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SIGNpost 00842

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST

Post00842 New: Hep Surveillance Guide + Abstracts + News 02 March 2016

CONTENTS
1. New: WHO publishes its first hepatitis surveillance guide

2. Abstract: A randomized controlled trial of sublingual misoprostol and
intramuscular oxytocin for prevention of postpartum hemorrhage
3. Abstract: Priority Technologies Of The Medical Waste Disposal System
4. Abstract: A proposed nationwide reporting system to satisfy the ethical
obligation to prevent drug diversion-related transmission of hepatitis
C in healthcare facilities
5. Abstract: Burden of Hepatitis C Virus Infection Among Older Adults in
Long-Term Care Settings: a Systematic Review of the Literature and
Meta-Analysis
6. Abstract: Sero-prevalence and associated risk factors for hepatitis C
virus infection among voluntary counseling testing and anti retroviral
treatment clinic attendants in Adwa hospital, northern Ethiopia
7. Abstract: Seroprevalence and Predictors of Hepatitis B Virus Infection
among Pregnant Women Attending Routine Antenatal Care in Arba Minch
Hospital, South Ethiopia
8. Abstract: High HIV prevalence in a respondent-driven sampling survey of
injection drug users in Tehran, Iran
9. Abstract: Disinfection practices in intravenous drug administration
10. Abstract: Experience of intravitreal injections in a tertiary Hospital
in Oman
11. Abstract: Outcomes of switching directly to oral fingolimod from
injectable therapies: Results of the randomized, open-label,
multicenter, Evaluate Patient OutComes (EPOC) study in relapsing
multiple sclerosis
12. Abstract: Event and Cost Offsets of Switching 20% of the Type 1
Diabetes Population in Germany From Multiple Daily Injections to
Continuous Subcutaneous Insulin Infusion: A 4-Year Simulation Model
13. No Abstract: Sharps rules not followed
14. News
– New Jersey Hospital Patients Told of Possible HIV, Hepatitis Exposure
– Scotland UK: NHS spends £3,000 a day on needles for heroin addicts
– UK: Healthcare worker who put 8,000 patients at risk of hepatitis C is
named as a surgeon who caught the virus during an operation and DIED
from it in 2012
– New Jersey USA: Hospital warns patients of possible HIV, hepatitis
exposure
– Washington USA: Volunteers helping to pick up used needles in parks,
neighborhoods
– Colorado USA: Nearly 3K Patients Put At Risk Due to Contaminated Needles
The patients are being tested for diseases such as HIV, Hepatitis B and
Hepatitis C
– Cambodia: Country investigates second village clinic over HIV
contamination

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1. New: WHO publishes its first hepatitis surveillance guide
__________________________________________________________________
HUTIN, Yvan J.-F. <hutiny@who.int>
Sign Moderator <sign.moderator@gmail.com>
Tue, Mar 1, 2016
WHO publishes its first hepatitis surveillance guide

Dear Allan :

WHO publishes today its first viral hepatitis surveillance guide. The
document should be useful to those working on the prevention of injection-
associated infections as it can monitor the association between acute
viral hepatitis and exposure to health care settings, including
injections.

http://who.int/hepatitis/news-events/hep-surveillance-guide/en/

Regards,

Dr Yvan J. Hutin

Strategic Information, Global Hepatitis Programme
WHO Headquarters, Avenue Appia, Geneva 1211, Switzerland
Office +41227914166
Mobile +41795959641
__________________________________________________________________
WHO publishes its first hepatitis surveillance guide

29 February 2016 – Viral hepatitis is a global public health problem of
epidemic proportions, but many countries do not have the surveillance
systems to generate epidemiological information. Such information is key
to developing national efforts to prevent and control hepatitis epidemics.

The World Health Organization (WHO) has released the first surveillance
guide for hepatitis, “Technical considerations and case definitions to
improve surveillance for viral hepatitis”. The document outlines key
actions for improving hepatitis surveillance systems, and provides case
definitions for such surveillance.
Download the guide at
http://who.int/hepatitis/publications/hep-surveillance-guide-pub/en/
Direct:
http://apps.who.int/iris/bitstream/10665/204501/1/9789241549547_eng.pdf
__________________________________________________________________

Technical considerations and case definitions to improve surveillance for
viral hepatitis

Technical report

Authors: WHO

Technical considerations and case definitions to improve surveillance for
viral hepatitis

Publication details

Number of pages: 72

Publication date: February 2016

Languages: English

WHO reference number: WHO/HIV/2016.03

Download the document

Technical considerations and case definitions to improve surveillance for
viral hepatitis [pdf, 303kb]
http://apps.who.int/iris/bitstream/10665/204501/1/9789241549547_eng.pdf

Overview

Many countries do not have the epidemiological information needed to plan,
implement, monitor, evaluate and update national strategies for the
prevention and control of viral hepatitis. The technical aspects
associated with viral hepatitis surveillance are perceived as complex, and
little guidance is available. In the absence of a sound evidence base,
viral hepatitis remains a silent epidemic. Tools are available, however,
to optimize surveillance and generate information that can effectively
direct prevention, control and treatment policies.

In 2010 and 2014, World Health Assembly resolutions called for stronger
surveillance of viral hepatitis. In response, the World Health
Organization (WHO) has developed these technical considerations to assist
and guide Member States in implementing and/or optimizing viral hepatitis
surveillance.

Related links:

Presentation by Dr Yvan J-F Hutin, Global Hepatitis Programme

Technical considerations and case definitions to improve surveillance for
viral hepatitis [pdf, 934kb]
http://who.int/entity/hepatitis/publications/hep-surveillance-present.pdf

View video presentation on YouTube https://youtu.be/pErvgnYGUuw
__________________________________________________________________
________________________________*_________________________________

2. Abstract: A randomized controlled trial of sublingual misoprostol and
intramuscular oxytocin for prevention of postpartum hemorrhage
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/25990482

Arch Gynecol Obstet. 2015 Dec;292(6):1231-7.
A randomized controlled trial of sublingual misoprostol and intramuscular
oxytocin for prevention of postpartum hemorrhage.

Priya GP1, Veena P2,3, Chaturvedula L1, Subitha L4.

1Department of Obstetrics and Gynecology, JIPMER, Pondicherry, India.
2Department of Obstetrics and Gynecology, JIPMER, Pondicherry, India.
veenup_2001@yahoo.com.
3, DII-11, JIPMER Quarters, Dhanvantari nagar, Pondicherry, 605006, India.
veenup_2001@yahoo.com.
4Department of Social and Preventive Medicine, JIPMER, Pondicherry, India.

