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SIGNpost 00870

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST

Post00870 Waste Handlers + Diabetes + Abstracts + News  14 September 2016

CONTENTS
0. Moderators Note
1. Abstract: Comparison of awareness about precautions for needle stick
injuries: a survey among health care workers at a tertiary care center
in Pakistan
2. Abstract: Occupational Exposure to Infection: A study on Healthcare
Waste Handlers of a Tertiary Care Hospital in South India
3. Abstract: Worldwide Injection Technique Questionnaire Study: Population
Parameters and Injection Practices
4. Abstract: New Insulin Delivery Recommendations
5. Abstract: Examining Factors That Impact Inpatient Management of
Diabetes and the Role of Insulin Pen Devices
6. Abstract: Cross-cultural adaptation of an environmental health
measurement instrument: Brazilian version of the health-care waste
management • rapid assessment tool
7. Abstract: Hepatitis C Virus
8. Abstract: The Prison Economy of Needles and Syringes: What
Opportunities Exist for Blood Borne Virus Risk Reduction When Prices
Are so High?
9. Abstract: HIV/AIDS-related knowledge awareness and risk behaviors among
injection drug users in Maanshan, China: a cross-sectional study
10. Abstract: Recovering infectious HIV from novel syringe-needle
combinations with low dead space volumes
11. Abstract: A Randomized Trial Comparing the Pharmacokinetics, Safety,
and Tolerability of DFN-02, an Intranasal Sumatriptan Spray Containing
a Permeation Enhancer, With Intranasal and Subcutaneous Sumatriptan in
Healthy Adults
12. Abstract: Healthcare Personnel Attire and Devices as Fomites: A
Systematic Review
13. News
– USA: Garrison Wins $4.6M in Lawsuit Over Needle Stick at Target
– Nigeria: LASSA: 154 Dead, 24 States record cases
– USA: EDITORIAL: Give Addicts Somewhere To Put Their Waste

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Item 10. Abstract: Recovering infectious HIV from novel syringe-needle
combinations with low dead space volumes
__________________________________________________________________
________________________________*_________________________________

1. Abstract: Comparison of awareness about precautions for needle stick
injuries: a survey among health care workers at a tertiary care center
in Pakistan
__________________________________________________________________

Free PMC Article https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5015332/

Patient Saf Surg. 2016 Sep 7;10(1):19.
Comparison of awareness about precautions for needle stick injuries: a
survey among health care workers at a tertiary care center in Pakistan.

Qazi AR1, Siddiqui FA1, Faridi S1, Nadeem U2, Umer NI2, Mohsini ZS2, Edhi
MM2, Khan M3.

1Department of General Surgery, Liaquat National Hospital and Medical
College, Karachi, Pakistan.
2Liaquat National Hospital and Medical College, Karachi, Pakistan.
3Dhaka Medical College, Karachi, Pakistan.

BACKGROUND: Needle stick injuries (NSIs) have the potential of causing
Hepatitis B and Hepatitis C, which is constantly adding to the burden of
chronic liver disease in our country. It poses a risk to Health Care
Workers (HCWs) and the patients they deal with. In order to limit the
spread of these viruses, it is imperative that these HCWs be fully
equipped with knowledge regarding prevention of NSIs and dealing with one,
regardless of their designation. We therefore aimed to assess and compare
the level of awareness about precautions for needle stick injuries amongst
all those greatest at risk.

METHODS: This was a cross- sectional study carried out at Liaquat National
Hospital, Karachi, Pakistan. A 23 itemed self-administered questionnaire
was given to hospital staff including doctors, lab technicians and nurses
via convenience sampling, in various departments. Data was analyzed via
SPSS 18 software and a p-value of <0.05 was considered significant.

RESULTS: A total of 198 responses were taken for this study, out of which
70 (35.4 %) were doctors, 70 (35.4 %) nursing staff and 58 (29.3 %)
laboratory technicians. Of all HCWs, 101 (51 %) knew that the standard
method of discarding needles is without recapping. 159 (80.3 %) were still
recapping needles. 180 (90.9 %) HCWs were vaccinated against Hepatitis B.
36 (18.2 %) were aware that blood should be allowed to flow after an NSI
and site of prick should be washed with an antiseptic.

CONCLUSION: The awareness was found to be very low amongst all HCWs. It
should therefore be made compulsory for all HCWs to attend proper
preparatory classes by the infection control department at the time of
employment in order to improve the level of awareness and ensure safe
practices.

KEYWORDS: Awareness; Doctors; Health care workers; Laboratory technicians;
Needle stick injuries; Nursing staff

Free PMC Article https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5015332/
__________________________________________________________________
________________________________*_________________________________

2. Abstract: Occupational Exposure to Infection: A study on Healthcare
Waste Handlers of a Tertiary Care Hospital in South India
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27608779

J Assoc Physicians India. 2015 Nov;63(11):24-7.
Occupational Exposure to Infection: A study on Healthcare Waste Handlers
of a Tertiary Care Hospital in South India.

Shivalli S1, Sowmyashree H2.

1Assistant Professor.
2Pre Final Year MBBS Student, Community Medicine, Yenepoya Medical
College, Yenepoya University , Mangalore, Karnataka.

INTRODUCTION: Occupational exposure to infection is an important public
health concern. Such accidents are associated with a few, but pose
significant risk to worker’s health, family and the community.

OBJECTIVE: 1) To assess the knowledge and attitude of waste handlers
regarding healthcare waste management in tertiary care hospital of
Mangalore. 2) To assess the occupational risk of exposure to infection in
their work setting.

METHOD: A cross-sectional study was conducted among healthcare waste
handlers (involved in collection, storage and safe disposal) in a tertiary
care hospital of Mangalore, India. A semi-structured and pre-tested
proforma was used to assess respondents’ knowledge and percentage score
was calculated based on a scoring system. Chi square and independent
sample t tests were applied to judge the association of study variables
with knowledge and occupational risk of infection.

