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SIGNpost 00848

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST

Post00848 Job + Courses + Abstracts + Outbreak News 13 April 2016

CONTENTS
1. WHO Injection Safety Guidelines
2. Abstract: Laboratory-acquired dengue virus infection by needlestick
injury: a case report, South Korea, 2014
3. Abstract: Prevalence of Needlestick Injuries Among Healthcare Workers
in the Accident and Emergency Department of a Teaching Hospital in
Nigeria
4. Abstract: Practices and impacts post-exposure to blood and body fluid
in operating room nurses: A cross-sectional study
5. Abstract: A method of determining the presence of blood in and on a
dental needle after the administration of local anesthetic
6. Abstract: Harm reduction policy in Taiwan: toward a comprehensive
understanding of its making and effects
7. Abstract: Syringe Stockpiling by Persons Who Inject Drugs: An
Evaluation of Current Measures for Needle and Syringe Program Coverage
8. Abstract: Design study to develop screen savers aimed at improving hand
hygiene behavior
9. Abstract: Evaluation of the efficacy of antibacterial medical gloves in
the ICU setting
10. Abstract: Transmission of Hepatitis B and C Virus Infection Through
Body Piercing: A Systematic Review and Meta-Analysis
11. No Abstract: More on Managing Hazardous Materials and Waste. A Further
Examination into EC.02.02.01
12. No Abstract: Seaweed on the Beach: Reducing the Burden of Healthcare
Waste
13. No Abstract: Harm reduction interventions should encompass people who
inject image and performance enhancing drugs
14. No Abstract: Editorial: TRANSFORM-ing patient safety culture: a
universal imperative
15. Employment: PATH is recruiting for a “Policy & Advocacy Officer,
Immunization Supply Chain (7357)”
16. Courses: Health Supply Chain Management – Nairobi Kenya
17. News
– HEPATITIS C – USA (06): (UTAH) NOSOCOMIAL SPREAD

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__________________________________________________________________
________________________________*_________________________________

1. WHO Injection Safety Guidelines
__________________________________________________________________

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]
__________________________________________________________________
________________________________*_________________________________

2. Abstract: Laboratory-acquired dengue virus infection by needlestick
injury: a case report, South Korea, 2014
__________________________________________________________________

http://aoemj.biomedcentral.com/articles/10.1186/s40557-016-0104-5

Ann Occup Environ Med. 2016 Apr 7;28:16.
Laboratory-acquired dengue virus infection by needlestick injury: a case
report, South Korea, 2014.

Lee C1, Jang EJ1, Kwon D1, Choi H1, Park JW1, Bae GR1.

1Department of Epidemic Intelligence Service, Korea Centers for Disease
Control and Prevention, 643 Yeonje-ri, Osong-eup, Cheongju, Heungduk-gu
Korea.

BACKGROUND: Dengue fever is one of the most dominant vector-borne
diseases, putting approximately 3.9 billion people at risk worldwide.
While it is generally vector-borne, other routes of transmission such as
needlestick injury are possible. Laboratory workers can be exposed to
dengue virus transcutaneously by needlestick injury. This is the first
case, to our knowledge, of dengue virus infection by needlestick injury in
a laboratory environment. This paper evaluates the risk and related health
concerns of laboratory workers exposed to dengue virus.

CASE PRESENTATION: We evaluated a 30-year-old female laboratory worker
exposed to the dengue virus by needlestick injury while conducting virus
filtering. During admission, she showed symptoms of fever, nausea,
myalgia, and a characteristic maculopapular rash with elevated aspartate
aminotransferase (AST) of 235 IU/L and alanine aminotransferase (ALT) of
269 IU/L. She had been diagnosed by a positive nonstructural protein 1
(NS1) antigen (Ag) rapid test one day prior to symptom onset along with
positive immunoglobulin M (IgM) enzyme-linked immunosorbent assay (ELISA)
on the ninth day of symptom onset. Reverse transcription polymerase chain
reaction (RT-PCR), also conducted on the ninth day, was negative. After
proper symptomatic treatment, she recovered without any sequelae. As a
result of thorough epidemiologic investigation, it was determined that she
had tried to recap the needle during the virus filtering procedure and a
subsequent needlestick injury occurred.

CONCLUSIONS: In the context of health promotion of laboratory workers, we
suggest that the laboratory biosafety manual be revised and reinforced,
and related prevention measures be implemented. Furthermore, health
authorities and health care providers in Korea should be fully informed of
proper dengue fever management.

KEYWORDS: Dengue; Laboratories; Needlestick injuries

Free Article
http://aoemj.biomedcentral.com/articles/10.1186/s40557-016-0104-5
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Prevalence of Needlestick Injuries Among Healthcare Workers
in the Accident and Emergency Department of a Teaching Hospital in
Nigeria
__________________________________________________________________

http://www.amhsr.org/text.asp?2015/5/6/392/177973
Ann Med Health Sci Res. 2015 Nov-Dec;5(6):392-6.

Prevalence of Needlestick Injuries Among Healthcare Workers in the
Accident and Emergency Department of a Teaching Hospital in Nigeria.

Isara AR1, Oguzie KE1, Okpogoro OE1.

1Department of Community Health, College of Medical Sciences, University
of Benin, P. M. B. 1154, Benin City, Nigeria.

BACKGROUND: Healthcare workers (HCWs) are continually exposed to hazards
from contact with blood and body fluids of patients in the healthcare
setting.

