Renewed Call to Action on Worldwide Injection Safety

September 28, 2015

Evelyn McKnight and Lauren Lollini

Advocates from all over the world met in Glasgow, Scotland to participate in  the World Hepatitis Summit

Advocates from all over the world met in Glasgow, Scotland to participate in the World Hepatitis Summit

Steve Langan, director of HONOReform recently attended the World Hepatitis Summit, hosted by the World Hepatitis Alliance. Following is his report.

I am grateful for the opportunity to represent HONOReform and our advocates and stakeholders at the inaugural World Hepatitis Summit earlier this month in Glasgow. I commend the leadership and staff of the World Hepatitis Alliance—Charles Gore, Raquel Peck, Su Wang, just to name a few—who put together a thoughtful and comprehensive meeting.

About 700 of us attended, representing 90 countries. It was a thrilling meeting. I reconnected with old friends and allies and met a lot of people from all over the world who share the desire to prevent and treat viral hepatitis.

According to the WHA, 400 million people are affected with viral hepatitis. Almost a million and a half people throughout the world die every year as a result of being affected by viral hepatitis. It’s the seventh leading killer in the world. Still, it seems that many people remain nonchalant not only about the disease itself but by its most common form of transmission in developing countries—through the medical injection process.

Earlier this year, Evelyn McKnight and I attended the Safe Injection Global Network meeting at the World Health Organization. Evelyn shared her powerful story. The WHO made a commitment to focus on encouraging developing countries—India, Egypt and Uganda, as a starting place—to only use single-use injection devices and to put these one-time-use devices in to play by 2020.

This one fact alone is, to us, a sufficient call to action: Up to 70 percent of the infections of viral hepatitis in India are transmitted through healthcare.

This call to action makes me think of the men and women in the villages west of Delhi. We had the opportunity last year to visit India and meet patients and their family members who were infected with viral hepatitis during healthcare. Watching Evelyn McKnight talk with these patients—mediated by a translator, but the emotions were universal—is one of the most memorable moments of my career.

For them, and for the many other patients throughout the world who go to the doctor and come out with an injection of viral hepatitis, we encourage the WHO and its many partners—governments and industry, in particular—to renew the commitment to injection safety in developing countries.

We have said it before but we will say it again: No person should go in to a medical facility for treatment and leave with an infection of viral hepatitis. Not in 2015. Not with all of the resources and materials that can easily, and affordably, be put in to play.

Please, tell your nurses

September 21, 2015

Evelyn McKnight and Lauren Lollini

Marilyn Cahalane shares her experience on advocating for needlestick prevention for housekeeping staff

Marilyn Cahalane shares her experience on advocating for needlestick prevention for housekeeping staff

Today we are pleased to share the insights of Marilyn Cahalane, RN BSN on the potential exposure to sharps injuries that housekeeping staff face.

Marilyn’s one minute video

Hi, I’m Marilyn Cahalane. Im a retired nurse after 44 years of practice.

Oftentimes I would hear from my housekeeping people, “Please, please tell your nurses.”

Anytime after a code or a very critical situation that occurred in a patient room, my housekeeping people, would be right there – wonderful people – to clean up the room after we had left it a mess.

Needles were stuck in mattresses, thrown on top of the covers, thrown in the wastebasket, even dropped on the floor.

My housekeeping people came to clean and would be inadvertently stuck.

Please, we have safety devices that take care of human error issues like this. Please research that and enforce it within your immediate surroundings. Thank you.

World Hepatitis Summit 2015

September 14, 2015

Evelyn McKnight and Lauren Lollini

Antonio Oñate of the  Fundacion Hepatos Aion of Mexico shares his thoughts about the recent World Hepatitis Summit and the global impact of viral hepatitis

Antonio Oñate of the
Fundacion Hepatos Aion of Mexico shares his thoughts about the recent World Hepatitis Summit and the global impact of viral hepatitis

The World Hepatitis Alliance Summit has ended; countries with different cultures face the same opponent. People around the world are working according to their particular circumstance – some, under a clear strategy, others day by day – but all familiar with the challenges and difficulties of others, because they have lived it and therefore recognized in the other his equal.

