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SIGNpost 00834

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST

Post00834   Reader Response + Devices + Abstracts + News    06 January 2016

CONTENTS
0. Moderators Note
1. Response to SIGN 00833 item #1 on safe injection policies
2. Abstract: Safety engineered injection devices for intramuscular,
subcutaneous and intradermal injections in healthcare delivery
settings: a systematic review and meta-analysis
3. Abstract: Hepatitis C oubreaks in Poland in 2003-2013. Medical
procedures as a dominant route of HCV transmission
4. Abstract: Incidence of percutaneous injury in Taiwan healthcare
workers
5. Abstract: Hepatitis-B Vaccination Status And Knowledge, Attitude
And Practice Of High Risk Health Care Worker About Body Substance
Isolation
6. Abstract: Level of knowledge among medical personnel about infections
transferred through direct contact–results of questionnaire survey
7. Abstract: Low vaccination coverage among italian healthcare workers in
2013
8. Abstract: Survey of occupational hazards in Minnesota veterinary
practices in 2012
9. Abstract: Diverse HIV epidemics among people who inject drugs in
Thailand: evidence from respondent-driven sampling surveys in Bangkok
and Chiang Mai
10. Abstract: Intimate injection partnerships are at elevated risk of
high-risk injecting: a multi-level longitudinal study of HCV-
serodiscordant injection partnerships in San Francisco, CA
11. Abstract: Safety of Epidural Corticosteroid Injections
12. Abstract: Pre-filled syringes: a review of the history, manufacturing
and challenges
13. Abstract: Assessment of hand hygiene techniques using the World Health
Organization’s six steps
14. Abstract: Predictors of hand hygiene practice among Saudi nursing
students: A cross-sectional self-reported study
15. Abstract: A hand hygiene compliance check system: brief communication
on a system to improve hand hygiene compliance in hospitals and reduce
infection
16. Abstract: Compounding with Silicones
17. News
– Philippines: The City at the Heart of the Philippines’s HIV Epidemic
– ‘Half’ of injecting drug users in Wales at Hepatitis C risk
– Australia: Southport family faces anxious wait after four-year-old had
hypodermic needle pulled from her foot
– Grandmother who was injected with a USED needle during flu jab faces
agonising six-month wait to see if she has HIV or hepatitis
– N.J. USA: Recycling workers getting pricked by Bayonne’s illegally
discarded needles
The web edition of SIGNpost is online at:
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and get updates on your device!
__________________________________________________________________
________________________________*_________________________________

0. Moderators Note
__________________________________________________________________
This is the first edition of SIGNpost for 2016.

We start this year with Joel Schoenfeld’s reponse to the recent post on
Safe Injection Policies in SIGNpost 00833

The abstract that follows is “Safety engineered injection devices for
intramuscular,subcutaneous and intradermal injections in healthcare
delivery settings: a systematic review and meta-analysis”

Free text at the link

http://bmcnurs.biomedcentral.com/articles/10.1186/s12912-015-0119-1
Very best wishes for a safe and productive 2016!
__________________________________________________________________
________________________________*_________________________________

1. Response to SIGN 00833 item #1 on safe injection policies

This response from Joel Schoenfeld was held over from 18 December 2015.

Joel was one of the early manufacturers of syringes with reuse prevention
features for immunization programs.
__________________________________________________________________
Joel Schoenfeld <Joelscho@me.com>
Date: Fri, Dec 18, 2015
Subject: SResponse to SIGN 00833 item #1 on safe injection policies
To: sign.moderator <sign.moderator@gmail.com>

Dear Allan:

Wishing you a happy holiday and a wonderful New Year.

My comments are in response to this weeks SIGN posting about item #1
on safe injection policies.

Sincerely,

Joel Schoenfeld
____________________________________________________________
Response to NEW INJECTION SAFETY POLICY AND GLOBAL CAMPAIGN:

I am very happy to see the new safety policy that WHO and SIGN are
promoting. However, I ask WHY?

All of us agree on the statistics. WE know that 16 billion injections are
given worldwide and that reused equipment causes a threat.

I observed the key initiatives for the rational use of safe syringes but I
can’t understand certain objectives and WHY we are not focusing on
resolving one item at a time.

The EPI program was originally established to make sure that all
children’s vaccination programs would be administered with safer syringes.
Some of these key players worked endlessly to see that certain specific
functions would be met. Every design had to be tested in independent
laboratories and then tested in the field.

A number of these inventions met all of the specific standards. One in
particular was that it would not be able to be aspirated. After endless
hours of design, engineering, creativity and expenses, some of the designs
met all of those standards.

Now you’re asking for modifications to these designs by adding needle-
stick protection devices when we haven’t even scratched the surface of
protecting the children from unsafe devices!

The health care workers provide excellent work and dedication but cannot
do it at the expense of the children. WHY can’t we take care of one
problem at a time and stay focused until that problem is solved?

Some organizations were complaining about added cost of using safer
syringes. These safer syringes are still not being used in equal numbers
to the vaccines that are being administered. It’s my opinion that added
costs, and additional engineering will just be another excuse for not
adding the safety that is needed to our existing vaccination programs.

Global communication campaigns and health care worker training are
essential to successful programs to better ensure injection safety through
the use of safety engineered injection devices, but, only if they are
ordered and used.

May I remind everyone who has ever worked on this project how much
dedication and diligence we all put into it. Let us see the children safe
and protected from being immunized with syringes that can be reused.

Our focus must remain on the children and we must make sure that every
syringe used in 2016 will be auto-destructing. We can plan for improvement
in the future, but not until we catch up to our responsibilities.

May I remind our readers that there are organizations like WHO and others
that would share the technology with interested parties so that enough
auto-destruct syringes can be produced.

Respectfully yours,

Joel Schoenfeld
__________________________________________________________________
________________________________*_________________________________

2. Abstract: Safety engineered injection devices for intramuscular,
subcutaneous and intradermal injections in healthcare delivery
settings: a systematic review and meta-analysis
__________________________________________________________________
http://bmcnurs.biomedcentral.com/articles/10.1186/s12912-015-0119-1

Free Full Text and PDF at the link

BMC Nurs. 2015 Dec 30;14:71.

