*SAFE INJECTION GLOBAL NETWORK* SIGNPOST *SAFE INJECTION GLOBAL NETWORK* Post00509 Abstracts + HCWM + News 19 August 2009 SIGN 2009 > 30 November - 2 December 2009 @ WHO HQ Geneva CONTENTS 1. Abstract: Professional biological risk factors of health care workers 2. Abstract: Treatment of infectious waste: development and testing of an add-on set for used gravity displacement autoclaves 3. Abstract: Health care professionals' perceptions and knowledge of infection control practices in a community hospital 4. Abstract: Combined DTP-HBV-HIB vaccine versus separately administered DTP-HBV and HIB vaccines for primary prevention of diphtheria, tetanus, pertussis, hepatitis B and Haemophilus influenzae B (HIB) 5. Abstract: HIV-risk behavior among injecting or non-injecting drug users in Cape Town, Pretoria, and Durban, South Africa 6. Abstract: Evaluation of disinfecting procedures for aseptic transfer in hospital pharmacy departments 7. Abstract: Hand hygiene: seeing is believing 8. Abstract: Revisiting the moist heat sterilization myths 9. Abstract: Inactivation of virus in intravenous immunoglobulin G using solvent/detergent treatment and pasteurization 10. Abstract: Large-dose intravenous ferric carboxymaltose injection for iron deficiency anemia in heavy uterine bleeding: a randomized, controlled trial 11. Abstract: Perceived knowledge of blood-borne pathogens and avoidance of contact with infected patients 12. Abstract: Endophthalmitis due to inadvertent globe penetration during retrobulbar injection of saline solution for laser in situ keratomileusis 13. Abstract: Life-Threatening Flecainide Intoxication in a Young Child Secondary to Medication Error (September) 14. Abstract: Contact tracing and serosurvey among healthcare workers exposed to Crimean-Congo haemorrhagic fever in Greece 15. Abstract: Awareness among barbers about health hazards associated with their profession 16. Five Weeks until the 1st African Congress On Infection Prevention Control - 2009 17. News - India: Freedom from shots, kids can sniff measles vaccine - India: Needle-Free Measles Vaccine Expected To Enter Clinical Trials In India - India: First powder vaccine for measles to be tested in India - Canada: More Needles Given to Drug Users - USA: Woman convicted in vaccine scheme heads to prison - USA: Supes to get report on needle exchange - China: Expert: HIV/AIDS epidemic still on rise in China - USA: Hepatitis Cased Linked to South Dakota Clinic - USA: Siouxland Urology Associates - Response to Lawsuit Allegations - USA: Attorneys: Bankruptcies could delay hepatitis trials - Canada: City studies safe-injection site for Toronto - USA: Editorial > Sticking Point - China: China’s Incinerators Loom as a Global Hazard This edition of SIGNpost is located at: http://uqconnect.net/signfiles/Archives/SIGN-POST00509.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. Abstract: Professional biological risk factors of health care workers __________________________________________________________________________ Medicina (Kaunas). 2009;45(7):530-6. [Professional biological risk factors of health care workers] [Article in Lithuanian] Gailiene G, Cenenkiene R. Department of Infection Control, Hospital of Kaunas University of Medicine, Eiveniu 2, 50009 Kaunas, Lithuania. greta.gailiene@kmuk.lt Health care workers are attributed to the group at highest risk of biological factors, as they are daily exposed to fluids of the human body. The risk of sharps injuries and exposure to blood is associated with bloodborne infections. The aim of this study was to determine the frequency and type of professional biological risk factors, to evaluate the use of personal protective devices, application of immunoprophylaxis to health care workers in the surgical departments. METHODS. A retrospective study was carried out from January to June 2006. Data were collected in the surgical departments of Hospital of Kaunas University of Medicine. An anonymous questionnaire survey was performed. RESULTS. More than half (51.4%) of the respondents experienced sharps injuries, 62.1% were exposed to biological fluids, and 39.6% of the workers experienced both injury and exposure. In all cases, the hands were injured during sharps injuries. Exposure of healthy skin and eyes to biological fluids occurred in 63% and 20% of the cases, respectively. Majority of exposures were blood splashes (60%). Physicians most frequently experienced sharps injury during the surgery (79.3%), nurses - during the preparation of instruments (35.1%), supporting staff - disposing the waste (75.8%). Commonly physicians were injured by surgical needles (72.4%), nurses - by needlestick (72.4%), and supporting staff - by glass waste (60.6%). Majority of the respondents (86%) were not vaccinated with HB vaccine. No personal protective equipment was used by 14.5% of the respondents during sharps injuries and 5% during exposures. CONCLUSIONS. More than half of the respondents experienced sharps injury or exposure to biological fluids during the study period. Physicians and nurses experience sharps injury and exposure to biological fluids more commonly as compared to supporting staff. Hepatitis B vaccination is insufficient among health care workers. __________________________________________________________________________ _____________________________________*____________________________________ 2. Abstract: Treatment of infectious waste: development and testing of an add-on set for used gravity displacement autoclaves __________________________________________________________________________ Waste Manag Res. 2009 Jun;27(4):343-53. Treatment of infectious waste: development and testing of an add-on set for used gravity displacement autoclaves. Stolze R, Kühling JG. ETLog Health EnviroTech & Logistics GmbH, Berlin, Germany. stolze@etlog- health.de The safe management of potentially infectious healthcare waste is gaining increasing worldwide importance. In developing countries, simple incinerators are used for the treatment of this type of waste stream. However, as these incinerators produce high emissions and represent the main generators of dioxin and furans in these countries, alternative and cost-effective solutions are needed. As steam treatment systems do not produce persistent organic pollutants, the use of existing (older) medical autoclaves could represent a solution for the treatment of infectious waste. ETLog Health EnviroTech & Logistics, the German-based consulting and engineering company carried out the first research into whether gravity air displacement autoclaves can be used for the safe decontamination of infectious waste. The research showed that it is not possible to decontaminate waste using this type of autoclave. A subsequent research and development phase might, however, make it possible to develop a new process cycle. Tests carried out on the basis of international standards and norms showed that by applying this process cycle and using an add-on set, it is possible to treat healthcare waste using the existing stock of older medical autoclaves. The process cycle and the add-on set developed were tested under existing conditions in Hanoi, Vietnam using the treatment cycle developed for a 13- year-old autoclave. All the parameters for infectious waste decontamination were reached. As modified autoclaves prevent the emission of toxic substances, this approach presents an interim solution, which avoids the impacts on human health and the environment caused by the incineration of healthcare waste. __________________________________________________________________________ _____________________________________*____________________________________ 3. Abstract: Health care professionals' perceptions and knowledge of infection control practices in a community hospital __________________________________________________________________________ Health Care Manag (Frederick). 2009 Jul-Sep;28(3):230-8. Health care professionals' perceptions and knowledge of infection control practices in a community hospital. Lewis KL, Thompson JM. Author Affiliations: Department of Health Sciences (Dr Lewis); and Health Services Administration Program (Dr Thompson), James Madison University, Harrisonburg, Virginia. As hospital-acquired infections increase, it is essential that infection control practitioners and hospital administrators have an understanding of the perceptions and knowledge of health care providers as they relate to infection control practices. This article describes the use of the Health Belief Model, a theory-based model used to predict health-related behaviors, in assessing hospital clinical professionals' perceptions and knowledge of infection control practices and summarizes findings from an exploratory study conducted in a community hospital. A total of 130 providers within a hospital setting completed a 51-item survey instrument. The scores for the 6 Health Belief Model constructs show variation, with perceived severity, perceived benefits, and self-efficacy rated higher than perceived susceptibility and cues to action. Knowledge on hand hygiene practices was limited. Providers did not identify any perceived barriers or possible cues to action to increase the likelihood of engaging in proper infection control practices. The constructs of perceived susceptibility and cues to action show a need for improvement by determining appropriate cues for this workforce and addressing susceptibility of workers. These findings can be used by administrators and infection control practitioners to develop and disseminate educational and other interventions to increase compliance with infection control protocols. __________________________________________________________________________ _____________________________________*____________________________________ 4. Abstract: Combined DTP-HBV-HIB vaccine versus separately administered DTP-HBV and HIB vaccines for primary prevention of diphtheria, tetanus, pertussis, hepatitis B and Haemophilus influenzae B (HIB) __________________________________________________________________________ Cochrane Database Syst Rev. 2009 Jul 8;(3):CD005530. Combined DTP-HBV-HIB vaccine versus separately administered DTP-HBV and HIB vaccines for primary prevention of diphtheria, tetanus, pertussis, hepatitis B and Haemophilus influenzae B (HIB). Bar-On ES, Goldberg E, Fraser A, Vidal L, Hellmann S, Leibovici L. Department of Medicine E, Beilinson Campus, Rabin Medical Center, 39 Jabotinsky Street, Petah-Tiqva, Israel, 49100. BACKGROUND: Advantages to combining childhood vaccines include reducing the number of visits, injections and patient discomfort, increasing compliance, and optimizing prevention. The World Health Organization recommends that routine infant immunization programs include a vaccination against Haemophilus influenza type B (HIB) in the combined diphtheria, tetanus, pertussis (DTP)-hepatitis B (HBV) vaccination. The effectiveness and safety of the combined vaccine should be carefully and systematically assessed to ensure their acceptability by the community. OBJECTIVES: To compare the effectiveness of combined DTP-HBV-HIB vaccine with DTP-HBV and HIB vaccinations. