*SAFE INJECTION GLOBAL NETWORK* SIGNPOST *SAFE INJECTION GLOBAL NETWORK* Post00464 Injections + AdverseEvents + Abstracts + News 10 September 2008 CONTENTS 1. HIV infections in Uganda from medical injections 2. Adverse events following traditional male circumcision: Adolescent boys: who cares? 3. Abstract: Male circumcision for HIV prevention: a prospective study of complications in clinical and traditional settings in Bungoma, Kenya 4. Abstract: Efficacy of Adding 2% (w/v) Chlorhexidine Gluconate to 70% (v/v) Isopropyl Alcohol for Skin Disinfection Prior to Peripheral Venous Cannulation 5. Abstract: Lack of association between measles virus vaccine and autism with enteropathy: a case-control study 6. Abstract: Healthcare epidemiology: hospital staffing and health care- associated infections: a systematic review of the literature 7. Abstract: A cluster of hepatitis B infections associated with incorrect use of a capillary blood sampling device in a nursing home in the Netherlands, 2007 8. Abstract: Adverse reactions and pathogen safety of intravenous immunoglobulin 9. Abstract:Comparison of four methods of hand washing in situations of inadequate water supply 10. Abstract: Dissection of familial correlations in hepatitis C virus (HCV) seroprevalence suggests intrafamilial viral transmission and genetic predisposition to infection12. Abstract: Inhaled insulin: a novel and non-invasive way for insulin administration? 13. Abstract: Short communication safety, tolerability and pharmacokinetics of enfuvirtide administered by a needle-free injection system compared with subcutaneous injection 14. Abstract: HIV prevention for injecting drug users: the first 25 years and counting 15. Abstract: An alternative approach to combination vaccines: intradermal administration of isolated components for control of anthrax, botulism, plague and staphylococcal toxic shock 16. Abstract: Device-associated infection rates and mortality in intensive care units of Peruvian hospitals: findings of the International Nosocomial Infection Control Consortium 17. No Abstract: Put an end to Steinman pin sharps injuries 18. No Abstract: With long hours, less staff nurses fear needlesticks. ANA survey finds infections remain major concern 19. No Abstract: SHEA/APIC Guideline: Infection Prevention and Control in the Long-Term Care Facility July 2008 20. No Abstract: Hand washing project in Peru 21. Bill & Melinda Gates Foundation Now Accepting Proposals for Grand Challenges Explorations Round 2 22. US CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Launches New Blog 23. SafeHandS Phase II: The SafeHandS newsletter (In SafeHandS) is now available online 24. News - UK: Will The 'Bare Below The Elbows' Rule For Doctors Cut Infection Rates Or Just Patient Confidence? - Myanmar: NLD members accused of medical offences - Canada: More open NCC names first ombudswoman: Lawyer hired to 'foster confidence' in commission - USA: Hepatitis C Battle Intensifying - Africa: Patient safety: Civil society to sensitize patients - Africa: What Africa Should Do To Improve Patient Safety - Dr Sambo - Africa: What Africa must do to improve patient safety - USA: Nurses' travel for medical tests compensable: Court - USA: 20 Drugs the FDA Is Watching: First New Quarterly Report IDs Drug Side Effects Under FDA Investigation - UK: Cabinet to look again at contaminated transfusions: Fortrose hepatitis C sufferer wins minister’s pledge - Australia: Anaphylaxis Risk Higher than Normal with HPV Vaccine, but Still Rare - Africa: Circumcision Problems Impair HIV Prevention - Study - USA: No More Needles in Trash, State Says This edition of SIGNpost is located at: http://uqconnect.net/signfiles/Archives/SIGN-POST00464.txt and is printer friendly. 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Subscribe or un-subscribe by email to: sign@uq.net.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/ Download the latest injection safety Best Practices review at: http://www.uqconnect.net/signfiles/Files/BestPracticesJul2003.pdf Use the Toolbox at: http://www.who.int/injection_safety/toolbox/en/ Get SIGN files on the web at: http://www.uqconnect.net/signfiles/Files/ SIGNpost archives: http://www.uqconnect.net/signfiles/Archives/?M=D __________________________________________________________________________ _____________________________________*____________________________________ 1. HIV infections in Uganda from medical injections David Gisselquist kindly posts his letter to JAMA in response to Mermin J, Musinguzi J, Opio A, Kirungi W, Ekwaru JP, Hladik W, et al. Risk factors for recent HIV infection in Uganda. JAMA 2008; 300; 540-549. Discussion, comments and additions please: sign@uq.net.au or use your reply button __________________________________________________________________________ Date: Tue, 9 Sep 2008 From: David Gisselquist Subject: HIV infections in Uganda from medical injections To: SIGNpost Dear Allan, A recent article in JAMA reports evidence suggesting that 18% of incident HIV infections in Uganda are from medical injections (ie, the population attributable fraction of HIV incidence associated with medical injections is 18%). Because the authors of the article did not see this result in their evidence, I submitted the following letter to JAMA. Because the letter was rejected, I am sending it to SIGN -- to reach those who might be interested in this evidence and its import. Best regards, David .......................................................................... __________________________________________________________________________ To the editor: In a recent article, Mermin and colleagues use information from a 2004-05 national survey and BED assays to examine risks for HIV incidence in Ugandan adults.(1) As they note, incidence was associated with behavioral and biological sexual variables, including reported numbers of sexual partners in the previous year, infection with herpes simplex virus type 2, and others. Significantly, Mermin and colleagues recognize incident infections in 28 (0.56%) of 4,999 adults who reported no sexual partners in the past year. Calculating from their reported data, the population attributable fraction (PAF) of HIV incidence associated with 1 or more vs. no reported sexual partners is 43%. In other words: if information on sexual behavior is accurate, if BED assays correctly identified incident infections, and if all adults had similar incidence from non-sexual risks, sexual transmission accounts for a minority of HIV incidence. This result seemingly leaves a variety of blood exposures to account for a majority of HIV infections in Ugandan adults. Let's look at blood exposures. Mermin and colleagues=E2=80=99 reported data show no trend for incidence associated with transfusions. In their multivariate analysis, HIV incidence was not statistically associated with number of medical injections by a health professional in previous year (1). (pp543-544) (Their analysis may have obscured a significant association by dividing those who received injections into three groups receiving 1, 2, or 3 or more injections.) Importantly, from their data the PAF of HIV incidence associated with any vs. no reported injections by health professionals in the past year is 18%. This is similar to a 29% PAF for HIV incidence associated with injections in Masaka, Uganda, during 1999-2005 (calculated from reported data).2 In addition, other common blood exposures that Mermin and colleagues do not consider, such as phlebotomy, dental care, tattoos, and shaving, could contribute important proportions of HIV incidence. From Mermin and colleagues reported data and from much other evidence,(3) HIV transmission in Uganda as in other countries with generalized epidemics is a 2-way street infections come from blood exposures as well as from sexual partners. Just as it would be foolish to assume that all accidents on a 2-way street are caused by traffic coming from one direction, it is equally foolish to ignore evidence that HIV infections come not only from sex but also from blood. It is crucial to warn Africans at risk to look both ways. References 1. Mermin J, Musinguzi J, Opio A, Kirungi W, Ekwaru JP, Hladik W, et al. Risk factors for recent HIV infection in Uganda. JAMA 2008; 300; 540-549. 2. Whitworth JA, Biraro S, Shafer LA, Morison LA, Quigley M, White RG, et al. HIV incidence and recent injections among adults in rural southwestern Uganda. AIDS 2007; 21: 1056-1058. 3. Gisselquist D. Points to Consider: Responses to HIV/AIDS in Africa, Asia, and the Caribbean. London: Adonis & Abbey, 2008. __________________________________________________________________________ _____________________________________*____________________________________ 2. Adverse events following traditional male circumcision: Adolescent boys: who cares? __________________________________________________________________________ Adolescent boys: who cares? George P Schmid a, Bruce Dick b The paper by Bailey et al.1 in this issue of the Bulletin is the first to systematically investigate adverse events following traditional male circumcision. It highlights the frequency of lingering and permanent sequelae, including sequelae that likely impair sexual functioning. In one of the few other studies that has explored this issue, between 2001 and 2005, the Eastern Cape province of South Africa recorded 1748 hospital admissions, 177 deaths and 107 genital mutilations/amputations following circumcision.2 Despite this significant morbidity among adolescents and young men, it is surprising that so little attention has been paid to the complications of traditional male circumcision by most organizations.. Globally, 30–34% of men are circumcised.3 Most of these circumcisions are performed for cultural or religious reasons during adolescence, outside formal health-care settings, without anaesthesia and in challenging traditional settings. Within sub-Saharan Africa, this is a particularly important issue within the context of current efforts to “scale-up” male circumcision services for HIV prevention.4 There, depending on the country, 15% to 80% of men are circumcised.5 These circumcisions, when done in adolescence, as in Bungoma, Kenya, are typically practiced as part of “rites of passage” ceremonies, as the adolescent moves from childhood to manhood. The ceremonies, variable from society to society, often last for weeks and are held under secretive circumstances. They may include instructions on how to behave as men and responsible community members and deliberately test the adolescents’ ability “to be men” – their tolerance to pain – but factors sometimes associated with the circumcision, such as cold, hunger or dehydration, are also challenging. Circumcision is performed without anaesthesia, often using a single cutting instrument (of unknown sharpness and sterility) for multiple boys, without the use of sutures to prevent haemorrhage. The populations affected seem very aware of the consequences.6,7 Of initiates in South Africa, 70% expected complications to occur,8 and pain is particularly feared.7 Although not wanting to lose the traditional activities that surround circumcision, parents are also aware of the high likelihood of significant complications occurring and many would prefer that their sons be circumcised in the formal health-care system.6,7,9 Male circumcision provides partial protection for men against acquiring HIV infection through heterosexual sex, about 60% effectiveness at two years of follow-up,3 with one study now showing protection over 42 months of 64%.10 Countries in sub-Saharan Africa are developing strategies to make male circumcision part of a comprehensive strategy for HIV prevention. The critical question is how to increase young men’s access to and use of safe male circumcision services. Bailey et al. show that the focus of these efforts should not only be on traditional circumcising communities but also on the formal health-care setting, the focus for interventions in countries and communities where there is high HIV prevalence and low male circumcision prevalence. Here, too often, there is currently insufficient training, supervision, hygiene, equipment and supplies. That the adverse event rate of 35.2% in traditional settings was twice the rate of 17.7% in medical settings is scarcely comforting.1 WHO and UNAIDS recognize that services must be safe and have developed a variety of guidance documents and training tools (available at: www.who.int/hiv/topics/malecircumcision/en/index.html) while international partners are addressing additional needs, including ways of working with the private sector and supplying appropriate surgical commodities. In those communities where the tradition of male circumcision occurs, it likely makes an important contribution to HIV prevention. However, working with traditional circumcisers to improve the safety of male circumcision remains a challenge. We must, therefore, explore ways to increase the provision of safe and humane male circumcision services to those who want to be circumcised in these settings. Several examples were discussed during a meeting of faith-based organizations, convened by the Catholic Medical Mission Board, in collaboration with WHO and other UNAIDS cosponsors in 2007.9 This meeting indicated that many parents and adolescent boys want a clinical option in the formal health-care setting as well as traditional activities. By providing male circumcision in a clinical facility and at the same time supporting traditional activities surrounding the circumcision, it is possible to contribute to adolescent boys’ sexual and reproductive health via counselling and education programmes that are currently lacking or which could be enhanced. In addition to improving adolescent boys’ access to safe male circumcision services when these are provided within a traditional context, when developing male circumcision programmes in the formal health-care system, we must carefully regulate the providers to ensure that they are adequately trained and have the equipment and supplies to perform male circumcision safely and effectively. The paper by Bailey et al. is timely, with important messages. By recognizing the need for safe services for adolescent boys, wherever delivered, male circumcision can provide an entry point for promoting safer sex practices, improving sexual and reproductive health and contributing to positive gender attitudes and behaviours. ¦ References 1. Bailey RC, Egesah O, Rosenberg S. Male circumcision for HIV prevention: Complications in clinical and traditional settings in Bungoma, Kenya. Bull World Health Organ 2008; 86: 669-78. 