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SIGNpost 00615

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

Post00615 Challenges + HCWM + Students + Abstracts + News7 September 2011

CONTENTS

0. Moderators Note
1. Grand Challenges Explorations Round 8: Design New Approaches to Optimize
Immunization Systems
2. Abstract: Analysis: the impact of needle, syringe, and lancet disposal
on the community
3. Abstract: Health care waste management practice in a hospital
4. Abstract: Sharps injuries among medical students
5. Abstract: Educational programmes and sharps injuries in health care
workers
6. Abstract: Evaluation of brilliance and visibility of fluorescence and
chemiluminescence solution for training of preparing injections
7. Abstract: Nosocomial infections: knowledge and source of information
among clinical health care students in Ghana
8. Abstract: Description of nosocomial infection prevention practices by
anesthesiologists in a university hospital
9. Abstract: An evaluation of sharp safety blood evacuation devices
10. Abstract: Epidemiological changes in hepatitis B prevalence in an
entire population after 20 years of the universal HBV vaccination
programme
11. Abstract: Endophthalmitis After Intravitreal Injection: The Importance
of Viridans Streptococci
12. Abstract: Transfusion-Associated Babesiosis in the United States: A
Description of Cases
13. Abstract: Nursing and physician attire as possible source of nosocomial
infections
14. Abstract: A 16-week open-label, multicenter pilot study assessing
insulin pump therapy in patients with type 2 diabetes suboptimally
controlled with multiple daily injections
15. Abstract: Botulinum Toxin for Glabellar Lines: A Review of the Efficacy
and Safety of Currently Available Products
16. No Abstract: Safe Injection Practices: Keeping Safety In and the “Bugs”
Out
17. No Abstract: Electronic online infection prevention and control modules
for health care workers
18. No Abstract: Disinfection and sterilization of prion-contaminated
medical instruments
19. No Abstract: Hepatitis in drug users: time for attention, time for
action
20. News
– USA: CDC Sees More Exposure to Infections in Diabetes Testing
– UK: Nurse Rebecca Leighton returns home as GMP chief Peter Fahy
speaks out over ‘pressure’ of Stepping Hill case
– UK: Contaminated blood inquiry resumes hearing evidence: Lord Penrose is
chairing the inquiry into how people were infected with Hepatitis C and
HIV through transfusions
– Chris Evans in a Dramatic New Clip From Puncture
– USA: Hepatitis C numbers on the rise in county: Outbreak blamed on
increased IV drug usage
– UK: Seven patients’ deaths part of sabotage probe
– USA: Diabetes device-related infections a growing concern, CDC says
– USA: Five More Reports of Avastin Injections Causing Blindness
– USA: Repackaged Avastin caused eye infections in Florida
– USA: Wisconsin Clinic Warns of Possible Disease Exposures
– USA; Disease exposure via medical devices a growing concern, CDC says
Dean Clinic in Madison testing patients
– WHO: Pentavalent, Easyfive, Removed From Who List Of Prequalified
Vaccines
– WHO Advisory Committee Concludes That New Meningitis Vaccine Is
Safe
– Iran: Iranian HIV Physician Released From Tehran Prison

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__________________________________________________________________
________________________________*_________________________________

0. Moderators Note
__________________________________________________________________

The next edition of SIGNpost will be posted on 12 September.

Apologies in advance: due to travel, there will be no SIGNpost editions
posted until 6 October 2011 when normal postings will resume.

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__________________________________________________________________
________________________________*_________________________________

1. Grand Challenges Explorations Round 8: Design New Approaches to Optimize
Immunization Systems
__________________________________________________________________

Design New Approaches to Optimize Immunization Systems
Grand Challenges Explorations Round 8
August 2011

Immunization is one of the world’s most cost-effective health
interventions. However, each year approximately 25 million infants are not
fully vaccinated, and at least 2.4 million children die from vaccine-
preventable diseases.

Since immunization programs were launched in low- and middle-income
countries worldwide in the mid-1970s, most countries have been using the
same standard package of six vaccines – measles, tetanus, diphtheria,
whooping cough (pertussis), tuberculosis, and polio – in their national
immunization schedule. In the last decade, however, as the public health
impact of vaccines has become increasingly clear, interest in and funding
for new vaccine development and delivery has surged. Throughout the next
decade, low- and middle-income countries will have opportunities to
introduce many new lifesaving vaccines into their standard immunization
programs-in some cases doubling the number of vaccines offered in their
programs within ten years.

The cost of traditional vaccines such as measles, diphtheria-tetanus-
pertussis, and polio is low – often between $0.10 USD to $0.25 USD per
dose. Due to both the investments made to discover and develop them, and
because some of them are complex to manufacture, the cost of newer vaccines
is significantly higher, ranging from $1.00 USD up to $15.00 USD. These
increasing costs are driving the need to modify vaccine presentations.

With the introduction of these new vaccines, countries are facing new
challenges-both in delivering these vaccines and in ensuring immunization
programs reach new target populations. In 2010, a quarter of a million
doses of pentavalent vaccine, costing nearly $1M USD, expired in one
country’s central store because the system charged with delivering these
vaccines was not yet ready to manage it. Another country was forced to
delay its plans to introduce new vaccines because adding the new vaccine
into the immunization program required a nine-fold expansion of the
national storage system. Hence, low- and middle-income countries must find
new ways to improve the logistics of national immunization programs to
address the increasing burden facing their supply systems.

More at:
http://www.grandchallenges.org/ImproveVaccines/Topics/Pages/OptimizeImmuniz
ationSystemsRound8.aspx/

or http://www.grandchallenges.org/ then navigate to
http://www.grandchallenges.org/Explorations/Pages/TopicsOverview.aspx
__________________________________________________________________
________________________________*_________________________________

2. Abstract: Analysis: the impact of needle, syringe, and lancet disposal
on the community
__________________________________________________________________

J Diabetes Sci Technol. 2011 Jul 1;5(4):848-50.

Analysis: the impact of needle, syringe, and lancet disposal on the
community.

Gold K.

Diabetes Research and Wellness Foundation, Washington D.C.

There are over 7.5 billion needles and syringes used outside of the health
care system each year by individuals with diabetes, migraines, allergies,
infertility, arthritis, HIV, hepatitis, multiple sclerosis, osteoporosis,
psoriasis, or other conditions.

Disposal of needles, syringes, lancets, and other medical products are not
regulated in the home, while these same products used in health care
facilities are strictly regulated. Home- generated medical waste is
routinely placed into curbside trash, placing sanitation workers and
custodial personnel at personal risk of a needle- stick injury.

The Coalition for Safe Community Needle Disposal is working to establish a
solution that is satisfactory to all stakeholders, sharing the burden of
these programs with the pharmaceutical industry, medical device industry,
waste management industry, recycling companies, and local and state
governments.

© 2011 Diabetes Technology Society.
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Health care waste management practice in a hospital
__________________________________________________________________

J Nepal Health Res Counc. 2010 Oct;8(2):86-90.

Health care waste management practice in a hospital.

Paudel R, Pradhan B.

Community Medicine and Family Health Department, Maharajgunj Campus,
Institute of Medicine , Tribhuvan University, Nepal.

Background: Health-care waste is a by-product of health care. Its poor
management exposes health-care workers, waste handlers and the community to
infections, toxic effects and injuries including damage of the environment.
It also creates opportunities for the collection of disposable medical
equipment, its re-sale and potential re-use without sterilization, which
causes an important burden of disease worldwide. The purpose of this study
was to find out health care waste management practice in hospital.

Methods: A cross-sectional study was conducted in Narayani Sub-Regional
Hospital, Birgunj from May to October 2006 using both qualitative and
quantitative methods. Study population was four different departments of
the hospital (Medical/Paediatric, Surgical/Ortho, Gynae/Obstetric and
Emergency), Medical Superintendent, In-charges of four different
departments and all sweepers. Data was collected using interview, group
discussion, observation and measurement by weight and volume.

Results: Total health-care waste generated was 128.4 kg per day while 0.8
kg per patient per day. The composition of health care waste was found to
be 96.8 kg (75.4%) general waste, 24.1 kg (8.8%) hazardous waste and 7.5 kg
(5.8%) sharps per day by weight. Health staffs and sweepers were not
practicing the waste segregation. Occupational health and safety was not
given due attention. Majority of the sweepers were unaware of waste
management and need of safety measures to protect their own health.