For those involved in this problem it is not only a full-time job, it’s a personal matter that is constrained by the pervasive lack of resources and political commitment of many decision makers to prevent prompt and effective medical care. A recurring theme is the voracious appetite for profits of pharmaceutical companies.

But camaraderie is a link between the participants and shows that not all storm clouds darken the sky; there are rays of hope. People who work at government level show their commitment as human beings who seek to help others, their names very rarely recognized in the media but through them their governments have decided to take action:

Brazil is a case closer to us in American continent but Egypt, Georgia, Scotland among others,  have made successful negotiations with manufacturers of drugs for hepatitis C that will provide access to an important treatment of their populations affected by the “silent enemy”.

Special mention is that of Egypt. It not only achieved a fair price but also has a clear strategy: to treat its 10 million people infected with hepatitis C by 2025. From October 2014 to August 2015 they gave 130,000 treatments and have been getting the cure for 85%. Next year it aims to provide 350,000 treatments.

Another case is Scotland. They recognized early in this century the serious public health threat from hepatitis and established a strategy to be developed in several phases, which began in 2006 and continues today. They have a strategic vision, which demonstrates the importance of planning ahead with short and medium term goals. They showed to other governments of the world that the time of analysis and planning should have been 10 years ago, not now that the bomb has exploded and urgent action is needed.

The remaining countries continue to do the best they can despite the Olympic sized lack of commitment by their decision makers.

The battle under such circumstances is unmatched, to say it politely. Governments remain entrenched despite seeing such a large segment of its population annihilated under the pretext of not having enough resources.

Talking about the discrimination, stigmatization and loss of jobs that patients and their families face should exert enough pressure on our governments to act promptly to stop the spread of the disease and reduce the number of deaths from this war without quarter.

A good example for taking action is the serious problem of the use and sharing of injected drugs and the importance of an injection safety program.

Thanks to the World Hepatitis Alliance, the Ministry of Health of Scotland, the governments of Brazil, Egypt and Georgia, to the people who work in government, and the pharmaceutical companies that genuinely share our goals.

But especially you, the patient, family member, and friend that advocate to seek a better quality of life for those affected by hepatitis C . And to all the parents, brothers, children, wives, husbands who have died in this unjust war, thank you for your courage and tenacity.

Thanks and keep fighting!

Podcast on Drug Diversion Prevention Includes Expert Kim New

August 31, 2015

Evelyn McKnight and Lauren Lollini

Kimberly New, JD BSN RN, participated in a podcast on drug diversion

Kimberly New, JD BSN RN, participated in a podcast on drug diversion

Starting in July 2009, when we read reports of the outbreak at Rose Medical Center in Denver, HONOReform became involved in drug diversion prevention. An addicted healthcare worker diverted medication for her own use, refilled syringes with saline and then left them to be administered to patients. Diversion of narcotics is a patient safety issue and it’s an injection safety issue…and so much more.

One of our aims is to encourage colleagues throughout the country to address drug diversion at a national and federal level. We are grateful for the positive response we are receiving. We will provide an update with more specific information in the near future.

Drug diversion is not an uncomplicated problem. It is the space where bureaucracies, including healthcare systems and law enforcement, come together. Oftentimes, a thorough awareness of the problem is lacking—and the necessary and proper procedures are not in place.

We are glad to share this 17-minute podcast, a clear description of the problem and some of the solutions, on our blog this week. Kimberly New, JD RN, of Diversion Specialists, who is one of the leading voices of drug diversion prevention and a close colleague of HONOReform, talks with Dr. Howard Zucker, MD JD, Commissioner of the New York State Department of Health.

