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SIGNpost 00838

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST

Post00838 Blogs: NSI HCV HCWs + Zika + Abstracts + News 03 February 2016

CONTENTS
0. Moderators Note: Apologies!
1. Blog: Hepatitis C Virus Still Unacceptably High Risk for Healthcare
Workers
2. New: US CDC’s Safe Healthcare Blog: Convinced They are Doing the Right
Things…
3. ZIKA: WHO statement on the first meeting of the International Health
Regulations (2005) (IHR 2005) Emergency Committee on Zika virus and
observed increase in neurological disorders and neonatal malformations
4. Abstract: Hepatitis C virus prevalence and genotype distribution in
Pakistan: Comprehensive review of recent data
5. Abstract: Healthcare associated Crimean-Congo haemorrhagic fever in
Turkey 2002-2014 – A multi-centre retrospective cross-sectional study
6. Abstract: The Frequency, Causes and Prevention of Needlestick Injuries
in Nurses of Kerman: A Cross-Sectional Study
7. Abstract: Occupational injuries prone to infectious risks amongst
healthcare personnel in Kuwait: a retrospective study
8. Abstract: The injecting use of image and performance-enhancing drugs
(IPED) in the general population: a systematic review
9. Abstract: Incidence of hepatitis C in Brazil
10. Abstract: Declining trends in the rates of assisted injecting: a
prospective cohort study
11. Abstract: High Prevalence and Incidence of HIV and HCV Among New
Injecting Drug Users With a Large Proportion of Migrants-Is Prevention
Failing?
12. Abstract: High rates of abscesses and chronic wounds in community-
recruited injection drug users and associated risk factors
13. Abstract: Lemierre syndrome with cervical spondylodiscitis and
epidural abscess associated with direct injection of heroin into the
jugular vein
14. Abstract: Comparison of SGA oral medications and a long-acting
injectable SGA: the PROACTIVE study
15. Abstract: Indications and the requirements for single-use medical
gloves
16. No Abstract: Incident hepatitis among repeat blood donors: A sentinel
event signaling possible health care-associated infection and need for
reporting to public health authorities
17. No Abstract: The role of ultraviolet marker assessments in
demonstrating cleaning efficacy
18. No Abstract: Tuberculous abscess at the site of penicillin injections
19. No Abstract: Tuberculous abscess following intramuscular penicillin
20. No Abstract: Oil sterilisation of syringes
21. News
– Americas: Zika will likely spread throughout the Americas: WHO
– India: RIMS nurses reuse syringes, expose patients to infection

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0. Moderators Note: Apologies!
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1. Blog: Hepatitis C Virus Still Unacceptably High Risk for Healthcare
Workers

Ctossposted from InfectionControl.tips with moderators thanks to Amber
Hogan Mitchell.

Amber Hogan mitchell is at the http://internationalsafetycenter.org/
__________________________________________________________________
https://tinyurl.com/gpnwlxx
Hepatitis C Virus Still Unacceptably High Risk for Healthcare Workers
By Amber Hogan Mitchell (2), http://infectioncontrol.tips (01.01.16)
Edited by: Andrew Duong (6)

Abstract:

Background: A recently published study describes that the prevalence of
occupational hepatitis C virus (HCV) infection is higher than the general
population. This study provides insights into the risk associated with
virus acquisition from other surveillance systems that quantify
needlestick and other blood and body fluid exposure incidents among the
healthcare workforce.

Significance: For decades, healthcare facilities have focused on
preventing occupational exposure to bloodborne pathogens using universal
and standard precautions, and adhering to federal regulations. Based on
occupational incident surveillance data (EPINet), it seems that this may
not still be the case. As HCV infections among healthcare workers are
still unacceptably high and occupational incident data confirms that
exposures are still occurring and can be prevented, this article provides
evidence for suggesting that policies at the national, local, and facility
level need to be improved in order to decrease transmission of bloodborne
pathogens.

Main Article:

With workplace controls for bloodborne pathogens having been solidly in
place in healthcare settings for decades, a new study reveals that we may
need to drastically improve our focus in order to protect healthcare
workers from ongoing exposures to viruses like hepatitis C virus (HCV).
HCV causes Hepatitis C that is a chronic liver infection that can cause
long-term health effects and even death. There is currently no cure.
Hepatitis C is transmitted via blood and today most people in the general
population become infected with the virus by sharing needles or other
equipment to inject drugs. It is a risk to healthcare workers who get
stuck with needles, sharp instruments, blood or body fluids from patients
that are infected with HCV. The Centers for Disease Control and
Prevention (CDC) estimates that HCV infection has increased 150% from 2010
to 2013 and many people do not know they are infected.1

A recently published study in Occupational and Environmental Medicine
authored by Claudia Westermann and her research team in Germany,
illustrate that we need to do better to control and prevent occupational
exposures to HCV.

Westermann and her team conducted a meta-analysis of papers published from
1989-2014 to estimate the prevalence of HCV infection among healthcare
workers compared to the general population. Their systematic review
indicates that healthcare workers have a more than 200% higher prevalence
of HCV infection than the public at large and a nearly 300% higher
prevalence for some categories of workers, especially those with the most
frequent exposures to blood including medical and laboratory technical
professions.2 With the use of engineering controls and the requirement
for facilities to use safety-engineered medical devices, safe disposal
practices and extensive training, this extraordinarily high prevalence
seems unfathomable in a population that has greater protections in place
than the general public.

occupational risk to needlesticks and sharps injuries are still
unacceptably high

The International Safety Center’s Exposure Prevention Information Network
(EPINet®) data supports that occupational risk to needlesticks and sharps
injuries are still unacceptably high. The 2013 sharps injury summary data
from a network of 30 US hospitals illustrates that more than 50% of
injuries are from devices that are not a safety design despite regulations
from OSHA to use them. It also indicates, that of the safety devices that
were used, more than 70% did not have safety features activated to protect
the users from the contaminated sharp.3

In the US, we clearly have more work to do. Actually, only a handful of
countries have requirements in place to use safety engineered devices,
which begs the question; if countries like the US have regulations in
place to protect healthcare workers from bloodborne pathogens like HCV,
but compliance is still lower than ideal, how much higher is the risk in
countries around the world that do not have regulations in place?

Based on Westermann et al data from around the world, the risk of
infection can be much higher! In some countries like Italy, Saudi Arabia,
Egypt, and Nigeria, odd ratios (ORs) can range from higher than 2.0 to up
to 17.0. That means essentially that healthcare workers in some countries
are 200% to more than 1,700% more likely to be infected with HCV despite
having bloodborne pathogens training that the general population does not
typically have access to.

