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SIGNpost 00832

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST

Post00832 Note + WHO MDVP + IDU + Outbreak News 09 December 2015

CONTENTS
0. Moderators Note
1. Download the WHO Multi-Dose Vial Policy (MDVP) Revision 2014 Handling
of Multi-Dose Vaccine Vials after Opening
2. Abstract: Surveillance of adverse events following immunisation in
Australia annual report, 2013
3. Abstract: Hepatitis-B Infections among the Injection Drug Abusers: An
Emerging Risk in Public Health, Bangladesh
4. Abstract: Patterns of substance use and correlates of lifetime and
active injection drug use among women in Malaysia
5. Abstract: Potential cost-effectiveness of supervised injection
facilities in Toronto and Ottawa, Canada
6. Abstract: The promise and pitfalls of long-acting injectable agents for
HIV prevention
7. Abstract: Evaluation of the potential for virus dispersal during hand
drying: a comparison of three methods
8. News
– Singapore: Gaps found in response to SGH Hep C cluster: Review committee
– Singapore: SGH Hepatitis C cluster: Police rule out foul play
– New Zealand: Needles found in recycling in New Plymouth
– Cambodia: Unlicensed Cambodian doctor gets 25 years in prison for
spreading HIV with dirty needles
– Korea: Clinic operation suspended for mass infection

The web edition of SIGNpost is online at:
http://signpostonline.info/archives/1953

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__________________________________________________________________
________________________________*_________________________________

0. Moderators Note
__________________________________________________________________

The last edition of SIGNpost for 2015 will be posted next week on
Wednesday 16 December.

If you have any urgent notices or announcements for SIGNposting please let
me know.

The first edition of SIGNpost for 2016 will be posted on Wednesday
6 January.

Very best wishes for a safe and productive 2016!

allan
__________________________________________________________________
________________________________*_________________________________

1. Download the WHO Multi-Dose Vial Policy (MDVP) Revision 2014 Handling
of Multi-Dose Vaccine Vials after Opening
__________________________________________________________________
Multi-Dose Vial Policy (MDVP) Revision 2014
– Handling of Multi-Dose Vaccine Vials after Opening

This revision to the multi-dose vial policy provides updated guidance on
how to handle all opened multi-dose vials of WHO pre-qualified vaccines.

It outlines the conditions under which opened multi-dose vials can be kept
for 28 days and which must be discarded after six hours or at the end of
the immunization session, whichever comes first, along with a description
of the visual triggers that can be used to guide vaccine handling by
vaccinators.

PDF 231 KB requires Adobe Acrobat Reader

http://apps.who.int/iris/bitstream/10665/135972/1/WHO_IVB_14.07_eng.pdf
__________________________________________________________________
________________________________*_________________________________

2. Abstract: Surveillance of adverse events following immunisation in
Australia annual report, 2013
__________________________________________________________________

Free Full Text https://tinyurl.com/hrxyvh8

Commun Dis Intell Q Rep. 2015 Sep 30;39(3):E369-86.
Surveillance of adverse events following immunisation in Australia annual
report, 2013.

Mahajan D1, Dey A1, Cook J2, Harvey B2, Menzies R1, Macartney K1.

1National Centre for Immunisation Research and Surveillance of Vaccine
Preventable Diseases, University of Sydney and The Children’s Hospital at
Westmead, Sydney, New South Wales.
2Office of Product Review, Therapeutic Goods Administration, Canberra,
Australian Capital Territor.

This report summarises Australian passive surveillance data for adverse
events following immunisation (AEFI) for 2013 reported to the Therapeutic
Goods Administration (TGA) for 2013 and describes reporting trends over
the 14-year period 1 January 2000 to 31 December 2013. There were 3,161
AEFI records for vaccines administered in 2013. This is an annual AEFI
reporting rate of 13.9 per 100,000 population, the 2nd highest since 2000
and an increase of 59% compared with 2012 (1,994 AEFI records; 8.8 per
100,000 population).

The increase was partly due to implementation of enhancements to vaccine
safety reporting. This included stimulated reporting of AEFI as part of
the extension of national human papillomavirus (HPV) vaccination under the
National Immunisation Program to males aged 12-13 years, along with a
catch-up program for males aged 14 and 15 years in February 2013 (n=785;
includes males and females), in which certain events, such as syncope,
were closely monitored. Eighty-two per cent (n=341/414) of the syncope
reports were following HPV vaccination and of these 57% (n=195) were males
and 43% (n=146) were females. In addition, reporting rates for most other
the vaccines were higher in 2013 compared with 2012.

