Blood Borne Pathogens

Background The World Health Organization recommends universal and quality-controlled screening of blood donations for the major transfusion-transmissible infections (TTIs): human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) and syphilis. The study objectives were to determine the seroprevalence of these TTIs among blood donors at the Provincial Hospital of Tete, Mozambique, and to assess the local pre-donation screening performance. Methods All consenting voluntary and replacement candidate blood donors were consecutively included from February to May 2009. Sera of all candidates, independent of deferral by questionnaire, were submitted to screening with quality-assured rapid or simple assays for HIV, HBV surface antigen (HBsAg), HCV and syphilis. Assays locally used by the blood bank for HBV and syphilis screening were run in parallel to quality-assured external assays supplied during the study, and all discordant samples were submitted to confirma...

Healthcare workers (HCWs) are potentially exposed to risk of infection with blood-borne pathogens (BBP). Universal precautions (UPs) are a set of precautions designed to prevent transmission of HIV, HBV and other blood borne pathogens while providing health care. The knowledge and understanding of UPs among HCWs in developing countries is inadequate. Present study was conducted to assess the knowledge on standard Universal precautions among medical and nursing students. The cross sectional study was conducted among 50 nursing and 50 medical students. A questionnaire was prepared based on the WHO and CDC guidelines. In the present study overall correct response from medical students was 75.6% and from nursing students was 85%. Nursing students were better than medical students in almost all aspects of knowledge regarding Universal precautions as well as compliance to Universal precautions. This difference was statistically significant.

Blood and body fluid exposures place healthcare workers at risk for blood-borne infections. To determine the extent of the problem in Iran, we assessed blood and body fluid exposure in healthcare workers in Fars Province hospitals. We distributed 2,118 questionnaires using a stratified random sampling method among nurses of these hospitals. We used Chi-square test, Student's t-test, and multiple logistic regression analysis for determining risk factors for exposure. The overall prevalence of blood and body fluid exposures was 79% with a rate of exposure to sharps devices of 50%. Hypodermic needles were involved in most exposures (73%) with the most common source of injury being needle recapping (35%). Blood was the most frequent contaminant (87%) in mucocutaneous exposures, most commonly associated with inserting and removing intravenous lines (50%). Sharps injuries were independently associated with gender, professional level, and hospital location; mucocutaneous exposures were...

A prevalence survey was performed to estimate the magnitude and predictors for needlestick injury (NSI) in nurses of Fars province hospitals. METHODS: Questionnaires were distributed in 52 hospitals to a stratified random sample of 2118 (46.3%) nurses between April and September 2005 to collect self-reported NSI in the past 12-months. RESULTS: Of the 1555 nurses who returned a completed questionnaire, 49.6% (95% confidence interval [95 CI] 47.1%-52.1%) recalled at least one sharps injury, of which 52.6% were classified as NSI. Just over one fourth (26.3%; 95 CI 24.1%-28.6%, 409/1555) of respondents sustained at least one NSI, 75.6% (95 CI 71.1%-79.6%) recalled having sustained between 1 and 4 injuries in the past 12-months, of which 72.2% involved a hollow-bore needle and 95.1% of injuries involved fingers. Predictors of NSI included being a registered nurse (odds ratio [OR] 1.6, 95% CI 1.1-2.3) or midwife (OR 2.4, 95% CI 1.4-3.9) compared with nurse managers, being employed in a hospital located in other cities smaller than Shiraz (OR 1.4, 95% CI 1.1-1.8). Nurses who reported a previous contaminated NSI were less likely to sustain a further injury (OR 0.3, 95% CI 0.2-0.4). CONCLUSION: The prevalence of NSI in Iranian nurses is high, with the majority of injured staff having sustained up to 4 NSIs in a 12-month period. Nearly all NSIs were high-risk injuries involving a hollow-bore needle. Providing nursing staff with safety-engineered devices, including retractable syringes when hollowbore needles are to be used, will be an important step toward reducing our NSI epidemic.

Exposure to patients' blood and body fluids would prone the dental students to the risk of blood borne infections. Several studies have shown a high prevalence of these exposures in dental settings particularly in developing countries. However, few studies have evaluated the epidemiology of these exposures in dental students in Iran. To assess the epidemiology of occupational exposures among dental students and consequently designing the appropriate interventions in order to prevent these exposures. In this cross-sectional study performed during March to June 2011, all 191 Shiraz clinical dental students were asked to complete a self-administered questionnaire. This questionnaire included demographic information and experience of sharp injuries and mucocutaneous contaminations. Chi square and t-test were employed to evaluate the risk factors of exposure. 80%of the participants were exposed to the patients' blood or body fluids during their clinical course. No association was...

Background. Suspicion of catheter-related bloodstream infection (CR-BSI) leads frequently to unnecessary catheter withdrawals, and many catheter-tip cultures yield negative results. The objective of this study was to compare the yield of 3 microbiological procedures to assess CR-BSI without catheter withdrawal. Methods. The study was prospectively performed in a group of patients without neutropenia or blood disorders who were admitted to the intensive care unit during a 37-month period with sepsis suspected on clinical grounds and who had central venous catheters inserted for 148 h. The microbiological procedures compared were semiquantitative cultures from hub and skin (superficial), differential quantitative blood cultures, and differential time to positivity between cultures of blood obtained from catheter hubs and peripheral blood. Results. Of the 204 episodes of suspected CR-BSI included in the study, 28 were confirmed to be CR-BSI. We obtained the following results for sensitivity, specificity, positive and negative predictive values, and accuracy: superficial cultures, 78.6%, 92.0%, 61.1%, 96.4%, and 90.2%, respectively; differential quantitative blood cultures, 71.4%, 97.7%, 83.3%, 95.6%, and 94.1%, respectively; and differential time to positivity, 96.4%, 90.3%, 61.4%, 99.4%, and 91.2%, respectively. Conclusions. CR-BSI can be assessed without catheter withdrawal in patients without neutropenia or blood disorders who have catheters inserted for a short time and are hospitalized in the intensive care unit. Convenience, use of resources, and expertise should determine the technique of choice in different medical contexts. Because of ease of performance, low cost, and wide availability, we recommend combining semiquantitative superficial cultures and peripheral vein blood cultures to screen for CR-BSI, leaving differential quantitative blood cultures as a confirmatory and more specific technique.