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, issue 1) which contains the Acute Respiratory Infection Group's Specialized Register; MEDLINE (January 1966 to March 2009) and EMBASE (January 1990 to March 2009). SELECTION CRITERIA: Randomized or quasi-randomized controlled trials comparing vaccination with any combined DTP-HBV-HIB vaccine, with or without three types of inactivated poliovirus (IPV) or concomitant oral polio vaccine (OPV) in any dose, preparation or time schedule, compared with separate vaccines or placebo, administered to infants aged up to two years. DATA COLLECTION AND ANALYSIS: Two review authors independently inspected references identified by the searches and evaluated them against the inclusion criteria, extracted data and assessed the methodological quality of included trials. MAIN RESULTS: Meta-analysis was performed to pool the results of 18 studies. There were no data on clinical outcomes for the primary outcome and all studies used immunogenicity and reactogenicity (adverse events). In two immunological responses the combined vaccine achieved lower responses than the separate vaccines for HIB and HBV. Comparison found little heterogeneity. No significant differences in immunogenicity were found for pertussis, diphtheria, polio and tetanus. Serious adverse events were comparable. Minor adverse events were more common in children given the combined vaccine. AUTHORS' CONCLUSIONS: We could not conclude that the immune responses elicited by the combined vaccine were different from, or equivalent to, the separate vaccines. Data for the primary outcome (prevention of disease) were lacking. There was significantly less immunological response for HIB and HBV, and more local reactions in the combined injections. However, these differences rely mostly on one study each. Studies did not use an intention-to-treat analysis and we were uncertain about the risk of bias in many of the studies. These results are therefore inconclusive. Studies addressing clinical end- points whenever possible, using correct methodology and a large enough sample size should be conducted. __________________________________________________________________________ _____________________________________*____________________________________ 5. Abstract: HIV-risk behavior among injecting or non-injecting drug users in Cape Town, Pretoria, and Durban, South Africa __________________________________________________________________________ Subst Use Misuse. 2009;44(6):886-904. HIV-risk behavior among injecting or non-injecting drug users in Cape Town, Pretoria, and Durban, South Africa. Parry CD, Carney T, Petersen P, Dewing S, Needle R. Alcohol & Drug Abuse Research Unit, Medical Research Council, Tygerberg, South Africa. cparry@mrc.ac.za The rapid assessment aimed to describe drug use and sexual practices that place injection and noninjection drug users (IDUs/NIDUs) at risk for HIV in South Africa. The sample comprised 85 key-informant (KI) and focus- group (FG) interviewees in or serving locations with high levels of drug use in Cape Town, Durban, and Pretoria. HIV testing of drug-using KIs was conducted using the SmartCheck Rapid HIV-1 Antibody Test. The findings indicated that commonly used drugs had differing effects on sexual and drug-use practices. Risky injecting behaviors among IDUs were common, and most interviewees engaged in sex when on drugs, some without condoms. These behaviors were also influenced by trust in intimate relationships. Injection drug users seemed more knowledgeable about HIV transmission than NIDUs, and 20% of IDUs who agreed to HIV screening tested positive. Views about drug- and HIV-intervention services, accessibility, and their efficacy were mixed. The findings suggest greater synergy is needed between drug- and HIV- intervention sectors and that consideration should be given to making various risk-reduction strategies more accessible. The study's limitations have been noted. __________________________________________________________________________ _____________________________________*____________________________________ 6. Abstract: Evaluation of disinfecting procedures for aseptic transfer in hospital pharmacy departments __________________________________________________________________________ PDA J Pharm Sci Technol. 2009 Mar-Apr;63(2):123-38. Evaluation of disinfecting procedures for aseptic transfer in hospital pharmacy departments. Mehmi M, Marshall LJ, Lambert PA, Smith JC. School of Life and Health Sciences, Aston University, Birmingham, UK. Current practice in National Health Service (NHS) hospitals employs 70% Industrial Methylated Spirit spray for surface disinfection of components required in Grade A pharmaceutical environments. This study seeks to investigate other agents and procedures that may provide more effective sanitisation. Several methods are available to test the efficacy of disinfectants against vegetative organisms. However, no methods currently available test the efficacy of disinfectants against spores on the hard surfaces encountered in the pharmacy aseptic processing environment. Therefore, a method has been developed to test the efficacy of disinfectants against spores, modified from British Standard 13697 and Association of Analytical Chemists standards. The testing procedure was used to evaluate alternative biocides and disinfection methods for transferring components into hospital pharmacy cleanrooms, and to determine which combinations of biocide and application method have the greatest efficacy against spores of Bacillus subtilis subspecies subtilis 168, Bacillus subtilis American Type Culture Collection (ATCC) 6633, and Bacillus pumilis ATCC 27142. Stainless steel carrier test plates were used to represent the hard surfaces in hospital pharmacy cleanrooms. Plates were inoculated with 10(7)-10(8) colony-forming units per milliliter (CFU/mL) and treated with the various biocide formulations, using different disinfection methods. Sporicidal activity was calculated as log reduction in CFU. Of the biocides tested, 6% hydrogen peroxide and a quaternary ammonium compound/chlorine dioxide combination were most effective compared to a Quat/biguanide, amphoteric surfactant, 70% v/v ethanol in deionised water and isopropyl alcohol in water for injection. Of the different application methods tested, spraying followed by wiping was the most effective, followed closely by wiping alone. Spraying alone was least effective. __________________________________________________________________________ _____________________________________*____________________________________ 7. Abstract: Hand hygiene: seeing is believing __________________________________________________________________________ Healthc Q. 2009;12 Spec No Patient:110-4. Hand hygiene: seeing is believing. Plante-Jenkins C, Belu F. Trillium Health Centre in Mississauga, Ontario, canada. Hand hygiene is one of the most important measures to prevent the transmission of infections. The infection prevention and control team at Trillium Health Centre has developed an interactive visual portrayal of the efficacy of alcohol-based hand rub use. Staff participate by having fingertip bacteria colony counts determined prior to and after hand sanitizing. During the process, infection control practitioners are able to provide one-on-one coaching on proper hand sanitizing. Seeing is believing. The visible and often dramatic decreases in the fingertip bacterial colony counts after using the hand rub help convey effectiveness. Staff find this cost-effective educational exercise fun, engaging and convincing. __________________________________________________________________________ _____________________________________*____________________________________ 8. Abstract: Revisiting the moist heat sterilization myths __________________________________________________________________________ PDA J Pharm Sci Technol. 2009 Mar-Apr;63(2):89-102. Revisiting the moist heat sterilization myths. Agalloco J, Akers J, Madsen R. Agalloco & Associates, Belle Mead, NJ, USA. JAgalloco@aol.com This paper reviews the prevailing myths regarding steam sterilization currently prevalent in the pharmaceutical industry. It updates an earlier article by the same authors on the that subject that was originally published in 1998. The text addresses the current situation with respect to the beliefs debunked in the original effort, as well as several new mistruths that have emerged in the intervening years. __________________________________________________________________________ _____________________________________*____________________________________ 9. Abstract: Inactivation of virus in intravenous immunoglobulin G using solvent/detergent treatment and pasteurization __________________________________________________________________________ Hum Antibodies. 