Chlorine disinfection tablets are an inexpensive, discreet, safe, and highly portable alternative to thin bleach that can be distributed to increase the frequency and effectiveness of syringe cleaning.
Cleaning syringes doesn't offer an absolute guarantee of safety, but there is good evidence that hepatitis C and HIV are killed by a simple rinse with cold water, rinse with bleach, rinse with cold water regime.
If everyone who reused injecting equipment did it routinely there would be a massive reduction in blood borne virus transmission.
Chlorine tablets come in small boxes of 2,400 tablets (1,200 strips of 2), although we can split into multiples of 100 (50 strips of 2) if you don't need a whole box.
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Due to issues with customs, we only supply this product to UK delivery addresses.
We think that needle and syringe programmes should give at least one strip of two tablets per transaction in order to ensure that people who inject drugs have enough to be able to disinfect used syringes whenever they need to,
Of course, as part of the transaction, people who inject drugs should be advised to never re-use injecting equipment. Cleaning can never provide an absolute guarantee of protection from infection. However, distributing the tablets enables NSP workers to easily open a dialogue about disinfection of equipment and gives people who inject drugs the opportunity to have the means to disinfect previously used equipment with them at all times, which will greatly reduce the risk of syringe reuse.
We are working towards all illicit drug injections being administered with sterile equipment but this is a huge task, and re-use of syringes remains common. At current distribution levels every syringe issued is used an average of 3 times, making workable strategies to encourage disinfection vital in the fight against the spread of BBV’s and bacterial infections.
In a perfect world, all syringes used by people who inject drugs would be previously unused and therefore sterile. But, we should never allow the ‘perfect to be the enemy of the good. Harm reduction is about using pragmatic strategies to ensure the best possible outcomes for drug users in the UK.
We would recommend that 2 tablets are offered at every transaction, so that injecting drug users have access to the equipment they (or their friends) need to clean syringes at all times.
The individual effervescent Chlorine Tablets are based on what is known as a a dry chlorine donor, sodium dichloroisocyanurate (NaDCC). The NaDCC is blended with effervescent components (which ensure it dissolves quickly in water) before being compressed into tablets and put in individual sachets. The result is a fast-dissolving, highly convenient, and accurate alternative to liquid bleach.
Our chlorine tablets are produced exclusively for us in the UK, by a fully accredited and licenced Medicines Manufacturer. The dose is carefully controlled, and each tablet contains 1 gram of the active ingredient: Sodium Dichloroisocyanurate Anhydrous, this chemical is also known as Troclosene Sodium and NaDCC.
This produces a disinfectant solution of 1,000 parts per million when mixed with 1 mug (250ml) water.
The tablets have the advantages over liquid chlorine bleach because the tablets are:
Stable and do not deteriorate with age or adverse storage conditions;
A consistant strength; and
Are dry and safe to store;
The tablets also:
Dissolve quickly and easily;
Are less caustic and damaging to skin and fabric than liquid bleach; and
On the practice notes and FAQ pages we aim to give you the information you need to use our products as safely as possible.
If you have any further questions or would like to discuss an issue with us, we are always happy to provide support, information and advice to users of our products – full contact details are in the about us section.
How to use them
The tablets are very easy to use. Clear and simple instructions are provided on the wrapper.
To use the tablets, you:
Dissolve the tablet in one cup (250ml) of water
Once with water
Once with chlorine solution
Once with water.
The water should be clean, not having previously been in contact with any used injecting equipment, and either in 2 separate containers or drawn up from the stream from a tap.
Q: I work in a needle and syringe programme, how many tablets should I give out with each transaction?
A: At least one pack of two tablets per transaction will ensure that injectors can choose to disinfect used syringes in most situations they encounter.
Q: Does giving out chlorine tablets encourage people to reuse syringes?
A: No! In most circumstances, the person would probably have still chosen to reuse the syringe, but would not have had the ability to disinfect it prior to reuse
Q: Why not just give out more syringes?
