Policy, engineering and educational efforts

You Won’t Believe the Things I See. And Hear.

Pam Demski-Hart is on the board of directors of HONOReform
Pam Demski-Hart, BS, MT, ASCP, CHSP is on the board of directors of HONOReform

HONOReform is proud to reprint board member Pam Demski-Hart’s recent contribution to the CDC’s Safe Healthcare Blog. Pam is the principal and founder of Healthcare Accreditation Resources LLC, a consulting service for ambulatory healthcare and dental facilities. She shares in this blog her personal observations of unsafe injection practices in healthcare settings. Pam discusses the differences between reality and perception when it comes to what infection control practices are — and are not. The blog is posted here in its entirety. We urge you to share with all healthcare providers, and to combat the dangerous denial of the presence of unsafe injections.


They greet me at the facility door with a handshake and a cheerful comment, “We’re pretty sure we’re OK!”

And that’s when I cringe and prepare myself. Read more

HONOReform’s Annual Report


At this time of year, we review our activities of the previous year. Join us as we look back on 2015 through the lens of HONOReform.

HONOReform is the only national advocacy organization dedicated to protecting patients by safeguarding the medical injection process “from manufacturing to disposal.” Our vision is a nation in which healthcare providers always follow fundamental injection safety practices that protect patients with every injection.

HONOREFORM INTERNATIONAL                                                                                    
Evelyn McKnight shared her story and the ongoing efforts of HONOReform at the landmark World Health Organization Safe Injection Gliobal Network meeting. At the end of the meeting, WHO representatitves shared the goal of having single-use only injection devices in use in developing countries by 2020. Additionally, Steve Langan represented HONOReform in Glasgow, Scotland at the first international meeting hosted by the World Hepatitis Alliance.

PRESENTATIONS AND MEDIA                                                                                          
Led by co-founder and president Evelyn McKnight, who frequently presents her story and the ongoing need to always use safe healthcare practices, HONOReform presented at 30 events in 2015 attended by over 2500 people. HONOReform was featured in local and national media dozens of times in 2015, including an appearance in the May 21 US News and World Report article, “Unsafe Injections Put Patients in Peril.”

HONOREFORM OUTREACH                                                                                              
Evelyn and HONOReform are active on social media, particularly twitter (#HONOReform). On our streamlined website, click on “JOIN THE CONVERSATION” to receive up-to-the-minute information from HONOReform (on Twitter and Facebook). Also, be sure to check out and subscribe to the HONOReform blog, “Survivor Stories,” edited by Evelyn and Lauren Lollini. To submit an idea for our blog or an article, contact Steve Langan at 402.659.6343 or steve@HONOReform.org.

OUR ACADEMIC PARTNERS                                                                                              
HONOReform appreciates the many opportunities this year to meet, in person and online, with students from numerous universities and colleges, as they studied the consequences of unsafe injections. We welcome the opportunity to share the HONOReform story and highlight the need to always emphasize injection safety. Our academic partners include University of Nebraska-Omaha, Midland University, Methodist Nursing College, the College of St Mary, St Louis Univerity and Southeast Community College – among others.

THE SIPC AND THE CAMPAIGN                                                                                        
HONOReform is a proud member of the Safe Injection Practices Coalition (SIPC), which provides support for the One and Only Campaign. The SIPC continues to develop and distribute its award-winning materials, and we continue to raise awareness among healthcare providers and patients about the absolute need for safe injection practices. As always, please contact HONOReform and allow us to help you access the matierals that will be most useful to you and your institution-if you are a healthcare worker-or your family-if you are a patient.

Sadly, some healthcare providers in the United States continue to reuse and misuse medical equipment, including syringes. Additional focus areas this year included reuse and misuse of single- and multi-dose vials of medication and responding to increasing reports of drug diversion among healthcare workers. Through the HONOResponse program, HONOReform is poised to help patients and communitities immediately following a patient notification or confirmed outbreak.

SOME GOALS FOR 2016                                                                                                    
Thank you to our supporters for helping us work toward these goals:

To develop an education program, at no or reduced cost, on injection safety for healthcare workers and to work in tandem with colleagues to advance these and other infection prevention efforts.

To organize and help host a national meeting on drug diversion prevention and then to follow up on the action steps we adopt at the meeting to influence mitigation and elimination of the problem.

To continue to encourage international leaders to focus on making injection safety a priority.


Learning from our Mistakes: A New Model of Malpractice Resolution

Evelyn McKnight, president of HONOReform
Evelyn McKnight, president of HONOReform

“Dear sir or madam: you have been potentially exposed to Hepatitis C, Hepatitis B and HIV through unsafe practices by your healthcare provider. Please come to our facility to be tested.”

Those were the opening sentences of an official letter that I received from the Nebraska Health Department in 2002.

Thus began my involvement in malpractice litigation as a plaintiff.

But through this experience, we have developed a new model of malpractice resolution – one that requires not only compensation for the victim, but also safeguards the welfare of the community through remediation of medical error.

I was honored to share this model in a TEDx Omaha Talk last month. Please take a look at the talk, share it with your network, and join our campaign by following HONOReform Foundation’s Facebook page!

Methodist Monday – Leah’s perspective

NMC Logo

Leah Mittermeier, a Junior Level Nursing Student at Nebraska Methodist College, shares her perspectives on injection safety

Hearing Evelyn McKnight’s story really put into perspective what could go wrong if safe injection practices don’t take place. As a nurse I would feel so much shame in knowing my actions threatened people’s lives. I want to be as knowledgeable as possible with injections to ensure every patient I come in contact with is safe.

Being a patient safety advocate means speaking up anytime you see anything that could put a patient in danger. I know that it could be awkward confronting a colleague who was practicing unsafely, but at the end of the day, the patient’s safety and well being should come first. It is our responsibility as nurses to speak up for our patients. They might not realize that an unsafe practice is going on, so it is our responsibility to be on watch for anything threatening to the patient.

I’m very inspired to meet someone who had such a terrible experience and turn it into a learning opportunity for the world. I was impressed how calm Evelyn McKnight is after the experience and the fact that she doesn’t seem to hold grudges against the people involved.

Reused syringes causes infection control breach in New Jersey

Lauren Lollini is a patient safety advocate who has been integral in changing laws to keep patients safe as well as a member of the Drug Diversion Prevention Committee.
Lauren Lollini is a patient safety advocate who has been integral in changing laws to keep patients safe as well as a member of the Drug Diversion Prevention Committee.

Last week, reports of a nurse administering flu shots to 67 employees in New Jersey was found to be reusing syringes. While the risk for transmission appears to be low in this incident, it is yet another reminder about how easy the episode of exposure for an infectious disease can be. One shortcut taken either to save time or money can put patients at risk for HIV, Hepatitis B or C.

More than 150,000 patients have been told, over the last 10 years, they needed to get tested following a syringe misuse to include syringe reuse. Despite the protocols put into effect by the CDC, we continue to hear stories of patients put into harm’s way.
Read more

Renewed Call to Action on Worldwide Injection Safety

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

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.

August is National Immunization Awareness Month

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.

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

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.

Reflection on FDA Guidance on Filliing of Medication Vials

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.

© Copyright 2016 HONOReform