Standard operating procedure for packing of safe injecting kits

 STANDARD  OPERATING  PROCEDURE  

FOR  PACKAGING  OF  STERILE  INJECTING  KITS  CHAMPION-­IDU  PSI  THAILAND  

       This  document  is  meant  to  provide  clear  and  simple  instructions  to  drop-­‐in  center  staff  in  the  preparation  of  safe  injecting  kits  under  the  CHAMPION-­‐IDU  project.  The  guidelines  herein  should  be  followed  at  all  project  sites.    This  document  contains  the  following  sections:  

! Objectives  ! Commodities  ! Equipment  ! Eligibility  ! Steps  ! M&E  ! Payment  

OBJECTIVES  The  new  packing  arrangements  have  been  developed  by  PSI  for  several  reasons  that  are  explicated  below:    

! Meaningful  participation:  The  meaningful  participation  of  members  of  the  project  client  group  is  considered  best  practice  by  many  international  agencies  and  peer-­‐led  groups  across  the  world.  PSI  therefore  is  keen  on  following  such  recommendations  to  increase  meaningful  participation  of  people  who  inject  drugs  by  developing  mechanisms  through  which  people  who  inject  drugs  can  contribute  to  the  success  of  the  CHAMPION-­‐IDU  project.  By  encouraging  clients  to  undertake  packing  activities  at  drop-­‐in  center  level,  PSI  and  its  partners  will  be  creating  opportunities  for  empowerment  of  the  client  group.  

! Education:  Beyond  meaningful  participation  and  empowerment,  the  packing  process  will  provide  additional  opportunities  to  give  information,  education  and  training  to  clients.  In  particular,  all  packing  activities  will  be  preceded  by  a  short  training  on  hand  washing  and  sterilization.  This  will  directly  contribute  to  IDUs  understanding  of  what  sterile  injecting  equipment  is,  why  such  equipment  is  needed,  why  it  is  so  important  in  terms  of  health  promotion  and  how  that  is  linked  to  HIV  prevention.  Clients  involved  in  the  packing  should  be  able  to  explain  the  what  defines  “sterile”.  

! Supporting  PWID:  By  providing  a  stipend  to  clients  of  the  CHAMPION-­‐IDU  project,  PSI  will  encourage  clients  to  gain  a  bit  of  work  experience  thereby  contributing  to  the  overarching  project  objective  of  improving  the  quality  of  life  of  people  who  use  drugs.  

! Promotion:  Finally,  conducting  the  packing  process  at  DIC  level  should  contribute  to  the  promotion  of  the  CHAMPION-­‐IDU  project.  With  this  opportunity,  new  IDUs  can  be  reached  and  stimulated  to  join  activities  beyond  the  packing  at  the  DIC  or  later  through  outreach.  

COMMODITIES    The  CHAMPION-­‐IDU  safe  injecting  kit  should  always  contain  the  following  items:  

! 5x  needles  ! 5x  syringes  ! 5x  vials  of  sterile  water  ! 5x  cotton  balls  ! 5x  filters  ! 5x  alcohol  swabs  

 In  addition,  at  the  discretion  of  the  DIC  manager,  additional  items  can  be  included  in  the  kit:  

! condoms  ! spoons  ! tourniquets  

 All  items  should  be  packed  into  the  designated  CHAMPION-­‐IDU  plastic  bag  depending  on  the  size  of  the  needle/syringe  used:  

! Orange  bag:  #27  needle,  1ml  syringe,  detachable  ! Black  bag:  #27  needle,  1ml  syringe,  non-­‐detachable  ! Blue  bag:  #25  needle,  1ml  syringe  ! Green  bag:  #25  needle,  3ml  syringe  

 Note  that  bags  with  the  small  filters  should  be  punched  in  the  lip  to  easily  identify  bags  with  different  filter  types.    

EQUIPMENT    In  order  to  ensure  that  items  in  the  kit  remain  sterile,  the  following  equipment  has  been  provided  to  you.  The  equipment  below  is  absolutely  necessary  to  properly  pack  all  items  into  the  bags.    

