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SIGNpost 00590

*SAFE INJECTION GLOBAL NETWORK*  SIGNPOST  *SAFE INJECTION GLOBAL NETWORK*

Post00590    YourSpace + Abstracts + Grants + News     16 March 2011

CONTENTS
1. This is Your Space for posting your Notes on Progress, Activities,
Articles, and SIGN country network news
2. Abstract: A review of hepatitis viral infections in Pakistan
3. Abstract: Frequency of hepatitis B and C in rural and periurban Sindh.
4. Abstract:Survey of needle-stick injuries in paediatric health personnel
of 5 university hospitals in Tehran
5. Abstract: Shooting Up: The Interface of Microbial Infections and Drug
Abuse
6. Abstract: Postexposure prophylaxis for deadly bloodborne viral
infections
7. Abstract:An outbreak of skin and soft tissue infection caused by
Mycobacterium abscessus following acupuncture
8. Abstract: Tuberculosis among Health Care Workers
9. Abstract: Neckties for physicians: Yes? No? Maybe?
10. Grant: Enhanced HIV Prevention in the Republic of Uganda under the
President’s Emergency Plan for AIDS Relief (PEPFAR)
11. Grant: Support for Strengthening and Expanding HIV/AIDS Surveillance
Activities in the Republic of South Africa under the President’s
Emergency Plan for AIDS Relief (PEPFAR)
12. News
– India: Maternal deaths: Team from Chandigarh arrives for probe
– India: Test finds 1 of 3 Jodhpur I V samples contaminated
– Hypodermic Needle Puncture Resistance Standard Developed by ASTM
Protective Clothing Committee
– USA: N.Y. Infection Scares Prompt Proposal to Criminalize Reckless
Medical Practices
– Ensure Safe Medication Practices in a Surgery Center: Practical
Solutions and Rules Overview
– India: Three inquiries have been completed
– India: Deadly drip kills another woman in Jodhpur, toll now 16
– USA: Judge rules against class-action status for lawsuit against
Siouxland practice
– India: IPA urges Rajasthan CM to set up hospital pharmacies in all govt
hospitals
– USA: : Lawrence Hospital Surgery Patients Warned of Possible Hepatitis,
HIV Exposure
– USA: Handling Household Medical Waste: What You Should Do To Protect
Yourself, Others
– USA: Sanctions needed to help prevent infection
– Drug Use Increasingly Associated With Microbial Infections
– USA: Rules for Beyond Use Dating of Medications Drawn Into Syringes:
Q&A With Anesthesiologist Dr. Clifford Gevirtz of Somnia
– Philippines: DOH alarmed over rising HIV cases in Cebu
– Rethinking The Syringe: Interview With SafePoint’s Marc Koska Share
– UK: Inquiry begins into contaminated blood
– Africa: US Funding to Train 140,000 African Health Workers
– UK: Doctor who injected her sister with unlicensed drug is struck off
register
– USA: Notes from the Field: Deaths from Acute Hepatitis B Virus
Infection Associated with Assisted Blood Glucose Monitoring in an
Assisted-Living Facility – North Carolina, August-October 2010

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__________________________________________________________________________
_____________________________________*____________________________________

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Articles, and SIGN country network news

Discussion, comments and additions please: sign@uqconnect.net.au
__________________________________________________________________________

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2. Abstract: A review of hepatitis viral infections in Pakistan
__________________________________________________________________________

J Pak Med Assoc. 2010 Dec;60(12):1045-58.

A review of hepatitis viral infections in Pakistan.

Bosan A, Qureshi H, Bile KM, Ahmad I, Hafiz R.

National Institute of Health.

A review of published literature on viral hepatitis infections in Pakistan
is presented. A total of 220 abstracts available in the Pakmedinet and
Medline have been searched. All relevant articles were reviewed to
determine the prevalence of hepatitis viral infections in Pakistan. Two
hundred and three (203) relevant articles/abstracts including twenty nine
supporting references are included in this review.

Of the articles on prevalence of hepatitis infection, seven were related
to Hepatitis A, fifteen to Hepatitis E while the remaining articles were
on frequency of hepatitis B and C in different disease and healthy
population groups. These included eight studies on healthy children, three
on vertical transmission, nineteen on pregnant women, fifteen on healthy
individuals, six on army recruits, thirty one on blood donors, thirteen on
health care workers, five on unsafe injections, seventeen on high risk
groups, five on patients with provisional diagnosis of hepatitis, thirty
three on patients with chronic liver disease, four on genotypes of HBV and
five on genotypes of HCV.

This review highlights the lack of community-based epidemiological work as
the number of subjects studied were predominantly patients, high risk
groups and healthy blood donors.

High level of Hepatitis A seroconversion was found in children and this
viral infection accounts for almost 50%-60% of all cases of acute viral
hepatitis in children in Pakistan.

Hepatitis E is endemic in the country affecting mostly the adult
population and epidemic situations have been reported from many parts of
the country.

The mean results of HBsAg and Anti-HCV prevalence on the basis of data
aggregated from several studies was calculated which shows 2.3% and 2.5%
prevalence of HBsAg and Anti-HCV in children, 2.5% and 5.2% among pregnant
women, 2.6% and 5.3% in general population, 3.5% and 3.1% in army
recruits, 2.4% and 3.6% in blood donors, 6.0% and 5.4% in health care
workers, 13.0% and 10.3% in high risk groups, 12.3% and 12.0% in patients
with provisional diagnosis of hepatitis and 25.7% and 54% in patients with
chronic liver disease respectively.

This review has illustrated the high endemicity of hepatitis viral
infections in Pakistan where hepatitis B and C potentially account for a
serious burden of the disease.

This review has triggered the launching of a network intervention for the
control of hepatitis viral infectious. This review was used as the basis
for the launch of hepatitis programme, but putting it into a formal review
took time and the hepatitis program was initiated.
__________________________________________________________________________
_____________________________________*____________________________________

3. Abstract: Frequency of hepatitis B and C in rural and periurban Sindh.
__________________________________________________________________________

J Pak Med Assoc. 2010 Oct;60(10):853-7.

Frequency of hepatitis B and C in rural and periurban Sindh.

Aziz S, Khanani R, Noorulain W, Rajper J.

Medical Unit 4, Civil Hospital Karachi, Dow University of Health Sciences,
Karachi, Pakistan.

OBJECTIVES: To determine the frequency of HBV and HCV and identify risk
factors for transmission of these viruses in rural and periurban Sindh.

METHOD: This is a descriptive/cross sectional study done between June 2007
to May 2008, in which screening and evaluation of risk factors for
Hepatitis B virus surface antigen (HBsAg) and HCV Antibody. (Anti-HCV) in
two remote villages namely Taluka Tharo Shah and Jalbani, District
Nausheroferoz (where investigators had to walk in the area to reach the
population) and a subsection of Gharo District Thatta (periurban area) was
done. Included were children of more than one year of age and all
previously unscreened adults who were counseled and a written consent was
obtained. All drug addicts by history were excluded. A structured
information sheet regarding risk factors was filled and screening done by
immunochromatography (ICT) kits.

RESULTS: Of the 573 subjects enrolled who met the inclusion criteria,
females were 52.5%. Mean age (years) of participants was 24.74 +/- 14.41.
In two remote villages 7.0% were HBsAg positive and 28.6% were Anti HCV
reactive, whereas in periurban area 3.1% were HBsAg reactive and 3.9% were
Anti HCV positive. In the analysis of risk factors for transmission of
infection, blood related factors especially for HCV like surgical, dental
procedures and body piercing were main factors noted more in rural as
compared to the periurban area.

CONCLUSION: The frequency of HCV in our study is alarming and that of HBV
also quite high which underline the need of mass HBV vaccination. Overall
(in both urban and rural areas) immediate steps must be taken to reduce
transmission of these viruses by limiting use of unsafe
(unsterilized/reused) injections for therapeutic purposes), razor blades,
body piercing equipment and proper sterilization of surgical, dental and
circumcision equipment.
__________________________________________________________________________
_____________________________________*____________________________________

4. Abstract:Survey of needle-stick injuries in paediatric health personnel
of 5 university hospitals in Tehran
__________________________________________________________________________

J Pak Med Assoc. 2011 Feb;61(2):127-31.

Shiva F, Sanaei A, Shamshiri AR, Ghotbi F.

Pediatric Infections Research Center, Department of Pediatrics, Shahid
Beheshti University of Medical Sciences, Tehran, Iran.

OBJECTIVE: To study the prevalence and correlates of needle-stick injury
in the health personnel of the Paediatric Department of five university-
affiliated hospitals in Tehran, from April till June 2009.

METHODS: Cross-sectional questionnaire survey. Physicians undergoing
paediatric training and nurses working in the paediatric departments
filled up a pre-designed questionnaire. Relevant variables were compared
between doctors and nurses.

RESULTS: Three-hundred fifty-five health personnel were enrolled. Of these
49.3% had incurred needle stick injury at least once, 36.7% doctors and
54.9% nurses (p=0.002). Nurses fared better than the doctors as regards
knowledge about hazards of improper needle disposal. Correct answers from
doctors and nurses respectively were: 45.6% vs. 59.3% about needle
separation and 41.9% vs. 81.2% about recapping, (p=0.02 and <0.001).
Doctors 11.1% and Nurses 37.7% believed injections to be better than oral
medication for children, (p<0.001), however, 68.9% of doctors and 46.6% of
nurses believed that parents preferred injections to oral medicines for
their children, (p<0.001). Only 26.6% knew about auto-disable syringes.
Vaccinated against Hepatitis B was present in 92.7%. Doctors 58.7% and
55.3% nurses knew HBV to be the most common needle transmitted infection,
(p=0.56).

CONCLUSION: Needle-stick injuries are common among Paediatric health care
personnel and their knowledge about prevention strategies is suboptimal.
Most, health personnel are immunized against Hepatitis B.
__________________________________________________________________________
_____________________________________*____________________________________

5. Abstract: Shooting Up: The Interface of Microbial Infections and Drug
Abuse
__________________________________________________________________________

J Med Microbiol. 2011 Mar 9.