Hepatitis C virus (HCV) is mostly transmitted through blood-to-blood contact during injection drug use via shared contaminated syringes/needles or injection paraphernalia. This paper used meta-analytic methods to assess whether HCV prevalence and incidence varied across different racial/ethnic groups of injection drug users (IDUs) sampled internationally. The 29 prevalence and 11 incidence studies identified as part of the HCV Synthesis Project were categorized into subgroups based on similar racial/ethnic comparisons. The effect estimate used was the odds or risk ratio comparing HCV prevalence or incidence rates in racial/ethnic minority groups versus those of majority status. For prevalence studies, the clearest disparity in HCV status was observed in the Canadian and Australian Aboriginal versus White comparison, followed by the US non-White versus White categories. Overall, Hispanic IDUs had greater HCV prevalence, and HCV prevalence in African-Americans was not significantly greater than that of Whites in the US. Aboriginal groups showed higher HCV seroconversion rates when compared to others, and African-Americans had lower seroconversion rates compared to other IDUs in the US. The findings suggest that certain minority groups have elevated HCV rates in comparison to other IDUs, which may be a consequence of stigma, discrimination, different risk behaviors or decreased access to health care, services and preventive education. Future research should seek to explicitly explore and explain racial/ethnic variations in HCV prevalence and incidence, and define the groups more precisely to allow for more accurate detection of possible racial/ethnic differences in HCV rates.

Health care workers (HCWs) are at high risk for occupational blood exposures (OBEs) and transmission of bloodborne pathogens. This study elucidated the incidence rate and epidemiological characteristics of OBEs among HCWs and investigated the pathogen transmission rate for hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). Self-reported OBEs from January 1, 2011 to December 31, 2015 were obtained from the electronic recording system. OBE incidence densities per 100 person-years and per 100 bed-years were calculated with a 5-year trend analysis. OBE characteristics and pathogen transmission rates were evaluated. Among 10,452 HCWs and 1072 average yearly beds, 1076 OBEs were reported. OBE incidence rate was 5.6 cases per 100 person (full-time equivalent)-years and 20.3 per 100 bed-years. Incidence rate decreased and was significantly associated with a decrease of beds served per HCW. Housekeeping showed the highest OBE rate (14.8%) followed by do...

Prior to the introduction of recombinant human erythropoietin (EPO), red blood cell (RBC) transfusions were frequently required when iron and anabolic steroids failed to improve the clinical symptoms of anemia associated with hemoglobin (Hb) levels that were commonly less than 7 g/dL. After the approval of EPO in the US in 1989, the Hb levels of patients on hemodialysis dramatically improved and the need for RBC transfusions decreased significantly. The need for RBC transfusion remains for patients who require an immediate increase in their RBC mass due to symptomatic anemia and is likely to increase due to changes in the management of anemia in dialysis patients resulting from clinical trials data, regulatory changes, and new reimbursement policies for EPO. The safety of the blood supply has greatly improved over the last few decades and the risk of transfusion-transmitted diseases has now been dramatically reduced. Non-infectious complications of transfusion currently cause the majority of morbidity and mortality associated with transfusion in the US. Transfusion also brings a risk of alloimmunization, a particular concern for dialysis patients waiting for kidney transplantation. Knowledge of the risks of RBC transfusions will help clinicians better assess the risks and benefits of transfusing patients with ESRD. This article reviews the modern day infectious and noninfectious risks of allogeneic RBC transfusions. The United States (US) Food and Drug Administration (FDA) approval of recombinant human erythropoietin (EPO) in 1989 led to a dramatic improvement in hemoglobin (Hb) levels and anemia symptoms in patients with ESRD. Prior to the introduction of EPO, Hb levels of 5-7 g/dl were common in hemodialysis patients, who often required frequent blood transfusions when iron and anabolic steroid treatments failed to improve the clinical symptoms of anemia. The availability of EPO led to a significant reduction in the number of RBC units transfused among patients undergoing dialysis, although the need for RBC transfusion has not been eliminated entirely. 2 Results of recent clinical trials, changes in product labeling for epoetin alfa and darbepoetin alfa, and new regulatory and reimbursement policies are leading to lower doses of erythropoietic stimulating agents (ESAs) and Hb levels making the need for RBC transfusion in dialysis patients more likely. EPO and iron therapy have been successful in increasing Hb levels in dialysis patients, decreasing the need for RBC transfusions and improving a patient's general well-being. However, for patients who have symptomatic anemia requiring an immediate increase in

Prior to the introduction of recombinant human erythropoietin (EPO), red blood cell (RBC) transfusions were frequently required when iron and anabolic steroids failed to improve the clinical symptoms of anemia associated with hemoglobin (Hb) levels that were commonly less than 7 g/dl. After the approval of EPO in the United States in 1989, the Hb levels of patients on hemodialysis dramatically improved and the need for RBC transfusions decreased significantly. The need for RBC transfusion remains for patients who require an immediate increase in their RBC mass due to symptomatic anemia and is likely to increase due to changes in the management of anemia in dialysis patients resulting from clinical trials data, regulatory changes, and new reimbursement policies for EPO. The safety of the blood supply has greatly improved over the last few decades, and the risk of transfusion‐transmitted diseases has now been dramatically reduced. Noninfectious complications of transfusion currently c...

Although the risk of infection with hepatitis and human immunodeficiency viruses from blood transfusions has been reduced to negligible levels, emerging infections continue to offer threats. Such threats occur with any infection that has an asymptomatic, blood-borne phase. In the past, it was thought that any emerging transfusion-transmitted disease would have epidemiologic properties similar to those of AIDS or viral hepatitis. Over the past 20 years, however, greatest concern has arisen from variant Creutzfeldt-Jakob disease, West Nile virus, and Babesia. These and other emerging infections are discussed in the context of blood safety.

