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SIGNpost 00852


Post00852 Listserv Moves in May + Job +  Abstracts + News     11 May 2016

0. Moderators Note: Moving to a new Listserv at the end of May 2016
1. Abstract: Needlestick injuries at a tertiary teaching hospital in
2. Abstract: Accidents at work in the health care – legal aspects in
3. Abstract: Post exposure prophylaxis following occupational exposure to
HIV: a survey of health care workers in Mbeya, Tanzania, 2009-2010
4. Abstract: Patient safety and quality of care in developing countries
in Southeast Asia: a systematic literature review
5. Abstract: Acceptability and Feasibility of Delivering Pentavalent
Vaccines in a Compact, Prefilled, Autodisable Device in Vietnam and
6. Abstract: Nurse Perceptions and Safety Practices of the Carpuject
Cartridge System
7. Abstract: An Investigation into Dental Local Anaesthesia Teaching in
United Kingdom Dental Schools
8. Abstract: Safety of epidural steroid injections
9. Abstract: The Influence of Contextual and Psychosocial Factors on
10. Abstract: Injectable silk foams for soft tissue regeneration
11. Vacancy: Senior Immunization Specialist (Routine Immunization), P-5,
NYHQ O/P to Nairobi, Kenya, #16789
12. News
– USA: Exclusive: Patient safety issues prompt leadership shake-up at NIH
– Hepatitis C – Israel: (Jerusalem) Nosocomial
– USA: Hepatitis C is Killing More of Us Each Year Than Any Other
Infectious Disease
– UK: Dad’s horror after finding blood-filled syringes and dirty needles
dumped outside his Wirral home
– USA: Hepatitis C Now Leading Infectious Disease Killer in U.S.

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1. Abstract: Needlestick injuries at a tertiary teaching hospital in

Epidemiol Infect. 2016 May 6:1-6.
Needlestick injuries at a tertiary teaching hospital in Singapore.

Seng M1, Sng GK2, Zhao X2, Venkatachalam I3, Salmon S3, Fisher D3.

1Preventive Medicine,National University Health System,Singapore.
2Saw Swee Hock School of Public Health,National University of Singapore,
National University Health System,Singapore.
3Division of Infectious Diseases,University Medicine Cluster, National
University Health System,Singapore,Singapore.

This study investigated the incidence and risk to staff groups for
sustaining needlestick injuries (NSIs) in the National University
Hospital (NUH), Singapore.

A retrospective cohort review of incident NSI cases was undertaken to
determine the injury rate, causation, and epidemiological profile of such

Analysis of the risk of sustaining recurrent NSI by occupation and
location was done using the Cox proportional hazards model.

There were 244 NSI cases in 5957 employees in NUH in 2014, giving an
incidence rate of 4·1/100 healthcare workers (HCWs) per year. The
incidence rate was highest for doctors at 21·3, and 2·7 for nurses; 40·6%
of injuries occurred in wards, and 32·8% in operating theatres.

There were 27 cases of repeated NSI cases.

The estimated cost due to NSIs in NUH ranged from US$ 109 800 to US$ 563
152 in 2014.

We conclude that creating a workplace environment where top priority is
given to prevention of NSIs in HCWs, is essential to address the high
incidence of reported NSIs.

The data collected will be of value to inform the design of prevention
programmes to reduce further the risk of NSIs in HCWs.

KEYWORDS: Needlestick injuries; occupational health

2. Abstract: Accidents at work in the health care – legal aspects in
Pol Merkur Lekarski. 2016 Jan;40(235):70-4.

Accidents at work in the health care – legal aspects in Poland.

Szereda K1, Szymanska J2.

1Social Insurance Company (ZUS), Branch Office in Lublin, Poland.
2Chair and Department of Pedodontics, Medical University of Lublin,

An accident at work is a sudden event caused by external circumstances
that occurred in relation to work. Referring to the current legislation,
the Supreme Court judgments and the opinions contained in publications,
the authors discuss the legal aspects of selected accidents: needle stick
injuries, cuts with other sharp tools, heart attacks and strokes among
health professionals and social workers in Poland.

It has been stressed that defining rigid criteria that allow for stating
unequivocal work – accidents relationships would be difficult or even

Especially in the case of medical personnel the long-term and negative
impact of stress on health is significant, and thus the occurrence of
work accidents – heart attack or stroke.

© 2016 MEDPRESS.

KEYWORDS: Poland; accident at work; health care workers; law

3. Abstract: Post exposure prophylaxis following occupational exposure to
HIV: a survey of health care workers in Mbeya, Tanzania, 2009-2010

Pan Afr Med J. 2015 May 15;21:32. Free Full Text

Post exposure prophylaxis following occupational exposure to HIV: a
of health care workers in Mbeya, Tanzania, 2009-2010.

Mponela MJ1, Oleribe OO2, Abade A3, Kwesigabo G4.

