Blood-borne Research Articles

Analysis of characteristic and postexposure practices of occupational blood and body fluid exposures among health care workers in Chinese tertiary hospitals: a retrospective ten-year study

BackgroundOccupational blood and body fluid exposure (OBEs) is a highly concerning global health problem in health facilities. Improper or inadequate post-exposure practices increase the risk of infection with bloodborne pathogens. Understanding risk factors for OBEs and evaluating the post-exposure practices will contribute to healthcare workers’ (HCWs) well-being.MethodsThis study retrospectively synthesized and reviewed the 10-year data (from 2010 to 2020) on OBEs in a tertiary teaching hospital.ResultsA total of 519 HCWs have reported OBEs, increasing yearly from 2010 to 2020. Of these, most were nurses (247 [47.2%]), female (390 [75.1%]), at 23–27 years old (207 [39.9%]). The hepatitis B was the primary bloodborne pathogen exposed to HCWs, with 285 (54.9%) cases, internal medicine was the main exposure site (161 [31.0%]), and sharp injury was the main exposure route (439 [84.6%]). Data analysis shows that there are significant differences between exposure route, exposed pathogens, and exposure site among the different occupational categories (X2 = 14.5, 43.7, 94.3, all P < 0.001). 3.3% of HCWs did not take any post-exposure practices. For percutaneous exposure, 4.7% did not rinse the wound, 3.3% did not squeeze out the wound, and 2.3% did not disinfect the wound. In the case of mucosal exposure, 90.4% clean the exposure area immediately.ConclusionsThe data from the past decade underscores the seriousness of current situation of OBEs in Chinese tertiary hospital, particularly among young HCWs, and with hepatitis B as the predominant blood-borne pathogen. This study also identifies HCWs may take incorrect post-exposure practices. It’s crucial in the future to discuss the effectiveness of main groups targeted for focused specialty-specific guidance for the prevention of such accidents, meanwhile, to include blood-borne disease immunity testing in mandatory health check-ups. Additionally, focus on optimizing post-exposure practices, offering significant steps toward prevention of such incidents and reducing infection risks should also be considered in future studies.

DépistaFest: The evaluation of an inclusive, positive, and playful STBBI screening campaign's effectiveness.

Young adults are disproportionately affected by sexually transmitted and blood-borne infections (STBBIs), and rates of STBBI screening in this population are persistently low. The present study examined the effectiveness of Club Sexu's social marketing campaign, DépistaFest, in increasing STBBI screening, screening intentions, and general STBBI and STBBI screening knowledge among young adults in Quebec, Canada. Grounded in the health belief model, the campaign provided practical and scientifically accurate information on STBBIs and screening using an inclusive, positive, and playful approach. A sample of 686 participants (M = 28.0years old) was recruited through Club Sexu's social media to complete an online survey assessing campaign exposure, recent STBBI screening, screening intentions, and general STBBI and screening knowledge. Logistic regressions and ANCOVAs were performed to examine group differences on outcome variables. Compared to nonexposed participants, those who were exposed to the campaign were 2.11 times more likely to report having been tested in the past 6months, and 2.07 times more likely to report planning to get tested in the next 6months. Exposed participants were also more likely to correctly answer general STBBI knowledge questions and reported higher levels of self-perceived STBBI screening knowledge than nonexposed participants. The findings support the effectiveness of an STBBI prevention campaign grounded in the health belief model. Future STBBI prevention campaigns aimed at young adults would benefit from destigmatizing STBBIs and normalizing STBBI screening using an inclusive, positive, and playful approach.

Whole genome sequence-based molecular characterization of blood isolates of carbapenem-resistant Enterobacter cloacae complex from ICU patients in Kolkata, India, during 2017-2022: emergence of phylogenetically heterogeneous Enterobacter hormaechei subsp. xiangfangensis.