In common with other developed countries, the United States has placed a great deal of emphasis on blood safety. As a result of careful donor selection and the use of advanced tests, including nucleic acid testing (NAT), the risk of transmission of human immunodeficiency virus and hepatitis C virus has been reduced to about 1 in 1.5 million donations. NAT for hepatitis B virus has not been introduced, but nevertheless the risk is low. Attention recently has been focused on emerging infections. NAT for West Nile virus was implemented within 6 to 8 months of recognition of the need to prevent transfusion transmission of this newly introduced virus. Approximately 1000 potentially infectious donations were identified and removed from the blood supply during the 2003 season. Other emerging infections attracting attention include Chagas' disease, babesiosis, malaria, and variant Creutzfeldt-Jakob disease.

In the past, when Kenyans sought advanced medical care, their journey almost always led to Nairobi. As the capital city, Nairobi has long held the lion's share of Kenya's healthcare infrastructure, drawing talent, investment, and policy attention. But that era of centralization is giving way to a new chapter in Kenya's healthcare story-one where secondary cities like Kisumu, Mombasa, and Eldoret are rising as healthcare hubs in their own right. This evolution isn't accidental. It's the result of deliberate planning, infrastructure investments, and a growing recognition that regional equity in healthcare access is no longer optional-it's essential. Among the changemakers driving this shift is Jayesh Saini, whose leadership across multiple health ventures has proven instrumental in transforming care delivery in these cities. Kisumu: Western Kenya's Gateway to Advanced Care Kisumu, long known as a political and economic capital for the western region, is now asserting itself as a center for advanced outpatient and diagnostic services. The city's location-close

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Office of the Director This statement reflects the panel's assessment of medical knowledge available at the time the statement was written. Thus, it provides a "snapshot in time" of the state of knowledge on the conference topic. When reading the statement, keep in mind that new knowledge is inevitably accumulating through medical research.

Introduction: Brucellosis is a worldwide zoonotic disease that remains an important public health problem in India. As clinical manifestations of human brucellosis are variable in nature, and no constellation of clinical findings can be considered characteristic laboratory help is must in the diagnosis. In the laboratory, brucellosis is generally diagnosed by serological tests. Though many serological tests with different principles are available, serological testing does not provide direct evidence for the presence of the pathogen, hence isolation of Brucella spp. from the clinical specimen is considered to be the gold standard. Brucella is highly infectious and requires level 3 bio-containment facilities and technically skilled personnel, Brucella cultures are rarely performed. Due to the rampant use of rifampin for the treatment of tuberculosis and reports on development of resistance in virtually all organisms the sensitivity of Brucellae to the traditional drugs cannot be presumed. Aim: To isolate, identify the Brucellae from blood culture and to assess the antimicrobial susceptibility of the isolates to WHO recommended anti-brucellar antibiotics by agar dilution method. Materials and Methods: A total of 169 blood samples were collected for brucella culture, from 593 epidemiologically, clinically and serologically suspected cases of human brucellosis. Of the 169 blood cultures 77 yielded Brucella, of which 9 were from the western Maharashtra and 68 from Northern Karnataka. The isolates were identified using conventional methods. The minimal inhibitory concentration (MIC) values for streptomycin, gentamicin, doxycycline, rifampin and trimethoprim-sulfamethoxazole were determined by using agar dilution method. Results: Isolation rate for Brucella was 45.5%. Of the 77 isolates, 75 were identified as B. melitensis and 2 as B. abortus. All the isolates were sensitive to all the drugs tested. Conclusion: Human brucellosis due to B.melitensis is fairly a common disease in this area. The current WHO recommended drug regimen for the treatment of human brucellosis continues to be effective as no drug resistance is noted in the study.

Brief Research Article Injections have been acknowledged as the most common procedure used in the health-care sector. An estimated 16 billion injections are administered yearly, [1] whereas several billion injections are administered annually in nations with fewer resources. [1-3] The World Health Organization (WHO) estimates that 2 million needlestick injuries occur among health-care workers throughout each year. Because of substandard procedures, there is a danger of HIV infections as well as hepatitis B and C infections spreading. [4,5] Thus, it is crucial to address injection procedures' safety precautions and provide preventative care to prevent the unintentional spread of blood-borne infections. When the injection does not pose a risk to the patient, the injector, or the community as a whole, the WHO deems it safe. [6] To mitigate the risk, we must prevent infectious and noninfectious adverse events. Sterilized needles, hygienic preparation areas, swift and appropriate disposal of outdated supplies, and a secure manner of ultimate disposal are also crucial. The percentage and frequency distribution of observed practice of various aspect of safe injection practice like recapping, the suitability and appropriateness of injection equipment, the usage of sharps containers, the knowledge of risk assessment, the efficacy and accessibility of training program that all reduce the risk of infection transmission. [6,7] Global initiatives to lower the risk of hazardous injections have been implemented in large part by the international community, led by the Safe Injection Global Network. [8] Between 2000 and 2010, there was a significant reduction in the unsafe injection prevalence in emerging and economically disadvantaged countries (from 1.35 to 0.16 per person-year). Nonetheless, the WHO Eastern Mediterranean Region continued to have a high rate of unsafe injections-0.57 per person yearly. In 2010, the average for Sub-Saharan Africa and Latin America was a mere 0.04-0.05 Patients and health-care providers are at significant risk of both infectious and noninfectious adverse effects due to the hazardous nature of injection techniques. According to the International Physical Activity and the Environment Network study findings, 3-6 billion injections are administered annually in India. Remarkably, studies imply that every year, at least 50% of injections performed globally are harmful. Aim of the study is to examine the overall effectiveness of the existing infrastructure and systems within health-care facilities in facilitating safe injection practices. A descriptive survey approach was used where total 26 healthcare facilities were observed and healthcare worker were interviewed. The tool consists of observational checklist. Several aspects of injection safety were found to be satisfactory in both government and private health-care facilities city. Nevertheless, opportunities for improvement exist, warranting specific measures. The implementation of regular in-service educational training sessions is crucial.

