*SAFE INJECTION GLOBAL NETWORK* SIGNPOST *SAFE INJECTION GLOBAL NETWORK* SIGN 2009 30 November to 2 December 2009 at WHO HQ Geneva Post00518 Vax + IDUs + Abstracts + Polymers + News 28 October 2009 CONTENTS 1. Online: State of the world's vaccines and immunization. Third edition 2. Executive Summary: Return on investment 2: Evaluating the cost- effectiveness of needle and syringe programs in Australia 2009 3. Abstract: HIV seroprevalence in a sample of Tanzanian intravenous drug users 4. Abstract: Prevalence and Correlates of Hepatitis C Infection among Male Injection Drug Users in Detention, Tehran, Iran 5. Abstract: Hepatitis C and HIV prevalence using oral mucosal transudate, and reported drug use and sexual behaviours of youth in custody in British Columbia 6. Abstract: Persistence and change in disparities in HIV infection among injection drug users in New York City after large-scale syringe exchange programs. 7. Abstract: Comparison of acceptability, skin tolerance, and compliance between handwashing and alcohol-based handrub in ICUs: results of a multicentric study 8. Abstract: An evaluation of an educational intervention to reduce inappropriate cannulation and improve cannulation technique by paramedics 8. Abstract: Pseudo-outbreak of Serratia marcescens in a tertiary care hospital 10. Abstract: Hepatitis C infection and related factors in hemodialysis patients in china: systematic review and meta-analysis 11. Abstract: Occupational health nurses' roles, credentials, and continuing education in Ontario, Canada 12. Abstract: Quality of life outcomes with sublingual immunotherapy 13. Abstract: Sublingual immunotherapy in children: facts and needs 14. Abstract: EMLA cream for carpal tunnel syndrome: how it compares with steroid injection 15. Abstract: A Comparison of the Effectiveness of Landmark-guided Injections and Ultrasonography Guided Injections for Shoulder Pain 16. Abstract: Injectable corticosteroid and local anesthetic preparations: a review for radiologists 17. No Abstract: Comment:Study methods affect findings of safety trial of blunt suture needles 18. No Abstract: Workplace hazards among Australian dental students 19. No Abstract: Patients, beware: 731 nurses reveal what to watch out for in the hospital 20. No Abstract: Impact of a prevention strategy targeting hand hygiene and catheter care on the incidence of catheter-related bloodstream infections 21. No Abstract: Swine flu advice for dentists issued 22. No Abstract: Localized amyloidosis at the site of enfuvirtide injection 23. No Abstract: The yin and yang of paracetamol and paediatric immunisations 24. Advances in medical polymers and devices 25. 14th ICID - Call for Abstracts 26. News - India: Eye operation victims to get compensation - USA Puerto Rico: 250 million Accusure insulin syringes recalled - India: 11 lose sight after free op - USA: Nurse who stole painkillers still waiting to learn fate - USA: Modesto pair face jail for giving out clean needles - Sri Lanka: Rubella deaths: The probe widens - Australia: Most hepatitis C infections amongst gay men in Sydney linked to injecting drug use - USA: New law would allow local pharmacies to sell over-the-counter needles - Copper kills hospital superbugs, could save thousands of lives - Canada: Tattoo Shop Owner Faces 21 Health Charges - TED Talks: Marc Koska: 1.3m reasons to re-invent the syringe - U.N. Report Documents How Opium Contributes To Spread of Disease, Deaths - Australia: Needle exchanges prevented 32,000 HIV cases: report - News Outlets Examine Challenges With Expanding Global Child Immunization Campaigns - Syringe programs save money - Australia: New study vindicates needle exchange campaigners - State of the World’s Vaccines: Childhood immunization at record high - USA: Audubon: No Hepatitis C Cases Linked to Surgery Tech - One pair of dirty hands equals many infections - Improper Waste Disposal Poses Health Threat To Developing Countries This edition of SIGNpost is located at: http://uqconnect.net/signfiles/Archives/SIGN-POST00518.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. Online: State of the world's vaccines and immunization. Third edition Download the complete report or its chapters at: http://www.who.int/immunization/sowvi/en/index.html __________________________________________________________________________ State of the world's vaccines and immunization. Third edition The State of the world's vaccines and immunization (Third edition) is a call to action to governments and donors to sustain and increase funding for immunization in order to build upon the progress made so far in meeting the global goals. It focuses on the major developments in vaccines and immunization since 2000. Part 1 examines the impact of immunization on efforts to meet the Millennium Development Goals, especially the goal to reduce deaths among children under five. It looks at the development and use of vaccines and at the safeguards that have been put in place to ensure their safety, efficacy, and quality. It sets out the progress and challenges in meeting the immunization-related global goals. It discusses both the cost of scaling up immunization coverage to meet these goals, and efforts to ensure that the achievements are sustainable in the long term. Finally, it looks beyond 2015 to likely changes in the immunization landscape. Part 2 describes over 20 vaccine-preventable diseases and reviews progress since 2000 in efforts to protect populations against these diseases through the use of vaccines. Full document: http://www.who.int/immunization/sowvi/en/index.html __________________________________________________________________________ _____________________________________*____________________________________ 2. Executive Summary: Return on investment 2: Evaluating the cost- effectiveness of needle and syringe programs in Australia 2009 Since 1986 NCHECR has undertaken studies of disease natural history, viral transmission, and therapeutic and preventive effectiveness. Its major strength is in bringing together collaborative interdisciplinary teams to address key epidemiological and clinical research questions. The work presented in this report was directly commissioned and funded by the Commonwealth of Australia Department of Health and Ageing. The National Centre in HIV Epidemiology and Clinical Research is funded by the Australian Government Department of Health and Ageing and is affiliated with the Faculty of Medicine, The University of New South Wales. Its work is overseen by the Ministerial Advisory Committee on AIDS, Sexual Health and Hepatitis. A copy of the report is available here: http://tinyurl.com/yf5ruly The National Centre in HIV Epidemiology and Clinical Research (NCHECR) is recognised internationally as a research leader in the field of HIV/AIDS. Studies around other blood borne viruses, particularly hepatitis C and sexually transmitted infections are also part of the Centre’s research profile. The NCHECR undertakes research that focuses on epidemiology, clinical research and clinical trials, in collaboration with other research centres, government departments, the pharmaceutical industry, community groups, health clinics and general practitioners. __________________________________________________________________________ Return on investment 2: Evaluating the cost-effectiveness of needle and syringe programs in Australia 2009 Executive summary This project aimed to: 1. Estimate the population benefits of needle and syringe programs (NSPs) on HIV and hepatitis C virus (HCV) related outcomes among injecting drug users (IDUs) in Australia and in each State and Territory over the period from 2000 to 2009. 2. Explore changes in the provision of NSPs, populations at risk, and sharing behaviour on these outcomes. 3. Calculate the net present value and future values and cost- effectiveness of NSPs in terms of HIV and HCV infections averted from a health sector (government as third party payer) perspective. Population model methods A mathematical epidemic model was developed to simulate HIV and HCV transmission among IDUs in Australia. The model was informed by detailed biological data, Australian IDUs behavioural data (e.g., the annual NSP survey/finger prick survey), and the number of injecting equipment units distributed by NSPs each year. The model described IDUs in the community and not those in prisons. The extensive available data enabled the model to describe well the complex injecting behaviour and mixing patterns of Australian IDUs and viral transmissions within this population. The model was used to determine the populationlevel effectiveness of NSPs in preventing transmissions of HIV and HCV through the distribution of sterile injecting equipment. It accurately reflected the current HIV and HCV epidemiology in Australia. Separate analyses were carried out for IDUs in Australia and by each Australian state and territory as well as Australian Aboriginal and Torres Strait Islander people who inject drugs. The decade from 2000-2009 was investigated to estimate the number of HIV and HCV infections with and without NSPs in the past, thus determining the effectiveness of NSPs. The model was then used to forecast epidemic trajectories over the next 70 years (2010-2079) under assumptions that funding and services of NSPs or behaviour of IDUs remain unchanged or according to changes in conditions. This time horizon was chosen in order to consider whole of lifetime impacts. Shorter timeframes are also analysed. These results became inputs into an economic analysis. Economic analysis methods An economic analysis used the epidemic model results and detailed data on costs. Costs associated with NSPs were provided by State and Territory health departments. Healthcare costs for HIV and HCV were estimated from activity-based analysis and national databases. All costs are presented in 2008 Australian dollars. The outcome of interest from the economic analysis was: · Disability-Adjusted-Life-Years (DALYs). A range of time horizons were chosen for the analyses: · 2000-2009 · 2010-2019 · 2010-2029 · Life-time of current IDU cohort. Discounting was applied at 3% and 5% where appropriate (discounting assesses the value of money at different time periods) [1]. Summary of investment · The number of needles and syringes distributed in Australia increased during the past decade (from ~27 million to ~31 million). · Expenditure on NSPs increased by 36% (adjusted for inflation) over this time period, mostly associated with personnel and not principally for equipment (Table a); a significant portion of the increased investment has been the Illicit Diversion Supporting Measures for NSPs to increase referrals to drug treatment and other services. · Over the last decade there has been o Increases in funding for primary sites. o Increases in the number of secondary sites. o Increases (by 15%) in the numbers of units of equipment provided. o Stable spending on sterile injection equipment. o At the time of writing there were 85 primary sites, 737 secondary sites, 20 enhanced secondary sites, and 118 vending machines. Effectiveness of NSPs It was estimated that over the last decade (2000-2009) NSPs have directly averted: · 32,050 new HIV infections; · 96,667 new HCV infections. Table b summarises the epidemiological benefits of NSPs over the last decade. When secondary transmissions (sexual or mother-to-child transmission from infected IDUs) are considered, the epidemiological benefits are even greater. The cumulative benefits of NSPs are further pronounced if long-term projections are considered, as the preventative effects of NSPs flow through to influence the incidence of long-term clinical complications. Economic analysis of NSPs during 2000-2009 During 2000-2009, gross funding for NSP services was $243m. This investment yielded: · Healthcare costs saved of $1.28 billion ($1.12bn-$1.45bn, IQR). · Approximately 140,000 DALYs gained. · Net financial cost-saving of $1.03 billion ($876m-$1.98bn, IQR). The net present value of NSPs (in 2000) is $896m (disc 3%)(Table c) and $817m (disc 5%). It was estimated that: · For every one dollar invested in NSPs, more than four dollars were returned (additional to the investment) in healthcare cost-savings in the short- term (ten years) if only direct costs are included; greater returns are expected over longer time horizons. · NSPs were found to be cost-saving over 2000-2009 in seven of eight jurisdictions and cost-effective in the other jurisdiction. Over the longer term, NSPs are highly cost saving in all jurisdictions. · The majority of the cost savings were found to be associated with HCV- related outcomes. However, when only HIV-related outcomes were considered in the analysis, it cost $4,500 per DALY gained associated with HIV infection. · If patient/client costs and productivity gains and losses are included in the analysis, then the net present value of NSPs is $5.85bn; that is, for every one dollar invested in NSPs (2000-2009), $27 is returned in cost savings. This return increases considerably over a longer time horizon. · NSPs are very cost-effective compared to other common public health interventions, such as vaccinations (median cost per QALY of $58,000), allied health, lifestyle, and in-patient interventions (median cost of $9,000 per DALY gained), and interventions addressing diabetes and impaired glucose tolerance or alcohol and drug dependence (median cost of $3,700 per DALY gained) [2]. Results about future NSPs If NSPs were to decrease in size or number, then relatively large increases in both HIV and HCV could be expected with associated losses of health and life and reduced returns on investment (Table d). Significant public health benefits can be attained with further expansion of sterile injecting equipment distribution. Investment in NSPs was cost-saving for current NSP funding when analysed for all time periods. Cost savings were: · $782m (2010-2019) · $3.23bn (2010-2029) · $17.75bn (2010-2059) · $28.71bn (2010-2079). The net present value of current NSP investment at 2010 (discounted 3%): · $641m (2010-2019) · $2.27bn (2010-2029) · $8.41bn (2010-2079). Increased funding and provision of NSPs would be associated with greater cost-savings. The maximum return would be achieved at 125% to 200% of current levels (Table e); this is when the total net savings (NPV) is maximal. Expansion of NSPs in all jurisdictions would be costsaving. There is potential for expansion, considering that only approximately 50% of all injections are currently with a sterile syringe. Conclusions Investment in NSPs (2000-2009) has resulted in: · An estimated 32,050 HIV infections and 96,667 HCV infections averted; · Substantial healthcare cost savings to government related to HCV and HIV; · Substantial gains in Disability Adjusted Life years. For every dollar currently spent on the activities of NSP, more than four dollars will be returned (in addition to the investment; i.e., five times the investment) and approximately 0.2 days of disability-adjusted life gained. Over a longer time horizon there is even greater return. Results from model-based projections into the future (2010 onwards) suggest that: · Maintenance of current levels of NSP funding will continue