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SIGNpost 00860

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST

Post00860 Outbreaks + Fakes + Abstracts + News 06 July 2016

CONTENTS
0. Moderators Note
1. Abstract: PCR-Based Molecular Diagnosis of Hepatitis Virus (HBV and
HDV) in HCV Infected Patients and Their Biochemical Study
2. Abstract: Molecular epidemiologic analysis of three Hepatitis C virus
outbreaks in the Jammu & Kashmir State, India
3. Abstract: Factors Associated with Occupational Needle Stick and Sharps
Injuries among Hospital Healthcare Workers in Bale Zone, Southeast
Ethiopia
4. Abstract: Risk of occupational exposure to the HBV infection in non-
clinical healthcare personnel
5. Abstract: Use of specific immunoglobulins and vaccines for the
management of accidental needlestick injury in the child: a practical
review in the anti-vaccination movement era
6. Abstract: Impact of waste management training intervention on
knowledge, attitude and practices of teaching hospital workers in
Pakistan
7. Abstract: Gap analysis of infection control practices in low- and
middle-income countries
8. Abstract: Reuse of insulin pens among multiple patients at 2 Veterans
Affairs medical centers
9. Abstract: Oral delivery of insulin for treatment of diabetes: status
quo, challenges and opportunities
10. Abstract: Occupational HIV risk for health care workers: risk factor
and the risk of infection in the course of professional activities
11. Abstract: Percutaneous and Mucocutaneous Exposure Among Orthopaedic
Surgeons: Immediate Management and Compliance With CDC Protocol
12. Abstract: Impact of Ipsilateral Blood Draws, Injections, Blood
Pressure Measurements, and Air Travel on the Risk of Lymphedema for
Patients Treated for Breast Cancer
13. Abstract: Injectable Cosmetic Procedures for the Male Patient
14. Abstract: Education of hand rubbing technique to prospective medical
staff, employing UV-based digital imaging technology
15. No Abstract: APIC salutes the 2016 Heroes of Infection Prevention
16. No Abstract: WHO method of hand hygiene kills most germs
17. News
– India: What’s ailing rural India: Punjab’s killer drug needles
– Indonesia: Police Refuse to Name Health Centers Using Fake Vaccines
– Indonesia: Distribution chain blamed for fake vaccine circulation
– Indonesia: Bio Farma says none of its vaccines counterfeited
– Scotland UK: Thousands of dirty needles dumped by Glasgow drug addicts
posing major health risk
– UK: Nasal spray flu vaccine effective in the UK

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0. Moderators Note
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Subscribe or unsubscribe by email to: sign.moderator@gmail.com
or signmoderator@googlegroups.com
__________________________________________________________________
________________________________*_________________________________

1. Abstract: PCR-Based Molecular Diagnosis of Hepatitis Virus (HBV and
HDV) in HCV Infected Patients and Their Biochemical Study
__________________________________________________________________
http://www.hindawi.com/journals/jpath/2016/3219793/

J Pathog. 2016;2016:3219793. Full Free Article

PCR-Based Molecular Diagnosis of Hepatitis Virus (HBV and HDV) in HCV
Infected Patients and Their Biochemical Study.

Riaz MN1, Faheem M2, Anwar MA3, Raheel U3, Badshah Y3, Akhtar H3, Tamanna
K4, Tahir M5, Sadaf Zaidi NU3, Qadri I6.

1Atta-ur-Rahman School of Applied Biosciences, National University of
Sciences and Technology, Islamabad 44000, Pakistan; Department of
Microbiology, Hazara University, Mansehra 21120, Pakistan.
2Atta-ur-Rahman School of Applied Biosciences, National University of
Sciences and Technology, Islamabad 44000, Pakistan; Ciencias Genomicas e
Biotecnologia, Universidade Catolica de Brasilia, 70790-160 Brasilia, DF,
Brazil.
3Atta-ur-Rahman School of Applied Biosciences, National University of
Sciences and Technology, Islamabad 44000, Pakistan.
4Department of Microbiology, Hazara University, Mansehra 21120, Pakistan.
5Laboratory of Biochemistry and Protein Chemistry, Cell Biology
Department, University of Brasilia, 70910-900 Brasilia, DF, Brazil.
6King Fahd Medical Research Center, King Abdul Aziz University, Jeddah
21589, Saudi Arabia.

Seroprevalence of HCV indicates that HCV is found in more than 10% of HBV-
or HDV-infected patients worldwide leading to liver disease. Here we show
HBV and HDV coinfection association with HCV infected Pakistani patients,
study of disease severity, and possible interpretation of associated risk
factors in coinfected patients.

A total of 730 liver diseased patients were included, out of which 501
were found positive for HCV infection via PCR. 5.1% of patients were
coinfected with HBV while 1% were coinfected with HBV and HDV both. LFTs
were significantly altered in dually and triply infected patients as
compared to single HCV infection. Mean bilirubin, AST, and ALT levels were
highest (3.25 mg/dL, 174 IU/L, and 348 IU/L) in patients with triple
infection while dual infection LFTs (1.6 mg/dL, 61 IU/L, and 74 IU/L) were
not high as in single infection (1.9 mg/dL, 76 IU/L, and 91 IU/L).

The most prominent risk factor in case of single (22%) and dual infection
(27%) group was “reuse of syringes” while in triple infection it was
“intravenous drug users” (60%).

It is concluded that HBV and HDV coinfections are strongly associated with
HCV infected Pakistani patients and in case of severe liver disease the
possibility of double and triple coinfection should be kept in
consideration.

Free Article http://www.hindawi.com/journals/jpath/2016/3219793/
__________________________________________________________________
________________________________*_________________________________

2. Abstract: Molecular epidemiologic analysis of three Hepatitis C virus
outbreaks in the Jammu & Kashmir State, India
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27357565

J Med Microbiol. 2016 Jun 27.
Molecular epidemiologic analysis of three Hepatitis C virus outbreaks in
the Jammu & Kashmir State, India.

Chadha S1, Sharma U2, Chaudhary A3, Prakash C4, Gupta S5, Venkatesh S6.

11National Centre for Disease Control.
22National Centre for Disease Control.
33National Centre Disease Control.
44National Centre for Disease Control.
55National Centre for Disease Control.
66National Centre for Disease Control.

Outbreaks of Hepatitis C Virus (HCV) infections are associated with unsafe
injection practices, intravenous drug abuse and other exposures to blood
and body fluids.

We report here, 3 outbreaks of HCV infection from the Jammu and Kashmir (J
& K) state of India which occurred over a period of 3 years and in which
molecular epidemiological investigations identified a presumptive common
source of infection, most likely a single healthcare venue.

Representative blood samples, collected from cases of Hepatitis C were
sent to the National Centre for Disease Control (NCDC) for molecular
characterization. These samples were positive by HCV ELISA. Subsequently,
specimens were also tested for the presence of HCV RNA by RT-PCR.

