Regional state state-financed organization health
"Center medical prevention city of Stary Oskol"
Restrictions on entry and exit, removal of property, etc.,
Removal of property only after disinfection and permission from the epidemiologist,
Strengthening control over food and water supply,
Normalization of communication between separate groups of people,
Carrying out disinfection, deratization and disinsection.
Prevention of especially dangerous infections
1. Specific prevention of especially dangerous infections is carried out with a vaccine. The purpose of vaccination is to induce immunity to the disease. Vaccination can prevent infection or significantly reduce it Negative consequences. Vaccination is divided into planned and epidemic indications. It is carried out for anthrax, plague, cholera and tularemia.
2. Emergency prevention for persons who are at risk of contracting a particularly dangerous infection is carried out antibacterial drugs(anthrax).
3. For prevention and in cases of disease, immunoglobulins (anthrax) are used.
Prevention of anthrax
Application of the vaccine
Used to prevent anthrax live vaccine. Workers involved in livestock farming, meat processing plants and tanneries are subject to vaccination. Revaccination is carried out every other year.
Use of anthrax immunoglobulin
Anthrax immunoglobulin is used to prevent and treat anthrax. It is administered only after an intradermal test. When using the drug with therapeutic purpose anthrax immunoglobulin is given as soon as the diagnosis is made. For emergency prophylaxis, anthrax immunoglobulin is administered once. The drug contains antibodies against the pathogen and has an antitoxic effect. For seriously ill patients, immunoglobulin is administered for therapeutic purposes according to vital signs under the guise of prednisone.
Use of antibiotics
If necessary for emergency indications as preventative measure antibiotics are used. All persons who have contact with patients and infected material are subject to antibiotic therapy.
Anti-epidemic measures
Identification and strict recording of disadvantaged settlements, livestock farms and pastures.
Establishing the time of the incident and confirming the diagnosis.
Identification of a population at high risk of disease and establishment of control over emergency prevention.
Medical and sanitary measures for plague
Plague patients and patients suspected of having the disease are immediately transported to a specially organized hospital. Patients with the pneumonic form of plague are placed one at a time in separate rooms, and patients with the bubonic form of plague are placed several in one room.
After discharge, patients are subject to 3-month observation.
Contact persons are observed for 6 days. When in contact with patients with pneumonic plague, contact persons are given antibiotic prophylaxis.
Prevention of plague(vaccination)
Preventive immunization of the population is carried out when a massive spread of plague among animals is detected and a particularly dangerous infection is introduced by a sick person.
Routine vaccinations are carried out in regions where natural endemic foci of the disease are located. A dry vaccine is used, which is administered intradermally once. It is possible to re-administer the vaccine after a year. After vaccination with an anti-plague vaccine, immunity lasts for a year.
Vaccination can be universal or selective - only for the threatened population: livestock breeders, agronomists, hunters, food processors, geologists, etc.
Re-vaccinate after 6 months. persons at risk reinfection: shepherds, hunters, agricultural workers and employees of anti-plague institutions.
Maintenance personnel are given preventive antibacterial treatment.
Anti-epidemic measures for plague
Identification of a plague patient is a signal for the immediate implementation of anti-epidemic measures, which include:
Carrying out quarantine measures. The introduction of quarantine and the definition of a quarantine territory are carried out by order of the Extraordinary Anti-Epidemic Commission;
Contact persons from the plague outbreak are subject to observation (isolation) for six days;
Carrying out a set of measures aimed at destroying the pathogen (disinfection) and destroying pathogen carriers (deratization and disinfestation).
When identifying natural source In case of plague, measures are taken to exterminate rodents (deratization).
If the number of rodents living near people exceeds the 15% limit for getting into traps, measures are taken to destroy them.
There are two types of deratization: preventive and exterminatory. General sanitary measures, as the basis for rodent control, should be carried out by the entire population.
Epidemic threats and economic damage caused by rodents will be minimized if deratization is carried out in a timely manner.
Anti-plague suit
Work in a plague outbreak is carried out in an anti-plague suit. An anti-plague suit is a set of clothing that is used by medical personnel when carrying out work in conditions of possible infection with a particularly dangerous infection - plague and smallpox. It protects the respiratory organs, skin and mucous membranes of personnel involved in medical and diagnostic processes. It is used by sanitary and veterinary services.
Medical, sanitary and anti-epidemic measures for tularemia
Epidemic surveillance
Epidemic surveillance of tularemia is the continuous collection and analysis of information about episodes and vectors of the disease.
Prevention of tularemia
A live vaccine is used to prevent tularemia. It is intended to protect humans in areas of tularemia. The vaccine is administered once, starting at age 7.
Anti-epidemic measures for tularemia
Anti-epidemic measures for tularemia are aimed at implementing a set of measures, the purpose of which is the destruction of the pathogen (disinfection) and the destruction of carriers of the pathogen (deratization and disinfestation).
Preventive actions
Anti-epidemic measures, carried out on time and in full, can lead to a rapid cessation of the spread of especially dangerous infections, localize and eliminate the epidemic focus in as soon as possible. Prevention of especially dangerous infections - plague, cholera, anthrax and tularemia is aimed at protecting the territory of our state from the spread of especially dangerous infections.
Main literature
1. Bogomolov B.P. Differential diagnosis infectious diseases. 2000
2. Lobzina Yu.V. Selected issues in the treatment of infectious patients. 2005
3. Vladimirova A.G. Infectious diseases. 1997
Identification and implementation of primary measures for particularly dangerous infections (plague, cholera, yellow fever, anthrax). When identifying a patient suspected of having a particularly dangerous infection, the paramedic is obliged to:
notify the head of the medical institution and the regional sanitary and epidemiological surveillance authorities;
call ambulance and, if necessary, consultants;
isolate family members and neighbors (at home); prohibit them from leaving, close windows and ventilation ducts;
stop the appointment, close the windows and doors (in outpatient settings), inform the manager by phone or by express;
prohibit the use of sewerage and water supply;
carry out the necessary emergency assistance in accordance with the diagnosis;
upon receiving the package, change into protective clothing (anti-plague suit type I or IV);
compile lists of persons who were in contact with the patient, identify possible source infection;
carry out the necessary examination of the patient;
report to the former consultants and emergency physician basic information about the patient, epidemiological history;
upon confirmation of the diagnosis, issue a referral to a hospital;
carry out routine disinfection (disinfection of feces, vomit, rinsing water after washing hands).
When reporting information about a suspected particularly dangerous infection, you must provide the following:
date of illness;
preliminary diagnosis, who made it (last name, first name, position, name of institution), on the basis of what data it was made (clinical, epidemiological, pathological);
date, time and place of identification of the patient (corpse);
current location (hospital, clinic, first aid station, train);
last name, first name, patronymic of the patient (corpse);
name of the country, city, region (where the patient (corpse) came from);
what type of transport arrived (number of train, bus, car), time and date of arrival;
address of permanent residence;
whether you received chemoprophylaxis or antibiotics;
did you receive preventive vaccinations against this infection;
measures taken to eliminate and localize the outbreak of the disease (number of contacts), carrying out specific prevention, disinfection and other anti-epidemic measures;
what kind of help is needed (consultants, medications, disinfectants, transport);
signature under this message (last name, first name, patronymic, position);
the name of the person who transmitted and received this message, the date and hour of transmission of the message.
Hospitalization of patients is mandatory, isolation of contacts is carried out by order of the epidemiologist. In exceptional cases, when the infection is widespread, a quarantine is established in the area of the outbreak with isolation of contacts. In other cases, the terms of observation of contacts are determined by the incubation period: for cholera - 5 days, for plague - 6 days, for anthrax - 8 days. With everyone especially dangerous disease activities are carried out by order of the epidemiologist.
