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SIGNpost 00830

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST

Post00830    One! + Abstracts + India + Nepal + News     25 November 2015

CONTENTS
1. USA: The One & Only campaign offers resources to raise awareness about
safe injection practices
2. Abstract: Injection practice in Kaski district, Western Nepal: a
community perspective
3. Abstract: An Outbreak of Hepatitis B in a Rural Area of West Bengal,
India
4. Abstract: Barriers to the Adoption of Safety-Engineered Needles
Following a Regulatory Standard: Lessons Learned from Three Acute Care
Hospitals
5. Abstract: A quality improvement project to reduce the intraoperative
use of single-dose fentanyl vials across multiple patients in a
pediatric institution
6. Abstract: Hepatitis C virus infection and risk factors in the general
population: a large community-based study in eastern China, 2011-2012
7. Abstract: Epidemiology of hepatitis C: related hepatocellular carcinoma
in Cameroon
8. Abstract: Correlates of Skin and Soft Tissue Infections in Injection
Drug Users in a Syringe-Exchange Program in Malmö, Sweden
9. Abstract: Accurate genetic detection of hepatitis C virus transmissions
in outbreak settings
10. Extract: Digging Deeper into Hepatitis C Virus Outbreaks
11. Abstract: Hand Washing Practices Among Emergency Medical Services
Providers
12. Abstract: Changing the needle for lumbar punctures: results from a
prospective study
13. Abstract: Technosphere Insulin: Inhaled Prandial Insulin
14. News
– Australia: Nurses say supervised injecting room only way forward for
prison program
– USA: Not using free syringe disposal program has high costs
– NY USA: First responders team up for safe disposal of needles
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__________________________________________________________________
________________________________*_________________________________

1. USA: The One & Only campaign offers resources to raise awareness about
safe injection practices

Crossposted with thanks from IAC Express #1215 from the Immunization
Action Coalition express@immunize.org www.immunize.org
__________________________________________________________________
The One & Only campaign offers resources to raise awareness about safe
injection practices

The One & Only Campaign is a public health campaign, led by CDC and the
Safe Injection Practices Coalition (SIPC), to raise awareness among
patients and health care professionals about safe injection practices. A
selection of background information from the campaign’s website is
reprinted below.

Since 2001, more than 150,000 patients in the United States have been
notified of potential exposure to hepatitis B virus (HBV), hepatitis C
virus (HCV), and HIV due to lapses in basic infection control practices.
Many of these lapses involved health care providers reusing syringes,
resulting in contamination of medication vials or containers which were
used then on subsequent patients.

The goal of the One & Only Campaign is to ensure patients are protected
each and every time they receive a medical injection. This will be
attained by empowering patients and re-educating health care providers
regarding safe injection practices. Targeted education and awareness
campaigns focus on influencing the culture of patient safety. Patients and
providers must both insist on nothing less than One Needle, One Syringe,
Only One Time for each and every injection.

Order print publications related to injection safety from CDC-INFO on
Demand or download them from the campaign website.

Related Links
One & Only Campaign website
http://www.oneandonlycampaign.org/

CDC’s Injection Safety: One & Only Campaign web page
http://www.cdc.gov/injectionsafety/1anOnly.html
__________________________________________________________________
________________________________*_________________________________

2. Abstract: Injection practice in Kaski district, Western Nepal: a
community perspective
__________________________________________________________________

http://www.biomedcentral.com/1471-2458/15/435 Free Open Access

BMC Public Health. 2015 Apr 29;15:435.
Injection practice in Kaski district, Western Nepal: a community
perspective.

Gyawali S1, Rathore DS2, Shankar PR3, Kumar VK4, Maskey M5, Jha N6.

1Department of Pharmacology, Manipal College of Medical Sciences, Pokhara,
Nepal. sudeshgy@hotmail.com.
2Department of Pharmacy, L.R. Institute of Pharmacy, Jabli-kyar, Solan,
India. rathoredsp66@gmail.com.
3Department of Pharmacology, Xavier University School of Medicine,
Oranjestad, Aruba, Kingdom of the Netherlands. ravi.dr.shankar@gmail.com.
4Department of Statistics, PN Multiple Campus, Pokhara, Nepal.
vkkc2001@gmail.com.
5Department of Community Medicine, Manipal College of Medical Sciences,
Pokhara, Nepal. manzasharma@gmail.com.
6Department of Clinical Pharmacology & Therapeutics, KIST Medical College,
Imadol, Nepal. nishajha32@gmail.com.

BACKGROUND: Previous studies have shown that unsafe injection practice is
a major public health problem in Nepal but did not quantify the problem.

The present community-based study was planned to: 1) quantify injection
usage, 2) identify injection providers, 3) explore differences, if any, in
injection usage and injection providers, and 4) study and compare people’s
knowledge and perception about injections between the urban and rural
areas of Kaski district.

