Scratching the surface: National implementation and early evaluation of self-care wound pack provision to prevent bacterial infections in people who inject drugs.

Background: People Who Inject Drugs (PWID) are at a higher risk of poor health outcomes and injecting site skin and soft tissue infections (SSTIs). Amongst PWID populations, delays in seeking healthcare following onset of SSTI and poor adherence to treatment regimens are common and likely to result in the requirement for longer-term wound management, use of intensive antibiotics, surgical intervention (e.g. debridement, amputation), and may progress to systemic illness such as endocarditis and septicaemia. Public Health Wales led national implementation of self-care wound packs (ACT packs) available via needle and syringe programmes (NSP) to prevent or reduce the severity of bacterial infections related to injecting drug use.

Method: Pre-implementation, a mixed methods pilot study evaluated: acceptability; initial outcomes; ease of use; pack specification; and training needs of PWID and health/social care professionals. PWID (n=39) were opportunistically recruited following presentation of an SSTI at time of NSP attendance. Post-implementation, the evaluation framework included effectiveness of community-based wound treatment pathways.

Results: Pre-implementation evaluation evidenced high levels of acceptability amongst PWID and health/social care staff. 89% reported ease of use, 92% positive infection outcomes following initial use and 97% appropriateness of pack content. PWID and staff identified the need for visual training tools. Post-implementation evaluation evidenced substantial regional variation in community-based treatment services and pathways, including lack of timely access to primary care and over reliance on emergency departments for antibiotic and low threshold wound care.

Conclusion: Evaluation demonstrated effectiveness and acceptability of the self-care ACT wound pack as first-line treatment of early SSTIs amongst PWID. NSP services provide the opportunity for engagement and delivery this harm reduction intervention contributing to the reduction of injecting-relate bacterial infections and improving health outcomes.