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SIGNpost 00598

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

Post00598  World Blood Day + Field Notes + Abstracts + News   11 May 2011

CONTENTS
1. World Blood Donor Day 2011
2. The New TECHNET21 website
3. Notes From the Field: Deaths From Acute Hepatitis B Virus Infection
Associated With Assisted Blood Glucose Monitoring in an Assisted-Living
4. Abstract: The epinet data of four Indian hospitals on incidence of
exposure of healthcare workers to blood and body fluid: a multicentric
prospective analysis
5. Abstract: To the point: needlestick injuries, risks, prevention and the
law
6. Abstract: Staff nurses’ sites of choice for administering intramuscular
injections to adult patients in the acute care setting
7. Abstract:Community-based distribution of injectable contraceptives in
an African setting: Community trial in Madagascar
8. Abstract: Injected with controversy: sales and administration of
injectable contraceptives in Uganda
9. Abstract: Helsinki Declaration on patient safety in anaesthesiology:
Putting words into practice – Experience in Germany
10. Abstract: The contribution of labelling to safe medication
administration in anaesthetic practice
11. Abstract: Sero-prevalence of Hepatitis B Virus infection in
Balochistan province of Pakistan
12. Abstract: Hepatitis C virus infection among adolescents and young
adults — massachusetts, 2002–2009
13. Abstract: Reducing harm from injecting pharmaceutical tablet or
capsule material by injecting drug users
14. Abstract: The Cost-effectiveness of Screening for Chronic Hepatitis B
Infection in the United States
15. Abstract: Preface: seventh world congress on vaccines, immunisation
and immunotherapy
16. Abstract: Methods of rapid microbiological assay and their application
to pharmaceutical and medical device fabrication
17. Abstract: Microbial air purity in hospitals. Operating theatres with
air conditioning system
18. No Abstract: Evidence on acupuncture safety needs to be based on
large-scale prospective surveys, not single case reports
19. New European Course on Medical Device Regulation
20. Webcast: On Recognizing and Correcting Unsafe Injection Practices
21. The first-ever online Cold Chain event – connecting the international
cold chain pharmaceutical community Online: May 17 through June 9 2011
22. World Blood Donor Day: Paint the world red in 2011!
23. WHO Health Technologies e-Documentation Centre
24. News
– USA: Boulder County approves state’s first syringe exchange program:
22-year-old informal policy becomes official under new state law
– Canada: Most nurses don’t use recommended intramuscular injection site
despite potential risks
– Australia: Injection dissension
– Canada: Supreme Court of Canada to determine who has control over
Vancouver’s supervised injection site
– Canada:  Top Court to Weigh Future of Vancouver’s Controversial Safe-
Injection Site
– USA: Hepatitis Awareness Month — May 2011
– Africa: Injection Drug Use Helps Drive HIV/AIDS in Africa
– USA: Hepatitis C cases rising among Massachusetts youth
– India – Nagaland: State LFA visit Australia for ‘Harm Reduction
Studies’
– Ireland: Minister For Health Pledges Ireland’s Support For WHO SAVE
LIVES: Clean Your Hands
– Technology: The rad professor
– Australia: Australian Capital Territory Prison Workers Fight Needle
Exchange
– USA: Assisted living center cited after needle stick
– Safer healthcare depends on in-depth investigation, not quick fixes,
says expert
– USA: Unsafe Injection Practices Persist Despite Education Efforts”
– USA: Hospital Errors Occur 10 Times More Than Reported, Study Finds

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__________________________________________________________________________
_____________________________________*____________________________________

1. World Blood Donor Day 2011
__________________________________________________________________________

Subject: World Blood Donor Day 2011
From: “worldblooddonorday” <worldblooddonorday[at]who.int>

Dear All,

It is a great pleasure for us to announce the global celebration of World
Blood Donor Day (WBDD) which will be held on 14 June 2011 (for more
details visit, http://www.who.int/worldblooddonorday ).

Established as an annual event by the Fifty-eighth World Health Assembly
in resolution WHA58.13, the observance of the day is an activity organized
by World Health Organization (WHO) in collaboration with many key
international organizations including the International Federation of Red
Cross and Red Crescent Societies, the International Federation of Blood
Donor Organizations and the International Society of Blood Transfusion. It
calls on Member States, organizations of the United Nations system,
multilateral and bilateral agencies, international organizations,
nongovernmental organizations and bodies concerned with global blood
safety to come together in promoting and supporting voluntary non-
remunerated blood donation as the foundation for safe and sufficient
supplies of blood and blood products. This day has become an integral part
of national blood donor programmes and an occasion to thank, appreciate
and acknowledge voluntary blood donors.

The theme for World Blood Donor Day 2011 is, “More blood. More life.” This
theme reinforces the urgent need for more people all over the world to
become life-savers by volunteering to donate blood regularly. WHO and
partners are encouraging communities in every country to join the World
Blood Donor Day campaign and “Paint the world red”, whether by
symbolically colouring, covering or lighting monuments, popular landmarks
and buildings in red; staging artistic, cultural or musical events with a
red-coloured theme; or forming a “human blood drop” in prominent public
places.

Each year, a host country is identified for a global event that provides
the focus for an international publicity campaign. The 2011 global event
will take place in Buenos Aires, Argentina and will be hosted by the
Government of Argentina. The event is also designed to support national
blood transfusion services, blood donor organizations and other
nongovernmental organizations in strengthening and expanding their
voluntary blood donor programmes and to reinforce regional, national and
local campaigns, therefore we hope that you too will support the event and
will take part in the celebrations.

Thank you for your attention, for your support and collaboration.

Kind regards,

Neelam Dhingra

Dr Neelam Dhingra
MBBS, MD, CTM
Coordinator
Blood Transfusion Safety (BTS)
World Health Organization-HQ
Tel. direct: +41 22 791 4660
Fax direct: +41 22 791 4836
E-mail: dhingran[at]who.int
www.who.int/bloodsafety
http://hinfo.humaninfo.ro/gsdl/healthtechdocs
World Blood Donor Day 14 June
www.who.int/worldblooddonorday
__________________________________________________________________________
_____________________________________*____________________________________

2. The New TECHNET21 website
__________________________________________________________________________

The New TECHNET21 website

The new TechNet21 or Technical Network for Strengthening Immunization
Services, website was launched at the end of 2010.

The TechNet21 URL is: http://techhnet21.org

The purpose is toto provide an information bridge between the tens of
thousands of people working in countries delivering vaccines and the
policy makers who mostly work in Geneva, New York and Copenhagen and in
WHO and UNICEF their Regional offices.

Forums – Documents – Tools – Photos – Blogs – Events – Jobs – Proposals –
Publications – Newsletters – Links

http://techhnet21.org now includes:

A space for moderated discussions for debate on difficult issues.

A photo depot where you can post your pictures or select pictures for use
in presentations;

A new networking space to link colleagues who have similar ideas and face
similar challenges;

A new depot where software and other tools are available for download;

Latest news and research articles on immunization are streamlined through
RSS feeds;

The latest job announcements, expert database and more.

Upcoming Events

Requests for Proposals

Recent Publications

Recent Newsletters

* Please go to http://TechNet21.org subscribe! click:’Login’ to start the
easy process.

If you are already a member of the TechNet21 forum you will not
need to re-register with the new site.

Login to http://TechNet21.org and please send us your comments.

TechNet21 is generously supported by the Bill and Melinda Gates
Foundation, under the oversight of WHO and UNICEF.
__________________________________________________________________________
_____________________________________*____________________________________

3. Notes From the Field: Deaths From Acute Hepatitis B Virus Infection
Associated With Assisted Blood Glucose Monitoring in an Assisted-Living

Crossposted with thanks from the MMWR. 2011;60:182 and the Journal of the
American Medical Association, April 2011
__________________________________________________________________________

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

KEYWORDS: assisted living facilities, blood glucose self-monitoring,
hepatitis b virus, infection control, north carolina, patient safety,
public health.

MMWR. 2011;60:182

Sharing of blood glucose monitoring equipment in assisted-living
facilities has resulted in at least 16 outbreaks of hepatitis B virus
(HBV) infection in the United States since 2004.1?,2 On October 12, 2010,
the North Carolina Division of Public Health (NCDPH) and the Wayne County
Health Department were notified by a local hospital of four residents of a
single assisted-living facility with suspected acute HBV infection. NCDPH
requested HBV testing of all persons who had resided in the facility
during January 1-October 13, 2010, and defined an outbreak-associated case
as either (1) positive hepatitis B surface antigen and core immunoglobulin
M (IgM) results or (2) clinical evidence of acute hepatitis (jaundice or
serum aminotransferase levels twice the upper limit of normal) with onset
=6 weeks after admission to the facility. Records were reviewed for
potential health-care-associated exposures and HBV-related risk factors.
Infection control practices were assessed through observations and
interviews with facility staff.

The investigation identified unsafe practices, including sharing of
reusable fingerstick lancing devices approved for single patient use only
and shared use of blood glucose meters without cleaning and disinfection
between patients. Of 87 persons who had resided in the facility during the
study period, 47 were excluded from analysis because of HBV immunity (20
persons), chronic infection (one person), or unknown HBV status (26
persons). Of the remaining 40, eight met the case definition. Of these,
all were hospitalized, and six died from hepatitis complications. All
eight were among the 15 residents whom facility staff had assisted with
blood glucose monitoring; none of 25 residents who had not been assisted
with blood glucose monitoring were infected.

Despite long-standing and recently expanded infection control
recommendations,2?,3 HBV transmission continues to occur through sharing
of fingerstick lancing devices and other blood glucose monitoring
equipment. These practices put residents at risk for severe illness and
death. In accordance with NCDPH recommendations, the facility now uses
individually assigned blood glucose meters and single-use, autodisabling
fingerstick lancing devices. The facility also offered HBV vaccine to all
susceptible residents. NCDPH and the state licensing agency issued a
notification to all health-care providers and licensed health-care
facilities statewide warning of the potential for HBV transmission through
unsafe diabetes-care practices. This outbreak underscores the need for
increased efforts to promote compliance with infection-control guidelines
in assisted-living facilities.

Reported by: Z Moore, MD, J-M Maillard, MD, M Davies, MD, North Carolina
Dept of Health and Human Svcs; N Dailey, MD, EIS Officer, CDC.

REFERENCES

1. Centers for Disease Control and Prevention (CDC). Transmission of
hepatitis B virus among persons undergoing blood glucose monitoring in
long-term-care facilities-Mississippi, North Carolina, and Los Angeles
County, California, 2003-2004. MMWR Morb Mortal Wkly Rep.
2005;54(9):220-223. Medline

2. CDC. Infection prevention during blood glucose monitoring and insulin
administration. Atlanta, GA: US Department of Health and Human Services,
CDC; 2010; Available at
http://www.cdc.gov/injectionsafety/blood-glucose-monitoring.html. Accessed
February 10, 2011.

