*SAFE INJECTION GLOBAL NETWORK* SIGNPOST *SAFE INJECTION GLOBAL NETWORK* SIGN 2009 30 November to 2 December 2009 at WHO HQ Geneva Post00516 Abstracts + Funds + News 14 October 2009 CONTENTS 1. Abstract: Starting a health care system green team 2. Abstract: Healthcare-associated infection and the patient experience: a qualitative study using patient interviews 3. Abstract: Reframing governance, security and conflict in the light of HIV/AIDS: A synthesis of findings from the AIDS, security and conflict initiative 4. Abstract: Hand-washing practices of facial plastic surgeons 5. Abstract: Using high-impact interventions to reduce infection risk by standardising good practice 6. Abstract: Effectiveness and limits of the cleaners steam in hospitals 7. Abstract: Today's sterilizer is not your father's water heater 8. Abstract: Semmelweis revisited: hand hygiene and nosocomial disease transmission in the anesthesia workstation 9. Abstract: An integrated supervised injecting program within a care facility for HIV-positive individuals: a qualitative evaluation 10. Abstract: Are you prepared? Defining occupational health resource needs to prevent infectious disease transmission in the health care sector 11. Abstract: Occupational exposures in emergency medical service providers and knowledge of and compliance with universal precautions 12. Abstract: Chlorhexidine-based antiseptic solutions effectively reduce catheter-related bacteremia 13. Abstract: Cocaine vaccine for the treatment of cocaine dependence in methadone-maintained patients: a randomized, double-blind, placebo- controlled efficacy trial 14. Abstract: The INFUSE-Morphine IIB Study: Use of Recombinant Human Hyaluronidase (rHuPH20) to Enhance the Absorption of Subcutaneous Morphine in Healthy Volunteers 15. Abstract: Methicillin-resistant Staphylococcus aureus and Acinetobacter baumannii on computer interface surfaces of hospital wards and association with clinical isolates 16. No Abstract: The future of harm reduction programmes in Russia 17. No Abstract: Healthcare-associated infection: moving behind headlines to clinical solutions 18. No Abstract: National patient safety goals and implementation 19. Fund Title: Strengthening Clinical Services in Lesotho 20. Report on the market for injectable and needle-free delivery systems 21. E-DRUG: Public Campaign Warns Citizens of Dangers of Counterfeit Medicines in Cambodia 22. News - Hand-washing detectors could help save lives - Technology could potentially slash number of hospital-related infections - USA: Peninsula physician patents device to help stem hospital infections - USA: Contaminated Heparin Raises Questions About Drug Safety - Taiwan: Haemophilia patients battle to sue firm that sold tainted drug in Asia - Bayer owned company could face victims in Taiwan over its marketing of infectious blood products - USA: Opting not to vaccinate, gambling with children’s health - USA: OSHA Clarifies ‘Containerization’ for Blood, Body Fluids - USA: Feature: Federal Needle Exchange Funding Ban Battle Continues Canada: Health unit warns of tainted cocaine - Expert describes 'devastating' symptoms - USA: Thousands Potentially Exposed to Infection at Broward General Med. Ctr. - Allergic reaction to vaccines should be investigated - Emerging retrovirus turns up in new patients: Novel virus can spread between people, may lie behind other common illnesses - Sudan: Suspected Ebola kills 23 in Sudan - India: Enter infection-free zones - UK: Revealed: Drug users in Scotland spend £1.4bn every year to feed their habits - Opinion piece responds to 'skeptics' of development aid - USA: Injury and hazards in home health care nursing are a growing concern - Australia: Needle Program a Success - Good hand hygiene can eliminate bacterial contamination in computer devices This edition of SIGNpost is located at: http://uqconnect.net/signfiles/Archives/SIGN-POST00516.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: Starting a health care system green team __________________________________________________________________________ AORN J. 2009 Jul;90(1):33-40. Starting a health care system green team. Mejia EA, Sattler B. UAB Highlands, Birmingham, AL, USA. The health care industry is often overlooked as a major source of industrial pollution, but as this becomes more recognized, many health care facilities are beginning to pursue green efforts. The OR is a prime example of an area of health care that is working to lessen its environmental impact. Nurses can play key roles in identifying areas of waste and presenting ideas about recovering secondary materials. For instance, although infection prevention measures encourage one-time use of some products, nurses can investigate how to reprocess these items so they can be reused. This article examines how the efforts of a Green Team can affect a hospital's waste stream. A health care Green Team can facilitate a medical facility's quest for knowledge and awareness of its effect on the waste stream and environment. __________________________________________________________________________ _____________________________________*____________________________________ 3. Abstract: Healthcare-associated infection and the patient experience: a qualitative study using patient interviews __________________________________________________________________________ J Hosp Infect. 2009 Oct 9. Healthcare-associated infection and the patient experience: a qualitative study using patient interviews. Burnett E, Lee K, Rushmer R, Ellis M, Noble M, Davey P. University of Dundee and Social Dimensions of Health Institute, Dundee, UK. There is an increasing emphasis on the need for further patient involvement within healthcare to ensure that the voice of the patient is heard. This exploratory study utilised in-depth face-to-face interviews with patients to explore narratives from their experiences around healthcare-associated infection (HCAI). Interviews were undertaken with patients who had been diagnosed with a Staphylococcus aureus bloodstream infection and patients who had been in the same hospital but had not been diagnosed with a bloodstream infection. The lack of both verbal and written communications was a major concern for most patients regardless of their infection status. Some patients also stated that they were not comfortable about asking questions, and only a small number of patients and relatives stated that they would challenge staff about their practice. Although some patients retained confidence in the National Health Service (NHS), the majority had very little or no confidence in the NHS in relation to HCAI and would have serious concerns about this if they were to return to hospital. The results suggest that there are a number of issues that must be addressed in order to enhance the quality of care, safety of patients and the patient experience in relation to infection prevention and control. In addition, policy-makers, managers and all healthcare workers must ensure that patients are involved in the design and evaluation of systems change and information. __________________________________________________________________________ _____________________________________*____________________________________ 4. Abstract: Reframing governance, security and conflict in the light of HIV/AIDS: A synthesis of findings from the AIDS, security and conflict initiative __________________________________________________________________________ Soc Sci Med. 2009 Oct 8. Reframing governance, security and conflict in the light of HIV/AIDS: A synthesis of findings from the AIDS, security and conflict initiative. de Waal A. Social Science Research Council, HIV/AIDS and Social Transformation, Emergencies and Humanitarian Action, One Pierrepont Plaza, Brooklyn, NY 11201, United States. This paper draws upon the findings of the AIDS, Security and Conflict Initiative (ASCI) to reach conclusions about the relationship between HIV/AIDS, security, conflict and governance, in the areas of HIV/AIDS and state fragility, the reciprocal interactions between armed conflicts (including post-conflict transitions) and HIV/AIDS, and the impact of HIV/AIDS on uniformed services and their operational effectiveness. Gender issues cut across all elements of the research agenda. ASCI commissioned 29 research projects across regions, disciplines and communities of practice. Over the last decade, approaches to HIV/AIDS as a security threat have altered dramatically, from the early anticipation that the epidemic posed a threat to the basic functioning of states and security institutions, to a more sanguine assessment that the impacts will be less severe than feared. ASCI finds that governance outcomes have been shaped as much by the perception of HIV/AIDS as a security threat, as the actual impacts of the epidemic. ASCI research found that the current indices of fragility at country level did not demonstrate any significant association with HIV, calling into question the models used for asserting such linkages. However at local government level, appreciable impacts can be seen. Evidence from ASCI and elsewhere indicates that conventional indicators of conflict, including the definition of when it ends, fail to capture the social traumas associated with violent disruption and their implications for HIV. Policy frameworks adopted for political and security reasons translate poorly into social and public health policies. Fears of much- elevated HIV rates among soldiers with disastrous impacts on armies as institutions, have been overstated. In mature epidemics, rates of infection among the military resemble those of the peer groups within the general population. Military HIV/AIDS control policies follow a different and parallel paradigm to national (civilian) policies, in which armies prioritize command responsibility and operational effectiveness over individual rights. Law enforcement practices regarding criminalized and stigmatized activities, such as injecting drug use and commercial sex work, are an important factor in shaping the trajectory of HIV epidemics. __________________________________________________________________________ _____________________________________*____________________________________ 5. Abstract: Hand-washing practices of facial plastic surgeons __________________________________________________________________________ Arch Facial Plast Surg. 2009 Jul-Aug;11(4):230-4. Hand-washing practices of facial plastic surgeons. Leventhal DD, Lavasani L, Reiter D. Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA. OBJECTIVES: (1) To define and characterize knowledge of effective hand hygiene and its scientific basis among practicing facial plastic surgeons; (2) to review the existing literature of, basis for, and guidelines on hand washing in clinical practice; and (3) to motivate and facilitate optimum hand hygiene among facial plastic surgeons. METHODS: National Web- based physician survey and literature review. RESULTS: We conducted a national Web-based survey of members of the American Academy of Facial Plastic and Reconstructive Surgery regarding general patient safety practices. A subset of the survey assessed physicians' knowledge of hand hygiene, including supporting rationale and actual practices. One hundred and twenty-two facial plastic surgeons of various demographics replied to the online survey. Of these, 65 (53%) correctly knew which hand washing agents are most effective at killing microorganisms, 88 (74%) knew the preferred hand-washing method for visibly soiled hands, and 51 (42%) correctly identified the indications for hand washing. CONCLUSIONS: Adherence to hand hygiene practices is suboptimal among facial plastic surgeons. There seems to be a lack of knowledge regarding indications, methods, and appropriate agents for hand hygiene. Promotion of Centers for Disease Control and Prevention guidelines is an important step in increasing hand hygiene compliance among facial plastic surgeons. __________________________________________________________________________ _____________________________________*____________________________________ 6. Abstract: Using high-impact interventions to reduce infection risk by standardising good practice __________________________________________________________________________ Nurs Times. 2009 Jul 21-27;105(28):14-6. Using high-impact interventions to reduce infection risk by standardising good practice. Coghill E. Newcastle upon Tyne Hospitals NHS Foundation Trust. This paper describes the implementation of three high-impact interventions across an NHS trust with the aim of reducing the number of healthcare- associated infections. The initiative was phase 1 of the trust's implementation of seven interventions identified in the Department of Health's Saving Lives programme as reducing infections in patients at increased risk. E-learning, reviews of documentation and policies and procedures were used to support the implementation process. contact is can be not compatible with hospital obligations. __________________________________________________________________________ _____________________________________*____________________________________ 7. Abstract: Effectiveness and limits of the cleaners steam in hospitals __________________________________________________________________________ athol Biol (Paris). 