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SIGNpost 00833

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST

Post00833 CU 6 Jan 2016 + SDGs + Abstracts+ News   16 December 2015

CONTENTS
0. Moderators Note – SIGNpost returns on 6 January 2016
1. 2015 Highlights: New injection safety policy and global campaign
2. WHO launches new report: “Health in 2015: from MDGs to SDGs”
3. Abstract: Attitude, reporting behavour and management practice of
occupational needle stick and sharps injuries among hospital healthcare
workers in Bale zone, Southeast Ethiopia: a cross-sectional study
4. Extract: Patterns of Needlestick and Sharps Injuries Among Training
Residents
5. Abstract: Chronic hepatitis B virus in the Philippines
6. Abstract: Intravitreal Injection-Technique and Safety
7. Abstract: Usefulness of intra-articular botulinum toxin injections. A
systematic review
8. Abstract: Factors Affecting Hand Hygiene Adherence at a Private
Hospital in Turkey
9. Extract: New cases of HIV in Europe reach highest level since 1980s
10. News
– Singapore:Why It Matters: Report on hepatitis C outbreak at Singapore
General Hospital
– USA: Parents Angry After Needle-Sticking Incident At Philadelphia
Elementary School
– Needlestick injuries most common in first six months of residency

The web edition of SIGNpost is online at:
http://signpostonline.info/archives/1955

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!
__________________________________________________________________
________________________________*_________________________________

0. Moderators Note – SIGNpost returns on 6 January 2016
__________________________________________________________________

This is the last edition of SIGNpost for 2015.

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. 2015 Highlights: New injection safety policy and global campaign
__________________________________________________________________

http://www.who.int/injection_safety/en/
New injection safety policy and global campaign
Each year, at least 16 billion injections are given worldwide. Reused
equipment poses a continued challenge, particularly in developing
countries.

WHO and the Safe Injection Global Network (SIGN) have a new initiative to
address this, promoting the rational and safe use of injections. Key
initiative objectives are:

(1) to prevent reuse and needle-stick injuries through global
communication campaigns and health-care worker training;

(2) to better ensure injection safety through the use of safety engineered
injection devices; and

(3) to leverage past WHO SIGN network findings.

New guidelines
www.who.int/injection_safety/global-campaign/injection-safety_guidline.pdf
pdf, 826kb

More on injection safety policy and global campaign
http://www.who.int/injection_safety/global-campaign/en/

Read the press release on smart syringes
http://www.who.int/mediacentre/news/releases/2015/injection-safety/en/
__________________________________________________________________
________________________________*_________________________________

2. WHO launches new report: “Health in 2015: from MDGs to SDGs”

WHO today launched a new comprehensive analysis of global health trends
since 2000 and an assessment of the challenges for the next 15 years.
__________________________________________________________________

http://www.who.int/mediacentre/news/releases/2015/mdg-sdg-report/en
From MDGs to SDGs, WHO launches new report

WHO News release

8 DECEMBER 2015 | GENEVA – WHO today launched a new comprehensive analysis
of global health trends since 2000 and an assessment of the challenges for
the next 15 years.

“Health in 2015: from MDGs to SDGs” identifies the key drivers of progress
in health under the United Nations Millennium Development Goals (MDGs). It
lays out actions that countries and the international community should
prioritize to achieve the new Sustainable Development Goals (SDGs), which
come into effect on 1 January 2016.

Report: “Health in 2015: from MDGs to SDGs”
The 17 SDGs are broader and more ambitious than the MDGs, presenting an
agenda that is relevant to all people in all countries to ensure that “no
one is left behind.” The new agenda requires that all 3 dimensions of
sustainable development – economic, social and environmental – are
addressed in an integrated manner.

Universal health coverage to achieve health related goals

Almost all the SDGs are directly related to health or will contribute to
health indirectly. One goal (SDG3) specifically sets out to “Ensure
healthy lives and promote well-being for all at all ages.” Its 13 targets
build on progress made on the MDGs and reflect a new focus on
noncommunicable diseases and the achievement of universal health coverage.

“Universal health coverage cuts across all of the health-related goals,”
says Dr Marie-Paule Kieny, Assistant Director-General of Health Systems
and Innovation at WHO. “It is the linchpin of development in health and
reflects the SDGs strong focus on equity and reaching the poorest, most
disadvantaged people everywhere.”

