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SIGNpost 00835

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST

Post00835   Hep C in HCWs + Knees + Abstracts + News 13 January 2016

CONTENTS
0. Moderators Note
1. Hepatitis C in Health Care Workers — new study
2. Abstract: Review | The prevalence of hepatitis C among healthcare
workers: a systematic review and meta-analysis
3. Abstract: Editorial Commentary: Intra-articular Corticosteroid
Injection at the Time of Knee Arthroscopy Is Not Recommended
4. Abstract: Intraoperative Corticosteroid Injection at the Time of Knee
Arthroscopy Is Associated With Increased Postoperative Infection Rates
in a Large Medicare Population
5. Abstract: AMSSM scientific statement concerning viscosupplementation
injections for knee osteoarthritis: importance for individual patient
outcomes
6. Abstract: Acute hepatitis C virus infection related to capillary blood
glucose meter
7. Abstract: Prevalence of percutaneous injuries and associated factors
among health care workers in Hawassa referral and adare District
hospitals, Hawassa, Ethiopia, January 2014
8. Abstract: Health protection during the Ebola crisis: the Defence
Medical Services approach
9. Abstract: Teaching methotrexate self-injection with a web-based video
maintains patient care while reducing healthcare resources: a pilot
study
10. Abstract: High frequency of active HCV infection among seropositive
cases in west Africa and evidence for multiple transmission pathways
11. Abstract: The cost-effectiveness of harm reduction
12. Abstract: The burden of hepatitis C to the United States medicare
system in 2009: Descriptive and economic characteristics
13. Abstract: People who inject drugs in prison: HIV prevalence,
transmission and prevention
14. Abstract: Alternative delivery of a thermostable inactivated polio
vaccine
15. Abstract: Hard surface biocontrol in hospitals using microbial-based
cleaning products
16. No Abstract: Managing risk of hepatitis B after sharps injuries
17. News

– UK: Needles in recycling could cost Tewkesbury Borough Council £222,500
this year
– USA: US Congress lifts funding ban for needle exchange programs
– Deseret Utah USA: Investigation finds more cases of hepatitis C at
McKay-Dee, Davis hospitals

The web edition of SIGNpost is online at:
http://signpostonline.info/archives/2010

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/

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and get updates on your device!
__________________________________________________________________
________________________________*_________________________________

0. Moderators Note
__________________________________________________________________
This edition contains a lot of links to Full Open Access Articles. Happy
reading.

Also – Please share this brochure widely

” Making all injections safe ”

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
__________________________________________________________________
________________________________*_________________________________

1. Hepatitis C in Health Care Workers — new study

Many thanks to Amber Hogan for this. Best wishes for 2016!

The abstract follows in Item 2, below.
__________________________________________________________________
From: Dr Amber H Mitchell <amber.mitchell@internationalsafetycenter.org>
To “sign.moderator@gmail.com” <sign.moderator@gmail.com>
Date: Thu, Jan 7, 2016
Subject: Hep C in HCW — new study
Mailed by: internationalsafetycenter.org

Dear Sign Moderator,

Happy New Year and thank you for the important role you play keeping us
all informed, motivated, and engaged!

I’m forwarding this new article on HCV infection prevalence among
healthcare workers compared to the general public. I thought it would be
a great piece to share with the group.

It is open access:
http://oem.bmj.com/content/early/2015/10/05/oemed-2015-102879.full

My best to you.

Amber

Amber Hogan Mitchell, DrPH, MPH, CPH
President | Executive Director
International Safety Center
PH: +1.713.816.0013
EM: amber.mitchell@internationalsafetycenter.org
Web: www.internationalsafetycenter.org
LinkedIn: www.linkedin.com/in/amberhoganmitchell
__________________________________________________________________
________________________________*_________________________________

2. Abstract: Review | The prevalence of hepatitis C among healthcare
workers: a systematic review and meta-analysis
__________________________________________________________________

Free Open Access Article

Occup Environ Med doi:10.1136/oemed-2015-102879
Review | The prevalence of hepatitis C among healthcare workers: a
systematic review and meta-analysis

Claudia Westermann1, Claudia Peters1, Birgitte Lisiak2, Monica
Lamberti3, Albert Nienhaus1,2

1University Medical Center Hamburg-Eppendorf, Institute for Health
Services Research in Dermatology and Nursing, Hamburg, Germany
2Institution for Statutory Accident Insurance and Prevention in Health
and Welfare Services, Hamburg, Germany
3Department of Biochemistry, Biophysics and General Pathology, Second
University of Naples, Naples, Italy

Correspondence to Claudia Westermann, University Medical Center
Hamburg-Eppendorf, Institute for Health Services Research in Dermatology
and Nursing, Martinistrasse 52, Hamburg 20246, Germany;
c.westermann@uke.de

The aim of this study was to estimate the prevalence of viral hepatitis C
(HCV) infection among healthcare workers (HCWs) compared to the general
population. A systematic search for the years 1989–2014 was conducted in
the Medline, Embase and Cochrane databases.

Studies on hepatitis C in HCWs were included if they incorporated either a
control group or reference data for the general population. The study
quality was classified as high, moderate or low. Pooled effect estimates
were calculated to determine the odds of occupational infection.
Heterogeneity between studies was analysed using the X2 test (p<0.10) and
quantified using the I2 test. 57 studies met our criteria for inclusion
and 44 were included in the meta-analysis.

