|This page is ONLY for people who use needles to inject drugs. The information herein is graphic and not intended for those who are opposed to Harm Reduction measures.|
Disinfecting "works" with bleach can help to reduce the risk of HIV transmission when no other safer options are available. You are encouraged to stop using drugs or, if that is not possible, use a clean, never-used needle and syringe each time you inject. Disinfection with bleach is not as safe as always using a sterile needle and syringe. However, the steps outlined here should enhance the effectiveness of bleach disinfection of needles and syringes.
The recommended procedures consist of three basic steps: (1) cleaning the needle and syringe to remove blood, blood clots, and other organic material, (2) disinfecting with bleach, and (3) rinsing with clean water to remove the bleach.
Because blood can interfere with the effectiveness of bleach disinfection, cleaning before disinfecting with bleach is very important if blood is present in the syringe and/or needle ("Get the red out"). Since blood may be present in hard-to-see places, pre-bleach cleaning should be performed even if no blood is visible in the syringe. Blood clots are likely to form in small places, such as inside the hollow bore of the needle. In blood clots or dried blood, the virus can become embedded in clotted or crystallized proteins, which makes it more difficult for the bleach to penetrate and inactivate the virus. Repeated cleaning/rinsing may dislodge these clots and allow the bleach to contact the HIV and inactivate it.
Disinfecting injection equipment with chemicals, such as bleach, does not guarantee that HIV or other viruses, bacteria, and fungi are inactivated, but consistent and thorough disinfection of injection equipment with bleach should reduce transmission of HIV if equipment is shared or re-used.
Specifically, the procedures for cleaning, disinfecting, and rinsing needles and syringes (as outlined in the bulletin) are as follows:
How long will this process take?
It will probably take 5-10 minutes total time to follow the recommended procedures for cleaning and disinfecting.
What if I am unable or unwilling to follow all steps
Although it is important to follow all steps in the bleach disinfection procedures to ensure maximum effectiveness, drug users who indicate they may be unable to do so should be encouraged to perform as much of the process as possible. The more steps done, the more effective the disinfection process is likely to be in reducing risk of HIV transmission. Remember: sterile, nondisposable syringe/needle units are not designed to be re-used.
If there is no blood in the syringe, it's clean, right?
No. As previously mentioned, small amounts of blood can still be present in the syringe or needle that cannot be seen. Even small amounts, when injected directly into the bloodstream, could transmit HIV. This is why it is important not to re-use or share needles and syringes, but if no other safer option is available a person who injects drugs should clean and disinfect needles and syringes with full-strength household bleach between each use.
What if dried blood gets in a crevice in a syringe--will it still live?
First, needles and syringes should not be re-used or shared. Full-strength bleach is recommended to disinfect needles and syringes for those that have no other option but to share. The need to use full-strength bleach is related to the difficulty in cleaning the inner parts of the equipment and being unable to scrub the small, inaccessible areas that may contain infectious matter. In particular, needles and syringes used by persons who inject drugs often contain clotted blood in their recessed areas, which is more difficult to clean and disinfect and may be more effectively inactivated by full-strength bleach. In addition, needles and syringes can place HIV directly into the bloodstream, while environmental surfaces are much less likely to facilitate transmission of the virus.
Should the disinfected needle dry out before re-using it?
In the context of disinfecting syringes and needles in this setting, there is no difference in the safety of a wet or dry needle that has been disinfected. Drying cannot be depended on to inactivate microorganisms on a needle or syringe.
Won't 100% bleach cause pain or damage to the user? Will undiluted bleach hurt the user if it gets into the bloodstream?
First, bleach should be referred to as full-strength household bleach. Second, the bleach should be completely rinsed (with clean water) out of the syringe and needle (and other drug injecting equipment) before they are used. Rinsing with clean water at least 3 times is ideal. Full-strength household bleach will irritate the skin and eyes and should never be injected into the skin or bloodstream.
What about cookers, cotton balls, etc.? Can these be shared?
How can HIV be transmitted from sharing a cotton ball?
Cookers, cotton balls, and other drug preparation and injection equipment should not be shared or re-used because they may be contaminated with blood. Blood or other infectious fluids may be present on cotton balls and could transmit HIV or other infectious agents. This is the same reason a physician does not use the same cotton ball to swab patients' arms before giving injections. Do not share cookers, cotton, or rinse water used by other people.
What is the difference between "disinfection" and "sterilization"?
Sterilization kills all living organisms, such as bacteria, viruses, fungi, and spores, and usually involves heating (e.g., autoclaving) the instrument at very high temperatures or using a very powerful chemical for longer time periods. Disinfectants can kill or inactivate certain infectious organisms, but often are not able to kill all microorganisms. Disinfecting injection equipment with chemicals, such as bleach, does not guarantee that HIV is inactivated. Disinfectants and boiling water do not sterilize equipment.
Is disinfection by boiling worth trying? Are there other types of syringes besides plastic that wouldn't melt in boiling water?
Boiling of needles and syringes (and other drug injection equipment) for 15 minutes will disinfect the equipment. However, a limited trial of boiling a small number of insulin syringes (the type of syringe most commonly used by persons who inject drugs) damaged some of them (partially bent, distorted shape). In addition, boiling needles and syringes may not be possible in some situations where needles and syringes are being re-used and shared.
