*SAFE INJECTION GLOBAL NETWORK* SIGNPOST *SAFE INJECTION GLOBAL NETWORK* SIGN 2009 30 November to 2 December 2009 at WHO HQ Geneva Post00511 Request + Abstracts + MedTech HTA + News 2 September 2009 CONTENTS 1. Request to SIGN for grey/unpublished literature on injection safety 2. Abstract: Body fluid exposure in nurses of Fars province, Southern Iran 3. Abstract: Impact of infection control activities on the rate of needle stick injuries at a tertiary care hospital of Pakistan over a period of six years: an observational study 4. Abstract: Decline of viral hepatitis prevalence among asymptomatic Egyptian blood donors: a glimmer of hope 5. Abstract: Injection drug use, unsafe medical injections, and HIV in Africa: a systematic review 6. Abstract: Medical waste incinerator constructed with locally produced materials: experience during the immunization campaign 2002 against measles in Douala, Cameroon 7. Abstract: Exposure rate of needlestick and sharps injuries among Australian veterinarians 8. Abstract: Hands-free technique in the operating room: reduction in body fluid exposure and the value of a training video 9. Abstract: The current status of hand washing and glove use among care staff in Japan: its association with the education, knowledge, and attitudes of staff, and infection control by facilities. 11. Abstract: Skin disinfection and its efficacy before administering injections 12. Abstract: Pre-operative antiseptic skin preparation 13. Abstract: Survey of teaching/learning of healthcare-associated infections in UK and Irish medical schools 14. Abstract: Inactivation of animal and human prions by hydrogen peroxide gas plasma sterilization 15. Abstract: Protecting the blood supply from emerging pathogens: the role of pathogen inactivation 16. MedTech Forum 2009 policy debate on HTA: Prof Dr Peter Sawicki of IQWiG joins the panel 17. News - India: Police arrest 6 for supplying blood tainted with hepatitis B, C to hospitals in northern India - India: Blood sold in UP found contaminated - India: Children’s Hospital Accused Of Illegal Blood Transfusions - Nigeria: NAFDAC seizes drugs worth N24m - Researcher Develops Inhalable Measles Vaccine - India: Inhalable measles vaccine soon in India = India: Blood racket: Contaminated blood could have caused Hepatitis = USA: Prosecutors Reduce Charges Against Scrub Tech = Africa: Injection drug use, unsafe medical injections, and HIV in Africa: a systematic review - Malaysia: Why barber shops must disinfect equipment - USA: City backs biomedical waste disposal plan - Opinion: Tide turns in favour of drug reform This edition of SIGNpost is located at: http://uqconnect.net/signfiles/Archives/SIGN-POST00511.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. Request to SIGN for grey/unpublished literature on injection safety Please reply to: Arshad Altaf __________________________________________________________________________ Subject: Request to SIGN for grey/unpublished literature on injection safety From: Arshad Altaf To: SIGN Moderator sigh@uq.net.au Date: Sat, 29 Aug 2009 Hi Allan, I am writing on behalf of the group (myself, Aamir Khan (lead person), Lubna Samad and Affan Ifran) here in Pakistan. We are conducting a systemic review of prevalence of unsafe injections throughout the world and intend to summarize these results by country/GBD region, age and sex. This is part of the global burden of diseases study. While we are conducting and organizing literature search we would like SIGN to share with us any grey or unpublished literature related to injection safety (reuse /unnecessary injections) and needle stick related infections as well as prevalence of infections (excluding immunizations and drug abuse and needle exchange programs). If anyone has any relevant material please do contact me. Kind regards. Arshad Altaf Karachi, Pakistan __________________________________________________________________________ _____________________________________*____________________________________ 2. Abstract: Body fluid exposure in nurses of Fars province, Southern Iran __________________________________________________________________________ Arch Iran Med. 2008 Sep;11(5):515-21. Body fluid exposure in nurses of Fars province, Southern Iran. Askarian M, Shaghaghian S, Gillen M, Assadian O. Department of Community Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. askariam@sums.ac.ir BACKGROUND: Blood and body fluid exposures place healthcare workers at risk for blood-borne infections. To determine the extent of the problem in Iran, we assessed blood and body fluid exposure in healthcare workers in Fars Province hospitals. METHODS: We distributed 2,118 questionnaires using a stratified random sampling method among nurses of these hospitals. We used Chi-square test, Student's t-test, and multiple logistic regression analysis for determining risk factors for exposure. RESULTS: The overall prevalence of blood and body fluid exposures was 79% with a rate of exposure to sharps devices of 50%. Hypodermic needles were involved in most exposures (73%) with the most common source of injury being needle recapping (35%). Blood was the most frequent contaminant (87%) in mucocutaneous exposures, most commonly associated with inserting and removing intravenous lines (50%). Sharps injuries were independently associated with gender, professional level, and hospital location; mucocutaneous exposures were related to professional level and hospital location. Only 28% of nurses reported their exposures. CONCLUSION: The high level of risk found among nurses in Fars Province highlights the urgent need for interventions to enhance their occupational safety and to prevent unnecessary transmission of blood-borne viruses. __________________________________________________________________________ _____________________________________*____________________________________ 3. Abstract: Impact of infection control activities on the rate of needle stick injuries at a tertiary care hospital of Pakistan over a period of six years: an observational study __________________________________________________________________________ BMC Infect Dis. 2009 May 29;9:78. Impact of infection control activities on the rate of needle stick injuries at a tertiary care hospital of Pakistan over a period of six years: an observational study. Zafar A, Habib F, Hadwani R, Ejaz M, Khowaja K, Khowaja R, Irfan S. Department of Pathology and Microbiology, Aga Khan University Hospital, Karachi, Pakistan. afia.zafar@aku.edu BACKGROUND: Accidental exposure to blood and body fluids is frequent among health care workers. They are at high risk of nosocomial transmission of blood borne pathogens due to injuries caused by used sharps. We are reporting impact of surveillance and educational program on the rate of needle stick injuries among health care workers at a tertiary care hospital in Pakistan. METHODS: At Aga Khan University Hospital sharp injuries are reported to infection control office. To reduce these incidents a quality improvement project was inducted in the year 2005. Health care workers were educated; surveillance data from 2002 to 2007 was analyzed and compared with various risk factors. RESULTS: During study period 1382 incidents were reported. Junior doctors sustained highest number of injuries (n = 394; 28.5%) followed by registered nurses (n = 283; 20.4%). Highest number of incidents was reported during blood collection (19%). An increasing trend was observed in the pre intervention years (2002-04). However noticeable fall was noted in the post intervention period that is in year 2006 and 2007. Major decline was noted among nurses (from 13 to 5 NSI/100 FTE/year). By relating and comparing the rates with various activities directly linked with the use of syringes a significant reduction in incidents were found including; hospital admissions (p-value 0.01), surgeries and procedures performed (p = 0.01), specimens collected in the laboratory (p = 0.001) and patients visits in clinics (p = 0.01). CONCLUSION: We report significant reduction in needle stick injuries especially during post intervention study period. This is being achieved by constant emphasis on improving awareness by regular educational sessions, implemented as a quality improvement project. __________________________________________________________________________ _____________________________________*____________________________________ 4. Abstract: Decline of viral hepatitis prevalence