*SAFE INJECTION GLOBAL NETWORK* SIGNPOST *SAFE INJECTION GLOBAL NETWORK* SIGN 2009 30 November to 2 December 2009 at WHO HQ Geneva Post00515 Waste Law + Abstract Round-Up + Book + News 07 October 2009 CONTENTS 1. Interview: HCWM Policy Advances in RSA - National Environmental Management: Waste Act, 2008 2. Abstract: Prevalence of and risk factors for hepatitis B and C infection among Mongolian blood donors 3. Abstract: Quality of medication use in primary care - mapping the problem, working to a solution: a systematic review of the literature 4. Abstract: Occupational and nonoccupational postexposure prophylaxis for HIV in 2009 5. Abstract: Waste management in hospitals. Current situation in the state of North Rhine-Westphalia 6. Abstract: Sharps management and the disposal of clinical waste 7. Abstract: Discounting future green: money versus the environment. 8. Abstract: Knowledge and attitude regarding standard precautions in a Brazilian public emergency service: a cross-sectional study 9. Abstract: Injection drug use is a risk factor for HCV infection in urban Egypt 10. Abstract: Young adult injection drug users in the United States continue to practice HIV risk behaviors 11. Abstract: Presence of hepatitis C virus in syringes confiscated in prisons in Australia 12. Abstract: Acute hepatitis C virus infection in young adult injection drug users: a prospective study of incident infection, resolution, and reinfection 13. Abstract: Improving substance abuse treatment enrollment in community syringe exchangers 14. Abstract: Application and evaluation of a web-based education program on blood-borne infection control for nurses 15. Abstract: Quality of paediatric blood transfusions in two district hospitals in Tanzania: a cross-sectional hospital based study 16. Abstract: Women and vaccinations: From smallpox to the future, a tribute to a partnership benefiting humanity for over 200 years 17. Abstract: Preventing healthcare-associated infection: risks, healthcare systems and behaviour 18. Abstract: Hand hygiene and infection in hospitals: what do the public know; what should the public know? 19. Abstract: A national study of cross infection control: 'are we clean enough?' 20. Abstract: Occupational blood exposure among unlicensed home care workers and home care registered nurses: are they protected? 21. Abstract: The long and winding road leading to the identification of the hepatitis C virus 22. Abstract: Assessing the risk from emerging infections 23. Abstract: Compliance with hand hygiene on surgical, medical, and neurologic intensive care units: Direct observation versus calculated disinfectant usage 24. Abstract: Clean Hands Campaign. No chance for hospital infections! 25. Abstract: Evaluation of home health care nurses' practice and their employers' policies related to bloodborne pathogens 26. Abstract: Attitudes and behavior of dental students concerning infection control rules: a study with a 10-year interval 27. Abstract: Do we need an ethical framework for hospital infection control? 28. Abstract: Infection control during filoviral hemorrhagic fever outbreaks: preferences of community members and health workers in Masindi, Uganda 29. Abstract: Dangers of cornstarch powder on medical gloves: seeking a solution 30. Abstract: Efficacy and safety of AIR inhaled insulin compared to insulin lispro in patients with type 1 diabetes mellitus in a 6-month, randomized, noninferiority trial 31. Abstract: Safety of intravenous infusion of doripenem 32. Abstract: Ethyl chloride spray for sensory relief for botulinum toxin injections of the hands and feet 33. Abstract: A systematic review and meta-analysis of the risk of microbial contamination of aseptically prepared doses in different environments 34. Abstract: The potential role of mobile phones in the spread of bacterial infections 35. No Abstract: Health care waste management at an academic hospital: knowledge and practices of doctors and nurses 36. No Abstract: A survey of needlesticks and sharp instrument injuries in emergency health care in Turkey 37. No Abstract: Hepatitis B-related policies: Inconsistent patient safety in Indonesian hospitals 38. Book Review: Networked disease: emerging infections in the global city 39. Country Representative - Mozambique 40. Announcing the 2nd The International Conference on ICT for Africa 2010-- March 25-28, 2010; Yaounde-Cameroon 41. News - USA: More than 1,800 Broward General patients may have been exposed to blood- borne infection: - Australia: Needle program success - Pakistan: Hazardous injections - USA: Ex-Army nurse faces four years for admitting he infected patient w with hepatitis - Africa: The hidden cost of disease transmission associated with unsafe injection practice - Corporate Council on Africa Health Plenary - Australia: Hepatitis C rates halved after heroin drought - Egypt: Hepatitis C emerges as Egypt’s top health crisis This edition of SIGNpost is located at: http://uqconnect.net/signfiles/Archives/SIGN-POST00515.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. Interview: HCWM Policy Advances in RSA - National Environmental Management: Waste Act, 2008 This transcript of an interview of Dr. Rose Mulumba, Country Director of the Making Medical Injections Safer project in RSA, by Marcia Rock, JSI, was originally posted to the HCWM working group and is posted in edited form to the SIGN community. Many thanks to Rose and Marcia for this. Congratulations! __________________________________________________________________________ From: Marcia Rock Sent: 02 October 2009 Subject: Fwd: HCWM Policy Advances in RSA - National Environmental Management: Waste Act, 2008 Important progress of legislation on HCWM in RSA - Best regards to all. Marcia Rock Marcia N. Rock, MPH Technical Officer HCWM Focal Point John Snow, Incorporated 1616 N. Fort Myer Drive Arlington, VA 22209-3100 Tel (703)310-5257Fax (703)528-7480 .......................................................................... __________________________________________________________________________ Dear HCWM Working Group, Along with appropriate technology, POLICY is probably the most important area for protecting health and the environment and for achieving improvements in the management of healthcare waste. In an historic development, the Republic of South Africa (RSA) has developed and recently enacted the New Waste Management Act. This Act was Assented in March 2009 and promulgated in July 2009. Dr. Rose Mulumba, Country Director of the Making Medical Injections Safer project in RSA, has been integrally involved in the process. We asked her about that experience and her responses appear here. This interview is shared for those whose work is also affected by national policy. Your questions and comments are welcome and further information can be provided upon request. .......................................................................... __________________________________________________________________________ The text of this interview has been edited to remove proprietary information directly related to the crucial work carried out by JSI in support of this national legislation. .......................................................................... __________________________________________________________________________ 1) Rose, What is the status of the New Waste Management Act in the RSA? The New Waste Management Act process is under way. Despite a few reservations from some of the stakeholders, the Legislative process itself seems to have gone on well, with the Bill passed and the new Act now assented into Law by the State President. A date for when the Act comes into effect is however yet to be promulgated and the Act specifically asks for a strategy to be put in place within 2 years. MMIS is part of the development processes related to the said strategy, which needs to be in place before the Law can come into effect. It has been Gazetted in the meantime to the general Public for information and be downloaded on www.lexinfo.co.za, please go to latest news and click on 2008 Acts. The Waste Management Act is Act 59 of 2008. Part of the strategy will deal with the various streams of waste (therefore including health care waste and heath care risk waste) and address areas such as Municipal Waste. MMIS belongs to the group working on health care risk waste, the outcome of which will consist in Regulations attached to Act 59. Acts of Parliament are meant to deal just with general principles and matters. We are glad things have gone on well thus far. 2) How will the National Environmental Management: Waste Act, 2008 affect the management of healthcare waste in South Africa? Act 59 of 2008 ESSENTIALLY REFORMS THE LAW REGULATING WASTE MANAGEMENT IN SOUTH AFRICA. In this context it makes provision for institutional arrangements and planning matters; for national norms and standards for regulating the management of waste by all spheres of government; for specific waste management measures; for the licensing and control of waste management activities; for the remediation of contaminated land; for the national waste information system ; for compliance and enforcement; and provides for matters connected therewith. Following promulgation, Regulations will be put in place with regard to Health Care Risk Waste according to section 69 of the Act. 4) What was the most important part of the process leading to ACT 59 of 2008? MAKING A STRATEGIC DECISION A FEW YEARS AGO TO SEPARATE THE LEGISLATIVE AND REGULATORY PROCESSES FROM THE POLICY AND STRATEGY DEVELOPMENT ONE. 5) What are the next steps to move from Act to Policy to Strategy? . DRAFTING AND FINALISING REGULATIONS FOR ACT 59 OF 2008 . CONSULTING AND AGREEING WITH STAKEHOLDERS ON A COMMON STRATEGY AND POLICY, THE DRAFTS OF WHICH HAVE BEEN CIRCULATED AS WELL AS PRESENTED AT A NATIONAL WASTE MANAGEMENT FORUM. 6) What advice would you give to others who are striving to achieve develop policy and plans to improve the management of healthcare waste in their country? . TO NOT BE SHY IN ACKNOWLEDGING THE EXTENT OF THE CHALLENGES FACED IN THIS AREA . AT THE SAME TIME BE SYSTEMATIC BY BREAKING UP THE TASK IN PIECES. THEY WILL REALISE THAT A POLICY FOR EXAMPLE ISN'T ENOUGH WITHOUT A STRATEGY TO IMPLEMENT IT. . SIMILARLY, AS MUCH AS A LEGISTATIVE FRAMEWORK IS PARAMOUNT IN CONTEXTUALISING WHAT THE ABOVE TOOLS WOULD DO, AN ACT OF PARLIAIMENT WITHOUT REGULATIONS STILL LEAVES LOOPHOLES WHICH IS ONE OF THE BIG PROBLEMS WITH HCW OR WASTE MANAGEMENT IN GENERAL: THE LACK OF SPECIFIC FRAMES OF REFERENCE AND THE INABILITY TO PIN DOWN INSTITUTIONS AND/OR INDIVIDUALS WHO FAIL TO ADHERE TO WHAT COULD BE DEFINED AS NORM OR STANDARD. LIKEWISE, DO NOT UNDER ESTIMATE THE IMPORTANCE OF GUIDELINES, HOWEVER, ALL THESE TOOLS SHOULD SERVE A DIFFERENT ALTOUGH RELATED PURPOSE. . IDENTIFY ROLE PLAYERS; ENCOURAGE COOPERATIVE GOVERNANCE (BETWEEN THE DIFFERENT SPHERES OF GIVEN GOVERNMENT DEPARTMENTS -NATIONAL, PROVINCIAL AND LOCAL - AS WELL AS BETWEEN DIFFERENT GOVERNEMENT DEPARTMENTS - HEALTH, ENVIRONMENTAL AND WATER AFFAIRS FOR EXAMPLE); RAISE AWARENESS AND SHARE INFORMATION WITH THE GENERAL PUBLIC. . ENSURE BUY-IN FROM DECISION MAKERS. . ALL OF US ALSO NEED TO REALISE AS WELL THAT THIS CAN ONLY BE A MULTI- YEAR PROCESS IN TERMS OF IMPLEMENTATION, THERE NEEDS TO BE A REALISATION THAT CERTAIN THINGS WILL NEED TO BE "PHASED OUT" AND CAN ONLY BE DONE AWAY WITH OVER TIME. . AND THAT OVER SUCH TIME, THERE SHOULD BE WORK DONE IN THE FORM OF EVALUATION AND/OR RESEARCH TO MEASURE PROGRESS AND CHART A DIFFERENT COURSE OF ACTION IF AND WHEN NEEDED. Rose, Thank you for sharing this experience and congratulations for the progress that your work and the work of the MMIS project represents. __________________________________________________________________________ _____________________________________*____________________________________ 2. Abstract: Prevalence of and risk factors for hepatitis B and C infection among Mongolian blood donors __________________________________________________________________________ Transfusion. 2009 Sep 25. Prevalence of and risk factors for hepatitis B and C infection among Mongolian blood donors. Tserenpuntsag B, Nelson K, Lamjav O, Triner W, Smith P, Kacica M, McNutt LA. From the Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, and Albany Medical College, Albany, New York; the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; the Blood Center at Ministry of Health Mongolia, Ulaanbaatar, Mongolia; and the New York State Department of Health, New York, New York. BACKGROUND: Mongolia has one of the highest rates of viral hepatitis infections worldwide yet risk factors have been largely unstudied. This sentinel study of hepatitis infection in Mongolia determined the prevalence of hepatitis B virus surface antigen (HBsAg) and hepatitis C virus antibody (anti-HCV) among a sample of blood donors and identified demographic and behavioral factors associated with hepatitis infection. STUDY DESIGN AND METHODS: Data were collected by interview from 923 Ministry of Health Blood Center donors between August 2004 and February 2005. The exposure variables collected included donor demographics and health and behavioral risk factors. Bivariate and multivariate analyses assessed the prevalence ratio of hepatitis infection for each exposure. RESULTS: Of 923 donors, 72 tested positive for HBsAg (7.8%; 95% confidence interval [CI], 6.1%-9.7%), 89 donors tested positive for anti-HCV (9.6%; 95% CI, 7.8%-11.5%), and six (0.6%) tested positive for both HBsAg and anti-HCV. Prevalence of HBsAg was highest among donors 18 to 19 years and anti-HCV tended to be most prevalent among those more than 40 years of age. Both pregnancy and alcohol use were associated with seroprevalent anti-HCV. CONCLUSION: This sentinel study of hepatitis prevalence among Mongolian blood donors sheds considerable light on the epidemiology of hepatitis virus infection as well as the sociodemographic and behavioral risk factors associated with infection. Young age (HBsAg) and pregnancy (anti- HCV) were significant risk factors for hepatitis virus infection, indicating that improvements in education, vaccination rates, and general infection control procedures in health care institutions may reduce behavioral and nosocomial transmission. __________________________________________________________________________ _____________________________________*____________________________________ 3. Abstract: Quality of medication use in primary care - mapping the problem, working to a solution: a systematic review of the literature __________________________________________________________________________ BMC Med. 2009 Sep 21;7(1):50. Quality of medication use in primary care - mapping the problem, working to a solution: a systematic review of the literature. Garfield S, Barber N, Walley P, Willson A, Eliasson L. BACKGROUND: The UK, USA and the World Health Organization have identified improved patient safety in healthcare as a priority. Medication error has been identified as one of the most frequent forms of medical error and is associated with significant medical harm. Errors are the result of the systems that produce them. In industrial settings, a range of