Algorithm of actions in the event of an emergency. Emergency situations in the work of medical personnel - description, features and algorithm of actions Emergency situation in medicine
Injected with a needle? Provided first aid without gloves? Participated in a fight? And you are worried: could you get HIV at the same time? Rather standard situations. Do they require emergency HIV prevention? We will discuss in this article.
Possibilities of HIV transmission in everyday life
First, you need to decide on the answer to the question: how is HIV transmitted? Read about this in detail in the articles on our website. The second question concerns the risks of HIV infection in everyday situations. We are not discussing the risks of HIV transmission read about this.
Is infection possible in everyday life? IN Methodological recommendations MR 3.1.0087-14 "Prevention of HIV infection"indicates the "potential risk of infection from needlestick injury from syringes of unknown origin."
For the prevention of infection in this and other cases, the possibility of prescribing emergency drug prophylaxis is provided.
"Can be used in persons who have a potential risk of infection (sexual contact or rape by a person with unknown HIV status, needle injury from syringes of unknown origin, etc.)."
Do you need emergency prophylaxis for needle pricks? The MR states that "the epidemiological effectiveness of the last measure has not yet been studied, but it has psychotherapeutic significance." This is understandable: the likelihood of HIV transmission with a single needle prick is extremely low !
First aid
The provision made in the Methodological Guidelines seems to be controversial MU 3.1.3342-16 "Epidemiological surveillance of HIV infection"... This document says:
"There have been isolated cases of HIV transmission when the blood of an HIV infected person gets on the damaged skin and mucous membranes of an uninfected person, for example, when providing first aid and treating the wound surface without using gloves or other barrier means."
The MU also states that "transmission through close household contact with a source of HIV has not been detected" ... But why is it not possible to get blood on damaged skin and mucous membranes in everyday life?The algorithm of actions after an emergency when providing assistance to an injured person at home or as a result of an accident is not described in the MU.
And the treatment of the wound surface is more likely to concern medical workers, do you think? And if you have to stop the blood with an open injury? It will not be superfluous to find out how health workers behave in such situations.
What a health worker should do in an emergency
The actions of health workers in situations that may lead to HIV infection are regulated by SanPin 3.1.5 2826-10 "Prevention of HIV infection".
If there is reason to assume the presence of a contact that has entailed the risk of HIV infection, preventive chemical prophylaxis is prescribed (clause 8.1.3.3.). What are these reasons? For example, a cut with a scalpel during a surgical operation, or a fountain of blood splashing into the face from a cut vessel (no one is safe from accidents).
What should medical workers do in such cases?
"8.3.3.1. Actions of a medical worker in an emergency:
- in case of cuts and injections, immediately remove gloves, wash hands with soap under running water, treat hands with 70% alcohol, lubricate the wound with 5% alcohol solution of iodine;
- if blood or other biological fluids get on the skin, this place is treated with 70% alcohol, washed with water and soap and re-treated with 70% alcohol;
–If blood and other biological fluids of the patient get on the mucous membranes of the eyes, nose and mouth: rinse the oral cavity with plenty of water and rinse with 70% ethanol solution, rinse the nasal mucosa and eyes with plenty of water (do not rub);
–If blood and other biological fluids of the patient get on the gown, clothing: take off work clothes and immerse in a disinfectant solution or in a bix (tank) for autoclaving;
- start taking antiretroviral drugs as soon as possible for the purpose of post-exposure prophylaxis of HIV infection.
HIV infection or hepatitis? Who is more dangerous?
A cut with a scalpel, of course, is associated with a high risk of HIV transmission and "hygienic" procedures are indispensable in this case - chemoprophylaxis is needed, and drugs are prescribed for prophylactic purposes. In everyday life, such situations cannot occur. But a broken nose and fists are common, what is a wedding without a fight?
Broken noses and fists are extremely unlikely for HIV transmission. But for parenteral hepatitis, it is more likely. The infectious dose of the virus for parenteral hepatitis is 100 times less than for HIV. Read about it.
Unlike HIV infection, there is a vaccine for hepatitis B, and hepatitis C is curable. In the Russian documents regulating the prevention of hepatitis, the list of emergency measures is not specified.
