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SIGNpost 00839

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST

Post00839  I-in-P revised + Jan in Jan + Abstracts + News 10 February 2016

CONTENTS
0. Moderators Note
1. Immunization in Practice is now online and available in print format
2. Jan’s annual note on ETLog Health’s Health Care Waste progress
3. Abstract: Knowledge, attitudes and perceptions of occupational hazards
and safety practices in Nigerian healthcare workers
4. Abstract: Cross Sectional Study Of Prevalence And Risk Factors Of
Hepatitis B And Hepatitis C Infection In A Rural Village Of India
5. Abstract: Hepatitis-B Vaccination Status And Knowledge, Attitude And
Practice Of High Risk Health Care Worker About Body Substance Isolation
6. Abstract: A Human Factors Engineering Study of the Medication Delivery
Process during an Anesthetic: Self-filled Syringes versus Prefilled
Syringes
7. Abstract: Quality Assurance and Quality Control, Part 2
8. Abstract: HIV Prevalence, Estimated Incidence, and Risk Behaviors Among
People Who Inject Drugs in Kenya
9. Abstract: HIV/AIDS-related knowledge awareness and risk behaviors among
injection drug users in Maanshan, China: a cross-sectional study
10. Abstract: Sharing of Needles and Syringes among Men Who Inject Drugs:
HIV Risk in Northwest Bangladesh
11. Abstract: Intradermal vaccination using the novel microneedle device
MicronJet600: Past, present, and future
12. Abstract: The Association between Intravitreal Steroids and Post-
Injection Endophthalmitis Rates
13. Abstract: Contamination Control
14. No Abstract: Injection Rhymes with Infection?
15. No Abstract: Health Care Hazmats: There’s More On Site Than Just
Bloodborne Pathogens
16. No Abstract: It stops with us: Peer responses increase availability of
sterile injecting equipment
17. No Abstract: A response to the relationship between different types of
sharps containers and Clostridium difficile infection rates in acute
care hospitals
18. No Abstract: Reply to Dikon in response to “A response to the
relationship between different types of sharps containers and
Clostridium difficile infection rates in acute care hospitals”
20. Even Vets do it! Abstract: Using shared needles for subcutaneous
inoculation can transmit bluetongue virus mechanically between
ruminant hosts
21. News
– Pakistan: 12m Pakistanis suffer from hepatitis B&C
– Pakistan: 12 Million Pakistani Affected By Hepatitis B, C
– Colordo USA: Surgical tech accused of switching needles ID’d
– USA: Swedish Medical Center patients react to news they need HIV,
hepatitis tests
– Canada: Prison needle programs touted to reduce HIV and Hep C

The web edition of SIGNpost is online at:

SIGNpost 00839

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
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Visit the SIGNpostOnline archives at: http://signpostonline.info

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__________________________________________________________________
________________________________*_________________________________

0. Moderators Note
__________________________________________________________________

What a month for SIGNpost! Apologies for any inconvenience.

The signpost archive website signpostonline.info was hacked, adding 58
pages of advertisements then blocking the site entirely for most of a
week.

All is now restored and additional security measure have been installed.

This week Hardware failure in the main computer has forced the preparation
and editing of SIGNpost to the slower backup computer.

Apologies to Facebook followers for the delay in updates on Facebook.

Read on

__________________________________________________________________
________________________________*_________________________________

1. Immunization in Practice is now online and available in print format

Crossposted from Technet-21.org with thanks.

The list of revised and updated modules follows Jhilmil Bahl’s note below.

Please note that the download links for the Global Mid Level Management
Modules are on the same page.
__________________________________________________________________

https://tinyurl.com/jlaxd2k

By: Jhilmil Bahl, www.Technet-21.org (08.02.16)

I have the pleasure of sharing with you the updated version of our popular
publication, ‘Immunization in Practice: A practical guide for health
staff’.

The revision of IIP was intended to meet the demand to provide high
quality immunization services to reach all infants in a sustainable way,
building upon the experiences of polio eradication.

This updated version includes details on several new vaccines that have
become more readily available and used in recent years. Other major
updates include an expanded section on integration with other health
interventions (module 1), details on storing vaccines and temperature
monitoring (module2), micro planning with inputs from the community
(module 4), immunization checklist (module 5), enhanced data and AEFI
monitoring (module 6), tools and strategies for involving communities
(module 7).

I would like to express my sincere thanks to all the many people who have
contributed to the development of this publication.

Electronic version of this publication can be found at
http://www.who.int/immunization/documents/training/en/

French version will be available by February end.

More than 10,000 copies of the previous version were distributed and the
publication was translated into several local languages including Nepali,
Baha Indonesia, Vietnamese.

I hope you will support us in our efforts towards a wider distribution and
use of this publication.
__________________________________________________________________

http://www.who.int/immunization/documents/training/en/

Immunization, Vaccines and Biologicals Immunization training resources
Immunization in Practice – A practical guide for health staff

Introduction
pdf, 148kb

Module 1 : Target diseases and vaccines
pdf, 1.81Mb

Module 2 : The vaccine cold chain
pdf, 2.13Mb

Module 3 : Ensuring safe injections
pdf, 718kb

Module 4 : Microplanning for reaching every community
pdf, 1.23Mb

Module 5 : Managing an immunization session
pdf, 995kb

Module 6 : Monitoring and surveillance
pdf, 605kb

Module 7 : Partnering with communities
pdf, 323kb
__________________________________________________________________
http://www.who.int/immunization/documents/training/en/
Global Mid level Management modules (MLM)

This new series of modules on immunization training for Mid-level Managers
(MLM) replaces the last version which was published in 1991.

There have been many changes in the world of immunization since then, so
these modules are an attempt to provide the immunization manager with up
to date technical knowledge, explain how to recognize management and
technical problems and take corrective action, and how to make the best
use of resources. Each MLM module is organized around a series of steps in
which technical information is followed by learning activities.

Module 1 : Cold chain, vaccines and safe-injection equipment management
pdf, 4.84Mb

Module 2 : Partnering with communities
pdf, 3.26Mb

Module 3 : Immunization safety
pdf, 3.19Mb

Module 4 : Supportive supervision
pdf, 2.66Mb

Module 5 : Monitoring the immunization system
pdf, 3.92Mb

Module 6 : Making a comprehensive annual national immunization plan and
budget
pdf, 2.56Mb

Module 7 : The EPI coverage survey
pdf, 3.35Mb

Module 8 : Making disease surveillance work
pdf, 3.89Mb
__________________________________________________________________
________________________________*_________________________________

2. Jan’s annual note on ETLog Health’s Health Care Waste progress
__________________________________________________________________

From: Jan-Gerd Kuehling <kuehling[at]etlog-health.de>
Date: Sat, Jan 2, 2016 at 11:10 PM
Subject: A short review of 2015 – and all the best for 2016!
To: SIGN Moderator <sign.moderator@gmail.com>
Dear Friends & Partners of ETLog Health

Different than in other years, I thought it might be better to send my
yearly mail not at the end of the year 2015 but in the beginning of
2016 as a fresh start.

But first of all – our best wishes for New Year 2016 and we hope you
had a good, successful and peaceful year 2015. I think we all learned
again, how important peace is in our global world. Short before
Christmas we received a sad mail from one of our projects, but later
more on this.

