Prevention of HIV infection in hospitals. Prevention of HIV infection in medical institutions

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On increasing the effectiveness of preventive work on HIV infection in treatment and preventive institutions of the Omsk region

Accepted Main Department of Health of the Omsk Region.
  1. IN last years V Russian Federation There is an epidemiological spread of HIV infection. Over the 10 months of 1997, the number of registered cases of HIV infection increased by 2.3 times compared to 1996.
  2. Intensive development epidemics in the western territories of the country (Krasnodar Territory, Kaliningrad, Rostov, Nizhny Novgorod regions) indicates that the main factors contributing to the spread of HIV are the massive introduction of infection into the territory and the rooting of the pathogen among drug addicts.
  3. In the Omsk region, there is active migration of the population, widespread drug addiction and sexual emancipation of young people, which are prerequisites for a possible complication of the epidemiological situation regarding HIV infection.
  4. In order to increase the effectiveness of preventive measures against HIV infection and the readiness of treatment and preventive institutions in the region to work in conditions of mass cases of HIV infection, in pursuance of the Law of the Russian Federation "On preventing the spread in the Russian Federation of the disease caused by the human immunodeficiency virus (HIV infection)" and the order of the Ministry of Health of the Russian Federation “On strengthening measures to prevent HIV infection among users of psychoactive substances” N 293 dated July 19, 1996, I order:
  5. 1. Approve the list of Appendices of this order:
  6. - Appendix No. 1 “Standard work plan for the prevention of HIV infection”;
  7. - Appendix No. 2 “List of indications for testing populations for HIV infection”;
  8. - Appendix No. 3 “Pre- and post-test medical counseling on HIV infection”;
  9. - Appendix No. 4 “Measures to prevent occupational infection of medical workers”;
  10. - Appendix No. 5 “Scheme of actions of medical workers when identifying a patient with a suspected or confirmed diagnosis of HIV infection”;
  11. - Appendix No. 6 “List of medical measures carried out in relation to patients with different results of serological testing for HIV infection”;
  12. - Appendix No. 7 "Recommendations for limiting the dissemination of confidential information";
  13. - Appendix No. 8 “Organization of medical care for HIV-infected persons”;
  14. - Appendix No. 9 “Organization of dispensary observation for HIV infection”;
  15. - Appendix No. 10 “List of indications for examining corpses for HIV infection”;
  16. - Appendix No. 11 “Rules for collecting and sending material from a corpse for testing for HIV infection.”
  17. 2. To the Director of the Department of Health, Yunyaev N.A., chief doctors of regional health care institutions, chief doctors of rural areas, urban districts and city health care institutions:
  18. 2.1.
  19. Ensure the organization of HIV infection prevention in accordance with the requirements of the Appendices of this order.
  20. 2.2.
  21. 2.4.
  22. Ensure that patients have the opportunity to undergo anonymous testing for HIV antibodies in each health care facility, with relevant information for the public posted in a prominent place in the health facility.
  23. 2.5.
  24. In order to prevent the intrahospital spread of HIV infection, consider persons at risk for HIV infection and, first of all, all drug addicts and persons who abuse drugs by parenteral administration as potentially HIV-infected persons.
  25. 2.6.
  26. Ensure strict control and full compliance with safety requirements for blood transfusions (increased demands on the selection of donor candidates, blood transfusions only if there is a negative test result for HIV infection, strict indications for transfusion of blood and its components). 2.7. Provide healthcare facilities with the necessary amount of disinfectants, disinfection equipment and equipment, personal protective equipment against infection, instructional, methodological and policy documents on the prevention of HIV infection.
  27. 2.8.
  28. Ensure the implementation of measures to prevent occupational infection of medical workers with HIV infection (Appendix No. 4).
  29. 2.9.
  30. Ensure strict compliance with the requirements of the anti-epidemic regime for HIV infection and viral hepatitis in all health care facilities, with a hearing
  31. this issue
  32. 3. Chief doctors of rural areas should ensure readiness to provide routine and emergency medical specialized care to HIV-infected people in outpatient and inpatient settings in all pathology profiles.
  33. 4. To the Director of the Omsk Health Department, N.A. Yunyaev, the chief physician of the Regional Clinical Psychiatric Hospital, Yu.V. Korolev, the chief psychiatrist of the State Healthcare Institution, M.G. Usov:
  34. 4.1.
  35. To provide medical counseling and voluntary screening for HIV infection of patients on the basis of the regional drug treatment clinic and the city adolescent drug treatment clinic.
  36. 4.2.
  37. Through the efforts of district narcologists, conduct seminars and meetings with doctors of the general network on the early diagnosis of drug addiction, substance abuse and alcoholism, with the involvement of specialists from the Omsk Center for the Prevention and Control of AIDS (1st quarter of 1998).
  38. 5. To the director of the Omsk health department, N.A. Yunyaev, the chief physicians of the regional dermatovenerological dispensary, Yu.F. Kolyada, rural areas and urban districts:
  39. 5.1.
  40. Provide medical counseling and voluntary screening for HIV infection to patients at regional and district dermatovenerological clinics.
  41. 5.2.
  42. Ensure complete screening for HIV infection of all patients with sexually transmitted diseases.
  43. 6. The director of the Omsk health department, Yunyaev N.A., the chief doctors of rural areas, urban districts and regional health care facilities that have pathology departments in the structure of the institution, ensure the correct collection of cadaveric material for laboratory testing for HIV infection (Appendices No. 10 and N eleven).
  44. 7.4.
  45. Check the readiness of specialized bases assigned to provide medical care to HIV-infected persons.
  46. 8. The chief infectious disease specialists of the State Healthcare Institution and the Omsk Health Department, together with the Omsk Center for the Prevention and Control of AIDS, ensure the organization and control of the work of clinical medical institutions of health care facilities in the city and rural areas on the provision of medical care for HIV infection (permanently).
  47. 9. Director of the Omsk Department of Health, N.A. Yunyaev. strengthen the material, technical and medical support of the AIDS department of the State Clinical Hospital No. 1, ensure its effective operation.
  48. 10. Acting Chief Physician of the Omsk Center for Prevention and Control of AIDS I.V. Borovsky:
  49. 10.1.
  50. Strengthen organizational and methodological work on HIV infection in health care facilities in the city and rural areas.
  51. 10.2.
  52. Prepare a draft standard agreement between the administration of a healthcare facility and a medical worker providing medical care to HIV-infected persons, as well as pathological examinations of corpses and forensic medical examinations.
  53. 10.3.
  54. Together with the chief infectious disease specialists of the State Healthcare Institution and the Omsk Health Department, conduct a seminar on the problem of HIV infection for doctors of clinical medical institutions assigned to provide medical care to HIV-infected persons (and backups) (February 1998).
  55. 10.4.
  56. 13. Ask the rector of the Omsk State Medical Academy Novikov A.I. consider the issue of participation of academy specialists in scientific research on the problem of HIV infection. Submit to the General Directorate of Health by 04/01/1998 proposals for the implementation of research work and practical assistance to health care.
  57. 14. To the head of the planning and economic department of the State Budgetary Institution L.M. Baidina:
  58. 14.1. Resolve the issue of allocating funds for the purchase of test systems imported production
  59. for reference studies for HIV infection. Accelerate the allocation of funds for the purchase of a PCR complex for the AIDS Center.
  60. 15. To ask the Chairman of the Committee on Pharmaceutical Activities and Drug Production of the Omsk Region Administration Yurgel N.V. assign one of the pharmacies in Omsk to provide medications to HIV-infected people.
  61. 16. Entrust control over the execution of the order to first deputy Rumyantsev N.V.
  62. 17. Consider GUZO order No. 6 dated 03/05/1996 and GUZO order No. 25 dated 02/24/1997 as no longer in force.
  63. Boss
  64. General Directorate of Health

