Transmission Of Blood-borne Diseases Research Articles

Incidence, Knowledge, Attitude and Practice of Healthcare Workers Regarding Needle Stick Injuries at a Tertiary Care Hospital in Riyadh, Saudi Arabia

Background: A needle stick injury is a serious occupational health hazard in health care settings. Health care workers are at risk of bloodborne diseases and the psychological consequences of these injuries. Objectives: we aimed in this study to assess the prevalence of NSI among health care workers in King Saud Medical City and to assess their knowledge, attitude and practices regarding needle stick injuries. Methods: A cross-sectional study was conducted from 17th August 2022 until 30th November 2023. A structured questionnaire from Saudi Ministry of Health guidelines was used to collect the data. The content validity was evaluated by four academics from King Khalid University in Abha, and some minor changes were made. Results: As regard the prevalence of NSI, out of 220 participants, 132 individuals did not report any needle-stick injuries (NSI). While 92.3% of participants accurately defined NSI and acknowledged blood-borne disease transmission risks, only 39.1% followed preventive measures like recapping needles and proper disposal. There were knowledge gaps observed, with varying awareness levels on Hepatitis B and C prevention. Participants demonstrated awareness of post-exposure guidelines but lacked knowledge on immediate actions to take post-injury. Attitudes towards NSI varied, with a significant percentage 44.1% prioritizing patient care over healthcare worker safety. Interestingly, significant support was shown for immediate reporting of sharp injuries and the belief that NSIs are preventable. In terms of practice, adherence to safe needle practices varied, with the majority 90.9% using assigned disposal containers and being vaccinated against Hepatitis B, but not all receiving recent training on safe devices. Conclusion: This study revealed that NSIs remain a prevalent occupational health hazard among healthcare workers. Although a significant number of participants demonstrated adequate knowledge and awareness of NSIs and bloodborne disease transmission risks, there were noticeable gaps in their implementation of preventive measures and immediate post-injury actions. Attitudes towards NSIs varied, with some prioritizing patient care over healthcare worker safety. However, there was strong support for the immediate reporting of sharp injuries and belief in the preventability of NSIs.

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.

Managing Addiction and Overdose Deaths: The Debate Over America's Safe Injection Spaces.

In the decade between 2010 and 2020, the number of people killed by opioid overdoses more than tripled, reaching 68,630. Among drug users in their second and third decades of life, hepatitis B and C are also on the rise. New York City's two new supervised drug injection sites (SDISs) reversed 114 overdoses within two months, and 585 people injecting drugs visited the facility 4,974 times. By providing medical professionals and a sterile and safe environment, supervised injection sites reduce overdose risk and save lives. This suggests that SDISs could be an important adjunct to currently failing strategies to combat the nation's raging opioid crisis, particularly in the aftermath of the COVID-19 pandemic. Here, we examine the perception and impact of SDISs as well as efforts by the United States Congress (H.R. 7029 and H.R. 6159) toward their prevention. We look into the perspectives of major stakeholders, such as residents, business owners, drug users, legislators, taxpayers, and the general public, and investigate the short- and long-term consequences of SDISs based on crime statistics and published data on opioid use, overdose deaths, and blood-borne disease transmission rates.

Efficacy of D-Limonene Nanoemulsion Against Rhipicephalus annulatus and Rhipicephalus sanguineus Ticks.

Ticks infestation has a negative impact against human and animal health through blood sucking, transmission of blood-borne diseases and also caused economic losses. In the present study the adulticidal, ovicidal and larvicidal activity of D-limonene nanoemulsion (DLN) were evaluated against two tick species; Rhipicephalus annulatus and Rhipicephalus sanguineus. Nanoemulsion form of D-limonene was prepared, and its characteristics were evaluated using a UV spectrophotometer and zeta droplet size measurement. Acetylcholinesterase activity was determined. The results revealed significant adulticidal effect with low LC50 and LC90 for D-limonene pure form (DL) against both adult tick spp. (R. annulatus and R. sanguineus) ((0.958 and 1.559%) and (2.26 and 3.51%), respectively). DLN LC50 and LC90 values were ((1.277 and 2.396) and (3.97 and 7.28), respectively) against R. annulatus and R. sanguineus, respectively. DL and DLN showed significant ovicidal effect against R. sanguineus at high concentrations (10 and 5%). In larval packet test, LC50 and LC90 values of DL were ((1.53 and 2.22%) and (6.81 and 12.07%), respectively) against R. annulatus and R. sanguineus, respectively, while LC50 and LC90 values of DLN were ((6.48 and 11.26%) and (7.82 and 13.59%), respectively) against R. annulatus and R. sanguineus, respectively. Significant acetylcholinesterase inhibition percentage was detected for both ticks spp. which treated by DL and DLN. Pure DL is more effective than DLN form against R. annulatus and R. sanguineus.

