*SAFE INJECTION GLOBAL NETWORK* SIGNPOST *SAFE INJECTION GLOBAL NETWORK* Post00503 IT + Waste + Abstracts + TALC + GIS + News 15 July 2009 CONTENTS 0. Moderators Note Re: Listserve Problems 1. New Document: Logistics of Health Care Waste Management: Information and Approaches for Developing Country Settings 2. Abstract: Self-reported needle-stick injuries among dentists in north Jordan 3. Abstract: Prevalence of hepatitis C and B infection and HC V genotypes among hemodialysis patients in Khuzestan province, Southwest Iran 4. Abstract: Healthcare-associated infections as patient safety indicators 5. Abstract: Risky business: failure to prevent and failure to communicate 6. Abstract: Standardization as a key to quality 7. Abstract: Infection prevention and control in the design of healthcare facilities 8. Abstract: The authors respond 9. Abstract: A situation update on HIV epidemics among people who inject drugs and national responses in South-East Asia Region 10. Abstract: Complexity, cofactors, and the failure of AIDS policy in Africa 11. Abstract: Analysis of the epidemiologic patterns of HIV transmission in Dehong prefecture, Yunnan province 12. Abstract: Survival analysis of 530 HIV infected former unsafe commercial blood and plasma donors 13. Abstract: Outcomes of a patient-to-patient outbreak of genotype 3a hepatitis C 14. Abstract: Impact of a prevention strategy targeting hand hygiene and catheter care on the incidence of catheter-related bloodstream infections 15. Abstract: Occurrence of Hepatitis C Virus infection in type 2 diabetic patients attending Plateau state specialist hospital Jos Nigeria 16. Abstract: Exubera inhaled insulin in patients with type 1 and type 2 diabetes: the first 12 months 18. Abstract: Combined DTP-HBV-HIB vaccine versus separately administered DTP-HBV and HIB vaccines for primary prevention of diphtheria, tetanus, pertussis, hepatitis B and Haemophilus influenzae B (HIB) 19. Abstract: Corticosteroid injection for de Quervain's tenosynovitis 20. Abstract: The preparation and administration of intravenous drugs before and after protocol implementation 21. Abstract: A qualitative exploration of reasons for poor hand hygiene among hospital workers: lack of positive role models and of convincing evidence that hand hygiene prevents cross-infection 22. Abstract: Impact of finger rings on transmission of bacteria during hand contact 23. Abstract: Surgical hand antisepsis with alcohol-based hand rub: comparison of effectiveness after 1.5 and 3 minutes of application 24. No Abstract: E.U. laws to enforce needlestick safety 25. No Abstract: Successful control of norovirus outbreak in an infirmary with the use of alcohol-based hand rub 26. No Abstract: Do neckties and pens act as vectors of hospital-acquired infections? 27. Final Call for Registration and Participation in Health GIS 2009 28. [hif-net] David Morley 29. News - Africa: Poor syringe hygiene can be fatal - USA: Open Door clinics drop needle exchange - Saudi Arabia: Tainted transfusion: Girl gets compensation - USA: Las Vegas summit to give health care workers an understanding of infection prevention - UK: Hospital unit could pose serious risk to patients health - USA: Fake Oakland Dentist Busted, Police Say - USA: U.S. House Democrats eye funding for needle exchanges - China: New HIV/AIDS cases surge in Beijing - Canada: Downtown Eastside junkies putting city workers at risk - USA: Bail Denied for Surgery Technician in Hepatitis C Scare - UK: New initiative to reducing the spread of Hepatitis C - USA: Medical examiners went fairly easy on one doctor in hepatitis case - USA: State health department reports 10th suspected hepatitis case tied to dirty needles - Canada: Canada's 1st needle exchange program to end after 29 years - Canada: Insite Drug-Injection Facility Awaits Fate amid Controversy - USA: Arthroscopic Shavers May Retain Tissue After Cleaning: FDA This edition of SIGNpost is located at: http://uqconnect.net/signfiles/Archives/SIGN-POST00503.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 __________________________________________________________________________ _____________________________________*____________________________________ 0. Moderators Note __________________________________________________________________________ The moderator wishes to apologize for delayed and or missing SIGNpost these last two weeks. Apologies also for the cryptic messages from the listserver that arrived without STGNpost. The University IT software engineers are working on the problem and hope to have it resolved. Thank you for your patience and understanding as these technical difficulties are brought under control. __________________________________________________________________________ _____________________________________*____________________________________ 1. New Document: Logistics of Health Care Waste Management: Information and Approaches for Developing Country Settings __________________________________________________________________________ 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 http://www.deliver.jsi.com, or at the direct link here: http://tinyurl.com/HCWM-LogiGuide 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. Comments welcome! 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 __________________________________________________________________________ _____________________________________*____________________________________ 2. Abstract: Self-reported needle-stick injuries among dentists in north Jordan __________________________________________________________________________ East Mediterr Health J. 2009 Jan-Feb;15(1):185-9. Self-reported needle-stick injuries among dentists in north Jordan. Khader Y, Burgan S, Amarin Z. Department of Public Health and Community Medicine, Jordan University of Science and Technology, Irbid, Jordan. The incidence of needle-stick injuries and the reporting attitudes among dentists in the north of Jordan were assessed with a cross-sectional survey. The study included 170 general dental practitioners (119 males and 51 females), of whom 113 (66.5%) were injured within the preceding 12 months. Needle-stick injury was significantly associated with higher age and a higher number of patients treated daily. Of those who were injured, 77.9% did not report the injury. Reasons for not reporting needle-stick injury were: because it took place before use on a patient (41.2%), ignorance of the risk (20.8%), being busy (25.0%) and dissatisfaction with follow-up procedures (13.0%). The study highlights the need for continuous education programmes about handling of sharp dental instruments and reporting injuries. __________________________________________________________________________ _____________________________________*____________________________________ 3. Abstract: Prevalence of hepatitis C and B infection and HC V genotypes among hemodialysis patients in Khuzestan province, Southwest Iran __________________________________________________________________________ Saudi J Kidney Dis Transpl. 2009 Jul;20(4):681-4. Prevalence of hepatitis C and B infection and HC V genotypes among hemodialysis patients in Khuzestan province, Southwest Iran. Assarehzadegan MA, Shakerinejad G, Noroozkohnejad R, Amini A, Rahim Rezaee SA. Department of Immunology, Faculty of Medicine, Ahwaz Joundishapur University of Medical Sciences, Ahwaz, Khuzestan, Iran. Assarehzadeganma831@mums.ac.ir. Hepatitis B (HBV) and C (HCV) virus infection are the most important infections transmitted by the parenteral route in hemodialysis patients. This study is the first report of prevalence of viral hepatitis and hepatitis C virus genotypes in southwest Iran among hemodialysis patients. A cross-sectional study was carried out among 214 hemodialysis patients of the Central hemodialysis unit, from March 2005 to August 2006. Serum samples were tested for HBsAg and anti-HCV using specific enzyme linked immunoassay (ELISA) kits and confirmed by PCR (HBV) and RT PCR (HCV). HCV genotypes were determined with HCV genotype specific primers using HCV genotype kit. Out of 214 hemodialysis patients, 34 were positive for anti- HCV (7.9%, 95% CI: 4.32-11.56) and 11 for HBsAg (5.1%, 95% CI: 2.18-8.1). The duration of treatment by hemo-dialysis was significantly associated with HBV and HCV positivity (P< 0.001). The predominant HCV genotype in the region was 1a (41.1%, 7/17), whilst genotypes 3a and 1b were found in 35.2% (6/17) and 23.5% (4/17) subjects, respectively. In conclusion although anti-HCV and HBsAg positivity in hemodialysis patients in Khuzestan province are smaller than those found in some other Iranian provinces and neighboring countries, they are still high. Enforcement of universal precautions in infection control, routine testing of patients, and serial determination of hepatic enzymes should be the common practice in dialysis centers in Iran. __________________________________________________________________________ _____________________________________*____________________________________ 4. Abstract: Healthcare-associated infections as patient safety indicators __________________________________________________________________________ Healthc Pap. 2009;9(3):8-24. Healthcare-associated infections as patient safety indicators. Gardam MA, Lemieux C, Reason P, van Dijk M, Goel V. MSc, MD, CM, MSc, FRCPC, Ontario Agency for Health Protection and Promotion, Dalla Lana School of Public Health, University of Toronto, Infection Prevention and Control Unit, University Health Network. Healthcare-associated infections (HAIs) are a pressing and imminent patient safety concern as they cause substantial preventable morbidity and mortality. Despite this, there is a strong tendency for healthcare administrators and providers to view them as far less of a threat to patient safety than adverse events such as medication administration errors and falls. Further, validated strategies to prevent HAIs are frequently slow to be adopted. This paper reviews two HAIs of increasing visibility and importance - namely, methicillin-resistant Staphylococcus aureus and Clostridium difficile - and discusses the pivotal importance of hand hygiene and environmental cleaning in their prevention. Possible reasons why HAIs are approached differently from other patient safety issues are discussed, including the false sense of security created by the advent of antibiotics, the lack of randomized controlled trials supporting infection-control interventions and the systemic multifactorial causes of HAIs that result in a need for interventions that go far beyond traditional clinical boundaries. Suggested strategies to improve patient safety with respect to HAIs are provided, including a focus on the role of potential links to accreditation; the role of public reporting; healthcare facility design; change management strategies; visible leadership and role modelling; collaboration between facilities and with public health; reducing hospital overcrowding; and accountability and funding. Finally, the impact of the burgeoning interest of the media, the threat of legal liability and the well-being of healthcare providers are discussed. __________________________________________________________________________ _____________________________________*____________________________________ 5. Abstract: Risky business: failure to prevent and failure to communicate __________________________________________________________________________ Healthc Pap. 2009;9(3):44-50. Risky business: failure to prevent and failure to communicate. Moore DL, Ste-Marie M. PhD, MD, FRCP, Associate Infection Control Physician for Child and Adolescent Services, The Montreal Children's Hospital, McGill University Health Centre. Healthcare-associated infections (HAIs), important threats to patient safety, are considered differently from other adverse events. Gardam and his colleagues discuss several reasons for this and outline approaches that may bring about changes in attitudes and enhance HAI prevention. We comment on the potential preventability of HAIs, the need for improved communication strategies and the different vision of the role of infection control personnel suggested by Gardam et al. Recent developments in infection control structure and management and patient safety in Quebec are summarized. __________________________________________________________________________ _____________________________________*____________________________________ 6. Abstract: Standardization as a key to quality __________________________________________________________________________ Healthc Pap. 2009;9(3):56-8. Standardization as a key to quality. Smith K. DPHil, President and Chief Executive Officer, St. Joseph's Healthcare Hamilton. The increasing attention to healthcare-associated infections is essential and long overdue. The authors of the lead article point out that standardization is a key dimension of quality. We, as healthcare providers, must leave behind the historical approach of "accommodating" broad clinical variation in practice, tolerance of low compliance in applying clear evidence that enhances outcome, and accommodating intransigent, colleagues who reject infection control practices. We know from the behavioural literature that unless an issue affects "me," buy-in is significantly limited; clearly, we must help each person in the chain of care feel an impact. There is much we can do, and each of us must demand change. __________________________________________________________________________ _____________________________________*____________________________________ 7. Abstract: Infection prevention and control in the design of healthcare facilities __________________________________________________________________________ Healthc Pap. 2009;9(3):32-7. Infection prevention and control in the design of healthcare facilities. Farrow TS, Black SM. BArch, MArchUD, OAA, MAIBC, NSAA, NAA, FRAIC, Senior Partner, Farrow Partnership Architects Inc. The lead paper, "Healthcare-Associated Infections as Patient Safety Indicators," written by Gardam, Lemieux, Reason, van Dijk and Goel, puts forward the design of healthcare facilities as one of many strategies to improve patient safety with respect to healthcare-associated infections. This commentary explores some of the issues in balancing infection prevention and control priorities with other needs and values brought to the design process. This balance is challenged not only by a lack of supporting evidence but also by the superficial nature in which infection prevention and control are often discussed within a design context. For the physical environment to support any patient safety initiative, the design of the processes must be developed in conjunction with that of the physical environment so that compliance can be natural and convenient. Finally, consideration is given to the value of documenting decision- making related to infection prevention and control in facility design and ongoing assessments of existing facilities. __________________________________________________________________________ _____________________________________*____________________________________ 8. Abstract: The authors respond __________________________________________________________________________ Healthc Pap. 2009;9(3):30-62. The authors respond. Gardam MA, Lemieux C, Reason P, van Dijk M, Goel V. MSc, MD, CM, MSc, FRCPC, Ontario Agency for Health Protection and Promotion, Dalla Lana School of Public Health, University of Toronto, Infection Prevention and Control Unit, University Health Network. We read the six commentaries about our paper with great interest. It is clear from the breadth of the contributors' expertise that controlling the spread of infectious diseases in healthcare settings is indeed a multi- factorial problem that requires a team-based multidisciplinary response. Indeed, it is this multi-factorial nature that makes improving our record all the more challenging. For example, one could focus on, and sustain significant improvements in, cleaning and yet have a limited impact on infection rates because of poor compliance with hand hygiene and isolation procedures. __________________________________________________________________________ _____________________________________*____________________________________ 9. 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. __________________________________________________________________________ _____________________________________*____________________________________ 10. Abstract: Complexity, cofactors, and the failure of AIDS policy in Africa __________________________________________________________________________ J Int AIDS Soc. 2009 Jul 10;12(1):12. Complexity, cofactors, and the failure of AIDS policy in Africa. Stillwaggon E. Global AIDS policy still treats HIV as an exceptional case, abstracting from the context in which infection occurs. Policy is based on a simplistic theory of HIV causation, and evaluated using outdated tools of health economics. Recent calls for a health systems strategy - preventing and treating HIV within a programme of comprehensive health care - have not yet influenced the silo approach of AIDS policy. Evidence continues to accumulate, showing that multiple factors, such as malnutrition, malaria and helminthes, increase the risk of sexual and vertical transmission of HIV. Moreover, complementary interventions that reduce viral load, improve immune response, and interrupt pathways of transmission could increase the effectiveness of antiretroviral drugs and other tools of AIDS policy. In health economics, the omission of estimates of increasing returns generated by disease or treatment synergies biases cost-effectiveness analysis against multiple, yet inexpensive, interventions. Current tools of cost-effectiveness analysis only identify local maxima in a complex landscape, and can play, at best, a marginal role in the epidemic, especially where it is already generalized. Cost- effectiveness analyses for HIV that are based on the wrong epidemiological model can generate Type III errors: we get precise answers to the wrong questions about how to intervene. To control the epidemic, AIDS policy needs to utilize an epidemiological model that reflects the interactions of biological as well as behavioural variables that determine the course of HIV epidemics around the world. Cost-effectiveness analysis can benefit from using economic concepts of externalities and increasing returns to incorporate disease interaction and beneficial treatment spillovers for coinfections in HIV-prevention policy. __________________________________________________________________________ _____________________________________*____________________________________ 11. Abstract: Analysis of the epidemiologic patterns of HIV transmission in Dehong prefecture, Yunnan province __________________________________________________________________________ Zhonghua Yu Fang Yi Xue Za Zhi. 2008 Dec;42(12):866-9. [Analysis of the epidemiologic patterns of HIV transmission in Dehong prefecture, Yunnan province] [Article in Chinese] Duan S, Guo HY, Pang L, Yuan JH, Jia MH, Xiang LF, Ye RH, Yang YC, Lu JY, Luo W, Sun JP. Dehong Center for Disease Control and Prevention, Dehong 678400, Yunnan province, China. OBJECTIVE: To uncover the transmission patterns of the HIV epidemic in Dehong prefecture. METHODS: The reviewed case reports, data of sentinel surveillance, testing and special survey were analyzed by SAS 8.0 program. The transmission patterns were modeled by utilizing data including sizes of the whole population and the high risk groups, high risk behavior data from 1989 to 2007, and the population index such as sex ratio and fertility rate. RESULTS: In 2005, case reports showed the proportion of people infected with HIV through sexual contact was 39.1%, and 46.9% in 2006. Among 1636 cases reported between January 1 to September 20, 2007, the proportion of people infected with HIV through sexual contact was 52%. From 1989 to 2007, the proportion of HIV infection among drug users was declining, while HIV infection through sexual contact was rising after standardizing the population tested/surveyed. The Asian Epidemic Model has shown that the proportions of incident HIV infections through sexual transmissions were 50.6%, 52.3% and 52.7% respectively from 2005 to 2007. Correspondingly, the proportions of incident cases by injecting drug user were 48.9%, 47.2% and 46.7% respectively during this period. Moreover, the Workbook method has shown that, among adults living with HIV in 2007, 50.3% were infected through injecting drugs and 48.4% through unsafe sexual activity. CONCLUSION: The rapid rise in HIV infections through injecting drug in Dehong prefecture has been initially curbed. HIV epidemic has already witnessed a change from predominantly through drug injecting-related activity to an almost equally fuelled epidemic by sexual and drug-related transmission. __________________________________________________________________________ _____________________________________*____________________________________ 12. Abstract: Survival analysis of 530 HIV infected former unsafe commercial blood and plasma donors __________________________________________________________________________ Zhonghua Yu Fang Yi Xue Za Zhi. 2008 Dec;42(12):879-83. [Survival analysis of 530 HIV infected former unsafe commercial blood and plasma donors] [Article in Chinese] Dou ZH, Yu L, Zhao HX, Ma Y, Peng GP, Lu LX, Li ZH, Fu JH, Zhang FJ. National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China. OBJECTIVE: To investigate HIV survival time and it's influencing factors among former commercial blood and plasma donors engaged in unsafe blood donation practices in China. METHODS: HIV/AIDS cases from 8 counties (districts) in 4 provinces confirmed prior to January 24, 2006 related with former commercial blood and plasma donors were selected and data regarding infection, AIDS progression, death, and influencing factors were retrospectively collected. RESULTS: In 530 cases of HIV infection, 334 (63.0%) cases had developed AIDS, 168 (50.3%) had received antiretroviral therapy (ART), and 152 (29.0%) had died. For the 530 cases, there was an average (10.1 +/- 1.8) years of observation from time of infection. Among 166 AIDS patients not receiving ART, average survival was 9.1 years (95% CI: 9.1 - 9.4), with an 8 year survival rate of 52.0%. Among 168 AIDS patients receiving ART, average survival was 12.1 years (95% CI: 11.9 - 12.3), with a 12-year survival rate of 80.0%. In 3 years of ART, average survival was longer in the treatment group as compared to the no treatment group with a hazard ratio for death of 12.2. Univariate analysis showed a significant difference (P < 0.05) in AIDS patient average survival based on gender, age, location, ART status, and baseline CD(4)(+) T cells count. Results from multivariate COX-regression showed that highly active ant iretroriral therapy (HAART) was the strongest protective factor for prolonging AIDS patients' survival (HR = 13.3, P = 0.00). CONCLUSION: Although there are many factors influencing AIDS patients survival, intervention with HAART is the principle measure to prolong survival and decrease the risk of death. __________________________________________________________________________ _____________________________________*____________________________________ 13. Abstract: Outcomes of a patient-to-patient outbreak of genotype 3a hepatitis C __________________________________________________________________________ Hepatology. 