PURPOSE: In India, two third of maternal deaths occur in rural areas where
there is lack of transportation facilities, lack of refrigeration to store
the injectable uterotonic drug such as oxytocin, lack of skilled personnel
to administer them and lack of sterile syringes and needles. Hence, this
study was conceived to evaluate misoprostol as a safe, effective, easily
administered non-parenteral drug in the prevention of postpartum
hemorrhage.

METHODS: This study was conducted during the period from August 2012 to
July 2014. Low risk women with singleton pregnancy at term admitted for
vaginal delivery were eligible for the study. A total of 500 women were
randomized to two groups, 250 in each group, either to receive 400 mcg
misoprostol sublingually or 10 units oxytocin intramuscularly at the
delivery of anterior shoulder. Patient factors, labor parameters, blood
loss and side effects were noted.

RESULTS: The women in both the groups were well matched with respect to
age, parity, gestational age and labor parameters. There was statistical
significance in the blood loss (p = 0.04) between the two groups. The
average blood loss was 70 ml in misoprostol group and 75 ml in oxytocin
group. Shivering was the statistically significant side effect (p = 0.004)
in the misoprostol group and nausea was the statistically significant side
effect (p = 0.003) in the oxytocin group.

CONCLUSIONS: Sublingual misoprostol is as effective as intramuscular
oxytocin as a prophylactic oxytocic in the active management of third
stage of labor for prevention of postpartum hemorrhage.

KEYWORDS: Oxytocin; Postpartum hemorrhage; Sublingual misoprostol
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Priority Technologies Of The Medical Waste Disposal System
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26856137

Gig Sanit. 2015;94(7):35-7.
[Priority Technologies Of The Medical Waste Disposal System].

[Article in Russian]

Samutin NM, Butorina NN, Starodubova NY, Korneychuk SS, Ustinov AK.

The annual production of waste in health care institutions (HCI) tends to
increase because of the growth of health care provision for population.

Among the many criteria for selecting the optimal treatment technologies
HCI is important to provide epidemiological and chemical safety of the
final products.

Environmentally friendly method of thermal disinfection of medical waste
may be sterilizators of medical wastes intended for hospitals, medical
centers, laboratories and other health care facilities that have small and
medium volume of processing of all types of waste Class B and C.

The most optimal method of centralized disposal of medical waste is a
thermal processing method of the collected material.
__________________________________________________________________
________________________________*_________________________________

4. Abstract: A proposed nationwide reporting system to satisfy the ethical
obligation to prevent drug diversion-related transmission of hepatitis
C in healthcare facilities
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/25767254

Clin Infect Dis. 2015 Jun 15;60(12):1816-20.
A proposed nationwide reporting system to satisfy the ethical obligation
to prevent drug diversion-related transmission of hepatitis C in
healthcare facilities.

Lahey T1, Nelson WA2.

1Geisel School of Medicine at Dartmouth Medical School, Hanover Dartmouth-
Hitchcock Medical Center, Lebanon.
2Geisel School of Medicine at Dartmouth Medical School, Hanover The
Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New
Hampshire.

In 2012, dozens of patients of Exeter Hospital in New Hampshire contracted
new hepatitis C infections that were tracked back to a cardiac technician
who ultimately confessed to drug diversion.

A multistate epidemiological investigation of hepatitis C cases occurring
in multiple hospitals revealed that the technician had been fired from
prior institutions due to similar drug diversion activity, about which
Exeter Hospital had not been notified.

In this article, we highlight the institutional ethical issues raised by
this outbreak, and propose a national centralized reporting system to
support institutional fulfillment of the ethical obligation to protect the
health of patients by preventing such nosocomial outbreaks.

© The Author 2015. Published by Oxford University Press on behalf of the
Infectious Diseases Society of America. All rights reserved.

KEYWORDS: disease outbreaks; hepatitis C; institutional ethics;
intravenous substance abuse; quality improvement
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Burden of Hepatitis C Virus Infection Among Older Adults in
Long-Term Care Settings: a Systematic Review of the Literature and
Meta-Analysis
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26915098

Curr Infect Dis Rep. 2016 Mar;18(4):13.
Burden of Hepatitis C Virus Infection Among Older Adults in Long-Term Care
Settings: a Systematic Review of the Literature and Meta-Analysis.

Alvarez KJ1, Smaldone A2, Larson EL2,3.

1New York State Department of Health, Metropolitan Area Regional Office,
Bureau of Communicable Disease Control, 145 Huguenot Street, Suite 603,
New Rochelle, NY, 10801, USA. kimberly.alvarez@health.ny.gov.
2Columbia School of Nursing, Columbia University, 617 West 168th Street,
New York, NY, 10032, USA.
3Center for Interdisciplinary Research to Prevent Infection, Columbia
School of Nursing, Columbia University, 617 West 168th Street, New York,
New York, 10032, USA.

Hepatitis C virus (HCV) infection is a significant cause of morbidity and
mortality worldwide. The magnitude of the HCV burden has previously been
the subject of debate, as representative data tend to exclude high-risk
populations, including institutionalized persons.

The purpose of this systematic review and meta-analysis was to estimate
the prevalence of HCV infection among older adults in long-term care (LTC)
and assess factors associated with the prevalence of HCV in this setting.

The Preferred Reporting Items for Systematic Review and Meta-Analyses
checklist was used as the methodological guide. Two reviewers
independently assessed the study quality using a validated modified
quality assessment tool. Six articles met inclusion criteria; the majority
were cross-sectional studies (83.3 %) designed to estimate HCV infection
prevalence rates and identify associated risk factors.

HCV prevalence ranged from 1.4 to 11.8 %. A pooled HCV infection
prevalence of 3.3 % (95 % confidence interval: 1.5-7.2 %) was estimated
based on 1920 LTC residents with substantial heterogeneity noted (Q
=?51.1, p < 0.001; I (2) = 90.2).

Three of six studies reported statistically significant factors associated
with an increased risk for HCV infection, including older age, female
gender, history of blood transfusions, short duration of LTC residence,
and hepatitis B virus positivity.

This study reports a higher prevalence of HCV infection among older adults
in LTC settings compared to community- dwelling older adults; however,
accurate estimation of prevalence is limited by heterogeneity between and
within studies, variation in sampling and recruitment methodologies, and
absence of the HCV-RNA test to confirm active infection.