Analysis of high and moderate quality studies showed a significantly
increased OR for HCV infection in HCWs relative to control populations,
with a value of 1.6 (95% CI 1.03 to 2.42). Stratification by study region
gave an OR of 2.1 in low prevalence countries; while stratification by
occupational groups gave an increased prevalence for medical (OR 2.2) and
for laboratory staff (OR 2.2). The OR for professionals at high risk of
blood contact was 2.7. The pooled analysis indicates that the prevalence
of infection is significantly higher in HCWs than in the general
population. The highest prevalence was observed among medical and
laboratory staff.

Prospective studies that focus on HCW-specific activity and personal risk
factors for HCV infection are needed.
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Editorial Commentary: Intra-articular Corticosteroid
Injection at the Time of Knee Arthroscopy Is Not Recommended
__________________________________________________________________
http://www.arthroscopyjournal.org/article/S0749-8063(15)00889-0/fulltext
Editorial Commentary: Intra-articular Corticosteroid Injection at the Time
of Knee Arthroscopy Is Not Recommended.

Arthroscopy. 2016 Jan;32(1):96.

Hunt TJ.

In a population of Medicare patients undergoing knee arthroscopy, a
significant increase in the incidence of postoperative infection at 3 and
6 months was found in patients who received an intra-articular
corticosteroid injection at the time of knee arthroscopy compared with a
matched control group that did not receive an injection.

Intra-articular corticosteroid injection at the time of knee arthroscopy
is not recommended.

Copyright © 2016 Arthroscopy Association of North America. Published by
Elsevier Inc. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Intraoperative Corticosteroid Injection at the Time of Knee
Arthroscopy Is Associated With Increased Postoperative Infection Rates
in a Large Medicare Population
__________________________________________________________________

http://www.arthroscopyjournal.org/article/S0749-8063(15)00777-X/fulltext
Free Full Text

Arthroscopy. 2016 Jan;32(1):90-5.
Intraoperative Corticosteroid Injection at the Time of Knee Arthroscopy Is
Associated With Increased Postoperative Infection Rates in a Large
Medicare Population.

Cancienne JM1, Gwathmey FW1, Werner BC2.

1Department of Orthopaedic Surgery, University of Virginia Health System,
Charlottesville, Virginia, U.S.A.
2Department of Orthopaedic Surgery, University of Virginia Health System,
Charlottesville, Virginia, U.S.A.. Electronic address: bcw4x@virginia.edu.

PURPOSE: To employ a national database of Medicare patients to evaluate
the association of ipsilateral intra-articular knee corticosteroid
injections at the time of knee arthroscopy with the incidence of
postoperative infection.

METHODS: A national Medicare insurance database was queried for patients
who underwent ipsilateral intra-articular corticosteroid injection of the
knee at the time of knee arthroscopy from 2005 to 2012. Patients who
underwent arthroscopically assisted open procedures, those who underwent
more complex arthroscopic procedures, and those for whom laterality were
not coded were excluded. This study group was compared to a control cohort
of patients without intraoperative steroid injections that was matched to
the study group for age, gender, obesity, diabetes mellitus, and smoking
status. Infection rates within 3 and 6 months postoperatively were
assessed using International Classification of Diseases, 9th Revision, and
Current Procedural Terminology codes.

RESULTS: The incidence of postoperative infection rates after knee
arthroscopy was significantly higher at 3 months (0.66%; odds ratio [OR],
2.6; P < .0001) and 6 months (1.92%; OR, 3.6; P < .0001) in patients who
underwent ipsilateral intra-articular knee steroid injection at the time
of knee arthroscopy (n = 2,866) compared with matched controls without
intraoperative injections (n = 170,350) at 3 months (0.25%) and 6 months
(0.54%).

CONCLUSIONS: The present study demonstrates a significant increase in
postoperative infection in Medicare patients who underwent ipsilateral
intra-articular knee corticosteroid injections at the time of knee
arthroscopy compared with a matched control group without intraoperative
injection.

LEVEL OF EVIDENCE: Therapeutic Level III, retrospective comparative study.

Copyright © 2016 Arthroscopy Association of North America. Published by
Elsevier Inc. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

5. Abstract: AMSSM scientific statement concerning viscosupplementation
injections for knee osteoarthritis: importance for individual patient
outcomes
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26729890

Br J Sports Med. 2016 Jan;50(2):84-92.
AMSSM scientific statement concerning viscosupplementation injections for
knee osteoarthritis: importance for individual patient outcomes.

Trojian TH1, Concoff AL2, Joy SM3, Hatzenbuehler JR4, Saulsberry WJ5,
Coleman CI6.

1Community and Preventive Medicine, Lead Physician Drexel Athletics,
Philadelphia, Pennsylvania, USA.
2Department of Orthopedics and Sports Medicine, St Jude Medical Center,
Fullerton, California, USA.
3Department of Orthopaedic Surgery, The Cleveland Clinic, Cleveland, Ohio,
USA.
4Maine Medical Center Sports Medicine, Portland, Maine, USA.
5UCONN School of Pharmacy, Hartford Hospital Evidence-Based Practice
Center, Portland, Maine, USA.
6Hartford Hospital Evidence-Based Practice Center, Portland, Maine, USA.

Osteoarthritis (OA) is a disabling disease that produces severe morbidity
reducing physical activity.

Our position statement on treatment of knee OA with viscosupplementation
injection (hyaluronic acid, HA) versus steroid (intra-articular
corticosteroids, IAS) and placebo (intra-articular placebo, IAP) is based
on the evaluation of treatment effect by examining the number of
participants within a treatment arm who met the Outcome Measures in
Rheumatoid Arthritis Clinical Trials-Osteoarthritis Research Society
International (OMERACT-OARSI) criteria, which is different and more
relevant than methods used in other reviews which examined if the average
change across the treatment groups were clinically different.

