, the
Netherlands.

BACKGROUND: The cost-effectiveness of a hand hygiene (HH) program in low-
and middle-income countries (LMICs) is largely unknown. We assessed the
cost-effectiveness of a HH program in a large tertiary Vietnamese
hospital.

METHODS: This was a before and after study of a hand hygiene program where
HH compliance, incidence of hospital-acquired infections (HAIs), and costs
were analyzed.The HH program was implemented in 2 intensive care and 15
critical care units. The program included upgrading HH facilities,
providing alcohol-based handrub at point of care, HH campaigns, and
continuous HH education.

RESULTS: The HH compliance rate increased from 25.7% to 57.5% (P < .001).
The incidence of patients with HAI decreased from 31.7% to 20.3% (P <
.001) after the intervention. The mean cost for patients with HAI was
$1,908, which was 2.5 times higher than the costs for patients without an
HAI. The mean attributable cost of an HAI was $1,131. The total cost of
the HH program was $12,570, which equates to a per-patient cost of $6.5.
The cost-effectiveness was estimated at -$1,074 or $1,074 saved per HAI
prevented. The intervention remained cost savings under various scenarios
with lower HAI rates.

CONCLUSION: The HH program is an effective strategy in reducing the
incidence of HAIs in intensive care units and is cost-effective in
Vietnam. HH programs need to be encouraged across Vietnam and other LMICs.

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

KEYWORDS: Antibiotic resistance; Cost-effectiveness; Hand hygiene;
Hospital-acquired infection; Low- and middle-income country; Vietnam
__________________________________________________________________
________________________________*_________________________________

16. Abstract: Hand Hygiene: Knowledge and Attitudes of Fourth-Year
Clerkship Medical Students at Alfaisal University, College of
Medicine, Riyadh, Saudi Arabia
__________________________________________________________________
http://dx.doi.org/10.7759%2Fcureus.310 Free Full Text

Cureus. 2015 Aug 24;7(8):e310.

Hand Hygiene: Knowledge and Attitudes of Fourth-Year Clerkship Medical
Students at Alfaisal University, College of Medicine, Riyadh, Saudi
Arabia.

Hamadah R1, Kharraz R1, Alshanqity A1, AlFawaz D1, Eshaq AM1, Abu-Zaid A1.

1College of Medicine, Alfaisal University.

INTRODUCTION: Little is known about the clerkship (clinical) medical
students’ knowledge of hand hygiene as the single most important
precautionary measure to reduce nosocomial healthcare-associated
infections. The aim of this study is to explore the knowledge of, and
attitudes towards, hand hygiene practices among fourth-year clerkship
medical students at Alfaisal University, College of Medicine, Riyadh,
Saudi Arabia.

MATERIALS AND METHODS: A cross-sectional, paper-based, Yes/No formatted
questionnaire was administered to explore the students’ knowledge of, and
attitudes towards, hand hygiene practices. Data were decoded in Microsoft
Excel sheet and presented as numbers and percentages.

RESULTS: One hundred and eleven students (n=111/147) participated in the
questionnaire (response rate: 76%). Although the majority of students had
a fair knowledge of hand hygiene practices, a number of them had some
misconceptions.

Only 14% of students correctly agreed to the statement: “Traditional hand
washing (water, plus regular soap) decreases the number of germs.”
Furthermore, only 32% of students correctly answered that “hand washing
with a regular soap, instead of an antiseptic soap, is better in limiting
the transmission of clostridium difficile infections”.

Almost all students (93%) agreed to the importance of hand hygiene
education in medical curricula and its awareness in healthcare centers.

Despite the importance of hand hygiene, only 13% of students reviewed the
respective WHO and CDC guidelines before starting their clinical training
in the teaching hospital.

DISCUSSION: The students’ inadequate knowledge about hand hygiene needs to
be enriched by well-structured curricular and extra-curricular programs as
well as more positive attitudes by healthcare workers.

KEYWORDS: attitude; clerkship; curriculum; hand hygiene; healthcare;
infection; knowledge; medical education; medical students; saudi arabia
__________________________________________________________________
________________________________*_________________________________

17. Abstract: A prospective observational study of needle handling
practices at a University Veterinary Teaching Hospital
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26425795

N Z Vet J. 2015 Oct 1:1-11.

A prospective observational study of needle handling practices at a
University Veterinary Teaching Hospital.

Riley CB1, McCallum S1, MacDonald JA1, Hill KE1.

