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The Operation and Maintenance of Needle and Syringe Vending Machines (NSVMS) 1

OPERATIONAL DIRECTIVE

Enquiries to: Ms Lisa Bastian OD number: OD: 0554/14 Phone number: (08) 9388 4840 Date: 28/08/2014 Supersedes: OD 0167/08 (23/12/2008) File No: F-AA-29091

Subject: The Operation and Maintenance of Needle and Syringe Vending Machines (NSVMS)

This document should be read in conjunction with the Operational Directive OD: 0553/14 — Provision of sterile needles and syringes from rural and regional hospitals to people who inject drugs. This Operational Directive applies to all individual sites invited by the Sexual Health and Blood-borne Virus Program (SHBBVP) to install and operate a needle and syringe vending machine (NSVM). Professor Bryant Stokes A/DIRECTOR GENERAL DEPARTMENT OF HEALTH WA

This information is available in alternative formats on request from a person with disability.

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The Operation and Maintenance of Needle and Syringe Vending Machines (NSVMS)

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TITLE: The Operation and Maintenance of Needle and Syringe Vending Machines (NSVMs)

1. BACKGROUND

The primary public health strategy in Australia to prevent the transmission of blood-borne viruses such as HIV and hepatitis B and C, among and from people who inject drugs, is to provide access to sterile needles and syringes.

In Western Australia, the Poisons Act 1964 provides a legislative framework for needle and syringe provision to take place through needle and syringe programs (NSPs) approved by the Chief Executive Officer.

Increasing access to needles and syringes as a strategy to reduce the transmission of blood-borne viruses is supported by:

WA Health Networks - Hepatitis C Model of Care Implementation Plan 2010-2014

WA Health Networks - HIV Model of Care Implementation Plan 2010-2014

Drug and Alcohol Interagency Strategic Framework for Western Australia 2011-2015

National Drug Strategy 2009-2015

National Aboriginal and Torres Strait Islander Blood Borne Viruses and Sexually Transmissible Infections Strategy 2014-2017

National Hepatitis C Virus Strategy 2014-2017

National Hepatitis B Virus Strategy 2014-2017

National HIV Strategy 2014-2017.

There are four models of NSPs currently operating in Western Australia:

i. Needle and Syringe Exchange Programs (NSEPs) — NSEPs supply free sterile needles and syringes conditional on the return of used items, i.e. exchanged, or a cost recovery may apply.

ii. Health Service-based NSPs — outlets such as regional and rural hospitals, public health units and community health centres that provide access to free sterile needles and syringes as a component of their service.

iii. Pharmacy-based NSPs — pharmacy-based NSPs are run on a commercial basis via the retail of sterile needles and syringes.

iv. Needle and Syringe Vending Machines (NSVMs) — a self-service device which vends sterile needles and syringes.

Effective: August 2014

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The introduction of NSVMs as a component of a comprehensive statewide NSP is intended to provide equitable and anonymous access to sterile needles and syringes in order to minimise the spread of blood-borne viruses such as HIV and hepatitis B and C, among and from people who inject drugs.

A review of the statewide NSP1 made specific recommendations in relation to the installation of NSVMs across Western Australia. Furthermore, in regard to Aboriginal people who inject drugs, studies undertaken in 20012 and 20083 also supported the wider provision of NSVMs in both metropolitan and rural locations.

NSVMs are considered a complementary service to other methods of needle and syringe provision. An NSVM can provide access to sterile needles and syringes particularly for people who inject drugs who do not wish to attend staffed NSPs, thereby retaining customer anonymity. In addition, NSVMs have the potential to alleviate some of the demands on busy individual sites which are currently providing NSP services as well as improve availability and access in areas, which, for a variety of reasons, may be unable to provide staffed NSP outlets.

2. CRITERIA FOR NSVM SITES

Invitations to install and operate an NSVM will be extended to individual sites by the Sexual Health and Blood-borne Virus Program based on the following criteria as relevant to the site:

2.1 Volume of needles and syringes (NS) distributed

NSVMs have the potential to alleviate some of the demands on busy individual sites that are currently distributing NS to people who inject drugs. Individual sites that currently distribute large volumes of NS will be considered as potential sites for an NSVM.

2.2 Gaps in services

Individual sites that do not currently distribute NS will be considered as potential sites for an NSVM.

2.3 Availability of free NS within local area

In regional areas access to sterile NS is primarily limited to pharmacies, hospitals and some public health units and community health centres. Typically, during business hours pharmacies retail NS, and public health units and community health centres distribute NS free of charge. After-hours, regional hospitals become the primary source for accessing free NS. Should an NSVM replace the free after-hours service provided by a hospital, this may limit access to NS. Therefore, the availability of other existing outlets that distribute free NS within the local area will be considered as a factor in determining NSVM sites.

