*SAFE INJECTION GLOBAL NETWORK* SIGNPOST *SAFE INJECTION GLOBAL NETWORK* Post00473 Reminder + Evaluation + Abstracts + News 12 November 2008 CONTENTS 0. SIGN 2008 Meeting: Abstracts Reminder 1. Report: Evaluation of retractable syringes in an immunization campaign in Peru 2. Abstract: Hepatitis B vaccination status and needle stick injuries among medical students in a Nigerian university 3. Abstract: Needlestick injuries in veterinary medicine 4. Abstract: Microwave inactivation of Escherichia coli in healthcare waste 5. Abstract: Accidents with biological material and immunization against hepatitis B among students from the health area 6. Abstract: Intravenous therapy: a guide to good practice 7. Abstract: Strategies for preventing peripheral intravenous cannula infection 8. Abstract: Patient acceptance and issues of education of two durable insulin pen devices 9. Abstract: Understanding and measuring AIDS-related stigma in health care settings: a developing country perspective 10. Abstract: Rapid assessment of drug use and sexual HIV risk patterns among vulnerable drug-using populations in Cape Town, Durban and Pretoria, South Africa 11. Abstract: Expanding the public health benefits of syringe exchange programs 12. Abstract: Safety of Acupuncture Practice in Japan: Patient Reactions, Therapist Negligence and Error Reduction Strategies 13. Abstract: How to evaluate sharp safety-engineered devices 14. Abstract: Prion disease transmission: can we apply standard precautions to prevent or reduce risks? 15. Abstract: Instrument integrity and sterility: the perioperative practitioner's responsibilities 16. Abstract: Decontamination in the dental setting 17. Abstract: The perspectives of injection drug users regarding safer injecting education delivered through a supervised injecting facility 18. Abstract: Hepatitis C Virus Acquisition among Injecting Drug Users: A Cohort Analysis of a National Repeated Cross-sectional Survey of Needle and Syringe Program Attendees in Australia, 1995-2004 19. Abstract: Hygienic hand washing among nursing students in Turkey 20. Abstract: Sterile versus non-sterile glove use and aseptic technique 21. Abstract: Adoption of Alcohol-Based Handrub by United States Hospitals: A National Survey 22. Abstract: Comment: Surgical hand antisepsis: the evidence 23. No Abstract: Achieving the potential of HIV prevention interventions: critical global need for collaborative dissemination efforts 24. No Abstract: Laying down the law on healthcare-associated infections 25. News - Uzbekistan: Uzbek children in 'Aids outbreak' - India: Marc Koska's Safe Injection Campaign Set to Save Millions of Lives - Viet Nam : Medical staff contract HIV via unsafe occupational practices - Pakistan: Hepatitis B, C on rise due to [sic] contaminated water - USA: University of Connecticut Professor Awarded for HIV Prevention Method - Women's hands have more kinds of bacteria than men's, study finds - USA: Las Vegas Hepatitis Scare Class Action Lawsuit Not Certified by Court - Estonia: Estonia Has One of Europe's Top Rates of Injecting Drug Users - USA: Class-Action Lawsuit Rejected in Hepatitis C Outbreak - Needle-free injection device approved in Europe and Australia - USA: FDA sends in federal marshals to seize tainted heparin - UK: HIV prevalence stable among UK injecting drug users - Canada: Third Saskatchewan Health Region Reports Reuse of Syringes in Operating Room - Nigeria: Medical Waste - Their Wealth, Residents' Death - Germany: Doctor in Germany HIV scandal This edition of SIGNpost is located at: http://uqconnect.net/signfiles/Archives/SIGN-POST00473.txt and is printer friendly. If your email reader truncates your SIGNpost - click on the link above to download the complete posting. Please send your requests, notes on progress and activities, articles, news, and other items for posting to: sign@uq.net.au Normally, items received by Tuesday will be posted in the Wednesday edition. 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 __________________________________________________________________________ _____________________________________*____________________________________ 0. SIGN 2008 Meeting: Abstracts Reminder SIGN 2008 Meeting presenters are reminded to please submit abstracts of their presentations by Monday 16 November for inclusion in the meeting report. __________________________________________________________________________ To: SIGN 2008 Meeting presenters Dear SIGN Colleagues, Thank you for your presentation given at the 2008 SIGN meeting in Moscow, Russian Federation, 13-15 October. Many thanks for the meeting presentation abstracts received to date! We are hoping to complete the draft of the 2008 meeting report as soon as is possible. If you have not emailed an abstract of your meeting presentations, please email us an abstract of approximately 300 to 450 words summarizing your presentation and its main conclusions. Your abstract file would be appreciated * The closing date for submission of SIGN 2008 meeting abstracts for inclusion in the meeting report is: Monday 16 November 2008 Many thanks in advance. It was a great pleasure to work with you at the meeting. regards and best wishes, allan bass SIGN 2008 meeting rapporteur __________________________________________________________________________ _____________________________________*____________________________________ 1. Report: Evaluation of retractable syringes in an immunization campaign in Peru Discussion, comments and additions please: sign@uq.net.au or use your reply button __________________________________________________________________________ Subject: New posting From: "Muller, Nancy" To: "SIGN Moderator" Hi Allan, Below is a link a summary report of an evaluation of retractable syringes in a measles-rubella immunization campaign in Peru. In 2006, UNICEF and the Peruvian Ministry of Health (MOH), with assistance from PATH, performed an evaluation in Lima and Cuzco to assess perceptions of acceptability and safety of automatic retractable syringes in an immunization setting and their affect on waste disposal. The results of the evaluation showed that retractable syringes were seen as a reliable, easy to use, and a preferred alternative to standard disposables in the campaign setting. The evaluation also found that retractable syringes also have the potential to significantly improve the safe management of sharps waste in this setting. Link to the summary: http://www.path.org/publications/details.php?i=1638. For more information about the evaluation please contact Fabiola Quiroz (UNICEF-Peru) at fquiroz@unicef.org or Maria Ana Mendoza at mmendoza@minsa.gob. For more information on PATH's work on injection safety please contact Nancy Muller at nmuller@path.org. Best regards, Nancy Muller Senior Program Officer PATH __________________________________________________________________________ _____________________________________*____________________________________ 2. Abstract: Hepatitis B vaccination status and needle stick injuries among medical students in a Nigerian university __________________________________________________________________________ Niger J Med. 2008 Jul-Aug;17(3):330-2.Links Hepatitis B vaccination status and needle stick injuries among medical students in a Nigerian university. Okeke EN, Ladep NG, Agaba EI, Malu AO. Department of Medicine, Jos University Teaching Hospital, Jos, Nigeria. edinony@yahoo.com BACKGROUND: Hepatits B virus (HBV) is the most common blood borne pathogen that poses an occupational risk to Health-care workers. The incidence of infection following needle stick injury has been reported to be high among medical students. Effective vaccines against HBV are available. The aim of this study was to determine the vaccination status and prevalence of needlestick injury among medical students in a tertiary institution in a developing country (Nigeria). METHOD: Information regarding hepatitis B status, history of needlestick injury and awareness of risk factors for HBV were obtained from clinical medical students using a self administered questionnaire. Three hundred and forty six students responded. RESULTS: Three hundred and five (88.7%) agreed that medical education exposes one to HBV infection and 315 (91.6%) were aware of the availability of vaccine against HBV. Only 42 (47.7%) were vaccinated against HBV. Majority (57.4%) gave lack of opportunity as reason for non immunization while 34.7% had never given it a thought. One hundred and sixty-six (48%) of the respondents admitted to a previous needlestick injury and only 17 (10.2%) of those who reported history of needlestick injury had post-exposure prophylaxis against HBV infection. CONCLUSION: HBV vaccination status is very low among medical students in Nigeria and the prevalence of needle stick injuries is high. Universities must not only provide HBV vaccination free of charge but also enforce its use by these students. __________________________________________________________________________ _____________________________________*____________________________________ 3. Abstract: Needlestick injuries in veterinary medicine __________________________________________________________________________ Can Vet J. 2008 Aug;49(8):780-4. Needlestick injuries in veterinary medicine. Weese JS, Jack DC. Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, Ontario. jsweese@uoguelph.ca Needlestick injuries are an inherent risk of handling needles during the course of veterinary practice. While significant effort has been expended to reduce needlestick injuries in human medicine, a relatively lax approach seems to be prevalent in veterinary medicine. It appears that needlestick injuries are very common among veterinary personnel and that serious adverse effects, while uncommon, do occur. Clients may also receive injuries in clinics during the course of animal restraint, and at home following prescription of injectable medications or fluids. Because of occupational health, personal health, and liability concerns, veterinary practices should review the measures they are taking to reduce the likelihood of needlestick injuries and develop written needlestick injury avoidance protocols. __________________________________________________________________________ _____________________________________*____________________________________ 4. Abstract: Microwave inactivation of Escherichia coli in healthcare waste __________________________________________________________________________ Waste Manag. 