A: You should do that as well! One of the reasons that we know syringes must be being reused is because even on conservative estimates, we only distribute enough syringes for about one third of all the injections that take place. Increasing the number of syringes distributed will have some effect on the need to re-use, but it is likely that to achieve a situation where no-one ever feels the need to re-use would require a 4-5 fold increase in distribution.
Q: Who should be targeted?
A: Anyone who injects, or anyone who knows someone who injects. The chlorine tablets are cheap, discreet and portable. Everyone who injects should have easy access to them.
Q: Are there any videos that show exactly how to do it?
A: There’s a video we made for the Harm Reduction Works campaigns showing how to effectively disinfect a syringe using thin household bleach. The technique when using chlorine tablets is exactly the same (apart from having to dissolve the tablet in water first). To watch it click HERE.
Q: Is bleaching syringes risk free?
A: No. It’s always better to use a new sterile syringe. However, in situations where a sterile syringe is not available, bleaching represents the best available alternative.
What we can say, is that if the syringe is rinsed with water after the bleach, there is no risk from the bleach.
Q: Needle & syringe programmes have been around for 25 years, why have we not been told to encourage bleaching before?
A: Advice to clean syringes was not widely given when we didn't know for sure that it would kill the virus. The field was exercising the 'precautionary principle' and so published cleaning advice we knew – in the real world - would rarely if ever be followed (hence it wasn't given prominence, or even given at all). This was because we were worried about giving advice that might not be reliable.
Before we published the advice in the harm reduction works campaign, and sourced these chlorine tablets we consulted widely on whether we should move to change the cleaning advice based on the findings at Yale.
We talked to drug users, virologists, epidemiologists, public health scientists, and the department of health about their view on the science behind these findings, and what we should do, and the clear consensus amongst the scientists was that:
The same methodology for assessing HIV survival in syringes has been tested, and is reliable;
The methodology for the effect of bleach on HIV in syringes has been published and so is a valid experimental method;
The HCV survival in syringes (without the addition of bleach) studies have been published in reputable journals so we know the method they're using for seeing if the HCV is alive is valid;
The HCV survival in syringes studies showed that HCV is less resilient than HIV, and the two viruses are physically similar in composition, so there's no reason to think that they'd behave differently when exposed to bleach (i.e the experimental results are what you'd expect them to be) it's a matter of chemistry: bleach vs viral particle is (thankfully) no contest;
The delay in publication is just the normal process of collecting full results from a range of experiments, and submitting to journals, and not because of a flaw in the trial, or a series of rejections because of questionable methodology;
Yale is one of the world's leading universities, and Robert Heimer's team has a long and distinguished record in the field, so we should take their findings seriously, especially given that we're in the midst of very high levels of HCV incidence, and (complex) cleaning messages to date appear to have had little effect.
And the drug user groups:
Confirmed what you say about the levels of confusion about cleaning methods;
Were clear that complicated instructions are likely to lead to no action at all;
Are concerned that a perception of inevitability of infection is a real problem, that is exacerbated by talk of soaking in bleach.
In the light of that, as we're in the midst of a serious HCV epidemic, with high levels of syringe reuse, high levels of HCV incidence, and
Low levels of cleaning,
we went ahead.
As the method is proven against HIV, after the essential caveat that a new syringe is always better, at the very least published resources for drug users should show the 1x1x1 method, and say that this does kill HIV.
We think that by changing the advice to something more manageable, accessible and likely to be done, there is a real chance to prevent a lot of HCV infections.
Q: Can traces of chlorine bleach left in a syringe after flushing with water cause physical problems?
A:No! When a syringe is flushed out with water after flushing with bleach, only microscopic traces of bleach will remain and these will cause no health problems.
Q: Why don't you recommend making the solution stronger - with less water?
