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SIGNpost 00867

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST

Post00867 Supply Chain + Abstracts + News    24 August 2016

CONTENTS
1. Call for Proposals: 9th Global Health Supply Chain Summit
2. Abstract: Knowledge and Practice on Injection Safety among Primary
Health Care Workers in Kaski District, Western Nepal
3. Abstract: Perception and prevalence of work-related health hazards
among health care workers in public health facilities in southern India
4. Abstract: Seroprevalence of Blood Borne Pathogens among Health Care
Workers and Their Hepatitis B Vaccination Status in Tertiary Care
Hospitals in India
5. Abstract: Awareness about needlestick harms and health seeking
behaviour among the Safai Karamcharis at Dr. Rajendra Prasad Government
Medical College Kangra at Tanda (Himachal Pradesh)
6. Abstract: Assessment of infection control practices in teaching
hospitals of Quetta
7. Abstract: Needle-stick dengue virus infection in a health-care worker
at a Japanese hospital
8. Abstract: Seroprevalence of Hepatitis B Infection in Nigeria: A
National Survey
9. Abstract: Individual-level needle and syringe coverage in Melbourne,
Australia: a longitudinal, descriptive analysis
10. Abstract: Administrative risk quantification of subcutaneous and
intravenous therapies in Italian centers utilizing the Failure Mode
and Effects Analysis approach
11. Abstract: Assessment of knowledge, attitudes and practices toward
prevention of hepatitis B virus infection among students of medicine
and health sciences in Northwest Ethiopia
12. Abstract: Vaccination of healthcare workers: A review
13. Abstract: The effect of the application of manual pressure before the
administration of intramuscular injections on students’ perceptions of
post-injection pain: a semi-experimental study
14. Abstract: Are healthcare workers’ mobile phones a potential source of
nosocomial infections? Review of the literature
15. No Abstract: Sharps injuries among US dermatology trainees: A cross-
sectional study
16. News
– India: India is discarding needles but reusing syringes – and this is
spreading disease

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1. Call for Proposals: 9th Global Health Supply Chain Summit

Crossposted from TechNet-21 with thanks http://www.technet-21.org/en/
__________________________________________________________________

2016 Global Health Supply Chain Summit


9th Global Health Supply Chain Summit

Dates: November 16-18, 2016

Venue: Golden Tulip Hotel, Dar es Salaam, Tanzania

Conference theme

Integrating Global Health Supply Chains forSustainableHealth Outcomes:
AcceleratedInnovation, EffectivePartnerships, and EnhancedLocal Ownership

Call for Proposals

The GHSCS organizing committee is pleased to announce the call for
abstractsfor 2016 Summit. The 2016 conference will be held at the Golden
Tulip Hotel, in Dar es salaam, Tanzania. The 9th Global Health Supply
Chain Summit (GHSCS) will focus onSustainableHealth Outcomes,
AcceleratedInnovation, EffectivePartnerships, and EnhancedLocal Ownership

The 2016 summit will explore emerging trends in integrating supply chains,
better aligning incentives among the different entities in the supply
chain, ensuring constructive partnership between public and private
industry. We are also interested to explore ways to ensure effective local
ownership and management of health supply chains. The conference will
assemble a collection of experts in the field -academics, country
planners, NGOs, logistics practitioners, expert from industry and donor
representatives to explore these topics. The three day conference will
include two days of presentations and discussions and one day of training
regarding best practice tools in supply chain management. Attendees will
thus get access to both best practice results as well as “how-to” ideas
for implementation in their respective contexts. The format will involve
focused presentations of around 20 – 30 minutes, themed break-out
discussions, keynote speakers and training tutorials.

For 2016, the summit will focus on the following main themes:

Integrative supply chains: Integration of supply chains across products
and donors. Potential benefits and challenges Innovative supply chain to
ensure sustainable results Local ownership: Importance, how to achieve
local ownership, what are the main challenges, success stories.
‘The GHSC organizing committee would like to encourage representatives
from country governments to make abstract submissions according to the
conference themes. IAPHL will be offering a limited number of scholarships
to country government employees who have their abstract accepted for the
conference. In addition the organizing committee will also provide a
limited number of scholarships. The GHSCS Program Committee is currently
seeking proposals for focused presentations.

Submission Guidelines

To be considered for presentation at this summit, please complete
theattached proposal form giving author information and an extended
abstract and email the document to Prof. Yehuda Bassok (ybassok@gmail.com)
by August 25, 2016. Proposals and presentations may be written and
delivered in English or French. Simultaneous translation will be provided
in the conference. Proposals will be reviewed by the program committee and
acceptances notified by September 15, 2016.

Timeline Summary

Submission deadline: August 25, 2016
Notification of acceptance: September 15, 2016
Conference: November 16-18, 2016

Program Committee

Program Chair:Professor Yehuda Bassok, University of Southern California,
Los Angeles

Program Committee:

Ravi Anupindi, University of Michigan, Ann Arbor, MI (USA) Kjetil Bordvik,
Ministry of Health and Care Services, Government of Norway, Oslo (Norway)
Sriram Dasu, University of Southern California, Los Angeles, CA (USA)
Jeremie Gallien, London Business School, London (UK) Liuichi Hara,Takeda
Pharmaceuticals (Denmark) Ananth Iyer, Purdue University, West Lafayette,
IN (USA) Lloyd Matowe, Pharmaceutical Systems Africa (Liberia, Nigeria, &
Zambia) David Sarley, Bill & Melinda Gates Foundation, Seattle, WA (USA)
Anthony Savelli, Chemonics International, Washington DC (USA) Noel Watson,
Ops Mend (USA) Prashant Yadav, William Visiting Professor at the
Department of Global Health at Harvard Medical School

2016 Global Health Supply Chain Summit


__________________________________________________________________
________________________________*_________________________________

2. Abstract: Knowledge and Practice on Injection Safety among Primary
Health Care Workers in Kaski District, Western Nepal
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27540325

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4975588/ Free Full Article

Malays J Med Sci. 2016 Jan;23(1):44-55.
Knowledge and Practice on Injection Safety among Primary Health Care
Workers in Kaski District, Western Nepal.

