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SIGNpost 00871

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST

Post00871   HCV + NSI + OH + Abstracts + News 21 September 2016

CONTENTS
1. Abstract: An outbreak of HCV genotype 6a and 2a infection in South
China: Confirmation of iatrogenic transmission by phylogenetic analysis
of the NS5B region
2. Abstract: Clinical features and treatment outcomes of septic arthritis
due to Mycobacterium massiliense associated with intra-articular
injection: a case report
3. Abstract: Viral Infections Among the Nursing Personnel – a Survey
4. Abstract: Clinical treatment adherence of health care workers and
students exposed to potentially infectious biological material
5. Abstract: Bedeutung der Hepatitis C-Virusinfektion in der
zahnärztlichen Praxis
6. Abstract: Effect of modifying the information and training structure on
the occupational safety of health care workers in exposure to blood and
body fluids: A quasi-experimental study
7. Abstract: Prevalence of Hepatitis B and C Viral Infection Among
Pregnant Women in Peshawar, Pakistan
8. Abstract: Differences in efficiency, satisfaction and adverse events
between self-administered intradermal and nurse-administered
intramuscular influenza vaccines in hospital workers
9. Abstract: Challenges and recent advances in the subcutaneous delivery
of insulin
10. Abstract: Correlates of Skin and Soft Tissue Infections in Injection
Drug Users in a Syringe-Exchange Program in Malmö, Sweden
11. Abstract: Anatomical recommendations for safe botulinum toxin
injection into temporalis muscle: a simplified reproducible approach
12. Abstract: Awareness assessment of harmful effects of mercury in a
health care set-up in India: A survey-based study
13. Abstract: Single-use, electricity-free amplification device for
detection of HIV-1
14. Extract/No Abstract: Preventing needlestick injuries and blood-borne
infections–not yet there
15. News
– China: Shenyang Woman in Legal Battle After Vaccination Gone Bad
Victim seeks compensation after contracting painful, lifelong kidney
disease
– Canada: Needle exchange program distributes 70,000 needles per month
Harm reduction program successful at decreasing transmission of blood-
borne illnesses
– Australia: Guards vote down prison needle exchange, health advocates
threaten legal action

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1. Abstract: An outbreak of HCV genotype 6a and 2a infection in South
China: Confirmation of iatrogenic transmission by phylogenetic analysis
of the NS5B region
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27633350

Mol Med Rep. 2016 Sep 13.
An outbreak of HCV genotype 6a and 2a infection in South China:
Confirmation of iatrogenic transmission by phylogenetic analysis of the
NS5B region.

Shao X1, Luo Q1, Cai Q1, Zhang F2, Zhu J1, Liu Y1, Zhao Z1, Gao Z1, Zhang
X1.

1Department of Infectious Disease, The Third Affiliated Hospital of Sun
Yat-Sen University, Guangzhou, Guangdong 510630, P.R. China.
2Department of Internal Medicine, Zijin County People’s Hospital, Heyuan,
Guangdong 517400, P.R. China.

An outbreak of hepatitis C virus (HCV) infections, for which the risk
factor was unknown, was previously identified in North Guangdong, China.

In the present study, a total of 736 local residents were surveyed
regarding their lifetime risk factors for HCV infection. Serum anti-HCV
antibodies and HCV RNA were examined to confirm infection. In the
HCV-positive samples, the core and nonstructural protein 5B sequences were
amplified, and phylogenetic analysis was performed to determine the
association between HCV subtypes and transmission routes.

A total of 374 individuals were positive for anti-HCV antibodies. Blood
transfusion, blood product transfusion, people who inject drugs and
intravenous injection at a local clinic were identified as independent
risk factors for HCV infection.

Phylogenetic analysis revealed that the two predominant subtypes of HCV,
2a and 6a, were primarily focused in four homologous clusters.

Patients with a history of intravenous injection at a local clinic were
more likely to be found in the four clusters, compared with patients
exposed to other risk factors.

The present emergency retrospective survey showed a specific
epidemiological feature of HCV infection in Zijin County and found genetic
homology among individuals exposed to intravenous injection at a local
clinic.

Further evidence is required to confirm the causal association between the
outbreak of HCV infection and intravenous injection.
__________________________________________________________________
________________________________*_________________________________

2. Abstract: Clinical features and treatment outcomes of septic arthritis
due to Mycobacterium massiliense associated with intra-articular
injection: a case report
__________________________________________________________________

http://bmcresnotes.biomedcentral.com/articles/10.1186/s13104-016-2245-6

BMC Res Notes. 2016 Sep 15;9(1):443. Free full text
Clinical features and treatment outcomes of septic arthritis
due to Mycobacterium massiliense associated with intra-articular
injection: a case report.

Lee H1, Hwang D1, Jeon M2, Lee E3, Kim T1, Yu SN4, Kim Y2, Lee BI2.

