– in case of cuts and injections, immediately remove gloves, wash your hands with soap and running water, treat your hands with 70% alcohol, lubricate the wound with a 5% alcohol solution of iodine;

– if blood or other biological fluids come into contact with the skin, the area is treated with 70% alcohol, washed with soap and water and re-treated with 70% alcohol;

– if the patient’s blood and other biological fluids come into contact with the mucous membranes of the eyes, nose and mouth: rinse the oral cavity with plenty of water and rinse with a 70% solution of ethyl alcohol,nasal mucosa and eyes are washed generously with water (do not rub);

– if blood or other biological fluids of the patient get on the gown or clothes: remove work clothes and immerse in a disinfectant solution or in a tank for autoclaving;

– Start taking antiretroviral drugs as soon as possible for post-exposure prophylaxis of HIV infection.

8.3.3.2. Necessary as possible short time after contact, test for HIV and viral hepatitis B and C the person who may be a potential source of infection and the person in contact with him. HIV testing of a potential source of HIV infection and a contact person is carried out using rapid testing for HIV antibodies after an emergency with the obligatory sending of a sample from the same portion of blood for standard HIV testing in an ELISA. Samples of plasma (or serum) from the blood of a person who is a potential source of infection and a contact person are transferred for storage for 12 months to the AIDS center of a constituent entity of the Russian Federation.

The victim and the person who may be a potential source of infection must be interviewed about the carriage of viral hepatitis, STIs, inflammatory diseases of the genitourinary tract, and other diseases, and counseled regarding less risky behavior. If the source is infected with HIV, determine whether he or she received antiretroviral therapy. If the victim is a woman, a pregnancy test should be performed to determine if she is breastfeeding. In the absence of clarifying data, post-exposure prophylaxis begins immediately; if additional information becomes available, the regimen is adjusted.

8.3.3.3. Carrying out post-exposure prophylaxis of HIV infection with antiretroviral drugs:

8.3.3.3.1. Antiretroviral medications should be started within the first two hours after the accident, but no later than 72 hours.

8.3.3.3.2. The standard regimen for post-exposure prophylaxis of HIV infection is lopinavir/ritonavir + zidovudine/lamivudine. In the absence of these drugs, any other antiretroviral drugs can be used to initiate chemoprophylaxis; If it is not possible to immediately prescribe a full-fledged HAART regimen, one or two available drugs are started. The use of nevirapine and abacavir is possible only in the absence of other drugs. If the only available drug is nevirapine, only one dose of the drug should be prescribed - 0.2 g (repeated administration is unacceptable), then when other drugs are received, full-fledged chemoprophylaxis is prescribed. If chemoprophylaxis is started with abacavir, testing for hypersensitivity reactions to it should be carried out as soon as possible or abacavir should be replaced with another NRTI.

1. Take emergency infection prevention measures (remove biomaterial, treat the affected area appropriate to the level of the accident).

2. Immediately notify the head nurse of the department, the head of the department, and at night and on weekends - the doctor on duty.

3. Fill out the accounting documentation:

Medical accident log;

An official investigation report in the event of an emergency;

Write an explanatory note in free form in your own hand, detailing the circumstances and reasons for what happened.

6. Dispensary observation, with blood donation for HIV and markers of hepatitis B and C after 3, 6 and 12 months from the date of the accident.

Composition of the "Anti-HIV" first aid kit. Emergency personal prevention measures.

Composition of the "Anti-HIV" first aid kit:

5% alcohol solution of iodine - 10ml;

Sterile gauze wipes;

Bactericidal patch 3-4 pcs.;

Spare pair of gloves.

If the skin is damaged (cut, puncture), immediately remove gloves, wash your hands with soap and running water, treat your hands with 70% alcohol, lubricate the wound with a 5% alcohol solution of iodine.

If drops of blood or other biological fluids come into contact with the skin, the area is treated with 70% alcohol, washed with soap and water and re-treated with 70% alcohol.

If infected material gets on the mucous membranes of the eyes, rinse them immediately with plenty of water. Don't rub!

If infected material gets on the mucous membrane of the oropharynx, immediately rinse the mouth and throat with plenty of water and rinse with 70% alcohol.

Immediately notify the head of the department about the injury. older sister departments (at night - by the doctor on duty).

If infected material gets on clothing or shoes; remove work clothes and immerse in a disinfectant solution or in a tank (tank) for autoclaving.