Blood-borne infections caused by the carbapenem-resistant Enterobacter cloacae complex (CR-ECC) are major public threats with respect to the challenges encountered during treatment. This study describes the whole genome sequencing-based molecular characteristics of blood isolates (n = 70) of CR-ECC from patients admitted to the intensive care unit of tertiary care hospitals in Kolkata, India, during 2017-2022 with respect to species identification, antimicrobial resistance (AMR) profiling, mechanism of drug resistance, and molecular subtypes. Vitek2 MALDI and species-specific PCR identified Enterobacter hormaechei subsp. xiangfangensis (47.14%) as the emerging CR-ECC subspecies in Kolkata. The predominating carbapenemase and extended-spectrum β-lactamase genes found were blaNDM-1 (51.42%) and blaCTX-M-15 (27%), respectively. Besides, blaNDM-4, blaNDM-5, blaNDM-7, blaCMH-3, blaSFO-1, blaOXA-181, blaOXA-232, blaKPC-3, and blaDHA-7 genes were also detected, which were not previously reported from India. A multitude of Class 1 integrons (including In180, In4874, In4887, and In4888, which were novel) and plasmid replicon types (IncFIB, IncFII, IncX3, IncHI1-HI2, IncC, and IncR) involved in AMR dissemination were identified. Reverse transcription-PCR and western blot revealed that carbapenem resistance in non-carbapenemase-producing CR-ECC isolates was contributed by elevated levels of ampC, overexpression of acrAB, and loss of ompF. A total of 30 distinct sequence types (STs) were ascertained by multi-locus sequence typing; of which, ST2011, ST2018, ST2055, ST2721, and ST2722 were novel STs. Pulsed-field gel electrophoresis analysis showed heterogeneity (69 pulsotypes with a similarity coefficient of 48.40%) among the circulating isolates, suggesting multiple reservoirs of infections in humans. Phylogenetically and genetically diverse CR-ECC with multiple AMR mechanisms mandates close monitoring of nosocomial infections caused by these isolates to forestall the transmission and dissemination of AMR.IMPORTANCEThe emergence and extensive dissemination of the carbapenem-resistant Enterobacter cloacae complex (CR-ECC) have positioned it as a critical nosocomial global pathogen. The dearth of a comprehensive molecular study pertaining to CR-ECC necessitated this study, which is the first of its kind from India. Characterization of blood isolates of CR-ECC over the last 6 years revealed Enterobacter hormaechei subsp. xiangfangensis as the most prevalent subsp., exhibiting resistance to almost all antibiotics currently in use and harboring diverse transmissible carbapenemase genes. Besides the predominating blaNDM-1 and blaCTX-M-15, we document diverse carbapenemase and AmpC genes, such as blaNDM-4, blaNDM-7, blaOXA-181, blaOXA-232, blaKPC-3, blaCMH-3, blaSFO-1, and blaDHA-7, in CR-ECC, which were not previously reported from India. Furthermore, novel integrons and sequence types were identified. Our findings emphasize the need for strengthened vigilance for molecular epidemiological surveillance of CR-ECC due to the presence of epidemic clones with a phylogenetically diverse and wide array of antimicrobial resistance genes in vulnerable populations.

Come back when you're infected: pharmacy access to sterile syringes in an Arizona Secret Shopper Study, 2023.

Pharmacies are critical healthcare partners in community efforts to eliminate bloodborne illnesses. Pharmacy sale of sterile syringes is central to this effort. A mixed methods "secret shopper" syringe purchase study was conducted in the fall of 2022 with 38 community pharmacies in Maricopa and Pima Counties, Arizona. Pharmacies were geomapped to within 2 miles of areas identified as having a potentially high volume of illicit drug commerce. Daytime venue sampling was used whereby separate investigators with lived/living drug use experience attempted to purchase syringes without a prescription. Investigator response when prompted for purchase rationale was "to protect myself from HIV and hepatitis C." A 24-item instrument measured sales outcome, pharmacy staff interaction (hostile/neutral/friendly), and the buyer's subjective experience. Only 24.6% (n = 28) of 114 purchase attempts across the 38 pharmacies resulted in syringe sale. Less than one quarter (21.1%) of pharmacies always sold, while 44.7% never sold. Independent and food store pharmacies tended not to sell syringes. There emerged distinct pharmacy staff interactions characterized by body language, customer query, normalization or othering response, response to purchase request and closure. Pharmacy discretion and pharmacy policy not to sell syringes without a prescription limited sterile syringe access. Investigators reported frequent and adverse emotional impact due to pharmacy staff negative and stigmatizing interactions. Pharmacies miss opportunities to advance efforts to eliminate bloodborne infections by stringent no-sale policy and discretion about syringe sale. State regulatory policy facilitating pharmacy syringe sales,limiting pharmacist discretion for syringe sales, and targetingpharmacy-staff level education may help advance the achievement of public health goals to eliminate bloodborne infections in Arizona.