1Division of Infectious Disease, Department of Internal Medicine,
Soonchunhyang University Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul,
Korea.
2Department of Orthopedic Surgery, Soonchunhyang University Hospital, 59
Daesagwan-ro, Yongsan-gu, Seoul, Korea.
3Division of Infectious Disease, Department of Internal Medicine,
Soonchunhyang University Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul,
Korea. shegets@schmc.ac.kr.
4Department of Internal Medicine, Soonchunhyang University Hospital, 17
Soonchunhyang 6-gil, Dongnam-gu, Cheonan, Chungcheongnam-do, Korea.

BACKGROUND: There are increasing reports on nosocomial Mycobacterium
massiliense infection, but septic arthritis and osteomyelitis because of
that microorganism is rare. This report focuses on the clinical aspects of
M. massiliense arthritis outbreak concurrent with soft tissue infection.

CASE PRESENTATION: An outbreak of septic arthritis among patients who had
been injected at a single clinic occurred in South Korea between April and
September 2012.

This may be associated with repeated injection of triamcinolone
contaminated with M. massiliense. Nine of the Korean patients visited our
hospital complaining of painful swelling of the knees. During treatment
course, patients are suffered from soft tissue abscess around the
injection site. Acid-fast bacilli culture for infected tissue was positive
in five patients, and polymerase chain reaction for non-tuberculous
mycobacteria was positive in four patients. They were treated with
antibiotics, repeated arthroscopic surgeries, incision and drainage for a
long time. All patients were eventually cured but three patients have
suffered from a decreased range of motion.

CONCLUSION: Early clinical suspicion and microbiological diagnosis are key
factors in reducing morbidity since septic arthritis with M. massiliense
manifests late after the injection and treatment of it is a laborious
process.

KEYWORDS: Case report; Intra-articular injection; Mycobacterium
massiliense; Non-tuberculous mycobacteria; Septic arthritis

Free full text
http://bmcresnotes.biomedcentral.com/articles/10.1186/s13104-016-2245-6
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Viral Infections Among the Nursing Personnel – a Survey
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27617486

Gesundheitswesen. 2016 Sep 12.
[Viral Infections Among the Nursing Personnel – a Survey].

[Article in German]

Wicker S1, Rabenau HF2, Schachtrupp A3, Schalk R4.

1Betriebsärztlicher Dienst, Universitätsklinikum Frankfurt.
2Institut für Medizinische Virologie, Universitätsklinikum Frankfurt.
3B. Braun Melsungen.
4Institut für Pflegeentwicklung und Nursing Research, Universitätsklinikum
Frankfurt.

Background and Aim: Healthcare workers (HCW) are at risk of occupational
infections and can also transmit diseases to patients. The acceptance of
measures to improve safety is linked to knowledge and risk awareness of
HCW.

The purpose of our study was to ascertain the knowledge and risk awareness
of nursing staff regarding occupational infections and vaccinations as
well as the frequency of needlestick injuries (NSI) in relation to the
level of education.

Methods: In the context of a conference on nursing, an anonymous
questionnaire was distributed to the participants.

Results and Conclusions: Nursing staff had insufficient knowledge of viral
occupational infections with regard to the actual hazard. At the same
time, more than 60?% of the respondents rated the probability of
contracting occupational infections as “pretty high” to “very high”.

In addition, 62.1?% of the study participants also stated that they did
not feel sufficiently trained to care for patients with highly contagious
or rare infectious diseases.

Intensified training and awareness programs for nursing personnel are
required to increase the knowledge of occupational infections.

© Georg Thieme Verlag KG Stuttgart · New York.
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Clinical treatment adherence of health care workers and
students exposed to potentially infectious biological material
__________________________________________________________________

Free full text https://dx.doi.org/10.1590/S0080-623420150000200011

Rev Esc Enferm USP. 2015 Apr;49(2):261-6.
[Clinical treatment adherence of health care workers and students exposed
to potentially infectious biological material].

[Article in Portuguese]

Almeida MC1, Canini SR2, Reis RK2, Toffano SE3, Pereira FM2, Gir E2.

1Ribeirão Preto College of Nursing, Universidade de São Paulo, Ribeirão
Preto, SãoPaulo, Brazil.
2Ribeirão Preto College of Nursing, Universidade de São Paulo, Ribeirão
Preto, São Paulo, Brazil.
3Universidade Federal de São João Del Rei, Divinópolis, Minas Gerais,
Brazil.

OBJECTIVE: To assess adherence to clinical appointments by health care
workers (HCW) and students who suffered accidents with potentially
infectious biological material.

METHOD: A retrospective cross-sectional study that assessed clinical
records of accidents involving biological material between 2005 and 2010
in a specialized unit.

RESULTS: A total of 461 individuals exposed to biological material were
treated, of which 389 (84.4%) were HCWs and 72 (15.6%) students. Of the
461 exposed individuals, 307 (66.6%) attended a follow-up appointment.
Individuals who had suffered an accident with a known source patient were
29 times more likely to show up to their scheduled follow-up appointments
(OR: 29.98; CI95%: 16.09-55.83).

