*SAFE INJECTION GLOBAL NETWORK* SIGNPOST *SAFE INJECTION GLOBAL NETWORK* Post00502 PQS Meeting + HCWM Doc + Abstracts + Notices 08 July 2009 CONTENTS 1. PQS (performance Quality and Safety) consultative meeting with the industry, back to back with the SIGN meeting - 3rd and 4th December 2009 2. Document: Logistics of Health Care Waste Management: Information and Approaches for Developing Country Settings 3. Chinese EPINet and recall rates for percutaneous injuries: an epidemic proportion of underreporting in the Taiwan healthcare system 4. How to contain generalized HIV epidemics? A plea for better evidence to displace speculation 5. Abstract: Comparison of oral versus injectable vitamin-d for the treatment of nutritional vitamin-d deficiency rickets 6. Abstract: Use of supervised injection facilities and injection risk behaviours amongyoung drug injectors 7. Abstract: A situation update on HIV epidemics among people who inject drugs and national responses in South-East Asia Region 8. Abstract: Factors affecting health care workers' adoption of a website with infection control guidelines 9. Abstract: Viral hepatitis: Global goals for vaccination 10. Abstract: Generalized public health and industrial nurses work together 12. Abstract: Long-term safety of repeated administrations of a new formulation of botulinum toxin type A in the treatment of glabellar lines: Interim analysis from an open-label extension study. 13. Abstract: The absorbable dermal staple device: a faster, more cost- effective method for incisional closure 14. Abstract: A seroepidemiologic analysis of hepatitis B in Sichuan province 15. Abstract: Tetanus and Pertussis vaccines: their usefulness in the aging population 16. No Abstract: Beyond the bin: how healthcare is responding to the sustainability movement 17. No Abstract: Practice of standard precautions among health care workers in a large teaching hospital 18. Surveillance for Acute Viral Hepatitis - United States, 2007 19. Courses: Certificate in Harm Reduction 20. International Forum on Quality and Safety in Health Care 2010- Call for Abstracts 21. News - Tuberculosis: TB Vaccine Too Dangerous for Babies With AIDS Virus, Study Says - India: India struggles to quash dirty syringe industry - USA: Thousands Exposed to Hepatitis C at Denver Hospital - Pakistan: Administering unsafe injections high in Pakistan - USA: Nevada HEPATITIS OUTBREAK: Doctor responsibility weighed: Does reinstatement of Carrera defy 'captain of the ship' notion? - Nepal: Needle-users most at risk of Hepatitis-C - USA: Over 2 billion used needles end up in trash each year - USA: 5,700 may be at risk for hepatitis C in Colorado due to medical tech - Pakistan: 4.7% Pakistanis infected with hepatitis C - USA: Nevada: Doctor gets probation, fine, reprimand in hepatitis outbreak This edition of SIGNpost is located at: http://uqconnect.net/signfiles/Archives/SIGN-POST00502.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/ Revised injection safety assessment tool: TOOL C [pdf 1.78Mb] http://www.who.int/injection_safety/Injection_safety_final-web.pdf 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 Get the final report of the SIGN Meeting 2008, Moscow, Russian Federation [2.36Mb] at: http://www.who.int/injection_safety/2008MeetingReport.pdf __________________________________________________________________________ _____________________________________*____________________________________ 1. PQS (performance Quality and Safety) consultative meeting with the industry, back to back with the SIGN meeting - 3rd and 4th December 2009 Denis Maire, WHO, post this advance notice of the PQS meeting. THE PQS meeting will be held at WHO/HQ on 3rd and 4th December 2009. The SIGN annual meeting will be held where SIGN started ten years ago, in Geneva at WHO/HQ. It will be held from Monday 30 November to Wednesday 2 December 2009. __________________________________________________________________________ From: "Maire, Denis Georges" To: Subject: PQS (performance Quality and Safety) consultative meeting with the industry, back to back with the SIGN meeting - 3rd and 4th December 2009 Date: Fri, 3 Jul 2009 Dear Moderator, I am pleased to announce that the WHO Quality Safety and Standard Unit of the Immunization Vaccine and Biologicals Department is organizing the PQS (performance Quality and Safety) consultative meeting with the industry on 3rd and 4th December 2009. This meeting will be back to back with the SIGN meeting in the WHO premises in Geneva. It is planned to have the first day addressing general prequalification matters with all partners (including WHO, UNICEF, PATH, Optimize and the industry), while the second day will focus on the prequalification of devices to ensure the safety of injections. The objectives of this meeting will be on the Thursday 3rd to: 1. Provide updates on the prequalification process of equipment and devices 2. Review the recent changes in performance specifications and verification protocols 3. Present the new PQS interactive web based database 4. Discuss the future prequalification challenges to best respond to the need of introducing innovative technologies= On the Friday 4th December: 1. Discuss the way prequalification of devices contributes to ensuring the safety of injections in immunization as well as in curative settings 2. Discuss and agree on a way forward to better