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SIGNpost 00851

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST

Post00851 MultiDoseVials + Clean Hands + Abstracts + News 04 May 2016

CONTENTS

1. Multi Dose Vials: Dose per Container Partnership (DPCP) an update
2. Multi Dose Vials: Programmatic Impact of Vaccine Presentation (Dose Per
Container)
3. Abstract: Reducing the underreporting of percutaneous exposure
incidents: A single-center experience
4. Abstract: Occupational exposure to bloodborne pathogens in a
specialized care service in Brazil
5. Abstract: Sharp Decrease of Reported Occupational Blood and Body Fluid
Exposures in French Hospitals, 2003-2012: Results of the French
National Network Survey, AES-RAISI
6. Abstract: Microbiology for Radiologists: How to Minimize Infection
Transmission in the Radiology Department
7. Abstract: Hepatitis B virus infection in Indonesia
8. Abstract: Serosurveillance of vaccine preventable diseases and
hepatitis C in healthcare workers from Lao PDR
9. Abstract: Self-reported hand hygiene practices, and feasibility and
acceptability of alcohol-based hand rubs among village healthcare
workers in Inner Mongolia, China
10. Abstract: An automated hand hygiene training system improves hand
hygiene technique but not compliance
11. Abstract: Adherence to hand hygiene guidelines – significance of
measuring fidelity
12. Abstract: Monitoring and improving the effectiveness of surface
cleaning and disinfection
13. Abstract: Mobile Phones as a Potential Vehicle of Infection in a
Hospital Setting
14. Abstract: Bioceramic microneedles with flexible and self-swelling
substrate
15. Abstract: Role of healthcare apparel and other healthcare textiles in
the transmission of pathogens: a review of the literature
16. No Abstract: Transmission of a multidrug-resistant HIV-1 from an
occupational exposure, in São Paulo, Brazil
17. Abstract: Zika Virus: A Global Threat to Humanity: A Comprehensive
Review and Current Developments
18. New Report: US Institute of Medicine publishes the first phase of a
report on eliminating hepatitis B and C in the United States
19. News
– Philippines: Fake vaccine gang busted in Las Piñas

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1. Multi Dose Vials: Dose per Container Partnership (DPCP) an update
__________________________________________________________________

www.technet-21.org/en/forums/dose-per-container-partnership-dpcp-an-update
Dose per Container Partnership (DPCP) an update

From Craig Burgess via TechNet 21
Dose per Container Partnership (DPCP)

The issue: Multi-dose containers are used to offer lower prices, higher
supply volumes, and minimize cold chain storage and distribution
requirements. As new, more expensive, vaccines are introduced in multi-
dose presentations, maximizing the use of every dose in a container
increases in importance. HCWs need to be more strategic about when to open
a container; diligent about how they care for open containers, and
potentially more active with communication and community outreach to
ensure optimal attendance and timely vaccination of every child. Thus, the
number of doses per container (DCP) may also impact on health systems in
terms of timely, safe and equitable vaccination coverage, supply and cold
chain, wastage rates, cost and HCW behavior.

Immunization stakeholders need information and tools to assess which dose
per container presentations are appropriate for a country’s specific
context and priorities.

Initial 2015 response: With Bill & Melinda Gates Foundation (BMGF)
funding, JSI Research & Training Institute, Inc. (JSI) helped identify
evidence gaps by interviewing key stakeholders and analyzing existing
research. An informal network of partners interested in advancing this
work was created after a consultative meeting in July 2015.

Launch of the partnership: The Dose Per Container Partnership (DPCP) was
launched in March 2016 as a project, funded by the BMGF and implemented by
JSI in partnership with PATH, Agence de Médecine Préventive (AMP), Clinton
Health Access Initiative (CHAI), HERMES modeling team and the
International Vaccine Access Center (IVAC) / Johns Hopkins University. The
DPCP aims to address the complexity of vaccine product and program
decision-making to include DPC considerations. Understanding and assessing
the trade-offs between cost and health impact allows better informed
decisions about the impact of the dose per container selected.

DPCP objectives and work streams: The DPCP project will run from February
2016 – December 2017, guided by a Technical Advisory Group (TAG), and aims
to achieve two objectives:

i) To gain a deeper understanding of the decision making processes, trade-
offs, data

and tools used to assess DPC decisions at global and national levels in
order to recommend process improvements;

ii) To provide guidance and tools including trade-offs to be considered by
countries and facilitate

sharing of best practices for country level decision makers.

These will be implemented through three technical work streams:

A global cross-country review of current DPC-related decision making tools
and processes; Prospective research studies in two African countriesl will
include data collection to improve modeling efforts, economic analysis and
see the actual effect on the various systems variables; and Synthesis of
data supporting global level policy and country decisions.
Stakeholders: DPCP aims to inform, support and influence stakeholders at:

a) Global level, by providing evidence that fills critical gaps in
knowledge, analysis, and policy. This includes ensuring that stakeholders
will continue to be informed about sustainable decisions on DPC when
considering vaccine products and program designs; and

b) Country level, by producing easy-to-use and -understand guides and
tools to assess DPC tradeoffs, including cost and systems impact to inform
vaccine product selection

Information about the DPCP will be made available through partners engaged
with the project, the JSI website https://tinyurl.com/grx9jh5 ,
announcements via the technet forum and various formal and informal
opportunities where immunization practitioners meet globally, regionally
or nationally.
__________________________________________________________________
________________________________*_________________________________

