SAFER INJECTION PRACTICES

Why is safer injection important ? For the prevention of morbidity and mortality related to injection drug use. In other words, to keep from getting sick or dying. You are the one who really knows if you are injecting safely; it’s up to you to make sure that you take care of yourself.

Examples: Injection drug use is a factor in one third of all AIDS cases in the United States; and more than one half of all new HIV infections. People who inject drugs make up ½ of all new Hepatitis C infections in the United States; the prevalence of HCV amongst injection drug users is estimated at 73%. 10% – 60% of these will develop some form of chronic liver disease. Hepatitis B is found in semen, blood and saliva; it is spread by contaminated syringes and unprotected sexual contact. This is all preventable by taking a few precautions. It’s worth making the effort to stay healthy.

Abscesses and Soft Tissue Infections 87% of our clients report having 1 or more soft tissue infections in the past, 25% of those people had a current soft tissue infection at the time of their interview. To avoid getting an abscess or other soft tissue infection: Always use a clean, fresh cooker. Always use new cotton. Before injection, clean up with soap and water; or use an alcohol swab where you are going to shoot. This is one of the best ways to keep from getting abscesses. Don’t use alcohol pads on the injection site after injecting. It keeps your blood from coagulating properly, and you want a scab to keep the germs out. And don’t forget to use a brand new, sterile syringe each time you inject. Don’t hit in the same spot over and over; try rotating where you inject.

What to do if you have an abscess: Keep it clean by washing with soap and water. Soak it in hot water or use a wet towel if you can’t do that. Keep it covered with a clean bandage or cloth. If you have chest pains, see red streaks coming out of the abscess, or it’s growing and hurts really badly you need to go to the doctor. You don’t want to risk Cellulitis or Endocarditis. Don’t pop it yourself, it can be dangerous. See a doctor if you’re unsure about anything.

Safer Injection Practices The more a needle pushes through the inside of a vein, the more clotting & scar tissue develop and the inside of the vein gets smaller and smaller. You want to rotate injection sites to keep your veins as healthy as they can be. When using the same vein over again, move the shot up towards the heart; this will help the blood to flow better once the shot goes in. Always shoot up towards the heart, and with the bevel of the needle up. Blood moves slowly in the legs due to gravity. Try shooting somewhere else if at all possible, and never shoot in the groin. Deep Vein Thrombosis and Emboli are more likely to originate in the leg veins. Veins in your hands and feet are small, they roll and can be easily damaged. Be careful and take your time if using them. And don’t forget to wash up first; they get infected easily.

Safer Injection Practices You always want to shoot with the flow of blood, that means always shoot towards the heart; so if you’re shooting in your neck, you have to point the needle down. Keep the bevel of the needle facing up. If you are muscling, use a longer IM needle. The insulin syringes aren’t long enough and don’t reach the muscle. This opens you up for infections like botulism, tetanus, necrotizing fasciitis, as well as cellulitis and abscesses. You want to inject into veins, not arteries. Arteries carry the blood from the heart to your body, and have a pulse. If it has a pulse, don’t stick the needle in. If you are back-loading, make sure that the needle and cooker have never been used before. Throw them away afterwards so that there is no confusion later.

Warning Signs That You Hit An Artery The blood flow is so strong it forces back the plunger. The blood is frothy when you register. You bleed heavily after taking out the needle. The shot hurts and bruises quickly. Injection site becomes swollen, hot, red and sore. If the redness spreads quickly. If you hit an artery: pull out, hold your arm or leg over your head, and apply pressure for 10-15 mins. If the bleeding doesn’t stop, call 911.

IM Shots Be sure that everything is brand new and clean. If you are muscling, you are at greater risk for infections. You can shoot on your thigh between the hip and the knee. You can shoot on the top outside of your butt cheeks. You can shoot into your shoulder. Relax your muscle before hitting, it will hurt less. Make sure you rotate injection sites. It’s a good idea to get a tetanus booster shot if you muscle. Don’t muscle Coke or Speed, it’s more painful and more likely to develop an abscess. Use an IM needle, it will help lower the risk of soft tissue infections.

IM Shots These are the best locations for muscling

REMEMBER: Try and find somewhere that’s clean, well lit, private and that has running water. Always use clean supplies and don’t share anything except your lighter. Clean the injection site before fixing. Rotate injection spots, so you don’t get an infection and to help veins last longer. If you use a tourniquet, your veins will thank you. Drink plenty of water, helps your blood flow better. Don’t re-use cookers or cottons. Cotton fever is not a loose piece of cotton; it’s an infection caused by bacteria, and it is preventable.