In any case, washing the mucous membranes and skin will not hurt. To do this, you can use not only water, but also disinfectants sold in pharmacies. It is good when such disinfectants based on, for example, chlorhexidine, are in home or automobile first aid kits. There are a lot of such drugs.
Remember!
- The basic rule of preventing infection with blood-borne infections is to reduce the infectious dose. For this, hygienic procedures are suitable - washing the wound surface or mucous membranes with water.
- The hygienic measures proposed in emergency situations are more “psychotherapeutic” than preventive. In any case, for HIV infection. But hygiene is never superfluous.
- In cases where you are seriously afraid of a possible infection, do not limit yourself to reading this article - contact a medical organization. Specialists know what to do in such cases. The main thing is not to delay!
Option 1: Emergency prevention of parenteral viral hepatitis and HIV infection (Appendix 12 to SanPiN 2.1.3.2630-10)
In order to avoid infection with parenteral viral hepatitis, HIV infection, the rules for working with stabbing and cutting instruments should be observed.
In case of cuts and injections, immediately treat and remove gloves, squeeze blood out of the wound, wash hands with soap and water under running water, treat hands with 70% alcohol, lubricate the wound with 5% iodine solution.
If blood or other biological fluids get on the skin, this place is treated with 70% alcohol, washed with water and soap and re-treated with 70% alcohol.
If blood gets on the mucous membranes of the eyes, they are immediately washed with water or 1% boric acid solution; if it gets on the nasal mucosa, it is treated with a 1% solution of protargol; on the mucous membrane of the mouth - rinse with 70% alcohol solution or 0.05% potassium permanganate solution or 1% boric acid solution.
The mucous membranes of the nose, lips, conjunctiva are also treated with a solution of potassium permanganate at a dilution of 1: 10000 (the solution is prepared ex tempore).
For the purpose of emergency prevention of HIV infection, azidothymidine is prescribed for 1 month. The combination of azidothymidine (retrovir) and lamivudine (elivir) enhances antiretroviral activity and overcomes the formation of resistant strains.
If there is a high risk of HIV infection (a deep cut, visible blood getting on damaged skin and mucous membranes from patients infected with HIV), you should contact the territorial AIDS Centers for chemoprophylaxis.
Persons exposed to the threat of HIV infection are under the supervision of an infectious disease doctor for 1 year with a mandatory examination for the presence of a marker of HIV infection.
Personnel who have come into contact with material infected with the hepatitis B virus are injected simultaneously with a specific immunoglobulin (no later than 48 hours) and the hepatitis B vaccine in different parts of the body according to the scheme 0 - 1 - 2 - 6 months. with subsequent monitoring of markers of hepatitis (not earlier than 3 - 4 months after the introduction of immunoglobulin).
If contact has occurred with a previously vaccinated health worker, it is advisable to determine the level of anti-HBs in the blood serum. If there is an antibody concentration of 10 IU / L and higher, vaccine prophylaxis is not carried out; in the absence of antibodies, it is advisable to simultaneously administer 1 dose of immunoglobulin and a booster dose of the vaccine.
Option 2:Actions of a medical worker in an emergency (Resolution of the Chief State Sanitary Doctor of the Russian Federation of 11.01.2011 No. 1 “On the approval of SP 3.1.5.2826-10“ Prevention of HIV infection ”).
In case of cuts and injections, immediately remove gloves, wash hands with soap and water under running water, treat hands with 70% alcohol, lubricate the wound with 5% alcohol solution of iodine;
- if blood or other biological fluids get on the skin, this place is treated with 70% alcohol, washed with water and soap and re-treated with 70% alcohol;
- if the patient's blood and other biological fluids get on the mucous membrane of the eyes, nose and mouth: rinse the oral cavity with plenty of water and rinse with 70% ethanol solution, rinse the nasal mucosa and eyes with plenty of water (do not rub);
- if the patient's blood and other biological fluids get on the gown, clothes: take off work clothes and immerse them in a disinfectant solution or in a bix (tank) for autoclaving;
- start taking antiretroviral drugs as soon as possible for the purpose of post-exposure prophylaxis of HIV infection.
It is necessary, as soon as possible after contact, to test for HIV and viral hepatitis B and C a person who may be a potential source of infection, and a person who has been in contact with him. Testing for HIV of a potential source of HIV infection and of the person in contact is carried out by the method of rapid testing for HIV antibodies after an emergency with the obligatory direction of a sample from the same portion of blood for standard HIV testing in ELISA. Samples of plasma (or serum) of 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 the constituent entity of the Russian Federation.
