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SIGNpost 00824

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST

Post00824 Waste-inar + Extract + Abstract + News 14 October 2015

CONTENTS
1. Asia Webinar Series: Sustainable Health Care Waste Management
2. Abstract: The prevalence of hepatitis C among healthcare workers: a
systematic review and meta-analysis
3. Extract: Management of sharps injuries in the healthcare setting
4. Abstract: An Epidemiological Study of Needlestick Injury among
Healthcare Workers in Ahmadu Bello University Teaching Hospital, Zaria,
Nigeria
5. Abstract: Evolution of the global burden of viral infections from
unsafe medical injections, 2000-2010
6. Abstract: Transmission of hepatitis C virus in dialysis units: a
systematic review of reports on outbreaks
7. Abstract: Viral transmission risk factors in an Egyptian population
with high hepatitis C prevalence
8. Abstract: Sharps practice in focus
9. Abstract: Developing models for the prediction of hospital healthcare
waste generation rate
10. Abstract: Serious Neurologic Events after Epidural Glucocorticoid
Injection – The FDA’s Risk Assessment
11. Abstract: ‘Dynamic modelling of hepatitis C virus transmission among
people who inject drugs: a methodological review
12. Abstract: Pattern of Drug Use and Associated Behaviors Among Female
Injecting Drug Users From Northeast India: A Multi-Centric, Cross-
Sectional, Comparative Study
13. Abstract: Complications and Management of Polymethylmethacrylate
(PMMA) Injections to the Midface
14. Abstract: Vaccination and All-Cause Child Mortality From 1985 to 2011:
Global Evidence From the Demographic and Health Surveys
15. Abstract: Does Injection Site Matter? A Randomized Controlled Trial to
Evaluate Different Entry Site Efficacy of Knee Intra-articular
Injections
16. Abstract: Methods of Sterilization and Monitoring of Sterilization
Across Selected Dental Practices in Karachi, Pakistan
17. Abstract: Consensus statement: patient safety, healthcare-associated
infections and hospital environmental surfaces
18. No Abstract: Accidental Needlestick Exposures linked to the
Administration of Local Anesthesia by Healthcare Workers
19. No Abstract: Washing uniforms below 60°C may increase risk of
bacterial infection
20. No Abstract: Doctors and medical students in India should stop wearing
white coats
21. News
– Singapore: SGH to take responsibility, pay for treatment needed by
infected patients
– N.J. USA: Patients tested for HIV and hepatitis after nurse reuses
syringe to administer
– Scotland UK: NHS alert as two new botulism cases in injecting drug
users emerge in Glasgow and Lanarkshire
– Singapore: Hep C Outbreak: Human Error Possible, But Difficult To Occur
– Singapore: TTSH ‘strengthening overall system, vigilance’ in wake of
SGH Hepatitis C cluster
– Global Safety Syringes Market: Immunization Programs in Asia Pacific
and Rest of the World to Propel Market at 9.7% CAGR
– Singapore: Singapore hospital to screen 951 people after Hepatitis C
outbreak

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__________________________________________________________________
________________________________*_________________________________

1. Asia Webinar Series: Sustainable Health Care Waste Management

Register at: https://tinyurl.com/o8ghzmw
__________________________________________________________________
https://tinyurl.com/o8ghzmw

Asia Webinar Series

Sustainable Health Care Waste Management

Reducing health care’s carbon footprint through waste management
While their primary responsibility is to heal and “do no harm,” hospitals
and health facilities worldwide are a large contributor to environmental
problems, which in turn are making the planet and its people sick.

From reducing the amount of wastes they dispose of each day and replacing
toxic chemicals with safer alternatives, the health sector is stepping up
in reducing its carbon footprint and protecting public health from climate
change.

In this first Health Care Without Harm-Asia Global Green and Healthy
Hospitals webinar, GGHH members in Taiwan and the Philippines will share
their environmentally sound practices in reducing, re-using, and recycling
their wastes.

Learn how Health Care Without-Harm Asia works with hospitals across the
region in introducing alternative waste management solutions that do not
do harm the environment and human health.

Featuring:

Dr. Shou-Hsin Chien, Superintendent of the Taichung Tzu Chi Hospital

Nurse Shiela Yap, Infection Control Nurse of Maria Reyna Xavier University
Hospital

Ayeth Enrile, Health Care Without Harm-Asia’s Medical Waste and Safer
Chemicals Campaigner

Ruth Stringer, Health Care Without Harm’s International Science and Policy
Coordinator

Date and Time:
October 14 (Wednesday)
2:00 PM, Philippines, Malaysia, Singapore, Taiwan
11:45 AM, Nepal
5:00 PM, Sydney, Australia

CLICK HERE TO REGISTER! https://tinyurl.com/o8ghzmw

www.noharm-asia.org
www.greenhospitals.net
__________________________________________________________________
________________________________*_________________________________

2. Abstract: The prevalence of hepatitis C among healthcare workers: a
systematic review and meta-analysis
__________________________________________________________________
http://oem.bmj.com/content/early/2015/10/05/oemed-2015-102879.long

Occup Environ Med. 2015 Oct 5. pii: oemed-2015-102879. Open Access
The prevalence of hepatitis C among healthcare workers: a systematic
review and meta-analysis.

Westermann C1, Peters C1, Lisiak B2, Lamberti M3, Nienhaus A4.

1University Medical Center Hamburg-Eppendorf, Institute for Health
Services Research in Dermatology and Nursing, Hamburg, Germany.
2Institution for Statutory Accident Insurance and Prevention in Health and
Welfare Services, Hamburg, Germany.
3Department of Biochemistry, Biophysics and General Pathology, Second
University of Naples, Naples, Italy.
4University Medical Center Hamburg-Eppendorf, Institute for Health
Services Research in Dermatology and Nursing, Hamburg, Germany Institution
for Statutory Accident Insurance and Prevention in Health and Welfare
Services, Hamburg, Germany.

The aim of this study was to estimate the prevalence of viral hepatitis C
(HCV) infection among healthcare workers (HCWs) compared to the general
population.

A systematic search for the years 1989-2014 was conducted in the Medline,
Embase and Cochrane databases. Studies on hepatitis C in HCWs were
included if they incorporated either a control group or reference data for
the general population. The study quality was classified as high, moderate
or low. Pooled effect estimates were calculated to determine the odds of
occupational infection. Heterogeneity between studies was analysed using
the I2 test (p<0.10) and quantified using the I2 test. 57 studies met our
criteria for inclusion and 44 were included in the meta-analysis.

Analysis of high and moderate quality studies showed a significantly
increased OR for HCV infection in HCWs relative to control populations,
with a value of 1.6 (95% CI 1.03 to 2.42).

Stratification by study region gave an OR of 2.1 in low prevalence
countries; while stratification by occupational groups gave an increased
prevalence for medical (OR 2.2) and for laboratory staff (OR 2.2). The OR
for professionals at high risk of blood contact was 2.7.

The pooled analysis indicates that the prevalence of infection is
significantly higher in HCWs than in the general population.

The highest prevalence was observed among medical and laboratory staff.

Prospective studies that focus on HCW-specific activity and personal risk
factors for HCV infection are needed.

Published by the BMJ Publishing Group Limited.

KEYWORDS: Healthcare workers < Materials; exposures and occupational
groups

Free full Open Access text
http://oem.bmj.com/content/early/2015/10/05/oemed-2015-102879.long
__________________________________________________________________
________________________________*_________________________________

3. Extract: Management of sharps injuries in the healthcare setting
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26223519

BMJ. 2015 Jul 29;351:h3733.
Management of sharps injuries in the healthcare setting.

Riddell A1, Kennedy I2, Tong CY3.