Although the health MDGs missed a number of global targets, the overall
results were impressive. The past 15 years witnessed major declines in
child and maternal mortality and progress in the fight against HIV, TB and
malaria in developing countries.

Key ingredients for success included a doubling in global funding for
health, the creation of new funding mechanisms and partnerships, and the
critical role of civil society in tackling diseases such as HIV/AIDS.
Research investments led to the scale-up in all countries of new
interventions such as antiretroviral therapy for HIV treatment and
insecticide-treated bednets to prevent malaria.

Health and the SDGs

The WHO report presents the latest data and in-depth analysis for the key
areas outlined in the health SDGs:

* reproductive, maternal, newborn, child and adolescent health;

* infectious diseases including HIV, tuberculosis, malaria, hepatitis and
neglected tropical diseases;

* noncommunicable diseases (NCDs) including heart disease, cancer and
diabetes;

* mental health and substance use including narcotics and harmful use of
alcohol;

* injuries and violence; and

* universal health coverage.

“Snapshots” on 34 different health topics outline trends, achievements
made, reasons for success, challenges and strategic priorities for
improving health in the different areas. These “snapshots” range from air
pollution to hepatitis to road traffic injuries.

In this report, WHO also explores how health contributes to and benefits
from the other 16 SDGs and examines the implications of emerging issues
such as technological and environmental change on global health.

WHO’s work aligned with SDG health targets

The SDG health-related targets closely reflect the main priorities in
WHO’s programme of work for 2014-2019; many of these targets have already
been agreed by Member States in the World Health Assembly. For example,
the global voluntary targets for the prevention and control of
noncommunicable diseases set in 2013 are closely linked to SDG Target 3.4,
to reduce premature NCD mortality by one third by 2030. The WHO governing
bodies will have a critical role in follow-up and review of implementation
of the health-related SDGs.

“One of the biggest challenges will be measuring progress across a
staggering number of targets, particularly with the lack of health data in
developing countries,” says Dr Kieny. The SDG monitoring requires regular,
high-quality data, for example on the causes of death, from all population
groups so that we know where we need to target resources.”

WHO is working with partners to establish a Health Data Collaborative in
early 2016 that aims to support countries to build better health data
systems. An early product of this global collaboration is the “WHO Global
Reference List of 100 Core Indicators”, published earlier this year, which
is already being used to guide work in many countries.

“As the global agency with the mandate to cover the whole health agenda,
WHO will take a leading role in supporting countries to set their own
national targets and strategies, advising on best-buy interventions,
defining research priorities and monitoring progress in achieving the
health-related SDGs,” says Dr Kieny.

In 2016, WHO will publish the first in a series of annual reports on the
SDGs to set the baseline and measure progress towards achieving the goals
over the next 15 years.
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Attitude, reporting behavour and management practice of
occupational needle stick and sharps injuries among hospital healthcare
workers in Bale zone, Southeast Ethiopia: a cross-sectional study
__________________________________________________________________

http://www.occup-med.com/content/10/1/42 Open Access Free Full Text

J Occup Med Toxicol. 2015 Dec 3;10:42.
Attitude, reporting behavour and management practice of occupational
needle stick and sharps injuries among hospital healthcare workers in Bale
zone, Southeast Ethiopia: a cross-sectional study.

Bekele T1, Gebremariam A2, Kaso M1, Ahmed K1.

1Department of Public Health, College of Medicine and Health Sciences,
Madda Walabu University, Oromia, Ethiopia.
2Department of Public Health, College of Medicine and Health Sciences,
Adigrat University, Adigrat, Tigray Ethiopia.

BACKGROUND: Although the prevalence of blood borne pathogens in many
developing countries is high, documentation of infections due to
occupational exposure is limited. Seventy percent of the world’s HIV
infected population lives in Sub-Saharan Africa, but only 4 % of cases are
reported from this region. Under reporting of needle stick and/or sharps
injuries in healthcare facilities was common.

METHODS: An institutional based cross-sectional study was conducted in
December 2014 among healthcare workers in four hospitals of Bale zone,
Southeast Ethiopia. A total of 362 healthcare workers were selected
randomly from each of the working departments. Data were collected using
self-administered questionnaire and were entered using Epi-Info version
3.5 and analysed using SPSS version 20.0. Multivariable logistic
regression analysis was used to identify independent effect of each
variable on the reporting behaviour of needle stick and/or sharp injury.