V.A. Samoilov

  1. (pre)┌───┬────────────────────────────────── ──────── ─────┬────────────┬─────────────┬─────── ───┐ │ N │ EVENTS │ deadline │ performers │ mark │ │p/p│ │ executions │ │ performed. │ ├───┼───────────────────────────────── ─────────── ───┼────────────┼─────────────┼───────── ─┤ │ │I. Organizational and methodological work │ │ │ │ │1. │Drawing up and approval of an action plan for │December │Ch. doctor │ │ │ │prevention of HIV infection in health care facilities │ │chief medical officer │ │ │ │ │ │hospital. epid.│ │ │2. │Confirmation by order of the institution │permanently │Chap. doctor │ │ │ │responsible person for organizing prevention│ │ │ │ │ │HIV infections in health care facilities (chief medical officer) │ │ │ │ │3. │Drawing up and approval of a plan for operational │December │-"- │ │ │ │measures when identifying an HIV-infected person │ │ │ │ │ │or a person suspected of this infection │ │ │ │ │4. │Development of a medical education program ia │December │ chief medical officer │ │ │of the population on the problem of HIV infection of the population │ │hospital epid.│ │ │ │of the assigned territory │ │ │ │ │5. │ │ │instructions, orders GUZO, │ │ │ │ │ │methodological recommendations for the section │ │ │ │ │ │prevention of HIV infection │ │ │ │ │6.Development of a plan for seminars with doctors,│December │Nachmed │ │ │ │middle and junior honey. employees │ │ │ │ │7. │Report at planning meetings with the chief physician and │monthly │medical director │ │ │ │meetings about the epidemiological situation in the departments│and at │epidemiological facilities, analysis of HIV screening. in ELISA, about the necessary │ │ │ │ identified deficiencies in the epidemiological and disinfection regimen, │ │ │ │ │ │with recommendations for their elimination │ │ │ │ │8. current orders │ constantly │chief medical officer │ │ │ │Ministry of Health of the Russian Federation, orders and orders │ │hospital. epidemiological│ │ │ │GUZO, OCGSEN, RCGSEN, methodological │ │ │ │ │ │recommendations, inspection reports │ │ │ │ │ │II. Personnel training │ │ │ │ │1. │Training of doctors at local and out-of-town bases │according to the plan │chief medical officer │ │ │ │on the problem of HIV infection │training │ │ │ │2. │Certify all healthcare facility employees for knowledge │once a year │Chief Medical Officer │ │ │ │the problem of HIV infection, OST 42-21-2-85 │ │ │ │ │3. │Conducting a conference and seminars on│according to the plan of health care facilities│chief medical officer │ │ │ │prevention of HIV infection with doctors and paramedics │(at least │hospital epidemiology│ │ │ │medical workers │1 time in │ │ │ │ │ │quarter) │ │ │ │4. │Familiarization and study of newly released │constantly │chief medical officers │ │ │ │as well as current orders, instructions, │ │hospital. epid.│ │ │ │instructions and methodological recommendations on │ │ │ │ │ │prevention of HIV infection (including algorithms │ │ │ │ │ │actions on HIV infection) │ │ │ │ │ │III. Treatment and diagnostic work │ │ │ │ │1. │Conduct medical examination for │ │ │ │ │HIV infection according to clinical and │ │ │ │ │ │epidemiological indications, including │ │ │ │ │ │anonymous, in accordance with Order N 295 from │ │ │ │ │ │10.30.1995 Ministry of Health of the Russian Federation │ │ │ │ │2. │Ensure compliance with the rules for collecting and │constantly │the medical director │ │ │ │transporting blood to the laboratory of the AIDS center│ │hospital. epid.│ │ │3. │Control over the quality of registration of referrals │constantly │responsible│ │ │ │blood samples to the laboratory of the AIDS center │ │for delivery │ │ │ │ │ │blood samples │ │ │4. │Ensure interaction on treatment and │constant │medical │ │ │ │diagnostic issues with the territorial │ │ │ │ │ │AIDS center │ │ │ │ │5. │Ensure pre- and post-test │continuous │primary medical │ │ │ │consultation of all patients examined for │ │ │ │ │ │HIV infection in health care facilities │ │ │ │ │6. │Ensure the implementation of the action algorithm │with the │chief medical officer │ │ │ │med. workers upon detection of a case of │ │ │ │ │HIV infection (in accordance with the order of the GUZO) │ │ │ │ │7. │Ensure the readiness of healthcare facilities to provide medical services. │constantly │Ch. doctor of health care facilities │ │ │ │assisting patients with HIV infection │ │ │ │ │ │IV. Preventive work │ │ │ │ │1. │Ensure control over compliance with the sanitary │constant │medical │ │ │ │anti-epidemic regime in departments │ │hospital. epid.│ │ │ │Healthcare facility (OST 42-21-2-85) │ │ │ │ │2. │Provide for medical needs. personnel │permanently │Ch. medical facility doctor │ │ │ │means of preventing professional │ │ │ │ │ │infection │ │ │ │ │3. │Control over the implementation of preventive measures │constantly │chief medical officer │ │ │ │occupational infection of honey. staff │ │hospital. epid.│ │ │4. │Analysis of serological screening for HIV- │quarterly- │nachmed │ │ │ │infection. Based on the results of the analysis, a thorough │hospital. epidemiological│ │ │ │organizational measures for correction │ │ │ │ │ │screening │ │ │ │ │ │V. Anti-epidemic measures │ │ │ │ │1. │Carrying out anti-epidemic measures in │upon │the medical director │ │ │ │in accordance with the operational plan │identifying │hospital. epid.│ │ │ │VI. Health education │ │ │ │ │1. │Carrying out sanitary and educational work according to │according to with │principal │ │ │ │HIV infection to the extent approved by a separate │plan │ │ │ │ │plan │ │ │ │ └───┴───────── ───────── ─────────────────────────────┴────────── ──┴─────── ──────┴──────────┘(/pre)

Pre- and post-test medical counseling on HIV infection

  1. Laboratory testing for HIV seropositivity must be accompanied by pre-test and post-test counseling.
  2. Pre- and post-test counseling is carried out in medical institutions, at the place where a blood sample is taken for testing and the test result is issued. It is carried out by a doctor (or paramedic) who refers the patient for examination.
  3. Counseling is a confidential dialogue between a patient and a health professional, based on identifying a person’s individual needs (psychosocial, medical and legal) and aimed at preventing the transmission of HIV infection and providing psychological support.
  4. Objectives of pre-test counseling:
  5. - collecting an epidemiological history, identifying behavioral stereotypes in patients that increase the risk of contracting HIV infection;
  6. - establishing clinical symptoms of HIV infection in the patient;
  7. - assessment of the patient’s knowledge on the problem of HIV infection;
  8. - explaining the rules for personal prevention of HIV infection and reinforcing safe behavior patterns in the patient;
  9. - information about methods for diagnosing HIV infection (primarily laboratory testing), as well as medical and social support services;
  10. - psychological support for the patient.
  11. When collecting an epidemiological history from a patient, med. The employee pays attention to the following questions:
  12. - alcohol and drug use (injection and tablet forms);
  13. - sexual activity and its types (presence of a regular sexual partner, casual sex, homosexual contacts);
  14. - using condoms;
  15. - presence of manifestations of STDs in this moment, history of STDs;
  16. - frequent and massive blood transfusions, direct blood transfusions;
  17. - professional contact with blood and its components;
  18. - travel outside the country, to areas unfavorable for HIV infection;
  19. - date and reason for the last examination for HIV infection, the result of the study;
  20. - the above “risk” factors for a sexual partner.
  21. The nature of the counseling after the test depends on the result obtained (negative or positive).
  22. The effectiveness of the consultation largely depends on the correct selection of personnel and the preparedness of the staff. Consultation staff must meet certain requirements:
  23. 1. Have the necessary knowledge of epidemiology, clinical presentation, diagnosis and measures to prevent HIV infection.
  24. 2. Have a sufficient understanding of the lifestyle of various “at-risk” and “target” groups, be able to tactfully discuss their sexual and everyday problems with patients.
  25. 3. Have certain psychotherapeutic skills, be able to recognize the most common psychological and clinical complications associated with HIV infection: fear, anxiety, depression, neurological disorders and suicidal tendencies.
  26. 4. Be knowledgeable about all health and social support services available to people living with HIV and have the ability to communicate effectively, tactfully and compassionately with a wide range of stakeholders.