Explaining the Experiences of Operating Room Nurses From Surgery of Patients With Blood-Borne Diseases: A Phenomenological Study

Background: Operating room nurses are exposed to blood-borne diseases, so it is important to examine their experience to prevent possible injuries. Based on this, the present study was conducted with the aim of explaining the experience of operating room nurses in the surgery of patients with blood-borne diseases. Methods: The research design is a descriptive phenomenological study. Sampling was performed purposefully, and participants were selected based on the inclusion and exclusion criteria. Data were collected using semi-structured oral interviews and then analyzed using Colaizzi’s method. Results: In this study, data were obtained through interviews with 15 operating room nurses. As a result of data analysis, 5 main themes and 16 sub-themes were identified, including a tense role, respect for patients’ privacy, functional compatibility, desire to have an experienced team, and the heroic feeling. Conclusion: Nurses experience negative and positive emotions while attending the surgery of the mentioned patients. In order to increase the quality of care and reduce burnout of nurses, these feelings should be paid attention to.

Hepatitis C Virus Testing, Infection, and Cases Reported Through Public Health Surveillance During Expanded Screening Recommendations, United States, 2013-2021.

Hepatitis C virus (HCV) infection is the most common bloodborne infection in the United States. We assessed trends in HCV testing, infection, and surveillance cases among US adults. We used Quest Diagnostics data from 2013-2021 to assess trends in the numbers tested for HCV antibody and proportion of positivity for HCV antibody and HCV RNA. We also assessed National Notifiable Diseases Surveillance System 2013-2020 data for trends in the number and proportion of hepatitis C cases. We applied joinpoint regression for trends testing. Annual HCV antibody testing increased from 1.7 million to 4.8 million from 2013 to 2021, and the positivity proportion declined (average, 0.2% per year) from 5.5% to 3.7%. The greatest percentage-point increase in HCV antibody testing occurred in hospitals and substance use disorder treatment facilities and among addiction medicine providers. HCV RNA positivity was stable at about 60% in 2013-2015 and declined to 41.0% in 2021 (2015-2021 average, -3.2% per year). Age-specific HCV RNA positivity was highest among people aged 40-59 years during 2013-2015 and among people aged 18-39 years during 2016-2021. The number of reported hepatitis C cases (acute and chronic) declined from 179 341 in 2015 to 105 504 in 2020 (average decline, -13 177 per year). The proportion of hepatitis C cases among those aged 18-39 years increased by an average of 1.4% per year during 2013-2020; among individuals aged 40-59 years, it decreased by an average of 2.3% per year during 2013-2018. HCV testing increased, suggesting improved universal screening. Various data sources are valuable for monitoring elimination progress.

Frequency of Needlestick and Sharp Injuries, Their Associated Risk Factors and Safety Measures among Healthcare Workers of Fauji Foundation Hospital, Rawalpindi

Background: Needlestick and sharp injuries (NSSIs) are significant occupational hazards for healthcare workers (HCWs), facilitating the transmission of bloodborne pathogens such as HIV, hepatitis B, and C viruses. Despite known risks, the frequency and associated factors contributing to these injuries in healthcare settings, particularly in developing countries, are not well-documented. Objective: This study aimed to determine the frequency of NSSIs, identify their associated risk factors, and evaluate the safety measures adopted by HCWs in a tertiary care hospital in Rawalpindi, Pakistan. Methods: A cross-sectional study was conducted from May to September 2022 at Fauji Foundation Hospital, Rawalpindi. A total of 250 HCWs, including paramedical staff, doctors, nurses, and allied health professionals, participated in the study. Ethical approval was obtained from the Center of Advanced Studies in Health and Technology research committee and the Head of the Department of Pathology. A structured questionnaire was developed to collect data on demographic characteristics, history of NSSIs, risk factors, and safety measures adopted post-injury. Data were analyzed using SPSS version 25, employing non-parametric tests due to the non-normal distribution of data. Results: Among the participants, 76.8% (n=192) reported experiencing NSSIs at least once during their employment. The highest incidence of NSSIs was observed among HCWs aged 26-30 years (31.6%, n=79) and those with 2-7 years of work experience (50.4%, n=126). The most common risk factors for NSSIs were heavy workload (40%) and recapping of needles (22%). Only 38% (n=95) of HCWs reported the incident, and 44% (n=111) were vaccinated against hepatitis B following exposure. Moreover, 58% (n=145) used personal protective equipment, and 73.6% (n=184) utilized safety boxes for sharp waste disposal post-injury. Conclusion: The study highlights a high prevalence of NSSIs among HCWs, with inadequate reporting and post-exposure prophylaxis. There is a critical need for enhanced training on safe handling of sharps and increased adherence to universal precautions to mitigate the risk of NSSIs in healthcare settings.

