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SIGNpost 00847

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST

Post00847 HC Waste + Phlebotomy + HCV + Abstracts + News 6  April 2016

CONTENTS
1. India: ‘New Bio-Medical Waste Management Rules will Change The way
Country Used to Manage Waste Earlier
2. Abstract: Findings of Phlebotomy Practices in Kenya in 2010: Need for
Action
3. Abstract: The spread of hepatitis C virus genotype 1a in North America:
a retrospective phylogenetic study
4. Abstract: Staff perception on biomedical or health care waste
management: a qualitative study in a rural tertiary care hospital in
India
5. Abstract: Heavy Metal Contamination of Soils around a Hospital Waste
Incinerator Bottom Ash Dumps Site
6. Abstract: Occupational exposure to bloodborne pathogens among health
care workers in Botswana: Reporting and utilization of postexposure
prophylaxis
7. Abstract: How Much do Needlestick Injuries Cost? A Systematic Review of
the Economic Evaluations of Needlestick and Sharps Injuries Among
Healthcare Personnel
8. Abstract: Prevention of needle-stick injuries in healthcare facilities:
a meta-analysis
9. Abstract: Public health and international drug policy
10. Abstract: Safe intravenous administration in pediatrics: A 5-year
Pediatric Intensive Care Unit experience with smart pumps
11. Abstract: Variation in health care worker removal of personal
protective equipment
12. Abstract: Eight-Year Experience With Botulinum Toxin Type-A Injections
for the Treatment of Nonneurogenic Overactive Bladder: Are Repeated
Injections Worthwhile?
13. Abstract: Symposium: evidence for the use of intra-articular cortisone
or hyaluronic acid injection in the hip
14. Abstract: Platelet-rich plasma does not enhance return to play in
hamstring injuries: a randomised controlled trial
15. Abstract: Prefilled syringes for intravitreal injection reduce
preparation time
16. Abstract: Lasting hand self-disinfection: A backup for hospital hand
hygiene?
17. News
– India: MoEF notifies revised rules for bio-medical waste management
– Finland: When Recycling Goes Wrong: 19 Finns Get Pricked With Dirty
– USA: Officials: 12 cases of hepatitis linked to West Virginia clinic

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1. India: ‘New Bio-Medical Waste Management Rules will Change The way
Country Used to Manage Waste Earlier

The government of India Press release follows below.

Link to the new rules: http://nabh.co/Announcement/BMW_Rules_2016.pdf

BMW Chart: Major changes proposed in the Bio- Medical Waste Management
Rules, 2016 and its likely implication [pdf 7 PAGES]

http://pibphoto.nic.in/documents/rlink/2016/mar/p201632701.pdf
__________________________________________________________________

Press Information Bureau Government of India

Ministry of Environment and Forests PRESS RELEASE

http://pib.nic.in/newsite/PrintRelease.aspx?relid=138353

27-March-2016 18:33 IST
‘New Bio-Medical Waste Management Rules will Change The way Country Used
to Manage Waste Earlier; Make a Big Difference to Clean India Mission’:
Javadekar

New Bio-Medical Waste Management Rules Notified

“The new bio-medical waste management rules will change the way country
used to manage this waste earlier. Under the new regime, the coverage has
increased and also provides for pre-treatment of lab waste, blood samples,
etc. It mandates bar code system for proper control. It has simplified
categorisation and authorisation.Thus, it will make a big difference to
clean India Mission”,Union Minister of State (IC) Environment, Forest &
Climate Change, ShriPrakashJavadekar, said here today, while releasing the
new Bio-medical Waste Management Rules, 2016.

[Photo: ShriPrakashJavadekar releasing the new Bio-Medical Waste
Management Rules]

The major salient features of BMW Management Rules, 2016 include the
following:-

(a) The ambit of the rules has been expanded to include vaccination camps,
blood donation camps, surgical camps or any other healthcare activity;

(b) Phase-out the use of chlorinated plastic bags, gloves and blood bags
within two years;

(c) Pre-treatment of the laboratory waste, microbiological waste, blood
samples and blood bags through disinfection orsterilisation on-site in the
manner as prescribed by WHOor NACO;

(d) Provide training to all its health care workers and immunise all
health workers regularly;

(e) Establish a Bar-Code System for bags or containers containing bio-
medical waste for disposal;

(f) Report major accidents;

(g) Existing incinerators to achieve the standards for retention time in
secondary chamber and Dioxin and Furans within two years;

(h) Bio-medical waste has been classified in to 4 categories instead 10 to
improve the segregation of waste at source;

(i) Procedure to get authorisation simplified. Automatic authorisation for
bedded hospitals. The validity of authorization synchronised with
validity of consent orders for Bedded HCFs. One time Authorisation for
Non-bedded HCFs;

(j) The new rules prescribe more stringent standards for incinerator to
reduce the emission of pollutants in environment;

(k) Inclusion of emissions limits for Dioxin and furans;

(l) State Government to provide land for setting up common bio-medical
waste treatment and disposal facility;

(m) No occupier shall establish on-site treatment and disposal facility,
if a service of `common bio-medical waste treatment facility is available
at a distance of seventy-five kilometer.

(n) Operator of a common bio-medical waste treatment and disposal facility
to ensure the timely collection of bio-medical waste from the HCFs and
assist the HCFs in conduct of training

Bio-medical waste

i. Biomedical waste comprises human & animal anatomical waste, treatment
apparatus likeneedles, syringes and other materials used in health care
facilities in the process of treatment and research. This waste is
generated during diagnosis, treatment or immunisation in hospitals,
nursing homes, pathological laboratories, blood bank, etc. Total bio-
medical waste generation in the country is 484 TPD from 1,68,869
healthcare facilities (HCF), out of which 447 TPD is treated.

Proper Bio-medical waste management

ii. Scientific disposal of Biomedical Waste through segregation,
collection and treatment in an environmentally sound manner minimises the
adverse impact on health workers and on the environment. The hospitals are
required to put in place the mechanisms for effective disposal either
directly or through common biomedical waste treatment and disposal
facilities. The hospitals servicing 1000 patients or more per month are
required to obtain authorisation and segregate biomedical waste in to 10
categories, pack five colour backs for disposal. There are 198 common
bio-medical waste treatment facilities (CBMWF) are in operation and 28 are
under construction. 21,870 HCFs have their own treatment facilities and
1,31,837 HCFs are using the CBMWFs.

