online canadian pharmacy http://www.canadianpharmacy365.net/ pharmacy ratings phentermine no prescription

SIGNpost 00869

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST

Post00869 HC Waste + SEDs + Abstracts + News 07 September 2016

CONTENTS
0. Moderators Note
1. Abstract: Use of safety-engineered devices by healthcare workers for
intravenous and/or phlebotomy procedures in healthcare settings: a
systematic review and meta-analysis
2. Abstract: Sharp truth: health care workers remain at risk of bloodborne
infection
3. Abstract: Biological accidents in last-year medical students from three
hospitals in Lima Peru
4. Abstract: Knowledge, awareness, and attitude regarding infection
prevention and control among medical students: a call for educational
intervention
5. Abstract: Developing a policy to empower informal carers to administer
subcutaneous medication in community palliative care; a feasibility
project
6. Abstract: Recovering infectious HIV from novel syringe-needle
combinations with low dead space volumes
7. Abstract: Historical trends in the hepatitis C virus epidemics in North
America and Australia
8. Abstract: A Novel Option for Prandial Insulin Therapy: Inhaled Insulin
9. Abstract: Monitoring harm reduction in European prisons via the Dublin
Declaration
10. Abstract: Acceptance of multiple injectable vaccines in a single
immunization visit in The Gambia pre and post introduction of
inactivated polio vaccine
11. Abstract: Assessing the global threat from Zika virus
12. No Abstract: APIC publishes updated Professional and Practice
Standards for infection preventionists
13. News
– North Carolina USA: Editorial: Raleigh ‘Safe syringe’ idea worthy of
support
– UK: Faversham: Boy, three, falls on to needle in play park
– USA: Politics Are Tricky but Science Is Clear: Needle Exchanges Work
– Pakistan: Congo fever: Precautions urged while handling sacrificial
animals

The web edition of SIGNpost is online at:

SIGNpost 00860

More information follows at the end of this SIGNpost!

Please send your requests, notes on progress and activities, articles,
news, and other items for posting to: sign.moderator@gmail.com

Normally, items received by Tuesday will be posted in the Wednesday
edition.

Subscribe or unsubscribe by email: signmoderator@googlegroups.com

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

Visit the SIGNpostOnline archives at: http://signpostonline.info

Like SIGNpost on Facebook at: https://www.facebook.com/SIGN.Moderator
and get updates on your device!
__________________________________________________________________
________________________________*_________________________________

0. Moderators Note
__________________________________________________________________

WHO Handbook on Healthcare Waste Management. PDF Download @ the Link
The World Health Organization (WHO) handbook Safe management of waste from
health-care activities(commonly known as “the Blue Book”) has been the
definitive information source on how to deal with these wastes,
particularly in low and middle income countries.

The second edition of the handbook contains guidance on the most
environmentally sustainable waste treatment technologies, how to plan the
setting up of a waste management system and a host of other essential
subjects.

It is a source of impartial health-care information and guidance on safe
waste management practices.

WHO Handbook on Healthcare Waste Management. Download PDF

http://apps.who.int/iris/bitstream/10665/85349/1/9789241548564_eng.pdf
__________________________________________________________________
________________________________*_________________________________

1. Abstract: Use of safety-engineered devices by healthcare workers for
intravenous and/or phlebotomy procedures in healthcare settings: a
systematic review and meta-analysis
__________________________________________________________________

https://dx.doi.org/10.1186/s12913-016-1705-y

BMC Health Serv Res. 2016 Sep 1;16:458. Full Free Article
Use of safety-engineered devices by healthcare workers for intravenous
and/or phlebotomy procedures in healthcare settings: a systematic review
and meta-analysis.

Ballout RA1, Diab B2, Harb AC3, Tarabay R2, Khamassi S4, Akl EA5.

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

BACKGROUND: The acquisition of needle-stick injuries (NSI) in a healthcare
setting poses an occupational hazard of transmitting blood-borne pathogens
from patients to healthcare workers (HCWs). The objective of this study
was to systematically review the evidence about the efficacy and safety of
using safety-engineered intravenous devices and safety-engineered
phlebotomy devices by HCWs.

METHODS: We included randomized and non-randomized studies comparing
safety-engineered devices to conventional/standard devices that lack
safety features for delivering intravenous injections and/or for blood-
withdrawal procedures (phlebotomy).

The outcomes of interest included NSI rates, and blood-borne infections
rates among HCWs and patients. We conducted an extensive literature search
strategy using the OVID interface in October 2013. We followed the
standard methods for study selection and data abstraction. When possible,
we conducted meta-analyses using a random-effects model. We used the GRADE
methodology to assess the quality of evidence by outcome.

RESULTS: We identified twenty-two eligible studies: Twelve assessed
safety-engineered devices for intravenous procedures, five for phlebotomy
procedures, and five for both. Twenty-one of those studies were
observational while one was a randomized trial. All studies assessed the
reduction in NSIs among HCWs.

