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SIGNpost 00862

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST

Post00862 RFI:RUP + Microaray + Hepatitis + Abstracts + News 20 July 2016

CONTENTS
1. RFI: Question regarding the use reuse prevention syringes (RUP) for
therapeutic injections as a policy?
2. Opinion Survey: Microarray Patches for Dermal Delivery of Vaccines?
3. Comment: The global burden of viral hepatitis: better estimates to
guide hepatitis elimination efforts
4. Abstract: Knowledge, attitudes, beliefs, values, preferences, and
feasibility in relation to the use of injection safety devices in
healthcare settings: a systematic review
5. Abstract: Incidence of transmissible diseases in a network of assisted
reproduction clinics throughout Queensland
6. Abstract: Hepatitis C Virus Infections Associated with Unsafe Injection
Practices at a Pain Management Clinic, Michigan, 2014-2015
7. Abstract: Monitoring of hematogenous occupational exposure in medical
staff in infectious disease hospital
8. Abstract:Sharps and Needlestick Injuries Among Medical Students,
Surgical Residents, Faculty, and Operating Room Staff at a Single
Academic Institution
9. Abstract: Investigation of current cognition of occupational exposure
to HIV in healthcare workers in Liuzhou, China
10. Abstract: Complexity of occupational exposures for home health-care
workers: nurses vs. home health aides
11. Abstract: Lacerations and Embedded Needles Caused by Epinephrine
Autoinjector Use in Children
12. Abstract: Oral Tocofersolan Corrects or Prevents Vitamin E Deficiency
in Children with Chronic Cholestasis
13. Abstract: Nonprescription syringe sales: Resistant pharmacists’
attitudes and practices
14. Abstract: Rural people who inject drugs: A cross-sectional survey
addressing the dimensions of access to secondary needle and syringe
program outlets
15. Abstract: Recovering infectious HIV from novel syringe-needle
combinations with low dead space volumes
16. Abstract: An assessment of hand hygiene practices of healthcare
workers of a semi-urban teaching hospital using the five moments of
hand hygiene
17. Abstract: Pharmacological study and pharmaceutical intervention to
reduce intravenous injection-induced vascular injury
18. Abstract: Seroprevalence and Correlates of Hepatitis C Virus Infection
in Secondary School Children in Enugu, Nigeria
19. No Abstract: The global burden of viral hepatitis: better estimates to
guide hepatitis elimination efforts
20. No Abstract: Design Trumps Training
21. No Abstract: Investigation and intervention of nursing staff
psychological state after needle stick injury
22. No Abstract: Sharps injury watch
23. No Abstract: Essential Precautions for Health Care, General Industry
24. News
– Indonesia: Fake vaccine scandal prompts Indonesian parents to rush to
inoculate children
– Heroin use threatening Kenya’s HIV/Aids gains, clean needles helpful
– Kenya: Health Workers Face Risk of HIV Infection
– Indonesia: Indonesia orders overhaul of drug agency after fake vaccine
scandal
– USA: Ex-Oklahoma dentist sentenced over HIV, hepatitis scare

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SIGNpost 00862

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and get updates on your device!
__________________________________________________________________
________________________________*_________________________________

1. RFI: Question regarding the use reuse prevention syringes (RUP)for
therapeutic injections as a policy
__________________________________________________________________
ALTAF, Arshad <altafa@who.int>
to: sign.moderator <sign.moderator@gmail.com>
date: Thu, Jul 14, 2016

subject: Question regarding the use reuse prevention syringes (RUP) for
therapeutic injections as a policy
Dear SIGN Colleagues,

I would like to pose a question to everyone and would welcome a response
send directly to me at altafa@who.int

Do we know how many low and middle income countries are using RUPs in the
curative sector as a national policy?

Our colleague Selma Khamassi has informed me that Uganda, Kenya and
Tanzania are the three countries she is aware of.

Any additional information in this regard will be highly appreciated.

Kind regards to everyone.

Arshad
Dr Arshad Altaf, MBBS MPH
Consultant
Injection Safety
Service Delivery and Safety (SDS)
Health Systems and Innovation (HIS)
Room 4163, Tel +41 76 757 9559
World Health Organization
20, Av Appia, CH-1211 Geneva 27, Switzerland

E-mail: altafa@who.int
__________________________________________________________________
________________________________*_________________________________

2. Opinion Survey: Microarray Patches for Dermal Delivery of Vaccines?
__________________________________________________________________
from: McGray, Sarah <smcgray@path.org>
to: sign.moderator <sign.moderator@gmail.com>
date: Thu, Jul 14, 2016
subject: microarray patches for dermal delivery of vaccines
Dear colleagues,

Microarray patches (MAPs) are under development for delivering vaccine
into the skin. The technology has exciting potential, especially for
application to immunization programs in low- and middle-income countries.

We’d like to hear from experts in low- and middle-income country
immunization programs about your opinions on the potential feasibility of
MAPs for immunization, especially for novel delivery scenarios like self-
administration of vaccine at home, as well as more traditional
immunization settings in LMICs. We have created an online survey as a
forum for you to share your thoughts.

We value your input on this topic. The survey will be open for one week
and should take no more than 20 minutes:
https://www.surveymonkey.com/r/vaccinepatch

The results will inform dialogue with vaccine manufacturers and other
stakeholders as we work to advance this exciting new method for vaccine
delivery. I encourage you to share your opinion in the survey and to
forward the link above to other colleagues, particularly those in LMIC
immunization programs. I’m always happy to chat in person as well and have
included my contact information below.

I hope to hear from you.

Best regards,

Sarah

Sarah McGray
Program Officer, Devices & Tools
PATH
Tel: 206.285.3500
Skype: smcgray
Email: smcgray@path.org

www.path.org
__________________________________________________________________
________________________________*_________________________________

3. Comment: The global burden of viral hepatitis: better estimates to
guide hepatitis elimination efforts

Crossposted from the Lancet.com with thanks.
__________________________________________________________________

www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31018-2
The global burden of viral hepatitis: better estimates to guide hepatitis
elimination efforts

Stefan Z Wiktoremail, Yvan J-F Hutin

Published Online: 06 July 2016
Article has an altmetric score of 7

DOI: http://dx.doi.org/10.1016/S0140-6736(16)31018-2

A recurring question about viral hepatitis is why it receives so little
funding and attention from global health policy makers and donors. For
example, the Sustainable Development Goals have a goal to “end the
epidemics of” HIV, tuberculosis, and malaria by 2030 while only
“combating” hepatitis, despite the fact that hepatitis accounts for more
deaths than each of those infections individually.1, 2 One reason for this
is the difficulty in accurately quantifying and explaining the morbidity
and mortality related to viral hepatitis. This difficulty stems from the
fact that hepatitis deaths are caused by five distinct viruses (hepatitis
A–E) with different routes of transmission, that death occurs decades
after infection, and that when people die with hepatitis-related liver
cancer and cirrhosis, these deaths are not always linked to the underlying
infection.3

In The Lancet, Jeffrey Stanaway and colleagues4 have made a major advance
in addressing these challenges. Using the Global Burden of Disease (GBD)
Study approach, which estimates the causes of mortality and morbidity and
their relative importance, they have assessed the burden of disease caused
by viral hepatitis from 1990 to 2013 at the country, regional, and global
levels.

The main conclusion from their analysis is that viral hepatitis
accounted for 1·45 million deaths (95% uncertainty interval [UI] 1·38–
1·54) in 2013, a 63% (95% UI 52–75) increase compared with the 0·89
million deaths (0·86–0·94) in 1990. Morbidity also increased in terms of
years lived with disability (from 0·65 million [0·45–0·89] to 0·87 million
[0·61–1·18]) and disability-adjusted life-years (DALYs; from 31·7 million
[30·2–33·3] to 42·5 million [39·9–45·6]). The biggest increase was noted
for hepatitis C infection, for which the rate of DALYs increased by 43%.

Most of the morbidity and mortality is caused by hepatitis B and C
infections (96% [95% UI 94–97] of mortality and 91% [88–93] of DALYs in
2013), because these two viruses cause chronic, life-long infections,
resulting in progressive liver damage that leads to cirrhosis and
hepatocellular carcinoma. Finally, the burden of disease was not equally
distributed worldwide. Hepatitis-related mortality was highest (=33·50
deaths per 100 000 population per year) in Oceania, western sub-Saharan
Africa, and central Asia. However, in absolute numbers, east Asia and
south Asia have the greatest number of hepatitis deaths (52% of the total
number of deaths). Unlike HIV, which primarily occurs in low-income
countries (mostly in Africa), 58% of hepatitis deaths occurred in upper-
middle-income countries and high-income countries.

