Safe Injection Practices Research Articles

Cluster of HIV Infections Attributed to Unsafe Injection Practices--Cambodia, December 1, 2014-February 28, 2015.

In December 2014, local health authorities in Battambang province in northwest Cambodia reported 30 cases of human immunodeficiency virus (HIV) infection in a rural commune (district subdivision) where only four cases had been reported during the preceding year. The majority of cases occurred in residents of Roka commune. The Cambodian National Center for HIV/AIDS (acquired immunodeficiency syndrome), Dermatology and Sexually Transmitted Diseases (NCHADS) investigated the outbreak in collaboration with the University of Health Sciences in Phnom Penh and members of the Roka Cluster Investigation Team. By February 28, 2015, NCHADS had confirmed 242 cases of HIV infection among the 8,893 commune residents, an infection rate of 2.7%. Molecular investigation of the HIV strains present in this outbreak indicated that the majority of cases were linked to a single HIV strain that spread quickly within this community. An NCHADS case-control study identified medical injections and infusions as the most likely modes of transmission. In response to this outbreak, the Government of Cambodia has taken measures to encourage safe injection practices by licensed medical professionals, ban unlicensed medical practitioners, increase local capacity for HIV testing and counseling, and expand access to HIV treatment in Battambang province. Measures to reduce the demand for unnecessary medical injections and the provision of unsafe injections are needed. Estimates of national HIV incidence and prevalence might need to be adjusted to account for unsafe injection as a risk exposure.

Cost-Effectiveness of Combined Sexual and Injection Risk Reduction Interventions among Female Sex Workers Who Inject Drugs in Two Very Distinct Mexican Border Cities.

BackgroundWe evaluated the cost-effectiveness of combined single session brief behavioral intervention, either didactic or interactive (Mujer Mas Segura, MMS) to promote safer-sex and safer-injection practices among female sex workers who inject drugs (FSW-IDUs) in Tijuana (TJ) and Ciudad-Juarez (CJ) Mexico. Data for this analysis was obtained from a factorial RCT in 2008–2010 coinciding with expansion of needle exchange programs (NEP) in TJ, but not in CJ.MethodsA Markov model was developed to estimate the incremental cost per quality adjusted life year gained (QALY) over a lifetime time frame among a hypothetical cohort of 1,000 FSW-IDUs comparing a less intensive didactic vs. a more intensive interactive format of the MMS, separately for safer sex and safer injection combined behavioral interventions. The costs for antiretroviral therapy was not included in the model. We applied a societal perspective, a discount rate of 3% per year and currency adjusted to US$2014. A multivariate sensitivity analysis was performed. The combined and individual components of the MMS interactive behavioral intervention were compared with the didactic formats by calculating the incremental cost-effectiveness ratios (ICER), defined as incremental unit of cost per additional health benefit (e.g., HIV/STI cases averted, QALYs) compared to the next least costly strategy. Following guidelines from the World Health Organization, a combined strategy was considered highly cost-effective if the incremental cost per QALY gained fell below the gross domestic product per capita (GDP) in Mexico (equivalent to US$10,300).FindingsFor CJ, the mixed intervention approach of interactive safer sex/didactic safer injection had an incremental cost-effectiveness ratio (ICER) of US$4,360 ($310–$7,200) per QALY gained compared with a dually didactic strategy. Using the dually interactive strategy had an ICER of US$5,874 ($310–$7,200) compared with the mixed approach. For TJ, the combination of interactive safer sex/didactic safer injection had an ICER of US$5,921 ($104–$9,500) per QALY compared with dually didactic. Strategies using the interactive safe injection intervention were dominated due to lack of efficacy advantage. The multivariate sensitivity analysis showed a 95% certainty that in both CJ and TJ the ICER for the mixed approach (interactive safer sex didactic safer injection intervention) was less than the GDP per capita for Mexico. The dual interactive approach met this threshold consistently in CJ, but not in TJ.InterpretationIn the absence of an expanded NEP in CJ, the combined-interactive formats of the MMS behavioral intervention is highly cost-effective. In contrast, in TJ where NEP expansion suggests that improved access to sterile syringes significantly reduced injection-related risks, the interactive safer-sex combined didactic safer-injection was highly cost-effective compared with the combined didactic versions of the safer-sex and safer-injection formats of the MMS, with no added benefit from the interactive safer-injection component.