Conclusions: Health care waste management practice in the hospital was
unsatisfactory because of the lack of waste management plan and
carelessness of patients, visitors and staffs. Therefore the hospital
should develop the waste management plan and strictly follow the National
Health Care Waste Management Guideline. Key words: health care waste,
management, practice, sub-regional hospital.
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Sharps injuries among medical students
__________________________________________________________________

Occup Med (Lond). 2009 Oct;59(7):509-11.

Sharps injuries among medical students.

Varsou O, Lemon JS, Dick FD.

Department of Environmental and Occupational Medicine, University of
Aberdeen, Aberdeen, UK. o.varsou@googlemail.com

BACKGROUND: Medical students may be at risk of sharps injuries for several
reasons. These exposures can transmit a range of blood-borne pathogens
including hepatitis B, hepatitis C and human immunodeficiency virus.

AIMS: To evaluate medical students’ knowledge regarding the prevention and
management of sharps injuries and their experience of such exposures in the
calendar year 2007.

METHODS: A cross-sectional, web-based, survey of fourth and fifth year
medical students enrolled at the University of Aberdeen in Scotland. All
students were at the mid-point of their year of study. An invitation e-mail
and two electronic reminders were sent, on specified days, to the study
population. These contained a summary of the study and the link to the
anonymous questionnaire.

RESULTS: Of the 395 medical students e-mailed, 238 (60%) responded. When
compared with fourth year medical students, final year students had higher
mean knowledge scores for sharps injury management (P < 0.01). Of total,
18% reported resheathing used needles and 31% reported disposing of sharps
for others, indicating poor compliance with standard precautions. In the
event of an injury, 29% stated that they would scrub the wound. Only 44%
were familiar with policies for reporting exposures. In all, 11% of
students had experienced at least one contaminated sharps injury in 2007
and, of those, 40% had reported the most recent incident.

CONCLUSIONS: Medical students are at risk of sharps injuries and their
knowledge regarding the prevention and management of these exposures is
limited: training on these issues should be increased.
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Educational programmes and sharps injuries in health care
workers
__________________________________________________________________

Occup Med (Lond). 2009 Oct;59(7):512-4.

Educational programmes and sharps injuries in health care workers.

Brusaferro S, Calligaris L, Farneti F, Gubian F, Londero C, Baldo V.

Department of Experimental and Clinical Pathology and Medicine, University
of Udine, Udine, Italy.

BACKGROUND: Sharps injuries in health care personnel still represent a
significant problem worldwide. Many studies show a reduction in sharps
injuries following the introduction and use of different protection
devices, but few studies focus on the role of training programmes in the
prevention of such injuries.

AIMS: To analyse the influence of training programmes on sharps injuries in
health care workers (HCW).

METHODS: The study was carried out in a 350-bed university hospital in
north-eastern Italy with 700 HCW. Training courses on biological risk for
physicians, nurses, ancillary operators and laboratory technicians have
been in place since 1998. Data on all sharps injuries reported by HCW
between 1998 and 2006 were analysed together with information on HCW who
attended the training courses.

RESULTS: Between 1998 and 2006, there was a reduction in the incidence of
sharps injuries from 11 to 4% (P < 0.01). During the same period, the
number of trained HCW increased from 26 to 69% (P < 0.01). Trained
personnel had a statistically significant lower relative risk (RR) for
injury with RR = 0.06 (95% CI 0.02-0.18).

CONCLUSIONS: A continuous educational effort for HCW leads to a reduction
of sharps injuries.
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Evaluation of brilliance and visibility of fluorescence and
chemiluminescence solution for training of preparing injections
__________________________________________________________________

Yakugaku Zasshi. 2011;131(9):1361-7.

Evaluation of brilliance and visibility of fluorescence and
chemiluminescence solution for training of preparing injections.

Ishiwata S, Taga A, Sano H, Kobayashi M, Nomiyama J, Harada S, Kita A,
Takada M, Sugiura R. Source Laboratory of Molecular Pharmacogenomics,
Faculty of Pharmacy, Kinki University.

Personnel who prepare and administer chemotherapeutic agents have been
reported to develop untoward effects. The use of appropriate techniques for
preparing these agents is encouraged, and educational training systems that
involve the use of a fluorescent or chemiluminescence reagent as placebos
have been established to minimize potential exposure to these agents.
However, the optimum conditions for the use and visibility of these
placebos remain obscure.

In this study, our results indicated that the fluorescence intensity of
fluorescent reagent decreased when it was used at a concentration greater
than 0.01%. Because drops created due to splashes and leaks are extremely
small and easily evaporate, it is possible that the fluorescence resulting
from such drops readily disappears despite using an anti-evaporation
reagent.

We also developed a method to evaluate the visibility of the small drop;
using this method, we determined the distance at which the drop present on
the pin could be seen by the observer. The distance at which the drop was
clearly recognized as a pinpoint by using the fluorescence method was
almost comparable to that for the chemiluminescence method.

In the chemiluminescence method, the drop on the pin was faintly visible as
a slightly bright area because of low background when observed at a certain
distance that was much greater than that at which the drop was clearly
visible; however, such an area was not observed in the fluorescence method.

The results of our study will help in the selection of a training method
depending on the situation.
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Nosocomial infections: knowledge and source of information
among clinical health care students in Ghana
__________________________________________________________________

Int J Gen Med. 2011;4:571-4.

Nosocomial infections: knowledge and source of information among clinical
health care students in Ghana.

Bello AI, Asiedu EN, Adegoke BO, Quartey JN, Appiah-Kubi KO, Owusu-Ansah B.

Department of Physiotherapy, School of Allied Health Sciences, College of
Health Sciences, University of Ghana, Accra, Ghana;
AbstractBACKGROUND: This study determined and compared the knowledge of
nosocomial infections among clinical health care students at the College of
Health Sciences, University of Ghana.

METHODS: Two hundred undergraduate health care students from four academic
programs participated in the study. The study sample was drawn from each
academic program by a simple random sampling technique using the class
directory from each course. The Infection Control Standardized
Questionnaire (ICSQ) was used to assess the knowledge of students about
three main domains, ie, hand hygiene, nosocomial infections, and standard
precautions. A maximum score of 50 was obtainable, and respondents with
scores =70% were classified as having a satisfactory knowledge. The
response on each item was coded numerically to generate data for
statistical analysis. Comparison of knowledge on the domains among
categories of students was assessed using the Kruskal-Wallis test, while
associations between courses of study and knowledge about nosocomial
infections were determined using the Chi-square test. All statistical tests
had a significant level of 5% (P < 0.05)

RESULTS: Overall mean percentage score of the participants on ICSQ was 65.4
± 2.58, with medical, physiotherapy, radiography, and nursing students
recording mean percentage scores of 70.58 ± 0.62, 65.02 ± 2.00, 64.74 ±
1.19, and 61.31 ± 2.35, respectively. The main source of information about
the prevention of nosocomial infections as cited by participants was their
routine formal training in class. There was no significant association (P >
0.05) between course of study and knowledge of students about preventive
measures for nosocomial infections.

CONCLUSION: The students sampled demonstrated moderate knowledge of
nosocomial infections and this was acquired largely through formal
classroom training. These findings underscore the need for more emphasis on
education about this important source of infection in the clinical training
curriculum.
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Description of nosocomial infection prevention practices by
anesthesiologists in a university hospital
__________________________________________________________________

Rev Bras Anestesiol. 2011 Mar-Apr;61(2):177-81, 182-7, 95-100.

Description of nosocomial infection prevention practices by
anesthesiologists in a university hospital.

[Article in English, Portuguese, Spanish]

Kishi D, Videira RL.

Disciplina de Anestesiologia Faculdade de Medicina da Universidadede São
Paulo (USP), Hospital das Clínicas (HC) of Faculdade de Medicina of USP
(FM/USP), Brazil. dk3www@yahoo.com

BACKGROUND AND OBJECTIVES: Anesthesiologists play an important role in the
prevention of nosocomial infections. In anesthetic practice, physiologic
barriers are routinely breached, allowing patient contamination with
microorganisms and the consequent development of infection. The lack of
adhesion to recommended practices can facilitate transmission of
microorganisms. It is important to describe prophylactic practices of
anesthesia-related nosocomial infections performed by anesthesiologists.

