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SIGNpost 00597


Post00597     Climate News + Abstracts + AIDSTAR 1 + News     04 May 2011

1. New: Be Informed – The HCWH Climate and Health News Service
2. Abstract: Circumstances Surrounding the Community Needle-Stick Injuries
in Georgia
3. Abstract:Acute hepatitis B infection following a community-acquired
needlestick injury
4. Abstract: Updated review on the prevention of biological hazards in the
nursing students
5. Abstract: Transmission of Hepatitis C Virus During Myocardial Perfusion
Imaging in an Outpatient Clinic
6. Abstract: A situational analysis of HIV and AIDS in Pakistan
7. Abstract: Role of Service Providers of Needle Syringe Program in
Preventing HIV/AIDS
8. Abstract: Medication errors – new approaches to prevention
9. Abstract: Measurement of hand hygiene compliance and gloving practices
in different settings for the elderly considering the location of hand
hygiene opportunities during patient care
10. Abstract: A realistic approach towards hand hygiene for long-term care
residents and health care personnel
11. Abstract: Novel administration routes for allergen-specific
immunotherapy: a review of intralymphatic and epicutaneous allergen-
specific immunotherapy
12. Abstract: Sterility of pediatric lipid emulsions repackaged by an
automated compounding device
13. Abstract: Managing Unused Pharmaceuticals in a Hospice Setting: A
Pilot Study
14. Abstract: Professional challenges and opportunities in clinical
microbiology and infectious diseases in Europe
15. Abstract: Crimean-Congo hemorrhagic fever: basics for general
16. No Abstract: Concerns about injectable naltrexone for opioid
17. No Abstract: Prevention of needlestick injuries among health care
18. USAID-AIDSTAR: Case Study: The International HIV/AIDS Alliance in
19. News
– USA: New law helps law enforcement, health care workers pricked by
‘dirty’ needles
– USA: VA official admits to ‘failure of leadership’ at Dayton clinic
– Press Release: Resource Now Available to Help Clinicians Reduce Risk of
– Blood Exposure from Short Peripheral IV Catheter Insertion
– Canada: Alberta healthcare worker infected with blood-borne viruses
– Libya: In Libyan revolt, hope for resolving 13-year medical drama
– USA: OSHA Inspecting ASC Sharps Safety Programs in 4 States
– Just Like a Junkie: When Your Doctor Uses Dirty Needles
– Low-Cost Sensor Can Diagnose Bacterial Infections
– Africa: Injection Drug Use Helps Drive HIV/AIDS in Africa
– Australia: Aussie travellers given unnecessary shots: report
– France: Patient prisoners
– Gates Foundation Funds Bold Ideas Including Empty Virus Shells to
Improve Polio Immunity, Dirt-Charged Cell Phones, and Fertilizer
Pellets that Reduce Health Risks
– USA: Healthcare Experts Call for More Enforcement, Empowerment and
Safety by Design
– Nevada USA: Desai, partner face allegations of conspiracy, health care
fraud in federal indictment
– Pakistan: Petition: Registration of firms dealing in syringes

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1. New: Be Informed – The HCWH Climate and Health News Service

Be Informed

The HCWH Climate and Health News Service is a brand-new free service that
aims to keep you  –  health professionals, climate experts and decision
makers – informed on the latest developments, trends, resources and
events around the world.

If you’re not already a subscriber, you can sign-up for free subscribe

HCWH Newsletters:

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specific products.

2. Abstract: Circumstances Surrounding the Community Needle-Stick Injuries
in Georgia

J Community Health. 2011 May 1.

Circumstances Surrounding the Community Needle-Stick Injuries in Georgia.

Butsashvili M, Kamkamidze G, Kajaia M, Kandelaki G, Zhorzholadze N.

Maternal and Child Care Union, 8 Nutsubidze st, Tbilisi, 0177, Georgia.

Community needle-stick injuries are important public health problem due to
concern of blood-borne pathogen transmission. Purpose of this study was to
describe circumstances related to non-occupational needle-stick injuries
in Georgia.

Data were collected from one outpatient clinic in Tbilisi. Medical records
from 2002 to 2007 were reviewed. Blood tests were performed on HBV, HCV
and HIV at first visit and 6 months after exposure.

25 (54.4%) study subjects were children playing in street/yard and being
accidentally stuck by used needle. Most frequent circumstances related to
needle stick among adult individuals were recapping or discarding used
needle while taking care of family member needed home injections (12
cases). Eight participants (17.4%) reported accidentally stepping on used
needle at sea shore. No infection with HIV and HCV were documented. Only
one case of HBV infection occurred in female patient taking care of mother
with chronic HBV infection.

Study suggests that seroconversion for blood- borne infections after
community needle-stick injuries is very low.

Family members of patients receiving home injections should be informed
about potential risks and advised using infection-control measures.

Parents/teachers should be educated about the circumstances related to
exposure to used needles among children.

3. Abstract:Acute hepatitis B infection following a community-acquired
needlestick injury

J Infect. 2011 Apr 13.

Acute hepatitis B infection following a community-acquired needlestick

Res S, Bowden FJ.

School of General Practice, Rural and Indigenous Health, Australian
National University Medical School, Australia.

We report a case of acute Hepatitis B infection occurring 2 months after a
community-acquired needlestick injury. The patient had a history of
incomplete vaccination and Hepatitis B vaccine booster was delayed. He did
not receive immunoglobulin.

This is only the second report of Hepatitis B transmission in this

Copyright © 2011 The British Infection Association. All rights reserved.

4. Abstract: Updated review on the prevention of biological hazards in the
nursing students

Rev Enferm. 2010 Dec;33(12):42-7.

[Updated review on the prevention of biological hazards in the nursing

[Article in Spanish]

Moreno Arroyo MC.

Escuela Universitaria de Enfermería de a Universidad de Barcelona.

If the carrying out a practices is something extremely important in all
degree studies, in the case of nursing this is something even more
fundamental and of great educational impact. During that period, students
not only put their knowledge and theory into practice, they get in touch
with reality and they also expose themselves to a series of risks inherent
to our profession.

In addition to that, one has to take into account the appearance of
various factors that aggravate their susceptibility, their inexperience as
professionals, their exposure to some degree of stress due to the variable
conditions and uncertainties in their environment, the lack of coverage
under the PRL law makes this group more vulnerable to the risks.

5. Abstract: Transmission of Hepatitis C Virus During Myocardial Perfusion
Imaging in an Outpatient Clinic

Am J Cardiol. 2011 Apr 28.

Transmission of Hepatitis C Virus During Myocardial Perfusion Imaging in
an Outpatient Clinic.

Moore ZS, Schaefer MK, Hoffmann KK, Thompson SC, Xia GL, Lin Lin Y,
Khudyakov Y, Maillard JM, Engel JP, Perz JF, Patel PR, Thompson ND.

North Carolina Department of Health and Human Services, Raleigh, North

Reports of health care-associated viral hepatitis transmission have been
increasing in the United States. Transmission due to poor infection
control practices during myocardial perfusion imaging (MPI) has not
previously been reported.

The aim of this study was to identify the source of incident hepatitis C
virus (HCV) infection in a patient without identified risk factors who had
undergone MPI 6 weeks before diagnosis.

Practices at the cardiology clinic and nuclear pharmacy were evaluated,
and HCV testing was performed in patients with shared potential exposures.
Clinical and epidemiologic information was obtained for patients with HCV
infection, and molecular testing was performed to assess viral

Evidence of HCV transmission among patients who had undergone MPI at the
cardiology clinic on 2 separate dates was found, involving 2 potential
source patients and a total of 5 newly infected patients. Molecular
testing identified a high degree of genetic homology among viruses from
patients with common procedure dates.

The nuclear medicine technologist routinely drew up flush from multidose
vials of saline solution using the same needle and syringe that had been
used to administer radiopharmaceutical doses. Multipatient use of vials
was not observed, but a review of purchasing invoices and interviews with
staff members suggested that this had occurred.

No evidence of transmission via contamination of radiopharmaceuticals at
the nuclear pharmacy was found.

In conclusion, transmission of HCV occurred because of unsafe injection
practices during MPI. Cardiologists should carefully review their
infection control practices and the practices of other staff members
involved with these procedures.

Copyright © 2011 Elsevier Inc. All rights reserved.

6. Abstract: A situational analysis of HIV and AIDS in Pakistan

Virol J. 2011 Apr 25;8(1):191.

A situational analysis of HIV and AIDS in Pakistan.

Ilyas M, Asad S, Ali L, Shah M, Badar S, Sarwar MT, Sumrin A.

