Transmission Of Blood-borne Infections Research Articles

Seroprevalence of Hepatic Viruses and Associated Risk Factors Among Rehabilitated Patients During the Post-Addictive Phase

Background: Drug addiction poses a major public health risk, particularly in terms of the transmission of blood-borne infections like Hepatitis B (HBV), Hepatitis C (HCV), and Human Immunodeficiency Virus (HIV) among users.Objective: To assess the seroprevalence of HBV, HCV, and HIV and identify associated risk factors among drug users in rehabilitation centers in Islamabad, Pakistan.Methods: A cross-sectional study was conducted on 203 drug users from July to October 2022. Participants were screened for HBV, HCV, and HIV using immunochromatographic tests (ICT) and confirmed by Enzyme-Linked Immunosorbent Assay (ELISA). Demographic and risk factor data were collected through structured forms. Statistical analysis was performed using SPSS version 20.0, including descriptive statistics and chi-square tests for associations.Results: The prevalence rates for HCV, HBV, and HIV were 15.8%, 9.3%, and 3.4%, respectively. Intravenous drug users showed a higher prevalence of HCV (8.4%) compared to non-intravenous users (7.4%). Needle sharing (55.7%) and low socio-economic status (83.2%) were significant risk factors.Conclusion: HCV is highly prevalent among drug users, especially intravenous users, necessitating targeted harm reduction strategies and enhanced rehabilitation facilities.

Safe Injection Self-Efficacy is Associated with HCV and HIV Seropositivity Among People Who Inject Drugs in the San Diego-Tijuana Border Region.

Safe injection self-efficacy (SISE) is negatively associated with injection risk behaviors among people who inject drugs (PWID) but has not been examined in differing risk environments. We compared responses to a validated SISE scale between PWID in San Diego, California and Tijuana, Mexico, and examine correlates of SISE among PWID in Tijuana. PWID were recruited via street outreach for a longitudinal cohort study from October 2020-September 2021. We compared SISE scale items by city. Due to low variability in SISE scores among San Diego residents, we restricted analysis of factors associated with SISE to Tijuana residents and identified correlates of SISE score levels (low, medium, high) using ordinal logistic regression. Of 474 participants, most were male (74%), Latinx (78%) and Tijuana residents (73%). Mean age was 44. Mean SISE scores among San Diego residents were high (3.46 of 4 maximum) relative to Tijuana residents (mean: 1.93). Among Tijuana residents, White race and having previously resided in San Diego were associated with higher SISE scores. HCV and HIV seropositivity, homelessness, fentanyl use, polysubstance co-injection, and greater injection frequency were associated with lower SISE scores. We found profound inequalities between Tijuana and San Diego SISE, likely attributable to differential risk environments. Associations with fentanyl and polysubstance co-injection, injection frequency, and both HIV and HCV seropositivity suggest that SISE contribute to blood-borne infection transmission risks in Tijuana. SISE reflects an actionable intervention target to reduce injection risk behaviors, but structural interventions are required to change the risk environment.

Safe Injection Self-Efficacy is associated with HCV and HIV seropositivity among people who inject drugs in the San Diego-Tijuana border region.

Safe injection self-efficacy (SISE) is negatively associated with injection risk behaviors among people who inject drugs (PWID) but has not been examined in differing risk environments. We compared responses to a validated SISE scale between PWID in San Diego, California and Tijuana, Mexico, and examine correlates of SISE among PWID in Tijuana. PWID were recruited via street outreach for a longitudinal cohort study from October 2020 - September 2021. We compared SISE scale items by city. Due to low variability in SISE scores among San Diego residents, we restricted analysis of factors associated with SISE to Tijuana residents and identified correlates of SISE scores (low, medium, high) using ordinal logistic regression. Of 474 participants, most were male (74%), Latinx (78%) and Tijuana residents (73%). Mean age was 44. Mean SISE scores among San Diego residents were high (3.46 of 4 maximum) relative to Tijuana residents (mean: 1.93). Among Tijuana residents, White race and having previously resided in San Diego were associated with higher SISE scores. HCV and HIV seropositivity, homelessness, fentanyl use, polysubstance co-injection, and greater injection frequency were associated with lower SISE scores. We found profound inequalities between Tijuana and San Diego SISE, likely attributable to differential risk environments. Associations with fentanyl and polysubstance co-injection, injection frequency, and both HIV and HCV seropositivity suggest that SISE contribute to blood-borne infection transmission risks in Tijuana. SISE reflects an actionable intervention target to reduce injection risk behaviors, but structural interventions are required to intervene upon the risk environment.