among asymptomatic Egyptian blood donors: a glimmer of hope __________________________________________________________________________ Eur J Intern Med. 2009 Sep;20(5):490-3. Decline of viral hepatitis prevalence among asymptomatic Egyptian blood donors: a glimmer of hope. Ismail AM, Ziada HN, Sheashaa HA, Shehab El-Din AB. Urology and Nephrology Center, Mansoura University, Mansoura, Egypt. BACKGROUND: Viral hepatitis is an important etiological agent of chronic hepatitis and liver disease and is a major cause of morbidity and mortality especially in Egypt since it has the highest prevalence of hepatitis C virus (HCV) infection. We aimed to assess if there is any change in the annual seroprevalence of both HCV and hepatitis B virus (HBV) infection in Egypt in the current era. METHODS: Our study included 55,922 potentially healthy asymptomatic blood donors; 52,280 males and 3642 females with mean age of 30.98+/-8.6 years. All of them were volunteers for the first time and 70% were from rural areas. We applied our own questionnaire that included past medical history, surgical history, and history of blood donation. We screened their sera for the presence or absence of anti-HCV antibodies with the 3rd generation enzyme- linked immunosorbent assay (ELISA) and the presence or absence of hepatitis B surface antigen (HBsAg) with ELISA. RESULTS: The cumulative seroprevalence of HCV and HBV infection was 11.95% and 1.3% respectively. The annual seroprevalence of both viruses showed a declining pattern throughout the study period from 17.7% to 7.4% regarding HCV and HBV infection from 2.3% to 0.9%. The decline trends for both viral infections were observed for both genders. CONCLUSION: This study carries a glimmer of hope because of a decline in seroprevalence of viral hepatitis in Egypt. However stringent implementation of infection control programs in Egypt is mandatory to face this furious health problem. 2009 European Federation of Internal Medicine. __________________________________________________________________________ _____________________________________*____________________________________ 5. Abstract: Injection drug use, unsafe medical injections, and HIV in Africa: a systematic review __________________________________________________________________________ Harm Reduct J. 2009 Aug 28;6(1):24. Injection drug use, unsafe medical injections, and HIV in Africa: a systematic review. Reid SR. The reuse of injecting equipment in clinical settings is well documented in Africa and appears to play a substantial role in generalized HIV epidemics. The U.S. and the WHO have begun to support large scale injection safety interventions, increased professional education and training programs, and the development and wider dissemination of infection control guidelines. Several African governments have also taken steps to control injecting equipment, including banning syringes that can be reused. However injection drug use (IDU), of heroin and stimulants, is a growing risk factor for acquiring HIV in the region. IDU is increasingly common among young adults in sub-Saharan Africa and is associated with high risk sex, thus linking IDU to the already well established and concentrated generalized HIV epidemics in the region. Demand reduction programs based on effective substance use education and drug treatment services are very limited, and imprisonment is more common than access to drug treatment services. Drug policies are still very punitive and there is widespread misunderstanding of and hostility to harm reduction programs e.g. needle exchange programs are almost non-existent in the region. Among injection drug users and among drug treatment patients in Africa, knowledge that needle sharing and syringe reuse transmit HIV is still very limited, in contrast with the more successfully instilled knowledge that HIV is transmitted sexually. These new injection risks will take on increased epidemiological significance over the coming decade and will require much more attention by African nations to the range of effective harm reduction tools now available in Europe, Asia, and North America __________________________________________________________________________ _____________________________________*____________________________________ 6. Abstract: Medical waste incinerator constructed with locally produced materials: experience during the immunization campaign 2002 against measles in Douala, Cameroon __________________________________________________________________________ Med Trop (Mars). 2009 Jun;69(3):245-50. [Medical waste incinerator constructed with locally produced materials: experience during the immunization campaign 2002 against measles in Douala, Cameroon] [Article in French] Guévart E, Bita Fouda A, Mbous JA, Makoutode M, Bessaoud K. Délégation provinciale de la santé publique du Littoral, Douala, Cameroun. guevart_edouard@yahoo.fr Incineration is still the method of choice for disposal of biomedical waste. Combustion at 800+ degrees C eliminates all risk of injury by reducing the waste to ashes and destroying all microorganisms. The purpose of (t)his report is to present a modular double-chambered incinerator in conformity with recommendations for developing countries. The incinerator described here provides the following advantages: suitability for low-cost artisanal construction, excess-air combustion, low risk of accidents and contamination, after-burner for smoke, energy efficiency, easy operation/maintenance, and safety. It is made from locally produced clay bricks reinforced with a steel frame and features two chambers for combustion and post-combustion. It functions on a batch basis with a 2- hour cycle. The immunization campaign against measles that was carried out in 5 districts of Douala in December 2002 produced 800,000 self-disabling syringes with needles. These by-products were immediately discarded in cardboard safety boxes (5-liter capacity, 1 kg) that were taken to the incinerator and burned at the rate of two batches per day. RESULTS: The construction cost of the incinerator was 3,500,000 FCFA (5,300 euros). A total of 5,816 boxes were incinerated, i.e., 29,080 litres, 872,400 syringes, 6,281 kg. Incineration required 126 batches over a period of 11 weeks. The ashes (240 litres, i.e. 0.8% of the total incinerated volume) were virtually free from solid residue. Fuel consumption was negligible. Smoke was never excessive, thick or odorous. Temperatures measured during preliminary trials were always above 800 degrees C. According to the WHO, toxic emissions are negligible if incineration is carried out at temperatures higher than 700 degrees C for less than 2 hours a day. Further study will be necessary to confirm this preliminary experience with regard to temperature control and smoke/ash composition and to test the incinerator in various climatic and operating conditions. _____________________________________*____________________________________ 7. Abstract: Exposure rate of needlestick and sharps injuries among Australian veterinarians __________________________________________________________________________ J Occup Med Toxicol. 2009 Aug 28;4(1):25. Exposure rate of needlestick and sharps injuries among Australian veterinarians. Leggat PA, Smith DR, Speare R. BACKGROUND: Needlestick and sharps injuries (NSI) represent an important occupational health issue in veterinary practice. Little is known about the distribution and correlates of NSI among Australian veterinarians. METHODS: A questionnaire-based NSI survey was mailed to 1094 veterinarians registered with the Veterinary Surgeons Board of Queensland during 2006. RESULTS: A total of 664 surveys were returned from 1038 eligible participants (response rate 64.0%) with 56.8% being male, around one-third in the >50 years age group and about half aged 31-50 years. Just over two- fifths were working in small animal practice only. Around three quarters (75.3%) reported suffering at least one NSI in the previous 12 months, while 58.9% reported suffering from at least one contaminated NSI during the previous 12 months, which crudely extrapolates to an exposure rate rates of 75.3 and 58.9 NSI per 100 person-years respectively. Risk factors for contaminated NSI were female gender, working in small or mixed animal practice, being less experienced, seeing more patients per week and working longer hours per week. The most common causative devices were syringes (63.7%), suture needles (50.6%) and scalpel blades (34.8%). CONCLUSION: The exposure rate of NSI is high for Queensland veterinarians and clearly remains a major occupational health problem. Current guidelines and strategies to reduce NSI in veterinary practice should be promoted, but appear to be adapted from human health care. Studies to understand why veterinarians have such high NSI rates are required to not only identify risk factors for NSI, but also to determine attitudes and beliefs about NSI. From these studies specific strategies for veterinarians can be designed and trialed to develop evidence-based guidelines and policies that are effective in decreasing the exposure rate of NSI in veterinary practice. __________________________________________________________________________ _____________________________________*____________________________________ 8. Abstract: Hands-free technique in the operating room: reduction in body fluid exposure and the value of a training video __________________________________________________________________________ Public Health Rep. 2009 Jul-Aug;124 Suppl 1:169-79. Hands-free technique in the operating room: reduction in body fluid exposure and the value of a training video. Stringer B, Haines T, Goldsmith CH, Blythe J, Berguer R, Andersen J, De Gara CJ. Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada. OBJECTIVES: This study sought to determine if (1) using a hands-free technique (HFT)--whereby no two surgical team members touch the same sharp item simultaneously--> or = 75% of the time reduced the rate of percutaneous injury, glove tear, and contamination (incidents); and (2) if a video-based intervention increased HFT use to > or = 75%, immediately and over time. METHODS: During three and four periods, in three intervention and three control hospitals, respectively, nurses recorded incidents, percentage of HFT use, and other information in 10,596 surgeries. The video was shown in intervention hospitals between Periods 1 and 2, and in control hospitals between Periods 3 and 4. HFT, considered used when > or = 75% passes were done hands-free, was practiced in 35% of all surgeries. We applied logistic regression to (1) estimate the rate reduction for incidents in surgeries when the HFT was used and not used, while adjusting for potential risk factors, and (2) estimate HFT use of about 75% and 100%, in intervention compared with control hospitals, in Period 2 compared with Period 1, and Period 3 compared with Period 2. RESULTS: A total of 202 incidents (49 injuries, 125 glove tears, and 28 contaminations) were reported. Adjusted for differences in surgical type, length, emergency status, blood loss, time of day, and number of personnel present for > or = 75% of the surgery, the HFT-associated reduction in rate was 35%. An increase in use of HFT of > or = 75% was significantly greater in intervention hospitals, during the first post-intervention period, and was sustained five months later. CONCLUSION: The use of HFT and the HFT video were both found to be effective. __________________________________________________________________________ _____________________________________*____________________________________ 9. Abstract: The current status of hand washing and glove use among care staff in Japan: its association with the education, knowledge, and attitudes of staff, and infection control by facilities. __________________________________________________________________________ Environ Health Prev Med. 2009 Aug 25. The current status of hand washing and glove use among care staff in Japan: its association with the education, knowledge, and attitudes of staff, and infection control by facilities. Takahashi I, Osaki Y, Okamoto M, Tahara A, Kishimoto T. Faculty of Health Sciences, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan, t- ikuko@yamaguchi-u.ac.jp. OBJECTIVE: Hand hygiene is a basic measure to prevent infections. The purpose of this study was to obtain suggestions for the improvement of hand hygiene by evaluating the education, knowledge, and attitudes of care staff at facilities for the elderly in regard to hand washing and glove use, as well as infection control policies by those facilities. METHODS: Among a total of 147 special nursing homes and health service facilities for the elderly in Yamaguchi Prefecture, Japan, questionnaires were sent from October to November 2007 to 56 facilities which had agreed to participate in this survey. Two types of questionnaire, one for the facility manager and the other for care staff, were sent to each facility. RESULTS: The questionnaire was responded to by 42 managers (response rate 28.6%) and 1,323 staff members (response rate 26.3%). The rate of compliance with hand hygiene among them was 34.0%. Personal factors promoting hand hygiene were education and attitudes, while facility- related factor was the implementation of hand-washing evaluation. CONCLUSION: Since the hand hygiene compliance rate is low among care staff at facilities for the elderly, it is necessary to take measures to improve hand hygiene. Educational programs for hand hygiene should be developed in view of the conditions of individual facilities. __________________________________________________________________________ _____________________________________*____________________________________ 11. Abstract: Skin disinfection and its efficacy before administering injections __________________________________________________________________________ Nurs Stand. 2009 Jun 3-9;23(39):42-4. Skin disinfection and its efficacy before administering injections. Gittens G, Bunnell T. Faculty of Health and Social Care, University of Hull. G.Gittens@2007.hull.ac.uk The need to disinfect a patient's skin before subcutaneous or intramuscular injection is a much debated practice. Guidance on this issue varies between NHS organisations that provide primary and secondary care. However, with patients being increasingly concerned with healthcare- associated infections, a general consensus needs to be reached whereby this practice is either rejected or made mandatory. __________________________________________________________________________ _____________________________________*____________________________________ 12. Abstract: Pre-operative antiseptic skin preparation __________________________________________________________________________ Br J Nurs. 2009 Jun 11-24;18(11):665-9. Pre-operative antiseptic skin preparation. Murkin CE. Royal Devon and Exeter Healthcare NHS Foundation, Exeter. Theatre nurses use antiseptic skin preparation products every day, but little thought seems to be given as to why a surgeon has a particular preference for one antiseptic skin preparation over another - whether it is for its efficacy, safety or application properties. Woodhead et al (2004) states that nurses still work in a ritualistic environment. Rituals are 'any action performed according to custom, without understanding the reasons why it is being practised'. Nursing practice should be evidence- based; nurses should understand the rationale behind the choice of a particular antiseptic, and be knowledgable about the clinical effectiveness of antiseptic's use pre- operatively, to achieve optimum results. This article focuses on the main types of antiseptic skin preparation while highlighting each product's activity and the relevant considerations for choosing the appropriate product for each patient. Theatre staff need to emphasize the importance of skin preparation and the correct application techniques, while educating the scrub team and surgeons with respect to skin preparation. __________________________________________________________________________ _____________________________________*____________________________________ 13. Abstract: Survey of teaching/learning of healthcare-associated infections in UK and Irish medical schools __________________________________________________________________________ J Hosp Infect. 