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SIGNpost 00591

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

Post00591  HW Code + SEDs + Assessment + Abstracts + News    23 March 2011

CONTENTS
1. World Hepatitis Day 28 July 2011 – Brief notes for collaborators
2. WHO Online Public Hearing: Guidelines for monitoring the implementation
of the WHO Global Code of Practice on the International Recruitment of
Health Personnel
3. New Injection Safety Resource from AIDSTAR-One
4. Passive safety device features 10 times more effective in preventing
needlesticks
5. IFC Self-Assessment Guide for Health Care Organizations
6. Abstract: Notification and support for people exposed to the risk of
Creutzfeldt-Jakob disease (CJD) (or other prion diseases) through
medical treatment (iatrogenically)
7. Abstract: Emergent viral threats in blood transfusion
8. Abstract: International databases: usefulness and limitations in
hemovigilance
9. Abstract: Patient safety and root cause analysis
10. Abstract: European regulation on blood and blood components
11. Abstract: The assessment of infection control in dental practices in
the municipality of São Paulo
12. Abstract: Changes in blood-borne infection risk among injection drug
users
13. Abstract: Infection disclosure in the injecting dyads of Hungarian and
Lithuanian injecting drug users who self-reported being infected with
hepatitis C virus or human immunodeficiency virus
14. Abstract: HIV prevalence in prison is 15 times greater than in the
community as a whole
15. Abstract: Hand hygiene
16. Abstract: What do you mean you can’t sterilize it? The reusable
medical device matrix
17. Excerpt: Control of Viral Infections and Diseases
18. Abstract: HIV Transmitted from a Living Organ Donor — New York City,
2009
19. No Abstract: Waste not. Developing a hospital recycling program
20. 2nd Pre-filled Syringes Americas – Conference
21. The IDRC Doctorate Research Awards Competition is now open!
22. Sixty-fourth World Health Assembly
23. News
– India: Death merchants
– Nevada USA: Health district sends 101 letters advising HIV, hepatitis
tests Tools
– Fiji: Health licenses to be requirement for tattoo outlets
– Nevada USA: Latest Infection Risk Case Spurs Alert
– USA: Some Health Care Workers Maintain Unsafe Injection Practices
– Nevada USA: Board Says Doctor Admitted He Reused Biopsy Needle Guides
– Nevada USA: Bulletin urges health care providers not to reuse single-
use devices Tools
– USA: Hepatitis C transmission still high among injection drug users
– USA: Nurse suspected of infecting 23  patients by ‘stealing drugs from
IV bags with a syringe’
– India: Three Rajasthan doctors suspended for pregnancy deaths
– India: Manufacturer to face legal action for contaminated IV fluids

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More information follows at the end of this SIGNpost!

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

__________________________________________________________________________
_____________________________________*____________________________________

1. World Hepatitis Day 28 July 2011 – Brief notes for collaborators
__________________________________________________________________________

World Hepatitis Day 2011 – Brief notes for collaborators requesting
information

Background:

In 2010 the 63rd World Health Assembly called for a comprehensive response
to viral hepatitis. As mandated by the WHA, from 2011 onwards, World
Hepatitis Day is promoted on 28 July in order to provide an opportunity
for awareness raising and greater understanding of viral hepatitis as a
global public health problem, and to stimulate the strengthening of
preventive and control measures of hepatitis-related morbidity and
mortality in all World Health Organization (WHO) Member States.

The World Hepatitis Alliance is a non-governmental organisation working in
partnership with the WHO to coordinate World Hepatitis Day.

Strategic objective:
The overarching strategic objective of World Hepatitis Day is to convince
key stakeholders of the urgency to take action to prevent, identify and
treat viral hepatitis.

The primary audiences are:
*       Ministries of Health and policy makers
*       Medical and health practitioners
*       The general public
*       Existing advocacy groups and activists

Outreach to these groups can be achieved through:
*       WHO Regional and Country Offices
*       Civil society groups
*       The media
*       Professional associations
*       Academia

Campaign Theme:
This is hepatitis…

Slogan:
Know it. Confront it.  Hepatitis affects everyone, everywhere.
Outcomes:
Desired outcomes include increased awareness and understanding of
hepatitis among the general public, ongoing support for the World
Hepatitis Day cause and a sense of urgency amongst all stakeholders to
prioritise action. Evaluation of the campaign’s success will be based on
indicators including:
*       Number of countries who participate in the World Hepatitis Day
campaign
*       Activities initiated by the WHO Regional Offices
*       Media impact- number of press articles and features
*       World Hepatitis Day website usage -visits and downloads
*       High profile endorsements
*       Increase in partners and quality of collaboration
*       National strategies and allocation of resources

WHO products
*       Technical fact sheets on viral hepatitis
*       Fact files to “visualize” facts around hepatitis
*       WHO web notifications and news updates (e.g.
http://www.who.int/mediacentre/events/annual/world_hepatitis_day/en/)
*       News in WHO Bulletin (June issue)
*       Press release
*       Statement by the Director General of WHO
*       Campaign Poster
*       Audio-visual materials
*       Photo stories and first person accounts
*       Toolkit for WHO country offices and event organizers

WHO Focal Points: download the pdf:
http://uqconnect.net/signfiles/Files/HepDay_PreBriefiExt5.pdf
__________________________________________________________________________
_____________________________________*____________________________________

2. WHO Online Public Hearing: Guidelines for monitoring the implementation
of the WHO Global Code of Practice on the International Recruitment of
Health Personnel

The web-based public hearing and the draft Guidelines can be accessed at
http://bit.ly/eCNlMS

Crossposted with thanks from the Pan American Health Organization,
PAHO/WHO, equity luistserve PAHO/WHO Website: http://new.paho.org/equity/
__________________________________________________________________________

The World Health Organization (WHO) is pleased to announce the launch of a
web-based public hearing from 21 March to 17 April 2011 on the draft of:

Guidelines for monitoring the implementation of the WHO Global Code of
Practice on the International Recruitment of Health Personnel

WHO invites you to contribute to this public hearing on the draft
Guidelines and kindly requests you to disseminate this call for
contributions among your relevant contacts and networks.

The web-based public hearing and the draft Guidelines can be accessed at
http://bit.ly/eCNlMS
http://www.who.int/hrh/migration/code/hearing/en/index.html

All persons concerned with the international recruitment of health
personnel are invited to contribute to this web-based public hearing on
the draft Guidelines – Member States, health workers, recruiters,
employers, academic and research institutions, health professional
organizations, and any relevant subregional, regional and international
organizations, whether governmental or nongovernmental.

Input received during the course of this web-based public hearing will
contribute to a revised draft of the Guidelines. Complementary documents
concerning the Code are also available for download from the HRH website.
http://www.who.int/hrh/en/

Contributions can be submitted in any of the six official languages
(Arabic, Chinese, English, French, Russian and Spanish). Please note that
at this stage, we request that comments should not focus on the formatting
of the documents and we are not expecting any data to be provided. Please
limit contributions to 2000 words.

