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Harm Reduction Journal Nov 2021Provision of sterile syringes is an evidence-based strategy of reducing syringe sharing and reusing and yet, access to sterile syringes through pharmacies and syringe...
Assessing the relationship between syringe exchange, pharmacy, and street sources of accessing syringes and injection drug use behavior in a pooled nationally representative sample of people who inject drugs in the United States from 2002 to 2019.
Provision of sterile syringes is an evidence-based strategy of reducing syringe sharing and reusing and yet, access to sterile syringes through pharmacies and syringe exchange programs (SEPs) in the United States remains inadequate. This nationally representative study examined associations between obtaining syringes from pharmacies, SEPs, and sterilizing syringes with bleach and risk of syringe borrowing, lending and reusing syringes in a pooled cross-sectional dataset of 1737 PWID from the 2002-2019 National Survey on Drug Use and Health. Logistic regression was used to produce odds ratios (OR) of the odds of injection drug behaviors after adjusting for obtaining syringes from SEPs, pharmacies, the street, and other sources and potential confounders of race, ethnicity, sex, education, and insurance coverage. Obtaining syringes through SEPs was associated with lower odds of borrowing (OR = .4, CI = .2, .9, p = .022) and reusing syringes (OR = .3, CI = .2, .6, < .001) compared to obtaining syringes on the street. Obtaining syringes from pharmacies was associated with lower odds of borrowing (OR = .5, CI = .3, .9, p = .037) and lending (OR = .5 CI = .3, .9, p = .020) syringes. Using bleach to clean syringes was associated with increased odds of borrowing (OR = 2.0, CI = 1.3, 3.0, p = .002), lending (OR = 2.0, CI = 1.3, 3.0, p = .002) and reusing syringes (OR = 2.4, CI = 1.6, 3.6, p < .001). Our findings support provision of syringes through pharmacies and SEPs as a gold-standard strategy of reducing sharing and reuse of syringes in the US.
Topics: Cross-Sectional Studies; HIV Infections; Humans; Needle Sharing; Needle-Exchange Programs; Pharmaceutical Preparations; Pharmacies; Pharmacy; Substance Abuse, Intravenous; Syringes; United States
PubMed: 34789270
DOI: 10.1186/s12954-021-00565-6 -
Eye (London, England) Dec 2020To investigate whether agitation promotes the release of silicone oil by different models of syringe used for intravitreal injection.
BACKGROUND/OBJECTIVES
To investigate whether agitation promotes the release of silicone oil by different models of syringe used for intravitreal injection.
METHODS
This lab study analyzed eight syringe models by light microscopy for the release of silicone oil under agitation (flick), without agitation, and positive controls. Fourier-Transform Infrared Spectroscopy (FTIR) was performed to identify the molecular compounds inside the syringes.
RESULTS
A total of 240 syringes were analyzed. The presence of silicone oil droplets was observed in all positive controls. When agitated by flicking, 100% of the samples of the syringes disclosed silicone oil, except the BD Plastipak syringe, which presented 40% of positivity. Without agitation, a smaller percentage of samples with silicone oil was observed. Agitation by flicking had a 265-fold greater chance of presenting oil droplets when compared with the syringes without agitation. There was a statistically significant difference between the three conditions (P < 0.05). Analysis of the tip of the plunger rubber by FTIR indicated the presence of polysiloxane (silicone oil) in all models of syringe.
CONCLUSIONS
Agitation of the syringe promotes the release of silicone oil. It is recommended to improve the technique of injection and the manufacture of specific syringes for ophthalmological use.
Topics: Humans; Intravitreal Injections; Silicone Oils; Syringes
PubMed: 32127655
DOI: 10.1038/s41433-020-0800-9 -
Harm Reduction Journal Sep 2022Existing research in urban areas has documented a multitude of ways in which law enforcement may affect risks for bloodborne infectious disease acquisition among people...
BACKGROUND
Existing research in urban areas has documented a multitude of ways in which law enforcement may affect risks for bloodborne infectious disease acquisition among people who inject drugs (PWID), such as via syringe confiscation and engaging in practices that deter persons from accessing syringe services programs (SSPs). However, limited work has been conducted to explore how law enforcement may impact SSP implementation and operations in rural counties in the United States. This creates a significant gap in the HIV prevention literature given the volume of non-urban counties in the United States that are vulnerable to injection drug use-associated morbidity and mortality.
OBJECTIVE
This study explores the influence of law enforcement during processes to acquire approvals for SSP implementation and subsequent program operations in rural Kentucky counties.
METHODS
From August 2020 to October 2020, we conducted eighteen in-depth qualitative interviews among persons involved with SSP implementation in rural counties in Kentucky (USA). Interviews explored the factors that served as barriers and facilitators to SSP implementation and operations, including the role of law enforcement.