Task No. 2
Review the material from the disciplines “Fundamentals of Microbiology and Immunology” and “Infectious Diseases with a Course in Epidemiology” on a given topic.
Task No. 3
Answer the following questions:
1. What types of prevention do you know?
2. What is a “focus of infection”?
3. What is disinfection?
4. What types, varieties and methods of disinfection do you know?
5. What measures are taken at the source of infection?
6. When is an emergency notification sent?
8. What is the paramedic’s tactics when identifying a particularly dangerous infection?
Task No. 4
Prepare for a vocabulary dictation on the following terms:
infectious process, infectious disease, incubation period of the disease, prodromal period of the disease, mechanism of transmission of infection, pathogenic microorganisms, virulence, sporadia, epidemic, pandemic, epidemiological process, immunity, acquired artificial active (passive) immunity, sterile and non-sterile immunity, individual prevention, public prevention, vaccines, toxoids, immune sera (heterologous and homologous), bacteriophages, source of infection, zoonoses, anthroponoses, disinfection, deratization, disinfestation, chronic carriage, convalescence, exotoxins, endotoxins, especially dangerous infections.
Task No. 5
Develop a medical and preventive conversation on the topic:
· Prevention of helminthiases (for preschoolers)
· Prevention of spread viral infections(for schoolchildren)
· Prevention infectious diseases(for adults)
· Prevention of diseases caused by protozoa (for adults)
To do this, divide into subgroups, each topic must be voiced, coincidences are not welcome. When conducting a conversation, consider age characteristics your listeners. The conversation should be conducted in a language that the audience can understand (think microbiology seminars). The time allotted for the conversation is 10 minutes.
Task No. 6
Imagine that one of the tour operators invited you to participate in the creation of a “Memo for Tourists” traveling outside the Russian Federation.
Your tactics:
1. Familiarize yourself with the direction of travel of tourists.
2. Find out all the possible information about this country from the Internet.
3. Develop a memo according to the following plan:
Preparing for the trip.
Stay in foreign country(catering, living conditions, recreation.)
Returning from a trip.
Suggested countries: Türkiye, Vietnam, Egypt, China, Thailand.
Divide into subgroups and choose one of the directions.
Task No. 7.
Complete a health education newsletter on one of the given topics:
“Wash your hands before eating!”
You can suggest the topic that is of greatest interest to you.
When a patient suspected of having an acute infectious disease is identified in a clinic or hospital, the following primary anti-epidemic measures are carried out (Appendix No. 4):
Transportable patients are transported by ambulance to a special hospital.
For non-transportable patients, medical care is provided on the spot by calling a consultant and a fully equipped ambulance.
Measures are being taken to isolate the patient at the place of his identification, before hospitalization in a specialized infectious diseases hospital.
The nurse, without leaving the room where the patient has been identified, notifies the head of her institution about the identified patient by telephone or by messenger, and requests the appropriate medications, stowage of protective clothing, personal prophylactic means.
If plague or contagious viral hemorrhagic fevers are suspected, the nurse, before receiving protective clothing, must cover the nose and mouth with any bandage (towel, scarf, bandage, etc.), having previously treated the hands and open parts of the body with any antiseptic agents and provide assistance to the patient, wait for arrival an infectious disease specialist or a doctor of another specialty. After receiving protective clothing (anti-plague suits of the appropriate type), it is put on without removing your own, unless it is heavily contaminated with the patient’s secretions.
The arriving infectious disease doctor (therapist) enters the room where the patient is identified in protective clothing, and the employee accompanying him near the room must dilute a disinfectant solution. The doctor who identified the patient takes off the robe and bandage that protected him Airways, places them in a tank with a disinfectant solution or a moisture-proof bag, treats shoes with a disinfectant solution and moves to another room, where they undergo complete sanitary treatment, change into a spare set of clothes (personal items are placed in an oilcloth bag for disinfection). Exposed parts of the body, hair are treated, the mouth and throat are rinsed 70° ethyl alcohol, antibiotic solutions or 1% solution are instilled into the nose and eyes boric acid. The issue of isolation and emergency prophylaxis is decided after the conclusion of a consultant. If cholera is suspected, personal preventive measures are taken to intestinal infections: after examination, hands are sanitized antiseptic. If the patient's discharge gets on clothes or shoes, they are replaced with spare ones, and contaminated items are subject to disinfection.
The arriving doctor in protective clothing examines the patient, clarifies the epidemiological history, confirms the diagnosis, and continues treatment of the patient according to indications. It also identifies persons who were in contact with the patient (patients, including those discharged, medical and service personnel, visitors, incl. those who left the medical institution, persons at their place of residence, work, study.). Contact persons are isolated in a separate room or box or are subject to medical observation. If plague, hypothyroidism, monkeypox, acute respiratory or neurological syndromes are suspected, contacts in rooms connected through ventilation ducts are taken into account. Lists of identified contact persons are compiled (full name, address, place of work, time, degree and nature of contact).
Entry is temporarily prohibited medical institution and a way out of it.
Communication between floors stops.
Posts are posted at the office (ward) where the patient was, at entrance doors clinics (departments) and on the floors.
It is prohibited for patients to walk in and out of the department where the patient is identified.
Admissions, discharges of patients, and visits by their relatives are temporarily suspended. It is prohibited to remove items until final disinfection has been carried out.
Reception of patients for health reasons is carried out in isolated rooms with a separate entrance.
In the room where the patient is identified, the windows and doors are closed, the ventilation is turned off, and the ventilation holes, windows, doors are sealed with adhesive tape, and disinfection is carried out.
If necessary, emergency prophylaxis is provided to medical staff.
Seriously ill patients receive medical care before arrival medical team.
Using a sampling device, before the evacuation team arrives, the nurse who identified the patient takes material for laboratory examination.
In the office (ward) where the patient is identified, ongoing disinfection is carried out (disinfection of secretions, care items, etc.).
Upon arrival of the consultant team or evacuation team, the nurse who identified the patient carries out all the orders of the epidemiologist.
If urgent hospitalization of a patient is required for vital reasons, then the nurse who identified the patient accompanies him to the hospital and carries out the orders of the doctor on duty at the infectious diseases hospital. After consultation with an epidemiologist, the nurse is sent for sanitation, and in case of pneumonic plague, GVL and monkeypox, she is sent to the isolation ward.
Hospitalization of patients to the infectious diseases hospital is provided by the Emergency Medical Service by evacuation teams consisting of a doctor or paramedical worker, an orderly, familiar with the biological safety regime and a driver.
All persons taking part in the evacuation of those suspected of having the plague, CVHF, or the pulmonary form of glanders - type I suits, those with cholera - type IV (in addition, it is necessary to provide surgical gloves, an oilcloth apron, a medical respirator of at least protection class 2, boots) .
When evacuating patients suspected of having diseases caused by other microorganisms of pathogenicity group II, use protective clothing provided for the evacuation of infectious patients.
Transport for hospitalization of cholera patients is equipped with an oilcloth lining, dishes for collecting the patient’s secretions, disinfectant solutions in working dilution, and packaging for collecting material.
At the end of each flight, the personnel serving the patient must disinfect shoes and hands (with gloves), aprons, undergo an interview with the person responsible for the biological safety of the infectious diseases hospital to identify violations of the regime, and sanitize.
In the hospital where there are patients with diseases classified as group II (anthrax, brucellosis, tularemia, legionellosis, cholera, epidemic typhus and Brill's disease, rat typhus, Q fever, HFRS, ornithosis, psittacosis), an anti-epidemic regime is established, provided for corresponding infections. Cholera hospital according to the regime established for departments with acute gastrointestinal infections.