1Department of Infection, Barts Health NHS Trust, London E1 2ES, UK.
2Occupational Health Service, Guy’s and St Thomas’ NHS Foundation Trust,
London, UK.
3Department of Infection, Barts Health NHS Trust, London E1 2ES, UK
Blizard Institute, Barts and the London School of Medicine and Dentistry,
Queen Mary University of London, London, UK william.tong@nhs.net.
__________________________________________________________________

Extract Extract Extract Extract Extract Extract Extract Extract Extract

BMJ. 2015 Jul 29;351:h3733. http://www.bmj.com/content/351/bmj.h3733.long
Management of sharps injuries in the healthcare setting.

Anna Riddell, specialist registrar in infectious diseases and virology1,

Ioana Kennedy, consultant occupational health physician2, C Y William
Tong, consultant virologist and honorary reader13

Correspondence to: C Y William Tong william.tong@nhs.net

The bottom line

– First aid should be undertaken as soon as possible and a risk assessment
needs to be carried out urgently by an appropriately trained individual

– If post-exposure prophylaxis is deemed necessary this should begin as
soon as possible without waiting for the test results of the source
patient

– Post-exposure prophylaxis using antiretroviral drugs within the hour
after injury can considerably reduce the risk of HIV transmission

– Hepatitis B vaccine is highly effective in the prevention of hepatitis
B; all healthcare workers should be immunised against the virus – Despite
the lack of post-exposure prophylaxis to hepatitis C, such exposure should
be followed up vigorously as treatment has a high success rate

Sharps injuries are common in the healthcare setting. Between 2004 and
2013 a total of 4830 healthcare associated occupational exposures to body
fluid were reported in the UK, 71% of these for percutaneous injuries.1 As
the reporting system is likely to have recorded only cases with an
important exposure, the actual burden of sharps injuries is likely to be
much higher. Healthcare workers need to be familiar with immediate
management both for themselves if they become injured and for assisting
injured colleagues. Many healthcare workers do not know how to manage a
sharps injury,2 particularly if this occurs out of hours. This review
presents a summary of the immediate management of sharps injuries and
outlines the risk assessment and management strategies to prevent the
transmission of HIV, hepatitis B virus, and hepatitis C virus.

Sources and selection criteria

We searched PubMed and the Cochrane Library for articles published over
the past 20 years using the terms “sharps injury”, “needle stick injury”,
and “body fluid exposure” and hand selected the most relevant and
appropriate articles. To search for relevant UK national guidelines we
also accessed the UK Department of Health and Public Health England …
__________________________________________________________________
________________________________*_________________________________

4. Abstract: An Epidemiological Study of Needlestick Injury among
Healthcare Workers in Ahmadu Bello University Teaching Hospital, Zaria,
Nigeria
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26445065

West Afr J Med. 2014 Oct-Dec;33(4):234-8.
An Epidemiological Study of Needlestick Injury among Healthcare Workers in
Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.

[Article in English, French]

Tukur D1, Aliyu A, Lawal A, Oyefabi AM.

1Department of Community Medicine, Ahmadu Bello University Zaria, Nigeria.
Abstract

BACKGROUND: Occupationally acquired infections are leading causes of
morbidity and mortality among health care workers. The study aimed to
determine knowledge, attitude and preventive practices of health care
workers on needle stick injuries in Ahmadu Bello University Teaching
Hospital, Zaria.

METHODS: This was a cross sectional descriptive study in which stratified
sampling technique was used to sample respondents. Data was collected
using structured, close ended self-administered questionnaire.

RESULTS: A total of 166 respondents completed the questionnaires out of
250 distributed questionnaires. Forty-three (25.9%) were males, 123
(74.1%) were females. The combined mean age was 40.9 ± 9.8 years. All the
respondents were aware and knew of transmission of blood borne pathogens.
Majority 116 (70.7%) had ever sustained injury while at work and 14 (8.8%)
sustained injury in the last 3 months. The incidence of injury increases
with work duration (c2= 17.88, p=0.001) and length of practice (c2=10.38,
p=0.001). Eighty percent of respondents had received training on universal
precautions. The commonest place of exposure was in the wards (65.6%) and
circumstances of exposure were respectively sudden patient movements
21(19.3%) and recapping needle 20 (18.3%). Only 52 (43.3%) of respondents
took appropriate measure (rinsing and disinfecting) the site after injury.

CONCLUSION: This study revealed the high risk health care workers are
exposed to at work. There is urgent need to improve the safety of health
care workers through continuing education and strict adherence to
universal precautions. There is need to establish a surveillance system to
monitor such incidents and provision of post-exposure prophylaxis to those
accidentally exposed.
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Evolution of the global burden of viral infections from
unsafe medical injections, 2000-2010
__________________________________________________________________
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0099677

PLoS One. 2014 Jun 9;9(6):e99677. Free Open Access Article
Evolution of the global burden of viral infections from unsafe medical
injections, 2000-2010.

Pépin J1, Abou Chakra CN1, Pépin E1, Nault V1, Valiquette L1.

1Department of Microbiology and Infectious Diseases, Université de
Sherbrooke, Sherbrooke, Québec, Canada.

BACKGROUND: In 2000, the World Health Organization estimated that, in
developing and transitional countries, unsafe injections accounted for
respectively 5%, 32% and 40% of new infections with HIV, hepatitis B virus
(HBV) and hepatitis C virus (HCV). Safe injection campaigns were organized
worldwide. The present study sought to measure the progress in reducing
the transmission of these viruses through unsafe injections over the
subsequent decade.

METHODS: A mass action model was updated, to recalculate the number of
injection- related HIV, HCV and HBV infections acquired in 2000 and
provide estimates for 2010. Data about the annual number of unsafe
injections were updated. HIV prevalence in various regions in 2000 and
2010 were calculated from UNAIDS data. The ratio of HIV prevalence in
healthcare settings compared to the general population was estimated from
a literature review. Improved regional estimates of the prevalence of HCV
seropositivity, HBsAg and HBeAg antigenemia were used for 2000 and 2010.
For HIV and HCV, revised estimates of the probability of transmission per
episode of unsafe injection were used, with low and high values allowing
sensitivity analyses.

RESULTS: Despite a 13% population growth, there was a reduction of
respectively 87% and 83% in the absolute numbers of HIV and HCV infections
transmitted through injections. For HBV, the reduction was more marked
(91%) due to the additional impact of vaccination. While injections-
related cases had accounted for 4.6%-9.1% of newly acquired HIV infections
in 2000, this proportion decreased to 0.7%-1.3% in 2010, when unsafe
injections caused between 16,939 and 33,877 HIV infections, between
157,592 and 315,120 HCV infections, and 1,679,745 HBV infections.

CONCLUSION: From 2000 to 2010, substantial progress was made in reducing
the burden of HIV, HCV and HBV infections transmitted through injections.
In some regions, their elimination might become a reasonable public health
goal.

Free Open Access Article
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0099677
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Transmission of hepatitis C virus in dialysis units: a
systematic review of reports on outbreaks
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26449566

Int J Artif Organs. 2015 Oct 8:0.
Transmission of hepatitis C virus in dialysis units: a systematic review
of reports on outbreaks.

Fabrizi F1, Messa P.

1Division of Nephrology, Maggiore Hospital, IRCCS Foundation, Milano –
Italy.

BACKGROUND: Hepatitis C virus (HCV) outbreaks among patients on
hemodialysis are still an important health concern all over the world.

AIMS: We performed a systematic review of reports on HCV outbreaks within
dialysis units of developed and less-developed countries (between 1992 and
2015) to evaluate risk factors and practices associated with patient-to-
patient transmission of HCV in this setting.

METHODS: The research was performed using the PubMed Database and the
Outbreak Database; studies were selected according to the PRISMA
algorithm. Inclusion criteria were established before the papers were
retrieved in order to avoid selection biases.