RESULTS: Nearly six out of ten injuries (58.7 %) were not reported to the
concerned body. The main reasons for not reporting the injuries were time
constraint (35.1 %), sharps which caused injury were not used on any
patient (27.0 %), the source patients did not have disease of concern
(20.3 %), and lack of knowledge that it should be reported (14.9 %).

Half of healthcare workers (HCWs) those who experienced injury had sought
medical care next to self based action. Respondents with monthly salary of
450 to 1000 Ethiopian Birr (1 US Dollar = 22.00 Ethiopian Birr) were about
six times more likely to report occupational needle stick and/or sharps
injury (NSSI) than HCWs with salary of 2001 to 8379 birr (AOR?=?5.73).
However, HCWs who had no knowledge about probability of infection
transmission through NSSI and not taking any self based measures after
occurrence of injury were 45 % (AOR = 0.55) and 93 % (AOR = 0.07) less
likely to report occupational injury than their counterparts,
respectively.

CONCLUSIONS: Occupational needle stick and/or sharps injuries are common
among HCWs at the study area. Even though majority of respondents were
concerned about the risk of NSSI exposure, most respondents did not report
it to the concerned body. Therefore, provision of on job training on the
risk of occupational NSSI exposure may strengthen HCWs to practice timely
reporting and its management in case of occupational injury exposure.

KEYWORDS: Bale zone; Ethiopia; Healthcare workers; Injury; Oromia;
Reporting behavior

http://www.occup-med.com/content/10/1/42 Open Access Free Full Text
__________________________________________________________________
________________________________*_________________________________

4. Extract: Patterns of Needlestick and Sharps Injuries Among Training
Residents
__________________________________________________________________

https://archinte.jamanetwork.com/article.aspx?articleid=2472945

JAMA Intern Med. 2015 Dec 7:1-2.
Patterns of Needlestick and Sharps Injuries Among Training Residents.

Marnejon T1, Gemmel D2, Mulhern K3.

1St Elizabeth Health Center, Departments of Medical Education and Internal
Medicine, Youngstown, Ohio2Northeastern Ohio Medical University,
Rootstown3Lake Erie College of Osteopathic Medicine, Erie,
Pennsylvania4Ohio University Heritage College of Osteopat.
2St Elizabeth Health Center, Departments of Medical Education and Internal
Medicine, Youngstown, Ohio.
3Northeastern Ohio Medical University, Rootstown.

This observational study analyzes the incidence of needlestick and sharps
injuries reported by medical residents between January 2000 and June 2014
trained at a US hospital.

Needlestick and sharps injuries (NSIs), a common occupational hazard for
health care workers, are serious due to seroconversion risk. According to
the US Centers for Disease Control and Prevention, more than 385?000
needlestick injuries occur annually among US hospital employees.1 Current
research on residents is sparse and conflicting. Needlestick and sharps
injuries have been reported highest during the first postgraduate year
(PGY),2- 5 but studies have relied on self-reported data or a small sample
of residents in single institutions. Other investigations have not found a
pattern of NSIs by PGY level.6- 8 This study systematically examined
whether NSIs varied by PGY level and described patterns of NSIs among
house staff.

[ Image of first page with illustration https://tinyurl.com/nmtoe6f ]
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Chronic hepatitis B virus in the Philippines
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/26643262

J Gastroenterol Hepatol. 2015 Dec 8.
Chronic hepatitis B virus in the Philippines.

Gish RG1,2,3,4, Sollano JD Jr5, Lapasaran A6, Ong JP7.

1Department of Medicine, Division of Gastroenterology and Hepatology,
Stanford University, Stanford, California, USA.
2Hepatitis B Foundation, Doylestown, Pennsylvania, USA.
3National Viral Hepatitis Roundtable, San Francisco, California, USA.
4FAIR Foundation, Palm Desert, California, USA.
5Section of Gastroenterology, University of Santo Tomas, Manila,
Philippines.
6Schools of Nursing and Medicine, University of Nevada-Reno, Reno, Nevada,
USA.
7Section of Gastroenterology, Department of Medicine, University of the
Philippines-Philippine General Hospital, Manila, Philippines.