2009 May;57(3):252-7. [Effectiveness and limits of the cleaners steam in hospitals] [Article in French] Meunier O, Meistermann C, Schwebel A. Laboratoire d'Hygiène Hospitalière, les Hôpitaux Universitaires de Strasbourg, 1 Place-de-l'Hôpital, 67091 Strasbourg Cedex, France. olivier.meunier@chru-strasbourg.fr We assessed bactericidal activity of the cleaners steam used for the bio- cleaning of the hospital surfaces. We performed of samples (Rodac) before and after use of cleaner steam and compared with bactericidal effect of disinfecting detergent used in hospital for surfaces. We studied this effectiveness for different time of steam contact. Finally, we wanted to prove, by air sampling, that aero-bio-contamination was possible generated by using cleaners steam. We show that bactericidal effect of the cleaner steam is superior of some tested disinfecting detergent, for the treatment of one square meter till 2 min. This effectiveness diminishes to be just identical in that some disinfecting detergent when use of the cleaner steam is up to two or four square meters surfaces till 2 min. On the other hand, the cleaner steam is less efficient in terms of bacterial destruction when the time of contact steam-soil is superior in 2 min for six square meter surface. The air bacterial pollution, generated by the use of the cleaner steam, is restricted and not significantly augmented if measured in 44 cm above the soil in the course of cleaning. The cleaner steam is indeed a very good equipment for the cleaning of surfaces but it is necessary to respect a time of minimal contact of 2 min for four square meters surfaces treaties to acquire an antibacterial effect at least so important as that acquired with used disinfecting detergent. The disinfection of surfaces is then user-dependent and the time of requested contact is can be not compatible with hospital obligations. __________________________________________________________________________ _____________________________________*____________________________________ 8. Abstract: Today's sterilizer is not your father's water heater __________________________________________________________________________ AORN J. 2009 Jul;90(1):81-8; quiz 89-92. Today's sterilizer is not your father's water heater. Moore TK. Today's sterilizers are sophisticated, automatic, and computerized devices that accurately execute programmed jobs, creating uniform conditions inside pressure vessels to achieve sterilization. Specialized knowledge is necessary to ensure that the right cycle is selected; this requires an educated and competent operator. Perioperative nurses need to understand regulatory requirements for sterilizers, sterilizer design and performance validation, sterilizer cycle functions for everyday use, and everyday sterilization procedures. __________________________________________________________________________ _____________________________________*____________________________________ 9. Abstract: Semmelweis revisited: hand hygiene and nosocomial disease transmission in the anesthesia workstation __________________________________________________________________________ AANA J. 2009 Jun;77(3):229-37. Semmelweis revisited: hand hygiene and nosocomial disease transmission in the anesthesia workstation. Biddle C. Virginia Commonwealth University, Richmond, Virginia, USA. Hospital-acquired infections occur at an alarmingly high frequency, possibly affecting as many as 1 in 10 patients, resulting in a staggering morbidity and an annual mortality of many tens of thousands of patients. Appropriate hand hygiene is highly effective and represents the simplest approach that we have to preventing nosocomial infections. The Agency for Healthcare Research and Quality has targeted hand-washing compliance as a top research agenda item for patient safety. Recent research has identified inadequate hand washing and contaminated anesthesia workstation issues as likely contributors to nosocomial infections, finding aseptic practices highly variable among providers. It is vital that all healthcare providers, including anesthesia providers, appreciate the role of inadequate hand hygiene in nosocomial infection and meticulously follow the mandates of the American Association of Nurse Anesthetists and other professional healthcare organizations. __________________________________________________________________________ _____________________________________*____________________________________ 10. Abstract: An integrated supervised injecting program within a care facility for HIV-positive individuals: a qualitative evaluation __________________________________________________________________________ A IDS Care. 2009 May;21(5):638-44. An integrated supervised injecting program within a care facility for HIV- positive individuals: a qualitative evaluation. Krüsi A, Small W, Wood E, Kerr T. British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada. While there has been growing interest in comprehensive models of treatment and care for individuals living with HIV/AIDS, little attention has been given to the potential role that supervised injecting programs could play in increasing access to prevention and care services for HIV-positive injection drug users (IDU). We conducted 22 semi-structured interviews with HIV-positive IDU regarding a supervised injection program integrated in an HIV focused care facility known as the Dr. Peter Centre (DPC). We also interviewed seven staff members who supervise injections within the facility. All interviews were audio recorded, transcribed verbatim, and a thematic analysis was conducted. Participant and staff reports indicated that the integrated supervised injection program influenced IDUs' access to care by building more open and trusting relationships with staff, facilitating engagement in safer injection education and improving the management of injection- related infections. Participants and staff viewed the program as facilitating the delivery of care through mediating overdose risks, reducing the need to punitively manage drug use on-site and reducing the risks of encountering used syringes on the premises. For some participants, however, feelings of shame and fear of judgment in relation to their drug use limited initial uptake of the program. Our findings identify mechanisms through which integrated supervised injection programs may serve to better facilitate access and delivery of comprehensive care for HIV-positive IDU and highlight the benefits of addressing HIV-positive IDUs' drug use in the context of comprehensive __________________________________________________________________________ _____________________________________*____________________________________ 11. Abstract: Are you prepared? Defining occupational health resource needs to prevent infectious disease transmission in the health care sector __________________________________________________________________________ Healthc Manage Forum. 2009 Spring;22(1):52-6. Are you prepared? Defining occupational health resource needs to prevent infectious disease transmission in the health care sector. Pollock SL, Yassi A, Connell I, Gamage B, Copes R. School of Population and Public Health at UBC. This article discusses the extent of resource allocation to Occupational Health (OH) to prevent infectious disease exposure and transmission in British Columbia (B.C.). It also characterizes the delineation of roles and responsibilities within OH services in B.C. health care settings and highlights areas where improvements to current OH programs could be made to prevent and control occupational infections. Given the breadth of OH responsibilities, resource allocation in many health care institutions for these services is inadequate and roles and responsibilities may not be clearly delineated. __________________________________________________________________________ _____________________________________*____________________________________ 12. Abstract: Occupational exposures in emergency medical service providers and knowledge of and compliance with universal precautions __________________________________________________________________________ Am J Infect Control. 2009 Oct 6. Occupational exposures in emergency medical service providers and knowledge of and compliance with universal precautions. Harris SA, Nicolai LA. Population Studies and Surveillance, Cancer Care Ontario, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Occupational Cancer Research Centre, Toronto, Ontario, Canada. BACKGROUND: Little is known about compliance with universal precautions (CUP) or occupational exposures to blood and body fluids among Emergency Medical Services (EMS) providers. The objective of this study was to obtain estimates of CUP and knowledge of universal precautions (KUP), occupational exposures, and needle and lancet sticks in the prehospital environment. METHODS: A convenience sample of workers (n=311, 51% response) from 17 agencies in Virginia that provided emergency ground transportation (volunteer, commercial, government rescue squads, and fire departments) completed a questionnaire on certification and training, KUP, CUP, exposures and needlesticks, risk perceptions, and demographic variables. RESULTS: Nearly all EMS providers reported exposures and were concerned about risk of HIV and hepatitis. Providers reported inconsistent CUP when treating patients or using needles, including failure to wear gloves (17%) and to appropriately dispose of contaminated materials (79%), including needles (87%), at all times. Certification type (advanced and basic) was related to both KUP and CUP. Of those respondents reporting current sharps use, 40% recapped needles. A lancet stick was reported by 1.4% (n=5), and 4.5% reported a needlestick (n=14). CONCLUSION: EMS providers working in the prehospital environment experience significant exposures but are not consistently using universal precautions. __________________________________________________________________________ _____________________________________*____________________________________ 13. Abstract: Chlorhexidine-based antiseptic solutions effectively reduce catheter-related bacteremia __________________________________________________________________________ Pediatr Nephrol. 2009 Sep;24(9):1741-7. Chlorhexidine-based antiseptic solutions effectively reduce catheter- related bacteremia. Onder AM, Chandar J, Billings A, Diaz R, Francoeur D, Abitbol C, Zilleruelo G. Department of Pediatrics, Division of Pediatric Nephrology, School of Medicine, West Virginia University/Health Sciences Center, Morgantown, WV 26506, USA. aonder@hsc.wvu.edu The aim of this retrospective study was to investigate if the application of chlorhexidine-based solutions (ChloraPrep) to the exit site and the hub of long-term hemodialysis catheters could prevent catheter-related bacteremia (CRB) and prolong catheter survival when compared with povidone-iodine solutions. There were 20,784 catheter days observed. Povidone-iodine solutions (Betadine) were used in the first half of the study and ChloraPrep was used in the second half for all the patients. Both groups received chlorhexidine-impregnated dressings at the exit sites. The use of ChloraPrep significantly decreased the incidence of CRB (1.0 vs 2.2/1,000 catheter days, respectively, P = 0.0415), and hospitalization due to CRB (1.8 days vs 4.1 days/1,000 catheter days, respectively, P = 0.0416). The incidence of exit site infection was similar for the two groups. Both the period of overall catheter survival (207.6 days vs 161.1 days, P = 0.0535) and that of infection-free catheter survival (122.0 days vs 106.9 days, P = 0.1100) tended to be longer for the catheters cleansed with ChloraPrep, with no statistical significance. In conclusion, chlorhexidine-based solutions are more effective for the prevention of CRB than povidone-iodine solutions. This positive impact cannot be explained by decreased number of exit site infections. This study supports the notion that the catheter hub is the entry site for CRB. __________________________________________________________________________ _____________________________________*____________________________________ 14. Abstract: Cocaine vaccine for the treatment of cocaine dependence in methadone-maintained patients: a randomized, double-blind, placebo- controlled efficacy trial __________________________________________________________________________ Arch Gen Psychiatry. 2009 Oct;66(10):1116-23. Cocaine vaccine for the treatment of cocaine dependence in methadone- maintained patients: a randomized, double-blind, placebo-controlled efficacy trial. Martell BA, Orson FM, Poling J, Mitchell E, Rossen RD, Gardner T, Kosten TR. Department of Medicine, Yale University School of Medicine, New Haven, CT, USA. CONTEXT: Cocaine dependence, which affects 2.5 million Americans annually, has no US Food and Drug Administration-approved pharmacotherapy. OBJECTIVES: To evaluate the immunogenicity, safety, and efficacy of a novel cocaine vaccine to treat cocaine dependence. DESIGN: A 24-week, phase 2b, randomized, double-blind, placebo-controlled trial with efficacy assessed during weeks 8 to 20 and follow-up to week 24. SETTING: Cocaine- and opioid-dependent persons recruited from October 2003 to April 2005 from greater New Haven, Connecticut. PARTICIPANTS: One hundred fifteen methadone-maintained subjects (67% male, 87% white, aged 18-46 years) were randomized to vaccine or placebo, and 94 subjects (82%) completed the trial. Most smoked crack cocaine along with using marijuana (18%), alcohol (10%), and nonprescription opioids (44%). INTERVENTION: Over 12 weeks, 109 of 115 subjects received 5 vaccinations of placebo or succinylnorcocaine linked to recombinant cholera toxin B- subunit protein. Main Outcome Measure Semiquantitative urinary cocaine metabolite levels measured thrice weekly with a positive cutoff of 300 ng/mL. RESULTS: The 21 vaccinated subjects (38%) who attained serum IgG anticocaine antibody levels of 43 microg/mL or higher (ie, high IgG level) had significantly more cocaine- free urine samples than those with levels less than 43 microg/mL (ie, low IgG level) and the placebo-receiving subjects during weeks 9 to 16 (45% vs 35% cocaine-free urine samples, respectively). The proportion of subjects having a 50% reduction in cocaine use was significantly greater in the subjects with a high IgG level than in subjects with a low IgG level (53% of subjects vs 23% of subjects, respectively) (P = .048). The most common adverse effects were injection site induration and tenderness. There were no treatment-related serious adverse events, withdrawals, or deaths. CONCLUSIONS: Attaining high (>or=43 microg/mL) IgG anticocaine antibody levels was associated with significantly reduced cocaine use, but only 38% of the vaccinated subjects attained these IgG levels and they had only 2 months of adequate cocaine blockade. Thus, we need improved vaccines and boosters. Trial Registration clinicaltrials.gov Identifier: NCT00142857. __________________________________________________________________________ _____________________________________*____________________________________ 15. Abstract: The INFUSE-Morphine IIB Study: Use of Recombinant Human Hyaluronidase (rHuPH20) to Enhance the Absorption of Subcutaneous Morphine in Healthy Volunteers __________________________________________________________________________ J Pain Symptom Manage. 