Problems of unscientific Bio-medical waste disposal

iii. The quantum of waste generated in India is estimated to be 1-2 kg per
bed per day in a hospital and 600 gm per day per bed in a clinic. 85% of
the hospital waste is non-hazardous, 15% is infectious/hazardous. Mixing
of hazardous results in to contamination and makes the entire waste
hazardous. Hence there is necessity to segregate and treat. Improper
disposal increases risk of infection; encourages recycling of prohibited
disposables and disposed drugs; and develops resistant microorganisms

Consultation process for new Bio-medical Waste ManagementRules, 2016

iv. The draft Bio-medical Waste Rules were published in June, 2015
inviting public objections and suggestions. Stakeholders consultation
meets were organized in New Delhi, Mumbai and Kolkata.Consultative
meetings with relevant Central Ministries, State Governments, State
Pollution Control Boards and major Hospitals were also held. The
suggestions / objections (about 50) received were examined by the Working
Group in Ministry. Based on the recommendations of the Working Group, the
Ministry has published the Bio- medical Waste Management Rules, 2016.

BMW Chart: Major changes proposed in the Bio- Medical Waste Management
Rules, 2016 and its likely implication [pdf 7 PAGES]

http://pibphoto.nic.in/documents/rlink/2016/mar/p201632701.pdf

***

HK
__________________________________________________________________
________________________________*_________________________________

2. Abstract: Findings of Phlebotomy Practices in Kenya in 2010: Need for
Action
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27025699

J Infect Dis. 2016 Apr 15;213 Suppl 2:S53-8.
Findings of Phlebotomy Practices in Kenya in 2010: Need for Action.

Kimani D1, Kamau R2, Gadde R3, Selenic D4, Maina S5, Marum L6, Hongjiang
G4, Mwalili S1, Marfin A4, Mwangi J1.

1Division of Global HIV/AIDS, US Centers for Disease Control and
Prevention.
2Ministry of Public Health and Sanitation, National AIDS and STI Control
Program.
3Becton, Dickinson and Company (BD), Franklin Lakes, New Jersey.
4Division of Global HIV/AIDS, US Centers for Disease Control and
Prevention, Atlanta, Georgia.
5Jhpiego, Nairobi, Kenya.
6Division of Global HIV/AIDS, US Centers for Disease Control and
Prevention, Lusaka, Zambia.

BACKGROUND: Phlebotomy, a commonly performed medical procedure in
healthcare, is essential for disease diagnosis and patient management.
However, poorly performed phlebotomy can compromise patient safety,
healthcare worker (HCW) safety, and specimen quality. We carried out a
study between June and July 2010 to assess knowledge, quality and safety
of phlebotomy before implementation of a public-private partnership
between Becton, Dickinson and Company and the US President’s Emergency
Plan for AIDS Relief.

METHODS: This was a cross-sectional observational study in 8 healthcare
facilities within 4 regions of Kenya. HCWs were observed conducting venous
and capillary blood collections, and pre- and posttests were offered
during HCW training.

RESULTS: Of 283 blood samples obtained, 194 were venous draws conducted by
72 HCWs and 89 were capillary draws performed by 33 HCWs. Based on 12
preset quality-associated criteria, none of the 194 observed phlebotomies
met the standard. In total, 91 HCWs were trained in phlebotomy. The mean
knowledge increase between pre- and posttraining test was 41%, ranging
from 39% to 45% (95% confidence interval, 29.3%-53.5%;P< .001).

CONCLUSIONS: Inadequate knowledge and imperfect phlebotomy procedures were
noted. This formed the basis for the safe phlebotomy partnership to
address these deficiencies. To ensure sustainability, safe phlebotomy
practices were integrated into preservice training.

Published by Oxford University Press for the Infectious Diseases Society
of America 2016. This work is written by (a) US Government employee(s) and
is in the public domain in the US. [Free full text in the USA only]

KEYWORDS: blood specimen quality; phlebotomy; preanalytical errors;
public-private partnerships
__________________________________________________________________
________________________________*_________________________________

3. Abstract: The spread of hepatitis C virus genotype 1a in North America:
a retrospective phylogenetic study

“INTERPRETATION: The expansion of genotype 1a before 1965 suggests that
nosocomial or iatrogenic factors rather than past sporadic behavioural
risk … were key contributors to the hepatitis C virus epidemic in North
America.”
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27039040

Lancet Infect Dis. 2016 Mar 30. pii: S1473-3099(16)00124-9.
The spread of hepatitis C virus genotype 1a in North America: a
retrospective phylogenetic study.

Joy JB1, McCloskey RM2, Nguyen T2, Liang RH2, Khudyakov Y3, Olmstead A4,
Krajden M5, Ward JW3, Harrigan PR6, Montaner JS6, Poon AF6.

1BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Department
of Medicine, University of British Columbia, Vancouver, BC, Canada.
Electronic address: jjoy@cfenet.ubc.ca.
2BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
3Division of Viral Hepatitis, Centers for Disease Control and Prevention,
Atlanta, GA, USA.
4BC Centre for Disease Control, Vancouver, BC, Canada.
5Department of Pathology and Laboratory Medicine, University of British
Columbia, Vancouver, BC, Canada; BC Centre for Disease Control, Vancouver,
BC, Canada.
6BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Department
of Medicine, University of British Columbia, Vancouver, BC, Canada.

BACKGROUND: The timing of the initial spread of hepatitis C virus genotype
1a in North America is controversial. In particular, how and when
hepatitis C virus reached extraordinary prevalence in specific demographic
groups remains unclear. We quantified, using all available hepatitis C
virus sequence data and phylodynamic methods, the timing of the spread of
hepatitis C virus genotype 1a in North America.

METHODS: We screened 45?316 publicly available sequences of hepatitis C
virus genotype 1a for location and genotype, and then did phylogenetic
analyses of available North American sequences from five hepatitis C virus
genes (E1, E2, NS2, NS4B, NS5B), with an emphasis on including as many
sequences with early collection dates as possible. We inferred the
historical population dynamics of this epidemic for all five gene regions
using Bayesian skyline plots.

FINDINGS: Most of the spread of genotype 1a in North America occurred
before 1965, and the hepatitis C virus epidemic has undergone relatively
little expansion since then. The effective population size of the North
American epidemic stabilised around 1960. These results were robust across
all five gene regions analysed, although analyses of each gene separately
show substantial variation in estimates of the timing of the early
exponential growth, ranging roughly from 1940 for NS2, to 1965 for NS4B.