3. Food and Drug Administration. Use of fingerstick devices on more than
one person poses risk for transmitting bloodborne pathogens: initial
communication: update 11/29/2010. Washington, DC: US Department of Health
and Human Services, FDA; 2010; Available at
http://www.fda.gov/medicaldevices/safety/alertsandnotices/ucm224025.htm.
Accessed February 10, 2011.
__________________________________________________________________________
_____________________________________*____________________________________

4. Abstract: The epinet data of four Indian hospitals on incidence of
exposure of healthcare workers to blood and body fluid: a multicentric
prospective analysis

Free Article http://tinyurl.com/Epinet4India-1
__________________________________________________________________________

Indian J Med Sci. 2010 Dec;64(12):540-8.

The epinet data of four Indian hospitals on incidence of exposure of
healthcare workers to blood and body fluid: a multicentric prospective
analysis.

Chakravarthy M, Singh S, Arora A, Sengupta S, Munshi N.

Department of Anesthesia, Critical care and Pain relief, Wockhardt Forits
Hospitals, Bangalore, Karnataka – 560 076, India.

BACKGROUND: Sharps injury (SI) and blood and body fluid exposure are
occupational hazards to healthcare workers (HCWs). Although data from the
developed countries have shown the enormity of the problem, data from
developing countries, such as India, arelacking. Purpose : The purpose of
this study was to cumulate data from fourmajor hospitals in India and
analyze the incidence of SI and blood and body fluid exposure in HCWs.

MATERIALS AND METHODS: Four Indian hospitals (hospital A, B, C and D) from
major cities of India participated in this multicentric study. Data
ranging from 6 to 26 months were collected from these hospitals using
Exposure Prevention Information network (EPINet) which is the database
created by International Healthcare Worker Safety Research and Resource
Center, University of Virginia.

RESULTS: Two hundred and forty-three sharp injuries and 22 incidents of
blood or body fluid exposure were encountered in the cumulated 50 months
of our study. The incidence of SIswas thehighestamong nurses (55%) of
allthe HCWs, akin to the global data. An injury rate of nearly 20% among
housekeeping staff seems to be specific to the Indian data. Patient’s room
followed by operation theater appeared to be common locations of injury in
our study. The source of the injury was identified in majority (64%) of
the injuries. A major part of the group was not the primary users of the
sharp (38%). Disposable needles caused nearly half of the injuries. Suture
needles contributed to a reasonable number of injuries in one of the
hospitals.

CONCLUSIONS: The incidence of SI is the highest among nurses and the
housekeeping staff (>30% each). A substantial number of injuries are
avoidable.

Free Article http://tinyurl.com/Epinet4India-1

http://www.indianjmedsci.org/article.asp?issn=0019-5359;year=2010;volume=
64;issue=12;spage=540;epage=551;aulast=Chakravarthy
__________________________________________________________________________
_____________________________________*____________________________________

5. Abstract: To the point: needlestick injuries, risks, prevention and the
law
__________________________________________________________________________

Br J Nurs. 2011 Apr 27;20(8):4-11.

To the point: needlestick injuries, risks, prevention and the law.

Adams D.

Healthcare staff are at risk of infections if they are exposed to
bloodborne pathogens from needlestick injuries (NSIs). In 2010, the
European Union adopted a directive to prevent injuries and infections to
healthcare workers from sharp objects, including NSIs. It recommended an
integrated approach to preventing these injuries; this includes risk
assessment, training and the provision of safety needle devices (SNDs).

This directive has to be enshrined in UK legislation by May 2013. NSIs are
under reported, but nearly half of nurses may have had such an injury.
NSIs occur in many clinical areas, often when nurses are busy or tired,
and most are caused by conventional hollow-bore needles.

SNDs, if implemented and used correctly, reduce the risk of NSI. This
article examines: the legislation; the prevalence of NSI; the risk of
infection transmission; devices and procedures associated with NSI; SNDs;
and costs of NSIs and SNDs.
__________________________________________________________________________
_____________________________________*____________________________________

6. Abstract: Staff nurses’ sites of choice for administering intramuscular
injections to adult patients in the acute care setting
__________________________________________________________________________

J Adv Nurs. 2011 May;67(5):1034-40.

Staff nurses’ sites of choice for administering intramuscular injections
to adult patients in the acute care setting.

Walsh L, Brophy K.

Lorna Walsh BN MEd RN Nurse Educator Center for Nursing Studies, St
John’s, Newfoundland, Canada Kathleen Brophy BN MEd RN Nurse Educator
Centre for Nursing Studies, St John’s, Newfoundland, Canada.

ABSTRACT: Aim.  The aim of this descriptive, correlational study was to
determine intramuscular injection sites presently being used by acute care
nurses in one Canadian province and factors that contribute to site
selection.

Background.  Intramuscular injections are routinely administered by nurses
in acute care settings. Recent nursing literature recommends that the
ventrogluteal site, rather than the dorsogluteal site, should be used for
these injections, although evidence in the literature to support this
claim is lacking.

Method.  A convenience sample of nurses employed in acute care settings
was accessed through a database at the professional association. Six
hundred and fifty-two nurses were sent a questionnaire. Two hundred and
sixty-four questionnaires were returned giving a response rate of 42·2%.
Data were collected during 2007.

Findings.  Nurses are preferentially using the dorsogluteal site over the
ventrogluteal site, and site selection varied significantly with age,
level of preparation, years in nursing and knowledge of nerve injury as a
complication with the selected site.

Conclusions.  Nurses are not preferentially using the ventrogluteal site
for intramuscular injections to adults as recommended in recent nursing
literature. Additional research on the safety of a properly mapped
dorsogluteal site is needed.

© 2010 The Authors. Journal of Advanced Nursing © 2010 Blackwell
Publishing Ltd.
__________________________________________________________________________
_____________________________________*____________________________________

7. Abstract:Community-based distribution of injectable contraceptives in
an African setting: Community trial in Madagascar
__________________________________________________________________________

Sante. 2011 May 9.

Community-based distribution of injectable contraceptives in an African
setting: Community trial in Madagascar.

Brunie A, Hoke TH, Razafindravony B.

Family Health International PO Box 13950 Research Triangle Park NC 27709
États-Unis Family Health International PO Box 13950 Research Triangle Park
NC 27709 États-Unis.

Community-based distribution of family planning provides a way of reaching
underserved populations in developing countries. This article reports
findings from an introductory trial of community-based distribution of
Depot Medroxyprogesterone Acetate (DMPA), a progestin-only injectable
contraceptive.

The project, conducted in Madagascar in 2007 in collaboration with the
Malagasy government, was intended to test the safety, acceptability, and
contribution to policy goals of adding contraceptive injections to the
range of methods already offered by paraprofessional community-based
health workers in rural areas.

In total, 61 agents in 13 communities were trained and initiated service
offering DMPA. The intervention was evaluated after 7 months. Data
collection included interviews with agents, their supervisors, and a
sample of 303 clients, and review of agents’ records. In support of the
objectives, the descriptive analysis primarily examined the quality of
agents’ services (safety), three-month reinjection rates (acceptability),
and DMPA uptake (contribution). Interviews with agents to test knowledge
about correct practices indicated that they are able to provide high
quality services. To capture mastery of essential techniques, a composite
quality score was calculated from agents’ answers.

The average score was 23.3 out a maximum possible of 27. All agents scored
at least 18 points, and 80% of them received 22 points or more. Interviews
with clients further confirmed that agents were competent. The majority of
clients were satisfied with the services they received, and a very large
proportion (94%) of the women eligible for a second injection received it
from the agent. There were no complaints from the communities, and women
reported that acceptability among their partners was also high. Finally,
the program attracted new users: the 61 agents recruited a total of 1,662
women over six months, 41% of whom were not using family planning when
they initiated DMPA.

Encouraged by the findings from the pilot project, the Malagasy government
has proceeded to expand the program. As of March 2010, a total of 1,109
agents had been trained. At the international level, this study further
contributes to the growing body of evidence that well-trained community-
based health workers can safely provide injectable contraceptives,
potentially helping to increase contraceptive coverage in rural areas with
a nationally scaled-up program.

While community-based family planning services in Latin America and Asia
have included injectables since the 1970s, experiences in sub-Saharan
Africa have been very limited. Madagascar was one of the first countries,
and several others (Ethiopia, Kenya, Nigeria, Malawi, Rwanda, Uganda, and
Zambia) are beginning to include injectables in community-based family
planning programs.

Furthermore, a recent technical consultation convened by the World Health
Organization concluded that global evidence supports the introduction,
continuation, and scale-up of community-based provision of injectable
contraceptives.

Despite this momentum, further efforts are required to expand this
approach and increase the choice of contraceptive methods available to
underserved populations.
__________________________________________________________________________
_____________________________________*____________________________________

8. Abstract: Injected with controversy: sales and administration of
injectable contraceptives in Uganda
__________________________________________________________________________

Int Perspect Sex Reprod Health. 2011 Mar;37(1):24-9.

Injected with controversy: sales and administration of injectable
contraceptives in Uganda.

Stanback J, Otterness C, Bekiita M, Nakayiza O, Mbonye AK.

Deputy Director Family Health International, Durham, NC, USA,
jstanback@fhi.org.

CONTEXT: Informal drug shops are the first line of health care in many
poor countries. In Uganda, these facilities commonly sell and administer
the injectable contraceptive depot medroxyprogesterone acetate (DMPA),
even though they are prohibited by law from selling any injectable drugs.
It is important to understand drug shop operators’ current practices and
their potential to provide DMPA to hard-to-reach populations.

METHODS: Between November 2007 and January 2008, 157 drug shops were
identified in three rural districts of Uganda, and the operators of the
124 facilities that sold DMPA were surveyed. Data were analyzed with
descriptive methods.

RESULTS: Only 35% of operators reported that the facility in which they
worked was a licensed drug shop and another 9% reported that the facility
was a private clinic; all claimed to have some nursing, midwifery, or
other health or medical qualification. Ninety-six percent administered
DMPA in the shop. Operators gave a mean of 10 injections (including three
of DMPA) per week.

Forty-three percent of those who administered DMPA reported disposing of
used syringes in sharps containers; in the previous 12 months, 24% had had
a needle-stick injury and 17% had had a patient with an injection-related
abscess. Eleven percent said they had ever reused a disposable syringe.
Overall, contraceptive knowledge was low, and attitudes toward family
planning reflected common traditional biases.