Treat the skin of the hands and other parts of the body under contaminated clothing with 70% alcohol.

Wipe shoes twice with a rag soaked in a solution of one of the disinfectants.

If biological fluids get on the floor, walls, furniture, equipment, or contaminated area, pour a disinfectant solution (maintain the exposure time), then wipe with a rag soaked in a disinfectant solution. Dispose of used rags into a container with a disinfectant solution.

1. When preparing for manipulations with patients, make sure

integrity of the emergency first aid kit (f.50).

2. Perform manipulations in the presence of a second healthcare worker, who will be able to continue performing them in the event of a glove rupture or cut.

3. Treat the skin of the nail phalanges with iodine before putting on gloves.

4. For a cut or puncture tool in contact with

biological fluids, skin of hands or hands wearing gloves, you must:

Remove gloves and place in a container for disinfection;

Wash your hands with antiseptic soap and lather twice under running water,

Treat the wound with a sterile gauze pad moistened with 70% ethyl alcohol or another alcohol-based antiseptic (at least 30 seconds);

Treat the wound with a sterile gauze cloth moistened with a 5% alcohol solution of iodine,

Cover with bactericidal adhesive tape.

5. If biological fluids come into contact with unprotected skin:

Treat the skin with a sterile gauze pad moistened with 70% ethyl alcohol;

Wash your skin under running water, lathering twice with antiseptic soap;

6. For massive skin contamination blood and other

biological fluids:

Rinse biological fluid from the skin under running water;

Treat with a sterile gauze pad moistened with 70% ethyl alcohol;

Wash the contaminated area of ​​skin with running water and

twice soaping with antiseptic soap;

Dry with a disposable towel or napkin;

Re-treat with a sterile gauze pad moistened with 70% ethyl alcohol.

7. In case of contact with biological fluids into the nose:

in the eyes:

Rinse with plenty of water and can be used disposable syringe,

Dry your eyes with a sterile gauze pad.

8. In case of contact with biological fluids in the mouth:

Rinse with plenty of water;

Rinse your mouth with 70% ethyl alcohol.

Ethyl alcohol solution 70% - 50.0

Alcohol solution of iodine 5% - 10.0

Sterile cotton balls in sealed packaging

Actions of a medical worker in an emergency.

Each medical and preventive institution must develop an Algorithm for the action of medical personnel in an emergency and based on:

Sanitary and epidemiological rules SP 3.1.5. 2826-10 “Prevention of HIV infection”

Information letter dated 01.11.2010. “The procedure for post-exposure prophylaxis of HIV infection in medical and preventive institutions of the Udmurt Republic.”

Preventive measures in case of contact of infectious biological liquids infected with HIV with the skin and mucous membranes, as well as with injections and cuts:

In accordance with clause 8.3.3.1. SP 3.1.5. 2826-10:

In case of cuts or punctures, immediately:

Take off your gloves

Wash your hands with soap and running water,

Clean your hands with 70% alcohol

Lubricate the wound with a 5% alcohol solution of iodine;

If blood or other biological fluids come into contact with the skin:

This place is treated with 70% alcohol,

Wash with soap and water and re-treat with 70% alcohol;

If blood or other biological fluids of the patient come into contact with the mucous membranes of the eyes, nose and mouth:

Rinse the oral cavity with plenty of water

Rinse with 70% ethyl alcohol solution,

The mucous membrane of the nose and eyes is washed generously with water (do not rub);

If the patient's blood or other biological fluids come into contact with a gown or clothing:

Remove work clothes and immerse in a disinfectant solution or in a bix (tank) for autoclaving;

Note:

Start taking antiretroviral drugs as soon as possible for post-exposure prophylaxis of HIV infection.

Examination of an injured health worker after an emergency.

In accordance with clause 8.3.3.2. SP 3.1.5. 2826-10 it is necessary, as soon as possible after contact, to examine for HIV and viral hepatitis B and C a person who may be a potential source of infection and the person in contact with him. HIV testing of a potential source of HIV infection and a contact person is carried out using rapid testing for HIV antibodies after an emergency with the obligatory sending of a sample from the same portion of blood for standard HIV testing in an ELISA. Samples of plasma (or serum) from the blood of a person who is a potential source of infection and a contact person are transferred for storage for 12 months to the BUI UR "URC AIDS and IZ".