Sequencing was carried out for all positive samples. A total of 812 cases
were laboratory-confirmed by HCV ELISA. One hundred and fifteen samples
were sent to the NCDC for RT-PCR and 77 were positive. Subtype 3a of HCV
was found in all samples from Anantnag (February, 2013) and subtype 3b in
all samples from Srinagar (May, 2015). Subtype 3a and 3g were identified
from 2 samples from the Kulgam outbreak (July, 2014).

A detailed epidemiological investigation should be conducted whenever a
cluster of HCV cases is revealed, as this potentially allows for the
identification of larger outbreaks.

Epidemiological investigations of outbreaks should be further supported by
inclusion of molecular tests.

Efforts to limit therapeutic injections to only those cases having strong
medical/surgical indications and restricting the use of non-sterile
needles are essential to prevent transmission of HCV.
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Factors Associated with Occupational Needle Stick and Sharps
Injuries among Hospital Healthcare Workers in Bale Zone, Southeast
Ethiopia
__________________________________________________________________

http://dx.doi.org/10.1371/journal.pone.0140382

PLoS One. 2015 Oct 15;10(10):e0140382. Free Open Access Article
Factors Associated with Occupational Needle Stick and Sharps Injuries
among Hospital Healthcare Workers in Bale Zone, Southeast Ethiopia.

Bekele T1, Gebremariam A2, Kaso M1, Ahmed K1.

1Department of Public Health, College of Medicine and Health Sciences,
Madda Walabu University, Bale-Goba, Oromia, Ethiopia.
2Department of Public Health, College of Medicine and Health Sciences,
Adigrat University, Adigrat, Tigray, Ethiopia.

BACKGROUND: Needle stick and sharps injuries are occupational hazards to
healthcare workers. Every day healthcare workers are exposed to deadly
blood borne pathogens through contaminated needles and other sharp
objects. About twenty blood borne pathogens can be transmitted through
accidental needle stick and sharp injury. The study was conducted to
determine the lifetime and past one year prevalence of needle stick and
sharps injuries and factors associated with the past one year injuries
among hospital healthcare workers in Southeast Ethiopia.

METHODS: An institutional based cross sectional study was conducted in
December 2014 among healthcare workers in four hospitals of Bale zone,
Southeast of Ethiopia. A total of 362 healthcare workers were selected
randomly from each department in the hospitals. Data were collected using
self- administered questionnaire. The collected data were entered into
Epi-Info version 3.5 and analyzed using SPSS version 20.0. Multivariable
logistic regression analysis was used to identify the independent effect
of each independent variable on the outcome variable. Written informed
consent was secured from the participants.

RESULTS: The prevalence of lifetime needle stick and sharp injury was
37.1% with 95% CI of 32.0% to 42.5%. The prevalence of injury within the
past one year was 19.1% with 95% CI of 14.9% to 23.3%. Emergency ward was
a department with highest needle stick and sharp injury (31.7%). The main
cause of injury was syringe needles (69.8%). Participants who practiced
needle recapping had higher odds of needle stick and sharp injury within
the past 12 months (AOR = 3.23, 95% CI: 1.78, 5.84) compared to their
counterparts.

CONCLUSIONS: Nearly one out of five respondents had experienced needle
stick and/or sharp injury at least once within past one year. There were
practices and behaviors that put healthcare workers at risk of needle
stick and sharp injury at the study area. Needle recapping was key
modifiable risk behavior. Health policy makers and hospital administrators
should formulate strategies to improve the working condition for
healthcare workers and increase their adherence to universal precautions.
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Risk of occupational exposure to the HBV infection in non-
clinical healthcare personnel
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27364104

Med Pr. 2016;67(3):301-310. doi: 10.13075/mp.5893.00272.
Risk of occupational exposure to the HBV infection in non-clinical
healthcare personnel.

Rymer W1, Gladysz A2, Filipowski H3, Zubkiewicz-Zarebska A4, Tuminska A5,
Knysz B6.

1Wroclaw Medical University / Uniwersytet Medyczny we Wroclawiu, Wroclaw,
Poland (Department of Infectious Diseases, Hepatology and Acquired Immune
Deficiencies / Katedra i Klinika Chorób Zakaznych, Chorób Watroby i
Nabytych Niedoborów Odpornosciowych). weronika.rymer@umed.wroc.pl.
2Wroclaw Medical University / Uniwersytet Medyczny we Wroclawiu, Wroclaw,
Poland (Department of Infectious Diseases, Hepatology and Acquired Immune
Deficiencies / Katedra i Klinika Chorób Zakaznych, Chorób Watroby i
Nabytych Niedoborów Odpornosciowych). agladysz@mp.pl.
3Wroclaw Medical University / Uniwersytet Medyczny we Wroclawiu, Wroclaw,
Poland (Department of Patophysiology / Katedra i Zaklad Patofizjologii).
speat.hf@gmail.com.
4Wroclaw Medical University / Uniwersytet Medyczny we Wroclawiu, Wroclaw,
Poland (Department of Infectious Diseases, Hepatology and Acquired Immune
Deficiencies / Katedra i Klinika Chorób Zakaznych, Chorób Watroby i
Nabytych Niedoborów Odpornosciowych). a.w.zubkiewicz@gmail.com.
5Wroclaw Medical University / Uniwersytet Medyczny we Wroclawiu, Wroclaw,
Poland (Department of Physiology / Katedra i Zaklad Fizjologii).
anna.tuminska@gmail.com.
6Wroclaw Medical University / Uniwersytet Medyczny we Wroclawiu, Wroclaw,
Poland (Department of Infectious Diseases, Hepatology and Acquired Immune
Deficiencies / Katedra i Klinika Chorób Zakaznych, Chorób Watroby i
Nabytych Niedoborów Odpornosciowych). brygidaknysz@gmail.com.

Abstract in English, Polish

BACKGROUND: Occupational risk of blood-borne infections is investigated
mostly among nurses and doctors, studies concerning non-clinical health
personnel (nCHP) being rare. The analysis of the occupational exposure to
the hepatitis B virus (HBV) infection and the history of vaccination
against the HBV in the nCHP group has been the aim of the study.

MATERIAL AND METHODS: A retrospective analysis of 458 cases of the
occupational exposure to biological agents was conducted: group I –
doctors (N = 121, 28%), group II – nursing staff (N = 251, 55%), group III
– nCHP (N = 86, 19%).

RESULTS: In the group III the source was usually unknown (group: I –
0.83%, II – 11.16%, III – 86.05%, p < 0.001), and the proportion of
individuals vaccinated against hepatitis B before the exposure was the
lowest (group: I – 98.35%, II – 97.19%, III – 77.91%, p < 0.001). In this
group most exposures resulted from injuries caused by needles/sharps
deposited in waste sacks (60%) or anywhere outside of the medical waste
container (5%). The possibility of the HBV infection risk during the
exposure was found in 25 cases and was significantly more frequent in the
group III. The qualification for the HBV post-exposure prophylaxis was
also significantly more frequent in the group III.