METHODS: Structured questionnaires were distributed to be answered
voluntarily and anonymously by anesthesiologists.

RESULTS: Among 112 anesthesiologists, 75% answered the questionnaire.
Surgical mask is used by 95.2% of anesthesiologists, 96.3% wear gloves
frequently, 98.9% wear sterile gloves for neuraxial block, 91.3% use
sterile technique for central venous puncture, 95.1% wash their hands
between cases, 91.6% try to maintain the endotracheal tube sterile, 96.3%
discard the prefilled propofol syringe at the end of each anesthesia, 30%
clean the vials before using it in the neuraxial blocks, and 19.8% clean
the vials before intravenous use.

CONCLUSIONS: Respondents showed good adhesion to practices of nosocomial
infection prophylaxis and to improve them educational multidisciplinary
campaigns are necessary.

Copyright © 2011 Elsevier Editora Ltda. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

9. Abstract: An evaluation of sharp safety blood evacuation devices
__________________________________________________________________

Nurs Stand. 2011 Jun 29-Jul 5;25(43):41-7.

An evaluation of sharp safety blood evacuation devices.

Ford J, Phillips P.

Surgical Materials Testing Laboratory, Princess of Wales Hospital,
Bridgend. joanna@smtl.co.uk

This article describes an evaluation of three sharp safety blood evacuation
devices in seven Welsh NHS boards and the Welsh Blood Service. Products
consisted of two phlebotomy needles possessing safety shields and one
phlebotomy device with wings, tubing and a retractable needle. The device
companies provided the devices and appropriate training.

Participating healthcare workers used the safety device instead of the
conventional device to sample blood during the evaluation period and each
type of device was evaluated in random order. Participants filled in a
questionnaire for each type of device and then a further questionnaire
comparing the two shielded evacuation needles with each other

Results showed that responses to all three products were fairly positive,
although each device was not liked by everyone who used it.

When the two shielded evacuation devices were compared with each other,
most users preferred the device with the shield positioned directly above
the needle to the device with the shield at the side. However, in
laboratory tests, the preferred device produced more fluid splatter than
the other shielded device on activation.
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Epidemiological changes in hepatitis B prevalence in an
entire population after 20 years of the universal HBV vaccination
programme
__________________________________________________________________

Epidemiol Infect. 2011 Aug;139(8):1159-65.

Epidemiological changes in hepatitis B prevalence in an entire population
after 20 years of the universal HBV vaccination programme.

Shen LP, Zhang Y, Wang F, Zhang S, Yang JY, Fang KX, Yu T, Wang XY, Zhang
WY, Bi SL.

National Institute for Viral Disease Control and Prevention, Center for
Disease Control and Prevention, Beijing 102206, China.

A universal hepatitis B vaccination programme has been conducted in Long An
county since 1986. To investigate the epidemiological changes in hepatitis
B virus (HBV) infection we conducted a serosurvey there in 2005. A total of
4686 subjects were enrolled and vaccination history and blood samples
collected. HBV infective markers were determined by radioimmunoassay. The
results were compared with the data of 1985.

Our results show that the overall HBsAg prevalence was 7·5%, less than half
of the prevalence reported in 1985. HBsAg and anti-HBc antibody prevalence
in people born after 1985 decreased markedly. The gender difference in
HBsAg prevalence was abolished in subjects aged <20 years.

The administration of a first dose of vaccine within 24 h could reduce the
HBsAg prevalence by half. In conclusion, the marked epidemiological changes
in HBV prevalence found in this serosurvey indicate that the implementation
of HBV vaccination was highly successful.
__________________________________________________________________
________________________________*_________________________________

11. Abstract: Endophthalmitis After Intravitreal Injection: The Importance
of Viridans Streptococci
__________________________________________________________________

Retina. 2011 Sep;31(8):1525-33.

Endophthalmitis After Intravitreal Injection: The Importance of Viridans
Streptococci.

Chen E, Lin MY, Cox J, Brown DM.

From the *Retina Consultants of Houston, The Methodist Hospital, Houston,
Texas; and †Rush University Medical Center, Section of Infectious Diseases,
Chicago, Illinois.

PURPOSE: To determine the rate of postinjection endophthalmitis and compare
microbial etiology and outcomes in office-based injection-related
endophthalmitis versus those acquired after operating room procedures.

METHODS: Retrospective, observational case series. Consecutive cases of
endophthalmitis seen at Retina Consultants of Houston between July 2000 and
July 2010 were classified as postsurgical or post-intravitreal injection.
Cases secondary to glaucoma surgery, trauma, and endogenous sources were
excluded. Main study measures were incidence of endophthalmitis,
microbiology results, and visual outcomes.

RESULTS: In all, 109 cases of endophthalmitis were identified: 88
postsurgical and 21 post-intravitreal injection (3 from clinical trials and
5 from outside ophthalmologists). A total of 33,580 intravitreal injections
were performed at Retina Consultants of Houston (endophthalmitis rate =
0.04%, 13 of 33,580; 95% confidence interval, 0.02-0.07%). The most common
organisms isolated overall were coagulase-negative staphylococci, while
viridans streptococci, a component of human oral flora, was identified over
three times more often in the postinjection group compared with the
postsurgical group. Compared with all other culture-positive cases related
to intravitreal injection, postinjection endophthalmitis secondary to
viridans streptococci presented much more rapidly (P < 0.001) and final
visual outcomes were much worse (P = 0.004)

CONCLUSION: Although the overall risk of postinjection endophthalmitis is
low, viridans streptococci were identified over three times more frequently
in postinjection cases compared with postsurgical cases and these cases had
much worse clinical outcomes. The office-based setting for intravitreal
injections may lead to a higher risk for infection from oral pathogens.
__________________________________________________________________
________________________________*_________________________________

12. Abstract: Transfusion-Associated Babesiosis in the United States: A
Description of Cases
__________________________________________________________________

Transfusion-Associated Babesiosis in the United States: A Description of
Cases

Barbara L. Herwaldt, MD, MPH; Jeanne V. Linden, MD, MPH; Elizabeth
Bosserman, MPH; Carolyn Young, MD; Danuta Olkowska, MD; and Marianna
Wilson, MS

+ Author Affiliations

From the Centers for Disease Control and Prevention, Atlanta, Georgia; New
York State Department of Health, Wadsworth Center, Albany, New York; and
Rhode Island Blood Center, Providence, Rhode Island.

Background: Babesiosis is a potentially life-threatening disease caused by
intraerythrocytic parasites, which usually are tickborne but also are
transmissible by transfusion. Tickborne transmission of Babesia microti
mainly occurs in 7 states in the Northeast and the upper Midwest of the
United States. No Babesia test for screening blood donors has been
licensed.

Objective: To ascertain and summarize data on U.S. transfusion-associated
Babesia cases identified since the first described case in 1979.

Design: Case series.

Setting: United States.

Patients: Case-patients were transfused during 1979-2009 and had
posttransfusion Babesia infection diagnosed by 2010, without reported
evidence that another transmission route was more likely than transfusion.
Implicated donors had laboratory evidence of infection. Potential cases
were excluded if all pertinent donors tested negative.

Measurements: Distributions of ascertained cases according to Babesia
species and period and state of transfusion.

Results: 159 B. microti transfusion-associated cases were included; donors
were implicated for 136 (86%). The case-patients’ median age was 65 years
(range, <1 to 94 years). Most cases were associated with red blood cell
components; 4 were linked to whole blood-derived platelets. Cases occurred
in all 4 seasons and in 22 (of 31) years, but 77% (122 cases) occurred
during 2000-2009. Cases occurred in 19 states, but 87% (138 cases) were in
the 7 main B. microti-endemic states. In addition, 3 B. duncani cases were
documented in western states.

Limitation: The extent to which cases were not diagnosed, investigated,
reported, or ascertained is unknown.

Conclusion: Donor-screening strategies that mitigate the risk for
transfusion transmission are needed. Babesiosis should be included in the
differential diagnosis of unexplained posttransfusion hemolytic anemia or
fever, regardless of the season or U.S. region.

