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SIGNpost 00844

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST

Post00844 Key IS Documents updated + Abstracts + News 16 March 2016

CONTENTS
1. New: 3 Key Injection Safety documents updated and ready for use
2. NEW REPORT: Sharps Injuries among Hospital Workers in Massachusetts,
2013
3. Abstract: Evaluation of the first open-access hepatitis B and safe
injection online training course for health professionals in China
4. Abstract: Seroprevalence and risk factors of Hepatitis B and Hepatitis
C infections among pregnant women in the Asante Akim North Municipality
of the Ashanti region, Ghana; a cross sectional study
5. Abstract: Focus on harm reduction in fight against HIV, says report
6. Abstract: The John N. Insall Award: Do Intraarticular Injections
Increase the Risk of Infection After TKA?
7. Abstract: Deaths following vaccination: What does the evidence show?
8. Abstract: A study of the incidence of BCG vaccine complications in
infants of Babol, Mazandaran (2011-2013)
9. Abstract: Risk factors for fatal and nonfatal reactions to subcutaneous
immunotherapy: National surveillance study on allergen immunotherapy
(2008-2013)
10. Abstract: Safety and efficacy of tuberculin skin testing with
microneedle MicronJet600™ in healthy adults
11. Abstract: Use of hyaluronidase to correct hyaluronic acid injections
in aesthetic medicine
12. Abstract: Silicon Injection Granulomata: 67Ga Citrate Findings in Free
Silicon Buttock Augmentation
13. Abstract: Antimicrobial activity of silver doped fabrics for the
production of hospital uniforms
14. No Abstract: A needlestick injury – what next?
15. News
– Kentucky USA: Hypodermic needle disposal education measure picks up
amendment, surprising sponsor Denham
– Canada: Lack of snow reveals used needles around Regina

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SIGNpost 00844

More information follows at the end of this SIGNpost!

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Subscribe or un-subscribe by email to: sign.moderator@gmail.com or to
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Visit the SIGNpostOnline archives at: http://signpostonline.info

Like SIGNpost on Facebook at: https://www.facebook.com/SIGN.Moderator
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__________________________________________________________________
________________________________*_________________________________

1. New: 3 Key Injection Safety documents updated and ready for use
__________________________________________________________________
New: 3 Key Injection Safety documents updated and ready for use

Three key documents have all been updated in line with the 2015 WHO
injection safety guidelines.

These documents can help in planning injection safety programmes.

1) The Aide-memoire for a national strategy for the safe and appropriate
use of injections

www.who.int/injection_safety/about/country/en/AMENG.pdf [pdf, 212kb]

[ Extract below ]

2) The Guiding principles to ensure injection device security

www.who.int/injection_safety/toolbox/docs/en/Guiding_Principle_Inj.pdf
[pdf, 217kb]
3) Managing an injection safety policy,

www.who.int/injection_safety/toolbox/en/ManagingInjectionSafety.pdf
[pdf, 1.88Mb]
__________________________________________________________________

Extract Extract Extract Extract Extract Extract Extract

Text from page 1 of 2 omitting the sidebar checklist.
__________________________________________________________________
AIDE-MEMOIRE for a national strategy for the safe and appropriate use of
injections
Worldwide, each year, the overuse of injections and unsafe injection
practices combine to cause an estimated 8 to 16 million hepatitis
B virus infections, 2.3 to 4.7 million hepatitis C virus infections and
80,000 to 160,000 HIV infections*. Among unsafe practices, the
re-use of syringes and/or needles without sterilization is of
particular concern.

Injection-associated transmission of bloodborne pathogens can be
prevented through the development of a strategy to reduce injection
overuse and achieve injection safety and its implementation by
a national coalition, with the assistance of a coordinator.

The three elements of a strategy for the safe and appropriate use
of injections are described in detail overleaf:

¦ Behaviour change among patients and health-care workers
to decrease injection overuse and achieve injection safety

¦ The availability of necessary equipment and supplies, namely
a transition to the exclusive use of WHO prequalified AD/
RUP/SIP* syringes for therapeutic injections;

¦ The management of sharps waste.
————————————————–

Words of advice

¦ Conduct an initial assessment

¦ Secure government commitment and support for the safe
and appropriate use of injections

¦ Establish a national injection safety coalition, coordinated
by the Ministry of Health

¦ Develop a national policy and plan

¦ Develop a systematic strategy for behaviour change
among patients and health-care workers to decrease
injection overuse and achieve injection safety

¦ Ensure the continuous availability of injection equipment
and infection control supplies

¦ Set up a waste management system for the safe disposal
of sharps

¦ Monitor the impact of activities on injection frequency,
injection safety and injection-associated infections

RUP: Reuse prevention SIP: Sharps injury prevention

* Syringes engineered to prevent reuse are not suitable for certain
medical procedures e.g. when administering multiple medicines, maintenance
of IV lines, local anaesthesia and nasal feeding. Conventional disposable
syringes should be used safely in these and similar instances.

