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SIGNpost 00859

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST

Post00859 CleanMed + Syringe Codes + Abstracts + Job + News 29 June 2016

CONTENTS
0. Moderators Note
1. Conference: CleanMed Europe 2016 will be held at UN City, Copenhagen,
19-21 October. 2016
2. Abstract: Current Situation Survey of the Measures to Prevent
Medication Errors in the Operating Room: Report of the Japan Society of
Anesthesiologists Safety Commission Working Group for Consideration of
Recommendations for Color Coding of Prepared Syringe Labels for
Prevention of Medication Errors
3. Abstract: The Danish PEP Registry: Experience with the use of post-
exposure prophylaxis following blood exposure to HIV from 1999-2012
4. Abstract: Next-Generation Sequencing Reveals Frequent Opportunities for
Exposure to Hepatitis C Virus in Ghana
5. Abstract: Expanding access to prevention, care and treatment for
hepatitis C virus infection among people who inject drugs
6. Abstract: Interest in self-Administration of Subcutaneous Depot
Medroxyprogesterone Acetate in the United States
7. Abstract: Spine Injectables: What Is the Safest Cocktail?
8. Abstract: Inhaled Technosphere Insulin Compared With Injected Prandial
Insulin in Type 1 Diabetes: A Randomized 24-Week Trial
9. Abstract: Moderate evidence to recommend submucosal injection of
dexamethasone in reducing post-operative oedema and pain after third
molar extraction
10. Abstract: Infection prevention and control in dental surgeries in the
Pará state prison system in Brazil
11. Job Opening | HCWH International Managing Director Position Open
12. News
– USA: Illegal Dumping Difficult for Towns to Manage, as Needles Make
Cleanup Dangerous
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0. Moderators Note
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__________________________________________________________________
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1. Conference: CleanMed Europe 2016 will be held at UN City, Copenhagen,
19-21 October. 2016

Crossposted from Health Care Without Harm with thanks.
__________________________________________________________________

http://www.cleanmedeurope.org/about/what-is-cleanmed-europe.html
CleanMed Europe

CleanMed Europe is the only European conference on sustainability within
the healthcare sector. The conference addresses the environmental impact
of the healthcare sector on a local, regional and global level. This is
organised by Health Care Without Harm Europe.

CleanMed Europe 2016 will be held at UN City, Copenhagen, from the 19th –
21st October.

This conference will look at the processes of creating health through
sustainable development. CleanMed Europe is Europe’s leading conference on
sustainable healthcare. The conference provides the optimal platform to
hear about the latest industry trends, discuss diverse topics, and network
with international thought-leaders.

CleanMed Europe showcases cutting-edge sustainable practices in
healthcare. It is the ideal venue for healthcare innovators to gather
ideas and find new ways to inspire their organisations.

HCWH and the UN have a long working relationship, dating back to 2002,
including collaborations with WHO, UNDP, and UNEP on healthcare waste,
mercury substitution, climate change, and green procurement.

The UN City in Copenhagen is the healthcare procurement hub for the UN
globally, giving you the opportunity to be in contact not only with
European healthcare procurers, but also with UN procurement experts based
in the city.

Alongside our main programme of workshops and presentations, there will be
tours through the UN City and visits to local hospitals before the
conference. The city and venue are an ideal setting to discuss the latest
industry trends and evoke cutting edge ideas.

We look forward to realising another inspiring CleanMed Europe with you,
as we work together to drive the sustainability movement in healthcare
forward.

Registration for CleanMed Europe 2016 is now open! Click here to register!
http://www.cleanmedeurope.org/attend.html
Latest news

First keynote speaker announced

CleanMed Europe is happy to announce the first of our keynote speakers –
Dr. Hans Kluge.

An exciting addition to CleanMed Europe, Director of the Division of
Health Systems and Public Health in the WHO Europe region Dr. Hans Kluge
will draw from his impressive portfolio.

Another successful CleanMed

Health Care Without Harm’s founder and President Gary Cohen reflects on
another successful CleanMed US and the future of toxin-free hospitals.

Proposals deadline extended

The call for proposals deadline has been extended to give YOU the
opportunity to shape the CleanMed Europe 2016 programme.
Submit an application TODAY

Register for CleanMed Europe 2016!
http://www.cleanmedeurope.org/attend.html

© CleanMed Europe 2003-2016

CleanMed 2013 Photos by John Cairn
CleanMed 2012 Photos by Daniel Montan, Studio Bus
UN City Photos by Adam Mørk

http://www.cleanmedeurope.org/home.html
__________________________________________________________________
________________________________*_________________________________

2. Abstract: Current Situation Survey of the Measures to Prevent
Medication Errors in the Operating Room: Report of the Japan Society of
Anesthesiologists Safety Commission Working Group for Consideration of
Recommendations for Color Coding of Prepared Syringe Labels for
Prevention of Medication Errors

[Mod: Please note that the results have been reformatted for email]
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27319102

Masui. 2016 May;65(5):542-7.
[Current Situation Survey of the Measures to Prevent Medication Errors in
the Operating Room: Report of the Japan Society of Anesthesiologists
Safety Commission Working Group for Consideration of Recommendations for
Color Coding of Prepared Syringe Labels for Prevention of Medication
Errors].

[Article in Japanese]

Shida K, Suzuki T, Sugahara K, Sobue K.

