Reducing the risk of infections when injecting

We recognise that some ways of injecting drugs carry less risk than others. This information can help you reduce harm.

How to reduce risk of infections when injecting

Infections from injecting happen when bacteria or viruses enter your bloodstream, most often through:

  • Dirt and debris, including dirty water
  • Blood and other body fluids

The following steps can help to reduce the risk of:

  • Bacterial infections
  • Blood-borne virus (BBV) transmission - including HIV, Hepatitis B and Hepatitis C
  • Vein damage 
  • Overdose
  • Developing a dependence

Preparing a safer space

Step 1: Choose your space

Where possible, choose a space that:

  • Is warm, clean and dry
  • Is well lit 
  • Has running water and soap

Step 2: Wash your hands

Before preparing your space, wash your hands with soap and water for at least 20 seconds.

If you don’t have soap and water, you can use new alcohol swabs or hand sanitiser gel.

  • If using swabs, use a swiping motion in one direction. Rubbing in a circular or back and forth motion can spread dirt and bacteria around
  • If using hand sanitiser gel, let your hands air dry for at least 10 seconds and then rub them together. Wiping your hands instead of letting them air dry can make them dirty again

Step 3: Clean your surface

Wipe the surface down with soap and water. If you don’t have soap and water, you can use alcohol swabs, or hand sanitiser gel.

If you can’t clean the area, lay out a fresh disposable surface - like a sheet of newspaper, magazine or paper towel - for your injecting equipment to go on.

Preparing your injecting equipment

Step 1:

Wash your hands (see Step 2 above).

Step 2: 

Lay out your equipment. If any of your equipment is in sterile packaging, don’t remove it until you’re ready to use it.

Reused needles and syringes are the main cause of infections and BBVs when injecting. Reusing blunt needles can also cause pain and damage the injection site, which can lead to infections. To help reduce the risks:

  • If you can, use a new sterile needle and syringe every time. You can get all the equipment you need from a needle and syringe service 
  • If you find yourself in a situation where you have to reuse, only use your own and flush it through with thin bleach and prepared water (see step 3 below). Watch how to clean a syringe

Sharing needles and syringes with other people can also increase the risk of infection and BBVs. To help reduce the risk of harm:

  • No matter how well equipment has been cleaned, keep your used equipment separate from other people
  • Unless new sterile equipment is used to mix and divide up, each person should use all their own equipment

 Step 3:

Prepare your water. Dirty water can be a source of infection, so use the safest water you can find.

  • An unused and unopened sterile water ampoule (amp) is the safest thing to use. You can sometimes get these from the needle and syringe service or you can also buy them online
  • Boiled, then cooled water is the next best thing. Use the water as soon as it has cooled: water that has been in the kettle for a while is more likely to get recontaminated with bacteria
  • Cold water from a kitchen tap is the next best thing. Water from bathroom taps, as this water can come from a storage tank, so a kitchen tap is better
  • Bottled water is often contaminated with bacteria, even if it’s sealed, so it’s better to use fresh tap water. Whilst our stomachs can kill these bacteria, if injected that does not occur

Using water from the following is very unsafe and can increase your risk of infection: 

  • Shared cups of water: Use a fresh cup instead
  • Partly used water amps: Use fresh tap water instead to reduce the risk of contamination
  • A toilet: If there is no alternative, try to use water that runs down the rim of the toilet when you flush it, and not water that has been standing in the bowl to help reduce the risk of bacteria
  • Water from puddles: This is too dangerous even as a last resort. Try asking people for almost-empty bottles of water

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