1a Institute of Veterinary, Animal, and Biomedical Sciences, Massey
University , Private Bag 11222, Palmerston North 4442 , New Zealand.

AIM: To determine the period prevalence of needlestick injury (NSI) at the
Massey University Veterinary Teaching Hospital (VTH) and to identify
handling and disposal practices that may contribute to the risk of NSI.

METHODS: Observations of personnel were conducted in the equine (EVH) and
companion animal (CAH) clinics of the VTH during scheduled clinical
activities over 9 and 10 day periods, respectively. The number and type of
NSI incidents, needle uncapping, capping and disposal events were recorded
for veterinarians, nurses and other personnel (visitors and students).The
number of needle related practices, as a proportion of observations, were
compared between CAH and EVH, and veterinarians, nurses and others using
X2 tests.

RESULTS: Needlestick injury was not observed during 190 and 163 needle
handling and disposal observations in the CAH and EVH, respectively.
Uncapping of needles by mouth was observed and was practised more by
veterinarians (15/119; 13%) than nurses (2/42; 5%) and others (6/193; 3%)
(p=0.001). Two handed needle recapping after use was observed 265/354
times, and the one handed scooping technique was rarely observed (8/352).
In the case of needle disposal, EVH workers used a container that was not
purpose built for disposal more than CAH staff (p=0.02), or placed them in
a pocket more frequently (p=0.003). Needle disposal containers were
available on adjacent bench tops for 65/190 (34%) CAH observations, but no
EVH observations. For 51/163 (31%) EVH observations the needle disposal
containers were located on the ground, whereas none were observed there in
the CAH. No approved sharps containers were observed in the immediate EVH
and CAH work areas for 47/163 (28.8%) and 1/191 (0.5%) needle handling
activities, respectively.

CONCLUSIONS: Unsafe needle handling practices must be reduced by policies
and training programmes to encourage safe needle-related practices, and
ensuring that approved sharps containers are available in close proximity
to where needles are used.

KEYWORDS: Needlestick; injury; needle handling; veterinary hospital
__________________________________________________________________
________________________________*_________________________________

18. Abstract: Septic arthritis of both knees following intra-articular
injection of petrol
__________________________________________________________________
Free Article
http://www.jivresearch.org/jivr/index.php/jivr/article/view/341

J Inj Violence Res. 2015 Jan;7(1):38-40.

Septic arthritis of both knees following intra-articular injection of
petrol.

Janbakhsh A1, Mansouri F, Vaziri S, Sayad B, Afsharian M, Ghaffari P.

1Department of Orthopaedic Surgery, Imam Reza Hospital, Kermanshah, Iran.
E-mail: a_janbakhsh@yahoo.com.

A 70 years old man was referred to our center with bilateral knee
arthritis following intra-articular petrol injection. Because of previous
antibiotics use gram stain and culture were negative. Septic arthritis was
diagnosed and antibiotics and drainage were started. After 2 years he
improved eventually and was able to walk. But, some movement limitation
remained.

© 2015 KUMS, All rights reserved.
__________________________________________________________________
________________________________*_________________________________

19. No Abstract: Improving hand hygiene in hospitals–more is better
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26220071

BMJ. 2015 Jul 28;351:h3931.

Improving hand hygiene in hospitals–more is better.

Muller MP1.

1St Michael’s Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada
mullerm@smh.ca.

Comment on
Comparative efficacy of interventions to promote hand hygiene in hospital:
systematic review and network meta-analysis. [BMJ. 2015]
__________________________________________________________________
________________________________*_________________________________

20. No Abstract: Emotional motivators might improve hand hygiene among
healthcare workers
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26220073

BMJ. 2015 Jul 28;351:h3968.

Emotional motivators might improve hand hygiene among healthcare workers.

McCay L.
__________________________________________________________________
________________________________*_________________________________

21. No Abstract: Recognising design’s role in reducing HAIs
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26285541

Health Estate. 2015 May;69(5):27-9.

Recognising design’s role in reducing HAIs.

Berest M, Ringer C.
__________________________________________________________________
________________________________*_________________________________

22. CDC updates and expands its vaccine safety website

Crossposted from IAC Express with thanks.
The Immunization Action Coalition http://www.immunize.org/subscribe
__________________________________________________________________
CDC updates and expands its vaccine safety website

CDC’s Immunization Safety Office has revamped its vaccine safety site to
create a better user experience. The newly updated website includes six
distinct modules to connect all audiences to the most relevant
information. The first four modules focus on different areas of vaccine
safety, including research, in-depth vaccine and burden information, and
answers to common concerns. The other two modules are separated by
audience with content for parents and caregivers and a newly created
section for health care providers. Please visit the redesigned Vaccine
Safety website to learn more about vaccine safety and to take a look at
these new modules.