Shooting Up: The Interface of Microbial Infections and Drug Abuse.

Kaushik KS, Kapila K, Praharaj AK.

1 University of Texas at Austin, Austin, USA;

Illicit drug control has been on the global agenda for more than a
century. Infections have long been recognized as one of the most serious
complications of drug abuse. Drug users are susceptible to pulmonary,
endovascular, skin and soft tissue, bone and joint and sexually
transmitted infections caused by a wide-range of bacterial, viral, fungal
and protozoal pathogens. In addition, IDUs are at increased risk for
parenterally acquired infections such as the human immunodeficiency virus
(HIV), Hepatitis B virus (HBV), Hepatitis C virus (HCV), tetanus and
malaria.

Factors related to drug use such as unsterile injection practices,
contaminated drug paraphernalia and drug adulterants, increase exposure to
microbial pathogens. Illicit drugs also affect several components of the
complex immune system and thus modulate host immunity. In addition,
lifestyle practices such as multiple sexual partners, overcrowded housing
arrangements and malnutrition serve as co-factors in increasing the risk
of infection.

In this review we present an overview of the unique aspects of microbial
pathogenesis, immune modulation and common infections associated with drug
use. We have restricted the definition of drug abuse to the use illegal
drugs (such as opiates, marijuana, cocaine, heroin and amphetamines), not
including alcohol and nicotine.
__________________________________________________________________________
_____________________________________*____________________________________

6. Abstract: Postexposure prophylaxis for deadly bloodborne viral
infections
__________________________________________________________________________

J Environ Pathol Toxicol Oncol. 2010;29(4):293-315.

Postexposure prophylaxis for deadly bloodborne viral infections.

Edlich RF, Gubler K, Wallis AG, Clark JJ, Dahlstrom JJ, Long WB 3rd.

Biomedical Engineering and Emergency Medicine, University of Virginia
Health System, Charlottesville, VA, USA. richardedlich@gmail.com

The purpose of this report is to discuss management of operating room
personnel who have had occupational exposure to blood and other body
fluids that might contain hepatitis B virus (HBV), hepatitis C virus
(HCV), human immunodeficiency virus (HIV), and human T-cell lymphotropic
virus type I (HTLV-I). HBV postexposure prophylaxis includes starting
hepatitis B vaccine series in any susceptible unvaccinated operating room
personnel who sustain an exposure to blood or body fluid during surgery.

Postexposure prophylaxis with hepatitis B immune globulin (HBIG) is an
important consideration after determining the hepatitis B antigen status
of the patient. Ideally, all operating room personnel should be vaccinated
with hepatitis B vaccine before they pursue their career in surgery.
Immune globulin and antiviral agents (eg, interferon with or without
ribavirin) should not be used for postexposure prophylaxis of operating
room personnel exposed to patients with HCV; rather, follow-up HCV testing
should be initiated to determine if infection develops.

Postexposure prophylaxis for HIV involves a basic four-week regimen of two
drugs (zidovudine and lamivudine; lamivudine and stavudine; or didanosine
and stavudine) for most exposures. An expanded regimen that includes a
third drug must be considered for HIV exposures that pose an increased
risk for transmission. When developing a postexposure prophylaxis regimen,
it is helpful to contact the National Clinicians’ Postexposure Prophylaxis
Hotline, (888) 448-4911.

Prevention should be a major consideration in postexposure prophylaxis
with the use of the double-glove hole indication system by all operating
room personnel.
__________________________________________________________________________
_____________________________________*____________________________________

7. Abstract:An outbreak of skin and soft tissue infection caused by
Mycobacterium abscessus following acupuncture
__________________________________________________________________________

Clin Microbiol Infect. 2010 Jul;16(7):895-901.

An outbreak of skin and soft tissue infection caused by Mycobacterium
abscessus following acupuncture.

Koh SJ, Song T, Kang YA, Choi JW, Chang KJ, Chu CS, Jeong JG, Lee JY, Song
MK, Sung HY, Kang YH, Yim JJ.

Epidemic Intelligence Service, Division of Public Health and Hygiene
Policy, Gyeonggi Provincial Office, Seoul, Korea.

Although outbreaks of Mycobacterium abscessus infection have been
reported, none of these reports has identified the potential sources of
infection and modes of transmission.

In April 2008, we identified and investigated an outbreak of M. abscessus
skin and soft tissue infections following acupuncture among the patients
who visited an oriental medical clinic. Active surveillance of patients
who had visited the clinic was conducted to define the extent of the
outbreak. Environmental cultures and a case-control study were performed
to elucidate the source of infection and mode of transmission.

From 1002 patients interviewed, 109 patients were identified as having
suffered M. abscessus skin and soft tissue infections at acupuncture
sites. A single strain of M. abscessus was isolated from the wounds of 31
patients and nine environmental samples, including a diluted
glutaraldehyde solution.

The case-control study revealed that a higher numbers of visits to the
clinic for acupuncture (adjusted OR (aOR) 20.12; 95% CI 4.34-93.35) and
the use of interferential current therapy or low-frequency therapy (aOR
36.12; 95% CI 5.54-235.44) were associated with the development of M.
abscessus infection.

The contaminated diluted glutaraldehyde solution that was used to
disinfect the physical therapy devices may have been the source of the
outbreak of M. abscessus infection in the 109 patients who underwent
acupuncture.
__________________________________________________________________________
_____________________________________*____________________________________

8. Abstract: Tuberculosis among Health Care Workers
__________________________________________________________________________

Emerg Infect Dis. 2011 Mar;17(3):488-94.

Tuberculosis among Health Care Workers.

Baussano I, Nunn P, Williams B, Pivetta E, Bugiani M, Scano F.

University “A. Avogadro,” Novara, Italy (I. Baussano); Centro per la
Prevenzione Oncologica-Piemonte, Novara (I. Baussano); Imperial College,
London, UK (I. Baussano); World Health Organization, Geneva, Switzerland
(P. Nunn, B. Williams, F. Scano); University of Turin, Turin, Italy (E.
Pivetta); Centro per la Prevenzione Oncologica-Piemonte, Turin (E.
Pivetta); and Regional Reference Centre for Tuberculosis Prevention, Turin
(M. Bugiani).

To assess the annual risk for latent tuberculosis infection (LTBI) among
health care workers (HCWs), the incidence rate ratio for tuberculosis (TB)
among HCWs worldwide, and the population-attributable fraction of TB to
exposure of HCWs in their work settings, we reviewed the literature.

Stratified pooled estimates for the LTBI rate for countries with low (<50
cases/100,000 population), intermediate (50-100/100,000 population), and
high (>100/100,000 population)

TB incidence were 3.8% (95% confidence interval [CI] 3.0%-4.6%), 6.9% (95%
CI 3.4%-10.3%), and 8.4% (95% CI 2.7%-14.0%), respectively.

For TB, estimated incident rate ratios were 2.4 (95% CI 1.2-3.6), 2.4 (95%
CI 1.0-3.8), and 3.7 (95% CI 2.9-4.5), respectively. Median estimated
population-attributable fraction for TB was as high as 0.4%. HCWs are at
higher than average risk for TB.

Sound TB infection control measures should be implemented in all health
care facilities with patients suspected of having infectious TB.
__________________________________________________________________________
_____________________________________*____________________________________

9. Abstract: Neckties for physicians: Yes? No? Maybe?
__________________________________________________________________________

Mo Med. 2010 Nov-Dec;107(6):366-7.

Neckties for physicians: Yes? No? Maybe?

Abuannadi M, O’Keefe JH, Brewer J.

Mid America Heart Institute/University of Missouri-Kansas City, USA.

Comment in:
Mo Med. 2010 Nov-Dec;107(6):370-1.
Mo Med. 2010 Nov-Dec;107(6):368-9.

Nosocomial infections, especially those involving resistant
microorganisms, represent one of the challenging problems of modern
medicine. Health care providers play an important role in the transmission
of these infections.

White coats and neckties are among the culprits implicated as vectors for
transmission of infections by health care providers.

Both pathogenic and non-pathogenic bacteria commonly colonize neckties and
avoiding neckties is a simple measure that may prove helpful in our fight
against nosocomial infections.
__________________________________________________________________________
_____________________________________*____________________________________

10. Grant: Enhanced HIV Prevention in the Republic of Uganda under the
President’s Emergency Plan for AIDS Relief (PEPFAR)

Application due date: Application Due Date: 04/27/2011

Crossposted from the US CDC National Prevention Information Network’s
(NPIN) Funding Database with thanks.
http://www.cdcnpin.org/scripts/locates/LocateFund.asp
__________________________________________________________________________

Fund Number: 4297

Fund Title: Enhanced HIV Prevention in the Republic of Uganda under the
President’s Emergency Plan for AIDS Relief (PEPFAR)

Fund Category: HIV/AIDS

Description:
Grant Amounts: Approximate Current Fiscal Year Funding: $350,000;
Approximate Total Project Period Funding: $1,750,000.

The purpose of this program is to improve the effectiveness of HIV
prevention programming in Uganda by improving risk-group targeting,
incorporating evidence-based prevention intervention design, delivering
combination prevention packages at multiple levels, and by strengthening
prevention intervention program monitoring and evaluation.

Measurable outcomes of the program will be in alignment with one (or more)
of the
following performance goals and will be met by the end of project period:
(1) Enhanced Prevention Plan (EPP) developed and implemented utilizing
data from censuses, HIV/AIDS indicator surveys, demographic and health
surveys or other data sources to improve risk-group targeting by
maximizing the use of socio-demographic and epidemiologic data related to
HIV prevalence/incidence.
(2) Develop, incorporate, and strengthen theoretically grounded, evidence-
based prevention interventions and increase the likelihood that evidence-
based interventions will be delivered with sufficient fidelity to
influence mediators, outcomes, and impacts.
(3) EPP delivered to optimize risk reduction by integrating behavioral,
biomedical, and structural interventions that include combination
prevention strategies at multiple levels.
(4) EPP developed to include monitoring and evaluation framework which
includes specific indicators, data sources, and data analysis plan;
implementation planning that delineates the activities, roles, and
responsibilities for EPP activities, and a timeline; and an integration
and dissemination plan.