2009 Oct 9. The INFUSE-Morphine IIB Study: Use of Recombinant Human Hyaluronidase (rHuPH20) to Enhance the Absorption of Subcutaneous Morphine in Healthy Volunteers. Thomas JR, Yocum RC, Haller MF, Flament J. City of Hope (J.R.T.), Duarte, California; Rockwell Medical Technologies, Inc. (R.C.Y.), Wixom, Michigan, USA; Halozyme Therapeutics, Inc. (M.F.H.), San Diego, California, USA; and European Organisation for Research and Treatment of Cancer AISBL-IVZW (J.F.), Brussels, Belgium. Morphine is usually given intravenously (IV) for the treatment of moderate-to-severe pain, but subcutaneous (SC) administration is a viable alternative for parenteral delivery. The pharmacokinetics of SC morphine may be enhanced by coadministration with a hyaluronidase product. In this Phase IV, double-blind, randomized, crossover study, 18 healthy adults received a single dose of 2mg morphine SC with 150U of recombinant human hyaluronidase (rHuPH20), SC with 0.9% normal saline, or IV on three consecutive days. The primary endpoint was time to maximum plasma morphine concentration (T(max)) for SC injection with rHuPH20 vs. SC injection without rHuPH20. Safety and tolerability were assessed each study day, the day after the last injection, and 28 days after the last injection. After SC dosing, morphine mean T(max) was significantly shorter with rHuPH20 than without it. Mean maximum plasma morphine concentration (C(max)) after SC dosing was 29% greater with rHuPH20 than without rHuPH20 (P=0.023), although the extent of exposure of morphine was similar. T(max) was shortest and C(max) was highest with IV administration. For the major active metabolite of morphine, morphine-6-glucuronide, mean T(max) after SC morphine was significantly shorter with rHuPH20 than without rHuPH20 (a difference of approximately 17.5minutes; P=0.0169). Coadministration of morphine with rHuPH20 appeared safe and well tolerated. Compared with SC morphine alone, rHuPH20 shortens morphine T(max) and raises C(max) in healthy adults, without changing the extent of exposure. __________________________________________________________________________ _____________________________________*____________________________________ 16. Abstract: Methicillin-resistant Staphylococcus aureus and Acinetobacter baumannii on computer interface surfaces of hospital wards and association with clinical isolates __________________________________________________________________________ BMC Infectious Diseases 2009, 9:164doi:10.1186/1471-2334-9-164 Methicillin-resistant Staphylococcus aureus and Acinetobacter baumannii on computer interface surfaces of hospital wards and association with clinical isolates Po-Liang Lu , L. k Siu , Tun-Chieh Chen , Ling Ma , Wen-Gin Chiang , Yen- Hsu Chen , Sheng-Fung Lin and Tyen-Po Chen Published: 1 October 2009 Abstract (provisional) Background: Computer keyboards and mice are potential reservoirs of nosocomial pathogens, but routine disinfection for non-water-proof computer devices is a problem. With better hand hygiene compliance of health-care workers (HCWs), the impact of these potential sources of contamination on clinical infection needs to be clarified. Methods: This study was conducted in a 1600-bed medical center of southern Taiwan with 47 wards and 282 computers. With education and monitoring program of hand hygiene for HCWs, the average compliance rate was 74% before our surveillance. We investigated the association of methicillin- resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa and Acinetobacter baumannii, three leading hospital-acquired pathogens, from ward computer keyboards, mice and from clinical isolates in non-outbreak period by pulsed field gel electrophoresis and antibiogram. Results: Our results revealed a 17.4% (49/282) contamination rate of these computer devices by S. aureus, Acinetobacter spp. or Pseudomonas spp. The contamination rates of MRSA and A. baumannii in the ward computers were 1.1% and 4.3%, respectively. No P. aeruginosa was isolated. All isolates from computers and clinical specimens at the same ward showed different pulsotypes. However, A. baumannii isolates on two ward computers had the same pulsotype. Conclusion: With good hand hygiene compliance, we found relatively low contamination rates of MRSA, P. aeruginosa and A. baumannii on ward computer interface, and without further contribution to nosocomial infection. Our results suggested no necessity of routine culture surveillance in non-outbreak situation. __________________________________________________________________________ _____________________________________*____________________________________ 17. No Abstract: The future of harm reduction programmes in Russia __________________________________________________________________________ Lancet. 2009 Oct 10;374(9697):1213. Links The future of harm reduction programmes in Russia. The Lancet. __________________________________________________________________________ _____________________________________*____________________________________ 18. No Abstract: Healthcare-associated infection: moving behind headlines to clinical solutions __________________________________________________________________________ J Hosp Infect. 2009 Oct 9. Healthcare-associated infection: moving behind headlines to clinical solutions. Pittet D. Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle-Perret Gentil, 1211 Geneva 14, Switzerland. __________________________________________________________________________ _____________________________________*____________________________________ 19. No Abstract: National patient safety goals and implementation __________________________________________________________________________ AORN J. 2009 Jul;90(1):123-7. National patient safety goals and implementation. Watson DS. Covidien, Fox Island, WA, USA. __________________________________________________________________________ _____________________________________*____________________________________ 20. Fund Title: Strengthening Clinical Services in Lesotho Application Due Date: 16 November 2009. See below for details. Crossposted from US CDC NPIN with thanks __________________________________________________________________________ Fund Number: 3927 Fund Title: Strengthening Clinical Services in Lesotho Fund Category: HIV/AIDS Description: Total Grant Amounts: approximately $25,000,000. The United States Government, as represented by the United States Agency for International Development (USAID) Mission to Southern Africa, is seeking applications from organizations to implement a five-year program to assist USAID to implement and manage a strengthening of clinical services program in Lesotho. The overall goals of the program are to strengthen community systems and structures to improve the well-being of HV positive pregnant women, their families and prevent the spread of HIV to their children as fully described in the Request for Applications (RFA). The purpose for the Cooperative Agreement is to provide state-of-art technical expertise in effective and tested approaches to providing comprehensive and integrated HIV/AIDS care and treatment, and including activities being provided under the current prevention of mother to child transmission (PMTCT) programs. The Recipient will be responsible for ensuring achievement of the program objectives. Sponsor(s): US Agency for International Development Bureau for Africa Funder's Fund ID: RFA-674-10-0001 Application Due Date: 11/16/2009 Project Start Date: 01/18/2010 Fund Duration: Five years. Application Process: All Applicants must submit the application using the SF-424 series, which includes the: SF-424, Application for Federal Assistance; SF-424A, Budget Information - Nonconstruction Programs; SF-424B, Assurances - Nonconstruction Programs. The application shall be split into two separate parts: a. Technical Application; and b. Cost/Business Application. All applications shall be in Engligh. Number of Awards: 1 Cooperative Agreement Award Notes: Subject to the availability of funds, USAID intends to provide approximately $25,000,000 in total USAID funding for the life of the activity. USAID intends to award one Cooperative Agreement pursuant to this RFA. USAID reserves the right to fund any one or none of the applications submitted. Eligible Locations: - International Fund Notes: For program synopsis and guidance, visit the website: http://www07.grants.gov/search/search.do;jsessionid= KPJhKNmfDwx4pnY9By00yRXJqLMMzngXVh2tr8xrWTFc5x02m2Jn!478192032?oppId= 49748&mode=VIEW . Application Contact Name: Francinah Hlatshwayo Title: Acquisition & Asst Specialist Application Contact Address: USAID/Southern Africa Box 43, Groenkloof, 0027 Pretoria, South Africa Email: fhlatshwayo@usaid.gov Technical Contact Name: Leona Sasinkova Title: Agreement Officer Technical Contact Address: USAID/Southern Africa Box 43, Groenkloof, 0027 Pretoria, South Africa Email: lsasinkova@usaid.gov Contact Tel: +27(012)452-2166 Support Types: - Cooperative Agreements Subject Areas: - Health Care Programs/Services - HIV/AIDS Prevention - International Cooperation - Medical Treatments and Therapies - Perinatal Transmission Audiences: - Developing Nations - Families - Pregnant Women with HIV/AIDS Eligibility: - Commercial Organizations - Community Based Organizations - International Agencies - Religious Organizations - Unrestricted Eligibility Notes: Qualified applicants may be US or non-US non-governmental organizations (NGOs), private voluntary organizations (PVOs), for-profit companies willing to forego profit, and Public International Organizations. Faith- based and community organizations that fit the criteria above are also eligible to apply. In support of the Agency's interest in fostering a larger assistance base and expanding the number and sustainability of development partners, USAID encourages applications from potential new partners. __________________________________________________________________________ _____________________________________*____________________________________ 21. Report on the market for injectable and needle-free delivery systems This is the text of a press release for a commercial business market research report and is not endorsed by SIGNpost. __________________________________________________________________________ Report on the market for injectable and needle-free delivery systems News-Medical.Net (28.09.09) Reportlinker.com announces that a new market research report is available in its catalogue. Drug Delivery Markets: Implantable / Injectable and Needle-Free Delivery Systems http://tinyurl.com/yf7mz9x With pharmaceutical companies increasingly looking for ways to extend the revenue-earning lifetime of their biggest products, drug delivery has become an important focus of the industry. Kalorama's Drug Delivery Markets: Implantable / Injectable and Needle-Free Delivery Systems provides detail for business planners on the market for implantable / injectable delivery system markets. Biopharmaceutical products are driving growth of needle-free systems; there will likely be significant increases in revenues in the vaccine arena. This report looks at that trend and reports current and forecasted revenues for the implantable/injectable drug delivery market, segmented into two main categories: Needle-free drug delivery Other Injectable/Implantable Kalorama's unique analysis offers segmentation of this market for: Drug Delivery Technology Revenues Pharmaceuticals Sold via Delivery Technology This breakout makes the report relevant to business plans of either device technology companies or pharmaceutical concerns. (This market analysis does not include drug-eluding stents or prefilled or regular syringes. Kalorama considers these separate markets) With pharmaceutical companies increasingly turning to drug delivery to extend the revenue-earning lifetime of their biggest products, drug delivery has become an important focus of the pharmaceutical industry. Kalorama's Drug Delivery Markets: Implantable / Injectable and Needle-Free Delivery Systems, the second volume of Kalorama's popular series focusing on global drug delivery systems markets, provides the definitive break down of the market for implantable / injectable delivery system markets. The report covers both pharmaceuticals sold through implantable/injectable delivery systems and the technologies themselves including: This focused report provides information on the revenues for relevant companies and provides information critical to assessing the opportunities available in this market, including: Detailed Profiles of Key Companies in Implantable/Injectable Delivery and Brief Round-Up of smaller players Current Market Size and Forecasts to 2013 Needle-Free Cost Savings, Protein-Coated Microcrystal Technology, Nanotechnology, and Other Trends and Developments New Products in Development Kalorama's trusted information-gathering process provides most accurate study of the implantable/injectable delivery drug market available today. Information and analysis presented in this report is based on extensive interviews with senior management of top companies in the industry. While major research literature and government information is culled, information is corroborated and key market insights originate from interviews with industry leaders. Source: http://www.reportlinker.com __________________________________________________________________________ _____________________________________*____________________________________ 22. E-DRUG: Public Campaign Warns Citizens of Dangers of Counterfeit Medicines in Cambodia __________________________________________________________________________ e-drug mailing list e-drug@healthnet.org http://list.healthnet.org/mailman/listinfo/e-drug E-DRUG: Public Campaign Warns Citizens of Dangers of Counterfeit Medicines in Cambodia Date: Thu, 08 Oct 2009 13:53:06 -0400 From: "Francine Pierson" Dear All, Please see the below press release. Best regards, Francine Pierson USP __________________________________________________________________________ Public Campaign Warns Citizens of Dangers of Counterfeit Medicines in Cambodiaand Greater MekongSubregion USAID, USP Screen Public Service Announcements, Documentary to Raise Awareness of Serious Public Health Threat in Developing Countries October 8, 2009, Phnom Penh, Cambodia As part of a large-scale effort to combat the dire public health consequences of counterfeit medicines on citizens in developing countries, a public service announcement (PSA) campaign is being launched in Cambodia this week by the United States Agency for International Development (USAID) and the United States Pharmacopeial (USP) Convention - with the cooperation and support of authorities in Cambodia. The PSAs are being broadcast nationally on Cambodian television and throughout Southeast Asia, where the proliferation of substandard and counterfeit medicines intended to treat HIV/AIDS, malaria, tuberculosis and other life- threatening conditions remains a major threat to the lives and livelihood of citizens struggling with these diseases. Translated into five languages, the 'Pharmacide' PSAs are being screened at an October 8th ceremony in Phnom Penh, Cambodia, by Flynn Fuller, USAID Cambodia Mission director; Patrick Lukulay, Ph.D., director of USP's Drug Quality and Information (DQI) Program, which is supported by USAID; and Mark Hammond of Living Films, who directed the PSAs as well as a short documentary that is also being screened. The PSA campaign is an activity of the DQI Program. Implemented by USP, a nonprofit scientific organization that develops globally recognized standards for the quality of medicines, the DQI Program advances strategies to improve the quality of medicines on four continents. A key function of the program is rooting out substandard and counterfeit medicines, which the World Health Organization estimates account for between 10 and 30 percent of all medicines in the developing world. 'Counterfeit and substandard medicines pose a grave threat to patients in Southeast Asia, but their presence in these countries remains a largely unknown problem,' said Mr. Fuller. 'These poor-quality medicines can contribute to adverse reactions in patients, including protracted illness and death, but may go undetected as severe symptoms and death may be wrongly attributed to the course of their disease. This is a fate that no one deserves. It is a problem that USAID, USP and national authorities take very seriously, and we hope to reach patients directly through this PSAcampaign.' 'Though they may look similar or almost identical to the intended medicine, counterfeit drugs may contain little or no active ingredient,' added Dr. Lukulay. 