Looking back I have to say it was again in all aspects a good year for
ETLog. We finished successfully several projects, are working on a
couple of on-going projects, were awarded with new once and have
several promising projects in the pipeline. The financial situation is
very stable and we exceeded our turn-over and also our win targets.
The renovation of our office in Kremmen is going according to the plan
and we think we can move in summer 2016 from the side building to the
main building.

In 2015, we worked again for dozens of projects, serving our clients
in more than 10 countries including Tajikistan, Ghana, Uzbekistan,
Moldavia, Sudan, Belarus, Kazakhstan, Kyrgyzstan, Vietnam, Russia,
Qatar, etc. – and of course also in Germany. Our clients in 2015
included the World Bank, WHO, UNDP, EU, GIZ, the German federal
environmental agency (UBA), KfW and different private clients.

As every year, the main working area of ETLog in 2015 remained to be
the healthcare waste and waste water sector, but hospital infection
control became more and more important for us. It will take too long
to report on all projects – just a few highlights:

For UNDP/Global Fund, we could continue our work on the reduction of
the environmental impacts; some hopefully helpful documents can be
downloaded here: https://tinyurl.com/jycscrz or
http://www.eurasia.undp.org/content/rbec/en/home/library/hiv_aids/rapid-
assessment-healthcare-waste-global-fund.html
We hope that the Part C of the toolkit will be soon uploaded.

In Central Asia, the improvement of the healthcare waste situation is
still progressing fast, with major projects in nearly all countries.

We finished successfully our PPP-Project in Tajikistan with our
partner EPOS ( https://tinyurl.com/zs6k7kz ),
in Uzbekistan the national healthcare waste training system is
officially recognized and integrated as post-graduated training and
the treatment equipment for nearly 150 hospitals will be tendered
soon. Also the two UNDP-GEF healthcare waste projects in Kazakhstan
and Kyrgyzstan are on track and will heavily contribute to the
improvement of the situation. The project in Russia unfortunately was
overshadowed from the political situation; nevertheless we hope that
the developed documents can contribute to further develop the
healthcare waste system.

In December, I had the chance to work again for WHO in Vietnam on a
guideline for healthcare waste for minor waste producers. It was good
to see that the World Bank financed healthcare waste project could
overcome the problems and is now also back on track. The KfW financed
waste and waste water project will also start in 2016, so I guess we
will hear some more good news from Vietnam next year.

There are many more projects worthwhile to be reported, e.g. the GIZ
managed project in Ghana/Kumasi, the ongoing projects in West Africa
as aftermath of the Ebola crisis and all the other projects. Also the
EU healthcare waste project (http://www.hcwm.eu/) is still running.
Just visit the web-site to learn more about latest developments and
achievements.

But there are not only good news. As mentioned in the beginning of the
mail, just before Christmas we received news from Yemen that the
project we worked for – the new central healthcare waste treatment
plant for Sana – was hit and destroyed during the war. Attached,
please find some shocking pictures of the autoclave and the treatment
side. This demonstrates again how fast dreams and efforts of dozens of
motivated people can be destroyed in just a few moments. Let us hope
that peace will come soon to all the struggling countries and let’s
hope that Europe will continue to provide shelter for all the refugees
from these countries until peace is back.

Difficult to come up now with some positive words – it seems a bit
biting. But allow me to thank you for our pleasant association
throughout the year and to send you season greeting and a best wishes
for a prosperous, healthy, sustainable and hopefully peaceful New Year
2015 wherever you will have to work!

HAPPY NEW YEAR!

Hope to see you next year somewhere and best regards from Berlin, Germany

Yours

Jan

___________

ETLog Health EnviroTech & Logistics GmbH

Jan-Gerd Kühling

Managing Partner
Kavalierstrasse 15
13187 Berlin
Germany

Tel.: ++ 49 (0)30 / 44 31 87 – 41
Fax: ++ 49 (0)30 / 44 31 87 – 49
E-Mail: kuehling[at]etlog-health.de
Skype-Username: etlog-jgk
Web: www.etlog-health.com
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Knowledge, attitudes and perceptions of occupational hazards
and safety practices in Nigerian healthcare workers
__________________________________________________________________

http://bmcresnotes.biomedcentral.com/articles/10.1186/s13104-016-1880-2
Free Full Article

BMC Res Notes. 2016 Feb 6;9(1):71.

Knowledge, attitudes and perceptions of occupational hazards and safety
practices in Nigerian healthcare workers.

Aluko OO1, Adebayo AE2, Adebisi TF3, Ewegbemi MK4, Abidoye AT5, Popoola
BF6.

1Department of Community Health, Faculty of Clinical Sciences, Obafemi
Awolowo University, Ife, Nigeria. ooaluko@gmail.com.
2Department of Community Health, Faculty of Clinical Sciences, Obafemi
Awolowo University, Ife, Nigeria. ayobamiadebayo1@gmail.com.
3Department of Community Health, Faculty of Clinical Sciences, Obafemi
Awolowo University, Ife, Nigeria. talk2toteeteealways@yahoo.com.
4Department of Community Health, Faculty of Clinical Sciences, Obafemi
Awolowo University, Ife, Nigeria. ewegbemimatthew@gmail.com.
5Department of Community Health, Faculty of Clinical Sciences, Obafemi
Awolowo University, Ife, Nigeria. atabidoye233@yahoo.com.
6Department of Community Health, Faculty of Clinical Sciences, Obafemi
Awolowo University, Ife, Nigeria. drconfianza@gmail.com.

BACKGROUND: By profession, healthcare workers (HCWs) attend to clients and
patients through a variety of preventive and curative services. However,
while their attention is focused on providing care, they are vulnerable to
hazards that could be detrimental to their health and well-being. This is
especially true in developing countries where health service delivery is
fraught with minimal protective precautions against exposures to numerous
fomites and infectious agents. This study assessed the workplace hazards
and safety practices by selected HCWs in a typical health care facility
(HCF) in Nigeria.

METHODS: The study utilized a descriptive cross-sectional design and
stratified sampling technique to identify 290 respondents. The study used
mixed methodology and collected data by validated instruments with
resulting data analyzed by IBM-SPSS, version 20.

RESULTS: The results showed that over half of the respondents were
registered nurses, female, married (61.7 %) with 5 years median work
experience (70.3 %).

Most respondents (89 %) were knowledgeable about hazards in HCFs,
identified recapping used needles as a risky practice (70 %) and
recognized that effective hand washing prior to, and after every clinical
procedure in preventing cross infection (100 %).

Also, most respondents (96.2 %) believed they were at risk of occupational
hazards while about two-thirds perceived the risk as high.

In addition, only 64.2 and 87.2 % had completed Hepatitis B and Tetanus
immunizations, respectively. Only 52.1 % “always” complied with standard
procedures and most (93.8 %) practice safe disposal of sharps (93.8 %)
while those that did not (40 %) generally implicated lack of basic safety
equipment.

In this study, the practice of hand washing by respondents was not
influenced by occupation and education.

CONCLUSIONS: The high level of knowledge demonstrated by respondents was
at variance with practice, therefore, measures aimed at promoting safety
practices and, minimizing exposure to hazards such as; provision of safety
equipment, pre-placement and routine training of staff on safety practices
and adequate reinforcement of staff capacity and capability through drills
in all HCFs should be institutionalized and made mandatory.