This work is an extension of an earlier global analysis of the GBD Study2
that for the first time combined deaths due to acute and chronic infection
to provide an improved estimation of the true burden of viral hepatitis.
Both Stanaway and colleagues’ study4 and the earlier analysis2 used
complex statistical methods that rely on several assumptions and on
estimations of the incidence and prevalence of hepatitis infection, as
well as the number of deaths recorded by death certification.
Unfortunately, these measures are particularly weak for hepatitis, with
widely varying estimates for the number of people living with hepatitis
infection and documented under-reporting of deaths due to hepatitis-
related cirrhosis and liver cancer.3, 5

Stanaway and colleagues’ study4 has several important implications. It
provides convincing evidence that viral hepatitis is a major contributor
to the global disease burden and shows that this disease requires a
stronger national and international response. Such an effective response
needs to combine interventions that prevent new infections (eg,
immunisation, safe health care, and harm reduction) and scaling up of
testing and treatment to reduce mortality among the estimated 400 million
people with chronic hepatitis B and C infection.

Addressing the global
burden of hepatitis infection will require substantial additional
resources. Since most of the hepatitis burden is in high-income countries
and upper-middle-income countries that do not receive development
assistance, in many countries, these resources will probably need to come
from national health budgets. For low-income countries and lower-middle-
income countries, it is hoped that the improved understanding of the high
burden of hepatitis will lead to an increase in international development
assistance.

Thumbnail image of Figure.
James Cavallini/Science Photo Library

There are indications that the momentum is building to better address
viral hepatitis. Several countries—such as Egypt, Georgia, and Mongolia—
have adopted elimination goals, and in May, 2016, WHO adopted the first-
ever global hepatitis strategy with a goal to eliminate viral hepatitis as
a public health threat by 2030, defined as a reduction in incidence by 90%
and mortality by 65%.6 Global estimates documenting the high level of
hepatitis-related mortality were key in advocating for the global strategy
and are now further supported by Stanaway and colleagues’ findings.4
Improved national estimates are now needed to monitor the success of this
strategy.

We declare no competing interests. SZW and YJ-FH are part of WHO’s Global
Hepatitis Programme and contributed to WHO’s global health sector strategy
on viral hepatitis 2016–21.

References

WHO. World health statistics 2016: monitoring health for the SDGs,
sustainable development goals. World Health Organization, Geneva;
2016http://apps.who.int/iris/
bitstream/10665/206498/1/9789241565264_eng.pdf?ua=1. ((accessed June 29,
2016).)

GBD 2013 Mortality and Causes of Death Collaborators. Global, regional,
and national age–sex specific all-cause and cause-specific mortality for
240 causes of death, 1990–2013: a systematic analysis for the Global
Burden of Disease Study 2013. Lancet. 2015; 385: 117–171

Mahajan, R, Xing, J, Liu, SJ et al. Mortality among persons in care with
hepatitis C virus infection: the Chronic Hepatitis Cohort Study (CHeCS),
2006–2010. Clin Infect Dis. 2014; 58: 1055–1061

Stanaway, JD, Flaxman, AD, Naghavi, M et al. The global burden of viral
hepatitis from 1990 to 2013: findings from the Global Burden of Disease
Study 2013. Lancet. 2016; (published online July 6.)
http://dx.doi.org/10.1016/S0140-6736(16)30579-7.

Basnayake, SK and Easterbrook, PJ. Wide variation in estimates of global
prevalence and burden of chronic hepatitis B and C infection cited in
published literature. J Viral Hepat. 2016; 23: 545–559

WHO. Draft global health sector strategies. Viral hepatitis, 2016–2021.
Report by the Secretariat. Agenda item A69/32. World Health Organization,
Geneva; 2016http://apps.who.int/gb/ebwha/pdf_files/WHA69/A69_32-en.pdf?
ua=1. ((accessed June 21, 2016).)
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Knowledge, attitudes, beliefs, values, preferences, and
feasibility in relation to the use of injection safety devices in
healthcare settings: a systematic review
__________________________________________________________________

http://hqlo.biomedcentral.com/articles/10.1186/s12955-016-0505-8

Health Qual Life Outcomes. 2016 Jul 13;14(1):102. Open Access Article
Knowledge, attitudes, beliefs, values, preferences, and feasibility in
relation to the use of injection safety devices in healthcare settings: a
systematic review.

Tarabay R1, El Rassi R2, Dakik A2, Harb A1, Ballout RA3, Diab B1, Khamassi
S4, Akl EA5,6,7.

1Lebanese University, Beirut, Lebanon.
2American University of Beirut, Beirut, Lebanon.
3Faculty of Medicine, American University of Beirut, Beirut, Lebanon.
4World Health Organization, Geneva, Switzerland.
5Department of Internal Medicine, American University of Beirut, Beirut,
Lebanon. ea32@aub.edu.lb.
6Department of Internal Medicine, American University of Beirut Medical
Center, P.O. Box: 11-0236, Riad-El-Solh Beirut, 1107 2020, Beirut,
Lebanon. ea32@aub.edu.lb.
7Department of Clinical Epidemiology and Biostatistics, McMaster
University, Hamilton, ON, Canada. ea32@aub.edu.lb.

BACKGROUND: Adopting technologies such as injection safety devices in
healthcare settings can enhance injection safety. Developing guidelines
for appropriate adoption of such technologies need to consider factors
beyond evidence for their health effects. The objective of this study is
to systematically review the published literature for evidence among
healthcare workers and patients about knowledge, attitudes, beliefs,
values, preferences, and feasibility in relation to the use of injection
safety devices in healthcare settings.

METHODS: We included both qualitative and quantitative studies conducted
with the general public, patients, and healthcare workers, administrators,
or policy makers. We searched MEDLINE, EMBASE, CINHAL and CENTRAL. We used
a duplicate and independent approach to title and abstract screening, full
text screening, data abstraction and risk of bias assessment.

RESULTS: Out of a total of 6568 identified citations, we judged fourteen
studies as eligible for this systematic review. All these studies were
surveys, conducted with healthcare workers in high-income countries. We
did not identify any qualitative study, or a study of the general public,
patients, healthcare administrators or policy makers. We did not identify
any study assessing knowledge, or values assigned to outcomes relevant to
injection safety devices. Each of the included studies suffered from
methodological limitations, which lowers our confidence in their findings.

Based on the findings of six studies, the injection safety devices were
generally perceived as easy to use and as an improvement compared with
conventional syringes. Some of these studies reported few technical
problems while using the devices. In three studies assessing perceived
safety, the majority of participants judged the devices as safe. Two
studies reported positive perceptions of healthcare workers regarding
patient tolerance of these injection safety devices. One study found that
less than half the nurses felt comfortable using the insulin pens.

Findings from four studies assessing preference and satisfaction were not
consistent.

CONCLUSIONS: This systematic review identified evidence that injection
safety devices are generally perceived as easy to use, safe, and tolerated
by patients.

There were few reports of technical problems while using the devices and
some discomfort by nurses using the insulin pens.

KEYWORDS: Acceptance; HCW; Injection safety devices; Injections;
Preferences; Satisfaction
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Incidence of transmissible diseases in a network of assisted
reproduction clinics throughout Queensland
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26174439

Aust N Z J Obstet Gynaecol. 2015 Oct;55(5):515-7.
Incidence of transmissible diseases in a network of assisted reproduction
clinics throughout Queensland.

Harrison K1, Darling N1, Vargas K1, Irving J2, Osborn J2, Yazdani A3,
Molloy D1.

1Queensland Fertility Group, Spring Hill, Queensland, Australia.
2Queensland Fertility Group, Toowoomba, Queensland, Australia.
3Queensland Fertility Group Research Foundation, Spring Hill, Queensland,
Australia.

In assisted reproduction, knowledge of the presence of transmissible
disease assists diagnosis and permits appropriate risk minimisation.

The overall incidence was lowest in the Brisbane full-cost clinic and
highest in the Springwood low-cost clinic. Male partners predominated over
females, particularly in the low-cost clinic.

Hepatitis C was the most commonly detected infection with the highest
incidence in the low-cost clinic. HIV was the least commonly detected
infection amongst those tested.

© 2015 The Royal Australian and New Zealand College of Obstetricians and
Gynaecologists.
KEYWORDS:
assisted; disease; reproduction; transmissible
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Hepatitis C Virus Infections Associated with Unsafe Injection
Practices at a Pain Management Clinic, Michigan, 2014-2015
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27425190

Pain Med. 2016 Jul 17. pii: pnw157.
Hepatitis C Virus Infections Associated with Unsafe Injection Practices at
a Pain Management Clinic, Michigan, 2014-2015.

Coyle JR1, Goerge E2, Kacynski K3, Rodgers R3, Raines P3, Vail LS3, Lowhim
S3.

1*Michigan Department of Health and Human Services, Communicable Disease
Division, Bureau of Disease Control and Prevention, Lansing, Michigan
coylej@michigan.gov.
2*Michigan Department of Health and Human Services, Communicable Disease
Division, Bureau of Disease Control and Prevention, Lansing, Michigan.
3Ingham County Health Department, Lansing, Michigan, USA.