There are no required or mandatory national or international
surveillance/reporting systems that track occupational seroconversion to
HCV or other bloodborne pathogens following a needlestick, sharp object
injury, or splatter. Westermann’s paper in conjunction with EPINet data
may support the implication that injuries from sharps and other blood and
body fluid splashes and splatters can cause cases of occupational HCV,
despite the use of post-exposure prophylaxis. This amplifies the need for
CDC, National Institute for Occupational Safety and Health (NIOSH), and
the Occupational Safety and Health Administration (OSHA) to provide
updated information on preventing HCV transmission (Note: CDC’s last
published guidance for occupational exposure to bloodborne pathogens like
HCV was in 2001).4

Number of total exposures is gravely under-estimated

In addition, surveillance systems should be put in place that track HCV
infections back to a specific occupational exposure, so that future
infections can be prevented. Based on what limited data CDC does collect
voluntarily, data from 2013 indicates that there were 52 confirmed cases
of HCV infection from needlesticks but this dataset shows an incomplete
picture. Follow-up data (HCV infection status) was not available from
1,459 out of 2,138 needlesticks. This could mean that HCV infections
following needlesticks from hospitals submitting data to CDC are actually
higher and since neither CDC, NIOSH, nor OSHA require healthcare
facilities to report needlesticks, the number of total exposures is
gravely under-estimated.5

How can we possibly combat emerging infectious disease threats, when the
traditional, long-standing ones are still a problem? The outlook appears
grim. However, motivation is often elicited through evidence, knowledge
and understanding.

References:

[1] Centers for Disease Control and Prevention (CDC). Viral Hepatitis
Surveillance. United States, 2013.
http://www.cdc.gov/hepatitis/statistics/2013surveillance/pdfs/2013hepsurve
illancerpt.pdf. Accessed December 30, 2015.

[2] Westermann, C. et al. The prevalence of hepatitis C among healthcare
workers: a systematic review and meta-analysis. Occup Environ Med
2015;0:1–9.
http://oem.bmj.com/content/early/2015/10/05/oemed-2015-102879.full.pdf+htm
l Accessed December 29, 2015.

[3] International Safety Center. Exposure Prevention Information Network,
Sharp Object Injury Summary Data 2013.
http://internationalsafetycenter.org/wp-
content/uploads/2015/08/Official-2013-NeedleSummary.pdf. Accessed
December 29. 2015

[4]Centers for Disease Control and Prevention (CDC). Morbidity and
Mortality
Weekly Report (MMWR). Updated U.S. Public Health Service Guidelines for
the Management of Occupational Exposures to HBV, HCV, and HIV and
Recommendations for Postexposure Prophylaxis.
http://www.cdc.gov/mmwr/pdf/rr/rr5011.pdf . Accessed December 29, 2015.

Centers for Disease Control and Prevention (CDC). Acute Hepatitis C
reports by risk/behavior, United States 2013.
http://www.cdc.gov/hepatitis/statistics/2013surveillance/pdfs/hcv_surv-201
3_figure4.6b.pdf. Accessed December 29, 2015.
__________________________________________________________________
________________________________*_________________________________

2. New: US CDC’s Safe Healthcare Blog: Convinced They are Doing the Right
Things…

Many thanks to Ed Krisiunas,President WNWN International for the link!
__________________________________________________________________
Convinced They are Doing the Right Things…

Posted on January 21, 2016 by CDC’s Safe Healthcare Blog

Guest Author: Pamela Dembski Hart BS MT ASCP CHSP

Founder and Principal, Healthcare Accreditation Resources LLC
Plymouth, MA

In my last blog post, I discussed the differences between reality and
perception when it comes to what safe injection/infection control
practices are — and are not.

So, how do we get every healthcare worker on the same page when it comes
to reinforcing correct procedures? Especially when some healthcare workers
are in a sort of denial that unsafe practices actually do happen. Or,
worse yet, when they are absolutely convinced they are doing the right
thing when, in fact, they couldn’t be more wrong.

It’s my belief that this problem could be addressed by requiring
competencies. In other words, instituting a written test or requiring
administrators/trainers to observe practices at a facility. It could start
with something as simple as, “Tell me about safe injection practices. Walk
me through your procedure for preparing, administering, and disposing of a
needle and syringe.”

That’s where the gaps in learning and knowledge may become apparent.

Why not make such a test a component of the healthcare worker’s job
performance at an annual review? Key competencies should be assessed
through a written exam, peer review, and/or observation. It is my belief
continuing education credits do not suffice as a barometer for competency
of an individual, however, they are accepted for most healthcare
professionals.

Many CDC documented incidents of unsafe injection practices have occurred
at outpatient practices, and there has been an explosion in the growth of
these settings in recent years. It is estimated that up to 70% of
surgeries take place in an outpatient setting. But I wonder, how regularly
do outpatient settings have staff meetings? How often are demonstrations
of competency documented on an annual basis? How many states require
accreditation for these kinds of settings?

Administration must also set an example by accepting no less than 100%
adherence to safe injection practices, and establishing job consequences
for failure to follow safe practices. Yes, there will be a written warning
in your file for failure to follow protocol.

Recently, a nurse had set up a system of monitoring data after an incident
in her facility. When I visited the facility three months later, I was
informed they had abandoned data collection after two months. When asked
why, she responded, “We didn’t think we had a problem anymore.”

Clearly she didn’t understand the need for constant vigilance. I asked,
“Would you take vital signs post-surgery at 15 minutes and at one half
hour? And then when the patient seemed OK at those two intervals, just
stop observing and recording based on a few ‘normal’ results?”

Learn to know what you don’t know and always ask if you’re unsure.
Posted on January 21, 2016 by CDC’s Safe Healthcare Blog
__________________________________________________________________
________________________________*_________________________________

3. ZIKA: WHO statement on the first meeting of the International Health
Regulations (2005) (IHR 2005) Emergency Committee on Zika virus and
observed increase in neurological disorders and neonatal malformations

Moderators Note: “Zika can be transmitted through blood, but this is an
infrequent mechanism.”
__________________________________________________________________

https://tinyurl.com/htyehsb
WHO statement on the first meeting of the International Health Regulations
(2005) (IHR 2005) Emergency Committee on Zika virus and observed increase
in neurological disorders and neonatal malformations

WHO statement 1 February 2016

The first meeting of the Emergency Committee (EC) convened by the
Director-General under the International Health Regulations (2005) (IHR
2005) regarding clusters of microcephaly cases and other neurological
disorders in some areas affected by Zika virus was held by teleconference
on 1 February 2016, from 13:10 to 16:55 Central European Time.

The WHO Secretariat briefed the Committee on the clusters of microcephaly
and Guillain-Barré Syndrome (GBS) that have been temporally associated
with Zika virus transmission in some settings. The Committee was provided
with additional data on the current understanding of the history of Zika
virus, its spread, clinical presentation and epidemiology.

The following States Parties provided information on a potential
association between microcephaly and other neurological disorders with
Zika virus: Brazil, France, United States of America, and El Salvador.

The Committee advised that the recent cluster of microcephaly cases and
other neurological disorders reported in Brazil, following a similar
cluster in French Polynesia in 2014, constitutes a Public Health Emergency
of International Concern (PHEIC).

The Committee provided the following advice to the Director-General for
her consideration to address the PHEIC (clusters of microcephaly and other
neurological disorders) and their possible association with Zika virus, in
accordance with IHR (2005).

Microcephaly and other neurological disorders

* Surveillance for microcephaly and GBS should be standardized and
enhanced, particularly in areas of known Zika virus transmission and areas
at risk of such transmission.

* Research into the etiology of new clusters of microcephaly and other
neurological disorders should be intensified to determine whether there is
a causative link to Zika virus and/or other factors or co-factors.

