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SIGNpost 00604

*SAFE INJECTION GLOBAL NETWORK*  SIGNPOST  *SAFE INJECTION GLOBAL NETWORK*
Post00604  Archives + Mercury + Measles + Abstracts + News  22 June 2011
CONTENTS
0. Moderators note: SIGNpost Archives
1. Health Care Without Harm: Two New Guides for Mercury Phase-Out
2. New: The State of World’s Midwifery 2011: Delivering Health, Saving
Lives
3. Journal of Infectious Diseases Supplement: Global Progress Toward
Measles Eradication and Prevention of Rubella and Congenital Rubella
Syndrome
4. Abstract: Measles supplementary immunization activities and GAVI funds
as catalysts for improving injection safety in Africa
5. Abstract: Blood-borne viruses in health care workers: Prevention and
management
6. Abstract: Lack of risk-awareness and reporting behavior towards HIV
infection through needlestick injury among European medical students
7. Abstract: Needlestick and Sharps Injuries among Health Care Workers at
Public Tertiary Hospitals in an Urban Community in Mongolia
8. Abstract: Knowledge and beliefs among health care workers regarding
hepatitis B infection and needle stick injuries at a tertiary care
hospital, Karachi
9. Abstract: An investigation of the disposal of dental clinical waste in
Ibadan City, south-west Nigeria
10. Abstract: Health financing in Africa: overview of a dialogue among
high level policy makers
11. Abstract: A systematic review of hepatitis C virus epidemiology in
Asia, Australia and Egypt
12. Abstract: A systematic review of hepatitis C virus epidemiology in
Europe, Canada and Israel
13. Abstract: Drug use and HIV in West Africa: a neglected epidemic
14. Abstract: Bioethical differences between drug addiction treatment
professionals inside and outside the Russian Federation
15. Abstract: The Cedar Project: risk factors for transition to injection
drug use among young, urban Aboriginal people
16. Abstract: Approaches to minimize infection risk in blood banking and
transfusion practice
17. Abstract: Overview of revised measures to prevent malaria transmission
by blood transfusion in France
18. Abstract: Intraneural injections and regional anesthesia: the known
and the unknown
19. Abstract: Epinephrine auto-injector use and demographics in a Veterans
Administration population
20. Abstract: Chlorhexidine antisepsis significantly reduces the incidence
of sepsis and septicemia during parenteral nutrition in surgical
infants.
22. Abstract: Lack of effect on blood alcohol level of swabbing
venepuncture sites with 70% isopropyl alcohol
23. No Abstract: When is postexposure prophylaxis recommended for
needlestick?
24. No Abstract: In focus: Addressing sharps safety.
25.  News
– India: Woman gets HIV: 2 nursing homes get showcause notice
– Canada: HIV epidemic may be coming for indigenous Canadians
– USA: Sharps Safety in Ambulatory Settings: What Would You Do?
– In Iran, a Brotherhood of Doctors and Patients
– Prisons: Removing needles from correctional settings
– Zambia: Healthcare Workers Learn Improved Blood Collection Skills –
– Partners collaborate to improve safety for medical staff and patients.
– Pakistan: Former Health DG jailed over graft
– India: Fungus found in IV fluid bottle at hosp
– Iran: Jailed Iran brothers win global health prize
– Africa: New meningitis shot could halt African epidemics
The printer friendly edition of SIGNpost is online at:
http://signpostonline.info/archives/603
More information follows at the end of this SIGNpost!
Please send your requests, notes on progress and activities, articles,
news, and other items for posting to: sign@lists.uq.edu.au
Normally, items received by Tuesday will be posted in the Wednesday
edition.
Subscribe or un-subscribe by email to: sign@lists.uq.edu.au, sign@who.int
More information follows at the end of this SIGNpost!
Visit the WHO injection safety website and the SIGN Alliance Secretariat
at: http://www.who.int/injection_safety/en/
__________________________________________________________________________
_____________________________________*____________________________________
0. Moderators note: SIGNpost Archives
SIGNpost readers may have noticed that SIGNpost Archives are now hosted on
the new SIGNpostOnline website.
SIGNpost pdf archives are located at:
http://signpostonline.info/archives-by-year
SIGNpost pdf archive files are navigable using bookmarks and are
searchable using the free Adobe Acrobat Reader at:
http://get.adobe.com/reader/
2011 posts are available on the http://signpostonline.info home page and
via the archive links.
Please appreciate that the complete site is under construction and not all
of the pages are complete or fully functional. Please stay tuned and check
for developments.
Your suggestions would be appreciated.
best regards,
allan
__________________________________________________________________________
_____________________________________*____________________________________
1. Health Care Without Harm: Two New Guides for Mercury Phase-Out
__________________________________________________________________________
Two New Guides for Mercury Phase-Out
HCWH has put together a booklet (available in Spanish, English, Portuguese
and Chinese) that provides hospitals with a step by step guide to
substituting mercury-based medical devices.
Complementary to this, the WHO has issued a Technical Guidance Document
(currently only in English), that identifies available resources that support the
equivalent accuracy and comparable clinical utility of the substituted products,
while protecting health-care workers and the environment.
HCWH Mercury Guides
http://www.noharm.org/global/issues/toxins/mercury/resources.php#hgguides
WHO Technical Guidance http://tinyurl.com/WHO-MercuryTechGuide
http://www.who.int/water_sanitation_health/publications/2011/mercury_therm
ometers/en/index.html
__________________________________________________________________________
_____________________________________*____________________________________
2. New: The State of World’s Midwifery 2011: Delivering Health, Saving Lives
Crossposted from the WHO/PAHO Equity List
http://listserv.paho.org/Archives/equidad.html
Twitter http://twitter.com/eqpaho
__________________________________________________________________________
The State of World’s Midwifery 2011: Delivering Health, Saving Lives
United Nations Population Fund (UNFPA), June 2011
Main page available online at: http://bit.ly/lmykw7
English:  http://bit.ly/jD5lAL
French:   http://bit.ly/lIIX8Q
Spanish: http://bit.ly/iY5r5e
The report confirms the critical role midwives play in improving maternal
and newborn health and survival. It highlights the shortage of skilled
midwives in many low-income countries, stressing the need to train and
deploy more midwives in all parts of a country – especially remote and
rural areas.
The report, commissioned and coordinated by the United Nations Population
Fund (UNFPA), was launched at the Triennial Congress of the International
Confederation of Midwives in Durban, South Africa today.
Increasing women’s access to quality midwifery has become a focus of
global efforts to realize the right of every woman to the best possible
health care during pregnancy and childbirth. A first step is assessing the
situation.
The report supported by 30 partners, provides the first comprehensive
analysis of midwifery services and issues in countries where the needs are
greatest.
The report provides new information and data gathered from 58 countries in
all regions of the world. Its analysis confirms that the world lacks some
350,000 skilled midwives — 112,000 in the neediest 38 countries surveyed
— to fully meet the needs of women around the world. The report explores
a range of issues related to building up this key health workforce.
Content:
Foreword
Executive Summary
Introduction
Part 1: Midwifery around the world
Part 2: The state of midwifery today
Part 3: Moving Forward
Part 4: Country profiles
References and Notes
Annex 1: Abbreviations, acronyms and glossary
Annex 2: Data dictionary
Annex 3: Workforce estimates
Annex 4: Lives saved analysis
English: http://www.unfpa.org/sowmy/resources/en/main.htm
French: http://www.unfpa.org/sowmy/resources/fr/main.htm
Spamish : http://www.unfpa.org/sowmy/resources/es/main.htm
__________________________________________________________________________
_____________________________________*____________________________________
3. Journal of Infectious Diseases Supplement: Global Progress Toward
Measles Eradication and Prevention of Rubella and Congenital Rubella
Syndrome
__________________________________________________________________________
In a supplement published online in the Journal of Infectious Diseases,
global health researchers, including those from the U.S., make the case
that the highly contagious disease can and should be eliminated from the
world.
Global Progress Toward Measles Eradication and Prevention of Rubella and
Congenital Rubella Syndrome
Volume 204 suppl 1 July 1, 2011
http://jid.oxfordjournals.org/content/204/suppl_1.toc
__________________________________________________________________________
_____________________________________*____________________________________
4. Abstract: Measles supplementary immunization activities and GAVI funds
as catalysts for improving injection safety in Africa
__________________________________________________________________________
J Infect Dis. 2011 Jul;204 Suppl 1:S190-7.
Measles supplementary immunization activities and GAVI funds as catalysts
for improving injection safety in Africa.
Hoekstra EJ, van den Ent MM, Dao H, Khalaf H, Salovaara A.
United Nations Children’s Fund (UNICEF) Program Division, Health Section,
New York, New York 10017, USA. ehoekstra@unicef.org
BACKGROUND: In 2000, reuse of disposable syringes and inadequately
sterilized syringes resulted in 39% of all injections being unsafe,
causing 22 million infections. We describe the contribution of measles
supplemental immunization activities (SIAs) and Global Alliance for
Vaccines and Immunisation (GAVI) funding in replacing disposable and
sterilizable syringes with auto-disable (AD) syringes to improve injection
safety in 39 African countries.