'It can be very difficult for patients to discern any difference, often requiring complex testing to determine the authenticity of a medicine. However, the difference can truly be life and death, which is why it is so essential for citizens to purchase medicines from a licensed pharmacy. The PSAs underscore the consequences of purchasing these drugs through alternative means, which is unfortunately an attractive option among an economically deprived population because of the lower cost. We hope that once citizens are made aware of the consequences, they will not look at this as a viable alternative.' Further compounding the problem, Lukulay added, 'not only do substandard drugs affect the individual taking them, but those that contain some but not all of an active ingredient can contribute to the development of drug- resistant strains of these diseases. This is a serious public health threat in developing countries, impacting not only the individual patient but the greater population of citizens, all of whom may suffer when a medicine is no longer effective because resistance has developed.' The PSAs show the life cycle of a counterfeit drug from the counterfeiter to the dealer to the victim. It notes that 'counterfeiting is a crime against humanity, against you,' and urges citizens to always use a licensed pharmacy when purchasing medicines. Through the DQI Program, USP advances the quality of medicines via a variety of activities that include implementing active surveillance programs in which medicines are taken off the market and tested; establishing 'sentinel sites' within countries to perform testing; and training local chemists working in government laboratories, medical students and other qualified parties to conduct such testing in a cost- effective manner. To view the PSA and video from the event, visit http://www.youtube.com/uspharmacopeia. For more information, please visit http://www.usp.org/ ### USP's Advancing Public Health Since 1820 The United States Pharmacopeial (USP) Convention is a scientific, nonprofit, standards-setting organization that advances public health through public standards and related programs that help ensure the quality, safety, and benefit of medicines and foods. USP's standards are recognized and used worldwide. For more information about USP visit http://www.usp.org __________________________________________________________________________ _____________________________________*____________________________________ 23. News - Hand-washing detectors could help save lives - Technology could potentially slash number of hospital-related infections - USA: Peninsula physician patents device to help stem hospital infections - USA: Contaminated Heparin Raises Questions About Drug Safety - Taiwan: Haemophilia patients battle to sue firm that sold tainted drug in Asia - Bayer owned company could face victims in Taiwan over its marketing of infectious blood products - USA: Opting not to vaccinate, gambling with children’s health - USA: OSHA Clarifies ‘Containerization’ for Blood, Body Fluids - USA: Feature: Federal Needle Exchange Funding Ban Battle Continues Canada: Health unit warns of tainted cocaine - Expert describes 'devastating' symptoms - USA: Thousands Potentially Exposed to Infection at Broward General Med. Ctr. - Allergic reaction to vaccines should be investigated - Emerging retrovirus turns up in new patients: Novel virus can spread between people, may lie behind other common illnesses - Sudan: Suspected Ebola kills 23 in Sudan - India: Enter infection-free zones - UK: Revealed: Drug users in Scotland spend £1.4bn every year to feed their habits - Opinion piece responds to 'skeptics' of development aid - USA: Injury and hazards in home health care nursing are a growing concern - Australia: Needle Program a Success - Good hand hygiene can eliminate bacterial contamination in computer devices Selected news items reprinted under the fair use doctrine of international copyright law: http://www4.law.cornell.edu/uscode/17/107.html __________________________________________________________________________ Hand-washing detectors could help save lives - Technology could potentially slash number of hospital-related infections By Cristen Conger, Discovery Channel (13.10.09) New health care technology could sniff out one of the leading causes of death in the United States. HyGreen hand hygiene sensors, developed at the University of Florida, can detect whether doctors and health care workers have followed hand-washing procedures before making contact with patients. If they don't, their ID badges will vibrate and alert a database that the employees failed to wash up. The technology could potentially cut down on the 2 million incidences of hospital-related infections each year in the United States, many of which are transmitted by hand. "If you look at the hospitals in the United States and all the health care workers," said Richard Melker, HyGreen Chief Technology Officer, "hand hygiene adherence in the best of the hospitals is around 50 percent." Compare this number to the percentage desired by The Joint Commission, which accredits and certifies health care organizations around the nation. The organization's National Patient Safety Goal (NPSG) campaign intends to boost hand-washing compliance to at least 90 percent among participating hospitals. The HyGreen system basically works like a Breathalyzer for the hands. When health care workers enter a patient's room, they wash up and run their hands beneath a nearby HyGreen sensor. The HyGreen sensor activates a green LED light on workers' badges to signal that their hands are clean. A proximity monitor by the patient's bed then sends out infrared and acoustic signals to the badges, and when the health care workers approach, the monitor verifies that the green badge light is illuminated. If it isn't, the badges quietly vibrate to alert health care workers to clean up. Because of the potential for cross-contamination, the area around the patient's bed should be treated as a "cocoon of protection," Melker told Discovery News. However, the technology isn't intended to alarm patients or hinder doctors and other medical professionals from doing their jobs. In fact, HyGreen is designed to promote hand hygiene accountability discreetly in hospitals rooms. "All we want to do is remind the health care workers to wash their hands," Melker explained. "We don't want to make a big deal out of it." Whenever the HyGreen bed monitors verify if health care workers have washed their hands, they send that information, along with the time and location, to a wireless database maintained by the hospital's infection prevention team. That way, hospitals can know in real time which workers aren't washing up. And, if a hospital-acquired infection breaks out, they can pinpoint the source more accurately. Anecdotal reports from pre-market testing indicate that health care workers respond favorably to HyGreen's silent surveillance and practice better hand hygiene. "Even if every bed on a floor isn't monitored, there's a buzz that goes around about the new technology, and everyone washes their hands more often," Melker notes. Most hospitals directly monitor hand hygiene, and health care workers also keep an eye on one other. But the incidence rate of hospital-acquired infection remains high, resulting in 90,000 deaths every year and costing anywhere from $6.7 billion to $45 billion in related health care expenses. Hand-washing is undoubtedly the first line of defense in curbing the transmission of infectious diseases in hospitals, but figuring out exactly why health care workers fail to wash up is "the $64 million question," said Anne Marie Pettis, Director of Infection Prevention for the University of Rochester Medical Center and spokesperson for the Association for Professionals in Infection Control. "The most frequent reason [health care workers] give for not washing their hands is not having convenient access to sinks or hand rubs," Pettis told Discovery News. "Over the last several years, we've tried to take that obstacle away as much as possible." Although the reasons behind low hand hygiene compliance remain unclear, HyGreen could answer the question of how to improve those habits once they're installed at early adopter hospitals in spring 2010. "It's very good timing that we've come up with a solution at a time when the hospitals need to solve this problem," Melker said. © 2009 Discovery Channel URL: http://www.msnbc.msn.com/id/33297138/ns/health-health_care/ © 2009 MSNBC.com .......................................................................... __________________________________________________________________________ USA: Peninsula physician patents device to help stem hospital infections By Diane Urbani de la Paz, Peninsula Daily News, WA USA (13.10.09) AGNEW -- Capping a career as a family doctor who has practiced from California to Kazakhstan, Marion Yandell has invented a small device he believes will knock down an enormous problem. The Agnew man recently patented the NuGene -- "as in 'new generation,'" he said -- a vial designed to keep injectable medications sterile. The NuGene has the potential, Yandell said, to reduce hospital-acquired infections. These illnesses, also called nosocomial infections, are a leading cause of death across the United States. Every year an estimated 1.7 million people catch these infections -- which include staph and related blood-borne diseases -- while in U.S. hospitals, according to the Centers for Disease Control. Of those, about 99,000 die. Yandell, who practiced in Southern California for four decades, served missions in Mexico, eastern Europe and elsewhere and retired in 1996 to Agnew, began concentrating two years ago on a device that would protect intravenous drugs from what he describes as "microbe-laden" air in hospitals. He explains the need for the NuGene by giving a brief medical history lesson. Contaminated air "Before 1900, all medicines were kept in open jars and bottles, exposing the medicine to contaminated ambient air," he said. "Doctors realized this was not sterile, so rubber stoppers were put on medicine vials under sterile conditions. The contaminated ambient air problem was thought to be solved. "It was not solved. It was just delayed. When the needle on the end of the syringe is inserted into a sterile medicine vial and medicine is withdrawn, this creates a partial vacuum," and no more medicine can come into the syringe. To address the vacuum problem, "doctors and nurses have been taught that before they insert the needle into the medicine vial, they must pull back on the plunger in the syringe. This action brings in contaminated ambient air. "Then they stick the needle through the rubber stopper and push the ambient air inside the sterile vial. The medicine is no longer sterile." The NuGene, Yandell said, keeps air away from the medication with an internal bladder that expands as medicinal fluid is withdrawn by the needle. It sounds simple, he acknowledges. And Yandell came up with the idea, he said, the way many inventors create solutions: by looking at the problem from a new angle. Seeks manufacturer Yandell, 83, must now find a manufacturer for the NuGene. He worked with Sequim attorney Jacques Dulin to move the device through the patent process. At this point he is optimistic about selling his product through a pharmaceuticals company and believes NuGene could be in use in hospitals within a year. If that happens, however, Yandell won't be finished as an inventor. He's also working on a device to keep needles sterile: a biconical structure that would protect their surfaces from ambient air. But the doctor doesn't posit that NuGene or the needle protector -- or both -- can eradicate hospital-acquired infections. His two designs are aimed at keeping injected drugs sterile, but other hospital conditions can trigger infections. "The air people breathe, dirty hands and dirty instruments can all cause nosocomial diseases," Yandell said. Cassie Sauer, spokeswoman for the Washington State Hospital Association, said health care providers -- and patients -- are doing more to halt hospital infections. "One of the biggest things we're doing is working on hand-washing in hospitals," Sauer said. "We know hand-washing habits aren't where they should be . . . among doctors, nurses, aides and food-service workers." Patients themselves can be one of the most effective influences on hand- washing, she added, by simply asking their providers to do it and do it often. Sauer herself used this method 16 months ago when she went into the hospital to give birth to her baby. The resident physician remarked on something that had been written on her chart: "Patient is very interested in seeing us wash our hands." Limited antibiotics Another way to combat hospital-acquired diseases: Prescribe antibiotics only when necessary. Many patients ask for the drugs, believing they will help them recover from a nasty flu, Sauer said. "They won't help," she said, noting that overprescribed antibiotics have led to drug-resistant infections. Washington state hospitals are also placing renewed emphasis on keeping surgical sites clean, Sauer said. "Patients are encouraged to wash [the site of the operation] with Hibiclens," an antimicrobial skin cleanser, and to refrain from shaving the area since razors can nick the skin. "We're also trying to increase the rates of flu shots among health care providers," she added. "Only half are getting regular flu shots," and the hospital association is pushing for a much higher rate. The state association has not kept track of hospital-acquired infections in Washington state, Sauer said, but beginning in December, the state Department of Health will be required to adhere to a new law mandating the reporting of such infections. So in coming years, the state's medical community will be armed with statistics and trend information. As for Yandell's device, Sauer agreed with the inventor that it would not wipe out the problem of nosocomial diseases. "I am not at all discounting the invention," she said, "but it sounds like it would prevent one subset of infections" only. "It would be terrific," Sauer added, "if it is proven to be successful." .......................................................................... __________________________________________________________________________ USA: Contaminated Heparin Raises Questions About Drug Safety By Chris Emery, Contributing Writer, MedPage Today (12.10.09) Reviewed by Zalman S. Agus, MD; Emeritus Professor University of Pennsylvania School of Medicine and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner Lax compliance with federal regulations resulted in bacterial bloodstream infections from contaminated heparin syringes in several states, according to a new Centers for Disease Control and Prevention report that has raised concerns about drug safety in an increasingly complex pharmaceutical industry. Responding to reports of outbreaks of Serratia marcescens bloodstream infections between October 2007 and February 2008, CDC investigators traced the infections to syringes of the blood thinner heparin produced by a single company, according to the report published Oct. 12 in the Archives of Internal Medicine. Inspection of the manufacturing facility revealed that the company (which remained unnamed in the report) violated FDA Good Manufacturing Practices, the comprehensive body of regulations that govern all aspects of production. However, it was hard for CDC to determine the source of the contaminated syringes in the first place, since they moved through multiple distributors before reaching patients and were not marked with the name of the original manufacturer. "Close collaboration among federal