Primary Funding Source: None.

Full Article Free at http://tinyurl.com/TransfusAssoBabesio
__________________________________________________________________
________________________________*_________________________________

13. Abstract: Nursing and physician attire as possible source of nosocomial
infections
__________________________________________________________________

AJIC: American Journal of Infection Control
Volume 39, Issue 7 , Pages 555-559, September 2011

Nursing and physician attire as possible source of nosocomial infections

Presented as an abstract at the 48th Interscience Conference on
Antimicrobial Agents and Chemotherapy, Washington, DC, October 25-28, 2008.

Yonit Wiener-Well, MD, Margalit Galuty, RN, MSc, Bernard Rudensky, PhD,
Yechiel Schlesinger, MD, Denise Attias, BSc, Amos M. Yinnon, MD

Background: Uniforms worn by medical and nursing staff are not usually
considered important in the transmission of microorganisms. We investigated
the rate of potentially pathogenic bacteria present on uniforms worn by
hospital staff, as well as the bacterial load of these microorganisms.

Methods: Cultures were obtained from uniforms of nurses and physicians by
pressing standard blood agar plates at the abdominal zone, sleeve ends, and
pockets. Each participant completed a questionnaire.

Results: A total of 238 samples were collected from 135 personnel,
including 75 nurses (55%) and 60 physicians (45%). Of these, 79 (58%)
claimed to change their uniform every day, and 104 (77%) defined the level
of hygiene of their attire as fair to excellent. Potentially pathogenic
bacteria were isolated from at least one site of the uniforms of 85
participants (63%) and were isolated from 119 samples (50%); 21 (14%) of
the samples from nurses’ gowns and 6 (6%) of the samples from physicians’
gowns (P = NS) included of antibiotic-resistant bacteria.

Conclusion: Up to 60% of hospital staff’s uniforms are colonized with
potentially pathogenic bacteria, including drug-resistant organisms. It
remains to be determined whether these bacteria can be transferred to
patients and cause clinically relevant infection.
__________________________________________________________________
________________________________*_________________________________

14. Abstract: A 16-week open-label, multicenter pilot study assessing
insulin pump therapy in patients with type 2 diabetes suboptimally
controlled with multiple daily injections
__________________________________________________________________

J Diabetes Sci Technol. 2011 Jul 1;5(4):887-93.

A 16-week open-label, multicenter pilot study assessing insulin pump
therapy in patients with type 2 diabetes suboptimally controlled with
multiple daily injections.

Frias JP, Bode BW, Bailey TS, Kipnes MS, Brunelle R, Edelman SV.

University of California, San Diego, San Diego, California.

Background: We assessed the efficacy, safety, and patient-reported outcomes
(PROs) of insulin pump therapy in patients with type 2 diabetes mellitus
(T2DM) who were suboptimally controlled with a multiple daily injection
(MDI) regimen.

Methods: In this subanalysis of a 16-week multicenter study, 21 insulin-
pump-naïve patients [age 57 ± 13 years, hemoglobin A1c (A1C) 8.4 ± 1.0%,
body weight 98 ± 20 kg, total daily insulin dose 99 ± 65 U, mean ± standard
deviation] treated at baseline with MDI therapy with or without oral
antidiabetic agents discontinued all diabetes medications except metformin
and initiated insulin pump therapy. Insulin was titrated to achieve the
best possible glycemic control with the simplest possible dosing regimen.
Outcome measures included A1C, fasting and postprandial glucose, body
weight, incidence of hypoglycemia, and PROs.

Results: Glycemic control improved significantly after 16 weeks: A1C 7.3 ±
1.0% (-1.1 ± 1.2%, p < .001), fasting glucose 133 ± 33mg/dl (-32 ± 74
mg/dl, p < .005), and postprandial glucose 153 ± 35 mg/dl (-38 ± 46 mg/dl,
p < .001). At week 16, the mean daily basal, bolus, and total insulin doses
were 66 ± 36, 56 ± 40, and 122 ± 72 U (1.2 U/kg), respectively, and 90% of
patients were treated with two or fewer daily basal rates. Body weight
increased by 2.8 ± 2.6 kg (p < .001). Mild hypoglycemia was experienced by
81% of patients at least once during the course of the study with no
episodes of severe hypoglycemia. There were significant improvements in PRO
measures.

Conclusions: Insulin pump therapy using a relatively simple dosing regimen
safely improved glucose control and PROs in patients with T2DM who were
unable to achieve glycemic targets with MDI therapy. Controlled trials are
needed to further assess the clinical benefits and cost-effectiveness of
insulin pumps in this patient population.

© 2011 Diabetes Technology Society.
__________________________________________________________________
________________________________*_________________________________

15. Abstract: Botulinum Toxin for Glabellar Lines: A Review of the Efficacy
and Safety of Currently Available Products
__________________________________________________________________

Am J Clin Dermatol. 2011 Aug 30.

Botulinum Toxin for Glabellar Lines: A Review of the Efficacy and Safety of
Currently Available Products.

Dessy LA, Fallico N, Mazzocchi M, Scuderi N.

Department of Plastic and Reconstructive Surgery, Sapienza University of
Rome, Rome, Italy.

Facial rhytides represent a widespread aesthetic concern. In particular,
glabellar lines are perceived as a sign of aging and may give an erroneous
impression of negative emotions. The onset of glabellar lines is closely
related to the movements of the underlying muscles. Botulinum toxins
inhibit the release of acetylcholine into the synaptic cleft and therefore
result in temporary muscle paralysis. The observation that botulinum toxin
(BTX) smoothed facial lines when used therapeutically led researchers to
study the toxin effect on glabellar lines. Nowadays, the use of BTX to
smooth glabellar frown lines represents the leading procedure in aesthetic
facial treatments and an increasing number of BTX formulations are becoming
available.

This article provides a comparative evaluation of currently available BTX
options for the treatment of glabellar lines. Toxins have been divided into
three groups, based on whether they have obtained approval for cosmetic use
(approved treatments) or not (off-label treatments), or whether they are
still under investigation (experimental treatments). We examine the basic
similarities and differences between available botulinum toxins, and
summarize the pharmacokinetics and dosing.

All approved treatments consist of BTX type A (BTX-A) and differ in their
molecular weight, as some formulations are made of a BTX-A complex of
900?kDa while the latest option on the market is a 150?kDa BTX-A that is
free from complexing proteins. As for the dosage, the important aspect that
emerges from this comparison is that even within a given serotype, such as
BTX-A, formulations are not interchangeable as each possesses distinctive
characteristics that are attributed to the unique toxin purification and
manufacturing processes. There is a substantial body of published evidence
on the use of these approved treatments for facial enhancement, proving
efficacy and safety. We investigate the methods of evaluation used for each
toxin and review the safety and efficacy data reported in the literature.

Minor adverse effects, such as headache, blepharoptosis, and injection-site
reactions, are relatively frequent but transient, whilst major adverse
effects are rare. Some botulinum toxins, i.e. BTX type B, that are approved
for therapeutic applications are used off-label for cosmetic indications,
thus without the approval of the health regulatory committees and without
sufficient published evidence on safety and efficacy.

As for experimental treatments, a number of BTX products are currently in
development or have been recently launched for aesthetic applications.
These products have been specifically designed to overcome some of the
limitations present in the older generation of products.

However, some of these toxins may be easily purchased via the Internet,
without having any license or approval for cosmetic or therapeutic
indications; these products must be considered unsafe and are potentially a
severe health risk for patients.
__________________________________________________________________
________________________________*_________________________________

16. No Abstract: Safe Injection Practices: Keeping Safety In and the “Bugs”
Out
__________________________________________________________________

J Emerg Nurs. 2011 Sep 1.

Safe Injection Practices: Keeping Safety In and the “Bugs” Out.

Paparella S.
__________________________________________________________________
________________________________*_________________________________

17. No Abstract: Electronic online infection prevention and control modules
for health care workers
__________________________________________________________________

Aust Nurs J. 2011 Aug;19(2):41, 43.

Electronic online infection prevention and control modules for health care
workers.

Greig S.

Australian Commission on Safety and Quality in Health Care.
__________________________________________________________________
________________________________*_________________________________

18. No Abstract: Disinfection and sterilization of prion-contaminated
medical instruments
__________________________________________________________________

Infect Control Hosp Epidemiol. 2010 Dec;31(12):1304-6; author reply 1306-8.