AIM: To determine the prevalence of needlestick injuries (NSIs) and
associated factors among HCWs in the Accident and Emergency Department of
the University of Benin Teaching Hospital (UBTH), Benin City, Nigeria.

SUBJECTS AND METHODS: This was a cross-sectional study. Data were
collected using a structured, self-administered questionnaire and analyzed
using IBM SPSS version 20. Univariate, bivariate, and binary logistic
regression analyses were done. The level of significance was set at P <
0.05.

RESULTS: The prevalence of NSIs 12 months preceding the study was 51.0%
(50/98). Doctors 8/10 (80.0%) and nurses 28/40 (70.0%) had the highest
occurrence. Recapping of needles 19/50 (38.0%) and patient aggression
13/50 (26.0%) were responsible for most injuries. The majority 31/50
(62.0%) of the injuries were not reported. The uptake of postexposure
prophylaxis (PEP) was low 11/50 (22.0%). The factors that were
significantly associated with NSI include age 30 years and above (odds
ratio [OR] =0.28, confidence interval [CI] = 0.11-0.70), work duration of
three years and above (OR = 0.29, CI = 0.11-0.75), and being a nurse (OR =
3.38, CI = 1.49-9.93) or a paramedic (OR = 0.18, CI = 0.06-0.52).

CONCLUSION: The high prevalence of NSIs among the HCWs, especially in
doctors and nurses is an indication that HCWs in UBTH are at great risk of
contracting blood-borne infections. Efforts should be made to ensure that
injuries are reported and appropriate PEP undertaken following NSIs.

KEYWORDS: Healthcare workers; Needlestick injuries; Postexposure
prophylaxis

Free Article http://www.amhsr.org/text.asp?2015/5/6/392/177973
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Practices and impacts post-exposure to blood and body fluid
in operating room nurses: A cross-sectional study
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27045563

Int J Nurs Stud. 2016 May;57:39-47.
Practices and impacts post-exposure to blood and body fluid in operating
room nurses: A cross-sectional study.

Kasatpibal N1, Whitney JD2, Katechanok S3, Ngamsakulrat S3, Malairungsakul
B3, Sirikulsathean P4, Nuntawinit C5, Muangnart T6.
Author information
1Division of Nursing Science, Faculty of Nursing, Chiang Mai University,
Chiang Mai, Thailand. Electronic address: nongyaok2003@gmail.com.
2Department of Biobehavioral Nursing and Health Systems, School of
Nursing, University of Washington, Seattle, WA, USA.
3Operating Room and Recovery Room Service, Maharaj Nakorn Chiang Mai
Hospital, Chiang Mai University, Chiang Mai, Thailand.
4Operating Room, Rajavithi Hospital, Bangkok, Thailand.
5Operating Room, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
6Operating Room, Police General Hospital, Bangkok, Thailand.

BACKGROUND: Improper or inadequate actions taken after blood and body
fluid exposures place individuals at risk for infection with bloodborne
pathogens. This has potential, significant impact for health and well-
being.

OBJECTIVES: To evaluate the practices and the personal impact experienced
following blood and body fluid exposures among operating room nurses.

DESIGN: A cross-sectional, multi-center study.

SETTINGS: Government and private hospitals from all parts of Thailand.

PARTICIPANTS: Operating room nurses from 247 hospitals.

METHODS: A questionnaire eliciting responses on characteristics, post-
exposure practices, and impacts was sent to 2500 operating room nurses.

RESULTS: Usable questionnaires were returned by 2031 operating room nurses
(81.2%). Of these 1270 had experience with blood and body fluid exposures
(62.5%). Most operating room nurses did not report blood and body fluid
exposures (60.9%).

The major reasons of underreporting were low risk source (40.2%) and
belief that they were not important to report (16.3%).

Improper post- exposure practices were identified, 9.8% did not clean
exposure area immediately, 18.0% squeezed out the wound, and 71.1% used
antiseptic solution for cleansing a puncture wound.

Post-exposure, 58.5% of them sought counseling, 16.3% took antiretroviral
prophylaxis, 23.8% had serologic testing for hepatitis B and 43.1% for
hepatitis C. The main personal impacts were anxiety (57.7%), stress
(24.2%), and insomnia (10.2%).

CONCLUSIONS: High underreporting, inappropriate post-exposure practices
and impacts of exposure were identified from this study. Comprehensive
education and effective training of post-exposure management may be keys
to resolving these important problems.

Copyright © 2016 Elsevier Ltd. All rights reserved.

KEYWORDS: Blood–body fluid exposures; Impacts; Needlesticks; Nurses;
Operating room; Post-exposure; Practices; Sharp injuries
__________________________________________________________________
________________________________*_________________________________

5. Abstract: A method of determining the presence of blood in and on a
dental needle after the administration of local anesthetic
__________________________________________________________________

http://jada.ada.org/article/S0002-8177(14)60115-X/fulltext
Free Full Text

J Am Dent Assoc. 2014 Jun;145(6):557-62.
A method of determining the presence of blood in and on a dental needle
after the administration of local anesthetic.

Kotze MJ1, Labuschagne W2.

1Dr. Kotze is a senior lecturer, Department of Maxillofacial and Oral
Surgery, School of Dentistry, Faculty of Health Sciences, University of
Pretoria, P.O. Box 1266, Pretoria, Gauteng 0001, South Africa, e-mail
thinus.kotze@up.ac.za. Address correspondence to Dr. Kotze.
2Ms. Labuschagne is the operational manager for infection control,
occupational health and quality assurance, School of Dentistry, Faculty of
Health Sciences, University of Pretoria, Gauteng, South Africa.