Sponsor(s):
US Department of Health and Human Services
Public Health Service
Centers for Disease Control and Prevention

Funder’s Fund ID: CDC-RFA-GH11-1164

Application Due Date: 04/27/2011

Award Date: 09/01/2011

Fund Duration: Five years.

Application Process:
Registering your organization through www.Grants.gov, the official agency-
wide E-grant website, is the first step in submitting an application
online. Registration information is located on the “Get Registered” screen
of www.Grants.gov. Please visit www.Grants.gov at least 30 days prior to
submitting your application to familiarize yourself with the registration
and submission processes. The “one-time” registration process will take
three to five days to complete. However, the Grants.gov registration
process also requires that you register your organization with the Central
Contractor Registry (CCR) annually. The CCR registration can require an
additional one to two days to complete.

International organizations also require a NATO CAGE Code (NCAGE). The
NCAGE request may take from two business days to two weeks to complete.
NCAGE is needed before registering with the CCR. After registering with
CCR, the applicant can proceed to register with Grants.gov (See “Other
Submission Requirements” section for more information).

Submit the application electronically by using the forms and instructions
posted for this funding opportunity on www.Grants.gov. If access to the
Internet is not available or if the applicant encounters difficulty in
accessing the forms on-line, contact the HHS/CDC Procurement and Grant
Office Technical Information Management Section (PGO-TIMS) staff at (770)
488-2700 for further instruction.

Number of Awards: 1 award

Award Notes:
Approximate Current Fiscal Year Funding: $350,000; Approximate Total
Project Period Funding: $1,750,000 (This amount is an estimate, and is
subject to availability of funds and includes direct costs for
international organizations or direct and indirect costs for domestic
grantees for all years.)

Eligible Locations: – National – International

Fund Notes:
For program synopsis and guidance, visit the website:
http://tinyurl.com/6fts7ov
or
http://www07.grants.gov/search/search.do;jsessionid=
lm5wN2TYLcCNVQV9MZpNyQgrV2yGGJS1WnW6f9cs2mXbp69wmrVn!-1426519834?oppId=
74913&mode=VIEW.

Application Contact Address:
Tech Info Management Section
DHHS
CDC Procurement & Grants Office
2920 Brandywine Road, MS E-14
Atlanta, GA 30341
United States
Email: pgotim@cdc.gov
Phone: 770-488-2700

Technical Contact Name:
Bradford N Bartholow
Title: Project Officer
Technical Contact Address:
DHHS/CDC
2190 Kampala Place
Dulles, VA 201892190
United States
Email: bnb1@ug.cdc.gov

Contact Note:
Technical Contact Telephone: +256 752 751 036

Support Types:
– Cooperative Agreements

Subject Areas:
– HIV/AIDS Prevention
– International Cooperation
– Program Evaluation
– Program Management

Audiences: – At Risk Persons – Developing Nations

Eligibility:
– City Agencies
– Colleges/Universities
– Commercial Organizations
– Community Based Organizations
– County Agencies
– Hospitals
– International Agencies
– IRS 501 (c)(3) Organizations
– Minority Owned Organizations
– Nonprofit Organizations
– Religious Organizations
– Research Institutions
– State Agencies
– Tribal Organizations
– Woman Owned Organizations

Eligibility Notes:
Eligible applicants that can apply for this funding opportunity are listed
below: Nonprofit with 501C3 IRS status (other than institution of higher
education); Nonprofit without 501C3 IRS status (other than institution of
higher education); For-profit organizations (other than small business);
Small, minority, and women-owned businesses; Universities; Colleges;
Research institutions; Hospitals; Community-based organizations; Faith-
based organizations; Federally recognized or state-recognized American
Indian/Alaska Native tribal governments; American Indian/Alaska native
tribally designated organizations; Alaska Native health corporations;
Urban Indian health organizations; Tribal epidemiology centers; State and
local governments or their Bona Fide Agents (this includes the District of
Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, the
Commonwealth of the Northern Marianna Islands, American Samoa, Guam, the
Federated States of Micronesia, the Republic of the Marshall Islands, and
the Republic of Palau); Political subdivisions of States (in consultation
with States); Non-domestic (non-U.S.) entity; Other (specify).

A Bona Fide Agent is an agency/organization identified by the state as
eligible to submit an application under the state eligibility in lieu of a
state application. If applying as a bona fide agent of a state or local
government, a legal binding agreement, from the state or local government
as documentation of the status is required. Attach with “Other Attachment
Forms” when submitting via www.grants.gov.
__________________________________________________________________________
_____________________________________*____________________________________

11. Grant: Support for Strengthening and Expanding HIV/AIDS Surveillance
Activities in the Republic of South Africa under the President’s
Emergency Plan for AIDS Relief (PEPFAR)

Application Due Date: 04/25/2011

Crossposted from the US CDC National Prevention Information Network’s
(NPIN) Funding Database with thanks.
http://www.cdcnpin.org/scripts/locates/LocateFund.asp
__________________________________________________________________________

Fund Number: 4301

Fund Title: Support for Strengthening and Expanding HIV/AIDS Surveillance
Activities in the Republic of South Africa under the President’s Emergency
Plan for AIDS Relief (PEPFAR)

Fund Category: HIV/AIDS

Description:
Grant Amounts: Approximate Current Fiscal Year Funding: $2,800,000.00;
Approximate Total Project Period Funding: $20,000,000.00.

The purpose of this program is to develop, implement, and evaluate new HIV
surveillance activities, where necessary, or to strengthen current HIV
surveillance activities in South Africa. These activities will enable the
South African government and its partners to monitor and assess the HIV
epidemic through surveys and surveillance to better target resources
nationally.

Applicants are expected to respond to one or more of the following program
activities and submit a separate application and budget for the program
area they intend to implement or work in:
(1) National Population-based Household Survey; (2) National HIV Drug
Resistance Surveillance; (3) National Pharmacovigilence Surveillance; (4)
Surveillance of HIV Positive pre-ART Persons; (5) HIV Surveillance in
Underserved Groups at High Risk or Special Populations such as, but not
limited to, MSM, intravenous drug users, sex workers, discordant couples,
health professionals, migrant workers, military personnel, prisoners,
and/or teachers; (6) Maternal and Infant Mortality Surveillance; (7)
Monitoring the use and outcomes of biomedical HIV prevention
interventions.

Sponsor(s):
US Department of Health and Human Services
Public Health Service
Centers for Disease Control and Prevention

Funder’s Fund ID: CDC-RFA-GH11-1154

Application Due Date: 04/25/2011

Award Date: 09/01/2011

Fund Duration: Five years.

Application Process:
Registering your organization through www.Grants.gov, the official agency-
wide E-grant website, is the first step in submitting an application
online. Registration information is located on the “Get Registered” screen
of www.Grants.gov. Please visit www.Grants.gov at least 30 days prior to
submitting your application to familiarize yourself with the registration
and submission processes. The “one-time” registration process will take
three to five days to complete. However, the Grants.gov registration
process also requires that you register your organization with the Central
Contractor Registry (CCR) annually. The CCR registration can require an
additional one to two days to complete.

International organizations also require a NATO CAGE Code (NCAGE). The
NCAGE request may take from two business days to two weeks to complete.
NCAGE is needed before registering with the CCR. After registering with
CCR, the applicant can proceed to register with Grants.gov (See “Other
Submission Requirements” section for more information).

Submit the application electronically by using the forms and instructions
posted for this funding opportunity on www.Grants.gov. If access to the
Internet is not available or if the applicant encounters difficulty in
accessing the forms on-line, contact the HHS/CDC Procurement and Grant
Office Technical Information Management Section (PGO-TIMS) staff at (770)
488-2700 for further instruction.

Number of Awards: 1 to 7 awards

Award Notes:
Approximate Current Fiscal Year Funding: $2,800,000.00; Approximate Total
Project Period Funding: $20,000,000.00 (This amount is an estimate, and is
subject to availability of funds and includes direct costs for
international organizations or direct and indirect costs for domestic
grantees for all years.)

Eligible Locations: – National – International

Fund Notes:
For program synopsis and guidance, visit the website:
http://tinyurl.com/5s4yx33
or
http://www07.grants.gov/search/search.do;jsessionid=
zL96N5TTGDPL61xvJJF4kvcRNR1SbksWJN1Lyh1TPVDhsvyddZ2J!478093133?oppId=
73993&mode=VIEW.

Application Contact Address:
Tech Info Management Section
DHHS
CDC Procurement & Grants Office
2920 Brandywine Road, MS E-14
Atlanta, GA 30341
United States
Email: pgotim@cdc.gov
Phone: 770-488-2700

Technical Contact Name:
Katherine Robinson
Title: Project Officer
Technical Contact Address:
DHHS/CDC
CDC South Africa
PO Box 9536
Pretoria, 0001
South Africa
Email: robinsonk@sa.cdc.gov

Contact Note:
Technical Contact Telephone: +27-12-424-9000

Support Types: – Cooperative Agreements

Subject Areas:
– HIV/AIDS Prevention
– International Cooperation
– Program Development
– Program Evaluation
– Program Management
– Surveillance

Audiences: – Developing Nations

Eligibility:
– City Agencies
– Colleges/Universities
– Commercial Organizations
– Community Based Organizations
– County Agencies
– Hospitals
– International Agencies
– IRS 501 (c)(3) Organizations
– Minority Owned Organizations
– Nonprofit Organizations
– Religious Organizations
– Research Institutions
– State Agencies
– Woman Owned Organizations

Eligibility Notes:
Eligible applicants that can apply for this funding opportunity are listed
below: Nonprofit with 501C3 IRS status (other than institution of higher
education); Nonprofit without 501C3 IRS status (other than institution of
higher education); For-profit organizations (other than small business);
Small, minority, and women-owned businesses; Universities; Colleges;
Research institutions; Hospitals; Community-based organizations; Faith-
based organizations; Federally recognized or state-recognized American
Indian/Alaska Native tribal governments; State and local governments or
their Bona Fide Agents (this includes the District of Columbia, the
Commonwealth of Puerto Rico, the Virgin Islands, the Commonwealth of the
Northern Marianna Islands, American Samoa, Guam, the Federated States of
Micronesia, the Republic of the Marshall Islands, and the Republic of
Palau); Non-domestic (non-U.S.) entity; Other (specify).