to provide o substantial and increasing healthcare cost savings; o gains in life years. · Increases in the funding and provision of NSPs will: o avert additional HCV and HIV infections; o lead to further and increased cost-savings of funding up to 150-200% of current level if met with demand; o reduce marginal return on investment as funding increased. o the maximum return would be achieved at 150% to 200% of current levels. It is important to note that this report is based on the effectiveness of NSPs in averting HIV and HCV infections among IDUs only and not on the many other benefits of NSPs, such as avoided mental health episodes and injecting related injury, psychosocial benefits, other support, referral, education and prevention etc. Costs of NSPs in this analysis included some other services (but not primary healthcare or drug and alcohol programs or the human resource cost of providing sterile injecting equipment) and thus results are conservative estimates of the true return on investment. __________________________________________________________________________ _____________________________________*____________________________________ 3. Abstract: HIV seroprevalence in a sample of Tanzanian intravenous drug users __________________________________________________________________________ AIDS Educ Prev. 2009 Oct;21(5):474-83. HIV seroprevalence in a sample of Tanzanian intravenous drug users. Williams ML, McCurdy SA, Bowen AM, Kilonzo GP, Atkinson JS, Ross MW, Leshabari MT. School of Public Health, University of Texas Health Science Center at Houston, USA. Mark.L.Williams@uth.tmc.edu Injection drug use has recently emerged in sub-Saharan Africa. The purpose of this study was to assess the factors associated with increased risk of testing HIV-positive in a sample of injection drug users (IDUs) in Dar es Salaam, Tanzania. Participants were recruited by a trained outreach worker or were referred by IDUs who had completed the study. Blood specimens and self-reported socioeconomic and behavioral data were collected from 315 male and 219 female IDUs. Data were analyzed using univariate odds ratios and multivariate logistic regression modeling. Forty-two percent of the sample tested HIV-positive. Several socioeconomic, injection, and sexual factors were found to be associated with increased odds of testing HIV- positive. Multivariate analysis showed that having had sex more than 81 times in past 30 days, earning less than 100,000 shillings (US$76) in the past month, residency in Dar es Salaam for less than 5 years, and injecting for 3 years were independently associated with the greatest risk of infection. The rate of HIV infection in this sample of IDUs was found to be very high, suggesting that injection drug use may be a factor in the continuing epidemic in sub-Saharan Africa. The factors associated with increased risk of HIV infection suggest further research is needed on the needle use and sexual networks of IDUs. __________________________________________________________________________ _____________________________________*____________________________________ 4. Abstract: Prevalence and Correlates of Hepatitis C Infection among Male Injection Drug Users in Detention, Tehran, Iran __________________________________________________________________________ J Urban Health. 2009 Oct 21. Prevalence and Correlates of Hepatitis C Infection among Male Injection Drug Users in Detention, Tehran, Iran. Kheirandish P, Seyedalinaghi S, Jahani M, Shirzad H, Seyed Ahmadian M, Majidi A, Sharifi A, Hosseini M, Mohraz M, McFarland W. Iranian Research Center for HIV/AIDS (IRCHA), Department of Infectious and Tropical Diseases, Tehran University of Medical Sciences, Tehran, Iran. For the benefit of planning for the future care and treatment of people infected with hepatitis C virus (HCV) and to help guide prevention and control programs, data are needed on HCV seroprevalence and associated risk factors. We conducted a cross-sectional sero-behavioral survey of injection drug users (IDU) detained for mandatory rehabilitation during a police sweep of Tehran, Iran, in early 2006. During the study period, a consecutive sample comprising 454 of 499 (91.0%) men arrested and determined to be IDU by urine test and physical examination consented to a face-to-face interview and blood collection for HCV antibody testing. Overall, HCV prevalence was 80.0% (95% confidence interval (CI) 76.2-83.6). Factors independently associated with HCV infection included history of incarceration (adjusted OR 4.35, 95% CI 1.88-10.08), age of first injection 9 times more likely to report sex for trade. Five Aboriginal youth were identified with HCV; prevalence estimate 1.2% (95% CI: 0.53-2.77%); 3 reported injecting drugs, the other 2 reported using cocaine/crack and sharing non-injection drug paraphernalia. Two youth were identified with HIV, prevalence estimate 0.48% (95% CI: 0.14%-1.72%). CONCLUSION: IDU, HCV and HIV prevalence remain low. Interventions are needed to prevent transition to IDU and further opportunities for prevention and harm reduction should be explored while the youth are in custody. __________________________________________________________________________ _____________________________________*____________________________________ 6. Abstract: Persistence and change in disparities in HIV infection among injection drug users in New York City after large-scale syringe exchange programs. __________________________________________________________________________ Am J Public Health. 2009 Oct;99 Suppl 2:S445-51. Persistence and change in disparities in HIV infection among injection drug users in New York City after large-scale syringe exchange programs. Des Jarlais DC, Arasteh K, Hagan H, McKnight C, Perlman DC, Friedman SR. Beth Israel Medical Center, 160 Water St-24th Fl, New York, NY 10038, USA. dcdesjarla@aol.com OBJECTIVES: We examined racial/ethnic disparities in HIV infection among injection drug users (IDUs) before and after implementation of large-scale syringe exchange programs in New York City. METHODS: Participants were recruited from IDUs entering the Beth Israel drug detoxification program in New York City. Participants (n = 1203) recruited from 1990 through 1994, prior to large-scale syringe exchange programs (pre-exchange), were compared with 1109 participants who began injecting in 1995 or later and were interviewed in 1995 through 2008 (post-exchange). RESULTS: There were large differences in HIV prevalence among pre-exchange vs post-exchange participants (African Americans, 57% vs 15%; Hispanics, 53% vs 5%; Whites, 27% vs 3%). Pre- and post-exchange relative disparities of HIV prevalence were similar for African Americans vs Whites (adjusted odds ratio [AOR] = 3.46, 95% confidence interval [CI] = 2.41, 4.96 and AOR = 4.02, 95% CI = 1.67, 9.69, respectively) and Hispanics vs Whites (AOR = 1.76, 95% CI = 1.49, 2.09 and AOR = 1.49, 95% CI = 1.02, 2.17). Racial/ethnic group differences in risk behavior did not explain differences in HIV prevalence. CONCLUSIONS: New interventions are needed to address continuing disparities in HIV infection among IDUs, but self-reported risk behaviors by themselves may not be adequate outcome measures for evaluating interventions to reduce racial/ethnic disparities in HIV infection. __________________________________________________________________________ _____________________________________*____________________________________ 7. Abstract: Comparison of acceptability, skin tolerance, and compliance between handwashing and alcohol-based handrub in ICUs: results of a multicentric study __________________________________________________________________________ Intensive Care Med. 2009 Jul;35(7):1216-24. . Comparison of acceptability, skin tolerance, and compliance between handwashing and alcohol-based handrub in ICUs: results of a multicentric study. Souweine B, Lautrette A, Aumeran C, Bénédit M, Constantin JM, Bonnard M, Guélon D, Amat G, Aublet B, Bonnet R, Traoré O. CHU Clermont-Ferrand, unité de réanimation médicale, Pôle REUNNIRH, Hôp G Montpied, 63003, Clermont-Ferrand, France. OBJECTIVE: We compared handwashing (HW) and alcohol-based handrub (ABH) for skin tolerance, acceptability, and hand hygiene compliance in health- care workers (HCWs) in a multicentric study. DESIGN AND SETTING: Before/after study over two periods (P1 and P2) in seven ICUs. Monitoring of methicillin-resistant Staphylococcus aureus (MRSA) acquisition in two ICUs (U4 and U6). SUBJECTS AND PATIENTS: All HCWs of the seven ICUs, and the patients of U4 and U6 without MRSA carriage on admission. INTERVENTIONS: Handwashing was available in P1 and P2. ABH was introduced after P1 and available throughout P2. HCWs completed questionnaires on skin tolerance in P1 and P2, and on acceptability in P2. Compliance with hand hygiene was assessed in P1 and P2 using a standardized method. ICU- acquired MRSA colonization/infection in U4 and U6 was recorded. MEASUREMENTS AND MAIN RESULTS: Hand erythema was reported during P1 and P2 by 21.7 and 11% of HCWs, respectively (P = 0.01), itching by 15.8 and 7.1% (P = 0.02), oozing by 0.8 and 1.1% (P = 0.82), and bleeding by 4.2 and 1.1% (P = 0.1). ABH was considered easier and quicker than HW (P < 0.01), but overall acceptability did not differ between the two. Compliance increased from 51% (334/647) in P1 to 60% (251/418) in P2, P < 0.01. No significant reduction in MRSA colonization/infection between P1 and P2 (P = 0.30) was observed, but the study was underpowered. CONCLUSIONS: Self- report questionnaires show that when ABH is available in ICUs, fewer unpleasant skin sensations are reported. ABH is considered to be easier and quicker to use than HW and compliance is improved after glove removal. __________________________________________________________________________ _____________________________________*____________________________________ 8. Abstract: An evaluation of an educational intervention to reduce inappropriate cannulation and improve cannulation technique by paramedics __________________________________________________________________________ Emerg Med J. 2009 Nov;26(11):831-6. An evaluation of an educational intervention to reduce inappropriate cannulation and improve cannulation technique by paramedics. Siriwardena AN, Iqbal M, Banerjee S, Spaight A, Stephenson J. Faculty of Health, Life & Social Sciences, University of Lincoln, Brayford Pool, Lincoln LN6 7TS, UK; nsiriwardena@lincoln.ac.uk. BACKGROUND: Intravenous cannulation enables administration of fluids or drugs by paramedics in prehospital settings. Inappropriate use and poor technique carry risks for patients, including pain and infection. We aimed to investigate the effect of an educational intervention designed to reduce the rate of inappropriate cannulation and to improve cannulation technique. Method: We used a non-randomised control group design, comparing two counties in the East Midlands (UK) as intervention and control areas. The educational intervention was based on Joint Royal Colleges Ambulance Liaison Committee guidance and delivered to paramedic team leaders who cascaded it to their teams. We analysed rates of inappropriate cannulation before and after the intervention using routine clinical data. We also assessed overall cannulation rates before and after the intervention. A sample of paramedics was assessed post-intervention on cannulation technique with a "model" arm using a predesigned checklist. RESULTS: There was a non-significant reduction in inappropriate (no intravenous fluids or drugs given) cannulation rates in the intervention area (1.0% to 0%) compared with the control area (2.5% to 2.6%). There was a significant (p<0.001) reduction in cannulation rates in the intervention area (9.1% to 6.5%; OR 0.7, 95% CI 0.48 to 1.03) compared with an increase in the control area (13.8% to 19.1%; OR 1.47, 95% CI 1.15 to 1.90), a significant difference (p<0.001). Paramedics in the intervention area were significantly more likely to use correct hand-washing techniques post- intervention (74.5% vs. 14.9%; p<0.001). CONCLUSION: The educational intervention was effective in bringing about changes leading to enhanced quality and safety in some aspects of prehospital cannulation. __________________________________________________________________________ _____________________________________*____________________________________ 9. Abstract: Pseudo-outbreak of Serratia marcescens in a tertiary care hospital __________________________________________________________________________ New Microbiol. 2009 Jul;32(3):273-6. Pseudo-outbreak of Serratia marcescens in a tertiary care hospital. Dundar D, Meric M, Vahaboglu H, Willke A. Medical Faculty of Kocaeli University, Department of Clinical Microbiology, Kocaeli, Turkey. devrimdundar@hotmail.com The aim of this study was to describe a pseudo-outbreak due to Serratia marcescens associated with laboratory contamination, and also the epidemiologic and laboratory methods used to determine the source of contamination. An apparent increase in positive culture results for Serratia marcescens was observed in the Clinical Microbiology Laboratory of Kocaeli University Hospital between September and November 2007. An outbreak investigation including retrospective and prospective studies using chart review, environmental sampling and random arbitrary polymorphic DNA-polymerase chain reaction (RAPD-PCR) of randomly selected isolates were performed by the Infection Control Committee. Nine out of 67 strains belonged to a real infection. S. marcescens was also isolated from saline solution in the specimen processing area of the laboratory. It was recognized that the technician has been using the same stock saline solution for processing specimens without changing the injector. RAPD patterns of the clinical isolates were identical to the pattern of saline strain. The contaminated saline solution was discarded, the technician was trained and no additional cases of suspected contamination have been observed. This pseudo-outbreak emphasize the importance of the observation of specimen processing procedures and the training of laboratory workers. __________________________________________________________________________ _____________________________________*____________________________________ 10. Abstract: Hepatitis C infection and related factors in hemodialysis patients in china: systematic review and meta-analysis __________________________________________________________________________ Ren Fail. 2009;31(7):610-20. Hepatitis C infection and related factors in hemodialysis patients in china: systematic review and meta-analysis. Sun J, Yu R, Zhu B, Wu J, Larsen S, Zhao W. Department of Geriatrics, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210029, China. BACKGROUND AND AIMS: To provide a comprehensive and reliable tabulation of available data on the epidemiological characteristics and risk factors for hepatitis C virus (HCV) infection in maintenance hemodialysis (HD) patients in China, and to help inform prevention programs and guide future research. METHODS: A systematic review was constructed based on the computerized literature database by two reviewers independently. Ninety- five