The majority of AEFI reports described non-serious events while 5% (n=158)
were classified as serious. There were 4 reports of death; however, all
deaths were investigated by the TGA and no clear causal relationship with
vaccination was found. The most commonly reported reactions were injection
site reaction (13%), rash (10%), pyrexia (8%), and syncope (7%).

Commun Dis Intell 2015;39(3):E369-E386.
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Hepatitis-B Infections among the Injection Drug Abusers: An
Emerging Risk in Public Health, Bangladesh
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26620025

Mymensingh Med J. 2015 Oct;24(4):813-24.
Hepatitis-B Infections among the Injection Drug Abusers: An Emerging Risk
in Public Health, Bangladesh.

Hossain KJ1, Nandi AK.

1Dr Kazi Jahangir Hossain, Associate Professor Department of Health
Education, National Institute of Preventive and Social Medicine (NIPSOM),
Mohakhali, Dhaka, Bangladesh.

The objective of the study was to determine the incidence of Hepatitis-B
(HBV) infection among the injection drugs abusers (IDUs).

The research work was a cross-sectional study. A total of 400 IDUs were
selected from July 2012 to June 2013 at the Outpatient Department of the
Central Drug Addiction Treatment Center, Tejgaon, Dhaka, Bangladesh. They
were selected consecutively following the purposive sampling method on the
basis of defined selection criteria. Research instruments were a pre-
tested interviewer questionnaire and blood specimen.

Results showed that 79.70%(315) of the IDUs were found literate and
20.3%(85) illiterate. In present occupation, majority of them 60.5%(242)
had no work and 39.5%(158) specific occupation. The mean age of them was
27.9±6.4 years. In marital status, 46.5%(186) were unmarried, 20.7%(83)
married after addiction and 30.3%(121) married before addiction. Majority
of the IDUs 75.2%(289) started their addiction with cannabis. In addition
to injection drugs use, all of them were multiple drug abusers.

In response to the sharing of needle, 35.7%(143) of the IDUs shared needle
uncommonly and 64.3%(257) did not shared it at all. Ninety-three percent
(372) of them were heterosexual and polygamous having extramarital sex
with multiple partners. The quality of sex-partners was wife, friends,
brothel & hotel based sex sellers and street sex sellers. Majority of IDUs
{82.0%(328)} did not use condom at all and 15.5(62) sold blood several
times in their lifetime.

Seven percent {7.0%(28)} injection drug abusers had been suffering from
hepatitis-B virus (HBV) infection. HBV infection was found to be
significantly (p= 0.05) associated with the quality of sex partners and
number of sex partners, and age and marital status.

There is no significant association with sharing of needle particularly
occasional sharing of needle. Altering the behaviors of IDUs, especially
their sexual lifestyles, drug habit, using of disposable syringe without
sharing of needle, and also alternative preventive measures against
injection drugs are still the applicable way to control spread of the HBV
among the IDUs in Bangladesh.
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Patterns of substance use and correlates of lifetime and
active injection drug use among women in Malaysia
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/26636885

Am J Drug Alcohol Abuse. 2015 Dec 4:1-13.
Patterns of substance use and correlates of lifetime and active injection
drug use among women in Malaysia.

Wickersham JA1,2, Loeliger KB1,3, Marcus R1, Pillai V2, Kamarulzaman A1,2,
Altice FL1,3,2.

1a Yale University School of Medicine , Department of Internal Medicine,
Infectious Diseases Section, AIDS Program , New Haven , CT , USA.
2c University of Malaya, Centre of Excellence for Research in AIDS , Kuala
Lumpur , Malaysia.
3b Yale University School of Public Health , Department of Epidemiology of
Microbial Diseases , New Haven , CT , USA.

BACKGROUND: While drug use is associated with HIV risk in Southeast Asia,
little is known about substance use behaviors among women, including drug
injection.

OBJECTIVES: To describe patterns of substance use among women using
alcohol and drugs in Malaysia and identify correlates of lifetime and
active drug injection, a risk factor for HIV transmission.

METHODS: A survey of 103 women who used drugs in the last 12 months
assessed drug use history and frequency, including drug injection and drug
use during pregnancy, self-reported HIV-status, childhood and adulthood
physical and sexual abuse, and access to and utilization of harm reduction
services, including needle-syringe exchange programs (NSEP) and opioid
agonist maintenance therapy (OAT). Principal component analyses (PCA) were
conducted to assess drug use grouping.