CONCLUSION: The predictor in both univariate and multivariate analyses for
adherence to clinical follow-up appointment was having a known source
patient with nonreactive serology for the human immunodeficiency virus
and/or hepatitis B and C.

Free full text https://dx.doi.org/10.1590/S0080-623420150000200011
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Bedeutung der Hepatitis C-Virusinfektion in der
zahnärztlichen Praxis
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27622545

Swiss Dent J. 2016;126(7-8):687-93.

Bedeutung der Hepatitis C-Virusinfektion in der zahnärztlichen Praxis.

[Article in French, German]

Hauser-Gerspach I1, Erb S, Meyer J.

1Klinik für Präventivzahnmedizin und Orale Mikrobiologie, UZB-
Universitätszahnkliniken, Basel, Switzerland.

This article gives a short overview about the epidemiology, transmission,
clinical appearance, testing and therapy of hepatitis C virus infection
and its importance in the healthcare setting.

Standard infection control measures in dental practice remain essential
for the prevention of HCV transmission.

Free full text http://www.sso.ch/pubmed.cfm?a=sdj-2016-07-08-04
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Effect of modifying the information and training structure on
the occupational safety of health care workers in exposure to blood and
body fluids: A quasi-experimental study
__________________________________________________________________

Am J Infect Control. 2016 Sep 12. pii: S0196-6553(16)30617-4.
Effect of modifying the information and training structure on the
occupational safety of health care workers in exposure to blood and body
fluids: A quasi-experimental study.

Sarbaz M1, Kimiafar K2, Taherzadeh Z3, Naderi H4, Eslami S5.

1Department of Medical Records and Health Information Technology, School
of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad,
Iran.
2Department of Medical Records and Health Information Technology, School
of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad,
Iran. Electronic address: kimiafarkh@mums.ac.ir.
3Neurogenic Inflammation Research Center, Mashhad University of Medical
Sciences, Mashhad, Iran; Targeted Drug Delivery Research Center, Mashhad
University of Medical Sciences, Mashhad, Iran.
4Department of Infectious Diseases, Imam Reza Hospital, School of
Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
5Department of Medical Informatics, School of Medicine, Mashhad University
of Medical Sciences, Mashhad, Iran; Pharmaceutical Research Center,
Mashhad University of Medical Sciences, Mashhad, Iran; Department of
Medical Informatics, Academic Medical Center, University of Amsterdam,
Amsterdam, The Netherlands.

This study was a quasi-experimental design to assess the effect of a Web-
based information system on the occupational exposure to blood and body
fluids (BBFs) among health care workers (HCWs).

The outcome was the number of exposure incidents with BBFs among HCWs in
both hospital A (intervention) and hospital B (control).

The findings showed that the implementation of the Web-based information
system about infection prevention and control in hospital A decreased
exposure incidents with BBFs among the HCWs (P?<?.001).

Copyright © 2016 Association for Professionals in Infection Control and
Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

KEYWORDS: Occupational exposure; health care workers; information
technology
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Prevalence of Hepatitis B and C Viral Infection Among
Pregnant Women in Peshawar, Pakistan
__________________________________________________________________

https://dx.doi.org/10.5812/hepatmon.36383

Hepat Mon. 2016 Jun 1;16(6):e36383. Free Full Article & PDF
Prevalence of Hepatitis B and C Viral Infection Among Pregnant Women in
Peshawar, Pakistan.

Ahmad I1.

1Assistant Professor, Department of Life Sciences, King Fahd University of
Petroleum and Minerals, Dhahran, Saudi Arabia.

BACKGROUND: Viral hepatitis during pregnancy is associated with a high
risk of maternal complications. The virus has a high risk of vertical
transmission and it has been reported as the leading cause of maternal
death.

OBJECTIVES: To study the prevalence of hepatitis B (HBV) and hepatitis C
(HCV) viral infections among pregnant women in the Peshawar district of
Pakistan.

MATERIALS AND METHODS: The cross-sectional study took place between July
2013 and April 2014. A total of 10,288 samples were collected from
pregnant women living in different areas of the Peshawar district. The
samples were centrifuged at a high speed in order to obtain a clear
supernatant serum. All samples were screened for HBV and HCV using the
immunochromatographic technique.

RESULTS: The overall prevalence of HBV was found to be 1.16%, although it
varied throughout the study period. The highest prevalence of HBV (1.69%)
was observed during January 2014. The overall prevalence of HCV infection
among the pregnant women was observed to be 1.42%. The highest prevalence
of HCV infection (2.22%) was found during March 2014.

CONCLUSIONS: The overall prevalence of HBV and HCV was 1.16% and 1.42%,
respectively. The incidence of HCV infection among the pregnant women was
higher than that of HBV infection.