In this interview, Kim New says, “We need to identify problems quickly and protect patients from potential harm.” We could not agree more. Thank you, Kim and Dr. Zucker, for coming together to address the problem, and thanks to our colleagues at the New York Health Department for encouraging and organizing this conversation.

August is National Immunization Awareness Month

August 24, 2015

Evelyn McKnight and Lauren Lollini

Dr Angela Pannier explains a new model for vaccines that would eliminate the use of syringes, thus eliminating a potential source of transmission of disease through unsafe injections.

Dr Angela Pannier explains a new model for vaccines that would eliminate the use of syringes, thus eliminating a potential source of transmission of disease through unsafe injections.

Each year, 20 million Hepatitis B cases (30% of all new infections), 2 million Hepatitis C cases (40% of all new infections) and 2,500 HIV cases (5% of all new infections) occur because of unsafe injections globally. These unsafe injections are often caused because of poor injection practices throughout the world (especially in underdeveloped countries), including lack of education (i.e. trained medical personnel) and lack of appropriate storage conditions (i.e. refrigeration or freezer). Conditions throughout the world often do not allow for proper medical waste disposal, which in turn can further allow for possible misuse or reuse of syringes. Therefore, there is a significant need to eliminate unnecessary injections globally and find alternative delivery strategies. However, vaccinations, for a variety of reasons, are most effectively administered through injection.

Vaccination is considered to be one of the most successful public health interventions of the modern era, leading to a dramatic increase in life expectancy and complete eradication of smallpox worldwide. Further development of vaccines and immunization programs have led to the control of numerous infectious diseases including diphtheria, tetanus, pertussis, measles, mumps, and rubella. However, effective vaccination strategies are lacking for a number of pathogens of global health importance (e.g. rotavirus, malaria, HIV, and Toxoplasma among others). In addition, rapid emergence of new infectious disease pandemics, such as pandemic influenza A virus and Ebola, demonstrates the urgent need for vaccine platforms that quickly move from disease identification to vaccines.

Traditional vaccines use weakened or dead bacteria or viruses to stimulate an immune reaction and are administered through injection (or nasal spray) because the bacteria or viruses cannot elicit a protective response if given any other way (e.g. bacteria or virus become damaged if consumed orally or do not reach their intended targeted if given transdermally). Furthermore, current vaccines cannot survive without refrigeration, which limits their use in less developed countries, a health concern in its own right.

Our multidisciplinary team at the University of Nebraska is developing a new model for vaccines that would eliminate the use of syringes. Rather than using weakened or dead bacteria or viruses to stimulate an immune reaction, we propose using genetic material (i.e. DNA) to prompt an immune response, which could allow for oral delivery. This new vaccine model would contain a replica of encoded genetic material from a virus or bacteria. DNA is extremely stable and can be stored on the shelf, thus eliminating the need for cold storage that prevents worldwide administration of vaccines. DNA can also be created in the lab very quickly, allowing for response to pandemics within a matter of weeks. Our team is especially focused on the development of polymers to protect these DNA vaccines so that they could be delivered orally via pill form. Along with eliminating the need for syringes, this would greatly expedite global distribution.

For these pills we are using two natural, safe polymers, chitosan and zein, the former found in the exoskeleton of crustaceans and the latter one made from a biodegradable protein from corn currently used in food and drug manufacturing. Due to this unique combination of materials, we propose that the DNA vaccine can be taken orally and protected as it moves through the digestive system. Once it reaches the intestine, the genetic material can be absorbed by the body, prompt an immune reaction, and build up future immunity. Vaccines based on this model are already used in veterinary medicine but in injection form. We believe that with our proposed system, we will have safer, faster, and easier vaccines for humans that eliminate the possibility of unsafe injections and the use of syringes entirely.