The Role of Primary Prevention in Decreasing HCV Related Disease Burden in Pakistan

Objective: To identify the most effective primary preventive interventions for reducing the disease burden of HCV infection in Pakistan. Study Design: Literature Review. Methods: A comprehensive review of the published literature on the effectiveness of primary prevention interventions to reduce the incidence and prevalence of HCV infection was undertaken by using the scientific data bases. Results: The review identified 15 relevant studies. These studies identified the key risk factors responsible for high disease burden of HCV infection in Pakistan, that is, therapeutic injections, unsafe medical/surgical practices, needle stick injuries, unscreened blood transfusions, poor knowledge and risk awareness. Conclusion: There is an immense need of further research and pragmatic guidance for policy makers to evaluate the effectiveness of primary prevention in reducing the transmission of HCV infection. The government of Pakistan and main health authorities should intervene more effectively to control the high rates of HCV infection. Safe injection practices along with safe medical/surgical practices; safe blood supply and risk awareness among the general population should be the main priorities for preventing the spread of HCV infection in Pakistan.

Using medical student observers of infection prevention, hand hygiene, and injection safety in outpatient settings: A cross-sectional survey

Health care-associated infection outbreaks have occurred in outpatient settings due to lapses in infection prevention. However, little is known about the overall infection prevention status in outpatient environments. A cross-sectional design was employed to assess infection prevention policies and practices at 15 outpatient sites across New Mexico in 2014 during a medical student outpatient rotation. A standardized infection prevention checklist was completed via staff interview; observations of injection safety practices and hand hygiene behavior were conducted. Aggregate data were analyzed using Excel (Microsoft, Redmond, WA) and Stata (version 12.1, Stata Corp, College Station, TX) statistical software. Medical practice staff interviews reported a mean of 92.8% (median, 96.7%; range, 75.0%-98.9%) presence of recommended policies and practices. One hundred sixty-three injection safety observations were performed that revealed medication vial rubber septums were disinfected with alcohol 78.4% (95% confidence interval [CI], 71.1%-84.7%) of the time before piercing. Three hundred thirty hand hygiene observations revealed 33.9% (95% CI, 28.8%-39.1%) use of alcohol-based handrub, 29.1% (95% CI, 24.2%-34.0%) use of soap and water, and 37.0% (95% CI, 31.8%-42.4%) use of no hand hygiene. These findings support the need for ongoing infection prevention quality improvement initiatives in outpatient settings and underscore the importance of assessing both self-report and observed behavior of infection prevention compliance.

Safe Injection Practices in Primary Health Care Settings of Naxalbari Block, Darjeeling District, West Bengal.

Unsafe injection can transmit many diseases to patients, injection providers and healthy people of community. To find out critical steps whether executed according to recommended best practice methods, availability of equipments in health facilities for safe injection practices and some important steps of waste disposal methods. This facility-based cross-sectional observational study was conducted among 30 Auxiliary nurse midwives (ANM) & 27 nursing staffs (NS) to assess certain aspects of their practice while administrating injection and disposal of the disposables. Health facilities were also observed to asses necessary equipments of safe injection and waste disposal methods. Among the health workers 93.3% ANM and 100% NS took sterile syringe from sterile unopened packet, all of the study subjects washed hand before giving injection, 13.3% of ANMs and 8% of NS are fully vaccinated against Hep B, 53.3% of ANM and all NS are practices non recapping. Only 13.33% sub centres along with PHC & BPHC had at least one puncture resistant leak proof container, 86.7% sub centres, PHC are free from loose needles. Transport for off side treatment is the method of waste disposal in case of 73.3% cases sub centres, PHC & BPHC. There is need to educate, train and motivate service providers in proper methods of giving injection along with improve the adequacy of supply of required equipments.