The victim and the person who may be a potential source of infection should be interviewed about the carriage of viral hepatitis, STIs, inflammatory diseases of the genitourinary system, other diseases, and counseling should be provided regarding less risky behavior. If the source is infected with HIV, check to see if they have received antiretroviral therapy. If the victim is a woman, a pregnancy test should be carried out to find out if she is breastfeeding. In the absence of clarifying data, post-exposure prophylaxis begins immediately; when additional information appears, the scheme is adjusted.
Post-exposure prophylaxis of HIV infection with antiretroviral drugs:
Antiretroviral drugs should be started within the first two hours after the accident, but no later than 72 hours.
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 HAART regimen, one or two available drugs are taken.
Nevirapine and abacavir can only be used if no other drug is available. If nevirapine is the only drug available, only one dose of the drug should be prescribed - 0.2 g (its repeated administration is unacceptable), then, when other drugs are received, full-fledged chemoprophylaxis is prescribed. If chemoprophylaxis is started with abacavir, a hypersensitivity test should be conducted as soon as possible or the abacavir should be replaced with another NRTI.
Emergency registration is carried out in accordance with the established requirements:
- LPO employees must immediately report each emergency to the head of the unit, his deputy or a higher head;
- injuries sustained by health workers should be accounted for in each health care facility and recorded as an industrial accident with the drawing up of an Industrial Accident Act;
- the Register of occupational accidents should be completed;
- 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 the medical worker's official duties.
All health care providers should be provided with or, if necessary, have access to rapid HIV tests and antiretroviral drugs. The stock of antiretroviral drugs should be kept in any health facility at the choice of the health authorities of the constituent entities of the Russian Federation, but in such a way that examination and treatment can be organized within 2 hours after an emergency.
The authorized 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.
Dental Instrument Processing Sequence Used dental instruments and materials are decontaminated after each patient is taken. If tools and materials are disposable, ensure that they are safely disposed of. Before cotton swabs, plastic saliva ejectors, etc. are sent to the city's landfill, they must be disinfected by immersing them for one hour in 1% chloramine solution, or 6% hydrogen peroxide solution, or 3% bleach solution, or for 30 minutes in a solution of Incept. The tips of drills, wastelands, air and water pistols, ultrasonic devices for removing dental plaque after each patient are treated twice with 70 ° alcohol and at the end of the shift are treated with 3% chloramine for 60 minutes or with a solution of Incept for 30 minutes. Instruments in contact with the patient's mucous membrane and contaminated with biological fluids (dental hand tools, glasses, mirrors, burs) and gloves are disinfected immediately after use, then undergo pre-sterilization treatment and sterilization. Disinfection is carried out by completely immersing the used instruments for 30 minutes in a container with an inccept solution (3% chloramine for 60 minutes or 6% hydrogen peroxide solution for 60 minutes, or 2% Virkons solution for 10 minutes, or a solution sidex for 15 minutes, or 0.1% chlorosept solution for 60 minutes). The disinfectant solution is used six times and then changed. Further, the instruments undergo pre-sterilization processing: the instruments are immersed in another container with an incasept solution at t \u003d 20-45 °, where each instrument is washed with a brush for 15 s; wash tools with running water; rinse with distilled water; check the quality of cleaning: from blood - by azapiran test (if the test is positive, repeat the entire pre-sterilization treatment); from alkali - phenolphthalein test (if the test is positive, repeat steps 2 and 3); tools are wiped with dry towels or dried with hot air until moisture disappears. Products made of glass, metals, silicone rubber are sterilized without packaging (in open containers) or in paper packaging by dry heat (dry hot air). Sterilization mode: 60 min at t \u003d 180 °. Polishers, dental scalers and burs are treated in the same way as instruments. Dental mirrors are disinfected, then pre-sterilized (pp. 2, 3 and 4), after which they are sterilized with glass beads at a high temperature: stored in Petri dishes. Rubber gloves, cotton swabs, products made of polymers, textiles, latex are sterilized in bix by autoclaving in two modes: at t \u003d 120 °, pressure 1 atm. within 45 minutes or at t \u003d 132 °, pressure 2 atm. within 30 minutes. The shelf life of the sterility of instruments in a sealed package (in a bix, in a kraft paper bag) is three days, after opening the bix, the material in it is considered sterile during the working day. Features of the organization of admission to patients with an increased risk of infection.
