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

SIGNpost 00826

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST

Post00826 Pharmacists? RFI + Abstracts + News 28 October 2015

CONTENTS
1. RFI: Pharmacists Ability to Administer Injections
2. Abstract: How to administer intramuscular injections
3. Abstract: Knowledge, attitude and practices of HIV post exposure
prophylaxis amongst health workers in Lagos University Teaching
Hospital
4. Abstract: Hepatitis B outbreak in a nursing home associated with
reusable lancet devices for blood glucose monitoring, Northern Germany
2010
5. Abstract: Intra-articular corticosteroid for knee osteoarthritis
6. Abstract: Epidemiology of hepatitis C virus in Iran
7. Abstract: Which Psychoactives Substances are Found in Used Syringes?
8. Abstract: Role of healthcare workers in early epidemic spread of Ebola:
policy implications of prophylactic compared to reactive vaccination
policy in outbreak prevention and control
9. Abstract: Hepatitis B vaccine by intradermal route in non responder
patients: an update
10. Abstract: Bacteria on smartphone touchscreens in a German university
setting and evaluation of two popular cleaning methods using
commercially available cleaning products
11. News
– Singapore: SGH hepatitis C cluster update: 589 patients have tested
negative for virus
– Singapore: 2 patients who recently tested positive for Hepatitis C are
part of cluster: SGH
– Georgia USA: Story of Macon nurse re-using needles is false
– Singapore: SGH Hep C cluster: International experts arrive on Thursday
– Singapore: Fifth death linked to Hepatitis C outbreak at SGH
– UK: Thousands of dental patients offered HIV and hepatitis tests after
dentist reused surgery equipment
– UK: Thousands of patients offered HIV and hepatitis tests after
whistleblower claims dentist re-used equipment

The web edition of SIGNpost is online at:
http://signpostonline.info/archives/1923

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. RFI: Pharmacists Ability to Administer Injections

Crossposted with thanks from E-DRUG
http://lists.healthnet.org/mailman/listinfo/e-drug
__________________________________________________________________
Date: Fri, 23 Oct 2015
From: “Sarah Marie Anderson” <sarah_anderson@jsi.com>
Subject: [e-drug] Pharmacists Ability to Administer Injections

Dear E-drug participants,

I am a current 4th year pharmacy student at Cedarville University, located
in the United States, doing a rotation at John Snow Inc. I am working on a
project assessing the current regulations regarding whether or not
pharmacists are permitted to administer injectable products in various
countries.

In addition, I am seeking information about current policies and concerns,
in country, that may be preventing pharmacists from administering
injectable products.

If you would be willing, below is a link to a brief questionnaire to
record responses. Your assistance in this project is greatly appreciated.

Link to questionnaire: http://goo.gl/forms/iAcLjWmbSs

Sincerely,

Sarah Anderson
Doctorate of Pharmacy Candidate, 2016
Cedarville University, School of Pharmacy
John Snow Inc.
sarah_anderson@jsi.com
__________________________________________________________________
________________________________*_________________________________

2. Abstract: How to administer intramuscular injections
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26488992

Nurs Stand. 2015 Oct 21;30(8):36-9.
How to administer intramuscular injections.

Chadwick A1, Withnell N1.

1School of Nursing, Midwifery, Social Work and Social Sciences, The
University of Salford, Greater Manchester, England.

Rationale and key points This article aims to help nurses to administer
intramuscular injections in a safe, effective and patient-centred manner.
Following administration of an intramuscular injection, the patient should
be observed for a period of time to reduce any risk of harm.

> Nurses should possess the knowledge, skill, professional judgement and
accountability to administer intramuscular injections safely.

> Nurses should ensure the correct drug is prepared using the correct
method at the correct dose for administration to the correct patient.

> Local and national protocols should be adhered to. Reflective activity
Clinical skills articles can help update your practice and ensure it
remains evidence based.

Apply this article to your practice. Reflect on and write a short account
of: 1. Your most recent experience in injection administration. 2. How
reading this article will change your practice.

Subscribers can upload their reflective accounts at: rcni.com/portfolio .

KEYWORDS: administering injections; clinical procedures; clinical skills;
intramuscular injection; medication errors
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Knowledge, attitude and practices of HIV post exposure
prophylaxis amongst health workers in Lagos University Teaching
Hospital
__________________________________________________________________

http://www.panafrican-med-journal.com/content/article/19/172/full/

Pan Afr Med J. 2014 Oct 20;19:172.
Knowledge, attitude and practices of HIV post exposure prophylaxis amongst
health workers in Lagos University Teaching Hospital.

Ajibola S1, Akinbami A2, Elikwu C3, Odesanya M4, Uche E2.

1Department of Haematology Ben Carson School of Medicine, Babcock
University Teaching Hospital, Ilisan-Remo, Ogun State, Nigeria.
2Department of Haematology, Lagos State University College of Medicine,
Ikeja, Lagos, Nigeria.
3Department of Medical Microbiology Ben Carson School of Medicine, Babcock
University Teaching Hospital, Ilisan-Remo, Ogun State, Nigerian.
4Oak Hospitals Ikorodu, Lagos, Nigeria.

INTRODUCTION: Timely PEP after needle stick exposure to high risk body
fluids can reduce the rate of occupational transmission significantly.
Ignorance of this may increase the risk of seroconversion to HIV for
healthcare workers. This study was conducted with the aim of demonstrating
the current level of knowledge and practise of healthcare workers as
regards PEP.

METHODS: This was a cross-sectional study, pretested questionnaire were
self administered to 372 health workers from various clinical specialties.
The responses were collated and analyzed; results were presented in
frequency tables.