Background: Insufficient training in infection control and occupational health among healthcare workers (HCWs) in countries with high human immunodeficiency virus (HIV) and tuberculosis (TB) burdens requires attention. We examined the effectiveness of a 1-year Certificate Program in Occupational Health and Infection Control conducted in Free State Province, South Africa in an international partnership to empower HCWs to become change agents to promote workplace-based HIV and TB prevention. Methods: Questionnaires assessing reactions to the program and Knowledge, Attitudes, Skills, and Practices were collected pre-, mid-, and postprogram. Individual interviews, group project evaluations, and participant observation were also conducted. Quantitative data were analyzed using Wilcoxon signed-rank test. Qualitative data were thematically coded and analyzed using the Kirkpatrick framework. Results: Participants recruited (n ¼ 32) were mostly female (81%) and nurses (56%). Pre-to-post-program mean scores improved in knowledge (þ12%, p ¼ 0.002) and skills/practices (þ14%, p ¼ 0.002). Preprogram attitude scores were high but did not change. Participants felt empowered and demonstrated attitudinal improvements regarding HIV, TB, infection control, and occupational health. Successful projects were indeed implemented. However, participants encountered considerable difficulties in trying to sustain improvement, due largely to lack of pre-existing knowledge and experience, combined with inadequate staffing and insufficient management support. Training is essential to strengthen HCWs' occupational health and infection control knowledge, attitudes, skills, and practices, and workplace-based training programs such as this can yield impressive results. However, the considerable mentorship resources required for such programs and the substantial infrastructural supports needed for implementation and sustainability of improvements in settings without pre-existing experience in such endeavors should not be underestimated.

La sécurité transfusionnelle a fait de grand progrès en France. Le risque viral a été réduit d'un facteur de plus de 1500 au cours de ces 20 dernières années. Comparativement, le risque d'accident ABO a diminué seulement de moitié. Les incidents graves de la chaîne transfusionnelle font l'objet de déclaration obligatoire en France et d'une analyse approfondie selon des méthodes inspirées des enquêtes réalisées au sein d'autres systèmes à risque comme l'aéronautique. L'objectif est de mieux comprendre les causes favorisant la survenue des erreurs humaines afin de mettre en oeuvre des actions de prévention, erreurs qui sont retrouvées dans la majorité des accidents.

The 2B proteins of coxsackievirus and poliovirus (PV) share significant structural similarity and exhibit similar biochemical activities, namely inhibition of protein secretion and modification of membrane permeability. Both proteins contain two hydrophobic domains in the carboxy-terminal two-thirds of their sequence, of which one has the potential to form a cationic amphipathic alpha-helix. To gain more insight into the structural requirements of enterovirus protein 2B for its functioning in viral RNA replication, a chimeric cDNA approach was used. Chimeric coxsackie B3 virus (CBV3) genomes were constructed that expressed either the entire PV 2B protein or hybrid proteins in which specific segments of CBV3 2B were substituted by their corresponding PV counterparts. In vitro synthesis and processing of the chimeric polyproteins showed no abnormalities. CBV3 genomes carrying the entire PV 2B gene failed to replicate. A chimeric genome that expressed a hybrid 2B protein consisting of ...

Infection with the Hepatitis B Virus (HBV) is a serious global health risk. With between 257 and 291 million expected cases worldwide, it is linked to signi cant disease and death because of clinical consequences such liver cirrhosis and hepatocellular cancer. While the resources available of immunization, screening, and management, the prevalence of prolonged Hepatitis B Virus is still signi cant [1]. HBV modes of transmission include exposure to the infected and body and body transmission. Additionally, contaminated instruments and multiple sexual partners are also thought to be involved [2]. The

Background: Due to the recognition of risks associated with NSIs, safety strategies have been adopted to lessen the risk of injury and have shown to be effective in reducing NSIs. Methods: Eight university hospitals reporting the highest rates of NSIs (Phase 1) were selected for the intervention (Phase 2). Sharp injury protection syringes were supplied, and training on the use of safety devices was conducted. Questionnaires were re-administered post-intervention, focusing on injuries due to needles on disposable syringes. Injury rates of at least one injury due to needle on disposable syringe in the past three months were significantly reduced from 30.3/100 person in phase 1 to 2.16/100 person in phase 2 (P-value < 0.0001). well as the use of sharp injury protection syringes lead to reductions in NSIs among nurses. This is the first study that assessed the risk of needle on a disposable syringe in particular, followed by the implementation of safety engineered devices in attempt to lessen the risk of injury. Evaluations of safety interventions of this sort, across other departments of hospital units and among other personnel are needed.

To determine the frequency of Needle venipuncture. For discard of used needles, 49.7% Stick Injury (NSI) among doctors working at a recapped and threw, 41.3% bend and threw and tertiary care public hospital and their attitudes only 9% used needles cutters. Nearly half (43%) towards safe needle practice. suffered from NSI during last six months. Among Methodology: This survey was performed during sufferers, 34% discarded blood, 13% washed with January and February 2010 in Civil Hospital, soap and water, 28% did nothing after the Karachi. Data were collected using a self-incident. Only 9% reported the incident to the reporting questionnaire that included concerned authorities. demographic information, duration of clinical Conclusion: There were several deficiencies in experience, HBV vaccination and its titer, usage of safe needle practices and there was lack of protective gloves during venipuncture, number of adverse incident reporting facility and guidelines. NSI during last six months, post exposure Increased awareness about the hazards, prophylaxis (PEP) measures used and the preventive measures and reporting strategies practice for discard of used needles. after NSI will help to optimize the occupational Results: Total 155 doctors participated with mean safety of health care workers. (Rawal Med J clinical experience of 20.06±30 months. 93% 2013;38: 226-229). respondents were vaccinated against HBV but Key words: Needle stick injuries, health only 24% knew their antibody titer. Only 31% care workers, occupational safety. always wore gloves while performing