2008;17(3-4):79-84. Inactivation of virus in intravenous immunoglobulin G using solvent/detergent treatment and pasteurization. Aghaie A, Pourfatollah AA, Bathaie SZ, Moazzeni SM, Khorsand Mohammad Pour H, Sharifi Z. Iranian Blood Transfusion Organization and Iranian Blood Research and Fractionation, Research centre, Tehran, Iran. Aghaie_a@yahoo.com The safety of plasma derived medicinal products, such as immunoglobulin, depends on viral inactivation steps that are incorporated into the production process. Several attempts have been made to validate the effectiveness of these inactivation methods against a range of physio- chemically diverse viruses. Treatment with solvent/detergent (S/D) and pasteurization (P) has been continuously used in our IgG production and these methods were analysed in this study as models of viral inactivation. Bovine Viral Diarrhoea Virus (BVDV), Herpes Simplex Virus (HSV) and Vesicular Stomatitis Virus (VSV) were employed as models of HCV, HBV and HIV respectively. Polio and Reo viruses also were used as stable viruses to chemical substances. The infectivity of a range of viruses before and after treatment with two methods of viral inactivation was measured by end point titration and their effectiveness expressed as Logarithmic Reduction Factors (LRF). Solvent/detergent treatment reduced the amount of enveloped viruses by 5-6 logs. The reduction factor was between 5-6 logs for all viruses used in the pasteurization process. A final log reduction factor was obtained as the sum of the two individual methods. Both inactivation methods have advantages and disadvantages with respect to their ability to inactivate viruses. Thus,combination of two robust virus inactivation steps, solvent/detergent and pasteurization, increases the safety margin of immunoglobulin preparations. __________________________________________________________________________ _____________________________________*____________________________________ 10. Abstract: Large-dose intravenous ferric carboxymaltose injection for iron deficiency anemia in heavy uterine bleeding: a randomized, controlled trial __________________________________________________________________________ Transfusion. 2009 Jul 22. Large-dose intravenous ferric carboxymaltose injection for iron deficiency anemia in heavy uterine bleeding: a randomized, controlled trial. Van Wyck DB, Mangione A, Morrison J, Hadley PE, Jehle JA, Goodnough LT. From DaVita, Inc., Tucson, Arizona; American Regent/Luitpold Pharmaceuticals, Norristown, Pennsylvania; the University of Mississippi Medical Center, Jackson, Mississippi; the Medical Network for Education and Research, Decatur, Georgia; The Obstetric Group, Montgomery, Alabama; and the Stanford University School of Medicine, Stanford, California. BACKGROUND: The objective was to evaluate efficacy and safety of rapid, large-dose intravenous (IV) administration of ferric carboxymaltose compared to oral iron in correcting iron deficiency anemia due to heavy uterine bleeding. STUDY DESIGN AND METHODS: In a randomized, controlled trial, 477 women with anemia, iron deficiency, and heavy uterine bleeding were assigned to receive either IV ferric carboxymaltose ( /= 12 g/dL) of anemia (73% vs. 50%, p < 0.001). Patients treated with ferric carboxymaltose compared to those prescribed ferrous sulfate reported greater gains in vitality and physical function and experienced greater improvement in symptoms of fatigue (p < 0.05). There were no serious adverse drug events. CONCLUSIONS: In patients with iron deficiency anemia due to heavy uterine bleeding, rapid IV administration of large doses of a new iron agent, ferric carboxymaltose, is more effective than oral iron therapy in correcting anemia, replenishing iron stores, and improving quality of life. __________________________________________________________________________ _____________________________________*____________________________________ 11. Abstract: Perceived knowledge of blood-borne pathogens and avoidance of contact with infected patients __________________________________________________________________________ J Nurs Scholarsh. 2009 Mar;41(1):13-9. Perceived knowledge of blood-borne pathogens and avoidance of contact with infected patients. Kagan I, Ovadia KL, Kaneti T. Quality & Patient Safety in Nursing, Rabin Medical Center, Clalit Health Care Services, Tel Aviv, Israel. kaganily@post.tau.ac.il PURPOSE: To examine the relationship between nurses' knowledge of blood- borne pathogens (BBPs), their professional behavior regarding handwashing, compliance with standard precautions (SPs), and avoidance of therapeutic contact with BBP-infected patients. DESIGN: This cross-sectional design study took place in a regional medical center in Central Israel during 2003. METHODS: Of the 180 participants, 159 (88.3%) were women with an average educational level of 16.40 years (SD=2.66). The mean age of the sample was 39.41 (SD=10.1). Data were collected using a structured questionnaire including sociodemographic information, level of knowledge concerning three BBPs (human immunodeficiency virus [HIV], hepatitis B virus [HBV], and hepatitis C virus [HCV]), level of compliance with SPs, understanding of SP principles, and avoidance of therapeutic contact with BBP-infected patients. FINDINGS: Levels of HIV-related knowledge were significantly higher than were those of HBV- and HCV-related knowledge. Only 96 participants (54.5%) stated that all patients should be treated as BBP-carriers. The understanding of the basic principle of SPs did not influence the relationship between perceived knowledge and self-reported compliance with SPs; 77.3% of the sample reported that they avoid therapeutic contact with BBP-infected patients. The level of perceived knowledge did not contribute to the nurses' avoidance of care of BBP carriers. CONCLUSIONS: Perceived knowledge of BBPs has a weak effect on compliance with SPs and willingness to care for BBP-infected patients. RECOMMENDATIONS: Nurses must identify their preconceptions when caring for BBP-carriers. Further research on this issue is needed to attempt to understand the forces acting on our nursing staff, in order to ensure appropriate care of BBP-infected patients. CLINICAL RELEVANCE: Our study indicated some reluctance among nurses to care for patients with blood- borne pathogens. This appears to be the result of value systems and not a lack of knowledge, indicating a need to integrate a psychoeducational approach to education of nurses. __________________________________________________________________________ _____________________________________*____________________________________ 12. Abstract: Endophthalmitis due to inadvertent globe penetration during retrobulbar injection of saline solution for laser in situ keratomileusis __________________________________________________________________________ J Cataract Refract Surg. 2009 Jun;35(6):1132-3. Endophthalmitis due to inadvertent globe penetration during retrobulbar injection of saline solution for laser in situ keratomileusis. Han Y, Lam HH, Stewart JM. Department of Ophthalmology, University of California, San Francisco, California 94143-0730, USA. A 31-year-old woman presented with visual acuity of counting fingers and presumed bacterial endophthalmitis in the left eye 10 days after refractive surgery. During the procedure, a retrobulbar injection of balanced salt solution had been performed to assist with globe suction by the microkeratome. A perforation site was identified in the inferonasal retina. Following intravitreal antibiotic injection and surgical intervention, the visual acuity returned to 20/20. Retrobulbar injection to facilitate laser in situ keratomileusis carries risks. Careful monitoring for signs of infection is recommended if globe perforation is recognized. __________________________________________________________________________ _____________________________________*____________________________________ 13. Abstract: Life-Threatening Flecainide Intoxication in a Young Child Secondary to Medication Error (September) __________________________________________________________________________ Ann Pharmacother. 2009 Aug 11. Life-Threatening Flecainide Intoxication in a Young Child Secondary to Medication Error (September). D'Alessandro LC, Rieder MJ, Gloor J, Freeman D, Buffo-Sequiera I. Department of Paediatrics, Children's Hospital, London Health Sciences Centre, University of Western Ontario, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada. OBJECTIVE: To describe a case of life-threatening flecainide intoxication in a toddler, secondary to accidental reversal of syringes used for oral administration. CASE SUMMARY: A 2-year-old male with a history of a persistent junctional reciprocating tachycardia had been receiving flecainide 4.8 mg/kg/day (1 mL 3 times daily) and nadolol 2 mg/kg/day (5 mL once daily) for 10 months. One morning, 3 hours after the drugs were administered, he became bradycardic (heart rate 50 beats/min) and then presented to the emergency department with vital signs absent. After initial cardiopulmonary resuscitation and epinephrine, he was bradycardic; this was followed by wide-complex tachycardia that converted rapidly to narrow-complex tachycardia after bolus administration of intravenous sodium bicarbonate for suspected flecainide intoxication. Following resuscitation, he remained hemodynamically stable and was discharged in normal sinus rhythm without neurologic sequelae. Drug concentrations obtained at the time of presentation showed a serum concentration of flecainide of 0.668 micro/mL. Drug formulations were also analyzed and found to contain the expected concentration of flecainide. DISCUSSION: Literature regarding adverse drug events in the pediatric outpatient population is reviewed, as well as how these risks apply to flecainide, a medication with a low margin of safety. Pediatric experience with flecainide intoxication and sodium bicarbonate administration as an antidote is reviewed. Analysis of the serum drug concentrations demonstrated blood concentrations consistent with syringe reversal, which would have produced a 5-fold flecainide overdose. The Naranjo probability scale indicated a highly probable relationship between flecainide ingestion and the life-threatening event in this case. CONCLUSIONS: This case of life-threatening flecainide intoxication in a young child, secondary to accidental reversal of medication syringes, underscores the importance of providing