METHODS: A descriptive, cross-sectional mixed-methods study was conducted
from July to November 2012, using a questionnaire based survey and focus
group discussions (FGDs). A semi-structured questionnaire advocated by the
World Health Organization was modified and administered to household heads
and injection receivers in selected households and the FGDs were conducted
using a topic guide. The district was divided into urban and rural areas
and 300 households from each area were selected. Twenty FGDs were held.

RESULTS: In 218 households (36.33%) [99 in urban and 119 in rural] one or
more members received at least one injection. During the three month
recall period, 258 subjects (10.44%) reported receiving injection(s) with
a median of two injections.

The average number of injections per person
per year was calculated to be 2.37. Health care workers (34.8%), staff of
medical dispensaries (37.7%), physicians (25.2%), and traditional healers
(2.3%) were consulted by the respondents for their basic health care needs
and for injections.

Compared to urban respondents, more rural respondents preferred injections
for fever (p < 0.001).

People preferred injections due to injections being perceived by them as
being powerful, fast-acting, and longer lasting than oral pills. More than
82% of respondents were aware of, and named, at least one disease
transmitted by using unsterile syringes during injection administration or
when syringes are shared between people.

CONCLUSIONS: Less preference for injections and high awareness about the
association between injections and injection-borne infections among the
general population is encouraging for safe injection practice.

However, respondents were not aware of the importance of having qualified
injection providers for safe injections and were receiving injections from
unqualified personnel.

http://www.biomedcentral.com/1471-2458/15/435 Free Open Access
__________________________________________________________________
________________________________*_________________________________

3. Abstract: An Outbreak of Hepatitis B in a Rural Area of West Bengal,
India
__________________________________________________________________
Free Full Article
http://sljid.sljol.info/articles/abstract/10.4038/sljid.v5i2.8077/

Sri Lankan Journal of Infectious Diseases 2015 Vol.5 (2):51-57
An Outbreak of Hepatitis B in a Rural Area of West Bengal, India

DK Biswas,1 R Bhunia,2 P Das3

1 Purba Medinipur, West Bengal, India
2 Lady Dufferin Victoria Hospital, Kolkata, West Bengal, India
3 Department of Community Medicine, College of Medicine & Sagore Dutta
Hospital, Kamarhati, Kolkata, West Bengal, India

Address for correspondence:
Dr. Dilip Kumar Biswas <dilipbiswas29@gmail.com>

PDF Download link: http://dx.doi.org/10.4038/sljid.v5i2.8077

Introduction: There were limited data on outbreaks of hepatitis in rural
settings in India. We describe an outbreak of Hepatitis B virus infection
to confirm the existence of an outbreak of Hepatitis B in a rural area of
West Bengal, India and to determine risk factors for the outbreak and
recommend preventive measures.

Methods: We surveyed the entire village retrospectively followed by a
cross sectional case control study. We selected Hepatitis B surface
Antigen (HBsAg) positive patients as cases and recruited neighbours as
controls with a ratio of 1:2. The study was undertaken between November
2013 and June 2014. We collected blood samples which were sent to the
laboratory for virological examination. Data were analyzed with Epi-info
and Excel software.

Results: We surveyed 2170 residents. Of the 1085 residents in the risk
population, 54 were tested for hepatitis B and13 identified as hepatitis B
positive. Among them 77% (10) were men. Overall attack rate was 0.59%
(13/1085). One patient died (Case Fatality Ratio= 7.7%). Of the tested
population, 53% (7) were illiterate and 39% (5) were migrant labour by
occupation. Compared with controls, significantly higher number of cases
were given injection by local medical practitioners (LMP) (OR 7.50 95% CI
1.19-78.93) and had unsafe sex with sex workers (OR 15.63, 95% CI
1.34-767.41).

Conclusion: Injections given by LMPs and unsafe sex with sex workers were
risk factors for the outbreak. Awareness programmes were carried out for
LMPs on safe injection practice and villagers on safe sex and blood borne
diseases. Hepatitis B vaccination was recommended for infants and adults.

Key words : Hepatitis B, Unsafe injection, Rural, India
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Barriers to the Adoption of Safety-Engineered Needles
Following a Regulatory Standard: Lessons Learned from Three Acute Care
Hospitals
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/26571471

Healthc Policy. 2015 Aug;11(1):90-101.
Barriers to the Adoption of Safety-Engineered Needles Following a
Regulatory Standard: Lessons Learned from Three Acute Care Hospitals.

Chambers A1, Mustard CA2, Holness DL3, Nichol K4, Breslin FC5.

1Doctoral Student, Institute for Work and Health Toronto, ON.
2President and Senior Scientist, Institute for Work and Health Professor,
Dalla Lana School of Public Health, University of Toronto Toronto, ON.
3Professor, Dalla Lana School of Public Health Director, Department of
Medicine, University of Toronto Chief Physician, St. Michael’s Hospital,
Toronto, ON.
4Director of Nursing, University Health Network, Assistant Professor,
Dalla Lana School of Public Health, University of Toronto Toronto, ON.
5Scientist, Institute for Work and Health, Toronto, ON.