These comments can be submitted by fax (+ 41 22 791 47 47) or by email to:
Draft_guidelines@who.int
Clarification or queries can be addressed to Department of Human Resources
for Health, Health Workforce Migration and Retention Team

__________________________________________________________________________
_____________________________________*____________________________________

3. New Injection Safety Resource from AIDSTAR-One

Lots of good material here.
__________________________________________________________________________

From: “John Nicholson” <john_nicholson[at]jsi.com>
To: <sign@uqconnect.net>
Subject: New Injection Safety Resource from AIDSTAR-One

For easy access to research summaries and links to promising practices and
tools, visit the new Injection Safety Topic within AIDSTAR-One’s HIV
Prevention Knowledge Base at: http://tinyurl.com/AIDSTAR1-Injection

Original URL:
www.aidstar-
one.com/focus_areas/prevention/pkb/biomedical_interventions/injection_safe
ty
__________________________________________________________________________
_____________________________________*____________________________________

4. Passive safety device features 10 times more effective in preventing
needlesticks

Crossposted from http://www.premierinc.com with thanks.
http://tinyurl.com/NeedleStickSEDs
__________________________________________________________________________

Passive safety device features 10 times more effective in preventing
needlesticks

Passive safety engineered devices (SEDs) that automatically or semi-
automatically activate the safety feature were found to be 10 times more
effective in preventing needlestick injuries (NSI), compared to fully
manual devices requiring active engagement of the safety feature,
according to a recent study conducted in 61 French hospitals. This is one
of the largest multi-center studies comparing one sharps safety device to
another. Knowledge of the most effective designs is important, both to
guide the choice for users among available devices and to guide
manufacturers in developing new safety technology.

NSI rates vary with the type of safety feature NSI rates differed
according to the type of safety feature. Among the active devices, the
semiautomatic (e.g., push button or plunger devices) were found to be
safer than those with hinged recap/toppling shield, which in turn were
safer than manually activated devices such as those with sliding sleeve
protection. Passive devices, e.g., self retracting lancets and IV
catheters that automatically shield the needle during use, were the most
effective in preventing NSIs.

User acceptance of a device may influence efficacy More than one-fourth of
all the NSIs in this study were from non-activation or incomplete
activation and could have been avoided. Factors contributing user
acceptance of SEDs, which may also influence the efficacy of SEDs, include
the design of the device, training provided before and after introduction
of the device, ease of use, changes in technique, the perceived risk of
occupational infection, and patient safety issues. For example, healthcare
workers’ concerns for patient safety or comfort may reduce the efficacy of
such SEDs, because users may delay activation or rate the device as being
more difficult to use. Passive devices, which do not rely on user
activation, may address some of these issues.

A study conducted by the Premier Safety Institute® confirms the authors’
suggestion that user preference varies and might influence device
activation. In the Premier study, 875 clinicians in 30 hospitals assessed
the performance considerations of 10 different types of syringe and
phlebotomy (34,075) devices. The top 10 performance considerations
identified by study participants follow. It was noted that for syringes,
the ability of the device to deliver an accurate dose was identified as
more important than the safety feature.

Top 10 performance considerations of phlebotomy devices
1. Reliable safety feature
2. Ease of use
3. Easily disposed in sharps container
4. Does not interfere with blood draw
5. No risk of spray or drip
6. Satisfactory for standard procedures
7. One-handed
8. Permits procedure visualization
9. Range of sizes available
10. Use on heavy, thin, fragile veins

Top 10 performance considerations of syringes
1. Accuracy of dose
2. Reliable safety feature
3. Hands remain behind needle
4. Visibility of medicine
5. Exposed sharp covered after use
6. One-handed
7. Does not interfere with procedure
8. Simple and self-evident
9. Range of syringe and gauge size
10. Does not take more time to activate

This French study provides evidence that passive SEDs that require no
input from the user are more effective than active SEDs for NSI
prevention. The authors note that further studies are needed to determine
whether their higher cost may be offset by savings related to fewer NSIs
and to a reduced need for user training.

http://www.premierinc.com/quality-safety/tools-services/safety/safety-
share/02-22-full.jsp#Story-1-needlesticks

http://tinyurl.com/NeedleStickSEDs
__________________________________________________________________________
_____________________________________*____________________________________

5. IFC Self-Assessment Guide for Health Care Organizations

Crossposted  with thanks from the HNP Flash Newsletter
<hnpflash@worldbank.org>

IFC is a member of the World Bank Group.
__________________________________________________________________________

Self-Assessment Guide for Health Care Organizations is for external use by
health care organizations in our client countries to help them aim at
meeting international standards of Patient Safety, Service Quality, and
Ethics.

It will be useful to all kind organizations and in particular to those who
seek to achieve some form of international accreditation.

Developed with the support from the Joint Commission International (JCI),
the foremost health accreditation body, and other medical experts, it
includes a basic Code of Conduct which may be adapted for local use and is
fully in line with World Health Organization (WHO) efforts in this area.

http://www.ifc.org/ifcext/che.nsf/AttachmentsByTitle/2010HCSelfAGuidelines
ToC/$FILE/1TCntntsIntrdctn.pdf

http://tinyurl.com/HCOrg-Assessment-IFC
__________________________________________________________________________
_____________________________________*____________________________________

6. Abstract: Notification and support for people exposed to the risk of
Creutzfeldt-Jakob disease (CJD) (or other prion diseases) through
medical treatment (iatrogenically)
__________________________________________________________________________

Cochrane Database Syst Rev. 2011 Mar 16;3:CD007578.

Notification and support for people exposed to the risk of Creutzfeldt-
Jakob disease (CJD) (or other prion diseases) through medical treatment
(iatrogenically).

Ryan R, Hill S, Lowe D, Allen K, Taylor M, Mead C.

Centre for Health Communication and Participation, Australian Institute
for Primary Care & Ageing, La Trobe University, Bundoora, VIC, Australia,
3086.

BACKGROUND: Creutzfeldt-Jakob disease (CJD) and variant CJD (vCJD) are
rare and always-fatal diseases transmissible via certain medical
procedures. If a person is exposed to the disease risk through medical
treatment, they may need to be notified of this to prevent them passing
the risk to others in healthcare settings and to enable additional
infection control measures to be put in place for certain procedures. As
CJD is incurable, and unable to be screened for or effectively treated,
communicating this risk information after an exposure incident may have
significant implications for the person at risk, their families/ carers
and healthcare professionals. The best ways to notify people of their
exposure to the risk of CJD or vCJD, and to support them subsequently, are
currently unknown.

OBJECTIVES: To evaluate the effects of interventions to notify and support
consumers (patients and their family members or carers) in situations
where exposure to the risk of CJD or vCJD has occurred as a result of
medical treatment (iatrogenically), on consumer, healthcare provider and
healthcare system outcomes.

SEARCH STRATEGY: We searched the Cochrane Consumers and Communication
Review Group Specialised Register (10 February, 2009), the Cochrane
Central Register of Controlled Trials (CENTRAL, The Cochrane Library,
Issue 1 2009), MEDLINE (OVID SP), EMBASE (OVID SP), PsycINFO (OVID SP),
CINAHL (EBSCO Host), Current Contents (OVID SP) and Dissertation Abstracts
(Proquest) from start date to February 2009. We searched MEDLINE In-
process and Other Non-indexed Citations (OVID SP) and Sociological
Abstracts (CSA) in November 2009. We searched reference lists, websites,
and contacted consumer groups and experts for details of relevant
research.

SELECTION CRITERIA: Randomised and quasi-randomised controlled studies,
controlled before-and-after studies and interrupted time series analyses
assessing the effects of any intervention to communicate with (notify or
support) people exposed to the risk of CJD or vCJD through medical
treatment were included. We sought outcomes relevant to consumers, health
providers and health services, including both benefits and harms.

DATA COLLECTION AND ANALYSIS: Cochrane reviewTwo authors independently
assessed studies for inclusion against selection criteria, and would have
applied standard Cochrane review methodology were any studies
identified.Thematic synthesisWe also conducted a thematic synthesis by
systematically identifying and screening those studies that met the same
population, intervention and outcome criteria as the Cochrane review, but
that were identified from the broader literature providing evidence on
policy implementation and consumer experiences. We systematically
extracted and synthesised the data from these studies to produce a
thematic synthesis, presented in appendices to this Cochrane review, which
assembles evidence on the views, experiences and acceptability of
notification and support strategies for people at risk.