agencies, public health authorities, and clinicians was critical to the identification of the cause of this outbreak," David Blossom, of the Centers for Disease Control and Prevention, and colleagues wrote. "In the course of the investigation, we also identified several challenges to medical product tracking that should be addressed promptly so that disease outbreaks caused by exposure to contaminated medications can be dealt with more efficiently in the future." Beginning October 2007, the CDC received reports of 161 S. marcescens infections among patients at medical centers in nine states. Using information from facilities in Texas and Illinois, investigators determined the infections were cause by syringes prefilled with heparin and saline. They ultimately traced the infections to a single manufacturer. CDC received 83 blood samples from infected patients and determined the bacteria in 70 of the samples matched strains found in the prefilled syringes from the manufacturing facility. Soon after the CDC inspection, the company discontinued producing medical products and issued a voluntary national recall of the prefilled syringes. The authors concluded that the incident highlights important issues concerning the safety of pharmaceuticals. Drug manufacturers must ensure that they are in full compliance with the FDA requirements, they wrote, and distributors, healthcare facilities, and pharmacies should keep track of the lot numbers of products they distribute, so contaminated products can be traced to their origins more rapidly. Investigations of possible adverse drug events should include both epidemiologic and laboratory components. The authors noted that cases of infection from the syringes may have been under-reported and that they were not always able to determine exactly what patients were infected by which syringe lots. In an accompanying editorial, William K. Hubbard, BA, MA, a former FDA associate commissioner, wrote that the outbreak demonstrates the important role the FDA plays in protecting the American public from dangerous drugs. This is particularly important as medicines are increasingly manufactured abroad and travel through complex distribution networks, he wrote. He noted a recent case in which heparin produced at a Chinese facility described as a "primitive" pig farm is believed to have contributed to dozens of deaths in the U.S. "One might initially think this case is an anomaly, given that the heparin was produced in China," he wrote. "But, unfortunately, it is rapidly becoming the norm. Indeed, today, 80% of Americans' pharmaceutical ingredients are imported." "We simply must, as a nation, recognize that we cannot reverse this trend toward globalization, that the solution to a safe drug supply is a strong FDA, not reliance on foreign governments," he wrote. He lamented that the FDA's annual budget has generally remained flat or been in decline since the mid-1990s. The agency lost about a 1,000 of its 9,000 staff between 1995 to 2007, which he described as a "huge loss" for an agency tasked with protecting "our foods, drugs, blood supply, medical devices, pet food, cosmetics, dietary supplements, x-ray machines, cell phones, and many other consumer products." "Just as cities cannot educate their children without teachers, extinguish fires without firefighters, and patrol their streets without policemen," he wrote, "the FDA cannot protect this vast array of products without the staff to do so." The authors reported no outside sources of funding and no financial conflicts of interest. Action Points 1. Note that finding the source of the outbreak was made more difficult by a complex distribution process and inadequate drug labeling and record keeping. 2. Note that a commentator argued that the incident highlights the importance of the FDA in protecting Americans from contaminated drugs, and the need to provide more resources for the FDA. Primary source: Archives of Internal Medicine Blossom D, et al "Multistate outbreak of Serratia marcescens bloodstream infections caused by contamination of prefilled heparin and isotonic sodium chloride solution syringes" Arch Intern Med 2009; 169: 1705-11. .......................................................................... __________________________________________________________________________ Taiwan: Haemophilia patients battle to sue firm that sold tainted drug in Asia - Bayer owned company could face victims in Taiwan over its marketing of infectious blood products Sarah Boseley, health editor, guardian.co.uk,(11.10.09) People with haemophilia in Taiwan are appealing a decision by the US courts that says they cannot sue a multinational drugs firm in the United States over allegations that they contracted HIV from contaminated blood products that the company knowingly dumped in Asia. The news comes as US pharmaceutical firms meet UK victims of the scandal, which affected nearly 1,200 people with haemophilia in Britain during the 1970s and 1980s. Haemophiliacs in the UK were refused permission to sue in the US courts by a judge who said the British courts were better placed to hear the evidence. The news comes as several US pharmaceutical firms meet UK victims of the scandal, who were refused permission to sue in the US on the grounds that their case could be better heard by the UK courts. Some 6,000 people in the UK were infected with hepatitis or HIV or both during the 1970s and 1980s, of whom 2,000 have now died. The US companies are attempting to reach a settlement with some of the 1,200 who contracted HIV, of whom about 300 are still alive. Lord (Robert) Winston has called this "the worst treatment disaster in the history of the NHS". One man, Haydn Lewis, who contracted HIV from contaminated blood he believed came from the US and then unwittingly passed the virus to his wife, said: "The main reason was to get a judgment in a court of law which suggests which of the two parties were at fault - the companies who provided the products or the Department of Health, which purchased them. For years we've had this denial of responsibility. We are still " unaware of who is the guilty party." The charges by the Taiwanese victims against the company, Cutter, which is now owned by Bayer, are particularly dramatic. The UK and other European authorities refused to buy blood products that had not been heat-treated in the 1980s, for fear of HIV contamination. Documents in the possession of US lawyers show, however, that Cutter did its utmost to continue marketing the products in Asia. Cutter made a product called Koate, given to haemophiliacs to enable their blood to clot in the event of an injury. Documents in the court case brought on behalf of the Taiwanese haemophilia patients showed that some of the donated blood used to make the drug came from paid prisoners. Prisons had exceptionally high levels of people with HIV. In the mid-1970s it was known that blood products carried a danger of infection from hepatitis, and that those coming from the US were particularly risky. In the 1980s, once it was recognised that HIV was blood-borne, Cutter's market for non-heat-treated Koate began to dry up. Its executives, it is alleged, decided to carry on supplying the far east regardless. Baum, Hedlund, Aristei & Goldman, the US lawyers representing Taiwanese haemophiliacs who contracted HIV from blood transfusions, allege that Cutter put sales above lives. A copy of Cutter's 1985 far east region marketing plan suggests that the strategy was to offload stocks of Koate before the "hysteria over Aids" set in and caused a slump in sales.Sales in New Zealand had been hit as the US products were replaced by local and Commonwealth supplies, the document says. "What Koate business Cutter had left in New Zealand, as of 1982, was terminated when Aids became an issue there," it says. "Aids has not become a major issue in Asia. Perhaps it is because the region has so many other health hazards of greater, more common, concern." The document says: "The hepatitis risk of American-made concentrates is not of such concern in a region where hepatitis B is so prevalent. If we see a need for a heat-treated product in the far east, we will react to the demand swiftly. Otherwise, we will try to continue to dominate the markets with low-cost " Koate and Konyne." Of 1,200 people in the UK with haemophilia who were infected with HIV, only about 300 are now alive. Of those, some 180 still have cases in the UK courts. Lawyers for the US drug firms have offered compensation to those affected in the UK, and say the offer will be withdrawn unless 95% of claimants agree to it. A spokesperson for Bayer said of the Taiwanese case: "Bayer is committed to the highest ethical standards, to promoting our medications responsibly and to providing life-saving therapies for the global haemophilia community." * This article was amended on 13 October 2009. The original stated that people with haemophilia in Taiwan and Hong Kong had permission to sue Bayer. Although they were granted permission to sue in January 2009 the US courts have struck out their claim. Taiwanese haemophiliac patients are currently appealing this decision. This and the related headings have been corrected. guardian.co.uk © Guardian News and Media Limited 2009 .......................................................................... __________________________________________________________________________ USA: Opting not to vaccinate, gambling with children’s health By: Editorial Board, St. Louis Post-Dispatch USA (11.10.09) Suppose you were asked for a list of the game-changers in modern medicine -- treatments that saved the most lives and had the greatest health impact. You might name organ transplants or drugs to fight cancer and AIDS. Maybe if you knew someone with heart disease, you’d think about angioplasty and stents. Vaccines probably wouldn’t make your list. They should. Since the English physician Edward Jenner created the first crude smallpox vaccine in 1796, millions of lives have been saved -- and many, many serious complications have been averted -- by immunizations. But a growing number of parents in Missouri and Illinois are opting out of routine vaccinations for their children, as Valerie Schremp Hahn reported in Friday’s Post-Dispatch. That unfortunate trend puts children, and the communities they live in, at risk. Some parents opt not to have their children vaccinated their children because of fears -- now long discredited -- about a link between the preservative thimerosal and autism. A number of large, well-controlled studies conducted around the world have found no evidence of harm caused by thimerosal in vaccines. Ironically, with the exception of trace amounts in some flu vaccines, thimerosal hasn’t been used in childhood vaccines in the United States since 1999. Other parents express concern about the vanishingly rare chance of a child’s developing serious complications after immunization, or they voice philosophical objections to government immunization requirements for school-age kids. The immunization requirements are driven by the very real harms that vaccine-preventable diseases can do. In the 1920s, before a vaccine was available, about 17,500 kids died every year in the United States from diphtheria. About 150,000 contracted pertussis -- whooping cough -- another potentially fatal childhood illness. Those illnesses are rare today, but they still occur -- especially in children who haven’t been immunized against them. A 2005 whooping cough outbreak sickened almost 26,000 people. In 2006, the United States experienced its largest mumps outbreak in more than 20 years. The good news is that, even with some parents opting out, the overall vaccination rates in Missouri and Illinois and around the country remain high. But immunization rates for some dangerous diseases are very low. The U.S. Centers for Disease Control and Prevention reports that just 21 percent of school-age children received seasonal flu shots (which are recommended, but not required) last year. That’s much lower than the 41 percent of infants and 67 percent of the elderly who got the shots. Seasonal flu kills about 36,000 Americans every year -- more than the total number of homicide and AIDS deaths combined. The risks of contracting seasonal flu are highest among the very young and the very old. The H1N1 strain of influenza strikes school-age kids, yet 40 percent of parents recently surveyed by the University of Michigan said they would not get their school-age children vaccinated for H1N1 influenza, better known as swine flu. Many said they were concerned about the new vaccine’s safety. But it’s made the same way seasonal flu vaccines are -- and have been for years. Some fearful parents, and at least one public health official in Tennessee, cited rumors and unpublished reports circulating on the Internet. Fears and ignorance can have deadly consequences. The CDC reported Friday that 76 children have died of H1N1 influenza so far this year, including 19 in the past week. Flu season is still a month away. There’s still time to act. .......................................................................... __________________________________________________________________________ USA: OSHA Clarifies ‘Containerization’ for Blood, Body Fluids Occupational Health Safety (10.10.09) OSHA's Bloodborne Pathogens Standard, 29 CFR 1910.1030, has provisions for the protection of employees during the containment, storage, and transport of regulated waste other than contaminated sharps. The standard defines regulated waste as liquid or semi-liquid blood or other potentially infectious material (OPIM); contaminated items that would release blood or OPIM in a liquid or semi-liquid state if compressed; items that are caked with dried blood or OPIM and are capable of releasing these materials during handling; contaminated sharps; and pathological and microbiological wastes containing blood or OPIM. In a Letter of Interpretation dated June 2, 2009, posted to the agency’s Web site this week, OSHA’s Richard Fairfax, director of the Enforcement Programs Directorate, noted that compliance with the BBP standard is evaluated on a case-by-case basis, and he clarified some of the standard’s provisions. In response to the questions, "What are the policies for disposal of blood/body fluids and infectious waste? Is blood treated differently than other body fluids?" Fairfax wrote, "In general, regulated wastes, other than contaminated sharps, must be placed in containers which are: (i) Closable; (ii) Constructed to contain all contents and prevent leakage of fluids during handling, storage, transport or shipping; (iii) Labeled or color-coded in accordance with paragraphs (g)(1)(i); (iv) Closed prior to removal to prevent spillage or protrusion of contents during handling, storage, transport, or shipping [29 CFR 1910.1030(d)(4)(iii)(B)(1) (i)-(iv)]. When asked if it was acceptable to throw out items contaminated with blood or body fluids in either septic systems or normal garbage, and, if so, how much blood and body fluids can be present, the director said, "It is the employer's responsibility to determine the existence of regulated waste. This determination is not based on actual volume of blood, but rather on the potential to release blood (e.g., when