The victim and the person who may be a potential source of infection must be interviewed about the carriage of viral hepatitis, STIs, inflammatory diseases of the genitourinary tract, and other diseases, and counseled regarding less risky behavior. If the source is infected with HIV, determine whether he or she received antiretroviral therapy. If the victim is a woman, a pregnancy test should be performed to determine if she is breastfeeding. In the absence of clarifying data, post-exposure prophylaxis begins immediately; if additional information becomes available, the regimen is adjusted.

Carrying out post-exposure prophylaxis of HIV infection with antiretroviral drugs, in accordance with SP 3.1.5. 2826-10:

Clause 8.3.3.3: The decision to carry out post-exposure prophylaxis for HIV infection is made by the doctor responsible for the management of patients with HIV infection in the health care facility where the emergency occurred. On the weekend, holidays and on the night shift, the doctor on duty of the department where the emergency occurred, with the subsequent referral of the injured employee for a consultation at the BUI UR "URC AIDS and Illness" to an infectious disease doctor for correction of ART.

Clause 8.3.3.3.1: Antiretroviral medications should be started within the first two hours after the accident, but no later than 72 hours.

In each health care facility, a specialist responsible for storing ARVs must be determined by order of the chief physician; the storage location for ARVs must be determined, ensuring their availability around the clock, including at night and on weekends.

Clause 8.3.3.3.2: The standard regimen for post-exposure prophylaxis of HIV infection is lopinavir/ritonavir + zidovudine/lamivudine. In the absence of these drugs, any other antiretroviral drugs can be used to initiate chemoprophylaxis; If it is not possible to immediately prescribe a full-fledged HAART regimen, one or two available drugs are started. The use of nevirapine and abacavir is possible only in the absence of other drugs. If the only available drug is nevirapine, only one dose of the drug should be prescribed - 0.2 g (repeated administration is unacceptable), then when other drugs are received, full-fledged chemoprophylaxis is prescribed. If chemoprophylaxis is started with abacavir, testing for hypersensitivity reactions to it should be carried out as soon as possible or abacavir should be replaced with another NRTI.

Registration of an emergency situation is carried out in accordance with established requirements in accordance with SP 3.1.5. 2826-10:

Clause 8.3.3.3.3:

1. Health care facility employees must immediately report each emergency to the head of the unit, his deputy or a senior manager;

2. injuries received by health workers and resulting in at least 1 day of incapacity for work or transfer to another job must be taken into account in each health care facility and registered as an industrial accident with the drawing up of an Industrial Accident Report (in 3 copies), on based on the resolution of the Ministry of Labor of the Russian Federation dated October 24, 2002 No. 73 “On approval of the forms of documents required for the investigation and recording of industrial accidents, and provisions on the peculiarities of the investigation of industrial accidents in certain industries and organizations”

3. you should fill out the Occupational Accident Register;

4. it is necessary to conduct an epidemiological investigation of the cause of the injury and establish a connection between the cause of the injury and the performance of official duties by the health worker;

5. all other emergency situations are recorded in the “Medical Institution Emergency Situations Log” with the execution of an Emergency Situation Report in 2 copies.

Clause 8.3.3.3.4:

All health care facilities should be provided with, or have access to, rapid HIV tests and antiretroviral drugs when necessary. A stock of antiretroviral drugs should be stored in any health care facility in such a way that examination and treatment can be organized within 2 hours after an emergency. The health care facility must identify a specialist responsible for the storage of antiretroviral drugs, a storage location with access, including at night and on weekends.

Clause 5.6:

Examination of an injured healthcare worker for HIV infection is carried out with mandatory pre- and post-test counseling on the prevention of HIV infection.

Clause 5.7:

Counseling should be conducted by a trained specialist (preferably an infectious disease specialist, epidemiologist or psychologist) and include basic provisions regarding HIV testing, possible consequences testing, determining the presence or absence of individual risk factors, assessing the examinee’s awareness of HIV prevention issues, providing information on routes of HIV transmission and methods of protection against HIV infection, types of assistance available for those infected with HIV.

Clause 5.8:

When conducting pre-test counseling, it is necessary to fill out an informed consent form for testing for HIV infection in two copies, one form is given to the person being examined, the other is kept in the health care facility.

Monitoring contacts receiving chemoprophylaxis for HIV infection.