BACKGROUND: A number of jurisdictions have introduced regulation to
accelerate the adoption of safety-engineered needles (SENs). This study
examined the transition to SENs in three acute care hospitals prior to and
following the implementation of a regulatory standard in Ontario. This
paper focuses on the ongoing barriers to the prevention of needlestick
injuries among healthcare workers.

METHODS: Information from document review and 30 informant interviews were
used to prepare three case studies detailing each organization’s
implementation activities and outcomes.

RESULTS: All three hospitals responded to the regulatory requirements with
integrity and needlestick injuries declined. However, needlestick injuries
continued to occur during the activation of safety devices, during
procedures and during instrument disposal. The study documented
substantial barriers to further progress in needlestick injury prevention.

CONCLUSIONS: Healthcare organizations should focus on understanding their
site-specific challenges that contribute to ongoing injury risk to better
understand issues related to product limitations, practice constraints and
the work environment.

Copyright © 2015 Longwoods Publishing.
__________________________________________________________________
________________________________*_________________________________

5. Abstract: A quality improvement project to reduce the intraoperative
use of single-dose fentanyl vials across multiple patients in a
pediatric institution
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26566703

Paediatr Anaesth. 2015 Nov 14.

A quality improvement project to reduce the intraoperative use of single-
dose fentanyl vials across multiple patients in a pediatric institution.

Buck D1, Subramanyam R1, Varughese A1.

1Department of Anesthesia, Cincinnati Children’s Hospital Medical Center,
Cincinnati, OH, USA.

OBJECTIVE: The use of a single-dose vial across multiple patients presents
a risk to sterility and is against CDC guidelines. We initiated a quality
improvement (QI) project to reduce the intraoperative use of single-dose
vials of fentanyl across multiple patients at Cincinnati Children’s
Hospital Medical Center (CCHMC).

METHODS: The initial step of the improvement project was the development
of a Key Driver Diagram. The diagram has the SMART aim of the project, key
drivers inherent to the process we are trying to improve, and specific
interventions targeting the key drivers. The number of patients each week
receiving an IV dose of fentanyl, from a vial previously accessed for
another patient was tracked in a high turnover operating room (OR). The
improvement model used was based on the concept of building Plan-Do-Study-
Act (PDSA) cycles. Tests of change included provider education, provision
of an increased number of fentanyl vials, alternate wasting processes, and
provision of single-use fentanyl syringes by the pharmacy.

RESULTS: Prior to initiation of this project, it was common for a single
fentanyl vial to be accessed for multiple patients. Our data showed an
average percentage of failures of just over 50%. During the end of the
project, after 7 months, the mean percentage failures had dropped to 5%.
Preparation of 20 mcg single-use fentanyl syringes by pharmacy, combined
with education of providers on appropriate use, was successful in reducing
failures to below our goal of 25%.

CONCLUSIONS: Appropriately sized fentanyl syringes prepared by pharmacy,
education on correct use of single-dose vials, and reminders in the OR,
reduced the percentage of patients receiving a dose of fentanyl from a
vial previously accessed for another patient in a high-volume
otolaryngology room.

© 2015 John Wiley & Sons Ltd.

KEYWORDS: anesthesiology; infection control; patient safety; pediatrics;
quality improvement
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Hepatitis C virus infection and risk factors in the general
population: a large community-based study in eastern China, 2011-2012
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/25600557

Epidemiol Infect. 2015 Oct;143(13):2827-36.

Hepatitis C virus infection and risk factors in the general population: a
large community-based study in eastern China, 2011-2012.

Huang P1, Zhu LG2, Zhai XJ2, Zhu YF2, Yue M3, Su J1, Wang J4, Yang HT2,
Zhang Y5, Shen HB1, Peng ZH1, Yu RB1.
Author information
1Department of Epidemiology and Biostatistics,School of Public Health,
Nanjing Medical University,Nanjing,China.
2Jiangsu Provincial Centre for Disease Control and
Prevention,Nanjing,China.
3Department of Infectious Diseases,The First Affiliated Hospital of
Nanjing Medical University,Nanjing,China.
4School of Nursing, Nanjing Medical University,Nanjing,China.
5Department of Epidemiology,Medical Institute of Nanjing
Army,Nanjing,China.

Limited information is available on the prevalence of hepatitis C virus
(HCV) in the general population in China.

A community-based epidemiological study was conducted in three counties in
eastern China. A total of 149 175 individuals were investigated in 60
communities in three counties in Jiangsu province, eastern China, of whom
1175 subjects [0·79%, 95% confidence interval (CI) 0·74-0·83] were HCV
antibody positive.