RESULTS
Participants described scenarios in which rural law enforcement advocated for SSP implementation; however, they also reported police opposing rural SSP implementation and engaging in adverse behaviors (e.g., targeting SSP clients) that may jeopardize the public health of PWID. Participants reported that efforts to educate rural law enforcement about SSPs were particularly impactful when they discussed how SSP implementation may prevent needlestick injuries.
CONCLUSIONS
The results of this study suggest that there are multiple ways in which rural SSP implementation and subsequent operations in rural Kentucky counties are affected by law enforcement. Future work is needed to explore how to expeditiously engage rural law enforcement, and communities more broadly, about SSPs, their benefits, and public health necessity.
Topics: Humans; Kentucky; Law Enforcement; Needle-Exchange Programs; Substance Abuse, Intravenous; Syringes; United States
PubMed: 36180853
DOI: 10.1186/s12954-022-00684-8 -
Harm Reduction Journal Aug 2023Syringe vending machines (SVM) can improve access to sterile injecting equipment, but they have not been widely implemented or evaluated. We evaluate the cost of SVM...
BACKGROUND
Syringe vending machines (SVM) can improve access to sterile injecting equipment, but they have not been widely implemented or evaluated. We evaluate the cost of SVM installed between July 2019-December 2020 in Tbilisi, Georgia.
METHODS
The SVM were stocked with several kit types, including injecting equipment for opioid or stimulant users, naloxone, male and female condoms, and pregnancy tests. We gathered financial data from the project to estimate fixed (staff time, start-up costs, equipment, running costs, and consumables) and variable (harm reduction kits) costs. We calculated the full cost of the SVM intervention, cost per user, cost per additional syringe accessed by SVM users, and cost per kit distributed (2020 Euros).
RESULTS
SVM access cards were issued to 1132 users, and 29,238 kits were distributed through SVM, total cost €204,358. Staff costs were 51% of total, consumable costs 28%, equipment 10%, and start up, recurrent costs, and overheads 5% or less each. Opioid and stimulant kits were most accessed (35% and 32% of total). Cost per user was €66/year, and cost per transaction €7, of which €5 fixed costs and €2 variable. If monthly transactions increased from the average of 1622/month to highest monthly usage (4714), fixed costs per transaction would decrease to < €1. It cost €0.55 per additional syringe accessed/user/month.
CONCLUSIONS
This study provides evidence for governments about the cost of SVM, a novel harm reduction intervention. This is particularly relevant where Global Fund is withdrawing and harm reduction services need to be incorporated into national budgets.
Topics: Humans; Male; Female; Substance Abuse, Intravenous; Needle-Exchange Programs; Syringes; Analgesics, Opioid; Georgia (Republic)
PubMed: 37533020
DOI: 10.1186/s12954-023-00829-3 -
Journal of the American Pharmacists...To describe injection drug users (IDUs) who access syringes through different outlets to help inform the prevention needs of IDUs who underuse safe syringe sources in... (Comparative Study)
Comparative Study
Comparison of injection drug users accessing syringes from pharmacies, syringe exchange programs, and other syringe sources to inform targeted HIV prevention and intervention strategies.
OBJECTIVE
To describe injection drug users (IDUs) who access syringes through different outlets to help inform the prevention needs of IDUs who underuse safe syringe sources in New York City (NYC), where syringe availability is high compared with other U.S. cities.
DESIGN
Cross sectional.
SETTING
NYC, 2005-2007.
PARTICIPANTS
285 IDUs.
INTERVENTION
Participants were recruited using random street-intercept sampling in 36 socioeconomically disadvantaged neighborhoods.
MAIN OUTCOME MEASURES
IDUs using syringe exchange programs (SEPs), pharmacies, or other outlets as a primary syringe source were compared based on sociodemographic characteristics, injection practices, and medical service use.
RESULTS
Chi-square tests and polytomous logistic regression were used to compare IDUs with different self-reported primary syringe sources used in the 6 months preceding study entry. Compared with IDUs using other syringe sources, those primarily using SEPs were less likely to be black (adjusted odds ratio 0.26 [95% CI 0.11-0.57]), more likely to inject daily (3.32 [1.58-6.98]), and more likely to inject with a new syringe (2.68 [1.30-5.54]). Compared with IDUs using other syringe sources, those primarily using pharmacies were less likely to be black (0.39 [0.17-0.90]).
CONCLUSION
These data suggest that pharmacies and SEPs may be reaching different populations of IDUs and highlight a subpopulation of highly marginalized IDUs (i.e., black race, infrequent injectors) who are underusing safe syringe sources in NYC. Targeted interventions are needed to reduce racial disparities and increase use of safe syringe outlets.
