Interim Guidance for Syringe Services Programs

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 gear, vaccination, testing for infectious ailments reminiscent of viral hepatitis and HIV, naloxone distribution, and linkage to infectious illness care and substance use remedy. SSPs stop infectious ailments, assist hyperlink purchasers to remedy for substance use issues, and have the potential to forestall overdose deaths amongst individuals who inject medicine.1

SSPs must be thought of by state, native, territorial, and tribal jurisdictions as important public well being infrastructure that ought to proceed to function through the COVID-19 pandemic. During this time, it’s essential that SSPs have the capability to make sure the protection of workers, 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 workers and the clientele they serve. SSP workers carry out quite a lot of features, with some workers offering direct affected person care providers (e.g., drawing blood for infectious illness testing, responding to overdoses, treating injection-related wounds). Considerations for each healthcare personnel and different employees are due to this fact included into this steerage.

Education, Prevention, and Screening for SARS-CoV-2 an infection (the virus that causes COVID-19 sickness)

  • Provide training to purchasers and workers (together with volunteers) prevent the spread of SARV-CoV-2, together with putting informative signage and provides in extremely seen locations.
  • Ensure all purchasers, workers, and volunteers put on cloth face coverings always to guard others. Cloth face coverings shouldn’t be positioned on anybody who has bother respiratory, or is unconscious, incapacitated, or in any other case unable to take away the masks with out help.
    • For workers offering healthcare providers (e.g., nurses), appropriate PPE must be used when interacting with purchasers with suspected or confirmed COVID-19.
  • Ensure all purchasers, workers, and volunteers keep physical distancing (staying a minimal of six ft aside) as a lot as attainable throughout interactions (recognizing that this won’t be possible for all interactions), together with workers/consumer interactions and workers/workers interactions (e.g., throughout breaks and meals).
  • Remind all purchasers and workers to wash hands with 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 will not be attainable and to adjust to federal, state, and native an infection management practices required in that setting.
  • Consider offering providers open air or in an open-air area to reduce threat of transmission if enough confidentiality for purchasers might be offered. If SSP providers are performed indoors, the entire above precautions must be adopted.
  • Screen all purchasers for attainable COVID-19 symptoms and up to date historical past of a detailed contact to somebody with identified or suspected COVID-19 upon getting into the SSP. Work along with your native well being division for steerage on the place to refer purchasers who’re exhibiting COVID-19 symptoms 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 signs, 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 standards for discontinuation of home isolation.
    • Consider different strategies to supply providers and gear 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’ houses, telehealth service provision).
  • Staff and volunteers who report COVID-19 signs ought to be sent home immediately to home isolate. If they expertise any of the emergency warning signs for COVID-19, they need to search medical consideration instantly. Guidance for when it’s secure to return to work must be adopted, for healthcare personnel providing care to clients, and for volunteers and different workers not providing direct client care.
  • Ensure that workers and volunteers observe guidelines for preventing infection, and purchasers have entry to hygiene provides reminiscent of cleaning soap, alcohol-based hand sanitizers that comprise at the least 60% alcohol, tissues, and trash baskets.
  • Provide hygiene provides reminiscent of 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.
  • Ensure that sick go away insurance policies are versatile, non-punitive, and in line with public well being steerage. Ensure that workers and volunteers are conscious of and perceive these insurance policies. Have a contingency plan for staff absences within the occasion of sickness or different rising points. For workers who’re at higher risk for severe illness, implement particular insurance policies to reduce face-to-face contact, or assign work duties that enable them to take care of a distance of six ft from different employees, purchasers and guests, or to telework if attainable.

Additional issues and process changes to forestall SARS-CoV-2 transmission:

