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SIGNpost 00850

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST

Post00850 Sharps Injuries + Health $ + Abstracts + News 27 April 2016

CONTENTS
1. New Report: Sharps Injuries among Hospital Workers in Massachusetts,
2014
2. World Immunization Week 2016: Close the immunization gap
3. Abstract: Development assistance for health: past trends, associations,
and the future of international financial flows for health
4. Abstract: No-needle, single-visit adult male circumcision with Unicirc:
a multi-centre field trial
5. Abstract: Several issues on the epidemiology of Zika virus disease
6. Abstract: Evidence and recommendations for use of intra-articular
injections for knee osteoarthritis
7. Abstract: Variability in syringe components and its impact on
functionality of delivery systems
8. Abstract: Particulate matter in injectable drug products
9. Abstract: A Biopharmaceutical Industry Perspective on the Control of
Visible Particles in Biotechnology Derived Injectable Drug Products
10. Abstract: Ethanol-based handrubs: Safe for patients and health care
workers
11. No Abstract: Access to needle and syringe programs by people who
inject image and performance enhancing drugs
12. News
– UK: What to do if you discover dirty needles after school run mum found
syringes
– Libya: 10 people infected in Hepatitis C outbreak in east Libya
– USA: Child Finds Used Syringe, Family Faces Threat of Disease

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__________________________________________________________________
________________________________*_________________________________

1. New Report: Sharps Injuries among Hospital Workers in Massachusetts,
2014
__________________________________________________________________
Laramie, Angela (DPH) <Angela.Laramie@massmail.state.ma.us>
date: Tue, Apr 26 2016
subject:NEW REPORT: Sharps Injuries among Hospital Workers in
Massachusetts, 2014
Hello to all!

We are pleased to release our most recent data report, “Sharps Injuries
among Hospital Workers in Massachusetts, 2014”.

Please feel free to distribute the report as you’d like.

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

The direct link is: https://tinyurl.com/zpco5fq

Many thanks to the occupational health and infection control staff who
provided the data that makes this and other reports possible.
Angela K. Laramie, MPH
Sharps Injury Surveillance Project
Occupational Health Surveillance Program
Massachusetts Department of Public Health
250 Washington Street, 4th Floor
Boston, MA 02108
www.mass.gov/dph/ohsp
__________________________________________________________________
________________________________*_________________________________

2. World Immunization Week 2016: Close the immunization gap
__________________________________________________________________

http://www.who.int/campaigns/immunization-week/2016/en/
World Immunization Week 2016: Close the immunization gap
Immunization game-changers should be the norm worldwide

21 April 2016 — Immunization averts 2 to 3 million deaths annually.

However, an additional 1.5 million deaths could be avoided, if global
vaccination coverage improves.

Today, nearly 1 in 5 children worldwide are still missing routine
immunizations for preventable diseases.

During World Immunization Week 2016, WHO highlights recent gains in
immunization coverage, and outlines further steps needed to meet global
vaccination targets by 2020.

Read the press release
www.who.int/mediacentre/news/releases/2016/world-immunization-week/en/

Watch the video on immunization week

Read the commentary on vaccines
http://www.who.int/mediacentre/commentaries/vaccines/en/index.html

Global Vaccine Action Plan 2011 – 2020
www.who.int/immunization/global_vaccine_action_plan/en/index.html
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Development assistance for health: past trends, associations,
and the future of international financial flows for health
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27086170

Free Full Text: http://dx.doi.org/10.1016/S0140-6736(16)30168-4

Lancet. 2016 Apr 12. pii: S0140-6736(16)30168-4.
Development assistance for health: past trends, associations, and the
future of international financial flows for health.

Dieleman JL1, Schneider MT2, Haakenstad A3, Singh L2, Sadat N2, Birger M2,
Reynolds A2, Templin T2, Hamavid H2, Chapin A2, Murray CJ2.

1Institute for Health Metrics and Evaluation, Seattle, WA, USA. Electronic
address: dieleman@uw.edu.
2Institute for Health Metrics and Evaluation, Seattle, WA, USA.
3Harvard TH Chan School of Public Health, Boston, MA, USA.

