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SIGNpost 00593

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

Post00593   Environment +  Abstracts + VSSM + News         06 April 2011

CONTENTS
1. Corporate Environmental Responsibility – Put into Practice
2. Abstract: Knowledge of blood-borne transmission risk is inversely
associated with HIV infection in sub-Saharan Africa
3. Abstract: Occupational exposure to HIV among health care providers: a
qualitative study in Yunnan, China
4. Abstract: Total Numbers of Undiagnosed Carriers of Hepatitis C and B
Viruses in Japan Estimated by Age- and Area-Specific Prevalence on the
National Scale
5. Abstract: Vaginal tenofovir gel trial results suggest substantial
nonsexual HIV transmission
6. Abstract: The risk of transmitting prion disease by blood or plasma
products
7. Abstract: A standardized comparison of commercially available prion
decontamination reagents using the Standard Steel-Binding Assay
8. Abstract: Contrast and Cost Savings by Implementation of a Multidose
Bulk IV Contrast Delivery System
9. Abstract: Syringe disposal among injection drug users in San Francisco
10. Abstract: Accelerated Transition to Injection Among Male Heroin
Initiates in Hanoi, Vietnam: Implications for Early Harm Reduction
Interventions
11. Abstract: Stery-hand: A new device to support hand disinfection
12. Abstract: Preliminary risk analysis applied to the transmission of
Creutzfeldt-Jakob disease
13. No Abstract: Data trump speculation and distortion of HIV transmission
routes in sub-Saharan Africa
14. No Abstract: HIV Infection – United States, 2005 and 2008
15. No Abstract: Term ‘flash sterilization’ to go away
16. No Abstract: Multiple use of pen needles in diabetes therapy.
Disposable instead of multiple use!
17. No Abstract: The reality of hand hygiene compliance in two Finnish
hospitals based on watching and analysing two hospital reality
television series
18. No Abstract: The psychological impact of needlestick injuries.
19. New: The Immunological Basis For Immunization Series: Module 17:
Rabies
20. Vaccine Stock Supplies Management(VSSM) Evaluation In Paraguay
21. News
– USA: Two VA dental clinic patients test positive for hepatitis B
– USA: More lawsuits filed in Alabama IV nutrition contamination
– USA: Study: States Need Work on Guidelines for Provider-Patient
Transmission of Bloodborne Pathogens
– Philippines: More units of donated blood positive for HIV
– USA: GJMV finds needles in recycling: Massie notes that needles pose
health risk to employees
– UN Warns of AIDS Atrocities
– Nevada USA: 2nd Vegas doctor reports he reused biopsy devices
– Nevada USA: Doctor apologizes to patients in reused needle case
– USA: Nine die in Alabama during bacteria outbreak
– USA: Brandon Regional Hospital Aids Diabetics, Others in Disposal of
Used Needles, Lancets
– Nevada USA: EDITORIAL: After Desai, urologist reused single-use devices

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__________________________________________________________________________
_____________________________________*____________________________________

1. Corporate Environmental Responsibility – Put into Practice

From Marcia Rock

Dear SIGNPost,

Please receive this development as an example of an innovative and
inspirational way to apply technical expertise to protect health and the
environment.

We need more innovations like this, to achieve our aims at both country
and global levels. It is more important than ever before.

Now is the time to take action.

Best regards,
Marcia
__________________________________________________________________________

From: Jan-Gerd Kühling <kuehling[at]etlog-health.de>
Date: Tue, Mar 22, 2011
Subject: Corporate Environmental Responsibility – Put into Practice

Dear Friends, Partners and Colleagues of ETLog Health

Normally I only send one message at the end of the year to inform you
about the latest developments of ETLog Health. This time I make an
exception, as an old and big wish became finally reality.

You might know that at ETLog Health, we take our environmental
responsibility very serious. We thought long how we can best improve our
ecological footprint and we came to the conclusion that CO2 emission
compensation is not enough. Protection of nature and the conservation of
biodiversity is another major tasks for the future.

To combine both – biodiversity and emission compensation – we initiated in
2010 the internal and self-financed project “Kremmen 2011”. Today I´m
pleased to inform you that the project became reality.

Best regards from Berlin

Yours

Jan-Gerd Kühling

P.S.: We are just updating our Web-site. Please visit our new web-site in
about two months.

ETLog Health EnviroTech & Logistics GmbH

Jan-Gerd Kühling
Managing Partner
Kavalierstrasse 15
13187 Berlin
Germany

Tel.: ++ 49 (0)30 / 44 31 87 – 41
Fax: ++ 49 (0)30 / 44 31 87 – 49
E-Mail: kuehling[at]etlog-health.de
Skype-Username: etlog-jgk
Web: www.etlog-health.com
………………………………………………………………..
__________________________________________________________________________

Corporate Environmental Responsibility – Put into Practice!

“It is not only for what we do that we are held responsible, but also for
what we do not do”   Moličre

ETLog Health GmbH is a small to medium sized company based in Berlin. The
focus of our activity is the consultancy and support to hospitals in
developing and emerging countries to establish environmental management
systems, and to increase hospital hygiene. With over 80 donor-funded
projects in almost 40 countries, ETLog Health GmbH is one of the world’s
leading consulting firms for healthcare waste projects. For our
development cooperation work, we often have to travel the world.

Where possible, we use modern communication facilities to minimize
travelling, or we travel climate-friendly by train.

However, there is sometimes no alternative to flying. We are aware of our
responsibility to the environment. To work on the one hand for better
environmental standards in developing and transition countries, and to be
on the other hand partly responsible for the release of greenhouse gases –
that we see as a contradiction that needed to be resolved.

Merely adopting an environmental policy was not enough for us. The
purchase of emission certificates is a better way to minimize the
environmental footprint. But we wanted more and went a step further to
compensate for our emissions, following the principle:

“Work Globally, Act Locally!”

In February 2010, ETLog Health acquired from the German Federal Government
9.4632 hectares land of former possession of the GDR. The area is located
in a predominantly agricultural district.

Forestry retreat areas are therefore of high importance for biodiversity.
Of our 10 hectares, about 4 hectares are ecologically valuable floodplain
forest. This part of our forest will be managed in future in an extensive
and sustainable way to protect it for future generations. A further 2
hectares of the land is swamp land, which like all wetlands has a high
biological diversity which will be preserved.