The prevalence was low in children (0·09%, 95% CI 0·04-0·17), but
increased progressively from adolescents (0·20%, 95% CI 0·15-0·28) to
adults aged ?21 years (95% CI 0·15-1·64). Women had a higher prevalence
of HCV infection than men in most age groups.

In a multilevel regression analysis, age, sex, education, occupation,
blood transfusion [odds ratio (OR) 2·91, 95% CI 1·09-5·37], invasive
testing (OR 1·28, 95% CI 1·14-1·61), and dental therapy (OR 2·27, 95% CI
1·41-3·42) were associated with HCV infection.

In conclusion, although the prevalence of HCV in this population was lower
than reported from national levels, the total reservoir of infection is
significant and warrants public health measures, such as health education
to limit the magnitude of the problem.

KEYWORDS: Epidemiological study; general population; hepatitis C virus
antibody; risk factor
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Epidemiology of hepatitis C: related hepatocellular carcinoma
in Cameroon
__________________________________________________________________

http://www.panafrican-med-journal.com/content/article/19/379/full

Pan Afr Med J. 2014 Dec 15;19:379. Free Article
Epidemiology of hepatitis C: related hepatocellular carcinoma in Cameroon.

Andoulo FA1, Noah DN2, Djapa R1, Kowo M1, Talla P3, Medjo EH4, Djomkam
IK1, Nonga BN5, Njoya O1, Ndam EC3.

1Yaounde University Hospital Center, Department of internal medicine and
specialties, Faculty of medicine and biomedical sciences, University of
Yaounde I, Yaoundé, Cameroon.
2Yaounde Central Hospital, Department of internal medicine and
specialties, Faculty of medicine and pharmaceuticals sciences, University
of Douala, Douala, Cameroon.
3Yaounde General Hospital, Department of internal medicine and
specialties, Faculty of medicine and biomedical sciences, University of
Yaounde I, Yaoundé, Cameroon.
4Yaounde Central Hospital, Department of Radiology, Faculty of medicine
and biomedical sciences, University of Yaounde I, Yaoundé, Cameroon.
5Yaounde University Hospital Center, Department of surgery and
specialties, Faculty of medicine and biomedical sciences, University of
Yaounde I, Yaoundé, Cameroon.

INTRODUCTION: Hepatocellular carcinoma (HCC) is a global public health
problem. Hepatitis C virus (HCV) infection accounts for close to 24% of
HCC in developing countries especially when associated with cirrhosis.
There exists no vaccine against HCV to prevent the occurrence of HCV-
related HCC. A sound knowledge of the epidemiology and prevention of the
initial infection is vital. The aim of our study was to determine the
epidemiologic profile of HCV-related HCC in Cameroon to improve its’
management.

METHODS: It was a prospective study of histologically proven HCV-related
HCC seen in two University Centers in Yaounde, Cameroon from March 2012 to
January 2013. Demographic data (age, gender), alcohol abuse (>80g/day),
presence of cirrhosis, tobacco abuse and parenteral exposition were
analyzed.

RESULTS: Twenty-six patients with histologically proven HCV-related HCC
were included (18 men (69.2%) and 8 women (30.8%); mean age +/- SD,
61.46+/-10.18 years).

A total of 22 (84.6%) patients had a parenteral exposition, 02 (7.7%)
patients were alcoholics and 06 (23.1%) patients were smokers.

The proportion of patients with cirrhosis was 69.2% against 30.8%
cirrhosis-free. Patients with cirrhosis were relatively younger than those
cirrhosis-free (mean age +/- SD, 59.05+/-10.05 years vs 66.87+/- 8.72
years, p=0.06). HCV-related HCC was more prevalent in 60 years and above
patients (53.8%, 95%CI: 33.4-73.4). The relative risk of HCC among
alcoholics patients was high (RR: 1.5, 95%CI: 1.13-1.99, p<0.05).

CONCLUSION: In Cameroon, HCV-related HCC is more prevalent among age older
than 60 years, a finding which is relatively less to that found in western
countries, male gender is twice more at risk than female gender and
cirrhosis frequency is less compared to that observed elsewhere. HCV and
alcohol play a synergistic role in the occurrence of HCC in our
environment.

KEYWORDS: Cameroon; Hepatocellular carcinoma; alcohol; cirrhosis;
developing countries; epidemiology; hepatitis C; parenteral exposition
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Correlates of Skin and Soft Tissue Infections in Injection
Drug Users in a Syringe-Exchange Program in Malmö, Sweden
__________________________________________________________________
Subst Use Misuse. 2015 Nov 19:1-7.

Correlates of Skin and Soft Tissue Infections in Injection Drug Users in a
Syringe-Exchange Program in Malmö, Sweden.

Dahlman D1, Håkansson A2, Björkman P3, Blomé MA3, Kral AH4.