percent confidence intervals (CI) of infection rates were calculated using the approximate normal distribution model. Odds ratios and 95% CI were calculated by fixed or random effects models. RESULTS: Forty-three studies met our inclusion criteria. The pooled prevalence of HCV infection among HD patients in China was 41.1% (95% CI 39.5-42.6%). No significant difference was found in HCV infection rates between male and female HD patients (OR = 0.75, 95% CI 0.52-1.07, p = 0.11). HD patients with blood transfusion were 5.65 times more likely to be infected with HCV than HD patients without blood transfusion. A longer duration of HD was associated with increased HCV prevalence. Co-infection with hepatitis B virus did not increase the probability of HCV infection among HD patients (OR = 1.19, 95% CI 0.34-3.20, p = 0.73). CONCLUSIONS: Viral hepatitis is still one of the main complications in HD patients, with hepatitis C being the most common one. The key to reducing the incidence of viral hepatitis in HD patients is to control contagion and reduce the frequency of blood transfusion and cross-infection. __________________________________________________________________________ _____________________________________*____________________________________ 11. Abstract: Occupational health nurses' roles, credentials, and continuing education in Ontario, Canada __________________________________________________________________________ AAOHN J. 2009 Sep;57(9):389-95. doi: 10.3928/08910162-20090826-01. Occupational health nurses' roles, credentials, and continuing education in Ontario, Canada. Alleyne J, Bonner A. Workplace Safety & Insurance Board, Toronto, Ontario, Canada. The role of the occupational health nurse is broad and includes health care provider, manager/coordinator, educator/advisor, and case manager and consultant, depending on the type of industry and the country in which the nurse practices. Regardless of the type of role, the occupational health nurse must participate in continuing nursing education (CNE) activities. This study describes the roles, credentials, and number of CNE activities undertaken by occupational health nurses working in Ontario, Canada. Using a nonexperimental descriptive design, a questionnaire was mailed to all practicing occupational health nurses who are members (n=900) of a local nursing association. Three hundred fifty-four questionnaires were returned. Nurses reported a variety of roles in the following categories: case management, health promotion, policy development, infection control/travel health, ergonomics, education, research, health and safety, direct care, consultation, disaster preparedness, and industrial hygiene. Sixty-five percent of nurses held an occupational health nurse credential, and 19% of nurses attended more than 100 hours of CNE annually. Occupational health nurses have multiple workplace roles. Many attend CNE activities and they often prepare for credentialing. Copyright (c) 2009, SLACK Incorporated. __________________________________________________________________________ _____________________________________*____________________________________ 12. Abstract: Quality of life outcomes with sublingual immunotherapy __________________________________________________________________________ Am J Otolaryngol. 2009 Sep-Oct;30(5):305-11. Quality of life outcomes with sublingual immunotherapy. Wise SK, Woody J, Koepp S, Schlosser RJ. Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, SC 29425, USA. PURPOSE: Immunotherapy is the titrated exposure of allergens to induce immunologic tolerance and offers long-term immune modification. Traditional subcutaneous immunotherapy (SCIT) has resulted in several deaths and raised safety concerns. Sublingual immunotherapy (SLIT) is an alternative administration route for allergen-specific immunotherapy. Compared to SCIT, SLIT has a shorter escalation phase, equal or greater efficacy for rhinitis, and an improved safety profile. The purpose of this study was to evaluate quality of life measures in a preliminary patient sample initiating SLIT at our institution. MATERIALS AND METHODS: Patients with appropriate allergen reactivity were given the option to pursue immunotherapy by traditional SCIT or by SLIT techniques. Patients choosing SLIT completed the mini-Rhinoconjunctivitis Quality of Life Questionnaire (m-RQLQ), a 14-item Likert-type questionnaire, at baseline and during maintenance therapy. Patients typically reached maintenance dosing in less than 5 weeks. RESULTS: Paired m-RQLQ data were available for 15 patients after antigen titration. Initial m-RQLQ results indicate statistically significant (P < .05) improvement on 12 of 14 domains, including impact on regular and recreational activities, sleep, nose rubbing and nose blowing, stuffy nose and runny nose, itchy eyes, sore eyes, watery eyes, thirst, and tiredness. In addition, total m-RQLQ score showed statistically significant improvement (P = .001). No serious adverse events occurred with the initiation of SLIT. CONCLUSION: These results indicate that SLIT is effective in controlling allergic symptoms and is safe in an introductory patient sample. Double- blind placebo-controlled trials are needed to confirm our preliminary results. __________________________________________________________________________ _____________________________________*____________________________________ 13. Abstract: Sublingual immunotherapy in children: facts and needs __________________________________________________________________________ Ital J Pediatr. 2009 Oct 23;35(1):31. Sublingual immunotherapy in children: facts and needs. Marseglia GL, Incorvaia C, La Rosa M, Frati F, Marcucci F. Allergen specific immunotherapy (SIT) is the practice of administering gradually increasing doses of the specific causative allergen to reduce the clinical reactivity of allergic subjects, and is the only treatment targeting the causes of hypersensitivity and not only the symptoms, as done by drugs. The traditional, subcutaneous immunotherapy (SCIT) was burdened by the problem of systemic reactions which may be sometimes severe and - though very rarely - even fatal. This was the background to develop non injections routes for SIT and particularly sublingual immunotherapy (SLIT), that emerged as a real treatment option for respiratory allergy. A number of studies was conducted to evaluate efficacy and safety of SLIT, the first meta-analysis - including 22 placebo-controlled trials - concluded for positive results in both issues, but the number of studies on children was too low to draw definite conclusions. Since then, many other studies became available and make possible to analyze SLIT in children in its well defined aspects as well as in sides still requiring more solid data. __________________________________________________________________________ _____________________________________*____________________________________ 14. Abstract: EMLA cream for carpal tunnel syndrome: how it compares with steroid injection __________________________________________________________________________ Electromyogr Clin Neurophysiol. 2009 Sep-Oct;49(6-7):287-9. EMLA cream for carpal tunnel syndrome: how it compares with steroid injection. Moghtaderi AR, Jazayeri SM, Azizi S. Shiraz University of Medical Sciences, Shiraz, Iran. moghtaderia@yahoo.com BACKGROUND: A standard treatment option for carpal tunnel syndrome (CTS) is local injection of anesthetic-corticosteroid. This clinical trial was designed to compare the safety and efficacy of daily application of the EMLA cream (lidocaine 2.5% plus prilocaine 2.5%) with that of a single injection of methyl prednisolone acetate (Depo-Medrol) 40 mg. METHODS: In this randomized, parallel-group, open-label, single-center, case- controlled, prospective study, 65 participants (70 hands) aged 18-75 years with clinical & electrodiagnostic evidences of CTS were randomized to receive either the EMLA cream (n = 30 patients, 35 hands, group 1) or one injection of methylprednisolone acetate 40 mg at wrist (n = 35 patients, group 2). Outcome assessments included the visual analog scale and clinical assessment. RESULTS: After 4 weeks of treatment, patients in both groups reported significant changes (P < 0.001) in pain intensity. Both treatments were well tolerated, with treatment-related adverse events (AEs) reported in 2 patients in group 1 (5.7%) and 10 patients in group 2 (28.5%) No systemic treatment-related AEs were observed with the EMLA cream. CONCLUSION: EMLA cream was effective in reducing pain associated with CTS and well tolerated and it may offer patients with CTS an effective, noninvasive symptomatic treatment. __________________________________________________________________________ _____________________________________*____________________________________ 15. Abstract: A Comparison of the Effectiveness of Landmark-guided Injections and Ultrasonography Guided Injections for Shoulder Pain __________________________________________________________________________ Clin J Pain. 2009 Nov-Dec;25(9):786-9. A Comparison of the Effectiveness of Landmark-guided Injections and Ultrasonography Guided Injections for Shoulder Pain. Ucuncu F, Capkin E, Karkucak M, Ozden G, Cakirbay H, Tosun M, Guler M. Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Farabi Hospital, Karadeniz Technical University, Trabzon, Turkey. AIM: To compare the effectiveness of landmark-guided local injections and ultrasonography (USG) guided injections for shoulder pain. METHODS: A total 60 consecutive patients with shoulder pain due to soft tissue disorders was enrolled, and randomly assigned to receive triamcinolone (40 mg) either by landmark-guided (LMG, n=30) or USG guided (n=30) injection. The patients were evaluated on admission and 6 weeks after the injection. Clinical assessment included demographic and clinical data, a visual analoge scale (VAS) for pain (0 to 10 cm), the Constant scale (0 to 100) for function, passive and active shoulder range of motion (ROM) with goniometric evaluation, and postinjection adverse effects. RESULTS: Initial demographic, clinical and USG findings in the groups exhibited no significant differences. Six weeks after injection, the VAS and the Constant score showed a significantly better improvement in USG group compared with LMG group (mean VAS score decrease: 4.0+/-1.7 for USG vs. 2.2+/-0.9 for LMG, P<0.05; mean Constant score change: 32.2 for USG vs. 12.2 for LMG, P<0.05). Significant improvements were observed in active and passive ROM values in both groups, USG group values being better. Initially 18 patients in LMG and 24 patients in USG had limited shoulder ROM, of which 6 was returned to normal values in LMG group and 12 in USG group at 6 week after injection (P<0.05). CONCLUSIONS: Our results indicate that the injection of corticosteroids to patients with shoulder pain due to soft tissue disorders under the USG- guidance may improve therapeutic effectiveness and reduce adverse effects. __________________________________________________________________________ _____________________________________*____________________________________ 16. Abstract: Injectable corticosteroid and local anesthetic preparations: a review for radiologists __________________________________________________________________________ Radiology. 2009 Sep;252(3):647-61. Injectable corticosteroid and local anesthetic preparations: a review for radiologists. MacMahon PJ, Eustace SJ, Kavanagh EC. Department of Radiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland. petermacmahon@yahoo.com Corticosteroids and local anesthetics are some of the most commonly administered medications in radiology departments. These medications have marked variability in their formulations, which may increase their adverse event profile for specific procedures. In particular, certain corticosteroid preparations are associated with adverse central nervous system (CNS) sequelae. This is most likely due to distal embolization by particulate formulations.Nonparticulate steroid formulations are not associated with such events. Local anesthetics have severe CNS and cardiac adverse effects if injected intravascularly and have recently been associated with intraarticular chondrolysis if used in large doses. This review discusses these medications with particular emphasis on their established and postulated adverse effects. The administering radiologist should be aware of these potential effects and how best to reduce their occurrence. __________________________________________________________________________ _____________________________________*____________________________________ 17. No Abstract: Comment:Study methods affect findings of safety trial of blunt suture needles __________________________________________________________________________ Am J Obstet Gynecol. 2009 Oct;201(4):e11-2. Study methods affect findings of safety trial of blunt suture needles. Jagger J, Berguer R, Gomaa AE. Comment on: Am J Obstet Gynecol. 2008 Dec;199(6):641.e1-3. __________________________________________________________________________ _____________________________________*____________________________________ 18. No Abstract: Workplace hazards among Australian dental students __________________________________________________________________________ Aust Dent J. 2009 Jun;54(2):186-8. Workplace hazards among Australian dental students. Smith DR, Leggat PA, Walsh LJ. __________________________________________________________________________ _____________________________________*____________________________________ 19. No Abstract: Patients, beware: 731 nurses reveal what to watch out for in the hospital __________________________________________________________________________ Consum Rep. 2009 Sep;74(9):18-23. Patients, beware: 731 nurses reveal what to watch out for in the hospital. [No authors listed] __________________________________________________________________________ _____________________________________*____________________________________ 20. No Abstract: Impact of a prevention strategy targeting hand hygiene and catheter care on the incidence of catheter-related bloodstream infections __________________________________________________________________________ Crit Care Med. 2009 Nov;37(11):2999. Impact of a prevention strategy targeting hand hygiene and catheter care on the incidence of catheter-related bloodstream infections. Zingg W, Imhof A, Maggiorini M, Stocker R, Keller E, Ruef C. Infection Control Program (WZ), University Hospitals of Geneva, Geneva, Switzerland, Department of Internal Medicine (AI), Medical Intensive Care Unit (MM), Surgical Intensive Care Unit (RS), Neurosurgical Intensive Care Unit (EK), Internal Medicine and Infectious Diseases (CR), Division of Hospital Epidemiology, University Hospital, Zurich, Switzerland. __________________________________________________________________________ _____________________________________*____________________________________ 21. No Abstract: Swine flu advice for dentists issued __________________________________________________________________________ Br Dent J. 2009 May 23;206(10):511. Swine flu advice for dentists issued. [No authors listed] __________________________________________________________________________ _____________________________________*____________________________________ 22. No Abstract: Localized amyloidosis at the site of enfuvirtide injection __________________________________________________________________________ Ann Intern Med. 2009 Oct 6;151(7):515-6. Localized amyloidosis at the site of enfuvirtide injection. Morilla ME, Kocher J, Harmaty M. __________________________________________________________________________ _____________________________________*____________________________________ 23. No Abstract: The yin and yang of paracetamol and paediatric immunisations __________________________________________________________________________ Lancet. 