  • Continue to supply sterile injection gear and strategies for disposal, in addition to pores and skin cleaning provides reminiscent of alcohol pads and hand sanitizer, to assist cut back threat of COVID-19 an infection, in addition to to forestall pores and skin and gentle tissue infections associated to unsafe injection practices.
  • If obligatory, change insurance policies to extend the variety of syringes every consumer can obtain per go to to allow longer durations between visits. This apply will reduce the necessity to entry SSPs continuously and will help guarantee sterile injection within the occasion of SSP closure or restricted hours.
    • Ensure purchasers have enough provides to make use of sterile gear with every injection. Dispense sufficient provides to make sure continued means of purchasers to inject with sterile gear if SSP closure or restricted hours might occur through the pandemic.
  • Provide provides via cell providers, supply, or mail-order providers, at any time when attainable.
  • Provide counseling providers and referrals to care by phone and/or utilizing on-line instruments, the place possible.
  • Review present service provision procedures to determine methods to reduce alternatives for COVID-19 publicity and transmission.
    • Consider lowering or eliminating processes that contain non-essential consumer bodily contact with workers or objects (e.g., filling out paper kinds, utilizing shared writing utensils).
    • Consider methods to shorten the length of consumer visits as acceptable (e.g., eliminating redundant administrative processes).
    • Reduce grouping of purchasers if attainable (e.g., provide staggered consumer appointments, cut back the variety of purchasers inside at one time, guarantee purchasers keep acceptable bodily distancing (minimal six ft aside) whereas ready exterior).
    • Consider installing a section 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 medicine 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:
    • Daily operations (e.g., figuring out if hours of operation will probably be modified to make sure that some SSP providers within the space stay open always in all communities);
    • Acceptance of latest purchasers (e.g., creating 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, workers, or purchasers are obligatory primarily based on the evolving scenario).
  • Continue to assist hyperlink purchasers with substance use remedy reminiscent of treatment for opioid use dysfunction (MOUD). Work with applications providing MOUD and with behavioral well being companies to make sure entry to 14-28 days of treatment, relying on the soundness of the affected person. The Substance Abuse and Mental Health Services Administration (SAMHSA) posted COVID-19 guidanceexternal icon offering potential flexibility for Opioid Treatment Programs (OTPs) to permit applications to supply drugs for prolonged durations, and to provoke buprenorphine remedy utilizing telehealth.
  • If sterile injection gear is unavailable or can’t in any other case be offered, present bleach, sterile water, and instructionspdf icon for cleansing syringes. This doesn’t guarantee sterile injection, however might cut back the chance of infectious illness transmission.

1 Centers for Disease Control and Prevention. (2019). Summary of the protection and effectiveness of syringe providers applications. https://www.cdc.gov/ssp/syringe-services-programs-summary.html

Additional Resources

General 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

Recommendation Regarding the Use of Cloth Face Coverings, Especially in Areas of Significant Community-Based Transmission: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover.html

Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings: https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html

Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens from Persons for Coronavirus Disease 2019 (COVID-19): https://www.cdc.gov/coronavirus/2019-nCoV/lab/guidelines-clinical-specimens.html?deliveryName=USCDC_2067-DM23796

Implementation of Mitigation Strategies for Communities with Local COVID-19 Transmission (CDC): https://www.cdc.gov/coronavirus/2019-ncov/downloads/community-mitigation-strategy.pdfpdf icon

Guidance for healthcare personnel and different essential employees:

Interim U.S. Guidance for Risk Assessment and Public Health Management of Healthcare Personnel with Potential Exposure in a Healthcare Setting to Patients with Coronavirus Disease (COVID-19): https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html

COVID-19 Resources for Clinics and Healthcare Facilities: https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/index.html

COVID-19 Guidelines for Workers Critical to Maintenance of the Infrastructure: https://www.cdc.gov/coronavirus/2019-ncov/community/critical-workers/implementing-safety-practices.html

Guidance for different amenities/teams which might be related for SSPs:

COVID-19 Resources for Community and Faith-Based Leaders: https://www.cdc.gov/coronavirus/2019-ncov/community/organizations/index.html

COVID-19 Resources for Homeless Shelters: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/homelessness.html

COVID-19 Guidance for People dwelling with HIV/AIDS: https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/hiv.html

COVID-19 Guidance for People with Medical Conditions: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/

Guidance on Preparing Workplaces for COVID-19 (OSHA): https://www.osha.gov/Publications/OSHA3990.pdfpdf iconexternal icon

Harm discount assets:

How to wash your syringes shopper data sheet: https://www.cdc.gov/hiv/pdf/library/pocket-guides/cdc-hiv-syringe-service-pocket-guide.pdfpdf icon

Summary of the protection and effectiveness of syringe providers applications: https://www.cdc.gov/ssp/syringe-services-programs-summary.html

COVID-19 Guidance for People who Use Drugs and Harm Reduction Programs (Harm Reduction Coalition):
https://harmreduction.org/miscellaneous/covid-19-guidance-for-people-who-use-drugs-and-harm-reduction-programs/external icon

Practicing hurt discount within the COVID-19 Outbreak: https://www.vitalstrategies.org/resources/practicing-harm-reduction-in-the-covid-19-outbreak/external icon

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