CONCLUSIONS: The exposure to the occupational risk of the HBV infection
also concerns the non-clinical healthcare personnel. The non-clinical
healthcare personnel comprises one of the main groups of the HBV post-
exposure recipients. It is essential to determine the causes of the low
hepatitis B vaccination coverage in the nCHP and consider introduction of
mandatory vaccination in this group in Poland. Med Pr 2016;67(3):301-310.
This work is available in Open Access model and licensed under a CC BY-NC
3.0 PL license.

KEYWORDS: HBV; needlestick injury; non-clinical healthcare personnel;
occupational risk of HBV infection; orderlies; vaccination against HBV
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Use of specific immunoglobulins and vaccines for the
management of accidental needlestick injury in the child: a practical
review in the anti-vaccination movement era
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27347887

J Chemother. 2016 Jun 27:1-4.
Use of specific immunoglobulins and vaccines for the management of
accidental needlestick injury in the child: a practical review in the
anti-vaccination movement era.

Sollai S1, Iacopelli J1, Giovannini M1, Prato M1, Galli L1, de Martino M1,
Chiappini E1.

1a Department of Health Science , University of Florence, Anna Meyer
Children’s University Hospital , Florence , Italy.

INTRODUCTION: Accidental needle injury is a common but still discussed
problem.

OBJECTIVE: We discuss possible options to optimize the management of
injured children in light of the available literature findings.

RESULTS: The risk of viral infection is low. However, blood investigations
are mandatory, as well as appropriate counselling. Anti-HBV
immunoglobulins are recommended in all unvaccinated subjects exposed to a
HBsAg-positive source; however, there is no agreement regarding their
administration in unvaccinated children. Use of anti-tetanus
immunoglobulins in unvaccinated child with minor and clean wound is well
defined; however, wound type classification in the event of needlestick
injury may be difficult and subjective. There is no agreement on the
routine use of antiretroviral prophylaxis.

CONCLUSION: From a practical point of view, several unsolved issues have
emerged regarding the management of the children with needlestick injury,
which appear particularly relevant in the anti-vaccination movement era.
International guidelines should be encouraged at this regard.

KEYWORDS: HBV; HCV; HIV; Immunization; Needlestick injuries; Prophylaxis;
Tetanus
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Impact of waste management training intervention on
knowledge, attitude and practices of teaching hospital workers in
Pakistan
__________________________________________________________________

http://dx.doi.org/10.12669/pjms.323.9903 Free Open Access Article

Pak J Med Sci. 2016 May-Jun;32(3):705-10.
Impact of waste management training intervention on knowledge, attitude
and practices of teaching hospital workers in Pakistan.

Kumar R1, Somrongthong R2, Ahmed J3.

1Ramesh Kumar, MBBS, PhD. College of Public Health Sciences, Chulalongkorn
University, Bangkok, Thailand, Assistant Professor Health Services Academy
Islamabad, Pakistan.
2Ratana Somrongthong, PhD. Associate Professor College of Public Health
Sciences, Chulalongkorn University, Bangkok, Thailand.
3Jamil Ahmed, FCPS. Department of Family and Community Medicine, College
of Medicine and Medical Sciences, Arabian Gulf University, Bahrain.

OBJECTIVE: To evaluate the sustainability and effectiveness of training as
an intervention to improve the knowledge, attitude and practices of
hospital workers on health care waste management.

METHOD: We conducted this quasi-experimental study in two tertiary care
teaching hospitals in Rawalpindi in October 2013. Training, practical
demonstrations and reminders on standard waste management were given to
138 hospital workers in one hospital and compared with 137 workers from
the control hospital. We collected data 18 months after intervention
through a structured questionnaire to assess the impact of the
intervention. We used paired t-test to compare the scores on knowledge,
attitude and practices at baseline and first follow up and final impact
assessment. Chi square test was used to compare group variables between
intervention and control groups.

RESULTS: After 18 months since intervention the mean scores on knowledge
attitude and practices differed statistically significantly since baseline
and intervention group had statistically significantly better knowledge
positive attitudes and good health care waste management practices (p <
0.001). Health care and sanitary workers in intervention group scored
statistically significantly higher (p < 0.001).

CONCLUSION: Trainings of health and sanitary workers on health care waste
management guidelines were sustainable among the intervention group after
18 months which shows the positive impact of our intervention. It is
recommended that the trainings as intervention be included in the overall
policies of the public and private sector hospitals in Pakistan and other
similar settings.

KEYWORDS: Hospital workers; Intervention; Knowledge attitude and practice;
Training; Waste management

http://pjms.com.pk/index.php/pjms/article/view/9903/4332 Open Access PDF
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Gap analysis of infection control practices in low- and
middle-income countries
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26198467

Infect Control Hosp Epidemiol. 2015 Oct;36(10):1208-14.
Gap analysis of infection control practices in low- and middle-income
countries.

Weinshel K1, Dramowski A2, Hajdu Á3, Jacob S4, Khanal B5, Zoltán M6,
Mougkou K7, Phukan C8, Inés Staneloni M9, Singh N10.

11Society for Healthcare Epidemiology of America,Arlington,Virginia.
22Stellenbosch University,Cape Town,South Africa.
33National Center for Epidemiology,Budapest,Hungary.
44George Washington University,Washington,DC.
55B. P. Koirala Institute of Health Sciences,Nepal.
66Markhot Ferenc Teaching Hospital and Outpatient Clinic,Eger,Hungary.
77National Kapodistrian University,Athens School of
Medicine,Athens,Greece.
88Gauhati Medical College and Hospital,Guwahati,India.
99Hospital Italiano de Buenos Aires,Buenos Aires,Argentina.
1010Children’s National Medical Center,George Washington
University,Washington,DC.

BACKGROUND: Healthcare-associated infection rates are higher in low- and
middle-income countries compared with high-income countries, resulting in
relatively larger incidence of patient mortality and disability and
additional healthcare costs.

OBJECTIVE: To use the Infection Control Assessment Tool to assess gaps in
infection control (IC) practices in the participating countries.

METHODS: Six international sites located in Argentina, Greece, Hungary,
India, Nepal, and South Africa provided information on the health facility
and the surgical modules relating to IC programs, surgical antibiotic use
and surgical equipment procedures, surgical area practices, sterilization
and disinfection of equipment and intravenous fluid, and hand hygiene.
Modules were scored for each country.

RESULTS: The 6 international sites completed 5 modules. Of 121 completed
sections, scores of less than 50% of the recommended IC practices were
received in 23 (19%) and scores from 50% to 75% were received in 43 (36%).
IC programs had various limitations in many sites and surveillance of
healthcare- associated infections was not consistently performed. Lack of
administration of perioperative antibiotics, inadequate sterilization and
disinfection of equipment, and paucity of hand hygiene were found even in
a high-income country. There was also a lack of clearly written defined
policies and procedures across many facilities.

CONCLUSIONS: Our results indicate that adherence to recommended IC
practices is suboptimal. Opportunities for improvement of IC practices
exist in several areas, including hospital-wide IC programs and
surveillance, antibiotic stewardship, written and posted guidelines and
policies across a range of topics, surgical instrument sterilization
procedures, and improved hand hygiene.
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Reuse of insulin pens among multiple patients at 2 Veterans
Affairs medical centers
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26198627

Infect Control Hosp Epidemiol. 2015 Oct;36(10):1121-9.
Reuse of insulin pens among multiple patients at 2 Veterans Affairs
medical centers.

