1. ABSCESS PREVENTION & MANAGEMENT

2. WHAT IS AN ABSCESS? A collection of pus anywhere in the body e.g. under the skin May progress to being an open wound. In this case it is scientifically called as an ulcer

3. HOW DO ABSCESSES FORM? May result from injecting non soluble substances, such as SP, which can remain trapped under the skin May result from bacteria contaminating the site of an injection May result from dead (necrotic) tissue at the site of an injection

4. STAGES OF ABSCESS DEVELOPMENT 1. May start off as a hard lump at an injection site

5. CONTD. 2. Localized skin redness appears

6. CONTD. 3. Soft swelling appears

7. 4. The area becomes tender CONTD.

8. 5. A fever may or may not develop

9. CONTD. 6. The abscess may go on to increase in size and discharge pus

10. CONTD. 7. Abscess may progress to an open wound called an ulcer

11. CARING FOR ABSCESS

12. AIMS OF ABSCESS CARE To prevent increase in size and other complications through provision of early treatment To heal the abscess as quickly as possible To provide appropriate pain relief To refer complicated cases for appropriate medical treatment

14. CARING FOR ABSCESSES 1.Encourage injecting into sites far from the abscess area (at least 12 inches away from the abscess site) till the abscess is healed 2.There may be need to cover the abscess area with a clean dressing to prevent it from being knocked 3.If the abscess is discharging pus or other fluid it will require a daily dressing: Clean the area with water or saline and apply a clean gauze dressing

15. CONTD. 4.Encourage early reporting of complications, such as increase in abscess size, black tissue around the area (necrosis,) or increase in pain 5.Sometimes, the patient may have to be referred to a bigger hospital for management of complicated cases

16. ABSCESS COMPLICATIONS Pain Chronic, non healing ulcer Tissue death (necrosis), or gangrene (may lead to amputation of the limb itself) Spread of infection through the blood stream leading to infection of the heart valves, bone infection and other abscesses

17. PREVENTION OF ABSCESSES

18. PREVENTION OF ABSCESS

19. CONTD. Educate clients on safe injecting methods:  Always inject in veins and avoid arteries  Differentiation between arteries and veins  Rotation of injecting sites  How to inject safely  Sites where NOT to inject Outreach staff should distribute alcohol (spirit) / betadine / savlon swabs along with needle / syringe to every injecting client

20. DIFFERENCE BETWEEN VEIN & ARTERY 1. Never inject into an artery 2. If you hit an artery:  There will be excruciating pain in the area  Bleeding may not stop  You may need to see a doctor

21. SITES TO AVOID DURING INJECTING These include – Groin – Heart – Neck – Forehead – Part of hand below wrist – Part of legs below the ankle

22. RISK OF INJECTING LEVELS IN THE BODY

23. CONCLUSIONS Abscesses are formed due to a variety of reasons NSEP is an effective means of preventing Abscess Clients should be taught to inject safely and to take care of their veins Abscess once formed lead to a number of complications

24. Overdose prevention and management

25. Introduction IDUs are at high risk for premature mortality, 13 times more as compared to the general population 65% of overdose cases took place at home or at a friend’s home A significant number of overdose deaths occurred in people who combined opioid use with alcohol

26. Opioids - Action Opioids act on the brain and produce a number of effects. Apart from getting a high, the users also experience the following effects: Drowsiness: due to ‘depressant’ effect on the brain Suppression of cough: due to the effect of opioids on the brain cough centre Constriction of the pupils in the eyes Constipation: due to the effect of opioids on the gut system Suppression of respiratory centre in the brain

27. Opioids - Action After continuous use of opioids, an individual develops ‘tolerance’ for the opioid The individual has to increase the dose to get the same effect Use of lesser quantity leads to development of ‘withdrawal’ symptoms However, tolerance does not develop for the respiratory depression effect of opioid Individual ‘at risk’ for overdose

28. Opioid overdose Overdose – Intake of dose in quantity (dose) which is more than the body can handle Individual starts having discomfort Life threatening symptoms appear Individual may die if he/she is not provided adequate medical care

29. Risks factors for Opioid Overdose Staying away from drugs If the individual has abstained from taking opioids for some period (even as less as 3 days) due to any reason (e.g. imprisonment, detoxification) Change in the purity of the opioids In case, the purity of the drug increases, even if the quantity is the same, the individual may have overdose