HIV (Human immunodeficiency virus) transmission has been reduced by
protected sex and screening of blood products and other body fluids in the
developed countries. It has been reported that Pakistan is at high risk of
HIV/AIDS infection but presently the prevalence rate is considerably low.

The number of reported cases of HIV/AIDS in Pakistan has been continuously
increasing since 1987. By 2010 the total number of registered cases has
reached to 6000 and this figure is on the rise with the passage of time.

Some serious strategies must be implemented to control this deadly

Free Article

7. Abstract: Role of Service Providers of Needle Syringe Program in
Preventing HIV/AIDS

AIDS Educ Prev. 2010 Dec;22(6):546-57.

Role of Service Providers of Needle Syringe Program in Preventing

Tsai TI, Morisky DE, Chen YM.

School of Nursing, National Yang Ming University, Taipei, Taiwan.

To provide a national-scale picture of the needle exchange program in
Taiwan, this study examined (a) needle and syringe program (NSP) service
providers’ AIDS-relevant harm reduction knowledge and attitudes; and (b)
NSP services schemes and operation barriers encountered by different
service modalities.

A self-administrated questionnaire was mailed to all participating NSP
service providers in Taiwan. A total of 414 service providers completed
the postal survey.

This study confirms that NSP service providers play an essential role in
providing comprehensive activities to reduce HIV/AIDS infection for drug
misusers. Knowledge and attitudes of service providers were found to be
independently and important predictors of NSP service provisions.
Community-based and clinical-based providers had diverse service schemes
and encountered operation problems due to different organization
characteristics, professional training, and ethical concern.

For the future planning of NSP programs, service-specific education and
professional support are essential component of service delivery and

8. Abstract: Medication errors – new approaches to prevention

Paediatr Anaesth. 2011 Apr 25.

Medication errors – new approaches to prevention.

Merry AF, Anderson BJ.

Department of Anaesthesiology, University of Auckland, and Auckland City
Hospital, Auckland, New Zealand.

Medication errors in pediatric anesthesia represent an important risk to
children. Concerted action to reduce harm from this cause is overdue. An
understanding of the genesis of avoidable adverse drug events may
facilitate the development of effective countermeasures to the events or
their effects.

Errors include those involving the automatic system of cognition and those
involving the reflective system. Errors and violations are distinct, but
violations often predispose to error. The system of medication
administration is complex, and many aspects of it are conducive to error.

Evidence-based practices to reduce the risk of medication error in general
include those encompassed by the following recommendations: systematic
countermeasures should be used to decrease the number of drug
administration errors in anesthesia; the label on any drug ampoule or
syringe should be read carefully before a drug is drawn up or injected;
the legibility and contents of labels on ampoules and syringes should be
optimized according to agreed standards; syringes should always be
labeled; formal organization of drug drawers and workspaces should be
used; labels should be checked with a second person or a device before a
drug is drawn up or administered.

Dosage errors are particularly common in pediatric patients. Causes that
should be addressed include a lack of pediatric formulations and/or
presentations of medication that necessitates dilution before
administration or the use of intravenous formulations for oral
administration in children, a frequent failure to obtain accurate weights
for patients and a paucity of pharmacokinetic and pharmacodynamic data.

Technological innovations, including the use of bar codes and various
cognitive aids, may facilitate compliance with these recommendations.
Improved medication safety requires a system-wide strategy standardized at
least to the level of the institution; it is the responsibility of
institutional leadership to introduce such strategies and of individual
practitioners to engage in them.

9. Abstract: Measurement of hand hygiene compliance and gloving practices
in different settings for the elderly considering the location of hand
hygiene opportunities during patient care

Am J Infect Control. 2011 May;39(4):339-41.

Measurement of hand hygiene compliance and gloving practices in different
settings for the elderly considering the location of hand hygiene
opportunities during patient care.

Eveillard M, Pradelle MT, Lefrancq B, Guilloteau V, Rabjeau A, Kempf M,
Vidalenc O, Grosbois M, Zilli-Dewaele M, Raymond F, Joly-Guillou ML,
Brunel P.

Laboratory of Bacteriology and Hygiene, Angers Teaching Hospital, Angers,
France; Study Group for Host Pathogen Interactions (GEIHP), Angers Medical
School, Angers University, Angers, France; Network for Infection Control
ANJELIN (anjou éviction et lutte contre les infections nosocomiales),
Regional Center for Functional Rehabilitation, Angers, France.

We monitored hand hygiene and gloving practices by direct observation in 8
health care settings for elderly persons in western France.

Compliance with hand hygiene was better than that reported by previous
studies, was better for single contacts and before or after a series of
successive contacts than inside series, and was closely related to gloving
practices. Practices differed among the settings.

Copyright © 2011 Association for Professionals in Infection Control and
Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

10. Abstract: A realistic approach towards hand hygiene for long-term care
residents and health care personnel

Am J Infect Control. 2011 May;39(4):336-8.

A realistic approach towards hand hygiene for long-term care residents and
health care personnel.

Schweon SJ, Kirk J.

Pleasant Valley Manor Nursing Home, Stroudsburg, PA.

The Centers for Disease Control and Prevention and The World Health
Organization’s hand hygiene recommendations focus on health care personnel
in all health care settings.

In the long-term care facility (LTCF) environment, where, for many
residents, the LTCF is also their home, the recommendations may not be
applicable to commonly encountered LTCF situations.

The recommendations also do not address the importance of resident hand
hygiene program to promote health and prevent infection.

Copyright © 2011 Association for Professionals in Infection Control and
Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

11. Abstract: Novel administration routes for allergen-specific
immunotherapy: a review of intralymphatic and epicutaneous allergen-
specific immunotherapy

Immunol Allergy Clin North Am. 2011 May;31(2):391-406.

Novel administration routes for allergen-specific immunotherapy: a review
of intralymphatic and epicutaneous allergen-specific immunotherapy.

von Moos S, Kündig TM, Senti G.

Clinical Trials Center, Center for Clinical Research, University and
University Hospital Zürich, Moussonstrasse 2, 8091 Zürich, Switzerland.

For the past century, subcutaneous allergen-specific immunotherapy has
been the state-of-the-art treatment for IgE-mediated allergic disease.
Current research on allergen-specific immunotherapy is focused on
enhancing its efficacy, safety, and patient convenience with the goal of
offering a broadly accepted treatment option.

There is a growing interest in intralymphatic allergen-specific
immunotherapy because it is a highly efficacious and safe treatment route
that requires only 3 injections.

Concurrently, epicutaneous allergen-specific immunotherapy is attracting
increasing attention because of its capacity to offer a safe, needle-free,
and potentially self-administrable treatment option for IgE-mediated
allergic diseases.

In this article, we discuss the principles and immunologic rationale of
these unconventional routes of allergen-specific immunotherapy while
highlighting their developmental process and clinical relevance.

Copyright © 2011 Elsevier Inc. All rights reserved.

12. Abstract: Sterility of pediatric lipid emulsions repackaged by an
automated compounding device

JPEN J Parenter Enteral Nutr. 2011 May-Jun;35(3):391-4.

Sterility of pediatric lipid emulsions repackaged by an automated
compounding device.

Ybarra JV, Rose WE, Curtis CS, Sacks GS.

Auburn University, James I. Harrison School of Pharmacy, Auburn, Alabama.

Background: The daily requirement of intravenous (IV) lipid in pediatric
patients is often less than the volumes and sizes available in
prepackaged, commercially available preparations. In clinical practice, IV
lipid emulsions (IVLEs) have been repackaged into syringes to prevent
infusions from exceeding 12 hours, to reduce waste, and to improve patient

Recent data suggest an increasing risk of contamination when these
preparations are repackaged manually. This study investigates the
sterility of small volumes of IVLE that have been repackaged into empty IV
bags by means of an automated compounding device (ACD).

Methods: A total of 152 IVLE bags were repackaged with an ACD in an
International Standards Organization class 5 environment. IVLE repackaging
was conducted over a period of 3 weeks (week 1, n = 52; week 2, n = 52;
week 3, n = 48). Forty commercially available bags of IVLE served as
controls. At 0, 24, 48, and 120 hours after repackaging, IVLEs were
filtered and placed onto blood agar medium.

Results: Microbial growth occurred in 12 of the 152 repackaged
preparations compared with 0 of the 40 controls (7.9% vs 0%, P = .07).
Positive cultures consisted of gram-positive cocci (n = 5, 3.3%), gram-
positive rods (n = 5, 3.3%), and yeast (n = 2, 1.3%). There was no
difference in positive bacterial or yeast growth between weeks 1, 2, and
3, suggesting an absence of outside contamination during preparation.