Disinfection and sterilization of prion-contaminated medical instruments.

Belay ED, Schonberger LB, Brown P, Priola SA, Chesebro B, Will RG, Asher
DM.

Comment on Infect Control Hosp Epidemiol. 2010 Feb;31(2):107-17.
__________________________________________________________________
________________________________*_________________________________

19. No Abstract: Hepatitis in drug users: time for attention, time for
action
__________________________________________________________________

Lancet. 2011 Aug 13;378(9791):543-4.

Hepatitis in drug users: time for attention, time for action.

Amon JJ.

Health and Human Rights Division, Human Rights Watch, New York, NY 10118,
USA. amonj@hrw.org

Comment on Lancet. 2011 Aug 13;378(9791):571-83.
__________________________________________________________________
________________________________*_________________________________

20. News

– USA: CDC Sees More Exposure to Infections in Diabetes Testing
– UK: Nurse Rebecca Leighton returns home as GMP chief Peter Fahy
speaks out over ‘pressure’ of Stepping Hill case
– UK: Contaminated blood inquiry resumes hearing evidence: Lord Penrose is
chairing the inquiry into how people were infected with Hepatitis C and
HIV through transfusions
– Chris Evans in a Dramatic New Clip From Puncture
– USA: Hepatitis C numbers on the rise in county: Outbreak blamed on
increased IV drug usage
– UK: Seven patients’ deaths part of sabotage probe
– USA: Diabetes device-related infections a growing concern, CDC says
– USA: Five More Reports of Avastin Injections Causing Blindness
– USA: Repackaged Avastin caused eye infections in Florida
– USA: Wisconsin Clinic Warns of Possible Disease Exposures
– USA; Disease exposure via medical devices a growing concern, CDC says
Dean Clinic in Madison testing patients
– WHO: Pentavalent, Easyfive™, Removed From Who List Of Prequalified
Vaccines
– WHO Advisory Committee Concludes That New Meningitis Vaccine Is
Safe
– Iran: Iranian HIV Physician Released From Tehran Prison

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

USA: CDC Sees More Exposure to Infections in Diabetes Testing
By Leigh Page, Becker’s ASC Review, USA (06.09.11)

The Centers for Disease Control & Prevention said more patients in group
settings are being exposed to blood-borne infections during diabetes
testing, glucose monitoring and insulin delivery, according to a Milwaukee
Journal Sentinel report.

Misused equipment and poorly trained staff have forced thousands to undergo
blood testing for HIV, hepatitis B and hepatitis C over the past decade.
For example, more than 2,300 patients were potentially exposed to
infectious disease at a Wisconsin hospital where a fingerstick blood
glucose sampling pen wasn’t properly cleaned between uses.

The CDC counted at least 15 outbreaks of HBV infection in the past 10 years
associated with failing to follow basic principles of infection control
when assisting with blood glucose monitoring.
__________________________________________________________________
__________________________________________________________________

UK: Nurse Rebecca Leighton returns home as GMP chief Peter Fahy
speaks out over ‘pressure’ of Stepping Hill case
Manchester Evening News, UK (06.09.11)

Stepping Hill hospital nurse Rebecca Leighton returned to her parents’ home
in Denton as police chief Peter Fahy spoke of the ‘pressure’ his force was
under over the investigation into patient deaths.

Miss Leighton, 27, was pictured with her boyfriend Tim Papworth as she left
her family home to be driven away by her dad. It is the first time she has
been seen in public since she was dramatically released from prison last
Friday.

Greater Manchester Police chief constable Mr Fahy has told how police were
‘under pressure’ to catch the Stepping Hill saboteur when Miss Leighton was
charged.

But he insisted the pressure they were under didn’t lead to a rushed
decision to charge her.

And he compared the ‘complex’ investigation to find the real poisoner at
Stepping Hill Hospital to Agatha Christie mystery ‘Murder on the Orient
Express’.

Ms Leighton, 27, from Stockport, spent six weeks in custody accused of
contaminating saline fluids at the hospital before all charges against her
were dramatically dropped.

Asked if he thought it was right to charge Ms Leighton Mr Fahy said: “Yes,
I think you must remember the pressure officers were under.

“It is common sense that officers were under pressure to make sure there
was not another occurrence of contamination at the hospital.

“That did not translate into a decision to charge.

“The CPS set high standards. The evidence was assessed by the CPS who still
decided to charge.”

Speaking about the problems facing the investigating officers, Mr Fahy
said: “The difficulty is you don’t only have to prove that someone is
responsible but you also have to eliminate the possibility that no one else
could be involved.

“We have a situation where 700 people may have had access to the crime
scene and yet we have to show that no one else could be involved. It is
like Murder on the Orient Express but with a lot more people on the train.”

He insisted a team of detectives was ‘determined’ to identify those
responsible. He said: “It is a very complex investigation, 700 people had
access to a crime scene that was never shut.

“We did discuss shutting one ward with the hospital but it was decided that
moving people out of a ward could pose a risk to their welfare.

“The situation is almost unique. Normally in a murder in a house or a pub
you can quickly establish who was at the scene. This will take many months.
And the transient nature of some hospital staff – who may have moved on –
is another difficulty we have to face – tracking them down.

“Our nightmare was that we could have another death. Nothing has happened
since we got involved.”

Ms Leighton was first held on suspicion of murder and then formally charged
with causing criminal damage with intent to endanger life two days later.
Last week prosecutors said it was ‘no longer appropriate’ to continue
proceedings against her.

And last night a police source said: “It has been an investigation to find
the truth, not a witch-hunt against anyone.

“There was a great deal of consideration about a fast moving situation that
had huge implications of patient care and access to the vulnerable.

“Then a tipping point was reached and the decision was made to arrest
Rebecca Leighton.

Evidence put to the CPS passed the threshold test that had to be met.”
Police are continuing to probe the deaths of Tracey Arden, 44, Arnold
Lancaster, 71, and Derek Weaver, 83, and the deaths of a further four
unnamed victims.

Officers believe another 33 people may also have been potential victims of
contamination but survived. Anyone with information should contact the
incident room on 0161 856 2480 or Crimestoppers, anonymously, on 0800 555
111.
__________________________________________________________________
__________________________________________________________________

UK: Contaminated blood inquiry resumes hearing evidence: Lord Penrose is
chairing the inquiry into how people were infected with Hepatitis C and HIV
through transfusions
stv.tv, Scotland UK (06.09.11)

Evidence: The inquiry will hear from witnesses until December.

An inquiry into how people were infected with Hepatitis C and HIV from
contaminated blood is to resume hearing evidence.

Hundreds of people in Scotland, many of them haemophiliacs who need regular
transfusions, were given contaminated blood in the 1970s and 1980s.

The inquiry, which is investigating how the NHS collected, treated and
supplied blood, is also hearing testimony from patients and evidence on how
they were monitored.

Lord Penrose is chairing the inquiry, which began two years ago at the
instigation of the Scottish Government.

The current session, the fourth since the inquiry began taking evidence in
March this year, is expected to run until December.

The inquiry opened in March 2009 with a minute’s silence for all those who
died from infected blood products.

An interim report was published last September after the inquiry team had
read 80,000 reports and taken more than 100 witness statements, but did not
draw any conclusions.

Lord Penrose has said no individuals or institutions will be held
criminally liable as a result of the probe, after health Secretary Nicola
Sturgeon indicated in April 2008 that compensation would not form part of
the inquiry.

He told the inquiry that “actions and failures” may be identified, but
added: “Neither of those matters will involve finding individuals or
institutions legally liable to penalties, or for damages or for breach of
duty in a legal sense.”
__________________________________________________________________
__________________________________________________________________

Chris Evans in a Dramatic New Clip From Puncture
by: Karen Benardello, We Got This Covered.com (05.09.11)

A dramatic new clip from the upcoming independent film Puncture, starring
Chris Evans and Brett Cullen, has been released by its distributor,
Millennium Entertainment. The clip, titled “I’ll See You in Court,”
features Chris Evans‘ character, Mike Weiss, a Houston lawyer who’s
determined to take Cullen’s character, Nathaniel Parker, to court.

