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SIGNpost 00865

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST

Post00865 Abstracts + Risks + NSI + Recall News 10 August 2016

CONTENTS
0. Moderators Note
1. Abstract: Assessment of the safety of injection practices and
injection-related procedures in family health units and centers in
Alexandria
2. Abstract: Biological risk among hospital housekeepers
3. Abstract: Work-related Injuries Among Emergency Medical Technicians in
Western Turkey
4. Abstract: Job stress and needlestick injuries: which targets for
organizational interventions?
5. Abstract: Prevalence of percutaneous injuries and associated factors
among health care workers in Hawassa referral and adare District
hospitals, Hawassa, Ethiopia, January 2014
6. Abstract: Subcutaneously administered antibiotics: a national survey of
current practice from the French Infectious Diseases (SPILF) and
Geriatric Medicine (SFGG) society networks
7. Abstract: Self-reported occupational health problems among Libyan
dentists
8. Abstract: A system dynamics approach for hospital waste management in a
city in a developing country: the case of Nablus, Palestine
9. Abstract: Ready-to-use pre-filled syringes of atropine for anaesthesia
care in French hospitals – a budget impact analysis
10. Abstract: Improved Insulin Pharmacokinetics Using a Novel Microneedle
Device for Intradermal Delivery in Patients with Type 2 Diabetes
11. Abstract: Outbreak of extrapulmonary tuberculosis infection associated
with acupuncture point injection
12. Abstract: Intra-articular steroid injection for osteoarthritis of the
hip prior to total hip arthroplasty : is it safe? a systematic review
13. No Abstract: The inaugural Healthcare Infection Society Middle East
Summit: ‘No action today. No cure tomorrow.’
14. No Abstract: Concerns raised over poor blood safety systems in India
15. News
– USA: Amikacin Injection Recalled for Potential Glass Particulates

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SIGNpost 00865

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0. Moderators Note
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or signmoderator@googlegroups.com
__________________________________________________________________
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
__________________________________________________________________
________________________________*_________________________________

1. Abstract: Assessment of the safety of injection practices and
injection-related procedures in family health units and centers in
Alexandria
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/25162737

J Egypt Public Health Assoc. 2014 Aug;89(2):66-73.
Assessment of the safety of injection practices and injection-related
procedures in family health units and centers in Alexandria.

Elhoseeny TA1, Mourad JK.

1aDepartment of Health Administration and Behavioural Sciences, High
Institute of Public Health bFamily Medicine Centers, Ministry of Health,
Alexandria, Egypt.

BACKGROUND: The Safe Injection Global Network (SIGN) developed an
intervention strategy for reducing overuse of injections and promoting the
administration of safe injections. Tool C–Revised is designed to assess
the safety of the most common procedures that puncture the skin within
health services.

OBJECTIVE: The aim of the study was to assess injection safety within the
primary healthcare facilities in Alexandria using Tool C–Revised.

PATIENTS AND METHODS: STUDY SETTING: A total of 45 family health units and
centers in Alexandria were selected by proportional allocation from the
eight regions of Alexandria.

DATA COLLECTION: The Tool C–Revised of the WHO was used for observation
of the entire facility, injection practices and injection-related
procedures, and sterilization practices. Interview of different health
providers and immediate supervisor of injections was carried out.

RESULTS: Indicators that reflect risk included: deficiency of alcohol-
based hand rub for cleansing hands (13.3%), compliance with hand wash
before preparing a procedure (56.9% before injection practices, 61.3%
before phlebotomy, and 67.6% before lancet puncture), and wearing a new
pair of gloves before new procedures (48.6% before injection practices,
9.7% for phlebotomy, 11.8% for lancet puncture, and 80% for both
intravenous injections and infusions).

Enough disposable equipment in all facilities for at least 2 weeks
dependent on the statement of the average numbers of procedures per week
was shown.

Only 38% of the providers had received training regarding injection safety
in the last 2 years and 62.5% had completed their three doses of hepatitis
B vaccine.

Only 42.2% of staffs who handled healthcare waste had access to heavy
gloves.

CONCLUSION: Indicators related to injection and injection-related
practices that reflect risk to patients include deficiency of alcohol-
based hand rub tools, nonadherence to hand hygiene before preparing an
injection, and inadequate adherence to using a clean barrier when opening
a glass ampule and use of gloves.

Indicators that may reflect risk to patients and providers include
inadequate injection safety training and incomplete hepatitis B
vaccination of healthcare providers.

