*SAFE INJECTION GLOBAL NETWORK* SIGNPOST *SAFE INJECTION GLOBAL NETWORK* Post00508 Courses + Alert + Abstracts + News 12 August 2009 CONTENTS 1. New Global Health eLearning Courses 2. HIV, nosocomial - Mexico: Mexico City, alert 3. Abstract: Injection safety at primary health care level in south- western Saudi Arabia 4. Abstract: Final report of the safety assessment of hyaluronic acid, potassium hyaluronate, and sodium hyaluronate 5. Abstract: Comparison of adverse events between oral and intravenous formulations of antimicrobial agents: a systematic review of the evidence from randomized trials 6. Abstract: The trends and risk factors for hepatitis B occurrence in Estonia 7. Abstract: Botulinum toxin type A injection without isopropyl alcohol antisepsis 8. Abstract: Treatment of autologous fat injection for hemifacial atrophy 9. Abstract: Frequent HCV reinfection and superinfection in a cohort of injecting drug users in Amsterdam 10. Abstract: Hand hygiene: revolution and globalization 11. Abstract: Facemasks and Hand Hygiene to Prevent Influenza Transmission in Households: A Randomized Trial 12. Abstract: Applicability of press needles to a double-blind trial: a randomized, double-blind, placebo-controlled trial 13. Abstract: Biofilms, infection, and parenteral nutrition therapy 14. Abstract: Cost-Benefit Analysis of Preventing Nosocomial Bloodstream Infections among Hemodialysis Patients in Canada in 2004 15. Abstract: A vault nanoparticle vaccine induces protective mucosal immunity 16, York University Certificate in Harm Reduction 17. Kuwait Lab Technology Conference & ExhibitionKuwait Lab Technology Conference & Exhibition 18. News - Nigeria: Effective Management of Medical Waste - Iran: Court rules against Health Ministry - USA: Hep B Lawsuit Filed Against New Jersey Oncologist - Africa: BD and PEPFAR Collaboration Will Improve Blood-Drawing Practices in Hospitals and Clinics in Sub-Saharan Africa - Asia: Opinion - Hope to reality: Transforming the AIDS response - UK: Clinic helps beat steroid abuse - South Asia: Injecting drug users take central role in anti-stigma film - UK: Hartlepool mum's terror as she finds children playing with needles - USA: Three More Hepatitis C Cases Discovered - Indonesia, South Asia new flashpoints in AIDS fight: experts - Mexico: Piden investigar presuntos contagios de VIH en hospital mexicano - USA: Patient Suing Doctor In NJ Hepatitis Outbreak: Nearly 3,000 Urged To Get Tested For Hep B, C & HIV - USA: Certain Blood Transfusions Increase Risk of Infection - Brazil - UK: Brazil returns hazardous UK waste - One use only: the broken syringe that saves lives - USA: OSHA Investigates Biohazard Waste Practices at Audubon Surgery Center - USA: New York Hep C Lawsuit - Machine designed to reduce infections and cut back on expensive "disposables" - USA: State Trains Inmates in Preventing Hepatitis C This edition of SIGNpost is located at: http://uqconnect.net/signfiles/Archives/SIGN-POST00508.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/ __________________________________________________________________________ _____________________________________*____________________________________ 1. New Global Health eLearning Courses __________________________________________________________________________ New Global Health eLearning courses USAID's Global Health eLearning Center is pleased to announce the release of two new courses: Newborn Sepsis and Human Resources for Health Basics. Do you know the nature of organisms causing neonatal sepsis? Do you know how inadequate attention to human resources in health broadly affects international development efforts? Take these courses to find the answers to these questions and to learn much more. One-time registration at http://www.globalhealthlearning.org will give you free access to these courses, as well as to 29 other courses on a variety of global health topics. __________________________________________________________________________ Global Health eLearning Center Current technical information for global health professionals The Global Health eLearning Center developed by the USAID Bureau of Global Health is a response to repeated requests from field staff for access to technical public health information. We have heard from USAID Population, Health, and Nutrition officers (PHNs) and from Foreign Service Nationals (FSNs) that they want to be current on global health topics, yet find it a challenge to obtain the information because of logistical and time constraints. The Global Health eLearning Center provides Internet-based courses that: Provide useful and timely continuing education for health professionals Offer state-of-the-art technical content on key public health topics Serve as a practical resource for increasing public health knowledge A resource for USAID staff and partners around the world The Global Health eLearning Center offers a menu of courses that learners can use to expand their knowledge in key public health areas, and to access important up-to-date technical information that USAID public health professionals should know. The primary audiences for the Learning Center are PHN officers and FSNs at USAID missions around the world. However, staff at USAID/Washington, its Cooperating Agencies (CAs), and other partners may also benefit from the Learning Center. A flexible learning program for busy professionals Each course is authored by a subject matter expert or a team of experts, is highly focused, and can be completed in about one to two hours. Although courses are designed to be taken online, a printer-friendly format allows you to download course materials for further study. A blend of technical and programmatic content The courses combine technical content with program principles, best practices, and case studies. They are intended to provide concrete examples and to stimulate your thinking about ways you can use the principles you have learned in the course to solve problems in the field. __________________________________________________________________________ _____________________________________*____________________________________ 2. HIV, nosocomial - Mexico: Mexico City, alert Crossposted from ProMED-mail with thanks __________________________________________________________________________ Date: Tue, 11 Aug 2009 From: ProMED-mail Subject: PRO/EDR> HIV, nosocomial - Mexico: Mexico City, alert HUMAN IMMUNODEFICIENCY VIRUS, NOSOCOMIAL - MEXICO: MEXICO CITY, ALERT A ProMED-mail post ProMED-mail is a program of the International Society for Infectious Diseases Date: Sun 9 Aug 2009 Source: Yahoo Noticias, Espanol, Associated Press [trans. Mod.MPP, edited] < http://espanol.news.yahoo.com/s/ap/090809/salud/amn_med_mexico_sida_transf usion The Mexican National Human Rights Commission [NHRC] requested a public hospital to investigate the cases of 2 children who were infected with HIV [human immunodeficiency virus], the virus that causes AIDS [acquired immunodeficiency syndrome], on whom they performed blood transfusions in 2008. The governmental committee asked the La Raza Hospital in Mexico City to investigate whether there are other patients who were infected, but their recommendations are not mandatory. According to the NHRC, the hospital failed to comply with norms on testing, classification, and handling of blood. On Sunday [9 Aug 2009], the commission reported that the affected patients were a 10 year old child and an adolescent of 13 years. In addition, there was another report of an infection identified in a relative of a person cared for in the same hospital. - -- communicated by: ProMED-mail [HIV transmission by blood transfusion is rare and almost always a consequence of laxity in the testing and handling of blood and blood products. The precise route of transmission in this incident has yet to be established. Further information is awaited. - Mod.CP] __________________________________________________________________________ _____________________________________*____________________________________ 3. Abstract: Injection safety at primary health care level in south- western Saudi Arabia __________________________________________________________________________ East Mediterr Health J. 2009 Mar-Apr;15(2):443-50. Injection safety at primary health care level in south-western Saudi Arabia. Mahfouz AA, Abdelmoneim I, Khan MY, Daffalla AA, Diab MM, Shaban H, Al Amri HS. Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia. mahfouz@kku.edu.sa In a study of injection safety in Abha health district, Saudi Arabia, data were collected from 47 physicians and 85 nurses at 24 primary health care centres, using an observation checklist and an interview questionnaire. All centres used individually packed disposable syringes and puncture- proof containers to collect used needles. Needlestick injury in the previous year was reported by 14.9% of physicians and 16.5% of nurses (0.21 and 0.38 injuries/person/year respectively). Logistic regression analysis identified recapping the needle after use (physicians and nurses) and bending the needle before disposal (physicians) as significant risk factors for injury. __________________________________________________________________________ _____________________________________*____________________________________ 4. Abstract: Final report of the safety assessment of hyaluronic acid, potassium hyaluronate, and sodium hyaluronate __________________________________________________________________________ Int J Toxicol. 2009 Jul-Aug;28(4 Suppl):5-67. Final report of the safety assessment of hyaluronic acid, potassium hyaluronate, and sodium hyaluronate. Becker LC, Bergfeld WF, Belsito DV, Klaassen CD, Marks JG Jr, Shank RC, Slaga TJ, Snyder PW; Cosmetic Ingredient Review Expert Panel, Andersen FA. MS, Cosmetic Ingredient Review, 1101 17th Street, NW, Suite 412, Washington, DC 20036, USA. info@cir-safety.org Hyaluronic acid, sodium hyaluronate, and potassium hyaluronate function in cosmetics as skin conditioning agents at concentrations up to 2%. Hyaluronic acid, primarily obtained from bacterial fermentation and rooster combs, does penetrate to the dermis. Hyaluronic acid was not toxic in a wide range of acute animal toxicity studies, over several species and with different exposure routes. Hyaluronic acid was not immunogenic, nor was it a sensitizer in animal studies. Hyaluronic acid was not a reproductive or developmental toxicant. Hyaluronic acid was not genotoxic. Hyaluronic acid likely does not play a causal role in cancer metastasis; rather, increased expression of hyaluronic acid genes may be a consequence of metastatic growth. Widespread clinical use of hyaluronic acid, primarily by injection, has been free of significant adverse reactions. Hyaluronic acid and its sodium and potassium salts are considered safe for use in cosmetics as described in the safety assessment. __________________________________________________________________________ _____________________________________*____________________________________ 5. Abstract: Comparison of adverse events between oral and intravenous formulations of antimicrobial agents: a systematic review of the evidence from randomized trials __________________________________________________________________________ Pharmacoepidemiol Drug Saf. 2009 Aug 3. Comparison of adverse events between oral and intravenous formulations of antimicrobial agents: a systematic review of the evidence from randomized trials. Kouranos VD, Karageorgopoulos DE, Peppas G, Falagas ME. Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece. BACKGROUND: Some clinicians may favor a strategy of early switch to oral antimicrobial therapy for patients responding to initial intravenous therapy. An important relevant consideration refers to the comparative safety and tolerability between oral and intravenous antimicrobial therapy. LITERATURE SEARCH/STUDY SELECTION: We sought to evaluate the above- mentioned issue by performing a systematic review of randomized studies comparing the occurrence of adverse events between oral and intravenous antimicrobial therapy with the same agents. FINDINGS: Ten relevant studies (five randomized controlled trials, three randomized cross-over studies, and two randomized, placebo-controlled, parallel- design studies) were included. Seven of the studies evaluated antibacterials (fluoroquinolones in four, and telithromycin, amoxicillin- clavulanic acid, and linezolid in one study each, respectively), whereas two studies evaluated ganciclovir, and one evaluated isavuconazole. No difference was observed in the rate of total adverse events between oral and intravenous administration of the same antimicrobial agents in any of the included studies that reported specific relevant data. Injection site reactions were noted more frequently with intravenous treatment in one study. No serious drug-related adverse events were reported, while study withdrawals due to adverse events did not considerably differ between the compared groups in any of the included studies. CONCLUSION: There are only limited comparative data regarding the adverse events associated with the administration of the same antimicrobial agents by the oral and intravenous route. Our review indicates that the adverse event profile of oral and intravenous antimicrobial therapy does not differ considerably; however, this issue requires validation by further studies. Copyright (c) 2009 John Wiley & Sons, Ltd. __________________________________________________________________________ _____________________________________*____________________________________ 6. Abstract: The trends and risk factors for hepatitis B occurrence in Estonia __________________________________________________________________________ Cent Eur J Public Health. 2009 Jun;17(2):108-11. The trends and risk factors for hepatitis B occurrence in Estonia. Paat G, Uusküla A, Tefanova V, Tallo T, Priimägi L, Ahi K. PRAXIS Center for Policy Studies, Tallinn, Estonia. gerli.paat@praxis.ee Hepatitis B virus (HBV) infection is prevalent worldwide and is a significant cause of morbidity and mortality. This article describes the trend in HBV occurrence in Estonia from 1990 to 2005 in Estonia, with the aim of highlighting key determinants in transmission dynamics, risk groups, and possible implications for prevention and control. A marked increase in reported numbers of new HBV cases occurred in mid 1990s (reaching 39 per 100,000 population) and decline thereafter. We present data on HBV prevalence from different population groups (persons with verified sexually transmitted infection, prisoners, medical personnel, blood donors and injection drug users). Special vaccination programmes introduced in Estonia have been successful in the prevention of HBV, however, we suggest that the main risk groups such as injection drug users (IDUs), men having sex with men (MSM) and HIV infected persons should be actively encompassed into HBV vaccination programme. __________________________________________________________________________ _____________________________________*____________________________________ 7. Abstract: Botulinum toxin type A injection without isopropyl alcohol antisepsis __________________________________________________________________________ BMC Res Notes. 2009 Aug 3;2(1):156. Factors associated with HIV infection among delivered women in Sergipe, Brazil. Lemos LM, Gurgel RQ, Rivas JJ, de Souza L. BACKGROUND: In Brazil, the number of HIV cases has increased mostly amongst poor less educated women in the northeast region. This combination increased the risk for vertical transmission. This study aims to identify risk factors associated with HIV infection at delivery in Sergipe-NE Brazil. FINDINGS: This was a case-control study, with 39 cases and 117 controls that gave birth at the official health system hospitals. All patients were tested for HIV at hospital admission, using a rapid test and were interviewed about socioeconomic conditions and health attitudes and practices. Univariate and multivariate logistic analysis were performed to evaluate the factors associated with HIV infection. In the univariate analysis, association with HIV positivity was found for the variables "antenatal HIV test" (OR: 4.44; CI: 1.93 - 10.29) and "intravenous drug use" (OR= 12.08; 95% CI 1.28 - infinity). Three patients were intravenous drug users, all HIV+. After logistic multivariate regression, not being tested for HIV during antenatal care (OR= 4.98; 95% CI: 2.13- 12.22; p< 0.001) and lack of knowledge on how to prevent HIV infection (OR= 2.56; 95%CI: 1.09 - 6.27; p= 0.030) were independently associated with HIV positivity. CONCLUSIONS: Drug use, limited knowledge about how to prevent AIDS, and lack of HIV testing during pregnancy were risk factors for infection with HIV. Although it was not conceived to evaluate effectiveness of procedures to prevent vertical transmission, the risk factors here detected may corroborate official recommendation for rapid HIV testing at delivery as an effective procedure to prevent vertical transmission. __________________________________________________________________________ _____________________________________*____________________________________ 8. Abstract: Treatment of autologous fat injection for hemifacial atrophy __________________________________________________________________________ Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2007 Dec;21(12):1308-11. [Treatment of autologous fat injection for hemifacial atrophy] [Article in Chinese] Xie Y, Li Q, Zheng D. Department of Plastic & Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University, Shanghai, 200011, PR China. amiyayun@gmail.com OBJECTIVE: To evaluate an improved treatment of an autologous fat injection for hemifacial atrophy to increase the survival rate of the fat graft and decrease complications including colliquation, necrosis, and absorption of the graft fat. METHODS: From March 1999 to October 2004, 31 patients with hemifacial atrophy underwent an improved treatment by an autologous fat injection for their diseases. There were 12 males and 19 females aged 19-28 years (average, 23.5 years). The patients were divided into the following 3 groups according to the atrophy extent: the mild group (n=9), the moderate group (n=19), and the severe group (n=3). Based on the previous researches on the fat transplantation techniques, the improved treatment combined the following strategies that were simply called "3L3M": low position for the fat donation, low pressure for the fat harvesting, and low-speed centrifugation for purification of the fat; multi-point, multi-tunnel, and multi-plane for injections of the fat graft. The preoperative and the postoperative photos were taken and the findings were compared to make clear whether the hard and firm masses and cysts existed; then, the decision was made about whether the patients needed another operation according to whether the patients had a natural facial expression and whether the patients had comfortable feelings as well as the X-ray findings. RESULTS: All the patients had a satisfactory symmetrical face after 1 injection of the fat in 15 patients, 2 injections in 13 patients, and 3 injections in 3 patients. The effect of the 3rd injection was better than that of the 2nd injection; the effect of the 2nd injection was better than that of the 1st injection; the fat volume for the injection could be gradually decreased. The fat volumes for injections were as follows: 8-14 ml (average, 11 ml) in the submaxillary region, 15-25 ml (average, 20 ml) in the buccal region, 5-10 ml (average, 7.5 ml) in the zygomatic region, and 18-20 ml (average, 19 ml) in the forehead region. The follow-up for 3-5 years revealed that there was no infection, hard and firm mass, cyst or other complications. The pigmentation in the affected face was significantly improved. CONCLUSION: Compared with the traditional treatments, the improved treatment of an autologous fat injection for hemifacial atrophy can achieve a satisfactory symmetry of the face with no injury to the donor site or complications in the recipient site. This improved method is an ideal treatment for hemifacial atrophy. __________________________________________________________________________ _____________________________________*____________________________________ 9. Abstract: Frequent HCV reinfection and superinfection in a cohort of injecting drug users in Amsterdam __________________________________________________________________________ J Hepatol. 2009 Jun 18. Frequent HCV reinfection and superinfection in a cohort of injecting drug users in Amsterdam. van de Laar TJ, Molenkamp R, van den Berg C, Schinkel J, Beld MG, Prins M, Coutinho RA, Bruisten SM. Cluster of Infectious Diseases, Public Health Service, Amsterdam, The Netherlands; Department of Internal Medicine, Centre for Infection and Immunity Amsterdam (CINIMA), Academic Medical Centre, Amsterdam, The Netherlands. BACKGROUND/AIMS: This study investigates the occurrence of HCV reinfection and superinfection among HCV seroconverters participating in the Amsterdam Cohort Studies among drug users from 1985 through 2005. METHODS: HCV seroconverters (n=59) were tested for HCV RNA at five different time points: the last visit before seroconversion (t=-1), the first visit after seroconversion (t=1), six months after (t=2) and one year after (t=3) seroconversion, and the last visit prior to November 2005 (t=4). If HCV RNA was present, part of the NS5B region was amplified and sequenced. Additional phylogenetic analysis and cloning was performed to establish HCV reinfection and superinfection. RESULTS: Multiple HCV infections were detected in 23/59 (39%) seroconverters; 7 had HCV reinfections, 14 were superinfected, and 2 had reinfection followed by superinfection. At the moment of HCV reinfection, 7/9 seroconverters were HIV-negative: persistent HCV reinfection developed in both HIV-positive cases but also in 4/7 HIV-negative cases. In total, we identified 93 different HCV infections, varying from 1 to 4 infections per seroconverter. Multiple HCV infections were observed in 10/24 seroconverters with spontaneous HCV clearance (11 reinfections, 3 superinfections) and in 13/35 seroconverters without viral clearance (20 superinfections). CONCLUSIONS: HCV reinfection and superinfection are common among actively injecting drug users. This might further complicate the development of an effective HCV vaccine. __________________________________________________________________________ _____________________________________*____________________________________ 10. Abstract: Hand hygiene: revolution and globalization __________________________________________________________________________ Rev Med Suisse. 2009 Apr 1;5(197):716-8, 720-1. [Hand hygiene: revolution and globalization] [Article in French] Pittet D. Service prévention et contrôle de l'Infection et Centre de collaboration de l'Organisation mondiale de la santé pour la sécurité des patients, HUG, 1211 Genève 14. didier.pittet@hcuge.ch Hand hygiene is the primary measure to prevent healthcare-associated infections and the spread of antimicrobial resistance. Low staff compliance remains a major problem. Successful promotion requires a multimodal strategy. The World Health Organization (WHO) proposes an approach including at least five components: system change, in particular the recourse to alcohol-based hand rubbing as the new standard of care, staff education using newly developed tools, monitoring and feedback of staff performance, reminders in the workplace, and promotion of an institutional safety climate. Patient participation in hand hygiene promotion is under testing. Early results of the strategy tested in a large number of healthcare settings in both limited- and high-resource countries are extremely encouraging. __________________________________________________________________________ _____________________________________*____________________________________ 11. Abstract: Facemasks and Hand Hygiene to Prevent Influenza Transmission in Households: A Randomized Trial __________________________________________________________________________ Ann Intern Med. 2009 Aug 3. Facemasks and Hand Hygiene to Prevent Influenza Transmission in Households: A Randomized Trial. Cowling BJ, Chan KH, Fang VJ, Cheng CK, Fung RO, Wai W, Sin J, Seto WH, Yung R, Chu DW, Chiu BC, Lee PW, Chiu MC, Lee HC, Uyeki TM, Houck PM, Peiris JS, Leung GM. School of Public Health and University of Hong Kong; Hospital Authority and Centre for Health Protection, Department of Health, Government of the Hong Kong SAR; Hong Kong Sanatorium and