Safety engineered injection devices for intramuscular, subcutaneous and
intradermal injections in healthcare delivery settings: a systematic
review and meta-analysis.

Harb AC1, Tarabay R2, Diab B2, Ballout RA3, Khamassi S4, Akl EA5.

1Department of Anaesthesiology, American University of Beirut, Beirut,
Lebanon.
2Lebanese University, Beirut, Lebanon.
3American University of Beirut, Beirut, Lebanon.
4World Health Organization, Geneva, Switzerland.
5Department of Internal Medicine, American University of Beirut, Beirut,
Lebanon.

BACKGROUND: Occupational sharps injuries are associated with transmission
of bloodborne viruses to healthcare workers, including hepatitis B virus
(HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV).
Similarly reuse of syringes in healthcare settings might transmit these
infections between patients.

The objective of this study was to systematically review the evidence
about the effects of the use by health care workers of two types of safety
engineered injection devices, when delivering intramuscular, subcutaneous,
or intradermal injectable medications: sharps injury protection syringes
and reuse prevention syringes.

METHODS: We included both randomized and non-randomized studies comparing
safety syringes to syringes without safety features. Outcomes of interest
included needlestick injuries, and HIV, HBV and HCV infections amongst
HCWs (for sharps injury prevention syringes) and patients (for reuse
prevention syringes). When possible, we conducted meta-analyses using a
random-effects model. We tested results for heterogeneity across studies
using the I statistic. We assessed the quality of evidence by outcome
using the GRADE methodology.

RESULTS: We included nine eligible studies: six assessed devices that
qualify as sharps injury prevention devices, and three assessed devices
that qualify as both injury prevention devices and reuse prevention
devices. Eight studies were observational while one was randomized. All
studies assessed a single outcome: needle stick injuries among healthcare
workers.

For sharp injury prevention syringes, the meta-analysis of five
studies resulted in a pooled relative risk of 0.54 [0.41, 0.71] for the
effect on needlestick injuries per healthcare worker. The associated
quality of evidence was rated as moderate. For reuse prevention syringes,
data from one study provided a relative risk of 0.40 [0.27, 0.59] for the
effect on needlestick injuries per healthcare worker. The associated
quality of evidence was rated as moderate. We identified no studies
reporting on the effect on the reuse of syringes.

CONCLUSIONS: We identified moderate quality evidence that syringes with
sharps injury prevention feature reduce the incidence of needlestick
injuries per healthcare worker. We identified no studies reporting data
for the remaining outcomes of interest for HCWs. Similarly we identified
no studies reporting on the effect of syringes with a reuse prevention
feature on the reuse of syringes or on the other outcomes of interest for
patients.

KEYWORDS: HBV; HCV; HIV; Health care worker; Meta-analysis; Needlestick
injuries; Reuse prevention syringes; Sharps injury prevention syringes;
Systematic review

Free Full Text Article and PDF
http://bmcnurs.biomedcentral.com/articles/10.1186/s12912-015-0119-1
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Hepatitis C oubreaks in Poland in 2003-2013. Medical
procedures as a dominant route of HCV transmission
__________________________________________________________________

Przegl Epidemiol. 2015;69(3):465-72, 585-90.

http://www.przeglepidemiol.pzh.gov.pl/pobierz-artykul?id=1957 Free PDF
Hepatitis C oubreaks in Poland in 2003-2013. Medical procedures as a
dominant route of HCV transmission.

[Article in English, Polish]

Stepien M1, Rosinska M1.

1Department of Epidemiology, National Institute of Public Health-National
Institute of Hygiene in Warsaw.

BACKGROUND: According to the data from routine epidemiological
surveillance in Poland, over 70% of patients diagnosed with HCV infection
report exclusively medical exposure which suggests that infection was
probably associated with procedures performed in health care settings. To
a large extent, neither the source nor the mechanism of transmission,
however, may be determined. Infections detected in an acute phase,
accounting for ca 2-3% of registered hepatitis C cases per year, better
reflect the actual routes of HCV transmission. Epidemiological
investigations of acute hepatitis C outbreaks allow for identifying the
procedures in which the virus is transmitted.

OBJECTIVE: To identify mechanisms and breaches of safety procedures, which
are most frequently associated with HCV infection, based on a review of
recent hepatitis C outbreaks in health care settings in Poland.

METHODS: A systematic review of reports on acute hepatitis C cases
registered in routine surveillance in 2006-2013 and literature review in
PubMed and SCOPUS.

RESULTS: A total of six outbreaks were documented in which 116 cases were
detected. Of them, four outbreaks were identified based on surveillance
data, including one unconfirmed outbreak, and information on two outbreaks
was retrieved from publications. Five of the described outbreaks were
acquired in health care settings, including two outbreaks which occurred
in dialysis units and one outbreak was associated with alternative
medicine procedures.

Probably, infections were most commonly transmitted due to mistakes of
medical personnel resulting from negligence or ignorance of procedures,
i.e. multiple use of disposable equipment and improper use of personal
protective equipment (failure to change disposable gloves). In one case,
neither breaches of procedure nor actions which could lead to HCV
infection were determined.

CONCLUSIONS: A detailed epidemiological investigation should be conducted
in each registered case of acute hepatitis C as detected symptomatic cases
allow for identifying the outbreaks. Epidemiological investigations of
outbreaks should be improved by inclusion of molecular tests.
Identification of breaches of binding procedures indicates a necessity of
continuing training of personnel and enhanced control of compliance with
binding recommendations, especially with regard to injection safety.

Free full text [PDF]
http://www.przeglepidemiol.pzh.gov.pl/pobierz-artykul?id=1957
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Incidence of percutaneous injury in Taiwan healthcare workers
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/25762054

Epidemiol Infect. 2015 Nov;143(15):3308-15.
Incidence of percutaneous injury in Taiwan healthcare workers.

Wu HC1, Ho JJ2, Lin MH2, Chen CJ3, Guo YL4, Shiao JS5.