Indicators that may reflect risk to providers include nonadherence to
safety precautions related to injection practices, such as inadequate
access to heavy gloves by staff handling healthcare waste.
__________________________________________________________________
________________________________*_________________________________

2. Abstract: Biological risk among hospital housekeepers
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/25136771

Arch Environ Occup Health. 2016;71(2):59-65.
Biological risk among hospital housekeepers.

Ream PS1, Tipple AF1, Barros DX1, Souza AC1,2, Pereira MS2.

1a College of Nursing, Federal University of Goias , Goiania , Brazil.
2b Department of Nursing, Nutrition and Physiotherapy, Pontifical Catholic
University of Goias , Goiania , Brazil.

Although not directly responsible for patient care, hospital housekeepers
are still susceptible to accidents with biological material. The
objectives of this study were to establish profile and frequency of
accidents among hospital housekeepers, describe behaviors pre- and
postaccident, and risk factors.

This was a cross-sectional study with hospital housekeepers in Goiania,
Brazil. Data were obtained from interviews and vaccination records.

The observations were as follows: (1) participating workers: 94.3%; (2)
incomplete hepatitis B vaccination: 1 in 3; and (3) accident rate: 26.5%,
mostly percutaneous with hypodermic needles, and involved blood from an
unknown source; roughly half occurred during waste management.

Upon review, length of service less than 5 years, completed hepatitis B
vaccination, and had been tested for anti-HBs (hepatitis B surface
antigen) influenced frequency of accidents.

These findings suggest that improper disposal of waste appears to enhance
the risk to hospital housekeepers. All hospital workers should receive
continued training with regard to waste management.

KEYWORDS: Blood-borne pathogens; hazardous waste; hospital housekeeping;
needlestick injuries; occupational accident
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Work-related Injuries Among Emergency Medical Technicians in
Western Turkey
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27491511

Prehosp Disaster Med. 2016 Aug 5:1-4.
Work-related Injuries Among Emergency Medical Technicians in Western
Turkey.

Yilmaz A1, Serinken M1, Dal O2, Yaylaci S3, Karcioglu O3.
Author information
11Pamukkale University Medical Faculty,Department of Emergency
Medicine,Denizli,Turkey.
22Acibadem University Hospital,Department of Emergency
Medicine,Istanbul,Turkey.
33Adnan Menderes University Medical Faculty,Department of Emergency
Medicine,Aydin,Turkey.

OBJECTIVES: Emergency medical technicians (EMTs) and paramedics are at
serious risk for work-related injuries (WRIs) during work hours. Both EMTs
and paramedics have higher WRI rates, according to the literature data.
This study was designed to investigate causes and characteristics of WRIs
involving EMTs and paramedics staffed in Western Turkey.

METHODS: All health care personnel staffed in Emergency Medical Services
(EMS) in the city were interviewed face-to-face in their off-duty hours to
inform them about the study. Excluded from the study were those who
declined to participate in the study, those who were not on duty during
the two-month study period, and those who had been working in the EMS for
less than one year. The subjects were asked to answer multiple-choice
questions.

RESULTS: A total of 163 personnel (117 EMTs and 46 paramedics) comprised
the study sample. Eighty-three personnel (50.9%) were female and mean age
was 29.7 years (SD=8.4 years).

The most common mechanisms of WRI, as reported by the personnel, were
motor vehicle accidents (MVAs; 31.9%), needlestick injuries (16.0%),
ocular exposure to bodily fluids (15.4%), and sharp injuries (9.8%),
respectively.

Needlestick injuries commonly occurred during intravenous line procedures
(59.4%) and inside the cruising ambulance (n=20; 62.5%). Working inside
the cruising ambulance was the most commonly accused cause of the WRI
(41.3%).

CONCLUSION: Paramedic personnel and EMTs are under high risk of WRI. Motor
vehicle accidents and needlestick injuries were the most common causes of
WRI.

Strict measures need to be taken to restructure the interior design to
protect personnel from all kinds of WRIs.

KEYWORDS: EMS Emergency Medical Services; EMT emergency medical
technician; MVA motor vehicle accident; WRI work-related injury; accident;
ambulance; paramedic; work-related
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Job stress and needlestick injuries: which targets for
organizational interventions?
__________________________________________________________________
https://www.ncbi.nlm.nih.gov/pubmed/27481860

Occup Med (Lond). 2016 Jul 31. pii: kqw110.
Job stress and needlestick injuries: which targets for organizational
interventions?

d’Ettorre G1.