RESULTS: Amphetamine-type substances (ATS; 82.5%), alcohol (75.7%) and
heroin (71.8%) were the most commonly used drugs across the lifetime. Drug
injection was reported by 32.0% (n = 33) of participants with 21.4% (n =
22) having injected in the last 30 days. PCA identified two groups of drug
users: opioids/benzodiazepines and club drugs. Lifetime drug injection was
significantly associated with lower education, homelessness, prior
criminal justice involvement, opioid use, polysubstance use, childhood
physical and sexual abuse, and being HIV-infected, but not with prior OAT.

CONCLUSION: Women who use drugs in Malaysia report high levels of
polysubstance use and injection-related risk behaviors, including sharing
of injection equipment and being injected by others. Low OAT utilization
suggests the need for improved access to OAT services and other harm
reduction measures that prioritize women.

KEYWORDS: Malaysia; injection drug use; pregnancy; substance abuse; women
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Potential cost-effectiveness of supervised injection
facilities in Toronto and Ottawa, Canada
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/26616368

Addiction. 2015 Nov 30.
Potential cost-effectiveness of supervised injection facilities in Toronto
and Ottawa, Canada.

Enns EA1, Zaric GS2, Strike CJ3,4, Jairam JA3, Kolla G3, Bayoumi
AM5,6,7,8.

1Division of Health Policy and Management, University of Minnesota School
of Public Health, Minneapolis, MN, USA.
2Ivey Business School, Western University, London, ON, Canada.
3Dalla Lana School of Public Health, University of Toronto, Toronto, ON,
Canada.
4Center for Addiction and Mental Health, University of Toronto, Toronto,
ON, Canada.
5Centre for Research on Inner City Health, Li KaShing Knowledge Institute,
St Michael’s Hospital, Toronto, ON, Canada.
6Department of Medicine, University of Toronto, Toronto, ON, Canada.
7Institute of Health Policy, Management and Evaluation, University of
Toronto, Toronto, ON, Canada.
8Division of General Internal Medicine, St Michael’s Hospital, Toronto,
ON, Canada.

BACKGROUND AND AIMS: Supervised injection facilities (legally sanctioned
spaces for supervised consumption of illicitly obtained drugs) are
controversial public health interventions. We determined the optimal
number of facilities in two Canadian cities using health economic methods.

DESIGN: Dynamic compartmental model of HIV and hepatitis C transmission
through sexual contact and sharing of drug use equipment.

SETTING: Toronto and Ottawa, Canada.

PARTICIPANTS: Simulated population of each city.

INTERVENTIONS: Zero to five supervised injection facilities.

MEASUREMENTS: Direct health-care costs and quality-adjusted life-years
(QALYs) over 20?years, discounted at 5% per year; incremental cost-
effectiveness ratios.

FINDINGS: In Toronto, one facility cost $4.1 million and resulted in a
gain of 385 QALYs over 20?years, for an incremental cost-effectiveness
ratio (ICER) of $10?763 per QALY [95% credible interval (95CrI): cost-
saving to $278?311]. Establishing one facility in Ottawa had an ICER of
$6127 per QALY (95CrI: cost-saving to $179?272). At a $50?000 per QALY
threshold, three facilities would be cost-effective in Toronto and two in
Ottawa.

The probability that establishing three, four, or five facilities in
Toronto was cost-effective was 17, 21, and 41%, respectively. Establishing
one, two, or three facilities in Ottawa was cost-effective with 13, 35,
and 41% probability, respectively.

Establishing no facility was unlikely to be the most cost-effective option
(14% in Toronto and 10% in Ottawa).

In both cities, results were robust if the reduction in needle-sharing
among clients of the facilities was at least 50% and fixed operating costs
were less than $2.0 million.

CONCLUSIONS: Using a $50?000 per quality-adjusted life-years threshold for
cost-effectiveness, it is likely to be cost-effective to establish at
least three legally sanctioned spaces for supervised injection of
illicitly obtained drugs in Toronto, Canada and two in Ottawa, Canada. ©
2015 Society for the Study of Addiction.