KEYWORDS: Aging; Hepatitis C virus; Long-term care; Older adults
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Sero-prevalence and associated risk factors for hepatitis C
virus infection among voluntary counseling testing and anti retroviral
treatment clinic attendants in Adwa hospital, northern Ethiopia
__________________________________________________________________

Free BMC Article
http://bmcresnotes.biomedcentral.com/articles/10.1186/s13104-016-1936-3

BMC Res Notes. 2016 Feb 23;9(1):121.
Sero-prevalence and associated risk factors for hepatitis C virus
infection among voluntary counseling testing and anti retroviral treatment
clinic attendants in Adwa hospital, northern Ethiopia.

Atsbaha AH1, Asmelash Dejen T2, Belodu R3, Getachew K4, Saravanan M5,
Wasihun AG6.

1Tigray Regional Health and Research Laboratory, P.O.Box: 1807, Mekelle,
Ethiopia. ataklti.hailu2012@gmail.com.
2Department of Medical Microbiology and Immunology, Institute of
Biomedical Science, College of Health Sciences, Mekelle University,
P.O.Box: 1871, Mekelle, Ethiopia. tsehaye93@gmail.com.
3Department of Medical Microbiology and Immunology, Institute of
Biomedical Science, College of Health Sciences, Mekelle University,
P.O.Box: 1871, Mekelle, Ethiopia. drbrashmi@gmail.com.
4Department of Medical Microbiology and Immunology, Institute of
Biomedical Science, College of Health Sciences, Mekelle University,
P.O.Box: 1871, Mekelle, Ethiopia. koyeget@gmail.com.
5Department of Medical Microbiology and Immunology, Institute of
Biomedical Science, College of Health Sciences, Mekelle University,
P.O.Box: 1871, Mekelle, Ethiopia. bioinfosaran@gmail.com.
6Department of Medical Microbiology and Immunology, Institute of
Biomedical Science, College of Health Sciences, Mekelle University,
P.O.Box: 1871, Mekelle, Ethiopia. araya13e25@gmail.com.

BACKGROUND: Hepatitis C virus (HCV) is a major health concern where about
3 % of the world’s population is infected globally. In Ethiopia the
prevalence ranges from 0.9 to 1.3 % in the general populations. Human
immune deficiency virus (HIV) patients due to their weak immune response
are heavily affected by the virus. There is no data on magnitude and
associated risk factors for HCV infection among voluntary counseling,
testing center and anti retroviral treatment clinic Attendants in the
study area. Therefore, the aim of this study was to determine the sero-
prevalence and associated risk factors for HCV infection among voluntary
counseling testing and anti retroviral treatment clinic attendants Adwa
general hospital.

METHODS: Cross sectional study was carried out among 302 participants (151
HIV- negative from VCT and 151 HIV-positive from ART follow up) clinics of
Adwa hospital from September to December, 2014. About 5 ml of venous blood
samples were collected from study participants for anti HCV antibody
tests. Univariate analyses were used to identify associated variables with
anti HCV positivity. Variables having p < 0.05 were considered as
statistically significant association.

RESULTS: Out of the total 302 participants, 52.6 % of them were females
and 47.4 % males. The mean age of the participants was 34.1 year (SD ±
10.5). The overall sero-prevalence of HCV in this study was 4.3 %. The
prevalence HCV (6.6 %) was higher among the ART clinic attendants than the
VCT (2 %) clinic attendants. History of hospitalization (p = 0.001), tooth
extraction (p = 0.018) and blood transfusion (p = 0.041) showed
statistically significant association with anti-HCV antibody.

CONCLUSION: HCV sero-prevalence in this study was high. The prevalence was
three fold higher among HIV positive patients than their counter parts.
Thus, screening of HCV should be done among HIV patients for close
monitoring and better management in HIV patients.

Free BMC Article
http://bmcresnotes.biomedcentral.com/articles/10.1186/s13104-016-1936-3
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Seroprevalence and Predictors of Hepatitis B Virus Infection
among Pregnant Women Attending Routine Antenatal Care in Arba Minch
Hospital, South Ethiopia
__________________________________________________________________

Free Full Article http://www.hindawi.com/journals/heprt/2016/929016

Hepat Res Treat. 2016;2016:9290163.

Seroprevalence and Predictors of Hepatitis B Virus Infection among
Pregnant Women Attending Routine Antenatal Care in Arba Minch Hospital,
South Ethiopia.

Yohanes T1, Zerdo Z1, Chufamo N2.

1Department of Medical Laboratory Science, Arba Minch University, P.O. Box
21, Arba Minch, Ethiopia.
2School of Medicine, Department of Obstetrics and Gynecology, Arba Minch
University, P.O. Box 21, Arba Minch, Ethiopia.

Hepatitis B virus (HBV) is a serious cause of liver disease affecting
millions of people throughout the world. When HBV is acquired during
pregnancy, prenatal transmission can occur to the fetus.

Therefore, this study is aimed at estimating seroprevalence and associated
factors of HBV infection among pregnant women attending Antenatal Clinic
(ANC) of Arba Minch Hospital, Southern Ethiopia. A facility based cross-
sectional study was conducted on 232 pregnant women visiting ANC from
February to April, 2015. Data regarding sociodemographic and associated
factors were gathered using questionnaire. Serum samples were tested for
hepatitis B surface antigen (HBsAg) by Enzyme Linked Immunosorbent Assay.
Data was analyzed using SPSS version 20.

The overall seroprevalence of HBV infection was 4.3% (95% CI: 2.2-6.9%).

Multivariate analysis showed that history of abortion (AOR = 7.775; 95%
CI: 1.538-39.301) and having multiple sexual partners (AOR = 7.189; 95%
CI: 1.039-49.755) were independent predictors of HBsAg seropositivity.

In conclusion, the prevalence of HBV infection is intermediate.

Therefore, screening HBV infection should be routine part of ANC; health
information on having single sexual partner for women of childbearing age
and on following aseptic techniques during abortion should be provided to
health facilities working on abortion.

Free Full Article http://www.hindawi.com/journals/heprt/2016/9290163/
__________________________________________________________________
________________________________*_________________________________

8. Abstract: High HIV prevalence in a respondent-driven sampling survey of
injection drug users in Tehran, Iran
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/25280446

AIDS Behav. 2015 Mar;19(3):440-9.
High HIV prevalence in a respondent-driven sampling survey of injection
drug users in Tehran, Iran.

Malekinejad M1, Mohraz M, Razani N, Akbari G, McFarland W, Khairandish P,
Malekafzali H, Gouya MM, Zarghami A, Rutherford GW.