RESULTS: 36 papers reported on 45 outbreaks that involved 335 unique
patients on maintenance hemodialysis; no fatal cases were detected.
Nosocomial transmission of HCV was confirmed by phylogenetic analysis in
most (n = 31; 69%) reports.

>Sharing contaminated hemodialysis machines and multidose vials (heparin
or saline solution) was suggested responsible for HCV transmission in 8
(18%) and 6 (13%) outbreaks, respectively.

Breaches in environmental cleaning and disinfection practices, and
failures in medication preparation and administration practices was
considered in 29 (65%) outbreaks; however, the exact mechanism of
transmission of HCV could not be ascertained in each facility where an
outbreak occurred.

CONCLUSIONS: Our systematic review of reports on hepatitis C virus
outbreaks shows that, although the full extent of HCV transmission in
dialysis units is unknown, outbreaks continue to occur. Full compliance to
standard/specific infection control procedures and routine serologic
screening for HCV antibody play a pivotal role for preventing the
transmission of HCV within hemodialysis units.
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Viral transmission risk factors in an Egyptian population
with high hepatitis C prevalence
__________________________________________________________________
http://www.biomedcentral.com/1471-2458/15/1030 Open Access

BMC Public Health. 2015 Oct 7;15(1):1030.
Viral transmission risk factors in an Egyptian population with high
hepatitis C prevalence.

Mohlman MK1, Saleh DA2, Ezzat S3, Abdel-Hamid M4, Korba B5, Shetty K6, Amr
S7, Loffredo CA8.

1Lombardi Cancer Center, Georgetown University, 3970 Reservoir Rd,
Washington, DC, 20057, USA. m.k.mohlman@gmail.com.
2Cairo University, Cairo, Egypt. doa_a_saleh@yahoo.com.
3Menoufiya University, Shibin El Kom, Egypt. sameera.ezzat@57357.org.
4Minia University, Minia, Egypt. vhrl@link.net.
5Lombardi Cancer Center, Georgetown University, 3970 Reservoir Rd,
Washington, DC, 20057, USA. korbabe@georgetown.edu.
6Lombardi Cancer Center, Georgetown University, 3970 Reservoir Rd,
Washington, DC, 20057, USA. ks359@georgetown.edu.
7University of Maryland School of Medicine, Baltimore, MD, USA.
samr@epi.umaryland.edu.
8Lombardi Cancer Center, Georgetown University, 3970 Reservoir Rd,
Washington, DC, 20057, USA. cal9@georgetown.edu.

BACKGROUND: Egypt has the world’s highest prevalence of infection with
hepatitis C virus (HCV), which is a major cause of hepatocellular
carcinoma. The high HCV prevalence is largely attributed to the parenteral
antischistosomal therapy (PAT) campaigns conducted from the 1950s through
the 1980s; however, the primary modes of transmission in the post-PAT
period are not well known. In this study we examined the associations
between HCV prevalence and exposures to risk factors, including PAT, in a
high HCV prevalence population.

METHODS: Using a cross-sectional design, we examined the associations
between demographic characteristics and risk factors for HCV transmission
and HCV positivity prevalence among a sample of Egyptian residents. Data
were collected through an interview-administered survey, and the
association estimates were determined using ? (2) and logistic regression.

RESULTS: The highest HCV positivity prevalence was observed in cohorts
born before 1960, and declined precipitously thereafter; whereas the
proportion of subjects reporting PAT remained relatively stable. Being
male, having a rural residence, and having received PAT were all
associated with HCV positivity; however, PAT alone could not account for
the high prevalence of HCV.

CONCLUSIONS: In Egypt, PAT and other transmission factors yet to be
identified, as well as cohorts born before the 1960s and infected with
HCV, are most likely the main contributors to the current HCV endemic.
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Sharps practice in focus
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/25116569
Nurs Stand. 2014 Aug 19;28(50):65.
Sharps practice in focus.

de Raeve P1.

1European Federation of Nurses Associations.

The EU Sharps Directive on the prevention of sharps injuries in the
healthcare sector (see resources ) was incorporated into the national law
of all EU member states on May 11 2013.
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Developing models for the prediction of hospital healthcare
waste generation rate
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26437681

Waste Manag Res. 2015 Oct 5. pii: 0734242X15607422.
Developing models for the prediction of hospital healthcare waste
generation rate.

Tesfahun E1, Kumie A2, Beyene A3.

1School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
esubalew.tesfahun@gmail.com.
2School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
3Department of Environmental Health Science & Technology, Jimma
University, Jimma, Ethiopia.

An increase in the number of health institutions, along with frequent use
of disposable medical products, has contributed to the increase of
healthcare waste generation rate. For proper handling of healthcare waste,
it is crucial to predict the amount of waste generation beforehand.

Predictive models can help to optimise healthcare waste management
systems, set guidelines and evaluate the prevailing strategies for
healthcare waste handling and disposal.

However, there is no mathematical model developed for Ethiopian hospitals
to predict healthcare waste generation rate. Therefore, the objective of
this research was to develop models for the prediction of a healthcare
waste generation rate.

A longitudinal study design was used to generate long-term data on solid
healthcare waste composition, generation rate and develop predictive
models.

The results revealed that the healthcare waste generation rate has a
strong linear correlation with the number of inpatients (R2?=?0.965), and
a weak one with the number of outpatients (R2?=?0.424). Statistical
analysis was carried out to develop models for the prediction of the
quantity of waste generated at each hospital (public, teaching and
private).

In these models, the number of inpatients and outpatients were revealed to
be significant factors on the quantity of waste generated. The influence
of the number of inpatients and outpatients treated varies at different
hospitals. Therefore, different models were developed based on the types
of hospitals.

© The Author(s) 2015.

KEYWORDS: Ethiopia; Healthcare waste; generation rate; hospitals; models;
prediction
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Serious Neurologic Events after Epidural Glucocorticoid
Injection – The FDA’s Risk Assessment
__________________________________________________________________
http://www.nejm.org/doi/full/10.1056/NEJMp1511754 Free Full Text

N Engl J Med. 2015 Oct 7.
Serious Neurologic Events after Epidural Glucocorticoid Injection – The
FDA’s Risk Assessment.

Racoosin JA1, Seymour SM, Cascio L, Gill R.

1From the Division of Anesthesia, Analgesia and Addiction Products
(J.A.R.), and the Division of Pulmonary, Allergy, and Rheumatology
Products (S.M.S.), Office of New Drugs, and the Division of
Pharmacovigilance 2 (L.C.) and the Division of Epidemiology 2 (R.G.),
Office of Surveillance and Epidemiology, Center for Drug Evaluation and
Research, Food and Drug Administration, Silver Spring, MD.

At times, the Food and Drug Administration (FDA) must grapple with safety
concerns related to off-label uses of FDA-approved medications.

Over the past several years, we have sought to understand the risk of
serious neurologic events that occur after the epidural injection of
glucocorticoids (corticosteroids) — a procedure that is commonly performed
in the United States in an effort to manage radicular neck and back pain.

The FDA has not approved any injectable glucocorticoid product for
epidural administration, so any such use is considered off-label — part of
the practice of medicine and not regulated by the FDA.

In 2009, the FDA began evaluating serious neurologic events associated
with epidural glucocorticoid injections. Between 1997 and 2014, a total of
90 serious and sometimes fatal neurologic events were reported to the FDA
Adverse Event Reporting System (FAERS), including cases of paraplegia,
quadriplegia, spinal cord infarction, and stroke. (Compounded
glucocorticoids used in epidural injections have been associated with
fungal meningitis, but cases involving contaminated products were not
included in the case series under consideration.)