Multiple studies have shown a high prevalence of chronic hepatitis B (CHB)
infection in the Philippines, not only in high-risk populations but also
in the general population. The most recent national study estimated HBsAg
seroprevalence to be 16.7%, corresponding to an estimated 7.3 million CHB
adults.

The factors underlying the high prevalence of CHB and its sequelae include
the inadequate use of vaccination for prevention and the lack of treatment
for many Filipinos.

Since without medical monitoring and treatment of CHB the risk of
progression to liver failure and death is 25-30%, the ultimate medical and
societal costs will be very high if the Philippines fails to properly
address hepatitis B infection. It will be very important to move forward
with programs that can help to ensure universal vaccination of newborns,
screening and vaccination nationwide, and monitoring and treatment for CHB
persons.

*** It will also be crucial to address transmission of HBV in the health
care setting (via contaminated needles, syringes, and inadequately
sterilized hospital equipment) and via injection drug use and tattooing.

Because of the relatively low average per capita income and the lack of
coverage by PhilHealth of outpatient visits and medications, there is an
urgent need to move forward with a nationally supported program that
includes education for both the general public and healthcare workers on
liver disease and screening for hepatitis viruses, followed by, as
appropriate, vaccination or treatment, with expanded government coverage
for these for all those who could not otherwise afford it.

This article is protected by copyright. All rights reserved.

KEYWORDS: HBsAg prevalence; chronic hepatitis B; epidemiology; hepatitis
B; screening; surveillance; treatment; vaccination
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Intravitreal Injection-Technique and Safety
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/26649760

Asia Pac J Ophthalmol (Phila). 2015 Dec 8.
Intravitreal Injection-Technique and Safety.

Lai TY1, Liu S, Das S, Lam DS.

1From the *Department of Ophthalmology and Visual Sciences, The Chinese
University of Hong Kong, Ma Liu Shui; †2010 Retina and Macula Centre;
‡Dennis Lam & Partners Eye Center, Kowloon, Hong Kong; §C-MER (Shenzhen)
Dennis Lam Eye Hospital, Shenzhen; and ?State Key Laboratory of
Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University,
Guangzhou, People’s Republic of China.

Intravitreal (IVT) injection of therapeutic agents has become one of the
most commonly performed procedures in ophthalmology. Over the past decade,
a number of guidelines have been published that recommend proper
techniques to increase the safety of IVT injections.

Among the various complications of IVT injections, endophthalmitis can be
sight threatening.

The reported endophthalmitis rates after IVT injection range from 0.020%
to 0.085%, which are higher than what would be expected from a simple,
fast, and relatively atraumatic procedure. The 2 key issues involved in
the prevention of endophthalmitis are pre-IVT injection disinfection using
povidone-iodine (PVI) and the use of topical antibiotics as prophylaxis.
Whereas 5% PVI for 5 minutes is most commonly used in cataract surgery for
disinfection, the duration in IVT injection is much less and can be as
short as 30 seconds.

Further studies seem warranted to investigate whether longer duration of
PVI application in IVT injection can lower the endophthalmitis rate.
Recent data suggest that there is inadequate evidence to support the
routine use of prophylactic pre-, peri-, or postinjection antibiotics to
reduce the risk of endophthalmitis.

However, as many confounding factors such as the PVI regimens were not
standardized in previous studies, it is too soon to make a concrete
conclusion. Despite the availability of published guidelines, considerable
variations still exist in real-life clinical situations.

In this article, we describe our IVT injection practice protocol and
compare it with the most recent international guidelines. Finally, a
summary table that shows the clinical features of true, sterile, and
pseudoendophthalmitis is presented.
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Usefulness of intra-articular botulinum toxin injections. A
systematic review
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/26645160

Joint Bone Spine. 2015 Nov 29. pii: S1297-319X(15)00238-9.
Usefulness of intra-articular botulinum toxin injections. A systematic
review.

Khenioui H1, Houvenagel E2, Catanzariti JF3, Guyot MA4, Agnani O4, Donze
C4.

