*SAFE INJECTION GLOBAL NETWORK* SIGNPOST *SAFE INJECTION GLOBAL NETWORK* SIGN 2009 30 November to 2 December 2009 at WHO HQ Geneva Post00513 Intradermal Delivery + Abstracts + News 16 September 2009 CONTENTS 1. PATH Report on Intradermal Delivery of Vaccines 2. Abstract: Health care waste management: a neglected and growing public health problem worldwide 3. Abstract: Reducing Use of Injections Through Interactional Group Discussions A Randomized Controlled Trial 4. Abstract: Pilot study of postexposure prophylaxis for hepatitis C virus in healthcare workers 5. Abstract: Sharps injury reporting amongst surgeons 6. Abstract: An evaluation of a pilot study of a web-based educational initiative for educating and training undergraduate dental students in infection prevention 7. Abstract: Health care worker perceptions of hand hygiene practices and obstacles in a developing region 8. Abstract: Effect of topical treatments on irritant hand dermatitis in health care workers 9. Abstract: Safety of acupuncture: results of a prospective observational study with 229,230 patients and introduction of a medical information and consent form 10. Abstract: Transcutaneous needle-free injection of botulinum toxin: a novel treatment of childhood constipation and anal fissure 11. Abstract: A multi-center, double-blind, randomized controlled study of the safety and effectiveness of Juvéderm injectable gel with and without lidocaine 12. Abstract: The epidemiology and prevention of donor-derived infections 13. No Abstract: Comment: Needle-stick reporting among surgeons 14. No Abstract: Health care waste management at an academic hospital: knowledge and practices of doctors and nurses 15. No Abstract: ANSI/AAMI ST79: popular steam sterilization standard amended 16. No Abstract: Sterile processing certification: has its time come 17. News - Brunei: Diabetic Patients Query - ICAAC: Hospital Surfaces Major Source of C. difficile - USA: Editorial: Medical Inattention in New York Prisons - South Africa: 'Infected with HIV': Heart surgery man sues hospital, blood service - China: No Traces Of HIV Found In Victims [Syringe Attacks] - China: China needle attacks 'not toxic' - China: China issues all clear in syringe attack tests - Afghanistan: Afghan junkies risk triggering AIDS explosion - UK: Needle hotline to curb drug waste - India: FDA issues notices to 34 blood banks - USA: Three Las Vegas Hepatitis C Lawsuits Move Forward - China: Urumqi stabilizing as stabbings drop - China: Xinjiang hospital offers psychological counselling for needle attack victims - USA: NJ: 29 hepatitis cases tied to 1 doctor's office - Kenya: New measures to curb fake drugs - Mozambique: No HIV policy for injecting drug users - USA: New Jersey Doctor Linked to 29 Hepatitis B Cases - Australia: Hepatitis C infection rates 50 per cent down - USA: Calif. poised to regulate tattooing, piercing - Global medical devices industry: Procurement strategies and the impact of recession - USA: New York May Tighten Review of Inmate HIV/Hepatitis Care This edition of SIGNpost is located at: http://uqconnect.net/signfiles/Archives/SIGN-POST00513.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. PATH Report on Intradermal Delivery of Vaccines Crossposted from Technet English http://TECHNET21E.ORG with thanks __________________________________________________________________________ From: dkriste Subject: Report on Intradermal Delivery of Vaccines Date: 11 September 2009 Report on Intradermal Delivery of Vaccines We would like to share a report on intradermal delivery of vaccines that was commissioned by PATH's Disposable Jet Injector Project and Project Optimize (a collaborative project between WHO and PATH). The report was authored by Julian Hickling and Rebecca Jones from Working in Tandem Ltd. The purpose of the report is three-fold: 1) To summarize the clinical evidence supporting the intradermal route for vaccine administration and the devices being developed for this purpose; 2) to determine whether intradermal delivery broadly holds promise for vaccine applications for low- and middle-income countries in the future; and 3) to begin to prioritize vaccine targets and device strategies that best fit the public health needs in these countries and likely merit further investigation. We hope the document is useful to others and welcome comments from Technet members. All the best, Debbie Kristensen, Group Leader Vaccine Technologies, PATH and Darin Zehrung, Technical Officer, PATH http://www.technet21.org/forumV3/download.php?id=434 Filename: IDDReport_31aug09.pdf Filesize: 1.36 MB __________________________________________________________________________ _____________________________________*____________________________________ 2. Abstract: Health care waste management: a neglected and growing public health problem worldwide __________________________________________________________________________ Trop Med Int Health. 2009 Sep 4. Health care waste management: a neglected and growing public health problem worldwide. Harhay MO, Halpern SD, Harhay JS, Olliaro PL. Graduate Program in Public Health Studies, University of Pennsylvania School of Medicine, Philadelphia, PA, USA. Summary The objective of this Short Communication is to promulgate an inventory of 87 papers pertaining to health care waste management practices and challenges in 40 low and middle income countries worldwide amassed through a multi-language systematic review. Herein, we discuss the major gaps, failures, and frequently reported themes by geographic region. Following this we outline a proposed research agenda moving forward, and conclude that greater research and attention towards these unintended consequences of technologic progress in medical care delivery is needed to address and understand this growing public health threat around the world. __________________________________________________________________________ __________________________________________________________________________ 3. Abstract: Reducing Use of Injections Through Interactional Group Discussions A Randomized Controlled Trial __________________________________________________________________________ Indian Pediatr. 2009 Sep 3. pii: S097475590800456-1. Reducing Use of Injections Through Interactional Group Discussions A Randomized Controlled Trial. Bhunia R, Hutin Y, Ramkrishnan R, Ghosh PK, Dey S, Murhekar M. Field Epidemiology Training Programme (FETP), National Institute of Epidemiology (NIE), Indian Council of Medical Research (ICMR), Chennai; WHO India country office, New Delhi; Nilratan Sircar Medical College and Hospital, West Bengal,and #District Tuberculosis Centre, North 24 Parganas, West Bengal; India. Correspondence to: Dr Rama Bhunia, 60A/1R Dr S C Banerjee Road, Kolkata, West Bengal 700 010, India. rbhunia@gmail.com. Objective: To determine whether interactional group discussions could reduce prescriptions of injections by physicians. Study design: Randomized controlled trial. Setting: Rural public health care facilities, North 24 Parganas district, West Bengal, India. Subjects: 72 medical officers, 36 each in intervention and control groups. Intervention: Interactional group discussions. Outcome measure: Proportion of prescriptions including at least one injection. Results: In the intervention group, 249 of 1,080 prescriptions (23%) included at least one injection compared with 79 of 1,080 prescriptions (7%) before and after the intervention, respectively. (RR: 0.32, 95% CI:0.25 -0.40). In the control group, 231 of 1,080 prescriptions (21%) included at least one injection before the intervention vs 178 of 1,080 prescriptions (16%) after the intervention (RR 0.77, 95%; CI: 0.65 -0.92). Conclusion: Interactional group discussions reduce prescription of injections. __________________________________________________________________________ _____________________________________*____________________________________ 4. Abstract: Pilot study of postexposure prophylaxis for hepatitis C virus in healthcare workers __________________________________________________________________________ Infect Control Hosp Epidemiol. 2009 Oct;30(10):1000-5. Pilot study of postexposure prophylaxis for hepatitis C virus in healthcare workers. Corey KE, Servoss JC, Casson DR, Kim AY, Robbins GK, Franzini J, Twitchell K, Loomis SC, Abraczinskas DR, Terella AM, Dienstag JL, Chung RT. Harvard Medical School, Boston, MA, USA. BACKGROUND AND OBJECTIVE: Hepatitis C virus (HCV) transmission occurs in 0.2%-10% of people after accidental needlestick exposures. However, postexposure prophylaxis is not currently recommended. We sought to determine the safety, tolerability, and acceptance of postexposure prophylaxis with peginterferon alfa-2b in healthcare workers (HCWs) exposed to blood from HCV-infected patients. DESIGN: Open-label pilot trial of peginterferon alfa-2b for HCV postexposure prophylaxis. SETTING: Two academic tertiary-referral centers. METHODS: HCWs exposed to blood from HCV-infected patients were informed of the availability of postexposure prophylaxis. Persons who elected postexposure prophylaxis were given weekly doses of peginterferon alfa-2b for 4 weeks. RESULTS: Among 2,702 HCWs identified with potential exposures to bloodborne pathogens, 213 (7.9%) were exposed to an HCV antibody-positive source. Of 51 HCWs who enrolled in the study, 44 (86%) elected to undergo postexposure prophylaxis (treated group). Seven subjects elected not to undergo postexposure prophylaxis (untreated group). No cases of HCV transmission were observed in either the treated or untreated group, and no cases occurred in the remaining 162 HCWs who did not enroll in this study. No serious adverse events related to a peginterferon alfa-2b regimen were recorded, but minor adverse events were frequent. CONCLUSION: In this pilot study, there was a lower than expected frequency of HCV transmission after accidental occupational exposure. Although peginterferon alfa-2b was safe, because of the lack of HCV transmission in either the treated or untreated groups there is little evidence to support routine postexposure prophylaxis against HCV in HCWs. __________________________________________________________________________ _____________________________________*____________________________________ 5. Abstract: Sharps injury reporting amongst surgeons __________________________________________________________________________ Ann R Coll Surg Engl. 2009 Jul;91(5):430-2. Sharps injury reporting amongst surgeons. Kerr HL, Stewart N, Pace A, Elsayed S. Department of Orthopaedics, King's Mill Hospital, Nottinghamshire, UK. hui.kerr@gmail.com INTRODUCTION: The aim of this study was to evaluate the level of sharps injury reporting amongst surgeons. SUBJECTS AND METHODS: A total of 164 surgeons completed a questionnaire on the reporting of sharps injuries, on the reasons for not reporting and their practise of universal precautions. RESULTS: Out of 164 surgeons, only 25.8% had reported all their injuries, 22.5% had reported some and 51.7% had reported none. The top three reasons for not reporting their injuries included perception of low risk of transmission, not being concerned and no time. Of the respondents, 15.9% practised all three universal precautions of double-gloving, face shields and hands-free technique. CONCLUSIONS: We showed