IMPACT OF NEEDLE STICK INJURIES ON STUDENT NURSES AT KTH HOSPITAL, PESHAWAR, PAKISTAN

Needle stick injury (NSI) is a significant hazard in healthcare settings that poses a potential risk of transmission of blood-borne diseases. This cross-sectional study aims to determine the prevalence of NSI among student nurses in a tertiary care hospital in Peshawar and their knowledge about NSI prevention and control. The data collected through structured questionnaires, and the sample size was 147. The results showed 37% of students had experienced NSI during the last six months, while 70% were vaccinated and 75% were screened against HBS, HCV, and HIV. The study emphasizes the need for further training, workshops, and close supervision to prevent NSI complications and enhance safe practices during healthcare services. The positive effect of free vaccination and government attention to increasing the strength of nurses to control the increasing rate of NSI is also highlighted. Due to lack of proper supervision by trained staff, student nurses often suffer from needle stick injuries during their practical work. Patients may admitted to the hospital already contaminated with communicable diseases, and their beds are not labeled to indicate this. Exposure to NSIs can cause fear, insecurity, and low self-esteem in student nurses. There are many psychological consequences associated with NSIs, such as fear, anxiety, and depression. Student nurses are at substantial risk for NSIs because they often perform invasive procedures with minimal knowledge and experience. Education and awareness-raising about NSI prevention and reporting have been shown to positively impact previous studies. Observational studies conducted in Pakistan have recommended that nurse students receive further education to reduce the incidence of NSIs, as they are often deprived of advanced knowledge and experience. A lack of staff in hospitals can contribute to NSIs as nurses may ignore their safety while performing their duties. Two-handed recapping is responsible for approximately 80% of needle stick injuries.

Prevalence of residual risks of the transfusion-transmitted infections in Riyadh hospitals: A two-year retrospective study

Abstract This study aimed to evaluate the prevalence and trends of transfusion-transmitted infections (TTIs) in two hospitals in Riyadh, as well as to judge the best type of tests to ensure blood transfusion safety. By using serological and nucleic acid test (NAT) tests, these donors were screened for human immunodeficiency virus (HIV), hepatitis C virus (HCV), hepatitis B virus (HBV), human T-lymphotropic virus type 1 (HTLV-1), human T-lymphotropic virus type 2 (HTLV-2), syphilis, and malaria infection as a first time of donation. Out of 58,898 blood units, 336 units were reacted for HBsAg, 5,318 units for HBcAbs, 506 units for HCV antibodies, 214 units for HIV Ab/Ag combinations, 206 units for HTLV antibodies, 355 units for syphilis antibodies, and 81 units for malaria. Moreover, the genotypic prevalence of these products showed that 349 units reacted for HBV DNA, HCV RNA, and HIV RNA in blood donation. This study reflects the seriousness of the residual risk of TTI, which is still a threat factor for the transmission of blood-borne infectious diseases. It was discovered that utilising (NAT) could increase test sensitivities while also lowering residual TTI risks, improving blood safety, and being cost-effective.

Infant oral mutilation: data collection, clinical management and public health guidelines.

Infant oral mutilation (IOM) is a traditional practice involving extraction of an infant's unerupted primary tooth buds. IOM has implications for oral and overall health due to blood loss, infection or transmission of bloodborne diseases, such as human immunodeficiency virus. IOM also leads to long-term dental complications, such as malformation of the child's permanent dentition. IOM is practised primarily in East Africa but can also be seen among immigrant populations in other countries. Currently, there are no tools for a comparative IOM diagnosis and reporting. The aim of this paper is to describe a data collection tool for healthcare practitioners, which was created based on the existing literature and a clinical consultation with senior clinical and public health physicians working in the field.The tool can be used to record IOM-related data for appropriate diagnosis, management and treatment, as well as for monitoring preventive interventions on a community level. Furthermore, this article also summarises clinical guidelines to support practitioners with the management of acute IOM cases. The article concludes by providing recommendations and examples of community education and engagement programmes that could guide the development of interventions to eradicate IOM globally.