We performed a systematic literature search for all relevant articles from
1960 to August 2014 in the MEDLINE, EMBASE and Cochrane CENTRAL. We
performed a network meta-analysis (NMA) of the relevant literature to
determine if there is a benefit from HA as compared with IAS and IAP. 11
papers met the inclusion criteria from the search strategy.

On NMA, those participants receiving HA were 15% and 11% more likely to
respond to treatment by OMERACT-OARSI criteria than those receiving IAS or
IAP, respectively (p<0.05 for both).

In the light of the aforementioned results of our NMA, the American
Medical Society for Sport Medicine recommends the use of HA for the
appropriate patients with knee OA.

Published by the BMJ Publishing Group Limited.
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Acute hepatitis C virus infection related to capillary blood
glucose meter
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26739982

Saudi Med J. 2016 Jan;37(1):93-5.
Acute hepatitis C virus infection related to capillary blood glucose
meter.

Inayat F1, Rai AB.

1Division of Gastroenterology, Department of Medicine, Jinnah Hospital,
Allama Iqbal Medical College, Lahore, Pakistan. E-mail.
faisalinayat@hotmail.com.

Hepatitis C virus (HCV) infects an estimated 130-150 million people
worldwide, becoming the major cause of chronic liver disease, cirrhosis,
hepatocellular carcinoma, and liver transplantation.

There are various preventable modes of transmission of HCV infection,
including needlestick and sharps injuries.

However, HCV infection secondary to needlestick injury by a capillary
blood glucose meter (CBGM) lancet has not been previously well reported.

We describe an unusual case of a 25-year-old male medical student,
acquiring acute HCV infection with a lancing device of CBGM. The source
patient was a 54-year-old diabetic male with positive anti-HCV test
results. In our patient, after 3 months of initial exposure, a standard
set of investigations confirmed the diagnosis of acute HCV infection with
the same genotype (3a) as the source.

The CBGM, as in our case, may have a role in the transmission of HCV
infection warranting radical advancements in diabetes screening and
monitoring technology.
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Prevalence of percutaneous injuries and associated factors
among health care workers in Hawassa referral and adare District
hospitals, Hawassa, Ethiopia, January 2014
__________________________________________________________________

https://tinyurl.com/h62tn3l Free Open Access Article

BMC Public Health. 2016 Jan 5;16(1):8.
Prevalence of percutaneous injuries and associated factors among health
care workers in Hawassa referral and adare District hospitals, Hawassa,
Ethiopia, January 2014.

Kaweti G1, Abegaz T2.

1Health management information system, Hawassa University, P.O. Box: 1560,
Hawassa, Ethiopia. k.gudeta@hotmail.com.
2School of public and environmental health, Hawassa University, Hawassa,
Ethiopia. teferiabegaz@gmail.com.

BACKGROUND: Accidental percutaneous injury and acquiring blood-borne
diseases are common problems among health care workers (HCWs). However,
little is known about the prevalence and associated factors for needle
stick injury among HCWs in Ethiopia.

METHODS: A cross sectional study was conducted by including 526 HCWs
(physicians, nurses, laboratory technicians, midwives and others), working
in two public hospitals (Hawassa Referral and Adare District hospitals),
from January 1-30, 2014. Binary logistic regression was done to assess the
association of selected independent variables with accidental percutaneous
injury.

RESULTS: The prevalence of at least one episode of percutaneous injury was
about 46 % of which more than half (28 %) occurred within one year prior
to the study period and only 24 % took prophylaxis for human immune
deficiency virus (HIV) infection. The adjusted logistic regression
analysis revealed that HCWs who recap needles were twice as likely to face
a percutaneous injury. Chance of exposure to needle stick or sharp
injuries also increased with increase in educational status. Having a
previous history of needle stick or sharp injury was found as one of the
risk factors for the occurrence of another injury. Nurses and cleaners
were also at increased risk for the occurrence of percutaneous injuries.

CONCLUSION: Needle stick and sharp injuries were common among HCWs in the
study hospitals, which warrants training on preventive methods.

Free Open Access Article
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Health protection during the Ebola crisis: the Defence
Medical Services approach
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26744191

J R Army Med Corps. 2016 Jan 7. pii: jramc-2015-000516.
Health protection during the Ebola crisis: the Defence Medical Services
approach.

Bricknell M1, Terrell A2, Ross D3, White D4.

1Ministry of Defence, Head Medical Operations and Capability, HQ Surgeon
General, London, UK.
2Head Defence Public Health Unit, HQ Surgeon General, Lichfield, UK.
3Health Unit AMD, Camberley, UK.
4Ministry of Defence, Assistant Head Future Medical Plans, HQ Surgeon
General, London, UK.

This paper is a narrative of the policies, procedures, mitigations and
observations of the application of Force Health Protection measures
applied by the Ministry of Defence (MOD) for the deployment of military
personnel to West Africa as part of the UK contribution to the
international response to the Ebola crisis from July 2014 to July 2015.

The MOD divided the threat into three risk categories: risk from disease
and non-battle injury, Ebola risk for non-clinical duties and Ebola risk
for healthcare workers.

Overall risk management was directed and monitored by the OP GRITROCK
Force Health Protection Board.

There were six cases of malaria, four outbreaks of gastrointestinal
disease, two needlestick injuries in Ebola-facing healthcare workers, one
MOD Ebola case and five non-needlestick, high-risk exposures.

This experience reinforces the requirement for the Defence Medical
Services to have a high level of organisational competence to advise on
Force Health Protection for the MOD.