that despite local trust adherence to Department of Health policy, sharps injury reporting rates are inadequate. Further investment into healthcare worker education as well as a facilitation of the process of reporting may be necessary to improve reporting rates. __________________________________________________________________________ _____________________________________*____________________________________ 6. Abstract: An evaluation of a pilot study of a web-based educational initiative for educating and training undergraduate dental students in infection prevention __________________________________________________________________________ Br Dent J. 2009 Sep 12;207(5):223-6. An evaluation of a pilot study of a web-based educational initiative for educating and training undergraduate dental students in infection prevention. Lockhart DE, Smith AJ. University of Glasgow Dental Hospital & School, 378 Sauchiehall Street, Glasgow G2 3JZ, UK. d.lockhart@dental.gla.ac.uk OBJECTIVE: Evaluate the views of undergraduate dental students on a pilot web-based e-learning programme to establish its merit in providing education in infection prevention and control. The initiative was commissioned by NHS Education for Scotland as an educational resource for healthcare workers. Design, SAMPLE AND SETTING: This was a retrospective analysis of questionnaire data from the first cohort of dental students completing the programme in a UK dental school. METHODS: Dental students studied the course during the first three years of the curriculum. Data were collated via an anonymous semi-structured questionnaire distributed at a post-course feedback session. RESULTS: Sixty percent (51/85) of students returned questionnaires with 90% stating their knowledge of infection control had improved. Specific areas included: undertaking infection control audits (88%), managing sharps injuries (73%), use of personal protective equipment (55%) and hand hygiene (55%). On the other hand, 72% perceived the programme as too generic with just over half advocating a resource more relevant to dentistry. CONCLUSION: The programme has the potential to be a useful teaching aid but requires modification. A customised version for dental students has subsequently been commissioned. __________________________________________________________________________ _____________________________________*____________________________________ 7. Abstract: Health care worker perceptions of hand hygiene practices and obstacles in a developing region __________________________________________________________________________ Am J Infect Control. 2009 Sep 11. Health care worker perceptions of hand hygiene practices and obstacles in a developing region. Borg MA, Benbachir M, Cookson BD, Ben Redjeb S, Elnasser Z, Rasslan O, Gür D, Daoud Z, Bagatzouni DP. Infection Control Unit, Mater Dei Hospital, Msida, Malta. A structured self-assessment questionnaire was distributed to 8 southern and eastern Mediterranean hospitals to identify perceived obstacles to hand hygiene (HH). An insufficient number of sinks and alcohol handrub stations was rated by the vast majority of respondents as the most critical impediment, whereas improved availability of HH products was deemed the key intervention to increase compliance. The least importance and relevance were given to HH auditing and collegial reminders. While initiatives to improve HH compliance clearly must address infrastructural inadequacies, sociocultural issues also need to be considered when transposing initiatives found to be successful in Western countries to less-developed regions, to ensure that campaigns are not compromised by perceptual undercurrents. __________________________________________________________________________ _____________________________________*____________________________________ 8. Abstract: Effect of topical treatments on irritant hand dermatitis in health care workers __________________________________________________________________________ Am J Infect Control. 2009 Sep 11. Effect of topical treatments on irritant hand dermatitis in health care workers. Visscher M, Davis J, Wickett R. Skin Sciences Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. BACKGROUND: Irritant contact dermatitis (ICD) from repetitive hand hygiene is the primary reason for compliance failure among health care workers (HCWs). Chronic ICD has implications for infection control because higher bacterial counts are associated with increased skin compromise. Guidelines recommend lotions/creams to lessen irritation. We evaluated the effects of 5 to 10 daily applications of a test cream (A, glove and chlorhexidine gluconate compatible) and current lotions/creams (B) compared with a control of normal skin care. METHODS: Outcomes were visual skin erythema and dryness, excess erythema (quantitative image analysis), and hydration among 80 HCWs in an intensive care unit. RESULTS: Knuckle dryness was lower for both treatments than the no treatment control (P < .02) after 2 weeks. Skin treated with A had lower knuckle erythema (P=.03) than B and control. HCWs using A had lower excess erythema (right) than B and control (P < .04). Excess erythema was lower for A and B versus control (P=.003). CONCLUSION: Reduction in erythema suggests that frequent use of cream A may mitigate the damaging effects of repetitive hand hygiene and allow the skin to recover. Intensive treatment of HCW ICD may be required to counteract the skin compromise and minimize the negative impact on infection control. __________________________________________________________________________ _____________________________________*____________________________________ 9. Abstract: Safety of acupuncture: results of a prospective observational study with 229,230 patients and introduction of a medical information and consent form __________________________________________________________________________ Forsch Komplementmed. 2009 Apr;16(2):91-7. Safety of acupuncture: results of a prospective observational study with 229,230 patients and introduction of a medical information and consent form. Witt CM, Pach D, Brinkhaus B, Wruck K, Tag B, Mank S, Willich SN. Institute for Social Medicine, Epidemiology, and Health Economics, Charité University Medical Center, Berlin, Germany. claudia.witt@charite.de BACKGROUND: To evaluate the safety of acupuncture in a large number of patients receiving conventional health care and, based on these results, to develop a new medical consent form for acupuncture. METHODS: The prospective observational study included patients who received acupuncture treatment for chronic osteoarthritis pain of the knee or hip, low back pain, neck pain or headache, allergic rhinitis, asthma, or dysmenorrhoea. After treatment, all patients documented adverse events associated with acupuncture (defined as adverse effects). Patients who reported a need for treatment due to an adverse effect completed an additional standardised questionnaire on the most important adverse effect. Based on this data and considering ethical and legal aspects a new consent form was developed. RESULTS: A total of 229,230 patients received on average 10.2 +/- 3.0 acupuncture treatments. Altogether, 19,726 patients (8.6%) reported experiencing at least one adverse effect and 4,963 (2.2%) reported one which required treatment. Common adverse effects were bleedings or haematoma (6.1% of patients, 58% of all adverse effects), pain (1.7%) and vegetative symptoms (0.7%). Two patients experienced a pneumothorax (one needed hospital treatment, the other observation only). The longest duration of a side effect was 180 days (nerve lesion of the lower limb). The resulting medical consent form consists of five modules: Introduction to acupuncture and moxibustion, Risks of acupuncture treatment, Conditions which can increase the risk, Doctor's statement, and Consent. CONCLUSION: Acupuncture provided by physicians is a relatively safe treatment and the proposed consent form could support both patients and professionals in the process of obtaining informed consent. Copyright (c) 2009 S. Karger AG, Basel. __________________________________________________________________________ _____________________________________*____________________________________ 10. Abstract: Transcutaneous needle-free injection of botulinum toxin: a novel treatment of childhood constipation and anal fissure __________________________________________________________________________ J Pediatr Surg. 2009 Sep;44(9):1791-8. Transcutaneous needle-free injection of botulinum toxin: a novel treatment of childhood constipation and anal fissure. Keshtgar AS, Ward HC, Clayden GS. University Hospital Lewisham, National Health Service Trust, London, United Kingdom. ali.keshtgar@uhl.nhs.uk PURPOSE: Constipation is a common problem in children, and when it becomes chronic fecal impaction, overflow soiling and megarectum may develop. Children with chronic idiopathic constipation (IC) may not respond to conventional treatments of laxatives, enemas, and toilet training. The aims of the study were to evaluate the long-term outcome of transcutaneous needle-free injection of botulinum toxin (TNFBT) into the external anal sphincter (EAS) and to assess the extent of the toxin penetration into the sphincter. METHOD: Children were recruited if symptomatic with chronic constipation, soiling, painful defecation, and withholding behavior requiring disimpaction of stool and rectal biopsy under general anesthesia. A total dose of 200 U of botulinum toxin (BT) (Dysport; Ipsen Limited, Slough, United Kingdom) was injected transcutaneously into the EAS at 3 and 9-o'clock positions using J-tip needle-free syringes (National Medical Products Inc, Irvine, Calif). The depth and width of toxin penetration was assessed by endosonography. Outcome was measured by a validated symptom severity (SS) score questionnaire. The total SS score ranged between 0 (best) and 65 (worst). The outcome was compared with 31 children in a comparable historical control group at 3 and 12-month follow-up. RESULTS: Sixteen children were recruited with median age of 6.11 (range, 3-14.85) years and median duration of symptoms of 3.9 years (1.6-11.5). On endosonography, the median depth and width of BT penetration was 8 (7-10) mm and 8 (6-10) mm, respectively. At 3-month follow-up, the median SS score improved in all children after TNFBT from 32.50 (5-57) to 7.50 (0-26) (Wilcoxon's P < .0001). There were significant improvements in symptoms of constipation, soiling, painful defecation, general health and behavior, and fecal impaction of rectum (P < .05). Anal fissures healed in all 4 children. The SS score in the control group improved from 33 (12-49) to 15 (0-40) (P < .0001). At 12-month follow-up, the improvement of SS score in TNFBT group was significantly more than the control group as follows: 4 (0-25) vs 15 (0-51), respectively (Mann- Whitney U P < .002). Three patients had a second TNFBT injection for relapsed symptoms. There were no complications. The transcutaneous needle- free injection of botulinum toxin eliminates the risk of intravascular injection or needlestick injury. The transcutaneous needle-free injection of botulinum toxin also has other therapeutic applications including an alternative therapy to biofeedback training for dyssynergia of the EAS, treatment of muscle limb spasticity in cerebral palsy, and cosmetic treatment of overactive facial muscles and wrinkles and hyperhydrosis. CONCLUSION: Transcutaneous needle-free injection of botulinum toxin into the external anal sphincter is a novel and safe new treatment of chronic idiopathic constipation and anal fissure in children. A second injection may be required in 20% of patients. __________________________________________________________________________ _____________________________________*____________________________________ 11. Abstract: A multi-center, double-blind, randomized controlled study of the safety and effectiveness of Juvéderm injectable gel with and without lidocaine __________________________________________________________________________ J Cosmet Dermatol. 