A Bona Fide Agent is an agency/organization identified by the state as
eligible to submit an application under the state eligibility in lieu of a
state application. If applying as a bona fide agent of a state or local
government, a letter from the state or local government as documentation
of the status is required. Attach with “Other Attachment Forms” when
submitting via www.grants.gov.
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12. News

– India: Maternal deaths: Team from Chandigarh arrives for probe
– India: Test finds 1 of 3 Jodhpur I V samples contaminated
– Hypodermic Needle Puncture Resistance Standard Developed by ASTM
Protective Clothing Committee
– USA: N.Y. Infection Scares Prompt Proposal to Criminalize Reckless
Medical Practices
– Ensure Safe Medication Practices in a Surgery Center: Practical
Solutions and Rules Overview
– India: Three inquiries have been completed
– India: Deadly drip kills another woman in Jodhpur, toll now 16
– USA: Judge rules against class-action status for lawsuit against
Siouxland practice
– India: IPA urges Rajasthan CM to set up hospital pharmacies in all govt
hospitals
– USA: : Lawrence Hospital Surgery Patients Warned of Possible Hepatitis,
HIV Exposure
– USA: Handling Household Medical Waste: What You Should Do To Protect
Yourself, Others
– USA: Sanctions needed to help prevent infection
– Drug Use Increasingly Associated With Microbial Infections
– USA: Rules for Beyond Use Dating of Medications Drawn Into Syringes:
Q&A With Anesthesiologist Dr. Clifford Gevirtz of Somnia
– Philippines: DOH alarmed over rising HIV cases in Cebu
– Rethinking The Syringe: Interview With SafePoint’s Marc Koska Share
– UK: Inquiry begins into contaminated blood
– Africa: US Funding to Train 140,000 African Health Workers
– UK: Doctor who injected her sister with unlicensed drug is struck off
register
– USA: Notes from the Field: Deaths from Acute Hepatitis B Virus
Infection Associated with Assisted Blood Glucose Monitoring in an
Assisted-Living Facility – North Carolina, August-October 2010

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

India: Maternal deaths: Team from Chandigarh arrives for probe
Times of India, TNN , India (15.03.11)

JODHPUR: A team of four doctors from the Post Graduate Institute of
Medical Sciences ( PGIMS), Chandigarh arrived in Jodhpur on Monday to
probe the reasons behind the contamination in the IV fluid.

So far, 17 women have died allegedly due to the fluid, besides, three
newborns, at the government-run hospitals in Jodhpur over the past month.

Following separate inquiry by a two-member panel constituted by the state,
and S N Medical College administration, and a recent one ordered by the
divisional commissioner, this is the fourth inquiry into the deaths.

The first two committees, in their reports, had stated identical findings
that blamed the contaminated fluid, and poor hygienic conditions at the OT
and maternity ward at the Umaid Hospital for the deaths.

However, government was reportedly not convinced and ordered another
inquiry to corroborate the findings of the first two committees. The IV
fuid sample has been sent to the Central Drug Laboratory, Kolkata and the
report is expected to arrive in a couple of days.

“Report from Kolkata lab is expected soon so there is no point in
speculating. Let’s wait,” said D K Shringi, director, Rajasthan Drugs
Control.

Meanwhile, Jodhpur district officials had filed a case against the
manufacturing company Parental Surgicals Ltd, Indore that supplied the IV
fluid to the hospitals. Company manager Sanjay Shah was arrested on
February 28 and is in jail since then.

The government however, is yet to take any action against the hosptial
administation, despite the probe committees having pointed out the
unhygienic conditions as one of the causes for the deaths.

Moreover, the IV fluid of the same batch was supplied to several other
hospitals in Rajasthan and a few other states but complications were
reported in Rajasthan only. “Reasons are crystal clear as the management
of the hospital was pathetic,” said a top official from the health
directorate.

“Deaths at the Jodhpur hospitals have also brought to the fore the
indifferent attitude of the politicians across the board who have not
raised a voice on the issue,” said a family member of one of the victims.
The state government has announced Rs 5 lakh compensation to the next kin
of the deceased.

The first three deaths were reported on February 13 at the Umaid Hospital.
Since then, 14 others were shifted to the ICU wards of the super-
speciality M G Hospital and MDM hospital, both attached to the S N Medical
College.

Besides, three women delivered stillborn babies after they developed
complications. The pattern is the same in all the deaths, where after
being administered the IV fluid, women start bleeding profusely leading to
multiple organ failure.

A committee, comprising Himanshu Bhushan and Anjana Saxena from the union
health ministry and Dr Sudha Salhan, ex-HOD of gynaecology from Safdarjung
had suggested that the doctors who administered the IV fluid were neither
trained to administer it nor had any protocols to follow.

Another committee of two doctors from Jaipur, comprising gynaecologist B S
Meena and microbiologist R K Maheshwari, had pointed out pathetic hygienic
conditions at the operation theatre and the labour room of the Umaid
Hospital.
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India: Test finds 1 of 3 Jodhpur I V samples contaminated
Indian Express, India (15.03.11)

Jaipur: One of the three samples of intravenous fluids from Jodhpur’s
Umaid Hospital has tested positive for bacterial contamination. Samples of
the IV fluids suspected to have been responsible for the deaths of 17
pregnant women at the hospital since February 13 were sent to the Central
Drug Lab in Kolkata on February 23.

The result of the test came as another pregnant woman – number 17 –
succumbed to excessive bleeding in Jodhpur on Monday.

Rajasthan Health Minister Aimaudin Ahmed confirmed that the reports of the
Kolkata lab had been released this evening.

“Of the three samples sent, one tested positive for bacterial endotoxins
and failed the drug sterility test,” Ahmed said. “The licences of the two
suppliers of drugs from Jodhpur, Anshul Pharma and Rentographics Pharma,
have been revoked and prosecution against the drug manufacturer Parentral
Surgical India Ltd will now begin.”

Ahmed said doctors at Umaid Hospital had tested samples from three batches
of five per cent dextrose and ringer lactate fluids manufactured by
Parentral Surgical India Ltd on February 21 after the deaths of 12
pregnant women.

“According to the hospital, samples from batches 0002, 0007 and 0077
tested positive for bacterial contamination. According to the report from
the Kolkata lab, batch 0077 tested positive for bacterial contamination,”
Ahmed said.

Senior health officials said that samples sent for testing to Jaipur’s SMS
Hospital too had returned positive results for bacterial contamination.
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__________________________________________________________________________

Hypodermic Needle Puncture Resistance Standard Developed by ASTM
Protective Clothing Committee
Infection Control Today, USA (15.03.11)

Due to risk of infection from bloodborne pathogens such as human
immunodeficiency virus (HIV) and hepatitis C, hypodermic needlesticks pose
a life-safety risk to healthcare professionals, law enforcement officials,
sanitation workers and others. A new ASTM International standard addresses
the unique mechanics of hypodermic needle puncture as related to
protective clothing. ASTM F2878, Test Method for Protective Clothing
Material Resistance to Hypodermic Needle Puncture, was developed by
Subcommittee F23.20 on Physical, part of ASTM International Committee F23
on Personal Protective Clothing and Equipment.

“Over the past several years, a number of new protective equipment
technologies have been developed to prevent needle stick, however, there
has been no standardized test method available for technology developers
and users to reference when conducting comparative analysis,” says John
Cronin, product manager at Warwick Mills Inc., and an F23 member. “With
the publication of ASTM F2878, there is now an appropriate method for
conducting comparative analysis of hypodermic needle puncture resistance.”

Cronin notes that environments in which needlestick-resistant personal
protective equipment is needed are varied and dynamic and that no single
standard can fully replicate the conditions to which this equipment is
exposed. “However, ASTM F2878 addresses a critical gap in users’ ability
to look at overall personal protective equipment performance in a
comprehensive way,” says Cronin. “Users of needle-resistant personal
protective equipment can now make an apples-to-apples performance
comparison when evaluating various forms of protection.”

To purchase ASTM standards, visit www.astm.org and search by the standard
designation number, or contact ASTM Customer Relations (phone:
610-832-9585service@astm.org). ASTM International welcomes and
encourages participation in the development of its standards. For more
information on becoming an ASTM member, visit www.astm.org/JOIN.

ASTM International is one of the largest international standards
development and delivery systems in the world. ASTM International meets
the World Trade Organization (WTO) principles for the development of
international standards: coherence, consensus, development dimension,
effectiveness, impartiality, openness, relevance and transparency. ASTM
standards are accepted and used in research and development, product
testing, quality systems and commercial transactions.
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__________________________________________________________________________

USA: N.Y. Infection Scares Prompt Proposal to Criminalize Reckless Medical
Practices
Irene Tsikitas, OutpatientSurgery.net (15.03.11)

State legislator wants to make it a felony to reuse sharps or engage in
other practices that expose patients to infection.

A New York hospital alerted 10 patients last week that they may have been
exposed to bloodborne pathogens from improperly sterilized surgical trays.
The incident comes amid a state legislator’s push to toughen sanctions on
reckless and negligent practices that expose patients to bloodborne
diseases.

