Syringe providers applications (SSPs) are community-based prevention applications that may present a spread of providers, together with entry to and disposal of sterile syringes and injection tools, vaccination, testing for infectious illnesses resembling viral hepatitis and HIV, naloxone distribution, and linkage to infectious illness care and substance use therapy. SSPs forestall infectious illnesses, assist hyperlink purchasers to therapy for substance use problems, and have the potential to stop overdose deaths amongst individuals who inject medication.1
SSPs must be thought-about by state, native, territorial, and tribal jurisdictions as important public well being infrastructure that ought to proceed to function in the course of the COVID-19 pandemic. Throughout this time, it’s essential that SSPs have the capability to make sure the protection of employees, volunteers, and purchasers. This steerage describes actions for jurisdictional public well being authorities, in addition to SSPs, to assist the well being and well-being of their employees and the clientele they serve. SSP employees carry out quite a lot of capabilities, with some employees offering direct affected person care providers (e.g., drawing blood for infectious illness testing, responding to overdoses, treating injection-related wounds). Issues for each healthcare personnel and different staff are due to this fact included into this steerage.
Training, Prevention, and Screening for SARS-CoV-2 an infection (the virus that causes COVID-19 sickness)
- Present training to purchasers and employees (together with volunteers) forestall the unfold of SARV-CoV-2, together with inserting informative signage and provides in extremely seen locations.
- Guarantee all purchasers, employees, and volunteers put on material face coverings always to guard others. Fabric face coverings shouldn’t be positioned on anybody who has hassle respiratory, or is unconscious, incapacitated, or in any other case unable to take away the masks with out help.
- For employees offering healthcare providers (e.g., nurses), applicable PPE must be used when interacting with purchasers with suspected or confirmed COVID-19.
- Guarantee all purchasers, employees, and volunteers keep bodily distancing (staying a minimal of six ft aside) as a lot as potential throughout interactions (recognizing that this is not going to be possible for all interactions), together with employees/consumer interactions and employees/employees interactions (e.g., throughout breaks and meals).
- Remind all purchasers and employees to wash fingers with cleaning soap and water upon arrival or entry right into a facility, or use an alcohol-based hand sanitizer with at the least 60% alcohol if handwashing is just not potential and to adjust to federal, state, and native an infection management practices required in that setting.
- Contemplate offering providers open air or in an open-air house to reduce threat of transmission if satisfactory confidentiality for purchasers might be supplied. If SSP providers are performed indoors, the entire above precautions must be adopted.
- Display all purchasers for potential COVID-19 signs and up to date historical past of an in depth contact to somebody with identified or suspected COVID-19 upon getting into the SSP. Work together with your native well being division for steerage on the place to refer purchasers who’re exhibiting COVID-19 signs for diagnostic testing or for additional care, or work to rearrange/facilitate COVID-19 testing on the SSP if possible. If somebody is exhibiting any emergency warning indicators, search emergency medical care instantly.
- Any purchasers with suspected or confirmed COVID-19 ought to ideally be excluded from the power till they meet the factors for discontinuation of dwelling isolation.
- Contemplate various strategies to supply providers and tools to purchasers not allowed into the power or to purchasers who select to not enter to keep away from publicity (e.g., supply of apparatus to purchasers’ properties, telehealth service provision).
- Employees and volunteers who report COVID-19 signs ought to be despatched dwelling instantly to dwelling isolate. In the event that they expertise any of the emergency warning indicators for COVID-19, they need to search medical consideration instantly. Steerage for when it’s protected to return to work must be adopted, for healthcare personnel offering care to purchasers, and for volunteers and different employees not offering direct consumer care.
- Make sure that employees and volunteers comply with pointers for stopping an infection, and purchasers have entry to hygiene provides resembling cleaning soap, alcohol-based hand sanitizers that comprise at the least 60% alcohol, tissues, and trash baskets.
- Present hygiene provides resembling alcohol-based hand sanitizer with at the least 60% alcohol to purchasers experiencing homelessness or in any other case with out common entry to cleaning soap and water for handwashing.
- Make sure that sick go away insurance policies are versatile, non-punitive, and in line with public well being steerage. Make sure that workers and volunteers are conscious of and perceive these insurance policies. Have a contingency plan for employees absences within the occasion of sickness or different rising points. For employees who’re at greater threat for extreme sickness, implement particular insurance policies to reduce face-to-face contact, or assign work duties that enable them to keep up a distance of six ft from different staff, purchasers and guests, or to telework if potential.
Extra issues and process changes to stop SARS-CoV-2 transmission:
- Proceed to supply sterile injection tools and strategies for disposal, in addition to pores and skin cleaning provides resembling alcohol pads and hand sanitizer, to assist scale back threat of COVID-19 an infection, in addition to to stop pores and skin and comfortable tissue infections associated to unsafe injection practices.
- If crucial, change insurance policies to extend the variety of syringes every consumer can obtain per go to to allow longer intervals between visits. This apply will decrease the necessity to entry SSPs regularly and might help guarantee sterile injection within the occasion of SSP closure or restricted hours.
- Guarantee purchasers have satisfactory provides to make use of sterile tools with every injection. Dispense sufficient provides to make sure continued potential of purchasers to inject with sterile tools if SSP closure or restricted hours could occur in the course of the pandemic.