BACKGROUND: Disbursements of development assistance for health (DAH) have
risen substantially during the past several decades. More recently, the
international community’s attention has turned to other international
challenges, introducing uncertainty about the future of disbursements for
DAH.

METHODS: We collected audited budget statements, annual reports, and
project-level records from the main international agencies that disbursed
DAH from 1990 to the end of 2015. We standardised and combined records to
provide a comprehensive set of annual disbursements. We tracked each
dollar of DAH back to the source and forward to the recipient. We removed
transfers between agencies to avoid double-counting and adjusted for
inflation. We classified assistance into nine primary health focus areas:
HIV/AIDS, tuberculosis, malaria, maternal health, newborn and child
health, other infectious diseases, non-communicable diseases, Ebola, and
sector-wide approaches and health system strengthening. For our
statistical analysis, we grouped these health focus areas into two
categories: MDG-related focus areas (HIV/AIDS, tuberculosis, malaria,
child and newborn health, and maternal health) and non-MDG-related focus
areas (other infectious diseases, non-communicable diseases, sector-wide
approaches, and other). We used linear regression to test for structural
shifts in disbursement patterns at the onset of the Millennium Development
Goals (MDGs; ie, from 2000) and the global financial crisis (impact
estimated to occur in 2010). We built on past trends and associations with
an ensemble model to estimate DAH through the end of 2040.

FINDINGS: In 2015, US$36·4 billion of DAH was disbursed, marking the fifth
consecutive year of little change in the amount of resources provided by
global health development partners. Between 2000 and 2009, DAH increased
at 11·3% per year, whereas between 2010 and 2015, annual growth was just
1·2%. In 2015, 29·7% of DAH was for HIV/AIDS, 17·9% was for child and
newborn health, and 9·8% was for maternal health. Linear regression
identifies three distinct periods of growth in DAH. Between 2000 and 2009,
MDG-related DAH increased by $290·4 million (95% uncertainty interval [UI]
174·3 million to 406·5 million) per year. These increases were
significantly greater than were increases in non-MDG DAH during the same
period (p=0·009), and were also significantly greater than increases in
the previous period (p<0·0001). Between 2000 and 2009, growth in DAH was
highest for HIV/AIDS, malaria, and tuberculosis. Since 2010, DAH for
maternal health and newborn and child health has continued to climb,
although DAH for HIV/AIDS and most other health focus areas has remained
flat or decreased. Our estimates of future DAH based on past trends and
associations present a wide range of potential futures, although our mean
estimate of $64·1 billion (95% UI $30·4 billion to $161·8 billion) shows
an increase between now and 2040, although with a large uncertainty
interval.

INTERPRETATION: Our results provide evidence of two substantial shifts in
DAH growth during the past 26 years. DAH disbursements increased faster in
the first decade of the 2000s than in the 1990s, but DAH associated with
the MDGs increased the most out of all focus areas. Since 2010, limited
growth has characterised DAH and we expect this pattern to persist.
Despite the fact that DAH is still growing, albeit minimally, DAH is
shifting among the major health focus areas, with relatively little growth
for HIV/AIDS, malaria, and tuberculosis. These changes in the growth and
focus of DAH will have critical effects on health services in some low-
income countries. Coordination and collaboration between donors and
domestic governments is more important than ever because they have a great
opportunity and responsibility to ensure robust health systems and service
provision for those most in need.

FUNDING: Bill & Melinda Gates Foundation.

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

4. Abstract: No-needle, single-visit adult male circumcision with Unicirc:
a multi-centre field trial
__________________________________________________________________

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0121686

PLoS One. 2015 Mar 30;10(3):e0121686. Open Access
No-needle, single-visit adult male circumcision with Unicirc: a multi-
centre field trial.

Millard PS1, Goldstuck ND2.

1University of New England, Portland, Maine, United States of America.
2Faculty of Medicine and Health Sciences, Stellenbosch University and
Department of Obstetrics and Gynaecology, Tygerberg Hospital, Cape Town,
South Africa.

BACKGROUND: Voluntary medical male circumcision (VMMC) is a priority HIV
preventive intervention. Current adult circumcision methods need
improvement.