prevent reuse and make injection safer Please note that an individual invitation will be sent shortly to all partners and separately from the one of SIGN. However, if you are interested in participating in that meeting, you are welcome to already contact us at the PQS secretariat. With best regards, Mr Denis Maire Quality, Safety and Standards Immunization, Vaccines & Biologicals World Health Organization Room M115, 20 Avenue Appia 1211 Geneva, Switzerland Tel: +41 22 791 5882 Fax: + 41 22 791 4384 Mobile: +41 796340096 Email: maired@who.int __________________________________________________________________________ _____________________________________*____________________________________ 2. Document: Logistics of Health Care Waste Management: Information and Approaches for Developing Country Settings Crossposted from TECHNET21 with thanks. http://technet21.org __________________________________________________________________________ The Supply Chain Management Team within the USAID | DELIVER PROJECT is pleased to announce the availability of a new technical document, Logistics of Health Care Waste Management Information and Approaches for Developing Country Settings You can find the document on the USAID | DELIVER website www.deliver.jsi.com, or at the direct link here. http://deliver.jsi.com/dlvr_content/resources/allpubs/guidelines/LogiHealt WastMgmt.pdf or http://is.gd/1qKir Abstract: Medical or health care waste (HCW) refers to all waste generated by health care facilities, research facilities, and laboratories. Health care waste management (HCWM) is a major health and environmental concern. Hazardous waste, including sharps and other infectious waste, pose a serious risk to human health and the general environment. In many developing countries, disposing of this waste is complicated by limited financial and human resources. This document considers the reality of HCWM practices in resource-limited settings. Solutions offered within this text are based on actual experience in developing countries and are presented as practical solutions to vexing logistics problems in HCWM. Marcia N. Rock, MPH Technical Officer HCWM Focal Point John Snow, Incorporated 1616 N. Fort Myer Drive Arlington, VA 22209-3100 Tel (703)310-5257 Fax (703)528-7480 __________________________________________________________________________ _____________________________________*____________________________________ 3. Chinese EPINet and recall rates for percutaneous injuries: an epidemic proportion of underreporting in the Taiwan healthcare system __________________________________________________________________________ J Occup Health. 2009;51(2):132-6. Chinese EPINet and recall rates for percutaneous injuries: an epidemic proportion of underreporting in the Taiwan healthcare system. Shiao JS, McLaws ML, Lin MH, Jagger J, Chen CJ. Department of Nursing, National Taiwan University, College of Medicine and NTU Hospital, Taiwan. OBJECTIVES: As an occupational injury, percutaneous injury (PI) can result in chronic morbidity and death for healthcare workers (HCWs). A pilot surveillance system for PIs using the Chinese version of Exposure Prevention Information Network (EPINet) was introduced in Taiwan in 2003. We compared data from EPINet and recall of PIs using a cross-sectional survey for rates to establish the reliability of the new system. METHODS: HCWs from hospitals that had implemented EPINet for > or =12 months completed a survey for recall of contaminated PIs sustained between October 2004 and September 2005, type of item involved, and reasons for reporting or not reporting the PI. Comparative data from EPINet for the same period were analyzed. RESULTS: The EPINet rate, 36.1/1,000 HCW (95%CI 31.8-41.1) was almost 5 times lower (p<0.0001) than the PI recall rate for 2,464 HCWs of 170/1,000 HCWs (95%CI 155.4-185.5). Approximately 2.5 PIs were recalled for every 1,000 bed-days of care. The recall rate by physicians was 268.3/1,000, 188.5/1,000 for nurses, 88.9/1,000 for medical technologists and 81.3/1,000 for support staff. Hollow-bore needle items most commonly recorded on EPINet includ, disposable needles and syringes were underreported by 81%, vacuum tube holder/needles by 67%, and arterial blood gas needles by 75%. Nearly 63% of the reasons for underreporting were related to the complexity of the reporting process, while 37% were associated with incorrect knowledge about the risks associated with PIs. CONCLUSIONS: EPINet data underestimates a commonplace occupational injury with nearly four in five PIs not reported. Addressing the real barriers to reporting must begin with hospital administrators impressing on HCWs that reporting is essential for designing appropriate safety interventions. __________________________________________________________________________ _____________________________________*____________________________________ 4. How to contain generalized HIV epidemics? A plea for better evidence to displace speculation __________________________________________________________________________ Int J STD AIDS. 2009 Jul;20(7):443-6. How to contain generalized HIV epidemics? A plea for better evidence to displace speculation. Gisselquist D, Potterat JJ, St Lawrence JS, Hogan M, Arora NK, Correa M, Dinsmore WW, Mehta G, Millogo J, Muth SQ, Okinyi M, Ounga T. Hershey, PA 17033. In the worst generalized HIV