Measures to prevent occupational infection of medical workers

  1. Prevention of occupational infection of medical workers is ensured by solving a number of organizational and technical issues of prevention, as well as measures in the event of an epidemiologically hazardous production situation. The complex of these measures coincides with the precautions recommended for viral hepatitis B.
  2. Organizational measures aimed at preventing occupational infection:
  3. - training of all medical workers on the epidemiology of HIV infection and preventive protective measures during medical procedures and when working with blood. Conducting periodic certifications of employees on their knowledge of the above issues, including before defending their qualification category;
  4. - implementation of a system of external and internal control over the prevention of occupational infection of medical workers;
  5. - providing employees of medical institutions with the necessary protective equipment to prevent occupational infection (gauze mask, safety glasses, plastic shield or protective screen, rubber gloves). When performing surgical operations, HIV-infected persons are additionally recommended - aprons with sleeves made of waterproof fabric, double latex or chain mail gloves;
  6. - registration and accounting in each medical institution of all cases of epidemiologically hazardous production situations for their analysis and implementation of appropriate preventive measures;
  7. - annual testing for HIV infection of medical personnel providing medical care to HIV-infected persons, as well as performing laboratory testing for HIV;
  8. - counseling and voluntary testing for HIV infection of patients from high-risk groups for whom extensive surgical interventions with large blood losses are planned;
  9. - exclusion from invasive procedures of medical workers suffering from any diseases that reduce the ability to perform these manipulations, as well as employees with exudative changes in the skin and weeping dermatitis.
  10. Generally accepted measures to prevent occupational infection of honey. workers during invasive procedures:
  11. - performing normal hygiene measures, including regular hand washing and using protective clothing as intended;
  12. - use of special protective equipment when carrying out invasive procedures: gauze mask, goggles, plastic shield or protective screen, rubber gloves;
  13. - careful handling of sharp instruments, using them only for their intended purpose. Proper safe handling and, if necessary, disposal of used sharps.
  14. If a case occurs that could lead to occupational infection of honey. employee, a set of preventive measures is carried out:
  15. 1. The employee stops the medical procedure and takes off his protective gloves.
  16. 2. The area of ​​the body contaminated with blood is treated.
  17. If the skin is contaminated with blood or other biological fluids, the remaining biomaterial is removed with a swab, and the skin is treated with a disinfectant solution or 70-degree alcohol. If the integrity of the skin is damaged, do not stop the bleeding, but squeeze the blood out of the wound, wash the wound with water and treat it with a 5% alcohol solution of iodine.
  18. If the patient's blood gets on the mucous membranes of the mouth, they are rinsed generously with 70-degree alcohol or a 0.05% solution of potassium permanganate. The eyes are washed with a 0.05% solution of potassium permanganate.
  19. 3. Reported in this case administration of the medical institution, an act is drawn up.
  20. 4. The patient who underwent the procedure is counseled and tested for HIV infection, subject to his consent.
  21. Ingredients of a first aid kit for emergency assistance in case of blood contact with the skin and mucous membranes, injections and cuts:
  22. 1. 5% iodine solution;
  23. 2. 70% ethyl alcohol solution;
  24. 3. cotton wool, bandage;
  25. 4. adhesive plaster;
  26. 5. potassium manganese for preparing a 0.05% solution (0.05 grams per 100 ml of water);
  27. 6. pipettes for eyes and nose.
  28. Each health care facility keeps a special log, which records cases of emergency situations when providing medical care to HIV-infected persons (damage to the integrity of the skin and mucous membranes: contact of biological fluids from the patient with the unprotected mucous membranes of the specialist). Such cases are reported to the Omsk AIDS Center (33-09-33), and honey. the employee is registered with a dispensary.

Scheme of actions of medical workers when identifying a patient with a suspected or confirmed diagnosis of HIV infection in a medical institution I. Ambulance and emergency medical care and sanitary aviation service