1Department of Nursing,Hsin Sheng Junior College of Medical Care and
Management,Taoyuan,Taiwan,ROC.
2Institute of Labour,Occupational Safety and Health,Ministry of
Labour,Executive Yuan,Taipei,Taiwan,ROC.
3Occupational Safety and Health Administration,Ministry of
Labour,Executive Yuan,Taipei,Taiwan,ROC.
4Department of Environmental and Occupational Medicine,College of
Medicine, National Taiwan University (NTU) & NTU
Hospital,Taipei,Taiwan,ROC.
5Department of Nursing,College of Medicine, National Taiwan University
(NTU) & NTU Hospital,Taipei,Taiwan,ROC.

Reporting of percutaneous injuries (PIs) to the Chinese Exposure
Prevention Information Network (EPINet) became mandatory for all public
and tertiary referral hospitals in Taiwan in 2011.

We have estimated the number of microbially contaminated PIs and the
national PI incidence using a retrospective secondary data analysis
approach to analyse 2011 data from the Chinese EPINet to determine the
types of PI, mechanisms of occurrence and associated risks.

The results revealed a national estimate of PIs between 6710 and 8319 in
2011. The most common incidents for physicians were disposable syringes,
suture needles, and disposable scalpels; while for nurses they were
disposable syringes, intravenous catheters, and lancets.

About 13·0% of the source patients were seropositive for hepatitis B virus
(HBV) surface antigen, 13·8% were seropositive for hepatitis C virus
(HCV), and 1·1% seropositive for human immunodeficiency virus (HIV).

From these results we estimate that annually 970 full-time healthcare
workers (HCWs) would be exposed to HBV, 1094 to HCV, and 99 to HIV.

This study improves our understanding of the mechanisms and risks of PIs
and informs the development of more efficient preventive measures to
protect HCWs from such injuries.

KEYWORDS: Blood-borne virus transmission; needle-stick (sharps) injury;
occupation-related infections
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Hepatitis-B Vaccination Status And Knowledge, Attitude And
Practice Of High Risk Health Care Worker About Body Substance Isolation
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26721035

J Ayub Med Coll Abbottabad. 2015 Jul-Sep;27(3):664-8.
Hepatitis-B Vaccination Status And Knowledge, Attitude And Practice Of
High Risk Health Care Worker About Body Substance Isolation.

Quddus M, Jehan M, Ali NH.

BACKGROUND: HBV infection is occupational risk for health care worker
(HCW). They play an important role in dissemination of hepatitis B in
society. This study aimed to assess Hepatitis B vaccination status of high
transmitter risk group and their knowledge attitude and practice regarding
Body substance Isolation.

METHOD: This questioner based cross sectional study was conducted in
January 2013 to March 2014. 400 HCW comprising of 55% male and 45% female
belonging to four groups 100 each doctor, nurse, Operation Theatre and
clinical laboratory technician working at different tertiary hospitals in
Karachi- Pakistan were included in the study.

RESULTS: 28% doctors, 20% nurses, 64% operation theatre and 68% lab-
technician were fully immunized. Among rest 31% were unaware of vaccine,
45% did not consider themselves among high risk group, 15% expected
management to get them vaccinated, 9% found it expensive. Biosafety
practices were correctly performed by 42%. 29% performed injection safe
practice, 10% aseptic rules and 19% properly sterilized equipment. Blood
spill was immediately cleaned by 80% among them 48% applied disinfectant,
40% cleaned it water and detergent, 12% cleaned and disinfected. Blood
samples disposal was 52% in any available container, 17% in dustbin and
30% in biohazard bags.

In case of accidental needle stick exposure 62 encouraged bleeding, 19%
applied alcohol, 11% washed with water, 8% waited for medical help.
Regarding discarding used syringe 42% used engineered device, 44% common
container, 10% bent needles and 4% one handed scoop technique.

Warning symbols were identified by 32% amongst them 30% identified
biohazard, 8% harmful, 12% inflammable and 50% danger signs.

CONCLUSION: To prevent HCW from Hepatitis their complete immunization
should be mandatory and rigid BSI protocol monitored daily.
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Level of knowledge among medical personnel about infections
transferred through direct contact–results of questionnaire survey
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26519847

Przegl Epidemiol. 2015;69(3):503-6, 615-8.
Level of knowledge among medical personnel about infections transferred
through direct contact–results of questionnaire survey.

[Article in English, Polish]

Kolpa M1, Grochowska A1, Gniadek A2, Jurkiewicz B1.

1Department of Nursing, Institute of Health Sciences, State Higher
Vocational School in Tarnów.
2Institute of Nursing and Obstetrics, Faculty of Health Sciences,
Jagiellonian University – Collegium Medicum.

INTRODUCTION: Nosocomial infections are an important issue all over the
world. The most important vector for transmitting infections in a hospital
are the hands of the medical personnel, which is why their adequate
hygiene is an essential prevention method.

THE AIM OF THE STUDY: was to evaluate the medical personnel’s level of
knowledge on the prevention of nosocomial infections transferred through
direct contact.

MATERIAL AND METHODS: The diagnostic survey method with a proprietary
questionnaire was used for the research. The research was conducted
between May and June 2013 on a group of 100 randomly chosen medical
workers of one of Cracow hospitals (nurses, doctors and paramedics). The
age of the interviewees ranged from 23 to 60 years old.

RESULTS: Despite the fact that most of the respondents took part in
courses related to nosocomial infections and declared the will to take
part in more courses related to this issue, the level of knowledge of the
medical personnel on the prevention of nosocomial infections transferred
through direct contact and the post-exposure procedures is insufficient.

Only 28.0% of the respondents knew that the dominant hand decontamination
method according to WHO is disinfection,

22.0% of the surveyed medical personnel admitted that they put covers on
needles after they performed the injection

and 11.0% of the interviewees mentioned that they change the gloves before
contact with the patient only sometimes.

CONCLUSIONS: The surveyed group has not demonstrated a sufficient
knowledge of the rules of preventing infections transferred through direct
contact and the post-exposure procedures. The level of knowledge of the
surveyed medical personnel was dependent on, e.g., years of experience and
taking part in courses on nosocomial infections.

Free full text PDF
http://www.przeglepidemiol.pzh.gov.pl/pobierz-artykul?id=1963
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Low vaccination coverage among italian healthcare workers in
2013
__________________________________________________________________

http://www.tandfonline.com/doi/full/10.4161/hv.34415 Free Full Text

Hum Vaccin Immunother. 2015;11(1):133-9.
Low vaccination coverage among italian healthcare workers in 2013.

