Skin and needle hygiene intervention for injection drug users: Results from a randomized, controlled Stage I pilot trial

Phillips, Kristina T.; Stein, Michael D.; Anderson, Bradley J.; Corsi, Karen F.

doi:10.1016/j.jsat.2012.01.003

Cited by 21 publications

(15 citation statements)

References 50 publications

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“…Regardless, educating PWID about the high-risk practices identified in the BIRSI should be considered as part of any behavioral intervention. Hospitalized PWID in this study have enrolled in a large RCT focused on reducing high-risk injection practices through psychoeducation, skills training, and motivational interviewing using a two-session intervention and many are expected to continue injecting (Phillips et al, 2012). Similar recent interventions have shown positive results related to reduced injection-site complications (Roux et al, 2016).…”

Section: Discussionmentioning

confidence: 99%

Risk Factors Associated With Skin and Soft Tissue Infections Among Hospitalized People Who Inject Drugs

Phillips

Anderson

Herman

et al. 2017

Journal of Addiction Medicine

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Objectives Skin and soft tissue infections (SSTIs) are common among people who inject drugs (PWID) and can lead to serious morbidity and costly emergency room and hospital utilization. A range of high-risk injection practices may contribute to these infections. The goal of the current study was to examine risk practices that were associated with SSTIs in a sample of hospitalized PWID. Methods PWID (N = 143; 40.6% female) were recruited from inpatient medical units at a large urban hospital and completed a baseline interview that focused on infection risk. Measures included demographics, substances used/injected, and self-report of SSTIs (i.e., abscesses, ulcers, or cellulitis) within the last year. The Bacterial Infections Risk Scale for Injectors (BIRSI), a 7-item index, assessed specific behaviors expected to increase the risk of acquiring SSTIs (e.g., injection without skin cleaning, intramuscular injection). Results The sample was 58% Caucasian and averaged 38.7 (SD = 10.7) years of age. Ninety-three participants (65%) reported at least one SSTI within the last year. Using a logistic regression model, the BIRSI (OR = 1.87, p = .004) and total number of injections over the last three months (OR = 2.21, p = .002) were associated with past year SSTIs. Conclusions In conclusion, rates of last year SSTIs were high in this sample of hospitalized PWID. Results suggest that interventions should target specific injection practices to reduce infection risk.

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Section: Discussionmentioning

confidence: 99%

Risk Factors Associated With Skin and Soft Tissue Infections Among Hospitalized People Who Inject Drugs

Phillips

Anderson

Herman

et al. 2017

Journal of Addiction Medicine

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“…Intervention programs with nasal decolonization and chlorhexidine body washes decrease S. aureus infection rates in surgical and dialysis patients [2, 30]. In the light of PWIDs frequent overall S. aureus colonization [1, 17, 22, 42] and high infection rates [16, 45], this group might benefit from similar interventions. Previous studies on chlorhexidine wash as a means of decreasing skin and soft tissue infections (SSTI) in American recruits did not show any significant reduction of the SSTI frequency [13], but was significantly associated with lower frequency of nasal MRSA colonization [25].…”

Section: Discussionmentioning

confidence: 99%

“…In microbiological studies, PWID are more frequently colonized with S. aureus than the average population (35% of recent injectors compared to 11% in healthy controls, P < 0.05) [42], with nasal colonization in 28–45% [1, 17, 22]. Another concern regarding S. aureus is the development and spread of methicillin-resistant S. aureus (MRSA) [4].…”

