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Abscess Prevention & Management

Abscess Prevention & Management. What is an Abscess?. A collection of pus anywhere in the body, e.g ., under the skin How do abscesses form? May result from injecting non-soluble substances, such as SP, which can remain trapped under the skin

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Abscess Prevention & Management

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  1. Abscess Prevention & Management

  2. What is an Abscess? • A collection of pus anywhere in the body, e.g., under the skin • How do abscesses form? • May result from injecting non-soluble substances, such as SP, which can remain trapped under the skin • May result from bacteria contaminating the site of an injection • May result from dead (necrotic) tissue at the site of an injection

  3. Abscess- The complications Abscess may progress to an open wound called an ulcer Contd..

  4. Abscess- The Complications • Pain • Chronic, non-healing ulcer • Tissue death (necrosis), or gangrene (may lead to amputation of the limb itself) • Spread of infection through the blood-stream leading to infection of the heart valves, bone infection and other abscesses

  5. Risk Levels of Injecting in the Body

  6. Abscess Care • Prevent increase in size and other complications through provision of early treatment • Treat abscess as quickly as possible • Provide appropriate pain relief • Refer complicated cases for appropriate medical treatment

  7. Conclusion • Abscesses are formed due to a variety of reasons • NSEP is an effective means of preventing Abscess • Clients should be taught to inject safely and to take care of their veins • Abscesses once formed can lead to a number of complications

  8. The role of the PM ???

  9. Opioid Overdose

  10. Opioid Overdose • Overdose – Intake of drugs in quantity (dose) which is more than the body can handle • Individual starts having discomfort • Life-threatening symptoms appear • Individual may die if he/she is not provided timely and adequate medical care

  11. Risks Factors for Opioid Overdose • Staying away from drugs • Change in the purity of the opioids • Mixing different type of drugs • Physical illness or recent infections • Mental health

  12. Overdose Prevention – Education • Avoid mixing drugs • If you are drinking alcohol and injecting together, inject first and wait for it to take effect before you start drinking • After abstinence, if you are using opioids: • Divide the normal dose in half, do a tester shot and allow the drugs to take effect before you do more • Try changing the route of administration; i.e., if you usually inject, try snorting • If you have a new dealer or unfamiliar supply, use a small amount at first to see how strong it is • Avoid using alone; if you overdose, you need someone to help you • Take care of your health • Eat well, drink plenty of water, and sleep properly

  13. Overdose Management • First aid should be provided before medical help arrives • Remember the acronym ‘SCARE ME’; follow the steps • Management of Opioid Overdose • S– Stimulate by waking the client • C– Call for medical help • A– Maintain the airway • R– Rescue breathing • E– Evaluate • M– Muscular Injection of Naloxone • E– Evaluate and Support Contd…

  14. Overdose Management • Airway maintenance • Make sure nothing is blocking the airway, and there is nothing in the mouth. If necessary, use finger to get the stuff out • Rescue breathing and recovery position • Put the client in recovery position • If the client is not breathing, thenrescue breathing should be done Contd…

  15. Overdose Management Recovery position Contd…

  16. Overdose Management Rescue Breathing Contd…

  17. Overdose Management • Muscular injection of Naloxone • Naloxone is a specific antidote to treat opioid overdose • Naloxone reverses the life-threatening symptoms caused by overdose • It wakes the client up and makes him/her breathe • It has no effect except in the presence of opioid drugs • It is routinely used in Emergency Medical Services

  18. What not to do While Helping • Do not leave someone who’s overdosing alone unless absolutely necessary to call for help- he/she could stop breathing and die • Do not put him/her in the bath; he/she can die • Do not give him/her anything to drink or induce vomiting; he/she could choke • Do not make him/her drink salt water, or put salt in his/her mouth. This does not help; on the contrary, he/she may choke • Do not inject salt water as this is dangerous and can cause sudden death among the clients

  19. To Summarize… • Opioid overdose is a common cause of death among IDUs • There are many factors which place an individual at risk of opioid overdose • Overdose can be managed in community as well as primary healthcare setting with minimal training and expertise • Naloxone injection can be used to treat opioid overdose • Educating the IDU clients, their peers and family members can easily prevent overdose and its associated harms, including death

  20. The Role of the PM ???

  21. Sexually transmitted infections (STIs)

  22. Introduction • As the name suggests these are infections which transmit from one person to another through sexual route • These infections are usually caused by microorganisms such as bacteria or virus

  23. Common STIs • Syphilis • Gonorrhoea • Chancroid • Herpes • LGV

  24. Consequences of STI • Risk of transmission to partner • Increase in symptoms leading to pain, disability • Spread of infection to other parts of body • Increased risk of HIV