Staph & MRSA Prevention & Reduction Anyone can get a Staph infection, many people who have Staph think they have a spider bite. You are more likely to get Staph if you have a cut or scratch, or if you have contact with someone who has a Staph infection. The best way to prevent a Staph infection is to keep hands and wounds clean. If you have a wound, cover it with a bandage. Most Staph infections are easily treated with antibiotics, go see a doctor. Some infections like MRSA are really hard to treat, and need immediate medical attention. If there is something weird going on with your skin, see a doctor. Don’t buy antibiotics on the street, or use someone else’s.

Girls are different: Women usually have smaller more delicate veins, so it is especially important to use a tourniquet and rotate where you shoot. Take control of your using by learning how to inject yourself. You don’t have to wait for your boyfriend to go first. Your risk of contracting something nasty goes way down when you prepare and inject your own drugs. Women, especially women of color are at a much higher risk of contracting HIV. Take control of the situation.

Glossary Naloxone - Naloxone is a drug used to counter the effects of opioid overdose, for example heroin or morphine overdose. Naloxone is specifically used to counteract life-threatening depression of the central nervous system and respiratory system. It is marketed under various trademarks including Narcan, Nalone, and Narcanti. Cellulitis - Cellulitis is an inflammation of the connective tissue underlying the skin, that can be caused by a bacterial infection. Cellulitis can be caused by bacteria, and often occurs where the skin has previously been broken: injection sites, cracks in the skin, cuts, burns, insect bites, surgical wounds. Treatment requires appropriate antibiotics. Skin on the face or lower legs is most commonly affected by this infection, though cellulitis can occur on any part of the body. Cellulitis may be superficial — affecting only the surface of the skin — but cellulitis may also affect the tissues underlying the skin and can spread to the lymph nodes and bloodstream. It is unrelated to cellulite, a cosmetic condition featuring dimpling of the skin. Endocarditis - Endocarditis is an inflammation of the inner layer of the heart (the endocardium). The most common structures involved are the heart valves. As the valves of the heart do not actually receive any blood supply of their own, defense mechanisms (such as white blood cells) cannot enter. So if an organism (such as bacteria) establishes a hold on the valves, the body cannot get rid of them. Thrombosis - Thrombosis is the formation of a clot (or thrombus) inside a blood vessel, obstructing the flow of blood through the circulatory system (your veins, arteries and the blood that circulates through them). Thrombosis can develop into an Emboli.

Glossary Emboli - an embolism (or Emboli if there are more than one) occurs when a clot migrates from one part of the body (through circulation of the blood) and causes a blockage (occlusion) of a blood vessel in another part of the body. Emboli often have more serious consequences when they occur in areas of the body that have no redundant blood supply, such as the brain, heart, and lungs. A redundant blood supply is when an area of the body receives blood from more than one source; if a part of the body recieves blood from only one source and that source gets blocked with an Embolism, this is very serious condition and requires medical attention. Abscess - An abscess is a collection of pus that has accumulated in a cavity formed by the tissue on the basis of an infectious process (usually caused by bacteria or parasites) or other foreign materials (e.g. splinters or bullet wounds). It is a defensive reaction of the tissue to prevent the spread of infectious materials to other parts of the body. The organisms or foreign materials that have gained access to a part of tissue kill the local cells, resulting in the release of toxins. The toxins trigger an inflammatory response, which draws huge amounts of white blood cells to the area and increases the regional blood flow.

Glossary Staph Infection - Staph is the shortened name for Staphylococcus (pronounced: staf-uh-low- kah-kus), a type of bacteria. These bacteria can live harmlessly on many skin surfaces, especially around the nose, mouth, genitals, and anus. But when the skin is punctured or broken for any reason, staph bacteria can enter the wound and cause an infection. S. aureus most commonly causes skin infections like folliculitis, boils, impetigo, and cellulitis.Infections caused by S. aureus can occasionally become serious. This happens when the bacteria move from a break in the skin into the bloodstream. This can lead to infections in other parts of the body, such as the lungs, bones, joints, heart, blood, and central nervous system. Staph infections are common in areas where many people are in close contact, and can be prevented by keeping clean as well as keeping wounds clean and covered. Treatment requires appropriate antibiotics. MRSA - A strain of Staphylococcus that is resistant to many antibiotics. Requires medical treatment. Necrotizing Fasciitis - commonly known as “flesh-eating bacteria,” is a rare infection of the deeper layers of skin and subcutaneous tissues, easily spreading within the subcutaneous tissue. Many types of bacteria can cause necrotizing fasciitis of which Group A streptococcus (also known as Streptococcus pyogenes) is the most common cause. Amputation of the affected organ(s) may be necessary. Repeat explorations usually need to be done to remove additional necrotic tissue (dead tissue). Typically, this leaves a large open wound which often requires skin grafting. The associated systemic inflammatory response is usually profound, and most patients will require monitoring in an intensive care unit.