Assessment of Stigma, Violence and Coping Mechanisms Among HIV Infected People Who Inject Drugs in Akwa-Ibom State, Nigeria

People who inject drugs (PWIDs) living with HIV face high levels of stigma, violence, and rape due to their risky lifestyles, potentially facilitating the spread of HIV. This study assessed the level and type of stigma and violence among PWIDs attending Heartland Alliance in Akwa Ibom State and their coping mechanisms. This descriptive cross-sectional study of 442 PWIDs receiving care at four one-stop shops in the state was conducted using mixed methods. Quantitative data were collected through pretested structured questionnaires and an adopted stigma scale, administered by trained research assistants using Computer Assisted Personal Interviewer (CAPI). For qualitative data, one focus group discussion (FGD) was held at each site with 8-10 purposively selected PWIDs, and transcripts were analyzed thematically. The study findings reveals that most respondents were male (78%) with a mean age of 32.7±7 years. Pentazocine use was common (52%), and 18% shared needles, with 15% sharing blood after injections among friends. More than half (58%) missed more than one dose of ARVs in the past week. Perceived stigma (59%) was more common than internal stigma (18%), with predictors being student status, non-disclosure of HIV status, and non-adherence to treatment. PWIDs Physical violence (47.5%) and verbal abuse (37.1%) were prevalent among PWIDs. Female PWIDs had a ninefold higher risk of rape. Coping mechanisms included isolation, increased substance use, battle readiness, and positive reframing. <i>Conclusion</i>: PWIDs face significant levels of stigma, violence, and non-adherence, jeopardizing treatment outcomes and perpetuating STI, HIV, and blood-borne infection transmission. Establishing harm-reduction programs is essential to address these vulnerabilities and the consequences associated with drug use.

Evaluation of Nursing Intervention Measures in Infection Control at Dialysis Units in Mosul City Hospitals

Abstract Background: Nursing staff must take adequate precautions and implement appropriate practices to substantially reduce the risk of workplace transmission of blood-borne infections to patients and staff within dialysis units. This study aimed to evaluate the intervention measures for staff nurses in the dialysis unit. Materials and Methods: A descriptive cross-sectional design was used to conduct the study from December 1, 2021, to April 1, 2022, in three Mosul City hospitals. A convenience sample was selected. Sixty nurses participated in the study. Results: The study findings show that 41.7% of the study sample was within the 25–29 year age group, and the highest percentage was of males (51.7%). Regarding qualifications, 43.3% of nurses had a bachelor’s degree, and 76.7% of them had less than 5 years of experience working in the dialysis unit. All the subjects received vaccination against the hepatitis virus. There are limitations in some nurses’ practices, such as wearing a face shield, cleaning and disinfecting the beds and chairs, and external surfaces of the machines during pre- and post-dialysis. Conclusion: The study concludes that there are clear defects in the application of some nursing procedures and measures to control the transmission of infections inside hemodialysis units in Mosul city hospitals.

International harm reduction indicators are still not reached: results from a repeated cross-sectional study on drug paraphernalia distribution in Germany, 2021