CDC’s Immunization Safety Office identifies possible vaccine side effects
and conducts studies to determine whether health problems are caused by
vaccines.

Related Links
CDC’s Vaccine Safety website
http://www.cdc.gov/vaccinesafety/index.html

CDC’s NCIRD Vaccine Safety and Adverse Events web page
http://www.cdc.gov/vaccines/vac-gen/safety/default.htm
__________________________________________________________________
________________________________*_________________________________

23. News

– SINGAPORE: 4 deaths at renal ward could be linked to Hepatitis C: SGH

– NJ USA: Almost 70 patients tested for HIV and hepatitis after nurse is
caught REUSING a syringe while giving flu shots at New Jersey offices

– Singapore: SGH hepatitis C outbreak: Mystery of virus spread confounds
medical experts

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/q39fldz
Singapore: SGH hepatitis C outbreak: Mystery of virus spread confounds
medical experts

Transmission via dialysis machines ruled out; use of multi-dose vials
under probe

Salma Khalik, Straits Times, Singapore (07.10.15)

SINGAPORE – It is a virus that does not spread easily – and dies quickly.

That is why experts are still racking their brains over the source of the
hepatitis C virus that infected at least 21 kidney patients at Singapore
General Hospital (SGH).

The hepatitis C virus is generally transmitted by blood or blood products.
It is not airborne and cannot be spread through social contact, sharing of
utensils or drinking from the same glass, or through food or water.

Professor Fong Kok Yong, chairman of SGH’s medical board, said the virus
is “very fragile and dies quickly” when exposed. He added that the chance
of the virus being spread through contaminated blood was “very minuscule”.

PROTOCOL FOR MULTI-DOSING

You use a new needle, new syringe for every patient, for every episode.

DR TRACY AYRE, SGH’s chief nurse. When using multi-dose vials, she said
the protocol is for a doctor or a nurse to swab the rubber top of the vial
before injecting a new needle into the vial to extract the liquid. Not
only does the blood bank take great care, but also, not all the infected
patients had a blood transfusion. Furthermore, they were from different
blood groups, and would not be receiving blood from the same donor.

The hospital had at first suspected that the virus was spread through a
dialysis machine, which kidney failure patients use to clean their blood
of toxins.

But by the end of May, investigations had shown that this was not the
source of transmission as the patients had used different machines, and
other patients using those machines were not infected.

The hospital then turned to the use of multi-dose vials, possibly those
containing insulin, which some diabetic patients need.

These vials contain more than one dose and are often shared between two
and three patients.

SGH’s chief nurse, Dr Tracy Ayre, said the protocol is for the user,
either a doctor or a nurse, to swab the rubber top of the vial before
injecting a new needle into the vial to extract the required amount of
liquid.

She said: “You use a new needle, new syringe for every patient, for every
episode.”

With one vial shared by about three patients, in order to infect more than
20 patients, a fairly large number of vials would need to be contaminated.

When posed this question, Professor Ang Chong Lye, SGH’s chief executive
officer, replied: “That’s why we couldn’t confirm that it is from multi-
dosing. We took that extra precaution to stop multi- dosing.

“But we cannot pinpoint for sure that that is the ultimate cause.”

Asked if it had ruled out foul play, SGH said: “Since investigations are
ongoing, we cannot rule out any possibility.”

Hopefully, the new review committee set up by the Health Ministry can shed
more light.
__________________________________________________________________
__________________________________________________________________
https://tinyurl.com/p5t7zmv
NJ USA: Almost 70 patients tested for HIV and hepatitis after nurse is
caught REUSING a syringe while giving flu shots at New Jersey offices

* Nurse administered flu shots to 67 employees at Otsuka Pharmaceutical
* Department of Health said she had not changed syringe between patients
* Employees were warned they may have been exposed to ‘infected blood’
* They’re now being tested for HIV and hepatitis but results will take
months

By Hannah Parry, www.dailymail.com UK (07.10.15)

Dozens of co-workers are being screened for HIV and hepatitis after a
nurse was found reusing a syringe to administer flu shots.

Employees at Otsuka Pharmaceutical, who received the vaccination at their
offices in Princeton, New Jersey on September 30, have been warned they
may have been exposed to ‘infected blood.’