1Local Health Authority of Brindisi, Health Unit of Occupational
Prevention and Protection, piazza Di Summa, 72100 Brindisi, Italy.
gabriele.det@libero.it.

BACKGROUND: Needlestick injuries (NSIs) represent a major concern for the
safety of health care workers involved in clinical care. The percentage of
health workers reporting these injuries varies between 9 and 38% and the
occurrence of NSI is most frequent among employees having close clinical
contact with patients or patient specimens. These injuries appear to occur
most frequently where organizational factors contribute to the risk.

AIMS: To investigate the interactions between organizational level
interventions focused on work-related stress (WRS) and the occurrence of
NSIs among nurses employed in hospital departments, and to determine the
impact of such interventions on the safety budget.

METHODS: Comparison of NSI occurrence among nurses employed in hospital
health care departments in two 3-year periods, before and after
interventions aimed at minimizing WRS. The economic cost of NSIs
occurrence was calculated.

RESULTS: The study group consisted of 765 nurses. The cumulative 3-year
incidence of NSIs after the implementation of management stress
interventions was significantly lower than the cumulative 3-year incidence
observed before implementation (OR 0.60; 95% CI 0.43-0.83). A cost saving
from managing fewer NSIs than during the first study period was found.

CONCLUSIONS: This study found a reduction in NSI occurrence and associated
costs following an intervention to bring about proactive, integrated and
comprehensive management of stress in the workplace.

© The Author 2016. Published by Oxford University Press on behalf of the
Society of Occupational Medicine. All rights reserved.

KEYWORDS: Health care workers; needlestick injuries; occupational
intervention; work-related stress.
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Prevalence of percutaneous injuries and associated factors
among health care workers in Hawassa referral and adare District
hospitals, Hawassa, Ethiopia, January 2014
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4700653/
Free Full Article https://dx.doi.org/10.1186/s12889-015-2642-0

BMC Public Health. 2016 Jan 5;16:8.
Prevalence of percutaneous injuries and associated factors among health
care workers in Hawassa referral and adare District hospitals, Hawassa,
Ethiopia, January 2014.

Kaweti G1, Abegaz T2.

1Health management information system, Hawassa University, P.O. Box: 1560,
Hawassa, Ethiopia. k.gudeta@hotmail.com.
2School of public and environmental health, Hawassa University, Hawassa,
Ethiopia. teferiabegaz@gmail.com.

BACKGROUND: Accidental percutaneous injury and acquiring blood-borne
diseases are common problems among health care workers (HCWs). However,
little is known about the prevalence and associated factors for needle
stick injury among HCWs in Ethiopia.

METHODS: A cross sectional study was conducted by including 526 HCWs
(physicians, nurses, laboratory technicians, midwives and others), working
in two public hospitals (Hawassa Referral and Adare District hospitals),
from January 1-30, 2014. Binary logistic regression was done to assess the
association of selected independent variables with accidental percutaneous
injury.

RESULTS: The prevalence of at least one episode of percutaneous injury was
about 46% of which more than half (28%) occurred within one year prior to
the study period and only 24% took prophylaxis for human immune deficiency
virus (HIV) infection. The adjusted logistic regression analysis revealed
that HCWs who recap needles were twice as likely to face a percutaneous
injury. Chance of exposure to needle stick or sharp injuries also
increased with increase in educational status. Having a previous history
of needle stick or sharp injury was found as one of the risk factors for
the occurrence of another injury. Nurses and cleaners were also at
increased risk for the occurrence of percutaneous injuries.

CONCLUSION: Needle stick and sharp injuries were common among HCWs in the
study hospitals, which warrants training on preventive methods.

Free Full BMC Article https://dx.doi.org/10.1186/s12889-015-2642-0
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Subcutaneously administered antibiotics: a national survey of
current practice from the French Infectious Diseases (SPILF) and
Geriatric Medicine (SFGG) society networks
__________________________________________________________________

http://dx.doi.org/10.1016/j.cmi.2014.11.017 Free Open Archive Article

Clin Microbiol Infect. 2015 Apr;21(4):370.e1-3.
Subcutaneously administered antibiotics: a national survey of current
practice from the French Infectious Diseases (SPILF) and Geriatric
Medicine (SFGG) society networks.

Forestier E1, Paccalin M2, Roubaud-Baudron C3, Fraisse T4, Gavazzi G5,
Gaillat J6.