2009 Aug 24. Survey of teaching/learning of healthcare-associated infections in UK and Irish medical schools. O'Brien D, Richards J, Walton KE, Phillips MG, Humphreys H. Department of Microbiology, Beaumont Hospital, Dublin, Ireland; Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland. All medical doctors have an important role to play in the diagnosis, management and prevention of healthcare-associated infection (HCAI). Strengthening the contribution of medical doctors and medical students to HCAI prevention programmes should include measures that enhance knowledge, improve practice and develop appropriate attitudes to the safety and quality of patient care. The Hospital Infection Society (HIS) funded a review of medical education on HCAI throughout medical schools in the UK and the Republic of Ireland. A questionnaire was drafted and circulated to all medical schools and 31 of 38 (82%) responded. The prevalence and transmission of HCAI were taught by 97% and 100% of medical schools, respectively, but the importance of HCAI as a quality and safety issue was covered in only 60% of medical schools. Multiple choice questions (MCQs) and objective structure clinical examinations (OSCEs) were the most popular methods of assessment. Lectures, discussion of cases and practical demonstrations were considered useful by >90% of respondents and online material and log books by 67% and 60%, respectively. More than 80% were willing to share a common pool of educational resources. An agreed curriculum should be developed for educating medical students in HCAI prevention and control, to outline optimum methods for assessment and develop a shared pool of educational resources. __________________________________________________________________________ _____________________________________*____________________________________ 14. Abstract: Inactivation of animal and human prions by hydrogen peroxide gas plasma sterilization __________________________________________________________________________ Infect Control Hosp Epidemiol. 2009 Aug;30(8):769-77. Inactivation of animal and human prions by hydrogen peroxide gas plasma sterilization. Rogez-Kreuz C, Yousfi R, Soufflet C, Quadrio I, Yan ZX, Huyot V, Aubenque C, Destrez P, Roth K, Roberts C, Favero M, Clayette P. SPI-BIO, CEA, Fontenay aux Roses, France. Prions cause various transmissible spongiform encephalopathies. They are highly resistant to the chemical and physical decontamination and sterilization procedures routinely used in healthcare facilities. The decontamination procedures recommended for the inactivation of prions are often incompatible with the materials used in medical devices. In this study, we evaluated the use of low-temperature hydrogen peroxide gas plasma sterilization systems and other instrument-processing procedures for inactivating human and animal prions. We provide new data concerning the efficacy of hydrogen peroxide against prions from in vitro or in vivo tests, focusing on the following: the efficiency of hydrogen peroxide sterilization and possible interactions with enzymatic or alkaline detergents, differences in the efficiency of this treatment against different prion strains, and the influence of contaminating lipids. We found that gaseous hydrogen peroxide decreased the infectivity of prions and/or the level of the protease-resistant form of the prion protein on different surface materials. However, the efficiency of this treatment depended strongly on the concentration of hydrogen peroxide and the delivery system used in medical devices, because these effects were more pronounced for the new generation of Sterrad technology. The Sterrad NX sterilizer is 100% efficient (0% transmission and no protease-resistant form of the prion protein signal detected on the surface of the material for the mouse-adapted bovine spongiform encephalopathy 6PB1 strain and a variant Creutzfeldt-Jakob disease strain). Thus, gaseous or vaporized hydrogen peroxide efficiently inactivates prions on the surfaces of of medical devices. __________________________________________________________________________ _____________________________________*____________________________________ 15. Abstract: Protecting the blood supply from emerging pathogens: the role of pathogen inactivation __________________________________________________________________________ Transfus Clin Biol. 2009 May;16(2):70-4. Protecting the blood supply from emerging pathogens: the role of pathogen inactivation. Blajchman MA. Department of Pathology and Molecular Medicine, McMaster University, HSC 4N67 Hamilton, ON, Canada. blajchma@mcmaster.ca As a consequence of the many blood-safety interventions introduced since the mid-1980s, the major causes of transfusion-associated mortality have shifted from being mainly due to transfusion-transmitted infections (TTIs) to being mainly due to non-infectious serious events such as TRALI, hemolytic reactions, transfusion overload, and graft versus host disease. Thus, TTIs now account for only 10 to 15% of all transfusion associated mortalities! Relevantly, manufacturers of purified plasma protein fractions have, over the same time period, shown that pathogen inactivation technologies can be successfully implemented resulting in little or no transmission of HIV, HCV or HBV since the late 1980s. These technologies, however, cannot be applied to cellular blood components. Thus, new technologies have evolved over the past decade to treat cellular blood components as well as plasma. These technologies, particularly those involving plasma and platelets, have begun to be used in Europe and this proactive paradigm has evolved to become a potential pre-emptive approach for ridding the blood supply of most TTIs (virus, bacteria, and protozoa). However, in order for pathogen inactivation technologies to become widely accepted, they must be shown to be both cost effective and not associated with new risks to recipients! __________________________________________________________________________ _____________________________________*____________________________________ 16. MedTech Forum 2009 policy debate on HTA: Prof Dr Peter Sawicki of IQWiG joins the panel __________________________________________________________________________ MedTech Forum 2009 policy debate on HTA: Prof Dr Peter Sawicki of IQWiG joins the panel Dear colleagues, The programme of this year's MedTech Forum is a series of high-level sessions to discuss the state of healthcare policy in Europe and the way forward in times of economic crisis. One of this year's highlights is the high-level debate "What should define value?: Assessing Health Technology" chaired by Prof Mike Drummond of the University of York from 11.00-12.30 on Wednesday, 7 October. This debate aims at highlighting different stakeholders' views on the effect of Health Technology Assessment (HTA) on the quality of healthcare and the uptake of innovative and cost-efficient technologies in Europe. The debate will focus on: Why is HTA key to European health policy? Where is the role of the European Union and its institutions? Is European health policy on the right track? How are the different stakeholders, such as clinicians and patients, affected and what is their role? The panellists are: Jérôme Boehm, European Commission DG SANCO Yann Le Cam, Eurordis Prof Dr Peter Sawicki, Institute for Quality and Efficiency in Health Care (IQWiG) Prof Claudio Jommi, Bocconi University Prof Angelo Auricchio, European Heart Rhythm Association (EHRA) Prof Mike Drummond, University of York (chair) Three other high-level debates on the topics "Access to high-quality care: What incentives for physicians, patients and industry?", "Is MedTech short in talent for continued growth?" and "Delivering healthcare through innovation: The EU's next steps?" are also organised on that day. They will be followed by a CEO Summit with global and European leaders. Download the programme for more information. The MedTech Forum will take place from 6-8 October at the Crowne Plaza hotel in Brussels. The conference is your unique opportunity to network with over 400 delegates representing European institutions, Health Ministries, NGOs, scientific societies, academia and industry on how the MedTech industry can contribute to "Fostering Health - For People, For Europe"! Register now on http://www.medtechforum.eu. Registration is free for NGOs, Press and EU Officials. Eucomed, on behalf of the European Medical Technology Industry, is looking forward to welcoming you to Brussels! __________________________________________________________________________ _____________________________________*____________________________________ 17. News - India: Police arrest 6 for supplying blood tainted with hepatitis B, C to hospitals in northern India - India: Blood sold in UP found contaminated - India: Children’s Hospital Accused Of Illegal Blood Transfusions - Nigeria: NAFDAC seizes drugs worth N24m - Researcher Develops