systematic techniques have been designed to reduce error and waste. The first stage of these processes is to map out the whole system and its reliability at each stage. However, to date, studies of medication error and solutions have concentrated on individual parts of the whole system. In this paper we wished to conduct a systematic review of the literature, in order to map out the medication system with its associated errors and failures in quality, to assess the strength of the evidence and to use approaches from quality management to identify ways in which the system could be made safer. METHODS: We mapped out the medicines management system in primary care in the UK. We conducted a systematic literature review in order to refine our map of the system and to establish the quality of the research and reliability of the system. RESULTS: The map demonstrated that the proportion of errors in the management system for medicines in primary care is very high. Several stages of the process had error rates of 50% or more: repeat prescribing reviews, interface prescribing and communication and patient adherence. When including the efficacy of the medicine in the system, the available evidence suggested that only between 4% and 21% of patients achieved the optimum benefit from their medication. Whilst there were some limitations in the evidence base, including the error rate measurement and the sampling strategies employed, there was sufficient information to indicate the ways in which the system could be improved, using management approaches. The first step to improving the overall quality would be routine monitoring of adherence, clinical effectiveness and hospital admissions. CONCLUSION: By adopting the whole system approach from a management perspective we have found where failures in quality occur in medication use in primary care in the UK, and where weaknesses occur in the associated evidence base. Quality management approaches have allowed us to develop a coherent change and research agenda in order to tackle these, so far, fairly intractable problems. __________________________________________________________________________ _____________________________________*____________________________________ 4. Abstract: Occupational and nonoccupational postexposure prophylaxis for HIV in 2009 __________________________________________________________________________ Top HIV Med. 2009 Jul-Aug;17(3):104-8. Occupational and nonoccupational postexposure prophylaxis for HIV in 2009. Landovitz RJ. University of California Los Angeles, Center for Clinical AIDS Research and Education, Los Angeles, CA, USA. Data supporting the efficacy of HIV postexposure prophylaxis (PEP) come largely from a small number of older studies and case reports in health care workers, studies of transmission from infected mothers to their infants, and animal studies. These data also provide support for the current recommendations regarding duration of PEP and the window of time within which PEP should be started. Although much of the available data are from experience with older 2-drug regimens, newer potent 2- and 3-drug regimens are increasingly used in occupational exposure management, and drugs with mechanisms of action targeting early events in infection (eg, entry inhibitors, integrase inhibitors) may in the future become attractive options. Nonoccupational PEP remains controversial, although its feasibility and safety have been demonstrated in a number of programs. Existing recommendations generally call for its use within 72 hours of high-risk contact with a high-risk or HIV-infected source individual. This article summarizes a presentation on PEP for HIV infection made by Raphael J. Landovitz, MD, at the IAS-USA continuing medical education course held in Los Angeles in February 2009. The original presentation is available as a Webcast at www.iasusa.org. __________________________________________________________________________ _____________________________________*____________________________________ 5. Abstract: Waste management in hospitals. Current situation in the state of North Rhine-Westphalia __________________________________________________________________________ Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2009 Jul;52(7):753-63. [Waste management in hospitals. Current situation in the state of North Rhine-Westphalia] [Article in German] Popp W, Hansen D, Hilgenhöner M, Grandek M, Heinemann A, Blättler T. Krankenhaushygiene, Universitätsklinikum Essen, Hufelandstr. 55, 45122 Essen. walter.popp@uk-essen.de In 20 hospitals in North Rhine-Westphalia in-plant handling wastes and the delivery of the waste to the disposer were examined. Deficits were seen regarding risk assessment and operating instructions, support by company doctors, personal protection equipment, and break areas for the waste collecting personnel. Also the qualification of the waste management officer and his/her time contingent, correct declaration of the wastes, the training of the waste collecting personnel, the cleaning of multi-use containers and transportation vehicles, storage of the wastes at the collecting points, and the use of sharp collecting boxes were to be partly criticized. Consequences and recommendations are given, concerning the company's obligations (e.g., provide risk assessment, operating instructions), waste management officer (e.g., qualification, enough time contingent, regular inspections), waste collecting personnel (e.g., training courses), industrial safety (e.g., protection equipment, break area wash places), company doctors, transportation vehicles in the house (e.g., regular cleaning), one-way collectors (e.g., labelling at the site of the collection), multi-use collectors (e.g., cleaning), and compressing containers (e.g., larger maintenance openings). __________________________________________________________________________ _____________________________________*____________________________________ 6. Abstract: Sharps management and the disposal of clinical waste __________________________________________________________________________ Br J Nurs. 2009 Jul 23-Aug 12;18(14):860, 862-4. Sharps management and the disposal of clinical waste. Blenkharn JI. Blenkharn Environmental, London. Dangerous errors in clinical waste management continue to occur and inappropriate items find their way into clinical waste sacks that are not designed to hold sharp or heavy items, or fluids. Although great attention is given to the safe use of sharps, needles still find their way into waste sacks instead of a sharps bin. Sharps injuries among ancillary and support staff, and waste handlers working in the disposal sector, can occur at a rate greater than for health-care staff. Blood and body fluid exposures from carelessly packaged clinical waste are similarly common, with almost 100% of waste handlers having blood splashes on their clothing within four hours of starting a shift. Blood splashes are also common on the outside surfaces of sharps bins and on the frames supporting clinical waste sacks. Using forensic techniques, blood residues invisible to the naked eye can be detected on all surfaces of most sharps bins and on the bench top, walls and floor where the bins were positioned. Care is required when disposing of clinical waste, to protect and maintain the immediate environment from contamination, and to ensure the safety of those who come into contact with waste as it passes along the disposal chain. __________________________________________________________________________ _____________________________________*____________________________________ 7. Abstract: Discounting future green: money versus the environment. __________________________________________________________________________ J Exp Psychol Gen. 2009 Aug;138(3):329-40. Discounting future green: money versus the environment. Hardisty DJ, Weber EU. Department of Psychology, Columbia University, New York, NY 10027, USA. djh2117@columbia.edu In 3 studies, participants made choices between hypothetical financial, environmental, and health gains and losses that took effect either immediately or with a delay of 1 or 10 years. In all 3 domains, choices indicated that gains were discounted more than losses. There were no significant differences in the discounting of monetary and environmental outcomes, but health gains were discounted more and health losses were discounted less than gains or losses in the other 2 domains. Correlations between implicit discount rates for these different choices suggest that discount rates are influenced more by the valence of outcomes (gains vs. losses) than by domain (money, environment, or health). Overall, results indicate that when controlling as many factors as possible, at short to medium delays, environmental outcomes are discounted in a similar way to financial outcomes, which is good news for researchers and policy makers alike. __________________________________________________________________________ _____________________________________*____________________________________ 8. Abstract: Knowledge and attitude regarding standard precautions in a Brazilian public emergency service: a cross-sectional study __________________________________________________________________________ Rev Esc Enferm USP. 2009 Jun;43(2):313-9. Knowledge and attitude regarding standard precautions in a Brazilian public emergency service: a cross-sectional study. Oliveira AC, Marziale MH, Paiva MH, Lopes AC. Department of Basic Nursing, College of Nursing, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil. acoliveira@ufmg.br The purpose of this study was to assess the knowledge and attitude of health care professionals regarding their use of universal precaution measures at a public emergency service. The study also aimed to assess the rates of occupational accidents involving biological substances among those workers. This study was performed with 238 workers, from June to November 2006, using univariate and multivariate analysis. The chance of not adopting precaution measures was 20.7 (95% CI: 5.68 - 75.14) times greater among drivers compared to physicians. No significant association was found between adopting universal precaution measures. The occupational accident rate was 20.6% (40.8% involving sharp-edged objects). The risk of physicians having an occupational accident was 2.7(95% CI: 1.05 -7.09) times higher than that of drivers. The fact that a staff member had adequate knowledge about universal precaution measures was insufficient to foster compatible attitudes towards reducing the risk of transmitting infectious agents and causing occupational accidents. __________________________________________________________________________ _____________________________________*____________________________________ 9. Abstract: Injection drug use is a risk factor for HCV infection in urban Egypt __________________________________________________________________________ PLoS One. 2009 Sep 28;4(9):e7193. Injection drug use is a risk factor for HCV infection in urban Egypt. Jimenez AP, Mohamed MK, Eldin NS, Seif HA, El Aidi S, Sultan Y, Elsaid N, Rekacewicz C, El-Hoseiny M, El-Daly M, Abdel-Hamid M, Fontanet A. Emerging Disease Epidemiology Unit, Institut Pasteur, Paris, France. adelapaez@yahoo.com OBJECTIVE: To identify current risk factors for hepatitis C virus (HCV) transmission in Greater Cairo. DESIGN AND SETTING: A 1:1 matched case- control study was conducted comparing incident acute symptomatic hepatitis C patients in two "fever" hospitals of Greater Cairo with two control groups: household members of the cases and acute hepatitis A patients diagnosed at the same hospitals. Controls were matched on the same age and sex to cases and were all anti- HCV antibody negative. Iatrogenic, community and household exposures to HCV in the one to six months before symptoms onset for cases, and date of interview for controls, were exhaustively assessed. RESULTS: From 2002 to 2007, 94 definite acute symptomatic HCV cases and 188 controls were enrolled in the study. In multivariate analysis, intravenous injections (OR = 5.0; 95% CI = 1.2-20.2), medical stitches (OR = 4.2; 95% CI = 1.6-11.3), injection drug use (IDU) (OR = 7.9; 95% CI = 1.4-43.5), recent marriage (OR = 3.3; 95% CI = 1.1-9.9) and illiteracy (OR = 3.9; 95% CI = 1.8-8.5) were independently associated with an increased HCV risk. CONCLUSION: In urban Cairo, invasive health care procedures remain a source of HCV transmission and IDU is an emerging risk factor. Strict application of standard precautions during health care is a priority. Implementation of comprehensive infection prevention programs for IDU should be considered. __________________________________________________________________________ _____________________________________*____________________________________ 10. Abstract: Young adult injection drug users in the United States continue to practice HIV risk behaviors __________________________________________________________________________ Drug Alcohol Depend. 2009 Sep 1;104(1-2):167-74. Young adult injection drug users in the United States continue to practice HIV risk behaviors. Rondinelli AJ, Ouellet LJ, Strathdee SA, Latka MH, Hudson SM, Hagan H, Garfein RS. San Diego State University, Graduate School of Public Health, 5500 Campanile Drive, San Diego, CA 92182, USA. BACKGROUND: Injection drug users (IDUs) are at risk of acquiring HIV through injection and sexual practices. METHODS: We analyzed data collected in five U.S. cities between 2002 and 2004 to identify correlates of HIV infection among 3285 IDUs ages 15-30 years. RESULTS: Overall, HIV prevalence was 2.8% (95% CI 2.3-3.4), ranging from 0.8% in Chicago to 6.3% in Los Angeles. Mean age was 24 years, 70% were male, 64% non-Hispanic (NH) white, 7% NH black, 17% Hispanic, and 12% were other/mixed race. HIV infection was independently associated with: race/ethnicity (NH black [AOR 4.1, 95% CI 1.9-9.1], Hispanic [AOR 3.6, 95% CI 1.5-8.4], or other/mixed [AOR 2.3, 95% CI 1.1-5.2] vs. NH white); males who only had sex with males compared to males who only had sex with females (AOR 15.3, 95% CI 6.8-34.5); injecting methamphetamine alone or with heroin compared to heroin only (AOR 4.0, 95% CI 1.7-9.7); reporting inconsistent means of obtaining income compared to regular jobs (AOR 2.3, 95% CI 1.1-4.8); and having a history of exchanging sex for money/drugs (AOR 2.8, 95% CI 1.5-5.2). CONCLUSIONS: More than two decades after injection and sexual practices were identified as risk factors for HIV infection, these behaviors remain common among young IDUs. While racial/ethnic disparities persist, methamphetamine may be replacing cocaine as the drug most associated with HIV seropositivity. HIV prevention interventions targeting young IDUs and address both sexual and injection practices are needed. __________________________________________________________________________ _____________________________________*____________________________________ 11. Abstract: Presence of hepatitis C virus in syringes confiscated in prisons in Australia __________________________________________________________________________ J Gastroenterol Hepatol. 