2. Multi Dose Vials: Programmatic Impact of Vaccine Presentation (Dose Per
Container)

Crossposted from the the JSI website https://tinyurl.com/grx9jh5 with
thanks.
__________________________________________________________________
Programmatic Impact of Vaccine Presentation (Dose Per Container)
Geographic Scope: Worldwide

Client(s): Bill & Melinda Gates Foundation

Technical Expertise: Immunization

The global effort to protect all children from vaccine preventable disease
has historically used multi-dose containers in low and middle income
countries in order to offer lower prices, higher supply volumes, and
minimize cold chain storage and distribution requirements. As newer, more
expensive vaccines are introduced in multi-dose presentations, however,
stakeholders are becoming increasingly aware that the burden of cost
efficiency moves from the purchaser to the healthcare worker (HCW). In
order to achieve maximum utilization of every dose in a container, HCWs
need to be strategic about when to open a container, diligent about how
they care for open containers, and potentially more active with
communication and community outreach to ensure optimal attendance and
timely vaccination of every child. This calculation may reduce their
willingness to open a container for every eligible child they see. Thus,
the number of doses per container (DCP) may also have an impact on the
ability to efficiently achieve goals of timely, safe and equitable
vaccination coverage.

Given the complexity associated with assessing the trade-offs between cost
and health impact, particularly in lower and middle income countries where
resources are limited, it is important that immunization stakeholders have
the information and tools they need to assess which dose per container
presentations are appropriate given a country’s programmatic and financial
priorities.

DOSE PER CONTAINER PARTNERSHIP

With Bill & Melinda Gates Foundation support between April and October,
2015, JSI Research & Training Institute, Inc. (JSI) identified evidence
gaps by interviewing key stakeholders and analyzing existing research. JSI
then convened a consultative meeting in July, 2015 that helped create an
informal network of partners interested in advancing this work. JSI
continues to serve as the coordinating body and technical architect of the
next phase of activity which aims to fill the agreed upon list of critical
gaps in knowledge, analysis, and processes for decision-making.

The Dose Per Container Partnership (DPCP) is a project, funded by the Bill
& Melinda Gates Foundation and implemented by JSI and its partners AMP
Services, Clinton Health Access Initiative, the HERMES modeling team and
the International Vaccine Access Center (IVAC) through Johns Hopkins
University, Bloomberg School of Public Health, and PATH, which aims to
address the complexity of vaccine product and program decision-making to
include considerations of DPC. Understanding and assessing the trade-offs
between cost and health systems impact allows better informed decisions
about the impact of the dose per container selected and how that decision
would affect coverage (equity, timeliness and session size), wastage rate,
cost effectiveness and cost benefit, safety, cold and supply chains ,
distribution capacity and healthcare worker behavior and needs.

DPCP builds upon and collects additional evidence to assess how DPC
choices affect cost / immunization systems tradeoffs (high, equitable, and
timely coverage; vaccine wastage; safety; cold chain and supply chain; and
HCW behaviors) with primary stakeholders:

a) Global stakeholders: Providing evidence that fills critical gaps in
knowledge, analysis, and policy; making processes guiding stake¬holders to
make informed, sustainable decisions on DPC when considering vaccine
products and program designs; and

b) Country stakeholders: Producing easy-to-use and -understand guides and
tools to assess DPC tradeoffs, including cost and systems impact to inform
vaccine product selection.

© 2016 John Snow, Inc. and JSI Research & Training Institute, Inc.
44 Farnsworth Street | Boston, MA 02210 | USA | 617.482.9485
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Reducing the underreporting of percutaneous exposure
incidents: A single-center experience
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27125915

Am J Infect Control. 2016 Apr 25. pii: S0196-6553(16)00153-X.
Reducing the underreporting of percutaneous exposure incidents: A single-
center experience.

Fritzsche C1, Heine M2, Loebermann M2, Klammt S2, Podbielski A3,
Mittlmeier T4, Reisinger EC2.

1Division of Tropical Medicine and Infectious Diseases, Department of
Medicine, Rostock University Medical Center, Rostock, Germany. Electronic
address: Carlos.Fritzsche@med.uni-rostock.de.
2Division of Tropical Medicine and Infectious Diseases, Department of
Medicine, Rostock University Medical Center, Rostock, Germany.
3Institute of Medical Microbiology, Virology and Hygiene, Rostock
University Medical Center, Rostock, Germany.
4Department of Trauma and Reconstructive Surgery, Rostock University
Medical Center, Rostock, Germany.

Although risk reduction strategies have been implemented throughout the
world, underreporting of percutaneous exposure incidents (PEIs) is common
among exposed health care workers. The aim of this study was to determine
the incidence rate of reported PEIs before and after implementation of an
intensified reporting management policy.

The introduction of an intensified reporting system led to significantly
increased reporting after a PEI has occurred. However, continuous
education needs to be provided to improve awareness.

Copyright © 2016. Published by Elsevier Inc.

KEYWORDS: Underreporting; bloodborne infections; needlestick injuries;
percutaneous exposure incident
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Occupational exposure to bloodborne pathogens in a
specialized care service in Brazil
__________________________________________________________________

http://www.ajicjournal.org/article/S0196-6553(15)00619-7/fulltext

Am J Infect Control. 2015 Aug;43(8):e39-41. Open Access
Occupational exposure to bloodborne pathogens in a specialized care
service in Brazil.