Hospital; St Paul's Hospital; St Teresa's Hospital; and Hong Kong Baptist Hospital, Hong Kong; National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; and Seattle Quarantine Station, Division of Global Migration and Quarantine, Centers for Disease Control and Prevention and National Center for Preparedness, Detection and Control of Infectious Diseases, Seattle, Washington. BACKGROUND: Few data are available about the effectiveness of nonpharmaceutical interventions, such as hand hygiene and facemasks, for preventing influenza virus transmission. OBJECTIVE: To investigate whether hand hygiene and use of facemasks prevents household transmission of influenza. DESIGN: Cluster randomized controlled trial. Randomization was computer generated; allocation was concealed from treating physicians and clinics and implemented by study nurses at the time of the initial household visit. Participants and personnel administering the interventions were not blinded to group assignment. SETTING: Households in Hong Kong. PATIENTS: 407 people presenting to outpatient clinics with influenza-like illness who were positive for influenza A or B virus by rapid testing (index patients) and 794 household members (contacts) in 259 households. INTERVENTION: Lifestyle education (control) (134 households), hand hygiene (136 households), or surgical facemasks plus hand hygiene (137 households) for all household members. MEASUREMENTS: Influenza virus infection in household contacts, as confirmed by reverse transcription polymerase chain reaction (RT-PCR) or diagnosed clinically after 7 days. RESULTS: Sixty (8%) household contacts in the 259 households had RT-PCR- confirmed influenza virus infection in the 7 days after intervention. Hand hygiene without or with facemasks seemed to reduce influenza transmission, but the differences in transmission compared with the control group were not statistically significant. In 154 households in which interventions were implemented within 36 hours of symptom onset in the index patient, transmission of RT-PCR-confirmed infection seemed to be reduced, an effect attributable to reductions in infection among participants using facemasks plus hand hygiene (adjusted odds ratio, 0.33 [95% CI, 0.13 to 0.87]). Adherence to interventions was variable. Limitation: The delay from index patient symptom onset to intervention and variable adherence may have mitigated intervention effectiveness. CONCLUSION: Hand hygiene and facemasks seemed to prevent household transmission of influenza virus when implemented within 36 hours of index patient symptom onset. These findings suggest that nonpharmaceutical interventions are important for mitigation of pandemic and interpandemic influenza. Primary Funding Source: Centers for Disease Control and Prevention. __________________________________________________________________________ _____________________________________*____________________________________ 12. Abstract: Applicability of press needles to a double-blind trial: a randomized, double-blind, placebo-controlled trial __________________________________________________________________________ Clin J Pain. 2009 Jun;25(5):438-44. Applicability of press needles to a double-blind trial: a randomized, double-blind, placebo-controlled trial. Miyazaki S, Hagihara A, Kanda R, Mukaino Y, Nobutomo K. Department of Health Services, Management and Policy, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. OBJECTIVES: Owing to a lack of a suitable needle procedure, it has been impossible to evaluate the efficacy of acupuncture in clinical studies using double-blind testing. We evaluated the applicability of a new kind of press needle (Pyonex) to a double-blind trial by comparing the press needle with a placebo (lacking the needle element). METHODS: The purpose of the study consisted of 2 phases. In the phase 1, to evaluate the applicability and efficacy of the press needles, 90 participants who had never been treated using acupuncture were randomly assigned to receive either the press needle (n=45) or a placebo (n=45). The applicability was measured using a questionnaire regarding the perception of penetration, and efficacy was measured using a visual analog scale of low back pain (LBP). When the applicability and efficacy of the press needles were confirmed in phase 1, the mechanism of LBP relief by the press needles was examined in phase 2. RESULTS: In phase 1, intergroup comparisons showed no significant differences concerning the perception of penetration. In addition, for patients with LBP, the press needles reduced the subjective evaluation of LBP compared with the placebo (P<0.05). In phase 2, visual analog scale results indicated that LBP was reduced significantly more in the press needle group than in the local anesthesia group (P<0.05). DISCUSSION: The participants could not distinguish between the press needle and a placebo, and the data from the press needle group suggested a specific influence on patients with LBP. These findings imply that the press needle and a placebo provide an effective means of realizing a double-blind setting for clinical studies of acupuncture. __________________________________________________________________________ _____________________________________*____________________________________ 13. Abstract: Biofilms, infection, and parenteral nutrition therapy __________________________________________________________________________ JPEN J Parenter Enteral Nutr. 2009 Jul-Aug;33(4):397-403. Biofilms, infection, and parenteral nutrition therapy. Machado JD, Suen VM, Figueiredo JF, Marchini JS. Department of Clinical Medicine, Hospital of the School of Medicine of Ribeirão Preto, SP. juliana@infonet.com.br Parenteral nutrition therapy is used in patients with a contraindication to the use of the gastrointestinal tract, and infection is one of its frequent and severe complications. The objective of the present study was to detect the presence of biofilms and microorganisms adhering to the central venous catheters used for parenteral nutrition therapy by scanning electron microscopy. Thirty-nine central venous catheters belonging to patients with clinical signs of infection (G1) and asymptomatic patients (G2) and patients receiving central venous catheters for clinical monitoring (G3) were analyzed by semiquantitative culture and scanning electron microscopy. The central venous catheters of G1 presented more positive cultures than those of G2 and G3 (81% vs 50% and 0%, respectively). However, biofilms were observed in all catheters used and 55% of them showed structures that suggested central venous catheters colonization by microorganisms. Approximately 53% of the catheter infections evolved with systemic infection confirmed by blood culture. The authors conclude that the presence of a biofilm is frequent and is an indicator of predisposition to infection, which may even occur in patients who are still asymptomatic. __________________________________________________________________________ _____________________________________*____________________________________ 14. Abstract: Cost-Benefit Analysis of Preventing Nosocomial Bloodstream Infections among Hemodialysis Patients in Canada in 2004 __________________________________________________________________________ Value Health. 2009 Jul 29. Cost-Benefit Analysis of Preventing Nosocomial Bloodstream Infections among Hemodialysis Patients in Canada in 2004. Hong Z, Wu J, Tisdell C, O'Leary C, Gomes J, Wen SW, Njoo H. Blood Safety Surveillance Division, Public Health Agency of Canada, Ottawa, ON, Canada; Objectives: Hemodialysis-associated bloodstream infection (BSI) is a significant public health problem because the number of hemodialysis patients in Canada had doubled from 1996 to 2005.Our study aimed to determine the costs of nosocomial BSIs in Canada and estimate the investment expenses for establishing infection control programs in general hospitals and conduct cost-benefit analysis. Materials and Methods: The data from the Canadian Nosocomial Infection Surveillance Program was used to estimate the incidence rate of nosocomial BSI. We used Canadian Institute of Health Information data to estimate the extra costs of BSIs per stay across Canada in 2004. The cost of establishing and maintaining an infection control program in 1985 was estimated by the US Centers for Disease Control and Prevention and converted into 2004 Canadian costs. The possible 20% to 30% reduction of total nosocomial BSIs was hypothesized. Results: A total of 2524 hemodialysis-associated BSIs were projected among 15,278 hemodialysis patients in Canada in 2004. The total annual costs to treat BSIs were estimated to be CDN$49.01 million. Total investment costs in prevention and human resources were CDN$8.15 million. The savings of avoidable medical costs after establishing infection control programs were CDN$14.52 million. The benefit/cost ratio was 1.0 to 1.8:1. Conclusion: Our study provides evidence that the economic benefit from implementing infection control programs could be expected to be well in excess of additional cost postinfection if the reduction of BSI can be reduced by 20% to 30%. Infection control offered double benefits: saving money while simultaneously improving the quality of care. __________________________________________________________________________ _____________________________________*____________________________________ 15. Abstract: A vault nanoparticle vaccine induces protective mucosal immunity __________________________________________________________________________ PLoS One. 2009;4(4):e5409. A vault nanoparticle vaccine induces protective mucosal immunity. Champion CI, Kickhoefer VA, Liu G, Moniz RJ, Freed AS, Bergmann LL, Vaccari D, Raval-Fernandes S, Chan AM, Rome LH, Kelly KA. Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, California, United States of America. BACKGROUND: Generation of robust cell-mediated immune responses at mucosal surfaces while reducing overall inflammation is a primary goal for vaccination. Here we report the use of a recombinant nanoparticle as a vaccine delivery platform against mucosal infections requiring T cell- mediated immunity for eradication. METHODOLOGY/PRINCIPAL FINDINGS: We encapsulated an immunogenic protein, the major outer membrane protein (MOMP) of Chlamydia muridarum, within hollow, vault nanocapsules (MOMP- vaults) that were engineered to bind IgG for enhanced immunity. Intranasal immunization (i.n) with MOMP-vaults induced anti-chlamydial immunity plus significantly attenuated bacterial burden following challenge infection. Vault immunization induced anti- chlamydial immune responses and inflammasome formation but did not activate toll-like receptors. Moreover, MOMP-vault immunization enhanced microbial eradication without the inflammation usually associated with adjuvants. CONCLUSIONS/SIGNIFICANCE: Vault nanoparticles containing immunogenic proteins delivered to the respiratory tract by the i.n. route can act as "smart adjuvants" for inducing protective immunity at distant mucosal surfaces while avoiding destructive inflammation. __________________________________________________________________________ _____________________________________*____________________________________ 16, York University Certificate in Harm Reduction __________________________________________________________________________ YORK UNIVERSITY Certificate in Harm Reduction The Certificate in Harm Reduction consists of 117 hours of instruction (3 courses in total) and is designed to introduce service providers, administrators and policy makers to the principles, concepts and practices of harm reduction; to provide an opportunity to critically examine examples of harm reduction work; and to become familiar with strategies for mobilizing support for and developing harm reduction programs in communities and institutions. Course #1: Theory and History of Harm Reduction (offered online) Course #2: Harm Reduction Policies and Strategies (offered over 5 full days, commencing November 23) Course #3: Harm Reduction Programs and Practice (offered over 5 full days) For information regarding dates, fees and location please visit our web- site at www.coned.yorku.ca Upon successful completion of all three courses the participant is awarded a Certificate in Harm