Introducing auto-disable syringes to the national immunization programme in Madagascar.
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OBJECTIVE: To evaluate the safety and coverage benefits of auto-disable (AD) syringes, weighed against the financial and logis- tical costs, and to create appropriate health policies in Madagascar. METHODS: Fifteen clinics in Madagascar, trained to use AD syringes, were randomized to implement an AD syringe only, mixed (AD syringes used only on non-routine immunization days), or sterilizable syringe only (control) programme. During a five-week period, data on administered vaccinations were collected, interviews were conducted, and observations were recorded. FINDINGS: The use of AD syringes improved coverage rates by significantly increasing the percentage of vaccines administered on non-routine immunization days (AD-only 4.3%, mixed 5.7%, control 1.1% (P<0.05)). AD-only clinics eliminated sterilization sessions for vaccinations, whereas mixed clinics reduced the number of sterilization sessions by 64%. AD syringes were five times more expensive than sterilizable syringes, which increased AD-only and mixed clinics' projected annual injection costs by 365% and 22%, respectively. However, introducing AD syringes for all vaccinations would only increase the national immunization budget by 2%. CONCLUSION: The use of AD syringes improved vaccination coverage rates by providing ready-to-use sterile syringes on non-routine immunization days and decreasing the number of sterilization sessions, thereby improving injection safety. The mixed programme was the most beneficial approach to phasing in AD syringes and diminishing logistical complications, and it had minimal costs. AD syringes, although more expensive, can feasibly be introduced into a developing country's immunization programme to improve vaccination safety and coverage. (+info)
Minimising the risk of prion transmission by contact tonometry.
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AIMS: The unknown prevalence of variant Creutzfeldt-Jakob disease (vCJD) in the UK population has led to fears of horizontal transmission through routine medical procedures. The potential risk of transmission via contact tonometry was examined. METHODS: The total amount of protein carried over by tonometer tips after applanation of patients was assessed. RESULTS: Tonometer tips had an inherent ability to carry proteinaceous material. There was a large variability in the load carried over between individual patients. Rinsing tonometer tips in water reduced protein carryover. Wiping the tonometer tips also reduced carriage, though less dramatically. CONCLUSION: There is a small theoretical risk of transmission of vCJD by contact tonometry through reuse, but this should be reduced if the prisms are washed and wiped. In the light of these findings a protocol for the management of reusable tonometer prisms is recommended. (+info)
The utility of the tongue blade test for the diagnosis of mandibular fracture.
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A short cut review was carried out to establish whether the tongue blade test is useful in the clinical assessment of patients with mandibular trauma. Altogether 269 papers were found using the reported search, of which two presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. A clinical bottom line is stated. (+info)
Syringe access for the prevention of blood borne infections among injection drug users.
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BACKGROUND: Approximately one-third of acquired immunodeficiency syndrome cases in the United States are associated with the practice of sharing of injection equipment and are preventable through the once-only use of syringes, needles and other injection equipment. DISCUSSION: Sterile syringes may be obtained legally by 4 methods depending on the state. They may be purchased over the counter, prescribed, obtained at syringe exchange programs or furnished by authorized agencies. Each of these avenues has advantages and disadvantages; therefore, legal access through all means is the most likely way to promote the use of sterile syringes. SUMMARY: By assisting illicit drug injectors to obtain sterile syringes the primary care provider is able to reduce the incidence of blood borne infections, and educate patients about safe syringe disposal. The provider is also able to initiate discussion about drug use in a nonjudgmental manner and to offer care to patients who are not yet ready to consider drug treatment. (+info)
Effect of disposable infection control barriers on light output from dental curing lights.
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PURPOSE: To prevent contamination of the light guide on a dental curing light, barriers such as disposable plastic wrap or covers may be used. This study compared the effect of 3 disposable barriers on the spectral output and power density from a curing light. The hypothesis was that none of the barriers would have a significant clinical effect on the spectral output or the power density from the curing light. METHODS: Three disposable barriers were tested against a control (no barrier). The spectra and power from the curing light were measured with a spectrometer attached to an integrating sphere. The measurements were repeated on 10 separate occasions in a random sequence for each barrier. RESULTS: Analysis of variance (ANOVA) followed by Fisher's protected least significant difference test showed that the power density was significantly less than control (by 2.4% to 6.1%) when 2 commercially available disposable barriers were used (p < 0.05). There was no significant difference in the power density when general-purpose plastic wrap was used (p > 0.05). The effect of each of the barriers on the power output was small and probably clinically insignificant. ANOVA comparisons of mean peak wavelength values indicated that none of the barriers produced a significant shift in the spectral output relative to the control ( p > 0.05). CONCLUSIONS: Two of the 3 disposable barriers produced a significant reduction in power density from the curing light. This drop in power was small and would probably not adversely affect the curing of composite resin. None of the barriers acted as light filters. (+info)
Single-dose versus multi-dose vaccine vials for immunization programmes in developing countries.