CONCLUSION: Provision of DMPA is common in rural drug shops, but needs to
be made safer. Absent stronger regulation and accreditation, drug shop
operators can be trained as community-based providers to help meet the
extensive unmet demand for family planning in rural areas.
__________________________________________________________________________
_____________________________________*____________________________________

9. Abstract: Helsinki Declaration on patient safety in anaesthesiology:
Putting words into practice – Experience in Germany
__________________________________________________________________________

Best Pract Res Clin Anaesthesiol. 2011 Jun;25(2):291-304.

Helsinki Declaration on patient safety in anaesthesiology: Putting words
into practice – Experience in Germany.

Schleppers A, Prien T, Van Aken H.

German Society of Anaesthesiology and Intensive Care, Roritzer Str. 27,
90419 Nürnberg, Germany; Professional Association of German
Anaesthesiologists, Roritzer Str. 27, 90419 Nürnberg, Germany.

For years now, the German Society of Anaesthesiology and Intensive Care
Medicine and the Professional Association of German Anaesthesiologists
have been actively involved in efforts to improve patient safety. To this
end, a whole range of activities have been initiated in recent years and,
since February 2011, collected together on our home page ‘PATSI’ (
www.patientensicherheit-ains.de).

Further, the implementation of syringe labelling (ISO 26825) with
additional information on drugs frequently used in intensive care was
carried out. Under the item Helsinki Declaration, all decisions and
recommendations so far worked out by our speciality have, in structured
form, been assigned to individual points and saved as PDF files. This has
made it possible for every anaesthesiological department in Germany to
integrate all the relevant instructions and conditions of the Helsinki
Declaration into their own individual work structures.

These systematic solutions represent a major contribution towards reducing
the possibility of errors at the workplace. We are certainly still in the
early stages of our efforts to achieve a nationwide integration of a
cultural change in the way we deal with mistakes in medicine.

We have incorporated the item ‘learning from mistakes’ in our project
‘critical incident reporting system for anaesthesia, intensive care
medicine, emergency care, and pain therapy, CIRS-AINS’, and have brought
out a range of relevant illustrative publications. Accepting these
‘mistakes’ as an opportunity to critically examine ourselves and our work
with a view to learning from them and further improving our speciality
service is, we believe, a great challenge for future developments in
anaesthesia.

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

10. Abstract: The contribution of labelling to safe medication
administration in anaesthetic practice
__________________________________________________________________________

Best Pract Res Clin Anaesthesiol. 2011 Jun;25(2):145-59.

The contribution of labelling to safe medication administration in
anaesthetic practice.

Merry AF, Shipp DH, Lowinger JS.

Department of Anaesthesiology, University of Auckland, Private Bag 92019,
Auckland 1142, Auckland City Hospital, New Zealand.

The administration of medications is central to anaesthetists’ care of
patients. Errors are inevitable in any human endeavour, but should be
distinguished from violations. The incidence of medication errors in
anaesthesia has been estimated as 1 per 13 000 administrations, excluding
errors in recording. Adverse medication events follow a proportion of
these errors. Labelling is a key element of medication safety.

There is a long-standing need for improvements in the labelling of
ampoules and vials. An international standard exists for labelling
syringes used during anaesthesia (ISO 26825). Australia has recently
released national recommendations for labelling lines and injectable
medications that complement this and other relevant standards.

The provision of at least some medications in pre-filled syringes would
reduce the number of steps involved in medication administration, increase
the certainty that syringe labels are correct and probably reduce
medication errors.

Pre-printed, peel-off flag labels on ampoules and vials are a less
expensive alternative to pre-filled syringes to facilitate correct
labelling. The medication name on user-applied labels should be matched to
that on the relevant ampoule or vial at the time of drawing up any
medication. All lines and catheters should be labelled.

Any medicine or fluid that cannot be identified (e.g., in an unlabelled
syringe or other container) should be considered unsafe and discarded.
Reducing adverse medication events will require the engagement of
individual anaesthetists.

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

11. Abstract: Sero-prevalence of Hepatitis B Virus infection in
Balochistan province of Pakistan
__________________________________________________________________________

Saudi J Gastroenterol. 2011 May-Jun;17(3):180-4.

Sero-prevalence of Hepatitis B Virus infection in Balochistan province of
Pakistan.

Sheikh NS, Sheikh AS, Sheikh AA, Yahya S; Rafi-U-Shan, Lateef M.

Department of Cardiology, Addenbrooke’s Hospital NHS Trust, Cambridge,
United Kingdom.

Background/Aim: The objective was to evaluate the sero-prevalence of
hepatitis B surface antigen (HBsAg) and IgM antibodies to hepatitis core
antigen in Balochistan Province of Pakistan.

Design of the study: A cross- sectional, population-based study. Place and
time of the study: The study was conducted in Balochistan from 1 st
January 2004 to 31 st December, 2008. The screening areas included
Barkhan, Eashani, Khuzdar, Kodi Zikriani, Kohlu, Rakhni and Turbat.

Materials and Methods: A total of 15,260 subjects were enrolled; 11,900
(78%) agreed to undergo screening. Fresh serum samples were tested for the
presence of hepatitis B surface antigen and IgM antibodies to hepatitis B
core antigen.

Results: HBsAg was detected in 1166 (9.8%) while anti-HBc IgM was found in
117 (10.0%). HBsAg positivity was seen in 875 (12.7%) males and 291 (5.8%)
females. The prevalence of hepatitis B in Balochistan varies from 3.3% in
Khuzdar to 17.0% in Kodi Zikriani.

Conclusions: It is utmost important to educate the public, to take proper
measures to control the spread of infection and vaccination in order to
interrupt transmission of this threatening public health problem in
Balochistan province of Pakistan.

Free Article http://tinyurl.com/HepB-BalluchPakistan
__________________________________________________________________________
_____________________________________*____________________________________

12. Abstract: Hepatitis C virus infection among adolescents and young
adults — massachusetts, 2002–2009

Free Article – Complete article with graphics at:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6017a2.htm
__________________________________________________________________________

MMWR Morb Mortal Wkly Rep. 2011 May 6;60(17):537-41.

Hepatitis C virus infection among adolescents and young adults —
massachusetts, 2002–2009.

Centers for Disease Control and Prevention (CDC).

Hepatitis C virus (HCV) infection is a major cause of liver disease and
hepatocellular carcinoma in the United States. Of the estimated 2.7–3.9
million persons with active HCV infection, most were born during
1945–1964 and likely were infected during the 1970s and 1980s, before the
advent of prevention measures. Nationwide, rates of acute, symptomatic HCV
infection declined during 1992–2005 and then began to level. Declines
also were observed in rates of newly reported HCV infection in
Massachusetts.

Although these declines were evident among reported cases overall in
Massachusetts during 2002–2006, an increase was observed among cases in
the 15–24 year age group. In response to this increase, the Massachusetts
Department of Public Health (MDPH) launched a surveillance initiative to
collect more detailed information on cases reported during 2007–2009
among this younger age group and to examine the data for trends through
2009.

This report describes results of both efforts, which revealed continued
increases in rates of newly reported HCV infection among persons aged
15–24 years. These cases were reported from all areas of the state,
occurred predominantly among non-Hispanic white persons, and were equally
distributed among males and females. Of cases with available risk data,
injection drug use (IDU) was the most common risk factor for HCV
transmission.

The increase in case reports appears to represent an epidemic of HCV
infection related to IDU among new populations of adolescents and young
adults in Massachusetts.

The findings indicate the need for enhanced surveillance of HCV infection
and intensified hepatitis C prevention efforts targeting adolescents and
young adults.

Free Article – Complete article with graphics at:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6017a2.htm
__________________________________________________________________________
_____________________________________*____________________________________

13. Abstract: Reducing harm from injecting pharmaceutical tablet or
capsule material by injecting drug users
__________________________________________________________________________

Drug Alcohol Rev. 2011 May;30(3):287-90.

Reducing harm from injecting pharmaceutical tablet or capsule material by
injecting drug users.

Roux P, Carrieri MP, Keijzer L, Dasgupta N.

INSERM, U912 (SE4S), Marseille, France Université Aix Marseille, IRD, UMR-
S912, Marseille, France ORS PACA, Observatoire Régional de la Santé
Provence Alpes Côte d’Azur, Marseille, France Study Lead at Apothicom,
Paris, France Department of Epidemiology, Gillings School of Global Public
Health, University of North Carolina, Chapel Hill, USA.

Background. It has long been known that drug users may use a variety of
pharmaceutical preparations by injection, many of which are not intended
for intravenous administration (e.g. buprenorphine, methylphenidate,
oxycodone). The introduction of tablet fillers such as talc or starch, in
the blood circulation may cause, besides local injection site
complications, pulmonary emboli. To reduce the harmful consequences of
injecting such solutions, drug users have been encouraged to use filters.

This research studied the effectiveness of an injection drug user syringe
filter (IDUSF) in eliminating these particles. Methods. Generic
buprenorphine and methylphenidate (Ritaline®), both containing talc, are
frequently diverted for use by injection in France.

The aim of our laboratory-based study was to compare the effectiveness of
an IDUSF (Sterifilt®, filter pore size = 10 µm) versus no filtration, at
reducing the number of particles in solutions of dissolved generic
buprenorphine and Ritaline®.

Results. Compared with a non-filtered solution drawn up through a 30G
needle, filtering of the generic buprenorphine solution eliminated
approximately 85% of all particles between 1 and 5 µm in diameter and 97%
of particles between 5 and 18 µm. In the Ritaline® solution, these values
were two-thirds and 95%, respectively.

Conclusion. Preliminary results indicate that IDUSF are effective in
significantly filtering out large particles, which are responsible for
major harms like pulmonary emboli. One strategy for alleviating these
consequences is to promote the implementation of IDUSF in harm reduction
programs, accompanied by training of social workers, peers and drug users.

© 2011 Australasian Professional Society on Alcohol and other Drugs.
__________________________________________________________________________
_____________________________________*____________________________________

14. Abstract: The Cost-effectiveness of Screening for Chronic Hepatitis B
Infection in the United States
__________________________________________________________________________

Clin Infect Dis. 2011 May 6.

The Cost-effectiveness of Screening for Chronic Hepatitis B Infection in
the United States.

Eckman MH, Kaiser TE, Sherman KE.

Division of General Internal Medicine and the Center for Clinical
Effectiveness.

Background. Hepatitis B virus (HBV) continues to cause significant
morbidity and mortality in the United States. Current guidelines suggest
screening populations with a prevalence of =2%.

Our objective was to determine whether this screening threshold is cost-
effective and whether screening lower-prevalence populations might also be
cost-effective.