Gyawali S1, Rathore DS2, Shankar PR3, Kc VK4, Jha N5, Sharma D1.

1Department of Pharmacology, Manipal College of Medical Sciences, Pokhara,
Kaski, Pin code: 33700, Nepal.
2NIMS Institute of Pharmacy, NIMS University, Shobha Nagar, Jaipur-Delhi
Highway, Jaipur, Pin code: 303121, India.
3Department of Pharmacology, Xavier University School of Medicine,
Oranjestad, Aruba, Kingdom of the Netherlands.
4Department of Statistics, Prithvi Narayan Multiple Campus, Pokhara,
Kaski, Pin code 33700, Nepal.
5Department of Clinical Pharmacology and Therapeutics, KIST Medical
College, Imadol, Lalitpur, Pin code: 44705, Nepal.

BACKGROUND: Unsafe injection practice can transmit various blood borne
infections. The aim of this study was to assess the knowledge and practice
of injection safety among injection providers, to obtain information about
disposal of injectable devices, and to compare the knowledge and practices
of urban and rural injection providers.

METHODS: The study was conducted with injection providers working at
primary health care facilities within Kaski district, Nepal. Ninety-six
health care workers from 69 primary health care facilities were studied
and 132 injection events observed. A semi-structured checklist was used
for observing injection practice and a questionnaire for the survey.
Respondents were interviewed to complete the questionnaire and obtain
possible explanations for certain observed behaviors.

RESULTS: All injection providers knew of at least one pathogen transmitted
through use/re-use of unsterile syringes. Proportion of injection
providers naming hepatitis/jaundice as one of the diseases transmitted by
unsafe injection practice was significantly higher in urban (75.6%) than
in rural (39.2%) area. However, compared to urban respondents (13.3%), a
significantly higher proportion of rural respondents (37.3%) named
Hepatitis B specifically as one of the diseases transmitted. Median
(inter-quartile range) number of therapeutic injection and injectable
vaccine administered per day by the injection providers were 2 (1) and 1
(1), respectively. Two handed recapping by injection providers was
significantly higher in urban area (33.3%) than in rural areas (21.6%).
Most providers were not aware of the post exposure prophylaxis guideline.

CONCLUSION: The knowledge of the injection providers about safe injection
practice was acceptable. The use of safe injection practice by providers
in urban and rural health care facilities was almost similar. The
deficiencies noted in the practice must be addressed.

KEYWORDS: Nepal; health personnel; injection; injection safety; needle
stick injury

Free PMC Article https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4975588/
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Perception and prevalence of work-related health hazards
among health care workers in public health facilities in southern India
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4273523/

Int J Occup Environ Health. 2015;21(1):74-81. Free PMC Article
Perception and prevalence of work-related health hazards among health care
workers in public health facilities in southern India.

Senthil A, Anandh B, Jayachandran P, Thangavel G, Josephin D, Yamini R,
Kalpana B.

BACKGROUND: Health care workers (HCWs) are exposed to occupational related
health hazards. Measuring worker perception and the prevalence of these
hazards can help facilitate better risk management for HCWs, as these
workers are envisaged to be the first point of contact, especially in
resource poor settings.

OBJECTIVE: To describe the perception of occupational health hazards and
self-reported exposure prevalence among HCWs in Southern India.

METHODS: We used cross sectional design with stratified random sampling of
HCWs from different levels of health facilities and categories in a
randomly selected district in Southern India. Data on perception and
exposure prevalence were collected using a structured interview schedule
developed by occupational health experts and administered by trained
investigators.

RESULTS: A total of 482 HCWs participated. Thirty nine percent did not
recognize work-related health hazards, but reported exposure to at least
one hazard upon further probing. Among the 81·5% who reported exposure to
biological hazard, 93·9% had direct skin contact with infectious
materials. Among HCWs reporting needle stick injury, 70·5% had at least
one in the previous three months. Ergonomic hazards included lifting heavy
objects (42%) and standing for long hours (37%). Psychological hazards
included negative feelings (20·3%) and verbal or physical abuse during
work (20·5%).

CONCLUSION: More than a third of HCWs failed to recognize work-related
health hazards. Despite training in handling infectious materials, HCWs
reported direct skin contact with infectious materials and needle stick
injuries. RESULTS indicate the need for training oriented toward
behavioral change and provision of occupational health services.

KEYWORDS: Ergonomic; Health workers,; India,; Occupational hazards,;
Occupational health,

Free PMC Article https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4273523/
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Seroprevalence of Blood Borne Pathogens among Health Care
Workers and Their Hepatitis B Vaccination Status in Tertiary Care
Hospitals in India
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27530589

Glob J Health Sci. 2016 Jun 17;9(1):60736.
Seroprevalence of Blood Borne Pathogens among Health Care Workers and
Their Hepatitis B Vaccination Status in Tertiary Care Hospitals in India.

Dafei M1, Sarin SK, Kannan AT, Agrawal K, Garg S, Agrawal K, Dehghani A.

1. adehghani42@gmail.com.

BACKGROUND & AIM: Occupational exposure to blood-borne pathogens, mainly
human immunodeficiency virus (HIV), hepatitis B (HBV) and hepatitis C
(HCV), poses a serious risk to healthcare workers (HCWs), especially in
developing countries, due to the high prevalence of these pathogens and
fewer safety precautions. The aim of this study was to investigate the
seroprevalence of HBV, HCV, and HIV infections and to measure the
vaccination practices in HCWs at three tertiary care hospitals in Delhi,
India.

METHOD: In a descriptive (cross-sectional) study, the HCWs of three
tertiary hospitals were selected by simple random sampling and divided
into four different groups (nurses, laboratory and operational theater
technicians, doctors and housekeeping workers). The participants were
screened for the presence of hepatitis B surface antigen (HBs Ag),
antibody to hepatitis B surface antigen (anti HBs), antibody to hepatitis
C (anti HCV), and antibody to HIV (anti HIV). From June 2010 to April
2012, a structured questionnaire was administered to 850 HCWs after
obtaining consent.