RESULTS: A total of 43 healthcare waste handlers participated in the study
and all were females. Almost half of them had poor knowledge (< 50% score)
about healthcare waste management.

As much as 41.8% of them had exposure to healthcare waste and ‘needle
stick injury’ was the most common type. Age, literacy and experience did
not significantly (p>0.05) influence the knowledge and occupational risk
of infection.

CONCLUSIONS: Respondents’ knowledge regarding healthcare waste management
was unsatisfactory. They were at high risk of occupational exposure to
infection. It emphasizes the need of refresher training and reinforcement
of personal protection measures in their work setting.

© Journal of the Association of Physicians of India 2011.
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Worldwide Injection Technique Questionnaire Study: Population
Parameters and Injection Practices
__________________________________________________________________

https://dx.doi.org/10.1016/j.mayocp.2016.06.011 Open Access

Mayo Clin Proc. 2016 Sep;91(9):1212-23. Free full text
Worldwide Injection Technique Questionnaire Study: Population Parameters
and Injection Practices.

Frid AH1, Hirsch LJ2, Menchior AR3, Morel DR4, Strauss KW5.

1Department of Endocrinology, Skane University Hospital, Malmö, Sweden.
2BD Diabetes Care, Franklin Lakes, NJ.
3University of Liege, Liege, Belgium.
4BD, Le Pont de Claix, France.
5BD Diabetes Care, Erembodegem, Belgium. Electronic address:
kenneth_strauss@europe.bd.com.

From February 1, 2014, through June 30, 2015, 13,289 insulin-injecting
patients from 423 centers in 42 countries took part in one of the largest
surveys ever performed in diabetes.

The goal was to assess patient characteristics, as well as historical and
practical aspects of their injection technique.

Results show that 4- and 8-mm needle lengths are each used by nearly 30%
of patients and 5- and 6-mm needles each by approximately 20%.

Higher consumption of insulin (as measured by total daily dose) is
associated with having lipohypertrophy (LH), injecting into LH, leakage
from the injection site, and failing to reconstitute cloudy insulin.

Glycated hemoglobin values are, on average, 0.5% higher in patients with
LH and are significantly higher with incorrect rotation of sites and with
needle reuse.

Glycated hemoglobin values are lower in patients who distribute their
injections over larger injection areas and whose sites are inspected
routinely.

The frequencies of unexpected hypoglycemia and glucose variability are
significantly higher in those with LH, those injecting into LH, those who
incorrectly rotate sites, and those who reuse needles.

Needles associated with diabetes treatment are the most commonly used
medical sharps in the world. However, correct disposal of sharps after use
is critically suboptimal. Many used sharps end up in public trash and
constitute a major accidental needlestick risk.

Use of these data should stimulate renewed interest in and commitment to
optimizing injection practices in patients with diabetes.

Copyright © 2016 Mayo Foundation for Medical Education and Research.
__________________________________________________________________
________________________________*_________________________________

4. Abstract: New Insulin Delivery Recommendations

[Reformatted for readability]
__________________________________________________________________

https://dx.doi.org/10.1016/j.mayocp.2016.06.010 Open Access

Mayo Clin Proc. 2016 Sep;91(9):1231-55. Free full text
New Insulin Delivery Recommendations.

Frid AH1, Kreugel G2, Grassi G3, Halimi S4, Hicks D5, Hirsch LJ6, Smith
MJ7, Wellhoener R8, Bode BW9, Hirsch IB10, Kalra S11, Ji L12, Strauss
KW13.

1Department of Endocrinology, Skane University Hospital, Malmö, Sweden.
2Department of Endocrinology, University of Groningen, University Medical
Center Groningen, Groningen, the Netherlands.
3Città della Salute e della Scienza Torino, Torino, Italy.
4University for Sciences and Medicine Joseph Fourier Grenoble and
Diabetology Department CHU Grenoble, Grenoble Cedex, France.
5Barnet, Enfield & Haringey Mental Health Trust, London, UK.
6BD Diabetes Care, Franklin Lakes, NJ.
7BD Medical.
8Private practice, Kassel, Germany.
9Atlanta Diabetes Associates, Atlanta, GA.
10University of Washington Medical Center-Roosevelt, Seattle.
11Bharti Hospital & B.R.I.D.E., Karnal, India.
12Peking University Peoples Hospital, Beijing, China.
13BD Diabetes Care, Erembodegem, Belgium. Electronic address:
kenneth_strauss@europe.bd.com.

Many primary care professionals manage injection or infusion therapies in
patients with diabetes.

Few published guidelines have been available to help such professionals
and their patients manage these therapies. Herein, we present new,
practical, and comprehensive recommendations for diabetes injections and
infusions.

These recommendations were informed by a large international survey of
current practice and were written and vetted by 183 diabetes experts from
54 countries at the Forum for Injection Technique and Therapy: Expert
Recommendations (FITTER) workshop held in Rome, Italy, in 2015.

Recommendations are organized around the themes of anatomy, physiology,
pathology, psychology, and technology.

Key among the recommendations are that the shortest needles (currently the
4-mm pen and 6-mm syringe needles) are safe, effective, and less painful
and should be the first-line choice in all patient categories;

intramuscular injections should be avoided, especially with long-acting
insulins, because severe hypoglycemia may result;

lipohypertrophy is a frequent complication of therapy that distorts
insulin absorption, and, therefore, injections and infusions should not be
given into these lesions and correct site rotation will help prevent them;

effective long-term therapy with insulin is critically dependent on
addressing psychological hurdles upstream, even before insulin has been
started; inappropriate disposal of used sharps poses a risk of infection
with blood-borne pathogens;

and mitigation is possible with proper training, effective disposal
strategies, and the use of safety devices.

Adherence to these new recommendations should lead to more effective
therapies, improved outcomes, and lower costs for patients with diabetes.