Background: Needlestick and sharps injuries (NSSIs) are one of the major risk factors for blood-borne infections at healthcare facilities. This study examines the current situation of NSSIs among health care workers at public tertiary hospitals in an urban community in Mongolia and explores strategies for the prevention of these injuries. Findings: A survey of 621 health care workers was undertaken in two public tertiary hospitals in Ulaanbaatar, Mongolia, in July 2006. A semi-structured and self-administered questionnaire was distributed to study injection practices and the occurrence of NSSIs. A multiple logistic regression analysis was performed to investigate factors associated with experiencing NSSIs. Among the 435 healthcare workers who returned a completed questionnaire, the incidence of NSSIs during the previous 3 months was 38.4%. Health care workers were more likely to report NSSIs if they worked longer than 35 hours per week (odds ratio, OR: 2.47; 95% confidence interval, CI: 1.31-4.66) and administered more than 10 injections per day (OR: 4.76; 95% CI: 1.97-11.49). The likelihood of self-reporting NSSIs significantly decreased if health care workers adhered to universal precautions (OR: 0.34; 95% CI: 0.17-0.68). Conclusions: NSSIs are a common public health problem at public tertiary hospitals in Mongolia. The promotion of adequate working conditions, elimination of excessive injection use, and adherence to universal precautions will be important for the future control of potential infections with blood-borne pathogens due to occupational exposures to sharps in this setting.

To study transfusion-transmitted virus (TTV) infection in 75 patients on hemodialysis and examine its relationship with age, sex, duration of dialysis, history of transfusion, and chronic elevation of alanine aminotransferase (ALT) levels. Study: Serum TTV was analyzed by polymerase chain reaction (PCR), TTV genotypes by restriction fragment length polymorphism, and hepatitis C virus (HCV) RNA by PCR. Results: Transfusion-transmitted virus was detected in 32 patients (42.7%). Transfusion-transmitted virus genotypes were as follows: G1 in 16 patients; G2, 3; G3, 1; G4, 2; G2-G5, 6; and unclassified, 4. Mean duration of dialysis was 37 ± 32 months for TTV-positive patients and 43 ± 37 months for TTV-negative patients (not significant). Twenty-seven (84%) TTV-positive patients and 27 (63%) TTV-negative patients had a history of transfusions (p ‫ס‬ 0.04). Chronic ALT elevation was observed in 9 patients; 5 of them were TTV-positive (16%) and 4 were TTV-negative (9%) (not significant). Four (40%) HCV RNA-positive patients and 5 (8%) HCV RNA-negative patients had chronic ALT elevation (p ‫ס‬ 0.003). Three TTV-positive patients with chronic ALT elevation were also infected with HCV. The two patients with isolated TTV infection did not have another clinical feature to explain their ALT elevation. Conclusions: Transfusion-transmitted virus had a high prevalence in the patients on hemodialysis; genotype G1 accounts for half of the cases. Transfusion-transmitted virus infection depends on the transfusional antecedent but not on the duration of dialysis. Chronic ALT elevation is significantly associated with HCV infection but not TTV infection. However, TTV could be a causative agent of chronic ALT elevation in some patients.

Background: In the Russian Federation, dentistry has become a very popular career choice among applicants, leading to a significant increase in the number of graduates from dental faculties and universities, as well as a growth in the number of educational institutions providing higher medical education in dentistry. Objectives: The aim of this study was to review the current status, requirements, and prospects of dental education in the Russian Federation. Methods: Statistical, informative, and analytical official reports in Russia, as well as foreign information sources, cross-sectional studies, and the data on official websites of higher education institutions were analyzed. Results: In the Russian Federation, there has been an increase in the number of dental universities and faculties, as well as the number of dentistry students over the past 10 years. There is a surge in the number of admitted students, the number of dentists graduating from universities, and clinical residents of dental specialties. At the same time, the tuition fees are the highest for all specialties and are going up every year. There is also an increase in the total number of dentists, and they are concentrated in Moscow and other big cities in the country. Conclusion: Currently, in the Russian Federation, we can speak of the skewness of medical education toward dentistry. To meet the challenges facing dentistry, it seems reasonable to match the future dental workforce with the future needs of the population. The current situation in the healthcare system of the Russian Federation needs to be improved for medical dentistry education and dental health staffing, and all these issues can only be solved by introducing fundamental changes.

Exposure to blood-borne infections (HIV, hepatitis B, hepatitis C) poses a serious risk to health care workers (HCWs). The aim of this cross-sectional study was to determine the level of knowledge and attitudes on occupational exposure in primary health care. In 2009, a total of 100 health care workers from the Primary Health Care Centre in Inđija, Autonomous Province of Vojvodina, Serbia were included in the study. The results suggested that the health care workers who participated in the survey possess basic knowledge about blood-borne virus transmission routes. Most incorrect answers were related to the transmission of blood-borne viruses by tears, saliva, urine and stool. This study also demonstrated that health workers tend to unrealistically estimate the risk of HIV infections. As for the level of education about the prevention and control of blood-borne infections, 49 % of the participants had never had any education on this topic, while 22 % had been educated during the last...

Background Accidental exposure to blood-borne pathogens (BBPs) is a risk for health care workers (HCWs). To study the pattern of occupational exposure to blood and body fluids (BBFs) at a tertiary care hospital. This study reports a 17-year experience (1985)(1986)(1987)(1988)(1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001) of ongoing surveillance of HCW exposure to BBFs at a 420-bed academic tertiary care hospital. A total of 1590 BBF exposure-related accidents were reported to the Infection Control Office. The trend showed a decrease in these exposures over the years with an average 6 standard error of 96 6 8.6 incidents per year. In the last 6 years, the average rate of BBF exposures was 0.57 per 100 admissions per year (average of needlestick injuries alone was 0.46 per 100 admissions). For 2001, the rates of exposure were found to be 13% for house officers, 9% for medical student, 8% for attending physicians, 5% for nurses, 4% for housekeeping, 4% for technicians and 2% for auxiliary services employees. The reason for the incident, when stated, was attributed to a procedural intervention (29%), improper disposal of sharps (18%), to recapping (11%) and to other causes (5%). Conclusions The current study in Lebanon showed that exposure of HCWs to BBPs remains a problem. This can be projected to other hospitals in the country and raises the need to implement infection control standards more efficiently. Similar studies should be done prospectively on a yearly basis to study rates and identify high-risk groups.