2. Weiss HA, Halperin D, Bailey RC, Hayes RJ, Schmid G, Hankins CA. Male circumcision for HIV prevention: From evidence to action? AIDS 2008; 22: 567-74 pmid: 18316997. 3. WHO and UNAIDS announce recommendations from expert meeting on male circumcision for HIV prevention. Geneva: UNAIDS & WHO; 2007. Available from: http://www.who.int/hiv/pub/meetingreports/mc_montreux_march07/en/ [accessed on 12 August 2008]. 4. Male circumcision. Global trends and determinants of prevalence, safety and acceptability. WHO and Joint United Nations Programme on HIV/AIDS; 2007. Available from: http://www.who.int/hiv/topics/malecircumcision/MC_Glob_Trends_Dets_Final.p df [accessed on 12 August 2008]. 5. Meissner O, Buso DI. Traditional male circumcision in the Eastern Cape – scourge or blessing? S Afr Med J 2007; 97: 371-3 pmid: 17599221. 6. Rain-Taljaard RC, Lagarde E, Taljaard DJ, Campbell C, MacPhail C, Williams B, et al., et al. Potential for an intervention based on male circumcision in a South African town with high levels of HIV infection. AIDS Care 2003; 15: 315-27 doi: 10.1080/0954012031000105379 pmid: 12828151. 7. Westercamp N, Bailey RC. Acceptability of male circumcision for prevention of HIV/AIDS in sub-Saharan Africa: A review. AIDS Behav 2007; 11: 341-55 doi: 10.1007/s10461-006-9169-4 pmid: 17053855. 8. Peltzer K, Nqeketo A, Petros G, Kanta X. Traditional circumcision during manhood initiation rituals in the Eastern Cape, South Africa: A pre-post intervention evaluation. BMC Public Health 2008; 8: 64- doi: 10.1186/1471-2458-8-64 pmid: 18284673. 9. Male adolescent circumcision for HIV prevention and as an entry point for sexual and reproductive health the role of faith based organizations [Meeting Report]. Limuru, Kenya: September, 2007. 10. Bailey RC, Moses S, Parker CB, Agot K, Maclean I, Krieger JN, et al. The protective effect of male circumcision is sustained for at least 42 months: results from the Kisumu, Kenya trial [Abstract THAC05.]. XVII International AIDS Conference, 3-8 August 2008. Affiliations a. Department of HIV/AIDS, World Health Organization, 20 avenue Appia, 1211 Geneva 27, Switzerland. b. Department of Child and Adolescent Health and Development, World Health Organization, Geneva, Switzerland. http://www.who.int/bulletin/volumes/86/9/08-057752/en/index.html __________________________________________________________________________ _____________________________________*____________________________________ 3. Abstract: Male circumcision for HIV prevention: a prospective study of complications in clinical and traditional settings in Bungoma, Kenya __________________________________________________________________________ Bulletin of the World Health Organization 2008;86:669–677. Male circumcision for HIV prevention: a prospective study of complications in clinical and traditional settings in Bungoma, Kenya Robert C Bailey,a Omar Egesahb & Stephanie Rosenbergc Objective Male circumcision reduces the risk of HIV acquisition by approximately 60%. Male circumcision services are now being introduced in selected populations in sub-Saharan Africa and further interventions are being planned. A serious concern is whether male circumcision can be provided safely to large numbers of adult males in developing countries. Methods This prospective study was conducted in the Bungoma district, Kenya, where male circumcision is universally practised. Young males intending to undergo traditional or clinical circumcision were identified by a two-stage cluster sampling method. During the July–August 2004 circumcision season, 1007 males were interviewed 30–89 days post- circumcision. Twenty-four men were directly observed during and 3, 8, 30 and 90 days post-circumcision, and 298 men underwent clinical exams 45–89 days post-procedure. Twenty-one traditional and 20 clinical practitioners were interviewed to assess their experience and training. Inventories of health facilities were taken to assess the condition of instruments and supplies necessary for performing safe circumcisions. Findings Of 443 males circumcised traditionally, 156 (35.2%) experienced an adverse event compared with 99 of 559 (17.7%) circumcised clinically (odds ratio: 2.53; 95% confidence interval: 1.89–3.38). Bleeding and infection were the most common adverse effects, with excessive pain, lacerations, torsion and erectile dysfunction also observed. Participants were aged 5 to 21 years and half were sexually active before circumcision. Practitioners lacked knowledge and training. Proper instruments and supplies were lacking at most health facilities. Conclusion Extensive training and resources will be necessary in sub- Saharan Africa before male circumcision can be aggressively promoted for HIV prevention. Two-thirds of African men are circumcised, most by traditional or unqualified practitioners in informal settings. Safety of circumcision in communities where it is already widely practised must not be ignored. http://www.who.int/bulletin/volumes/86/9/08-051482.pdf __________________________________________________________________________ _____________________________________*____________________________________ 4. Abstract: Efficacy of Adding 2% (w/v) Chlorhexidine Gluconate to 70% (v/v) Isopropyl Alcohol for Skin Disinfection Prior to Peripheral Venous Cannulation __________________________________________________________________________ Infect Control Hosp Epidemiol. 2008 Sep 4. [Epub ahead of print] Efficacy of Adding 2% (w/v) Chlorhexidine Gluconate to 70% (v/v) Isopropyl Alcohol for Skin Disinfection Prior to Peripheral Venous Cannulation. Small H, Adams D, Casey AL, Crosby CT, Lambert PA, Elliott T. From the Department of Clinical Microbiology and Infection Control, University Hospital Birmingham NHS Foundation Trust, The Queen Elizabeth Hospital, Edgbaston (H.S., D.A., A.L.C., T.E.), and the Department of Pharmaceutical and Biological Sciences, Aston University, Aston Triangle (P.A.L.), Birmingham, England; and Enturia, Leawood, Kansas (C.T.C.). We undertook a clinical trial to compare the efficacy of 2% (w/v) chlorhexidine gluconate in 70% (v/v) isopropyl alcohol with the efficacy of 70% (v/v) isopropyl alcohol alone for skin disinfection to prevent peripheral venous catheter colonization and contamination. We found that the addition of 2% chlorhexidine gluconate reduced the number of peripheral venous catheters that were colonized or contaminated. __________________________________________________________________________ _____________________________________*____________________________________ 5. Abstract: Lack of association between measles virus vaccine and autism with enteropathy: a case-control study __________________________________________________________________________ PLoS ONE. 2008 Sep 4;3(9):e3140. Lack of association between measles virus vaccine and autism with enteropathy: a case-control study. Hornig M, Briese T, Buie T, Bauman ML, Lauwers G, Siemetzki U, Hummel K, Rota PA, Bellini WJ, O'Leary JJ, Sheils O, Alden E, Pickering L, Lipkin WI. Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, New York, United States of America. mady.hornig@columbia.edu BACKGROUND: The presence of measles virus (MV) RNA in bowel tissue from children with autism spectrum disorders (ASD) and gastrointestinal (GI) disturbances was reported in 1998. Subsequent investigations found no associations between MV exposure and ASD but did not test for the presence of MV RNA in bowel or focus on children with ASD and GI disturbances. Failure to replicate the original study design may contribute to continued public concern with respect to the safety of the measles, mumps, and rubella (MMR) vaccine. METHODOLOGY/PRINCIPAL FINDINGS: The objective of this case-control study was to determine whether children with GI disturbances and autism are more likely than children with GI disturbances alone to have MV RNA and/or inflammation in bowel tissues and if autism and/or GI episode onset relate temporally to receipt of MMR. The sample was an age-matched group of US children undergoing clinically-indicated ileocolonoscopy. Ileal and cecal tissues from 25 children with autism and GI disturbances and 13 children with GI disturbances alone (controls) were evaluated by real-time reverse transcription (RT)-PCR for presence of MV RNA in three laboratories blinded to diagnosis, including one wherein the original findings suggesting a link between MV and ASD were reported. The temporal order of onset of GI episodes and autism relative to timing of MMR administration was examined. We found no differences between case and control groups in the presence of MV RNA in ileum and cecum. Results were consistent across the three laboratory sites. GI symptom and autism onset were unrelated to MMR timing. Eighty-eight percent of ASD cases had behavioral regression. CONCLUSIONS/SIGNIFICANCE: This study provides strong evidence against association of autism with persistent MV RNA in the GI tract or MMR exposure. Autism with GI disturbances is associated with elevated rates of regression in language or other skills and may represent an endophenotype distinct from other ASD. __________________________________________________________________________ _____________________________________*____________________________________ 6. Abstract: Healthcare epidemiology: hospital staffing and health care- associated infections: a systematic review of the literature __________________________________________________________________________ Clin Infect Dis. 2008 Oct 1;47(7):937-44. Healthcare epidemiology: hospital staffing and health care-associated infections: a systematic review of the literature. Stone PW, Pogorzelska M, Kunches L, Hirschhorn LR. 1Columbia University School of Nursing, New York, New York; and 2JSI Research and Training Institute, Boston, Massachussets. In the past 10 years, many researchers have examined relationships between hospital staffing and patients' risk of health care-associated infection (HAI). To gain understanding of this evidence base, a systematic review was conducted, and 42 articles were audited. The most common infection studied was bloodstream infection ([Formula: see text]; 43%). The majority of researchers examined nurse staffing ([Formula: see text]; 90%); of these, only 7 (18%) did not find a statistically significant association between nurse staffing variable(s) and HAI rates. Use of nonpermanent staff was associated with increased rates of HAI in 4 studies ([Formula: see text]). Three studies addressed infection control professional staffing with mixed results. Physician staffing was not found to be associated with patients' HAI risk ([Formula: see text]). The methods employed and operational definitions used for both staffing and HAI varied; despite this variability, trends were apparent. Research characterizing effective staffing for infection control departments is needed. __________________________________________________________________________ _____________________________________*____________________________________ 7. Abstract: A cluster of hepatitis B infections associated with incorrect use of a capillary blood sampling device in a nursing home in the Netherlands, 2007 __________________________________________________________________________ Euro Surveill. 