For safety-engineered intravenous devices, the pooled relative risk for
NSI per HCW was 0.28 [0.13, 0.59] (moderate quality evidence).

The pooled relative risk for NSI per device used or procedure performed
was 0.34 [0.08,1.49] (low quality evidence).

For safety-engineered phlebotomy devices, the pooled relative risk for NSI
per HCW was 0.57 [0.38, 0.84] (moderate quality evidence).

The pooled relative risk for NSI per device used or procedure performed
was 0.53 [0.43,0.65] (moderate quality evidence).

We identified no studies assessing the outcome of blood-borne infections
among healthcare workers or patients.

CONCLUSION: There is moderate-quality evidence that the use of safety-
engineered devices in intravenous injections and infusions, and phlebotomy
(blood-drawing) procedures reduces NSI rates of HCWs.

KEYWORDS: Blood-borne pathogens; Healthcare setting; Healthcare workers;
Intravenous; Meta-analysis; Needle-stick injuries; Phlebotomy; Safety-
engineered devices; Systematic review

Free BMC Article https://dx.doi.org/10.1186/s12913-016-1705-y
__________________________________________________________________
________________________________*_________________________________

2. Abstract: Sharp truth: health care workers remain at risk of bloodborne
infection
__________________________________________________________________

http://occmed.oxfordjournals.org/content/65/3/210

Occup Med (Lond). 2015 Apr;65(3):210-4. Free full text
Sharp truth: health care workers remain at risk of bloodborne infection.

Rice BD1, Tomkins SE2, Ncube FM2.

1Department of HIV and STI, Centre for Infectious Disease Surveillance and
Control, Public Health England, 61 Colindale Avenue, Colindale, London NW9
5EQ, UK. brian.rice@phe.gov.uk.
2Department of HIV and STI, Centre for Infectious Disease Surveillance and
Control, Public Health England, 61 Colindale Avenue, Colindale, London NW9
5EQ, UK.

BACKGROUND: In 2013, new regulations for the prevention of sharps injuries
were introduced in the UK. All health care employers are required to
provide the safest possible working environment by preventing or
controlling the risk of sharps injuries.

AIMS: To analyse data on significant occupational sharps injuries among
health care workers in England, Wales and Northern Ireland before the
introduction of the 2013 regulations and to assess bloodborne virus
seroconversions among health care workers sustaining a blood or body fluid
exposure.

METHODS: Analysis of 10 years of information on percutaneous and
mucocutaneous exposures to blood or other body fluids from source patients
infected with a bloodborne virus, collected in England, Wales and Northern
Ireland through routine surveillance of health care workers reported for
the period 2002-11.

RESULTS: A total of 2947 sharps injuries involving a source patient
infected with a bloodborne virus were reported by health care workers.
Significant sharps injuries were 67% higher in 2011 compared with 2002.
Sharps injuries involving an HIV-, hepatitis B virus- or hepatitis C virus
(HCV)-infected source patient increased by 107, 69 and 60%, respectively,
between 2002 and 2011. During the study period, 14 health care workers
acquired HCV following a sharps injury.

CONCLUSIONS: Our data show that during a 10-year period prior to the
introduction of new regulations in 2013, health care workers were at risk
of occupationally acquired bloodborne virus infection. To prevent sharps
injuries, health care service employers should adopt safety-engineered
devices, institute safe systems of work and promote adherence to standard
infection control procedures.

© The Author 2015. Published by Oxford University Press on behalf of the
Society of Occupational Medicine. All rights reserved.

KEYWORDS: HIV; Hepatitis; occupational injury; sharp injury; surveillance.

Free Full Article
http://occmed.oxfordjournals.org/content/65/3/210.full.pdf+html
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Biological accidents in last-year medical students from three
hospitals in Lima Peru
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27571394

Medwave. 2016 Aug 11;16(7):e6514.
Biological accidents in last-year medical students from three hospitals in
Lima Peru.

[Article in English, Spanish]

Charca-Benavente LC1, Huanca-Ruelas GH2, Moreno-Loaiza O2.

1Facultad de Medicina, Universidad Nacional de San Agustín de Arequipa,
Arequipa, Perú. Address; Urbanización Guardia Civil, Manzana F, Lote 11,
Paucarpata, Arequipa, Perú. Email: lily_797_chc@hotmail.com.
2Facultad de Medicina, Universidad Nacional de San Agustín de Arequipa,
Arequipa, Perú

Abstract in English, Spanish

OBJECTIVE: To determine the frequency and characteristics of biological
accidents in last-year medical students from three hospitals in Lima.

METHODS: Cross-sectional study performed at three Public Health Insurance
hospitals in Lima, in December 2014. The study population comprised last-
year medical interns. Biological accidents were recorded with a
questionnaire of exposure to blood and body fluids based on the formats
used by the Exposure Prevention Information Network system and the Centers
for Disease Control and Prevention. We inquired about occurrence and
number of biological accidents as well as the characteristics of the last
accident. Categorical data are presented as absolute and percentage
frequencies and numeric data, as median and interquartile ranges.