Methods. We developed a Markov state transition model to examine screening
of asymptomatic outpatients in the United States. The base case was a 35-
year-old man living in a region with an HBV infection prevalence of 2%.

Interventions (versus no screening) included screening for Hepatitis B
surface antigen followed by treatment of appropriate patients with (1)
pegylated interferon-a2a for 48 weeks, (2) a low-cost nucleoside or
nucleotide agent with a high rate of developing viral resistance for 48
weeks, (3) prolonged treatment with low-cost, high-resistance nucleoside
or nucleotide, or (4) prolonged treatment with a high-cost nucleoside or
nucleotide with a low rate of developing viral resistance. Effectiveness
was measured in quality-adjusted life years (QALYs) and costs in 2008 US
dollars.

Results. Screening followed by treatment with a low-cost, high- resistance
nucleoside or nucleotide was cost-effective ($29,230 per QALY).
Sensitivity analyses revealed that screening costs <$50,000 per QALY in
extremely low-risk populations unless the prevalence of chronic HBV
infection is <.3%.

Conclusions. The 2% threshold for prevalence of chronic HBV infection in
current Centers for Disease Control and Prevention/US Public Health
Service screening guidelines is cost-effective. Furthermore, screening of
adults in the United States in lower-prevalence populations (eg, as low as
.3%) also is likely to be cost-effective, suggesting that current health
policy should be reconsidered.
__________________________________________________________________________
_____________________________________*____________________________________

15. Abstract: Preface: seventh world congress on vaccines, immunisation
and immunotherapy

Open Access – Free at:
http://www.landesbioscience.com/journals/vaccines/article/14904/
__________________________________________________________________________

Hum Vaccin. 2011 Jan 1;7:1.

Preface: seventh world congress on vaccines, immunisation and
immunotherapy.

Kurstak E.

Infections Control World Organization Faculty of Medicine, University of
Montreal, Montréal, Québec, Canada.

This special issue of Human Vaccines is based on the Seventh World
Congress on Vaccines, Immunisation and Immunotherapy (WCVII), which was
organized from 26 to 28 of May 2010 by the Infections Control World
Organization (ICWO) in Berlin, Germany.

The venue of the Congress at the elegant Kaiserin Friedrich Haus
(previously harboring the Academy of Arts of East Germany) was located in
the historic city center. The full three days of Congress with morning
plenary sessions, afternoon symposia, and poster presentations were
attended, from all continents, by medical specialists in immunisation,
immunotherapy and scientists devoted to developing new immunogenic and
safe vaccines.

The Congress was held under the auspices and with the scientific
cooperation of Medical Faculties of the University of Montreal, Charité-
Universitätsmedizin Berlin, University of Genoa, University of Barcelona,
University of Florence, University of Milan, Griffith University, Gold
Coast, Robert-Koch-Institute, Berlin, Max-Planck-Institute for Infection
Biology, Berlin, Karolinska Institutet, Stockholm, Fraunhofer USA Center
for Molecular Biotechnology, and Netherlands Vaccine Institute, among
others.

The opening lecture of the Congress on new vaccination strategies against
tuberculosis was delivered by Professor Dr Stefan H.E. Kaufmann, Director
of the Max-Planck- Institute.

Free Article
http://www.landesbioscience.com/journals/vaccines/article/14904/
__________________________________________________________________________
_____________________________________*____________________________________

16. Abstract: Methods of rapid microbiological assay and their application
to pharmaceutical and medical device fabrication
__________________________________________________________________________

Biocontrol Sci. 2011 Mar;16(1):13-21.

Methods of rapid microbiological assay and their application to
pharmaceutical and medical device fabrication.

Shintani H, Sakudo A, McDonnel GE.

Faculty of Science and Engineering, Chuo University, Kasuga, Bunkyo,
Tokyo, Japan. shintani@mail.hinocatv.ne.jp

There are several well-developed rapid microbiological methods now
becoming available that may have useful applications in pharmaceutical and
medical devices. They are ATP bioluminescence, fluorescent labeling,
electrical resistance, and nucleic acid probes. In choosing to employ
rapid methods, the microbiologist should examine their prospective
performances against the specific requirements for that sector. Some
methods may require expensive equipment and offer full automation, and
others represent only a small investment. The regulatory view of these
methods is changing and they still officially have not been approved in
medical and pharmaceutical area, but it will still be up to the
microbiologist to demonstrate that the method chosen is fit for the
purpose intended.
__________________________________________________________________________
_____________________________________*____________________________________

17. Abstract: Microbial air purity in hospitals. Operating theatres with
air conditioning system
__________________________________________________________________________

Rocz Panstw Zakl Hig. 2010;61(4):425-9.

[Microbial air purity in hospitals. Operating theatres with air
conditioning system].

[Article in Polish]

Krogulski A, Szczotko M.

Zaklad Higieny Komunalnej, Narodowy Instytut Zdrowia Publicznego-
Panistwowy Zaklad Higieny, Warszawa. akrogulski@pzh.gov.pl

The aim of this study was to show the influence of air conditioning
control for microbial contamination of air inside the operating theatres
equipped with correctly working air-conditioning system.

This work was based on the results of bacteria and fungi concentration in
hospital air obtained since 2001.

Assays of microbial air purity conducted on atmospheric air in parallel
with indoor air demonstrated that air filters applied in air-conditioning
systems worked correctly in every case.

To show the problem of fluctuation of bacteria concentration more
precisely, every sequences of single results from successive measure
series were examined independently.
__________________________________________________________________________
_____________________________________*____________________________________

18. No Abstract: Evidence on acupuncture safety needs to be based on
large-scale prospective surveys, not single case reports
__________________________________________________________________________

Pain. 2011 May 5.

Evidence on acupuncture safety needs to be based on large-scale
prospective surveys, not single case reports.

Witt CM, Lao L, Macpherson H.

Institute for Social Medicine, Epidemiology and Health Economics, Charité
University Medical Center, 10098 Berlin, Germany; University of Maryland
School of Medicine, Baltimore, MD, USA Tel.: +49 30 450529002; fax: +49 30
450529917.
__________________________________________________________________________
_____________________________________*____________________________________

19. New European Course on Medical Device Regulation

Crossposted from http://www.eucomed.org with thanks
__________________________________________________________________________

New European Course on Medical Device Regulation

In June 2011, the European Center of Pharmaceutical Medicine, (ECPM) and
PharmaCenter (University of Basel) will launch a new European Course on
Medical Device Regulation.

This is the first complete and comprehensive university-based post-
graduate (second cycle) education for medical devices regulation.

Medical technology regulatory affairs is incorporated into the structure
of each business organisation, be it medical device industry, contract
organisations, university institutions, hospitals, conformity assessment
bodies and regulatory authorities according to their specific needs.

This new postgraduate training programme tackles the vast field of
regulatory affairs of medical devices and their technologies. It comprises
the many aspects of legal, administrative, scientific and technological
requirements regarding the development, marketing and monitoring of
medical devices, also relating to the combination with other products like
food, food additives, nutraceuticals and, in particular, medicinal
products.

This course is targeted at professionals working in the medical technology
and pharmaceutical industry, contract/service organisations, public
health, academic and government decision- and policy makers, who have
basic understanding of medical or pharmaceutical technologies and their
related fields. The course can be considered an in-depth, comprehensive
and systematic immersion into medical device development, regulation,
market introduction and control.

More information: http://www.ecmdr.eu/
__________________________________________________________________________
_____________________________________*____________________________________

20. Webcast: On Recognizing and Correcting Unsafe Injection Practices

Crossposted from IAC Express with thanks.
__________________________________________________________________________

State University Of New York Webcast On Recognizing And Correcting Unsafe
Injection Practices Scheduled For May 19
IAC Express.org (09.05.11)

A webcast titled “Take Your Best Shot: Injection Safety” is scheduled for
May 19 from 9:00 a.m. to 10:00 a.m. ET. The event is sponsored by the
School of Public Health, State University of New York at Albany. For
details, go to: http://www.albany.edu/sph/cphce/phl_0511.shtml
__________________________________________________________________________
_____________________________________*____________________________________

21. The first-ever online Cold Chain event – connecting the international
cold chain pharmaceutical community Online: May 17 through June 9 2011

Crossposted from https://www.coldchainonlineevent.com/index.cfm#highlights
__________________________________________________________________________

The first-ever online Cold Chain event – connecting the international cold
chain pharmaceutical community

Cold Chain & Temperature Control Distribution Summit

Online: May 17th through June 9th 2011

* 20 Speakers 16 Webinars

Implementing Regulatory Compliant International Best Practices for Quality
Distribution of Pharmaceuticals

Dear Temperature Control Logistics and QA Professionals,

“Based on projected market growth rates, 7 of the top 10 global pharma
products in 2014 will require cold-chain handling.” Pharmaceutical
Commerce

As the quote above illustrates, cold chain is no longer just a buzzword,
it’s a way of life in most biopharma companies. But just like most things
in life, it’s not easy…

With today’s complex, global supply chains, the pressure to deliver
medicines safely to patients in distant destinations is hugely
challenging. Issues such as supply chain security, theft and diversion
consistently plague high value pharmaceuticals – a trend which in turn
drives the need for better risk analysis and mitigation in the cold chain,
critical to ensuring visibility and control.

Additional supply chain monitoring is also required to manage and analyze
temperature and stability data. Add to this differing regional and
country-specific regulations and the complexities of working with multiple
air, sea and road transportation partners and the role of the cold chain
logistics professional is never-ending.

So what can you do to pull all these critical components together to
ensure effective logistics to deliver temperature sensitive
pharmaceuticals?

Many biopharma companies today are setting up cross-functional and cross-
national cold chain project teams to share experiences from other offices
and are cutting costs by rolling out unified technology and processes.

They are also sending their cold chain project team members in new markets
to online training to get up to speed with industry best practices. This
is where we are delighted to come in…

Pharma IQ is proud to present Cold Chain & Temperature Control
Distribution Summit, the first ever online cold chain event for the
pharmaceutical community.

Over the past ten years, IQPC has launched more than ten cold chain events
covering regions from Latin America and the US to Europe and South Africa,
developing some 74,000+ cold chain contacts globally. With this experience
behind us and a reputed cold chain event brand, we are proud to announce
the launch of our first truly global offering – the Cold Chain Online
event.

Covering global regulatory, risk mitigation and logistical challenges, the
online event will provide a forum for the international cold chain
pharmaceutical community to network and learn from the comfort of their
desks. During the series of 16 webinars, participants can see who is
‘logged in’ to the event and initiate a private chat to exchange ideas and
contact details.