  1. When an HIV-infected or AIDS patient contacts the service and needs urgent medical care on site, all activities and medical procedures must be carried out in compliance with personal preventive measures. All honey used. the instruments are collected separately in a marked container and subjected to thorough disinfection and disposal upon arrival at the substation (in accordance with OST 42-21-2-85).
  2. Hospitalization of HIV-infected patients is carried out in designated treatment and preventive institutions approved by this order, taking into account the required type of specialized medical care.
  3. The team doctor reports the provision of medical care to an HIV-infected or AIDS patient to the chief physician of the substation (to monitor the activities carried out) and to the Omsk Center for the Prevention and Control of AIDS (tel. 64-34-91, 64-30-25) for control for the anti-epidemic measures taken.
  4. II.
  5. Territorial clinic
  6. 1. Clinical and epidemiological data are recorded in detail in the patient’s outpatient record.
  7. 2. A blood sample is taken from the patient’s vein and sent for testing to an AIDS diagnostic laboratory.
  8. 3. The head of the institution is informed about this case. A council of specialists is meeting.
  9. 6. In the case of providing medical care to a patient with an already established diagnosis of HIV infection, the necessary anti-epidemic measures are carried out in the clinic, and the Omsk Center for the Prevention and Control of AIDS is urgently informed about this case (tel. 64-34-91, 64-30 -25).
  10. III.
  11. In a hospital setting of any profile
  12. If a patient has clinical and (or) epidemiological data that allows one to suspect HIV infection:
  13. 1. Clinical and epidemiological data are recorded in detail in the medical record.
  14. 2. The head of the institution is informed about this case, a council of specialists gathers, and, if necessary, specialists from the clinical department of the AIDS Center are called.
  15. 3. A blood sample is taken from a vein from the patient, which is sent for testing to an AIDS diagnostic laboratory.
  16. 4. If the immunoblot result is negative and the clinical diagnosis of HIV infection is canceled by a council of specialists, this case is considered not confirmed.
  17. 5. If the immunoblot result is positive or questionable for HIV infection, obtained from the AIDS diagnostic laboratory, as well as if the result is negative, but there are abnormalities in the immunogram and (or) convincing clinical and epidemiological data allowing one to suspect AIDS, prompt information about this case is transmitted to the Omsk Center for Prevention and Control of AIDS (tel. 64-34-91, 64-30-25).
  18. Together with the center’s specialists, the issue of the need to transfer the patient to a specialized department for AIDS patients is resolved.
  19. 6. In the case of providing medical care to a patient with an already established diagnosis of HIV infection, anti-epidemic measures are carried out in the hospital as for viral hepatitis B, and the Omsk Center for the Prevention and Control of AIDS is required to be informed about this case.
  20. IV.
  21. Autopsy department, forensic medical examination bureau
  22. If an autopsy reveals evidence of the possible presence of HIV infection: 1. Samples of cadaveric blood and cerebrospinal fluid are collected and sent to the laboratory to be tested for the presence of antibodies to HIV. 2. Fence is carried out required material.
  23. for diagnostics
  24. opportunistic infections
  25. If clinical and epidemiological data are identified in a patient that allows one to suspect HIV infection, the chief medical officer or chief physician of the Central District Hospital is notified. The patient is sent for a consultation to the clinical health clinic of the Central District Hospital, the clinical department of the AIDS Center. The head of the FAP or medical outpatient clinic is responsible for the appearance of a patient with suspected HIV infection at the clinical health facility.
  26. In the conditions of the Central District Hospital, a set of measures is being implemented, specified in sections 2 and 3.
  27. VI.
  28. Laboratories performing laboratory tests for HIV infection
  29. When receiving doubtful or positive immunoblot results for the first time, laboratory specialists inform the epidemiological department of the Omsk Center for the Prevention and Control of AIDS by telephone (64-34-91, 64-30-25).
  30. VII.
  31. Omsk Center for Prevention and Control of AIDS
  32. 1. Ensures registration and recording of emergency notifications in the event of HIV infection or suspicion of this disease sent from health care facilities.
  33. 2. Provides methodological assistance and consultations with healthcare facility specialists when identifying a patient with a suspected or confirmed diagnosis of HIV infection.
  34. 3. Ensures the conduct of an epidemiological investigation, counseling of patients and the implementation of primary anti-epidemic measures when registering patients with a positive immunoblot result. It also ensures the collection of epidemiological data when registering persons with a questionable immunoblot result, in cases where the patient:
  35. - used drugs;
  36. - had contact with an HIV-infected person;
  37. - has clinical signs of AIDS;
  38. - died, and there is no way to continue medical observation of him to exclude HIV infection.
  39. In each case of doubtful IB, the timing and frequency of repeated laboratory examinations during dispensary observation are determined.
  40. 4. Ensures the implementation of a standard plan of operational measures when registering a case of HIV infection, approved by the GUZO.
  41. 5. Each case of registration of a questionable immunoblot is discussed at the medical level. Council of the AIDS Center with the involvement of consultants to develop tactics for treatment, diagnostic and anti-epidemic measures.
  42. VIII.
  43. Action of specialists of medical institutions in the event of death of an HIV-infected person
  44. - MSCh-9 dissection department by phone 56-14-39, head of the dissection department.
  45. 2. The corpse is placed in a plastic bag for transportation.
  46. 3. Delivery of the corpse and medical documentation to the pathology department of Medical Unit No. 9 is carried out no later than 12 hours from the moment of death of the patient.
  47. 4. To deliver the deceased to the autopsy department:
  48. - a car from the health department motor depot is called (dispatch telephone number 30-34-16);
  49. - the corpse is accompanied by a doctor from the department where the patient died.
  50. Together with the corpse, the medical history of the deceased is transferred to the dissection department, where the clinical diagnosis and laboratory test results (including for HIV infection) must be indicated.
  51. 5. Final disinfection in the department where the deceased was located is carried out by the health care facility.
  52. 6. Special disinfection car after transporting the corpse is carried out by the regional disinfection station on its territory.
  53. IX.
  54. Actions of medical workers in case of death
  55. HIV-infected and the need to send a corpse
  56. for forensic medical research:
  57. 1. Operational information in the event of the death of an HIV-infected person is transmitted to the EMS Bureau by phone: 13-16-00; 13-45-00; 24-40-41.
  58. 2. The body and medical documentation are delivered to the Bureau of Medical Examinations.
  59. X. Pathological examination of the corpse
  60. HIV-infected
  61. 1. An autopsy of the corpse of an HIV-infected person (or if HIV infection is suspected) is carried out in the autopsy department of MSCh-9 (in the case of a forensic medical examination - in morgue No. 2 of the BSME) by a specially trained team in compliance with the requirements of the anti-epidemic regime;
  62. - the autopsy is carried out in the presence of the attending physician, specialists and a consultant from the AIDS center (to call, contact numbers are 33-09-33, 64-30-25);
  63. - when indicated, the selection of material for laboratory testing is carried out in accordance with Appendix No. 11 of this order;
  64. - in case of emergencies, medical actions. workers are carried out in accordance with Appendix No. 4 of this order;
  65. - after opening, the room is treated with a 3% chloramine solution, exposure is 1 hour;
  66. - after disinfection, the instruments are sterilized (6% hydrogen peroxide solution at a temperature of 50 degrees - 3 hours);
  67. - clothes used during autopsy are disinfected in a 3% chloramine solution for 2 hours, then washed in the usual way.
  68. 2. Preparing the corpse for release:
  69. The corpse is released only to the closest relative upon presentation of a passport and a certificate from the Omsk Center for the Prevention and Control of AIDS stating that the relatives have received medical consultation on the problem of HIV infection, incl. for the burial of the deceased. Relatives are not recommended to open the coffin when saying goodbye.

List of medical measures carried out in relation to patients with different results of serological testing for HIV infection

  1. 1. Tactics when a positive reaction is detected in ELISA (arbitration study) before receiving an answer about the immunoblot result:
  2. - if the patient is a donor, - exclusion from donation and prevention of transfusion of previously donated blood;
  3. - it is recommended to refrain from prematurely informing the patient or his relatives about the results of the ELISA study.
  4. 2. Tactics for identifying persons with a positive ELISA reaction obtained in an arbitration laboratory, but with a negative immunoblot result:
  5. - exclusion from donation;
  6. - medical observation in the presence of clinical and epidemiological indications.
  7. 3. Tactics for identifying a patient with signs of AIDS with negative results of a serological test:
  8. - if there are clear clinical indications of AIDS without serological confirmation of HIV infection, serological testing is repeated several times with a new portion of blood;
  9. - clinical observation of the patient;
  10. - strengthening control over the anti-epidemic regime in health care facilities where the patient is being observed.
  11. 4. Tactics for identifying individuals with questionable immunoblot results:
  12. - communication of the results of blood serum testing to the patient;
  13. - identification of epidemiological risk factors in the patient.
  14. Given that such individuals may be in early seroconversion, it is also necessary to:
  15. - re-examination of blood serum in immunoblot reaction 3 months and 6 months after the initial examination;
  16. - dispensary observation with clinical examination of the patient during these periods;
  17. - exclusion from donation;
  18. - recommendations for safe sex.
  19. If there are no changes in the immunoblotting reaction during repeated blood serum tests, as well as clinical manifestations, patients are considered seronegative for HIV and are removed from the register.
  20. 5. Tactics in case of detection of antibodies to HIV-gp 41, 120, 160 glycoproteins in the subject (positive immunoblotting result):
  21. - an “Operational report on a person in whose blood an immunoblot test revealed antibodies to HIV” is sent to the Russian AIDS Center and the Ministry of Health of Russia according to f. 266/у-88 (sent from Omsk AIDS Center);
  22. - measures are being taken to limit the circle of people who know about the infected person and to maintain the secrecy of the diagnosis;
  23. - the results of the blood serum test are reported to the patient by the doctor of the AIDS Center (at the place of residence) in the conditions maximum limit possible suicidal behavior;
  24. - the patient is excluded from all types of donation (blood, milk, organs), and previously donated blood, if intact, is destroyed;
  25. - the patient is sent to the specialized department of the State Clinical Hospital No. 1, where a clinical and immunological examination is carried out and the final diagnosis is established;
  26. - women are advised not to have children and to protect themselves from pregnancy, since pregnancy and childbirth have an adverse effect on the course of HIV infection and in 25 - 50% of cases infected children are born;
  27. - pregnant women, if the timing of pregnancy allows, are offered to have an artificial termination. If a woman refuses an abortion, delivery is recommended in a specialized department;
  28. - mothers are advised to refuse breastfeeding if either the mother or the child are infected. For feeding, you can use pasteurized mother's milk;
  29. - all persons who had the opportunity to become infected from the identified person or be a source of infection for him are examined. In each specific case, the circle of subjects is determined by the epidemiologist. It can be:
  30. 1. donors from whom the patient received blood or its preparations, organs, sperm;
  31. 2. sexual partners;
  32. 3. children of seropositive women;
  33. 4. mothers of seropositive children;
  34. 5. milk donors for seropositive children;
  35. 6. recipients of blood, sperm, organs of the patient;
  36. 7. partners of infected persons in parenteral drug use;
  37. 8. if a nosocomial outbreak is suspected - those who received parenteral or invasive interventions in the same institution (or department), at the same time as the infected person, and medical. personnel who performed parenteral or invasive procedures, mothers of deceased children who were in a hospital outbreak.
  • The medical professional undertakes to follow the following principles:
  • 1. The patient (a member of his family) should, if possible, be the main and only source of primary information about himself, and the amount of information should be limited to what is necessary for effective service and assistance.
  • 2. Within the institution, information about the patient is disclosed only to certain employees and to the extent necessary to help the patient.
  • 3. Other institutions, consultants, and specialists may be acquainted with confidential information only to the extent necessary for the service. When using a telephone for the benefit of a patient, the patient's name, as well as his address, should not be mentioned.
  • 4. Only information necessary for maintenance is subject to documentation. The use and retention of records is determined by the facility, program of care, and the best interests of the patient.
  • In the medical documents of an HIV-infected patient, instead of the diagnosis "HIV infection", a diagnostic code is entered.
  • The staff of the institution, in accordance with the above, undertakes to follow all regulations and common sense for the benefit of the patient and his family members. If by chance, through the fault of an employee, any information that is potentially dangerous to the patient or his property is disclosed and may lead to discrimination against the patient, he must report this to the head of the institution so that measures can be taken to protect the patient.
  • You should remember about criminal liability for disclosing information constituting medical confidentiality (Article 137 of the Criminal Code of the Russian Federation).

