Emergency situations in the work of a health worker. Algorithm of actions in case of cuts and injections

In case of damage to the skin (cut, injection):

· immediately remove gloves and immerse them in a disinfectant solution;

· let the blood drain;

Wash your hands under running water;

· treat with 70° alcohol;

· lubricate with 5% iodine solution;

· Cover the cut with a band-aid.

When hit biological material on the skin:

· treat with 70° alcohol,

Wash thoroughly with soap,

· re-treat the skin with 70° alcohol.

If biological material comes into contact with the mucous membrane of the eye:

· rinse with water.

If biomaterial gets on the nasal mucosa:

· rinse with water.

If biological material enters the oral cavity:

· rinse with water and then rinse with 70° alcohol.

If biological material gets on a gown, personal protective equipment (screen, glasses):

· remove contaminated clothing and immerse in a disinfectant solution or place in a container for autoclaving

· shoes are treated by wiping them twice with a rag soaked in a solution of one of the disinfectants.

If infected material gets on the floor, walls, furniture, equipment and other surrounding objects:

Fill the contaminated area with any disinfectant solution with exposure according to the regime viral hepatitis.

An employee who finds himself in an epidemiological emergency situation immediately reports the fact of the emergency to the head of the unit. For each case, a “Workplace Accident Report” is drawn up and a “Workplace Accident Register” is filled out. The act records the date, place, commission of three people, full name, head of the department (doctor on duty), head nurse, occupational safety specialist, full name. persons injured during accidents, position, length of service in the specialty, location and nature of damage, time of injury, detailed description situation: Full name the patient with whose blood there was contact, as well as the measures taken: the method of treating the skin and mucous membranes. Describe in detail the situation and the use of funds personal protection, compliance with safety regulations. The act is certified by signatures indicating positions and surnames.

Medical accident log (HIV prevention)

Express testing of patients and employees for the presence of antibodies to HIV and viral parenteral hepatitis is carried out as quickly as possible. Serum samples are then sent to the AIDS laboratory. Within 72 hours from the moment of occurrence of AS, seek advice from an epidemiological specialist of the Center or branch regional center on the prevention and control of AIDS and infectious diseases with your passport details, insurance policy and SNILS.

For the purpose of emergency prevention of HIV infection, azidothymidine (Retrovir) is prescribed for 1 month.

Persons exposed to the threat of HIV infection are under the supervision of an infectious disease specialist for 1 year with mandatory examination for the presence of a marker of HIV infection (after 3, 6 and 12 months).

“Nurses and midwives are at risk of contracting HIV, hepatitis B and C, just like everyone else, but the risk is greatly reduced if they are careful both in their personal lives and in professional activity. And it’s impossible not to note how big the role is nursing staff not only in preventing the spread of HIV and other infections in medical institutions, but also in reducing occupational risk and social consequences diseases."

International Council of Nurses.

Risk occupational disease Medical workers who come into contact with various biological fluids are most often susceptible to HIV infection and hepatitis B and C:

· blood and its components;

· sperm;

· saliva;

· vaginal secretion;

· tears;

· breast milk infected woman.

Manipulations during which contamination with blood and other biological fluids may occur:

· invasive procedures;

· contact with mucous membranes (intact and damaged);

· contact with damaged skin of patients;

· contact with surfaces contaminated with blood and other biological fluids.

Nurse safety conditions in the workplace:

1. special clothing that protects the sister from possible ingress of blood and other secretions when performing manipulations:

· medical cap (scarf);

· disposable rubber gloves;

· 4-layer gauze mask or respirator;

· glasses, shields;

· waterproof apron or robe.

2. means of collection and delivery of laboratory material:

· disposable syringes and needles;

· special containers for collecting biological material;

· containers for transportation.

· containers for pre-sterilization cleaning and disinfection;

· containers for recycling;

· disinfectants and antiseptics.

Nurse safety rules in the workplace:

· Wash hands before and after contact with the patient.

· Consider the patient's blood and secretions as potentially infectious.

· Consider anything that is stained with blood or other secretions as potentially infected.

· To reduce the risk of infection, treat skin before putting on gloves. nail phalanges iodine

· If the integrity of the skin is damaged, before starting the manipulation, the damage should be covered with an adhesive plaster or lubricated with BF glue.

· Strictly follow the rules for removing gloves and washing hands (liquid soap and disposable towels).

· Cleaning must be done with latex gloves.