BACKGROUND: In the case of medication errors which are among the more
frequent adverse events that occur in the hospital, there is a need for
effective measures to prevent incidence. According to the Japan Society of
Anesthesiologists study “Drug incident investigation 2005-2007 years”,
“Error of a syringe at the selection stage” was the most frequent (44.2%).
The status of current measures and best practices implemented in Japanese
hospitals was the focus of a subsequent investigation.

METHODS: Representative specialists in anesthesiology certified hospitals
across the country were surveyed via a questionnaire sampling that lasted
46 days. Investigation method was via the Web with survey responses
anonymous.

RESULTS: With respect to preventive measures implemented to mitigate risk
of medication errors in perioperative settings, responses included:

incident and accident report (215 facilities, 70.3%),

use of pre-filled syringes (180 facilities, 58.8%),

devised the arrangement of dangerous drugs (154 facilities, 50.3%),

use of the product with improper connection preventing mechanism (123
facilities, 40.2%),

double-check (116 facilities, 37.9%),

use of color barreled syringe (115 facilities, 37.6%),

use of color label or color tape (89 facilities, 29.1%),

presentation of medication such as placing the ampoule or syringe on a
tray by dividing color code for drug class on a tray (54 facilities,
17.6%),

the discontinuance of handwritten labels (23 facilities, 7.5%), use of a
drug verification system that uses bar code (20 facilities, 6.5%),

and facilities that have not implemented any means (11 facilities, 3.6%),

others not mentioned (10 facilities, 3.3%),

and use of carts that count/ account the agents by drug type and record
selection and number picked automatically (6 facilities, 2.0%).

Drug name identification affixed to the syringe via perforated label torn
from the ampoule/vial, etc. (245 facilities, 28.1%),

handwriting directly to the syringe (208 facilities, 23.8%),

use of the attached label (like that comes with the product) (187
facilities, 21.4%),

handwriting on the plain tape (87 facilities, 10.0%),

printing labels (62 facilities, 7.1%),

printed color labels (44 facilities, 5.0%),

handwriting on the color tape (27 facilities, 3.1%),

machinery for printing the drug name by scanning bar code of the ampoule,
etc.(10 facilities, 1.1%),

others (3 facilities, 0.3%),

no description on the prepared drug (0 facilities, 0%).

The awareness of international standard color code, such as by the
International Organization for Standardization (ISO), was only 18.6%.

CONCLUSIONS: Targeting anesthesiology certified hospitals recognized by
the Japan Society of Anesthesiologists, the result of the survey on the
measures to prevent medication errors during perioperative procedures
indicated that various measures were documented in use.

However, many facilities still use hand written labels (a common cause for
errors).

Confirmation of the need for improved drug name and drug recognition on
syringe was documented.
__________________________________________________________________
________________________________*_________________________________

3. Abstract: The Danish PEP Registry: Experience with the use of post-
exposure prophylaxis following blood exposure to HIV from 1999-2012
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26529586

Infect Dis (Lond). 2016;48(3):195-200.
The Danish PEP Registry: Experience with the use of post-exposure
prophylaxis following blood exposure to HIV from 1999-2012.

Lunding S1, Katzenstein TL2, Kronborg G3, Storgaard M4, Pedersen C5, Mørn
B6, Lindberg JÅ7, Kronborg TM8, Jensen J9.

1a Department of Pulmonary and Infectious Diseases, Nordsjælland Hospital,
Hillerød, Denmark.
2b Department of Infectious Diseases, Rigshospitalet, Copenhagen,
Denmark.
3c Department of Infectious Diseases, Hvidovre Hospital, Hvidovre,
Denmark.
4d Department of Infectious Diseases, Skejby Hospital, Århus, Denmark.
5e Department of Infectious Diseases, Odense Hospital, Odense, Denmark.
6f Department of Infectious Diseases, Ålborg Hospital, Ålborg, Denmark.
7g Department of Medicine, Herning Hospital , Herning, Denmark.
8h Medical Faculty, Copenhagen University, Copenhagen, Denmark.
9i Department of Medicine, Kolding Hospital, Kolding, Denmark.

BACKGROUND: The risk of occupational exposures to blood cannot be
eliminated completely and access to post-exposure prophylaxis (PEP) to
prevent HIV transmission is important. However, PEP administration has
been associated with frequent adverse effects, low compliance and
difficulties to ensure a proper risk assessment. This nationwide study
describes 14 years of experience with the use of PEP following blood
exposure in Denmark.

METHODS: A descriptive study of all PEP cases following non-sexual
exposure to HIV in Denmark from 1999-2012.

RESULTS: A total of 411 cases of PEP were described. There was a mean of
29.4 cases/year, increasing from 23 cases in 1999 to 49 cases in 2005 and
then decreasing to 16 cases in 2012. Overall 67.2% of source patients were
known to be HIV-positive at the time of PEP initiation, with no
significant change over time. The median time to initiation of PEP was 2.5
h (0.15-28.5) following occupational exposure. Adverse effects were
reported by 50.9% with no significant difference according to PEP regimen.
In 85.1% of cases with available data, either a full course of PEP was
completed or PEP was stopped because the source was tested HIV-negative.
Only 6.6% stopped PEP early due to adverse effects.

CONCLUSIONS: PEP in Denmark is generally prescribed according to the
guidelines and the annual number of cases has declined since 2005. Adverse
effects were common regardless of PEP regimens used and new drug regimens
should be considered.

KEYWORDS: Denmark; HIV; Post-exposure prophylaxis; occupational exposure
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Next-Generation Sequencing Reveals Frequent Opportunities for
Exposure to Hepatitis C Virus in Ghana
__________________________________________________________________

http://dx.doi.org/10.1371%2Fjournal.pone.0145530

PLoS One. 2015 Dec 18;10(12):e0145530. Free Open Access Article
Next-Generation Sequencing Reveals Frequent Opportunities for Exposure to
Hepatitis C Virus in Ghana.