    • Hospital workers most often encounter sources of infection with infectious and viral diseases. Moreover, this is dangerous not only for the employee himself. Infected personnel may transmit the infection to the patient they work with. For this reason, the prevention of HIV infection among health workers is one of the most urgent. According to the Ministry of Health, infections with HIV and other diseases constantly occur in hospitals, despite the fact that prevention of occupational infection is carried out very often. There are a number of actions designed to protect personnel from infection and further spread of the disease. The reason for frequent cases of infection is the negligence of the workers themselves, violation of the algorithm for performing a particular procedure.

    Medical staff are always at risk of contracting HIV infection. This is especially true for professions that are constantly in contact with the blood of patients, for example, surgeons, procedural nurses, gynecologists, and so on.

    For infectious diseases, public health has identified possible risk factors—instruments or procedures through which infection can occur.

    These include:

    1. Direct contact with the patient’s liquid tissues (blood, lymph, saliva);
    2. Syringe needles;
    3. Medical scalpels, tweezers.

    Hospitals periodically monitor epidemiological safety and prevent HIV infection among staff to prevent infection and reduce the risk of infection among health workers and patients.

    The importance of biological safety of medical institutions is stated in the law of the Ministry of Health of the Russian Federation “On biological safety” dated August 16, 2017.

    Routes of HIV infection

    HIV infection has a short lifespan outside the human body, so it is impossible to become infected with this virus through clothing, dishes, or through communication. Infection can only occur through direct contact with the patient's blood.

    A medical worker directly works with material: biological and infectious. Medicine requires fresh, undisinfected body fluids. Thus, the following routes of infection can be distinguished:

    1. In case of an accidental needle prick after a patient during blood sampling or performing medical procedures;
    2. If blood gets on the surface of mucous membranes or biological fluids get into open wounds of the skin;

    At correct execution actions during such an incident can avoid further development of the disease. But HIV is a specific disease, the development of which does not allow one to quickly notice the infection. As a result, before the first symptoms appear infected person unaware of infection.


    If the patient is sick

    If the attending physician knows that the patient has HIV infection, regardless of the main course of treatment, he is prescribed antiretroviral prevention therapy. Precaution protects both health care workers and the patient. Also, similar therapy is prescribed to all people in direct contact with the patient.


    Important! HIV is an intracellular virus that attacks the immune system, so drugs in tablet form have no effect on it.

    After an intramuscular injection, a course is prescribed to rehabilitate the body, since the medicine itself greatly affects the patient’s condition. These procedures carry the highest risk of infection for a medical worker, since sharp needles are used, and drops of the patient’s blood are released onto the surface of the skin. For safety reasons, healthcare workers are advised not to carry out such procedures if they are feeling unwell or if there are scratches or wounds on the skin of their hands.

    Treatment of HIV diseases does not imply complete recovery from the disease, but only suppression of its development for some time. This means that upon contact with the blood of a person who has undergone full course rehabilitation, you can still get infected. It is important to understand that infection occurs through contact with blood or serum. The latter does not contain blood cells, but may contain HIV proteins.

    After completing the course of treatment, each patient is assigned a number in the Federal Register of HIV-Infected Persons with the corresponding records. In order for the disease not to develop, it is necessary to periodically, in accordance with its number, undergo repeated courses of treatment.

    If a healthcare worker is sick

    Despite the fact that medical institutions constantly carry out the prevention of occupational HIV infection among medical workers, there are still many cases of occupational infection. Unscrupulous employees and personnel are periodically identified. AIDS is not decreasing, largely thanks to such people. In order to protect patients like workers, they undergo mandatory HIV testing once a year, and some even more often. When carrying out various manipulations with cutting devices, additional and repeated briefings are carried out daily, for which both the instructing and the instructing must sign. Disinfection is constantly carried out over the working surface in laboratory premises and at blood collection points. Also, after working with reusable instruments that come into contact with the mucous membranes of patients, they are placed in a disinfectant solution.


    If it is discovered that a medical worker is infected with HIV, his fate depends on the type of activity: cosmetologists and dentists lose the right to work in their profession. Doctors of other positions are required to transfer to a department where there is no risk of infecting the patient (therapist, paramedic).

    What to do when you are diagnosed with HIV

    Due to the negligence of medical personnel in hospitals, there is a problem of HIV infection of inpatients. In this case, the person will not find out about the disease until the next scheduled examination, since such tests are not performed upon discharge.

    In departments where the risk of such an incident is high, there is prevention of nosocomial HIV infection. It is based on precautions established for hospital employees, as well as a number of rules for inpatients. The text of SanPin on the prevention of hospital-acquired HIV infection contains the following provisions:

    1. Every patient is considered a potential source of infection, regardless of status, age and gender.
    2. Hospitals must be equipped with all necessary equipment and means for disinfecting laboratory equipment;
    3. If a virus infection is suspected, a set of measures is taken to identify and suppress the spread of the disease;
    4. An extraordinary investigation is being conducted for further prevention. Immunodeficiency is caused by viruses. A special set of measures establishes the route of infection and stops further spread;
    5. An emergency situation involving HIV infection is recorded in a special journal.

    It should be understood that not all hospital departments have the same risk of infection. For example, dentistry is more dangerous compared to therapeutic dentistry. Also, the risk of infection is high in private clinics without a license, since disinfection there can be carried out with other drugs that are not recommended for use in hospitals that do not work on HIV. Such procedures can be carried out incorrectly, without technology.

    When visiting a private clinic, you should proceed as follows:

    1. Request a license to provide the requested services;
    2. Check the disinfection log and the name of the drugs;
    3. Check the time of the last procedure;
    4. Make sure that the doctor uses all necessary personal hygiene products (gloves, sterile wipes, etc.).

    You can find out all the necessary requirements in SanPin, which is freely available in any clinic.

    If infection occurs

    If an emergency situation occurs, it is necessary to take all measures to prevent the development of the disease and its spread. In medicine, there is strict subordination among medical workers and there is a law on the security of personal information; an employee with whom an incident occurred is obliged to report it only to his immediate superior. He makes a decision about future fate his subordinate (in accordance with the requirements of the law).

    If there is a further need to perform work, all damage must be thoroughly disinfected to prevent blood or lymph from getting on the working tool.