As these clusters have occurred in areas newly infected with Zika virus,
and in keeping with good public health practice and the absence of another
explanation for these clusters, the Committee highlights the importance of
aggressive measures to reduce infection with Zika virus, particularly
among pregnant women and women of childbearing age.

As a precautionary measure, the Committee made the following additional
recommendations:

Zika virus transmission

*Surveillance for Zika virus infection should be enhanced, with the
dissemination of standard case definitions and diagnostics to at-risk
areas.

*The development of new diagnostics for Zika virus infection should be
prioritized to facilitate surveillance and control measures.

* Risk communications should be enhanced in countries with Zika virus
transmission to address population concerns, enhance community engagement,
improve reporting, and ensure application of vector control and personal
protective measures.

* Vector control measures and appropriate personal protective measures
should be aggressively promoted and implemented to reduce the risk of
exposure to Zika virus.

* Attention should be given to ensuring women of childbearing age and
particularly pregnant women have the necessary information and materials
to reduce risk of exposure.

* Pregnant women who have been exposed to Zika virus should be counselled
and followed for birth outcomes based on the best available information
and national practice and policies.

Longer-term measures

* Appropriate research and development efforts should be intensified for
Zika virus vaccines, therapeutics and diagnostics.

* In areas of known Zika virus transmission health services should be
prepared for potential increases in neurological syndromes and/or
congenital malformations.

Travel measures

There should be no restrictions on travel or trade with countries, areas
and/or territories with Zika virus transmission.

* Travellers to areas with Zika virus transmission should be provided with
up to date advice on potential risks and appropriate measures to reduce
the possibility of exposure to mosquito bites.

* Standard WHO recommendations regarding disinsection of aircraft and
airports should be implemented.

Data sharing

* National authorities should ensure the rapid and timely reporting and
sharing of information of public health importance relevant to this PHEIC.

* Clinical, virologic and epidemiologic data related to the increased
rates of microcephaly and/or GBS, and Zika virus transmission, should be
rapidly shared with WHO to facilitate international understanding of the
these events, to guide international support for control efforts, and to
prioritize further research and product development.

Based on this advice the Director-General declared a Public Health
Emergency of International Concern (PHEIC) on 1 February 2016. The
Director-General endorsed the Committee’s advice and issued them as
Temporary Recommendations under IHR (2005). The Director-General thanked
the Committee Members and Advisors for their advice.
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Hepatitis C virus prevalence and genotype distribution in
Pakistan: Comprehensive review of recent data
__________________________________________________________________

http://www.wjgnet.com/1007-9327/full/v22/i4/1684.htm
Free Open Access Article

World J Gastroenterol. 2016 Jan 28;22(4):1684-700.
Hepatitis C virus prevalence and genotype distribution in Pakistan:
Comprehensive review of recent data.

Umer M1, Iqbal M1.

1Muhammad Umer, Mazhar Iqbal, Health Biotechnology Division, National
Institute for Biotechnology and Genetic Engineering, Faisalabad 38000,
Pakistan.

Hepatitis C virus (HCV) is endemic in Pakistan and its burden is expected
to increase in coming decades owing mainly to widespread use of unsafe
medical procedures. The prevalence of HCV in Pakistan has previously been
reviewed.

However, the literature search conducted here revealed that at least 86
relevant studies have been produced since the publication of these
systematic reviews. A revised updated analysis was therefore needed in
order to integrate the fresh data.

A systematic review of data published between 2010 and 2015 showed that
HCV seroprevalence among the general adult Pakistani population is 6.8%,
while active HCV infection was found in approximately 6% of the
population.

Studies included in this review have also shown extremely high HCV
prevalence in rural and underdeveloped peri-urban areas (up to 25%),
highlighting the need for an increased focus on this previously neglected
socioeconomic stratum of the population.

While a 2.45% seroprevalence among blood donors demands immediate measures
to curtail the risk of transfusion transmitted HCV, a very high prevalence
in patients attending hospitals with various non-liver disease related
complaints (up to 30%) suggests a rise in the incidence of nosocomial HCV
spread. HCV genotype 3a continues to be the most prevalent subtype
infecting people in Pakistan (61.3%).

However, recent years have witnessed an increase in the frequency of
subtype 2a in certain geographical sub- regions within Pakistan. In Khyber
Pakhtunkhwa and Sindh provinces, 2a was the second most prevalent genotype
(17.3% and 11.3% respectively).

While the changing frequency distribution of various genotypes demands an
increased emphasis on research for novel therapeutic regimens, evidence of
high nosocomial transmission calls for immediate measures aimed at
ensuring safe medical practices.

KEYWORDS: Epidemiology; Hepatitis C; Hepatitis C virus; Hepatitis C virus
genotypes; Liver cancer; Pakistan

Free Article http://www.wjgnet.com/1007-9327/full/v22/i4/1684.htm
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Healthcare associated Crimean-Congo haemorrhagic fever in
Turkey 2002-2014 – A multi-centre retrospective cross-sectional study
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26806137

Clin Microbiol Infect. 2016 Jan 19. pii: S1198-743X(16)00005-7.
Healthcare associated Crimean-Congo haemorrhagic fever in Turkey 2002-2014
– A multi-centre retrospective cross-sectional study.

Leblebicioglu H1, Sunbul M2, Guner R3, Bodur H4, Bulut C5, Duygu F6,
Elaldi N7, Senturk GC8, Ozkurt Z9, Yilmaz G10, Fetcher TE11, Beeching
NJ12.

1Department of Infectious Diseases and Clinical Microbiology, Ondokuz
Mayis University Medical School, Samsun, Turkey. Electronic address:
hakanomu@yahoo.com.
2Department of Infectious Diseases and Clinical Microbiology, Ondokuz
Mayis University Medical School, Samsun, Turkey.
3Department of Infectious Diseases and Clinical Microbiology, Yildirim
Beyazit University Medical School, Ankara, Turkey.
4Department of Infectious Diseases and Clinical Microbiology, Ankara
Numune Research and Training Hospital, Ankara, Turkey.
5Department of Infectious Diseases and Clinical Microbiology, Ankara
Research and Training Hospital, Ankara, Turkey.
6Department of Infectious Diseases and Clinical Microbiology,
Gaziosmanpasa University Medical School, Tokat, Turkey.
7Department of Infectious Diseases and Clinical Microbiology, Cumhuriyet
University Medical School, Sivas, Turkey.
8Department of Infectious Diseases and Clinical Microbiology, SB Diskapi
Yildirim Beyazit Training and Research Hospital, Ankara, Turkey.
9Department of Infectious Diseases and Clinical Microbiology, Ataturk
University Medical School, Erzurum, Turkey.
10Department of Infectious Diseases and Clinical Microbiology, Karadeniz
Technical University Medical School, Erzurum, Turkey.
11Department of Infectious Diseases and Clinical Microbiology, Ondokuz
Mayis University Medical School, Samsun, Turkey; Liverpool School of
Tropical Medicine, Liverpool, United Kingdom.
12Liverpool School of Tropical Medicine, Liverpool, United Kingdom; NIHR
HPRU in Emerging and Zoonotic Infections, University of Liverpool,
Liverpool L69 7BE, United Kingdom.
Healthcare-related transmission of Crimean-Congo haemorrhagic fever (CCHF)
is a well-recognised hazard.