Democratic Assemblyman Ken Zebrowski of New City, N.Y., recently
introduced legislation that would criminalize the act of “reckless
infection of a patient with a communicable disease by a health care
provider,” making it a felony in New York. The law would apply to
“reckless conduct such as the reuse of a syringe, needle or other sharp.”

Mr. Zebrowski’s late father was believed to have contracted hepatitis C
from a tainted blood transfusion he received during surgery in the 1970s.
The assemblyman introduced the bill after it was announced in January that
at least 229 patients treated at the state-run Rockland Psychiatric Center
had potentially been exposed to bloodborne pathogens through shared
lancing devices used to obtain blood samples.

That infection scare was followed up by the news last week that 10
patients who underwent surgery at Lawrence Hospital in Bronxville, N.Y.,
in January were to be tested for hepatitis B and C and HIV because
hospital officials 9 surgical trays hadn’t been properly sterilized.

“There’s no reason why anyone should get hepatitis today through a medical
procedure,” says Mr. Zebrowski. “It just shouldn’t happen.”
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__________________________________________________________________________

Ensure Safe Medication Practices in a Surgery Center: Practical Solutions
and Rules Overview
By Pamela Dembski Hart, Becker’s ASC Review (15.03.11)

The following article is written by Pamela Dembski Hart, CHSP, BS, MT
(ASCP), principal of Healthcare Accreditation Resources.

The nation is witnessing an alarming growth of patient-to-patient
transmission of infectious diseases in outpatient settings. In the last
decade, as many as 150,000 patients in the United States were notified of
potential exposure to hepatitis B virus, hepatitis C virus and HIV due to
lapses in basic infection control practices in healthcare settings.(1)
Reports of these type of incidents continue to occur almost daily. The
majority of these cases derive from the reuse of a syringe intended for a
single use, the re-entry into a vial intended for a single-dose
administration and inadequate or improper sterilization or disinfection of
patient care equipment.

Also, a recent survey conducted (2) of approximately 6,000 healthcare
providers demonstrated recurrent misconceptions and errors regarding
infection prevention and safe injection practices. These results serve as
a reminder that unacceptable practices continue despite efforts to enhance
adherence to infection prevention guidelines. Increased education and
oversight is paramount to improve compliance and decrease the incidence of
bloodborne disease transmission from these unsafe injection practices.
Here are five critical areas ambulatory surgery centers should focus on
and steps to follow to help achieve and maintain medication safety and
safe injection practices.

1. Single-dose vials

Follow aseptic technique and use for one patient only.

Enter only once, for one procedure.

Enter using a new, clean needle and new, clean syringe.

Never use on additional patients.

Discard any medication remaining in the vial at the end of the procedure.

Select the smallest vial size available when purchasing.

Do not pool unused contents from single use vials.

Discard unopened vial according to manufacturer expiration dates.

According to the Institute for Safe Medication Practices, the size of the
single-use vial or the volume contained within does not absolve the
clinician from adhering to the requirements as listed above. Large volume
(as seen with the drug propofol) does not make it suitable for multi-
patient use. Single-use vials traditionally do not contain preservatives
to prevent microbial growth, which may occur after the initial entry into
the vial.

2. Multi-dose vials

Must be labeled by the manufacturers as a multi-dose vial.

Follow aseptic technique. Cleanse the access diaphragm of vials using
friction and a sterile 70 percent isopropyl alcohol, or other approved
antiseptic swab. Allow the diaphragm to dry before inserting any device
into the vial.

If used for more than one patient, use with new needle and new syringe.
Do not reuse syringes. Pathogenic contamination is not visible to the
naked eye and enters the syringe after injection.

Do not access multi-dose vials in the immediate patient area (e.g.,
treatment area, OR, patient rooms or bays). This means withdraw medication
in an area segregated from patient care (medication room or area separated
by a wall or screen).

Label with 28-day expiration (discard) date upon opening or withdrawing
first dose. Discard unopened vials according to manufacturers’ expiration
dates. Note: Some expiration dates for opened vials may be shorter than 28
days and must be disposed of accordingly.

A needle or other device should never be left inserted into a medication
vial septum for multiple uses. This provides a direct route for
microorganisms to enter the vial and contaminate the fluid.

3. IV bags/prefilled syringes

Do not use bags or bottles of IV solutions as a general supply for
multiple patients.

Once the bag is spiked, use within one hour. Discard tubing and bag. Note:
According to APIC, this is an unresolved issue and recommends use as close
as possible to spiking bag. Never spike the bag the night or even hours
before anticipated use.

Same syringe cannot be used for multiple patients to inject medications
into an IV tubing port that is several feet away from another patient’s IV
catheter site.

Everything from the medication bag to the patient’s catheter is a single
interconnected unit. All of the components are directly or indirectly
exposed to the patient’s blood and cannot be used for another patient.

A syringe that intersects through ports in the IV tubing or bags also
becomes contaminated and cannot be used for another patient. Separation
from the patient’s IV by distance, gravity and/or positive infusion
pressure does not ensure that small amounts of blood are not present in
these items.

Pre-filled syringes/medications that are pre-drawn are labeled with the
time of draw, initials of the person drawing, medication name, strength
and expiration date or time. All pre-filled syringes not for immediate use
must be labeled as indicated above.

4. Insulin pens

Insulin pens containing multiple doses of insulin are meant for use by a
single patient only, and are not to be shared between patients.

Identifying the insulin pen with the name of the patient and other patient
identifiers provides a mechanism for verifying that the correct pen is
used on the correct patient, and can help minimize medication errors.

Disposable needle should be ejected from the insulin pen and properly
discarded after each injection. A new needle should be attached to the
insulin pen before each new injection.

Patients should be advised that sharing of their insulin pens could result
in transmission of hepatitis viruses, HIV or other bloodborne pathogens.

5. Adhere to safe injection practices

The following is recommended:

Designate someone to provide ongoing oversight for infection control
issues.

Develop written infection prevention and control policies.
Provide training.

Conduct quality assurance assessments.

Store all medication according to manufacturers’ temperature requirements.

Learn more about Healthcare Accreditation Resources.

References
1) Safe Injection Practices Colition and Safe Injection Policy Task
Force/HONOReform
2) Pugliese G, Gosnell C, Bartley JM, Robinson S. Injection practices
among clinicians in United States health care settings. Am J Infect
Control. 2010;38:789- 98). www.premierinc.com/injectionpractices.
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India: Three inquiries have been completed
Ajay Parmar,TNN, Times of India (14.03.11)

JODHPUR: The government has ordered another inquiry, now involving doctors
from the PGIMER, Chandigarh. Three inquiries have already been completed
into the deaths, while an administrative inquiry is still on. Questions
are being raised on the significance of the latest PGIMER inquiry as a lot
has changed at the hospital since the deaths.

The other inquiries have attributed the deaths to fluid contamination and
pre-existing lacunae at the hospital. Among 16 women, three had delivered
stillborns taking the total death toll to 19 allegedly due to contaminated
glucose administered to these women. These deaths have followed a pattern:
after the IV fluid was administered, the women started bleeding profusely
leading to multi-organ failures and death.

Recently, a committee from the Union health ministry and an ex-HOD of
gynaecology from Safdarjung Hospital (Delhi) had submitted a report that
suggested the doctors administering the IV fluid were neither trained nor
did they follow protocols.

“They were junior doctors who weren’t taught how these fluids needed to be
administered,” said the report. Another committee of two doctors from
Jaipur pointed out pathetic hygienic conditions at Umed Hospital’s
operation theatre and the labour room. One representative of the IV fluid
supplying company is already in judicial custody.
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__________________________________________________________________________

India: Deadly drip kills another woman in Jodhpur, toll now 16
Ajay Parmar,TNN, Times of India (14.03.11)

JODHPUR: Deaths caused by suspected contaminated intravenous fluid in a
Jodhpur government hospital continue with an alarming pattern: another
woman with a premature Caesarean delivery died on Sunday, raising the toll
to 16 in over a month.

Angry family members of Prem Kanwar (30) took her body only after
assurances from Umed hospital that they would consider their demand for
treating the death as caused by IV contamination. The hospital has
reported the case to the district administration.

Prem Kanwar had a premature Caesarean delivery at Umaid Hospital but the
baby could not be saved. Her condition worsened and her uterus was removed
following uncontrolled bleeding.

She was shifted to MG Hospital’s ICU, where she died. Umaid and MG
hospitals are attached to Jodhpur Medical College and Hospital.

”She had been on ventilator since February 18,” said Arvind Mathur,
superintendent, MG Hospital.

There have been 16 such deaths of women since the first week of last
month, blamed on contaminated IV fluid. One more pregnant woman, Sagar
Kanwar, is battling for her life in MG Hospital’s ICU.

A shaken state government has sent samples of the suspected fluid to
Central Drug Laboratory, Kolkata. Its report is expected in two days.

The government has ordered another inquiry, now involving doctors from the
PGIMER, Chandigarh.

Three inquiries have alreday been completed into the deaths, while an
administrative inquiry is still on.

Questions are being raised on the significance of the latest PGIMER
inquiry as a lot has changed at the hospital since the deaths. The other
inquiries have attributed the deaths to fluid contamination and pre-
existing lacunae at the hospital.

Among 16 women, three had delivered stillborns taking the total death toll
to 19 allegedly due to contaminated glucose administered to these women.
………………………………………………………………..
__________________________________________________________________________

USA: Judge rules against class-action status for lawsuit against Siouxland
practice

KTIV, Iowa, USA (13.03.11)

SIOUX CITY, Iowa (KTIV) – A federal judge refuses to expand a lawsuit
against the Siouxland Urology Center in Dakota Dunes, South Dakota.

The suit claims the former patients could have been exposed to blood-borne
infections because medical equipment that was intended for single-patient
use, was reused.