    Important! If an employee notifies his boss about his infection and continues his work, the boss will be responsible for the further spread of HIV.

    If biological fluids come into contact with mucous membranes, infection may not occur immediately, so the employee must immediately treat with alcohol or an alcohol-based skin antiseptic (reducing the concentration to avoid burns). After a few days, you need to do an HIV test to make sure you don't have the disease.

    Damage to the skin is the most likely route of infection. Vessels approach the surface of the wound, blood circulation increases, so it is impossible to quickly neutralize the source of HIV infection. A similar situation is often observed in the surgical department, since it is almost impossible to quickly replace a surgeon.

    According to statistics of HIV infections, more than 73 cases at work are recorded annually. More than half of them occur due to incorrect actions in the first minutes of infection. For example, when a source of infection comes into contact with the eye, many people treat the wound big amount water, although it is necessary to rinse with a solution of potassium permanganate.

    Often, patients themselves do not inform the doctor about the disease, and he does not conduct the necessary analysis.

    Prevention of HIV infections in medical institutions including outpatient clinics and hospitals

    The main measure to combat HIV in hospitals is the prevention of occupational infection. Measures to prevent HIV infection in medical institutions are established in SanPin and were listed above. Activities carried out in medical institutions are mainly preventive. Infections spread less in health care facilities, so measures have been relaxed here.

    But used instruments are always disinfected, and compliance with safety regulations is also required:

    1. Use of tools for purposes other than their intended purpose is prohibited;
    2. When working with biological fluids, carry out treatment before and after procedures;
    3. The requirements of the charter must be fulfilled by all employees of the institution, regardless of the type of activity;
    4. Neglect of protective equipment is punishable by a fine and a reprimand, which will be entered into the work record book;
    5. All actions the result of which may lead to the spread of HIV are considered negligence or breach of official duties;
    6. Employees are required to use gloves and glasses to prevent infection through mucous membranes and accidental wounds;
    7. The instrument is processed in the morning and evening, as well as after each procedure. To do this, they are placed in special containers with a working solution.

    Advice! To avoid burns to the skin of your hands during processing, you must use personal protective equipment (for example, gloves).

    Performing procedures using syringes also requires a number of actions:

    1. Syringes are only allowed to be used once;
    2. The instrument is unpacked immediately before the procedure.

    Methodological recommendations “Prevention of HIV infection and parenteral hepatitis among medical personnel of health care facilities” dated 06/21/01.

    HIV infection and blood-contact (parenteral) viral hepatitis B and C belong to the category of infectious diseases leading to the development of acquired immunodeficiency syndrome (AIDS), and in viral hepatitis - cirrhosis with the possible development of carcinoma.

    Infection of a medical worker most often occurs when the skin and mucous membranes are contaminated with the patient’s biological fluids (blood, serum, liquor, etc.), as well as when they are injured during medical procedures (cuts, injections, damage to the skin with small fragments of bone, etc.).

    The highest risk of infection is observed with deep lesions of the skin exposed to blood visible on medical instruments, in contact with an instrument that was in a vein or artery of the patient (for example, with a needle during phlebotomy) or in the patient’s body.

    On average, the risk of HIV infection when blood from an HIV-infected patient penetrates the skin is 0.3%. With superficial skin lesions, the risk of infection decreases and is 0.1% or less, depending on the blood volume and HIV titer.

    So far, data on the risk of HIV infection with certain skin lesions is limited. No cases of infection have been reported from such injuries.

    Infection with hepatitis B and C viruses, unlike HIV, occurs much easier and more often due to their lower infectious dose and the high stability of the virus in the external environment.

    The risk of occupational infection is most often exposed to medical workers in hematological, intensive care, dental, gynecological, obstetric, surgical, pathology departments, hemodialysis departments, treatment rooms, laboratories, workers in the production of blood, its components and preparations, workers support services(laundresses, disinfectants, cleaners, etc.) and funeral homes.

    Considering the possible contamination of human blood and biological material with HIV and hepatitis viruses, the rules of prevention apply to employees of all medical institutions, regardless of their profile and position.

    To prevent occupational infection, the following rules must be observed:

    When performing any medical procedures, a healthcare worker must be dressed in a gown, a cap, a disposable mask (and, if necessary, goggles or protective shields), removable shoes, in which it is prohibited to go outside the departments, laboratories, manipulation rooms, etc.;

    All manipulations during which hands may become contaminated with blood, serum or other biological fluids should be carried out wearing double rubber medical gloves. Rubber gloves, once removed, are not reused due to the possibility of contamination of hands. During work, gloves are treated with 70% alcohol or any other disinfectants that have a virucidal effect;

    Employees of all health care facilities must take precautions when performing manipulations with cutting and piercing instruments (needles, scalpels, scissors); when opening bottles, vials, test tubes with blood or serum, you should avoid injections, cuts to gloves and hands;

    If the skin is damaged, it is necessary to immediately treat the gloves with disinfectant solutions and remove them, squeeze out the blood from the wound; then under running water wash your hands thoroughly with soap, treat them with 70% alcohol and lubricate the wound with a 5% iodine solution. If your hands are contaminated with blood, you should immediately treat them for at least 30 seconds. a swab moistened with a skin antiseptic approved for use (70% alcohol, 3% chloramine solution, iodopirone, sterillium, octeniderm, octenisept, chlorhexidine, etc.), wash them twice with warm running water and soap and wipe dry with an individual towel (napkin) ;

    If blood or other biological fluids come into contact with the mucous membranes of the eyes, they should be immediately washed with water or a 1% solution of boric acid,

    treat the nasal mucosa with 1% protargol solution,

    the oral mucosa - rinse with a 70% alcohol solution or a 0.05% potassium permanganate solution or a 1% boric acid solution;

    Development, washing, rinsing of medical instruments, pipettes, laboratory glassware, instruments or devices that have come into contact with blood or serum should only be carried out with rubber gloves after preliminary disinfection (disinfection) with any disinfectant solution that has a virucidal effect;

    If there are wounds on the hands, exudative skin lesions or weeping dermatitis, the health worker is removed from patient care and contact with patient care items for the duration of the illness. If it is necessary to perform work, all damage must be covered with finger caps, adhesive tape, etc.;

    The surfaces of work tables at the end of the working day (and immediately if contaminated with blood) are treated with disinfectants that have virucidal agents. If the surface is contaminated with blood or serum, the procedures are performed twice: immediately and at intervals of 15 minutes;

    Delivery of blood (serum) samples from departments throughout the hospital to the laboratory should be carried out in containers (containers, sterilization boxes, etc.) with closing lids, made of material that does not deteriorate during disinfection; It is strictly prohibited to deliver samples in hands or pockets of clothing, in bags, briefcases and other personal items;

    Blood (serum) samples must be delivered in test tubes or vials, hermetically sealed with rubber or cotton-gauze stoppers, wrapped in plastic film. It is especially necessary to pack blood samples when transporting them outside of health care facilities, delivering containers with the test material in cooler bags;

    It is prohibited to carry out any parenteral and therapeutic-diagnostic procedures by medical personnel or their relatives in premises that are not intended for serving patients;

    Workers of autopsy shops, morgues and funeral institutions must use personal protective equipment (solid long gowns with ties at the back, hats, masks, oilcloth or plastic apron up to the ankles, reinforced gloves, glasses, shields, on their feet - shoes without laces, galoshes or boots and etc.);

    It is allowed to eat, smoke and use cosmetics only in areas specially designated for these purposes.
    Prevention of viral hepatitis incidence
    To protect medical workers who have not previously been vaccinated against hepatitis B, regardless of the presence or absence of infection in the patient, 3-fold specific immunization is carried out according to the schedule with a vaccine registered in the prescribed manner and approved for use in the Russian Federation.

