Handwashing factsheet endo

nfective endocarditis (IE), although relatively uncommon, can be a real issue for injecting drug users. It is caused by bacteria entering the blood stream through poor injecting, and can be fatal if left untreated. IE can be avoided by using a more hygienic and safer injecting regime.

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reaking down the word endocarditis helps explain its meaning: ‘endo’ means inside; ‘card’ refers to the heart; ‘itis’ signifies the process of inflammation. Put it all together and you have an inflammation of the inside of the heart, usually caused by a bacterial infection and occasionally by a fungus entering the bloodstream.

Infection-causing microbes enter the bloodstream during the injection process and build up on the valves of the heart, weakening them as well as other parts of the heart muscle (see diagram).

Endocarditis can eventually cause a heart murmur, as well as fever, chest pains, fainting spells, shortness of breath and heart palpations. IE can be treated with antibiotics if detected early.

Unfortunately, injecting drug users can be at high risk for infective endocarditis, as unhygienic injecting practices and equipment allow aggressive bacteria many opportunities to enter the blood.

Acute infective endocarditis can come on very quickly (acute) with a rapid onset of symptoms over 1-2 days; these include high fever, chest pains, shortness of breath, cough, small haemorrhages (eg bruising) on the palms and soles of the feet and delirium.

If the attack is very severe, damage to the heart can cause shock; the patient may suddenly collapse, and will have a rapid pulse and pale, cool, clammy skin.

Acute endocarditis can appear extremely fast, and most often occurs when an aggressive type of skin bacteria (such as staphylococcus which normally live normally on the surface of the skin) enters the bloodstream.

Acute infective endocarditis can result in death very quickly if left untreated.

swabbing your injecting site in one direction prior to injecting; and, definitely, not touching the needle.

Chronic infective endocarditis can build up (chronic) over weeks, sometimes months. Symptoms are more vague and include a lowgrade fever (less than 38.4 degrees C), chills, night sweats, pain in the muscles and joints, a persistent tired feeling, headaches, shortness of breath, poor appetite, weight loss, small tender nodules on the fingers and toes, and tiny haemorrhages on the whites of the eyes, the palate, inside the cheeks, on the chest, on the fingers and toes, and odd chest pains.

The slower, chronic form of infective endocarditis is most often caused by one of the group of streptococci that normally live in the mouth and throat. This form has a slow and insidious progression that can occur over weeks or months if left untreated. It can progress for as long as a year before it also is fatal.

The chances of getting endocarditis are determined by how easily bacteria can get into the body. The main bacteria affecting drug users (Staphylococcus aureus) is the same bug that can cause things like septicaemia, cellulitis and abscesses. If you have an infected sore on your skin you must take care to avoid spreading the bacteria to your injecting site, potentially allowing entry into your bloodstream or deeper skin tissue.

The risk to injecting drug users is increased further if you; drink heavily; have had endocarditis in the past; have HIV/AIDS or any other disease which compromises the immune system; have , a malformation of the heart or an implanted device in the heart (such as an artificial heart valve); have , cancer with chemotherapy; or have a history of chronic illness.

Any injecting drug user who has any of these risks or a compromised immune system should talk with their doctor or dentist before any dental or medical procedure is done which might introduce infection.

Prevention for injecting drug users comes with hygienic injecting practices and the use of antibiotics (if required) before undergoing any medical or dental procedure in which bacteria have a chance of entering the blood.

Hygienic injecting practices include such things as: washing your hands before and after injecting yourself and/or others;

Since the bacteria that cause infective endocarditis are found on the skin or in soft tissue infections, such as abscesses or cellulitis, you need to pay particular attention that your injection site and injecting equipment are as hygienic and/or sterile as possible. Licking the needle tip and/or injection site, blowing on the needle tip and/or injecting site, and coughing or sneezing on or around your gear are all ways of transferring streptococci bacteria that could be living inside your mouth or throat.

Endocarditis can be suspected based on your medical history, risk factors and symptoms. Testing involves a thorough physical examination, blood tests and an echocardiogram (ECG) which uses sound waves determine the structure of the inside of the heart.

The first line of defensive treatment is a combination of antibiotics given intravenously, over a course of weeks, and this may include hospital admission. Despite the seriousness of the condition, endocarditis is treatable as long as it is recognised early.

1. Never EVER lick, touch or blow on your spike or works before a hit.

2. Never inject near any skin infection or wound, no matter how small.

3. If you have a heart condition, HIV/AIDS (or a compromised immune system) or have had Endocarditis in the past - tell your GP and dentist before surgery to receive preventative antibiotics.

4. Never cough, sneeze on/near your gear.

5. Never pick or squeeze pimples or sores in between hits (as you might do on the coke).

If you can’t help yourself then ensure you seriously wash your hands