Topics: Adult; Chi-Square Distribution; Cross-Sectional Studies; Ethnicity; Female; HIV Infections; Humans; Logistic Models; Male; Needle Sharing; Needle-Exchange Programs; New York City; Pharmacies; Socioeconomic Factors; Substance Abuse, Intravenous; Surveys and Questionnaires; Syringes
PubMed: 20199954
DOI: 10.1331/JAPhA.2010.09193 -
Human Vaccines & Immunotherapeutics Sep 2021Auto-disable (AD) syringes are specifically designed to prevent syringe reuse. However, the notion that specific AD syringe designs may be unsafe due to reuse concerns...
Auto-disable (AD) syringes are specifically designed to prevent syringe reuse. However, the notion that specific AD syringe designs may be unsafe due to reuse concerns related to the syringe's activation point has surfaced. We conducted a systematic review for evidence on the association between AD syringe design and syringe reuse, adverse events following immunization (AEFI), or blood borne virus (BBV) transmission. We found no evidence of an association between AD syringe design and unsafe injection practices including syringe reuse, AEFIs, or BBVs. Authors of three records speculated about the possibility of AD syringe reuse through intentionally defeating the disabling mechanism, and one hinted at the possibility of reuse of larger-than-required syringes, but none reported any actual reuse instance. In contrast to AD syringes, standard disposable syringes continue to be reused; therefore, the global health community should expand the use of AD syringes in both immunization and therapeutic context as an essential strategy for curbing BBV transmission.
Topics: Disposable Equipment; Immunization; Immunization Programs; Injections; Syringes
PubMed: 33989509
DOI: 10.1080/21645515.2021.1911514 -
JPEN. Journal of Parenteral and Enteral... Jan 2019Since initial report in 1972, misconnections continue to be an issue, especially in hospitalized patients with multiple access devices. A new small-bore connector... (Comparative Study)
Comparative Study
BACKGROUND
Since initial report in 1972, misconnections continue to be an issue, especially in hospitalized patients with multiple access devices. A new small-bore connector standard (ENFit) has been proposed in order to minimize misconnections.
METHODS
Commercially available finalized ENFit tubes of a variety of sizes (14 French [Fr] size, 18Fr, 20Fr, 24Fr, and low-profile) were obtained for current testing. Variety of commercially available formulas including blenderized tube feeding (BTF) products (Jevity 1 Cal, Abbott Nutrition, Abbott Park, IL; Nourish, Functional Formularies, Centerville, OH; Real Food Blends, Chesterton, IN) were tested.
RESULTS
Data from individual measurements were aggregated for ENFit and legacy tubes and revealed higher syringe compression force in legacy tubes compared with ENFit tubes for 20Fr size with Jevity formula. Our institution's BTF formula revealed that legacy tubes had lower syringe compression force than ENFit tubes for 14Fr tube size. Remaining measurements revealed no significant difference. Model 1 of regression analysis revealed that only formula and tube size were significant with R of 0.63. Model 2 evaluating the impact of tube size, blender, time of blending, and legacy vs ENFit revealed that tube size, blender used, and blending time were significant with legacy vs ENFit being nonsignificant (R of 0.72).
CONCLUSIONS
Overall, only a small number of tube sizes (14Fr and 20Fr) with selected formulas revealed a significant difference between ENFit and Legacy tubes, with remaining studies finding no significant difference. Regression analysis revealed that variables such as formula, size of tube, blender used, and time of blending may have more impact on compression force.
Topics: Enteral Nutrition; Food Handling; Food, Formulated; Humans; Intubation, Gastrointestinal; Mechanical Phenomena; Medical Errors; Syringes
PubMed: 29846003
DOI: 10.1002/jpen.1174 -
Advances in Wound Care Oct 2021Opioid use disorder and transition to injection drug use (IDU) are an urgent, nationwide public health crisis. Wounds and skin and soft tissue infections (SSTIs) are...
Opioid use disorder and transition to injection drug use (IDU) are an urgent, nationwide public health crisis. Wounds and skin and soft tissue infections (SSTIs) are common complications of IDU that disproportionately affect people who inject drugs (PWID) and are a major source of morbidity and mortality for this population. Injections in a nonsterile environment and reusing or sharing needles facilitates bacterial inoculation, with subsequent risk of serious complications such as sepsis, gangrene, amputation, and death. PWID are susceptible to infections with a wide spectrum of organisms beyond common culprits of SSTI, including and spp., as well as . Syringe services programs (SSPs) are cost-effective and successful in reducing harms associated with IDU. SSPs provide new equipment to PWID and aid in discarding used equipment. SSPs aim to reduce the risks of unhygienic injecting practices, which are associated with transmission of infections and blood-borne pathogens. Concurrently run SSPs and wound care clinics are uniquely positioned to facilitate care to PWID. Providing new, sterile equipment as well as early wound care intervention can reduce morbidity and mortality as well as health care expenditures by reducing the number of SSTI and injection-related wounds that require hospital admission. Establishment of wound care clinics as part of an SSP represents an untapped potential to reduce harm.