RESULTS: We collected 100 respondents; 85% of them had had a biological
accident during the last year, with a median of 2 and interquartile range
of 3. The most frequent type of exposure was percutaneous (71.8%) and the
most common device was the hollow needle (54.1%). The most frequent place
of occurrence and activities at the moment of exposure were at the
delivery room (44.7%), while supervising a vaginal delivery (24.7%), and
during suturing (24.7%). Three accidents involved high-risk patients, but
only one student received antiviral prophylaxis; 49.4% attributed the
cause of the accident to fatigue, and 75.3% of accidents are not reported.
Gloves are the most used protective barrier (95%).

CONCLUSIONS: The frequency of biological accidents among last-year medical
students is high. Underreporting and inappropriate use of protective
barriers increase the risk of medical students for biological accidents.

KEYWORDS: biohazard release; body fluids; medical students; needlestick
injuries; universal precautions
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Knowledge, awareness, and attitude regarding infection
prevention and control among medical students: a call for educational
intervention
__________________________________________________________________

https://dx.doi.org/10.2147/AMEP.S109830 Free Full Article

Adv Med Educ Pract. 2016 Aug 22;7:505-10.
Knowledge, awareness, and attitude regarding infection prevention and
control among medical students: a call for educational intervention.

Ibrahim AA1, Elshafie SS2.

1Department of Physiology and Biophysics, Weill Cornell Medical College in
Qatar.
2Aspetar, Laboratory Department, Qatar Orthopedic and Sports Medicine
Hospital, Doha, Qatar.

BACKGROUND: Medical students can be exposed to serious health care-
associated infections, if they are not following infection prevention and
control (IPC) measures. There is limited information regarding the
knowledge, awareness, and practices of medical students regarding IPC and
the educational approaches used to teach them these practices.

AIM: To evaluate the knowledge, awareness, and attitude of medical
students toward IPC guidelines, and the learning approaches to help
improve their knowledge.

METHODS: A cross-sectional, interview-based survey included 73 medical
students from Weill Cornell Medical College, Qatar. Students completed a
questionnaire concerning awareness, knowledge, and attitude regarding IPC
practices. Students’ knowledge was assessed by their correct answers to
the survey questions.

FINDINGS: A total of 48.44% of the respondents were aware of standard
isolation precautions, 61.90% were satisfied with their training in IPC,
66.13% were exposed to hand hygiene training, while 85.48% had sufficient
knowledge about hand hygiene and practiced it on a routine basis, but only
33.87% knew the duration of the hand hygiene procedure.

CONCLUSION: Knowledge, attitude, and awareness of IPC measures among Weill
Cornell Medical Students in Qatar were found to be inadequate.
Multifaceted training programs may have to target newly graduated medical
practitioners or the training has to be included in the graduate medical
curriculum to enable them to adopt and adhere to IPC guidelines.

KEYWORDS: education; infection prevention; medical students
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Developing a policy to empower informal carers to administer
subcutaneous medication in community palliative care; a feasibility
project
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27568776

Int J Palliat Nurs. 2016 Aug;22(8):369-78.
Developing a policy to empower informal carers to administer subcutaneous
medication in community palliative care; a feasibility project.

Lee L1, Howard K2, Wilkinson L3, Kern C4, Hall S5.

1Specialist Nurse Practitioner, St Barnabas Lincolnshire Hospice,
Lincolnshire UK.
2Community Macmillan Clinical Nurse Specialist, Lincolnshire Community
Health Services, Boston, UK.
3Senior Macmillan Clinical Nurse Specialist, Lincolnshire Community Health
Services, Lincoln UK.
4Community Macmillan Clinical Nurse Specialist, Lincolnshire Community
Health Services, Grantham UK.
5Case Manager, Lincolnshire Community Health Services, Lincoln UK.

BACKGROUND: This article describes the development and implementation of a
policy to support community professionals to train informal carers to
give, ‘as required ‘, subcutaneous medications to their relative. In a
rural county, Lincolnshire, despite out of hours responsive services,
patients could wait up to one hour for subcutaneous medications.
Additionally there were increasing requests from carers to participate in
this role.

AIM: To provide a safe and effective framework via a robust policy to
support informal carers to give, as required, subcutaneous medications in
today’s health-care environment.

METHODS: A group of professionals working in adult community palliative
care formed a working party to scope the literature and existing policies,
and to consider risks, legalities and local infrastructure. The policy was
developed and based on available literature. A consultation process on the
policy was commenced before a series of educational workshops supported
its roll out.

RESULTS: The small number of informal carers (n=5) who undertook this role
reported positive experiences and felt empowered. Professionals found the
policy was able to be implemented quickly and was adhered to.