BACKGROUND: In 2015, the Michigan Department of Health and Human Services
(MDHHS) was notified of an acute case of hepatitis C virus (HCV). The
patient had no traditional HCV risk factors. The only known subcutaneous
exposure was health care received at a pain management clinic.

DESIGN: A field investigation was undertaken to determine the likely route
of HCV acquisition and assess potential risk to other patients.

SETTING AND PATIENTS: The investigation involved a free-standing
outpatient pain management clinic and its patients with a subcutaneous
exposure.

METHODS: Investigators utilized the Centers for Disease Control and
Prevention’s (CDC) viral hepatitis health care-associated infection
investigation protocol to guide field investigation, assess risk to
patients, perform patient notification, and test patients for blood-borne
pathogens.

RESULTS: The index case was found to be the final patient seen in the
clinic’s operating room for the week. Examining the MDHHS viral hepatitis
registry revealed another acute HCV patient seen immediately before the
index case. The second acute case was preceded by a patient chronically
infected with HCV. Due to the possibility of patient-to-patient HCV
transmission, 122 patients were recommended to be tested for blood-borne
pathogens. Ninety- two patients presented for testing. No additional
transmission events were discovered.

CONCLUSION: Health care-associated transmission of HCV likely occurred at
an outpatient pain management clinic; possibly the result of multiple
patient use of single-dose vials. Because no other cases were discovered
this may represent an isolated incident as opposed to a systematic
breakdown in infection control standards. This circumstance highlights the
need for continued vigilance and adherence to CDC’s Minimum Expectations
for Safe Care in Outpatient Settings.

© 2016 American Academy of Pain Medicine. All rights reserved. For
permissions, please e-mail: journals.permissions@oup.com.

KEYWORDS: Health Care-Associated Infection; Hepatitis C Virus; Injection
Safety; Outbreak Investigation; Standard Precautions
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Monitoring of hematogenous occupational exposure in medical
staff in infectious disease hospital
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26832901

Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2015 Oct;33(10):766-8.
[Monitoring of hematogenous occupational exposure in medical staff in
infectious disease hospital].

[Article in Chinese]

Xie M1, Zhou J2, Wang Y1.

1Huai’an Fourth People’s Hospital, Huai’an 223002, China.
2Huai’an Fourth People’s Hospital, Huai’an 223002, China; E-mail:
xmxxcx5933@163.com.

OBJECTIVE: To investigate the status and risk factors for hematogenous
occupational exposure in medical staff in an infectious disease hospital,
and to provide a scientific basis for targeted preventive and control
measures.

METHODS: The occupational exposure of 395 medical workers in our hospital
was monitored from January 2012 to December 2014, among whom 79
individuals with occupational exposure were subjected to intervention and
the risk factors for occupational exposure were analyzed.

RESULTS: The high-risk group was mainly the nursing staff (69.6%). The
incidence of hematogenous occupational exposure was high in medical
personnel with a working age under 3 years, aged under 25 years, and at
the infection ward, accounting for 63.3%, 72.1%, and 72.2%, respectively.
Hepatitis B virus, hepatitis C virus, Treponema pallidum, and human
immunodeficiency virus were the primary exposure sources.

Sharp injury was the major way of injury (91.1%), with needle stick injury
accounting for the highest proportion (86.1%). Injury occurred on the hand
most frequently (91.1%).

The high-risk links were improper disposal during or after pulling the
needle, re-capturing the needle, and processing waste, accounting for
46.8%, 17.7%, and 12.7%, respectively. Seventy-nine professionals with
occupational exposure were not infected.

CONCLUSION: The main risk factor for hematogenous occupational exposure in
medical staff in the infectious disease hospital is needle stick injury.

Strengthening the occupational protection education in medical staff in
infectious disease hospital, implementing protective measures,
standardizing operating procedures in high-risk links, and enhancing the
supervision mechanism can reduce the incidence of occupational exposure
and infection after exposure.
__________________________________________________________________
________________________________*_________________________________

8. Abstract:Sharps and Needlestick Injuries Among Medical Students,
Surgical Residents, Faculty, and Operating Room Staff at a Single
Academic Institution
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27397414

J Surg Educ. 2016 Jul 5. pii: S1931-7204(16)30072-1.
Sharps and Needlestick Injuries Among Medical Students, Surgical
Residents, Faculty, and Operating Room Staff at a Single Academic
Institution.

Choi LY1, Torres R2, Syed S2, Boyle S2, Ata A2, Beyer TD2, Rosati C2.

1Department of General Surgery, Albany Medical Center, Albany, New York.
Electronic address: choil@mail.amc.edu.
2Department of General Surgery, Albany Medical Center, Albany, New York.

BACKGROUND: The hospital is a place of high risk for sharps and
needlestick injuries (SNI) and such injuries are historically
underreported.

METHODS: This institutional review board approved study compares the
incidence of SNI among all surgical personnel at a single academic
institution via an anonymous electronic survey distributed to medical
students, surgical residents, general surgery attendings, surgical
technicians, and operating room nurses.

RESULTS: The overall survey response rate was 37% (195/528). Among all
respondents, 55% (107/195) had a history of a SNI in the workplace. The
overall report rate following an initial SNI was 64%. Surgical staff
reported SNIs more frequently, with an incidence rate ratio (IRR) of 1.33
(p = 0.085) when compared with attendings. When compared with surgical
attendings, medical students (IRR of 2.86, p = 0.008) and residents (IRR
of 2.21, p = 0.04) were more likely to cite fear as a reason for not
reporting SNIs. Approximately 65% of respondents did not report their
exposure either because of the time consuming process or the patient
involved was perceived to be low-risk or both.

CONCLUSIONS: The 2 most common reasons for not reporting SNIs at our
institution are because of the inability to complete the time consuming
reporting process and fear of embarrassment or punitive response because
of admitting an injury. Further research is necessary to mitigate these
factors.

Copyright © 2016. Published by Elsevier Inc.

KEYWORDS: Interpersonal and Communication Skills; Medical Knowledge;
Patient Care; Practice-Based Learning and Improvement; Professionalism;
Systems-Based Practice; medical student; needlestick; operating room
nurse; resident; sharps; surgery attending; surgical technician
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Investigation of current cognition of occupational exposure
to HIV in healthcare workers in Liuzhou, China
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26506770

Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2015 Apr;33(4):255-7.
[Investigation of current cognition of occupational exposure to HIV in
healthcare workers in Liuzhou, China].

[Article in Chinese]

Li Y, Ge X, Liu G, Qiu L, Mo Y, Li F.

OBJECTIVE: To investigate the current cognition of occupational exposure
to human immunodeficiency virus (HIV) and the personal occupational
protection awareness in healthcare workers in Liuzhou, China.

METHODS: A total of 270 healthcare workers were selected from 10 hospitals
in Liuzhou by stratified random sampling for a cross-sectional study. And
a self-administered questionnaire of occupational exposure to HIV was
designed to conduct a survey.

The descriptive analysis of data was carried out by Excel. And a logistic
regression analysis was done to analyze the effects of different factors
on healthcare workers’ cognition of occupational exposure to HIV using the
statistical analysis software SPSS 19.0.

RESULTS: A total of 260 usable questionnaires (96.3%) were returned. Among
them, 220 healthcare workers (84.6%) had received the trainings on
occupational exposure to HIV; 223 healthcare wofkers (85.8%) were aware of
the rules and regulations on prevention of occupational exposure to HIV
and the operation procedures in their hospitals. The healthcare workers
who had not received the trainings or had not known the rules and
regulations and the operation procedures were mainly from primary or
secondary hospitals.

A total of 106 healthcare workers (40.8%) had directly contacted patients’
blood or body fluids; 154 healthcare workers (59.2%) were injured by sharp
instruments, and most were hollow needle stick injuries (98/154, 63.6%).

A total of 168 healthcare workers (68.08%) had better cognitive awareness
of occupational exposure to HIV, and 76 healthcare workers (29.2%) had
moderate cognitive awareness. Some healthcare workers had poor knowledge
in the common sense of AIDS/HIV and occupational exposure to HIV, the
personal protection awareness of occupational exposure, or the disposal
measures after occupational exposure.

The univariate analysis using chi-square test showed that occupation and
professional title were significantly correlated with the cognition
(P<0.05).

The multivariate logistic regression analysis showed that the doctors
(OR3.8; P<0.05), nurses (OR3.04, P<0.05), and laboratory technicians
(OR=9.51, P<0.05) had better awareness compared with the others.

The healthcare workers with a primary or lower professional title had
poorer awareness compared with the healthcare workers with a higher
professional title (OR=0.47, P<0.05).