1a Malmo Addiction Center , Psychiatry Skane , Malmo , Sweden.
2b Department of Clinical Sciences , Lund University , Lund , Sweden.
3c Department of Infectious Diseases, Division of Clinical Sciences , Lund
University , Malmo , Sweden.
4d RTI International , San Francisco , California , USA.

BACKGROUND: Injection drug users (IDUs) are at increased risk of various
medical conditions, including bacterial skin and soft tissue infections
(SSTIs). SSTIs, which are painful and can lead to life-threatening
complications, are common but scarcely studied.

OBJECTIVES: To investigate life time, past 12 month and past 30-day
prevalence for SSTI related to injection drug use, in IDUs at Malmö
syringe exchange program (Malmö SEP). To investigate factors associated
with having ever had an SSTI.

METHODS: IDUs were recruited from Malmö SEP (N = 80). They participated in
a survey with questions about demographics, drug use, and experience of
SSTIs. Factors independently associated with self-reported SSTI ever were
assessed using logistic regression analysis.

RESULTS: The lifetime reported prevalence of SSTI was 58%, past 12 months
30%, and past 30 days 14%. Factors independently associated with SSTI ever
were age (adjusted odds ratio [AOR] = 1.09; 95% confidence interval [CI] =
1.01-1.18), female sex (AOR = 6.75; 95% CI = 1.40-32.47), having ever
injected prescribed drugs (AOR = 52.15; 95% CI = 5.17-525.67), and having
ever injected in the neck (AOR = 8.08; 95% CI = 1.16-56.08).
Conclusions/Importance: SSTI is common among IDUs in Malmö. Women and
those injecting in the neck or injecting prescribed drugs (crushed
tablets/liquids), are more likely to have had an SSTI.

KEYWORDS: abscess; injection drug use; risk injection; skin and soft
tissue infection; syringe exchange
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Accurate genetic detection of hepatitis C virus transmissions
in outbreak settings
__________________________________________________________________
http://jid.oxfordjournals.org/content/early/2015/11/17/infdis.jiv542.long

J Infect Dis. 2015 Nov 17. pii: jiv542. Free Full Article
Accurate genetic detection of hepatitis C virus transmissions in outbreak
settings.

Campo DS1, Xia GL1, Dimitrova Z1, Lin Y1, Forbi JC1, Ganova-Raeva L1,
Punkova L1, Ramachandran S1, Thai H1, Skums P1, Sims S1, Rytsareva I1,
Vaughan G1, Roh HJ1, Purdy MA1, Sue A1, Khudyakov Y1.

1Molecular Epidemiology and Bioinformatics Laboratory, Division of Viral
hepatitis, Centers for Disease Control and Prevention, Atlanta, 30333,
USA.

Hepatitis C is a major public health problem in the United States and
worldwide. Outbreaks of hepatitis C virus (HCV) infections are associated
with unsafe injection practices, drug diversion, and other exposures to
blood, being difficult to detect and investigate.

Here, we developed and validated a simple approach for molecular detection
of HCV transmissions in outbreak settings. We obtained sequences from the
HCV hypervariable region 1 (HVR1) using End-Point Limiting-Dilution (EPLD)
from 127 cases involved in 32 epidemiologically defined HCV outbreaks and
193 individuals with unrelated HCV strains.

We compared several types of genetic distances and calculated a threshold
using minimal Hamming distances that identifies transmission clusters in
all tested outbreaks with 100% accuracy. The approach was also validated
on sequences from 239 individuals obtained using next-generation
sequencing, showing the same accuracy as EPLD. In average, nucleotide
diversity of the intra-host population was 6.2-times greater in the source
than in any incident case, allowing the correct detection of transmission
direction in 8 outbreaks for which source cases were known.

A simple and accurate distance-based approach for detecting HCV
transmissions developed here streamlines molecular investigation of
outbreaks, thus improving the public health capacity for rapid and
effective control of hepatitis C.

Published by Oxford University Press for the Infectious Diseases Society
of America 2015.

This work is written by (a) US Government employee(s) and is in the
public domain in the US.

http://jid.oxfordjournals.org/content/early/2015/11/17/infdis.jiv542.long
__________________________________________________________________
________________________________*_________________________________

10. Extract: Digging Deeper into Hepatitis C Virus Outbreaks
__________________________________________________________________

http://jid.oxfordjournals.org/content/early/2015/11/17/infdis.jiv543.long

J Infect Dis. 2015 Nov 17. pii: jiv543. Free Open Access
Digging Deeper into Hepatitis C Virus Outbreaks.

Olmstead AD.