2008;28(5):840-8. Epub 2007 Apr 6. Microwave inactivation of Escherichia coli in healthcare waste. Tonuci LR, Paschoalatto CF, Pisani R Jr. University of Ribeirão Preto, Post-Graduate Program in Environmental Technology, Rua José Bonifácio, 799, 13560-610 São Carlos, SP, Brazil. Public healthcare wastes from the city of Ribeirão Preto, SP, Brazil, pre- sterilised in an autoclave, were inoculated with 5 x 10(5) microorganisms of the species Escherichia coli in vegetative form for microwave processing on a laboratory scale. An analysis was made of the influence of radiation exposure time (15, 25, 30 and 40 min) and power per waste mass unit (60, 80 and 100 W/kg) on the percentage of inactivation of the microorganisms at an incoming waste moisture level of 50%. The experimental results were adjusted based on Chick's law. The activation energies and the Arrhenius pre-exponential factors were determined by the least squares method. The kinetic parameters obtained allow one to predict the degree of inactivation achieved with E. coli in typical healthcare waste, based on the radiation exposure time and temperature. For example, the waste disinfection time required for the inactivation level equivalent to 4Log 10 was estimated to range from 48 to 53 min for wastes processed at 100 W/kg and at temperatures of 90-105 degrees C, respectively. Thus, under the operational conditions of the equipment currently used in Ribeirão Preto, the process of inactivation is probably ineffective, since the exposure time to radiation is only 30 min at the average power of approximately 80 W/kg. __________________________________________________________________________ _____________________________________*____________________________________ 5. Abstract: Accidents with biological material and immunization against hepatitis B among students from the health area __________________________________________________________________________ Rev Lat Am Enfermagem. 2008 May-Jun;16(3):401-6. Accidents with biological material and immunization against hepatitis B among students from the health area. [Article in English, Portuguese, Spanish] Gir E, Netto JC, Malaguti SE, Canini SR, Hayashida M, Machado AA. Ribeirão Preto College of Nursing, University of São Paulo, Brazil. egir@eerp.usp.br Undergraduate students from the health area often handle piercing-cutting instruments in their academic activities, which exposes them to the risk of contracting infections. This study aimed to analyze accidents with biological material among these students. Out of 170 accidents registered, 83 (48.8%) occurred with Dentistry students, 69 (40.6%) with Medical students, 11 (6.5%) with Nursing students and in 06 (3.5%) of the cases there was no such information in the files. Most accidents, 106 (62.4%), occurred with students from private schools and 55 (32.3%) with those from public schools. Percutaneous accidents occurred in 133 (78.2%) exposures and there was immediate search for specialized health care in only 38 (21.3%) accidents. In 127 (74.7%) accidents, the immunization schedule against hepatitis B was complete. Therefore, schools need to offer courses and specific class subjects regarding biosafety measures, including aspects related to immunization, especially the vaccine against hepatitis B. __________________________________________________________________________ _____________________________________*____________________________________ 6. Abstract: Intravenous therapy: a guide to good practice __________________________________________________________________________ Br J Nurs. 2008 Oct 23-Nov 12;17(19):S4-S12. Intravenous therapy: a guide to good practice. Scales K. Imperial College Healthcare NHS Trust, Charing Cross Hospital, London. This article provides an overview of the principles of good practice that underpin intravenous (IV) therapy. The indications for choosing the IV route and selecting an appropriate vascular access device (VAD) are explained. Common insertion sites for VAD placement and the care and management of VADs are reviewed. Infection control aspects of IV therapy are be highlighted, including the management of IV equipment and the importance of the nurse's role in the prevention of infection associated with IV therapy. Common complications of IV therapy are explained and strategies suggested for their prevention. The article addresses the issues associated with general IV therapy, it does not address specialist subjects such as parenteral nutrition, chemotherapy or blood transfusion. __________________________________________________________________________ _____________________________________*____________________________________ 7. Abstract: Strategies for preventing peripheral intravenous cannula infection __________________________________________________________________________ Br J Nurs. 2008 Oct 23-Nov 12;17(19):S14-21. Strategies for preventing peripheral intravenous cannula infection. Morris W, Heong Tay M. Royal Berkshire NHS Foundation Trust. Peripheral intravenous (IV) cannulation is a procedure that involves breaching the integrity of the skin, exposing patients to the risk of infection. Acquisition of infection has associated costs both for patients and the NHS. The high number of peripheral IV cannulae (PICs) inserted annually has resulted in serious infection and significant morbidity (O'Grady et al, 2002). Risks associated with PIC infection must be addressed to reduce patient morbidity and increased cost of prolonged hospital admission and treatment. This article discusses the sources and routes of infection associated with peripheral IV cannulation, and examines healthcare management strategies for preventing infection when performing peripheral cannulation. These comprise: the Peripheral Venous Cannulation Policy, which empowers practitioners to challenge poor cannulation skills and standardize practice; education, which provides learning opportunities within programmes such as Infection Control Core Competencies Study Days, designed to promote infection prevention strategies directly related to cannula care and aimed at all levels of Trust staff; and the Peripheral Cannula Care Plan, which ensures accurate documentation of cannulation procedures. This last strategy is simple to use and provides a route for improving cannula-related documentation. A high standard of documentation will also assist audit, which is crucial to reducing PIC infection. __________________________________________________________________________ _____________________________________*____________________________________ 8. Abstract: Patient acceptance and issues of education of two durable insulin pen devices __________________________________________________________________________ Diabetes Technol Ther. 2008 Aug;10(4):299-304. Patient acceptance and issues of education of two durable insulin pen devices. Asakura T, Seino H, Jensen KH. Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Niigata University of Pharmacy and Applied Life Sciences, Niigata City, Japan. asa-mac@m7.dion.ne.jp BACKGROUND: Insulin pen devices offer patients a more convenient, accurate, and discreet mode of insulin delivery than traditional syringes and vials. This open-label, randomized, comparative crossover study assessed patient preference for two reusable pens: NovoPen 4 (Novo Nordisk A/S, Copenhagen, Denmark) and OptiClik (Sanofi-Aventis, Bridgewater NJ). METHODS: Thirty-five diabetes patients with no previous experience of pen devices (mean age 56.7 years; range 17-80 years; 57% male) used both pens to deliver a 10 unit saline dose into an injection cushion. Half received guidance according to official instruction manuals, and half were given no instructions. Learning times were also measured. Participants completed a detailed questionnaire to determine their preferences. RESULTS: Overall, 32 of 35 participants preferred NovoPen 4 compared with two of 35 for OptiClik (91.4% vs. 5.7% respectively, P<0.001), and one had no preference. NovoPen 4 was significantly favored over OptiClik in almost all questionnaire criteria, including safety (P<0.001), size of pen (P<0.001), appearance (P<0.001), and ease of use (P<0.001). The majority of patients were able to use NovoPen 4 without guidance (94.4%) compared with just over half for for OptiClik (55.6%, P<0.01). Learning time was also significantly faster for NovoPen 4 (62.6 s) than for OptiClik (95.8 s) (P<0.05). CONCLUSIONS: Patients learned how to use both pens quickly (under 2 min), but NovoPen 4 was preferred by participants over OptiClik. Patient acceptance of a pen device may support insulin initiation, particularly in type 2 diabetes. __________________________________________________________________________ _____________________________________*____________________________________ 9. Abstract: Understanding and measuring AIDS-related stigma in health care settings: a developing country perspective __________________________________________________________________________ SAHARA J. 2007 Aug;4(2):616-25. Understanding and measuring AIDS-related stigma in health care settings: a developing country perspective. Mahendra VS, Gilborn L, Bharat S, Mudoi R, Gupta I, George B, Samson L, Daly C, Pulerwitz J. Population Council, 142 Golf Links, New Delhi 110 003, India. vmahendra@popcouncil.org AIDS-related stigma and discrimination remain pervasive problems in health care institutions worldwide. This paper reports on stigma-related baseline findings from a study in New Delhi, India to evaluate the impact of a stigma-reduction intervention in three large hospitals. Data were collected via in-depth interviews with hospital staff and HIV- infected patients, surveys with hospital workers (884 doctors, nurses and ward staff) and observations of hospital practices. Interview findings highlighted drivers and manifestations of stigma that are important to address, and that are likely to have wider relevance for other developing country health care settings. These clustered around attitudes towards hospital practices, such as informing family members of a patient's HIV status without his/her consent, burning the linen of HIV- infected patients, charging HIV-infected patients for the cost of infection control supplies, and the use of gloves only with HIV-infected patients. These findings informed the development and evaluation of a culturally appropriate index to measure stigma in this setting. Baseline findings indicate that the stigma index is sufficiently reliable (alpha = 0.74). Higher scores on the stigma index--which focuses on attitudes towards HIV- infected persons--were associated with incorrect knowledge about HIV transmission and discriminatory practices. Stigma scores also varied by type of health care providers--physicians reported the least stigmatising attitudes as compared to nursing and ward staff in the hospitals. The study findings highlight issues particular to the health care sector in limited-resource settings. To be successful, stigma-reduction interventions, and the measures used to assess changes, need to take into account the sociocultural and economic context within which