HIV prevention during an emergency. Prevention of occupational infection of medical personnel with bloodborne infections
Prevention of HIV infection among health workers
Completed:
1st year student
102 groups
Faculty of Pediatrics
First name Last name: Danilov N.V.
Checked:
Department Assistant, Candidate of Medical Sciences
Yasavieva Rezeda Ildusovna
Izhevsk 2016
Plan:
1. Introduction
2. Causes and characteristics of emergency situations among health workers
3. Protective devices and safe technologies (universal precautions)
4. Risk assessment in an emergency
6. Primary prevention
7. Registration of an emergency situation is carried out in accordance with established requirements
8. Decision to prescribe and start post-exposure prophylaxis (PEP)
9. Standard PKP scheme
10. Lack of indications for PEP
Introduction
Healthcare workers are at risk of contracting blood-borne infections, including hepatitis B and C viruses, as well as human immunodeficiency virus. Most often, professional infection of health workers with these infections occurs due to an accidental prick or cut with a sharp medical instrument, as well as when infected biological fluid gets on the mucous membranes. Measures to prevent occupational HIV infection of medical workers are regulated by the Sanitary and Epidemiological Rules SP 3.1.5.2826 - 10 “Prevention of HIV infection”
Causes and characteristics of emergency situations among health workers
The main identified causes of emergency situations were non-compliance with safety rules when working with sharp instruments and biomaterial (52.6%) and non-compliance by health workers with universal safety rules for protecting the skin and mucous membranes when in contact with biomaterial (26.3%). This category includes cases of non-use of barrier protective equipment (gown, apron, gloves, goggles or plastic shields), manipulation by medical workers with untreated wounds and microtraumas of the hands. Both the technology standards for carrying out the procedure are violated (putting a cap on a needle, removing a needle from a syringe by hand, carrying used equipment with unprotected needles, etc.), as well as the rules for the disposal of sharp instruments (cleaning a workplace with a sharp instrument left on it, removing used sharp instruments in pierceable containers, etc.).
Protective devices and safe technologies (universal precautions):
· When performing procedures that may result in splashing of blood, saliva, or gingival secretions, it is necessary to use surgical masks, safety glasses, or plastic shields;
· Medical workers with exudative and eczema lesions of the skin should refrain from direct contact with patients and from working with instruments until signs of the disease are completely eliminated;
· Use of gloves when in contact with blood, damaged areas of the patient’s skin, as well as when processing organs and tissue surfaces contaminated with blood or other biological fluids of the body;
· Gloves should be changed after working with each patient;
· Be sure to use gowns or aprons during procedures. Take precautions (TB) to avoid needle pricks, cuts with a scalpel or other sharp instruments and devices when carrying out procedures, washing and disinfecting used instruments, when disposing of used needles;
· To avoid getting pricked with used needles, you should not remove or put on the caps on them, bend them or break them with your hands, or remove needles from syringes; collect used needles and sharp instruments in special puncture-resistant containers; promptly replace containers for cutting and piercing instruments, avoiding their overfilling; place containers for used sharp instruments so that they are easy to use and cannot tip over; move containers with used cutting and piercing instruments only if they are carefully closed;
· When working with biological fluids, use only automatic pipettes (with dispensers);
· Contaminated materials used in laboratory tests must be placed in sealed containers, disinfected and disposed of in accordance with current disposal regulations;
· Place all used disposable materials in leak-proof, sealable containers.