Conclusions: The positive microbial growth suggests a concerning incidence
of contamination of IVLEs repackaged with an ACD. Additional research is
needed to further identify and validate the clinical impact of these

13. Abstract: Managing Unused Pharmaceuticals in a Hospice Setting: A
Pilot Study

Am J Hosp Palliat Care. 2011 Apr 26.

Managing Unused Pharmaceuticals in a Hospice Setting: A Pilot Study.

Kreisberg J, Zheng C.

Teleosis Institute, Berkeley, CA.

With the escalating use of pharmaceuticals in health care, there has been
increasing anxiety over the potential health risks associated with
pharmaceutical waste accumulating in the environment.

This research provided nurses in a hospice care facility in Concord,
California, with education and training to offer patients a medication
disposal service through the use of mail-back envelopes.

Over the 6-month study period, 160 of the 400 distributed mailers were
returned for disposal. The total weight of pharmaceuticals diverted for
incineration was 107 pounds, with an average weight of 0.66 pounds per

This study suggests that the mailer system and proper education of medical
staff have the potential to improve medical waste management, but
alternative approaches may be necessary to increase the rate of envelop

14. Abstract: Professional challenges and opportunities in clinical
microbiology and infectious diseases in Europe

Lancet Infect Dis. 2011 May;11(5):408-415.

Professional challenges and opportunities in clinical microbiology and
infectious diseases in Europe.

Read RC, Cornaglia G, Kahlmeter G; for the European Society of Clinical
Microbiology and Infectious Diseases Professional Affairs Workshop group.

Department of Infection and Immunity, School of Medicine, University of
Sheffield, Sheffield, UK.

The two closely linked specialties of clinical microbiology and infectious
diseases face important challenges. We report the consensus of clinical
microbiologists and infectious disease physicians assembled by the
European Society for Clinical Microbiology and Infectious Diseases.

Both specialties have different training requirements in different
European countries and are not universally recognised as professions. The
specialties are rapidly evolving as they adapt to the changing demands
within hospital practice, including the need to deal with emerging
infections, rapidly increasing internationalisation, and immigration.

Clinical microbiology needs to develop and master technological advances
such as laboratory automation and an avalanche of new methods for rapid
diagnostics. Simultaneously, the pressure for concentration, amalgamation,
and out-sourcing of laboratory services is ever-increasing. Infectious
disease physicians have to meet the professional challenge of
subspecialisation and the continual need to find new niches for their
skills. Despite these challenges, each of these specialties continues to
thrive in Europe and will enjoy important opportunities over the next few

The recently formed European Centre for Disease Prevention and Control in
Stockholm, Sweden, will increase demands in areas of surveillance of
infectious diseases and antimicrobial resistance on both specialties.

Copyright © 2011 Elsevier Ltd. All rights reserved.

15. Abstract: Crimean-Congo hemorrhagic fever: basics for general

Med Trop (Mars). 2010 Dec;70(5-6):429-38.

[Crimean-Congo hemorrhagic fever: basics for general practitioners].

[Article in French]

Flusin O, Iseni F, Rodrigues R, Paranhos-Baccalà G, Crance JM, Marianneau
P, Bouloy M, Peyrefitte CN.

Unité de virologie, Institut de Recherche Biomédicale des Armées-CRSSA
antenne de Grenoble, La Tronche.

Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne disease described
in more than 30 countries in Europe, Asia and Africa. The causative agent
is the Crimean-Congo hemorrhagic fever virus (CCHFV) that is a member of
the genus Nairovirus of the family Bunyaviridae. CCHFV that is
characterized by a high genetic variability is transmitted to humans by
tick bites or * contact with fluids from an infected individual or animal.

The initial symptoms of CCHF are nonspecific and gradually progress to a
hemorrhagic phase that can be lethal (case-fatality rate: 10 to 50%).
Characteristic laboratory findings of CCHF are thrombocytopenia, elevated
liver and muscle enzymes, and coagulation defects. The pathogenesis of
CCHF remains unclear but might involve excessive pro-inflammatory cytokine
production and dysfunction of the innate immune response. Diagnosis of
CCHF is based mainly on isolation of the virus, identification of the
viral genome by molecular techniques (RT-PCR), and serological detection
of anti-CCHFV antibodies.

There is currently no specific treatment for CCHFV infection and the
efficacy of ribavirin is controversial. In absence of an effective
vaccine, prevention is based mainly on vector control, protection
measures, and information to increase the awareness of the population and
of healthcare workers.

16. No Abstract: Concerns about injectable naltrexone for opioid

Lancet. 2011 Apr 30;377(9776):1468-70.

Concerns about injectable naltrexone for opioid dependence.

Wolfe D, Carrieri MP, Dasgupta N, Wodak A, Newman R, Bruce RD.

Open Society Institute, International Harm Reduction Development Program,
New York, NY 10019, USA.

Comment on Lancet. 2011 Apr 30;377(9776):1506-13.

17. No Abstract: Prevention of needlestick injuries among health care

Am J Infect Control. 2011 May;39(4):347-8.

Prevention of needlestick injuries among health care workers.

Vandijck DM, Labeau SO, Blot SI.

Department of General Internal Medicine and Infectious Diseases, Ghent
University Hospital, Ghent, Belgium; Faculty of Medicine and Health
Sciences, Ghent University, Ghent, Belgium; Faculty of Healthcare,
University College Ghent,

18. USAID-AIDSTAR: Case Study: The International HIV/AIDS Alliance in

Crossposted from with thanks.

Case Study: The International HIV/AIDS Alliance in Ukraine

AIDSTAR-One’s first case study in the Promising Approaches to Combination
Prevention series examines the efforts of the Alliance-Ukraine to reach
most-at-risk populations (MARPs) in Ukraine.

Through its partner organizations, the Alliance-Ukraine provides the
majority of HIV prevention services in the country, targeting the primary
driver of Ukraine’s HIV epidemic: injecting drug use.

Community engagement, advocacy for supportive policies, and linkages to
government services complement evidence-based programming.

View the interactive case study:

Download the International HIV/AIDS Alliance in Ukraine Case Study (PDF,
642 KB).

Visit our Case Study Series page to see other recent publications.

For additional information about the practice and related materials, visit
the Promising Practices Database – HIV/AIDS Alliance Ukraine: Combination
Approaches for Injecting Drug Users.

19. News

– USA: New law helps law enforcement, health care workers pricked by
‘dirty’ needles
– USA: VA official admits to ‘failure of leadership’ at Dayton clinic
– Press Release: Resource Now Available to Help Clinicians Reduce Risk of
– Blood Exposure from Short Peripheral IV Catheter Insertion
– Canada: Alberta healthcare worker infected with blood-borne viruses
– Libya: In Libyan revolt, hope for resolving 13-year medical drama
– USA: OSHA Inspecting ASC Sharps Safety Programs in 4 States
– Just Like a Junkie: When Your Doctor Uses Dirty Needles
– Low-Cost Sensor Can Diagnose Bacterial Infections
– Africa: Injection Drug Use Helps Drive HIV/AIDS in Africa
– Australia: Aussie travellers given unnecessary shots: report
– France: Patient prisoners
– Gates Foundation Funds Bold Ideas Including Empty Virus Shells to
Improve Polio Immunity, Dirt-Charged Cell Phones, and Fertilizer
Pellets that Reduce Health Risks
– USA: Healthcare Experts Call for More Enforcement, Empowerment and
Safety by Design
– Nevada USA: Desai, partner face allegations of conspiracy, health care
fraud in federal indictment
– Pakistan: Petition: Registration of firms dealing in syringes

Selected news items reprinted under the fair use doctrine of international
copyright law:

USA: New law helps law enforcement, health care workers pricked by ‘dirty’
Sequim Gazette, Sequim Washington, USA (03.05.11)

Gov. Christine Gregoire signed legislation today giving certain categories
of workers the right to request a test for all blood borne pathogens if
pricked by a needle on the job.

First responders, health care workers and law enforcement officers all
face the possibility of an accidental needle stick. If the needle involved
is “dirty” – that is, used – the person who is accidentally pricked could
be exposed to a number of potentially deadly blood borne pathogens, said
Jennifer Waldref, communications specialist with the Democratic Caucus, in
a news release.

Waldref said that until today workers only had the right to request that
the patient or owner of the needle be tested for the HIV virus.

Now they can request a test for all blood borne pathogens, she said.

State Rep. Kevin Van De Wege, D-Sequim, who sponsored the legislation,
said it is about updating an older statute to reflect today’s public
health hazards.

“The original bill was passed during the heightened AIDS awareness of the
1980s, but the reality is a cop or nurse is much more likely to be exposed
to Hepatitis C than HIV,” Van De Wege said. “The new law means these
people can be informed of their exposure so they can quickly begin proper

The idea for updating the law was brought to Van De Wege by constituents
regularly exposed to blood borne pathogens on the job, including fire
fighters and emergency room personnel from the Olympic Peninsula, Waldref

Testing for blood borne pathogens is performed on the individual whose
blood may already be on the needle. If the individual refuses the test, a
court can still order it, she said.