Khalil Sda S1, Khalil OA2, Lopes-Júnior LC3, Cabral DB4, Bomfim Ede O4,
Landucci LF5, Santos Mde L6.
Author information
1Faculty of Health Sciences, Graduate Program in Nursing, University of
Brasília (UnB), Brasília, Federal District, Brazil.
2Federal Institute of Education, Science and Technology of Paraná (IFPR),
Londrina, Paraná, Brazil. Electronic address: omar.khalil@ifpr.edu.br.
3Department Maternal-Infant Nursing and Public Health, Who Collaborating
Centre for Nursing Research Development, São Paulo, Brazil.
4Department General and Specialized Nursing, Who Collaborating Centre for
Nursing Research Development, São Paulo, Brazil.
5Rio Preto University Center (UNIRP), Department of Dentistry, São José do
Rio Preto, São Paulo, Brazil.
6Faculty of Medicine of São José do Rio Preto (FAMERP), Department of
Nursing, São José do Rio Preto, São Paulo, Brazil.

In a retrospective study about the epidemiology of exposure to bloodborne
pathogens among health care providers, 71.10% of the analyzed events
occurred among health professionals, mainly auxiliary nurses.

Percutaneous exposure (83.04%) was the most frequent.

Greater advances are necessary in the development of public policies for
this issue in terms of inspection of regulatory norms and raising the
professionals’ awareness through policy and education.

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

KEYWORDS: Exposure of body fluids to mucosal membranes; Health care
providers; Percutaneous injuries

Free full text
http://www.ajicjournal.org/article/S0196-6553(15)00619-7/fulltext
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Sharp Decrease of Reported Occupational Blood and Body Fluid
Exposures in French Hospitals, 2003-2012: Results of the French
National Network Survey, AES-RAISI
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/25896252

Infect Control Hosp Epidemiol. 2015 Aug;36(8):963-8.
Sharp Decrease of Reported Occupational Blood and Body Fluid Exposures in
French Hospitals, 2003-2012: Results of the French National Network
Survey, AES-RAISIN.

Floret N1, Ali-Brandmeyer O1, L’Hériteau F2, Bervas C3, Barquins-Guichard
S4, Pelissier G5, Abiteboul D5, Parneix P3, Bouvet E2, Rabaud C1; Working
Group AES-RAISIN.

11Est France Infection Control Coordinating Center,Nancy,France.
22Paris-Northern France Infection Control Coordinating
Center,Paris,France.
33Southwestern France Infection Control Coordinating
Center,Bordeaux,France.
44National Institute for Health Surveillance,Saint-Maurice,France.
55Group for the Prevention of Occupational Infections in Healthcare
Workers,Paris,France.

OBJECTIVE: To assess the temporal trend of reported occupational blood and
body fluid exposures (BBFE) in French healthcare facilities.

METHOD: Retrospective follow-up of reported BBFE in French healthcare
facilities on a voluntary basis from 2003 to 2012 with a focus on those
enrolled every year from 2008 to 2012 (stable cohort 2008-12).

FINDINGS: Reported BBFE incidence rate per 100 beds decreased from 7.5% in
2003 to 6.3% in 2012 (minus 16%). Percutaneous injuries were the most
frequent reported BBFE (84.0% in 2003 and 79.1% in 2012).

Compliance with glove use (59.1% in 2003 to 67.0% in 2012) and sharps-
disposal container accessibility (68.1% in 2003 to 73.4% in 2012) have
both increased. A significant drop in preventable BBFE was observed (48.3%
in 2003 to 30.9% in 2012).

Finally, the use of safety-engineered devices increased from 2008 to 2012.

CONCLUSION: Of the 415,209 hospital beds in France, 26,158 BBFE could have
occurred in France in 2012, compared with 35,364 BBFE in 2003. Healthcare
personnel safety has been sharply improved during the past 10 years in
France.
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Microbiology for Radiologists: How to Minimize Infection
Transmission in the Radiology Department
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26046943

Radiographics. 2015 Jul-Aug;35(4):1231-44.
Microbiology for Radiologists: How to Minimize Infection Transmission in
the Radiology Department.

Mirza SK1, Tragon TR1, Fukui MB1, Hartman MS1, Hartman AL1.

1From the Department of Diagnostic Radiology, Allegheny Health Network,
Allegheny General Hospital, 320 E North Ave, Pittsburgh, PA 15212 (S.K.M.,
M.S.H.); Department of Medicine, University of Pittsburgh Medical Center,
Pittsburgh, Pa (T.R.T.); Aurora Neuroscience Innovation Institute, Aurora
St Luke’s Medical Center, Milwaukee, Wis (M.B.F.); and Center for Vaccine
Research, University of Pittsburgh, Pittsburgh, Pa (A.L.H.).

The implementation of standardized infection control and prevention
practices is increasingly relevant as modern radiology practice evolves
into its more clinical role. Current Centers for Disease Control and
Prevention, National Institutes of Health, and World Health Organization
guidelines for the proper use of personal protective equipment,
decontamination of reusable medical equipment, and appropriate management
of bloodborne pathogen exposures will be reviewed.