· When opening bottles with medicines, test tubes with blood and its components, ampoules with serums, you should avoid injections, cuts on gloves and hands.

· You cannot transfuse blood and its components without receiving a negative answer to the “Form 50”.

· Disposable instruments cannot be reused.

· You cannot use reusable instruments that have not passed the entire processing cycle and test control for occult blood and sterility.

· Workplaces must have work containers with lids, containers with disinfection solutions for used syringes, needles, gloves, cotton-gauze material (each container must be clearly marked).

· Before the end of exposure in the disinfection solution, it is strictly forbidden to disassemble medical instruments; only after disinfection and wearing thick rubber gloves.

· Used needles should not be bent, broken by hand, or recapped.

· Sharp instruments subject to reuse place in a separate durable container for processing.

· Do not store infected material containing blood or its components in open containers without disinfectants.

· Transportation biological fluids should be carried out in closed containers with sealed lids, the outer parts of the container are treated with disinfectants. Referral forms should not be placed on the tubes. Containers must be disinfected after delivery.

· For resuscitation, breathing bags must be available to avoid the use of mouth-to-mouth or mouth-to-nose methods.

In every department medical institution, whose personnel are at risk of infection with HIV and HBV, must have a “first aid kit” containing the following items:

1. ethyl alcohol 70% - 100 ml; 5% alcohol solution of iodine;

2. potassium permanganate in 50 mg portions. x 2 (the solution is prepared before use);

3. distilled water – 100 ml;

4. dressing material: bandage, cotton wool, adhesive plaster; fingertips.

· If biological fluid gets into your eyes, you should rinse them with a pale pink solution of potassium permanganate 1:10000, for which you need to have a 50 mg sample of the drug, which dissolves in 500 ml. distilled water.

· If biological fluid gets on the mucous membranes of the oropharynx, immediately rinse your mouth with 0.05% (50 mg of potassium permanganate and 100 ml of distilled water) solution of potassium permanganate or 70% ethyl alcohol.

· If biological fluid gets into the nasal cavity, rinse with a 0.05% solution of potassium permanganate.

· If biological fluid gets on unprotected skin, treat it with 70% ethyl alcohol, wash with soap and water and re-treat with alcohol. Don't rub!

· For injections and cuts through gloves:

Wash your gloved hands with running water and soap,

Remove gloves and immerse in disinfectant solution,

Squeeze the blood out of the wound with the other hand (with a glove if there is damage to the skin),

Wash under running water and soap (do not rub!)

Treat the wound with 70% ethyl alcohol and let it dry, then lubricate it with a 5% iodine solution and seal it with an adhesive plaster.

· If you puncture unprotected skin with a used needle or cut, you should wash the injury site with soap and water without stopping the bleeding; treat the injury site twice 5% alcohol solution iodine or 70% ethyl alcohol (after each treatment, allow the solution to dry); cover the injection site with an adhesive plaster or apply a bandage.

The administration is immediately informed about the accident, and an infectious disease specialist is brought in for consultation. All cases of injury are recorded in the “emergency” log.

Laboratory examination of persons involved in an emergency situation is carried out after 3, 6 and 12 months.

Every patient should be considered as potentially infected with HIV and other blood-borne infections.

SUBJECTIVE EXAMINATION.

The reason for petition.

Reason for applying medical care. Complaints.

The patient's opinion about his health and condition.

Expected result from treatment.

General state patient.

Weakness: to what extent and for how long.

Weight loss, since when?

Sweating.

Increase in temperature: since when, constant or in attacks, degree of increase in temperature.

Presence of dizziness, fainting.

Availability skin itching(in what places, what does the patient associate with its appearance).

Musculoskeletal system.

Pain, localization, nature of pain, intensity, constancy and frequency, connection with movement, changes in weather.

Decreased muscle strength (general or specific groups).

Respiratory system.

Nose: breathing through the nose (free, difficult); nasal discharge, its nature, quantity; nosebleeds.

Larynx: feeling of dryness, soreness, hoarseness, difficulty and pain when swallowing.

Cough: intensity, frequency, dry or wet.

Sputum: nature (mucous, purulent, presence of blood), quantity, smell, at what time of day the volume is greatest, in what position.

Hemoptysis: how often and when, quantity, color (scarlet, dark, black).

Pain in chest: localization, character (dull, sharp, stabbing, aching); connection with breathing, coughing, changes in body position; which eases the pain.

Shortness of breath: constant or paroxysmal, at rest or during physical activity, intensity, which increases shortness of breath, difficulty inhaling or exhaling, which relieves shortness of breath.