Inhalable Measles Vaccine - India: Inhalable measles vaccine soon in India = India: Blood racket: Contaminated blood could have caused Hepatitis = USA: Prosecutors Reduce Charges Against Scrub Tech = Africa: Injection drug use, unsafe medical injections, and HIV in Africa: a systematic review - Malaysia: Why barber shops must disinfect equipment - USA: City backs biomedical waste disposal plan - Opinion: Tide turns in favour of drug reform Selected news items reprinted under the fair use doctrine of international copyright law: http://www4.law.cornell.edu/uscode/17/107.html __________________________________________________________________________ India: Police arrest 6 for supplying blood tainted with hepatitis B, C to hospitals in northern India By Biswajeet Banerjee, The Canadian Press (01.09.09) LUCKNOW, INDIA - Police charged six people, including a doctor, for spreading infectious diseases after they allegedly supplied blood contaminated with hepatitis B and C to blood banks in northern India, police said Tuesday. Police raided blood banks in Lucknow, the capital of Uttar Pradesh state, last month and seized about 60 pouches of blood ready for delivery to hospitals and private clinics, said Vinay Chandra, a senior police official. Each pouch contained a unit, or 3/4 of a pint (350 millilitres), of blood. The seized samples had a low hemoglobin count and were unfit for human use, superintendent of Police Paresh Pandey said, adding he initially suspected animal blood had been mixed with human blood, but later discovered it was diluted with saline water. Some of the blood samples tested positive for the hepatitis B and C viruses. Others had been diluted to make three units of blood from a single unit, Chandra said. The men running the blood supply racket bought blood from professional donors who were paid as little as 25 rupees (50 U.S. cents) a unit. Diluted blood was sold to blood banks for 1,000 to 1,500 rupees (US$20-$30) a unit, Pandey said. The suspected leader of the scam was a doctor who works at a state-run hospital, while three others were medical technicians employed at pathological laboratories in Lucknow, Chandra said. No details were available about the other two suspects. Chandra said the men were arrested Sunday on charges of forgery and fraud, spreading infectious diseases, and for violating the Drug and Cosmetics Act. If found guilty, they could be sentenced to life terms in prison. The fraud became known last month after a woman tested positive for hepatitis B after surgery at a Lucknow clinic. The virus was traced to a blood transfusion during the operation. Lack of stringent legislation and oversight allows blood banks in India to supply untested blood to hospitals. Last week, media reports said at least four children in Rajasthan state were given blood donated by a man who later tested positive for HIV. Copyright © 2009 The Canadian Press. .......................................................................... __________________________________________________________________________ India: Blood sold in UP found contaminated by Neharika Sabharwal - TheMedGuru (31.08.09) Lucknow, August 31: A week after the intricate network of a flourishing trade for spurious blood was unraveled by the Lucknow police, official reports confirmed the ominous truth that the blood samples were indeed infected and the platelets contaminated with bacterial growth. Nearly 70 units of blood with fake labels of the state’s largest blood bank at King George’s Medical College (KGMC) were seized. Since the date of collection and expiry was missing on all the bags, samples for a detailed examination were sent to Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS). Analysis of the adulterated samples reveals the quality of blood as extremely poor. The levels of hemoglobin are very low with the Hepatitis virus strains present. Beside the blood quantity being less than indicated on the bag, the blood groups did not tally with the labeling and there were signs of improper storage of blood samples. According to official sources, "SGPGIMS laboratory, in its report, had confirmed that all the samples sent for testing were infected and poor in component." The report was also submitted to the Food and Drug Administration (FDA) of United States. The modus operandi The operation was sleek, with all minute details taken into consideration. The raid in Thakurganj area, the dubious collection and distribution center, unearthed syringes, saline bottles, wrappers of registered hospitals and blood banks, stickers of blood groups, and other instruments used for blood donation. Agents would scout for professional donors like drug addicts, the poor and needy in the slums and railway stations, luring them with a measly sum of Rs 50 and Rs 100. They would then draw the blood and mix it in saline and ordinary water. The adulterated blood was subsequently supplied to various hospitals in Lucknow, Basti, Faizabad and Sitapur at Rs 1,000-1,500 per unit. What is appalling is that the operation was being run with the help of several well-known private blood banks and doctors. Dr A.K. Shukla, chief medical officer of Lucknow said, "We found that even ward boys and paramedical staff at government hospitals were involved in the racket. They referred needy people to these adulterators. Sadly, a large number of people must have suffered due to the spurious blood." Blood banks and hospitals under the scanner Uttar Pradesh Police have arrested six persons of the 14-member gang supplying "untested and unusable blood" to private hospitals, nursing homes and government hospitals in the city. What is cause for concern is that over a period of a year, 100,000 units of the contaminated blood was sold which could have affected nearly one lakh persons. A joint team of the FDA and police conducted surprise inspections of many private hospitals and blood banks across the city and a show-cause notice was issued to three blood banks. "Charak Pathology, Indira Diagnostic Centre and Kohli Blood Bank were found functioning without proper facilities of blood extraction and storage. They were also not having proper certificates," an FDA official said. .......................................................................... __________________________________________________________________________ India: Children’s Hospital Accused Of Illegal Blood Transfusions CNN (31.08.09) Authorities have launched random HIV tests at a private children’s hospital in western India after it was allegedly found to have been carrying out blood transfusions illegally. NEW DELHI, India (CNN) - Authorities have launched random HIV tests at a private children’s hospital in western India after it was allegedly found to have been carrying out blood transfusions illegally. H.S. Brar, child health officer of Rajasthan state’s Sri Ganganagar district, told CNN Monday that a criminal case had been filed against administrators at the hospital. The accusations include that the hospital gave children infusions of blood that had not been properly tested. Results from two of the four children tested so far for HIV have been negative. Reports are awaited for the other two. Until now, district authorities have also examined blood samples of eleven donors, which are not found to be infected, Brar said. More recipients and donors will be tested randomly, he added. The incident is the second uncovered recently alleged involving alleged problems with India’s blood handling systems. Last week, police in neighboring Uttar Pradesh state arrested six men for running a "fake" blood bank. The operation was in place for about two to three years. Police said some 100,000 units, which could be contaminated in many instances, were believed to have been sold out from the raided address. Preliminary investigation showed that the arrested suspects had been buying blood mainly from urchins, beggars and drug addicts in and around Lucknow, the capital of Uttar Pradesh, for some Rs 400, or about $8, per unit. They would take it out from donors in a tiny room, store it in a refrigerator, package it with fake labels of authorized facilities and sell it off to attendants of patients in need, police said. .......................................................................... __________________________________________________________________________ Nigeria: NAFDAC seizes drugs worth N24m Triumph, Nigeria (31.09.09) The National Agency for