Don’t miss this opportunity to join the international cold chain community
in sharing the latest and best solutions to today’s cold chain
transportation, packaging and QA challenges.

We look forward to seeing you and your team online!

Kind regards
Courtney Becker-James
Pharma IQ
………………………………………………………………..
__________________________________________________________________________

WHO:
Temperature control logistics and QA professionals from all corners of the
world will connect online to listen to industry best practices and
international case studies.
No travel and accommodation costs inhibiting attendance. The Cold Chain
online event offers delegates from multiple continents a convenient, low
cost opportunity to learn across borders on international ‘hot topics’ and
network in one platform.
There are no sales pitches, giving participants only real information that
will help advance their cold chain practices.

WHAT:
The first-ever online cold chain eventwill act as a “litmus test” for cold
chain professionals to understand the leading solutions and strategies in
temperature controlled distribution from around the world, giving insight
into the “state of play” of cold chain in new markets such as Latin
America, the Middle East, Europe, US and Asia Pacific. Plus! Regulators
from around the world will provide the global cold chain professional with
necessary compliance information to help establish global quality and
regulatory processes.

WHERE:
In the comfort of your home or office! No traveling expenses or timing
conflicts. This online event takes place by using your computer or laptop.

WHEN:
Starting May 17th through June 9th (spread over one month to decrease the
time commitment per week). All sessions will be live, so you’ll only have
one chance to ask questions during Q&A. However, all sessions are recorded
so if you can’t make a particular session, don’t worry, you’ll have access
to all 16 sessions to view at your convenience.

WHY:
To connect the international cold chain life science community and
disseminate best practices. Over the past ten years, IQPC has launched
more than ten cold chain events covering regions from Latin America and
the US to Europe and South Africa, developing some 74,000+ pharma cold
chain contacts globally. With this experience behind us and reputed cold
chain event brand, we are proud to announce the launch of a truly global
offering – the Cold Chain Online event.

HOW:
Simply register by clicking
http://www.coldchainonlineevent.com/#registration
__________________________________________________________________________
_____________________________________*____________________________________

22. World Blood Donor Day: Paint the world red in 2011!

More about paint the world red http://www.who.int/worldblooddonorday/en/
__________________________________________________________________________

Paint the world red in 2011

On 14 June 2011, countries worldwide will celebrate World Blood Donor Day
with events to raise awareness of the need for safe blood and blood
products and to thank voluntary unpaid blood donors for their life-saving
gifts of blood.

The theme for World Blood Donor Day 2011 is, “More blood. More life.” This
theme reinforces the urgent need for more people all over the world to
become life-savers by volunteering to donate blood regularly.
………………………………………………………………..
__________________________________________________________________________

* World Blood Donor Day: new blood for the world

Young people play an important role in maintaining supplies of safe blood

News release

14 JUNE 2010 | GENEVA – People under the age of 25 contribute an estimated
38% of reported voluntary blood donations, according to new global data
from the WHO, released on World Blood Donor Day, 14 June.

World Blood Donor Day is celebrated each year to highlight the
contribution voluntary unpaid blood donors make to public health. This
year’s slogan, “New blood for the world,” aims to raise awareness of the
role young people play in maintaining supplies of safe blood.

“This is the first time we have data for blood donation by age,” said
Carissa Etienne, Assistant Director-General for Health Systems and
Services at WHO. “It’s important to see that in many countries a lot of
young people are already giving blood. Countries can use this to encourage
more young people to become donors.”

Figures from the 2008 Blood Safety Survey1 reveal that 14 countries
collect more than half of their total donations from under 25s: Botswana,
Burkina Faso, Gabon, Guinea, India, Jordan, Kiribati, Lao People’s
Democratic Republic, Malawi, Papua New Guinea, Republic of Korea, Tuvalu,
Viet Nam, and Zimbabwe .

Standard age limits for blood donation are 18 to 65 years of age, but in
some countries donations are accepted from people as young as 16 years,
provided their parents consent. Voluntary unpaid donations are preferred
over paid donations because supplies are generally safer, and there is
less risk of donor exploitation. Evidence suggests that voluntary
donations also promote other healthy lifestyle choices among young donors.

“Young people are the hope and future of a safe blood supply in the
world,” said Dr Neelam Dhingra, Coordinator of Blood Transfusion Safety at
WHO. “We are confident more countries can achieve 100 per cent voluntary
unpaid blood donation if they focus efforts on engaging young people.”

Today, 62 countries obtain all, or nearly all (more than 99%), of their
blood supplies from unpaid donors – up from 57 last year. Belarus, Islamic
Republic of Iran, Kenya, Malaysia and Zambia are the latest to join this
list.

“In 77 countries, however, donations are still well below the level
required to meet patients’ needs,” Dr Dhingra added.

WHO recommends that blood donation by at least 1% a country’s population
is generally sufficient to meet a country’s basic requirements for safe
blood. Requirements are higher in countries with more developed health
systems. Among the greatest needs: to replace blood lost in childbirth (a
major cause of maternal deaths worldwide), and to treat the anaemia that
threatens the lives of thousands of children who have malaria or are
undernourished.

In May 2010, WHO Member States agreed on a resolution on the availability,
safety and quality of blood products. The resolution paves the way to
increase access to safe blood transfusions and to safe and affordable
blood products in developing countries. It also echoes the Melbourne
Declaration, released on World Blood Donor Day 2009 in Melbourne,
Australia, which calls on countries to achieve 100% voluntary unpaid blood
donation by 2020.

Starting 14 June, a week-long programme of high-profile events celebrate
voluntary blood donation. This year, international World Blood Donor Day
events are taking place in Barcelona, Spain and at Expo 2010 in Shanghai,
China. A number of communities, including Barcelona, will gather
volunteers in a prominent public space to stand together all dressed in
red in the form of a “blood drop” as part of their celebration.

__________________________________________________________________________
_____________________________________*____________________________________

23. WHO Health Technologies e-Documentation Centre

http://hinfo.humaninfo.ro/gsdl/healthtechdocs
__________________________________________________________________________

WHO Health Technologies e-Documentation Centre

The Health Technologies e-documentation centre is published by the WHO
Essential Health Technologies (EHT) Department, Health Systems and
Services Cluster. This version contains 556 documents, publications and
other resources in various languages, selected from a wide range of
technical information materials.

We hope users will find the contents of this online library useful in
their work, and would appreciate feedback that would help us improve this
Health Technology e-documentation centre.

http://hinfo.humaninfo.ro/gsdl/healthtechdocs
__________________________________________________________________________
_____________________________________*____________________________________

24. News

– USA: Boulder County approves state’s first syringe exchange program:
22-year-old informal policy becomes official under new state law
– Canada: Most nurses don’t use recommended intramuscular injection site
despite potential risks
– Australia: Injection dissension
– Canada: Supreme Court of Canada to determine who has control over
Vancouver’s supervised injection site
– Canada:  Top Court to Weigh Future of Vancouver’s Controversial Safe-
Injection Site
– USA: Hepatitis Awareness Month — May 2011
– Africa: Injection Drug Use Helps Drive HIV/AIDS in Africa
– USA: Hepatitis C cases rising among Massachusetts youth
– India – Nagaland: State LFA visit Australia for ‘Harm Reduction
Studies’
– Ireland: Minister For Health Pledges Ireland’s Support For WHO SAVE
LIVES: Clean Your Hands
– Technology: The rad professor
– Australia: Australian Capital Territory Prison Workers Fight Needle
Exchange
– USA: Assisted living center cited after needle stick
– Safer healthcare depends on in-depth investigation, not quick fixes,
says expert
– USA: Unsafe Injection Practices Persist Despite Education Efforts”
– USA: Hospital Errors Occur 10 Times More Than Reported, Study Finds

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

USA: Boulder County approves state’s first syringe exchange program: 22-
year-old informal policy becomes official under new state law
By Vanessa Miller,  Boulder Daily Camera, Colorado USA (10.05.11)

As a patrol officer in 1987, Tim Lewis — now a commander with the
Longmont Police Department — was searching the car of a man arrested in a
fight and, while digging through the front seat, was stuck with a dirty
needle stashed between the seat cushions.

The suspect who had been using the needle revealed during medical
questioning that he had the potentially fatal Hepatitis C virus, and Lewis
had to undergo testing and treatment.

‘The Works’
For more information on Boulder County’s 22-year-old — and now state-
sanctioned — syringe exchange program, visit bit.ly/bouldercountysyringe.

At the time, Lewis was among the first officers in the country to be
treated for exposure to Hepatitis C.

“We didn’t know a lot about it, but we knew enough to know that it was bad
and scary,” he said Tuesday.

That wasn’t the last time Lewis would be inadvertently stuck with a dirty
needle during an investigation, but Lewis said he’s never had such a scare
while investigating drug users who participate in Boulder County’s syringe
exchange program.

“They have a horrible addiction, and their lives are a mess, but that
piece of their life they work very hard at,” Lewis said.

Boulder County’s syringe exchange program — an informal agreement between
local law enforcement and Boulder County Public Health not to arrest drug
users who come in and swap used syringes for safe and clean drug
paraphernalia — dates back 22 years.

On Monday, the Boulder County Board of Health made that agreement official
when it gave formal approval to the county’s long-standing syringe
exchange, making it the first approved program of its kind in Colorado.

Lewis said he believes the program has saved the lives of users and
officers alike, and he’s glad to see it sanctioned as legitimate.

“Seeing one of your officers or detectives get stuck with a needle at a
drug abuser’s home or car — there is nothing worse than that,” Lewis
said. “They all have families to take care of, and we try to keep them
safe in everything we do.”

Boulder County Public Health started its informal “The Works” program in
March 1989, eight years after the first cases of HIV were identified. It
was a way to exchange needles, offer treatment and reduce the potential
harm of communal drug use for local addicts.

At the time, Boulder was only the third city in the United States to offer
drug users access to clean and safe equipment.

“They were really visionaries and pioneers in preventing the spread of HIV
and infectious diseases,” said Carol Helwig, HIV and sexually transmitted
infections outreach coordinator for Boulder County Public Health.

The goal of the program always has been to reduce the spread of infectious
disease, keep needles off the streets and out of waterways, and to
increase treatment among injecting drug users. To access the program, a
user needs only to call the health department or stop in at one of the
three Boulder County locations and say, “I’d like to do an exchange,”
Helwig said.

An outreach coordinator will swap out dirty syringes, drug cookers,
tourniquets and sterile water for clients — most commonly people who use
heroin, methamphetamine and cocaine — and there is no risk that
authorities will arrest the users on suspicion of possessing drug
paraphernalia.

Colorado lawmakers last year created an exemption in Colorado’s drug
paraphernalia law allowing counties to adopt syringe exchange programs,
like Boulder County’s, through a local approval process. Boulder County
was first to go through that approval process.