The protocol of the safety training and drills should be responsive to
evidence-based emerging and sectoral safety challenges.
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Cross Sectional Study Of Prevalence And Risk Factors Of
Hepatitis B And Hepatitis C Infection In A Rural Village Of India
__________________________________________________________________

http://dx.doi.org/10.1590/S0004-28032015000400013

Arq Gastroenterol. 2015 Dec;52(4):321-4.

Cross Sectional Study Of
Prevalence And Risk Factors Of Hepatitis B And
Hepatitis C Infection In A Rural Village Of India.

Bhate P1, Saraf N2, Parikh P1, Ingle M1, Phadke A1, Sawant P1.

1Department of Gastroenterology, Lokmanya Tilak Municipal Medical College,
Sion Mumbai, India.
2Siddhakala Aurved Mahavidyalay Sangamner, Maharashtra, India.

Background – Hepatitis B virus and hepatitis C virus are among the
principal causes of severe liver disease. There is limited data of
epidemiology of Hepatitis B in community, more so in rural population.

Objective – To find the prevalence of hepatitis B and C infection in
community and study the risk factors for their transmission.

Methods – This was a community based cross sectional study. A total of
1833 randomly selected subjects from a rural area were interviewed for
risk factors for transmission and tested for markers of hepatitis B and
hepatitis C infection. All the positive card tests were confirmed by
ELISA.

Results – Out of 2400 subjects, rate for participation was 76.38%. None of
the subjects was positive for anti hepatitis C virus antibody. Point
prevalence for HBsAg positivity was 0.92. Being healthcare worker and
having tattoo were significantly associated with HBsAg positive results.

Nose and ear piercing was reported by almost. History of blood or blood
product transfusion, I/V drug abuse, multiple sexual partners, unsafe
Injections, hemodialysis and any h/o surgery was not associated with HBsAg
positivity.

Conclusion – Health care workers are at high risk for transmission of
hepatitis B.

Educating common people regarding mode of transmission of Hepatitis B and
C will help to reduce their transmission.

Free full text http://dx.doi.org/10.1590/S0004-28032015000400013
__________________________________________________________________
________________________________*_________________________________

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

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

Free Full Article PDF
http://jamc.ayubmed.edu.pk/index.php/jamc/article/download/313/112
J Ayub Med Coll Abbottabad. 2015 Jul-Sep;27(3):664-8.

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

Quddus M, Jehan M, Ali NH.

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

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

RESULTS: 28% doctors, 20% nurses, 64% operation theatre and 68% lab-
technician were fully immunized. Among rest 31% were unaware of vaccine,
45% did not consider themselves among high risk group, 15% expected
management to get them vaccinated, 9% found it expensive.

Biosafety practices were correctly performed by 42%.

29% performed injection safe practice, 10% aseptic rules and 19% properly
sterilized equipment.

Blood spill was immediately cleaned by 80% among them 48% applied
disinfectant, 40% cleaned it water and detergent, 12% cleaned and
disinfected.

Blood samples disposal was 52% in any available container, 17% in dustbin
and 30% in biohazard bags.

In case of accidental needle stick exposure 62 encouraged bleeding, 19%
applied alcohol, 11% washed with water, 8% waited for medical help.

Regarding discarding used syringe 42% used engineered device, 44% common
container, 10% bent needles and 4% one handed scoop technique. Warning
symbols were identified by 32% amongst them 30% identified biohazard, 8%
harmful, 12% inflammable and 50% danger signs.

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

Free Full Article PDF
http://jamc.ayubmed.edu.pk/index.php/jamc/article/download/313/112
__________________________________________________________________
________________________________*_________________________________

6. Abstract: A Human Factors Engineering Study of the Medication Delivery
Process during an Anesthetic: Self-filled Syringes versus Prefilled
Syringes
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26845139
Anesthesiology. 2016 Feb 4.

A Human Factors Engineering Study of the Medication Delivery Process
during an Anesthetic: Self-filled Syringes versus Prefilled Syringes.

Yang Y1, Rivera AJ, Fortier CR, Abernathy JH 3rd.

1From the Department of Industrial Engineering, Clemson University,
Clemson, South Carolina (Y.Y.); Department of Information Management
Services, Children’s Hospital of Wisconsin, Milwaukee, Wisconsin (A.J.R.);
Department of Pharmacy, Massachusetts General Hospital, Boston,
Massachusetts (C.R.F.); and Department of Anesthesia and Perioperative
Medicine, Medical University of South Carolina, Charleston, South Carolina
(J.H.A.).

BACKGROUND: Prefilled syringes (PFS) have been recommended by the
Anesthesia Patient Safety Foundation. However, aspects in PFS systems
compared with self- filled syringes (SFS) systems have never been
explored. The aim of this study is to compare system vulnerabilities (SVs)
in the two systems and understand the impact of PFS on medication safety
and efficiency in the context of anesthesiology medication delivery in
operating rooms.

METHODS: This study is primarily qualitative research, with a quantitative
portion. A work system analysis was conducted to analyze the complicated
anesthesia work system using human factors principles and identify SVs.
Anesthesia providers were shadowed: (1) during general surgery cases (n =
8) exclusively using SFS and (2) during general surgery cases (n = 9)
using all commercially available PFS. A proactive risk assessment focus
group was followed to understand the risk of each identified SV.

RESULTS: PFS are superior to SFS in terms of the simplified work processes
and the reduced number and associated risk of SVs. Eight SVs were found in
the PFS system versus 21 in the SFS system. An SV example with high risk
in the SFS system was a medication might need to be “drawn-up during
surgery while completing other requests simultaneously.” This SV added
cognitive complexity during anesthesiology medication delivery. However,
it did not exist in the PFS system.

CONCLUSIONS: The inclusion of PFS into anesthesiology medication delivery
has the potential to improve system safety and work efficiency. However,
there were still opportunities for further improvement by addressing the
remaining SVs and newly introduced complexity.
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Quality Assurance and Quality Control, Part 2
__________________________________________________________________
https://www.ncbi.nlm.nih.gov/pubmed/26714362

Int J Pharm Compd. 2015 May-Jun;19(3):215-21.
Quality Assurance and Quality Control, Part 2.

Akers MJ.

The tragedy surrounding the New England Compounding Center and
contaminated steroid syringe preparations clearly points out what can
happen if quality-assurance and quality-control procedures are not
strictly practiced in the compounding of sterile preparations.

This article is part 2 of a two-part article on requirements to comply
with United States Pharmacopeia general chapters <797> and <1163> with
respect to quality assurance of compounded sterile preparations.

Part 1 covered documentation requirements, inspection procedures,
compounding accuracy checks, and part of a discussion on bacterial
endotoxin testing. Part 2 covers sterility testing, the completion from
part 1 on bacterial endotoxin testing, a brief dicussion of United States
Pharmacopeia <1163>, and advances in pharmaceutical quality systems.
__________________________________________________________________
________________________________*_________________________________

8. Abstract: HIV Prevalence, Estimated Incidence, and Risk Behaviors Among
People Who Inject Drugs in Kenya
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26226249

J Acquir Immune Defic Syndr. 2015 Dec 1;70(4):420-7.

HIV Prevalence, Estimated Incidence, and Risk Behaviors Among People Who
Inject Drugs in Kenya.

Kurth AE1, Cleland CM, Des Jarlais DC, Musyoki H, Lizcano JA, Chhun N,
Cherutich P.