Copyright © 2016 Mayo Foundation for Medical Education and Research.
Published by Elsevier Inc. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Examining Factors That Impact Inpatient Management of
Diabetes and the Role of Insulin Pen Devices
__________________________________________________________________

https://dx.doi.org/10.1016/j.jcjd.2016.07.001 Open Access

Can J Diabetes. 2016 Sep 2. pii: S1499-2671(15)30051-4. Free full text
Examining Factors That Impact Inpatient Management of Diabetes and the
Role of Insulin Pen Devices.

Smallwood C1, Lamarche D2, Chevrier A2.

1Health Economics and Outcomes Research, BD Canada, Mississauga, Ontario,
Canada. Electronic address: chelsea_smallwood@bd.com.
2McGill University Health Centre (Royal Victoria site), Montreal, Quebec,
Canada.

Insulin administration in the acute care setting is an integral component
of inpatient diabetes management. Although some institutions have moved to
insulin pen devices, many acute care settings continue to employ the vial
and syringe method of insulin administration.

The aim of this study was to evaluate the impact of insulin pen
implementation in the acute care setting on patients, healthcare workers
and health resource utilization. A review of published literature,
including guidelines, was conducted to identify how insulin pen devices in
the acute care setting may impact inpatient diabetes management.
Previously published studies have revealed that insulin pen devices have
the potential to improve inpatient management through better glycemic
control, increased adherence and improved self-management education.
Furthermore, insulin pen devices may result in cost savings and improved
safety for healthcare workers.

There are benefits to the use of insulin pen devices in acute care and, as
such, their implementation should be considered.

Copyright © 2016 Becton Dickinson Canada Inc. Published by Elsevier Inc.
All rights reserved.

Keywords: adherence, diabetes, glycemic control, health resource
utilization, inpatient, insulin pen device, needlestick injuries

___________________

Résumé

L’administration d’insuline dans les établissements de soins de courte
durée fait partie intégrante de la prise en charge du diabète en milieu
hospitalier. Bien que certains établissements aient maintenant adopté les
stylos à insuline, plusieurs établissements de soins de courte durée
continuent d’utiliser la fiole ou la seringue comme mode d’administration
de l’insuline. Le but de cette étude était d’évaluer les conséquences de
l’introduction des stylos à insuline dans les établissements de soins de
courte durée sur les patients, les travailleurs de la santé et
l’utilisation des ressources en santé.

Une revue de la littérature existante, dont les lignes directrices, a été
menée pour déterminer de quelle manière les stylos à insuline dans les
établissements de soins de courte durée peuvent avoir des répercussions
sur la prise en charge du diabète en milieu hospitalier. Les études
précédemment publiées ont révélé que les stylos à insuline ont le
potentiel d’améliorer la prise en charge en milieu hospitalier par le
biais d’une meilleure régulation de la glycémie, d’une observance accrue
et d’un meilleur enseignement en matière de prise en charge autonome. De
plus, les stylos à insuline peuvent entraîner des réductions de coûts et
améliorer la sécurité des travailleurs de la santé.

L’utilisation des stylos à insuline comporte des avantages et, de ce fait,
leur introduction devrait être considérée.

Keywords: adherence; blessures par piqûres d’aiguilles; diabetes; diabète;
glycemic control; health resource utilization; inpatient; insulin pen
device; malades hospitalisés/en milieu hospitalier; needlestick injuries;
observance; régulation de la glycémie; stylo à insuline; utilisation des
ressources en santé
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Cross-cultural adaptation of an environmental health
measurement instrument: Brazilian version of the health-care waste
management • rapid assessment tool
__________________________________________________________________

https://dx.doi.org/10.1186/s12889-016-3618-4 Open Access

BMC Public Health. 2016 Sep 5;16:928. Full Free Text
Cross-cultural adaptation of an environmental health measurement
instrument: Brazilian version of the health-care waste management • rapid
assessment tool.

Cozendey-Silva EN1, da Silva CR2, Larentis AL3, Wasserman JC4, Rozemberg
B3, Teixeira LR3.

1Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation,
ENSP/FIOCRUZ, Rua Leopoldo Bulhões 1480, Prédio Primeiro de Maio.
Manguinhos, CEP 21041-210., Rio de Janeiro, RJ, Brazil.
ensilva@ensp.fiocruz.br.
2Municipal Health Foundation of Niteroi, VIPAHE/FMS, Av Ernani do Amaral
Peixoto, 171, Centro-CEP 24020-071., Niterói, RJ, Brazil.
3Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation,
ENSP/FIOCRUZ, Rua Leopoldo Bulhões 1480, Prédio Primeiro de Maio.
Manguinhos, CEP 21041-210., Rio de Janeiro, RJ, Brazil.
4Network of Environment and Sustainable Development (REMADS-UFF),
University Federal Fluminense, Av. Gal. Milton Tavares de Souza, s/n.
Praia Vermelha, CEP 24210-346., Niterói, RJ, Brazil.

BACKGROUND: Periodic assessment is one of the recommendations for
improving health- care waste management worldwide. This study aimed at
translating and adapting the Health-Care Waste Management – Rapid
Assessment Tool (HCWM- RAT), proposed by the World Health Organization, to
a Brazilian Portuguese version, and resolving its cultural and legal
issues. The work focused on the evaluation of the concepts, items and
semantic equivalence between the original tool and the Brazilian
Portuguese version.

METHODS: A cross-cultural adaptation methodology was used, including:
initial translation to Brazilian Portuguese; back translation to English;
syntheses of these translation versions; formation of an expert committee
to achieve consensus about the preliminary version; and evaluation of the
target audience’s comprehension.

RESULTS: Both the translated and the original versions’ concepts, items
and semantic equivalence are presented. The constructs in the original
instrument were considered relevant and applicable to the Brazilian
context. The Brazilian version of the tool has the potential to generate
indicators, develop official database, feedback and subsidize political
decisions at many geographical and organizational levels strengthening the
Monitoring and evaluation (M&E) mechanism. Moreover, the cross-cultural
translation expands the usefulness of the instrument to Portuguese-
speaking countries in developing regions.