A safe injection does not harm the recipient, does not expose the
provider to any avoidable risks and does not result in any waste
that is dangerous for other people.

[Page 2 www.who.int/injection_safety/about/country/en/AMENG.pdf ]

Additional information on the safe and appropriate use of injections can
be obtained on the World-Wide Web at

http://www.who.int/injection_safety/en/ and on the Safe Injection Global
Network internet forum at

sign@who.int
Secretariat of the Safe Injection Global Network
Department of Service Delivery and Safety
World Health Organization
20 Avenue Appia, CH-1211 Geneva 27, Switzerland
Email: sign@who.int
__________________________________________________________________
________________________________*_________________________________

2. New Report: Sharps Injuries among Hospital Workers in Massachusetts,
2013
__________________________________________________________________

Laramie, Angela (DPH) <Angela.Laramie[at]massmail.state.ma.us>
date: Wed, Mar 16, 2016

New Report: Sharps Injuries among Hospital Workers in Massachusetts, 2013
We are pleased to release our most recent data report, “Sharps Injuries
among Hospital Workers in Massachusetts, 2013”. Please feel free to
distribute the report as you’d like.

It can also be found on the Occupational Health Surveillance Program
website (www.mass.gov/dph/ohsp) under Needlesticks and other Sharps
Injuries, Data and Statistics.

The direct link is: https://tinyurl.com/hnjk85h or full link:
http://www.mass.gov/eohhs/docs/dph/occupational-health/injuries/injuries-
hospital-2013.pdf

Many thanks to the occupational health and infection control staff who
provide the data that makes this and other reports possible.

Kind regards,
Angela and Devan

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Angela K. Laramie, MPH and Devan Hawkins, MS
Sharps Injury Surveillance Project
Occupational Health Surveillance Program
Massachusetts Department of Public Health
250 Washington Street, 4th Floor
Boston, MA 02108
www.mass.gov/dph/ohsp
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Evaluation of the first open-access hepatitis B and safe
injection online training course for health professionals in China
__________________________________________________________________

http://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-016-0608-2

BMC Med Educ. 2016 Mar 8;16(1):81.
Evaluation of the first open-access hepatitis B and safe injection online
training course for health professionals in China.

Wang J1, Feng Q2, Tam A3, Sun T4, Zhou P5, So S6.

1Asian Liver Center at Stanford University, 780 Welch Road, CJ130, 94304,
Palo Alto, CA, USA. alcjwang@gmail.com.
2School of Public Health, Guangxi Medical University, No.22, Shuangyong
Road, Nanning City, Guangxi Province, China. fengqm1963@163.com.
3Asian Liver Center at Stanford University, 780 Welch Road, CJ130, 94304,
Palo Alto, CA, USA. andrew.tam@ucsf.edu.
4Shandong Provincial Center for Disease Control and Prevention, No. 16992,
Jingshi Road, Jinan City, Shandong Province, China. t.sun@163.com.
5Shandong Provincial Center for Disease Control and Prevention, No. 16992,
Jingshi Road, Jinan City, Shandong Province, China. peijingzhou@163.com.
6Asian Liver Center at Stanford University, 780 Welch Road, CJ130, 94304,
Palo Alto, CA, USA. samso@stanford.edu.

BACKGROUND: Despite the high prevalence of chronic hepatitis B virus (HBV)
infection in China, HBV infection prevention and long-term care knowledge
of health professionals is inadequate. To address this knowledge gap, we
developed an open-access evidence-based online training course, “KnowHBV”,
to train health professionals on prevention of HBV transmission and safe
injections. We conducted an evaluation of the course with health
professionals in China to examine its effectiveness in improving knowledge
and learner’s satisfaction of the course.

METHODS: Between July and December 2011, 1015 health professionals from
selected hospitals and disease control institutions of Shandong province
registered for the course and 932 (92 %) completed the three-module
course. Participants’ demographic information, pre- and post-course
knowledge test results and learner’s feedback were collected through the
course website.

RESULTS: Pre-course knowledge assessment confirmed gaps in HBV
transmission routes, prevention and long-term care knowledge. Only 50.4 %
of participants correctly identified all of the transmission routes of
HBV, and only 40.7 % recognized all of the recommended tests to monitor
chronically infected persons.