Forbi JC1, Layden JE2,3, Phillips RO4,5, Mora N2, Xia GL1, Campo DS1,
Purdy MA1, Dimitrova ZE1, Owusu DO4, Punkova LT1, Skums P1, Owusu-Ofori
S4, Sarfo FS4,5, Vaughan G1, Roh H1, Opare-Sem OK4, Cooper RS2, Khudyakov
YE1.

1Molecular Epidemiology and Bioinformatics Laboratory, Division of Viral
Hepatitis, Centers for Disease Control and Prevention, Atlanta, Georgia,
United States of America.
2Department of Public Health Sciences, Loyola University Chicago, Maywood,
Illinois, United States of America.
3Department of Medicine, Loyola University Chicago, Stritch School of
Medicine, Maywood, IL, United States of America.
4Komfo Anokye Teaching Hospital, Kumasi, Ghana, West Africa.
5Kwame Nkrumah University of Science and Technology, Kumasi, Ghana, West
Africa.

Globally, hepatitis C Virus (HCV) infection is responsible for a large
proportion of persons with liver disease, including cancer. The infection
is highly prevalent in sub-Saharan Africa. West Africa was identified as a
geographic origin of two HCV genotypes. However, little is known about the
genetic composition of HCV populations in many countries of the region.

Using conventional and next-generation sequencing (NGS), we identified and
genetically characterized 65 HCV strains circulating among HCV-positive
blood donors in Kumasi, Ghana. Phylogenetic analysis using consensus
sequences derived from 3 genomic regions of the HCV genome, 5′-
untranslated region, hypervariable region 1 (HVR1) and NS5B gene,
consistently classified the HCV variants (n = 65) into genotypes 1 (HCV-1,
15%) and genotype 2 (HCV-2, 85%).

The Ghanaian and West African HCV-2 NS5B sequences were found completely
intermixed in the phylogenetic tree, indicating a substantial genetic
heterogeneity of HCV-2 in Ghana. Analysis of HVR1 sequences from intra-
host HCV variants obtained by NGS showed that three donors were infected
with >1 HCV strain, including infections with 2 genotypes. Two other
donors share an HCV strain, indicating HCV transmission between them. The
HCV-2 strain sampled from one donor was replaced with another HCV-2 strain
after only 2 months of observation, indicating rapid strain switching.

Bayesian analysis estimated that the HCV-2 strains in Ghana were expanding
since the 16th century. The blood donors in Kumasi, Ghana, are infected
with a very heterogeneous HCV population of HCV-1 and HCV-2, with HCV-2
being prevalent.

The detection of three cases of co- or super-infections and transmission
linkage between 2 cases suggests frequent opportunities for HCV exposure
among the blood donors and is consistent with the reported high HCV
prevalence.

The conditions for effective HCV-2 transmission existed for ~ 3-4
centuries, indicating a long epidemic history of HCV-2 in Ghana.
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Expanding access to prevention, care and treatment for
hepatitis C virus infection among people who inject drugs
__________________________________________________________________

http://www.ijdp.org/article/S0955-3959(15)00208-X/fulltext

Int J Drug Policy. 2015 Oct;26(10):893-8. Free Full Text
Expanding access to prevention, care and treatment for hepatitis C virus
infection among people who inject drugs.

Grebely J1, Bruggmann P2, Treloar C3, Byrne J4, Rhodes T5, Dore GJ6;
International Network for Hepatitis in Substance Users.

1The Kirby Institute, UNSW Australia, Sydney, Australia; Australian
Injecting and Illicit Drug Users League, Canberra, Australia. Electronic
address: jgrebely@kirby.unsw.edu.au.
2Arud Centres for Addiction Medicine, Zurich, Switzerland.
3Centre for Social Research in Health, UNSW Australia, Sydney, Australia.
4International Network of People Who Use Drugs, Canberra, Australia.
5Centre for Research on Drugs and Health Behaviour, London School of
Hygiene and Tropical Medicine, London, United Kingdom.
6The Kirby Institute, UNSW Australia, Sydney, Australia.

In high income countries, the majority of new and existing cases of
hepatitis C virus (HCV) infection occur among people who inject drugs
(PWID), and epidemics in many low and middle income countries are
increasingly concentrated among PWID (Hajarizadeh, Grebely, & Dore, 2013).
HCV transmission continues among PWID in many settings (Hagan, Pouget, Des
Jarlais, & Lelutiu-Weinberger, 2008; Page, Morris, Hahn, Maher, & Prins,
2013; Wiessing et al., 2014). However, high coverage of combined harm
reduction programs (opioid substitution treatment [OST] and needle and
syringe programs [NSP]) (Degenhardt et al., 2010; Hagan, Pouget, & Des
Jarlais, 2011; MacArthur et al., 2014; Turner et al., 2011; van den Berg
et al., 2007) and OST alone (Aspinall et al., 2014; Nolan et al., 2014;
Tsui, Evans, Lum, Hahn, & Page, 2014; White, Dore, Lloyd, Rawlinson, &
Maher, 2014) can reduce HCV incidence.
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Interest in self-Administration of Subcutaneous Depot
Medroxyprogesterone Acetate in the United States
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27326938

Contraception. 2016 Jun 17. pii: S0010-7824(15)30152-9.
Interest in self-Administration of Subcutaneous Depot Medroxyprogesterone
Acetate in the United States.