 Mask  (box,  50  pcs)      Latex  gloves  (box,  100  pcs)                                        Tweezers  (unit,    

             stainless  steel)    

Tweezers  holder                      Medicine  counting  table       Small  plastic  bags  (unit,  stainless  steel)   (unit,  stainless  steel)  

 Soap  (bottle,  500ml)     Flip  chart  paper          Alcohol  (bottle,  500ml)

ELIGIBILITY    The  packaging  process  is  designed  to  provide  opportunities  for  clients  of  the  CHAMPION-­‐IDU  project  to  become  more  familiar  with  the  CHAMPION-­‐IDU  project  and  to  attract  clients  to  the  drop-­‐in  center.  As  such,  it  is  recommended  that  priority  be  given  to  IDUs  to  conduct  the  packing.    Approximately  two  weeks  before  the  packing  begins,  DIC  managers  should  make  an  announcement  to  all  clients  (through  posters  at  the  DIC  and  outreach  workers)  about  recruitment  opportunities  to  pack  safe  injecting  kits.  All  clients  interested  in  participating  in  the  process  should  write  their  names  on  a  piece  of  paper  and  put  their  names  in  a  box.  A  few  days  before  packing  begins,  the  DIC  manager  (with  at  least  one  witness)  should  draw  the  names  to  make  a  list  of  selected  clients  to  handle  the  packing  activity.      In  the  case  that  not  enough  clients  can  be  recruited  for  the  packing,  it  is  recommended  to  invite  the  partners  of  clients  who  have  submitted  their  names.  This  will  provide  opportunities  for  each  site  to  work  more  closely  with  partners  of  IDUs  and  sensitize  them  to  the  services  offered  by  the  project.    A  small  compensation  will  be  provided  to  clients  who  conduct  the  packing  (see  Payment  section  below).  Please  note  that  outreach  workers  (field  staff  and  volunteers)  will  not  be  compensated  for  packing  safe  injecting  kits  –  payment  will  only  be  provided  to  clients  and  their  partners  (see  PAYMENT  section  below).

STEPS    Below  is  a  detailed  process  for  each  step  of  the  packing  activity.  Note  that  during  the  packing,  at  least  one  staff  should  oversee  the  process  at  the  DIC.  In  addition,  it  is  recommended  that  all  peer  educators  participate  at  least  once  in  the  training  and  provide  assistance  in  the  packing  process  supervision.    Training  

! Prior  to  starting  the  packing,  it  is  required  that  selected  clients  doing  the  packing  undergo  a  short  training  session  to  clarify  all  the  steps  in  the  process.  The  training  should  be  delivered  by  a  person  assigned  by  the  DIC  manager.  The  training  should  not  be  longer  than  2  hours.    

Setting  up  the  work  space    

1. Select  the  area  where  the  packing  will  take  place.  You  will  need  enough  space  for  people  to  sit  comfortably  and  spread  the  commodities  for  packing  so  they  are  accessible  by  all  packers.  Once  the  space  has  been  selected,  the  area  should  be  cleaned  (broom,  soap).  

2. Once  the  area  is  clean,  spread  a  number  of  flip  chart  papers  to  cover  the  area.  Spread  all  the  commodities  on  top  of  the  flip  chart  paper.  

3. Place  the  tweezers  holder  for  easy  access.  

Keeping  things  clean      

 1. Before  inserting  commodities  

into  the  CHAMPION-­‐IDU  bags,  it  is  important  to  ensure  that  items  do  not  get  contaminated  before  they  are  inserted  into  the  bag.  As  such,  it  is  important  for  all  packers  to  wash  their  hands  thoroughly  (see  poster).    

2. Once  hands  are  washed,  put  on  a  pair  of  latex  gloves.  Be  careful  not  to  touch  anything  before  starting  to  pack!  

3. Slip  on  a  mask  to  cover  your  nose  and  mouth.  

4. Disinfect  the  tweezers  with  the  alcohol  and  place  them  in  the  holder.    

 Packing  needles  and  syringes  

1. Needles  and  syringes  will  be  delivered  at  the  DIC  separately.  Needles  and  syringes  come  in  boxes  of  100  pieces.  Each  injecting  kit  should  contain  5  needles  and  5  syringes.    

2. Open  the  boxes  containing  the  needles  and  the  syringes.  

3. Use  your  hands  to  pick  strips  of  5  units  and  place  them  in  the  CHAMPION-­‐IDU  bag.  

4. Ensure  that  the  needle/syringe  size  corresponds  to  the  right  bag.  As  a  reminder:  

a. Orange  bag:  #27  needle,  1ml  syringe,  detachable  

b. Black  bag:  #27  needle,  1ml  syringe,  non-­‐detachable  

c. Blue  bag:  #25  needle,  1ml  syringe  

d. Green  bag:  #25  needle,  3ml  syringe  

Packing  sterile  water  1. Sterile  water  will  be  delivered  

at  the  DIC  in  large  boxes  containing  smaller  boxes.  Each  small  box  will  contain  50  pieces.  

2. Open  the  boxes  containing  the  sterile  water.  

3. Pick  strips  of  5  units  of  sterile  water  and  place  them  in  the  CHAMPION-­‐IDU  bag.  

     Packing  cotton  balls  

1. Cotton  balls  will  come  to  the  DIC  in  a  large  box  containing  200  small  packs  of  5  units  of  cotton  balls.  