  25. Linkage of STIs & HIV • Persons suffering from STI have 2 to 4 times increased risk of getting HIV infection • HIV decreases immunity and increases vulnerability to getting STI • Genital ulcers –sores make it easier for HIV to enter the body

  26. Link between STIs & HIV Impaired Immunity STI HIV Unprotected sexual intercourse

  27. STI Signs and Symptoms - Males • Urethral discharge (Discharge or pus from the penis)/Burning or pain during urination/frequent urination • Genital itching • Swelling in groin/scrotal swelling • Blisters or ulcers on the genitals, anus, mouth, lips • Itching or tingling in genital area • Ano-rectal discharge • Warts on genitals, anus or surrounding area

  28. STI Signs and Symptoms - Females • Unusual /foul smelling vaginal discharge • Genital itching • Abnormal and /or heavy vaginal bleeding • Pain during sexual intercourse • Lower abdominal pain (pain below the belly button, pelvic pain) • Blisters/ulcers on the genitals, anus or surrounding area, mouth, lips

  29. Syndromic Management 'Syndromic management of STIs' recommends that such medicines be given, which will cover all the possible organisms that might cause a symptom or a group of symptoms

  30. STI Treatment Component

  31. STIs and IDUs IDUs equally vulnerable to STIs as any HRG Drugs injected often having analgesic properties; may reduce pain of STIs IDUs often need antibiotics for abscesses; may hide ulcers/partially treat STIs IDUs often inject in groin or penis; genital ulcers may be attributed to injections; missing out STI-related symptoms Swelling of the lymph nodes in groins may be caused by infections from blisters/abscesses in the foot or unhygienic living conditions rather than STIs Stigma attached to STIs generally, may also bar IDUs from reporting signs and symptoms

  32. The Role of the PM ???

  33. Detoxification

  34. Drug Dependence • Many drug users are dependent on the drugs they use • Besides opioids that IDUs predominantly inject they may be dependent on other drugs (e.g., benzodiazepines, alcohol) as well • Experiencing any 3 of the following criteria within last one year should be considered dependence: • Tolerance • Withdrawal • Loss of control • Preoccupation with substance use • Craving • Continued use despite harm

  35. Drugs: The Vicious Cycle People continue to use drugs to avoid withdrawal It is one of the major reasons for not being able to stop drug use

  36. Withdrawal Symptoms • Different for different type of substances • Both physical and psychological symptoms seen • Psychological symptoms are similar; difference in physical symptoms • Onset of withdrawal symptoms is different with different substances • Severity of withdrawal depends on: • Amount of drug consumed in the recent period • Severity of dependence • Individual-related factors: physical status, psychological status, presence of other illness • Withdrawal of some drugs (alcohol, benzodiazepines, etc) can lead to death

  37. Detoxification • Detoxification is the medical management of withdrawal • Assistance provided to the body to clear itself of the effects of drugs, when drug user decides to stop drug use • A set of interventions aimed at managing acute withdrawal state • Prevent potentially life-threatening complications • Form of palliative care for those who want to become abstinent • Point of first contact with the treatment system and first step to recovery • Detoxification can be carried out in both inpatient as well as outpatient setting

  38. Need for post detoxification services • Detoxification alone is Not Recommended as a treatment strategy • Detoxification alone leads to high rates of relapse • Detoxification should be seen as the first step towards treatment • Post detoxification services : • periodic counselling • counselling for relapse prevention • psychosocial rehabilitation • occupational rehabilitation, etc.

  39. Need for post detoxification services • Detoxification services are often not long enough • Patients not educated about long term management of drug use disorders • Majority of patients do not receive any drug use related treatment post detoxification • Rehabilitation services are expensive and unaffordable by many

  40. Role of PM • PM should ensure that: • Doctor, Nurse, ORWs & PEs are well trained on abscess, STIs, overdose • PEs & ORWs regularly educate IDUs on these issues- this should be part of the BCC plan at outreach and educational sessions at the DIC • STI kits are timely requisitioned and procured from SACS • Medicines, cotton wools, bandages, etc. for abscess management are regularly procured and stocked

  41. PM should ensure that… • Linkages with hospitals and other institutes for advanced services that may be needed for some clients are built and maintained • Special advocacy efforts are made for post detoxification services as formal linkages don’t exist between harm reduction (IDU-TI), detoxification and rehabilitation services • All clinical services, referrals and their effectiveness are regularly monitored and appropriate steps are taken for solving issues, if any, for continued quality services

  42. THANK YOU!

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