    Vaccination against viral hepatitis B can be carried out to any person who has no contraindications, regardless of the presence of one or another marker of infection with the hepatitis B virus.

    Preliminary screening is carried out for serological markers of the hepatitis B virus (HBsAg, anti-HBs, anti-HCV). However, it is not necessary to carry it out, because additional administration of purified vaccine antigen does not have a pathological effect on the body of a person who has antibodies to HBsAg. In addition, administering the vaccine to them leads to an increase in their concentration.

    In cases where the hands or other parts of the body are injured with contamination of the skin and mucous membranes with biological fluids, the victims must have their blood taken for analysis to determine markers of viral hepatitis B.

    A blood test for the presence of markers of viral hepatitis is carried out with the aim of conducting an epidemiological investigation (identifying sources of infection, subsequently resolving the issue of occupational infection, etc.) and determining further tactics for protecting the employee from infection with viral hepatitis.

    After determining the patient’s status and depending on his condition, the issue of tactics for the prevention of viral hepatitis in a medical worker is decided.

    1. HBs-positive patient:

    1.1. Those who have not previously been vaccinated against hepatitis B are given a specific immunoglobulin and immunized with the hepatitis B vaccine according to epidemic indications 3 times according to a shortened schedule of 0-1-2 months with revaccination after 12 months. Vaccination in these cases should be carried out as soon as possible - no later than 1-2 days after the injury;

    1.2. Vaccinated in the past:

    2. HBs-negative patient:

    2.1. Those who have not previously been vaccinated against hepatitis B are immunized with the hepatitis B vaccine 3 times according to the 0-1-3 month schedule. Vaccination in these cases should be carried out as soon as possible - no later than 1-2 days after the injury;

    2.2. Vaccinated in the past: no vaccination.

    3. Source unknown or status not established:

    3.1. Those who have not previously been vaccinated against hepatitis B are immunized with the hepatitis B vaccine 3 times according to the 0-1-3 month schedule. Vaccination in these cases should be carried out as soon as possible - no later than 1-2 days after the injury;

    3.2. Vaccinated in the past:

    If there is an adequate (antibody level sufficient for protection) immune response, vaccination is not carried out;

    If there is an inadequate response (antibody levels insufficient to provide protection), one booster dose of the vaccine is administered;

    In the absence of an immune response, prophylaxis is carried out with a specific immunoglobulin and one booster dose of the vaccine is administered.


    Individual work

    Questions for self-study

    2. Solving situational problems

    1. Study of theoretical material

    2. Introduction to situational tasks on the topic

    3. Solving problems and justifying your decision

    4. Discussion of solutions

    5. View slides on the topic of the lesson


    Individual work

    1. Define viral hepatitis

    2. Classification of hepatitis

    3. Clinical signs of the main types of hepatitis

    4. Risk groups for hepatitis and HIV infection

    5. Routes of transmission of hepatitis and HIV infection

    6. Measures to prevent parenteral hepatitis and HIV infection


    3. Work in the department

    1. Briefing

    2. Study the task

    3. Work in the department:

    Providing practical assistance to nursing department staff

    Strengthen hand hygiene skills and use of sterile gloves

    Practice skills in treating skin and mucous membranes during infectious accidents

    Explore content emergency first aid kit in the treatment room

    Design of diaries


    Working in small groups

    1. Algorithms for hand hygiene and the use of sterile gloves

    2. List of contents of the emergency first aid kit

    3. Algorithms for treating skin and mucous membranes in infectious accidents

    4. Disinfection of used material and instruments

    5. Disposal of waste material

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    Date of the lesson:__________________________________________Teacher: ____________________

    EXPLANATORY NOTE.
    This workbook designed to consolidate knowledge on given topics of practical classes. It includes various forms of control, allowing for both current control of knowledge and self-control. It is designed to assist students both in independent preparation for practical classes and in performing independent work in class. To get started you need:


    • Understand the goals and objectives of the topic being studied;

    • Read the list of recommended literature and, if necessary, use it;

    • Study all the background information on the theoretical justification;

    • Study the standards of nursing practice;

    • Complete independent work tasks, guided by the educational map;

    • Complete all self-control tasks presented in the workbook.

    The increase in the number of HIV-infected people in the Russian Federation and the increase in the number of medical procedures performed during the provision of inpatient and outpatient medical care to them has led to the fact that over the past five years the number of registered cases of injury to medical personnel has increased by 1.5 times, which entails the need for timely organization and conduct of chemoprophylaxis for occupational HIV infection and provision of medical organizations with antiretroviral drugs for these purposes.

    According to the reports of investigations of biological accidents, in half of the cases there were violations of biological safety requirements, including the failure to use personal protective equipment and the violation of the manipulation algorithm.

    Transmission of the human immunodeficiency virus (HIV) in a healthcare setting is possible: from a patient to a healthcare worker; from health care worker to patient during invasive procedures; from patient to patient.

    Biological fluids that can cause HIV infection through contact: blood, semen, vaginal secretions, any fluids mixed with blood, synovial, cerebrospinal, pleural, pericardial and amniotic fluids containing HIV cultures and culture media.

    Patient's HIV status and stage of disease. If the patient has an acute infection or a late stage of the disease (AIDS), then there is more virus in the blood and the risk of infection is higher;

    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);

    Treatment of the wound surface (immediate rinsing of biological fluid with water and treatment with an antiseptic solution) reduces the risk of infection;

    The real danger of infection of a medical worker arises when the skin and mucous membranes are contaminated with the patient’s biological fluids (blood, serum, liquor), or when they are injured during medical procedures (cuts, injections, damage to the skin with small fragments of bone, etc.).

    The highest risk of infection is observed in cases of deep lesions of the skin exposed to blood visible on a medical instrument, in contact with an instrument that was in a vein, artery, or in the patient’s body.

    On average, the risk of infection when blood from an HIV-infected patient passes through the skin is 0.3 percent. For superficial skin lesions, the risk of infection is reduced to 0.1 percent and depends on the volume of blood and the amount of virus in the blood.

    When performing any medical procedures, a medical worker must wear a gown, cap, disposable mask, and, if necessary, use goggles or protective shields;

    All manipulations during which hands may become contaminated with blood, serum or other biological fluids should be carried out wearing medical gloves (if necessary, double gloves, chain mail gloves, reinforced gloves);

    Medical workers of all services of the Ministry of Defense must take precautions when performing manipulations with cutting and piercing instruments (needles, scalpels, scissors); when opening bottles, vials, tubes with blood or serum, you should avoid crushing the glass to avoid cuts to gloves and hands;

    Use safe medical devices with engineered protection against injury (auto-disable and self-locking syringes, vacutainers and monovets for blood collection, scalpels with a protective screen, etc.);

    Instead of chemical disinfection, which requires such dangerous procedures as washing the needle and syringe, soaking and transferring syringes and needles from one container to another, use physical (hardware) disinfection methods;

    If there are wounds on the hands, exudative skin lesions or weeping dermatitis, the medical worker is removed from caring for patients and contact with items to care for them for the duration of the illness. If it is necessary to perform work, all damage to the skin must be covered with finger caps and adhesive tape;

    If blood or serum gets on the surface of work tables, they are treated with disinfectants with virucidal properties twice: immediately and at intervals of 15 minutes;

    Blood (serum) samples are transported in test tubes or vials, hermetically sealed with rubber stoppers (screw caps); completed referral forms are attached separately;

    Transportation of tubes with blood (serum) samples from department to department and across the territory of the Moscow Region should be carried out in closed containers (containers, sterilization boxes, etc.) made of material that does not deteriorate during disinfection. When transporting samples outside the Moscow Region, delivery is carried out in cooler bags.

    If an emergency occurs at the workplace, a medical worker is obliged to stop work, immediately take measures to prevent HIV infection, and report the incident to the head of the structural unit or his deputy.