Dr. Angela K. Pannier is a Biomedical Engineer, Associate Professor, and William E. Brooks Engineering Leadership Fellow in the Department of Biological Systems Engineering at the University of Nebraska-Lincoln. She also holds a courtesy appointment in the Department of Surgery and the Mary and Dick Holland Regenerative Medicine Program at the University of Nebraska Medical Center.

Dr. Pannier’s collaborators on the research described above are: Dr. Tadeusz Wysocki, Professor of Computer and Electronics Engineering, University of Nebraska-Lincoln; Dr. Amanda Ramer-Tait, Assistant Professor of Food Science and Technology, University of Nebraska-Lincoln; Dr. Deborah Brown, Associate Professor, School of Biological Sciences, University of Nebraska-Lincoln; and Dr. Paul Davis, Assistant Professor of Biology, University of Nebraska at Omaha.

Up to 1.5 million deaths, annually, caused by infections of viral hepatitis

August 17, 2015

Evelyn McKnight and Lauren Lollini

Steve Langan, director of HONOReform, will attend the inaugeral World Hepatitis Summit

Steve Langan, director of HONOReform, will attend the inaugeral World Hepatitis Summit

We stand alongside our many colleagues throughout the world, including representatives of the WHO, one of whom, Dr. Stefan Wiktor, refers to hepatitis as the “silent epidemic.” Hepatitis is the seventh leading cause of death throughout the world Many of these cases of hepatitis, especially in developing countries, are caused by unsafe injection practices.

HONOReform is honored to be included in the inaugural World Hepatitis Summit, which will occur early next month in Glasgow. We are grateful to the World Hepatitis Alliance for including us in these meetings. HONOReform continues to seek ways to expand and provide injection safety education and awareness in developing countries. I will report back from these meetings. In the meantime, we encourage you to read about the proposed WHO-led pilot program--in India, Egypt and Uganda–to which we aim to lend the leadership of Evelyn McKnight and HONOReform’s experience, determination and voice.

The Dire Need for Injection Safety Activism in India, by Dr. Mudasir Firdosi

August 10, 2015

Evelyn McKnight and Lauren Lollini

Dr Mudasir Firdosi shares his views on World Hepatitis Day activities

Dr Mudasir Firdosi shares his views on World Hepatitis Day activities

In this blog, reprinted with his permission from Greater Kashmir, our colleague, Dr. Mudasir Firdosi, reflects on World Hepatitis Day. Unlike many of the reflections on and around July 28 that appeared in the United States and throughout the developing world, it’s not happy news. Dr. Firdosi calls the fact that awareness and education programs hardly exist in India “a criminal silence.” At HONOReform, we continue to learn all we can about the need to shore up medical injection safety in India–and beyond. Our aim is to help make a difference, in the U.S. and throughout the world. No patient should ever receive an infection of hepatitis C while receiving healthcare. We thank our many colleagues, including Dr. Firdosi, for sharing their education and insight. We encourage you to read his full editorial here.

Methodist Mondays: Advocacy is Imperative to Patient Safety

August 3, 2015

Evelyn McKnight and Lauren Lollini


Cortney Pasek is a nursing student at Nebraska Methodist College

Cortney Pasek is a nursing student at Nebraska Methodist College

Following is another installment in our “Methodist Mondays” thread. Nursing student Cortney Pasek describes her commitment to safe injection practices from her perspective as a future health care provider.

After reading Dr. Evelyn McKnight’s book, A Never Event, and hearing her speak, safe injection practices are of the utmost importance. Her heart-wrenching story will forever stay with me and be the motivation behind my safe injection practices.

A patient safety advocate requires one to be a communicator, educator, supporter, and caregiver. Advocacy is imperative to patient safety, as is empowering patients to be their own advocate. Her story has helped healthcare professionals and patients alike, worldwide, to find their voices. The videos on the One and Only Campaign website were also very beneficial.