Mike becomes upset that Nathaniel won’t release a needle that can prevent
spreading HIV because it costs too much money. The young lawyer is also
upset that his partner, Paul Danziger, played by the film’s co-director,
Mark Kassen, and their client settled a lawsuit against Nathaniel out of
court.

Puncture marks the feature debuts of Kassan, his brother Adam (who co-
directed the movie with him), and screenwriter Chris Lopata. The film
follows the talented Mike and his long-time friend Paul, who’s a
functioning drug addict, as they’re struggling to keep their personal
injury law firm open.

They agree to take on a case involving ER nurse Vicky, portrayed by Vinessa
Shaw, who was pricked by a contaminated needle while working. Puncture
follows Mike and Paul as they’re determined to stand up for their clients,
and take on health care and pharmaceutical conspiracies.

Check out the “I’ll See You in Court” clip below, and tell us what you
think. While Chris Evans is known for his action roles as of late, his turn
in Puncture already looks promising. I’m looking forward to seeing his
performance when the film opens in select theaters on September 23.

I’ll See You in Court Trailer: http://www.youtube.com/watch?v=44kbpm8DFGE
Watch Puncture Trailer – http://youtu.be/bviVmnhNIcM?hd=1
__________________________________________________________________
__________________________________________________________________

USA: Hepatitis C numbers on the rise in county: Outbreak blamed on
increased IV drug usage
Sarah Kloepping, Herald Times Reporter, Manitowoc, WI USA (05.09.11)

MANITOWOC – Manitowoc County is seeing an increased number of Hepatitis C
cases, but health officials say that’s only one symptom of a bigger problem
in the community.

“We have a large number of people who are addicted to IV drugs, and
addiction is something that is very difficult to get treatment for,” said
Amy Wergin, public health nurse manager.

In 2010, Manitowoc County had 35 new cases of Hepatitis C, a slow-
developing liver disease spread primarily by exposure to human blood from
an infected person. So far this year, 44 cases have been reported with
nearly 200 people still needing to be tested.

“All you need is one person in a group with an infectious disease and it
just moves from person to person to person,” Wergin said. “And that’s
basically what happened. We had a couple people with a longstanding
infection and then as the number of addicted people went up and they
started sharing their needles and their works, they spread the disease.”

Symptoms
Public health nurse Carrie Redo said people often don’t know they’ve been
infected by the virus, which causes inflammation of the liver and could
lead to liver cancer or complete liver failure, until years later because
symptoms rarely are present.

“It’s kind of like a smoldering fire … and it’s really, really slow, but
if you add to it drugs, alcohol, Tylenol, it’s like pouring gasoline on it
and then it goes really quick,” she said. “Most of the clients I’m working
with have no symptoms,” They’re shocked that they have it.”

Wergin said Hepatitis C traditionally is discovered when a middle-aged
person goes to their doctor for another reason and liver damage is found.
Typical cases are men who used IV drugs or had a blood transfusion during
the Vietnam War, other individuals who had transfusions before testing was
available to check if the blood was safe to use, or someone who got a
tattoo or piercing at an unlicensed location.

“The people who are over the age of 50 are old cases,” Wergin said. “Those
are people who have probably been infected for 30 years or longer.”

Younger individuals
But in Manitowoc County, the number of younger individuals found with the
disease is increasing. So far this year, more than 40 percent of cases in
the county were younger than 30, compared to 30 percent in 2010 and 23
percent in 2009.

“And 99 percent of them are related to IV drug use,” Wergin said. “With
these younger people … they truthfully are what I’d call a new case, as
opposed to somebody who’s had it for many years and is just discovering
it.”

Statistics
According to the most recent statistics available from the Wisconsin
Hepatitis C Program, in 2009, 16 other counties in the state had the same
or more reported cases than Manitowoc County.

Milwaukee County had the most cases at 695, Dane County had 151 and Kenosha
County had 114.

Of the total 1,855 confirmed cases and 600 probable cases throughout the
state in 2009, approximately 38 percent were between the ages of 45 and 54
and 22 percent were between 55 and 64.

Wergin said when someone is diagnosed, he or she is interviewed to find out
who they might have spread the virus to. An attempt is then made to track
those people down for testing.

“It’s a very contagious virus,” Wergin said. “If you’re sharing a needle
with someone who has Hepatitis C, that’s a good bet you’re going to get
it.”

Treatments are available for Hepatitis C, but until patients are drug and
alcohol free Redo said they shouldn’t be treated because if they don’t take
the medication like they should, may become resistant to it.

“And the treatment is expensive, Redo said. “The treatment is hard on the
body … it’s compared to like (chemotherapy) and it can go all the way up
to
a year, depending on what strain you have. Hepatitis C is the No. 1 reason
for liver transplants.”

Wergin and Redo said their hope is through continued education of how to
prevent spreading the virus, the number of cases in the county will begin
to decrease.
__________________________________________________________________
__________________________________________________________________

UK: Seven patients’ deaths part of sabotage probe
Yorkshire Post, UK (03.09.11)

Greater Manchester Police last night revealed it was investigating the
deaths of seven patients -and potentially 40 victims in total – connected
with sabotaged saline drips at a Stockport hospital.

The force revealed more details of the ongoing investigation in the wake of
the dramatic release from prison of Rebecca Leighton, a 27-year-old nurse,
after the Crown Prosecution withdrew its case against her.

Four names of those whose deaths are being probed have yet to be revealed
but their families are aware that the cases have been referred to police by
Stockport Coroner John Pollard.

Detectives had previously announced they were looking at the suspicious
deaths of Tracey Arden, 44, Arnold Lancaster, 71, and Derek Weaver, 83.

Explaining the decision to drop the charges against Miss Leighton, CPS
prosecutor Nazir Afzal said: “The inquiries, which are still ongoing, have
not so far provided us with a stronger case which would meet the test that
there is sufficient evidence for a realistic prospect of conviction.”

He said the prosecution could be restarted if “further evidence is
presented” but added “on the evidence currently available there is not a
case in law which could proceed”.

Speaking about the potential 40 victims, Assistant Chief Constable Terry
Sweeney said: “All these people who came into the contact of the hospital
were particularly poorly people so we have to understand the impact of
contamination, although we are clear there was contamination in a number of
saline products.

“This investigation is without doubt one of the most complex investigations
that our most senior detectives have ever worked on, comparable in size and
scope to the Manchester bomb inquiry.

“The scope of this investigation is extensive and we cannot rule out making
other arrests in our search for the truth, and this remains as true as
ever.”

The force has interviewed 200 out of 700 people they want to speak to. The
list includes potential victims as well as staff at Stepping Hill hospital,
patients and visitors.

Police said there had been no further cases of product contamination or
related deaths since the initial incidents, but it “cannot rule out further
incidents”.

Mr Sweeney said: “In this case our further investigation has shown that
there were over 700 people who could have had access to the area concerned
in a tight time period.”

He said a working hospital is a very busy working environment where “huge
numbers” of people come and go. “No one has made any definitive admissions
in this case, there is obviously no CCTV of patient treatment and many
members of staff had legitimate access to the areas and materials involved,

“We need a long period of time to complete this investigation and eliminate
those who were not involved and it is only right in these circumstances to
discontinue the case until we can deal with these issues.

“The decision to charge Rebecca Leighton by the CPS was the correct one at
the time and was based on the information and evidence available then.
__________________________________________________________________
__________________________________________________________________

USA: Diabetes device-related infections a growing concern, CDC says
MassDevice.com (02.09.11)

Improper use of glucose monitoring and insulin delivery devices in clinical
settings has the Centers for Disease Control & Prevention worried about an
uptick in infectious disease transmission.

The number of patients exposed to blood-borne infections during diabetes
testing, glucose monitoring and insulin delivery in group settings is on
the rise, according to the Centers for Disease Control & Prevention.

Misused equipment and improperly trained staff have forced thousands to
undergo blood testing for HIV, hepatitis B and hepatitis C over the past
decade, but an aging population and increasing rate of diabetes has the CDC
concerned about an uptick in potential outbreaks.

Bad hospital practices were blamed in the most recent patient advisory,
when more than 2,300 patients were potentially exposed to infectious
disease at a Wisconsin hospital where a fingerstick blood glucose sampling
pen wasn’t properly cleaned between uses.