At-home disposal practices of used insulin needles among patients with diabetes in China: A single-center, cross-sectional study.

Most insulin injections for people with diabetes are administered at home, thus generating many used needles. Unsafe disposal of these at-home needles can lead to needle stick injuries, blood-borne disease transmission, and environmental contamination. Previous studies have shown varying results on the prevalence of and factors associated with safe sharps disposal practices of people with diabetes. To assess the prevalence of and the factors associated with the safe disposal of used insulin needles among patients with diabetes. We collected data from 271 insulin-using patients at a tertiary care hospital in China. A self-designed instrument was used to assess sociodemographic data, disease- and treatment-related characteristics, sharps disposal practices, education on diabetes self-management and sharps disposal, and awareness of the potential risks associated with unsafe sharps disposal. Multivariate logistic regression analysis was used to explore factors associated with safe sharps disposal practices. Only 10.3% (28/271) of participants disposed of used at-home insulin needles in a safe manner, and 14.8% (45/271) of participants had received previous instruction on sharps disposal. Previous sharps disposal instruction (AOR = 4.143, 95% CI = 1.642-10.450) and awareness of the risk of blood-borne pathogen transmission (AOR = 3.064, 95% CI = 1.332-7.046) were associated with safe disposal of used insulin needles. In our study, the prevalence of safe sharps disposal practices was low, and a minority of respondents had received previous instruction on sharps disposal. Participants who had previously received instruction and were aware of the risk of blood-borne pathogen transmission were more likely to handle sharps safely. Our study findings suggest that health care professionals should pay attention to sharps disposal practices of patients with diabetes and conduct diabetes education programs that include information on safe sharps disposal methods and potential hazards of unsafe sharps disposal.

Noninvasive Approach of Plasmodium falciparum Molecular Detection for Malaria Surveillance in Malaria Endemic Areas in Cameroon

Accurate, cost-effective, and noninvasive alternative molecular methods are needed for detecting low malaria parasitemia. The currently-used nested polymerase chain reaction (nPCR) requires blood as well as skilled personnel in order to minimise the risk of bloodborne disease transmission. Therefore, this study is aimed at assessing the accuracy of a noninvasive and more affordable malaria diagnosis with saliva using the loop-mediated isothermal amplification (LAMP) technique. A cross-sectional study was conducted in the Centre and Southwest regions of Cameroon. Matched blood and saliva samples collected from symptomatic and asymptomatic participants were tested for malaria using rapid diagnostic tests, microscopy, PCR, and LAMP. Statistics were performed using R studio software at 95% confidence interval. A total of 100 participants (65% symptomatic and 35% asymptomatic) aged between 1 and 74 years with a balanced gender distribution ratio of 1.08 were included in our study. The prevalence of malaria was 61%, 57%, 59%, 42%, 35%, 17%, and 16% for blood-RDT, blood-PCR, blood-LAMP, blood-RT-LAMP, saliva-PCR, saliva-RT-LAMP, and saliva-LAMP, respectively. Both saliva and blood showed a sensitivity of 43.90% and respective specificities of 68.75% and 57.62%. When using RT-LAMP, sensitivities of 49.38% and 48.21% and specificities of 94.11% and 66.67% were recorded for saliva and blood, respectively. Sensitivities of 70.23% and 73.49% and specificities of 62.5% and 76.47% were recorded, respectively, for saliva-LAMP and saliva-RT-LAMP when compared to saliva-PCR as the gold standard. Saliva-LAMP and saliva-RT-LAMP had a fair agreement (к = 0.221 and 0.352, respectively) with saliva-PCR. Homemade LAMP and RT-LAMP technologies match the WHO recommendations and after proper validation in a larger sample size, could serve for malaria diagnosis in developing countries.

Dental Braces as IMF in Pediatric Population or in Children; A Conservative Concept

Mandibular fracture is less common in children. Fracture management is a complex issue in children that needs immediate diagnosis and appropriate treatment to ensure favorable outcome. Intermaxillary fixation (IMF) is an integral part in the management facial bone fractures. Conventional methods have disadvantages, like the risk of transmission of blood-borne diseases, stressful procedures, and mutilation to teeth, tooth buds, and also periodontium. Use of orthodontic bracket and elastics as IMF is an effective and efficient alternative technique in management of mandibular fracture because it removes the disadvantages of standard Intermaxillary fixation and provides a stable occlusal & functional thereafter.