The structure, procedure and mode of operation of a provisional hospital are established the same as for an infectious diseases hospital (patients suspected of this disease are placed individually or in small groups according to the timing of admission and, preferably, according to clinical forms and according to the severity of the disease). When the presumptive diagnosis is confirmed in the provisional hospital, patients are transferred to the appropriate department of the infectious diseases hospital. In the ward, after the patient is transferred, final disinfection is carried out in accordance with the nature of the infection. The remaining patients (contacts) are sanitized, their linen is changed, and preventive treatment is given.
Excretions of patients and contacts (sputum, urine, feces, etc.) are subject to mandatory disinfection. Disinfection methods are used in accordance with the nature of the infection.
In hospital, patients should not use a shared toilet. Bathrooms and toilets must be locked with a key kept by the biosafety officer. Toilets are opened to drain disinfected solutions, and baths are opened to process those discharged. In case of cholera, sanitary treatment of a patient with I-II degree of dehydration is carried out in reception department(they do not use a shower) with a subsequent disinfection system for flush water and the room, III-IV degrees of dehydration are carried out in the ward.
The patient’s belongings are collected in an oilcloth bag and sent for disinfection in a disinfection chamber. In the pantry, clothes are stored in individual bags, folded into tanks or plastic bags, the inner surface of which is treated with an insecticide solution.
Patients (vibrio carriers) are provided with individual pots or bedpans.
Final disinfection at the place where the patient (vibration carrier) is identified is carried out no later than 3 hours from the moment of hospitalization.
In hospitals, current disinfection is carried out by junior medical personnel under the direct supervision of senior nurse departments.
Personnel carrying out disinfection must be dressed in a protective suit: removable shoes, anti-plague or surgical gown, complemented by rubber shoes, an oilcloth apron, a medical respirator, rubber gloves, and a towel.
Food for patients is delivered in kitchen dishes to the service entrance of the uninfected block and there they are poured and transferred from the kitchen dishes to the hospital pantry dishes. The dishes in which the food entered the department are disinfected by boiling, after which the tank with the dishes is transferred to the pantry, where they are washed and stored. The dispensing room must be equipped with everything necessary to disinfect leftover food. Individual dishes are disinfected by boiling.
The nurse responsible for compliance with the biological safety of the infectious diseases hospital monitors the disinfection of the hospital's wastewater during the period of epicomplications. Disinfection of wastewater from cholera and provisional hospitals is carried out by chlorination so that the concentration of residual chlorine is 4.5 mg/l. Control is carried out by daily obtaining laboratory control information and recording data in a journal.
General organizational issues. When identifying a patient suspected of having plague, cholera, contagious hemorrhagic viral fevers (Ebola, Lassa and cercopithecus fevers) and monkeypox, all primary anti-epidemic measures are carried out upon establishing a preliminary diagnosis based on clinical and epidemiological data. When a final diagnosis is established, measures to localize and eliminate foci of the infections listed above are carried out in accordance with current orders and guidelines for each nosological form.
The principles of organizing anti-epidemic measures are the same for all infections and include:
1) identification of the patient;
2) information about the identified patient;
3) clarification of the diagnosis;
4) isolation of the patient with subsequent hospitalization;
5) treatment of the patient;
6) observational, quarantine and other restrictive measures;
7) identification, isolation, and emergency prophylaxis for persons in contact with the patient;
8) provisional hospitalization of patients with suspected plague, cholera, GVL, monkeypox;
9) identification of those who died from unknown causes, pathological autopsy of the corpse with the collection of material for laboratory (bacteriological, virological) research, with the exception of those who died from GVL, disinfection, proper transportation and burial of corpses. Autopsies of those who died from GVL, as well as collection of material from the corpse for laboratory research, are not performed due to the high risk of infection;
10) disinfection measures;
11) emergency prevention of the population;
12) medical surveillance of the population;
13) sanitary control for external environment(laboratory research possible factors transmission of cholera, monitoring the number of rodents and their fleas, conducting an epizootological survey, etc.);
14) health education.
All these activities are carried out by local authorities and health care institutions together with anti-plague institutions that provide methodological guidance, advisory and practical assistance.
All treatment-and-prophylactic and sanitary-epidemiological institutions must have the necessary supply of medications for etiotropic and pathogenetic therapy; installations for collecting material from patients (corpses) for laboratory research; disinfectants and packs of adhesive plaster for sealing windows, doors, ventilation holes in one office (box, ward); means of personal prevention and personal protection(type I anti-plague suit).
The primary alarm about the identification of a patient with plague, cholera, GVL and monkeypox is made to three main authorities: the chief physician of the medical institution, the emergency medical service station and the chief physician of the territorial SES.
Chief physician The SES puts into effect a plan of anti-epidemic measures, informs the relevant institutions and organizations about the case of the disease, including territorial anti-plague institutions.
When carrying out primary anti-epidemic measures after establishing preliminary diagnosis the following deadlines must be followed incubation period: for plague - 6 days, cholera - 5 days, Lassa, Ebola and cercopithecus fevers - 21 days, monkeypox - 14 days.
From a patient with suspected cholera, material is collected by the medical worker who identified the patient, and if plague is suspected, by the medical worker of the institution where the patient is located, under the guidance of specialists from the departments of especially dangerous infections of the SES. Material from patients with GVL is taken only at the place of hospitalization by laboratories performing these studies. Collected material urgently sent for examination to a special laboratory.
When identifying cholera patients, only those persons who communicated with them during the period are considered contacts. clinical manifestations diseases. Medical workers who have been in contact with patients with plague, GVL or monkeypox (if these infections are suspected) are subject to isolation until a final diagnosis is made or for a period equal to the incubation period. Persons who have been in direct contact with a cholera patient, as directed by an epidemiologist, must be isolated or left under medical supervision.
Further activities are carried out by specialists from the departments of especially dangerous infections of the SES, anti-plague institutions in accordance with current instructions and comprehensive plans.
Knowledge by a doctor of various specializations and qualifications of the main early manifestations of especially dangerous infections, constant awareness and orientation in the epidemic situation in the country, republic, region, district will allow timely diagnosis of these diseases and take urgent anti-epidemic and treatment and preventive measures. In this regard, a health care professional should suspect the disease of plague, cholera, GVL or monkeypox based on clinical and epidemiological data.
Primary measures in medical institutions. Anti-epidemic measures in all medical institutions are carried out according to a single scheme in accordance with the operational plan of the institution.
The procedure for notifying the chief physician of a hospital, clinic or a person replacing him is determined specifically for each institution. Information about an identified patient to the territorial SES, higher authorities, calling consultants and evacuation teams is carried out by the head of the institution or a person replacing him.
If a patient suspected of suffering from plague, cholera, GVL or monkeypox is identified, the following primary anti-epidemic measures are carried out in a clinic or hospital:
1) measures are taken to isolate the patient at the place of his identification before hospitalization in a specialized infectious diseases hospital;
2) transportable patients are delivered by ambulance to a hospital special for these patients. For non-transportable patients, medical care is provided on the spot with a call to a consultant and an ambulance equipped with everything necessary;
3) a medical worker, without leaving the premises where the patient is identified, notifies the head of his institution about the identified patient by telephone or by messenger; requests appropriate medications, protective clothing, personal prophylaxis;
4) entry into and exit from a medical facility is temporarily prohibited;
5) communication between floors is stopped;
6) posts are posted at the office (ward) where the patient was, at the entrance doors of the clinic (department) and on the floors;
8) admission, discharge of patients, and visits by their relatives are temporarily suspended;
9) admission of patients for health reasons is carried out in isolated rooms;
10) in the room where the patient is identified, the windows and doors are closed, the ventilation is turned off and the ventilation holes are sealed with adhesive tape;
11) contact patients are isolated in a separate room or box. If plague, GVL or monkeypox is suspected, contacts in rooms connected through ventilation ducts are taken into account. Lists of identified contact persons are compiled (full name, address, place of work, time, degree and nature of contact);
12) before receiving protective clothing, a medical worker who suspects plague, GVL and monkeypox must temporarily cover his nose and mouth with a towel or mask made from improvised materials (bandage, gauze, cotton wool); if necessary, emergency prophylaxis is carried out for medical staff;
13) after receiving protective clothing (an anti-plague suit of the appropriate type), put it on without removing your own, unless it is heavily contaminated with the patient’s secretions;
14) seriously ill patients are provided with emergency medical care before the arrival of the medical team;
15) using a special sampling device, before the arrival of the evacuation team, the health worker who identified the patient takes materials for bacteriological research;
16) in the office (ward) where the patient is identified, ongoing disinfection is carried out;
17) upon the arrival of a team of consultants or an evacuation team, the health worker who identified the patient carries out all the orders of the epidemiologist;
18) if urgent hospitalization of a patient is required for vital reasons, then the health worker who identified the patient accompanies him to a specialized hospital and carries out the orders of the doctor on duty at the infectious diseases hospital. After consultation with an epidemiologist, the health worker is sent for sanitation, and in case of pneumonic plague, GVL and monkeypox - to the isolation ward.