The number of participants that answered all six multi-part multiple-
choice knowledge questions correctly increased from 183 (19.7 %) before
taking the course to 395 (42.4 %) on their first attempt upon completion
of the course. Over 90 % of the 898 participants who completed the
learner-feedback questionnaire rated the course as ‘good’ or ‘very good’;
over 94 % found the course instructional design helpful; 57.5 %, 65.7 %
and 68.5 % reported that half or more than half of the course content in
modules 1, 2 and 3 respectively provided new information; and 93.2 % of
the participants indicated they preferred the online learning over
traditional face-to-face classroom learning.

CONCLUSIONS: The “KnowHBV” online training course appears to be an
effective online training tool to improve HBV prevention and care
knowledge of the health professionals in China.

Free BMC Article
http://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-016-0608-2
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Seroprevalence and risk factors of Hepatitis B and Hepatitis
C infections among pregnant women in the Asante Akim North Municipality
of the Ashanti region, Ghana; a cross sectional study
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4765455/

Afr Health Sci. 2015 Sep;15(3):709-13. Free PMC Article
Seroprevalence and risk factors of Hepatitis B and Hepatitis C infections
among pregnant women in the Asante Akim North Municipality of the Ashanti
region, Ghana; a cross sectional study.

Ephraim R1, Donko I2, Sakyi SA3, Ampong J1, Agbodjakey H1.

1Department of Medical Laboratory Technology, School of Allied Health
Sciences, College of Health and Allied Sciences, University of Cape Coast.
2Department of Laboratory Technology, University of Cape Coast.
3Department of Molecular Medicine, School of Medical Sciences, College of
Health Sciences, Kwame Nkrumah University of Science and Technology.

BACKGROUND: Viral hepatitis is a serious public health problem affecting
billions of people globally with maternal-fetal transmission on the rise.

OBJECTIVES: This study sought to determine the prevalence and factors
associated with hepatitis B virus (HBV) and hepatitis C virus (HCV)
infections among pregnant women in the Asante Akim North Municipality, in
the Ashanti region of Ghana.

METHODS: In this cross-sectional study 168 pregnant women were recruited
from the Agogo Presbyterian hospital. Blood samples were collected for the
detection of Hepatitis B Surface Antigen (HBsAg) and anti-HCV antibodies.
A pretested questionnaire was used to obtain demographic data and identify
the risk factors associated with the two infections.

RESULTS: Of the 168 participants studied, 16 (9.5%) tested positive for
HBV and 13 (7.7%) tested positive for HCV representing 9.5% and 7.7%
respectively. A participant tested positive for both HBV and HCV co-
infection representing 0.6%. Undertaking blood transfusion, tattooing and
sharing of needles were associated with hepatitis C infection (P=0.001).
HBV was not associated with any of the risk factors (P>0.05).

CONCLUSION: Our findings suggest a high prevalence of hepatitis B and
hepatitis C among pregnant women; blood transfusion, tattooing and sharing
of hypodermic needles were associated with hepatitis C infection. Measures
to reduce the disease and transmission burden must be introduced.

KEYWORDS: Ghana; Hepatitis B; Hepatitis C; pregnant women; risk factors;
seroprevalence

Free PMC Article https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4765455/
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Focus on harm reduction in fight against HIV, says report
__________________________________________________________________
https://www.ncbi.nlm.nih.gov/pubmed/26966144

BMJ. 2016 Mar 10;352:i1479. doi: 10.1136/bmj.i1479.
Focus on harm reduction in fight against HIV, says report.

Cousins S1.

1Kathmandu.

Extract
New HIV infections among people who inject drugs could be virtually
eliminated by 2030 if a small percentage of global drug control spending
is redirected towards harm reduction programmes, a new report has said.

The report, The Case for a Harm Reduction Decade: Progress, Potential and
Paradigm Shifts,1 by UK based non-governmental organisation Harm Reduction
International (HRI), found that redirecting 7.5% of the money spent on the
“war on drugs” could reduce HIV related deaths by 94%.

The modelling by David Wilson, head of infectious disease modelling at the
Centre for Population Health at the Burnet Institute in Melbourne, found
that even if 2.5% …
__________________________________________________________________
________________________________*_________________________________

6. Abstract: The John N. Insall Award: Do Intraarticular Injections
Increase the Risk of Infection After TKA?
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26970991

Clin Orthop Relat Res. 2016 Mar 12.
The John N. Insall Award: Do Intraarticular Injections Increase the Risk
of Infection After TKA?

Bedard NA1, Pugely AJ1, Elkins JM1, Duchman KR1, Westermann RW1, Liu SS1,
Gao Y1, Callaghan JJ2.

1University of Iowa, Iowa City, IA, 52242, USA.
2University of Iowa, Iowa City, IA, 52242, USA. john-callaghan@uiowa.edu.

BACKGROUND: Infection after total knee arthroplasty (TKA) can result in
disastrous consequences. Previous research regarding injections and risk
of TKA infection have produced conflicting results and in general have
been limited by small cohort size.