Faith leaders' perceptions of needle exchange programs in the rural Illinois Delta Region: Religion as a social determinant of health.

Despite increasing drug use in rural communities, potentially life-saving harm reduction interventions, such as needle exchange programs (NEPs), remain underutilized. Religion is an integral component of the rural culture that has been shown to influence health, yet no studies to date have explored rural faith leaders' perceptions of harm reduction strategies. An online cross-sectional survey was conducted among rural faith leaders (n = 133) in the rural Illinois Delta Region. While most of the respondents felt that drug abuse was an issue in their communities, support was mixed regarding whether they were in favor of NEPs with the majority of respondents having never heard of an NEP before this survey. While the majority believed that NEPs would help decrease bloodborne disease transmission, it was also perceived that NEPs would increase drug use. Significant differences in perceptions based on race, marital status, and political party also exist. Congruent with previous harm reduction literature, many rural faith leaders have varied perceptions of NEPs. Rural faith leaders could benefit from education about NEPs, including the possible positive and negative impacts they can have on the community. Future studies should explore contextual differences among rural faith leaders. To date, no studies have examined faith-based organizations' perceptions of NEPs. The findings have the potential to increase the current body of knowledge and provide data to support recommendations for engaging faith-based organizations in behavioral health service delivery.

Opioid-related hospitalizations and intravenous drug users: Socio-demographic, spatial, and comorbid associations among hospital inpatients and community-based harm reduction organization participants.

To provide an updated analysis of opioid-related injuries in Nevada and provide a first-time analysis of the intravenous drug user (IDU) population within Clark County. Cross-sectional study. Center for Health Information Analysis (CHIA) database and IDU data from Trac-B Exchange (Trac-B). Patients hospitalized for opioid-related causes (n = 9,064) and participants from Trac-B. Variables assessed included age, gender, and race/ethnicity. Zip codes were retrieved to find differences in geographical usage patterns of hospital or sterile injection equipment (SEP) sites. Contingency tables were utilized to determine the frequency of comorbidities. Additionally, GIS was used to investigate potential spatial patterns of interest. Totally 5,268 out of the 9,064 opioid-related cases reported in Nevada were Clark County residents. The highest frequency for comorbidities associated with opioid-related hospitalizations (ORHs) included: infections, chronic bodily pain, and malnutrition. There was a higher proportion of 18-35-year-olds who used SEPs as compared to hospitals and a higher proportion of individuals aged 36 years or older who used hospitals as compared to using SEPs. Of the nearly 100 zip codes in Clark County, six showed a disproportionally high frequency of ORHs, and three comprised the majority of injection drug use. There is an opioid epidemic in Nevada that has contributed to addiction, heroin usage, injection drug use, and transmission of bloodborne diseases. Understanding the ORHs and intravenous drug use trends can help guide the development of program interventions.

Donor and Recipient Matching in Facial Vascularized Composite Allotransplantation: A Closer Look at the Donor Pool.

Identifying a donor for facial vascularized composite allotransplant recipients can be a lengthy, emotionally challenging process. Little is known about the relative distribution of key donor characteristics among potential donors. Data on actual wait times of patients are limited, making it difficult to estimate wait times for future recipients. The authors retrospectively reviewed charts of nine facial vascularized composite allotransplant patients and provide data on transplant wait times and patient characteristics. In addition, they analyzed the United Network for Organ Sharing database of dead organ donors. After excluding donors with high-risk characteristics (e.g., active cancer or risk factors for blood-borne disease transmission), the authors calculated the distribution of relevant donor-recipient matching criteria (i.e., ethnicity, body mass index, age, ABO blood group, cytomegalovirus, Epstein-Barr virus, hepatitis C virus) among 65,201 potential donors. The median wait time for a transplant was 4 months (range, 1 day to 17 months). The large majority of United Network for Organ Sharing-recorded deaths from disease were white (63 percent) and male (58 percent). Female donors of black, Hispanic, or Asian descent are underrepresented, with 7, 5, and 1 percent of all recorded deaths from disease, respectively. Potential donors show cytomegalovirus and Epstein-Barr virus seropositivity of 65 and 95 percent, respectively. The number of annual hepatitis C-positive donors increased over time. Actual facial vascularized composite allotransplant wait times vary considerably. Although most patients experience acceptable wait times, some with underrepresented characteristics exceed acceptable levels. Cytomegalovirus-seropositive donors present a large portion of the donor pool, and exclusion for seronegative patients may increase wait time. Hepatitis C-seropositive donors may constitute a donor pool for underrepresented patient groups in the future.

