Tag: Hacks for Preventing Escalation

Basic universal precautions for surfaces that should be used at each harm reduction services sites include:

• All surfaces touched by supplies should be wiped down with a broad-spectrum antimicrobial surface cleaner at the beginning and end of each shift.
• Harm reduction staff or volunteers should wipe down all surfaces used by more than one person, including pens, clipboards, chairs, desks, cabinet fronts, floors, doors, steering wheels, and so on. This should be done regularly/at least once per month with a broad spectrum anti-microbial surface cleaner.

Harm reduction providers should, as a matter of course, include environmental cleanup of syringe litter and paraphernalia in and around where they provide services. The benefits of providing this kind of cleanup cannot be overstated. Not only will you be able to prevent needlestick injury in the community, you’ll also create goodwill with neighbors and others.

In order to do this properly, workers should never handle used sharps or supplies with bare hands. Instead, they should wear medical or work gloves and use tongs or other tools to pick up each syringe or piece of litter, one at a time, putting them in a sharps container. Workers should also wear gloves.

In general, exposed syringes, that is, unpackaged, unused single syringes, and safer injection supplies such as cottons, cookers, tourniquets, etc. should always be treated with universal precautions. This means that staff and volunteers should never handle them without gloves and/or proper precautions, even if they are capped. Syringes that are still in containers such as boxes or bags are not subject to universal precautions.

Safer injection supplies, especially used supplies, should always be treated with universal precautions. This means that staff and volunteers should never handle any supplies or equipment that might enter a participant’s body without gloves and/or proper precautions.

Safety for Accepting Used Equipment

Used syringes should always be treated with universal precautions and as if they are contaminated. Harm reduction workers should never use bare hands to handle used sharps or sharps containers. Instead, they should use gloved hands to open the large sharps container, and ask participants to place their used syringes and waste inside. The exchange worker who manages the sharps container on the shift should wear gloves throughout the shift to avoid cross-contamination.

REMINDER: Avoid Cross-Contamination

Harm reduction workers can avoid cross-contamination by being mindful not to touch any used object and then a new one, such as a used syringe and then new supplies. Instead, harm reduction workers should change or remove gloves in-between to handle another object or set of objects.

To help prevent needlestick injury and pathogen exposure, harm reduction workers should always wear closed shoes while working. Flat shoes that are comfortable for walking, made of leather or another heavy material, are also recommended but not required.

Harm reduction workers are advised to wear long pants made of heavier denim or canvas to site. If skirts or shorts are worn, they should be of heavier fabric and reach at least to the knee. Be thoughtful about wearing dangling jewelry or other accessories that might get caught on things.

Proper hand washing is crucial to preventing the spread of infection, and staff and volunteers are encouraged to wash their hands several times a day and are instructed to do so before and after each shift and after handling any used supplies.

To hand wash properly: jewelry on the hands or wrists (such as rings and stones) should be removed prior to washing. Use running water, soap lather, and friction to clean all surfaces of the hands for at least 30 seconds. Next, rinse well with running water and dry one’s hands with paper towels. If soap and water are not available, use an alcohol-based hand sanitizer of at least 70% isopropyl alcohol with the understanding that it is not as effective as hand washing.

Infectious diseases have always been humanity’s companions and are spread in a myriad of ways. Direct contact infectious disease transmission occurs when there is physical contact between an infected person and a susceptible person, such as with a sexually transmitted disease or respiratory illness. Indirect contact transmission occurs when there is no direct human-to-human contact. Indirect contact occurs from a reservoir like a used surface or objects, or from vectors such as mosquitoes or ticks.

Direct contact infections spread when disease-causing microorganisms pass from the infected person to the healthy person via direct physical contact with blood or body fluids. Examples of direct contact are touching, kissing, sexual contact, contact with oral secretions, or contact with body lesions.

Indirect contact infections spread when an infected person sneezes or coughs, sending infectious droplets into the air. If healthy people inhale the infectious droplets, or if the expelled droplets land directly in their eyes, nose, or mouth, they risk becoming ill.

Droplets generally travel between three and six feet and land on surfaces or objects including tables, doorknobs, and telephones. Healthy people can breathe these directly or touch used objects with their hands, and then touch their eyes, nose, or mouth.

Universal precautions for pathogen control were initially developed for medical providers during the beginning of the HIV epidemic. Though pathogen control had been practiced in medicine since the 19^th century, using universal precautions was a new approach because it starts with the assumption that everyone and all used materials are a potential risk for pathogen transmission. Starting from that assumption, universal precautions treat every situation, person, and all materials as if they are a potential risk for pathogen transmission.

REMINDER: Get Vaccinated

With few exceptions, harm reduction workers should be required to be vaccinated for all of the following:

• COVID—annually
• Influenza—annually
• Tetanus—every 10 years
• Hepatitis A—every 20 years
• Hepatitis B—lifetime after third shot

A disproportionate number of people who suffer from a disordered relationship with substances also suffer from a physical disability. By some estimates, twice as many people who use drugs have a physical disability as the rest of the population. Because of this, it’s essential that harm reduction organizations think carefully about the disability-related accommodations their spaces make for people who might have physical limitations. This especially includes physical accommodations and communication accommodations.
These accommodations include:

Building Entrances and Exits: Ensure that entrances and exits are at least 32 inches wide. This is the standard necessary for a wheelchair to pass. Doorways should also be clearly marked with signage.

Walkways: Ensure that pathways are clear and at least 36 inches wide for wheelchair access.

Restrooms: Ensure restrooms have accessible stalls, sinks, and fixtures.

Seating: Try to ensure that there’s always at least some seating available for people who have trouble standing for long periods of time.

Signage: Provide signage that is clear, visible, and in braille where possible, for easy navigation.

Assistive Technology: If possible, offer assistive listening devices, captioning services, and other technologies to aid communication for individuals with hearing or vision impairments.

Information and Communication: Ensure that information and communication, including websites, are accessible to people with disabilities (e.g., screen reader compatibility, captioned videos). Make use of the Web Content Accessibility Guidelines when designing websites.

Language Accessibility: Though not disability accessibility per se, language accessibility is still critical. Make signage, paperwork, and educational materials available in common non-English languages like Spanish or whatever is most common in your community. For languages that are less common in your community, think about using a live translation service like the Language Line.

Parking: If applicable, provide designated accessible parking spaces with proper signage and access aisles.