1Service de médecine physique et de réadaptation, centre hospitalier
Saint-Philibert, groupe hospitalier de l’institut catholique de Lille,
115, rue du Grand-But, BP 249, 59462 Lomme cedex, France; Université Nord
de France, 1, rue Lefèvre, 59000 Lille, France; Université catholique de
Lille, 60, boulevard Vauban, 59800 Lille, France. Electronic address:
Khenioui.Hichem@ghicl.net.
2Université Nord de France, 1, rue Lefèvre, 59000 Lille, France;
Université catholique de Lille, 60, boulevard Vauban, 59800 Lille, France;
Service de rhumatologie, centre hospitalier Saint-Philibert, groupe
hospitalier de l’institut catholique de Lille, 115, rue du Grand-But, BP
249, 59462 Lomme cedex, France.
3Service de médecine physique et de réadaptation, centre hospitalier
Saint-Philibert, groupe hospitalier de l’institut catholique de Lille,
115, rue du Grand-But, BP 249, 59462 Lomme cedex, France; Université Nord
de France, 1, rue Lefèvre, 59000 Lille, France; Service de rhumatologie,
centre hospitalier Saint-Philibert, groupe hospitalier de l’institut
catholique de Lille, 115, rue du Grand-But, BP 249, 59462 Lomme cedex,
France; Service de médecine physique et réadaptation, centre de SSR
pédiatrique Marc-Sautelet, 10, rue du Petit-Boulevard, 59650 Villeneuve-
d’Ascq, France.
4Service de médecine physique et de réadaptation, centre hospitalier
Saint-Philibert, groupe hospitalier de l’institut catholique de Lille,
115, rue du Grand-But, BP 249, 59462 Lomme cedex, France; Université Nord
de France, 1, rue Lefèvre, 59000 Lille, France; Service de rhumatologie,
centre hospitalier Saint-Philibert, groupe hospitalier de l’institut
catholique de Lille, 115, rue du Grand-But, BP 249, 59462 Lomme cedex,
France.

Botulinum toxin is a proven and widely used treatment for numerous
conditions characterized by excessive muscular contractions. Recent
studies have assessed the analgesic effect of botulinum toxin in joint
pain and started to unravel its mechanisms.

LITERATURE-SEARCH-METHODOLOGY: We searched the international literature
via the Medline database using the term “intraarticular botulinum toxin
injection” combined with any of the following terms: “knee”, “ankle”,
“shoulder”, “osteoarthritis”, “adhesive capsulitis of the shoulder”.

RESULTS: Of 16 selected articles about intraarticular botulinum toxin
injections, 7 were randomized controlled trials done in patients with
osteoarthritis, adhesive capsulitis of the shoulder, or chronic pain after
joint replacement surgery. Proof of anti-nociceptive effects was obtained
in some of these indications and the safety and tolerance profile was
satisfactory. The studies are heterogeneous. The comparator was usually a
glucocorticoid or a placebo; a single study used hyaluronic acid. Pain
intensity was the primary outcome measure.

DISCUSSION-CONCLUSION: The number of randomized trials and sample sizes
are too small to provide a satisfactory level of scientific evidence or
statistical power. Unanswered issues include the effective dosage and the
optimal dilution and injection modalities of botulinum toxin. Copyright ©
2015 Société française de rhumatologie. Published by Elsevier SAS. All
rights reserved.

KEYWORDS: Adhesive capsulitis of shoulder; Botulinum toxin; Intra
articular injection; Osteoarthritis; Rheumatology
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Factors Affecting Hand Hygiene Adherence at a Private
Hospital in Turkey
__________________________________________________________________

http://www.eajm.org/eng/makale/2822/200/Full-Text Free Full Text

Eurasian J Med. 2015 Oct;47(3):208-12.

Factors Affecting Hand Hygiene Adherence at a Private Hospital in Turkey.

Teker B1, Ogutlu A2, Gozdas HT3, Ruayercan S1, Hacialioglu G1, Karabay O2.

1Infection Control Committee, Private Nisa Hospital, Istanbul, Turkey.
2Department of Infectious Diseases and Clinical Microbiology, Sakarya
University Faculty of Medicine, Sakarya, Turkey.
3Department of Infectious Diseases and Clinical Microbiology, Dr. Münif
Islamoglu Kastamonu State Hospital, Kastamonu, Turkey.