Reduction from York University A National Harm Reduction Program Advisory Committee assisted in the development of the curriculum for this Program and we wish to thank them for their contributions. To register or request information please contact: The Division of Continuing Education (DCE) York University, Atkinson Building, Room 107 4700 Keele Street, Toronto, ON M3J 1P3 Canada Phone: 416-736-5616; Fax: 416-650-8042; Email: dce@yorku.ca Website: www.coned.yorku.ca __________________________________________________________________________ _____________________________________*____________________________________ 17. Kuwait Lab Technology Conference & ExhibitionKuwait Lab Technology Conference & Exhibition __________________________________________________________________________ Under the patronage of H.E. Dr. Helal Al-Sayer Minister of Health, Kuwait Dear Colleague, Kuwait Lab Technology Conference & Exhibition will held on 4 - 5 November 2009 at the Radisson SAS Hotel. It is now only a few weeks away - don’t miss your opportunity to learn from an interactive case study led agenda, network with laboratory industry professionals and meet with our distinguished faculty of expert speakers. Register now to avoid disappointment. Conference Topics: · Modern Laboratory Management · Lab Safety Management · Laboratory Accreditation and Training · Instrumentation and Automation · Measurement, Testing and Quality Control · Laboratory Technology · Biotechnology and Life-Sciences · Oil, Gas and Petrochemical · Environmental Science · Materials Science · Food & Water Analysis · Medical and Pharmaceutical sciences · Nanotechnology Don't miss this landmark event! To ensure your place call +965 24342828 or email Hudhaib Al-Allatti at hudhaib@kuwaitlabex.com Keynote Speakers Dr. Ali Bumajdad, Kuwait University, Kuwait Dr. Ute Pieper, Health EnviroTech & Logistics, Germany Dr. Mohammad A. Aljafar, United Laboratories Co., Kuwait Dr. Markus Laeubli, Metrohm International, Switzerland Dr. Abubaker Hamed Ali Salem, Sebha University, Libya Mr. Andy Saleh, MedLabs Consultancy Group, Jordan Dr. M. A. Gondal, King Fahd University of Petroleum & Minerals, Saudi Arabia Dr. Nina Parkinson, Bapco, Bahrain Event Brochure: http://www.kuwaitlabex.com/Lab_Expo_2009.pdf __________________________________________________________________________ _____________________________________*____________________________________ 18. News - Nigeria: Effective Management of Medical Waste - Iran: Court rules against Health Ministry - USA: Hep B Lawsuit Filed Against New Jersey Oncologist - Africa: BD and PEPFAR Collaboration Will Improve Blood-Drawing Practices in Hospitals and Clinics in Sub-Saharan Africa - Asia: Opinion - Hope to reality: Transforming the AIDS response - UK: Clinic helps beat steroid abuse - South Asia: Injecting drug users take central role in anti-stigma film - UK: Hartlepool mum's terror as she finds children playing with needles - USA: Three More Hepatitis C Cases Discovered - Indonesia, South Asia new flashpoints in AIDS fight: experts - Mexico: Piden investigar presuntos contagios de VIH en hospital mexicano - USA: Patient Suing Doctor In NJ Hepatitis Outbreak: Nearly 3,000 Urged To Get Tested For Hep B, C & HIV - USA: Certain Blood Transfusions Increase Risk of Infection - Brazil - UK: Brazil returns hazardous UK waste - One use only: the broken syringe that saves lives - USA: OSHA Investigates Biohazard Waste Practices at Audubon Surgery Center - USA: New York Hep C Lawsuit - Machine designed to reduce infections and cut back on expensive "disposables" - USA: State Trains Inmates in Preventing Hepatitis C Selected news items reprinted under the fair use doctrine of international copyright law: http://www4.law.cornell.edu/uscode/17/107.html __________________________________________________________________________ Nigeria: Effective Management of Medical Waste By Olagoke Olatoye, Daily Triumph - Kano,Nigeria (11.08.09) Poor waste management in Nigeria is a major problem for stakeholders and for others concerned with managing the nation’s environment. From industries, food vendors and road users, the signs are of all over as waste is indiscriminately thrown around with commuters even throwing empty sachets of water or empty cans of drinks through the windows of moving vehicles. For many observers, many Nigerian roads are filthy as they are filled with the carcasses of accident vehicles and all manner of rubbish thrown out of moving vehicles. But for many environmental experts, the health sector is among the worst culprits of poor waste management. They worry because medical and hospital waste have direct effect on human hygiene and easily pose a health threat to members of the public. They say, for instance, that visitors to hospitals could suffer fresh ailments after inhaling odours oozing from blood-sucked bandages used to treat wounds or other blood-sucked operation equipment that are carelessly disposed off by hospital authorities. According to Dr Akin Fajolu, a Lagos-based Public Health Consultant, medical waste refers to waste generated from activities within healthcare facilities such as hospitals, clinics and medical laboratories. Others include medical research centres, pharmaceutical industries and radiological centres. According to him, a prime step toward effective health management must start from an effective management of the waste generated from the sector for the safety of the patients, the workers and the immediate community. To do that, he says that medical authorities must give special attention to planning, procurement, staff training and behaviour. The staff, he says, must also be trained on the use of tools, machines, pharmaceutical equipment and the proper disposal methods in and out of every health centre. ``It is very crucial that the medical authorities manage the waste well,'' he said, adding that such is necessary to prevent exposure to toxins by the society. According to him, 80 per cent of the total health wastes are similar to domestic waste, while the remaining 20 per cent are considered hazardous. Mr Ola Oresanya, Managing Director, Lagos Waste Management Authority (LAWMA), agrees with Fajoku. Oresanya said waste produced in the course of healthcare activities carries a higher potential for infection and injury than any other type of waste. According to him, inadequate and inappropriate handling of it may have serious impact on the environment. In view of its place in the overall healthcare effort, he suggested that it be made an integral feature of healthcare services. According to him, medical wastes could be solid, liquid or gaseous, and they are normally generated during the process of diagnosis, immunisation, treatment and medical research. Other avenues of generating waste, he says, include stocks and dishes as well as swabs used to inoculate cultures, slides; sharps: scalpels, lancets, needles, suture needles, broken glasses and vials. ``It could also be pathological waste like human or animal tissues, as well as organ or body parts removed during surgery, like placenta and umbilical cords.'' Others include infectious wastes involving discarded cultures of infected patients, live or attenuated vaccine or serum, as well as discarded gloves. Other categories of medical waste, he further says, are body fluid like blood, semen, vaginal secretions and medical hardware constituents like mercury in blood pressure machines. They could also include thermometers, batteries, fluorescent lamps; and general waste like household waste and the recyclable; and emission from incinerators and kitchens. Oresanya, who described the hospitals as major generators of specialised waste, identified other various sources of medical wastes to include laboratories, biotechnology institutions and production units, trado- medical centre, blood banks and collection centres. Others, he says, include funeral homes and mortuaries, as well as dental laboratories. According to him, a joint survey carried out in 2004 by the Federal Ministry of Health and an NGO -- Making Medical Injection Safer -- revealed that open dumping of infectious waste was observed in 83 per cent of the facilities visited. ``These dangerous practices provide an opportunity for equipment re-use and pose a health threat which is preventable with a good management system,'' he observed. He identifies current medical waste management systems in Lagos to include burning in open air, open pit burning, dropping in uncovered bins and the burying without treatment. Other waste management methods, he said, include the use of cart pushers to transport waste, the use of unaccredited waste collectors, the washing in public drains, and use of cellophane bags for collection of waste. To ensure effective management of medical wastes, he suggests an integral approach involving all stakeholders who will first segregate such waste based on categories. Such segregated waste, he said, should be collected in identifiable containers, bins or bags of different colours. According to him, the means of identification should be conspicuously displayed at each waste collection point to ensure proper procedure of transportation toward disposals. He said that waste routes must be designated, while hospitals must find ways to effectively dispose the category that can be disposed internally. ``With such categorisation, different waste groups can be treated depending on costs, safety, the back up services and environmental acceptability''. Commenting on how lives could be saved with good healthcare waste management, Oresanya suggests a need to develop and plan a comprehensive healthcare waste management strategy. He also suggests a planned and programmed waste collection treatment and disposal device, which are appropriate for waste type and local circumstances. Other devices, he said, include the use of regional incineration facilities, as well as established training programmes for workers so as to support the quest for quality work. On the benefit of good medical waste management, Fajolu says that it will reduce HIV/AIDS, sepsis and hepatitis transmission from contaminated needles and poorly disposed medical items. He said that it will also control zoo-noses -- a disease passed to human through insects, birds, rats and other animals. Other benefits include reduced community exposure, prevention of illegal repackaging of contaminated needles, as well as the prevention of the long-term effect such as cancer from the release of toxic substances like dioxin and mercury into the environment. On the control and prevention of hazards associated with the healthcare waste management, he suggested more enlightenment programmes on waste issues by training all key stakeholders. ``Such training will be particularly useful in the use and disposal of injection, the commonest instrument often abused,'' he said. He further suggested a reduction of medical waste via the selection of appropriate and sustainable methods of treatment and final disposal. Mrs Abimbola Jijoho-Ogun, a LAWMA Official, who said the issue is of utmost concern. According to her, it must always be taken care of when budgets are being proposed for hospitals. ``Handling the waste from medical services must be a key components in the budgets of healthcare.'' To make that possible, she said, however, that there is the need for a reliable data for use in healthcare waste management. Supporting the LAWMA official, Dr Abimbola Showande, Country Director, John Snow Incorporated, an NGO, says that there is indeed the need for proper financial support toward proper medical waste disposal. Dr Jide Idris, the Lagos state Commissioner for Health, believes medical waste management is crucial to meeting set goals in the sector. He suggests the establishment of an effective and sustainable medical waste management plan in the country. According to him, medical waste is not being properly collected and disposed by the healthcare providers. Idris said that a monitoring team of health facilities recently confirmed this. He listed the risks and hazards of improper disposal of medical waste as numerous. ``As needle sticks and injures, so does improper waste management transmits diseases and infections like cholera, dysentery and environmental pollution.'' For effective waste management in