CONCLUSION: From the small numbers audited it could be suggested that if
the process is well managed and the informal carers feel supported they
can safely and effectively administer subcutaneous injections in community
palliative care. More importantly, if a policy is available, staff can
respond to requests from carers in a timely manner.

KEYWORDS: Community palliative care; Empowering carers; Informal carers;
Policy; Subcutaneous medication; Symptom control.
__________________________________________________________________
________________________________*_________________________________

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

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

AIDS Res Hum Retroviruses. 2016 Jul 12. [Epub ahead of print]
Recovering infectious HIV from novel syringe-needle combinations with low
dead space volumes.

Abdala N1, Patel A2, Heimer R3.

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

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

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

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

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

7. Abstract: Historical trends in the hepatitis C virus epidemics in North
America and Australia
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27571901

J Infect Dis. 2016 Aug 28. pii: jiw389.
Historical trends in the hepatitis C virus epidemics in North America and
Australia.

Rodrigo C1, Eltahla AA1, Bull RA1, Grebely J2, Dore GJ2, Applegate T2,
Page K3, Bruneau J4, Morris MD5, Cox AL6, Osburn W6, Kim AY7, Schinkel J8,
Shoukry NH4, Lauer GM7, Maher L2, Hellard M9, Prins M10, Estes C11, Razavi
H11, Lloyd AR1, Luciani F1; InC3 Study Group.

1School of Medical Sciences, Faculty of Medicine, UNSW Australia, Sydney,
NSW, Australia.
2The Kirby Institute, UNSW Australia, Sydney, NSW, Australia.
3University of New Mexico, Albuquerque, New Mexico, USA.
4CRCHUM, Université de Montréal, Montreal, QC, Canada.
5Department of Epidemiology and Biostatistics, University of California,
San Francisco, San Francisco, CA, USA.
6Department of Medicine, Johns Hopkins Medical Institutions, Baltimore,
MD, USA.
7Harvard Medical School, Boston, MA, USA.
8Department of Internal Medicine, Division of Infectious Diseases,
Tropical Medicine and AIDS, Center for Infection and Immunity Amsterdam,
Academic Medical Center, Meibergdreef, Amsterdam, The Netherlands.
9Burnet Institute, Melbourne, VIC, Australia.
10Department of Internal Medicine, Division of Infectious Diseases,
Tropical Medicine and AIDS, Center for Infection and Immunity Amsterdam,
Academic Medical Center, Meibergdreef, Amsterdam, The Netherlands GGD
Public Health Service of Amsterdam, Amsterdam, The Netherlands.
11Center for Disease Analysis, Louisville, CO, USA.

BACKGROUND: Bayesian evolutionary analysis (coalescent analysis) based on
genetic sequences has been used to describe the origins and spread of
rapidly mutating RNA viruses such as Influenza, Ebola, HIV and hepatitis C
virus (HCV).

METHODS: Full length subtype 1a and 3a sequences from early HCV infections
from the International Collaborative of Incident HIV and Hepatitis C in
Injecting Cohorts (InC3), as well as from public databases from a time
window of 1977 – 2012, were used in a coalescent analysis with BEAST
software to estimate the origin and progression of the HCV epidemic in
Australia and North America. Convergent temporal trends were sought via
independent epidemiological modelling.

RESULTS: The epidemic of subtype 3a had more recent origins (around 1950)
than subtype 1a (around 1920) in both continents. In both modelling
approaches and in both continents, the epidemics underwent exponential
growth between 1955 and 1975, which then stabilized in the late 20th
century.

CONCLUSIONS: Historical events that fuelled the emergence and spread of
injecting drug use, such as the advent of intravenous medical therapies
and devices, and growth in the heroin trade, as well as population mixing
during armed conflicts, are likely drivers for the cross-continental
spread of the HCV epidemics.

© The Author 2016. Published by Oxford University Press for the Infectious
Diseases Society of America.
__________________________________________________________________
________________________________*_________________________________

8. Abstract: A Novel Option for Prandial Insulin Therapy: Inhaled Insulin
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27580306

Postgrad Med. 2016 Aug 31.
A Novel Option for Prandial Insulin Therapy: Inhaled Insulin.

Dailey G1, Ahmad A2, Polsky S3, Shah V4.

1a 10666 N Torrey Pines Rd MC 212A, La Jolla , California A 92037 , United
States.
2b Scripps Whittier Diabetes Institute , San Diego , California , United
States.
3c Barbara Davis Center for Diabetes , 1775 Aurora Court Mailstop A140,
Aurora , Colorado 80045 , United States.
4d Barbara Davis Center for Childhood Diabetes , Denver , Colorado ,
United States.

