bacterial infections

endocarditis
abscesses and septicaemia

Our bodies have a number of natural defences that protect us from disease and other infections. When we inject drugs into our body we bypass our main natural defence system, the skin. This leaves the body vulnerable to nasty infections and diseases from bacteria, fungi and viruses, including HIV, and the Hepatitis B and Hepatitis C viruses.

All drugs have harms associated with them and injecting drugs, outside a medical setting, carries the risk of bacterial infections. Injectable drugs which are used in medical settings are prepared in sterile laboratories, stored in sterile packaging and usually administered to the patient in a clinical environment. By contrast, illicit injectable drugs are not produced, stored or used like this and can be full of germs (bacteria) and a variety of other harmful particles.

To reduce the chances of harmful germs entering the bloodstream, it is important that everything used in preparing and administering an injection is clean: hands, injection site, water, spoon, etc., and that sterile syringes are used. (See 'Safer injecting', below.) Using clean, quality filters can also help reduce infections and injecting-related damage.

Filtering helps to remove insoluble particles and contaminants that can cause the body damage if injected. Although the effectiveness will depend on the filter materials and techniques used, filtering drugs can greatly reduce the chance of bacterial and fungal infections. However, it is important to note that no filter will remove viruses.

endocarditis

Endocarditis is caused by bacteria found on the skin, which enter the bloodstream during the injecting process. The bacteria then lodges on the heart valves where it begins to grow, forming what are known as 'vegetations'. If left without treatment, the bacterial vegetations can destroy the heart valves either partly or completely, possibly leading to heart failure and death. Symptoms of endocarditis include high fever, pains in the chest, coughing, shortness of breath, delirium and possible collapse. Treatment for endocarditis involves a stay in hospital and intravenous antibiotics over a period of weeks. Treatment could include heart valve replacement for valves that no longer function effectively.

The best way to prevent endocarditis is to use a sterile injecting procedure and equipment. If your heart valves are already damaged and you inject drugs you are highly susceptible to getting endocarditis. You can reduce the chance of getting endocarditis by using a skin wash containing povidone-iodine and chlorhexidine, in conjunction with a sterile injecting procedure. (For more information on sterile injecting procedures contact VIVAIDS or your local Needle and Syringe Program. See Chapter 4 for NSP contact details.)

Sterile injecting procedures are not always practical or do-able, so keep your hands, injecting site, equipment and the surface on which you prepare your drugs as clean and new as you can. Don't cough or sneeze on your gear or injecting sites and always be sure to wash your hands in warm soapy water before and after every hit.