INTERPRETATION: The expansion of genotype 1a before 1965 suggests that
nosocomial or iatrogenic factors rather than past sporadic behavioural
risk (ie, experimentation with injection drug use, unsafe tattooing, high
risk sex, travel to high endemic areas) were key contributors to the
hepatitis C virus epidemic in North America.

Our results might reduce stigmatisation around screening and diagnosis,
potentially increasing rates of screening and treatment for hepatitis C
virus.

FUNDING: The Canadian Institutes of Health Research, Michael Smith
Foundation for Health Research, and BC Centre for Excellence in HIV/AIDS.

Copyright © 2016 Elsevier Ltd. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Staff perception on biomedical or health care waste
management: a qualitative study in a rural tertiary care hospital in
India
__________________________________________________________________

Free PLOSone Article http://dx.plos.org/10.1371/journal.pone.0128383

PLoS One. 2015 May 29;10(5):e0128383.
Staff perception on biomedical or health care waste management: a
qualitative study in a rural tertiary care hospital in India.

Joshi SC1, Diwan V2, Tamhankar AJ3, Joshi R4, Shah H4, Sharma M5, Pathak
A6, Macaden R7, Stålsby Lundborg C8.

1Department of Community Medicine, R.D. Gardi Medical College, Ujjain,
India.
2Department of Public Health and Environment, R.D. Gardi Medical College,
Ujjain, India; International Center for Health Research, R.D. Gardi
Medical College, Ujjain, India; Department of Public Health Sciences,
Karolinska Institutet, Stockholm, Sweden.
3Department of Public Health Sciences, Karolinska Institutet, Stockholm,
Sweden; Indian Initiative for Management of Antibiotic Resistance,
Department of Environmental Medicine, R.D. Gardi Medical College, Ujjain,
India.
4Department of Microbiology, R.D. Gardi Medical College, Ujjain, India.
5Department of Public Health Sciences, Karolinska Institutet, Stockholm,
Sweden; Department of Pharmacology, R.D. Gardi Medical College, Ujjain,
India.
6Department of Public Health Sciences, Karolinska Institutet, Stockholm,
Sweden; Department of Pediatrics, R.D. Gardi Medical College, Ujjain,
India; Department of Women and Children’s Health, International Maternal
and Child Health Unit, Uppsala University, Uppsala, Sweden.
7St. Johns Research Institute, Bangalore, India.
8Department of Public Health Sciences, Karolinska Institutet, Stockholm,
Sweden.

BACKGROUND: Health care or biomedical waste, if not managed properly, can
be of high risk to the hospital staff, the patients, the community, public
health and the environment, especially in low and middle income settings
where proper disposal norms are often not followed. Our aim was to explore
perceptions of staff of an Indian rural tertiary care teaching hospital on
hospital waste management.

METHOD: A qualitative study was conducted using 10 focus group discussions
(FGDs), with different professional groups, cleaning staff, nurses,
medical students, doctors and administrators. The FGD guide included the
following topics: (i) role of Health Care Waste Management (HCWM) in
prevention of health care associated infections, (ii) awareness of and
views about HCWM- related guidelines/legislation, (iii) current HCWM
practices, (iv) perception and preparedness related to improvements of the
current practices, and (v) proper implementation of the available
guidelines/legislation. The FGDs were recorded, transcribed verbatim,
translated to English (when conducted in Hindi) and analysed using content
analysis.

RESULTS: Two themes were identified: Theme (A), ‘Challenges in integration
of HCWM in organizational practice,’ with the categories (I) Awareness and
views about HCWM, (II) Organizational practices regarding HCWM, and (III)
Challenges in Implementation of HCWM; and Theme (B), ‘Interventions to
improve HCWM,’ with three categories, (I) Educational and motivational
interventions, (II) Organizational culture change, and (III) Policy-
related interventions.

CONCLUSION: A gap between knowledge and actual practice regarding HCWM was
highlighted in the perception of the hospital staff. The participants
suggested organizational changes, training and monitoring to address this.
The information generated is relevant not merely to the microsystem
studied but to other institutions in similar settings.

Free PLOSone Article http://dx.plos.org/10.1371/journal.pone.0128383
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Heavy Metal Contamination of Soils around a Hospital Waste
Incinerator Bottom Ash Dumps Site
__________________________________________________________________

http://www.hindawi.com/journals/jeph/2016/8926453/ Free Full Article

J Environ Public Health. 2016;2016:8926453.
Heavy Metal Contamination of Soils around a Hospital Waste Incinerator
Bottom Ash Dumps Site.

Adama M1, Esena R2, Fosu-Mensah B1, Yirenya-Tawiah D1.

1Institute for Environment and Sanitation Studies, University of Ghana,
Legon, Ghana.
2School of Public Health, University of Ghana, Legon, Ghana.

Waste incineration is the main waste management strategy used in treating
hospital waste in many developing countries. However, the release of
dioxins, POPs, and heavy metals in fly and bottom ash poses environmental
and public health concerns.

To determine heavy metal (Hg, Pb, Cd, Cr, and Ag) in levels in incinerator
bottom ash and soils 100?m around the incinerator bottom ash dump site,
ash samples and surrounding soil samples were collected at 20 m, 40 m, 60
m, 80 m, 100 m, and 1,200 m from incinerator. These were analyzed using
the absorption spectrophotometer method. The geoaccumulation (I geo) and
pollution load indices (PLI) were used to assess the level of heavy metal
contamination of surrounding soils.

The study revealed high concentrations in mg/kg for, Zn (16417.69), Pb
(143.80), Cr (99.30), and Cd (7.54) in bottom ash and these were above
allowable limits for disposal in landfill. The study also found soils
within 60 m radius of the incinerator to be polluted with the metals.

It is recommended that health care waste managers be educated on the
implication of improper management of incinerator bottom ash and
regulators monitor hospital waste incinerator sites.

Free Full Article http://www.hindawi.com/journals/jeph/2016/8926453/
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Occupational exposure to bloodborne pathogens among health
care workers in Botswana: Reporting and utilization of postexposure
prophylaxis
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27021510

Am J Infect Control. 2016 Mar 24. pii: S0196-6553(16)00132-2.
Occupational exposure to bloodborne pathogens among health care workers in
Botswana: Reporting and utilization of postexposure prophylaxis.