CONCLUSION: The translated and original versions presented concept, item
and semantic equivalence and can be applied to Brazil.

KEYWORDS: Cross-cultural comparison; Environmental health; Health care
evaluation; Medical waste; Public policies; Rapid evaluation; Waste
management

Free BMC Article
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Hepatitis C Virus
__________________________________________________________________
https://www.ncbi.nlm.nih.gov/pubmed/27595226

Ann Intern Med. 2016 Sep 6;165(5):ITC33-ITC48. doi: 10.7326/AITC201609060.
Hepatitis C Virus.

Kim A.

This issue provides a clinical overview of hepatitis C virus, focusing on
transmission, prevention, screening, diagnosis, evaluation, and treatment.

The content of In the Clinic is drawn from the clinical information and
education resources of the American College of Physicians (ACP), including
MKSAP (Medical Knowledge and Self-Assessment Program).

Annals of Internal Medicine editors develop In the Clinic in collaboration
with the ACP’s Medical Education and Publishing divisions and with the
assistance of additional science writers and physician writers.
__________________________________________________________________
________________________________*_________________________________

8. Abstract: The Prison Economy of Needles and Syringes: What
Opportunities Exist for Blood Borne Virus Risk Reduction When Prices
Are so High?
__________________________________________________________________

https://dx.doi.org/10.1371/journal.pone.0162399 Open Access

PLoS One. 2016 Sep 9;11(9):e0162399. Free full text
The Prison Economy of Needles and Syringes: What Opportunities Exist for
Blood Borne Virus Risk Reduction When Prices Are so High?

Treloar C1, McCredie L2, Lloyd AR2.

1Centre for Social Research in Health, UNSW Australia, Sydney, Australia.
2Inflammation and Infection Research Centre, School of Medical Sciences,
UNSW Australia, Sydney, Australia.

AIM: A formal Needle and Syringe Program (NSP) is not provided in
Australian prisons. Injecting equipment circulates in prisons as part of
an informal and illegal economy. This paper examined how this economy
generates blood- borne virus (BBV) risk and risk mitigation opportunities
for inmates.

METHOD: The HITS-p cohort recruited New South Wales inmates who had
reported ever injecting drugs and who had a negative HCV serological test
within 12 months prior to enrolment. For this study, qualitative
interviews were conducted with 30 participants enrolled in HITS-p.
Participants included 10 women and were incarcerated in 12 prisons.

RESULTS: A needle/syringe was nominated as being typically priced in the
‘inside’ prison economy at $100-$150, with a range of $50-$350. Purchase
or hire of equipment was paid for in cash (including transactions that
occurred outside prison) and in exchange for drugs and other commodities.

A range of other resources was required to enable successful needle/
syringe economies, especially relationships with visitors and other
prisoners, and violence to ensure payment of debts.

Strategies to mitigate BBV risk included retaining one needle/syringe for
personal use while hiring out others, keeping drug use (and ownership of
equipment) “quiet”, stealing used equipment from the prison health clinic,
and manufacture of syringes from other items available in the prison.

CONCLUSIONS: The provision of prison NSP would disrupt the inside
economies built around contraband needles/syringes, as well as minimise
BBV risk.

However, any model of prison NSP should be interrogated for any
unanticipated markets that could be generated as a result of its
regulatory practices.
__________________________________________________________________
________________________________*_________________________________

9. Abstract: HIV/AIDS-related knowledge awareness and risk behaviors among
injection drug users in Maanshan, China: a cross-sectional study
__________________________________________________________________

Free BMC Article https://dx.doi.org/10.1186/s12889-016-2786-6

BMC Public Health. 2016 Feb 1;16:97.
HIV/AIDS-related knowledge awareness and risk behaviors among injection
drug users in Maanshan, China: a cross-sectional study.

Chen B1, Zhu Y2, Guo R3, Ding S4, Zhang Z5, Cai H6, Zhu H7, Wen Y8.

1School of Public Health, Wannan Medical College, 22 West Wenchang Road,
Wuhu, Anhui Province, 241002, China. chenbf1980@163.com.
2School of Public Health, Wannan Medical College, 22 West Wenchang Road,
Wuhu, Anhui Province, 241002, China. kutuomonk@foxmail.com.
3School of Public Health, Wannan Medical College, 22 West Wenchang Road,
Wuhu, Anhui Province, 241002, China. guorui0710075@126.com.
4School of Public Health, Wannan Medical College, 22 West Wenchang Road,
Wuhu, Anhui Province, 241002, China. dss522@126.com.
5Centre for Disease Control of Maanshan City, 849 Jiangdong Dadao,
Maanshan, Anhui Province, 241000, China. 962847809@qq.com.
6Centre for Disease Control of Maanshan City, 849 Jiangdong Dadao,
Maanshan, Anhui Province, 241000, China. mascdc3836@163.com.
7Centre for Disease Control of Maanshan City, 849 Jiangdong Dadao,
Maanshan, Anhui Province, 241000, China. 842032683@qq.com.
8School of Public Health, Wannan Medical College, 22 West Wenchang Road,
Wuhu, Anhui Province, 241002, China. wyf@wnmc.edu.cn.

BACKGROUND: Unsafe injection practices significantly increase the risk of
human immunodeficiency virus (HIV) infection among injection drug users
(IDUs). Little is known about how demographic characteristics of IDUs are
linked to HIV-related risk behaviors in the central regions of China.

METHODS: A cross-sectional survey was conducted at Mandatory
Detoxification Centers (MDCs) and the community in Maanshan, China.

RESULTS: Of the 916 IDUs, 96.4 % reported a history of heroin use during
the past year, 93.4 % had HIV/AIDS knowledge, 16.8 % reported receptive
syringe sharing and 12.2 % reported inconsistent condom use in commercial
sex in the past year.

Unsafe injection practice was associated with increased odds of minority
ethnicity, lower level of education, and no peer education in the past
year.

