Workforce Safety for Syringe Services Programs (SSP)

Transcription

1 Workforce Safety for Syringe Services Programs (SSP) March 19, 2018

2 Presenters Joanna Berton Martinez, MPH Senior Trainer, Harm Reduction Coalition (HRC) Emma Roberts, Director of Capacity Building Services Harm Reduction Coalition (HRC) Haley Coles, Director, Sonoran Prevention Works Adrian Neil, Jr., AIDS United (AU)

3 Capacity Building Strategic Grantmaking Formative Research Policy & Advocacy Ending AIDS

4 Getting to Zero CBA Program AIDS United s Getting to Zero capacity building assistance (CBA) program, in partnership with the Harm Reduction Coalition and The Bridging Group, provides free technical assistance and training to community-based organizations (CBOs) across the country. CBA providers offer CBOs tailored, results-oriented assistance focused on: Strengthening HIV prevention efforts among people living with and at high risk for contracting HIV; Organizational and program development best practices to improve impact and sustainability; and Evidence-based interventions: WILLOW, Project Start +, and Healthy Relationships G2Zero works in partnership with: To learn more about the Getting to Zero program, cba@aidsunited.org.

5 Harm Reduction Coalition POLICY & ADVOCACY TRAINING & CAPACITY BUILDING OVERDOSE PREVENTION & ADVOCACY NATIONAL & REGIONAL CONFERENCES RESOURCES & PUBLICATIONS Harm Reduction Coalition creates spaces for dialogue and action that help heal the harms caused by racialized drug policies.

6 Mission: To end health disparities faced by those made vulnerable by drug use in Arizona through harm reduction focused education, advocacy, and evidence-based programming Vision: Removing barriers to facilitate empowerment, health equity, and dignity for Arizonans impacted by drug use

7 Webinar Goal The goal of this webinar is to promote best practices for workforce safety, including OSHA compliance, among community organizations directly and indirectly funded by CDC to implement HIV prevention services, including syringe services programs (SSP).

8 Learning Objectives By the end of the session, participants will be able to: 1. Identify bloodborne pathogens to prevent during SSP delivery 2. Identify measures an SSP can put in place for workforce safety 3. Describe harm reduction strategies to reduce exposure to blood borne pathogens

9 Glossary ECP OPIM PPE PWID PWUD PLWHA SAS SSP Exposure Control Plan Other Potentially Infectious Material Personal Protective Equipment People Who Inject Drugs People Who Use Drugs People Living with HIV/AIDS Syringe Access Services Syringe Services Programs

10 Webinar Outline I. Syringe Service Programs: An Effective Intervention a. The Need for SSPs b. The Benefits of SSPs: HIV Prevention, HCV Reduction, Overdose Response c. Federal Funding Guidelines II. Bloodborne Pathogens: Prevention at an SSP a. What is the Risk III. OSHA and Universal Precautions a. Sharps and Used Sharps b. Proper Disposal c. Other Potentially Infectious Material (OPIM) IV. Exposure Control Plan and Accidental Needlestick Protocols a. SSP-Specific Exposure Control Plans b. Preventing Accidental Needlesticks and Post-exposure Protocols V. Harm Reduction and Best Practices for SSPs a. Safety First! VI. Question and Answer Session a. Technical Assistance b. Recommended Resources

11 Part I Syringe Services Programs: An Effective Intervention

12 SSPs Provide: Sterile needles and syringes Safe disposal Referrals to treatment Overdose education Hep A + B vaccinations HIV and hepatitis prevention services and linkage to care Centers for Disease Control and Prevention, Infographic

13 The Need for SSPs Among PWID who self-reported, more than one out of four (27%) shared injection equipment during the preceding 12 months. 1 PWUD performed the majority (82.8%) of reported overdose reversals. 2 1 HIV Infection and HIV-Associated Behaviors Among Persons Who Inject Drugs 20 Cities, United States, MMWR Opioid Overdose Prevention Programs Providing Naloxone to Laypersons United States, MMWR 2015 Photo Credit: Doug Wilson. Dave Purchase handing out syringes on his own in Tacoma, Wash., in the late 1980s. New York Times, January 27, 2013