2008 Jul 3;13(27). pii: 18918. A cluster of hepatitis B infections associated with incorrect use of a capillary blood sampling device in a nursing home in the Netherlands, 2007. Götz HM, Schutten M, Borsboom GJ, Hendriks B, van Doornum G, de Zwart O. Division of Infectious Disease Control, Municipal Public Health Service Rotterdam Rijnmond, The Netherlands. gotzh@ggd.rotterdam.ni In July 2007, two residents of a nursing home were diagnosed with acute Hepatitis B virus infection. To identify risk factors for HBV infection a retrospective cohort study among residents was performed. Case finding included discharged diabetes patients and those receiving home care. Among 32 residents one case of chronic hepatitis B was found that could be identified by genotyping as the source patient for the acute cases. Diabetes and finger sticks were risk factors for HBV infection. Most likely the cause of transmission was a multiclix finger stick device developed for use in individual patients but used in multiple patients. Education and training in the use of new equipment and hygiene audits remain the cornerstones in infection control practices. __________________________________________________________________________ _____________________________________*____________________________________ 8. Abstract: Adverse reactions and pathogen safety of intravenous immunoglobulin __________________________________________________________________________ Curr Drug Saf. 2007 Jan;2(1):9-18. Adverse reactions and pathogen safety of intravenous immunoglobulin. Carbone J. Clinical Immunology Unit, University Hospital Gregorio Marañon, Madrid, Spain. carbone@teleline.es The range of diseases in which intravenous immunoglobulin (IVIG) is effective has expanded significantly since its initial use in primary antibody deficiency. This biological medicine must comply with three conditions: therapeutic efficacy, clinical tolerance and viral safety. Factors relevant to the viral safety of IVIG include: effective use of donor exclusion criteria, screening of donations in order to exclude potentially infectious donations, testing of plasma pools for evidence of viral infection, validated steps for removal and/or inactivation of potentially present infectious agents, equipment cleaning, traceability of lots, and post-marketing follow-up of patients. Variables potentially affecting the risk and intensity of adverse events associated with administration of IVIG include: patient age, underlying condition, dose, concentration, IgA content, stabilizing agent and rate of infusion. Mild adverse reactions (headache, flushing, low backache, nausea) are often associated with a fast infusion rate, and respond rapidly on slowing the infusion. Very rare serious and potentially fatal side effects include: anaphylactic reactions, aseptic meningitis, acute renal failure, and thrombotic complications. Many of these serious adverse reactions have occurred in patients who had significant risk factors or underlying disease states. Clinicians should pay close attention to patient selection and consider the potential risk/benefit ratio versus alternate therapies. __________________________________________________________________________ _____________________________________*____________________________________ 9. Abstract:Comparison of four methods of hand washing in situations of inadequate water supply __________________________________________________________________________ West Afr J Med. 2008 Jan;27(1):24-8. Comparison of four methods of hand washing in situations of inadequate water supply. Ogunsola FT, Adesiji YO. Department of Medical Microbiology and Parasitology, College of Medicine, Idi-Araba, University of Lagos, Nigeria. BACKGROUND: Hand washing is the single most important means of preventing hospital acquired infections, but requires for effectiveness, a constant supply of running water and proper facilities. Most developing countries do not have constant running water facilities, so alternate methods have been developed and used in clinics and hospitals. OBJECTIVE: To compare and validate alternate methods of hand washing developed for use in Nigeria. METHODS: The hands of 12 volunteers were pre-contaminated with known isolates of Klebsiella pneumoniae, Escherichia coli and Pseudomonas aeruginosa. The volunteers washed their hands as described by Ayliffe. The hands and equipment were cultured pre- and post-contamination and post- hand washing. The water used for the hand wash was also cultured pre-hand washing to control for water-based contamination. Each method was evaluated three times and various parts of the equipment were cultured to determine the areas contaminated by the hands during the hand wash. RESULTS: "Elbow-way" was shown to be the best and the gold standard Sink and Tap for promoting an effective hand washing, as there was no evidence of post-contamination. The worst was the single-bowl method in which the hands of all the 12 (100%) volunteers were contaminated from the bowl, followed by the two-bowl initiative 10 (83%) and the bucket and bowl 9 (75%). CONCLUSION: The bucket and bowl as well as the single-bowl methods most commonly used in hospitals result in gross contamination of the bowls and bucket and are therefore unsafe and should be discouraged. The elbow way on the other hand appears to be an easy and safe alternative in situations where there is no running water. __________________________________________________________________________ _____________________________________*____________________________________ 10. Abstract: Dissection of familial correlations in hepatitis C virus (HCV) seroprevalence suggests intrafamilial viral transmission and genetic predisposition to infection __________________________________________________________________________ Gut. 2008 Sep;57(9):1268-74. Epub 2008 May 14. Dissection of familial correlations in hepatitis C virus (HCV) seroprevalence suggests intrafamilial viral transmission and genetic predisposition to infection. Plancoulaine S, Mohamed MK, Arafa N, Bakr I, Rekacewicz C, Trégouët DA, Obach D, El Daly M, Thiers V, Féray C, Abdel-Hamid M, Abel L, Fontanet A. INSERM U550, Laboratoire de Génétique Humaine des Maladies Infectieuses, Faculté de Médecine Necker, 156 rue de Vaugirard, 75015 Paris, France. plancoulaine@necker.fr OBJECTIVE: Unsafe injections and transfusions used during treatments are considered to be responsible for many cases of transmission of hepatitis C virus (HCV) in developing countries, but cannot account for a substantial proportion of present infections. The aim of the present work was to investigate familial clustering of HCV infection in a population living in a highly endemic area. DESIGN, SETTING AND PARTICIPANTS: A large seroepidemiological survey was conducted on 3994 subjects (age range, 2-88 years) from 475 familial clusters in an Egyptian rural area. Epidemiological methods appropriate for the analysis of correlated data were used to estimate risk factors and familial dependences for HCV infection. A phylogenetic analysis was conducted to investigate HCV strain similarities within and among families. MAIN OUTCOME MEASURES: HCV familial correlations adjusted for known risk factors, similarities between viral strains. RESULTS: Overall HCV seroprevalence was 12.3%, increasing with age. After adjustment for relevant risk factors, highly significant intrafamilial resemblances in HCV seroprevalence were obtained between father-offspring (odds ratio (OR) = 3.4 (95% confidence interval (CI), 1.8 to 6.2)), mother-offspring (OR = 3.8 (95% CI, 2.5 to 5.8)), and sibling-sibling (OR = 9.3 (95% CI, 4.9 to 17.6)), while a weaker dependence between spouses (OR = 2.2 (95% CI, 1.3 to 3.7)) was observed. Phylogenetic analysis showed greater HCV strain similarity between family members than between unrelated subjects, indicating that correlations can be explained, in part, by familial sources of virus transmission. In addition, refined dissection of correlations between first-degree relatives supported the role of host genes predisposing to HCV infection. CONCLUSIONS: Current HCV infection in endemic countries has a strong familial component explained, at least partly, by specific modes of intrafamilial viral transmission and by genetic predisposition to infection. __________________________________________________________________________ _____________________________________*____________________________________ 12. Abstract: Inhaled insulin: a novel and non-invasive way for insulin administration? __________________________________________________________________________ Curr Drug Saf. 2006 May;1(2):151-8. Inhaled insulin: a novel and non-invasive way for insulin administration? Quattrin T. Division of Endocrinology/Diabetes, Women and Children's Hospital of Buffalo, Associate Professor of Pediatrics, State University of New York at Buffalo, 219 Bryant Street, Buffalo, New York 14222, USA. tquattrin@upa.chob.edu Over the past few years significant steps forward have been made towards the development of insulin formulations suitable for inhalation via several delivery systems. This innovative route of insulin delivery offers the potential of administering pre-meal insulin in a non-invasive way to patients currently receiving multiple daily injections. This article describes the pharmacodynamic and pharmacokinetic profiles and the efficacy and safety data of inhaled insulin preparations. Particular emphasis is placed on Exubera, which currently has the largest pool of efficacy and safety data. In patients with type 1 diabetes 24-week trials have demonstrated that inhaled insulin was equally efficacious to short acting insulin (2-4 daily injections). Results of trials conducted in type 2 diabetes showed inhaled insulin efficacy too, and a potential role for inhaled insulin in patients failing oral medications. Safety data have shown that the most common reported adverse event is mild cough, which appears to be decreasing in frequency during the course of therapy. Higher antibody titers have been observed in patients treated with inhaled insulin compared to subjects treated with sub-cutaneous insulin. However, the titers do not present any association with clinical correlates. The safety area in need of higher scrutiny is naturally the area of pulmonary function tests (PFTs). A brief synopsis of PFTs is followed by the review of PFTs data following short and long term treatment with inhaled insulin. Two-year data in type 2 diabetes showed a significant change in Forced Expiratory Volume in 1 second (FEV1) after 6 months of treatment, but not after 9, 12,18,24 months of treatment and 6 and 12 months of wash-out. In type 1 diabetes a significant change in Diffusing Lung Capacity of Carbon Monoxide (DLCO) was observed after 24 weeks of inhaled insulin therapy. Long-term data in type 1 diabetes are only available as part of a pooled sample composed of patients with both type 1 and type 2 diabetes. In these patients, who had received inhaled insulin for at least 4 years, annualized changes of FEV1 and DLCO were similar in the group treated with inhaled insulin compared to the group treated with sub-cutaneous insulin. __________________________________________________________________________ _____________________________________*____________________________________ 13. Abstract: Short communication safety, tolerability and pharmacokinetics of enfuvirtide administered by a needle-free injection system compared with subcutaneous injection __________________________________________________________________________ Antivir Ther. 2008;13(5):723-7. Short communication safety, tolerability and pharmacokinetics of enfuvirtide administered by a needle-free injection system compared with subcutaneous injection. Gottlieb M, Thommes JA; WAND Study Team. Collaborators (12) Synergy Hematology and Oncology, Los Angeles, CA, USA. MGOTT@aol.com BACKGROUND: Injection site reactions (ISRs) can present a challenge to patients when using enfuvirtide (ENF). This study compared ISRs associated with use of a needle-free injection device (NFID) with those associated with a standard 27-gauge half-inch needle/syringe (NS). METHODS: In this single-blind, crossover study, 58 ENF-naive participants were randomized to self-administer ENF with the NFID for 4 weeks (followed by 4 weeks using NS) or with the NS for 4 weeks (followed by 4 weeks using the NFID). A primary composite endpoint of painful ISR was defined as the combination of grade 1-3 ongoing pain plus either associated grade 3-4 (> or =25 mm) induration or grade 2-4 nodules/cysts (>20 mm). An ISR summary score described ISR frequency/severity. Self-reported device preference was also evaluated at baseline and at study completion. RESULTS: Fewer participants using NFID experienced the primary composite endpoint of painful ISRs (10/28; 35.7%) compared with NS (20/28; 71.4%) (P=0.004). There was a trend towards a reduced incidence/severity of ISR signs and symptoms with NFID, with significant reductions seen in pain/discomfort and pruritus (P<0.05 and P<0.01, respectively). At the end of the study, most participants (22/25; 88%) expressed a preference for NFID. Haematoma was the sole NFID-related serious adverse event, but this did not lead to discontinuation. CONCLUSIONS: Compared with a standard NS, use of an NFID to administer ENF was associated with a substantially lower incidence of painful ISRs, was generally safe and well-tolerated, and was preferred by most participants in the study. __________________________________________________________________________ _____________________________________*____________________________________ 14. Abstract: HIV prevention for injecting drug users: the first 25 years and counting __________________________________________________________________________ Psychosom Med. 2008 Jun;70(5):606-11. Epub 2008 Jun 2. HIV prevention for injecting drug users: the first 25 years and counting. Des Jarlais DC, Semaan S. Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York, New York 10038, USA. dcdesjarla@aol.com During the last three decades, both the injection of illicit psychoactive drugs and HIV infection among injecting drug users (IDUs) have spread throughout industrialized and developing countries. Extremely rapid transmission of HIV has occurred in IDU populations with incidence rates of 10 to 50/100 person-years. In sharp contrast, there are many examples of very effective HIV risk reduction for IDUs, both in preventing initial epidemics and in bringing existing epidemics under control. IDUs are capable of learning basic information about HIV/AIDS and modifying their behavior to protect both themselves and their peers. Effective HIV prevention for IDUs requires programs that treat IDUs with dignity and respect, provide accurate information and the means for behavior change- access to sterile injection equipment, condoms, and drug abuse treatment. Programs that provide these services need to be implemented on a public health scale for IDU populations at risk for HIV infection. __________________________________________________________________________ _____________________________________*____________________________________ 15. Abstract: An alternative approach to combination vaccines: intradermal administration of isolated components for control of anthrax, botulism, plague and staphylococcal toxic shock __________________________________________________________________________ J Immune Based Ther Vaccines. 2008 Sep 3;6(1):5. [Epub ahead of print] An alternative approach to combination vaccines: intradermal administration of isolated components for control of anthrax, botulism, plague and staphylococcal toxic shock. Morefield GL, Tammariello RF, Purcell BK, Worsham PL, Chapman J, Smith LA, Alarcon JB, Mikszta JA, Ulrich RG. ABSTRACT: BACKGROUND: Combination vaccines reduce the total number of injections required for each component administered separately and generally provide the same level of disease protection. Yet, physical, chemical, and biological interactions between vaccine components are often detrimental to vaccine safety or efficacy. METHODS: As a possible alternative to combination vaccines, we used specially designed microneedles to inject rhesus macaques with four separate recombinant protein vaccines for anthrax, botulism, plague and staphylococcal toxic shock next to each other just below the surface of the skin, thus avoiding potentially incompatible vaccine mixtures. RESULTS: The intradermally- administered vaccines retained potent antibody responses and were well- tolerated by rhesus macaques. Based on tracking of the adjuvant, the vaccines were transported from the dermis to draining lymph nodes by antigen-presenting cells. Vaccinated primates were completely protected from an otherwise lethal aerosol challenge by Bacillus anthracis spores, botulinum neurotoxin A, or staphylococcal enterotoxin B. CONCLUSIONS: Our results demonstrated that the physical separation of vaccines both in the syringe and at the site of administration did not adversely affect the biological activity of each component. The vaccination method we describe may be scalable to include a greater number of antigens, while avoiding the physical and chemical incompatibilities encountered by combining multiple vaccines together in one product. __________________________________________________________________________ _____________________________________*____________________________________ 16. Abstract: Device-associated infection rates and mortality in intensive care units of Peruvian hospitals: findings of the International Nosocomial Infection Control Consortium __________________________________________________________________________ Rev Panam Salud Publica. 2008 Jul;24(1):16-24. Device-associated infection rates and mortality in intensive care units of Peruvian hospitals: findings of the International Nosocomial Infection Control Consortium. Cuellar LE, Fernandez-Maldonado E, Rosenthal VD, Castaneda-Sabogal A, Rosales R, Mayorga-Espichan MJ, Camacho-Cosavalente LA, Castillo-Bravo LI. Division of Infection Control, Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima, Peru. OBJECTIVES: To measure device-associated infection (DAI) rates, microbiological profiles, bacterial resistance, and attributable mortality in intensive care units (ICUs) in hospitals in Peru that are members of the International Nosocomial Infection Control Consortium (INICC). METHODS: Prospective cohort surveillance of DAIs was conducted in ICUs in four hospitals applying the definitions for nosocomial infections of the U.S. Centers for Disease Control and Prevention National Nosocomial Infections Surveillance System (CDC-NNIS) and National Healthcare Safety Network (NHSN). RESULTS: From September 2003 to October 2007 1 920 patients hospitalized in ICUs for an aggregate of 9 997 days acquired 249 DAIs, accounting for a rate of 13.0% and 24.9 DAIs per 1 000 ICU-days. The ventilator-associated pneumonia (VAP) rate was 31.3 per 1 000 ventilator- days; the central venous catheter-associated bloodstream infections (CVC- BSI) rate was 7.7 cases per 1 000 catheter-days; and the rate for catheter-associated urinary tract infections (CAUTI) was 5.1 cases per 1 000 catheter-days. Extra mortality for VAP was 24.5% (RR 2.07, P < 0.001); for CVC-BSI the rate was 15.0% (RR 2.75, P = 0.028). Methicillin-resistant strains accounted for 73.5% of all Staphylococcus aureus DAIs; 40.5% of the Enterobacteriaceae were resistant to ceftriaxone, 40.8% were resistant to ceftazidime, and 32.0% were resistant to piperacillin-tazobactam. Sixty- five percent of Pseudomonas aeruginosa isolates were resistant to ciprofloxacin, 62.0% were resistant to ceftazidime, 29.4% were resistant to piperacillin-tazobactam, and 36.1% were resistant to imipenem. CONCLUSIONS: The high rates of DAIs in the Peruvian hospitals in this study indicate the need for active infection control. Programs consisting of surveillance of DAIs and implementation of guidelines for infection prevention can ensure improved patient safety in the ICUs and throughout hospitals. __________________________________________________________________________ _____________________________________*____________________________________ 17. No Abstract: Put an end to Steinman pin sharps injuries __________________________________________________________________________ Ann R Coll Surg Engl. 2008 Jul;90(5):436. Put an end to Steinman pin sharps injuries. Granville-Chapman J, Loke J. Surgical Department, British Military Field Hospital, Iraq. jgchapman@doctors.org.uk __________________________________________________________________________ _____________________________________*____________________________________ 18. No Abstract: With long hours, less staff nurses fear needlesticks. ANA survey finds infections remain major concern __________________________________________________________________________ AIDS Alert. 2008 Aug;23(8):94-5. With long hours, less staff nurses fear needlesticks. ANA survey finds infections remain major concern. [No authors listed] __________________________________________________________________________ _____________________________________*____________________________________ 19. No Abstract: SHEA/APIC Guideline: Infection Prevention and Control in the Long-Term Care Facility July 2008 __________________________________________________________________________ Infect Control Hosp Epidemiol. 2008 Sep 3. No abstract available. SHEA/APIC Guideline: Infection Prevention and Control in the Long-Term Care FacilityJuly 2008. Smith PW, Bennett G, Bradley S, Drinka P, Lautenbach E, Marx J, Mody L, Nicolle L, Stevenson K. __________________________________________________________________________ _____________________________________*____________________________________ 20. No Abstract: Hand washing project in Peru __________________________________________________________________________ Can J Infect Control. 2008 Spring;23(1):23-4. Hand washing project in Peru. Cortez YG, Berroa JA, Diaz AG, Peña GL, Vasquez RD. __________________________________________________________________________ _____________________________________*____________________________________ 21. Bill & Melinda Gates Foundation Now Accepting Proposals for Grand Challenges Explorations Round 2 __________________________________________________________________________ Now Accepting Proposals for Grand Challenges Explorations Round 2 SEATTLE -- The Bill & Melinda Gates Foundation announced today that it is now accepting grant proposals for Round 2 of Grand Challenges Explorations, a five-year US$100 million initiative to encourage bold and unconventional research on new global health solutions. Proposals for six topics will be accepted online at www.gcgh.org/explorations through November 2, 2008. Round 2 follows on the heels of the initiative's first funding round, which closed in May of this year, and generated nearly 4,000 applications from scientists in more than 100 countries. Two new topics are being introduced in Round 2 along with the initial four topics from Round 1. One of the primary objectives of Grand Challenges Explorations is to involve scientists around the world who do not typically work in global health. This includes those with innovative ideas in Africa, Asia, and other parts of the developing world; people working in the private sector; and young investigators. The initiative uses an agile, accelerated grantmaking process. Applications are two pages, and preliminary data about the proposed research are not required. In addition, the online application process has been streamlined for Round 2. The topic areas for which proposals will be accepted in Round 2 are: Create new vaccines for diarrhea, HIV, malaria, pneumonia, and TB. Create new tools to accelerate the eradication of malaria. Create new ways to protect against infectious diseases, including alternatives to traditional vaccination. Create new drugs and delivery systems to limit the emergence of resistance in the disease-causing agent. Create new ways to prevent or cure HIV infection that fall outside current research on vaccines and other biomedical and behavior-change strategies. Explore the basis for latency in TB, with the goal of discovering new ways to identify and eliminate latent infection. The foundation and an independent group of reviewers will select the most innovative proposals, and grants will be awarded within approximately three months from the proposal submission deadline. Initial grants will be $100,000 each. Projects showing success will have the opportunity to receive additional funding of $1 million or more. Round 1 grants are expected to be announced in October. Full descriptions of the topic areas and application instructions are available at http://www.gcgh.org/explorations http://www.gcgh.org/explorations/Pages/Introduction.aspx ### Bill & Melinda Gates Foundation Guided by the belief that every life has equal value, the Bill & Melinda Gates Foundation works to help all people lead healthy, productive lives. In developing countries, it focuses on improving people's health and giving them the chance to lift themselves out of hunger and extreme poverty. In the United States, it seeks to ensure that all people—especially those with the fewest resources—have access to the opportunities they need to succeed in school and life. Based in Seattle, the foundation is led by CEO Jeff Raikes and co-chair William H. Gates Sr., under the direction of Bill and Melinda Gates and Warren Buffett. http://www.gatesfoundation.org/default.htm © 1999-2008 Bill & Melinda Gates Foundation. __________________________________________________________________________ _____________________________________*____________________________________ 22. US CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Launches New Blog __________________________________________________________________________ CDC Launches New Blog Exchange ideas on HIV/AIDS, viral hepatitis, STD and TB prevention research and programs on Health Protection Perspectives, the new blog by Dr. Kevin Fenton, Director of CDC's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Read and discuss the Director's first post -- A New Conversation... http://www.cdc.gov/nchhstp/blog/ __________________________________________________________________________ _____________________________________*____________________________________ 23. SafeHandS Phase II: The SafeHandS newsletter (In SafeHandS) is now available online __________________________________________________________________________ The SafeHandS newsletter (In SafeHandS) is now available online In SafeHandS Newsletter 2008 Volume 3, Issue 2, September [pdf 445kb] (SafeHandS Phase II) http://tinyurl.com/6dgztf or http://www.uow.edu.au/content/groups/public/@web/@health/documents/doc/uow 049488.pdf _ SafeHandS Phase II: A new three year project from July 2008 – June 2011 SafeHandS has renewed funding until June 2011! Read about our new activities in this article and see how you can become involved. At the end of the newsletter there are forms to complete if you are interested in applying for a small grant for a project, becoming a member of our reference group, or recommending an organisation to form a partnership with SafeHandS SafeHandS is a network for health care worker (HCW) safety in the Asia- Pacific region which has been operating since January 2005. The project, which is managed by the Albion Street Centre (ASC) in Sydney, Australia, was originally funded by the Australian Agency for International Development (AusAID) for three years. Renewed funding will see the next phase of the project continue, maintain and extend the activities of SafeHandS. New activities will strengthen SafeHandS through the founding of an international reference group, the formation of partnerships with regional organisations and the establishment of a grant scheme to support individual health facilities to become demonstration sites for health care worker safety improvement. Background Health care workers are essential to the prevention of transmission of human immunodeficiency virus (HIV) and other blood borne