1Tanzania Field Epidemiology and Laboratory Training Program (TFELTP),
Tanzania ; Muhimbili University of Health and Allied Sciences (MUHAS),
2Excellence & Friends Management Care Center, Abuja, Nigeria.
3Tanzania Field Epidemiology and Laboratory Training Program (TFELTP),
4Muhimbili University of Health and Allied Sciences (MUHAS), Tanzania.

INTRODUCTION: Approximately, 1,000 HIV infections are transmitted
annually to health care workers (HCWs) worldwide from occupational
exposures. Tanzania HCWs experience one to nine needle stick injuries
(NSIs) per year, yet the use of post-exposure prophylaxis (PEP) is
largely undocumented. We assessed factors influencing use of PEP among
HCWs following occupational exposure to HIV.

METHODS: A cross-sectional study was conducted in Mbeya Referral
Hospital, Mbozi and Mbarali District Hospitals from December 2009 to
January 2010 with a sample size of 360 HCWs. Participants were randomly
selected from a list of eligible HCWs in Mbeya hospital and all eligible
HCWs were enrolled in the two District Hospitals. Information regarding
risk of exposure to body fluids and NSIs were collected using a
questionnaire. Logistic regression was done to identify predictors for
PEP use using Epi Info 3.5.1 at 95% confidence interval.

RESULTS: Of 291 HCWs who participated in the study, 35.1% (102/291) were
exposed to NSIs and body fluids, with NSIs accounting for 62.9% (64/102).
Exposure was highest among medical attendants 38.8% (33/85). Out of
exposed HCWs, (22.5% (23/102) used HIV PEP with females more likely to
use PEP than males. Reporting of exposures (OR=21.1, CI: 3.85-115.62) and
having PEP knowledge (OR =6.5, CI: 1.78-23.99) were significantly
associated with using PEP.

CONCLUSION: Despite the observed rate of occupational exposure to HCWs in
Tanzania, use of PEP is still low. Effective prevention from HIV
infection at work places is required through proper training of HCWs on
PEP with emphasis on timely reporting of exposures.

KEYWORDS: HIV; Post exposure prophylaxis; health care workers;
occupational exposure

4. Abstract: Patient safety and quality of care in developing countries
in Southeast Asia: a systematic literature review

Int J Qual Health Care. 2015 Aug;27(4):240-54.
Patient safety and quality of care in developing countries in Southeast
Asia: a systematic literature review.

Harrison R1, Cohen AW1, Walton M1.

1School of Public Health, University of Sydney, Sydney, New South Wales
2006, Australia.

OBJECTIVE: To establish current knowledge of patient safety and quality
of care in developing countries in Southeast Asia, current interventions
and the knowledge gaps.

STUDY DESIGN: Systematic review and narrative synthesis.

DATA SOURCES: Key words, synonyms and subject headings were used to
search seven electronic databases in addition to manual searching of
relevant journals.

DATA SYNTHESIS: Titles and abstracts of publications between 1990 and
2014 were screened by two reviewers and checked by a third. Full text
articles were screened against the eligibility criteria. Data on design,
methods and key findings were extracted and synthesized.

RESULTS: Four inter-related safety and quality concerns were evident from
33 publications: (i) the risk of patient infection in healthcare
delivery, (ii) medications errors/use, (iii) the quality and provision of
maternal and perinatal care and (iv) the quality of healthcare provision

CONCLUSIONS: Large-scale prevalence studies are needed to identify the
full range of safety and quality problems in developing countries in
Southeast Asia.

Sharing lessons learnt from extensive quality and safety work conducted
in industrialized nations may contribute to significant improvements. Yet
the applicability of interventions utilized in developed countries to the
political and social context in this region must be considered.

Strategies to facilitate the collection of robust safety and quality data
in the context of limited resources and the local context in each country
are needed.

© The Author 2015. Published by Oxford University Press in association
with the International Society for Quality in Health Care; all rights

KEYWORDS: patient safety, developing countries; patient safety, incident
reporting and analysis; patient safety, medical errors; quality culture;
quality management, adverse events; specific populations

5. Abstract: Acceptability and Feasibility of Delivering Pentavalent
Vaccines in a Compact, Prefilled, Autodisable Device in Vietnam and

PLoS One. 2015 Jul 17;10(7):e0132292. Open Access
Acceptability and Feasibility of Delivering Pentavalent Vaccines in a
Compact, Prefilled, Autodisable Device in Vietnam and Senegal.

Guillermet E1, Dicko HM1, Mai le TP2, N’Diaye M3, Hane F4, Ba SO3, Gomis
K3, Tho NT2, Lien NT2, Than PD2, Dinh TV2, Jaillard P1, Gessner BD1,
Colombini A1.