    Unprotected skin of the face and hands - treat the area of ​​contamination with a cotton swab moistened with 70% alcohol or an alcohol-based skin antiseptic (do not rub!), wash with running water and soap, dry with a disposable towel or napkin and re-treat with alcohol or an alcohol-based skin antiseptic;

    Rinse your mouth and throat with 70% alcohol or 0.05% potassium permanganate solution, spit it out (do not swallow!); to prepare a 0.05% solution, dissolve 0.05 g of potassium permanganate in 100 ml of water;

    Rinse eyes thoroughly with running water, then with a prepared 0.01% solution of potassium permanganate (to prepare a solution, dissolve 0.05 g in 500 ml of water) or 1% solution of boric acid;

    All cases of biological accidents registered in the MO log must be considered at meetings of the commission for the prevention of nosocomial infections and monitoring compliance with biological safety requirements (hereinafter referred to as the Commission) of the MO where the accident occurred. The commission analyzes the event, establishes the connection between the cause of the injury and the performance of official duties by the medical worker, and takes measures to prevent similar situations.

    In order to document the fact of a biological accident when working with an HIV-infected patient, in addition to a journal entry, the Commission draws up a report on an industrial accident in form N-1, approved by Resolution No. 73. The report is approved by the chief physician and certified by the seal of the medical organization in question. within which the powers of the Commission extend. A copy of the report on an accident that occurred while providing medical care to an HIV-infected person or when working with material from him is sent to the regional center for the prevention and control of AIDS within 10 days.

    1

    1. Belousova A.K., Serbina L.A. Practical skills and abilities of an infectious disease nurse. - Rostov n/a: Phoenix, -2012.

    2. Evplov V.I. Prevention of nosocomial infections. Collection of documents, comments, recommendations. - Rostov: Phoenix, 2011.

    3. Kuleshova L.I., Pustovetova E.V., Rubashkina L.A. Infection control in health care institutions. - Rostov: Phoenix, 2009.

    4.Aslonyants, A.M., Ishchenko, O.Yu. International Journal of Experiential Education. Use of modular-competency technology by a teacher of the discipline “Public Health and Healthcare”. Moscow: Academy of Natural Sciences, 2014 (10), 41-45.

    5. Salalykina E.V., Lynova E.N. Modern communication processes in organizing the activities of medical personnel // Collection of materials of the 1st international (X All-Russian) scientific and methodological conference RIC BashSU - 2014-P.75-77.

    6. Salalykina E.V., Lynova E.N. Professional burnout - as a reason for the deterioration of staff interaction in a team // Collection of materials of the 1st international (X All-Russian) scientific and methodological conference of the RIC Bashkir State University - 2014-P.160-162.

    The relevance of this work is due to the fact that the work of medical workers is a complex, intense and responsible type of activity. Healthcare workers come into contact with various infectious factors every day. The leading harmful factor that has a negative impact on the health of medical staff is biological. One of the pressing problems is that among medical workers, the risk of contracting HIV infection increases in emergency situations (contact with the blood of HIV-infected people during cuts, injections in the workplace and at home).

    The purpose of the work is to study the prevention of HIV infection in health care facilities.

    1) give general characteristics HIV infection as a disease;

    2) consider the historical stages of the development of HIV infection and current state problems with HIV infection;

    3) study the prevention of HIV infection: determine regulations regulating the prevention and treatment of HIV infection; consider personal protective equipment for medical staff; consider ensuring the infection safety of medical personnel when working with biological materials;

    4) conduct a practical study of methods and techniques for protecting medical staff when working with HIV infection.

    Object of study: HIV infection.

    Subject of research: methods and techniques for preventing HIV infection in health care facilities.

    Research methods:

    Theoretical methods: theoretical analysis literature on the research problem, system analysis;

    Biographical (study of medical documentation);

    Practical (observation, questioning, interviewing).

    Research hypothesis: medical personnel are among those at increased risk of HIV infection. Compliance with the principles of prevention in the workplace is the main component of comprehensive prevention of HIV infection as a dangerous nosocomial disease.

    HIV infection is a long-term infectious disease that develops as a result of infection with the human immunodeficiency virus (HIV). The concept of “acquired immunodeficiency syndrome” (AIDS) was first introduced by M. Gottlieb in 1982 and defined it as a combination of opportunistic infections dangerous to the human body against the background of immunodeficiency. The modes of transmission of HIV infection include: contact (sexual); parenteral; vertical. Doctors who provide care to HIV-infected patients are at the highest risk of contracting HIV: nursing staff, mainly procedural nurses; operating surgeons and operating nurses; obstetricians-gynecologists; pathologists. Currently, HIV/AIDS is the most important medical and social problem, because the number of cases and infections continues to grow throughout the world, covering people who are not included in groups with risk factors for infection. Transmission of HIV infection in health care facilities is possible: from patient to health worker; from a medical professional to a patient when using invasive methods of diagnosis and treatment; from patient to patient. To prevent occupational infection, universal precautions must be followed. In the event of an accident involving a risk of infection, local treatment is immediately carried out, for which a first aid kit is used for emergency prevention of self-infection with HIV infection.

    Research methods: observation; study of medical documentation; questionnaires, interviews.

    The study consisted of four stages.

    At the first stage, the work of the nurse was observed and the reporting documentation of the activities of the admission department was studied.

    At the second stage, observation of the work of a nurse in a specific case from practice was carried out.

    At the third stage, an anonymous survey of nursing staff in the surgical department of the hospital was conducted in order to study the attitude of medical personnel to infectious safety in the workplace.

    At the fourth stage, the nurse was interviewed.

    When analyzing the work of a nurse in the emergency department and observing a case from practice, it was found that when caring for HIV-infected patients, the nurse deals with a large number of different diseases, accompanied by damage to the anatomical and physiological systems of the body and various organs in various combinations. Therefore, the nurse must have the skills to care for such categories of patients, and know and follow safety rules.

    The conclusions from the survey research are as follows:

    1. Among the survey participants, the age group of young nurses under 30 years old was most represented, the second largest was the age group from 31 to 40 years old.
    2. The majority of respondents have worked in this institution for up to 10 years.
    3. Most respondents noted that they are exposed to biological factors, such as vaccines and body fluids. But, nevertheless, only 60% of health workers take into account harmfulness in their wages.
    4. All respondents know what occupational diseases are.
    5. 60% of respondents rated the conditions for organizing their workplace in terms of infection safety as good or excellent. This is quite a high estimate. But only 40% of respondents rated the safety of the workplace for their health as excellent.
    6. The vast majority of respondents (90%) agreed that their institution needs to improve the level of knowledge in the field of occupational safety and health protection for health workers.

    Based on the interview results, it was concluded that the nurse interviewed has sufficient knowledge about how to protect medical staff when working with infectious patients.

    The nurse's recommendation was the following: to develop a memo for nursing staff on the prevention of occupational infection with HIV/AIDS, since not all nurses, especially those who have recently come to work, have the necessary knowledge on this issue.

    Offers:

    1. Before entering all premises, install dispensers with disinfectant, since the hands of personnel are the main sources of the spread of infection. The management of the department was asked to pay attention to this recommendation.
    2. Improving regulatory, legal and methodological documents related to the protection of health of medical workers and the prevention of occupational diseases.
    3. Analysis of employee health indicators based on the results of annual medical examinations.

    Bibliographic link

    Lynova E.N., Glushak D.V., Makovkina D.V. ORGANIZATION OF HIV INFECTION PREVENTION IN HEALTH CARE AS A MEDICAL AND SOCIAL PROBLEM // International Journal of Applied and basic research. – 2016. – No. 11-4. – pp. 716-718;
    URL: https://applied-research.ru/ru/article/view?id=10655 (access date: 01/09/2020). We bring to your attention magazines published by the publishing house "Academy of Natural Sciences"

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