Clinical trial and performance evaluation of the Wantai HBsAg (CMIA) diagnostic kit for screening blood donors in China

In China, according to the ‘Technical Operating Procedures for Blood Stations (2019 Edition),’ blood stations are authorized to utilize Chemiluminescence Immunoassay (CLIA) to detect pathogen markers linked with transfusion-transmissible infections. However, currently, there is no approved CLIA reagent for the screening of blood-borne diseases in China, specifically for the detection of Hepatitis B surface antigen. The objective of this research project is to conduct a comprehensive evaluation of the performance of the Wantai Chemiluminescent Microparticle Hepatitis B surface antigen reagent. This study evaluates the performance of the Wantai Chemiluminescent Microparticle Immunoassay (CMIA) on the Wan200 + analyzer in screening for Hepatitis B Surface Antigen (HBsAg) in blood samples. The clinical trial component of this evaluation is included as part of the documentation submitted to the National Medical Products Administration (NMPA) of China for the approval of blood screening reagents. The evaluation plan of this study encompasses two main components: clinical trials and performance assessment. We adopted a controlled trial design, utilizing the WanTai Chemiluminescent Microparticle Immunoassay (CMIA) on the Wan200 + analyzer and the Enzyme-Linked Immunosorbent Assay (ELISA) to screen for Hepatitis B Surface Antigen (HBsAg) in routine blood donor samples and reference serum panel samples. To ensure the accuracy of the screening, we additionally employed Abbott's ELISA reagents and HBV DNA for validation. The assessment primarily focused on key performance indicators such as sensitivity, specificity, and analytical sensitivity. Moreover, this clinical trial data has been included as part of the submission to China's National Medical Products Administration (NMPA). In the clinical trials of this study, a total of 10,470 blood donor samples underwent simultaneous testing using both CMIA and ELISA methods. Across two clinical trials, there was remarkable concordance between CMIA and the two ELISA reagents, with Kappa values exceeding 0.82. Among the 269 samples that were double-reactive in the enzyme immunoassay (ELISA) tests, CMIA exhibited a 100% reactivity detection rate. However, CMIA produced 14 and 6 false-positive results in the respective clinical trials, resulting in specificities of 99.73% and 99.89%. In contrast, the specificities for Wantai ELISA and Xin Chuang ELISA were both greater than 99.94%.When testing samples in the gray zone serum plates, CMIA's detection limit significantly exceeded that of the two ELISA assays. CMIA had a detection cutoff of 0.05 IU/mL, while the two ELISA reagents had cutoffs of 0.1 IU/mL and 0.09 IU/mL, respectively. CMIA's detection limits for the adr and adw subtypes were 0.05 IU/mL, and for the ay subtype, it was 0.1 U/mL. The detection limit for 10 HBV mutant samples was 0.5 U/mL. In 165 cases where ELISA tested negative but HBV DNA tested positive, CMIA detected 5 HBsAg-positive samples. This study evaluated the performance of the Wantai CMIA in screening for HBsAg among blood donors. The results demonstrate outstanding performance of CMIA in both clinical trials and performance assessments, detecting all true positive samples with a sensitivity of 100%. It exhibits excellent concordance with the two ELISA assays. Of particular note is its superiority in early detection of HBsAg in the screening of early-stage hepatitis B infections, reducing the window period compared to ELISA. CMIA achieves a specificity exceeding 99.73% for negative blood donors, aligning with the European Union's standards for blood screening assay specificity. In summary, Wantai's CMIA displays high sensitivity and specificity in blood donor screening, making it suitable for screening blood donors in China.

Summary of the National Advisory Committee on Sexually Transmitted and Blood-Borne Infections (NAC-STBBI) Statement: Recommendations on Screening for Syphilis in Non-Pregnant Adults and Adolescents.