Upadhyay UD1, Zlidar VM2, Foster DG3.

1Advancing New Standards in Reproductive Health, Bixby Center for Global
Reproductive Health, and the Department of Obstetrics, Gynecology &
Reproductive Science, University of California, San Francisco, San
Francisco, CA 94612, USA. Electronic address: ushma.upadhyay@ucsf.edu.
2Public Health Institute, United States. Electronic address:
vzlidar@gmail.com.
3Advancing New Standards in Reproductive Health, Bixby Center for Global
Reproductive Health, and the Department of Obstetrics, Gynecology &
Reproductive Science, University of California, San Francisco, San
Francisco, CA 94612, USA. Electronic address: diana.greenefoster@ucsf.edu.

OBJECTIVE: Subcutaneous depot medroxyprogesterone acetate (DMPA-SC) is a
low-dose formulation of DMPA that non-medical personnel can administer
safely and effectively. We sought to determine United States women’s
interest in self-administration of DMPA-SC to understand whether such use
can overcome barriers to contraceptive access.

STUDY DESIGN: We analyzed survey data on contraceptive attitudes collected
in March-July 2011 from 1592 women at 13 family planning and 6 abortion
clinics throughout the US. A mixed-effects logistic regression model with
random site effects examined the determinants of interest in self-
administering DMPA-SC.

RESULTS: Overall, 21% (95% CI: 19%-23%) of women reported interest in
self- administration. A multivariable model found women currently using
DMPA (AOR=3.93, 95% CI: 2.37-6.53, p<.001) and women who previously used
DMPA (AOR=1.71, 95% CI: 1.26-2.32 p<.001) were more likely to have an
interest in DMPA-SC than those who never used it. Women reporting
difficulty obtaining or refilling a prescription were almost twice as
likely to have interest in DMPA-SC as women who reported no difficulty
(AOR=1.99, 95% CI: 1.43-2.77, p<.001). Women surveyed at abortion sites
were more likely to report interest in self-administration than women
surveyed at family planning sites (AOR=1.55, 95% CI: 1.05-2.30, p<.05).
Interest in DMPA-SC was primarily driven by a desire to eliminate
unnecessary return visits to a facility for repeat injections.

CONCLUSIONS: Offering women the option to self-administer DMPA-SC at home
can expand access and tailor contraceptive provision to the needs of
clients, thus supporting client-centered care. To the extent that self-
administration may improve contraceptive continuation, DMPA-SC can prevent
unintended pregnancies among women who discontinue DMPA use because of
difficulty returning for repeat injections.

IMPLICATIONS: There is substantial interest in self-administration of
DMPA-SC among current DMPA users, women who have recently had an abortion,
and women reporting difficulty returning to a family planning provider.
Offering self-administration of DMPA-SC could potentially increase
contraceptive continuation, reduce unintended pregnancies, and enhance
reproductive autonomy among DMPA users.

Copyright © 2016. Published by Elsevier Inc.

KEYWORDS: Acceptability; Depot medroxyprogesterone acetate; Injections;
Self- administration; Self-injection; Subcutaneous DMPA
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Spine Injectables: What Is the Safest Cocktail?
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27341350

AJR Am J Roentgenol. 2016 Jun 24:1-8.
Spine Injectables: What Is the Safest Cocktail?

MacMahon PJ1, Huang AJ2, Palmer WE2.

11 Department of Radiology, Mater Misericordiae University Hospital,
Whitty Bldg, North Circular Rd, Dublin 7, Ireland.
22 Department of Musculoskeletal Imaging and Intervention, Massachusetts
General Hospital, Boston, MA.

OBJECTIVE: Spinal injections are common pain management procedures using
corticosteroids and local anesthetics. Most corticosteroid preparations
are particulate suspensions, such as methylprednisolone acetate and
triamcinolone acetonide.

In the cervical spine, particulate corticosteroids have been linked to
catastrophic complications, including blindness, paralysis, and death.
Serious neurologic injuries have also been reported at the thoracic,
lumbar, and sacral levels.

CONCLUSION: Nonparticulate preparations, such as dexamethasone, are safer
but have shorter-lived antiinflammatory effects. Local anesthetics are
often mixed with corticosteroids in pain management procedures.

Although everyday risks are minimal, injection techniques should take into
account neural and cardiac toxicities. In this article, we discuss the
potential for serious adverse events associated with injected medications.

We review the current literature to make conclusions on medication
combinations that balance safety and efficacy.

KEYWORDS: corticosteroids; crystals; epidural; infarction; injection;
local anesthetic; safety

Abstract and references
http://www.ajronline.org/doi/abs/10.2214/AJR.16.16379
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Inhaled Technosphere Insulin Compared With Injected Prandial
Insulin in Type 1 Diabetes: A Randomized 24-Week Trial
__________________________________________________________________

http://care.diabetesjournals.org/content/38/12/2266.long

Diabetes Care. 2015 Dec;38(12):2266-73. Full Free Article
Inhaled Technosphere Insulin Compared With Injected Prandial Insulin in
Type 1 Diabetes: A Randomized 24-Week Trial.

Bode BW1, McGill JB2, Lorber DL3, Gross JL4, Chang PC5, Bregman DB6;
Affinity 1 Study Group.