BackgroundTo prevent the transmission of blood-borne infections and reach the elimination of viral hepatitis by 2030, the World Health Organization (WHO) has set the goal to distribute 300 sterile needles and syringes each year per person who injects drugs (PWID). We aimed to assess drug paraphernalia distribution in Germany in 2021, including the WHO indicator, and to analyse changes to the distribution measured in 2018.MethodsWe conducted a repeated cross-sectional study of low-threshold drug services in Germany. We assessed type and quantity of distributed drug paraphernalia and the number of supplied PWID in 2021 using an online and paper-based questionnaire. We conducted a descriptive statistical analysis of data from 2021, assessed fulfillment of the WHO indicator and changes in services that participated 2021 and in the previous study 2018.ResultsFive hundred and eighty-nine of 1760 distributed questionnaires were returned in 2021. 204 drug services from 15 out of 16 federal states confirmed drug paraphernalia distribution, covering 20% of Germany’s rural and 51% of urban counties. 108 services had also participated in 2018. The most frequently distributed paraphernalia for injecting drug use in 2021 were syringes (97% of services), needles (96%) and vitamin C (90%). Pre-cut aluminium foil (79% of services) and pipes (28%) for inhaling, and sniff tubes (43%) for nasal use were distributed less frequently. We found a median reduction in distributed syringes by 18% and by 12% for needles compared to 2018. Of 15 states, two reached the 2030 WHO-target for needles and one for syringes.ConclusionsThe current national estimates and changes from 2018 to 2021 for drug paraphernalia distribution seem far from meeting the WHO target. Reasons could include a change in drug consumption behaviour towards less injecting use and more inhaling, and effects of the COVID-19 pandemic (supply difficulties, social distancing, lockdown, reduced opening hours of services). We observed pronounced regional differences in drug paraphernalia distribution. To close existing gaps, Germany should expand its drug paraphernalia distribution programmes and other harm reduction services, such as drug consumption rooms. Further investigation of determinants for adequate distribution is essential to reduce blood-borne infections in this key population.

Sharp injuries during clinical training among medical students in the University of Peradeniya, Sri Lanka

Introduction: Medical students are exposed to blood and body fluids during their clinical training which increased the risk of transmission of blood-borne infections. The objective of the study is to assess the prevalence, knowledge, attitudes and practices regarding sharp injuries among final medical students of the University of Peradeniya, Sri Lanka Methods: A survey was done among 210 final-year medical students of the University of Peradeniya with a self-administered online questionnaire including demographic information, experience, knowledge and reporting behavior following sharp injuries. Results: Response rate was 80% (n=168). Sharp injuries were experienced by 22.6%. Most of the sharp injuries were sustained during venepuncture (39.5%). The majority (58.9%) did not adhere to universal precautions as they did not anticipate the event. One-third of the students (31.6%) did not know about universal precautions. Most of the students (68.4%) who had a sharp injury did not seek post-exposure assistance or prophylaxis. The majority of this group thought there is no risk (64%). Twenty-five students have not completed the full course of the hepatitis B vaccine. More than half (51.8%) of the fully vaccinated group were unaware of their immune status. The majority (67.3%) believed that their knowledge is not adequate regarding the prevention and management of needle stick injuries. The majority (97%) believed more emphasis should be given to knowledge and practice regarding sharp injuries. Conclusion: The knowledge, attitudes and practices of medical students regarding the prevention and management of sharp injuries were unsatisfactory. Poor awareness was observed regarding immune status following hepatitis B vaccination among medical students.

Is tattooing associated with increased seroprevalence of transfusion-transmitted infections among blood donors: A single-center study from Southeastern India.

The regulations in India mandate a blanket deferral period of 12 months for donors from the time of acquiring a tattoo. The rationale is that using nonsterile needles, the same dyes for many persons, and other unhygienic practices result in the transmission of blood-borne infections. However, currently, autoclavable tattoo equipment, professional tattoo gun, single-use dye, and needle for tattooing have come up and are known to be devoid of the risks mentioned above. Hence, this study was designed to assess if the seroprevalence of transfusion-transmitted infections (TTIs) among tattooed blood donors was higher than in other nontattooed donors. This cross-sectional comparative study was conducted in the Department of Transfusion Medicine at the tertiary care teaching hospital in Pondicherry from September 2017 to May 2019. The study group included blood donors in the age group of 18-60 years with one or more tattoos, and the control group was chosen among blood donors of the same age without a tattoo. The sampling technique was consecutive. The serological prevalence of the two groups was compared for HIV, hepatitis B virus, hepatitis C virus, Syphilis, and Malaria. A total of 368 donors were recruited for the study, 184 donors with tattoos and 184 donors without a tattoo. The detected seroprevalence of TTI among the tattooed and nontattooed groups was 3.8% and 4.3%, respectively. There was no significant association found between tattooing and seroprevalence of TTI. About 60% of the ones who got a tattoo had obtained it from a licensed tattoo parlor. We found that the seroprevalence of TTI among tattooed donors was similar to that of nontattooed donors. However, the seroprevalence among donors who had undergone more than one tattooing experience was higher than those who had a single tattooing event.