1*New York University College of Nursing, New York, NY; †Baron Edmond de
Rothschild Chemical Dependency Institute, Mount Sinai Beth Israel, New
York, NY; and ‡National AIDS & STI Control Programme (NASCOP), Nairobi,
Kenya.

OBJECTIVE: HIV infection in sub-Saharan Africa increasingly occurs among
people who inject drugs (PWID). Kenya is one of the first to implement a
national needle and syringe program. Our study undertook a baseline
assessment as part of evaluating needle and syringe program in a seek,
test, treat, and retain approach.

METHODS: Participants enrolled between May and December 2012 from 10
sites. Respondent-driven sampling was used to reach 1785 PWID for HIV-1
prevalence and viral load determination and survey data.

RESULTS: Estimated HIV prevalence, adjusted for differential network size
and recruitment relationships, was 14.5% in Nairobi (95% CI: 10.8 to 18.2)
and 20.5% in the Coast region (95% CI: 17.3 to 23.6). Viral load (log10
transformed) in Nairobi ranged from 1.71 to 6.12 (median: 4.41;
interquartile range: 3.51-4.94) and in the Coast from 1.71 to 5.88
(median: 4.01; interquartile range: 3.44-4.72). Using log10 viral load 2.6
as a threshold for HIV viral suppression, the percentage of HIV-infected
participants with viral suppression was 4.2% in Nairobi and 4.6% in the
Coast. Heroin was the most commonly injected drug in both regions, used by
93% of participants in the past month, typically injecting 2-3 times/day.

Receptive needle/syringe sharing at last injection was more common in
Nairobi (23%) than in the Coast (4%). Estimated incidence among new
injectors was 2.5/100 person-years in Nairobi and 1.6/100 person-years in
the Coast.

CONCLUSIONS: The HIV epidemic is well established among PWID in both
Nairobi and Coast regions. Public health scale implementation of
combination HIV prevention has the potential to greatly limit the epidemic
in this vulnerable and bridging population.
__________________________________________________________________
________________________________*_________________________________

9. Abstract: HIV/AIDS-related knowledge awareness and risk behaviors among
injection drug users in Maanshan, China: a cross-sectional study
__________________________________________________________________

Free BMC Article https://tinyurl.com/jsyt3v6

BMC Public Health. 2016 Feb 1;16(1):97.
HIV/AIDS-related knowledge awareness and risk behaviors among injection
drug users in Maanshan, China: a cross-sectional study.

Chen B1, Zhu Y2, Guo R3, Ding S4, Zhang Z5, Cai H6, Zhu H7, Wen Y8.
Author information
1School of Public Health, Wannan Medical College, 22 West Wenchang Road,
Wuhu, Anhui Province, 241002, China. chenbf1980@163.com.
2School of Public Health, Wannan Medical College, 22 West Wenchang Road,
Wuhu, Anhui Province, 241002, China. kutuomonk@foxmail.com.
3School of Public Health, Wannan Medical College, 22 West Wenchang Road,
Wuhu, Anhui Province, 241002, China. guorui0710075@126.com.
4School of Public Health, Wannan Medical College, 22 West Wenchang Road,
Wuhu, Anhui Province, 241002, China. dss522@126.com.
5Centre for Disease Control of Maanshan City, 849 Jiangdong Dadao,
Maanshan, Anhui Province, 241000, China. 962847809@qq.com.
6Centre for Disease Control of Maanshan City, 849 Jiangdong Dadao,
Maanshan, Anhui Province, 241000, China. mascdc3836@163.com.
7Centre for Disease Control of Maanshan City, 849 Jiangdong Dadao,
Maanshan, Anhui Province, 241000, China. 842032683@qq.com.
8School of Public Health, Wannan Medical College, 22 West Wenchang Road,
Wuhu, Anhui Province, 241002, China. wyf@wnmc.edu.cn.

BACKGROUND: Unsafe injection practices significantly increase the risk of
human immunodeficiency virus (HIV) infection among injection drug users
(IDUs). Little is known about how demographic characteristics of IDUs are
linked to HIV-related risk behaviors in the central regions of China.

METHODS: A cross-sectional survey was conducted at Mandatory
Detoxification Centers (MDCs) and the community in Maanshan, China.

RESULTS: Of the 916 IDUs, 96.4 % reported a history of heroin use during
the past year, 93.4 % had HIV/AIDS knowledge, 16.8 % reported receptive
syringe sharing and 12.2 % reported inconsistent condom use in commercial
sex in the past year. Unsafe injection practice was associated with
increased odds of minority ethnicity, lower level of education, and no
peer education in the past year. Unsafe sex practice was associated with
increased odds of being single, 18-30 years of age, non-local residence,
and history of methamphetamine use in the past year.

CONCLUSIONS: Integrated interventions to promote safe injection and
protected commercial sex practices targeting IDUs must also consider
individual and socio-environmental factors.

Free BMC Article https://tinyurl.com/jsyt3v6
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Sharing of Needles and Syringes among Men Who Inject Drugs:
HIV Risk in Northwest Bangladesh
__________________________________________________________________

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0148276
Free Full Text

PLoS One. 2016 Feb 5;11(2):e0148276. doi: 10.1371/journal.pone.0148276.
eCollection 2016.
Sharing of Needles and Syringes among Men Who Inject Drugs: HIV Risk in
Northwest Bangladesh.

Pasa MK1, Alom KR1, Bashri Z2, Vermund SH3.
1Department of Anthropology, University of Rajshahi, Rajshani, Bangladesh.
2Institute of Environmental Science, University of Rajshahi, Rajshani,
Bangladesh.
3Vanderbilt Institute for Global Health and Department of Pediatrics,
Vanderbilt University School of Medicine, Nashville, Tennessee, United
States of America.

INTRODUCTION: Injection drug use is prevalent in northwestern Bangladesh.
We sought to explore the context of needle/syringe sharing among persons
who inject drugs (PWID), examining risk exposures to blood-borne
infections like the human immunodeficiency virus (HIV) and hepatitis in a
region where these dual epidemics are likely to expand.

METHODS: We used a qualitative research approach to learn about injection
practices, conducting 60 in-depth interviews among PWID. We then conducted
12 focus group discussions (FGDs) that generated a checklist of salient
issues, and followed up with personal observations of typical days at the
drug-use venues. Content and interpretative frameworks were used to
analyze qualitative information and socio-demographic information, using
SPSS software.

RESULTS: We found that needle/syringe-sharing behaviours were integrated
into the overall social and cultural lives of drug users. Sharing
behaviours were an central component of PWID social organization. Sharing
was perceived as an inherent element within reciprocal relationships, and
sharing was tied to beliefs about drug effects, economic adversity, and
harassment due to their drug user status. Carrying used needles/syringes
to drug-use venues was deemed essential since user-unfriendly needle-
syringe distribution schedules of harm reduction programmes made it
difficult to access clean needles/syringes in off-hours. PWID had low
self-esteem. Unequal power relationships were reported between the field
workers of harm reduction programmes and PWID. Field workers expressed
anti-PWID bias and judgmental attitudes, and also had had misconceptions
about HIV and hepatitis transmission. PWID were especially disturbed that
no assistance was forthcoming from risk reduction programme staff when
drug users manifested withdrawal symptoms.