CONCLUSION: Healthcare workers have the risk of occupational exposure to
HIT. They do not have comprehensive and systematic knowledge related to
occupational exposure to HIV, and they have a high demand for training.
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Complexity of occupational exposures for home health-care
workers: nurses vs. home health aides
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27406330

J Nurs Manag. 2016 Jul 13.
Complexity of occupational exposures for home health-care workers: nurses
vs. home health aides.

Hittle B1, Agbonifo N2, Suarez R2, Davis KG2, Ballard T1.

1College of Nursing, University of Cincinnati, Cincinnati, OH, USA.
2Department of Environmental Health, College of Medicine, University of
Cincinnati, Cincinnati, OH, USA.

AIM: To identify occupational exposures for home health-care nurses and
aides.

BACKGROUND: Home health-care workers’ occupational injury rates in the USA
are higher than the national average, yet research on causative exposures
and hazards is limited.

METHODS: Participants were interviewed about annual frequency of
occupational exposures and hazards. Exposure and hazard means were
compared between home health-care nurses and aides using a Wilcoxon two-
sample test.

RESULTS: A majority of the sample was over 40 years old and obese,
potentially increasing injury risks. Home health-care nurses performed
more clinical tasks, increasing exposure to blood-borne pathogens. Home
health-care aides performed more physical tasks with risk for occupational
musculoskeletal injuries. They also dispensed oral medications and anti-
cancer medications, and were exposed to drug residue at a frequency
comparable to home health-care nurses. Both groups were exposed to
occupational second-hand smoke.

CONCLUSIONS: Establishing employee safety-related policies, promoting
healthy lifestyle among staff, and making engineered tools readily
available to staff can assist in decreasing exposures and hazards.

IMPLICATIONS FOR NURSING MANAGEMENT: Implications for nursing management
include implementation of health- promotion programmes, strategies to
reduce exposure to second-hand smoke, ensuring access to and education on
assistive and safety devices, and education for all staff on protection
against drug residue.

© 2016 John Wiley & Sons Ltd.

KEYWORDS: home health-care; home health-care aides; home health-care
nurses; occupational exposures; occupational hazards
__________________________________________________________________
________________________________*_________________________________

11. Abstract: Lacerations and Embedded Needles Caused by Epinephrine
Autoinjector Use in Children
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26452720

http://www.annemergmed.com/article/S0196-0644(15)00588-0/fulltext

Ann Emerg Med. 2016 Mar;67(3):307-315.e8. Free Full Text
Lacerations and Embedded Needles Caused by Epinephrine Autoinjector Use in
Children.

Brown JC1, Tuuri RE2, Akhter S3, Guerra LD4, Goodman IS5, Myers SR6,
Nozicka C7, Manzi S8, Long K6, Turner T9, Conners GP10, Thompson RW11,
Park E3.

1Seattle Children’s Hospital and University of Washington, Seattle, WA.
Electronic address: julie.brown@seattlechildrens.org.
2Medical University South Carolina Children’s Hospital, Charleston, SC.
3Seattle Children’s Hospital and University of Washington, Seattle, WA.
4Lawrence General Hospital, Lawrence, MA.
5Baystate Medical Center, Springfield, MA.
6Children’s Hospital of Philadelphia, Philadelphia, PA.
7Rosalind Franklin University, Chicago, IL.
8Boston Children’s Hospital, Boston, MA.
9University of Alberta, Edmonton, Alberta, Canada.
10Children’s Mercy Hospitals & Clinics, University of Missouri Kansas City
School of Medicine, Kansas City, MO.
11Boston Medical Center and Boston University, Boston, MA.

STUDY OBJECTIVE: Epinephrine autoinjector use for anaphylaxis is
increasing. There are reports of digit injections because of incorrect
autoinjector use, but no previous reports of lacerations, to our
knowledge.

We report complications of epinephrine autoinjector use in children and
discuss features of these devices, and their instructions for use, and how
these may contribute to injuries.

METHODS: We queried emergency medicine e-mail discussion lists and social
media allergy groups to identify epinephrine autoinjector injuries
involving children.

RESULTS: Twenty-two cases of epinephrine autoinjector-related injuries are
described. Twenty-one occurred during intentional use for the child’s
allergic reaction. Seventeen children experienced lacerations. In 4 cases,
the needle stuck in the child’s limb. In 1 case, the device lacerated a
nurse’s finger. The device associated with the injury was operated by
health care providers (6 cases), the patient’s parent (12 cases, including
2 nurses), educators (3 cases), and the patient (1 case). Of the 3
epinephrine autoinjectors currently available in North America, none
include instructions to immobilize the child’s leg. Only 1 has a needle
that self-retracts; the others have needles that remain in the thigh
during the 10 seconds that the user is instructed to hold the device
against the leg. Instructions do not caution against reinjection if the
needle is dislodged during these 10 seconds.

CONCLUSION: Epinephrine autoinjectors are lifesaving devices in the
management of anaphylaxis. However, some have caused lacerations and other
injuries in children.

Minimizing needle injection time, improving device design, and providing
instructions to immobilize the leg before use may decrease the risk of
these injuries.

Copyright © 2015 American College of Emergency Physicians. Published by
Elsevier Inc. All rights reserved.

Comment in Design Trumps Training. [Ann Emerg Med. 2016]
https://www.ncbi.nlm.nih.gov/pubmed/26507905
__________________________________________________________________
________________________________*_________________________________

12. Abstract: Oral Tocofersolan Corrects or Prevents Vitamin E Deficiency
in Children with Chronic Cholestasis
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27429423

J Pediatr Gastroenterol Nutr. 2016 Jul 16.
Oral Tocofersolan Corrects or Prevents Vitamin E Deficiency in Children
with Chronic Cholestasis.

Thébaut A1, Nemeth A, Le Mouhaër J, Scheenstra R, Baumann U, Koot B,
Gottrand F, Houwen R, Monard L, de Micheaux SL, Habes D, Jacquemin E.
1*Pediatric Hepatology and Pediatric Liver Transplantation Unit, National
Reference Centre for biliary atresia, Assistance Publique – Hôpitaux de
Paris, Université Paris Sud, Hepatinov, Le Kremlin-Bicêtre, France †Center
for Inherited metabolic Diseases, Karolinska University Hospital Solna,
Stockholm, Sweden ‡Medical Department, Orphan Europe, Puteaux, France
§Beatrix Childrens Hospital, University Medical Center Groningen, The
Netherlands ||Division of Paediatric Gastroenterology and Hepatology,
Children[Combining Acute Accent]s Hospital, Hannover Medical School,
Hannover, Germany ¶Paediatric Gastroenterology and Hepatology department,
Academisch Medisch Centrum, Amsterdam, The Netherlands #Pediatric
Gastroenterology and Hepatology department, CHRU de Lille, Hôpital Jeanne
de Flandre, Lille, France **Wilhelmina Childrens Hospital, University
Medical Center Utrecht, The Netherlands ††INSERM U1174, Université Paris –
Sud, Orsay, France.

BACKGROUND/AIMS: d-alpha-tocopheryl polyethylene glycol 1000 succinate
(Tocofersolan, Vedrop), has been developed in Europe to provide an orally
bioavailable source of vitamin E in children with cholestasis. The aim was
to analyze the safety/efficacy of Vedrop in a large group of children with
chronic cholestasis.

METHODS: 274 Children receiving Vedrop for vitamin E deficiency or for its
prophylaxis were included from 7 European centers. Median age at treatment
onset was 2 months and median follow-up was 11 months. Vedrop was
prescribed at a daily dose of 0.34 ml/kg (25?IU/kg) of body weight. Three
methods were used to determine a sufficient serum vitamin E status:
vitamin E; vitamin E/(total cholesterol); vitamin E/(total cholesterol +
triglycerides).

RESULTS: Before Vedrop therapy, 51% of children had proven vitamin E
deficiency, 30% had normal vitamin E status and 19% had an unknown vitamin
E status. During the first months of treatment, vitamin E status was
restored in the majority of children with insufficient levels at baseline
(89% had a normal status at 6 months). All children with a normal baseline
vitamin E status had a normal vitamin E status at 6 months. Among children
with an unknown vitamin E status at baseline, 93% had a normal vitamin E
status at 6 months. A sufficient vitamin E status was observed in 80% of
children with significant cholestasis (serum total bilirubin > 34.2?µmol/
L). No serious adverse reaction was reported.

CONCLUSIONS: Vedrop seems a safe and effective oral formulation of vitamin
E that restores and/or maintains sufficient serum vitamin E level in the
majority of children with cholestasis, avoiding the need for intramuscular
vitamin E injections.
__________________________________________________________________
________________________________*_________________________________

13. Abstract: Nonprescription syringe sales: Resistant pharmacists’
attitudes and practices
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27423213

Drug Alcohol Depend. 2016 Jun 27. pii: S0376-8716(16)30170-3.
Nonprescription syringe sales: Resistant pharmacists’ attitudes and
practices.