General Provisions
This Procedure for the provision of medical care to medical workers and the conduct of chemoprophylaxis of HIV infection, the prevention of other blood-borne infections in the event of an emergency in public medical organizations of the Novosibirsk region regulates the provision of medical care and other measures taken in the event of an emergency in public medical organizations of the Novosibirsk region, in for the prevention of occupational infection with HIV and other blood-borne infections of medical workers.
II. Measures to prevent occupational exposure to HIV infection and blood-borne infections
2.1. The main task of preventing occupational infection of medical workers is the maximum prevention of contact with blood (body fluids) of any patient. In healthcare settings, all patients should be considered potential sources of infection.
2.2. If the work of medical personnel does not exclude contact with blood, body fluids and tissues at the workplace, a first aid kit should be completed. It includes:
70% solution of ethyl alcohol (200.0 ml.);
5% alcohol solution of iodine (50.0 ml.);
Adhesive plaster - 1 pc .;
Sterile gauze napkins - 10 pcs .;
Surgical cotton wool - 50.0 g;
Sterile gauze bandage - 2 pcs .;
2.3. When carrying out parenteral manipulations, it is necessary to make sure of the integrity of the skin. If there are open wounds, it is necessary to protect the damaged skin with waterproof dressings. Medical personnel must be vaccinated against hepatitis "B" without fail.
2.4. If during work contact with blood or other biological fluids of the patient may occur, you must always use personal protective equipment: mask, goggles (or screen), gown, gloves, cap, apron if necessary. Gloves must be worn before any parenteral manipulation of the patient.
2.5. When providing medical assistance, it is prohibited:
a) removing disposable needles with unprotected hands;
b) putting on protective caps on disposable needles after use;
c) it is prohibited to pipet biological fluids by mouth in laboratories;
2.6. When collecting medical waste, it is prohibited:
a) manually destroy, cut waste of classes B and C, including used systems for intravenous infusion, in order to disinfect them;
b) manually remove the needle from the syringe after using it, put the cap on the needle after injection;
c) transfer (reload) unpackaged waste of classes B and C from one container to another;
d) compact waste of classes B and C;
e) carry out any operations with waste without gloves or the necessary personal protective equipment and overalls;
f) use soft disposable packaging to collect sharp medical instruments and other sharp objects;
g) install disposable and reusable containers for waste collection at a distance of less than 1 m from heating devices.
III. Actions in case of emergency
3.1. Emergency situations associated with contact with blood and other body fluids.
In order to avoid infection with parenteral viral hepatitis, HIV infection, it is necessary to follow the rules of safe handling of piercing and cutting instruments.
3.1.1. in case of cuts and injections: immediately remove gloves, wash hands with soap under running water, treat hands with 70% alcohol solution, lubricate the wound with 5% iodine solution.
3.1.2. If blood or other biological fluids get on the skin: treat this place with a 70% alcohol solution, rinse with soap and water and re-treat with a 70% alcohol solution.
3.1.3. If blood gets on the mucous membranes of the eyes and (or) the mucous membrane of the nose: immediately rinse the mucous membranes with plenty of water, it is strictly forbidden to rub; in case of contact with the mucous membrane of the mouth, rinse the oral cavity with plenty of water and rinse with a 70% solution of ethyl alcohol.
3.2. Accidents involving spills and splashes of blood and other biological fluids.
3.2.1. If blood or biological fluids with an admixture of the patient's blood get into the working clothes of a medical worker, take off the contaminated clothes, observing the removal rules, immerse them in a disinfectant solution or in a bix (tank) for autoclaving.
3.2.2. If a container with blood is destroyed (a test tube is broken or overturned, etc.):
a) put on gloves (if they were not worn);
b) limit the accident site with a rag abundantly moistened with a disinfectant solution (concentration according to the regime provided for inactivation of viruses of blood-borne infections) for the duration of exposure;
c) after exposure, wearing gloves, collect the broken container with a scoop and brush and place it in class B waste;
d) take off gloves, dispose of in class B waste in accordance with safety requirements.