2009 Apr 6. Outcomes of a patient-to-patient outbreak of genotype 3a hepatitis C. Mailliard ME, Capadano ME, Hrnicek MJ, Gilroy RK, Gulizia JM. Department of Internal Medicine, University of Nebraska College of Medicine, Omaha, NE. Between March 2000 and July 2001, at least 99 persons acquired a hepatitis C virus genotype 3a (HCV-3a) infection in an oncology clinic. This nosocomial HCV outbreak provided an opportunity to examine the subsequent clinical course in a well-defined cohort. This was a retrospective/prospective observational study of the short-term significant health outcomes of a large, single-source, patient-to-patient HCV-3a outbreak. Outbreak patients or their legal representatives consenting to study were enrolled between September 2002 and December 2007. We measured history and physical examinations, medical records, HCV serology, HCV RNA and genotype, liver enzymes, histology, response to antiviral therapy, and liver-related morbidity and mortality.Sixty-four of the 99 known HCV-3a outbreak patients participated. During a 6-year period, six patients developed life-threatening complications from liver disease, three died, one received a liver transplant, and two were stable after esophageal variceal banding or diuretic therapy of ascites. Thirty- three patients underwent antiviral therapy, with 28 achieving a sustained viral remission. One patient acquired HCV-3a infection sexually from an outbreak patient and was successfully treated. Eleven study patients died of malignancy, including two that had achieved a sustained viral remission after antiviral therapy. Conclusion: Our patient cohort had a nosocomial source and an oncologic or hematologic comorbidity. Compared with previous HCV outcome studies, a patient-to-patient HCV outbreak in an oncology clinic exhibited significant morbidity and mortality. Attention is needed to the public health risk of nosocomial HCV transmission, emphasizing infection control, early diagnosis, and therapy. (HEPATOLOGY 2009.). __________________________________________________________________________ _____________________________________*____________________________________ 14. Abstract: Impact of a prevention strategy targeting hand hygiene and catheter care on the incidence of catheter-related bloodstream infections __________________________________________________________________________ Crit Care Med. 2009 Jul;37(7):2167-73; quiz 2180. Links Impact of a prevention strategy targeting hand hygiene and catheter care on the incidence of catheter-related bloodstream infections. Zingg W, Imhof A, Maggiorini M, Stocker R, Keller E, Ruef C. Infection Control Programme, University of Geneva Hospitals, Geneva, Switzerland. walter.zingg@hcuge.ch OBJECTIVES: To study the impact of a teaching intervention on the rate of central venous catheter-related bloodstream infections (CRBSI) in intensive care patients. DESIGN: Prospective before/after interventional cohort study on medical and surgical intensive care units. SETTING: University hospital with five adult intensive care units. PATIENTS: All patients with a central venous catheter on the five ICUs from September to December 2003 (baseline period) and from March to July 2004 (intervention period). INTERVENTIONS: Educational program with teaching of hand hygiene, standards of catheter care, and preparation of intravenous drugs. MEASUREMENTS AND MAIN RESULTS: The primary outcome variable was the rate of CRBSIs per 1000 catheter days during a baseline period of 4 months and an intervention period of 5 months. The secondary outcome variable was compliance with hand hygiene. Of the patients, 499 patients with 6200 catheter days in the baseline period and 500 patients with 7279 catheter days were monitored in the intervention period. The incidence density of CRBSI decreased from 3.9 per 1000 catheter days in the preintervention phase to 1.0 per 1000 catheter days in the intervention phase (p < 0.001). The risk for CRBSI was significantly higher in the baseline period in both univariate and multivariate analysis. Other independent risk factors were hospitalization in the medical ICU and male gender. Time to CRBSI was significantly longer in the intervention period (median 9 days vs. 6.5 days, respectively; p = 0.02). Compliance with hand hygiene improved slightly from 59% in the baseline period to 65% in the intervention period, but the rate of correct performance of the practice increased from 22.5% to 42.6% (p = 0.003). CONCLUSIONS: Evidence-based catheter-care procedures, guided by healthcare workers' perceptions and including bedside teaching, reduce significantly the CRBSI rate and demonstrate that improving catheter care has a major impact on its prevention. __________________________________________________________________________ _____________________________________*____________________________________ 15. Abstract: Occurrence of Hepatitis C Virus infection in type 2 diabetic patients attending Plateau state specialist hospital Jos Nigeria __________________________________________________________________________ Virol J. 2009 Jul 8;6(1):98. Occurrence of Hepatitis C Virus infection in type 2 diabetic patients attending Plateau state specialist hospital Jos Nigeria. Ndako JA, Echeonwu GO, Shidali NN, Bichi IA, Paul GA, Onovoh E, Okeke LA. BACKGROUND: Glucose intolerance is observed more in patients with HCV infection compared with control subjects with liver disease, Initial studies suggested that Hepatitis C virus infection may be an additional risk factor for the development of diabetes mellitus. This study was therefore carried out to determine the correlation of HCV infection and diabetes. METHOD: Three hundred (300) confirmed type 2 diabetic patients were screened for hepatitis C virus antibodies at the Plateau state specialist hospital, Jos, using Grand diagnostic test strip. Questionnaire comprising of age, sex, family history on diabetes, duration of disease and marital status were issued to subjects. RESULT Overall result showed that the prevalence rate of HCV infection was 33(11%).In response to diabetic status, females subjects had a higher prevalence of 178(59.3%) compared to males 122(40.7%).Those aged 47-57 recorded the highest seroprevalence 10(30.3%) to the Hepatitis C Virus, while Patients without family history of diabetes showed a higher seroprevalence of 13(39.4%).Subjects who never had any blood transfusion recorded a prevalence rate of 6(18.2%). Marital status showed no significant difference [(P=0.275; P.0.05)]. Considering duration of developing diabetes, patients within the range of 1-10years diabetic status recorded the highest prevalence rate 25(75.8%) compared to other ranges considered. CONCLUSION: This study hence, suggests a relatively strong association between HCV infection and diabetes, this therefore call for an urgent approach strategy in the control and management of this disease of the endocrine system. __________________________________________________________________________ _____________________________________*____________________________________ 16. Abstract: Exubera inhaled insulin in patients with type 1 and type 2 diabetes: the first 12 months __________________________________________________________________________ Diabetes Technol Ther. 2009 Jul;11(7):427-30. Exubera inhaled insulin in patients with type 1 and type 2 diabetes: the first 12 months. Alabraba V, Farnsworth A, Leigh R, Dodson P, Gough SC, Smyth T. 1 Diabetes Centre, Selly Oak Hospital, University Hospital Birmingham NHS Foundation Trust, University of Birmingham , Birmingham, United Kingdom . Background: Following National Institute for Clinical Excellence approval of inhaled insulin Exubera((R)) (Pfizer, New York, NY) in 2006, we established a dedicated clinic in January 2007 to monitor the efficacy and safety of Exubera. Between January and October 2007, eight patients started Exubera: six because of needle phobia (DSM-IV criteria) and two with injection site problems. Methods: Data were collected at the clinic over a 12-month period from February 2007 at 3-, 6-, 9-, and 12-month intervals. The clinic is jointly led by a consultant diabetologist and a diabetes specialist nurse within the secondary care setting. Results: Inhaled insulin was well tolerated in all eight patients who had previously experienced significant problems with initiation or intensification of subcutaneous insulin injections. Mean hemoglobin A1c was 10.7% (range, 8.1-14.2%) at initaition, 8.3% (7.2-9.4%) at 3 months, 7.7% (6.9-9.0%) at 6 months, 7.4% (6.7-8.4%) at 9 months, and 7.5% (6.5-8.7%) at 12 months. At 6 months, six patients had a reduction in forced expiratory volume in the first second (FEV(1)) by 4-12%, whereas five patients had a reduction of 2-12% at 12 months. One developed dyspnea, with a 29% fall in FEV(1), which was transient and secondary to an upper respiratory tract infection. Two patients with the highest starting and most improved hemoglobin A1c developed significant retinopathy. Conclusions: Our 12-month audit data demonstrate that the initiation of inhaled insulin in this difficult-to-treat group of patients resulted in a significant improvement in glycemic control. The subsequent withdrawal of an alternative and acceptable form of insulin treatment now presents a renewed challenge for our patients and healthcare professionals. __________________________________________________________________________ _____________________________________*____________________________________ 18. Abstract: Combined DTP-HBV-HIB vaccine versus separately administered DTP-HBV and HIB vaccines for primary prevention of diphtheria, tetanus, pertussis, hepatitis B and Haemophilus influenzae B (HIB) __________________________________________________________________________ Cochrane Database Syst Rev. 2009 Jul 8;(3):CD005530. Combined DTP-HBV-HIB vaccine versus separately administered DTP-HBV and HIB vaccines for primary prevention of diphtheria, tetanus, pertussis, hepatitis B and Haemophilus influenzae B (HIB). Bar-On ES, Goldberg E, Fraser A, Vidal L, Hellmann S, Leibovici L. Department of Medicine E, Beilinson Campus, Rabin Medical Center, 39 Jabotinsky Street, Petah-Tiqva, Israel, 49100. BACKGROUND: Advantages to combining childhood vaccines include reducing the number of visits, injections and patient discomfort, increasing compliance, and optimizing prevention. The World Health Organization recommends that routine infant immunization programs include a vaccination against Haemophilus influenza type B (HIB) in the combined diphtheria, tetanus, pertussis (DTP)-hepatitis B (HBV) vaccination. The effectiveness and safety of the combined vaccine should be carefully and systematically assessed to ensure their acceptability by the community. OBJECTIVES: To compare the effectiveness of combined DTP-HBV-HIB vaccine with DTP-HBV and HIB vaccinations. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, issue 1) which contains the Acute Respiratory Infection Group's Specialized Register; MEDLINE (January 1966 to March 2009) and EMBASE (January 1990 to March 2009). SELECTION CRITERIA: Randomized or quasi-randomized controlled trials comparing vaccination with any combined DTP-HBV-HIB vaccine, with or without three types of inactivated poliovirus (IPV) or concomitant oral polio vaccine (OPV) in any dose, preparation or time schedule, compared with separate vaccines or placebo, administered to infants aged up to two years. DATA COLLECTION AND ANALYSIS: Two review authors independently inspected references identified by the searches and evaluated them against the inclusion criteria, extracted data and assessed the methodological quality of included trials. MAIN RESULTS: Meta-analysis was performed to pool the results of 18 studies. There were no data on clinical outcomes for the primary outcome and all studies used immunogenicity and reactogenicity (adverse events). In two immunological responses the combined vaccine achieved lower responses than the separate vaccines for HIB and HBV. Comparison found little heterogeneity. No significant differences in immunogenicity were found for pertussis, diphtheria, polio and tetanus. Serious adverse events were comparable. Minor adverse events were more common in children given the combined vaccine. AUTHORS' CONCLUSIONS: We could not conclude that the immune responses elicited by the combined vaccine were different from, or equivalent to, the separate vaccines. Data for the primary outcome (prevention of disease) were lacking. There was significantly less immunological response for HIB and HBV, and more local reactions in the combined injections. However, these differences rely mostly on one study each. Studies did not use an intention-to-treat analysis and we were uncertain about the risk of bias in many of the studies. These results are therefore inconclusive. Studies addressing clinical end-points whenever possible, using correct methodology and a large enough sample size should be conducted. __________________________________________________________________________ _____________________________________*____________________________________ 19. Abstract: Corticosteroid injection for de Quervain's tenosynovitis __________________________________________________________________________ Cochrane Database Syst Rev. 2009 Jul 8;(3):CD005616. Corticosteroid injection for de Quervain's tenosynovitis. Peters-Veluthamaningal C, van der Windt DA, Winters JC, Meyboom-de Jong B. Department of General Practice, University Medical Center Groningen, Antonius Deusinglaan 1, Groningen, Netherlands, 9713 AV. BACKGROUND: De Quervain's tenosynovitis is a disorder characterised by pain on the radial (thumb) side of the wrist and functional disability of the hand. It can be treated by corticosteroid injection, splinting and surgery. OBJECTIVES: To summarise evidence on the efficacy and safety of corticosteroid injections for de Quervain's tenosynovitis. SEARCH