viruses as well as to the provision of treatment and care of people living with HIV (PLHIV), including achieving the aim of significantly expanding access to HIV therapy. Current HIV management strategies, including pharmacological interventions, nutrition and counselling can be complex. Committed and well educated HCW are needed to ensure patients are appropriately cared for and that the disease burden is minimised. As well as providing direct care, HCW can provide education for PLHIV, their families and their communities in health maintenance, the prevention of HIV transmission and reduction in stigma and discrimination. HCW may be anxious about contracting an infectious disease through the course of their work and be fearful of conducting certain procedures or managing certain categories of patients.1,2 Fear of HIV infection has been shown to impact on recruitment and retention of HCW.3,4 This concern may be justified if HCW do not have access to knowledge, equipment and resources likely to minimise the risk of transmission. HCW anxieties may mean that infected patients, or those who may be considered at risk of having a blood borne virus, are not provided with optimal health care. Literature from the Severe Acute Respiratory Syndrome (SARS) epidemic in 2003 suggests that nurses who feel confident in control measures are more likely to be willing to care for patients.5 Every effort should be made to ensure that all HCW operate in an environment that is as safe as possible for both them and their patients. From previous work in the region, ASC staff are aware that HCW are concerned about their safety and that this may mean that patients experience discrimination or inappropriate care. At the same time, exposures such as needlestick injuries are underreported, often because it is perceived no follow up (such as post exposure prophylaxis) is available. It has been observed that a clear understanding of priorities for HCW safety are misunderstood, with some low or no cost safety precautions not being taken and other costly interventions being implemented un-necessarily (such as inappropriate use of chemicals or personal protective equipment) for low risk situations. Maintenance and support of the health workforce in the light of HIV infection is a current World Health Organization priority.3 In order to engage HCW in the care of patients with HIV and associated communicable diseases it is critical to provide them with a safe working environment where they feel supported. HCW need to be able to talk to and support each other, especially in situations where other support mechanisms are limited. The sense of isolation faced by HCW within large health systems needs to be addressed. New research and the refinement and imSafeHands ..Information, support and practical solutions to promote health care worker safety in the Asia Pacific In SafeHandS Volume 3 Issue 2 provement of clinical practice are taking place constantly and there is a need for easy access to this information for all HCW in the region. There is limited published data which is relevant to HCW operating in resource poor settings, especially in relation to practical experiences and lessons which can be readily adapted and adopted __________________________________________________________________________ _____________________________________*____________________________________ 24. News - UK: Will The 'Bare Below The Elbows' Rule For Doctors Cut Infection Rates Or Just Patient Confidence? - Myanmar: NLD members accused of medical offences - Canada: More open NCC names first ombudswoman: Lawyer hired to 'foster confidence' in commission - USA: Hepatitis C Battle Intensifying - Africa: Patient safety: Civil society to sensitize patients - Africa: What Africa Should Do To Improve Patient Safety - Dr Sambo - Africa: What Africa must do to improve patient safety - USA: Nurses' travel for medical tests compensable: Court - USA: 20 Drugs the FDA Is Watching: First New Quarterly Report IDs Drug Side Effects Under FDA Investigation - UK: Cabinet to look again at contaminated transfusions: Fortrose hepatitis C sufferer wins minister’s pledge - Australia: Anaphylaxis Risk Higher than Normal with HPV Vaccine, but Still Rare - Africa: Circumcision Problems Impair HIV Prevention - Study - USA: No More Needles in Trash, State Says Selected news items reprinted under the fair use doctrine of international copyright law: http://www4.law.cornell.edu/uscode/17/107.html __________________________________________________________________________ UK: Will The 'Bare Below The Elbows' Rule For Doctors Cut Infection Rates Or Just Patient Confidence? MedicalNewsToday.com (09.09.08) Should surgeons be bare below the elbows and tie less or are new UK dress rules for doctors compromising their professional image without sufficient evidence that hospital-acquired infections will be reduced? That's the question posed by urology consultant Mr Adam Jones from the Royal Berkshire Hospital, Reading, UK, in the September issue of BJU International. Charting the history and attire of surgeons from the early nineteenth century, he points out that it is hard to find significant evidence that the 'bare below the elbows' rule outside the operating theatre will reduce hospital-acquired infections like MRSA and C.difficile. "The evidence for the roles of ties, shirt cuffs, rings or watches in infection is hard to find and mostly in obscure medical journals" says Mr Jones. "Indeed similar levels of bacterial contamination have been reported on doctors' stethoscopes and pens." However, research has shown that patients don't like to see surgeons walking around in what they perceive as casual clothing - they feel more confident in their professional competence when they see them in white coats. "In America and much of Europe doctors change into some type of 'uniform' from their street clothes, but this has significant implications in terms of sufficient changes of clothes, laundry services and adequate changing rooms" says Mr Jones. "Any uniform would have to confer some degree of seniority or status to maintain patient confidence." He points out that hospitals have come a long way since the Victorian practices described by Lord Moynihan (1865 -1936), one of the first surgeons in England to use rubber gloves. Describing a consultant from his medical student days in Leeds, Lord Moynihan says: "The surgeon arrived and threw off his jacket to avoid getting pus or blood on it. He rolled up his shirt sleeves and in the corridor to the operating room took an ancient frock from the cupboard, it bore signs of a chequered past and was utterly stiff with blood. One of these coats was worn with special pride, indeed joy, as it had belonged to a retired member of staff." Infection rates were huge during this period, says Mr Jones, and someone having an amputation had a less than 50 per cent chance of survival. "Surgery was the last resort and not the treatment of choice" he points out. "Indeed pus exuding from a wound, known as laudable pus, was seen as a sign of healing and thought to be essential." Evidence of surgeons' attire from that period mainly comes from drawings and paintings of the time. And operating theatres were just what the name suggested - an auditorium with a raised platform where the surgeon would perform the operation in front of an audience. Mr Jones' commentary highlights the surgeons behind other key historical advances: -- Obstetrician Oliver Wendell Holmes (1809-1894) established an early link between infection, surgeons' attire and cleanliness. He urged fellow surgeons to wash themselves, put on clean clothes and refrain from deliveries for 48 hours after coming into contact with a case of puerperal fever. -- Hungarian Ignaz Semmelweis (1818-1865) from the Vienna Maternity Hospital, noticed that a ward attended by medical students had a death rate of about 20 per cent while a ward attended by midwives had a death rate of three per cent. Students regularly came straight from the anatomy dissecting rooms without washing their hands, then performed internal examinations. Infection rates plummeted when they started washing their hands with chloride of lime when they entered the ward. -- Joseph Lister (1827-1912) treated his first compound fracture - which was normally fatal in the 1860s - with wool soaked in carbolic acid (now known as phenol) after noticing it was used by a local sewage works to reduce the smell of the waste. He reported on the first 11 patients treated that way in the Lancet in 1867. Nine recovered without losing their limb, one survived but required an amputation and one died. -- During the Franco-Prussian War (1870-1871) the Germans, but not the French, adopted Lister's two great principles, that germs caused infections and laudable pus was not beneficial or inevitable. The German death rate after amputations was significantly lower than the French rate of 76 per cent. -- Polish surgeon Johannes Von Mikulicz-Radecki (1850-1905) was probably the first to use a face mask and William Halstead (1852-1922) is said to be the first surgeon to use rubber gloves. He commissioned them from the Goodyear rubber company for his theatre sister who developed a skin irritation caused by repeatedly immersing her hands in antiseptic solution. Scottish surgeon William MacEwan (1848-1924) is credited with the introduction of a sterilisable surgical gown. But infection was not just a problem in Victorian times. "The introduction of the 'bare below the elbows policy' by the UK Government is a response to rising rates of hospital-acquired infections like MRSA and C.difficile" says Mr Jones. "But medical opinion is divided. Some feel the rules will undermine patient confidence and others feel it could, despite the flimsy evidence available, help to reduce infection rates. "I suspect some compromise will need to be found that maintains the patient's perception of a highly professional doctor and yet also reflects the concern that doctors' clothing is transmitting infection". "Bare below the elbows: a brief history of surgeon attire and infection." Jones A. BJU International. 102, pp 665-666. (September 2008). DOI - 10.1111/j.1464-410X.2008.07713.x Click here to view abstract online. The new policy was announced by Health Secretary Alan Johnson on 17 September 2007 with instructions that all acute hospitals should have a 'bare below the elbows' policy in place by January 2008. The announcement can be found here. Established in 1929, BJU International is published 23 times a year by Wiley-Blackwell and edited by Professor John Fitzpatrick from Mater Misericordiae University Hospital and University College Dublin, Ireland. It provides its international readership with invaluable practical information on all aspects of urology, including original and investigative articles and illustrated surgery. http://www.bjui.org About Wiley-Blackwell Wiley-Blackwell was formed in February 2007 as a result of the acquisition of Blackwell Publishing Ltd. by John Wiley & Sons, Inc., and its merger with Wiley's Scientific, Technical, and Medical business. Together, the companies have created a global publishing business with deep strength in every major academic and professional field. Wiley-Blackwell publishes approximately 1,400 scholarly peer-reviewed journals and an extensive collection of books with global appeal. For more information on Wiley- Blackwell, please visit http://interscience.wiley Wiley-Blackwell Article URL: http://www.medicalnewstoday.com/articles/120682.php .......................................................................... __________________________________________________________________________ Myanmar: NLD members accused of medical offences by Naw Say Phaw, Democratic Voice of Burma - Oslo,Norway (09.09.08) Sep 9, 2008 (DVB)–Six National League for Democracy members from Magwe division arrested on 6 September have now been identified, according to their colleagues from the NLD. In Salin township, around 70 members of the township police and Swan Arr Shin raided the houses of Ko Thein Aung and Ko Nyein Maung and arrested them, an NLD member said. They were remanded in custody on Sunday and their trial is set for 19 September. In Pyint Phyu township, Ko Kyi Htay Maung and Ko Oo from Madeh village, Ko Than Tun from Kani village and Ko Htay Myint from Nyaungpinsaunk village were arrested, according to MP-elect Dr Aung Moe Nyo. “Ko Htay Myint was arrested on the 6th on the pretext that some illegal lottery tickets were found in his bag when he was visiting Ko Kyi Htay Maung, who had already been arrested,” Dr Aung Moe Nyo said. “Ko Oo was with Ko Htay Myint at the time and was arrested for no reason.” Dr Aung Moe Nyo said Than Tun and Kyi Htay Maung had been accused of illegal possession of syringes and practising medicine without a licence. “Their village is about 13 miles from Pwint Phyu and is not easy to travel to – no doctor goes there,” he said. “They have been doing their best to look after the health of local people by giving injections, and that is why they were detained for keeping syringes and needles.” Dr Aung Moe Nyo said the authorities had been angry that Kyi Htay Maung and Win Maung, who was arrested on similar charges two months ago, had led a successful campaign against the regime’s constitution before the May referendum. “The authorities bear a grudge against U Win Maung and U Kyi Htay Maung for their role in rallying people to oppose the constitution in the May referendum,” Dr Aung Moe Nyo said. “They were also