Van De Wege, who is also a firefighter and first responder with Clallam
County Fire District 3, said the bill will provide greater peace of mind
for people who regularly put themselves at risk to protect public health
or safety.

“This doesn’t stop needle sticks from happening,” he said, “but it means
that when they do happen, these workers don’t have to live with the fear
of not knowing. It also means they can take steps to protect their family
members from exposure.”

The bill is House Bill 1454. Representatives from health care, law
enforcement, and firefighter unions took part in today’s bill signing
ceremony in Olympia.

USA: VA official admits to ‘failure of leadership’ at Dayton clinic
By Jack Torry, Washington Bureau, Dayton Daily News, Ohio USA (03.05.11)

WASHINGTON – A senior U.S. Veterans Affairs official acknowledged that a
“failure of leadership” in the Dayton VA Medical Center’s dental clinic
after a dentist repeatedly did not switch latex gloves or sterilize
instruments between patients.

Testifying before the House Veterans Affairs Committee Tuesday, Robert
Petzel, under secretary for health at the VA in Washington, assailed
leaders at the dental clinic, where 535 of its patients may have been
exposed to blood-borne pathogens by an 81-year-old dentist who has since

“I want to be perfectly clear: That was a failure of leadership within the
dental clinic,” Petzel said. “The people that worked with this individual
knew that this was not appropriate. The technicians knew that it was not
appropriate. The chief of dentistry knew that was not appropriate. And for
a long period of time, none of these people took the kind of action that
they needed to take,” Petzel said.

“And unquestionably that is a failure of leadership.”

Petzel said not “everyone in” the medical center “knew this was going on.
… I think the primary failure there was the leadership in the dental

By holding the leaders of the clinic responsible, Petzel appeared to be
endorsing the VA’s inspector general’s report released last week that
concluded that the dentist “did not adhere to established infection
control guidelines and policies, and multiple dental clinic staff had
direct knowledge of these repeated infractions.”

Petzel, who was sharply questioned by committee members, apologized “to
those veterans who have been affected by these lapses in safety practices
at any of our facilities.”

He insisted that “our practice is to provide more information to our
veterans in an abundance of caution, even if the risk to their health is

Rep. Mike Turner, R- Centerville, who attended the hearing, complained
that “although the administration said there was a failure of leadership,
no one was ever held accountable.”

In particular, Turner pointed out that the dentist has retired and the
medical center’s former director – Guy Richardson – was assigned to a post
in Cincinnati. Two dental clinic supervisors are facing potential
disciplinary action.

After the hearing, Turner issued a statement saying that the “VA owes us a
clear explanation of the events that have occurred and have yet to release
to our community, documents which show that they taken every step
necessary to notify veterans that may have been infected by the dentist in

Two patients from the dental clinic have tested positive in preliminary
screenings for hepatitis B and one for hepatitis C.

The Dayton dental clinic was just one part of a broader hearing into
medical sanitization at VA centers in Miami and St. Louis, where 1,800
veterans 1,800 veterans may have been put at risk because of improper
cleaning of dental equipment.

Rep. Bob Filner, D-Calif., the committee’s senior Democrat, castigated the
VA officials who testified, saying that “we don’t know anything about

“The most recent notification, the egregious incidents at Dayton, Ohio,
affected over 500 veterans and involved a whole host of problems,” Filner
said. “The findings beg the question of proper accountability, effective
oversight and enforcement of clear policies and procedures.” John Daigh,
the assistant inspector general for the VA, testified that the inspector
general’s reports show that the VA “provides veterans with high quality
medical care.”

But he added that the agency “has had several high profile and highly
publicized incidents that would naturally shake the faith of those who
receive care from the VA.”

Staff writer Ben Sutherly contributed to this report.

Press Release: Resource Now Available to Help Clinicians Reduce Risk of
Blood Exposure from Short Peripheral IV Catheter Insertion
PRNewswire (03.05.11)

Press Release: BD Launches Making Safety Safer(SM) Campaign

SANDY, Utah, May 3, 2011 /PRNewswire/ — Healthcare workers now have the
ability to better identify risks for exposure to bloodborne pathogens,
take precautions to better protect themselves, and share information and
experiences as a result of a new program developed by BD Medical, a
segment of BD (Becton, Dickinson and Company) and the world’s leading
provider of IV catheters.

The BD Making Safety Safer(SM) program will provide nurses and other
healthcare professionals with a forum to share information on risks,
precautions and interventions, learn from experts and peers, and assist
hospitals and other healthcare organizations in addressing ongoing
concerns relating to blood exposure due to insertion of a short peripheral
IV catheter (SPIVC).

Cheryll Collins, BSN, RN, OCN was exposed to blood from a patient infected
with HIV and Hepatitis C.  “As I unhooked the [needle] chamber, the
patient pulled her arm away.  The blood that was left in the hub went
straight across my face and into my eye,” said Collins. “That incident had
a profound impact on my life, as well the lives of my husband and family.”
To view a video of her personal story, visit

“Although the healthcare industry has come a long way in reducing the risk
of needlestick injuries and their potential dangers, mucocutaneous blood
exposure during a short peripheral IV catheter insertion is still a risk
today,” said John Ledek, Vice President, BD Medical – Medical Surgical
Systems. “BD created this educational resource to enable clinicians to
better protect themselves.”

This program will help educate nurses to approach short peripheral IV
insertion with more caution, such as using appropriate personal protective
equipment and taking other appropriate precautions to better protect
themselves from contaminated blood.

BD also is sponsoring online forums on blood safety and inviting
clinicians to learn and share their experiences. Visit to access these resources online.
SPIVCs are the most commonly used device to access a patient’s blood
vessels. Blood exposure, including exposure that may occur upon insertion
of an SPIVC, presents a risk to clinicians and patients.  According to
multiple published studies, up to 37.8 percent of healthcare workers
report having experienced at least one blood or body fluid exposure in the
preceding year (1, 2, 3).  A recent report from the International
Healthcare Worker Safety Center at the University of Virginia shows that
nurses are at greatest risk, reporting 48.6 percent of blood or bodily
fluid exposures(4).

(1)  Doebbeling BN, Vaughn TE, McCoy KD, Beekmann SE, Woolson RF, Ferguson
KJ, et al. Percutaneous injury, blood exposure, and adherence to standard
precautions: are hospital-based health care providers still at risk? Clin
Infect Dis. 2003 Oct 15;37(8):1006-13.

(2)  Zhang M, Wang H, Miao J, Du X, Li T, Wu Z. Occupational exposure to
blood and body fluids among health care workers in a general hospital,
China. Am J Ind Med. 2009 Feb;52(2):89-98.

(3)  Tarantola A, Koumare A, Rachline A, Sow PS, Diallo MB, Doumbia S, et
al. A descriptive, retrospective study of 567 accidental blood exposures
in healthcare workers in three West African countries. J Hosp Infect. 2005

(4)  EPINet. International Healthcare Worker Safety Center, University of
Virginia. U.S.  Blood and Body Fluid Exposure Report.  2007 [Mar 7, 2011]

SOURCE BD (Becton, Dickinson and Company)

Canada: Alberta healthcare worker infected with blood-borne viruses
Canadian OH&S News Canada (02.05.11)

Healthcare workers are not among the more than 200 people who have been
contacted by provincial officials in Alberta to get tested for human
immunodeficiency virus (HIV) and Hepatitis C.

As of April 26, Alberta Health Services (AHS) had contacted 213 of 226
former patients after learning that a healthcare employee, who was
unknowingly infected with the two blood-borne viruses, had been working in
hospitals in the Edmonton area between July of 2006 and March of 2009,
says AHS spokesman Kerry Williamson.

The agency is not disclosing whether the worker in question was a doctor,
a nurse or some other medical professional, but notes that the employee
took part in neurosurgeries during the nearly three-year window.

“The healthcare worker is no longer working in Alberta,” Williamson says.
“Though the risk of infection is very low, AHS is recommending the
potentially exposed [patients] undergo simple blood tests for HIV and
Hepatitis C,” Williamson advises.

Patients who underwent surgeries outside of the identified dates are not
at risk of exposure, says Williamson, although anyone with concerns can
call HealthLINK Alberta. There was also “no risk posed to other healthcare
workers” and precautionary blood testing has not been recommended for
them, he adds.