METHODS: We assessed trends in nationwide introduction of AD syringes
against measles catch-up SIAs and GAVI funding using World Health
Organization/United Nations Children’s Fund (UNICEF) Joint Reporting Form
for Immunization and UNICEF supply data.
RESULTS: In 19 (49%) of 39 countries, the measles program catalyzed the
introduction of injection safety equipment, including AD syringes and
safety boxes, training, and procurement of safety equipment during SIAs.
GAVI was catalytic through financial support in 14 countries (36%) for
including safe injection equipment in routine immunization. Additionally,
GAVI funded 21 countries that had already introduced AD syringes in their
national program. UNICEF AD syringe shipments to sub-Saharan Africa
increased from 11 million to 461 million from 1997 to 2008. All 39
countries stopped using sterilizable syringes by 2004.
CONCLUSIONS: The measles mortality reduction program and GAVI complemented
each other in improving injection safety. All countries continued with AD
syringes for immunization after measles catch-up SIAs and GAVI funding
ended.
© The Author 2011. Published by Oxford University Press on behalf of the
Infectious Diseases Society of America. All rights reserved.
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5. Abstract: Blood-borne viruses in health care workers: Prevention and
management
__________________________________________________________________________
J Clin Virol. 2011 Jun 14.
Blood-borne viruses in health care workers: Prevention and management.
Deuffic-Burban S, Delarocque-Astagneau E, Abiteboul D, Bouvet E,
Yazdanpanah Y.
ATIP-AVENIR, Inserm U995, Université Lille Nord de France, 152 rue du
Docteur Yersin, 59120 Loos, France; EA2694, Université Lille Nord de
France, 1 place de Verdun, 59045 Lille Cedex, France.
Three pathogens account for most cases of occupationally acquired blood-
borne infection: hepatitis B virus (HBV), hepatitis C virus (HCV) and
human immunodeficiency virus (HIV). The highest proportion of occupational
transmission is due to percutaneous injury (PI) via hollow-bore needles
with vascular access.
We briefly review prevention and management of blood-borne pathogens in
health care workers (HCWs) in developed countries. HCW compliance with
standard precautions is necessary for prevention of PI. Safety-engineered
devices are now being increasingly promoted as an approach to decreasing
the rate of PI. Prevention of HBV transmission requires HCW immunization
through vaccination against HBV. In non-vaccinated HCWs (or HCWs with an
unknown antibody response to vaccination) exposed to an HbsAg-positive or
an untested source patient, post-exposure prophylaxis with HBV vaccine,
hepatitis B immunoglobulin or both must be started as soon as possible.
Although no available prophylaxis exists for HCV, it is crucial to
identify HCV exposure and infection in health care settings and to
consequently propose early treatment when transmission occurs. Following
occupational exposure with potential for HIV transmission, use of
antiretroviral post-exposure prophylaxis must be evaluated.
Patients need to be protected from blood- borne pathogen-infected HCWs,
and especially surgeons performing exposure- prone procedures (EPPs) with
risk of transmission to the patient. However, HCWs not performing EPPs
should be protected from arbitrary administrative decisions that would
restrict their practice rights.
Finally, it must be emphasized that occupational blood exposure is of
great concern in developing countries, with higher risk of exposure to
blood-borne viruses because of a higher prevalence of the latter than in
developed countries, re-use of needles and syringes and greater risk of
sustaining PI, since injection routes are more frequently used for drug
administration than in developed countries.
Copyright © 2011 Elsevier B.V. All rights reserved.
__________________________________________________________________________
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6. Abstract: Lack of risk-awareness and reporting behavior towards HIV
infection through needlestick injury among European medical students
__________________________________________________________________________
Int J Hyg Environ Health. 2011 Jun 10.
Lack of risk-awareness and reporting behavior towards HIV infection
through needlestick injury among European medical students.
Salzer HJ, Hoenigl M, Kessler HH, Stigler FL, Raggam RB, Rippel KE,
Langmann H, Sprenger M, Krause R.
Section of Infectious Diseases, Division of Pulmonology, Department of
Internal Medicine, Medical University of Graz, Austria.
Medical students are at risk for occupational needlestick injuries (NSIs)
which can result in substantial health consequences and psychological
stress. Therefore, an open online survey among final year medical students
from Austria, Germany, and the United Kingdom (UK) was conducted.
The aim of the study was to evaluate risk-awareness and reporting behavior
regarding needlestick injury (NSI), post-exposure prophylaxis, and level
of education regarding the transmission of HIV through NSIs.
Of 674 medical students, 226 (34%) reported at least one NSI during
medical school. Respondents from Austria and Germany experienced a
significantly higher number of NSIs in comparison to respondents from the
UK. Seventy- six respondents (34%) did not report their most recent injury
to an employee health office. Almost one third were not familiar with
reporting procedures in case of a NSI and 45% of the study population
feared that reporting an injury might have an adverse effect on their
study success. 176 respondents (78%) who had suffered a NSI were not aware
of the patient’s HIV status. Education regarding NSIs and HIV transmission
reduced the actual risk of experiencing a NSI significantly.
* These data indicate that medical students are at high risk of suffering
NSIs during medical school. The rate of nonreporting of such injuries to
an employee health service is alarmingly high.
Improved medical curricula including precise recommendations may
contribute to a more efficient prevention of occupational HIV infection in
medical students.
Copyright © 2011 Elsevier GmbH. All rights reserved.
__________________________________________________________________________
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7. Abstract: Needlestick and Sharps Injuries among Health Care Workers at
Public Tertiary Hospitals in an Urban Community in Mongolia
__________________________________________________________________________
BMC Res Notes. 2011 Jun 14;4(1):184.
Needlestick and Sharps Injuries among Health Care Workers at Public
Tertiary Hospitals in an Urban Community in Mongolia.
Kakizaki M, Ikeda N, Ali M, Enkhtuya B, Tsolmon M, Shibuya K, Kuroiwa C.
BACKGROUND: Needlestick and sharps injuries (NSSIs) are one of the major
risk factors for blood-borne infections at healthcare facilities. This
study examines the current situation of NSSIs among health care workers at
public tertiary hospitals in an urban community in Mongolia and explores
strategies for the prevention of these injuries.
FINDINGS: A survey of 621 health care workers was undertaken in two public
tertiary hospitals in Ulaanbaatar, Mongolia, in July 2006. A semi-
structured and self-administered questionnaire was distributed to study
injection practices and the occurrence of NSSIs. A multiple logistic
regression analysis was performed to investigate factors associated with
experiencing NSSIs. Among the 435 healthcare workers who returned a
completed questionnaire, the incidence of NSSIs during the previous 3
months was 38.4%. Health care workers were more likely to report NSSIs if
they worked longer than 35 hours per week (odds ratio, OR: 2.47; 95%
confidence interval, CI: 1.31-4.66) and administered more than 10
injections per day (OR: 4.76; 95% CI: 1.97-11.49). The likelihood of self-
reporting NSSIs significantly decreased if health care workers adhered to
universal precautions (OR: 0.34; 95% CI: 0.17-0.68).
CONCLUSIONS: NSSIs are a common public health problem at public tertiary
hospitals in Mongolia. The promotion of adequate working conditions,
elimination of excessive injection use, and adherence to universal
precautions will be important for the future control of potential
infections with blood-borne pathogens due to occupational exposures to
sharps in this setting.
Free full text
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8. Abstract: Knowledge and beliefs among health care workers regarding
hepatitis B infection and needle stick injuries at a tertiary care
hospital, Karachi
__________________________________________________________________________
J Coll Physicians Surg Pak. 2011 May;21(5):317-8.
Knowledge and beliefs among health care workers regarding hepatitis B
infection and needle stick injuries at a tertiary care hospital, karachi.
Habib F, Khan DK, Shan-E-Abbas, Bhatti F, Zafar A.
Department of Pathology and Microbiology, The Aga Khan University
Hospital, Karachi.
Hepatitis B virus (HBV) infection is a recognized occupational risk for
health care workers (HCWs). This study aimed to assess the knowledge and
beliefs of HCWs regarding HBV transmission and needle stick injuries
(NSIs).
A cross-sectional questionnaire based KAP study was conducted at Civil
Hospital, Karachi, during the period of January to September 2006. HCWs
were inquired about possible modes of HBV transmission and association
with NSIs. Data were entered using EpiInfo 6.04d software. Statistical
analysis was performed using SPSS 12.5 software.
A total of 343 HCWs participated, and those answered at least 5 correct
modes of HBV transmission were considered knowledgeable. Knowledgeable
group was more likely to report NSIs (p < 0.006), more vaccinated (p <
0.001) and were also more likely to attend awareness session (p < 0.009).
Overall knowledge were inadequate and behaviour and attitude towards
clinical practices were found compromised.
To reduce the occupational risk, effort should be focused to establish
effective infection control program and training of staff.
__________________________________________________________________________
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9. Abstract: An investigation of the disposal of dental clinical waste in
Ibadan City, south-west Nigeria
__________________________________________________________________________
Waste Manag Res. 2011 Mar;29(3):318-22.
An investigation of the disposal of dental clinical waste in Ibadan City,
south-west Nigeria.
Morenikeji OA.