2009 Oct;24(10):1655-7. Presence of hepatitis C virus in syringes confiscated in prisons in Australia. Dolan K, Larney S, Jacka B, Rawlinson W. National Drug and Alcohol Research Center, University of New South Wales, Sydney, NSW 2052, Australia. BACKGROUND AND AIMS: Needlestick injuries are an occupational hazard for prison officers. This study aimed to assess the presence of hepatitis C virus (HCV) in syringes found in prisons. METHODS: Sixty-nine syringes found in prisons were tested for HCV RNA using previously published methods. RESULTS: Three syringes tested positive for HCV RNA. CONCLUSION: Compared to the prevalence of HCV among injecting drug users in prisons, few syringes were found to contain HCV RNA. It is likely that conditions under which syringes are kept in prisons are not favorable for survival of detectable HCV RNA. Further work is needed to establish the risk of HCV transmission posed by needlestick injuries in prison settings. __________________________________________________________________________ _____________________________________*____________________________________ 12. Abstract: Acute hepatitis C virus infection in young adult injection drug users: a prospective study of incident infection, resolution, and reinfection __________________________________________________________________________ J Infect Dis. 2009 Oct 15;200(8):1216-26. Acute hepatitis C virus infection in young adult injection drug users: a prospective study of incident infection, resolution, and reinfection. Page K, Hahn JA, Evans J, Shiboski S, Lum P, Delwart E, Tobler L, Andrews W, Avanesyan L, Cooper S, Busch MP. University of California, San Francisco, 2Blood Systems Research Institute, and 3California Pacific Medical Center, San Francisco, and 4Novartis Vaccines and Diagnostics, Emeryville, California. Background. Hepatitis C virus (HCV) infection, clearance, and reinfection are best studied in injection drug users (IDUs), who have the highest incidence of HCV and are likely to represent most infections. Methods. A prospective cohort of HCV-negative young IDUs was followed up from January 2000 to September 2007, to identify acute and incident HCV and prospectively study infection outcomes. Results. Among 1,191 young IDUs screened, 731 (61.4%) were HCV negative, and 520 (71.1%) of the 731 were enrolled into follow-up. Cumulative HCV incidence was 26.7/100 person- years of observation (95% confidence interval [CI], 21.5-31.6). Of 135 acute/incident HCV infections, 95 (70.4%) were followed; 20 (21.1%) of the 95 infections cleared. Women had a significantly higher incidence of viral clearance than did men (age- adjusted hazard ratio, 2.91 [95% CI, 1.68-5.03]) and also showed a faster rate of early HCV viremia decline ([Formula: see text]). The estimated reinfection rate was 24.6/100 person- years of observation (95% CI, 11.7-51.6). Among 7 individuals, multiple episodes of HCV reinfection and reclearance were observed. Conclusions. In this large sample of young IDUs, females show demonstrative differences in their rates of viral clearance and kinetics of early viral decline. Recurring reinfection and reclearance suggest possible protection against persistent infection. These results should inform HCV clinical care and vaccine development. __________________________________________________________________________ _____________________________________*____________________________________ 13. Abstract: Improving substance abuse treatment enrollment in community syringe exchangers __________________________________________________________________________ Addiction. 2009 May;104(5):786-95. Comment in: Addiction. 2009 May;104(5):796-7. Improving substance abuse treatment enrollment in community syringe exchangers. Kidorf M, King VL, Neufeld K, Peirce J, Kolodner K, Brooner RK. Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA. mkidorf@jhmi.edu AIM: The present study evaluated the effectiveness of an intervention combining motivational enhancement and treatment readiness groups, with and without monetary incentives for attendance and treatment enrollment, on enhancing rates of substance abuse treatment entry among new registrants at the Baltimore Needle Exchange Program (BNEP). DESIGN: Opioid-dependent study participants (n = 281) referred by the BNEP were assigned randomly to one of three referral interventions: (i) eight individual motivational enhancement sessions and 16 treatment readiness group sessions (motivated referral condition--MRC); (ii) the MRC intervention with monetary incentives for attending sessions and enrolling in treatment--MRC+I); or (iii) a standard referral condition which directed participants back to the BNEP for referral (standard referral- SRC). Participants were followed for 4 months. FINDINGS: MRC+I participants were more likely to enroll in any type of treatment than MRC or SRC participants (52.1% versus 31.9% versus 35.5%; chi(2) = 9.12, P = 0.01), and more likely to enroll in treatment including methadone than MRC or SRC participants (40.4% versus 20.2% versus 16.1%; chi(2) = 16.65, P < 0.001). MRC+I participants also reported less heroin and injection use than MRC and SRC participants. CONCLUSIONS: Syringe exchange sites can be effective platforms to motivate opioid users to enroll in substance abuse treatment and ultimately reduce drug use and number of drug injections. __________________________________________________________________________ _____________________________________*____________________________________ 14. Abstract: Application and evaluation of a web-based education program on blood-borne infection control for nurses __________________________________________________________________________ Korean Acad Nurs. 2009 Apr;39(2):298-309. [Application and evaluation of a web-based education program on blood- borne infection control for nurses] [Article in Korean] Choi JS, Kim KS. Department of Nursing Science, Konyang University, Daejeon, Korea. jschoi408@empal.com PURPOSE: To develop a web-based program on blood-borne infection control and to examine the effect of the newly developed program on perceived threat of diseases, knowledge, preventive health behaviors for blood-borne infections, and incidence rates of accidental needle sticks and other sharp object injuries in nurses. METHODS: The program was developed through the processes of analysis, design, development, implementation, and evaluation. The research design involved a nonequivalent control group for pretest and posttest experiments. The setting was a 745-bed general hospital located in Korea. RESULTS: The program was designed and developed after consulting previous studies. After development of the program was completed, it was evaluated and revised by a panel of experts. The total score for perceived threat of diseases, knowledge, preventive health behaviors in the experimental group was significantly higher compared to the control group (p<.05). The incidence rates for needle sticks and other sharp object injuries in the experimental group were significantly lower compared to the control group (p<.05). CONCLUSION: Application of a Web- based, blood-borne infection control program is effective, and can be expanded to other healthcare workers who also have a high risk of blood- borne infections. __________________________________________________________________________ _____________________________________*____________________________________ 15. Abstract: Quality of paediatric blood transfusions in two district hospitals in Tanzania: a cross-sectional hospital based study __________________________________________________________________________ BMC Pediatr. 2009 Aug 14;9:51. Quality of paediatric blood transfusions in two district hospitals in Tanzania: a cross-sectional hospital based study. Mosha D, Poulsen A, Reyburn H, Kituma E, Mtei F, Bygbjerg IC. Kilimanjaro Christian Medical Centre, PO Box 3010, Moshi, Tanzania. dfmosha@hotmail.com BACKGROUND: Blood transfusion (BT) can be lifesaving for children; however, monitoring the quality of BT is important. The current study describes the quality of paediatric BT delivered in two district hospitals in north-east Tanzania in order to identify areas for quality assurance and improvement in the administration of BT. METHODS: All 166 children admitted in the paediatric wards and receiving BT through April to June 2007 were prospectively observed. Medical records, request forms and registers in the laboratories were reviewed to identify blood source, blood screening and indications for BT. BT was observation before, during and after transfusion process. RESULTS: Malaria related anaemia accounted for 98% of the BTs. Ninety-two percent of the children were assessed for paleness. Clinical signs such as difficult breathing and symptoms of cardiac failure were only assessed in 67% and 15% of the children respectively, prior to the BT decision. Pre- transfusion haemoglobin and body temperature were recorded in 2/3 of the patients, but respiratory rate and pulse rate were not routinely recorded. In 40% of BTs, the transfusion time exceeded the recommended 4 hours. The zonal blood bank (ZBB) and local donors accounted for 10% and 90% of the blood, respectively. ABO and RhD typing and screening for HIV and syphilis were undertaken in all transfused blood. Evidence for hepatitis B or C infection was not checked except in the ZBB. CONCLUSION: Criteria for BT are not always fulfilled; time to initiate and complete the transfusion is often unacceptable long and monitoring of vital signs during BT is poor. Blood from the ZBB was often not available and BT often depended on local donors which implied lack of screening for hepatitis B and C. It is recommended that an external supervision system be established to monitor and evaluate the quality of BT performance in the laboratories as well as in wards. __________________________________________________________________________ _____________________________________*____________________________________ 16. Abstract: Women and vaccinations: From smallpox to the future, a tribute to a partnership benefiting humanity for over 200 years __________________________________________________________________________ Hum Vaccin. 2009 Jul;5(7):450-4. Women and vaccinations: From smallpox to the future, a tribute to a partnership benefiting humanity for over 200 years. Datta SK, Bhatla N, Burgess MA, Lehtinen M, Bock HL. GlaxoSmithKline Biologicals, Rixensart, Belgium. Sanjoy.K.Datta@gskbio.com Vaccines were first developed in England over 200 years ago and have made a significant positive impact on human society since. Not often realized is the intimate relationship shared between vaccines and women. Women were key to the initial development of vaccines; some were even advocating the concept of protection against infectious disease through prior asymptomatic infection (by variolation) before the publication of the report of the first successful smallpox vaccination in 1798. Since that milestone, women have been important partners in the development of vaccines and advocates for their widespread introduction. Modern vaccine development would not be possible without the altruistic informed consent granted by many women for the participation of themselves or their children in vaccine clinical trials all over the world. Vaccines have rewarded women handsomely in return. Individual women benefit in many ways ranging from safer pregnancies to preventing cancers to attractive, unblemished skin. Some vaccines are even specifically designed to prevent diseases primarily affecting women such as cervical cancer. Vaccines also have offered societal benefits to women. These include better maternal health and fostering an environment more amenable to effective family planning. With these advances, women become more empowered and have access to better economic opportunities. The challenge of meeting the millennium development goals specifically targeted for women will be facilitated by vaccines. A better realization by women of the benefits of this partnership secured over the past 200 years will enable them to reap fully the rewards of the future. __________________________________________________________________________ _____________________________________*____________________________________ 17. Abstract: Preventing healthcare-associated infection: risks, healthcare systems and behaviour __________________________________________________________________________ Intern Med J. 2009 Sep;39(9):574-81. Preventing healthcare-associated infection: risks, healthcare systems and behaviour. Ferguson JK. Division of Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia. john.ferguson@hnehealth.nsw.gov.au More than 177 000 potentially preventable healthcare-associated infections (HAIs) occur per annum in Australia with sizable attributable mortality. Organizational systems to protect against HAI in hospitals in Australia are relatively poorly developed. Awareness and practice of infection control by medical and other healthcare staff are often poor. These lapses in practice create significant risk for patients and staff from HAI. Excessive patient exposure to antimicrobials is another key factor in the emergence of antibiotic-resistant bacteria and Clostridium difficile infection. Physicians must ensure that their interactions with patients are safe from the infection prevention standpoint. The critical preventative practice is hand hygiene in accord with the World Health Organization 5 moments model. Improving the use of antimicrobials, asepsis and immunization also has great importance. Hospitals should measure and feed back HAI rates to clinical teams. Physicians as leaders, role models and educators play an important part in promoting adherence to safe practices by other staff and students. They are also potentially effective system engineers who can embed safer practices in all elements of patient care and promote essential structural and organizational change. P atients and the public in general are becoming increasingly aware of the risk of infection when entering a hospital and expect their carers to adhere to safe practice. Poor infection control practice will be regarded in a negative light by patients and their families, regardless of any other manifest skills of the practitioner. __________________________________________________________________________ _____________________________________*____________________________________ 18. Abstract: Hand hygiene and infection in hospitals: what do the public know; what should the public know? __________________________________________________________________________ J Hosp Infect. 