2009 Sep;8(3):205-10. A multi-center, double-blind, randomized controlled study of the safety and effectiveness of Juvéderm injectable gel with and without lidocaine. Weinkle SH, Bank DE, Boyd CM, Gold MH, Thomas JA, Murphy DK. INTRODUCTION: Pain is a common patient complaint during dermal filler injections. The primary objective of this study was to compare a new formulation of Juvéderm((R)) injectable gel with lidocaine (denoted as JUV + L) to commercially-available Juvéderm((R)) injectable gel without lidocaine (denoted as JUV) with respect to procedural pain scores in subjects desiring nasolabial fold (NLF) correction. METHODS: Subjects received randomized treatment with the lidocaine filler in one NLF and the filler without lidocaine in the other NLF. Investigators determined the appropriate formulation (Ultra or Ultra Plus) and volume of material to inject but were blinded as to which syringe contained lidocaine. Subjects rated procedural pain (pain during injection) using an 11-point scale within 30 min after receiving treatment in both NLFs and compared procedural pain between right and left NLFs using a 5-point scale. NLF severity was rated by both subjects and investigators before and 2 weeks after treatment. RESULTS: The mean difference on the procedural pain scale was 3.4 (P < 0.0001), and 93% of subjects found JUV + L to be less or slightly less painful than JUV. Improvement in NLF severity was comparable for both products. Common treatment site reactions (CTRs) of pain and tenderness were considerably less frequent for JUV + L than JUV while all other CTRs showed no statistically significant differences. CONCLUSION: The dermal filler formulated with lidocaine is effective in reducing procedural pain during correction of facial wrinkles and folds while maintaining a similar safety and effectiveness profile to the filler without lidocaine. __________________________________________________________________________ _____________________________________*____________________________________ 12. Abstract: The epidemiology and prevention of donor-derived infections __________________________________________________________________________ Adv Chronic Kidney Dis. 2009 Jul;16(4):234-41. The epidemiology and prevention of donor-derived infections. Ison MG. Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA. mgison@northwestern.edu Donor-derived infectious diseases are infections that are present in an organ donor and have the potential to be transmitted to at least 1 transplant recipient. Several recent transmissions have been covered by the lay media and in the medical literature, including a recent transmission of HIV and hepatitis C virus from 1 donor to 4 recipients. These reports have highlighted the importance and clinical impact of this rare complication of organ transplantation. Donor-derived infectious diseases appear to complicate less than 1% of all transplant procedures, but, when a transmission occurs, significant morbidity and mortality can occur. A number of guidelines and policies define the optimal screening of organ donors to prevent the transmission of infectious diseases. Unfortunately, there are significant limitations in our screening methods, and only some pathogens are screened for routinely. The regulatory framework related to and the epidemiology, identification, and management of donor-derived infectious disease transmission shall be reviewed. __________________________________________________________________________ _____________________________________*____________________________________ 13. No Abstract: Comment: Needle-stick reporting among surgeons __________________________________________________________________________ Ann R Coll Surg Engl. 2009 Jul;91(5):443-4; author reply 444 Comment on: Ann R Coll Surg Engl. 2009 Jan;91(1):12-7. Needle-stick reporting among surgeons. Kelly S. __________________________________________________________________________ _____________________________________*____________________________________ 14. No Abstract: Health care waste management at an academic hospital: knowledge and practices of doctors and nurses __________________________________________________________________________ S Afr Med J. 2009 Jun;99(6):444-5. Health care waste management at an academic hospital: knowledge and practices of doctors and nurses. Ramokate T, Basu D. __________________________________________________________________________ _____________________________________*____________________________________ 15. No Abstract: ANSI/AAMI ST79: popular steam sterilization standard amended __________________________________________________________________________ Biomed Instrum Technol. 2009 Jul-Aug;43(4):325-6. ANSI/AAMI ST79: popular steam sterilization standard amended. Bremner J. __________________________________________________________________________ _____________________________________*____________________________________ 16. No Abstract: Sterile processing certification: has its time come __________________________________________________________________________ Biomed Instrum Technol. 2009 Jul-Aug;43(4):321-2. Sterile processing certification: has its time come. Ly C. Kettering Health Network, Ohio, USA. __________________________________________________________________________ _____________________________________*____________________________________ 17. News - Brunei: Diabetic Patients Query - ICAAC: Hospital Surfaces Major Source of C. difficile - USA: Editorial: Medical Inattention in New York Prisons - South Africa: 'Infected with HIV': Heart surgery man sues hospital, blood service - China: No Traces Of HIV Found In Victims [Syringe Attacks] - China: China needle attacks 'not toxic' - China: China issues all clear in syringe attack tests - Afghanistan: Afghan junkies risk triggering AIDS explosion - UK: Needle hotline to curb drug waste - India: FDA issues notices to 34 blood banks - USA: Three Las Vegas Hepatitis C Lawsuits Move Forward - China: Urumqi stabilizing as stabbings drop - China: Xinjiang hospital offers psychological counselling for needle attack victims - USA: NJ: 29 hepatitis cases tied to 1 doctor's office - Kenya: New measures to curb fake drugs - Mozambique: No HIV policy for injecting drug users - USA: New Jersey Doctor Linked to 29 Hepatitis B Cases - Australia: Hepatitis C infection rates 50 per cent down - USA: Calif. poised to regulate tattooing, piercing - Global medical devices industry: Procurement strategies and the impact of recession - USA: New York May Tighten Review of Inmate HIV/Hepatitis Care Selected news items reprinted under the fair use doctrine of international copyright law: http://www4.law.cornell.edu/uscode/17/107.html __________________________________________________________________________ Brunei: Diabetic Patients Query by Counter Pain, Bru Direct Brunei's No. 1 News Website. (15.09.09) I am a diabetic and I rely on injections for my insulin twice a day, of course I am most grateful, because I am supplied with the necessary medication free of charge, as I run out of syringes frequently , I was asked by the person at the dispensary, how many times do I use the disposable syringe, of course I use it only once because it is clearly stated on the package "do not desterilize and reuse" but I was told to reuse it, in fact the person said it could be used up to four times. I am worried because once the disposable syringe is used it is not sterile anymore. How do I sterilize a used disposable syringe? Where do I keep used the syringe before reusing it? What if the needle is contaminated? The whole vile of insulin could get contaminated too, because I have to push the needle into the vile to get the insulin before injection. What would happen if I inject myself with contaminated insulin and a non sterile needle? And injections are quite painful even using a sharp new needle causes a considerable pain, try using a blunt needle and feel the pain. Please help, I need advice. .......................................................................... __________________________________________________________________________ ICAAC: Hospital Surfaces Major Source of C. difficile By Crystal Phend, Senior Staff Writer, MedPage Today (15.09.09) Reviewed by Zalman S. Agus, MD; Emeritus Professor, University of Pennsylvania School of Medicine. SAN FRANCISCO -- Healthcare workers are just as likely to pick up Clostridium difficile spores from bed rails and other surfaces around a hospital room as from touching an infected patient's skin, researchers found. Gloves tested positive for the spore form of the diarrheal bacteria 50% of the time after contact with the most commonly touched objects around a patient -- the same proportion as from commonly-examined skin sites -- according to a prospective study by Dubert M. Guerrero, MD, of Case Western Reserve's University Hospitals in Cleveland, and colleagues. The mean number of C. difficile colonies picked up was similar as well (14 versus 7 CFU per handprint, P=0.22), they reported here at the Interscience Conference on Antimicrobial Agents and Chemotherapy. "These results reinforce the importance of environmental disinfection and glove use when touching surfaces in rooms of C. difficile-infected patients, the researchers noted. At most hospitals, it's common procedure to keep gown, gloves, and warning signs outside infected patients' rooms, Guerrero said. But other studies have shown that "healthcare workers are less likely to wash their hands if they just touch the bed rail or the bedside table than if they examine the patient," said co-author Curtis Donskey, MD, of the Cleveland VA Medical Center. It's not necessarily a time issue; rather, healthcare workers "often don't appreciate how important environmental surfaces can be," Donskey said. They may go into a room as a group -- most with no intention of touching the patient -- and forget that they rested a hand on the bed rail, he noted. The same is true for many infectious diseases that have become endemic in hospitals, including methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci, commented John Boyce, MD, of the Hospital of Saint Raphael in New Haven, Conn., who was not involved in the study. For the prospective observational study, Guerrero's group cultured handprints from gloved hands after contact with 120 skin sites of 30 patients infected with C. difficile as well as with 120 surfaces around the patients. Half of the patients produced at least one positive culture for C. difficile