BACKGROUND: In the study reported in this article, the authors aimed to
demonstrate the presence of blood on the surface and in the lumen of two
gauges of dental needles after administration of local anesthetic (LA) by
using three LA-administering techniques normally used for the extraction
of teeth.

METHODS: The authors obtained standardized photographs of 200 urine
dipsticks after moistening the dipstick’s chemical pads for blood with the
first drop of liquid discharged from the needle lumen after LA
administration. Using the histogram function of a software program, the
authors analyzed differences in gray-scale values of the different blood
parameters for the presence of blood. They used luminol spray to expose
small quantities of blood on the surface of the needle after LA
administration.

RESULTS: Blood was identified at 39 percent in the lumen and at 16 percent
on the surface of the needles when analyzed after LA administration.

CONCLUSIONS: With the method used, it was possible to demonstrate and
quantify the percentage of blood present in the lumen of needles (39
percent) after the administration of dental LA. Furthermore, the technique
was adequately sensitive for demonstrating the quantity of blood in two
needles of different diameters.

PRACTICAL IMPLICATIONS: By demonstrating the presence, as well as
quantifying the percentage, of blood on two dental needles of different
gauges after the administration of LA, dental health care workers can be
motivated to report needlestick injuries and to follow the approved
protocols recommended by their institutions.

KEYWORDS: Anesthesia; dental bloodborne pathogens; dental students;
disease transmission; occupational exposure; patient-to-professional
transmission; photography
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Harm reduction policy in Taiwan: toward a comprehensive
understanding of its making and effects
__________________________________________________________________

Free Full Article https://tinyurl.com/hf5hl2g

Harm Reduct J. 2016 Apr 4;13(1):11.
Harm reduction policy in Taiwan: toward a comprehensive understanding of
its making and effects.

Chen JS1.

1Institute of Science, Technology and Society, National Yang-Ming
University, 155, Sec. 2, Linong St., Beitou District, Taipei City, 11221,
Taiwan. jschen1973@ym.edu.tw.

BACKGROUND: In response to the spread of HIV caused by needle sharing
among injection drug users (IDUs), the Taiwan Centers for Disease Control
implemented a pilot harm reduction program in 2005 that expanded
nationwide in 2006. The policy led to a significant reduction in the
number of HIV-positive cases among IDUs in 4 years.

METHODS: This article aims to provide a critical evaluation of this harm
reduction policy in Taiwan. The research leading to this article included
a thorough literature review and in-depth interviews with 31 active policy
participants, including people working in hospitals, the academia, non-
governmental organizations, community pharmacies, the legal system, and
health authorities at both the central and local levels. The collected
data were analyzed on the basis of situational analysis.

RESULTS: The article examines the policy success by showing how this
policy was assembled and by exposing the frictions and adjustments during
its formation and implementation. Inter-departmental conflicts within or
without the government and the efforts to coordinate them are addressed,
and the transnational dimensions of this harm reduction policy are also
discussed. The article then reflects on the effects of the policy and asks
where the line should be drawn between what is harm reduction and what is
not.

CONCLUSIONS: This case illustration reveals the complexity of
understanding an assembled health policy that involves multiple
participants. The article intends to render an analytic account to enable
a comparison with similar policies in other countries.

KEYWORDS: Assemblage; HIV; Harm reduction; Taiwan; Transnationality

Free PMC Article https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4819272/
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Syringe Stockpiling by Persons Who Inject Drugs: An
Evaluation of Current Measures for Needle and Syringe Program Coverage
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27049004

Am J Epidemiol. 2016 Apr 4. pii: kwv259.
Syringe Stockpiling by Persons Who Inject Drugs: An Evaluation of Current
Measures for Needle and Syringe Program Coverage.

McCormack AR, Aitken CK, Burns LA, Cogger S, Dietze PM.

Needle and syringe program (NSP) coverage is commonly used to assess NSP
effectiveness. However, existing measures don’t capture whether persons
who inject drugs (PWIDs) stockpile syringes, an important and novel aspect
of NSP coverage.

In this study, we determine the extent of stockpiling in a sample of
Australian PWIDs and assess whether including stockpiling enhances NSP
coverage measures.

As part of the Illicit Drug Reporting System study, PWIDs reported
syringes procured and given away, total injections in the last month, and
syringes currently stockpiled in 2014. We calculated NSP coverage with and
without stockpiling to determine proportional change in adequate NSP
coverage. We conducted receiver operating characteristic curve analysis to
determine whether inclusion of stockpiled syringes in the measure improved
sensitivity in discriminating cases and noncases of risky behaviors.

Three-quarters of the sample reported syringe stockpiling, and stockpiling
was positively associated with nonindigenous background, stable
accommodation, no prison history, longer injecting careers, and more
frequent injecting. Compared with previous measures, our measure was
significantly better at discriminating cases of risky behaviors.

Our results could inform NSP policy to loosen restricted-exchange
practice, allowing PWIDs greater flexibility in syringe procurement
practices, promoting greater NSP coverage, and reducing PWIDs’ engagement
in risky behaviors.

© The Author 2016. Published by Oxford University Press on behalf of the
Johns Hopkins Bloomberg School of Public Health. All rights reserved.