Trends and distinct profiles of persons who inject drugs in the United States, 2015–2019

Drug injection represents a major health problem in the US, with severe health consequences including the transmission of blood-borne infections. An examination of the most recent trends in drug injection is warranted by the fast-evolving drug epidemic and recent policy changes such as the federal funding ban on needle exchange programs. This research examines current drug injection trends, patterns, and socioeconomic and behavioral profiles of people who inject drugs (PWID). Data were derived from the 2002 to 2019 National Survey on Drug Use and Health (NSDUH). After examining the annual prevalence of drug injection since 2002, a latent class analysis was conducted to identify drug injection and other substance misuse patterns among PWID using the latest (2015–2019) NSDUH datasets. Associations between class membership and behavioral health comorbidities and treatment receipt were also assessed. The drug injection prevalence among US adults aged 18–64 increased from 0.21% in 2002/2004 to 0.36% in 2017/2019. Three distinctive groups were identified: the heroin injection group (45.2%), the methamphetamine injection group (28.0%), and the multi-drug injection group (26.8%). The methamphetamine injection group reported greater risks of experiencing serious psychological distress, suicidality, and limited substance use treatment. Special attention is needed for those who primarily injected methamphetamine. Programs to promote harm reduction and increase access to addiction treatment need to be expanded in at-risk communities while accounting for their distinct socioeconomic and drug use/misuse profiles.

To study the incidences of needle stick injury among critical care nurses working in rural tertiary care hospital

Needle-stick injuries (NSIs) are a hazard for nursing staff and public health. Nursing workers are at high risk for occupational exposure to blood-borne pathogens via sharp injuries of the needle-stick. Needle-stick injuries (NSIs) are described as penetrating wounds caused by a device that is contaminated with another person’s body fluids. Needle-stick injuries are injuries acquired by needles like -scalp vein needles, hypodermic needles, blood sample collection needles, intracath stylets, lumbar puncture needles used to connect parts of IV delivery systems. Needle-stick injuries (NSIs) form a medium for the transmission of bloodborne infections. Strict use of personnel protective equipment while working in the hospital should be made compulsory. To study incidences of needle stick injury among nurses working in Rural tertiary care Unit, Loni. Ethical approval for this study was obtained from the Institutional Ethical Committee. Seventy-six nurses, who fulfilled inclusion criteria were included and data was obtained through survey. This study involves 76 nursing staff. Of them all, 27(35.5%) nursing staff experienced NSIsThe administration of medication was common action that caused most of needle-stick injuries mentioned by 14 (18.4%) nursing staff. IV cannula was the device that caused many needle-stick injuries reported by 17 (21.1%) nursing staff. Thenursing professionals are the main key players in both elective and emergency situations. There is a quite higher incidence of needle stick injury among critical care nurses. This might be due to handling of emergency cases and attempting to secure the intravenous line or to deliver the medications. Creating awareness and training appropriately is mandatory for critical care nurses.

The Prevalence of Transfusion Transmitted Infections among Blood Donors in Pakistan: A Retrospective Study

ObjectivesThis study aimed to determine the prevalence of blood transfusion-transmitted infections (TTIs), among blood donors in Pakistan, specifically HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), syphilis, and malaria.MethodsData records of all registered blood donors (n = 120 968) during 2008–2019, at a blood transfusion center in a tertiary care hospital were assessed. Frequency of the seropositive donors for HIV, HCV, HBV, syphilis, and malaria was analyzed.ResultsThe overall age range of the donors was 25–65 years. Nearly all were male (99.0%). HCV, syphilis, and malaria were more prevalent among those aged 26–35 years. Most donors (81.1%) were residents of Islamabad city. The infection with the highest prevalence among the screened blood donors was HCV (1.5%; 95% CI: 0.423–0.661) followed by syphilis (0.8%; 95% CI: 1.149–1.432). HCV and syphilis were most frequently observed in blood group B positive (B+) donors while HIV was more common in those who were O+. The frequency of co-infection of syphilis with HCV and HIV was 0.02% and 0.01%, respectively.ConclusionsAmong male blood donors, the most prevalent TTI infection was HCV followed by HIV; the latter is on the rise. HCV and syphilis are the most frequent co-infections.