The remaining 4 hectares are wasteland. As the CO2 compensation of ETLog
Health, this land will be in the upcoming years converted into extensively
managed floodplain forest.

In case of further interest in our project: the future biological reserve
of ETLog Health is located about 50 km northwest of Berlin. Please contact
us if you want to visit it with us. And if you want to reduce your carbon
footprint immediately – You are welcome to plant a tree in our reserve
__________________________________________________________________________
_____________________________________*____________________________________

2. Abstract: Knowledge of blood-borne transmission risk is inversely
associated with HIV infection in sub-Saharan Africa
__________________________________________________________________________

J Infect Dev Ctries. 2011 Mar 21;5(3):182-98.

Knowledge of blood-borne transmission risk is inversely associated with
HIV infection in sub-Saharan Africa.

Brewer DD.

Interdisciplinary Scientific Research, Seattle, WA, United States.
dbrewer@interscientific.net.

INTRODUCTION: Accurate, comprehensive knowledge of an infectious
pathogen’s modes of transmission helps people to avoid infection. Growing
evidence suggests that blood-borne HIV transmission is widespread in sub-
Saharan Africa.

METHODOLOGY: I examined the association between knowledge of blood-borne
HIV risk and prevalent HIV infection in Demographic and Health Survey data
from 16 sub-Saharan African countries. I also searched three online
databases for evidence of public education campaigns focused on blood-
borne HIV risks in these countries.

RESULTS: Knowledge was moderately to strongly inversely related to HIV
prevalence at the national level (i.e., countries in which many
respondents were aware of blood-borne risk had lower HIV prevalence than
countries in which few respondents were aware of such risk). At the
individual level, respondents who knew about blood-borne HIV risks were
modestly less likely to be infected than those who did not show awareness
of this risk, independent of demographic and sexual behavior variables.
This relationship was stronger in southern Africa than in west, central,
and east Africa. In parallel analyses, knowledge of condom use as a way to
prevent HIV was positively associated with prevalent HIV infection at both
the national and individual levels. West, central, and east African
countries with low to moderate HIV prevalence had implemented public
education campaigns that included a focus on blood-borne transmission
risks. Such campaigns were absent from high prevalence countries in
southern Africa.

CONCLUSION: These findings suggest that knowledge of blood-borne HIV risk
protects against HIV infection and that public education campaigns are
important for spreading that knowledge.

Free Article : http://jidc.org/index.php/journal/article/view/1308/518
__________________________________________________________________________
_____________________________________*____________________________________

3. Abstract: Occupational exposure to HIV among health care providers: a
qualitative study in Yunnan, China
__________________________________________________________________________

J Int Assoc Physicians AIDS Care (Chic). 2008 Jan-Feb;7(1):35-41. Epub
2007 Jul 19.

Occupational exposure to HIV among health care providers: a qualitative
study in Yunnan, China.

Lin C, Li L, Wu Z, Wu S, Jia M.

UCLA-NPI Center for Community Health, University of California, Los
Angeles, CA, USA.

With the HIV/AIDS epidemic spreading, health care providers (HCPs) in
China are facing a growing risk of occupational exposure to and infection
with HIV. There is a need to describe occupational exposure cases and
compliance with postexposure prophylaxis (PEP) guidelines among HCPs.
Qualitative in-depth interviews were conducted with 33 HCPs in Yunnan
Province, China.

Information about occupational exposures the HCPs and their co-workers
experienced was collected and analyzed using ATLAS.ti.

Most occupational exposure accidents happened during emergencies, when
HCPs did not have time to consider self-protection. Exposure to HIV caused
exposed HCPs severe adverse psychological pressure, such as stress and
anxiety. Compliance with PEP guidelines among participants was poor;
barriers to better compliance were identified.

This study underscored the importance of institutional support in
promoting compliance with PEP guidelines among exposed providers. Further
training and emphasis on universal precautions and PEP guidelines may
reduce the risk of occupational infections.

Š 2008 Sage Publications
__________________________________________________________________________
_____________________________________*____________________________________

4. Abstract: Total Numbers of Undiagnosed Carriers of Hepatitis C and B
Viruses in Japan Estimated by Age- and Area-Specific Prevalence on the
National Scale
__________________________________________________________________________

Intervirology. 2011 Mar 30.

Total Numbers of Undiagnosed Carriers of Hepatitis C and B Viruses in
Japan Estimated by Age- and Area-Specific Prevalence on the National
Scale.

Tanaka J, Koyama T, Mizui M, Uchida S, Katayama K, Matsuo J, Akita T,
Nakashima A, Miyakawa Y, Yoshizawa H.

Department of Epidemiology, Infectious Disease Control and Prevention,
Hiroshima University Graduate School of Biomedical Sciences, Tokyo, Japan.

Objective: To estimate total numbers of undiagnosed carriers of hepatitis
C virus (HCV) and hepatitis B virus (HBV) in Japan.

Methods: Area- and age-specific prevalence of HCV as well as HBV was
determined in the first- time blood donors [20-39 years (n = 2,429,364)]
and examinees of periodical health check-ups [40-74 years (6,204,968 for
HCV and 6,228,967 for HBV)] in Japan. Prevalence in adolescents [5-19
years (79,256 for HCV and 68,792 for HBV)] was determined in a single
prefecture, and that of HCV in the elderly (=75 years) was estimated by
the exponential model. HBV infection was determined by the detection of
hepatitis B surface antigen, and HCV infection by either the algorithm or
assuming persistent infection in 70% of the individuals with antibody to
HCV.

Results: Of the total population of 127,285,653 in 2005, 807,903 (95% CI
679,886-974,292) were estimated to be infected with HCV at a carrier rate
of 0.63%, and 903,145 (837,189-969,572) with HBV at that of 0.71%.

Conclusion: Accurate estimation of undiagnosed HCV and HBV carriers in the
general population would help to predict the future burden of liver
disease, and take appropriate measures for improving healthcare.
__________________________________________________________________________
_____________________________________*____________________________________

5. Abstract: Vaginal tenofovir gel trial results suggest substantial
nonsexual HIV transmission
__________________________________________________________________________

WebmedCentral EPIDEMIOLOGY, 1(12):WMC001292.

Vaginal tenofovir gel trial results suggest substantial nonsexual HIV
transmission.

Brewer, D. D., Potterat, J. J., Gisselquist, D., & Collery, S. (2010).