1 Hales, J., Scorsonelli, L. and O’Brien, B. (2008). Needle and Syringe Program Review. Department of Health, Western

Australia. Available at: http://www.public.health.wa.gov.au/cproot/1787/2/10747%20NSP%20REVIEW%20FINAL.pdf 2 Grey, D., Saggers, S., Atkinson, D., Carter, M., Loxley, W., & Hayward, D. (2001).The Harm Reduction Needs of Aboriginal

People Who Inject Drugs, National Drug Research Institute, Curtin University of Technology. 3 Lamond, T. (2008). Aboriginal Blood-borne Virus Scoping Project: Report on fieldwork undertaken in Kalgoorlie and Bunbury.

Drug and Alcohol Office.

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2.4 Rate of hepatitis C notifications

The rate of hepatitis C notifications will be considered when identifying potential sites for an NSVM. Providing anonymous access to sterile NS, where the rate of hepatitis C amongst people who inject drugs is highest, may contribute to a reduction in hepatitis C transmission.

3. REQUIREMENTS REGARDING THE INSTALLATION OF AN NSVM

3.1 NSVM specifications and placement

NSVMs to be installed in WA should be designed for the purpose of vending needles and syringes and have the following features:

ability to dispense a range of injecting equipment products which may include Fitpack®, Fitpack® Plus, Sterafit™, Sterafit™ Plus, and Fitstick®

capacity to vend a minimum of 50 units

suitable for outdoor use

highly resistant to theft, tampering and vandalism.

It is of particular importance that machines are installed in an area that provides discrete access for clients. At the same time the location must offer protection from the elements, adequate lighting in order to reduce the incidence of vandalism, and access to a power source if required to operate the machine. Staff from the Sexual Health and Blood-borne Virus Program will visit individual sites to assist with determining an appropriate on-site location for the NSVM. If a suitable on-site location cannot be identified, one-off financial assistance to undertake minor refurbishments may be provided by negotiation with the Sexual Health and Blood-borne Virus Program.

3.2 Ownership of NSVM and insurance

The NSVM remains the property of the Sexual Health and Blood-borne Virus Program, Communicable Disease Control Directorate, Department of Health (WA). The responsibility for insurance of the NSVM is to be undertaken by the Department of Health’s RiskCover policy. Should a claim need to be made, the individual site manager is required to contact the SHBBVP to organise repairs and the insurance claim.

4. ROLE AND RESPONSBILITIES OF INDIVIDUAL SITES OPERATING AN NSVM

4.1 Approval to operate an NSVM

Requests for approval to operate an NSVM must be submitted to the Sexual Health and Blood-borne Virus Program prior to the NSVM being installed by the individual site. If the request is approved by the Director of the Communicable Disease Control Directorate, an approval under the Poisons Act 1964 will be issued.

4.2 Promotion of the NSVM

High profile promotional activities are not seen as appropriate in this instance, therefore the NSVM is to be promoted through the distribution of promotional material including flyers and posters to clients accessing existing services in the area. Flyers and posters will be provided by the Sexual Health and Blood-borne

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Virus Program to the individual site for distribution. Promotional material must be distributed by the individual site no less than one month prior to the NSVM being installed and becoming operational.

4.3 Formal requests for information about an NSVM

In the event the installation and ongoing operation of an NSVM attracts media attention, media liaison and responsiveness will be maintained through the Department of Health’s Public Affairs Branch. The Public Affairs Branch is the official point of contact for all comment to the media to ensure a consistent, accurate and timely approach. This includes mainstream media (print, radio and TV).

See Operational Directive OD113/08 Media Communications.

All other requests for information about the NSVM should be directed to the Sexual Health and Blood-borne Virus Program.

4.4 Hours of operation

Where an NSVM is installed to complement existing NSP services, the operating hours of the NSVM are to be negotiated with the Sexual Health and Blood-borne Virus Program.

If an NSVM is replacing an existing NSP, the operating hours of the NSVM are to be consistent with current NSP times to ensure continuity of service provision and accessibility.

Where an NSVM is replacing an existing free service, the previous NSP operating times must still be maintained when the machine is out of order. During these times sterile needles and syringes are to be made available to clients at no cost from within the individual site, as outlined in Section 4.9 of this Operational Directive.

The hours of operation are to be submitted to the Sexual Health and Blood-borne Virus Program for approval by the Director of the Communicable Disease Control Directorate and will be stated on individual program approvals.