Risk assessment in an emergency:
Risk of infection:
Factors that influence the risk of HIV infection include:
The patient’s HIV status and stage of the disease (with acute HIV infection or a late stage of the disease, there is more virus in the blood and the risk of infection is higher);
The patient is taking antiretroviral therapy, which reduces the risk of infection;
The patient has treatment-resistant strains of HIV (in this case, antiretroviral therapy may be ineffective);
The degree of contamination of the instrument with infectious material (a needle prick after taking blood from a vein is more dangerous compared to a needle prick after an intramuscular injection;
When injecting with an instrument with an internal cavity (hollow needle), where there may be a larger amount of infected material, the risk of infection increases;
An injection needle is more dangerous than a surgical needle for suturing;
The degree of violation of the integrity of the skin and mucous membranes when a health worker is injured (the risk of infection increases with deep intramuscular injury with a contaminated instrument, especially when injured by a hollow needle that enters a blood vessel);
Cuts are less dangerous than puncture and laceration wounds;
Timely treatment of the wound surface (washing with soap and water and treatment with an antiseptic solution) reduces the risk of infection.
All medical organizations must have an “Anti-AIDS” first aid kit in case of an emergency, which is stored in a place accessible to personnel.
1. Solution of ethyl alcohol 70% - 2 bottles of 100 ml.
2. 5% alcohol solution of iodine.
3. Sterile distilled water - 2 bottles of 100 ml.
4. Cotton-gauze swabs, napkins (sterile).
5. Dressing material (cotton wool, bandage, etc.).
6. Adhesive plaster (Furoplast, BF glue).
7. Eye pipettes - 2-3 pcs.
8. Disposable rubber gloves, finger pads.
9. Scissors with rounded jaws.
10. Rapid test for HIV infection
11. PKP kit
Primary prevention:
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, the mucous membrane of the nose and eyes is washed generously with water (do not rub);
If blood or other biological fluids of the patient get on the gown or clothing: remove work clothes and immerse in a disinfectant solution or in a tank for autoclaving;
Assessment of the risk of HIV infection and HBV and HCV infection
It is necessary, as soon as possible after an emergency, to examine for HIV infection and hepatitis B and C a person who may be a potential source of infection, and a person contaminated with him. Testing for HIV infection of a potential source of HIV infection and a person who contaminated with it 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 testing for HIV using an enzyme-linked immunosorbent assay.
Registration of an emergency situation is carried out in accordance with established requirements:
LPO employees must immediately report each emergency to the head of the unit, his deputy or a senior manager;
Injuries received by medical workers must be taken into account in each municipality and registered as an industrial accident with the drawing up of an Industrial Accident Report;
You should fill out the Occupational Accident Register;
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 and send the report and report in the prescribed form within 3 days to the State Budgetary Institution "IOC AIDS".
The decision to prescribe and start post-exposure prophylaxis:
Post-exposure prophylaxis (PEP) for HIV infection is a medical intervention aimed at preventing the development of infection after possible exposure to HIV. For emergency post-exposure prophylaxis of the disease, persons exposed to the risk of contracting HIV infection are provided with first aid and prescribed
antiretroviral drugs. The contacted person must ensure
HIV counseling and testing, medical follow-up.
The decision to prescribe PEP depends on the nature of the damage to the mucous membranes and skin, the depth of the damage, the type of damaging instrument, the volume of biological fluid; there are 3 degrees of risk of infection:
Post-exposure prophylaxis should be provided in all health care settings and used in conjunction with standard infection control measures. PEP should be started within the first two hours after the accident, but no later than 72 hours. Individuals receiving PEP must respect ethical principles, human rights and medical confidentiality.
The registration of the appointment of PEP is carried out through a meeting of the medical commission of the Moscow Region.
Standard PCP scheme:
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 (Nucleoside reverse transcriptase inhibitor). (SP 3.1.5.2826 – 10 “Prevention of HIV infection”).
No indication for PEP:
· If the source of biological material is HIV-negative;
· If the material comes into contact with the skin and there is no damage to the skin;
· If the HIV status is unknown and there are no risk factors for contracting HIV infection from the source of biological material;
· 72 hours after the emergency;
· If the victim refuses PEP (in writing).