Department of Zoology, University of Ibadan, Ibadan, Nigeria.
jumokemorenikeji@yahoo.co.uk
This study investigated the disposal of dental clinical waste in and from
dental surgeries in Ibadan, south-west Nigeria and followed the waste
trail to the rubbish tips.
A questionnaire was sent to 130 dentists in dental practices in Ibadan
city. Rubbish collectors and scavengers were interviewed to see if they
encountered clinical dental waste.
The response rate of dentists was 93%. A total of 68.6% of the dentists
sampled stated that there were no special disposal facilities for the
different kinds of waste materials generated in their clinics: 52.9%
disposed of sharp items into the waste bins; and 77.7% said there was no
special treatment/disposal of needles and other items used on patients
with infectious diseases.
Most practices burned their wastes in the hospital area and 73.6% said
they were not aware of any rules or body to regulate dental waste disposal
in Nigeria. Rubbish collectors and scavengers knew what dental rubbish
looked like and tried to avoid it.
The survey clearly demonstrates a failure by dentists to dispose of waste
appropriately and also provides evidence that scavengers encounter the
waste.
There is need for the government to provide recommendations, reinforced by
legislation and education, to the dental profession concerning the waste
materials that they generate.
__________________________________________________________________________
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10. Abstract: Health financing in Africa: overview of a dialogue among
high level policy makers
__________________________________________________________________________
This article is part of the supplement: Perceptions and views on public
health proceedings at the occasion of the Fifteenth Ordinary Session of
the Assembly of the African Union .
Proceedings
Health financing in Africa: overview of a dialogue among high level policy
makers
Luis Gomes Sambo , Joses Muthuri Kirigia  and Georges Ki-Zerbo
World Health Organization, Regional Office for Africa, B.P. 06,
Brazzaville, Congo
BMC Proceedings 2011, 5(Suppl 5):S2doi:10.1186/1753-6561-5-S5-S2
Published:      13 June 2011
Background: Even though Africa has the highest disease burden compared
with other regions, it has the lowest per capita spending on health. In
2007, 27 (51%) out the 53 countries spent less than US$50 per person on
health. Almost 30% of the total health expenditure came from governments,
50% from private sources (of which 71% was from out-of-pocket payments by
households) and 20% from donors. The purpose of this article is to reflect
on the proceedings of the African Union Side Event on Health Financing in
the African continent.
Methods: Methods employed in the session included presentations, panel
discussion and open public discussion with ministers of health and finance
from the African continent.
Discussion: The current unsatisfactory state of health financing was
attributed to lack of clear vision and plan for health financing; lack of
national health accounts and other evidence to guide development and
implementation of national health financing policies and strategies; low
investments in sectors that address social determinants of health;
predominance of out- of-pocket spending; underdeveloped prepaid health
financing mechanisms; large informal sectors vis-à-vis small formal
sectors; and unpredictability and non-alignment of majority of donor funds
with national health priorities.
Countries need to develop and adopt a comprehensive national health policy
and a costed strategic plan; a comprehensive evidence-based health
financing strategy; allocate at least 15% of the national budget to health
development; use GFATM and PEPFAR funds for health systems strengthening;
strengthen intersectoral collaboration to address health determinants;
advocate among donors to implement the Paris Declaration on Aid
Effectiveness and its Accra Agenda for Action; ensure universal access to
health services for pregnant women, lactating mothers and children aged
under five years; strengthen financial management capacities; and develop
prepaid health financing systems, especially health insurance to
complement tax funding.
In addition, countries need to institutionalize national health accounts;
undertake feasibility studies of various health financing mechanisms; and
document and share best practices in health financing.
Conclusion: There was consensus that every country ought to have an
evidence-based comprehensive health financing strategy with a road map for
attaining universal health service coverage vision; and increase physical
and financial access by pregnant women, lactating mothers and by children
under five years to quality health services.
Free PDF 215KB
http://www.biomedcentral.com/content/pdf/1753-6561-5-S5-S2.pdf
__________________________________________________________________________
_____________________________________*____________________________________
11. Abstract: A systematic review of hepatitis C virus epidemiology in
Asia, Australia and Egypt
__________________________________________________________________________
Liver Int. 2011 Jul;31 Suppl 2:61-80.
A systematic review of hepatitis C virus epidemiology in Asia, Australia
and Egypt.
Sievert W, Altraif I, Razavi HA, Abdo A, Ahmed EA, Alomair A, Amarapurkar
D, Chen CH, Dou X, El Khayat H, Elshazly M, Esmat G, Guan R, Han KH, Koike
K, Largen A, McCaughan G, Mogawer S, Monis A, Nawaz A, Piratvisuth T,
Sanai FM, Sharara AI, Sibbel S, Sood A, Suh DJ, Wallace C, Young K, Negro
F.
Monash Medical Centre and Monash University, Melbourne, Vic., Australia.
BACKGROUND: The hepatitis C pandemic has been systematically studied and
characterized in North America and Europe, but this important public
health problem has not received equivalent attention in other regions.
AIM: The objective of this systematic review was to characterize hepatitis
C virus (HCV) epidemiology in selected countries of Asia, Australia and
Egypt, i.e. in a geographical area inhabited by over 40% of the global
population.
METHODOLOGY: Data references were identified through indexed journals and
non-indexed sources. In this work, 7770 articles were reviewed and 690
were selected based on their relevance.
RESULTS: We estimated that 49.3-64.0 million adults in Asia, Australia and
Egypt are anti-HCV positive. China alone has more HCV infections than all
of Europe or the Americas. While most countries had prevalence rates from
1 to 2% we documented several with relatively high prevalence rates,
including Egypt (15%), Pakistan (4.7%) and Taiwan (4.4%).
* Nosocomial infection, blood transfusion (before screening) and injection
drug use were identified as common risk factors in the region. Genotype 1
was common in Australia, China, Taiwan and other countries in North Asia,
while genotype 6 was found in Vietnam and other Southeast Asian countries.
In India and Pakistan genotype 3 was predominant, while genotype 4 was
found in Middle Eastern countries such as Egypt, Saudi Arabia and Syria.
CONCLUSION: We recommend implementation of surveillance systems to guide
effective public health policy that may lead to the eventual curtailment
of the spread of this pandemic infection.
© 2011 John Wiley & Sons A/S.
__________________________________________________________________________
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12. Abstract: A systematic review of hepatitis C virus epidemiology in
Europe, Canada and Israel
__________________________________________________________________________
Liver Int. 2011 Jul;31 Suppl 2:30-60.
A systematic review of hepatitis C virus epidemiology in Europe, Canada
and Israel.
Cornberg M, Razavi HA, Alberti A, Bernasconi E, Buti M, Cooper C, Dalgard
O, Dillion JF, Flisiak R, Forns X, Frankova S, Goldis A, Goulis I, Halota
W, Hunyady B, Lagging M, Largen A, Makara M, Manolakopoulos S, Marcellin
P, Marinho RT, Pol S, Poynard T, Puoti M, Sagalova O, Sibbel S, Simon K,
Wallace C, Young K, Yurdaydin C, Zuckerman E, Negro F, Zeuzem S.
Department of Gastroenterology, Hepatology and Endocrinology, Hannover
Medical School, Hannover, Germany.
BACKGROUND AND AIM: Decisions on public health issues are dependent on
reliable epidemiological data. A comprehensive review of the literature
was used to gather country-specific data on risk factors, prevalence,
number of diagnosed individuals and genotype distribution of the hepatitis
C virus (HCV) infection in selected European countries, Canada and Israel.
METHODOLOGY: Data references were identified through indexed journals and
non-indexed sources. In this work, 13,000 articles were reviewed and 860
were selected based on their relevance.
RESULTS: Differences in prevalence were explained by local and regional
variances in transmission routes or different public health measures. The
lowest HCV prevalence (= 0.5%) estimates were from northern European
countries and the highest (= 3%) were from Romania and rural areas in
Greece, Italy and Russia.
* The main risk for HCV transmission in countries
with well- established HCV screening programmes and lower HCV prevalence
was injection drug use, which was associated with younger age at the time
of infection and a higher infection rate among males.
* In other regions, contaminated glass syringes and nosocomial infections
continue to play an important role in new infections. Immigration from
endemic countries was another factor impacting the total number of
infections and the genotype distribution.
Approximately 70% of cases in Israel, 37% in Germany and 33% in
Switzerland were not born in the country. In summary, HCV epidemiology
shows a high variability across Europe, Canada and Israel.
CONCLUSION: Despite the eradication of transmission by blood products, HCV
infection continues to be one of the leading blood-borne infections in the
region.
© 2011 John Wiley & Sons A/S.
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13. Abstract: Drug use and HIV in West Africa: a neglected epidemic
__________________________________________________________________________
Trop Med Int Health. 2011 Jun 14. doi: 10.1111/j.1365-3156.2011.02806.x.
Drug use and HIV in West Africa: a neglected epidemic.
Raguin G, Lepretre A, Ba I, Ndoye I, Toufik A, Brucker G, Girard PM.