OBJECTIVE: Nosocomial infections are the main problems rising morbidity
and mortality in health care settings. Hand hygiene is the most effective
method for preventing these infections. In this study, we aimed to
investigate the factors related with hand hygiene adherence at a private
hospital in Turkey.

MATERIALS AND METHODS: This study was conducted between March and June
2010 at a private hospital in Turkey. During the observation period,
employees were informed about training, then posters and images were
hanged in specific places of the hospital. After the initial observation,
training on nosocomial infections and hand hygiene was provided to the
hospital staff in March 2010. Contacts were classified according to
occupational groups and whether invasive or not. These observations were
evaluated in terms of compatibility with hand hygiene guidelines.

RESULTS: Hand hygiene adherence rate of trained doctors was higher than
untrained ones before patient contact and after environment contact [48%
(35/73) versus 82% (92/113) p<0.05 and 23% (5/22) versus 76% (37/49)
p<0.05 respectively]. Hand hygiene adherence rate of trained nurses was
higher than untrained ones before patient contact [63% (50/79) versus 76%
(37/49) p<0.05]. Hand hygiene adherence rate of trained assistant health
personnel was higher than untrained ones before asepsis [20% (2/10) versus
73% (16/22) p<0.05]. In addition, it was seen that hand antiseptics were
used when hand washing was not possible.

CONCLUSION: The increase at the rate of hand washing after training
reveals the importance of feedback of the observations, as well as the
training. One of the most important ways of preventing nosocomial
infections is hand hygiene training that should be continued with
feedbacks.

KEYWORDS: Hand hygiene adherence; feedback; observation; training
__________________________________________________________________
________________________________*_________________________________

9. Extract: New cases of HIV in Europe reach highest level since 1980s
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/26613746

BMJ. 2015 Nov 26;351:h6419.

New cases of HIV in Europe reach highest level since 1980s.

Wise J1.

1London.
__________________________________________________________________

Extract

Europe has recorded the highest number of new HIV cases ever, and most of
the growth came from eastern European countries, figures have shown.

Surveillance data released by the European Centre for Disease Prevention
and Control and the World Health Organization’s Regional Office for
Europe1 showed that 142?197 people had HIV newly diagnosed in 2014, the
highest number recorded since reporting began in the 1980s. Some 77% of
these new cases were diagnosed in the east of the region.

Since 2005 the rates of new diagnoses have … [payment required]
__________________________________________________________________
________________________________*_________________________________

10. News

– Singapore: Why It Matters: Report on hepatitis C outbreak at Singapore
General Hospital

– USA: Parents Angry After Needle-Sticking Incident At Philadelphia
Elementary School

– Needlestick injuries most common in first six months of residency

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/zqzdbfw Full video at the link
Singapore: Why It Matters: Report on hepatitis C outbreak at Singapore
General Hospital

By Salma Khalik, The Straits Times, Singapore (10.12.15)

The Straits Times senior health correspondent Salma Khalik discusses with
digital news editor Ernest Luis how thorough the Independent Review
Committee’s probe report was for the Hepatitis C cluster at Singapore
General Hospital, what actions will be taken next, and the wider national
implications for the public and healthcare professionals.
__________________________________________________________________
__________________________________________________________________

https://tinyurl.com/hkoclat

USA: Parents Angry After Needle-Sticking Incident At Philadelphia
Elementary School
By Annie McCormick, WPVI TV, Philadelphia PA USA (10.12.15)

SPRING GARDEN (WPVI) — Action News found parental outrage Thursday at a
Philadelphia elementary school, two days after a second-grader brought
hypodermic needles to school with her.

Officials say five students were stuck with the needles when the 7-year-
old girl brought them to school in the city’s Spring Garden section.

All but one of the students were back at school the following day.

But parents dropping their children off at George Meade Elementary School
Thursday morning were upset.

Some said they weren’t properly informed.

“We didn’t know about it until this morning,” said parent Stacey Smith,
adding she never got a letter from the school. “To see it on the news is a
shock,” said parent Hakim Bryant. Asa Carey of North Philadelphia said he
found out from his little sister who was in the classroom during the
incident, but was unharmed. “My little sister was telling me about the
little girl was running and chasing the little kids, and they were
screaming and telling the teacher to come here she has a needle,” said
Carey.

Wednesday night one boy told Action News the girl with the needles chased
the students like she was playing a game.