· Contact with non-hazardous biological fluids that do not contain visible blood (feces, saliva, urine, sweat);
Preventive measures in medical institutions are carried out on the basis that each patient is regarded as a potential source of blood-borne infections (HIV infection, hepatitis B and C). Therefore, general precautions must be observed when working with blood, body fluids (sperm, vaginal secretions, any fluids mixed with blood, HIV-containing cultures and culture media, synovial fluid, cerebrospinal fluid, pleural fluid, pericardial fluid, amniotic fluid).
Action of a nurse in an emergency
. If biological fluid comes into contact with the skin, immediately:
1.1 For 30 seconds, treat with a swab moistened with a skin antiseptic or 70% alcohol.
2 Wash twice with running water and soap, wipe with a towel.
1.3 Re-treat with skin antiseptic or 70% alcohol.
2. If biological fluid comes into contact with gloved hands:
2.1 Treat gloves with a cloth moistened with a disinfectant.
2 Wash with running water, remove gloves with the working surface facing inward.
3 Treat your hands with antiseptic or 70% alcohol, wash with running water and soap.
3. If biological fluid gets into your eyes:
Rinse with running water, rinse with a 0.01% solution of potassium permanganate using a disposable syringe or pipette.
4. If biological fluid gets on the nasal mucosa:
Rinse with a 0.05% solution of potassium permanganate using a disposable syringe or pipette.
5. If biological fluid gets on the mucous membrane of the oropharynx
Rinse with 70% alcohol or 0.05% potassium permanganate solution
6. For an injection or cut:
Wash your hands, without removing gloves, with running water and soap.
Remove gloves with the working surface facing inward and dump them into the disinfectant solution.
If blood comes from the wound, do not stop it for 1-2 minutes; if not, squeeze the blood out of the wound, wash with running water and soap.
Treat the wound with 70% alcohol, then the skin around the wound with a 5% iodine solution and seal with a plaster or put on a fingertip.
7. If biological material gets on a gown or clothing:
Remove clothes and soak in a disinfectant solution, the skin of the hands and other parts of the body if they are contaminated through clothes, after removing them, treat with 70% alcohol
Wash the surface with soap and water and re-treat with 70% alcohol.
8. If biological material gets on the surface of a wall, floor, or equipment:
Twice with an interval of 15 minutes. wipe them with a 6% solution of hydrogen peroxide or a 0.1% solution of purzhevel.
Treatment.
Notify manager department about the occurrence of an emergency.
Find out the patient's HIV status.
Conduct a blood test of the health worker and the patient using ELISA.
Assess the risk of infection.
In case of high and medium risk, start chemoprophylaxis within no later than 72 hours.
Register the emergency in the “Register of Emergency Situations with Biological Material”.
Draw up a “Report on damage or contamination of the skin and mucous membranes by biological material.”
Refer the injured healthcare worker to the infectious disease department.
Provide a referral for registration at a dispensary, indicating the characteristics of the emergency situation, the degree of risk of infection, and the preventive measures taken.
Warn the injured healthcare worker that he or she may serve as a source of HIV infection during the entire observation period (12 months) and the need to take precautions to avoid possible transmission of HIV.
Appendix No. 2
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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, you can use a 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.
– 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.
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.
Ministry of Health of the Russian Federation State budgetary educational institution of higher professional education
"Saratov State Medical University
named after V.I. Razumovsky" Ministry of Health
Russian Federation
(Saratov State Medical University of the Ministry of Health of Russia)
Department propaedeutics of internal diseases
(name of the department) ALGORITHM
Contraindications: No.
Equipment: first aid kit in case of accidents: 33% solution of sodium sulfacyl (albucid), 70% ethyl alcohol, 50 mg portions of Potassium permanganate - 5 pieces, 500 ml graduated container with sterile water for diluting potassium permanganate, glass rod, 5% alcohol solution of iodine, rubber finger pads 1-2 pcs per employee of the security office, sterile pipettes - 2 pcs, sterile gauze wipes 1 pack; sterile gauze balls, sterile bandage - 2 pcs, bactericidal patch 1 pc, containers with disinfectant.