spores on their skin, and the same proportion tested positive for spores on the surfaces around them. The tested skin sites -- chest, abdomen, hands, and forearms -- were about equally contaminated. Of the environmental surfaces, the bed rail stood out as a source of transmission: 43% of contacts produced positive cultures compared with 20% of table touches and 17% for both the phone and call button. Healthcare workers picked up the greatest mean number of colonies of C. difficile from the abdomen -- 29 CFU per handprint. The researchers also tested relative contamination levels after touching an infected patient's groin and found it to be far worse than any other site, environmental or other areas of the skin, with an average of 121 CFU transferred per handprint. However, this area is not commonly examined in real world practice and, thus, may not represent as great a risk, Guerrero said. Given the importance of environmental surfaces in C. difficile transmission, more studies are needed to determine how to decrease the burden of spores, which have proven remarkably difficult to kill, the researchers noted. Spores often continue to shed from the skin even after treatment and most antiseptic soaps are ineffective. For cleaning environmental surfaces, bleach is one of the only disinfectants that kill spores, Donskey said. Possible routes may be by adjusting the frequency and timing of environmental cleaning and by assessing novel sporicidal agents for disinfecting. The study was funded by the Department of Veterans Affairs and Cleveland VA Medical Center as well as by a Wyeth Pharmaceuticals Antimicrobial Resistant Fellowship. Guerrero disclosed a financial relationship with Wyeth Pharmaceuticals. Primary source: Interscience Conference on Antimicrobial Agents and Chemotherapy Source reference: Guerrero DM, et al "Hand acquisition of Clostridium difficile after contact with environmental surfaces versus skin of patients with C. difficile infection" ICAAC 2009; Oral session K-1911. Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal. Article and video at: http://www.medpagetoday.com/MeetingCoverage/ICAAC/15980 .......................................................................... __________________________________________________________________________ USA: Editorial: Medical Inattention in New York Prisons New York Times, New York USA (15.09.09) Prison inmates are the sickest people in society, with infection rates for blood-borne viruses like H.I.V. and hepatitis C far higher than the general population. Failing to test, counsel and treat these inmates makes it more likely that they will spread infection once they are released and suffer catastrophic illnesses that shorten their lives and drive up public health costs. The New York State Legislature had this problem in mind when it passed a bill that requires the State Department of Health to ensure that prison H.I.V. and hepatitis programs are operating effectively and meet prevailing medical standards. Corrections officials, who tend to rebel against oversight of just about any kind, want Gov. David Paterson to veto this bill. He should ignore them and sign it. The state correctional system has unquestionably improved medical care over the last several years. But a recent report by the Correctional Association of New York, which is authorized by the Legislature to monitor the prisons, found troubling inconsistencies in care in the state prison system, which is said to house 20 percent of the H.I.V.-infected inmates in the United States. The report, based on state records, estimates that the state has identified through testing fewer than half of the H.I.V.-positive inmates and only about 70 percent of those with hepatitis C. The report finds that the number of people receiving treatment varies significantly from place to place, which is suspicious given that the population is fairly homogenous. The variation raises questions about the consistency and effectiveness of medical policies from prison to prison. Prison medical officials argue that the treatment regime is fine and that oversight is unnecessary. But critics in the Legislature rightly point out that the prison health system is the only one in the state not overseen by the Health Department. The prison system, with about 4,000 infected inmates, is the largest provider of treatment for H.I.V., the virus that causes AIDS, in the state. Other critics argue than the Health Department’s initiative would cost money at time when the state can’t afford it. But better diagnoses and treatment in prison would save more money than it would cost by preventing further infections and keeping many patients from moving on to costly, catastrophic illnesses. .......................................................................... __________________________________________________________________________ South Africa: 'Infected with HIV': Heart surgery man sues hospital, blood service Ingrid Oellermann, The Witness, South Africa (15.09.09) A CIVIL lawsuit being brought against the SA National Blood Service and St Augustines hospital by a Glencoe man who claims he contracted HIV through a blood transfusion will go on trial in Pietermaritzburg in the high court from March 15 to 26 next year. The case was due to be heard between October 12 and 16, but was yesterday postponed until 2010 after an agreement between the parties. The Glencoe man, whose name cannot be published due to his alleged HIV status, alleges that he was infected with HIV during a heart bypass operation at St Augustine’s hospital on September 20, 2003, during which he underwent a blood transfusion, and that contaminated blood was administered to him. He claims that either the SA National Blood Service or St Augustines hospital or both were negligent in that they failed to take adequate steps to ensure that no HIV infected blood was available for transfusion; that they failed to take adequate steps to screen donors or monitor them after they had donated blood; that they failed to properly test the blood available for transfusion to ensure it was not infected; and that they failed to properly inform him of the risk of contracting HIV when receiving a blood transfusion. The SA National Blood Service and St Augustines are opposing the lawsuit and indicate in replying papers that they dispute all the allegations against them. The man is claiming damages totalling R2 764 224 for past and future medical costs incurred as a result of being infected with the HIV virus; as well as loss of earnings, pain and discomfort; the fact that he suffers from depression and had developed a panic disorder; anticipated deterioration in his health and dimunition of his life expectancy. .......................................................................... __________________________________________________________________________ China: No Traces Of HIV Found In Victims [Syringe Attacks] BERNAMA, (14.09.09) BEIJING, Sept 14 (Bernama) -- No traces of HIV virus, radioactive or toxic substances were found in samples taken from the 248 victims of the Urumqi syringe attack incident. "Neither were the samples contaminated with other dangerous viruses such as anthrax bacillus, yersinia pestis, francisella tularensis, brucella and botulinum toxin. "However, some patients showed various levels of anxiety and depression and had been recommended for psychological counselling," Qian Jun, head of the disease control and biological security office under China's Academy of Military Medical Sciences told a press briefing yesterday. The Urumqi syringe attack incident began about a month after the July 5 riots, causing panic among the people and threatening the security of the people. Local authorities had confirmed by Sept 4, that 531 people had fallen victim and that the majority were of Han ethnicity. Thousands of angry and panic-stricken residents in Urumqi took to the streets early this month, protesting against syringe attacks and demanding security guarantees from the local authorities. Urumqi police have given an assurance that they would expedite the investigation and prosecution of the suspects. As of Sept 3, 21 people were detained in connection with the syringe attack. Last Saturday, two men and a woman were sentenced to jail terms ranging from seven to 15 years, for syringe stabbings and threatening victims with needles while committing robbery. .......................................................................... __________________________________________________________________________ China: China needle attacks 'not toxic' BBC News (14.09.09) No dangerous chemicals have found in blood samples from the victims of recent needle attacks in China's Xinjiang region, state media have said. Rumours had been rife that the needles contained radioactive substances, poison or even HIV. Blood samples from 250 reported victims were examined in a Beijing lab, said state-run Xinhua news agency. The syringe attacks began in August, a month after riots between ethnic Uighur and Han Chinese left about 200 dead. Three people have received jail sentences over the needle attacks. The wave of attacks has raised tension in the region, amid long-standing animosity between the Uighur and Han communities. Security fears A total of 531 people reported being attacked with hypodermic needles, with 171 showing "obvious syringe marks", according to Xinjiang officials. The head of disease control at China's Academy of Military Medical Sciences said no traces of radioactive substances, toxic chemicals, HIV or other poisonous or viral substances were found in the samples they checked, Xinhua reported. Thousands of angry residents of Urumqi, Xinjiang's capital, protested earlier this month, demanding better security over the needle attacks and swifter legal action after July's riots. At least five people were killed in unrest around these latest protests. The Chinese government has been struggling to restore calm in Xinjiang since the July riots, the worst ethnic unrest in the country for decades. A number of people have been arrested and charged over the violence, but no one has been tried yet. Three Uighurs were sentenced on Saturday to jail terms ranging from seven to 15 years for syringe stabbings or threats to use needles in robberies. Story from BBC NEWS: http://news.bbc.co.uk/go/pr/fr/-/2/hi/asia-pacific/8254278.stm © BBC MMIX .......................................................................... __________________________________________________________________________ China: China issues all clear in syringe attack tests By Peter Foster in Beijing, Telegraph.co.uk (14.09.09) Blood tests taken from alleged victims of mysterious syringe attacks which sparked panic in the restive Chinese province of Xinjiang have not revealed the presence of any toxic substances, local health officials have confirmed. The tests for "radioactive, viral or poisonous substances" were conducted on 250 of the alleged victims, but all produced negative results said China's state news agency, Xinhua, citing local disease control experts. Anger at the alleged attacks provoked protests in Xinjiang's capital, Urumqi earlier this month, when crowds gathered in the city's main square to call for the resignation of senior Communist Party officials for failing to