“Whoever’s kid it is, they should’ve checked their book bags before they
came in,” said parent Lashonda Peterson.

Peterson’s daughter, one of the five injured, was stuck in the back. The
8-year-old girl now has to get tested regularly to see if she contracted
anything. “Now I have to worry about if the needle was clean or if the
needle was dirty,” she said. “I hope it was clean!”

Asked if the syringes contained anything, Philadelphia School District
spokesman Fernando Gallard responded, “We don’t know that. We do know they
came from the child’s home.”

Philadelphia police are investigating the case and are interviewing
everyone involved, including parents.

The school district says it immediately called the parents of the students
who were injured, and called parents of students in the vicinity of the
incident the next day.

School officials say they also sent letters home with the children.

“The principal is doing everything she can, but she’s just one person,”
said parent Lekya Davis. “My point is, a parent has to do a job, too.”

Counselors are on hand for all students at the school, including the
little girl who brought the needles. She is too young to face any charges.

Detectives are investigating if anyone gave her the needles or if there
was any negligence that led to her bringing them to school.
__________________________________________________________________
__________________________________________________________________

https://tinyurl.com/hcl2npy

Needlestick injuries most common in first six months of residency
By Shayna Bejaimal, MD and James Jiang, MD, 2 Minute Medicine (09.12.15)

1. Dental, obstetric and gynecology and surgical residents were more
likely to incur needlestick injuries.

2. First-year residents in the first 6 months of training were at highest
risk for needlestick injuries.

Evidence Rating Level: 2 (Good)

Study Rundown: Healthcare professionals are at risk for needlestick
injuries (NSI), putting them at risk for highly infectious diseases, such
as HIV or hepatitis. It is important to understand the risk factors
associated with NSIs in order to decrease their frequency. This study
systematically examined whether NSIs varied by postgraduate year (PGY)
level, and described NSIs among hospital house staff of different
subspecialties.

Over half of all NSIs occurred in the PGY1, of which, 63% occurred within
the first 6 months of residency. Needlestick injuries were highest among
dental, obstetrics and gynecology, and surgical residents. Family medicine
residents were least likely to be injured. The most prevalent instrument
for NSIs was the suture needle. Other mechanisms include scalpels and
blood gas syringes. Of the few cases where patients had hepatitis, no
residents incurred seroconversion. Strengths of this study include
systematic examination to NSIs as previous studies were based on self-
report. It was also important to include dental residents, as they are an
often missed but high-risk resident population. Limitations include only
examining residents from a single training hospital. Further studies
powered to analyze risk of seroconversion in patients with hepatitis and
HIV would be of interest.

Click to read the study in JAMA Internal Medicine
https://archinte.jamanetwork.com/article.aspx?articleid=2472945

Relevant Reading: Risk of needlesticks and occupational exposures among
residents and medical students
https://archinte.jamanetwork.com/article.aspx?articleid=616436

In-Depth [cross-sectional study]: This study completed a cross-sectional
study of all NSIs by residents between January 2000 to June 2014 in Mercy
Health Youngstown Hospital. During this time, NSIs were analyzed to look
for incidence across different programs, PGY level, anatomical sites of
common NSIs, and prevalent instruments in NSIs. Statistical analysis
included X2 goodness-of-fit testing with a significance level of 0.05.

Over the 14-year study period, 129 NSIs were reported in residents – 67 in
PGY-1, 37 in PGY-2, 16 in PGY-3, 7 in PGY-4, and 2 in PGY-5. The incidence
of NSIs was higher than expected (X2 goodness-of-fit statistic = 15.889, p
= 0.003). Of those 67 NSIs in PGY-1, 62.7% occurred within the first 6
months of training. Dental residents had the highest rate of NSIs at 30.6%
(22 of 72 residents), followed by obstetrics and gynecology at 28.9% (13
of 45 residents) and surgical residents at 18.5% (41 of 222 residents).
Internal, transitional, and family medicine exhibited the lowest rates of
NSI. Common sites for NSIs were the left index finger and the left middle
finger. Instruments used during NSIs included suture needles (43.4%, n =
53), scalpels (11.6%, n = 15) and blood gas syringes (10.1%, n = 13).

Image: PD

©2015 2 Minute Medicine, Inc. All rights reserved.
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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]
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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
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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
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* 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
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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
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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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