Unsafe sex practice was associated with increased odds of being single,
18-30 years of age, non-local residence, and history of methamphetamine
use in the past year.

CONCLUSIONS: Integrated interventions to promote safe injection and
protected commercial sex practices targeting IDUs must also consider
individual and socio-environmental factors.

Free BMC Article https://dx.doi.org/10.1186/s12889-016-2786-6
__________________________________________________________________
________________________________*_________________________________

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

[Mod: This was posted last week without the link]
__________________________________________________________________

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

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

Abdala N1, Patel A2, Heimer R3.

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

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

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

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

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

https://www.ncbi.nlm.nih.gov/pubmed/27405590
__________________________________________________________________
________________________________*_________________________________

11. Abstract: A Randomized Trial Comparing the Pharmacokinetics, Safety,
and Tolerability of DFN-02, an Intranasal Sumatriptan Spray Containing
a Permeation Enhancer, With Intranasal and Subcutaneous Sumatriptan in
Healthy Adults
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27613076

Headache. 2016 Sep 10.
A Randomized Trial Comparing the Pharmacokinetics, Safety, and
Tolerability of DFN-02, an Intranasal Sumatriptan Spray Containing a
Permeation Enhancer, With Intranasal and Subcutaneous Sumatriptan in
Healthy Adults.

Munjal S1, Gautam A2, Offman E3, Brand-Schieber E2, Allenby K2, Fisher
DM4.

1Dr. Reddy’s Laboratories Ltd, Princeton, NJ, USA. smunjal@drreddys.com.
2Dr. Reddy’s Laboratories Ltd, Princeton, NJ, USA.
3Dr. Reddy’s Laboratories, Hyderabad, India (A. Gautam); Celerion,
Montreal, Canada.
4P Less Than, San Francisco, CA, USA.

OBJECTIVE/BACKGROUND: Intranasal sumatriptan (Imitrex® ) may be an
alternative for patients who refuse injections and cannot tolerate oral
agents, but due to low bioavailability and slow absorption, the clinical
utility of the currently marketed formulation is limited, highlighting an
unmet need for an effective non-oral migraine medication with a rapid
onset of action.

To overcome the slow absorption profile associated with intranasal
administration, we evaluated the impact of 1-O-n-Dodecyl-ß-D-
Maltopyranoside (DDM, Intravail A-3™), a permeation enhancer, on
sumatriptan’s pharmacokinetic profile by comparing the pharmacokinetic
characteristics of two commercial sumatriptan products, 4 mg subcutaneous
and 6 mg subcutaneous in healthy adults, with DFN-02 – a novel intranasal
agent comprised of sumatriptan 10 mg plus 0.20% DDM.

We also determined the pharmacokinetic characteristics of DDM and
evaluated its safety and tolerability.

METHODS: We conducted two studies: a randomized, three-way crossover study
comparing monodose and multidose devices for delivery of single doses of
DFN-02 with commercially available intranasal sumatriptan 20 mg in 18
healthy, fasted adults, and an open-label, randomized, single-dose, three-
way crossover bioavailability study comparing DFN-02 with 4 mg and 6 mg
subcutaneous sumatriptan in 78 healthy, fasted adults. In the study
comparing DFN-02 with IN sumatriptan, subjects received a single dose of
DFN-02 (sumatriptan 10 mg plus DDM 0.20%) via monodose and multidose
delivery systems with at least 5 days between treatments. In the
comparison with SC sumatriptan, subjects received a single dose of each
treatment with at least 3 days between treatments. In both studies, blood
was sampled for pharmacokinetic evaluation of sumatriptan and DDM through
24 hours post-dose; safety and tolerability were monitored throughout.

RESULTS: In the comparison with commercially available intranasal
sumatriptan 20 mg, DFN-02 had a more rapid absorption profile; tmax was 15
minutes for DFN-02 monodose, 10.2 minutes for DFN-02 multidose, and 2.0
hours for commercially available intranasal sumatriptan 20 mg.

Compared with 4 and 6 mg subcutaneous sumatriptan, DFN-02’s median tmax
(10 minutes) was significantly earlier (15 minutes; P?<?.0001). Mean
sumatriptan exposure metrics were similar for DFN-02 and 4 mg sumatriptan:
AUC0-2 : 35.12 and 44.82 ng*hour/mL, respectively; AUC0-8 : 60.70 and
69.21 ng*hour/mL, respectively; Cmax : 51.79 and 49.07 ng/mL,
respectively. With 6 mg subcutaneous sumatriptan, these exposure metrics
were about 50% larger (AUC0-2 : 67.17 ng*hour/mL; AUC0-8 : 103.78 ng*hour/
mL; Cmax : 72.75 ng/ mL). Inter-subject variability of AUC0-2 , AUC0-8 ,
and Cmax was 42-58% for DFN-02, 15-22% for 4 mg subcutaneous sumatriptan,
and 15-25% for 6 mg subcutaneous sumatriptan. DDM exposure was low (mean
Cmax : 1.63 ng/mL), tmax was 30 minutes, and it was undetectable by 4
hours.

There were no serious adverse events, discontinuations due to adverse
events, or remarkable findings for vital signs, physical examinations
(including nasal and injection site examinations), or clinical laboratory
assessments. The overall incidence of adverse events was comparable across
treatments, and all treatment-related events were mild in severity.
Adverse events occurring in =10% of subjects were dysgeusia (19%),
headache (18%), nausea (15%), paresthesia (15%), and dizziness (12%).

CONCLUSIONS: In healthy subjects, DFN-02, an intranasal spray containing
10 mg sumatriptan plus DDM, had a more rapid absorption profile than
commercially available intranasal sumatriptan 20 mg, and systemic exposure
from a single-dose administration of DFN-02 was similar to 4 mg SC
sumatriptan and two-thirds that of 6 mg SC sumatriptan.