3.2.3. If the blood test tube is damaged during centrifuge operation:
a) open the lid slowly, only 40 minutes after a complete stop;
b) place all centrifuge glasses and broken glass in a disinfectant solution (concentration according to the regime provided for inactivation of hepatitis viruses) for the duration of exposure;
c) wipe the inner and outer surfaces of the centrifuge and the lid with a napkin with a disinfectant solution, wiping twice with an interval of 15 minutes.
3.3. Algorithm of actions when registering an emergency.
3.3.1. Carry out anti-epidemic measures in accordance with the situation that has occurred:
a) providing first aid in emergency situations associated with contact with blood and other biological fluids;
b) limiting the impact of a biological agent in emergency situations associated with spills and splashing of blood and other biological fluids.
3.3.2. Immediately notify the head of the department, his deputy or a superior manager.
3.3.3. Examine for HIV and viral hepatitis B and C, STIs a person who can be a potential source of infection and a person who has been in contact with him. In emergency situations, the health worker and the patient are examined for HIV using code 120 (emergency).
3.3.4. Testing for HIV of a potential source of HIV infection and the person in contact should be carried out by the method of 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 ELISA, with the obligatory execution of informed consent for HIV testing in 2 copies and pre- and post-test counseling with a note in the medical documentation (on the informed consent form). Samples of blood plasma (or serum) of a person who is a potential source of infection and a contact person should be transferred for storage for 12 months to the laboratory of the state budgetary healthcare institution of the Novosibirsk region "City Infectious Diseases Clinical Hospital N 1" (hereinafter - GBUZ NSO "GIKB N 1 ").
3.3.5. Informed consent forms, with a mark on the conduct before and after the test counseling, should be stored with a package of documents (an act of a medical accident in a medical organization, the results of HIV, VH, STI testing of an injured medical worker and a potential source of infection) in a medical organization with a responsible person.
3.3.6. The Commission for Investigation of Emergency Situations in a Medical Organization (hereinafter - the Commission) shall conduct:
a) epidemiological investigation:
Causes of injury and establishing a connection between the cause of injury and the performance of the medical worker's official duties;
Potential infection of the injured healthcare professional;
b) control of the completeness and timeliness of emergency measures, the appointment of post-exposure prophylaxis and the preparation of documents for an emergency in a medical organization in accordance with the current legislation of the Russian Federation;
3.3.7. In the course of an epidemiological investigation with a potential source, to clarify the carriage of viral hepatitis, STIs, inflammatory diseases of the genitourinary system, other diseases, immunization against hepatitis B, if the source is infected with HIV, find out if he received antiretroviral therapy.
If the victim is a woman, a pregnancy test should be performed to find out if she is breastfeeding. In the absence of clarifying data, post-exposure prophylaxis should be started immediately; when additional information appears, the scheme is adjusted.
3.3.8. Consultation with epidemiologists of GBUZ NSO "GIKB N 1" by phone 218-20-17 on the appointment of post-exposure prophylaxis and the preparation of documents for an emergency and a medical organization.
3.3.9. Post-exposure prophylaxis of HIV infection with antiretroviral drugs should be started within the first two hours after the accident, but no later than 72 hours.
3.4. Emergency post-exposure prophylaxis of HIV infection with antiretroviral drugs.
3.4.1. The decision to start chemoprophylaxis is made by the Commission, taking into account all the features of the registered case in the medical organization.
3.4.2. Indications for starting chemoprophylaxis:
a) if contact has occurred with the biological material of a patient with HIV infection;
b) if the HIV status of the patient, with whose blood the contact occurred, is unknown, and the result of testing for HIV antibodies using approved express tests is positive;
c) in the absence of rapid tests for rapid diagnosis, post-exposure prophylaxis should be started immediately; when additional information appears, the scheme is adjusted.
3.4.3. The standard regimen for post-exposure prophylaxis of HIV infection is lopinavir / ritonavir + zidovudine / lamivudine.
In the absence of these drugs, use any other antiretroviral drugs to start chemoprophylaxis; if it is not possible to immediately prescribe a full HAART regimen, start taking one or two available drugs.