Towards safe injection practices for prevention of hepatitis C transmission in South Asia: Challenges and progress.

To summarize the available information about injection use and its determinants in the South Asian region. We searched published and unpublished literature on injection safety in South Asia published during 1995-2016 using the keywords "injection" "unsafe injection" and "immunization injection" and combined these with each of the countries and/or their respective states or provinces in South Asia. We used a standardized questionnaire to abstract the following data from the articles: the annual number of injections per capita, the proportion of injections administered with a reused syringe or needle, the distribution of injections with respect to prescribers and providers and determinants of injection use. Although information is very limited for certain countries (i.e., Bhutan, Maldives and Sri Lanka), healthcare injection use is very common across South Asia, with cross-country rates ranging from 2.4 to 13.6 injections/person/year. Furthermore, recent studies show that 5% to 50% of these injections are provided with reused syringes, thus creating potential to transmission of blood-borne pathogens. Qualified and unqualified practitioners, especially in the private sector, are the major drivers behind injection use, but patients also prefer injections, especially among the rural, poor or uneducated in certain countries. According to available data, Pakistan and India have recently taken steps towards achieving safe injection. Potential interventions include the introduction of reuse prevention devices, and patient-, community- and patient/community and provider-centered interventions to change population and practitioner behavior. Injection use is common in South Asian countries. Multilevel interventions aiming at patients, providers and the healthcare system are needed to reduce injection use and reuse.

An Outbreak of Hepatitis B in a Rural Area of West Bengal, India

Introduction There were limited data on outbreaks of hepatitis in rural settings in India. We describe an outbreak of Hepatitis B virus infection to confirm the existence of an outbreak of Hepatitis B in a rural area of West Bengal, India and to determine risk factors for the outbreak and recommend preventive measures. Methods We surveyed the entire village retrospectively followed by a cross sectional case control study. We selected Hepatitis B surface Antigen (HBsAg) positive patients as cases and recruited neighbours as controls with a ratio of 1:2. The study was undertaken between November 2013 and June 2014. We collected blood samples which were sent to the laboratory for virological examination. Data were analyzed with Epi-info and Excel software. Results We surveyed 2170 residents. Of the 1085 residents in the risk population, 54 were tested for hepatitis B and13 identified as hepatitis B positive. Among them 77% (10) were men. Overall attack rate was 0.59% (13/1085). One patient died (Case Fatality Ratio= 7.7%). Of the tested population, 53% (7) were illiterate and 39% (5) were migrant labour by occupation. Compared with controls, significantly higher number of cases were given injection by local medical practitioners (LMP) (OR 7.50 95% CI 1.19-78.93) and had unsafe sex with sex workers (OR 15.63, 95% CI 1.34-767.41). Conclusion Injections given by LMPs and unsafe sex with sex workers were risk factors for the outbreak. Awareness programmes were carried out for LMPs on safe injection practice and villagers on safe sex and blood borne diseases. Hepatitis B vaccination was recommended for infants and adults.

Mesotherapy for facial rejuvenation: indications and injection techniques

Evidence has broadened the aesthetic nurses's understanding of the factors that influence ageing, skin cell function, cell-to-cell interaction, and intermolecular transport and communication. This has stimulated an interest in the application of mesotherapy, a technique involving micro-injections to the papillary dermis, using active and essential ingredients which directly stimulate fibroblast cells. Clinical experience supports the technique as a simple, safe, cost-effective and well-tolerated treatment modality performed by suitably trained practitioners who follow safe injection practice with appropriate aseptic techniques.

Validation of the Immunization Data Reported under Health Management Information System by the Primary Health Centres of Rural Vadodara

To study the immunization data reported by the primary health centre/sub-centre (PHC/SC) and validate them at the village level, and to also assess the quality of care during immunization. A sample of 20 PHCs, 13 rural and 7 tribal, was selected using a stratified random sampling. For every PHC, two SCs and for every SC, one village were selected. Data on immunization were collected from the PHC/SC records and were validated by interviewing five beneficiaries from the village. The process evaluation of immunization session was done wherever possible to assess the quality of care. The district availability of vaccines was 77.0 per cent while the overall accessibility was 90 per cent. Following validation, the gap between reported and validated data was 15 per cent and 25 per cent of reported utilization and coverage, respectively. Process evaluation revealed that the process was followed correctly at 62 per cent as per the assessment score. Only a part of the gap could be accounted for by the reasons justified by the service providers. However, a substantial part of the gap may be chiefly due to over-reporting mainly to meet the dictated targets. Process evaluation revealed lacunae in safe injection practices.