2009 Oct 17;374(9698):1305-6. The yin and yang of paracetamol and paediatric immunisations. Chen RT, Clark TA, Halperin SA. Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. rtc1@cdc.gov Comment on: Lancet. 2009 Oct 17;374(9698):1339-50. __________________________________________________________________________ _____________________________________*____________________________________ 24. Advances in medical polymers and devices __________________________________________________________________________ Advances in medical polymers and devices Processing Talk - UK (27.10.09) An Applied Market Information product story Edited by the Processingtalk editorial team The global medical-device market is valued at around USD200bn (GBP122.4bn) and the US accounts for about 45 per cent of this. Markets are growing in east Europe, Brazil, Russia, India and China, according to the consultant Len Czuba. The Middle East and Africa have potential for growth, but there are limitations of infrastructure and political instability. Current healthcare trends include minimally invasive surgery: device developments include a silicone-access port for multiple instruments from Covidien; microendoscopes from Biovision Technologies; and remote handgrips from Novare Surgical Systems that simulate real hand feeling. Biodegradable/bioabsorbable materials are increasing in usage, but can be difficult to process. Materials and device development were discussed extensively at the AMI conference on Medical Grade Polymers 2009, which took place in the Hilton, Philadelphia, PA. Demand for medical plastics is expected to reach USD6.55bn in the US in 2012. The FDA has regulated medical devices in the US since 1976 and its standards are recognised worldwide. The process is risk- and data-based - benefit must outweigh risk. Approvals include good manufacturing practice and control of materials supplies to ensure consistent products. Tests vary with category - implants are highest risk. If a new device is a modification of an existing one, then approval is simpler, involving a 510(k) submission; completely new devices must undergo a full premarket approval (PMA) process. There are currently around 30-50 of these submissions per year, compared with 3-4,000 510(k) applications, according to Laura Byrd, an engineer in the PMA office. Sometimes applications arrive on pallets in trucks, as the paperwork is comprehensive. Polymer manufacturers can submit a master file to the FDA and give written approval for manufacturers to access these reports. Medical Murray is involved in developing and manufacturing new high-tech disposables and implants, and works with companies and physicians. Tanner Hargens is a biomaterials expert with the company. Material specification includes mechanical, chemical, biocompatibility, electrical and thermal properties, as well as processability. It is expensive to take a new device to market because of the cost of design and tests to obtain performance data, as well as FDA approval. The company estimates a cost of around USD150,000 to USD1m and a one- to four- year time frame to take a device through the 510(k) level, and 2.5 to 10 years and USD1-80m for a PMA. Current projects include a new polyurethane synthetic ear cartilage. Polymers used in implants include polyethylene, PEEK, silicone, polysulfone, PTFE, polypropylene and polycarbonate, along with the bioabsorbables polylactide (PLA), polyglycolide (PGA) and copolymers of PLA/PGA. Processing can build in material stresses or knit lines with lower strength and methods such as solvent casting can give issues with solvent removal. Sterilisation affects materials in different ways depending on the technique, from ethylene oxide and gamma irradiation to autoclave. The rewards are seeing a device operational and improving the quality of life for patients. The company Polymaterials aims to develop biocompatible and biodegradable polymer scaffolds using rapid tooling techniques to model each implant to the patient. The objective is to form a temporary structure that acts as a mould for a new body-part using host cells. In one study, the company has used biodegradable polyurethane to model an ear cartilage, which was then seeded with cartilage cells. Cell retention can be an issue and is usually improved by modifying the scaffold surface; however in this case a gel composite containing fibrinogen, growth factors, thrombin and calcium chloride was used as a carrier for the cells, giving a high efficiency of seeding. The scaffold is expected to last for between one and two years. The company is also looking at scaffolds for bone and fat (for example in breast-tissue replacement). Dr Vipul Dave at Cordis is involved in developing cardiac stents that also release drugs. He is using supercritical carbon dioxide to purify poly(lactide-co-glycolide). After loading with the drug, solvent removal cannot use high temperatures or the drug will degrade, so alternative techniques must be employed. The rate of drug release can be controlled by factors such as the crystallinity of the polymer. Smart heart patches are being developed by Dr Wakatsuki of the Medical College of Wisconsin. Cardiomyocytes are mixed with a polymer suspension and moulded into a band shape, then grown with a current applied to simulate the heart beating. This generates a pulsating band of material. Long-term there is hope of creating healthy cardiac muscle patches to apply to failing hearts, as currently there are 20-40,000 US patients waiting for heart transplants and only 2,500 hearts are available each year. Dr Guangyu Lu is the manager for plastics at Teleflex Medical in the critical-care research and development department. He has reviewed the factors in selecting a material from physicochemical properties to cost. Blood contact polymers should not: adsorb protein, release additives into the bloodstream, carry infection, cause clots or cancer, or provoke an immune response or irritation. Coatings are used on medical devices for protection and to improve biocompatibility. Hydrophilic/lubricious polymers include polyvinyl pyrrolidone (PVP), polyethylene oxide (PEO) and polyvinyl alcohol (PVA). Coatings are applied by dip coating, spray coating, brush, roll or blade. Key performance measures include substrate adhesion, durability and mechanical properties, thickness and swelling in body fluids, particle and leachables release, biocompatibility and degradation of implants. Bayer Material Science has been studying polyurethane hydrophilic coatings. An aqueous dispersion can be used or a low boiling solvent, permitting low temperature or ambient curing. The resulting film has extensive entanglement during curing and gives a uniform, transparent, insoluble film that does not require external crosslinking. The coating has been tested for biocompatibility. Solvay Advanced Polymers has a range of materials for medical applications, including polycarbonate, polyarylamide, polysulfone, polyphenylsulfone and PEEK. These have been tested for compatibility with sterilisation methods and disinfectants, including hundreds of repeat cycles of use and cleaning. The company has introduced the Solviva Biomaterials range, which has the potential for implant use, including PEEK, self-reinforcing polyphenylene, polyphenylsulfone and polysulfone. Biological safety testing is carried out by NAMSA, based primarily on the ISO 10993 Part 1 standard. Currently there is blurring between medical and pharmaceutical devices, as more are combined. First an assessment plan is drawn up, then materials are selected for fitness for purpose, physicochemical and toxicological properties. Other factors are then considered, such as the manufacturing processes, leachables and degradation products. Eight principles are applied in all and these will be expanded in the new version of the standard, due for release around March 2010. Currently tests are being carried out on bioabsorbable polymers to examine decomposition products. Ciba Expert Services has recently evaluated a surgical mask containing antimicrobials in the polymer (either silver/zinc or triclosan). Tests were developed to simulate breathing through the mask and exposure to saliva, and analytical techniques were honed to detect the key components. Inhalation exposure of 10 hours or leaching exposure to 10 masks gave acceptable safety margins for exposure to triclosan, silver and zinc. Rubber is a key component in the pharmaceutical industry, including seals for many vials and lids. Companies such as Helvoet Pharma use halobutyl and other rubbers, minimising leaching of vulcanising components. Another alternative is to coat rubber with Teflon. The company has taken a risk-based approach to assess its manufacturing practices based on an FDA report from 2004, 'Pharmaceutical CGMPS for the 21st Century'; the ISO 15378 standard and ICH Q9 from the European Medicines Agency Inspections (EMEA). Critical process parameters are closely monitored during manufacturing. The World Health Organization (WHO) has noted that: 'The European (EP), Japanese (JP) and Unites States (USP) pharmacopoieas all describe materials of the same type, but there are considerable differences in classification and presentation.' Michael Eakins specialises in pharmaceutical consultancy and has looked at control of plastics. For example, in the USP 661, there are specific tests for polyethylene and polypropylene in plastic containers, in the EP 6.0 section 3.1.3 there is an alternative range of tests, with a further set for containers (rather than materials) in JP XV, section 7.02. This is important for global businesses. The International Pharmaceutical Aerosol Consortium on Regulation and Science (IPAC-RS) is a global association of companies that manufacture orally inhaled and nasal drug products (OINDP). Its members include: 3M, Astrazeneca, Chiesi, Abbott, Boerhinger Ingelheim, Mannkind, Glaxosmithkline, Novartis, Pfizer, Schering Plough, Sanofi-Aventis, Teva and Vectura. There is a materials working group, the aim of which is: 'To improve materials quality and integrity, and reduce supply-chain problems by optimising control strategies.' There have been issues due to variation in material composition, processing (or conditions) and finishing. Patient safety and high quality are top priorities for the OINDP. Dr Dennis Jenke of Baxter Healthcare is involved with materials in contact with drugs in delivery systems and packaging. The definition of secondary packaging can become blurred; for example, an overbag is heated in an autoclave oven at 120C in direct contact with the primary bag and volatile substances have the opportunity to migrate between the two. Both the drug and the packaging need to perform to the required standard, and key factors include: adsorption of drug onto packaging; degradation of drug or packaging, for example leaching of components or environmental stress cracking; change in pH or precipitation; and protection against exposure to light, loss of solvent, water-vapour adsorption or microbial contamination. Dr Jenke highlighted several cases involving rubber: in one instance a new drug stabiliser caused a vulcanising agent to leach and increased the risk of red cell aplasia; in another instance, BHT leached from a rubber stopper in infusion pumps after the latex was replaced with chlorobutyl rubber. Resmed makes around six million product units each year worldwide with a turnover of about USD1bn. The company is looking for confidentiality of intellectual property from its material suppliers, uniform data presentation and consistent polymer to be supplied across the globe. Expertise in medical injection moulding is supplied by Mack Molding: it works with designers to develop new devices. Recent projects include a gas-assisted over-moulded handle. Infection transfer is a big issue in healthcare. Momentive Performance Materials has an antimicrobial silicone. Silicones comprise three - five per cent of the USD20bn of medical polymers and are used in applications varying from catheters to surgical instruments. Silver ions are incorporated, which are toxic to the bacteria, by destabilising the cell membrane, deactivating sulphur-containing proteins and blocking oxygen-transport enzymes. PVC has been used in medical applications for decades, but with the phthalate plasticizer controversy, replacement materials have been sought. Teknor Apex has developed medical thermoplastic elastomers: these are easy to process, approach the clarity of PVC, retain natural colour on gamma sterilisation and have lower specific gravity (lighter weight parts). The cost is higher, but less material is used by weight and TPE is very good in over-moulding. The company also supplies flexible PVC and is examining alternative plasticisers in PVC. The next AMI international conference on medical-grade polymers is planned for 14-15 September 2010 at The Hilton City Avenue, Philadelphia. http://www.processingtalk.com/news/apm/apm141.html Copyright © 2000-2009 Pro-Talk Ltd. __________________________________________________________________________ _____________________________________*____________________________________ 25. 