2009 Sep 25. Hand hygiene and infection in hospitals: what do the public know; what should the public know? Fletcher M. National Patient Safety Agency, London, UK. Healthcare-associated infection (HCAI) is a topic of increasing public interest, particularly to users of health services. At the same time, there is a move towards greater openness and transparency across the whole healthcare sector. Thus we see public reporting of performance in relation to rates of HCAI and infection control practices is increasingly well established in the NHS in England. So does any of this make a difference? And how embedded is the 'public right to know'? In this paper it is argued that, although the public right to know about rates of HCAIs is well recognised, the evidence base about the impact of such information is limited. The paper suggests actions which can be taken by boards and senior leaders in healthcare organisations to increase impact. Furthermore the example of hand hygiene suggests that we have some way to go in creating an environment in which patients feel empowered to ask questions that may reduce their own vulnerability to infection. __________________________________________________________________________ _____________________________________*____________________________________ 19. Abstract: A national study of cross infection control: 'are we clean enough?' __________________________________________________________________________ Br Dent J. 2009 Sep 26;207(6):267-74. A national study of cross infection control: 'are we clean enough?'. Shah R, Collins JM, Hodge TM, Laing ER. UCL Eastman Dental Institute, 256 Gray's Inn Road, London, WC1X 8LD. r.shah@eastman.ucl.ac.uk OBJECTIVE: To establish what cross infection control policies and procedures are in place within UK orthodontic departments and how they compare with recommended guidelines. DESIGN: A hospital-based cross- sectional study investigating UK orthodontic departments between March 2007 and January 2008. SUBJECTS AND METHODS: The main outcome measure was a questionnaire constructed for the study, based on current cross infection control guidelines. All orthodontic departments within district general hospitals were invited to participate via email and the response rate was 48%. RESULTS: Five key areas were explored, which included a) training, education and personal protection, b) the clinical environment, c) decontamination of instruments, d) decontamination of appliances and impressions and e) disposal of waste. Ninety-eight percent of departments provided training in cross infection control and 98% also had a policy to check staff immunisation status. With respect to the clinical environment, 97% of the departments surveyed had separate 'clean' and 'dirty' zones. Half of all departments used central sterile services departments (CSSD) for instrument sterilisation. Seventy-eight percent of departments had a policy to decontaminate impressions/appliances at the chairside and all departments used 'yellow bags' for clinical waste and puncture-proof containers for sharps waste. CONCLUSIONS: UK orthodontic departments have implemented policies and procedures which would ensure a high standard of cross infection control. In particular, this related to the decontamination of surfaces and instruments, the use of personal protection and disposal of clinical waste. Most departments had policies and procedures in place for staff education and training in cross infection control and personal protection. __________________________________________________________________________ _____________________________________*____________________________________ 20. Abstract: Occupational blood exposure among unlicensed home care workers and home care registered nurses: are they protected? __________________________________________________________________________ Am J Ind Med. 2009 Jul;52(7):563-70. Occupational blood exposure among unlicensed home care workers and home care registered nurses: are they protected? Lipscomb J, Sokas R, McPhaul K, Scharf B, Barker P, Trinkoff A, Storr C. School of Nursing, University of Maryland, Baltimore, Maryland 21201, USA. lipscomb@son.umaryland.edu BACKGROUND: Little is known about the risk of blood exposure among personnel providing care to individual patients residing at home. The objective of this study was to document and compare blood exposure risks among unlicensed home care personal care assistants (PCAs) and home care registered nurses (RNs). METHODS: PCAs self-completed surveys regarding blood and body fluid (BBF) contact in group settings (n = 980), while RNs completed mailed surveys (n = 794). RESULTS: PCAs experience BBF contact in the course of providing care for home-based clients at a rate approximately 1/3 the rate experienced by RNs providing home care (8.1 and 26.7 per 100 full time equivalent (FTE), respectively), and the majority of PCA contact episodes did not involve direct sharps handling. However, for PCAs who performed work activities such as handling sharps and changing wound dressings, activities much more frequently performed by RNs, PCAs were at increased risk of injury when compared with RNs (OR = 7.4 vs. 1.4) and (OR = 6.3 vs. 2.5), respectively. CONCLUSION: Both PCAs and RNs reported exposures to sharps, blood, and body fluids in the home setting at rates that warrant additional training, prevention, and protection. PCAs appear to be at increased risk of injury when performing nursing-related activities for which they are inexperienced and/or lack training. Further efforts are needed to protect home care workers from blood exposure, namely by assuring coverage and enforcement of the Occupational Safety and Health Administration (OSHA) Bloodborne Pathogen Standard [Occupational Safety and Health Administration. 1993. Frequently Asked Questions Concerning the Bloodborne Pathogens Standard. Available at: http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table= INTERPRETATIONS&p_id=21010#Scope. Accessed May 30, 2008]. http://tinyurl.com/ybpu88t __________________________________________________________________________ _____________________________________*____________________________________ 21. Abstract: The long and winding road leading to the identification of the hepatitis C virus __________________________________________________________________________ J Hepatol. 2009 Sep 10. The long and winding road leading to the identification of the hepatitis C virus. Houghton M. Epiphany Biosciences Inc., One California Street, Suite 2800 San Francisco, CA 94111, USA. This review describes work conducted largely in my laboratory at the Chiron corporation between 1982 and 1989 that led to the identification of the hepatitis C virus (HCV). Key colleagues included Dr. Qui-Lim Choo in my laboratory and Dr. George Kuo also of Chiron as well as my collaborator Dr. Daniel Bradley at the CDC who provided many biological samples from the NANBH chimpanzee model. Numerous molecular approaches were explored including the screening of tens of millions of bacterial cDNA clones derived from these materials. While this early genomics approach resulted in the identification of many host gene activities associated with NANBH, no genes of proven infectious etiology could be identified. A separate avenue of our research led to the molecular characterization of the complete hepatitis delta viral genome but unfortunately, this could not be used as a molecular handle for HCV. Largely following input from Dr. Kuo, I initiated a blind cDNA immunoscreening approach involving the large- scale screening of bacterial proteomic cDNA libraries derived from NANBH- infectious chimpanzee materials (prior to the development of PCR technology) using sera from NANBH patients as a presumptive source of viral antibodies. Eventually, this novel approach to identifying agents of infectious etiology led to the isolation of a single small cDNA clone that was proven to be derived from the HCV genome using various molecular and serological criteria. This discovery has facilitated the development of effective diagnostics, blood screening tests and the elucidation of promising drug and vaccine targets to control this global pathogen. __________________________________________________________________________ _____________________________________*____________________________________ 22. Abstract: Assessing the risk from emerging infections __________________________________________________________________________ Epidemiol Infect. 2009 Nov;137(11):1521-30. Assessing the risk from emerging infections. Morgan D, Kirkbride H, Hewitt K, Said B, Walsh AL. Department of Gastrointestinal, Emerging and Zoonotic Infections, Health Protection Agency Centre for Infections, London, UK. dilys.morgan@hpa.org.uk Emerging infections pose a constant threat to society and can require a substantial response, thus systems to assess the threat level and inform prioritization of resources are essential. A systematic approach to assessing the risk from emerging infections to public health in the UK has been developed. This qualitative assessment of risk is performed using algorithms to consider the probability of an infection entering the UK population, and its potential impact, and to identify knowledge gaps. The risk assessments are carried out by a multidisciplinary, cross- governmental group of experts working in human and animal health. This approach has been piloted on a range of infectious threats identified by horizon scanning activities. A formal risk assessment of this nature should be considered for any new or emerging infection in humans or animals, unless there is good evidence that the infection is neither a recognized human disease nor a potential zoonosis. __________________________________________________________________________ _____________________________________*____________________________________ 23. Abstract: Compliance with hand hygiene on surgical, medical, and neurologic intensive care units: Direct observation versus calculated disinfectant usage __________________________________________________________________________ Am J Infect Control. 2009 Sep 21. Compliance with hand hygiene on surgical, medical, and neurologic intensive care units: Direct observation versus calculated disinfectant usage. Scheithauer S, Haefner H, Schwanz T, Schulze-Steinen H, Schiefer J, Koch A, Engels A, Lemmen SW. Department of Infection Control and Infectious Diseases, University Hospital Aachen, Aachen, Germany. BACKGROUND: Hand hygiene (HH) is considered the single most effective measure to prevent and control health care-associated infections (HAIs). Although there have been several reports on compliance rates (CRs) to HH recommendations, data for intensive care units (ICUs) in general and for shift- and indication-specific opportunities in particular are scarce. METHODS: The aim of this study was to collect data on ICU-, shift-, and indication-specific opportunities, activities and CRs at a surgical ICU (SICU), a medical ICU (MICU), and a neurologic ICU (NICU) at the University Hospital Aachen based on direct observation (DO) and calculated disinfectant usage (DU). RESULTS: Opportunities for HH recorded over a 24- hour period were significantly higher for the SICU (188 per patient day [PD]) and MICU (163 per PD) than for the NICU (124 per PD). Directly observed CRs were 39% (73/188) in the SICU, 72% (117/163) in the MICU, and 73% (90/124) in the NICU. However, CRs calculated as a measure of DU were considerably lower: 16% (29/188) in the SICU, 21% (34/163) in the MICU, and 25% (31/124) in the NICU. Notably, CRs calculated from DO were lowest before aseptic tasks and before patient contact. CONCLUSIONS: To the best of our knowledge, this study provides the first data picturing a complete day, including shift- and indication-specific analyses, and comparing directly observed CRs with those calculated based on DU, the latter of which revealed a 2.75-fold difference. Worrisomely, CRs were very low, especially concerning indications of greatest impact in preventing HAIs, such as before aseptic task. Thus, the gathering of additional data on CRs and the reasons for noncompliance is warranted. __________________________________________________________________________ _____________________________________*____________________________________ 24. Abstract: Clean Hands Campaign. No chance for hospital infections! __________________________________________________________________________ Unfallchirurg. 2009 Jul;112(7):679-82. [Clean Hands Campaign. No chance for hospital infections!] [Article in German] Reichardt C, Eberlein-Gonska M, Schrappe M, Gastmeier P. Institut für Hygiene und Umweltmedizin, Charité-Universitätsmedizin Berlin, Hindenburgdamm 27, 12203 Berlin. christiane.reichardt@charite.de There are approximately 500,000 hospital acquired infections per year in Germany of which about 20-30% (100,000-150,000) could be prevented. Hospital acquired infections are associated with increased mortality and prolonged hospital stay. Based on approximately 4 additional days of hospital stay, nosocomial infections cause additional 2 million hospital days per year. In other words, 6 hospitals each with 1,000 beds would be caring solely for patients with nosocomial infections for 1 year in Germany. Experts agree that careful hand hygiene is the single most effective measure to prevent transmission of pathogens. The rate of nosocomial infections can be reduced by improved compliance of hand hygiene as demonstrated in the literature. The ''AKTION Saubere Hände'' (Clean Hands Campaign) is a national campaign by the National Reference Centre for the Surveillance of Nosocomial Infections, the Society for Quality Management in the Health System and the Action Alliance Patient Safety aimed at the sustained improvement of hand hygiene behaviour in German hospitals. __________________________________________________________________________ _____________________________________*____________________________________ 25. Abstract: Evaluation of home health care nurses' practice and their employers' policies related to bloodborne pathogens __________________________________________________________________________ AAOHN J. 2009 Jul;57(7):275-80. Evaluation of home health care nurses' practice and their employers' policies related to bloodborne pathogens. Scharf BB, McPhaul KM, Trinkoff A, Lipscomb J. University of Maryland, USA. The purpose of this descriptive study was to assess home health care nurses' exposure to bloodborne pathogens, evaluate Medicare Certified Home Healthcare Agency (MCHHA) and hospice organization practices related to the Occupational Safety and Health Administration's (OSHA) Bloodborne Pathogens Standard and the Needlestick Safety and Prevention Act, and link the two to recommend safety improvements. This study evaluated the experiences of 355 home health care nurses and 30 MCHHA and hospice employers in one mid-Atlantic state regarding bloodborne pathogen programs and practices and blood and sharps contact. An index was developed to evaluate employer compliance with OSHA's Bloodborne Pathogens Standard. Employer policies and nurse practice related to the OSHA Bloodborne Pathogens Standard did not meet all requirements despite identified risk. Thirty-eight home health care nurses from 12 of the 30 employers reported needlestick injuries within the past year, yet employers reported only 18 nurse needlestick injuries within the same year. Using the bloodborne pathogen compliance index, employers can review and revise their exposure control plans to ensure compliance. This intervention should benefit both employer policies and nurse practice to improve safety and decrease the risks from bloodborne pathogens in the