Sterile, disposable syringe/needle units are NOT designed to be re-used. This equipment is manufactured to be used once and disposed of, which is what CDC recommends. The materials from which these units are made cannot withstand repeated attempts at disinfecting or sterilizing them. However, when a person who injects drugs cannot use a never-used, sterile needle and syringe, the bleach disinfection procedures can help reduce risks of HIV transmission.
Glass syringes can be boiled without damage, and some syringes and needles may be more resistant to the effects of heat during boiling.
Do all brands of household bleach contain adequate amounts of sodium hypochlorite?
Yes, if the bleach is fresh and undiluted, and is contained in unopened containers that have not been exposed to heat or sunlight during storage. There is slight variation in the concentration of sodium hypochlorite in different brands of household bleach and within a single brand between individual bottles of household bleach, but this is not significant.
Will undiluted bleach damage drug "works"?
Undiluted bleach can damage "works". Even so, it reduces the risk of HIV infection from re-using drug injection equipment. The advantages of disinfecting drug works far outweigh any damage bleach might cause, which should make this an easy choice.
What are the "other chemicals" that could be used to clean needles?
The use of diluted liquid household dishwashing detergent is advocated by some researchers based on some laboratory studies of its effectiveness in inactivating HIV. The dishwashing detergent is prepared by mixing one tablespoon of liquid dishwashing detergent in one cup of clean water.
HIV is obviously not a resistant microorganism and can be readily inactivated by a wide variety of common chemicals or proprietary germicides used both in the hospital or in the home. Household bleach (sodium hypochlorite), however, is a broad-spectrum, rapid-acting, very inexpensive, and easily available chemical that has been widely used as a germicide and studied extensively in this role for decades. When used according to the suggested procedures for needle and syringe disinfection in this unique and specific situation, it is at least as effective as other chemicals and perhaps even more so.
Are there any recommendations for using alcohol or hydrogen
peroxide for disinfecting needles? What about other
Cleaning with alcohol and hydrogen peroxide may reduce the risk of HIV transmission through shared drug injection equipment compared with taking no steps to clean/disinfect the needle, syringe, and other injection equipment. However, bleach has been found to be effective against HIV in addition to being widely available and inexpensive. Other chemicals may have a variety of disadvantages such as toxicity or inability to penetrate residual blood and other organic materials.
Do you recommend testing of persons who have been using the old methods?
We recommend that persons involved in behaviors that may place them at risk of HIV infection, such as injecting drug use, be routinely tested for HIV, usually at 6-month intervals. It does not matter what type of disinfection procedure, if any, has been used--injecting drugs is extremely dangerous for many reasons.
What referrals can we use for needle acquisition/exchange?
Where are needle exchange programs available? What are the
legal aspects of a needle exchange program?
First, persons who inject drugs who cannot be dissuaded from continuing to inject drugs should be urged to obtain sterile, never-used needles and syringes.
Federal law prohibits federal agencies from distributing needles and syringes that may be used for illegal drug use. Most (about 40) states, however, allow the purchase of new, sterile needles and syringes from pharmacies without a prescription. In addition, needle/syringe exchange programs are functioning in a limited number of cities in the United States, often with limited geographic coverage and hours of operation. Many states, including Kentucky, have laws making it a criminal offense to possess needles and syringes that are intended for illegal drug injection.
Does this information affect disinfection of other piercing
objects (earrings, tattoos, acupuncture) besides works?
No. These disinfection procedures for needles and syringes are intended to be used only when there is no safer option. They do not apply to other piercing objects. The procedures for ear piercing, tattooing, acupuncture, and other commercial (often licensed) activities should require single-use or heat-sterilized equipment.
What is the risk of HIV transmission from blood-contaminated
water? Does this have implications for jacuzzis, swimming
The route of entry and the relative amount of virus a person is exposed to play an important role in whether transmission of HIV occurs. Since HIV in needles and syringes is likely to be injected directly into another person's blood, sharing or re-using needles is an effective way of transmitting the virus. Avoiding drugs is the best way to avoid transmission of HIV by this route. For those who continue to inject drugs, using sterile needles and syringes is the only way to completely avoid exposure to HIV through drug injection, and disinfecting equipment with bleach is very important in reducing amounts of virus in equipment that is shared or re- used.
However, the amount of virus that might be present in jacuzzis, swimming pools, etc., is so small that the risk of transmitting HIV is negligible. This is because the virus would be so diluted by the large volumes of water that it would be harmless to bathers and swimmers. In addition, chemicals used in the water also reduce the likelihood that HIV could survive.
Why is a bleach and water solution effective on surfaces and not in syringes?
Environmental surfaces, such as floors, examining tables, counters, etc., that may have infectious fluids (such as blood) may still be cleaned with a solution of 1 part bleach to 10 parts water (or 1 part bleach to 100 parts water if stronger concentrations are too harsh for the surface). It is much easier to physically remove blood and other potentially infectious materials from environmental surfaces than from small inaccessible areas within needles and syringes--that is why full-strength bleach is necessary for cleaning "works". Another consideration is that contact with environmental surfaces is in no way similar to being injected with a needle.