Source
Ensemble pour une Solidarité Thérapeutique en Réseau (ESTHER), Paris,
France  Service des Maladies Infectieuses et Tropicales, Hôpital St
Antoine, Faculté de Médecine Pierre et Marie Curie, Université Paris VI,
France  Institut de Médecine et d’Epidémiologie Appliquée, Paris, France
Centre Hospitalier National Psychiatrique de Thiaroye, Université Cheikh
Anta Diop, Dakar, Sénégal  Centre National de Lutte contre le Sida, Dakar,
Sénégal  Observatoire français des drogues et des toxicomanies, France
Institut National de la Santé et de la Recherche Médicale, Unité 707,
Paris, France.
Injecting drug use is poorly documented in West Africa. HIV prevalence
studies are still rare.
Recent studies show that drug injection is on the rise.
There is an urgent need to take this component of the HIV epidemic into
account and to establish adapted intervention strategies.
© 2011 Blackwell Publishing Ltd.
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14. Abstract: Bioethical differences between drug addiction treatment
professionals inside and outside the Russian Federation
__________________________________________________________________________
Harm Reduct J. 2011 Jun 10;8(1):15.
Bioethical differences between drug addiction treatment professionals
inside and outside the Russian Federation.
Mendelevich VD.
This article provides an overview of a sociological study of the views of
338 drug addiction treatment professionals. A comparison is drawn between
the bioethical approaches of Russian and foreign experts from 18
countries.
It is concluded that the bioethical priorities of Russian and foreign
experts differ significantly. Differences involve attitudes toward
confidentiality, informed consent, compulsory treatment, opioid agonist
therapy, mandatory testing of students for psychoactive substances, the
prevention of mental patients from having children, harm reduction
programs (needle and syringe exchange), euthanasia, and abortion.
It is proposed that the cardinal dissimilarity between models for
providing drug treatment in the Russian Federation and in the majority of
the countries of the world stems from differing bioethical preferences
among drug addiction treatment experts.
Free full text
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15. Abstract: The Cedar Project: risk factors for transition to injection
drug use among young, urban Aboriginal people
__________________________________________________________________________
CMAJ. 2011 Jun 13.
The Cedar Project: risk factors for transition to injection drug use among
young, urban Aboriginal people.
Miller CL, Pearce ME, Moniruzzaman A, Thomas V, Christian CW, Schechter
MT, Spittal PM.
Background Studies suggest that Aboriginal people in Canada are over-
represented among people using injection drugs. The factors associated
with transitioning to the use of injection drugs among young Aboriginal
people in Canada are not well understood.
Methods The Cedar Project is a prospective cohort study (2003-2007)
involving young Aboriginal people in Vancouver and Prince George, British
Columbia, who use illicit drugs. Participants’ venous blood samples were
tested for antibodies to HIV and the hepatitis C virus, and drug use was
confirmed using saliva screens. The primary outcomes were use of injection
drugs at baseline and tranisition to injection drug use in the six months
before each follow-up interview.
Results Of 605 participants, 335 (55.4%) reported using injection drugs at
baseline. Young people who used injection drugs tended to be older than
those who did not, female and in a relationship. Participants who injected
drugs were also more likely than those who did not to have been denied
shelter because of their drug use, to have been incarcerated, to have a
mental illness and to have been involved in sex work.
Transition to injection drug use occurred among 39 (14.4%) participants,
yielding a crude incidence rate of 19.8% and an incidence density of 11.5
participants per 100 person -years. In unadjusted analysis, transition to
injection drug use was associated with being female (odds ratio [OR] 1.98,
95% confidence interval (CI) 1.06-3.72), involved in sex work (OR 3.35,
95% CI 1.75-6.40), having a history of sexually transmitted infection (OR
2.01, 95% CI 1.07-3.78) and using drugs with sex-work clients (OR 2.51,
95% CI 1.19-5.32). In adjusted analysis, transition to injection drug use
remained associated with involvement in sex work (adjusted OR 3.94, 95% CI
1.45-10.71).
Interpretation The initiation rate for injection drug use of 11.5
participants per 100 person-years among participants in the Cedar Project
is distressing. Young Aboriginal women in our study were twice as likely
to inject drugs as men, and participants who injected drugs at baseline
were more than twice as likely as those who did not to be involved in sex
work.
__________________________________________________________________________
_____________________________________*____________________________________
16. Abstract: Approaches to minimize infection risk in blood banking and
transfusion practice
__________________________________________________________________________
Infect Disord Drug Targets. 2011 Feb;11(1):45-56.
Approaches to minimize infection risk in blood banking and transfusion
practice.
Lindholm PF, Annen K, Ramsey G.
Department of Pathology, Northwestern University, Feinberg School of
Medicine, 303 East Chicago Avenue, Chicago, IL 60611, USA.
lp-lindholm@northwestern.edu
The use of blood donor history and state-of-the-art FDA-licensed
serological and nucleic acid testing (NAT) assays have greatly reduced the
“infectious window” for several transfusion-transmitted pathogens.
Currently transmission of human immunodeficiency virus (HIV), Human T-cell
Lymphotropic Virus (HTLV), hepatitis viruses and West Nile Virus are rare
events. The seroprevalence of cytomegalovirus in the donor population is
high and cytomegalovirus infection can cause significant complications for
immunocompromised recipients of blood transfusion. Careful use of CMV
seronegative blood resources and leukoreduction of blood products are able
to prevent most CMV infections in these patients.
Currently, bacterial contamination of platelet concentrates is the
greatest remaining infectious disease risk in blood transfusion.
Specialized donor collection procedures reduce the risk of bacterial
contamination of blood products; blood culture and surrogate testing
procedures are used to detect potential bacterially contaminated platelet
products prior to transfusion. A rapid quantitative immunoassay is now
available to test for the presence of lipotechoic acid and
lipopolysaccharide bacterial products prior to platelet transfusion.
Attention has now turned to emerging infectious diseases including variant
Creutzfeldt-Jakob disease, dengue, babesiosis, Chagas’ disease and
malaria. Challenges are presented to identify and prevent transmission of
these agents. Several methods are being used or in development to reduce
infectivity of blood products, including solvent- detergent processing of
plasma and nucleic acid cross-linking via photochemical reactions with
methylene blue, riboflavin, psoralen and alkylating agents.
Several opportunities exist to further improve blood safety through
advances in infectious disease screening and pathogen inactivation
methods.
__________________________________________________________________________
_____________________________________*____________________________________
17. Abstract: Overview of revised measures to prevent malaria transmission
by blood transfusion in France
__________________________________________________________________________
Vox Sang. 2008 Oct;95(3):226-31.
Overview of revised measures to prevent malaria transmission by blood
transfusion in France.
Garraud O, Assal A, Pelletier B, Danic B, Kerleguer A, David B, Joussemet
M, de Micco P.
Etablissement Français du Sang, Saint-Denis, France.
olivier.garraud@efs.sante.fr
Plasmodial transmission by blood donation is rare in non-endemic
countries, but a very serious complication of blood transfusion. The
French national blood service (Etablissement Français du Sang and Centre
de Transfusion sanguine des Armees) intended to revise the measures to
strengthen blood safety with regard to Plasmodiae as transmissible
pathogens.
To limit the risk of transmission during infusion, serious additive
measures have been taken for more than a decade in France, which is the
European country with the highest rate of exposure to imported plasmodial
infections or malaria. These measures were revised and strengthened after
the occurrence of a lethal transfusion-transmitted infection in 2002, but
did not prevent another occurrence in 2006.
This report examines the weaknesses of the systems and aims at emphasizing
the safety measures already taken and addresses issues to best respond to
that risk.
__________________________________________________________________________
_____________________________________*____________________________________
18. Abstract: Intraneural injections and regional anesthesia: the known
and the unknown
__________________________________________________________________________
Minerva Anestesiol. 2011 Jan;77(1):54-8.
Intraneural injections and regional anesthesia: the known and the unknown.
Jeng CL, Rosenblatt MA.
Department of Anesthesiology, Mount Sinai School of Medicine, New York, NY
10029-6579, USA.
Peripheral nerve injury is a rare complication of regional anesthesia.
Intraneural injections were once considered harbingers of neural injury
with practitioners focusing on their avoidance. With ultrasound guidance,
it is now possible to visualize the difference between perineural (outside
the nerve), intraneural (below the epineurium), and intrafascicular
(within the perineurium) injections and to determine their association
with postoperative neurological complications. We also now have a better
understanding of the multifactorial nature of neurologic injury based on
the nerve anatomy, site of needle insertion, bevel type, location of the
needle tip, pressure achieved during injection, and underlying patient
factors.
Using ultrasound guidance during nerve blocks has revealed that
not all intraneural injections result in injury, and its use will continue
to provide insight into the mechanism of anesthetic-related nerve injury.
__________________________________________________________________________
_____________________________________*____________________________________
19. Abstract: Epinephrine auto-injector use and demographics in a Veterans
Administration population
__________________________________________________________________________
Allergy Asthma Proc. 2010 Jul;31(4):304-7.
Epinephrine auto-injector use and demographics in a Veterans
Administration population.
Amirzadeh A, Verma P, Lee S, Klaustermeyer W.
Department of Medicine, Division of Allergy and Immunology, Veterans
Administration Greater Los Angeles Healthcare System, University of
California-Los Angeles, Los Angeles, California 90073, USA.
aliamirzadeh@gmail.com
The epinephrine auto-injector has been widely used over a long period of
time. Certain aspects of this therapy and demographic data, however, have
not been well studied. This study investigates patient use and
understanding of epinephrine auto-injector use.