1Agence de Médecine Préventive (AMP), Ferney-Voltaire, France.
2Ministry of Health, National Institute of Hygiene and Epidemiology, Hai
Ba Trung, Ha Noi, Viet Nam.
3Ministry of Health, Fann Résidence, Dakar, Senegal.
4University of Ziguinchor, Ziguinchor, Senegal.

BACKGROUND: Prefilled syringes are the standard in developed countries
but logistic and financial barriers prevent their widespread use in
developing countries. The current study evaluated use of a compact,
prefilled, autodisable device (CPAD) to deliver pentavalent vaccine by
field actors in Senegal and Vietnam.

METHODS: We conducted a logistic, programmatic, and anthropological study
that included a) interviews of immunization staff at different health
system levels and parents attending immunization sessions; b) observation
of immunization sessions including CPAD use on oranges; and c) document

RESULTS: Respondents perceived that the CPAD would improve safety by
being non-reusable and preventing needle and vaccine exposure during
preparation. Preparation was considered simple and may reduce
immunization time for staff and caretakers. CPAD impact on cold storage
requirements depended on the current pentavalent vaccine being used; in
both countries, CPAD would reduce the weight and volume of materials and
safety boxes thereby potentially improving outreach strategies and waste
disposal. CPAD also would reduce stock outages by bundling vaccine and
syringes and reduce wastage by using a non-breakable plastic
presentation. Respondents also cited potential challenges including
ability to distinguish between CPAD and other pharmaceuticals delivered
via a similar mechanism (such as contraceptives), safety, and concerns
related to design and ease of administration (such as activation, ease of
delivery, and needle diameter and length).

CONCLUSIONS: Compared to current pentavalent vaccine presentations in
Vietnam and Senegal, CPAD technology will address some of the main
barriers to vaccination, such as supply chain issues and safety concerns
among health workers and families. Most of the challenges we identified
can be addressed with health worker training, minor design modifications,
and health messaging targeting parents and communities. Potentially the
largest remaining barrier is the marginal increase in pentavalent cost–
if any–from CPAD use, which we did not assess in our study.

6. Abstract: Nurse Perceptions and Safety Practices of the Carpuject
Cartridge System

J Nurs Care Qual. 2016 May 3.
Nurse Perceptions and Safety Practices of the Carpuject Cartridge System.

Prentiss AS1, Cockerel A, Butler E.

1Baptist Hospital of Miami, Baptist Health South Florida, Miami.

Injectable medications have been found to be associated with a higher
incidence of errors than with other medication preparations. Carpuject
syringe systems have been implemented to protect patients and improve
safety; however, an overall lack of knowledge of the device was
discovered. The purpose of this study, using a pre/postsurvey design, was
to investigate nursing knowledge of and practices with the prefilled
Carpuject syringe system and narcotic dilution practices before and after
multidisciplinary interventions. Statistically significant differences
were found before and after interventions.

7. Abstract: An Investigation into Dental Local Anaesthesia Teaching in
United Kingdom Dental Schools

SAAD Dig. 2016 Jan;32:7-13.
An Investigation into Dental Local Anaesthesia Teaching in United Kingdom
Dental Schools.

Oliver G, DavidD A, Bell C, Robb N.

AIM: To review the current teaching of the use and administration of
local anaesthesia in United Kingdom dental schools, along with their
local guidelines and protocols.

METHODS: A qualitative and quantitative questionnaire was sent to sixteen
UK dental schools to probe the methods of local anaesthetic teaching
within each school.

RESULTS: 14 of the 16 schools replied and the responses show a variety of
practices being taught in the dental schools. 2% Lidocaine 1:80,000
Adrenaline is the first choice local anaesthetic solution for the
majority of clinical situations.

CONCLUSION: 2% Lidocaine with 1:80,000 Adrenaline remains the gold
standard dental local anaesthetic with teaching about its safety and uses
in all but a few situations. Most are taught the use of additional aids
such as safety syringes and topical anaesthesia. There is variation with
regards to the use of alternative anaesthetic agents.

8. Abstract: Safety of epidural steroid injections

Expert Opin Drug Saf. 2016 May 5.
Safety of epidural steroid injections.

Schneider B1, Zheng P1, Mattie R1, Kennedy DJ1.

1a Stanford University , Department of Orthopedics , 450 Broadway Street,
Redwood City CA , 94063.

INTRODUCTION: Epidural steroid injections (ESI) are a commonly utilized
treatment for cervical and lumbar radicular pain. All medical procedures
and medications carry an inherent level of risk, that must be balanced
with the effectiveness of the treatment to determine the risk to benefit
ratio for a patient.

Areas covered: This article will outline the risks of ESIs and in doing
so help shed light on the procedural risks versus the risks of the
medication. Additionally, it will help differentiate minor adverse events
from significant permanent complications. Expert

Opinion: Catastrophic complications of ESI such as paralysis and stroke
unquestionably warrant the recent increased attention given to the safety
of these injections.

While a single major complication is unacceptable, the relative rate of
these major complications must be put in prospective. The true rate is
small enough that it is impossible to calculate.