home health care setting. __________________________________________________________________________ _____________________________________*____________________________________ 26. Abstract: Attitudes and behavior of dental students concerning infection control rules: a study with a 10-year interval __________________________________________________________________________ Braz Dent J. 2009;20(3):221-5. Attitudes and behavior of dental students concerning infection control rules: a study with a 10-year interval. Abreu MH, Lopes-Terra MC, Braz LF, Rímulo AL, Paiva SM, Pordeus IA. Department of Community and Preventive Dentistry, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil. maurohenriqueabreu@ig.com.br The study compared the attitudes and behavior of 4th-year dental students regarding infection control rules in 1995 and 2005. Self-administrated questionnaires were applied to 592 students at 5 different dental schools in 1995 (n=350) and in 2005 (n=242). The chi-square and Fisher's exact tests were used for statistical analysis of data. Significance level was set at p<0.05. The response rate was 90.3% in 1995 and 81.0% in 2005. There was no improvement in the use of rubber gloves (p=0.316), face masks (p=0.572) or gowns (p=0.862) between 1995 and 2005. There was a lesser frequency of the use of protective eyewear in 2005 (p<0.001). No student used the individual protection equipment correctly. There was a decrease in the sterilization of burs in 2005 when compared to 1995 (p<0.001). No student could describe the correct use of the autoclave. Disinfection and use of a dental chair barrier were done correctly by a minority of students in 1995 (2.8%) and 2005 (6.1%) (p=0.069). Most students correctly discarded perforating/cutting instruments in both years (p=0.749). The attitudes and behavior of dental students concerning infection control are worrisome. There was no improvement and, for some parameters, there was a worsening in the procedures over the time period evaluated. __________________________________________________________________________ _____________________________________*____________________________________ 27. Abstract: Do we need an ethical framework for hospital infection control? __________________________________________________________________________ J Hosp Infect. 2009 Sep 25. Do we need an ethical framework for hospital infection control? Millar M. Microbiology Department, Barts and the London NHS Trust, London, UK. Strategies for the control of the spread of infection in hospitals may lead to constraints on individual autonomy, freedom of movement, or contact with others. Codes of (ethical) practice for healthcare professionals tend to emphasise responsibilities to individual patients. Ethical frameworks for public health focus on groups of individuals (populations), the majority of whom are relatively healthy and empowered. Hospital infection control professionals must take account of both of these perspectives, sensitive to the care of infected and potentially infectious individuals, while protecting the vulnerable and relatively dependent population of hospital patients from further compromise to their health. A number of frameworks for an ethics of public health have been proposed over the last few years but there are sufficient differences in ethical considerations between collective interventions that aim to protect and promote the health of the public and interventions taken in the context of hospital infection control to justify a distinctive ethics of hospital infection control. Professional bodies may be best placed to lead the development of such a framework. __________________________________________________________________________ _____________________________________*____________________________________ 28. Abstract: Infection control during filoviral hemorrhagic fever outbreaks: preferences of community members and health workers in Masindi, Uganda __________________________________________________________________________ Trans R Soc Trop Med Hyg. 2009 Sep 22. Infection control during filoviral hemorrhagic fever outbreaks: preferences of community members and health workers in Masindi, Uganda. Raabe VN, Mutyaba I, Roddy P, Lutwama JJ, Geissler W, Borchert M . London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK; University of Minnesota Medical School, 420 Delaware St S.E., Minneapolis, MN 55455, USA. Interviews were conducted with health workers and community members in Masindi, Uganda on improving the acceptability of infection control measures used during an Ebola outbreak. Measures that promote cultural sensitivity and transparency of control activities were preferred and should be employed in future control efforts. We suggest assessing the practicality of body bags with viewing windows, and face shields with or without chin protectors, in future outbreaks. __________________________________________________________________________ _____________________________________*____________________________________ 29. Abstract: Dangers of cornstarch powder on medical gloves: seeking a solution __________________________________________________________________________ Ann Plast Surg. 2009 Jul;63(1):111-5. Comment in: Ann Plast Surg. 2009 Jul;63(1):1. Dangers of cornstarch powder on medical gloves: seeking a solution. Edlich RF, Long WB 3rd, Gubler DK, Rodeheaver GT, Thacker JG, Borel L, Chase ME, Fisher AL, Mason SS, Lin KY, Cox MJ, Zura RD. Departments of Plastic Surgery, University of Virginia Health System, Charlottesville, VA, USA. richardedlich@gmail.com This article reviews information on the hazards of cornstarch powder on medical gloves. Dusting powders were first applied to latex gloves to facilitate donning. After 1980, manufacturers devised innovative techniques without dusting powder. It has been well documented that these powders on gloves present a health hazard to patients and health care workers by 5 different mechanisms. First, the glove cornstarch has documented detrimental effects on wound closure techniques. Second, this powder potentiates wound infection. Third, cornstarch induces peritoneal adhesion formation and granulomatous peritonitis. Finally, these powders serve as carriers as latex allergen and they precipitate a life- threatening allergic reaction in sensitized patients. These well- documented hazards of glove powder have caused the United Kingdom and Germany to ban cornstarch powder on medical gloves over 10 years ago. __________________________________________________________________________ _____________________________________*____________________________________ 30. Abstract: Efficacy and safety of AIR inhaled insulin compared to insulin lispro in patients with type 1 diabetes mellitus in a 6-month, randomized, noninferiority trial __________________________________________________________________________ Diabetes Technol Ther. 2009 Sep;11 Suppl 2:S17-25. Efficacy and safety of AIR inhaled insulin compared to insulin lispro in patients with type 1 diabetes mellitus in a 6-month, randomized, noninferiority trial. Comulada AL, Renard E, Nakano M, Rais N, Mao X, Webb DM, Milicevic Z. Instituto de Endocrinología, Diabetes & Metabolismo, Toa Baja, Puerto Rico. BACKGROUND: Patients with type 1 diabetes may prefer features of AIR inhaled insulin (developed by Alkermes, Inc. [Cambridge, MA] and Eli Lilly and Company [Indianapolis, IN]; AIR is a registered trademark of Alkermes, Inc.) over insulin injection, but the two methods need to be compared for efficacy and safety. METHODS: This multicenter, 6-month, parallel-group, noninferiority trial had 500 patients with type 1 diabetes randomized to morning doses of basal insulin glargine plus either preprandial injectable insulin lispro or preprandial AIR insulin. We hypothesized that AIR insulin is noninferior (upper bound of the 95% confidence interval < or = 0.4%) to insulin lispro for change-from-baseline hemoglobin A1C (A1C). RESULTS: Baseline A1C was 7.95 +/- 0.08% for both groups. At end point, A1C was lower with insulin lispro than with AIR insulin by 0.27% (95% confidence interval 0.11, 0.43; P< 0.001). Noninferiority of AIR insulin to insulin lispro was not demonstrated, but similar percentages of patients in each group achieved A1C <7.0% (P = 0.448). Overall daily blood glucose was similar between groups at baseline (P = 0.879) and end point (P = 0.161). Two-hour postprandial blood glucose change from baseline was significantly (P < 0.001) higher with AIR insulin (20.77 +/- 4.33 mg/dL at 3 months and 15.85 +/- 3.08 mg/dL at end point) than with insulin lispro (3.29 +/- 4.14 mg/dL at 3 months and 1.67 +/- 2.91 mg/dL at end point). Overall hypoglycemia was similar between treatment groups (P = 0.355). The AIR insulin group had greater decrease in diffusing capacity of the lung for carbon monoxide at end point (P = 0.020) and greater incidence of cough (P = 0.024) and dyspnea (P = 0.030). Body weight decreased in the AIR insulin group and increased in the insulin lispro group. CONCLUSIONS: Insulin lispro provided lower A1C than AIR insulin, but the difference may components. __________________________________________________________________________ _____________________________________*____________________________________ 31. Abstract: Safety of intravenous infusion of doripenem __________________________________________________________________________ Clin Infect Dis. 2009 Aug 15;49 Suppl 1:S28-35. Safety of intravenous infusion of doripenem. Redman R, File TM Jr. Anti-Infectives Clinical Development, Johnson & Johnson Pharmaceutical Research & Development, 6500 Paseo Padre Pkwy., Fremont, CA 94555, USA. rredman@its.jnj.com Carbapenems remain a mainstay for the empirical treatment of serious nosocomial infection. Although the tolerance and safety profile of the carbapenems as a class is favorable, the primary safety concern is the potential for treatment-emergent seizures. In preclinical testing, doripenem, a new carbapenem antibiotic, showed negligible neurotoxic effects. The safety and tolerability of intravenous doripenem was evaluated in 1 phase 2 and in 6 phase 3 clinical trials conducted with patients with nosocomial pneumonia, including ventilator- associated pneumonia; complicated intra-abdominal infection; and complicated urinary tract infection. Safety data were available from 1817 patients who received doripenem and 1325 patients who received 1 of 4 active comparator drugs as part of this development program. Overall, intravenous doripenem was found to be safe and well tolerated, demonstrating a safety profile comparable to that of comparator agents and a limited propensity to induce seizures, including when administered via 1-h or 4-h infusion. j. __________________________________________________________________________ _____________________________________*____________________________________ 32. Abstract: Ethyl chloride spray for sensory relief for botulinum toxin injections of the hands and feet __________________________________________________________________________ J Cutan Med Surg. 2009 Sep-Oct;13(5):253-6. Ethyl chloride spray for sensory relief for botulinum toxin injections of the hands and feet. Richards RN. BACKGROUND:Botulinum toxin injections are effective in the treatment of palmar and plantar hyperhidrosis, but discomfort has limited its use. OBJECTIVE:To study the use of ethyl chloride medium-stream spray in reducing injection discomfort. METHODS:We used ethyl chloride medium-stream spray, in conjunction with precooling by frozen ice packs, in our No Sweat Clinic for our most recent 51 consecutive cases of botulinum toxin injection. RESULTS:Ethyl chloride spray greatly facilitated the injection procedure, and all patients completed the injections without hesitation or delay. CONCLUSION:Ethyl chloride medium-stream spray, in conjunction with precooling by frozen ice packs, is highly effective in reducing painful injection sensations. Its use is safe, economical, and easy to learn and does not require special equipment. __________________________________________________________________________ _____________________________________*____________________________________ 33. Abstract: A systematic review and meta-analysis of the risk of microbial contamination of aseptically prepared doses in different environments __________________________________________________________________________ J Pharm Pharm Sci. 2009;12(2):233-42. A systematic review and meta-analysis of the risk of microbial contamination of aseptically prepared doses in different environments. Austin PD, Elia M. Pharmacy Department, Southampton University Hospitals NHS Trust, Southampton, United Kingdom. Peter.Austin@suht.swest.nhs.uk PURPOSE: To review microbial contamination rates about preparation of individual and batch doses using aseptic techniques within pharmaceutical (controlled) and clinical (ward and theatre) environments. METHODS: Systematic review, involving amalgamation of data using a random effect model and metaanalysis. RESULTS: A total of 19 studies from 17 reports (7277 doses), mostly single arm studies, were identified for analysis. The overall contamination rates for doses prepared in clinical environments were found to be 5.0% (95% CI; 1.8%, 13.1%, n = 8 studies) for individual doses and 2.0% (95% CI; 0.3%, 13.1%; n = 5) for doses prepared as part of a batch. Rates for doses prepared in pharmaceutical environments were found to be 1.9% (95% CI; 0.8%, 4.2%; n = 5) for individual doses and 0.0% (95% CI; 0.0%, 0.8%; n= 1) for doses prepared as part of a batch. The results indicate greater overall contamination rates of doses prepared in clinical than pharmaceutical environments, in those prepared individually than in batch preparation, and in those in which additions rather than no additions were made. Significant differences were only found between pharmaceutical and clinical environments for batch doses, and between batch and individual doses prepared in a pharmaceutical environment. The studies differed substantially in sample size, interventions and comparison conditions, especially in the clinical setting. The quality of the data was judged to be low. CONCLUSION: Contamination rates in clinical and pharmaceutical environments were commonly found to be unacceptably high. Intuitive recommendations for reducing contamination rates by carrying out the procedures in a pharmaceutical environment using batch doses are supported by an evidence base that needs to be strengthened further. __________________________________________________________________________ _____________________________________*____________________________________ 34. Abstract: The potential role of mobile phones in the spread of bacterial infections __________________________________________________________________________ J Infect Dev Ctries. 