Chiarello E1.

1Saint Louis University, Department of Sociology & Anthropology, Saint
Louis University, 1921 Morrissey Hall, Saint Louis, MO 63108, United
States. Electronic address: Chiarello@slu.edu.

OBJECTIVES: To examine barriers to nonprescription syringe sales (NPSS) in
pharmacies by examining resistant pharmacists’ willingness to provide
syringes to people who inject drugs (PWID) and their current practices for
provision or refusal.

METHODS: Qualitative, semi-structured, in-depth interviews with community
pharmacists in California, Kansas, Mississippi, and New Jersey.
Participants include seventeen community pharmacists who expressed ethical
concerns about providing syringes drawn from a larger sample of 71
community pharmacists participating in a study of ethical decision-making.
Analysis captures pharmacists’ descriptions of their experiences providing
syringes to suspected PWID.

RESULTS: Pharmacists who identified syringes as a key ethical issue
exhibited significant ambivalence about providing syringes to PWID. Most
of these pharmacists were aware of harm reduction logics, but endorsed
them to varying degrees. Moral concerns about supplying PWID with syringes
were mediated by law and organizational policy. Many pharmacists who
considered syringes an ethical challenge allayed their concerns by
creating informal policy and engaging in deterrence practices designed to
dissuade PWID from coming to the pharmacy.

CONCLUSIONS: As heroin abuse rates continue to rise, pharmacists are
undoubtedly integral allies in the fight to prevent the spread of
communicable diseases like HIV/AIDS and Hepatitis C. Education should be
aimed at identifying barriers to NPSS resulting from resistant
pharmacists’ attitudes and practices. Increased education paired with
favorable law and organizational policy and decentralization of syringe
provision could increase access to clean needles and decrease public
health risks.

Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

KEYWORDS: Behavior; HIV/AIDS; Heroin; Nonprescription syringe sales;
Pharmacist; Qualitative research
__________________________________________________________________
________________________________*_________________________________

14. Abstract: Rural people who inject drugs: A cross-sectional survey
addressing the dimensions of access to secondary needle and syringe
program outlets
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27398816

Aust J Rural Health. 2016 Jul 11.
Rural people who inject drugs: A cross-sectional survey addressing the
dimensions of access to secondary needle and syringe program outlets.

Fisher K1, Smith T2, Nairn K3, Anderson D1.

1University of Newcastle Department of Rural Health (UONDRH), Tamworth,
New South Wales, Australia.
2University of Newcastle Department of Rural Health Taree, Tamworth, New
South Wales, Australia.
3Hunter New England Local Health District (HNELHD), Health Reform
Transitional Organisation Northern, Newcastle, New South Wales, Australia.

OBJECTIVE: To better understand issues related to access to injecting
equipment for people who inject drugs (PWID) in a rural area of New South
Wales (NSW), Australia.

DESIGN: Cross-sectional face-to-face survey using convenience and snowball
sampling.

SETTING: Six regional and rural population centres in Northern NSW, within
the Hunter New England Local Health District.

PARTICIPANTS: The sample included 190 PWID who had accessed a needle and
syringe program outlet within 4 weeks of the survey.

MAIN OUTCOME MEASURES: Data include demographic information, preferred
location for accessing injecting equipment, reasons for that preference,
whether they obtained enough equipment, travelling distance to an NSP and
self-reported hepatitis C virus status.

RESULTS: Sixty percent self-identified as Aboriginal people. The median
age of respondents was 32 years and 60% were men. A significantly larger
proportion (P < 0.05) of the Aboriginal respondents were women (27% versus
11.6%) and younger (37.6 versus 12.7%) compared to non-Aboriginal
respondents. Most preferred to access injecting equipment at a community
health facility (62.6%), as opposed to other secondary outlets, where they
gained enough equipment (67.4%). Just over 80% said they were tested for
HCV in the past year, with about 37% told they had tested positive.

CONCLUSIONS: There are complex dimensions affecting how rural PWID access
secondary NSP outlets. Although access is similarly limited as other rural
health services because of the nature of injecting drug use and
sensitivities existing in rural communities, there is potential for
application of unique access models, such as, promoting secondary
distribution networks.

© 2016 National Rural Health Alliance Inc.

KEYWORDS: Aboriginal; injecting equipment; people who use drugs; secondary
distribution
__________________________________________________________________
________________________________*_________________________________

15. Abstract: Recovering infectious HIV from novel syringe-needle
combinations with low dead space volumes
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27405590

AIDS Res Hum Retroviruses. 2016 Jul 12.
Recovering infectious HIV from novel syringe-needle combinations with low
dead space volumes.

Abdala N1, Patel A2, Heimer R3.

1Yale School of Public Health, Epidemiology of Microbial Diseases , 60
College Street , New Haven, Connecticut, United States , 06520 ;
nadia.abdala@yale.edu.
2Yale School of Public Health, Epidemiology of Microbial Diseases, New
Haven, Connecticut, United States ; amisha.patel@yale.edu.
3Yale University School of Medicine, Department of Epidemiology and Public
Health, New Haven, Connecticut, United States ; robert.heimer@yale.edu.

AIMS: To determine if detachable syringe-needle combinations redesigned to
reduce their dead space volume may substantially reduce the burden of
exposure to infectious HIV among people who inject drugs. In this study,
two novel, low dead space (LDS) syringe-needle designs – one added a
piston to the plunger (LDS syringe); the other added a filler to the
needle (LDS needle) to reduce their dead space – were compared to standard
detachable needle-syringe combinations and to syringes with fixed needles.

METHODS: LDS and standard syringes attached to LDS and standard needles of
23, 25, and 27 gauge size were contaminated with HIV-infected blood in the
laboratory. The proportion of syringe-needle combinations containing
infectious HIV were analyzed after syringes were (1) stored up to 7 days
at 22oC, or (2) rinsed with water.

RESULTS: Detachable syringes attached to 25 gauge needles yielded
comparable proportions of syringes with infectious HIV whether the needle
was standard or LDS. Among needles of greater diameter (23-gauge), LDS
needles tended to reduce recoverable HIV to a greater extent than standard
needles. Syringes with fixed needles showed superior results to LDS
syringes attached to needles of equivalent diameter and were less likely
to get clogged by blood.

CONCLUSIONS: Detachable LDS syringe-needle designs must be recommended
with caution since they still pose potential risk for HIV transmission.
Distribution of LDS syringes and needles must be accompanied by
recommendations and instructions for proper rinsing and disinfection of
syringe-needles in order to decontaminate syringes-needles combinations
and reduce the chances of their reuse.
__________________________________________________________________
________________________________*_________________________________

16. Abstract: An assessment of hand hygiene practices of healthcare
workers of a semi-urban teaching hospital using the five moments of
hand hygiene
__________________________________________________________________

https://dx.doi.org/10.4103/0300-1652.184058

Niger Med J. 2016 May-Jun;57(3):150-4.
An assessment of hand hygiene practices of healthcare workers of a semi-
urban teaching hospital using the five moments of hand hygiene.

Shobowale EO1, Adegunle B2, Onyedibe K3.

1Department of Medical Microbiology and Parasitology Ben Carson School of
Medicine, Babcock University, Ilishan-Remo, Nigeria.
2Department of Medical Microbiology and Parasitology, Babcock University
Teaching Hospital, Ilishan-Remo, Nigeria.
3Department of Medical Microbiology and Parasitology, University of Jos,
Jos, Nigeria.

BACKGROUND: Hand hygiene has been described as the cornerstone and
starting point in all infection control programs, with the hands of
healthcare staff being the drivers and promoters of infection in
critically ill patients. The objectives of this study were to access
healthcare workers compliance with the World Health Organization (WHO)
prescribed five moments of hand hygiene as it relates to patient care and
to determine the various strata of healthcare workers who are in default
of such prescribed practices.

METHODS: The study was an observational, cross-sectional one. Hand hygiene
compliance was monitored using the hand hygiene observation tool developed
by the WHO. A nonidentified observer was used for monitoring compliance
with hand hygiene. The observational period was over a 60-day period from
August 2015 to October 2015.

RESULTS: One hundred and seventy-six observations were recorded from
healthcare personnel. The highest number of observations were seen in
surgery, n = 40. The following were found to be in noncompliance before
patient contact – anesthetist P = 0.00 and the Intensive Care Unit P =
0.00 while compliance was seen with senior nurses (certified registered
nurse anesthetist [CRNA]) P = 0.04. Concerning hand hygiene after the
removal of gloves, the following were areas of noncompliance – the
emergency room P = 0.00, CRNA P = 0.00, dental P = 0.04, and compliance
was seen with surgery P = 0.01. With regards to compliance after touching
the patient, areas of noncompliance were the anesthetists P = 0.00, as
opposed to CRNA P = 0.00, dental P = 0.00, and Medicine Department P =
0.02 that were compliant. Overall, the rates of compliance to hand hygiene
were low.