KEYWORDS: HBV; HCV; ICT; Prevalence

Free PMC Article https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5011400/
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Differences in efficiency, satisfaction and adverse events
between self-administered intradermal and nurse-administered
intramuscular influenza vaccines in hospital workers
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26529074

Vaccine. 2015 Nov 27;33(48):6635-40.
Differences in efficiency, satisfaction and adverse events between self-
administered intradermal and nurse-administered intramuscular influenza
vaccines in hospital workers.

Coleman BL1, McNeil SA2, Langley JM3, Halperin SA4, McGeer AJ5.

1Mount Sinai Hospital, 600 University Avenue, Toronto, ON, Canada;
University of Toronto, 155 College Street, Toronto, ON, Canada. Electronic
address: bcoleman@mtsinai.on.ca.
2Canadian Center for Vaccinology, Dalhousie University, 6299 South Street,
Halifax, NS, Canada; QE II Health Sciences Centre, Nova Scotia Health
Authority, 1276 South Park Street, Halifax, NS, Canada. Electronic
address: shelly.mcneil@cdha.nshealth.ca.
3Canadian Center for Vaccinology, Dalhousie University, 6299 South Street,
Halifax, NS, Canada; IWK Health Centre, Nova Scotia Health Authority, 5980
University Avenue, Halifax, NS, Canada. Electronic address:
jmlangle@dal.ca.
4Canadian Center for Vaccinology, Dalhousie University, 6299 South Street,
Halifax, NS, Canada; QE II Health Sciences Centre, Nova Scotia Health
Authority, 1276 South Park Street, Halifax, NS, Canada. Electronic
address: scott.halperin@dal.ca.
5Mount Sinai Hospital, 600 University Avenue, Toronto, ON, Canada;
University of Toronto, 155 College Street, Toronto, ON, Canada. Electronic
address: amcgeer@mtsinai.on.ca.

Vaccinating healthcare workers against influenza takes tens of thousands
of hours of work annually. This study was undertaken to determine the
acceptability, success rate, and time to vaccinate healthcare workers in
nurse-led groups that self-vaccinated with intradermal influenza vaccine
compared with nurse-administered intramuscular vaccine.

METHODS: Volunteer hospital workers were randomly assigned to groups that
either self-administered intradermal influenza vaccine (Intanza(®)) in a
nurse- led group or received nurse-administered intramuscular vaccine
(Vaxigrip(®)). Research assistants timed vaccination procedures; pre- and
post-injection questionnaires assessed acceptability and reactogenicity.

RESULTS: 810 adults, 21-69 years of age, from two study sites were
vaccinated: 401 self-administered the intradermal vaccine while 409
received their intramuscular vaccine from a nurse. Of those who self-
administered for the first time, 98.5% were successful on their first
attempt with an additional 1.5% on their second attempt. Acceptability was
high: 96% were very or somewhat certain that they administered the vaccine
correctly, 83% would choose intradermal influenza vaccine again and of
those, 75% would choose self-administration again, if given the choice. It
took 51.3-72.6s per person for the nurses to guide the groups through the
self- administration process, which was significantly less time than it
took to individually administer the intramuscular vaccines (93.6s).

CONCLUSION: Self-administration of intradermal influenza vaccine by people
working in healthcare settings is a possible alternative to nurse
administered vaccinations, with nurse-led group sessions a good way of
teaching the technique while being available to respond to unanticipated
problems (NCT01665807).

Copyright © 2015 Elsevier Ltd. All rights reserved.

KEYWORDS: Campaign; Influenza vaccines; Intradermal; Intramuscular;
Vaccination
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Challenges and recent advances in the subcutaneous delivery
of insulin
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27626885

Expert Opin Drug Deliv. 2016 Sep 20:1-8.
Challenges and recent advances in the subcutaneous delivery of insulin.

Guo X1, Wang W1.

1a Department of Endocrinology , Peking University First Hospital ,
Beijing , China.

INTRODUCTION: The morbidity of diabetes mellitus is increasing, and
subcutaneous injection of exogenous insulin is well established as an
effective therapeutic strategy for reducing complications associated with
the disease. However, the pain that accompanies repeated injections is an
important drawback, and can detrimentally affect the adherence to therapy.
Recently, there have been great improvements in injection devices and
techniques, including the development of microneedle systems and
quantitative injection technologies, which have increased the accuracy of
injection, decreased leakage of insulin to the skin surface, and reduced
pain.

AREAS COVERED: This review highlights some limitations of current
techniques for the injection of insulin and its analogs, and describes new
methodologies and strategies that have been developed in an attempt to
overcome these limitations. Furthermore, novel technologies currently
under development that are potential future prospects for insulin delivery
are discussed.

EXPERT OPINION: New technologies have provided easier and well-tolerated
treatment regimens for diabetes patients. However, to further improve
patients’ satisfaction, self-regulated insulin delivery, automatic
adjustment of needle length, memory function to the injection device, use
of novel materials could be introduced into insulin injection. Intelligent
control of insulin delivery and soluble microneedle arrays may be
important areas of future research.