able to encourage polling station guards and referendum officials not to play dirty tricks, so the No campaign won a landslide victory in U Win Maung’s Letpannwe village and Ko Kyi Htay Maung’s Madeh village,” he said. “It could also be that they are doing this in an effort to frighten people as the Saffron Revolution anniversary approaches.” Dr Aung Moe Nyo said the NLD members had been trying to help people who had no other means of getting medical assistance. “Everywhere in Burma there are many people who keep syringes to help people in places were there are no doctors or medics,” Dr Aung Moe Nyo said. “Some of them have been trained by the health department but they are not officially allowed give injections – they can only administer paracetamol, Burmiton and other such medicines,” he said. “But due to public demand they also give out analgesic injections, vitamins and so on. They are doing it out of the desire to help rather than for personal gain.” .......................................................................... __________________________________________________________________________ Canada: More open NCC names first ombudswoman: Lawyer hired to 'foster confidence' in commission Mohammed Adam, Ottawa Citizen - Ontario, Canada (09.09.08) OTTAWA - In a drive for more openness and accountability, the National Capital Commission has named an Ottawa lawyer and mediation expert as its first ombudswoman. Laura Bruneau, 42, who has worked on several high-profile cases, including the tainted-blood scandal, began work yesterday as part-time NCC ombudswoman. She will work on an initial three-year contract that pays $1,160 a day for 50 days' work each year. In making the announcement, NCC board chairman Russell Mills said Ms. Bruneau will bring considerable knowledge and experience to a job that is designed "to give a voice" to people who feel they are not well treated by the NCC. "My mission is to foster further confidence in the National Capital Commission and the way I can do that is by promoting the principles of fairness, integrity and good governance," Ms. Bruneau added. Ms. Bruneau, president of the Bruneau Group, a firm that administers settlements in class-action lawsuits, was picked from a list of 15 candidates who applied for the job. She has lived in Ottawa since she was five years old. Her firm has worked on cases such as the Air France plane crash as well as the Christian Brothers residential-school case in the early 1990s. It also handled tainted-blood compensation claims after transfusion recipients received blood contaminated with hepatitis C from the Red Cross in the 1980s. "She's had a vast experience in dealing with a lot of complex issues," Mr. Mills said. "She is a good listener, a person who has the skills to deal sensitively with the public. She has terrific qualifications for the job." Mr. Mills said the ombudswoman has an important role to play at the NCC and will be a tremendous asset to the community. To ensure her independence, Ms. Bruneau will report directly to the board, he said. She will act on public complaints, but will not initiate her own investigations. Mr. Mills said the job is not a permanent one because the NCC is not sure how busy the office will be. If Ms. Bruneau needs more time than the stipulated 50 days to do her job, it will be made available. "If there are enough complaints to justify a full-time job, then there will be one," Mr. Mills said. "But our objective is to make the NCC as accountable and open as they can possibly be and in a very well-run organization, an ombudsman shouldn't be too busy." Ms. Bruneau said her main task in the next few months is to set up an office, develop regulations and determine the mechanics of filing complaints. She said when the office is up and running, she will introduce herself to residents of the Ottawa region. © The Ottawa Citizen 2008 Copyright © 2008 CanWest Interactive .......................................................................... __________________________________________________________________________ USA: State association honors county for needle, syringe disposal program By: Ellen Holland, Atascadero News - Atascadero,USA (09.09.08) The San Luis Obispo County Integrated Waste Management Authority has been honored for taking progressive steps towards a statewide ban of needles and syringes from household trash. The new state law, which was passed in 2006 and became effective Sept. 1, makes it illegal to dispose of home-generated hypodermic needles in any place other than biohazard containers due to risks associated with improper storage for workers who collect and sort waste. According to the California Integrated Waste Management Board, Californians dispose of more than 300 million household needles and syringes on an annual basis. If these needles are improperly disposed of they can poke through clothing, including boots and heavy gloves, and expose waste workers to viruses such as HIV and hepatitis from the needle users or infectious organisms that adhere to the needle from the surrounding trash. “Proper disposal of sharps waste is a critical step to ensure the health and safety of Californians who use and work around these items every day,” IWMB chair Margo Reid Brown said through a release. “Having proper disposal procedures in place and more facilities to handle them will reduce dangerous and potentially hazardous waste from entering our landfills or causing a public safety threat.” SLO is the only county in the state to provide free biohazard containers for proper household syringe storage, a program which was made possible through a $300,000 grant received from the California IWMB last year, said county IWMA manager Bill Worrell. “Every pharmacy in the county gives out free sharps containers to the public and takes them back when they are full,” Worrell said, noting SLO County IMWA then picks up the containers and sends them away for proper disposal as medical waste. The state grant paid for 60,000 containers that will be provided to citizens free of charge for the next two and a half years. Worrell expects when the grant funds run out the public will have to pay for the containers, which typically last for three to four months and cost between $1 and $2 each. Last month the California Resource Recovery Association presented the SLO County IWMA with an award for its household needle disposal program. “We’ve worked really had to get ready [for the new law’s implementation],” Worrell said. For a complete listing of pharmacies in SLO County visit www.ima.com and click on medical waste. .......................................................................... __________________________________________________________________________ USA: Hepatitis C Battle Intensifying By Annette Wells, Las Vegas Review - Journal - Las Vegas,NV,USA (08.09.08) Liver specialists in Nevada are seeing an increase in patients since health officials in February announced an outbreak of hepatitis C cases linked to an endoscopy clinic. Dr. Robert Gish, a California physician who has had a part-time practice in Nevada for the past two decades, said his patient load has doubled since the outbreak was made public. Some of his new patients underwent procedures at the 700 Shadow Lane facility and have tested positive for hepatitis C. Other patients are just learning they have the disease and are seeking treatment, Gish said. Dr. Donald Hillebrand, another liver specialist from California with a part-time Nevada practice, said his patient load "has picked up substantially." Hillebrand was hired by Southwest Medical Associates in April to help with an anticipated growth in liver patients as a result of the outbreak, linked to the Endoscopy Center of Southern Nevada, 700 Shadow Lane. Hillebrand said he is seeing two general types of liver patients in Southern Nevada. One group is composed of those with end-stage liver disease; the other consists of general hepatology patients, those with hepatitis C or B or who just need a liver doctor. "I've seen a few individuals that were patients of the Endoscopy Center. Some of them have reasons for liver disease independent of the procedures. It is going to be a difficult task for someone to sort that out, to determine whether they got the disease at the clinic versus another time in life," Hillebrand said. "We are talking to patients about that aspect, and it is frustrating. It is frustrating for the patients, and it is frustrating for us. ... What we tell our patients is, while it would be helpful to know the source, you have to move forward.'' That entails a liver specialist evaluating how much of problem hepatitis C is going to be for the patient, he said. How treatable hepatitis C will be is strongly influenced by its strain, liver function and the patient's overall health. For many, losing weight through diet and exercise and abstaining from alcohol might be all they need. Some patients will need to receive riboveron and interferon, drugs known more for their side effects than effectiveness. "It was brutal,'' said Paul Lorenz, a patient of Gish who spent 66 weeks undergoing interferon treatment. "It was pills in the morning, pills at night and an injection once a week. ... It was like having the worst flu you've ever had multiplied by 10. Aches, fevers, chills, sweat and a lot of time thinking crazy things. Everything they said would happen happened.'' Lorenz, an Air Force veteran, thinks his blood could have been tainted by inoculations during his deployment to Vietnam. Lorenz said he was so angry he could kill when he found out he had hepatitis C. He was not a patient of the Endoscopy Center or its affiliated clinic on Burnham Avenue that also was linked to hepatitis transmission. Fortunately for Lorenz, an electrician, he is among the 50 percent of patients for which interferon works. The virus has been undetectable in his blood for two years. The same can't be said for another Gish patient, Raymond Sword, 55. Sword, who said his hepatitis C could have been the result of drug use in the '70s and '80s, was diagnosed seven years ago after a routine physical exam. He began interferon treatments a few years later, which he calls "the worst thing that ever happened" to him. Sword, a shuttle bus driver, ended up with cirrhosis, which eventually led to end-stage liver disease. On May 13, he had a liver transplant at California Pacific Medical Center in San Francisco. Sword still has hepatitis C. "Treatment for hepatitis C has come a long way; the bad news is we still have a ways to go,'' said Hillebrand, medical director of Scripps' Center for Organ and Cell Transplantation in San Diego. "There are still things we just don't know about treatment.'' In some cases, patients with acute hepatitis C have "cleared" the disease on their own, Hillebrand said. The term acute hepatitis refers to the six-month period of time after the virus has entered the body and antibodies can be detected. In about half of the acute hepatitis C cases, patients' immune systems are able to clear the disease, both doctors said. "Hepatitis C is curable. You just have to know you have it and get treatment,'' said Gish, medical director of San Francisco's Pacific Medical Center's liver transplant program. "This is a situation where there's much awareness about liver disease, so more people are getting tested for it. If ever there was anything positive from this outbreak, it is that there is more awareness about liver disease.'' In February, the Southern Nevada Health District announced that six people had contracted hepatitis C and that they all had undergone procedures at the Endoscopy Center's Shadow Lane facility. An investigation by the Centers for Disease Control and Prevention and health district revealed that the reuse of syringes in a manner that contaminated vials of medication, and the reuse of those vials intended for a single patient, had exposed patients to hepatitis B and C and HIV. Notifications were sent to more than 60,000 former patients of the Shadow Lane facility, as well as its Desert Shadow Endoscopy Center affiliate, urging them to get tested for the blood-borne viruses. Health officials have not linked any HIV or hepatitis B cases to either of the two facilities; eight hepatitis C cases are linked to the Shadow Lane facility and one to the Burnham facility. About 400 former patients of the Shadow Lane facility have tested positive for hepatitis C. Health officials have said 77 of them are "possibly" linked to that clinic. In June, the health district set up a hepatitis C exposure registry to help identify patients who had procedures at the two clinics. A little more than 7,000 former patients -- 75 percent from Shadow Lane and 25 percent from Burnham -- have responded to the registry, said Brian Labus, senior epidemiologist. While 95 percent of the patients are from Southern Nevada, registry respondents come from 43 states, Labus said. Their average age is 65. Labus said 91 percent of the former patients reported no risk factors other than having a procedure done at the endoscopy center. Nine percent of the respondents reported having at least one risk factor. "After hearing about the hepatitis C outbreak, I thought about whether I had ever went to any of those clinics,'' said Sword, a father of two teenagers. "I never had, but it saddens me to know that a whole lot of people may have this awful disease because they did nothing other than go to the wrong place.'' Find this article at: http://www.lvrj.com/news/27986474.html .......................................................................... __________________________________________________________________________ Africa: Patient safety: Civil society to sensitize patients PANA, Afrique en ligne - Angers,France (07.09.08) Yaounde, Cameroon - Against the backdrop of a heightened campaign to ensure patient safety, the civil society is planning to sensitize patients across Africa to make them more alert to the issues involved in the campaign, according to Ms. Robinah Kaitirimba, a Patients for Patient Safety Champion. Ms. Kaitirimba, who is the national coordinator of the Uganda National Health Consumers Organisation, told PANA on the sidelines of the just- concluded 58th session of the World Health Organisation (WHO) Regional Committee for Africa in Yaounde, Cameroon, that the plan would include a 'patients recruitment campaign' in the entire African region. Ms. Kaitirimba was one of the speakers at the ceremony organised on the fringes of the WHO session to enable African Ministers to sign on to the first Global Patient Safety Challenge, ''Clean Care is Safer Care', a flagship programme of the World Alliance for Patient Safety. The alliance is a WHO programme, and its 'Clean Care is Safer Care' initiative works towards catalysing global commitment and action to reduce health-care-associated infections (HAI) worldwide. She said in order to ensure the success of the campaign, the civil society would have to be strengthened through donor support, so it can then be able to hold the various governments to the commitments they have made regarding the campaign. Some 39 African health ministers have signed on to the campaign, by pledging to, among others, work to reduce health care-associated infections through actions such as acknowledging the importance of health care-associated infection; enhancing ongoing campaigns at national/sub- national levels to promote and improve hand hygiene among health care providers and making reliable information available on health care associated infection at community and district levels in order to foster appropriate actions. ``With the signing of the pledge, it is now up to the civil society to hold the various governments to their commitments. But first, the civil society itself must be strengthened to enable it carry out its duties effectively,'' Ms. Kaitirimba said. She sited the current ''limping support'' for the civil society by donors as inadequate. The other Patients for Patient safety champion at the ceremony, Mr. Cosmas Kalwambo of Zambia, corroborated Ms. Kaitirimba's statement that the civil society is presently too weak to act effectively to hold governments to their commitments. However, he blamed the situation on lack of the necessary data to show the seriousness of the problems of health care-associated infections, especially in Africa. ''There is very few data available in this area. Without a research data proving this is big problem, international donors won't see it as such, hence may not be inclined to supporting efforts by the civil society to help tackle the problem,'' Mr. Kalwambo said. He also expressed concern that patients were not empowered enough to challenge health care personnel who might be falling short of meeting safety procedures, saying that the current campaign seemed to be 'more tailored to health care personnel than patients'. According to the WHO, health care-associated infection is a global problem, with more than 1.4 million people suffering from it at any given time. It is estimated that in hospitals in developed countries, 5% to 10% of patients acquire one or more infections in health facilities - a figure believed to be between two and 20 times higher in developing countries. .......................................................................... __________________________________________________________________________ Africa: What Africa Should Do To Improve Patient Safety - Dr Sambo Medical News Today (press release) - UK (05.09.08) World Health Organization (WHO) Regional Director for Africa, Dr Luis Sambo, has called on African countries to prioritize "patient safety", a concept that refers to processes or structures which, when applied, reduce the possibility of adverse events resulting from exposure to the health- care system across a range of diseases and procedures. A report by Dr Sambo, to be discussed on Tuesday at the fifty-eighth session of the WHO Regional Committee for Africa taking place in Yaoundé, Cameroon, lists ten actions which could significantly improve patient safety in the African Region. These are the development of a national policy for patient safety; raising awareness of all stakeholders on the importance of patient safety; ensuring safe surgical care; minimizing healthcare-associated infections; and ensuring adequate funding for patient safety activities. Others are improving knowledge and learning in patient safety; re- orienting health systems to make patient safety an integral part of quality care; ensuring appropriate use, quality and safety of medicines; and strengthening surveillance and capacity for research. "Every patient has the right to treatment using the safest technology available in health facilities. Therefore, all health care professionals and institutions have obligations to provide safe and quality health care and to avoid unintentional harm to patients," WHO Regional Director for Africa, Dr Luis Sambo, says in the report. Healthcare-associated infection is a global problem, with over 1.4 million people suffering from it at any given time. It is estimated that in hospitals in developed countries, 5% to 10% of patients acquire one or more infections in health facilities, the risk being two to 20 times higher in developing countries, with patients undergoing surgery being the most affected. Medical errors could result in numerous preventable injuries and deaths; worldwide, adverse events have been estimated to occur in 4% to 16% of all hospital patients. More than half of these occur in surgical care, and more than half are preventable. Unsafe blood and medicines are other important sources of patient harm worldwide. Factors blamed for the high rate of healthcare-associated infections in Africa include weak health care delivery systems; poor infrastructure to support basic but essential procedures such as hand hygiene; weak management capacity; under-equipped health facilities; poor injection and blood safety procedures; overcrowding; and limited microbiological information. In 2004, 7% of countries in the African Region did not test all donated blood for HIV; 22% did not test for hepatitis B and 51% did not test for hepatitis C. The proportion of infections caused by syringes or needles reused without sterilization ranged from 1.5% to 69.4% A recent WHO survey on the quality of antimalarial drugs in seven African countries revealed that between 20% and 90% of the products failed quality testing. The report calls for global action to ensure that all concerned players contribute to this important component of health-care systems. http://www.afro.who.int Article URL: http://www.medicalnewstoday.com/articles/120261.php .......................................................................... __________________________________________________________________________ Africa: What Africa must do to improve patient safety PANA, Afrique en ligne - Angers,France (05.09.08) Yaounde, Cameroon - With patient safety now a topical issue across the world, the World Health Organisation's (WHO) Regional Director for Africa, Dr. Luis Sambo, has called on African countries to prioritize patient safety. The call coincided with the signing, in Yaounde, Cameroon, of a pledge by African Ministers committing their countries to certain actions to reduce health care-associated infections. Dr. Sambo, in a report to the current 58th session of the Regional Committee for Africa in Cameroon's capital, listed 10 actions which he said could significantly improve patient safety in the African Region. The actions include the development of a national policy for patient safety; awareness creation among stakeholders on the importance of patient safety; ensuring save surgical care; minising health care-associated infections and ensuring adequate funding for patient safety activities. Other include knowledge and learning in patient safety; re-orienting health systems to make patient safety an integral part of quality care; ensuring appropriate use, quality and safety of medicines and strengthening surveillance and capacity for research. ``Every patient has the right to treatment using the safest technology available in health facilities. Therefore, all health care professionals and institutions have obligations to provide safe and quality health care and to avoid unintentional harm to patients,'' Dr. Sambo said. According to the WHO, health care-associated infection is a global problem, with more than 1.4 million people suffering from it at any given time. It is estimated that in hospitals in developed countries, 5% to 10% of patients acquire one or more infections in health facilities - a figure believed to be between two and 20 times higher in developing countries. In 2005, the World Alliance for Patient Safety - a WHO progamme - launched the First Global Patient Safety challenge, whose flagship is the 'Cleaner Care is Safer Care' initiative. Some 39 African countries Wednesday signed on to the campaign, which by year's end would have covered 80% of the world's population. .......................................................................... __________________________________________________________________________ USA: Nurses' travel for medical tests compensable: Court Sally Roberts, Business Insurance - Chicago,IL,USA (05.09.08) PHILADELPHIA—Employers must compensate employees for travel expenses and nonwork time spent receiving treatment for exposure to blood-borne diseases while on the job, a federal appeals court ruled Thursday. In Secretary of Labor vs. Beverly Healthcare-Hillview, the 3rd U.S. Circuit Court of Appeals ruled that a nursing home operator was given sufficient notice that such expenses were covered under the Bloodborne Pathogens Standard. That 1991 standard requires employers to make treatment available at no cost to employees for occupational exposure to blood-borne diseases, such as hepatitis and HIV. Beverly Healthcare-Hillview argued that it fully complied with the plain "at no cost" language of the standard, which it said did not encompass compensation for nonwork time or travel expenses. The case involves two Beverly nursing home nurses who were poked by needles while at work in separate incidents in 2002 and 2004. Each subsequently sought treatment at a designated off-site medical facility during nonwork hours for potential exposure to blood-borne diseases, according to court papers. Beverly paid for the cost of the medical evaluations and procedures, but did not reimburse the employees for travel time or the nonwork hours they spent receiving their initial and follow-up treatments. It argued that the ordinary meaning of the word "cost" is the amount charged to purchase goods and services and that the two employees were not "charged" for nonwork time or travel expenses. Beverly was given two citations by the Occupational Safety and Health Administration for failing to reimburse the employees for travel and nonwork expenses. Beverly appealed to an administrative law judge, who upheld the citations. A two-member majority of the Occupational Safety and Health Review Commission subsequently reversed, and the 3rd Circuit on Thursday again upheld the citations against Beverly. The appeals court said that while the relevant "at no cost" language in the standard is ambiguous, various OSHA directives and opinion letters provide sufficient notice of the Secretary of Labor's interpretation that the standard includes compensation for travel expenses and nonwork time. The appeals court vacated the commission’s order and remanded the case for further proceedings. "We are pleased that the court upheld the department's position," a Labor Department spokesperson said in an e-mail. "The court ruled that OSHA's interpretation of the requirements of the blood-borne pathogens standard is reasonable and that the agency has provided adequate notice to the public of those requirements. The decision is an important affirmation of OSHA's practices." Attempts to seek comment from Beverly Healthcare’s attorney were unsuccessful. .......................................................................... __________________________________________________________________________ USA: 20 Drugs the FDA Is Watching: First New Quarterly Report IDs Drug Side Effects Under FDA Investigation By Daniel J. DeNoon, Reviewed by Louise Chang, MD, WebMD Health News (05.09.08) Sept. 5, 2008 -- The FDA is "evaluating" new adverse-event reports for 20 drugs, the agency announced today. A 2007 federal law requires the FDA to disclose all its investigations into reports of possibly drug-related adverse events. Today's list is the first of this series of quarterly reports. The list includes adverse events reported between Jan. 1 and March 31, 2008. FDA officials say it will be "weeks or months" before more recent reports are made. All of the reports on the list come from the FDA's early-warning system for drugs already on the market. This Adverse Event Reporting System (AERS) collects reports from patients, hospitals, doctors, and drug companies