RESULTS: This study revealed a high level of awareness among the
respondents as 83.3% were aware of PEP. Despite the high level of
awareness, respondents still have an inadequate knowledge about PEP, only
32% of the respondents could name at least two of the recommended drugs
for PEP, only 54.0% of respondents knew when to commence PEP following
occupational exposure to HIV. There was a low level of practice of PEP
among the respondents as only 6.3% of respondents had PEP despite
occurrence of needle stick injury.

CONCLUSION: This study revealed a general low level use of PEP despite the
average knowledge of PEP and the favourable attitude towards HIV PEP
amongst the respondents.

KEYWORDS: Health care workers; Post exposure prophylaxis; human
immunodeficiency virus

Free PMC Article
http://www.panafrican-med-journal.com/content/article/19/172/full/
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Hepatitis B outbreak in a nursing home associated with
reusable lancet devices for blood glucose monitoring, Northern Germany
2010
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/25611818

J Med Virol. 2015 Apr;87(4):583-8.
Hepatitis B outbreak in a nursing home associated with reusable lancet
devices for blood glucose monitoring, Northern Germany 2010.

Diercke M1, Monazahian M, Petermann H, Gerlich WH, Schüttler CG, Wend U,
Dehnert M, Dreesman J.

1Governmental Institute of Public Health of Lower Saxony (NLGA), Hannover,
Germany; Postgraduate Training for Applied Epidemiology (PAE), Robert Koch
Institute (RKI), Berlin, Germany in association with the European
Programme for Intervention Epidemiology Training (EPIET), European Centre
for Disease Prevention and Control (ECDC), Stockholm, Sweden.

In September 2010, an outbreak of acute hepatitis B virus (HBV) infections
in a nursing home was notified to public health authorities in Northern
Germany.

To identify the route of transmission and prevent further cases a
retrospective cohort study was conducted. Blood samples of residents were
tested for serologic markers of HBV infection and HBV subgenotypes and
sequences were analyzed. Outbreak-related cases were defined as residents
of the nursing home with detection of hepatitis B surface antigen (HBsAg)
and the HBV DNA sequence of the outbreak strain in 2010. Information on
possible risk factors as patient care, invasive diagnostic, and
therapeutical procedures was collected using a standardized questionnaire.

Risk ratios (RR) and 95% confidence intervals (CI) were estimated with
exact Poisson regression and binomial regression. Sixty-four residents
were included in the study, 5 of them were outbreak-related cases, 12 had
a past HBV infection.

The outbreak strain belonged to HBV genotype D2 (HBsAg subtype ayw3,
Ala118) which is not prevalent in Germany but in Eastern Europe. All cases
(median age 81) were female, had diabetes, blood glucose monitoring, and
chiropody.

In multivariable analysis only blood glucose monitoring was associated
with HBV infection (RR?=?22, 95%CI 3.0-8). Blood glucose monitoring was
reported to be done by nursing home staff with patient-based reusable
lancet devices.

In nursing home settings the use of single use lancets for blood glucose
monitoring is recommended strongly to prevent transmission. National
guidelines on the handling of point-of-care devices and reusable equipment
in long-term care facilities should be developed.

© 2015 Wiley Periodicals, Inc.

KEYWORDS: blood glucose monitoring; disease outbreak; genotype; hepatitis
B
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Intra-articular corticosteroid for knee osteoarthritis
__________________________________________________________________

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005328.pub3/abstract
Full Free text at the link

Cochrane Database Syst Rev. 2015 Oct 22;10:CD005328.
Intra-articular corticosteroid for knee osteoarthritis.

Jüni P1, Hari R, Rutjes AW, Fischer R, Silletta MG, Reichenbach S, da
Costa BR.

1Institute of Primary Health Care (BIHAM), University of Bern,
Gesellschaftsstrasse 49, Bern, Switzerland, 3012.

BACKGROUND: Knee osteoarthritis is a leading cause of chronic pain,
disability, and decreased quality of life. Despite the long-standing use
of intra- articular corticosteroids, there is an ongoing debate about
their benefits and safety. This is an update of a Cochrane review first
published in 2005.

OBJECTIVES: To determine the benefits and harms of intra-articular
corticosteroids compared with sham or no intervention in people with knee
osteoarthritis in terms of pain, physical function, quality of life, and
safety.

SEARCH METHODS: We searched the Cochrane Central Register of Controlled
Trials (CENTRAL), MEDLINE, and EMBASE (from inception to 3 February 2015),
checked trial registers, conference proceedings, reference lists, and
contacted authors.

SELECTION CRITERIA: We included randomised or quasi-randomised controlled
trials that compared intra-articular corticosteroids with sham injection
or no treatment in people with knee osteoarthritis. We applied no language
restrictions.

DATA COLLECTION AND ANALYSIS: We calculated standardised mean differences
(SMDs) and 95% confidence intervals (CI) for pain, function, quality of
life, joint space narrowing, and risk ratios (RRs) for safety outcomes. We
combined trials using an inverse-variance random-effects meta-analysis.