A Review of the CDC Recommendations for Prevention of HAIs in Outpatient Settings

According to the Centers for Disease Control and Prevention (CDC), most health care–associated infections (HAIs) are caused by contamination from the hands of health care providers or patients, contamination from the environment, and contamination from the patient’s own skin. To mitigate common sources of infection transmission, frontline health care providers must be compliant with basic infection-prevention interventions, including hand hygiene, environmental cleaning and disinfection, safe injection practices, and designation of a trained health care professional to be responsible for the infection prevention and control program. Integration of CDC recommendations should incorporate a bundled approach to these interventions and should be part of a comprehensive approach to infection prevention and control. Effective infection-prevention practices in outpatient settings are critical for reducing the risk of infection transmission, improving patient safety and patient outcomes, and reducing costs associated with health care delivery.

Injection practice in Kaski district, Western Nepal: a community perspective.

BackgroundPrevious studies have shown that unsafe injection practice is a major public health problem in Nepal but did not quantify the problem. The present community-based study was planned to: 1) quantify injection usage, 2) identify injection providers, 3) explore differences, if any, in injection usage and injection providers, and 4) study and compare people’s knowledge and perception about injections between the urban and rural areas of Kaski district.MethodsA descriptive, cross-sectional mixed-methods study was conducted from July to November 2012, using a questionnaire based survey and focus group discussions (FGDs). A semi-structured questionnaire advocated by the World Health Organization was modified and administered to household heads and injection receivers in selected households and the FGDs were conducted using a topic guide. The district was divided into urban and rural areas and 300 households from each area were selected. Twenty FGDs were held.ResultsIn 218 households (36.33%) [99 in urban and 119 in rural] one or more members received at least one injection. During the three month recall period, 258 subjects (10.44%) reported receiving injection(s) with a median of two injections. The average number of injections per person per year was calculated to be 2.37. Health care workers (34.8%), staff of medical dispensaries (37.7%), physicians (25.2%), and traditional healers (2.3%) were consulted by the respondents for their basic health care needs and for injections. Compared to urban respondents, more rural respondents preferred injections for fever (p < 0.001). People preferred injections due to injections being perceived by them as being powerful, fast-acting, and longer lasting than oral pills. More than 82% of respondents were aware of, and named, at least one disease transmitted by using unsterile syringes during injection administration or when syringes are shared between people.ConclusionsLess preference for injections and high awareness about the association between injections and injection-borne infections among the general population is encouraging for safe injection practice. However, respondents were not aware of the importance of having qualified injection providers for safe injections and were receiving injections from unqualified personnel.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1775-5) contains supplementary material, which is available to authorized users.

Injection safety knowledge and practices among clinical health care workers in Garissa provincial general hospital

Background : The World Health Organization estimates that approximately 16 billion injections are administered in developing countries annually. Injection safety is therefore critical in preventing occupational exposure and infection from blood borne pathogens, hence prevention is a vital part of any comprehensive plan for protecting health workers, patients and maintaining a safe environment. Objective : To determine the knowledge and practice of injection safety among clinical healthcare workers at the Garissa Provincial General Hospital. Design : A cross-sectional descriptive study. Setting : The Garissa provincial General Hospital from September 2011 to July 2012. Results : Injection safety knowledge was high with a score of 12.65 (SD ± 2.3) out of the total of 16 items. Appropriate injection safety practices were reported by most of the respondents. The level of knowledge was not significantly associated with respondents’ demographic characteristics(p>0.05), but was significantly associated with hand washing practice(p<0.05).Inferences were made on an appropriate injection safety practices like non-recapping of needles, hand washing and proper waste management. Drug administration practice varied in the different departments (p=0.043) and recapping of needles was significantly associated with training (p=0.047), designation (p=0.02) and area of deployment (p=0.017). Conclusion : Knowledge on injection safety was high but reported and observed practices were below the set standard. Risky practices such as recapping used syringes, re-use of disposable syringes and overfilling of sharp boxes were observed. There was insufficient provision of injection safety equipment, Poor waste handling and inadequate personal protective gear. Over prescription of unnecessary injections was widespread.

