Download Reducing the Spread of Bloodborne Pathogens

Reducing the Spread of
Bloodborne Pathogens in NKY
Lynne Saddler, MD, MPH
District Director of Health
Jennifer Hunter, RN, MSN
Director of Clinical Services
Stephanie Vogel, M.Ed., MCHES
Director of Population Health
Heroin Use in NKY
Evidence that the increase in IV drug use (particularly
heroin) has led to an increase in
•
•
•
•
•
Drug overdoses and untimely deaths
Emergency room visits and hospitalizations
Babies born to women with drug addiction
Communicable diseases (e.g. hepatitis C)
Arrests and incarceration drug possession,
trafficking, and other criminal activity
• Impact on businesses
National Perception of NKY?
EDGEWOOD, Ky. — Zach
Wayman says he first
contracted hepatitis C
several years ago by
sharing needles with
other heroin addicts.
Heroin Overdoses
St. Elizabeth Emergency Departments
(Covington, Ft. Thomas, Edgewood, Florence and Grant)
1000
900
800
745
700
600
545
500
565*
447
400
300
200
* Includes ONLY
252
January Through June
overdoses.
100
0
2011
2012
2013
2014
2015
Ashel Kruetzkamp, RN, MSN — St. Elizabeth Healthcare
Overdose Deaths
Source: Kentucky Office of Drug Control Policy
Public Health Concerns
• Needles, syringes, and other equipment for injection
drug use can become contaminated with blood that
contains hepatitis C, hepatitis B, and HIV and these
viruses can be transmitted when such equipment is
shared among injection drug users .
• Contaminated drug injection equipment puts the public
and first responders at risk for exposure through
accidental needle sticks when such contaminated
equipment is improperly discarded.
Local, State
National Case Rates
Hepatitis C Case Rate per 100,000
14
12
Case Rates per 100,000
10
8
NKY
6
State
4
National
2
0
2009
2010
2011
2012
Year
2013
2014
Diseases Associated with
IV Drug Use
• Hepatitis C – viral infection of the liver that
can proceed to liver failure and death if
untreated. Medication costs to treat=$84,000
• Hepatitis B – viral infection of the liver that
can become a lifelong infection.
• HIV –chronic disease with a lifetime cost of
$600,000 to treatment.
Communicable Disease Control
In KRS 211.180, health departments under
the authority of the Cabinet for Health and
Family Services:
“…perform the duties of detection,
prevention, and control of communicable
diseases…”
IV Drug Use & Disease
INFECTIOUS DISEASES SPREAD BY IV DRUG USE (2014)
Source: NKY Health Department Epidemiology Unit
Diagnosis
Boone
County
Campbell
County
Grant
County
Kenton
County
NKY
*
Acute
hepatitis B
7
7
Fewer
than 5
22
38 (9.4)
Acute
hepatitis C
9
10
Fewer
than 5
22
44 (10.9)
Non-acute
hepatitis B
19
17
Fewer
than 5
40
80 (19.8)
Non-acute
hepatitis C
173
223
66
396
858
(212.7)
HIV cumulative
from 1982, living
and deceased
120
155
31
413
719
NKY Heroin Impact
Response Task Force
Syringe
Access
Exchange
Program
SB 192-Kentucky’s Heroin Law
General Assembly of the Commonwealth of Kentucky passed
Senate Bill 192 in the 2015 Regular Session which amends KRS
218A.500, adding sections (5) (a) – (c) which enables:
“local health departments to operate a substance abuse treatment
outreach program which allows participants to exchange hypodermic
needles and syringes with the consent of the local board of health and
the legislative body of the city and county in which the program
would operate.”
What is a Syringe Access
Exchange Program (SAEP)?
• A public health program for people who inject
drugs intravenously to reduce the spread of
communicable diseases like Hepatitis C and B and
HIV.
• Exchanges sterile syringes, needles, and clean
injection equipment for contaminated equipment.
• Properly disposes of contaminated equipment.
• Touch point for health care access including
mental health and addictions treatment
What is a SAEP?
Health care access • Testing for HIV, HCV, STD’s, pregnancy
• Vaccinations (e.g. Hepatitis A & B)
• Naloxone (overdose prevention)
• Enrollment in health care coverage
• Counseling & education – treatment
• Other health department services and
referrals to other health care providers
Advantages of Locating at
an SAEP at County Health Center
• Cost-efficient (staff, vaccines, labs).
• Use existing procedures.
• Many SAEP services already offered at the
county health centers.
• People who inject drugs use or have used the
Health Department for a variety of reasons.
• A recent survey of users indicate that this
population trusts Health Department staff.
Window of Opportunity
IV drug use (heroin) epidemic
Increased Hepatitis C rates
We are here
Increased HIV rates
Scott County, Indiana
• The Indiana State Department of Health and the Centers for
Disease Control and Prevention (CDC) responded to a large
outbreak of human immunodeficiency virus (HIV) infections
among persons who inject drugs in Scott County, Indiana.
• CDC has issued a health advisory recommending that health
departments ensure persons actively injecting drugs have
access to integrated prevention services, including but not
limited to access to sterile injection equipment from a reliable
source.
Do SAEP’s Work?
YES
Benefits of SAEP’s
• Reduces HIV transmission among injection drug
users.
• Advances public safety, including the safety of
law enforcement officials, by taking
contaminated syringes off the streets and out of
parking lots, parks, school grounds and
playgrounds.
• Serve as an important link to mental health and
addiction treatment services as well as other
health care services.
• Cost effective interventions compared to treating
HIV and Hepatitis C.
Misconceptions & Myths
Syringe Access Exchange Programs:
Do NOT encourage individuals to begin using drugs.
Do NOT increase drug use among existing users.
Do NOT increase crime in neighborhoods in which such
a program operates.
Our Work To Date
Approvals
• District Board of Health resolution
• Williamstown City Council approved operation of the
program
Program Plans
• Obtaining feedback
• Reviewed and approved by the Board
• Staff trained by national harm reduction experts
Funding
• Private Foundation
• Other state grants
Support
• Presentations and conversations
Current Local Support
• Grant County Local Board of Health
• N KY Agency for Substance Abuse Policy (N
KY ASAP)
• NKY Heroin Impact Response Task Force (N
KY HIRT)
• NKY Hates Heroin
• NKY People Advocating Recovery
• St. Elizabeth Healthcare
• N KY Office of Drug Control Policy
Questions