Abdool Karim and colleagues demonstrated that vaginal tenofovir gel
provides partial protection against HIV in South African women. However,
the study design of their double-blind, randomized, placebo-controlled
CAPRISA 004 trial did not allow for determining the mode of HIV
acquisition for participants with incident infection.

The available evidence suggests substantial nonsexual transmission.

Trial participants’ reported exposure to HIV through penile-vaginal sex,
at the aggregate level, was unrelated to HIV incidence over time.
Moreover, the CAPRISA 004 trial data imply a questionably high nominal per
act transmission probability for coital acts without a condom (1.8% in the
tenofovir gel arm and 3.0% in the placebo arm).

Based on the results of dosing studies, the vaginal tenofovir gel appears
to be a somewhat inefficient vehicle for delivering tenofovir
systemically, thereby serving to prevent HIV acquisition from either blood
or sexual exposures.

Further analysis of the trial data and making the full trial protocol and
data public would allow competing interpretations of the CAPRISA 004
results to be investigated.

New trials that include critical design features for determining modes of
HIV transmission would provide the most definitive evidence.

link to free article: http://www.webmedcentral.com/article_view/1292
__________________________________________________________________________
_____________________________________*____________________________________

6. Abstract: The risk of transmitting prion disease by blood or plasma
products
__________________________________________________________________________

Transfus Apher Sci. 2010 Dec;43(3):387-91.

The risk of transmitting prion disease by blood or plasma products.

Knight R.

UK National CJD Surveillance Unit, University of Edinburgh, United
Kingdom. R.Knight@ed.ac.uk

Various experimental studies have shown infectivity in blood in relation
to bovine spongiform encephalitis (BSE) and variant Creutzfeldt-Jakob
disease (vCJD).

Human to human transmission vCJD infection has been reported via
transfusion of non-leukocyte-reduced red cells and, probably, via factor
VIII concentrates.

A number of precautionary measures are in place but uncertainties remain,
especially concerning the number of BSE- infected people in the
population. Additional measures such as prion filtration need
consideration.

Copyright Š 2010 Elsevier Ltd. All rights reserved.
__________________________________________________________________________
_____________________________________*____________________________________

7. Abstract: A standardized comparison of commercially available prion
decontamination reagents using the Standard Steel-Binding Assay
__________________________________________________________________________

J Gen Virol. 2011 Mar;92(Pt 3):718-26. Epub 2010 Nov 17.

A standardized comparison of commercially available prion decontamination
reagents using the Standard Steel-Binding Assay.

Edgeworth JA, Sicilia A, Linehan J, Brandner S, Jackson GS, Collinge J.

MRC Prion Unit, Department of Neurodegenerative Disease, UCL Institute of
Neurology, Queen Square, London WC1N 3BG, UK.

Prions are comprised principally of aggregates of a misfolded host protein
and cause fatal transmissible neurodegenerative disorders of mammals, such
as variant Creutzfeldt-Jakob disease in humans and bovine spongiform
encephalopathy in cattle. Prions pose significant public health concerns
through contamination of blood products and surgical instruments, and can
resist conventional hospital sterilization methods.

Prion infectivity binds avidly to surgical steel and can efficiently
transfer infectivity to a suitable host, and much research has been
performed to achieve effective prion decontamination of metal surfaces.

Here, we exploit the highly sensitive Standard Steel-Binding Assay (SSBA)
to perform a direct comparison of a variety of commercially available
decontamination reagents marketed for the removal of prions, alongside
conventional sterilization methods.

We demonstrate that the efficacy of marketed prion decontamination
reagents is highly variable and that the SSBA is able to rapidly evaluate
current and future decontamination reagents.
__________________________________________________________________________
_____________________________________*____________________________________

8. Abstract: Contrast and Cost Savings by Implementation of a Multidose
Bulk IV Contrast Delivery System
__________________________________________________________________________

J Am Coll Radiol. 2011 Apr;8(4):265-70.

Contrast and Cost Savings by Implementation of a Multidose Bulk IV
Contrast Delivery System.

Routhier J, Piazzo K, Sodickson A.

PURPOSE: In an effort to standardize clinical operations and reduce
intravenous (IV) contrast costs, the authors’ department switched from
100-mL single-use IV contrast vials to a multidose IV contrast delivery
system using iopromide 370. The purpose of this study was to assess IV
contrast use, waste, and cost savings resulting from the implementation of
this multidose system.

METHODS: A review was conducted of consecutive pulmonary embolism (PE) CT
angiography, head and neck (HN) CT angiography, and abdomen/pelvis (AP) CT
examinations performed according to standard department protocol 2 weeks
before and 2 weeks after the implementation of a multidose IV contrast
delivery system. The amount of contrast loaded and injected for each
examination was recorded, and total contrast used and wasted were
calculated. Volumes of used and wasted contrast were compared before and
after implementation using Wilcoxon’s rank-sum test. Associated cost
savings are reported.

RESULTS: There were 32 PE, 27 HN, and 124 AP examinations performed using
the 100-mL single-use vial technique and 27 PE, 25 HN, and 175 AP
examinations using the multidose technique. Use of the multidose system
resulted in average reductions in used contrast volume of 15.9, 35.1, and
11.4 mL, respectively, for PE, HN, and AP examinations (Wilcoxon’s P <
.0001). For PE and HN examinations, this was due to reduced contrast
waste, as these protocols require less than the 100-mL contents of the
single-use vial. For AP examinations, savings were due to reduction in
contrast volume through the use of higher iodine concentration. Associated
cost savings annualize to approximately $31,800 for these 3 examination
types alone at the authors’ institution.

CONCLUSION: The implementation of a multidose bulk IV contrast material
delivery system results in significant contrast and cost savings.

Copyright Š 2011 American College of Radiology. Published by Elsevier Inc.
All rights reserved.
__________________________________________________________________________
_____________________________________*____________________________________

9. Abstract: Syringe disposal among injection drug users in San Francisco
__________________________________________________________________________

Am J Public Health. 2011 Mar;101(3):484-6.

Syringe disposal among injection drug users in San Francisco.

Wenger LD, Martinez AN, Carpenter L, Geckeler D, Colfax G, Kral AH.