14th ICID - Call for Abstracts On-line Abstract Submission is now available. The deadline for abstract submissions is November 1, 2009 __________________________________________________________________________ Subject: 14th ICID - Call for Abstracts Dear Colleague: On behalf of the International Society for Infectious Diseases, I would like to invite you to submit abstracts for presentation at the 14th International Congress on Infectious Diseases. The Congress will be held in Miami, Florida on March 9-12, 2010. The scientific program for the Congress is nearly complete and we have an outstanding line up of speakers and topics that will be of interest to anyone active in the fields of infectious diseases or travel medicine. The November 1 deadline for abstract submissions to the 14th ICID is fast approaching. I urge you to submit your abstract as soon as possible, and plan on joining your colleagues and peers from around the world in Miami for this educational and enjoyable meeting. Take advantage of reduced registration fees by registering on or before January 15, 2010. Please visit www.isid.org for complete information including Congress registration, hotel reservation, and abstract submission instructions. I look forward to seeing you in Miami. Sincerely yours, Raul Isturiz MD President, ISID http://www.isid.org/14th_icid/ __________________________________________________________________________ _____________________________________*____________________________________ 26. News - India: Eye operation victims to get compensation - USA Puerto Rico: 250 million Accusure insulin syringes recalled - India: 11 lose sight after free op - USA: Nurse who stole painkillers still waiting to learn fate - USA: Modesto pair face jail for giving out clean needles - Sri Lanka: Rubella deaths: The probe widens - Australia: Most hepatitis C infections amongst gay men in Sydney linked to injecting drug use - USA: New law would allow local pharmacies to sell over-the-counter needles - Copper kills hospital superbugs, could save thousands of lives - Canada: Tattoo Shop Owner Faces 21 Health Charges - TED Talks: Marc Koska: 1.3m reasons to re-invent the syringe - U.N. Report Documents How Opium Contributes To Spread of Disease, Deaths - Australia: Needle exchanges prevented 32,000 HIV cases: report - News Outlets Examine Challenges With Expanding Global Child Immunization Campaigns - Syringe programs save money - Australia: New study vindicates needle exchange campaigners - State of the World’s Vaccines: Childhood immunization at record high - USA: Audubon: No Hepatitis C Cases Linked to Surgery Tech - One pair of dirty hands equals many infections - Improper Waste Disposal Poses Health Threat To Developing Countries Selected news items reprinted under the fair use doctrine of international copyright law: http://www4.law.cornell.edu/uscode/17/107.html __________________________________________________________________________ India: Eye operation victims to get compensation Express News Service, India (27.10.09) HYDERABAD: The State Government has decided to pay a compensation of Rs 50,000 to those who lost their eye sight due to botched up cataract operations conducted by Bollineni Hospitals in Nellore and also decided to see that the hospital pay Rs 1.50 lakh as an additional compensation to the victims. These decisions were taken at a review meeting convened by Chief Minister K Rosaiah here today. It was also decided that the Government should supply blood platelets free of cost to the dengue patients. Briefing media about the deliberations of the meeting, Health Minister D Nagendar stated that the Government had ordered an inquiry into the Bollineni hospital issue and the report would come up in two to three days. He stated that on prima face the eye operations failed because of contaminated medicines and saline and added that action would be taken against those responsible. Nagendar said the Government would not impose any restrictions on health camps as it would discourage institutions which come forward for such activities. The Health minister stated that a team of eye doctors from Sarojini Devi eye hospital were sent to Nellore and Chennai where the patients were being treated. Speaking on the measures to be taken to assist the dengue patients, he said that Government would make available the blood platelets free of cost to the BPL families. .......................................................................... __________________________________________________________________________ USA Puerto Rico: 250 million Accusure insulin syringes recalled The Associated Press (27.10.09) WASHINGTON -- A Huntsville, Ala., company is recalling about 250 million Accusure insulin syringes it has distributed nationwide since January 2002 because the products' needles could detach from the syringes. Qualitest Pharmaceuticals has received about four complaints related to the needle detaching from the syringe, said Dr. Carole Ben-Maimon, senior vice president of corporate strategy for the company. No injuries resulting from the problem have been reported to the company, she said. If the needle becomes detached from the syringe during use, it can become stuck in the insulin vial, push back into the syringe, or remain in the skin after an injection, the company said. The recall includes all Accusure insulin syringes, regardless of lot number. They were distributed from January 2002 to October 2009 to wholesale and retail pharmacies nationwide and in Puerto Rico. The recall announced Tuesday expands an earlier one of two lots of Accusure insulin syringes. Ben-Maimon said the company expanded the recall to include all syringes because it received a complaint of a syringe not included in the first recall. The recalled syringes come from multiple manufacturers, she said. The syringes could expire several years after they were sold on the market, she added. Consumers who have these products should stop using them and contact the company at 800-444-4011 for more information. Adverse reactions can be reported to the Food and Drug Administration at http://www.fda.gov/medwatch/report.htm. .......................................................................... __________________________________________________________________________ India: 11 lose sight after free op News24, South Africa (26.10.09) New Delhi - At least 11 people lost vision in one of their eyes after a free cataract surgery went wrong in India's southern state of Andhra Pradesh, news reports said on Monday. The operated eye had to be removed after the patients developed infection during the weekend following the surgery by the private Bollineni Eye Hospital in the Nellore district, the NDTV network reported. Doctors say the infection may have been due to contamination of drugs or the instruments used. The condition of 20 other patients who underwent surgery and are currently hospitalised in the southern Chennai metropolis is raising fresh concerns, a report in the Hindustan Times newspaper said. The eye camp proved to be a nightmare for families of the patients. One local man who paid $257, was operated on along with those who got the treatment free of charge, his daughter said. "Doctors say my father may lose the vision in the other eye too if the infected eye is not removed," Dhivya, who uses only one name, told NDTV. Andhra Pradesh Health Minister Danam Nagender ordered a probe and instructed hospital authorities to stop all such operations. "Losing eyesight is like losing life. If it is a case of negligence we'll take action," Nagender told reporters. The hospital authorities have little idea what went wrong but denied negligence by doctors. They said the infection could be from eyedrops rather than the surgery. "There could be several reasons for the infection and we will know the facts after the testing of the swabs which have already been sent to government labs," N Sai Murali, chief ophthalmologist at the hospital, told the Hindustan Times. Botched eye surgeries at such free treatment camps in India are not uncommon and are reported by the local media at regular intervals. In August of last year, 35 people complained of loss of vision after treatment for eye ailments at a free eye camp in the neighbouring Tamil Nadu state. That incident resulted in a state government ban on free eye-surgery camps. Investigations showed that the hospital had used expired medicines for post-surgery treatment, blinding the patients. - SAPA .......................................................................... __________________________________________________________________________ USA: Nurse who stole painkillers still waiting to learn fate by Dan Boniface, 9NEWS.com - Denver,CO,USA (26.10.09) BOULDER - A former surgical nurse at Boulder Community Hospital will wait a little longer before learning his fate for stealing the drug fentanyl from patients and covering up what he had done. The sentencing for Ashton Daigle was postponed Monday. Back in June, Daigle pleaded guilty to six felonies in federal court to avoid a life sentence. He admitted he fed his fentanyl addiction at the expense of as many as 300 patients at Boulder Community Hospital. Many of those victims were expected to testify at his sentencing hearing. Daigle also admitted he used dirty needles to steal the drug which he replaced with saline solution or dirty tap water. After the incident, the hospital says it improved its drug security. .......................................................................... __________________________________________________________________________ USA: Modesto pair face jail for giving out clean needles Merrill Balassone, The Modesto Bee, Fresno Bee - Fresno,CA,USA (25.10.09) MODESTO -- Mono Park in Modesto's airport neighborhood has earned some dirty nicknames. Needle Park, for the used hypodermic syringes on the ground, in the nearby alleys and stuck into trees. Or Heroin Park. Now, the park has given its name to the "Mono Park Two" -- Kristy Tribuzio, 36, and Brian Robinson, 37 -- arrested for handing out clean needles to drug addicts who shoot up methamphetamine and heroin there. They face up to a year in jail for doing what they believe is a public health service: preventing people from sharing needles and curbing the spread of HIV and hepatitis C. "Our community is in crisis," said Tribuzio, an aspiring high school teacher. "Our intention was never to defy authority." Local critics, including Stanislaus County District Attorney Birgit Fladager and Sheriff Adam Christianson, said a needle exchange program in Modesto would enable drug users to continue their addiction. Assistant District Attorney Carol Shipley said the Sheriff's Department began investigating the needle exchange after neighbors complained. "It's illegal, and our board [of supervisors] has supported law enforcement in not legalizing it," Shipley said. .......................................................................... __________________________________________________________________________ Sri Lanka: Rubella deaths: The probe widens By Kumudini Hettiarchchi and Nadia Fazlulhaq, Pic by Chathuri Dissanayake Sunday Times.lk - Columbo,Sri Lanka As two top-level independent committees probed a child’s death following a rubella vaccine shot, the vials are to be sent abroad for quality-testing. Some of the rubella vaccine vials from Wariyapola will be sent for testing to a foreign laboratory, recognized by the WHO, in a country other than the country of manufacture which is India, explained Prof. Manouri Senanayake, Professor of Paediatrcis, Faculty of Medicine, University of Colombo who is heading the five-member Technical Committee set up to investigate all aspects of the rubella incident. In the latest incident in the rubella saga, 12-year-old Asanthi Wasana Premathilake of Wariyapola died on October 12, while eight months earlier Peshala Hansini of Matara also succumbed after being administered the vaccine. The report of the Technical Committee which began investigations immediately after Asanthi’s death is being compiled and will be released soon, stressed Prof. Senanayake, explaining that their inquiries covered a wide area. The other members of the committee are Chief JMO Colombo, Dr. Ananda Samarasekera; Consultant Immunologist of the Medical Research Institute, Dr. Rajiv de Silva; Senior Lecturer in Pharmacology, Medical Faculty, University of Colombo, Dr. Shalini Sri Renganathan; and Consultant Community Physician of the Epidemiology Unit, Dr. Sriyani Dissanayake. It will not be a run-of-the-mill report, the Sunday Times understands, with an important large-scale study also being undertaken with both international and local expertise to assess the allergy status of the Sri Lankan population. Asanthi died nearly 60 hours after being administered the rubella vaccine on October 10 at the Wariyapola MOH clinic. Although schoolgirls are given the vaccine in school, after the Matara death of Peshala in March, any child who is prone to allergies is asked to come to the nearest MOH clinic for the injection, it is learnt. Having been given the vaccine at the MOH clinic, Asanthi who developed adverse effects, was taken to the Wariyapola District Hospital and later transferred to the Kurunegala Teaching Hospital where she died on the evening of October 12. The Technical Committee visited the Wariyapola MOH clinic and both the Wariyapola and Kurunegala Hospitals and interviewed doctors ranging from consultants to medical officers. They also spoke to the regional epidemiologist and other categories of staff, the Sunday Times understands. "We visited the child’s home and spoke to the parents, other children as well as adult women who were immunized," said Prof. Senanayake, adding that they took into their custody all documents including the autopsy report. Tissue and blood specimens, including those taken ante-mortem (before death) are being analyzed, she said, explaining that the Ministry of Health had provided full cooperation and encouraged the committee in its bid to co-opt not only local but international experts for their views and advice. The report from the second committee which is looking into the administrative aspects of the Wariyapola incident will come out this week, as soon as they interview the dead child’s parents, said the Director of the Drug Regulatory Authority, Dr. Hemantha Beneragama who is heading it. "We have all the other interviews, but were awaiting the right time after the alms-giving in view of the sensitive nature of the issue, to talk to the parents," he said, adding that his three-member committee is hoping to visit Wariyapola once again on Tuesday. Meanwhile, a health source indicated that another inquiry is being conducted at provincial level while the Government Medical Officers’ Association (GMOA) called on the government to send samples of the present lot of vaccines to an accredited laboratory for analysis of all components not only the active ingredient. The GMOA wants the continuation of the rubella vaccination programme as otherwise babies will be born with Congenital Rubella Syndrome, said Assistant Secretary Dr. Chandana Atapattu, pointing out, however, that since 1996 when it was first administered no serious adverse effects had been reported. "But this year Medical Officers of Health have reported to us that there are more allergic reactions compared to previous years," he said. The severe allergic reactions may not be due to the rubella virus which is the active ingredient in the vaccine, he says, but due to some other, even the gelatine used as a stabilizer. These incidents indicate there is something wrong with the product. -------------------------------------------------------------------------- Stringent guidelines followed The strong message which came from all health sources was that there are stringent guidelines and testing procedures to ensure safety and efficacy when procuring vaccines for the Expanded Programme of Immunization (EPI). The main condition set by the Epidemiology Unit when getting vaccines for the EPI is that the manufacturer has to be pre-qualified by the WHO, said Dr. Virginie Mallawaarachchi who is attached to the unit. Pre-qualification status is granted to a manufacturer by the WHO after it undergoes rigorous screening and testing of samples, it is learnt. Even after that, when Sri Lanka imports a vaccine, a detailed dossier from the manufacturer (in this case the Serum Institute of Pune, India) which includes the manufacturing process