Kassa G1, Selenic D2, Lahuerta M3, Gaolathe T4, Liu Y2, Letang G4,
Courtenay-Quirk C2, Mwaniki NK5, Gaolekwe S6, Bock N2.

1Mailman School of Public Health, ICAP-Columbia University, New York, NY.
Electronic address: gechbel@gmail.com.
2Division of Global HIV/AIDS, Centers for Disease Control and Prevention,
Atlanta, GA.
3Mailman School of Public Health, ICAP-Columbia University, New York, NY;
Department of Epidemiology, Mailman School of Public Health, Columbia
University, New York, NY.
4Botswana Harvard AIDS Institute Partnerships, Gaborone, Botswana.
5Ministry of Health Botswana, Gaborone, Botswana.
6Centers for Disease Control and Prevention Botswana, Gaborone, Botswana.

BACKGROUND: This study assessed reporting behavior and satisfaction with
postexposure prophylaxis (PEP) systems among health care workers (HCWs) at
risk for occupational bloodborne pathogen exposure (BPE) in 3 public
hospitals in Botswana.

METHODS: A cross-sectional survey among HCWs provided information on
perceptions, attitudes, and experiences with occupational exposures,
reporting, and postexposure care. HCWs potentially in contact with blood
or body fluids were surveyed using audio computer-assisted self-interview.

RESULTS: Between August 2012 and April 2013, 1,624 HCWs completed the
survey; most were women (72%), and almost half (48%) were nurses. Sixty-
seven percent of them had ever received training related to BPE
management; 62% perceived themselves to be at high risk for BPE. Among the
426 HCWs who were exposed to sharps injuries or splashes in the last 6
months, 160 (37%) reported the exposure. Of these, 111 of the 160 (69%)
received PEP, and 79 of the 111 (71%) completed their medication. Whereas
>92% of the total HCWs had ever been tested for HIV, only 557 (37%) were
tested in their own health facility. Most HCWs (87%, n?=?1,406) reported
they would be interested in testing themselves. Of HCWs who reported an
exposure, less than half (49%, n?=?78) were satisfied with existing
reporting systems.

CONCLUSIONS: Underreporting of occupational exposures and dissatisfaction
with PEP management is common among HCWs. Improved PEP management
strategies and regular monitoring are needed.

Copyright © 2016 Association for Professionals in Infection Control and
Epidemiology, Inc. All rights reserved.

KEYWORDS: Bloodborne pathogens; health care worker; occupational exposure;
postexposure prophylaxis
__________________________________________________________________
________________________________*_________________________________

7. Abstract: How Much do Needlestick Injuries Cost? A Systematic Review of
the Economic Evaluations of Needlestick and Sharps Injuries Among
Healthcare Personnel
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27022671

Infect Control Hosp Epidemiol. 2016 Mar 29:1-12. Open Access Article
How Much do Needlestick Injuries Cost? A Systematic Review of the Economic
Evaluations of Needlestick and Sharps Injuries Among Healthcare Personnel.

Mannocci A1, De Carli G2, Di Bari V2, Saulle R1, Unim B1, Nicolotti N2,
Carbonari L3, Puro V2, La Torre G1.

11Department of Public Health and Infectious Diseases,Sapienza University
of Rome,Italy.
22Department of Epidemiology,Pre-Clinical Research and Advanced
Diagnostics,L. Spallanzani National Institute for Infectious
Diseases,Rome,Italy.
33Department of Economics and Finance & CEIS,University of Rome “Tor
Vergata”Italy.

OBJECTIVE To provide an overview of the economic aspects of needlestick
and sharps injury (NSI) management among healthcare personnel (HCP) within
a Health Technology Assessment project to evaluate the impact of safety-
engineered devices on health care

METHODS A systematic review of economic analyses related to NSIs was
performed in accordance with the PRISMA statement and by searching PubMed
and Scopus databases (January 1997-February 2015). Mean costs were
stratified by study approach (modeling or data driven) and type of cost
(direct or indirect). Costs were evaluated using the CDC operative
definition and converted to 2015 International US dollars (Int$).

RESULTS A total of 14 studies were retrieved: 8 data-driven studies and 6
modeling studies. Among them, 11 studies provided direct and indirect
costs and 3 studies provided only direct costs. The median of the means
for aggregate (direct + indirect) costs was Int$747 (range, Int$199-
Int$1,691). The medians of the means for disaggregated costs were Int$425
(range, Int$48-Int$1,516) for direct costs (9 studies) and Int$322 (range,
Int$152-Int$413) for indirect costs (6 studies). When compared with data-
driven studies, modeling studies had higher disaggregated and aggregated
costs, but data-driven studies showed greater variability. Indirect costs
were consistent between studies, mostly referring to lost productivity,
while direct costs varied widely within and between studies according to
source infectivity, HCP susceptibility, and post-exposure diagnostic and
prophylactic protocols. Costs of treating infections were not included,
and intangible costs could equal those associated with NSI medical
evaluations.

CONCLUSIONS NSIs generate significant direct, indirect, potential, and
intangible costs, possibly increasing over time. Economic efforts directed
at preventing occupational exposures and infections, including provision
of safety-engineered devices, may be offset by the savings from a lower
incidence of NSIs.

Infect. Control Hosp. Epidemiol. 2016;1-12.
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Prevention of needle-stick injuries in healthcare facilities:
a meta-analysis
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/25765502

Infect Control Hosp Epidemiol. 2015 Jul;36(7):823-9.
Prevention of needle-stick injuries in healthcare facilities: a meta-
analysis.

Tarigan LH1, Cifuentes M2, Quinn M2, Kriebel D2.

11Department of Epidemiology,School of Public Health University of
Indonesia,Depok,West Java,Indonesia.
22Department of Work Environment,College of Health Sciences University of
Massachusetts Lowell,Lowell,Massachusetts,USA.

OBJECTIVE To estimate the summary effectiveness of different needle-stick
injury (NSI)-prevention interventions.

DESIGN We conducted a meta-analysis of English-language articles
evaluating methods for reducing needle stick, sharp, or percutaneous
injuries published from 2002 to 2012 identified using PubMed and Medline
EBSCO databases. Data were extracted using a standardized instrument.
Random effects models were used to estimate the summary effectiveness of 3
interventions: training alone, safety-engineered devices (SEDs) alone, and
the combination of training and SEDs.