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Excessive vaccine wastage and safety concerns have prompted the international health community to develop and supply vaccines in formats other than the standard multi-dose vial. This article presents a programmatic and economic comparison of the major differences between the multi-dose vials and single-dose formats used for immunization services in developing countries. Multi-dose vials, in general, sell at a lower per-dose price and occupy less cold-chain capacity than single-dose formats. However, higher wastage rates may offset these benefits, especially for more expensive vaccines. Single-dose formats offer several important programmatic benefits, such as increased vaccination opportunities and improved vaccine safety. One single-dose format, the prefilled auto-disable (AD) device, provides additional injection safety and convenience features because it physically combines the vaccine and AD syringe. Selecting the appropriate vaccine presentation will depend on many factors. However, multi-dose vials are likely to be most appropriate for cheaper vaccines and in settings where cold-chain storage capacity is restricted. Single-dose formats will be most appropriate for more expensive vaccines and where there are problems with unsafe injection practices. Prefilled AD injection devices will be particularly useful in expanding outreach services while eliminating the possibility of needle reuse. (+info)
Bronchoscopy with the Vision Sciences BF100 disposable-sheath device: French experience after 328 procedures.
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BACKGROUND: In spite of adhesion to recommended disinfection procedures, the transmission of infections by bronchoscopes is a permanent problem. OBJECTIVE: The new device may prevent nosocomial infections because it consists of two parts: a specific bronchoscope Vision Sciences BF100 and a single-use protective sheath for each procedure. The aim of this paper is to report our practice and the difficulties encountered when using this system. METHODS: We report our experience from 1997 to 2002 after 328 elective and emergency endoscopic procedures with the BF100 device. In a retrospective study, we describe the population and the incidents during procedure. We discuss the impact of the use of BF100 on the cost of bronchoscopies. RESULTS: The major constraint is the care required in assembling the optical device and disposable sheath. The intrinsic qualities of the optics are confirmed; any sample may be taken although image quality and suction capacity are inferior to videoscopes. Maneuverability is inferior to videoscopes, but improves with a short experience. In addition, this device is expensive. CONCLUSIONS: The technical performances of the BF100 device are inferior to those of videoscopes but the concept of sterile single-use sheaths is able to prevent the nosocomial infections related to bronchoscopes. Because of the cost, examination with the BF100 should be reserved to patients with proved or suspected infection (multiresistant bacteria, tuberculosis, hepatitis C and B virus, HIV, prions) and immunosuppression (hematologic diseases). (+info)
An assessment of safe injection practices in health facilities in Swaziland.
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OBJECTIVES: To determine the magnitude and causes of unsafe injection practices in Swaziland. DESIGN: A safe injection practices questionnaire was administered and injection practice was observed. SETTING: A selected variety of health facilities in Swaziland. SUBJECTS: Health workers in each facility. OUTCOME MEASURES: Unsafe injection and collection for disposal practices. RESULTS: All injections observed involved disposable syringes. Although all injections were given at the correct site, using the correct dosage and equipment, unsafe injection technique was observed. Needles were changed on the same syringe at 8 facilities (31%) and syringes and needles were reused at 2 facilities (8%). Recapping of needles after use occurred at 8 facilities (31%). More than one-quarter of nurses reported having pricked their finger in the previous 6 months; in almost half of these cases this was after administration of an injection. Seven nurses (25%) recalled seeing a case of an abscess or a mild adverse event following an injection in the previous 12 months. Interviewers observed used syringes and needles being placed in a safe container in three-quarters of facilities. Almost all respondents reported that syringes and needles were buried or burned. CONCLUSIONS: Auto-disable syringes should be used for all routine and supplemental vaccination. The increased cost of auto-disable syringes represents only a small increase in the national Expanded Programme on Immunisation (EPI) budget. (+info)