Topics: Bacterial Infections; Drug Users; Humans; Skin Diseases, Infectious; Soft Tissue Infections; Substance Abuse, Intravenous; Syringes; United States
PubMed: 33913781
DOI: 10.1089/wound.2020.1243 -
Harm Reduction Journal Dec 2022Australian needle and syringe distribution occurs via a mix of modalities, including syringe dispensing machines (SDMs). SDMs are electronic vending machines providing...
BACKGROUND
Australian needle and syringe distribution occurs via a mix of modalities, including syringe dispensing machines (SDMs). SDMs are electronic vending machines providing (often) 24-h access to needles/syringes and may attract greater numbers of people who are younger, female, and/or have limited connection to health care services compared to individuals accessing fixed-site needle and syringe programs (NSPs). However, validating the demographic characteristics of SDM clients has proven difficult in previous research.
METHODS
In this paper, we analyse SDM order and client demographic data from four SDMs located in South-East Melbourne, Australia, and compare this against the managing fixed-site NSP between May 2017 and December 2020. SDM data were collected via a novel 0-9 numeric keypad input tool. Via the tool, SDM clients were requested to input their categorised age, gender and postcode. Given the novelty of the tool, we evaluate the feasibility of the data collection method. We analysed data according to: (1) total SDM orders made, (2) estimated 'unique SDM presentations' and (3) describing the demographics of unique SDM clients. Importantly, we noted substantial invalid demographic data, and consequently, severely restricted data for analysis.
RESULTS
There were 180,989 SDM orders made across the four SDMs to an estimated 90,488 unique SDM presentations. There was little variation in unique presentations across days of the week, but 69% occurred out of NSP operating hours. Across the study period, the SDMs distributed 66% of the number of syringes distributed by the fixed-site NSP. Due to invalid demographic data, our restriction method provided only 10,914 (6% of all data) unique presentations for analysis. There were some demographic differences between SDM and NSP client, but these should be treated with caution.
CONCLUSIONS
The data collection tool provides a novel means of comparing SDM and fixed-site presentations, demonstrating the substantial expansion of service via the SDMs. However, the validity of the demographic data was highly questionable and requires significant data coding, meaning it is not feasible for community NSPs. While we recommend the inclusion of automatically collected SDM order data, the use of a 0-9 numeric keypad to collect demographic data-while an innovation-requires alteration to support NSP data.
Topics: Humans; Female; Australia; Substance Abuse, Intravenous; Needle-Exchange Programs; Syringes; Demography
PubMed: 36544124
DOI: 10.1186/s12954-022-00726-1 -
Scientific Reports Sep 2022The objective of this study was to examine the dependence of the pressure level in the wound area on the height of the syringe needle from the wound, the gauge of the...
The objective of this study was to examine the dependence of the pressure level in the wound area on the height of the syringe needle from the wound, the gauge of the needle, and the flow rate using the Bernoulli equation. This study was the control-volume analysis using the Bernoulli equation. At a given height of the syringe needle from the wound, the gauge of the syringe needle was fixed, and the pressure in the wound area, which depended on the flow rate of the irrigation solution discharged from the tip of the needle, was calculated according to the Bernoulli equation and the definition of the flow rate. At a constant flow rate of the irrigation solution, the velocity of the irrigation solution discharged through the syringe needle decreased (7.80 → 0.80) with an increase in the diameter of the needle (18G → 14G). At a constant inner diameter of the needle, the velocity of the irrigation solution increased with a reduction in the flow rate of the solution. As the velocity of the irrigation solution increased, the pressure in the wound area increased. As the height of the syringe needle from the wound area increased, the pressure in the wound area increased. In order to maintain the pressure of 8-15 psi when nurses perform syringe-based irrigation, it is necessary to set the flow rate of the cleaning solution from 3.5 cc/s to less than 4.8 cc/s for 19G. In addition, 20G maintains the flow rate of the solution at 2.6 cc/s or more and less than 3.5 cc/s, 22G maintains the flow rate of solution at 1.3 cc/s or more and less than 1.8 cc/s, and 25G maintains the flow rate of solution at 0.5 cc/s. This study provides nurses with a reference for the flow rate at which syringe-based irrigation can be performed while maintaining the appropriate pressure based on fluid dynamics, which can be used as the basis for wound nursing standards.
Topics: Humans; Hydrodynamics; Needles; Surgical Wound Infection; Syringes; Therapeutic Irrigation
PubMed: 36056149
DOI: 10.1038/s41598-022-19402-2