We report a multi-centre retrospective cross- sectional study undertaken
in Turkey in 2014 in 9 hospitals which are regional reference centres for
CCHF, covering years 2002-2014 inclusive. Data were systematically
extracted from charts of all personnel with a reported health care
injury/accident related to CCHF. Blood samples were tested for CCHF
IgM/IgG by ELISA and/or viral nucleic acid detection by PCR after the
injury.

Fifty-one healthcare-related exposures were identified. 25/51 (49%)
resulted in laboratory confirmed infection with a 16% (4/25) overall
mortality.

The main route of exposure was needlestick injury in 32/51 (62.7%).

A potential benefit of post-exposure prophylaxis with ribavirin was
identified.

Copyright © 2016. Published by Elsevier Ltd.

KEYWORDS: Crimean-Congo haemorrhagic fever; Healthcare associated;
Ribavirin
__________________________________________________________________
________________________________*_________________________________

6. Abstract: The Frequency, Causes and Prevention of Needlestick Injuries
in Nurses of Kerman: A Cross-Sectional Study
__________________________________________________________________

http://dx.doi.org/10.7860%2FJCDR%2F2015%2F16729.6965

J Clin Diagn Res. 2015 Dec;9(12):DC13-DC15. Free Full Article
The Frequency, Causes and Prevention of Needlestick Injuries in Nurses of
Kerman: A Cross-Sectional Study.

Balouchi A1, Shahdadi H2, Ahmadidarrehsima S1, Rafiemanesh H3.

1Student, Department of Medical Surgical, Student Research Committee
(SRC), School of Nursing and Midwifery, Zabol University of Medical
Sciences (ZBMU) , Zabol, IR Iran .
2Faculty of Nursing and Midwifery, Department of medical surgical, Zabol
University of Medical Sciences (ZBMU) , Zabol, IR Iran .
3Student of Epidemiology, Department of Epidemiology and Biostatistics,
School of Public Health, Tehran University of Medical Sciences , Tehran,
Iran .

INTRODUCTION: The needlestick injuries can cause the transmission of
infectious diseases. Compared to other members of the community of health
care nurses are at great risk of needle stick injury because of their
frequent performance with vein punctures and taking care of patients
suffering from different infectious diseases.

AIM: The main aim of this study was to assess Prevalence, causes and
preventive of Needle Sticks injuries among nurses in Kerman (south of
Iran).

MATERIALS AND METHODS: This cross-sectional study was conducted from
December 2014 to March 2015 on 240 nurses employed in two hospitals of
Kerman. Sampling was performed through simple random sampling. Data
gathered through a researcher made questioner. Data analysed by use
descriptive analytical testes.

RESULTS: From the nurses’ perspective the main physical and human causes
of needlestick injuries were syringe needles (82) and crowded wards (74).
The majority of the nurses believed the most effective method to prevent
needlestick were training (82).

CONCLUSION: Due to the high prevalence of injuries caused by sharp objects
in nurses, needlestick injuries are suggested to be recorded in special
forms and their causes to be checked by the Infection Control Committee.
Since syringe needle heads and angiocatheter are the main causes of
needlestick injuries, providing safe medical equipment should also be
emphasized.

KEYWORDS: Communicable diseases; Infection Control Committee; Prevalence

Free Full Article http://dx.doi.org/10.7860%2FJCDR%2F2015%2F16729.6965
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Occupational injuries prone to infectious risks amongst
healthcare personnel in Kuwait: a retrospective study
__________________________________________________________________

https://www.karger.com/Article/FullText/369462

Med Princ Pract. 2015;24(2):123-8. Free Full Text
Occupational injuries prone to infectious risks amongst healthcare
personnel in Kuwait: a retrospective study.

Omar AA1, Abdo NM, Salama MF, Al-Mousa HH.

1Infection Control Directorate, Ministry of Health, Kuwait City, Kuwait.

OBJECTIVE: The study aimed at determining the prevalence of incident
occupational exposure to blood and other potentially infectious materials
(OPIM) among healthcare personnel (HCP) during 2010 and at evaluating the
factors associated with these incidents.

SUBJECTS AND METHODS: An epidemiological, retrospective, record-based
study was conducted. All self-reported incidents of occupational exposure
to blood and OPIM among HCP from all healthcare settings of the Kuwait
Ministry of Health during 2010 were included.

RESULTS: The total number of the exposed HCP was 249. The prevalence of
incident exposure was 0.7% of the HCP at risk. Their mean age was 32.31 ±
6.98 years.

The majority were nurses: 166 (66.7%), followed by doctors: 35 (14.1%),
technicians: 26 (10.4%) and housekeeping personnel: 22 (8.8%).

Needle stick injury was the most common type of exposure, in 189 (75.9%),
followed by sharp-object injury, mucous-membrane exposure and contact with
nonintact skin. The majority of needle stick exposures, i.e. 177 (93.7%),
were caused by hollow-bore needles.

Exposure to blood represented 96.8%, mostly during drawing blood and the
insertion or removal of needles from patients [88 (35.4%)] and when
performing surgical interventions [56 (22.6%)].

Easily preventable exposures such as injuries related to 2-handed
recapping of needles [24 (9.6%)] and garbage collection [21 (8.4%)] were
reported.

Exposures mainly occurred in the inpatient wards [75 (30.1%)] and
operating theaters [56 (22.6%)]. Among the exposed HCP, 130 (52.2%) had
been fully vaccinated against hepatitis B virus (HBV).

CONCLUSION: Needle stick injuries are the most common exposure among HCP
in Kuwait, and nurses are the most frequently involved HCP category.

A good proportion of exposures could be easily prevented.

HBV vaccination coverage is incomplete.

© 2014 S. Karger AG, Basel.
__________________________________________________________________
________________________________*_________________________________

8. Abstract: The injecting use of image and performance-enhancing drugs
(IPED) in the general population: a systematic review
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26806443

Health Soc Care Community. 2016 Jan 25.
The injecting use of image and performance-enhancing drugs (IPED) in the
general population: a systematic review.

Brennan R1, Wells JS1, Van Hout MC1.

1School of Sport, Health and Exercise Science, Waterford Institute of
Technology, Waterford, Ireland.

Injecting use of image and performance-enhancing drugs (IPED) in the
general population is a public health concern. A wide and varied range of
IPED are now easily accessible to all through the online market.

A comprehensive literature review was undertaken according to Critical
Appraisal Skills Programme (CASP) guidelines for systematic review, to
identify the relevant literature. No date restrictions were placed on the
database search in the case of human growth hormone melanotan I and II,
and oil and cosmetic injectables. In the case of anabolic androgenic
steroids search dates were restricted to January 2014-2015. Publications
not in English and with a lack of specificity to the topic were excluded.
The review yielded 133 relevant quantitative and qualitative papers,
clinical trials, clinical case presentations and editorials/reports.

Findings were examined/reviewed under emergent themes which
identified/measured extent of use, user profiling, sourcing, product
endorsement, risk behaviours and health outcomes in users.

Motivation for IPED use may be grounded in appearance, pursuit of health
and youth, and body image disturbance. IPED users can practice moderated
use, with pathological use linked to high-risk behaviours, which may be
normalised within IPED communities. Many IPED trajectories and pathways of
use are not scientifically documented. Much of this information may be
available online in IPED specific discussion forums, an underutilised
setting for research, where uncensored discourse takes place among users.