Potential causes of these adverse events included technique-related
problems such as intrathecal injection, epidural hematoma, direct spinal
cord injury, and embolic infarction after inadvertent intraarterial
injection.
__________________________________________________________________
________________________________*_________________________________

11. Abstract: ‘Dynamic modelling of hepatitis C virus transmission among
people who inject drugs: a methodological review
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25270261

J Viral Hepat. 2015 Mar;22(3):213-29.
‘Dynamic modelling of hepatitis C virus transmission among people who
inject drugs: a methodological review.

Cousien A1, Tran VC, Deuffic-Burban S, Jauffret-Roustide M, Dhersin JS,
Yazdanpanah Y.

1IAME, UMR 1137, INSERM, Paris, France; IAME, UMR 1137, Sorbonne Paris
Cité, Univ Paris Diderot, Paris, France.

Equipment sharing among people who inject drugs (PWID) is a key risk
factor in infection by hepatitis C virus (HCV).

Both the effectiveness and cost-effectiveness of interventions aimed at
reducing HCV transmission in this population (such as opioid substitution
therapy, needle exchange programmes or improved treatment) are difficult
to evaluate using field surveys.

Ethical issues and complicated access to the PWID population make it
difficult to gather epidemiological data. In this context, mathematical
modelling of HCV transmission is a useful alternative for comparing the
cost and effectiveness of various interventions.

Several models have been developed in the past few years. They are often
based on strong hypotheses concerning the population structure.

This review presents compartmental and individual-based models to
underline their strengths and limits in the context of HCV infection among
PWID. The final section discusses the main results of the papers.

© 2014 John Wiley & Sons Ltd.

KEYWORDS: antiviral treatment; dynamic modelling; harm reduction policies;
hepatitis C; injecting drug users
__________________________________________________________________
________________________________*_________________________________

12. Abstract: Pattern of Drug Use and Associated Behaviors Among Female
Injecting Drug Users From Northeast India: A Multi-Centric, Cross-
Sectional, Comparative Study
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26441158

Subst Use Misuse. 2015 Oct 6:1-9.
Pattern of Drug Use and Associated Behaviors Among Female Injecting Drug
Users From Northeast India: A Multi-Centric, Cross-Sectional, Comparative
Study.

Ambekar A1, Rao R1, Agrawal A1, Goyal S1, Mishra A1, Kishore K2, Mukherjee
D2, Albertin C2.

1a National Drug Dependence Treatment Centre, Department of Psychiatry,
All India Institute of Medical Sciences , Ansari Nagar , New Delhi ,
India.
2b United Nations Office on Drugs and Crime , Chanakyapuri , New Delhi ,
India.

BACKGROUND: Studies from developed countries document the presence of
injecting drug use among females and significantly higher vulnerabilities
and risks as compared with male injecting drug users (IDUs). Studies
comparing vulnerabilities and drug use patterns between female and male
IDUs are not available for developing countries.

OBJECTIVES: The aim of the study was to assess the drug use pattern and
related HIV vulnerabilities among female IDUs and compare these findings
with those from male IDUs from four states of Northeast India.

METHOD: The study used data collected as part of a nationwide study of
drug use pattern and related HIV vulnerabilities among IDUs. Ninety-eight
female and 202 male IDUs accessing services from harm reduction sites
across the four states of Northeast region of India were chosen through
random sampling methodology. Drug use pattern, injecting practices, and
knowledge of HIV were assessed using a structured questionnaire.

RESULTS: Significantly higher proportion of female IDUs was uneducated,
unemployed, reported their occupation as sex workers, and switched to
injecting drug use faster as compared with male IDUs. Female IDUs
practicing sex work differed significantly from those who did not with
respect to frequency of daily injections, choice of drugs injected, and
concomitant use of non- injecting drugs. More than half of female IDUs
initiated sharing within the first month of injecting.

CONCLUSIONS: The study demonstrates that female IDUs differ from male IDUs
in their drug use pattern, initiation into injection as well as injecting
behavior, which would be an important consideration during designing of
female- specific interventions.

KEYWORDS: Northeast India; female drug user; injecting-drug use; opioid
use
__________________________________________________________________
________________________________*_________________________________

13. Abstract: Complications and Management of Polymethylmethacrylate
(PMMA) Injections to the Midface
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26446059

Aesthet Surg J. 2015 Oct 7. pii: sjv195.
Complications and Management of Polymethylmethacrylate (PMMA) Injections
to the Midface.

Limongi RM1, Tao J1, Borba A1, Pereira F1, Pimentel AR1, Akaishi P1,
Velasco E Cruz AA1.

1Dr Limongi is an Affiliate Professor, Ophthalmology Referral Center at
the Hospital das Clínicas, Federal University of Goiás, Goiânia, Goiás,
Brazil. Dr Tao is an Affiliate Professor, Gavin Herbert Eye Institute,
University of California, Irvine, CA, USA. Dr Borba is an Affiliate
Professor, Department of Ophthalmology, University of São Paulo, São
Paulo, Brazil. Drs Pereira and Akaishi are Affiliate Professors, and Dr
Cruz is Chairman and Professor, Department of Ophthalmology, University of
São Paulo – Ribeirão Preto, São Paulo, Brazil. Dr Pimentel is an Affiliate
Professor, Department of Ophthalmology, University of Minas Gerais, Belo
Horizonte, Minas Gerais, Brazil.

BACKGROUND: Polymethylmethacrylate (PMMA) has been used as an injectable
filler to treat hollows and reduce rhytids. PMMA injections have been
associated with several side effects, however, the literature is scarce on
periorbital complications and their treatments.

OBJECTIVES: The purpose of this study is to report a series of
complications after periorbital PMMA injections to the midface and to
describe their management.

METHODS: Retrospective chart review, including photography and
histopathology when available.

RESULTS: The authors identified 11 cases of complications of PMMA
injections to the midface. Patient ages ranged from 36 to 62 years (mean,
47 years; median, 44 years). Two (18%) were males and 9 (82%) were
females. Adverse effects began between 2 to 24 months after injection
(mean, 7.2 months; median, 6 months). All patients had edema, erythema,
and contour irregularity. Seven (64%) patients had nodules, 4 (36%) had
yellow, xanthomatous skin changes, and 2 (18%) had eyelid malposition.
Histopathology demonstrated a giant cell inflammation in 5 of 6 cases.
Corticosteroid injection was tried in 6 cases but was associated with
minimal clinical improvement. Surgical debulking of the implanted material
was performed in 9 (82%) cases and was effective in improving edema,
erythema, and nodularity.

CONCLUSIONS: PMMA injection to the midface may be associated with chronic
inflammation, fibrotic nodules, yellowing of the skin, and eyelid
malposition. Intralesional corticosteroid injections yielded minimal or no
improvement; surgical debulking achieved favorable results.

LEVEL OF EVIDENCE: 4 Therapeutic.

© 2015 The American Society for Aesthetic Plastic Surgery, Inc. Reprints
and permission: journals.permissions@oup.com.
__________________________________________________________________
________________________________*_________________________________

14. Abstract: Vaccination and All-Cause Child Mortality From 1985 to 2011:
Global Evidence From the Demographic and Health Surveys
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26453618

Am J Epidemiol. 2015 Oct 8. pii: kwv125.
Vaccination and All-Cause Child Mortality From 1985 to 2011: Global
Evidence From the Demographic and Health Surveys.

McGovern ME, Canning D.

Based on models with calibrated parameters for infection, case fatality
rates, and vaccine efficacy, basic childhood vaccinations have been
estimated to be highly cost effective. We estimated the association of
vaccination with mortality directly from survey data. Using 149 cross-
sectional Demographic and Health Surveys, we determined the relationship
between vaccination coverage and the probability of dying between birth
and 5 years of age at the survey cluster level.

Our data included approximately 1 million children in 68,490 clusters from
62 countries. We considered the childhood measles, bacillus Calmette-
Guérin, diphtheria- pertussis-tetanus, polio, and maternal tetanus
vaccinations. Using modified Poisson regression to estimate the relative
risk of child mortality in each cluster, we also adjusted for selection
bias that resulted from the vaccination status of dead children not being
reported.