compacted in the waste container)." Fairfax did not make a distinction between clinics and hospitals regarding rules for body fluid disposals. He reiterated that the agency approaches each facility setup on a case-by-case basis and that it’s the responsibility of the management at each facility to know the rules of the BBP standard. "Employers in clinics and hospitals must comply with the Bloodborne Pathogens Standard," he wrote. "Employers must evaluate their individual workplaces and institute measures to eliminate or minimize employee exposure to blood or OPIM based on the unique set of scenarios or tasks in the facility. An exposure control plan is the employer's written program which is required to outline the protective measures taken." Copyright 2008 1105 Media Inc. .......................................................................... __________________________________________________________________________ USA: Feature: Federal Needle Exchange Funding Ban Battle Continues Drug War Chronicle, Issue #603, (09.10.09) Years of effort by harm reductionists, public health authorities, HIV/AIDS researchers and activists, and drug law reformers to undo the more than 20-year-old ban on federal funding for needle exchange programs (NEPs) may come to fruition this year, but there are significant obstacles to overcome. Still, advocates of the reform are cautiously optimistic. Since 1988, the US government has prevented local and state public health authorities from using federal funds for NEPs, which studies have shown to be effective in reducing HIV infection rates among injection drug users (IDUs) and their sexual partners, promoting public health and safety by taking syringes off the streets, and protecting law enforcement personnel from injuries. NEPS have been endorsed by the World Health Organization, the American Medical Association, Centers for Disease Control and Prevention Director Thomas Frieden, and former Surgeons General Everett Koop and David Satcher, among many others. Injection drug use accounts for up to 16% of the 56,000 new HIV infections in the US every year -- or nearly 9,000 people. IDUs represent 20% of the more than 1 million people living with HIV/AIDS in the US and the majority of the 3.2 million Americans living with hepatitis C infection. Still, those numbers could have been higher. In a 2008 study, the CDC concluded that the incidence of HIV among injection drug users had decreased by 80% in the past 20 years, in part due to needle exchange programs. There are today an estimated 185 NEPs operating in 36 states, the District of Columbia, and Puerto Rico. But they rely on local or private funds, and many of them are failing to meet demand because of lack of funding. While the CDC says that its public health policy goal is 100% needle exchange, current estimates are that only 3.2% of needles used by drug users in urban areas are exchanged for clean ones. The federal funding ban was first removed in a July 10 vote of the House Subcommittee on Labor, Health and Human Services, Education, and Related Agencies. A week later, the full Appropriations Committee approved the bill after voting down an amendment proposed by US Rep. Chet Edwards (D- TX) that would have reinstated the funding ban. But the Appropriations Committee did approve an amendment dictating that federally funded NEPs could not operate "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." A floor amendment by Rep. Mark Souder (R-IN) to reinstate the funding ban also was defeated, clearing the way for repeal of the ban to pass the House. But the thousand-foot language remains in the appropriations bill approved by the House, and it's extremely objectionable to reform advocates. The Senate committee working on the issue did not include ending the funding ban, but reform advocates are pinning their hopes on both ending the ban and killing the thousand-foot restriction on the end- game House-Senate appropriations conference committee. "The Senate has taken up their version of the bill in committee, but hasn't had a full vote," explained Daniel Raymond, policy director for the Harm Reduction Coalition. "At the committee level, the Senate chose not to take any action on the ban. At this point, there is a conflict between the House and the Senate." HRC is lobbying the Senate to repeal the ban, without the restrictions. "We commend the full House for recognizing that NEPs are essential, effective tools that work in our fight against HIV and hepatitis transmission," said Kevin Robert Frost, chief executive of the Foundation for AIDS Research. "And while the compromise in the bill isn't perfect, we are hopeful that a final bill will reach President Obama's desk without limitations." "We urge Congress to recognize both the benefit and cost-savings of syringe exchange programs, and the research that NEPs do not have detrimental impact on communities," said Marjorie Hill of Gay Men's Health Crisis, which has just released yet another study demonstrating NEPs' effectiveness in decreasing the transmission of blood-borne diseases. "For too long, we have allowed ideology to drive public health policy. It is time to remove the federal funds ban for syringe exchange and remove the harmful 1,000 feet restriction," added Hill. "The House bill, as it stands, still puts ideology before science by limiting how federal funds can be used for NEPs," Frost said. "But we have time to fix the legislation, and I'm hopeful that the full US Congress will realize the importance of allowing local elected and public health officials to make their own decisions about how to address their HIV and hepatitis epidemics." "I believe that the president, the Senate, and the House all want to do the right thing and they're trying to figure out how to do it," said Bill McColl of AIDS Action. "If they follow their own rhetoric about science- and evidence-based HIV/AIDS prevention policy, then they will remove the thousand-foot restriction," he said. "The thousand-foot provision is a backdoor means of reinstating the funding ban," McColl continued. "There is almost no urban environment in which it would allow needle exchanges to operate. There are no currently existing needle exchanges that would be able to get federal funding, so it just doesn't make sense to change the policy that way. Drug policy groups have gone and literally shown Congress maps of what would be excluded. They've got letters from mayors and police saying this is not a workable provision. Again, Congress and the president know what the science is." In addition to eliminating federally-funded needle exchanges in vast swathes of the urban landscape, the thousand-foot rule would have other insidious effects, said McColl. "Having that rule would have undesirable side effects, in that it would separate needle exchange from other public health services. Our AIDS program does testing in areas with lots of drug use -- that's where we need to be testing, and that's where we want the population to have clean syringes. With federal funding available and with the thousand-foot rule, prevention services will be driven away from needle exchanges." Alice Bell, prevention project coordinator for Prevention Point Pittsburgh, already lives with geographical restrictions. "We have a local regulation that specifies 1,500 feet from schools only, not all the other restrictions in the current language of the federal bill. We have to move our main needle exchange site because the building we're in is being sold, and we're having trouble finding a good place. Any federal restrictions would make it even tougher," she said. Bell wants the federal funding ban ended, but worries that the thousand- foot rule would put a crimp in her efforts. "We still want it. We need the federal funding. Our program is expanding, but we can't really expand our exchange service because we don't have money for needles. The toughest thing is always getting money for needles. Ending the federal funding ban would make a huge difference to us." Federal funding becomes even more significant when coupled with economic hard times and budget problems at the state and local level, Bell noted. "We're mostly funded through foundations and private donations, and we've begun getting some state and county money for overdose prevention and HIV prevention, but the needle exchange -- the core of what we do -- is the toughest to get funded." "The Senate will most likely go along with the House in conference committee," said Drug Policy Alliance director of national affairs Bill Piper. "They will probably take a bunch of appropriations bills and put them in a massive omnibus spending bill. It is far from clear that there will be a ban in what comes out of the Congress." But the thousand-foot rule has to go, he said. "A lot of groups have been lobbying really hard on the thousand-foot issue," Piper noted. "It would be an effective ban is many cities. Here in DC, for example, the only place you could do a needle exchange program would be down at the docks on the Potomac. The strategy is to convince the conference committee to either take that out or come up with something better." Advocates are lobbying hard right now, said the Harm Reduction Coalition's Raymond. "Right now, we're doing a push to make sure the Senate is educated about the issue and ask the leadership to get on board with House's action to address the ban," he said. "The House version has the thousand-foot restriction, so we're also making the arguments about why that's not workable and needs to be redone. We've been circulating maps showing its impact to House members who are focused on the issue. This restriction goes far beyond any reasonable desire to balance public health with other interests. When that provision was thrown in at the last minute, its effects hadn't really been thought out," he argued. "We keep up the work in reaching out to Congress on both House and Senate side," said Raymond, "and we're also asking the White House to show some leadership and urge the Senate to address the federal ban. We don't want this issue to get lost in the shuffle, we're calling on everyone in the community to make our voices heard and reaching out to our elected officials." It may take awhile to get settled, said Piper. "The entire appropriations process is messed up, and a lot of will depend on if, when, and how the Senate deals with health care," he explained. "Supposedly, they will get the appropriations bills done by the end of October, but I think that's a fantasy. Last year, they didn't even do this year's appropriations bills until March." Still, AIDS Action's McColl maintains a positive outlook. "I think the members who will be called on to vote on this understand the issues," he said. "I have a pretty good feeling about this. I'm hopeful this is the year." Drug War Chronicle - world’s leading drug policy newsletter .......................................................................... __________________________________________________________________________ Canada: Health unit warns of tainted cocaine - Expert describes 'devastating' symptoms By Bruce Deachman, The Ottawa Citizen (09.10.09) Drug users in Ottawa may be at risk of life-threatening infections brought on by contaminated cocaine, according to a warning from Ottawa Public Health. The public health unit issued an advisory on Sept. 25, after it became aware of a suspected case of febrile neutropenia/agranulocytosis -- a decrease in white blood cells that fight infection -- in a reported cocaine user. Dr. Vera Etches, Ottawa's associate medical officer of health, says the case turned out to be unrelated to agranulocytosis. She said another suspected Ottawa case, from about a month ago, has not been confirmed. The health unit first issued a warning last March, after hearing about contaminated cocaine in British Columbia and Alberta. The contaminated cocaine is laced with levamisole, a veterinary antibiotic commonly used to treat worm infestations. "The source of the cocaine has not been determined," said Donna Churipuy, a manager in the health protection division of the Peterborough County- City Health Unit, where a similar case was discovered on Oct. 2. In that case, the patient was treated and released. "Levamisole is not available in Canada," she added, "so it's suspected that it's coming into the country already mixed into the cocaine." In recent months, levamisole has been found in cocaine in various parts of western Canada, including 10 reported incidents on Vancouver Island and the lower B.C. mainland, and 39 in Alberta. One Alberta death last March was attributed to levamisole-laced cocaine, while the U.S. Department of Health and Human Services last month issued an alert about the risk. In the U.S., the Drug Enforcement Administration and state laboratories found that 70 per cent of cocaine tested positive for levamisole, as opposed to 30 per cent a year earlier. Churipuy describes the symptoms of ingesting the levamisole-contaminated cocaine as "devastating." "People develop a really high fever, and then chills and they get swollen glands and opportunistic infections -- painful sores in their mouth or around their anus, and other skin infections such as abscesses or lung infections, and they appear really quickly and suddenly worsen quickly." © Copyright (c) The Ottawa Citizen .......................................................................... __________________________________________________________________________ USA: Thousands Potentially Exposed to Infection at Broward General Med. Ctr. AboutLawsuits.com USA (09.10.09) A Florida nurse is suspected to have fled the country after potentially exposing 1,800 patients to infectious diseases such as HIV and hepatitis by using disposable IV equipment on multiple patients at Broward General Medical Center in Fort Lauderdale. Qui Lan, a former nurse at the hospital has reportedly left the country after resigning from her post. Lan’s resignation came a day after the medical center suspended her for reusing IV equipment that was contaminated with other patients’ bodily fluids. Lan could face criminal charges if any of the 1,851 patients she serviced at the hospital are determined to have contracted an infectious disease. The hospital said Lan’s activities were reported by an anonymous tipster who saw her reuse a saline solution IV bag. The hospital did its own investigation into Lan’s activities and confirmed her actions, which violate basic medical and nursing standards. Hospital officials say Lan, who had worked at the medical center since 2004, admitted to knowing that it was wrong to reuse equipment, but would not answer questions probing why she had done it. Several media reports say Lan appears to have left the country. Broward General Medical Center indicates that it appears Lan was changing the needles and some of the tubing from IVs between patients, but was leaving other parts of the tubing and reusing IV bags. Hospital officials have expressed concern that fluids from previous patients may have gotten into the tubing or bag and infected patients. Hospital officials say the risk of infection is low, but the potential remains. This is the latest in a string of incidents in recent months where a large number of patients were potentially exposed to infectious