protect public safety. The disturbances followed a bout of vicious ethnic violence in July between the Turkic Uighur minority and the dominant Han Chinese populations. More than 200 were killed, but the majority – about 150 – of the deaths were Han according to government figures. Three people – a 19-year-old student and two heroin addicts - were sentenced to up to 15 years in jail on Saturday for the attacks which the Chinese government has blamed on 'separatist elements' among the Uighur population. However many elements of the syringe attacks have remained unexplained, with more than 530 people reporting to hospital claiming to have been attacked, but only 171 showing any obvious signs, such as puncture wounds or scratches. Reporting of the attacks increased sharply after a government text message campaign designed to reassure Urumqi's residents back-fired spectacularly, deepening panic among citizens. China has suffered cases of mass-hysteria around syringe attacks in the past. In 2002 the north eastern city of Tianjin was gripped by rumours that an HIV-Aids patient who had contracted the disease in a blood-donor scandal was conducting 'revenge' attacks in the city. The rumours turned out to be unfounded. According to internet reports this weekend, China's government has ordered internet companies to censor any mention of such attacks, for fear of sparking a repeat of the panic in the capital ahead of next month's 60th anniversary celebrations for the founding of the People's Republic of China. .......................................................................... __________________________________________________________________________ Afghanistan: Afghan junkies risk triggering AIDS explosion Nic Robertson, CNN (14.09.09) KABUL, Afghanistan (CNN) -- Afghanistan's reputation as the world's leading narcotics supplier is well-known, but in a squalid ruin in Kabul, the country hides a darker secret -- a huge home grown drug addiction problem now on the brink of fueling an HIV/AIDS epidemic. Here junkies lie in their own filth, wasted limbs poking out of blood- spattered clothing as they blank out the abject misery of their surroundings. In one room, a veritable narcotics bazaar offers pills and drug paraphernalia -- with hits retailing at less than $4. One user claims he has been an addict for 22 years, although it is difficult to talk to any of the dazed and ragged occupants of the drug rooms. The atmosphere is edgy and -- as thick clouds of burning opium fill the air -- dizzyingly toxic. The Kabul den is just the tip of the iceberg in a country awash with narcotics. The government estimates the number of addicts in Afghanistan could be as many as five percent of its 25 million people. Watch Nic Robertson's report from the 'house of hopelessness' » And though nascent efforts are being made to tackle the problem, chronic funding shortfalls have prompted the United Nations to warn that drug use will escalate, potentially driving an HIV/AIDS crisis as junkies move from smoking to high risk needle-sharing. Afghanistan has always been a major narcotics supplier -- responsible for 95 percent of the world's heroin -- although this was scaled back under the rule of the Taliban, which outlawed poppy cultivation and imposed strict penalties for drug users. Since 2001, when the extremist regime was ousted by a U.S.-led invasion that installed President Hamid Karzai, production has doubled. And for many in the country still mired in poverty and conflict, these cheap drugs offer a tempting escape. The last United Nations survey of Afghanistan's drug problem four years ago estimated the country's addicts to number about 200,000. According to Afghan Counter Narcotics Minister Khodaidad, the figure is now far greater. "More than 1.2 million people in Afghanistan are addicts. It's a very huge number and every year it increases," he told CNN. Khodaidad says the Afghan government is largely powerless to control the production of opium while Taliban extremists, who now control and draw funding from drug crops, control cultivation areas despite major international military efforts to push them back. "We did very little due to weakness of governors, due to insurgents, due to pressure of terrorism in the area," he added. "We don't have sufficient law enforcement agencies -- the police, the border security force, and other special forces to control this area -- so it will take time." But, says Jean-Luc Lemahieu, head of the UN's Office on Drugs and Crime (UNODC) in Kabul, time is something Afghanistan does not have. As intravenous drug use takes hold, raising the prospect of needle sharing, he says HIV/AIDS will follow quickly. "The little data we have at the moment are very alarming," he told CNN. "They tell us that we should not wait longer and if not, this country will be saddled with another burden it just can not afford. "I think it is already happening today. We have seen, now, a few HIV/AIDS cases. Hopefully we can contain the problem, although it is unlikely given the problems with the health structures." The U.N. has begun a program to detox users willing to get off drugs in Afghanistan. A renovated warehouse in Kabul offers hope to 100 addicts in the biggest facility of its kind in the country. Watch Robertson go inside the detox clinic » In the center's clean, bare rooms, shaven-headed junkies tremble under blankets as they go through the agonizing cold turkey of weaning their ravaged bodies off drug dependency. Therapy sessions also help motivate them to kick their deadly habit. "Here we deal with the problem from a humanitarian perspective, not from an addiction perspective, to save lives," says Jehan Zeb Khan, UNODC program manager. But says Khan, with what little funding there is now dwindling fast, the salvation offered to these lucky few may be short lived -- they will be forced back out on the streets, where more opium dens will flourish, bringing yet more misery for Afghanistan. .......................................................................... __________________________________________________________________________ UK: Needle hotline to curb drug waste BBC News Scotland (14.09.09) A 24-hour hotline aimed at cutting the number of discarded needles and other drug waste on the streets of Dundee has been launched. Tayside Police said the service, operated in partnership with the city council, would lead to the "rapid removal" of drugs paraphernalia. The new line replaces a former arrangement which involved people contacting the council's waste service. In future, people can call 01382 433063 day or night. Discarded needles and syringes can carry a range of blood-borne viruses including Hepatitis B and C and HIV. Anyone who finds a needle or syringe is advised not to touch it or dispose of it other than by contacting the new hotline. Insp Bryan Knight of Tayside Police, said the service would remove any confusion about how people should deal with the issue. He said: "'The hotline will help to ensure that drug litter is removed quickly. "It also provides us with another way in which we can gather information about where drug misuse is taking place in the city." Jimmy Black from the council's environment services added: "This is just the first of a number of initiatives we are taking to deal with discarded needles on our streets. ''By offering a 24-hour number we hope to get people to immediately report anything they find and I would urge them for their own safety to use the number rather than try to deal with discarded drugs paraphernalia themselves.'' Story from BBC NEWS © BBC MMIX .......................................................................... __________________________________________________________________________ India: FDA issues notices to 34 blood banks Press Trust India (13.09.09) Lucknow, Sep 13 (PTI) With a view to check the sale of contaminated blood in the state, the Food and Drug Administration (FDA) department has served show cause notices to 34 blood banks while cancelling license of one other. "We have served show cause notice to 34 blood banks and cancelled licence of one for not following the norms", an FDA official said here. The department is running a state-wide campaign after a racket supplying contaminated blood was unearthed in the state capital recently. During the drive, 47 blood banks across the state were checked, he said .......................................................................... __________________________________________________________________________ USA: Three Las Vegas Hepatitis C Lawsuits Move Forward Occupational Health Safety (11.09.09) * A bankruptcy judge decided Wednesday to allow three civil trials to take place amid the bankruptcy of three medical clinics involved in the 2008 outbreak. Chief U.S. Bankruptcy Judge Mike Nakagawa of Las Vegas decided Wednesday to allow the first three civil trials to take place in a Hepatitis C scandal that erupted in the city last year. The plaintiffs' lawsuits name the Endoscopy Center of Southern Nevada and two related clinics that filed for Chapter 7 bankruptcy protection on July 17, 2009, which had automatically delayed the trials. The clinics closed after the Southern Nevada Health District announced in February 2008 that 40,000 patients might have been exposed to Hep C and other bloodborne illnesses, allegedly because nurse anesthetists had been using syringes on more than one patient, according to coverage of the outbreak by the Las Vegas Review- Journal. The first trial, set for Oct. 19, is the case of Michael Washington, who was infected with Hep C in a case genetically linked to the Endoscopy Center of Southern Nevada, Brian Haynes and Paul Harasim have reported for the newspaper. The outbreak was cited in a February 2009 Government Accountability Office study about health care-associated infections at ambulatory surgical centers. More than 5,100 ASCs were operating nationwide and serving Medicare beneficiaries in 2007, and those centers performed more than 6 million surgeries paid for by Medicare that year, according to the study, which recommended collecting comprehensive patient safety data from outpatient centers and regular, random surveys to be done at them. While five data sources exist on health care-associated infections at ambulatory surgical centers, none of them provides information for assessing the extent of the problem nationwide, GAO reported. The American Association for Accreditation of Ambulatory Surgery Facilities, Inc. is the largest U.S. accrediting organization for ambulatory surgical centers, having been created in 1980 to ensure high- quality patient care in ASCs. More than 1,100 outpatient surgical facilities are AAAASF accredited. .......................................................................... __________________________________________________________________________ China: Urumqi stabilizing as stabbings drop People's Daily Online (11.09.09) Uygur Autonomous Regional Political and Legislative Affairs Committee said Thursday that the situation in Urumqi has been improving. The number of stabbings has decreased in the past few days. Out of the 40 latest reported stabbing cases on Tuesday, only 20 were confirmed, and all of the 20 took place before that day, the official surnamed Liu, said in an exclusive