Sharp injuries and their relationship with stress among nurses working in acute care settings

Sharp injuries are common reasons for the transmission of blood-borne diseases in acute care settings. Fear of sharp injuries and their consequences can expose nurses to high levels of stress (sharp injuries stress). To examine the occurrence of sharp injuries and to assess their relationship with stress among nurses working in acute care settings. This was a cross-sectional study. A total of 150 nurses working in 10 acute care settings in two selected hospitals in Alexandria, Egypt, were selected as the population of this study. Data on the occurrence of sharp injuries were collected using a sharp injuries circumstances questionnaire (including questions regarding number, instrument and reasons/procedures that caused sharp injuries, etc.), and two scales were used to measure sharp injuries stress (the Impact of Event Scale-Revised and the Post-Traumatic Stress Syndrome Questions Inventory). More than 13% of nurses experienced sharp injuries, and 25% of injuries were caused by contaminated instruments. Sharp injuries stress scores were high in nurses, with 65% of nurses experiencing sharp injuries and 30.8% of nurses who did not experience sharp injuries having high Impact of Event Scale-Revised scores. In addition, 45% of nurses who experienced sharp injuries and 15.39% of nurses who did not experience sharp injuries had high Post-Traumatic Stress Syndrome Questions Inventory (PTSSQI) scores. There was a significant relationship between the occurrence of sharp injuries and stress scales at P < .05. Nurses are exposed to sharp injuries, leading to sharp injury stress pre- and post-occurrence of injuries. Sharp injuries stress can make nurses prone to Post-Traumatic Stress Syndrome (PTSS). Factors that lead to the occurrence of sharp injuries and sharp injuries stress should be investigated, and a psychological rehabilitation unit should be instituted to help nurses working in acute care settings deal with the sharp injuries-related stressors they are facing.

Infectious safety of donor blood

Infectious safety of donor blood

Tattooing among Iranian prisoners: results of the two national biobehavioral surveillance surveys in 2015–2016

BackgroundTattooing is among identified risk factor for blood-borne diseases. ObjectiveThis study aims to determine the prevalence of tattooing during lifetime and in prisons and its related factors among Iranian prisoners. MethodsThis is a cross-sectional study. The required data was obtained from hepatitis B and C surveillance surveys in prisons in 2015–2016 that was collected through face-to-face interview. 12,800 prisoners were selected by multi-stage random sampling from 55 prisons of 19 provinces in Iran. Weighted prevalence and associated factors (using Chi-Square test and multivariate logistic regression) were determined by Stata/SE 14.0 survey package. ResultsOut of 12,800 prisioners, 11,988 participated in the study (93.6% participation rate). The prevalence of tattooing in lifetime and in prisons was 44.7% and 31.1% respectively. The prevalence of tattooing during lifetime was significantly associated with age<35 years, being single, illiteracy, history of imprisonment, drug use, piercing during lifetime, extramarital sex and history of STI; the prevalence of tattooing in prison had a significant association with history of imprisonment, drug use, piercing in prison, and history of extramarital sex (p<0.05). Study limitationsInformation and selection bias was one of the study limitations. ConclusionThe results of this study showed that the prevalence of tattooing during lifetime and in prison among prisoners was significantly high especially in high-risk groups such as drug users and sexually active subjects. Given the role of tattooing, drug injection and sex in the transmission of blood-borne diseases, harm reduction programs are recommended to reduce these high-risk behaviors in prisons.

Is One-Pen, One-Patient Achievable in the Hospital? A Quality Improvement Project to Reduce Risks of Inadvertent Insulin Pen Sharing at a Large Academic Medical Center

The Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDC), and Institute for Safe Medicine Practices (ISMP) have issued warnings regarding the risk of potential transmission of blood-borne diseases if an insulin pen is used for more than one person. Many hospitals continue to use insulin pens due to their benefits of decreased risk of dosing error and improved work efficiency. Best practices for insulin pen use have been published; however, little is known about how these perform in hospitals. This article describes a multifaceted quality improvement project to address the safety issues of single-patient insulin pens. Major interventions included adding patient-specific bar coding on insulin pens, redesign of labels, systematic removal of discharged patients' medications, and ongoing staff education. Self-reported events of insulin pen sharing events over 40 months showed a significant increase in the number of patient-days between events. The significant change occurred after implementation of patient-specific bar code scanning. There was a gradual decrease in latent errors found during medication drawer audits, and nursing compliance with patient-specific bar code scanning improved over time, reaching 90% on the last recorded month. Of 35 expert recommendations for insulin pen safety, 28 directly affected pen sharing-8 had been implemented prior to this project, and 20 had been implemented by the conclusion. Insulin pen use is highly complex in hospital settings where multiple steps provide opportunities for error. To protect patients, all gaps need to be reviewed, and interventions that address major contributing factors are required to ensure safe insulin pen use.