Published by the BMJ Publishing Group Limited.

KEYWORDS: PUBLIC HEALTH; TROPICAL MEDICINE
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Teaching methotrexate self-injection with a web-based video
maintains patient care while reducing healthcare resources: a pilot
study
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/24951881

Rheumatol Int. 2015 Jan;35(1):93-6.
Teaching methotrexate self-injection with a web-based video maintains
patient care while reducing healthcare resources: a pilot study.

Katz SJ1, Leung S.

1Division of Rheumatology, 562 Heritage Medical Research Centre,
University of Alberta, Edmonton, AB, T6G 2S2, Canada,
Steven.Katz@ualberta.ca.

The aim of the study was to compare standard nurse-led methotrexate self-
injection patient education to a web-based methotrexate self-injection
education video in conjunction with standard teaching on patient self-
confidence for self-injection, as well as patient satisfaction, patient
knowledge and teaching time.

Consecutive rheumatology patients seen for methotrexate self-injection
education were enrolled. Prior to education, patient self-confidence for
self-injection, age, gender and education were recorded. Patients were
randomized 1:1 to standard teaching or the intervention: a 12-min
methotrexate self-injection education video followed by further in-person
nurse education. Patients recorded their post-education confidence for
self-injection, satisfaction with the teaching process and answered four
specific questions testing knowledge on methotrexate self-injection. The
time spent providing direct education to the patient was recorded.

Twenty-nine patients participated in this study: 15 had standard (C)
teaching and 14 were in the intervention group (I). Average age, gender
and education level were similar in both groups. Both groups were
satisfied with the quality of teaching. There was no difference in pre-
confidence (C = 5.5/10 vs. I = 4.7/10, p = 0.44) or post-confidence (C =
8.8, I = 8.8, p = 0.93) between the groups. There was a trend toward
improved patient knowledge in the video group versus the standard group (C
= 4.7/6, I = 5.5/6, p = 0.15). Nurse teaching time was less in the video
group (C = 60 min, I = 44 min, p = 0.012), with men requiring longer
education time than women across all groups.

An education video may be a good supplement to standard in-person nurse
teaching for methotrexate self-injection. It equals the standard teaching
practise with regard to patient satisfaction, confidence and knowledge
while decreasing teaching time by 25 %.
__________________________________________________________________
________________________________*_________________________________

10. Abstract: High frequency of active HCV infection among seropositive
cases in west Africa and evidence for multiple transmission pathways
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/25477425

Clin Infect Dis. 2015 Apr 1;60(7):1033-41.
High frequency of active HCV infection among seropositive cases in west
Africa and evidence for multiple transmission pathways.

Layden JE1, Phillips RO2, Owusu-Ofori S3, Sarfo FS2, Kliethermes S1, Mora
N4, Owusu D3, Nelson K5, Opare-Sem O2, Dugas L4, Luke A4, Shoham D4, Forbi
JC6, Khudyakov YE6, Cooper RS4.

1Department of Public Health Sciences Department of Medicine, Stritch
School of Medicine, Loyola University Chicago, Maywood, Illinois.
2Komfo Anokye Teaching Hospital Kwame Nkrumah University of Science and
Technology, Kumasi, Ghana.
3Komfo Anokye Teaching Hospital.
4Department of Public Health Sciences.
5Departments of Epidemiology and International Health, Johns Hopkins
School of Public Health, Baltimore, Maryland.
6Molecular Epidemiology and Bioinformatics Laboratory, Division of Viral
Hepatitis, Centers for Disease Control, Atlanta, Georgia.

BACKGROUND: Sub-Saharan Africa (SSA) has one of the highest global
hepatitis C virus (HCV) prevalence estimates. However, reports that
suggest high rates of serologic false positives and low levels of viremia
have led to uncertainty regarding the burden of active infection in this
region. Additionally, little is known about the predominant transmission
risk factors in SSA.

METHODS: We prospectively recalled 363 past blood donors (180 who were
rapid screen assay [RSA] positive and 183 who were RSA negative at time of
donation) to identify the level of active infection and risk factors for
infection at a teaching hospital in Kumasi, Ghana. Participants had repeat
blood testing and were administered a questionnaire on risk factors.

RESULTS: The frequency of HCV active infection ranged from 74.4% to 88%
depending on the criteria used to define serologically positive cases.
Individuals with active disease had biochemical evidence of liver
inflammation and median viral loads of 5.7 log copies/mL. Individuals from
the northern and upper regions of Ghana had greater risks of infection
compared with participants from other areas. Additional risk factors
included traditional circumcision, home birth, tribal scarring, and
hepatitis B virus coinfection.

CONCLUSIONS: Viremic infection was common among serologically confirmed
cases. Attention to testing algorithms is needed in order to define the
true HCV burden in SSA. These data also suggest that several transmission
modes are likely contributing to the current HCV epidemic in Ghana and
that the distribution of these practices may result in substantial
regional variation in prevalence.

© The Author 2014. Published by Oxford University Press on behalf of the
Infectious Diseases Society of America. All rights reserved. For
Permissions, please e-mail: journals.permissions@oup.com.

KEYWORDS: Africa; HCV; prevalence; transmission
__________________________________________________________________
________________________________*_________________________________

11. Abstract: The cost-effectiveness of harm reduction
__________________________________________________________________

http://www.ijdp.org/article/S0955-3959(14)00311-9/abstract
Free Open Access Article
Int J Drug Policy. 2015 Feb;26 Suppl 1:S5-11.

The cost-effectiveness of harm reduction.