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“The Centers for Disease Control and Prevention (CDC) has become
increasingly concerned about the risks for transmitting hepatitis B virus
(HBV) and other infectious diseases during assisted blood glucose (blood
sugar) monitoring and insulin administration,” the CDC reported. “Reports
of HBV (hepatitis B) infection outbreaks linked to diabetes care have been
increasing.”

The problem is of particular concern in long-term care facilities where
patients often need help testing their glucose levels and injecting
insulin.

“In the last 10 years, alone, there have been at least 15 outbreaks of HBV
infection associated with providers failing to follow basic principles of
infection control when assisting with blood glucose monitoring,” according
to the CDC’s site. “Due to under-reporting and under recognition of acute
infection, the number of outbreaks due to unsafe diabetes care practices
identified to date are likely an underestimate.”

In 2010 dozens of health fair attendees in New Mexico were put at risk when
a fingerstick device was reused. In 2009 more than 2,000 people were urged
to undergo testing after individual insulin pens were used for multiple
patients.

In the Wisconsin outbreak, patients were potentially exposed to HIV and
other diseases over the course of five years when a nurse, who was a
certified diabetic educator and who left her job two weeks ago, used a
fingerstick pen on multiple patients. Her job was to train newly diagnosed
diabetics on proper glucose monitoring and insulin injection, the
Associated Press reported.

A hospital whistleblower reported the nurse for using a fingerstick pen
meant for demonstration on inanimate objects on patients. She used a clean
needle each time, but blood can backflow into the pen’s reservoir and
contaminate the next person pricked by the pen.

No incidence of actual disease exposure were found as of Monday, according
to the news wire.

“This is what we call infection control 101,” CDC epidemiologist Joe Perz
told the Milwaukee Wisconsin Journal Sentinel. “One of the most common
myths is that contamination is limited to the needle. An insulin cartridge
is a form of syringe. And a syringe and needle should be seen as a single
device. One can contaminate the other.”

News Well, Diabetes, Diseases, Insulin Management
__________________________________________________________________
__________________________________________________________________

USA: Five More Reports of Avastin Injections Causing Blindness
By Andrew Pollack, New York Times, NY USA (01.09.11)

LOS ANGELES – Five more patients who were being treated with the drug
Avastin for eye disease have been blinded, according to one of the patients
and medical professionals.

The latest cases occurred last month at the Veterans Affairs medical center
in Los Angeles. Late Thursday, the Department of Veterans Affairs confirmed
that the problem had occurred and said that an investigation into the
matter was continuing.

“Our deepest sympathy goes out to the veterans affected by the Avastin eye
injections,” it said in a statement.

Avastin, made by Genentech, is a cancer drug but is commonly used to treat
the wet form of age-related macular degeneration and other eye diseases
because it costs only about $50 an injection.

That saves Medicare and patients hundreds of millions of dollars a year
compared with using Lucentis, a somewhat similar Genentech drug approved
for the treatment of eye diseases but costing about $2,000 an injection.

To use Avastin for eye disease, a vial meant for a cancer patient must be
divided into numerous tiny doses and each dose placed in a syringe for
injection into the eye. The extra handling increases the risk of bacterial
contamination and other problems.

On Tuesday, the Food and Drug Administration issued an alert saying that 12
patients in the Miami area had suffered eye infections after being injected
with Avastin. Some of the patients lost all of the remaining vision in
their treated eye, the F.D.A. said.

Earlier this year, four patients at the Veterans Affairs hospital in
Nashville also suffered infections from the bacterially contaminated
Avastin. The family of one man has filed a claim for $4 million, saying the
infection left the man blind and with brain damage.

In the cases in Los Angeles, no contaminant has been identified, according
to medical professionals and a patient involved. The five patients, who had
macular degeneration, all received their injections of Avastin on Aug. 12
at the V.A. Sepulveda Ambulatory Care Center in the San Fernando Valley.

“We all ended up in the E.R. over the course of the next few days and put
together the connection,” said the patient in Los Angeles. Most of the
patients lost all of their vision in the eye that received the injection,
he said.

This man, who said his vision had not recovered, spoke on the condition of
anonymity because he and other patients were in talks with the V.A. about
the situation.

He said he learned from V.A. officials that the drug had come from the
pharmacy at the main campus of the V.A. Greater Los Angeles Healthcare
System in Los Angeles.

The recent incidents could lead doctors and patients to use the far more
expensive Lucentis instead of Avastin. In its statement, Veterans Affairs
said that its Los Angeles medical center had suspended use of Avastin for
macular degeneration on Aug. 15 and was now buying Lucentis to resume
therapy for the 30 to 40 treatments it administers a week.

Some proponents of the use of Avastin say that there have been more than
two million injections of the drug to treat eyes over the last six years
with few problems.

The cases are also likely to raise questions about so-called compounding
pharmacies, which prepare customized drugs for patients, including doses of
Avastin to treat eye problems.

The F.D.A. has limited oversight of these pharmacies.

In its alert on Tuesday, the F.D.A. said the 12 cases of lost vision in
Miami had been traced to a single compounding pharmacy, which it did not
identify.
__________________________________________________________________
__________________________________________________________________

USA: Repackaged Avastin caused eye infections in Florida
by Debra Sherman, editing by Dave Zimmerman, Reuters (31.08.11)

CHICAGO (Reuters) – Repackaged injections of the cancer drug Avastin, also
known as bevacizumab, have caused a cluster of serious eye infections in
the Miami, Florida area, the Food and Drug Administration said on
Wednesday.

The Florida Department of Health notified the FDA of Streptococcus
endophthalmitis infections in three clinics following injections given
through the eye of repackaged Avastin, manufactured by Roche Holdings.

Investigators traced the tainted injections to a single pharmacy located in
Hollywood, Florida. The pharmacy repackaged the Avastin from sterile
injectable 100 mg/4 mL, single-use, preservative-free vials into individual
1 mL single-use syringes.

The pharmacy then distributed the Avastin to multiple eye clinics.

The FDA said it is aware of at least 12 patients in at least three of these
clinics who had eye infections. While all of the patients had visual
deficits prior to their injections with Avastin, some of these patients
lost all remaining vision in that eye due to the endophthalmitis.

The agency and Florida health officials continue to investigate.
__________________________________________________________________
__________________________________________________________________

USA: Wisconsin Clinic Warns of Possible Disease Exposures
ClaimsJournal.com usa (31.08.11)

A Madison-based clinic is trying to track down hundreds of patients after a
nurse apparently spent years improperly using diabetic injection devices on
them, potentially exposing them to blood-borne diseases such as HIV.

Dean Clinic officials on Monday began trying to contact by phone and letter
2,345 patients who saw the nurse between 2006 and when she left her job two
weeks ago. They want the patients to come in for testing for HIV as well as
hepatitis B and C. State and local health officials said they’re monitoring
the situation, but no one had detected any diseases connected to the nurse
as of late Monday afternoon.

The clinic’s chief medical officer, Dr. Mark Kaufman, said the nurse is a
certified diabetic educator. Her job called for her to train newly-
diagnosed diabetics on how to inject insulin and test their blood sugar
levels.

Clinic officials declined to identify the nurse.

Earlier this month, another clinic employee reported that the nurse was
improperly using a device known as an insulin demonstration pen, which
resembles a large hypodermic needle and injects insulin into the
bloodstream, as well as a more widely-known finger prick device for blood
tests, Kaufman said.

The nurse was supposed to demonstrate how to use the pen on pillows and
oranges, not on the patients themselves, Kaufman said. But an internal
investigation showed she was using the same pen on people. She used clean
needles each time, but using the pen on a person could allow a microscopic
backwash of blood to flow back into the pen’s reservoir, potentially
contaminating it and putting the next patient at risk, Kaufman said.

The finger prick device is supposed to be used on people, but the entire
device should be used only once per patient, Kaufman said. The nurse
changed needles but used the same handle from patient to patient, creating
a risk that blood could get onto it, dry and infect the next fresh needle
and patient.