Childhood vaccination, and in particular measles and tetanus vaccination,
is associated with substantial reductions in childhood mortality. We
estimated that children in clusters with complete vaccination coverage
have a relative risk of mortality that is 0.73 (95% confidence interval:
0.68, 0.77) times that of children in a cluster with no vaccinations.

Although widely used, basic vaccines still have coverage rates well below
100% in many countries, and our results emphasize the effectiveness of
increasing coverage rates in order to reduce child mortality.

© The Author 2015. Published by Oxford University Press on behalf of the
Johns Hopkins Bloomberg School of Public Health. All rights reserved. For
permissions, please e-mail: journals.permissions@oup.com.

KEYWORDS: bacillus Calmette-Guérin; child mortality; diphtheria-pertussis-
tetanus; measles; missing data; polio; tetanus; vaccinations
__________________________________________________________________
________________________________*_________________________________

15. Abstract: Does Injection Site Matter? A Randomized Controlled Trial to
Evaluate Different Entry Site Efficacy of Knee Intra-articular
Injections
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26434090

Bol Asoc Med P R. 2015 Apr-Jun;107(2):78-81.
Does Injection Site Matter? A Randomized Controlled Trial to Evaluate
Different Entry Site Efficacy of Knee Intra-articular Injections.

Dávila-Parrilla A, Santaella-Santé B, Otero-López A.

BACKGROUND: Complaints of knee pain secondary to early osteoarthritis may
account for up to 30% of visits to primary care physicians. Due to the
proposed inflammatory changes in early osteoarthritis, intra-articular
injections of corticosteroids (IACS) have been considered as an option for
disease progression modification, pain control, and improvement of
function. However, some studies have suggested poor accuracy rates of IA
injections depending on the entry site chosen. It is therefore the aim of
this study to evaluate the efficacy of IA knee corticosteroid injection in
reducing pain and improving function in patients with early osteoarthritis
and whether the low accuracy rates reported with the Anterolateral joint
line injection site translate to worse functional and pain outcome
measures as compared to Suprapatellar lateral injections.

MATERIALS AND METHODS: The study was carried out as an open-label,
randomized controlled trial with 60 sequential patients recruited. Simple
randomization separated groups into anterolateral joint line or
suprapatellar lateral injection sites. Improvements were measured with
WOMAC and VAS scores after injection of Lidocaine and steroid solution.

RESULTS: Patients receiving IACS injections had a measurable improvement
in self- reported outcomes as evidenced by standard deviation change in
WOMAC and VAS scores. The majority of patients had a clinically
significant improvement in VAS scores as compared to their initial
measures with a notable amount of patients improving significantly as well
on their WOMAC scores, irrespective of the injection site chosen.

CONCLUSIONS: We have therefore continued the use of palpation-guided
intra-articular knee injections in an effort to reduce costs as compared
to other injection modalities with positive results in our osteoarthritis
patients.
__________________________________________________________________
________________________________*_________________________________

16. Abstract: Methods of Sterilization and Monitoring of Sterilization
Across Selected Dental Practices in Karachi, Pakistan
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26454384

J Coll Physicians Surg Pak. 2015 Oct;25(10):713-6.
Methods of Sterilization and Monitoring of Sterilization Across Selected
Dental Practices in Karachi, Pakistan.

Ahmed H1.

1Department of Operative Dentistry, Ziauddin College of Dentistry/Ziauddin
University, Karachi.

OBJECTIVE: To assess methods of sterilization in dental practices in
Karachi and secondly to investigate methods of monitoring sterilization in
dental practices in Karachi, Pakistan.

STUDY DESIGN: Cross-sectional, descriptive study.

PLACE AND DURATION OF STUDY: Dental colleges, hospitals and private
clinics of Karachi, Pakistan, from January to March 2013.

METHODOLOGY: A total of 251 questionnaires were obtained. Descriptive
statistics were computed and differences between groups were assessed
through chi-square test using Statistical Package for the Social Sciences
(SPSS) version 16.0. P-value < 0.05 was taken as statistically
significant.

RESULTS: Autoclave, used by 155 (61.8%) dentists was the most common
method of sterilization followed by more than one method, 65 (25.9%); dry
heat, 24 (9.6%); and cold sterilization, 7 (2.8%). Majority of dentists,
126 (50.1%), never monitored sterilization and those who did monitored
mostly monthly. Statistically significant difference was found amongst the
three groups of dentists monitoring sterilization (p=0.09) and methods of
sterilization (p < 0.01).

CONCLUSION: Statistically significant difference was found in infection
control practices of specialists, postgraduate trainees and general
dentists regarding method of monitoring sterilization with majority of
dentists never monitoring sterilization.
__________________________________________________________________
________________________________*_________________________________

17. Abstract: Consensus statement: patient safety, healthcare-associated
infections and hospital environmental surfaces
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26437762

Future Microbiol. 2015 Oct 6.

Consensus statement: patient safety, healthcare-associated infections and
hospital environmental surfaces.

Roques C1, Al Mousa H2, Duse A3, Gallagher R4, Koburger T5, Lingaas E6,
Petrosillo N7, Škrlin J8.

1Laboratory on Bacterial Adhesion & Biofilm Formation, University Paul
Sabatier, UMR 5503 – Hospital practitioner at the Federative Institute of
Biology, Purpan Hospital – Toulouse, France.
2Infection Control Association, Infection Control Directorate, Sabah
Health Area, PO Box 12414, Al-Shamiya, Kuwait.
3Department of Clinical Microbiology & Infectious Diseases, National
Health Laboratory Service & Wits School of Pathology, Houghton,
Johannesburg, Gauteng, South Africa.
4Infection Prevention & Control, Royal College of Nursing, London, UK.
5Hygiene Nord GmbH, Griefswald, Germany.
6Department of Infection Prevention, Oslo University Hospital, Oslo,
Norway.
7Infectious Diseases Division, National Institute for Infectious Diseases,
‘Lazzaro Spallanzani’, Rome, Italy.
8Center for Clinical Microbiology & Hospital Infections, University
Hospital Zagreb, Zagreb, Croatia.

Healthcare-associated infections have serious implications for both
patients and hospitals. Environmental surface contamination is the key to
transmission of nosocomial pathogens. Routine manual cleaning and
disinfection eliminates visible soil and reduces environmental bioburden
and risk of transmission, but may not address some surface contamination.

Automated area decontamination technologies achieve more consistent and
pervasive disinfection than manual methods, but it is challenging to
demonstrate their efficacy within a randomized trial of the multiple
interventions required to reduce healthcare-associated infection rates.

Until data from multicenter observational studies are available, automated
area decontamination technologies should be an adjunct to manual cleaning
and disinfection within a total, multi-layered system and risk-based
approach designed to control environmental pathogens and promote patient
safety.

KEYWORDS: automated area decontamination technologies; healthcare-
associated infections; hospital environment; manual cleaning and
disinfection; nosocomial pathogens; surface contamination; systems
approach
__________________________________________________________________
________________________________*_________________________________

18. No Abstract: Accidental Needlestick Exposures linked to the
Administration of Local Anesthesia by Healthcare Workers
__________________________________________________________________
http://dx.doi.org/10.1017/ice.2015.229 Page 1 of 2 image [Free]

Infect Control Hosp Epidemiol. 2015 Oct 9:1-2.

Accidental Needlestick Exposures linked to the Administration of Local
Anesthesia by Healthcare Workers.

Martin H1, Hermos C1, Barysauskas CM2, Bradbury S3, Sullivan S4, Ellison
RT1.