MAIN RESULTS: We identified 27 trials (13 new studies) with 1767
participants in this update. We graded the quality of the evidence as
‘low’ for all outcomes because treatment effect estimates were
inconsistent with great variation across trials, pooled estimates were
imprecise and did not rule out relevant or irrelevant clinical effects,
and because most trials had a high or unclear risk of bias. Intra-
articular corticosteroids appeared to be more beneficial in pain reduction
than control interventions (SMD -0.40, 95% CI -0.58 to -0.22), which
corresponds to a difference in pain scores of 1.0 cm on a 10-cm visual
analogue scale between corticosteroids and sham injection and translates
into a number needed to treat for an additional beneficial outcome (NNTB)
of 8 (95% CI 6 to 13). An I2 statistic of 68% indicated considerable
between-trial heterogeneity. A visual inspection of the funnel plot
suggested some asymmetry (asymmetry coefficient -1.21, 95%CI -3.58 to
1.17). When stratifying results according to length of follow-up, benefits
were moderate at 1 to 2 weeks after end of treatment (SMD -0.48, 95% CI
-0.70 to -0.27), small to moderate at 4 to 6 weeks (SMD -0.41, 95% CI
-0.61 to -0.21), small at 13 weeks (SMD -0.22, 95% CI -0.44 to 0.00), and
no evidence of an effect at 26 weeks (SMD -0.07, 95% CI -0.25 to 0.11). An
I2 statistic of = 63% indicated a moderate to large degree of between-
trial heterogeneity up to 13 weeks after end of treatment (P for
heterogeneity=0.001), and an I2 of 0% indicated low heterogeneity at 26
weeks (P=0.43). There was evidence of lower treatment effects in trials
that randomised on average at least 50 participants per group (P=0.05) or
at least 100 participants per group (P= 0.013), in trials that used
concomittant viscosupplementation (P=0.08), and in trials that used
concomitant joint lavage (P=0.001).Corticosteroids appeared to be more
effective in function improvement than control interventions (SMD -0.33,
95% CI -0.56 to -0.09), which corresponds to a difference in functions
scores of -0.7 units on standardised Western Ontario and McMaster
Universities Arthritis Index (WOMAC) disability scale ranging from 0 to 10
and translates into a NNTB of 10 (95% CI 7 to 33). An I2 statistic of 69%
indicated a moderate to large degree of between-trial heterogeneity. A
visual inspection of the funnel plot suggested asymmetry (asymmetry
coefficient -4.07, 95% CI -8.08 to -0.05). When stratifying results
according to length of follow-up, benefits were small to moderate at 1 to
2 weeks after end of treatment (SMD -0.43, 95% CI -0.72 to -0.14), small
to moderate at 4 to 6 weeks (SMD -0.36, 95% CI -0.63 to -0.09), and no
evidence of an effect at 13 weeks (SMD -0.13, 95% CI -0.37 to 0.10) or at
26 weeks (SMD 0.06, 95% CI -0.16 to 0.28). An I2 statistic of = 62%
indicated a moderate to large degree of between-trial heterogeneity up to
13 weeks after end of treatment (P for heterogeneity=0.004), and an I2 of
0% indicated low heterogeneity at 26 weeks (P=0.52). We found evidence of
lower treatment effects in trials that randomised on average at least 50
participants per group (P=0.023), in unpublished trials (P=0.023), in
trials that used non-intervention controls (P=0.031), and in trials that
used concomitant viscosupplementation (P=0.06).

Participants on corticosteroids were 11% less likely to experience adverse
events, but confidence intervals included the null effect (RR 0.89, 95% CI
0.64 to 1.23, I2=0%). Participants on corticosteroids were 67% less likely
to withdraw because of adverse events, but confidence intervals were wide
and included the null effect (RR 0.33, 95% CI 0.05 to 2.07, I2=0%).

Participants on corticosteroids were 27% less likely to experience any
serious adverse event, but confidence intervals were wide and included the
null effect (RR 0.63, 95% CI 0.15 to 2.67, I2=0%).

We found no evidence of an effect of corticosteroids on quality of life
compared to control (SMD -0.01, 95% CI -0.30 to 0.28, I2=0%).

There was also no evidence of an effect of corticosteroids on joint space
narrowing compared to control interventions (SMD -0.02, 95% CI -0.49 to
0.46).

AUTHORS’ CONCLUSIONS: Whether there are clinically important benefits of
intra-articular corticosteroids after one to six weeks remains unclear in
view of the overall quality of the evidence, considerable heterogeneity
between trials, and evidence of small-study effects. A single trial
included in this review described adequate measures to minimise biases and
did not find any benefit of intra-articular corticosteroids.

In this update of the systematic review and meta-analysis, we found most
of the identified trials that compared intra-articular corticosteroids
with sham or non- intervention control small and hampered by low
methodological quality.

An analysis of multiple time points suggested that effects decrease over
time, and our analysis provided no evidence that an effect remains six
months after a corticosteroid injection.
__________________________________________________________________
Plain language summary

Joint corticosteroid injection for knee osteoarthritis

Review question

We searched the literature until 3 February 2015 for studies of the
effects on pain, function, quality of life, and safety of intra-articular
(injected into the joint) corticosteroids compared with sham injection or
no treatment in people with knee osteoarthritis.

Background

Osteoarthritis is a disease associated with a breakdown of cartilage of
the joints, such as the knee. When the joint loses cartilage, the body
responds by growing bone abnormally, which can result in the bone becoming
misshapen and the joint painful and unstable. This can affect physical
function and the ability to use the joint.

Although osteoarthritis is generally thought to be of degenerative rather
than inflammatory origin, an inflammatory component may be present at
times. Intra-articular corticosteroids are potent anti-inflammatory agents
injected inside the knee joint.

Study characteristics

After searching for all relevant studies to 3 February 2015, we found 27
randomised controlled trials with a total of 1767 participants, of a
duration ranging from two weeks to one year.

[***] Key results

Pain

• People who received intra-articular corticosteroids rated improvement in
their pain to be about 3 on a scale of 0 (no pain) to 10 (extreme pain)
after 1 month.
• People who received a placebo rated improvement in their pain to be
about 2 on a scale of 0 (no pain) to 10 (extreme pain) after 1 month.

Another way of saying this is:
• 44 people out of 100 who receive intra-articular corticosteroids respond
to treatment (44%).
• 31 people out of 100 who receive a placebo respond to treatment (31%).
• 13 more people respond to treatment with intra-articular corticosteroids
than with placebo (difference of 13%).