Food Drug and Drug Administration and Control (NAFDAC) in Abuja seized unregistered intravenous fluids worth more than N24 million. Dr. Paul Orhii, the Director-General of the agency, told newsmen that consignments of the fluids were seized on August 21 by NAFDAC regulatory officers on routine surveillance on Dutse-Kano-Maiduguri road in Jigawa state. He said 5,000 cartoons of the fluids valued at more than N24 million were labeled in French without NAFDAC registration number. ``The driver of the truck, marked PIN 0955RB, from the Republic of Benin, refused to stop when flagged down by NAFDAC officers until he was pursued. ``When the truck driver was interrogated, he claimed that the consignments were construction materials, and brought a document to support the claim," he said. Orhii explained that on close examination, it was discovered that the truck contained 5,000 cartons of intravenous D5 glucose A drip. He said the truck was impounded, while the three occupants were arrested and interrogated. Orhii added that the culprits initially tried to induce and compromise the NAFDAC regulatory officer who intercepted the consignment, and when the move failed, they resorted to threat, harassment and intimidation of the officer. He announced the immediate accelerated promotion of the NAFDAC officers, including Mrs Faith Chukwura, Chief Laboratory Technologists, and Mr Iluyomade Martins, Principal Officer, both of whom are in the Lagos office of the agency. Others were Mr. Kenneth Azikwe, Assistant Chief Regulatory Officer and Unit Head, Jigawa and Mr Nathaniel Lukas, Regulatory Officer 1, Jigawa. Orhii said the promotions were to encourage the officers of the agency to be courageous and honest in the discharge of their duties, promising that stimulus packages would be given to reward them and their immediate supervisors. The Director-General reiterated the agency's commitment to zero tolerance for fake drugs and substandard products in the country. The News Agency of Nigeriia (NAN) reports that a container load of fake maloxine and Amalar, anti-malarial drugs worth N32.1 million was intercepted at Apapa port in Lagos three month ago. .......................................................................... __________________________________________________________________________ Researcher Develops Inhalable Measles Vaccine By Véronique LaCapra, Voice of America, Washington, DC USA (31.08.09) * An adult could inhale the dry powder measles vaccine using a simple, low-cost plastic bag inhaler * The dry powder measles vaccine could be given to infants using a face mask inhaler Most vaccines are given as a liquid shot using a needle and syringe, but this method can lead to infection if needles are reused or not disposed of safely. Bob Sievers is a chemistry professor at the University of Colorado in Boulder, and the head of a small chemical company called Aktiv-Dry. With a grant from the Bill and Melinda Gates Foundation, Sievers is developing a dry powder form of the measles vaccine that would be inhaled, instead of injected. The first advantage of a needle-free vaccine, says Sievers, is that it does not hurt. "There's no pain associated with inhaling an aerosol, like there is getting a needle-stick." Since an inhalable vaccine would eliminate the need for injection, vaccine recipients would not be at risk of infection from reused needles. Health care providers would be safe from accidental needle-sticks, and there would be no contaminated needles to dispose of. "You can step on a used needle that's thrown out in the trash dump, and contract hepatitis B or something else that would really be only because you had used needles in delivering the vaccine for measles." Liquid measles vaccine is usually made up in batches, with multiple doses in a single vial. If something happens to contaminate the vial, then everyone vaccinated with that batch would be infected. Sievers explains his powder vaccine will be distributed as individually- wrapped doses, so "there's never a chance you're going to be cross- contaminated by the person that came before you." Another problem with the liquid vaccine is that once it's mixed, it must be used within six hours. That's not the case with Sievers' inhalable version. "You can keep it for two years, as a dry powder," he says. Sievers' team has also worked hard to keep down the cost of their vaccine, and it will not cost any more than the current liquid vaccine. Animal studies have shown the new vaccine is both safe and effective at preventing measles infection. Sievers plans to begin human clinical trials in India in 2010. If all goes well, he says the inhalable dry powder measles vaccine could be available for use in two to four years. And he adds that in the future, the same method could be used to create inhalable dry powder versions of other vaccines and medications. Sievers spoke about his work this week at the annual meeting of the American Chemical Society, where he was presented with an Astellas Award for his significant contribution to improving public health. .......................................................................... __________________________________________________________________________ India: Inhalable measles vaccine soon in India Ankita Malik, Press Trust of India - New Delhi,India (30.08.09) New Delhi, Aug 30 (PTI) A single deep breath will soon be enough to vaccinate children against measles as human trials of an inhalable vaccine for the deadly disease are expected to begin early next year in India. Serum Institute of India will be conducting the trials of the new vaccine in the country. "The phase-I trials are expected to begin by the first quarter of next year once the animal testing, currently under process, is completed," Prasad Kulkarni, Additional Medical Director, Serum Institute of India told PTI. The vaccine is expected to hit the market in 2.5-3 years after the trials begin, Kulkarni added. The US scientists, who have developed the dry powder vaccine against measles, say the inhalable vaccine will reduce the risks of needle infections like HIV and hepatitis and greatly benefit developing countries. .......................................................................... __________________________________________________________________________ India: Blood racket: Contaminated blood could have caused Hepatitis Thaindian.com, IANS (30.08.09) Lucknow, Aug 30 (IANS) More than a week after police busted a massive racket in adulterated blood in Uttar Pradesh, another report on the quality of blood seized reveals that it was infected with the highly contagious Hepatitis B and C virus - painting an alarming picture of the possibility of patients having contracted it. The Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), in another report to the government Friday, said the Hepatitis virus strains were found in the adulterated blood. The report was also submitted to the Food and Drug Administration (FDA), an FDA source said Sunday. A detailed examination of the blood, seized by the authorities from a private nursing home run illegally by a government doctor had revealed that very poor quality blood with extremely low levels of haemoglobin was being supplied to patients in different hospitals. Over a period of two years, 100,000 units of the contaminated blood were sold. Uttar Pradesh Police arrested six people, including an anaesthetist from the state-run Balrampur Hospital, in connection with the racket on Aug 22. The racket was allegedly being run with the connivance of several well- known private blood banks and doctors. "We have received the report but the details cannot be revealed now because it will be presented in the court as evidence against the accused on Monday," FDA commissioner Lalit Verma told IANS. The blood seized by the police with fake labels of the state’s largest blood bank at King George’s Medical College (KGMC) were sent for detailed examination to the SGPGIMS. Earlier, a report by the SGPGIMS revealed that saline water was being mixed with the blood to increase its quantity, which led to further dilution of the already low haemoglobin level in the blood. Lucknow Superintendent of Police (City) Paresh Pandey, who busted the racket, had initially said he suspected animal blood was being mixed with human blood. Later, it was found that the blood was being diluted with saline water. Last week a joint team of the FDA and police raided a number of private hospitals