MAIN RESULTS: Results of the Cochrane reviewNo studies meeting the study
design criteria were identified for inclusion in this Cochrane
review.Results of thematic synthesisIn total, 49 studies and pieces of
literature meeting the same population, intervention and outcome criteria
as the Cochrane review, but identified from the broader literature
providing evidence on policy implementation and consumer experiences, were
included and formed the basis of a thematic synthesis, and which is
presented in appendices to this Cochrane review. The thematic synthesis
indicates that ideally communication may be considered as a longitudinal
multicomponent programme, ensuring that notification and support are
coordinated; that communication is tailored and responsive to need; and
that activities to support individual risk communication, such as
widespread education and monitoring of access to health care for those at
risk, are in place. The thematic synthesis also indicates that poor
communication practices may have negative impacts or cause harm, such as
discrimination in accessing health care.

AUTHORS’ CONCLUSIONS: There is insufficient rigorous evidence to determine
the effects of interventions to notify people at CJD or vCJD risk and to
support them subsequently, or to identify the best approach to
communication in these situations. The thematic synthesis can be used to
inform policy and practice decisions for communicating with people at risk
in the absence of rigorous evaluative studies.
__________________________________________________________________________
_____________________________________*____________________________________

7. Abstract: Emergent viral threats in blood transfusion
__________________________________________________________________________

Transfus Clin Biol. 2011 Mar 15.

[Emergent viral threats in blood transfusion.]

[Article in French]

Pozzetto B, Garraud O.

EA3064, groupe immunité des muqueuses et agents pathogènes (Gimap),
département biologie médecine santé, université Jean-Monnet Saint-Étienne,
faculté de médecine Jacques-Lisfranc, 15, rue Ambroise-Paré, 42023 Saint-
Étienne cedex 2, France; Laboratoire de bactériologie-virologie-hygiène,
hôpital Nord, avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France.

During the last 20 years, the safety of blood products increased
dramatically with regard to the infectious risk and notably to that
represented by retroviruses (HIV and HTLV) and hepatitis B and C viruses.

The aim of this review is to identify the residual and emergent viral
threats that could be responsible for the occurring of new contaminations
in the receivers of blood products. Beside many other viruses (HHV-8,
erythrovirus B19, hepatitis A and E viruses…), a special attention has
been paid to emerging arbovirus diseases (West Nile virus infection,
dengue, chikungunya) that threaten to occur in the French metropolitan
area following the implantation in Europe of the mosquito Aedes
albopictus, the main vector of dengue and chikungunya in temperate
regions. Another blood-linked risk, notably in United Kingdom and France,
is the prion agent responsible for the variant form of the Creutzfeldt-
Jakob disease.

The review is concluded by a brief overview of the measures aimed to
control these emergences, including the exclusion of at-risk donors, the
diagnostic tests able to detect a specific agent, the leukocyte reduction
of labile blood products, and the physical or chemical treatments aiming
the nonspecific inactivation of infectious agents potentially present in
blood without impairing significantly the physiological properties of
blood compounds.

The ability to control prospectively the new viral risks linked to blood
products is a challenge for the preservation of the confidence of both
clinicians and receivers in the safety of blood transfusion.

Copyright © 2011 Elsevier Masson SAS. All rights reserved.
__________________________________________________________________________
_____________________________________*____________________________________

8. Abstract: International databases: usefulness and limitations in
hemovigilance
__________________________________________________________________________

Transfus Clin Biol. 2010 Dec;17(5-6):306-9.

[International databases: usefulness and limitations in hemovigilance].

[Article in French]

Wiersum-Osselton JC.

TRIP Dutch National Hemovigilance Office, Postbus 40551, 2504 LN Den Haag,
Pays-Bas.

A number of international databases are well-known and useful tools for
professionals in blood transfusion. The advent of national hemovigilance
registries and an international focus on transfusion practice and
transfusion safety has led individuals and organisations to collect and
compare data. This has led to the development of internationally useful
indicators, for instance figures for the numbers of red cell products
transfused per 1000 in the population.

An international database of
hemovigilance data (surveillance database for transfusion associated
adverse reactions and events [STARE]) is currently being developed by the
International Hemovigilance Network. In the pilot phase, it is seen that
differences exist between the rates of adverse reactions and events.

Factors such as the working method and definitions in use in the countries
must be taken into account and efforts made to increase uniformity of the
data. The remaining variability might then generate hypotheses of areas or
types of increased risk, which would need to be further investigated in
specific projects.
__________________________________________________________________________
_____________________________________*____________________________________

9. Abstract: Patient safety and root cause analysis
__________________________________________________________________________

Transfus Clin Biol. 2010 Dec;17(5-6):386-9.

[Patient safety and root cause analysis].

[Article in French]

Auroy Y, Andreu G, Aullen JP, Benhamou D, Caldani C, Canivet N, de
Lardemelle C, du Roure FD, François A, Gruber M, Sandid I, Linget C,
Loulière B, Perrin M, Rebibo D, Richomme X, Tinard X.

Service d’Anesthésie-Réanimation, Hôpital d’Instruction des Armées du Val-
de-Grâce, 74 boulevard de Port-Royal, 75005 Paris, France.
yves.auroy@wanadoo.fr

Safety in the field of transfusion medicine has greatly improved in
France. The risk of viral transmission has decreased by a factor greater
than 1500 within the last 20 years. In comparison, the risk related to ABO
error has decreased only by half.

The reporting of critical incidents, which occur at any step of the
transfusion procedure is now mandatory in France and is subject to an in-
depth analysis, using methods close to that used in aviation safety.

The goal of these analyses is to better understand human factors in order
to implement more adequate prevention measures.

Copyright © 2010. Published by Elsevier SAS.
__________________________________________________________________________
_____________________________________*____________________________________

10. Abstract: European regulation on blood and blood components
__________________________________________________________________________

Transfus Clin Biol. 2010 Dec;17(5-6):310-4.

[European regulation on blood and blood components].

[Article in French]

Sandid I.

Cellule réglementation et traçabilité des produits sanguins labiles,
agence française de sécurité sanitaire des produits de santé, 143-147,
boulevard Anatole-France, 93285 Saint-Denis cedex, France.

The European regulation on blood and blood components is declined in four
directives: the Directive 2002/98/EC known as “mother Directive” and three
directives called “daughter Directives” 2004/33/EC, 2005/61/EC and
2005/62/EC.

It constitutes a common basis of provisions of quality and safety of blood
in the European Union (EU), thus guaranteeing this safety and this quality
with the whole of the citizens circulating in Member States of the Union.
It cannot prevent a Member State for maintaining or introducing more
stringent protective measures. It encourages the anonymous, voluntary and
unpaid blood donations. It envisages many provisions for the prospective
blood donor eligibility, the blood collection, the testing, processing,
storage, transport, distribution and issuing of blood and blood components
and the haemovigilance.

In the field of the haemovigilance, this European regulation widened the
field of competence of the national systems to the notification of serious
adverse events of the transfusion chain and the serious adverse reactions,
which have occurred in the blood donors. The European directives were
transposed in the French national law between 2004 and 2007 by legislative
and lawful ways.

Copyright © 2010 Elsevier Masson SAS. All rights reserved.
__________________________________________________________________________
_____________________________________*____________________________________

11. Abstract: The assessment of infection control in dental practices in
the municipality of São Paulo
__________________________________________________________________________

Braz J Infect Dis. 2011 Feb;15(1):45-51.

The assessment of infection control in dental practices in the
municipality of São Paulo.

Matsuda JK, Grinbaum RS, Davidowicz H.

Instituto de Assistência Médica ao Servidor Público Estadual.

OBJECTIVE: The goal of this study was to evaluate the infection control
measures actually implemented by dental surgeons during dental practice,
as patients and professionals are exposed to high biological risk in
dental care environments.

METHOD: 614 questionnaires (90.69%) were answered by professionals
registered in updating or in post-graduate courses in the Municipality of
São Paulo.