Note that these numbers may considerably overestimate the true benefit due
to the low quality of the evidence.

Physical function

• People who received intra-articular corticosteroids rated improvement in
their physical function to be about 2 on a scale of 0 (no disability) to
10 (extreme disability) after 1 month.
• People who received a placebo rated improvement in their physical
function to be about 1 on a scale of 0 (no disability) to 10 (extreme
disability) after 1 month.

Another way of saying this is:

• 36 people out of 100 who received intra-articular corticosteroids
respond to treatment (36%).
• 26 people out of 100 who received a placebo respond to treatment (26%).
• 10 more people respond to treatment with intra-articular corticosteroids
than with placebo (difference of 10%).

Note that these numbers may considerably overestimate the true benefit due
to the low quality of the evidence.

Side effects

• 13 people out of 100 who used intra-articular corticosteroids
experienced side effects (13%).
• 15 people out of 100 who used a placebo experienced side effects (15%).
• 2 more people experienced side effects with placebo than with intra-
articular corticosteroids (difference of 2%).

Dropouts because of side effects

• 6 people out of 1000 who used intra-articular corticosteroids dropped
out because of side effects (0.6%).
• 17 people out of 1000 who used a placebo dropped out because of side
effects (1.7%).
• 11 more people dropped out because of side effects with placebo than
with intra-articular corticosteroids (difference of 1.1%).

Side effects resulting in hospitalisation, persistent disability, or death

• 3 people out of 1000 who used intra-articular corticosteroids
experienced side effects resulting in hospitalisation, persistent
disability, or death (0.3%).
• 4 people out of 1000 who used a placebo experienced side effects
resulting in hospitalisation, persistent disability, or death(0.4%).
• 1 more person experienced side effects resulting in hospitalisation,
persistent disability, or death with placebo than with intra-articular
corticosteroids (difference of 0.1%).

Based on the evidence, intra-articular corticosteroids may cause a
moderate improvement in pain and a small improvement in physical function,
but the quality of the evidence is low and results are inconclusive.
Intra-articular corticosteroids appear to cause as many side effects as a
placebo. However, we do not have precise and reliable information about
side effects.

Quality of evidence

We graded the quality of the evidence as low for all of our findings,
which means that we have little confidence in these results. This was
because results were generally highly discordant across studies and mainly
based on small studies of low quality.
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Epidemiology of hepatitis C virus in Iran
__________________________________________________________________

http://www.wjgnet.com/1007-9327/full/v21/i38/10790.htm Free Full Text

World J Gastroenterol. 2015 Oct 14;21(38):10790-810.
Epidemiology of hepatitis C virus in Iran.

Taherkhani R1, Farshadpour F1.

1Reza Taherkhani, Fatemeh Farshadpour, Department of Microbiology and
Parasitology, School of Medicine, Bushehr University of Medical Sciences,
Bushehr 7514633341, Iran.

In Iran, the prevalence of hepatitis C virus (HCV) infection is relatively
low according to the population-based epidemiological studies. However,
the epidemiology of HCV is changing and the rate of HCV infection is
increasing due to the growth in the number of injecting drug users in the
society.

In addition, a shift has occurred in the distribution pattern of HCV
genotypes among HCV-infected patients in Iran. Genotype 1a is the most
prevalent genotype in Iran, but in recent years, an increase in the
frequency of 3a and a decrease in 1a and 1b have been reported.

These variations in the epidemiology of HCV reflect differences in the
routes of transmission, status of public health, lifestyles, and risk
factors in different groups and geographic regions of Iran.

Health policy makers should consider these differences to establish better
strategies for control and prevention of HCV infection. Therefore, this
review was conducted to present a clear view regarding the current
epidemiology of HCV infection in Iran.

KEYWORDS: Blood donors; Epidemiology; Genotypes; Hemodialysis; Hemophilia;
Hepatitis C virus; Injecting drug users; Iran; Occult hepatitis C virus;
Thalassemia
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Which Psychoactives Substances are Found in Used Syringes?
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/26486458

Therapie. 2015 Oct 20.
[Which Psychoactives Substances are Found in Used Syringes?]

[Article in French]

Nordmann S1, Nefau T2, Micalle J1, Duplessy C3, Catusse JC4, Frauger E1.

1CEIP-Addictovigilance PACA-Corse, Service de Pharmacologie Clinique &
Pharmacovigilance, CHU Timone, Assistance Publique-Hôpitaux de Marseille,
UMR 7289 Aix Marseille Université-CNRS, Institut des Neurosciences Timone,
secteur PiiCi, Marseille, France.
2Laboratoire de Santé Publique – Environnement, UMR 8079, Université Paris
Sud, Châtenay-Malabry, France.
3Association SAFE, Paris, France.
4Centre d’Accueil et d’Accompagnement et de Réduction des Risques pour les
Usagers de Drogues Sleep’in, Groupe PSA/SOS, Marseille, France.

OBJECTIVE: The aim of this study is to analyze the residual content of
used syringes.

METHODS: Used syringes were collected in March 2014 at 9 sites in
Marseille (automatic injection kit dispensers, streets, drug-user risk
reduction centers [Centres d’Accueil et d’Accompagnement à la Réduction de
Risques pour Usagers de Drogues, CAARUD]). Several substances (n = 28)
were investigated using liquid chromatography and mass spectrometry
method.

RESULTS: On average 2 ± 1 substances in each syringe were found among 254
syringes analyzed. The most detected substances were cocaine,
buprenorphine, methylphenidate and cathinones (in 57%, 56%, 39% and 19% of
the syringes respectively). Heroin and morphine were found in 10% of the
syringes.