Correspondence: andrea.olmstead@bccdc.ca

Methods for investigating outbreaks of Hepatitis C virus (HCV) have
evolved since the discovery of the virus in 1989. Early investigations
focused on epidemiological evidence such as likelihood of exposure, risk
factors, temporal information, and serological evidence to identify
members of an outbreak (1–3). Streamlined nucleic acid sequencing methods
provided an important means of verifying suspected transmission events
and, over time, sequencing has become a standard outbreak investigation
tool (4–6). When the viral sequences from different individuals are found
to be identical or very similar, the probability is very high that those
individuals are part of the same transmission chain. Unfortunately,
interpreting the relationship between viral sequences in different
individuals is not always straightforward.

RNA viruses such as HCV mutate very rapidly causing the sequences between
the source and recipient of a transmission to quickly diverge. The
magnitude of this divergence depends on the amount of time elapsed and on
the region of the virus sequenced. This story is further complicated by
the fact that, because of this rapid evolutionary rate, individuals are
actually infected with entire swarms of non-identical but closely related
HCV variants, termed

© The Author 2015. Published by Oxford University Press for the Infectious
Diseases Society of America.

This is an Open Access article distributed under the terms of the Creative
Commons Attribution-NonCommercial-NoDerivs licence
__________________________________________________________________
________________________________*_________________________________

11. Abstract: Hand Washing Practices Among Emergency Medical Services
Providers
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4644042/

West J Emerg Med. 2015 Sep;16(5):727-35. Free Full Article

Hand Washing Practices Among Emergency Medical Services Providers.

Bucher J1, Donovan C1, Ohman-Strickland P2, McCoy J1.

1Rutgers Robert Wood Johnson Medical School, Department of Emergency
Medicine, New Brunswick, New Jersey.
2Rutgers School of Public Health, New Brunswick, New Jersey.

INTRODUCTION: Hand hygiene is an important component of infection control
efforts. Our primary and secondary goals were to determine the reported
rates of hand washing and stethoscope cleaning in emergency medical
services (EMS) workers, respectively.

METHODS: We designed a survey about hand hygiene practices. The survey was
distributed to various national EMS organizations through e-mail.
Descriptive statistics were calculated for survey items (responses on a
Likert scale) and subpopulations of survey respondents to identify
relationships between variables. We used analysis of variance to test
differences in means between the subgroups.

RESULTS: There were 1,494 responses. Overall, reported hand hygiene
practices were poor among pre-hospital providers in all clinical
situations. Women reported that they washed their hands more frequently
than men overall, although the differences were unlikely to be clinically
significant. Hygiene after invasive procedures was reported to be poor.
The presence of available hand sanitizer in the ambulance did not improve
reported hygiene rates but improved reported rates of cleaning the
stethoscope (absolute difference 0.4, p=0.0003). Providers who brought
their own sanitizer were more likely to clean their hands.

CONCLUSION: Reported hand hygiene is poor amongst pre-hospital providers.
There is a need for future intervention to improve reported performance in
pre- hospital provider hand washing.

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4644042/
__________________________________________________________________
________________________________*_________________________________

12. Abstract: Changing the needle for lumbar punctures: results from a
prospective study
__________________________________________________________________
http://www.clineu-journal.com/article/S0303-8467(14)00496-X/abstract

Clin Neurol Neurosurg. 2015 Mar;130:74-9. Free Open Access
Changing the needle for lumbar punctures: results from a prospective
study.

Engedal TS1, Ørding H2, Vilholm OJ3.

1Department of Neurology, Lillebaelt Hospital, Vejle, Denmark. Electronic
address: tsengedal@gmail.com.
2Department of Anesthesiology, Lillebaelt Hospital, Vejle, Denmark.
Electronic address: oerding@dadlnet.dk.
3Department of Neurology, Lillebaelt Hospital, Vejle, Denmark. Electronic
address: ole.vilholm@rsyd.dk.

OBJECTIVE: Post-dural puncture headache (PDPH) is a common complication of
diagnostic lumbar punctures. Both a non-cutting needle design and the use
of smaller size needles have been shown to greatly reduce the risk of
PDPH. Nevertheless, larger cutting needles are still widely used. This
study describes the process of changing the needle in an outpatient clinic
of a Danish neurology department.

METHODS: Prospective interventional trial. Phase 1: 22G cutting needle.
Phase 2: 25G non-cutting needle. Practical usability of each needle was
recorded during the procedure, while the rate of PDPH and the occurrence
of socioeconomic complications were acquired from a standardized
questionnaire.

RESULTS: 651 patients scheduled for diagnostic lumbar punctures were
screened for participation and 501 patients were included. The response
rate was 80% in both phases. In phase 2, significant reductions were
observed in occurrence of PDPH (21 vs. 50, p=0.001), number of days spent
away from work (55 vs. 175, p<0.001), hospitalizations (2 vs. 17,
p<0.001), and number of bloodpatch treatments (2 vs. 10, p=0.019).
Furthermore, during the procedure, both the need for multiple attempts
(30% vs. 44%, p=0.001), and the failure-rate of the first operator (17%
vs. 29%, p=0.005) were reduced.