1Service de Maladies Infectieuses, Centre Hospitalier, Chambéry, France.
Electronic address: emmanuel.forestier@ch-chambery.fr.
2Service de Gériatrie, Centre Hospitalier Universitaire, Poitiers, France.
3Pole de Gérontologie clinique, Centre Hospitalier Universitaire,
Bordeaux, France.
4Service de Gériatrie, Centre Hospitalier, Alès, France.
5Service de Gériatrie, Centre Hospitalier Universitaire, Grenoble, France.
6Service de Maladies Infectieuses, Centre Hospitalier, Annecy, France.

A national survey was performed to explore antibiotic prescription by the
subcutaneous (sc) route among French infectious diseases and geriatric
practitioners.

Among the participating physicians, 367 (96.1%) declared administering sc
antibiotics at some point. Ceftriaxone was prescribed sc by all but one,
and ertapenem, teicoplanin, aminoglycosides and amoxicillin by 33.2%,
39.2%, 35.1% and 15.3%, respectively.

The sc route was resorted to mainly in case of unavailable oral,
intravenous or intramuscular routes, especially during palliative care.

Pain, skin necrosis and lack of efficacy were the main adverse effects,
reported by 70.8%, 12.8% and 19.9% of practitioners, respectively.

Further studies are needed to precise the indications, modalities and
tolerance of sc antibiotic use.

Copyright © 2014 European Society of Clinical Microbiology and Infectious
Diseases. Published by Elsevier Ltd. All rights reserved.

KEYWORDS: Antibiotics; ceftriaxone; ertapenem; subcutaneous; teicoplanin

Free full text http://dx.doi.org/10.1016/j.cmi.2014.11.017
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Self-reported occupational health problems among Libyan
dentists
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/25876947

J Contemp Dent Pract. 2015 Jan 1;16(1):31-5.
Self-reported occupational health problems among Libyan dentists.

Arheiam A1, Ingafou M2.

1Lecturer Department of Community and Preventive Dentistry, Benghazi
University, Benghazi, Libya, Phone: 00218924126742, e-mail:
arheiam@yahoo.com.
2Department of Oral Medicine, Benghazi University, Benghazi, Libya.

OBJECTIVES: To investigate the prevalence of the most common occupation-
related health problems as well as factors associated with their incidence
among dental practitioners.

MATERIALS AND METHODS: A cross-sectional, questionnaire-based survey of
Libyan dental practitioners. Participants provided information regarding
their experience of occupationally related problems they encountered over
the past 12 months which included inquiries about musculoskeletal pain,
percutaneous injuries, allergy, eye and sight problems, and hearing
problems.

RESULTS: Musculoskeletal problems were the most frequently reported
(48.2%), followed by percutaneous injuries (35%), eye problems (22%),
allergy (11%) and hearing problems (7.6%). Musculoskeletal problems were
significantly higher among dentists who work in private sector, full timer
as well as those who prefer to work in a sitting position (p=0.021, 0.027
and 0.008, respectively).

Practitioners with less than 5 years in service
reported significantly higher percentage of percutaneous injuries
(p=0.027) than their senior counterparts, whereas practitioners who spent
more than 10 years in service were more likely to suffer from visual
disturbances (p=0.033).

CONCLUSION: The findings of this study indicate that musculoskeletal
problems and percutaneous injuries are the most commonly reported
occupational health problems among dentists, whereas allergic reactions
and hearing problems are the least reported ones.

CLINICAL SIGNIFICANCE: Dentists should use alternate working positions to
minimise musculoskeletal problems and adopt more effective strategies to
prevent percutaneous injuries particularly among novices.

KEYWORDS: Dentists; Hazards
__________________________________________________________________
________________________________*_________________________________

8. Abstract: A system dynamics approach for hospital waste management in a
city in a developing country: the case of Nablus, Palestine
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27488196

Environ Monit Assess. 2016 Sep;188(9):503.
A system dynamics approach for hospital waste management in a city in a
developing country: the case of Nablus, Palestine.

Al-Khatib IA1, Eleyan D2, Garfield J3.

1Institute of Environmental and Water Studies, Birzeit University, P.O.
Box 14, Birzeit, West Bank, Palestine. ikhatib@birzeit.edu.
2Computer Science Department, Birzeit University, West Bank, Palestine.
3Worcester Business School, University of Worcester, Worcester, UK.

Hospitals and health centers provide a variety of healthcare services and
normally generate hazardous waste as well as general waste. General waste
has a similar nature to that of municipal solid waste and therefore could
be disposed of in municipal landfills.

However, hazardous waste poses risks to public health, unless it is
properly managed. The hospital waste management system encompasses many
factors, i.e., number of beds, number of employees, level of service,
population, birth rate, fertility rate, and not in my back yard (NIMBY)
syndrome. Therefore, this management system requires a comprehensive
analysis to determine the role of each factor and its influence on the
whole system.