Many adults with type 2 diabetes (T2D) do not achieve or maintain glycemic
targets on oral antidiabetes drugs (OADs) alone and require insulin
therapy. Although initiating basal insulin is common when treatment needs
to be intensified, individualization of therapy (in line with current
guidelines) may lead more health care professionals (HCPs) to add rapid-
acting insulin (RAI) to OAD regimens for treatment of postprandial
hyperglycemia to achieve glycated hemoglobin (A1C) targets.

HCPs and patients are concerned about the burden associated with
injections. Inhaled Technosphere® insulin (inhaled TI) – as an alternative
to injectable bolus doses of prandial insulin – may increase patient and
HCP willingness to intensify therapy and improve compliance with more
complex regimens. Clinical studies have shown that inhaled TI is effective
and well tolerated as a prandial insulin, and has the potential to improve
treatment satisfaction and quality of life in adults with T2D.

The favorable pharmacokinetic profile of inhaled TI (i.e., a very rapid
onset of action and a short duration of anti-hyperglycemic effect) may
reduce the risk of insulin stacking (overlapping effects of RAI injections
taken < 4 hours apart) and postprandial hypoglycemia.

In this review, we present inhaled TI as an alternative to OADs or
injected insulin as adjunctive therapy, for consideration by HCPs striving
to achieve glycemic targets for their patients.

KEYWORDS: hypoglycemia; inhaled insulin; oral antidiabetes drugs; prandial
insulin; type 2 diabetes
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Monitoring harm reduction in European prisons via the Dublin
Declaration
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/25757526

Int J Prison Health. 2009;5(4):251-5.
Monitoring harm reduction in European prisons via the Dublin Declaration.

Lines R1, Stöver H, Donochoe MC, Lazarus JV.

1International Harm Reduction Association, London, UK.

The Dublin Declaration on Partnership to fight HIV/AIDS in Europe and
Central Asia is the key policy document on HIV/AIDS in the European Region
as a whole Among the Declaration’s 33 actions for governments are many
that apply to prison populations.

Based upon an analysis of these commitments, and a review of the current
status of states in meeting those targets, it is clear that the scale-up
of HIV/AIDS prevention and treatment programmes and services in prisons
lags far behind what is needed, what is available outside of prisons, and
what is mandated within the Declaration itself.

KEYWORDS: Dublin Declaration; Europe; HIV/AIDS; Methadone; Syringe
exchange
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Acceptance of multiple injectable vaccines in a single
immunization visit in The Gambia pre and post introduction of
inactivated polio vaccine
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27570237

Vaccine. 2016 Aug 25. pii: S0264-410X(16)30604-1.
Acceptance of multiple injectable vaccines in a single immunization visit
in The Gambia pre and post introduction of inactivated polio vaccine.

Idoko OT1, Hampton LM2, Mboizi RB3, Agbla SC3, Wallace AS2, Harris JB2,
Sowe D4, Ehlman DC2, Kampmann B5, Ota MO6, Hyde TB2.
Author information
1Vaccines and Immunity Theme, Medical Research Council Unit, Gambia.
Electronic address: bukkyidoko@gmail.com.
2Global Immunization Division, Centres for Disease Control and Prevention,
Atlanta, USA.
3Vaccines and Immunity Theme, Medical Research Council Unit, Gambia.
4Ministry of Health and Social Welfare, Banjul, Gambia.
5Vaccines and Immunity Theme, Medical Research Council Unit, Gambia;
Academic Department of Paediatrics, Imperial College London, UK.
6WHO Regional Office for Africa, Brazaville, Congo.

BACKGROUND: As the World Health Organization (WHO) currently recommends
that children be protected against 11 different pathogens, it is becoming
increasingly necessary to administer multiple injectable vaccines during a
single immunization visit. In this study we assess Gambian healthcare
providers’ and infant caregivers’ attitudes and practices related to the
administration of multiple injectable vaccines to a child at a single
immunization visit before and after the 2015 introduction of inactivated
polio vaccine (IPV). IPV introduction increased the number of injectable
vaccines recommended for the 4-month immunization visit from two to three
in The Gambia.

METHODS: We conducted a cross-sectional questionnaire-based survey before
and after the introduction of IPV at 4months of age in a representative
sample of all health facilities providing immunizations in The Gambia.
Healthcare providers who administer vaccines at the selected health
facilities and caregivers who brought infants for their 4month
immunization visit were surveyed.

FINDINGS: Prior to IPV introduction, 9.9% of healthcare providers and
35.7% of infant caregivers expressed concern about a child receiving more
than 2 injections in a single visit. Nevertheless, 98.8% and 90.9% of
infants received all required vaccinations for the visit before and after
IPV introduction, respectively. The only reason why vaccines were not
received was vaccine stock-outs. Infant caregivers generally agreed that
vaccinators could be trusted to provide accurate information regarding the
number of vaccines that a child needed.

CONCLUSION: Healthcare providers and infant caregivers in this resource
limited setting accepted an increase in the number of injectable vaccines
administered at a single visit even though some expressed concerns about
the increase.

Published by Elsevier Ltd.