and blood banks across the city and a show cause notice was served to three blood banks. "Charak Pathology, Indira Diagnostic Centre and Kohli Blood Bank were found functioning without proper facilities of blood extraction and storage. They were also not having proper certificates," an FDA official said. The gang used to buy blood from professional donors like drug addicts, rickshaw pullers and beggars and would mix it with saline water to make three units from one unit of blood, police said. This was sold at Rs.1,000-1,500 per unit. .......................................................................... __________________________________________________________________________ USA: Prosecutors Reduce Charges Against Scrub Tech P. Solomon Banda, Associated Press Writer, Associated Press (28.08.09) DENVER (AP) Federal prosecutors reduced the number of charges they're pursuing against a surgery technician accused of swapping her dirty syringes for ones filled with powerful painkillers meant for patients, possibly exposing thousands to hepatitis C. Twenty-six-year-old Kristen Diane Parker now faces 19 counts each of tampering and illegally obtaining a controlled substance, down from 21 charges each handed up in a grand jury indictment last month. U.S. attorney spokesman Jeff Dorschner says the reduction in a revised indictment released Friday comes as details emerge about patients who have tested positive for the incurable, sometimes fatal liver disease. Prosecutors have linked 35 hepatitis C cases in patients at two Colorado hospitals to Parker, but say they'll focus on 19 cases they believe will be easiest to prove at trial. "The prosecutors decided to refine the indictments and focus on the cases that have the strongest evidence," Dorschner said. A message left for Gregory Graf, Parker's attorney, was not immediately returned. Sixteeen of the patients in the latest indictment are alleged to have contracted the disease after having surgery at Rose Medical Center in Denver, while one had surgery at Audubon Surgery Center in Colorado Springs. During a police interview videotaped June 30, the 26-year-old Parker told a detective that she kept dirty saline-filled syringes in her pocket and watched for opportunities when doctors and nurses left the room. She then allegedly stole syringes filled with Fentanyl from operating carts and replaced them with the used syringes. Parker came under suspicion while at Rose after an incident March 23 when a needle in her scrub-top pocket pricked a co-worker while the two talked in a hallway. She passed a drug test after that incident but then was placed on administrative leave and later fired when she failed a drug test after she was caught in an operating room where she was not assigned on April 13. She faces charges for both incidents. Prosecutors publicly released dates and places of the alleged offenses, but declined to released additional information. Parker's attorneys have access to details, including patient medical records and other private information that is not available to the public. Investigators believe up to 6,000 patients in Colorado may have been exposed by the dirty needles and contaminated saline. Investigations are also under way at hospitals in New York and Texas, where Parker also worked. No likely cases have been reported in those other states. Fentanyl is a narcotic painkiller 80 to 100 time stronger than morphine. © 2009 The Associated Press .......................................................................... __________________________________________________________________________ Africa: Injection drug use, unsafe medical injections, and HIV in Africa: a systematic review 7thSpace Interactive (press release) - New York,NY,USA (28.08.09) The reuse of injecting equipment in clinical settings is well documented in Africa and appears to play a substantial role in generalized HIV epidemics. The U.S.and the WHO have begun to support large scale injection safety interventions, increased professional education and training programs, and the development and wider dissemination of infection control guidelines. Several African governments have also taken steps to control injecting equipment, including banning syringes that can be reused.However injection drug use (IDU), of heroin and stimulants, is a growing risk factor for acquiring HIV in the region. IDU is increasingly common among young adults in sub-Saharan Africa and is associated with high risk sex, thus linking IDU to the already well established and concentrated generalized HIV epidemics in the region. Demand reduction programs based on effective substance use education and drug treatment services are very limited, and imprisonment is more common than access to drug treatment services.Drug policies are still very punitive and there is widespread misunderstanding of and hostility to harm reduction programs e.g.needle exchange programs are almost non-existent in the region. Among injection drug users and among drug treatment patients in Africa, knowledge that needle sharing and syringe reuse transmit HIV is still very limited, in contrast with the more successfully instilled knowledge that HIV is transmitted sexually. These new injection risks will take on increased epidemiological significance over the coming decade and will require much more attention by African nations to the range of effective harm reduction tools now available in Europe, Asia, and North America. Author: Savanna Reid Credits/Source: Harm Reduction Journal 2009, 6:24 .......................................................................... __________________________________________________________________________ Malaysia: Why barber shops must disinfect equipment Malaysia Star. Kuala Lumpur Malaysia (27.08.09) HEPATITIS B and C are life-threatening viruses. Hepatitis C is a blood borne virus which spreads via blood-to-blood contact. There is a small risk of infection caused by having a haircut at a barber shop where the electrical clippers, scissors or sometimes unchanged razors used on a person might nick someone and then the machine used on another patron. This is possible because studies have suggested that the Hepatitis C virus can live outside of the body in dried blood for four days! In the United States, it is a government requirement for barbers to disinfect their scissors, combs and electrical clippers after cutting each client’s hair. Barber shops in the US usually keep a jar of "barbicide" (a disinfectant manufactured by King Research) to disinfect the equipment before cutting another client’s hair. A client can request that all equipment be disinfected before the barber proceeds to cut his hair. In Malaysia, however, there is no control on disinfecting the hair clippers, scissors or combs. A barber could unintentionally be infecting someone with the Hepatitis C virus. Sometimes the virus can also spread at a dentist clinic, if the equipment is not sterilised. There is a need for awareness among the public, Health Ministry and barbers to prevent the spread of the Hepatitis C virus and to put up signboards outside barber shops so that it can warn patrons to request the barber to disinfect their equipment before they proceed to cut their hair. At the same time, the Government should make sure it is equipped to enforce such a ruling. .......................................................................... __________________________________________________________________________ USA: City backs biomedical waste disposal plan By Kelly Cuculiansky, Daytona Beach News-Journal - FL,USA (27.08.09) PORT ORANGE -- Residents can count on Port Orange fire stations to safely dispose of used needles and syringes through a new community program. With the help of several sponsors, the city has established the Community Sharps Disposal Program for residents to properly dispose of biohazardous waste associated with home treatments such as insulin shots for diabetes and other chronic diseases. In addition to providing drop-off sites at fire stations, the program also offers free, puncture-resistant replacement containers to Port Orange residents. Russell Rafferty, the city's division chief for emergency medical services, told City Council members on Tuesday that the Fire Department could be one of the first in the country with such a program. During the meeting, officials recognized area businesses that helped make it possible. Port Orange Family Days