RTI International, San Francisco, CA 94104, USA. lynndee@rti.org

To assess the prevalence of improperly discarded syringes and to examine
syringe disposal practices of injection drug users (IDUs) in San
Francisco, we visually inspected 1000 random city blocks and conducted a
survey of 602 IDUs.

We found 20 syringes on the streets we inspected. IDUs reported disposing
of 13% of syringes improperly.

In multivariate analysis, obtaining syringes from syringe exchange
programs was found to be protective against improper disposal, and
injecting in public places was predictive of improper disposal.

Few syringes posed a public health threat.
__________________________________________________________________________
_____________________________________*____________________________________

10. Abstract: Accelerated Transition to Injection Among Male Heroin
Initiates in Hanoi, Vietnam: Implications for Early Harm Reduction
Interventions
__________________________________________________________________________

J Community Health. 2011 Mar 31.

Accelerated Transition to Injection Among Male Heroin Initiates in Hanoi,
Vietnam: Implications for Early Harm Reduction Interventions.

Clatts MC, Goldsamt LA, Minh Giang L, Colón-López V.

School of Public Health, University of Puerto Rico, PO Box 365067, San
Juan, PR, 00936-5067, USA, michael.clatts@upr.edu.

This paper examines changes in the interval between first heroin smoking
and onset of injection in a large, out-treatment sample of male heroin
users in Hanoi, Vietnam (n = 1,115).

Mean age at initiation of heroin use (smoking) was 18.4 and mean age of
onset of heroin injection was 20.9 years. Full multivariate analysis
indicates that the interval between first heroin use (smoking) and first
heroin injection has been significantly attenuated among more recent
heroin initiates (P = 0.0043), suggesting that heroin users in Vietnam may
be at increased risk for exposure to HIV relatively soon after onset of
heroin use, highlighting the need for behavioral interventions that target
heroin smokers.

Critical intervention goals include delaying the onset of injection and
improved education about safer drug sharing and drug injection practices.
__________________________________________________________________________
_____________________________________*____________________________________

11. Abstract: Stery-hand: A new device to support hand disinfection
__________________________________________________________________________

Conf Proc IEEE Eng Med Biol Soc. 2010;2010:4756-9.

Stery-hand: A new device to support hand disinfection.

Szilagyi L, Lehotsky A, Nagy M, Haidegger T, Benyo B, Benyo Z.

Sapientia University of Transylvania, Tîrgu Mures, Romania.
lalo@ms.sapienia.ro

Incomplete disinfection can cause serious complications in surgical care.
The teaching of effective hand washing is crucial in modern medical
training. To support the objective evaluation of hand disinfection, we
developed a compact, mobile device, relying on digital imaging and image
processing.

The hardware consists of a metal case with matte black interior, ultra-
violet lighting and a digital camera. Image segmentation and clustering
are performed on a regular notebook. The hand washing procedures performed
with a soap mixed with UV-reflective powder. This results the skin showing
bright under UV light only on the treated (sterile) surfaces. When the
surgeon inserts its hands into the box, the camera placed on the top takes
an image of the hand for evaluation.

The software performs the segmentation and clustering automatically.
First, the hand contour is determined from the green intensity channel of
the recorded RGB image. Then, the pixels of the green channel belonging to
the hand are partitioned to three clusters using a quick, histogram based
fuzzy c-means algorithm. The optimal threshold between the intensities of
clean and dirty areas is extracted using these clusters, while the final
approximated percentage of the clean area is computed using a weighting
formula.

The main advantage of our device is the ability to obtain objective and
comparable result on the quality of hand disinfection. It may find its
best use in the clinical education and training.
__________________________________________________________________________
_____________________________________*____________________________________

12. Abstract: Preliminary risk analysis applied to the transmission of
Creutzfeldt-Jakob disease
__________________________________________________________________________

Pharmazie. 2011 Jan;66(1):75-9.

Preliminary risk analysis applied to the transmission of Creutzfeldt-Jakob
disease.

Bertrand E, Schlatter J.

Jean Verdier University Hospital, Bondy, France.

Transmissible spongiform encephalopathy (TSE) is a degenerative disease of
the central nervous system. As yet, there is no human screening test and
no effective treatment. This disease is invariably fatal. General
preventive measures are therefore essential. The objective of this study
is to analyze and address on a prioritized basis the risks relating to the
transmission of Creutzfeldt-Jakob disease during surgical operations by
means of a preliminary risk analysis (PRA).

The PRA produces 63 scenarios with maximum risk relating to operational
and legal dangers. The study recommends a number of courses of action,
such as training and internal controls, in order to reduce the risks
identified. A procedure has been drawn up and assessed for each action.

This PRA makes it possible to target and significantly reduce the
potential dangers for transmission of Creutzfeldt-Jakob disease through
the use of medical instruments.
__________________________________________________________________________
_____________________________________*____________________________________

13. No Abstract: Data trump speculation and distortion of HIV transmission
routes in sub-Saharan Africa
__________________________________________________________________________

Int J STD AIDS. 2011 Feb;22(2):118-20.

Data trump speculation and distortion of HIV transmission routes in sub-
Saharan Africa.

Brewer DD, Okinyi M, Potterat JJ.

Interdisciplinary Scientific Research, Seattle, WA, USA.

The reprint of the letter is available [Free] through:
http://www.interscientific.net/IJSA2011.html
__________________________________________________________________________
_____________________________________*____________________________________

14. No Abstract: HIV Infection – United States, 2005 and 2008
__________________________________________________________________________

MMWR Surveill Summ. 2011 Jan 14;60 Suppl:87-9.

HIV Infection – United States, 2005 and 2008.

Hall HI, Hughes D, Dean HD, Mermin JH, Fenton KA; Centers for Disease
Control and Prevention (CDC).

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention,
CDC, Atlanta, GA 30333, USA. ixh1@cdc.gov

Free Article
__________________________________________________________________________
_____________________________________*____________________________________

15. No Abstract: Term ‘flash sterilization’ to go away
__________________________________________________________________________

OR Manager. 2011 Jan;27(1):5.

Term ‘flash sterilization’ to go away.

[No authors listed]

__________________________________________________________________________
_____________________________________*____________________________________

16. No Abstract: Multiple use of pen needles in diabetes therapy.
Disposable instead of multiple use!
__________________________________________________________________________

Pflege Z. 2011 Jan;64(1):16-9.

[Multiple use of pen needles in diabetes therapy. Disposable instead of
multiple use!].