diseases through the reuse of dirty medical equipment. In September, New Jersey officials linked a New Jersey oncologist, Dr. Parvez Dara, to 29 cases of hepatitis B infections, which state officials say may be due to how his staff administers injectable drugs. The office has been repeatedly cited for infection control violations since 2002. In Colorado, a surgical technician faces multiple criminal charges after admitting this summer that she stole injections of fentanyl, a powerful pain reliever and opioid, for her self, and then used the dirty needles to inject patients with saline solutions. The nurse, Kristen Diane Parker, did so knowing that she had hepatitis C, which she likely contracted from using dirty heroin needles. Thousands of former patients at several facilities where Parker previously worked have required testing for hepatitis and other blood borne diseases. In Las Vegas, between 2004 and 2008, several thousand people treated at the Endoscopy Center of Southern Nevada and Desert Shadow Endoscopy Center, were exposed to hepatitis and HIV due to unsafe medical practices, including reuse of syringes and vials of medication intended for only single use. In February 2008, health officials shut the clinics down after identifying the problems, and over 40,000 former patients were advised by the Southern Nevada Health District to get tested for potentially fatal blood-borne diseases like Hepatitis C or HIV. Earlier this year, several Veteran Affairs clinics discovered problems with sanitation procedures that potentially exposed patients to contaminated medical equipment. The VA had to test more than 10,000 patients for HIV, Hepatitis C and other blood borne infections after discovering that several facilities incorrectly cleaned or used endoscopic equipment used in colonoscopy procedures. In some cases, the equipment was not cleaned after every use, and in other cases an incorrectly used valve meant that blood from a previous operation could be trapped and then exposed to the following patients. At least five of the veterans have tested positive for HIV and more than 40 for hepatitis after being treated with equipment that may not have been properly sterilized. .......................................................................... __________________________________________________________________________ Allergic reaction to vaccines should be investigated Shari Roan, Mel Melcon, Los Angeles Times (09.10.09) Some people have an allergic reaction after having an immunization, an experience that often -- and quite naturally -- leads to an avoidance of any future immunizations. But new guidelines published this week state that any allergic reaction to a shot should be investigated to understand the cause, rather than just giving up on vaccinations. About 235 million doses of vaccines are given each year in the United States, and about 235 cases of anaphylaxis, a serious medical reaction, occur. Milder reactions to vaccines, such as redness and soreness at the injection site and fever are common and should not deter people from getting future immunizations, said Dr. John M. Kelso, the chief author of the report. However, when a serious reaction occurs, the patient should be evaluated by an allergist to determine the culprit allergen. This can be done through allergy testing. Vaccine components that could cause reactions include gelatin or egg protein, yeast, latex from the syringe plungers, neomycin and thimerosal. Once the problem allergen is identified, individuals and their doctors can make decisions about receiving future vaccines in order to ensure safety. "Persons with a history of allergy to egg or a past reaction to an influenza vaccine may still be able to receive the H1N1 vaccine or the seasonal flu vaccine safely," Dr. James T. Li, an author of the report, said in a news release. "I believe that anyone with this concern should check with their doctor and consult with an allergist." The guidelines are online at http://www.allergyparameters.org .......................................................................... __________________________________________________________________________ Emerging retrovirus turns up in new patients: Novel virus can spread between people, may lie behind other common illnesses Emerging Health Threats Forum (08.10.09) A retrovirus first seen in prostate cancer patients three years ago has now been discovered in the blood of people suffering from chronic fatigue syndrome (CFS), Vincent Lombardi and colleagues report1 today in Science. The virus can be passed on from person to person and may be linked with other health conditions, experts say. "We have discovered a highly significant association between the XMRV [xenotropic murine leukemia virus-related virus] retrovirus and CFS," write Lombardi, from the Whittemore Peterson Institute in Nevada, USA, and colleagues. Two-thirds of 101 patients included in the study had the viral DNA in their blood, compared with just 3.7% of healthy controls. The virus could play a part in causing CFS, suggest the authors. Like HIV and other retroviruses, it could be responsible for immune and neurological effects seen in infected people. They noted signs of an immune response specific to XMRV in the patients they studied. But the finding raises more questions than it answers, they caution. The virus may well have nothing to do with causing CFS. Writing2 in an associated article, John Coffin and Jonathan Stoye call for more research to pin down the role of this virus in CFS and other diseases. "Closely related viruses cause a variety of major diseases, including cancer, in many other mammals," they write. "Further study may reveal that XMRV is a cause of more than one well-known ‘old’ disease, with potentially important implications for diagnosis, prevention, and therapy." The study comes on the heels of recent research suggesting a link between prostate cancer and XMRV. The viruses found in the two sets of patients are effectively identical genetically, according to Lombardi and colleagues. "Both conditions are associated with dysfunction of [the antiviral enzyme] RnaseL, which is an important element of intracellular anti-viral immunity," explains Yasuhiro Takeuchi, from the Division of Infection and Immunity at University College London in the UK. "This could help XMRV infection in these patients." Cell-culture experiments conducted by Lombardi and colleagues suggest that XMRV can spread between people through transmission of either infected cells or viral particles alone. "Given that infectious virus is present in plasma and blood cells, blood-borne transmission is a possibility," write Coffin and Stoye. The authors note that some 3.7% of healthy controls tested positive for the virus. In the earlier study of prostate cancer patients, this figure was 5% in the control group. Putting these together, Coffin and Stoye suggest that "perhaps 10 million people in the United States and hundreds of millions worldwide are infected with a virus whose pathogenic potential for humans is still unknown." The form of XMRV now seen in humans can be traced back to a mouse virus, the xenotropic murine leukemia virus (MLV), explain Coffin and Stoye. This is called an "endogenous" virus because it infects reproductive cells and can therefore be passed on to offspring. Their similarity leaves "little doubt" that XMRV emerged by cross-species transmission, they say, and this probably happened outside the laboratory. Both MLV and XMRV belong to the group of gammaretroviruses, notes Takeuchi, which are known to cause cancer, immunological and neurological diseases in animals. The experts are mystified as to why the virus is coming to light now. Stoye suggests one explanation could be the use of improved methods to identify novel viruses in tissues taken from different sources. "[This] reflects a continuing trend over the past 40 years for identifying novel viruses more and more quickly," he notes. "I expect our knowledge of XMRV in human health will expand very fast," says Takeuchi. "I think many researchers are starting or have started to look [for it]". .......................................................................... __________________________________________________________________________ Sudan: Suspected Ebola kills 23 in Sudan By Vision reporter and Agencies, New Vision - Uganda (07.10.09) A haemorrhagic disease suspected to be Ebola has killed at least 23 people and infected dozens more in Southern Sudan, the spokesman of the Southern Sudanese army (SPLA) said yesterday. Most of the dead are SPLA soldiers. Army spokesman Kuol Diem Kuol said blood samples of soldiers had been sent to laboratories for testing but doctors suspected it was Ebola. "So far, from the SPLA, there are 20 killed and three wives (of soldiers) also died," Kuol told Reuters. "There is a huge number of the population affected that we don’t have the (exact) number of." Kuol said symptoms included vomiting blood and bleeding from the ears and nose, adding it was widespread in the Western Bahr al-Ghazal state. A UN official in the south said they had attempted an assessment but needed more information from the local government to be able to assess the situation. Health officials say there is still no known cure for the disease, which is spread through bodily fluids, including blood. The World Health Organisation says Ebola, one of the most virulent viral diseases known to mankind, was discovered in Southern Sudan and the neighbouring Democratic Republic of Congo in 1976. The strain of Ebola that broke out in what was then Zaire has one of the highest case fatality rates of any human virus, roughly 90%. The strain that broke out later in Sudan has a case fatality rate of around 50%. The virus is believed to be transmitted to humans via contact with an infected animal host. It is then transmitted to other people that come into contact with blood and bodily fluids of the infected person, and by human contact with contaminated medical equipment such as needles. Uganda has experienced two outbreaks of Ebola. On October 15, 2000, Ebola was confirmed in Gulu, northern Uganda. By the end of January 2001, 425 Ebola cases had been reported in Gulu, Masindi and Mbarara. Of those, 224 died - a death rate of 53%. Among them were 14 health workers in Gulu who had worked in the isolation wards. On November 24, 2007, the health ministry confirmed another outbreak of Ebola in Bundibugyo district. Health officials confirmed a total of 149 cases of this new Ebola species, with 37 deaths attributed to the strain. .......................................................................... __________________________________________________________________________ India: Enter infection-free zones Express Buzz, Express News Service, India (07.10.09) KOCHI: There are many instances of hospitals turning out to be hatcheries of disease. But Kochiites can heave a sigh of relief as some hospitals in the city and suburbs will soon be infectionfree zones. Twenty hospitals, which include 12 private hospitals and eight government hospitals, have been certified as ‘Safe I Hospitals’ by the assessing panel set up by the district administration, National Rural Health Mission (NRH M) and Indian Academy of Paediatrics (IAP) - the joint promoters of the project. The project was started on October 14, 2008. "We first floated an expert committee to design guidelines for Safe I Hospital certification. The committee identified five norms - safe injection practices, safe infusion practices, safety of health care workers, safety from hospital- based infections and hospital waste management,’’ said Dr K V Beena, district manager, NRHM. "Thirty-two hospitals in Kochi submitted applications for implementing the project and of these 20 complied with the norms set by the project,’’ she said. Training was imparted to 93 percent of staff nurses and 81 percent of doctors in these hospitals in the last one year. "Training was given to doctors and nurses in core areas and hands on training was imparted to nurses. Posters depicting the manner in which an injection has to be administered and correct positioning of hands were given to each hospital,’’ Beena said. At the end of the project the assessment panel comprising a doctor, nursing superintendent and PRO of NRHM examined the effectiveness of training. According to the promoters of the project, less than one-third of these hospitals had facilities like an infection control committee, a full-time nurse for infection control, an infection control manual, injection manual and a facility to report injuries when the project was started. It was with the technical support of BD India, a pharmaceutical company, that the project was implemented. "Of the standards prescribed by the National Accreditation Board for Hospital we selected the portion meant for Safe I,’’ said Dr K M Abraham, state co-ordinator, Safe I Hospital. "We followed the directives of the World Health Organisation and the Pollution Control Board as well,’’ he said. Amrita Institute of Medical Sciences, Kochi , Malankara Orthodox Syrian Church Medical College, Kolenchery, Ernakulam General Hospital, Women and Children Hospital, Mattanchery, Taluk Hospital, Fort Kochi, Taluk Hospital, Karuvelippady, Taluk Hospital, Tripunithura, Taluk Hospital, Perumbavur, Taluk Hospital, North Paravur, Taluk Hospital, Kothamangalam, PVS Hospital, Kochi, Giridhar Eye Institute, Kadavanthra, Ernakulam Medical Centre, Lourdes Hospital, Lakeshore Hospital, Lisie Hospital, Welcare Hospital, Vyttila, Devamatha Hospital, Koothattukulam, Specialists Hospital and Saint Joseph Hospital, Kothamangalam are the hospitals which have been issued ‘Safe I Hospital’ certificate. .......................................................................... __________________________________________________________________________ UK: Revealed: Drug users in Scotland spend £1.4bn every year to feed their habits By Magnus Gardham, Scottish Daily Record (07.10.09) SCOTLAND'S drug users are spending an astonishing £1.4BILLION a year to feed their habits. And the drugs scourge leaves the nation with a £3.5billion annual bill. The harrowing scale of the illegal drugs industry was revealed yesterday in a new Government report. The numbers of users are staggering. Experts who researched drug use in 2006, the latest year where figures were available, found that 50,077 people in Scotland were taking heroin. A total of 15,697 were hooked on crack cocaine and 18,019 were using "illicit" supplies of the heroin substitute methadone. There were also 115,541 cocaine users, 70,182 users of amphetamines - or "speed" - and 102,418 people taking ecstasy. A shocking 363,323 Scots were using cannabis. And 93,790 were illegally using tranquilisers such as diazepam and temazepam, known as "jellies" or "benzos". Most of the users were classed as "recreational". But tens of thousands, including 40,000 people who took cannabis, were described as "problem users". The report said heroin users took the drug on an average of 261 days in the year, consuming a total supply of nearly 11.5 tons. Each user spent an average of £11,000, making the heroin market worth just less than £551million. Users spent £268million on cannabis, £248million on cocaine, £182million on