QUESTIONS/PURPOSES: The purpose of this study was to evaluate if
intraarticular injection before TKA increases the risk of postoperative
infection and to identify if time between injection and TKA affect the
risk of TKA infection.

METHODS: The Humana data set was reviewed from 2007 to 2014 for all
patients who received a knee injection before TKA. Current Procedural
Terminology (CPT) codes and laterality modifiers were used to identify
patients who underwent knee injection followed by ipsilateral TKA.

Postoperative infection within 6 months of TKA was identified using
International Classification of Diseases, 9th Revision/CPT codes that
represent two infectious endpoints: any postoperative surgical site
infection (encompasses all severities of infection) and operative
intervention for TKA infection (surrogate for deep TKA infection). The
injection cohort was stratified into 12 subgroups by monthly intervals out
to 12 months corresponding to the number of months that had elapsed
between injection and TKA. Risk of postoperative infection was compared
between the injection and no injection cohorts.

In total, 29,603 TKAs (35%) had an injection in the ipsilateral knee
before the TKA procedure and 54,081 TKA cases (65%) did not. The
PearlDiver database does not currently support line-by-line output of
patient data, and so we were unable to perform a multivariate analysis to
determine whether other important factors may have varied between the
study groups that might have had a differential influence on the risk of
infection between those groups. However, the Charlson Comorbidity index
was no different between the injection and no injection cohorts (2.9 for
both) suggesting similar comorbidity profiles between the groups.

RESULTS: The proportion of TKAs developing any postoperative infection was
higher among TKAs that received an injection before TKA than in those that
did not (4.4% versus 3.6%; odds ratio [OR], 1.23; 95% confidence interval
[CI], 1.15-1.33; p < 0.001). Likewise, the proportion of TKAs developing
infection resulting in return to the operating room after TKA was also
higher among TKAs that received an injection before TKA than those that
did not (1.49% versus 1.04%; OR, 1.4; 95% CI, 1.3-1.63; p < 0.001).

Month-by-month analysis of time between injection and TKA revealed the
odds of any postoperative infection remained higher for the injection
cohort out to a duration of 6 months between injection and TKA (ORs ranged
1.23 to 1.46 when 1-6 months between injection and TKA; p < 0.05 for all)
as did the odds of operative intervention for TKA infection when injection
occurred within 7 months of TKA (OR ranged from 1.38 to 1.88 when 1-7
months between injection and TKA; p < 0.05 for all).

When the duration between injection and TKA was longer than 6 or 7 months,
the ORs were no longer elevated at these endpoints, respectively.

CONCLUSIONS: Injection before TKA was associated with a higher risk of
postoperative infection and appears to be time-dependent with closer
proximity between injection and TKA having increased odds of infection.

Further research is needed to better evaluate the risk injection before
TKA poses for TKA infection; a more definitive relationship could be
established with a multivariate analysis to control for other known risk
factors for TKA infection.

LEVEL OF EVIDENCE: Level III, therapeutic study.
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Deaths following vaccination: What does the evidence show?
__________________________________________________________________

Free PMC Article https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4599698/

Vaccine. 2015 Jun 26;33(29):3288-92.
Deaths following vaccination: What does the evidence show?

Miller ER1, Moro PL2, Cano M2, Shimabukuro TT2.

1Immunization Safety Office (ISO), Centers for Disease Control and
Prevention (CDC), Atlanta, GA, United States. Electronic address:
Erm4@cdc.gov.
2Immunization Safety Office (ISO), Centers for Disease Control and
Prevention (CDC), Atlanta, GA, United States.

Vaccines are rigorously tested and monitored and are among the safest
medical products we use. Millions of vaccinations are given to children
and adults in the United States each year. Serious adverse reactions are
rare.

However, because of the high volume of use, coincidental adverse events
including deaths, that are temporally associated with vaccination, do
occur. When death occurs shortly following vaccination, loved ones and
others might naturally question whether it was related to vaccination.

A large body of evidence supports the safety of vaccines, and multiple
studies and scientific reviews have found no association between
vaccination and deaths except in rare cases.

During the US multi-state measles outbreak of 2014-2015, unsubstantiated
claims of deaths caused by measles, mumps, and rubella (MMR) vaccine began
circulating on the Internet, prompting responses by public health
officials to address common misinterpretations and misuses of vaccine
safety surveillance data, particularly around spontaneous reports
submitted to the US Vaccine Adverse Event Reporting System (VAERS).

We summarize epidemiologic data on deaths following vaccination, including
examples where reasonable scientific evidence exists to support that
vaccination caused or contributed to deaths.