[Article in German]

Loczenski B.

B.Loczenski@Berliner-Pflegeberatung.de
__________________________________________________________________________
_____________________________________*____________________________________

17. No Abstract: The reality of hand hygiene compliance in two Finnish
hospitals based on watching and analysing two hospital reality
television series
__________________________________________________________________________

J Hosp Infect. 2011 Jan;77(1):86-7.

The reality of hand hygiene compliance in two Finnish hospitals based on
watching and analysing two hospital reality television series.

Hintikka A, Kainulainen K, Anttila VJ.
__________________________________________________________________________
_____________________________________*____________________________________

18. No Abstract: The psychological impact of needlestick injuries.
__________________________________________________________________________

Ir J Med Sci. 2011 Apr 1.

The psychological impact of needlestick injuries.

O’Connor MB.

Department of Rheumatology, South Infirmary Victoria University Hospital,
Cork, Ireland, mortimeroconnor@gmail.com.
__________________________________________________________________________
_____________________________________*____________________________________

19. New: The Immunological Basis For Immunization Series: Module 17:
Rabies

Crossposted from Global Immunization News, with thanks.
__________________________________________________________________________

The Immunological Basis For Immunization Series: Module 17: Rabies

(ISBN 978 92 4 150108 8)

This IVB document is now online.
http://whqlibdoc.who.int/PUBLICATIONS/2011/9789241501088_ENG.PDF

The main purpose of the modules of the series – which are published as
separate/vaccine specific modules – is to give immunization managers and
vaccination professionals a brief and easily-understood overview of the
scientific basis of vaccination. This module focuses on Rabies.
__________________________________________________________________________
_____________________________________*____________________________________

20. Vaccine Stock Supplies Management(VSSM) Evaluation In Paraguay

Crossposted from Global Immunization News, with thanks.
__________________________________________________________________________

Vaccine Stock Supplies Management(VSSM) Evaluation In Paraguay

31/03/2011 from Nora Lucia Rodriguez, WHO/PAHO
Between 7-11 March 2011, the Ministry of Health of Paraguay, in
collaboration with PAHO and WHO, conducted an evaluation of a pilot
project to improve vaccine management using WHO’s Vaccine Stock Supplies
Management Software (VSSM). VSSM is a MS Access-based software to be used
for managing vaccine inventory at storage facilities. Paraguay implemented
the VSSM at the national vaccine warehouse in May 2010 and five regional
warehouses in July 2010.

The evaluation had the following objectives: 1) determine the usefulness
of VSSM for decision-making in warehouse operations, 2) evaluate the
impact of using the VSSM in warehouse operations, and 3) document the
experience and difficulties related to the use of the software.

The teams visited the national warehouse and warehouses in four regions.
Evaluation teams interviewed staff and observed the use of the software.
The evaluation included comparing physical stocks against the VSSM stock
reports.

The evaluation demonstrated that the personnel at the vaccine warehouses
were proficient in the use of the VSSM and its reports. The personnel
interviewed considered VSSM to be very useful, effective, and reliable for
managing warehouse operations, highlighting that one database contained
all data needed to make decisions in real-time.

Users stated that using VSSM has resulted in improvements in warehouses
operations, i.e., reception, storage, and distribution of vaccines and
other injection supplies. No difficulties with the use of the software
were reported. The Ministry of Health of Paraguay has decided to implement
the VSSM nationwide.

Of the four countries pilot testing the VSSM in the Americas, Paraguay is
the first to evaluate the usefulness of this tool developed by WHO.
__________________________________________________________________________
_____________________________________*____________________________________

21. News

– USA: Two VA dental clinic patients test positive for hepatitis B
– USA: More lawsuits filed in Alabama IV nutrition contamination
– USA: Study: States Need Work on Guidelines for Provider-Patient
Transmission of Bloodborne Pathogens
– Philippines: More units of donated blood positive for HIV
– USA: GJMV finds needles in recycling: Massie notes that needles pose
health risk to employees
– UN Warns of AIDS Atrocities
– Nevada USA: 2nd Vegas doctor reports he reused biopsy devices
– Nevada USA: Doctor apologizes to patients in reused needle case
– USA: Nine die in Alabama during bacteria outbreak
– USA: Brandon Regional Hospital Aids Diabetics, Others in Disposal of
Used Needles, Lancets
– Nevada USA: EDITORIAL: After Desai, urologist reused single-use devices

Selected news items reprinted under the fair use doctrine of international
copyright law: http://www4.law.cornell.edu/uscode/17/107.html
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USA: Two VA dental clinic patients test positive for hepatitis B
By B Sutherly,  Dayton Daily News (05.05.11)

DAYTON – Two patients seen at the Dayton VA Medical Center’s dental clinic
have confirmed cases of hepatitis B, a spokesman said Monday.

VA officials are unsure if the two patients contracted the disease at the
dental clinic. A clinic dentist failed to follow proper infection control
protocols, potentially exposing at least 535 patients to bloodborne
pathogens between January 1992 and July 2010.

They are the first two confirmed cases linked to the scandal, which has
prompted the reassignment of the medical center’s director and has elected
officials calling for congressional hearings.

Epidemiological testing, which could take months, may or may not determine
whether the clinic was the source of those infections.

The two patients have been notified, VA spokesman Todd Sledge said.

Three other dental clinic patients tested positive for hepatitis C, but
the VA is still determining if those cases  may have been false positives.
It’s also possible those three patients have the virus in an inactive
form, Sledge said.

Hepatitis is inflammation of the liver.

Dr. Dwight Pemberton, the dentist who reportedly failed to change gloves
and sterilize instruments between patients, retired Feb. 11 at age 81.
According to records, his supervisors knew of the problems.
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USA: More lawsuits filed in Alabama IV nutrition contamination
By Hannah Wolfson, The Birmingham News, Alabama USA (05.04.11)

Birmingham, ALABAMA — Two more lawsuits were filed Tuesday against the
Birmingham pharmacy linked to contaminated IV nutrition that sickened 19
people, nine of whom died.

Donald Mottern filed a lawsuit on behalf of his mother, Lavonne Mottern,
who died at Princeton Baptist Medical Center on March 14 after stomach
surgery.

In a separate complaint, Todd Hammond and his mother, Shirley Haynesworth,
filed suit claiming that Hammond, who was hospitalized at Select Specialty
Hospital, an acute care unit housed at Trinity Medical Center, suffered
ill effects.