Background: With increased availability of antibiotics and antifungal agents hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are becoming a cause for significant concern in HIV infected children. We determined the seroprevalence and risk factors for HBV and HCV among HIV infected children aged 18 months to 17 years, attending the Paediatric HIV Care and Treatment Center (CTC) at Muhimbili National Hospital (MNH) in Dar-es-Salaam, Tanzania. Methods: Investigations included; interviews, physical examination and serology for HBsAg, IgG antibodies to HCV and alanine aminotransferase (ALT) levels. HIV serostatus and CD4 counts were obtained from patient records. Results: 167 HIV infected children, 88(52.7%) males and 79(47.3%) females were enrolled. The overall prevalence of hepatitis co-infection was 15%, with the seroprevalence of HBV and HCV being 1.2% and 13.8%, respectively. Hepatitis virus co-infection was not associated with any of the investigated risk factors and there was no association between HBV and HCV. Elevated ALT was associated with hepatitis viral co-infection but not with ART usage or immune status. The high seroprevalence (15%) of hepatitis co-infection in HIV infected children attending the Paediatrics HIV CTC at the MNH calls for routine screening of hepatitis viral coinfection and modification in the management of HIV infected children.

Background: According to the latest Tanzanian National AIDS Control Programme (NACP) report a total of 147,271 individuals donated blood during the year 2002. However, blood safety remains an issue of major concern in transfusion medicine in Tanzania where national blood transfusion services and policies, appropriate infrastructure, trained personnel and financial resources are inadequate. Most of the donated blood is screened for HIV alone. We determined among blood donors at Muhimbili National Hospital (MNH), the seroprevalence of human immunodeficiency virus (HIV), hepatitis C virus (HCV), hepatitis B surface antigen (HBsAg) and syphilis by donor type, sex and age and to determine association, if any, in the occurrence of the pathogens. The sample included 1599 consecutive donors, 1424(89.1%) males and 175 (10.9%) females, who donated blood between April 2004 and May, 2005. Most of them 1125 (70.4%) were replacement donors and a few 474 (29.6%) voluntary donors. Their age (in years) ranged from 16 to 69, and most (72.2%) were between 20-39 years. Results: Two hundred and fifty four (15.9%) of the donated blood had serological evidence of infection with at least one pathogen and 28 (1.8%) had multiple infections. The current seroprevalence of HIV, HBsAg, HCV and syphilis among blood donors at MNH in Dar es Salaam was found to be 3.8%, 8.8%, 1.5% and 4.7%, respectively. Respective seroprevalences among HIV seronegative blood donors were 8.7% for HBV, 1.6% for HCV and 4.6% for syphilis. The differences in the prevalence of HIV and syphilis infections between replacement and voluntary donors were statistically significant (P < 0.05). Syphilis was the only infection that occurred more frequently among HIV infected (12.1%) than non-infected (4.6%) blood donors (P < 0.05), and whose prevalence increased with age (X 2 = 58.5 df = 5, P < 0.001). There were no significant sex differences in the occurrence of pathogens. Finally, there were significant associations in the occurrence of HBsAg and syphilis (OR = 2.2, 95% CI 1.1.-4.2) and HIV and syphilis (OR = 2.2, 95% CI 1.0-5.3). The high (15.9%) seroprevalence of blood-borne infections in blood donated at MNH calls for routine screening of blood donors for HBV, HCV, HIV and syphilis and for strict selection criteria of donors, with emphasis on getting young voluntary donors and for establishment of strict guidelines for blood transfusions.

Background: With increased availability of antibiotics and antifungal agents hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are becoming a cause for significant concern in HIV infected children. We determined the seroprevalence and risk factors for HBV and HCV among HIV infected children aged 18 months to 17 years, attending the Paediatric HIV Care and Treatment Center (CTC) at Muhimbili National Hospital (MNH) in Dar-es-Salaam, Tanzania. Methods: Investigations included; interviews, physical examination and serology for HBsAg, IgG antibodies to HCV and alanine aminotransferase (ALT) levels. HIV serostatus and CD4 counts were obtained from patient records. Results: 167 HIV infected children, 88(52.7%) males and 79(47.3%) females were enrolled. The overall prevalence of hepatitis co-infection was 15%, with the seroprevalence of HBV and HCV being 1.2% and 13.8%, respectively. Hepatitis virus co-infection was not associated with any of the investigated risk factors and there was no association between HBV and HCV. Elevated ALT was associated with hepatitis viral co-infection but not with ART usage or immune status. The high seroprevalence (15%) of hepatitis co-infection in HIV infected children attending the Paediatrics HIV CTC at the MNH calls for routine screening of hepatitis viral coinfection and modification in the management of HIV infected children.

Associate Professor, Department of Virology, Pasteur Institute of Iran, Tehran, Iran Assistant Professor, Dental Research Center, Dentistry Research Institute, Tehran University of Medical Sciences AND Department of Operative Dentistry, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran Associate Professor, Dental Research Center, Dentistry Research Institute, Tehran University of Medical Sciences AND Department of Operative Dentistry, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran Postgraduate Student, Department of Orthodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran Research Member of Dental Research Center, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran Postgraduate Student, Department of Pediatric Dentistry, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran

Injection drug use and associated hepatitis C virus (HCV) and HIV infections are on the rise in Russia and the republics of the former Soviet Union. While small targeted studies have found widespread drug use and disease among atrisk populations, there have been few attempts to comprehensively evaluate the extent of these epidemics in general post-Soviet societies. We conducted a two-stage cluster randomized survey of the entire adult population of T'bilisi, Republic of Georgia, and assessed the burden of HCV, HIV, and risk behaviors for blood-borne infections in 2,000 study participants. Of the 2,000 surveyed individuals, 162 (8.1%) had injected illicit drugs during their lifetimes. Of the individuals who had injected illicit drugs, 138 (85.2%) reported sharing needles with injection partners. HCV was found in 134 (6.7%) of the total surveyed population but in 114 (70.4%) of those who had injected illicit drugs. We found HIV in only three (0.2%) individuals, all of whom had injected illicit drugs. Injection drug use and high-risk injection practices are very common in Georgia and may be harbingers of a large burden of HCV-associated liver diseases and a potentially serious HIV epidemic in the years to come.