With DFN-02, plasma sumatriptan peaked 5 minutes earlier than with both
subcutaneous formulations. Systemic exposure to sumatriptan was similar
with DFN-02 and 4 mg subcutaneous sumatriptan; both yielded lower systemic
exposure than 6 mg subcutaneous sumatriptan. Systemic exposure to DFN-02’s
excipient DDM was short-lived. DFN-02’s safety and tolerability appear to
be comparable to subcutaneous sumatriptan. Addition of a permeation
enhancer improved the absorption profile compared with commercially
available intranasal sumatriptan 20 mg.

© 2016 American Headache Society.

KEYWORDS: DDM; intranasal; migraine; pharmacokinetics; safety;
sumatriptan; tolerability
__________________________________________________________________
________________________________*_________________________________

12. Abstract: Healthcare Personnel Attire and Devices as Fomites: A
Systematic Review
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27609491

https://dx.doi.org/10.1017/ice.2016.192 Free Full Text

Infect Control Hosp Epidemiol. 2016 Sep 9:1-7.
Healthcare Personnel Attire and Devices as Fomites: A Systematic Review.

Haun N1, Hooper-Lane C2, Safdar N3.

11Division of Hospital Medicine,University of Wisconsin School of Medicine
and Public Health,Madison,Wisconsin.
22Ebling Library,University of Wisconsin School of Medicine and Public
Health,Madison,Wisconsin.
33Division of Infectious Disease,University of Wisconsin School of
Medicine and Public Health,Madison,Wisconsin.

BACKGROUND Transmission of pathogens within the hospital environment
remains a hazard for hospitalized patients. Healthcare personnel clothing
and devices carried by them may harbor pathogens and contribute to the
risk of pathogen transmission.

OBJECTIVE To examine bacterial contamination of healthcare personnel
attire and commonly used devices.

METHODS Systematic review.

RESULTS Of 1,175 studies screened, 72 individual studies assessed
contamination of a variety of items, including white coats, neckties,
stethoscopes, and mobile electronic devices, with varied pathogens
including Staphylococcus aureus, including methicillin-resistant S.
aureus, gram-negative rods, and enterococci.

Contamination rates varied significantly across studies and by device but
in general ranged from 0 to 32% for methicillin-resistant S. aureus and
gram-negative rods. Enterococcus was a less common contaminant. Few
studies explicitly evaluated for the presence of Clostridium difficile.
Sampling and microbiologic techniques varied significantly across studies.

Four studies evaluated for possible connection between healthcare
personnel contaminants and clinical isolates with no unequivocally direct
link identified.

CONCLUSIONS Further studies to explore the relationship between healthcare
personnel attire and devices and clinical infection are needed.
__________________________________________________________________
________________________________*_________________________________

13. News

– USA: Garrison Wins $4.6M in Lawsuit Over Needle Stick at Target

– Nigeria: LASSA: 154 Dead, 24 States record cases

– USA: EDITORIAL: Give Addicts Somewhere To Put Their Waste

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/zubyusl
USA: Garrison Wins $4.6M in Lawsuit Over Needle Stick at Target

By Karl Nelson, Newsmax, USA (12.09.16)

Carla Denise Garrison won a $4.6 million jury verdict following her
lawsuit against Target Corp. for being stuck by a needle picked up in a
Target parking lot in May of 2014.

Garrison had parked in Target’s lot and then got out of her vehicle when
her daughter, Kaileigh, who was 8 year’s old at the time, picked up a
hypodermic needle, USA Today reported. Garrison proceeded to swat the
needle from her daughter’s hand, sticking herself in her right palm,
according to court documents.

Garrison’s lawyer tried to settle with the retailer for $12,000, but the
offer was rejected. Instead, Target offered Garrison $750, WFMY News 2
noted.

Court documents show that “Garrison was treated at AnMed Health, where she
was tested for HIV and hepatitis. She was also prescribed medication
because of the potential risk that she would contract HIV. She has tested
negative for both HIV and hepatitis thus far.”

Garrison’s attorney said, “When we started this, we were trying to get
Target to make my client whole, to pay for her medical bills and the time
that her husband had to take off work. We tried to be reasonable and not
take this to trial. But Target took a really hard stance on it…and I think
the jury sent a message.”

Target plans to appeal, SpreadIt reported.

Target’s spokeswoman, Erika Winkels, said in a recent statement: “The
final damages award has not yet been determined by the Court. Target is
currently considering post-trial motions and appeal options.”

Target’s lawyer, Knox Haynsworth III, argued that Garrison could not prove
her case.

“A merchant is not an insurer of the safety of his customer but owes only
the duty of exercising ordinary care to keep the premises in reasonably
safe condition,” Haynsworth wrote, citing a case from 1969.

Garrison refused to comment on the incident, saying Friday that she was
“too overwhelmed” to speak on the issue, USA Today noted.

The $4.6 million verdict is one of the largest amounts awarded in the
history of Anderson County litigation, according to Richard Shirley, Clerk
of Court.
__________________________________________________________________
__________________________________________________________________

LASSA: 154 Dead, 24 States record cases


Nigeria: LASSA: 154 Dead, 24 States record cases

By Chioma Obinna, Vanguard, Nigeria [edited] (11.09.16)

– We are all vulnerable — Experts How poor surveillance fuels fever

[ Extract: Person-to-person transmission occurs in both community
and health-care settings, where the virus may be spread by
contaminated medical equipment, such as re-used needles. ]

Nigeria may be battling the worst outbreak of Lassa fever in history.
The fever which has afflicted over 284 has killed about 154 Nigerians
from different parts of the country from August 2015 to date. Fresh
cases are recorded every day in some states like Ondo and Bauchi,
where the outbreak had earlier stopped, signaling that the disease
could spread further.

Before now, millions of Nigerians did not imagine the seriousness of
the threat of Lassa outbreak. Unfortunately, months after the
inauguration of the committee on the fever, the current outbreak has
taken a new dimension, as the country may have failed to interrupt the
transmission. Currently, the likely risk for medical personnel is the
newest security threat confronting Nigeria. With the deaths of many
doctors in the country, the threat of possible epidemic of the disease
cannot be ruled out coupled with the resurgence of wild polio virus at
a time Nigeria is facing serious economic challenges.