Sustained and significant increases in Canadian rates of infectious syphilis prompted the National Advisory Committee on Sexually Transmitted and Blood-Borne Infections (NAC-STBBI) to update the existing screening recommendation for non-pregnant adults and adolescents. These guidelines were developed following the 2014 World Health Organization Handbook. The research question was: "What is the clinical utility of syphilis screening using risk-based versus population-wide approaches for adolescents and adults?" The evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. The environmental scan included 11 guidelines on syphilis screening published between 2014 and January 2023. Two systematic reviews were identified and included. In the updated literature search from November 6, 2019, to January 17, 2023, there were no published systematic reviews on the effectiveness of risk-based screening or the comparison of risk-based and interval screening; however, one recent randomized control trial in Canada was published. Evidence for outcomes, patient values and preferences, resources, acceptability, equity, cost and cost effectiveness and feasibility were reviewed. This statement provides two screening recommendations for adults and adolescents. Recommendation 1: NAC-STBBI recommends syphilis screening in all sexually active persons with a new or multiple partners and/or upon request of the individual. They also recommend screening every three to six months in individuals with multiple partners. Recommendation 2: NAC-STBBI recommends that targeted "opt-out" screening programs should be considered as frequently as every three months when serving population groups and/or communities experiencing a high prevalence of syphilis (and other STBBI). Both are strong recommendations with moderate certainty of evidence.

Retrospective Analysis of Blood Test Results of Volunteer Blood Donors

To analyze the results of unqualified blood screening among blood donors in Shaoxing region. 257 145 blood samples from volunteer blood donors from 2017 to 2021 were tested for HBsAg, HCV, HIV, TP, ALT, HTLV, and NAT. All blood test results were analyzed retrospectively. Over the 5-year period, the average failure rate of the tests for volunteer blood donors was 1.22%. In the descending order from high to low, the positive rates of ALT, HBsAg, NAT, TP, HCV, HIV, HTLV were 0.32%, 0.25%, 0.20%, 0.19%, 0.17%, 0.07%, and 0.01% respecitively. Of these, HBsAg (χ2=65.23), ALT (χ2=47.32), and HCV (χ2=12.73) were significantly different between different years (P <0.05), but TP (χ2=4.19), HIV (χ2=7.58), NAT (χ2=7.62), and HTLV (χ2=6.75) were no significant differences (P >0.05). And the positivity rates of HBsAg and HCV was a trend of decreasing. By comparing nucleic acid and enzyme immunoassay positive tests, the two methods were found to complement each other. The age and gender distribution difference of the positive population could help to better ensure safe blood recruitment. It is necessary to strengthen blood testing efforts and continuously pay attention to the changing patterns of positive blood-borne diseases in order to improve blood quality and safety.

COMMUNITY BASED MODEL OF HEPATITIS B ELIMINATION IN TRIPURA, NORTH EAST INDIA

Liver can be affected by various virus like Hepatitis A, B, C, D, E. Hepatitiss B and C are blood borne and can cause chronic complications leading to chronic liver disease, cirrhosis and hepatocellular carcinoma. In 1984 Taiwan launched first universal vaccination against Hepatitis B with plasma derived vaccine and they could reduce the burden significantly with in a short period. In 1987 recombinant DNA vaccine become available and hepatitis B vaccination became a target area but the the program did not received proper momentum. A science based social orbanisation, Hepatitis Foundation of Tripura started hepatitis B prevention movement at Tripura, a small state of North East Region of India in 2002. Gradually the program extended following various public heath method. This out of the box model could achieve a great success towards elimination of Hepatitis B. This Tripura model adopted by a social organisation, could act as template for HBV elimination.

Hepatitis C virus reinfection incidence among gay and bisexual men with HIV in Australia from 2016 to 2020.

There is some concern that hepatitis C virus (HCV) reinfection might impact HCV micro-elimination efforts among gay and bisexual men (GBM) with HIV. However, there is a limited understanding of reinfection incidence in the context of unrestricted government-funded HCV treatment. We aimed to estimate HCV reinfection incidence among GBM with HIV in Australia from 2016 to 2020. Data were from 39 clinics participating in ACCESS, a sentinel surveillance network for blood borne viruses and sexually transmissible infections across Australia. GBM with HIV who had evidence of treatment or spontaneous clearance with at least one positive HCV RNA test, a subsequent negative HCV RNA test, and at least one additional HCV RNA test between 1st January 2016 and 31st December 2020 were eligible for inclusion. A new HCV RNA positive test and/or detectable viral load was defined as a reinfection. Generalised linear modelling was used to examine trends in reinfection. Among 12 213 GBM with HIV who had at least one HCV test, 540 were included in the reinfection incidence analysis, of whom 38 (7%) had evidence of reinfection during the observation period. Over 1124 person-years of follow-up, the overall rate of reinfection was 3.4/100PY (95% CI 2.5-4.6). HCV reinfection incidence declined on average 30% per calendar year (Incidence Rate Ratio 0.70, 95% CI 0.54-0.91). HCV reinfection incidence has declined among GBM with HIV in Australia since government-funded unrestricted DAAs were made available. Ongoing HCV RNA testing following cure and prompt treatment for anyone newly diagnosed is warranted to sustain this.