METHODS: Field trial in 3 primary care centres. Minimally invasive VMMC
using the Unicirc instrument following topical lidocaine/prilocaine
anesthetic. Men were followed up at 1 and 4 weeks.

RESULTS: We circumcised 110 healthy volunteers. Two men complained of
transient burning pain during circumcision, but none required injectable
anaesthesia. Median blood loss was 1ml and median procedure time was 9.0
min. There were 7 (6.3%) moderate complications (5 (4.5%) post-operative
bleeds requiring suture and 2 (1.8%) post-operative infections) affecting
7 men. No men experienced significant wound dehiscence. 90.4% of men were
fully healed at 4 weeks of follow-up and all were highly satisfied.

CONCLUSIONS: Use of topical anaesthesia obviates the need for injectable
anesthetic and makes the Unicirc procedure nearly painless. Unicirc is
rapid, easy to learn, heals by primary intention with excellent cosmetic
results, obviates the need for a return visit for device removal, and is
potentially cheaper and safer than other methods. Use of this method will
greatly facilitate scale-up of mass circumcision programs.

TRIAL REGISTRATION: ClinicalTrials.gov NCT02091726.

Free Open Access Article
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0121686
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Several issues on the epidemiology of Zika virus disease
__________________________________________________________________

Free Full Text in the original Chinese. The Google translation is very
readable http://zhlxbxzz.yiigle.com/CN112338201604/889132.htm?locale=zh_CN
https://www.ncbi.nlm.nih.gov/pubmed/27087204

Zhonghua Liu Xing Bing Xue Za Zhi. 2016 Apr 10;37(4):450-4.
[Several issues on the epidemiology of Zika virus disease].

[Article in Chinese]
Lu GY1, Su YY2, Wang N3.

1Department of Intensive Medicine, The First Affiliated Hospital of Xiamen
University, Xiamen 361003, China.
2The State Key Laboratory of Molecular Vaccinology and Molecular
Diagnostics, National Institute of Diagnostics and Vaccine Development in
Infectious Diseases, School of Public Health, Xiamen University, Xiamen
361102, China.
3National Center for AIDS/STD Control and Prevention, Chinese Center for
Disease Control and Prevention, Beijing 102206, China.

Zika virus belongs to Aedes mosquito-borne flavivirus. In response to the
current cluster of congenital malformations (microcephaly) and other
neurological complications (Guillain-Barré Syndrome) that could be linked
to Zika virus infection, WHO declares that Zika virus is of global public
health importance. Data sources were from peer review articles and WHO
documents. The sources of Zika virus infection would include patients,
people with asymptomatic infections and primates.

The infectious period of Zika virus remains unclear. However, according to
the period that RNA of Zika virus can be positively detected in blood,
saliva, urine or semen, we can presume that the communicable period may
last for 2 months or even longer. Zika virus is primarily transmitted to
humans by infected Aedes spp. mosquitoes. Presumptive vertical, blood or
sexual routes of transmission have been reported. More evidence indicated
the existence of a cause-effect relationship between Zika virus infection
and congenital microcephaly/Guillain-Barre syndrome.

Strategies include successful control the amount of mosquitoes and
minimize the contacts between mosquitoes and human beings could
effectively prevent the Zika virus transmission. Other preventive measures
as cutting off vertical, blood or sexual routes of transmission should
also be adopted.

The epidemiology of Zika virus remains uncertain which calls for further
research.

Free Full Text in the original Chinese. The Google translation is very
readable http://zhlxbxzz.yiigle.com/CN112338201604/889132.htm?locale=zh_CN
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Evidence and recommendations for use of intra-articular
injections for knee osteoarthritis
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27103055

Ann Phys Rehabil Med. 2016 Apr 18. pii: S1877-0657(16)30007-0.
Evidence and recommendations for use of intra-articular injections for
knee osteoarthritis.

Nguyen C1, Lefèvre-Colau MM2, Poiraudeau S2, Rannou F3.