1Atlanta Diabetes Associates, Atlanta, GA bbode001@aol.com.
2Division of Endocrinology, Metabolism and Lipid Research, Washington
University School of Medicine in St. Louis, St. Louis, MO.
3New York Hospital Queens, New York-Presbyterian Healthcare System,
Flushing, NY.
4Centro de Pesquisas em Diabetes Ltda., Porto Alegre, Brazil.
5MannKind Corporation, Paramus, NJ.
6Sanofi, Bridgewater, NJ Department of Pathology, Albert Einstein College
of Medicine, Bronx, NY.

OBJECTIVE: To compare the efficacy and safety of Technosphere insulin (TI)
and insulin aspart in patients with type 1 diabetes.

RESEARCH DESIGN AND METHODS: This open-label noninferiority trial compared
the change in HbA1c from baseline to week 24 of prandial TI (n = 174) with
that of subcutaneous aspart (n = 171), both with basal insulin, in
patients with type 1 diabetes and HbA1c 7.5-10.0% (56.8-86.0 mmol/mol).

RESULTS: Mean change in HbA1c in TI patients (-0.21% [-2.3 mmol/mol]) from
baseline (7.94% [63.3 mmol/mol]) was noninferior to that in aspart
patients (-0.40% [-4.4 mmol/mol]) from baseline (7.92% [63.1 mmol/mol]).
The between-group difference was 0.19% (2.1 mmol/mol) (95% CI 0.02-0.36),
satisfying the noninferiority margin of 0.4%. However, more aspart
patients achieved HbA1c <7.0% (53.0 mmol/mol) (30.7% vs. 18.3%). TI
patients had a small weight loss (-0.4 kg) compared with a gain (+0.9 kg)
for aspart patients (P = 0.0102).

TI patients had a lower hypoglycemia event rate than aspart patients (9.8
vs. 14.0 events/patient-month, P < 0.0001).

Cough (generally mild) was the most frequent adverse event (31.6% with TI,
2.3% with aspart), leading to discontinuation in 5.7% of patients.
Treatment group difference for mean change from baseline in forced
expiratory volume in 1 s was small (40 mL) and disappeared upon TI
discontinuation.

CONCLUSIONS: In patients with type 1 diabetes receiving basal insulin,
HbA1c reduction with TI was noninferior to that of aspart, with less
hypoglycemia and less weight gain but increased incidence of cough.

TRIAL REGISTRATION: ClinicalTrials.gov NCT01445951.

© 2015 by the American Diabetes Association. Readers may use this article
as long as the work is properly cited, the use is educational and not for
profit, and the work is not altered.

Comment in Technosphere Inhaled Insulin: Is Faster Better? [Diabetes Care.
2015] https://www.ncbi.nlm.nih.gov/pubmed/26604279
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Moderate evidence to recommend submucosal injection of
dexamethasone in reducing post-operative oedema and pain after third
molar extraction
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27339243

Evid Based Dent. 2016 Jun;17(2):58-9.

Moderate evidence to recommend submucosal injection of dexamethasone in
reducing post-operative oedema and pain after third molar extraction.

Freda NM1, Keenan AV1.

1NYU College of Dentistry, New York, USA.

Data sources The electronic databases searched included: PubMed/MEDLINE,
Cochrane Central Register of Controlled Trials (Central) and Web of
Science until June 2015. There was no restriction to language and the
reference lists from relevant studies were searched for further articles.

Study selection Randomised and prospective controlled trials that compared
the effect of submucosal injection of dexamethasone with that of placebo
after impacted third molar surgery in humans. Studies involving volunteers
with decompensated metabolic disease were excluded.

Data extraction and synthesis Study selection, data extraction and quality
assessment (risk of bias) were assessed by two reviewers. All
disagreements were resolved through discussion. A meta-analysis was
performed for all continuous variables (oedema, pain and trismus) when at
least two of the studies analysed the same data type.

Results Eight studies involving a total of 476 patients of which six were
included in the meta-analysis. All of the surgical procedures were
performed on the lower molars, submucosal injections of dexamethasone were
used in concentrations of 4 mg, 8 mg, or 10 mg, and saline was used as a
control. Antibiotic medications were administered prophylactically before
surgery or by continuous use after the procedure. Seven of the eight
studies identified the impactions according to the Pell and Gregory
Classification. Oedema was measured using facial contours of pre-
established reference points.

The meta-analysis presented a mean difference (MD) of -2.20 (95% CI -2.70
to -1.70), with a statistically significant difference favouring
dexamethasone (P< 0.00001).

Trismus (assessed using inter-incisal distance upon maximum opening) had a
MD of -2.92 (95% CI -7.13 to 1.29) and showed no statistically significant
difference between groups.

Pain was assessed using both visual analogue scales and number of
analgesic taken; however, only studies including a VAS were used for meta-
analysis. Pain presented with a MD of -1.79 (95% CI -3.28 to -0.30) and
showed a statistically significant difference favouring dexamethasone.

Conclusions The review found moderate quality evidence that submucosal
injections of dexamethasone reduced post-operative oedema and pain
compared to a placebo following impacted third molar surgery.

There was no significant difference, in regards to trismus, between
placebo and dexamethasone.
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Infection prevention and control in dental surgeries in the
Pará state prison system in Brazil
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27320900

Am J Infect Control. 2016 Jun 16. pii: S0196-6553(16)30296-6.
Infection prevention and control in dental surgeries in the Pará state
prison system in Brazil.

Lima CM1, Smith AJ2, Fonseca Silva AS3, Flório FM4, Zanin L1.