Schirmer P1, Winston CA1, Lucero-Obusan C1, Winters M2, Lesse A3, de
Comarmond C4, Oda G1, Martinello RA1, Holodniy M1.

11Office of Public Health,Department of Veterans Affairs,Washington,DC.
22Stanford University,Stanford,California.
33Veterans Affairs Western New York Healthcare System,Buffalo Medical
Center,Buffalo,New York.
45W. G. “Bill” Hefner Veterans Affairs Medical Center,Salisbury,North
Carolina.

OBJECTIVE: To determine whether reuse of insulin pens among multiple
patients resulted in transmission of bloodborne pathogens (BBP).

DESIGN: Retrospective cohort study.

SETTING: Two Veterans Affairs medical centers.

PATIENTS: Veterans who received insulin via insulin pens from 2010 to
2013. METHODS Patients were identified through electronic health records,
notified of possible exposure, and serotested for human immunodeficiency
virus, hepatitis C virus (HCV), and hepatitis B virus. Newly discovered
case patients were assessed in relation to potential proximate patients to
determine viral strain relatedness by HCV envelope (env) gene sequencing.

RESULTS: Of 1,791 hospitalized veterans who received insulin via insulin
pen, 1,155 were tested for at least 1 viral infection after exposure. Of
these, 67 patients were newly diagnosed with 1 or more viral BBPs. For
human immunodeficiency virus and hepatitis B virus no additional strain
testing of case or proximate patients was possible; 8 HCV cases and 45
proximates (40 unique patients; 5 patients were positive for 2 genotypes)
were identified as needing strain testing. Only 3 cases and their 19
proximates had samples available for further testing. None of the 26
remaining proximate patients had blood available for further testing.
Median genetic distance between the HCV env sequences of those available
for additional testing ranged from 14% to 24%, indicating nonrelatedness.

CONCLUSIONS: Our investigation revealed that exposure to insulin pen reuse
did not result in HCV transmission among patients who had viral genetic
analysis performed. Analysis for any additional potential transmission of
blood- borne pathogens was limited by the available samples.
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Oral delivery of insulin for treatment of diabetes: status
quo, challenges and opportunities
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27364922

J Pharm Pharmacol. 2016 Jun 30.
Oral delivery of insulin for treatment of diabetes: status quo, challenges
and opportunities.

Wong CY1, Martinez J1, Dass CR1,2.

1School of Pharmacy, Curtin University, Bentley, Australia.
2Curtin Biosciences Research Precinct, Bentley, Australia.

OBJECTIVES: Diabetes mellitus is characterised by progressive ß-cell
destruction and loss of function, or loss of ability of tissues to respond
to insulin. Daily subcutaneous insulin injection is standard management
for people with diabetes, although patient compliance is hard to achieve
due to the inconvenience of injections, so other forms of delivery are
being tested, including oral administration. This review summarises the
developments in oral insulin administration.

METHODS: The PubMed database was consulted to compile this review
comparing conventional subcutaneous injection of insulin to the desired
oral delivery.

KEY FINDINGS: Oral administration of insulin has potential benefits in
reducing pain and chances of skin infection, improving the portal levels
of insulin and avoiding side effects such as hyperinsulinemia, weight gain
and hypoglycaemia. Although oral delivery of insulin is an ideal
administration route for patients with diabetes, several physiological
barriers have to be overcome. An expected low oral bioavailability can be
attributed to its high molecular weight, susceptibility to enzymatic
proteolysis and low diffusion rate across the mucin barrier.

CONCLUSIONS: Strategies for increasing the bioavailability of oral insulin
include the use of enzyme inhibitors, absorption enhancers, mucoadhesive
polymers and chemical modification for endogenous receptor-mediated
absorption. These may help significantly increase patient compliance and
disease management.

© 2016 Royal Pharmaceutical Society.

KEYWORDS: diabetes; formulation; insulin; oral; tablet
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Occupational HIV risk for health care workers: risk factor
and the risk of infection in the course of professional activities
__________________________________________________________________

https://dx.doi.org/10.2147/TCRM.S104942 Free Full PDF

Ther Clin Risk Manag. 2016 Jun 14;12:989-94.
Occupational HIV risk for health care workers: risk factor and the risk of
infection in the course of professional activities.

Wyzgowski P1, Rosiek A2, Grzela T1, Leksowski K3.

1Department of General Surgery, Military Hospital, Nicolas Copernicus
University in Torun, Bydgoszcz, Poland.
2Public Health Department, Faculty of Health Sciences, Nicolas Copernicus
University in Torun, Bydgoszcz, Poland.
3Department of General Surgery, Military Hospital, Nicolas Copernicus
University in Torun, Bydgoszcz, Poland; Public Health Department, Faculty
of Health Sciences, Nicolas Copernicus University in Torun, Bydgoszcz,
Poland.

Virtually created panic among health care workers about pandemic acquired
immune deficiency syndrome prompted us to review the scientific literature
to investigate the risk of human immunodeficiency virus (HIV) transmission
in the daily works of health care workers, especially surgeons and
anesthesiologists. In this review, we report worldwide valuations of the
number of HIV infections that may occur from unsafe daily work in health
care.

We also present how to minimize the risk of infection by taking
precautions and how to utilize postexposure prophylaxis in accordance with
the latest reports of the Centers for Disease Control and Prevention.

HIV- infected patients will be aging, and most of them will become the
candidates for procedures such as major vascular reconstruction and artery
bypass grafting, where the risks of blood contact and staff injury are
high.

For these reasons, all health care workers need to know how to prevent,
and fight following the accidental exposure to HIV.

KEYWORDS: HIV infection; anesthesiologist; risk factor; surgeons
__________________________________________________________________
________________________________*_________________________________

11. Abstract: Percutaneous and Mucocutaneous Exposure Among Orthopaedic
Surgeons: Immediate Management and Compliance With CDC Protocol
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/25967855

J Orthop Trauma. 2015 Oct;29(10):e391-4.
Percutaneous and Mucocutaneous Exposure Among Orthopaedic Surgeons:
Immediate Management and Compliance With CDC Protocol.

Maniar HH1, Tawari AA, Suk M, Bowen TR, Horwitz DS.

1Department of Orthopaedic Surgery, Geisinger Medical Center, Danville,
PA.

BACKGROUND: Orthopaedic surgeons are at a high risk of sustaining a
percutaneous or mucocutaneous exposure to blood and body fluids. The
Center for Disease Control and Prevention recommends a wash with soap and
water and notification of the concerned hospital authorities after any
percutaneous/ mucocutaneous exposure, but a systematic amenability with
these guidelines is not always seen.

This cross-sectional study was undertaken to determine current knowledge
and practices of orthopaedic surgeons in case of a percutaneous sharp
injury exposure, emphasizes the immediate first aid steps taken after an
exposure, the degree of reporting, and to explore the reasons for
noncompliance.