interview with the Global Times. The first attack occurred August 17 and five others followed over two days from August 22 to August 23, the official said, adding high-ranking officials in Xinjiang immediately tried to stem further attacks even though the nature of the attack was unclear. According to a medical document released by Liu, the first documented attack was against a woman surnamed Zhang who was riding bus No. 502. She was treated at the First Affiliated Hospital of Xinjiang Medical University. Police started speculating that the attacks appeared were organized after the 12th syringe attack, Liu said. The official told Global Times that by August 30, no one was arrested for any attack and more people have since been stabbed. Out of fear that forceful warnings would spread panic, the government opted to send text messages to people and beef up security. Efforts by the authorities to prevent the attacks in Urumqi have helped to return life to some level of normalcy in the capital of the Xinjiang Uygur Autonomous Region as of Thursday. The official was also concerned about the potential for the attacks to spread outside of the city. Reports that some were using dirty needles to poke people in Korla and Shihezi, an almost entirely Han city, strained people's nerves, he said. In nearby Changji, about 35 kilometers northwest of Urumqi, workers at the No. 1 Secondary School chased three suspects Monday they believed attacked people with needles outside the school gate. Some 200 angry passers-by rounded up suspects before police officers came. Three people were suspected of stabbing people but one managed to escape. One of the suspects was a Uygur man in his 20s. Suspects reportedly stabbed 18 people and eight of them were confirmed to have been attacked with needles, the Changji prefecture police authorities told the Global Times. In an apparent move to quell deadly protests over the stabbings, the Urumqi government has sent nearly 20,000 officials to 502 communities. While authorities are working hard to stop the syringe stabbings in Urumqi, they are encountering difficulties tracking down evidence and finding suspects, Liu said. He said although the stabbings are "soft violence", the intention is to incite public fear and trigger ethnic resentment. "There are two major difficulties in tracking down suspects. One is, in the first few days, more people went to the hospital instead of calling for the police, missing the best opportunity to catch suspects," Liu said. "The second is that there were hardly any proof at the site of attacks as any needle-shaped tool could be used as weapon and they got lost easily." Source:Global Times .......................................................................... __________________________________________________________________________ China: Xinjiang hospital offers psychological counselling for needle attack victims Xinhua, www.chinaview.cn (11.09.09) URUMQI, Sept. 11 (Xinhua) -- Li Yuzhen felt relieved after a second doctor reassured her that she was not infected after a syringe needle attack in Urumqi, capital of China's far western Xinjiang region. Another doctor has told her she has nothing to worry about after checking her syringe mark last week, Li said. "But the mark became red and swollen only a couple of days later and I was wondering if I had contracted any virus," she told He Hong, head of the skin disease department of Urumqi General Hospital affiliated to Lanzhou Military Region. He conducted a careful check-up and later made an example to show her the symptom was not a result of infection but of finger scratches. "I can at last have a sound sleep," said Li, who breathed a sigh of relief after the doctor's counselling. Li said she could not sleep for days for fears of virus infections even after the assurance from the first doctor. Li is not alone. Many other victims are also deeply worried about possible hidden infections. Alimuhan, a woman of the Kazak ethnic minority group, also went to the military hospital for counselling amid lingering fear of HIV infection. She was relieved after a doctor told her the possibility of HIV infection could be ruled out. "HIV infections have prerequisites: first the needle is contaminated with HIV virus; second the stabbing is deep," Wang Huilin, a skin doctor told her. The fears did not vanish easily even after medical experts earlier ruled out the possibility that radioactive substances, anthrax or toxic chemicals were used in recent needle attacks. By last Friday, local authorities had confirmed 531 victims of hypodermic syringe stabbings, 171 of whom showed obvious syringe marks. The majority of the victims were of the Han ethnic group. Tens of thousands of angry and panic residents in Urumqi took to the streets last week, protesting against needle attacks and demanding security guarantees. The Urumqi General Hospital also arranged for three psychological experts and opened four counselling hotlines to help ease victims' fears and panic. In addition, the hospital handed out local newspapers disclosing the sabotages of the needle attackers and brochures on infectious diseases prevention. "We seek to make the residents know well the vicious intentions of the 'three forces' (of extremism, separatism and terrorism) and learn basic knowledge on infectious diseases to ease panic and anxiety as soon as possible," said Shen Kaijin, head of the hospital's emergency center. .......................................................................... __________________________________________________________________________ USA: NJ: 29 hepatitis cases tied to 1 doctor's office By BETH DeFALCO (AP)(11.09.09) TRENTON, N.J. — Several thousand patients of a New Jersey doctor should get tested for blood-borne diseases because of an outbreak linked to his office that has led to more than two dozen being diagnosed with hepatitis B, state health officials said. In March, the state said five of Dr. Parvez Dara's patients were found to have hepatitis B and that nearly 2,800 patients should get tested for it. There are now 29 positive cases, plus 68 others who tested positive for antibodies but cannot be definitely linked to the outbreak, according to the state Health Department. The state is aware of nearly 1,400 patients who have been tested so far. On Aug. 12, state epidemiologist Dr. Christina Tan sent a letter to 2,000 more patients and to patients in the first group who had yet to get tested urging them to do so. In July, the department responded to an Associated Press open records request by declining to release any information about the test results, citing the ongoing investigation. The department quietly released the test results on its Web site Sept. 1, nearly three weeks after sending out the letter to patients. Health Department spokeswoman Donna Leusner said the investigation is ongoing, but a report was prepared at the request of the Board of Medical Examiners, which suspended Dara's license in April. A spokesman for Dara criticized the health department for releasing the test results while the investigation is still open, saying it was a "rush to judgment." "There are a number of possible medical reasons that explain why hepatitis B may have developed among patients — particularly those being treated for cancer with chemotherapy," said Dara spokesman Tim White. Health inspectors visited Dara's office in March and described conditions there as unsanitary. The inspectors said they found blood on the floor of a room where chemotherapy was administered, blood in a bin where blood vials were stored, unsterile saline and gauze, and open medication vials. Inspectors also cited problems with cross-contamination of pens, refrigerators and countertops; use of contaminated gloves; and misuse of antiseptics, among other health code violations. Following the inspection, county health officials sent a March 28 letter to Dara's patients warning them of the risk and suggesting they be tested for the liver diseases hepatitis B and hepatitis C and for HIV, the virus that causes AIDS. "Evidence gathered at this time suggests that since 2002, some clinic staff provided care in a manner that put patients at risk for infection caused by bloodborne viruses, including hepatitis B," the Aug. 12 letter told patients. "The investigation to date suggests that the hepatitis B infections identified may be associated with the method by which medications were administered and procedures performed at the practice." Dara, originally from Pakistan, has been practicing at his Toms River office for 23 years and has been a licensed oncologist in New Jersey since 1980. He estimated that he saw 45 to 60 patients a day, with about a dozen receiving chemotherapy each day. Copyright © 2009 The Associated Press. .......................................................................... __________________________________________________________________________ Kenya: New measures to curb fake drugs By Sammy Cheboi, The Daily Nation, Nairobi Kenya (10.09.09) All medicines sold in Kenya to be stamped by government Drugs sold in Kenya will bear a government symbol to curb counterfeits. However, the fight against the illicit multi-billion shilling drug trade was far from won, Medical Services minister Anyang’ Nyong’o said on Thursday. The World Health Organisation said three years ago that nearly 25 per cent of pharmaceutical drugs sold in the developing world were fake. And recent studies suggest a proliferation of fake drugs as the makers acquire more sophisticated equipment. Speaking during a tour of pharmaceutical companies in Nairobi, Prof Nyong’o complained that the Kenya Medical Supplies Agency and Pharmacy and Poisons Board were failing to stop the entry of fake drugs. “We have to take drastic measures to safeguard the health of Kenyans. Soon, we will require that all drugs arriving on Kenyan soil and those made locally bear a government symbol,” he said. The counterfeit drug racket has become increasingly attractive for criminal syndicates due to the huge profits and because the punishment meted out to those caught is much less severe than for dealing in hard drugs like cocaine. WHO has warned that the increasing availability of counterfeit drugs for malaria and other diseases poses a big threat to public health. The UN says that global sales of counterfeit drugs, including anti- malarials, could reach $75 billion in a few years. The decision to stamp drugs with a GoK sign, Prof Nyong’o said, would also help to check theft of government drugs. “Merely indicating on cartons that the drugs belong to the government is no longer a deterrent in curbing public drugs from being diverted to private businesses,” he said. He said for every Sh5 billion worth of drugs, an estimated Sh3 billion are diverted. .......................................................................... __________________________________________________________________________ Mozambique: No HIV policy for injecting drug users IRIN Plus News (10.09.09) MAPUTO, 10 September 2009 (PlusNews) - Víctor, 25, a self-employed mechanic, opens the hood of one of several cars crammed into his back yard in Maputo, the Mozambican capital. He has a reputation for being a good mechanic, but few people in the neighbourhood realize his "inspiration" comes from taking