All cases are limited to case reports and not detected in even the
largest published cohorts of ESI. Moreover, recent advances in medication
selection and technique have further reduced the incidence of these very
rare complications. Conversely, the more common adverse events are rather
minor, generally transient, and mostly occur at incidences of less than

KEYWORDS: Complications; Epidural; Hematoma; Injection; Paralysis;

9. Abstract: The Influence of Contextual and Psychosocial Factors on

Am J Trop Med Hyg. 2016 May 2. pii: 15-0657.
The Influence of Contextual and Psychosocial Factors on Handwashing.

Seimetz E1, Boyayo AM1, Mosler HJ2.

1Department of Environmental Social Sciences, Eawag: Swiss Federal
Institute of Aquatic Science and Technology, Duebendorf, Switzerland;
Institut Universitaire de Sciences de la Santé, Université de Ngozi,
2Department of Environmental Social Sciences, Eawag: Swiss Federal
Institute of Aquatic Science and Technology, Duebendorf, Switzerland;
Institut Universitaire de Sciences de la Santé, Université de Ngozi,

Even though washing hands with soap is among the most effective measures
to reduce the risk of infection, handwashing rates in infrastructure-
restricted settings remain seriously low. Little is known about how
context alone and in interaction with psychosocial factors influence hand
hygiene behavior.

The aim of this article was to explore how both contextual and
psychosocial factors affect handwashing practices.

A cross-sectional survey was conducted with 660 caregivers of primary
school children in rural Burundi.

Hierarchical regression analyses revealed that household wealth, the
amount of water per person, and having a designated place for washing
hands were contextual factors significantly predicting handwashing
frequency, whereas the contextual factors, time spent collecting water
and amount of money spent on soap, were not significant predictors.

The contextual factors explained about 13% of the variance of reported
handwashing frequency. The addition of the psychosocial factors to the
regression model resulted in a significant 41% increase of explained
variation in handwashing frequency. In this final model, the amount of
water was the only contextual factor that remained a significant

The most important predictors were a belief of self-efficacy, planning
how, when, and where to wash hands, and always remembering to do so.

The findings suggest that contextual constraints might be perceived
rather than actual barriers and highlight the role of psychosocial
factors in understanding hygiene behaviors.

© The American Society of Tropical Medicine and Hygiene.

10. Abstract: Injectable silk foams for soft tissue regeneration
Free PMC Article

Adv Healthc Mater. 2015 Feb 18;4(3):452-9.
Injectable silk foams for soft tissue regeneration.

Bellas E1, Lo TJ, Fournier EP, Brown JE, Abbott RD, Gil ES, Marra KG,
Rubin JP, Leisk GG, Kaplan DL.

1Biomedical Engineering, Tufts University, Medford, MA, 02155, USA.

Soft tissue fillers are needed for restoration of a defect or
augmentation of existing tissues. Autografts and lipotransfer have been
under study for soft tissue reconstruction but yield inconsistent
results, often with considerable resorption of the grafted tissue.

A minimally invasive procedure would reduce scarring and recovery time as
well as allow the implant and/or grafted tissue to be placed closer to
existing vasculature. Here, the feasibility of an injectable silk foam
for soft tissue regeneration is demonstrated. Adipose-derived stem cells
survive and migrate through the foam over a 10-d period in vitro. The
silk foams are also successfully injected into the subcutaneous space in
a rat and over a 3-month period integrating with the surrounding native
tissue. The injected foams are palpable and soft to the touch through the
skin and returning to their original dimensions after pressure is applied
and then released.

The foams readily absorb lipoaspirate making the foams useful as a
scaffold or template for existing soft tissue filler technologies, useful
either as a biomaterial alone or in combination with the lipoaspirate.

© 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

KEYWORDS: biomedical applications; porous scaffolds; regenerative
medicine; silk; soft tissue

11. Vacancy: Senior Immunization Specialist (Routine Immunization), P-5,
NYHQ O/P to Nairobi, Kenya, #16789

Opening Date 4 May 2016 E. Africa Standard Time
Closing Date 26 May 2016 E. Africa Standard Time

To apply go to

[Edited for space, full text at the link]

Senior Immunization Specialist (Routine Immunization), P-5, NYHQ O/P to
Nairobi, Kenya, #16789

Job Number: 495858 |
Location: Programme Division, UNICEF NYHQ
Work Type : Fixed Term Staff

If you are a committed, creative professional and are passionate about
making a lasting difference for children, the world’s leading children’s
rights organization would like to hear from you.