Objective To determine the proportion of preventable hospital-acquired bloodstream infections (HA-BSIs), the authors prospectively examined consecutive cases in a large university hospital over an 18-month period. Patients and methods Medical charts were assessed with the physician in charge of the patient within 4 days after HA-BSI diagnosis to determine whether the infection was healthcare-related. Preventability was assessed using a validated tool. Results of 378 HA-BSIs (incidence rate, 1.00 per 1000 patient-days), 341 were first HA-BSI episodes in a patient, and 272 (79.8%) were secondary to an identifiable source, of whom 196 (57.5%) were related to medical management. These 196 HA-BSIs were related to an invasive procedure (n¼163), a non-invasive medical management (n¼30) or both (n¼3). Results Of the 272 patients with HA-BSIs from identifiable sources, 55 (20.2%) had no underlying disease, 115 (42.3%) had an ultimately fatal underlying disease, 99 (36.4%) had a rapidly fatal disease, and three (1.1%) were not evaluated. Of the 196 iatrogenic HA-BSIs, 66 were considered preventable (most of them being related to an intravascular catheter), 84 were of uncertain preventability, and 46 were not preventable. In total, 66 of the 341 HA-BSIs (19.4%) were considered preventable, and 191 (56.0%) were not preventable. Conclusion Although evaluation of the preventability of hospital-associated adverse events has been reported to be difficult and of limited reliability, our simple method may help to identify wards or HA-BSI types that warrant in-depth evaluation.

Background-Unstable atherosclerotic plaque is characterized by an infiltrate of inflammatory cells. Both macrophages and T cells have been implicated in mediating the tissue injury leading to plaque rupture; however, signals regulating their activation remain unidentified. Infectious episodes have been suspected to render plaques vulnerable to rupture. We therefore explored whether plasmacytoid dendritic cells (pDCs) that specialize in sensing bacterial and viral products can regulate effector functions of plaque-residing T cells and thus connect host infection and plaque instability. Methods and Results-pDCs were identified in 53% of carotid atheromas (nϭ30) in which they localized to the shoulder region and produced the potent immunoregulatory cytokine interferon (INF)-␣. IFN-␣ transcript concentrations in atheroma tissues correlated strongly with plaque instability (PϽ0.0001). Plaque-residing pDCs responded to pathogenderived motifs, CpG-containing oligodeoxynucleotides binding to toll-like receptor 9, with enhanced IFN-␣ transcription (Pϭ0.03) and secretion (Pϭ0.007). IFN-␣ emerged as a potent regulator of T-cell function, even in the absence of antigen recognition. Specifically, IFN-␣ induced a 10-fold increase of tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) on the surface of CD4 T cells (PϽ0.0001) and enabled them to effectively kill vascular smooth muscle cells (Pϭ0.0003). Conclusions-pDCs in atherosclerotic plaque sense microbial motifs and amplify cytolytic T-cell functions, thus providing a link between host-infectious episodes and acute immune-mediated complications of atherosclerosis. (Circulation.

Background— Unstable atherosclerotic plaque is characterized by an infiltrate of inflammatory cells. Both macrophages and T cells have been implicated in mediating the tissue injury leading to plaque rupture; however, signals regulating their activation remain unidentified. Infectious episodes have been suspected to render plaques vulnerable to rupture. We therefore explored whether plasmacytoid dendritic cells (pDCs) that specialize in sensing bacterial and viral products can regulate effector functions of plaque-residing T cells and thus connect host infection and plaque instability. Methods and Results— pDCs were identified in 53% of carotid atheromas (n=30) in which they localized to the shoulder region and produced the potent immunoregulatory cytokine interferon (INF)-α. IFN-α transcript concentrations in atheroma tissues correlated strongly with plaque instability ( P &lt;0.0001). Plaque-residing pDCs responded to pathogen-derived motifs, CpG-containing oligodeoxynucleotides b...

Objectives: The objectives of the study are to evaluate the efficacy of double gloving to provide a mechanical barrier against communicable diseases and also to evaluate different parameters affecting glove perforation rate. Methods: This prospective study was performed in the Department of General Surgery at Tertiary Care Teaching Hospital of Gujarat. This study involved a group of surgeons and operation theater nursing staff. Randomization of the participants was done with the closed envelope method in two groups: Single gloving and double gloving. Glove perforation rate and hand contamination rate were calculated and compared between both groups. Participants of double-gloving groups were also asked for discomfort using double gloves and compromised tactile sensations. Results: There was no statistically significant difference in the glove perforation rate between single gloves and double outer gloves (p=0.55). However, the glove perforation rate was significantly lower in double inner gloves than in single gloves (p=0.004). The hand contamination rate was significantly lower among perforated double gloves than perforated single gloves (p=0.00001). Awareness of glove perforation was absent in the majority of the participants in both groups. All the participants in the double-gloving group were comfortable with using double gloves and their tactile sensations were not compromised. Conclusion: This study concluded that double gloving efficiently prevented hand contaminations during surgery. There was no significant difference noted in glove perforation rates in both single and double-gloving groups. Double gloving is recommended for the surgeons and nursing staff to protect them from blood-borne infections and eliminate the chances of surgical site infections in the patients.

Objective: This study was carried out to assess knowledge and practice towards infection control measures in particular hand hygiene among dentists in Mansoura Faculty of Dentistry and to investigate associated factors with better knowledge and practice. Methods: Cross sectional study was conducted on 115 dentists in Mansoura Faculty of dentistry. An anonymous 36 item self-administered English questionnaire was used. It included personal data, workplace hygiene measures, perceived knowledge benefits, hand hygiene practice and complete hepatitis B vaccination. Results: Over a quarter (27%) of the respondents wash their hands before wearing gloves and 72.2% wash their hands when they are visibly soiled. Two thirds (69.6%) washed their hands when the worn gloves became torn. The majority strongly knew  that hand washing helps to prevent transmission of infection to patients (94%), health workers (94%) and health workers&#39; family members (99.5%). The main barriers to regular hand hyg...