1Institute for Health Policy Studies, University of California, 3333
California Street, Suite 265, San Francisco, CA, 94118, USA,
MMalekinejad@ucsf.edu.

Iran is facing unprecedented dual drug use and HIV epidemics. We conducted
a cross-sectional survey to obtain HIV prevalence and risk behavior data
from injection drug users (IDU) in Tehran.

We used respondent-driven sampling (RDS) to recruit IDU through successive
waves starting with 24 “seeds,” conducted anonymous face-to-face
interviews and HIV testing and counseling, and used RDSAT to adjust data.

During 44 weeks, 1,726 study referral coupons resulted in 645 (37 %) IDU
referrals, of whom 548 (85 %) were enrolled. From those enrolled, 84 %
were incarcerated, 47 % employed, 55 % single, 27 % under 30 years of age,
and 26 % homeless. The adjusted HIV prevalence was 26.6 % (95 % confidence
interval 21.3-32.1), and was higher among certain IDU subgroups (e.g.,
those who sharing injection paraphernalia).

Our estimates of HIV prevalence were higher than some other estimates;
however, repeated surveys using similar methodology are needed to monitor
the trend of HIV epidemic over time.
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Disinfection practices in intravenous drug administration
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26899528

Am J Infect Control. 2016 Feb 18. pii: S0196-6553(16)00014-6.
Disinfection practices in intravenous drug administration.

Helder OK1, Kornelisse RF2, Reiss IK2, Ista E3.

1Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia
Children’s Hospital, Rotterdam, The Netherlands. Electronic address:
o.helder@erasmusmc.nl.
2Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia
Children’s Hospital, Rotterdam, The Netherlands.
3Department of Pediatric Surgery, Intensive Care Unit, Erasmus MC-Sophia
Children’s Hospital, Rotterdam, The Netherlands.

The aim of the study was to determine the effectiveness of a feedback
intervention on adherence to disinfection procedures during intravenous
medication preparation and administration.

We found that full adherence to the protocols significantly improved from
7.3% to 21.5% (P?<?.001) regarding medication preparation and from 7.9% to
15.5% (P?=?.012) regarding medication administration.

However, disinfection practices still need improvement.

Copyright © 2015 Association for Professionals in Infection Control and

Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

KEYWORDS: Infection prevention; adherence; hand hygiene; hospital-acquired
infections
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Experience of intravitreal injections in a tertiary Hospital
in Oman
__________________________________________________________________

http://dx.doi.org/10.4103%2F0974-620X.169896 Free Full Article

Oman J Ophthalmol. 2015 Sep-Dec;8(3):166-70.
Experience of intravitreal injections in a tertiary Hospital in Oman.

Al-Hinai AS1.

1Department of Ophthalmology, Sultan Qaboos University Hospital, Muscat,
Sultanate of Oman.

AIM: To find out statistical data regarding intravitreal injections in an
outpatient department setup at a tertiary center in Oman.

DESIGN: Retrospective chart review.

METHODS: Data collection of patients who underwent intravitreal injections
from November 2009 to May 2013 at Sultan Qaboos University Hospital.

RESULTS: Throughout a period of 42 months, a total of 711 intravitreal
injections were performed. That included 214 patients (275 eyes). Around
one-third of the eyes received two injections or more. The injected agents
were bevacizumab (59.8%), ranibizumab (32.3%), triamcinolone (7.5%), and
very few patients with endophthalmitis received intravitreal antibiotics
and antifungal agents. The three most common indications for the injection
therapy were diabetic macular edema (50.9%), choroidal neovascularization
(24.3%), and retinal vein occlusive diseases (11.5%). Serious adverse
events were rare, and they occurred as ocular (0.9% per patient) and
systemic (3.3% per patient). There were 42 eyes received intravitreal
triamcinolone, and 24% of them developed intraocular hypertension that
required only medical treatment.

CONCLUSION: Different intravitreal agents are currently used to treat many
ocular diseases. Currently, therapy with intravitreal agents is very
popular, and it carries a promising outcome with more efficiency and
safety.

KEYWORDS: Antivascular endothelial growth factors; Oman; choroidal
neovascularization; diabetic macular edema; intravitreal; retina; retinal
vascular occlusion
__________________________________________________________________
________________________________*_________________________________

11. Abstract: Outcomes of switching directly to oral fingolimod from
injectable therapies: Results of the randomized, open-label,
multicenter, Evaluate Patient OutComes (EPOC) study in relapsing
multiple sclerosis
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26265273

Mult Scler Relat Disord. 2014 Sep;3(5):607-19.
Outcomes of switching directly to oral fingolimod from injectable
therapies: Results of the randomized, open-label, multicenter, Evaluate
Patient OutComes (EPOC) study in relapsing multiple sclerosis.

Fox E1, Edwards K2, Burch G3, Wynn DR4, LaGanke C5, Crayton H6, Hunter
SF7, Huffman C8, Kim E9, Pestreich L10, McCague K11, Barbato L12; EPOC
study investigators.

1Central Texas Neurology Consultants, PA, 16040 Park Valley Drive,
Building B, Suite 100, Round Rock, TX 78681, USA. Electronic address:
foxtexms@gmail.com.
2Multiple Sclerosis Center of Northeastern New York, NY, USA. Electronic
address: kedwards@tristateneuro.com.
3Blue Ridge Research Center, VA, USA. Electronic address:
brresearch@aol.com.
4Consultants in Neurology Multiple Sclerosis Center,IL, USA. Electronic
address: dwynnmd@gmail.com.
5North Central Neurology Associates, AL, USA. Electronic address:
claganke@prn-inc.net.
6Multiple Sclerosis Center of Greater Washington, VA, USA. Electronic
address: msdoc1@hotmail.com.
7Advanced Neurosciences Institute, TN, USA. Electronic address:
sfhunter@neurosci.us.
8Meridien Research, FL, USA. Electronic address:
chuffman@meridienresearch.net.
9Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA. Electronic
address: edward.kim@novartis.com.
10Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA. Electronic
address: linda.pestreich@novartis.com.
11Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA. Electronic
address: kevin.mccague@novartis.com.
12Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA. Electronic
address: lou.barbato@novartis.com.

BACKGROUND: The Evaluate Patient OutComes (ClinicalTrials.gov Identifier:
NCT01216072) study was conducted in North America to assess patient- and
physician- reported treatment satisfaction in patients with relapsing
multiple sclerosis (MS) who received oral fingolimod for 6 months after
switching from an injectable disease-modifying therapy (iDMT), without an
intervening washout.