According to Prof Oyewale Tomori, no fewer than 3 people are diagnosed
of the disease daily in the latest outbreak. “We have little value for
life, until more than 100 people die, it is not an emergency. For many
years, Lassa has been with us but we don’t take it seriously. In other
parts of the world, when a single person dies of a disease, it is a
national emergency. For how long are we going to continue to call
tragedy an embarrassment?”

He explained that the breakdown in disease surveillance did not make
the country notice that Lassa has consistently brought sorrow, pains
and agony to several homes. “If you are not hearing of new cases, it
is not that the disease is not occurring, but because our disease
surveillance is not up to par. We deceive ourselves that it’s a
seasonal disease, but the fact remains that it occurs throughout the
year. At least, 3 people are diagnosed of Lassa daily somewhere in the
country,” Tomori said.

“We abandon disease surveillance and control activities; there was a
time people worked together, the laboratories at Ibadan, the Ministry
of Health, NIMR [National Institute For Medical Research], joined
forces to protect the country. In the 1960s to 1980s at Ibadan, we
produced every reagent we needed in the country. We did not depend on
importation.”

Sadly, with the new trend of the infectious disease, only few Nigeria
laboratories can give accurate results. To Tomori, 6-7 laboratories in
the country cannot give proper results due to lack of support. The
only few that function in the country have the support of partner
agencies and backing from abroad.

The professor of virology also, in a report, described Lassa as an
annual recurrent budget of death for poor people of Nigeria, adding:
“Because we have lived in a state of denial of the disease, we handle
it with characteristic laxity. Lassa lacks the zeal and trepidation
that Ebola outbreak inspired and Nigeria still wakes up every year an
outbreak is reported, “running in any which direction, and forgetting
about the disease till another year another outbreak.”

To another stakeholder, a renowned professor of pharmacognosy and
president, Bioresources Development Group, Prof Maurice Iwu, Lassa was
more than an embarrassment because the country has the personnel
required, knowledge of the fever and how to prevent it, but the
disease still claims lives. Iwu argued that unless the country adopts
the approach used during the Ebola outbreak, many more people would
fall victim. “As long as Lassa fever is anywhere in the country, as
long as we have restaurants that don’t keep good hygiene, as long as
we have houses that are co-infested with rat and horse, as long as we
have dirty environment, we are all vulnerable,” he said. “The only
thing we can do is keep track of the virus, and from time to time do
research. Our universities should make sure that 80 per cent of their
research is localized to treat our own diseases, issues and viruses we
live with.”

Findings by Sunday Vanguard show that as far as the average Nigerian
is concerned, a confirmation of pockets of the disease across the
states is alarming, while an epidemic would be catastrophic. Such
fears are well founded. The latest Lassa fever outbreak affected 24
states in Nigeria. Unlike outbreaks of the past, it is spreading in
rural and urban areas. In the country today, millions of people are
walking around with high fevers and other kinds of symptoms that could
confuse diagnosis of Lassa fever. Worse still, Nigeria has been listed
among countries that may be threatened by global spread of Zika virus,
another terrible, viral disorder caused by mosquitoes. This time, even
health workers are not spared.

WHO updates

An update on the World Health Organization (WHO) website showed that
between August 2015 and 17 May 2016, WHO has been notified of 273
cases of Lassa fever, including 149 deaths in Nigeria. Of these, 165
cases and 89 deaths have been confirmed through laboratory testing
(case fatality rate; CFR: 53.9 per cent).

The cases were reported from
23 states. Since August 2015, 10 health care workers (HCW) have been
infected with Lassa virus, of whom 2 have died. Of these 10 cases, 4
were nosocomial infections. Just 2 weeks ago, 2 medical doctors died
from the disease in Anambra and Delta States. As of 17 May 2016, 8
states reported Lassa fever cases (suspected, probable, and
confirmed), deaths and/or following of contacts for the maximum 21-day
incubation period.

Currently, 248 contacts are being followed up in
the country. The other 15 previously affected states have completed
the 42-day period following last known possible transmission.

Public health response

Currently, 2 national laboratories are supporting the laboratory
confirmation of Lassa cases by polymerase chain reaction (PCR) tests.
All the samples were also tested for Ebola, dengue, yellow fever and
so far have tested negative. The 2 laboratories that are currently
operational are Virology laboratory, Lagos University Teaching
Hospital and Lassa fever research and control centre, Irrua specialist
hospital.

Along with other key partners, WHO is supporting the Federal Ministry
of Health in surveillance and response of Lassa outbreaks including
contacts tracing, follow up and community mobilisation. Of particular
concern since the onset of Lassa fever outbreaks in Nigeria is the
high proportion of deaths among the cases that is still under
investigation.

According to WHO, Lassa fever is an acute viral haemorrhagic illness
caused by Lassa virus, a member of the arenavirus family of viruses.
It is transmitted to humans from contacts with food or household items
contaminated with rodent excreta. The disease is endemic in the rodent
population in parts of West Africa like Nigeria.

Humans usually become infected with Lassa virus from exposure to urine
or faeces of infected mastomys rats. Lassa virus may also be spread
between humans through direct contact with the blood, urine, faeces,
or other bodily secretions of a person infected with Lassa fever.

There is no epidemiological evidence supporting airborne spread
between humans. Person-to-person transmission occurs in both community
and health-care settings, where the virus may be spread by
contaminated medical equipment, such as re-used needles. Sexual
transmission of Lassa virus has been reported. It also occurs in all
age groups and both sexes.

The people at greatest risk are those living in rural areas where
mastomys [the multimammate mouse] are usually found, especially in
communities with poor sanitation or crowded living conditions.