A medical worker or a person injured in an emergency after an episode of emergency contact with a source of infection must be observed for 12 months by an infectious disease doctor at the BHU UR "URC AIDS and Illness" or an infectious disease doctor at the place of work (place of medical care) with control dates repeat testing for HIV, HCV, HBV at 3, 6 and 12 months after exposure.

To identify adverse events associated with taking drugs, a laboratory examination is carried out: general analysis blood, biochemical blood test (o. bilirubin, ALT, AST, amylase/lipase). Recommended frequency of examination: after 2 weeks, then after 4 weeks from the start of chemoprophylaxis.

It is necessary to provide psychological support and, if necessary, refer the person contacted for consultation to a psychologist/psychotherapist, an infectious disease specialist at the BUZ UR "URC AIDS and IZ" upon his request.

Precautionary measures.

• 1. All manipulations during which hands may become contaminated with blood, serum or other biological fluids should be carried out with rubber gloves.
• 2. When performing manipulations medical worker must be dressed in a robe, cap, and replaceable shoes, which are prohibited from entering outside the manipulation rooms.
• 3. Medical workers who have wounds on their hands, exudative skin lesions or weeping dermatitis are removed from caring for patients and contact with care items for the duration of their illness. If work needs to be done, all damage must be covered with finger caps and adhesive tape.
• 4. If there is a risk of blood or serum splashing, eye and face protection should be worn. protective mask, glasses, protective shields.
• 5. Disassembly, washing, rinsing of medical instruments, pipettes, laboratory glassware, instruments or apparatus that have come into contact with blood or serum should be carried out after preliminary disinfection (disinfection) and only with rubber gloves.
• 6. All manipulations with an HIV-infected patient must be performed in the presence of a second specialist, who in the event of an emergency can provide assistance to the victim and also continue performing the manipulation.
• 7. Health care workers should treat blood and other body fluids as potentially contaminated materials.

When do emergencies involving the likelihood of infection of healthcare workers most often occur?

How to prevent emergencies and occupational infections of medical workers?

What means personal protection should healthcare professionals use?

What is the algorithm of actions in case an emergency does occur?

IN Russian Federation second place (more than 30%) in general structure Occupational morbidity among medical personnel is occupied by blood-borne infections, second only to tuberculosis. In this regard, healthcare institutions should implement a system of preventive measures aimed at preventing the occurrence of medical accidents and occupational infections of personnel.

Medical workers can become infected with blood-borne infections in the event of emergency situations, which include injuries and microtraumas from contaminated sharp medical instruments, contact with blood and other biological fluids on mucous membranes and unprotected skin.

Emergency situations associated with the likelihood of infection of health care workers most often occur:

• when performing injections;
• collection of venous blood;
• transfer of sharp surgical instruments from hand to hand, improper handling of epidemiologically dangerous medical waste;
• cleaning the workplace;
• failure to comply with infection safety requirements during work.

The risk of contracting HIV infection when pricked with a contaminated needle is 0.3%, hepatitis B - from 1 to 30%, hepatitis C - up to 7%.

Potentially hazardous patient fluids include:

• blood;
• sperm;
• vaginal discharge;
• lymph;
• synovial fluid;
• cerebrospinal fluid;
• pleural fluid;
• pericardial fluid;
• amniotic fluid.

The following are at high risk of contracting bloodborne infections:

• nurses performing invasive procedures, including procedural, guard, ward, operating room nurses;
• doctors of surgical specialties performing surgical interventions;
• obstetricians-gynecologists;
• anesthesiologists-resuscitators;
• pathologists;
• dentists and dentists;
• laboratory service staff;
• ambulance staff medical care;
• junior medical personnel involved in the processing of single-use and reusable medical products, and the management of medical waste.

The following factors contribute to the occurrence of emergencies among medical workers:

• shortage of working time;
• night work;
• professional inexperience of the medical worker;
• lack of infectious alertness.

MEASURES TO PREVENT EMERGENCIES AND OCCUPATIONAL INFECTION OF MEDICAL WORKERS

For work where contact with an infected person is possible biological material, medical workers are admitted only after appropriate instruction at the workplace, which must be noted in the instruction logbook.

Instructing medical workers on occupational safety issues, including the prevention of occupational infections and safe handling of medical waste, is carried out by the head of the structural unit at least once a year.