Finally, we sought to create awareness about the prevailing Center for
Disease Control and Prevention guidelines after any exposure to blood or
body fluids.

MATERIALS AND METHODS: We conducted a cross-sectional survey using an
anonymous prepared questionnaire. The study population included
exclusively orthopaedic surgeons, including residents, fellows, and
attending physicians at 4 US institutions. The questionnaire was also
available online on the OTA Web site as a part of survey monkey. The
questionnaire comprised 9 multiple choice questions, and more than 1
response could be given for some questions. The questions addressed
previous needle stick/sharp injury exposure, number of times that had
happened, whether reported to the hospital administration, reason for
nonreporting, and risk perception for transmission of blood-borne
pathogens (human immunodeficiency virus, HBsAg, and hepatitis C virus).
The questions were also asked based on what should be done in four
different clinical settings based on respondents risk perception.

RESULTS: Of fifty eight attendings, 7 fellows, 45 residents, and 7
respondents who did not indicate their position participated in the survey
for a total of 117 respondents. Out of 99, 24 had sustained it once, 18
twice, 11 three times, and 35 at least 4 times.

When questioned about informing the incident to the hospital
administration, 38% had always reported the incident, 33% had never
reported the incident, and the remaining 29% had not reported it every
time. Of note, 87% gave the correct response about the risk of
transmission of human immunodeficiency virus after an exposure. On
questioning about the risk of hepatitis B transmission, from an HBsAg- and
HBeAg-positive source, 13% gave the correct response, whereas from HBsAg-
positive and HBeAg-negative source, 30% gave the correct response.

Regarding transmission of hepatitis C virus from a positive source, 36%
responded correctly. The surgeons seemingly attempted to risk stratify
their exposure, and they were more likely to report their exposure in the
higher risk scenarios.

CONCLUSIONS: This study demonstrates that orthopaedic surgeons of all
levels of training are at high risk of occupational exposure to blood-
borne pathogens.

Moreover, despite the level of training, the majority of surgeons do not
follow the recommended steps, although we do not know the reasons for such
behavior.

Also, there is a low awareness of the significant risk of hepatitis
transmission among orthopaedic surgeons treating a population with a high
prevalence of undiagnosed hepatitis.

Comment in Invited Commentary. [J Orthop Trauma. 2015]
__________________________________________________________________
________________________________*_________________________________

12. Abstract: Impact of Ipsilateral Blood Draws, Injections, Blood
Pressure Measurements, and Air Travel on the Risk of Lymphedema for
Patients Treated for Breast Cancer
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26644530

J Clin Oncol. 2016 Mar 1;34(7):691-8.
Impact of Ipsilateral Blood Draws, Injections, Blood Pressure
Measurements, and Air Travel on the Risk of Lymphedema for Patients
Treated for Breast Cancer.

Ferguson CM1, Swaroop MN1, Horick N1, Skolny MN1, Miller CL1, Jammallo
LS1, Brunelle C1, O’Toole JA1, Salama L1, Specht MC1, Taghian AG2.

1All authors: Massachusetts General Hospital, Harvard Medical School,
Boston, MA.
2All authors: Massachusetts General Hospital, Harvard Medical School,
Boston, MA. ataghian@partners.org.

PURPOSE: The goal of this study was to investigate the association between
blood draws, injections, blood pressure readings, trauma, cellulitis in
the at- risk arm, and air travel and increases in arm volume in a cohort
of patients treated for breast cancer and screened for lymphedema.

PATIENTS AND METHODS: Between 2005 and 2014, patients undergoing treatment
of breast cancer at our institution were screened prospectively for
lymphedema. Bilateral arm volume measurements were performed
preoperatively and postoperatively using a Perometer. At each measurement,
patients reported the number of blood draws, injections, blood pressure
measurements, trauma to the at- risk arm(s), and number of flights taken
since their last measurement. Arm volume was quantified using the relative
volume change and weight-adjusted change formulas. Linear random effects
models were used to assess the association between relative arm volume (as
a continuous variable) and nontreatment risk factors, as well as clinical
characteristics.

RESULTS: In 3,041 measurements, there was no significant association
between relative volume change or weight-adjusted change increase and
undergoing one or more blood draws (P = .62), *** injections (P = .77),
number of flights (one or two [P = .77] and three or more [P = .91] v
none), or duration of flights (1 to 12 hours [P = .43] and 12 hours or
more [P = .54] v none). By multivariate analysis, factors significantly
associated with increases in arm volume included body mass index = 25 (P =
.0236), axillary lymph node dissection (P < .001), regional lymph node
irradiation (P = .0364), and cellulitis (P < .001).

CONCLUSION: This study suggests that although cellulitis increases risk of
lymphedema, ipsilateral blood draws, injections, blood pressure readings,
and air travel may not be associated with arm volume increases. The
results may help to educate clinicians and patients on posttreatment risk,
prevention, and management of lymphedema.

© 2015 by American Society of Clinical Oncology.
__________________________________________________________________
________________________________*_________________________________

13. Abstract: Injectable Cosmetic Procedures for the Male Patient
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26355626

J Drugs Dermatol. 2015 Sep;14(9):1043-51.
Injectable Cosmetic Procedures for the Male Patient.

Wieczorek IT, Hibler BP, Rossi AM.

More than ever, male patients are seeking cosmetic procedures for a
variety of reasons including but not limited to: a less aged appearance,
social, or work related issues.

Injectable neurotoxins and fillers are appealing to the male patient for
their safety, rapid results, and minimal downtime. However, methods
applied to the female patient do not always translate to the male patient.
In this article, we review the anatomical, biological, and behavioral
differences in men.

We also provide an in-depth discussion of the techniques and dosages that
are used in men, emphasizing the distinctions between the sexes. While
once overlooked, this gender is becoming an important demographic in
cosmetic dermatology.
__________________________________________________________________
________________________________*_________________________________

14. Abstract: Education of hand rubbing technique to prospective medical
staff, employing UV-based digital imaging technology
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27352974

Acta Microbiol Immunol Hung. 2016 Jun;63(2):217-28.
Education of hand rubbing technique to prospective medical staff,
employing UV-based digital imaging technology.

Lehotsky Á1, Szilágyi L2,3, Demeter-Iclanzan A4, Haidegger T5,6, Wéber G1.

1Department of Surgical Research Techniques, Semmelweis University ,
Budapest, Hungary.
2Department of Control Engineering and Information Technology, Budapest
University of Technology and Economics , Budapest, Hungary.
3Computational Intelligence Research Group, Department of Electrical
Engineering, Sapientia University of Transylvania , Tîrgu Mures, Romania.
4University of Medicine and Pharmacy , Tîrgu Mures, Romania.
5Antal Bejczy Center for Intelligent Robotics, Óbuda University ,
Budapest, Hungary.
6Austrian Center for Medical Innovation Technology (ACMIT) , Wiener
Neustadt, Austria.

The aim of this study was to objectively assess the hand hygiene
performance of medical students. Hand rubbing technique was evaluated by
employing innovative UV-light-based imaging technology, identifying
patterns and trends in missed areas after applying WHO’s six-step
protocol.