the medical sector, analysts suggest that the waste generators be encouraged to work with stakeholders and governments at all levels to agree on the best way out, that way, society will be freed from the hazards associated with the poor handling of medical wastes. (NAN/Features) .......................................................................... __________________________________________________________________________ Iran: Court rules against Health Ministry Tehran Times, Health Desk, Tehran Iran (11.08.09) TEHRAN -- Shahid Beheshti Judicial Complex has ruled against the Iranian Blood Transfusion Organization (IBTO) and Health Ministry on the hemophilia case, Iranian Hemophilia Society Director Ahmad Ghavidel said here on Sunday. It is the fifth such ruling on the hemophilia case issued against the Ministry of Health over the past years, Ghavidel said. The court made the IBTO and the Health Ministry liable to pay plaintiffs partial to full damages. Over 100 Iranian hemophiliacs became infected with HIV through contaminated blood imported to Iran through 1983 to 1986, Ghavidel explained. In the 1980s, large numbers of hemophiliacs in Iran became infected with HIV after receiving tainted clotting substances sold by a subsidiary of France’s Mérieux pharmaceutical company. The group of HIV-positive Iranians has filed a lawsuit asking for damages from the company, the ministry, and IBTO. .......................................................................... __________________________________________________________________________ USA: Hep B Lawsuit Filed Against New Jersey Oncologist Newsinferno.com, USA (11.08.09) Toms River, New Jersey oncologist, Dr. Parvez Dara, who the Associated Press (AP) says has been implicated in a hepatitis B outbreak that occurred earlier this year, is being sued by one of his patients. Roland Jacobsen, of Manchester, alleges he came down with hepatitis B after being treated for prostate cancer in 2008 and 2009, in Dara’s offices, reported the AP. According to Jacobsen’s lawyer, his client was not infected prior to treatment by Dara, according to earlier testing, said the AP. "He goes in for treatment and bam, there it is". It not only affects him, but his wife and everyone he’s surrounded by," said Jacobsen’s attorney, quoted the AP. In April we wrote that thousands of Dara’s patients had to undergo testing for some serious blood borne diseases such as hepatitis B; hepatitis C; and HIV, the virus that causes AIDS. The AP wrote, at that time, that about 3,000 people treated by Dara had to undergo testing after five of his patients reportedly tested positive for hepatitis B. Hepatitis b is a liver infection that can be transmitted through blood and blood products. Once the five cancer patients were confirmed as being infected, health officials sent a letter- dated March 28- to all of Dara’s patients going back to 2002 warning them of the risks of the blood borne diseases and urging them to receive testing, said the AP in an earlier report. Dara has offices in Toms River and Manchester, New Jersey, the AP reported previously. The state department is not saying how many additional patients tested positive following the letters, the AP just said. While Dara’s attorney claims the five patients were also seen at the same hospital and claims they could have been contaminated there, health officials argue that the hospital was ruled out as an infection source. "The investigation looked at all sites where the patients received care". The only common site was the physicians’ office," said state Health Department spokeswoman Marilyn Riley, quoted the AP previously. A spokesman for Dara, Timothy White, said the doctor expects to be found innocent in the lawsuit. "To publicly link a medical practice to these occurrences before or during an ongoing investigation is irresponsible," he said, quoted the AP. Fox News previously reported that New Jersey health officials believe shoddy injection practices might be to blame. Dara, who treats cancer patients and patients with blood disorders, said the AP, administers chemotherapy, which is injected, at his offices, said Fox News. Once a hearing revealed blood on the floor of a chemotherapy room, blood in a bin storing blood vials, open vials of medication, and unsterile saline and gauze in the Toms River office, said the AP, Dara’s license to practice medicine was suspended. In addition, inspectors discovered an array of incidences of cross-contamination, antiseptic misuse, and use of contaminated gloves, to name a few, reported the AP. Dara’s numerous health code violations go back as far as 2002 and involve the physician paying over $50,000 in fines for health code violations regarding infection control, said the AP, citing court records. Dara, who was born in Pakistan, was practicing for 23 years in his Toms River office and saw about 45 to 60 patients- 12 or so receiving chemotherapy- daily. .......................................................................... __________________________________________________________________________ Africa: BD and PEPFAR Collaboration Will Improve Blood-Drawing Practices in Hospitals and Clinics in Sub-Saharan Africa PR Newswire (press release) (11.08.09) Blood Collection Safety Protects Patients And Health Workers FRANKLIN LAKES, N.J., Aug. 11 /PRNewswire/ -- BD (Becton, Dickinson and Company), a leading global medical technology company, and the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) today announced a joint initiative to help protect health workers and patients in African countries by improving blood collection safety in clinics and hospitals. In recent years, safer blood collection has become more critical than ever in sub-Saharan nations and other developing countries severely impacted by the HIV/AIDS pandemic. Access to HIV treatment in developing countries has significantly increased in recent years, which in turn has greatly expanded the quantity of blood drawing for HIV screening and monitoring tests. "Doctors, nurses and other health workers in countries with high infectious disease prevalence face a constant risk of contracting HIV/AIDS and other diseases in their work environment. In particular, blood drawing and other procedures involving blood and sharp devices must be done as safely as possible to protect health workers," said Gary Cohen, Executive Vice President, BD. "Far too few clinicians are currently available to support health needs in sub-Saharan Africa, and all efforts to improve procedures and protect health workers will serve to strengthen fragile health systems in developing countries. BD is very pleased to collaborate with PEPFAR on this essential initiative." The three-year initiative -- which may be extended up to two additional years -- is scheduled to begin in October in Kenya and expand to include up to four additional PEPFAR-supported countries. It will ultimately support in-service training for as many as 10,000 healthcare workers. When fully implemented, the monitoring component of the initiative aims to track as many as two million blood draws within each participating country. "A critical role of international development partners such as PEPFAR is to develop and support national leadership," said Ambassador Eric Goosby, U.S. Global AIDS Coordinator. "PEPFAR is proud to partner with BD to invest in health systems strengthening and health worker capacity-building for safe blood collection. Efforts like these build the capacity of partner countries, support the scale up of proven HIV interventions, and ultimately help create a sustainable response to HIV/AIDS." The program will help hospital and clinical personnel improve their blood- drawing procedures and specimen handling, processes that are critical to the proper management of HIV/AIDS patients. The initiative will also work to control exposure to the virus among health workers by providing post- exposure prophylaxis. In addition, the program will help prevent needlestick injuries by establishing or enhancing needle stick injury surveillance. These monitoring measures can identify practices that pose risks to health workers and patients. According to the International Health Care Worker Safety Center at the University of Virginia, injuries from needles filled with blood present a far higher risk of spreading disease than needles used for injections. Reflecting PEPFAR's focus on empowering developing nations in the battle against HIV/AIDS, Ministries of Health in participating countries will take the lead in developing individualized policies, guidelines and standard operating procedures for blood drawing and specimen handling. The safe blood collection initiative announced today will be implemented by PEPFAR through the U.S. Department of Health and Human Services' Centers for Disease Control and Prevention. As part of their collaboration, PEPFAR and BD will work on the ground with Ministries of Health, national reference laboratories and various implementing partners. BD and PEPFAR are also collaborating on two other programs aimed at improving the healthcare systems of sub-Saharan Africa: In October 2007, BD and PEPFAR launched a five-year initiative to improve the quality of laboratories in Sub-Saharan Africa. In October 2008, BD, PEPFAR and the International Council of Nurses announced a three-year, public-private partnership to establish a new Wellness Centre for Healthcare Workers(R) in Kampala, Uganda. About PEPFAR The U.S. President's Emergency Plan for AIDS Relief (PEPFAR) was launched in 2003 to combat global HIV/AIDS, and is the largest commitment by any nation to combat a single disease in history. Under PEPFAR, the U.S. Government has already committed more than $25 billion to the fight against global HIV/AIDS. As of September 30, 2008, PEPFAR supported life- saving antiretroviral treatment for more than 2.1 million men, women and children living with HIV/AIDS, compassionate care for more than 10 million people affected by HIV/AIDS, including more than 4 million orphans and vulnerable children, and prevention of mother-to-child transmission programs that allowed nearly 240,000 babies to be born HIV-free. For more information, please visit http://www.PEPFAR.gov. About BD BD is a leading global medical technology company that develops, manufactures and sells medical devices, instrument systems and reagents. The Company is dedicated to improving people's health throughout the world. BD is focused on improving drug delivery, enhancing the quality and speed of diagnosing infectious diseases and cancers, and advancing research, discovery and production of new drugs and vaccines. BD's capabilities are instrumental in combating many of the world's most pressing diseases. Founded in 1897 and headquartered in Franklin Lakes, New Jersey, BD employs approximately 28,000 people in approximately 50 countries throughout the world. The Company serves healthcare institutions, life science researchers, clinical laboratories, the pharmaceutical industry and the general public. For more information, please visit http://www.bd.com. SOURCE BD (Becton, Dickinson and Company) .......................................................................... __________________________________________________________________________ Asia: Opinion - Hope to reality: Transforming the AIDS response Michel Sidibe, Denpasar, Jakarta Post, Jakarta Indonesia (11.08.09) More than a thousand people become infected with HIV in Asia each day. If only we had invested in reaching populations at higher risk and their partners, most of these infections could have been averted - at a cost of less than half a US dollar per person. The Commission on AIDS in Asia has recommended that the AIDS epidemic in the region be redefined. We must transform the AIDS response so that it works for people.This means protecting sex workers, men who have sex with men, transgender, injecting drug users and women. How can we do this? 1. Decriminalize consensual adult sexual behavior and drug use. 2. Address HIV transmission among intimate partners. 3. Invest in evidence-informed HIV prevention, treatment, care and support programs. 