1Department of Public Health, Research Center, São Leopoldo Mandic School
of Dentistry, Campinas, SP, Brazil.
2Infection Research Group, Faculty of Medicine, Glasgow Dental Hospital,
School, Glasgow, United Kingdom.
3Department of Integrated Dental Clinic, Research Center, São Leopoldo
Mandic School of Dentistry, Campinas, SP, Brazil.
4Department of Public Health, Research Center, São Leopoldo Mandic School
of Dentistry, Campinas, SP, Brazil. Electronic address:
flaviaflorio@yahoo.com.

Prison populations have higher levels of bloodborne viruses with
consequently higher risks of cross-infection. This study assessed
infection prevention and occupational hazards in prison dental surgeries
in the Brazilian state of Pará.

Investigations were undertaken by a single examiner in 11 prison clinics.

Manual washing of instruments with no detergents and dry heat
sterilization were the main instrument decontamination methods used.

Most surgeries had insufficient instruments for daily clinical work
requirements.

Half of dentists interviewed worked single-handed with no documented
policies or health and safety procedures.

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

KEYWORDS: Instrument cleaning; Instrument sterilization; Occupational
hazards; Working conditions
__________________________________________________________________
________________________________*_________________________________

11. Job Opening | HCWH International Managing Director Position Open

Application details follow below:

Crossposted from Health Care Without Harm with thanks.
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https://tinyurl.com/hu6embf
Job Opening | HCWH International Managing Director Position Open
News posted by hcwh-global-admin on June 13, 2016

Global Tags: Global, job announcement
International Managing Director
Health Care Without Harm (HCWH) – www.noharm.org and
www.greenhospitals.net

Click here to download as pdf https://tinyurl.com/zsc7cw6

Location: Flexible and virtual capable; provided willingness to partially
overlap with Pacific Standard Time business hours. Office co-location
possible in Boston, Buenos Aires, Brussels, Manila, Reston, or San
Francisco.

Position Status: Full time employment

Candidate must be willing and able to travel extensively

Organization Overview: Health Care Without Harm (HCWH) is a not-for-profit
organization that works to transform health care worldwide so that it
reduces its environmental footprint, becomes a community anchor for
sustainability and a leader in the global movement for environmental
health and justice. Our vision is that health care mobilizes its ethical,
economic and political influence to create an ecologically sustainable,
equitable and healthy world. We seek to carry out our mission and vision
by adhering to three overarching goals: protecting public health from
climate change; transforming the supply chain, and building leadership for
environmental health.

HCWH has offices in the US (Boston and Reston), Europe (Brussels), Latin
America (Buenos Aires) and Asia (Manila), and partner organizations in
multiple countries including Australia, Brazil, China, India, Nepal and
South Africa. HCWH works with hospitals and health care systems, health
professionals, ministries of health, NGOs and international organizations
such as WHO and UNDP. HCWH’s Global Green and Healthy Hospitals Network
has more than 650 members from 37 countries, representing the interests of
more than 20,000 hospitals and health centers committed to reduce health
care’s environmental footprint and promote environmental health. You can
learn more about our organizations at www.noharm.org and
www.greenhospitals.net.

Position Overview:

HCWH is looking for a dynamic manager with deep international experience,
multiple cultural competencies and a strong organizing background to serve
as the International Managing Director. The position requires excellent
people and organizational skills. Working with and reporting to the
International Director for Program and Strategy, this position will help
lead the ongoing international development of Health Care Without Harm—one
of the world’s leading environmental health organizations and networks.
The position will also work closely with the President and co-founder of
HCWH and an International Council composed of the Directors all regional
offices; as well as with partner organizations; and global staff.

Responsibilities:

Governance: Coordinate and facilitate annual international planning and
budgeting, while supporting the operations of HCWH’s global governance
structure, its continuing evolution and long-term strategic planning
process.

Convene the International Council: Accountable for convening monthly
teleconference meetings and 1-2 annual face-to-face meetings of the
International Council (IC).
Staff the International Council: Accountable for managing agenda,
documentation of decisions and recommendations, and facilitate/follow-
through to assure their implementation as appropriate.
Annual Planning and Budget: Accountable for coordinating annual planning
and budgeting among various HCWH regional entities, global staff/projects
and partners, and IC deliberations in collaboration with the finance
teams.
Governance Monitoring and Review: Responsible for regular review and
implementation of any revision of international agreements between
entities, partnership agreements, etc.
Long-Term Organizational Development Planning: Responsible for
coordinating and facilitating a long-term organizational development
planning process that establishes and implements an evolving framework for
an International Health Care Without Harm structure in collaboration with
the International Council.
Management and Organizational Development: Manage and coordinate the
global HCWH operations and set of networks in collaboration with
appropriate stakeholders, including: creating a balanced approach between
organizational and network-based development by supporting the
organizational development of HCWH regional offices and a robust global
network membership system; supervising designated international staff;
overseeing formal relationships with partners, re-grants between HCWH
entities and to partner organizations, project and grant reporting;
participating in fundraising.

Global Management Duties:

Accountable for managing agreements and reporting related to re-grants
from one HCWH-entity to the other (eg. From U.S. to Latin America or
Europe to SE Asia) in collaboration with relevant executive and
administrative staff in the relevant regions.

Accountable for managing agreements and reporting related to re-grants
from HCWH entities to partner organizations in other countries/regions in
collaboration with relevant executive and administrative staff in the
relevant regions and with similar counterparts in partner organizations.
Responsible for supporting and providing guidance to HCWH regional
organizations and their executive directors in Asia, Europe and Latin
America in their efforts to transition from oversight by HCWH
international staff to develop robust organizational infrastructure (such
as active boards, advisory boards, etc.) and in their management of their
organizations.