METHODS: In this open-label, multicenter study, patients were randomized
3:1 to once-daily fingolimod 0.5mg or iDMT. The primary study objective
was to evaluate differences in satisfaction measured using the Treatment
Satisfaction Questionnaire for Medication v1.4.

RESULTS: Of 1053 patients randomized, 790 patients received fingolimod and
263 patients received iDMT. Treatment satisfaction improved significantly
in patients who switched to fingolimod compared with those who continued
iDMT. Patients also reported significant improvements in health-related
quality of life, reduced depression, and reduced fatigue severity after a
switch to fingolimod. No difference between the treatment groups was
detected on the Patient Reported Indices for MS Activities scale. The
safety profile of fingolimod was consistent with that reported in the
pivotal phase 3 studies. The most commonly reported adverse events were
more prevalent in patients who switched to fingolimod than in those who
continued iDMT (headache: 12% vs 3%; fatigue: 12% vs 6%). No significant
relationship between lymphocyte counts and infection rates was observed
and there was no evidence of additive immune-system effects, which might
be expected when switching to a different class of immunomodulatory
therapy with no intervening washout.

CONCLUSION: Patients who switched from iDMT to fingolimod had significant
improvements in most self-reported outcomes compared with those who
continued iDMT.

Copyright © 2014 Elsevier B.V. All rights reserved.

KEYWORDS: Depression; Fatigue; Fingolimod; Multiple sclerosis;
Satisfaction
__________________________________________________________________
________________________________*_________________________________

12. Abstract: Event and Cost Offsets of Switching 20% of the Type 1
Diabetes Population in Germany From Multiple Daily Injections to
Continuous Subcutaneous Insulin Infusion: A 4-Year Simulation Model
__________________________________________________________________
J Diabetes Sci Technol. 2016 Feb 22. pii: 1932296816633720.
Event and Cost Offsets of Switching 20% of the Type 1 Diabetes Population
in Germany From Multiple Daily Injections to Continuous Subcutaneous
Insulin Infusion: A 4-Year Simulation Model.

Zöllner YF1, Ziegler R2, Stüve M3, Krumreich J4, Schauf M3.

1Hamburg University of Applied Sciences, Hamburg, Germany
yorkfrancis.zoellner@haw-hamburg.de.
2Diabetes Clinic for Children and Adolescents, Muenster, Germany.
3Johnson & Johnson Medical GmbH, Norderstedt, Germany.
4Econ-Epi, Wentorf/Hamburg, Germany.

BACKGROUND: Most patients with type 1 diabetes (T1D) administer insulin by
multiple daily injections (MDI). However, continuous subcutaneous insulin
infusion (CSII) therapy has been shown to improve glycemic control
compared with MDI.

OBJECTIVE: The objective was to determine the key medical event and cost
offsets generated over a 4-year period by introducing CSII to T1D patients
who have inadequately controlled glucose metabolism on MDI in Germany.

METHODS: A decision-analytic budget impact model, simulating a treatment
switch scenario, was developed. In the base case, all T1D patients
received MDI, while in the switch scenario, 20% of the eligible T1D
population, randomly selected, moved to CSII. The model focused on 2
medical endpoints and their corresponding cost offsets: severe
hypoglycemic events requiring hospitalization (SHEH) and complication-
borne diabetic events (CDEs) avoided. Event rates and costs were taken
from the literature and official sources, adopting a health insurance
perspective.

RESULTS: Compared with the base case, treating 20% of patients with CSII
in the switch scenario resulted in 47?864 fewer SHEH and 5543 fewer CDEs.
This led to total cost offsets of €183?085?281 within the 4-year time
horizon. Of these, 92% were driven by avoided SHEH. Compared to an
expected budget impact (cost increase) of 83%, only treatment costs
considered, the total impact of the switch scenario amounted merely to a
24.5% increase in costs (reduction by 58.5% points; a factor of 3.4).

CONCLUSION: The use of CSII resulted in fewer SHEH and CDEs compared to
MDI. The incurred CSII implementation costs are hence offset to a
substantial degree by cost savings in complication treatment. © 2016
Diabetes Technology Society.

KEYWORDS: German costs data; budget impact; complication-borne diabetic
events; continuous subcutaneous insulin infusion; glucose monitoring;
severe hypoglycemic events; type 1 diabetes
__________________________________________________________________
________________________________*_________________________________

13. No Abstract: Sharps rules not followed
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26845784

J Perioper Pract. 2015 Dec;25(12):244.
Sharps rules not followed.

[No authors listed]
__________________________________________________________________
________________________________*_________________________________

14. News

– New Jersey Hospital Patients Told of Possible HIV, Hepatitis Exposure

– Scotland UK: NHS spends £3,000 a day on needles for heroin addicts

– UK: Healthcare worker who put 8,000 patients at risk of hepatitis C is
named as a surgeon who caught the virus during an operation and DIED
from it in 2012

– New Jersey USA: Hospital warns patients of possible HIV, hepatitis
exposure

– Washington USA: Volunteers helping to pick up used needles in parks,
neighborhoods

– Colorado USA: Nearly 3K Patients Put At Risk Due to Contaminated Needles
The patients are being tested for diseases such as HIV, Hepatitis B and
Hepatitis C

– Cambodia: Country investigates second village clinic over HIV
contamination

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

http://www.medscape.com/viewarticle/859526
New Jersey Hospital Patients Told of Possible HIV, Hepatitis Exposure

By Marcus E. Howard, Reuters Health Information, (29.02.16)

(Reuters) – More than 200 people treated at a New Jersey medical center
may have been exposed to HIV or hepatitis B or C because of a former
employee accused of tampering with drugs, the hospital said on Thursday.

Shore Medical Center in Somers Point, located on the southern New Jersey
coast outside of Atlantic City, sent letters last week to 213 patients who
were treated with certain intravenous medications, including morphine,
between June 1, 2013 and Sept. 17, 2014.

“We have been working with public health authorities to determine if
patients could have been exposed to blood-borne pathogens at Shore through
contact with this employee’s blood,” said hospital spokesman Brian Cahill
in a statement.

Free testing and support are being offered to the patients, the hospital
said. New Jersey Health Department spokeswoman Dawn Thomas described the
risk of exposure as low.

Frederick McLeish, 53, a former pharmacist at the hospital, is accused of
removing the drugs from vials intended to be used in the preparation of
intravenous medications for patients, and replacing them with a saline
solution.

His attorney, John Zarych, declined to comment on the case.