4. Adopt an "AIDS plus Millennium Development Goal" approach. Many countries are changing laws that criminalize consensual adult sexual behavior (including sex work) and drug use, and courts are helping to clarify bad laws. In Indonesia, the Supreme Court ruled that drug users need care, not prison. In Nepal, the highest court has established that transgender and men who have sex with men have equality under the constitution. And in India, the Delhi High Court has restored dignity to millions, by reading down an archaic law that discriminated against men who have sex with men. New Zealand has legalized sex work and reaped the dual benefits of public health and public safety. Australia has demonstrated that law enforcement and public health goals can go hand in hand while dealing with drug use. We can remove punitive laws and policies that block effective responses to AIDS. But the real transformation has to be in the hearts and minds of people. Courts and parliaments can only create an enabling environment. Societies and communities have to change the social norms that allow stigma and discrimination. In India, a pregnant woman was recently branded on her forehead as being HIV positive by hospital staff during a routine check-up. This inhumane treatment of the woman triggered protests by the local community and by human rights activists, which led the Gujarat government to open an investigation. It is this sort of community mobilization that is needed to put an end to such discriminatory acts. Bad laws and a discriminatory society have had a severe impact on women. Many Asian women become infected because their husbands or male partners contracted HIV through drug use or through sex with another man or with a sex worker. In India, being monogamous is the only risk factor for an estimated 90 percent of women living with HIV. In 2008, 35 percent of adults living with HIV in Asia were women, and most of them were in steady relationships. HIV prevention programs must be scaled-up. Political leaders must ensure that existing HIV services are expanded to reach the most vulnerable. This includes starting needle exchange programs and offering oral substation therapy to drug users, increasing access to antiretroviral drugs, distributing condoms and offering voluntary HIV counseling and testing services to those at higher risk. It is heartening that requests to the Global Fund to Fight AIDS, Tuberculosis and Malaria for such programs have increased substantially in recent years. However, we need US$7.5 billion in 2010 to reach country targets, but only 10 percent of this was available in 2007. We must therefore invest wisely and equitably, especially now in the midst of an economic crisis. Unlike Africa, where the AIDS epidemic can overwhelm development efforts, the Asia and Pacific region can combine development and the AIDS response. Reducing poverty, increasing education and investment in health must become the foundations for sustainable economic growth in the region. This is what I call the "AIDS plus MDG" movement. Recently I read about Nisha, a person living with HIV in Nepal. She lost her husband in 2004, when there was no access to treatment. Today, she is on antiretroviral therapy. She is staying healthy, has gone back to work and can look after her three children. Her family has come to accept her, and her children go to school, where they are being taught how to protect themselves. Access to treatment has given her an opportunity to fulfill her dreams - this is hope becoming reality. The writer is UNAIDS Executive Director. .......................................................................... __________________________________________________________________________ UK: Clinic helps beat steroid abuse Glasgow Evening Times (10.08.08) A pioneering clinic for steroid users has convinced almost 30% of people accessing its services to stop injecting. The Steroid Drop-In Clinic is the only one of its kind in Scotland and opened in February as a six-month pilot as part of the Turning Point needle exchange project in West Street, Glasgow. The clinic is a joint initiative between Glasgow Addiction Services (GAS), of which NHS Greater Glasgow and Clyde is a partner, and Glasgow Drugs Crisis Centre. Its aim is to persuade people not to inject steroids by providing health education packs about the risks, as well as dietary and training regimes to safely gain the body image they are after. However, if users are determined to continue injecting they will be educated about how to do so safely and be given packs which include single-use needles. Out of 72 steroid injectors who used the Tuesday evening clinic during the first 10 weeks of opening, 19 - or 27% - decided to leave without the special needle equipment after receiving specialist advice. Carole Hunter, lead pharmacist for GAS, said: "We realised that growing numbers of people using the established needle exchange service were steroid users. "They were also identified as an at-risk group from the Govern-ment's Advisory Council on the Misuse of Drugs. "This group needed different information about harm reduction and they are also at risk from Hepatitis A and B and other blood-borne viruses if they share or re-use injecting equipment. "Working with the manufacturers of needle exchange equipment we came up with a specific pack for people who use performance and image-enhancing drugs." She added that many in this predominantly male group were shocked when told of the health risks. .......................................................................... __________________________________________________________________________ South Asia: Injecting drug users take central role in anti-stigma film UNAIDS (10.08.09) The lives of injecting drug users and the HIV-related stigma and discrimination they face was one focus of the IX International Congress on AIDS in Asia and the Pacific as the film Suee (Needle) was launched by Response Beyond Borders, the Asian consortium on drug use HIV, AIDS and poverty. Unveiled during the satellite session, ‘Reforming treatment environments – How to make compulsory drug treatment HIV friendly’, the film gives a voice to this vulnerable group with anti-stigma messages conveyed by the injecting drug users themselves. It was directed by award-winning Indian movie director, author and screen-writer, Sai Paranjpye, who set out to present an uncompromising insight into a world where HIV prevalence is disproportionately high. Ms Paranjpye, a Cannes Film Festival award winner, worked closely with injecting drug users on Suee and spent time interviewing them on location and involving them as actors in the film. They ‘own’ the project as much as is practically possible. She also consulted a full range of partners and obtained feed back on the script and other help from NGOs working in HIV prevention with injecting drug users, especially Sharan in Delhi and Sankalp in Mumbia. She also received input from the International Center for Research on Women and World Bank teams, among others. Suee explores a number of areas in the lives of injecting drug users including treatment, care, peer and community support, rehabilitation and the workplace. It is intended to convey messages of hope and not to trigger reactions of pity or fear; empowering the audience by raising awareness and presenting facts in a non-judgmental way. Made for general consumption, the film can also be used in youth campaigns, providing education and information for young people to help prevent HIV and reduce both risk and vulnerability. The film emerged from the South Asia Region Development Marketplace (SAR DM), an initiative spearheaded by the World Bank. It consists of a competitive grants programme that identifies and supports small scale projects demonstrating an innovative approach to reducing HIV stigma and discrimination in the region. 26 civil society organisations from across South Asia won grants of US$ 40,000 each to bring their ideas to fruition. Ms Paranjpye has used her SAR DM award to produce not only the Suee film but another, called "The sound of the horn", which deals with truck drivers. Stigma and discrimination are seen as major barriers to scaling up HIV prevention services in the region. They marginalise those living with the virus and contribute to their social isolation and rejection. They also discourage vulnerable groups from accessing HIV treatment, care and support services. It is hoped that Suee, once widely disseminated, will take its place among a range of interventions helping to reduce stigma and discrimination against South Asia’s injecting drug users. The film was selected by the screening committee of the Congress and will be shown again on August 11. Note: Partners and sponsors of the South Asia Region Development Marketplace include: UNAIDS, UNICEF, UNODC, UNDP, the Global Fund, the Government of Norway, the International Center for Research on Women, the International Finance Corporation, and the Swedish International Development Cooperation Agency (SIDA) .......................................................................... __________________________________________________________________________ UK: Hartlepool mum's terror as she finds children playing with needles Mirror.co.uk (10.08.09) A terrified mum caught her two young girls injecting each other with potentially lethal used needles while playing doctors and nurses. Three-year-old Savannah Murphy and Gypsey, five, were playing in the street with cousin Callum Chapman, five, when they found the syringes in dumped rubbish bags. Mum Debra Chapman, from Hartlepool, took all three to hospital and is awaiting test results. They have been given hepatitis B injections. Debra, 28, said: "Savannah had two stab marks on her right hand and one in her left leg. The first thing that went through my mind was that they might have caught Aids or TB." .......................................................................... __________________________________________________________________________ USA: Three More Hepatitis C Cases Discovered Michael Booth, Denver Post Denver Colorado USA (08.08.09) State health authorities say three more cases of hepatitis C virus infection have been potentially linked to a surgery technician's drug- theft scheme. While working at Rose Medical Center in Denver and later at Audubon Surgery Center in Colorado Springs, the technician is alleged to have stolen syringes containing the painkiller Fentanyl from surgery carts, injected herself with the drug, and refilled the used syringes with saline solution. Following the testing of thousands of former patients, the state is issuing weekly updates on the number of cases possibly associated with the technician. The health department now says 20 Rose patients have at least preliminary matches to the technician's HCV. Audubon has said the single case linked to it will prove unrelated once more extensive tests are performed. The technician has pleaded not guilty to federal drug charges. .......................................................................... __________________________________________________________________________ Indonesia, South Asia new flashpoints in AIDS fight: experts By Arlina Arshad, AFP (08.08.09) JAKARTA - India, Indonesia and Pakistan have become key fronts in Asia's fight against HIV/AIDS, health experts said ahead of the International Congress on AIDS in Asia and the Pacific next week. Delegates from 65 countries will gather on the Indonesian resort island of Bali from Sunday to Thursday to discuss strategy and "renew our commitment to fight the disease," congress chairman Zubairi Djoerban said. Two of the main talking points are expected to be how to reach the 75 percent of sufferers who are not receiving treatment, and how to stop the disease spreading among intravenous drug users. But Djoerban said that, without a matching commitment from governments to tackle the disease that killed 380,000 people across Asia in 2007, the conference would achieve little. "We can discuss prevention and treatment but with no leadership and commitment from countries and the community, we won't achieve much," he said. An estimated five million Asians are living with HIV, especially in southeastern countries such as Thailand, Cambodia, the Philippines and Indonesia, according to a UN report released last year. While there are some bright spots, such as Cambodia, where HIV prevalence has declined through