RESULTS: Among 850 HCWs, 51.8% were nurses and 50.6% were female with a
mean (SD) age of 34(8.7) years. The overall seroprevalence of HBsAg,
anti-HCV, and anti-HIV was 1.1%, 0.3%, and 0.1%, respectively. There was a
high proportion of HBsAg positivity among housekeeping workers (4.9%)
followed by nurses (3.3%). Out of 9 positive cases of HBsAg, 66% (6) were
never vaccinated and out of a total of 11 positive subjects, 72 % (8) had
previous exposure in the workplace. Complete HBV vaccination was done in
78.2% (605) of the HCWs and 11.3% (75) were partially vaccinated. Only
20.1% had checked their anti-HBs. Protective (>10 IU/mL) anti-HBs was seen
in 70.6% (600) of the participants, indicating that nearly one third of
HCWs were not protected against HBV infection. The majority of the study
subjects (63.6%) believed that they were immunized against hepatitis B and
did not need to check the immunity titer.

CONCLUSION: Not all HCWs were vaccinated and the majority of vaccinated
subjects did not know their immunity level. Housekeeping workers had a
high seropositivity rate of infections and a low rate of vaccination
against HBV. Institutional policy and training were found to be of
paramount importance to improve the quality of health in HCWs.
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Awareness about needlestick harms and health seeking
behaviour among the Safai Karamcharis at Dr. Rajendra Prasad Government
Medical College Kangra at Tanda (Himachal Pradesh)
__________________________________________________________________

http://www.ijmm.org/text.asp?2016/34/3/408/167675

Indian J Med Microbiol. 2016 Jul-Sep;34(3):408-9.
Awareness about needlestick harms and health seeking behaviour among the
Safai Karamcharis at Dr. Rajendra Prasad Government Medical College Kangra
at Tanda (Himachal Pradesh).

Thakur S1, Thakur K1, Sood A1, Jaryal SC1.

1Department of Microbiology, Dr. Rajendra Prasad Government Medical
College, Kangra, Tanda, Himachal Pradesh, India.

Dear Editor,

During the collection, handling and disposal of hospital waste, the Safai
Karamcharis (SKs) encounter needle pricks or sharps injuries. Since no
data on the frequency and after effects of such encounters existed in our
hospital, we planned a questionnaire based survey and serological
investigation in the SKs working in Dr. Rajendra Prasad Government Medical
College and Hospital, Kangra at Tanda, Himachal Pradesh.

We studied the prevalence of HIV, hepatitis B virus (HBV) and hepatitis C
virus (HCV) infections in this group. After obtaining informed consent,
questionnaire was administered to the participants. Five millilitre of
blood was drawn aseptically from the participants and tested for HBs
antigen, and antibodies for HCV, HIV-1 and HIV-2.

We studied total 80 SKs. None had received hepatitis B vaccination in the
past. History of unintentional injury with sharps or needles during work
was reported by 55 (68.7%). Multiple encounters were reported by 36 (45%).
Though all of them washed the injured body part with water, only few used
soap to clean the part. Consultation with a doctor was sought by only 7
(12%).

Most of them that is, 74 (92%) were not even aware of any post exposure
prophylaxis (PEP) that can be had to prevent diseases after sharps
injuries. They also showed ignorance about whom to approach for
consultation after the injury.

Thirty-eight (47.5%) of them had been tested for HIV, HCV, and HBsAg
earlier for some other study and were all found to be non-reactive
(unpublished data). Awareness regarding HIV, HBV, and HCV as a disease
acquired by sharps injury was reported by 47.5%, 5%, and 0% respectively.

Only 1 member of the study group was reactive for HBs Antigen, and none
were reactive for HIV-1, HIV-2 or HCV. Our state falls under low
endemicity for HIV, HBV, and HCV, which may have been the reason for the
low prevalence of these infections in our study group despite frequent
sharps injuries they receive.

The study was done to check the prevalence of infections and needle
pricks. Based on the results of this study, we counselled the SKs to get
vaccinated against hepatitis B and to consult the medical officer in
casualty regarding the need of PEP against HIV whenever they get a
needlestick injury again.

The same group was followed after 2 years to see the effects of the
earlier study. We found that 9 SKs had taken 1-month PEP after consulting
the doctors in last 2 years. Five of them were females and 8 had a needle
prick while one had injury by a surgical blade. Four of them were
classified as moderate exposure while 5 were mild exposures. The source
was unknown in all and all were given basic regimen for 1-month. To our
surprise, none of them had got vaccinated for hepatitis B. So, we
counselled them again and the main reason we found was their reluctance to
pay from their own pockets for the vaccine. This time we were able to
initiate the process of hepatitis B vaccination as the vaccine was
available in the hospital supply.

We again taught them the universal work precautions and guidelines for
hospital waste disposal. We talked to their supervisors to provide them
with heavy duty gloves to handle the hospital waste. Use of puncture proof
containers for the sharps and needles was emphasised. We also planned
follow-up training of SKs at regular intervals. The training of the
interns and staff nurses is also being done in batches.
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Assessment of infection control practices in teaching
hospitals of Quetta
__________________________________________________________________

http://jpma.org.pk/full_article_text.php?article_id=7855

J Pak Med Assoc. 2016 Aug;66(8):947-51. Free full text
Assessment of infection control practices in teaching hospitals of Quetta.

Anwar M1, Majeed A1, Saleem RM1, Manzoor F2, Sharif S2.

1Health Services Academy, Islamabad, Pakistan.
2Department of Zoology, Lahore College for Women University, Lahore,
Pakistan.

OBJECTIVE: To identify the gaps in infection control and prevention
practices in teaching hospitals.

METHODS: This cross-sectional study was conducted at Bolan Medical Complex
and Sandeman Medical College Hospital, Quetta, from August 2012 to January
2013.The study comprised members (n=7) of infection control committee who
were interviewed through a self-developed, closed-ended questionnaire and
their perception regarding infection control and prevention was recorded.
Data was analysed using SPSS 16.