Both received total parenteral nutrition, an intravenous supplement given
to people who can’t eat or be tube-fed, mixed by Meds IV.

Health officials could release results of their investigation sometime
this week into the outbreak of Serratia marcescens at six Alabama
hospitals.

Meanwhile, the Alabama Board of Pharmacy said it won’t let Meds IV reopen
until the investigation is complete and that the Food and Drug
Administration seized company records last week, the Associated Press
reported. The pharmacy voluntarily shut down operations and recalled all
products made this year.
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USA: Study: States Need Work on Guidelines for Provider-Patient
Transmission of Bloodborne Pathogens
by Jaimie Oh, Becker’s Hospital Review (04.04.11)

Researchers suggest there is a need for standardizing evidence-based
practices into state guidelines in order to minimize provider-to-patient
transmission of bloodborne pathogens, according to a study published in
Infection Control and Hospital Epidemiology.

Researchers reviewed 50 states’ laws and guidelines to see whether state
policies have been modified since the CDC’s 1991 guidelines for reducing
the risk of provider-to-patient transmission of bloodborne pathogens. They
also assessed whether state laws require prospective notification of
patients and/or expert review panels to manage infected providers; how
often infected-providers issues come to the attention of state health
departments; and how state health departments handled these risks.

Only 19 states require infected providers to notify patients of providers’
bloodborne pathogen infection, and 10 of 50 state health department
officials reported these risks as requiring significant departmental
effort. No state law required providers’ viral burdens as part of a risk
assessment, and only three of 50 states have modified policies or laws
since initial passage in 1991.

Read the study about state guidelines for risk management of provider-to-
patient transmission of bloodborne pathogens.
http://www.jstor.org/pss/10.1086/659405
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Philippines: More units of donated blood positive for HIV
By Mayen Jaymalin (The Philippine Star) (04.04.11)

MANILA, Philippines – More units of donated blood have been found to be
positive for the AIDS-causing human immunodeficiency virus (HIV), the
Department of Health (DOH) reported yesterday.

Data from the Philippine HIV-AIDS Registry in February indicated that more
than one in every five blood units they have tested has been contaminated
with HIV.

“Out of the 67 blood units referred for HIV confirmation, 15 units were
positive for HIV and 50 units were negative for HIV and two units had
indeterminate results,” the report said.

But government health experts clarified that the 15 HIV-positive units do
not automatically translate to 15 people since one blood donor can donate
more than one blood unit.

Based on the same report released last Friday, there was one reported HIV
case acquired through blood transfusion.

Dr. Gerard Belimac, DOH – National AIDS/Sexually Transmitted Infection
Prevention and Control Program manager, however, insisted that it is very
rare that a “contaminated” blood had been transfused to another person.

The health official said they are now in the process of investigating the
recently reported transfusion of HIV-contaminated blood.

Belimac said they have already identified the concerned hospital.

He however declined to identify it but said it is situated outside Metro
Manila.

He then asked the public to help the DOH to prevent a repeat of such case
by refraining from giving “doubtful” blood donations.

“Our main message to the public is that if they were exposed to risky
behaviors, please avoid donating blood because you could be donating your
blood to your loved ones, to your friends,” Belimac said.
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USA: GJMV finds needles in recycling: Massie notes that needles pose
health risk to employees
By David Coyan, Jackson Times Journal, Ohio USA (01.04.11)

WELLSTON — An incident at Gallia-Jackson-Meigs-Vinton Solid Waste (GJMV)
has left Mike Massie, Recycling Coordinator, very concerned about the
safety of workers there.

This incident, however, wasn’t a robbery, or even an assault. Instead, it
was someone carelessly, or at the least, unknowingly, throwing hypodermic
needles into a recycling bin at the facility located at 1056 S. New
Hampshire Ave. in Wellston.

“The needles are a big issue because the can poke the fingers of our
workers, which then puts them at the risk of being infected,” said Massie.
“The health department recommends that needles be disposed of inside a
two-liter bottle or other like container and then disposed of in the
garbage. They are not recyclable anyway.”  Workers are at risk because
when recyclables are brought in from the bins, they are sorted by hand. In
the instance that needles are traveling down the belt along with other
items, they run the risk of being stabbed by the needles. Also, the act of
dumping out the bins also puts the workers at risk. Various diseases can
be shared when a “dirty” needle sticks another person, and being stuck can
come at a tremendous cost not only to GJMV, but the workers as well.

Workers can contract various diseases including hepatitis and other
illnesses that can affect them for the rest of their life, and, in the
event that a worker is stuck at the center, GJMV is forced to lose
manpower while that person goes to the emergency room to be checked out.

“We have to assume the worst when someone is stuck by a needle,” Massie
explained. “We cannot afford to take every precaution we can to ensure the
safety of our workers.”

Massie also noted that dumping things other than what the bins intend to
hold into them is illegal. Illegal dumping is punishable by fine and in
some instances, even jail time. Massie noted that if someone were caught,
they would be turned over to the Sheriff’s office.

GJMV continues to offer an alternative to disposing of steel and aluminum
cans, newspapers and magazines, type one and two plastics, bottles and
jugs, as well as clear, brown and green bottles at various drop points in
Wellston, Jackson, Coalton and Oak Hill. Recycling provides an excellent
opportunity for residents to save themselves money in the long run on
garbage bills. Many municipalities can charge extra if households exceed
their minimum bag limit.
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UN Warns of AIDS Atrocities
Dinesh Chandra Gaur, TopNews New Zealand (02.04.11)

Though, now in its 30th year, the awareness against AIDS has still a long
way to go, according to the officials from the UN.

A lot is needed to be done to ease down the effects of this lethal disease
that claims some 2 million lives every year.

It is the world’s most dangerous leading infectious killer and can spread
easily through unprotected sexual intercourse, transfusions of
contaminated blood; and the sharing of contaminated needles, syringes or
other sharp instruments.

Releasing the statistics, Ban Ki-moon, Secretary General, stated, “We have
a unique opportunity to take stock of the progress and to critically and
honestly assess the barriers that keep us shackled to a reality in which
the epidemic continues to outpace the response”.

He added that as many as 27 million people have lost their lives so far
after getting infected from AIDS. In addition, more than 60 million people
have been infected with human immunodeficiency virus (HIV).