of the vaccine from beginning to end is evaluated by many experts under a WHO formatted system. Control samples are also tested by the MRI’s National Control Lab (NCL) for vaccines which is mandated by Gazette notification and also recognized by the WHO, the Sunday Times understands. However, the procedures do not end there. After the lot of vaccines is imported, the Epid Unit cannot use them until the NCL tests samples the shipment and issues a Lot Release Certificate in addition to a certificate from the government of the country of origin that the stock is of good quality. "We are accountable. We will never compromise on quality," assured NCL Head Dr. Omala Wimalaratne. With regard to the Wariyapola incident, she said, that the NCL was quality-testing the vials from there while also making arrangements to send some vials to a WHO-recognized laboratory either in Australia or Europe for an independent quality report. The quality-testing of the vaccine began soon after the adverse reaction was reported on October 10 while the child was still in hospital, it is learnt. When asked, Dr. Wimalaratne said there were no quality issues in the batch used in Matara in March and the WHO team which had independently investigated it had also come to the same conclusion. .......................................................................... __________________________________________________________________________ Australia: Most hepatitis C infections amongst gay men in Sydney linked to injecting drug use Michael Carter, Aidsmap, London, UK (25.10.09) Injecting drug use is the behaviour most associated with hepatitis C virus infection in both HIV-positive and HIV-negative gay men in Sydney, a study published in the online edition of Sexually Transmitted Infections shows. The Australian researchers also found that rates of hepatitis C infection about ten times higher in HIV-positive men than they were in HIV-negative men. Although no new hepatitis C infections were detected in men with HIV, there were five in the HIV-negative men, and the investigators found that many of these men had reported sex with an HIV-positive man, use of sex toys, fisting, and ulcerative sexually transmitted infections. Hepatitis C is a blood-borne virus and its main mode of transmission is injecting drug use. Sexual transmission of the virus is thought to be rare. However there have recently been outbreaks of hepatitis C amongst HIV-positive gay men and sex seems to be the most likely mode of transmission. It seems that sexual activity that involves contact with blood is associated with the transmission of hepatitis C in HIV-positive gay men, for example fisting, use of sex toys, and unprotected anal sex, especially in the context of recreational drug use and group sex. Investigators in Sydney, Australia wished to obtain a better understanding of the transmission of hepatitis C in gay men. They therefore analysed the results of two studies - one involving HIV- negative men, the other men with HIV - to determine the prevalence, incidence, and risk factors for hepatitis C. Study populations A total of 1,427 HIV-negative men recruited to the Health in Men (HIM) study and 245 HIV-positive men from the Positive Health study were included in the investigators’ analyses. Information from the HIM study from 2001-2007 was studied, with the Positive Health study providing testing data from 2005-2007. Both these studies were therefore able to analyse the results of tests for hepatitis C conducted since the sexual transmission of the epidemic became apparent in HIV-positive gay men in Europe in around 2002. Injecting drug use strongly associated with hepatitis C in HIV-negative men At baseline, 15 HIV-negative men were infected with hepatitis C. This provided a prevalence of approximately 1%. The investigators note that this prevalence is comparable to that in the general Australian population. I njecting drug use was strongly associated with infection with hepatitis C (OR = 56.18; 95% CI 12.55-251.5). Only two of the hepatitis C-infected men did not report this behaviour, and the investigators note that these men both had tattoos or piercings, a possible mode of hepatitis C transmission. Other characteristics associated with an increased risk of hepatitis C infection on entry to the study were older age, number of sexual partners, initiating anal sex at a younger age, and a history of sex work. There were five new infections with hepatitis C during the study, providing an incidence rate of 0.11 per 100 person years. Only one of the men newly-infected with hepatitis C reported injecting drug use. Four of the men (including the individual with a history of injecting drugs) said that they had sex with an HIV-positive man prior to their infection with hepatitis C. As regards other sexual risk factors, unprotected anal sex was reported by one man, three said that they had used sex toys, and one reported fisting. Syphilis and infection with genital herpes were each reported by one individual. High hepatitis C prevalence in HIV-positive gay men Hepatitis C prevalence was much higher in the HIV-positive cohort. At baseline, 23 individuals were co-infected, providing a prevalence of 9.39%. Questions about injecting drug use were answered by 18 men, and 16 said that they had a history of such behaviour. Despite the contemporary epidemic of sexually transmitted hepatitis C amongst HIV-positive gay men in northern Europe, there were no new infections with this virus during follow-up in this cohort. The investigators note that HIV-positive gay men have historically had a higher prevalence of hepatitis C virus than their HIV-negative peers. For example, in a 1980s Sydney clinic cohort, 12% of those with HIV were infected with hepatitis C compared to 4% of HIV-negative men. Although low, the incidence of what seems to be sexually acquired hepatitis C in HIV-negative gay men was in Sydney than has been reported in a number of other recent studies. The low numbers of infections made statistical analysis difficult. There was only a weak association with unprotected anal sex with an HIV-positive man. However, the investigators noted that two of the recently infected men reporting sex with an HIV-infected man were diagnosed with syphilis or genital herpes. They therefore suggest "as both...are ulcerative sexually transmitted infections, these data suggest that the presence of ulcers may have facilitated hepatitis C transmission." "In these highly sexually active cohorts of homosexual men prevalent hepatitis C infection was almost ten times more common in HIV-positive men, and was related to injecting drug use in about 90% of cases in both HIV-negative and HIV-positive men", comment the investigators. Sexual risk factors seemed to be involved in the few new infections they identified, and the investigators conclude, "more carefully designed studies are warranted to elucidate whether the increase in the hepatitis C epidemic in homosexual men in some settings is attributable to sexual transmission or to increases in other risky behaviours, such as injecting drug use, and body piercing and tattooing." Reference Jin F et al. Prevalence, incidence and risk factors for hepatitis C in homosexual men: data from two cohorts of HIV negative and HIV positive men in Sydney, Australia. Sex Transm Infect (online edition), 2009. .......................................................................... __________________________________________________________________________ USA: New law would allow local pharmacies to sell over-the-counter needles By Kurtis Alexander, Santa Cruz Sentinel, USA (25.10.09) SANTA CRUZ -- An ordinance being drafted by a county supervisor would make it OK for pharmacies to sell needles without a prescription, a practice currently barred in much of the county because of the implications for intravenous drug use. Supervisor John Leopold, who plans to introduce the new law as soon as next week, says making sure clean needles are available, even if they're being used illegally, is a proven way of preventing the spread of blood- borne diseases like AIDS and Hepatitis C. "This is good health policy," said Leopold, who before entering politics worked as the director of the Santa Cruz AIDS Project. With last month's suspension of the AIDS Project needle-exchange program, a method for many drug users in the county to get sterile syringes, Leopold says his ordinance is timely. "With the future of the exchange in question, we have to figure out another way," he said. "Having pharmacies participate will help us meet this basic health need." A 2004 state law allows counties across California to choose whether to permit the sale of over-the-counter syringes. While Santa Cruz County opted to do so, the decision did not include cities where the bulk of county pharmacies exist. "Without the local jurisdictions approving this, it hasn't had the kind of effect we've wanted," said Merle Smith, the AIDS Project's current executive director. The new ordinance is written to allow pharmacies in the cities, not just the unincorporated areas, to sell over-the-counter syringes. Smith, who had to shut the agency's needle-exchange program because of state budget cuts, supports Leopold's proposal. A survey by Oakland-based Rose Associates suggests that while only 17 percent of those using needle exchanges have recently bought a syringe at a pharmacy, 80 percent would. "Expanded access through pharmacies is nothing but good," said Valerie Rose, a community health consultant who conducted the survey, which included Santa Cruz County. According to the Drug Policy Alliance Network, a third of all reported AIDS cases in the United States have been among injection drug users and their sexual partners. About 700 people in Santa Cruz County are living with AIDS, according to the AIDS Project. Under the proposed county ordinance, the Health Services Agency would work with pharmacies choosing to sell over-the-counter needles. The agency, said Community Health Service Director Leslie Goodfriend, would make sure needles were being properly disposed of as well as ensure health information, about disease testing and making safer choices, was provided to drug users. State law allows the county to permit the sale of up to 10 needles to individuals without prescriptions or collecting personal information. .......................................................................... __________________________________________________________________________ Copper kills hospital superbugs, could save thousands of lives by Andrew Schneider. Cold Truth (blog) (24.10.09) Centuries ago alchemists proclaimed copper a life-saving metal. Some Native American shamans and Amazonian jungle healers use potions and trinkets of copper to treat hundreds of maladies. Millions of people wear copper bracelets to ease the pain of arthritis. And late-night hucksters and Internet spammers claim copper can cure everything from ruptured Achilles tendons to varicose veins. MRSA bacteria Finally, researchers are starting to take a serious look at this ubiquitous metal antimicrobial properties. Dr. Michael Schmidt, vice chairman of the Microbiology and Immunology Department at the Medical University of South Carolina, is studying copper’s effectiveness in killing lethal bacteria at two U.S. hospitals and one in Chile. The research is collecting and counting bacteria found on many common hospital work surfaces and points of patient contact - toilet seats, faucets, hand rails and the like. Analysis will be done again on identical surfaces that have been replaced with copper or a blend of copper and other metals. Infectious disease specialists at the Centers for Disease Control say Schmidt’s work and that of a handful of other researchers have already shown that copper is a natural microbicide and can kill the most serious of hospital-spawned bacteria almost on contact. They call the research vital because more than 120,000 people a year die from infections acquired while hospitalized, and that’s just in the U.S. In several speeches, Schmidt has said that patients have a one in 20 chance of developing a serious infection once they enter a hospital for treatment. Infection-control teams facing the probability of mammoth contamination problems from the H1N1 flu undoubtedly wish the copper research was further along. A separate study in a hospital in the UK has shown that copper door plates, faucets, light switches and other fixtures killed highly infectious bacteria more rapidly than the traditional stainless steel, plastics and other materials commonly used in medical facilities. Peter Lambert, a professor of microbiology at Aston University in Birmingham, England, conducted the research and reported this year that the copper metal all but eliminated two of the fiercest hospital-acquired super bugs - the common name for bacteria which has become resistant to traditional treatment. The World Health Organization says that the super bugs - C. difficile, the major cause of antibiotic-associated diarrhea, and MRSA, or methicillin- resistant Staphylococcus aureus - claim "far more than 500,000 lives a year." Both Lambert and Schmidt say the copper suffocates germs, preventing them from breathing, without the need of additional antibacterial sprays or other chemicals. Lambert’s tests, which were paid for by the copper industry, have shown that the metal kills off the deadly MRSA and C difficile and other dangerous germs, including the flu virus and the E coli food poisoning bug, the professor has reported. Lambert described a 10-week trial on a medical ward where several fixtures were replaced with copper versions. He says every 12 hours the fixtures were swabbed for bacteria and the results compared with the traditional non-copper fixtures found in a hospital room. The professor reported that about 95 percent fewer bacteria were found on the copper surface. "The copper is quietly working away in the background," he reported. .......................................................................... __________________________________________________________________________ Canada: Tattoo Shop Owner Faces 21 Health Charges Jodie Sinnema, Edmonton Journal, Edmonton Canada (23.10.09) Eric Anderson, who ran the now-closed Zipp's Tattoo and Museum Shoppe on Whyte Avenue in Edmonton, faces 21 charges relating to health code violations and obstruction of justice. The health charges include keeping improper records of customers, improperly discarding used needles, and reusing tattoo and piercing equipment. When they initially approached Anderson, public health officials say he told them his shop was closed and he was only tattooing dogs. Customers of the shop should be tested for HIV and hepatitis B and C, said Rob O'Neill, prosecutor for Alberta Health Services. In business at a different Whyte Avenue location since 1978, Zipp's was also closed for infection control and unsanitary conditions in 2007. Anderson's first court date is set for Oct. 27; he faces a maximum fine of $42,000 (US $39,647). .......................................................................... __________________________________________________________________________ TED Talks: Marc Koska: 1.3m reasons to re-invent the syringe Exchange Morning Post (23.10.09) Reuse of syringes, all too common in under-funded clinics, kills 1.3 million each year. Marc Koska clues us in to this devastating global problem with facts, photos and hidden-camera footage. He shares his solution: a low-cost syringe that can't be used twice. Marc Koska wants to improve health care in the developing world by re- designing dangerous medical tools -- and offering education to practitioners in under-funded clinics. In 1984, Marc Koska read an article that predicted HIV would spread widely through unsafe injections. He writes, "Appalled at the prospect of such an avoidable catastrophe, I decided there and then to try and do something about it." The prediction, sadly, turned out to be true: syringe reuse now accounts for 1.3 million deaths -- more than malaria. In the next years, Koska undertook the study of public health to find out what could be done. He determined that the design of syringes was the critical issue. Today, Koska's solution to the problem, the K1 syringe -- it locks down after a single injection, preventing reuse -- is in use by millions. But he hasn't stopped there: In 2005, he founded a nonprofit, SafePoint, which aims to educate people in the developing world about the dangers of reusing any instruments that come into contact with blood. http://www.exchangemagazine.com/morningpost/2009/week43/Friday/102324.htm See the TED Ideas worth spreading video at: http://www.youtube.com/watch?v=9E3a0H-Xc_g .......................................................................... __________________________________________________________________________ U.N. Report Documents How Opium Contributes To Spread of Disease, Deaths The Kaiser Daily Global Health Policy Report (22.10.09) The U.N. Office on Drugs and Crime (UNODC) on Wednesday released a report - "Addiction, Crime and Insurgency: The Transnational Threat of Afghan Opium" - documenting how "[t]he smuggling of Afghan opiates is fueling addiction and drug use along trafficking routes from Iran to Central Asia," and contributing to the spread of diseases, the Associated Press reports (Oleksyn, 10/21). "Of the 15.4 million opiate users worldwide, 11.3 million use heroin, while the rest use opium," Reuters reports. "Nearly half the world's heroin is consumed in Europe and Russia and 42 percent of the world's opium users are in Iran. Heroin and opium cause up to 100,000 deaths a year and are helping spread HIV at an unprecedented rate, the report found" (Nichols, 10/22). The report tracked how "'[t]he Afghan opiate trade fuels consumption and addiction in countries along drug trafficking routes before reaching the main consumer markets in Europe (estimated at 3.1 million heroin users), contributing to the spread of HIV/AIDS and other blood-borne diseases,'" the AP reports. The UNODC also notes, "'Iran faces the world's most serious opiate addiction problem, while injecting drug use in Central Asia is causing an HIV epidemic'" (10/21). The Kaiser Daily Global Health Policy Report is published by the Kaiser Family Foundation. © 2009 Henry J. Kaiser Family Foundation .......................................................................... __________________________________________________________________________ Australia: Needle exchanges prevented 32,000 HIV cases: report By Brendan Trembath for AM, ABC News, Australia (22.10.09) A new report has found needle and syringe exchange programs have directly prevented tens of thousands of cases of HIV and hepatitis C. There are nearly 1,000 sites around the country where clean needles and syringes are handed out to drug users. Researchers from the University of New South Wales, who authored the report, say it is also saving on health costs. For every $1 spent on needle and syringe exchange programs, state and federal governments save $4. In the heart of Sydney's Kings Cross there are two spots where clean needles and syringes are handed out. The director of the Kirketon Road centre, Dr Ingrid van Beek, says the range of people who come to needle syringe programs is quite surprising. "Of course [there's] the more drug-dependent person that you see on the streets, and I think most people assume that's the only sort of person that injects drugs," she said. "But we see people from tradesmen through to professionals, people from the arts. It's really very wide." The report has found the 30 million needles and syringes distributed every year in Australia since 2000 have directly prevented more than 32,000 cases of HIV infection and close to 100,000 cases of hepatitis C, representing a saving in healthcare costs of more than $1 billion. Associate Professor David Wilson led the team which completed the report. "Not only do these programs save people from dying, but they also save Australians a load of money," he said. "Hepatitis C can lead to cirrhosis of the liver, can lead to cancer and so forth, and eventually one might require a liver transplant. A liver transplant costs between $110,000 and $120,000 just for a single transplant." Professor Wilson says the findings should provide good evidence and strong support for needle and syringe programs. "We've also shown that these programs can extend further and there should be a demand for that," he said. "We will actually get greater health outcomes and more economic return if we can expand the programs even further, by another 50 per cent or so." Dr Van Beek says the report will help the work at Kirketon Road. "I think it's really important evidence for us at the community coalface," she said. "It's important for us to be able to explain to the community the benefits to them that these sorts of programs have." The report was commissioned by the Federal Government and it will not please everyone. The Christian Democratic Party opposes needle and syringe exchange programs. The party's leader, Fred Nile, did not return several phone calls but in the past the party has said exchange programs have contributed to an increase in the number of addicts and facilitated the spread of Hepatitis C. But Dr van Beek says the people they see would be injecting any way. She is convinced it is better to give them clean needles and syringes. "Before, you know, we just didn't see these people necessarily because they might have been in back lanes or squats, or other sorts of situations," she said. "Now ... they're coming to a health service and by being able to engage with them of course we are able to also talk to them about their drug dependency, that's a problem, and to refer them to drug-treatment programs. .......................................................................... __________________________________________________________________________ News Outlets Examine Challenges With Expanding Global Child Immunization Campaigns The Kaiser Daily Global Health Policy Report (22.10.09) Wednesday's release of the WHO, UNICEF and the World Bank joint report on childhood vaccines highlighted gains in recent global vaccination campaigns and also found that nearly 24 million infants worldwide don't get the recommended first-year vaccination. The following news outlets examined the challenges associated with the expansion of global immunization campaigns to reach this population: "The Global Immunization Vision and Strategy (GIVS), co-sponsored by WHO and UNICEF, estimates that by vaccinating 90 percent of the world's children against 14 illnesses for which there are vaccines (diphtheria, pertussis, tetanus, measles, polio, tuberculosis, hepatitis B, Hib disease, rubella, meningococcal disease, pneumococcal disease, rotavirus, and, where applicable, Japanese encephalitis and yellow fever), … two million child deaths could be prevented," Scientific American reports. "[S]aving lives does not come cheaply," Scientific American writes, noting the increased per-child costs of immunizations," from "a few dollars on average" in the 1980s to today's cost of $18. "To meet the GIVS target, that figure would increase to $30, due to the sheer number of vaccines required and the complexity of newer formulas. Such per-child costs may not sound like much in today's expensive U.S. health care market, but for many developing countries, that is more than 10 percent of annual per capita income," the magazine writes. "Much of the tab is picked up by governments, although international aid organizations, such as UNICEF, are currently buying more than half of the vaccines that go to children." "The substantial costs" of vaccination campaigns "can be recouped in the long run by savings on subsequent reduced medical treatment for the illnesses. The cost of vaccinating against smallpox across the globe between 1967 and 1977 cost about $100 million. The eradication of the disease, however, has saved an estimated $1.3 billion a year since then, according to the report." The article includes information on other vaccine-related issues, including how the growth of the vaccine industry had previously led to more competition, driving vaccine prices down (Harmon, 10/21). In related news, Inter Press Service examines how efforts that previously helped drive down costs of vaccines for developing countries have since "evaporated," as documented in the joint report. "Manufacturers used to sell their drugs at a lower price to developing countries because they could get a higher price from industrialised countries but industrialised and developing countries no longer use the same vaccines; manufacturers no longer maintain excess production capacity; and competition among suppliers has decreased," the news service writes. Efforts to expand vaccination campaigns will face the challenge of an existing "10-billion-dollar gap … between the costs of immunisation in 72 of the world's poorest countries - 35 billion dollars - and the estimated funding flow to support immunisation - 25 billion dollars," IPS writes. "Efforts to expand immunisation will also meet challenges in bringing vaccines to 35 lower-middle incomes countries - containing a population of nearly two billion people - which are not eligible for GAVI funding but where immunisation costs could cost tens of billions of dollars" (Clifton, 10/21). The Kaiser Daily Global Health Policy Report is published by the Kaiser Family Foundation. © 2009 Henry J. Kaiser Family Foundation .......................................................................... __________________________________________________________________________ Syringe programs save money ScienceAlert (22.10.09) Source: University of New South Wales, Australia Every dollar spent on Australia’s needle and syringe programs (NSPs) saves state and federal budgets four dollars by preventing life-threatening infections, according to research from the University of New South Wales (UNSW). UNSW’s National Centre in HIV Epidemiology and Clinical Research (NCHECR) found that the 30 million needles and syringes distributed every year in Australia since 2000 have directly prevented more than 32,000 cases of HIV infection and close to 100,000 cases of hepatitis C, representing a saving in healthcare costs of almost $1.3 billion. The findings will be released on Thursday 22 October in the report, Return on Investment 2: Evaluating the cost-effectiveness of needle and syringe programs in Australia, commissioned by the Australian Department of Health and Ageing. Launching the report in Sydney in conjunction with the UNSW researchers will be Professor Michael Kidd, chair of the Ministerial Advisory Committee on Blood Borne Viruses and Sexually Transmissible Infections and Dr John Herron, chair of the Australian National Council on Drugs. Led by Associate Professor David Wilson, the NCHECR team used a range of clinical, behavioural and economic data to analyse how effective NSPs have been in preventing the life-threatening HIV infections and hepatitis C, which are easily transmitted when injecting drug users do not have access to sterile injecting equipment. A/Professor Wilson said: "After more than two decades of successful operation, NSPs remain a cornerstone of Australia’s HIV prevention strategy and a primary reason why we have largely contained the epidemic in this country. "Additionally, Australia’s NSPs have proven to be a foundation for preventing transmission of the more infectious hepatitis C virus. "This study provides strong evidence to suggest that increased spending should be invested in expanding NSPs. Not only would it significantly reduce health burdens but it will ultimately save Australian taxpayers substantial amounts of money," he said. From 2000 to 2009, needle and syringe programs cost a total of $243 million. The national NSP costs are made up of nearly 1,000 sites around the country, including outlets, clinics, pharmacies and vending machines, which distribute sterile injecting equipment. "As well as the health care savings, needle and syringe programs have given us substantial gains in quality and length of life in Australia," said the study’s health economist Dr Jonathan Anderson. "The infections prevented by the program led to Australians gaining 140,000 extra Disability Adjusted Life Years, meaning people lived in better health for longer," he said. The report indicates that an additional 50 per cent increase in distribution of sterile injecting equipment could lead to optimal results, yielding a further 37 per cent decrease in HIV and 23 per cent decrease in hepatitis C cases over the next 10 years. A copy of the report will be available here: http://tinyurl.com/yf5ruly .......................................................................... __________________________________________________________________________ Australia: New study vindicates needle exchange campaigners Reporter: Matt Peacock, Australian Broadcasting Corporation (22.10.09) Broadcast: 22/10/2009 A major study has found that for every dollar spent on the controversial needle exchange programs the public purse is four dollars better off, but anti-drug campaigners remain unconvinced. The programs were established two decades ago by a renegade group of health and community workers when the AIDS epidemic reached crescendo. Today the programs are mainstream and are responsible for the distribution of over 30 million clean syringes across Australia each year. Transcript KERRY O’BRIEN, PRESENTER: When needle exchange programs were first introduced in Australia more than 20 years ago, at the height of the AIDS epidemic, the measure attracted considerable controversy. More than 30 million clean syringes are handed out free across the country each year. Now a major study into the scheme has concluded that for every dollar spent, more than $4 has been saved to the health system by preventing the spread of diseases like HIV and Hepatitis C. But anti-drug campaigners remain unconvinced. Matt Peacock reports. MACEON MCDONALD, FORMER INTRAVENOUS DRUG USER: We were kids, we were teenagers, and they were wonderful times. When I started injecting drugs, needles were extremely hard to come by, so if you were lucky enough to get a clean needle you shared it with all of your friends. We didn't know what the consequences were. And we were young and