As part of an ongoing quality assurance program, we evaluated 66 patients
who had been given an epinephrine auto-injector and followed in the
Allergy and Immunology Clinics at the West Los Angeles Veterans Medical
Center. Data analyzed included patient demographics, medical indications
for epinephrine auto- injector prescriptions, and the patient’s
understanding and use of the device.
The mean age of our patients was 50 years. There were 44 men (66.7%) and
22 women (33%). Twenty-three patients were prescribed epinephrine auto-
injector for adverse food reactions.
Ninety-two percent (92%) of the patients knew how to use their epinephrine
auto-injector properly, however, only 58% carried their device with them
consistently. Of the patients, 91% understood why the auto-injector was
prescribed. Of the total patients prescribed epinephrine auto-injector,
79% refilled their medication before the 1 year expiration date. Only 12%
of the patients studied had required the use of their auto-injector. Most
patients knew how and when to administer their epinephrine auto-injector.
Despite detailed instructions in a specialty clinic only a slight majority
carried it consistently. These data clearly indicate that further patient
education or other measures are needed to improve compliance and effective
use.
__________________________________________________________________________
_____________________________________*____________________________________
20. Abstract: Chlorhexidine antisepsis significantly reduces the incidence
of sepsis and septicemia during parenteral nutrition in surgical
infants.
__________________________________________________________________________
J Pediatr Surg. 2011 Jun;46(6):1064-9.
Chlorhexidine antisepsis significantly reduces the incidence of sepsis and
septicemia during parenteral nutrition in surgical infants.
Bishay M, Retrosi G, Horn V, Cloutman-Green E, Harris K, De Coppi P, Klein
N, Eaton S, Pierro A.
Surgery Unit, University College London Institute of Child Health and
Great Ormond Street Hospital for Children, London WC1N 1EH, United
Kingdom.
BACKGROUND/PURPOSE: After a change in national policy, central venous
catheter (CVC) antisepsis with chlorhexidine was introduced in our
hospital. Our aim was to evaluate whether this change reduced the rate of
infection seen during parenteral nutrition (PN) in infants requiring
gastrointestinal surgery.
METHODS: Two groups of consecutive infants were compared: control, 98
infants who had CVC antisepsis with 70% isopropanol alone, and
chlorhexidine, 112 infants who had CVC antisepsis with 2% chlorhexidine in
70% isopropanol. Incidence rates of sepsis (blood cultures taken) and
septicemia (blood cultures positive) were compared by Poisson regression.
RESULTS: Seventy-one percent of infants experienced clinically suspected
sepsis. The incidence of septicemia was 32%. The incidence rate ratio for
sepsis was 0.72 (95% confidence interval, 0.61-0.84) for the chlorhexidine
group vs control (P < .0005). The incidence rate ratio for septicemia was
0.49 (95% confidence interval, 0.36-0.67; P < .0005); that is, over a
given period of PN, patients had half the rate of positive blood cultures
after the introduction of chlorhexidine antisepsis compared with before.
CONCLUSION: (1) The incidence of sepsis and septicemia among surgical
infants on PN for gastrointestinal anomalies is high. (2) Chlorhexidine
CVC antisepsis has significantly reduced this incidence, and we advocate
its use in this group of patients.
Copyright © 2011 Elsevier Inc. All rights reserved.
__________________________________________________________________________
_____________________________________*____________________________________
22. Abstract: Lack of effect on blood alcohol level of swabbing
venepuncture sites with 70% isopropyl alcohol
__________________________________________________________________________
Emerg Med Australas. 2010 Feb;22(1):9-12.
Lack of effect on blood alcohol level of swabbing venepuncture sites with
70% isopropyl alcohol.
Tucker A, Trethewy C.
Department of Emergency Medicine, Royal Brisbane & Women’s Hospital,
Brisbane, Queensland. aftucker@gmail.com
OBJECTIVE: It is standard practice to clean the skin using a non-alcohol-
containing swab before forensic blood alcohol sampling, because of the
belief that the use of an alcohol-containing swab will contaminate the
sample. The present study aimed to determine whether cleaning the skin
with 70% isopropyl alcohol swabs, before venepuncture, alters measured
blood alcohol level (BAL).
METHODS: Volunteers aged >18 years had paired venous blood tests, which
were drawn within 2 min of each other. One arm was swabbed with a 70%
isopropyl alcohol swab and allowed to dry before venepuncture. The other
was swabbed with saline, and these concurrent samples were used as
controls. BAL was tested using the enzymatic method. Pathologists
analysing the samples were blinded to the swabbing technique used. The
mean differences and standard deviations of each of the paired samples
were analysed using Student’s t- test.
RESULTS: Fifty-six paired venous blood samples were obtained from
volunteers. Mean BAL in the isopropyl alcohol-swabbed group was 3.27 mg/dL
with a standard deviation of 1.14 mg/dL. Mean BAL in the saline-swabbed
group was 3.41 mg/dL with a standard deviation of 1.11 mg/dL. The mean
difference was 0.14 mg/dL, with a standard error of 0.157. There was no
statistically significant difference between the groups.
CONCLUSIONS: The present study demonstrated that the use of 70% isopropyl
alcohol swabs does not significantly affect BAL when used before
venepuncture. This has implications that challenge current forensic blood
alcohol sample acquisition.
__________________________________________________________________________
_____________________________________*____________________________________
23. No Abstract: When is postexposure prophylaxis recommended for
needlestick?
__________________________________________________________________________
Am Fam Physician. 2011 Jun 15;83(12):1374.
When is postexposure prophylaxis recommended for needlestick?
Matin M, Goldschmidt RH.
__________________________________________________________________________
_____________________________________*____________________________________
24. No Abstract: In focus: Addressing sharps safety.
__________________________________________________________________________
AORN J. 2011 Mar;93(3):C5.
In focus: Addressing sharps safety.
Burnette M.
__________________________________________________________________________
_____________________________________*____________________________________
25.  News
– India: Woman gets HIV: 2 nursing homes get showcause notice
– Canada: HIV epidemic may be coming for indigenous Canadians
– USA: Sharps Safety in Ambulatory Settings: What Would You Do?
– In Iran, a Brotherhood of Doctors and Patients
– Prisons: Removing needles from correctional settings
– Zambia: Healthcare Workers Learn Improved Blood Collection Skills –
– Partners collaborate to improve safety for medical staff and patients.
– Pakistan: Former Health DG jailed over graft
– India: Fungus found in IV fluid bottle at hosp
– Iran: Jailed Iran brothers win global health prize
– Africa: New meningitis shot could halt African epidemics
Selected news items reprinted under the fair use doctrine of international
copyright law: http://www4.law.cornell.edu/uscode/17/107.html
__________________________________________________________________________
India: Woman gets HIV: 2 nursing homes get showcause notice
Times of India, TNN, India (22.06.11)
LUCKNOW: Chief medical officer of Sultanpur on Tuesday issued show cause
notices to private nursing homes where Durga was admitted.
Durga, a native of Baddhaiya area of Sultanpur got HIV infection after she
administered infected blood, the source of which could not be ascertained
so far.
Taking a note of this, chief medical officer (CMO), Dr J L Mishra
constituted a probe in the case. The committee however could not scan the
records of government blood bank, the only blood bank in Sultanpur. “The
team was busy checking details and records of the nursing homes in
question,” said Dr Mishra adding that the final report is expected by
Wednesday. The officer agreed that there was no other source for blood
units in the city.
So, why is the probe team focusing on nursing homes and not the blood
bank? Answering this he said, “We are trying to get details from all the
ends and nursing homes are a crucial link.”
Meanwhile, show cause notices were issued to private nursing homes, where
Durga was admitted. Citing preliminary report, he said that the nursing
homes were not keeping proper records. Besides this, name of doctors
mentioned on admission ticket were not present. They also found that Durga
was not attended by a female doctor which is another violation of the laid
down rules. “Procedural irregularities at the nursing homes have made it
difficult to trace the source of blood transfused to the patient.”
The CMO has also written to the anti retroviral therapy centre at
Chhatrapati Shahuji Maharaj Medical University ( CSMMU) to find out the
possibilities of getting HIV infection from contaminated blood or blood
products. Head of the ART centre, Prof AK Tripathi in this regard said,
“Transfusing contaminated blood means 100 % chances of getting the
infection. Presence of the virus can be confirmed from the lymph nodes
with 4-5 hours and from the blood stream in 3-4 days.”
Durga was first admitted to Vandana nursing home on June 2, where doctors
told her husband to arrange two units of blood. She was then given three
units of blood at Allied Nursing Home on June 6. HIV infection was
confirmed at Astha Nursing Home, which referred her to government women’s
hospital.
Doctors at government women hospital confirmed that Durga had HIV.
………………………………………………………………..
__________________________________________________________________________
Canada: HIV epidemic may be coming for indigenous Canadians
17:26 22 June 2011 by Wendy Zukerman, New Scientist
An HIV epidemic may be about to hit indigenous Canadians, an analysis of
government data suggests.