Colleagues of infected worker not at risk: union

Heather Smith, president of the United Nurses of Alberta, says her union
does not believe that colleagues of the unidentified employee are at risk
of infection. “We’re not advocating co-worker testing,” says Smith. The
use of universal precautions, including safe procedures and personal
protective equipment, almost entirely rules out the potential for
infection of colleagues, she suggests.

“Healthcare workers are not always privy to [disease] information
regarding patients and clients they come into contact with either, which
again is why universal precautions are so important across the
[healthcare] system,” Smith adds.

The regulatory colleges that advise nurses and physicians in the province
each have their own protocols for screening blood-borne virus infections
(BBVIs) among members. Physicians diagnosed with a BBVI are legally
required to notify the College of Physicians and Surgeons of Alberta
(CPSA) before getting their licence to practice or during annual renewal,
says college spokeswoman Kelly Eby.

If a doctor is infected, the college would “ensure that the physician is
provided with the information and the support that they need, and that
safeguards are put in place to protect their patients,” says Eby. She
notes that there have only been about two or three cases in the last five
years where doctors have reported BBVIs.

Safeguards, including possible modifications to a doctor’s practice, would
depend on the physician’s particular circumstances. “Obviously, someone
who does invasive surgery would have a lot more risk factors than somebody
who is a general practitioner,” Eby notes.

The College and Association of Registered Nurses of Alberta (CARNA), whose
BBVI -screening protocol shares some similarities with that of the CPSA,
notes that infected nurses typically do not have to notify their employers
or occupational health and safety personnel. However, a BBVI-positive
nurse would have a “professional responsibility” to inform his employer of
any required practice modifications, CARNA information indicates.

Andy Weiler, spokesman for Alberta’s Department of Health and Wellness,
says the provincial health minister has reviewed BBVI protocols and is
satisfied that current screening is appropriate. “We’re not moving towards
any type of mandatory testing” of healthcare workers, he adds.

Libya: In Libyan revolt, hope for resolving 13-year medical drama
By Shashank Bengali, McClatchy Newspapers, USA (01.05.11)

For 13 years, a real-life medical drama has vexed this city, tracing the
tortuous contours of Moammar Gadhafi’s long reign over Libya:

A public health crisis. A politically motivated witch hunt. Faulty
science. Conspiracy theories. Prisoner abuse. Geopolitical gamesmanship.
And, at its heart, more than 400 children who inexplicably found
themselves infected with HIV.

Now, the revolt in eastern Libya has raised the tantalizing possibility
that the truth in the case of the Benghazi Six will finally come out.

“There is something missing in this story, and if things change in Tripoli
many secrets will open up,” said Ali Bin Jalil, a pediatrician who was
working at Al Fateh Hospital in Benghazi in 1998, when it was hit with the
biggest hospital-borne outbreak of HIV in history.

In the span of a few months, at least 426 patients in the children’s
wards, some as young as 4 months, tested positive for the virus that
causes AIDS. Seventeen mothers also became infected, most likely through
breast-feeding. Sixty-two of the children have died.

Ignoring the findings of international experts – who determined that the
virus was spread by poor hygiene at the hospital – a Libyan court
convicted five Bulgarian nurses and a Palestinian medical intern who were
working in the ward of deliberately injecting the children with HIV. They
were sentenced to death by firing squad and spent more than seven years in
prison. Human rights groups accused Libyan authorities of beating the six
prisoners with wires, administering electric shocks, forcing objects down
their throats and unleashing dogs on them as they screamed.

It was difficult not to see Gadhafi’s politics at work in the case. At the
start, Libyan officials accused the medics of plotting with the CIA and
Israel’s Mossad spy agency – two of Gadhafi’s favorite bogeymen – to
infect the children. They later withdrew that, charging instead that the
six were freelancers conducting medical experiments.

The case would become an important bargaining chip for Gadhafi, who by the
2000s was trying to patch up relations with the West. At one point, he
offered to spare the nurses’ lives if Scottish authorities released Abdel
Baset al-Megrahi, the Libyan former intelligence officer imprisoned for
the 1988 Pan Am 103 bombing. In 2007, after lobbying from France and
others, he agreed to extradite the six to Bulgaria.

Bulgaria’s president immediately commuted their sentences and set them
free, deeply angering parents of the AIDS victims.

“It was shameful,” said Idriss Laga, 53, whose infant daughter was among
those infected at the hospital. “That was all to support Saif’s political
ambitions,” referring to Gadhafi’s son, Saif al-Islam, the architect of
the regime’s one-time rapprochement, who’s vowed lately that his father
would fight his opponents “until the last bullet.”

Scientists have called the charges against the medics “garbage,” and so
much time has passed that at least a dozen of the children have had
children of their own (all are HIV-negative).

But it’s a testament to the power of Gadhafi’s relentless message machine
– a four-decade program of simultaneously assailing the Western world and
playing its victim – that nearly every Libyan connected with the case
thinks that the Benghazi Six are guilty.

Bin Jalil said, “That’s what we’ve always been told by the investigators.”
Laga, for his part, said the key to the case lay with “John,” a British
man whom one of the nurses named in a jailhouse confession that she later
retracted, saying it was extracted by torture.

Over the past two months, with a thoroughness that suggests a communal
cleansing, Benghazi, the new opposition capital, has scrubbed itself of
all reminders of Gadhafi’s rule. Osama Ali Eljhawi, the director of a
special medical center in Benghazi that Gadhafi established for the AIDS
patients, is one of the few who are starting to see the case in a new

“The nurses had no motive,” Eljhawi, a portly, genial man who was a
pediatrician in the hospital when the outbreak occurred, finally
acknowledged near the end of an hourlong interview in his office.

But he dismissed the allegations of hospital negligence, adding, “If the
nurses didn’t inject them, someone else did.”

That explanation flies in the face of several high-powered inquiries,
including one by the Nobel Prize-winning scientist who discovered HIV, Luc
Montagnier. In 2003, at the invitation of the Libyan government, he and
the prominent Italian virologist Vittorio Colizzi examined blood samples
and concluded that the infections in some of the children predated the
nurses’ arrival at the hospital.

The strain of HIV matched a particularly virulent form prevalent in West
and Central Africa, which was probably how it entered Benghazi, they said.
Noting severe shortages of drugs and medical supplies at the hospital, as
well as a lack of understanding of a virus that had been exceedingly rare
in Libya to that point, they argued that the hospital staff had most
likely spread HIV by reusing needles and catheters.

“No evidence has been found for a deliberate injection of HIV-contaminated
material,” the report concluded.

The Gadhafi regime promptly convened a Libyan panel that reached the
opposite conclusion, which the court favored.

Colizzi, who traveled to Libya to conduct the inquiry and testified at the
nurses’ trial, said the Benghazi doctors’ unwillingness to believe the
research stemmed from simple fear: admitting guilt would run afoul of a
regime for which the case had become extremely valuable.

“If they had to say they were responsible, they could be put in jail. They
could be killed by the Gadhafi system,” Colizzi said in a phone interview.
“So there is some kind of alliance between the Gadhafi system and the
Benghazi doctors for the same objective: for Gadhafi to play politics, for
the doctors to escape responsibility.”

Underscoring the case’s importance to Gadhafi, doctors said that the
regime had lavished the children’s families with $1 million each in
compensation, established the AIDS center in Benghazi and waived
bureaucratic restrictions so that they could purchase – with government
money – name-brand anti-retroviral drugs directly from U.S. and European

“He always made special accommodations for them,” Eljhawi said. “Other HIV
cases in Libya are in a bad state. They have a shortage of drugs, even
generic ones. … But if I wanted anything for the Benghazi cases I would
just write a letter saying, ‘As you know, this issue is under the direct
care of Moammar Gadhafi.’ It was the magic word.'”

That special relationship appears to be over: When the anti-Gadhafi
uprising began in mid-February, the supply of drugs from Tripoli abruptly
stopped. Doctors are scrambling to replenish their stock before it runs
out in two months.

It may take longer to establish the truth in this case.

“The full story will hopefully come out in time,” said Jamal Ben-Amer, a
respected Benghazi physician who’s unconnected to the case. “I know it is
very hard for outside people to believe what we are saying. But I don’t
believe it could be an accident. This is always what we have been told.”

USA: OSHA Inspecting ASC Sharps Safety Programs in 4 States
Irene Tsikitas, Outpatient Surgery Magazine (30.04.11)

Unannounced inspections will focus on processes for protecting workers
from exposure to contaminated sharps.

If you operate a surgery center in Alabama, Florida, Georgia or
Mississippi, inspectors from the Occupational Safety and Health
Administration may be paying an unannounced visit soon to review your
sharps safety policies.