KEYWORDS: Acceptance; Caregivers; Healthcare providers; Multiple
injectable vaccines; Single visit; The Gambia
__________________________________________________________________
________________________________*_________________________________

11. Abstract: Assessing the global threat from Zika virus
__________________________________________________________________

http://science.sciencemag.org/content/353/6300/aaf8160.full

Science. 2016 Aug 12;353(6300):aaf8160. Free Full Article
Assessing the global threat from Zika virus.

Lessler J1, Chaisson LH2, Kucirka LM3, Bi Q2, Grantz K4, Salje H5,
Carcelen AC6, Ott CT2, Sheffield JS7, Ferguson NM8, Cummings DA4, Metcalf
CJ9, Rodriguez-Barraquer I2.

1Department of Epidemiology, Johns Hopkins Bloomberg School of Public
Health, Baltimore, MD, USA. justin@jhu.edu.
2Department of Epidemiology, Johns Hopkins Bloomberg School of Public
Health, Baltimore, MD, USA.
3Department of Epidemiology, Johns Hopkins Bloomberg School of Public
Health, Baltimore, MD, USA. Department of Surgery, Johns Hopkins
University School of Medicine, Baltimore, MD, USA.
4Department of Biology, Emerging Pathogens Institute, University of
Florida, Gainesville, FL, USA.
5Department of Epidemiology, Johns Hopkins Bloomberg School of Public
Health, Baltimore, MD, USA. Mathematical Modelling of Infectious Diseases
Unit, Institut Pasteur, Paris, France.
6Department of International Health, Johns Hopkins Bloomberg School of
Public Health, Baltimore, MD, USA.
7Department of Gynecology and Obstetrics, Johns Hopkins University School
of Medicine, Baltimore, MD, USA.
8Department of Medicine, School of Public Health, Imperial College London,
London, UK.
9Department of Ecology and Evolutionary Biology, Princeton University,
Princeton, NJ, USA. Office of Population Research, Princeton University,
Princeton, NJ, USA.

First discovered in 1947, Zika virus (ZIKV) infection remained a little-
known tropical disease until 2015, when its apparent association with a
considerable increase in the incidence of microcephaly in Brazil raised
alarms worldwide.

There is limited information on the key factors that determine the extent
of the global threat from ZIKV infection and resulting complications.

Here, we review what is known about the epidemiology, natural history, and
public health effects of ZIKV infection, the empirical basis for this
knowledge, and the critical knowledge gaps that need to be filled.

Copyright © 2016, American Association for the Advancement of Science.
__________________________________________________________________
________________________________*_________________________________

12. No Abstract: APIC publishes updated Professional and Practice
Standards for infection preventionists
__________________________________________________________________

http://www.ajicjournal.org/article/S0196-6553(16)30642-3/fulltext

Am J Infect Control. 2016 Sep 1;44(9):963. Free Full Text
APIC publishes updated Professional and Practice Standards for infection
preventionists.

[No authors listed]
__________________________________________________________________
________________________________*_________________________________

13. News

– North Carolina USA: Editorial: Raleigh ‘Safe syringe’ idea worthy of
support

– UK: Faversham: Boy, three, falls on to needle in play park

– USA: Politics Are Tricky but Science Is Clear: Needle Exchanges Work

– Pakistan: Congo fever: Precautions urged while handling sacrificial
animals

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

http://www.newsobserver.com/opinion/editorials/article100253847.html
North Carolina USA: Editorial: Raleigh ‘Safe syringe’ idea worthy of
support

News & Observer, By The Board, Raleigh North Carolina USA (06.09.16)

Photo: Registered Nurse Carol Simmons prepares a bag of sterile IV
injection supplies – including syringes, alcohol swabs and sterile water –
for Krista Spears, a patient at a needle exchange program in Huntington,
West Virginia. Huntington has adopted a model intervention program to try
to prevent drug overdoses. Pew Charitable Trusts TNS

Advocates of “safe syringe” programs in which people can exchange old
needles for new ones or just get new needles are hardly pandering to
addicts or encouraging them. Rather, such programs – a coalition will open
a program in Raleigh next week – recognize the public health threat that
dirty needles pose in spreading HIV or hepatitis. And police officers, who
can be stuck by dirty needles in the course of their work, can benefit as
well.

In addition to the needles, the program also will offer material on
services for addicts and on overdose rescue.

The problem with this program, in which the coalition will partner with
Sigma Health Services in Wake County, is that a state law setting out
guidelines included a prohibition against using public money to buy clean
needles. This is shortsighted and a serious problem. In addition, the
money for such purchases would likely be insignificant.

Again, this is a public health issue. It’s not encouraging drug use. In
time, it might help curb HIV and hepatitis. Medical professionals see the
wisdom in it, and Wake County’s public health units ought to be able to
participate, pending a change in the flaws in the state law.
__________________________________________________________________
__________________________________________________________________

www.kentonline.co.uk/faversham/news/boy-three-falls-onto-needle-102021/
UK: Faversham: Boy, three, falls on to needle in play park

by Bess Browning, Kent Online, Kent UK (06.09.16)

A three-year-old boy fell onto a needle in a children’s play area and has
been tested for HIV and Hepatitis B.