KEYWORDS: coverage; harm reduction; needle and syringe program; people who
inject drugs; syringe stockpiling
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Design study to develop screen savers aimed at improving hand
hygiene behavior
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27040563

Am J Infect Control. 2016 Mar 31. pii: S0196-6553(16)00133-4.
Design study to develop screen savers aimed at improving hand hygiene
behavior.

Weggelaar-Jansen AM1, van Buren-Jansen E2, van ‘t Schip S2, Pel JJ3,
Nieboer AP2, Helder OK4.
Author information
1Department of Health Policy and Management, Erasmus University,
Rotterdam, The Netherlands. Electronic address: annemarie@weggelaar.com.
2Department of Health Policy and Management, Erasmus University,
Rotterdam, The Netherlands.
3Department of Neuroscience, Erasmus Medical Centrum, Rotterdam, The
Netherlands.
4Sophia Children’s Hospital, Department of Paediatrics, Erasmus MC-Sophia
Children’s Hospital, Rotterdam, The Netherlands.

BACKGROUND: Displaying screen savers with gain-framed messages are
effective to improve hand hygiene, but the design of screen savers has not
been studied yet.

METHODS: Based on the literature, scientific propositions were developed
for the design of screen savers, exploring 2 strategies to subconsciously
influence hand hygiene behavior; the first was to gain attention, and the
second was to exert peer pressure. The designed screen savers were tested
for attention with an eye-tracking study (N?=?27) and for the influence of
peer pressure with a questionnaire (N?=?25).

RESULTS: Twenty-five propositions for gaining attention concerned the
format and color of the screen saver itself and color, position, and style
of visual and text elements. Seven propositions for peer pressure
concerned the influence of peers, role models, and feelings of being
watched. Eye- tracking measurements showed that text on the 4 screen
savers based on propositions gained more, earlier, and longer attention
and the visual elements gained earlier and longer attention than the
control screen savers. The questionnaire results showed that feelings of
peer pressure were evoked by 3 screen savers; of these, one was not based
on propositions.

CONCLUSIONS: Screen savers designed according to scientific propositions
for visual attention and peer pressure have the potential to alter hand
hygiene behavior.

Copyright © 2016 Association for Professionals in Infection Control and

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

KEYWORDS: Infection control; design study; eye tracking; hand hygiene;
screen saver
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Evaluation of the efficacy of antibacterial medical gloves in
the ICU setting
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/25982193

J Hosp Infect. 2015 Jul;90(3):248-52.
Evaluation of the efficacy of antibacterial medical gloves in the ICU
setting.

Kahar Bador M1, Rai V2, Yusof MY3, Kwong WK2, Assadian O4.

1Department of Medical Microbiology, University of Malaya, Kuala Lumpur,
Malaysia.
2Department of Anaesthesia, Faculty of Medicine, University of Malaya,
Kuala Lumpur, Malaysia.
3Department of Medical Microbiology, University of Malaya, Kuala Lumpur,
Malaysia; Department of Infection Control, University of Malaya Medical
Centre, Kuala Lumpur, Malaysia.
4Institute for Skin Integrity and Infection Prevention, University of
Huddersfield, Huddersfield, UK. Electronic address: o.assadian@hud.ac.uk.

BACKGROUND: Inappropriate use of medical gloves may support microbial
transmission. New strategies could increase the safety of medical gloves
without the risk of patient and surface contamination.

AIM: To compare the efficacy of synthetic antibacterial nitrile medical
gloves coated with polyhexamethylen-biguanid hydrochloride (PHMB) on the
external surface with identical non-antibacterial medical gloves in
reducing glove contamination after common patient care measures in an
intensive care unit (ICU) setting.

METHODS: ICU staff wore either standard or antibacterial gloves during
patient care activities. The number of bacteria on gloves was measured
semi- quantitatively immediately after the performance of four clinical
activities.

FINDINGS: There was a significant difference in mean bacterial growth
[colony- forming units (cfu)] between control gloves and antibacterial
gloves {60 [standard deviation (SD) 23] vs 16 (SD 23) cfu/glove imprint, P
< 0.001}. In three of the four clinical activities (intravenous fluid
handling, oral toilet and physiotherapy), the antibacterial gloves had
significantly less bacterial contamination compared with the control
gloves (P = 0.011 and <0.001, respectively). Although antibacterial gloves
showed lower bacterial contamination after changing linen compared with
control gloves, the difference was not significant (P = 0.311).

CONCLUSION: This study showed that use of antibacterial medical gloves
significantly reduced bacterial contamination after typical patient care
activities in 57% of the investigated clinical activities (P < 0.01). The
use of antibacterial medical gloves may support reduction of cross-
contamination in the ICU setting.

Copyright © 2015 The Healthcare Infection Society. Published by Elsevier
Ltd. All rights reserved.

KEYWORDS: Antibacterial glove; Medical glove; Surface transmission
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Transmission of Hepatitis B and C Virus Infection Through
Body Piercing: A Systematic Review and Meta-Analysis
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26632685

Medicine (Baltimore). 2015 Nov;94(47):e1893.
Transmission of Hepatitis B and C Virus Infection Through Body Piercing: A
Systematic Review and Meta-Analysis.

Yang S1, Wang D, Zhang Y, Yu C, Ren J, Xu K, Deng M, Tian G, Ding C, Cao
Q, Li Y, Chen P, Xie T, Wang C, Wang B, Yao J, Threapleton D, Mao C, Ruan
B, Li L.