The hospital detected a problem and fired McLeish, of Egg Harbor Township,
after an internal investigation. On Jan. 21 he was indicted by an Atlantic
County grand jury on charges of drug tampering, theft and drug possession.
He was released on bail the same day, according to a court official.

On Monday, McLeish was arraigned in Atlantic County Superior Court. A
status hearing, at which he is expected to enter a plea, has been
scheduled for March 7.

McLeish had been authorized to prescribe, dispense or administer
medication, according to the Atlantic County prosecutor’s office.

The hospital, state health department and Centers for Disease Control and
Prevention are still investigating.
__________________________________________________________________
__________________________________________________________________

https://tinyurl.com/z5xu879
Scotland UK: NHS spends £3,000 a day on needles for heroin addicts

SCOTLAND’S cash-strapped NHS is spending £3,000 a day helping heroin
addicts feed their habit.

By Tom Martin, Express.co.uk, U.K (27.02.16)

Scotland’s NHS is reportedly spending £3,000 on needles for drug addicts
Syringes, spoons, and foil have been handed out as hospitals and GP
surgeries battle a recruitment and waiting times crisis.

The 12 million items, which also include filters and sharps bins, have
been distributed at a cost of £3.3million since 2012.

NHS Greater Glasgow and Clyde spent the most, at £1.9million, followed by
Tayside at £350,886. NHS Ayrshire and Arran, NHS Fife, Lanarkshire, and
Lothian also spent six-figure sums. But the true cost will be higher, as
six health boards said they did not hold the information.

People will be shocked at the sheer cost involved here
Alex Johnstone,Scottish Tories and Conservative MSP
Officials have defended the practice, saying it stops people sharing
needles and spreading Hepatitis C and HIV. But critics fear it is another
admission the war on drugs has been lost.

The revelation comes as Scottish Lib Dems today vote on a manifesto plan
which would see those caught with drugs referred for treatment rather than
be sent to jail.

Leader Willie Rennie argues current drugs policy “is costly and fails to
work for everyone”.

The health board figures were obtained by the Scottish Tories and
Conservative MSP Alex Johnstone said: “Nobody’s saying the NHS should shut
up shop and leave drug users to their own devices.

“However, people will be shocked at the sheer cost involved here, and
would prefer to see a society that helped people beat drug addiction,
rather than facilitate it.

“If the Liberal Democrats’ crazy plan to basically decriminalise all drugs
went ahead, the burden on the NHS would be immense. That’s not what people
want from the NHS, particularly at a time of squeezed budgets.”

Public Health Minister Maureen Watt said: “Fewer Scots are taking drugs.
The number of adults reporting drug use is continuing to fall among the
general population, while drug taking among young people is at its lowest
level in a decade.

“We have invested significantly in prevention services and injecting
equipment provision under the auspices of our work on Hepatitis C since
2008.

“As a result of this and other activities we have seen a real reduction in
the number of new infections of Hepatitis C in injecting drug users in
recent years.”

An NHS Greater Glasgow and Clyde spokeswoman said: The provision of
equipment for drug users is designed to promote safer practice amongst
injecting drug users and to promote engagement with treatment and recovery
services.

“By using clean injecting equipment from needle exchanges, drug users
reduce the risk of contracting blood-borne viruses such as HIV and
Hepatitis B and C and related infections, benefitting both drug users and
the wider community.

“There has also been a change in packs provided to clients which aims to
improve efficiency and reduce waste. While this has resulted in more
visits to the pharmacy it has lowered the equipment costs.”

Ministers have increased the overall Scottish NHS budget to £13billion a
year. But, according to Audit Scotland, this was slashed by 0.7 per cent
between 2008-9 and 2014-15, when inflation is taken into account.

Last week the Royal College of General Practitioners (Scotland) said that
funding for family doctors has been cut by £1.6billion over the past 10
years.
__________________________________________________________________
__________________________________________________________________

https://tinyurl.com/zjazwcx
UK: Healthcare worker who put 8,000 patients at risk of hepatitis C is
named as a surgeon who caught the virus during an operation and DIED from
it in 2012

By Anna Hodgekiss, MAILONLINE, Daily Mail, UK (26.02.16)

– Consultant surgeon Robert Pickard had no idea he was infected until 2008

– It is thought he unwittingly contracted the virus from a needle-stick
injury

– The father-of-two stopped working immediately after his diagnosis

– But health bosses did not let any former patients know until this week

– Two are thought to have caught hep c from Mr Pickard – triggering recall
of more than 8,000 patients he treated between 1982 and 2008 for blood
tests

The mystery healthcare worker at the centre of a hepatitis C scandal was
named today – as it emerged he caught it from a random needle stick injury
while on duty.

Consultant Robert Pickard is the medic mentioned in a letter sent to more
than 8,000 patients treated as far back as 1982 urging them to have blood
tests.

Mr Pickard, who died from the disease aged 73 in 2012, is thought to have
contracted the condition while carrying out a routine operation.

He had no idea he had the infection until it cropped up in a blood test in
2008 – at which point he immediately stopped working.

The alarm was raised this week after two of Mr Pickard’s patients were
found to have contracted hepatitis C.

The father-of-two was a general surgeon at three hospitals in Lanarkshire:
Law, Stonehouse and Wishaw General.

He also worked at the William Harvey Hospital in Kent for three months.

Mr Pickard started in general surgery but also did gastrointestinal and
vascular work as well as breast, thyroid and paediatric surgery.

A biography on the Royal College of Surgeons website pays tribute to his
‘sense of humour and delightful eccentricities, such as his shambolic
attire’.

And it salutes his ‘complete lack of pomposity, his warmth and
thoughtfulness for everyone regardless of status’.

It also describes how three years before his death, he was found to have
hepatitis C, ‘most probably due to an unrecognised needle stick injury
during surgery’.

Despite undergoing ‘vigorous treatment’, the disease progressed to
cirrhosis – where the liver becomes irreparably scarred – and he later
developed an inoperable liver tumour.

Mr Pickard died on 12 August 2012, aged 73.

Mr Pickard was based primarily at Wishaw General Hospital, Lanarkshire
(pictured). He died frim hepatitis C aged 73 in 2012 – and is thought to
have contracted it from a random needle stick injury while at work

Mr Pickard, who tested positive for hepatitis C in 2008, also worked at
William Harvey hospital in Kent

Victims can carry the hepatitis C virus for years without knowing it
because the symptoms don’t become obvious until major damage has been
caused.