The administration of a medical organization is obliged to organize the work and rest regime of medical workers in accordance with labor legislation, provide personnel with the necessary personal protective equipment, hand hygiene products, safe medical products (including vacuum tubes for collecting venous blood (Fig. 1), blunt-ended suture surgical needles, scalpels with protective caps (Fig. 2), etc. d.).

When performing professional duties, personnel of medical organizations must consider each patient as a potential source of infection, including HIV infection and viral hepatitis. During manipulations involving contact with biological fluids, a medical worker must strictly observe precautions and use the necessary personal protective equipment.

Medical workers with exudative lesions of the skin of the hands are excluded from performing invasive manipulations for the duration of the disease.

If there are cuts, scratches, abrasions, etc. on the skin of the hands, carefully seal the damaged areas with adhesive tape before starting work, and use finger pads if necessary.

Important!

Regardless of the use of gloves, before any contact with the patient or objects in his environment, as well as after such contact, the medical worker is required to perform hand hygiene, and, if necessary, disinfect the hands of surgeons.

To prevent the development of dermatitis and skin trauma, medical personnel must follow a number of recommendations:

• do not resort to frequent hand washing with soap; when performing hand hygiene, give preference to alcohol-containing skin antiseptics;
• avoid using hot water while washing hands;
• do not use hard brushes to wash your hands;
• When using towels, do not rub the skin of your hands to avoid the formation of microcracks;
• do not put on gloves after treating your hands until they are completely dry;
• regularly use creams, lotions, balms and other hand skin care products.

Medical instruments and medical devices contaminated with biological fluids of patients can be disassembled, washed and rinsed only after preliminary disinfection.

During surgical interventions and other invasive procedures, special care must be taken when using sharp medical instruments, especially when applying sutures during suturing of wounds and blood vessels.

Do not point the tip of the instrument at your own non-dominant hand or the hands of an assistant during operations.

When transferring medical instruments, use a tray (Figure 3) or a neutral area on the operating table (Figure 4).

To transport contaminated instruments in the operating room, it is advisable to use magnetic mats.

If blood and other epidemiologically dangerous biological fluids of patients get on the floor, walls, furniture, equipment and other surrounding objects, it is necessary to treat the contaminated area with a disinfectant solution that is active against pathogens of blood-borne infections.

All departments of a medical organization in which personnel may come into contact with the blood of patients must be provided with emergency prevention kits for parenteral infections (Anti-AIDS first aid kits; Fig. 5), as well as leaflets with an algorithm for post-contact measures in emergency situations.

Composition of the pack for emergency prevention of parenteral infections:

70% ethyl alcohol;

5% alcohol solution of iodine;

sterile medical gauze bandage (5 m × 10 cm) - 2 pcs.;

bactericidal adhesive plaster (at least 1.9 cm × 7.2 cm) - 3 pcs.;

sterile medical gauze napkin (at least 16×14 cm, No. 10) - 1 pack;

Responsibility for the availability and configuration of equipment is usually assigned to the senior nurses of the institution.

Note:

1. The emergency prevention kit for parenteral infections is placed in a case or container with strong locks (fasteners). The material and design of the container must allow disinfection.

2. The equipment should be equipped with medical devices registered in the Russian Federation. After expiration dates medications and medical products are subject to write-off and disposal in accordance with current legislation.

PERSONAL PROTECTION EQUIPMENT FOR MEDICAL WORKERS

All manipulations in which there is a risk of transmitting blood-borne infections must be performed using barrier protective equipment, which includes a medical gown or suit (overalls), closed shoes, a cap (cap), a mask, and gloves.

As additional funds To protect against a high risk of infection, waterproof sleeves and aprons can be used.

When performing medical procedures that may result in splashing of blood or other body fluids, personnel should use special face shields or safety glasses (Figure 6).

In rooms where invasive procedures are performed, there should be a spare set of medical clothing.

Washing of workwear is carried out centrally; washing of workwear at home is prohibited.

When performing invasive manipulations with high level of epidemiological risk, gloves are used that reduce the likelihood of infection of a medical worker:

• double gloves, including those with puncture indicator (Fig. 7);

• gloves with internal antibacterial coating (Fig. 8);

• “chainmail” gloves (Fig. 9).

If the integrity of the gloves is compromised, they must be removed as soon as possible and hand hygiene performed.