1From the State Key Laboratory for Diagnosis and Treatment of Infectious
Diseases, Collaborative Innovation Center for Diagnosis and Treatment of
Infectious Diseases, The First Affiliated Hospital, College of Medicine,
Zhejiang University, Hangzhou (SY, CY, JR, KX, MD, GT, CD, QC, PC, TX, CW,
BW, BR, LL); Division of Epidemiology, The Jockey Club School of Public
Health and Primary Care, The Chinese University of Hong Kong, Hong Kong;
Shenzhen Municipal Key Laboratory for Health Risk Analysis, Shenzhen
Research Institute of The Chinese University of Hong Kong, Shenzhen,
Guangdong Province (DW, YZ, DT, CM); Zhejiang Institute of Medical-care
Information Technology (YL); and Zhejiang Provincial Center for Disease
Control and Prevention, Hangzhou, China (JY).

Hepatitis B and hepatitis C are 2 types of potentially life-threatening
liver diseases with high infection rate. Body piercing represents a
progressively popular sociocultural phenomenon which is also a potential
exposure approach for hepatitis B virus (HBV) and hepatitis C virus (HCV).

Conclusions from those researches with statistically risk assessment of
body piercing on HBV and HCV transmission are contradictory.Systematically
analyze the association between body piercing and the risk of transmitting
hepatitis B virus and hepatitis C virus for general population. Make
evidence-based recommendations to the current practice and wake up public
awareness of this health-threatening behavior.

Comprehensive and high sensitivity search strategies were performed to
exhaustively search related studies before 15 January 2015 (MEDLINE,
EMBASE, WANFANG, CNKI datasets for published literatures, and Google and
Google scholars for related grey articles). Two authors identified
relevant studies for the review, abstracted data, and assessed literature
quality independently and critically according to the selection criteria
and quality assessment standard. Odds ratio (OR) and corresponding 95%
confidence interval (CI) were used to estimate risk of HBV and HCV
infection in relation to body piercing status. Subgroup analysis and
sensitivity analysis were conducted to examine the source of heterogeneity
and test the robust of the results.

A total of 40 studies were included in this systematic review (10 for Hep-
B, 26 for Hep-C, 4 for both Hep-B and Hep-C), the pooled OR (95% CI) for
the association between body piercing and transmission of HBV/HCV is 1.80
(1.18, 2.75) and 1.83 (1.27, 2.64), respectively. Subgroup analysis
suggested that highest risk of body piercing related to hepatitis C
infection was for former soccer and veterans with OR of 4.63 (2.65, 8.10),
while strongest association between body piercing and hepatitis B was for
samples derived from students/community with OR of 2.40 (1.44, 4.02).

The current systematic review and meta-analysis suggests that body
piercing is significantly associated with the transmission of HBV as well
as HCV, having body piercing probably can increase the risk of getting
infected.

Evidence from this study strongly recommends that comprehensive and
effective programs should be established to provide safer piercing
practice.
__________________________________________________________________
________________________________*_________________________________

11. No Abstract: More on Managing Hazardous Materials and Waste. A Further
Examination into EC.02.02.01
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26852464

Jt Comm Perspect. 2016 Jan;36(1):13-4.
More on Managing Hazardous Materials and Waste. A Further Examination into
EC.02.02.01.

Tolomeo K; Joint Commission on Hospital Accreditation.
__________________________________________________________________
________________________________*_________________________________

12. No Abstract: Seaweed on the Beach: Reducing the Burden of Healthcare
Waste
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26026832

Explore (NY). 2015 Jul-Aug;11(4):331-2.
Seaweed on the Beach: Reducing the Burden of Healthcare Waste.

Cohen G, Howard J.
__________________________________________________________________
________________________________*_________________________________

13. No Abstract: Harm reduction interventions should encompass people who
inject image and performance enhancing drugs
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27048560

BMJ. 2016 Apr 5;353:i1889.
Harm reduction interventions should encompass people who inject image and
performance enhancing drugs.

McVeigh J1, Kimergård A2, Bates G3, Hope VD4, Ncube F4.

1Centre for Public Health, Liverpool John Moores University, Liverpool L3
2ET, UK J.McVeigh@ljmu.ac.uk.
2Addictions Department, King’s College London, London, UK.
3Centre for Public Health, Liverpool John Moores University, Liverpool L3
2ET, UK.
4National Infection Service, Public Health England, London, UK.
__________________________________________________________________
________________________________*_________________________________

14. No Abstract: Editorial: TRANSFORM-ing patient safety culture: a
universal imperative
__________________________________________________________________
http://link.springer.com/article/10.1007/s11606-014-3138-9/fulltext.html
Free full article

J Gen Intern Med. 2015 Apr;30(4):384-6.
TRANSFORM-ing patient safety culture: a universal imperative.

Robinson E1, Lagu T.

1Value Institute, Christiana Care Health System, 501 West 14th Street,
Suite 1N81, Wilmington, DE, 19801, USA, ERobinson@ChristianaCare.org.

Comment on
The TRANSFORM Patient Safety Project: a microsystem approach to improving
outcomes on inpatient units. [J Gen Intern Med. 2015]

Free PMC Article https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4370999/
__________________________________________________________________
________________________________*_________________________________

15. Employment: PATH is recruiting for a “Policy & Advocacy Officer,
Immunization Supply Chain (7357)”

To apply, please click ont the following link: http://bit.ly/1UqUVyF

Crossposted from TechNet-21 with thanks.
__________________________________________________________________

PATH is recruiting for a “Policy & Advocacy Officer, Immunization Supply
Chain (7357)”
To apply, please click ont the following link: http://bit.ly/1UqUVyF

NOTE: This position is for 1.5 years CONTINGENT UPON FUNDING. Please
include a cover letter describing your interest in the role and how you
meet the qualifications.