Worldwide, HIV infection rates are higher among indigenous people than
others – like many socially disadvantaged groups, indigenous populations
are more likely to use intravenous drugs, and so more likely to catch the
virus from contaminated needles, says Neil Andersson of CIET Canada, an
epidemiological research and training organisation based in Ottawa,
Ontario.
Andersson and colleagues’ analysis suggests that among indigenous
Canadians, however, the virus has now moved beyond drug injectors,
increasing the likelihood of an epidemic within the wider indigenous
population.
The researchers studied over 13,000 new cases of HIV recorded by the
Australian, Canadian and New Zealand governments across two time periods –
1999-2003 and 2004-08. The records document each patient’s sex, age,
indigenous status, and how they were exposed to the virus.
Not just drug users
In Australia and New Zealand, rates of HIV diagnosis were similar among
indigenous and non-indigenous people – although indigenous Australian
women were three times (1999-2003) and six times (2004-08) as likely to be
diagnosed with HIV as non-indigenous women. But the largest differences
between the indigenous and non-indigenous populations were in Canada.
Here, rates of diagnosis were four times higher in indigenous men than in
non-indigenous men, and 14 times (1999-2003) and 20 times (2004-08) higher
in indigenous women than in non-indigenous women.
“Many of the aboriginal [Canadian] women who became HIV positive were not
intravenous drug users,” says Andersson. “The concern is what will happen
next in indigenous communities there.” In Botswana and Swaziland, where
the virus has advanced to the general population, 35 to 40 per cent of
young women now have HIV.
Although indigenous Australian women were diagnosed with HIV at higher
rates than non-indigenous women, the numbers are “very small”, says Frank
Bowden at the Australian National University in Canberra, who was not
involved with the study. For example, between 2004 and 2008 only 21
indigenous women were diagnosed with HIV. During the same period 460
indigenous Canadian women were diagnosed. “In Canada the situation is
striking,” he says.
Bowden suspects that Canada indigenous drug users are “conduits” and are
spreading the virus through sex with non-users. In Australia and New
Zealand, by contrast, HIV rates are relatively low amongst this risk
group, he says, thanks to widespread needle exchange programmes that began
in the mid-1980s.
Journal reference: International Health, DOI: 10.1016/j.inhe.2011.03.010
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__________________________________________________________________________
USA: Sharps Safety in Ambulatory Settings: What Would You Do?
By Marcia Patrick,  posted in Becker’s ASC Review (22.06.11)
[Marcia Patrick, RN, MSN, is CIC Director, Infection Prevention and
Control, MultiCare Health System, Tacoma, WA]
The following article was originally published in Preventing Infection in
Ambulatory Care, the quarterly e-publication from the Association for
Professionals in Infection Control and Epidemiology (APIC). To learn more
about receiving this resource and joining APIC, visit
www.apic.org/ambulatorynewsletter. To learn more about APIC, visit
www.apic.org.
Bloodborne Pathogens are diseases that are caused by exposure to the blood
or body fluids of another person. These include hepatitis B virus,
hepatitis C virus and human immunodeficiency virus (HIV). There are
others, but these are the big three that cause the most infections from
exposures. The goals of the Occupational Safety and Health Administration
(OSHA) Bloodborne Pathogen Standard are to prevent exposures of workers to
bloodborne pathogens and ensure proper medical management following an
exposure.
Avoiding contaminated sharps injuries to healthcare workers is a
responsibility of every employer. The OSHA Bloodborne Pathogens Standard
(29CFR1910.1030) and subsequent updates to it are legal requirements for
any work setting in which there is a possibility of on-the-job exposure to
blood, bloody body fluids or fluids containing other potentially
infectious materials (OPIM). These include cerebrospinal, pericardial,
pleural, peritoneal, synovial and amniotic fluids; semen; vaginal
secretions; and fluids that cannot be differentiated. OPIM does NOT
include tears, sweat, saliva (except in dental settings), urine or stool,
as these do not contain bloodborne pathogens unless they are visibly
bloody. However, they may contain other pathogens, so protection for ALL
body fluids is a must.
The complete article and Questions and Answers on Sharps injuries in
ambulatory care settings are at:http://tinyurl.com/AmbSharpsInj-Beckers-1
original URL:
http://www.beckersasc.com/asc-quality-infection-control/sharps-safety-in-
ambulatory-settings-what-would-you-do.html
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__________________________________________________________________________
In Iran, a Brotherhood of Doctors and Patients
By Tina Rosenberg, Opinionator, New York Times, N.Y. USA (20.06.11)
Few doctors anywhere in the world have done their country a greater
service than the Iranian brothers Arash and Kamiar Alaei.  Kamiar, who is
37, is currently living in Albany, N.Y., where he is working on a
doctorate in public health.   Arash, who is 42, is a resident of Tehran’s
notorious Evin prison – where until recently, Kamiar lived as well.
Kamiar was released from prison a few months ago, but out of concern for
Arash, kept the news quiet.  Now that Arash has completed half of his six-
year sentence – it is customary in Iran for first offenders to be released
at the halfway mark, although Kamiar stayed longer – Kamiar has started to
speak out on his brother’s behalf.  Last week, the brothers received a
major award – the Global Health Council’s Jonathan Mann Award for Global
Health and Human Rights.
The brothers’ story is a sobering reminder of the risks run even by
sophisticated and well-connected advocates for social change.  But their
work has borne fruit: the changes that the Alaei brothers were
instrumental in creating are still mostly in place in Iran today, and will
likely last.  In Fixes, we normally look at successful projects.  But
today I want to highlight the achievements of two people who did
extraordinary things while working under hostile and ultimately dangerous
circumstances.
Late last year, I wrote about Iran’s extraordinary programs to fight AIDS
– a disease that in Iran, as in many other countries, is concentrated
among injecting drug users.  In the early years of the Iranian revolution,
the ayatollahs decreed very harsh measures for drug users.  All treatment
was abolished; possessions of heroin could bring the death penalty.
These policies led to astronomically high H.I.V. rates among drug users
that threatened to unleash a wider AIDS epidemic.  But during the
government of Mohammad Khatami, Iran abandoned this approach and
instituted a pragmatic, humane policy toward drug users, which includes
the widespread use of needle exchange and the provision of methadone
maintenance therapy – even in prisons.  The policy has greatly reduced
infection among drug users and kept H.I.V. from spreading into the general
population.  Among the biggest heroes of this story are the Alaei
brothers.
The complete article is online at: http://tinyurl.com/NYT-IranMannPrize or
http://opinionator.blogs.nytimes.com/2011/06/20/in-iran-a-brotherhood-of-
doctors-and-patients/
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__________________________________________________________________________
Prisons: Removing needles from correctional settings
Robert Hood, CorrectionsOne.com, (20.06.11)
Until correctional administrators can guarantee a totally drug-free
environment, they need to manage the risk of infections caused by inmate
access to needles
Most correctional officials are aware of the United States Supreme Court
decision (Estelle v Gamble) which ruled prisoners have a constitutional
right to healthcare and prohibits “deliberate indifference to serious
medical need.”
Today’s correctional healthcare providers understand the offender’s right
to health services comparable to those available to the general public.
Correctional healthcare workers face the following challenges according to
the Center for Disease Control and Prevention (CDC):
* Jails and prisons can be unpredictable work settings
* Security issues are often a higher concern than infection control
* Inmates may have a higher rate of bloodborne diseases
Until correctional administrators can guarantee a totally drug-free
environment, they need to manage the risk of infections caused by inmate
access to needles.
Infections prevented in prison will reduce healthcare costs and provide a
better environment for inmates and staff. More than 20 percent of state
offenders and 50 percent of federal offenders are in for drug offenses;
many would use a needle if available.
The unfortunate death of correctional officer Gary Pearce, who was stabbed
with a needle infected with an HIV blood-filled syringe, stresses the
danger of needle access in correctional settings.
Pearce opened a security gate for inmate Graham Farlow at Long Bay Jail in
Australia, was assaulted with a contaminated needle, and eventually died
from an AIDS-related illness.
Sixty prisons worldwide have needle-exchange programs because inmate
access to drugs and needles is prevalent. Earlier this year, prison
officers in Canada threatened to walk off the job because of a proposal to
introduce an exchange program which could place staff at risk.
American correctional administrators continue to enhance drug and needle
interdiction programs, and seek safer solutions other than condoning
inmate access to needles.
Exposure to blood and other body fluids occurs across a wide variety of
occupations, but correctional staff are at even greater risk each and
every day. Prison workers come to work with additional concerns relating
to life-altering events such as accidental needlestick injuries and
potential assaults with unaccountable needle contraband.
The fluid nature of incarcerated populations ensures a higher percentage
of vaccinations is needed in correctional facilities and upon reentry into
the community. More than 22,000 inmates in federal and state prisons have
HIV (almost four times the general population). Hepatitis B virus (HBV)
and hepatitis C virus (HCV) is much higher among inmates than in the
community.
The World Health Organization (WHO) estimates the prevalence of TB is up
to 100 times higher in prison than in the community. Sixteen billion
needle injections are provided worldwide every year. Currently there are
24 vaccine preventable diseases in the world.