crack and £67million on ecstasy. The total spent of drugs came to £1.4billion - a quarter of what Scotland spends on food in a year and more than eight times what we spend on whisky. The report also measures the price of the drug problem for society. Drug users inflict massive burdens on the NHS, police and courts - and the ordinary people they rob to pay for their next fix. The cost of drug use to the justice system in 2006 was put at £610.4million. Users stole £120million of goods from people's homes and £50million worth from shops, as well as committing frauds worth nearly £190million. The NHS paid £92.2million to keep users in hospital and more than 46,000 drug-takers visited accident and emergency at a cost of £9.8million. It cost the health service £17.3million to treat users who have HIV or full-blown AIDS, many of whom used dirty needles. The total health cost of the drug problem was estimated at £180.5million. Social services were also left with a massive bill. Social care, including the job of caring for addicts' kids, cost £112million. The direct cost to the economy from drug users being unemployed was a colossal £819million. But the most shocking figure of all was the "wider cost to society" - in lost and ruined lives and the misery inflicted on victims of drug crime. Experts put the total at £1.8billion. A second report, published yesterday by Glasgow University, estimated that 55,238 Scots were hooked on heroin or tranquilisers in 2006 - nearly 4000 more than in 2003. In total, almost two per cent of Scots aged 15 to 64 were addicted. But in Glasgow, the figure was 3.27per cent. And it was 2.6per cent in Dundee and 2.57per cent in Inverclyde. The university researchers found "significant" rises in heroin use in Glasgow, North and East Ayrshire, North Lanarkshire and West Dunbartonshire between 2003 and 2006. And they warned that "nobody has a clear idea" of the number of users in touch with treatment services. Reacting to the two reports, Scottish Drugs Forum director David Liddell said: "The figures confirm largely what we already know - that Scotland continues to have one of the highest rates of problematic drug use in Europe. "They underline all too clearly why we must continue to invest in treatment, and focus that investment on the most effective range of treatment, care and rehabilitation services. "That includes areas like housing, family support and employability. "We must also continue to address the underlying issues of poverty, deprivation and other social and health inequalities. "These issues are overwhelmingly at the root of Scotland's drug problem." The figures sparked a political row, with Labour accusing the SNP government of not doing enough to fight the drug plague. Community safety minister Fergus Ewing said the Government's drug strategy, including a cash boost for NHS treatment services, was making progress. But he admitted: "It is unacceptable that some people are still having to wait months to get the help they seek." Ewing added: "Dealing with Scotland's drugs problem is not straightforward. "It involves a combination of education, prevention, treatment and enforcement - and a shared determination. But we are committed to turning round lives and helping deliver a safer, stronger Scotland." Labour claimed cash to tackle the problem, including budgets for specialised drug courts, was being cut by the SNP. Justice spokesman Richard Baker said: "These figures are quite simply shocking and it is becoming increasingly clear the SNP are not taking action against drug abuse. "Recorded drug crimes are increasing and the evidence points to a worsening situation. "But despite a manifesto commitment to invest more in drug rehabilitation, the SNP are investing less. At a time when drug misuse is increasing, it is wrong to be cutting budgets designed specifically to help people kick their addictions." Lib Dem justice spokesman Robert Brown said: "Ministers must explain why, when we have the facilities for rehabilitation, many drug abusers still are not getting the treatment they need." And Tory spokesman John Lamont said: "We have to expand the range of rehabilitation services and move to abstinence and recovery." Cops take £6.8m of dealers' gear in just one month Police in Strathclyde have seized £6.8million worth of drugs in the past month. The huge haul was worth just £2million less than all the drugs seized in the region in the whole of last year. The Strathclyde force are four weeks into the Break the Circle of Violence campaign, a major crackdown on organised crime. Senior officers said yesterday that the drugs seizures prove the blitz is working. Assistant Chief Constable George Hamilton said: "The results we have had in the first four weeks are very positive. "This sends a strong message to the criminal fraternity - we can and will make your life a misery." As well as seizing the drugs, Strathclyde officers working on the campaign have arrested 51 people suspected of links to major crime gangs, recovered £150,000 in cash and reported more than 1100 people for drug offences. Fourteen suspects were held for alleged gun crimes and 27 guns have been seized. Hamilton promised the crooks more of the same. He vowed: "Targeting serious organised crime groups will be part of our everyday business. Shipments "We will continue to detect and disrupt these groups by relentlessly enforcing the law at every opportunity." There are 367 serious crime gangs in Scotland and 152 of them are in Strathclyde, a recent study found. No less than 92 per cent of the gangs are involved in the drug trade, with more than 70 ordering shipments direct from countries such as Colombia and Afghanistan. Organised crime is estimated to be worth £2.6billion a year in Scotland. .......................................................................... __________________________________________________________________________ Opinion piece responds to 'skeptics' of development aid KaiserNetwork.org (07.10.09) After a recent trip to Africa, "to see firsthand the region's fight against malaria," Tachi Yamada, the president of the Global Health Program at the Bill & Melinda Gates Foundation, writes in a CNN opinion piece that a visit to a pediatric hospital ward in Zanzibar that did not have "a single patient" was the "single most memorable image of the trip." Yamada discusses some of the foundation's work to combat malaria, highlighting the project in Zambia, where the malaria incidence "declined by more than 50 percent, and child mortality from all causes, including malaria, declined by 30 percent" because of the use of proven interventions, including insecticide spraying, bed net distribution and others. He writes, "Zambia, Zanzibar, and other success stories provide a beacon of hope for the dream of a world free of malaria, articulated by Bill and Melinda Gates in 2007 when they put out a call to eradicate the disease." Several "outspoken" voices "question the value and true impact of development assistance," Yamada writes. However, malaria proves that "political will, advice on planning, funds to purchase sound, scientifically validated tools, and the courage to measure results objectively," along with "development assistance can have an enormous impact in a short period of time," according to Yamada. "Where have all the patients gone? Home, where they can live happier, healthier lives. Let them be the retort to the skeptics of development assistance," he concludes (Yamada, 10/5). .......................................................................... __________________________________________________________________________ USA: Injury and hazards in home health care nursing are a growing concern Eureka! Science News (07.10.09) Published: Wednesday, October 7, 2009 - 10:05 in Health & Medicine Patients continue to enter home healthcare ''sicker and quicker," often with complex health problems that may require extensive nursing care. This increases the risk of needlestick injuries in home healthcare nurses. While very few studies have focused on the risks of home healthcare, it is the fastest growing healthcare sector in the U.S. In a recent study, led by researchers at Columbia University Mailman School of Public Health, the rate of needlestick-type injuries was 7.6 per 100 nurses. At this rate, the scientists estimate that there are nearly 10,000 such injuries each year in home care nurses. The findings, reported in the paper, "The Prevalence and Risk Factors for Percutaneous Injuries in Registered Nurses in the Home Health Care Sector," were published in the September 2009 issue of American Journal of Infection Control. According to lead author Robyn Gershon, DrPH, professor of clinical Sociomedical Sciences at the Mailman School of Public Health and principal investigator, "although professionally and personally rewarding for many, home care nursing can be both physically and emotionally demanding. Our study findings suggest that home healthcare work may be dangerous for nurses who work in this setting. These types of injuries are serious as they can result in infection with bloodborne pathogens, such as hepatitis and HIV." A critical finding of this study was the statistical correlation between needlesticks and exposure to stressful conditions in the patients' household. Nurses reporting household stressors, such as cigarette smoke, unsanitary conditions, air pollution, and vermin, were nearly twice as likely to report needlestick injuries. Most significant was the fact that home healthcare nurses exposed to violence in their patients' households were nearly three and a half times more likely to also report needlestick injuries, according to the study. The home healthcare sector is a very important part of the nation's healthcare infrastructure with over 1.3 million workers in the field, including roughly 125,000 RNs. Many procedures previously performed only in the hospital are now routinely performed in the home. Over 700 home healthcare RNs from across New York State were recruited for this study, which was funded by the National Institute for Occupational Safety and Health (NIOSH), the Centers for Disease Control and Prevention (CDC). The provision of a safe work environment in the home healthcare sector is complicated by the fact that worker safety in this setting is largely unregulated. Certain OSHA regulations do not apply to workers employed in individual households. However, home healthcare agencies accredited by the Joint Commission must be in compliance with certain infection control and other standards. Protecting workers from violence in the healthcare setting is an ongoing and well recognized challenge according to Dr. Gershon, "These results indicate that household hazards in general, and home care violence in particular, needs addressing." "Many of the unsafe conditions identified in this study can also increase risk of harm to patients," said Dr. Gershon. She further noted that as healthcare increasingly moves out from the acute care setting and into the home setting, efforts to improve the health and safety of workers in this sector is critical, with benefits to home health care workers and patients alike. "Dr. Gershon's research on home healthcare and how it affects elderly patients and caregivers alike is key to helping us evaluate the ways to ensure that both frail older adults and their home health providers remain as safe and healthy in the home setting as possible," says Linda Fried, MD, MPH, dean of the Mailman School of Public Health. "This research is especially important since we know that 20% of the U.S. population will be over 65 years old by the year 2030." Dr. Fried is an epidemiologist and geriatrician whose career has been dedicated to the science of healthy aging. Source: Columbia University's Mailman School of Public Health .......................................................................... __________________________________________________________________________ Australia: Needle Program a Success Julia Medew, The Age, Melbourne Australia (06.10.09) St. Kilda's needle and syringe access program began operating 24 hours a day in late 2007. Since then, the Grey Street outreach remains the only one of its kind open every night in Victoria. Thanks to the additional hours, 1,000 more clients each month have access to sterile injection supplies, said Sue White, manager of health services for the Salvation Army's Crisis Service. The clients of the service include taxi drivers, truck drivers, skilled manual laborers, sex workers, and steroid-using body builders, said White. In an evaluation by Salvation Army and Monash University, the program's expansion contributed to a 51 percent increase in uptake of sterile needles and syringes between August 2007 and September 2008. The number of sharps returned for safe disposal grew 26 percent. The service has helped clients avoid needle sharing and other practices known to spread infections such as HIV and hepatitis C. Needle-exchange users are also offered referrals for counseling, detoxification programs, and other health-related services. Since the service went 24-hours, drug- and crime-related complaints to the local council have changed little, according to the evaluation. Based on this success, other syringe and needle programs should consider expanding their hours, White said. .......................................................................... __________________________________________________________________________ Good hand hygiene can eliminate bacterial contamination in computer devices NewsMedicalNet.com (01.10.09) Although hospital computer equipment can act as a reservoir for pathogenic organisms, including MRSA, researchers writing in the open access journal BMC Infectious Diseases found that bacterial contamination rates from computer equipment were low, possibly as the result of good hand hygiene. Yen-hsu Chen, from Kaohsiung Medical University Hospital, Taiwan, led a team of researchers who studied IT equipment in a 1600-bed medical center in southern Taiwan with 47 wards and 282 computers. He said, "Most hospital computer devices are not waterproof, or otherwise designed for disinfection needs. Clinically, A. baumannii, P. aeruginosa, and MRSA cause the most common nosocomial infections, and their presence correlates with environmental surface contamination. We screened 282 computer stations, looking for these bacteria and other, less dangerous, species". The results revealed a 17.4% (49/282) contamination rate of S. aureus, Acinetobacter spp. or Pseudomonas spp. The contamination rates of MRSA and A. baumannii in the ward computers were 1.1% and 4.3%, respectively. No P. aeruginosa was found. According to Chen, "No clinical correlation of contamination of these computer devices to clinical isolates was found. Routine disinfection and even surveillance of these computer devices may not be mandatory in non-outbreak settings". http://www.biomedcentral.com/bmcinfectdis/ __________________________________________________________________________ _____________________________________*____________________________________ __________________________________________________________________________ * 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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