The Effectiveness of Bleach in the Prevention of Hepatitis C Transmission - Final Report

8. Recommendations

"For both hepatitis B and C, preventing the initiation of drug injection and establishing harm reduction practices among injection drug users hold the key to effective control of transmission1."

• Bleach disinfection should not be recommended outside the context of a broad-based harm reduction strategy. Although partial effectiveness cannot be excluded, the published data clearly indicate that bleach disinfection has limited benefit in preventing HCV transmission among injection drug users. More research is needed into the ability of bleach to disinfect needles and equipment, into proper bleaching procedures and into IDU behaviour. Bleach distribution and education programs for people who use injection drugs must be careful not to impart a false sense of security regarding bleach's protective efficacy.

• Support the establishment of safe injection sites as part of a comprehensive harm reduction strategy. The published data show that neither bleach disinfection nor needle exchange programs are sufficient to stop transmission of HCV and other bloodborne pathogens. European experience suggests that safe injection sites may have greater success. Such sites not only reduce the harm associated with IDU, they also provide access to comprehensive support programs.

• Support IDU education programs. Injection drug users must be educated about the risks of their drug use, including the possibility of infection with HIV, HCV or other bloodborne pathogens. Safe injection techniques - using sterile technique and equipment (needles, syringes, cookers, filters, etc.) for every injection - are key. This education should be part of a comprehensive self-care harm reduction framework adapted for ethnicity, educational level and IDU culture.

• Target high-risk groups. Persons at high risk of experimenting with or initiating injection drug use should be specifically targeted to prevent IDU-associated infections. Research should investigate the factors that cause people to start injecting drugs, to enable the development and evaluation of prevention programs.

There are many unanswered questions about the best way to prevent transmission of bloodborne pathogens among people who use injection drugs, and no easy answers. What is clear is that a comprehensive approach is essential, and that there is no silver bullet. An expert panel should now be convened in Canada to discuss the issues raised in this report, to develop appropriate policy and to determine next steps, including identifying the necessary components of a comprehensive, integrated approach to effective hepatitis C prevention.

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