Wilson DP1, Donald B2, Shattock AJ2, Wilson D3, Fraser-Hurt N3.

1The Kirby Institute, UNSW Australia, Australia. Electronic address:
dwilson@unsw.edu.au.
2The Kirby Institute, UNSW Australia, Australia.
3Global HIV/AIDS Program, World Bank, United States.

HIV prevalence worldwide among people who inject drugs (PWID) is around
19%. Harm reduction for PWID includes needle-syringe programs (NSPs) and
opioid substitution therapy (OST) but often coupled with antiretroviral
therapy (ART) for people living with HIV. Numerous studies have examined
the effectiveness of each harm reduction strategy.

This commentary discusses the evidence of effectiveness of the packages of
harm reduction services and their cost-effectiveness with respect to HIV-
related outcomes as well as estimate resources required to meet global and
regional coverage targets.

NSPs have been shown to be safe and very effective in reducing HIV
transmission in diverse settings; there are many historical and very
recent examples in diverse settings where the absence of, or reduction in,
NSPs have resulted in exploding HIV epidemics compared to controlled
epidemics with NSP implementation. NSPs are relatively inexpensive to
implement and highly cost-effective according to commonly used
willingness-to-pay thresholds.

There is strong evidence that substitution therapy is effective, reducing
the risk of HIV acquisition by 54% on average among PWID. OST is
relatively expensive to implement when only HIV outcomes are considered;
other societal benefits substantially improve the cost-effectiveness
ratios to be highly favourable. Many studies have shown that ART is cost-
effective for keeping people alive but there is only weak supportive, but
growing evidence, of the additional effectiveness and cost-effectiveness
of ART as prevention among PWID.

Packages of combined harm reduction approaches are highly likely to be
more effective and cost-effective than partial approaches. The coverage of
harm reduction programs remains extremely low across the world.

The total annual costs of scaling up each of the harm reduction strategies
from current coverage levels, by region, to meet WHO guideline coverage
targets are high with ART greatest, followed by OST and then NSPs. But
scale-up of all three approaches is essential. These interventions can be
cost-effective by most thresholds in the short-term and cost-saving in the
long-term.

Copyright © 2015 The Authors. Published by Elsevier B.V. All rights
reserved.

KEYWORDS: Cost-effectiveness; HIV; Harm reduction; People who inject drugs

Free full text
__________________________________________________________________
________________________________*_________________________________

12. Abstract: The burden of hepatitis C to the United States medicare
system in 2009: Descriptive and economic characteristics
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26707033

Hepatology. 2015 Dec 28.
The burden of hepatitis C to the United States medicare system in 2009:
Descriptive and economic characteristics.

Rein DB1, Borton J1, Liffmann DK1, Wittenborn JS1.

1NORC at the University of Chicago.

OBJECTIVE: To estimate and describe the Medicare beneficiaries diagnosed
with hepatitis C virus (HCV) in 2009, incremental annual costs by disease
stage, incremental total Medicare HCV payments in 2009, and the number of
cases entering Medicare from 2014-2024.

DATA SOURCES: Surveillance, Epidemiology, and End Results (SEER)-Medicare
linked data from 2002-2009. National Health and Nutrition Examination
Survey (NHANES) data from 2003-2012.

STUDY DESIGN: We weighted the 2009 SEER-Medicare data to create system
estimates, used an inverse probability weighted two-part, probit and
generalized linear model to estimate incremental per patient per month
costs, and used simulation to estimate annual 2009 Medicare burden,
presented in 2014 dollars.

DATA EXTRACTION METHODS: We summarized patient characteristics, diagnoses,
and costs from SEER- Medicare files into a person year panel dataset.

PRINCIPAL FINDINGS: We estimated 407,786 patients with diagnosed HCV in
2009, of whom 61.4% had one or more comorbidities defined by the study. In
2009, 68% of patients were diagnosed with chronic HCV only, 9% with
cirrhosis, 12% with decompensated cirrhosis, 2% with liver cancer, 2% with
a history of transplant, and 8% who died. Annual costs for patients with
chronic infection only, and decompensated cirrhosis were higher than the
values used in many previous cost-effectiveness studies, and Treatment of
DCC accounted for 63.9% of total Medicare’s HCV expenditures. Medicare
paid $2.7 billion (Cr.I. $0.7-$4.6 billion) in incremental costs for HCV
in 2009.

CONCLUSIONS: The costs of HCV to Medicare in 2009 were substantial and
expected to increase over the next decade. Annual costs for patients with
chronic infection only, and decompensated cirrhosis were higher than
values used in many cost-effectiveness analyses. This article is protected
by copyright. All rights reserved.

© 2015 by the American Association for the Study of Liver Diseases.

KEYWORDS:
Burden of Disease; Cost; Hepatitis C Virus; Medicare; Propensity Score
Matching
__________________________________________________________________
________________________________*_________________________________

13. Abstract: People who inject drugs in prison: HIV prevalence,
transmission and prevention
__________________________________________________________________

http://www.ijdp.org/article/S0955-3959(14)00293-X/abstract
Free Open Access Article

Int J Drug Policy. 2015 Feb;26 Suppl 1:S12-5.
People who inject drugs in prison: HIV prevalence, transmission and
prevention.

Dolan K1, Moazen B2, Noori A2, Rahimzadeh S3, Farzadfar F2, Hariga F4.

