Hand washing is a most basic health promotion activity. It is effective in preventing the transmission of infections, and improving general and vascular health.
Hand washing among people who inject drugs
Scott’s (2008) study indicates that very few people who inject drugs wash their hands prior to preparation, even though the majority of injections were prepared where washing facilities were accessible. Concern was expressed about the increase in bacterial infections seen in people who inject drugs. Unclean hands and skin is a valid source of such bacteria. The lack of hand washing noted in a number of studies suggests it may not be seen as important by people who inject drugs. Something recognised in New Zealand specific studies and observation.
Why is hand washing so important?
Quite simply, the importance lies primarily with eliminating the spread of the bacteria Staphylococcus aureus(S. aureus). S. aureus,the most common cause of staph infections, is frequently part of our skin flora and found in greatest concentration in the nose, throat and on skin (with site specific infection).
The spread of S. aureus is through human-to-human contact. The infection itself can be spread most easily through contact with pus from an infected wound, by skin-to-skin contact with an infected person, and contact with objects such as towels, sheets or clothing used by an infected person. An important and previously unrecognised means of transmission is during sexual contact.
S. aureus can cause a range of illnesses from minor skin infections, such as pimples, boils, cellulitis, carbuncles, and abscesses, to life-threatening diseases such as pneumonia, meningitis, endocarditis, toxic shock syndrome (TSS), chest pain, and sepsis.
People who inject drugs are often in an immune-suppressed state (compromised immune systems), due in part to their drug use and in part to particular injecting complications (such as abscesses, soft tissue infections, etc), and hence are more susceptible to infection than the general population. They are also at greater risk of complicated secondary infections.Of particular significance to treatment is that S. aureus infections are increasingly becoming multi-drug resistant.
Methicillin-resistant Staphylococcus aureus (MRSA) and multi-drug-resistant MRSA is responsible for several difficult-to-treat infections in humans. For this reason alone, good personal hygiene, hand and environmental cleanliness is increasingly more important to people who inject drugs.
Hand Hygiene New Zealand. (2009). Guidelines on hand hygiene for New Zealand hospitals.Hand Hygiene New Zealand – Ringa HoroiaAotearoa: Auckland District Health Board
Kluytmans J, van Belkum A, Verbrugh H (July 1997). Nasal carriage of Staphylococcus aureus: epidemiology, underlying mechanisms and associated risk. Clinical Microbiology Review,10 (3): 505–20.
Longtin, Y; Sax, H; Allegranzi, B; Schneider, F & Pittet, D. (2011). Hand hygiene. New England Journal of Medicine, 364:e24.
Ministry of Health.(2002).Guidelines for the control of methicillin-resistant Staphylococcus aureus in New Zealand. Ministry of Health: Wellington.
Scott, J. 2008. Safety, Risks and Outcomes from the Use of Injecting Paraphernalia. Scottish Government Social Research.