14 The Benefits of SSPs Prevent HIV and engage people living with HIV into care Prevent hepatitis B Reduce hepatitis C Get naloxone to the people who are most likely to reverse an opiate-overdose Are more likely to link someone into drug treatment and/or link people living with HIV to care than individuals not participating in an SSP Centers for Disease Control and Prevention, Infographic

15 Federal Funding Guidelines Funds can be used for: Staff Supplies (e.g., alcohol pads, sterile water, cotton) Testing kits for viral hepatitis and HIV Syringe disposal services Navigation services to ensure linkage to services Provision of naloxone to reverse drug overdoses Communication, outreach and educational materials Condoms Planning and evaluation activities Funds cannot be used for: The purchase of sterile needles or syringes The Consolidated Appropriations Act of 2016 restricts the use of federal funds for SSPs. Department of Health and Human Services Implementation Guidance to Support Certain Components of Syringe Services Programs, 2016

16 Part II Bloodborne Pathogens: Prevention at an SSP

17 Bloodborne Pathogens Bloodborne pathogens are viruses, bacteria, and other microorganisms that are present in human blood or other potentially infectious materials (OPIM) and can cause disease in humans. They are spread when the bodily fluids of an infected person enter the blood stream of another person.

18 Examples of Bloodborne Pathogens HIV Hepatitis B Hepatitis C Syphilis Centers for Disease Control and Prevention, Infographic

19 What is the Risk? Accidental needlesticks are low in occurrence at SSPs With proper training, the likelihood for an accidental needlestick at the worksite reduces significantly Photo Credit: CDC/Debora Cartagena

20 SSP Tip #1 An SSP can start prevention measures today by training new workers about bloodborne pathogen prevention upon hiring, staff or volunteer orientation, and once a year together as a team.

21 Part III OSHA and Universal Precautions

22 What is OSHA and why is it relevant to SSPs? OSHA = Occupational Safety Health Administration OSHA created a Bloodborne Pathogen Standard designed to protect at-risk employees from exposure to blood and OPIM United States Department of Labor, OSHA

23 OSHA s Bloodborne Pathogen Standard Employees and healthcare workers covered by this standard include those who: Have direct patient/resident contact Draw blood Work with blood and other bodily fluid specimens Handle contaminated equipment, biohazardous or infectious waste Clean up blood spills or blood by-products

24 Universal Precautions Universal Precautions is an approach to infection control to treat all human blood and certain human body fluids as if they were known to be infectious for HIV, HBV and other bloodborne pathogens. United States Department of Labor, OSHA

25 Sharps Sharps is a medical term for devices with sharp points or edges that can puncture or cut skin For SSPs, this is typically a syringe or needle but can also be other materials related to drug use Examples of sharps: needles, syringes, lancets, auto injectors Photo Credit: George Hodan

26 Used Sharps Used Sharps is when the device has been used and is no longer new or sterile. Applying Universal Precautions is acting as if the used sharp has been infected, even if you re not sure

27 SSP-Specific Universal Precautions If a syringe is found, act as if it has been used and apply Universal Precautions to dispose of properly.

28 Proper Disposal Used Sharps Locate sharps container Open lid Put on a glove nitrile, latex, vinyl Pick up syringe by the barrel Drop *point down* Close lid Dispose of glove in trash Wash your hands Photo Credit: George Hodan

29 U.S. Food and Drug Administration

30 Sharps Container Safety All SSP sharps containers should be: Made of a heavy-duty plastic Leak-resistant Able to close with a tight-fitting lid, without sharps being able to come out but with a flap or door to be able to drop sharps in Upright and stable during use Properly labeled and color coded Locked down and secured un-openable when ¾ full

31 Example from the Field A When syringe services programming is conducted from a van or vehicle, extra care is needed to secure the sharps container during transport.