Attacks of suffocation (asthma): duration, what is associated with them, how they are alleviated.

The cardiovascular system:

Palpitations: constant or in attacks (intensity, duration, what is associated with them).

Heart failure: constant or intermittent (intensity, duration, what is associated with it).

Pain in the heart area: constant or in attacks, their nature (stabbing, aching, squeezing), what is accompanied by (a feeling of melancholy, fear of death), intensity and duration, irradiation, causes of occurrence (excitement, exercise stress, eating, smoking...).

Swelling (in the evening, on the lower extremities).

Digestive system.

Appetite, perversion of appetite (for what food).

Satiety (normal, fast, constant feeling of hunger).

Thirst and amount of fluid consumed.

Chewing and swallowing: what causes difficulties, what food does not pass; use of dentures.

Heartburn: connection with the intake and nature of food, which makes it easier.

Belching: character (air, sour, bitter, smelly) rotten eggs, eaten food...).

Abdominal pain: nature, localization, irradiation, connection with food intake and its nature, frequency, dependence on the act of defecation.

Distension, heaviness, bloating: frequency, connection with food.

Vomiting: frequency, connection with food, nature of the vomit, presence of blood, smell, connection with pain, does vomiting relieve pain.

Stool: regularity, consistency, smell, color, impurities, worms.

The passage of feces and gases: free and difficult, pain during defecation, itching in the anus.

Urinary system.

Frequency and amount of urination (day, night).

Dysuric phenomena.

Urinary dysfunction: urinary retention, delayed excretion, involuntary (incontinence, incontinence).

Swelling (in the morning, on the face).

History of the disease.

Since when has he considered himself sick?

What preceded the disease (mental trauma, overwork, hypothermia...).

Onset of the disease (how it manifested itself, how it progressed).

Course of the disease:

1. sequence of manifestation and course individual symptoms;

2. exacerbations and their causes, duration;

3. Seeing a doctor;

4. conducted research and its results;

5. the nature of the treatment and its effectiveness;

6. change in ability to work since the onset of the disease.

Anamnesis of life.

Place of Birth;

Social status;

Family status;

Development in childhood (lag);

Education, specialty;

Living conditions;

Nutrition (routine, regularity, variety, calorie content...);

Professional production conditions: beginning labor activity, profession, its changes, occupational hazards;

Bad habits;

Allergy history;

Gynecological history;

Previous operations, injuries;

Epidemiological history (previous infectious and sexually transmitted diseases, possible contacts).

Sources of information (indicate specific sources of information).

OBJECTIVE EXAMINATION.

Physical data: height, weight.

Consciousness: conscious (clear, confused), unconscious.

Facial expression: painful, puffy, anxious, suffering, wary, indifferent, calm.

Position in bed: active, passive, forced.

Condition of the skin, skin appendages and visible mucous membranes:

Color: physiological coloring, pallor, yellowness, hyperemia, cyanosis (diffuse and local), acrocyanosis (cyanosis on the lips, tip of the nose, ears, terminal phalanges of fingers and toes, cheeks), pigmentation.

State: increased dryness, increased humidity, rash, scratching, scars, trophic ulcers, bedsores.

Swelling and its localization.

Development of the p/f layer: normal, increased and decreased.

Condition of nails and hair.

Musculoskeletal system: deformation of the skeleton, joints, their pain.

Muscle tone(kept, promoted, demoted).

Cramps.

Paralysis.

Body temperature: within normal limits, fever.

Respiratory system: respiratory rate, breathing characteristics (rhythm, depth, type).

Type (thoracic, abdominal, mixed).

Rhythm (rhythmic, arrhythmic).

Depth (superficial, deep).

Tachypneous.

Bradypnoe.

Pathological types of breathing: large Kussmaul breathing, Biot breathing, Cheyne-Stokes breathing.

Asphyxia.

Dyspnea (expiratory, inspiratory, mixed).

Normal breathing is 16-20 per minute, shallow, rhythmic.

Arterial pressure: hypertension, normotension, hypertension.

Pulse: number of beats per minute, rhythm, filling, tension.

Normal pulse is 60-80 beats per minute, satisfactory filling and tension.

Ability to eat and drink: appetite (preserved, impaired), chewing disorder (what caused it, reserves), nausea, vomiting; the amount of liquid drunk and food eaten (part of a portion), artificial nutrition.

Natural departures.