KEYWORDS: HCV; HIV/AIDS; Harm reduction; injection drug use; mathematical
modeling; supervised injection facility
__________________________________________________________________
________________________________*_________________________________

6. Abstract: The promise and pitfalls of long-acting injectable agents for
HIV prevention
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/26633643

Curr Opin HIV AIDS. 2016 Jan;11(1):122-8.

The promise and pitfalls of long-acting injectable agents for HIV
prevention.

Landovitz RJ1, Kofron R, McCauley M.

1aUCLA Center for Clinical AIDS Research & Education, Los Angeles,
California bFHI 360, Connecticut Avenue, Washington, District of Columbia,
USA.

PURPOSE OF REVIEW: Preexposure prophylaxis for HIV prevention is highly
effective when taken as prescribed. Adherence to required dosing regimens
for protection may pose challenges. Long-acting agents for HIV prevention
may have the potential to improve adherence via favorable pharmacokinetics
supportive of infrequent dosing. This review focuses on the potential
benefits and considerations for the study and use of 2 long-acting
injectable agents, cabotegravir (GSK1265744LA, CAB LA) and rilpivirine
(TMC278LA, RPV LA), for use as chemoprophylaxis for HIV prevention.

RECENT FINDINGS: Oral RPV is United States Food and Drug Administration
approved for HIV treatment (in combination with other antiretrovirals).
Both CAB LA and RPV LA are currently in phase 2a
safety/tolerability/pharmacokinetic studies in anticipation and support of
future efficacy evaluation. Both agents have favorable pharmacokinetics,
and use is complicated by injection site reactions.

SUMMARY: Long-acting injectable formulations, if safe and well tolerated,
may improve pharmacokinetic coverage of exposures to HIV infection.
Complexities around safety, tolerability, and starting/stopping protocols
require careful consideration.
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Evaluation of the potential for virus dispersal during hand
drying: a comparison of three methods
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/26618932

J Appl Microbiol. 2015 Nov 30.

Evaluation of the potential for virus dispersal during hand drying: a
comparison of three methods.

Kimmitt PT1, Redway KF1.

1University of Westminster, Department of Biomedical Sciences, 115 New
Cavendish Street, London, United Kingdom.

AIMS: To use a MS2 bacteriophage model to compare three hand-drying
methods, paper towels (PT), a warm air dryer (WAD) and a jet air dryer
(JAD), for their potential to disperse viruses and contaminate the
immediate environment during use.

METHODS AND RESULTS: Participants washed their gloved hands with a
suspension of MS2 bacteriophage and hands were dried with one of the three
hand-drying devices. The quantity of MS2 present in the areas around each
device was determined using a plaque assay. Samples were collected from
plates containing the indicator strain, placed at varying heights and
distances and also from the air. Over a height range of 0.15-1.65 m, the
JAD dispersed an average of >60 and >1300-fold more plaque-forming units
(pfu) compared to the WAD and PT (P <0.0001), respectively. The JAD
dispersed an average of >20 and >190-fold more pfu in total compared to
WAD and PT at all distances tested up to 3 m (P <0.01), respectively. Air
samples collected around each device 15 minutes after use indicated that
the JAD dispersed an average of >50 and >100-fold more pfu compared to the
WAD and PT (P <0.001), respectively.

CONCLUSIONS: Use of the JAD lead to significantly greater and further
dispersal of MS2 bacteriophage from artificially contaminated hands when
compared to the WAD and PT.

SIGNIFICANCE AND IMPACT OF STUDY: The choice of hand drying device should
be considered carefully in areas where infection prevention concerns are
paramount, such as healthcare settings and the food industry.

This article is protected by copyright. All rights reserved.

KEYWORDS: MS2 bacteriophage; Virus; aerosolization; cross-contamination;
dispersal; hand drying; hand hygiene
__________________________________________________________________
________________________________*_________________________________

8. News

– Singapore: Gaps found in response to SGH Hep C cluster: Review committee
– Singapore: SGH Hepatitis C cluster: Police rule out foul play
– New Zealand: Needles found in recycling in New Plymouth
– Cambodia: Unlicensed Cambodian doctor gets 25 years in prison for
spreading HIV with dirty needles
– Korea: Clinic operation suspended for mass infection

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/hnxkam9
Singapore: Gaps found in response to SGH Hep C cluster: Review committee

Hepatitis C cluster is an unusual healthcare-associated infection and not
picked up easily through the current national surveillance system, due to
its unique characteristics, an independent review committee finds.