3.4.4. For post-exposure prophylaxis of HIV infection use:
a) nucleoside reverse transcriptase inhibitors (hereinafter - NRTIs): azidothymidine (retrovir 100 mg); combivir (lamivudine 150 mg + zidovudine 300 mg);
b) protease inhibitors (PIs): kaletra (lopinavir 200 mg + ritonavir 50 mg).
3.4.5. To reduce the risk of occupational HIV infection, use the standard chemoprophylaxis regimen regardless of the degree of risk:
Combivir N 60 - 1 tab. x 2 times a day (per os) + Kaletra N 120 - 2 caps. x 2 times a day (per os) - 4 weeks.
3.4.6. In the absence of these drugs, to start chemoprophylaxis, use azidothymidine 200 mg x 3 times a day or combivir - 1 tab. x 2 times a day.
Nevirapine and abacavir can only be used in the absence of other drugs. If nevirapine is the only drug available, prescribe only one dose of the drug - 0.2 g (repeated administration is unacceptable), then, when other drugs are received, prescribe full-fledged chemoprophylaxis.
If chemoprophylaxis is started with abacavir, hypersensitivity testing should be done as soon as possible or abacavir should be replaced with other NRTIs.
3.4.7. In order to carry out chemoprophylaxis in a timely manner, it is necessary to have a minimum supply of antiretroviral drugs per person in the amount of:
· Combivir tab. N 60 - (1 package);
Kaletra capsule N 120 - (1 pack);
3.4.8. For the period of holidays and weekends, emergency provision of drugs for post-exposure chemoprophylaxis is carried out in the state budgetary organization of the Novosibirsk region "City Clinical Infectious Diseases Hospital N 1": Novosibirsk, st. S. Shamshin, 40, around the clock by the doctor of the admission department (tel .: 218-17-79)
3.5. Post-exposure prophylaxis of viral hepatitis B
3.5.1. A medical worker (unvaccinated against hepatitis B), who has come into contact with an infected material, should inject the vaccine against hepatitis B. Vaccination should be carried out according to the scheme 0 - 1 - 2 - 6 months, followed by monitoring of hepatitis B markers.
3.5.2. If contact has occurred with a previously vaccinated healthcare professional, determine serum anti-HBs levels. If there is an antibody concentration in the titer of 10 IU / L and higher, vaccine prophylaxis is not carried out, in the absence of antibodies, a booster dose of the vaccine should be administered.
3.6. Registration of an emergency.
3.6.1. Injuries or emergencies must be registered in the register of emergency situations during medical manipulations, which is kept in each structural unit of the medical organization. The journal is kept in the form approved by the decree of the Chief State Sanitary Doctor of the Russian Federation dated July 21, 2016. N 95.
3.6.2. Each medical accident in a medical organization is drawn up by an Act on a medical accident in an institution in 2 copies, drawn up in the form approved by the decree of the Chief State Sanitary Doctor of the Russian Federation dated July 21, 2016. N 95. One copy is sent to the epidemiologist of the AIDS Center, the second copy remains in the medical organization where the emergency occurred.
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 institution must develop an Algorithm for the actions of medical personnel in an emergency and on the basis of:
Sanitary and Epidemiological Rules of the Joint Venture 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 with infectious biological fluids infected with HIV on the skin and mucous membranes, as well as in case of 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 water under running water,
Treat hands with 70% alcohol,
Lubricate the wound with 5% alcohol solution of iodine;
If blood or other biological fluids get on the skin:
This place is treated with 70% alcohol,
They are washed with soap and water and re-treated with 70% alcohol;
If the patient's blood and other biological fluids get into the mucous membranes of the eyes, nose and mouth:
Rinse the oral cavity with plenty of water
Rinse with 70% ethanol solution,
The mucous membrane of the nose and eyes are rinsed with plenty of water (do not rub);
If blood and other biological fluids of the patient get on the gown, clothing:
Take off 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 the 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 a person who has been in contact with him. Testing for HIV of a potential source of HIV infection and of the person in contact is carried out by the method of rapid testing for HIV antibodies after an emergency with the obligatory direction of a sample from the same portion of blood for standard HIV testing in ELISA. Samples of blood plasma (or serum) of a person who is a potential source of infection and a contact person are transferred for storage for 12 months at the BUZ UR "URC AIDS and IZ".