“It has been a very long time coming,” Helwig said. “But we are incredibly
grateful for the opportunity to operate under full legal protection.”

Helwig said the program, which serves an average of 200 people a year
directly and up to 600 people indirectly, is about “social justice.”

“We have had local legitimacy, but being approved on a state level really
provides legitimacy that this programming is important,” she said, adding
that the program sends the message to users that “the services we provide
are legitimate and valuable because they are legitimate and valuable
members of society.”

Although participants in Boulder County’s syringe exchange program don’t
have to provide a name and don’t face paraphernalia charges, they are
asked to fill out anonymous surveys that include a “unique identifier,”
Helwig said.

They are encouraged to get tested for HIV and Hepatitis C and to get
vaccinated for Hepatitis B, and Helwig said statistics show that nearly
all users undergo the testing and many of them get vaccinated within a
year of starting with the program.

Joy Eckstine, executive director of Boulder’s Carriage House day shelter,
which works largely with the homeless community, said research shows that
needle exchange programs don’t increase drug use, and she believes the
county’s program has been tremendously helpful — noting occasions when
she’s overheard shelter clients talking about it with other drug users.

“They’re like, ‘Hey, it’s really important to have clean needles,'”
Eckstine said.
………………………………………………………………..
__________________________________________________________________________

Canada: Most nurses don’t use recommended intramuscular injection site
despite potential risks
ScienceBlog.com, Press Release (09.05.11)

Seven out of ten hospital nurses who took part in a Canadian study used
the dorsogluteal (DG) buttock site to administer intramuscular injections
– despite the potential risks of sciatic nerve injury – with only 14%
using the ventrogluteal (VG) hip site recommended by the nursing
literature.

The research, published in the May issue of the Journal of Advanced
Nursing, found that younger, newer nurses were significantly more likely
to follow the latest VG site advice than their older, experienced
colleagues. It also discovered that more than one in four nurses using the
DG site were unaware of the potential risk of nerve damage.

Just over 40% of the staff nurses surveyed responded to the postal
questionnaire. Most of the 264 respondents were aged between 30 and 49
years and had been working in nursing for more than ten years.

“Recent nursing literature suggests that the VG site is preferable because
it is located away from major nerves and muscles, can provide better
access to muscle tissue and offers faster medication uptake” says lead
author Lorna Walsh, a nurse educator at the Centre for Nursing Studies, St
John’s, Canada.

“It’s estimated that more than twelve billion intramuscular injections are
administered every year throughout the world and unsafe injection
practices have a significant impact on patient ill health and death.
Complications can include skin and tissue trauma, muscle fibrosis and
contracture, nerve palsies and paralysis, abscesses and gangrene.

“Although three-quarters of the nurses in our study said they were aware
of potential nerve damage when using the DG site, this site was used
significantly more often than other sites.”

Key findings of the study include:

71% of the nurses preferred using the DG site (buttock), 14% the VG site
(hip), 7% the deltoid site (upper arm) and 7% the vastus lateralis site
(thigh).

44% of the nurses gave intramuscular injections very frequently (four to
five a week), 21% frequently (one to four a week), 18% occasionally (less
than one to four a week) and 17% seldom or never (less than one a month).

Only 15% of nurses based their site selection on the recommendations in
the nursing literature. 85% used the site they felt most comfortable with,
80% said ease of locating the injection site influenced their choice, 60%
followed the recommendation of their nursing education programme and 56%
followed traditional usage.

Patient discomfort was the most frequent complication – 78% for the DG
site, 88% for the VG site, 90% for the vastus lateralis site and 100% for
the deltoid site.

The potential for nerve injury was the second most mentioned complication
– by 74% using the DG site, 30% using the VG site, 32% using the vastus
lateralis site and 53% using the deltoid site.

The relationship between site selection and awareness of potential nerve
injury was significant. 74% of nurses who routinely used the DG site
recognised the potential for nerve injury, but 26% did not. 70% of nurses
who used the VG site stated correctly that nerve damage was not a
recognised complication, but 30% thought it was.

Site selection varied significantly with age. 67% of nurses aged 20-24
used the VG site. The figures then declined rapidly by age group to 28%
(25 to 29 years), 10% (30 to 39), 5% (40 to 49) and 8% (50 plus).
The reverse was true for the DG site, ranging from 89% of nurses in the
oldest age group down to 33% of nurses in the youngest age group.
Site selection also varied by education, with 30% of baccalaureate
prepared nurses using the VG site, compared with 5% of diploma prepared
nurses.

The nurses who had been in nursing the longest were most likely to use the
DG site (81% for 20 plus years versus 41% for one to four years) and newer
nurses were most likely to use the VG site (44% for one to four years
versus 5% for 20 plus years).

“Our research clearly shows that the majority of nurses are not using the
VG site, as recommended in the recent nursing literature, and further
research is needed to find out why” says co-author and fellow nurse
educator Kathleen Brophy.

“Advocates of the VG site also need to base their rationale for using this
site on reasons other than potential sciatic nerve damage when using the
DG site, as the majority of nurses are aware of this, but still use the
site.

“We also feel that additional research is needed to explore the safety of
properly-mapped DG injections.”

Notes

Staff nurses’ sites of choice for administering intramuscular injections
to adult patients in the acute care setting. Walsh L and Brophy K. Journal
of Advanced Nursing. 67.5, pp1034-1040. (May 2011)
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Australia: Injection dissension
BY Donna Carton, Frankston Standard Leader, Victoria Australia (09.05.11)

DRUG addicts will have 24-hour access to clean needles, thanks to a cash
boost for the peninsula program from the State Government.

Sharps, the needle exchange program based in Frankston, gives out almost
40,000 needles a month to injecting drug users.

Organisers say that the system is a great success, helping to keep more
syringes off the streets and preventing the spread of HIV/AIDS and
Hepatitis C among users.

The government money (the amount is yet to be decided), announced in last
week’s Budget, will increase the nightly three-hour mobile syringe service
to a 24-hour service.

However, Frankston councillors have declared their opposition to the move.

Mayor Kris Bolam said councillors were “horrified” at the prospect and it
“will set us back another 10 years”.

“Frankston doesn’t need another social experiment at this time,” Cr Bolam
said. “My personal view is I consider abstinence the more morally
acceptable approach to curing drug addiction.”

Peninsula Health’s general manager of community health Rob Macindoe said
the needle exchange program, which began in 1990, was vital.

“It keeps people out of hospital, saving huge amounts of health service
money and it helps us engage with drug injectors so they can seek support
and other services,” Mr Macindoe said.

“Frankston has the highest rate of return of used equipment, about 95 per
cent, of any other needle exchange program, which is of great benefit to
the general community.”

Needle and syringe program co-ordinator Sean Swift said the amount of
money to be given to the program was yet to be announced.

“As soon as we know the details, we will talk to all stakeholders,
including council, as we always do,” Mr Swift said.

“Council fears may be arguable if we were talking about a fixed shopfront,
but this is a mobile service. The service goes out to them, it doesn’t
bring people into Frankston.”

Mental Health Minister Mary Wooldridge said the Government decided to fund
programs that operated in areas of high drug use and were under pressure
due to heavy demand.
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Canada: Supreme Court of Canada to determine who has control over
Vancouver’s supervised injection site
By Sarah Douziech, The Province, Canada (08.05.11)

Canada’s top court will hear arguments Thursday about whether a safe drug-
injection site in Vancouver’s Downtown Eastside should be legally allowed
to stay open under B.C.’s jurisdiction.

At issue before the Supreme Court of Canada May 12 is which
government-federal or provincial-has power over Insite and whether
shutting it down infringes on the human rights of drug users.

The site, co-managed by PHS Community Services Society and Vancouver
Coastal Health, allows drugs addicts clean, safe space and equipment to
inject their own street drugs under medical staff supervision and has
operated under federal drug law exemptions for several years.

Recently, the federal Conservative government ended those exemptions and
has been seen as keen to close the facility.

PHS director Mark Townsend said Sunday he thought the overwhelming
evidence showing the site has saved lives and taxpayer money should have
been enough to convince Conservatives to cool their ‘tough-on-crime’
agenda in Insite’s case.

“It’s easy to attack drug users,” Townsend said. “This shouldn’t be a
political thing, it’s a public health thing.”

As part of a lengthy legal battle between B.C. and the federal
Conservative government, provincial courts decided in 2010 that Insite
fell within provincial control under health care, preventing federal
officials from shutting it down.

According to court documents, Ottawa appealed that decision, arguing
provincial courts were “unjustified” in allowing provincial health
interests to overrule federal drug laws.

The province and its 13 supporters, including PHS, B.C. Civil Liberties
Association and the Canadian Medical Association, argue that criminal law
enforcement efforts are not undermined by Insite’s continued operation.

It also says Canada lacks any evidence to support its position, adding
Insite hasn’t had a negative impact on federal efforts to control
narcotics.

Insite was opened in 2003, in part, to deal with a ‘health crisis’ raging
in the Downtown Eastside where large numbers of injection drug users were
being infected with diseases like hepatitis and HIV/AIDS, transmitted by
dirty needles.

Recently The Lancet, a leading medical journal, reported overdose
fatalities in city blocks closest to the facility decreased by 35 per cent
following its 2003 opening, compared to a nine per cent decrease for the
rest of the city. An Angus-Reid poll in June 2010 found 68 per cent of
British Columbians support Insite and its services while 30 per cent
opposed it and two per cent were undecided.

-with Postmedia files

© Copyright (c) The Province
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Canada:  Top Court to Weigh Future of Vancouver’s Controversial Safe-
Injection Site
James Keller, Canadian Press (08.05.11)

Canada’s Supreme Court this week will preside over the case that will
decide the fate of the supervised-injection facility Insite in Vancouver.
The court will hear testimony as to whether Insite is a health care
provider operating under the jurisdiction of the provincial government,
and whether shuttering the site violates the rights of drug users in
Vancouver’s impoverished Downtown Eastside.

“Many people are watching this closely to see how well the social
interests of these individuals are going to be acknowledged and recognized
at the Supreme Court of Canada,” explained University of British Columbia
law professor Margot Young. “It’s easy to get caught up in the intricacies
of arcane constitutional arguments, but the case is really about real
people who are in need and who are among the most neglected groups in
Canadian society.”

Insite opened in 2003 in response to an epidemic of overdose deaths in
Downtown Eastside, operating with an exemption from federal drug laws.
Presciently worried that the new ruling Conservative government would
order the site closed, the Portland Hotel Society, which runs the facility
with funding from the province, asked a B.C. judge to allow it to remain
open under provincial jurisdiction. The B.C. Court of Appeal upheld a
ruling in favor of that request.

