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Needle- and syringe-exchange programs aim to decrease infections among those who are dependent on injection drugs. Some have questioned whether church sponsorship of such programs constitutes illicit cooperation in the evil of drug abuse. This article examines the question under classical formulations of cooperation and in light of current empirical evidence and concludes that this is not the case. Questions are also raised about whether, if substance dependence is a disease and not a moral failing, an analysis based on cooperation is actually the appropriate category of analysis., A RECENT ANNOUNCEMENT that a needle-exchange program would be sponsored by Catholic Charities of the Diocese of Albany led to vociferous moral objections from a few Catholic bloggers and from [...]

The need for dental health care professionals to use efficient medical equipment and adopt safe medical methods to prevent percutaneous injuries and transmission of blood borne pathogens is discussed.

The evolution of infection control standards since the 1970s is reviewed. Topics include infectious diseases in dentistry, isolation precautions used in hospitals, standard infection control precautions, and the American Dental Association response to the CDC's Recommended Infection Control Practices for Dentistry, 2003.

International organizations must do more to teach medical personnel in developing countries how to prevent occupational exposure to infectious organisms. In particular, they should be taught not to re-use hypodermic needles.

Reloading syringes of needles already in tissue with additional anesthesia may be an accepted dental practice that decreases the risk of needlesticks. Eighty-seven dentists in upstate New York responded to a survey asking how they inject second doses of anesthesia in dental patients requiring anesthesia. Only three percent of dentists removed the needle to replace the empty anesthesia cartridge. The rest left the needle in place. The rate of needlesticks in the past year was low, and most dentists said they administered over 50 injections a week. Some needle and cartridge damage was noted.

Implementing syringe exchange programs (SEPs) may reduce the spread of AIDS with minimal impact on crime. Drug addicts who share needles have a high risk of contracting AIDS because the needle gets contaminated with blood after each use. However, all 50 states have laws restricting the sale and possession of intravenous needles and syringes. In most states, these cannot be bought and sold without a prescription. Studies have shown that the deregulation of syringe marketing could reduce the spread of AIDS. There is little evidence that this would encourage people to use intravenous drugs., We report the results of a survey of laws and regulations governing the sale and possession of needles and syringes in the United States and its territories and discuss legal and public health proposals to increase the availability of sterile syringes, as a human immunodeficiency virus (HIV) transmission prevention measure, for persons who continue to inject drugs. Every state, the District of Columbia (DC), and the Virgin Islands (VI) have enacted state or local laws or regulations that restrict the sale, distribution, or possession of syringes. Drug paraphernalia laws prohibiting the sale, distribution, and/or possession of syringes known to be used to introduce illicit drugs into the body exist in 47 states, DC, and VI. Syringe prescription laws prohibiting the sale, distribution, and possession of syringes without a valid medical prescription exist in 8 states and VI. Pharmacy regulations or practice guidelines restrict access to syringes in 23 states. We discuss the following legal and public health approaches to improve the availability of sterile syringes to prevent blood-borne disease among injection drug users: (1) clarify the legitimate medical purpose of sterile syringes for the prevention of HIV and other blood-borne infections; (2) modify drug paraphernalia laws to exclude syringes; (3) repeal syringe prescription laws; (4) repeal pharmacy regulations and practice guidelines restricting the sale of sterile syringes; (5) promote professional training of pharmacists, other health professionals, and law enforcement officers about the prevention of blood-borne infections; (6) permit local discretion in establishing syringe exchange programs; and (7) design community programs for safe syringe disposal. JAMA. 1997;277:53-62

Since the early 1990's the US blood supply has become extremely safe. Blood has been screened for HIV since 1985. The test detects antibodies against the virus, but researchers are developing a test that will detect viral antigens directly. Mandatory screening for the hepatitis B virus has been in place since 1972. In 1990, a test for the hepatitis C virus was developed. Screening for human T-cell lymphotropic viruses I and II has reduced the risk of contracting these infections, which are rare in the US. Blood tests are available for cytomegalovirus, but most Americans have already been exposed and are not likely to develop an infection. All blood is tested for syphilis, although the organism that causes it does not usually survive long in stored, refrigerated blood. Tests for Trypanosoma cruzi are being developed for use in areas of the US that have many immigrants from Latin America, where the disease is endemic. The use of incompatible blood is responsible for most complications of blood transfusion.