4.5 Products to be vended

No limit is to be set on the number of products to be vended to each client. The types of products to be vended are to be negotiated by the individual site with the Sexual Health and Blood-borne Virus Program, but must include a minimum of two (2) products, with one being a standard (e.g. Fitpack®, Sterafit™) and the other a product with additional items (sterile water, swabs) included (e.g. Fitpack Plus®, Sterafit Plus™). Agreed products will be approved by the Director of the Communicable Disease Control Directorate and will be stated on individual program approvals.

The range of products available to be vended along with the recommended vend price per unit, is set out in Schedule 1 of this Operational Directive.

4.6 Revenue

Revenue derived from the sale of products vended from the NSVM is to be expended on the future purchase of products for the machine as well as ongoing costs associated with the NSVM including electricity, service and maintenance.

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Should ongoing costs exceed revenue, then meeting these costs can be negotiated with the Sexual Health and Blood-borne Virus Program.

Individual sites will be required to create and manage a cost centre (or other auditable mechanism) to track NSVM revenue and expenditure.

4.7 Ordering, restocking and collection of coins from NSVM

Ordering and restocking of all products and collection of coins from the NSVM will be the responsibility of individual site staff, as designated by the manager of the individual site.

For security purposes, restocking and collection of coins should be done at the same time by no less than two staff and keys to the NSVM must be kept in a secure location.

4.8 Service and maintenance

It is the responsibility of each individual site to regularly perform basic servicing of the NSVM including cleaning the exterior of the machine. Training on how to perform basic servicing will be provided to staff of the individual site at the time the machine is installed by the NSVM manufacturer.

4.9 Malfunction of NSVM

In the event of reported malfunction of the NSVM, an ‘out of order’ notice and advice regarding other points of access to needles and syringes is to be attached to the NSVM.

For rural and regional hospital sites, in accordance with OD: 0553/14 Provision of sterile needles and syringes from rural and regional hospitals to people who inject drugs, if the NSVM is out of order, needles and syringes are to be made available to clients at no cost from within the individual site. A notice advising this and the notices as above are to be attached to the NSVM. During this time the individual site can obtain injecting equipment at no cost from the Sexual Health and Blood-borne Virus Program to distribute to clients.

Similarly should a significant disaster event (e.g. a cyclone) impact on the provision of free needles and syringes, the service is to be maintained in accordance with individual site’s Disaster Management Plan.

In the interest of staff safety, security personnel should respond to malfunctions, vandalism or other issues relating to the NSVM, e.g. lost coins, out of stock. If security personnel are unavailable, no less than two staff should attend to the machine.

To rectify NSVM malfunctions individual site staff should follow steps as outlined in Schedule 2 of this Operational Directive. In the event that an agent is called out by the SHBBVP to service the NSVM, the cost of this is the responsibility of the individual site and should be paid through the revenue of the NSVM. If this cost exceeds the revenue, then meeting these costs can be negotiated with the SHBBVP.

4.10 Return of used needles and syringes

The provision of sterile needles and syringes via the NSVM is not contingent upon the return of used needles and syringes. Most clients dispose of their injecting

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equipment in domestic waste as the products vended, when used properly, allow for this. Occasionally some clients may return used equipment and in this instance individual site staff must direct clients to an appropriate means of disposal; i.e. domestic waste or disposal bin.

The provision of metal needle and syringe disposal units may be negotiated with the SHBBVP. The installation and servicing of these are the responsibility of the individual site. Any costs incurred are the responsibility of the individual site and should be paid through the revenue of the NSVM. If this cost exceeds the revenue, then meeting these costs can be negotiated with the SHBBVP.

4.11 Staff training and education

Training on how to operate and maintain the NSVM will be provided to individual site staff at the time the machine is installed by the NSVM manufacturer. An operational manual will also be provided. Staff are to use this manual should they encounter difficulties with the NSVM. A copy of the manual is to be placed on the inside of the machine so it is easily accessible by staff.

For staff directly involved in operation and maintenance of the NSVM it is expected they will attend training on how to maintain and operate the machine, as well as training in NSP provision as provided by the NSP Coordinator based at the individual site and/or other agencies. To obtain details of agencies that offer training in NSP provision contact the Sexual Health and Blood-borne Virus Program. Staff who have received training in the operation and maintenance of the NSVM either from the manufacturer or from a colleague should endeavour to train other staff in the operation and maintenance of the NSVM to accommodate for staff turnover.