STRATEGY: We searched the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, Issue 2), MEDLINE (1966 to April 2009), EMBASE (1956 to April 2009), CINAHL (1982 to April 2009), AMED (1985 to April 2009), DARE, Dissertation Abstracts and PEDro (physiotherapy evidence database). SELECTION CRITERIA: Randomised and controlled clinical trials evaluating the efficacy and safety of corticosteroid injections for de Quervain's tenosynovitis. DATA COLLECTION AND ANALYSIS: After screening abstracts of studies identified by the search we obtained full text articles of studies which fulfilled the selection criteria. We extracted data using a predefined electronic form. We assessed the methodological quality of included trials by using the checklist developed by Jadad and the Delphi list. We extracted data on the primary outcome measures: treatment success; severity of pain or tenderness at the radial styloid; functional impairment of the wrist or hand; and outcome of Finkelstein's test, and the secondary outcome measures: proportion of patients with side effects; type of side effects and patient satisfaction with injection treatment. MAIN RESULTS: We found one controlled clinical trial of 18 participants (all pregnant or lactating women) that compared one steroid injection with methylprednisolone and bupivacaine to splinting with a thumb spica. All patients in the steroid injection group (9/9) achieved complete relief of pain whereas none of the patients in the thumb spica group (0/9) had complete relief of pain, one to six days after intervention (number needed to treat to benefit (NNTB) = 1, 95% confidence interval (CI) 0.8 to 1.2). No side effects or local complications of steroid injection were noted. AUTHORS' CONCLUSIONS: The efficacy of corticosteroid injections for de Quervain's tenosynovitis has been studied in only one small controlled clinical trial, which found steroid injections to be superior to thumb spica splinting. However, the applicability of our findings to daily clinical practice is limited, as they are based on only one trial with a small number of included participants, the methodological quality was poor and only pregnant and lactating women participated in the study. No adverse effects were observed. __________________________________________________________________________ _____________________________________*____________________________________ 20. Abstract: The preparation and administration of intravenous drugs before and after protocol implementation __________________________________________________________________________ Pharm World Sci. 2009 Jun;31(3):413-20. The preparation and administration of intravenous drugs before and after protocol implementation. Tromp M, Natsch S, van Achterberg T. Department of Internal Medicine and Nijmegen Institute for Infection, Inflammation and Immunity (N4i), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. OBJECTIVES: This paper reports on a pilot study examining the incidence of nurses' errors in preparation and administration of intravenous drugs. Furthermore, the study aimed to evaluate the short-term effects of implementation of a new protocol for preparation and administration of intravenous drugs. SETTING: Two nursing departments of internal medicine at a 953 beds University Medical Centre in The Netherlands. METHODS: By means of a prospective, quasi-experimental design, nurses were observed during the process of preparation and administration of intravenous drugs. Observation was performed before and after the implementation of a new protocol. Seventy-two nurses at two nursing departments were observed during the study. MAIN OUTCOME MEASURE: A mean pre-test and post-test quality score at two departments of internal medicine. RESULTS: At baseline, average quality scores for nurses at the two departments were 64 (intervention ward) and 67 (control ward) on a 0-100 quality scale. The pre-test quality scores were not statistically significant for the two nursing wards (T = 1.36, df = 55, P = 0.18). After the implementation of the new protocol, nurses at the intervention ward scored better (72) than nurses at the control ward (69). The mean score at the intervention ward was significantly higher than the score in nurses of the control ward (T = -2.20, df = 53, P = 0.04). CONCLUSIONS: The number of errors in the preparation and administration of intravenous drugs is high. This study shows that implementing a protocol for the preparation and administration of these drugs can reduce the number of errors. __________________________________________________________________________ _____________________________________*____________________________________ 21. Abstract: A qualitative exploration of reasons for poor hand hygiene among hospital workers: lack of positive role models and of convincing evidence that hand hygiene prevents cross-infection __________________________________________________________________________ Infect Control Hosp Epidemiol. 2009 May;30(5):415-9. A qualitative exploration of reasons for poor hand hygiene among hospital workers: lack of positive role models and of convincing evidence that hand hygiene prevents cross-infection. Erasmus V, Brouwer W, van Beeck EF, Oenema A, Daha TJ, Richardus JH, Vos MC, Brug J. Department of Public Health, University Medical Center Rotterdam, Rotterdam, The Netherlands. v.erasmus@erasmusmc.nl OBJECTIVE: To study potential determinants of hand hygiene compliance among healthcare workers in the hospital setting. DESIGN: A qualitative study based on structured-interview guidelines, consisting of 9 focus group interviews involving 58 persons and 7 individual interviews. Interview transcripts were subjected to content analysis. SETTING: Intensive care units and surgical departments of 5 hospitals of varying size in The Netherlands. PARTICIPANTS: A total of 65 nurses, attending physicians, medical residents, and medical students. RESULTS: Nurses and medical students expressed the importance of hand hygiene for preventing of cross-infection among patients and themselves. Physicians expressed the importance of hand hygiene for self-protection, but they perceived that there is a lack of evidence that handwashing is effective in preventing cross-infection. All participants stated that personal beliefs about the efficacy of hand hygiene and examples and norms provided by senior hospital staff are of major importance for hand hygiene compliance. They further reported that hand hygiene is most often performed after tasks that they perceive to be dirty, and personal protection appeared to be more important for compliance that patient safety. Medical students explicitly mentioned that they copy the behavior of their superiors, which often leads to noncompliance during clinical practice. Physicians mentioned that their noncompliance arises from their belief that the evidence supporting the effectiveness of hand hygiene for prevention of hospital-acquired infections is not strong. CONCLUSION: The results indicate that beliefs about the importance of self-protection are the main reasons for performing hand hygiene. A lack of positive role models and social norms may hinder compliance. __________________________________________________________________________ _____________________________________*____________________________________ 22. Abstract: Impact of finger rings on transmission of bacteria during hand contact __________________________________________________________________________ Infect Control Hosp Epidemiol. 2009 May;30(5):427-32. Impact of finger rings on transmission of bacteria during hand contact. Fagernes M, Lingaas E. Institute of Nursing and Health Sciences, University of Oslo, Oslo, Norway. mette.fagernes@siv.no OBJECTIVE: To investigate the impact of finger rings on the transmission of bacteria from the hands of healthcare workers and the impact on the microflora on the hands of healthcare workers in clinical practice. DESIGN: Our study had a nonequivalent control group posttest-only design (pre-experimental). Healthcare workers who wore finger ring(s) on 1 hand and no ring on the other hand (n = 100) and a control group of healthcare workers who did not wear any rings (n = 100) exchanged standardized hand shakes with an investigator wearing sterile gloves. Samples from the gloved hands of the investigators and the bare hands of the healthcare workers were thereafter obtained by the glove juice technique. SETTING: Two Norwegian acute care hospitals. PARTICIPANTS: Healthcare workers (n = 200) during ordinary clinical work. RESULTS: A significantly higher bacterial load (odds ratio, 2.63 [95% confidence interval, 1.28-5.43]; P = .009) and a significantly higher number of bacteria transmitted (odds ratio, 2.43 [95% confidence interval, 1.44-4.13]; P = .001) were associated with ringed hands, compared with control hands. However, a multiple analysis of covariance revealed no statistically significant effect of rings alone. The prevalence of nonfermentative gram-negative bacteria (42% vs 26%) and Enterobacteriaceae (26% vs 13%) was also significantly higher among persons who wore rings than among persons who did not wear rings. However, no statistically significant differences in the incidence of transmission of these pathogens were detected after hand contact. The prevalence of Staphylococcus aureus and incidence of transmission of S. aureus were the same in both groups. CONCLUSIONS: Wearing finger rings increases the carriage rate of nonfermentative gram- negative bacteria and Enterobacteriaceae on the hands of healthcare workers. However, no statistically significant differences in the incidence of transmission of nonfermentative gram- negative bacteria or Enterobacteriaceae were detected between the healthcare workers who wore rings and those who did not. __________________________________________________________________________ _____________________________________*____________________________________ 23. Abstract: Surgical hand antisepsis with alcohol-based hand rub: comparison of effectiveness after 1.5 and 3 minutes of application __________________________________________________________________________ Infect Control Hosp Epidemiol. 2009 May;30(5):420-6. Surgical hand antisepsis with alcohol-based hand rub: comparison of effectiveness after 1.5 and 3 minutes of application. Weber WP, Reck S, Neff U, Saccilotto R, Dangel M, Rotter ML, Frei R, Oertli D, Marti WR, Widmer AF. Department of Surgery, University Hospital Basel, Basel, Switzerland. OBJECTIVE: Research has shown 1.5 minutes of surgical hand antisepsis with alcohol-based hand rub to be at least as effective under experimental conditions as the 3-minute reference disinfection recommended by European Norm 12791. The aim of the present study was to validate the effectiveness of 1.5 minutes of surgical hand antisepsis in a clinical setting by comparing the effectiveness of 1.5- and 3-minute applications of alcohol- based hand rub (45% vol/vol 2-propanol, 30% vol/vol 1-propanol, and 0.2% mecetronium ethylsulphate). DESIGN: Prospective crossover trial in which each surgeon served as his or her own control, with individual randomization to the 1.5- or the 3-minute group during the first part of the trial. SETTING: Basel University Hospital, Switzerland. PARTICIPANTS: Thirty-two surgeons with different levels of postdoctoral training. METHODS: We measured the bactericidal effectiveness of 1.5 minutes and 3 minutes of surgical hand antisepsis with alcohol-based hand rub by assessing the mean (+/-SD) log10 number of colony-forming units before the application of hand rub (baseline), after the application of hand rub (immediate effect), and after surgery (sustained effect) so as to follow European Norm 12791 as closely as possible. RESULTS: The immediate mean (+/-SD) log10 reduction in colony-forming units (cfu) was 2.26 +/- 1.13 log10 cfu for the 1.5-minute group and 3.01 +/- 1.06 log10 cfu for the 3- minute group (P = .204). Similarly, there was no statistically significant difference between the 2 groups with respect to the sustained effect; the mean (+/-SD) log10 increase in bacterial density during surgery was 1.08 +/- 1.13 log10 cfu for the 1.5- minute group and 0.95 +/- 1.27 log10 cfu for the 3-minute group (P = .708). No adverse effects were recorded. CONCLUSION: In this clinical trial, surgical hand antisepsis with alcohol- based hand rub resulted in a similar bacterial reduction, regardless of whether it was applied for 3 or 1.5 minutes, which confirms experimental data generated with healthy volunteers. __________________________________________________________________________ _____________________________________*____________________________________ 24. No Abstract: E.U. laws to enforce needlestick safety __________________________________________________________________________ Nurs Times. 