Preventing HIV Transmission The Role of Sterile Needles and Bleach (1995) / Chapter Skim
Currently Skimming:
6 THE EFFECTIVENESS OF BLEACH AS A DISINFECTANT OF INJECTION DRUG EQUIPMENT
6 THE EFFECTIVENESS OF BLEACH AS A DISINFECTANT OF INJECTION DRUG EQUIPMENT
Pages 167-197
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 167... ...
It reviews the history of bleach distribution programs and includes descriptions of these programs in San Francisco, Chicago, New York, and the various locations involved in the National AIDS Demonstration Research Project. Method variation in bleach use by injection drug users, encompassing substances and techniques used, comparisons of injection drug users who disinfect and those who do not, and problems with bleach disinfection are also discussed, as well as provisional federal regulations and the extension of bleach distribution programs.
|
From page 168... ...
, the use of bleach to clean and disinfect previously used needles and syringes has been encouraged by outreach workers in an attempt to improve the safety of the inherently unsafe practice of sharing needles and syringes among injection drug users. This chapter reviews the scientific literature on the efficacy of bleach as a disinfectant and the effectiveness of bleach distribution programs on reducing the potential harmful effects associated with injection drug use risk behaviors and HIV transmission.
|
From page 169... ...
As a result, HIV-infected injection drug users are likely to be able to transmit the virus to others by sharing injection equipment throughout the entire course of their infection. Increasing levels of HIV and lIIVinfected cells appear in the blood of infected persons as immune containment of virus replication fails and clinical disease becomes manifest.
|
From page 170... ...
Furthermore, the effectiveness of a disinfection procedure is influenced significantly by a number of factors, including the nature and number of contaminating microorganisms, the type and condition of the materials to be disinfected, and the amount of organic matter (such as blood) present (Klein and Deforest, 1965a; Rhame, 1986; Rutala and Weber, 1987; Rutala, 1987; Van Houton and Hayre, 1991~.
|
From page 171... ...
. Household bleach manufactured in the United States contains approximately 5 percent sodium hypochlorite (50,000 milligrams per milliliter chlorine tC121~.
|
From page 172... ...
The virus present in such supernatants is not associated with infected cells, and this is referred to as cell-free virus. The infectious titer of cell-free HIV found in tissue culture supernatants ranges from 104 to 106 tissue culture infectious doses (TCID)
|
From page 173... ...
For these reasons, the experimental methods that have been used to monitor HIV inactivation by disinfectants have (to various degrees) approximated, but not reproduced, the circumstances through which HIV transmission occurs between injection drug users sharing contaminated injection equipment.
|
From page 174... ...
, examined the inactivation of cell-free HIV by commonly used disinfectants. Their results suggested that 25 percent ethanol or 1 percent glutaraldehyde should be sufficient to disinfect medical instruments, and that 0.2 percent sodium hypochlorite should be sufficient to disinfect contaminated environmental surfaces.
|
From page 175... ...
In sum, when used appropriately, there is no doubt that bleach can effectively disinfect surfaces contaminated by HIV-infected blood. BLEACH DISTRIBUTION PROGRAMS In the mid-1980s, the recognition of an impending epidemic in the spread of HIV infection in injection drug users led to discussion among health care professionals and providers concerning potential intervention strategies to limit virus transmission.
|
From page 176... ...
The initial bleach distribution efforts were part of a broader education program to decrease the risk of HIV infection among injection drug users that included condom distribution and voluntary HIV counseling and testing. The educational message delivered was: "The best protection is to stop using drugs; if you can't stop using, don't inject; if you can't stop injecting, at least keep your own outfit and don't share it with anyone; if you do share, use bleach to reduce your risk." The recommended protocol for bleach disinfection was to fill needles and syringes twice with bleach, followed by two water rinses (Newmeyer, 1988; Froner et al., 1987; Watters, 1987~.
|
From page 177... ...
increases in bleach use, they noted important additional effects of outreach efforts that included bleach distribution on other HIV-related risk behaviors, including decreases in needle sharing and increases in condom use (Chaisson et al., 1987; Sorenson et al., 1989~. Moreover, in these early studies of the adoption of bleach disinfection by injection drug users, a significant positive relationship was observed between access to community health outreach workers and reported use of bleach disinfection (Watters, 1987~.
|
From page 178... ...
Similarly, researchers in New York (Friedman et al., 1990) helped form an organization of injection drug users in an effort to decrease HIV risk behaviors.
|
From page 179... ...
Crack cocaine-smoking injection drug users are also more likely to use unsafe needles and to share rinse water, cookers, and cotton (Edlin et al., 1993~. Injection drug users who disinfect their injection equipment with bleach or alcohol are also more likely to be acquainted with other HIV risk reduction behaviors (Celentano et al., 1991~.
|
From page 180... ...
formed the basis of the program evaluation component of this project. As such, these data represent a fraction of the total number of injection drug users who were served (or at least assessed)
|
From page 181... ...