By Justin Ong, Channel News Asia (08.12.15)

SINGAPORE: A gap in the national response system to outbreaks led to
Singapore General Hospital (SGH) not recognising its Hepatitis C virus
(HCV) cluster in a timely manner and resulted in delays in escalating the
matter to and within the Ministry of Health (MOH).

This was according to a 79-page report released on Tuesday (Dec 8) by the
Independent Review Committee (IRC) set up to investigate the HCV cluster
at SGH’s renal ward. The virus infected 25 patients.

In the report, which was submitted to MOH on Saturday and subsequently
accepted by the ministry, the committee also identified breaches in
infection control as the likely cause of the cluster.

The committee, which was formed in late September, said the HCV cluster
highlighted a gap in the current system response to outbreaks, as the
virus is an “unusual” healthcare-associated infection and not picked up
easily through the current national surveillance system due to its unique
characteristics. The committee said SGH did not investigate and manage the
outbreak optimally.

It observed that the SGH renal team did not recognise the four cases
detected in mid-May as an outbreak, due to HCV’s unusual nature, and the
fact that SGH had changed its HCV screening test in 2014 to a more
sensitive one – thus picking up cases that the older test could not.

This led to the SGH renal team’s failure to immediately report that cases
to SGH’s infection control unit.

Also, overall outbreak investigations performed by SGH were inadequate
when the hospital briefed MOH’s Director of Medical Services, Associate
Professor Benjamin Ong, on Sep 3, said the IRC.

Assoc Prof Ong therefore had to ask for additional investigation and
action to be undertaken within the next two weeks.

The committee added that when faced with the uncommon and unfamiliar event
of an HCV cluster, SGH showed a lack of clarity on roles and
responsibilities for the management of such infection outbreaks.

DELAYED ESCALATION

The absence of an established framework for such unusual and unfamiliar
events resulted in delays in the escalation processes within and from SGH
to MOH, according to the report.

The committee said that SGH was focused on putting in place infection
control measures before escalating to MOH, as it was working within the
existing paradigm where the management of healthcare-associated infections
is the responsibility of the hospital, and that SGH was taking
responsibility before informing MOH.

In response to the question of whether earlier escalation and action might
have resulted in fewer deaths and infections, the committee noted that the
tightening of infection control measures by SGH from early June had slowed
the spread of HCV, but unless MOH had been informed very much earlier, the
outcome in the affected wards might not be substantially different.

“On hindsight, it’s easy to say that. It remains a plausible suggestion
but it’s difficult for us to be very specific about outcomes we can draw
from that,” said Prof Leo during the question-and-answer session.

Nonetheless, said the IRC, earlier escalation to MOH could have helped SGH
in investigation and case finding, including the earlier recall of
patients for screening, additional epidemiological resources and earlier
validation of phylogenetic test results.

There was also no evidence of deliberate delay by SGH or MOH staff in
escalating the outbreak or informing Minister for Health Gan Kim Yong on
Sep 18, said the IRC.

The decision made by Assoc Prof Ong on Sep 3 to ask SGH to complete key
aspects of investigation was professionally valid and appropriate, said
the IRC, as judgement had to be made regarding the severity of cluster and
steps for containment, and the additional info Assoc Prof Ong had asked of
SGH was essential in making an informed decision.

The committee also said it found no evidence to suggest there were
political considerations in not informing Minister Gan earlier, and that
all officers acted professionally and ethically.

In its report, the IRC also noted that not all cases of HCV infections
were reported by doctors and laboratories to MOH; and even then, notified
cases were not classified by the Ministry as acute HCV infections, due to
prevailing definitions at the time.

The lack of a specific division within MOH to oversee outbreaks of such
unusual infections, said the committee, also hindered its ability to
respond in a timely way to the event.

The IRC comprised of the following members:

– Prof Leo Yee Sin (Chairman) – Director and Clinical Director, Tan Tock
Seng Hospital
– Prof Lim Seng Gee – Senior Consultant, Division of Gastroenterology and
Hepatology, Department of Medicine at the National University Hospital
(NUH)
– Assoc Prof Helen Oh – Head of Infectious Diseases at Changi General
Hospital (CGH)
– Dr Titus Lau – Senior Consultant, Division of Nephrology at NUH
– Ms Paulin Koh – Chief Nurse at CGH
– Assoc Prof Quek Swee Chye – Deputy Chairman of the Medical Board at NUH
– Dr Jeffrey Cutter – Director (Communicable Disease Division) at MOH

Also present at the press conference on Tuesday were Assistant Professor
Angela Chow, Head of the Department of Clinical Epidemiology at TTSH’s
Institute of Infectious Disease and Epidemiology, and Professor Tan Chorh
Chuan, President of the National University of Singapore. They were
appointed as resources for the IRC to tap on during the review.