The safety benefits of solvent-detergent-treated frozen plasma (SD FP) seem to be outweighed by the costs. SD FP is a technique that purifies multiple units of blood plasma with a SD mixture. This process eliminates envelope-covered viruses such as HIV and hepatitis. Researchers applied a decision analysis model to a large hypothetical group of plasma-transfused patients. The model approximated the predicted benefits and costs of SD FP. Results revealed that one unit of SD FP lengthened patients' lives by approximately 35 minutes. The cost incurred for each unit of SD FP was about $19.30. These cost-benefit estimates were applied to national plasma transfusion figures. For the 2.2 million plasma units that are transfused into U.S. patients each year, SD FP would save 147 years of life at a cost $42.5 million. The cost effectiveness of SD FP was estimated at $289,300 per year of life. SD FP creates an increased risk of transmitting a nonenveloped virus such as the hepatitis A virus., Objective. - To determine the public health and economic implications of solvent-detergent-treated frozen plasma (SD FP). While this processing technique nearly eliminates the risk of transmitting lipid-enveloped viruses (hepatitis B and C and human immunodeficiency virus), it has associated costs and, because it requires pooling many plasma units, may increase risks of nonenveloped virus transmission. Design. - A previously published Markov decision analysis model was modified to assess transfusion-related outcomes in hypothetical cohorts of plasma recipients. In-hospital mortality and other characteristics were determined in 61 patients receiving plasma transfusions at a medium-sized tertiary care center to provide data for the model. Other parameters were obtained from the medical literature. Main Outcome Measures. - Expected SD FP costs, benefits, and cost-effectiveness, assessed as cost per quality-adjusted life-year saved. Results. - Compared with untreated plasma, a unit of SD FP produces a net benefit of 35 minutes in quality-adjusted life expectancy at a cost of about $19. Extrapolated to the 2.2 million plasma units transfused annually in the United States, SD FP would save 147 quality-adjusted life-years at a cost of $42.5 million. The marginal cost-effectiveness, $289 300 per quality-adjusted life-year saved in the baseline analysis, was most sensitive to estimates of SD treatment cost and the clinical setting of plasma use. in sensitivity analysis, the net benefit of SD FP was negated by the existence of even a minute risk of nonenveloped virus infection. Conclusions. - From a public health perspective, the relatively high costs and small benefits of reducing enveloped virus infection risks with SD FP (and the additional risks of nonenveloped virus transmission) do not appear to justify widespread implementation of this new technology.

Dental personnel should take basic precautions against bacterial infection during the course of routine oral examinations. Such precautions should vary depending on whether or not the dental worker anticipates contact with saliva, blood or saliva contaminated with blood. Handwashing before and after each examination is essential regardless of the anticipated level of contact. Immunizations against infectious diseases such as hepatitis B and influenza are recommended if contact with saliva or blood is anticipated, as is the wearing of gloves, facial protection and protective clothing. Potentially contaminated instruments should be handled by a properly gloved worker and should be sterilized between examinations. Written polices on how to prevent infection and limit the spread of blood or saliva should be posted, and all surface areas should either be kept covered with disposable protective wraps or frequently disinfected.

The risk of acquiring disease from the multiple blood transfusions associated with extracorporeal membrane oxygenation (ECMO) may be reduced by careful transfusion practices and prudent blood-product management. ECMO is used in some newborns with respiratory or cardiac failure. Researchers reviewed the medical records of 59 newborns treated with ECMO between December 1989 and November 1992 to determine if two revisions in blood product preparation and transfusion methods reduced infants' risks of acquiring disease from donated blood. Results revealed that infants treated with ECMO after the second and third revisions of transfusion practices had decreased exposure to fresh frozen plasma (FFP) and FFP-transfusion volumes. However, the total volumes of packed red blood cells used did not change significantly between protocols. Total donor exposures decreased from 14.1 to 7.5 for each patient between implementation of the first and third protocols., Objective. Extracorporeal membrane oxygenation (ECMO) has dramatically improved the survival of neonates with life-threatening respiratory and cardiac failure. However, ECMO requires numerous transfusions with significant risks. This study evaluated the effects of changing transfusion practices and blood component management on blood donor exposures in neonatal ECMO. Design. A 3-year retrospective chart review of all neonatal ECMO patients from December 1989 through November 1992 was undertaken. During this 3-year period, transfusion practices and blood product preparation were altered twice to reduce blood donor exposures. The use of apheresis platelets and fresh frozen plasma (FFP), and preserving the expiration date on packed red blood cells (PRBCs) through the use of a sterile connecting device, allowed multiple transfusions from individual donor components. In addition, education of the ECMO physicians was focused on standardizing and reducing transfused volumes. Sixty-four surviving neonatal patients (91.4%) were evaluated. Five patients had excessive bleeding and were excluded from analysis. The remaining 59 patients were divided into three protocols based upon the transfusion practice at the time of their ECMO course. Protocol 1 received PRBCs less than 5 days of age, volume-reduced platelet concentrates, and standard FFP units up to 24 hours after thawing. Changes in transfusion practice for protocol 2 included extended outdate for PRBCs to 10 days, and using single donor apheresis platelet aliquots. The third protocol entailed the use single donor apheresis FFP aliquots in addition to the protocol 2 changes. Results. Total PRBC transfusion volumes (721 [+ or -] 406 ml for protocol 1, 637 [+ or -] 172 ml for protocol 3) and associated blood donor exposures (5 [+ or -] 2.1 for protocol 1, 3.9 [+ or -] 0.9 for protocol 3) did not change substantially over the reviewed period. However, FFP transfusion volumes (478 [+ or -] 170 ml for protocol 1,274 [+ or -] 63 ml for protocol 3), FFP-related donor exposures (4.5 [+ or -] for protocol 1, 1.2 [+ or -] 0.4 for protocol 3) and platelet-related donor exposures (4.6 [+ or -] 3.6 for protocol 1, 2.5 [+ or -] 1.5 for protocol 3) were reduced progressively and significantly from protocol 1 to protocol 3 (P < .01, Tukey&apos;s B test adjusted for multiple comparisons). The total number of donor exposures per patient while on ECMO was decreased from 14.1 in protocol 1 to 10.0 in protocol 2 to 7.5 in protocol 3 (P < .01). Conclusions. We conclude that the changes in blood bank component selection and management as well as physician practice were effective in substantially reducing Ecmo-related transfusion volumes and the resulting donor exposures. Pediatrics 1994;94:341-346; extracorporeal membrane oxygenation, transfusion, blood donor exposure, sterile connection device, apheresis.