CONCLUSION: Interventions must take social context into account when
scaling up programmes in diverse settings. The social organization of PWID
include values that foster needle-syringe sharing. Utilization and impact
of risk reduction programmes might be improved with expanded clean
needle/syringe distribution at times and venues convenient for PWID,
better trained and non-judgmental staff, and medical assistance for health
problems, including drug withdrawal symptoms.

Free full text

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0148276
__________________________________________________________________
________________________________*_________________________________

11. Abstract: Intradermal vaccination using the novel microneedle device
MicronJet600: Past, present, and future
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/25745830
Hum Vaccin Immunother. 2015;11(4):991-7.

Intradermal vaccination using the novel microneedle device MicronJet600:
Past, present, and future.

Levin Y1, Kochba E, Hung I, Kenney R.

1a NanoPass Technologies ; Nes Ziona , Israel.

Intradermal immunization has become a forefront of vaccine improvement,
both scientifically and commercially. Newer technologies are being
developed to address the need to reduce the dose required for vaccination
and to improve the reliability and ease of injection, which have been
major hurdles in expanding the number of approved vaccines using this
route of administration.

In this review, 7 y of clinical experience with a novel intradermal
delivery device, the MicronJet600, which is a registered hollow
microneedle that simplifies the delivery of liquid vaccines, are
summarized. This device has demonstrated both significant dose-sparing and
superior immunogenicity in various vaccine categories, as well as in
diverse subject populations and age groups. These studies have shown that
intradermal delivery using this device is safe, effective, and preferred
by the subjects.

Comparison with other intradermal devices and potential new applications
for intradermal delivery that could be pursued in the future are also
discussed.

KEYWORDS: AE, adverse event; BCG, Bacillus Calmette–Guérin; BD, Becton
Dickinson; CDC, Center of Disease Control; DTP, diphtheria, pertussis and
tetanus; EMEA, European Medicines Agency; FDA, Food and Drug
Administration; GMT, geometric mean titer; HA, hemagglutinin; HBV,
hepatitis B virus; HIV, Human immunodeficiency virus; HPV, human papilloma
virus; ID, intradermal; IM, Intramuscular; IPV, inactivated polio vaccine;
MEMS, Micro Electro Mechanical System; Mantoux; PPD, Purified protein
derivative; SAGE, Strategic Advisory Group of Experts; SQ, subcutaneous;
WHO, World Health Organization; dose-sparing; icddr,b, International
Center for Diarrheal Disease Research, Bangladesh; immunogenicity;
influenza vaccine; intradermal; microneedles; vaccine delivery; vaccine
device
__________________________________________________________________
________________________________*_________________________________

12. Abstract: The Association between Intravitreal Steroids and Post-
Injection Endophthalmitis Rates
__________________________________________________________________

http://www.aaojournal.org/article/S0161-6420(15)00676-4/fulltext
Free Full Text

Ophthalmology. 2015 Nov;122(11):2311-2315.e1.
The Association between Intravitreal Steroids and Post-Injection
Endophthalmitis Rates.

VanderBeek BL1, Bonaffini SG2, Ma L3.

1Scheie Eye Institute, Department of Ophthalmology, University of
Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania;
Center for Clinical Epidemiology and Biostatistics, Department of
Biostatistics & Epidemiology, University of Pennsylvania Perelman School
of Medicine, Philadelphia, Pennsylvania; Leonard Davis Institute,
University of Pennsylvania Perelman School of Medicine, Philadelphia,
Pennsylvania. Electronic address: Brian.VanderBeek@uphs.upenn.edu.
2Lake Erie College of Osteopathic Medicine, Bradenton, Florida.
3Leonard Davis Institute, University of Pennsylvania Perelman School of
Medicine, Philadelphia, Pennsylvania.

PURPOSE: To determine whether there is a difference in the risk of
endophthalmitis after an intravitreal steroid injection compared with an
anti-vascular endothelial growth factor (VEGF) agent injection.

DESIGN: Retrospective cohort study.

PARTICIPANTS: A total of 75,249 beneficiaries in a large national US
medical claims database representing 406 380 intravitreal injections.

METHODS: Data were searched for all intravitreal injections (Current
Procedural Terminology 67028) performed between 2003 and 2012. Cohorts
were created on the basis of injections using anti-VEGF agents
(bevacizumab, ranibizumab, aflibercept, and pegaptanib) and intraocular
steroids (triamcinolone and dexamethasone). Endophthalmitis was defined as
having a new endophthalmitis diagnosis (International Classification of
Diseases 9th Revision 360.0x) and a “tap-and-inject” procedure (Current
Procedural Terminology 67015, 67025), a vitrectomy (67036), or an
intravitreal antibiotic injection on the same day, between 1 and 14 days
post- injection. Exclusion occurred for any history of endophthalmitis, <6
months in the plan, or <1 month follow-up. The main outcome measure was
the odds of endophthalmitis using logistic regression while controlling
for injection-associated diagnosis, age, race, and gender.

RESULTS: A total of 387,714 anti-VEGF injections and 18 666 steroid
intravitreal injections were performed and followed by 73 (rate=0.019% or
1/5283 anti- VEGF injections) and 24 (rate=0.13% or 1/778 steroid
injections) cases of endophthalmitis, respectively. After controlling for
diagnosis, age, race, and gender, the odds ratio (OR) for endophthalmitis
occurring was 6.92 (95% confidence interval, 3.54-13.52, P<0.001) times
higher post-steroid injection compared with anti-VEGF injections.

CONCLUSIONS: The rate of endophthalmitis post-intravitreal steroid
injection in a national cohort was 0.13% (1/778 injections). This rate
conferred a significantly increased OR of 6.92 for endophthalmitis
compared with anti-VEGF agents.

Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier
Inc. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

13. Abstract: Contamination Control
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26714364
Int J Pharm Compd. 2015 May-Jun;19(3):232-8.

Contamination Control.

Akers MJ.

There are serious consequences if contamination control is not enforced
and contaminated products/preparations are released to the market. The
greatest risk of microbial contamination is exposure of sterile (also
termed “critical”) sites to potential sources of contamination.

Contamination control basically involves at least fourteen entities to
control or that help to determine the extent (quality) of control. Some of
these entities are covered in this article; others will be covered in
subsequent articles by the author.
__________________________________________________________________
________________________________*_________________________________

14. No Abstract: Injection Rhymes with Infection?
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26845143

Anesthesiology. 2016 Feb 4.
Injection Rhymes with Infection?

Sandberg WS1, Talbot TR.

1From the Department of Anesthesiology (W.S.S.) and Departments of
Medicine and Health Policy (T.R.T.), Vanderbilt University School of
Medicine, Nashville, Tennessee.
__________________________________________________________________
________________________________*_________________________________

15. No Abstract: Health Care Hazmats: There’s More On Site Than Just
Bloodborne Pathogens
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26742281

Occup Health Saf. 2015 Dec;84(12):38, 40.

Health Care Hazmats: There’s More On Site Than Just Bloodborne Pathogens.

Hamel KD.
__________________________________________________________________
________________________________*_________________________________

16. No Abstract: It stops with us: Peer responses increase availability of
sterile injecting equipment
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26838468

Int J Drug Policy. 2016 Jan 8. pii: S0955-3959(15)00373-4.
It stops with us: Peer responses increase availability of sterile
injecting equipment.

Higgs P1, Cogger S2, Kelsall J3, Gavin N3, Elmore K4, Francis P4, Dietze
P2.