The plaintiffs, all from Iowa, want more than $5-million on allegations
that include negligence, medical malpractice, and emotional distress.

They sought to make it a class action suit representing more than six-
thousand patients.

A statement from the Woods Fuller law firm, representing the plaintiffs
says, “The patients disagree with the ruling and will seek immediate
review of class certification…”

The law firm goes on to say they will appeal.

Video story at: http://www.ktiv.com/Global/story.asp?S=14240672
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__________________________________________________________________________

India: IPA urges Rajasthan CM to set up hospital pharmacies in all govt
hospitals
Peethaambaran Kunnathoor, Chennai, pharmabiz.com, India (12.02.11)

The Hospital Pharmacy Division of the Indian Pharmaceutical Association
(IPA) has urged the Chief Minister of Rajasthan to set up full-fledged
hospital pharmacy departments in all the government hospitals as
recommended by the Hathi Committee in 1975 and National Human Rights
Commission in 1999.

IPA’s appeal is in the wake of the death of 15 pregnant women and three
children at Umaid Hospital in Jodhpur three weeks ago due to the
administration of contaminated IV fluid.

The hospital pharmacy division will approach the central health ministry
as well as the state healthcare managers of all states requesting them to
put up hospital pharmacies in all the urban and rural healthcare
institutions.

Dr R N Gupta, chairman of the Hospital Pharmacy Division in his letter to
Ashokh Ghelot, the Chief Minister, stated that the tragedy would have been
averted had the hospital pharmacy was functioned in the hospital.
Expressing regret over the incident, he said IPA would voluntarily support
and provide all assistance to the government in establishing the full
fledged pharmacy department in every district and Taluk hospitals. He
informed the chief minister that the efficiency and services of the highly
qualified pharmacists in the state can be utilized for establishing a
strong healthcare system in the state of Rajasthan.

He said if the drugs and other healthcare products pass through the hands
of pharmacists, they will check and test the quality, sterility, expiry
date, contamination, etc before passing them into the hands of patients.
According to Gupta, the reason for the terrible incident is the lack of
efficient pharmacists in the hospital. He appealed to the healthcare
managers of other states to be wary of such incidents and take
precautionary measures.

According to reports, it was because of the administration of contaminated
IV fluid that led to the tragedy in which 15 pregnant women and three new-
borns died. Following the incident, the government registered a case
against the drug company, Parental Surgical India Pvt. Ltd which allegedly
supplied the contaminated glucose and arrested its manager, Sanjay Shah.

The Hathi Committee Report of 1975 says that the duties of a hospital
pharmacy department is to verify and check up thoroughly the drug
formulations available for the use of patients, and make close
surveillance with a view to ensuring that patients in hospitals receive
quality drugs. It will also monitor the functioning of the drug stores in
the hospitals.

Dr Gupta said the National Human Rights Commission Report suggests for
urgent need to set up hospital pharmacies under a chief pharmacist who
should be at least a post graduate in hospital pharmacy. The report says
that the department of hospital pharmacy must develop policies and
procedures for procurement of multi-source medical items and their
inventory control, receipts handling, storage, quality control,
distribution, dispensing etc. The hospital pharmacy should review the
purchase of medical supplies from intermediaries like Medical Supply
Division and private agencies.

While emphasizing the need for hospital pharmacy division, Dr Gupta, who
is also a Professor of Pharmaceuticals Sciences, said the hospital
pharmacy with the help of hospital’s Therapeutics Committee should develop
a hospital formulary for IV fluids, selection and distribution of drugs,
safe administration of drugs, rational use of drugs and reporting of drug
product defects.

The department will take initiative to furnish a warehousing facility in
the hospital under proper environmental control and lay down guidelines
for the Good Warehousing Practices.
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__________________________________________________________________________

USA: : Lawrence Hospital Surgery Patients Warned of Possible Hepatitis,
HIV Exposure
Jane Lerner, Journal News, White Plains NY (11.03.11)

Ten surgery patients of Lawrence Hospital Center (LHC) in Bronxville are
being notified of the need to get tested for HIV, hepatitis B and
hepatitis C due to improperly cleaned equipment.

The state Department of Health said the hospital reported that nine
surgical trays were found to have been improperly sterilized after they
had been used during procedures. They had, however, been cleaned and
disinfected.

Letters are being mailed to the 10 patients at risk for blood-borne
infections. The hospital will perform the screenings at no cost.

LHC characterized the situation as an “isolated incident.” On Thursday,
spokesperson Alisa Holland said hospital officials were unavailable to
confirm how the contamination occurred or what actions have been taken to
correct it.

The notice marks the second time in less than one month that an area
health care facility has warned of possible exposure to blood-borne
diseases. In February, more than 200 patients of the state-run Rockland
Psychiatric Center were told they needed to get tested following a case of
hepatitis B transmitted through a lancing device to collect blood samples.

Linda R. Greene, who serves on the board of the Association for
Professionals in Infection Control, said hospitals and other facilities
have become very vigilant about cleanliness. “I don’t think that we are
getting more careless,” she said. “I think that we have become more aware
of the risk of transmission posed by blood-borne pathogens.”

“In order to do due diligence, we really have to notify patients and make
them aware of potential exposure,” said Greene.
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__________________________________________________________________________

USA: Handling Household Medical Waste: What You Should Do To Protect
Yourself, Others
by Klark Byrd, Sidney Sun Telegraph, Nebraska USA (11.03.11)

SIDNEY – Do you know how to properly dispose of household medical waste?
Or that there are state laws regulating the management of infectious
medical waste? If not, you’re not alone.

At some point, every home in America produces some medical waste. Needles
required by diabetics who inject insulin are medical waste – infectious
medical waste, to be exact – but so too are the Band-Aids used on minor
cuts and scrapes.

According to the U.S. Environmental Protection Agency, the Medical Waste
Tracking Act of 1988 defined medical waste as “any solid waste that is
generated in the diagnosis, treatment or immunization of human beings or
animals …,” which includes surgical gloves, swabs, lancets, needles and
bandages.

Far too often, hospitals like Sidney’s own Memorial Health Center are
inadvertently put at risk when a person seeking proper disposal for their
household medical waste brings it into the hospital.

“As a facility, we are approached regularly by the community to dispose of
such items as insulin syringes and capped/uncapped needles that are not
properly sealed or contained, setting the hospital at risk for exposure of
infectious diseases,” said Greg Dyson, MHC Director of Quality.

MHC does not accept medical waste from outside its own operations, and
that’s not an uncommon practice for hospitals or clinics throughout the
state, according to the Nebraska Department of Environmental Quality.

Jim Harford, NDEQ’s waste assistance coordinator, said commercial waste
collection is done by weight and that he doesn’t “think anybody is looking
for increased medical costs.”

“The public shouldn’t expect them to do that, it is an additional cost for
them,” he said. “And if you’ve got a needle that goes through a hospital,
they can autoclave it and it still ends up in the landfill.”

Despite the costs, Harford said some clinics do take household medical
waste as a service to their patients, but patients can just as easily and
safely manage the waste themselves.

Non-infectious household medical waste is considered just another solid
waste product to be disposed of in a permitted municipal landfill. But,
Harford said, the disposal of infectious waste, which includes sharps
(needles and lancets) and wastes contaminated with blood or body fluids,
is a special waste product that must undergo proper management techniques.

Medical waste guidelines written by the NDEQ suggest that infectious waste
material should either be treated in a way that makes it no longer
infectious or should be properly packaged to reduce the risk of exposing
others.

Harford said sharps, the most common of infectious medical wastes, should
be placed into an easily-sealed thick, opaque, plastic container. Harford
suggests using a heavy laundry detergent bottle because they have large
mouths, strong caps and are constructed of thick plastic.

When the bottle is ready for disposal, Harford said seal the cap tight and
do not label it as biohazard material.

“Don’t label it to let people know the contents,” he said. “Let’s not tell
everybody that you’ve got syringes out there in the street. There are
people out there who want those syringes. Anyone can go through your
garbage and it’s perfectly legal.”

And though Harford says that once the container is in the compactor
trucks, it’s no longer a danger, Sidney’s Solid Waste Department
Superintendent Rob Campbell suggests bringing the bottle to the landfill
office. He said it would further reduce the risk to solid waste employees
as the bottle, if disposed with other trash, could burst open in the
bailer.

“The other thing we like to stress is that the landfill itself is a safe
depository for this stuff,” Harford said. “They’re engineered to handle
it, they’re double-lined, they have ground water management. They are
inspected closely by the department, the waste is going to the right
place.”

For more information on NDEQ regulations for medical waste disposal, visit
its website at http://www.deq.state.ne.us. To learn more about the safe
disposal of needles, including options for home needle destruction
devices, visit http://www.safeneedledisposal.org.
………………………………………………………………..
__________________________________________________________________________

USA: Sanctions needed to help prevent infection
The Journal News, LoHud.com, New York USA (11.03.11)

Once again, people treated at an area hospital, ostensibly there to get
better, have been warned that they could have been exposed to blood-borne
illnesses via medical equipment. This time the venue was Lawrence Hospital
in Bronxville. The circumstances there, while not fully detailed, add more
impetus for sanctions being pushed in the Legislature by a Rockland
lawmaker.

A bill recently introduced by state Assemblyman Ken Zebrowski, D-New City,
would create a felony charge for medical professionals who expose patients
to blood-borne diseases through reckless acts, like reusing syringes or
other clearly dangerous actions. Not all patient-to-patient transmissions
would reach that threshold, but for the most egregious cases of
negligence, serious sanctions should be brought.

Cause for alarm

On Thursday, the New York State Department of Health announced that 10
surgical patients at Lawrence Hospital were possibly exposed to hepatitis
B, hepatitis C and/or HIV after hospital staff discovered that nine
surgical trays had not been correctly sterilized. Equipment placed on the
trays could have led to exposure, but state officials say the risk of
exposure is low.