CONCLUSIONS: Our study showed that smaller, non-cutting needles reduce the
incidence of PDPH and are easily implemented in an outpatient clinic.
Changing the needle resulted in fewer socioeconomic complications and
fewer overall costs, while also reducing procedural difficulty. Copyright
© 2015 The Authors. Published by Elsevier B.V. All rights reserved.

KEYWORDS: Headache disorders/etiology; Post-dural puncture headache;
Spinal puncture/adverse effects; Spinal puncture/instrumentation; Spinal
puncture/methods

Free full text
http://www.clineu-journal.com/article/S0303-8467(14)00496-X/abstract
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13. Abstract: Technosphere Insulin: Inhaled Prandial Insulin
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http://www.ncbi.nlm.nih.gov/pubmed/26567896

Expert Opin Biol Ther. 2015 Nov 15.

Technosphere Insulin: Inhaled Prandial Insulin.

Setji TL1, Hong BD1, Feinglos MN1.

1a Department of Medicine, Division of Endocrinology , Duke University
Medical Center , Durham , NC USA.

INTRODUCTION: Insulin therapy is a mainstay for treatment of diabetes
mellitus, however many barriers to insulin exist. Insulin human inhalation
powder (technosphere insulin) is a new FDA approved alternative to
subcutaneous bolus insulin. Areas covered: This is an overview of
technosphere insulin (TI). Pharmacokinetics, clinical efficacy, safety and
tolerability are discussed.

Expert Opinion: TI is more quickly absorbed than subcutaneous insulin
therapies and has a shorter duration of action. It appears to be
noninferior compared with subcutaneous insulin regimens, and is associated
with less hypoglycemia. Thus, it may serve as an alternative insulin agent
in patients reluctant to administer multiple subcutaneous injections of
insulin daily or in patients who experience late postprandial hypoglycemia
with subcutaneous insulin.

Cough is the most common side effect, but tends to be mild and transient.
A small decrease in the forced expiratory volume has been demonstrated,
but does not appear to progress and is reversible. Patients should have
periodic pulmonary function tests. TI is contraindicated in patients with
chronic lung disease.

The long-term risk of lung cancer is being monitored but at this point
does not appear to be higher than the expected incidence of lung cancer in
this population.
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14. News

– Australia: Nurses say supervised injecting room only way forward for
prison program
– USA: Not using free syringe disposal program has high costs
– NY USA: First responders team up for safe disposal of needles

Selected news items reprinted under the fair use doctrine of international
copyright law: http://www4.law.cornell.edu/uscode/17/107.html
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https://tinyurl.com/o7v42e7
Australia: Nurses say supervised injecting room only way forward for
prison program

By Matthew Raggatt, The Canberra Times, Canberra Australia (21.11.15)

The nurses’ union has reluctantly backed a supervised injecting room as
the best model for a needle and syringe program in Canberra’s adult
prison.

Expressing widespread concerns about the supervised model, including that
it will not guarantee detainees’ anonymity, the Australian Nursing and
Midwifery Federation submission said it was the only valid option to meet
the government’s policy aim for a program without creating a prison black
market for needles.

“The federation has been specifically asked not to comment on the merits
or otherwise of a needle and syringe program, but to suggest how an NSP
model might operate,” it said.

“The only way to ensure that blood-borne viruses’ transmission within the
Alexander Maconochie Centre can be addressed is the establishment of a
supervised injecting room, where the needle and syringe will be used only
once and will be disposed of appropriately before the detainee rejoins the
prison population.”

The federation’s ACT secretary Jenny Miragaya, who wrote the submission,
lodged mid-November, to the government’s working party on the program,
said a comprehensive workforce review was also warranted given the
increased pressures the record prison population and potential needle
program created.

The working party, which is jointly led by Community and Public Sector
Union ACT regional secretary Vince McDevitt, was established after the
government deferred the controversial needles plan in April due to
protracted opposition by prison staff.

Ms Miragaya said no model answered all the problems raised by key
stakeholders, but several conditions could make a supervised injecting
model safer. These included the detainee being required to remain under
supervision for 15 to 30 minutes after taking the drug.

“This is not a decision taken lightly by the federation, who has
reiterated its concerns in respect of addressing other modes of blood-
borne virus transmission, e.g. tattooing and body piercing, as well as the
detection of contraband and other dirty needles and syringes within AMC,”
she said.

Ms Miragaya said she was unsure how anonymity could be guaranteed when
detainees would need to be escorted to the injecting room.

She said her members who remained conscientiously opposed to the
establishment of the program on moral or religious grounds would need to
be catered for.

Mr McDevitt welcomed the nurses’ views and said submissions from about 25
stakeholders the working group had written to were due by the end of the
month.

“Over the years there has been various discussions, even a vending
machine, and everything in the scale – [from] a free-for-all, special
programs or an injecting room, and different models of injecting room,” he
said.