KEYWORDS: Injection complication; injection safety; injection technique;
patient satisfaction; subcutaneous insulin injection
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Correlates of Skin and Soft Tissue Infections in Injection
Drug Users in a Syringe-Exchange Program in Malmö, Sweden
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/26583450

Subst Use Misuse. 2015;50(12):1529-35.
Correlates of Skin and Soft Tissue Infections in Injection Drug Users in a
Syringe-Exchange Program in Malmö, Sweden.

Dahlman D1, Håkansson A2, Björkman P3, Blomé MA3, Kral AH4.

1a Malmo Addiction Center , Psychiatry Skane , Malmo , Sweden.
2b Department of Clinical Sciences , Lund University , Lund , Sweden.
3c Department of Infectious Diseases, Division of Clinical Sciences , Lund
University , Malmo , Sweden.
4d RTI International , San Francisco , California , USA.

BACKGROUND: Injection drug users (IDUs) are at increased risk of various
medical conditions, including bacterial skin and soft tissue infections
(SSTIs). SSTIs, which are painful and can lead to life-threatening
complications, are common but scarcely studied.

OBJECTIVES: To investigate life time, past 12 month and past 30-day
prevalence for SSTI related to injection drug use, in IDUs at Malmö
syringe exchange program (Malmö SEP). To investigate factors associated
with having ever had an SSTI.

METHODS: IDUs were recruited from Malmö SEP (N = 80). They participated in
a survey with questions about demographics, drug use, and experience of
SSTIs. Factors independently associated with self-reported SSTI ever were
assessed using logistic regression analysis.

RESULTS: The lifetime reported prevalence of SSTI was 58%, past 12 months
30%, and past 30 days 14%. Factors independently associated with SSTI ever
were age (adjusted odds ratio [AOR] = 1.09; 95% confidence interval [CI] =
1.01-1.18), female sex (AOR = 6.75; 95% CI = 1.40-32.47), having ever
injected prescribed drugs (AOR = 52.15; 95% CI = 5.17-525.67), and having
ever injected in the neck (AOR = 8.08; 95% CI = 1.16-56.08).

CONCLUSIONS/IMPORTANCE: SSTI is common among IDUs in Malmö. Women and
those injecting in the neck or injecting prescribed drugs (crushed
tablets/liquids), are more likely to have had an SSTI.

KEYWORDS: abscess; injection drug use; risk injection; skin and soft
tissue infection; syringe exchange
__________________________________________________________________
________________________________*_________________________________

11. Abstract: Anatomical recommendations for safe botulinum toxin
injection into temporalis muscle: a simplified reproducible approach
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27631881

Surg Radiol Anat. 2016 Sep 8. [Epub ahead of print]
Anatomical recommendations for safe botulinum toxin injection into
temporalis muscle: a simplified reproducible approach.

Lee WK1, Bae JH2, Hu KS2, Kato T3, Kim ST4,5.

1Department of Orofacial Pain and Oral Medicine, Yonsei University College
of Dentistry, Seoul, South Korea.
2Division in Anatomy and Developmental Biology, Department of Oral
Biology, Human Identification Research Center, Yonsei University College
of Dentistry, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-749, South Korea.
3Department of Oral Anatomy and Neurobiology, Osaka University Graduate
School of Dentistry, Osaka, Japan.
4Department of Orofacial Pain and Oral Medicine, Yonsei University College
of Dentistry, Seoul, South Korea. k8756050@yuhs.ac.
5Division in Anatomy and Developmental Biology, Department of Oral
Biology, Human Identification Research Center, Yonsei University College
of Dentistry, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-749, South Korea.
k8756050@yuhs.ac.

PURPOSE: The objective of this study was to simplify the anatomically safe
and reproducible approach for BoNT injection and to generate a detailed
topographic map of the important anatomical structures of the temporal
region by dividing the temporalis into nine equally sized compartments.

METHODS: Nineteen sides of temporalis muscle were used. The topographies
of the superficial temporal artery, middle temporal vein, temporalis
tendon, and the temporalis muscle were evaluated. Also evaluated was the
postural relations among the foregoing anatomical structures in the
temporalis muscle, pivoted upon a total of nine compartments.

RESULTS: The temporalis above the zygomatic arch exhibited an oblique
quadrangular shape with rounded upper right and left corners. The distance
between the anterior and posterior margins of the temporalis muscle was
equal to the width of the temporalis rectangle, and the distance between
the reference line and the superior temporalis margin was equal to its
height. The mean ratio of width to height was 5:4.

CONCLUSIONS: We recommend compartments Am, Mu, and Pm (coordinates of the
rectangular outline) as areas in the temporal region for BoNT injection,
because using these sites will avoid large blood vessels and tendons, thus
improving the safety and reproducibility of the injection.