Protective clothing, procedure for using a protective suit. Anti-plague suit provides protection medical personnel from infection with pathogens of plague, cholera, GVL, monkeypox and other pathogens of pathogenicity groups I-II. It is used when serving a patient in outpatient clinics and hospitals, when transporting (evacuating) a patient, carrying out current and final disinfection (disinsection, deratization), when taking material from a patient for laboratory research, during the autopsy and burial of a corpse, door-to-door visits.
Depending on the nature of the work performed, the following types of protective suits are used:
First type - a full protective suit consisting of overalls or pajamas, a hood (large headscarf), anti-plague robe, cotton-gauze mask (dust respirator), goggles, rubber gloves, socks (stockings), rubber or tarpaulin boots and towels. To autopsy a corpse, you must additionally have a second pair of gloves, an oilcloth apron, and oversleeves.
This type of suit is used when working with patients with pneumonic or septic forms of plague, until a final diagnosis is made in patients with bubonic and cutaneous forms of plague and until the first negative result of a bacteriological study is obtained, as well as with GVL.
Second type - a protective suit consisting of overalls or pajamas, an anti-plague robe, a hood (large headscarf), a cotton-gauze mask, rubber gloves, socks (stockings), rubber or tarpaulin boots and a towel. Used in servicing and providing medical care patients with monkeypox.
Third type- a protective suit consisting of pajamas, an anti-plague robe, a large scarf, rubber gloves, socks, deep galoshes and a towel. It is used when working with patients with bubonic or cutaneous plague who are receiving specific treatment.
Fourth type - a protective suit consisting of pajamas, medical gown, cap or gauze scarf, socks, slippers or shoes. Used in treating cholera patients. When performing the toilet, the patient wears rubber gloves, and when handling discharge, a mask.
Sets of protective clothing (robe, boots, etc.) must be sized and labeled.
How to put on a suit . An anti-plague suit is put on before entering the outbreak area. Costumes must be put on slowly, in a certain sequence, carefully.
The order of putting on is as follows: overalls, socks, rubber boots, hood or large headscarf, anti-plague robe. When using a phonendoscope, it is worn in front of the headscarf. The ribbon at the collar of the robe, as well as the belt of the robe, are tied in front on the left side with a loop, after which the ribbon is secured to the sleeves.
The respirator is put on the face so that the mouth and nose are closed, for which top edge The mask should be at the level of the lower part of the orbits, and the lower one should go slightly under the chin. The upper straps of the respirator are tied in a loop at the back of the head, and the lower ones - on the crown (like a sling bandage). Having put on a respirator, cotton swabs are placed on the sides of the wings of the nose.
Glasses must fit well and be checked for reliable fastening of the metal frame to the leather part; the glasses must be rubbed with a special pencil or a piece of dry soap to prevent them from fogging. After putting on the glasses, place a cotton swab on the bridge of the nose. Then gloves are put on, previously checked for integrity. For the belt of the robe with right side lay down a towel. During a postmortem examination of a corpse, a second pair of gloves, an oilcloth (rubberized) apron, and oversleeves are additionally put on.
Procedure for removing the suit. The anti-plague suit is removed after work in a room specially designated for this purpose or in the same room in which the work was carried out, after it has been completely disinfected. To do this, the room must have:
1) a tank with a disinfectant solution (Lysol, carbolic acid or chloramine) for disinfecting a robe, headscarf, towel;
2) a basin with hand sanitizer;
3) a jar with 70% ethyl alcohol for disinfecting glasses and a phonendoscope;
4) a pan with a disinfectant solution or soapy water to disinfect cotton-gauze masks (in the latter case, by boiling for 40 minutes).
When decontaminating a suit disinfectants all parts of it are completely immersed in the solution.
If the disinfection of the suit is carried out by autoclaving or in a disinfection chamber, the suit is folded, respectively, into bins or chamber bags, which are treated from the outside with a disinfectant solution.
The suit is removed slowly and in a strictly established order. After removing part of the suit, gloved hands are immersed in a disinfectant solution. The ribbons of the robe and apron, tied with a loop on the left side, make it easy to remove the suit.
Costumes are removed in the following order:
1) thoroughly wash gloved hands in a disinfectant solution for 1-2 minutes;
2) slowly remove the towel;
3) wipe the oilcloth apron with a cotton swab, generously moistened with a disinfectant solution, remove it, rolling it up from the outside inward;
4) remove the second pair of gloves and sleeves;
5) boots and galoshes are wiped with cotton swabs with a disinfectant solution from top to bottom (a separate swab for each boot);
6) without touching open parts skin, remove the phonendoscope;
7) remove the glasses by pulling them forward and upward, backwards with both hands;
8) the cotton-gauze bandage is removed without touching its outer side;
9) untie the ties of the collar, the belt of the robe and, lowering the upper edge of the gloves, release the ties of the sleeves, remove the robe, wrapping the outer part of it inward;
10) remove the scarf, carefully collecting all its ends in one hand at the back of the head;
11) remove gloves, check them for integrity in a disinfectant solution (but not with air);
12) wash the boots again in a tank of disinfectant solution and remove them.
After removing the anti-plague suit, wash your hands thoroughly with warm water and soap. It is recommended to take a shower after work.
The efficiency and quality of anti-epidemic, diagnostic and therapeutic measures in the event of particularly dangerous infections largely depend on the preliminary training of medical workers. Important given readiness medical service polyclinic network, since it is most likely that workers at this level will be the first to meet patients with especially dangerous infections.
REMINDER
TO THE MEDICAL WORKER WHEN CARRYING OUT PRIMARY MEASURES IN THE OCCU
In the event of identifying a patient suspected of having plague, cholera, GVL or smallpox, he is obliged, based on the data clinical picture disease suggests a case of hemorrhagic fever, tularemia, anthrax, brucellosis, etc., it is necessary first of all to establish the reliability of its connection with the natural source of infection.
Often decisive factor When establishing a diagnosis, the following epidemiological history data are used:
- Arrival of a patient from an area unfavorable for these infections for a period of time equal to the incubation period;
- Communication of the identified patient with a similar patient along the route, at the place of residence, study or work, as well as the presence there of any group diseases or deaths of unknown etiology;
- Staying in areas bordering the parties that are unfavorable for these infections or in exotic territory for the plague.
During the period of initial manifestations of the disease, OI can give pictures similar to a number of other infections and non-infectious diseases:
For cholera- with spicy intestinal diseases, toxic infections of various natures, poisoning with pesticides;
During the plague- with various pneumonias, lymphadenitis with elevated temperature, sepsis of various etiologies, tularemia, anthrax;
For monkeypox- With chicken pox, generalized vaccine and other diseases accompanied by rashes on the skin and mucous membranes;
For Lasa fever, Ebola, and Marburg-With typhoid fever, malaria. In the presence of hemorrhages, it is necessary to differentiate from yellow fever, Dengue fever (see clinical and epidemiological characteristics of these diseases).