This review underscores the need for future internet and clinical research
to investigate prevalence and patterns of injecting use, and to map health
outcomes in IPED users.

This paper provides community-based clinical practice and health promotion
services with a detailed examination and analysis of the injecting use of
IPED, highlighting the patterns of this public health issue.

It serves to disseminate updated publication information to health and
social policy makers and those in health service practice who are involved
in harm reduction intervention.

© 2016 John Wiley & Sons Ltd. KEYWORDS: IPED ; anabolic steroids; body
image; community based health; image and performance enhancing; injecting
drug use; internet; needle and syringe programs
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Incidence of hepatitis C in Brazil
__________________________________________________________________

http://dx.doi.org/10.1590/0037-8682-0230-2015 Free Full Text

Rev Soc Bras Med Trop. 2015 Dec;48(6):665-73.
Incidence of hepatitis C in Brazil.

Hanus JS1, Ceretta LB1, Simões PW1, Tuon L1.

1Programa de Residência Multiprofissional em Saúde Coletiva, Unidade
Acadêmica de Ciências da Saúde, Universidade do Extremo Sul Catarinense,
Criciúma, Santa Catarina, Brazil.

INTRODUCTION: Hepatitis C is a public health problem of global dimensions,
affecting approximately 200 million people worldwide. The main objective
of this study was to estimate the incidence rate of hepatitis C in Brazil
during the period between 2001 and 2012.

METHODS: An epidemiological, temporal, and descriptive study was performed
using data from the Information System for Reportable Diseases.

RESULTS: Between 2001 and 2012, a total of 151,056 hepatitis C cases were
recorded, accounting for 30.3% of all hepatitis notifications in Brazil.
The average gross coefficient for the analysis period was 6.7 new cases
per 100,000 inhabitants. The regions with the highest rates were the
Southeast region (8.7 new cases/100,000 inhabitants) and the South (13.9
new cases/100,000 inhabitants). There was a predominance of men with
respect to the incidence rate (8.0 new cases/100,000 inhabitants) compared
to women (5.5 new cases/100,000 inhabitants). Injection drug use was the
most common source of infection, and members of the white race, residents
of urban areas, and those aged 60 to 64 years had the highest incidences.

CONCLUSIONS: Over the last 10 years, the incidence of hepatitis C in
Brazil has increased, mainly in the South and Southeast. The adoption of
fast, accurate diagnostic methods, together with epidemiological
awareness, can facilitate early intervention measures for adequate control
of the disease.

Free full text http://dx.doi.org/10.1590/0037-8682-0230-2015
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Declining trends in the rates of assisted injecting: a
prospective cohort study
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26817687

Harm Reduct J. 2016 Jan 27;13(1):2.

Free Open Access Article https://tinyurl.com/hcqze7n or long form
http://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-016-
0092-3
Declining trends in the rates of assisted injecting: a prospective cohort
study.

Pedersen JS1, Dong H2, Small W3,4, Wood E5,6, Nguyen P7, Kerr T8,9,
Hayashi K10,11,12.

1Cumming School of Medicine, University of Calgary, 3330 Hospital Drive
NW, Calgary, AB, T2N 4N1, Canada. jspeders@ucalgary.ca.
2British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital,
608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
hdong@cfenet.ubc.ca.
3British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital,
608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
wsmall@cfenet.ubc.ca.
4Faculty of Health Sciences, Simon Fraser University, 8888 University
Drive, Burnaby, BC, 15A 1S6, Canada. wsmall@cfenet.ubc.ca.
5British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital,
608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. uhri-
ew@cfenet.ubc.ca.
6Department of Medicine, University of British Columbia, St. Paul’s
Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. uhri-
ew@cfenet.ubc.ca.
7British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital,
608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
pnguyen@cfenet.ubc.ca.
8British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital,
608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. uhri-
tk@cfenet.ubc.ca.
9Department of Medicine, University of British Columbia, St. Paul’s
Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. uhri-
tk@cfenet.ubc.ca.
10British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital,
608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
khayashi@cfenet.ubc.ca.
11Department of Medicine, University of British Columbia, St. Paul’s
Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
khayashi@cfenet.ubc.ca.
12B.C. Centre for Excellence in HIV/AIDS, University of British Columbia,
St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6,
Canada. khayashi@cfenet.ubc.ca.

BACKGROUND: Assisted injecting has been associated with increased risk of
blood-borne infections, overdose, and other harms among people who inject
drugs (PWID), particularly women. Given the changing availability of
relevant harm reduction interventions in Vancouver, Canada, in recent
years, we conducted a gender-based analysis to examine changes in rates
and correlates of assisted injecting over time among active PWID.

METHODS: Using data from a prospective cohort of PWID in Vancouver, we
employed gender-stratified multivariable generalized estimating equations
to examine trends in assisted injecting and identify the correlates during
two periods: June 2006-November 2009 and December 2009-May 2014.

RESULTS: Among 1119 participants, 376 (33.6 %) were females. Rates of
assisted injecting declined between 2006 and 2014 among males (21.9 to
13.8 %) and females (37.0 to 25.6 %). In multivariable analyses, calendar
year of interview also remained independently and negatively associated
with assisted injecting among males (adjusted odds ratio [AOR] 0.95, 95 %
confidence interval [CI] 0.92-0.99) and females (AOR 0.93, 95 % CI
0.89-0.97). Syringe borrowing remained independently associated with
assisted injecting throughout the study period among females (AOR 1.53, 95
% CI 1.10-2.11 during 2006-2009; AOR 2.15, 95 % CI 1.24-3.74 during
2009-2014) and during 2009-2014 among males (AOR 1.88, 95 % CI 1.02-3.48).

CONCLUSIONS: Our findings demonstrate assisted injecting has significantly
decreased for both males and females over the past decade. Nevertheless,
rates of assisted injecting remain high, especially among women, and are
associated with high-risk behavior, indicating a need to provide safer
assisted injecting services to these vulnerable sub-populations of PWID.

Free Open Access Article https://tinyurl.com/hcqze7n
__________________________________________________________________
________________________________*_________________________________

11. Abstract: High Prevalence and Incidence of HIV and HCV Among New
Injecting Drug Users With a Large Proportion of Migrants-Is Prevention
Failing?
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26820260

Subst Use Misuse. 2016 Jan 28:1-11.
High Prevalence and Incidence of HIV and HCV Among New Injecting Drug
Users With a Large Proportion of Migrants-Is Prevention Failing?

Folch C1,2,3, Casabona J1,2,3,4, Espelt A2,5,6, Majó X7, Meroño M8,
Gonzalez V1,2,9, Wiessing L10, Colom J7, Brugal MT2,5; REDAN Study Group.