1Université Paris Descartes, PRES Sorbonne Paris Cité, Service de
Rééducation et de Réadaptation de l’Appareil Locomoteur et des Pathologies
du Rachis, Hôpital Cochin, Assistance Publique – Hôpitaux de Paris, Paris,
France; Université Paris Descartes, PRES Sorbonne Paris Cité, Laboratoire
de Pharmacologie, Toxicologie et Signalisation Cellulaire, INSERM UMR-S
1124, UFR Biomédicale des Saints Pères, Paris, France. Electronic address:
christelle.nguyen2@aphp.fr.
2Université Paris Descartes, PRES Sorbonne Paris Cité, Service de
Rééducation et de Réadaptation de l’Appareil Locomoteur et des Pathologies
du Rachis, Hôpital Cochin, Assistance Publique – Hôpitaux de Paris, Paris,
France; Université Paris Descartes, PRES Sorbonne Paris Cité, INSERM UMR-S
1153 et Institut Fédératif de Recherche sur le Handicap, Paris, France.
3Université Paris Descartes, PRES Sorbonne Paris Cité, Service de
Rééducation et de Réadaptation de l’Appareil Locomoteur et des Pathologies
du Rachis, Hôpital Cochin, Assistance Publique – Hôpitaux de Paris, Paris,
France; Université Paris Descartes, PRES Sorbonne Paris Cité, Laboratoire
de Pharmacologie, Toxicologie et Signalisation Cellulaire, INSERM UMR-S
1124, UFR Biomédicale des Saints Pères, Paris, France.

Pharmacological treatments are widely recommended in international
guidelines for management of osteoarthritis (OA). However, the use of
intra-articular (IA) therapies of diverse active drugs remains
controversial.

We critically reviewed studies of the efficacy and safety of IA injections
of corticosteroids (CS), hyaluronic acid (HA), platelet-rich plasma (PRP),
and botulinum toxin A (BTA) and evidence-based international
recommendations for their use in treating knee OA. The process of article
selection was unsystematic. Articles were selected on the basis of
authors’ expertise, self-knowledge, and reflective practice. Only studies
assessing knee OA were included.

IA CS and HA injections were conditionally to fully recommended for
treating knee OA. No recommendations have been formulated for IA PRP or
BTA. The evidence remains inconsistent and controversial for the use of IA
therapies for knee OA.

The characteristics of and selection criteria for the OA population that
would likely benefit from these therapies need to be identified.
Accurately phenotyping and selecting patients is mandatory in future
randomized controlled trials. Therefore, efficacy and safety meta-analyses
should be performed, as should qualitative and sensitivity analyses of
published trial results.

Copyright © 2016 Elsevier Masson SAS. All rights reserved.

KEYWORDS: Botulinum toxin A; Corticosteroids; Evidence-based medicine;
Hyaluronic acid; Intra-articular injections; Osteoarthritis; Platelet-rich
plasma
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Variability in syringe components and its impact on
functionality of delivery systems
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/22293836

PDA J Pharm Sci Technol. 2011 Sep-Oct;65(5):468-80.
Variability in syringe components and its impact on functionality of
delivery systems.

Rathore N1, Pranay P, Eu B, Ji W, Walls E.

1Drug Product and Device Development, Amgen, Thousand Oaks, CA.

Prefilled syringes and autoinjectors are becoming increasingly common for
parenteral drug administration primarily due to the convenience they offer
to the patients. Successful commercialization of such delivery systems
requires thorough characterization of individual components. Complete
understanding of various sources of variability and their ranking is
essential for robust device design.

In this work, we studied the impact of variability in various primary
container and device components on the delivery forces associated with
syringe injection.

More specifically, the effects of barrel size, needle size, autoinjector
spring force, and frictional forces have been evaluated. An analytical
model based on underlying physics is developed that can be used to fully
characterize the design space for a product delivery system.

LAY ABSTRACT: Use of prefilled syringes (syringes prefilled with active
drug) is becoming increasingly common for injectable drugs. Compared to
vials, prefilled syringes offer higher dose accuracy and ease of use due
to fewer steps required for dosage.