RESULTS: Out of surveyed professionals 30.62% admitted that surface
protection barriers were not used, whereas 34.17% were using non ideal or
outdated pre-disinfection practices. The autoclave was used by 69.38% of
participants, although 33.80% were not monitoring control of the
sterilization cycles. Chemical and biological indicators were not used
simultaneously by 83.21% of respondents and were not employed on a daily
or weekly basis by at least 81.75%. Dubious methods of sterilization were
cited by 44.77%. Occupational accidents caused by cutting and piercing
objects were reported by 47.88%; however, the biologic risk was
underestimated by 74.15% of the professionals who suffered the accidents.
Irritant solutions were used as an antiseptic agent by 18.55%.

CONCLUSIONS: Infection control measures reported by dental surgeons during
their practices are deficient. It is necessary to educate, raise awareness
of professionals, and promote constant updating courses on procedures
which aim at improving safety of dental care.
__________________________________________________________________________
_____________________________________*____________________________________

12. Abstract: Changes in blood-borne infection risk among injection drug
users
__________________________________________________________________________

J Infect Dis. 2011 Mar;203(5):587-94.

Changes in blood-borne infection risk among injection drug users.

Mehta SH, Astemborski J, Kirk GD, Strathdee SA, Nelson KE, Vlahov D,
Thomas DL.

Department of Epidemiology, Johns Hopkins Bloomberg School of Public
Health, Baltimore, MD 21205, USA. shmehta@jhsph.edu
Comment in:

J Infect Dis. 2011 Mar;203(5):571-4.
Abstract
BACKGROUND: Population-level hepatitis C virus (HCV) infection incidence
is a surrogate for community drug-related risk.

METHODS: We characterized trends in human immunodeficiency virus (HIV) and
HCV infection incidence and HCV infection prevalence among injection drug
users (IDUs) recruited over 4 periods: 1988-1989, 1994-1995, 1998, and
2005-2008. We calculated HIV and HCV infection incidence within the first
year of follow-up among IDUs whose test results were negative for these
viruses at baseline (n = 2061 and n = 373, respectively). We used Poisson
regression to compare trends across groups.

RESULTS: HIV infection incidence declined significantly from 5.5 cases/100
person-years (py) in the 1988-1989 group to 2.0 cases/100 py in the
1994-1995 group to 0 cases/100 py in the 1998 and 2005-2008 groups.
Concurrently, HCV infection incidence declined but remained robust (22.0
cases/100 py in the 1988-1989 cohort to 17.2 cases/100 py in the 1994-1995
cohort, 17.9 cases/100 py in the 1998 cohort, and 7.8 cases/100 py in the
2005-2008 cohort; P = .07). Likewise, HCV infection prevalence declined,
but chiefly in younger IDUs. For persons aged <39 years, relative to the
1988-1989 cohort, all groups exhibited significant declines (adjusted
prevalence ratio [PR] for the 2005-08 cohort, .73; 95% confidence interval
[CI], .65-.81). However, for persons aged = 39 years, only the 2005-2008
cohort exhibited declining prevalence compared with the 1988-1989 cohort
(adjusted PR, .87; 95% CI, .77-.99).

CONCLUSIONS: Although efforts to reduce blood-borne infection incidence
have had impact, this work will need to be intensified for the most
transmissible viruses, such as HCV.

Free Article
__________________________________________________________________________
_____________________________________*____________________________________

13. Abstract: Infection disclosure in the injecting dyads of Hungarian and
Lithuanian injecting drug users who self-reported being infected with
hepatitis C virus or human immunodeficiency virus
__________________________________________________________________________

Scand J Infect Dis. 2011 Jan;43(1):32-42.

Infection disclosure in the injecting dyads of Hungarian and Lithuanian
injecting drug users who self-reported being infected with hepatitis C
virus or human immunodeficiency virus.

Gyarmathy VA, Neaigus A, Li N, Ujhelyi E, Caplinskiene I, Caplinskas S,
Latkin CA.

European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal.
anna.gyarmathy@emcdda.europa.eu

The aim of this study was to assess the prevalence and correlates of
disclosure to network members of being hepatitis C virus (HCV)- or human
immunodeficiency virus (HIV)-infected among injecting dyads of infected
injection drug users (IDUs) in Budapest, Hungary and Vilnius, Lithuania,.
Multivariate generalized estimating equations (GEE) were used to assess
associations.

Very strong infection disclosure norms exist in Hungary, and HCV
disclosure was associated with using drugs and having sex within the dyad.
Non-ethnic Russian IDUs in Lithuania were more likely to disclose HCV
infection to non-Roma, emotionally close and HCV-infected network members,
and to those with whom they shared cookers, filters, drug solutions or
rinse water or got used syringes from, and if they had fewer non-IDU or
IDU network members. Ethnic Russian Lithuanian IDUs were more likely to
disclose HCV if they had higher disclosure attitude and knowledge scores,
‘trusted’ network members, and had lower non-injecting network density and
higher injecting network density. HIV-infected Lithuanian IDUs were more
likely to disclose to ‘trusted’ network members. Disclosure norms matched
disclosure behaviour in Hungary, while disclosure in Lithuania to
‘trusted’ network members suggests possible stigmatization.

Ongoing free and confidential HCV/HIV testing services for IDUs are needed
to emphasize and strengthen disclosure norms, and to decrease stigma.
__________________________________________________________________________
_____________________________________*____________________________________

14. Abstract: HIV prevalence in prison is 15 times greater than in the
community as a whole
__________________________________________________________________________

HIV AIDS Policy Law Rev. 2010 Oct;15(1):5-6.

HIV prevalence in prison is 15 times greater than in the community as a
whole.

[No authors listed]

A report released in April 2010 by Correctional Service of Canada (CSC) on
infectious diseases and risky behaviours reveals elevated HIV and
hepatitis C (HCV) rates in federal prisons, and calls for the
implementation of urgent comprehensive harm reduction measures.
__________________________________________________________________________
_____________________________________*____________________________________

15. Abstract: Hand hygiene
__________________________________________________________________________

Infect Dis Clin North Am. 2011 Mar;25(1):21-43. Epub 2010 Dec 16.

Hand hygiene.

Bolon M.

Department of Medicine, Division of Infectious Diseases, Northwestern
University Feinberg School of Medicine, 645 North Michigan Avenue, Suite
900, Chicago, IL 60611, USA. m-bolon@northwestern.edu

The toll of health care-associated infections on patients and the seeming
ease of the procedure thought best able to prevent them have focused a
spotlight onto hand hygiene performance. Poor performance of hand hygiene
by health care workers inspires outrage in the general public.

Much is understood regarding barriers to and motivators of hand hygiene
performance. Guidelines encouraging use of alcohol-based hand hygiene
agents have facilitated hand hygiene improvement efforts.

These efforts and evidence that improved hand hygiene performance is
associated with a reduction in health care-associated infections should
encourage those in the hand hygiene campaigns.

Copyright © 2011 Elsevier Inc. All rights reserved.
__________________________________________________________________________
_____________________________________*____________________________________

16. Abstract: What do you mean you can’t sterilize it? The reusable
medical device matrix
__________________________________________________________________________

Can Oper Room Nurs J. 2010 Dec;28(4):6-11, 20-4.

What do you mean you can’t sterilize it? The reusable medical device
matrix.

Stephens A, Assang A.

University Health Network, Toronto General Hospital, USA.
Anne.Stephens@uhn.on.ca

Health Canada recommends that hospitals should have procedures in place to
ensure Reusable Medical Devices (RMD) are cleaned, disinfected and
sterilized according to the manufacturer’s instructions. For the purpose
of this paper, reusable medical devices will be referred to as RMDs and
include all instrumentation and devices that the Central Processing
Department (CPD) resterilizes for use in the hospital. Patient safety in
surgery begins in CPD. Manufacturer recommendations for the
decontamination and sterilization of surgical instrumentation are of
utmost importance to Operating Room (OR) and CPD staff. With
recommendations that are unclear, nonspecific or unattainable there was a
need to define what it means institutionally to meet standards and provide
safe patient care while continuing to support the advancement of surgical
technology. The purpose of this paper is to describe the challenges faced
by one multisite organization (The University Health Network) in managing
the sterilization of surgical instrumentation.