In this research, a hospital waste management simulation model is
presented based on the system dynamics technique to determine the
interaction among these factors in the system using a software package,
ithink. This model is used to estimate waste segregation as this is
important in the hospital waste management system to minimize risk to
public health. Real data has been obtained from a case study of the city
of Nablus, Palestine to validate the model.

The model exhibits wastes generated from three types of hospitals
(private, charitable, and government) by considering the number of both
inpatients and outpatients depending on the population of the city under
study.

The model also offers the facility to compare the total waste generated
among these different types of hospitals and anticipate and predict the
future generated waste both infectious and non-infectious and the
treatment cost incurred.

KEYWORDS: Developing countries; Generation rate; Hazardous waste;
Hospitals; Palestine; System dynamics
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Ready-to-use pre-filled syringes of atropine for anaesthesia
care in French hospitals – a budget impact analysis
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27481691

Anaesth Crit Care Pain Med. 2016 Jul 29. pii: S2352-5568(16)30087-X.
Ready-to-use pre-filled syringes of atropine for anaesthesia care in
French hospitals – a budget impact analysis.

Benhamou D1, Piriou V2, De Vaumas C3, Albaladejo P4, Malinovsky JM5, Doz
M6, Lafuma A6, Bouaziz H7.

1CHU Bicêtre, Service Anesthésie-Réanimation, Hôpitaux universitaires
Paris Sud, Hôpital Bicêtre (AP-HP), 78 rue du Général Leclerc, 94 270 Le
Kremlin Bicêtre.
2Hospices Civils de Lyon Sud, Service d’Anesthésie-Réanimation, 165 Chemin
du Grand Revoyet, 69310 Pierre Bénite.
3Clinique Saint Jean l’Hermitage, Unité d’Anesthésie pôle ASUR, 41, Avenue
de Corbeil, 77000 Melun.
4Anesthésie-Réanimation – Hôpital Michallon, Avenue Maquis du Grésivaudan,
38700 La Tronche.
5Hôpital Maison Blanche, Service d’Anesthésie-Réanimation, 45 rue Cognac,
Jay 51092 Reims cedex.
6Cemka-Eval, 43, bd Maréchal Joffre, 92340 Bourg-la-Reine.
7CHU Hôpital Central, Service Anesthésie-Réanimation, CHRN Anesthésie-
réanimation 29 avenue du Maréchal de Lattre de Tassigny, 54035 Nancy
cedex.

BACKGROUND: Patient safety is improved by the use of labelled, ready-to-
use, pre-filled syringes (PFS) when compared to conventional methods of
syringe preparation (CMP) of the same product from an ampoule. However,
the PFS presentation costs more than the CMP presentation.

OBJECTIVE: To estimate the budget impact for French hospitals of switching
from atropine in ampoules to atropine PFS for anaesthesia care.

METHODS: A model was constructed to simulate the financial consequences of
the use of atropine PFS in operating theatres, taking into account wastage
and medication errors. The model tested different scenarios and a
sensitivity analysis was performed.

RESULTS: In a reference scenario, the systematic use of atropine PFS
rather than atropine CMP yielded a net one-year budget saving of
€5,255,304. Medication errors outweighed other cost factors relating to
the use of atropine CMP (€9,425,448). Avoidance of wastage in the case of
atropine CMP (prepared and unused) was a major source of savings
(€1,167,323). Significant savings were made by means of other scenarios
examined. The sensitivity analysis suggests that the results obtained are
robust and stable for a range of parameter estimates and assumptions.

STUDY LIMITATIONS: The financial model was based on data obtained from the
literature and expert opinions.

CONCLUSION: The budget impact analysis shows that even though atropine PFS
is more expensive than atropine CMP, its use would lead to significant
cost savings. Savings would mainly be due to fewer medication errors and
their associated consequences and the absence of wastage when atropine
syringes are prepared in advance.

Copyright © 2016 Société française d’anesthésie et de réanimation (Sfar).
Published by Elsevier Masson SAS. All rights reserved.

KEYWORDS: Conventional methods of preparation (CMP); Pre-filled syringes
(PFS); anaesthesia; atropine; budget impact analysis; health economics.;
ready-to-use intravenous drugs
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Improved Insulin Pharmacokinetics Using a Novel Microneedle
Device for Intradermal Delivery in Patients with Type 2 Diabetes
__________________________________________________________________

http://online.liebertpub.com/doi/full/10.1089/dia.2016.0156 Free Full Text

Diabetes Technol Ther. 2016 Aug 8.
Improved Insulin Pharmacokinetics Using a Novel Microneedle Device for
Intradermal Delivery in Patients with Type 2 Diabetes.