Not only this, some 7,000 new cases of HIV infected people are reported
everyday all across the globe that includes 1,000 children.

Though, Ban hopes for significant improvements in bringing down the
infection rates by 2015, he has maintained that the need of the hour is
the joint efforts and generation of awareness against this disease.
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Nevada USA: 2nd Vegas doctor reports he reused biopsy devices
Las Vegas Review-Journal (31.03.11)

LAS VEGAS (AP) – A second Las Vegas physician is notifying patients that
he’ll pay for them to get HIV and hepatitis tests after he improperly
reused medical devices during biopsy procedures.

Nevada State Medical Board says Dr. Lawrence Newman voluntarily reported
that he had been sterilizing and reusing single-use plastic endocavity
needle guides.

Board executive Doug Cooper told the Las Vegas Review-Journal that Newman
reported reusing devices during 150 prostate biopsies over three years.
Cooper says it’s not clear whether Newman will face board discipline.

The board recently suspended another urologist, Dr. Michael Kaplan, after
finding he improperly reused the guides from Dec. 20 to March 11.

The Southern Nevada Health District hasn’t identified infections due to
the reused devices, but it is notifying more than 100 of Kaplan’s patients
to get tested.
___

Information from: Las Vegas Review-Journal, http://www.lvrj.com

Please read the updated long article at: http://tinyurl.com/4x2bav8
or:
http://www.lvrj.com/news/second-doctor-tells-medical-board-he-reused-
needle-guides-in-biopsies-118958369.html?ref=369
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Nevada USA: Doctor apologizes to patients in reused needle case
By Paul Harasim, Las Vegas Review-Journal (31.03.11)

A letter sent by Dr. Lawrence Newman to 150 of his patients takes
“complete responsibility” for putting them at risk for HIV and hepatitis
because of his breach of infection control.

The Monday letter, obtained Thursday from one of Newman’s patients who had
a prostate biopsy , said the information the physician had been operating
under, that endocavity needle guides could be reused after processing
“with a high level disinfectant,” was “incorrect.”

On Wednesday, Doug Cooper, executive director of the Nevada State Medical
Board, said the urologist recently reported himself to the board and began
notifying his patients after he realized that he had been doing for three
years “the same thing” as Dr. Michael Kaplan. Cooper said Newman remains
under investigation.

Kaplan, whose license was summarily suspended in early March, stopped
using single-use needle guides only when they became “too bloody,”
according to authorities.

A medical professional, who received one of Newman’s letters and asked not
to be identified, was none too pleased with the physician.

“I feel like I’ve been violated, abused and taken advantage of,” he said.
“He tarnishes the whole medical profession. My wife sells medical devices,
and she found it incredible that he (Newman) would go against what the
manufacturer said in its instructions. I trusted the guy and here he is
cutting corners so he can save $10 on buying a new device. He better get
suspended, too. ”

According to Kaplan’s attorney, Dominic Gentile, his client reused the
single-use medical devices after a vendor from Providian Medical said the
needle guides manufactured by CIVCO Medical Solutions could be reused.

A source familiar with the state’s infection control efforts said Newman,
like Kaplan, told authorities a vendor had said the plastic needle guides
could be used more than once.

Newman’s letter to patients does not say where he got his misinformation.

Gentile also said a Providian vendor told an investigator for his law firm
that CIVCO officials said the needle guides could be reused.

On Thursday, CIVCO officials wasted few words in denying that anyone in
the company ever represented that the devices could be used more than
once.

But the maker of medical devices that are distributed worldwide did not
deny that a distributor could be misrepresenting its product.

“Our disposable is clearly labeled single use only and we have never said
otherwise,” a statement released by the company said. “We cannot speak for
others involved in its distribution.”

What Providian officials had to say Thursday does not rebut allegations
that an employee could have misrepresented how a single use device should
be used.

“We are working to gather more information so that we can understand the
facts of this situation,” a company statement reads.

“We want to understand completely the facts involved so we can determine
what course of action may be warranted. We are fully committed to
compliance with all government regulations and safety standards.”

Mark Brager, a spokesman for AdvaMed, a manufacturers’ trade association,
said Thursday a physician should never take the word of a vendor over
instructions from a manufacturer.

“If the doctor has a question, he should contact both the manufacturer and
the FDA,” Brager said.

According to the Veterans Affairs Southern Nevada Healthcare System,
Newman also sees VA patients under a contract with the government. Dave
Martinez, a VA spokesman, said patients seen by Newman at a clinic in the
past need not worry.

He said the local VA health system has never reprocessed or reused single-
use items and that no physician working for the VA “engages in
reprocessing of equipment.”

“Any eligible veteran who may have seen an outside physician on their own
can visit their assigned primary care provider in the VA to discuss if
testing is necessary,” Martinez said.

In his letter to patients, in which he said their “safety and well-being
are of utmost importance to me,” Newman said he understood that it had to
“very disturbing and disappointing” for them to learn that they were now
at risk for blood-borne diseases.

He tried to reassure them: “Based on similar incidents that have occurred
in other states (as well as in Nevada), it is believed that the risk of
contracting a disease is very low.”

The medical professional who had a prostate biopsy done by Newman was
angered by such a generalization.

“Try telling that to patient in Dr. Dipak Desai’s clinics who got
hepatitis” after reuse of single-use syringes and vials of medicine, he
said.

“What’s the matter with doctors in this town? You’d think after all the
pain and suffering caused by those clinics that they would be extra
careful about infection control.”

Newman, who was unavailable for comment, apologized in his letter to
patients, which said:

“I extend my sincere and deepest apologies to you for any inconvenience
this will cause you. It has always been my goal to provide quality patient
care and I hope to continue to ensure that all of my patients receive safe
medical care in the future. … I will personally be available to answer
any and all of your questions to the best of my ability.”

Read Dr. Lawrence Newman’s full letter http://lvrj.com/newman_letter
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USA: Nine die in Alabama during bacteria outbreak
By Peggy Gargis, Reuters (30.03.11)

BIRMINGHAM, Alabama (Reuters) – Nine patients in Alabama have died after
receiving intravenous nutrition that authorities say was contaminated, but
it was unclear whether the bacteria contributed to the deaths.
Alabama authorities said they were investigating an outbreak of Serratia
marcescens bacteremia, a bacterial infection in the blood, in 19 patients
at six hospitals in the state who all received total parenteral nutrition
(TPN).