innocent. MATT PEACOCK, REPORTER: Decades later a clean Maceon McDonald found out the consequences of his experiment with heroin. MACEON MCDONALD: I ended up with what they call end-stage liver disease, which, as I said to my doctor: "What does that mean?" He said, "It means you're going to die." So I think I was about six months or so away from dying. MATT PEACOCK: A needle shared by the young Maceon McDonald had infected him with Hepatitis C. It would take a liver transplant to save his life. But dirty needles also spread the AIDS virus. By the 1980s at Sydney's King's Cross, drug and alcohol specialist Dr Alex Wodak found himself at the centre of an exploding public health crisis. DR ALEX WODAK, ST VINCENTS ALCOHOL & DRUG SERVICE: I couldn't look the other way. I couldn't pretend this wasn't going to happen. This was going to happen, and it was happening on my watch, and it was happening right now. Once HIV got into the general population, putting the genie back in the bottle would be terrible. MATT PEACOCK: Australia these days is a vastly different place. Drug users across the country are daily given fresh needles by government-funded programs. ASSOC. PROF. DAVID WILSON, MEDICINE, UNSW: We have almost 1000 sites across Australia that hand out needles and syringes. These range from primary outlets and pharmacies, vending machines and also mobile clinics. They distribute approximately 30 million needles and syringes every single year. MATT PEACOCK: The catalyst came in 1986 when Dr Alex Wodak took matters into his own hands, breaking the law and providing drug users with free, fresh needles. An action that galvanised anti-drug campaigners. GARY CHRISTIAN, DRUG FREE AUSTRALIA: Once the movement for safe use of drugs which needle exchange is part of, started back in 1992, we saw massive increases in drug use in Australia. MATT PEACOCK: But according to a long-term study released today by the University of NSW, there's been huge benefits from needle and syringe programs. ASSOC. PROF. DAVID WILSON: Over the last 10 years we have saved over 32,000 HIV infections in Australia, and we've saved almost 100,000 Hepatitis C infections. MATT PEACOCK: What does that mean in dollar and cents terms? ASSOC. PROF. DAVID WILSON: This means that we have invested about $240 million into the programs, but we have gained back about $1.2 billion. We have had incredible health-care savings. DR ALEX WODAK: It's a huge difference, there's no other way of looking at it. Huge saving in lives, huge number of HIV and Hepatitis C infections prevented. And of course a huge saving in billions of dollars. GARY CHRISTIAN: There is no science which is supporting the notion that they are actually decreasing HIV transmission within Australia. MATT PEACOCK: Dr Wodak's opponents like Drug Free Australia's Gary Christian remain unconvinced that free needles help. GARY CHRISTIAN: Is it condoning drug use, is it increasing drug use at the same time as alleviating it? When it comes to this report and trying to cost all that, where they haven't looked at the other side, I think we would need to say that the dollar figures are quite dubious. ADVERTISEMENT: They could have slept with someone who's been doing drugs and shared a needle with someone who shared a needle with someone who had the AIDS virus. MATT PEACOCK: Anti-drug campaigners claim that education about sexually- transmitted AIDS has prevented its spread more than clean needles, which might simply through their availability encourage drug use. ADVERTISEMENT: Use a shared needle and you run a very real risk of catching AIDS. MATT PEACOCK: But the recent heroin user Eliot Marshall says a dirty needle won't deter an addict in search of a fix. ELIOT MARSHALL, DRUG USER: Just saying no doesn't work, and we know it doesn't work because there's too many more factors involved with it, there's too many things that need to be dealt with. They need to be dealt with the underlying issue of why someone uses drugs in the first place. MACEON MCDONALD: I wish clean needles existed when I was using back in the '70s, because the chances are that with clean needles I would never have contracted HCV in the first place and would never have needed a liver transport. So I'm proof that if needles were available by the Government, the Government wouldn't have had to spend $400,000 on my operation and thousands and thousands of dollars each year on my medication. ASSOC. PROF. DAVID WILSON: This program a bargain compared to most other programs. When I consider all of the programs that I have evaluated in the past, this is by far the most effective program in terms of health-care outcomes and also savings of money. MATT PEACOCK: And with Hepatitis C infections on the rise, especially in Australian jails, even Drug Free Australia concedes that needle exchange programs do make sense. GARY CHRISTIAN: With Hep C the evidence is there that needle exchanges do lessen the incidence and the prevalence as a result. MATT PEACOCK: The Australian example, according to Dr Alex Wodak, is one that other countries should now follow. DR ALEX WODAK: It's time that the politicians around the world in other countries started getting real like the Australian politicians did all those years ago. .......................................................................... __________________________________________________________________________ State of the World’s Vaccines: Childhood immunization at record high By Elizabeth Kiem, UNICEF (21.10.09) NEW YORK, USA, 21 October 2009 - More children are being immunized against deadly diseases than ever before, yet without better funding and improved access, at least 24 million infants are left unprotected. VIDEO: Watch now http://www.unicef.org/videoaudio/ramfiles/8535h_sowvchopra.ram A report released today by UNICEF, the World Bank and the World Health Organization finds that one in five children are not receiving routine vaccinations against preventable diseases like measles, tetanus and diphtheria. The report, ‘State of the World’s Vaccines and Immunizations’ (SOWV), shows that recent declines in child mortality rates are a direct result of higher immunization rates. "Worldwide, measles death fell by 74 per cent between 2000 and 2007, and vaccinations played an important part in that decline," said UNICEF Executive Director Ann M. Veneman. "Such progress must inspire new efforts to immunize children around the globe against life-threatening diseases." Gains from expanded coverage As many nations worldwide confront the challenge of rolling out new vaccines against the H1N1 virus, SOWV underscores the prominent role of vaccination in preventing a range of communicable diseases. In the past three decades, immunization against diphtheria, tetanus, pertussis, polio, measles and tuberculosis has become increasingly routine, saving an estimated 2.5 million young lives every year. But improved access and cold chain control (the system to store and transport vaccines safely from manufacturers to recipients) are necessary to make further gains. "Even in countries with high levels of coverage we do find pockets, large pockets sometimes, of children who are just completely excluded. And that reflects also that there may be groups of children… which are also excluded from the health system as a whole," says UNICEF Chief of Health and Associate Director of Programmes, Dr. Mickey Chopra. Funding gap for new vaccines Rapid advances in vaccine technology in the past decade have led to the development of several new vaccines. Most significantly, vaccines against pneumococcal disease and rotovirus directly address the two leading causes of all child deaths. Dr. Chopra calls these vaccines "wonderful," but warns that a funding gap makes it a challenge to incorporate the new vaccines into national immunization programs in the places that need it most. "There is a danger that care givers and mothers will believe that their children are fully immunized against pneumonia and diarrhoea… and we believe these vaccines will only cover 20 to 30 per cent of the cases of pneumonia and diarrhoea," said Dr. Chopra. UNICEF advocates scaling-up sensitization to behavioural prevention like handwashing and exclusive breastfeeding as key interventions in the fight against diarrhoea and pneumonia. Vaccination is a child’s right The challenge for UNICEF, which regards the provision of childhood immunizations as a basic right, is to ensure that funding for these vaccines is sustained. An estimated $1 billion per year will be needed to deliver new and existing vaccines to every child in the 72 poorest countries. The report recognizes the roles of financing partnerships like the GAVI Alliance, which includes WHO, UNICEF, the World Bank and the Bill & Melinda Gates Foundation in reversing a downward trend in immunization rates. But ensuring that recent progress is sustained requires as much advocacy work as donor resources. "Making a big push and getting immunization entrenched into health systems and policies and making communities and mothers aware that this is something their child has a right to can make this a sustainable intervention even when global attention may shift to other issues and diseases," said Dr. Chopra. UNICEF’s leading role UNICEF is the world’s largest procurer of vaccines, supplying necessary vaccines to more than half of the world’s children. In 2007 alone, the organization bought 3.2 billion doses. Significantly, increased demand has meant that manufacturers in developing countries are increasingly the dominant providers, meeting 86 per cent of the global demand for traditional vaccines. The expanding market for affordable vaccines, combined with the boom in research and development, bodes well for future immunization goals. The 2009 SOWV report cites the potential for new vaccines against malaria, tuberculosis and AIDS within the next decade. .......................................................................... __________________________________________________________________________ USA: Audubon: No Hepatitis C Cases Linked to Surgery Tech Associated Press (20.10.09) There is no evidence that any patients at Audubon Surgery Center in Colorado Springs contracted hepatitis C from a surgery technician who stole drug-filled syringes and replaced them with used ones containing saline solution, according to officials of the facility. When the actions of Kristen Diane Parker came to light, health officials feared that as many as 1,220 patients may have been exposed to the virus. Prosecutors say Parker infected 16 patients at Rose Medical Center in Denver, where she worked before coming to Audubon. However, Audubon officials say no such transmission occurred there. Under an agreement that includes a 20-year prison term, Parker last month pleaded guilty to some of the charges for which she was indicted. .......................................................................... __________________________________________________________________________ One pair of dirty hands equals many infections Reuters (20.10.09) WASHINGTON (Reuters) - A single doctor, nurse or technician with dirty hands can undo all the good work of an entire hospital staff trained to carefully wash their hands to prevent the spread of infection, French researchers reported on Monday. This may be especially likely to happen just at the worst time -- when a hospital is overwhelmed with a disaster or a pandemic of infectious diseases and staff are reassigned to cope, the team at France's National Institute of Health and Medical Research or INSERM said. Their mathematical model may explain some real-world outbreaks, they added in the Proceedings of the National Academy of Sciences. Patients often get infected in hospitals with a variety of germs, include methicillin-resistant Staphylococcus aureus or MRSA superbugs. Staff who fail to properly wash their hands are often to blame for these so-called nosocomial infections. These infections cost billions of dollars to treat and tens of thousands of patients die from them every year. Laura Temime and colleagues at INSERM used a mathematical model of a hypothetical intensive care unit to try to calculate how this might happen. One so-called "superspreader" who failed to wash his or her hands, and who traveled about the hospital treating many patients, could greatly raise the nosocomial infection rate, they calculated. In fact a single traveling radiologist, physical therapist or other worker who failed to properly wash his or her hands after each patient visit could create a rate of infection equivalent to 23 percent of all the other staffers failing to wash their hands, Temime's team calculated. Infection rates increased by up to three times more when a staffer moving around the hospital failed to wash his or her hands compared with a nurse, for instance, assigned to one ward. "Our findings may explain several reports of outbreaks that were traced back to peripatetic healthcare workers," they wrote. © Thomson Reuters 2009 .......................................................................... __________________________________________________________________________ Improper Waste Disposal Poses Health Threat To Developing Countries KaiserNetwork.org (19.10.09) "Half the world’s population could be at risk from exposure to mounting volumes of improperly disposed medical waste, according to a review published this month in Tropical Medicine and International Health," an Emerging Health Threats News article reports. According to the study authors, "The documented growth in and poor disposal of health care waste appears to represent a real threat to the health of at least 40 … low and middle income nations." The researchers suggest that burning waste in an incinerator is not a good solution and that a better solution "lies in changing the way health care is delivered, so that less dangerous waste is generated in the first place," Emerging Health Threats writes (10/16). http://www.eht-forum.org/news.html?fileId=news091016065552&from=home&id=0 __________________________________________________________________________ _____________________________________*____________________________________ __________________________________________________________________________ * SAFETY OF INJECTIONS brief yourself at: www.injectionsafety.org A fact sheet on injection safety is available at: http://www.who.int/mediacentre/factsheets/fs231/en/index.html * Visit the WHO injection safety website and the SIGN Alliance Secretariat at: http://www.who.int/injection_safety/en/ Download the latest injection safety Best Practices review at: http://www.uqconnect.net/signfiles/Files/BestPracticesJul2003.pdf Use the Toolbox at: http://www.who.int/injection_safety/toolbox/en/ Subscribe or un-subscribe by email to: sign@uq.net.au, sign@who.int or on subscribe online at: http://www.who.int/injection_safety/sign/en/ Get SIGN files on the web at: http://www.uqconnect.net/signfiles/Files/ get SIGNpost archives at: http://www.uqconnect.net/signfiles/Archives/?M=D The SIGN Secretariat, the Department of Essential Health Technologies, WHO, Avenue Appia 20, CH-1211 Geneva 27, Switzerland. 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