For 70 years, UNICEF has been working on the ground in 190 countries and
territories to promote children’s survival, protection and development.
The world’s largest provider of vaccines for developing countries, UNICEF
supports child health and nutrition, good water and sanitation, quality
basic education for all boys and girls, and the protection of children
from violence, exploitation, and AIDS. UNICEF is funded entirely by the
voluntary contributions of individuals, businesses, foundations and

Purpose of the Position

Under the general guidance of the Senior Immunization Specialist in the
Immunization Unit, Health Section, the incumbent will provide technical
assistance to regional and country offices primarily in Africa in the
design, formulation, management, execution, monitoring and evaluation of
routine immunization programs, ensuring that corresponding plans of
action and programme activities are in place and funded to improve
routine immunization coverage and equity. They will provide support to
UNICEF Regional and Country offices and national governments, with a
special focus on ensuring health systems are inclusive of children who
are socially, geographically and economically marginalized from accessing
routine immunization services, and other basic health and nutrition
packages. In coordination with the HQ and regional colleagues, the
incumbent will monitor progress of countries based on regular review of
key immunization indicators and support the reporting to global partners.

Key Expected Results [EDITED]

1. Equity and immunization analysis and strategy development:

2. Monitoring and evaluation of equity strategies in immunization:

3. Advocacy for Immunization and equity:

4. Documentation of equity strategies in immunization:

5. Representation:

Qualifications of Successful Candidate

Advanced university degree in public health, or a related technical field

Ten years relevant experience in public health programs, of which at
least 6-8 years is in developing countries. Experience in more than one
country is an advantage.

Extensive experience in providing technical assistance to and/or managing
a national routine immunization program, especially a developing country
context. Specific experience in supporting health and/or immunization
programs develop and implement successful strategies to reach out to and
actively engage populations containing children who are socially,
geographically and economically marginalized from accessing health and/or
routine immunization services is desirable.

Demonstrated experience in health policy development, advocacy and
financial/program management, workforce training and presenting at
conference/large meetings.

Technical expertise in epidemiology, disease control and immunization.

Peer-reviewed publications on immunization is an advantage.

Previous work experience in a UN context an asset.

Fluency in English is required (another UN language, i.e. French is

Competencies of Successful Candidate

Core Values

Diversity and Inclusion
Core competencies

Communication: Level III
Working with People: Level III
Drive for Results: Level III
Functional Competencies

Applying Technical Expertise: Level III
Planning and Organizing: Level III
Formulating Strategies and Concepts: Level III
Relating and Networking: Level III
Learning and Researching: Level III
Creating and Innovating: Level III
Technical Knowledge: Level III
To view our competency framework, please click here.

UNICEF is committed to diversity and inclusion within its workforce, and
encourages qualified female and male candidates from all national,
religious and ethnic backgrounds, including persons living with
disabilities, to apply to become a part of our organisation.

Opening Date 4 May 2016 E. Africa Standard Time
Closing Date 26 May 2016 E. Africa Standard Time

12. News

– USA: Exclusive: Patient safety issues prompt leadership shake-up at NIH

– Hepatitis C – Israel: (Jerusalem) Nosocomial

– USA: Hepatitis C is Killing More of Us Each Year Than Any Other
Infectious Disease

– UK: Dad’s horror after finding blood-filled syringes and dirty needles
dumped outside his Wirral home

– USA: Hepatitis C Now Leading Infectious Disease Killer in U.S.

Selected news items reprinted under the fair use doctrine of
international copyright law:
USA: Exclusive: Patient safety issues prompt leadership shake-up at NIH

By Lena H. Sun, The Washington Post, USA (10.05.16)

The National Institutes of Health is overhauling the leadership of its
flagship hospital after an independent review concluded that patient
safety had become “subservient to research demands” on the agency’s
sprawling Bethesda campus.

The shake-up at the NIH Clinical Center, which was announced to staff
Tuesday, represents the most significant restructuring at the nation’s
premier biomedical research institution in more than half a century.

Full free article at the link


” Last June, NIH halted operations at part of the unit after the FDA
conducted an inspection following fungal contamination in materials
intended for injection. The inspection also found defects in the unit’s
air handling system and a lack of compliance with standard operating
procedures. ”

” The report concluded that the pharmacy unit was running beyond its
physical and personnel capacity. Responsiveness to investigator requests
gradually became de facto prioritized above patient safety,” it said.”
Hepatitis C – Israel: (Jerusalem) Nosocomial

Crossposted with thanks from ProMED-mail <>
ProMED-mail is a program of the International Society for Infectious
Diseases <>

Date: Tue 10 May 2016 Source: Israel Hayom [edited]

The Health Ministry on [Mon 9 May 2016], launched an epidemiological
investigation into potential negligence in a Jerusalem hospital, after
5 people who underwent medical tests there on the same day were
diagnosed with hepatitis C. All 5 cases were traced back to
computerized axial tomography [CAT] scans that included the injection
of a contrasting agent, performed in Misgav Ladach Hospital in the
capital on 17 Mar 2016. 7 other individuals, who underwent CAT scans
on the same day, were contacted by ministry officials and asked to
come in for additional testing.