DISCUSSION: The findings however from our study show that the rates of
compliance in our local center are still low. The reasons for this could
include lack of an educational program on hand hygiene; unfortunately,
healthcare workers in developing settings such as ours regard such
programs as being mundane.

CONCLUSION: The observance of hand hygiene is still low in our local
environment. Handwashing practices in our study show that healthcare
workers pay attention to hand hygiene when it appears there is a direct
observable threat to their wellbeing. Educational programs need to be
developed to address the issue of poor hand hygiene.

KEYWORDS: Alcohol hand rub; compliance; hand washing; healthcare
associated infections; healthcare workers; infection control
__________________________________________________________________
________________________________*_________________________________

17. Abstract: Pharmacological study and pharmaceutical intervention to
reduce intravenous injection-induced vascular injury
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/25759054

Yakugaku Zasshi. 2015;135(3):465-72.
[Pharmacological study and pharmaceutical intervention to reduce
intravenous injection-induced vascular injury].

[Article in Japanese] Free full text

Yamada T1.

1Department of Pharmacy, Kyushu University Hospital.

Intravenous injection often causes vascular injury such as venous
irritation, vascular pain, and phlebitis. Vascular injury deteriorates the
patient’s QOL and sometimes limits the continuation of injection therapy.

Pharmaceutical intervention and pharmacological mechanisms used to reduce
vascular injury induced by vinorelbine and epirubicin were reviewed.

A multivariate logistic regression analysis revealed that the dose of
vinorelbine (=40 mg) was a significant predictor for venous irritation.
Alteration of the volume of normal saline for vinorelbine dissolution,
from 50 to 100 mL, significantly decreased the grade of venous irritation.
On the other hand, the phlebitis scores were significantly higher in
patients treated with epirubicin ready-to-use solution compared with
lyophilized powder. The change of formulation of epirubicin to lyophilized
powder decreased the risk of venous irritation. The concentration inducing
50% cell viability inhibition was lower in the order of vesicant,
irritant, and nonvesicant drugs on porcine aorta endothelial cells
(PAECs), suggesting that the injuring effects of anticancer drugs on PAECs
may be relevant as an indicator of the frequency of their vascular injury.

The exposure to vinorelbine of PAECs rapidly depleted intracellular
glutathione levels and increased intracellular reactive oxygen species
production. Moreover, exposure to epirubicin increased intracellular lipid
peroxide levels and enhanced the phosphorylation of p38 mitogen-activated
protein kinase.

These results demonstrate that oxidative stress plays an important role in
vinorelbine- and epirubicin-induced endothelial cell injury, and may
therefore increase the potential for vascular injury upon intravenous
injection.

Free full text https://dx.doi.org/10.1248/yakushi.14-00161
__________________________________________________________________
________________________________*_________________________________

18. Abstract: Seroprevalence and Correlates of Hepatitis C Virus Infection
in Secondary School Children in Enugu, Nigeria
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27397953

Ann Med Health Sci Res. 2016 May-Jun;6(3):156-61. Full Free Article
Seroprevalence and Correlates of Hepatitis C Virus Infection in Secondary
School Children in Enugu, Nigeria.

Eke CB1, Ogbodo SO2, Ukoha OM3, Muoneke VU1, Ibekwe RC1, Ikefuna AN1.

1Department of Pediatrics, College of Medicine, University of Nigeria,
Enugu, Nigeria.
2Department of Biochemistry, College of Medicine, Enugu State University
of Science and Technology Teaching Hospital, Enugu, Nigeria.
3Department of Pediatrics, Enugu State University of Science and
Technology Teaching Hospital, Enugu, Nigeria.

BACKGROUND: Although children comprise a small fraction of the burden of
hepatitis C virus (HCV) infections, which is a major global health
challenge, a significant number of them develop chronic HCV infection and
are at risk of its complications.

AIM: The aim of the current study was to determine the prevalence and
associated factors of HCV infection in school children in Enugu urban.

SUBJECTS AND METHODS: This was a cross-sectional seroepidemiological study
involving children aged 10-18 years selected using multistage systematic
sampling in Enugu metropolis, Southeast Nigeria. The anti-HCV was tested
using a 3(rd) generation enzyme-linked immunosorbent assay. Data were
analyzed using SPSS Version 16.0 with the level of significance set at P <
0.05.

RESULTS: Four hundred and twenty children were selected and screened
comprising 210 (50.0%) males and females. The seroprevalence of anti-HCV
was 4 (1.0%). Three (75%) out of the four positive cases for the anti-HCV
were females while one was a male giving a male to female ratio of 0.3-1.
Traditional scarifications/tattoos were the putative risk factors observed
to be significantly associated with anti-HCV seropositivity.

CONCLUSION: This study has demonstrated an anti-HCV seroprevalence of 1.0%
among children aged 10-18 years in Enugu with traditional scarification as
the predominant associated risk factor. Proper health education including
school health education and promotion of behavioral change among the
public on the practice of safe scarifications/tattoos should be encouraged
in our setting.

KEYWORDS: Anti-hepatitis C virus; Children; Prevalence; Risk factors

Free Article https://dx.doi.org/10.4103/0300-1652.184058
__________________________________________________________________
________________________________*_________________________________

19. No Abstract: The global burden of viral hepatitis: better estimates to
guide hepatitis elimination efforts
__________________________________________________________________
Lancet. 2016 Jul 6. pii: S0140-6736(16)31018-2.
The global burden of viral hepatitis: better estimates to guide hepatitis
elimination efforts.

Wiktor SZ1, Hutin YJ2.

1Department of HIV/AIDS and Global Hepatitis Programme, World Health
Organization, 1211 Geneva 27, Switzerland. Electronic address:
wiktors@who.int.
2Department of HIV/AIDS and Global Hepatitis Programme, World Health
Organization, 1211 Geneva 27, Switzerland.
__________________________________________________________________
________________________________*_________________________________

20. No Abstract: Design Trumps Training
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26507905

Ann Emerg Med. 2016 Mar;67(3):316-7.
Design Trumps Training.

Wears RL1, Fairbanks RJ2.

1Department of Emergency Medicine, University of Florida, Jacksonville,
FL; Clinical Safety Research Unit, Imperial College London, London, UK.
Electronic address: wears@ufl.edu.
2National Center for Human Factors in Healthcare, MedStar Health,
Washington DC; Department of Emergency Medicine, Georgetown University and
MedStar Washington Hospital Center, Washington DC.
Comment on
Lacerations and Embedded Needles Caused by Epinephrine Autoinjector Use in
Children. [Ann Emerg Med. 2016]
__________________________________________________________________
________________________________*_________________________________

21. No Abstract: Investigation and intervention of nursing staff
psychological state after needle stick injury
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/25916364

Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2015 Feb;33(2):124-5.
[Investigation and intervention of nursing staff psychological state after
needle stick injury].

[Article in Chinese]

Guo Y, Zhao S, Wang W, Guo C1.

1E-mail: gygcy1985@163.com.
__________________________________________________________________
________________________________*_________________________________

22. No Abstract: Sharps injury watch
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/25227389

Nurs Stand. 2014 Sep 23;29(3):63.
Sharps injury watch.

De Raeve P.
__________________________________________________________________
________________________________*_________________________________

23. No Abstract: Essential Precautions for Health Care, General Industry
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27311200

Occup Health Saf. 2016 May;85(5):12-3.
Essential Precautions for Health Care, General Industry.

Laws J.
__________________________________________________________________
________________________________*_________________________________

24. News

– Indonesia: Fake vaccine scandal prompts Indonesian parents to rush to
inoculate children

– Heroin use threatening Kenya’s HIV/Aids gains, clean needles helpful

– Kenya: Health Workers Face Risk of HIV Infection

– Indonesia: Indonesia orders overhaul of drug agency after fake vaccine
scandal

– USA: Ex-Oklahoma dentist sentenced over HIV, hepatitis scare

Australia: Cosmetic surgeon operating from unit could have risked blood
infections, NSW Health says

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/zpgeu75
Indonesia: Fake vaccine scandal prompts Indonesian parents to rush to
inoculate children

By Samantha Hawley and Ake Prihantari, ABC News, Australia (20.07.16)

PHOTO: Vaccination in JakartaParents are racing to have their children
properly vaccinated. (ABC News: Samantha Hawley)

MAP: Indonesia

A small medical clinic in eastern Jakarta is bursting at the seams.

Key points

-Saline solution was passed off as vaccines

-President says issue dates back 13 years

-Indonesian police have arrested 23 suspects

The doctors and nurses are struggling to keep up with the demand, and
babies cry as their parents line the humid corridors.

They endure a long wait to have their children re-inoculated after a fake
vaccine scandal shocked the nation.

In Indonesia there are calls for the death penalty to apply to those
convicted of being involved in the criminal syndicate police say operated
for 13 years but only came to the public’s attention late last month.