TPN is a nutritional solution fed to patients by injection.

“Of the 19 that received the substance, nine of those are no longer living
… These were very fragile individuals and it’s not clear whether the
bacteria contributed to their deaths,” said Dr. Jim McVay, a senior
official with the Alabama Department of Public Health.

Authorities identified bacteria first in the patients and then ran
cultures on the TPN, he said.

“TPN is liquid nutrition fed through an IV using a catheter. Use of
contaminated products may lead to bacterial infection of the blood,” said
a department statement.

The Centers for Disease Control and Prevention (CDC) is helping with an
investigation, the department said.

“CDC’s initial investigation identified TPN produced by a single pharmacy,
Meds IV, as a potential common source and has determined that these
hospitals received TPN from this pharmacy,” the department said in a
statement.

The pharmacy was notified and informed its customers of the possibility of
contamination. On March 24, it recalled all of its IV compounded products
and has discontinued all production.

The affected hospitals stopped using TPN received from this pharmacy, the
statement said.

It said the U.S. Food and Drug Administration is aware of the voluntary
recall, and that the pharmacy and the hospitals are cooperating with the
investigation.

The affected hospitals are Baptist Princeton, Baptist Shelby, Baptist
Prattville, Medical West, Cooper Green Mercy and Select Specialty Hospital
in Birmingham.

(Editing by Matthew Bigg and Jerry Norton) Š Thomson Reuters 2011
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USA: Brandon Regional Hospital Aids Diabetics, Others in Disposal of Used
Needles, Lancets
By Kevin Brady, The BrandonPatch.com, Florida USA (30.03.11)

The Hillsborough County Health Department coordinates the Bay Area Sharps
Disposal Program for area residents whose health conditions require
injected medications. Brandon Regional Hospital is one of the 12
participating disposal sites.

Brandon Regional Hospital has joined the list of Tampa Bay area medical
centers making it easier for residents to safely dispose of “sharps” –
needles and other items used in the treatment of diabetes and other health
conditions.

As noted in a report issued by the Hillsborough County Health Department,
which coordinates the program, “the improper disposal of sharps threatens
every member of the community” because these items could be “contaminated
with hepatitis, HIV and/or other serious diseases.”

The Bay Area Sharps Disposal Program is for residents with medical
conditions that require injected medications.

“While helping prevent accidental needle sticks in our community, you may
also be protecting  yourself from liability,” the department release
further notes.

Professional health practitioners and businesses fall under state and
federal biomedical waste laws and regulations and are not allowed to
participate in the residents-only disposal program.

“Sharps” is the term used to describe medical items that can puncture or
lacerate. Included are syringes with attached needles and the disposable
lancets used by
diabetics and patients with other medical conditions.

Because of the risk of injury and contamination, sharps should never be
discarded in curbside trash, at landfills or in solid-waste containers.

Keep the following tips in mind:

Never snap off needles or attempt to recap them.

Do not bring sharps to approved disposal sites (see below) in anything
other than site-approved containers.

Properly seal containers. Disposal site officials have the right to refuse
improperly packaged containers to protect the safety of employees.

Give filled and properly sealed containers to authorized personnel. Never
leave any container unattended.

Never dispose of a sharps in household waste.

Be prepared to show proof that documents your need to use syringes.

Use an approved container to store your sharps or, as a substitute, store
sharps in a coffee can or liquid detergent container that seals securely.

Permanently seal closed containers.

The county’s health department offers an online fact sheet on how and
where to dispose of sharps.

Disposal sites include: [Edited]
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Nevada USA: EDITORIAL: After Desai, urologist reused single-use devices
Las Vegas Review – Journal, Las Vegas Nevada USA (30.03.11)

Posted: Mar. 30, 2011 | 2:05 a.m.
The Southern Nevada medical community still needs makeup to cover the
shiner left three years ago by Dr. Dipak Desai and the cheap, disgusting,
disease-spreading practices of his local endoscopy centers.

Despite the good work of scores of outstanding physicians and
organizations here, a perception resulted from the reuse of contaminated
supplies at the centers: Las Vegas doctors are willing to compromise
patient safety if they can make more money.

Now, with Desai still in the headlines because of the ongoing criminal and
civil cases against him, the local health care industry has suffered
another blow to its reputation. Dr. Michael Kaplan, a urologist, had his
medical license suspended this month following a joint state and federal
investigation that found he was reusing single-use medical devices.

Following the discovery that Dr. Kaplan was discarding $10 plastic needle
guides only when they became “too bloody,” the Southern Nevada Health
District sent letters to 101 of his patients, advising them to be tested
for HIV and hepatitis. Additionally, Nevada’s chief health care officer,
Dr. Tracy Green, sent a bulletin to every health care provider, directing
them to not reuse items intended only for one use, an astonishingly
obvious reminder akin to telling doctors and nurses they need to wash
their hands after using the restroom.

To have another major breach of infection control in this valley is both
outrageous and disheartening.

There are major differences between Desai and Dr. Kaplan, to be sure.
Foremost, there are no known cases of disease related to Dr. Kaplan’s
practices. And Dr. Kaplan did not run his practice like a cattle call, as
Desai did.

Last week, Dr. Kaplan’s lawyer ran an advertisement defending the reuse of
the needle guides because the physician was told by a vendor it was OK to
reuse the devices “three to five times” if he disinfected them.

Food and Drug Administration standards allow some single-use medical
devices to be reprocessed at an FDA-approved facility. But the needle
guides Dr. Kaplan used are not on the list of products approved for FDA
reprocessing, and Dr. Kaplan’s office is not authorized to reprocess
single-use devices.

The proper protocol for Dr. Kaplan was clear enough: Use the single-use
needle guides just once, then throw them away. He trusted the word of a
vendor enough to abandon basic infection control? He’s the physician. He’s
the party ultimately responsible for the care of his patients.

Cost is a consideration in many health care decisions. But taking a chance
at spreading infection — no matter how small the increased risk — to
save $10?

That’s horrific, especially when considering all the hidden costs of
Desai’s wrongdoing and the investigation of Dr. Kaplan. Now Dr. Green, the
state’s chief health care officer, has told all hospitals and health care
providers to again “review their policies and educate their staff” on
these protocols. We will all pay for this lost productivity, one way or
another.
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