If a patient is suspected of having one of the quarantine infections, the medical worker must:
1. Take measures to isolate the patient at the place of detection:
- Prohibit entry and exit from the outbreak, isolate family members from communicating with the sick person in another room, and if it is not possible to take other measures, isolate the patient;
- Before hospitalizing the patient and carrying out final disinfection, it is prohibited to pour the patient’s discharge into the sewer or cesspool, water after washing hands, dishes and care items, or remove things and various objects from the room where the patient was;
2. The patient is provided with the necessary medical care:
- if plague is suspected in a severe form of the disease, streptomycin or tetracycline antibiotics are administered immediately;
- in severe cases of cholera, only rehydration therapy is performed. Cordially - vascular agents not administered (see assessment of the degree of dehydration in a patient with diarrhea);
- when carrying out symptomatic therapy for a patient with GVL, it is recommended to use disposable syringes;
- depending on the severity of the disease, all transportable patients are sent by ambulance to hospitals specially designated for these patients;
- for non-transportable patients, assistance is provided on site with the call of consultants and an ambulance equipped with everything necessary.
3. By telephone or by messenger, notify the head physician of the outpatient clinic about the identified patient and his condition:
- Request appropriate medications, protective clothing, personal prophylactic equipment, material collection equipment;
- Before receiving protective clothing, a medical worker who suspects plague, GVL, or monkeypox should temporarily cover his mouth and nose with a towel or mask made from improvised material. For cholera, personal prevention measures for gastrointestinal infections must be strictly observed;
- Upon receipt of protective clothing, they put it on without removing their own (except for those heavily contaminated with the patient’s secretions)
- Before putting on PPE, carry out emergency prevention:
A) in case of plague - treat the nasal mucosa and eyes with a solution of streptomycin (100 distilled water per 250 thousand), rinse the mouth with 70 grams. alcohol, hands - alcohol or 1% chloramine. Inject intramuscularly 500 thousand units. streptomycin - 2 times a day, for 5 days;
B) with monkeypox, GVL - like with the plague. Anti-smallpox gammaglobulin metisazon - in the isolation ward;
C) For cholera - one of the means of emergency prevention (tetracycline antibiotic);
4. If a patient is identified with plague, GVL, or monkeypox, the medical worker does not leave the office or apartment (in case of cholera, if necessary, he can leave the room after washing his hands and taking off the medical gown) and remain until the arrival of the epidemiological and disinfection brigade.
5. Persons who were in contact with the patient are identified among:
- Persons at the patient’s place of residence, visitors, including those who had left by the time the patient was identified;
- Patients who were in this institution, patients transferred or referred to other medical institutions, discharged;
- Medical and service personnel.
6. Collect material for testing (before the start of treatment), fill out a referral to the laboratory in pencil.
7. Carry out ongoing disinfection in the fireplace.
8. after the patient leaves for hospitalization, carry out the complex epidemiological activities in the outbreak until the arrival of the disinfection team.
9. Further use of a medical worker from the outbreak of plague, GVL, monkeypox is not permitted (sanitation and in the isolation ward). In case of cholera, after sanitization, the health worker continues to work, but he is under medical supervision at the place of work for the duration of the incubation period.
BRIEF EPIDEMIOLOGICAL CHARACTERISTICS OF OOI
|
Name of infection |
Source of infection |
Transmission path |
Incubus period |
|
A sick man |
14 days |
||
|
Plague |
Rodents, humans |
Transmissible - through fleas, airborne, possibly others |
6 days |
|
Cholera |
A sick man |
Water, food |
5 days |
|
A sick man |
Vector-borne - Aedes-Egyptian mosquito |
6 days |
|
|
Lasa fever |
Rodents, sick person |
Airborne, airborne, contact, parenteral |
21 days (from 3 to 21 days, more often 7-10) |
|
Marburg disease |
A sick man |
21 days (from 3 to 9 days) |
|
|
Ebola fever |
A sick man |
Airborne, contact through the conjunctiva of the eyes, parapteral |
21 days (usually up to 18 days) |
|
Monkeypox |
Monkeys, sick person until 2nd contact |
Air-droplet, air-dust, contact-household |
14 days (from 7 to 17 days) |
MAIN SIGNAL SIGNS of OOI
PLAGUE- acute sudden onset, chills, temperature 38-40°C, sharp headache, dizziness, impaired consciousness, insomnia, conjunctival hyperemia, agitation, the tongue is coated (chalky), phenomena of increasing cardiovascular insufficiency develop. After a day, signs of the disease characteristic of each form develop:
Bubonic form: the bubo is sharply painful, dense, fused with the surrounding subcutaneous tissue, motionless, its maximum development is 3-10 days. The temperature lasts 3-6 days, the general condition is serious.
Primary pulmonary: against the background of the listed signs, pain appears in the chest, shortness of breath, delirium, cough appears from the very beginning of the disease, the sputum is often foamy with streaks of scarlet blood, and there is a discrepancy between the data of an objective examination of the lungs and the general serious condition of the patient. The duration of the disease is 2-4 days, without treatment 100% mortality;
Septic: early severe intoxication, a sharp drop in blood pressure, hemorrhage on the skin, mucous membranes, bleeding from internal organs.
CHOLERA - light form: fluid loss, loss own weight occurs in 95% of cases. The onset of the disease is acute rumbling in the abdomen, loose stools 2-3 times a day, and maybe vomiting 1-2 times. The patient’s well-being is not affected, and working capacity is maintained.
Moderate form: fluid loss of 8% of body weight, occurs in 14% of cases. The onset is sudden, rumbling in the stomach, vague intense pain in the abdomen, then loose stools up to 16-20 times a day, which quickly loses the fecal character and smell, green, yellow and pink color of rice water and diluted lemon, defecation without urge uncontrollable (for 500-100 ml are excreted once; an increase in stool is typical with each defect). Vomiting occurs along with diarrhea and is not preceded by nausea. Severe weakness develops and an unquenchable thirst appears. General acidosis develops and diuresis decreases. Blood pressure drops.
Severe form: algid develops with a loss of fluid and salts of more than 8% of body weight. The clinical picture is typical: severe emaciation, sunken eyes, dry sclera.
YELLOW FEVER: sudden acute onset, severe chills, headaches and muscle pain, heat. The patients are safe, their condition is serious, nausea and painful vomiting occur. Pain in the pit of the stomach. 4-5 days after a short-term drop in temperature and improvement in general condition, a secondary rise in temperature occurs, nausea, vomiting of bile appears, nose bleed. At this stage, three warning signs are characteristic: jaundice, hemorrhage, and decreased urine output.
LASSA FEVER: V early period symptoms: - the pathology is often not specific, a gradual increase in temperature, chills, malaise, headache and muscle pain. In the first week of the disease, severe pharyngitis develops with the appearance of white spots or ulcers on the mucous membrane of the pharynx and tonsils of the soft palate, followed by nausea, vomiting, diarrhea, chest and abdominal pain. By the 2nd week, diarrhea subsides, but abdominal pain and vomiting may persist. Dizziness, decreased vision and hearing are common. A maculopapular rash appears.
In severe cases, symptoms of toxicosis increase, the skin of the face and chest becomes red, the face and neck are swollen. Temperature is about 40°C, consciousness is confused, oliguria is noted. Subcutaneous hemorrhages may appear on the arms, legs, and abdomen. Hemorrhages into the pleura are common. The febrile period lasts 7-12 days. Death often occurs in the second week of illness from acute cardiovascular failure.
Along with severe ones, there are mild and subclinical forms of the disease.