Almost 70 patients have now been called in for testing but face a long,
anxious wait as it can be months before serious infections such as HIV
show up in blood work.

Healthcare provider TotalWellness confirmed that the nurse contracted to
carry out the flu shots had ‘failed to follow proper medical procedures
and safeguards.’

Officials have not yet revealed whether disciplinary action will be taken
against the nurse.

The New Jersey Department of Health sent out letters to the 67
pharmaceutical co-workers two days after the vaccinations to warn them
that the syringe ‘was reused multiple times’, NBC 10 reported.

While the letter said the risk of contamination was low, it urged those
affected to seek testing for hepatitis B, hepatitis C and HIV.

‘Syringe reuse may have exposed you to infected blood,’ the letter stated.
‘At this time NJDOH is not aware of any disease transmission, but you may
be at risk for developing an infection as a result of this improper
practice.’

The Department of Health said that the nurse had changed the needle
between each injection, but re-used the same syringe each time.

Both the needle and syringe should be only ever be used once and disposed
of, added Jill Swanson, West Windsor Health Officer.

Free blood tests are now taking place for the employees at the West
Windsor Township Senior Center, run by the Centers for Disease Control and
Prevention (CDC), in partnership with the Health Department and
TotalWellness.

Patients must then be re-tested in four to six months before they can be
given a clean bill of health.

One Otsuka Pharmaceutical employee told NBC News that having to wait so
long for the results was giving her ‘incredible anxiety.’

Officials investigating the incident also found that the nurse also gave
less than the recommended dose of flu shot at the Mercer County clinic.

The Department of Health warned that anyone wanting to be protected
against flu this winter would need to have another vaccination.

A spokesperson for TotalWellness said the company was ‘dedicated to
ensuring all participants receive any and all appropriate screenings, care
and counseling until this matter is resolved.’

Otsuka Pharmaceutical were unavailable for comment.

It is not the first time a medical blunder has potentially put lives at
risk.

In 2014, more than 4,000 patients were warned they could have been exposed
to HIV and hepatitis at a New York hospital after insulin pens used to
treat diabetes were reused on more than one person.

South Nassau Communities Hospital in Oceanside on Long Island, near New
York City, said 4,200 patients may have received insulin from the pens –
not a single-use disposable needle – that could have been used on more
than one patient from as far back as 2011.

‘The risk of infection from this is extremely low,’ the hospital said in a
statement, adding it was recommending patients ‘be tested for hepatitis B,
hepatitis C and HIV.’

When asked if anyone was confirmed to have been infected a hospital
spokeswoman said ‘not to my knowledge.’

HIV and hepatitis are spread by sharing bodily fluids such as blood and
semen. The most common way HIV is spread in the U.S. is through sex and
sharing needles, according to the Aids.gov website.
_________________________________________________________________
__________________________________________________________________

www.channelnewsasia.com/news/singapore/4-deaths-at-renal-ward/2172724.html
SINGAPORE: 4 deaths at renal ward could be linked to Hepatitis C: SGH

*A total of 22 patients at a renal ward in Singapore General Hospital have
been diagnosed with the Hepatitis C virus.

By Justin Ong, Channel News Asia, Singapore (06.10.15) update (07.10.15)

SINGAPORE: Twenty-two patients at a renal ward in the Singapore General
Hospital (SGH) have been diagnosed with the Hepatitis C virus. Among them,
four have died, possibly from the virus.

In a media conference on Tuesday (Oct 6), SGH said that in early June, the
hospital discovered an increased frequency of Hepatitis C virus infections
in a renal ward. The hospital subsequently stepped up checks for the virus
in patients with abnormal liver function tests in the same ward, and found
22 patients infected.

All 22 patients were admitted and stayed in the newly-renovated Ward 67
between April to June 2015. Among them, eight have died, including four
who had “multiple co-morbidities and severe sepsis”, and the possibility
that the Hepatitis C virus could have been a contributing factor has not
been ruled out.

Another three deaths were “thoroughly evaluated” and “no link to the
Hepatitis C virus infection has been established”. One recent death is
pending review.

Of the 22 infected, the youngest is 24 years old, and the remaining are
between 50 and 60 years old.

Hepatitis C is a liver disease that is transmitted by blood-bourne routes,
and is not air-borne like SARS. The average time period from exposure to
symptom onset is two to 24 weeks. If left untreated, the long-term effect
of the virus is cirrhosis, liver failure, or liver cancer.