parents with accurate dispensing information and labeling medication bottles and syringes in an unambiguous manner. __________________________________________________________________________ _____________________________________*____________________________________ 14. Abstract: Contact tracing and serosurvey among healthcare workers exposed to Crimean-Congo haemorrhagic fever in Greece __________________________________________________________________________ Scand J Infect Dis. 2009 Aug 14:1-4. Contact tracing and serosurvey among healthcare workers exposed to Crimean-Congo haemorrhagic fever in Greece. Maltezou HC, Maltezos E, Papa A. From the Department for Interventions in Healthcare Facilities, Hellenic Centre for Disease Control and Prevention, Athens, Greece. We investigated the probability of nosocomial transmission of Crimean- Congo haemorrhagic fever (CCHF) virus among healthcare workers (HCWs) who cared for the first CCHF case in Greece. Specific IgM and/or IgG antibodies against CCHF virus were not detected in the 21 HCWs studied. Although person-to-person transmission did not take place, education of HCWs about the modes of CCHF virus transmission and appropriate infection control measures is needed in order to avoid future nosocomial cases. __________________________________________________________________________ _____________________________________*____________________________________ 15. Abstract: Awareness among barbers about health hazards associated with their profession __________________________________________________________________________ J Ayub Med Coll Abbottabad. 2008 Apr-Jun;20(2):35-8. Awareness among barbers about health hazards associated with their profession. Wazir MS, Mehmood S, Ahmed A, Jadoon HR. Department of Community Medicine, Ayub Medical College, Abbottabad, Pakistan. salimwazir_dr@gmail.com BACKGROUND: Barbers are important professionals of the community which are still owned, cared and financed by the community especially the rural one. Barbers besides performing duties in social events like marriage, circumcision etc is also responsible for hair and nail cutting. In urban settings they have developed their profession by incorporating facial massage and make-up. It is the need of their profession to utilize instruments like knife, blades etc. The objective of the study was to assess awareness among barbers regarding health hazards related to their profession and to identify professional practices linked with infection transmission. METHODS: This descriptive cross sectional study was conducted in Kharian city of district Gujrat, located almost mid-way between Lahore and Islamabad, from June 2003 to September 2003. Sample of 50 barbers were selected by simple random sampling technique. Data was collected by using a semi-structured questionnaire and a checklist. Data was analyzed using SPSS 10. RESULTS: The mean age of barbers interviewed was 33.3 years with SD +/- 8.3. It was found that 29 (58%) barbers denied about any health hazards associated with their profession whereas 21 (42%) had knew about hepatitis, AIDS; they also described the role of contaminated blades, clips, towels, apron, and combs in causing skin problems. It was observed that 90% of barbers did not wash hands, 80% did not change the apron, 66% did not change towel during barbering services to different customers. Besides 7 (14%) barbers were also performing minor surgeries like circumcision, in growing toe nail excision and abscess drainage. There was significant difference in level of awareness among barbers in respect of age; educational status and duration of working. Age group (15-25) had better knowledge about the health hazards than barbers in age group (26-50). There is a significant difference (p < 0.05) in the awareness of those who got formal education. As for the effect of media on the knowledge of these workers, it was observed that 78% of them had the access to TV and out of these 69% had significant knowledge about health hazards related to barbering profession. CONCLUSION: The level of knowledge among barbers about health hazards associated with their profession is very poor. Majority of them do not have any perception of unhealthy working practices in barbering. Awareness about threat of receiving hazardous infection from their customers is also unsatisfactory. __________________________________________________________________________ _____________________________________*____________________________________ 16. Five Weeks until the 1st African Congress On Infection Prevention Control - 2009 __________________________________________________________________________ 1st African Congress On Infection Prevention Control - 2009 Hosted By Infection Prevention Control African Network (IPCAN) 21 - 23 September 2009 Speke Resort Kampala * Registration can be done by fax * There is a $100 prize for the best free paper * The provisional programme Topics Infection Prevention & Control in Africa Emerging Infectious Diseases: IPC implications Occupationally acquired diseases Water as a vector for infection: concerns in Africa Blood borne virus transmission: safety aspects The World of sterilization of medical devices The impact of HIV on IPC programmes in Africa. The role of copper in IPC- looking into the future Community based IPC, rituals and practice TB containment guidelines: can these be implemented in Africa? Transfer of technologies to manufacture IPC technologies in Africa Monitoring & Evaluation: Getting it right? Education Programmes in IPC: what is happening in Africa Bundling: a new concept in IPC management Managing Healthcare Waste What is new in phlebotomy? WHO draft guidelines Healthcare associated infections: current situation in Africa * Invited speakers from - World Health Organisation - International Federation of Infection Control - World Federation of Hospital Sterile Supplies Please visit the website: http://www.ipcan2009.co.za __________________________________________________________________________ _____________________________________*____________________________________ 17. News - India: Freedom from shots, kids can sniff measles vaccine - India: Needle-Free Measles Vaccine Expected To Enter Clinical Trials In India - India: First powder vaccine for measles to be tested in India - Canada: More Needles Given to Drug Users - USA: Woman convicted in vaccine scheme heads to prison - USA: Supes to get report on needle exchange - China: Expert: HIV/AIDS epidemic still on rise in China - USA: Hepatitis Cased Linked to South Dakota Clinic - USA: Siouxland Urology Associates - Response to Lawsuit Allegations - USA: Attorneys: Bankruptcies could delay hepatitis trials - Canada: City studies safe-injection site for Toronto - USA: Editorial > Sticking Point - China: China’s Incinerators Loom as a Global Hazard Selected news items reprinted under the fair use doctrine of international copyright law: http://www4.law.cornell.edu/uscode/17/107.html __________________________________________________________________________ India: Freedom from shots, kids can sniff measles vaccine Kounteya Sinha, IANS, Times of India - New Delhi,India (18.08.09) NEW DELHI: A single deep breath could soon vaccinate a child against measles. Next year, India will start human trials of a measles vaccine that will not require a syringe. Instead, a single long breath will deliver the vaccine straight into the child's lungs. This breakthrough - dry powder inhalable measles vaccine, if found to be as effective as the present day injectible vaccine - will do away with risks of dirty needle infections like HIV and hepatitis and will greatly benefit countries like India which seriously lack proper cold chain facilities and clean water. The creator of the dry-powder vaccine, Robert Sievers from the University of Colorado, said, "The vaccine is moving toward clinical trials next year in India. Childhood vaccines that can be inhaled and delivered directly to mucosal surfaces offer significant advantages over injection. They may not only reduce the risk of infection from unsterilized needles, but may also prove more effective against the disease." According to Sievers, the present candidate vaccine could be a perfect option for areas of developing countries that often lack electricity for refrigeration, clean water and sterile needles needed to administer traditional liquid vaccines. Dr Anupam Sibal, senior pediatrician of Apollo hospital, said, "Measles mortality among malnourished children is an important concern in India. So improvement in measles vaccine coverage will be a boon." He said, "Any option which is a non-injectible oral or inhalation is usually more attractive for parents who fear taking their children for an injection." The Indian trials will be conducted by the Serum Institute of India. Officials in SII told TOI the human trials would start only next year when the animal studies prove successful. The Phase-1 study would see the vaccine's safety on around 30 adults. The inhaler developed by Siever's team has been found to be just as effective in delivering measles vaccine as the injection during the animal tests. So far, an inhalable vaccine is available for only one disease. It is a wet mist vaccine for influenza. The weakened measles virus is mixed with supercritical carbon dioxide - part gas, part liquid - to produce microscopic bubbles and droplets, which are then dried to make an inhalable powder. The powder is puffed into a small, cylindrical, plastic sack, with an opening like the neck of a plastic water bottle, and administered. .......................................................................... __________________________________________________________________________ India: Needle-Free Measles Vaccine Expected To Enter Clinical Trials In India Kaiser Family Foundation (17.08.09) "A new needle-free measles vaccine with the potential to save thousands of children's lives" is set to enter clinical trials in India next year, "where measles kills almost 200,000" infants and children annually, the Press Association reports. Doctors believe that the vaccine, which is "the first of its kind" and "uses an inhalable