Convenience to end users can be further enhanced through the use of
prefilled syringes in combination with delivery devices such as
autoinjectors. These devices allow patients to self-administer the drug by
following simple steps such as pressing a button. These autoinjectors are
often spring-loaded and are designed to keep the needle tip shielded prior
to injection. Because the needle is not visible to the user, such
autoinjectors are perceived to be less invasive than syringes and help the
patient overcome the hesitation associated with self-administration.

In order to successfully develop and market such delivery devices, we need
to perform an in-depth analysis of the components that come into play
during the activation of the device and dose delivery. Typically, an
autoinjector is activated by the press of a button that releases a
compressed spring; the spring relaxes and provides the driving force to
push the drug out of the syringe and into the site of administration.

Complete understanding of the spring force, syringe barrel dimensions,
needle size, and drug product properties is essential for robust device
design. It is equally important to estimate the extent of variability that
exists in these components and the resulting impact it could have on the
performance of the device.

In this work, we studied the impact of variability in syringe and device
components on the delivery forces associated with syringe injection. More
specifically, the effect of barrel size, needle size, autoinjector spring
force, and frictional forces has been evaluated.

An analytical model based on underlying physics is developed that can be
used to predict the functionality of the autoinjector.
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Particulate matter in injectable drug products
__________________________________________________________________

Full Free Text http://journal.pda.org/content/67/3/186.long

PDA J Pharm Sci Technol. 2013 May-Jun;67(3):186-200.
Particulate matter in injectable drug products.

Langille SE1.

1Office of Pharmaceutical Science Center for Drug Evaluation and Research
Food and Drug Administration 10903 New Hampshire Ave, Bldg. 51, Rm. 4158
Silver Spring, MD 20993.

Clinicians have had concerns about particulate matter contamination of
injectable drug products since the development of the earliest intravenous
therapeutics. All parenteral products contain particulate matter, and
particulate matter contamination still has the potential to cause harm to
patients.

With tens of millions of doses of injectable drug products administered in
the United States each year, it is critical to understand the types and
sources of particulate matter that contaminate injectable drug products,
the possible effects of injected particulate matter on patients, and the
current state of regulations and standards related to particulate matter
in injectable drug products.

Today, the goal of manufacturers, regulators, and standards-setting
organizations should be to continue to minimize the risk of particle-
induced sequelae, especially in high-risk patients, without trading
unnecessary manufacturing burden for minimal safety gains.

LAY ABSTRACT: All injectable drug products are contaminated with some
level of solid particulate matter, including, for example, fibers, dust,
rubber, and silicone. These materials enter drug products primarily during
the manufacturing process.

The possible effects on patients of injectable drug products containing
particulate matter depend on a number of factors. However, given the large
number of patients receiving injectable drug products each year in the
United States and the potential for particulate matter to cause harm to
patients, it is critical to continue to minimize particulate matter
contamination in injectable drug products.

Manufacturing standards and regulations have helped improve manufacturing
quality. Nevertheless, manufacturers, regulators, and standards-setting
organizations must continue to work toward improving manufacturing quality
and minimizing the risk of harm from particle contamination, especially in
high-risk patients.

KEYWORDS: Current good manufacturing practice (cGMP); Injectable;
Parenteral; Particulate matter; Pharmaceutical quality
__________________________________________________________________
________________________________*_________________________________

9. Abstract: A Biopharmaceutical Industry Perspective on the Control of
Visible Particles in Biotechnology Derived Injectable Drug Products
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27091885

PDA J Pharm Sci Technol. 2016 Apr 18. pii: pdajpst.2015.006189.
A Biopharmaceutical Industry Perspective on the Control of Visible
Particles in Biotechnology Derived Injectable Drug Products.

Mathonet S1, Mahler HC2, Esswein ST3, Mazaheri M4, Cash PW4, Wuchner K5,
Kallmeyer G6, Das T7, Finkler C6, Lennard A8.

1Sanofi; serge.mathonet@sanofi.com.
2Lonza;
3Abbvie;
4medimmune;
5Janssen R&D;
6La Roche Ltd;
7Bristol Myers Squibb;
8Amgen.

The EP and Unite[d] States Pharmacopeial (USP) monographs for Parenteral
Preparations require drug products for parenteral administration to be
“practically free” or “essentially free” of visible particles,
respectively. Both terms can be considered and have been used
interchangeably. These definitions acknowledge the probabilistic nature of
visual particle inspection.