The doctors, nurses and suppliers involved passed off saline solution, in
some cases mixed with antibiotics, as vaccinations including for hepatitis
C, hepatitis A, measles, tetanus and whooping cough, in a nation where the
diseases are prevalent.

PHOTO: Woman holds child at medical clinic. Angry parents face long waits
at Indonesian clinics. (ABC News: Samantha Hawley)

Yuliana, 27, told the ABC she was shocked and panicked when she discovered
her nine-month-old daughter had received the fake vaccine.

“When she was younger she got a high temperature every month, she was
often sick and her immune system was weak,” she said.

“I’m very disappointed and I hope they will get punished for it, because
the victims are toddlers who are innocent.”

The vaccinations were sold as a superior imported product, which came with
a much higher price.

Indonesian reports suggest one couple involved were making the equivalent
of $10,000 a week through the illegal activity.

PHOTO: ‘How cruel that doctor was’ Indonesian mother Nuke Monilia and son
Nuke Monilia says those involved in the scam were ‘cruel’. (ABC News:
Samantha Hawley)

Nuke Monilia, 30, who had always used the same doctor, was getting her two
sons, aged five and 22 months, vaccinated again. “I was torn between
believing and disbelieving,” she said. “I never thought this could happen,
how cruel the doctor was.”

Indonesian police have arrested 23 suspects, including three doctors, and
President Joko Widodo has called for calm while the investigation
continues.

PHOTO: Crowds at a Jakarta clinic. Medical staff are unable to answer
many of the distressed parents’ questions. (ABC News: Samantha Hawley)

“The public needs to be calmed down because this is not a problem of the
past one or two years, this issue dates back 13 years,” Mr Widodo said.

But that is a hard ask for the parents waiting at the clinic in Ciracas,
East Jakarta, where the medical staff are bombarded by questions they
cannot, or do not, have the authority to answer.

“The perpetrators deserve life sentences,” Tri Ratnaningtyas told the ABC,
while waiting for her four-year-old son to see the doctor.

“I want them to be punished according to what they have done.”

As the cries ring out across the small building, a man named Maulana
stands quietly holding his young son’s hand but expressing fears the real
impact of the scandal might not yet have surfaced.

“Well, I basically want the suspect to be severely punished, by this I
mean the death sentence,” he said.
__________________________________________________________________
__________________________________________________________________

https://tinyurl.com/h8e4nmr
Heroin use threatening Kenya’s HIV/Aids gains, clean needles helpful

By Thomson Reuters Foundation, The Star, Nairobo Kenya (19.07.20)

Photo: Samples of needle and syringe programme kits that the Nairobi
Outreach Services Trust (NOSET) provides to heroin users to encourage safe
injecting practices are pictured in Nairobi, Kenya, July 13, 2016. /
REUTERS

Rashid Hassan Mohammed began using drugs when he was 15, after fleeing an
abusive home in the Kenyan coastal city of Mombasa and joining a street
gang.

He was diagnosed with HIV in 2014 and realised that he needed to give up
drugs after years of sharing needles with fellow addicts.

“I didn’t think that when you inject, or share the same injection with
your friend, it may cause HIV,” said Mohammed, 34, who has been receiving
methadone treatment for a year to wean his body off heroin.

“I thought it was only sex.”

The number of Kenyans injecting heroin has surged in recent years as the
East African nation has become a major transit route for international
drug cartels moving heroin from Afghanistan to Europe, experts say.

Narcotics have spilled on to the local market, where people are largely
unaware that injecting drugs can lead to HIV infection, sparking concerns
that Kenya’s success in tackling HIV could be reversed.

“The number of users are increasing both along the coast and in Nairobi.
There there is evidence that it is also spreading out to places like
Kisumu,” said Calleb Angira, director of the Nairobi Outreach Services
Trust, who has worked with addicts for almost 30 years.

“That is because the interventions we have are not enough,” said Angira,
who set up NOSET in 2005 to offer HIV prevention and treatment services to
drug users in Ngara, an estate outside Nairobi’s city centre.

Over the past 20 years, Kenya has slashed its HIV prevalence rate to six
percent today from 11 percent in 1996.

This has been done through campaigns to encourage safer sex between
heterosexual couples and improved access to antiretroviral drugs,
according to the United Nations Programme on HIV/AIDS.

Government data shows that little has been done in Kenya to reduce the
risk to injecting drug users, sex workers and men who have sex with men,
who together make up more than 30 percent of new infections.

At risk

HIV prevalence among injecting drug users is around 18 percent – three
times the national prevalence rate – and around four percent of new HIV
infections occur among people who inject drugs, government figures show.

According to government statistics, Kenya had 18,000 injecting drug users
in 2011.

“The majority of injectors worldwide are young men,” said Chris Beyrer,
president of the International AIDS Society.

“This is a sexually active population and very often their wives,
girlfriends, female partners are very much at risk.”

Injecting drug users need easy access to sterile needles to make their
habits safer, opiate substitutes to help them stop injecting and HIV
testing and treatment, experts say.

But stigma and punitive laws often mean they are mistreated or turned away
when they seek services, according to UNAIDS.

“Society rejects them,” Angira told the Thomson Reuters Foundation. “Even
their families reject them. They’re isolated. They’re criminalised.
They’re seen as hopeless people.”

Drug users fear asking for clean needles, as this can lead to police
harassment or criminal prosecution. “Governments and donors are also
reluctant to fund these services because of a false belief that they
condone drug use and encourage illegal behaviour,” Beyrer said.

“Despite the evidence that shows very clearly that providing sterile
injecting equipment does not encourage people to inject, it’s a widely
held view that what we should be doing is stopping injecting drug use,” he
said.

Kenya was slow to initiate programmes for injecting drug users, but
recognised the need for specialised services after some 100 addicts died
from withdrawal during a 2011 heroin shortage, triggered by a crackdown on
drug barons.

Addicts came out from the shadows seeking help.

“We realised that we didn’t have the capacity as government to provide
treatment,” said Helgar Musyoki, a programme manager with Kenya’s National
AIDS and STI Control Programme.

“We learned our lesson.”

Clean needles

In 2013, the government approved its first needle and syringe programme.
Funded with donor money, it provides drug users with clean, free equipment
to reduce the transmission of HIV and other diseases.

The government has not put any of its own money into these services but
has allowed donors to open seven needle and syringe programmes in its two
largest cities.

More are needed, experts said.

“What the needle and syringe programme did was to bring them (drug users)
out very clearly, knowing that the programme was actually targeting them,”
Angira said. “They came and said: ‘I’m injecting’ and that made them
access other services like HIV testing.”

The government opened its first clinic providing oral heroin substitutes
in 2014, and has pledged to treat 2,000 patients over two years.

Three methadone clinics are operating in Kenya, with another three
scheduled to open in August. It also plans to equip three mobile vans with
methadone to reach injecting drug users across the country.

NOSET staff says that even the limited services offered to injecting drug
users are having an impact. “With the interventions, the (HIV) rates are
going down,” said Nancy Ndwiga, who oversees NOSET’s HIV treatment.

More funding is needed for services and to train heath workers to provide
services to injecting drug users.

“This is a new route of HIV transmission. There’s not a lot of people in
any African country with experience (of it),” Beyrer said.

Former heroin users like Mohammed are grateful for the services that exist
for injecting drug users. “They (NOSET) saved my life,” he said. Although
he has been clean for over a year, he has yet to contact his family who he
has not seen since he left home. “It’s not easy to be trusted, but I know
one day I will earn their trust again.”
__________________________________________________________________
__________________________________________________________________

http://allafrica.com/stories/201607180839.html
Kenya: Health Workers Face Risk of HIV Infection

By Eunice Kilonzo, Daily Nation, Nairobi Kenya, AllAfrica.com (17.07.16)

Despite the risks, many health workers do not access medication that
prevents the infections in good time nor do they adhere to them, a study
reveals.

The survey titled Report on Occupational Exposure to Blood/Body Fluids and
HIV Post Exposure Prophylaxis in Health Care Facilities in Kenya (2011 –
2014) shows that despite the risk of potential exposure, “access and
adherence to Post Exposure Prophylaxis (PEP) to prevent HIV infection was
sub optimal amongst the health workers.”

PEP is an antiretroviral treatment administered for 28 days to reduce the
likelihood of HIV infection after potential exposure.

Most of these infections, nearly one in four, occurred in medical wards,
followed by surgical wards, the theatre and lastly the maternity ward.

The exposure happened in the morning hours and at night. They were exposed
during injections, while collecting blood and when they were inserting a
drip while others stepped on the infected needles.

This means that over 130, 000 health workers — doctors, nurses and other
medical personnel — are at risk of HIV that infects nearly 100, 000
Kenyans annually.