DISCUSSION-CONCLUSION: This study helps define the main substances
consumed by injection drugs users. It highlighted differencies in used
substances according to neighbourhood and site of collection and thus help
to adjust prevention and harm reduction strategies.

© 2015 Société Française de Pharmacologie et de Thérapeutique.
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Role of healthcare workers in early epidemic spread of Ebola:
policy implications of prophylactic compared to reactive vaccination
policy in outbreak prevention and control
__________________________________________________________________
Free BMC Article http://www.biomedcentral.com/1741-7015/13/271

BMC Med. 2015 Oct 19;13(1):271.
Role of healthcare workers in early epidemic spread of Ebola: policy
implications of prophylactic compared to reactive vaccination policy in
outbreak prevention and control.

Coltart CE1, Johnson AM2, Whitty CJ3.

1Research Department of Infection and Population Health, Institute of
Epidemiology, UCL, London, UK. cordelia.coltart@ucl.ac.uk.
2Research Department of Infection and Population Health, Institute of
Epidemiology, UCL, London, UK.
3Clinical Research Department, London School of Hygiene & Tropical
Medicine, London, UK.

Ebola causes severe illness in humans and has epidemic potential. How to
deploy vaccines most effectively is a central policy question since
different strategies have implications for ideal vaccine profile. More
than one vaccine may be needed. A vaccine optimised for prophylactic
vaccination in high-risk areas but when the virus is not actively
circulating should be safe, well tolerated, and provide long-lasting
protection; a two- or three-dose strategy would be realistic. Conversely,
a reactive vaccine deployed in an outbreak context for ring-vaccination
strategies should have rapid onset of protection with one dose, but
longevity of protection is less important.

In initial cases, before an outbreak is recognised, healthcare workers
(HCWs) are at particular risk of acquiring and transmitting infection,
thus potentially augmenting early epidemics. We hypothesise that many
early outbreak cases could be averted, or epidemics aborted, by
prophylactic vaccination of HCWs. This paper explores the potential impact
of prophylactic versus reactive vaccination strategies of HCWs in
preventing early epidemic transmissions. To do this, we use the limited
data available from Ebola epidemics (current and historic) to reconstruct
transmission trees and illustrate the theoretical impact of these
vaccination strategies.

Our data suggest a substantial potential benefit of prophylactic versus
reactive vaccination of HCWs in preventing early transmissions. We
estimate that prophylactic vaccination with a coverage >99 % and
theoretical 100 % efficacy could avert nearly two-thirds of cases studied;
75 % coverage would still confer clear benefit (40 % cases averted), but
reactive vaccination would be of less value in the early epidemic.A
prophylactic vaccination campaign for front- line HCWs is not a trivial
undertaking; whether to prioritise long-lasting vaccines and provide
prophylaxis to HCWs is a live policy question. Prophylactic vaccination is
likely to have a greater impact on the mitigation of future epidemics than
reactive strategies and, in some cases, might prevent them. However, in a
confirmed outbreak, reactive vaccination would be an essential
humanitarian priority.The value of HCW Ebola vaccination is often only
seen in terms of personal protection of the HCW workforce.

A prophylactic vaccination strategy is likely to bring substantial
additional benefit by preventing early transmission and might abort some
epidemics. This has implications both for policy and for the optimum
product profile for vaccines currently in development.

Free BMC Article http://www.biomedcentral.com/1741-7015/13/271
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Hepatitis B vaccine by intradermal route in non responder
patients: an update
__________________________________________________________________
http://www.wjgnet.com/1007-9327/full/v20/i30/10383.htm Full Free Article

World J Gastroenterol. 2014 Aug 14;20(30):10383-94.
Hepatitis B vaccine by intradermal route in non responder patients: an
update.

Filippelli M1, Lionetti E1, Gennaro A1, Lanzafame A1, Arrigo T1, Salpietro
C1, La Rosa M1, Leonardi S1.

1Martina Filippelli, Elena Lionetti, Alessia Gennaro, Angela Lanzafame,
Mario La Rosa, Salvatore Leonardi, Department of Medical and Pediatric
Science, University of Catania, 95100 Catania, Italy.

Vaccination is the main prophylactic measure to reduce the mortality
caused by hepatitis B virus (HBV) infection in healthy subjects since the
immune response to hepatitis B recombinant vaccination occurs in over 90%
of general population. Individuals who develop an anti-HBs titer less than
10 mIU/mL after primary vaccination cycle are defined “no responders”.

Many factors could cause a non response to the HBV vaccination, such as
administration of the vaccine in buttocks, impaired vaccine storage
conditions, drug abuse, smoking, infections and obesity. Moreover there
are some diseases, like chronic kidney disease, human immunodeficiency
virus infection, chronic liver disease, celiac disease, thalassaemia, type
I diabetes mellitus, down’s syndrome and other forms of mental retardation
that are characterized by a poorer response to HBV vaccination than
healthy subjects.

To date it is still unclear how to treat this group of patients at high
risk of hepatitis B infection. Recent studies seem to indicate that the
administration of HBV recombinant vaccine by the intradermal route is very
effective and could represent a more useful strategy than intramuscular
route.

This review focuses on the use of anti hepatitis B vaccine by intradermal
route as alternative to conventional intramuscular vaccine in all non
responder patients.

A comprehensive review of the literature using PubMed database, with
appropriate terms, was undertaken for articles in English published since
1983. The literature search was undertaken in September 2013.

KEYWORDS: Hepatitis B virus; Intradermal route; Non responders; Update;
Vaccine
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Bacteria on smartphone touchscreens in a German university
setting and evaluation of two popular cleaning methods using
commercially available cleaning products
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/25305112

Folia Microbiol (Praha). 2015 Mar;60(2):159-64.
Bacteria on smartphone touchscreens in a German university setting and
evaluation of two popular cleaning methods using commercially available
cleaning products.