stigma occurs. __________________________________________________________________________ _____________________________________*____________________________________ 10. Abstract: Rapid assessment of drug use and sexual HIV risk patterns among vulnerable drug-using populations in Cape Town, Durban and Pretoria, South Africa __________________________________________________________________________ SAHARA J. 2008 Sep;5(3):113-9. Rapid assessment of drug use and sexual HIV risk patterns among vulnerable drug-using populations in Cape Town, Durban and Pretoria, South Africa. Parry C, Petersen P, Carney T, Dewing S, Needle R. Alcohol and Drug Abuse Research Unit, South African Medical Research Council. cparry@mrc.ac.za This exploratory study examines the links between drug use and high-risk sexual practices and HIV in vulnerable drug-using populations in South Africa, including commercial sex workers (CSWs), men who have sex with men (MSM), injecting drug users (IDUs) and non-injecting drug users who are not CSWs or MSM (NIDUs). A rapid assessment ethnographic study was undertaken using observation, mapping, key informant interviews and focus groups in known 'hotspots' for drug use and sexual risk in Cape Town, Durban and Pretoria. Key informant (KI) and focus group interviews involved drug users and service providers. Purposeful snowball sampling and street intercepts were used to recruit drug users. Outcome measures included drug-related sexual HIV risk behaviour, and risk behaviour related to injection drug use, as well as issues related to service use. HIV testing of drug-using KIs was conducted using the SmartCheck Rapid HIV-1 Antibody Test. Non-injection drug use (mainly cannabis, methaqualone, crack cocaine and crystal methamphetamine) and injection drug use (mainly heroin) was occurring in these cities. Drug users report selling sex for money to buy drugs, and CSWs used drugs before, during and after sex. Most (70%) of the drug-using KIs offered HIV testing accepted and 28% were positive, with rates highest among CSWs and MSM. IDUs reported engaging in needle sharing and needle disposal practices that put them and others at risk for contracting HIV. There was a widespread lack of awareness about where to access HIV treatment and preventive services, and numerous barriers to accessing appropriate HIV and drug-intervention services were reported. Multiple risk behaviours of vulnerable populations and lack of access to HIV prevention services could accelerate the diffusion of HIV. Targeted interventions could play an important role in limiting the spread of HIV in and through these under-reached and vulnerable populations. __________________________________________________________________________ _____________________________________*____________________________________ 11. Abstract: Expanding the public health benefits of syringe exchange programs __________________________________________________________________________ Can J Psychiatry. 2008 Aug;53(8):487-95. Expanding the public health benefits of syringe exchange programs. Kidorf M, King VL. Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. mkidorf@jhmi.edu OBJECTIVE: To provide a brief history of community syringe exchange programs (SEPs), describe the clinical profile of those who attend them, identify factors interfering with the transition of SEP participants to more comprehensive substance abuse treatment services, review studies designed to improve rates of treatment seeking, and offer practical suggestions to facilitate links between SEPs and substance abuse treatment. METHOD: Relevant articles were identified using a PubMed literature search of English-language journals from 1997 to 2007. Studies were included that evaluated the effectiveness of SEPs or methods for increasing treatment enrolment in SEP participants or other out-of- treatment intravenous drug users. Relevant articles prior to 1997 were identified using reference lists of identified articles. RESULTS: SEPs have little impact on rates of drug use or injections. Substance abuse treatment reduces human immunodeficiency virus transmission through drug use reduction and psychosocial functioning improvement, yet SEP participants only infrequently engage in treatment. Psychological and pharmacological interventions delivered at the SEP setting can improve treatment seeking in SEP participants. Use of SEPs by substance abuse treatment programs can improve harm-reduction efforts at these settings. CONCLUSIONS: Efforts to improve the link between SEPs and substance abuse treatment should include interventions to enhance cooperation across programs, motivate treatment enrolment and SEP use, and expand access to treatment. A more fluent and bidirectional continuum of services can enhance the public health benefits of both of these health care delivery settings. __________________________________________________________________________ _____________________________________*____________________________________ 12. Abstract: Safety of Acupuncture Practice in Japan: Patient Reactions, Therapist Negligence and Error Reduction Strategies __________________________________________________________________________ Evid Based Complement Alternat Med. 2007 Sep 13. Safety of Acupuncture Practice in Japan: Patient Reactions, Therapist Negligence and Error Reduction Strategies. Yamashita H, Tsukayama H. LAc, Department of Acupuncture, Faculty of Health Sciences, Morinomiya University of Medical Sciences, 1 Nanko-Kita, Suminoe-Ku, Osaka, Japan 559-8611. yamashita@morinomiya.ac.jp. Evidence-based approach on the safety of acupuncture had been lagging behind both in the West and the East, but reliable data based on some prospective surveys were published after the late 1990s. In the present article, we, focusing on 'Japanese acupuncture', review relevant case reports and prospective surveys on adverse events in Japan, assess the safety of acupuncture practice in this country, and suggest a strategy for reducing the therapists' error. Based on the prospective surveys, it seems reasonable to suppose that serious adverse events are rare in standard practice by adequately trained acupuncturists, regardless of countries or modes of practice. Almost all of adverse reactions commonly seen in acupuncture practice-such as fatigue, drowsiness, aggravation, minor bleeding, pain on insertion and subcutaneous hemorrhage-are mild and transient, although we should be cautious of secondary injury following drowsiness and needle fainting. After demonstrating that acupuncture is inherently safe, we have been focusing on how to reduce the risk of negligence in Japan, as well as educating acupuncturists more about safe depth of insertion and infection control. Incident reporting and feedback system is a useful strategy for reducing therapist errors such as forgotten needles. For the benefit of acupuncture patients in Japan, it is important to establish mandatory postgraduate clinical training and continued education system. __________________________________________________________________________ _____________________________________*____________________________________ 13. Abstract: How to evaluate sharp safety-engineered devices __________________________________________________________________________ Nurs Times. 2008 Sep 9-15;104(36):42-5. How to evaluate sharp safety-engineered devices. Ford JL, Phillips P. Princess of Wales Hospital, Bridgend. With increasing concerns of occupational exposure to bloodborne viruses in healthcare settings, NHS trusts are under pressure to consider opting for safer sharps devices that are designed to protect users from needlestick injuries. However, with an ever-increasing range of 'sharp safety' devices on the market, deciding what to purchase is a complex issue. In addition, evidence shows that purchasing safety devices alone will not eliminate the problem of needlestick injuries. This article discusses the criteria that should be taken into account when trusts consider introducing sharp safety devices into their workplace. __________________________________________________________________________ _____________________________________*____________________________________ 14. Abstract: Prion disease transmission: can we apply standard precautions to prevent or reduce risks? __________________________________________________________________________ J Perioper Pract. 2008 Jul;18(7):298-304. Prion disease transmission: can we apply standard precautions to prevent or reduce risks? McDonnell G. STERIS Limited, Jay's Close, Viables, Basingstoke, Hampshire, UK. gerry_mcdonnell@steris.com Prion diseases present unique challenges to healthcare facilities, both in the care and treatment of patients. A significant cause for concern is in the routine reprocessing of medical devices used on patients and how disease transmission can be prevented on the reuse of devices. Investigations have shown that prion disease can be transmitted on medical devices, which can be a concern given the long incubation times associated with these diseases and that guidelines to control transmission only really apply in a small number of known or at risk cases. It is only recently that medical device-associated cleaning, disinfection and sterilization technologies have been investigated and the results of these studies are summarized in this report. The evidence would suggest that many simple decontamination steps can be applied to dramatically reduce the risks to patients, but the research has also given some surprises. Overall, it is reasonable to expect that standard precautions will be able to be applied both today as well as in the future to reduce the risk of prion disease transmission as well as the many other human pathogen concerns, although this may mean changes in some of our practices. __________________________________________________________________________ _____________________________________*____________________________________ 15. Abstract: Instrument integrity and sterility: the perioperative practitioner's responsibilities __________________________________________________________________________ J Perioper Pract. 