The inspections, which began April 25 and will continue until Sept. 30,
2012, are part of a regional emphasis program targeting bloodborne
infection hazards in the southeastern United States. “Needlestick and
other sharps-related injuries that expose workers to bloodborne pathogens
continue to be an important public health concern,” says Cindy Coe, OSHA’s
regional administrator in Atlanta. “Employers must take seriously their
responsibility to protect workers from these health risks.”

A sample of ASCs, freestanding emergency care clinics and primary care
medical clinics that provide acute, chronic and emergency care in the 4
targeted states will be inspected for their policies and programs aimed at
protecting workers from infection risks associated with contaminated
sharps devices, says OSHA. The agency will conduct these reviews in
addition to the usual inspections it launches in response to complaints or
allegations of sharps exposures. If violations of the bloodborne pathogens
standard (1910.1030) or any other OSHA standards are found, facilities
could be subject to citations and penalties, says the agency.

For more information, you can contact OSHA’s Benjamin Ross at (678)
237-0424. To report incidents or safety hazards that pose an imminent
danger in the workplace, call the agency’s toll-free hotline: (800) 321-
OSHA. And for tips and resources to develop and implement a sharps safety
policy at your facility, see AORN’s new Sharps Safety Tool Kit.

© Copyright Herrin Publishing Partners LP 2011
__________________________________________________________________________ Just Like a Junkie: When Your Doctor Uses Dirty Needles
By Trisha Torrey, Guide  April 29, 2011

What kills someone every 24 seconds and is responsible for 23 million
cases of hepatitis and 300,000 cases of HIV every year?

Reused syringes.  Dirty needles.  And while those are global statistics
(the rates aren’t nearly as high in the US), more than 125,000 Americans
have been exposed to hepatitis C because their doctor or nurse or whomever
injected them, reused a needle that had been used on someone else.

Barbara Ficarra, who writes the Health in 30 blog, brought this to my
attention. It’s one of those things that, as a patient, would never even
occur to me.  I don’t have medical training – yet I can’t even imagine a
health provider would consider reusing a syringe!  Turns out it happens
more frequently than we would think, especially in outpatient (called
“ambulatory”) settings.  In fact, in a CDC study of 70 centers in three
states, they found that it is relatively common for patients to be given
shots with a needle or syringe that have already been used.

Barbara asked in her blog what we patient empowerment / advocates would
recommend.  So here you go:

If you or a loved one is about to get an injection – of anything at all,
like a flu shot, or a vaccine, or even a pain injection – ANY shot – then
simply ask, “Has this syringe been used before?”  If there is any
hesitation at all, that means the person about to inject you doesn’t know
the answer, or knows that yes, they have been used before.  Ask him or her
to be sure that neither the syringe, nor the needle is being reused – that
you want newly opened, fresh equipment.

Also, observe yourself whether the vial they are drawing the medicine from
has been opened before. If so, tell them you want to watch them open a new
vial for you.

If anyone gives you trouble about it, ask them whether they would be
willing to use that syringe, or that vial, for themselves or for their
children!  Then watch their reactions.

And if you still aren’t sure they will be safe?  Then leave.  Go get your
injections somewhere else.  And report the problem to your state health
department.  This is no time to be polite.

Honestly – this should not even be a question. There is absolutely no
excuse in this day and age, for reusing any form of disposable equipment
or material that could put anyone at risk for infection.

Low-Cost Sensor Can Diagnose Bacterial Infections
By University of Illinois, USA (29.04.11)

CHAMPAIGN, Ill. – Bacterial infections really stink. And that could be the
key to a fast diagnosis.

Researchers have demonstrated a quick, simple method to identify
infectious bacteria by smell using a low-cost array of printed pigments as
a chemical sensor. Led by Universityof Illinois chemistry professor Ken
Suslick, the team published its results in the Journal of the American
Chemical Society.

Hospitals have used blood cultures as the standard for identifying blood-
borne bacterial infections for more than a century. While there have been
some improvements in automating the process, the overall method has
remained largely constant. Blood samples are incubated in vials for 24 to
48 hours, when a carbon dioxide sensor in the vials will signal the
presence of bacteria. But after a culture is positive, doctors still need
to identify which species and strain of bacteria is in the vial, a process
that takes up to another day.

“The major problem with the clinical blood culturing is that it takes too
long,” said Suslick, the Marvin T. Schmidt professor of chemistry, who
also is a professor of materials science and engineering and a member of
the Beckman Institute for Advanced Science and Technology. “In 72 hours
they may have diagnosed the problem, but the patient may already have died
of sepsis.”

While there has been some interest in using sophisticated spectroscopy or
genetic methods for clinical diagnosis, Suslick’s group focused on another
distinctive characteristic: smell. Many experienced microbiologists can
identify bacteria based on their aroma. Bacteria emit a complex mixture of
chemicals as by-products of their metabolism. Each species of bacteria
produces its own unique blend of gases, and even differing strains of the
same species will have an aromatic “fingerprint.

An expert in chemical sensing, Suslick previously developed an artificial
“nose” that can detect and identify poisonous gases, toxins and explosives
in the air.

“Our approach to this problem has been to think of bacteria as simply
micron-sized chemical factories whose exhaust is not regulated by the
EPA,” Suslick said. “Our technology is now well-proven for detecting and
distinguishing among different chemical odorants, so applying it to
bacteria was not much of a stretch.”

The artificial nose is an array of 36 cross-reactive pigment dots that
change color when they sense chemicals in the air. The researchers spread
blood samples on Petri dishes of a standard growth gel, attached an array
to the inside of the lid of each dish, then inverted the dishes onto an
ordinary flatbed scanner. Every 30 minutes, they scanned the arrays and
recorded the color changes in each dot. The pattern of color change over
time is unique to each bacterium.

“The progression of the pattern change is part of the diagnosis of which
bacteria it is,” Suslick said. “It’s like time-lapse photography. You’re
not looking just at a single frame, you’re looking at the motion of the
frames over time.”

In only a few hours, the array not only confirms the presence of bacteria,
but identifies a specific species and strain. It even can recognize
antibiotic resistance – a key factor in treatment decisions.

In the paper, the researchers showed that they could identify 10 of the
most common disease-causing bacteria, including the hard-to-kill hospital
infection methicillin-resistant Staphylococcus aureus (MRSA), with 98.8
percent accuracy. However, Suslick believes the array could be used to
diagnose a much wider variety of infections.

“We don’t have an upper limit. We haven’t yet found any bacteria that we
can’t detect and distinguish from other bacteria,” he said. “We picked out
a sampling of human pathogenic bacteria as a starting point.”

Given their broad sensitivity, the chemical-sensing arrays also could
enable breath diagnosis for a number of conditions. Medical researchers at
other institutions have already performed studies using Suslick’s arrays
to diagnose sinus infections and to screen for lung cancer.

Next, the team is working on integrating the arrays with vials of liquid
growth medium, which is a faster culturing agent and more common in
clinical practice than Petri dishes. They have also improved the pigments
to be more stable, more sensitive and easier to print. The device company
iSense, which Suslick co-founded, is commercializing the array technology
for clinical use.

The National Institutes of Health supported this research through the
Genes, Environment and Health Initiative. Co-authors of the paper included
professor James Carey, of the National University of Kaoshiung; U. of I.
of microbiology professor James Imlay; research specialist Karin Imlay;
and co-workers Crystal Ingison, Jennifer Ponder, Avijit Sen and Aaron

For more information visit

Africa: Injection Drug Use Helps Drive HIV/AIDS in Africa
Joe DeCapua, VOA News, USA  (29.04.11)

Injection drug use has long been a driving factor in the HIV/AIDS epidemic
in Eastern Europe and Central Asia. But now, there are signs it’s a
growing problem in sub-Saharan Africa, as well.

The Washington-based Center for Strategic and International Studies, CSIS,
sent a team to Kenya and Tanzania to study the relationship between
injection drugs and HIV / AIDS.

“Globally, we know that it is quite a serious problem. And we know that
one in every three new infections is attributable to injecting drug use.
We know that in Eastern Europe, Central Asia, the former Soviet Union, it
continues to be the major driver of the epidemic there. What we’re seeing
happen on a parallel track is that in many countries, where the new HIV
incidence is starting to stabilize and level off, that the proportion of
IDU-related infections is continuing to increase,” said CSIS team member
Lisa Carty, who co-wrote a report on the problem. Carty is deputy director
at the Global Health Policy Center at CSIS.