1National Drug Research Institute, Faculty of Health Sciences Curtin
University, Melbourne Office, Melbourne, Australia; Centre for Population
Health, The Burnet Institute, Melbourne, Australia. Electronic address:
peter.higgs@curtin.edu.au.
2Centre for Population Health, The Burnet Institute, Melbourne, Australia.
3Harm Reduction Victoria, Melbourne, Australia.
4North Richmond Community Health Centre, Melbourne, Australia.
__________________________________________________________________
________________________________*_________________________________

17. No Abstract: A response to the relationship between different types of
sharps containers and Clostridium difficile infection rates in acute
care hospitals
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26852081

Am J Infect Control. 2016 Feb 3. pii: S0196-6553(15)01295-X.
A response to the relationship between different types of sharps
containers and Clostridium difficile infection rates in acute care
hospitals.

Dikon A1.

1Robert Wood Johnson University Hospital Hamilton, Hamilton, NJ.
Electronic address: adikon@rwjuhh.edu
__________________________________________________________________
________________________________*_________________________________

18. No Abstract: Reply to Dikon in response to “A response to the
relationship between different types of sharps containers and
Clostridium difficile infection rates in acute care hospitals”
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26851197

Am J Infect Control. 2016 Feb 2. pii: S0196-6553(15)01296-1.
Reply to Dikon in response to “A response to the
relationship between different types of sharps containers and Clostridium
difficile infection rates in acute care hospitals”.

Pogorzelska-Maziarz M1.

1Jefferson College of Nursing, Thomas Jefferson University, Philadelphia,
PA. Electronic address: Monika.Pogorzelska-Maziarz@jefferson.edu.
__________________________________________________________________
________________________________*_________________________________

19. No Abstract: Necessary Infrastructure of Infection Prevention and
Healthcare Epidemiology Programs: A Review
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26832072

Infect Control Hosp Epidemiol. 2016 Feb 1:1-10.
Necessary Infrastructure of Infection Prevention and Healthcare
Epidemiology Programs: A Review.

Bryant KA1, Harris AD2, Gould CV3, Humphreys E4, Lundstrom T5, Murphy DM6,
Olmsted R7, Oriola S8, Zerr D9.

11University of Louisville School of Medicingy Programs: A
Reviewe,Louisville,Kentucky.
22University of Maryland School of Medicine,Baltimore,Maryland.
33Centers for Disease Control and Prevention,Atlanta,Georgia.
44Society for Healthcare Epidemiology of America,Arlington,Virginia.
55Premier Health,Dayton,Ohio.
66Main Line Health,Philadelphia,Pennsylvania.
77Trinity Health,Livonia,Michigan.
88Scripps Memorial Hospital,La Jolla,California.
99University of Washington,Seattle,Washington.
__________________________________________________________________
________________________________*_________________________________

20. Even Vets do it! Abstract: Using shared needles for subcutaneous
inoculation can transmit bluetongue virus mechanically between
ruminant hosts
__________________________________________________________________

http://www.nature.com/articles/srep20627 Free Full Article
Abstract: Using shared needles for subcutaneous inoculation can transmit
bluetongue virus mechanically between ruminant hosts

Karin E. Darpel, James Barber, Andrew Hope, Anthony J. Wilson, Simon
Gubbins, Mark Henstock, Lorraine Frost, Carrie Batten, Eva Veronesi, Katy
Moffat, Simon Carpenter, Chris Oura, Philip S. Mellor & Peter P. C.
Mertens

Scientific Reports 6, Article number: 20627 (2016)

Published online: 08 February 2016

Bluetongue virus (BTV) is an economically important arbovirus of ruminants
that is transmitted by Culicoides spp. biting midges. BTV infection of
ruminants results in a high viraemia, suggesting that repeated sharing of
needles between animals could result in its iatrogenic transmission.

Studies defining the risk of iatrogenic transmission of blood-borne
pathogens by less invasive routes, such as subcutaneous or intradermal
inoculations are rare, even though the sharing of needles is common
practice for these inoculation routes in the veterinary sector.

Here we demonstrate that BTV can be transmitted by needle sharing during
subcutaneous inoculation, despite the absence of visible blood
contamination of the needles. The incubation period, measured from sharing
of needles, to detection of BTV in the recipient sheep or cattle, was
substantially longer than has previously been reported after experimental
infection of ruminants by either direct inoculation of virus, or through
blood feeding by infected Culicoides.

Although such mechanical transmission is most likely rare under field
condition, these results are likely to influence future advice given in
relation to sharing needles during veterinary vaccination campaigns and
will also be of interest for the public health sector considering the risk
of pathogen transmission during subcutaneous inoculations with re-used
needles.
__________________________________________________________________
________________________________*_________________________________

21. News

– Pakistan: 12m Pakistanis suffer from hepatitis B&C

– Pakistan: 12 Million Pakistani Affected By Hepatitis B, C

– Colordo USA: Surgical tech accused of switching needles ID’d

– USA: Swedish Medical Center patients react to news they need HIV,
hepatitis tests

– Canada: Prison needle programs touted to reduce HIV and Hep C

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/gwln85c
Pakistan: 12m Pakistanis suffer from hepatitis B&C

* Specialists say reuse of syringes rapidly spreading viral infections

Daily Times, Karachi Pakistan (04.02.16)

KARACHI: “Hepatitis B and C are the major cause of liver failure in
Pakistan, which is one of the outcomes of inflammation of the liver and no
vaccine was available.”

Renowned gastroenterologist specialist Saad Khalid Niaz of the Health
Foundation expressed these views at a public awareness seminar entitled
‘Awareness on Hepatitis B and C’, held at Dr Panjwani Centre for Molecular
Medicine and Drug Research (PCMD), International Centre for Chemical and
Biological Sciences (ICCBS), University of Karachi on Wednesday. PCMD,
University of Karachi and Virtual Education Project Pakistan (VEPP)
jointly organised the seminar.

He said that jaundice was mainly caused by hepatitis A and E viruses,
while around 12 million Pakistanis are affected with Hepatitis B Virus
(HBV) and Hepatitis C Virus (HCV), adding that one person dies of
hepatitis every 30 seconds in the South Asian region but Pakistan is among
the worst afflicted nations but both the life-threatening diseases are
curable.

Talking about the causes of the infections, Saad Niaz said, “B and C are
transmitted through exposure to infective blood. HBV can be transmitted
from infected mothers to infants at the time of birth.”

Saad Niaz further said, “Transmission may also occur through transfusions
of HBV and HCV-contaminated blood and blood products, contaminated
injections during medical procedures and through injected drug use.

Both the viruses also pose a risk to healthcare including those workers
who sustain accidental needle stick injuries while caring for infected-
hepatitis patients. Sexual transmission is also possible, but is much less
common.”

He said that the Health Foundation was fighting against the spread of HBV
and HCV in the country and providing free of cost treatment to the
patients as it was a matter of concern that HBV and HCV were rapidly
spreading in the country.