dry powder to administer a weakened measles virus to the lungs … will be more effective against the disease and avoid the risk of dirty needle infection," the news service writes (8/16). "Robert Sievers, Ph.D., who leads the team that developed the dry-powder vaccine, said it's a perfect fit for use in back-roads areas of developing countries," where there is often no "electricity for refrigeration, clean water and sterile needles needed to administer traditional liquid vaccines," an American Chemical Society/EurekAlert! release writes. The vaccine is still being tested on animals for safety (8/16). Sievers also said that in addition to reducing the "risk of infection from HIV, hepatitis and other serious diseases due to unsterilised needles," inhalable vaccines "may prove more effective against disease," according to the Press Association (8/16). .......................................................................... __________________________________________________________________________ India: First powder vaccine for measles to be tested in India IANS, Times of India - New Delhi,India (17.08.09) NEW DELHI: The first dry powder inhalable vaccine for measles will be tested next year in India. Millions of infants and children suffer from the disease which kills almost 200,000 annually. Robert Sievers, University of Colorado-Boulder (UC-B), who led the team that developed the dry-powder vaccine, said it is a perfect fit for use in developing countries. Those areas often lack the electricity for refrigeration, clean water and sterile needles needed to administer traditional liquid vaccines. "Human clinical trials are expected to begin next year in India, after animal safety studies are completed this year" he said. "Measles vaccine dry powders have the potential to effectively vaccinate infants, children and adults by inhalation, avoiding the problems associated with liquid vaccines delivered by injection," he added. If the inhaler passes final safety and effectiveness tests, the Serum Institute of India Ltd. expects a demand growing to 400 million doses of measles vaccine a year. "Not only might they reduce the risk of infection from HIV, hepatitis, and other serious diseases due to unsterilised needles, they may prove more effective against disease," Seivers said. Although made for developing countries, the technology eventually could become the basis for a new generation of inhalable and pain free vaccines in the US and elsewhere. So far, an inhalable vaccine is available for only one disease. It is a wet mist vaccine for influenza. These findings were presented at the 238th National Meeting of the American Chemical Society (ACS). .......................................................................... __________________________________________________________________________ Canada: More Needles Given to Drug Users Frances Barrick, Waterloo Region Record, Canada (17.08.09) The number of sterile needles distributed to injection drug users in the Waterloo Region has increased three-fold over the past five years, said health officials. The uptick reflects better service provision rather than a growth in the number of IDUs, said Karen Verhoeve of the region's public health unit. "The demand has always been there," Verhoeve said. "It is just now that we are able to meet it better," in part because a provincial program has helped boost needle supplies and distribution. In 2008, the region's health unit distributed 185,591 needles, a 314 percent increase from 2004, according to a Waterloo Region Public Health report on its AIDS and STD programs. The region collected 73,787 needles last year, which was a 364 increase over 2004. Launched in 1995, the needle-exchange program helps prevent blood-borne infections among IDUs, noted the report. Besides needles, the program provides IDUs with sterile swabs, distilled water, and clean containers, in which drugs can be mixed and heated for injection. The sharing of injection equipment among IDUs can quickly transmit viruses such as hepatitis C, which is more infectious than HIV. The region's four needle-exchange sites logged 1,647 visits, mostly repeat clients ages 25-44. Safe needle disposal services are provided through 11 community organizations, including food banks, community kitchens, and shelters. .......................................................................... __________________________________________________________________________ USA: Woman convicted in vaccine scheme heads to prison abc13.com, Houston Texas, USA (17.08.09) HOUSTON (KTRK) -- A Houston woman who was convicted back in 2007 for her role in distributing fake flu vaccine will head to federal prison. In the summer and fall of 2005, more than 1,100 Exxon workers, dozens of senior citizens at local residence homes and other local citizens received shots of what was eventually determined by the FDA to be not legitimate flu vaccine. Gonzales, 52, was charged for her involvement, pleaded guilty and was sentenced to five years probation and fined $5,000. But Gonzales was re- arrested last month after violating terms of her probation. According to U.S. Attorney Tim Johnson, Gonzales admitted she has committed three felonies for which she has been convicted, all in Liberty County, including two charges for forging checks from a local business in June 2008 and stealing four night deposits from an area restaurant in October and November 2008. She also admitted failing to report to her federal probation officer for nearly a year and failing to alert probation that she had changed addresses. Gonzales has been in federal custody since her July arrest without bond. .......................................................................... __________________________________________________________________________ USA: Supes to get report on needle exchange By Colby Frazier, Daily Sound, Santa Barbara California USA (14.08.09) An intravenous drug syringe program implemented by the Pacific Pride Foundation for the last nine years has had a marked impact on the number of AIDS and other blood-borne diseases transferred via dirty needles, a Santa Barbara County Public Health Department report shows. Since the program’s inception in 2000, the report indicates that disease transfers from injection drug use has dropped from 32.3 percent to 3.7 percent in 2008, a statistic Michele Mickiewicz, a public information officer for the Health Department, said is a sign of success. "It’s nice for people to see ... " she said of the drastic fall in transfers of HIV and other illnesses through intravenous drug use, which peaked in 2000. "If people want to use drugs they’re going to do it whether we give them needles or not." The Board of Supervisors, which green-lighted the program in 2000, will receive its annual report on the program this Tuesday. While the program report appears in the Board’s agenda as thought it has some connection to the county, Mickiewicz said it does not. Rather, the report is made only because the law requires it. She said the county gives the program no funding and no county employees are involved. But the numbers compiled through the year by Pacific Pride Foundation, which calls the program "The Right Outfit," show demand remains high for the needles. In 2008, 610 people made 1,347 exchanges, of which 47 percent were in Santa Barbara and 53 percent were in Santa Maria: the only two needle exchange locations in the county. The makeup of these 1,347 exchanges indicates many people took more than one, and likely several, clean syringes. The numbers show 80,100 contaminated needles were collected and disposed of, while 65,938 clean syringes were distributed. In order receive a clean needle one must turn in a dirty one, the report said. Seventy-seven percent of the participants were male, while 23 percent were female. The average age of participants was 38. The numbers show 60 percent of the participants were white, 33 percent were Latino and 3 percent were American Indian, while 1 percent were black and 1 percent were Asian. According to the report, 100 percent were referred for substance abuse treatment and HIV testing, but only 6 percent were tested for HIV during the syringe exchange visit (many more were tested before or after the visit, the statistics show). Additionally, 46 percent were referred for other sexually transmitted disease tests, 22 percent were referred for mental health services and 13 percent were referred for food or shelter services. While the number of HIV transmissions through dirty needles has fallen greatly in the last decade, the statistics show a steep drop off has occurred in recent years. In 2006, about 18 percent of HIV cases in Santa Barbara County were identified in individuals who reported injection drug use as a risk factor. This figure fell to just under 15 percent in 2007 and plummeted to 3.7 percent last year. Attempts to reach officials at Pacific Pride Foundation yesterday evening for comment were unsuccessful. As a result, it was unknown at press time how much the program costs to run and where the organization receives the funding for the program. "The Right Outfit syringe exchange program saves lives and promotes health by reducing the transmission of HIV and other blood-borne diseases," the report concludes. "Furthermore, the program helps get contaminated needles off the street, and assists clients with accessing HIV testing, substance abuse counseling, and other needed services." .......................................................................... __________________________________________________________________________ China: Expert: HIV/AIDS epidemic still on rise in China China DailyBeijing China (14.08.09) BEIJING: China needs to upgrade its anti-AIDS efforts because the epidemic continues to spread - mainly through sexual transmission - from high-risk groups to average people, the country's leading AIDS-control agency warned Friday. The total number of confirmed HIV/AIDS cases on the Chinese mainland since the mid-1980s reached 295,000 by May, compared with 264,300 by September 2008, according to the National Center for AIDS/STD Control and Prevention, under