Responsible, in collaboration with other executive staff, for coordinating
development of robust global communications, financial, information
technology and other administrative capacities, and hiring/supervising
relevant staff when appropriate and agreed upon.

Oversee management of international budgets funded by HCWH US. Assure
coherence and synchronization with income generated in other regions.
Fundraising and grant reporting:

Accountable for development and implementation of income generation
strategy for HCWH’s Global Green and Healthy Hospitals Network (GGHH) in
consultation with development staff.
Responsible with others for funding proposal development.
Responsible with others for budgeting for proposals.
Accountable for grant reporting on global projects grants.
Global Team Convening:

Accountable for organizing and convening bi-annual global HCWH team
meetings.
Accountable for convening regular international staff meetings.
Responsible for facilitating cross-organizational communication and
collaboration in various areas.
Network Coordination

Responsible for building HCWH global structures, such as GGHH, as a robust
global network with a diverse yet clear set of membership, partnership and
engagement structures.
Responsible for establishing and maintaining an appropriate balance
between HCWH as a staff-based organization and a global network.
Responsible for assuring appropriate and consistent engagement with
business across HCWH as an international organization.
Responsible for management of institutional strategic partnerships with
organizations representing HCWH’s interests in specific countries and
synchronizing these partnerships with HCWH’s regional office structure.
Responsible for management of institutional partnerships and relationships
with international partner organizations
Qualifications:

Minimum Education: Bachelor’s degree. Combined experience/education as
substitute for minimum education.
Minimum Experience: 10 years of experience working on public health,
healthcare, environmental and/or related issues.
Minimum Field of Expertise: Familiarity with advocacy organizations,
international NGOs and networks, and member organizations required.
Preferred Education: Master’s degree or higher.
Preferred Experience: Multiple languages and cultural competencies;
international environment/development/health/organizing experience.
Preferred Field of Expertise: Familiarity with international management
and organizing and in a virtual non-governmental organization.
Staff /executive management experience preferred

To Apply:
Health Care Without Harm has contracted Global Recruitment Specialists to
assist with this recruitment effort. Please email a cover letter and
updated resume/CV to:

Patrick Shields, Search Manager
Global Recruitment Specialists “Positioning You for Success”
501 Westport Avenue, Suite 285, Norwalk, CT 06851 USA
Telephone: +1- 203-899-0499
Email: Shields@globalrecruitment.net
Web: www.globalrecruitment.net

Your cover letter should at least address the following topics:

Why you are interested in the position and Health Care Without Harm.
How you believe your skills and experiences will meet the needs of the
position and contribute to the Health Care Without Harm’s mission.
How you learned of this position.
Applications will be reviewed on a rolling basis.

Health Care Without Harm offers a competitive salary and benefits,
commensurate with experience and skills. Health Care Without Harm is an
equal opportunity employer.
__________________________________________________________________
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12. News

– USA: Illegal Dumping Difficult for Towns to Manage, as Needles Make
Cleanup Dangerous

Selected news items reprinted under the fair use doctrine of international
copyright law: http://www4.law.cornell.edu/uscode/17/107.html
__________________________________________________________________

https://tinyurl.com/hm2uddz
USA: Illegal Dumping Difficult for Towns to Manage, as Needles Make
Cleanup Dangerous

By SEAN CORCORAN, WCAI, Cape and Islands NPR Station, MA USA (22.06.16)

Some towns are turning to hidden cameras to help curb illegal dumping in
problem areas. Erecting gates has helped, too.
SEAN CORCORAN

Mashpee Town Manager Rodney Collins stopped his car and looked out the
window at a sectional couch.

“A couple weeks ago, this was not here,” he said.

We were at the overflow parking lot at South Cape Beach. The beige-colored
sofa was gross, and it was just tossed to one side of the lot. There’s
plenty of trash strewn around, too.

“People come to this parking lot, Sage Lot Pond parking lot, and they’re
supposed to be able to enjoy the recreation, enjoy the trail,” Collins
said. “They are supposed to be able to walk over to South Cape Beach. …
There are cans, there are bottles, there’s debris all over the place. And
now, on top of all that, we have the remnants of a two-piece couch.”

Collins is just about a year into his job as town manager, although he was
police chief for a decade before that. As we drove around town, he told me
about the time Conservation Agent Drew McManus took him out into the woods
to show him what people leave there. Collins said he’s been focused on the
issue ever since.

“You see the litter along the side of the road, you see it in the parking
lot,” he said. “You even see it at the beach. And ironically, at the
beach, we have trash containers. And there are still people throwing
things out of their cars, into the parking lot, onto the beach, wherever!
It never ceases to amaze me.”

This overflow parking lot for South Cape Beach in Mashpee was clean a few
weeks ago, said Mashpee Town Manager Rodney Collins. But now it’s littered
with debris, and someone dumped a sectional couch here.
CREDIT SEAN CORCORAN

Town leaders like Collins say they’re obligated to keep their communities
clean and safe. This is a tourist area, after all. So towns are installing
gates, they’re hiding video cameras, and they’re dispatching cleanup crews
to police roads. But the pollution problem is becoming tougher to manage.

“Every town is seeing the same thing, and none of us really have an
answer,” said Mashpee DPW Director Catherine Laurent. Although they’ve had
some success stopping illegal dumping in conservation and open space areas
by installing gates to block access.