Standard precautions apply to all patients at all times and are the
mainstay of infection control. Proper hand hygiene includes washing hands
with soap and water when exposed to certain infectious particles, such as
Clostridium difficile spores, which are not inactivated by alcohol-based
hand rubs.

The appropriate use of personal protective equipment in accordance with
recommendations from the Centers for Disease Control and Prevention
includes wearing a surgical mask during lumbar puncture.

Because radiologists may perform lumbar punctures for patients with prion
disease, it is important to appreciate that incineration is the most
effective method of inactivating prion proteins. However, there is
currently no consensus recommendation on the decontamination of prion-
contaminated reusable items associated with lumbar puncture, and
institutional policies should be consulted for directed management.

In the event of a needlestick injury, radiology staff must be able to
quickly provide appropriate initial management and seek medical attention,
including laboratory testing for bloodborne pathogens.

©RSNA, 2015.
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Hepatitis B virus infection in Indonesia
__________________________________________________________________

Open Access http://www.wjgnet.com/1007-9327/full/v21/i38/10714.htm

World J Gastroenterol. 2015 Oct 14;21(38):10714-20.
Hepatitis B virus infection in Indonesia.

Yano Y1, Utsumi T1, Lusida MI1, Hayashi Y1.
Author information
1Yoshihiko Yano, Takako Utsumi, Yoshitake Hayashi, Center for Infectious
Diseases, Kobe University Graduate School of Medicine, Kobe 650-0017,
Japan.

Approximately 240 million people are chronically infected with hepatitis B
virus (HBV), 75% of whom reside in Asia. Approximately 600000 of infected
patients die each year due to HBV-related diseases or hepatocellular
carcinoma (HCC).

The endemicity of hepatitis surface antigen in Indonesia is intermediate
to high with a geographical difference. The risk of HBV infection is high
in hemodialysis (HD) patients, men having sex with men, and health care
workers.

Occult HBV infection has been detected in various groups such as blood
donors, HD patients, and HIV-infected individuals and children.

The most common HBV subgenotype in Indonesia is B3 followed by C1. Various
novel subgenotypes of HBV have been identified throughout Indonesia, with
the novel HBV subgenotypes C6-C16 and D6 being successfully isolated.
Although a number of HBV subgenotypes have been discovered in Indonesia,
genotype-related pathogenicity has not yet been elucidated in detail.
Therefore, genotype-related differences in the prognosis of liver disease
and their effects on treatments need to be determined.

A previous study conducted in Indonesia revealed that hepatic steatosis
was associated with disease progression. Pre-S2 mutations and mutations at
C1638T and T1753V in HBV/B3 have been associated with advanced liver
diseases including HCC. However, drug resistance to lamivudine, which is
prominent in Indonesia, remains obscure.

Although the number of studies on HBV in Indonesia has been increasing,
adequate databases on HBV infection are limited. We herein provided an
overview of the epidemiology and clinical characteristics of HBV infection
in Indonesia.

KEYWORDS: Clinical characteristics; Epidemiology; Hepatitis B virus;
Indonesia; Prevention

Free Open Access Article
http://www.wjgnet.com/1007-9327/full/v21/i38/10714.htm
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Serosurveillance of vaccine preventable diseases and
hepatitis C in healthcare workers from Lao PDR
__________________________________________________________________

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0123647

PLoS One. 2015 Apr 14;10(4):e0123647. Open Access Peer Reviewed
Serosurveillance of vaccine preventable diseases and hepatitis C in
healthcare workers from Lao PDR.

Black AP1, Vilivong K2, Nouanthong P2, Souvannaso C2, Hübschen JM1, Muller
CP1.

1Institute of Immunology, Luxembourg Institute of Health (former Centre de
Recherche Public de la Santé)/Laboratoire National de Santé, Luxembourg,
Grand-Duchy of Luxembourg; Lao-Lux Laboratory, Institut Pasteur du Laos,
Vientiane, Lao PDR.
2Lao-Lux Laboratory, Institut Pasteur du Laos, Vientiane, Lao PDR.

BACKGROUND AND AIMS: Healthcare workers (HCW) have an increased risk of
exposure to infectious diseases and are a potential source of infections
for their patients. The Lao People’s Democratic Republic (Lao PDR) has no
national policy regarding HCW vaccinations and routine vaccination
coverage is low within the general population. This cross-sectional
serostudy determines the level of exposure and risk of infection in Lao
HCW against 6 vaccine preventable diseases and hepatitis C.

METHODS: 1128 HCW were recruited from 3 central, 2 provincial and 8
district hospitals. Sera were tested by ELISA for the presence of
antibodies and antigens to hepatitis B, hepatitis C, measles, rubella,
varicella zoster, tetanus and diphtheria.

RESULTS: Only 53.1% of the HCW had protective anti-hepatitis B surface
antigen antibodies (anti-HBs) with 48.8% having anti-hepatitis B core
antibodies (anti-HBc), indicating previous exposure and 8.0% were
hepatitis B surface antigen carriers. 3.9% were hepatitis C seropositive.
Measles and rubella antibodies were detected in 95.4% and 86.2% of the
HCW, with 11.9% of females being unprotected against rubella. Antibodies
against varicella zoster, tetanus and diphtheria were detected in 95%,
78.8% and 55.3%, respectively. Seroprevalence varied according to age,
gender and number of children.