epidemics in East and Southern Africa, from one-quarter to three-quarters of women aged 15 years can expect to be living with HIV or to have died with AIDS by age 40 years. This disaster continues in the face of massive HIV prevention programmes based on current inexact knowledge of HIV transmission pathways and risks. To stop this disaster, both the public and public health experts need better information about the specific factors that allow HIV to propagate so extensively in countries with generalized epidemics. This knowledge could be acquired by tracing HIV infections to their source - especially tracing HIV infections in women of all ages, and tracing unexplained HIV infections in children with HIV-negative mothers. __________________________________________________________________________ _____________________________________*____________________________________ 5. Abstract: Comparison of oral versus injectable vitamin-d for the treatment of nutritional vitamin-d deficiency rickets __________________________________________________________________________ J Coll Physicians Surg Pak. 2009 Jul;19(7):428-31. Comparison of oral versus injectable vitamin-d for the treatment of nutritional vitamin-d deficiency rickets. Billoo AG, Murtaza G, Memon MA, Khaskheli SA, Iqbal K, Rao MH. Department of Paediatrics, The Aga Khan University Hospital, Karachi. Objective: To assess the safety and acceptability of a single dose of vitamin-D versus the efficacy of injectable Vitamin-D versus oral vitamin- D. Study Design: Case control. Place and Duration of Study: It was carried out at the Department of Paediatrics, Kharadar General Hospital, Karachi, from August 2003 to April 2004. Methodology: Children of the age of 6 months to 3 years with clinical, biochemical and radiological evidence of vitamin- D deficiency rickets were included. The history, clinical examination, complete blood picture, serum calcium. Phosphorus, alkaline phosphatase and X-ray of wrist joint were done. The children were divided into two groups A and B. Group A was given oral vitamin-D and group B was given intramuscular injection of vitamin-D on the first day and then they were followed for two more visits at 30 and 90 days with clinical, biochemical and radiological examinations to assess the outcome. Results: There were 50 confirmed cases of rickets in each group. The mean age was 10.9+5.1 months and 14.7+8.1 months in group A and B respectively. In these children, clinical features were weakness, difficulty in walking, frontal bossing, ribcage deformity and widening of wrist were seen. After one dose of vitamin-D (cholecalciferol), there was appreciable gain of weight and height and raised levels of alkaline phosphatase became normal during follow-up. Radiological florid rickets and non-florid rickets in both groups healed clinically during follow-up period. Oral and injectable forms of vitamin-D (cholecalciferol) were effective but injectable form was shown to be statistically significant. There were no undesirable side effects and both forms of treatment were well- tolerated. __________________________________________________________________________ _____________________________________*____________________________________ 6. Abstract: Use of supervised injection facilities and injection risk behaviours amongyoung drug injectors __________________________________________________________________________ Addiction. 2009 Apr;104(4):614-9. Use of supervised injection facilities and injection risk behaviours among young drug injectors. Bravo MJ, Royuela L, De la Fuente L, Brugal MT, Barrio G, Domingo-Salvany A; Itínere Project Group. Collaborators (16) Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain. mbravop@isciii.es AIMS: To study the use of supervised injection facilities (SIFs) as a predictor of safer injecting practices. DESIGN: Cross-sectional study conducted with face-to-face interview using a structured questionnaire with computer-assisted personal interviewing. Dried blood spot samples were collected for human immunodeficiency virus (HIV) and hepatitis C virus (HCV) antibody testing. SETTING: All participants were street- recruited by chain referral methods in Madrid and Barcelona. PARTICIPANTS: A total of 249 young heroin drug injectors recruited by the ITINERE cohort study in two Spanish cities with SIFs. MEASUREMENTS: The main outcome measures were self-reported injecting behaviours and SIFs attendance. RESULTS: SIF users were more marginalized socially than non-users. They were also more often regular injectors (weekly or more versus sporadic) [odds ratio (OR) = 4.9, 95% confidence interval (CI): 2.7-8.8], speedball users (OR = 2.5, 95% CI: 1.5-4.3) and anti-HCV-positive (OR = 3.1, 95% CI: 1.4-7.1). In the logistic regression analysis, using SIFs was associated independently with not borrowing used syringes (OR = 3.3, 95% CI: 1.4-7.7). However, no significant association was found between SIF use and not sharing injection equipment indirectly (OR = 1.1, 95% CI: 0.5-2.2). CONCLUSIONS: SIFs attract highly disadvantaged drug injectors who engage none the less in less borrowing of used syringes than non-users of these facilities. The risks of indirect sharing should be emphasized when counselling SIF attendees. __________________________________________________________________________ _____________________________________*____________________________________ 7. Abstract: A situation update on HIV epidemics among people who inject drugs and national responses in South-East Asia Region __________________________________________________________________________ AIDS. 2009 Jul 17;23(11):1405-13. A situation update on HIV epidemics among people who inject drugs and national responses in South-East Asia Region. Sharma M, Oppenheimer E, Saidel T, Loo V, Garg R. World Health Organization, Regional Office for South-East Asia, New Delhi, India. sharmamu@searo.who.int We explore the magnitude of and current trends in HIV infection among people who inject drugs and estimate the reach of harm reduction interventions among them in seven high-burden countries of the South-East Asia Region. Our data are drawn from the published and unpublished literature, routine national HIV serological and behavioural surveillance surveys and information from key informants. Six countries (Thailand, Myanmar, Nepal, Indonesia, India, and Bangladesh) had significant epidemics of HIV among people who inject drugs. In Thailand, Indonesia, Bangladesh, Myanmar and India, there is no significant decline in the prevalence of HIV epidemics in this population. In Nepal, north-east India, and some cities in Myanmar, there is some evidence of decline in risk behaviours and a concomitant decline in HIV prevalence. This is countered by the rapid emergence of epidemics in new geographical pockets. Available programme data suggest that less than 12 000 of the estimated 800 000 (1.5%) people who inject drugs have access to opioid substitution therapy, and 20-25% were reached by needle-syringe programmes at least once during the past 12 months. A mapping of harm reduction interventions suggests a lack of congruence between the location of established and emerging epidemics and the availability of scaled-up prevention services. Harm reduction interventions in closed settings are almost nonexistent. To achieve significant impact on the HIV epidemics among this population, governments, specifically national AIDS programmes, urgently need to scale up needle-syringe programmes and opioid substitution therapy and make these widely available both in community and closed settings. __________________________________________________________________________ _____________________________________*____________________________________ 8. Abstract: Factors affecting health care workers' adoption of a website with infection control guidelines __________________________________________________________________________ Int J Med Inform. 2009 Jul 3. Factors affecting health care workers' adoption of a website with infection control guidelines. Verhoeven F, Steehouder MF, Hendrix RM, van Gemert-Pijnen JE. University of Twente, Faculty of Behavioral Sciences, Department of Technical and Professional Communication, PO Box 217, 7500 AE Enschede, The Netherlands. GOAL: To identify factors that could affect health care workers' (HCWs) adoption of a website for communicating infection control guidelines. METHODS: In total, 20 semi-structured interviews were conducted with HCWs in 5 different occupational groups and 4 different hospitals in the Netherlands and Germany. A website communicating guidelines for the prevention and control of Methicillin Resistant Staphylococcus aureus served as a casus. The HCWs, the majority of whom had prior experience with the website, were asked to give their opinions about factors that hinder or facilitate adoption of the website in practice. The interviews were based on the PRECEDE (Predisposing, Reinforcing, and Enabling Causes in Educational Diagnosis and Evaluation) model complemented by quality criteria for health-related websites. This model encompasses different categories of factors relevant to technology adoption in health care. RESULTS: A total of 361 interview statements were relevant to the four main categories of the PRECEDE model, yielding the following observations: CONCLUSION: Factors from multiple categories determine HCWs' adoption of web-based guidelines, but the organization appeared to be a paramount reinforcer of initiation and maintenance of technology adoption among HCWs. In order eliminate resistance and create ownership among HCWs toward the website, leading to a willingness to integrate the website into routine care, it is essential to more actively involve HCWs in the early phases of the design process. __________________________________________________________________________ _____________________________________*____________________________________ 9. Abstract: Viral hepatitis: Global goals for vaccination __________________________________________________________________________ J Clin Virol. 