drugs. "I can't work when I'm not high," he told IRIN/PlusNews. "Ideas don't come to me and I don't recognize the parts. I need to smoke [marijuana] first, and sometimes I shoot up." Víctor, who did not want to give his last name, started smoking marijuana when he was 15 years old and living with his father and stepmother, who mistreated him; loneliness and isolation led him to seek refuge in drugs. He was soon experimenting with other types of drugs and in 2003 injected heroin for the first time; he has not been able to stop injecting drugs since. Before he started working, he sold many of his personal possessions to pay for heroin and later cocaine. Víctor does not know his HIV status, but said he sometimes shared needles with up to 10 friends. "Having a disposable needle for each person would be the ideal, but it's not easy - that's why we share - but I don't think I have HIV," he said. "It's too bad drug consumption isn't legal in Mozambique. If it were, needles could easily be provided for people who inject drugs, as is the case now with condoms." In fact, countries with needle exchange programmes have not legalized drugs, but acknowledge that injecting drug users (IDUs) are at higher risk of HIV and should be targeted with prevention campaigns. According to the UN Office on Drugs and Crime (UNODC), between five and 10 percent of HIV infections worldwide are the result of injecting drug users sharing contaminated needles. Mozambique's 2005-2009 National Strategic Plan for the Fight Against HIV/AIDS does not recognize drug users as a vulnerable group, and there are no official estimates for the number of people infected with HIV as a result of drug use. Manuel Fernando Condula, coordinator of the National Network of NGOs Against Drugs, said the organization had developed campaigns for raising awareness in communities and schools about the risks of HIV infection linked to injecting drugs. The organization also runs workshops aimed at changing the behaviour of addicts in the Maputo neighbourhoods of Mafalala, Mavalane and Matutuíne, where drugs are bought and sold. "The Network's responsibility is that of reducing drug consumption among addicts and keeping new consumers from starting," Condula said, adding that many people in Mozambique were unaware of the risk of infection from needle-sharing. Get Jobs, a local NGO working to reduce the spread of HIV by education and connecting sex workers with other types of employment, carried out a survey between 2007 and 2008 in Maputo, Beira - Mozambique's second largest city - and the northern port city of Nacala, to determine the needs and habits of drug users. The results, which have yet to be made public, will be used to develop a programme targeting addicts. "When the project is executed, I don't believe we'll include the distribution of needles to users, as is done in some countries," Hélder Manuel Massingue, who coordinated the study, told IRIN/PlusNews. "This encourages drug use. I think the proper strategy is to discourage consumption, and reinforce the possibility of detoxification and the reintegration of addicts into society." Eugénia Teodoro, a clinical psychologist at the health ministry's department of mental health, said there were no specific HIV prevention strategies for IDUs and the number of addicts who shared needles was unknown, but that all drug and alcohol users were thought to be at risk of HIV infection. "We know that someone who is under the effects of alcohol and drugs can easily forget to use a condom," she commented. The ministry presents lectures on the consequences of alcohol and drug abuse and plans to establish treatment and rehabilitation centres for drug addicts. [ENDS] [This report does not necessarily reflect the views of the United Nations] .......................................................................... __________________________________________________________________________ USA: New Jersey Doctor Linked to 29 Hepatitis B Cases AboutLawsuits.com (10.09.09) State health officials in New Jersey say that at least 29 people treated at one doctor’s office have been diagnosed with hepatitis B, and suggest that thousands of other patients treated at the same office need to undergo testing for the blood borne disease. Officials in the New Jersey Health Department are recommending that nearly 2,800 patients of Dr. Parvez Dara, a New Jersey oncologist, should undergo testing for hepatitis B, according to the Associated Press. Nearly 1,400 of the doctor’s patients have already been tested since March, when five cases of infection sent up red flags among health inspectors. Since then, there have been a total of 29 positive cases, and 68 patients have tested positive for Hepatitis B antibodies, though not the infection itself. Hepatitis B is transmitted through the blood and is often obtained through use of infected needles or sexual contact. Although the five cases have not been definitively linked to Dr. Dara’s office, they were generally older adults without other risk factors which raised concerns among health officials. The state health department released the most recent testing results at the beginning of the month, while an ongoing investigation into Dara’s practice continues. The investigation began in March, when the first signs of the hepatitis B outbreak was detected. Health inspectors visiting his office then discovered a number of health code violations, and described Dara’s medical office as unsanitary. Dara’s office has been cited for infection control violations since 2002, and state health officials indicate that the hepatitis infection outbreak may be linked to the method his staff used to administer injectable drugs. Inspectors found blood on the floor, blood in bins where vials of blood was stored, unsterile gauze and saline, open medication vials, the use of contaminated gloves, misuse of antiseptics and cross contamination of surfaces such as refrigerators, countertops and pens. The Board of Medical Examiners suspended Dara’s license in April. The health department first sent out letters to Dara’s patients in March, indicating that they should get tested for possible blood-borne illnesses. In August, the department sent out an additional 2,000 letters to more of his patients, again suggesting that any who have not been tested should do so. A similar outbreak of hepatitis in Las Vegas last year, which was linked to unsafe medical practices at two endoscopy clinics, resulted in over 114 reports of hepatitis C and approximately 40,000 people treated at the clinics between March 2004 and January 2008 were notified that they may have been exposed to blood borne disease. A number of hepatitis infection lawsuits were filed as a result of the gross negligence at the two Las Vegas clinics, but the owners have limited insurance coverage available to satisfy the claims. .......................................................................... __________________________________________________________________________ Australia: Hepatitis C infection rates 50 per cent down Dina Rosendorff, ABC Online (09.09.09) Listen to MP3 of this story http://tinyurl.com/q925cp TONY EASTLEY: New figures on drug use in Australia reveal that the spread of hepatitis C has halved over the past decade, partly because of effective public health programs. That report and another, which shows that knowledge and exposure to intravenous drug use is particularly common among young people who attend music festivals, will be presented at a sexual health summit in Brisbane today. The reports have been compiled by the National HIV Research Centre at the University of New South Wales. With more - Dina Rosendorff. DINA ROSENDORFF: New figures from the University of New South Wales show there are more than 211,000 Australians living with chronic hepatitis C infection. While this number is quite high, health experts say the good news is the rates of new infections are falling. Associate Professor David Wilson is the head of the university's Surveillance and Evaluation Program for Public Health. DAVID WILSON: Over the last decade we've seen substantial declines in the number of new people who've become infected with hepatitis C. Since 1999 we've seen an approximate 50 per cent decrease in the number of new infections. DINA ROSENDORFF: Why do you think that is? DAVID WILSON: One of the main reasons is that we've got very effective needle and syringe programs where injecting drug users can access these programs and it does reduce the rates of viral transmission. DINA ROSENDORFF: Do you think public health officials would be happy with the rates of Hepatitis C in the community? DAVID WILSON: Unfortunately not, particularly amongst sub-populations like injecting drug users, the prevalence of hepatitis C is extraordinarily large, about 70 per cent of the entire population of that particular sub- group is infected and so no, we cannot be very happy with the rates, we've got a long way to go. DINA ROSENDORFF: So what's the next challenge for public health officials then? DAVID WILSON: I think getting more people on treatment for hepatitis C would be a very useful way forward; we only have about 3,500 people per year that receive treatment. DINA ROSENDORFF: While Associate Professor Wilson says the rate of hepatitis C transmission has fallen among people who inject drugs, another report from the university has shed light on just who may be exposed to those drug users. The study found they're likely to attend music festivals. The studies' author is Professor John de Wit. He's the director of the National Centre in HIV Social Research at the university. JOHN DE WIT: Between 40 and 50 per cent of these young people that participated in our survey had been exposed to injecting drug use in their social lives. DINA ROSENDORFF: Were you surprised by these findings? JOHN DE WIT: Yes I was very much surprised by that because we also asked these young people whether they injected themselves, and hardly any of these people, young people, injected themselves, but apparently there is a lot of injection, or they perceive a lot of injection in their social context, in their communities, amongst their friends, in their lives. DINA ROSENDORFF: You do realise that any parents listening to AM this morning are going to now be incredibly concerned about letting their children go to any future music festivals? JOHN DE WIT: Well that would be a wrong decision because it's not related to the music festival. It wasn't, they were not necessarily offered the injecting drugs at the music festivals, it was more a wider phenomenon in their social lives. DINA ROSENDORFF: Professor de Wit says his study will now be used to help focus future drug prevention strategies targeting young people. TONY EASTLEY: Dina Rosendorff. ©2009 ABC .......................................................................... __________________________________________________________________________ USA: Calif. poised to regulate tattooing, piercing By SUSAN FERRIS, Sacramento Bee (09.09.09) Tattoos were once a standard way for a guy to thumb his forearm at authority. But veteran tattoo artist Courtney McIntyre says more authority may be what's needed to better protect customers of the expanding body-art industry. He's in favor of a bill approved last week by the