RESULTS: Only 3(42.9%) of the committee members believed that the
administrative factors for causing hospital-acquired infections were
nurse-patient ratio. On the patient care side, 1(14.3%) participants at
one of the hospitals attributed infections to antibiotic use, 5(71.4%) to
invasive medical device and 1(14.3%) to other factors.

CONCLUSIONS: Poor perception held by the members of infection control
committee was the basic cause of bad outcome. Capacity-building of all the
stakeholders is required.

KEYWORDS: Infection control, Hospitals, Knowledge, Practices.
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Needle-stick dengue virus infection in a health-care worker
at a Japanese hospital
__________________________________________________________________

https://www.jstage.jst.go.jp/article/joh/57/5/57_14-0224-CS/_article

J Occup Health. 2015;57(5):482-3. Free full text
Needle-stick dengue virus infection in a health-care worker at a Japanese
hospital.

Ohnishi K1.

1Department of Infectious Diseases, Tokyo Metropolitan Bokutoh General
Hospital.

OBJECTIVES: About 160 patients in Japan were infected with dengue virus by
mosquito’s bites in the summer and autumn of 2014. In this report, I
describe a case of occupational dengue virus infection by needle-stick
injury from the 1990s to alert health-care workers to the fact that dengue
virus is among the causative agents responsible for occupational
infectious disease even in Japan.

CASE: A Japanese female in her thirties, a nurse at our hospital in Tokyo,
was admitted to our hospital in January 1992 three days after the onset of
fever, headache, and general malaise. She had never been overseas. Five
days before the onset of her symptoms, she had pricked her finger with an
injection needle used to draw blood from a febrile patient infected with
dengue virus. She was diagnosed with dengue virus infection based on three
findings: detection of the dengue virus genome in serum, isolation of
dengue virus from serum, and serum samples positive for IgM antibodies
against dengue virus.

CONCLUSIONS: The patient contracted dengue virus infection via a needle-
stick injury at our hospital. Although this occurred more than two decades
ago, in 1992, health-care workers should still be mindful of the risk of
dengue virus infection via needle-stick injury even in Japan.

Free full text
https://www.jstage.jst.go.jp/article/joh/57/5/57_14-0224-CS/_article
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Seroprevalence of Hepatitis B Infection in Nigeria: A
National Survey
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27527630

Am J Trop Med Hyg. 2016 Aug 15. pii: 15-0874.
Seroprevalence of Hepatitis B Infection in Nigeria: A National Survey.

Olayinka AT1, Oyemakinde A2, Balogun MS3, Ajudua A2, Nguku P3, Aderinola
M3, Egwuenu-Oladejo A3, Ajisegiri SW2, Sha’aibu S3, Musa BO4, Gidado S3,
Nasidi A5.

1Nigeria Field Epidemiology and Laboratory Training Programme, Abuja,
Nigeria. Department of Medical Microbiology, Ahmadu Bello University,
Zaria, Nigeria. debolaola@yahoo.com.
2Epidemiology Division, Federal Ministry of Health, Abuja, Nigeria.
3Nigeria Field Epidemiology and Laboratory Training Programme, Abuja,
Nigeria.
4Immunology Unit, Department of Medicine, Ahmadu Bello University Teaching
Hospital, Zaria, Nigeria.
5Nigeria Center for Disease Control, Abuja Nigeria.

Hepatitis B virus (HBV) infection accounts for about 1 million deaths
worldwide annually. This study was to determine the prevalence,
distribution of HBV, and factors associated with infection in an
apparently healthy population in Nigeria.

A cross-sectional study among the general population was conducted
employing a multistage sampling technique. Data on demographic, social,
and behavioral indicators were collected using questionnaires and blood
samples tested for HBV seromarkers. Descriptive, bivariate, and
multivariate analyses were done.

Prevalence of hepatitis B infection was 12.2% (confidence interval [CI] =
10.3-14.5). Of the participants, more than half, 527 (54.6%), had evidence
of previous exposure to HBV, while 306 (31.7%) showed no serologic
evidence of infection or vaccination. Only 76 (7.9%) participants showed
serologic evidence of immunity to HBV through vaccination.

Factors associated with testing positive for HBV infection were dental
procedure outside the health facility (odds ratios [OR] = 3.4, 95% CI =
1.52-7.70), local circumcision (OR = 1.73, 95% CI = 1.17-2.57), and
uvulectomy (OR = 1.65, 95% = 1.06-2.57).

With logistic regression, only dental procedure outside the health
facility (adjusted OR = 3.32, 95% CI = 1.38-7.97) remained significant.

This first national survey on seroprevalence of hepatitis B describes the
epidemiology and high prevalence of HBV infection in Nigeria and
highlights the need for improved vaccination against HBV.

© The American Society of Tropical Medicine and Hygiene.
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Individual-level needle and syringe coverage in Melbourne,
Australia: a longitudinal, descriptive analysis
__________________________________________________________________

https://dx.doi.org/10.1186/s12913-016-1668-z Full Open Access Article

BMC Health Serv Res. 2016 Aug 19;16(1):411.
Individual-level needle and syringe coverage in Melbourne, Australia: a
longitudinal, descriptive analysis.

O’Keefe D1,2, Scott N3,4, Aitken C3,4, Dietze P3,4.
Author information
1Centre for Population Health, Burnet Institute, 85 Commercial Rd,
Melbourne, VIC, 3004, Australia. daniel.okeefe@burnet.edu.au.
2School of Public Health and Preventive Medicine, Monash University, 99
Commercial Rd, Melbourne, VIC, 3004, Australia.
daniel.okeefe@burnet.edu.au.
3Centre for Population Health, Burnet Institute, 85 Commercial Rd,
Melbourne, VIC, 3004, Australia.
4School of Public Health and Preventive Medicine, Monash University, 99
Commercial Rd, Melbourne, VIC, 3004, Australia.