Around 215,000 people in the UK have it and it is spread by contact with
infected blood.

On Tuesday this week health officials announced that more than 8,000 of
his former patients are to be invited for blood tests to check against the
disease.

Of the 8,383 patients contacted, 7,311 are from Lanarkshire.

They also faced intense criticism after it emerged they had known about Mr
Pickard’s condition for more than eight years.

At the time, the UK Advisory Panel for Healthcare Workers Infected with
Bloodborne Viruses (UKAP) said patients did not need to be warned as the
risk was thought to be low.

But the U-turn follows admissions it was ‘probable’ the two patients had
been infected.

But Dr Iain Wallace, medical director for NHS Lanarkshire, said: ‘We would
like to reassure people that the likelihood of patients acquiring the
virus from a surgical procedure carried out by the healthcare worker is
low.

‘We know that some people receiving the letter may be anxious about what
this means for them. We have apologised to patients for any concern that
may be caused by this situation.

‘We are committed to supporting patients and are ensuring they have every
opportunity to get information about hepatitis C, the testing process and
the situation in general.

‘We are also putting on additional clinics locally to make it as
straightforward and convenient as possible for people to get tested.’

UKAP chairman Professor David Goldberg – who was deputy chairman of the
organisation at the time – has defended the decision not to notify
patients in 2008.

In 2008, Isabel Boyer was in charge of UKAP but she retired in 2015.

Speaking earlier this week, Mr Goldberg said there was no evidence then
that any patient had been infected by the healthcare worker.

He said: ‘I think it’s a very reasonable decision. It wasn’t the wrong
decision based on the evidence we had at the time.’

HEPATITIS C – THE SYMPTOMS

Hepatitis C is usually spread through blood-to-blood contact and can be
passed by sharing unsterilised needles, razors or toothbrushes.

The problem is the virus often doesn’t have any noticeable symptoms until
the liver has been significantly damaged.

This means many people have the infection without realising it – and when
symptoms do occur, they can be mistaken for another condition.

They include flu-like symptoms, such as muscle aches and a high
temperature (fever), feeling tired all the time, loss of appetite,
abdominal pain, feeling and being sick.

The only way to know for certain if these symptoms are caused by hepatitis
C is to get a blood test.
__________________________________________________________________
__________________________________________________________________

https://tinyurl.com/jhrg77o
New Jersey USA: Hospital warns patients of possible HIV, hepatitis
exposure

CBS News, CBS/AP, USA (25.02.16)

SOMERS POINT, N.J. — Officials at a southern New Jersey hospital have
notified 213 patients they may have been exposed to HIV or hepatitis B or
C because of drug tampering that may have caused patients to come in
contact with an employee’s blood.

The warning applied to patients at Shore Medical Center in Somers Point
who received intravenous morphine or hydromorphone medications at the
hospitals between June 1, 2013, and Sept. 17, 2014, the medical center
said.

A former pharmacist at the hospital allegedly tampered with the drugs by
replacing morphine with saline solution in vials that were administered to
patients, according to an internal investigation at the hospital and the
Atlantic County Prosecutor’s Office.

The ex-employee was arrested last month and charged with drug tampering,
theft and drug possession.

In its letter to patients, the hospital said the tampering may have caused
patients to come in contact with the ex-employee’s blood and urged
patients to get tested, The Press of Atlantic City reported. The hospital
said it’s providing free testing for patients who may have been exposed
and has set up a dedicated call center for affected patients and family
members who have questions.

A spokeswoman for the state Department of Health said the agency is
investigating a potential infection control breach at the hospital.

Arlene Polmonari, of Atlantic City, received the letter last week that she
might have been exposed to the diseases due to past surgeries for a knee
replacement and a procedure for her back.

“A phone call would have been nicer than this,” said Polmonari, who tested
negative for the diseases. “You know, to soften the blow a little, make
people not feel so hysterical about it.”

According to CBS Philadelphia, Brian Cahill, of Shore Medical Center,
released a statement saying the hospital takes “patient care very
seriously.”

“We have been working with public health authorities to determine if
patients could have been exposed to blood borne pathogens at Shore through
contact with this employee’s blood,” Cahill said in the statement. “We
have contacted all patients who received certain intravenous medications
between June 1, 2013 and September 17, 2014. We are providing free testing
and support through every step and are partnering with local health
department agencies during this testing period in order to be extremely
cautious.”

Earlier this month, a hospital in Colorado notified surgery patients that
they should get tested for HIV and hepatitis B and C, after a former
surgical technician allegedly removed a syringe containing the narcotic
drug Fentanyl Citrate from a workspace and replaced it with a similar
syringe at the beginning of a surgery.

© 2016 CBS Interactive Inc. All Rights Reserved. The Associated Press
contributed to this report.
__________________________________________________________________
__________________________________________________________________

https://tinyurl.com/hddyxo9
Washington USA: Volunteers helping to pick up used needles in parks,
neighborhoods

By Hana Kim, Q13 FOX,acoma Washington USA (24.02.16)

TACOMA — It’s a dirty reality in many neighborhoods — used needles on
sidewalks and in parks.

Some parts of Seattle are so bad that some residents in north Seattle are
attending classes to learn how to safely dispose of syringes.

In Pierce County, many residents are already experts at the practice.
Their efforts are a big reason why some parks known for needles are clean
now.

“We have a lot of big parks in Tacoma,” city resident Leslie Young said.

Parks that Young treats like her own backyard.

“People shouldn’t be finding needles on their playground,” Young said.

After finding hypodermic needles in her Tacoma neighborhood, Young is no
longer waiting for someone else to pick up the prickly mess.

“I started finding needles in my driveway,” Young said.

She volunteers her time looking to get rid of used needles that could pose
a danger to kids and families who come to play and enjoy the outdoors.

But she understands the reluctance others may have.

“There is a lot of fear associated with syringes; we really encourage
people to call us,” Alisa Solberg, of The Point Defiance Aids Project,
said.

The Point Defiance Aids Project is a needle exchange program trying to
combat that fear with a lesson on what you should do if you find a
syringe.

Experts say first, grab gloves and a bio hazard bin.

If you don’t have a bin, they recommend a hard plastic container like a
Gatorade bottle or a detergent container to drop the needles in.

Place the container or bottle away from your body and never hold onto the
container while dropping the needle in. Make sure the needle point is
facing down toward the ground — that way you eliminate coming in contact
with the needle.

Solberg says if you still feel uneasy, alert her group and they will get
rid of the needles in Pierce County.