Recombinant coagulation factors and their use in clinical practice

As is known, fresh frozen donor plasma is a blood component, which includes thermolabile and thermostable coagulation factors. Indications for transfusion of fresh frozen plasma are conditions in which there is a deficiency of plasma coagulation factors — bleeding, overdose of indirect anticoagulants, disseminated intravascular coagulation syndrome in the hypocoagulation phase. However, there are conditions not caused by the deficiency of all clotting factors, but associated with a lack of any link. These conditions include the most common congenital hemophilia A (factor VIII deficiency) and hemophilia B associated with factor IX deficiency, von Willebrand disease, as well as rare coagulopathy caused by a deficiency of other coagulation factors (proaccelerin, proconvertin, factor XI, fibrinogen). In such situations, it is more appropriate to replace the missing blood factors with drugs obtained from donor plasma (plasma coagulation factors) or obtained by genetic engineering (recombinant coagulation factors). Recombinant coagulation factors (RCFs) are lyophilized preparations of glycoproteins that have the biological activity of a blood coagulation factor isolated from plasma and are intended for replacement therapy in diseases associated with disorders of the blood coagulation system. The use of recombinant coagulation factors, unlike plasma ones, completely eliminates the risk of transmission of bloodborne infections, and also makes it possible to establish production regardless of the presence or absence of donor plasma reserves. The development, production and use of recombinant coagulation factors is a completely new step in the development of hematology and the treatment of hereditary diseases, which include congenital coagulopathy.

1197. Development and Implementation of Innovative Syringe Service Programs for Veterans in Rural and Urban Settings

BackgroundSyringe Services Programs (SSPs) is one aspect of a comprehensive Harm Reduction approach necessary to reduce the transmission of blood borne infections including Hepatitis B, Hepatitis C, and HIV. Substance Abuse and Mental Health Services Administration (SAMHSA) estimates that in 2019 that 595,000 veterans engage in opioid misuse with at least 57,000 veterans engaging in heroin. Stigmas to SSP are pervasive in the community and within the government system. Federal law prohibited the use of federal funds to purchase sterile needles or syringes for the purposes of illegal use of drugs by injection. It was officially clarified in May 24, 2021 that the prohibition to purchase syringes does not apply to Veterans Health Administration (VHA). While awaiting approximately 2 years to secure this clarification, syringes were obtained through a community donation. We aim to describe our process including difficulties encountered and data collected for SSP at two locations. Difficulties included developing an anonymous process to track quality, motivating providers to refer, educating highest risk veterans, providing face to face engagement during COVID-19 pandemic and ability to mail Harm Reduction kits containing sterile syringes.Illiana VA Program Information Sheet Orlando VA Program Information Sheet MethodsOf the 140 facilities within VHA, there are currently only two SSPs established, Illiana VA and Orlando VA. A retrospective analysis of Harm Reduction benefits was performed among veterans who engaged with the two SSPs between 2018 to 2021. Orlando VA SSP Intake Process Map Process that veteran undergo when they engage with Orlando VA SSPContents of Standard SSP Kit Distributed to Veterans at Orlando VA ResultsApproximately 3000 syringes were dispensed. Of the 17 veterans, 65% received syringes, 82% received naloxone, 100% engagement in mental health and 94% engagement in substance use disorder clinics. In total, 65% were screened for HIV, 82% for HCV and 29% for sexually transmitted infections. ConclusionThese numbers, while modest, are notable, especially given the financial and organizational barriers that were in place. Furthermore, the COVID-19 pandemic impacted full implementation and outreach. With the recent, official clarification on syringe purchase and support for SSPs, the number of SSPs in the VA will grow, along with opportunity for more robust data collection. The experience of both facilities is a model for programs currently in development and moves us closer to ending the HIV epidemic by 2030.Disclosures All Authors: No reported disclosures

Sharps injuries prevention among healthcare providers in surgical, medical and pediatric wards of a public hospital in Jimma Zone: a best practice implementation project.