Chicago's program represents the more intensive end of the range of NADR outreach programs in the frequency and duration of contacts that take place between street outreach workers and networks of injection drug users. As stated above, this program cannot be considered simply a bleach distribution program, although it uses bleach and other injection supplies as tools to facilitate interaction with street addicts and to reduce injection harm.
|
From page 182... ...
The sample of 641 seronegative injection drug users was primarily male (76 percent) ; about two-thirds were age 40 or younger; somewhat more than half were African American, 26 percent white, and 18 percent Hispanic; and almost half reported injecting twice a day or more at recruitment.
|
From page 183... ...
The prevalence of self-reported needle sharing among 500 injection drug user treatment entrants surveyed in 1992 was 67 percent. The higher rates of risky injections found in these independent samples of injection drug users in the same communities lend some credence to the potential causal effect of the intervention on the observed decline in injection drug-use risk behaviors and lIIV seroconversion.
|
From page 184... ...
184 Cal ._ .
|
From page 185... ...
reported that injection drug users in the study group most frequently reduced risk not by always using bleach to clean injection equipment, but, rather, by eliminating the sharing of syringes and other injection equipment altogether. These changes in injection practices occurred over a time when there was no syringe exchange in Chicago, nor were there local laws permitting the possession of
|
From page 186... ...
Limitations of Bleach Disinfection Although bleach, when properly used, provides an effective disinfectant in the health care setting, a number of variables may limit its effectiveness when used by injection drug users to disinfect contaminated needles and syringes. The physical and biological parameters that govern the effectiveness of any disinfectant (discussed earlier in this chapter)
|
From page 187... ...
behaviors." Impact of Bleach Disinfection on HIV Transmission If disinfection of injection equipment is an effective means of preventing HIV infection, then HIV seroconversion rates would be expected to be lower among injection drug users who consistently disinfect their injection equipment. Prior to the initiation of the original CHOW program in San Francisco, Chaisson and colleagues (1987)
|
From page 188... ...
It remains to be established whether these disappointing results derive from exaggerated reporting of injection drug users about their actual disinfection practices, the use of inadequate disinfection methods, contamination of water or ancillary injection paraphernalia with HIV, or the inability of bleach or alcohol to effectively disinfect contaminated needles and syringes within the context of their actual use by injection drug users. Responding to concerns arising from laboratory studies about prevailing methods for bleach inactivation of HIV and epidemiologic studies that suggest little, if any, protective effect of needle and syringe disinfection efforts, the Centers for Disease Control, the National Institute on Drug Abuse, and the Center for Substance Abuse Treatment (CSAT)
|
From page 189... ...
Other outreach workers have expressed concern that changing the guidelines undermines their credibility with injection drug users (Haverkos and Jones, 1994~. Whereas implementing these recommendations is likely to increase the effectiveness of bleach disinfection of needles and syringes, the lack of adequate laboratory models of injection equipment disinfection makes this difficult to document.
|
From page 190... ...
Unfortunately, evaluation and epidemiologic studies performed to date do not clearly identify the reasons for the similar rates of incident HIV infections reported between those who always clean their needles and syringes and those who never do. It is not yet known whether this results from inadequate disinfection techniques used by injection drug users who become infected, their overestimation of the frequency of their use of needle and syringe disinfection in interviews with researchers, or physical or biological factors that compromise the ability of bleach, a potent disinfectant in other circumstances, to effectively disinfect contaminated injection equipment.
|
From page 191... ...
Bleach distribution programs have been a popular and effective component of community health outreach efforts to decrease [IIV risk behaviors among injection drug users. Continued advocacy of bleach disinfection will be necessary even if sterile needles and syringes become more widely available through exchange programs or the relaxation of prescription laws.
|
From page 192... ...
As the reader will note, this cohort of injection drug users (which represented a sizable proportion of the needle exchange sample) had experienced substantial reductions in drug-use risk behavior and HIV incidence prior to the needle exchange evaluation study.
|
From page 193... ...
1993 Injection Drug Users Willingness to Adopt New Bleaching Recommendations. A paper presented at the 6th Annual AIDS Update in San Francisco, California.
|
From page 194... ...
Celentano, and T.S. Jones 1994 Inadequate bleach contact times during syringe cleaning among injection drug users.
|
From page 195... ...
National Institute on Drug Abuse 1994 OutreachiRisk Reduction Strategies for Changing HIV-Related Risk Behaviors Among Injection Drug Users: The National AIDS Demonstration Research (NADR) Project.
|
From page 196... ...
Nelson 1993 Difference in risk factors for human immunodeficiency virus type 1 seroconversion among male and female intravenous drug users. American Journal of Epidemiology 137:892-898.
|
From page 197... ...
Beatrice 1994 Bleach use and HIV seroconversion among New York City injection drug users. Journal of Acquired Immune Deficiency Syndromes 7(7)
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.