30. Risks factors for Opioid Overdose Mixing different type of drugs If opioids are mixed with alcohol, benzodiazepines which also inhibits the respiratory centre in the brain Physical illness or recent infections The individual will not be able to tolerate the same dose, if he is suffering from physical illness or recent infections Mental health In case of depression, the individual may attempt suicide by overdosing himself

31. Signs of Opioid overdose Presence of the following three symptoms/signs confirms opioid overdose: Coma: a state of unconsciousness, in which a person cannot be awakened and fails to respond normally to painful stimuli, light or sound Pinpoint pupils: constriction of the pupils of eye  the pupils become smaller in size Respiratory depression: difficulty in breathing finally leading to stopping the respiration

32. Other Signs of Opioid overdose Can’t be woken up by noise or pain Blue or ashy lips and fingernails from lack of oxygen Slow breathing (less than 1 breath every 5 seconds) Gasping, gurgling, or snoring Choking sounds Vomiting Pale face Tired body

33. Overdose prevention – education Avoid mixing drugs If you are drinking alcohol and injecting together, inject first and wait for it to take effect before you start planning to drinking After abstinence, if you are using opioids: Divide the normal dose in half, do a tester shot and allow the drugs to take effect before you do more Try changing the route of administration, that is, if you usually inject, try snorting

34. If you have a new dealer or unfamiliar supply, use a small amount at first to see how strong it is Avoid using alone; if you overdose, you need someone around to help Take care of your health. Eat well, drink plenty of water, and sleep properly Overdose prevention – education

35. Overdose Management First aid should be provided before medical help arrives Remember the acronym ‘SCARE ME’ Management of Opioid Overdose ‘SCARE ME‘  S – Stimulate by wakening the client  C – Call for medical help  A – Maintain the airway  R -- Rescue breathing  E -- Evaluate  M –Muscular Injection of Naloxone  E – Evaluate and Support

36. Overdose Management Stimulation (Wakening): try to wake them up by – Calling their name Shaking them Pressing the breastbone with your knuckles. Call for medical help: If the client doesn’t respond to noise or pain, call for medical help Put the person in the recovery position Do not leave the client alone

37. Overdose Management Airway maintenance Make sure nothing is blocking their airway, and there is nothing in the mouth. If necessary, use your finger to get the stuff out. Rescue Breathing and recovery position Put the client in recovery position If the client is not breathing  rescue breathing should be done

38. STEP – 1 Recovery position STEP – 2 STEP – 3STEP – 4

39. Rescue Breathing STEP – 1STEP – 2 STEP – 3

40. Overdose management Muscular injection of Naloxone Naloxone is a specific antidote to treat opioid overdose Naloxone reverses the life threatening symptoms caused by overdose It wakes you up and makes you breath It has no effect except in the presence of opioid drugs It is routinely used in Emergency Medical Services

41. Overdose management Intramuscular (IM, inside the muscles) or Sub-Cutaneous (SC, below the skin) routes may be used (at same doses as mentioned above), if Intravenous (IV) administration is not feasible. It takes one to five minutes to act, and lasts for 60-90 minutes Overdose may return because Naloxone wears off faster than heroin and other opiates It is important to continue supporting the person for a couple of hours following overdose

42. Overdose management Evaluate and Support Are they breathing on their own? Has the breathing started after the rescue breathing? If not, proceed to the next step

43. What not to do while helping Don’t leave someone who’s overdosing alone except if you absolutely must leave the area to call for help; he could stop breathing and die. Don’t put him in the bath; person can die. Don’t give him anything to drink or induce vomiting; he could choke. Do not make him drink salt water, or put salt in his mouth. This does not help. On the contrary, he may choke. Do not inject salt water as this is dangerous and can cause sudden death among the clients.

44. To Summarize… Opioid overdose is a common cause of death among injecting drug users There are many factors which place an individual at risk of opioid overdose Overdose can be managed in community as well as primary healthcare setting with minimal training and expertise Naloxone injection can be used to treat opioid overdose Educating the IDU clients, their peers and the family members of IDUs can easily prevent overdose and its associated harms, including death.