Egert M1, Späth K, Weik K, Kunzelmann H, Horn C, Kohl M, Blessing F.

1Faculty of Medical and Life Sciences, Microbiology and Hygiene Group,
Furtwangen University, Villingen-Schwenningen, Germany, Markus.Egert@hs-
furtwangen.de.

Smartphone touchscreens are known as pathogen carriers in clinical
environments. However, despite a rapidly growing number of smartphone
users worldwide, little is known about bacterial contamination of
smartphone touchscreens in non-clinical settings. Such data are needed to
better understand the hygienic relevance of these increasingly popular
items.

Here, 60 touchscreens of smartphones provided by randomly chosen students
of a German university were sampled by directly touching them with contact
agar plates.

The average bacterial load of uncleaned touchscreens was 1.37 ± 0.33
CFU/cm(2). Touchscreens wiped with commercially available microfiber
cloths or alcohol-impregnated lens wipes contained significantly less
bacteria than uncleaned touchscreens, i.e., 0.22 ± 0.10 CFU/cm(2) and 0.06
± 0.02 CFU/cm(2), respectively.

Bacteria isolated from cleaned and uncleaned touchscreens were identified
by means of MALDI Biotyping.

Out of 111 bacterial isolates, 56 isolates (50 %) were identified to genus
level and 27 (24 %) to species level. The vast majority of the identified
bacteria were typical human skin, mouth, lung, and intestinal commensals,
mostly affiliated with the genera Staphylococcus and Micrococcus.

Five out of 10 identified species were opportunistic pathogens.

In conclusion, the touchscreens investigated here showed low bacterial
loads and a species spectrum that is typical for frequently touched
surfaces in domestic and public environments, the general health risk of
which is still under debate.
__________________________________________________________________
________________________________*_________________________________

11. News

– Singapore: SGH hepatitis C cluster update: 589 patients have tested
negative for virus
– Singapore: 2 patients who recently tested positive for Hepatitis C are
part of cluster: SGH
– Georgia USA: Story of Macon nurse re-using needles is false
– Singapore: SGH Hep C cluster: International experts arrive on Thursday
– Singapore: Fifth death linked to Hepatitis C outbreak at SGH
– UK: Thousands of dental patients offered HIV and hepatitis tests after
dentist reused surgery equipment
– UK: Thousands of patients offered HIV and hepatitis tests after
whistleblower claims dentist re-used equipment

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/njptquh
Singapore: SGH hepatitis C cluster update: 589 patients have tested
negative for virus

Of the 601 patients tested, 589 tested negative and nine results are
pending, with three testing positive for hepatitis C.

Chew Hui Min, The Straits Times (27.10.15)

SINGAPORE – No new cases of hepatitis C were found on Tuesday (Oct 27),
the Singapore General Hospital (SGH) said in an update.

Of the 601 patients tested, 589 were tested negative and nine results are
pending. As announced earlier, three tested positive.

In addition, a total of 310 staff have been screened, of which 309 tested
negative. One test result is pending.

SGH announced on Oct 6 that 22 kidney patients had contracted hepatitis C
while receiving treatment in the hospital.

The hospital is screening patients who had stayed in wards 64A and 67 from
January to June for the disease.

It was announced earlier that three patients had tested positive, bringing
the total number of patients infected to 25.

Eight patients have died, with five of the deaths possibly linked to the
infection.

An independent review committee has been set up to investigate the spread
of the hepatitis C virus in the hospital.
__________________________________________________________________
__________________________________________________________________

https://tinyurl.com/otq82zu
Singapore: 2 patients who recently tested positive for Hepatitis C are
part of cluster: SGH

This brings the total number of affected patients infected to 25, says
Professor Fong Kok Yong, chairman of the hospital’s Medical Board.

Channel News Asia, Singapore (26.10.15)

SINGAPORE: Two more patients who tested positive for Hepatitis C after
they were screened by the Singapore General Hospital (SGH) have been found
to be part of a cluster announced earlier this month.

In a statement issued on Monday (Oct 26), Professor Fong Kok Yong,
chairman of SGH’s Medical Board, said: “Phylogenetic studies done for the
two patients who were tested positive as announced on Oct 23 showed that
they are part of the affected cluster, bringing the total number of
affected patients to 25.

“The patients were admitted to Wards 64A and 67 from April to June 2015.
We will provide the patients and their family with our full support and
ensure that the patients receive timely and appropriate care.”

SGH said that a total of 601 patients have been screened so far, 586
tested negative for the virus. The hospital has been screening patients
that had been admitted to its renal ward from January to June, following
the announcement of a cluster of 22 infections. It has said Hepatitis C
may have been a contributing factor in up to five deaths.

– CNA/hs
__________________________________________________________________
__________________________________________________________________

https://tinyurl.com/qjn558j
Georgia USA: Story of Macon nurse re-using needles is false

Ashley Trawick, 13WMAZ, Macon Georgia USA (24.10.15)

A story circulating on social media about a Macon nurse who re-used
needles at a flu shot clinic is a hoax.

A couple of satirical sites claim several people who were given the shots
had HIV and hepatitis, which exposed hundreds to the diseases.

“The Macon-Bibb County Health Department nurses administer flu vaccine
with pre-filled, disposable syringes, so the fictitious scenario suggested
is not feasible,” Nancy White, the Macon-Bibb Health Department
administrator, said in a statement. “The misfortune of such an
irresponsible hoax is that it could deter people from taking the most
important precaution for preventing the flu, and that is getting an annual
vaccination.”