– CNA/xq
__________________________________________________________________

Video and more at the link:
www.channelnewsasia.com/news/singapore/sgh-hep-c-cluster/2328078.html
__________________________________________________________________
__________________________________________________________________

https://tinyurl.com/jlvekl7
Singapore: SGH Hepatitis C cluster: Police rule out foul play

Singapore General Hospital lodged a police report in October after 25
patients at its renal ward tested positive for Hepatitis C.

Channel News Asia (08.12.15)

SINGAPORE: The police have ruled out foul play after Singapore General
Hospital (SGH) reported a Hepatitis C cluster at its renal ward.

“Pursuant to the police report lodged by the Singapore General Hospital on
Oct 20, 2015, in relation to the Hepatitis C cluster, police
investigations have not revealed evidence to suggest any foul play,” said
the police in a statement on Tuesday (Dec 8).

“The Police have submitted their findings to the Attorney-General’s
Chambers for review. The findings have also been shared with the
Independent Review Committee (IRC) appointed by the Ministry of Health.”

In October, SGH announced that 25 patients in its renal ward had
contracted the virus, and subsequently lodged a police report. The
hospital has screened hundreds of patients and staff, following the
discovery of the cluster.
__________________________________________________________________
__________________________________________________________________

https://tinyurl.com/zgxx4s3
New Zealand: Needles found in recycling in New Plymouth

Taranaki Daily News, Taranaki New Zealand (06.12.15)

Ratepayers around Taranaki are being warned for using their recycling bins
for rubbish, including disposing of things like medical waste and needles.

Since the region’s new recycling system and plant opened on October 1
about nine per cent of all of the recycling that has been picked up has
been “contaminated”.

In October 610 tonnes of recycling was collected from around the region,
but 54.9 tonnes of that was actually rubbish.

Nine per cent of the recycling being collected in Taranaki is actually
rubbish.

New Plymouth District Council’s manager of water and waste Mark Hall said
items likes household electronics, polystyrene, plastic bags and even
needles were becoming noticeable.

“People also put in chunky items of metals and bits of car parts for
example. They don’t go through here. They are better in the scrap metal
bin,” Hall said.

In one visit to the recycling plant, or the Materials Recovery Facility,
Hall discovered a vacuum cleaner, a garden hose, a metal tape measure and
a large pile of paper towels covered in what looked like it could have
been blood.

“I don’t know what that paper has been used to wipe up, but that is gross
contamination. We’ll probably know where it comes from.

“Generally if it’s one or two things and it’s what we call minor
contamination, then that’s OK, it’s basically accidental stuff. But when
it’s gross contamination or repeated gross contamination that’s
different.”

Hall said after only two months of the new collection system and the new
plant staff were already beginning to notice trends and identify repeat
offenders.

“What people might be interested to know is that every bit of a truck’s
trip is recorded on GPS and when contamination is spotted, because we have
a camera and can see it going in, they push a button to record the
contamination.”

Hall said already stickers were being put on the recycling bins, letting
people know what they had put out at the gate was not recyclable and
asking them not to do it again.

“You have a friendly reminder, then you have another reminder and then you
have a red sticker staying we won’t be picking up your bin because of
repeated contamination.

“I don’t think we’ve actually banned anyone just yet, but we’ve certainly
given out some stickers.”

Hall said he believed some of the contamination was genuinely a mistake,
but some of it could be deliberate.

Either way, staff had to sort through the recycling to separate the non
recyclables and get them ready for landfilling or disposal.

Despite the contamination issue, Hall said he was impressed with the way
ratepayers across Taranaki had embraced the new kerbside collection
system.

“I think they are being really enthusiastic, it’s great. It’s probably the
biggest change in our solid waste system in 22 years.

“There were some teething issues there around the changing of rubbish
days, the changing of methodology, getting the right container on the
right day, things like that.

“But people have cottoned on to this pretty quick and the feedback has
been very positive.”

For anyone who is unsure about what is recyclable, there is a recycling
search available on the council’s website and smart phone app (NPDC
Rubbish and Recycling) that can help with determining what is recyclable.