BACKGROUND: Coverage is used as one indicator of needle and syringe
program (NSP) effectiveness. At the individual level, coverage is
typically defined as an estimate of the proportion of a person who injects
drugs’ (PWID) injecting episodes that utilise a sterile syringe. In this
paper, we explore levels of individual syringe coverage and its changes
over time.

METHODS: Data were extracted from 1889 interviews involving 502
participants drawn from the Melbourne drug user cohort study (MIX). We
asked questions relating to participants syringe acquisition, distribution
and injecting frequency within the two weeks before interview. We created
a dichotomous coverage variable that classified participants as
sufficiently (=100 %) covered if all their injecting episodes utilised at
least one sterile syringe, and insufficiently (<100 %) covered if not. We
categorised participants as “consistently covered” if they were
sufficiently covered across interviews; as “consistently uncovered” if
they were insufficiently covered across interviews; and “inconsistently
covered” if they oscillated between coverage states. Chi-square statistics
tested proportions of insufficient coverage across sub-groups using broad
demographic, drug use and service utilisation domains. Logistic regression
tested predictors of insufficient coverage and inconsistently covered
categorisation.

RESULTS: Across the sample, levels of insufficient coverage were
substantial (between 22-36 % at each interview wave). The majority (50 %)
were consistently covered across interviews, though many (45 %) were
inconsistently covered.

We found strong statistical associations between insufficient coverage and
current hepatitis C virus (HCV) infection (RNA +).

Current prescription of opioid substitution therapy (OST) and using NSPs
as the main source of syringe acquisition were protective against
insufficient coverage.

CONCLUSION: Insufficient coverage across the sample was substantial and
mainly driven by those who oscillated between states of coverage,
suggesting the presence of temporal factors. We recommend a general
expansion of NSP services and OST prescription to encourage increases in
syringe coverage.

KEYWORDS: Harm reduction; Injecting drug use; Longitudinal analysis;
Syringe coverage

Free full text https://dx.doi.org/10.1186/s12913-016-1668-z
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Administrative risk quantification of subcutaneous and
intravenous therapies in Italian centers utilizing the Failure Mode
and Effects Analysis approach
__________________________________________________________________

https://dx.doi.org/10.2147/CEOR.S97323 Free Open Access Article

Clinicoecon Outcomes Res. 2016 Aug 3;8:353-9.
Administrative risk quantification of subcutaneous and intravenous
therapies in Italian centers utilizing the Failure Mode and Effects
Analysis approach.

Ponzetti C1, Canciani M2, Farina M2, Era S3, Walzer S4.

1Gruppo Policlinico di Monza, Alessandria, ANMDO National Association of
Hospital Physicians, Bologna.
2Studio EmmEffe Srl, Milan.
3Roche Spa, Monza, Italy.
4MArS Market Access & Pricing Strategy GmbH, Weil am Rhein; State
University Baden-Wuerttemberg, Health Care Management, Loerrach, Germany.

BACKGROUND: In oncology, an important parameter of safety is the potential
treatment error in hospitals. The analyzed hypothesis is that of
subcutaneous therapies would provide a superior safety benefit over
intravenous therapies through fixed-dose administrations, when analyzed
with trastuzumab and rituximab.

METHODS: For the calculation of risk levels, the Failure Mode and Effect
Analysis approach was applied. Within this approach, the critical
treatment path is followed and risk classification for each individual
step is estimated. For oncology and hematology administration, 35
different risk steps were assessed. The study was executed in 17
hematology and 16 breast cancer centers in Italy. As intravenous and
subcutaneous were the only injection routes in medical available for
trastuzumab and rituximab in oncology at the time of the study, these two
therapies were chosen.

RESULTS: When the risk classes were calculated, eight high-risk areas were
identified for the administration of an intravenous therapy in hematology
or oncology; 13 areas would be defined as having a median-risk
classification and 14 areas as having a low-risk classification (total
risk areas: n=35). When the new subcutaneous formulation would be applied,
23 different risk levels could be completely eliminated (65% reduction).
Important high-risk classes such as dose calculation, preparation and
package labeling, preparation of the access to the vein, pump infusion
preparation, and infusion monitoring were included in the eliminations.
The overall risk level for the intravenous administration was estimated to
be 756 (ex-ante) and could be reduced by 70% (ex-post). The potential harm
compensation for errors related to pharmacy would be decreased from eight
risk classes to only three risk classes.

CONCLUSION: The subcutaneous administration of trastuzumab (breast cancer)
and rituximab (hematology) might lower the risk of administration and
treatment errors for patients and could hence indirectly have a positive
financial impact for hospitals.

KEYWORDS: health economics; insurance premium; intravenous therapy;
oncology; safety; subcutaneous therapy

Free PMC Article https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4976806/
__________________________________________________________________
________________________________*_________________________________

11. Abstract: Assessment of knowledge, attitudes and practices toward
prevention of hepatitis B virus infection among students of medicine
and health sciences in Northwest Ethiopia
__________________________________________________________________

http://bmcresnotes.biomedcentral.com/articles/10.1186/s13104-016-2216-y

BMC Res Notes. 2016 Aug 19;9(1):410. Free Full Open Access Article
Assessment of knowledge, attitudes and practices toward prevention of
hepatitis B virus infection among students of medicine and health sciences
in Northwest Ethiopia.

Abdela A1, Woldu B1, Haile K1, Mathewos B1, Deressa T2.

1College of Medicine and Health Sciences, School of Biomedical and
Laboratory Sciences, University of Gondar, P.O.Box 196, Gondar, Ethiopia.
2College of Medicine and Health Sciences, School of Biomedical and
Laboratory Sciences, University of Gondar, P.O.Box 196, Gondar, Ethiopia.
tekalign09@gmail.com.

BACKGROUND: Hepatitis B virus (HBV) infection in the health setting is a
global public health problem. The risk of occupational exposure to HBV
among health care workers is a major concern, especially among students in
health professions. In Ethiopia, very little is known about the knowledge,
attitude, and practices (KAP) of trainees in the health professions
towards occupational risk of HBV. Thus, the aim of this study was to
assess the level of KAP of medicine and health Sciences students in
Northwest Ethiopia towards occupational risk of HBV infection.