Epidemiology of hepatitis C virus exposure in Egypt: Opportunities for prevention and evaluation.

To critically evaluate the current epidemiology data on exposures, rather than infection, to hepatitis C virus (HCV) transmission and recommend epidemiologic strategies to fill gaps. Standard methods for identifying and evaluating relevant epidemiologic literature and available data were used. There is a large body of literature on the epidemiology of HCV transmission in Egypt that collectively identifies ongoing iatrogenic exposures as the major driver for HCV transmission due to short comings in infection control and standard procedures. Additional epidemiologic studies on HCV transmission that requires the participation of human subject is unwarranted. Alternatively, very little literature was found on the epidemiology of exposure to HCV, infection control, and safe injection practices. The information that is available on patterns of HCV exposure shows high frequencies of inadequate infection control, problems in sterilization in health care facilities, low rates of hand washing, untrained personnel, lack of stated policies in facilities, HCV contamination of instruments and very large injection frequencies with low but very significant syringe and needle reuse. There is an important need to increase the number, size, and diversity of epidemiologic studies on HCV exposures, patterns of risk factors for infection, infection control, and safe injection practices. In addition to health care facilities evaluation, relevant knowledge attitude and practice studies are recommended. Epidemiologic methods on HCV exposure can be used to characterize the magnitude of exposures to HCV infection, target interventions to reduce exposures, and provide the best method for evaluating interventions by demonstrating the reduction of exposure to HCV infection.

Assessment of safe injection practices and disposal methods among nursing personnel at health care centres of Hoskote - Rural Bengaluru, India

Introduction: Unsafe injection practices are commonplace in developing country health settings. These unsafe practices predispose the health care workers to various risks and also facilitate transmission of an array of diseases to the health care professionals and the community. Aim: To assess safe injection practices and disposal methods among nursing personnel at health care centres. Materials and Methods: A hospital based cross-sectional study was conducted among 86 nurses at health care centres of rural Bengaluru. Data were collected using a 20 item questionnaire. Along with demographic details questions regarding knowledge, practices, and disposal methods were included. Data were subjected to descriptive analysis. Results: The study population consisted of 89.5% female nurses and 10.5% were males. Among them only 46.5% were protected by hepatitis B vaccination. During the last 12 months 25.6% nurses had accidental needlestick injury (NSI). The subjects who practiced squeezing out blood at the puncture site and washed their hands immediately after NSI were 51.2%. A total of 82.6% of the subjects were of the opinion that human immunodeficiency virus/AIDS was the only disease transmitted by unsafe injection. Regarding the methods of disposal of used needles and syringes in their hospital 89.5% had no information of the same. Conclusions: There is a great disparity between the ideal and practiced methods among the nursing personnel. There is an immediate need to reinforce the importance of safe practices periodically through training and motivation on safe injection practices and its disposal.

Key findings from a national enhanced HIV surveillance system: 2010 - 2012.