This specially designed hand hygiene education and assessment program
targeted 1,344 medical students at two distant sites in Central Europe.

Students were introduced to a short video, presenting the basics of hand
hygiene, and then received further demonstration from professional
trainers, focusing on the correct execution of WHO’s six-step technique.

To verify the acquired skill, participants rubbed their hands with UV-
marked alcohol-based solution. Digital images of the hands were recorded
under UV light, followed by computer evaluation and assessment. Immediate
objective visual feedback was given to the participants showing missed
areas on their hands.

The statistical analysis of missed spots was based on retrospective
expert-driven manual evaluation. Significant difference in rubbing quality
was found between female and male participants [35.3% (CI 95%: 33-38%)
versus 29.0% (CI 95%: 27-31%), p?<?0.001], dominant and non-dominant hands
[43.4% (CI 95%: 39-48%) versus 34.9% (CI 95%: 32-38%), p?=?0.002], and
various zones of the hands’ dorsal side.

Based on the participants’ feedback and the evaluation of the infection
control specialists, it can be stated that the identification of typically
missed patterns and the instant visual feedback have a vital role in
improving the hand hygiene technique of prospective medical staff.

KEYWORDS: fluorescein trial; hand hygiene assessment; medical students
training
__________________________________________________________________
________________________________*_________________________________

15. No Abstract: APIC salutes the 2016 Heroes of Infection Prevention
__________________________________________________________________

http://www.ajicjournal.org/article/S0196-6553(16)30438-2/fulltext

Am J Infect Control. 2016 Jul 1;44(7):739. Free Full Text
APIC salutes the 2016 Heroes of Infection Prevention.

[No authors listed]

https://dx.doi.org/10.1016/j.ajic.2016.05.007
__________________________________________________________________
________________________________*_________________________________

16. No Abstract: WHO method of hand hygiene kills most germs
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27295786

Nurs Times. 2016 Apr 20-26;112(16):4.
WHO method of hand hygiene kills most germs.

[No authors listed]
__________________________________________________________________
________________________________*_________________________________

17. News

– India: What’s ailing rural India: Punjab’s killer drug needles

– Indonesia: Police Refuse to Name Health Centers Using Fake Vaccines

– Indonesia: Distribution chain blamed for fake vaccine circulation

– Indonesia: Bio Farma says none of its vaccines counterfeited

– Scotland UK: Thousands of dirty needles dumped by Glasgow drug addicts
posing major health risk

– UK: Nasal spray flu vaccine effective in the UK

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/hvh5wb2
India: What’s ailing rural India: Punjab’s killer drug needles

Video: Archana Shukla CNBC-TV18 Moneycontrol.com, India (01.07.16)

In part II of our series ‘What’s Ailing Rural India’ from the state of
Punjab, CNBC TV18’s Archana Shukla reports on the rise of blood borne
infections and why the government’s attempt to tackle it is failing.

The economic impact of drug abuse on the healthcare system is often
ignored. The rampant use of drugs has led to a disturbing rise in HIV and
Hepatitis C infections in Punjab.

In part II of our series ‘What’s Ailing Rural India’ from the state of
Punjab, CNBC TV18’s Archana Shukla reports on the rise of blood borne
infections and why the government’s attempt to tackle it is failing.

Watch video for more

Video at: https://tinyurl.com/hvh5wb2
__________________________________________________________________
__________________________________________________________________

https://tinyurl.com/zozt9a7
Indonesia: Police Refuse to Name Health Centers Using Fake Vaccines

Jakarta Globe, Jakarta Indonesia (01.07.16)

Jakarta. Police have refused to name hospitals and health centers
allegedly using counterfeit vaccines as public anxiety following the
scandal grows.

The vaccines are alleged to have been produced for years in Bekasi, South
Tangerang and West Java’s Subang, as revealed by on-going investigations.
The fake vaccines are believed to have been widely circulated and found in
Jakarta, Banten, West Java, Central Java and North Sumatra with hospitals,
community health centers and pharmacies using the products.

“We are not able to provide data to the public for now,” National Police
chief Gen. Badrodin Haiti told reporters on Thursday (30/06), adding they
will coordinate and provide the data to the Heath Ministry behind closed
doors.

While investigating the alleged involvement of doctors in the
distributions, police have named 17 suspects across several regions for
allegedly producing, distributing and selling the counterfeit drugs.

Police have tested the authenticity of a number of vaccines, while the
Health Ministry has urged all hospitals to examine stock. Children under
the age of 10 have been advised to be re-vaccinated.

The National Police, Health Ministry and also the Food and Drugs
Monitoring Agency (BPOM) have formed a joint task force to crack down on
the vaccine circulation, which President Joko Widodo has called an
extraordinary crime.

Calls are growing among the public for authorities to promptly retract the
fake vaccines from all health facilities.
__________________________________________________________________
__________________________________________________________________

https://tinyurl.com/htakzxl Infographic at the link
Indonesia: Distribution chain blamed for fake vaccine circulation

By Hans Nicholas Jong & Arya Dipa, The Jakarta Post, Jakarta/Bandung
Indonesia (30.06.16)

The recent discovery of a nationwide counterfeit vaccine ring has revealed
a gap in the distribution chain of vaccines in the country.

Authorities believe that fake vaccines could be circulating in hospitals,
clinics and pharmacies because there is demand from patients to use
imported vaccines, which can be procured through unofficial supply chains,
unlike vaccines produced in the country.

“There is high demand from the upper-middle income bracket for alternative
vaccines. If they want a polio vaccine, for example, they don’t want those
produced by state-owned pharmaceutical company Bio Farma. They want the
imported vaccine. That’s why there’s a gap,” Food and Drug Monitoring
Agency (BPOM) chairman Tengku Bahdar Johan Hamid said.

The safety and authenticity of a vaccine could only be guaranteed if
children were vaccinated through the government’s Complete Basic
Immunization program, Bahdar added.

All vaccines used in the government’s immunization program, including
Hepatitis B, diphtheria, pertussis and tetanus, measles and tuberculosis,
are obtained from official distributors through a closely monitored
distribution chain.

“Before the vaccines are distributed, we have to evaluate them. Each
production batch has to be tested before they can be released,” Bahdar
said.

The procedure to test the safety of the vaccines is even more rigorous
than those of regular drugs.

“Then we carry out post-market monitoring by taking samples from those
circulating in the distribution channel as well as in medical facilities
and test them,” said Bahdar. “That’s the official distribution channel.”

To further ensure that no fake vaccines are distributed through the
official distribution channel, the government also requires all public
medical facilities to procure their vaccines through an e-catalogue.

Health Minister Nila F. Moeloek said e-purchases from producers were
distributed by official pharmaceutical traders to regional health agencies
and health facilities, including community health centers (Puskesmas) and
integrated health service posts (Posyandu).

The case is different with unofficial distribution channels, but the BPOM
has said there is not much it can do as its authorities are restricted.