Sharps injuries are a serious public health problem that healthcare providers face and constitute a major risk for the transmission of blood-borne infections. Prevention of sharps injuries in hospitals requires that healthcare providers comply with universal precautions. The aim of this study was to assess and improve the compliance of healthcare providers with protocols based on best available evidence for prevention of sharps injuries in medical, surgical and pediatric wards of the hospital. A three-phase clinical audit was carried out using the online JBI Practical Application of Clinical Evidence System and Getting Research into Practice Program. Six audit criteria based on available evidence were used. Phase 1 of the project was the baseline audit, phase 2 the implementation of the best practice, and phase 3 the follow-up audit. Data were collected through observation, interview and resource inventory. The postintervention compliance report showed maximum improvement in compliance in criterion 1 (sharps containers are not filled above the mark that indicates the bin is full) and criterion 2 (sharps containers are positioned out of the reach of children at a height that enables safe disposal by staff). Between the baseline and postintervention audits, the compliance rate for these criteria improved by more than half (criterion 1) and by nine-fold (criterion 2) (from 38 to 100% and 0 to 93%, respectively). During baseline, two nurses reported experiencing sharps injuries, noting that they think it is not important to report the injury if the patient is negative for HIV, and when they do not know where to report it, regardless. At the postintervention audit no injuries were reported. The best practice recommendations using a clinical audit process was an effective intervention for improving knowledge and compliance of healthcare workers with protocols for the prevention of sharps injuries in low-resource settings.

Injection of Anabolic Steroids in Men Who Had Sex with Men in Madrid and Barcelona: Prevalence Correlates and Role as a Risk Factor for Transmitted Infections

This study describes the prevalence of anabolic-androgenic steroid (AAS) injection, their main correlates, and the prevalence of specific AAS injection risk behaviours among men who have sex with men (MSM), an area insufficiently addressed in scientific research. Participants were HIV-negative MSM attending four HIV/STI diagnosis services: two clinics and two community programmes in Madrid and Barcelona. Participants answered an online self-administered questionnaire. Crude and adjusted lifetime prevalence and prevalence ratios (PRs) were calculated by different factors and using Poisson regression models with robust variance. Of the 3510 participants, 6.1% (95% CI: 5.3–6.9) had injected AAS before and 3.5% (95% CI: 2.9–4.2) had done so in the last 12 months. In the multivariate analysis, AAS injection was independently associated with being over 40 years old (aPR = 3.6; 95% CI: 2.0–6.5) and being born in Latin America (aPR = 2.5; 95% CI:1.9–3.4), and was less strongly associated (aPRs of around two) with having been recruited into STI clinics, having ever been paid for sex before, injected drugs, used drugs for sex, having been diagnosed with an STI before, and having been diagnosed with HIV at the recruitment consultation. Only three participants, 1.4%, of those who had injected AAS before had shared AAS or equipment for preparation or injecting before. Conclusions: In contrast to drugs, AAS injecting behaviours do not play a relevant, direct role in the transmission of blood-borne infections among MSM. However, AAS injectors have a higher prevalence of sexual risk behaviours. These findings should be confirmed using new studies that employ other sampling procedures.

2: Ex-vivo Normothermic Preservation Of Amputated Limbs With A Hemoglobin-based Oxygen Carrier (HBOC-201) Perfusate