CONCLUSION: An unacceptably high proportion of Lao HCW remain susceptible
to infection with hepatitis B, diphtheria, tetanus and rubella.
Furthermore, a high number of healthcare workers are chronically infected
with hepatitis B and C viruses. These data emphasize the need for a robust
HCW vaccination policy in addition to increased awareness within this
subpopulation.

Free PLOS Article
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0123647
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Self-reported hand hygiene practices, and feasibility and
acceptability of alcohol-based hand rubs among village healthcare
workers in Inner Mongolia, China
__________________________________________________________________

Open Access
www.journalofhospitalinfection.com/article/S0195-6701(15)00178-4/abstract

J Hosp Infect. 2015 Aug;90(4):338-43.
Self-reported hand hygiene practices, and feasibility and acceptability of
alcohol-based hand rubs among village healthcare workers in Inner
Mongolia, China.

Li Y1, Wang Y2, Yan D2, Rao CY3.

1Global Disease Detection Program, United States Centers for Disease
Control and Prevention, Beijing, China.
2Bayan Nur TB Dispensary, Bayan Nur Infectious Disease Hospital, Bayan
Nur, Inner Mongolia Autonomous Region, China.
3Global Disease Detection Program, United States Centers for Disease
Control and Prevention, Beijing, China; Global Disease Detection Branch,
Division of Global Health Protection, Centers for Disease Control and
Prevention, Atlanta, GA, USA. Electronic address: crao@cdc.gov.

BACKGROUND: Good hand hygiene is critical to reduce the risk of
healthcare-associated infections. Limited data are available on hand
hygiene practices from rural healthcare systems in China.

AIM: To assess the feasibility and acceptability of sanitizing hands with
alcohol-based hand rubs (ABHRs) among Chinese village healthcare workers,
and to assess their hand hygiene practice.

METHODS: Five hundred bottles of ABHR were given to village healthcare
workers in Inner Mongolia, China. Standardized questionnaires collected
information on their work load, availability, and usage of hand hygiene
facilities, and knowledge, attitudes, and practices of hand hygiene.

FINDINGS: In all, 369 (64.2%) participants completed the questionnaire.
Although 84.5% of the ABHR recipients believed that receiving the ABHR
improved their hand hygiene practice, 78.8% of recipients would pay no
more than US$1.5 out of their own pocket (actual cost US$4). The majority
(77.2%) who provided medical care at patients’ homes never carried hand
rubs with them outside their clinics. In general, self-reported hand
hygiene compliance was suboptimal, and the lowest compliance was ‘before
touching a patient’. Reported top three complaints with using ABHR were
skin irritation, splashing, and unpleasant residual. Village doctors with
less experience practised less hand hygiene.

CONCLUSION: The overall acceptance of ABHR among the village healthcare
workers is high as long as it is provided to them for free/low cost, but
their overall hand hygiene practice is suboptimal. Hand hygiene education
and training is needed in settings outside of traditional healthcare
facilities.

Published by Elsevier Ltd.

KEYWORDS: Hand hygiene; Healthcare-associated infection; Village doctors

Free full text Open Access
www.journalofhospitalinfection.com/article/S0195-6701(15)00178-4/abstract
__________________________________________________________________
________________________________*_________________________________

10. Abstract: An automated hand hygiene training system improves hand
hygiene technique but not compliance
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26059600

Am J Infect Control. 2015 Aug;43(8):821-5.
An automated hand hygiene training system improves hand hygiene technique
but not compliance.

Kwok YL1, Callard M2, McLaws ML3.

1School of Public Health and Community Medicine, UNSW Medicine, UNSW
Australia, Sydney, New South Wales, Australia.
2Infection Prevention and Control Unit, Campbelltown and Camden Hospital,
Sydney, New South Wales, Australia.
3School of Public Health and Community Medicine, UNSW Medicine, UNSW
Australia, Sydney, New South Wales, Australia. Electronic address:
m.mclaws@unsw.edu.au.

INTRODUCTION: The hand hygiene technique that the World Health
Organization recommends for cleansing hands with soap and water or
alcohol-based handrub consists of 7 poses. We used an automated training
system to improve clinicians’ hand hygiene technique and test whether this
affected hospitalwide hand hygiene compliance.

METHODS: Seven hundred eighty-nine medical and nursing staff volunteered
to participate in a self-directed training session using the automated
training system. The proportion of successful first attempts was reported
for each of the 7 poses. Hand hygiene compliance was collected according
to the national requirement and rates for 2011-2014 were used to determine
the effect of the training system on compliance.

RESULTS: The highest pass rate was for pose 1 (palm to palm) at 77% (606
out of 789), whereas pose 6 (clean thumbs) had the lowest pass rate at 27%
(216 out of 789). One hundred volunteers provided feedback to 8 items
related to satisfaction with the automated training system and most (86%)
expressed a high degree of satisfaction and all reported that this method
was time-efficient. There was no significant change in compliance rates
after the introduction of the automated training system. Observed
compliance during the posttraining period declined but increased to 82% in
response to other strategies.

CONCLUSIONS: Technology for training clinicians in the 7 poses played an
important education role but did not affect compliance rates.

Crown Copyright © 2015. Published by Elsevier Inc. All rights reserved.

KEYWORDS: Cleansing technique; Compliance; Seven poses
__________________________________________________________________
________________________________*_________________________________

11. Abstract: Adherence to hand hygiene guidelines – significance of
measuring fidelity
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26331437

J Clin Nurs. 2015 Nov;24(21-22):3197-205.
Adherence to hand hygiene guidelines – significance of measuring fidelity.