2008 Jul;18(7):292-6. Instrument integrity and sterility: the perioperative practitioner's responsibilities. Gilmour D. Crawley Day Surgery Unit, Crawley Hospital. diane.gilmour@afpp.org.uk Surgical instruments, whether single use or reusable, are defined by the University of Newcastle's Online Medical Dictionary as 'Hand held tools or implements used by health professionals for the performance of surgical tasks' (CancerWEB 1998). This definition, in its broadest terms, recognises that the inter- professional team (health professionals) are involved in the use, care and management of that tool or implement (performance of surgical tasks). Spry (2007) identifies that a surgical instrument could last 10 years if well made, carefully handled and appropriately used and that it is the responsibility of the surgical team and sterile services personnel to preserve and protect the life of each individual instrument. This article will identify the perioperative practitioner's responsibility in ensuring that each surgical instrument is fit for purpose, safe for use and will not harm the patient during use. The article will outline the process of instrument/set selection and the pre-, intra- and postoperative checks that should be made by the inter- professional team prior to, during and after use of that set/instrument. This article will also enable the practitioner to gain or reinforce their knowledge and understanding of the decontamination process and its application within the perioperative environment. __________________________________________________________________________ _____________________________________*____________________________________ 16. Abstract: Decontamination in the dental setting __________________________________________________________________________ J Perioper Pract. 2008 Jul;18(7):289-90. Decontamination in the dental setting. Gibson D. Eschmann Equipment, Peter Road, Lancing, West Sussex. With these factors taken into account it should be feasible to implement the best possible decontamination solution for any dental practice (hopefully opting for the two-room layout). With the correct equipment, facilities and fully trained and educated staff, today's general dental practice will be able to move forward in full compliance with the latest regulations and be ready for inevitable future changes in the law. __________________________________________________________________________ _____________________________________*____________________________________ 17. Abstract: The perspectives of injection drug users regarding safer injecting education delivered through a supervised injecting facility __________________________________________________________________________ Harm Reduct J. 2008 Oct 29;5(1):32. The perspectives of injection drug users regarding safer injecting education delivered through a supervised injecting facility. Fast D, Small W, Wood E, Kerr T. ABSTRACT: BACKGROUND: Unsafe injection practices are prevalent among injection drug users (IDU) and have resulted in numerous forms of drug- related harms including HIV/HCV transmission and other bacterial and viral infections. North America's first supervised injection facility (SIF) was established in Vancouver in order to address injection-related harms among IDU. This study sought to examine injection drug users' experiences receiving safer injecting education in the context of a SIF. METHODS: Semi-structured qualitative interviews were conducted with 50 individuals recruited from a cohort of SIF users known as the Scientific Evaluation of Supervised Injection (SEOSI) cohort. Audio recorded interviews elicited IDU perspectives regarding the provision of safer injecting education within the context of a SIF. Interviews were transcribed verbatim and a thematic analysis was conducted. RESULTS: Participant narratives indicate that significant gaps in knowledge regarding safer injecting practices exist among local IDU, and that these knowledge deficits result in unsafe injecting practices and negative health outcomes. However, IDU perspectives reveal that the SIF allows clients to identify and address these gaps in knowledge through a number of mechanisms that are unique to this facility, including targeted educational messaging that occurs as a part of the drug use cycle and not outside of it, in situ demonstration of safer injecting techniques that takes place the moment a client is experiencing difficulties, and enhanced opportunities to seek help from 'expert' healthcare professionals. Importantly, study participants indicated that the overall environment of the SIF promotes the adoption of safer injecting practices over time, both within and outside of the facility. CONCLUSIONS: We conclude that the SIF has been particularly effective in transmitting educational messages targeting unsafe and unhygienic injection practices to a population of active IDU. Consistent with previous work, results of this study indicate that SIFs represent a unique 'micro-environment' that can facilitate the reduction of numerous drug related harms. __________________________________________________________________________ _____________________________________*____________________________________ 18. Abstract: Hepatitis C Virus Acquisition among Injecting Drug Users: A Cohort Analysis of a National Repeated Cross-sectional Survey of Needle and Syringe Program Attendees in Australia, 1995-2004 __________________________________________________________________________ J Urban Health. 2008 Nov 1. Hepatitis C Virus Acquisition among Injecting Drug Users: A Cohort Analysis of a National Repeated Cross-sectional Survey of Needle and Syringe Program Attendees in Australia, 1995-2004. Falster K, Kaldor JM, Maher L; on behalf of the collaboration of Australian Needle and Syringe Programs. National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia, kfalster@nchecr.unsw.edu.au. High hepatitis C virus (HCV) prevalence has been documented among many injecting drug user (IDU) populations worldwide; however, there is limited published data on trends in incidence of infection in these epidemics over time. To address this, we used a novel method of analyzing data collected via repeat, cross-sectional sero-surveys by injection initiation cohorts to investigate trends in HCV seropositivity among a population of needle and syringe program (NSP) attendees in Australia between 1995 and 2004, and thereby infer annual incidence trends. Injection initiation cohorts were defined by their time of entry into the IDU population. We also investigated the associations between HCV antibody seroprevalence and risk factor data, and trends in risk factor data over the decade. Approximately 20,000 NSP attendees participated in the study over the 10- year period. Within each injection initiation cohort, we found an increase in HCV prevalence over time, with prevalence appearing to reach saturation around 90%. There was little indication that the slopes of increase had changed with more recent initiation cohorts. While duration of injecting was most strongly associated with HCV seropositivity in this study, we also found that self-reported history of needle and syringe sharing and imprisonment were independently associated with higher HCV prevalence regardless of duration of injecting, with the exception of IDUs who have 15 or more years injecting experience. In this group, recent risk behavior had no relationship to prevalence. In summary, our findings suggest a persistent HCV epidemic despite significant harm reduction efforts in Australia since the mid-1980s, with HIV incidence effectively constant in successive initiation cohorts. __________________________________________________________________________ _____________________________________*____________________________________ 19. Abstract: Hygienic hand washing among nursing students in Turkey __________________________________________________________________________ Appl Nurs Res. 2008 Nov;21(4):207-211. Hygienic hand washing among nursing students in Turkey. Celik S, Koçasli S. Department of Surgical Nursing, Zonguldak School of Nursing, Zonguldak Karaelmas University, 67100 Zonguldak, Turkey. The purpose of this study was to determine the application status of hand- washing information given within the context of infection control measures in practice areas among nursing students. This descriptive study was conducted with 430 students. A questionnaire was filled out by the students. In the statistical analysis, frequency, percentage, and chi(2) values were measured for all the questions in the hand-washing questionnaire. We determined that students wash their hands before and after each clinical procedure at a rate of 80.2%. Most of the students (71.9%) reported that they wash their hands for 1 minute or longer. The students' answers showed that the nursing education program, including hand-washing applications within the context of infection control measures, is updated but that the students neither practice what they have learned nor give adequate attention to the subject. __________________________________________________________________________ _____________________________________*____________________________________ 20. Abstract: Sterile versus non-sterile glove use and aseptic technique __________________________________________________________________________ Nurs Stand. 2008 Oct 15-21;23(6):35-9.Links Sterile versus non-sterile glove use and aseptic technique. Flores A. East Surrey Hospital, Surrey. ashley@flores.me.uk There is evidence indicating that improvements in infection control practice can reduce the incidence of healthcare-associated infection. This article explores the evidence base for glove use and aseptic technique. There is a lack of evidence regarding the influence of sterile versus clean gloves in clinical care. Therefore in practice, clean and aseptic techniques are often used interchangeably. Nurses must learn to select clean or aseptic technique, and therefore clean or sterile gloves, using a risk assessment protocol. Regular audits of aseptic technique and education are needed to improve care. __________________________________________________________________________ _____________________________________*____________________________________ 21. Abstract: Adoption of Alcohol-Based Handrub by United States Hospitals: A National Survey __________________________________________________________________________ Infect Control Hosp Epidemiol. 2008 Nov 5. Adoption of Alcohol-Based Handrub by United States Hospitals: A National Survey. Mody L, Saint S, Kaufman SR, Kowalski C, Krein SL. From the Divisions of Geriatric Medicine (L.M.) and General Internal Medicine (S.S., S.R.K., S.L.K.), University of Michigan Medical School, and the Geriatric Research and Education Center (L.M.) and the Health Services Research and Development Center of Excellence (S.S., C.K., S.L.K.), Veterans Affairs Ann Arbor Healthcare System, and the Veterans Affairs / University of Michigan Patient Safety Enhancement Program (S.S., S.R.K.), Ann Arbor, Michigan. The extent to which the use of alcohol-based handrub for hand hygiene has been adopted by US hospitals is unknown. A survey of infection control coordinators (response rate, 516 [72%] of 719) revealed that most hospitals (436 [84%] of 516) have adopted alcohol-based handrub. Leadership support and staff receptivity play a significant role in its adoption. __________________________________________________________________________ _____________________________________*____________________________________ 22. Abstract: Comment: Surgical hand antisepsis: the evidence __________________________________________________________________________ J Perioper Pract. 