PATH is an international organization that drives transformative
innovation to save lives and improve health, especially among women and
children. We accelerate innovation across five platforms—vaccines, drugs,
diagnostics, devices, and system and service innovations—that harness our
entrepreneurial insight, scientific and public health expertise, and
passion for health equity. By mobilizing partners around the world, we
take innovation to scale, working alongside countries primarily in Africa
and Asia to tackle their greatest health needs. Together, we deliver
measurable results that disrupt the cycle of poor health.

PATH’s Advocacy and Public Policy (APP)department works to improve global
health by increasing awareness and support of global health priorities by
working with policymakers, coalitions, and other influential individuals
and groups. Working in collaboration with advocacy and technical experts
across PATH, the policy and advocacy officer will support a project to
increase political will for immunization supply chains. The policy and
advocacy officer will report to the policy officer and will be part of a
team of over 30 staff working in six countries to promote PATH’s policy
and advocacy goals.

Duties and responsibilities include:

Provide day to day project management for a complex advocacy initiative
across multiple geographies, under a highly matrixed reporting structure.
Work in partnership with the policy officer overseeing the project and
communications officer to design strategies to include immunization supply
chain discussions in global political forums. Work closely with technical
and advocacy partners in Africa and Southeast Asia to design and execute
regional meetings to grow political will for immunization supply chain.
Liaise with and serve as the point of contact for technical experts
internal and external to PATH and advocacy partners. Contribute to donor
reporting, including tracking metrics. Develop and manage consultant
agreements and deliverables. Travel in Europe, Africa and Southeast Asia
to represent PATH and support the execution of events.

Required Skills:

Track record of developing advocacy strategies to achieve policy
objectives. Demonstrated effective project management and organizational
skills; event management skills desired. Ability to work with a variety of
work styles and personalities. Flexible and adaptable to changing
priorities. Demonstratedsuccess working effectively while under deadlines.
Ability to work in team environment with minimal supervision. Knowledge of
global health, ideally challenges facing immunization and/or health
systems, including supply chains Excellent written and oral communication
skills.

Job Location:

Washington, District of Columbia, United States

Required Experience:

Master’s degree in public policy or public health preferred. A minimum of
five to seven years of professional experience in related field, ideally
in a combination of technical and policy roles. Experience interfacing
with and navigating multilateral organizations. Direct experience working
in low or middle income countries is a plus.

PATH is dedicated to diversity and is an equal opportunity employer.

PATH is an equal opportunity employer. Every qualified applicant will be
considered for employment. PATH does not discriminate based on race,
color, religion, gender, gender identity or orientation, genetic
information, age, national origin, marital status, disability status,
political ideology, military or protected veteran status, or any other
characteristic protected by applicable federal, state, or local law.
__________________________________________________________________
________________________________*_________________________________

16. Courses: Health Supply Chain Management – Nairobi Kenya

Crossposted from Technet-21 with thanks.
__________________________________________________________________

www.pamsteele.co.uk/courses/supply-chain-leadership-management/2016/03/10
Courses: Health Supply Chain Management – Nairobi Kenya

Dear colleagues,

In July, Pamela Steele Associates (PSA) and Dr Andrew Brown will be
delivering three of our most popular workshops inNairobi, Kenya. Details
of these courses can be found below.

We would also like to take this opportunity to introduce the People that
Deliver Initiative’s recent publication; a guide to applying for funding
for development. The document provides practical guidance on applying for
funding and highlights nine potential sources of funding that can be
considered. If your own employer is unable to sponsor your development,
consider following up one of the opportunities outlined in this guide:
http://peoplethatdeliver.org/news/country-guide-applying-public-health-
supply-chain-management-development-funds or https://tinyurl.com/jyrc6hb

HEALTH SUPPLY CHAIN MANAGEMENT (11th– 15thJuly 2016)

What is it about?

The course structure is based on the 6 + 1 rights of a health supply
chain: the right goods, the right quantity, the right cost, the right
condition, the right place, the right time, and the right interventions.
By following this structure we are able to take participants on a journey
to understand the end-to-end requirements for a sustainable health supply
chain and help them to develop demonstrable competence in each function.

Who should attend?

The training is targeted at people who areresponsible for planning,
procuring, distributing or monitoring health programme supplies. It will
be especially useful to those with a health professional background who
are entering the health logistics and supply chain environment.

For further information and a detailed course agenda…

Visit:
www.pamsteele.co.uk/courses/health-supply-chain-management-hscm-
nairobi-2016/

Email:info@pamsteele.co.uk

SUPPLY CHAIN CAPACITY DEVELOPMENT (18th– 22ndJuly 2016)

What is it about?

This course focuses on national health supply chain systems strengthening
and the related theories of change. Participants learn about what makes a
supply chain functional, and how to approach supply chain capacity-
building systemically, to make the most of supply chain development
activities. Participants will also learn aboutthe tools and techniques for
embarking on SCCDreforms within their organisation, to detect early
warnings of potential stock shortages, and to manage the entire supply
chain capacity development programme cycle for successful and sustainable
development.

Who should attend?

If you are seeking a good understanding of the overall SCCD process that
breaks the silo mentality, struggling to build a compelling case for your
SCCD programme or want to make informed SCCD decisions that lead to
greater SCCD programme impact – this course is for you.