The victim and the person who may be a potential source of infection should be interviewed about the carriage of viral hepatitis, STIs, inflammatory diseases of the genitourinary system, other diseases, and counseling should be provided regarding less risky behavior. If the source is HIV-infected, check to see if they have received antiretroviral therapy. If the victim is a woman, a pregnancy test should be performed to find out if she is breastfeeding. In the absence of clarifying data, post-exposure prophylaxis begins immediately; when additional information appears, the scheme is adjusted.
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 conduct post-exposure prophylaxis of HIV infection is made by the doctor responsible for managing patients with HIV infection in the health care facility where the emergency occurred. On weekends, 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 BUZ UR "URC AIDS and IZ" to the infectious disease doctor for the correction of ARVT.
Clause 8.3.3.3.1: Antiretroviral drugs should be started within the first two hours after the accident, but no later than 72 hours.
In each healthcare facility, by order of the chief physician, a specialist responsible for storing ARVs should be determined, a place for storing ARVs should 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 HAART regimen, one or two available drugs are taken. Nevirapine and abacavir can only be used if no other drug is available. If nevirapine is the only drug available, only one dose of the drug should be prescribed - 0.2 g (its repeated administration is unacceptable), then, when other drugs are received, full-fledged chemoprophylaxis is prescribed. If chemoprophylaxis is started with abacavir, a hypersensitivity test should be done as soon as possible or the abacavir should be replaced with another NRTI.
Emergency registration is carried out in accordance with the established requirements in accordance with SP 3.1.5. 2826-10:
Clause 8.3.3.3.3:
1. employees of health care facilities must immediately report each emergency to the head of the unit, his deputy or a higher head;
2.injuries sustained by health workers and entailing at least 1 day of incapacity for work or transfer to another job must be accounted for in each healthcare facility and recorded as an occupational accident with the drawing up of an Occupational Accident Act (in 3 copies), on on the basis of the decree of the Ministry of Labor of the Russian Federation of 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 specifics of investigating industrial accidents in certain industries and organizations"
3. the Occupational Accident Register should be completed;
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 the medical worker's official duties;
5. All other emergencies are recorded in the "Log of emergency situations of medical facilities" with the execution of the Act on the emergency in 2 copies.
Clause 8.3.3.3.4:
All health care facilities should be provided with or, if necessary, have access to rapid HIV tests and antiretroviral drugs. A stock of antiretroviral drugs should be kept in any health facility in such a way that examination and treatment can be arranged within 2 hours after an emergency. A healthcare facility should have a specialist responsible for the storage of antiretroviral drugs, a storage location with access, including at night and on weekends.
Clause 5.6:
The examination for HIV infection of the injured health worker is carried out with obligatory pre- and post-test counseling on the prevention of HIV infection.
Clause 5.7:
Counseling should be carried out by a trained specialist (preferably an infectious disease doctor, epidemiologist or psychologist) and include the main provisions regarding HIV testing, the possible consequences of testing, determining the presence or absence of individual risk factors, assessing the awareness of the examined person on HIV prevention, providing information about the ways of HIV transmission and ways of protection against HIV infection, types of assistance available to the HIV-infected.
Clause 5.8:
When conducting pre-test counseling, it is necessary to fill out the informed consent form for the examination for HIV infection in two copies, one form is handed over to the person being examined, the other is kept in the healthcare 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 should be observed for 12 months by an infectious disease doctor of the BUZ UR "URTS AIDS and IZ" or an infectious disease doctor at the place of work (place of medical service) with deadlines retesting for HIV, HCV, HBV at 3, 6 and 12 months after exposure.
To identify undesirable phenomena associated with taking drugs, a laboratory examination is carried out: a general blood test, a 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, send the contact for a consultation to a psychologist / psychotherapist, infectious disease specialist, BUZ UR "URC AIDS and IZ" at his request.
Precautions.
- 1. All manipulations, which may lead to contamination of hands with blood, serum or other biological fluids, should be carried out with rubber gloves.
- 2. When performing manipulations, a medical worker must be dressed in a gown, a hat, removable shoes, which are prohibited outside the manipulation rooms.
- 3. Medical workers with wounds on their hands, exudative skin lesions or weeping dermatitis are suspended from caring for patients and contact with items for their care for the duration of the illness. If it is necessary to perform work, all damage should be covered with fingertips, adhesive plaster.