Kochba E1, Levin Y1, Raz I2, Cahn A2,3.

11 NanoPass Technologies Ltd. , Nes Ziona, Israel .
22 Diabetes Unit, Division of Internal Medicine, Hadassah Medical
Organization , Jerusalem, Israel .
33 Endocrinology and Metabolism Service, Division of Internal Medicine,
Hadassah Medical Organization , Jerusalem, Israel .

BACKGROUND: Currently available short-acting insulin analogs have slower
absorption compared with endogenous insulin occasionally resulting in
immediate postprandial hyperglycemia. Intradermal (ID) injection
facilitates faster drug absorption and may result in improved insulin
pharmacokinetics.

METHODS: Seventeen patients with type 2 diabetes were included in this
single-center, pilot, open-label crossover study. Patients received 0.2?U/
kg Insulin aspart ID injections using a MicronJet (MJ) needle and
subcutaneous (SC) injections, using a conventional needle in a crossover
design. Thirteen patients were studied under fasting conditions and four
before a standard meal test. The pharmacokinetic/pharmacodynamic (PK/PD)
profile, as well as the safety and tolerability of injections, was
compared.

RESULTS: Fourteen patients completed the study per-protocol. ID versus SC
injection demonstrated significantly shorter Tmax (median 35 vs. 87.5?min
[P < 0.001]), while the Cmax did not significantly differ (median 80 vs.
55 µU/mL [P = 0.085]). Median insulin area under the curve (AUC; 360 min)
did not differ between the groups (9914 vs. 10,936 µU/mL/min [p = 0.077]),
yet 0-60 min insulin AUC was higher with ID versus SC injection (mean ± SD
3821 ± 1429 vs. 2534 ± 737 µU/mL/min [p = 0.01]) and 4-6 h AUC was lower
with ID versus SC injection (mean ± SD 2054 ± 858 vs. 2929 ± 1412 µU/mL/
min [p = 0.02]). The relative bioavailability of the ID versus the SC
insulin (AUCID/AUCSC) was similar (median 0.91 [95% confidence interval
0.73-1.27]).

CONCLUSIONS: ID insulin injection delivered through an MJ needle
demonstrated superior PK profile compared with conventional SC
administration, including shorter Tmax and higher early and lower late
exposure in patients with type 2 diabetes. This may help achieve better
insulin coverage of meals and lower postprandial glucose excursions.
__________________________________________________________________
________________________________*_________________________________

11. Abstract: Outbreak of extrapulmonary tuberculosis infection associated
with acupuncture point injection
__________________________________________________________________

http://dx.doi.org/10.1016/j.cmi.2014.10.023 Open Archive Free Article

Clin Microbiol Infect. 2015 Apr;21(4):349-53.
Outbreak of extrapulmonary tuberculosis infection associated with
acupuncture point injection.

Jia Z1, Chen S2, Hao C3, Huang Y4, Liu Z2, Pan A2, Liao R5, Wang X6, Lu
Z7.

1National Institute of Drug Dependence, Peking University, Beijing 100191,
PR China; Takemi Program in International Health, Department of Global
Health and Population, Harvard School of Public Health, 665 Huntington
Avenue, Boston, MA 02115, USA.
2Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou,
Zhejiang 310006, PR China.
3School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong
510080, PR China; Takemi Program in International Health, Department of
Global Health and Population, Harvard School of Public Health, 665
Huntington Avenue, Boston, MA 02115, USA.
4Department of Epidemiology, Johns Hopkins Bloomberg School of Public
Health, Baltimore, MD 21205, USA.
5Office of Scientific Research, Peking University, Beijing 100871, PR
China. Electronic address: liaorikun@pku.edu.cn.
6Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou,
Zhejiang 310006, PR China. Electronic address: xmwang@cdc.zj.cn.
7Department of Biomedical Engineering, College of Engineering, Peking
University, Beijing 100871, PR China. Electronic address: zhlu@pku.edu.cn.

Mycobacterium tuberculosis infection is rarely reported to be associated
with acupuncture practices.

We performed a retrospective outbreak investigation of a unique outbreak
of 33 extrapulmonary M. tuberculosis infections related to acupuncture
point injection therapy (AIT) among clients who visited a private
traditional Chinese medicine clinical centre in China.