For further information and a detailed course agenda…

Visit:
http://www.pamsteele.co.uk/courses/sccd-a-framework-for-strengthening-
national-supply-chains-nairobi-2016/

Email:info@pamsteele.co.uk

SUPPLY CHAIN LEADERSHIP & MANAGEMENT (18th – 22nd July 2016)

What is it about?

PSA provides a space where you can transform the way you think and the
level at which you operate.

Our leadership development programmes will help you to define yourself as
a leader and give you the practical skills and knowledge to excel in your
role.

We enable you to develop the skills for authentic leadership through self-
awareness, dialogue and collaboration. We work with you to develop your
ability to operate strategically and transform your organisation, adapting
to the demands of complex environments and markets.

If you’re starting out on your leadership journey we support you to build
and sustain high performing teams and individual performance. We offer
senior leaders fresh approaches for working positively with power dynamics
and organisational conflict.

Who should attend?

All programmes are designed to meet the needs of:

Directors who want to discover new ways of thinking about their role.
Senior managers looking to learn from the experiences of other supply
chain.

Those recently promoted and facing significant leadership challenges for
the first time.

Aspiring leaders who are keen to take on more responsibility and wider
roles.

For further information and a detailed course agenda…

Visithttp://www.pamsteele.co.uk/courses/supply-chain-leadership-
management/

Email:info@pamsteele.co.uk

Regards,

Andrew N. Brown PhD BPharmPamela Steele

Health Systems Strengthening Consultant Founder and CEO

+61411137625,anbrown.hss@gmail.com +44 (0)7876699436,pam@pamsteele.co.uk

Skype: andrew.brown.ucSkype: pamela.awuor.steele

Andrew N. Brown PhD BPharm
Health Systems Strengthening Consultant
Adjunct Professional Associate, University of Canberra
+61411137625,anbrown.hss@gmail.com
Skype: Andrew.brown.uc
__________________________________________________________________
________________________________*_________________________________

17. News

– HEPATITIS C – USA (06): (UTAH) NOSOCOMIAL SPREAD

Selected news items reprinted under the fair use doctrine of international
copyright law: http://www4.law.cornell.edu/uscode/17/107.html
__________________________________________________________________
HEPATITIS C – USA (06): (UTAH) NOSOCOMIAL SPREAD

Crossposted with thanks to A ProMED-mail post
ProMED-mail is a program of the International Society for Infectious
Diseases <http://www.isid.org>

Date: Mon 4 Apr 2016
Source: KUTV [edited]

http://tinyurl.com/zal4azc

The Utah Department of Health and the CDC say they now have 16
confirmed cases of hepatitis C tied to an outbreak in Weber and Davis
Counties [Utah]. The cases are all tied to a nurse, accused of
stealing drugs from both Davis and McKay Dee Hospitals from 2011-2013.
The 1st cases popped up a couple years ago and started this
investigation that now has more than a dozen infected patients.

“We now know, half the people who may have been exposed by this nurse
have not come in for free hepatitis C testing” With 16 confirmed
cases, there is still concern that nearly half of the 7217 people who
may have been exposed have not come in for free testing.

Hepatitis C is treatable, but can cause death if left undiagnosed and
untreated.

“We do know in the USA, the most common way [to] transmit hepatitis C
is through needles and the only way to transmit hepatitis C is blood
to blood.” Dr. Angela Dunn, a CDC epidemiologist says the cases were
transferred through blood in a hospital setting but “unfortunately we
do not know how it happened.” The assumption is that the nurse, who
was working as an emergency room nurse, was sharing needles for IV
[intravenous] drugs with patients.

The now 16 known victims were exposed to a rare form of hepatitis C
between 2011-2013 at Davis and McKay Dee hospitals, where the
49-year-old nurse worked. The nurse’s record of troubles started at
Davis Hospital where she was let go for stealing Benadryl in 2013. She
started nursing at McKay Dee hospital not long after, where her
alleged drug diversion escalated to narcotic IV drugs that disappeared
on a weekly basis.

“Unfortunately I do not have a way of 100 percent knowing how the
virus is transmitted and the directionality of the virus,” Dunn said,
adding that the 49-year-old nurse could have contracted hepatitis C
from a patient and then passed it to others, or could have been the
original carrier passing it on a total of 7217 possible patients.

Hepatitis C 2b is it a pretty rare genotype. It is only 8 to 10
percent of all hepatitis C in Utah, therefore making it easy to
pinpoint connected cases. So far 3731 people have been tested, but
just as many still have not. The investigation found 53 hepatitis C
cases, but only 16 are linked to the nurse so far. One is from Davis
hospital the rest from patients of McKay Dee hospital in Weber
County.

“The good news” according to Dunn “is there is treatment for most
cases of hepatitis C and the hospitals are working closely with the
patients to get that done.”

[Byline: Heidi Hatch]

Communicated by: ProMED-mail <promed@promedmail.org>

[ProMED awaits more definitive numbers related to patients thought to
have been nosocomially infected.

Bloodborne viruses such as hepatitis B and C, and HIV can be
transmitted by the contamination of multidose vials with a syringe
containing blood harboring the virus. If the viruses are genetically
identical, not just the same genotype, this suggests that the patient
was injected by a syringe containing the medicine (likely a strong
analgesic, such as an opiate, that had been previously contaminated by
the healthcare worker’s blood).