2009 Jun 9-15;105(22) E.U. laws to enforce needlestick safety. Mooney H. __________________________________________________________________________ _____________________________________*____________________________________ 25. No Abstract: Successful control of norovirus outbreak in an infirmary with the use of alcohol-based hand rub __________________________________________________________________________ J Hosp Infect. 2009 Jul 8. Successful control of norovirus outbreak in an infirmary with the use of alcohol-based hand rub. Cheng VC, Tai JW, Ho YY, Chan JF. Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China; Infection Control Unit, Queen Mary Hospital, Hong Kong Special Administrative Region, China. __________________________________________________________________________ _____________________________________*____________________________________ 26. No Abstract: Do neckties and pens act as vectors of hospital-acquired infections? __________________________________________________________________________ BJU Int. 2009 Jun;103(12):1604-5. Do neckties and pens act as vectors of hospital-acquired infections? Pisipati S, Bassett D, Pearce I. Urology, Manchester Royal Infirmary, Manchester, UK. __________________________________________________________________________ _____________________________________*____________________________________ 27. Final Call for Registration and Participation in Health GIS 2009 __________________________________________________________________________ From: "Nitiporn Saardmoung" Subject: Final Call for Registration and Participation in Health GIS 2009, HYDERABAD, India Dear Friends, I am very happy to update that healthGIS 2009 is shaping up very well with a strong promise for informative and fruitful congregation. Highlights: Opening Ceremony to be graced by Honb'l Minister for Health and Family Welfare H.E. Sri Gulam Nabi Azad, and H.E. Dr. Y.S. Rajasekhar Reddy, Chief Minister. Andhra Pradesh, Key Note Speech by renowned experts in HealthGIS Technology Track by Industry 5 Free Workshops Nine Technical Sessions with confirmed 70 Paper presentations Poster Sessions Exhibits from GIS, Satellite Remote Sensing, Software Solutions, Telemedicine, Education and Health Industry Hardcopy Proceedings SMITALAY dance drama 4 Awards for Best Papers in Technical Sessions and Poster Sessions Several Gifts for winners in quizzes during conference At this point, I thank those who have registered before June 25 and ensured their place in the " 9 Technical Sessions" and for Papers in Proceedings. On massive requests, 3 more technical sessions are being created. Therefore, you have a golden last chance to make a presentation. Now, I invite others who could not register in time to register now by sending registration form by e-mail. They can pay the fee Now or "On Desk" during the conference. They can present their work in form of "Poster" (Guidelines Attached) or technical session. They are eligible for the 4 Best Paper Awards (Technical/ Application) and also can get their papers published after fast track peer review in the International Journal of Geoinformatics. Details about the Registration, please see the link http://www.e-geoinfo.net/healthgis2009/registration.html Avail this chance by confirming your registration and joining the experts from many countries assembling in Hyderabad, india. The Golkonda Hotel is the official hotel for accommodation and workshops during the conference which is offering very special rates. They will also provide airport assistance. Pl. visit the website for all the information and Program Schedule. http://www.e-geoinfo.net/healthgis2009/index.html I am eagerly looking forward to meet you all and work to "enable health geospatially". With warm regards, -- Dr. Nitin Kumar Tripathi, Organising Secretary HealthGIS 2009 President, Association for GeoInformation Technology (AgIT) Editor-in-Chief, International Journal of Geoinformatics Director, UNIGIS Centre, AIT Director, Academic Quality Assurance and Accreditation Asian Institute of Technolog P.O. Box:44, Klong Luang, Pathumthani 12120, Thailand Phone: +66-81751 8384 (Mobile), +66-2-963 9148 (Office), Fax: +66-2-501 1677 e-mail: nitingis@gmail.com __________________________________________________________________________ _____________________________________*____________________________________ 28. [hif-net] David Morley Crossposted from HIF-net with thanks. __________________________________________________________________________ To: "HIF-net" From: "Neil Pakenham-Walsh" Subject: [hif-net] David Morley Dear Colleagues We were very sad to hear that David Morley has died. He had a heart attack on July 2nd while on holiday, aged 86 . David Morley was Founder and President of Teaching-aids At Low Cost, a remarkable UK-based charity that has provided reference and learning materials for health workers and communities in developing countries since 1963. David was also Professor Emeritus at the Institute of Child Health, London. He has practised in Nigeria, East Africa, and India, and has also travelled in the Middle East, China and South America. Since retirement he has dedicated himself to a number of causes, most notably the challenge of meeting the information and learning needs of primary and district-level health workers. In recent years, David championed the production and distribution of e-TALC CD-ROMs containing high-quality content for health workers, and has distributed tens of thousands of these worldwide, especially to hospitals and health facilities in Africa with poor internet connectivity. David has been a longstanding supporter and regular contributor to HIF- net, HIFA2015 and CHILD2015. Many of us have worked closely with him on health information issues in the past 20 years. Many more of us will remember him from his days in Africa and worldwide as a great clinician, teacher and innovator. David was an inventive man, whose intellect never diminished; he was always generous with his time and allowed others to flourish under his watchful eye. He will be greatly missed. We send our sympathy to his widow Aileen, his children and grandchildren, who gave him great pleasure during his long life. David Chandler and Neil Pakenham-Walsh ________________________ HIF-net: working together to improve access to reliable information for health researchers and health professionals in developing and transitional countries. Send list messages to . To join or leave the list, send an email to . If joining, please include name, organization, country, and brief description of professional interests. Archive at: http://www.dgroups.org/groups/HIF-net/ Visit [web site]( http://dgroups.org/groups/hif-net ) __________________________________________________________________________ _____________________________________*____________________________________ 29. News - Africa: Poor syringe hygiene can be fatal - USA: Open Door clinics drop needle exchange - Saudi Arabia: Tainted transfusion: Girl gets compensation - USA: Las Vegas summit to give health care workers an understanding of infection prevention - UK: Hospital unit could pose serious risk to patients health - USA: Fake Oakland Dentist Busted, Police Say - USA: U.S. House Democrats eye funding for needle exchanges - China: New HIV/AIDS cases surge in Beijing - Canada: Downtown Eastside junkies putting city workers at risk - USA: Bail Denied for Surgery Technician in Hepatitis C Scare - UK: New initiative to reducing the spread of Hepatitis C - USA: Medical examiners went fairly easy on one doctor in hepatitis case - USA: State health department reports 10th suspected hepatitis case tied to dirty needles - Canada: Canada's 1st needle exchange program to end after 29 years - Canada: Insite Drug-Injection Facility Awaits Fate amid Controversy - USA: Arthroscopic Shavers May Retain Tissue After Cleaning: FDA Selected news items reprinted under the fair use doctrine of international copyright law: http://www4.law.cornell.edu/uscode/17/107.html __________________________________________________________________________ Africa: Poor syringe hygiene can be fatal Plus News - South Africa (14.07.09) NAIROBI, 14 July 2009 (PlusNews) - Injections and needles are still not being used properly in African health facilities, putting millions of patients at risk of infectious diseases such as HIV and hepatitis C, health experts warned at the Africa Health Conference in Kenya's capital, Nairobi. "Injections are being misused by quacks and even professionals, who use them as means of making money from patients, especially in poor countries where people perceive the syringe as a symbol of cure. In this kind of injection mania there is a need to put measures in place to ensure safety," said Susan Agunda, the Deputy Chief Nursing Officer in Kenya's Ministry of Health. According to the United Nations Children's Fund (UNICEF), in developing countries alone, 16 billion injections are administered each year, of which 90 percent are for curative purposes; 50 percent of the total number of injections are unsafe. Disturbingly, about half the syringes used in Africa are re-used. Agunda called for health care workers to be adequately trained in the safe handling of needles and other injection equipment. "Just providing injection devices and not training health care workers on their proper use and disposal is not enough," she said. "Most health care workers still resort to recapping of needles, which is very dangerous and leads to numerous accidental injuries, and puts health workers at risk of getting infections, including HIV and AIDS." In this kind of injection mania there is a need to put measures in place to ensure safetyConference delegates called on African governments to put in place national guidelines on injection and needle use. Staff shortages were also cited as a possible cause for unsafe injections in poor countries. The World Health Organization estimates that about 5 percent of new HIV infections could be due to syringe re-use, and that 58 percent of health care workers report needle-stick injuries, in which they are accidentally pricked or scratched by an infected needle. A study on injection safety in Kenya by the University of Nairobi found that 61 percent of nurses in the health facilities surveyed reported needle-stick injuries during a period of three months. Syringes used by diabetic patients to inject insulin were finding their way onto the streets and were being used by injecting drug users, a major driver of new HIV infections. Agunda warned that quacks in rural areas and urban slums were jeopardizing people's lives through poor syringe disposal and re-use. "In a bid to reduce their costs ... [they] could turn to syringe and needle re-use and infect a big number of people in such settings, and it is the reason there must adequate surveillance by governments in Africa to stem it." Report can be found online at: http://www.plusnews.org/report.aspx?ReportId=85278 This report does not necessarily reflect the views of the United Nations .......................................................................... __________________________________________________________________________ USA: Open Door clinics drop needle exchange Thadeus Greenson/The Times-Standard, Contra Costa Times - Walnut Creek,CA,USA (13.07.09) Just as needle exchange programs in Humboldt County are hitting a major snag, the issue is coming up for what promises to be a raging debate on Capitol Hill. This month, Open Door Community Health Centers' clinics in Arcata and Eureka quietly stopped administering the needle exchange program they have operated for almost a decade. It's not that the program wasn't successful -- quite the opposite, really. ”It's hard for anybody to imagine how big the program got,” said Open Door Community Health Centers Chief Operating Officer Cheyenne Spetzler. “The footprint of the program just kept getting bigger.” The Humboldt County Board of Supervisors authorized the needle exchange program in 2000, but has never run or funded it. Instead, with the supervision of Humboldt County Health Officer Dr. Ann Lindsay, the program has been run by a number of providers, including