His devastated mother, who does not wish to be named, has told of the
horrifying moment she found a syringe sticking out of her son’s hand after
he tripped and fell at a popular park in Lower Road, Faversham, used by
hundreds of kids every week.

He was taken to the William Harvey Hospital after the incident on Sunday,
where they were told he needed tests for HIV and Hepatitis B and now faces
six months of treatment.

His mum said: “It was the last day of the summer holidays so I wanted to
take the children out for the day and we decided to go to the park.

“It all happened so quickly but they were just playing and my son let out
a scream. I ran over and he had a needle sticking out of his left hand.

“I couldn’t believe it and did not know what to do.

“What sick and twisted individual would leave a needle laying around in a
children’s play area?

“What sick and twisted individual would leave a needle laying around in a
children’s play area?”

“I am angry and upset but I don’t know how to feel really. I feel numb and
can’t believe that this has happened in my home town.

“The council says they are going to increase their patrols but only until
the end of September and I’m not sure what difference this will make.

“I just want to warn other parents about this incident so that they can
check parks before their children play there.”

A council spokesman said: “We have been in contact with the parent of the
child and have started an accident investigation.

“We are deeply concerned and disappointed at the thoughtlessness of anyone
who would leave such an article in a children’s play area.

“All of our play areas are regularly inspected for safety by our
environment wardens and litter picked by our grounds maintenance
contractor Blenwood.

“We have made our environment wardens and the Swale Community Safety Unit
aware of the issue, and urge anyone who may come across discarded needles
to report it to us straight away so we can remove them safely.”
__________________________________________________________________
__________________________________________________________________

https://tinyurl.com/gvqcc73
USA: Politics Are Tricky but Science Is Clear: Needle Exchanges Work

By Austin Frakt, The New York Times, NY NY USA (05.09.16)

For decades, public health experts have known that syringe exchange
programs reduce the spread of certain viral infections — like H.I.V.,
hepatitis B and hepatitis C — by removing contaminated syringes from
circulation.

[Photo Restocking the needle exchange mobile unit at the Scott County
Health Department Needle Exchange Program in Austin, Ind. Credit Aaron
Borton for The New York Times]

They have known that programs using sterile injection equipment are both
safe and save money.

And yet they are rarely seen in the United States.

Evidence abounds that they work. A study of the first American program —
started in the Tacoma, Wash., area in 1988 — found that use of the
exchange was associated with a greater than 60 percent reduction in the
risk of contracting hepatitis B or C. Another study of over 1,600
injection drug users in New York found that those who didn’t use a syringe
exchange in the early 1990s were more than three times as likely to
contract H.I.V.

Syringe exchange programs do more than improve health. Because they are so
effective and far cheaper than the lifetime cost of treating H.I.V.,
hepatitis B or hepatitis C, they save taxpayers money. A cost-
effectiveness analysis published in 2014 replicated the findings of others
that came before it: A dollar invested in syringe exchange programs saves
at least six dollars in avoided costs associated with H.I.V. alone.

The most frequently expressed concerns about the programs are that they
promote drug use and raise crime levels. But according to many studies,
that isn’t so. Instead, they are associated with increased participation
in treatment programs.

Syringe exchange programs “reduce not only infectious disease but also
create an opportunity for people to get the care and provide a transition
into treatment for people in the community,” said Michael Botticelli,
director of the federal Office of National Drug Control Policy, at an
event sponsored by the Chamber of Commerce of northern Kentucky, a region
hit hard by illegal drug use.

In the 1990s and early 2000s, seven evidence reviews for federal
government agencies reaffirmed that syringe exchanges were effective, safe
and cost-effective. Since then, numerous other studies of programs have
replicated these results, including a systematic review by the World
Health Organization and another by the United Nations. These include
examination of exchange programs outside the United States, such as those
in Canada and Australia.

Syringe exchanges are endorsed by the 2015 National H.I.V./AIDS Strategy
for the United States and the 2012 President’s Emergency Plan for AIDS
Relief Blueprint. The American Medical Association says they work.

With all this evidence and the official endorsements, you’d think the
government would generously fund syringe exchanges. But just as the first
program opened in 1988, Congress prohibited federal funding for any such
programs. With the exception of a few years, that moratorium held until
this year. Though federal funds may now be used to support syringe
exchanges, they still may not be used to buy injection equipment.

Although most states and local governments limit or prohibit syringe
exchange programs, some restrictions have been lifted, offering additional
opportunities to study their effects. For example, in 2008, the District
of Columbia’s syringe exchange funding ban was lifted, and several
programs began offering harm reduction and exchange services. One study
found that the funding ban’s lift was associated with a 70 percent drop in
new H.I.V. cases tied to injection drug use.