Regarding the significance of genotypes of HCV, the following is
derived from a USA Veterans Administration publication,
<http://www.hepatitis.va.gov/provider/reviews/genotypes.asp#S1X>. [The
comments about response to therapy also relate to the newer anti-HCV
modes of therapy]:

An important variable for all patients with chronic hepatitis C virus
(HCV) is the “genotype” of HCV with which they are infected. This is
the strain of the virus to which they were exposed when they were
infected, often many years prior to their evaluation, and it is
determined by a simple blood test. Genotypes of HCV are genetically
distinct groups of the virus that have arisen during its evolution
(1). Approximately 75 percent of Americans with HCV have genotype 1 of
the virus (subtypes 1a or 1b), and 20-25 percent have genotypes 2 or
3, with small numbers of patients infected with genotypes 4, 5, or 6
(2). Most patients with HCV are found to have only 1 principal
genotype, rather than multiple genotypes (3-5). Genotype 4 is much
more common in Africa than in many other parts of the world, genotype
6 is common in Southeast Asia, and each area of the world has its own
distribution of genotypes (6).

Genotype generally has not been found in epidemiological studies to
play a large role in liver disease progression due to HCV. Rather,
genotype is of clinical importance principally as a factor in response
to HCV treatments. With all treatments tested to date, patients with
genotypes 2 and 3 are more than twice as likely as patients with
genotype 1 to achieve a sustained virological response to therapy
(2-5, 7). In addition, when using combination therapy with interferon
and ribavirin, patients with genotypes 2 or 3 generally are treated
for only 24 weeks, whereas it is recommended that patients infected
with genotype 1 receive treatment for 48 weeks.

1. Bukh J, Miller R, Purcell R: Genetic heterogeneity of hepatitis C
virus: quasispecies and genotypes. Semin Liver Dis 1995;15:41-63.
[abstract available at: <http://www.ncbi.nlm.nih.gov/pubmed/7597443>].

2. McHutchison JG, Gordon SC, Schiff ER, et al: Interferon alfa-2b alone
or in combination with ribavirin as initial treatment for chronic
hepatitis C. N Engl J Med 1998; 339:1485-1492. [available at: <
http://www.nejm.org/doi/full/10.1056/NEJM199811193392101>].

3. Manns MP, McHutchison JG, Gordon SC, et al: Peginterferon alfa-2b plus
ribavirin compared with interferon alfa-2b plus ribavirin for initial
treatment of chronic hepatitis C: a randomized trial. Lancet 2001;
358:958-965. [abstract available at: <
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(01)
06102-5/abstract>].

4. Fried MW, Shiffman ML, Reddy R, et al; Peginterferon alfa-2a plus
ribavirin for chronic hepatitis C virus infection. N Engl J Med 2002;
347:975-982. [available at: <
http://www.nejm.org/doi/full/10.1056/NEJMoa020047>].

5. Hadziyannis SJ, Sette H Jr, Morgan TR, et al: Peginterferon alpha-2a
and ribavirin combination therapy in chronic hepatitis C: a randomized
study of treatment duration and ribavirin dose. Ann Intern Med 2004;
140:346-355. [abstract available at: <
http://annals.org/article.aspx?articleid=717255>].

6. Simmonds P: Genetic diversity and evolution of hepatitis C virus – 15
years on. J Gen Virol. 2004;85:3173-88. [available at: <
http://jgv.microbiologyresearch.org/content/journal/jgv/10.1099/vir.0.8040
1-0#tab2>]

7. Zeuzem S. Heterogeneous virologic response rates to interferon-based
therapy in patients with chronic hepatitis C: who responds less well? Ann
Intern Med 2004; 140:370-381. [abstract available at:
http://annals.org/article.aspx?articleid=717258>].

– Mod.LL

A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/promed/p/5568>.
__________________________________________________________________
________________________________*_________________________________
http://www.health.utah.gov/epi/diseases/hepatitisC/investigation
Hepatitis C Investigation Information

Utah Department of Health, Bureau of Epidemiology

Public Health has initiated an investigation of hepatitis C virus (HCV)
infection. At this time, potential exposure to HCV associated with this
investigation may have occurred only in patients who:

Visited the emergency department at McKay-Dee Hospital between June 17,
2013 and November 25, 2014 and received certain medications, OR
Visited the emergency department at Davis Hospital and Medical Center
between June 17, 2011 and April 11, 2013 and received certain medications.
Public health is currently working with the all healthcare facilities
involved to identify potentially exposed individuals. Potentially exposed
individuals will receive a letter in the mail from McKay-Dee Hospital or
Davis Hospital and Medical Center. This letter will explain the situation;
provide information about HCV, and review steps the individual can take to
receive free HCV testing.

For more information regarding testing at McKay-Dee Hospital, contact
McKay-Dee Hospital at 801-387-8580 or visit McKay-Dee Hospital’s website.

For more information regarding testing at Davis Hospital and Medical
Center, contact Davis Hospital and Medical Center at 801-807-7383.

Additional cases have been identified in connection with this Hepatitis C
investigation. We are not releasing exact numbers until further
investigation is completed.

Those who received a letter from McKay Dee Hospital or Davis Hospital and
Medical Center related to this investigation are encouraged to get tested
before January 31, 2016.

No public health quarantine or isolation will be issued since HCV is not
spread through coughing, sneezing, or sharing food and beverages.

Frequently Asked Questions
Who is at risk?
Hepatitis C Virus (HCV) Infection
Testing
Treatment
Contacts
Resources
Services
__________________________________________________________________
________________________________*_________________________________

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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