The development of The Guidance Matrix by the network’s inter-professional
Reusable Medical Device (RMD) Committee, will be discussed along with
information about the elements of this tool and an illustration of how it
is used. The key benefits of The Guidance Matrix, including how its use
has facilitated transparent decision-making, communication and
collaboration regarding sterilization issues across the sites, will be
described. Sterilization processes in Central Processing Departments (CPD)
include chemical indicators, dated load indicators, and tamperproof locks
and filters.

The lack of an indicator of sterilization can be a frustrating experience
for an OR Nurse. But do we really understand the critical importance of
all these indicators? The foundation of sterilizing reusable medical
devices (RMDs) begins with proper processes, standards and subsequent
scientific validation from the vendors. According to AORN, patient safety
is vital and it begins with proper cleaning and processing of the surgical
instruments.

Surgical site infections can increase the length of stay and the cost of
the patients’ hospitalization, as well as increased risk, morbidity and
even mortality. 1 Today’s patients are far more informed than they were in
the past. They can gather information from the internet as well as from
television, radio, and print media. This knowledge empowers the patient to
expect that their healthcare providers are practicing due diligence. It is
the ethical duty and responsibility of nurses to provide safe, competent
care while protecting the rights of the patient and being accountable to
the professional governing bodies. In other words, we are advocates for
both our patients and the healthcare system.2 Using both new and
innovative instruments in the OR was, in the past, as simple as a surgeon
requesting an instrument, the perioperative nurse ordering the instrument
and CPD processing it for use in the OR. That is no longer the case.

With a wide range of more complex instrumentation and an increasing focus
on sterilization strategies, healthcare facilities have had to adopt a
more rigorous approach. There are many challenges in the world of sterile
processing. A common one, faced on a regular basis, is the provision of
vague, inaccurate reprocessing recommendations from the medical device
manufacturer.

Canadian centres are not able to meet European standards for reprocessing.
European cycles, often referred to as “Fractionated Steam Cycles”, are
different than the pre-vacuum steam cycles run in Canada.
__________________________________________________________________________
_____________________________________*____________________________________

17. Excerpt: Control of Viral Infections and Diseases
__________________________________________________________________________

Control of Viral Infections and Diseases.

Goldenthal KL, Midthun K, Zoon KC.

In: Baron S, editor. Medical Microbiology. 4th edition. Galveston (TX):
University of Texas Medical Branch at Galveston; 1996. Chapter 51.

Excerpt

Viral diseases range from trivial infections to plagues that alter the
course of history. Because of the enormous variations in viruses and in
their epidemiology and pathogenesis, there is no single, magic-bullet
approach to control. Each virus presents its own set of problems. This
chapter covers methods useful to various degrees in controlling selected
viral diseases. The most spectacular progress so far has involved
vaccines. Vector control and sanitation have contributed greatly. Also, a
number of therapeutic antiviral agents are now available, including some
for very serious infections such as human immunodeficiency virus type 1
(HIV-1) infection. In addition, interferon alpha is now available for the
therapy of several viral diseases.

Copyright © 1996, The University of Texas Medical Branch at Galveston

Sections
General Concepts
Introduction
Immunoprophylaxis
Sanitation and Vector Control
Antiviral Chemotherapy
Interferons: Cytokines With Antiviral Activity
Identifying New Effective Therapeutics
References
__________________________________________________________________________
_____________________________________*____________________________________

18. Abstract: HIV Transmitted from a Living Organ Donor — New York City,
2009
__________________________________________________________________________

MMWR Morb Mortal Wkly Rep. 2011 Mar 18;60(10):297-301.

HIV Transmitted from a Living Organ Donor — New York City, 2009.

Centers for Disease Control and Prevention (CDC).

Routine screening of organ donors for human immunodeficiency virus (HIV)
infection has made transmission of HIV through organ transplantation rare
in the United States. However, despite routine screening, transmission of
HIV can be an uncommon complication of organ transplantation and is a
public health concern. In 2010, the New York City (NYC) Department of
Health and Mental Hygiene (NYC DOHMH) was notified of a potential
transplant-related HIV infection.

This report summarizes the results of the subsequent public health
investigation, which confirmed HIV transmission through transplantation of
an organ from a living donor.

To reduce the risk for transmission of HIV through living-donor organ
transplantation, transplant centers should screen living donors for HIV as
close to the time of organ recovery and transplantation as possible, using
sensitive tests for both chronic and acute infections, namely, serology
and nucleic acid testing (NAT). Furthermore, clinicians should inform
transplant candidates of the potential risks for disease transmission and
advise donors during evaluation of their obligation to avoid behaviors
that would put them at risk for acquiring HIV before organ donation.

Free Article
__________________________________________________________________________
_____________________________________*____________________________________

19. No Abstract: Waste not. Developing a hospital recycling program
__________________________________________________________________________

Health Facil Manage. 2011 Jan;24(1):40-3.

Waste not. Developing a hospital recycling program.

Turpin B, Lee LD.

WM Healthcare Solutions, a subsidiary of Waste Management Inc, Houston,
USA. bturpin@wm.com
__________________________________________________________________________
_____________________________________*____________________________________

20. 2nd Pre-filled Syringes Americas – Conference
__________________________________________________________________________

2nd Pre-filled Syringes Americas – Conference

Examining the current market demand and developing safer, stable, cost-
effective pre-filled syringes

5th – 7th April 2011, Boston, USA

Background info

Key Speakers

* Dr. Ingrid Markovic, Expert Review Scientist , Food and Drug
Administration
* Jennifer Johns, Principal Packaging Engineer, Biopharmaceutics R&D,
Bristol-Myers Squibb
* Amanda Wolf, Scientist – Pharmaceutical Research and Development, Pfizer
* Raul Soikes, Sr. Director Program Management, Baxter BioPharma Solutions
* Michael Gross, Senior Consultant, Combination Products, Biologics
Consulting Group
* Dr. Jan Jezek, Chief Scientific Officer, Arecor
* Jim Spolyar, Sales and Technical Director, SKAN US
* Stephen A. Barat, Director, Toxicology and Operations, Forest Research
Institute
* Vinod Vilivalam, Director, <span style=”font-we
* Jim Nadlonek, Pharmaceutical Operations Specialist / West Coast Sales
Manager, BAUSCH + STROEBEL
* Horst Koller, Regulatory Affairs / Quality R&D PP, Schott
* Dr. Arno Fries, Director Product Management Tubular Glass,
Gerresheimer Bünde
* John Iannone, Program Manager, Toxicon
* Bryan K. Braxton, Associate Research Fellow, AMRI

Continuous growth in vaccines, blood stimulants, therapeutic proteins,
erythroproteins, interferons and rheumatoid arthritis has driven the
growth of pre-filled syringes market

With promising growth of 10-15% per annum, there were 2 billion pre-filled
syringe units sold in 2009 alone and expected to continue reaching 3.64bn
units in 2015 and 6.83bn by 20251.
Safety, stability, convenience and cost-effectiveness are the main factors
driving growth of the pre-filled syringes market. Prefilled syringe
manufacturers have had to therefore respond to increasing demand, new
requirements and more sophisticated forms of drug delivery.