2008 Aug;18(8):330-4, 339. Comment in: J Perioper Pract. 2008 Oct;18(10):412. Surgical hand antisepsis: the evidence. Tanner J. De Montfort University and University Hospitals Leicester, Charles Frears Campus, 266 London Road, Leicester LE2 1RQ. jtanner@dmu.ac.uk For 150 years members of the surgical team have been washing their hands with solutions designed to remove micro-organisms and therefore reduce surgical site infections in patients. This article discusses the evidence surrounding aspects of surgical hand antisepsis. __________________________________________________________________________ _____________________________________*____________________________________ 23. No Abstract: Achieving the potential of HIV prevention interventions: critical global need for collaborative dissemination efforts __________________________________________________________________________ AIDS. 2008 Nov 1. Achieving the potential of HIV prevention interventions: critical global need for collaborative dissemination efforts. Norton WE, Fisher WA, Fisher JD. aDepartment of Psychology, USA bCenter for Health, Intervention, and Prevention, University of Connecticut, Storrs, Connecticut, USA cDepartments of Psychology and Obstetrics and Gynecology, University of Western Ontario, London, Ontario, Canada. __________________________________________________________________________ _____________________________________*____________________________________ 24. No Abstract: Laying down the law on healthcare-associated infections __________________________________________________________________________ Lancet Infect Dis. 2008 Oct;8(10):583. Links Laying down the law on healthcare-associated infections. [No authors listed] __________________________________________________________________________ _____________________________________*____________________________________ 25. News - Uzbekistan: Uzbek children in 'Aids outbreak' - India: Marc Koska's Safe Injection Campaign Set to Save Millions of Lives - Viet Nam : Medical staff contract HIV via unsafe occupational practices - Pakistan: Hepatitis B, C on rise due to [sic] contaminated water - USA: University of Connecticut Professor Awarded for HIV Prevention Method - Women's hands have more kinds of bacteria than men's, study finds - USA: Las Vegas Hepatitis Scare Class Action Lawsuit Not Certified by Court - Estonia: Estonia Has One of Europe's Top Rates of Injecting Drug Users - USA: Class-Action Lawsuit Rejected in Hepatitis C Outbreak - Needle-free injection device approved in Europe and Australia - USA: FDA sends in federal marshals to seize tainted heparin - UK: HIV prevalence stable among UK injecting drug users - Canada: Third Saskatchewan Health Region Reports Reuse of Syringes in Operating Room - Nigeria: Medical Waste - Their Wealth, Residents' Death - Germany: Doctor in Germany HIV scandal Selected news items reprinted under the fair use doctrine of international copyright law: http://www4.law.cornell.edu/uscode/17/107.html __________________________________________________________________________ Uzbekistan: Uzbek children in 'Aids outbreak' By Martin Vennard, BBC News (11.11.08) More than 40 young children have been infected with HIV at a hospital in Uzbekistan, officials have said. Health authorities told the BBC that an investigation into the infections of the mainly new-born babies was taking place in the eastern town of Namangan. The United Nations says Central Asia has one of the world's fastest- growing HIV infection rates. Unsafe blood supplies and contaminated equipment are often blamed for spreading the infection. Stigma and secrecy The infections in Uzbekistan are just the latest case of mass contamination in a health facility in the region. In August, a court in Kyrgyzstan convicted nine medical workers of infecting 24 children with HIV, while last year 21 medical workers in Kazakhstan were found guilty of infecting dozens of babies. The staff concerned pleaded not guilty, saying poor hygiene conditions were to blame. The Uzbek cases were discovered in October, and have reportedly been referred to prosecutors. But they have not been reported in the local media, which is tightly controlled by the government. The officials who spoke to the BBC's Uzbek service were only prepared to comment on condition of anonymity. Aid workers say the stigma surrounding HIV/Aids and the atmosphere of secrecy means that many outbreaks of hospital-acquired infection do not get reported. In July this year, Jimmy Kolker, a senior UN official on HIV/Aids, called on Central Asian governments to record and share their information on cases. He was speaking at a meeting in Uzbekistan, which was discussing how to tackle a regional epidemic of HIV among women and children. Story from BBC NEWS: http://news.bbc.co.uk/go/pr/fr/-/1/hi/world/asia-pacific/7722735.stm © BBC MMVIII .......................................................................... __________________________________________________________________________ India: Marc Koska's Safe Injection Campaign Set to Save Millions of Lives in India PR-Inside.com (Pressemitteilung) - Wien,Austria (11.11.08) 2008-11-11 13:08:51 - Safepoint UK's 'One Injection, One Syringe' message comes to India on a grand scale East Sussex, 11 November 2008: Marc Koska OBE, (the British inventor of the single-use auto-disable syringe), together with his charity SafePoint UK, is embarking upon a one-week life-saving healthcare education mission to India on an enormous and unprecedented scale, starting 14 November 2008. According to a recent study by Indian Clinical Epidemiology Network (IndiaCLEN), around 65% of injections administered in India are unsafe - because they are performed with reused or unsterile equipment. Health problems resulting from unsafe injections worldwide, according to these annual figures from the World Health Organization, has reached epidemic proportions: • 230,000 HIV infections • 1,000,000 Hepatitis C infections • 21,000,000 Hepatitis B infections Resulting in: • 1,300,000 deaths Marc set up SafePoint Trust in 2006 to educate the public on the dangers of re-using syringes with its 'One Injection, One Syringe' message, in order to reduce the misery, illness and deaths being needlessly caused through unsafe injections. On 14th November 2008, Marc will lead a SafePoint team to India with the aim of informing hundreds of millions throughout that country of the fatal consequences of re-using syringes, by means of the SafePoint-produced public information film (or public service announcement) called ‘Sachin'. This is the moving story, narrated by Dr Kiran Bedi, the highly celebrated Indian social activist, about Sachin - the little boy who contracts HIV through the reuse of a syringe by his doctor. The film leaves no doubt that prevention is better than cure. Click here to watch the film in English: http://www.sharenow.com/base/content/48564/ Click here to watch the film in Hindi: http://www.sharenow.com/base/content/48563/ SafePoint claims that it will be the biggest media buyer throughout India for that week (14-21 November 2008), covering an incredible: • 14 hours of prime TV broadcast across 23 channels • Radio broadcasts from Dr Kiran Bedi spanning 160 cities, playing 28 times in each, making a total of 4,480 broadcasts • 307 cinemas that will screen ‘Sachin' 4 times per day per cinema, making a total of 8,596 screenings In addition, the SafePoint team, split into four groups, will hold concurrent press conferences in Delhi, Hyderabad, Jaipur and Chandigarh, commencing 14 November. In total, the teams will cover 14 regions over a gruelling four days. Preventing the devastating effect that unsafe injections have on innocent people's lives is the driving force behind Marc's tireless campaign. SafePoint offers a solution to the problem by informing the next generation and by raising awareness about this silent epidemic. The charity's educational campaigns on injection safety have the bold aim of ensuring that the 16 billion medical injections given globally every year are given safely. Focused and passionate social entrepreneur, Marc Koska, who has already been credited with saving well over 5.5 million lives through the invention of his auto-disable syringe, hopes that many more millions of lives will soon be saved as a result of his forthcoming campaign in India. The campaign is also expected to bring about major changes for the better in the way global healthcare is administered. 'We will be asking the public and legislators of India to sit up and listen to our life-saving message,' says Marc. 'We intend to both empower the people of India by opening their eyes to the dangers of reusing syringes, as well as to increase demand for the implementation of legislation in this field. This is paramount to our campaign.' Marc Koska, OBE Inventor of the single-use auto-disable syringe, social entrepreneur, Marc Koska, is the founder of SafePoint Trust and was awarded the Order of the British Empre in 2006 for his contribution to healthcare. http://www.marckoska.com Dr Kiran Bedi Dr Kiran Bedi is an award-winning Indian social activist and one of the most celebrated and widely known police officers of the Indian Police Force (now retied). She was awarded the Mother Teresa Memorial National Award for Social Justice in 2005. www.kiranbedi.com SafePoint Trust SafePoint Trust is a registered UK charity that has the aim of solving healthcare problems through education, predominantly in the developing world and focusing on injection safety. www.safepointtrust.org auto-disable, iatrogenic transmission, syringe, injection, disposable, use only once, HIV, AIDS, hepatitis, infections, needle Web: http://www.safepointtrust.org .......................................................................... __________________________________________________________________________ Viet Nam : Medical staff contract HIV via unsafe occupational practices Viet Nam News - Hanoi,Vietnam (10.11.08) HCM CITY — Bui Trong Hop, head of the Trung Vuong Emergency Hospital’s Department of Infection Control, said precautions had not been taken to prevent the transmission of HIV from patients to medical workers. Taking blood tests, collecting medical waste, giving injections, and cleaning tools were possible paths of transmission, he said. According to a survey of HCM City hospitals, more than 100 health workers have been infected by HIV due to occupational accidents since the beginning of the year. The HCM City Hospital for Tropical Disease’s Department of Infection