Human blood as a consumer good follows a different rationality of economic behavior. A vital issue in the blood market is the potential danger of passing on diseases such as hepatitis and AIDS. The argument for which the model is formulated is that voluntarily donated blood is less likely to be impregnated with diseases than commercially obtained quantities. The rationale behind this is that voluntarism provides no monetary incentive for sellers to lie to blood banks about their health condition.

The recognition that blood donated by individuals infected with human immunodeficiency virus (HIV, which is associated with AIDS) posed a critical threat to transfusion recipients compelled the development of screening programs at blood centers. However, there are several strategies for screening, and they differ in their cost and their effectiveness. Furthermore, the optimal strategies may be different for geographical areas of high and low HIV-prevalence. The majority of strategies rely on a combination of enzyme-linked immunosorbent assay (ELISA) as a simple, effective first screen, and the Western blot, which conclusively demonstrates specific antibodies to specific viral proteins, as a follow-up for blood samples found to be positive on the ELISA test. Donors who test positive on the Western blot are notified so that they do not remain in the pool of blood donors. However, several questions remain. Should samples which test negative on ELISA be tested with a second, different, ELISA? This would decrease the risk of a tainted donation entering the blood supply, but would drastically increase costs, as each specimen would be tested twice. Should blood that tests positive on a first ELISA be tested again before the laborious Western blot is used? If a donation is positive on a first ELISA, but negative on a second and negative on the Western blot, may it be safely used? The authors provide a detailed analysis of the costs and risks of each strategy of screening blood donations. They recommend that more elaborate screening procedures are appropriate for reducing the risk of transfusion-related HIV transmission in areas of high prevalence. However, they suggest that such procedures may not be necessary in regions with lower HIV prevalence. Other important factors for reducing the risk of HIV infection in transfusion recipients include reducing unnecessary transfusions, recruiting blood donors from low-risk groups, and decreasing the general incidence of HIV infection. (Consumer Summary produced by Reliance Medical Information, Inc.)

How safe is your office? Beyond the goal of a better work environment, there's another good reason to take the question seriously. 'Employees in physician offices are becoming more aware [...]

Background: Injecting drug use remains a major public health concern, particularly because of opiate overdose and transmission of blood-borne viruses. Sydney's Medically Supervised Injecting Centre (MSIC) opened on a trial basis in May 2001 in an effort to reduce the harms of drug use. In this report, we provide a brief overview of the reported public health impact of supervising injecting facilities (SIFs) and review the history and early process evaluations of the Sydney Centre. Methods: Medline, Internet searches and perusal of bibliographies of articles were used to identify key English language publications on SIFs. These were supplemented by interview with the Medical Director of Sydney MSIC, Dr Ingrid van Beek. Discussion and conclusions: It is difficult to be certain of the public health impact of SIFs but evidence from overseas and Sydney's early process evaluations provide promise that they may make a positive contribution to health.

Substantial controversy exists as to whether the United States should require that all transfused red blood cells (RBCs) and platelets have 99.9+% of residual white blood cells (WBCs) removed by [...]