Risk Of Blood-borne Transmission Research Articles

Identification of White-tailed Deer (Odocoileus virginianus) as a Novel Reservoir Species forTrypanosoma cruziin Texas, USA

Chagas disease, a vector-borne parasitic infection caused by Trypanosoma cruzi, represents a significant source of morbidity and mortality in the Americas. Mammalian reservoir species play a large role in propagating the sylvatic transmission cycle of this disease, and this cycle can spill over, resulting in human infections. Our understanding of the wildlife species implicated in propagating this transmission cycle is incomplete. We investigated white-tailed deer ( Odocoileus virginianus) as a potential novel reservoir for this parasite. Only one of the 314 hunter-harvested deer hearts collected across Texas, was PCR-positive (0.3%) for T. cruzi. This finding has potential implications for deer hunters, because it indicates that there might be a risk of blood-borne transmission during the field-dressing process. Hunters should be strongly encouraged to wear gloves and other personal protective equipment when handling carcasses to prevent exposure to infected blood.

Assessment of injection safety in Ha Dong General Hospital, Hanoi, in 2012

Background: Injection is one of the most frequently used medical methods to introduce drugs or other substances into the body for purposes of treatment or prevention. Unsafe injection can cause adverse outcomes, such as abscess and anaphylactic shock, and increases the risk of blood-borne transmission of viruses to patients and health care workers, as well as the community. Recognizing the importance of injection safety, in 2000 the Vietnamese Ministry of Health (MOH) collaborated with the Vietnam Nurses Association to launch the “Safe injection” program throughout the country, including Hanoi. Methods: This cross-sectional study, combining quantitative and qualitative analysis, was conducted from February to August 2012 in Ha Dong General Hospital using a structured questionnaire and observation checklist. The target population of the study was 109 nurses working in clinical departments and 436 injections were observed. Results: The percentage of nurses who are familiar with injection safety standards was found to be 82.6%. The proportion of practical injections that met the 23 standards of injection safety set by the MOH amounted to 22.2%. The factors related to safe injection practice of nurses who are younger age group (OR=3.1; p<0.05) and lower amount of working years (OR=2.8; p<0.05). Conclusions: Despite the high level of knowledge about safety injection, a low proportion of nurses performed correct safety injection practice. Moreover, the results demonstrated that experience might not always guarantee better practice. The findings raise the need for further training about this issue, especially among older nurses.

Assessment of injection safety in Ha Dong General Hospital, Hanoi, in 2012

Background: Injection is one of the most frequently used medical methods to introduce drugs or other substances into the body for purposes of treatment or prevention. Unsafe injection can cause adverse outcomes, such as abscess and anaphylactic shock, and increases the risk of blood-borne transmission of viruses to patients and health care workers, as well as the community. Recognizing the importance of injection safety, in 2000 the Vietnamese Ministry of Health (MOH) collaborated with the Vietnam Nurses Association to launch the “Safe injection” program throughout the country, including Hanoi. Methods: This cross-sectional study, combining quantitative and qualitative analysis, was conducted from February to August 2012 in Ha Dong General Hospital using a structured questionnaire and observation checklist. The target population of the study was 109 nurses working in clinical departments and 436 injections were observed. Results: The percentage of nurses who are familiar with injection safety standards was found to be 82.6%. The proportion of practical injections that met the 23 standards of injection safety set by the MOH amounted to 22.2%. The factors related to safe injection practice of nurses who are younger age group (OR=3.1; p<0.05) and lower amount of working years (OR=2.8; p<0.05). Conclusions: Despite the high level of knowledge about safety injection, a low proportion of nurses performed correct safety injection practice. Moreover, the results demonstrated that experience might not always guarantee better practice. The findings raise the need for further training about this issue, especially among older nurses.

Assessment of injection safety in Ha Dong General Hospital, Hanoi, in 2012

Background: Injection is one of the most frequently used medical methods to introduce drugs or other substances into the body for purposes of treatment or prevention. Unsafe injection can cause adverse outcomes, such as abscess and anaphylactic shock, and increases the risk of blood-borne transmission of viruses to patients and health care workers, as well as the community. Recognizing the importance of injection safety, in 2000 the Vietnamese Ministry of Health (MOH) collaborated with the Vietnam Nurses Association to launch the “Safe injection” program throughout the country, including Hanoi. Methods: This cross-sectional study, combining quantitative and qualitative analysis, was conducted from February to August 2012 in Ha Dong General Hospital using a structured questionnaire and observation checklist. The target population of the study was 109 nurses working in clinical departments and 436 injections were observed. Results: The percentage of nurses who are familiar with injection safety standards was found to be 82.6%. The proportion of practical injections that met the 23 standards of injection safety set by the MOH amounted to 22.2%. The factors related to safe injection practice of nurses who are younger age group (OR=3.1; p<0.05) and lower amount of working years (OR=2.8; p<0.05). Conclusions: A low proportion of nurses performed correct safety injection practice, which raises the need for further training about this issue, especially among older nurses.

The haemophilia certification system in Canada.