2009 Jul 2. Viral hepatitis: Global goals for vaccination. Lavanchy D. World Health Organization (WHO), HSE/EPR/BDP, 20, avenue Appia, CH-1211 Genève 27, Switzerland. In countries where hepatitis A is highly endemic, exposure to hepatitis A virus (HAV) is almost universal before the age of 10 years, and large- scale immunization efforts are not needed. In countries with high rates of disease in specific populations, vaccination of those populations against hepatitis A may be recommended. In areas of intermediate endemicity, where transmission occurs primarily from person to person in the general community (often with periodic outbreaks), control of hepatitis A may be achieved through widespread vaccination programmes [Hepatitis A vaccines. WHO position paper. Wkly Epidemiol Rec 2000;75:38-43]. Hepatitis B virus (HBV) is one of the world's most widespread infectious agents and the cause of millions of infections each year [Lavanchy D. Worldwide epidemiology of HBV infection, disease burden, and vaccine prevention. J Clin Virol 2005;34:S1-S3]. Between 500 thousand and 1.2 million people die each year from chronic infection-related cirrhosis, hepatocellular carcinoma (HCC) or from acute hepatitis B [Lavanchy D. Worldwide epidemiology of HBV infection, disease burden, and vaccine prevention. J Clin Virol 2005;34:S1-S3; Gay N, Edmunds W, Bah E, Nelson C. Estimating the global burden of hepatitis B. Geneva: World Health Organization, Department of Vaccines and Biologicals; 2001; Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin 2005;55:74-108]. Hepatitis B vaccine provides protection against infection and its complications including liver cirrhosis and HCC. It is therefore, the first vaccine against a cancer, the first vaccine protecting from a sexually transmitted infection, and the first vaccine against a chronic disease ever licensed [Hall A. We have a cancer vaccine-why don't we use it? Trop Med Int Health 1998;3:337-338]. The control and the eventual elimination of HBV infection are possible with the appropriate use of hepatitis B vaccines, and this will reduce significantly the disease burden and its associated costs. For hepatitis C and hepatitis E, no vaccines are yet available for public health use. __________________________________________________________________________ _____________________________________*____________________________________ 10. Abstract: Generalized public health and industrial nurses work together __________________________________________________________________________ Public Health Nurs. 2009 Jul-Aug;26(4):380-2. Generalized public health and industrial nurses work together. Schwem MA. Department of Nursing, University of Vermont, 106 Carrigan Drive, Burlington,VT 05405, USA.Sarah.Abrams@uvm.edu Occupational health has been considered a subset of public health nursing for years. The first industrial or occupational health nurses were employed by large companies in the 1890s but the role evolved quickly in the early 20(th) century. By mid-century, many large companies employed a physician and nurse(s) to provide examinations, screenings, episodic care, and trauma intervention for workers. Occupational health nurses faced different problems than community-based public health nurses in generalized nursing service. The intersection of public health and employee health was apparent, though, because large industries often constituted the main workplace for a smaller community and sickness could spread throughout a town if the occupational health nurse was not well- prepared in principles of infection control and health promotion. Excerpts from this July 1949 article about building relationship between public health and industrial nurses illustrate the benefits hoped for when they were formally connected to one another through cross-training and in- service education. The author, Margaret Schwem, was a supervisor at the Rensselaer County Department of Health in Troy, New York. In the original article, Schwem included a list of reference materials for those interested in public health and industrial nursing. __________________________________________________________________________ _____________________________________*____________________________________ 12. Abstract: Long-term safety of repeated administrations of a new formulation of botulinum toxin type A in the treatment of glabellar lines: Interim analysis from an open-label extension study. __________________________________________________________________________ J Am Acad Dermatol. 2009 Jul 2. Long-term safety of repeated administrations of a new formulation of botulinum toxin type A in the treatment of glabellar lines: Interim analysis from an open-label extension study. Monheit GD, Cohen JL; the Reloxin Investigational Group. Department of Dermatology, University of Alabama at Birmingham; Total Skin and Beauty Dermatology Center, Birmingham. BACKGROUND: A new formulation of botulinum toxin type A (BoNT-A) (Dysport) has recently been approved in the United States for the treatment of glabellar lines. OBJECTIVE: We sought to evaluate the long-term safety of repeated administrations of this BoNT-A formulation. METHODS: In all, 768 individuals (1500 planned) from phase III clinical trials received as many as 6 repeated treatments of open-label BoNT-A (50 U) over 17 months, with a minimum of 85 days between treatments. Participants received a telephone call at day 7 postinjection to check for adverse event (AE), with clinical evaluations on days 14 and 30, and monthly until retreatment, study completion, or early termination. Safety end points were AEs, changes in vital signs, and assessment of serum- neutralizing antibodies to BoNT-A. RESULTS: Of the 285 participants reporting at least one treatment-emergent AE at the interim analysis cutoff, only 74 (26%) reported at least one possibly or probably related event after 2259 treatments with BoNT-A. The incidence of treatment-emergent AEs around the injection sites and eyes was low (