1Program of International Research and Training, National Drug and Alcohol
Research Centre, University of New South Wales, Sydney, Australia.
Electronic address: K.dolan@unsw.edu.au.
2Non-Communicable Diseases Research Center, Endocrinology and Metabolism
Population Sciences Institute, Tehran University of Medical Sciences,
Tehran, Iran.
3Non-Communicable Diseases Research Center, Endocrinology and Metabolism
Population Sciences Institute, Tehran University of Medical Sciences,
Tehran, Iran; United Nations Office on Drugs and Crime (UNODC), Vienna,
Austria.
4United Nations Office on Drugs and Crime (UNODC), Vienna, Austria.

In 2011, over 10.1 million people were held in prisons around the world.
HIV prevalence is elevated in prison and this is due to the over
representation of people who inject drugs (PWID). Yet HIV prevention
programs for PWID are scarce in the prison setting. With a high proportion
of drug users and few prevention programs, HIV transmission occurs and
sometimes at an alarming rate.

This commentary focuses primarily on drug users in prison; their risk
behaviours and levels of infection. It also comments on the transmission
of HIV including outbreaks and the efforts to prevent transmission within
the prison setting.

The spread of HIV in prison has substantial public health implications as
virtually all prisoners return to the community. HIV prevention and
treatment strategies known to be effective in community settings, such as
methadone maintenance treatment, needle and syringe programs, condoms and
antiretroviral therapy should be provided to prisoners as a matter of
urgency.

Copyright © 2015 The Authors. Published by Elsevier B.V. All rights
reserved.

KEYWORDS: Outbreaks; People who inject drugs; Prevalence; Prevention;
Prison; Transmission
__________________________________________________________________
________________________________*_________________________________

14. Abstract: Alternative delivery of a thermostable inactivated polio
vaccine
__________________________________________________________________

http://www.sciencedirect.com/science/article/pii/S0264410X15002996
Open Access

Vaccine. 2015 Apr 21;33(17):2030-7.
Alternative delivery of a thermostable inactivated polio vaccine.

Kraan H1, Ploemen I2, van de Wijdeven G3, Que I4, Löwik C4, Kersten G5,
Amorij JP2.

1Intravacc (Institute for Translational Vaccinology), Bilthoven, The
Netherlands. Electronic address: heleen.kraan@intravacc.nl.
2Intravacc (Institute for Translational Vaccinology), Bilthoven, The
Netherlands.
3Bioneedle Technologies Group BV, Eindhoven, The Netherlands.
4Department of Radiology, Leiden University Medical Center, Leiden, The
Netherlands.
5Intravacc (Institute for Translational Vaccinology), Bilthoven, The
Netherlands; Division of Drug Delivery Technology, Leiden Academic Center
for Drug Research, Leiden University, Leiden, The Netherlands.

In the near future oral polio vaccine (OPV) will be replaced by
inactivated polio vaccine (IPV) as part of the eradication program of
polio. For that reason, there is a need for substantial amount of safe and
more affordable IPV for low-income countries.

Bioneedles, which are biodegradable mini-implants, have the potential to
deliver vaccines outside the cold-chain and administer them without the
use of needles and syringes.

In the current study, Bioneedles were filled with IPV, subsequently
lyophilized, and antigenic recoveries were determined both directly after
IPV-Bioneedle preparation as well as after elevated stability testing.
Further, we assessed the immunogenicity of IPV- Bioneedles in rats and the
residence time at the site of administration. Trivalent IPV was formulated
in Bioneedles with recoveries of 101±10%, 113±18%, and 92±15%,
respectively for serotypes 1, 2 and 3.

IPV in Bioneedles is more resistant to elevated temperatures than liquid
IPV: liquid IPV retained less than half of its antigenicity after 1 day at
45°C and IPV in Bioneedles showed remaining recoveries of 80±10%, 85±4%
and 63±4% for the three serotypes.

In vivo imaging revealed that IPV administered via Bioneedles as well as
subcutaneously injected liquid IPV showed a retention time of 3 days at
the site of administration. Finally, an immunogenicity study showed that
IPV-filled Bioneedles are able to induce virus-neutralizing antibody
titers similar to those obtained by liquid intramuscular injection when
administered in a booster regime. The addition of LPS-derivate PagL in
IPV-filled Bioneedles did not increase immunogenicity compared to IPV-
Bioneedles without adjuvant.

The current study demonstrates the pre-clinical proof of concept of IPV-
filled Bioneedles as a syringe-free alternative delivery system.

Further pre- clinical and clinical studies will be required to assess the
feasibility whether IPV-Bioneedles show sufficient safety and efficacy,
and may contribute to the efforts to eradicate and prevent polio in the
future.

Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights
reserved.

KEYWORDS: Adjuvant; Biodistribution; Bioneedles; Needle free; Vaccine
delivery

http://www.sciencedirect.com/science/article/pii/S0264410X15002996
Open Access Free Full Text Free PDF
__________________________________________________________________
________________________________*_________________________________

15. Abstract: Hard surface biocontrol in hospitals using microbial-based
cleaning products
__________________________________________________________________

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0108598
Free Open Access Article

PLoS One. 2014 Sep 26;9(9):e108598.

Hard surface biocontrol in hospitals using microbial-based cleaning
products.

Vandini A1, Temmerman R2, Frabetti A1, Caselli E3, Antonioli P4, Balboni
PG3, Platano D5, Branchini A6, Mazzacane S1.

1CIAS Laboratory, Centre for the Study of physical, chemical and
microbiological Contamination of Highly Sterile Environments, Department
of Architecture, University of Ferrara, Ferrara, Italy.
2Laboratory of Microbial Ecology and Technology, Ghent University, Ghent,
Belgium; Chrisal R & D Department, Lommel, Belgium.
3Department of Medical Sciences, Microbiology Section, University of
Ferrara, Ferrara, Italy.
4Department of Infection Prevention Control and Risk Management, Ferrara
University Hospital, Ferrara, Italy.
5Department of Biomedical and Neuromotor Sciences, University of Bologna,
Bologna, Italy.
6Department of Life Sciences and Biotechnology, University of Ferrara,
Ferrara, Italy.