“We are likely going to see more syringes in public,” Solberg said.

She blames the prescription pill epidemic.

“Worst man-made epidemic in history, the CDC reports 12 million people are
addicted to prescription opiates and many of them will transition into
injecting (heroin),” Solberg said.

Meanwhile, people like Leslie Young is doing her part to keep parks safe,
making a difference, one needle at a time.

“The more you raise the standard, you know, the less people do it,” Young
said.

Once you have a needles in a bio hazard bin, it must be sealed and marked
before you throw it away. Different counties have different rules on where
you can take the materials. For more information call your area health
department.
__________________________________________________________________
__________________________________________________________________

https://tinyurl.com/h4y22f4
Colorado USA: Nearly 3K Patients Put At Risk Due to Contaminated Needles
The patients are being tested for diseases such as HIV, Hepatitis B and
Hepatitis C

By Zach Winn, Campus Safety Magazine, USA (24.02.16)

A former employee at a Colorado hospital may have put thousands of
patients at risk of disease after police say he swapped needles that could
have been contaminated.

Rocky Allen was fired from the Swedish Medical Center on Jan. 22 and has
been charged with multiple crimes after police say he replaced syringes in
order to gain access to controlled substances.

Allen had worked as a surgical technician at the Englewood, Colorado
hospital since August of 2015, according to CBS News.

Investigators say Allen switched a syringe containing Fentanyl Citrate
with a similar syringe before a surgery in late January.

Since that discovery, the hospital has urged 2,900 people to get tested
for diseases that can be transmitted by needles, including HIV, Hepatitis
B and Hepatitis C. The people are former surgery patients that may have
been exposed to the contaminated needles.

An attorney representing a dozen of the former patients said two of his
clients have tested positive for Hepatitis B.

Allen has also worked at Banner Thunderbird Medical Center and John C.
Lincoln Medical Center, both of which are in Arizona. Those hospitals have
issued health alerts and begun offering testing to patients as well.

Allen was charged with tampering with a consumer product and obtaining a
controlled substance by deceit and subterfuge on Feb. 23.

Swedish Medical Center requires medications to be kept under lock and key
until they are used. The hospital released a statement apologizing to
patients and informing the public that they’ve opened their own
investigation. Local police and the Colorado Department of Public Health
and Environment are also investigating.
__________________________________________________________________
__________________________________________________________________

https://tinyurl.com/gvg56x3
Cambodia: Country investigates second village clinic over HIV
contamination

By NAN, Pulse Nigeria, Pulse News Agency, Nigeria (22.02.16)

In December, an unlicensed medic was sentenced to 25 years in prison for
transmitting HIV to 270 people through contaminated needles in a village
of Battambang province, 250 kilometres north-west of Phnom Penh.

Cambodia is investigating reports of a new crop of HIV cases that
villagers have linked to contaminated needles at a local health centre.

An official report on Monday in Phnom Penh stated that 10 people have been
diagnosed HIV-positive in the past two weeks out of a population of 1,000
in Peam village, around 35 kilometres from Phnom Penh.

It said that the unusual profile of the patients, such as old age and
monogamy, raised a red flag with provincial health authorities.

Meanwhile, Health Minister, Mam Bunheng, who declined to discuss details,
said it would only create chaos.

He said necessary actions would be taken.

The residents in their reactions blamed contaminated needles used by a
local doctor.

In December, an unlicensed medic was sentenced to 25 years in prison for
transmitting HIV to 270 people through contaminated needles in a village
of Battambang province, 250 kilometres north-west of Phnom Penh.

The preference for medication administered by injection and poor medical
training raises the risk of HIV transmission in local medical facilities.

According to UNAIDS, Cambodia has slowed HIV transmission since its peak
in the late 1990s, but there are still 75,000 people living with the virus
in a population of 15 million.
__________________________________________________________________
________________________________*_________________________________
New WHO Injection Safety Guidelines

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

The new guideline is:

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

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

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

This is an illustrated summary brochure for the general public.

pdf, 554kb [6 pages]

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

SIGN Meeting 2015

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

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

A report of the meeting will be posted ASAP
__________________________________________________________________
________________________________*_________________________________
* SAFETY OF INJECTIONS brief yourself at: www.injectionsafety.org

A fact sheet on injection safety is available at:
http://www.who.int/mediacentre/factsheets/fs231/en/index.html

* Visit the WHO injection safety website and the SIGN Alliance Secretariat
at: http://www.who.int/injection_safety/en/

* Download the WHO Best Practices for Injections and Related Procedures
Toolkit March 2010 [pdf 2.47Mb]:
http://whqlibdoc.who.int/publications/2010/9789241599252_eng.pdf

Use the Toolbox at: http://www.who.int/injection_safety/toolbox/en/

Get SIGN files on the web at: http://signpostonline.info/signfiles-2
get SIGNpost archives at: http://signpostonline.info/archives-by-year

Like on Facebook: http://facebook.com/SIGN.Moderator

The SIGN Secretariat, the Department of Health Systems Policies and
Workforce, WHO, Avenue Appia 20, CH-1211 Geneva 27, Switzerland.
Facsimile: +41 22 791 4836 E- mail: sign@who.int
__________________________________________________________________
________________________________*_________________________________
All members of the SIGN Forum are invited to submit messages, comment on
any posting, or to use the forum to request technical information in
relation to injection safety.

The comments made in this forum are the sole responsibility of the writers
and does not in any way mean that they are endorsed by any of the
organizations and agencies to which the authors may belong.

Use of trade names and commercial sources is for identification only and
does not imply endorsement.

The SIGN Forum welcomes new subscribers who are involved in injection
safety.

* Subscribe or un-subscribe by email to: sign.moderator@gmail.com, or to
sign@who.int

The SIGNpost Website is http://SIGNpostOnline.info

The SIGNpost website provides an archive of all SIGNposts, meeting
reports, field reports, documents, images such as photographs, posters,
signs and symbols, and video.

We would like your help in building this archive. Please send your old
reports, studies, articles, photographs, tools, and resources for posting.

Email mailto:sign.moderator@gmail.com
__________________________________________________________________
________________________________*_________________________________

The SIGN Internet Forum was established at the initiative of the World
Health Organization’s Department of Essential Health Technologies.

The SIGN Secretariat home is the Service Delivery and Safety (SDS)
Health Systems and Innovation (HIS) at WHO HQ, Geneva Switzerland.

The SIGN Forum is moderated by Allan Bass and is hosted on the University
of Queensland computer network. http://www.uq.edu.au
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