Last month, state health officials reported that Rockland Psychiatric
Center in Orangeburg was warning 229 people that blood-sugar tests
conducted during their hospitalizations put them at risk for disease
exposure. Lancets that stick the finger were changed, but the pen device
that held the lancet was shared among patients. Blood was found in the
barrel of the pen. One new case of hepatitis B has been linked to a
patient with a chronic form of the disease.

In 2007, a Long Island anesthesiologist exposed his patients by reusing
syringes; in 2008, a Las Vegas clinic had to alert 40,000 former patients
after it had reused syringes and vials of medication for six years. In
2009, Northern Westchester Hospital notified 2,700 former patients of
possible exposure to hepatitis C after a former surgical technician
admitted injecting herself with pain medication and returning tainted
syringes for use in surgery while working at two Colorado medical centers.
………………………………………………………………..
__________________________________________________________________________

Hypodermic Needle Puncture Resistance Standard Developed by ASTM
Protective Clothing Committee
Press release, ASTM International, PA USA (11.03.11)

W. CONSHOHOCKEN, Pa.- Due to risk of infection from blood-borne pathogens
such as human immunodeficiency virus and hepatitis C, hypodermic needle
sticks pose a life-safety risk to healthcare professionals, law
enforcement officials, sanitation workers and others. A new ASTM
International standard addresses the unique mechanics of hypodermic needle
puncture as related to protective clothing. ASTM F2878, Test Method for
Protective Clothing Material Resistance to Hypodermic Needle Puncture, was
developed by Subcommittee F23.20 on Physical, part of ASTM International
Committee F23 on Personal Protective Clothing and Equipment.

“Over the past several years, a number of new protective equipment
technologies have been developed to prevent needle stick, however, there
has been no standardized test method available for technology developers
and users to reference when conducting comparative analysis,” says John
Cronin, product manager, Warwick Mills Inc., and an F23 member. “With the
publication of ASTM F2878, there is now an appropriate method for
conducting comparative analysis of hypodermic needle puncture resistance.”

Cronin notes that environments in which needle stick-resistant personal
protective equipment is needed are varied and dynamic and that no single
standard can fully replicate the conditions to which this equipment is
exposed. “However, ASTM F2878 addresses a critical gap in users’ ability
to look at overall personal protective equipment performance in a
comprehensive way,” says Cronin. “Users of needle-resistant personal
protective equipment can now make an apples-to-apples performance
comparison when evaluating various forms of protection.”

To purchase ASTM standards, visit www.astm.org and search by the standard
designation number, or contact ASTM Customer Relations (phone:
610-832-9585service@astm.org). ASTM International welcomes and
encourages participation in the development of its standards. For more
information on becoming an ASTM member, visit www.astm.org/JOIN.

ASTM International is one of the largest international standards
development and delivery systems in the world. ASTM International meets
the World Trade Organization (WTO) principles for the development of
international standards: coherence, consensus, development dimension,
effectiveness, impartiality, openness, relevance and transparency. ASTM
standards are accepted and used in research and development, product
testing, quality systems and commercial transactions.

View this release on the ASTM Web site at www.astmnewsroom.org.

ASTM International
100 Barr Harbor Dr., Box C700
West Conshohocken, PA, 19428-2959, USA
………………………………………………………………..
__________________________________________________________________________

Drug Use Increasingly Associated With Microbial Infections
Science Daily (10.03.11)

ScienceDaily – Illicit drug users are at increased risk of being exposed
to microbial pathogens and are more susceptible to serious infections, say
physicians writing in the Journal of Medical Microbiology. The review,
which aims to improve the microbiological diagnosis of drug use-related
infections, assesses the role of drug-related practices in the spread of a
range of bacterial, viral, fungal and protozoal infections.

The review by collaborators from the Armed Forces Medical College, Pune,
India highlights convincing evidence that unsterile injection practices,
contaminated needles, syringes and the use of cutting agents all represent
avenues by which micro-organisms can enter the body. Outbreaks of tetanus,
Group A Streptococcal disease and, more recently, anthrax have all been
documented in illicit drug users.

Drug abuse not only enhances exposure to pathogens but can also increase
the risk of infection by facilitating the local growth of micro-organisms
and suppressing the user’s overall immunity. Dr Karishma Kaushik one of
the authors, says, “Drugs such as cannabis and opiates have been shown to
directly suppress immune function. Methadone has also been shown to
enhance HIV replication in immune cells. What’s more, dead or damaged
tissue at an injection site provides an ideal anaerobic environment for
certain pathogens to grow. The bacterial species Clostridia, for example,
thrive in anaerobic environments and can lead to wound botulism, tetanus
and necrotizing fasciitis — commonly known as the flesh-eating disease.”
The association between drug use and the transmission of certain viral
pathogens is well established. Illicit drug users represent the major risk
group for acquiring hepatitis C infection and also bear a substantial
burden of HIV infection globally. “Drug abuse accounts for at least 10% of
HIV infections globally and this may rise to 40% in the near future,”
explains Dr Kaushik. “Drug use also contributes to the spread of HIV in
non-drug user populations such as from injecting husbands to their non-
injecting wives. Associated lifestyle practices such as multiple sexual
partners are also co-factors in increasing the risk of infection,” she
says.

Dr Kaushik believes that an increased awareness of the microbial
complications associated with drug use will allow better diagnosis and
management of infections in this group. “Infections are one of the most
serious complications of drug abuse. They are frequently encountered in
the hospital setting and constitute a major burden to the health care
system. Yet drug users are a relatively poorly studied cohort of patients
seeking clinical care.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily
staff) from materials provided by Society for General Microbiology, via
EurekAlert!, a service of AAAS.

Journal Reference:

Karishma S. Kaushik, Ketoki Kapila, A. K. Praharaj. Shooting Up: The
Interface of Microbial Infections and Drug Abuse. Journal of Medical
Microbiology, 2011; DOI: 10.1099/jmm.0.027540-0
………………………………………………………………..
__________________________________________________________________________

USA: Rules for Beyond Use Dating of Medications Drawn Into Syringes: Q&A
With Anesthesiologist Dr. Clifford Gevirtz of Somnia

By Rob Kurtz, Becker’s ASC Review (10.03.10)

Clifford Gevirtz, MD, is employed by RAA of New York and practices
anesthesiology throughout New York and Long Island, N.Y. RAA is managed by
Somnia.

Q: As a practicing consultant pharmacist to ambulatory surgery centers, I
am often asked about the beyond use dating of medications drawn into
syringes. Since most ASCs do not have an isolator or glove box for this
procedure, I advocate following USP 797, and consider those pre-drawn
syringes an immediate-use compounded sterile preparation, and suggest a
one-hour beyond use dating. Is this too stringent? Does USP 797 apply in
these situations if they are not IV admixtures but are, for example,
injectable local anesthetics which are not given intravenously?

Dr. Clifford Gevirtz: Yes, I think you (the consulting pharmacist) are
going a bit far in your interpretation. To quote from the USP 797
guideline (www.usp.org/audiences/pharmacist/797FAQs.html):

“The beyond use data after initially entering or opening (e.g. needle
punctured) multiple dose container is 28 days.” As an example, a multi-
dose vial of lidocaine that was used to create a skin wheal prior to
starting an IV would be good for 28 days after first being entered.
However, if the expiration date of the vial is sooner than 28 days, then
it expires on that date. Good practice is note the date first entered on
the label.

“The standards in this chapter (USP 797) do not pertain to the clinical
administration of CSPs (compounded sterile preparations) to the patient
via…infusion…injection…” i.e., the rate of infusion and duration is
up to the clinician.

The product insert on propofol is of special interest; it states:

“Propofol Injectable Emulsion should be prepared for use just prior to
initiation of each individual anesthetic/sedative procedure. The vial
syringe rubber stopper should be disinfected using 70% isopropyl alcohol.
Propofol Injectable Emulsion should be drawn into sterile syringes
immediately after vials are opened. When withdrawing Propofol Injectable
Emulsion from vials, a sterile vent spike should be used. The syringe(s)
should be labeled with appropriate information including the date and time
the vial was opened. Administration should commence promptly and be
completed within 12 hours after the vials have been opened.”

The imported ampules of propoven actually suggest that the drug be
filtered with a 5 micron needle filter to remove any particulates as part
of the process of drawing up the medication.

Another common issue in providing analgesia in ambulatory settings involve
local anesthetic/opiate infusions. The USP poses this Q&A:

“If a pharmacy prepares an epidural bag of bupivacaine in 100 mL normal
saline, can an anesthesiologist add fentanyl to that same bag on the
floor? If so, what would the BUD (beyond use date) be?

“If fentanyl is added in worse (dirtier) than an ISO Class 5 environment
(outside of a sterile hood), then this becomes an Immediate-Use CSP, for
which there is no administration duration requirement. The Immediate-Use
CSPs’ section states a warning regarding potential harm to patients from
extended administration durations of contaminated CSPs.”
………………………………………………………………..
__________________________________________________________________________

Philippines: DOH alarmed over rising HIV cases in Cebu
PIA Press Release, Philippine Information Agency, Philippines (09.03.10)

Injecting drug users behind rising HIV/Aids cases

CEBU CITY, Mar 9 (PIA) – Health officials are alarmed over the rising
cases of the dreaded human immunodeficiency virus (HIV) in Cebu due to
drug use as the Department of Health (DOH) recently gathered partner
agencies and stakeholders in a consultative meeting to address the public
health threat.

DOH National Epidemiology Center Director Dr. Eric Tayag bared injecting
drug users have caused the increasing spread in the number of HIV cases
not only in Cebu but throughout the country due to the sharing of needles
from an infected person to another.

HIV ultimately causes the fatally Acquired Immune Deficiency Syndrome or
Aids resulting to death.

“Around 80 percent of the HIV/Aids cases we have are largely due to
injecting drug users where the rapid increase of incidence in other
countries is due to the same cause,” Tayag said over a recent interview
over local ANS CBN News.