The lumps, abscesses and ulcers occurred mostly on the neck, shoulders,
waist, knees and hips, localized at acupuncture point meridian sites.
These symptoms appeared from January to November 2011, with a peak cluster
of infections in September 2011 (nine cases). M. tuberculosis Beijing
strain was isolated and confirmed by DNA sequencing.

All diagnosed patients were treated empirically with appropriate
antibiotic treatment, and their condition improved.

Our study indicated that this outbreak was most likely resulted from
contaminated AIT. Drafting standard guidelines for AIT is urgently needed,
and routine medical supervision should be provided, including obligating
health providers to perform routine physical examinations that include
testing for infectious diseases.

Copyright © 2014. Published by Elsevier Ltd.

KEYWORDS: Acupoint injection; China; extrapulmonary Mycobacterium
tuberculosis infection; outbreak; routine medical supervision

Free full text http://dx.doi.org/10.1016/j.cmi.2014.10.023
__________________________________________________________________
________________________________*_________________________________

12. Abstract: Intra-articular steroid injection for osteoarthritis of the
hip prior to total hip arthroplasty : is it safe? a systematic review
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27482013

Bone Joint J. 2016 Aug;98-B(8):1027-35.
Intra-articular steroid injection for osteoarthritis of the hip prior to
total hip arthroplasty : is it safe? a systematic review.

Pereira LC1, Kerr J2, Jolles BM1.

1Centre Hospitalier Universitaire Vaudois, Site Hôpital Orthopédique,
Avenue Pierre Decker 4, CH-1011 Lausanne, Switzerland.
2Therap-ease Treatment Centre, 382 Morningside Road, Edinburgh, EH10 5HX,
UK.

AIMS: Using a systematic review, we investigated whether there is an
increased risk of post-operative infection in patients who have received
an intra-articular corticosteroid injection to the hip for osteoarthritis
prior to total hip arthroplasty (THA).

METHODS: Studies dealing with an intra-articular corticosteroid injection
to the hip and infection following subsequent THA were identified from
databases for the period between 1990 to 2013. Retrieved articles were
independently assessed for their methodological quality.

RESULTS: A total of nine studies met the inclusion criteria. Two
recommended against a steroid injection prior to THA and seven found no
risk with an injection. No prospective controlled trials were identified.
Most studies were retrospective. Lack of information about the methodology
was a consistent flaw.

CONCLUSIONS: The literature in this area is scarce and the evidence is
weak. Most studies were retrospective, and confounding factors were poorly
defined or not addressed. There is thus currently insufficient evidence to
conclude that an intra-articular corticosteroid injection administered
prior to THA increases the rate of infection. High quality, multicentre
randomised trials are needed to address this issue.

Cite this article: Bone Joint J 2016;98-B:1027-35.

©2016 The British Editorial Society of Bone & Joint Surgery.

KEYWORDS: Corticosteroid; Infection; Intra-articular steroid hip
injection; Revision; Safety; Sepsis; Systematic review; Total hip
arthroplasty
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________________________________*_________________________________

13. No Abstract: The inaugural Healthcare Infection Society Middle East
Summit: ‘No action today. No cure tomorrow.’
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26364210

J Hosp Infect. 2015 Nov;91(3):199-201.
The inaugural Healthcare Infection Society Middle East Summit: ‘No action
today. No cure tomorrow.’.

Otter JA1.

1Infection Prevention and Control, Imperial College Healthcare NHS Trust,
London, UK. Electronic address: jonathan.otter@kcl.ac.uk.

[Mod: page 1 of 3 preview at http://dx.doi.org/10.1016/j.jhin.2015.06.021
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14. No Abstract: Concerns raised over poor blood safety systems in India
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27312294

Lancet. 2016 Jun 11;387(10036):2369.
Concerns raised over poor blood safety systems in India.

Sharma DC.

“New data showing that thousands of people might have been infected with
HIV through contaminated blood have highlighted failings in India’s
donation system. Dinesh C Sharma reports.”

Free Full Text at the link https://tinyurl.com/jryku7b
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________________________________*_________________________________

15. News

– USA: Amikacin Injection Recalled for Potential Glass Particulates

Selected news items reprinted under the fair use doctrine of international
copyright law: http://www4.law.cornell.edu/uscode/17/107.html
__________________________________________________________________
http://www.medscape.com/viewarticle/867069?
USA: Amikacin Injection Recalled for Potential Glass Particulates

Troy Brown, RN, Medscape Medical News, USA (03.08.16)

Teva Pharmaceuticals is voluntarily recalling seven lots of amikacin
sulfate injection USP, 500 mg/2 mL (250 mg/mL) and 1 g/4 mL (250 mg/mL)
vials because of potential presence of glass particulate matter, the
company said in a news release.