The EP monograph 2031, Monoclonal Antibodies for Human Use’, as revised in
2011 set the following expectations and requirements for visible particles
in monoclonal antibody drug products, as noted below in excerpts from
different sections in the monograph: Definition: Examined under suitable
conditions of visibility, they are practically free from particles.
Production: As part of the in-process control each container (vial,
syringe or ampoule) is inspected after filling to eliminate containers
that contain visible particles. During development of the product it must
be demonstrated that either the process will not generate visible
proteinaceous particles in the final lot or such particles are reduced to
a low level as justified and authorised.

Tests-Appearance: They are without visible particles, unless otherwise
justified and authorised. The question remains unresolved for a clear
meaning of the term “without visible particles” that may lead to
differences in understanding between industry and agencies. Is this term
intended to mean “zero particles” or is there any intention to distinguish
between particle type such as: ‘zero extraneous visible particles’ or
‘zero proteinaceous particles’? Furthermore, how can ‘zero’ particles as a
criterion for release testing be reconciled with “practically free from
particles” as stated in the definition and a low, justified level of
particles after production? PHARMEUROPA Vol. 23, No. 3, July 2011 provided
explanatory notes and summary of changes to the monograph 2031 to be
published in Supplement 7.3. The merit of the 2011 monoclonal antibody
monograph revision was that EP experts acknowledged that protein products
may also contain proteinaceous particles at release or that protein
particles may form during storage. Indeed, industry experience has
demonstrated that therapeutic proteins such as monoclonal antibodies can
exhibit a propensity for self-association leading to the formation of
aggregates that range in size from nanometres (oligomers) to microns
(subvisible and visible particles). As a result, the requirement for Drug
Product appearance for monoclonal antibodies was changed from “Without
Visible Particles” to “Without Visible Particles unless otherwise
authorised or justified”. It was stated in the explanatory notes that: –

Without Visible particles was intentionally kept to give clear guidance
that the presence of visible particles is unwanted and the appropriate
formulation studies should be performed during development to find an
optimal formulation. – practically free could not be a pass/fail criteria
in a test and that – visual inspection is not a quality control test, even
though performed at the end of the production. As a result of the
probabilistic nature of detecting particles by visual inspection method,
without (zero) visible particles is an unrealistic requirement for QC
release/shelf life testing of any parenteral product and especially those
of biotechnological origin. Even with significant formulation and
container development, supported by long term stability studies and stress
stability studies (e.g. agitation) the probability of a visible particle
being present cannot be completely eliminated. Interestingly, a
requirement of without (zero) visible particles is not aligned with the
small molecule parenterals which states “essentially/practically free” of
visible particles.

In our view, “ractically free from particles” should be considered a
suitable acceptance criterion for injectable biotech and small-molecule
products, as long as appropriately defined. Furthermore, we argue that
visual inspection is a suitable QC release test and that “practically free
from particles” is a suitable specification when adequately described. The
purpose of this position paper is to review best practices in the industry
in terms of visual inspection process and associated operator training, QC
sampling, testing and setting acceptance criteria corresponding to
“practically free of visible particles” and providing considerations when
visible proteinaceous particles are deemed unavoidable. It also provides a
brief overview of visible particle characterization, and perspectives on
patient safety. This position paper applies to biotechnology derived drug
products including monoclonal antibodies in late phase development to
licensed products.

Copyright © 2016, Parenteral Drug Association.

KEYWORDS: 100% inspection; Lyophilized; QC sampling; particle
identification; proteinaceous particles; visible particles
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Ethanol-based handrubs: Safe for patients and health care
workers
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27091229

Am J Infect Control. 2016 Apr 15. pii: S0196-6553(16)00167-X.
Ethanol-based handrubs: Safe for patients and health care workers.

Pires D1, Bellissimo-Rodrigues F2, Pittet D3.