condom use, new infections are growing steadily in populous countries such as Bangladesh and China, the report added. In Indonesia and South Asia, Djoerban said the biggest threat was the lethal combination of dirty needles and unprotected sex. "We're concerned about India, Indonesia and Pakistan, where there is overlapping of drug injecting and unprotected sex... this includes sex workers taking drugs and drug users not using condoms," he said. "New infections are offsetting positive results from preventive actions." In Indonesia, where HIV/AIDS cases have tripled since 2005 to 26,632, according to official figures, prisoners and prostitutes have joined injecting drug users to become among the groups most at risk. A third of 254 prison deaths in the country in May this year were due to HIV/AIDS. Meanwhile, one of the worst HIV epidemics outside of Africa is under way in Indonesia's remote eastern province of Papua, where 2.4 out of every 100 people are infected due to an influx of migrants workers and a booming sex industry. Despite the gloomy outlook, the HIV prevalence in the region can be considered low compared with worst-hit Africa. "In South and Southeast Asia, the HIV prevalence is 0.3 percent. In sub- Saharan Africa, it's five percent," Djoerban said. The congress will try to push the United Nations and G8 countries to meet commitments made in the wake of the UN World Summit in 2005, particularly plans for "universal access" to antiretroviral treatment by next year. Only 25 percent of the 1.7 million HIV/AIDS sufferers in the Asia-Pacific region who need antiretroviral treatment are receiving it, Djoerban said. "We're not talking 100 percent, which is the ideal. If Latin America can treat 62 percent of sufferers there, we should strive towards that," he said. "We ask for commitment from the countries to achieve the targets they have set and if they say they can't, we'll discuss new efforts to help them reach their goals." The Bali congress will also cover topics ranging from HIV risks among transgenders and migrant workers to biomolecular advances in HIV treatment and the impact of the financial crisis on HIV/AIDS sufferers. Copyright © 2009 AFP .......................................................................... __________________________________________________________________________ Mexico: Piden investigar presuntos contagios de VIH en hospital mexicano Associated Press [Spanish] (09.08.09) MEXICO (AP) - La Comisión Nacional de los Derechos Humanos de México solicitó a un hospital público que investigue los casos de dos menores de edad que se contagiaron de VIH, el virus que causa el sida, luego que se les realizaron transfusiones de sangre en 2008. La comisión gubernamental pidió al hospital La Raza en la Ciudad de México que investigue si otros pacientes resultaron infectados, pero sus recomendaciones no son obligatorias. De acuerdo con la CNDH, el hospital no cumplió con las normas sobre pruebas, clasificación y manejo de la sangre. La comisión informó el domingo que los pacientes afectados eran un niño de 10 años y un adolescente de 13, además de que se tenía otro reporte de una infección presentada por un familiar de una persona atendida en el mismo hospital. Los nombres de las víctimas no fueron revelados. Envía este artículoComenta con tus amigosVersión para imprimir .......................................................................... __________________________________________________________________________ USA: Patient Suing Doctor In NJ Hepatitis Outbreak: Nearly 3,000 Urged To Get Tested For Hep B, C & HIV By Kathryn Brown, CBS 2 HD News Newark NJ USA (07.08.09) Regulators have indefinitely suspended the medical license of N.J. Dr. Parvez Dara, whose office is suspected as the source of a Hepatitis outbreak. Regulators have already indefinitely suspended the medical license of Dr. Parvez Dara, whose office is suspected as the source of a hepatitis outbreak. Dara's patients were advised to get tested after five cancer patients tested positive for the blood-borne infection. The state is still investigating the outbreak. Officials have refused to say how many more tested positive after the warnings were sent out, citing the ongoing investigation. Roland Jacobsen of Manchester is now suing. He claims he contracted the disease after being treated at Dara's Toms River offices. Jacobsen's attorney tells the Asbury Park Press that Jacobsen had tests showing clean blood before Dara treated him. Dara could not be reached for comment Dara's attorney had asked the Board of Medical Examiners to reinstate Dara's medical license, or at least allow him to perform consultations and exams. In April, Dara said there was no direct evidence that the hepatitis cases were linked to him. Members of the state Board of Medical Examiners decided to temporarily suspend the Ocean County oncologist's license on an emergency basis. Following that ruling, Dara fought to keep his license to practice medicine. "I went into this to heal sick people, not to make healthy people sick," Dara said. At a hearing in front of the medical board after the warning was sent out, prosecutors showed pictures of Dara's Tom's River oncology practice, and pointed to dozens of health code violations, including bloodstains in the chemotherapy treatment room, expired medication and non-sterile syringes. "That's going to be adjacent to open wounds in patients," Dr. Barbara Montana said. "When you are drawing blood in a patient you are going to be piercing the skin." Ken Palmer represents one of Dr. Dara's patients that has been infected with hepatitis B. She sought treatment in his office for breast cancer. Palmer said his client believes she got sick at Dara's office. "Absolutely, because she had a number of blood tests before -- and the time of her treatment with Dr. Dara links up with the time where she didn't treat with anybody else." Dara maintained his practice is sanitary and safe. "Patients have actually come into my office hugging me and actually praying, saying they will keep me in their prayers," Dara said. All of Dara's nearly 3,000 patients were encouraged to get tested for hepatitis B, hepatitis C and HIV. "The first thing I did was call my husband," said Linda Bradford, who husband is a patient of Dr. Dara's. "I was terrified. I thought what was going on here?!" The state is still looking for people who may have contracted hepatitis B. In the meantime, the investigation into exactly what sparked the outbreak is ongoing. .......................................................................... __________________________________________________________________________ USA: Certain Blood Transfusions Increase Risk of Infection By Meredith Hegg, Voice of America (07.08.09) The risk of infection in coronary artery bypass surgery doubles if doctors give the patient a transfusion of blood from another person, according to a study led by epidemiologist Mary Rogers. "There continued to be considerable variation across hospitals in the use of transfusions," Rogers says. This inconsistency concerns her, she adds, because "we found that [a transfusion of] allogeneic blood, which is blood from a person that is genetically dissimilar from yourself, yielded increased odds of in-hospital infection about twofold." The body's system-wide response Rogers says her analysis of nearly 25,000 Medicare patients in Michigan showed that the allogeneic transfusion recipients were at greater risk for a wide range of infections. "It increased the risk of infection at multiple sites, it wasn't just at the site where the incision was made, but it was increased risk of urinary tract infections, increased risk of respiratory tract infections, blood stream infection, skin infection," Rogers explains. "It was system wide." Transfusions of the patient's own blood did not appear to have much effect. The University of Michigan researcher suggests the body's reaction to foreign tissue may explain the difference. "There is an immune response to the receipt of this genetically dissimilar tissue and thus people are - their immune system is a bit suppressed, at least temporarily, which puts them at risk of various types of infections." Rogers stresses, "We don't think it's because of inadvertent contamination of the blood." Implications for hospital practice Rogers says this research suggests that hospitals should adopt certain practices to regulate transfusions and make them less common. "Some hospitals have [transfusion] coordinators. Some hospitals have offered bloodless surgery, which means that they try to minimize the use of allogeneic blood for certain procedures if possible." According to Rogers, several studies currently underway, in which patients are randomly assigned to different treatment groups, should provide more conclusive evidence. Her study is published in the online journal, BMC Medicine. .......................................................................... __________________________________________________________________________ Brazil - UK: Brazil returns hazardous UK waste BBC News, UK (06.08.09) Around 1,500 tons of hazardous waste which arrived in Brazil from the UK labelled as recyclable plastic is on its way back, authorities have said. The Brazilian Institute of Environment and Renewable Natural Resources said the cargo included used syringes, condoms and dirty nappies. Three British men have been arrested over alleged illegal shipments. Officers from the Environment Agency and Wiltshire Police raided three properties in Swindon in July. Three men, aged 24, 28 and 49, were bailed until the end of October. Formally complain The Institute said 81 containers arrived between February and May 2009 at Brazilian ports. It added that they were labelled recyclable plastic, but had been packed with domestic and hospital waste. They were sent back towards the UK from the port of Santos on Wednesday. The Environment Agency said it would investigate their contents before disposing of them safely. Brazil's government said it would formally complain to the World Trade Organisation over the deliveries. Under the Basel Convention, shipments of toxic waste from industrialised nations are banned, officials said. Waste can be exported for recycling, but it is illegal to send it abroad for disposal. The maximum penalty for doing so is an unlimited fine or up to two years in jail. Story from BBC NEWS: http://news.bbc.co.uk/go/pr/fr/-/2/hi/uk_news/8187081.stm © BBC MMIX .......................................................................... __________________________________________________________________________ One use only: the broken syringe that saves lives By Katie Scott Wired.co.uk UK (06.08.09) TEDGlobal attendee Marc Kosta is saving lives with a new design of syringe. In 1984, Marc Koska read a newspaper article predicting the spread of HIV through medical syringes. He decided to take action and spent the next ten years researching the spread of diseases through the use of dirty syringes. His studies found that there were 23,000 HIV infections due to unsafe injections each year, as well as one million of hepatitis C and 21 million of hepatitis B. This results in about 1.3 million deaths per year. The World Heath Organisation states that more than half of all injections in the developing world are carried out with re-used or unsterile equipment. Koska’s solution is a syringe that can only be used once. The AD (Auto Disable) syringe, or K1, is designed so that once the plunger has been pushed in, it cannot be pulled out without snapping. Importantly, the syringe can be manufactured on machines used for standard syringe production and Koska adds that he has targeted developing world manufacturers "to ensure wide availability and global affordability". More than a billion of the K1 syringes had been made by May last year. However, Kosta has also created a charity called Safepoint, which sets out to educate people about the dangers of re-using syringes. In India, the team reached over half a billion people with a TV, radio, newspaper and cinema advertising campaign which included the video below. Following this, Koska approached the Indian Federal Minister of Health to mandate the use of AD syringes in all public hospitals and clinics. This came into force in April this year. The charity had a similar success in Pakistan. The Safepoint team is now planning to target Africa. Video at: http://www.youtube.com/watch?v=LjMjjbBjSXc&feature=channel http://tinyurl.com/silentepidemic TEDGlobal: http://conferences.ted.com/TEDGlobal2009/ .......................................................................... __________________________________________________________________________ USA: OSHA Investigates Biohazard Waste Practices at Audubon Surgery Center KRDO, Colorado Springs Colorado (05.08.09) COLORADO SPRINGS - The Occupational Safety and Health Administration confirms to NEWSCHANNEL 13 that it is investigating Audubon Surgery Center's biohazard waste practices. A spokesperson from OSHA received a complaint about practices at Audubon sparking the investigation. The Colorado Springs based surgical center has one week to respond. The investigation could lead to OSHA investigators performing an onsite investigation. On July 24, The Colorado Department of Health and Environment reported Friday the first confirmed case of Hepatitis C from the Audubon Surgery Center linked to a surgical tech who is accused of swapping out needles with patients to feed a drug addiction. Kristen Parker was indicted Thursday by a federal grand jury in Denver and faces 42 criminal counts. 