According to a news release, the North Central District and the Macon-Bibb
County Health Department have requested to have the articles removed.
__________________________________________________________________
__________________________________________________________________

www.channelnewsasia.com/news/singapore/sgh-hep-c-cluster/2210142.html
Singapore: SGH Hep C cluster: International experts arrive on Thursday

Channel News Asia (22.10.15)

SINGAPORE: The first international expert appointed as part of the
Independent Review Committee (IRC) looking into the Hepatitis C cluster at
the Singapore General Hospital (SGH) has arrived, said the IRC on Thursday
(Oct 22).

Dr Scott Dewey Holmberg from the US Centers for Disease Control and
Prevention (CDC) in Atlanta and his assistant Dr Amanda Beaudoin have
arrived in Singapore, said the IRC. Dr Holmberg’s unit in the CDC is
responsible for national surveillance, outbreak investigations and
research projects in viral hepatitis, while Dr Beaudoin is a veterinary
medical officer from the CDC.

The other expert, Prof Trish Perl from Johns Hopkins University, is
expected to arrive later on Thursday with her assistant, Ms JoEllen
Harris. Prof Perl is in charge of putting in place mechanisms to prevent
potential healthcare-associated infections at her institution, while Ms
Harris is the programme director of the epidemiology and infection
prevention at the Johns Hopkins Health System.

Dr Holmberg will be here from Thursday till Oct 25, and Dr Beaudoin will
stay to assist the IRC till Oct 31. Both Prof Perl and Ms Harris will
depart on Oct 28, and both teams will continue to assist the IRC even
after they return to America, said IRC Chairman Prof Leo Yee Sin.

Said Prof Leo: “The experts will be assisting the Independent Review
Committee by working with the local team to investigate the outbreak,
reviewing the processes and identifying gaps in infection control, and
providing expert advice on analyses, interpretation and report of
findings.”

“The Committee members are working closely with the international experts
in the outbreak investigation, including accompanying them for site
visits, working on epidemiology data, and reviewing the cases and
infection control practices. There will be daily discussions with them.”

The IRC was set up after SGH’s announced on Oct 6 that 22 of its renal
ward patients had been infected with Hepatitis C, after which the hospital
started contacting patients who were admitted from January to June 2015 at
wards 64A and 67 for screening.

So far, one of the 598 people screened by SGH for Hepatitis C has tested
positive for the virus.

– CNA/av
__________________________________________________________________
__________________________________________________________________

https://tinyurl.com/o284kb4
Singapore: Fifth death linked to Hepatitis C outbreak at SGH

By Kirsten Han, theonlinecitizen.com, Singapore (20.10.15)

A medical review committee chaired by an external senior hepatologist has
found that a hepatitis C infection could not be ruled out as a
contributing factor to the death of a fifth patient following a viral
outbreak of hepatitis C at the Singapore General Hospital, local media
reported on Monday.

The hospital had revealed the viral outbreak in its renal wards earlier
this month, saying that four of the eight deaths out of the 22 affected
patients had been linked to the viral infection. A fifth death had been
under investigation then, and may now also be linked to the hepatitis C
infection.

“The committee concluded that the patient passed away from end-stage renal
disease and pneumonia. While the death was not caused directly by
hepatitis C virus, the committee could not rule out the possibility that
hepatitis C virus infection could have been a contributing factor,”
TODAYonline reported SGH Medical Board chairman Professor Fong Kok Yong
saying.

Minister for Health Gan Kim Yong said on Saturday that international
experts will be invited to advise the Independent Review Committee
investigating the outbreak, so as to ensure that the review is thoroughly
done.

“The Committee will also look at the processes in both SGH and the
Ministry of Health to identify whether there are any gaps and areas that
we can improve upon so that we can strengthen our system,” Mr Gan told The
Straits Times.

The hospital had previously contacted almost 1,000 people for hepatitis C
screenings. 484 patients and 294 hospital employees have tested negative.
The test results for 88 other cases are still pending. More tests will be
done as the hospital schedules appointments for more patients, as well as
for hospital staff currently on overseas leave.
__________________________________________________________________
__________________________________________________________________

https://tinyurl.com/ncy3ce8
UK: Thousands of dental patients offered HIV and hepatitis tests after
dentist reused surgery equipment

By Mark Smith, Mirror.co.UK, U.K. (20.10.15)

In February, dentist Mark Roberts was suspended by the the General Dental
Council amid concerns about poor infection control

More than 3,000 patients of a dentist may have been exposed to blood-borne
viruses like HIV and hepatitis.

Cardiff dentist Mark Roberts was suspended by the the General Dental
Council in February amid concerns about poor infection control practices.

A fellow member of staff at the Splott practice raised concerns about the
experienced dentist after he used anaesthetic cartridges – which are
typically used in root canal treatment – more than once when they should
have been thrown away.

Health bosses said the chances of patients contracting a blood-borne
illness such as Hepatitis B, Hepatitis C, or HIV was “very low”.

Mr Roberts provided NHS dental services at Splott Road Dental Surgery for
26 years, reports Wales Online.

Ruth Walker, the director of nursing for Cardiff and Vale University
Health Board, said 3,245 letters have been given out to patients in the
Splott area.

But she admitted there are thousands of other people who may have been
treated by Mr Roberts since he began at the practice in 1989 but are no
longer registered with the practice.

She said: “In line with our duty to protect and inform the public and make
sure we are as transparent as possible we need to make them aware that
there were concerns about this practice.

“Since this discovery Mark Roberts has been suspended by the General
Dental Council pending investigation and has been dismissed by his
employers IDH.

“It’s good to have a culture where staff feel comfortable to raise
concerns. We have been working closely with IDH to then take the right
action to protect the public.