Rare cases where a known or plausible theoretical risk of death following
vaccination exists include anaphylaxis, vaccine- strain systemic infection
after administration of live vaccines to severely immunocompromised
persons, intussusception after rotavirus vaccine, Guillain-Barré syndrome
after inactivated influenza vaccine, fall-related injuries associated with
syncope after vaccination, yellow fever vaccine-associated viscerotropic
disease or associated neurologic disease, serious complications from
smallpox vaccine including eczema vaccinatum, progressive vaccinia,
postvaccinal encephalitis, myocarditis, and dilated cardiomyopathy, and
vaccine-associated paralytic poliomyelitis from oral poliovirus vaccine.

However, making general assumptions and drawing conclusions about
vaccinations causing deaths based on spontaneous reports to VAERS – some
of which might be anecdotal or second-hand – or from case reports in the
media, is not a scientifically valid practice.

Published by Elsevier Ltd.

KEYWORDS: Adverse events; Death; Immunization; Vaccination; Vaccine safety

Free PMC Article https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4599698/
__________________________________________________________________
________________________________*_________________________________

8. Abstract: A study of the incidence of BCG vaccine complications in
infants of Babol, Mazandaran (2011-2013)
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4761123/

Caspian J Intern Med. 2016 Winter;7(1):48-51.
A study of the incidence of BCG vaccine complications in infants of Babol,
Mazandaran (2011-2013).

Barari-Savadkouhi R1, Shour A2, Masrour-Roudsari J1.

1Tropical Medicine and Infection Diseases Research Center, Babol
University of Medical Sciences, Babol, Iran.
2Deputy of Health, Babol University of Medical Sciences, Babol Iran.

BACKGROUND: BCG vaccination which is administered to prevent tuberculosis
is sometimes associated with serious complications. This study aimed to
determine the incidence of complications of BCG vaccination in Babol.

METHODS: All infants who received BCG vaccination between 2011-2013 in
health centers of Babol entered the study. Data regarding complications of
vaccine were extracted according to the National Inventory of babies. All
complicated cases were confirmed by the Academic Committee to review the
adverse consequences of the vaccine.

RESULTS: Among the 15984 vaccinated neonates, 150 (0.93%) cases presented
lymphadenitis. 46.5% were females and 53.5% were males; 43% were rural
residents and 57% were urban residents. No cases of lymphadenitis
including 1% of lymphadenitis with abscess formation were recovered
without treatment. Disseminated infection occurred in 3 cases of immune
deficient patients who responded to the treatment. Most complications
occurred during 4 months after vaccination.

CONCLUSION: According to the results of this study, the prevalence of
lymphadenitis in Babol was higher than the standard of WHO. This may be
attributed to type and vaccine storage and injection technique. These
findings justify further training of health-center workers.

KEYWORDS: BCG vaccination; Complications; Disseminated TB; Lymphadenitis;
Urine discoloration

Free PMC Article https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4761123/
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Risk factors for fatal and nonfatal reactions to subcutaneous
immunotherapy: National surveillance study on allergen immunotherapy
(2008-2013)
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26948485

Ann Allergy Asthma Immunol. 2016 Mar 3. pii: S1081-1206(16)00086-7.
Risk factors for fatal and nonfatal reactions to subcutaneous
immunotherapy: National surveillance study on allergen immunotherapy
(2008-2013).

Epstein TG1, Liss GM2, Murphy-Berendts K3, Bernstein DI4.

1Division of Immunology, Allergy, and Rheumatology, Department of
Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio;
Allergy Partners of Central Indiana, Indianapolis, Indiana. Electronic
address: epsteite@uc.edu.
2University of Toronto, Toronto, Ontario, Canada.
3Bernstein Clinical Research Center, LLC, Cincinnati, Ohio.
4Division of Immunology, Allergy, and Rheumatology, Department of
Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio;
Bernstein Clinical Research Center, LLC, Cincinnati, Ohio.

BACKGROUND: In 2008, an annual surveillance study of systemic reactions
(SRs) from subcutaneous immunotherapy (SCIT) injections was initiated in
North America.

OBJECTIVE: To define the incidence of SRs to SCIT.

METHODS: From 2008 to 2013, 27% to 51% of American Academy of Allergy,
Asthma, and Immunology and American College of Asthma, Allergy, and
Immunology members completed an annual survey of SCIT-related SRs of
varying severity. From 2012 to 2013, data were collected regarding SRs
with off-label sublingual immunotherapy (SLIT), selection of patients with
asthma for SCIT, and strategies for dose adjustment during pollen seasons.

RESULTS: From 2008 to 2013, data were gathered on 28.9 million injection
visits, including 344,480 patients for 2012 to 2013. Since 2008, a total
of 2 confirmed fatalities were directly reported that occurred under the
care of allergists. Two additional fatalities occurred under the care of
nonallergists. The rate of SRs from SCIT remained stable, occurring in
1.9% of patients, with 0.08% and 0.02% experiencing grade 3 and 4 SRs. SRs
occurred in 1.4% of patients receiving off-label SLIT, including 0.03%
with grade 3 SRs.