POSSIBLE SOURCES OF INFECTION

SGH said that all cases were reviewed by a Medical Review Committee, in
consultation with the Ministry of Health and chaired by an external senior
hepatologist.

SGH said that their initial investigation indicated that the source of
infection might be due to “intravenous (IV) injectable agents” or multi-
dose vials which typically contain insulin or vaccines.

Said Dr Tracy Carol Ayre, the chief nurse at SGH: “There are policies in
place that govern how intravenous drugs or drugs in general are prepared,
diluted and administered and that includes your infection control
practices, hand hygiene, new syringe, new needle, swabbing of the bungs.”

“In multi-dose insulin – and there are a number of multi-dose vials
currently – insulin vaccines are one of them. These are generally shared.
So you use it for that person, using a new syringe and new needle, but
it’s then shared among multiple patients. Because the idea is that you
would have swabbed the bung, you would have used a new syringe and new
needle for that episode and there’s no reason for it to be contaminated
again. So if in theory, that this is the cause of it at the end of the
day, then that may have been some contamination along that process.”

The hospital has since taken immediate precautionary measures, stopping
multi-dosing, even though it is, in SGH’s words, a “long established and
accepted practices in healthcare institution”.

Prof Fong Kok Yong, chairman of SGH’s Medical Board, said that there is
“no conclusive evidence” yet as investigations are still ongoing.

He also said that there had been no new cases of Hepatitis C virus
infection since they implemented their precautionary measures. Hospital
staff who provided care to the renal patients will also be screened.

SGH CEO Prof Ang Chong Lye said: “We would like to apologise unreservedly
for the grief, pain and anguish this has caused our patients and families.

“What happens to our patients is always our responsibility. We will spare
no effort in reviewing our processes and examining all possible sources of
infection to prevent recurrence.”

HEALTH MINISTRY CONVENES INDEPENDENT COMMITTEE TO PROVIDE ‘OBJECTIVE,
CRITICAL REVIEW’

Minister for Health Mr Gan Kim Yong said: “I am gravely concerned and
disappointed with the occurrence of the cluster of Hepatitis C cases in
SGH.”

Mr Gan added that he has appointed an independent review committee to
ensure an objective and thorough review of the incident, to prevent future
occurrences. “Going forward, the committee will take about two months to
complete this work,” he said.

“When the review is completed, we will share the outcome with the public
as well as with our healthcare clusters. We hope that the SGH as well as
all our healthcare institutions will learn from this incident and work
hard to continue to improve our patients’ safety. In this way, we will be
able to ensure that we will continue to take good care of our patients.”

Mr Gan also urged members of the public to not jump to conclusions before
the outcome of the review. Meanwhile, he said measures have been
introduced to ensure that this issue will not recur again.

He said: “Our first priority is to extend our help and support to the
patients to ensure that their conditions are managed and taken care of,
and also to provide support for the family members. Our second priority is
to look at how we can strengthen our precautionary measures and safeguards
to ensure this does not happen again.

“Then, we will also put our efforts into reviewing the process and see
where are the gaps and the possible weaknesses, so that we can introduce
additional measures to strengthen them. This will be the work of the
review committee going forward.”

MAKE POSSIBLE BREACHES KNOWN TO PUBLIC: WORKERS’ PARTY

A day after the press conference was held at SGH, the Workers’ Party
issued a press release in which it called for any breach in infection
controls to be made known to the public immediately.

“It was reported SGH had been aware of the infection cluster since early
June 2015, but information surrounding the outbreak was only made public
four months later, in October 2015. An outbreak of Hepatitis C is a
potential public health risk. The knowledge of such an outbreak is
relevant to all citizens as they weigh their treatment options,” said the
WP on Oct 7.

“Any potential health risks should be made known to the public and all
healthcare institutions as soon as possible so that the public can make
informed healthcare choices for themselves and their loved ones, and
institutions can take the necessary precautions.”

“Is there a timeframe within which healthcare institutions must report
such incidents to the Ministry? What does the Ministry believe is a
permissible interval of time before the public is made aware of such
incidents?”

The party said it welcomed the formation of an independent review
committee to investigate the incident. In its press release, it also asked
Health Minister Gan if any measures have been put in place outside of SGH
side June to mitigate the possible health risks, and to prevent the
cluster from expanding.

– CNA/es/xk/wl
__________________________________________________________________
________________________________*_________________________________

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
__________________________________________________________________

Comments are closed.