KEYWORDS: Botulinum toxin; Bruxism; Injection point; Temporal region;
Temporalis muscle
__________________________________________________________________
________________________________*_________________________________

12. Abstract: Awareness assessment of harmful effects of mercury in a
health care set-up in India: A survey-based study
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/23698903

Toxicol Ind Health. 2015 Dec;31(12):1144-51.
Awareness assessment of harmful effects of mercury in a health care set-up
in India: A survey-based study.

Halder N1, Peshin SS1, Pandey RM2, Gupta YK3.

1Department of Pharmacology, All India Institute of Medical Sciences, New
Delhi, India.
2Department of Biostatistics, All India Institute of Medical Sciences, New
Delhi, India.
3Department of Pharmacology, All India Institute of Medical Sciences, New
Delhi, India yk.ykgupta@gmail.com.

Mercury, one of the most toxic heavy metals, is ubiquitous in environment.
The adverse health impact of mercury on living organisms is well known.

The health care facilities are one of the important sources of mercury
release into the atmosphere as mercury items are extensively used in
hospitals.

To assess the awareness about mercury toxicity and the knowledge of proper
handling and disposal of mercury-containing items in health care set-up, a
questionnaire-based survey was carried out amongst doctors (n = 835),
nurses (n = 610) and technicians (n = 393) in government hospitals,
corporate hospitals and primary health care centres in the Indian states
of Delhi, Uttar Pradesh and Haryana.

The study was conducted using a tool-containing pretested structured
multiple-choice questionnaire.

Analysis of the results using STATA 11.1 software highlighted that overall
awareness was more in corporate sector. However, percentage range of
knowledge of respondents irrespective of health care sector was only
between 20 and 40%.

Despite the commitment of various hospitals to be mercury free, mercury
containing-thermometer/ sphygmomanometer are still preferred by health
professionals. The likely reasons are availability, affordability,
accuracy and convenience in use.

There is an urgent need for source reduction, recycling and waste
minimization.

Emphasis must be laid on mercury alternative products, education and
training of health personnel and public at large, about correct handling
and proper clean up of spills.

© The Author(s) 2013.

KEYWORDS: Mercury; environmental pollution; health care professionals;
health care sector; survey-based study
__________________________________________________________________
________________________________*_________________________________

13. Abstract: Single-use, electricity-free amplification device for
detection of HIV-1
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/27616198

J Virol Methods. 2016 Sep 8;237:132-137.
Single-use, electricity-free amplification device for detection of HIV-1.

Curtis KA1, Rudolph DL2, Morrison D2, Guelig D3, Diesburg S3, McAdams D3,
Burton RA3, LaBarre P3, Owen M2.

1Laboratory Branch, Division of HIV/AIDS Prevention, National Center for
HIV/AIDS, Hepatitis, STD, and TB Prevention, Centers for Disease Control
and Prevention, 1600 Clifton Road NE, Atlanta, GA 30329, USA. Electronic
address: czv2@cdc.gov.
2Laboratory Branch, Division of HIV/AIDS Prevention, National Center for
HIV/AIDS, Hepatitis, STD, and TB Prevention, Centers for Disease Control
and Prevention, 1600 Clifton Road NE, Atlanta, GA 30329, USA.
3PATH, 2201 Westlake Avenue, Suite 200, Seattle, WA 98121, USA.

Early and accurate diagnosis of HIV is key for the reduction of
transmission and initiation of patient care.

The availability of a rapid nucleic acid test (NAT) for use at the point-
of-care (POC) will fill a gap in HIV diagnostics, improving the diagnosis
of acute infection and HIV in infants born to infected mothers.

In this study, we evaluated the performance of non-instrumented nucleic
acid amplification, single-use disposable (NINA-SUD) devices for the
detection of HIV-1 in whole blood using reverse-transcription, loop-
mediated isothermal amplification (RT-LAMP) with lyophilized reagents.

The NINA-SUD heating device harnesses the heat from an exothermic chemical
reaction initiated by the addition of saline to magnesium iron powder.

Reproducibility was demonstrated between NINA-SUD units and comparable, if
not superior, performance for detecting clinical specimens was observed as
compared to the thermal cycler.

The stability of the lyophilized HIV-1 RT-LAMP reagents was also
demonstrated following storage at -20, 4, 25, and 30°C for up to one
month.

The single-use, disposable NAT minimizes hands-on time and has the
potential to facilitate HIV-1 testing in resource-limited settings or at
the POC.

Published by Elsevier B.V.

KEYWORDS: Diagnosis; HIV-1; Nucleic acid amplification; Point-of-care; RNA
__________________________________________________________________
________________________________*_________________________________

14. Extract/No Abstract: Preventing needlestick injuries and blood-borne
infections–not yet there
__________________________________________________________________

https://www.ncbi.nlm.nih.gov/pubmed/25534336

Ugeskr Laeger. 2014 Dec 22;176(52). pii: V66785.
[Preventing needlestick injuries and blood-borne infections–not yet
there].

[Article in Danish]

Lunding S1.

1Lunge- og infektionsmedicinsk Afdeling, Nordsjællands Hospital,
Dyrehavevej 29, 3400 Hillerød. lunding@dadlnet.dk.