Fortunato F1, Tafuri S, Cozza V, Martinelli D, Prato R.

1a Department of Medical and Surgical Sciences; University of Foggia;
Foggia, Italy.

Vaccination of healthcare workers (HCWs) reduces the risk of occupational
infections, prevents nosocomial transmission and maintains healthcare
delivery during outbreaks. Despite the European directive and national
legislation on workers’ protection, immunization coverage among HCWs has
often been very low.

In light of Italian National Vaccination Plan 2012-2014 recommendations,
the aim of this study was to assess levels of immunization and factors
influencing adherence to vaccinations needed for HCWs in Puglia region,
South Italy.

The study was conducted using an interview-based standardized anonymous
questionnaire administered to hospital employees in the period November
2009-March 2011. A total of 2198 health professionals responded in 51/69
Apulian hospitals (median age: 45 years; 65.2% nurses, 22.6% doctors and
12.2% other hospital personnel).

Vaccination coverage was 24.8% for influenza, 70.1% for hepatitis B, 9.7%
for MMR, 3.6% for varicella, and 15.5% for Td booster. Receiving
counselling from occupational health physicians (OHPs) was associated with
influenza (OR = 1.8; 95%CI = 1.5-2.2; P &lt; 0.001), hepatitis B (OR =
4.9; 95%CI = 3.9-6.3; P &lt; 0.001), varicella (OR = 43.7; 95%CI =
18.9-101.7; P &lt; 0.001), MMR (OR = 8.8; 95%CI = 4.1-18.6; P &lt; 0.001)
and tetanus (OR = 50.5; 95%CI = 30.1-88.3; P &lt; 0.001) vaccine uptake.

OHPs should be trained with standard guidelines specific for healthcare
settings and HCWs’ risk groups to facilitate their crucial role in
improving vaccine coverage among HCWs and increase awareness on the duty
to protect both employees and patients.

KEYWORDS: Td booster; healthcare workers; hepatitis B; influenza; measles;
mumps; rubella; vaccine; varicella

Free Article http://www.tandfonline.com/doi/full/10.4161/hv.34415
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Survey of occupational hazards in Minnesota veterinary
practices in 2012
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26720089

J Am Vet Med Assoc. 2016 Jan 15;248(2):207-18.
Survey of occupational hazards in Minnesota veterinary practices in 2012.

Fowler HN, Holzbauer SM, Smith KE, Scheftel JM.

OBJECTIVE To identify the scope of occupational hazards encountered by
veterinary personnel and compare hazard exposures between veterinarians
and technicians working in small and large animal practices.

DESIGN Cross- sectional survey.

POPULATION Licensed veterinarians and veterinary staff in Minnesota.

PROCEDURES A survey of Minnesota veterinary personnel was conducted
between February 1 and December 1, 2012. Adult veterinary personnel
working in clinical practice for > 12 months were eligible to participate.
Information was collected on various workplace hazards as well as on
workplace safety culture.

RESULTS 831 eligible people responded, representing approximately 10% of
Minnesota veterinary personnel. A greater proportion of veterinarians
(93%; 368/394) reported having received preexposure rabies vaccinations
than did veterinary technicians (54%; 198/365). During their career, 226
(27%) respondents had acquired at least 1 zoonotic infection and 636 (77%)
had been injured by a needle or other sharps.

Recapping of needles was reported by 87% of respondents; the most common
reason reported by veterinarians (41%; 142/345) and veterinary technicians
(71%; 238/333) was being trained to do so at school or work. Recent
feelings of depression were reported by 204 (25%) respondents. A greater
proportion of technicians (42%; 155/365) than veterinarians (21%; 81/394)
indicated working in an environment in which employees experienced some
form of workplace abuse.

CONCLUSIONS AND CLINICAL RELEVANCE Veterinary personnel in Minnesota were
exposed to several work-related hazards.

Practice staff should assess workplace hazards, implement controls, and
incorporate instruction on occupational health into employee training.
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Diverse HIV epidemics among people who inject drugs in
Thailand: evidence from respondent-driven sampling surveys in Bangkok
and Chiang Mai
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/25640153

Drug Alcohol Depend. 2015 Mar 1;148:126-35.
Diverse HIV epidemics among people who inject drugs in Thailand: evidence
from respondent-driven sampling surveys in Bangkok and Chiang Mai.

Prybylski D1, Manopaiboon C2, Visavakum P2, Yongvanitjit K3, Aramrattana
A4, Manomaipiboon P3, Tanpradech S2, Suksripanich O2, Pattanasin S2, Wolfe
M5, Whitehead SJ5.

1Thailand MOPH – U.S. CDC Collaboration, Nonthaburi 11000, Thailand;
Division of Global HIV/AIDS, Centers for Disease Control and Prevention,
Atlanta, 30333, USA. Electronic address: hjt1@cdc.gov.
2Thailand MOPH – U.S. CDC Collaboration, Nonthaburi 11000, Thailand.
3Bangkok Metropolitan Administration, Bangkok 10200, Thailand.
4Research Institute for Health Sciences, Chiang Mai, Thailand.
5Thailand MOPH – U.S. CDC Collaboration, Nonthaburi 11000, Thailand;
Division of Global HIV/AIDS, Centers for Disease Control and Prevention,
Atlanta, 30333, USA.

BACKGROUND: Thailand’s long-standing HIV sero-sentinel surveillance system
for people who inject drugs (PWID) is confined to those in methadone-based
drug treatment clinics and representative data are scarce, especially
outside of Bangkok.

METHODS: We conducted probability-based respondent-driven sampling (RDS)
surveys in Bangkok (n=738) and Chiang Mai (n=309) to increase
understanding of local HIV epidemics and to better inform the planning of
evidence-based interventions.