SETTING Healthcare facilities, mainly hospitals

PARTICIPANTS Healthcare workers including physicians, midwives, and nurses

RESULTS From an initial pool of 250 potentially relevant studies, 17
studies met our inclusion criteria. Six eligible studies evaluated the
effectiveness of training interventions, and the summary effect of the
training intervention was 0.66 (95% CI, 0.50-0.89).

The summary effect across the 5 studies that assessed the efficacy of SEDs
was 0.51 (95% CI, 0.40-0.64). A total of 8 studies evaluated the
effectiveness of training plus SEDs, with a summary effect of 0.38 (95%
CI, 0.28-0.50).

CONCLUSION Training combined with SEDs can substantially reduce the risk
of NSIs.
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Public health and international drug policy
__________________________________________________________________

Free Full Text Article Plus https://tinyurl.com/htdtouf

http://jid.oxfordjournals.org/content/213/suppl_2/S53.long
Public health and international drug policy

Joanne Csete, PhD, Prof Adeeba Kamarulzaman, MBBS, MRACP, Prof Michel
Kazatchkine, PhD, Prof Frederick Altice, MD, Marek Balicki, MD, Prof Julia
Buxton, PhD, Javier Cepeda, PhD, Megan Comfort, PhD, Prof Eric Goosby, MD,
João Goulão, MD, Prof Carl Hart, PhD, Prof Thomas Kerr, PhD, Prof
Alejandro Madrazo Lajous, LLD, Prof Stephen Lewis, Natasha Martin, DPhil,
Prof Daniel Mejía, PhD, Prof Adriana Camacho, PhD, David Mathieson, MA,
Prof Isidore Obot, PhD, Adeolu Ogunrombi, Prof Susan Sherman, PhD, Jack
Stone, MS, Nandini Vallath, MBBS, Peter Vickerman, PhD, Prof Tomáš
Zábranský, PhD, Prof Chris Beyrer, MDcorrespondenceemail

DOI: http://dx.doi.org/10.1016/S0140-6736(16)00619-X

In September, 2015, the member states of the UN endorsed Sustainable
Development Goals (SDGs) for 2030, which aspire to human-rights-centred
approaches to ensuring the health and wellbeing of all people. The SDGs
embody both the UN Charter values of rights and justice for all and the
responsibility of states to rely on the best scientific evidence as they
seek to better humankind.

In April, 2016, these same states will consider control of illicit drugs,
an area of social policy that has been fraught with controversy and
thought of as inconsistent with human rights norms, and in which
scientific evidence and public health approaches have arguably had too
limited a role.

© 2016 Elsevier Ltd. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Safe intravenous administration in pediatrics: A 5-year
Pediatric Intensive Care Unit experience with smart pumps
__________________________________________________________________

http://www.ncbi.nlm.nih.gov/pubmed/27026063

Med Intensiva. 2016 Mar 26. pii: S0210-5691(16)00049-8.
Safe intravenous administration in pediatrics: A 5-year Pediatric
Intensive Care Unit experience with smart pumps.

[Article in English, Spanish]

Manrique-Rodríguez S1, Sánchez-Galindo AC2, Fernández-Llamazares CM3,
Calvo-Calvo MM2, Carrillo-Álvarez Á2, Sanjurjo-Sáez M3.

1Servicio de Farmacia, Hospital General Universitario Gregorio Marañón,
Madrid, España. Electronic address: silvia.manrique@salud.madrid.org.
2Unidad de Cuidados Intensivos Pediátricos, Hospital General Universitario
Gregorio Marañón, Madrid, España.
3Servicio de Farmacia, Hospital General Universitario Gregorio Marañón,
Madrid, España.

OBJECTIVES: To estimate the impact of smart pump implementation in a
pediatric intensive care unit in terms of number and type of
administration errors intercepted.

DESIGN: Observational, prospective study carried out from January 2010 to
March 2015 with syringe and great volumen infusion pumps available in the
hospital.

SETTING: A tertiary level hospital pediatric intensive care unit.

PARTICIPANTS: Infusions delivered with infusion pumps in all pediatric
intensive care unit patients.

INTERVENTIONS: Design of a drug library with safety limits for all
intravenous drugs prescribed.

MAIN VARIABLES: Users’ compliance with drug library as well as number and
type of errors prevented were analyzed.

RESULTS: Two hundred and eighty-three errors were intercepted during 62
months of study. A high risk drug was involved in 58% of prevented errors,
such as adrenergic agonists and antagonists, sedatives, analgesics,
neuromuscular blockers, opioids, potassium and insulin. Users’ average
compliance with the safety software was 84%.

CONCLUSIONS: Smart pumps implementation has proven effective in
intercepting high risk drugs programming errors. These results might be
exportable to other critical care units, involving pediatric or adult
patients. Interdisciplinary colaboration is key to succeed in this
process.

Copyright © 2016 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

KEYWORDS: Administración intravenosa; Bombas inteligentes; Intravenous
administration; Safety; Seguridad; Smart pumps
__________________________________________________________________
________________________________*_________________________________

11. Abstract: Variation in health care worker removal of personal
protective equipment
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26138659

Am J Infect Control. 2015 Jul 1;43(7):750-1.
Variation in health care worker removal of personal protective equipment.

Zellmer C1, Van Hoof S1, Safdar N2.

1William S. Middleton Veterans Hospital and Section of Infectious
Diseases, Department of Medicine, University of Wisconsin, Madison, WI.
2William S. Middleton Veterans Hospital and Section of Infectious
Diseases, Department of Medicine, University of Wisconsin, Madison, WI.
Electronic address: ns2@medicine.wisc.edu.

In the current era of emerging pathogens such as Ebola virus, removal of
personal protective equipment (PPE) is crucial to reduce contamination of
health care workers.

However, current removal practices are not well described. We undertook a
systematic evaluation of health care worker removal of PPE for contact
isolation to examine variation in removal procedures.

Findings indicate that under usual conditions, only about half of health
care workers correctly remove their PPE, and very few remove their PPE in
the correct order and dispose of it in the proper location.

Published by Elsevier Inc.

KEYWORDS: Emerging pathogens; Healthcare associated infection
__________________________________________________________________
________________________________*_________________________________

12. Abstract: Eight-Year Experience With Botulinum Toxin Type-A Injections
for the Treatment of Nonneurogenic Overactive Bladder: Are Repeated
Injections Worthwhile?
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27032556

Int Neurourol J. 2016 Mar;20(1):40-6.
Eight-Year Experience With Botulinum Toxin Type-A Injections for the
Treatment of Nonneurogenic Overactive Bladder: Are Repeated Injections
Worthwhile?