[Extract via Google Translate:

With HIV epidemic come in the early 1980s came an increased focus on
health workers risk of infection with blood-borne infections through
needlestick injuries and mucocutaneous blodeksposition. The literature
shows that about 60 pathogens, including 26 virus and 18 bacteria /
Rickettsia species is described to be transferred [1]. Recently, there has
been focus on the risk of infection with Ebola virus among health workers
in several West African countries. Attention, however, have focused
primarily on the risk of infection with HIV and hepatitis B and C, which
are the majority of the reported cases of infection ….
__________________________________________________________________
________________________________*_________________________________

15. News

– China: Shenyang Woman in Legal Battle After Vaccination Gone Bad
Victim seeks compensation after contracting painful, lifelong kidney
disease

– Canada: Needle exchange program distributes 70,000 needles per month
Harm reduction program successful at decreasing transmission of blood-
borne illnesses

– Australia: Guards vote down prison needle exchange, health advocates
threaten legal action

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/z85zk33
Australia: Guards vote down prison needle exchange, health advocates
threaten legal action

Christopher Knaus, Canberra Times, Canberra ACT Australia (16.09.16)

Guards at the ACT’s jail have voted overwhelmingly against a needle
exchange at the Alexander Maconochie Centre, a move described as “bitterly
disappointing” by Justice Minister Shane Rattenbury and public health
advocates.

The vote leaves the government’s plans for a prison needle and syringe
program in serious jeopardy, and means a key element of the Labor-Greens
2012 parliamentary agreement has not been achieved.

[Justice Minister Shane Rattenbury described the result as “bitterly
disappointing” but said he would continue to fight for a needle exchange
if re-elected. Photo: Rohan Thomson]

The guards voted down the needle exchange 151 to four, following more than
a year of consultation and negotiations.

The needle exchange was designed to prevent inmates from sharing and using
dirty needles behind bars in an effort to curb the spread of hepatitis and
other blood-borne diseases.

Guards strongly opposed the plan, saying giving inmates needles was
unworkable and would put them in considerable danger.

Following a lengthy stalemate, the government and Community and Public
Sector Union, which represents guards, struck an agreement to consider a
needle syringe model that would address the concerns of guards.

Public Health Association of Australia chief executive officer Michael
Moore, a former ACT health minister and one of the key proponents of the
needle exchange, said the result of the ballot was not surprising.

Mr Moore signalled he was considering legal action to try to force the
government to implement a needle exchange at the Alexander Maconochie
Centre.

“This is, of course, not surprising but very disappointing,” he said. “I
think we have now wasted three or four years in getting to this stage.

“I don’t consider the issue dead at all, the next step is to consider
legal avenues and the role of government in terms of duty of care.

“We know a number of people have become Hepatitis C positive at the jail.
We know exactly how this could have been prevented.”

But the union said guards had participated in good faith, had listened to
stakeholders like the PHA, and considered all the evidence in weighing up
their vote.

CPSU ACT regional secretary Vince McDevitt said a meeting would now take
place next week to consider the result, and that the government had the
ability to bring on another ballot in six months.

But he said he hoped the government understood the ballot showed an
overwhelming consensus.

“We participated in this thing in good faith, and at the end of the day
the sentiment of officers was they didn’t think it was a good idea, they
didn’t support it,” he said.

“I think the 97 per cent rejection of the proposal speaks volumes and the
government will need to think through whether they choose to further
pursue the initiative.”

He said the PHA’s threat of legal action was “curious”.

“I’m curious given that all stakeholders to date have indicated that
without the support of correctional officers on the ground, no needle
syringe program could succeed,” he said.

“So the notion that any party would seek to unilaterally impose a regime,
a needle syringe regime, on a workforce is indeed curious.”

Mr Rattenbury said the result was bitterly disappointing, but that he
would continue to push for a needle exchange at the jail, should he be re-
elected in October.

Mr Rattenbury said that, despite the vehement opposition of guards, he had
remained optimistic and felt real progress was being made in addressing
the concerns of guards.

He said that optimism now felt misplaced. “I don’t think this is an
acceptable outcome to simply say we’re not going to take any steps here to
address this public health issue,” Mr Rattenbury said.

“It’s deeply concerning to me that detainees continue to contract blood-
borne viruses, we know that there are viable models to prevent it. They
work in other jails around the world, it’s proven that you can make it
work.”
__________________________________________________________________
__________________________________________________________________

https://tinyurl.com/gvpgkgf
Canada: Needle exchange program distributes 70,000 needles per month
Harm reduction program successful at decreasing transmission of blood-
borne illnesses

by Jonathan Migneault, Sudbury.com, Ontario Canada (16.09.16)

[ The Sudbury and District Health Unit’s needle exchange program
distributed 140,000 needles over a two-month period, in July and August
2016. File photo.]