While we are taught to check the labels for usage and expiration dates, the videos discuss the reasons behind the protocols, which I thoroughly enjoyed. I can only hope that if I am ever faced with similar trials and tribulations as Dr. Evelyn McKnight that I handle them with as much grace and forgiveness as she has. She is truly an inspiration.


Reflection on FDA Guidance on Filliing of Medication Vials

July 27, 2015

Evelyn McKnight and Lauren Lollini

Steve Langan, director of HONOReform, shares recent FDA guidance on medication vials

Steve Langan, director of HONOReform, shares recent FDA guidance on medication vials

Thank you to Dr. Tom McKnight for sharing his experience last week in the blog post titled “Summertime and Safe Injections.” From what we have learned from nurses, techs, office administration and nursing students, some providers and others insist, subtly or directly, on not “wasting” any medication. Sadly, regrettably, using medication from single-dose vials more than one time is a widespread practice, and so is the misuse of the multi-dose vial.

We are grateful to FDA for this clear response on overfilling vials. It’s a helpful document to include in HONOReform’s ongoing advocacy work. As they say, it takes a village to raise a child; we are finding that it takes a village to raise a body of knowledge regarding safe injections. FDA and CDC and others have taken a clear stand on virtually all aspects of injection safety.

We encourage all health care workers to join us. We invite all patients to always ask for a safe injection. And we thank Tom McKnight for demonstrating that patient safety must be, in all settings, the uppermost concern.

Summertime and Safe Injections

July 20, 2015

Evelyn McKnight and Lauren Lollini

Dr Tom McKnight is a co-founder of HONOReform and a family physician in Fremont, NE

Dr Tom McKnight is a co-founder of HONOReform and a family physician in Fremont, NE

Everyone agrees that summer is meant for fun, especially fun in the great outdoors. But sometimes injuries happen in the pursuit of fun, resulting in a trip to the Emergency Department.

I practice medicine in a town that is near a state park. Thousands of people flock there in the summertime, boating and swimming in the pretty blue lakes. When I first began my family medicine practice 30+ years ago, our hospital did not have Emergency Room physicians. The primary care physicians on staff were called in to care for patients who needed to be seen. I wish I would have kept track of how many times I trekked to the ER to stitch up a camper from the state lakes, who cut himself on a piece of glass or during a fall while waterskiing. I think it would be interesting to know.

Sometimes the nurse who was helping me would bring out a vial of lidocaine that had been used for the previous patient. I wouldn’t know if the previous healthcare provider had used safe injection practices or if they had reused needles and syringes to access the vial, thus contaminating it. The vial was usually not labeled, either. I would direct the nurse to throw out the previously used vial, and use a new vial. Some of the nurses thought this was unnecessary and it took some time and thoughtful discussion before we all agreed on designating a vial for each patient.

With so many people at the lakes, we might have many emergencies at once. It was not unusual to have 10 people waiting to be seen when an ambulance would roar in and all the doctors and nurses would drop what they were doing and rush to participate in the code. The pace was stressful and fast – a combination that can lead to error. We all had to be on our toes at all times to make sure that every action was safe for the patients as well as the staff. During a code, many injections are given very quickly. With several healthcare providers standing close together around the patient, working rapid-fire, there was the possibility of accidental needlesticks and improper disposal of sharps.

Not long ago I myself was a patient at the ER. I was stung many times while harvesting honey from our beehives – the bees were not going to give up the result of their hard work without a fight! I swelled up like a balloon, and felt my throat closing. We rushed to the ER where I was given IV’s to reduce the swelling. I was so glad that the staff had had had the thoughtful discussions about injection safety. They saved my life that day, and protected me from any disease that could have been transmitted through unsafe injections.

Our hospital now has emergency room physicians on staff. I am grateful, and not just because it frees me from being called in at any time of the day or night. I am grateful for their knowledge of and committment to injection safety, because we are all patients at some time. Although I have given up beekeeping, I haven’t given up waterskiing; I just might need to be stitched up after a fall!