The incubation period of Lassa fever ranges from 2-21 days. The onset
of the disease, when it is symptomatic, is usually gradual, starting
with fever, general weakness, and malaise. After a few days, headache,
sore throat, muscle pain, chest pain, nausea, vomiting, diarrhoea,
cough, and abdominal pain may follow. In severe cases facial swelling,
fluid in the lung cavity, bleeding from the mouth, nose, vagina or
gastrointestinal tract and low blood pressure may develop. Protein may
be noted in the urine. Shock, seizures, tremor, disorientation, and
coma may be seen in the later stages. Deafness occurs in 25 per cent
of patients who survive the disease. Death usually occurs within 14
days of onset in fatal cases and severe late in pregnancy, with
maternal death and/or fetal loss occurring in more than 80 per cent of
cases during the 3rd trimester.

Lassa fever is difficult to distinguish from other viral haemorrhagic
fevers such as Ebola virus disease as well as other diseases that
cause fever, including malaria, shigellosis, typhoid fever, and yellow
fever. Definitive diagnosis requires testing that is available only in
reference laboratories. Laboratory specimens may be hazardous and must
be handled with extreme care.

There is currently no vaccine that protects against Lassa fever. The
antiviral drug ribavirin seems to be an effective treatment for Lassa
fever if given early on in the course of clinical illness. There is no
evidence to support the role of ribavirin as post-exposure
prophylactic treatment.

Lassa timeline

Lassa fever is not new to Nigerians. The 1st ever documented case of
Lassa fever was reported in Nigeria in 1969 when 2 missionary nurses
died in a town called Lassa in the part of Nigeria now known as Borno
State. They had complaints of weakness, headaches, fever, and general
malaise.

A study in the journal Cell by a team that included Christian Happi of
Irrua Specialist Hospital — where experts confirm strains of Lassa
fever in samples had traced “ancient roots” of Lassa nearly 1000 years
to a region that is now present-day Nigeria. Until 2008, specimens
were flown abroad for confirmation. Since 2008, 2 centres have stepped
in to fill the gap in laboratory diagnosis and research into the fever
— Lassa Fever Research and Control Centre at Irrua Specialist
Hospital, Edo, and Lahor Research. Samples from the latest outbreaks
have undergone confirmation at Irrua, which also provided confirmation
for cases from 2012 onwards. In 2012, the number of cases peaked in
2012, when 1723 cases with 112 fatalities were recorded. In 2012, half
a million vials of ribavirin, an antiviral drug considered effective
were procured after the 1st case of Lassa was reported in Ebonyi. By
then, one doctor and up to 4 nurses had died, some others were
hospitalised at Federal Teaching Hospital, Abakiliki.

Lassa fever has the greatest impact among haemorrhagic fevers —
rivalled only by dengue. Up to 300 000 are infected annually in West
Africa alone, and an estimated 5000 of them die. During 2012 and 2013,
more than 2900 cases were reported in widespread outbreaks that
occurred across many states. In 2013, 3 deaths — among them a health
worker, it struck in Benue and Ondo States. Since the last quarter of
2015, the country has been battling the epidemic disorder, which at
the last count, has reached 24 states and killed 154 people. More than
684 suspected cases have so far been recorded in the Borno, Gombe,
Yobe, Taraba, Plateau, Nasarawa, Ebonyi, Edo, Ondo, Rivers, Bauchi,
Anambra, Lagos, Niger, Kano, Nassarawa, Plateau, Oyo, Gombe and Ondo,
Kano states and the FCT [Federal Capital Territory] among others and
still counting.
__________________________________________________________________
__________________________________________________________________

https://tinyurl.com/he76asp
USA: EDITORIAL: Give Addicts Somewhere To Put Their Waste

By Capitol Hill Times, Capitol Hill Times, Washington DC USA (09.09.16)

Parents should definitely not keep their children sheltered from the harsh
reality of the heroin and opioid crisis plaguing this city and others —
big and small — around the country.

What they shouldn’t have to do is constantly pick up used needles and
condoms from a pathway running along Lowell Elementary. Kids shouldn’t
have to worry about getting Hep-C or worse while walking to school.

Kudos to the Seattle Department of Transportation for addressing this
problem by shutting the pathway down for cleanup and to figure out a long-
term solution, though it sounds like this has been a persistent problem
the city has finally pulled from its pile of delayed maintenance projects.

While it would be great if heroin users would just find someplace else to
shoot their poison, that’s not likely. For the homeless, options are not
plentiful.

So, we are just going to reiterate our position, which is that the city
and county take the forthcoming recommendations of a joint heroin and
opioid task force and get right to work on fulfilling them — we’re fairly
confident safe consumption sites, where needles go in a sharps box and not
a bush at a park or school, will be among the recommendations. In the
words of Arnold Schwarzenegger, do it, do it now.

The right of way Lowell students and neighbors use regularly is quite
small, compared to Seattle’s public parks, which are also popular places
to inject, smoke and snort drugs. Think about the time, labor and cost
that goes into these cleanups, then think about how quickly those efforts
will be reversed, when people with addiction return to these freshly
groomed spaces and start the cycle all over. If the idea is that cutting
down vegetation to enhance visibility will discouraged drug use in certain
place, then some people at the city don’t realize how little someone with
addiction cares who sees them.

Safe consumption/injection spaces will come at a cost, but what’s the
price comparison for what we’re dealing with now?

People using dirty needles can spread infections, either between other
users or by carelessly tossing them somewhere for someone to find by
accident. Last we checked, health care still sucks in this country.

Heroin is one of the most dangerous drugs out there, and opiate-related
deaths have tripled since 2009. Not only would safe consumption spaces
provide a staff capable of preventing these overdose deaths through
intervention, it would avoid the potential trauma a child may someday face
when they stumble across an overdose victim on their way to school.

Honestly, if there is a big price tag attached to operating a number of
safe consumption sites in King County — and there has to be — maybe the
federal government could do us all a solid and make the pharmaceutical
companies and terrible doctors, who have been dolling out opiates like
candy for long, foot the bill.
__________________________________________________________________
________________________________*_________________________________

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
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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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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
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