2009 Sep 15;3(8):628-32. The potential role of mobile phones in the spread of bacterial infections. Akinyemi KO, Atapu AD, Adetona OO, Coker AO. Department of Microbiology, Lagos State University, Lagos, Nigeria. akinyemiko@yahoo.com BACKGROUND: Mobile phones are indispensable accessories both professionally and socially but they are frequently used in environments of high bacteria presence. This study determined the potential role of mobile phones in the dissemination of diseases. METHODOLOGY: Specifically, 400 swab samples from mobile phones were collected and divided into groups categorized by the owners of the phones as follows: Group A was comprised of 100 food vendors; Group B, 104 lecturers/students; Group C, 106 public servants; and Group D, 90 health workers. Samples were cultured and the resulting isolates were identified and subjected to antimicrobial susceptibility tests by standard procedures. RESULTS: The results revealed a high percentage (62.0%) of bacterial contamination. Mobile phones in Group A had the highest rate of contamination (92; 37%), followed by Group B (76; 30.6%), Group C (42; 16.9%), and Group D (38; 15.3%). Coagulase negative Staphylococcus (CNS) was the most prevalent bacterial agent from mobile phones in Group A (50.1%) and least from phones in Group D (26.3), followed by S. aureus. Other bacterial agents identified were Enterococcus feacalis, Pseudomonas aeruginosa, Escherichia coli, and Klebsiella spp. There was no statistical significance difference (P < 0.05) in the occurrence of S. aureus, the most frequently identified pathogenic bacterial agent isolated from the mobile phones in the study groups. Fluoroquinolones and third-generation cephalosporin were found to be effective against most isolates. CONCLUSION: Mobile phones may serve as vehicles of transmission of both hospital and community-acquired bacterial diseases. Strict adherence to infection control, such as hand washing, is advocated. __________________________________________________________________________ _____________________________________*____________________________________ 35. 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. __________________________________________________________________________ _____________________________________*____________________________________ 36. No Abstract: A survey of needlesticks and sharp instrument injuries in emergency health care in Turkey __________________________________________________________________________ J Emerg Nurs. 2009 Jun;35(3):205-10. A survey of needlesticks and sharp instrument injuries in emergency health care in Turkey. Serinken M, Karcioglu O, Kutlu SS, Sener S, Keysan MK. Department of Emergency Medicine, Pamukkale University, School of Medicine, Denizli, Turkey. __________________________________________________________________________ _____________________________________*____________________________________ 37. No Abstract: Hepatitis B-related policies: Inconsistent patient safety in Indonesian hospitals __________________________________________________________________________ Am J Infect Control. 2009 Aug;37(6):520-1. Hepatitis B-related policies: Inconsistent patient safety in Indonesian hospitals. Marjadi B, Susilo AP, McLaws ML. __________________________________________________________________________ _____________________________________*____________________________________ 38. Book Review: Networked disease: emerging infections in the global city Crossposted from he Lancet Infectious Diseases, Volume 9, Issue 10, Page 600, October 2009, with thanks. __________________________________________________________________________ The Lancet Infectious Diseases, Volume 9, Issue 10, Page 600, October 2009 Networked disease: emerging infections in the global city Harunor Rashid Networked disease: emerging infections in the global city Ali S Harris, Keil Roger Wiley-Blackwell, 2008 Pp 384. £24·99. ISBN-978-1-4051-6134-3 Written by a score of experts from sociology through medical humanities to geography, this book discusses how the interconnected fluid network formed by the flow of cash, commodities, people, and vectors helps spread infectious diseases among cities worldwide, and what the social and political reactions are to disease spread. Although the book primarily focuses on the role of this worldwide network on the spread of severe acute respiratory syndrome (SARS), a few other diseases such as avian influenza, AIDS, and tuberculosis are discussed. A meticulous social autopsy was done on SARS in the context of the Hong Kong, Singapore, and Toronto outbreaks to explore the vulnerability of cities worldwide, and to examine the effect of the epidemic on the social and cultural aspects of urban life. The authors, who were resident in those cities at the time of SARS, have shown the vulnerability of the cities due to pre-existing defects in health governance and infrastructure. The authors have established that the public reaction to the SARS outbreaks in those multicultural conurbations was very disappointing. Subsequent to the epidemic various social ills followed, for example, medical professionals became victims of stigmatism and health scares pervaded throughout the cities, Chinese expatriates were marginalised in Toronto and Singapore, and Hong Kong turned into a masked city because "mask-wearing became the quickly improvised, if obligatory, social ritual; failing to do one was met with righteous indignation, a clear sign of ritual violation". Although the authors have tried to substantiate that SARS spread through a network of culturally and commercially important cities like Hong Kong, Singapore, and Toronto they have not explained why more dominant cities worldwide like New York, London, Paris, and Tokyo were essentially spared despite having similar health risks. We hope the authors will include this discussion in future editions. Overall, this is a unique book that examines emerging infectious diseases through the lens of sociologists and would be an interesting reference for public-health practitioners, travel-health experts, infectious disease physicians, sociologists, and political scientists. Copyright © 2009 Elsevier Limited. __________________________________________________________________________ _____________________________________*____________________________________ 39. Country Representative - Mozambique Crossposted from HIF-net http://dgroups.org/groups/hif-net with thanks. __________________________________________________________________________ From: To: "HIF-net" Subject: [hif-net] Country Representative - Mozambique The Burnet Institute in Australia requires a Country Representative (to be based in Maputo) to lead, manage and be accountable for all aspects of Burnet's health and development program in Mozambique. A key objective for the successful applicant will be to diversify our donor base to increase resources to support plans for program growth. The Country Representative will also be responsible for scaling up the HIV component of our program and expanding the sector focus to include more emphasis on maternal and child health and health systems strengthening. The position comprises three main areas of responsibility: 1. Strategy Development, 2. Representation and Leadership, 3. Management (including program, finances, administration and human resource management) Key Selection Criteria include: * Post-graduate qualification in a relevant discipline such as public health, social sciences or economics/finance, public policy, international relations or management * Excellent communication skills with fluency in written and spoken Portuguese and English * Previous experience of work at the level of country director or country representative for an International NGO * Experience of work in the health and development sector in Mozambique and/or other Southern African countries * Demonstrated ability to engage at a high level with Government officials, INGO and bilateral and multilateral agency staff * Extensive experience (at least five years) in the planning, design, delivery and management (including monitoring and evaluation) of international development programs, preferably in the health sector * Experience in implementing capacity development strategies with government service providers and local NGOs * Proven experience (at least 5 years) of effective staff management and leadership * Comprehensive knowledge of current development issues (related to policy and practice) * Proven ability to manage financial and administrative systems including grants management, budgets, office management, human resource systems and information technology * Proficiency with Microsoft Office applications Application Process: Suitably qualified applicants can send a current CV and letter of application (strictly addressing the selection criteria above) to Ms Robyn Whitney, Mozambique Program Director on robynw@burnet.edu.au. (PLEASE ENSURE A LETTER OF APPLICATION IS INCLUDED) Application closing date is Thursday 22nd October 2009. The full position description is on our website - http://www.burnet.edu.au/home/general/employment Robyn Whitney Mozambique Program Director & Program Quality and Learning Advisor Burnet Institute 85 Commercial Road, Melbourne, Victoria, Australia 3004 GPO Box 2284, Melbourne, Victoria, Australia 3001 TEL + 61 3 9282 2118 MOBILE 0423 804 991 FAX +61 3 9282 2144 EMAIL robynw@burnet.edu.au WWW http://www.burnet.edu.au HIF-net: working together to improve access to reliable information for health researchers and health professionals in developing and transitional countries. __________________________________________________________________________ _____________________________________*____________________________________ 40. Announcing the 2nd The International Conference on ICT for Africa 2010-- March 25-28, 2010; Yaounde-Cameroon Crossposted from HIF-net http://dgroups.org/groups/hif-net with thanks. __________________________________________________________________________ To: "HIF-net" Subject: [hif-net] Announcing the 2nd The International Conference on ICT for Africa 2010-- MARCH 25-28, 2010; YAOUNDE-CAMEROON Esteemed Colleagues: With support from the National Science Foundation (NSF), The National Aeronautic and Space Administration (NASA) and The Ellis Trust, we are pleased to announce The International Conference on ICT for Africa 2010. The International Conference on ICT for Africa 2010 (ICIA 2010) is themed 'ICT for Development - Contributions of the South'. The conference and exhibition will take place MARCH 25-28, 2010 in YAOUNDE, CAMEROON (West Africa). Beyond just the typical Academic conference, ICIA 2010 will have a strong blend of academic and practitioner audiences as well as top policy makers from many developing and developed nations. Further, there will be a several exciting workshops including telemedicine, e-learning, grant writing and ICT policy. There will be real-world (life) illustrations of telemedicine and e-learning systems targeted for low-resource settings of developing and developed nations. The conference seeks to address a number of questions. What role can we play in the information age? Is Africa going to be only consumers of the information age or can Africa join the producers of ICT knowledge, products and services? What could be emergent patterns of ICT knowledge transfer in development? Is there an opportunity for unique contribution from Africa in this information age? If there is, then let us tell the story of what we have in this conference. This conference will bring together a fine mix of practitioners and academicians in the area of ICTs for sustainable development. The conference will explore the contributions of Africa to the global ICT for development discourse and efforts. Visit conference website for more: www.ictforafrica.org Submissions may cover key themes outline below: 1. ICT for Business and SMEs 2. ICT for Education and Journalism 3. ICT and Healthcare - Telemedicine 4. Internet and Society (Cybercrime) 5. ICT, Poverty and Development 6. Open-source Technologies in SSA 7. ICT and Gender 8. ICT Diffusion and Teledensity 9. ICT Project Sustainability 10. ICT in Government and Conflict 11. ICT Research in Sub-Saharan Africa ICIA 2010 creates a forum where participants can disseminate their research on the transfer, diffusion, and adoption of ICT within the context of Africa; the innovation and development of ICT solutions for and within this context; impacts of ICT on society and of society on ICT; and other relevant normative, empirical, and theoretical concerns of ICT development, implementation, strategy, management and policy that are distinctive to Africa and associated developing economies. Paper Submission Doctoral Consortium Papers . This is only open to doctoral, graduate and undergraduate students . 1500-2500 words of extended abstract (including references, figures and main text) . Visit the conference website to download the Submission Templates and Instructions. Track Sessions Papers . Research in Progress - 3000-5000 words (including references, figures and main text). . Full Papers - 5000 words (including references, figures and main text). . Visit the conference website to download the Submission Templates and Instructions. Submission Email Address . Please submit your paper electronically to Dr. Richard Boateng, ICITD, Southern University, Call for Papers Coordinator (richard@ictforafrica.org) on or before December 1, 2009. . For papers to appear in the proceedings, at least one author must register for the conference. Notification by Dec. 31, 2009. . For consideration for the best paper award, submit the full manuscript by Nov. 10, 2009. Important Dates December 1st 2009 Full Paper Submission December 31st 2009 Review Result Returned January 30th 2010 Final Paper Submission MARCH 25-28 Conference Dates Contact Conference Management, ICIA E-mail: info@ictforafrica.org Website: http://www.ictforafrica.org PLEASE FORWARD TO INTERESTED COLLEAGUES AND STUDENTS ********************************************************** Victor Wacham A. Mbarika, Ph.D. Founding Executive Director, The International Center for Information Technology and Development (ICITD)... www.icitd.com Editor-in-Chief, The African Journal of Information Systems (AJIS)... www.ajisonline.com Southern University, TT Allain #321, Baton Rouge, LA 70813, USA Phone: +1 225 715 4621 or +1 225 572 1042; Fax: +1 225 208 1046 Email: victor@mbarika.com Web Site: http://www.mbarika.com ********************************************************** [HIF-net profile: Victor Wacham Mbarika is Assistant Professor of Information Systems and Decision Sciences, Louisiana State University, USA. His publications include: "Africa's Least Developed Countries' Teledensity Problems and Strategies..." http://isds.bus.lsu.edu/victor/book.html victor@mbarika.com http://www.mbarika.com] __________________________________________________________________________ _____________________________________*____________________________________ 41. News - USA: More than 1,800 Broward General patients may have been exposed to blood- borne infection: - Australia: Needle program success - Pakistan: Hazardous injections - USA: Ex-Army nurse faces four years for admitting he infected patient w with hepatitis - Africa: The hidden cost of disease transmission associated with unsafe injection practice - Corporate Council on Africa Health Plenary - Australia: Hepatitis C rates halved after heroin drought - Egypt: Hepatitis C emerges as Egypt’s top health crisis Selected