There were no SLIT-related grade 4 SRs or fatalities.

Practices that never administered SCIT in patients with uncontrolled
asthma (Asthma Control Test score <20) had significantly fewer grade 3 and
4 SRs (odds ratio, 0.7; 95% confidence interval, 0.5-1.0, and odds ratio,
0.3; 95% confidence interval, 0.1-0.8, respectively). Lowering doses
during pollen seasons for patients with highly positive skin tests reduced
SRs of all severity grades (P < .05).

CONCLUSIONS: SCIT-related fatality rates may be decreasing, but continued
vigilance regarding modifiable risk factors, including careful patient
selection, is needed. Dose adjustment during pollen seasons for highly
sensitive patients may reduce risks. Potential risk for SRs from off-label
SLIT exists.

Copyright © 2016 American College of Allergy, Asthma & Immunology.

Published by Elsevier Inc. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Safety and efficacy of tuberculin skin testing with
microneedle MicronJet600™ in healthy adults
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26970160

Int J Tuberc Lung Dis. 2016 Apr;20(4):500-4.
Safety and efficacy of tuberculin skin testing with microneedle
MicronJet600™ in healthy adults.

Lee HJ1, Choi HJ2, Kim DR3, Lee H4, Jin JE4, Kim YR2, Lee MS2, Cho SN4,
Kang YA3.

1Clinical Vaccine Research Section, International Tuberculosis Research
Center, Changwon, Republic of Korea; Brain Korea 21 Plus Project for the
Medical Sciences, Department of Microbiology and Institute for Immunology
and Immunological Diseases, Yonsei University College of Medicine, Seoul,
Korea.
2Clinical Research Section, International Tuberculosis Research Center,
Changwon, Republic of Korea; Development and Delivery Unit, International
Vaccine Institute, Seoul, Republic of Korea.
3Division of Pulmonology, Department of Internal Medicine, Severance
Hospital, Institute of Chest Diseases, Yonsei University College of
Medicine, Seoul, Republic of Korea.
4Brain Korea 21 Plus Project for the Medical Sciences, Department of
Microbiology and Institute for Immunology and Immunological Diseases,
Yonsei University College of Medicine, Seoul, Republic of Korea.

SETTING: Intradermal injection using a syringe and needle is generally
accepted as the most accurate method for the tuberculin skin test (TST).
However, the Mantoux technique using a conventional needle is often
difficult to perform reliably, affecting testing results and safety.

OBJECTIVE: We evaluated the efficacy and safety of a novel intradermal
injection device, the MicronJet600(TM) microneedle, compared with
conventional injection in terms of skin reactivity to the TST.

DESIGN: A prospective, open-label clinical study was conducted. The TST
was administered by both methods in the same subject. For pain assessment,
participants filled in a visual analogue scale (VAS) after each TST. Any
side effects due to TST or injections were observed.

RESULTS: TST reaction rates (cut-off ?5 mm) from microneedles and needles
were respectively 44.0% and 47.2%, with no significant difference between
the two. Furthermore, agreement of positivity between the two methods was
excellent with both 5 mm and 10 mm cut-off values. However, the level of
pain experienced when microneedles were used for TST was significantly
lower than with conventional needles. No adverse effects were attributed
to the MicronJet device.

CONCLUSION: The novel microneedle device used for TST in this study was
effective, safe and less painful in healthy adult volunteers.
__________________________________________________________________
________________________________*_________________________________

11. Abstract: Use of hyaluronidase to correct hyaluronic acid injections
in aesthetic medicine
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/26964838

Rev Stomatol Chir Maxillofac Chir Orale. 2016 Mar 7. pii: S2213-6533(16)
00044-6.
[Use of hyaluronidase to correct hyaluronic acid injections in aesthetic
medicine].

[Article in French]

Lacoste C1, Hersant B2, Bosc R3, Noel W3, Meningaud JP3.

1Cabinet Esthelaser, 15, avenue d’Eylau, 75116 Paris, France.
2Service de chirurgie maxillo-faciale et de chirurgie plastique,
réparatrice et esthétique, hôpital Henri-Mondor, 51, avenue du Maréchal-
de-Lattre-de-Tassigny, 94010 Créteil, France. Electronic address:
Barbara.hersant@gmail.com.
3Service de chirurgie maxillo-faciale et de chirurgie plastique,
réparatrice et esthétique, hôpital Henri-Mondor, 51, avenue du Maréchal-
de-Lattre-de-Tassigny, 94010 Créteil, France.

Hyaluronic acid (HA) is the most commonly used filler in aesthetic
medicine. However, overcorrections are frequent even with experienced
practitioner.