Section: Introductionmentioning

confidence: 99%

High Perineal and Overall Frequency of Staphylococcus aureus in People Who Inject Drugs, Compared to Non-Injectors

et al. 2016

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To investigate the prevalence, distribution, and colonization burden of Staphylococcus aureus (S. aureus) and MRSA in different body sites among people who inject drugs (PWID) and compare it to a control group consisting of non-injectors. In this cross-sectional survey, 49 active PWID from the needle exchange program (NEP) in Malmö, Sweden, and 60 non-injecting controls from an emergency psychiatric inpatient ward at Malmö Addiction Centre were tested for S. aureus (including MRSA) by culture, PCR, and MALDI-TOF. Samples were taken from anterior nares, throat, perineum, and skin lesions if present. Sixty-seven percent of the PWID were colonized with S. aureus, compared to 50% of the controls (P = 0.08). Perineal carriage was significantly more frequent among PWID than in the control group [37 vs 17%, OR 2.96 (95% CI 1.13–7.75), P = 0.03], also after adjusting for sex and age in multivariate analysis [OR 4.01 (95% CI 1.34–12.03)]. Only one individual in the whole cohort (NEP participant) tested positive for MRSA. PWID may be more frequently colonized with S. aureus in the perineum than non-injection drug users, and there was a trend indicating more frequent overall S. aureus colonization in PWID, as well as higher perineal colonization burden. No indication of a high MRSA prevalence among PWID in Sweden was noted. However, further MRSA prevalence studies among PWID are needed. Knowledge about S. aureus colonization is important for the prevention of S. aureus infections with high morbidity in PWID.

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“…These studies have identified a number of risk factors: including being female, frequent injecting, and intra-muscular or subcutaneous injecting; whilst skin swabbing and hand washing were identified as protective factors (Larney et al, 2017). A limited number of behavioural change intervention studies have examined SSTI; including brief interventions addressing injection site cleaning, hand cleaning or needle bleaching (Mercure, Tetu, Lamonde, & Cote, 2008;Phillips, Stein, Anderson, & Corsi, 2012). However, HR behaviours learned through such brief interventions may become irrelevant within the everyday life of a PWID (Miller, 2005).…”

Section: Introductionmentioning

confidence: 99%

The experiences of people who inject drugs of skin and soft tissue infections and harm reduction: A qualitative study

Dunleavy

Hope

Roy

et al. 2019

International Journal of Drug Policy

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Background: Bacterial skin and soft tissue infections (SSTI) among people who inject drugs (PWID) are considered a public health concern. There is a lack of qualitative research examining the lived experience of PWID who have had SSTI. This paper explores PWID views and experiences of their SSTI, their perceptions on the causes of their SSTI and their harm reduction (HR) behaviours. The implications for HR service delivery and practice will be discussed. Methods: Between October 2015-January 2016, 22 in-depth interviews were conducted with PWID who had experienced a SSTI within the past year. Interviewees were recruited from an injecting equipment provision service and a drug treatment service in Glasgow and Edinburgh respectively. The interview transcripts were transcribed verbatim and underwent thematic analysis. Results: We found that the experience of SSTI can cause strong negative feelings, including panic and stigma and that there was limited knowledge of SSTI prior to first hand experience. The awareness of the unacceptable social and physical consequences of SSTI fostered a sense of personal responsibility and agency which led to the introduction or improved HR uptake. However, when PWID were struggling to inject or when their physical and political environments were compromised there was an increased risk for SSTI and reduced effectiveness of HR. Conclusion: Compared to HCV and HIV, SSTI as an injecting related harm has received less policy attention. Policy makers need to address SSTI HR within enabling environments, such as 'safer environment interventions'. It is recommended that peer based support, improved NSP provision and medically supervised injecting facilities are needed to deliver SSTI HR.

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Skin and needle hygiene intervention for injection drug users: Results from a randomized, controlled Stage I pilot trial

Cited by 21 publications

References 50 publications

Risk Factors Associated With Skin and Soft Tissue Infections Among Hospitalized People Who Inject Drugs

Risk Factors Associated With Skin and Soft Tissue Infections Among Hospitalized People Who Inject Drugs

High Perineal and Overall Frequency of Staphylococcus aureus in People Who Inject Drugs, Compared to Non-Injectors

The experiences of people who inject drugs of skin and soft tissue infections and harm reduction: A qualitative study

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