21 of the counts are for tampering with a consumer product (the liquid pain medication Fentanyl), the other 21 counts are for obtaining Fentanyl by deceit. 19 of the 21 counts are related to patients who, according to the U.S. Attorney's Office have tested positive for Hepatitis C following a surgery at Rose Medical Center, on a day Parker worked. The 20th count is for the day Parker stuck a co-worker with a needle that was in her pocket. The 21st count is for the day Parker tested positive for Fentanyl at Rose Medical Center. None of the counts deal with any patients at Audubon Surgery Center. NEWSCHANNEL 13's Josh Simeone is tracking this story and will have a full report on NEWSCHANNEL 13 at 10 p.m. .......................................................................... __________________________________________________________________________ USA: New York Hep C Lawsuit Newsinferno.com USA (04.08.09) In addition to the numerous hepatitis C cases cropping up nationwide and allegedly linked to former surgical tech Kristen Diane Parker, 26, what appears to be the first lawsuit in New York alleging hep C contamination due to Parker’s practices has been filed. The New York Post is reporting that David Swift, 53, a former patient at Northern Westchester Hospital is the first patient in New York to allege hep C contamination from Parker. Swift underwent outpatient ankle surgery in 2007 and was recently advised to undergo testing because he was administered Fentanyl when Parker was working in the operating room, said The Post. Last month, the Northern Westchester Hospital advised over 2,700 patients to receive testing, said LoHud.com, previously. Parker is infected with hepatitis C and, now, so too is Swift. "My wife and I try to live a healthy life. Now somebody else’s risky behavior is causing me a lot of hardship," said Swift, quoted The Post. Swift’s attorney filed the lawsuit late last week against both Parker and the Northern Westchester Hospital, said The Post. Parker allegedly swapped sterile Fentanyl syringes with dirty- potentially hepatitis C-contaminated-saline-filled syringes, endangering countless patients. Hepatitis C is spread by contact with infected body fluids, especially blood. The disease attacks the liver, and can lead to cirrhosis or cancer of the liver. There is no vaccine for hepatitis C and the incurable disease can be fatal. According to LoHud.com, hepatitis C is the leading cause of liver transplants. Parker worked at Rose from Oct. 21 to April 13 and at Colorado Springs’ Audubon Surgery Center from May 4 until June 29. Parker also worked at Christus St. John Hospital outside Houston, Texas between May 2005 and Oct. 2006, the Associated Press (AP) previously reported and at Northern Westchester Hospital in New York’s Mount Kisco between Oct. 8, 2007, and Feb. 28, 2008. Investigations continue in all three states and patients continue to be tested. We recently reported that 19 patients from Rose tested positive for the dangerous and sometimes deadly disease. LoHud.com recently reported that five of over 1,200 former surgical patients at Northern Westchester Hospital in New York have also tested positive for the hepatitis C virus, citing hospital officials. Three of those patients apparently contracted the disease prior to Parker’s employment at the facility. One patient from Audubon, said KRDO previously, also tested positive for the virus. More positive hepatitis C results are expected. Parker was indicted last week on 42 counts by a federal grand jury, 21 counts of product tampering and 21 counts of obtaining a controlled substance by deceit, reported the Denver Post previously. These charges, said the Denver Post, only relate to Parker’s alleged activities at Rose. Parker was also charged with three criminal counts earlier in the month that were connected to stealing Fentanyl, the Denver Post noted. The Denver Post reported that additional charges could be made in future indictments and that, if convicted, Parker could face life in prison. Although Parker alleges she did not know she was infected with hepatitis C at the time the crimes were committed, the Associated Press (AP) previously reported that Parker tested positive with the virus before she began working at Rose, but that Parker never followed-up on the diagnosis. The Denver Post noted that Parker was told at a pre-employment exam at Rose that she was likely infected with hepatitis C and Parker, herself, told police she shared needles when she used heroin. .......................................................................... __________________________________________________________________________ Machine designed to reduce infections and cut back on expensive "disposables" News-Medical.Net, (30.07.09)3 Johns Hopkins experts in applied physics, computer engineering, infectious diseases, emergency medicine, microbiology, pathology and surgery have unveiled a 7-foot-tall, $10,000 shower-cubicle-shaped device that automatically sanitizes in 30 minutes all sorts of hard-to-clean equipment in the highly trafficked hospital emergency department. The novel device can sanitize and disinfect equipment of all shapes and sizes, from intravenous line poles and blood pressure cuffs, to pulse oximeter wires and electrocardiogram (EKG) wires, to computer keyboards and cellphones. The invention, nicknamed "SUDS" for self-cleaning unit for the decontamination of small instruments, has already been shown to initially disinfect noncritical equipment better than manual cleaning, they report in the Annals of Surgical Innovation and Research online July 30. Study senior author and surgeon Bolanle Asiyanbola, M.D., says the four- year SUDS project was initially sparked by the rapid rise in use of expensive disposable items, a trend linked to efforts to prevent bacterial infections among and between patients in hospitals. Drawing on her experience in the operating room, where many batches of surgical clamps, retractors and scalpels have been sterilized, decontaminated and safely re-used for decades, Asiyanbola put together a team to end what she calls the "wasteful and unnecessary" practice of wiping down a lot of heavily used items with disinfectants and applying a lot of elbow grease. "If we can safely re-use equipment in the operating room, then we can do it elsewhere in the hospital for non-critical equipment," she says. In the study, the Johns Hopkins team showed that SUDS was able to disinfect some 90 pieces of used emergency-room equipment, placing as many as 15 items in the device and "fogging" the equipment with an aerosolized, commercially available disinfectant chemical, or biocide, called Sporicidin. None of the electronic circuitry appeared to be damaged by the decontamination process. Instruments tested were of the type that comes in direct contact with a patient's skin, the body's key barrier to infection. Repeated swabbing and lab culture testing of each decontaminated instrument showed that all items remained free of so-called gram-positive bacteria for two full days after cleaning, even after the equipment was returned to the emergency department and re-used. On the bacteria-free list were such potentially dangerous superbugs as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE). By contrast, testing of an equal number of similar items that were manually scrubbed down with a disinfectant solution, called Airex, showed that 25 percent of the devices had bacterial growth after two days, including growth of potentially dangerous gram-positive bacteria, such as MRSA and VRE, as well as gram-negative type bacteria, most notably, Pseudomonas aeruginosa, and Acinetobacter baumannii, plus some types of fungi. "Our study results with the prototype offer strong evidence that more can be done to disinfect noncritical equipment through automated decontamination processes in heavily trafficked areas of the hospital," says Asiyanbola, an assistant professor at the Johns Hopkins University School of Medicine. "We believe this SUDS device has the potential to further protect our patients and staff from hospital infections and save health care dollars by making it possible to clean and re-use more kinds of hospital equipment." The Hopkins inventors, who have patent applications pending, say more studies must be done to determine if SUDS is effective for other hospital superbugs, notably, Clostridium difficile. Asiyanbola worked closely with Karen Carroll, M.D., director of microbiology and a professor of pathology and medicine, and Allison Agwu, M.D., an assistant professor, both at Johns Hopkins, to assemble the necessary team to help test the prototype. Funding was provided by a grant from the Department of Surgery at The Johns Hopkins Hospital. Besides Asiyanbola, Carroll and Agwu, other Johns Hopkins University researchers involved in this study were C. Obasi, M.D., Richard Rothman, M.D., and T. Ross, M.T., at the School of Medicine; W. Akinpelu, M.Sc., and R. Hammons, Ph.D., at the University's Applied Physics Laboratory; C. Clarke, Ph.D., and R. Etienne-Cummings, Ph.D., at the University's Whiting School of Engineering; P. Hill, M.D., and S. Babola, Ph.D., at the University's Bloomberg School of Public Health. http://www.hopkinsmedicine.org .......................................................................... __________________________________________________________________________ USA: State Trains Inmates in Preventing Hepatitis C Associated Press (28.07.09) New Mexico health and corrections officials are training 10 male inmates on how to educate their peers about hepatitis C, a disease that affects roughly 38 percent of the state prison population. The inmates will receive 32 hours of training on the blood-borne virus and other infectious diseases. As of June, New Mexico recorded more than 2,400 confirmed hepatitis C cases among state inmates. __________________________________________________________________________ _____________________________________*____________________________________ __________________________________________________________________________ * 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. Telephone: +41 22 791 3680, Facsimile: +41 22 791 4836, E- mail: sign@who.int _____________________________________*____________________________________ __________________________________________________________________________ SIGN meets annually to aid collaboration and synergy among SIGN network participants worldwide. The 2009 SIGN annual meeting will be held from 30 November to Wednesday 2 December 2009 at WHO Headquarters in Geneva Switzerland. The PQS (performance Quality and Safety) consultative meeting with the industry, will be held back to back with the SIGN meeting on 3rd and 4th December 2009. Get the final report of the SIGN Meeting 2008, Moscow, Russian Federation [2.36Mb] at: http://www.who.int/injection_safety/2008MeetingReport.pdf Many SIGN files can be opened in Acrobat Reader. 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