“We have seen an improvement. But, I guess, what we’re finding now instead
is people are more blatant,” she said. “They’ll just drop something at the
end of a road. They aren’t even going into the woods anymore, they’re just
putting it in front of someone’s house or a cul-de-sac.”

In addition to the gates, conservation agents McManus and Katelyn Cadoret
said they’re increasingly using hidden cameras in areas they know people
are doing things they shouldn’t.

A few days ago a camera captured the license plate of a truck in an off-
limit area. But today, Cadoret shows me a small, box-size camera that
looks kinda broken, with a weird wire hanging out of it.

“We came across a vandalized camera,” she said, noting that vandalism is
one of the reasons Cadoret is reluctant to talk about the cameras.
“We’ve had cameras in the past,” she said. “But part of my position is to
be able to expand on our surveillance and just [get] more manpower in the
department.”

“They’ll just drop something at the end of a road. They aren’t even going
into the woods anymore. They’re just putting it in front of someone’s
house or a cul-de-sac.”

Some of the stuff people dump would cost money to dispose of at a transfer
station. There usually are fees for things like mattresses and old
appliances. But, if cost is the rationale people use for dumping, Laurent
rejects it. She said communities work to keep fees low, and in Mashpee,
there are discounts in place.

“Residence and property owners can bring mattresses at no cost to the
transfer station,” she said. “We’re still finding them in the woods. Scrap
metal, no charge to dispose of scrap metal. We find scrap metal in the
woods. So, yes, there are items that we do charge separately for. But
that’s really just recouping the cost to the town to recycle those items.”
Picking up trash from roadsides and hauling it out of the woods is hard,
seemingly endless work. And it’s also become more dangerous.

More often than ever, people are tossing hypodermic needles out of cars
and leaving them in conservation areas. The DPW, the police, conservation
agents – they’re all dealing with needles. Mashpee Health agent Glenn
Harrington said he’s even been retrieving needles from out back. Behind
town hall.

“We have found syringes, usually on Monday mornings, in the parking lot
right here at town hall,” he said. “People seem to be sitting in the
parking lot, dumping the needles and moving on, so we are finding them
Monday morning.”

Just like illegal dumping, needles aren’t a Mashpee problem alone. Every
community in the region is dealing with it.

Sandwich is one such town. So, in a corner of the cramped Sandwich fire
station is what looks like an oversized washing machine. The things you
put in it do get clean. They also gets torn, crushed, munched and a bunch
of other cool verbs that mean ‘breaking stuff down into tiny pieces.’

“It grinds it up into a fine confetti,” said Deputy Sandwich Fire Chief
John Burke, who brought this piece of innovation to the station. He first
saw one up at Boston University, where he teaches part-time, and he
thought it would be valuable to fire fighters.

“What the machine does is it disposes and sterilizes the medical waste or
needle sharps,” he said.

Sandwich Deputy Fire Chief John Burke brought this $30,000 machine to town
at no charge. It both breaks down and sanitizes medical waste and needles.
The station is beta testing this thirty-thousand-dollar innovation, which
has been shredding bloody fabrics and grinding up hypodermics since
September, at no charge to the department.

“All you need is a plug and some water,” he said. “And what you hear
occasionally is the steam – the water being heated up. And it steams the
medical waste to a temperate of 132 degrees. And that is a requirement to
sterilize.”

After thirty minutes of steaming and grinding, what comes out is a
confetti-like mix of cloth, plastic and tiny pieces of metal. Burke said
it’s so safe you can literally run your hands through it. I’m not running
my hands through the stuff, but I take some on my palm and sift through
it, amazed. Burke said he reacted the same way.

“I’m telling ya, it was like, for me, I’m looking at it, and I’m going,
‘This, this can’t be, right?’ Cause you have needles like we use in the
ambulance, and then you put it in, and it literally comes out the bottom
and you’re putting your hands through it.”

Burke said the stuff is so clean, it can be thrown into the household
trash.

“If there was any sharp edge at all, and say it were to knick your finger,
it’s all sterilized,” he said. “It’s cleaner. This is the cleanest trash
you will put in a waste stream.”

When the medical waste sanitizing machine completes a 30-minute load, what
comes out is confetti-like mix of debris that can be disposed of in the
household trash.
CREDIT SEAN CORCORAN

There’s no shortage of hypodermic needles to dispose of. Firefighters
bring them back from overdose calls, and Burke said sometimes residents
bring them in in coffee containers. Police officers from the station next
door bring in needles, too. Many times they take them from suspects.
Sometimes they’re reported by citizens.

“In 2012, we responded to 19 calls for hypodermic needles either on the
roadside, in the neighborhood. In the parking lot. 2015 we had 36 calls,”
said Sandwich Lt. Joshua Bound. He said needles have been found all over –
conservation areas and beaches, even local neighborhood streets.

“We’ll get calls from neighbors, ‘I was walking down the street, and we
suspect a passerby just flicked the needle out of a window.'”
So, like Mashpee with illegal dumping, Sandwich is turning to enforcement.
And cameras.

“We’re out there. We’re making stops,” Bound said. “We’re talking to
people. We’ve increased patrols in these problem areas, areas like our
public beaches. We do have some surveillance now. So, we’re keeping an eye
out.”

They’re also asking for people’s help. Imploring residents – if you see a
needle on the ground or spy a pickup truck loaded down with furniture as
it takes a turn into the woods, call them, officials say. They want to
hear about it.
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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]
__________________________________________________________________
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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
__________________________________________________________________
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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
__________________________________________________________________
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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
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The comments made in this forum are the sole responsibility of the writers
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