A:Although in principle overdosing might seem a reasonable step to take, the European Authorities approach regarding the use of biocides, through the Biocidal Product Regulation (BPR), is to reduce their use to the lowest concentration required to achieve biocidal efficacy.
All the new microbiological tests are now being tailored in this manner. In order to identify the lowest concentration a product has to be tested at three different concentrations. Two of them have to pass the test and one fail. The lowest of the two that have passed the test becomes the recommended dose. Overdosing opposes this approach so we can't recommend it.
However, if people do make the solution stronger, it may lead to greater viricidal effect.
Exchange Supplies is an organisation with our roots in the provision of confidential drug services, and we absolutely understand the need for discretion in the outer packaging of our goods when shipping to individual customers.
If you tick the discreet packaging tick box your order will be shipped in plain packaging, looking just like any other mail order package. There will be no branding, stickers, logos, or stamps on the outside that would enable someone to guess what the contents are. For UK orders we usually use Royal Mail tracked service as this is likely to draw less attention than an orange TNT lorry.
Overseas orders will have a label on the outside containing a customs notification declaring the contents.
Exchange Supplies is an organisation with its foundations in the provision of confidential healthcare to a patient group who care more about their confidentiality than any other - injecting drug users.
So you know we really mean it when we say we take your privacy, and right to confidentiality, very seriously. We dispatch goods to individuals in plain packaging.
We do, of course, collect information about you when you give it to us on the phone or through the website. When placing an order you will be required to supply your credit card or bank details but these will only be stored until your order has been despatched. We can only access these again by logging onto a secure server to assist us should there be a dispute with your payment. We respect your privacy and will not divulge data you supply to us for payment and delivery of goods without your permission, all data is stored in accordance with the Data Protection Act.
Please note that we are required by the carriers to give the mobile number and email address you supply to them. They may share this with the customs authorities in your country.
We have taken all reasonable care to protect your data and our system. Of course, if someone were to break into our password protected system and steal or corrupt data, that is a criminal act, and they would be liable for their actions and not us.
Exchange Supplies returns policy
By placing an order online, you are committing to buy the products you have selected.
If we supply you with incorrect (or faulty) goods please get in touch straight away so we can correct our mistake and supply the correct product(s).
Your assistance in returning the goods sent in error will be required, and we will, of course, cover the agreed associated shipping costs. We will normally arrange collection, or ask you to post the goods back by recorded delivery. If you choose to return goods using any other method, we reserve the right to only refund what it would have cost us to arrange collection by our courier.
If after delivery you want to cancel the order, please contact us so we can discuss the practical arrangements for returning the goods. We are an ethical business, and strive to offer the highest levels of customer service, but we have to reserve the right, at our discretion, to:
charge a restocking fee
not refund outbound carriage costs (based on the actual cost to us)
make you pay for return of the goods in a saleable condition.
Exchange Supplies terms & conditions for customers, and use of our website and its contents
The price payable for the goods is that as set out at the time you place your order and should coincide with those prices listed within the website. VAT, where applicable, is included in all prices displayed online. We reserve the right to adjust these prices without warning or prior notice. Errors and Omissions are unlikely because the webshop is integrated with our accounts system, but we have to stipulate that they are excepted (E&OE).
Some customers are exempt from VAT, the prices given in a web order may still show VAT, however, this will be deducted prior to dispatch.
We strongly recommend that you use a delivery address that is generally occupied during normal working hours (Monday to Friday, 09.00 to 17.30). If we have to organise redirection of your goods once dispatched, or pay for the goods to be returned to us, we reserve the right to pass on any additional costs to you.
We will not be liable for any return postage costs unless the goods are dispatched faulty or the incorrect items are sent to you.
If you are unhappy with any goods we supply, please call us on 01305 262244 and we will endeavour to resolve your complaint quickly.
Your order will not be dispatched until we have received clearance from your credit card company.
If all or any of your order is not ready for dispatch we will not take any money from you until the goods are ready to go.
Please also see our returns, privacy and delivery policies.
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