the Open Door, Redwoods Rural and Mobile Medical clinics. Susan Buckley, the director of the Public Health Branch of the Department of Health and Human Services, said the idea behind the needle exchange program is harm reduction, or reducing the negative effects drug use has on individuals and communities. ”From a public health perspective, what needle exchange does is reduce the spread of blood-borne pathogens,” Buckley said, adding that those include Hepatitis and HIV. “It also helps get dirty needles off the streets in a safe manner.” In most cases, the needle exchange program subsists on grant funding, but Spetzler said almost all the grants available for such programs only offer funding for the needles themselves, not for the costs of administering the programs. In Humboldt County, the vast majority of the programs' clients are located in Eureka, which was only served by the Open Door and Mobile Medical clinics. Spetzler said the Open Door clinics in Arcata and Eureka combined to exchange more than 190,000 needles in 2008, with 150,000 of them being exchanged at the Eureka location. Spetzler said administering the program in Arcata and Eureka simply became too much for Open Door Community Health Centers, both financially and practically. First, with declining funding and the promise of another sizable reduction once the state budget is finalized, Spetzler said Open Door is struggling to get by, and is making cutbacks in a variety of areas: The Arcata dental office was closed, they've stopped medical outreach services and staff members have been asked to take pay cuts. It got to the point, Spetzler said, where it was hard to justify having a full-time staff person on hand solely to administer the needle exchange program. Plus, as the program grew, there were additional problems. The centers were going through so many needles it necessitated massive deliveries, to the point that the clinics' storage space was filled with stacked palettes of needles, Spetzler said. Mothers, children and families that were comfortable coming into the clinics started feeling uneasy with what they were seeing. It wasn't an easy decision, Spetzler said, but it was eventually concluded that the needle exchange program had outgrown Open Door. ”It doesn't feel good to have to do this,” Spetzler said. “(But) a lot of good was done. We really impacted the level of Hepatitis C in the community. And we haven't had those reports of needles in playgrounds and stuff like that in a long time.” Humboldt County Department of Health and Human Services Programs Director Barbara LaHaie said that, with Open Door stepping away from the program, the county is currently weighing its options in finding another way to administer the program. Without a reliable funding stream, that may prove difficult. But federal help may be on the way. House Democrats unveiled a $160 billion measure Friday to fund the departments of Labor and Health and Human Services for the next fiscal year, and the measure contains a provision that would scrap the federal funding ban on needle exchange programs that has been in place for years. North Coast Congressman Mike Thompson applauded the move. ”Sterile needle exchange programs are an important way to reduce the transmission of diseases,” Thompson said in a statement issued Saturday. “Studies show that syringe exchange programs don't encourage or increase the use of illegal drugs, and actually increase enrollment in drug treatment programs. I support lifting the ban on federal funding, and applaud my colleagues on the appropriations committee for taking the first step to do so.” But, not everyone feels the same way, and the stage is being set for a battle over the merits and ethics of such programs. Rep. Todd Tiahrt, the top Republican on the House Labor and Health and Human Services Appropriations subcommittee, wasted little time Friday in blasting the proposal. ”I am very concerned that we would use federal tax dollars to support the drug habits of people who desperately need help,” Tiahrt told Reuters news service Friday. Many feel similarly, and argue that any program benefits would be eclipsed by the perception that the government is condoning drug use. *** Statistics, however, suggest that the programs can have large impacts. The U.S. Centers for Disease Control reports that 19 percent of the country's HIV cases can be attributed to injection drug use and the National Institutes of Health report that injection drug use is the primary cause of Hepatitis C. Needle exchange programs, proponents argue, simply ensure that injection drug users are shooting up with clean needles and are therefore less likely to contract a disease themselves or infect someone else with one. Some studies also have shown that injection drug users who utilize needle exchange programs are more likely to seek treatment. Now that the funding measure has been introduced, it will be debated by the whole House Appropriations Committee before heading to the House floor for consideration. It's a safe bet Humboldt County health officials will be watching closely. But whatever happens, Buckley said the county will work to ensure its needle exchange program continues. ”We're going to work in the community to make sure clean needles are available,” she said. .......................................................................... __________________________________________________________________________ Saudi Arabia: Tainted transfusion: Girl gets compensation Arab News - Jeddah,Saudi Arabia (12.07.09) JEDDAH: The medical disputes board at the Ministry of Health has ordered a private hospital in Jeddah to pay SR280,000 in compensation to a three- year-old girl who was mistakenly transfused blood contaminated with AIDS when she was eight months old, Al-Madinah newspaper reported on Saturday. The board also fined the hospital, which has not been named in the report, SR100,000 for serious medical negligence. The board’s investigations revealed that the child’s sensory organs, urinary tract and rectum were impaired because of the contaminated blood. The girl was supplied with the blood after developing complications related to anemia. The hospital’s pediatrician had recommended immediate blood transfusion, after which her condition worsened. Subsequent investigations revealed that the blood was contaminated with AIDS. On the parents’ insistence, the board launched an investigation, which revealed that a Filipino man had donated the blood. It was also learned during the investigations that two elderly people also died shortly after receiving blood from the same donor. The cause of their deaths remained a mystery until the board’s investigations. Investigators also found the Filipino donated blood at two other hospitals in Jeddah. Efforts to locate the donor went in vain, as he had left the Kingdom. According to statistics released by the Ministry of Health, 1,315 Saudis died of AIDS until 2008 out of a total of 13,926 cases diagnosed in the Kingdom. More than 10,500 of the diagnosed cases were foreigners. Under the law, foreigners who test HIV-positive are not allowed to work in the Kingdom. .......................................................................... __________________________________________________________________________ USA: Las Vegas summit to give health care workers an understanding of infection prevention Reno Gazette Journal - Reno,NV,USA (10.07.09) There will be a summit in Las Vegas on July 22 and July 23 to give health care professionals a chance to meet with Nevada State Health Division staff while learning the latest about new legislation that will change how their facilities report and respond to health care-associated infections The summit is at the Renaissance Las Vegas Hotel and is sponsored by the Nevada State Health Division. Titled “Healthcare-Associated Infections: Translating Knowledge into Practice,” the summit is aimed at health facility administrators, directors of nursing, infection preventionists, medical directors and other key facility staff. All of these medical professionals are invited to attend. The cost, which is being supported by the Nevada State Health Division, is $99 per person. Preventing infection and controlling outbreaks are major concerns for health facilities nationally and particularly in Nevada after Southern Nevada Health District officials last year identified the potential exposure of over 40,000 patients to hepatitis C from unsafe injection practices at two ambulatory surgical centers in Las Vegas. Recent actions by the Nevada Legislature will mean some significant changes to how health care facilities report and respond to such infections. Registration, hotel reservations and additional information about the summit, including the full agenda, can be found at the Nevada State Health Division website at: http://health.nv.gov/HCQC.htm/ .......................................................................... __________________________________________________________________________ UK: Hospital unit could pose serious risk to patients health by Julie Watt, Dumfries and Galloway Standard - Dumfries,UK (10.07.09) FEARS have been raised that a pharmacy unit inside Dumfries and Galloway Royal Infirmary poses a threat to patients’ health. NHS officials earmarked £800,000 for the re-development of the aseptic suite at a health board meeting on Monday. The region’s chief pharmacist, Michael Pratt, admitted in the last 12 months there had been three incidents of bacterial contamination, resulting in service reduction. The unit was also forced to close for three weeks as a result of a flood. Mr Pratt said: “Failure to redevelop the aseptic suite will increase the exposure of our services, and consequently our patients, to risk. The risks we are facing are exposing our patients, who are often immune compromised, to bacterial contamination. This may well have severe consequences for patients. “Recent bacterial contamination has resulted in a reduced level of service and even temporary closure of the facility on several occasions recently.” The aseptic suite was built as a sterile unit when the region’s flagship hospital opened in 1975. The majority of the workload which takes place there is the preparation of cytotoxic chemotherapy which treats cancer sufferers. Mr Pratt added: “Its function has been modified over the years but, despite significant efforts of both pharmacy and estates staff, it is becoming increasingly challenging to maintain a functioning suite. “Failure to redevelop the aseptic suite will have a dramatic effect on the board’s ability to provide cytotoxic chemotherapy to our cancer patients. “Action is required to provide an aseptic facility that is ‘fit for purpose’ and will allow a safe and dependable service for our patients.” .......................................................................... __________________________________________________________________________ USA: Fake Oakland Dentist Busted, Police Say Jeffrey Schaub, CBS 5 - San Francisco,CA,USA (10.07.09) Local police and state law enforcement officers, with guns drawn, raided a house near Grand Avenue and Lee Street in Oakland Friday where they said a phony dentist ran a "cash only" operation targeting low income and uninsured patients. Authorities executed a warrant, took the unlicensed dentist into custody and seized equipment from the makeshift home dental clinic — which appeared to be in poor condition and contained rusty dental equipment, bloody gauze and dirty needles. Investigators described it as a disgusting and dangerous scene. "We found instruments that were not properly bagged or sterilized. He was using the same instruments on his patients, from one person to another," said Nancy Butler, supervising investigator for the Dental Board of California. The arrested man was identified as Mario Pacheco, who is from El Slavador, and authorities said he lacked state dental and businesses licenses. Pacheco was booked into the Alameda County Jail late Friday afternoon. Investigators said the fake dentist offered what he called discount "full service" dentistry to vulnerable, low income persons who lacked health insurance coverage and would pay in cash. Officials said the raid was part of a larger crackdown by the state dental board, which made three other similar raids this week. © MMIX, CBS Broadcasting Inc. .......................................................................... __________________________________________________________________________ USA: U.S. House Democrats eye funding for needle exchanges By Jeremy Pelofsky, Reuters - USA (10.07.09) WASHINGTON (Reuters) - Democrats in the U.S. House of Representatives on Friday unveiled legislation to lift a ban on federal funding for needle exchange programs, a shift to try to reduce AIDS virus infections but one that likely will spark a fight. As part of a $160.7 billion measure to fund the Departments of Labor and Health and Human Services for fiscal 2010, which starts October 1, Democrats scrapped the prohibition that has been included in the annual spending bill in previous years. "Scientific studies have documented that needle exchange programs, when implemented as part of a comprehensive prevention strategy, are an effective public health intervention for reducing AIDS/HIV infections and do not promote drug use," said Representative David Obey, chairman of the House Appropriations Committee. President Barack Obama had pledged during the presidential election campaign to lift the ban but when his budget was released earlier this year, activists criticized him for failing to propose cutting the restriction. His predecessor, George W. Bush, opposed needle exchange programs, which health experts almost universally agree can reduce transmission of the AIDS virus and protect not only drug users but people they might infect. Republicans are girding for a fight over the ban and lawmakers could try to restore it as the legislation moves through the House during the next two weeks. "I am very concerned that we would use federal tax dollars to support the drug habits of people who desperately need help," said Representative Todd Tiahrt, the top Republican on the House Labor/HHS appropriations subcommittee. Injection drug use contributed 19 percent of the HIV cases according to the most recent data from the U.S. Centers for Disease Control and Prevention. Some cities have instituted their own needle exchange programs. "Injections of illicit drugs have been estimated to represent approximately one-third of the estimated 2-3 billion injections occurring outside of healthcare settings in the United States each year, second only to insulin injections by persons with diabetes," the CDC has said. The legislation includes $31.3 billion for the National Institutes of Health, $5.1 billion in heating aid for low-income households and almost $8 billion for programs aimed at reducing abortions. (Additional reporting by Maggie Fox; Editing by Bill Trott) © Thomson Reuters 2009 .......................................................................... __________________________________________________________________________ China: New HIV/AIDS cases surge in Beijing China Daily/Asia News Network, AsiaOne - Singapore (10.07.09) Beijing reported 501 new HIV/AIDS cases in the first five months this year, an 21.9 percent increase over the same period last year, local health officials said Thursday. Among the new cases, 44 percent were male homosexuals, said Deng Ying, director of the Beijing Disease Control and Prevention Center. As a group, homosexuals accounted for the highest infection rate, and the rate is continuing to rise, Deng said. Beijing has so far reported 6,383 HIV/AIDS cases, including 1,343 locals, 4,722 from other domestic provinces and 247 foreigners. Among the new cases, 68 percent were by sexual transmission, and nearly 12 percent were caused by intravenous drug use. Nationwide, sexual transmission had overtaken intravenous drug use to become the leading cause for HIV/AIDS infection. According to Deng, China had 276,000 HIV-positive patients at the end of last year, including an estimated 82,000 who had developed AIDS. However, according to estimates from the United Nations Joint Programm on HIV/AIDS, China now has 700,000 people living with HIV/AIDS. New cases of HIV/AIDS by sexual transmission have outnumbered those by intravenous drug use since 2006, indicating the deadly disease no longer just affects high-risk groups, Deng added. Data suggested that HIV infection among homosexuals has been growing since the city began monitoring the gay community in 2004. The infection rate among the gay community is higher than among those involved in unprotected heterosexual sex, said the official. "We need more intervention among the gay community, especially to encourage them to use condoms," said Shao Yiming, chief expert for the National Center for AIDS/STD Control and Prevention. The first case of HIV/AIDS was reported in Beijing in 1985. The country provides free HIV/AIDS testing services. Beijing tested 5,503 people during the first five months this year, with 141 being confirmed as HIV positive. Currently, all hotels three-star and above provide condoms. Nearly 2,000 automatic vending machines for condoms have been installed at dance halls, clubs and bars in the city. The city also established 22,000 sites for distributing free condoms. Condom use, methadone treatment and needle exchange remain three major tools to battle the illness, he added. "We have greatly intensified monitoring and testing efforts on high-risk groups in recent years," Shao told China Daily. "More HIV/AIDS cases will be confirmed with improved monitoring and testing efficiency. .......................................................................... __________________________________________________________________________ Canada: Downtown Eastside junkies putting city workers at risk By Elaine O'connor, The Province - Vancouver,BC,Canada (09.07.09) Dirty needles hidden in city of vancouver engineering wire splice boxes downtown. They are posing a risk to electrical employees. Photograph by: Handout , City Vancouver When Jody Weatherby planned a career as an electrician, he never imagined his work would have so much in common with a hazmat crew. But the veteran staffer of the City of Vancouver’s engineering services says that city electrical crews are handling dangerous materials — hundreds of dirty needles jammed into wire splice boxes in the downtown core. “I guess addicts have no place to put them and this is an easy place to drop them. The danger [to us] is obviously contamination and diseases that might be in there,” he says. Several weeks ago, Weatherby was on a crew rewiring traffic signals along Carrall Street, where the city is finishing a revitalization project. He was shocked to find one splice box — a wire junction box under the sidewalk — stuffed with 100 needles. These days, before crews can do the electrical work they are trained for, they have to don latex gloves and use tongs to pry out contaminated needles, known as “sharps.” If the needles fall into the conduit and get stuck, he says, they must then blow compressed air in the pipe, turning used syringes into “lethal darts.” Weatherby says boxes along Granville and in the Downtown Eastside are particularly bad. Weatherby thinks the use of electrical boxes for needle disposal indicates that the city core — and not just the Downtown Eastside — needs more, and more visible, sharps boxes. Some 1.9 million free needles were distributed in Vancouver last year. Al Luongo, the city’s manager for traffic and electrical operations, says dealing with needles is a routine part of working on city infrastructure downtown and all staff are trained on safe handling of sharps. “I would say it’s a moderate-to-low hazard,” Luongo said, noting that in his 22 years on the job, only one worker reported being pricked by a needle. © Copyright (c) The Province .......................................................................... __________________________________________________________________________ USA: Bail Denied for Surgery Technician in Hepatitis C Scare P. Solomon Banda, Associated Press (09.07.09) In Denver on Thursday, a judge denied bail for a surgical technician accused of a drug-theft scheme that potentially exposed nearly 6,000 patients to her hepatitis C infection. The technician is alleged to have stolen syringes filled with the powerful narcotic Fentanyl, then replaced them with dirty syringes filled with saline solution. She worked from Oct. 21 to April 13 at Denver's Rose Medical Center; she was fired when she failed a drug test after being discovered in an operating room where she was not assigned. From May 4 until June 29, she worked at Audubon Ambulatory Surgery Center in Colorado Springs. The woman tested positive for hepatitis C before beginning work at Rose, but she claimed in a videotaped deposition that hospital officials never made it clear she had the virus. She failed to follow up with her doctor as instructed, she said, because she was asymptomatic, did not have health insurance or money to see a doctor, and was distracted by her new job. US Magistrate Judge Craig B. Shaffer rejected this contention. "Short of shooting a flare into the sky, I don't know what more they could do," he said of the notice provided by Rose officials. Shaffer said the woman's failure to follow up as instructed, then proceeding to swap her used syringes knowing they would be used to administer patient injections, made her a risk to the community. Ten Rose patients have tested positive for hepatitis C infection. "Every time she did that she committed an assault," said Assistant US Attorney Jaime Pena. The technician is facing federal charges of tampering with a consumer product, creating a counterfeit controlled substance, and obtaining a controlled substance by deception or subterfuge. Additional charges may be forthcoming. .......................................................................... __________________________________________________________________________ UK: New initiative to reducing the spread of Hepatitis C stv.tv - UK (09.07.09) New "one hit kits" are being offered to drug addicts across Greater Glasgow and Clyde to help reduce the spread of Hepatitis C. The National Hepatitis C Action Plan recognises that the disease is not only spread through the sharing needles but also from the sharing of other paraphernalia such as filters and spoons. NHS Greater Glasgow and Clyde has introduced the new kits which includes a needle, spoon, filter and citric acid, along with a hard plastic safe disposal bin to ensure Hepatitis C is not spread by the sharing of equipment. Carole Hunter, lead pharmacist in the Addictions Partnership, said in a statement: "There are more than 50,000 people with Hepatitis C across Scotland and 95% of them have become infected through injecting drug use. "We know that the needle exchange programme has been hugely effective in reducing HIV cross-infection and the one hit kits are designed to deliver similar reductions in the spread of Hepatitis C." She added: "We introduced the kits to our needle exchanges in February this year to ensure intravenous drug users had a complete kit of sterile equipment and to stop people sharing spoons and filters and so prevent the spread of Hepatitis C through the sharing of equipment. "Health Boards and trusts throughout the UK are showing great levels of interest in this one hit kit initiative with a view to introducing it to their needle exchanges. "Some health systems already do provide spoons and filters as well as needles but NHS Greater Glasgow and Clyde and one other board in Scotland are the only two areas using the this single package of kit complete with a safe disposal bin." .......................................................................... __________________________________________________________________________ USA: Medical examiners went fairly easy on one doctor in hepatitis case By Jon Ralston, Las Vegas Sun - Las Vegas,NV,USA (08.07.09) On its face, the premise is laughable: A doctor who practiced at and co-owned a surgical center where unsafe medical practices are alleged to have infected patients with hepatitis C had no knowledge of such practices. Doubly laughable, in fact, because even though he was ignorant of syringe reuse and had no control over the clinic’s employees, as his attorney claimed, the physician supposedly has intimate knowledge that can be useful to regulators and prosecutors looking into the egregious behavior at the Endoscopy Center of Southern Nevada. But such is the case that the state Board of Medical Examiners has made, amid a torrent of outrage and derision, to justify what amounts to a plea deal with Dr. Eladio Carrera, who is expected to testify in disciplinary, and perhaps criminal and civil, actions against Dr. Dipak Desai, the most vilified figure in the