California legislature that imposes stricter training, registration and safety rules on artists that tattoo or brand skin with a hot iron, pierce anything other than an earlobe, or apply permanent cosmetics. "Laws are not terrible things," said McIntyre, owner of Tattoo the Body Embellished in Sacramento. He said he wishes more customers would express concern about safety, and ask to see how he and his artists sterilize equipment and dispose of every needle -- used only once -- in a safe fashion. Introduced by Assemblywoman Fiona Ma, D-San Francisco, the Safe Body Art Act is on the governor's desk waiting his attention. The act also applies to body artists operating out of vehicles or temporary booths at conventions or street fairs. If signed, the bill requires all body artists -- except for standard ear piercers -- to register annually with counties, and undergo sanitation and certified blood-borne pathogen training. Artists must also be at least 18 years old, prove they are vaccinated against hepatitis B, and show that they completed an accredited four-hour first aid and CPR course. The act also requires some training of employees of businesses that pierce earlobes, though it is not as extensive as those who pierce other body parts. "You don't just give someone an ear-piercing gun and say, 'Have a go at it,' " said Justin Malan, executive director of the California Conference of Directors of Environmental Health. Malan's organization supports the new rules, which were crafted with the help of parlor owners. The act would replace existing 10-year-old sanitation regulations and a requirement that parlor owners register with counties by paying a one-time $25 fee. The new act requires that parlor owners renew a county health permit every year. Public health officials say that California needs greater scrutiny of these businesses because of their extraordinary growth. In 10 years, there's been a 400 percent increase in the number of piercing and tattooing establishments. About 36 percent of Americans between 18 and 29 are tattooed now, according to estimates by the American Academy of Dermatology. Health officials are concerned that customers could suffer from infections and disease at the hands of untrained and unscrupulous artists, Malan said. Santa Clara County, he said, received a report two years ago of a possible hepatitis B infection that might have been transmitted at a tattoo show. "You just need a few dozen of these folks who aren't practicing safe body art to put the public at risk," Malan said. E-mail reporter Susan Ferriss at sferriss(at)sacbee.com. (Distributed by Scripps Howard News Service, www.scrippsnews.com.) Must credit Sacramento Bee .......................................................................... __________________________________________________________________________ Global medical devices industry: Procurement strategies and the impact of recession News-Medical.Net (09.09.09) http://www.researchandmarkets.com/research/1bdb59/global_medical_dev Research and Markets has announced the addition of Global Markets Direct's new report "Global Medical Devices Industry Outlook to 2010: Buyer Spend and Procurement Strategies and the Impact of Recession and Recovery" to their offering. "Global Medical Devices Industry Outlook to 2010" is a new report published by Global Markets Direct in association with ICD Research that analyzes how medical equipment companies spend, procurement strategies & practices and business are being affected by the recession. In an uncertain economic climate this report gives you access to the category- level spending outlooks, buyer budgets, supplier selection criteria, business challenges and investment opportunities of leading purchase decision makers. The report also identifies buyers and suppliers future growth, M&A and investment expectations. The research is based on an extensive survey of senior and C-level industry executives from our market leading panels. Scope The opinions and forward looking statements of over 150 medical device manufacturer respondents have been captured in our in-depth survey, of which 80% represent Directors, C-levels & Departmental Heads This report covers data and analysis on buyer spend, procurement and industry developments by medical device manufacturers and contractors and industry suppliers worldwide The report examines current practices and provides future expectations over the next 12-24 months The research is based on primary survey research conducted by Global Markets Direct in association with ICD Research accessing its B2B panels comprised of senior purchase decision makers and leading supplier organizations Key topics covered include buyer spend activity, procurement behaviors & strategies and how these have been affected by the recession, threats & opportunities for the medical devices industry, economic outlook and business confidence. In the report buyers identify what suppliers need to do to maintain their business and the key actions being taken by industry players to overcome the leading business threats The report provides qualitative analysis of the key industry threats and opportunities and contains full survey results The geographical scope of the research is global - drawing on the activity and expectations of leading industry players across the Americas, Europe, Asia-Pacific and Africa & Middle East Highlights As many as 56% of medical device manufacturers and contractors expect to increase their procurement spend over the next 12 months, and a further 20% looking to maintain it at current levels, and with many claiming to be re-evaluating their supplier base the market open to competition is expected to increase over the coming year 30% of industry buyers are seeking to engage in partnerships to optimize working capital and reduce costs - closer cooperation between suppliers and buyers is being sought during this time of market uncertainty Only 22% of industry buyers do not regularly evaluate suppliers to ensure they meet high ethical and environmental standards http://www.researchandmarkets.com .......................................................................... __________________________________________________________________________ USA: New York May Tighten Review of Inmate HIV/Hepatitis Care Jessica M. Pasko, Associated Press (04.09.09) Gov. David Paterson is considering a bill that would require the New York State Health Department to monitor the care of state and local prisoners with HIV or hepatitis C. Under the measure, the department would be responsible for conducting annual treatment reviews, mandating necessary changes, and releasing annual reports on its findings. The state Department of Correctional Services is currently responsible for overseeing the health care it provides inmates. Jails are governed at the local level with limited state involvement. Of New York's total prison population of roughly 59,400, 3,100 inmates are HIV-positive and 7,000 or so have hepatitis C, US Department of Justice data show. Advocates say that although prison health care has improved in recent years, inconsistencies among various prisons and jails remain. The issue of inmates with HIV and hepatitis C becomes a public health concern when the former prisoners return to their communities, supporters note. If Paterson signs the bill, monitoring of state prison care would begin immediately, and oversight of local jails would start in two years. The governor will review the legislation and seek information from the agencies before making a decision, said his spokesperson, Morgan Hook. If the bill becomes law, New York would become a leader in addressing HIV and hepatitis C in the correctional system, said Sen. Thomas Duane (Manhattan), who sponsored the measure. Neither the American Civil Liberties Union National Prison Project nor the National Commission on Correctional Health could recall any other state that has legislated prison monitoring and oversight by a health department. __________________________________________________________________________ _____________________________________*____________________________________ __________________________________________________________________________ * SAFETY OF INJECTIONS brief yourself at: www.injectionsafety.org A fact sheet on injection safety is available at: http://www.who.int/mediacentre/factsheets/fs231/en/index.html * Visit the WHO injection safety website and the SIGN Alliance Secretariat at: http://www.who.int/injection_safety/en/ Download the latest injection safety Best Practices review at: http://www.uqconnect.net/signfiles/Files/BestPracticesJul2003.pdf Use the Toolbox at: http://www.who.int/injection_safety/toolbox/en/ Subscribe or un-subscribe by email to: sign@uq.net.au, sign@who.int or on subscribe online at: http://www.who.int/injection_safety/sign/en/ Get SIGN files on the web at: http://www.uqconnect.net/signfiles/Files/ get SIGNpost archives at: http://www.uqconnect.net/signfiles/Archives/?M=D The SIGN Secretariat, the Department of Essential Health Technologies, WHO, Avenue Appia 20, CH-1211 Geneva 27, Switzerland. Telephone: +41 22 791 3680, Facsimile: +41 22 791 4836, E- mail: sign@who.int _____________________________________*____________________________________ __________________________________________________________________________ SIGN meets annually to aid collaboration and synergy among SIGN network participants worldwide. The 2009 SIGN annual meeting will be held from 30 November to Wednesday 2 December 2009 at WHO Headquarters in Geneva Switzerland. The PQS (performance Quality and Safety) consultative meeting with the industry, will be held back to back with the SIGN meeting on 3rd and 4th December 2009. Get the final report of the SIGN Meeting 2008, Moscow, Russian Federation [2.36Mb] at: http://www.who.int/injection_safety/2008MeetingReport.pdf Many SIGN files can be opened in Acrobat Reader. To access all the features in Adobe Acrobat documents download the Acrobat Reader at: http://www.adobe.com/products/acrobat/readstep2.html Translation tools are available at: http://www.google.com/language_tools or http://www.freetranslation.com __________________________________________________________________________ All members of the SIGN Forum are invited to submit messages, comment on any posting, or to use the forum to request technical information in relation to injection safety. The comments made in this forum are the sole responsibility of the writers and does not in any way mean that they are endorsed by any of the organizations and agencies to which the authors may belong. Use of trade names and commercial sources is for identification only and does not imply endorsement. Contributions to: sign@uq.net.au or use your reply button! The SIGN Forum welcomes new subscribers who are involved in injection safety. Please subscribe by sending an email to: sign@who.int _____________________________________*____________________________________ The SIGN Internet Forum was established at the initiative of the World Health Organization's Department of Essential Health Technologies. The SIGN Forum is moderated by Allan Bass and is hosted on the University of Queensland computer network. http://www.uq.edu.au __________________________________________________________________________