Hepatitis C is an infectious disease that primarily affects the liver.
About 80 percent of those exposed to the virus develop a chronic
infection, placing them in higher risk for liver failure, liver
cancer, or esophageal and gastric varices. There is no vaccine against
hepatitis C.

“The Shaare Zedek Medical Center [in Jerusalem] has diagnosed 3 cases
of acute hepatitis C, all of which were traced back to CAT scans
performed at Misgav Ladach,” Professor Itamar Grotto, head of the
Health Ministry’s Public Health and Disease Prevention Department told
Israel Hayom. “The review so far has found 2 more cases, one in
Hadassah Medical Center’s Mount Scopus campus, and another in its Ein
Kerem campus [Jerusalem], also involving the same date and injected
contrasting agent,” he explained. “Since hepatitis C infections
involve primarily blood-to-blood contact, we believe the intravenous
process is linked.” Grotto stressed that “these incidents are limited
to a specific date, and we know of 12 people who were given a
contrasting agent. It will take time to determine the origin of the

Misgav Ladach has temporarily closed its imaging center, referring
patients to other centers in Jerusalem. Meuhedet Health Care, Israel’s
3rd largest health care services provider that operates Misgav Ladach,
said the measure was a precautionary one, and that it was cooperating
with the Health Ministry’s investigation in full.

[Byline: Maytal Yasur Beit-Or]

Communicated by: ProMED-mail from HealthMap Alerts

[Clearly the intravenous contrast vial, or more likely the injection
apparatus itself, was contaminated with the hepatitis C virus. It
would be interesting to know the order of the CT scans in the 12
patients. Most cases of acute hepatitis C are subclinical or at least
anicteric (without jaundice) but the clinical characteristics of the 5
patients are not reported. – Mod.LL]
West Virginia USA: DHHR notifies more Raleigh Heart Clinic patients about
hepatitis risk

by Elaina Sauber, Charleston Gazette-Mail, West Virginia USA (09.05.16)
State health officials have notified more patients who may have been
exposed to hepatitis B, hepatitis C and HIV at the Raleigh Heart Clinic
in Beckley.

The West Virginia Department of Health and Human Resources announced
Monday that four additional cases of hepatitis C were detected by the
state Bureau of Public Health.

All of those cases were contracted before March 1, 2012 — which was the
original date state health officials had said patients at the Beckley
clinic were first exposed to risk.

The agency now recommends anyone who may have received a stress test at
the clinic prior to that date should consider being tested for those
diseases, according to a DHHR news release.

A bureau investigation conducted from November of 2014 to March of 2015
identified 12 patients who had contracted hepatitis B or hepatitis C —
all of whom received the cardiac stress tests.

While those cases all linked back to the clinic, there’s no definitive
answer as to how they were transmitted. Aside from reusing needles, the
viruses could have also been spread by medical staff reusing single-use
vials of medicine, not wearing proper equipment or not sanitizing the
area of the injection site, according to previous Gazette-Mail reports.

On March 11, the bureau issued more than 2,300 notifications to Raleigh
Heart Clinic patients who underwent stress testing with the use of
injectable medications between March 1, 2012, and March 27, 2015.

Dr. Rahul Gupta, state health officer, said the extent of possible
exposure to the diseases was unknown in March, when the notifications
were first sent out.

The bureau also set up a hotline that patients from the clinic could call
to report any additional diagnoses.

“We got calls from an individual who was diagnosed with Hepatitis C as
far back as October of 2010,” Gupta said.

On April 18, the department expanded its Frequently Asked Questions page
on the pathogen exposure, encouraging patients who received a cardiac
stress test at the clinic prior to March 1, 2012, to talk to their doctor
about whether they should be tested.

The bureau then heard from three more patients who were diagnosed with
Hepatitis C sometime between October 2010 and March 1, 2012.

“When we [received] more calls, we felt compelled to expand the
notification process to patients who’d had such tests … at that clinic
to ensure all individuals should get tested,” Gupta said.

He added that the “overwhelming majority” of calls made to the hotline
were from residents of Raleigh, Fayette and Wyoming counties.

The four new cases, however, “cannot be conclusively linked to the
clinic,” according to the press release.

Gupta stressed there have been no reported transmissions since March 30,
2015, when the clinic’s employees underwent training measures to ensure
they used only single-patient-dose vials and medications. The state
Health Department also ordered the clinic to switch to needle-free
injection systems, and staff was advised to obtain training on infection
control and injection safety.

The local health department has since visited the clinic to verify those
recommendations were followed, according to the Department of Health and
Human Resources.

It’s unclear how long the clinic had been conducting cardiac stress tests
via injection. Calls made to the clinic Monday were not returned.

The original 12 patients diagnosed included eight who contracted
hepatitis C after a heart stress test on three different days, and four
who got hepatitis B after a heart stress test on two different days,
according to health officials.