“In Pakistan, hepatitis B and C viral infections mostly occur due to
transfusion of unscreened blood, improper sterilisation of invasive
medical devices used in surgery and other internal examinations of the
patient, however, reuse of syringes by healthcare providers for common
ailments are the main reasons for the rapid spread of the viral
infections,” Saad Niaz said.
__________________________________________________________________
__________________________________________________________________

http://pakobserver.net/detailnews.asp?id=287985
Pakistan: 12 Million Pakistani Affected By Hepatitis B, C

Pakistan Observer, Pakistan Observer, Pakistan (04.02.16)

Thursday, February 04, 2016 – Karachi—“Around 12 million people are
affected with Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) in
Pakistan. Hepatitis is an inflammation of the liver. Pakistan is among the
worst afflicted nations. One person dies of hepatitis after every 30
seconds in the South Asian region. Both the diseases are life-threatening
but curable, people are not aware of the facts in the country.

Renowned Gastroenterologist Specialist Prof Dr Saad Khalid Niaz of the
Health Foundation expressed these views at a public awareness seminar
entitled “Awareness on Hepatitis B & C”, held at Dr. Panjwani Center for
Molecular Medicine and Drug Research (PCMD), International Center for
Chemical and Biological Sciences (ICCBS), University of Karachi,
Wednesday.

PCMD, University of Karachi and Virtual Education Project Pakistan (VEPP)
jointly organised the seminar. Dr Niaz said that hepatitis B and C were
the major causes of liver failure in Pakistan. He said jaundice was mainly
caused by hepatitis A and E viruses, which is one of the outcomes of
inflammation of the liver. He said that there was no vaccine for HCV but
HBV vaccine was available, and used to prevent HBV.

Talking about the causes of the infections, he said, “B and C are
transmitted through exposure to infective blood. HBV can be transmitted
from infected mothers to infants at the time of birth. Transmission may
also occur through transfusions of HBV and HCV-contaminated blood and
blood products, contaminated injections during medical procedures, and
through injection drug use. Both the viruses also pose a risk to
healthcare workers who sustain accidental needle stick injuries while
caring for infected-hepatitis patients. Sexual transmission is also
possible, but is much less common.”

He said that the Health Foundation was fighting against the spread of HBV
and HCV in the country and providing free of cost treatment to the
patients. He said that this was the matter of concern that HBV and HCV
were being spread in the country.

“In Pakistan, hepatitis B and C viral infections mostly occur due to
transfusion of unscreened blood, improper sterilization of invasive
medical devices used in surgery and other internal examinations of the
patient. However reuse of syringes by health care providers for common
ailments are main reasons for the rapid spread of the viral infections,”
he said.
__________________________________________________________________
__________________________________________________________________

https://tinyurl.com/jzbm933
Colordo USA: Surgical tech accused of switching needles ID’d

Blair Shiff, KUSA 9News.com, Colorado USA (04.02.16)

ENGLEWOOD – The now-former surgical technician who may be responsible for
roughly 2,900 people needing to be tested for HIV, hepatitis B and
hepatitis C has been identified.

Rocky Allen, 28, was registered to practice as a surgical technologist in
Colorado since July 2015.

According to state records, on Jan. 22, 2016, Allen allegedly removed a
syringe from the top of a work space and replaced the syringe with another
syringe. The syringe was on a container of Fentanyl. Fentanyl is used as
part of anesthesia to help prevent pain after surgery or other medical
procedure and is extremely addictive.

Swedish could not confirm the contents of the replacement syringe, citing
the ongoing criminal investigation into the matter.

After this switch was discovered, authorities tested Allen and found he
tested positive for Fentanyl and marijuana.

Swedish is contacting patients that hospital officials believe could have
been exposed to the diseases. All of those patients had surgery at the
hospital between Aug. 17, 2015 and Jan. 22, 2016.

The hospital tried to make it clear that it is also a victim in this case.

“This incident is about the brazen theft of drugs,” said Dr. Matthew
Fleishman, speaking for Swedish Medical Center. “In the operating room,
the suspect syringe was identified. It was confiscated. It was not used in
the case and the patient was not exposed.”

PREVIOUS STORY: http://on9news.tv/1SHsqu8

Fleishman added that there is no evidence of any infection among patients
at this time and could not share whether Allen’s blood has been tested for
the diseases, citing federal health privacy laws.

However, the positive test for Fentanyl reported by state officials is a
red flag that this may have been going on for awhile before the Jan. 22
incident.

“That’s the math,” said attorney Hollynd Hoskins, who represented victims
in a similar 2009 case at Rose Medical Center. “He tests positive for
Fentanyl, he had to gain access to it and inject it some time previous to
the time he got caught.”

Swedish administrators notified the Colorado Department of Health and
Environment of the situation on Jan. 23, spokesperson for the Colorado
Department of Public Health and Environment Mark Salley said.

Patients will be asked to have their blood tested for all three of these
possible infections, Salley said.

According to the World Health Organization, hepatitis B is a “potentially
life-threatening liver infection” that puts people at high risk of dying
from cirrhosis and liver cancer.

Hepatitis C is less likely to be life-threatening – somewhere between 15
and 45 percent of the people who contract it spontaneously clear the virus
within six months of infection. However, patients can develop chronic
disease, and if they do they are at risk for cirrhosis, according to the
WHO.

HIV weakens a person’s immune system and can lead to AIDS. While there is
no known cure, the disease can be controlled with proper medical care,
according to the Centers for Disease Control and Prevention.

In June, Patrick Evans had a stroke and became paralyzed. He was treated
at Swedish Hospital.

“I mean it’s difficult enough that I have a new life in a wheelchair and I
have to learn how to live differently right now,” he said. “Having this
happen is pretty devastating.”

In a statement issued by the hospital in response to questions from 9NEWS,
Swedish officials said they had “no evidence of any patient exposure” but
were “taking a position of extreme caution by offering free testing to all
patients who had surgery at Swedish Medical Center in locations where this
individual worked at any time during this individual’s employment,
including those days the employee was not on the schedule or in the
facility.”

“We deeply regret that one of our former employees may have put patients
at risk, and are sorry for any uncertainty or anxiety this may cause,”
Richard A. Hammett, President and CEO of Swedish Medical Center, said in
the statement. “Please know our first concern is the health, care, safety
and privacy of our patients and we are working diligently to look after
the wellbeing of the patients who may have been affected by the wrongful
actions of this individual.”

One former Swedish patient, who requested anonymity, said he received a
phone call Wednesday informing him of the situation. He said he was
frustrated because hospital officials would not tell him whether the
surgical technician was infected with any of the diseases, saying that
would violate his privacy rights.

That patient also said that he was told a criminal investigation is under
way.

The new investigation brings to mind the case of Kristen Parker, a former
surgical technician who infected numerous people with hepatitis C in 2008
and 2009.

Parker, who worked at Rose Medical Center in Denver and Audubon Ambulatory
Surgical Center in Colorado Springs, infected at least 18 people with
hepatitis C after stealing the powerful painkiller fentanyl and then
refilling syringes with a saline solution.

Parker, who was infected with hepatitis C, used her dirty needles in the
process.

After Parker’s case, state law changed drastically. In 2010, lawmakers
passed a bill requiring hospitals to report incidents of drug theft by
employees within two weeks. And those reports would have to be public.

Another law created DORA’s registry for surgical techs and assistants. The
goal of that law, was to prevent techs accused of stealing drugs in other
states from working in Colorado.
9NEWS At 9 p.m. 02/04/16. KUSA

Scott Patzer was tested as a result of the Parker case, and will go
through another round of testing after being treated at Swedish this
summer.