The federal government argues that British Columbia and Insite are asking
the court to create an “extraordinary” health care exemption in Canada’s
criminal law. In cases where two levels of government are claiming
jurisdiction, the federal government should be given priority, it says.

The B.C. government cites the “interjurisdictional immunity” principle, by
which the federal government cannot encroach on the province’s core role
of providing health care. Further, Insite is protected under the Charter
of Rights and Freedoms, it says. Closing the site would violate drug
users’ rights to life, liberty, and security since they would be at
greater risk of a fatal overdose, the province says.
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USA: Hepatitis Awareness Month — May 2011
Morbidity and Mortality Weekly Report (MMWR) 60(17);537  (06.05.11)

This month marks the 16th anniversary of Hepatitis Awareness Month in the
United States. Viral hepatitis, particularly infection with hepatitis B
virus (HBV) or hepatitis C virus (HCV), is a major cause of morbidity and
mortality. This issue of MMWR includes a report that focuses on a recent
trend in HCV infection.

The report shows an increase in cases of HCV infection during 2002–2009
among adolescents and young adults aged 15–24 years in Massachusetts and
highlights the fundamental role of surveillance in identifying emerging
patterns of transmission and developing appropriate public health
response. The Massachusetts cases were reported from all areas of the
state, primarily among non-Hispanic whites. Injection drug use (IDU) was
the most common risk factor for HCV transmission, and the increase in case
reports suggests an epidemic of HCV infection related to IDU in this age
group in Massachusetts.

In 2010, the Institute of Medicine (IOM) of the National Academies of
Sciences issued a report on viral hepatitis outlining recommendations for
the prevention and control of HBV and HCV infection, including improvement
in public health surveillance for viral hepatitis and viral hepatitis
screening linked with prevention and care (1). In response to the IOM
report, the U.S. Department of Health and Human Services is developing a
comprehensive viral hepatitis action plan that will set forth strategies
to improve viral hepatitis prevention, care, and treatment in the United
States. Additional information regarding viral hepatitis is available from
CDC at http://www.cdc.gov/hepatitis.

Reference
Institute of Medicine. Hepatitis and liver cancer: a national strategy for
prevention and control of hepatitis B and C. Washington, DC: National
Academies Press; 2010. Available at
http://www.nap.edu/openbook.php?record_id=12793&page=1. Accessed April 28,
2011.
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Africa: Injection Drug Use Helps Drive HIV/AIDS in Africa
TheBody.com (06.05.11)

From U.S. Centers for Disease Control and Prevention

In many countries experiencing a stabilizing of HIV incidence, the
proportion of injection drug use (IDU)-related infections is increasing,
say researchers with the Center for Strategic and International Studies
(CSIS) in Washington.

The problem is evident in sub-Saharan Africa, where heroin routes have
expanded. The uptick in African IDU-related infections is traceable to the
late 1990s, when “white” heroin became available in East Africa.

“I think the whole question of [IDU] and HIV prevention has been one
that’s really under-resourced and not really paid adequate attention to,
either from a policy or a programmatic point of view,” said Lisa Carty,
co-author of a CSIS report on the problem.

Advertisement
Epidemiological data of the type needed for planning and effective
treatment and prevention programs remain patchy, says the CSIS report.
Coastal areas such as Mombasa, 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,” Carty said.

Women are especially at risk, since “many women who inject drugs turn to
sex as a way of raising money to buy drugs,” said report co-author Dr.
Phil Nieberg, senior associate with Global Health Policy Center. “So
there’s an overlap between sex work and drug use.” Ironically, even male
IDUs disparage female drug injectors, he said.

Treating addiction as a disease rather than a crime could encourage more
addicts to seek help, Nieberg and Carty said. Counseling, needle-exchange
programs, and methadone maintenance treatment could be a part of that,
they said. Law enforcement efforts tend to push IDUs further away from
care and treatments, a situation that affects sex workers as well as men
who have sex with men.
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USA: Hepatitis C cases rising among Massachusetts youth
Reuters (06.05.11)

CHICAGO – (Reuters) – Hepatitis C infections are rising quickly among
white youth in Massachusetts, fueled by increases in the use of heroin and
other injection drugs, local and federal health researchers said Thursday.

Cases of the infection — a leading cause of liver damage and cancer —
have been dropping across the general population, but they started rising
in youth aged 15 to 24 between 2002 and 2006, a trend that continued
through 2009, a team from the Massachusetts Department of Public Health
reported.

“Of cases with available risk data, injection drug use was the most common
risk factor for HCV transmission,” the team wrote in the U.S. Centers for
Disease Control and Prevention’s weekly report on death and disease.

“The increase in case reports appears to represent an epidemic of HCV
infection related to IDU (injected drug use) among new populations of
adolescents and young adults in Massachusetts,” they wrote.

The CDC said in an editorial is had been documenting cases of Hepatitis C
infection for decades, but it called the recent epidemic among adolescents
and young adults and its apparent link to IV drug use “a disturbing
trend.”

“Law enforcement data suggest this trend might be occurring in other
states,” the CDC said, citing data showing increases in first-time heroin
use, which jumped to 180,000 in 2009 from 100,000 in 2002.

Law enforcement reports from officials in the Great Lakes, Mid-Atlantic,
New England, New York/New Jersey, Southeast, and West Central regions also
suggests that heroin use is increasing, particularly among younger users.

Hepatitis C, an infection caused by a virus that attacks the liver, is
considered one of the most serious of the hepatitis viruses. It is
commonly passed through contaminated blood — often through needles shared
during illegal drug use.

The latest cases were reported from across Massachusetts, mostly among
non-Hispanic whites, and were split evenly between males and females.

Of 1,196 cases in which doctors had a history of potential risk factors,
72 percent were in people who reported current or past injection drug use.

Among the 719 people who said they injected drugs in the preceding 12
months, 85 percent said they had used heroin, 29 percent had used cocaine,
1 percent had used methamphetamine and 4 percent had used other drugs.

They said the study suggested the need for better monitoring of Hepatitis
C infection and better prevention efforts targeting adolescents and young
adults, they said.

According to the CDC, 3.2 million Americans are infected. Most people who
are newly infected have no symptoms.

SOURCE: 1.usa.gov/jCKXwN Morbidity and Mortality Weekly Report, May 6,
2011.
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India – Nagaland: State LFA visit Australia for ‘Harm Reduction Studies’
MorungExpress, Nagaland India (05.05.11)

Dimapur, May 5 (MExN): A team of five members of Legislators Forum on AIDS
led by Kuzholuzo, Minister for Health and Family Welfare, accompanied by
Ralanthung, Deputy Speaker, Dr. Neikiesalie Kire MLA, Joshua Achumi MLA
and Dr. Vinito L. Chishi, State Coordinator, visited Sydney and Melbourne
from April 17 to 23, 2011 and returned on April 26.

A press note issued by LFA coordinator stated that the team was privileged
to visit and study different methods of Harm Reduction in relation with
Drugs users, prevention of HIV, program for stimulant users, Hepatitis-C,
Counseling services, Condom use and vending machines. Policy development
and research for public services was one important aspect the team learnt.
Another aspect, the note informed, was Medical Services including Needle
Syringe Program, sexual health, Drop-in Centre; outreach NSP and health at
night which was impressive. The team also visited Private Services such as
Pharmacotheraphy for opiate users-prescribing and dosing with successful
coordinated response from the clients, public and government sector. The
team also visited National Drug and Alcohol Research Centre which was very
educative and applicable to Nagaland. Finally, the team attended a
powerpoint presentation and lecture by Professor Alex Wodak at St. Vincent
Hospital on Portugal’s decriminalization policy which is relevant to
Nagaland.

“We are thankful to Professor Alex Wodak, and his Assistant Ms. Leah
McLeod who were the key persons to facilitate us during the trip. Other
staffs are Dr. Craig, Dr. Anthony and Mr. Allan Wilson who spent much time
for the Team,” stated LFA in the note.
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Ireland: Minister For Health Pledges Ireland’s Support For WHO SAVE LIVES:
Clean Your Hands
Medical News Today (05.05.11)

Dr. James Reilly, Minister for Health today (Thursday 5th May 2011)
reaffirmed his support for the WHO Hand Hygiene Day.

Hand hygiene in healthcare is everyone’s concern and everyone has a
responsibility to take appropriate action. The global annual campaign SAVE
LIVES: Clean Your Hands initiative aims to galvanise hand hygiene at the
point of patient care. As part of the day’s actions, healthcare facilities
world wide will demonstrate their continued commitment by signing up to
the global movement and undertaking and sharing locally driven activities
on hand hygiene improvements at the point of care.

The Minister pledged Ireland’s support to implement actions to reduce
hospital acquired infection and to share results and learning
internationally. The Minister commented: “Poor hygiene standards puts
lives in danger. We all need to play our part to dramatically improve
hygiene standards in hospitals. Improvement requires buy in from everybody
– hospital staff in all areas and visitors. Our goal is clean hands, clean
practices, clean products, clean environment and clean equipment. This is
an attainable goal and will be a priority for the health services.”

The aim of this year’s WHO Hand Hygiene Day is to build on the successful
WHO Clean Care is Safer Care campaign and to continue to inform the
general public about when and how to clean their hands. The focus on 2011
is for healthcare facilities to “check your status”i.e., Do you know where
your facility stands on hand hygiene improvement and sustainability? The
latest WHO Saves Lives; Clean Your Hands healthcare and facility
registration total now stands at 12,902. 43 acute and non-acute Irish
healthcare facilities have signed up to the initiative.

The Minister noted that while there has been a welcome decrease of 40% in
the number of MRSA cases reported between 2006 and 2009 we cannot become
complacent. The recent CRE outbreak in the Midwest demonstrates the need
for ongoing vigilance and attention to the threat posed by Antimicrobial
Resistance and Health Care Associated Infections.

Health care-associated infection is a major issue in patient safety as it
affects millions of people worldwide and complicates the delivery of
patient care. Infections contribute to patient deaths and disability,
promote resistance to antibiotics and generate additional expenditure to
those already incurred by the patients’ underlying disease.

To fight the spread of health care-associated infections which take a high
toll in human lives and affect hundreds of millions of patients worldwide
each year, WHO and its partners launched the Global Patient Safety
Challenge with the theme “Clean Care is Safer Care” on Thursday 13th
October 2005. As part of the launch the WHO Guidelines on Hand Hygiene in
Health Care (Advanced Draft) were made available.

The aim of the launch was to strengthen the commitment of interested
Member States to the Global Patient Safety Challenge and the critical role
of hand hygiene in controlling the spread of health care-associated
infection and multiresistant pathogens.