People who inject drugs represent an important risk group in Canada's HIV epidemic. I-Track is a national public health surveillance system designed to monitor HIV and hepatitis C prevalence and associated risk behaviour factors among people who inject drugs in Canada. Information is collected through cross-sectional surveys conducted periodically at sentinel sites across Canada. I-Track Phase 3 was conducted between April 26, 2010 and August 7, 2012 across 11 participating sentinel sites. To assess the prevalence of HIV, lifetime exposure to hepatitis C and associated risk behaviours among people who inject drugs in Canada to guide and help evaluate HIV and hepatitis C prevention, treatment and control activities. People who had injected drugs in the six months prior to the interview and who met the minimum age of consent participated in an interviewer administered survey and provided a blood sample for HIV and hepatitis C antibody testing. Descriptive analyses were performed with sex-based comparisons. There were 2,687 people who participated in the survey. 68.2% were male, 60.9% were between the ages of 30 and 49 years and 36.2% self-identified as Aboriginal. Among the participants who provided a blood sample of sufficient quantity for testing, 11.2% were HIV seropositive and their lifetime exposure to hepatitis C infection was 68.0%. Drugs commonly injected included cocaine (64.3%), hydromorphone (47.2%), non-prescribed morphine (47.0%), oxycodone (37.7%) and heroin (26.7%). Injecting with previously used needles and/or other injection equipment was reported by 15.5% and 34.5% of participants, respectively. Just over one-third reported having two or more sex partners in the six months prior to the interview (34.4%) and using a condom at last sex (36.6%). The majority of participants had tested at least once in their lifetime for HIV or hepatitis C (92.9% and 91.4%, respectively). A large proportion of the participants who reported being HIV positive were under the care of a doctor (95.0%) and nearly two-thirds were taking medications prescribed for their HIV infection at the time of the interview (66.0%). HIV seroprevalence and lifetime exposure to hepatitis C infection were high among I-Track Phase 3 participants. Although many participants reported safe injection and safe sexual practices, a high proportion of participants reported risk behaviours associated with acquisition and transmission of HIV and hepatitis C. People who inject drugs continue to represent an important risk group in Canada's HIV epidemic and the I-Track Phase 3 survey findings highlight the need for continued treatment and prevention services, as well as routine and integrated testing among people who inject drugs.

Assessment of Knowledge and Practices regarding Injection Safety and Related Biomedical Waste Management amongst Interns in a Tertiary Care Teaching Hospital, Delhi

Injuries caused by needle sticks and sharps due to unsafe injection practices are the most common occupational hazard amongst health care personnel. The objectives of our study were to determine the existing knowledge and practices of interns and change in their level following an information education and communication (IEC) package regarding safe injection practices and related biomedical waste management and to determine the status of hepatitis B vaccination. We conducted a follow-up study among all (106) interns in a tertiary care teaching hospital, Delhi. A predesigned semistructured questionnaire was used. IEC package in the form of hands-on workshop and power point presentation was used. A highly significant (P < 0.001) improvement in the knowledge of interns was observed after intervention with respect to the “three criteria of a safe injection” and cleaning of injection site. Thus, the baseline knowledge of interns was good in certain aspects of injection safety, namely, diseases transmitted by unsafe injections and their prevention. We conclude that IEC intervention package was effective in significantly improving the interns' knowledge regarding safe injection practices and biomedical waste management. Almost two-thirds of interns were immunised against hepatitis B before the intervention and this proportion rose significantly after the intervention.

Injection and sexual HIV/HCV risk behaviors associated with nonmedical use of prescription opioids among young adults in New York City

Prevalence of nonmedical prescription opioid (PO) use has increased markedly in the U.S. This qualitative study explores the drug-use and sexual experiences of nonmedical PO users as they relate to risk for HIV and HCV transmission. Forty-six New York City young adult nonmedical PO users (ages 18–32) completed in-depth, semi-structured interviews. Despite initial perceptions of POs as less addictive and safer than illegal drugs, PO misuse often led to long-term opioid dependence and transition to heroin use and drug injection. Injectors in the sample reported sporadic syringe-sharing, frequent sharing of non-syringe injection paraphernalia and selective sharing with fellow injectors who are presumed “clean” (uninfected). Participants reported little knowledge of HCV injection-related risks and safer injection practices. They also reported engaging in unprotected sex with casual partners, exchange sex and group sex, and that PO misuse increases the risk of sexual violence. Prevention efforts addressing HIV/HCV risk should be targeted to young nonmedical PO users.

Injection practices in Nepal: health policymakers' perceptions.