Even if only one of the gloves is damaged, both must be replaced. A new pair of gloves should be put on hands that are completely dry after treatment in order to prevent adverse reactions from the skin.

If gloves are contaminated with patient blood or secretions, remove them using a swab or napkin moistened with a disinfectant or antiseptic solution to avoid contamination of hands during removal of gloves.

Important!

Reuse of gloves is strictly prohibited. It is not recommended to treat gloves with alcohol-containing or other antiseptic agents - in this case, the porosity and permeability of the material increases.

MEDICAL EXAMINATIONS AND VACCINATIONS OF STAFF

Upon entering work, all medical workers must be vaccinated in accordance with the current schedule of preventive vaccinations, including against viral hepatitis B.

Vaccination of medical workers against viral hepatitis B is carried out regardless of age. When the intensity of post-vaccination immunity decreases, revaccination against viral hepatitis B is carried out, which is subject to medical workers who have contact with blood and/or its components, including:

• staff from blood service departments, hemodialysis departments, kidney transplant departments, cardiovascular and pulmonary surgery departments, burn centers and hematology;
• personnel of clinical diagnostic and biochemical laboratories;
• doctors, nursing and junior medical staff of surgical, urological, obstetric-gynecological, anesthesiological, resuscitation, dental, oncological, infectious diseases, therapeutic, including gastroenterological hospitals, departments and clinics;
• medical staff of emergency stations and departments.

Serological studies of the intensity of post-vaccination immunity to hepatitis B are recommended to be carried out every 5-7 years.

Medical workers of the following institutions and departments of medical organizations are subject to examination for the presence of HBsAg by ELISA and Anti-HCV IgG in blood serum upon hiring and annually thereafter:

• institutions for donating blood and its components;
• centers, departments of hemodialysis, organ transplantation, hematology;
• clinical diagnostic laboratories;
• surgical, urological, obstetric-gynecological, ophthalmological, otolaryngological, anesthesiological, resuscitation, dental, infectious diseases, gastroenterological hospitals, departments and offices (including dressing rooms, treatment rooms, vaccination rooms);
• dispensaries;
• perinatal centers;
• ambulance stations and departments;
• disaster medicine centers;
• FAPs, health centers.

Medical workers of the following institutions and departments of medical organizations are subject to mandatory screening for HIV infection using the ELISA method upon hiring and annually thereafter:

• centers for the prevention and control of AIDS;
• healthcare institutions, specialized departments and structural divisions of institutions engaged in direct examination, diagnosis, treatment, service, as well as forensic medical examination and other work with persons infected with HIV, having direct contact with them;
• surgical hospitals and departments;
• laboratories that screen the population for HIV infection and study blood and biological materials obtained from persons infected with the human immunodeficiency virus.

MEDICAL WASTE HANDLING

Collection, accumulation, storage, disinfection (neutralization) of medical waste must be carried out in accordance with the requirements of SanPiN 2.1.7.2790-10 “Sanitary and epidemiological requirements for the management of medical waste.”

Persons at least 18 years of age who are immunized against hepatitis B are allowed to work with medical waste.

Persons handling medical waste, upon hiring and then annually, must undergo mandatory safety training when working with waste.

Personnel working with medical waste are provided with special clothing and personal protective equipment.

To collect sharps medical waste, use puncture-proof, moisture-resistant containers equipped with needle removers and lids that prevent spontaneous opening (Fig. 10).

Containers for collecting sharp medical waste must be changed at least once every 72 hours, in operating rooms - after each operation.

When handling medical waste it is prohibited:

• manually destroy and cut waste of classes B and C, including used systems for intravenous infusions, hemacons with residual amounts of blood, in order to disinfect them;
• manually remove the needle from the syringe after using it, put the cap on the needle after injection;
• pour and reload unpackaged waste of classes B and C from one container to another;
• compact waste of classes B and C;
• carry out any operations with waste without gloves or the necessary personal protective equipment and protective clothing;
• use soft disposable packaging to collect sharp medical instruments and other sharp objects;
• install disposable and reusable waste collection containers at a distance of less than 1 m from heating devices.

RULES FOR WORKING WITH BIOLOGICAL MATERIAL

Biological materials should be delivered to the laboratory in closed containers or cooler bags, the design of which allows them to be washed and treated with disinfectants (Fig. 11).