Following the success of visiongain’s previous pre-filled syringes
conferences, we are proud to present the 2nd Pre-filled Syringes Americas
conference.
At this global event of pre-filled syringes, meet industry leaders from
around the world to discuss every aspect of pre-filled syringes market
from technological needs, design to safety and quality through to
regulatory issues. Spend three days in partnering; participate in special
panel discussions and evening networking drinks
Stay ahead of competition by learning about the latest developments on
technological advances in design, component materials, process
engineering, siliconisation, dosage, accuracy, auto-injections, quality,
safety and regulatory issues.

http://www.visiongain.com/Conference/292/2nd-Pre-filled-Syringes-Americas
__________________________________________________________________________
_____________________________________*____________________________________

21. The IDRC Doctorate Research Awards Competition is now open!

Crossposted with thanks from the Pan American Health Organization,
PAHO/WHO, equity luistserve PAHO/WHO Website: http://new.paho.org/equity/
__________________________________________________________________________

The IDRC Doctorate Research Awards Competition is now open!

International Development Research Centre IDRC – Canada

The deadline for submitting applications is April 1, 2011

IDRC offers these awards twice a year in April and November to Canadians,
permanent residents of Canada, and citizens of developing countries
pursuing doctoral studies at a Canadian university.

These awards are intended for field research in one or more developing
countries. Candidates must conduct their research in areas corresponding
to IDRC’s research priorities.

IDRC supports research on the following themes:

* Agriculture and environment

* Health and health systems

* Information and communication technologies for development

* Innovation, Policy, and Science

* Social and economic policy

Web page: http://bit.ly/dFckTI

Contact :Rosalie Vezina 613-236-6163 (ext.2607)  rvezina[at]idrc.ca
__________________________________________________________________________
_____________________________________*____________________________________

22. Sixty-fourth World Health Assembly
__________________________________________________________________________

Sixty-fourth World Health Assembly

Date: 16 – 24 May 2011
Location: Geneva, Switzerland

The Sixty-fourth session of the World Health Assembly will take place in
Geneva during 16 – 24 May 2011.

The Health Assembly will discuss a specific health agenda prepared by the
Executive Board as well as the programme budget, administration and
management matters of WHO.
__________________________________________________________________________
_____________________________________*____________________________________

23. News

– India: Death merchants
– Nevada USA: Health district sends 101 letters advising HIV, hepatitis
tests Tools
– Fiji: Health licenses to be requirement for tattoo outlets
– Nevada USA: Latest Infection Risk Case Spurs Alert
– USA: Some Health Care Workers Maintain Unsafe Injection Practices
– Nevada USA: Board Says Doctor Admitted He Reused Biopsy Needle Guides
– Nevada USA: Bulletin urges health care providers not to reuse single-
use devices Tools
– USA: Hepatitis C transmission still high among injection drug users
– USA: Nurse suspected of infecting 23  patients by ‘stealing drugs from
IV bags with a syringe’
– India: Three Rajasthan doctors suspended for pregnancy deaths
– India: Manufacturer to face legal action for contaminated IV fluids

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

India: Death merchants
Deccan Herald, India (23.03.11)

”There’s a massive racket in substandard drugs.”

Use of contaminated intravenous fluids has resulted in the death of 18
women over the past month in two government hospitals in Jodhpur. The
victims had been put on drip post-delivery and they developed
complications, which then led to their death.

Intravenous fluid samples taken from the hospitals have tested positive
for bacterial endotoxins. Legal action is being taken against the Indore-
based drug manufacturer, Parental Surgical (India) Ltd. Distribution of
medicines by this manufacturer have been banned. Jodhpur’s unfortunate
experience is not an isolated one in India. There are innumerable
instances of patients being administered contaminated blood, glucose and
other intravenous fluids, or medicines that have crossed their expiry
date.

The repeated use of soiled bandages, disposable syringes and contaminated
needles is widespread in the country. It has taken a ghastly tragedy to
draw the attention of authorities to the problem. Will they act on it?

It is said that roughly 10 per cent of the medicines available in the
market are counterfeit, contaminated or substandard. Profits are huge in
the trade. This is a massive racket that involves not just illicit
manufacturers but a long chain that includes distributors and then, of
course, the shops and hospitals through which these spurious medicines are
pushed. It is alleged that pharmacists selling counterfeit drugs profit
from doing so. If manufactures are able to push their contaminated drugs
easily, it is because hospital authorities are not vigilant. They prefer
to purchase medicines from those who grease their palms rather than
trusted manufacturers. The problem of contaminated medicines is not one
that is confined to allopathic medicines. Testing of some samples of
ayurvedic or homeopathic medicines has revealed presence of toxic metal.

Indian pharmaceutical companies export medicines to Africa and Latin
America. Therefore, the manufacture of substandard drugs and contaminated
fluids poses a grave public health threat that extends far beyond India’s
borders. Stern action against those responsible for Jodhpur tragedy is
welcome. But it must not stop there. The government must act against other
manufacturers of counterfeit and contaminated medicines. The crime they
are engaging in is not a minor one. It cannot be brushed aside as mere
negligence as they are causing the death of people. They cannot be allowed
to play with people’s lives. It is undermining the legitimacy of our
medical system.
………………………………………………………………..
__________________________________________________________________________

Nevada USA: Health district sends 101 letters advising HIV, hepatitis
tests Tools
By Paul Harasim, Las Vegas Review-Journal, Nevada USA (21.03.11)

The Southern Nevada Health District on Monday sent letters to 101 patients
of urologist Dr. Michael Kaplan, advising them to get tested for HIV and
hepatitis B and C.

In suspending Kaplan’s medical license eight days ago, authorities said
that Kaplan for three months re used what should be single-use-only
plastic needle guides for prostate/rectal biopsies, discarding them only
when they became “too bloody.”

“As of March 21, we have not identified any cases of disease related to
the procedures at Dr. Kaplan’s office, and based on similar incidents that
have occurred in other states, the risk of contracting a disease is
believed to be very low,” Dr. Lawrence Sands, the district’s chief health
officer, advises in the letter.

The notification comes three years after Las Vegas was rocked by an
unrelated hepatitis outbreak traced to reuse of syringes and single-dose
vials of anesthetic at Dr. Dipak Desai’s endoscopy centers. More than
40,000 of Desai’s patients were warned of possible exposure to hepatitis
and HIV, the largest such notification in American history. At least 100
men and women are thought to have contracted hepatitis.

While smaller in scope, Monday’s notices still generate much concern.

“Of course, I’m worried and angry about getting hepatitis and HIV because
a doctor didn’t follow directions,” said Alfred Slensky, 60, who received
a prostate biopsy from Kaplan in January. “How could you sleep good
without getting tested?”

According to the letter, at-risk patients either had a prostate biopsy or
a procedure that used the needle guide in implanting markers in the
prostate to help a radiation oncologist target a cancerous tumor during
therapy.

Both are invasive, going through the anus to the rectum, and involve
exposure to bodily fluids and blood.

The health district said the Nevada State Board of Medical Examiners and
Food and Drug Administration Office of Criminal Investigation “found that
Dr. Kaplan’s staff attempted to clean and disinfect the needle guides
prior to reusing them, but these needle guides were not designed or
intended to be reused.”

At-risk patients had procedures done between Dec. 20, 2010, when Kaplan
started re using the devices, and early this month, when authorities
stopped him, officials said.

“At this time we are not aware of any other procedures conducted by Dr.
Kaplan that might have put patients at risk, and testing is only
recommended for (those) patients,” the health district advised, adding
that “due to the time it can take for infection to be detected, it is
important to be tested soon and then again six months after the date of
your procedure(s).”

Jennifer Sizemore, a district spokeswoman, said patients should arrange
tests through their personal physicians. The health district is not
testing, nor is it paying for tests, she said.

Many urologists favor reusable stainless steel needle guides, which can be
sterilized with special cleaning solutions and high-pressure saturated
steam hotter than 185 degrees Fahrenheit.