1Infection Control Programme and World Health Organization (WHO)
Collaborating Centre on Patient Safety, Infection Control & Improving
Practices, University of Geneva Hospitals and Faculty of Medicine, Geneva,
Switzerland; Department of Infectious Diseases, Centro Hospitalar Lisboa
Norte and Faculdade de Medicina da Universidade de Lisboa, Lisbon,
Portugal.
2Infection Control Programme and World Health Organization (WHO)
Collaborating Centre on Patient Safety, Infection Control & Improving
Practices, University of Geneva Hospitals and Faculty of Medicine, Geneva,
Switzerland; Social Medicine Department, Ribeirão Preto Medical School,
University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
3Infection Control Programme and World Health Organization (WHO)
Collaborating Centre on Patient Safety, Infection Control & Improving
Practices, University of Geneva Hospitals and Faculty of Medicine, Geneva,
Switzerland. Electronic address: didier.pittet@hcuge.ch.

This issue of the American Journal of Infection Control presents a timely
and interesting article addressing the relative importance of alcohol
absorption by health care workers (HCWs) using ethanol-based handrubs
(EBHRs) for hand hygiene during patient care.1 Importantly, this is the
first study performed in a real-life setting. The objective of the study
was to investigate the kinetics of urinary ethanol and one of its
metabolites during clinical work by HCWs in a teaching hospital in Germany
where EBHR is the mainstay of hand hygiene.
__________________________________________________________________
________________________________*_________________________________

11. No Abstract: Access to needle and syringe programs by people who
inject image and performance enhancing drugs
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27107549

Int J Drug Policy. 2016 Feb 1. pii: S0955-3959(16)00039-6.
Access to needle and syringe programs by people who inject image and
performance enhancing drugs.

Iversen J1, Hope VD2, McVeigh J3.

1Viral Hepatitis Epidemiology and Prevention Program, The Kirby Institute,
UNSW Australia, Sydney, Australia. Electronic address:
JIversen@kirby.unsw.edu.au.
2Public Health England, Colindale Avenue, London, United Kingdom; Centre
for Research on Drugs and Health Behaviour, London School of Hygiene &
Tropical Medicine, United Kingdom.
3Centre for Public Health, Liverpool John Moores University, Liverpool,
United Kingdom.
__________________________________________________________________
________________________________*_________________________________

12. News

– UK: What to do if you discover dirty needles after school run mum found
syringes

– Libya: 10 people infected in Hepatitis C outbreak in east Libya

– USA: Child Finds Used Syringe, Family Faces Threat of Disease

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/zuemvvb

UK: What to do if you discover dirty needles after school run mum found
syringes

By Catherine Phillips, Worcester News, UK (26.04.16)

DIRTY needles should not be touched warn police after several syringes
were discovered by a school run mum.

Instead, Cathedral Safer Neighbourhood Team (SNT) has advised people to
place something on top of the needles such as a traffic cone or box then
contact the city council immediately.

They issued the advice after Michelle Barnes, from Conway, Tolladine,
found several used needles along the path on Midland Road, Worcester.

The horrified mum-of-four was walking her six-year-old daughter Leola to
Stanley Road Primary School when she found the needles which she believes
had fallen from behind a billboard.

The 37-year-old contacted the Worcester News to warn other parents.

She said: “I don’t judge anybody but when it comes down to people’s safety
it’s a different story.

“Children like to be adventurous and some climb up on the mud, they like
investigating but they don’t see the risks involved.”

A spokesman for the area’s safer neighbourhood team said: “[We are]
committed to tackling the issue of drugs in the area and will continue to
work with our partner agencies to do so.

“If you discover any discarded needles or similar items, do not touch them
unless there is an immediate danger to you or other residents.

“If there is something to hand that you can place on top of it to stop
others from getting to it, for example a cone or a box, then please do
this.”

They added that discarded needles could be reported to the council at the
Worcestershire Hub on 01905 722233 or online at worcester.gov.uk/report-
it.
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https://tinyurl.com/jy33rpf
Libya: 10 people infected in Hepatitis C outbreak in east Libya

The Libya Observer, Tripoli Libya (20.04.16)

Al-Marj Teaching Hospital in east Libya declared Tuesday a state of
emergency following the outbreak of Hepatitis C virus at the hospital’s
Hemodialysis Department, sources say.