“It was definitely a shocking thing to go through at the time, and now
obviously to have it happen a second time is, you just kind of wonder,
what am I doing wrong?” he said.

In another case, a former Boulder Community Hospital nurse, Ashton Daigle,
was sentenced to four-and-a-half years in federal prison after he stole
painkillers from surgical patients and sometimes gave them unsterilized
tap water in their place.

Like Parker, he was stealing fentanyl. He had faced up to life in prison,
but he cooperated in the investigation and he did not spread communicable
diseases to any patient.

Chris Vanderveen, Kevin Vaughan and Whitney Wild contributed to this
report.’

(© 2016 KUSA)
__________________________________________________________________
__________________________________________________________________

https://tinyurl.com/hfw3unt
USA: Swedish Medical Center patients react to news they need HIV,
hepatitis tests

By Ashley Michels, FOX31 Denver, Colorado USA (03.02.16)

ENGLEWOOD, Colo – Almost 3,000 patients of Swedish Medical Center will be
tested for HIV and hepatitis after a possible contamination between Aug.
17 and Jan. 22.

The hospital announced Wednesday that surgical technician Robert Allen had
been suspended on suspicion of drug diversion.

Sources said Allen allegedly used needles to inject himself with stolen
narcotics, then reused the needles on patients. Some patients also said
they were told by Swedish Medical Center that staff found a needle
infected with HIV, hepatitis B and hepatitis C in an operating room.

“The surgery was one of the goals of the last year of my life because I
was in so much pain. Great, get the surgery done, now I can move forward.
Now, what’s going to happen now?” patient Scott Rogalski said.

Rogalski had back surgery at Swedish Medical Center in September. The
hospital called him around 11:30 a.m. Wednesday to explain that he is one
of the approximately 2,900 patients who could have been exposed to the
potentially deadly viruses.

“It’s scary just not knowing. Was this person there when I was there?”
Rogalski said.

This does not affect every person who had surgery at Swedish Medical
Center. Patients who had surgery in the facilities where Allen worked will
get a free blood screening to test for the viruses.

So far, the hospital said it does not believe any of the patients have
been infected. But patients like Rogalski and others are nervous.

“I had a breakdown. I mean, that’s a lot to deal with when you’re
paralyzed and you just had a stroke. And then to hear that too,” patient
Patrick Evans said.

Evans is angry at Swedish for not being more specific about what happened
and about who could really be at risk.

“They wouldn’t tell me hardly anything. I’ve got questions I want
answered. I want details and they’re not giving them to me,” Evans said.

The hospital has not said for sure where exactly the HIV and hepatitis
came from. It will be at least a week before some patients can be screened
for the viruses. In the meantime, all they can do is wait.

“Until I get tested, I don’t know what the future is going to be like,”
Evans said.

Swedish Medical Center is contacting all of the affected patients by phone
or mail. If you had surgery there between Aug. 17 and Jan. 22, you can
call the patient care line. The phone number will be provided in the
correspondence from the hospital.

All other patients are not at risk and are asked not to call to avoid
tying up the phone lines.
__________________________________________________________________
__________________________________________________________________

https://tinyurl.com/h9nz5ve
Canada: Prison needle programs touted to reduce HIV and Hep C

Researchers hope new government’s “evidence-based” outlook will open door
for safe injection programs in Canadian jails.

By: Alex Ballingall, TheStar.com, Toronto Star, Canada (03.02.16)

After years pushing for safe drug-injection programs in Canadian jails,
health advocates say mounting evidence and a new government in Ottawa
present a chance to finally make it happen.

In a report published Wednesday, researchers in Toronto provide a
framework for the introduction of what they call “prison-based needle and
syringe programs” in Canada — programs that the authors argue are sorely
needed in provincial and federal jails to address levels of HIV and
hepatitis C infections that are “astronomically” high compared with those
in the general population.

“There’s lots of research to demonstrate how effective they are, and this
(new report) is meant to show that they can be effective in Canada as
well,” said Sandra Ka Hon Chu, director of research and advocacy for the
Canadian HIV/AIDS Legal Network, who contributed to the report.

“We involved a broad range of stakeholders, including former prisoners and
people who work in prison health care, to demonstrate how it might
actually work.”

Researchers held a conference with experts, interviewed health workers,
inmates and prison workers, and pored over existing studies to draft a
series of recommendations for a future safe injection regime in Canadian
jails. These include ensuring prisoners can easily access sterile needles
and syringes in a way that’s confidential and devoid of disciplinary
consequences.

It also argues prisoners should have access to drug education and
addiction support from trained personnel, and that the justice system
should generally move away from treating drug use as a crime and look at
it as a health and social issue.

Critics of the programs have argued they could lead to increased drug use,
or that prisoners could use syringes as weapons. The report counters that
several studies — including reports from federal government agencies —
found no evidence that prison needle programs lead to more drug use, and
that there are no reported cases of needles being used as weapons from 60
existing clean-needles programs in prisons in other countries.

Seth Clarke, one of the report authors from the Prisoners with HIV/AIDS
Support Action Network (PASAN), said that, assuming efforts to rid jails
of drugs will never be entirely successful, safe-injection programs could
mitigate the spread of HIV and hepatitis C by removing incentives to share
and reuse needles, while also reducing prison health care costs.

“No drugs in prison is an aspirational goal that isn’t really achievable,”
said Clarke, pointing out that the federal government also concluded this
in a 2012 report on the “alarming” drug use in its jails.

The prevalence of HIV in prisons is roughly 10 times higher than in the
general population, and it costs about $30,000 per year to treat an
infected prisoner, the report says. According to a 2010 study cited in the
report, 14 per cent of women and 17 per cent of men admitted to injecting
drugs while in prison. A 2014 report estimated that 80 per cent of men
entering federal prisons were identified as having substance abuse
problems.

There’s also a human rights element to the report’s argument — the authors
contend prisoners are entitled to receive comparable levels of health care
as people living outside jails.

PASAN researcher Annika Ollner said there’s optimism that the previous
government’s tough-minded approach to drugs in prison — which included
$120 million for Corrections Canada’s anti-drug strategy in 2008 — will
now give way to more support for harm-reduction strategies and the
Liberals’ repeated promise to make “evidence-based” decisions.

The research, Ollner said, is already there. Their report points out that
a 1999 study by Corrections Canada that reviewed international experiences
with safe-injection programs in jails found they are “effective and well-
proven,” and a 2006 study from the Public Health Agency of Canada found
that they decrease needle sharing, lead to more drug treatment referrals
and reduce the number of prison overdoses and deaths.

“We’re hopeful that this will move forward,” Ollner said.

A spokesperson for federal Health Minister Jane Philpott directed
questions about safe injection programs in prisons to the public safety
ministry, where spokesperson Scott Bardsley said the department couldn’t
comment because of an ongoing legal challenge for prisoner access to clean
needles that was launched in 2012.

Bardsley added, however, that “it is important to note that the government
is committed to implementing evidence-based policy,” and that the
department is mandated to address gaps in service for indigenous people
and those with mental illnesses in the criminal justice system.

Lauren Callighen, press secretary to Ontario’s corrections minister, Yasir
Naqvi, said the province already offers methodone and other treatments to
inmates with drug dependency issues, and works to ensure those in prison
have access to the same health care as everyone else. “We look forward to
reviewing this report and specific recommendations,” she said.
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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
__________________________________________________________________
________________________________*_________________________________

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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