11University of Massachusetts Medical School,Worcester,Massachusetts.
23Department of Biostatistics and Computational Biology,Dana-Farber Cancer
Institute,Boston,Massachusetts.
34Department of Infection Control,UMass Memorial Medical
Center,Worcester,Massachusetts.
45Department of Employee Health Services,UMass Memorial Medical
Center,Worcester,Massachusetts.
__________________________________________________________________
________________________________*_________________________________

19. No Abstract: Washing uniforms below 60°C may increase risk of
bacterial infection
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/25806441

Nurs Manag (Harrow). 2015 Apr;22(1):6.

Washing uniforms below 60°C may increase risk of bacterial infection.

[No authors listed]
__________________________________________________________________
________________________________*_________________________________

20. No Abstract: Doctors and medical students in India should stop wearing
white coats
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26198987

BMJ. 2015 Jul 21;351:h3855.

Doctors and medical students in India should stop wearing white coats.

Fernandes E.
__________________________________________________________________
________________________________*_________________________________

21. News

– Singapore: SGH to take responsibility, pay for treatment needed by
infected patients
– N.J. USA: Patients tested for HIV and hepatitis after nurse reuses
syringe to administer
– Scotland UK: NHS alert as two new botulism cases in injecting drug
users emerge in Glasgow and Lanarkshire
– Singapore: Hep C Outbreak: Human Error Possible, But Difficult To Occur
– Singapore: TTSH ‘strengthening overall system, vigilance’ in wake of
SGH Hepatitis C cluster
– Global Safety Syringes Market: Immunization Programs in Asia Pacific
and Rest of the World to Propel Market at 9.7% CAGR
– Singapore: Singapore hospital to screen 951 people after Hepatitis C
outbreak

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/pt5r3jt
Singapore: Singapore hospital to screen 951 people after Hepatitis C
outbreak

The Straits Times, iFreePress.com, Singapore (13.10.15)

The hospital added that since the announcement of the infections, 157
patients who did not stay in the affected ward during the period have
called to enquire about the Hepatitis C cluster.

Last week, SGH revealed that 22 patients staying in its renal wards had
contracted hepatitis C infections while receiving treatment.

SGH said that doctors and medical social workers have already spoken to
them, or will be contacting them, to address their concerns, and to offer
psychological and emotional support.

Questions were raised as to why the hospital, which first suspected that
the cases were related as early as mid-May, took so long to inform the
public about the situation. Of the 22, four – who were also ill with other
serious conditions – have since died.

Eight family conferences have been held, with nine more scheduled for the
next few days, while another five are being arranged, it said.

He had said then that the hospital had looked through its records of all
patients who had passed through the affected wards and had “identified 411
of them, whom we’ll be calling back just to check”.

As of 6 p.m. on Thursday night, SGH has already contacted 298 patients,
with 251 of them confirming their screening appointments.

Of the patients, 267 were admitted from January to March, while another
411 were from April to June. The Ministry of Health, on the other hand, is
forming its own committee to conduct an investigation on the hospital,
making sure SGH is taking all the measures necessary to avoid the incident
and is conducting an objective review process.

Hepatitis C is usually spread through unsafe injection practices, poor
sterilisation of medical equipment and unscreened blood transfusions,
according to the WHO.
__________________________________________________________________
__________________________________________________________________

https://tinyurl.com/n97nrnp

Global Safety Syringes Market: Immunization Programs in Asia Pacific and
Rest of the World to Propel Market at 9.7% CAGR

TMR Release, Medgadget.com USA (12.10.15)

The World Health Organization (WHO) estimates that unsafe injection
practices lead to over 1.3 million deaths across the globe every year.
Lately, there has been a spike in the needlestick injuries, mostly caused
by sharing, reuse, or unsafe disposal of non-sterile syringes. Growing
prevalence of needlestick injuries, coupled with increase in number of
patients suffering from various blood-borne infections due to unsafe
injection practices, boosts the growth of the global safe syringes market.
The safe syringes market worldwide is estimated to exhibit a CAGR of 9.70%
during the period between 2013 and 2019. The overall market was worth
US$3,419.1 mn in 2012 and is projected to reach a valuation of US$6,496.8
mn by 2019.

Automatic Retractable Safety Syringes Create Huge Opportunity for Growth
of Global Safety Syringes Market

Government legislations across nations have pushed manufacturers to
develop syringes with safety mechanisms. In a study conducted by the U.S.
Occupational Safety and Health Administration, it was found that around
5.6 mn healthcare workers are exposed to blood-borne infections through
needlestick injuries. This led to the introduction of the Federal
Needlestick Prevention Act in 2000 and the U.S. became the first country
to enforce the usage of safety syringes. Continuous growth in injectable
drugs market, along with increasing cases of needlestick injuries, will
propel the growth of the global safe syringes market. However, high cost
associated with safety syringes will restrain the overall growth of the
market in the next couple of years. Alternative drug delivery methods will
also hamper the growth of the global safety syringes market. The market
has a huge opportunity to grow with the introduction of automatic
retractable safety syringes.

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Asia Pacific and Rest of the World to be Fastest Growing Regions in Global
Safety Syringes Market

On the basis of product type, the global safety syringes market has been
segmented into retractable safety syringes and non-retractable safety
syringes. Retractable safety syringes market has been sub-segmented into
automatic retractable safety syringes and manual retractable safety
syringes. The demand for retractable safety syringes has been high in the
market, especially for the automatic ones. Non-usable auto-disable
syringes have also gained WHO’s approval for its safe injection practices
campaign.

In 2012, North America was the largest market for safety syringes in terms
of both volume and revenue. Europe was the second largest safety syringes
market during the same time and is expected to grow further during the
next couple of years. However, in the coming years, Asia Pacific and Rest
of the World are projected to be the fastest growing regions in the global
safety syringes market owing to the various immunization programs
initiated by the WHO and UNICEF.

Key Players in Global Safety Syringes Market

Some of the key players in the global safety syringes market are Unilife
Corporation, Terumo Corporation, Revolutions Medical Corporation, Smiths
Medical, Retractable Technologies Inc., and Becton, Dickinson & Company.
The key players are focusing on strategic partnerships to invest in
rapidly growing safety syringes market in Europe. Also, development of
automatic retractable safety syringes has emerged as a key priority for
the manufacturers.

Browse Full global safety syringes market Research Report With Complete
TOC @
http://www.transparencymarketresearch.com/retractable-safety-syringes.html

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Transparency Market Research (TMR) is a next-generation provider of
syndicated research, customized research, and consulting services. TMR’s
global and regional market intelligence coverage includes industries such
as pharmaceutical, chemicals and materials, technology and media, food and
beverages, and consumer goods, among others. Each TMR research report
provides clients with a 360-degree view of the market with statistical
forecasts, competitive landscape, detailed segmentation, key trends, and
strategic recommendations.

Website: http://www.transparencymarketresearch.com
__________________________________________________________________
__________________________________________________________________
www.channelnewsasia.com/news/singapore/ttsh-strengthening/2181060.html

Singapore: TTSH ‘strengthening overall system, vigilance’ in wake of SGH
Hepatitis C cluster

Tan Tock Seng Hospital also demonstrated its safe practices for multi-
dosing, which was raised as a possible cause of the virus spread at the
Singapore General Hospital.

By Justin Ong, Channel News Asia (09.10.15)

SINGAPORE: Tan Tock Seng Hospital (TTSH), one of Singapore’s largest
hospitals, on Fri (Oct 9) said it was strengthening its injection
practices in light of the Hepatitis C cluster at Singapore General
Hospital (SGH).

Multi-dosing – injection by attaching needles to a shared vial – was
identified by SGH as a possible cause of the virus spread, which infected
22 patients and possibly killed four in the hospital’s renal ward. The
Ministry of Health (MOH) has said it is not yet conclusive that multi-
dosing is the cause of the infections and an independent review
committee’s probe into the incident is expected to take two months.