1a Centre d’Estudis Epidemiològics sobre les Infeccions de Transmissió
Sexual i Sida de Catalunya (CEEISCAT), Agéncia de Salut Pública de
Catalunya (ASPC), Generalitat de Catalunya , Badalona , Spain.
2b CIBER Epidemiología y Salud Pública (CIBERESP) , Spain.
3c Fundació Institut d’Investigació Germans Trias i Pujol (IGTP) ,
Badalona , Spain.
4d Departament de Pediatria, d’Obstetrícia i Ginecologia i de Medicina
Preventiva i de Salut Pública, Facultat de Medicina, Universitat Autònoma
de Barcelona , Bellaterra (Cerdanyola del Vallés) , Spain.
5e Agéncia de Salut Pública de Barcelona , Spain.
6f Departament de Psicologia i Metodologia de les Ciéncies de la Salut,
Universitat Autònoma de Barcelona , Bellaterra (Cerdanyola del Vallés) ,
Spain.
7g Subdirecció General de Drogodependéncies, Agéncia Salut Pública de
Catalunya (ASPC), Departament de Salut de la Generalitat de Catalunya.
8h Ámbit Prevenció , Barcelona , Spain.
9i Microbiology Service, Hospital Universitari Germans Trias i Pujol ,
Badalona , Spain.
10j European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) ,
Lisbon , Portugal.

OBJECTIVES: The aim of this study was to assess differences in the
prevalence of HIV and HCV infection and associated risk factors between
new (injecting for =5 years) and long-term injectors and to estimate
HIV/HCV incidence among new injectors.

METHODS: Cross-sectional study among people who inject drugs (PWID) who
attended harm reduction centers in Catalonia in 2010-11. Anonymous
questionnaires and oral fluid samples were collected. Poisson regression
models were applied to determine the association between HIV/HCV infection
and risk factors.

RESULTS: Of the 761 participants, 21.4% were new injectors. New injectors
were younger than long-term injectors (mean age = 31.6 vs. 37.8) and were
more likely to be immigrants (59.0% vs. 33.4%). HIV and HCV prevalence was
20.6% and 59.4% among new injectors, and estimated HIV and HCV incidence
8.7 and 25.1 /100 person-years, respectively. Among new injectors, HIV
infection was associated with homelessness (PR = 3.10) and reporting a
previous sexually transmitted infection (PR = 1.79). Reporting
front/backloading (PR = 1.33) and daily injection (PR = 1.35) were risk-
factors for HCV infection. For long-term injectors, HIV risk factors were:
having shared syringes (PR = 1.85), having injected cocaine (PR = 1.38),
reporting front/backloading (PR = 1.30) and ever having been in prison (PR
= 2.03).

CONCLUSION: A large proportion of PWID in Catalonia are new injectors, a
subgroup with a high level of both sexual and parenteral exposure and a
high incidence rate of HIV/ HCV infections. It is important to improve
early diagnosis of these infections among this group, in particular among
migrants. To identify and address risk factors for homelessness PWID
should be a priority.

KEYWORDS: HIV, injecting drug use; Hepatitis C; migrants; new injectors
__________________________________________________________________
__________________________________________________________________

12. Abstract: High rates of abscesses and chronic wounds in community-
recruited injection drug users and associated risk factors
__________________________________________________________________
__________________________________________________________________
https://www.ncbi.nlm.nih.gov/pubmed/25469653

J Addict Med. 2015 Mar-Apr;9(2):87-93.
High rates of abscesses and chronic wounds in community-recruited
injection drug users and associated risk factors.

Smith ME1, Robinowitz N, Chaulk P, Johnson KE.

1From the Department of Medicine (MES, KEJ), Division of Infectious
Diseases, Johns Hopkins Medical Institutions, Baltimore, MD; and Baltimore
City Health Department (NR, PC), Baltimore, MD.

OBJECTIVES: Abscesses and chronic wounds are common among injection drug
users (IDUs) though chronic wounds have been understudied. We assessed the
risk factors associated with both acute and chronic wounds within a
community-based population of IDUs frequenting the Baltimore City Needle
Exchange Program (BNEP).

METHODS: We performed a cross-sectional study of BNEP clients aged 18
years or more who completed an in-person survey regarding active or prior
wounds including abscesses (duration <8 weeks) and chronic wounds
(duration =8 weeks), injection practices, and skin care. Factors
associated with wounds were analyzed using univariate and multivariate
logistic regressions.

RESULTS: Of the 152 participants, 63.2% were men, 49.3% were white, 44.7%
were African American, 34.9% had any type of current wound, 17.8% had an
active abscess, and 19.7% had a current chronic wound. Abscesses were more
common in women (odds ratio [OR], 2.56; 95% confidence interval [CI],
1.10-5.97) and those reporting skin-popping (OR, 5.38; 95% CI,
1.85-15.67). In a multivariate model, risk factors for an abscess included
injecting with a family member/partner (adjusted OR [AOR], 4.06; 95% CI,
0.99-16.58). In a multivariable analysis of current chronic wounds,
cleaning skin with alcohol before injection was protective (AOR, 0.061;
95% CI, 0.0064-0.58).

CONCLUSIONS: Abscesses and chronic wounds were prevalent among a sample of
IDUs in Baltimore. Abscesses were associated with injection practices, and
chronic wounds seemed linked to varying skin and tool cleaning practices.
There is a pressing need for wound-related education and treatment efforts
among IDUs who are at greatest risk for skin-related morbidity.
__________________________________________________________________
__________________________________________________________________

13. Abstract: Lemierre syndrome with cervical spondylodiscitis and
epidural abscess associated with direct injection of heroin into the
jugular vein
__________________________________________________________________

http://www.e-jmii.com/article/S1684-1182(13)00231-4/fulltext

J Microbiol Immunol Infect. 2015 Apr;48(2):238-9.
Lemierre syndrome with cervical spondylodiscitis and epidural abscess
associated with direct injection of heroin into the jugular vein.

Lin HY1, Liao KH2, Jean SS3, Ou TY3, Chen FL3, Lee WS4.

1Department of Neurosurgery, Wan Fang Medical Center, Taipei Medical
University, Taipei, Taiwan; Graduate Institute of Injury Prevention and
Control, College of Public Health and Nutrition, Taipei Medical
University, Taipei, Taiwan.
2Department of Neurosurgery, Wan Fang Medical Center, Taipei Medical
University, Taipei, Taiwan; Graduate Institute of Injury Prevention and
Control, College of Public Health and Nutrition, Taipei Medical
University, Taipei, Taiwan. Electronic address: khliao@tmu.edu.tw.
3Division of Infectious Diseases, Department of Internal Medicine, Wan
Fang Medical Center, Taipei Medical University, Taipei, Taiwan.
4Division of Infectious Diseases, Department of Internal Medicine, Wan
Fang Medical Center, Taipei Medical University, Taipei, Taiwan. Electronic
address: 89425@wanfang.gov.tw.

Pseudomonas aeruginosa infections rarely occur in intravenous drug users
with Lemierre syndrome.1,2 We report here the case of a patient, an
intravenous drug user with a history of injecting heroin directly into the
jugular vein, with thrombophlebitis, P. aeruginosa bacteremia, metastatic
cervical spondylodiscitis, and an epidural abscess.

The patient’s condition was initially complicated by moderate
quadriplegia, hyperreflexia, and hypothesia below the C5 dermatome.

He recovered well after surgical debridement, treatment with antibiotic
drugs, and rehabilitation.

© 2013 Published by Elsevier Inc.