Additional information is available through the health district’s help
line, 759-4636, its website, www.SNHD.info, or the State Board of Medical
Examiners, 888-890-8210.
………………………………………………………………..
__________________________________________________________________________

Fiji: Health licenses to be requirement for tattoo outlets
Filipe Naikaso, Fijivillage.com (21.03.11)

Tattoo outlets in the country are now becoming a popular business and
there are now revelations that the Health Ministry will be implementing a
policy for the outlets to have health licenses.

Health Ministry spokesperson Peni Namotu said with the type of services
these businesses provide, they are trying to set up a health license
system under which the tattoo shops should register for them to operate.

Namotu said this is based on the fact that the Ministry has policies
regarding the issue because of the high risk of infections like HIV.

He said applications for these types of businesses do not come to the
Ministry of Health but they are trying to request relevant inclusion to
prevent transmission of blood borne infections and complications like
scars.

Namotu added that with a tattoo license in place and continuous monitoring
of these tattoo shops, this will ensure the safety standards are adhered
to and it is safe for the public to use them.
………………………………………………………………..
__________________________________________________________________________

Nevada USA: Latest Infection Risk Case Spurs Alert
Paul Harasim, Las Vegas Review-Journal (18.03.11)

The Nevada State Health Division has issued a technical bulletin to remind
health care providers not to reuse single-use endocavity needle guides
during prostate biopsies. The bulletin follows the suspension of a
southern Nevada physician’s license for allegedly routinely reusing the
guides between patients.

Reuse of the guides on more than one patient “places the health, safety,
and welfare of the public at risk for blood-borne pathogens such as
hepatitis B, hepatitis C and HIV,” the notice said.

The notice recommends that health care providers “review their policies
and educate their staff regarding the use of single-use-only medical
devices.” “The thorough cleaning of single-use medical devices with the
use of hot water, scrubbing off blood and tissue matter soaked in Cidex
[sterilizing solution] is not acceptable in any circumstance or
situation.”

For the full advisory, visit:
http://health.nv.gov/Epidemiology/2011-03_NeedleGuideTechnicalBulletin.pdf
………………………………………………………………..
__________________________________________________________________________

USA: Some Health Care Workers Maintain Unsafe Injection Practices
By: Jessica Grogan, MDNews.com (18.03.11)

Although a survey of health care workers revealed that only a small number
of medical professionals practice unsafe injection procedures, this is
still a concern for the medical community.

A study that appeared in the December 2010 issue of the American Journal
of Infection Control was based on an online survey of 5,446 clinicians who
prepare and/or administer parenteral medications.

According to the study, the improper use of syringes, needles and
medication vials has caused the transmission of bloodborne pathogens, such
as hepatitis C. The study analyzed the injection practices of health care
workers in order to identify problems and opportunities for safe injection
practices education.

While the majority of survey respondents reported following approved
injection practices, study authors identified the following:

6% of respondents “sometimes or always” use single-dose or single-use
vials for more than one patient

0.9% of respondents “sometimes or always” reuse a syringe but change the
needle for use on a second patient

15.1% of respondents reuse a syringe to enter a multi-dose vial, and 6.5%
of those (1.1% overall) save that vial for use on another patient

For information about safe injection practices, visit the Centers for
Disease Control and Prevention website.
………………………………………………………………..
__________________________________________________________________________

Nevada USA: Board Says Doctor Admitted He Reused Biopsy Needle Guides
Paul Harasim, Las Vegas Review-Journal, Nevada USA (17.03.11)

The Nevada State Board of Medical Examiners (BME) recently suspended a
doctor for allegedly reusing needle guides during prostate and rectal
biopsies. Needle guides are the plastic sheaths through which needles are
directed to obtain biopsy material, and the single-use devices regularly
contact blood and body fluids.

In the suspension of Dr. Michael Kaplan’s license, BME said that the
doctor called for the guides to be washed between patients undergoing the
invasive procedures and discarded only when they became “too bloody.” The
motive behind Kaplan’s directive is not yet known. The devices cost about
$10 apiece. Kaplan acknowledged to BME and Food and Drug Administration
investigators “he had reused the endocavity needle guides during biopsy
procedures,” the suspension order states.

Patients who had biopsies performed by Kaplan between Dec. 20, 2010, and
March 11, 2011, could be at risk of blood-borne diseases such as HIV and
hepatitis C, said Dr. Lawrence Sands, chief health officer of the Southern
Nevada Health District. SNHD officials will issue a formal notification
once patients have been identified and recommendations are finalized. In
the meantime, affected patients should speak with their physician about
their concerns, said Stephanie Bethel, a district spokesperson.

Five people are searching through patient records “to see who has to be
notified,” said Doug Cooper, BME’s executive director. “We’re doing it as
fast as we can so the health district can notify patients,” he said.

BME cannot divulge how the alleged practice first came to its attention,
“because that source will probably be helping us with the investigation
down the line,” Cooper said. To date, no cases of disease transmission
have been linked to the lapse in infection control.
………………………………………………………………..
__________________________________________________________________________

Nevada USA: Bulletin urges health care providers not to reuse single-use
devices Tools
By Paul Harasim, Las Vegas Review-Journal, Nevada USA (17.03.11)

Nevada’s chief health care officer has issued a technical bulletin to all
health care providers, reminding them that the reuse of single-use only
endocavity needle guides during prostate biopsies “places the health,
safety and welfare of the public at risk for blood-borne pathogens such as
hepatitis B, hepatitis C and HIV.”

The unusual action this week by Dr. Tracy Green came on the heels of the
second major “breach of infection control” by a Southern Nevada physician
who was reusing devices intended to be used on only one patient.

“I’ve never heard of anything like this (bulletin) before,” said Dr.
Joseph Thornton, an associate professor of surgery at the University of
Nevada School of Medicine. “You’re just restating the obvious to people
who should know better. But maybe when you’ve had happen what’s happened
in this state, you have to.”

On Monday, the Nevada State Medical Board suspended Dr. Michael Kaplan’s
license, saying the physician only stopped reusing single-use only needle
guides for prostate/rectal biopsies when they became “too bloody.”

Southern Nevada Health District officials have announced that the time
frame when patients of Kaplan were at risk for contracting blood-borne
diseases was between Dec. 20, 2010, and March 11, 2011. Patients with
concerns should talk with their personal physicians, district officials
said.

Three years ago, more than 40,000 patients at Dr. Dipak Desai’s endoscopy
clinics were notified that they had to be tested for hepatitis C and HIV
after authorities saw his staffers reusing syringes and single-dose vials
of anesthetics.

Green’s bulletin tells all hospitals and other health care facilities to
“review their policies and educate their staff regarding the use of single
use only medical devices.”

It goes on to say: “The thorough cleaning of single use medical devices
with the use of hot water, scrubbing off blood and tissue matter or soaked
in Cidex” — a sterilizing solution — “is not acceptable in any
circumstance or situation.”

According to the suspension order brought against Kaplan, the needle
guides would be washed between patients, but the buildup of blood
eventually was too much after use on multiple patients, and only then were
they discarded.

Plastic endocavity needle guides are attached to the exterior of an
imaging instrument for viewing internal organs and structures, regularly
coming in contact with blood and body fluids as a needle passes through
the guide to obtain a tissue sample. When the same guide is used on
another patient, it is possible that any disease present could be
transmitted.
………………………………………………………………..
__________________________________________________________________________

USA: Hepatitis C transmission still high among injection drug users
Nicole Blazek, Clinical Advisor.com (17.03.11)

Efforts to control blood-borne infections have dramatically reduced HIV
incidence among injection drug users (IDUs), but declines in hepatitis C
virus (HCV) infection have been less substantial, prompting health
officials to call for better prevention and treatment strategies.