However Associate Professor Thomas Lew, chairman of TTSH’s medical board,
said: “We are reviewing our processes, looking at guidelines provided to
ensure we are in compliance with best practices … and strengthening our
overall system and vigilance.”

This would be done by “constant repetition of key messages” such as safe
injection practices for both single and multi-dosing, said Prof Lew, who
spoke during a media tour of TTSH and SGH organised by MOH to demonstrate
patient safety and infection control measures

Prof Lew said that out of 700 types of injectable drugs at TTSH, 13 are
multi-dose. “These 13 are not commonly administered, not available in
single dose, and there are no alternatives based on current manufactured
supply,” he stated.

Eight of these 13 multi-dose drugs can be used by different patients while
the rest are for a single patient only.

“This is consistent all over Singapore. We are not practising something
unique here,” said Prof Lew.

TTSH also explained safety procedures behind its use of haemodialysis
machines, which are another potential mode of transmission for the
Hepatitis C virus (HCV).

Each machine’s dialysers and bloodlines are single-use and discarded after
each patient has gone through haemodialysis, said the hospital. Before
TTSH starts patients on dialysis, they are also screened for blood-borne
viruses like Hepatitis C and HIV, on top of being screened every six
months as per national protocol.

INFECTION CONTROL AT SGH

Earlier, SGH – which has halted the practice of multi-dosing following the
Hepatitis C cluster – demonstrated its haemodialysis procedure in a
simulation room.

The chairman of SGH’s medical board, Prof Fong Kok Yong, also outlined the
hospital’s infection control programmes for staff such as e-learning,
training courses up to twice a year, and monthly audits of high-risk
wards.

When asked why SGH only released information about the Hepatitis C cluster
in October, four months after doctors noticed a spike in infections, Prof
Fong reiterated that Hepatitis C has a “long incubation period of up to
six months” and that it is a blood-borne virus.

“If it were airborne like SARS or MERS, the moment there is a case,
everybody jumps, isolates the patient and it’s a reportable disease,” he
said. “For blood-borne viruses, if you don’t do a test, you don’t even
know such a thing has occurred.”

Added Prof Fong: “The first thing we did was to ensure it’s not airborne,
that there was no danger to people around them (the infected patients) and
we implemented whatever infection control practices we have as what we did
in the stopping use of multi dosing.”

“There was no danger to other patients. We knew how it’s being transmitted
and we took action to further ensure there was no further chance of
spreading to anyone else,” he said.

“I’d like the independent review committee to make a thorough
investigation. We are fully cooperative, whatever they ask we have
provided them and they have a free hand to look at whatever they need to
look at.”

In an update on Friday evening, SGH said it has contacted 646 out of the
678 patients who were admitted to Wards 64A and 67 from January to June. A
total of 585 have confirmed their appointments for screening and 186 have
been screened to date. Additionally, 202 out of 273 staff have been
screened for the virus. Those tested will be informed when the results are
available in a week.

– CNA/jo
__________________________________________________________________
__________________________________________________________________
https://tinyurl.com/ohdrznf
Singapore: Hep C Outbreak: Human Error Possible, But Difficult To Occur

BY FOO JIE YING, Singapore-News (09.10.15)

Human error could have led to the hepatitis C outbreak in the Singapore
General Hospital (SGH), said Dr Desmond Wai.

But here’s the disclaimer: It is difficult for that to occur when the
protocols in place are so well thought out, the gastroenterologist in
private practice said.

On Tuesday, SGH revealed in a press conference that 22 patients in their
renal ward had been infected with the hepatitis C virus (HCV).

Eight of the 22 have died. In four of those cases, hepatitis C is
suspected to have contributed to the deaths, while three of the eight did
not die of the disease. The cause of one other fatality is still being
investigated.

While the cause of the infections is still under investigation, initial
findings point towards intravenous (IV) injectable agents as the source of
the infection.

These are stored in multi-dose vials, which hold more than one dose of
medication. SGH’s chief nurse, Dr Tracy Ayre, said the vials can be shared
between two or three patients.

With investigations ongoing, SGH reportedly said they cannot rule out any
possibility, including foul play.

A similar hepatitis C outbreak also happened in Nevada, US, in 2007, with
at least six patients infected.

Investigations found that when an infected patient needed another dose of
the same drug from a multi-dose vial, a new needle was used, but with the
same syringe.

A tiny backflow of blood from the first injection could have contaminated
the syringe.

The HCV, now in the syringe, was then introduced into the vial of
medicine, even though a new needle was used to draw more of the drug for
other patients.

But Dr Wai stressed that a set of needle and syringe had to be disposed
once it has any human contact.

“I can speak for only Mount Elizabeth Novena Hospital, where I work, but I
believe many hospitals here follow similar levels of protocol,” he said.

CONTAMINATION RISK

Some have questioned why multi-dose vials were used if they pose a risk of
contamination.

Using insulin vials as an example, Dr Wai explained: “One bottle contains
100 units. At each time, a patient may require five to 20 units of insulin
(before their meals).

“There’s no way that the insulin can come in different units. Otherwise,
the hospital will end up storing a lot (of vials). It is more economical
to keep all the insulin in one bottle.”

Precautions are taken at Mount E Novena Hospital to minimise the risk of
infection, he said.

For instance, while multi-dose vials can be shared among a few patients,
those at Mount E Novena use the same vial of drug throughout their stay.

But Dr Wai believes that the protocol in many Singapore’s public
hospitals, like SGH and the National University Hospital, should be
similarly robust to Mount E Novena’s as they are all accredited by the
Joint Commission International (JCI).

JCI looks at certain standards, such as having a minimum distance between
beds, and is considered the gold standard in global health care.

“All processes are scrutinised by external organisations like JCI, so they
have to be very robust and foolproof.

“If the source (of infection at SGH) is indeed the multi-dose vials, then
I would like to find out how it could have happened,” Dr Wai said.

One bottle contains 100 units. At each time, a patient may require five
to 20 units of insulin (before their meals). There’s no way that the
insulin can come in different units.

– Dr Desmond Wai, explaining why multi-dose vials are used

Steps to prevent contamination

Multi-dose vials were named one of the possible causes of the hepatitis C
infections in the Singapore General Hospital. Gastroenterologist Dr
Desmond Wai shows the precautions taken at Mount Elizabeth Novena Hospital
to prevent the spread of infections with these multi-dose vials.

Photos at the site https://tinyurl.com/ohdrznf

TNP PHOTOS: GAVIN FOO
1 Each time a new multi-dose vial is used, the date and time the vial is
opened will be written on its label.

At Mount Elizabeth Novena, patients do not share the multi-dose vials. Two
nurses administering the medicine will first check two identifiers of the
patient, usually their name and identification number or birthday. This
prevents a mix-up of patients, Dr Wai explains.

After confirming the patient’s identity and the dosage to be given, one of
the nurses cleans the rubber cover of the multi-dose vial with an alcohol
swab to remove any germs present.

2 The nurse then unwraps a disposable needle and syringe set from its
plastic packaging. Each needle and syringe set is separately packed so
they are kept sterile.

TNP PHOTOS: GAVIN FOO
3 The required dosage is drawn from the vial. Sometimes, the nurse flicks
the syringe to remove any air bubbles.

TNP PHOTOS: GAVIN FOO
4 The nurse disinfects the site of injection with an alcohol swab, before
giving the jab.

TNP PHOTOS: GAVIN FOO
5 Immediately after the injection, the needle and syringe is disposed into
a biohazard sharps bin – a small bin with a valve on top to prevent the
needles from sliding out. Needles and syringes have to be discarded after
the first human contact.

6 Other biohazard waste like used gloves are thrown in a biohazard waste
bin. The vial is then kept away for the next use. After the patient is
discharged, the opened multi-dose vial is given to the patient, or thrown
away, even if the medicine is not used up. This is to prevent an infection
from spreading, in the event that the vial has been contaminated.