RESULTS: PWID had different epidemiological profiles in these two cities.
Overall HIV prevalence was higher in Bangkok (23.6% vs. 10.9%, p<0.001)
but PWID in Bangkok are older and appear to have long-standing HIV
infections. In Chiang Mai, HIV infections appear to be more recently
acquired and PWID were younger and had higher levels of recent injecting
and sexual risk behaviors with lower levels of intervention exposure.
Methamphetamine was the predominant drug injected in both sites and
polydrug use was common although levels and patterns of the specific drugs
injected varied significantly between the sites. In multivariate analysis,
recent midazolam injection was significantly associated with HIV infection
in Chiang Mai (adjusted odds ratio=8.1; 95% confidence interval: 1.2-54.5)
whereas in Bangkok HIV status was not associated with recent risk
behaviors as infections had likely been acquired in the past.

CONCLUSION: PWID epidemics in Thailand are heterogeneous and driven by
local factors. There is a need to customize intervention strategies for
PWID in different settings and to integrate population-based survey
methods such as RDS into routine surveillance to monitor the national
response.

Published by Elsevier Ireland Ltd.

KEYWORDS: HIV; People who inject drugs; Respondent-driven sampling; Risk
behaviors; Thailand
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Intimate injection partnerships are at elevated risk of
high-risk injecting: a multi-level longitudinal study of HCV-
serodiscordant injection partnerships in San Francisco, CA
__________________________________________________________________

Free Full Text
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0109282

PLoS One. 2014 Oct 6;9(10):e109282.
Intimate injection partnerships are at elevated risk of high-risk
injecting: a multi-level longitudinal study of HCV-serodiscordant
injection partnerships in San Francisco, CA.

Morris MD1, Evans J1, Montgomery M2, Yu M1, Briceno A1, Page K3, Hahn JA4.

1Department of Epidemiology and Biostatistics, University of California
San Francisco, San Francisco, CA, United States of America.
2Joint Medical Program and Program in Medical Education for the Urban
Underserved, University of California San Francisco & University of
California, Berkeley, San Francisco, CA, United States of America.
3University of New Mexico Health Sciences Center, Albuquerque, New Mexico,
United States of America.
4Department of Medicine, University of California San Francisco, San
Francisco, CA, United States of America.

BACKGROUND: It is increasingly recognized that the risk for HIV and
hepatitis C (HCV) transmission among people who inject drugs (PWID), such
as syringe sharing, occurs in the context of relationships between (at
least) two people. Evidence suggests that the risk associated with
injection behavior varies with injection partner types.

METHODS: We utilized longitudinal dyad-level data from a study of young
PWID from San Francisco (2006 to 2013) to investigate the relationship-
level factors influencing high-risk injecting within HCV-serodiscordant
injection partners (i.e., individuals who injected together =5 times in
the prior month). Utilizing data from 70 HCV-serodiscordant injection
partnerships, we used generalized linear models to examine relationship-
level predictors (i.e., partnership composition, partnership closeness,
and partnership dynamics) of: (1) receptive syringe sharing (RSS); and (2)
receptive cooker use (RCU), as reported by the HCV-negative injection
partner.

RESULTS: As reported by the “at-risk” HCV-negative injection partner,
receptive syringe sharing (RSS) and receptive cooker use (RCU) were 19%
and 33% at enrollment, and 11% and 12% over all visits (total follow-up
time 55 person-years) resulting in 13 new HCV-infections (incidence rate:
23.8/100 person-years). Person-level factors, injection partnership
composition, and partnership dynamics were not significantly associated
with either RSS or RCU. Instead, intimate injection partnerships (those
who lived together and were also in a sexual relationship) were
independently associated with a 5-times greater risk of both RSS and a 7-
times greater risk of RCU when compared to injecting only partnerships.

CONCLUSION: Our findings suggest a positive, and amplified effect of
relationship factors on injecting drug risk behaviors among young PWID
injection partnerships. The majority of interventions to reduce injection
drug use related harms focus on individual-based education to increase
drug use knowledge. Our findings support the need to expand harm reduction
strategies to relationship-based messaging and interventions.

Free Full Text Article
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0109282
__________________________________________________________________
________________________________*_________________________________

11. Abstract: Safety of Epidural Corticosteroid Injections
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26715572

Drugs R D. 2015 Dec 29.
Safety of Epidural Corticosteroid Injections.

Pountos I1, Panteli M2, Walters G3, Bush D4, Giannoudis PV2.

1Academic Department of Trauma and Orthopaedics, Leeds General Infirmary,
Clarendon Wing Level A, Great George Street, Leeds, LS1 3EX, UK.
pountos@doctors.org.uk.
2Academic Department of Trauma and Orthopaedics, Leeds General Infirmary,
Clarendon Wing Level A, Great George Street, Leeds, LS1 3EX, UK.
3University of Leeds, Leeds, UK.
4Anaesthetic Department, Leeds Teaching Hospitals, NHS Trust, Leeds, UK.

BACKGROUND AND OBJECTIVE: Epidural corticosteroid injections (ESIs) have
been used for several decades and now represent the most common
intervention performed for the management of back pain with a radicular
component. However, several reports have presented devastating
complications and adverse effects, which fuelled concerns over the risk
versus clinical effectiveness. The authors offer a comprehensive review of
the available literature and analyse the data derived from studies and
case reports.

METHODS: Studies were identified by searching PubMed MEDLINE, Ovid
MEDLINE, EMBASE, Scopus, Google Scholar and the Cochrane Library to
retrieve all available relevant articles. Publications from the last 20
years (September 1994 to September 2014) were considered for further
analysis. Studies selected were English-language original articles
publishing results on complications related to the technique used for
cervical and lumbar ESIs. The studies had to specify the approach used for
injection. All studies that did not fulfil these eligibility criteria were
excluded from further analysis.

RESULTS: Overall, the available literature supports the view that serious
complications following injections of corticosteroid suspensions into the
cervical and lumbar epidural space are uncommon, but if they occur they
can be devastating.

CONCLUSIONS: The true incidence of such complications remains unclear.
Direct vascular injury and/or administration of injectates intra-
arterially represent a major concern and could account for the vast
majority of the adverse events reported.

Accurate placement of the needle, use of a non-particulate corticosteroid,
live fluoroscopy, digital subtraction angiography, and familiarisation of
the operator with contrast patterns on fluoroscopy should minimise these
risks.

