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Alert: Danger in Using Bleach to Clean Needles

The standard method to clean injection drug equipment that has been widely promoted turns out NOT to work. The three squirts in and out with household bleach (10% solution) followed by three squirts in and out with water looked promising in the laboratory. But now results have come back from actual use in the field: those injection drug users (IDUs) saying they used this method all the time had the same high HIV seroconversion rates as those who never used it. The problem is that HIV is a lot harder to kill in human blood, especially with the problem of clotting inside works, than in laboratory cultures. The CDC summarized the research in their report, issued along with the CSAT and NIDA, of April 19, 1993. Current research now suggests using full strength bleach (100% solution) and leaving the bleach inside the needle and syringe for a full 30 seconds each time (to be followed with the cleaning out with water). Shaking and tapping the syringe when it is filled with pre-bleach wash water, with the bleach, and with the rinse water are also recommended to improve effectiveness. This method does not guarantee sterilization but can play a role in "reducing" the risk of transmission. (For a good, 1-page summary of the research, see Medical Alert, 10/11, 1993.)  

Over the past several years, health departments and AIDS service organizations disseminated hundreds of thousand of leaflets teaching the old method that has since proven to be ineffective. It is shocking that there has been so little effort to now publicize these changes, which are of life-and-death importance. Why have the authorities been so lackadaisical about alerting us--are they embarrassed about calling attention to their mistakes? Or are they shrinking from the logical conclusion on the need to push for needle exchanges? Whatever the reasons may be, this appears to be another example of the callous disregard for life that has prevailed throughout the AIDS epidemic.  

Most health agencies are now putting out the updated method in their post-1993 literature. But without the needed highlighting that this is a critical change, most IDUs, believing they already know the proper bleach method, wont even look at the new literature. Getting the right concentration of bleach requires a conscious effort, and it will take a lot of work for IDUs to learn to wait the full 30 seconds each time. Because this new method is so complicated and because it still provides no guarantee, much more emphasis and effort should be devoted to not sharing needles/works at all.  

In short, it is urgently important to alert all IDUs that: 1. 10% bleach solution does NOT work; you must use full strength, 100% bleach. 2. It is important to leave the bleach in for a full 30 seconds each time; either time it with a watch or count from 1 to 100. 3. Shaking and tapping the syringe at all phases of cleaning can help. 4. Since it is so difficult to sterilize them for sure, your best bet is to never share needles/works.

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