32 SSP Tip #2 Once the perimeter of a lid for a sharps container has been secured on all-four sides, do not try to remove it as the hard plastic can cut your hand, and create an accidental bodily opening.

33 SSP Tip #3 Never handle another person s sharps container. Photo Credit: Martin Danielsson

34 SSP Tip #4 DISCOURAGE program participants from transporting used sharps in a plastic or paper bag. This is to avoid a needle from poking through This is for everybody s safety

35 Other Potentially Infectious Material (OPIM) For an SSP, other potentially infectious material would pertain to:... human body fluids: semen, vaginal secretions... any body fluid that is visibly contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids

36 SSP-Specific OPIM Used safer injection supplies like an alcohol wipes, band-aids, tourniquets, cotton filters, wound care dressing Items such as used condoms or tampons during outreach A blood spill on the bathroom floor, or surface area of a used sharps container Hepatitis C Prevention Poster (HRC)

37 Proper Disposal OPIM Dispose of OPIM properly Put on a glove nitrile, latex, vinyl Pick up material Dispose in trash container with a plastic liner If on mobile outreach: Use a bag or Use a glove as a bag Dispose in trash Wash hands

38 Example from the Field B In 2015, an HIV outbreak in rural Indiana was linked to PWID needle sharing More than 200 people infected with HIV as of 2017 More than 100 people co-infected with hepatitis C

39 Part IV Exposure Control Plan and Accidental Needlestick Protocols

40 What is an Exposure Control Plan (ECP)? Written description of safety measures to use at the worksite to prevent bloodborne pathogen transmission Procedures to follow if an exposure does occur OSHA R 2003 Occupational Safety and Health Administration Model Exposure Control Plan

41 SSP-Specific ECP Elements List job types that could present an exposure Explain how to prevent an exposure List protective equipment/supplies workers use Describe where safety equipment/supplies are located Identify where used sharps containers are stored Post hepatitis B vaccination availability Know procedures if someone is accidently stuck Cover training topic check-list with new workers

42 Best Practices for Implementing ECP Workers put ECP safety measures in practice so as to minimize or eliminate workplace exposure. Supervisors are responsible for ensuring the ECP is followed and provisions are made available to the workforce: Provide a copy of the program s ECP to workers upon orientation and at the SSP Enforce compliance Ensure new workers are properly trained Ensure all-staff attend a training once a year Make sure safety supplies and bio-hazardous disposal are in place Perform follow-up procedures if there is an exposure

43 Hepatitis B Vaccination Series Provide workforce option for Hep B vaccine series at no cost to the worker If person opts out, ask that they sign a declination form If they change their mind, provide the vaccination Photo Credit: CDC/Carlos Alonso OSHA Hepatitis B Vaccination Protection Fact Sheet

44 Personal Protective Equipment PPE is equipment worn to minimize exposure that can cause workplace injuries and illnesses. PPE is to be readily available and provided at no cost to the worker PPE is typically a selection of gloves in all sizes, at an SSP: nitrile, latex, vinyl (1 or 2 choices) puncture resistant Photo Credit: CDC/Amanda Mills

45 SSP Tip #5 If your SSP does not provide hepatitis B vaccinations on-site make arrangements for SSP workforce to go to a nearby clinic or see if a registered nurse can visit SSP to provide services to all staff. Centers for Disease Control and Prevention, Infographic

46 SSP Specific Safety Equipment and Supplies Other SSP safety tools include: Sharps container and lids Thick, large, red plastic liners Plastic bags for regular trash Bleach Paper towels Finger cots Band-aids Tongs* U.S. Food and Drug Administration

47 SSP Tip #6 If you have a cut on your finger, cover it with a band-aid and put on a finger cot.

48 Example from the Field C During community needle sweeps or outreach, if a syringe is discovered but is hard to reach, such as under a garbage dumpster, what safety protocols should staff follow?