BackgroundThe unnecessary and unsafe use of injections is common in developing countries like Nepal. Policymakers have an important role in promoting rational and safe injection use. Hence, the present study was carried out to explore the perception of health policymakers regarding safe injection practice in Nepal.MethodsAn exploratory qualitative study design was used in this study. Key policymakers from both the central and regional level were selected using purposive sampling. A semi-structured questionnaire advocated by the World Health Organization (WHO) was used after modifying the context. Interviews were conducted to clarify doubts and obtain additional information. The data was analyzed manually using deductive content analysis technique.ResultsIn total, eleven policymakers participated. All unanimously agreed that injection safety is a problem and seven participants reported that injections are overused. They shared the opinion that injections are administered by various providers, including formal and informal health providers, and also quacks. Almost half the respondents reported that the National Drug Policy discourages injection overuse, while others reported that the policy contains no provisions regarding injection overuse. Most policymakers stated that only single-use disposable injection equipment is used to provide injection, while others thought that sterilizable glass syringe is also used. More than half of the participants believed that the quality of injection equipment available in the Nepalese market is not regulated by any government institution. Almost two-third of the policymakers stated that syringes and needles are not reused, while the rest thought syringes might be reused without sterilization in some parts of the country. Almost half of the respondents stated that illegal commercialization of used syringes exists in Nepal. Almost all respondents thought that health care institutions have a waste management plan, while more than half of them opined that such plans are limited to tertiary care hospitals located in the capital.ConclusionsThe result of this study revealed a divergence of views among policymakers, even among those in the same ministry. Though there has been some effort from the government to increase the safety of injection practices, greater efforts are required, especially with regard to standardization of policies and procedures related to injection practice.

Individual and socio-environmental factors associated with unsafe injection practices among young adult injection drug users in San Diego.

Unsafe injection practices significantly increase the risk of hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infection among injection drug users (IDUs). We examined individual and socio-environmental factors associated with unsafe injection practices in young adult IDUs in San Diego, California. Of 494 IDUs, 46.9 % reported receptive syringe sharing and 68.8 % sharing drug preparation paraphernalia in the last 3 months. Unsafe injection practices were associated with increased odds of having friends who injected drugs with used syringes, injecting with friends or sexual partners, and injecting heroin. Perceived high susceptibility to HIV and perceived barriers to obtaining sterile syringes were associated with increased odds of receptive syringe sharing, but not with sharing injection paraphernalia. Over half the IDUs reported unsafe injection practices. Our results suggest that personal relationships might influence IDUs' perceptions that dictate behavior. Integrated interventions addressing individual and socio-environmental factors are needed to promote safe injection practices in this population.

Seroprevalence of hepatitis B and C virus infections among health students and health care workers in the Najran region, southwestern Saudi Arabia: the need for national guidelines for health students.

BackgroundThe objectives of the study were to study the seroprevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections among health college students (HS) and health care workers (HCWs) in the Najran Region of south-western Saudi Arabia and to study the students’ knowledge of occupational exposure to blood-borne viral infections.MethodsA cross-sectional study of a representative sample of 300 HS and 300 HCWs was conducted.ResultsAn overall seroprevalence of HBV of 1.7% and 8.7% was found among HS and HCWs, respectively. Two-thirds of HS (66.7%, 200) and 23.3% (70) of HCWs lack anti-HBs and are susceptible to HBV infection. An overall seroprevalence of HCV of 0% and 0.3% was found among the HS and HCWs, respectively. The present study indicates poor knowledge among HS and moderate knowledge among HCWs regarding occupationally transmitted blood-borne diseases, safe injection practices, and standard precautions to prevent occupationally transmitted blood-borne infections.ConclusionIt is mandatory to develop a structured program to raise awareness among HS, and current health colleges’ curricula should be upgraded to address these issues early. The HS should be considered new recruits to health services in terms of their initial screening for blood-borne infections and vaccination against HBV. The development of a novel continuing medical education and pre-employment awareness program for HCWs is recommended to address the following: blood-borne diseases transmitted occupationally, standard precautions to prevent occupationally transmitted blood borne infections, and safe injection practices.