“There are many regulations that restrict us from doing our job properly.
For instance there is Health Ministerial Regulation No. 35/2014, which
says we can only monitor drugs in pharmacies and not their procurement and
distribution. Therefore, the House of Representatives recommends a bill on
food and drug monitoring because they know there is a lot of territory we
can’t enter,” Bahdar said.

He cited Pramuka Market in East Jakarta as a well-known source for fake
drugs.

“The kiosks that sell medicine in Pramuka Market are not official. We
never check that market because it’s not supposed to be selling vaccines.
We acknowledge our mistakes,”he said.

Bahdar added that counterfeit vaccines could also enter medical facilities
such as hospitals and clinics through freelance salespeople.

“There might be public hospitals that procure vaccines not from the
government. And then there are freelance distributors that offer vaccines
at low prices. The procurement of vaccines through such means is illegal,”
he said.

The BPOM has detected 28 medical facilities, mostly private hospitals and
private clinics, that have procured vaccines through unofficial channels,
according to Bahdar.

These facilities are located in Jakarta, Surabaya, Yogyakarta, Mataram,
Palu, Subang, Pekanbaru, Bandung and Denpasar.

“If the vaccines were obtained from unofficial sources at low prices, they
could be fake,” Bahdar said.

The BPOM also determined that counterfeit versions of at least 12 vaccine
brands had been circulating in the country. These brands are produced by
Bio Farma, Sanofi Group and Glaxo Smith Kline (GSK).

Bio Farma said the company had implemented strict standards for its
vaccine production and distribution, both in public and private medical
facilities. Bio Farma corporate secretary M. Rahman Rustan said its
vaccines were distributed by official distributors that were audited
periodically in accordance to good distribution practices, such as 48-hour
maximum delivery time.

“Therefore, there are no leaks in delivery that could be misused by other
parties,” he said.
__________________________________________________________________
__________________________________________________________________

https://tinyurl.com/jyx7lap
Indonesia: Bio Farma says none of its vaccines counterfeited

By Arya Dipa, The Jakarta Post, Bandung, Indonesia (30.06.16)

Photo: It’s all genuine – Bio Farma president director Iskandar displays
samples of vaccines manufactured by the state pharmaceutical company in a
press conference in response to news reports on the circulation of fake
vaccines at his office in Bandung, West Java, on Thursday.
(thejakartapost.com/Arya Dipa)

Bio Farma president director Iskandar said there was no evidence that any
vaccine produced by the state-owned pharmaceutical company had been
counterfeited.

“Bio Farma has coordinated with the Health Ministry, the Drug and Food
Monitoring Agency [BPOM], the National Police’s Criminal Investigation
Agency [Bareskrim] and official vaccine distributors. Based on physical
examinations of the packing and results of laboratory tests, Bio Farma
vaccines suspected of having been counterfeited are genuine, not
counterfeit,” said Iskandar on Thursday.

He made the statement in response to reports of the widespread circulation
of fake vaccines nationwide.

Iskandar admitted, however, that several other Bio Farma products had been
counterfeited. These included serums and diagnostic tools such as Biosat
(anti-tetanus serum), Biosave (anti-snake venom) and Tuberculin purified
protein derivative (PPD), an extract of Mycobacterium tuberculosis, which
causes TB in humans.

“Bio Farma vaccines have not been counterfeited. They are genuine and none
of them have been counterfeited. What have been counterfeited are serums,”
said Iskandar.

Photo: Poor handling – Bio Farma corporate secretary M.Rahman Rustan shows
a vaccine damaged by improper storage during a press conference at the
company’s headquarters in Bandung on Thursday. (thejakartapost.com/Arya
Dipa)

Bio Farma marketing director Mahendra Suhardono said vaccines that had
been counterfeited were mostly imported vaccines, which were expensive.

Bio Farma-manufactured serum products were much more expensive than
vaccines, he further said.

“Serums are priced at above Rp 100,000 [US$7.60], far more expensive than
vaccines,” said Mahendra.

Bio Farma vaccines are sold to the government and distributors at
different prices. They include BCG, TT, DT, Td, DTP-HB-Hib, bOPV,
Hepatitis B (for babies) and measles vaccines. Bio Farma sells them in
packages starting from one to 20 doses.

The vaccines’ selling prices for the government, which are listed on the
e-catalogue and include value added tax (PPN), vary starting from Rp
20,900 per dose for Hepatitis B vaccines for babies to Rp 59,950 for BCG
vaccines in a package of 20 doses. These two types of vaccines are sold to
distributors at different prices. The Hepatitis B vaccine is sold at Rp
47,700 per dose while the BCG vaccine in a package of 20 doses is priced
at Rp 112, 500.

Iskandar said that among the measures the government could take to prevent
fake vaccines was the proper management of vaccine waste or used ampoules,
including expired vaccines.

Every health care facility and immunization center both public and private
should have a proper vaccine waste management procedure and facility, he
went on. (ebf)
__________________________________________________________________
__________________________________________________________________

https://tinyurl.com/hqofamy
Scotland UK: Thousands of dirty needles dumped by Glasgow drug addicts
posing major health risk

Only 16 dirty needles out of 13,000 distributed to drug users were
disposed of safely last year in Glasgow.

The shock figures were released as plans were unveiled for Glasgow City
Centre to house the UK’s first drug injecting facility.

The city’s Alcohol and Drug Partnership are considering the radical
proposal to tackle rising HIV cases amongst drug users and risk to the
public from discarded needles.

Current estimates suggest some 500 people are injecting drugs in public
places in the city centre.

Last year police and council staff in Glasgow dealt with hundreds of
instances of discarded needles.

Public health chiefs said Scotland was “decades behind” other European
countries in tackling problem drug use.

Research has shown that such facilities do not increase drug use,
frequency of injecting or higher rates of local drug-related crime.

Susanne Miller, chair of the Alcohol Drugs Partnership said: “We need to
make our communities safer for all people living in and visiting the city,
including those who publicly inject.

“Last year, the Assertive Outreach Team dealing with homeless injectors
distributed almost 13,000 sterile needles.

“Of that number, only 16 or 0.1 per cent of the used needles were returned
to an injecting equipment centre for safe disposal.”

Habitual public injectors’ are at risk of blood-borne viruses, overdose
and drug-related death, and other injecting-related complications such as
serious bacterial infections.

Last year saw an HIV outbreak in the city with 47 new infections compared
to the previously consistent annual average of 10.

There have also been several other outbreaks of serious infectious
diseases such as botulism and anthrax.

Scottish Conservative shadow secretary for health Donald Cameron said:
“There is no question that heroin addiction remains a major problem facing
society today.

“It’s a challenging issue and we think abstinence-based programmes
requiring complete co-operation of the state and the individual are the
best way of helping people beat this terrible drug.

“Whilst we accept the necessity of keeping needles off our streets,
Scotland does not want to risk tackling this problem with programmes which
encourage injecting and drug use.”

Dr Emilia Crighton, director of Public Health at NHSGGC, and vice chair of
the ADP, said: “We are decades behind other countries in the way we tackle
this problem.

“In line with our current research, it’s clear we need to move beyond the
current model in order to meet the needs of our communities and this very
vulnerable group.