METHODS: A cross-sectional study was conducted from February 2015 to June
2015. A total of 246 students of health care professions were included
into the study using a systematic random sampling technique. Data were
collected using self-administered structured questionnaire and analysed by
using SPSS version 20.

RESULTS: Majority of the study participants, (>80 %) had an adequate
knowledge on risk factors for HBV, its mode of transmissions, and
preventions. Two hundred of 246 (83.3 %) participants had positive
attitude towards following infection control guidelines, and 201 (81.7 %)
respondents believe that all HCWs should take HBV vaccine. However, only 5
(2 %) students had completed the three doses schedule of HBV vaccination.
Whereas, a significant number of students, 66 (26.8 %), had been exposed
to blood/body fluid via needle stick injury at least once since they
started their training in the health facility.

CONCLUSIONS: Our study found that trainees in health profession are at a
very high risk of contracting HBV infection during their training owing to
the low HBV vaccine uptake rate and high rate of accidental exposure to
blood. Thus, we recommend that all students in the health profession
should be vaccinated prior to their entry into professional practices.

KEYWORDS: Attitude; Health science students; Hepatitis B; Knowledge;
Northwest Ethiopia; Occupational exposure

Free PMC Article https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4992214/
__________________________________________________________________
________________________________*_________________________________

12. Abstract: Vaccination of healthcare workers: A review
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4685699/

Hum Vaccin Immunother. 2015;11(11):2522-37. Free PMC Article
Vaccination of healthcare workers: A review.

Haviari S1, Bénet T1,2,3, Saadatian-Elahi M1, André P1, Loulergue P3,4,5,
Vanhems P1,2,3.

1a Service d’Hygiène, Epidémiologie et Prévention, Hôpital Edouard
Herriot, Hospices Civils de Lyon ; Lyon , France.
2b Equipe Epidémiologie et Santé Publique, Université de Lyon, Université
Lyon 1 ; Lyon , France.
3c Institut National de la Santé et de la Recherche Médicale (INSERM),
French Clinical Research Investigation Network (F-CRIN), Innovative
Clinical Research Network in Vaccinology (I-REIVAC) ; Lyon , France.
4d Université Paris Descartes, Sorbonne Paris Cité, INSERM, CIC 1417,
Assistance Publique Hôpitaux de Paris (AP-HP), Groupe Hospitalier Cochin
Broca Hôtel Dieu, CIC Cochin-Pasteur ; Paris , France.
5e INSERM, F-CRIN, I-REIVAC, Cochin Center ; Paris , France.

Vaccine-preventable diseases are a significant cause of morbidity and
mortality. As new vaccines are proving to be effective and as the
incidence of some infections decreases, vaccination practices are
changing.

Healthcare workers (HCWs) are particularly exposed to and play a role in
nosocomial transmission, which makes them an important target group for
vaccination.

Most vaccine-preventable diseases still carry a significant risk of
resurgence and have caused outbreaks in recent years. While many
professional societies favor vaccination of HCWs as well as the general
population, recommendations differ from country to country. In turn,
vaccination coverage varies widely for each microorganism and for each
country, making hospitals and clinics vulnerable to outbreaks. Vaccine
mandates and non-mandatory strategies are the subject of ongoing research
and controversies.

Optimal approaches to increase coverage and turn the healthcare workforce
into an efficient barrier against infectious diseases are still being
debated.

KEYWORDS: coverage; healthcare worker; hepatitis; influenza; measles;
mumps; nosocomial; pertussis; vaccination; varicella
__________________________________________________________________
________________________________*_________________________________

13. Abstract: The effect of the application of manual pressure before the
administration of intramuscular injections on students’ perceptions of
post-injection pain: a semi-experimental study
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27535654

J Clin Nurs. 2016 Aug 18.
The effect of the application of manual pressure before the administration
of intramuscular injections on students’ perceptions of post-injection
pain: a semi-experimental study.

Öztürk D1, Baykara ZG2, Karadag A3, Eyikara E2.

1Baskent University, Faculty of Health Sciences, Nursing Department,
Fundamentals of Nursing, Ankara.
2Gazi University, Faculty of Health Science Department of Nursing,
Fundamentals of Nursing, Ankara.
3Koç University Faculty of Nursing, Istanbul.

AIM AND OBJECTIVES: To evaluate the efficacy of applying manual pressure
before intramuscular injection and compare it with the standard injection
technique in terms of reducing the young adult student’s post-injection
pain.

BACKGROUND: The administration of intramuscular injections is a procedure
performed by nurses and one that causes anxiety and pain for the patient.
Nurses have ethical and legal obligations to mitigate injection-related
pain and the nurses use of effective pain management not only provides
physical comfort to the patients, it also improves the patients’
experience.

DESIGN: Comparative experimental study.

METHODS: This study was conducted with first-year university students
(n=123) who were scheduled for hepatitis A and hepatitis B vaccination via
deltoid muscle injection. Students were randomly assigned to the groups.
Comparison group students (n=60) were given an injection using the
conventional method, i.e., without manual pressure being applied prior to
the injection. The experiment group students (n=63) received manual
pressure at the vaccination site immediately before injection for a period
of 10 seconds. The two techniques were used randomly. The subjects were
given pressure to the injection site and perceived pain intensity was
measured using Numerical Rating Scale.

RESULTS: Findings demonstrate that students experienced significantly less
pain when they received injections with manual pressure compared with the
standard injection technique. The post-injection average pain score in the
comparison group was higher than that in the experimental group (p<0.05).

CONCLUSIONS: This study’s results show that application of manual pressure
to the injection site before intramusculer injections reduces post-
injection pain intensity in young adult students (p<0.05). Based on these
results before the injection, applying manual pressure to the adult’s
intramuscular injection site is recommended.

RELEVANCE TO CLINICAL PRACTICE: Applying pressure to the injection area is
a simple and cost effective method to reduce the pain associated
injection.