49 Preventing Accidental Needlesticks at SSP Do not handle another person s used sharps/container Do not rush an exchange Be mindful of your surroundings If you find a syringe on the ground, dispose of properly or notify another SSP worker Centers for Disease Control and Prevention, Infographic

50 Post-Exposure Protocols 1. Wash needlestick or cut with soap and water 2. Report the incident to SSP supervisor 3. Seek medical treatment options immediately Photo Credit: Paul Brennan

51 Post-Exposure Prophylaxis (PEP) PEP uses antiretroviral medicines to prevent HIV infection Most effective when initiated immediately after exposure, must be taken within 72 hours Regimen lasts 28 days Only works if HIV-negative before exposure Getting on PEP immediately after exposure can prevent HIV There is no PEP equivalent for Hepatitis C, to date Get PEP treatment at nearest Urgent Care or ER

52 SSP Tip #7 Accidental needlesticks are rare at an SSP. Have a plan and make sure SSP workers and supervisors know protocols to promote prevention.

53 Part V HIV Prevention, Harm Reduction, and Best Practices for SSPs

54 HIV Prevention, Harm Reduction, and SSPs Addressing HIV Prevention via SSPs includes applying strategies such as: Incorporation of HIV testing, referral, & linkage to care Provision of HIV prevention information & condom distribution PrEP (pre-exposure prophylaxis) education & referral HIV and SSP integration facilitates more responsive service provision.

55 HIV Prevention, Harm Reduction, and SSPs Addressing HIV Prevention via SSPs includes applying culturally humble strategies such as: Treating participants with respect and dignity Involving the community in program implementation Recognizing socioeconomic inequalities Providing low-threshold services Being practical and realistic

56 Example from the Field D During SSP service provision, a participant discloses HIV positive status and being out of care. What best practices should staff follow?

57 Safety First! No matter how important SSP work is, put Safety First! Work in two s Wear closed-toe shoes Wear clothing that covers your legs Don t rush, tell participants one at a time Avoid getting crowded, tell participants make a line Keep a flashlight in SSP vehicle or back pack

58 Hand Washing Is the #1 thing you can do to prevent disease After disposing of used sharps and OPIM Before and after each SSP shift Before eating food on break After sneezing then serving the public Before and after using the restroom facilities

59 Ready With the Referrals Have some information ready if someone asks about: HIV testing Linkage to HIV care PrEP Detox Drug treatment Abscess care STI clinic Food pantry Temporary shelter What else?

60 Part VI Question and Answer

61 In Need of Technical Assistance? AIDS United s Getting to Zero capacity building assistance (CBA) program, in partnership with the Harm Reduction Coalition and The Bridging Group, provides free technical assistance and training to community-based organizations (CBOs) across the country. CBA providers offer CBOs tailored, results-oriented assistance focused on: Strengthening HIV prevention efforts among people living with and at high risk for contracting HIV; Organizational and program development best practices to improve impact and sustainability; and Evidence-based interventions: WILLOW, Project Start +, and Healthy Relationships G2Zero works in partnership with: To learn more about the Getting to Zero program, cba@aidsunited.org.

62 Recommended Resources Harm Reduction Coalition Capacity Building, Syringe Access Tools, and Policy and Advocacy Resources AIDS United Syringe Services Programs: Improving the Health of People Who Use Drugs Securing the Link: A Guide to Support Individuals Returning to the Community from Jail Syringe Access Fund (Grant Opportunities, Syringe Access Policy Organizing, and Informational Resources) Develop an Exposure Control Plan Prevent Needlestick and Sharps Injuries Sample Exposure Control Plan OSHA webpage about Universal Precautions

63 Questions?

64 Acknowledgements AIDS United acknowledges our partners the Harm Reduction Coalition and Sonoran Prevention Works for their leadership in content development and delivery of this webinar.

65

66 Thank you! March 19, 2018