The parallel LANA News Agency of the eastern government of Abdullah Al-
Thanni said 10 patients have been infected with Hepatitis C, but the real
reasons of the outbreak are still unclear.

The hospital’s administration said the reason was due to lack of resources
and medical staff.

The news agency added that the discovery of the contagious liver disease
was based on rapid blood tests and that samples have been sent to
authorized labs outside the hospital for confirmation.

Al-Marj is a town some 94 km to the east of Benghazi.
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https://tinyurl.com/zpd4hgx
USA: Child Finds Used Syringe, Family Faces Threat of Disease

By Michael Kitch, Laconia Daily Sun, New Hampshire USA (15.04.16)

LACONIA — With a child’s discovery of a discarded hypodermic needle, a
local family recently found themselves threatened by the scourge of
addiction, which through no doing of their own has cast a shadow over
their lives.

A father, who wished to remain anonymous, said that he his 7-year-old
daughter was playing in the family’s fenced backyard where she found a
discarded hypodermic needle in the vegetable garden. The needle had been
tossed over the 7-foot-high fence. The girl, who enjoys collecting things,
took the needle to her clubhouse and played with it for three days before
her parents discovered it.

“We were very concerned,” said the father, who was aware that blood from a
used needle may carry disease, especially the AIDS virus, HIV, and viral
hepatitis, particularly hepatitis C, or HCV. The Centers for Disease
Control estimates that about eight of 10 addicts infected with HIV are
also infected with HCV.

The father said that he took his daughter to the emergency department at
Lakes Region General Hospital at once and called the Laconia Police
Department to collect the needle.

“She was very scared,” he recalled, “and I probably scared her even more.”

He said that the staff at the emergency room drew blood from his daughter
as well as also tested residue in the syringe and the needle.The tests, he
said, indicated “the odds were in her favor and her chances of being
infected were remote.” He said that the “the staff at the hospital went
out of their way to make us feel comfortable. They were terrific.” The
family also contacted their primary care physician, who after consulting
with a number of other doctors, reached the same conclusion.

The father said that his daughter will undergo regular blood tests over
the course of a year, but for the moment — and hopefully forever — will be
spared intensive treatment on the recommendation of the physicians.
Nevertheless, he said that the incident “has affected our lives greatly
and will continue to do so.” There remains, he said, “the possibility she
may have contracted HIV or hepatitis C, and the chance she will need an
intensive, 30-day treatment that will wreak havoc on her body.”

The short-term side effects of the medications used to treat HIV include
anemia, diarrhea, dizziness, fatigue, headaches, nausea, vomiting, pain
and rashes. There are also long-term side effects of these medications.
They may cause body fat to be redistributed from the face and limbs to the
abdomen, and abnormal levels of blood sugar that can lead to diabetes.
Cholesterol and triglyceride levels may rise. Likewise, lactate, a waste
product in the body, may increase, causing problems ranging from muscle
aches to liver failure.

The father said that the ordeal “also slams it in our faces that this
problem doesn’t just affect those held in the grip of drug abuse. It also
affects a completely innocent 7-year-old and her innocent family.”

He urged those injecting drugs not to leave their needles where a child
can find it. “I can’t think of anything more selfish, abhorrent or wrong.”

At the same time, he asked parents to warn their children against touching
and handling discarded needles.

“Parents need to teach their children,” he said. “Bad things can happen.”

Police Chief Chris Adams said that anyone who finds a needle should
immediately report it to the police, either by dialing 911 or calling the
station at 524-5257.

“Do not touch it,” he stressed.

He explained that officers are equipped and prepared to handle discarded
needles safely and have secure containers where they can be kept before
being disposed of at the hospital. He said that the department is working
with the school to alert children and adolescents of the risks of handling
discarded needles.

“Don’t touch them,” he repeated. “Call us and let us deal with them.”

04-16 needles

This bundle of needles was found on a beach in Laconia recently. One child
in Laconia found a used needle when it was apparently tossed into the
family’s back yard over a tall fence. (Courtesy photo/Laconia Police
Department)
__________________________________________________________________
________________________________*_________________________________

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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