PREVENTING HEPATITIS C TRANSMISSION IN THE COMMUNITY

Blood awareness: What does it mean?

Blood awareness is staying alert to the possible or actual presence of blood in every conceivable situation, surrounding or circumstance.

It means being aware of the possibility blood borne viruses and organisms and introducing strategies and practices to prevent transmission from occurring.

Blood awareness recognises blood-to-blood transmission can occur in a wide variety of situations outside the clinical setting, and therefore seeks to prevent transmission through safe practices and procedures.

Examples of protective barriers include gloves, gowns, masks, and protective eyewear;

Protective barriers reduce the risk of exposure of the health-care worker's skin or mucous membranes to potentially infective materials. For standard precautions, protective barriers reduce the risk of exposure to blood, body fluids containing visible blood, and other fluids to which standard precautions apply.

Gloves should reduce the incidence of contamination of hands, but they cannot prevent penetrating injuries due to needles or other sharp instruments.

Masks and protective eyewear or face shields should reduce the incidence of contamination of mucous membranes of the mouth, nose and eyes.

Blood awareness in the clinical setting.

Standard infection control measures should always be adhered to.

First aid and occupational health and safety practices should always be strictly followed.

Those working in health care services should remain continually ‘ blood alert’, thereby preventing discrimination of individuals perceived or known to be infected by blood borne viruses through continued vigilance and safe blood procedures.

Blood awareness outside the clinical setting.

Injecting drug users (IDU) need to be aware that blood (even amounts too small to see), can pose the risk of infection through transmission. IDU need to practice safe  harm reduction Practices to prevent secondary transmission and re-infection.

Do not share toothbrushes, razors, hair brushes, or any other sharp personal grooming instruments in which minute amounts of blood may be present.

When dealing with blood or other body fluid spills always wear gloves. Make sure that others such as children present in the immediate vicinity of the spill be made aware of the spill and told to stay out of harms way until the spill has cleaned up. Full strength household bleach (that is well inside of the due date) should be used in clean-up.

Individuals receiving tattoos or body piercing should always be alert to the presence of blood and make inquiries concerning the health and safety practices of tattoo artists and body piercers to ensure they are safe from transmission. If in doubt they should go elsewhere.

Sexual practices can involve blood-to-blood contact i.e. anal sex, sex when menstruating, sex with toys and rough sex, which can inflict bleeding. Condoms and lube should be used, (particularly for anal sex), and precautions need to be taken for any sexual activities in which blood-to-blood transmission may occur.

Never share any drug injecting equipment including: needle, syringe, spoon, filters, water, swabs or tourniquets with others.

Blood awareness issues for educators

The promotion of blood awareness and safe procedures needs to be a key focus for harm reduction educators.

Blood awareness education supplements and therefore builds on earlier work in HIV prevention such as the promotion of using clean fits and never sharing, which was introduced through the establishment of a needle exchange network in New Zealand in 1988 primarily to prevent HIV transmission.

However, to prevent the transmission of hepatitis C, promotion of clean and sterile injecting equipment is only a beginning.

IDU need to be made blood aware through education in the form of clear information of the types of situations and environments blood-to-blood transmission can occur.

It is of extreme importance that health services use blood awareness as a central concept to educate individuals of the risks of blood-borne viruses to reduce the incidence of hepatitis C transmission in New Zealand.

Harm minimisation

This is central to hepatitis C prevention. The ‘harm’ in these terms relates to the associated consequences of drug use which can include infection with blood-borne viruses such as hepatitis C.

Harm minimisation-based policies represent a significant shift away from previous drug policies in New Zealand which were grounded in abstention and punishment.

Harm reduction is a pragmatic approach that focuses on reducing the harm associated with high-risk activities, not on preventing people from indulging in those activities. A major shift in New Zealand away from the abstention and punishment model towards a harm reduction approach came with the start of the Needle Exchange Programme in 1988.

Harm reduction, apart from seeking to reduce the harmful consequences of drug use for the user, recognises and seeks to reduce drug related harm to the wider community. Such an approach recognises the reality of drug use and believes that it is more effective for individuals and communities to reduce the harms that come about from drug use rather than attempting to eliminate drug use all together.

Harm reduction and hepatitis C.

Harm reduction relates directly to the prevention of hepatitis C transmission through unsafe intravenous drug use practices.