“We haven’t always told everybody everything but that is now changing.”

Public Health Wales confirmed that no other dentist at the Cardiff dental
practice is being investigated and a dedicated advice line has been set up
to answer people’s questions.

There is currently no evidence that any patients have so far been infected
by a blood-borne virus at the practice, which was taken over by IDH in
November 2014.

Dr Meirion Evans, consultant epidemologist for Public Health Wales, said:
“Based on clinical advice, we would not recommend screening for all
patients as the risk is very low unless you have other lifestyle factors
which may present a greater risk of transmission.

“However, if patients still have concerns after contacting the advice
line, a simple blood test can be arranged to offer them peace of mind.”

All you need to know

What is the issue?

It appears Mark Roberts did not always comply with expected standards of
infection control. It is believed a lack of compliance with these
standards may have put individuals at a potentially very low risk of
infection with certain blood-borne viruses.

How was it spotted?

The current owners of the dental practice had concerns over this historic
practice and brought them to the attention of Cardiff and Vale University
Health Board.

Have any other dentists at this practice been investigated for poor
hygiene compliance?

No other dentist was involved in this situation. Mark Roberts has been
dismissed from the practice and is under investigation by the General
Dental Council.

Why are hygiene standards so important?

Without proper sterilisation and hygiene standards infections can be
transferred from one patient to another. If transfer of blood occurred
between patients due to a lack of infection control then patients could
contract hepatitis B, hepatitis C and HIV.

What is the likelihood of the risk?

The possible risk is very low. Investigations of this type are very rare
and each is unique, so it is difficult to know the exact statistical level
of risk.

Is there any evidence that patients have been infected at the practice?

There are none at present.

Should I be tested?

The risk of transmission of infection is very low. Public Health Wales is
not recommending that patients of Mark Roberts access testing unless you
have one of the following:

You have ever injected drugs or shared snorting straws for drug use

You have received blood products and/or organ transplantation before 1992

You have received medical or dental procedures abroad which may be
unsterile

You are a sexual partner of someone who is hepatitis B, hepatitis C or HIW
positive

You have received tattooing or body piercing that may be unsterile

You were born in a country with an immediate or high-prevalence of
hepatitis B, hepatitis C such as Africa, Asia, the Caribbean, Central and
South America, Eastern and Southern Europe, the Middle East and the
Pacific Islands.

Who should I call?

The advice line number is 0800 952 0055. It will be open on the following
dates and times:

Tuesday, October 20, from midday to 10pm.

Wednesday, October 21, Thursday, October 22, and Friday, October 23,
between 8am and 8pm.

Saturday, October 24, and Sunday, October 25: CLOSED.

Monday, October 26 to Friday, October 30, from 9am to 5pm.
__________________________________________________________________
__________________________________________________________________
https://tinyurl.com/pn9eqcs
UK: Thousands of patients offered HIV and hepatitis tests after
whistleblower claims dentist re-used equipment

– Dr Mark Roberts is being investigated after a staff member blew the
whistle

– He worked at the dental practice in Cardiff between 1989 to February
2015

– Cardiff and Vale Health Board has written to 3,245 patients from
surgery

– A special hotline has been set up to deal test requests or give advice

By Kate Pickles For Mailonline, Daily Mail UK (20.10.15)

More than 3,000 patients are being offered HIV tests following accusations
an NHS dentist re-used equipment.

Mark Roberts, 51, was dismissed after a whistleblower claimed he ignored
guidelines and used anaesthetic cartridges more than once.

Root canal files, used to clean inside the tooth during treatment, were
also re-used rather than disposed of after one use, according to
allegations.

It is understood he did not re-use the actual needle, officials said.

The dentist was dismissed after a member of staff reported him for re-
using equipment.

A telephone hotline has now been set up for people to be tested for blood-
borne diseases including HIV and hepatitis B and C.

Mr Roberts, who worked at the Splott Road Dental Surgery from 1989 to
February 2015, has been suspended from practising by the General Dental
Council pending an inquiry.

A Cardiff and Vale Health Board spokesman said the claims of poor
infection control include the re-use of cartridges of local anaesthetic
syringes, which should have been thrown away after a single use.

The health board wrote to 3,245 patients registered at the surgery when
concerns were raised in February.

Now thousands of former patients are being offered blood tests in a case
which echoes that of ‘dirty’ dentist, Desmond D’Mello.

His alleged refusal to follow NHS safety guidelines sparked the biggest
patient recall after he was secretly filmed treating 166 patients across
three days.

NHS England alerted 22,000 patients after fears they could have been
exposed to infections while being treated at the Daybrook Dental Practice
in Nottingham.

A total of 4,526 patients were tested and five were diagnosed with
hepatitis C as a result, health bosses confirmed. No cases of hepatitis B
or HIV were found..

The dentist, who ran his practice for 32 years, is still suspended from
practising.

Health chiefs in Cardiff said there was a ‘very low risk’ that people had
contracted infections at Splott Dental Surgery, which is now under new
ownership.

Dr Meirion Evans, consultant epidemiologist for Public Health Wales, said
the risk to patients was ‘very low.’

‘Based on clinical advice, we would not recommend screening for all
patients as the risk is very low unless you have other lifestyle factors
which may present a greater risk of transmission,’ he said.

‘However if patients still have concerns after contacting the advice line,
a simple blood test can be arranged to offer them peace of mind.’

Ruth Walker, Executive Nurse Director at Cardiff and Vale University
Health Board said it was working with the new owners of the practice to
fully investigate the matter.

She said: ‘We would like to reiterate that these issues are historical and
there is no reason for patients currently registered at the dental
practice to be concerned about the care and treatment they receive.’
__________________________________________________________________
________________________________*_________________________________
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.