“It’s early days and we’re looking forward to constructive submissions.”

The Canberra Liberals have criticised the government’s call for the
program. An ACT Health spokesman said the Justice Health Service had 19
full-time equivalent staff.
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https://tinyurl.com/q8je4b7
USA: Not using free syringe disposal program has high costs

Christopher Gooding, Cumberland News Now, Massachusetts USA (20.11.15)

LITTLE FORKS – Life, right now, is up in the air for an employee at the
Cumberland Joint Services Management Authority – also known as the
landfill, or the dump – in Little Forks.

Working on the recyclables line separating aluminum from paper, paper from
plastics, the employee was stuck by the errant diabetic needle. Its
contents, if any, are unknown but that’s just the beginning of the worries
that come after someone is punctured by a dirty needle. Infectious
diseases, blood-borne diseases and more become considerations.

The more damning fact is it could have been prevented. For free,
nonetheless.

“You can go to any pharmacy and pick up a free SHARPS container. It starts
at the pharmacy level with free containers,” CJSMA waste reduction
coordinator Brenda Rioux says. “You bring it home, you use the container
and once the container is full you take it back to the pharmacy for proper
disposal.”

It’s that easy.

If someone becomes stuck with a needle, however, the employee is
immediately sent to the hospital and the beginning of a major life-upset
starts, which will include preventative medications, ongoing testing and
months of observations wondering what, if anything, may have infected the
employee. And it’s not just themselves who are impacted by the negligence.

“It’s a long and drawn out affair because you have to wait six-months to
find out if you’re infected or not… you’re sitting in limbo for six-
months,” recycling supervisor Scott Conrad says. “It’s not only that, it’s
your spouse or your partner, as well. One of the first things they tell
them, first thing right off the bat, is no unprotected sex for six months
because they could be passing something on if you are infected.”

Over the last year there were 90 instances of syringes appearing on the
line at CJSMA, each requiring an average of 20 minutes to shutdown and
visually confirm the line is free of any other possible threats to
employees. The math works out to 30 hours annually, or the lion’s share of
an entire workweek each year just dealing with syringes at the local
landfill. In this recent instance, the needle that stuck the employee was
in a grocery bag filled with used needles.

Staff at CJSMA are optimistic the recent incident will not have a negative
impact on their employee, but they do need the public to be aware of the
SHARPS program and treat used syringes responsibly.
__________________________________________________________________
__________________________________________________________________

http://www.fosters.com/article/20151119/NEWS/151119277
NY USA: First responders team up for safe disposal of needles

By Caitlin Andrews, Foster’s Daily Democrat, NY USA (19.11.15)

ROCHESTER — The Rochester Fire Department, Rochester Police Department and
Frisbie Memorial Hospital are teaming up to rid the streets of discarded
hypodermic needles, according to Rochester Fire Department Deputy Chief
Tim Wilder.

The joint effort to collect the discarded needles is effective immediately
and includes measures such as installing Sharps collection boxes in first-
responder vehicles, such as marked police cruisers and fire apparatus,
Wilder said. He said the effort is necessary because hypodermic needles
are found on the streets of Rochester “all the time.”

“We get calls about found needles weekly,” Wilder said. “It’s important
for people to know that if they see a needle in public, do not pick it up.
Call someone who can dispose of it safely.”

Exposed needles pose a serious health risk and can carry dangerous blood-
borne infections, such as hepatitis C, hepatitis B, and HIV, according to
a Rochester Fire Department press release. More discarded needles are
being found in public spaces throughout New Hampshire as a result of the
heroin epidemic, the release said.

Putting Sharps containers in first-responder vehicles not only protects
the people on the streets, but also the responders, said Rochester police
Capt. Gary Boudreau.

Another plus of the Sharps containers is how much time they will save.
Prior to getting the containers installed in the cruisers, police would
pick up needles while wearing plastic gloves and put the needles in an
evidence vial. The officer would then have to transport the needle to
Frisbie right away to dispose of it. Now, officers can collect multiple
needles before having to transport them, Boudreau said.

“We’ve been doing needle collection for years, and getting Frisbie and the
Fire Department on board is very important to helping us and the public,”
Boudreau said. “The needle problem is not a new problem, and it’s not
going away any time soon.”

Wilder said needles are found all over Rochester, including downtown.
Frisbie Memorial will be taking the lead in needle pickup, Wilder said,
and will be the first to respond to notification of a discarded needle. If
you find a discarded needle in Rochester, contact the emergency services
dispatch center available 24 hours a day, at 603-330-7127, then dial “0″
__________________________________________________________________
________________________________*_________________________________

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
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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
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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
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* 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
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We would like your help in building this archive. Please send your old
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The SIGN Internet Forum was established at the initiative of the World
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The SIGN Secretariat home is the Service Delivery and Safety (SDS)
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The SIGN Forum is moderated by Allan Bass and is hosted on the University
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