Ginette Cyr, a public health nurse with the health unit, said those
numbers – distributing 70,000 needles per month – are in line with figures
before the health unit took over administration of the program earlier
this year.

“It’s in line with what was previously distributed. It’s not an increase,”
Cyr said. “It’s been noted across the province that there is an increase
in injection drug use.”

During the same two-month period the health unit’s location at the Rainbow
Centre – one of two fixed sites that distributes clean needles to drug
users – recorded 450 visits for that purpose.

Cyr said Greater Sudbury has not been immune to the increased use of
opioids like fentanyl across the country.

In June, the health unit reported 124 people in Greater Sudbury died from
drug toxicity between 2008 and 2014.

Of those 124 drug-related deaths, 108 were due to prescription drugs,
primarily opioids like fentanyl and morphine.

“I would say that is a dramatic underestimate of the fatalities,” Dr. Mike
Franklyn, who practices addictions treatment in 13 communities across
Northern Ontario, said at the time.

Franklyn said the statistics underestimate deaths from drug overdoses
because fatalities are often attributed to other causes, like underlying
medical conditions, during autopsies.

The city’s needle exchange program, called The Point, is meant to reduce
the risk drug users might contract blood-borne diseases like HIV,
Hepatitis B and Hepatitis C.

Cyr said the program has proven successful in that regard.

The needle exchange program also puts drug users in contact with outreach
workers with the health unit and its three partner organizations: the
Sudbury Access

Centre for Youth, Réseau Access Network and the Ontario Aboriginal HIV/
AIDS Strategy.

Cyr said that if drug users say they would like to get help when
collecting their clean needles, the outreach workers and health-care
professionals can refer them local treatment programs.
__________________________________________________________________
__________________________________________________________________

https://tinyurl.com/gn5xhvf
China: Shenyang Woman in Legal Battle After Vaccination Gone Bad
Victim seeks compensation after contracting painful, lifelong kidney
disease.

By Yan Jie, Sixth Tone, Shanghai China (08.09.16)

Ever since Liu Haijiao received an inoculation in April 2012 against a
potentially lethal kidney disease, she has faced lawsuits, painful side
effects, and the prospect of lifelong illness.

Sixth Tone’s sister publication The Paper reported on Wednesday that after
years of lawsuits and restitution requests, Liu, 24, is still waiting on
the compensation to which she is legally entitled.

Liu’s case highlights the endless hoops Chinese citizens sometimes have to
jump through in pursuing their legal rights. Just last week, Chinese
Business View reported on the case of a father who has been trying for 12
years to find legal recourse after his son was immunized with what he says
was a fake vaccine.

Liu was vaccinated when she was a student at the Liaoning University of
Traditional Chinese Medicine in Shenyang, capital of Liaoning province in
northeastern China. According to Xu Chunjuan, head of the infectious
disease department at the center for disease control in Shenyang’s Huanggu
District, Liu was the only student to experience adverse side effects out
of the 98 who received the inoculation.

The day after she was vaccinated, blood in Liu’s urine had turned it
orange — “the color of tea,” as she described it. As a side effect of the
injection, Liu had contracted a painful chronic kidney disease, which she
said is likely to get worse over time.

Liu filed her first lawsuit against the district’s center of disease
control in 2014, hoping to receive compensation. She lost the suit because
she did not have the right certificates proving the vaccine had caused her
illness. In September 2015 and July 2016, she managed to obtain two such
documents from both the city and provincial medical associations.

According to district health authorities, Liu can now expect to receive
compensation of about 25,000 yuan ($3,700). But this, said Liu, is far too
low. “I think it should amount to between 300,000 and 400,000 yuan at
least,” she said, adding that her family had spent nearly 40,000 yuan on
the treatment, medical certificates, and litigation.

At the end of August, Liu submitted her application for a higher
compensation package to the district center for disease control. She is
still waiting on a result.

Liu also filed a second lawsuit in December 2014 against her university’s
affiliated hospital, where she was inoculated, and against the Changchun
Institute of Biological Products, which produced the vaccine. A ruling is
still pending.

In 2013, the year following Liu’s vaccination, the reported rate of
adverse events following immunizations in China was 1.66 per 100,000
vaccinations. This falls within the range set by the World Health
Organization, according to the Chinese Center for Disease Control and
Prevention.

Du Yifang, an associate professor at the law school of Fudan University in
Shanghai, keeps track of vaccine-related cases like Liu’s. He told Sixth
Tone that even good-quality vaccines can sometimes have serious side
effects. But, he said, Liu was in a relatively good situation compared
with other victims because she had managed to acquire the necessary
medical certificates. “To some extent, she is lucky,” Du said.

(Header image: Rafe Swan/Cultura/VCG))
__________________________________________________________________
________________________________*_________________________________

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
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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
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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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* Subscribe or unsubscribe by email: signmoderator@googlegroups.com

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The SIGNpost website provides an archive of all SIGNposts, meeting
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signs and symbols, and video.
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________________________________*_________________________________

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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