Similar to the general public, correctional healthcare staff will always
need to inject medications. A CDC study concludes on average 50 percent or
more needlesticks and sharps exposures go unreported. Every year 600,000
to $1 million needlestick injuries occur in the United States.
American hospital staff report that one case of “serious” infection by
bloodborne pathogens can add up to $1 million in testing, time from work,
and disability payments (even routine treatment ranges from $500 to
$3000). The litigious nature of many offenders raises additional concerns
for needles in correctional institutions.
Let’s face the facts. Illicit drugs enter correctional facilities
regardless of security measures. State-of-the-art electronic drug
detection equipment, staff, inmate and visitor searches, drug sniffing K-9
units, and urinalysis use reduces but does not eliminate drug
introduction. Incarceration of drug users contributes to higher rates of
diseases in prisons.
Prisoners who inject drugs will most likely share needles. Some inmates
claim the same needle would be used up to 200 times and by 100 people.
When the syringe’s needle gets dull, it is sharpened. If it breaks,
prisoners continue to use it, often leading to infected abscesses. Needle
sharing among prisoners is making prisons potential incubators of
bloodborne infections, including HIV and hepatitis – a solution is needed.
The Needlestick Safety & Prevention Act was created in 2000, and requires
employers to provide safer medical devices to address needlestick
injuries. Subsequent revisions of the Occupational Safety & Health
Administration (OSHA) bloodborne pathogens standard require employees to
evaluate safer medical devices to eliminate or minimize exposure to blood
or other potentially infectious materials.
The U.S. Food and Drug Administration (FDA) recently cleared a needle-free
injection system which has been used worldwide, and has been piloted in
local, state, and federal correctional facilities. This new technology
delivers vaccines and other liquid medications through the skin without a
needle. A custom-wound spring in the injector provides a unique force that
drives the liquid through a tiny hole in the end of the needle-free
syringe – creating a “fluid needle” that is able to penetrate the skin.
Needle-free injections are a natural fit for the corrections system.
Needle-free institutions improve the overall well being of inmates and
provide safer environments for staff. Although inmates will continue to
hide drugs in shampoo bottles, food, diapers, and virtually every part of
the human anatomy, removing needles from correctional institutions will
provide another level of protection.
PharmaJet is working to remove needles from our nation’s criminal justice
system. Correctional healthcare and prison staff have a right to work in a
safe environment. Most offenders will be released to the community, so too
are their infections and illnesses – creating a broader public health
risk. Inmates are members of our community, so if we don’t protect their
health, we will fail to protect the health of our community. As the number
of inmates released to the community increases, so will the public health
concerns for the public.
Issues relating to needlestick injuries, reuse, and disposal will be
addressed by use of needle-free technology.
* Avoiding needlestick injuries: Correctional healthcare professionals are
spared the occupational risk of being infected by blood borne pathogens
through needle stick injuries. Officers are exposed to accidental
needlestick injuries during cell and body searches. Nearly two-thirds (64
percent) of nurses report being accidentally stuck by a needle while
working, and an incredible 74 percent report being stuck by a contaminated
needle. There is an estimated 22 million needle-stick injuries world-wide
per year.
* Reducing needle-reuse: The World Health Organization (WHO) estimates 50
percent of needle-syringe injections are unsafe, and that over 23 million
people contract hepatitis, HIV, and other diseases each year because of
this practice. Estimates up to 40 to 70 percent of needles are re-used in
some countries.
* Reducing sharps disposal: Disposal of sharps medical waste requires
costly disposal services.
Evaluating the cost-effectiveness of needle-free technology should include
needlestick injuries, needle-reuse, and sharps disposals. More
importantly, staff safety and reducing potential weapons inside of secured
settings needs be factored in the equation.
There are health and moral justifications for needle-free correctional
institutions. Key stakeholders, including prison security and healthcare
staff, government officials, and policy-makers, need to be informed of the
risk of needle use in prisons. A national strategy for removing needles
from correctional environments should be part of institutional re-entry
plans and the standard of care for offenders. A needle-free program is a
win-win, frontline component for the next generation of correctional
healthcare.
About the author
Bob Hood has over 35 years of correctional experience at the local, state
and federal levels. He retired from the United States Department of
Justice, Federal Bureau of Prisons, as warden of America’s most secure
prison – the United States “Supermax” in Florence, Colorado.
In his role as warden, he communicated daily with inmates such as Terry
Nichols, the Oklahoma City bomber; Richard Reid, the Al-Qaeda “shoe
bomber”; Ted Kaczynski, the Unabomber; Ramzi Yousef, mastermind of the
1993 bombing of the world Trade Center, along with several WTC bombing
participants, Embassy bombing participants, and FBI Spy Robert Hanssen. He
has significant experience in managing disruptive inmates and developing
emergency plans for correctional facilities.
Security Magazine identified Mr. Hood as one of the “Top 25 Most
Influential People in the Security Industry,” and CBS aired a “60 Minutes”
special on his ability to effectively manage the most secured prison in
America.
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Zambia: Healthcare Workers Learn Improved Blood Collection Skills –
Partners collaborate to improve safety for medical staff and patients.
NewswireToday – /newswire/ – Lusaka, Zambia, (20.06.11)
Blood sample collection techniques will be made safer for healthcare
professionals and patients under a new program spearheaded by the Zambian
Ministry of Health in partnership with the U.S. government and BD (Becton,
Dickinson and Company). The program, named Good blood draw Applications
Zambia Initiative (GAZI), is designed to ensure reliable laboratory
results critical for quality patient care.
Zambia is the second country to participate in this global public/private
partnership, first launched in Kenya in June 2010. Under the three-year
GAZI Initiative, laboratory professionals, doctors, nurses and other
healthcare workers will train in blood-drawing procedures, specimen
handling, and improved safety through prevention of needle-stick injuries.
Drawing blood from patients’ veins using a needle and syringe is one of
the most commonly performed medical procedures in hospitals and clinics.
Given the prevalence of this procedure, it is vital that clinicians take
the necessary steps to protect themselves and their patients from
bloodborne infections resulting from accidental pricking, stabbing or
scratching with equipment that has been used collect blood.
The public-private partnership recruits experts from BD with support from
the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the U.S.
Department of Health and Human Services’ Centers for Disease Control and
Prevention (CDC). This partnership will strengthen laboratory services by
improving the quality of patient specimens and reducing incidences of
needle-stick injuries, thereby improving safety for both patients and
health workers.
BD volunteers will hold intensive training of trainer sessions for 22
healthcare workers from 10 hospitals and a training institution.
Participating institutions include University Teaching Hospital, Kamwala
Clinic and Maina Soko Military Hospital in Lusaka; Arthur Davidson
Hospital in Ndola; Ndola Central Hospital, Kabwe General Hospital, Kabwe
Mines Hospital; Mazabuka District Hospital, Monze Mission Hospital,
Livingstone General Hospital, and Ndola College of Biomedical Sciences.
Participating healthcare workers will conduct further training sessions of
healthcare workers at their sites under the observation of the BD experts.
Initially, approximately 420 professionals will be trained with additional
training administered throughout the three-year program.
“Safe blood sample collection is a vital tool in helping hospitals and
clinics diagnose illness and diseases. But healthcare workers can expose
themselves – and patients – to unnecessary risks from needle-stick
injuries if they do not use the correct procedures. BD’s training
programme is intended to reduce that risk,” said BD Global Health Director
Renuka Gadde.
About BD
BD (bd.com) is a leading global medical technology company that develops,
manufactures and sells medical devices, instrument systems and reagents.
The Company is dedicated to improving people’s health throughout the
world. BD is focused on improving drug delivery, enhancing the quality and
speed of diagnosing infectious diseases and cancers, and advancing
research, discovery and production of new drugs and vaccines. BD’s
capabilities are instrumental in combating many of the world’s most
pressing diseases. Founded in 1897 and headquartered in New Jersey, USA,
BD employs approximately 29,000 associates in more than 50 countries
throughout the world. The company serves healthcare institutions, life
science researchers, clinical laboratories, the pharmaceutical industry
and the general public.
About PEPFAR
The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) is the U.S.
Government initiative to support partner nations around the world in
responding to HIV/AIDS. It was launched in 2003, and is the largest
commitment by any nation to combat a single disease internationally in
history. Through PEPFAR, the U.S. Gov­ernment has committed approximately
US$32 billion to bilateral HIV/AIDS programmes, the Global Fund to Fight
HIV/AIDS, Tuberculosis and Malaria, and bilateral TB programmes through
Fiscal Year 2010. PEPFAR (PEPFAR.gov) is the cornerstone and largest
component of the President’s Global Health Initiative. This initiative
supports partner countries in improving health outcomes through
strengthened health systems, with a particular focus on improving the
health of women, newborns and children through programmes that address a
range of health issues. For more information, please visit the website,
twitter.com/uspepfar, or facebook.com/PEPFAR.
About CDC
The U.S. Centers for Disease Control and Prevention (CDC) is America’s
premier health promotion, prevention, and preparedness agency and a global
leader in public health. CDC is at the forefront of public health efforts
to prevent and control infectious and chronic diseases, injuries,
workplace hazards, disabilities, and environmental health threats. The
agency is globally recognised for conducting research and investigations
and for its action-oriented approach to public health. CDC’s Global AIDS
Program provides critical leadership in the fight against HIV/AIDS in
resource-constrained countries by assisting partner governments to
strengthen laboratory, epidemiology, surveillance, public health
evaluation and workforce capacity-essential components for strong
sustainable public health systems.