Kim SH1, Habashy D1, Pathan S1, Tse V1,2, Collins R1,2, Chan L1,2.
Author information
1Department of Urology, Concord Repatriation General Hospital, Sydney,
Australia.
2Department of Surgery, University of Sydney, Sydney, Australia.

PURPOSE: To investigate the efficacy and safety of repeated botulinum
toxin type-A (BTX-A) injections for patients with drug-refractory
nonneurogenic overactive bladder (NNOAB) and explore factors predictive of
outcome.

METHODS: Data were collected from all patients receiving repeated BTX-A
injections for drug-refractory NNOAB between 2004 and 2012. Trigone-
sparing injections were administered under sedation with antibiotic
prophylaxis. Patient characteristics including age, sex, preoperative
urodynamics, injection number, BTX-A dose, complications, and patient
global impression of improvement (PGI-I) scores were collected.
Correlations between patient factors and outcomes were assessed by using
Pearson’s chi-square tests.

RESULTS: Fifty-two patients with a mean age of 67.4 years (range, 26-93
years) received 140 BTX-A injections in total; 33 (64%), 15 (29%), and 4
patients (7%) received 2, 3 to 4, and 5 to 8 injections, respectively.
Mean follow- up time was 49 months (range, 9-101 months). Nine patients
developed urinary tract infection; additionally, 3 patients experienced
transient urinary retention. Median PGI-I score was 2 out of 7
(interquartile range [IQR], 2). For 46 patients, the PGI-I score remained
stable with the administration of each injection.

Pearson chi-square tests revealed that male patients or reduced bladder
compliance was associated with a higher (worse) PGI-I score. Median PGI-I
scores for men and women were 3 (IQR, 1) and 2 (IQR, 1), respectively;
additionally, median PGI-I scores for those with normal bladder compliance
and those with reduced bladder compliance were 2 (IQR, 2) and 4.5 (IQR,
1), respectively. Median PGI-I scores and complication rates were the same
in the older patient (=70 years) and younger (<70 years) patient cohorts.

CONCLUSIONS: Efficacy is maintained with repeated BTX-A injections.
Patients including the elderly show a good degree of tolerability with a
low complication rate. Male patients or reduced bladder compliance is
associated with poorer outcomes.

KEYWORDS: Botulinum Toxins; Treatment Outcome; Urinary Bladder,
Overactive; Urodynamics
__________________________________________________________________
________________________________*_________________________________

13. Abstract: Symposium: evidence for the use of intra-articular cortisone
or hyaluronic acid injection in the hip
__________________________________________________________________

Free PMC Article https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4808252/

J Hip Preserv Surg. 2015 Mar 31;3(1):5-15.
Symposium: evidence for the use of intra-articular cortisone or hyaluronic
acid injection in the hip.

Chandrasekaran S1, Lodhia P1, Suarez-Ahedo C1, Vemula SP1, Martin TJ1,
Domb BG2.

11. American Hip Institute.
21. American Hip Institute; 2. Hinsdale Orthopaedics.

The primary purpose of this review article is to discuss the role of
diagnostic, corticosteroid, hyaluronic acid (HA) and platelet rich plasma
(PRP) in the treatment of osteoarthritis (OA) and femoroacetabular
impingement (FIA). These treatments play an important biological role in
the non-operative management of these conditions.

Two independent reviewers performed an search of PubMed for articles that
contained at least one of the following search terms pertaining to intra-
articular hip injection-local anaesthetic, diagnostic, ultrasound,
fluoroscopic, image guided, corticosteroid, HA, PRP, OA, labral tears and
FAI. Seventy-two full text articles were suitable for inclusion. There
were 18 articles addressing the efficacy of diagnostic intra-articular hip
injections. With respect to efficacy in OA there were 25 articles
pertaining to efficacy of corticosteroid, 22 of HA and 4 of PRP. There
were three articles addressing the efficacy of biologics in FAI.

Diagnostic intra-articular hip injections are sensitive and specific for
differentiating between intra-articular, extra-articular and spinal causes
of hip symptoms. Ultrasound and fluoroscopy improves the precision of
intra-articular positioning of diagnostic injections.

Corticosteroids are more effective than HA and PRP in alleviating pain
from hip OA. A higher dose of corticosteroids produces a longer benefit
but volume of injection has no significant effect.

Intra-articular corticosteroids do not increase infection rates of
subsequent arthroplasty.

There is currently limited evidence to warrant the routine use of
therapeutic injections in the management of labral tears and FIA.

Free PMC Article https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4808252/
__________________________________________________________________
________________________________*_________________________________

14. Abstract: Platelet-rich plasma does not enhance return to play in
hamstring injuries: a randomised controlled trial
__________________________________________________________________

Free full text http://bjsm.bmj.com/content/49/14/943.long Open Access

Br J Sports Med. 2015 Jul;49(14):943-50.
Platelet-rich plasma does not enhance return to play in hamstring
injuries: a randomised controlled trial.

Hamilton B1, Tol JL2, Almusa E3, Boukarroum S2, Eirale C2, Farooq A4,
Whiteley R5, Chalabi H6.

1High Performance Sport NZ, Millennium Institute of Sport and Health,
Auckland, New Zealand Department of Sports Medicine, Aspetar, Doha, Qatar.
2Department of Sports Medicine, Aspetar, Doha, Qatar.
3Department of Radiology, Aspetar, Doha, Qatar.
4Athlete Health and Performance Research, Aspetar, Doha, Qatar.
5Department of Rehabilitation, Aspetar, Doha, Qatar.
6Director General for International Medical Affairs and Programs & Centers
of Excellence, Aspetar, Doha, Qatar.

BACKGROUND: To evaluate the efficacy of a single platelet-rich plasma
(PRP) injection in reducing the return to sport duration in male athletes,
following an acute hamstring injury.

METHODS: A randomised, three-arm (double-blind for the injection arms),
parallel- group trial, in which 90 professional athletes with MRI positive
hamstring injuries were randomised to injection with PRP-intervention,
platelet-poor plasma (PPP-control) or no injection. All received an
intensive standardised rehabilitation programme. The primary outcome
measure was time to return to play, with secondary measures including
reinjury rate after 2 and 6 months.