A novel technique for contained aspiration and irrigation of priapism

Abstract Background Ischemic priapism is a urological emergency requiring prompt corporal aspiration and irrigation, with risk of blood spillage that can place a significant biological hazard to the urologist and rest of emergency room staff. Aim The study sought to develop and validate a method for contained corporal aspiration that minimizes exposure to sharps and occupational hazards. Methods We used one large bore needle connected to a vacuum aspiration device and blood draw tubes for corporal aspiration and irrigation of ischemic priapism. Outcomes Feasibility of this method was assessed in 18 consecutive patients presenting to the emergency room with ischemic priapism. Clinical characteristics, resolution of priapism, and need for further interventions were documented. Results A total of 18 patients were treated using this technique. The mean time from onset to presentation was 12 hours. The etiology in all patients was recreational intracavernosal drug abuse, and 72% were HIV positive. Priapism completely resolved in all 18 patients. No patients required shunt procedures or further interventions to achieve detumescence. Clinical Implications This system can be used for safe management of ischemic priapism in any clinical scenario but is particularly beneficial to minimize exposure risk in the setting of increased risk of blood-borne infections. Strengths and Limitations This initial trial shows that this technique is safe and effective for cavernosal aspiration of ischemic priapism. Larger trials are required to validate this method. Conclusion Contained aspiration and irrigation of priapism can be used for effective management of ischemic priapism while minimizing health risks to urologists and emergency room staff.

Premarital Screening: A Catalyst for Achieving Good Health and Well-Being

Background: Premarital screening is a comprehensive examination that must be done before marriage, which includes examinations of reproductive organs, genetic diseases, infectious diseases, and blood-borne infections. The screening aims to avoid the risk of long-term diseases for couples and their descendants. This screening can also prevent maternal and infant mortality, birth defects, and stunting because risk factors can be detected and addressed early in the mother and baby-to-be. Despite its importance, premarital screening behavior is not culturally embedded. Aims: This study aimed to determine factors associated with premarital screening behavior. Methods: This research uses systematic review as its design from Google Scholar and Scopus databases that discuss the determinants of premarital screening behavior with quantitative methods. Articles were collected with the keywords "premarital" and "screening" published within the last five years, from 2018 to 2023. Results: The researchers discovered 1,151 articles. 10 articles fulfilled the criteria and objective of this study and were further reviewed. Older age, female, higher education level, consanguineous relationship between parents, history of genetic diseases, good knowledge and positive attitude, and the establishment of government regulations are factors associated with premarital screening behavior. Conclusion: Health promotion may be expanded to raise public awareness of the necessity of premarital health screening. It is also intended that future researchers would investigate premarital health screening behavior using various research approaches, such as cross-sectional or qualitative research.

Past meets present: Reviving 80-year-old Canadian dried serum from World War II and its significance in advancing modern freeze-dried plasma for prehospital management of haemorrhage.

During World War II, Charles H. Best utilized Charles R. Drew's plasma isolation and drying technique to lead Canada's initiative to provide dried serum as a means of primary resuscitation for British casualties on the frontlines. Serum was likely utilized over plasma for its volume expansion properties without the risk of clotting during prolonged storage. We reconstituted dried serum from 1943 and discovered intact albumin, as well as anti-thrombin, plasminogen, protein C and protein S activity. Proteomic analysis identified 71 proteins, most prominent being albumin, and positive for hepatitis B by serological testing. Transmission of blood-borne diseases ended the programme, until modern advances in testing and pathogen reduction revived this technology. We tested the latest iteration of Canadian freeze-dried plasma (FDP), which was stored for 4 years, and demonstrated that its clotting capacity remained equivalent tofresh frozen plasma. We recommend that FDP is a strong alternative to contemporary prehospital resuscitation fluids (e.g. normal saline/lactated Ringer's) in managing prehospital haemorrhage where whole blood is unavailable.