Ideally, all individual site staff should be oriented about the NSVM and at least read the Needle and Syringe Program Information Pack, which provides information about Needle and Syringe Programs in Western Australia. A copy of the information pack is available from the Sexual Health and Blood-borne Virus Program or visit:

http://www.public.health.wa.gov.au/3/1753/3/information_for_needle_and_syringe_program_nsp_pro.pm

Staff should also be encouraged to complete the online NSP Training and Orientation Package available at:

http://www.dao.health.wa.gov.au/nsp/

4.12 Client education and referral

Signage will be provided to the individual site by the Sexual Health and Blood-borne Virus Program and must be placed on the front of the machine.

Appropriate signage will include instructions on:

how to use the NSVM

local contact details of relevant support and treatment services

alternative local sources of sterile needles and syringes

safe disposal of used needles and syringes.

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http://www.dao.health.wa.gov.au/nsp/


All injecting equipment packs vended by the machine also include health information and contact details of relevant referral services.

4.13 Juvenile access

Individual site staff must follow harm reduction principles and assess whether refusal or access to injecting equipment from the NSVM will result in greater harm to juvenile clients. Should staff observe juveniles accessing the NSVM it is their responsibility to actively encourage referral of these juveniles to appropriate treatment and support services, with due consideration to issues of confidentiality. Referral should be made with reference to the signage placed on the front of the machine.

4.14 Client confidentiality

All Department of Health (WA) staff are bound by the WA Health Code of Conduct (see Operational Directive OD 0383/12) with regard to confidentiality. In any instance, regardless of their status, staff must respect and maintain the confidentiality of clients at all times.

4.15 Staff interaction with clients

It is likely some clients may feel anxiety and/or apprehension on approaching the NSVM to obtain injecting equipment. Individual site staff must adopt an empathetic non-judgemental approach to clients at all times.

4.16 Client responsibility

Activities by clients that threaten the safety of staff or destruction of property will not be tolerated.

All Department of Health (WA) staff must follow steps to address workplace aggression and violence as outlined in Prevention of Workplace Aggression and Violence Policy and Guidelines available at:

http://www.nursing.health.wa.gov.au/projects/publications.cfm

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http://www.nursing.health.wa.gov.au/projects/publications.cfm


SCHEDULE 1

PRODUCT RECOMMENDED

VEND PRICE ($per unit)

Fitpack® - contains 5 x 1mL needles and syringes with plastic disposal container 3.00

Fitpack® Plus – contains 3 x 1mL needles and syringes, 3 x 2mL water ampoules, 6 x alcohol swabs, 3 x spoons with plastic disposal container

3.00

Fitpack® - contains 5 x 1mL needles and syringes, and 5 x single use disposal receptacles

3.00

Sterafit™ - contains 5 x 1mL needles and syringes, 2 x alcohol swabs and 5 x single use disposal receptacles

3.00

Sterafit™ Plus – contains 3 x 1mL needles and syringes, 3 x 2mL water ampoules, 6 x alcohol swabs, 3 x spoons and 3 x single use disposal receptacles

3.00

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SCHEDULE 2

In the Event of a Needle and Syringe Vending Machine Malfunction

1. NSVM malfunction

Individual site staff to check the user manual for NSVM to attempt to fix the malfunction.

If staff are unable to fix the malfunction, they are to advise maintenance staff of the NSVM malfunction.

Individual site staff to apply appropriate signage to the NSVM to advise clients machine is ‘out of order’.

For rural and regional hospitals, staff to provide free sterile needles and syringes until NSVM has been fixed. During this time free needle and syringes can be obtained through the Sexual Health and Blood-borne Virus Program (SHBBVP) by calling (08) 9388 4841 or emailing [email protected]

2. Maintenance staff to attempt to fix the NSVM malfunction. If maintenance staff are experiencing difficulty fixing malfunction they are to call the NSVM supplier to obtain technical advice over the phone.

3. Maintenance staff to attempt to fix the NSVM malfunction with advice from the NSVM supplier.

4a. Maintenance staff able to fix malfunction Once malfunction has been fixed, individual site staff to remove ‘out of order’ signage and NSP service is to revert back to dispensing sterile needles and syringes via the NSVM.

5. Once machine malfunction has been fixed, individual site staff to remove the ‘out of order’ signage, NSP service is to revert back to dispensing sterile needles and syringes via the NSVM, and staff are to advise SHBBVP of the outcome.

4b. Maintenance staff unable to fix malfunction Designated staff member to contact SHBBVP by calling (08) 9388 4841 or emailing [email protected] to advise of malfunction. The SHBBVP will then arrange for further assistance and for a service of the machine if required.

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mailto:[email protected]

mailto:[email protected]

This document is available in different formats, upon request from

a person with disability. © Department of Health 2013

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