Using machine learning to estimate survival curves for patients receiving an increased risk for disease transmission heart, liver, or lung versus waiting for a standard organ.

IntroductionOver 19% of deceased organ donors are labeled increased risk for disease transmission (IRD) for viral blood‐borne disease transmission. Many potential organ recipients need to decide between accepting an IRD organ offer and waiting for a non–IRD organ.MethodsUsing machine learning and simulation, we built transplant and waitlist survival models and compared the survival for patients accepting IRD organ offers or waiting for non–IRD organs for the heart, liver, and lung. The simulation consisted of generating 20 000 different scenarios of a recipient either receiving an IRD organ or waiting and receiving a non–IRD organ.ResultsIn the simulations, the 5‐year survival probabilities of heart, liver, and lung recipients who accepted IRD organ offers increased on average by 10.2%, 12.7%, and 7.2%, respectively, compared with receiving a non–IRD organ after average wait times (190, 228, and 223 days, respectively). When the estimated waitlist time was at least 5 days for the liver, and 1 day for the heart and lung, 50% or more of the simulations resulted in a higher chance of 5‐year survival when the patient received an IRD organ versus when the patient remained on the waitlist. We also developed a simple equation to estimate the benefits, in terms of 5‐year survival probabilities, of receiving an IRD organ versus waiting for a non–IRD organ, for a particular set of recipient/donor characteristics.ConclusionFor all three organs, the majority of patients are predicted to have higher 5‐year survival accepting an IRD organ offer compared with waiting for a non–IRD organ.

Paraphernalia Laws, Criminalizing Possession and Distribution of Items Used to Consume Illicit Drugs, and Injection-Related Harm.

The United States remains in the grip of an unprecedented epidemic of drug-related harm. Infections of HIV, hepatitis C, and endocarditis related to lack of access to new syringes and subsequent syringe sharing among people who inject drugs have increased alongside a surge in opioid overdose deaths.Overwhelming evidence shows that using a new syringe with every injection prevents injection-related blood-borne disease transmission. Additionally, there is promising research suggesting that the distribution of fentanyl test strips to people who inject drugs changes individuals' injection decisions, which enables safer drug use and reduces the risk of fatal overdose. However, laws prohibiting the possession of syringes and fentanyl test strips persist in nearly every state.The full and immediate repeal of state paraphernalia laws is both warranted and needed to reduce opioid overdose death and related harms. Such repeal would improve the health of people who inject drugs and those with whom they interact, reducing the spread of blood-borne disease and fatal overdose associated with infiltration of illicitly manufactured fentanyl into the illicit drug supply. It would also free up scarce public resources that could be redirected toward evidence-based approaches to reducing drug-related harm.

Infectious Disease Transmission in Solid Organ Transplantation: Donor Evaluation, Recipient Risk, and Outcomes of Transmission.

In 2016, the Transplantation Society of Australia and New Zealand, with the support of the Australian Government Organ and Tissue authority, commissioned a literature review on the topic of infectious disease transmission from deceased donors to recipients of solid organ transplants. The purpose of this review was to synthesize evidence on transmission risks, diagnostic test characteristics, and recipient management to inform best-practice clinical guidelines. The final review, presented as a special supplement in Transplantation Direct, collates case reports of transmission events and other peer-reviewed literature, and summarizes current (as of June 2017) international guidelines on donor screening and recipient management. Of particular interest at the time of writing was how to maximize utilization of donors at increased risk for transmission of human immunodeficiency virus, hepatitis C virus, and hepatitis B virus, given the recent developments, including the availability of direct-acting antivirals for hepatitis C virus and improvements in donor screening technologies. The review also covers emerging risks associated with recent epidemics (eg, Zika virus) and the risk of transmission of nonendemic pathogens related to donor travel history or country of origin. Lastly, the implications for recipient consent of expanded utilization of donors at increased risk of blood-borne viral disease transmission are considered.