“I think the whole question of injecting drug use and HIV prevention has
been one that’s really been under resourced and not really paid adequate
attention to, either from a policy or a programmatic point of view,” she

White heroin

The report said, “While it’s clear the number of people injecting drugs is
large and growing, the kind of epidemiological data needed for planning
and implementing effective prevention and treatment programs remain
uncertain.” Epidemiology is the who, what, when, where, why and how of the

“White” heroin became readily available in East Africa starting in the
late 1990s, resulting in an increase in HIV infections through drug use.
Carty said, “It relates to drug trafficking routes coming out of South
Asia and the fact that those routes have actually expanded and, you know,
a lot of the sort of coastal cities of East Africa – Mombasa and Zanzibar
and Dar es Salaam – have become more and more an entry point for drug
trafficking out of the South Asia region in through Africa and then very
often up through Europe and on to the United States.”
Getting high, getting infected

Dr. Phil Nieberg, senior associate with the Global Health Policy Center,
is co-author of the CSIS report. He said the sharing of syringes by drug
addicts is a very easy way to transmit HIV. Far easier than sexual

“The reason is that usually with needle sharing there’s blood left in the
syringe or in the needle. So, basically, the second person to use the
needle is getting an injection of someone else’s blood that has a lot of
virus in it,” he said.

Women bear the brunt

And, as is the case in many sectors of the HIV/AIDS epidemic, women have
it worse than men.

“Women who are drug users have a much higher HIV risk than men who are
drug users. So that one reason for that is that many women, who inject
drugs, turn to sex as a way of raising money to buy drugs. So there’s an
overlap between sex work and drug use,” he said.

Women then face the triple stigma and discrimination threat of being HIV
positive, a sex worker and a drug addict.

“Even men who inject drugs stigmatize women who inject drugs, saying you
shouldn’t be doing this. I shouldn’t do it either, but I’m a man, but you
have responsibilities and family support,” he said.

In an effort to avoid law enforcement, injection drug users go underground
or hide. But that only takes them further from care and treatment. It’s a
similar situation for sexworkers and men having sex with men.

Both Nieberg and Carty said there are no easy answers for dealing with HIV
positive drug users. But they said treating addiction as a disease instead
of a crime could allow more addicts to seek help.

Counseling, needle exchange programs, the use of the heroin substitute
methadone could all be part of the plan. Changes in U.S. policy made last
year now allow more flexibility in foreign aid programs to deal with such

Australia: Aussie travellers given unnecessary shots: report
e-Travel Blackboard (29.04.11)

Ill-informed doctors are overprescribing often unnecessary injections to
Australians heading overseas, the consumer group CHOICE has found.

According to the CHOICE report, some medical experts have warned that GPs
lacking the experience and knowledge of certain diseases have rushed
through consultations, often over-servicing or even up-selling to
travellers seeking vaccinations.

“It’s wrong to give travellers shots they don’t need and it’s unsafe if
they walk away from the doctor’s surgery without ones they do,” CHOICE
spokesperson Ingrid Just said.

With the average cost of a single travel vaccine ranging from AU$45 to
$85, and with one in 11 Australians heading overseas each year, Ms Just
described travel vaccinations as “big business”, suggesting those with
“ambitious travel plans ask around and find an experienced travel doctor”.
“Not only could it save you money but also your health,” Ms Just said.

The CHOICE report advises using a specialist travel clinic or seeing a GP
with travel expertise when heading off the beaten track, whilst shopping
around for comparative costs is also recommended.

France: Patient prisoners
By Eve Irvine, FRANCE 24, France (29.04.11)

This week we’re looking at health behind bars to the Penitentiary of

First up, prisons deadliest inmate: Hepatitis C a viral blood borne
infection over 5 times more prevalent in jails than elsewhere but could
serving a sentence be the best time to cure this disease.

Video at:

Gates Foundation Funds Bold Ideas Including Empty Virus Shells to Improve
Polio Immunity, Dirt-Charged Cell Phones, and Fertilizer Pellets that
Reduce Health Risks
Bill & Melinda Gates Foundation Press Release (28.04.11)

Grand Challenges Explorations winners in 25 countries aim to transform
global health and development

SEATTLE – The Bill & Melinda Gates Foundation today announced 88 new
winners of US$100,000 each to support innovative research that has the
potential to dramatically improve lives in some of the world’s poorest
countries. The funding, made possible through the Grand Challenges
Exploration (GCE) program, will enable researchers worldwide to test
unorthodox ideas that address persistent health and development

“One bold idea is all it takes to catalyze new approaches to global health
and development,” said Dr. Tachi Yamada, president of Global Health at the
Bill & Melinda Gates Foundation. “Despite the progress in global health
and development, we vitally need creative ideas to discover and deliver
life-saving vaccines, eradicate the next disease or slow the spread of
preventable diseases,” he continued.

GCE asked researchers to tackle problems such as speeding progress toward
assuring polio eradication; leveraging cell phones for global health
solutions to improve access to life-saving vaccines; using new
technologies to improve maternal and newborn health; finding ways to
eliminate all reservoirs of HIV from a patient; and, creating next
generation sanitation technologies to help reduce the burden of diarrheal

“GCE winners are expanding the pipeline of ideas to address serious global
health and development challenges where creative thinking is most urgently
needed. This effort is critical if we are to spur on new discoveries that
ultimately could save millions more lives,” said Chris Wilson, director of
Global Health Discovery at the Bill & Melinda Gates Foundation.

Winners were selected from over 2,500 proposals and approximately 100
countries. They represent a wide range of backgrounds and disciplines,
including health researchers, computer and electronic engineers, and
entrepreneurs. Research areas for Round 6 of GCE included:

The Poliovirus Endgame: Creating Ways to Accelerate, Sustain and Monitor

Creating the Next Generation of Sanitation Technologies

Designing New Approaches to Cure HIV Infection

Creating Low-Cost Cell Phone-Based Applications for Priority Global Health

Creating New Technologies to Improve the Health of Mothers and Newborns
GCE continues its search for innovative ideas from all over the world,
using a quick and easy grant-making selection process. Applications for
the next round are being accepted through May 19, 2011.

Click here for Round 7 topics and application instructions.

Winning Round 6 research proposals include:

Strategies to accelerate the end of polio and sustain eradication:

James Flanegan of the University of Florida, U.S., will explore developing
a poliovirus vaccine composed of virus capsids – the protein shell of the
virus – that look like the virus but are not infectious.

Simon Carding of the University of East Anglia, UK, will test whether live
gut bacteria could generate immunity by delivering poliovirus antigens to
the intestinal mucosa.

Jacob John of Christian Medical College in India will study the effect of
inactivated poliovirus vaccine (IPV) on gut immunity in Indian children
previously given the oral polio vaccine (OPV). Boosting immunity with IPV
could result in strategies for accelerating polio eradication.
New life-saving vaccines and other tools:

Erez Lieberman-Aiden and his team at Harvard University, U.S., propose to
develop a low-cost microbial fuel cell (MFC) from naturally occurring soil
microbes which could be used to recharge a cell phone. These fuel cells do
not require any sophisticated materials to build, and can be easily
assembled using locally available materials.

Marc-Andre Langlois of the University of Ottawa, Canada, will develop
small molecules that combine together to form a toxic compound that
specifically eliminates only HIV-infected cells. If successful, it could
lead to a cure for HIV.

Innovative developments for next generation sanitation technologies:

Guillermo Bazan of the University of California, Santa Barbara in the U.S.
will explore an innovative way to break down human waste and convert the
energy into electricity and heat.

Virginia Gardiner of Loowatt Ltd. in the United Kingdom will develop a
waterless toilet that seals waste into a portable cartridge within
biodegradable film, for local anaerobic digestion. The digester produces
fuel and fertilizer, creating local waste treatment economies.
Olufunke Cofie of the International Water Management Institute in Ghana
will develop fertilizer pellets made from treated human waste for market
sale to increase agricultural productivity in sub-Saharan Africa and
reduce health risks from untreated waste.
About Grand Challenges Explorations

Grand Challenges Explorations is a US$100 million initiative funded by the
Bill & Melinda Gates Foundation. Launched in 2008, Grand Challenge
Explorations grants have already been awarded to nearly 500 researchers
from over 40 countries. The grant program is open to anyone from any
discipline and from any organization. The initiative uses an agile,
accelerated grant-making process with short two-page online applications
and no preliminary data required. Initial grants of $100,000 are awarded
twice a year. Successful projects have the opportunity to receive a
follow-on grant of up to US$1 million.