news items reprinted under the fair use doctrine of international copyright law: http://www4.law.cornell.edu/uscode/17/107.html __________________________________________________________________________ USA: More than 1,800 Broward General patients may have been exposed to blood- borne infection: By Robert Nolin and Jaclyn Giovis, OrlandoSentinel.com (06.10.09) * Nurse had been reusing saline bags, tubing during heart stress tests since 2004 More than 1,800 Broward General Medical Center patients who underwent heart stress tests since 2004 may have been exposed to HIV and other infectious diseases after a nurse knowingly reused medical supplies intended for one-time use. Hospital officials said Monday they have identified 1,851 at-risk patients and are urging them to undergo follow-up screening to determine if they were infected. Since 2004 until this month, the nurse - who was not identified - administered intravenous fluids during chemical cardiac stress tests with used saline bags and tubing. She later acknowledged she knew what she did was wrong, according to hospital officials. The problem was discovered after someone anonymously called the hospital, spokeswoman Cathy Meyer said. That was in early September. Since then, the hospital has been searching through medical files to determine who came in contact with the nurse for chemical stress tests. They found 1,851. Hospital officials sent out certified letters Saturday informing those patients they may have been exposed to HIV, hepititis B or hepititis C. A 24-hour hotline and website have been established, and hospital officials have contracted with a network of laboratories to screen the patients in question. Broward General will foot the bill. "This is the egregious act of one individual who blatantly violated the safety and health of our patients," said hospital CEO James Thaw. "We understand that this is alarming and may be frightening, but want to assure our patients we will assist in every way possible." Chief Operating Officer Alice Taylor said the nurse admitted to an investigator she should have used new equipment for each patient. When asked why she didn't, the nurse did not respond, Taylor said. The nurse was immediately suspended. She later resigned and has been reported to the Florida Board of Nursing. "This is such a basic practice," Taylor said of the need to change saline bags and tubing for each patient. "It's rudimentary nursing skills, so much so that we would not go and look for this sort of practice." The hospital has consulted with experts from the Centers for Disease Control and Prevention, as well as state and local health departments, Meyer said. "Although we believe the risk of exposure is low, it is important for patients to be tested, since there are treatment options available if patients do test positive," the hospital said. Monday, the hospital acted to alleviate those patients' fears. "We have an auditorium set up in the hospital with counselors, and we have had few people come in," Meyer said. More than a dozen patients have already contacted the hospital. The possibly affected patients are from South Florida, out of state and abroad. The kind of heart stress test the nurse conducted involved the injection of fluids. It was not the standard stress test in which patients are attached to electrodes while they run on a treadmill. Meyer said patients who underwent the chemical test between January 2004 and September 2009 should notify the hospital for screening, or inform their own physician they may have been exposed, even if they don't feel sick. If a disease is found, it will be investigated to determine its origin. Monday's announcement wasn't South Florida's first mass infectious disease scare this year. In February, the Department of Veterans Affairs warned some 10,000 former patients that they should be tested for HIV and hepititis after discovering three VA hospitals, including one in Miami, had used nonsterile equipment for colonoscopies and other procedures. Among the veterans who were later tested, six showed positive for HIV, 34 for hepititis C and 13 for hepititis B. Concerned patients may obtain additional information by calling 800-545-5716 or going to www.browardhealth.org/patientnotice. Staff Writer Diane Lade contributed to this report. Robert Nolin can be reached at rnolin@sunsentinel.com or 954-356-4525.. Copyright © 2009, South Florida Sun-Sentinel .......................................................................... __________________________________________________________________________ Australia: Needle program success JULIA MEDEW, The Age, Melbourne Australia (0610.09) TAXI drivers, tradesmen and body builders are among the growing number of people using St Kilda's 24-hour needle and syringe exchange program - the only service that operates all night, every night in Victoria. The manager of health services for the Salvation Army's Crisis Service, Sue White, said that since the Grey Street program started operating round the clock in late 2007, it had helped an extra 1000 people get clean equipment every month. Aside from local sex workers, she said, tradesmen were using the after- hours service alongside truck drivers and a small number of taxi drivers. Body builders who take steroids were also attending. An evaluation of the 24-hour service by the Salvation Army and Monash University found it had contributed to a 51 per cent rise in the number of needles and syringes being distributed between August 2007 and September 2008. The number returned for safe disposal increased 26 per cent. Ms White said the service had prevented people from sharing equipment - a practice known to spread viruses including HIV and hepatitis C. It had also exposed people to referrals for counselling, detox programs and other health-care services. The evaluation found that since the service extended its hours, there had been little change in drug-related crime or complaints to the local council. Ms White said other needle and syringe exchanges should consider expanding their hours, based on its success. A Victorian Taxi Directorate spokeswoman said it was not aware of any drivers using drugs. She said it was working with police ''to identify drivers who may be under the influence of drugs or alcohol''. A spokesman for the Victorian Taxi Association said he had also not heard of drivers using illicit drugs. ''It's very surprising and a bit concerning ... It's something we will look at,'' he said. .......................................................................... __________________________________________________________________________ Pakistan: Hazardous injections Dawn, Pakistan (05.10.09) THE danger to public health posed by the unsafe practice of syringe reuse without proper sterilisation as well as the over-reliance on injections was acknowledged years ago. Because this was recognised as a primary cause of the spread of hepatitis B and C, particularly in the rural areas and in the lower income areas of cities, ways of tackling the problem of unsafe injection practices were looked into by our health authorities. But implementation of solutions to the problem has been found wanting. One solution which the health authorities decided upon was regulating the quality of syringes by having all manufacturers and importers register their syringe products under the Drugs Act, 1976. But according to the Rawalpindi/Islamabad chapter of the Pakistan Medical Association, the deadline given by the Ministry of Health for registration of syringe products has been postponed time and again since the expiry of the first deadline on Dec 31, 2007. The deadline was recently extended yet again by another three months, from Sept 30, 2009 to Dec 31. No doubt ensuring safe injections is a daunting task here. Only a small percentage of injections use auto-disable syringes. Since the estimated number of injections administered annually is 1.5 billion, ensuring every injection is safe means we need to produce and/or import that many auto- disable syringes, which also cost more than ordinary syringes. On the other hand, approximately 94 per cent of the 1.5 billion injections are estimated to be unnecessary. Addressing this requires changing perceptions among the general population and doctors. Finally, proper medical waste disposal also needs to be ensured to prevent repackaging of syringes for resale. Only committed implementation of these measures will help stem the tide of unsafe injections that are fuelling diseases which are robbing families of their breadwinners. http://tinyurl.com/ydfpw5l Copyright © 2009 - Dawn Media Group .......................................................................... __________________________________________________________________________ USA: Ex-Army nurse faces four years for admitting he infected patient with hepatitis By Walter F. Roche Jr., Tribune-Review, Pittsburgh PA USA (02.10.09) Months after his banishment from a military hospital, a drug-addicted former Army nurse anesthetist bounced from job to job treating patients from Texas to Hawaii to Washington, D.C, Virginia and Florida. Later this month, that former nurse, Jon Dale Jones, 46, will face a federal judge for sentencing after accepting a plea deal in which he admitted infecting a patient under his care with hepatitis. Jones originally was charged with infecting 16 people at William Beaumont Army Medical Center in El Paso, but under a plea deal, he faces only one count and a jail term of four years and three months. He did not respond to a request for comment. The Texas Board of Nursing revoked his license in May but left the door open for him to regain it within a year, provided he prove he has kicked his drug habit. Health care advocates say Jones' case demonstrates a serious flaw in health care regulation . According to Dr. Sidney Wolfe of Washington-based Public Citizen, information on people like Jones has been gathered for more than two decades in a databank maintained by the Department of Health and Human Services, but only officials at federal health care facilities can access it. "This is exactly what this databank was designed to prevent," Wolfe said. The information is inaccessible because the federal agency never got around to issuing regulations, Wolfe said. David Bowman, an HHS spokesman, confirmed that the needed regulation was approved in late 2008 and is under review by the Obama administration. Records show Jones first was suspected of causing a hepatitis outbreak in the 2004 while he was working at Beaumont. Within weeks, he was barred from treating patients. Army officials revoked his nurse anesthetist privileges on March 9, 2006. Jones went to work at a non-government El Paso hospital in 2004, then worked briefly in Hawaii before landing at Georgetown University Medical Center in Washington in 2005. After getting caught stealing drugs at Georgetown, records show Jones got jobs at a hospital in Newport News, Va., before going on to the University of Miami Hospital in Florida. Officials at all those hospitals said that they notified all patients who might have come in contact with Jones and found no evidence of infections. One person who will be watching closely for the outcome of the Oct. 18 sentencing is Caroline Cayne, 53, a Maryland resident who says Jones was her nurse anesthetist when she underwent surgery in June 2006 at Georgetown. She said that she came under Jones' care on June 26, 2006. When she awoke from the surgery, Cayne said she was in excruciating pain. "I've been through three C-sections, but they were nothing like this," she said in a recent interview. "It was mind-numbing pain." Her heart, medical records show, was racing, and she went into tachycardia, a life-threatening condition. She did not contract hepatitis. Nearly two years later, she received a form letter from a Georgetown University Hospital official informing her that she might have been under the care of a nurse anesthetist charged in federal court with infecting patients with hepatitis. Georgetown officials declined to comment on either the Jones or Cayne cases. Cayne said she learned Jones' name through an Internet newspaper search. Jones' signature is affixed to many of her treatment documents. "He came up to put in the needle and his hands were shaking," she said. "The doctor (anesthetist) came over and said, 'I'll put the needle in.'" Cayne, who underwent a lengthy recuperation from complications of the surgery, said she was concerned that Jones would recover his credentials. "I'd like to be there in the courtroom and look him in the eye," she said. Walter F. Roche Jr. can be reached at wroche@tribweb.com or 412-320-7894. Images and text copyright © 2009 by The Tribune-Review Publishing Co. .......................................................................... __________________________________________________________________________ Africa: The hidden cost of disease transmission associated with unsafe injection practice - Corporate Council on Africa Health Plenary Roger Blunt*, Corporate Council on Africa (Washington, DC) (02.10.09) "The hidden cost of disease transmission associated with unsafe injection practice is considerably higher than the cost of preventing the disease." This is a quotation of the World Health Organization, which recommended in 2000 that all developing countries adopt AD syringes by 2004. It is important to note that the Nigerian Federal Government had passed a law which became effective in 2008 requiring the use of "safe" syringes. Our 23 million dollar single-use by design and manufacture syringe factory became the flagship project of our nonprofit Pan African Health Foundation, whose mission is to develop locally owned and operated, nonprofit medical supply factories in Africa, with the twin economic development objectives of generating sustainable employment and improving public health. The factory was commissioned in October 2008. Training and trial production were completed in the spring of 2009. The factory and its product were certified by Nigeria's National Agency for Drug Administration and Control. By December, this year, the factory is to be at full production, with 300 employees. At that point, the factory will be manufacturing more than 160 million syringes per year at World Health Organization standards. A planned expansion will increase the annual capacity to 800 million syringes. Project Delivery Method We used the program and construction management, design-build delivery method that provides unique opportunities for achieving sustainable economic development in Nigeria. Sustainable economic development can be achieved best in Africa through projects that create jobs, provide training in partnership with local universities, engage and support local businesses, and create value by using local materials. Thus, by engaging local entrepreneurial interests in mutually beneficial partnerships, many barriers to achieving successful projects can be eliminated. These business partnerships would be strategic in nature. They should be based on trust and respect for local partners and could thrive with transparency and accountable management. OUR EXPERIENCE ON THE SYRINGE PROJECT