MARBURG'S DISEASE: acute onset, characterized by fever, general malaise, headache. On the 3-4th day of illness, nausea, abdominal pain, severe vomiting, and diarrhea appear (diarrhea may last for several days). By the 5th day, in most patients, first on the torso, then on the arms, neck, face, a rash, conjunctivitis appears, hemorrhoidal diathesis develops, which is expressed in the appearance of pithechia on the skin, emapthema on the soft palate, hematuria, bleeding from the gums, in places of syringe Kolov, etc. The acute febrile period lasts about 2 weeks.
EBOLA FEVER: acute onset, temperature up to 39°C, general weakness, severe headaches, then pain in the neck muscles, in the joints of the leg muscles, conjunctivitis develops. Often dry cough sharp pains in the chest severe dryness in the throat and pharynx, which interfere with eating and drinking and often lead to cracks and ulcers on the tongue and lips. On the 2-3rd day of illness, abdominal pain, vomiting, and diarrhea appear; after a few days, the stool becomes tarry or contains bright blood.
Diarrhea often causes dehydration varying degrees. Usually on the 5th day, patients have a characteristic appearance: sunken eyes, exhaustion, weak skin turgor, the oral cavity is dry, covered with small ulcers similar to aphthous ones. On the 5th-6th day of illness, a macular-potulous rash appears first on the chest, then on the back and limbs, which disappears after 2 days. On days 4-5, hemorrhagic diathesis develops (bleeding from the nose, gums, ears, syringe injection sites, bloody vomiting, melena) and severe sore throat. Symptoms indicating involvement of the central nervous system in the process are often observed - tremor, convulsions, paresthesia, meningeal symptoms, lethargy or, conversely, agitation. In severe cases, cerebral edema and encephalitis develop.
MONKEYPOX: high fever, headache, pain in the sacrum, muscle pain, hyperemia and swelling of the mucous membrane of the pharynx, tonsils, nose, rashes on the mucous membrane are often observed oral cavity, larynx, nose. After 3-4 days, the temperature drops by 1-2°C, sometimes to low-grade fever, general toxic effects disappear, and health improves. After the temperature drops on the 3-4th day, a rash appears first on the head, then on the torso, arms, and legs. The duration of the rash is 2-3 days. Rashes on individual parts of the body occur simultaneously, the rash is predominantly localized on the arms and legs, simultaneously on the palms and soles. The nature of the rash is papular-vediculous. The development of the rash is from a spot to a pustule slowly, over 7-8 days. The rash is monomorphic (at one stage of development - only papules, vesicles, pustules and roots). Vesicles do not collapse when punctured (multi-locular). The base of the rash elements is dense (presence of infiltrates), the inflammatory rim around the rash elements is narrow and clearly defined. Pustules form on the 8-9th day of illness (6-7th day of the appearance of the rash). The temperature rises again to 39-40°C, the patients' condition worsens sharply, headaches and delirium appear. The skin becomes tense and swollen. Crusts form on days 18-20 of illness. There are usually scars after the crusts fall off. There is lymphadenitis.
REGIME FOR DISINFECTION OF MAIN OBJECTS IN CHOLERA
|
Disinfection method |
Disinfectant |
Contact time |
Consumption rate |
|
|
1. Room surfaces (floor, walls, furniture, etc.) |
irrigation |
0.5% solution DTSGK, NGK 1% chloramine solution 1% solution of clarified bleach |
60 min |
300ml/m3 |
|
2. Gloves |
dive |
3% myol solution, 1% chloramine solution |
120 min |
|
|
3.Glasses, phonendoscope |
Wipe twice with an interval of 15 minutes |
3% hydrogen peroxide |
30 min |
|
|
4. Rubber shoes, leather slippers |
wiping |
See point 1 |
||
|
5. Bed dress, cotton trousers, jacket |
chamber processing |
Steam-air mixture 80-90°C |
45 min |
|
|
6. Dishes of the patient |
boiling, immersion |
2% solution of soda, 1% chloramine solution, 3% rmezol solution, 0.2% DP-2 solution |
15 minutes 20 minutes |
|
|
7. Personnel protective clothing contaminated with secretions |
boiling, soaking, autoclanning |
See point 6 120°C p-1.1 at. |
30 min |
5l per 1 kg of dry laundry |
|
8. Protective clothing for personnel without visible signs of contamination |
boiling, soaking |
2% soda solution 0.5% chloramine solution 3% misol solution, 0.1% DP-2 solution |
15 minutes 60 min 30 min |
|
|
9. Patient's secretions |
add, mix |
Dry bleach, DTSGK, DP |
60 min |
200 gr. per 1 kg of discharge |
|
10. Transport |
irrigation |
CM. paragraph 1 |
ASSESSMENT OF THE DEGREE OF DEHYDRATION BY CLINICAL SIGNS
|
Symptom or Sign |
Degree of disinfection as a percentage |
||
|
I(3-5%) |
II(6-8%) |
III(10% and above) |
|
|
1. Diarrhea |
Watery stools 3-5 times a day |
6-10 times a day |
More than 10 times a day |
|
2. Vomiting |
No or insignificant amount |
4-6 times a day |
Very common |
|
3. Thirst |
moderate |
Expressive, drinks greedily |
Can't drink or drinks poorly |
|
4. Urine |
Not changed |
Small quantity, dark |
Not urinating for 6 hours |
|
Good, cheerful |
Feeling unwell, sleepy or irritable, agitated, restless |
Very drowsy, lethargic, unconscious, lethargic |
|
|
6. Tears |
Eat |
none |
none |
|
7. Eyes |
Regular |
Sunken |
Very sunken and dry |
|
8. Oral mucosa and tongue |
Wet |
dry |
Very dry |
|
9. Breathing |
Normal |
Rapid |
Very frequent |
|
10. Tissue turgor |
Not changed |
Each fold unravels slowly |
Each fold is straightened. So slow |
|
11. Pulse |
normal |
More often than usual |
Frequent, weak filling or not palpable |
|
12. Fontana (in young children) |
Doesn't stick |
sunken |
Very sunken |
|
13. Average estimated fluid deficit |
30-50 ml/kg |
60-90 ml/kg |
90-100 ml/kg |
EMERGENCY PREVENTION IN AREAS OF QUARANTINE DISEASES.
Emergency prevention applies to those who have contact with the patient in the family, apartment, place of work, study, recreation, treatment, as well as persons who are in the same conditions regarding the risk of infection (according to epidemiological indications). Taking into account the antibiogram of strains circulating in the outbreak, one of the following devices is prescribed:
|
DRUGS |
One-time share, in gr. |
Frequency of application per day |
Average daily dose |
|
|
Tetracycline |
0,5-0,3 |
2-3 |
1,0 |
4 |
|
Doxycycline |
0,1 |
1-2 |
0,1 |
4 |
|
Levomycetin |
0,5 |
4 |
2,0 |
4 |
|
Erythromycin |
0,5 |
4 |
2,0 |
4 |
|
Ciprofloxacin |
0,5 |
2 |
1,6 |
4 |
|
Furazolidone |
0,1 |
4 |
0,4 |
4 |
TREATMENT SCHEMES FOR PATIENTS WITH DANGEROUS INFECTIOUS DISEASES
|
Disease |
A drug |
One-time share, in gr. |
Frequency of application per day |
Average daily dose |
Duration of use, in days |
|
Plague |
Streptomycin |
0,5 - 1,0 |
2 |
1,0-2,0 |
7-10 |
|
Sizomycin |
0,1 |
2 |
0,2 |
7-10 |
|
|
Rifampicin |
0,3 |
3 |
0,9 |
7-10 |
|
|
Doxycycline |
0,2 |
1 |
0,2 |
10-14 |
|
|
Sulfatone |
1,4 |
2 |
2,8 |
10 |
|
|
anthrax |
Ampicillin |
0,5 |
4 |
2,0 |
7 |
|
Doxycycline |
0,2 |
1 |
0,2 |
7 |
|
|
Tetracycline |
0,5 |
4 |
2,0 |
7 |
|
|
Sizomycin |
0,1 |
2 |
0,2 |
7 |
|
|
Tularemia |
Rifampicin |
0,3 |
3 |
0,9 |
7-10 |
|
Doxycycline |
0.2 |
1 |
0,2 |
7-10 |
|
|
Tetracycline |
0.5 |
4 |
2,0 |
7-10 |
|
|
Streptomycin |
0,5 |
2 |
1,0 |
7-10 |
|
|
Cholera |
Doxycycline |
0,2 |
1 |
0,2 |
5 |
|
Tetracycline |
0,25 |
4 |
1,0 |
5 |
|
|
Rifampicin |
0,3 |
2 |
0,6 |
5 |
|
|
Levomecithin |
0.5 |
4 |
2,0 |
5 |
|
|
Brucellosis |
Rifampicin |
0,3 |
3 |
0,9 |
15 |
|
Doxycycline |
0,2 |
1 |
0,2 |
15 |
|
|
Tetracycline |
0,5 |
4 |
2,0 |
15 |
For cholera, an effective antibiotic can reduce the amount of diarrhea in patients with severe cholera, the period of vibrio excretion. Antibiotics are given after the patient is dehydrated (usually after 4-6 hours) and vomiting has stopped.