An absorbent material (gauze pad, fabric, cotton wool, etc.) is placed at the bottom of the container for transportation. The container must be marked and have the international “Biohazard” sign.

Delivery of material in shopping bags, suitcases, briefcases and other personal items is not allowed.

All delivered containers with liquid materials must be closed with stoppers (lids) to prevent spontaneous opening during transportation. Test tubes with biological fluids are additionally placed in a rack.

When receiving and disassembling material delivered to the laboratory, precautions must be observed.

The containers are placed on a tray or tray covered with a multi-layer gauze napkin moistened with a disinfectant solution.

Laboratory personnel, when accepting and disassembling biological material, must use personal protective equipment - masks and rubber gloves.

When working with biological material, it is not allowed to use test tubes with broken edges, it is forbidden to pipette with your mouth (it is necessary to use automatic pipettes, bulbs), and it is forbidden to pour liquid material over the edge of a test tube (bottle).

Centrifugation of biological fluids and other operations with a high potential for aerosol generation should be carried out in biological safety cabinets or separate cubicles. It is prohibited to remove undisinfected blood clots from test tubes by shaking them out.

To disinfect, tubes with blood clots must be immersed in a disinfectant solution in an inclined position using tweezers.

All work with biological material is carried out using personal protective equipment: gloves, masks, caps, medical gown or suit, medical shoes.

After finishing work with biological material, personnel perform mandatory hand hygiene.

ACTIONS OF MEDICAL STAFF IN THE EVENT OF EMERGENCY SITUATIONS

Algorithm of actions of medical personnel in emergency situations:

1. In case of injections and cuts with instruments contaminated with biological fluids of patients, it is necessary to immediately treat and carefully remove gloves, wash your hands with soap and running water, then treat them with a 70% ethyl alcohol solution, lubricate the wound with a 5% alcohol solution of iodine . If necessary, cover the damaged area of ​​skin with a bactericidal adhesive plaster or apply an aseptic bandage.

2. If blood or other biological fluids come into contact with the skin, it is necessary to treat the area of ​​skin at the site of contact with biological material with a 70% ethyl alcohol solution, then wash with soap and water, and re-treat with an alcohol solution.

3. If blood and other biological fluids get on the mucous membranes of the mouth, eyes and nose: rinse the oral cavity with plenty of water and rinse with a 70% solution of ethyl alcohol, immediately rinse the mucous membranes of the nose and eyes with plenty of water (do not rub!).

4. In case of contamination of work clothes with biological fluids that are potentially dangerous in relation to bloodborne infections, they must be removed and immersed in a working solution of a disinfectant (for example, “Abacteril”, “Alaminol”, “Wendelin”, “Hexaquart Forte”, “Lizarin”, "Mistral", etc.) or autoclave; Treat shoes with a working solution of disinfectant in accordance with the instructions supplied with it.

DOCUMENTING AN EMERGENCY

If an emergency occurs, the medical worker is obliged to inform his immediate supervisor or the head of the structural and functional unit about the incident. Information about the emergency situation is entered into the Emergency Situations Logbook during medical procedures.

A report on a medical accident in the institution is drawn up.

EXAMINATION OF THE VICTIM AND PATIENT

To resolve the issue of the need for emergency chemoprophylaxis, the injured healthcare worker and the patient, who is a potential source of infection, are immediately examined using rapid testing for antibodies to HIV with the obligatory sending of samples from the same portions of blood for testing for HIV using the standard ELISA method.

If a medical organization does not have its own laboratory, rapid tests for HIV antibodies can be performed by a trained medical professional who has been instructed in accordance with the order of the institution. Store rapid tests in accordance with the conditions specified in the instructions for their use.

Plasma (or serum) samples from the blood of a patient who is a potential source of infection and an injured medical worker are transferred to the Center for Prevention and Control of AIDS for storage for 12 months.

As soon as possible after an emergency, a person who may be a potential source of infection and a medical worker who has been exposed to the risk of infection are examined for markers of viral hepatitis B and C. If the medical worker injured in the emergency is a woman, a pregnancy test must be performed and find out if she is breastfeeding the baby.

POST-EXPOSURE PREVENTION AND FOLLOW-UP MONITORING AFTER AN EMERGENCY

Post-exposure chemoprophylaxis of HIV infection

The optimal time to begin chemoprophylaxis of HIV transmission is the first 2 hours from the moment of the emergency.