Background: In dental education, dental students are exposed to several oral microorganisms radiating from the patient mouth toward them. Hence, using personal protective equipment (PPE) is considered a must to protect them from radiating aerosols. This study was carried out to evaluate the knowledge, attitude, and practice of using (PPE) among 4th and 5th-grade dental students in both Mansoura and Delta Universities. A self-administered closed-ended questionnaire was designed to collect information about demographics, knowledge, attitude, and practice of using (PPE) among 4th and 5th-grade dental students. A total of 497 and 301 dental students were selected randomly from Mansoura and Delta Universities, respectively. Data were analyzed using (SPSS) program after collection. Results: Mansoura University students had significantly higher correct knowledge and attitude about changing gloves than those of Delta University students. As well, a significantly higher percentage of Mansoura University students agreed to wear a surgical mask during procedures (92%), remove gloves while walking around (70.2%), and wear long white coats (80.3%) compared to Delta University students respectively. However, Delta University students showed higher compliance to the use of most of PPE. Although Mansoura university students had higher correct knowledge and a higher positive attitude toward using and changing PPE, the compliance of Delta University students to the use of PPE was higher.

In the course of conducting forensic analysis of exposed to dangers from soft tissue, blood and bodily fluids in a human skeletal material, anthropologists are exposed to a number number of settings. Detailed dissection of muscular tissue is often of biological and chemical hazards. This paper reviews the primary concerns in terms of infection or exposure. Handling of human essential in order to link morphological features of the skeleton to tissue provides an avenue through which bloodborne pathogens may functional differences in locomotion, manipulation or posture and be transported. Scene recovery also includes a set of hazards investigate the interaction between soft and hard tissue. Removal through exposure to human, animal and soil vectors. Basic personof already dissected tissue reveals underlying skeletal morphology nel protection and laboratory procedures should be established for the protection of all personnel involved in this work. for research or teaching. Forensic anthropologists frequently work with extensive quantities of unpreserved soft tissue in various

Operating theaters were so-called in the United Kingdom because they traditionally consisted of semicircular amphitheaters to allow students to observe the medical procedures. An operation theater (OT) complex is the "heart" of any major surgical hospital. An operating theater, operating room (OR), surgery suite, or a surgery center is a room within a hospital within which surgical and other operations are carried out. The patient is the center point of a functioning OT complex. He/she is in isolation for varying times, away from his near and dear ones and is physically sick. Efforts should be directed to maintain vital functions, prevent infections/promote healing with safety, comfort, and economy. The establishment and working of the OT need specialized planning and execution and is not a simple civil engineering work. A "civil-mechanical-electrical-electronic-biomedical" combo effort driven and coordinated by the needs, preferences, and safety of the medical/surgical team forms the basis for starting and maintaining an OT. Hospital-acquired infection contributes to about 20% of admissions in the developing world. Hospitals should exercise great care in proper maintenance of the OR environment, heating ventilation and air-conditioning system (HVAC) system, and medical and nonmedical equipment inside the OR. Personnel involved in disinfection and sterilization process should follow aseptic protocols. Sterilization means complete eradication of microorganisms from the operating environment. The sources of bacteriological contamination can be from air, water, medical, paramedical staff, patients, and articles brought in to the sterile environment, clothing, instruments, infected body fluids, electronic gadgets, and personal items such as wallets, mobile phones, and jewelry. Aseptic protocols mean following safe and disciplined procedures to minimize or eradicate the microbiological load in the environment and in the instrument brought into the sterile field during the surgery. An operation theater (OT) complex is the "heart" of any hospital. An operating theater, operating room (OR), surgery suite, or a surgery center is a room within a hospital where surgical and other operations are carried out. The patient is the center point of a functioning OT complex. He/she is in isolation for varying times, away from his near and dear ones and is physically sick. Efforts should be directed to maintain vital functions, prevent infections/promote healing with safety, comfort, and economy. A "civil-mechanical-electrical-electronic-biomedical" combo effort driven and coordinated by the needs, preferences, and safety of the medical/surgical team forms the basis for starting and maintaining an OT. Hospitals should exercise great care in proper maintenance of the OR environment, heating ventilation and air-conditioning system (HVAC) system, and medical and nonmedical equipment inside the OR. Personnel involved in disinfection and sterilization process should follow aseptic protocols. Aseptic protocols mean following safe and disciplined procedures to minimize or eradicate the microbiological load in the environment and in the instrument brought into the sterile field during the surgery.

The aim of this study was to determine the frequency of occupational needlestick and sharps injuries in students in different departments of the Health Sciences Faculty, and to determine and compare the reasons for these injuries. Methods: This study is cross sectional type. Total of 840 (1st year students were not included) registered university students were identified and it was planned to contact all the students without selective sampling. Results: A total of 649 students voluntarily participated in the study. While injuries are seen more often in the departments (such as; nursing, midwifery, anesthesia) applying medical treatment. Conclusion: In respect of students exposed to occupational injuries while participating in clinical applications, it is also important that the necessary protective measures are taken by the institution that students are not left unsupervised in the application of medical treatment, that students are immunized and are educated in protection against occupational injuries.

Problem: Care of health care workers with a blood-borne pathogen (BBP) exposure who seek treatment in emergency departments needs to be standardized. A standardized system may lead to better care for exposed individuals. Methods: An interprofessional process was developed to standardize care of occupational BBP exposures in nonemployees. A health planning program design was conducted to compare outcomes before and after the standardized process was enacted. Results: Standardizing treatment of occupational exposures provided more efficient care for exposed nonemployee workers and allowed an improved use of ED resources. Implications for Practice: Programs developed to improve utilization of the emergency department have a greater chance of success when developed using an interprofessional, collaborative approach.