The DOH official expressed alarm over the fast rate of the HIV/Aids
incidence in Cebu which is estimated at over 200 cases.

Tayag said the country has officially recorded at present more than 5,000
HIV/Aids cases not to mention the unofficial cases.

Just last month, the Cebu City Health Department (CCHD) has recorded two
new HIV cases but declined to give the background of the two individuals,
according to a news report.

Dr. Ilya Tac-an, CCHD Social Hygiene Head said part of their prevention
advocacy drive is the use of condoms which they are promoting 100 percent
to prevent the spread of the killer disease, according to the same news
report.

Although Dr. Joseff Bullecer of the Aids Free Philippines-Cebu argued that
contraceptives is not the remedy to address the rising HIV cases stressing
that abstinence and faithfulness are still the best way to battle HIV.
Distribution of needle syringes to intravenous drug users as part of the
prevention measure has also been done by the CCHD but due to the question
on legality, this was stopped.

Cebu City’s 2011 annual budget has been realigned to finance HIV
prevention programs where at least P25M has been set aside for CCHD of
which part is for the HIV prevention programs, this was learned. (PIA-
Cebu/Fayette C. Riñen)
………………………………………………………………..
__________________________________________________________________________

Rethinking The Syringe: Interview With SafePoint’s Marc Koska Share
PSFK.com (09.03.11)

SafePoint’s founder Marc Koska has been searching for a solution to the
problem that effects Asia and Africa, killing scores of people on a daily
basis. The statistics are staggering. According to SafePoint’s site,
people are unaware of how deadly re-purposing syringes is for patients.
Kids can be injected by the same syringe already used 30-100 times. On a
yearly basis, this leads to 230,000 HIV infections, 21 million Hepatitis
infections, and 1.3 million deaths.

PSFK caught up with Marc to discuss his organization and recent push for
legislative change in developing nations:

What are you working on right now?

I am concentrating on campaigning for legislative change in Pakistan and
Tanzania through SafePoint. This will set the rules for the coming years,
but at the same time providing evidence of reuse through undercover
footage and public information films which we donate to the Government for
distribution.

How did SafePoint come to fruition?

It came about because the product was not enough by itself to guarantee
that the public got safe injections. The developing world public was in
need of information as well so they could demand safe injections as well
as being offered safe. Do you see what I mean – we had to create a
sandwich!

Give us some insight into your creative process and how you designed a
safer needle.

Always from the brief that it a) had to cost the same, b) had to be able
to be made on existing machinery and c) be used in the same way.

What trend makes you optimistic about the future?

Well, I am cautious about the increase in Social Entrepreneurship as an
activity and a buzz word, not because it isn’t a great trend, but because
it isn’t fully understood I believe. Not only is the definition imprecise
to me but also there is a huge range of activities being shoe horned into
the subject. Having said that, at least it exists and it is growing
massively. When I started we didn’t even have the phrase!

Do you feel that transparency is on the rise?

I don’t actually, but I am really encouraged that it is creeping into my
field and others and hope it does take hold. After the banking crisis we
do not see anymore openness in that sector, and I think the same with
International AID and not for profits. But there are examples such as
KIVA, where the connection between the lender and the borrower comes with
a photograph. The world needs a massive change on this subject, but not
sure we will see it sometime soon. I would like to make more and more of
an example in my sector with transparency, and am working on highlighting
this right now. So stay tuned!

Where do you go to find inspiration?

My inspiration comes from kids, especially my own, and any product or
process that focuses on quality rather than quantity. I love to travel,
and finding well made local products is a passion of mine. So much stuff
around the world is the same, and localization has diminished, but finding
something that is hand produced beautifully with care, is special. Wish
there was more!

Thanks Marc!

http://tinyurl.com/4vrfxzd or
http://www.psfk.com/2011/03/rethinking-the-syringe-interview-with-
safepoint%e2%80%99s-marc-koska.html/trackback

PSFK is the go-to source for new ideas for creative business.
………………………………………………………………..
__________________________________________________________________________

UK: Inquiry begins into contaminated blood
By Shan Ross. Scotsman, UK (09.03.11)

THE families of NHS patients whose lives were devastated after being
infected by contaminated blood have said they want lessons to be learned
from the scandal.

Their statement came on the first day of the Penrose Inquiry, set up two
years ago to investigate how hundreds of people in Scotland were infected
with hepatitis C and HIV following blood transfusions in the 1970s and
1980s.

The inquiry, which opened in Edinburgh yesterday with a one-minute
silence, is expected to run until 31 March. Evidence will be heard from
victims’ relatives, hepatologists and representatives from the Scottish
National Blood Transfusion Service.

Reading out the families’ statement on the steps of the inquiry, Patrick
McGuire, of Thompsons Solicitors, said: “HIV and hepatitis C have had a
devastating effect on the lives of the victims.

“They have experienced social stigma, financial hardship and their
infection has impacted heavily on the lives of their families.”

The inquiry began yesterday with the death, in November 2004, of Victor
Tamburrini, from Glasgow.

He was involved in a car accident in September 1984 and received a “plasma
protein solution” at Glasgow Royal Infirmary.

By 2001, Mr Tamburrini was diagnosed as having hepatitis C. He received a
liver transplant in 2002 but became ill again and died on 17 November,
2004.
………………………………………………………………..
__________________________________________________________________________

Africa: US Funding to Train 140,000 African Health Workers
AMichelle Faul. Associated Press (08.03.11)

The United States is spending up to $130 million over five years to
develop, expand, and enhance medical education in African countries that
receive support from the President’s Emergency Plan for AIDS Relief
(PEPFAR). In the process, the Medical Education Partnership Initiative
(MEPI) aims to train 140,000 new African health care workers and, in order
to encourage their retention on the continent, to build clinical and
research capacity in Africa.

It is a specific goal of MEPI to “improve and help create environments
that will make professionals want to remain in a country,” said Dr.
Francis S. Collins, director of the National Institutes for Health, which
is funding the initiative with PEPFAR.

“People want to come home more often than not because they know the
devastation that these diseases have wrought and want to help,” said Dr.
Eric Goosby, US global AIDS coordinator. Due to competitive demand amid a
global shortage of health professionals, however, some African countries
find that trained medical professionals who go abroad outnumber those who
remain to work in country.

MEPI will provide grants to African institutions in a dozen countries,
with 30 regional partners, national health and education ministries, and
more than 20 US institutions, including CDC. Twelve countries and 13
schools already have had grants approved. A measure of MEPI’s success will
be in its attraction of peer-reviewed research projects, Collins said.

In South Africa, the University of KwaZulu-Natal received a grant to work
with Columbia University to “enhance training, research capacity, and
expertise in HIV care.” A grant to Stellenbosch University could be used
to help strengthen a recruitment program targeting rural students, said
Dr. Jean Nachega, a university researcher and dean.
………………………………………………………………..
__________________________________________________________________________

UK: Doctor who injected her sister with unlicensed drug is struck off
register
Clare Dyer, BMJ 2011; 342:d1512 (08.03.11)

A doctor who injected her sister with an unlicensed drug that caused her
to have an anaphylactic reaction and die has been struck off the UK
medical register.

Yvonne Pambakian, medical director of a biotechnology company, also
injected her mother and a terminally ill cancer patient with the drug,
known as B-71. Her mother, Arpi Matossian-Rogers, had set up Amro Biotech
and developed the drug, which was intended to reduce insulin
concentrations.

B-71 had been tested on just 41 diabetic patients in the Netherlands, at a
dose of 2 mg, when Dr Pambakian gave her sister ….

http://www.bmj.com/content/342/bmj.d1512.short?etoc
………………………………………………………………..
__________________________________________________________________________

USA: Notes from the Field: Deaths from Acute Hepatitis B Virus Infection
Associated with Assisted Blood Glucose Monitoring in an Assisted-Living
Facility – North Carolina, August-October 2010

Z. Moore, MD; J.-M. Maillard, MD; M. Davies, MD; N. Dailey, MD

Morbidity and Mortalilty Weekly Report Vol. 60; No. 06: P. 182 (18.02.11)

Sharing of blood glucose monitoring equipment at assisted-living
facilities has been linked to at least 16 US outbreaks of hepatitis B
virus infection since 2004. In the current report, state and CDC authors
detail an HBV outbreak at such a facility in North Carolina.

On Oct. 12, 2010, a local hospital notified state and county health
officials that four residents of a single assisted-living facility had
suspected acute HBV infection. North Carolina Division of Public Health
(NCDPH) requested HBV testing of all who were residents of the assisted-
living facility Jan. 1-Oct. 13, 2010. Records were reviewed for possible
care-associated exposures and HBV risk factors. A review of infection
control practices included observations as well as interviews of staff.

Investigators discovered the sharing of reusable fingerstick lancing
devices, though they were only approved for single-patient use, as well as
the sharing of blood glucose meters without cleaning and disinfecting
between patients. Of eight residents who met criteria for outbreak-
associated HBV, all had been hospitalized and six had died from hepatitis
complications. All were among the 15 facility residents assisted in
monitoring blood glucose; no one who had not been assisted with blood
glucose monitoring was infected.

“Despite long-standing and recently expanded infection control
recommendations, HBV transmission continues to occur through sharing of
fingerstick lancing devices and other blood glucose monitoring equipment,”
the report said. “These practices put residents at risk for severe illness
and death. In accordance with NCDPH recommendations, the facility now uses
individually assigned blood glucose meters and single-use, autodisabling
fingerstick lancing devices. The facility also offered HBV vaccine to all
susceptible residents. NCDPH and the state licensing agency issued a
notification to all health care providers and licensed health care
facilities statewide warning of the potential for HBV transmission through
unsafe diabetes care practices.

“This outbreak underscores the need for increased efforts to promote
compliance with infection control guidelines in assisted-living
facilities,” the authors concluded.
__________________________________________________________________________
_____________________________________*____________________________________
__________________________________________________________________________
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