Doxycycline is the preferred antibiotic for adults (except pregnant women).
Furazolidone is the preferred antibiotic for pregnant women.
When vibrios cholerae resistant to these drugs are isolated in cholera foci, the issue of changing the drug is considered taking into account the antibiograms of the strains circulating in the foci.
LAYOUT FOR COLLECTING MATERIAL FROM A PATIENT WITH SUSPECTED CHOLERA (for hospital facilities non-infectious profile, ambulance stations, outpatient clinics).
1. Sterile wide-neck jars with lids or
Ground stoppers of at least 100 ml. 2 pcs.
2. Glass tubes (sterile) with rubber
small size necks or teaspoons. 2 pcs.
3. Rubber catheter No. 26 or No. 28 for taking material
Or 2 aluminum hinges 1 pc.
4.Plastic bag. 5 pieces.
5. Gauze napkins. 5 pieces.
7. Band-Aid. 1 pack
8. Simple pencil. 1 PC.
9. Oilcloth (1 sq.m.). 1 PC.
10. Bix (metal container) small. 1 PC.
11. Chloramine in a 300g bag, designed to receive
10l. 3% solution and dry bleach in a bag of
calculation 200g. per 1 kg. discharge. 1 PC.
12. Rubber gloves. Two pairs
13. Cotton gauze mask (dust respirator) 2 pcs.
Laying on each linear brigade of the joint venture, therapeutic area, local hospital, medical outpatient clinic, first aid station, health center - for everyday work when serving patients. Items subject to sterilization are sterilized once every 3 months.
SCHEME FOR COLLECTING MATERIAL FROM PATIENTS WITH OI:
|
Name of infection |
Material under study |
Quantity |
Method of collecting material |
|
Cholera |
A) feces B)vomit B) bile |
20-25 ml. pores B and C |
The material is collected in a separate bin. The Petri dish, placed in a bedpan, is transferred to a glass jar. In the absence of discharge - with a boat, a loop (to a depth of 5-6 cm). Bile - with duonal probing |
|
Plague |
A) blood from a vein B) punctate from bubo B) department of the nasopharynx D) sputum |
5-10 ml. 0.3 ml. |
Blood from the cubital vein - into a sterile test tube, juice from a bubo from the dense peripheral part - a syringe with the material is placed in a test tube. Sputum - in a wide-necked jar. Nasopharyngeal discharge - using cotton swabs. |
|
Monkeypox GVL |
A) mucus from the nasopharynx B) blood from a vein C) contents of rashes, crusts, scales D) from a corpse - brain, liver, spleen (at sub-zero temperatures) |
5-10 ml. |
We separate it from the nasopharynx using cotton swabs into sterile plugs. Blood from the cubital vein - into sterile tubes; the contents of the rash are placed into sterile tubes with a syringe or scalpel. Blood for serology is taken 2 times in the first 2 days and after 2 weeks. |
MAIN RESPONSIBILITIES OF THE MEDICAL PERSONNEL OF THE ENT DEPARTMENT OF THE CRH WHEN IDENTIFYING A PATIENT WITH OOI IN THE HOSPITAL (during a medical round)
- Doctor, who identified a patient with an acute respiratory infection in the department (at the reception) is obliged to:
- Temporarily isolate the patient at the site of detection, request containers for collecting secretions;
- Notify by any means the head of your institution (head of department, head physician) about the identified patient;
- Organize measures to comply with the rules of personal protection for health workers who have identified a patient (request and use anti-plague suits, means for treating mucous membranes and open areas of the body, emergency prevention, disinfectants);
- Provide emergency care to the patient medical care according to vital indications.
NOTE: the skin of the hands and face is generously moistened with 70° alcohol. The mucous membranes are immediately treated with a solution of streptomycin (250 thousand units in 1 ml), and for cholera - with a solution of tetracycline (200 thousand mcg/ml). In the absence of antibiotics, a few drops of 1% silver nitrate solution are injected into the eyes, and 1% into the nose. Protargol solution, rinse the mouth and throat with 70° alcohol.
- Charge nurse who took part in a medical round is obliged to:
- Request installation and collect material from the patient for bacteriological research;
- Organize ongoing disinfection in the ward before the arrival of the disinfection team (collection and disinfection of the patient’s discharge, collection of contaminated linen, etc.).
- Make lists of your closest contacts with the patient.
NOTE: After evacuating the patient, the doctor and nurse take off their protective clothing, pack it in bags and hand it over to the disinfection team, disinfect their shoes, undergo sanitary treatment and send it to their supervisor.
- Head of department Having received a signal about a suspicious patient, he is obliged to:
- Urgently organize the delivery to the ward of protective clothing, bacteriological equipment for collecting material, containers and disinfectants, as well as means for treating open areas of the body and mucous membranes, emergency prophylaxis;
- Set up posts at the entrance to the ward where the patient is identified and at the exit from the building;
- If possible, isolate contacts in wards;
- Report the incident to the head of the institution;
- Organize a census of your department’s contacts in the prescribed form:
- No. pp., surname, first name, patronymic;
- was undergoing treatment (date, department);
- left the department (date);
- the diagnosis with which the patient was in the hospital;
- location;
- place of work.
- Senior nurse of the department, having received instructions from the head of the department, is obliged to:
- Urgently deliver protective clothing, containers for collecting secretions, bacteriological storage, disinfectants, antibiotics to the ward;
- Separate patients from departments into wards;
- Monitor the work of posted posts;
- Conduct a census using the established contact form for your department;
- Accept the container with the selected material and ensure delivery of samples to the laboratory.
OPERATIONAL PLAN
Department activities when identifying cases of acute respiratory infections.
|
№№ PP |
Business name |
Deadlines |
Performers |
|
1 |
Notify and gather at workplaces officials departments in accordance with the existing scheme. |
Immediately upon confirmation of diagnosis |
Doctor on duty head department, head nurse. |
|
2 |
Call a group of consultants through the head physician of the hospital to clarify the diagnosis. |
Immediately if OI is suspected |
Doctor on duty head department. |
|
3 |
Introduce restrictive measures in the hospital: -prohibit access of outsiders to the buildings and territory of the hospital; -introduce a strict anti-epidemic regime in hospital departments -prohibit the movement of patients and staff in the department; -set up external and internal posts in the department. |
Upon confirmation of diagnosis |
Medical staff on duty |
|
4 |
Conduct instruction for department staff on the prevention of acute respiratory infections, personal protection measures, and hospital operating hours. |
When gathering personnel |
Head department |
|
5 |
Conduct explanatory work among patients in the department about measures to prevent this disease, compliance with the regimen in the department, and personal preventive measures. |
In the first hours |
Medical staff on duty |
|
6 |
Strengthen sanitary control over the work of the dispensing room, collection and disinfection of waste and garbage in the hospital. Carry out disinfection measures in the department |
constantly |
Medical staff on duty head department |
NOTE: further activities in the department are determined by a group of consultants and specialists from the sanitary and epidemiological station.