TAGS: HEP C, OUTBREAK, SGH, SINGAPORE GENERAL HOSPITAL, HUMAN ERROR,
PROTOCOL, WEEK111015
__________________________________________________________________
__________________________________________________________________
https://tinyurl.com/ojsknrs

Scotland UK: NHS alert as two new botulism cases in injecting drug users
emerge in Glasgow and Lanarkshire

Martin Williams, Evening Times, UK (09.10.15)

NHS staff are investigating two suspected cases of wound botulism in
injecting drug users.

It has been confirmed that one case has been identified in NHS Greater
Glasgow and Clyde and one in NHS Lanarkshire. Both individuals are
receiving hospital treatment

The reported onset of symptoms was in early October 2015.

The cause of the infections is being investigated with the focus on
injecting heroin users.

The development comes four months after Police Scotland confirmed 44
people in Scotland were admitted to hospitals in the six months from
December, last year with illness where botulism was suspected. It was
understood ten of those people died.

In a circular Duncan Hill, specialist pharmacist in substance abuse for
NHS Lanarkshire has said the source of the infection is “currently
unknown” but warned that previous investigations have linked cases to
batches of illicit contaminated heroin.

“As such there is a potential for more cases to arise,” he warned.

In June it emerged more than 2000 packs of foil had been handed out to
Glasgow heroin users in a bid to stop them injecting the drug.

Foil was given out by healthcare workers to cut down the risks connected
to injecting, following a botulism outbreak in the city.

Users can use the foil to heat up and inhale the class-A substance instead
of injecting with a needle.

Around 300 addiction staff were trained up as part of the project to
encourage drug users to try foil.

The pilot started in September last year but was stepped up following the
cases of heroin being contaminated with the botulism toxin.

Patients with botulism can often have blurred vision, slurred speech,
difficulty swallowing and muscle weakness. If left untreated the illness
can lead to paralysis and death.

Mr Hill warned: “Due to the complex nature of heroin distribution across
Scotland, there is a potential for cases of wound botulism to arise
locally.”

He asked all relevant health practitioners to increase awareness in
hospitals and other healthcare settings to support prompt diagnosis and
treatment as well as reporting possible or probable cases to the NHS.

He called for increased awareness among heroin users, their social
networks and drug treatment and harm reduction services regarding the
signs and symptoms of wound botulism infection and of the importance of
seeking medical treatment immediately.

He said heroin users should be encouraged to reduce or eliminate use use
by promoting access to appropriately-dosed opiate substitution treatment.

Mr Hill added: “The potential risk will depend on the stage of
contamination. If heroin contamination occurred early in the stage of
distribution, it cannot be excluded that additional wound botulism-
infected heroin injectors will be identified.

“Can you please take any opportunity to raise the awareness amongst
injecting drug users of the potential for serious soft tissue infections
and to advise them to seek medical attention immediately should they
develop such a condition.

“Wound botulism is a rare and very serious bacterial infection that is
acquired when spores of the botulism bacterium get into the body. The
spores can be found in soil but may also be present in contaminated
supplies of street drugs such as heroin.

“Drug users may become infected through injecting the contaminated drugs
into the skin and muscles.

“People who inject drugs who develop clinical signs of botulism should be
referred hospital for evaluation and sampling. Sampling cannot be done in
primary care.”

Dr Gillian Penrice, NHS Greater Glasgow and Clyde Consultant in Public
Heath Medicine, added: “I urge all drug injecting heroin users to be
extremely alert.

“Heroin users should avoid injecting heroin into their muscles. Injecting
heroin into a vein or smoking can reduce the risk of botulism, although
not using heroin at all is by far the best course of action.”
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https://tinyurl.com/pyz2d4a
N.J. USA: Patients tested for HIV and hepatitis after nurse reuses syringe
to administer

By Lila Blake, The IUSB Preface (USA) (08.10.15)

The Daily Mail reports that 67 employees at Otsuka Pharmaceutical, who
received their flu shots in office on September 30, were sent notification
from the New Jersey Department of Health that they may have been exposed
to infected blood after it was discovered that the syringe ‘was reused
multiple times’.

At an employer-sponsored flu clinic at Otsuka Pharmaceuticals last week,
the unnamed nurse committed an “infection control breach”, according to a
spokeswoman for the New Jersey Department of Health.

Nearly 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. Syringes that hold the vaccine, not needles, were
reused.

The Department of Health said the name of the nurse has been referred to
the state Board of Nursing, which will decide to take disciplinary actions
against the nurse.

In addition to failing to change syringes, the nurse reportedly gave less
than the recommended dosage of flu vaccine to each employee, NBC10
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. As a
result, they advised that the employees get another flu shot.

Luckily, experts believe that the risk of infection any of the workers
contracted any of the disease is low.

“Receiving less than the recommended amount is not harmful, but you might
not be fully protected against the flu”, the statement read. “We are
recommending that you get another flu shot this season to ensure that you
are completely protected”.

TotalWellness is dedicated to ensuring all participants receive any and
all appropriate screenings, care and counseling until this matter is
resolved.

The Department of Health said that the nurse had changed the needle
between each injection, but re-used the same syringe each time.
__________________________________________________________________
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https://tinyurl.com/owbw2zz
Singapore: SGH to take responsibility, pay for treatment needed by
infected patients

By Valerie Koh, TodayOnline.com, Singapore (07.10.15) updated (10.10.15)

SINGAPORE — While the Singapore General Hospital (SGH) yesterday (Oct 6)
promised to “take responsibility” and pay for any treatment needed by
patients infected by the hepatitis C outbreak at its renal ward, lawyers
TODAY spoke to said there is legal recourse within a three-year window
should affected patients opt to sue the hospital for medical negligence
over what happened.

The lawyers noted that the success of potential civil suits would hinge on
whether the hospital admits responsibility, or whether the patients are
able to prove that the hospital has been negligent.

You cannot expose a defendant indefinitely, waiting for you to sue them 20
years later.

SGH is contacting the 411 patients who had been admitted to its renal ward
during the first six months of the year. These patients will be screened
for any hepatitis C infections.

The blood-borne virus has an incubation of two weeks to six months,
according to the World Health Organisation (WHO). While some hepatitis C
carriers could suffer from cirrhosis — or hardening — of the liver within
two decades, lawyer Ramasamy Chettiar of Acies Law noted that the statute
of limitations for medical malpractice lawsuits expires within three
years. “You cannot expose a defendant indefinitely, waiting for you to sue
them 20 years later,” he said.

He added that if the hospital does not admit liability, the burden is on
patients filing the civil suit to prove that there is negligence, and that
they have been harmed in the process.

“They have to get an expert to get their records, and establish this. I
don’t think any ordinary person will be able to do it,” said Mr Chettiar.

Nevertheless, lawyer Jason Chan, a director at Amica Law, said affected
patients and their families could apply through the courts to acquire
information from the hospital. “Both parties have to disclose … evidence
that is potentially adverse to them. This ensures a level playing field,
that all information is actually disclosed by both parties,” said Mr Chan.

For now, SGH medical board chairman Professor Fong Kok Yong said that
there is no conclusive evidence as to what caused the cluster of
infections, although the hospital suspected that it could be linked to the
use of multi-dose vials.

Prof Fong said that two of the infected patients had each needed new anti-
viral drugs costing S$90,000. This was paid for by SGH, he said. So far,
22 patients have been infected. Among these, four patients with co-
existing conditions — such as pneumonia — and severe sepsis, an immune
response to an infection, have died, possibly due to the hepatitis C virus
infection. The hospital did not respond to queries on compensation for the
families of the deceased.
__________________________________________________________________
________________________________*_________________________________

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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