IDENTIFIED FOUR GUIDING PRINCIPALS FOR SUCCESS * First, Sustainability -A well-conceived project should include all relevant stakeholders in the Ministries of Health, Finance, Foreign Affairs, Labor, Local Government, Media and opinion leaders at the local and national levels; and, where appropriate, external financing and technical support services should be identified and consulted. Finally, with almost no exception, very few public-private partnership projects are sustained over the long term without dependable financing and host country support at the presidential level. * A second precondition for successful projects is the creation of a valid Partnership in which respect is shown for host country leadership. Project operational frameworks must incorporate key project decision- makers with vested interests in the project. U.S. investors and those providing technical assistance, themselves, must think this way in planning investments in Africa. The Port Harcourt Syringe Factory succeeded in large because the host country project leadership was respected. Frequently, we were able to have critical Project impact because we made arguments on their merits and not because we were the "experienced Americans." Thus, respect for host country project leadership and other host country leaders made it possible for our foundation to have a major impact on project outcome. * Another guiding principal for success would be the Audit and Evaluation component which is the "Third Rail" in building a sustainable project. The genuine partnership between our foundation and the Rivers State leadership enabled an effective evaluation and audit process. Host country project leaders welcomed the audits and evaluations because they did not view the Foundation as an "outsider" but as a respected member of the partnership seeking one goal...a sustainable, successful project. The Pan African Health Foundation/US financial contribution to the project was nominal, but our advice and participation were critical and well earned. The Syringe Factory Project was never referred to by the host country partners as their project but always as our project; and our Foundation always was involved when major host country decisions were discussed. During this four-year project, there were few weeks that passed without written or voice communications among project leaders. * Fourth, Information Technology provided the means and method for coordination and effective problem resolution. One of the core principles of building a sustainable health project is effective use of information technology. Each health project must have the technological capacity to share information, map and track funding and schedules. Projects that lack this capability misuse budgets, personnel, and compromise project goals. No African health project should be undertaken without such technological capacity. An important by-project of a well-conceived project that adheres to the four principles I have described produces a sense of great National Pride. I observed this in the people of Port Harcourt, Nigeria at the plant opening ribbon cutting ceremony last fall; and, our successful syringe project was recognized at the Clinton Global Initiative's Fifth Anniversary Board Meeting in New York City last week. Further Remarks The city of Port Harcourt, close to the site of this new syringe factory, is the capital of Rivers State and the epicenter of the region's oil industry. Despite its metropolitan population of nearly 3.7 million, Port Harcourt stands a mere shadow of the prosperous and livable city it once was. As Rivers State Governor Amaechi described in his address at the Conference of Speakers: "Today, our streets are narrow and congested. Our drains are blocked. Potable water is nearly absent. Our neighborhoods are rough, dilapidated, and dangerous." Health issues such as these should be addressed in a holistic manner so that local populations and governing bodies take ownership of health improvements; and, the improvements should be sustainable while addressing comprehensively the circumstances that contribute to poor health. Opportunities, based on our foundation's recent experience, suggest that a favorable climate exists in Rivers State - and other similarly situated political jurisdictions in Africa, for investing in health systems infrastructure such as municipal water works and associated distribution systems, waste disposal systems, as well as precise and reliable power for clinics, hospitals and their critical medical equipment. *Major General (AUS, Ret.) Roger R. Blunt, P.E. is Chairman of the Board, President, and Chief Executive Officer of Maryland based Essex Construction, and Managing Member of Tradewinds Africa with an office in Accra, Ghana. A West Point graduate and Registered Professional Engineer in the District of Columbia, he holds Masters Degrees in Civil Engineering and Nuclear Engineering from the Massachusetts Institute of Technology and the Doctor of Public Service Degree from the University of Maryland Eastern Shore. After an early career in the U.S. Army Corps of Engineers, which included service in the Far East, Europe, and the Middle East, General Blunt retired in 1986 and was awarded the Distinguished Service Medal. He became a laureate of the Washington Business Hall of Fame in 2001, was named a Hero in Business by the Retired Military Officers Association in 2002, and received the 2003 Hall of Fame Award of the American Minority Contractors and Business Association. In 2004, he received the Parren J. Mitchell Foundation's Lifetime Achievement Award and was inducted into the Maryland Chamber of Commerce Business Hall of Fame in 2005. -------------------------------------------------------------------------- General Blunt is Chairman and President of the Pan African Health Foundation/USA, whose Nigerian affiliate built an auto-disable, single-use syringe plant with an annual production capacity of 160 million syringes in Rivers States' delta region. Over the years, General Blunt has consulted or participated in economic development activities involving military facility design, guidelines for sustainable development, housing, commercial construction, and rural farm to market roads in several of Africa's countries including Saudi Arabia, Niger, Burkina Faso, Nigeria, Ghana, and Liberia. Copyright © 2009 Corporate Council on Africa. All rights reserved. Distributed by AllAfrica Global Media (allAfrica.com). .......................................................................... __________________________________________________________________________ Australia: Hepatitis C rates halved after heroin drought by Michael Woodhead, 6minutes.com.au (02.10.09) There has been a dramatic fall in the rates in hepatitis C in the last decade, but the burden of disease among those living with the infection is increasing substantially. Latest figures show that new notifications of hepatitis C have fallen by half between 1999 and 2006, with the decrease being attributed to a reduction in rates of IV drug abuse secondary to the heroin drought. However, with more than 200,000 people having chronic HCV infection the burden of disease such as advanced liver disease is increasing and HCV- related liver cirrhosis now accounts for almost one in three liver transplants, say researchers form the National Centre for HIV Epidemiology and Clinical Research in Sydney. Writing in the journal Hepatology (24: 1648-54), the say that there are still 10,000 new infections each year, with most being in young IV drug users. However, they note that only 1.4% of people with chronic HCV infection received treatment and they say that if there is to be any impact on rates of liver disease then treatment programs will need to be targeted towards IV drug users such as by providing it through opioid clinic settings. Meanwhile drug and alcohol specialists have called for needle and syringe programs to be introduced into prisons to reduce the spread of HCV. , Speakers at the Australia’s Drugs Conference in Melbourne said close to half of prisoners have a history of injecting drug use, and most reported sharing needles With prisoners are up to forty times more likely to have hepatitis C than someone in the general community, the conference voted almost unanimously to recommend a pilot scheme of needle and syringe programs in prisons. .......................................................................... __________________________________________________________________________ Egypt: Hepatitis C emerges as Egypt’s top health crisis Matt Bradley, Foreign Correspondent, The National. UAE (01.10.09) CAIRO // It was about 25 years ago, but Mukhtar Ismail Abdu said he remembers it all quite clearly. One day during primary school, Mr Abdu and his fellows were herded into a clinic where they were injected with a tartar emetic drug - part of a nationwide rural public health campaign to prevent a water-borne parasite known as bilharzia, or schistosomiasis, a parasite that has been endemic to Egypt’s Nile River valley since the time of the pharaohs. The treatment successfully reduced the rate of bilharzia infection to less than one per cent today from about 40 per cent in 1970, said Abdul Rahman Shahin, the spokesperson for Egypt’s ministry of health. But Mr Abdu’s needle, like those of millions of others, carried a hidden freeloader: the virus hepatitis C. "It was a time when everyone was injected by the same syringe, not like now when they use different syringes," said Mr Abdu, 41. "It bothers me because we were just schoolchildren." According to the ministry of health’s last comprehensive study in 1996, some 15 to 20 per cent of Egyptians tested positive for hepatitis C antibodies. The study linked the epidemic directly to Egypt’s otherwise laudable bilharzia treatment campaign, which ended only a few years before the hepatitis C virus was discovered in 1989. About one-third of Egyptians aged 50 and older - those who were more likely to have been injected with the tartar emetic shot during the therapy’s heyday - tested positive for hepatitis C. "I can tell you that those who have [hepatitis] C now, a very high percentage of them are the kids who were given this tartar emetic in the late [19]60s and ’70s and probably until the early ’80s. Because they were all infected with [hepatitis] C," said Dr Shahin. Faced with what is thought to be the world’s worst hepatitis C epidemic, Egypt’s ministry of health embarked on yet another ambitious effort in 2006 to prevent and treat a growing incidence of cirrhosis and liver cancer caused by the virus. hepatitis C is now Egypt’s worst public health crisis, said Manal El Sayed, a member of Egypt’s National Committee for the Control of Viral Hepatitis. To fight the scourge, the ministry of health convened the National Committee for the Control of Viral Hepatitis in 2006, charging its seven- member board with evaluating the problem and halting the epidemic’s spread. Before that, Egypt’s broken public health system, stymied by the epidemic’s daunting size, allowed the problem to metastasise for more than a decade. Only about half of Egyptians have health insurance, and the poorest people in rural areas were unable to pay for the costly Interferon protein therapy. "Before this programme, let me be very honest with you, nobody was given Interferon except those who could afford to pay for it because it was a very expensive therapy," said Dr Shahin. "The injection was bought by the minister of health at EGP 1,200 (Dh800) per injection." The Interferon regime requires 48 regular injections, bringing the total cost to nearly EGP 60,000. "Before this committee appeared, every doctor just gave whatever treatment he wanted, and they all gave different treatments" said Mr Abdu, who estimated that he earned about EGP600 each month as a day labourer before he started taking regular Interferon shots six months ago, which leave him too tired to work. "There was no good treatment at the time. We used to go to a doctor in Fayyoum who gave us capsules. They didn’t treat the symptoms but the doctor said they would limit the spread of the virus in the body." These days, Mr Abdu travels once every two weeks to Cairo from his home in rural Fayyoum to get free medical care to treat both his hepatitis C and bilharzia, which he also contracted despite the ill-fated treatment years ago. Since the programme began three years ago, health officials have treated 40,000 people, more than 70 per cent of whom reacted positively to the medication, said Dr Shahin. By the end of this year, 20 specialised liver centres across the country will offer free treatment to 60,000 patients, said Dr Sayed, as well as liver transplants for advanced cases. But the spread of hepatitis C did not end with the injections. The blood- borne virus is 10 times more contagious than the human immunodeficiency virus (HIV), and can be transmitted by means as obvious as dirty needles or as unassuming as shower loofahs, toothbrushes or nail clippers. Preventing the disease’s spread will require Egyptians to take a closer look at some of their more unsavoury habits, Dr Sayed said. "Now we have to focus much more on the non-infected people," she said, adding that "bad cultural habits" such as "mass tattooing, mass circumcisions, barber shops" can all act as vectors for disease. Tattoos are common among Egypt’s Christian minority and circumcisions are done for both men and women, often under unsterile circumstances. The committee launched an awareness-raising campaign in 2007, which focused on universities in the hope that educated youth would spread the word about hepatitis C in their home villages. After targeting about 150,000 students in 11 universities, 80 per cent of rural Egyptians now say they have heard about hepatitis C, according to the committee’s surveys. Given the extent of the disease, they are likely to have heard as much from their family, friends and neighbours as from any ministry-led health programme. Mr Abdu’s double afflictions - hepatitis C and bilharzia - might have given him the demeanour of a man who was thrown out of the frying pan and into the fire. Yet Mr Abdu said he holds no grudge or anger, only the mild bitterness that comes from missed opportunities. His disease was discovered five years ago, after Mr Abdu submitted to routine medical tests that he hoped would qualify him to work as a labourer in Saudi Arabia. He saved for two years to afford the EGP7,000 Saudi visa and labour permit, but was rejected after testing positive for hepatitis C. But recent news has buoyed his spirits. After four months of therapy, Mr Abdu tested negative for Hepatitis C two months ago. He still has a year of therapy ahead of him, and he is eager to get back to work. "Sometimes I feel frustrated," he said. "I’m not accustomed to sitting at home. And work also trains the body." __________________________________________________________________________ _____________________________________*____________________________________ __________________________________________________________________________ * 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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