Increasing and sustaining blood-borne virus screening in Spain and Portugal throughout the COVID-19 pandemic: a multi-center quality improvement intervention.

Around 57,000 people in Spain and Portugal currently living with HIV or chronic hepatitis C are unaware of their infection. The COVID-19 pandemic severely disrupted screening efforts for these infections. We designed an intervention to increase and sustain opportunistic blood-borne virus (BBV) screening and linkage to care (SLTC) by implementing the TEST model. The Plan Do Study Act (PDSA) method of quality improvement (QI) was implemented in 8 healthcare organizations (HCOs), including four hospitals, two clusters of community health centers, and two community-based organizations (CBOs). Baseline assessment included a review of BBV SLTC practices, testing volume, and results 12 months before the intervention. Changes in BBV testing rates over time were measured before, during, and after the COVID-19 lockdowns in 2020. A mixed ANOVA model was used to analyze the possible effect on testing volumes among HCOs over the three study periods. BBV testing was integrated into normal clinical flow in all HCOs using existing clinical infrastructure and staff. Electronic health record (EHR) systems were modified whenever possible to streamline screening processes, implement systemic institutional policy changes, and promote QI. Two years after the launch of the intervention in screening practices, testing volumes increased by 116%, with formal healthcare settings recording larger increases than CBOs. The start of the COVID-19 lockdowns was accompanied by a global 60% decrease in testing in all HCOs. Screening emergency department patients or using EHR systems to automate screening showed the highest resilience and lowest reduction in testing. HCOs recovered 77% of their testing volume once the lockdowns were lifted, with CBOs making the fullest recovery. Globally, enhanced screening techniques enabled HCOs to diagnose a total of 1,860 individuals over the research period. Implementation of the TEST model enabled HCOs to increase and sustain BBV screening, even during COVID-19 lockdowns. Although improvement in screening was noted in all HCOs, additional work is needed to develop strong patient linkage to care models in challenging times, such as global pandemics.

Addressing Fear of Negative Consequences of Overdose Response: A Qualitative Study of the Perceptions of Service Industry Workers Who Encounter an Opioid Overdose in an Urban Commercial District in Atlanta, Georgia.

The increased contamination of illicit drugs with fentanyl in the United States drug market has contributed to escalating mortality from drug overdose. Leisure and hospitality service industry workers are encountering opioid-triggered overdoses in their workplaces, such as restaurants and bars. Consequently, this increases the need for overdose education and naloxone distribution (OEND) training, which has been limited. We aimed to describe the experiences among service industry workers encountering an overdose in their workplace. We conducted in-depth qualitative interviews with service industry workers in Little Five Points (L5P), Atlanta, between October 2019 and April 2020 and triangulated methods with participant observations and fieldwork. Purposive criterion sampling methods were applied to recruit from different establishments in the L5P commercial district, which comprised restaurants, bars, retail shops, and theaters. After an initial seed sample was identified by engaging key stakeholders during fieldwork (business owners, managers, and the business association), a snowball sample followed for a final sample of N = 15. To contextualize the local population of harm reduction workers, people who use drugs and/or obtain safer drug consumption supplies in L5P (sterile syringes, safer using kits, naloxone), and service industry workers and their customers in L5P, the first author volunteered with an Atlanta syringe services program from October 2019 to April 2020. The first author conducted participant observations during the syringe exchange program and field notes were taken during observation (44 hours). This engagement ensured a rich, thick description. We used a pragmatic approach to thematic data analysis for this study. Data were analyzed iteratively and inductively from interviews and observations. Two independent researchers reviewed transcripts to identify passages in the data related to the question of interest. The passages were contextualized within the full data set independently to understand the relationships in developing a theory of what was commonly occurring across participants' experiences, and these relationships led to emerging salient themes regarding encountering an opioid overdose at work. One salient theme related to overdose response emerged with the service industry workers included fear of negative consequences of overdose response, specifically, fear of disease transmission from artifacts of drug use and overdose response, including the spread of blood-borne disease, violence, and exposure to unintentional overdose. When discussing drug use, participants' beliefs about the potential for personal danger from drug use artifacts (syringes and discarded drugs) and violence were identified as barriers to opioid overdose responses. Our findings provide valuable insights for tailoring OEND training for service industry workers to confront fears associated with opioid overdose response in their places of work to decrease mortality from the opioid epidemic. Harm reduction approaches need to be sensitive to the places in which overdose occurs and who the overdose responder is likely to be, which requires appropriately tailoring OEND training for service industry workers.