RESULTS: The adjusted HR for the PRP group compared with the PPP group was
2.29 (95% CI 1.30 to 4.04) p=0.004; for the PRP group compared with the no
injection group 1.48 (95% CI 0.869 to 2.520) p=0.15, and for the PPP group
compared with the no injection group 1.57 (95% CI 0.88 to -2.80) p=0.13.
The adjusted difference for time to return to sports between the PRP and
PPP groups was -5.7 days (95% CI -10.1 to -1.4) p=0.01; between the PRP
and no injection groups -2.9 days (95% CI -7.2 to 1.4) p=0.189 and between
the PPP and no injection groups 2.8 days (95% CI -1.6 to 7.2) p=0.210.
There was no significant difference for the secondary outcome measures. No
adverse effects were reported.

CONCLUSIONS: Our findings indicate that there is no benefit of a single
PRP injection over intensive rehabilitation in athletes who have sustained
acute, MRI positive hamstring injuries. Intensive physiotherapy led
rehabilitation remains the primary means of ensuring an optimal return to
sport following muscle injury.

TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Identifier: NCT01812564.

Published by the BMJ Publishing Group Limited.

KEYWORDS: Hamstring; Muscle; Platelet-Rich Plasma

Free full text http://bjsm.bmj.com/content/49/14/943.long Open Access
__________________________________________________________________
________________________________*_________________________________

15. Abstract: Prefilled syringes for intravitreal injection reduce
preparation time
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27034182

Dan Med J. 2016 Apr;63(4). pii: A5214.
Prefilled syringes for intravitreal injection reduce preparation time.

Subhi Y1, Kjer B, Munch IC.

1ysubhi@gmail.com.

INTRODUCTION: The demand for intravitreal therapy has increased
dramatically with the introduction of vascular endo-thelial growth factor
inhibitors. Improved utilisation of existing resources is crucial to
meeting the increased future demand. We investigated time spent preparing
intravitreal injection treatment using either prefilled syringes or vials
in routine clinical practice.

METHODS: We video-recorded preparations of intravitreal injections (n =
172) for each preparation type (ranibizumab prefilled syringe (n = 56),
ranibizumab vial (n = 56) and aflibercept vial (n = 60)) in a multi-centre
time and motion study. The preparation times for each step were extracted
from videos and the three preparation types were compared.

RESULTS: Prefilled syringes eliminated several steps in the preparation
process. Total preparation time was 40.3-45.1 sec. using vials, and the
use of prefilled syringes saved 25.5 sec. (95% confidence interval (CI):
23.3-27.6 sec., p < 0.0001). The preparation time when aflibercept vials
were used was 3.7 sec. (95% CI: 1.45-5.96 sec., p = 0.0014) longer than
when ranibizumab vials were used.

CONCLUSIONS: Prefilled syringes for intravitreal injections reduce
preparation time by eliminating preparation steps that both entail a risk
of contamination and are subject to variation. The amount of time saved
may enable increased utilisation of existing resources and outsourcing to
non-ophthalmologists.

FUNDING: This study was supported by a grant from Novartis. The funders
had no influence on the design of the study, analysis of the data,
preparation of the manuscript or the decision to publish.

TRIAL REGISTRATION: not relevant.
__________________________________________________________________
________________________________*_________________________________

16. Abstract: Lasting hand self-disinfection: A backup for hospital hand
hygiene?
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/25952619

Am J Infect Control. 2015 Jul 1;43(7):697-701.
Lasting hand self-disinfection: A backup for hospital hand hygiene?

Herruzo R1, Yela R2, Vizcaino MJ2.

1Department of Preventive Medicine, Public Health, and Microbiology,
Faculty of Medicine, Autonomous University of Madrid, Madrid, Spain.
Electronic address: rafael.herruzo@uam.es.
2Department of Preventive Medicine, Public Health, and Microbiology,
Faculty of Medicine, Autonomous University of Madrid, Madrid, Spain.

BACKGROUND: Hand disinfection should be performed on the occasion of 5
separate moments during patient care, but some occasions are skipped. Can
using hand antiseptics with residual effect reduce the problem of
infection spread? We evaluated a 30-minute residual effect by different
antiseptic products on endogenous and acquired microbiota.

METHODS: The products tested were 2% and 5% chlorhexidine, 1% and 10%
iodine povidone, 60° n-propanol, 0.2% mecetronium + isopropanol, and 0.6%
chlorhexidine + isopropanol + 0.1% benzalconium chloride. The
microorganisms identified were 3 ATCC and 9 multiresistant strains
isolated from intensive care unit patients (used as acquired microbiota).
Logarithmic (log10) reductions of the colony forming units obtained with
each antiseptic product and for each microorganism were calculated via in
vivo (6 volunteers) and in vitro tests.

RESULTS: The better in vivo and in vitro products with a residual effect >
2 log10 after 30 minutes on hands were 2%-5% chlorhexidine and 0.6%
chlorhexidine + isopropanol + 0.1% benzalconium chloride. This reduction
was significantly different (P < .01) from the other 4 antiseptics. This
residual effect (> 2 log10) can be considered a self-disinfecting hand
status in daily practice.

CONCLUSIONS: Hand antiseptics used in hospitals must pass tests of
residual efficacy (after 30 minutes on acquired microbiota) showing a
reduction > 2 log10 in vivo and in vitro. A good product can be the
mixture of chlorhexidine + alcohol + benzalconium chloride.

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

KEYWORDS: 30 min skin-residual-effect; Acquired microbiota; Seven
antiseptics
__________________________________________________________________
________________________________*_________________________________

17. News

– India: MoEF notifies revised rules for bio-medical waste management

– Finland: When Recycling Goes Wrong: 19 Finns Get Pricked With Dirty

– USA: Officials: 12 cases of hepatitis linked to West Virginia clinic

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/hgvl3qb
India: MoEF notifies revised rules for bio-medical waste management

Sushil Manav, Tribune News Service, Chandigarh, India (05.04.16)

What the rules say…

– Formation of district-level monitoring committees to monitor
implementation of rules

– Bar coding of bags meant for bio-medical waste

– Segregation of bio-medical waste into four categories instead of 10

– Installation of GPS devices on vehicles ferrying bio-medical waste
The Ministry of Environment and Forests (MoEF) has revised the guidelines
for the management of bio-medical waste in the country.

In a notification issued on March 28, the MoEF has announced its Bio-
Medical Waste Management Rules, 2016, in supersession of the earlier Bio-
Medical Waste (Management and Handling) Rules, 2011.