Free full text
http://www.e-jmii.com/article/S1684-1182(13)00231-4/fulltext
__________________________________________________________________
________________________________*_________________________________

14. Abstract: Comparison of SGA oral medications and a long-acting
injectable SGA: the PROACTIVE study
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/24870446

Schizophr Bull. 2015 Mar;41(2):449-59.
Comparison of SGA oral medications and a long-acting injectable SGA: the
PROACTIVE study.

Buckley PF1, Schooler NR2, Goff DC3, Hsiao J4, Kopelowicz A5, Lauriello
J6, Manschreck T7, Mendelowitz AJ8, Miller del D9, Severe JB4, Wilson
DR10, Ames D5, Bustillo J11, Mintz J12, Kane JM8; PROACTIVE Study.

1Medical College of Georgia, Georgia Regents University, Augusta, GA;
pbuckley@gru.edu.
2Downstate Medical Center, State University of New York, Brooklyn, NY;
Feinstein Institute for Medical Research, Zucker Hillside Hospital, Glen
Oaks, NY;
3Nathan Kline Institute, Orangeburg, NY;
4National Institute of Mental Health, Bethesda, MD;
5David Geffen School of Medicine, University of California at Los Angeles,
Los Angeles, CA;
6Columbia School of Medicine, University of Missouri, Columbia, MO;
7Harvard Medical School, Corrigan MH Center, Beth Israel Deaconess Medical
Center, Boston, MA;
8Feinstein Institute for Medical Research, Zucker Hillside Hospital, Glen
Oaks, NY;
9Department of Psychiatry Research, University of Iowa Carver College of
Medicine, Iowa City, IA;
10Department of Anthropology, The University of Florida College of
Medicine at Jacksonville, Jacksonville, FL;
11Department of Psychiatry, University of New Mexico School of Medicine,
Albuquerque, NM;
12Health Science Center, University of Texas, San Antonio, TX.

Until relatively recently, long-acting injectable (LAI) formulations were
only available for first-generation antipsychotics and their utilization
decreased as use of oral second-generation antipsychotics (SGA) increased.
Although registry-based naturalistic studies show LAIs reduce
rehospitalization more than oral medications in clinical practice, this is
not seen in recent randomized clinical trials.

PROACTIVE (Preventing Relapse Oral Antipsychotics Compared to Injectables
Evaluating Efficacy) relapse prevention study incorporated efficacy and
effectiveness features. At 8 US academic centers, 305 patients with
schizophrenia or schizoaffective disorder were randomly assigned to LAI
risperidone (LAI-R) or physician’s choice oral SGAs. Patients were
evaluated during the 30-month study by masked, centralized assessors using
2-way video, and monitored biweekly by on-site clinicians and assessors
who knew treatment assignment. Relapse was evaluated by a masked Relapse
Monitoring Board.

Differences between LAI-R and oral SGA treatment in time to first relapse
and hospitalization were not significant.

Psychotic symptoms and Brief Psychiatric Rating Scale total score improved
more in the LAI-R group. In contrast, the LAI group had higher Scale for
Assessment of Negative Symptoms Alogia scale scores. There were no other
between-group differences in symptoms or functional improvement.

Despite the advantage for psychotic symptoms, LAI-R did not confer an
advantage over oral SGAs for relapse or rehospitalization.

Biweekly monitoring, not focusing specifically on patients with
demonstrated nonadherence to treatment and greater flexibility in changing
medication in the oral treatment arm, may contribute to the inability to
detect differences between LAI and oral SGA treatment in clinical trials.

© The Author 2014. Published by Oxford University Press on behalf of the
Maryland Psychiatric Research Center. All rights reserved. For
permissions, please email: journals.permissions@oup.com. KEYWORDS:
clinical trial design; negative symptoms; psychotic symptoms; relapse
prevention; schizophrenia
__________________________________________________________________
________________________________*_________________________________

15. Abstract: Indications and the requirements for single-use medical
gloves
__________________________________________________________________

http://www.egms.de/static/en/journals/dgkh/2016-11/dgkh000261.shtml

GMS Hyg Infect Control. 2016 Jan 12;11:Doc01.
Indications and the requirements for single-use medical gloves.

Kramer A1, Assadian O2.

1Institute of Hygiene and Environmental Medicine, University Medicine
Greifswald, Germany.
2Institute for Skin Integrity and Infection Prevention, University of
Huddersfield, United Kingdom.

English, German

AIM: While the requirements for single-use gloves for staff protection are
clearly defined, the conventional medical differentiation between “sterile
surgical gloves” used during surgical procedures and “single-use medical
gloves” used in non-sterile medical areas does not adequately define the
different requirements in these two areas of use.

Sterilization of single-use medical gloves is not performed if sterility
is not required; thus, another terminology must be found to identify the
safety quality of non-sterile single-use medical gloves. Therefore, the
labeling of such gloves should reflect this situation, by introducing the
term “pathogen-free” single-use glove.

The hygienic safety of such a glove would be attainable by ensuring
aseptic manufacturing conditions during manufacturing and control of
pathogen load of batch controls after fabrication. Proposed
recommendation:

Because single-use gloves employed in non-sterile areas come into contact
not only with intact skin but also with mucous membranes, no potential
pathogens should be detectable in 100 mL of rinse sample. In order to
declare such gloves as pathogen-free we suggest absence of the indicator
species S. aureus and E. coli. In addition, the total CFU count should be
evaluated, since a high load indicates lack of optimal hygiene during the
manufacturing process.

Based on the requirements for potable water and findings obtained from
investigations of the bacterial load of such gloves after manufacturing,
the here suggested limit for the total bacterial count of <10(2) CFU/mL of
rinse sample per glove seems realistic.

KEYWORDS: definitions; indications; pathogen-free single-use gloves;
requirements; single-use medical gloves; “germ-poor” single-use gloves

Free Full Article:
http://www.egms.de/static/en/journals/dgkh/2016-11/dgkh000261.shtml
__________________________________________________________________
________________________________*_________________________________

16. No Abstract: Incident hepatitis among repeat blood donors: A sentinel
event signaling possible health care-associated infection and need for
reporting to public health authorities
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/25899171

Transfusion. 2015 Oct;55(10):2531-3.
Incident hepatitis among repeat blood donors: A sentinel event signaling
possible health care-associated infection and need for reporting to public
health authorities.

Moorman AC1, Stramer SL2, Schaefer MK3, Collier MG1, Suryaprasad A1,
Kuehnert MJ3, Moore Z4, Rowan E5, Habicht K6, Bradley K7, Fucci MC8,
Hopkins C9, Xu F1.

1Division of Viral Hepatitis.
2American Red Cross Scientific Support Office, Gaithersburg, Maryland.
3Division of Healthcare Quality Promotion, Centers for Disease Control and
Prevention, Atlanta, Georgia.
4North Carolina Department of Health and Human Services, Raleigh, North
Carolina.
5Alameda County Department of Public Health, Oakland, California.
6South Carolina Department of Health and Environmental Control, Columbia,
South Carolina.
7Oklahoma State Department of Health, Oklahoma City, Oklahoma.
8West Division Biomedical Services, American Red Cross, Tulsa, Oklahoma.
9East Division Biomedical Services, American Red Cross, Columbia, South
Carolina.
__________________________________________________________________
________________________________*_________________________________

17. No Abstract: The role of ultraviolet marker assessments in
demonstrating cleaning efficacy
__________________________________________________________________

Am J Infect Control. 2015 Dec 1;43(12):1347-9.

https://www.ncbi.nlm.nih.gov/pubmed/26654236
The role of ultraviolet marker assessments in demonstrating cleaning
efficacy.