Korhonen A1, Ojanperä H2, Puhto T2, Järvinen R2, Kejonen P2, Holopainen
A1.

1Nursing Research Foundation, Helsinki, Finland.
2Oulu University Hospital, Oulu, Finland.

AIMS AND OBJECTIVES: The aim was to evaluate the usability of fidelity
measures in compliance evaluation of hand hygiene.

BACKGROUND: Adherence to hand hygiene guidelines is important in terms of
patient safety. Compliance measures seldom describe how exactly the
guidelines are followed.

DESIGN AND METHODS: A cross-sectional observation study in a university
hospital setting was conducted. Direct observation by trained staff was
performed using a standardised observation form supplemented by fidelity
criteria. A total of 830 occasions were observed in 13 units. Descriptive
statistics (frequency, mean, percentages and range) were used as well as
compliance rate by using a standard web-based tool. In addition, the
binomial standard normal deviate test was conducted for comparing
different methods used in evaluation of hand hygiene and in comparison
between professional groups.

RESULTS: Measuring fidelity to guidelines was revealed to be useful in
uncovering gaps in hand hygiene practices. The main gap related to too
short duration of hand rubbing. Thus, although compliance with hand
hygiene guidelines measured using a standard web-based tool was
satisfactory, the degree of how exactly the guidelines were followed
seemed to be critical.

CONCLUSIONS: Combining the measurement of fidelity to guidelines with the
compliance rate is beneficial in revealing inconsistency between optimal
and actual hand hygiene behaviour.

RELEVANCE TO CLINICAL PRACTICE: Evaluating fidelity measures is useful in
terms of revealing the gaps between optimal and actual performance in hand
hygiene. Fidelity measures are suitable in different healthcare contexts
and easy to measure according to the relevant indicators of fidelity, such
as the length of hand rubbing. Knowing the gap facilitates improvements in
clinical practice.

© 2015 John Wiley & Sons Ltd.

KEYWORDS: compliance evaluation; fidelity measures; hand hygiene;
healthcare staff; observation study
__________________________________________________________________
________________________________*_________________________________

12. Abstract: Monitoring and improving the effectiveness of surface
cleaning and disinfection
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27131138

Am J Infect Control. 2016 May 2;44(5 Suppl):e69-76.
Monitoring and improving the effectiveness of surface cleaning and
disinfection.

Rutala WA1, Weber DJ2.

1Hospital Epidemiology, University of North Carolina Health Care, Chapel
Hill, NC; Division of Infectious Diseases, UNC School of Medicine, Chapel
Hill, NC. Electronic address: brutala@unch.unc.edu.
2Hospital Epidemiology, University of North Carolina Health Care, Chapel
Hill, NC; Division of Infectious Diseases, UNC School of Medicine, Chapel
Hill, NC.

Disinfection of noncritical environmental surfaces and equipment is an
essential component of an infection prevention program. Noncritical
environmental surfaces and noncritical medical equipment surfaces may
become contaminated with infectious agents and may contribute to cross-
transmission by acquisition of transient hand carriage by health care
personnel.

Disinfection should render surfaces and equipment free of pathogens in
sufficient numbers to prevent human disease (ie, hygienically clean).

Copyright © 2016 Association for Professionals in Infection Control and

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

KEYWORDS: Surface; cleaning; disinfection
__________________________________________________________________
________________________________*_________________________________

13. Abstract: Mobile Phones as a Potential Vehicle of Infection in a
Hospital Setting
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26083898

J Occup Environ Hyg. 2015;12(10):D232-5.
Mobile Phones as a Potential Vehicle of Infection in a Hospital Setting.

Chao Foong Y1, Green M, Zargari A, Siddique R, Tan V, Brain T, Ogden K.

1a Launceston Clinical School University of Tasmania , Tasmania ,
Australia.

The objective of this article is to investigate the potential role of
mobile phones as a reservoir for bacterial colonization and the risk
factors for bacterial colonization in a hospital setting.

We screened 226 staff members at a regional Australian hospital (146
doctors and 80 medical students) between January 2013 and March 2014.

The main outcomes of interest were the types of microorganisms and the
amount of contamination of the mobile phones.

This study found a high level of bacterial contamination (n = 168/226,
74%) on the mobile phones of staff members in a tertiary hospital, with
similar organisms isolated from the staff member’s dominant hand and
mobile phones.

While most of the isolated organisms were normal skin flora, a small
percentage were potentially pathogenic (n = 12/226, 5%).

Being a junior medical staff was found to be a risk factor for heavy
microbial growth (OR 4.00, 95% CI 1.54, 10.37).

Only 31% (70/226) of our participants reported cleaning their phones
routinely, and only 21% (47/226) reported using alcohol containing wipes
on their phones.

This study demonstrates that mobile phones are potentially vehicles for
pathogenic bacteria in a hospital setting.

Only a minority of our participants reported cleaning their phones
routinely.

Disinfection guidelines utilizing alcohol wipes should be developed and
implemented.

KEYWORDS: hospital; infection; mobile phones; vehicle
__________________________________________________________________
________________________________*_________________________________

14. Abstract: Bioceramic microneedles with flexible and self-swelling
substrate
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26126420

Eur J Pharm Biopharm. 2015 Aug;94:404-10.
Bioceramic microneedles with flexible and self-swelling substrate.