The new rules provide for reviewing the implementation of the rules in the
country once a year by the Centre through district-level monitoring
committees, bar coding of bags meant for bio-medical waste, reducing the
types of waste from 10 to four, installation of GPS devices on vehicles
carrying the wastes and bringing some more categories of institutions and
establishments under the ambit of the rules.

The new rules prescribe that the state government will constitute
district-level monitoring committees under the chairmanship of the
district collector or district magistrate or Deputy Commissioner or the
additional district magistrate to monitor the compliance of the provisions
in the healthcare facilities.

Increasing the ambit, vaccination camps, blood donation camps, surgical
camps, veterinary institutions, animal houses, ayush hospitals, research
and educational institutions, health camps, medical and surgical camps
etc. have been included in the Bio-Medical Waste Management Rules, 2016.
Bio-medical waste will be segregated into four categories instead of 10.
The bar-code system for bags or containers containing bio-medical waste
for disposal has also been introduced.

The new rules have been hailed by the existing service providers, but the
medical fraternity fears it will make treatment costlier.

“With bar coding of bags, it will be easier for the authorities to detect
violation by hospitals and service providers. By declaring ash released
from incinerators as non-hazardous, the MoEF has made our work easier, as
now, it can be disposed of in municipal waste landfills,” said Neeraj
Agarwal, Managing Director of Synergy Wastes Management Pvt Limited, one
of the leading service providers for bio-medical waste management of the
region.

“The government should subsidise the expenditure doctors have to spend on
the management of bio-medical waste in the interest of patients,” Dr DS
Jaspal, a former national vice-president of the Indian Medical Association
(Headquarters), said.
__________________________________________________________________
__________________________________________________________________

https://tinyurl.com/zdvhtqn
Finland: When Recycling Goes Wrong: 19 Finns Get Pricked With Dirty
Needles

Sputnik News Europe (01.04.16)

[Photo Needles © Sputnik/ Grigoriy Sisoev]

Up to nineteen patients who had blood tests taken at a Helsinki University
Central Hospital (HUS) in the city’s central district of Kamppi may have
been exposed to serious contagious diseases due to the unintentional use
of dirty needles.

Helsinki University Central Hospital gauged the risk of infection as
“slight”, but nevertheless admitted the risk that patients could have
potentially been exposed to HIV or Hepatitis B or C, Finland’s national
broadcaster Yle reports.

According to HUS officials, patients who had blood tests taken at the
HUSLAB laboratory in Kamppi between the hours of 8:45 am and 12:45 pm on
Wednesday, March 29 may have been exposed to contagious diseases due to
the use of dirty needles, which had already been in use. According to Asko
Järvinen of HUS, the incident has affected a maximum of 19 people. He
blamed the errors on a series of mistakes made by lab technicians.

“The needles that came into use again had previously been discarded and
placed in a cup that for an unknown reason was not emptied,” Järvinen told
Yle.

Markus Henriksson, health affairs officer at the National Supervisory
Authority for Welfare and Health (Valvira), called the case “serious.”

“It’s a serious case and feels really strange. My first reaction was
astonishment, but I am nevertheless satisfied that the issue was handled
so quickly and that precautionary measures for the future have been
taken,” Henriksson said.

[A researcher works near a blood test machine © AP PHOTO/ STEPHAN SAVOIA]

Järvinen ensured that the incident should not happen again and stated that
lab routines were immediately reviewed upon discovery of the errors.
According to hospital officials, it was the lab technician who erroneously
used dirty needles on patients who also notified his superiors of the
accident.

Piia Aarnisalo, CEO of HUSLAB, admitted later that the lab technicians
actually received a bonus for speedy work. Having acknowledged, that the
employees were rewarded with a financial bonus for a certain number of
blood samples taken, she also ruled out the possibility of haste being the
crucial factor behind the incident, says Yle.

Criminal charges have not been filed in connection with the case yet; if
they are, the lab technician may face a prison sentence of up to two
years, should the situation be categorized as endangering other people’s
health or causing personal injury.

According to Kimmo Nuotio, professor of criminal law at the University of
Helsinki, the classification of the crime depends on whether any of the
subjected people turn out to have been infected.
__________________________________________________________________
__________________________________________________________________

http://tinyurl.com/jptlhuw
USA: Officials: 12 cases of hepatitis linked to West Virginia clinic

Associated Press, USA (26.03.16)

BECKLEY, W.Va. – Officials have investigated at least 12 cases of
hepatitis linked to a heart clinic in West Virginia.

The viruses have been linked to injectable medications given during
cardiac stress tests at the Raleigh Heart Clinic, local news media outlets
reported.

Eight patients receiving cardiac stress tests have tested positive for
hepatitis C and four others have tested positive for hepatitis B, said
Allison Adler, director of communications for the Department of Health and
Human Resources. Adler said there has been no evidence of HIV
transmission.

The investigation started in November 2014, after a patient with no risk
factors for hepatitis C was diagnosed with the virus.

State Health Commissioner Dr. Rahul Gupta said Thursday that during
inspections, Department of Health and Human Resources investigators
witnessed several areas of improvement for the clinic.

“There are single-use vials,” he said of the clinic. “You have a drug in
one vial for a patient’s one-time use. But we find that it is often used
for multiple uses. So that’s one way of transmitting it because you can
change the needle but there’s always a risk with the vial.”

Gupta said the extent of how many individuals were exposed to the
pathogens is unknown.

Officials are now urging about 2,300 patients of the Raleigh Heart Clinic
to be tested for hepatitis B and C as well as HIV.

A class-action lawsuit has been filed by patient Pamela Vines against the
clinic on behalf of patients who had cardiac stress tests.

The Charleston Gazette-Mail reports that the Raleigh Heart Clinic has not
commented on the matter.
__________________________________________________________________
________________________________*_________________________________

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
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The comments made in this forum are the sole responsibility of the writers
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Use of trade names and commercial sources is for identification only and
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The SIGN Forum welcomes new subscribers who are involved in injection
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* Subscribe or un-subscribe by email to: sign.moderator@gmail.com, or to
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The SIGNpost Website is http://SIGNpostOnline.info

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We would like your help in building this archive. Please send your old
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Email mailto:sign.moderator@gmail.com
__________________________________________________________________
________________________________*_________________________________

The SIGN Internet Forum was established at the initiative of the World
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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
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__________________________________________________________________

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