Incidence of HIV infection decreased from 5.5 cases per 100 person-years
in a cohort of injection drug users recruited from 1988 to 1989 to zero
cases per 100 person-years in a cohort recruited between 2005 and 2008.

In contrast, HCV infections declined from 22 cases per 100 person-years in
the 1988 to 1989 cohort, to 17.2 per 100 person-years in a cohort
recruited in 1994 and 1995. A slight increase to 17.9 cases was reported
in another group recruited in 1998, before infections rates declined to
7.8 cases per 100 person-years from 2005 to 2008 (P=0.07).

The disparity in HIV and HCV reduction rates may be due to the fact that
HCV is 10-times more transmissible than HIV, according to study researcher
Shruti H. Mehta, MD, of the Johns Hopkins Bloomberg School of Public
Health, in Baltimore, and colleagues.

Because HCV can be acquired after just one instance of needle-sharing,
hazard reduction interventions such as needle exchange and substance abuse
treatment programs that have been effective at reducing HIV, may have less
of an impact. CDC estimates indicate that approximately one-third of IUDs
share needles.

“Efforts need to be intensified on both the prevention and treatment
fronts to reduce the reservoir of HCV-infected IDUs,” the researchers
wrote in the March 1 issue of the Journal of Infectious Diseases.

To get a better understanding of HCV incidence in IDUs, they analyzed data
from four cohorts of IDUs during a 20-year period (1988-1989, n=2,946;
1994-1995, n=391; 1998, n=244; 2005-2008, n=875).

The researchers found that compared with the 1988-1989 cohort, HCV
incidence significantly declined among patients younger than 39 years in
each subsequent cohort (adjusted prevalence ration=0.73; 95% CI:
0.65-0.81).

However, the same decreases were not observed in patients older than 39
years – among that age group HCV infection rates only declined in the most
recent cohort (adjusted prevalence ratio=0.87; 95% CI: 0.77 to 0.99).

“For many persons, the interval between initiation and injection simply
remains too brief for prevention strategies to be successful,” the
researchers wrote.

They emphasized the importance of targeting prevention efforts towards
very young IDUs and drug users who have not yet begun injecting. The other
strategy for reducing the HCV reservoir is treatment, the efficacy of HCV
treatment regimens is often limited among certain subpopulations including
blacks with genotype-1 HCV and those with HIV coinfection, the researchers
noted.

“With new, more efficacious therapeutics on the horizon, it is critical
that strategies to improve uptake and completion of HCV infection
treatment of IDUs be implemented,” they wrote.

Jason Grebely, PhD, and Gregory J. Dore, MBBS, PhD, of the University of
New South Wales in Sydney, Australia, offered several suggestions for
improving treatment and prevention.

“The development and implmentation of national harm-reduction strategies
including broader coverage, enhanced early access and intesnifcation and
combination of interventions are probably all needed,” they wrote.

Grebely and Dore also emphasized the importance of conducting randomized
clinical trials to evaluate new HCV interventions to ensure that they are
successful.
………………………………………………………………..
__________________________________________________________________________

USA: Nurse suspected of infecting 23  patients by ‘stealing drugs from IV
bags with a syringe’
By Daily Mail Reporter, Daily Mail, UK (17.03.11)

A female nurse has been suspended after 23 hospital patients were infected
when she allegedly stole drugs from intravenous bags of painkillers.

The nurse at St Cloud Hospital, Minnesota, is suspected of using a syringe
to take the medication for her own personal use.

As a criminal investigation got underway today, it was revealed all the
patients were treated at one unit over the past five months.

St Cloud president Craig Broman said: ‘We are deeply saddened and
sincerely regret this situation. We take this matter very seriously.’

But hospital officials fear more patients could be at risk from the
infection which causes a fever but can be treated by antibiotics.

There is no danger it could spread to visitors or staff and no evidence
that blood-borne diseases such as Hepatitis B, Hepatitis C and HIV were
introduced to patients.

The unnamed nurse was suspended after hospital records showed she was the
common link with all the patients.

She is suspected of causing the contamination when she replaced the drugs
with a saline solution or air to blow the bags up to make them appear
full.

No administrator was aware the IV bags contained bacteria or had been
tampered with because the theft was believed to have been carried out in a
storage area.

A hospital investigation began last month after tests found a rise in
organisms that usually do not infect patients and called in state health
experts and the Centers for Disease Control and Prevention.

The two most-frequently identified types of bacteria – Klebsiella oxytoca
and Ochrobactrum anthropi –  were discovered after the patients developed
fevers and were tested.

The hospital said it had introduced new procedures by replacing all
patient-controlled IV bags, testing the removed bags, and re-evaluating
the storage and use of drugs.

All the patients infected by the bacteria have been notified by the
hospital.

Beth Honkomp, director of quality and patient safety, said: ‘We want them
to know we are extremely sorry for what has happened.’

Any patient who believes they may be at risk after being treated at St.
Cloud is asked to call 320-255-5788.
………………………………………………………………..
__________________________________________________________________________

India: Three Rajasthan doctors suspended for pregnancy deaths
Sify (IANS), India (17.03.11)

Jaipur, March 17 (IANS) Three doctors of state-run hospitals in
Rajasthan’s Jodhpur city have been suspended for the death of 16 pregnant
women due to contaminated IV fluids, a state minister said Thursday.

‘We have suspended Sumitra Boda, head of gynaecology department at Jodhpur
Medical College, for supervisory negligence while Ajay Malviya of Mahatama
Gandhi Hospital and Mohan Makwana have been suspended for irregularities
in procurement of medicines,’ Medical and Health Minister A.A. Khan
informed the state assembly.

Since the second week of February, 16 women have died while giving birth
to babies at Umaid Hospital, which is part of Jodhpur Medical College, and
Mahatama Gandhi Hospital.

The action was taken after a team of experts from Chandigarh’s Post
Graduate Institute of Medical Education and Research (PGIMER) confirmed
that the women died due to administration of contaminated IV fluids, an
official of medical and health department said.

The official said the women gave birth in different operations theatres,
so the infection does not seem to be hospital generated.

The four-member PGIMER team Wednesday handed over to the state government
its report concluding that the IV fluids caused infection and excessive
bleeding in the women.

Earlier, a report of the Central Drugs Laboratory, Kolkata, also suggested
that contamination in IV fluids led to the women’s deaths.

Informed sources said that gross irregularities in procurement of IV
fluids were also found by the government.

‘Three government hospitals in Jodhpur bought IV fluid from Parental
Surgical India Pvt Ltd (Indore) through the local distributor Anshul
Pharma, ignoring the established norms,’ said an official.

The hospital administration had lodged a first information report against
the firm which manufactured the fluids, following which its quality
control manager Sanjay Shah was arrested.
………………………………………………………………..
__________________________________________________________________________

India: Manufacturer to face legal action for contaminated IV fluids
Apurva, Indian Express, India (16.03.11)

Jaipur: A day after one of the three samples of intravenous fluids from
Jodhpur’s Umaid Hospital tested positive for bacterial contamination, the
Rajasthan Drugs Controller said legal proceedings will be initiated
against the Indore-based drug manufacturer, Parenteral Surgical India Ltd.

The Jodhpur Police will also conduct a parallel investigation in the
incident.

Rajasthan Drug Controller DK Shringi on Tuesday said the report confirming
bacterial contamination in the IV fluid batch number 0007 had been sent to
his Madhya Pradesh counterpart.

“The MP drug controller will initiate proceedings against the manufacturer
on the basis of this report,” Shringi said.

Since February 13, 17 women admitted at Umaid Hospital died after being
administered contaminated IV fluids.

Shringi said the manufacturer will be charged under the Drugs and
Cosmetics Act and, if convicted, can even face life imprisonment. “The
report shows that the sample tested was substandard and it is unknown how
many other bottles are infected. Therefore, the ban on all products
manufactured by this company will stay.”
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