Cai B1, Xia W2, Bredenberg S1, Li H3, Engqvist H1.

1Division for Applied Materials Science, Department of Engineering
Sciences, The Ångström Laboratory, Uppsala University, Box 534, SE-751 21
Uppsala, Sweden.
2Division for Applied Materials Science, Department of Engineering
Sciences, The Ångström Laboratory, Uppsala University, Box 534, SE-751 21
Uppsala, Sweden. Electronic address: Wei.Xia@angstrom.uu.se.
3Otolaryngology and Head & Neck Surgery, Department of Surgical Sciences,
Uppsala University, Akademiska sjukhuset 78-79, 75185 Uppsala, Sweden.

To reduce the effort required to penetrate the skin and optimize drug
release profiles, bioceramic microneedle arrays with higher-aspect-ratio
needles and a flexible and self-swelling substrate have been developed.
Swelling of the substrate can assist in separating it from the needles and
leave them in the skin as a drug depot.

The preparation procedures for this bioceramic microneedle are described
in the paper. Clonidine hydrochloride, the model drug, was released in a
controlled manner by the microneedle device in vitro.

Results showed that the microneedle array with a flexible and self-
swelling substrate released the drug content faster than the array with a
rigid substrate. Disintegration of the needle material and diffusion of
the drug molecules are believed as the main control mechanisms of the drug
release from these microneedle arrays. Ex vivo skin penetration showed
that they can effectively penetrate the stratum corneum without an extra
device.

This work represents a progression in the improvement of bioceramic
microneedles for transdermal drug delivery.

Copyright © 2015 Elsevier B.V. All rights reserved.

KEYWORDS:Bioceramics; Clonidine; Controlled-release; Microneedles; Skin
penetration
__________________________________________________________________
________________________________*_________________________________

15. Abstract: Role of healthcare apparel and other healthcare textiles in
the transmission of pathogens: a review of the literature
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/25935701

J Hosp Infect. 2015 Aug;90(4):285-92.
Role of healthcare apparel and other healthcare textiles in the
transmission of pathogens: a review of the literature.

Mitchell A1, Spencer M2, Edmiston C Jr3.

1International Safety Center, The Public’s Health, Apopka, FL, USA.
Electronic address: Amber.Mitchell@internationalsafetycenter.org.
2Infection Preventionist Consultants, Boston, MA, USA.
3Department of Surgery, Surgical Microbiology and Hospital Epidemiology
Research Laboratory, Medical College of Wisconsin, Milwaukee, WI, USA.

Healthcare workers (HCWs) wear uniforms, such as scrubs and lab coats, for
several reasons: (1) to identify themselves as hospital personnel to their
patients and employers; (2) to display professionalism; and (3) to provide
barrier protection for street clothes from unexpected exposures during the
work shift.

A growing body of evidence suggests that HCWs’ apparel is often
contaminated with micro-organisms or pathogens that can cause infections
or illnesses.

While the majority of scrubs and lab coats are still made of the same
traditional textiles used to make street clothes, new evidence suggests
that current innovative textiles function as an engineering control,
minimizing the acquisition, retention and transmission of infectious
pathogens by reducing the levels of bioburden and microbial
sustainability.

This paper summarizes recent literature on the role of apparel worn in
healthcare settings in the acquisition and transmission of healthcare-
associated pathogens.

It proposes solutions or technological interventions that can reduce the
risk of transmission of micro-organisms that are associated with the
healthcare environment.

Healthcare apparel is the emerging frontier in epidemiologically important
environmental surfaces.

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

KEYWORDS: Active barrier apparel; Antimicrobial; Contaminated textiles;
Disinfection; Environmental pathogens; Healthcare apparel; Healthcare
laundering; Healthcare-associated infections; Occupational exposure;
Personal protective equipment
__________________________________________________________________
________________________________*_________________________________

16. No Abstract: Transmission of a multidrug-resistant HIV-1 from an
occupational exposure, in São Paulo, Brazil
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26244399

AIDS. 2015 Jul 31;29(12):1580-3.
Transmission of a multidrug-resistant HIV-1 from an occupational exposure,
in São Paulo, Brazil.

López-Lopes GI1, Coelho LP, Hornke L, Volpato AP, Lopércio AP, Cabral GB,
Ferreira JL, Domingues CS, Brígido LF.

1aRetrovirus Laboratory, Virology Center, Adolfo Lutz Institute, São
Paulo/SP bSpecialized Healthcare Service, SEA Barueri/SP cEpidemiological
Surveillance, Department of the São Paulo State Program for STDs and AIDS
STD/AIDS, São Paulo/SP, Brazil.
__________________________________________________________________
________________________________*_________________________________

17. Abstract: Zika Virus: A Global Threat to Humanity: A Comprehensive
Review and Current Developments
__________________________________________________________________

http://dx.doi.org/10.4103%2F1947-2714.179112
Open Access http://www.najms.org/text.asp?2016/8/3/123/179112

N Am J Med Sci. 2016 Mar;8(3):123-8.
Zika Virus: A Global Threat to Humanity: A Comprehensive Review and
Current Developments.

Hajra A1, Bandyopadhyay D2, Hajra SK3.