“In recent years Glasgow has been at the centre of outbreaks of anthrax,
botulism and most recently HIV infection in people who inject drugs.

“This public injecting group has high rates of hospital admissions,
incarceration and homelessness.

“Conventional treatment and services have not been as effective as we
would want in reducing health risks and the resulting costs.

“Our ultimate goal is for drug users to recover from their addiction and
remain drug free.

“However, until someone is ready to seek and receive help to stop using
drugs it is important to keep them as safe as possible while do they
continue to use drugs.”
__________________________________________________________________
__________________________________________________________________

https://tinyurl.com/hsf62lq
UK: Nasal spray flu vaccine effective in the UK

outbreaknewstoday.com USA (27.06.16)

On the same day The Centers for Disease Control and Prevention’s (CDC)
Advisory Committee on Immunization Practices (ACIP) voted that live
attenuated influenza vaccine (LAIV), also known as the “nasal spray” flu
vaccine, should not be used during the 2016-2017 flu season due to dismal
vaccine effectiveness studies, health officials in the United Kingdom said
provisional data shows that the Nasal spray flu vaccine has been effective
across the pond.

Photo: Nasal flu vaccine/CDC

Provisional figures released by Public Health England (PHE) show that the
childhood nasal spray flu vaccine has been effective in the UK, both in
protecting the children themselves and their communities from flu,
prompting health officials to remain confident that the children’s nasal
spray flu vaccine plays an important role in protecting children, their
families and others in the community from flu during the winter.
The National Institute for Health and Welfare in Finland has confirmed
that they saw similar effectiveness levels to the UK in 2015 to 2016 (46%
against laboratory confirmed disease), and have confirmed the nasal spray
flu vaccine will continue to be used in Finland for the forthcoming
winter.

From October 2016, the vaccine will be extended to healthy children in
school year 3 in England. Once again, children aged 2, 3 and 4, and in
school years 1 and 2 will also be eligible to receive the free vaccine
which is quick, effective and painless.

Dr Richard Pebody, head of flu surveillance for PHE said:

We estimate that overall, the vaccine was 57.6% (95% confidence interval:
25.1, 76) effective in preventing influenza infection amongst children in
2015 to 2016. These findings are encouraging and in line with what we also
typically see for the adult flu vaccine.

Prior to offering vaccination to all our youngest primary school aged
children this season, school age pilots took place in a number of areas
across England in 2014 to 2015. In areas where flu vaccine was piloted
amongst primary school age children, there was a 94% reduction in
GPinfluenza like illness consultation rates, 74% reduction in A&E
respiratory attendances and 93% reduction in hospital admissions due to
confirmed influenza in primary school children. In the same pilot areas,
GP ‘influenza like illness’ consultation rates for adults were 59% lower
compared to non-pilot areas.

Flu vaccine is the best protection we have against an unpredictable virus
which can cause severe illness and deaths each year not only amongst
children but also amongst at-risk groups, including older people, pregnant
women and those with an underlying health condition.

Based on intelligence to date, there is no reason to change current
recommendations regarding use of the children’s nasal spray vaccine in the
UK. We’re delighted that the UK leads the way in offering this vaccine to
children and we remain confident that the vaccines used in the Annual Flu
Vaccine programme are the most effective that are currently available in
protecting both those vaccinated and in reducing transmission of the flu
virus in our communities. We will continue to keep the vaccines used in
our programmes under review and to take advice from our independent expert
scientific committee, the Joint Committee on Vaccination and Immunisations
(JCVI).
__________________________________________________________________
________________________________*_________________________________

New WHO Injection Safety Guidelines

WHO is urging countries to transition, by 2020, to the exclusive use of
the new “smart” syringes, except in a few circumstances in which a syringe
that blocks after a single use would interfere with the procedure.

The new guideline is:

WHO Guideline on the use of Safety-Engineered Syringes for Intramuscular,
Intradermal and Subcutaneous Injections in Health Care

It is available for free download or viewing at this link:
www.who.int/injection_safety/global-campaign/injection-safety_guidline.pdf

PDF Requires Adobe Acrobat Reader [620 KB]
__________________________________________________________________
________________________________*_________________________________
Making all injections safe brochure

This is an illustrated summary brochure for the general public.

pdf, 554kb [6 pages]

www.who.int/injection_safety/global-campaign/injection-safety_brochure.pdf
__________________________________________________________________
________________________________*_________________________________

SIGN Meeting 2015

The Safe Injection Global Network SIGN meeting was held on 23-24 February
2015 at WHO Headquarters in Geneva Switzerland

The main topic of the meeting was the new injection safety policy
recommendation and developing the appropriate strategies for
implementation in countries worldwide.

A report of the meeting will be posted ASAP
__________________________________________________________________
________________________________*_________________________________
* SAFETY OF INJECTIONS brief yourself at: www.injectionsafety.org

A fact sheet on injection safety is available at:
http://www.who.int/mediacentre/factsheets/fs231/en/index.html

* Visit the WHO injection safety website and the SIGN Alliance Secretariat
at: http://www.who.int/injection_safety/en/

* Download the WHO Best Practices for Injections and Related Procedures
Toolkit March 2010 [pdf 2.47Mb]:
http://whqlibdoc.who.int/publications/2010/9789241599252_eng.pdf

Use the Toolbox at: http://www.who.int/injection_safety/toolbox/en/

Get SIGN files on the web at: http://signpostonline.info/signfiles-2 get
SIGNpost archives at: http://signpostonline.info/archives-by-year

Like on Facebook: http://facebook.com/SIGN.Moderator

The SIGN Secretariat, the Department of Health Systems Policies and
Workforce, WHO, Avenue Appia 20, CH-1211 Geneva 27, Switzerland.
Facsimile: +41 22 791 4836 E- mail: sign@who.int
__________________________________________________________________
________________________________*_________________________________
All members of the SIGN Forum are invited to submit messages, comment on
any posting, or to use the forum to request technical information in
relation to injection safety.

The comments made in this forum are the sole responsibility of the writers
and does not in any way mean that they are endorsed by any of the
organizations and agencies to which the authors may belong.

Use of trade names and commercial sources is for identification only and
does not imply endorsement.

The SIGN Forum welcomes new subscribers who are involved in injection
safety.

* Subscribe or unsubscribe by email: signmoderator@googlegroups.com

The SIGNpost Website is http://SIGNpostOnline.info

The SIGNpost website provides an archive of all SIGNposts, meeting
reports, field reports, documents, images such as photographs, posters,
signs and symbols, and video.
__________________________________________________________________
________________________________*_________________________________

The SIGN Internet Forum was established at the initiative of the World
Health Organization’s Department of Essential Health Technologies.

The SIGN Secretariat home is the Service Delivery and Safety (SDS) Health
Systems and Innovation (HIS) at WHO HQ, Geneva Switzerland.

The SIGN Forum is moderated by Allan Bass and is hosted on GoogleGroups

Subscribe or unsubscribe by email: signmoderator@googlegroups.com
__________________________________________________________________

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