Inherited bleeding disorders are caused by the deficiency or dysfunction of plasma proteins required for the development of a physiological hemostatic process1,2. Von Willebrand disease (vWD), haemophilia A and haemophilia B are the most common inherited disorders of hemostasis. In their severe forms, these disorders are life-threatening. However advanced treatment modalities have enabled even severely affected patients to reach the same life expectancy of the general male population at least in high-income countries3,4. Indeed, after the dramatic events of widespread blood-borne virus transmission in the 1970s–1980s in haemophilic patients, leading to a 35-to-40-year reduction in life expectancy in Canadian patients5, there has been a strong drive towards continuous improvement, primarily in the safety of replacement therapy6. There is now a very high degree of safety from risk of blood borne transmission of pathogens as evidenced by the absence of reported transmission of blood-borne viruses in persons with haemophilia since the late 1980s to date7. The safety of current replacement therapies was recently confirmed by a prospective surveillance program ongoing since 2008 and based on regular monitoring of 22,242 European patients (European Haemophilia Safety Surveillance System; www.euhass.org). Regular factor prophylaxis as a therapeutic regimen has been proven effective in preventing haemophilic arthropathy8. Even in the presence of neutralizing antibodies (inhibitors) directed against the deficient clotting factor, particularly in haemophilia A, bleeding can usually be treated successfully using activated variants of coagulation factors9. Moreover, immune tolerance induction (ITI), based on the long-term intravenous infusion of large doses of FVIII, eradicates inhibitors in as many as two-thirds of patients10. Therefore, improving quality of life has become the primary objective of care in developed countries; thus multiple modalities (psychosocial support, physiotherapy, integration into community life, etc), not just the infusion of the deficient factor, are made available to the patient and his family, to allow them to fully experience good health.

Reducing transfusion-associated malaria in Pakistan: an algorithmic approach

Blood transfusions represent a small but significant source of malaria transmission. Most blood banks rely solely on donor questioning to exclude malaria patients from donating blood. No guidelines exist for invitro screening of donor blood for malaria in endemic areas. Possible laboratory screening techniques include: microscopy; enzyme-linked immunosorbent assay (ELISA) antibody testing; polymerase chain reaction (PCR) testing; and rapid diagnostic antigen tests. However, all these modalities have diagnostic limitations. Based on a best evidence review, we present recommendations using an algorithmic approach to blood screening for malaria in Pakistan. This algorithm considers regional endemicity for malaria, as well as a detailed donor history, in order to decide whether donor blood should be tested with rapid antigen testing. We hope this algorithm will assist in the development of future national guidelines for screening blood for malaria that will reduce the risk of blood-borne transmission.

Evaluation of Pathogen Reduction Systems to Inactivate Dengue and Chikungunya Viruses in Apheresis Platelets Suspended in Plasma

The risk of blood-borne transmission of infectious diseases has led to an increasing awareness of the need for a safe and effective pathogen reduction technology. This study evaluated the efficacy of 2 pathogen reduction systems to inactivate dengue virus (DENV-2) and chikungunya virus (CHIKV) spiked into apheresis platelets (APLT) concentrates. Double-dose APLT collections (n = 3) were split evenly into two units and spiked with 107 infectious units of DENV-2 or CHIKV. APLTs samples were assayed for viral infectivity before and after Amotosalen photochemical treatment (PCT) or Riboflavin pathogen reduction treatment (PRT). Viral infectivity was determined by plaque assays. Platelet (PLT) count, pH and residual S-59 were measured during the storage of 5 days. Amotosalen PCT showed robust efficacy and complete inactivation of both viruses in APLTs, with up to 3.01 and 3.75 log reductions of DENV-2 and CHIKV respectively. At similar initial concentrations, Riboflavin PRT showed complete inactivation of CHIKV with up to 3.73 log reduction, much higher efficacy than against DENV-2 where a log reduction of up to 1.58 was observed. All post-treated APLTs maintained acceptable PLT yields and quality parameters. This parallel study of 2 pathogen reduction systems demonstrates their efficacy in inactivating or reducing DENV and CHIKV in APLTs and reaffirms the usefulness of pathogen inactivation systems to ensure the safety in PLTs transfusion.

Potential community and public health impacts of medically supervised safer smoking facilities for crack cocaine users

There is growing evidence of the public health and community harms associated with crack cocaine smoking, particularly the risk of blood-borne transmission through non-parenteral routes. In response, community advocates and policy makers in Vancouver, Canada are calling for an exemption from Health Canada to pilot a medically supervised safer smoking facility (SSF) for non-injection drug users (NIDU). Current reluctance on the part of health authorities is likely due to the lack of existing evidence surrounding the extent of related harm and potential uptake of such a facility among NIDUs in this setting. In November 2004, a feasibility study was conducted among 437 crack cocaine smokers. Univariate analyses were conducted to determine associations with willingness to use a SSF and logistic regression was used to adjust for potentially confounding variables (p < 0.05). Variables found to be independently associated with willingness to use a SSF included recent injection drug use (OR = 1.72, 95% CI: 1.09–2.70), having equipment confiscated or broken by police (OR = 1.96, 95% CI: 1.24–2.85), crack bingeing (OR = 2.16, 95% CI: 1.39–3.12), smoking crack in public places (OR = 2.48, 95% CI: 1.65–3.27), borrowing crack pipes (OR = 2.50, 95% CI: 1.86–3.40), and burns/ inhaled brillo due to rushing smoke in public places (OR = 4.37, 95% CI: 2.71–8.64). The results suggest a strong potential for a SSF to reduce the health related harms and address concerns of public order and open drug use among crack cocaine smokers should a facility be implemented in this setting.

A valuable device in the management of epistaxis.

A suction end for use in epistaxis is presented. It has advantages over commonly used devices in offering a comfortable length for handling and adequate diameter for effective control of severe haemorrhage. It is also disposable which reduces the risk of blood borne transmission of diseases.