The implementation of the Global Patient Safety Challenge comprises three
major strategies:

– global and national “Clean Care is Safer Care” campaigns,
– country statements pledging to address health care-associated infection,
– testing implementation in districts.

Source: Department of Health and Children, Ireland
Article URL: http://www.medicalnewstoday.com/articles/224376.php
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Technology: The rad professor
Catherine Caines, The Australian (05.05.11)

PROFESSOR Mark Kendall is medicine’s unlikely rebel. Faced with the
staggering statistic that 30 per cent of the needle vaccinations
administered in Africa each year are unsafe due to cross-contamination
caused by needle-stick injury, he has pioneered a rule-breaking
alternative.

Based at the Institute for Biotechnology & Nanotechnology at the
University of Queensland, Kendall is leading a team that aims to replace
needle injections with a  postage-stamp sized patch that allows a small
dose of vaccine to be administered more effectively than via traditional
needles. “Right now,” says Kendall, “we are leading the world in using
vaccines to deliver into the skin and we have demonstrated that, by using
the Nanopatch, we can achieve the same performance as a syringe but with
1/150th of a dose.”

He says the Nanopatch has many other important attributes that set it
apart from the needle, especially when trying to treat patients in Third
World conditions. One of these is that “because we dry-coat the vaccine to
the projections we don’t need to refrigerate the vaccine material and
that’s important for transportation”.

Becoming a leader in medical innovation has taken Kendall on a 12-year
journey from the University of Oxford, where he was associate director of
the PowderJect Centre for Gene and Drug Delivery Research, a university
research lecturer and lecturer at Magdalen College, to joining the
University of Queensland in a professorial position and winning the
Australian Medical Researcher Award in 2008.

Testament to Kendall’s experience is his industry understanding of how to
turn his innovations into commercial propositions and not have them
languish as successful lab research projects. He believes the Nanopatch
will become available in the next 10 years and will be the safest form of
vaccination technology ever.

“The Nanopatch is designed to place vaccines directly into the skin, where
our rich body of immune cells are.” Needles, by contrast, inject into
muscles, which have few immune cells. “The Nanopatch puts it to our immune
sweet spot. And by doing that we make vaccines work a lot better.”
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Australia: Australian Capital Territory Prison Workers Fight Needle
Exchange
Australian Associated Press (04.05.11)

A prison officers’ union recently voted against a proposed trial of a
needle-exchange program in a Canberra jail. The Australian Capital
Territory government is considering a pilot NEP at the Alexander
Maconochie Center in response to inmate drug use.

At a May 4 meeting in Canberra, prison officer members of the Community
and Public Sector Union (CPSU) unanimously agreed to oppose the trial. An
NEP would make life more difficult in an already very dangerous job,
members said.

“Effectively, prisoners will be given weapons that they can use against
staff,” Vince McDevitt, regional CPSU director, said in a statement.

Staff members at the center said it would only be a matter of time before
inmate access to needles would lead to an attack or death. In New South
Wales, a prison worker attacked with a needle later died of AIDS, they
noted.

The government is still awaiting findings of a review being conducted by
former territorial Health Minister Michael Moore. That review will address
how an NEP pilot might be implemented. An earlier government-commissioned
report on the center recommended an NEP trial.

Unions are calling for improved case management and more therapeutic
programs for drug-dependent inmates. Jails also need to do a better job of
confiscating drug paraphernalia, they note.
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USA: Assisted living center cited after needle stick
CNBC.com USA (04.05.11)

LAKE ZURICH, Ill. – An assisted living center has been cited with 17
safety and health violations after a nurse practitioner allegedly was hurt
in a needle stick incident.

Paradise Park Assisted Living center in Lake Zurich was cited by the U.S.
Occupational Safety and Health Administration. Getting pricked with a used
needle can expose workers to hepatitis and HIV, but it isn’t clear whether
the nurse got sick.

OSHA announced the citations Tuesday but didn’t identify the nurse. The
agency has levied $72,000 in penalties.

Paradise Park released a statement saying it would contest the alleged
violations and that it no longer operates the Lake Zurich facility.

OSHA says the facility failed to immediately do a blood test and that
nurses didn’t have easy access to containers for disposing used needles.

Copyright 2011 The Associated Press.
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Safer healthcare depends on in-depth investigation, not quick fixes, says
expert
Jane Feinmann, BMJ 2011; 342:d2685 (28.04.11)

Safe healthcare measures should be proactive, building on extensive
investigation of the causes of high risk behaviour in medicine, rather
than quick fix reactions to harmful incidents, a conference has heard.

Matthew Cooke, professor of emergency medicine at Warwick Medical School
and leader of the Health Foundation’s safer clinical systems programme,
warned, “We don’t treat patients before we know what’s wrong with them,
and in the same way we shouldn’t assume there are transferable quick fixes
for human factor issues in healthcare.” He was speaking at a seminar in
London last week organised by the Clinical Human Factors Group, an
increasingly influential independent coalition of healthcare professionals
and managers and users of services.

Professor Cooke was explaining the need for a second, two year phase of
the safer …

[Full text of this article] http://www.bmj.com/content/342/bmj.d2685.full
Subscription or fee payable
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USA: Unsafe Injection Practices Persist Despite Education Efforts”
Laura Landro, Wall Street Journal, New York USA  (26.04.11)

An online survey of US health care providers finds some reporting syringe
and needle reuse, putting patients at risk for blood-borne diseases such
as HIV and hepatitis B and C. The May-June 2010 poll of 5,446 eligible
respondents, conducted by the health care purchasing alliance Premier
Inc., included personnel from hospitals (66 percent) and non-hospital
settings (34 percent).

Unsafe practices identified included 6 percent reporting “sometimes or
always” using single-dose/single-use medication vials for more than one
patient; 0.9 percent “sometimes or always” reusing a syringe while
changing only the needle for use on another patient; and 15.1 percent
reusing a syringe to enter a multidose vial and then 6.5 percent saving
that vial for use on another patient (1.1 percent overall). Cost-savings
was most commonly cited as a motive.

Syringe and needle reuse is a problem involving a “small but disturbing
percentage of clinicians in various health care settings,” said Gina
Pugliese, vice president of the Premier Safety Institute.

Pugliese cited “lack of awareness and mistaken beliefs” behind some of the
risky practices. Some providers may wrongly assume contamination only
affects the needle but not the syringe, she said, or that syringe reuse
with IV tubes is unproblematic. Misapprehensions also include the reuse of
a single-dose vial, if it contains leftover medication, on more than one
patient, she noted.

A CDC study of 68 US ambulatory surgical centers in three states found
infection-control lapses were common. It cited in particular the use of
single-dose medication vials for more than one patient; nonadherence to
equipment-reprocessing recommendations; and mishandling of blood glucose
monitoring equipment.

On April 26, Premier and the Safe Practices Coalition sponsored a daylong
industry meeting in Washington to raise awareness about preventing unsafe
injection practices. CDC injection-safety guidelines can be found by
visiting: http://www.cdc.gov/injectionsafety/unsafePractices.html
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USA: Hospital Errors Occur 10 Times More Than Reported, Study Finds
By Jeffrey Young, Bloomberg, USA (07.04.00)

Hospitals and U.S. regulators fail to record at least 90 percent of
patient injuries, infections other safety issues, a study found.
Photographer: John Guillemin/Bloomberg

Hospitals and U.S. regulators fail to record at least 90 percent of
patient injuries, infections and other safety issues, a study found.

A review uncovered 354 so-called adverse events, such as pressure sores,
bloodstream infections and medication errors, at three U.S. teaching
hospitals. A system designed by the federal Agency for Healthcare Research
and Quality identified 35 cases at the same facilities while the
hospitals’ voluntary reporting programs found four, according to the
study, published in the journal Health Affairs.

An incomplete picture of how often patients are harmed undermines public
and private efforts to improve the quality of medical services in the
U.S., David Classen, a professor at the University of Utah School of
Medicine in Salt Lake City, and his co-authors conclude.

“Hospitals that use such methods alone to measure their overall
performance on patient safety may be seriously misjudging actual
performance,” the researchers wrote. “Reliance on such methods could
produce misleading conclusions about safety in the U.S. health-care system
and could misdirect patient-safety improvement efforts.”

Voluntary reporting by hospital operators and the U.S.- sanctioned method
for tracking adverse events failed to provide accurate insights into the
safety of U.S. hospitals, the study found. The report doesn’t disclose the
names of the hospitals because of confidentiality agreements.

Adverse Events

Adverse events occurred during one-third of admissions at the hospitals,
according to the researchers. Classen and his colleagues studied 795
patient records using the Cambridge, Massachusetts-based Institute for
Healthcare Improvement’s Global Trigger Tool. The institute’s method
involves reviews of patient charts by nurses, pharmacists and physicians.
The researchers didn’t try to establish whether the harm could have been
prevented.

The U.S. Agency for Healthcare Research and Quality’s Patient Safety
Indicators uses administrative data collected by hospitals to detect
medical errors. The Centers for Medicare and Medicaid Services uses these
standards to evaluate safety at hospitals, the researchers wrote. Donald
Berwick, the agency’s administrator, founded the Institute for Healthcare
Improvement.

Efforts to track patient safety intensified after a 1999 report by the
U.S. Institute of Medicine found that medical errors caused as many as
98,000 deaths and more than 1 million injuries each year.

Injured by Care

A six-year study of hospital admissions in North Carolina published in
November in the New England Journal of Medicine found almost one in five
patients were injured by their care.

Medical errors that caused harm to patients cost the U.S. $17.1 billion in
2008, according a review by the Seattle consulting firm Milliman Inc. of
medical claims from 2001 through 2008 that also was published in the
current issue of Health Affairs. Jill Van Den Bos, a Milliman health-care
consultant, is the lead author.

The study identified about 564,000 injuries to patients admitted to U.S.
hospitals and 1.8 million injuries to people using outpatient services.
The most common and most expensive injuries were pressure sores and
infections following surgery, Van Den Bos and her colleagues conclude.
__________________________________________________________________________
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* SAFETY OF INJECTIONS brief yourself at: www.injectionsafety.org

A fact sheet on injection safety is available at:
http://www.who.int/mediacentre/factsheets/fs231/en/index.html

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

* NEW: Download the  WHO Best Practices for Injections and Related
Procedures Toolkit  March 2010 [pdf 2.47Mb]:
http://whqlibdoc.who.int/publications/2010/9789241599252_eng.pdf

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The 2010 annual Safe Injection Global Network meeting was held from 9
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The SIGN 2010 meeting report pdf, 1.36Mb is available on line at:
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