While there hasn’t been any evidence of HIV transmission, patients are
recommended to get tested because it is transmitted the same way as

Left untreated, hepatitis C can cause liver cancer and cirrhosis.

At least two lawsuits have been filed against the clinic since late March
in Raleigh Circuit Court.

The suits, filed by two women who were patients during the exposure
period, allege that the clinic recklessly and knowingly put patients’
lives at risk by exposing them to potentially deadly blood-borne

Those who want to be tested may receive testing by their healthcare
provider or local health department.

The bureau’s hotline is available at 1-800-642-8244 to answer questions
from patients of the clinic who have questions about the notification.
USA: Hepatitis C is Killing More of Us Each Year Than Any Other
Infectious Disease

By Joanna Hayden PHD, CHES,, USA (09.05.16)

According to a report by the Centers for Disease Control published last
week in the journal Clinical Infectious Diseases, hepatitis C killed
almost 20,000 Americans in 2013. More of us died from hepatitis C than
from 60 other infectious diseases combined, including HIV and TB, with
‘baby boomers’ at greatest risk.

Summary source: Preidt, R. Hepatitis C Now Leading Infectious Disease
Killer in U.S. [Internet] HealthDay;2016 May 4 [cited 2016 May 8]
Available from:

CDC press release:

Hepatitis C is a virus that infects the liver. Prior to 1992, it spread
most commonly through blood transfusions and transplanted organs from
people who had the disease, which is why “baby boomers” are more likely
to be infected. Since 1992 when strict screening of blood and organ
donations for hepatitis C was put into place, the most common ways it
spreads is through sharing needles or syringes for injecting drugs, being
stuck by a needle in a health care setting that contains blood from an
infected person, or being born to a mom with the virus. Other less common
ways are from using an infected person’s razor or toothbrush, since there
may be blood on these items, or from sexual contact.

The hepatitis C virus is pretty tough as virus’s go, being able to
‘survive’ outside the body on hard surfaces (counter tops, bathroom
sinks, door knobs etc.,) for up to three weeks. To give you a comparison,
the flu virus only survives outside the body on hard surfaces for 2 – 8
hours. Cleaning surfaces with a 1 part bleach to 10 parts water solution
will kill the virus. (1/4 cup bleach mixed in 2 ½ cups water.)

Don’t think you’ll watch out for the symptoms, because in up to 80% of
cases, there aren’t any! This is why so many of us are infected and
don’t know it.

When there are symptoms, they usually take 6 – 7 weeks to show up, but
can happen anywhere from 2 weeks to 6 months after being infected. They
start off with a fever, tiredness, lack of appetite, nausea, vomiting and
joint pain all of which are common symptoms of other viral infections, so
can be easily mistaken for the flu, for example. But, with hepatitis C
you’ll also have pain in the abdomen, very dark urine, bowel movements
the color of clay, and the biggest telltale sign – the whites of your
eyes will turn yellow, as will your skin.

For up to 85% of people with hepatitis C, the virus remains in their
livers for the rest of their lives, being able to be spread to others
through their blood. For many of them, it will end up causing liver
failure, cirrhosis, liver cancer and for almost 20,000 people a year,
they will die from it, as the report above showed.

So, the take home message from this is – get tested for hepatitis C. All
it takes is a blood test to find out if you had or still have the virus.
Talk to your health care provider if you:

– were born between 1945 through 1965

– were treated for a blood clotting problem before 1987.

– received a blood transfusion or organ transplant before July 1992.

– are on long-term hemodialysis treatment.

– have abnormal liver tests or liver disease.

– work in health care or were exposed to blood through a needle stick
or other sharp object injury.

– are infected with HIV.

– currently or formerly used injection drug, even if you only injected
one time or did so many years ago.

There is treatment available for hepatitis C, but the first step is
finding out if you have the virus.

For more information:

Centers for Disease Control

World Health Organization – Fact sheet

National Institutes of Health

The opinions expressed herein are the writer’s alone, and do not reflect
the opinions of or anyone who works for is not responsible for the accuracy of any of the information
supplied by the writer.
UK: Dad’s horror after finding blood-filled syringes and dirty needles
dumped outside his Wirral home

By Craig Manning, Wirral Globe, Wirral UK. (06.05.16)

[Photo: Syringes and blood-stained swabs left scattered on the pavement]
Syringes and blood-stained swabs left scattered on the pavement

Blood-filled syringes have been found dumped in a Wirral street.

The discovery was made on Tuesday evening in Rock Ferry.

Householder Vincent Ashman fears public safety is being put at risk after
he discovered the used needles and blood-stained swabs scattered at the
front of his home.

Wirral Globe:

The 53-year-old security guard, above, said it is the latest incident in
a catalogue of anti-social behavior in his neighbourhood.

Mr Ashman, a father-of-two, has lived with his family in Moore Avenue for
21 years – but is now considering moving away.