Background:Ex-vivo normothermic perfusion (EVNP) has been used as an alternative to static cold storage (SCS) to improve allograft quality in solid organ and vascularized composite allotransplantation (VCA). Perfusates containing red blood cells (RBCs) have shown to improve outcomes during ex vivo normothermic organ perfusion when compared to acellular perfusates. However, the use of blood products is challenging due to limited availability, the need for cross-matching, and potential blood-borne infection transmission. To avoid limitations associated with the use of blood-based products, we evaluated the feasibility of EVNLP utilizing a polymerized Hemoglobin-Based Oxygen Carrier-201 (HBOC-201).Methods:Twenty-four porcine forelimbs were procured from Yorkshire pigs following euthanasia. Six forelimbs underwent EVNLP with an HBOC-201 based perfusate, six with an RBC-based perfusate, and twelve served as static cold storage (SCS) controls. EVNLP termination criteria included systolic arterial pressure ≥115 mmHg, fullness of compartments, or tissue oxygen saturation drop by 20%. Limb contractility, weight change, compartment pressure, tissue oxygen saturation, oxygen uptake rates (OUR) were assessed. Perfusate fluid-dynamics, gases, electrolytes, metabolites, methemoglobin (MetHb), creatine kinase (CK), and myoglobin concentration were measured. Limb viability was assessed with indocyanine green (ICG) angiography, infrared thermography (IRT), and muscle histology.Results:Warm ischemia time before EVNLP was 35.50±8.62 min in HBOC-201 perfused limbs and 30.17±8.03 min in RBC-perfused limbs (p=0.07). EVNLP duration in HBOC-201 and RBC-perfused limbs was 22.5±1.7 and 28.2±7.3 hours, respectively (p=0.04). Vascular flow (325±25 vs. 444.7±50.6 ml/min; p=0.39), OUR (2.0±1.45 vs. 1.3±0.92 mlO2/min*g of tissue; p=0.80), lactate (14.66±4.26 vs. 13.11±6.68 mmol/L; p=0.32), and perfusate pH (7.53±0.25 HBOC-201; 7.50±0.23 RBC; p=0.82) were not significantly different between treatment groups. Additionally, flexor (28.3±22.0 vs. 27.5±10.6; p=0.99) and extensor (31.5±22.9 vs. 28.8±14.5; p=0.82) compartment pressures, contractility (3±2 vs. 4±1 p=0.57), and percent weight change (23.1±3.0% vs. 13.2±22.7%; p=0.07) were not significantly different between HBOC-201 and RBC groups. In HBOC-201 perfused limbs, MetHb levels increased, reaching 47.8±12.1% at endpoint. Methemoglobin saturation did not affect OUR (ρ = -0.15, r2 = 0.022; p=0.45). Distal tissue preservation was confirmed by IRT and ICG angiography in both EVNLP groups. Hypoxic cell clusters were identified in the SCS control group at endpoint and were absent in both treatment arms.Conclusion:HBOC-201- and RBC-based perfusates similarly support isolated limb physiology, metabolism, and function. Optimization of modifiable factors, including HBOC-201 oxidation, may extend EVNLP durations employing HBOC-201 and overcome logistical constraints of the utilization of traditional blood products.

A public health response to a newly diagnosed case of hepatitis C associated with lapse in Infection Prevention and Control practices in a dental setting in Ontario, Canada.

Haliburton, Kawartha, Pine Ridge District Health Unit (HKPRDHU) investigated an exposure in an Ontario operatory dental facility related to a newly diagnosed hepatitis C virus (HCV) infection caused by a virus with an uncommon hepatitis C genotype. Lapses in Infection Prevention and Control (IPAC) and a second epidemiologically-linked case (with the same uncommon hepatitis C genotype) were identified, prompting a broader public health response and outbreak investigation. a) To describe the investigation of a newly diagnosed case of hepatitis C; b) to describe the broader public health response, and c) to address a paucity in the literature related to the risk of disease transmission in dental settings due to IPAC lapses. A collaborative approach with two dental practices, public health partners and regulatory bodies was used. An IPAC inspection was completed to determine and mitigate the risk of blood borne infection transmission within the facilities. Appropriate protocols were followed for the IPAC investigation and public health response. The investigation identified a risk of potential HCV transmission between two cases linked to the same dental facility. There were no other epi-linked cases of HCV identified. Challenges included a lack of adherence to IPAC standards in one of the dental settings and awareness in the dental community regarding HCV transmission, coordination with regulatory bodies and public health experts and low uptake of laboratory testing by patients. Despite the unique challenges associated with the investigation, HKPRDHU conducted a successful IPAC lapse investigation and public health response. Public health units need to maintain collaborative approaches with regulated health professionals, their regulatory bodies and public health experts.