Hyaluronidase is an enzyme that hydrolyzes HA. Hyaluronidase has been
recently proposed to correct unsatisfactory results of HA injections in
aesthetic medicine (overcorrection, asymmetry, Tyndall effect) and to
treat immediate complications such as arterial or venous thrombosis.

The objective of this technical note was to summarize the literature data
regarding the efficacy, safety and technique of use of hyaluronidase.
Hyaluronidase may be responsible for allergies.

The practitioner should take this risk and the possible drug interactions
into account before using this antidote in order to weigh up the
risk/benefit ratio.

Copyright © 2016 Elsevier Masson SAS. All rights reserved.

KEYWORDS: Acide hyaluronique; Aesthetic medicine; Filler; Hyaluronidase;
Hyaluronique acid; Injection; Médecine esthétique; Produit de comblement
__________________________________________________________________
________________________________*_________________________________

12. Abstract: Silicon Injection Granulomata: 67Ga Citrate Findings in Free
Silicon Buttock Augmentation
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26953658

Clin Nucl Med. 2016 Mar 5.
Silicon Injection Granulomata: 67Ga Citrate Findings in Free Silicon
Buttock Augmentation.

Strauss S1, Chun K, Benchekroun MT, Akamnonu O, Freeman L.

1From the Departments of Nuclear Medicine and Radiology, Montefiore
Medical Center, Albert Einstein College of Medicine, Bronx, NY.

Ga citrate is frequently used in the workup of fever of unknown origin.

Here, we report a case of avid Ga-citrate in bilateral gluteal regions of
a patient with a history of free silicon injection buttock augmentation
referred for suspected diagnosis of sarcoidosis. CT findings were
equivocal for inflammation/infection in the buttock region, and nuclear
scintigraphy allowed for more definitive diagnosis.
__________________________________________________________________
________________________________*_________________________________

13. Abstract: Antimicrobial activity of silver doped fabrics for the
production of hospital uniforms
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26485013

New Microbiol. 2015 Oct;38(4):551-8.
Antimicrobial activity of silver doped fabrics for the production of
hospital uniforms.

Condò C1, Messi P1, Anacarso I1, Sabia C1, Iseppi R1, Bondi M1, de
Niederhausern S1.

1Department of Life Sciences, University of Modena and Reggio Emilia,
Modena, Italy.

Among several alternatives to control hospital-acquired infections (HAIs),
a strategy could be the use of hospital uniforms imbued with antimicrobial
substances. For this purpose we evaluated the antibacterial activity of
two different silver doped fabrics employed for the production of hospital
uniforms. The study was conducted in two-step.

In the first the antimicrobial activity was evaluated in vitro against
Escherichia coli ATCC 25922, Pseudomonas aeruginosa ATCC 27853,
Staphylococcus aureus ATCC 6538, Enterococcus faecalis ATCC 29212.

In the second, we tested the total viable counts detected from beginning
to end of the work shift on experimental silver doped uniforms worn by
doctors, nurses, allied health assistants in different hospital wards. The
in vitro tests showed a remarkable antibacterial activity of both silver
doped samples (>99.9% reduction within 4h of exposure for Gram-positive
and within 24 h for Gram-negative bacteria).

The experimental uniforms provided results only slightly in agreement with
in vitro data. Even if the increase of total viable counts was somewhat
lower for experimental uniforms than traditional ones, significant
differences were not observed.

Despite the results on the uniforms worn, the addition of silver in
fabrics to make medical equipment (supplies) remains an interesting option
for HAI control.

KEYWORDS: Antibacterial activity; Fabrics; HAIs; Hospital uniforms; Silver

Free full text
http://www.newmicrobiologica.org/PUB/allegati_pdf/2015/4/551.pdf
__________________________________________________________________
________________________________*_________________________________

14. No Abstract: A needlestick injury – what next?
__________________________________________________________________

www.ncbi.nlm.nih.gov/pubmed/26953410

MMW Fortschr Med. 2015 Nov 5;157(19):49-50.
[A needlestick injury – what next?].

[Article in German]

Wicker S, Rabenau HF.
__________________________________________________________________
________________________________*_________________________________

15. News

– Kentucky USA: Hypodermic needle disposal education measure picks up
amendment, surprising sponsor Denham

– Canada: Lack of snow reveals used needles around Regina

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/hyy54hw
Kentucky USA: Hypodermic needle disposal education measure picks up
amendment, surprising sponsor Denham

By Melissa Patrick, Kentucky Health News, Kentucky USA (11.03.16)

A House bill to educate the public about how to safely dispose of
hypodermic needles easily passed, but was hit with a surprise amendment
that would require a one-for-one needle exchange at exchange programs.