This article is protected by copyright. All rights reserved.

KEYWORDS: Intramuscular injection; manual pressure; pain management
__________________________________________________________________
________________________________*_________________________________

14. Abstract: Are healthcare workers’ mobile phones a potential source of
nosocomial infections? Review of the literature
__________________________________________________________________

http://www.jidc.org/index.php/journal/article/view/26517478

J Infect Dev Ctries. 2015 Oct 29;9(10):1046-53. Free full text
Are healthcare workers’ mobile phones a potential source of nosocomial
infections? Review of the literature.

Ulger F1, Dilek A, Esen S, Sunbul M, Leblebicioglu H.

1Ondokuz Mayis University School of Medicine, Samsun, Turkey.
faulger@gmail.com.

Mobile communication devices help accelerate in-hospital flow of medical
information, information sharing and querying, and contribute to
communications in the event of emergencies through their application and
access to wireless media technology. Healthcare-associated infections
remain a leading and high-cost problem of global health systems despite
improvements in modern therapies.

The objective of this article was to review different studies on the
relationship between mobile phones (MPs) and bacterial cross-contamination
and report common findings.

Thirty-nine studies published between 2005 and 2013 were reviewed. Of
these, 19 (48.7%) identified coagulase-negative staphylococci (CoNS), and
26 (66.7%) identified Staphylococcus aureus; frequency of growth varied.
The use of MPs by healthcare workers increases the risk of repetitive
cyclic contamination between the hands and face (e.g., nose, ears, and
lips), and differences in personal hygiene and behaviors can further
contribute to the risks.

MPs are rarely cleaned after handling. They may transmit microorganisms,
including multiple resistant strains, after contact with patients, and can
be a source of bacterial cross-contamination.

To prevent bacterial contamination of MPs, hand-washing guidelines must be
followed and technical standards for prevention strategies should be
developed.
__________________________________________________________________
________________________________*_________________________________

15. No Abstract: Sharps injuries among US dermatology trainees: A cross-
sectional study
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26979357

J Am Acad Dermatol. 2016 Apr;74(4):756-8.
Sharps injuries among US dermatology trainees: A cross-sectional study.

Nambudiri VE1, Qureshi AA2, Vleugels RA3.

1Department of Dermatology, Brigham and Women’s Hospital, Boston, MA;
Department of Internal Medicine, Brigham and Women’s Hospital, Boston, MA.
Electronic address: vinod.nambudiri@gmail.com.
2Department of Dermatology, Rhode Island Hospital, Providence.
3Department of Dermatology, Brigham and Women’s Hospital, Boston, MA.
__________________________________________________________________
________________________________*_________________________________

16. News

– India: India is discarding needles but reusing syringes – and this is
spreading disease

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/hhm79le
India: India is discarding needles but reusing syringes – and this is
spreading disease

By Priyanka Vora, Scroll.in, Pulse, India (21.08.16)

Both HIV and hepatitis spread through the use of unsafe injections.

In a slum near Mumbai’s largest dumping ground, a doctor practising Unani
medicine sees more than 50 patients a day. For just Rs 20, he diagnoses
the disease, gives medicines and even administers an injection. In his
clinic at Shivaji Nagar in Govandi is a drawer cluttered with disposable
injections and a box filled with used syringes. After administering an
injection, the doctor meticulously scraps off the needle and discards it,
but he puts the used syringe next to the packed ones.

“I am aware that needles cannot be reused but syringes can be,” he said,
requesting anonymity. “There is no harm.”

The doctor is wrong. Not just needles, even syringes can transmit blood-
borne infections like HIV and hepatitis. According to India’s National
Aids Control Organisation, an estimated 86,000 new HIV infections were
recorded in the country last year. Viral hepatitis kills approximately
3,50,000 people every year in the South East Asia Region which includes
India, according to the World Health Organisation. There are no local
studies to measure the burden of viral hepatitis in India.

[Biomedical waste lying in open on the floor at a clinic in Byculla where
a doctor said he reused syringes. Photo: Priyanka Vora]

Dr Parveen Malhotra, head of the department of medical gastroenterology at
the Post-Graduate Institute of Medical Sciences in Rohtak in Haryana,
explained, “When an injection is administered to a person infected with
any blood borne virus such as hepatitis C, the blood remnants on the
needle and the syringe can spread the infection to any person who comes in
contact with the used equipment.”

Hence, conventional medical advice is to dispose all such material
immediately after the injection is administered.

A 2012 study by University of Nevada at Las Vegas researchers published in
the Indian Journal of Community Medicine found that 12% of HIV infections
in India are associated with unsafe injections. According to the same
study, an estimated 46% of hepatitis B cases and 38% of hepatitis C cases
in India spread through the reuse of needles and syringes. Such cases can
be easily avoided. The cheapest disposable injection costs as little as Rs
6.

So why do doctors and nurses continue to reuse syringes?

Syringe shortage

Nagma Quereshi is a 22-year-old woman who lives in Govandi. Pregnant with
her first child, she goes to Rajawadi Hospital, a municipal facility
regularly for her pregnancy check-ups. She is often administered an
injection, but she has rarely observed the nurse throw the used syringes
in the dustbin. “They [the nurses] just come and inject,” she said. “We
don’t get to see if they have removed the injection from a new packet.”

Healthcare experts said that in situations where the nurses are battling
shortage of injections, they are left with two options – either to reuse
injections or ask the patient to go and buy fresh ones. If they ask the
patient to buy, there is a risk of getting into an argument as hospitals
are expected to provide these consumables free of cost. In such a
situation, it proves easier to just reuse the syringe.

Dr Pravin Shingare, head of the directorate of medical education in
Maharashtra, however, insisted that injections were never reused in
government hospitals since the department provided them with adequate
supplies. “If need be, we locally purchase the equipment,” he said.

But studies have documented the widespread use of unsafe injections in
India.

A study by IPEN, a global network that works for toxics-free environments,
on injection practices in India which was published in the World Health
Organisation’s South-East Asia Journal of Public Health in 2012 found that
six out of ten injections administered in Indian healthcare establishments
were unsafe.