Also at risk were cleaners, waste handlers as well as medical students.
Those likely to be exposed are health care workers within the ages of 21
to 25 year, most of whom are students and main source of infections were
needle stick injuries at 76 per cent, followed by mucosal exposures at 10
per percent, and cuts at 5 per cent.

Interestingly, some patients also bit their care givers, exposing the
health care workers to infections; however, this was the lowest form of
exposure.

Once exposed, PEP should be initiated within 2 hours and the full dose
completed. The World Health Organisation (WHO) says it can reduce the risk
of HIV infection by more than 80 per cent.

But according to the study, sometimes this is not done as “24 hours
availability of PEP programmes in the facilities are not in place”.

Only one in 20 health workers adhered to the required six months follow up
after they received PEP. Non-adherence was linked to knowing the source of
the exposure, that is the patient, was negative which unfortunately, hints
at the knowledge gap on HIV window period.

That is, the time between potential exposure to HIV infection and the
point when the test will give an accurate result.

During the window period a person can be infected with HIV and be very
infectious but still test HIV negative.

OVERUSING SYRINGES

The study that was launched on Friday by the Health ministry was carried
out in 18 counties which are either low or high HIV burden regions, and
covered 53 health facilities (health centres or national teaching and
referral hospitals) as well as Faith-Based Institutions.

It was conducted in March 2015 where about 16, 976 health workers were
interviewed, of which 851 were exposed to either HIV or Hepatitis B.

After six months, only four tested positive for HIV. Occupational exposure
to blood or other body fluids in health care settings, according to the
research, constitutes “a small but significant risk of transmission of HIV
and other blood-borne pathogens”.

The ministry of Health recommends that health workers including students
and interns receive Hepatitis B vaccines as well as “use of safe devices,
proper waste disposal, and prompt management of exposures”.

The World Health Organization estimates in 2002, nearly 3 million health
workers were accidentally exposed to either HIV or other blood borne
infections, estimating that 16, 000 were exposed to the Hepatitis C virus,
another 66, 000 exposed to Hepatitis B virus while about 1,000 infected
with HIV.

As an alternative to injections, WHO recommends the use of oral medicines
instead. However, considering that nearly 90 per cent of injections are
used to administer medication, scientists are working to develop syringes
that cannot be used more than once.

One such effort is by British inventor Marc Koska, who has created the K-1
syringe, the first syringe to automatically become disabled once it’s
used.

A small ring inside of the barrel of the syringe allows the plunger to
move only in one direction, such that after it has been used, the plunger
locks in place and will break if forced.

Copyright © 2016 The Nation.
__________________________________________________________________
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https://tinyurl.com/jusu4r9
Indonesia: Indonesia orders overhaul of drug agency after fake vaccine
scandal

Published July 15, 2016 Reuters, Fox News Health (15.07.16)

Photo: Hospital workers collect information from parents who believe their
children may have received fake vaccines at a hospital in East Jakarta,
Indonesia (Copyright Reuters 2016)

JAKARTA – Indonesia on Friday ordered an immediate overhaul of the food
and drug monitoring agency, a month after police uncovered a syndicate
selling fake imported child vaccines to hospitals, pharmacies and clinics
over the past decade.

The scandal sparked a public uproar and exposed major government
deficiencies in ensuring drug safety amid a boom in Indonesia’s health
industry.

Investigators continue to unravel how widespread the reach of a drug-
making ring that sold fake booster vaccines for hepatitis B, diphtheria,
tetanus and whooping cough to health facilities in Jakarta and the island
of Java.

No illnesses or deaths have been directly linked to the fake vaccines.

“We can’t be half-hearted with this vaccine problem, and yesterday the
president decided to immediately restructure the (food and drug agency)”
Cabinet Secretary Pramono Anung said in a statement.

“With this we hope that this kind of thing won’t be repeated.”

The Food and Drugs Agency (FDA) has come under particular fire after
officials said they were aware of the fake vaccine problem as early as
2013. But little was done until a police investigation earlier this year
exposed the syndicate, leading to at least 18 arrests so far.

Under pressure from parliament, the health ministry on Thursday published
the names of 14 more health facilities around Jakarta that administered
the fake vaccines, prompting crowds of parents at hospitals demanding
information on whether their children were victims.

Health authorities have sought to reassure parents that the fake vaccines
were not harmful and their children could get re-vaccinated under a
government program to be launched next week.

Police uncovered the syndicate after a pharmacist in Bekasi, near Jakarta,
was arrested in May for selling medicine without a license. The drugs
turned out to be fake and led to the arrest of more than a dozen
distributors and makers of the fake vaccines.

Investigators said they were also questioning doctors and hospital
managers in the case.

“In some cases, directors signed the purchases of these vaccines, which
means we need to evaluate management,” Health Minister Nila Moeloek told
MetroTV.

“We must be thorough. We have to finish this.”
__________________________________________________________________
__________________________________________________________________

https://tinyurl.com/hoh7h2v
USA: Ex-Oklahoma dentist sentenced over HIV, hepatitis scare

By W. Scott Harrington. AP, CBS Affiliate KOTV, USA (14.07.16)

TULSA, Okla. — A former Oklahoma oral surgeon whose filthy clinics led to
thousands of patients being tested for HIV and hepatitis was sentenced
Thursday to six months’ house arrest for fraudulently billing Medicaid for
anesthesia services that were performed by unlicensed dental assistants.

W. Scott Harrington pleaded guilty in April to money laundering and agreed
to pay nearly $30,000 in restitution under an agreement with federal
prosecutors. He was also sentenced Thursday to two years’ probation and
ordered to pay a $20,000 fine within a month.

Harrington’s two Tulsa-area clinics were shuttered in 2013. State health
officials urged about 7,000 of his current and former patients to get
tested for diseases because of unsanitary conditions that included rusty
equipment and reused needles.

Of the 4,202 patients tested, one had contracted a disease — hepatitis C
— at a Harrington clinic. Investigators say it was the nation’s first
known transmission of hepatitis C between patients in a dental office.

Harrington surrendered his professional license in 2014 after more than 35
years in practice.

Prosecutors said in court records that Harrington behaved recklessly and
chose to “place efficiency ahead of patient care” so he could quickly move
from procedure to procedure.

Harrington’s attorney sought probation and a fine, saying his client was a
leader in his field and offered free dental services to patients who
couldn’t afford to pay for them.

The money laundering charge was the first criminal case brought against
Harrington after his clinics were closed in March 2013. Several civil
lawsuits were filed by former patients.

In the money laundering case, prosecutors alleged Harrington deposited
into his account more than $15,000 of Medicaid funds resulting from the
fraudulent billing for anesthesia performed between January and June of
2012.

Prosecutors also alleged that Harrington issued a $15,000 check from his
account payable to W.S. Harrington LLC, which was another entity
Harrington controlled for his personal benefit.

© 2016 The Associated Press.
__________________________________________________________________
__________________________________________________________________
Australia: Cosmetic surgeon operating from unit could have risked blood
infections, NSW Health says

By Naomi White, The Daily Telegraph, Australia (06.07.16)

PATIENTS who underwent treatments from an unregistered Sydney cosmetic
surgeon may have been infected with blood-borne viruses.

A warning has been issued by NSW Health urging anyone who received
treatments from a business run by Ms Pu Liu, also known as Mabel Liu, in
Sydney’s inner west to see their GP for blood tests.

Ms Liu, who performed the procedures in a residential apartment in Five
Dock, used injectable drugs not approved for use in Australia, NSW Health
said.

There was a risk her equipment and medications may have also been
contaminated because of poor hygiene and lack of sterilisation.

“Client records are not available from Ms Liu to identify people at risk,
so we are urging anyone who used her services to see their GP for advice
and to seek tests for hepatitis B, hepatitis C and HIV as a precaution,”
NSW Chief Health Officer Dr Kerry Chant said.

A neighbour reported syringes had regularly been left in the building’s
shared bins, which had concerned him.

He said Ms Liu, who appeared to be in her mid-40s, had lived at the unit
with her partner for about a year.

Public health officers raided Ms Liu’s business this year following a
complaint from one of her clients.

She was issued with two prohibition orders from the NSW Health Care
Complaints Commission (HCCC), including a ban on providing any more
cosmetic and medical procedures or possessing any drugs used for cosmetic
treatments, such as Botox or dermal fillers.

No criminal charges had been laid against Ms Liu ­because her business was
still being investigated by the HCCC, a NSW Health spokeswoman said.

“An infection may not present with symptoms right away, so the only way to
know if you are at risk (of blood-borne ­viruses) is to have a blood
test,” Dr Chant said.

She also urged anyone considering having a minor cosmetic procedure to
make sure they checked their practitioner’s credentials first.

The HCCC last week issued a warning about cosmetic services being offered
by unregistered practitioners through social media sites such as WeChat, a
popular platform in the Chinese community.
__________________________________________________________________
________________________________*_________________________________

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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