Scroll
questions to convey information about the patient (vibrio carrier)
- Full Name.
- Age.
- Address (during illness).
- Permanent residence.
- Profession (for children - child care institution).
- Date of illness.
- Date of request for help.
- Date and place of hospitalization.
- Date of collection of material for tank examination.
- Diagnosis upon admission.
- Final diagnosis.
- Accompanying illnesses.
- Date of vaccination against cholera and drug.
- Epidemiological history (connection with a body of water, food products, contact with a patient, vibrio carrier, etc.).
- Alcohol abuse.
- Use of antibiotics before illness (date of last dose).
- Number of contacts and measures taken against them.
- Measures to eliminate the outbreak and localize it.
- Measures to localize and eliminate the outbreak.
SCHEME
specific emergency prophylaxis for a known pathogen
|
Name of infection |
Name of the drug |
Mode of application |
(gr.) |
Frequency of application (per day) |
Average daily dose (gr.) |
Average dose per course |
Average duration course |
|
|
Cholera |
Tetracycline |
Inside |
0,25-0,5 |
3 times |
0,75-1,5 |
3,0-6,0 |
4 days |
|
|
Levomycetin |
Inside |
0,5 |
2 times |
1,0 |
4,0 |
4 days |
||
|
Plague |
Tetracycline |
Inside |
0,5 |
3 times |
1,5 |
10,5 |
7 days |
|
|
Olethetrin |
Inside |
0,25 |
3-4 times |
0,75-1,0 |
3,75-5,0 |
5 days |
||
NOTE: Extract from the instructions,
approved deputy minister of health
USSR Ministry of Health P.N. Burgasov 06/10/79
SAMPLING FOR BACTERIOLOGICAL STUDIES IN OOI.
|
Material collected |
The amount of material and what it is taken into |
Property required when collecting material |
|
I. MATERIAL ON CHOLERA |
||
|
excreta |
|
Glass Petri dish, sterile teaspoon, sterile jar with ground stopper, tray (sterilizer) for emptying the spoon |
|
Bowel movements without stool |
Same |
The same + sterile aluminum loop instead of a teaspoon |
|
Vomit |
10-15 gr. in a sterile jar with a ground stopper, filled 1/3 with 1% peptone water |
A sterile Petri dish, a sterile teaspoon, a sterile jar with a ground stopper, a tray (sterilizer) for emptying the spoon |
|
II.MATERIAL IN NATURAULAR SMALLPOX |
||
|
Blood |
A) 1-2 ml. dilute 1-2 ml of blood into a sterile test tube. sterile water. |
Syringe 10 ml. with three needles and wide lumen |
|
B) 3-5 ml of blood into a sterile tube. |
3 sterile tubes, sterile rubber (cork) stoppers, sterile water in ampoules 10 ml. |
|
|
|
With a cotton swab on a stick and immersed in a sterile test tube |
Cotton swab in a test tube (2 pcs.) Sterile tubes (2 pcs.) |
|
Contents of rashes (papules, vesicles, pustules) |
Before taking, wipe the area with alcohol. Sterile test tubes with ground-in stoppers and degreased glass slides. |
96° alcohol, cotton balls in a jar. Tweezers, scalpel, smallpox inoculation feathers. Pasteur pipettes, slides, adhesive tape. |
|
III. MATERIAL IN PLAGUE |
||
|
Bubo punctate |
A) the needle with punctate is placed in a sterile tube with a sterile rubber crust B) blood smear on glass slides |
5% tincture of iodine, alcohol, cotton balls, tweezers, 2 ml syringe with thick needles, sterile tubes with stoppers, fat-free glass slides. |
|
Sputum |
In a sterile Petri dish or a sterile wide-mouth jar with a ground stopper. |
Sterile Petri dish, sterile wide-necked jar with a ground stopper. |
|
Discharge from the nasopharyngeal mucosa |
On a cotton swab on a stick in a sterile test tube |
Sterile cotton buds in sterile tubes |
|
Blood for homoculture |
5 ml. blood into sterile tubes with sterile (cortical) stoppers. |
10 ml syringe. with thick needles, sterile tubes with sterile (cork) stoppers. |
MODE
Disinfection of various objects contaminated pathogenic microbes
|
(plague, cholera, etc.) |
||||
|
Object to be disinfected |
Disinfection method |
Disinfectant |
Time contact |
Consumption rate |
|
1.Room surfaces (floor, walls, furniture, etc.) |
Irrigation, wiping, washing |
1% chloramine solution |
1 hour |
300 ml/m 2 |
|
2. protective clothing (underwear, gowns, headscarves, gloves) |
autoclaving, boiling, soaking |
Pressure 1.1 kg/cm 2. 120° |
30 min. |
¾ |
|
2% soda solution |
15 minutes. |
|||
|
3% Lysol solution |
2 hours |
5 l. per 1 kg. |
||
|
1% chloramine solution |
2 hours |
5 l. per 1 kg. |
||
|
3. Glasses, phonendoscope |
wiping |
|
¾ |
|
|
4. Liquid waste |
Add and stir |
|
1 hour |
200gr./l. |
|
5.Slippers, rubber boots |
wiping |
3% peroxide solution hydrogen with 0.5% detergent |
¾ |
2x wiping at intervals. 15 minutes. |
|
6. Discharge of the patient (sputum, feces, food debris) |
Add and stir; Pour and stir |
Dry bleach or DTSGK |
1 hour |
200 gr. /l. 1 hour of discharge and 2 hours of solution doses. volume ratio 1:2 |
|
5% Lysol A solution |
1 hour |
|||
|
10% solution Lysol B (naphthalizol) |
1 hour |
|||
|
7. Urine |
Fill |
2% chlorine solution. lime, 2% solution of Lysol or chloramine |
1 hour |
Ratio 1:1 |
|
8. Dishes of the patient |
boiling |
Boiling in 2% soda solution |
15 minutes. |
Full immersion |
|
9. Used utensils (teaspoons, Petri dishes, etc.) |
boiling |
2% soda solution |
30 min. |
¾ |
|
3% solution chloramine B |
1 hour |
|||
|
3% per. hydrogen with 0.5 detergent |
1 hour |
|||
|
3% Lysol A solution |
1 hour |
|||
|
10. Hands in rubber gloves. |
Immersion and washing |
Disinfectant solutions specified in paragraph 1 |
2 minutes. |
¾ |
|
Hands |
-//-//-Wipe |
0.5% chloramine solution |
1 hour |
|
|
70° alcohol |
1 hour |
|||
|
11.Bed accessories |
Chamber disinfection |
Steam-air mixture 80-90° |
45 min. |
60 kg/m2 |
|
12. Synthetic products. material |
-//-//- Dive |
Steam-air mixture 80-90° |
30 min. |
60 kg/m2 |
|
1% chloramine solution |
5 o'clock |
|||
|
0.2% formaldehyde solution at t70° |
1 hour |
|||
DESCRIPTION OF PROTECTIVE ANTIPLAGUE SUIT:
- Pajama suit
- Socks-stockings
- Boots
- Anti-plague medical gown
- Kerchief
- Fabric mask
- Mask - glasses
- Oilcloth sleeves
- Oilcloth apron
- Rubber gloves
- Towel
- Oilcloth