A systematic review of outbreaks of bloodborne infections (hepatitis B and C, HIV) transmitted from patient to patient in healthcare settings

Healthcare facilities have always played an important role in transmission of bloodborne infections. Procedures involving blood and blood fluids pose a risk of transmitting hepatitis B, hepatitis C and HIV not only to healthcare workers, but also to patients. To assess the role of healthcare facilities in transmission of bloodborne infections and to identify risk groups among patients as well as transmission factors, a total of 75 outbreaks of hepatitis B, hepatitis C and HIV have been analyzed with reference to the data published in different countries in 2008–2020. The comparative analysis was conducted for the outbreaks in the United States during 1992–2008 and 2008–2019. Most of the outbreaks of bloodborne infections at healthcare facilities were caused by non-adherence to standard precautions among healthcare workers: Reusing disposable items; improper handwashing; reusing gloves; non-disinfecting surfaces, reusable equipment and devices; non-sterilizing reusable instruments. In terms of bloodborne infections, high-risk facilities include hemodialysis centers, oncohematology clinics, outpatient clinics, nursing homes, residential care facilities, and diabetes treatment centers. High-risk groups include patients undergoing hemodialysis, oncohematological patients, and patients with diabetes. Diagnosis of bloodborne infections on a regular basis, hepatitis B vaccination among high-risk patients, investigation of outbreaks, adoption of rules and procedures combined with training and compliance control of healthcare workers contribute to solution of the problem associated with nosocomial transmission of bloodborne infections.

Possibilities of using thrombin in diagnostic and therapeutic fibrogastroduodenoscopy for gastrointestinal bleeding

The issue of gastrointestinal bleeding has been relevant for several decades, and the mortality rate as a result of this pathology ranges within 10 %. Against the background of the impossibility of timely surgical intervention or in the presence of serious contraindications to surgical treatment, an alternative may be to improve the methods of non-operative hemostasis, namely, the combination of endoscopic manipulations with medication. Endoscopic methods of stopping bleeding include thermal, mechanical and injection. Most often, physicians resort to the use of adrenaline (leading to a state of vasoconstriction), various sclerosing drugs (in particular, ethyl alcohol), the action of which is aimed at providing chemical coagulation, as well as thrombin and fibrin glue, leading to local thrombus formation, as medications. Therapeutic endoscopy for gastrointestinal bleeding has a fairly high efficiency and helps to stop bleeding, which in most cases allows preparing the patient for surgery and in some cases helps to prevent relapse and translates the need for surgical treatment into the category of planned operations. The use of thrombin in such practice is limited by the impossibility of carrying out hemostasis under conditions of bleeding from large vessels, the risk of transmission of blood-borne infections and the low availability of this drug.

An outbreak of hepatitis C virus attributed to the use of multi-dose vials at a colonoscopy clinic, Waterloo Region, Ontario.

Hepatitis C virus (HCV) transmission has been epidemiologically linked to healthcare settings, particularly out-of-hospital settings such as endoscopy clinics and hemodialysis clinics. These have been largely attributed to lapses in infection prevention and control practices (IPAC). To describe the public health response to an outbreak of HCV that was detected among patients of a colonoscopy clinic in Ontario, and to highlight the risks of using multi-dose vials and the need for improved IPAC practices in out-of-hospital settings. Screening for HCV was conducted on patients and staff who attended or worked at the clinic within the same timeframe as the index case's procedure. Blood samples from positive cases underwent viral sequencing. Inspections of the clinic assessed IPAC practices, and a chart review was done to identify plausible mechanisms for transmission. A total of 38% of patients who underwent procedures at the clinic on the same day as the index case tested positive for HCV. Genetic sequencing showed a high degree of similarity in the HCV genetic sequence among the samples positive for HCV. Chart review and clinic inspection identified use of multi-dose vials of anesthesia medication across multiple patients as the plausible mechanism for transmission. Healthcare workers, especially those in out-of-hospital procedural/surgical premises, should be vigilant in following IPAC best practices, including those related to the use of multi-dose vials, to prevent the transmission of bloodborne infections in healthcare settings.