Practices surrounding syringe acquisition and disposal: effects of Syringe Exchange Programmes from different Brazilian regions—the AjUDE-Brasil II Project

The study describes practices relating to syringe acquisition and disposal by Syringe Exchange Programme (SEP) participants. A cross-sectional multi-city study enrolled 857 injection drug users (IDUs) from six SEPs in different Brazilian regions, and assessed self-reported acquisition and disposal behaviours. Seven hundred and nine males (82.9%) and 146 females (17.1%) were recruited through outreach and interviewed, most from the streets or their neighbourhoods (54.1%). The average age was 28.5 years; 76.4% reported injecting cocaine in the past 6 months. Sources for acquiring new syringes differed significantly between time of injection drug use debut and the 6 months prior to interview. Fifty-three percent of IDUs reported acquiring their syringes in pharmacies when they initiated injection drug use, whereas most reported acquiring new syringes in the 6 months before interview from several simultaneous sources: 69% through SEPs; 58% through pharmacies; 36% from friends and/or sexual partners; and 17% from other health services. Across SEPs, acquisition and disposal varied widely. Most interviewees discarded their syringes on the streets, in open fields, or in the garbage or sewage. Restrictions on syringe availability and unsafe practices may be functioning as barriers to the public health recommendation of one-time use of sterile syringes for IDUs and discouraging community support to SEPs. Further increase in access to legal, inexpensive and timely sterile syringes, as well as counselling about the merits of one-time use and safer disposal must be reinforced as part of efforts to minimise high-risk behaviours and curb the spread of blood-borne infections.     

改良直接注射法在SPECT显像应用的探讨

目的:探讨改良直接注射法在SPECT显像应用的效果。方法:将100例进行SPECT显像的患者,随机分成两组,用传统直接注射法和改良直接注射法注射99mTc-标记化合物。测量医护人员完成操作时间和注射器内放射性残留量。结果:传统直接注射法残留放射性活度明显高于改良直接注射法(P<0.01),而两者操作时间差异无统计学意义(P>0.05)。结论:改良直接注射法能显著减少注射器内放射性显像剂残留,保证SPECT检查质量。     

Stability of buprenorphine, haloperidol and glycopyrrolate mixture in a 0.9 % sodium chloride solution

Combinations of opioids and adjuvant drug solutions are often used in clinical practice while little information is available on their microbiological or chemical stability. Currently there are no commercially available, prepacked, readytouse epidural or subcutaneous mixtures. Thus, epidural and subcutaneous analgesic mixtures must be prepared in the pharmacy on an asneeded basis. Such mixtures are typically used for the treatment of severe pain in cancer patients. The aim of this study was to investigate the microbiological and chemical stability of a buprenorphine, haloperidol and glycopyrrolate mixture in a 0.9% sodium chloride solution. A high performance liquid chromatographic (HPLC) method and pHmeter were used to conduct the analyses. Antimicrobial activity of each component was studied by an agar dilution method. According to the results from the chemical and microbiological stability studies, this mixture can be stored in polypropylene (PP) syringes and polyvinyl chloride (PVC) medication cassettes for at least 30 days at either 21 °C or 4 °C, and for 16 days in PP syringes at 36 °C, and for 9 days in PVC medication cassettes at 36 °C.     

An observational pilot study of a novel loss of resistance syringe for locating the epidural space

BackgroundThe EpiFaith® syringe is a novel loss-of-resistance syringe that utilizes a spring-loaded plunger that automatically moves forward within the syringe when there is a loss of resistance. We evaluated the syringe in a clinical setting among a cohort of pregnant women receiving neuraxial labor analgesia.MethodsIn a non-randomized observational study, four anesthesiologists used the EpiFaith® syringe 10 times each while placing epidural catheters for labor analgesia. The anesthesiologists scored each placement on an 11-point Likert scale (−5 = absolutely worse, 0 = the same, and 5 = absolutely better than using their regular loss-of-resistance syringe technique).ResultsAll 40 neuraxial placements correctly located the epidural space. Air was used in the syringe in 35 of the 40 cases. In 50%, 27.5% and 22.5% of cases the anesthesiologists reported that using the EpiFaith® syringe was better than, the same as, or worse than using their regular syringe, respectively. There were no inadvertent dural punctures.ConclusionsThis feasibility study found that three of the four anesthesiologists scored the EpiFaith® syringe as better or the same as using their regular loss-of-resistance syringe. More extensive studies are required to determine if the EpiFaith® syringe reduces adverse outcomes such as unintentional dural punctures.     

Needle and syringe provision and disposal in an Australian regional centre

The aim of this study was to investigate the provision and disposal of needles and syringes in Geelong, Victoria, supplying a comparison of needles provided to needles returned through needle and syringe programmes (NSPs), needles disposed of in 'Sharpsafe' bins and needles discarded. This study combined quantitative data obtained from a number of sources and qualitative data obtained from 60 interviews. An average of 18,337 (SD = 2796) per month were dispensed from NSPs and an average of 5576 needles are returned to NSP sites in Geelong per month. For the current year, 450 needles and syringes per month were placed in publicly located disposal bins. On average there were 19 callouts to discarded needles per month in the Geelong region and these needles constituted 0.38% of the monthly average of needles provided through NSPs. It was concluded that, while discarded needles are of major community concern, the vast majority of needles and syringes provided in this regional centre are not discarded. Findings are discussed in relation to the current laws surrounding the possession of injecting equipment.     

Survival of HIV-1 in Syringes: Effects of Temperature during Storage

In a previous paper we demonstrated that HIV-1 survival in syringes was strongly associated with the volume of blood remaining and with the duration of storage at room temperature. The current study was performed to determine the effects of storage temperature upon the survival of HIV-1 inside syringes. At 4°C, 50% of all syringes contained viable HIV-1 at 42 days of storage, the longest storage duration tested. At room temperature (20°C), the last day that syringes with 2 μl of infected blood were positive was Day 21, and viable HIV-1 was recovered from 8% of syringes. The last day on which syringes with 20 μl were positive was Day 42, and viable HIV-1 was recovered from 8% of syringes. Above room temperature (27, 32, and 37°C), the likelihood of encountering syringes with viable HIV-1 when periods of storage exceeded 1 week decreased to less than 1%. The temperatures at which drug injectors are likely to store their used syringes will vary according to climate, season, and circumstances faced by the injector. The survival OF HIV-1 in contaminated syringes varied over a range of temperatures, and this may be a factor influencing the syringe-borne transmission of HIV-1.