In New Zealand the vast majority of individuals diagnosed with hepatitis C are those who inject, or have previously injected drugs.

Hepatitis C is the most significant health problem affecting people who inject or who have injected drugs in New Zealand. The prevention of hepatitis C transmission is a major target of harm reduction activities in this country.

Harm reduction programmes NEP

Harm reduction provides intravenous drug users with education and resources allowing individuals to make informed decisions about their drug using practices.

Harm reduction avoids making moral judgments about drug use, accepting that there are a variety of reasons people choose to inject drugs.

The focus of harm reduction is on the reduction of harm associated with drug use as opposed to a reduction of the drug use itself.

The mandate of Needle Exchange programme (NEP) outlets is essentially to enable IDU to avoid sharing injecting equipment or having to re-use their own. They provide a safe way of disposing of used equipment, thereby reducing the risks of infection from blood-borne viruses. There is a large body of evidence in New Zealand pointing to a significant public health success in preventing the wider spread of blood-borne viruses. The NEP not only benefits IDU but the wider community as a whole.

Harm reduction programmes involve measures which relate to encouraging intravenous drug users to change drug associated behaviour and practices that expose individuals to health risks. The best example of harm reduction applied to drug use in New Zealand is the Needle Exchange Programme (NEP). The outlets provide sterile injecting equipment, filters for the prevention of chalk and binder build up in IDU, (which can have serious secondary health problems), outreach work and educational literature and advice promoting safe disposal of injecting equipment. A collection and destruction ancillary service for injecting equipment has also been established in New Zealand.

Peer Service Model

Eighty per cent of national needle and syringe distribution in New Zealand is through the peer service model.

Dedicated needle exchange outlets (NEXs) in New Zealand are staffed by peers with direct experience of drug use and drug using culture. They are uniquely placed to give information and education surrounding blood awareness and reducing the risk of transmission of hepatitis C.

IDU keep a low profile and are generally hesitant to reveal their drug use if they feel that by doing so they may be opening themselves up to discrimination or prosecution.

Having direct experience of drug use and drug using culture, peer educators are able to give sound advice about reducing the risks of hepatitis C transmission and other drug associated harm and their advice is generally well received and respected by IDU.

The government & harm reduction

Harm reduction at health policy level is fundamentally a response to the following concerns:

Continued high rates of hepatitis C transmission among the drug injecting community in New Zealand and the potential impact this may have for the wider non-using public.

The potential of HIV/Aids and other blood-borne virus becoming widespread among IDU in New Zealand and the down-stream impact this would have on the wider non-using public.

The New Zealand Government does not condone the use of illegal drugs. However, they do acknowledge that drug use occurs in society for a variety of reasons and therefore accept health policy has a responsibility to reduce drug related harm. This outlook represents a significant shift in policy orientation in New Zealand from the outdated abstinence and punishment model to a harm minimisation strategy. This has resulted in legislation permitting legal purchases of injecting equipment from approved outlets whilst the drug use itself has remained illegal in status.

Safer using: what does it mean?

Safer using essentially includes a series of practices and precautions aimed at the prevention of harm through drug use.

Harm from drug use can manifest in a physical, psychological, legal, or social form. While such harms can never be completely eliminated the NZ NEP has strategies for addressing drug related harms within the framework of harm minimisation.

Aside from the obvious role of needle exchanges, (providing IDU with access to clean injecting equipment and disposal of used equipment), the program also provides information and education related to the full spectrum of harms associated with drug use.

Typically a client of a NEP in New Zealand would expect to find information, advice and products related to minimising the following drug related harms:

  • Prevention of blood borne viruses and bacterial infections.
  • Wheel filters for the prevention of harmful contaminants passing into the body from injecting drugs.
  • Hirudoid™ cream for care of bruising from injecting drugs.
  • Vein care advice.
  • Overdose protocols and advice.
  • Legal rights advice.
  • Education surrounding harmful drug side-effects, (often from inappropriate self-administration)
  • Advice for poppy season.
  • Medical referrals.
  • Outreach teams (very limited nationally).
  • The ability of an IDU to practice safer injecting is directly dependent on the drug injecting taking place within an infrastructure that provides:
  • Non partisan political support for harm reduction.
  • Government policy which provides accessible health and drug service.