about suspicious problems that might -- or might not -- be related to a medication. Just because a drug is on the list doesn't mean it isn't safe -- or even that it caused the suspected problem. Nobody should stop taking a drug just because it's on the list, the FDA says. "If a drug is listed, it means we have begun an analysis to see if there is a safety problem that requires further evaluation," Gerald Dal Pan, MD, MPH, director of the FDA office of surveillance and epidemiology, said at a news conference. When that evaluation is done, the FDA will either issue further warnings or an all-clear, Dal Pan said. Here's the list of drugs and the "adverse events" -- side effects -- reported to the AERS database: Product Name: Active Ingredient (Trade)or Product Class Potential Signal of Serious Risk/New Safety Information [Mod: edited to injectables] Arginine Hydrochloride Injection (R-Gene 10) Pediatric overdose due to labeling / packaging confusion Phenytoin Injection (Dilantin) Purple glove syndrome (discoloration, pain, and swelling of the hand that may lead to amputation) The report does not say how many people were affected by these possible drug reactions, nor does it give any indication of their severity. "Our safety evaluators will look at the seriousness of the event, whether we are seeing greater numbers of a certain kind of event we should not expect, whether there is something new and not known about the drug, or whether this is something known but which may require refinement of our knowledge," Dal Pan said. "This extends our commitment to keep the public and the health care community informed of what we are evaluating," Paul Seligman, MD, MPH, FDA associate director of safety policy and communication, said at the news conference. © 2008 WebMD, LLC. All rights reserved. Article Link: http://www.webmd.com/news/20080905/20-drugs-fda-is-watching .......................................................................... __________________________________________________________________________ UK: Cabinet to look again at contaminated transfusions: Fortrose hepatitis C sufferer wins minister’s pledge Eilidh Davies, Aberdeen Press and Journal-Aberdeen,Scotland,UK (04.09.08) A Westminster MP yesterday agreed to raise the issue of haemophiliac patients who contracted potentially fatal illnesses through contaminated blood at a Cabinet meeting. David Cairns, the Minister of State at the Scotland Office, made the commitment after speaking to haemophiliac Bruce Norval, 43, during a tour of Eden Court Theatre in Inverness. Mr Norval, of Fortrose, is among almost 5,000 people who were exposed to hepatitis C during the 70s and 80s. Of those, 1,200 were infected with HIV. He was diagnosed as hepatitis C-positive in 1990. He also has hepatitis B. Mr Norval said it was extremely important that the matter was discussed at the highest level as an independently-funded inquiry into the bungle nears its end. He said: “It’s an issue of decency because 5,000 people have been affected. If that many had died because of flooding, the Queen would be visiting the area. So why are we not recognised? “I’m likely to be dead before I’m 50.” He said Tony Blair’s government had not been interested in the sufferers, but he hoped that, with Mr Cairns’ help, Mr Brown might respond more favourably. Mr Norval said: “In Ireland, following an inquiry, sufferers were awarded between £30,000 and £300,000 per person. I have been unable to work since I was 30, after the symptoms of the disease became too much.” Mr Cairns said it was not his remit, but he would look into the matter and would respond in writing to him. Labour peer Lord Archer of Sandwell, a former solicitor general, is leading the inquiry about the long-term effects of the mistakes. Mr Norval believes he was infected in 1967 when he was treated with “blood plasma concentrate”, a product made up of a mix of different bloods, when he was aged just three. The Archer Independent Public Inquiry comes after a long campaign to investigate the mistakes that led to the infection of blood products. It is being funded privately and not by the Government, which said treatments had been given in “good faith”. It came after the Government admitted that files on the infection of patients through blood products had been destroyed. .......................................................................... __________________________________________________________________________ Australia: Anaphylaxis Risk Higher than Normal with HPV Vaccine, but Still Rare Reuters Health (03.09.08) A new report shows that the risk of anaphylaxis following immunization with the quadrivalent human papillomavirus vaccine (Gardasil) is higher than with other commonly administered vaccines; however, the absolute risk is still very low. In 2007, Australia began administering the HPV vaccine free to all females ages 12 to 26. In the current study, researchers investigated 12 suspected cases of anaphylaxis. Eight of the 12 were classified as anaphylaxis. Four of the eight had a negative skin-prick test for the HPV vaccine. From the 269,680 vaccine doses administered in schools, seven cases of anaphylaxis were identified, for an incidence rate of 2.6 cases per 100,000 doses. All cases of anaphylaxis were successfully managed with no serious long- term effects. Even so, the rate of anaphylaxis was higher than that seen with other vaccines: The conjugated meningococcal C vaccine, for example, has an anaphylaxis rate of 0.1 per 100,000 doses. "Anaphylaxis following HPV vaccination is a rare event, as defined by the World Health Organization, and it should not curtail population-based HPV vaccination programs," the authors concluded. In a related editorial, Dr. Neal A. Halsey of Johns Hopkins University wrote, "The risk of rare, but potentially serious adverse events should not discourage the administration of this vaccine in school-based clinics, which are an effective means of reaching adolescents." He added, however, that such programs must be prepared to quickly detect and effectively treat adverse reactions. The study, "Anaphylaxis Following Quadrivalent Human Papillomavirus Vaccination," and the editorial, "The Human Papillomavirus Vaccine and Risk of Anaphylaxis," were published in the Canadian Medical Association Journal (2008;179(6):525-533 and doi:10.1503/cmaj.081133.) .......................................................................... __________________________________________________________________________ Africa: Circumcision Problems Impair HIV Prevention - Study Laura MacInnis, Reuters (01.09.08) A World Health Organization (WHO) study released Monday raises doubts about the rapid implementation of male circumcision as a strategy to fight HIV/AIDS in Africa, where researchers found "shocking" rates of complications from the procedure. Studies have shown that male circumcision reduces the risk of female-to-male HIV infection by up to 70 percent. The WHO study authors, Kenyan Omar Egesah and Robert Bailey and Stephanie Rosenberg of the United States, found that as many as 35 percent of males circumcised by traditional practitioners in Kenya's Bungoma district had complications, including bleeding, infection, excessive pain, and erectile dysfunction. "Other common adverse effects reported were pain upon urination, incomplete circumcision requiring recircumcision, and laceration," said the authors, estimating that 6 percent of patients had life-long problems as a result. The researchers physically examined 298 of the 1,007 participants in the study; they intervened when they observed complications. While male circumcision is universally practiced in Bungoma, the study indicated that many clinicians there lacked sharp and sterile instruments and few were formally trained. Even public clinics had a complication rate of 18 percent. The study's findings "should serve as an alarm to ministries of health and the international health community that focus cannot only be on areas where circumcision prevalence is low," said the authors. "Extensive training and resources will be necessary to build the capacity of health facilities in sub-Saharan Africa before safe circumcision services can be aggressively promoted for HIV prevention," they wrote. The study, "Male Circumcision for HIV Prevention: A Prospective Study of Complications in Clinical and Traditional Settings in Bungoma, Kenya," was published in the Bulletin of the World Health Organization (2008;86(9):657-736). .......................................................................... __________________________________________________________________________ USA: No More Needles in Trash, State Says Mike Lee, San Diego Union-Tribune (08.31.08):: A state law in effect from Sept. 1 bars California residents from throwing medical sharps - including needles, syringes, and lancets - into regular trash or recycling bins. The law seeks to protect waste workers and others from potentially disease-transmitting needle sticks. However, some advocates worry it will complicate needle disposal for residents with self-medicated conditions. "It really seems like there wasn't a lot of publicity around the law and people are really confused about what the options are," said Kate Bartkiewicz of the San Diego Diabetes Coalition. Up to now, many patients have been collecting needles in coffee cans or milk jugs and tossing those containers into the trash. California's Integrated Waste Management Board has met with diabetes educators and created a searchable database of drop-off locations for sharps. The database shows five locations in San Diego County. "There are enough collection centers across the state, and we are encouraging local and county governments to open additional areas," said Andrew Hughan, spokesman for the board. Some companies accept sharps mailed to them in approved containers, but this practice could be expensive. Another alternative promoted by the state is to drop off used sharps at pharmacies or health care facilities. For example, San Luis Obispo County adopted a law forcing pharmacies that sell needles to provide free collection containers and free disposal. Other counties, such as San Diego, have no pharmacies that will currently accept sharps. The national pharmacy chain CVS does not accept used needles, but does offer mail-back containers for purchase on its Web site. San Diego officials suggest taking sharps to one of nine permanent centers for handling household hazardous waste. The county will also install drop- off kiosks in several rural communities and give out a limited number of disposal containers. __________________________________________________________________________ _____________________________________*____________________________________ __________________________________________________________________________ * SAFETY OF INJECTIONS brief yourself at: www.injectionsafety.org More information on the prevention of injection-associated infections can be obtained on the WHO web site at http://www.who.int/inf-fs/en/fact231.html and in French at http://www.who.int/inf-fs/fr/am231.html , on the web site of SIGN at www.injectionsafety.org and at the SIGN Secretariat, the Department of Essential Health Technologies, WHO, Avenue Appia 20, CH-1211 Geneva 27, Switzerland. Telephone: +41 22 791 3680, Facsimile: +41 22 791 4836, E- mail: sign@who.int _____________________________________*____________________________________ __________________________________________________________________________ SIGN meets annually to aid collaboration and synergy among SIGN network participants worldwide. The 2008 SIGN annual meeting will be held from 13 to 15 October 2008, in Moscow, Russia. The SIGN 2007 annual meeting was held 23 - 25 October in Geneva Switzerland. The SIGN 2007 meeting Report [pdf 2.63Mb] is available for download at: http://tinyurl.com/5rjy7n The final report of the November 2005 meeting is available for download from the SIGN website. The file is 773 KB and is in Adobe Acrobat format. http://www.who.int/entity/injection_safety/Final-SIGNHanoiReport7Feb06.pdf Many SIGN files can be opened in Acrobat Reader. To access all the features in Adobe Acrobat documents download the Acrobat Reader at: http://www.adobe.com/products/acrobat/readstep2.html Translation tools are available at: http://www.google.com/language_tools or http://www.freetranslation.com __________________________________________________________________________ All members of the SIGN Forum are invited to submit messages, comment on any posting, or to use the forum to request technical information in relation to injection safety. The comments made in this forum are the sole responsibility of the writers and does not in any way mean that they are endorsed by any of the organizations and agencies to which the authors may belong. Use of trade names and commercial sources is for identification only and does not imply endorsement. Contributions to: sign@uq.net.au or use your reply button! The SIGN Forum welcomes new subscribers who are involved in injection safety. Please subscribe by sending an email to: sign@who.int _____________________________________*____________________________________ The SIGN Internet Forum was established at the initiative of the World Health Organization's Department of Essential Health Technologies. The SIGN Forum is moderated by Allan Bass and is hosted on the University of Queensland computer network. http://www.uq.edu.au __________________________________________________________________________