BACKGROUND: Healthcare-Associated Infections (HAIs) are one of the most
frequent complications occurring in healthcare facilities. Contaminated
environmental surfaces provide an important potential source for
transmission of many healthcare-associated pathogens, thus indicating the
need for new and sustainable strategies.

AIM: This study aims to evaluate the effect of a novel cleaning procedure
based on the mechanism of biocontrol, on the presence and survival of
several microorganisms responsible for HAIs (i.e. coliforms, Staphyloccus
aureus, Clostridium difficile, and Candida albicans) on hard surfaces in a
hospital setting.

METHODS: The effect of microbial cleaning, containing spores of food grade
Bacillus subtilis, Bacillus pumilus and Bacillus megaterium, in comparison
with conventional cleaning protocols, was evaluated for 24 weeks in three
independent hospitals (one in Belgium and two in Italy) and approximately
20000 microbial surface samples were collected.

RESULTS: Microbial cleaning, as part of the daily cleaning protocol,
resulted in a reduction of HAI-related pathogens by 50 to 89%. This effect
was achieved after 3-4 weeks and the reduction in the pathogen load was
stable over time. Moreover, by using microbial or conventional cleaning
alternatively, we found that this effect was directly related to the new
procedure, as indicated by the raise in CFU/m2 when microbial cleaning was
replaced by the conventional procedure. Although many questions remain
regarding the actual mechanisms involved, this study demonstrates that
microbial cleaning is a more effective and sustainable alternative to
chemical cleaning and non-specific disinfection in healthcare facilities.

CONCLUSIONS: This study indicates microbial cleaning as an effective
strategy in continuously lowering the number of HAI-related microorganisms
on surfaces. The first indications on the actual level of HAIs in the
trial hospitals monitored on a continuous basis are very promising, and
may pave the way for a novel and cost-effective strategy to counteract or
(bio) control healthcare-associated pathogens.

Free Open Access Article
__________________________________________________________________
________________________________*_________________________________

16. No Abstract: Managing risk of hepatitis B after sharps injuries
__________________________________________________________________
https://www.ncbi.nlm.nih.gov/pubmed/26490050

BMJ. 2015 Oct 21;351:h5568.

Managing risk of hepatitis B after sharps injuries.

De Schryver AA1, Van Hooste W1, Van Acker H1, Claessens B1, Haenen R1, Van
Crombrugge K1, Godderis L1.

1IDEWE Occupational Health Services, Interleuvenlaan 58, B 3001 Leuven,
Belgium.

Comment in
Authors’ reply to De Schryver and colleagues. [BMJ. 2015]
https://www.ncbi.nlm.nih.gov/pubmed/26490160

Comment on
Management of sharps injuries in the healthcare setting. [BMJ. 2015]
https://www.ncbi.nlm.nih.gov/pubmed/26223519
__________________________________________________________________
________________________________*_________________________________

17. News

– UK: Needles in recycling could cost Tewkesbury Borough Council £222,500
this year

– USA: US Congress lifts funding ban for needle exchange programs

– Deseret Utah USA: Investigation finds more cases of hepatitis C at
McKay-Dee, Davis hospitals

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/jenrj8n
UK: Needles in recycling could cost Tewkesbury Borough Council £222,500
this year

By Robin Jenkins, Gloucestershire Echo U.K. (12.01.16)

Used needles have been found in recyclable waste loads in Tewkesbury
borough.

Tewkesbury Borough Council is set to spend £222,500 this year on sorting
recycling that has been contaminated by needles.

In the past 12 months, the authority says there have been more than 30
incidents of needles being found within material sent to a facility in
Bishop’s Cleeve to be sorted for recycling.

The needles and paraphernalia were associated with diabetes and illegal
drug use. They came from Tewkesbury, Winchcombe, Brockworth, Churchdown
and Woodmancote and led to nine loads of recyclable material being
diverted to landfill.

Council bosses say the needles caused increased risks to staff of the site
operator, Grundon Waste Management Ltd, and delayed the sorting process.

Val Garside, the council’s environmental and housing services group
manager, is recommending the move.

In a report to the meeting, she said Grundon had a year left of a three-
year contract, worth more than £2.2million, to process, sort and sell dry
recyclable material collected in the borough.

She said: “Whilst in general the contract has been progressing well, over
the last year there have been incidents of contamination within the
recyclate material, which is resulting in increased risks to staff and
significant impacts upon the sorting process. This level of contamination
in the recyclate stream has some clear consequences for both the operator
and the council which need to be actively addressed.

“In order for Grundon to continue to accept the material, and provide the
service to the council until the end of the current contract in April
2017, work has been done collectively with the operator to find an
effective solution. Grundon has reviewed its processes to enable this
material to continue to be accepted and sorted in a safer manner.

“This will result in all the council’s recycling being accepted and
processed in line with a variation of the contract specifications.

“The variation, however, does increase the cost of the processes and will
result in a one-off additional cost to the contract for 2016/17.”
__________________________________________________________________
__________________________________________________________________

https://tinyurl.com/jrjvqsf
USA: US Congress lifts funding ban for needle exchange programs

By Staff Writer, Lawyer Herald, USA (08.01.16)

The U.S. Congress has quitely lifted the federal funding ban on needle
exchange programs after more than a quarter century the programs went into
effect. The needle exchange programs provide clean needles, allowing
intravenous drug addicts to trade dirty syringes for clean ones to prevent
to help combat HIV.