The amended bill, which passed at the Wednesday Senate Health and Welfare
Committee meeting and now goes to the Senate floor, didn’t set well with
its sponsor, who said the amendment took him by surprise.

“At first blush, I have real problems with it,” Rep. Mike Denham, D-
Maysville, said in an interview. He said the amended bill would likely not
pass in the House, but said he would review it and then decide whether to
concur or not. He said he had already received emails and texts from his
constituents telling him they did not support the amendment.

The original bill, House Bill 160, would require the state Department for
Public Health to establish guidelines for disposal of hypodermic syringes,
needles and other sharps used for home medical purposes and disseminate
educational materials to pharmacies and the public. It was written to
increase the safety of landfill workers who are at constant risk of being
stuck by improperly disposed of needles.

Sen. Denise Harper Angel, D-Louisville, while supporting the original
bill, voted no on the amended one and told the committee that the
Louisville needle exchange program does not have a one-to-one requirement
and is working well. “The effort here is to diminish disease,” she said.

Needle exchanges were approved as part of an anti-heroin bill in 2015.
Republican Sen. Ralph Alvarado, a Winchester physician, who voted for the
amendment, said in an interview that the intent of the law was to only
allow a one-to-one needle exchange. He said many senators would have voted
against that measure if they had known it was not going to be a one-for-
one needle exchange.

The Office of the Attorney General released a formal opinion Dec. 18 that
said needle-exchange programs in the state do not have to have a one-for-
one exchange. The opinion was requested by state Senate President Robert
Stivers of Manchester, who along with other Republicans, also say that the
intent of the law was a one-for-one exchange.

Alvarado criticized then-Attorney General Jack Conway’s opinion: “That
wasn’t how it was presented originally to the state.”

In addition, Alvarlado said, “The one-for-one encourages more interaction,
more opportunity for involvement for the provider to provide treatment for
their disorders, to test them for communicable diseases and that sort of
thing.”

Dr. Sarah Moyer, the interim director of the Louisville Metro Department
of Public Health and Wellness, said in an e-mail that not requiring a one-
to-one exchange has been proven to reduce the spread of HIV and hepatitis
C, which is the intent of the program. Kentucky leads the nation in
hepatitis C and suffers more than 1,000 drug overdose deaths a year.

“A one-to-one syringe exchange implies that no needle sharing is
occurring,” Moyer wrote. “We know that is not the case. The ‘needs-based
negation model’ is a best practice across the country. Our goals are to
prevent the spread of HIV and hepatitis C in our community and to stop
intravenous drug users from sharing and reusing needles. The program is
working! Participants continue to return used and potentially infected
syringes for sterile ones.”

She added, “Our latest figures indicate that one syringe is being returned
for every 1.3 syringes distributed among returning clients. Overall the
rate is 1 to 1.7. We have more than 2,000 participants and the number
continues to grow. We’ve tested approximately 500 for hepatitis C and HIV
and referred those who test positive to medical treatment. We’ve also
referred 143 individuals to drug treatment.”

Alvarado said, “Even if the health departments want to do it this way now,
that is not how the law was intentionally meant to be passed.”

Needle-exchange programs operating or approved in the state are in
Jefferson, Fayette, Grant, Pendleton, Carter, Elliott, Franklin and
Jessamine counties.

Kentucky Health News is an independent news service of the Institute for
Rural Journalism and Community Issues, based in the School of Journalism
and Telecommunications at the University of Kentucky, with support from
the Foundation for a Healthy Kentucky.

Tags:Kentucky General Assembly · Needle exchange program · Rep. Mike
Denham · Sen. Ralph Alvarado
__________________________________________________________________
__________________________________________________________________

http://cjme.com/article/527287/lack-snow-reveals-used-needles-around-
regina
Canada: Lack of snow reveals used needles around Regina

By Adriana Christianson, News Talk 980 CJME, Saskatchewan Canada(10.03.16)

With so little snow on the ground this year, people have been reporting
used needles in Regina as early as February.

The Street Project is run by the Regina Qu’Appelle Health Region and
handles calls for safe pickup of dirty needles. The team normally gets
busier in the spring, but this year they started getting more calls in
February.

If you see a used needle on public property you can call the Street
Project at 306-766-7799 on weekdays before 6 p.m. to have someone pick it
up. On weekends and evenings you can call the fire department at 306 -777
-7830.

Or you can use a shovel or thick gloves to pick it up yourself. Always
store sharps in hard sided containers and don’t throw them in the garbage.

The Street Project will not clean up needles on private property, but
cleanup kits are available on loan to the public.

Used needles are found across the city, but more commonly reported in the
central area. Common places to find them include back alleys, sidewalks,
parking lots and gutters, but they are reported more in parks in warmer
weather.
__________________________________________________________________
________________________________*_________________________________

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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