Source: Becton, Dickinson and Company
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Pakistan: Former Health DG jailed over graft
The News International, Pakistan (19.06.11)
LAHORE: An accountability court on Saturday awarded three-year jail to
former Health Director General Dr Saeed Qureshi on charges of
misappropriating millions of rupees during the purchase of syringes and
vaccine for hospitals in Punjab.
The court acquitted four others in the scam. It also imposed a fine of Rs
0.5 million on Saeed Qureshi. A reference was filed against former Health
Director General Dr Saeed Qureshi, Ayyaz Ch, Muhammad Ashraf, Nazim Ali
and Zahid Kaleem for corruption of millions of rupees.
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India: Fungus found in IV fluid bottle at hosp
Times of India, TNN (18.06.11)
JAIPUR: A bottle of contaminated intravenous (IV) fluid was found in
Kanwatia Hospital at Shastri Nagar on Friday. The fungus was detected
before the IV fluid was administered to apatient.
The patient’s attendant bought the IV fluid bottle from the Lifeline store
of the hospital and handed over the bottle to the nursing staff. But,
before the nursing staff could administer the glucose to the patient, they
noticed that the bottle had fungus.
Principal medical officer Hari Om Sharma said the bottle had a minute hole
which might have caused contamination.
The hospital administration then seized all the bottles of the same batch
number as the contaminated fluid bottle. Sharma said they have seized all
the nine cartons each containing 24 bottle of IV fluid of batch number
P11FO12.
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Iran: Jailed Iran brothers win global health prize
by Kerry Sheridan, AFP (16.06.11)
WASHINGTON (AFP) – Two Iranian doctors who were jailed three years ago for
allegedly plotting to overthrow the government were awarded a global
health prize for their efforts to treat patients with HIV.
Kamiar and Arash Alaei were arrested in June 2008 and accused of
communicating with the United States in a bid to unseat the regime of
Iranian President Mahmoud Ahmadinejad.
Kamiar, 37, was released several months ago and was on hand to accept the
award in Washington, but his elder brother Arash, 42, remains in Tehran’s
Evin prison where he is serving a six-year sentence.
Until Arash is set free, Kamiar said he cannot move forward with his life.
“I feel I am not released yet,” he said in an interview with AFP before he
accepted the Global Health Council’s Jonathan Mann Award for Global Health
and Human Rights.
“The majority of nights I go back to prison and I continue my life in
prison,” he said.
Kamiar served two and a half years — a term he remembers as “870 days,
3,800 hours” — and is hopeful that Arash will be eligible for release
soon because he has now served half his sentence.
He declined to discuss the details of his detention, except that he was
kept in solitary confinement for two months. After eight months in prison,
he was allowed to see his brother, he said.
The pair, known for their efforts to help drug addicts infected with HIV
and improve conditions for sick prisoners, were not allowed to work as
doctors while behind bars.
Instead, Kamiar said they took on the role of peer counselors, teaching
fellow prisoners about basics such as hand-washing, and holding informal
talks with them about HIV, tuberculosis, and infectious diseases.
The Alaei brothers are regarded as pioneers of AIDS treatment in Iran,
where discussions about sex and drugs are often taboo.
Data is scarce about the prevalence of HIV/AIDS in the Islamic republic,
but according to UNAIDS there were 5,000-10,000 infections in 2009 and
about nine percent of people with advanced HIV infection were being
treated with antiretroviral drugs.
The brothers began treating HIV-positive patients in the late 1990s, and
they developed a three-pronged program that integrated prevention, care
and social support.
This “triangular” approach to AIDS care was first tried in a prison in
their hometown of Kermanshah and later became recognized as a best
practice model in the Middle East.
The Alaei brothers were not born in poverty but were taught by their
father, a Persian literature teacher, to use their education to help
others.
“He motivated us to do the public good, even if the community doesn’t
understand the situation,” said Kamiar.
Physicians for Human Rights has helped organize a letter-writing campaign
across 80 countries urging the brothers’ release.
“The appeal has been to allow the brothers to do their work,” said
Susannah Sirkin, deputy director of PHR.
“This is not a political campaign. This is a campaign by colleagues, many
of whom know the brothers and their work directly because they have worked
in concert with them or been inspired by their pioneering efforts inside
Iran.”
Kamiar said he was detained when he took a summer break from his US
studies and went to work in Iran for a few months, and has been unable to
understand why he was jailed.
“When you do some good, you don’t expect to be in prison,” Kamiar said.
“But I never got disappointed because I believe what I did was right. I
love my work, and until the last moment of my life I will do public
health, specifically for neglected populations.”
After his release, Kamiar quietly returned to Albany, New York where he
lives with his sister and is finishing up his doctoral degree.
The dean of the school of public health at the State University of New
York at Albany, Philip Nasca, told AFP that Kamiar used some of his time
in jail to teach himself Spanish, and was able to speak it with local
patients during a recent trip to the Dominican Republic.
“I think he kept his intellectual life alive and his mental life alive,”
said Nasca.
According to Jeff Sturchio, president of the US-based Global Health
Council which gave out the $10,000 award, the brothers serve as a powerful
symbol for health professionals worldwide.
“They really put themselves at risk in advocating for the rights of people
living with HIV and AIDS,” said Sturchio.
“If there are still places in the world where people are put in prison
just because they are advocating for the rights of people with HIV, then
that is a world that we would like to see changed.”
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Africa: New meningitis shot could halt African epidemics
Reuters (16.06.11)
* Cheap new vaccine “dramatically better” against A strain
* Experts say vaccine could end “meningitis belt” epidemics
* GSK and Sanofi shots designed for broader protection (Adds makers of
comparison vaccines, more details from study)
By Kate Kelland
LONDON, June 16 (Reuters) – A cheap new meningitis vaccine designed to
treat a type of the disease common in Africa could significantly reduce or
even halt future epidemics in Africa’s so-called “meningitis belt”,
scientists said.
International researchers said the vaccine, called MenAfriVac and made by
the Indian generic drugmaker Serum Institute, was far more effective than
older so-called meningococcal polysaccaride vaccines, including Mencevax
from GlaxoSmithKline, in trials in three African countries.
In two studies in the New England Journal of Medicine, in which
MenAfriVac’s potency and effectiveness was compared with a standard
vaccine often used during meningitis outbreaks in the region, scientists
said the new shot was “dramatically better”.
The first study involved 601 children under two years old in Mali and
Gambia, and the second involved 900 adults in Mali, Gambia, and Senegal.
Researchers measured immunogenicity 4 weeks after the first dose and found
that in the first study more than 96 percent of those who got MenAfriVac
had high levels of antibodies in their blood, compared with around 64
percent of those who got GSK’s Mencevax.
MenAfriVac was developed with funding from the Bill and Melinda Gates
Foundation specifically for use against meningitis A, a type which causes
regular epidemics in Africa, and costs just 50 U.S. cents per dose.
GSK’s Mencevax and another vaccine called Menomune made by Sanofi Aventis’
<SASY.PA> unit Sanofi Pasteur, offer protection against four meningitis
strains — A, C, Y and W-135 — and are therefore more expensive and less
targeted to Africa’s needs.
Marie-Pierre Preziosi of the World Health Organisation’s (WHO’s)
immunisation, vaccines and biologicals department, said that taking into
account all the effectiveness measures in both studies, including potency
and sustainability of protection, MenAfriVac was ” about 20 times more
effective” than currently-used polysaccaride vaccines.
She said its use could significantly reduce or stop epidemics in the belt
stretching from Senegal in the west to Ethiopia in the east, which
currently has the highest meningitis A rates in the world.
“The potential is there, there’s no doubt about that,” she said in a
telephone interview. “The studies were very conclusive. The new vaccine
was dramatically better than the currently used vaccine and this was shown
in all age groups, including adults.”
Bacterial meningitis, called meningococcal meningitis, is a serious
infection of the thin lining surrounding the brain and spinal cord. It can
cause severe brain damage and is fatal in 50 percent of cases if
untreated.
Even with antibiotic treatment, around 10 percent of patients die and up
to 20 percent are left with brain damage, deafness, epilepsy, or necrosis
leading to limb amputation.
According to the non-profit Meningitis Vaccine Project (MVP), which helped
develop the MenAfriVac vaccine, the seasonal outbreak of meningitis across
sub-Saharan Africa in 2009 infected at least 88,000 people and killed more
than 5,000.
WHO data released earlier this week showed Burkina Faso, Mali and Niger,
the first three countries to receive MenAfriVac after it was launched last
year, had their lowest recorded numbers of meningitis A cases in an
epidemic season this year.
The figures showed just four confirmed meningitis A cases in Burkina Faso,
the first country to introduce the vaccine nationwide. No confirmed cases
were reported in Mali, while four cases were reported in Niger, all in
unvaccinated people. (Editing by Jan Harvey and Sophie Walker
_____________________________________*____________________________________
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The SIGN 2010 meeting report pdf, 1.36Mb is available on line at:
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