An injection is considered to be unsafe if the healthcare provider fails
to follow the injection safety guidelines prescribed by the World Health
Organisation. Scrapping the needle after administering the injection and
throwing the used syringe in a bag are some of the safe injection
practices that healthcare providers are expected to follow.

A study by a team of doctors from the department of community medicine at
Pandit JNM Medical College in Raipur, Chhattisgarh, found that healthcare
providers at the hospital failed to adhere to the injection safety
guidelines prescribed by the World Health Organisation. In nine out of
every ten instances observed by a team of doctors to gauge safe injection
practices at government hospital in Chhattisgarh, the nurse did not shred
the needle after administering injections.

Another study published in the National Journal of Community Medicine
found in 23% of the 2,119 observations made by them at Pandit JNM Medical
College, the healthcare provider left the needle on the top of the vial
for an additional dose. “At times a vial contains multiple doses in such
situation, the nurse is expected to draw the medicine from the vial,
administer the injection and dispose it of,” said Dr Divya Sahu, director
and professor at the department of community medicine. “However, we saw
that the nurses were reusing the same injection to draw additional doses.”

The same study also observed the practice of reusing of the syringe by
inserting a new needle. “During our study, we observed at five different
instances where the nurse instead of disposing of the needle and syringe,
only disposed of the needle and reused the syringe with a new needle,”
said Sahu.

The study also found that in 26% of the instances, the used syringe were
kept in an area accessible to public including children who could play
with the biomedical waste.

Biomedical waste disposal

It is not just the deliberate reuse of injections that is a cause for
worry. Doctors suspect the presence of an illegal recycling industry that
recycles used medical equipment and sells them again in the market. “We
know of healthcare providers reusing the needles but also there is an
industry that recycles them,” said Dr Malhotra of the Post-Graduate
Institute of Medical Sciences in Rohtak.

Fears expressed by doctors in Haryana over the recycling of biomedical
waste are echoed by those in Mumbai too. This correspondent visited
several clinics in the slums of Mumbai to find that many continue to throw
their biomedical waste as household garbage.

A dental clinic located in Bharat Nagar slums of Bandra Kurla Complex, the
swanky financial neighbourhood of Mumbai, maintains a single dustbin which
is used to dump both used injections and tea cups. The clinic which is
operating in the locality for over two decades does not dispose of its
biomedical waste as required under the law. The attendant at the clinic
who has been working there for three years said that the sweeper who
collects the household garbage from the locality also collects the garbage
from the clinic which includes used gloves, injections and soiled cotton.

[Syringes discarded with tea cups to be thrown out with household garbage.
Photo: Priyanka Vora]

A Unani clinic in the same locality that boasts of treating nearly 100
patients every day disposes of its biomedical waste in a similar fashion.
“The lady who comes to clean the clinic puts all the waste in a black bag
and throws it off,” said the attendant at the clinic.

In Mumbai, which is home to over 10,000 healthcare establishments
including corporate hospitals, nursing homes and clinics, there is a
system in place for disposal of biomedical waste. The local corporation
has appointed an agency that collects the biomedical waste from the
healthcare facilities and performs the incineration process. In 2014,
about 12 metric tonnes of biomedical waste was generated in the city
officially.

Infectious disease expert Dr Om Shrivastav said it is wrong to expect the
patient to be vigilant here. “In our country, patients rarely question the
doctor,” he said. “The person disposing of these hazardous waste should be
made responsible for the waste he is discarding.” Shrivastav said the rise
in viral hepatitis infections is evidence that “somebody at the level of
disposal is not doing what they are expected to”.

Catching violators

An operator of biomedical waste disposers in Mumbai said, “We suspect that
some waste is being siphoned off from hospitals to the grey market where
they are perhaps recycled.” In 2010, the Mumbai police had nabbed a tempo
filled with biomedical waste near Deonar. The tempo was filled with used
medical equipment, including bloodstained gloves.

The Maharashtra Pollution Control Board’s officials did not deny the
possibility of biomedical waste being recycled. “We act promptly on any
complaints we receive,” said Amar Supate, principal scientific officer,
MPCB. “Last year, an FIR was filed after we found some people were
recycling biomedical waste. The problem is with very small clinics. It is
physically impossible to check their biomedical disposal mechanism. The
local corporations should keep a vigil and cancel their license if they
are found disposing off their waste as any other garbage.”

However, senior officials from Mumbai’s municipal corporation said it is
the responsibility of the pollution control boards to take action against
those found flouting biomedical rules.

This blame game only helps the healthcare establishments get away with
dangerous disposal practices.

Smart injects = smart solution?

Worried about used needles and syringes finding their way back into the
market, Malhotra’s department in Haryana has started distributing free
needle cutters among doctors practicing in localities where the burden of
Hepatitis cases is high.

“We are distributing burners so they can discard of these disposable waste
and they don’t fall into hands of recyclers,” he said.

However, this still leaves room for discretion on the part of doctors and
nurses.

To completely eliminate the possibility of reuse of injections, several
states in India are responding to WHO’s call to use safety engineered
syringes called smart injects which automatically get locked after the
injection is administered. Maharashtra is one of them. “We will be
adopting the reuse prevention injections or smart injections in all our
government hospitals,” said Sujata Saunik, principal health secretary,
government of Maharashtra.

But the smart injects cost 20% more than the conventional disposable
injections, according to industry experts.

While governments will be able to afford the injections, would private
clinics, particular those in poor neighbourhoods, shoulder the extra cost?
__________________________________________________________________
________________________________*_________________________________

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
__________________________________________________________________
________________________________*_________________________________

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any posting, or to use the forum to request technical information in
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Use of trade names and commercial sources is for identification only and
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The SIGN Forum welcomes new subscribers who are involved in injection
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The SIGNpost website provides an archive of all SIGNposts, meeting
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__________________________________________________________________
________________________________*_________________________________

The SIGN Internet Forum was established at the initiative of the World
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