case, and perhaps others. (Full disclosure: I had to be tested because I was one who had a colonoscopy performed by Desai.) The see-no-evil, hear-no-evil, speak-no-evil doctor who has agreed to tell all that he saw and heard is seen by some as yet another example of a physician coddled by a state board that needs to heal itself of that potent and hoary Nevada injection known as juice. Carrera’s punishment of a public reprimand (don’t you ever do that again!), a $15,000 fine (have to downgrade to a lesser Mercedes) and his returned license (please don’t send me to North Las Vegas) may seem more a love tap than a wrist slap to many. So why would the board make such a pact with someone many in the public, and certainly the infected patients, see as the devil? I tried to garner insight from Louis Ling, the medical board’s executive director, on why he would have negotiated this deal with Carrera and how he resolves the contradiction that the doctor has clean hands but knew about the dirty business of double-dipping in drug vials. “He (Carrera) was one of the doctors performing procedures there,” Ling said Tuesday in an exclusive interview on “Face to Face.” “He was a co- owner of the facility. But, there were certain things, and I can’t get too deep into this, but I guess I can say it this way: There were certain things regarding the management and the management structure of this facility in which Dr. Carrera knew about, but was not actively involved in. He wasn’t invited to participate in some of these things ... He gives us an inside view of this which we can now use to show how the place was really working on a day-to-day basis.” And this elaboration: “We have a nurse who was in the procedure room who knew what was going on when she was standing in the procedure room. We’ve got some technicians who knew how the equipment was being used and how it was cleaned. All we’ve got is little bits and pieces ... (Carrera) can tie it all together and say, ‘This is how we were running. This is how many procedures we were doing. This is why we were doing these things.’?” It’s a fairly compelling case for making the deal with Carrera, assuming his testimony is equally riveting and damning — and assuming this isn’t a case of letting off the worst guy to get to less culpable actors, which seems unlikely. Ling says that if people are expecting a Perry Mason moment with Carrera, though, they will be disappointed. “It isn’t going to happen,” Ling said. “There’s probably not going to be the smoking gun to the extent that everybody’s looking for. What everybody wants, I think, is a document written by Dr. Desai that says we’re changing from the small vials to the big vials (where the double-dipping occurred).” But, Ling reiterated, “we can’t try the case without him.” That’s the disciplinary case produced by a notoriously weak board. But what about the civil and criminal cases? “(Carrera attorney Tom) Pitaro is not going to let this guy testify at a board disciplinary hearing if he’s going to expose himself to criminal liability,” speculated Will Kemp, an attorney pursuing civil damages in the hepatitis C scare. “So that leads me to believe there is some deal on the table here that maybe Louis knows or doesn’t know about with the DA’s office where this guy’s agreed to testify to the grand jury.” Ling insisted he knows of no such deal. But he should hope there is one and that Carrera’s testimony convicts anyone eventually charged in this frightening case. Only then will people stop scoffing at the deal and perhaps acknowledge sometimes a devil in the hand is worth two in the stocks. .......................................................................... __________________________________________________________________________ USA: State health department reports 10th suspected hepatitis case tied to dirty needles The Associated Press (08.07.09) DENVER (AP) — A 10th hepatitis C case was diagnosed at a Colorado hospital where a surgery technician has been accused of swapping used syringes for clean ones filled with pain medication, health officials said Wednesday. Ned Calonge, chief medical director for the state health department, said the 10 hepatitis C cases involve people who had surgery at Rose Medical Center in Denver, which had employed 26-year-old Kristen Diane Parker. Parker is accused of is accused of injecting herself with painkillers meant for patients, then filling the used syringes with saline solution. Up to 6,000 patients may have been exposed to the blood-borne liver disease at Rose and at Colorado Springs' Audubon Ambulatory Surgery Center between October and June 29. The surgery patients are being test for hepatitis C. Rose Medical Center officials have said Parker took a blood test before starting her job in October, and tested positive for hepatitis C. They said people with the disease aren't barred from working in hospitals if precautions are taken. But Parker's attorney, Gregory Graf, said during a court hearing Monday that his client did not find out she had the disease until police contacted her, which was sometime in April Parker was scheduled to appear in federal court Thursday for a preliminary hearing on charges of tampering with a consumer product, creating a counterfeit controlled substance, and obtaining a controlled substance by deception or subterfuge. If convicted of all charges, Parker faces a maximum of 34 years in prison. .......................................................................... __________________________________________________________________________ Canada: Canada's 1st needle exchange program to end after 29 years CBC News, CBC.ca - Toronto,Ontario,Canada (07.07.09) A Vancouver program aimed at reducing the spread of diseases such as HIV and hepatitis among injection-drug users is shutting down. The needle exchange program provides clean hypodermic needles and syringes to drug addicts. But the group that has run the program, Canada's first, has lost its funding. The message on the Downtown Eastside Youth Activities Society's needle exchange van hotline blames the local health authority. "On July 5 of this year, DEYAS ceased to operate. After 29 years of serving the people of the Vancouver area, our funder, Vancouver Coastal Health Authority, has made the decision to terminate the funding to this program effective immediately," it said. But Anna Marie D'Angelo, spokeswoman for Vancouver Coastal Health, told CBC News that DEYAS's contract — worth $600,000 a year — simply expired, and they did not bid for a new contract. "DEYAS informed us that they could not meet our contract obligations that they have with us, and that they were going to cease providing the service through the contract at the end of June," said D'Angelo. Other agencies on the Downtown Eastside will continue to provide the needle exchange service, she said. Anne Livingston, former director at one of those agencies, the Vancouver Area Network of Drug Users, said street users have stopped using the DEYAS van anyway. "There's great admiration for the work that they did. It was just really unfortunate they didn't keep up with a more modern kind of model with secondary exchange…rather than becoming a sort of rigorous 'We're the professionals. We do the needle exchange. It has to be done our way,'" said Livingston. CBC News was unable to reach DEYAS early Tuesday morning. .......................................................................... __________________________________________________________________________ Canada: Insite Drug-Injection Facility Awaits Fate amid Controversy Elaine O'Connor, The Province - Vancouver,BC,Canada (07.07.09) Vancouver's supervised drug-injection facility Insite opened in 2003, and since then 30 peer-reviewed studies have found it helps reduce disease and overdose deaths. But its political future is far from secure. "There's really no academic debate about Insite anymore," said Dr. Thomas Kerr, a researcher with the British Columbia Center for Excellence in HIV/AIDS. By preventing new hepatitis C and HIV infections, Insite could save the Canadian health system $14 million (US $12 million) over 10 years, according to a 2008 Canadian Medical Association Journal study. Up to 1,517 HIV infections could be averted, according to the findings, which included a "decrease in needle sharing and reuse of syringes." A 2007 B.C. Center study observed a 30 percent increase in detox clients, and it noted that drug users accessing Insite were more likely to seek long-term treatment after it opened. A 2008 center study tracked 1,004 overdoses resulting in 453 medical treatments at Insite from March 2004 to July 2008; it concluded the program prevented 12 overdose deaths per year. However, some studies bolstering Insite's efficacy have been shown by three review papers to be poorly designed, according to Dr. Don Hedges, a New Westminster addiction expert. The $3 million (US $2.6 million) spent on Insite, Hedgers said, "would pay for hundreds of people to attend detox and residential treatment, and would obviously prevent many more than one overdose death" - the maximum benefit suggested by the critical reviews. Despite support from the province, city, and public health officials, the federal government is appealing a lower court's ruling that Insite provides drug users a constitutionally protected service. If the government's appeal is lost, Insite operator Portland Hotel Society plans to set up another supervised facility. If the appeal is successful, PHS plans to take the case to the Supreme Court of Canada and keep Insite open while the case is pending. Closing Insite "is immoral because we know in doing that, people will die. People don't need to die because they have an addiction to drugs," said Mark Townsend, PHS executive director. .......................................................................... __________________________________________________________________________ USA: Arthroscopic Shavers May Retain Tissue After Cleaning: FDA AboutLawsuits.com - USA (07.07.09) The FDA warns that some arthroscopic shavers, used during orthopedic procedures to cut and abrade tissue and bone, may still have small pieces of flesh and bone in them from prior patients, even after medical facilities clean the devices. This could expose patients to a risk of infections and blood borne diseases. According to a statement released Monday, the FDA is conducting a safety review of cleaning problems with arthroscopic shavers after it became aware of instances where pieces of tissue remained in shavers even after medical professionals indicated they cleaned the devices according to manufacturer recommendations. The pieces of tissue are often minute and could be missed by the human eye. Arthroscopic shavers use powered blades to scrape away tissue and for the debridement and cleaning of bone in a variety of procedures. They are used for fine, delicate work, often inside and around bone and joints. The manufacturers of several different arthroscopic shavers recently sent a warning letter to healthcare providers stressing the importance of following their recommended cleaning procedures. However, the FDA indicates that they remain concerned because retained tissue can compromise the entire sterilization process. The FDA review will include working with the manufacturers to determine what the health impact and specific risks associated with improperly cleaned arthroscopic shavers could be. In the interim, the FDA advices that medical staff charged with cleaning the shavers pay very close attention to manufacturer-recommended cleaning procedures. But even after those procedures are followed, the FDA recommends that the insides of all arthroscopic shavers be closely inspected for remaining tissue. The agency notes that one facility used a 3mm video scope to inspect the channels of the shaver’s hand piece. The FDA did not identify any specific brands of devices that may be prone to the cleaning problems. In addition, the agency has not recommended doctors stop using the instruments. Further recommendations and possible regulatory actions are being reserved until the FDA has better assessed the situation. __________________________________________________________________________ _____________________________________*____________________________________ __________________________________________________________________________ * 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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