The partial repeal passed by Congress in late December, spearheaded by
House Appropriations Chairman Hal Rogers and backed by Senate Majority
Leader Mitch McConnell, both from Kentucky. The decision is also supported
by West Virginia Republican Sen. Shelley Moore Capito who is on the
Appropriations Committee, Buzzfeed reported.

The funding ban repeal came in response to a massive HIV/AIDS outbreak in
Indiana, and the state’s decision to implement its own exchange to combat
growing heroin use. The repeal will allow federal government to make
resources available to pay on partial aspects of the needle exchange
programs including staff, vehicles, gas, rent, and everything but the
syringe. Local funds or private funds are expected to cover the direct
costs of syringes and needles.

HIV/AIDS experts and activists praised the decision as an effective end to
the ban, since syringes are a very inexpensive part of needle exchange
programs. Associate Dean of Global Health Sciences at the University of
california at San Diego, Dr. Steffanie Strathdee, said that the move is
basically a giant work around to conservative opposition.

Leana Wen, health commissioner in Baltimore, said that the needle exchange
programs reduce the transmission of disease, according to USA Today. Wen
said that the Congress has made a critical first step in helping every
state implements the evidence-based policy that has proven to save lives.

The U.S. government instituted a ban on federal funding for needle
exchange programs in 1988 for people who inject street drugs. In 1998, a
study from researchers at John Hopkins University found that clean needle
exchanges generally reduce the spread of HIV without increasing drug use.
Another study in 2004 by the World Health Organization (WHO) found similar
results.

According to Human Right Campaign’s (HRC’s) blog, the HRC successfully
lobbied the government to have the ban fully repealed in 2009. However,
when Republicans regained control of the House in 2011, they reinstituted
the ban.

The needle exchange programs applied in Washington DC succesfully dropped
needle-caused HIV cases by 80 percent, from 149 in 2007 to 30 in 2011. The
are at least 194 needle exchange programs operating in the U.S., under
budgets ranging from $100,000 to $300,000.

Tags: U.S. Congress, funding ban, needle exchange programs, needles, HIV,
AIDS, Washington DC, WHO
__________________________________________________________________
__________________________________________________________________

https://tinyurl.com/gr3ovq6
Deseret Utah USA: Investigation finds more cases of hepatitis C at McKay-
Dee, Davis hospitals

By Daphne Chen, Deseret News, Deseret Utah, USA (05.01.16)

The Utah Department of Health has identified more patients exposed to
hepatitis C in the investigation of McKay-Dee and Davis hospitals.

[Thousands may have been exposed to hepatitis C, health officials say
https://tinyurl.com/hy725u7 ]

SALT LAKE CITY — Two months after health officials began investigating how
a patient at McKay-Dee Hospital contracted hepatitis C, the Utah
Department of Health is confirming more patients have since tested
positive for the virus.

Angela Dunn, a medical epidemiologist with the Centers for Disease Control
and Prevention stationed at the Utah Department of Health, confirmed that
additional cases have been identified but said health officials would not
be releasing the final numbers until the investigation is complete.

Hospital officials asked nearly 7,200 patients at McKay-Dee Hospital in
Ogden and Davis Hospital and Medical Center in Layton to get tested for
hepatitis C in November after a former nurse and a patient both tested
positive for the same rare strain of hepatitis C.

Authorities are concerned that the former nurse, identified by Ogden
police as Elet Neilson, 49, of Layton, may have exposed patients to the
virus.

Chris Dallin, a spokesman for McKay-Dee Hospital, declined to confirm the
existence of additional cases until the health department completes its
report. That will likely be in February, he said, after hospital officials
finish processing the last of the free hepatitis C tests being offered to
patients until Jan. 31.

Hepatitis C, a virus that attacks the liver, is transmitted through
contact with infected blood, typically by sharing needles.

In recent years, several high-profile hepatitis C outbreaks have involved
hospital workers exposing patients to the bloodborne pathogen after
tampering with injection equipment to steal narcotics.

In 2009, a Denver hospital technician infected at least 18 patients with
hepatitis C after she stole syringes of pain medication and swapped them
with used syringes containing saline.

Neilson, the former McKay-Dee nurse now at the center of the
investigation, lost her nursing license in December 2014 after admitting
to stealing medication from her employer, according to licensing division
documents.

Dallin said the former nurse in was fired from McKay-Dee in 2014 after the
hospital found evidence she had stolen morphine and Dilaudid, both opioid
pain medications.

Authorities expanded the investigation to include patients at Davis
Hospital and Medical Center after they learned that Neilson was caught
stealing IV Benadryl from the hospital while employed there in 2012 and
2013.

Health officials are still calling on patients who received letters about
their possible exposure to come in for testing.

Chris Johnson, chief nursing officer at Davis Hospital and Medical Center,
said in a prepared statement the hospital has had “nearly 50 percent of
all those exposed tested.”

Dunn estimated the response rate was closer to 35 percent overall. That’s
still “pretty low,” she said.

She warned that hepatitis C usually lies dormant for years, but it can
lead to severe liver damage, liver cancer and liver failure if left
untreated.

Dunn said the additional patients identified have the same strain of
hepatitis C as the former nurse and the first patient, lending more
credibility to the possibility that the infections come from a common
source. Genotype 2b is found in about 8 percent of people with hepatitis
C, Dunn said.
__________________________________________________________________
________________________________*_________________________________

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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