The available literature has several limitations including incomplete
documentation, unreported data and inherent bias. Large registries and
well-structured observational studies are needed to determine the true
incidence of adverse events and address the safety concerns.
__________________________________________________________________
________________________________*_________________________________

12. Abstract: Pre-filled syringes: a review of the history, manufacturing
and challenges
__________________________________________________________________
https://www.ncbi.nlm.nih.gov/pubmed/25589433

Pharm Dev Technol. 2015 Jan;20(1):1-11. doi: 10.3109/10837450.2014.982825.
Pre-filled syringes: a review of the history, manufacturing and
challenges.

Sacha G1, Rogers JA, Miller RL.

1Department of Research and Development, Baxter Medical Products ,
Bloomington, IN , USA .

Pre-filled syringes are convenient devices for the delivery of parenteral
medications. They are small which makes them easy to carry and are
dependable for delivering a precise dose of medication. These and many
other reasons are leading to their growth in the pharmaceutical market.

There are a number of review articles that describe the advantages and
disadvantages of pre-filled syringes. However, there are few journal
articles that present information on their manufacturing and challenges.

The intent of this review article is to provide information on the history
of the pre-filled syringe, methods of their manufacture, methods of
filling syringes as a drug product and to examine the types of syringes
available.

This type of knowledge can familiarize the formulation scientist with the
choices available and their possible challenges.

KEYWORDS: Cyclic olefin polymer; delivery devices; filling; glass;
injections; pharmaceutical manufacturing
__________________________________________________________________
________________________________*_________________________________

13. Abstract: Assessment of hand hygiene techniques using the World Health
Organization’s six steps
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26707705

J Infect Public Health. 2015 Dec 18. pii: S1876-0341(15)00208-7.
Assessment of hand hygiene techniques using the World Health
Organization’s six steps.

Villanueva Arias A1, Garcell HG2, Ochoa YR3, Arias KF4, Miranda FR5.
Author information
1Infection Control Department, TCH Hamad Medical Corporation, Doha, Qatar.
Electronic address: Aarias@hamad.qa.
2Infection Control Department, TCH Hamad Medical Corporation, Doha, Qatar.
Electronic address: Hgarcell@hamad.qa.
3Nursing Department, TCH Hamad Medical Corporation, Doha, Qatar.
Electronic address: Yochoa@hamad.qa.
4Nursing Department, TCH Hamad Medical Corporation, Doha, Qatar.
Electronic address: Karias@hamad.qa.
5Nursing Department, TCH Hamad Medical Corporation, Doha, Qatar.
Electronic address: Fmiranda@hamad.qa.

The quality of hand hygiene was evaluated via direct observation for
compliance with the six recommended World Health Organization steps. A
total of 2497 HH opportunities, of which 1573 (63.0%) were hand rubs, were
monitored over a five month period. Compliance was higher in nurses
compared with physicians and auxiliaries and in steps 1 and 2 for hand
rubs as well as the first three steps of hand washing, with lower rates
after these steps. Rubbing of the thumbs and fingertips achieved the
lowest rates of compliance in both HH types. A combination of the five
recommended moments and six steps and staff education is recommended to
improve the quality of hand hygiene.

Copyright © 2015 King Saud Bin Abdulaziz University for Health Sciences.
Published by Elsevier Ltd. All rights reserved.

KEYWORDS:
Hand hygiene; Medical staff; Technique; WHO six steps
__________________________________________________________________
________________________________*_________________________________

14. Abstract: Predictors of hand hygiene practice among Saudi nursing
students: A cross-sectional self-reported study
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26707706

J Infect Public Health. 2015 Dec 18. pii: S1876-0341(15)00212-9.
Predictors of hand hygiene practice among Saudi nursing students: A cross-
sectional self-reported study.

Cruz JP1, Bashtawi MA2.

1Nursing Department, College of Applied Medical Sciences, Shaqra
University, PO Box 1678, Dawadmi 11911, Saudi Arabia. Electronic address:
cruzjprn@gmail.com.
2Nursing Department, College of Applied Medical Sciences, Shaqra
University, PO Box 1678, Dawadmi 11911, Saudi Arabia.

Hand hygiene is an important component of infection control, which is
critical to ensuring patients’ safety in hospitals. Nursing students are
regarded as healthcare workers in training and can also be vehicles of
cross-contamination within the hospital. Thus, this study aimed to
identify the predictors of hand hygiene practice among Saudi nursing
students.

A descriptive, cross-sectional, self-reported study was conducted among
198 Saudi nursing students. Knowledge, attitude, and practice of hand
hygiene were assessed using the WHO Hand Hygiene Knowledge Questionnaire
for Health-Care Workers and its adopted scales.

A regression analysis was performed to identify the predictors of hand
hygiene practice.

The respondents demonstrated moderate knowledge of hand hygiene (mean
13.20±2.80). The majority displayed a moderate attitude toward hand
hygiene (52.1%), while only a few reported a poor attitude (13.1%).
Approximately 68.7%, 29.8%, and 1.5% of the respondents reported moderate,
good, and poor practice of hand hygiene, respectively.

Having a good attitude toward hand hygiene, being male, being aware that
hand hygiene is an effective intervention in preventing healthcare-
associated infections (HAIs), attendance at hand hygiene trainings and
seminars, and being in the lower academic level of nursing education were
identified as predictors of better hand hygiene practice.

The importance of ensuring a positive attitude toward hand hygiene and
improving awareness of hand hygiene is emphasized, as are educational
interventions. Educational interventions should be implemented to
reinforce knowledge and instill a positive attitude toward hand hygiene.

Copyright © 2015 King Saud Bin Abdulaziz University for Health Sciences.

Published by Elsevier Ltd. All rights reserved.

KEYWORDS: Hand hygiene attitude; Hand hygiene knowledge; Hand hygiene
practice; Hand hygiene predictors; Saudi nursing students
__________________________________________________________________
________________________________*_________________________________

15. Abstract: A hand hygiene compliance check system: brief communication
on a system to improve hand hygiene compliance in hospitals and reduce
infection
__________________________________________________________________

J Med Syst. 2015 Jun;39(6):69.

A hand hygiene compliance check system: brief communication on a system to
improve hand hygiene compliance in hospitals and reduce infection.