the Chinese Center for Disease Prevention and Control. Among them, some 91,500 people infected by HIV have developed into AIDS patients and 43,400 people have already died. More than 52,000 people living with HIV/AIDS are receiving antiretroviral treatment. "The rise of the HIV/AIDS epidemic has yet to be under effective control. In the past five years, the number of new cases surpassed 40,000 every year," Wu Zunyou, director of the national AIDS center, said Friday. UNAIDS, the United Nations' anti-AIDS agency, estimated that actual number of HIV/AIDS cases could be more than 700,000 among China's 1.3 billion people, with nearly 57 percent of new cases originating from unprotected sex. Wu said the new estimation, conducted by his center, would be released in November. "HIV transmission through unsafe sex is particularly dangerous to the general public because it's now the leading cause of HIV/AIDS transmission in China, instead of needle sharing among drug users," Wu said. Gay people and prostitutes run a particularly high risk of contracting the AIDS virus, he said. A study among 18,000 gay people in 61 Chinese cities found the rate of HIV infection was 4.9 percent, much higher than the nation's average 0.05 percent. "The increase of HIV infections among gay people is faster than that among heterosexual groups in the past three years," he said. Contrary to common impression that HIV/AIDS is a health issue among young people, more senior citizens are falling prey to the disease. A total of 1,713 men older than 60 were infected by HIV in 2008, mainly due to unsafe sex, compared with 483 men of the same age group in 2005. "Once infected, they are more likely and quickly to develop into AIDS patients because their immune systems are weaker than young people," Wu said. Despite the expansion of monitoring and testing service networks, health workers also face huge challenges in conducting education among high-risk groups such as gays and prostitutes because it is very difficult to find them, Wu said. China's HIV/AIDS surveillance network was composed of 1,080 stations that cover 340,000 people by the end of 2008, compared with 431 stations covering 129,000 people in 2005. The number of counselling and testing stations also reached 6,077 in 2008 from 2,850 in 2005. However, health education was estimated to reach only 14.2 percent of gays and 43.3 percent of prostitutes, Wu said. "We need to encourage more people from these groups to stand up and help raise AIDS awareness among their peers," Wu said. AIDS has become the most deadly infectious disease in China since last year. Among some 45,000 HIV/AIDS cases newly reported in 2008, 9,748 patients already died. Copyright By chinadaily.com.cn .......................................................................... __________________________________________________________________________ USA: Hepatitis Cased Linked to South Dakota Clinic Newsinferno.com USA (13.08.09) In April we wrote that alleged malpractice at the Siouxland Urology Center in Dakota Dunes, South Dakota appeared to be the culprit in exposing 6,000 patients to HIV and hepatitis. Now, attorneys for the clinic’s former patients have said that some patients have tested positive for blood borne illnesses, reported KSFY. As with a variety of other similar contaminations, Siouxland Urology allegedly reused single use medical products, potentially passing on serious diseases to other patients. In a similar case in which medical equipment was rinsed--not sterilized--shoddy colonoscopies and endoscopies at Veterans Administration facilities exposed over 10,000 military veterans to HIV and hepatitis B and C following exposure to tainted equipment, with a number of patients testing positive the pathogens. At least one patient consulted with malpractice attorneys and more are expected. According to KSFY, five Siouxland Urology patients have filed a class action lawsuit and the attorneys involved say that some patients have tested positive for blood borne illnesses. One patient expressed concern because although he tested negative, thus far, for hepatitis, he has to return in six months for additional HIV testing and is considering an individual lawsuit, said KSFY. HIV is the virus that causes AIDS. In April we explained that South Dakota Department of Health inspectors-- who are registered nurses (RNs)--noticed that a saline bag, on a pole in an examining room where a cystoscopy was going to shortly take place, was dated two days prior, according to Bob Stahl, from the South Dakota Department of Health, reported CNN. The RN inspectors questioned the staff who said that "they routinely reused saline bags and tubing," had been doing so since the clinic’s opening in 2002, and did not understand why reusing one-time use medical supplies presented a problem, said Stahl, who noted that the bags and tubing clearly state "for single use only," said CNN. "They used the bags and tubing on multiple patients," Stahl said, quoted CNN, adding that, "It was their standard operating procedure…. They told the inspectors that this was a common practice all over the country. We disagreed and told them this was not a common practice." Reusing such supplies can enable patient bodily fluids to backflow into the saline bags and tubing. "Siouxland Urology Center informed certain of its patients by U.S. mail that a prior cystoscopy procedure could have potentially exposed them to an infectious disease," its Website said, according to CNN. The clinic’s clients are generally from South Dakota, Iowa, and Nebraska; the clinic is providing free blood tests to its potentially infected patients, said CNN. HIV and hepatitis B and C are spread by contact with infected body fluids. HIV--the human immunodeficiency virus--is the virus that causes AIDS (acquired immunodeficiency syndrome); AIDS is the final stage of HIV infection. Hepatitis B and C are liver diseases that can lead to cirrhosis or cancer of the liver. Vaccines exist only for hepatitis B. HIV/AIDS and hepatitis B and C can all be fatal. .......................................................................... __________________________________________________________________________ USA: Siouxland Urology Associates - Response to Lawsuit Allegations KCAU TV (press Release) (13.08.09) Siouxland Urology Center Blood Tests: No Evidence of Transmission of Blood-Borne Infection from Cystoscopy Procedure FOR IMMEDIATE RELEASE Dakota Dunes, S. Dakota, August 12, 2009. Siouxland Urology Center today reported the results of its free blood testing program to the South Dakota Department of Health. The testing revealed no evidence that hepatitis was transmitted patient-to-patient, and no cases of HIV were found at all. In cooperation with the South Dakota Department of Health, the Center offered its cystoscopy patients free blood tests out of an abundance of caution to determine whether any patients contracted a blood borne illness as a result of prior cystoscopy procedures. Of the over 3900 patients tested, a small number of patients tested positive for hepatitis, as was expected due to normal occurrence rates in the general population. Sixteen patients (0.4%) tested positive for hepatitis and had no known history of hepatitis at the time of their cystoscopy procedure. All patients have been notified of their test results. "Our first priority is the health and well-being of our patients, and we want to be sure that any patient that is positive for the hepatitis virus is obtaining the appropriate medical care," said Dr. John Wolpert, a Siouxland Urology Center physician. The Center's cystoscopy procedure did not cause the transmission of hepatitis to any patient. The Center conducted extensive review of the medical records and blood test results of cystoscopy patients treated before and after patients who tested positive. The review revealed no evidence of patient-to-patient transmission of hepatitis as a result of the cystoscopy procedure. Another 12 patients who tested positive for hepatitis disclosed their status to the Center prior to their cystoscopy procedure. Medical records and blood test results also confirm that none of these 12 patients transmitted hepatitis to any other Center patients during their cystoscopy procedures. From the beginning, the Center has said that its prior cystoscopy procedure -- which at all times was mindful of sterilization and sanitation issues -- was safe and effective, and had been commonly used across the country by other urologists. As a precautionary measure, and at the request of the South Dakota Department of Health, Siouxland Urology Center changed its cystoscopy procedures in January. Siouxland Urology Center also worked in coordination with the South Dakota Department of Health in notifying patients of the availability of free blood tests, administering the blood tests, and in its processes for data analysis. "The blood test results and medical record data reported to the Department of Health provide a welcome confirmation of what we believed from the beginning, that there is no evidence of the transmission of infection due to our procedures," said Wolpert. "We provided more than 3900 blood test to our patients at no charge because we care about our patients and it was the right thing to do." .......................................................................... __________________________________________________________________________ USA: Attorneys: Bankruptcies could delay hepatitis trials By Steve Green, Las Vegas Sun - Las Vegas,NV,USA (12.08.09) The bankruptcies of the Endoscopy Center of Southern Nevada and related companies are threatening to delay trials for patients who say they were infected with hepatitis because of unsafe medical procedures at the endoscopy clinics, attorneys say. The attorneys say that because of the bankruptcies filed July 17, lawyers for the companies controlled by Dr. Dipak Desai are now refusing to cooperate with depositions and other evidence-gathering procedures in preparation for at least 10 trials scheduled to start between this October and November 2011. The patients' lawyers are asking the U.S. Bankruptcy Court in Las