Sequencing:
I. If biological fluid (blood) comes into contact with unprotected skin of the hands
1. Immediately clean your hands with a swab moistened with 70% ethyl alcohol.
2. Immerse the tampon in a container with a disinfectant.
3. Wash your hands twice with warm running water and soap.
4. Re-treat your hands with 70% ethyl alcohol.
II. If biological fluid (blood) gets into the eyes
1. Rinse eyes with plenty of running water.
2. Take a 0.05% solution of potassium permanganate into a sterile pipette, drop it into your eyes and rinse them, making blinking movements with your eyelids.
3. Dry your eyes with a sterile cloth, from the outer corner of the eye to the nose.
4. Add 1-2 drops of 33% sodium sulfacyl solution (albucid).
5. Place used care items in a container with disinfectant.
III. If biological fluid (blood) gets into the nose
1. Rinse the nasal passages with plenty of running water.
2. Rinse with 0.05% potassium permanganate solution.
3. Blot your nose with a sterile gauze pad.
4. Drop 3-4 drops into both nasal passages of a 33% solution of sodium sulfacyl (albucid).
5. Immerse the pipette in a container with a disinfectant.
IV. If biological fluid (blood) gets into the oral cavity
1. Rinse your mouth with plenty of running water.
2. Rinse your mouth with 70% ethyl alcohol or 0.05% potassium permanganate solution.
Note: The head of the institution and the chairman of the commission on nosocomial infections are immediately informed about the accident and the measures taken in connection with it.
Literature
1.National standard of the Russian Federation.
“Technologies for performing simple medical services. Manipulations of nursing care." /The standard was developed by the Russian Nurses Association. Approved and put into effect by the Order of the Federal Agency for Technical Regulation and Metrology. Date of introduction 2009-01-01.
2. V.N. Oslopov, O.V. Epiphany. General patient care in a therapeutic clinic. Third edition, corrected and expanded. Textbook for Universities. /Moscow. "GEOTAR-Media". 2007. 400 p.
3. Fundamentals of nursing: textbook. for students avg. prof. textbook Establishments.
/AND. X. Abbyasov, S. I. Dvoinikov, JI.A. Karaseva and others] ; edited by S.I. Dvoinikov. - M.: Publishing center "Academy", 2007. - 336 p.
4. Obukhovets T.P., Chernova O.V. Fundamentals of Nursing. Editor: Kabarukhin B.V. Publisher: Phoenix, 2013.-768 p.
5. Ostrovskaya I.V. Fundamentals of Nursing. Textbook Grif Ministry of Defense of the Russian Federation.
Publisher: GEOTAR-Media, 2013.-320 p.
6. Kuleshova L.I. , Pustovetova E.V. Fundamentals of Nursing. Lecture course on nursing technologies. Editor: Morozov V.V. Publisher: Phoenix, 2012.-733 p.
7. Ostrovskaya I.V. Fundamentals of Nursing. Manipulation algorithms. Textbook Grif Ministry of Defense of the Russian Federation. Publisher: GEOTAR-Media, 2013.-160 p.
8. Mukhina S.A. Practical guide to the subject of Fundamentals of Nursing. Textbook Grif Ministry of Defense of the Russian Federation. Publisher: GEOTAR-Media, 2013.-512 p.
Developers:
assistant A.A. Ilyin
assistant L.S. Sulkowska
(position held) (signature) (initials, surname)
clinical resident M.S. Sinkeev
(position held) (signature) (initials, surname)
The algorithm was discussed and approved at the educational and methodological conference of the Department of Propaedeutics of Internal Diseases.
Head of the department
propaedeutics of internal diseases
Doctor of Medical Sciences Professor Yu.I. Skvortsov
The algorithm was discussed and approved by the Methodological Council for the specialty of Nursing on March 27, 2012. Protocol No. 7.
Chairman of the Methodological Council for
Specialties Nursing
Doctor of Medical Sciences Professor O.Yu. Aleshkina