Hong TS1, Bush EC, Hauenstein MF, Lafontant A, Li C, Wanderer JP,
Ehrenfeld JM.

1Department of Biomedical Engineering, Vanderbilt University, Nashville,
TN, 37232, USA, tracey.s.hong@Vanderbilt.Edu.

Hand hygiene compliance is the most significant, modifiable cause of
hospital-acquired infections, yet national averages for compliance rates
remain unsatisfactory. Noncompliance can contribute to patient mortality,
extended hospital stays, higher re-admission rates, and lower
reimbursement for hospitals under the Patient Protection and Affordable
Care Act.

Although several hand sanitizing tracking systems currently exist, they
pose problems of personal tracking, workflow interference, system
maintenance concerns, among others.

Considering these barriers, we created a prototype system that includes
compliance rate tracking, real-time sanitization reminders, and a data
archive for future studies.
__________________________________________________________________
________________________________*_________________________________

16. Abstract: Compounding with Silicones
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26714363

Int J Pharm Compd. 2015 May-Jun;19(3):223-30.

Compounding with Silicones.

Allen LV Jr.

Since the 1940s, methylchlorosilanes have been used to treat glassware to
prevent blood from clotting. The use of silicones in pharmaceutical and
medical applications has grown to where today they are used in many life-
saving devices (pacemakers, hydrocephalic shunts) and pharmaceutical
applications from tubing, to excipients in topical formulations, to
adhesives to affix transdermal drug delivery systems, and are also being
used in products as active pharmaceutical ingredients, such as
antiflatulents.

About 60% of today’s skin-care products now contain some type of silicone
where they are considered safe and are known to provide a pleasant “silky-
touch,” non-greasy, and non-staining feel. Silicones exhibit many useful
characteristics, and the safety of these agents supports their numerous
applications; their biocompatibility is partially due to their low-
chemical reactivity displayed by silicones, low-surface energy, and their
hydrophobicity. Silicones are used both as active ingredients and as
excipients.

In addition is their use for “siliconization,” or surface treatment, of
many parenteral packaging components. Dimethicone and silicone oil are
used as lubricants on stoppers to aid machineability, in syringes to aid
piston movement, or on syringe needles to reduce pain upon injection.

Silicones are also useful in pharmaceutical compounding as is discussed in
this artiele included with this article are in developing formulations
with silicones.
__________________________________________________________________
________________________________*_________________________________

17. News

– Philippines: The City at the Heart of the Philippines’s HIV Epidemic

– ‘Half’ of injecting drug users in Wales at Hepatitis C risk

– Australia: Southport family faces anxious wait after four-year-old had
hypodermic needle pulled from her foot

– Grandmother who was injected with a USED needle during flu jab faces
agonising six-month wait to see if she has HIV or hepatitis

– N.J. USA: Recycling workers getting pricked by Bayonne’s illegally
discarded needles

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/j4w9r37

Philippines: The City at the Heart of the Philippines’s HIV Epidemic

Ana P. Santos, The Atlantic, USA (06.01.16)

Extract Extract Extract Extract Extract Extract

New infections in the country have skyrocketed, even as they’re declining
worldwide. Cebu City, one of the hardest-hit areas, is struggling to
control the drug use that’s spreading the virus.

[Photos: Veejay Villafranca]

CEBU CITY, PHILIPPINES—The dealer’s hands move quickly as he dispenses
small vials from the waistband of his shorts, his front pockets bulging
from the weight of coins and small bills. From his back pocket, he hands
out syringes or collects them. Occasionally, he uses the t-shirt slung
over his shoulder to wipe away the beads of sweat that made his goatee
glisten.

The shanty where he works—a small room full to bursting with people—is
home to one of Cebu’s many “shooting galleries,” a place where people
gather to purchase and inject the narcotic pain reliever Nubain. At this
particular gallery, a small glass capsule containing 1 mL goes for Php
150, or around $3. For individuals on a tighter budget, the dealer can
squeeze out a single squirt for Php 20 ($0.50). Those who bring their own
supply of the drug only have to pay a fee to use the shooting gallery, a
charge of Php5-Php10 ($0.10 – $0.20).

An unused needle sells for another Php20 ($0.50), but few people who came
through the shooting gallery chose to purchase one—the dealer also
supplies free “service needles,” new and slightly used syringes on
rotation that any customer can use. It’s common for groups of customers to
split the cost of a vial of Nubain between them, and share a service
needle as they use it. The Philippine Department of Health (DOH) says that
the typical shooting gallery has three to five service needles on rotation
at a time, each of which can be used four to six times before it gets too
blunt. According to Genesis Samonte, the head of the department’s HIV
surveillance unit, one shared needle can infect four to six people with
HIV or hepatitis C.

[Reporting for this story was supported by a grant from the Pulitzer
Center on Crisis Reporting.]

Continues at the link https://tinyurl.com/j4w9r37
__________________________________________________________________
__________________________________________________________________

http://www.bbc.com/news/uk-wales-34984444
‘Half’ of injecting drug users in Wales at Hepatitis C risk

BBC News, U.K. (03.01.16)

Half of known injecting drug users are at risk of contracting Hepatitis C,
Public Health Wales has warned.

It said so-called legal highs had been “a real game changer” and the
health risk was becoming a “substantial” problem.

Some have turned to injecting legal highs, while heroin users are either
injecting both or have turned to using the psycho-active substances
instead.

There are 12,000 known users who visit needle exchanges across Wales. “It
isn’t under control,” said Josie Smith, head of substance misuse for
Public Health Wales.

“The new psycho-active substances have been a real game changer for risk
of Hepatitis C transmissions.

‘Wake-up call’

“In Swansea, mephedrone injecting was widespread both among people who
weren’t injecting before and those people who have history of injecting
heroin taking on injecting mephedrone as well or instead of.

“Certainly the advent of these new drugs has been a wake-up call.” She
said Public Health Wales had a “much better handle” on the problem now,
and was better equipped to test, screen, diagnose and refer for treatment,
while drug users are also more aware of the disease.

Current treatment for Hepatitis C can include a year’s worth of injections
and involve side-effects such as depression, tiredness and feeling sick.
In 2014, scientists said a new treatment “cured” 90% of patients with the
infection in 12 weeks.