– Stuff
__________________________________________________________________
__________________________________________________________________

https://tinyurl.com/parho7n
Cambodia: Unlicensed Cambodian doctor gets 25 years in prison for
spreading HIV with dirty needles

Author: Associated Press.

(AP) — A Cambodian court has sentenced an unlicensed medical practitioner
to 25 years in prison after finding him responsible for infecting more
than 100 villagers with HIV, the virus that causes AIDS, by reusing
unsanitized syringes. At least 10 of the infected people have died.

A spokesman for the court in the northwestern province of Battambang said
Yem Chrin was found guilty Thursday of torture and cruel behavior
resulting in death, intentionally spreading HIV and practicing medicine
without a license.

Yem Chrin was arrested in December last year and taken into protective
custody, with the authorities fearing he might be lynched by residents of
Roka village, where at least 106 of the 800 people tested were found to be
infected with HIV. Local newspapers reported the total was 300.
__________________________________________________________________
__________________________________________________________________

https://www.koreatimes.co.kr/www/news/nation/2015/12/116_191945.html
Korea: Clinic operation suspended for mass infection

By Chung Hyun-chae, Korea Times, Seoul Korea (27.11.15)

Photo: Dana Hyeondae Clinic in Yangcheon District, southwestern Seoul, has
been closed after a number of patients are confirmed to have been infected
by hepatitis C through reuse of syringes. / Yonhap

Hepatitis C infection caused by dirty needles

By Chung Hyun-chae,

Health authorities have suspended the operation of Dana Hyeondae Clinic in
Seoul, and its doctor’s license, after many patients were infected with
hepatitis C.

The infection happened due to syringe recycling, and the doctor’s wife
conducted medical procedures without a license in place of the doctor,
according to the Korea Centers for Disease Control and Prevention (KCDC),
Friday.

The doctor, surnamed Kim, 52, told authorities that he had reused syringes
since 2012 after he suffered brain damage following a car accident.

The KCDC confirmed that Kim had been affected by the accident, suffering
from a speech impediment and hand tremors, legally recognized as a minor
brain disorder _ an improper condition for him to continue practicing
medicine on patients.

“Kim has difficulty standing up and sitting down by himself, and his wife
helps him in his everyday life,” an official from Yangcheon Health Center
said.

“But suffering from the effects of brain damage cannot be an excuse for
improper medical procedures and poor infection management,” the official
said.

A former nurse at the clinic, however, said that they reused syringes
before 2012.

“As staffers there tell different stories, we are investigating all 2,268
patients who have visited the clinic since it opened in 2008,” a KCDC
official said.

Questions remain as to why the clinic was reusing syringes, as such
recycling does not help hospitals save much in costs.

“There is the possibility that someone who is not a specialist or without
a license reused syringes while practicing medicine instead of the
disabled doctor,” the KCDC official said.

Investigators already secured testimony and evidence that the doctor’s
wife practiced medicine such as instructing nurses to collect patients’
blood.

The KCDC filed a complaint with police against the couple for violating
medical law.

The authorities are also conducting tests for hepatitis B, human
immunodeficiency virus (HIV), malaria and syphilis, besides testing for
hepatitis C. So far, they have tested about 600 people.

The number of people who have been confirmed to have hepatitis C after
receiving intravenous injections at the hospital increased to 67 as of
Friday.

Health authorities plan to demand reimbursement from the clinic for
expenses related to its investigation.

Following the infections, people are demanding a change in the medical
licensing management system, saying that current regulations are too
loose, especially without thoroughly checking whether the doctors are
physically and mentally eligible to practice medicine.

Under the system, doctors can maintain their licenses only if they receive
24 hours of training given by the Korean Medical Association and the
Association of Korean Medicine every three years.

Related laws only prohibit the mentally ill from becoming accredited
medical personnel.

“The training is so simple, just like renewing a driver’s license,” a
medical professional said. “The system focuses on doctors’ knowledge, so
it cannot check their physical and mental health conditions.”
__________________________________________________________________
________________________________*_________________________________

New WHO Injection Safety Guidelines

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

The new guideline is:

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

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

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

This is an illustrated summary brochure for the general public.

pdf, 554kb [6 pages]

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

SIGN Meeting 2015

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The SIGNpost Website is http://SIGNpostOnline.info

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

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

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

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

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

The SIGN Forum is moderated by Allan Bass and is hosted on the University
of Queensland computer network. http://www.uq.edu.au
__________________________________________________________________

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