Control receives more than 40 HIV-infected patients a day. The Department said within three months three workers became infected with the virus. Nguyen Huu Chi, head of the department, said some staff continued to work because of their love for their patients. The Ministry of Health has said medical staff in hospitals also can contract hepatitis B and hepatitis C while caring for patients. — VNS .......................................................................... __________________________________________________________________________ Pakistan: Hepatitis B, C on rise due to [sic] contaminated water Staff Report, Daily Times - Lahore,Pakistan (08.11.08) RAWALPINDI: Diseases such as Hepatitis B and C are rapidly spreading in the city due to contaminated water and unhygienic conditions, a report issued by the Reality Welfare Organisation (RWO) said on Friday. The report also said that in October the RWO gathered 230 blood samples of residents of various areas of the city, conducted tests of Hepatitis B and C and found that 15.7 percent results were positive. The tests’ results showed a rise in Hepatitis C positive cases as compared to Hepatitis B, the report said, adding that 28 out of the 230 residents were suffering from Hepatitis C, six had Hepatitis B positive and two had both Hepatitis B and C positive. The rise was witnessed in hepatitis C cases as compared to the past year when only 15 persons were suffering from the disease. RWO media coordinator Muhammad Younus said that contaminated water and unhygienic conditions were causing fatal diseases such as Hepatitis B, C, Tuberculosis and skin related problems among the residents. He said that the main source of the spread of diseases was rat bite and mosquitoes. He said that the Punjab Government should take measures to cope with the situation. Younus said that there was also a need to educate the people about cleanliness. .......................................................................... __________________________________________________________________________ USA: University of Connecticut Professor Awarded for HIV Prevention Method Emily Volz; Daily Campus, University Wire, USA (07.11.08) An award from the National Institute of Drug Abuse (NIDA) will help the University of Connecticut's Robert Broadhead expand a successful peer- driven HIV prevention model overseas. Since the 1990s, the sociology professor has been working on stopping the spread of HIV/AIDS among injecting drug users. He developed a peer-based program in which active IDUs are recruited to educate fellow users about HIV-related risks. Those who choose to participate are offered cash incentives, and some are paid to recruit peers. A pilot test of the program in Yaroslavl Province, Russia, found a significant reduction in drug injection frequency and sharing of syringes and other equipment among 3,100 participants. In addition, overall HIV knowledge increased among IDUs at the pilot sites. The NIDA award will fund an overseas expansion of the program for one year. "I'll be returning to Ukraine in December to provide technical assistance to health educators," said Broadhead. Nearly one-third of IDUs in Ukraine are HIV-positive. The Global Fund to Fight AIDS, TB and Malaria is assisting by funding Broadhead's program at 17 new sites in Ukraine. "We are still so far behind in combating HIV in Central and Eastern Europe and Asia," said Broadhead. "We are playing a very serious catch-up game." Broadhead is also working on a manual for implementing the program in areas worldwide. The manual will be available in multiple languages, including Russian, Chinese (Mandarin), Vietnamese, Thai, Spanish, and English. .......................................................................... __________________________________________________________________________ Women's hands have more kinds of bacteria than men's, study finds Mary Engel, Los Angeles Times, USA (07.11.08) Researchers say our palms hold a greater diversity of bugs than anyone suspected. But they don't know why women's hands have roughly 40% more species of bacteria. For the gender that considers itself the more fastidious (and has the studies to back up the claim), women may be chagrined to learn that they harbor more varieties of germs on their hands than men do. In fact, we all -- male and female -- have whole worlds on our hands, and they're more diverse than anyone suspected. In a study published online Monday in the Proceedings of the National Academy of Science, researchers at the University of Colorado at Boulder swabbed 102 human palms and found more than 4,700 species of bacteria. Species varied from person to person; just five were shared among all 51 of the study's student volunteers. They even differed from hand to hand. An individual's right had different species than the left. It's well-established that hands are hotbeds for bacteria. That's why everyone from mothers on up to the national Centers for Disease Control and Prevention admonish us to wash them. What set this study apart is that it looked not at abundance but at diversity. It did so by extracting DNA from samples gathered on cotton swabs rather than using the standard method of trying to culture the samples in petri dishes to see what kinds of bacteria would grow. "Bacteria are tough to identify," said Noah Fierer, assistant professor of ecology and evolutionary biology and the paper's lead author. "Most of them can't be grown in the lab. The best way we have of identifying them is to look for their DNA." Fierer doesn't know why women's hands have roughly 40% more species of bacteria. It could be that men's more acidic skin discourages some species, or that sweat, hormones or women's greater use of hand creams play a role. "The findings don't necessarily mean that women have more germs than men, just more variety," he said, rather gallantly, in a phone interview. Not all bacteria found on hands are harmful. Most are probably neutral, Fierer said, and some may protect the skin from pathogenic varieties. Washing hands, by the way, reduces the abundance but not the variety of microbes, the study found. "We're not saying at all that washing hands is not a good idea," Fierer said. "We know that it reduces abundance and has a large effect on pathogens." Engel is a Times staff writer. .......................................................................... __________________________________________________________________________ USA: Las Vegas Hepatitis Scare Class Action Lawsuit Not Certified by Court AboutLawsuits.com - USA (07.11.08) Nevada District Judge Alan Earl, who is presiding over the Las Vegas endoscopy clinic lawsuits filed as a result of unsafe medical practices that caused over 100 people to develop Hepatitis C, has denied a request to certify a class action lawsuit for thousands of former patients who are claiming emotional distress stemming from the testing they underwent after discovering the problems at the clinics. In August 2008, Judge Earl ruled that cases for individuals who are pursuing lawsuits for emotional distress, but who have not actually been diagnosed with hepatitis or another disease, would be permitted to continue. However, the Las Vegas Review Journal reports that on November 4, 2008, the Judge indicated that every case will have to be pursued individually. This will likely make it not economically feasible for most of the emotional distress lawsuits to continue. Between 2004 and 2008, several thousand people treated at the Endoscopy Center of Southern Nevada and Desert Shadow Endoscopy Center, were exposed to unsafe medical practices, including reuse of syringes and vials of medication intended for only single use. In February 2008, health officials shut the clinics down after identifying the problems, and over 40,000 former patients were advised by the Southern Nevada Health District to get tested for potentially fatal blood-borne diseases like Hepatitis C or HIV. About 6,000 individuals treated at the clinic who were never actually diagnosed with an infection have retained personal injury lawyers to pursue claims for the emotional distress they experienced while waiting for the test results. While plaintiffs’ lawyers requested class action status so that all of the claims could be heard as one lawsuit, Judge Earl ruled that individual lawsuits are necessary because not all of the non-infected patients had the same experiences as a result of the emotional distress. According to local health officials, there are at least 114 confirmed cases of the Hepatitis C virus identified among former patients at the Las Vegas Clinics, and most of those victims have already filed lawsuits. Hepatitis C is a very serious infectious disease, which can lead to inflammation of the liver, liver cancer, cirrhosis of the liver or even death. There are concerns among those involved in the litigation about whether the defendants even have sufficient insurance coverage and assets to satisfy all of the lawsuits filed for individuals diagnosed with infections, as the clinic’s insurance policy is only $3 million. With every case for emotional distress forced to proceed as an individual lawsuit, many of these former patients will likely elect not to pursue their nominal claims, as they may only be entitled to a few hundred dollars each out of the available insurance coverage. .......................................................................... __________________________________________________________________________ Estonia: Estonia Has One of Europe's Top Rates of Injecting Drug Users Baltic News Service (06.11.08) A survey released Thursday by the European Monitoring Center for Drugs and Drug Addiction (EMCDDA) found Estonia has a higher prevalence of injecting drug users (IDUs) than other European nations. The EMCDDA report found that in most of the countries surveyed, IDUs represented between one and five people per 1,000 residents ages 14-44. In Estonia, the rate was estimated at 15 per 1,000 such inhabitants in 2004. Overall, the center said it is concerned over the rising number of injecting users of opiates in Europe, especially those under age 25. It noted that in Estonia, Bulgaria, Greece, Latvia, Luxembourg, Austria, and Romania, most overdoses are in IDUs younger than 25. Another worrying trend is the high rate of AIDS deaths in Portugal, Estonia, Spain, and Latvia, the report said. In Estonia, free HIV testing and counseling is offered in five cities, EMCDDA said. The number of tests carried out has increased steadily since the first reports of an Estonian HIV epidemic emerged in 2001, it noted. The report also highlighted progress Estonia has made in IDU-related services such as syringe exchange and substitute treatment. In 2006, around 1.6 million syringes were distributed through 