2. Open  the  box  containing  the  cotton  balls.  

3. Pick  each  small  pack  of  5  units  and  place  the  pack  in  the  CHAMPION-­‐IDU  bag.  

 Packing  alcohol  swabs  

1. Alcohol  swabs  will  come  to  the  DIC  in  a  box  containing  200  units  of  alcohol  swabs.  

2. Open  the  box  containing  the  alcohol  swabs.  

3. Pick  each  small  unit  of  alcohol  swabs  and  place  the  5  units  in  the  CHAMPION-­‐IDU  bag.  

 Packing  filters  

1. CHAMPION-­‐IDU  provides  clients  with  two  different  options  for  filters.  One  of  the  filters  will  come  in  a  box  containing  six  plastic  bottles  (each  bottle  contains  ~600  pieces).  The  other  filter  will  come  in  a  bag  containing  10,000  

pieces  (Apothicom).  2. Open  the  bottles  and  bags  

containing  the  filters.  3. Using  the  tweezers,  place  a  

quantity  of  filters  on  the  stainless  steel  medicine  counting  table.  Be  careful  not  to  mix  the  two  different  type  of  filters!  

4. Use  the  tweezers  to  count  5  units  of  filters  and  place  them  into  a  small  plastic  bag.  Seal  the  small  plastic  bag.  

5. Place  the  small  plastic  bag  in  the  CHAMPION-­‐IDU  bag.  

6. For  CHAMPION-­‐IDU  bags  containing  Apothicom  filters,  punch  a  hole  in  the  lip  of  the  bag  for  easy  identification.  

                 In  addition,  at  the  discretion  of  the  DIC  manager,  additional  items  can  be  included  in  the  kit:  

! condoms  ! spoons  ! tourniquets  

 PLEASE  USE  THE  TWEEZERS  TO  GRAB  EQUIPMENT.  IF  YOU  TAKE  A  BREAK,  LEAVE  YOUR  TWEEZERS  IN  THE  HOLDER.  WHEN  YOU  ARE  READY  TO  START  AGAIN,  GO  BACK  TO  THE  “KEEPING  THINGS  CLEAN”  SECTION  AND  FOLLOW  THE  INSTRUCTIONS.    

MONITORING  AND  EVALUATION    The  form  below  will  allow  you  to  record  the  number  of  kits  prepared  by  each  person.  It  is  critical  that  DIC  managers  record  the  number  of  packs  onto  the  M&E  form  before  storing  and  distribution.  All  forms  should  be  collected  by  the  DIC  manager,  scanned  and  sent  to  the  PSI  M&E  Officer.      

1. Note  the  date  in  the  first  column.  2. Use  the  form  to  record  the  name/UIC  number  for  each  client.  3. Indicate  the  number  of  kits  prepared  for  each  needle/syringe  size.    

a. A  DIC  staff  should  always  double  check  the  final  count  before  finalizing  payment.  

4. Note  the  date  that  the  client  received  the  financial  incentive  for  packing.  5. Once  the  client  has  received  the  funds,  it  is  important  that  he/she  signs  the  

form.  6. Once  the  client  has  signed  the  form,  the  Admin/Finance  officer  should  co-­‐

sign  to  confirm  that  payment  has  been  delivered.      

PAYMENT    This  section  clearly  defines  the  terms  and  conditions  of  payment  of  the  client  stipend  for  packing  safe  injecting  kits  in  the  context  of  the  CHAMPION-­‐IDU  project.    As  noted  in  the  ELLIGIBILITY  section  above,  it  should  be  clear  that  only  clients  (and  their  partners)  should  be  allowed  to  receive  project  funds  for  conducting  the  packing  activities  at  DIC  level  –  CHAMPION-­‐IDU  peer  outreach  workers  and  staff  are  not  eligible  to  receive  project  funds  for  packing  safe  injecting  kits.    Payment  to  clients  can  only  be  provided  under  the  conditions  listed  below:  

! The  client  has  been  recruited  by  the  CHAMPION-­‐IDU  team;  ! The  client  has  accurately  filled  out  the  M&E  form  (see  M&E  section  above);  ! The  Admin/Finance  Officer  has  verified  and  signed  the  form  and  double  

checked  the  quantity  of  safe  injecting  kits  prepared;  ! A  CHAMPION-­‐IDU  staff  supervised  the  packing  process.  

 The  terms  of  payment  are  as  follows:  

! For  each  kit  packed,  the  client  will  be  provided  THB  2.5;  ! Each  client  can  claim  a  maximum  of  THB  250  per  day  (maximum  of  100  

bags);  ! The  funds  should  be  paid  directly  to  the  client  in  cash;  ! The  Admin/Finance  Officer  signs  the  form  to  confirm  receipt  of  the  funds  by  

the  client.