Research Note: Factors Associated with Skin Cleaning Prior to Injection among Drug Users

Article excerpt

Injection drug users are at risk for a variety of infections when hygienic injection practices are not performed. Disinfecting the injection site prior to injecting reduces the risk of bacterial infections but has been overlooked in many prevention efforts. Using what is known about factors associated with risk-reduction behaviors of disinfecting equipment, we evaluated a model to determine whether those factors are associated with disinfection of the injection site. Sociodemographic and behavioral data were collected in interviews with 600 injection drug users. The majority of injection drug users do not clean the injection site prior to injecting. Results indicate that gender, ethnicity, and frequency of injection were significantly related to whether or not an injector cleaned the injection site. Failure to clean the injection site prior to injecting is a common practice and constitutes a health risk among injection drug users, particularly in a population prone to other infections. Prevention efforts need to incorporate all levels of sterilization procedures when working with these high risk populations.


The adverse health consequences associated with the use of nonsterile injection equipment by illicit drug users are well documented (McElrath & Jordan, 2005; Miller et al., 2004; Vlahov et al., 2004; Chitwood et al., 1995; Perucci, Davoli, Rapiti, Abeni, & Forastiere, 1991 ). Intervention efforts to decrease the transmission of life threatening viral infections among active injectors who cannot or will not cease use emphasize not reusing contaminated injection equipment (e.g., needles, syringes, cookers, cottons), using bleach to clean gear before it is reused, and the model of "one needle, one shot" (Centers for Disease Control and Prevention, 2004). Reductions in HIV related risk behaviors have been documented among injection drug users who adhere to these practices (Metzger & Navaline, 2003; Vlahov, Sullivan, Astmeborski, & Nelson, 1992; Herb, Walters, case, & Petitti, 1989).

Injection into a nonsterile site on the body is an additional major high risk behavior that has received much less attention, despite its association to endocarditis, abscesses, bacterial infections, and other adverse health problems. Bacterial infections associated with injection account for the majority of hospital admissions among injection drug users (Bassetti & Battegay, 2004; Scheidegger & Zimmerli, 1989) and place heavy demands on emergency departments (Makower, Pennycook, & Moulton, 1992). Mortality from endocarditis is high among injection drug users (English, Holman, & Milne, 1995) and a common cause of death among HIV positive injectors.

Disinfection of the injection site with alcohol prior to injection reduces the risk of bacterial infection (Vlahov et al, 1992; Gershon, 1998). However, little is known regarding the prevalence of cleaning the injection site among injection drug users or the association of other injection practices with this behavior. For example, the practice of using sterile injection equipment may be associated with cleaning the injection site. Understanding these relationships is crucial for the successful implementation of effective interventions to reduce bacterial infections among injection drug users.

The purposes of this study are to (1) describe the prevalence of not cleaning the injection site among injection drug users, (2) examine the association between not cleaning the injection site and other high risk injection behaviors, and (3) identify risk factors associated with not cleaning the injection site.


The data for this investigation were collected between July 1997 and August 1999 as part of a comprehensive study of HIV and other health risk behaviors among heroin users in Miami-Dade County Florida (Chitwood, Comerford, Kitner, Palacios, & Sanchez, 2001 ; Chitwood et al., 2000 ). The study was approved by the University of Miami Institutional Review Board. …