1Department of Internal Medicine, Institute of Post Graduate Medical
Education and Research (IPGMER), Kolkata, West Bengal, India.
2Department of Accident and Emergency, Lady Hardinge Medical College, New
Delhi, India.
3Consultant Physician, NMB Diagnostics, Serampore, Hooghly, West Bengal,
India.

At present, one of greatest concerns of medical personnel is Zika virus
(ZIKV). Though it has been reported for quite a long time, its rapid
emergence, new modes of transmission, and more importantly, the congenital
anomalies associated with it have made the situation worse.

It was first detected in 1947. After that, this infection was found in the
countries of Africa as well as Asia. At present, interestingly it has been
reported from Brazil. Microcephaly and intracranial calcification have
been postulated to be related to maternal infection with this virus.

Though it is asymptomatic in maximum number of cases, the serious
complications of the infection should be prevented at the earliest.

No specific treatment and vaccine are available till now. But research
continues and hopefully, success is not far off.

The right information about this infection should reach patients as well
as physicians. It will prevent unnecessary panic.

In August, Brazil is going to organize the Olympic and Paralympic Games
and all eyes are now focused on this. In this review article, the authors
have tried to focus on the important points about this infection.

The data were gathered after searching for relevant articles published in
PubMed, the World Health Organization’s (WHO) website, Centers for Disease
Control and Prevention’s (CDC) website, and some other related websites on
the Internet.

KEYWORDS: Aedes mosquitoes; Zika virus (ZIKV); microcephaly; pregnancy

Free Open Access Article
__________________________________________________________________
________________________________*_________________________________

18. New Report: US Institute of Medicine publishes the first phase of a
report on eliminating hepatitis B and C in the United States

Crossposted from IAC Express with thanks. The Immunization Action
Coalition welcomes redistribution of this issue of IAC Express or selected
articles. http://www.immunize.org/express/issue1242.asp
__________________________________________________________________
US Institute of Medicine publishes the first phase of a report on
eliminating hepatitis B and C in the United States
On April 11, the Institute of Medicine (IOM) published Eliminating the
Public Health Problem of Hepatitis B and C in the U.S. This report
explores the barriers that must be overcome to eliminate hepatitis B and C
in the United States, and reaffirms that hepatitis B and C elimination can
be achieved with sufficient resources, commitment, and strategies. The
introduction is reprinted below.

Viral hepatitis is the seventh leading cause of death in the world,
killing more people than road traffic injuries, HIV and AIDS, or diabetes.
Every year chronic viral hepatitis, of which hepatitis B and C are the
most common forms, kills a million people, roughly 20,000 of them in the
United States. These deaths could be prevented. Hepatitis B vaccine
conveys 95 percent immunity, and new therapies for hepatitis C cure the
vast majority of patients. A recent report from the National Academies of
Sciences, Engineering, and Medicine concluded that both hepatitis B and C
could be rare diseases in the United States, but there are substantial
obstacles to meeting this goal. The Centers for Disease Control and
Prevention Division of Viral Hepatitis and Department of Health and Human
Services Office of Minority Health commissioned the Academies to work in
two parts. The first report discusses the feasibility of eliminating
hepatitis B and C from the United States. A second report from the same
committee will recommend specific actions to hasten the end of these
diseases. This report will be released in 2017.

Go to Eliminating the Public Health Problem of Hepatitis B and C in the
U.S. to access different ways to order, download, and read the report.

https://tinyurl.com/zz28e3u
__________________________________________________________________
________________________________*_________________________________

19. News

– Philippines: Fake vaccine gang busted in Las Piñas

Selected news items reprinted under the fair use doctrine of international
copyright law: http://www4.law.cornell.edu/uscode/17/107.html
__________________________________________________________________
http://www.mb.com.ph/fake-vaccine-gang-busted-in-las-pinas/
Philippines: Fake vaccine gang busted in Las Piñas

by Jean Fernando, Manila Bulletin, Philippines (01.05.16)

The Las Piñas City police arrested four persons engaged in the
distribution of fake vaccines during a buy-bust operation Saturday night.

Sr. Supt. Jemar Modequillo, Las Piñas City police chief identified the
arrested suspects as Danilo Olivero,59, of Tayuman, Tondo Manila and said
to be the leader of the group; Abdul Camid Masa Pantawagas,35; Zapro
Halid and Khadafi Cadar, all residents of Teoville 3 Subdivision,
Paranaque City.

Modequilo said that the arrest of the four suspects came after Felix
Flores Jr., officer-in-charge operations manager of 2 World Traders Inc.
sought police assistance regarding the proliferation of fake drugs with
generic name Tetanus Antitoxin and carrying the brand name Antitet.

He said that a team was immediately formed for the arrest of the four
suspects.

The four suspects were arrested at around 8 p.m. at the parking lot of a
shopping mall along Alabang-Zapote Road, Las Piñas City.

Modequillo said that prior to the arrest of the four suspects, they
communicated with Flores for the sale of the vaccine at a cheaper price.

Flores agreed to meet with the suspects, without knowing that the person
they were dealing with is the operations manager of the company which is
the sole distributer of the said vaccine.

The police team which was formed by Modequilo immediately swooped down the
four suspects after they handed to Flores the 3 boxes containing 3,470
ampoules of the said fake vaccines worth P385,000.

The four suspects were now detained at the Las Piñas City police detention
cell pending the filing of appropriate charges.
__________________________________________________________________
________________________________*_________________________________

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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