And he feels let down by the police response when he reported the drug

“After finding the syringes I reported it to the police who said ‘it’s
nothing to do with us’ and passed me on to the council.

“One of the syringes had blood in it and another a liquid which I assumed
was heroin or something similar.

“Imagine if the needles had been picked up by a child on their way to

“The police are on patrol in the wrong areas. You’ll probably see more on
the beat in quieter areas like West Kirby than there are around here.

“The police and council are cutting back so much that soon people will be
left with no choice but to fend for themselves.”

He added: “This was a great estate, but now we want to get out.

“There’s no visible police presence here anymore.

“You may as well fend for yourself.”

Wirral Globe:

Wirral Council said: “We were informed about this incident at 9am this
morning [Wednesday] and within half-an-hour we had a Biffa crew round to
safely collect and dispose of the items.”

The local authority’s website has an online form to fill in if you
discover needles or syringes.

They advise if you find a syringe with a needle attached – or a needle by
itself – do not touch it but report it via the form as soon as possible.

They say they will aim to respond within two working hours.

To access the form click here.

Police are investigating the incident.

Neighbourhood Inspector Georgie Minnery said: “We take all reports of
drug use and dealing seriously and our neighbourhood officers have been
made aware of this location.

“We will also be speaking further with the resident who highlighted this
issue to us, as information from our community is vital in addressing
these issues, which affect the quality of life and safety of our
USA: Hepatitis C Now Leading Infectious Disease Killer in U.S.

CDC notes that nearly 20,000 Americans died in 2014 from the widespread,
but treatable, illness

By Robert Preidt, HealthDay (04.05.16)

WEDNESDAY, May 4, 2016 (HealthDay News) — The number of hepatitis C-
linked deaths in the United States reached a record high in 2014, and the
virus now kills more Americans than any other infectious disease, health
officials report.

There were 19,659 hepatitis C-related deaths in 2014, according to
preliminary data from U.S. Centers for Disease Control and Prevention.

Those tragically high numbers aren’t necessary, one CDC expert said.

“Why are so many Americans dying of this preventable, curable disease?
Once hepatitis C testing and treatment are as routine as they are for
high cholesterol and colon cancer, we will see people living the long,
healthy lives they deserve,” said Dr. Jonathan Mermin said in an agency
news release.

He directs the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD,
and TB Prevention.

If not diagnosed and treated, people with hepatitis C are at increased
risk for liver cancer and other life-threatening diseases. They may also
unknowingly infect others.

The new CDC study found that the number of hepatitis C-related deaths in
2013 exceeded the combined number of deaths from 60 other infectious
diseases, including HIV and tuberculosis.

The numbers might even be higher, the agency said. That’s because the new
statistics are based on data from death certificates, which often
underreport hepatitis C.

Most cases of hepatitis C are among baby boomers — those born between
1945 and 1965. According to the CDC, many were infected during medical
procedures such as injections and blood transfusions when these
procedures were not as safe as they are now. Many hepatitis C-infected
“boomers” may even have lived with the disease for many years without
knowing it, the CDC said.

The preliminary data also suggests a new wave of hepatitis C infections
among injection drug users. These “acute” cases of hepatitis C infection
more than doubled since 2010, increasing to 2,194 reported cases in 2014,
the CDC found.

The new cases were mainly among young whites with a history of injection
drug use who are living in rural and suburban areas of the Midwest and
Eastern United States.

“Because hepatitis C often has few noticeable symptoms, the number of new
cases is likely much higher than what is reported. Due to limited
screening and underreporting, we estimate the number of new infections is
closer to 30,000 per year,” said Dr. John Ward, director of CDC’s
Division of Viral Hepatitis.

“We must act now to diagnose and treat hidden infections before they
become deadly and to prevent new infections,” he added.

About 3.5 million Americans have hepatitis C and about half are unaware
of their infection. One-time hepatitis C testing is recommended for
everyone born from 1945 to 1965 and regular testing is suggested for
others at high risk, according to the CDC and the U.S. Preventive
Services Task Force.

Luckily, curative drugs have advanced the treatment of hepatitis C
infection over recent years. For people diagnosed with the virus, these
new and highly effective treatments can cure the vast majority of
infections in two to three months, the CDC said.

The new report was published online May 4 in the journal Clinical
Infectious Diseases.

SOURCE: Centers for Disease Control and Prevention, news release, May 4,

Copyright (c) 2016 HealthDay. All rights reserved.

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

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:

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]

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:

A fact sheet on injection safety is available at:

* Visit the WHO injection safety website and the SIGN Alliance
Secretariat at:

* Download the WHO Best Practices for Injections and Related
Procedures Toolkit March 2010 [pdf 2.47Mb]:

Use the Toolbox at:

Get SIGN files on the web at:
get SIGNpost archives at:

Like on Facebook:

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The comments made in this forum are the sole responsibility of the
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We would like your help in building this archive. Please send your old
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