Copyright 2011 Associated Press.
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USA; Disease exposure via medical devices a growing concern, CDC says
Dean Clinic in Madison testing patients
By Karen Herzog, Milwaukee Journal Sentinel, Milwaukee Wisconsin (31.08.11)

Diabetic patients who may have been exposed to blood-borne diseases at a
Madison-based clinic are now getting tested for hepatitis and HIV.

A nurse who worked at the clinic for the past five years misused equipment
to teach them to inject insulin and test their blood sugar levels, the
clinic said.

Meanwhile, federal officials said they have become increasingly concerned
about the risks of transmitting blood-borne viruses when diabetics are
assisted with testing their blood sugar levels and insulin injections, and
equipment is unsafely reused with multiple patients, as occurred at Dean
Clinic. Dean has about 60 locations in southern Wisconsin and is now re-
educating staff on the proper use of the devices, though the clinic said
only one nurse is accused of reusing equipment while training newly
diagnosed patients to manage their own care.

Outbreaks of hepatitis B associated with blood sugar monitoring have been
identified with increasing regularity, particularly in long-term care
settings such as nursing homes and assisted living facilities, where
residents often require assistance with testing and insulin injections,
according to the U.S. Centers for Disease Control and Prevention.

In the past 10 years, at least 15 hepatitis B outbreaks have been
associated with providers failing to follow basic principles of infection
control when assisting with blood glucose monitoring. Because of
underreporting and under-recognition of infection, the number of outbreaks
likely has been underestimated, the CDC says.

Safe use of diabetes management equipment is a major concern as more
Americans are diagnosed with the disease and as aging boomers move into
assisted living facilities, said Joe Perz, an epidemiologist in the CDC’s
Division of Healthcare Quality Promotion.

“This is what we call infection control 101,” he said. “One of the most
common myths is that contamination is limited to the needle. An insulin
cartridge is a form of syringe. And a syringe and needle should be seen as
a single device. One can contaminate the other.”

The former Dean Clinic employee accused of unsafe conduct is a registered
nurse and certified diabetes educator, trained to show diabetic patients
how to inject insulin with an insulin pen and how to test blood sugar
levels with a finger-stick device.

The nurse changed the needle in the insulin pen and changed the sharp
lancet used to get a drop of blood for testing blood sugar, clinic
officials said. But blood possibly could have adhered to the insulin pens
or finger-stick devices.

The insulin pens also were to be used only on objects, such as oranges, for
demonstration – not on patients.

Dean Clinic learned of the possible exposures in early August from a fellow
employee of the nurse. The health care system notified state and local
officials, along with the CDC.

It’s a good lesson for those training to be nurses, said JoAnn Appleyard,
director of the undergraduate program at University of Wisconsin-
Milwaukee’s College of Nursing.

“This was a very, very serious violation of basic practice,” she said. “You
use equipment only once that is exposed to someone else’s blood.”

Appleyard, a former administrator for quality and safety at a large medical
practice, said nursing students in their first semester of training learn
about quality, safety and risk management. “We can always learn from our
mistakes, or mistakes of others,” she said.

Risk of infection is hard to quantify, said Perz of the CDC.

Assisted monitoring of blood glucose and insulin administration occurs in
hospitals and clinics, schools and camps, and even at health fairs.

According to the CDC, dozens of attendees at a health fair in New Mexico in
2010 were potentially exposed to blood-borne viruses when finger-stick
devices were inappropriately reused for multiple people to conduct diabetes
screening. At a hospital in Texas in 2009, more than 2,000 people were
advised to undergo testing for blood-borne viruses after individual insulin
pens were used for multiple patients.

But misuse of diabetes equipment in a medical clinic setting is “fairly
unique,” Perz said.

Patients notified

Patients identified through electronic records as having met with the Dean
Clinic nurse for diabetes education were notified by phone calls and two
separate letters of their possible exposure.

“While it is hard to speculate on how much it will cost to test these
patients, Dean Clinic is committed to doing whatever it takes to meet the
needs of patients who may be affected,” said Kim Sveum, a spokeswoman for
Dean Clinic.

“We have contacted more than half of the people we need to reach. We are
hard at work seeking to reach the rest by the end of this week.”
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WHO: Pentavalent, Easyfive, Removed From Who List Of Prequalified
Vaccines
Hayatee Hasan, WHO/HQ, WHO Global Imunization News (31.08.11)

Following a routine audit conducted by a WHO team of one of the
manufacturing sites of the vaccine manufacturer, Panacea Biotec, and the
subsequent conclusions of an ad hoc committee convened by WHO, the
pentavalent vaccine, Easyfive has been delisted from WHO’s list of
prequalified vaccines.

Easyfive, containing diphtheria, tetanus, whole cell pertussis, hepatitis
B and haemophilus influenzae type b components, and two other vaccines – a
DTwP-hepatitis B vaccine and a monovalent hepatitis B vaccine – produced by
Panacea, were delisted as a result of deficiencies in quality systems found
at the company’s Lalru manufacturing site. The decision to delist was made
because of the risk, unless corrective action is taken by the manufacturer,
that the quality and safety of future batches of these vaccines will be
compromised. Batches of these vaccines already distributed to countries
should not be recalled and should continue to be used. This is because
there is no evidence of quality or safety defects with batches already
distributed whereas there is a real risk, if immunization is withheld, of
death or morbidity from the diseases against which the vaccines protect.

With regard to vaccine supply, the main concern brought about by this
situation relates to sufficiency of supply of the pentavalent vaccine. WHO
and UN procurement agencies have assessed that demand for pentavalent
vaccine in 2011 can be filled by existing suppliers of prequalified
pentavalent vaccine. Options to ensure sufficient supply to meet demand for
pentavalent vaccine in the mid- to long term are being reviewed.

The prequalified oral polio virus vaccines manufactured by the same company
remain prequalified, given that they are produced at a different site to
that which was audited and the fact that there is no evidence available to
WHO of inadequate quality assurance. For more information, see this link.
www.who.int/immunization_standards/vaccine_quality/DTP_mono_hepb_aug2011
__________________________________________________________________
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WHO Advisory Committee Concludes That New Meningitis Vaccine Is
Safe
Hayatee Hasan, WHO/HQ, WHO Global Imunization News (31.08.11)

Following review of new data for the meningococcal A conjugate vaccine,
MenAfriVac, WHO’s Global Advisory Committee on Vaccine Safety concluded
that the experience from the first three countries to introduce this
vaccine did not indicate any reasons for concern about the vaccine’s
safety. The data reviewed by the Advisory Committee – at its meeting of
15-16 June 2011 – were collected in Burkina Faso, Mali and Niger during the
September and December 2010 vaccination campaigns and from the surveillance
systems. Although the Committee recognized that it would not be practical
to conduct active surveillance on a widespread basis during future
immunization activities, it highlighted the need for continuous
surveillance as the vaccine is rolled out to ensure that further data on
the safety profile of the vaccine can be obtained.

Other issues discussed by the Committee included a new approach for
classifying serious adverse events following immunization, information
sheets describing the safety profile of important vaccines and the
development of a global strategy to enhance vaccine safety capacity in low-
and middle- income countries.

To read the full report, click here. www.who.int/wer/2011/wer8630.pdf

For more information on the Global Advisory Committee on Vaccine Safety,
see this link. http://www.who.int/vaccine_safety/en/index.html
__________________________________________________________________
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Iran: Iranian HIV Physician Released From Tehran Prison
The Kaiser Daily Global Health Policy Report, USA (29.08.11)
Monday, August 29, 2011

“Iranian HIV doctor Arash Alaei has been released from jail in Tehran after
spending more than three years behind bars for allegedly conspiring against
the regime, his U.S.-based brother said Monday,” Agence France-Presse
reports (Sheridan, 8/29).

Arash Alaei and his brother, Kamiar Alaei, who is also a physician, were
arrested in 2008 and “charged with ‘communication with an enemy government’
and for trying to ‘overthrow the government,’ according to Kamiar,” CNN
notes. “Kamiar Alaei served most of a three-year sentence and was released
in October 2010,” the news agency writes (8/29). The brothers, “regarded as
pioneers of AIDS treatment in Iran,” are known for their efforts to treat
people who use injecting drugs and prisoners, according to AFP (8/29).

The Kaiser Daily Global Health Policy Report is published by the Kaiser
Family Foundation. 2011 Henry J. Kaiser Family Foundation.
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