Urinary excretion: frequency, quantity, incontinence, urinary incontinence, catheter, independently, urinal.

Stool: independent, regular, character of stool (formed, liquid), color and presence of pathological impurities (blood, mucus, pus), fecal incontinence, colostomy bag, colostomy.

Sense organs (hearing, vision, smell, touch, speech).

Memory (preserved, impaired).

Use of reserves: glasses, lenses, hearing aid. device, removable dentures.

Sleep (disturbed falling asleep, often waking up, need to sleep during the day).

Ability to move: independently, with the help of (outsiders, devices).

Topic: “HUMAN NEEDS FOR HEALTH AND DISEASES”

Option 1: Emergency prevention of parenteral viral hepatitis and HIV infection (Appendix 12 to SanPiN 2.1.3.2630-10)

To avoid infection with parenteral viral hepatitis and HIV infection, you should follow the rules for working with piercing and cutting instruments.
In case of cuts and injections, immediately treat and remove gloves, squeeze out blood from the wound, wash your hands with soap and running water, treat your hands with 70% alcohol, lubricate the wound with a 5% iodine solution.
If blood or other body fluids come into contact with skin this area is treated with 70% alcohol, washed with soap and water and re-treated with 70% alcohol.
If blood gets on the mucous membranes of the eyes, they are immediately washed with water or a 1% solution of boric acid; in case of contact with the nasal mucosa, treat with a 1% solution of protargol; on the oral mucosa - rinse with a 70% alcohol solution or a 0.05% solution of potassium permanganate or a 1% solution of boric acid.
The mucous membranes of the nose, lips, and conjunctiva are also treated with a solution of potassium permanganate at a dilution of 1:10,000 (the solution is prepared ex tempore).
For the purpose of emergency prevention of HIV infection, azidothymidine is prescribed for 1 month. The combination of azidothymidine (Retrovir) and lamivudine (Elivir) enhances antiretroviral activity and overcomes the formation of resistant strains.
If there is a high risk of contracting HIV infection ( deep cut, hit visible blood on damaged skin and mucous membranes from patients infected with HIV) to prescribe chemoprophylaxis, you should contact the territorial Centers for the Control and Prevention of AIDS.
Persons exposed to the threat of HIV infection are under the supervision of an infectious disease specialist for 1 year with mandatory examination for the presence of a marker of HIV infection.
Personnel who have had contact with material infected with the hepatitis B virus are simultaneously administered specific immunoglobulin (no later than 48 hours) and a vaccine against hepatitis B in different parts of the body according to the scheme 0 - 1 - 2 - 6 months. with subsequent monitoring of hepatitis markers (not earlier than 3 - 4 months after the administration of immunoglobulin).
If the exposure occurred in a previously vaccinated health care worker, it is advisable to determine the level of anti-HBs in the blood serum. If there is an antibody concentration in the titer of 10 IU/l or higher, vaccine prophylaxis is not carried out; in the absence of antibodies, it is advisable to simultaneously administer 1 dose of immunoglobulin and a booster dose of the vaccine.

Option 2: Actions medical worker in an emergency (Resolution of the Chief State Sanitary Doctor of the Russian Federation dated January 11, 2011 No. 1 “On approval of SP 3.1.5.2826-10 “Prevention of HIV infection”).

In case of cuts and injections, immediately remove gloves, wash your hands with soap and running water, treat your hands with 70% alcohol, lubricate the wound with a 5% alcohol solution of iodine;
- if blood or other biological fluids come into contact with the skin, the area is treated with 70% alcohol, washed with soap and water and re-treated with 70% alcohol;
- if the patient’s blood and other biological fluids come into contact with the mucous membranes of the eyes, nose and mouth: oral cavity rinse with plenty of water and rinse with a 70% solution ethyl alcohol, the nasal mucosa and eyes are washed generously with water (do not rub);
- if the patient’s blood or other biological fluids get on the gown or clothes: remove the work clothes and immerse them in a disinfectant solution or in a tank (tank) for autoclaving;
- start taking antiretroviral drugs as soon as possible for post-exposure prophylaxis of HIV infection.