The administration of an intravenous drug containing glass particulate can
cause local irritation or swelling. Intravenous administration of a glass
particulate can also cause more serious and potentially life-threatening
outcomes, including blockage and clotting in the blood vessels and damage
to critical organs.

Amikacin sulfate is an aminoglycoside antibiotic used for the short-term
treatment of serious infections caused by susceptible strains of Gram-
negative bacteria. It is also effective against staphylococcal infections,
and is sometimes used as initial treatment in certain cases of confirmed
or suspected staphylococcal disease. Amikacin sulfate injection is
available as 2-mL and 4-mL vials, packaged in shelf packs of ten 500 mg/2
mL (250 mg/mL) and 1 g/4 mL (250 mg/mL) vials.

A company spokesperson told Medscape Medical News that they do not provide
specifics related to drug supply but that there is no shortage of the
drug.

The recalled lots are:

Lot # Expiration Date Strength Vial Size National Drug Code
(NDC) # (Individual Pack) NDC # (Shelf Pack – Carton of 10 Vials)
2381114 11/2016 1 gm/4 mL (250 mg/mL) 4 mL 0703-9040-01
0703-9040-03
2771114 11/2016 1 gm/4 mL (250 mg/mL) 4 mL 0703-9040-01
0703-9040-03
4760915 9/2017 1 gm/4 mL (250 mg/mL) 4 mL 0703-9040-01
0703-9040-03
7080315 3/2017 500 mg/2 mL (250 mg/mL 2 mL 0703-9032-01
0703-9032-03
7400315 3/2017 500 mg/2 mL (250 mg/mL) 2 mL 0703-9032-01
0703-9032-03
7410315 3/2017 500 mg/2 mL (250 mg/mL) 2 mL 0703-9032-01
0703-9032-03
7980415 4/2017 500 mg/2 mL (250 mg/mL) 2 mL 0703-9032-01
0703-9032-03

Teva also voluntarily recalled one lot of amikacin sulfate injection USP,
1 g/4 mL (250 mg/mL) vials on March 9, 2016, “due to the potential
presence of particulate matter identified as glass in one vial,” the
company said in a news release at the time. The recalled lot was #4750915;
Expiration Date 9/2017; Vial Size 1 g/4 mL (250 mg/mL); NDC # (Individual
Pack) 0703-9040-01; NDC # (Shelf Pack) 0703-9040-03.

The company has received no reports of adverse events or complaints linked
to either recall, a company spokesperson told Medscape Medical News.

Teva distributed amikacin sulfate injection 250 mg/mL, 2-mL and 4-mL vials
nationwide through wholesalers, retailers, and pharmacies. The company has
sent an Urgent Drug Recall Letter to its direct customers.

“Teva is arranging for impacted product to be returned to Inmar,” the
company said in the news release. “Anyone with an existing inventory of
the recalled lot(s) should stop use and distribution, and quarantine the
product immediately. Customers should notify all retail and medical
facility accounts. Customers who have further distributed the recalled
product should notify any accounts or additional locations which may have
received the recalled product and instruct them if they have redistributed
the product to notify their accounts, locations or facilities.”

Those with clinical questions should contact Teva Medical Information at
888-838-2872, option 3, then option 4. Those with customer service
questions should contact Teva Customer Service at 800-545-8800, Monday
through Friday, 8:00 AM to 5:00 PM ET.

Consumers who have experienced any problems potentially related to taking
this drug product should immediately contact their physician or other
healthcare provider.

Individuals with product quality complaint-related questions should
contact Teva Quality Assurance Services at 888-838-2872, option 3, then
option 3.

Adverse reactions that occur with the use of this product may be reported
to Teva Pharmaceuticals at 888-838-2872, option 3, then option 4.

Adverse events or product quality issues experienced with this product can
also be reported to the US Food and Drug Administration’s MedWatch Adverse
Event Reporting program online, by regular mail, or by fax.

The reporting form can be downloaded or requested by telephone at
800-332-1088. The completed form can be returned to the address on the
preaddressed form or submitted by fax to 1-800-FDA-0178.

More information on today’s recall is available on the FDA website.
http://www.fda.gov/Safety/Recalls/ucm514656.htm
__________________________________________________________________
________________________________*_________________________________

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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