Vegas to lift an automatic stay of legal actions granted to bankrupt companies. Lifting the stay would allow the patients' attorneys to proceed with trial preparations, the lawyers say. But the U.S. bankruptcy trustee is opposed to their motion, saying it may allow a select group of creditors to collect the limited insurance money that is available under Desai's policies -- leaving thousands of other creditors empty-handed. A hearing on the patients' request is set for Aug. 26 before bankruptcy Judge Mike Nakagawa. The patients trying to lift the stay are represented by the law firms Kemp, Jones & Coulthard and Edward M. Bernstein & Associates. The Endoscopy Center of Southern Nevada, the Gastroenterology Center of Nevada and the Desert Shadow Endoscopy Center are the companies that filed for bankruptcy. Thousands of patients charge in lawsuits they were infected with hepatitis or exposed to the risk of infection because of unsafe procedures at the clinics including the reuse of syringes and vials for anesthesia. The Southern Nevada Health District late last year classified 101 cases of chronic hepatitis C infection as possibly associated with the Endoscopy Center of Southern Nevada, 700 Shadow Lane; and four cases possibly associated with the Desert Shadow Endoscopy Center, 4275 Burnham Ave. Testing was urged for patients who had procedures done at the clinics between March 2004 and January 2008. Justice for patients allegedly infected with hepatitis can't come soon enough, attorneys said in recent court filings. "Time is of the essence in lifting the automatic stay for numerous reasons," attorney Will Kemp wrote. He said critical factual discovery and depositions have been under way for one of the initial trials set for Dec. 7 and other trials. "Defense counsel is now refusing to conduct these depositions absent relief from the automatic stay," he wrote. "Discovery needs to resume in the immediate future in these cases or the trial dates will be jeopardized." Of nine scheduled trials his firm is handling, he wrote: "All of these plaintiffs have been diagnosed with hepatitis and some of these plaintiffs are very ill." But U.S. Trustee Brian Shapiro is opposed to lifting of the automatic stay of legal proceedings against the bankrupt companies. "Shapiro has been advised that approximately 6,000 people have asserted claims against debtor and related entities and personnel," his attorneys wrote in a court filing. "It is Shapiro's understanding that a limited amount of insurance may be available. "If creditors are granted relief from the automatic stay, it may allow those creditors to make demand for payment from the insurance in place with the result that the insurance coverage will be exhausted. This could result in a benefit for those who are the fastest, or fortunate enough to have an early trial date or reach a settlement. "This is contrary to the basic concept of bankruptcy that no creditor receive preferential treatment," the attorneys wrote. Shapiro also said it's unfair to the thousands of other potential creditors or claimants that they haven't received notice of the effort to lift the stay. "Shapiro believes each of the potential claimants against the insurance of debtor is an 'interested party' to whom notice should be afforded. Without providing notice to each of the purportedly injured parties who are claimants on the fund, they are being deprived of an opportunity to object to the request for relief from the stay and may be precluded from sharing in the insurance if the policy limits are exhausted prior to their having an opportunity to present a claim," his attorneys wrote. Kemp, in his filing, laid out the massive scale of the pending litigation against Desai, his clinics and other defendants: --At least 300 people have filed lawsuits in Clark County District Court alleging they were infected with hepatitis or other infectious diseases. --Another 4,000 people were tested and found not to be infected, but have filed suit for their test costs and the emotional distress they endured while awaiting their results. --The defendants include not only the clinics, but surgeons, nurses and anesthesia manufacturers. --The drug makers are being sued on the theory that their sale of jumbo- sized 50-milliliter propofol drug vials contributed to the infections by prompting reuse of the vials, since the drug makers' literature said smaller 10-milliliter vials were ideal for endoscopies. Kemp said the drug makers' potential liability could significantly reduce the potential damages to be paid by the bankrupt clinics. Kemp suggested in his filing that proceeding with the initial trials as test cases will help determine damages in the remaining cases -- and help determine who will pay. "Determining the potential value of the cases will be an invaluable aid in ultimately resolving the bankruptcy," he wrote. .......................................................................... __________________________________________________________________________ Canada: City studies safe-injection site for Toronto By Michael McKiernan, National Post Canada (12.08.09) A city-sanctioned study is looking into the feasibility of Vancouver-style safe injection sites in Toronto, but critics fear the study’s support for such sites is a done deal. The study, part of Toronto Public Health’s drug strategy, comes as Vancouver’s six-year-old InSite program (pictured above) faces increasing doubts over its own future. The federal government wants it shut and has appealed a 2008 B.C. Supreme Court ruling that allowed it to continue operating. "It’s getting pushed out of Vancouver and they want to move the problem somewhere else, but we don’t want it here," said Rob Ford, city councillor for Etobicoke North. "My residents don’t want it, I don’t want it and I’ll do everything in my power to stop it. Who’s going to want to live in a community that’s invaded every day and night by drug users." Although commissioned under the city’s Toronto Drug Strategy, the funding for the study has come from the Ontario HIV Treatment Network, an independent non-profit organization. Mr. Ford led opponents of the controversial drug strategy when councillors passed it in December, 2005. "You don’t condone and enable drug use - it’s illegal. How can you say you’re helping people when you’re enabling them?" Supervised injection sites, like the one in Vancouver’s Downtown Eastside, offer a controlled environment for people to use drugs purchased elsewhere. Dr. Carol Strike of the Centre for Addiction and Mental Health is leading the study with Dr. Ahmed Bayoumi of St. Michael’s Hospital. She emphasized the limited scope of the study, which will also examine site options in Ottawa. "We’re not recommending establishing any site. We want to understand if it makes sense to have one in either city. Not just how many, but if it makes sense to have one at all," she said. The research will focus on the potential impact a safe injection site would have on drug use in the city, and whether it could cut transmission of diseases such as HIV or Hepatitis B and C. The city already offers a needle-exchange program that experts say have decreased infections and other health problems related to drug use. That’s not enough for Maureen Gilroy, a former city-council candidate and member of Citizens for a Better Toronto, a group that opposed the drug strategy. She says needle exchange encourages drug use and fears the injection sites could do the same. Instead, she wants more done to get people off drugs. "I’ve been to the clinics where they distribute needles. You walk in there, and they hand them out, no questions asked. There’s no effort to get them to stop," she said. According to Dr. Strike, injection sites around the world offer a wider range of services for addicts, which her study will examine. "Needle exchange provides injection equipment, education and other services to people. With supervised consumption, you get all those things, plus a place to use drugs. They would also offer a range of medical and social services beyond that which a needle exchange would," she said. She encourages residents to air their concerns, saying the researchers want to hear from as many perspectives as possible, whether their opinions are positive or negative. "In some places it’s not always well understood. Nobody has looked at this in Toronto and that’s why we want to make sure we hear all voices," she said. "We want to better understand their concerns about supervised sites and drug use in the community." Ms. Gilroy remains unconvinced her fears will find a sympathetic ear. "I’m surprised we don’t already have a site in this city. Nine times out of 10 the studies come out in favour because the people involved are already interested in safe injection sites.’’ Last year, a study by Dr. Strike’s co-author, Dr. Bayoumi, suggested Vancouver’s InSite would save the B.C. health system $14-million over 10 years and stop 10,000 HIV inspections. "We’re not sure the effects in Vancouver can be transferred directly to Toronto, where drug use is much less concentrated. that’s why we’re doing the study," said Dr.Strike. .......................................................................... __________________________________________________________________________ USA: Editorial > Sticking Point Washington Post, Washington DC USA (12.08.09) Congress could end the ban on federal funding of needle exchange programs -- and still kill D.C.'s vital effort. After securing the right from Congress last year to use its own money to fund needle exchange programs last year, the District stands to lose it. Confusingly, the threat is wrapped up in legislation that ostensibly would lift a 21-year-old ban on using federal money to fund syringe-swapping groups. We say "ostensibly" because the restrictions on where those organizations could operate are so broad that they would effectively shut down the city's only program. The House voted to end a 21-year-old ban and allow federal funding of needle exchange programs. It also voted to allow the District to use its own money for such a program. There's one catch: the programs cannot be located "within 1,000 feet of a public or private day care center, elementary school, vocational school, secondary school, college, junior college, or university, or any public swimming pool, park, playground, video arcade, or youth center, or an event sponsored by any such entity." This would render whole sections of cities off-limits. And it would effectively kill the District's one needle exchange program. None of this is a done deal. The Senate version of the bill doesn't have those onerous restrictions. When the House and Senate meet in conference committee to hash out the final legislation, this restrictive language must be removed. Since the 1990s, studies have shown that needle exchange programs work. They are effective in reducing the spread of HIV while not increasing drug use. Just ask the learned people at the Centers for Disease Control, the National Institutes of Health, the American Medical Association and the World Health Organization. An 80 percent reduction in the incidence of HIV in intravenous drug users over the past 20 years can be attributed in part to needle exchange programs funded by localities and private organizations, according to a 2008 report from the CDC. Those still resistant to the facts should look at communities and urban areas grappling with the HIV/AIDS epidemic to understand the importance of making all possible funds available to effectively fight the epidemic. They need only look out of their Washington window. An astounding 3 percent of District residents are living with HIV/AIDS. Intravenous drug use is the third-most-common mode of transmission. "People have been playing politics with people's health . . . for years," D.C. Councilmember David A. Catania (I-At Large) told The Post. It's time for them to stop. .......................................................................... __________________________________________________________________________ China: China’s Incinerators Loom as a Global Hazard By Keith Bradsher, New York Times, New York, USA (11.08.09) SHENZHEN, China -- In this sprawling metropolis in southeastern China stand two hulking brown buildings erected by a private company, the Longgang trash incinerators. They can be smelled a mile away and pour out so much dark smoke and hazardous chemicals that hundreds of local residents recently staged an all-day sit-in, demanding that the incinerators be cleaner and that a planned third incinerator not be built nearby. After surpassing the United States as the world’s largest producer of household garbage, China has embarked on a vast program to build incinerators as landfills run out of space. But these incinerators have become a growing source of toxic emissions, from dioxin to mercury, that can damage the body’s nervous system. And these pollutants, particularly long-lasting substances like dioxin and mercury, are dangerous not only in China, a growing body of atmospheric research based on satellite observations suggests. They float on air currents across the Pacific to American shores. Chinese incinerators can be better. At the other end of Shenzhen from Longgang, no smoke is visible from the towering smokestack of the Baoan incinerator, built by a company owned by the municipal government. Government tests show that it emits virtually no dioxin and other pollutants. But the Baoan incinerator cost 10 times as much as the Longgang incinerators, per ton of trash-burning capacity. The difference between the Baoan and Longgang incinerators lies at the center of a growing controversy in China. Incinerators are being built to wildly different standards across the country and even across cities like Shenzhen. For years Chinese government regulators have discussed the need to impose tighter limits on emissions. But they have done nothing because of a bureaucratic turf war, a Chinese government official and Chinese incineration experts said. The Chinese government is struggling to cope with the rapidly rising mountains of trash generated as the world’s most populated country has raced from poverty to rampant consumerism. Beijing officials warned in June that all of the city’s landfills would run out of space within five years. The governments of several cities with especially affluent, well-educated citizens, including Beijing and Shanghai, are setting pollution standards as strict as Europe’s. Despite those standards, protests against planned incinerators broke out this spring in Beijing and Shanghai as well as Shenzhen. Increasingly outspoken residents in big cities are deeply distrustful that incinerators will be built and operated to international standards. "It’s hard to say whether this standard will be reached -- maybe the incinerator is designed to reach this benchmark, but how do we know it will be properly operated?" said Zhao Yong, a computer server engineer who has become a neighborhood activist in Beijing against plans for an incinerator there. Yet far dirtier incinerators continue to be built in inland cities where residents have shown little awareness of pollution. Studies at the University of Washington and the Argonne National Laboratory in Argonne, Ill., have estimated that a sixth of the mercury now falling on North American lakes comes from Asia, particularly China, mainly from coal-fired plants and smelters but also from incinerators. Pollution from incinerators also tends to be high in toxic metals like cadmium. Incinerators play the most important role in emissions of dioxin. Little research has been done on dioxin crossing the Pacific. But analyses of similar chemicals have shown that they can travel very long distances. A 2005 report from the World Bank warned that if China built incinerators rapidly and did not limit their emissions, worldwide atmospheric levels of dioxin could double. China has since slowed its construction of incinerators and limited their emissions somewhat, but the World Bank has yet to do a follow-up report. Airborne dioxin is not the only problem from incinerators. The ash left over after combustion is laced with dioxin and other pollutants. Zhong Rigang, the chief engineer at the Baoan incinerator here, said that his operation sent its ash to a special landfill designed to cope with toxic waste. But an academic paper last year by Nie Yongfeng, a Tsinghua University professor and government adviser who sees a need for more incinerators, said that most municipal landfills for toxic waste lacked room for the ash, so the ash was dumped. Trash incinerators have two advantages that have prompted Japan and much of Europe to embrace them: they occupy much less real estate than landfills, and the heat from burning trash can be used to generate electricity. The Baoan incinerator generates enough power to light 40,000 households. And landfills have their own environmental hazards. Decay in landfills also releases large quantities of methane, a powerful global warming gas, said Robert McIlvaine, president of McIlvaine Company, an energy consulting firm that calculates the relative costs of addressing disparate environmental hazards. Methane from landfills is a far bigger problem in China than toxic pollutants from incinerators, particularly modern incinerators like those in Baoan, he said. China’s national regulations still allow incinerators to emit 10 times as much dioxin as incinerators in the European Union; American standards are similar to those in Europe. Tightening of China’s national standards has been stuck for three years in a bureaucratic war between the environment ministry and the main economic planning agency, the National Development and Reform Commission, said a Beijing official who insisted on anonymity because he was not authorized to discuss the subject publicly. The agencies agree that tighter standards on dioxin emissions are needed. They disagree on whether the environment ministry should have the power to stop incinerator projects that do not meet tighter standards, the official said, adding that the planning agency wants to retain the power to decide which projects go ahead. Yan Jianhua, the director of the solid waste treatment expert group in Zhejiang province, a center of incinerator equipment manufacturing in China, defended the industry’s record on dioxin, saying that households that burn their trash outdoors emit far more dioxin. "Open burning is a bigger problem according to our research," Professor Yan said, adding that what China really needs is better trash collection so that garbage can be disposed of more reliably. Critics and admirers of incinerators alike call for more recycling and reduced use of packaging as ways to reduce the daily volume of municipal garbage. Even when not recycled, sorted trash is easier for incinerators to burn cleanly, because the temperature in the furnace can be adjusted more precisely to minimize the formation of dioxin. Yet the Chinese public has shown little enthusiasm for recycling. As Mr. Zhong, the engineer at the Baoan incinerator, put it, "No one really cares." __________________________________________________________________________ _____________________________________*____________________________________ __________________________________________________________________________ * SAFETY OF INJECTIONS brief yourself at: www.injectionsafety.org A fact sheet on injection safety is available at: http://www.who.int/mediacentre/factsheets/fs231/en/index.html * Visit the WHO injection safety website and the SIGN Alliance Secretariat at: http://www.who.int/injection_safety/en/ Download the latest injection safety Best Practices review at: http://www.uqconnect.net/signfiles/Files/BestPracticesJul2003.pdf Use the Toolbox at: http://www.who.int/injection_safety/toolbox/en/ Subscribe or un-subscribe by email to: sign@uq.net.au, sign@who.int or on subscribe online at: http://www.who.int/injection_safety/sign/en/ Get SIGN files on the web at: http://www.uqconnect.net/signfiles/Files/ get SIGNpost archives at: http://www.uqconnect.net/signfiles/Archives/?M=D The SIGN Secretariat, the Department of Essential Health Technologies, WHO, Avenue Appia 20, CH-1211 Geneva 27, Switzerland. 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