Transcript Safer Injecting Practices

Safer Injecting Practices
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Common Drugs and Injecting
Practices
Heroin (pure/white heroin/ ‘No. 4’):
mainly in the north-eastern states
Heroin (Smack / brown sugar): not
readily injectable as it comes in the
form of crude, impure powder
Buprenorphine (Tidigesic/Norphine)
or Pentazocine (Fortwin): probably
the most popular drugs for injecting
among IDUs in India
Dextrprpoxyphene (Proxyvon /
Spasmo- Proxyvon / SP): available
as capsules and NOT AS
INJECTIONS
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• Before injecting, a user has to prepare or ‘cook’ the drug
• Most users mix the powder with an injectable sedative
drug (like Avil), boil it, filter it with a cotton swab and then
inject it
• Most users mix them with one or more of the following
sedatives for enhancement of the effects:
• Diazepam (Calmpose)
• Chlorpheniramine (Avil)
• Promethazine (Phenargan)
• Users open the capsules, take the powder out, crush it,
mix it with another liquid / drug and then inject it
• Seen only in the north-eastern states, very rare in other
parts of the country
Encouraging Safer Injecting
• Educate clients on safe injecting methods:
• Risks of sharing N/S, equipment, drugs
• Need for cleaning injecting sites
• Differentiating between arteries and veins
• Rotation of injecting sites
• Injecting in safer sites
• Sites where NOT to inject
• Outreach staff should distribute alcohol (spirit)/Betadine/
Savlon swabs along with needles/syringes to every injecting
client
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Arteries and Veins
1. Never
inject into
an artery
2. If you hit
an artery:
There will
be
excruciatin
g pain
 Bleeding
may not
stop
 May need
to see a
doctor
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Sites to Avoid When Injecting
These include
– Groin
– Heart
– Neck
– Forehead
– Part of palm
below the wrist
– Part of foot
below the
ankle
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Educating on Safer Injecting
 PEs and ORWs need to be trained on safer
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injecting practices
 Educative sessions on safer injecting
practices should be planned and
conducted regularly at the field level
 PEs and ORWs should discuss safer
injecting practices during one-on-one
interactions
 Special sessions with audio visual
aids/films may also be conducted at the
DIC level
Needle Syringe Exchange Programs
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Goal and Objectives
Goal :
To ensure that every injecting act is covered with
a safe needle/syringe
Objectives:
To facilitate safe injecting practices by:
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Providing new needles and syringes, alcohol swabs,
distilled water etc.
Practicing safe disposal
Removing contaminated needles/syringes from
circulation
To educate and inform IDUs and partners
about safe injecting practices
To befriend the IDUs and link them with other
services and assist in reduction of high risk
practices/behaviour
Basic Components of NSEP
Distribute
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Collect
Dispose
& INFORM
Who Implements NSEP?
PEs and ORWs in areas where IDUs
congregate/reside
2. Health workers
(nurse/counsellor/ANMs) at DICs/clinics
3. PEs/others designated as Secondary
Distributors (SDs) in far flung areas
difficult for ORW/PE to reach
4. Sometimes, NSEP may be implemented
by a local key informant
1.
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Where?
 At hotspots/sites
where IDUs can be
accessed
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 Static/Fixed sites –
Clinics or DICs
What Will Be Distributed?
1. Needles: 24”, 26”
2. Syringes: 1ml, 2ml, 5ml,
10ml
3. Other equipment: filter,
cooker, tourniquet (where
budget permits)
4. Need based IEC
5. Alcohol/spirit swabs (to
prevent abscesses)
6. Swabs, bandages, etc. (to
manage abscesses)
7. Condoms
8. Distilled water
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NSEP – Operational Aspects
 NSEP should operate all 7 days of the week
● At times when IDUs need it most
 The planning should be based on:
● Spot analysis
● Contact mapping
● Risk and vulnerability analysis
 A carefully planned outreach will determine
● Locations/contact points for delivering NSEP
● Number of N/S required
● Timing of operation
● Division of IDUs and areas amongst the outreach team
● Individual tracking and monitoring
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Operational Aspects
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N/S distribution should be accompanied by IDUs
returning used N/S
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Collection of used N/S from IDUs reduces
number of used N/S available for recirculation
and so reduces risk of contamination/sharing
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The return rate of N/S depends on:
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However, the return should not be a prerequisite for
distribution
The relationship between IDU and staff
Conducive environment for NSEP
For a Successful NSEP
Ensure:
 Easy accessibility of N/S
 Confidentiality of the IDU and partner
 Many IDUs are fearful of being identified and seen as
IDUs by the public and family/friends while accessing
NSEP
 Supply (delivery) meeting demand – in quantity
and quality
 Behaviour and attitude of outreach staff during
interaction with IDUs and partners
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Collection and Disposal of Needles
and Syringes
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Collection of Scattered N/S
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Collection of Scattered N/S
Often used N/S lie scattered in
fields/hotspots
These might prick children or be reused
by other IDUs, causing transmission of
infections
A 1-day activity should be organized
periodically by the TI to gather these
N/S
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Use the IDUs/PE/ORW for this activity
Inform the general community beforehand
Explain the importance of the activity
The local police station can also be informed
Precautions for Collecting Used N/S
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Wear latex plastic gloves (thick gloves, not the ones
used in clinics)
Do not recap N/S
Do not bend/break N/S manually
Always pick up from the barrel end (syringe end)
Use tongs, if possible, to pick up
Definitely use tongs to pick up if more than one N/S
Separate with a stick and pick up each N/S separately
Put N/S into the puncture-proof container ensuring
that needle-end faces downwards to avoid accidental
injury
Secure the lid of the container tightly
Avoid manual (direct hand) transfer of needles
/sharps waste from one container to another
Transfer collected N/S directly into the main sharp
container placed in the DIC
Materials Needed for Collection of
N/S
 Puncture proof boxes – serially numbered,
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marked with biohazard symbol
Thick colour-coded plastic bags – marked with
biohazard symbol
Thick rubber gloves
Tongs/large forceps
Plastic bin with sieve
Plastic bin without sieve
Disinfectant solution – sodium hypochloride,
bleach, large plastic bins (translucent white or
blue in colour)
Hub cutter for mutilating disinfected syringes, if
syringes are disposed of by burial on site
Monitoring of NSEP
 Monitor NSEP on a regular basis
 Three types of monitoring tools should be
employed:
 Weekly review meetings with outreach staff regarding
coverage, areas of weakness and next week’s work plan
 Record based monitoring to analyse and review
coverage, number of IDUs reached regularly, number of
N/S distributed and the return rates
 Field based monitoring: PM should regularly visit
hotspots, interact with clients, observe the outreach
staff and also interact with other community members
 Observation from the field visits should be tallied
with the records entered by the ORW to get a realistic
picture of the quality of the services being offered
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Role of the PM in NSEP
 Supervise NSEP outreach staff
 Build staff capacity and skill on NSEP
 Develop work plans with ORWs and PEs
 Liaise with other agencies, local NGOs,
CBOs and other groups in the community
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Points to Remember
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NSEP is the backbone of IDU TI programs
NSEP faces major resistance from the general
community; significant efforts must be dedicated
to conducting advocacy
NSEP serves not only to provide a safe method of
injecting, but also as an entry point into the IDU
community
Collection of the returned N/S and safe disposal is
as important as distribution of N/S
“Remember this is a Needle Syringe
Exchange Program, not a mere N/S
distribution program”
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