Bill & Melinda Gates Foundation

Guided by the belief that every life has equal value, the Bill & Melinda
Gates Foundation works to help all people lead healthy, productive lives.
In developing countries, it focuses on improving people’s health and
giving them the chance to lift themselves out of hunger and extreme
poverty. In the United States, it seeks to ensure that all
people-especially those with the fewest resources-have access to the
opportunities they need to succeed in school and life. Based in Seattle,
Washington, the foundation is led by CEO Jeff Raikes and Co-chair William
H. Gates Sr., under the direction of Bill and Melinda Gates and Warren

USA: Healthcare Experts Call for More Enforcement, Empowerment and Safety
by Design
By Jaimie Oh,  Becker’s ASC Review (28.04.11)

Healthcare experts from the Centers for Disease Control & Prevention, Safe
Injection Practices Coalition and other organizations spoke at a
teleconference on safe injection practices, urging healthcare
professionals to do more in order to protect patients from infection and

Speakers at the teleconference included Joseph Perz, prevention team
leader of the Division of Healthcare Quality Promotion at the CDC; Susan
Dolan, RN, CIC, hospital epidemiologist at The Children’s Hospital in
Denver; Sara Hart Weir, MS, of the Safe Injection Practices Coalition;
Gina Pugliese, RN, vice president of the Safety Institute at Premier
healthcare alliance and Rhonda Soest of Covidien Imaging.

The roundtable discussion emphasized greater enforcement of current safe
injection practices (including not re-using single-use syringes or single-
dose vials), patient and clinician empowerment, safety-driven product
design as well as education.

“Representatives from CMS and The Joint Commission are more carefully
reviewing injection practices as part of infection control and basic
patient safety inspections, but not all healthcare facilities are subject
to that oversight. So it is important we rely on educational outreach,”
Dr. Perz said.

Three Common Misconceptions

Dr. Perz also commented healthcare professionals, who never have the
intention of harming a patient, sometimes hold the following common

1. Contamination of injection devices is limited to the needle. Oftentimes
injectable technology encompasses both the needle and syringe. The common
perception is that only the needle becomes contaminated when used on
patient, but the needle and syringe should be treated as one unit.
Removing only the needle is not safe.

2. Presence of IV tubing or a valve can prevent backflow of injections.
“Consider everything from the needle to the syringe and medication bag all
the way to the patient as single unit,” Dr. Perz said.

3. If there is no blood, there is no risk. Healthcare professionals may
sometimes believe they are working in a sterile field because they only
see clear fluid. However, Dr. Perz said it’s important to remember
bacteria and other germs are not visible to the naked eye.

Nevada USA: Desai, partner face allegations of conspiracy, health care
fraud in federal indictment
Jeff German, Carri Geer Thevenot, Las Vegas Review-Journal (27/28.04.11)

Court document of indictment

Dr. Dipak Desai, the physician declared incompetent to stand trial on
criminal charges stemming from the hepatitis C outbreak, faces new federal
charges that could complicate the legal wrangling over his fate.

Desai and his former chief operating officer, Tonya Rushing, were indicted
by a federal grand jury Wednesday on conspiracy and health care fraud
charges, some of which mirror state charges filed against Desai last year.

The indictment comes as medical officials are trying to determine whether
Desai can ever face the state charges. He is under evaluation at Lakes
Crossing, the state’s mental hospital in Sparks.

Desai attorney Richard Wright was baffled by federal prosecutors’ pursuit
of some of the same charges filed in state court, especially after the
finding of incompetency.

“The federal indictment doesn’t render him competent,” he said.

The lawyer said he knew about the federal investigation but did not know
until Tuesday that prosecutors planned to indict Desai.

“Are we going to go forward anyway and litigate his competency all over
again?” Wright asked.


In all, Desai, 61, and Rushing, 43, are charged in the federal indictment
with one count of conspiracy, 25 counts of health care fraud and a
forfeiture count seeking to seize $8.1 million.

Rushing, a prosecution witness against Desai in the state case, has a May
6 arraignment on the new charges. Desai’s arraignment had not been set.

The indictment alleges the pair carried out a scheme from January 2005
through February 2008 to inflate the length of medical procedures and
overbill health insurance companies for anesthesia.

The insurers included Medicare, Medicaid and private entities such as Blue
Cross/Blue Shield, United Healthcare and the Culinary and Teamsters union
health funds.

At two of Desai’s clinics, the Endoscopy Center of Southern Nevada and the
Desert Shadow Endoscopy Center, nurse anesthetists were instructed to
falsify anesthesia times for endoscopies and colonoscopies, the indictment

The nurses were ordered to list 31 minutes of anesthesia time for each
procedure, even though they rarely required that much time, according to
the indictment.

“Desai imposed pressure on all (clinic) employees to schedule and treat as
many patients as possible in a given day,” the indictment states.

At Desert Shadow, nurse anesthetists saw between 60 and 80 patients a day,
making it impossible to spend 31 minutes with each patient, the indictment

Desai and Rushing in 2004 created a separate company, owned by Rushing, to
handle the anesthesia billing at the clinics.

The company, Healthcare Business Solutions, received 9 percent of money
collected for anesthesia services, giving Rushing “a financial incentive
to inflate anesthesia time,” the indictment states.

Between 2006 and 2007, the indictment charges, Rushing paid Desai $185,000
from money the company unlawfully earned.

U.S. Attorney’s office spokeswoman Natalie Collins declined to comment on
the indictment.


District Attorney David Roger said he did not know how the federal
indictment would affect the criminal case his office filed against Desai
and two nurse anesthetists in June.

Desai, a gastroenterologist who gave up his medical license after the
hepatitis outbreak at his clinics, and nurses Keith Mathahs and Ronald
Lakeman face several felony charges, including racketeering, insurance
fraud and neglect of patients.

The charges revolve around seven people whom authorities say were infected
with the potentially deadly hepatitis C virus at Desai’s endoscopy

“It is unknown which prosecuting agency will take Desai to trial first,”
Roger said Wednesday after learning of the federal indictment.

He declined further comment.

But the charges against Rushing are likely to complicate Roger’s case. The
district attorney did not charge Rushing, who has struck a deal to testify
against Desai.

“Her indictment comes as a surprise to me because she’s been a cooperating
witness with state and federal authorities,” said Rushing’s attorney,
Louis Schneider.

Schneider said he wasn’t sure now whether he would allow Rushing to take
the witness stand in the state case, which is set to go to trial in March.

While state and federal prosecutors have the legal right to pursue the
same charges, Wright said, “normally that’s not a judicious use of limited
prosecutorial resources.”

He said both jurisdictions have the same legal standards for competency,
but he acknowledged that different judges can have different opinions on
the issue.

A status check for Desai’s federal case was set for May 27. Wright said
the defendant will not be expected to appear at that hearing.


Douglas McNabb, a Washington, D.C., lawyer who specializes in federal
criminal defense, said nothing would preclude a federal judge from finding
Desai competent, despite the state court ruling to the contrary. The
federal case then could proceed to trial during the delay of the state

“Is there something that the feds know that would allow the feds to argue
that he is competent?” McNabb wondered aloud.

In March, under orders from District Judge Jackie Glass, Desai was taken
to Lakes Crossing for observation. Two court-appointed medical experts
from Las Vegas had found him incompetent to stand trial in the state case
in light of two strokes in recent years.

Desai is being evaluated by state physicians, who will decide whether his
competency can be restored. If Desai is deemed incompetent with no
possibility of recovery, state law requires dismissal of the local

The criminal investigation, which began shortly after health officials
disclosed the hepatitis C outbreak in February 2008, was one of the
largest by Las Vegas police.

Desai came under scrutiny after the Southern Nevada Health District linked
cases of hepatitis C to his clinics. Officials notified more than 50,000
former clinic patients about possible exposure to blood-borne diseases
because of unsafe injection practices.

* As many as 250 former clinic patients infected with hepatitis have filed
medical malpractice lawsuits. Thousands more have sued over the stress of
having to be tested for hepatitis C.

* Local health officials blamed the outbreak on nurse anesthetists reusing
vials of the sedative propofol that were contaminated by syringes used on
patients with hepatitis C.

Pakistan: Petition: Registration of firms dealing in syringes
The Express Tribune, Pakistan (13.04.11)

Hundreds of people are contracting diseases as they reuse syringes or use
substandard ones.


The Law Foundation has taken the government to court over delays in
registering firms that import medical syringes.

The constitutional petition names the federal health secretary and the
health ministry’s director-general.

The petitioner argued that a Lahore High Court bench ordered the
government to register the importers and exporters of disposable syringes
but time and again, an extension was given. Hundreds of people are
contracting diseases as they reuse syringes or use substandard ones. On
Tuesday, the petitioner’s counsel, submitted that disposable syringes are
imported to the province mainly by the Pakistan Chemists and Druggists
Association (PCDA).

Chief Justice Mushir Alam and Justice Syed Hasan Azhar Rizvi said, “In the
circumstances of the case, we would add the Pakistan Pharmaceutical
Manufacturers Association, the PCDA and the Sindh health secretary as
respondents.” The bench asked the petitioner to file an amended title. The
office was ordered to fix the hearing date after two weeks.
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