“Policies that limit syringe access are not in the best interest of public
health,” said Sean Allen, an infectious disease and public health
researcher at Johns Hopkins University and a co-author of the study.
“Syringe services programs can prevent new H.I.V. infections, but they
need to be accessible to work.”

Today, injection drug use — notably, of heroin — is on the rise and has
led to outbreaks of H.I.V. in some communities. In response, some leaders,
like Gov. Mike Pence of Indiana, the Republican vice-presidential nominee,
have reversed course and embraced the programs.

Today, only about 200 syringe exchange programs are operating in 33
states. In many areas where they could do a lot of good, resistance to
them remains strong.

Austin Frakt is a health economist with several governmental and academic
affiliations. He blogs at The Incidental Economist, and you can follow him
on Twitter at @afrakt.
__________________________________________________________________
__________________________________________________________________

https://tinyurl.com/jzbp99g
Pakistan: Congo fever: Precautions urged while handling sacrificial
animals

By Imran Adnan, Ali Ousat, The Express Tribune, Punjab Pakistan
(02.09.16)

University of Veterinary and Animals Sciences Vice Chancellor Talat Pasha
said the Livestock Department, which oversees the UVAS, was doing its best
to prevent a Congo virus epidemic ahead of Eidul Azha. PHOTO: ONLINE
University of Veterinary and Animals Sciences Vice Chancellor Talat Pasha
said the Livestock Department, which oversees the UVAS, was doing its best
to prevent a Congo virus epidemic ahead of Eidul Azha. PHOTO: ONLINE
RAWALPINDI / LAHORE / LAHORE: “People should be cautious about Congo virus
even if their animals appear to be healthy. Using a spray or removing
ticks from an infected animal might not be enough,” Bahalwalpur Rescue
1122 District Emergency Officer Asif Channar said on Thursday.

Speaking to The Express Tribune via phone, he advised people to use
protective equipment such as gloves and masks while handling sacrificial
animals.

He said people could get infected with Crimean-Congo Hemorrhagic Fever
virus on being bitten by infected ticks or squashing these. He said a
human could be infected if blood or a tissue from an infected animal came
into contact with his cuts, grazed on the skin, or was splashed onto his
eyes, nose or mouth.

Channar said most people were not aware of the hazard of being bitten by
ticks. Ticks have been found in scalp and between toes of Congo fever
patients.

Dr Alam Khan, a Congo fever patient at Karachi’s Aga Khan Hospital, said
laboratory tests had earlier diagnosed dengue fever only. “I came to Aga
Khan Hospital where they immediately took me to an isolation ward,” he
said. “It is unfortunate that some labs are not following standard
procedures… these are unable to diagnose Congo fever virus,” he said.

Medical reports of Khan, acquired by The Express Tribune, confirmed that
he had earlier been diagnosed with dengue fever. He said the government
had been unable to locate the virus’s origin. “Millions of sacrificial
animals have already been brought to cities,” he said.

The virus

The virus is transmitted mainly by Hyalomma ticks which have distinctive
brown and white bands on their legs. These are known in South Africa as
bont-legged ticks (Afrikaans: bontpootbosluise). The virus can remain in
the ticks for long periods, and even pass through the eggs to infect the
next generation of ticks.

Cattle and ostriches bitten by infected ticks do not develop disease, but
virus can circulate in their blood for up to a week, after which they
become immune to further infection. Non-infected ticks become infected if
they feed on animals during this period.

At risk

Occupational groups such as herders, farmers, abattoir workers,
veterinarians, animal health workers, hunters and persons informally
slaughtering domestic or wild animals are at higher risk of infection.
They often have exposure to ticks on the animals and in the animal
environment, and also often have exposure to animal blood, tissues (for
example during castration of calves, vaccination, notching or tagging of
ears and slaughtering etc).

**** Healthcare workers attending to people suffering from Congo fever are
also at risk of infection from needle-stick and splash exposures. There
have been several instances of secondary spread of infection from patients
to healthcare workers in Pakistan. This can occur through contact of
broken skin, mucous membranes with blood or blood-tinged body fluids and
wastes of a Congo fever patient, or via needle-stick injuries.

University of Veterinary and Animals Sciences Vice Chancellor Talat Pasha
said the Livestock Department, which oversees the UVAS, was doing its best
to prevent a Congo virus epidemic ahead of Eidul Azha. He said camps had
been set up at city entrances and animals markets to vaccinate sacrificial
animals against the virus. “People should not panic. They should wear
mask and gloves while slaughtering animals,” he said.

Communicable Diseases Director Asim Altaf said the government had set up
isolation wards at all public hospitals.

Published in The Express Tribune, September 2nd, 2016.
__________________________________________________________________
________________________________*_________________________________

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
__________________________________________________________________

Comments are closed.