Community Trust, Halifax Health Port Orange and Walmart Supercenter of Port Orange donated $5,000 to establish the program. John Evans, president of Family Days, said its important program for the medical community. "There's been a need recognized." Local fire stations have been accepting used syringes and needles, or "sharps," and properly disposing them for about 15 years. But sharps have been disposed of improperly by others and pose a public health risk to residents and city employees. "We find them in jugs on the side of the road. We find them being brought to our station in plastic bags and unfortunately that can cause a problem so we decided we needed a little bit of research," Rafferty said. That's why the most important component of the program will be the free replacement containers, he said. Some users resort to flushing sharps down the toilet, which pose a hazard for employees trying to maintain sewage infrastructure. Officials said there have been a few incidents where needles have stuck workers. According to the Safe Needle Disposal organization, there are about nine million syringe users administering at least three million injections annually. According to the Centers for Disease Control, syringe users in Florida are encouraged -- but not required -- to segregate and package their biomedical waste safely. The Florida Department of Health recommends using local disposal or needle mail-back programs, which can charge a fee. If those options are not possible, syringe users should check with their local garbage collection agency or landfill to be sure the waste can be disposed of with household garbage in proper containers. About 10 percent of the community produces contaminated needles, Rafferty said, which can carry HIV, AIDS, hepatitis and other infectious diseases. Volusia County began its own sharps disposal program in 1995. For a fee, residents can obtain and drop off filled containers at health department clinics. In other business, the City Council discussed the dissolution of the Water Authority of Volusia. The WAV executive board voted to dissolve the governmental planning board on Sept. 30. That vote requires all participating cities agree to terminate the organization. Council members voted unanimously to terminate it, but seemed disappointed as they recalled WAV's mission to protect and preserve water for the future through the cooperation of area cities, which has become fragmented. "Right now it's the only way we can go, but I hate to see us go that way,' said Vice Mayor Mary Martin. "We've struggled very hard to keep it going." City Manager Ken Parker predicted WAV's mission would reappear in a new format soon. "I think there are some interested cities in doing a cooperative effort in doing this," he said. "It may not look like what WAV looked like, but I think there may be cities that are interested in participating." .......................................................................... __________________________________________________________________________ Opinion: Tide turns in favour of drug reform Alex Wodak, Brisbane Times - Brisbane,Queensland,Australia (27.08.09) * Alex Wodak is director of the Alcohol and Drug Service at St Vincent's Hospital, Melbourne Australia One hundred years ago, the US convened the International Opium Conference. This meeting of 13 nations in Shanghai was the beginning of global drug prohibition. Prohibition slowly became one of the most universally applied policies in the world. But a century on, international support for this blanket drug policy is slowly but inexorably unravelling. In January, Barack Obama became the third US president in a row to admit to consumption of cannabis. Bill Clinton had admitted using cannabis but denied ever inhaling it. George Bush was taped saying in private he would never admit in public to having used cannabis. When Obama was asked whether he had inhaled cannabis, he said: ''Of course. That was the whole point.'' Obama has candidly discussed his drug use. ''Pot had helped, and booze; maybe a little blow [cocaine] when you could afford it.'' He has also admitted the ''war on drugs is an utter failure'' and called for more focus on a public health approach. In February, a Latin American drug policy commission similarly concluded that the ''drug war is a failure''. It recommended breaking the ''taboo on open debate including about cannabis decriminalisation''. The same month, an American diplomat said the US supported needle-exchange programs to help reduce the transmission of HIV and other blood-borne diseases, and supported using medication to treat those addicted to opiates. In March, the United Nations Commission on Narcotic Drugs met in Vienna as the culmination of a 10-year review of global drug policy. A ''political declaration'' was issued which, at the urging of the US, excluded the phrase ''harm reduction''. This omission caused a split in the fragile international consensus on drug policy and resulted in 26 countries, including Australia, demanding explicit support for harm reduction in a footnote. In April, Michel Kazatchkine, of the Global Fund to Fight Aids, Tuberculosis and Malaria, argued in favour of decriminalising illicit drugs to allow efforts to halt the spread of HIV to succeed. The same month, a national Zogby poll in the US provided evidence of changing opinion on the legalisation of cannabis: 52 per cent supported cannabis becoming legal, taxed and regulated. In May there was movement on several fronts. The Governor of California, Arnold Schwarzenegger, said: ''I think it's not time for [legalisation], but I think it's time for a debate.'' He was supported by a number of other American politicians, while Vicente Fox, a former Mexican president, said he was not yet convinced it was the solution but asked: ''Why not discuss it?'' The Colombian Vice-President, Francisco Santos Calderon, is already convinced. ''The only way you can really solve the problem [is] if you legalise it totally.'' Obama's drug czar, Gil Kerlikowske, the director of the Office of National Drug Control Policy, said he wanted to banish the idea of fighting a ''war on drugs'', while the United Nations Secretary-General, Ban Ki-moon, said criminal sanctions on same-sex sex, commercial sex and drug injections were barriers for HIV treatment services. ''Those behaviours should be decriminalised, and people addicted to drugs should receive health services for the treatment of their addiction,'' he said. In Germany, the federal parliament voted 63 per cent in favour to allow heroin prescription treatment. In July, the Economic and Social Council, a UN body more senior than the Commission on Narcotic Drugs, approved a resolution requiring national governments to provide ''services for injecting drug users in all settings, including prisons'' and harm reduction programs such as needle syringe programs and substitution treatment for heroin users. This month, Mexico removed criminal sanctions for possessing any illicit drug in small quantities while Argentina is making similar changes for cannabis. Portugal, Spain and Italy had earlier dropped criminal sanctions for possessing small amounts of any illicit drug, while the Netherlands and Germany have achieved the same effect by changing policing policy. It is now clear that support for a drug policy heavily reliant on law enforcement is dwindling in Western Europe, the US and South America, while support for harm reduction and drug law reform is growing. Sooner or later this debate will start again in Australia. Alex Wodak is director of the Alcohol and Drug Service at St Vincent's Hospital. Source: The Sydney Morning Herald __________________________________________________________________________ _____________________________________*____________________________________ __________________________________________________________________________ * 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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Please subscribe by sending an email to: sign@who.int _____________________________________*____________________________________ The SIGN Internet Forum was established at the initiative of the World Health Organization's Department of Essential Health Technologies. The SIGN Forum is moderated by Allan Bass and is hosted on the University of Queensland computer network. http://www.uq.edu.au __________________________________________________________________________