- 4. If there is a risk of splashing blood or serum, use eye and face protection, face shield, goggles, 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 the manipulation.
- 7. The healthcare professional should treat blood and other body fluids as potentially contaminated material.
(Order of the Ministry of Health of SO No. 116-p dated 16.02.2012)
All medical workers performing any manipulations, as well as junior medical personnel of medical and preventive institutions, regardless of their form of ownership, must be vaccinated against hepatitis B (vaccination complex consisting of 3 vaccinations and revaccination 1 time in 5-7 years).
Primary health care health workers who have suffered in emergency situations associated with the risk of HIV infection on working days find themselves in medical institution at the place of work.
Each medical worker must be familiarized with the order against signature and undergo technical training on the prevention of occupational infection with the passing of a test with an entry in the technical training journal.
Medical workers, those who have not been trained are not allowed to work.
In the event of a medical accident, you must:
1) handle damage depending on the type of accident (the processing procedure is described in section 4);
2) examine the patient for antibodies to HIV and hepatitis B and C (with pre- and post-test counseling and obtaining informed consent). Testing for antibodies to HIV is carried out by the method of express testing, with the obligatory direction of a sample from the same portion of blood for standard testing for HIV in ELISA.
3) report the emergency to the person responsible for the prevention of occupational infection with blood-borne infections;
4) register the accident in the logbook accidents at work and in the Journal of Emergency Situations during medical manipulations;
5) examine the injured healthcare provider for HIV antibodies and viral hepatitis B and C (ELISA method) with pre- and post-test counseling and obtaining informed consent.
Samples of blood plasma (or serum) of a person who is a potential source of infection and a contact person are transferred for storage for 12 months to the laboratory of the State Budgetary Healthcare Institution "OC AIDS and IZ";
6) if the victim health worker - woman, it is necessary take a pregnancy test and find out if breastfeeding is present;
7) with positive (dubious) result of the patient's examination for HIV infection - start taking antiretroviral drugs as soon as possible for the purpose of post-exposure prophylaxis of HIV infection;
8) in case of a negative result in the express test, it is necessary to assess the degree of danger of the patient as a source of infection according to the anamnesis. At high
the degree of likelihood of finding a patient in a seronegative window and a negative test result, it is necessary to start taking antiretroviral drugs for the purpose of post-exposure prophylaxis of HIV infection.
If the patient is HIV-positive, find out if they are receiving antiretroviral therapy.
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 may be used to initiate chemoprophylaxis; if it is not possible to immediately prescribe a full HAART regimen, one or two available drugs are taken, except for nevirapine and abacavir.
Early initiation of antiretroviral prophylaxis is recommended (in the first 2 hours after the emergency). If from the moment possible infection has passed more than 72 hours, it is inappropriate to start prophylaxis.
All antiretroviral drugs are administered within 30 days.
9) the personnel who had contact with the material infected with the hepatitis B virus are injected simultaneously with a specific immunoglobulin (no later than 48 hours) and the hepatitis B vaccine in different parts of the body according to the scheme 0-1-2-6 months. with subsequent monitoring of hepatitis markers (not earlier than 3-4 months after the administration of immunoglobulin). If contact has occurred with a previously vaccinated health worker, it is advisable to determine the level of anti-HBs in the blood serum. If there is a concentration of antibodies in the titer of 10 IU / L and higher, vaccine prophylaxis is not carried out; in the absence of antibodies, it is advisable to simultaneously administer 1 dose of immunoglobulin and a booster dose of the vaccine;
9) draw up the "Act on an industrial accident" (form N-1, approved by the Government of the Russian Federation No. 279 of March 11, 1999);
10) for the organization of dispensary observation and correction of HIV chemoprophylaxis schemes, the victims on the day of treatment should be sent to the GBUZ SO "OC AIDS and IZ" and its branches in administrative districts (in their absence - to the infectious disease specialist of the office of infectious diseases of the polyclinic at the place of residence)
Injured healthcare professional must be warned that he may be a source of infection during the entire observation period (maximum possible incubation period) and therefore he should take precautions, to avoid possible transmission of HIV (in within 12 months he cannot be a donor, he must have only protected sex).