- Present provides by cell providers, supply, or mail-order providers, every time potential.
- Present counseling providers and referrals to care by phone and/or utilizing on-line instruments, the place possible.
- Overview current service provision procedures to determine methods to reduce alternatives for COVID-19 publicity and transmission.
- Contemplate decreasing or eliminating processes that contain non-essential consumer bodily contact with employees or objects (e.g., filling out paper kinds, utilizing shared writing utensils).
- Contemplate methods to shorten the length of consumer visits as applicable (e.g., eliminating redundant administrative processes).
- Cut back grouping of purchasers if potential (e.g., supply staggered consumer appointments, scale back the variety of purchasers inside at one time, guarantee purchasers keep applicable bodily distancing (minimal six ft aside) whereas ready exterior).
- Contemplate putting in a piece of clear plastic on the buyer contact space to supply barrier safety (e.g., Plexiglas kind materials or clear plastic sheet).
- Use or encourage others to make use of peer-based supply fashions (e.g., offering sufficient provides to purchasers to allow them to distribute to different individuals who inject medication who could also be unwilling or unable to go to this system) to make sure sterile provides are reaching individuals who want them most, even within the occasion of SSP closure.
- Coordinate providers with different close by SSPs and neighborhood well being applications to allow:
- Every day operations (e.g., figuring out if hours of operation can be modified to make sure that some SSP providers within the space stay open always in all communities);
- Acceptance of recent purchasers (e.g., growing or revising new affected person consumption course of); and
- New procedures for visiting clinics or receiving providers (e.g., deciding if new security measures for amenities, employees, or purchasers are crucial based mostly on the evolving scenario).
- Proceed to assist hyperlink purchasers with substance use therapy resembling treatment for opioid use dysfunction (MOUD). Work with applications providing MOUD and with behavioral well being businesses to make sure entry to 14-28 days of treatment, relying on the steadiness of the affected person. The Substance Abuse and Psychological Well being Providers Administration (SAMHSA) posted COVID-19 steerageexterior icon offering potential flexibility for Opioid Therapy Packages (OTPs) to permit applications to supply medicines for prolonged intervals, and to provoke buprenorphine therapy utilizing telehealth.
- If sterile injection tools is unavailable or can’t in any other case be supplied, present bleach, sterile water, and directionspdf icon for cleansing syringes. This doesn’t guarantee sterile injection, however could scale back the chance of infectious illness transmission.
1 Facilities for Illness Management and Prevention. (2019). Abstract of the protection and effectiveness of syringe providers applications. https://www.cdc.gov/ssp/syringe-services-programs-summary.html
Basic steerage to scale back COVID-19 transmission:
Actions to scale back threat of COVID-19: https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/get-ready.html
Advice Concerning the Use of Fabric Face Coverings, Particularly in Areas of Important Neighborhood-Based mostly Transmission: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover.html
Interim An infection Prevention and Management Suggestions for Sufferers with Suspected or Confirmed Coronavirus Illness 2019 (COVID-19) in Healthcare Settings: https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html
Interim Tips for Amassing, Dealing with, and Testing Medical Specimens from Individuals for Coronavirus Illness 2019 (COVID-19): https://www.cdc.gov/coronavirus/2019-nCoV/lab/guidelines-clinical-specimens.html?deliveryName=USCDC_2067-DM23796
Implementation of Mitigation Methods for Communities with Native COVID-19 Transmission (CDC): https://www.cdc.gov/coronavirus/2019-ncov/downloads/community-mitigation-strategy.pdfpdf icon
Steerage for healthcare personnel and different essential staff:
Interim U.S. Steerage for Danger Evaluation and Public Well being Administration of Healthcare Personnel with Potential Publicity in a Healthcare Setting to Sufferers with Coronavirus Illness (COVID-19): https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html
COVID-19 Assets for Clinics and Healthcare Amenities: https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/index.html
COVID-19 Tips for Employees Essential to Upkeep of the Infrastructure: https://www.cdc.gov/coronavirus/2019-ncov/neighborhood/critical-workers/implementing-safety-practices.html
Steerage for different amenities/teams which might be related for SSPs:
COVID-19 Assets for Neighborhood and Religion-Based mostly Leaders: https://www.cdc.gov/coronavirus/2019-ncov/neighborhood/organizations/index.html
COVID-19 Assets for Homeless Shelters: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/homelessness.html
COVID-19 Steerage for Individuals residing with HIV/AIDS: https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/hiv.html
COVID-19 Steerage for Individuals with Medical Situations: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/
Steerage on Making ready Workplaces for COVID-19 (OSHA): https://www.osha.gov/Publications/OSHA3990.pdfpdf iconexterior icon
Hurt discount sources:
Learn how to clear your syringes shopper info sheet: https://www.cdc.gov/hiv/pdf/library/pocket-guides/cdc-hiv-syringe-service-pocket-guide.pdfpdf icon
Abstract of the protection and effectiveness of syringe providers applications: https://www.cdc.gov/ssp/syringe-services-programs-summary.html
COVID-19 Steerage for Individuals who Use Medicine and Hurt Discount Packages (Hurt Discount Coalition):
Training hurt discount within the COVID-19 Outbreak: https://www.vitalstrategies.org/sources/practicing-harm-reduction-in-the-covid-19-outbreak/exterior icon