Ifor Glyn, chief executive of Swansea-based charity Sands Cymru, said
there was a “massive amount” of infected users in the city.

“We’ve found it could be about 70% and a large amount don’t know about
it,” he said.

“It’s the same concern as HIV in as much as it’s usually transferable
through bodily fluids. Unless people get treated it could be fatal.”

But he added: “If all these people came forward for Hepatitis C treatment,
it would have a massive effect on health budgets.

“We reinforce the message of not to share needles and to have safe sex.”
__________________________________________________________________
__________________________________________________________________

https://tinyurl.com/z4bwprg
Australia: Southport family faces anxious wait after four-year-old had
hypodermic needle pulled from her foot

By Nicholas Mcelroy, Gold Coast Bulletin, Australia (02.01.16)

A FAMILY has an anxious year ahead after their little girl stood on a
hypodermic needle on a Gold Coast beach.

A day enjoying the sun and surf at Currumbin on Tuesday came to a
horrifying end for the McDermid family of Southport when four-year-old
Tigerlily screamed in pain.

Graham and Carmen McDermid turned to see a hypodermic needle sticking out
of Tigerlily’s right foot.

The family of four were just 100m north of the flagged area at Currumbin
Vikings Surf Life Saving Club.

Shocked at the sight, the distressed parents had to pull the dirty needle
out of the child’s foot.

“She was screaming in agony, lifting her leg up,” Mr McDermid said.
__________________________________________________________________
__________________________________________________________________

https://tinyurl.com/jrvrm7x
Grandmother who was injected with a USED needle during flu jab faces
agonising six-month wait to see if she has HIV or hepatitis

By Madlen Davies, MAILONLINE, UK (30.12.15)

* Heather Johnson, 58, was offered a flu jab at her GP surgery in
Derbyshire

* She claims a nurse accidentally injected her with a used needle

* Doctor called at her home four days later to explain a nurse had put a
pack of used needles back into the fridge where unused vaccines are stored

* Will have blood tests at 3 and 6 months to check for HIV and hepatitis

A grandmother faces a terrifying six-month wait to see if she has been
infected by a dirty needle used for her flu jab.

Heather Johnson, 58, was horrified to be told the nurse who gave the
injection had used a needle taken from a blister pack of used syringes.

It was only four days after the event that a doctor came to visit the
mother-of-two and her husband Ian at their home in Chesterfield,
Derbyshire.

There, he explained a nurse had put a pack of used needles back into the
fridge – where unused vaccines are stored.

Mrs Johnson, who is a carer for her mother, is now worried she could be
carrying blood-borne illnesses such as HIV or hepatitis.

Heather Johnson, 58, was injected with a used needle when she was offered
a flu jab at Rectory Road Medical Centre. She now anxiously awaits blood
tests to see if she has caught HIV or hepatitis

Heather Johnson, 58, was injected with a used needle when she was offered
a flu jab at Rectory Road Medical Centre. She now anxiously awaits blood
tests to see if she has caught HIV or hepatitis

After visiting the Rectory Road Medical medical centre in Stavely,
Derbyshire, for a routine appointment on November 13, she says she was
asked if she wanted a flu jab and said yes.

But when administering the vaccination, the nurse accidentally injected
her with a used needle.

Describing the event, Mrs Johnson said: ‘When the nurse went to give me
the injection, she put the needle in my arm and said “Oh, it’s empty”.

‘She took another needle out and that was empty too. The nurse didn’t
explain anything to me, just got out another pack and gave me the jab as
normal.

‘I was worried I had been given an injection of air but the nurse said it
was fine and I was sent on my way.’
__________________________________________________________________
__________________________________________________________________

https://tinyurl.com/jf6kucv
N.J. USA: Recycling workers getting pricked by Bayonne’s illegally
discarded needles

Jonathan Lin, The Jersey Journal, NJ USA (24.12.15)

BAYONNE — Amid an uptick in illegally discarded syringes and needles in
Bayonne, more than 10 recycling workers have been pricked by the sharp
objects, and face the risk of contracting diseases such as HIV/AIDS and
hepatitis.

Atlantic Coast Recycling, the Passaic-based company that receives and
processes the city’s recyclables, said there has been a “marked increase”
in the number of needles and syringes found in residents’ recyclables this
year, and that more than 10 of its employees have been pricked in the past
six months alone.

“All needle stick injuries must be treated as if the needles were infected
with a disease. Treatments and re-testing are taken over a six-month
period,” the company stated in a press release issued by City Hall this
week.

Reached by phone today, a company representative said no one is
immediately available to speak more specifically about the scope and the
cost of the problem. It’s not known at this time if any workers contracted
any diseases from being pricked.

Bayonne Mayor Jimmy Davis is advising residents that it’s illegal to
dispose of needles and syringes with the items they put out for recycling.

“The law is meant to protect recycling workers and others who might come
into contact with the sharp objects that could infect them,” he said.

City spokesman Joe Ryan provided a list of safety tips for disposing
syringes and needles:

1. Place used syringes and needles into an FDA-approved sharps container
or into a heavy-duty plastic container, such as a laundry detergent or a
bleach bottle. The bottle should be sturdy, puncture-resistant and should
not leak.

2. Close the screw-on lid tightly and label the sealed container as “Do
Not Recycle-Contains Sharps.” Wrap duct tape over the lid after you fill
the bottle with syringes.

3. Disposal: You may now dispose of the tightly sealed full container of
syringes in your household garbage — not in your recycling bin. Remember,
although you may feel healthy, your used syringes can transmit germs. In
addition, loose syringes thrown in your trash can seriously hurt people.

4. Do not put a plastic container with used needles and syringes out with
the recyclables.

5. Do not try to remove, bend, break, or recap needles used by another
sick person. This can lead to accidental needle sticks, which may cause
serious infections.

6. Pet owners who use needles to give medication to their pets should
follow the same disposal guidelines used for humans.

7. Many hospitals accept used needles and syringes when put in containers
using the steps listed.

8. Do not throw loose needles and other sharps into the trash.

9. Do not flush needles and other sharps down the toilet.
__________________________________________________________________
________________________________*_________________________________

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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