26 exchanges in Estonia. The number of syringes distributed annually per IDU doubled from 2005 to 2006, it found. However, given the growing size of the IDU community, Estonia should work to further expand the service, EMCDDA said. .......................................................................... __________________________________________________________________________ USA: Class-Action Lawsuit Rejected in Hepatitis C Outbreak Paul Harasim, Las Vegas Review-Journal Nevada USA (06.11.08) On Tuesday, District Court Judge Allan Earl refused to certify a planned class-action suit against the Endoscopy Center of Southern Nevada (ECSN), the site of an outbreak in which at least six people contracted hepatitis C. Health officials in January learned that ECSN staff had been reusing single-use vials of medicine on patients undergoing colonoscopies and other endoscopic procedures from 2004 to 2008. In all, the Southern Nevada Health District urged more than 40,000 clinic patients to get tested for HIV and hepatitis C. Eugenia Hedstrom, 70, was among those notified by health officials that she should get tested for the blood-borne infections. "When you get a letter like that, it scares you like you wouldn't believe," she said. "It's all you think about." Attorneys agreed to support a single class-action case for thousands of patients who were not infected. Around 6,000 came forward. With a $3 million policy cap on such claims, the patients would not be eligible for much, but "at least they'd get some kind of compensation for their stress," said Attorney Robert Cottle. But Earl denied the attorneys' motion in open court, saying he was not convinced that all the non-infected former patients wanted to be part of a class-action suit, Cottle said. The judge was also not convinced that all of them had had similar experiences, according to the attorney. A motion filed by attorneys for ECSN in opposition to class certification noted that two named plaintiffs who were deposed by the defense team admitted they did not suffer any mental anguish or emotional distress. In addition, the defense argued against the need for compensating former patients for HIV and hepatitis testing since many had received it for free. Plaintiffs' attorneys can have the judge's ruling reviewed by the Supreme Court, said Cottle. If it is not overturned, some cases could be consolidated or heard on an individual basis. .......................................................................... __________________________________________________________________________ Needle-free injection device approved in Europe and Australia Devices/Technology, News-Medical.Net, Australai (06.11.08) Antares Pharma, Inc. today announced that its license partner, Ferring Pharmaceuticals has received additional regulatory approvals in Europe and Australia for use of Antares' needle-free injection devices with its human growth hormone (hGH), Zomacton. Ferring has been notified recently that the mutual recognition process for European member states has been positively concluded for the Zomacton 10 mg formulation and the Antares' needle-free injection device (Zomajet Vision X) and consumables. Following an initial product launch in France, Ferring expects to launch in the other key European markets in 2009. The Zomacton 4 mg formulation with the Zomajet 2 Vision needle-free device and consumables was previously approved in Europe and is currently being marketed. In addition, the Therapeutic Goods Administration, Australia's regulatory agency for drugs and devices, has recently approved applications filed by Ferring for the Antares Zomajet 2 Vision and Vision X needle-free injection devices, and their associated consumables, to be used with Zomacton in both the 4 mg and 10 mg formulations. Paul Wotton, Ph.D., President and Chief Executive Officer of Antares, commented, We are pleased that Ferring continues to expand into new markets and is introducing the Vision X device for use with their Zomacton 10 mg product. The combination of the higher strength formulation with Antares' proprietary needle-free system will continue the focus for both companies of enhancing patient compliance and convenience with self administration of hGH. http://www.antarespharma.com/ .......................................................................... __________________________________________________________________________ USA: FDA sends in federal marshals to seize tainted heparin By Elizabeth Weise, USA TODAY, USA (06.11.08) Frustrated after twice asking a Cincinnati-based manufacturer of medical products to recall contaminated heparin, the Food and Drug Administration took the rare step Thursday of sending U.S. marshals to seize 11 lots of the blood-thinning drug. The company, Celsus Laboratories, distributes heparin to drug and medical- device manufacturers both in the United States and internationally. FDA testing in January found that large amounts of Chinese raw heparin imported into the United Sates were contaminated with the chemical oversulfated chondroitin sulfate. The FDA believes the substance was added to allow the product to pass tests that measure heparin levels. A major heparin recall ensued. Almost 250 deaths and hundreds of severe allergic reactions were blamed on tainted batches of the blood thinner, which is frequently given to patients having heart surgery and kidney dialysis. The two Celsus products were heparin sodium and heparin lithium. The sodium form is given directly to patients as a blood thinner. Just over 2 pounds of it was seized. Heparin lithium is used to coat medical devices, such as blood-collection tubes, to keep blood from clotting on them. About 31 pounds of that was seized. The seized heparin was worth about $112,000. That represented only a portion of the full 11 lots, which had already been shipped to other manufacturers. But because the FDA had warned those companies earlier, the drug was never used and no patients were put at risk, agency spokeswoman Karen Riley says. The FDA says it inspected Celsus Laboratories in April and found that two of its heparin products were contaminated. The company had sent a letter to its customers telling them its heparin was contaminated, but FDA wanted the company to physically recall the product because of the danger it presented to patients. FDA sent a follow-up letter to the company again asking for a recall on May 8. What the federal marshals did Thursday was to seize the contaminated heparin that remained at the company's facilities, Riley says. Celsus imported the raw heparin from Changzhou SPL, Riley says. FDA said in a release that it has also advised manufacturers who might have bought heparin from the company to contact the agency to make sure they don't have any of the contaminated heparin. "The product does not meet acceptable quality standards," the agency said. In addition, the agency has also notified Japan, Canada, Australia, the European Union and other countries to be on the watch for shipments of contaminated heparin from Celsus. Find this article at: http://www.usatoday.com/news/health/2008-11-06-heparin-contaminated_N.htm Copyright 2008 USA TODAY, a division of Gannett Co. Inc. .......................................................................... __________________________________________________________________________ UK: HIV prevalence stable among UK injecting drug users Roger Pebody, Aidsmap - UK (05.11.08) The prevalence of HIV infection among injecting drug users in the UK appears to be stable, the Health Protection Agency reported last week. Nonetheless, prevalence among newer injectors is rising, with one in one hundred becoming infected within three years of starting to inject. Compared to other countries, HIV infection among UK injecting drug users has been limited, owing to the early roll out of needle exchanges and other harm reduction programmes. However reports in 2005 indicated that HIV prevalence was rising, and there were suggestions that this could be attributed to changes in policy and service provision. The Health Protection Agency’s Unlinked Anonymous Prevalence Monitoring Programme’s Survey of Injecting Drug Users is an annual study of over 3,000 current and former injectors. The study is carried out at specialist services such as needle exchanges or methadone treatment programmes in England, Wales and Northern Ireland. Participants complete a questionnaire and provide an oral fluid sample for HIV testing. Whereas HIV prevalence among survey participants hovered just below 1.0% in the late 1990s, it increased to 1.4% in 2004 and 1.6% in 2005. However the recent data is more encouraging - prevalence appears to have dropped for two successive years, with the 2007 survey finding that 1.1% of users have HIV infection (41 of 3,580 people surveyed). Nonetheless, the Health Protection Agency is cautious in its interpretation of these trends, simply describing the 2007 figures as “similar to that seen in recent years”. Moreover, infections amongst people who have recently started to inject remain high. Prevalence amongst people who first injected in the last three years is considered a measure of recent transmission, and remained below 0.5% from 1991 to 2002. However it has risen since then, and is now at 1.0% (5 of 484 people surveyed). The number of HIV positive respondents who remain unaware of their infection has declined in recent years, with the figure now at 36%. Nonetheless just under a third of the sample has never taken an HIV test (except as part of this study, where they don’t receive the results). These findings are described in the Health Protection Agency’s annual report on infections among injecting drug users (IDUs). Some of the other key findings from the report include: Around one quarter of IDUs reported sharing of needles and syringes. This figure has declined in recent years, following an increase in the late 1990s. The sharing of filters, mixing water, spoons and other equipment is more common. Hepatitis C is the most important infectious disease affecting injectors. Almost half have been infected with the virus, and one fifth become infected within three years of starting to inject. Around half of IDUs who have hepatitis C are unaware of their infection. One third of injectors report having an abscess, sore or open wound at an injecting site in the last year. Associated bacterial infections include staphylococcus aureus (including community associated MRSA), severe group A streptococci, wound botulism and tetanus. Reference Shooting Up. Infections among injecting drug users in the United Kingdom 2007, an update: October 2008. London: Health Protection Agency 2008. http://www.hpa.org.uk/webw/HPAweb&HPAwebStandard/HPAweb_C/1224833091685 .......................................................................... __________________________________________________________________________ Canada: Third Saskatchewan Health Region Reports Reuse of Syringes in Operating Room Canadian Press, Canada (04.11.08) On Tuesday, a third health region in Saskatchewan said syringes were occasionally reused in an operating room at a local hospital to inject medicine into an intravenous bag. The Sun Country Health Region, in the southeastern corner of the province, said it discovered Weyburn General Hospital had been reusing syringes though it stressed the risk of infection is low. "There is an extremely low-level risk to any patient," the region said in a news release. "The risk is so low that follow-up testing is not recommended at this time." Last week, Saskatchewan public health officials ordered a review of infection control practices at provincial facilities following the news that up to 2,700 patients at a health clinic in High Prairie, Alberta, would be tested for hepatitis and HIV after it was learned that syringes were being reused there. .......................................................................... __________________________________________________________________________ Nigeria: Medical Waste - Their Wealth, Residents' Death By Stella Odueme, Daily Independent, Lagos, Nigeria (03.11.08) Lagos: Medical wastes when not properly disposed off can pose serious health hazards to the society, particularly anyone who comes in contact with them. Medical wastes are generated by hospitals and classified into different categories, including pathological and infectious, sharps, anatomical, highly infectious and radioactive wastes, which can pose serious danger to the people and the environment when not properly handled and disposed off. Segregation is therefore advocated at the point of generation and this is in four categories: Non-infectious wastes, which include paper/packaging material and food, among others, in a black coded bag; infectious wastes, which are blood/iv fluid lines; gloves, gauze/dressing and others in yellow coded bag; highly infectious wastes in red coded bag while sharp wastes, such as broken slides, lancet, broken ampules, retractables, needles, infusion sets, scalpels, blades and broken vial are to be placed in yellow coded safety boxes. It was in the effort to ensure effective planned system of controlling the production, storage, collection, transportation, processing and disposal of medical wastes that the Third Lagos Medical Waste Summit was held on October 30, 2008 with the theme 'Doing it Right' at the Lagos University Teaching Hospital, Idi-Araba. The first summit took place in 2006 while the second edition was last year. Just like the previous ones, there was technical session where experts lectured on the topic. These efforts are being facilitated by the Lagos State Waste Management Authority (LAWMA) in partnership with the Ministry of Health and other agencies. The graveness of the dangers of improper disposal of medical wastes is indeed disastrous, and the waste agency in its commitment at saving the society paid the ultimate price, as it lost one of its workers, Ejaeta Edward Onowenerhi. Described as committed to the course, he was diagnosed of hepatitis 2 and died in the process. LAWMA General Manager, Mr. Ola Oresanya, said the objectives of the summit included ensuring continuity and sustenance of the initiative, showcasing the extent of health care/medical management in the state and emphasising on key issues, such as the use of colour coded bins liners. Others are to encourage healthcare facilities through adequate budget for health care waste management and to create awareness on the need for instituting health care waste management committee within the facilities, among others. Speaking on the successes of the efforts since the inception of the summit, he noted that the synergy between LAWMA and Ministry of Health had been able to draw the attention of appreciable 45 per cent of health care facilities in Lagos to proper medical waste management while LAWMA had equally received support in form of supply of injection safety boxes through the health ministry and John Snow Incorporated. Oceanic Bank Plc has also been helping in the production of coded bin liners, just as the state government is procuring ECODAS shredding and sterilising equipment for effective medical waste management in the state. According to him, proper medical waste management also involves all administrative, adequate budgetary provisions, legal and strategic planning as well physical handling of waste and landfill management. He called on all health care facilities to rise up to the challenge in the interest of the people. While presenting post-humus award to the wife of the late Ejaeta, Orasanya assured that the fight against improper disposal of medical wastes would continue until the society is free of its menace. His daughter was equally given scholarship by the waste management agency. Chief Medical Director of LUTH, Prof. Akin Osibogun, who was the chairman on the occasion, said that infectious medical waste could lead to spread of infectious diseases, and, therefore, must be properly disposed off. "These wastes when improperly handled have harmful effects resulting in environmental pollution, reduce human reproductive capabilities, nosocomial infections and highly infectious diseases, such as HIV and hepatitis, which could affect both workers and patients directly and therefore have an indirect effect on the community and the nation at large through a negative impact on the nation's manpower and natural resources," he said. For him, just as the theme indicates, all efforts should be geared towards proper medical waste management and above all strive to achieving a system of sustainability. "There should be renewed effort to getting medical wastes under control by strict adherence to policies presently in place on healthcare waste management. Efforts to inject more funding into healthcare waste management to achieve the goal is necessary," he noted. Lagos Commissioner for Health, Dr. Jide Idris, noted that Lagos had the highest number of health facilities in the country with two tertiary health facilities, 26 general hospitals, about 190 primary health care centres and over 6,500 private health facilities. "The medical wastes generated daily pose a great challenge to the authorities, therefore, its effective management is very crucial. Waste management policies must be put in place at all levels with adequate infrastructure in place. There should be training of health workers to ensure proper process of management," he said. Idris, represented by Dr. Atinuke Onoiga, canvassed that all healthcare facilities irrespective of size, must join hands to ensure that the society and the environment are free from the menace. He called on Health Facilities Monitoring and Accreditation Agency (HEFAMAA) to go all out to sanction erring health facilities found to be mishandling medical wastes in the state. "Some progress has been recorded in the last two and half years largely due to the tireless work by LAWMA. However, there is still room for improvement. Changing people's attitude and practice has been very challenging particularly in the area of waste collection and segregation. Ministry of Health will not tolerate improper disposal of medical waste by health facilities. Anyone found by HEFAMMA would be penalised," he warned. Chairman, LAWMA Board, Taofihi Folami, noted that prior to the yearly summit,, medical wastes were mingled with domestic wastes, which could lead to HIV, hepatitis infection, tetanus and cancer, among other diseases. "Importance of a comprehensive healthcare management system cannot be over-emphasised, as it ensures that health workers are protected from needle stick injuries by immediate containment of injection equipment in safety boxes; patients are protected from serious infections caused by needle reuse and waste handlers are protected from exposure to infectious injection equipment carelessly discarded," he stated. He called on health care facilities to key into the initiative by ensuring that medical wastes are segregated at the point of generation and to also make adequate budgetary provision to take care of their wastes. AGM, Corporate Services, LAWMA, Olanrewaju Rufai, noted that man is exposed to various environmental challenges, and effective management of all forms of waste, especially medical waste, is one of them. Heath facilities must therefore imbibe the ideal method by implementing the developed policies on all forms of waste management, especially medical waste, in the interest of mankind. Copyright © 2008 Daily Independent. .......................................................................... __________________________________________________________________________ Germany: Doctor in Germany HIV scandal Reuters (24.11.08) Oct. 24 - German authorities say a doctor accused of re-using unsterilised needles may have infected hundreds. Investigators say the 56-year-old doctor in Bad Saulgau used contaminated needles many times over on different patients and more than 2, 000 may have been infected with the HIV or hepatitis virus. Paul Chapman reports. See the video at: http://www.reuters.com/news/video?videoId=92750 SOUNDBITES: Albert Reck, patient, saying (German): "About five or six years ago I started going to her practice after an acute hearing loss. Over time I was told she would carry out more treatments like injections of my own blood. I trusted her." Axel Mueller, Ravensburg District Court spokesman, saying (German): "According to the charge the syringes were inadequately cleaned. For example, some were cleaned only with washing-up liquid and similar products. Sometimes they weren't cleaned at all." __________________________________________________________________________ _____________________________________*____________________________________ __________________________________________________________________________ * SAFETY OF INJECTIONS brief yourself at: www.injectionsafety.org A fact sheet on injection safety is available at: http://www.who.int/mediacentre/factsheets/fs231/en/index.html * Visit the WHO injection safety website and the SIGN Alliance Secretariat at: http://www.who.int/injection_safety/en/ 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/ Subscribe or un-subscribe by email to: sign@uq.net.au, sign@who.int or on subscribe online at: http://www.who.int/injection_safety/sign/en/ Get SIGN files on the web at: http://www.uqconnect.net/signfiles/Files/ get SIGNpost archives at: http://www.uqconnect.net/signfiles/Archives/?M=D The SIGN Secretariat, the Department of Essential Health Technologies, WHO, Avenue Appia 20, CH-1211 Geneva 27, Switzerland. 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