Gillespie E1, Wright PL2, Snook K2, Ryan S2, Vandergraaf S2, Abernethy M2,
Lovegrove A2.

1Infection Control and Epidemiology Unit, Monash Health, Clayton,
Victoria, Australia. Electronic address:
elizabeth.gillespie@monashhealth.org.
2Infection Control and Epidemiology Unit, Monash Health, Clayton,
Victoria, Australia.

Cleaning standards measuring compliance using visual auditing alone can be
misleading, because visually clean surfaces might not be cleaned of
pathogens.

An evidence-based system using both visual auditing and ultraviolet marker
(UVM) assessments is recommended. Using a UVM system has enabled our
health service to measure infection risk and implement actions to improve
results.

We recommend adopting a combined monitoring process using visual auditing
with UVM audits to enhance cleaning and reduce the risk of health care-
associated infection.

Copyright © 2015 Association for Professionals in Infection Control and
Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

KEYWORDS: Cleaning; Environmental cleaning; Ultraviolet marker assessment
__________________________________________________________________
________________________________*_________________________________

18. No Abstract: Tuberculous abscess at the site of penicillin injections
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/18114000

Lancet. 1949 Mar 19;1(6551):478.
Tuberculous abscess at the site of penicillin injections.

FORBES GB, STRANGE FG.
__________________________________________________________________
________________________________*_________________________________

19. No Abstract: Tuberculous abscess following intramuscular penicillin
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/20997262

Lancet. 1946 Sep 14;2(6420):379.
Tuberculous abscess following intramuscular penicillin.

EBRILL D, ELEK SD.
__________________________________________________________________
________________________________*_________________________________

20. No Abstract: Oil sterilisation of syringes
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/20992922

Lancet. 1946 Jul 20;2(6412):87.
Oil sterilisation of syringes.

ROGERS KB.
__________________________________________________________________
________________________________*_________________________________

21. News

– Americas: Zika will likely spread throughout the Americas: WHO

– India: RIMS nurses reuse syringes, expose patients to infection

Selected news items reprinted under the fair use doctrine of international
copyright law: http://www4.law.cornell.edu/uscode/17/107.html
__________________________________________________________________

https://tinyurl.com/jtktdkj
Americas: Zika will likely spread throughout the Americas: WHO

Outbreak News Today (25.01.16)

The World Health Organization (WHO)/ Pan American Health Organization
(PAHO) believe that the Zika virus will continue it’s spread throughout
the countries and territories of the Americas (the one’s with the
appropriate vector), they noted in a statement yesterday.

The reason for this prediction is two-fold: You have a naive population
concerning immunity to Zika virus (much like Chikungunya virus two years
ago) and with the exception of Canada and continental Chile, the Aedes
mosquito vector is present in all other countries.

The PAHO says the most effective forms of prevention are (1) reducing
mosquito populations by eliminating their potential breeding sites,
especially containers and other items (such as discarded tires) that can
collect water in and around households; and (2) using personal protection
measures to prevent mosquito bites (see also recommendations below).

The role of Aedes mosquitoes in transmitting Zika is documented and well
understood, while evidence about other transmission routes is limited.
Zika has been isolated in human semen, and one case of possible person-to-
person sexual transmission has been described. However, more evidence is
needed to confirm whether sexual contact is a means of Zika transmission.

*** Zika can be transmitted through blood, but this is an infrequent
mechanism. Standard precautions that are already in place for ensuring
safe blood donations and transfusions should be followed.

Evidence on mother-to-child transmission of Zika during pregnancy or
childbirth is also limited. Research is currently under way to generate
more evidence regarding perinatal transmission and to better understand
how the virus affects babies.

There is currently no evidence that Zika can be transmitted to babies
through breast milk. Mothers in areas with Zika circulation should follow
PAHO/WHO recommendations on breastfeeding (exclusive breastfeeding for the
first 6 months, followed by continued breastfeeding with complementary
foods up to 2 years or beyond).

© 2016 Outbreak News Today
__________________________________________________________________
__________________________________________________________________

https://tinyurl.com/hcgbt8o
India: RIMS nurses reuse syringes, expose patients to infection

By Anbwesh Roy Choudhury, Hindustan Times, Ranchi, India (19.01.16)

Nurses at the Rajendra Institute of Medical Sciences (RIMS) reuse
syringes, exposing patients to the risk of infections, an internal
inspection found.

The hospital’s internal inspection team on Monday found a dozen syringes
allegedly reused on patients at the medicine ward of Jharkhand’s premier
state-run medical institution.

“I was shocked to find used syringes kept at bedside tables and tucked
under newspapers or above switch boards. The nurses were taken aback by
the surprise inspection. They were speechless,” said RIMS matron Vijaya
Lakshmi, who led the two-member team after complaints reached her office
on Friday.

Patients complained that the nurses administered injections with the same
syringe without sterilisation several times a day.

Showing the team four syringes, a patient Vikas Singh said, “Nurses asked
us to keep the syringes. They told us not to dispose them. I had no idea
they had put my ailing mother at risk.”

Reena Devi, another patient, said as the matron pulled a used syringe from
under a newspaper, “How will I know that a syringe has to be used once? I
kept it because nurses asked me to.”

The hospital matron passed a diktat of cutting salaries if nurses were
caught reusing syringes.

Some junior nurses grilled at the spot said they handed over the syringes
to the patients for disposal. However, according to World Health
Organisation and bio-medical disposal norms, syringes once used must be
instantly burned in the syringe crusher and those disposed in specially
marked bins must be sent to the shredder at a bio-medical disposal plant
Director-in-chief Indian Public Health Services Dr Sumant Mishra said,
“There is a risk of Hepatitis B and also HIV spreading through reuse,
apart from infections like tetanus. In the hospital all syringes are for
one-time (use and dispose) use, while smart syringes that lock after use
are used in large scale immunisation rounds.”

Last year there were two cases, in July and September, where nurses in
four wards at RIMS where caught reusing syringes several times. Three
cases each were also reported in 2013 and 2014. In 2013 WHO estimated that
two-thirds of 600 crore injections used in India every year are unsafe.
“It is unclear why nurses indulge in the malpractice. Syringes are
supplied by the hospital. And there are clear instructions they should be
destroyed in the WHO provided injection crusher after using once,” said
Lakshmi.

A senior RIMS official said there was a racket of selling fresh syringes
to retail outlets.

But the matron said, “I am unaware of such a racket.”

The RIMS administration has given assurances of forming a committee to
look into the matter.

RIMS director BL Sherwal said, “It is a shameful if it is happening. I
will speak to all heads of departments to check the practice. It can lead
to a host of infections.” He said there was no dearth of syringes at
hospitals.
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New WHO Injection Safety Guidelines

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

The new guideline is:

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

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

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

This is an illustrated summary brochure for the general public.

pdf, 554kb [6 pages]

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

SIGN Meeting 2015

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

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

A report of the meeting will be posted ASAP
__________________________________________________________________
________________________________*_________________________________
* 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

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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