PSGL-1 decorated with sialyl Lewisa/x promotes high affinity binding of myeloma cells to P-selectin but is dispensable for E-selectin engagement

Dissemination of multiple myeloma into the bone marrow proceeds through sequential steps mediated by a variety of adhesion molecules and chemokines that eventually results in the extravasation of malignant plasma cells into this protective niche. Selectins are a class of C-type lectins that recognize carbohydrate structures exposed on blood borne cells and participate in the first step of the extravasation cascade, serving as brakes to slow down circulating cells enabling them to establish firm adhesion onto the endothelium. Myeloma cells enriched for the expression of selectin ligands present an aggressive disease in vivo that is refractory to bortezomib treatment and can be reverted by small molecules targeting E-selectin. In this study, we have defined the molecular determinants of the selectin ligands expressed on myeloma cells. We show that PSGL-1 is the main protein carrier of sialyl Lewisa/x-related structures in myeloma. PSGL-1 decorated with sialyl Lewisa/x is essential for P-selectin binding but dispensable for E-selectin binding. Moreover, sialylation is required for E-selectin engagement whereas high affinity binding to P-selectin occurs even in the absence of sialic acid. This study provides further knowledge on the biology of selectin ligands in myeloma, opening the way to their clinical application as diagnostic tools and therapeutic targets.

Prevention of Viral Hepatitis and HIV Infection among People Who Inject Drugs: A Systematic Review and Meta-Analysis.

This study aimed to explore the current evidence on preventing blood-borne virus infections among people who inject drugs (PWID). We conducted a comprehensive search across three databases (PubMed, Embase, Cochrane Library) for relevant articles published in English between 2014 and 2023. We followed the Preferred Reporting Items for Systematic Reviews and Meta Analysis (PRISMA) guidelines, assessed the quality of the paper using the revised Cochrane Risk of Bias Tool (ROB 2), and conducted a meta-analysis using RevMan 5.3. Completing the harm reduction program (HRP) participation and receiving all three vaccine doses resulted in a 28% reduction in the risk of HBV infection (OR: 0.72, 95% CI: 0.37-1.42). Various interventions increased the willingness of PWIDs to undergo HCV treatment (OR: 5.91, 95% CI: 2.46-14.24) and promoted treatment adherence (OR: 15.04, 95% CI: 2.80-80.61). Taking PrEP, participating in HRP, and modifying risky behaviors were associated with a 33% reduction in the risk of HIV infection (OR: 0.67, 95% CI: 0.61-0.74). Conducting referrals, providing counseling, and implementing antiretroviral therapy resulted in a 44% reduction in the risk of viral transmission (OR: 0.56, 95% CI: 0.47-0.66). Co-infection may potentially compromise effectiveness, so it is important to consider drug resistance.

A comparative analysis of blood-borne infections among sickle cell anemia patients and first-time donors in Gabon

Managing sickle cell disease often requires transfusions, exposing multi-transfused sickle cell patients to a heightened risk of transfusion-transmitted infections. This study aimed to assess the seroprevalence of the human immunodeficiency virus (HIV), hepatitis B surface antigen (HBsAg), and hepatitis C virus (HCV) in multi-transfused sickle cell patients and first-time donors in Libreville. The serological testing for HBsAg, anti-HIV, and anti-HCV antibodies was conducted using commercial enzyme immunoassays and confirmed by the COBAS modular analyzer (Roche Diagnostics). The seroprevalence of HIV, HCV antibodies, and HBsAg was 4%, 10%, and 10%, respectively, in multi-transfused sickle cell patients and 5%, 0%, and 8% in first-time donors. Interestingly, HIV and HBsAg seroprevalence were similar in both groups, indicating that transfusion was not associated with these infections. However, HCV antibody seroprevalence was significantly higher in multi-transfused sickle cell patients than in first-time donors (10% vs. 0%, p&lt;0.001). Furthermore, the presence of anti-HCV antibodies in multi-transfused sickle cell patients was significantly associated with the number of donations received (7.20±2.37 vs. 3.96±2.06, p=0.042). These findings suggest that while blood transfusion is not a significant risk factor for HIV and HBsAg transmission, it may increase the risk of HCV transmission, particularly in multi-transfused sickle cell patients.