Prophylactic medication must be started no later than 72 hours after the injured healthcare worker comes into contact with biological material.

Post-exposure chemoprophylaxis for the transmission of HIV infection to a medical worker injured in an emergency situation begins to be carried out in cases where the patient, who is a potential source of infection:

• HIV positive;
• when examined using rapid testing for antibodies to HIV, has a positive result;
• unknown;
• belongs to risk groups (user of injecting drugs or psychoactive substances, has casual sexual contacts, sexually transmitted diseases, etc.).

To carry out anti-epidemic measures and chemo-prevention of HIV transmission in emergency situations, each medical organization must have a stock of antiretroviral drugs. Access of medical personnel to drugs for chemoprophylaxis should be unhindered at any time of the day, including on weekends and holidays.

To correct the chemoprophylaxis regimen, the victim is sent to the Center for Prevention and Control of AIDS on the next working day.

Post-exposure prophylaxis of viral hepatitis

If the examination results for viral hepatitis B and C are positive for the patient with whose biological fluids there was contact, the injured medical worker is referred for consultation with an infectious disease specialist. If there are epidemiological indications, emergency immunoprophylaxis of hepatitis B is carried out.

Unvaccinated medical workers are given the hepatitis B vaccine and, if possible, specific immunoglobulin within 48 hours of the emergency. The hepatitis B vaccine and specific immunoglobulin are administered simultaneously, but in different areas of the body. Immunoglobulin is administered in a dose of 0.06-0.12 ml (at least 6 IU) per 1 kg of body weight once, emergency vaccination is carried out according to the scheme 0-1-2-6 months.

In medical workers vaccinated against hepatitis B, the strength of immunity is determined (if possible). If the titer of protective antibodies at the time of contact is more than 10 mIU/ml, then hepatitis B prophylaxis is not carried out; if the antibody concentration is less than 10 mIU/ml, then the victim in an emergency is given a booster dose of the vaccine and 1 dose of immunoglobulin.

Dispensary observation of medical workers injured in emergency situations

The period of clinical observation is determined by the maximum duration incubation period HIV infection and is 1 year.

During observation, the injured medical worker is examined for HIV infection using the ELISA method after 3, 6, 12 months from the moment of the emergency. If markers of viral hepatitis B and/or C are detected in a patient who is a potential source of infection, then the injured medical worker must be examined for these infections 3 and 6 months after the emergency.

The affected medical worker should be warned that, despite negative examination results, he may be a source of infection for others during the entire observation period due to the existence of a seronegative (seroconversion) window. For 12 months, a medical worker involved in an emergency cannot have unprotected sex or become a donor.

After 12 months, if laboratory test results are negative, the victim is removed from dispensary observation.

Note!

If a positive result is obtained during the examination of the victim, an investigation is carried out into the circumstances and causes of the employee’s occupational disease in the manner established by the legislation of the Russian Federation.

ORGANIZATIONAL AND METHODOLOGICAL MEASURES FOR PREVENTION OF EMERGENCIES IN A MEDICAL ORGANIZATION

A medical organization must keep records and analyze emergency situations associated with the risk of infection of medical personnel. Accounting and analysis are carried out by a medical organization's epidemiologist, chief nurse or other specialist in accordance with the order of the institution.

In the course of retrospective epidemiological studies, the responsible specialist assesses the frequency of emergency situations in a medical organization as a whole, as well as by department, and identifies risk factors and risk groups among medical personnel.

When carrying out the analysis, it is necessary to calculate the proportion of emergency situations in which post-exposure preventive measures were carried out in accordance with the algorithms developed in the medical organization.

Based on the results of the study, measures are being developed to reduce the risk of infection among medical workers.

Note!

Algorithms for post-exposure prophylaxis in emergency situations, measures to prevent occupational infection, and a list of persons responsible for this section of activity must be set out in an order for the institution, which is approved by the head of the medical organization.

In order to prevent emergency situations and occupational infections, regular training of medical personnel is carried out. Trainings, business and educational role-playing games, and visual aids are most effective.

An assessment of the level of knowledge of medical personnel regarding the prevention of emergency situations should be carried out annually.

P. E. Sheprinsky, chief physician of the Vologda City Hospital No. 1
E.V. Dubel, head. epidemiological department - epidemiologist of the Vologda City Hospital No. 1