Necessary as possible short time after contact, test for HIV and viral hepatitis B and C the person who may be a potential source of infection, and the person in contact with him. HIV testing of a potential source of HIV infection and a contact person is carried out using rapid testing for HIV antibodies after an emergency with the obligatory sending of a sample from the same portion of blood for standard HIV testing in an ELISA. Blood plasma (or serum) samples of a person who is a potential source of infection and a contact person are transferred for storage for 12 months to the subject’s AIDS center Russian Federation.
The victim and the person who may be a potential source of infection must be asked about the carriage of viral hepatitis, STIs, inflammatory diseases genitourinary tract, other diseases, provide counseling regarding less risky behavior. If the source is infected with HIV, determine whether he or she received antiretroviral therapy. If the victim is a woman, a pregnancy test should be performed to determine if she is breastfeeding. In the absence of clarifying data, post-exposure prophylaxis begins immediately when additional information the scheme is being adjusted.

Carrying out post-exposure prophylaxis of HIV infection with antiretroviral drugs:
Antiretroviral medications should be started within the first two hours after the accident, but no later than 72 hours.
The standard regimen for post-exposure prophylaxis of HIV infection is lopinavir/ritonavir + zidovudine/lamivudine. In the absence of these drugs, any other antiretroviral drugs can be used to initiate chemoprophylaxis; If it is not possible to immediately prescribe a full-fledged HAART regimen, one or two available drugs are started.
The use of nevirapine and abacavir is possible only in the absence of other drugs. If the only available drug is nevirapine, only one dose of the drug should be prescribed - 0.2 g (repeated administration is unacceptable), then when other drugs are received, full-fledged chemoprophylaxis is prescribed. If chemoprophylaxis is started with abacavir, testing for hypersensitivity reactions to it should be carried out as soon as possible or abacavir should be replaced with another NRTI.

Registration of an emergency situation is carried out in accordance with established requirements:
- LPO employees must immediately report each emergency to the head of the unit, his deputy or a senior manager;
- injuries received by health workers must be taken into account in each health care facility and registered as an industrial accident with the drawing up of an Industrial Accident Report;
- you should fill out the Occupational Accident Register;
- it is necessary to conduct an epidemiological investigation of the cause of the injury and establish a connection between the cause of the injury and the performance of official duties by the health worker.

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

Sequence of processing of dental instruments Used dental instruments and materials are disinfected after each patient. If tools and materials are disposable, they must be disposed of safely. Before cotton swabs, plastic saliva ejectors, etc. are sent to the city landfill, they should be disinfected by immersing them for one hour in a 1% chloramine solution, or a 6% hydrogen peroxide solution, or a 3% bleach solution, or for 30 minutes in a solution of incrasept. After each patient, the tips of drills, waste pads, air and water pistols, and ultrasonic devices for removing dental plaque are treated twice with 70° alcohol and at the end of the shift they are treated with 3% chloramine for 60 minutes or incrasept solution for 30 minutes. Instruments that came into contact with the patient’s mucous membrane and were contaminated with biological fluids (dental hand tools, glass, mirrors, burs) and gloves are disinfected immediately after use, then undergo pre-sterilization treatment and sterilization. Disinfection is carried out by total immersion used instruments for 30 minutes in a container with incrasept solution (3% chloramine for 60 minutes or 6% hydrogen peroxide solution for 60 minutes, or 2% Virkons solution for 10 minutes, or Sidex solution for 15 minutes can also be used , or 0.1% chlorsept solution for 60 minutes). The disinfectant solution is used six times and then changed. Next, the instruments undergo pre-sterilization treatment: the instruments are immersed in another container with an incrasept solution at t = 20-45°, where each instrument is washed with a brush for 15 s; wash the instruments with running water; rinse with distilled water; check the quality of purification: from blood - azapyran test (with positive test repeat all pre-sterilization treatment); from alkali - phenolphthalein test (if the test is positive, repeat steps 2 and 3); instruments are wiped with dry towels or dried with hot air until the moisture disappears. Products made of glass, metals, and silicone rubber are sterilized without packaging (in open containers) or in paper packaging using the dry heat method (dry hot air). Sterilization mode: 60 min at t=180°. Polishers, working parts of dental plaque removal devices and burs are treated in the same way as instruments. Dental mirrors are subjected to disinfection, then pre-sterilization treatment (items 2, 3 and 4), after which they are sterilized with glass beads at high temperature: Stored in Petri dishes. Rubber gloves, cotton swabs, products made of polymers, textiles, latex are sterilized in containers by autoclaving in two modes: at t = 120°, pressure 1 atm. for 45 minutes or at t = 132°, pressure 2 atm. within 30 min. The shelf life of the sterility of instruments in sealed packaging (in a bag, in a kraft paper bag) is three days; after opening the bag, the material in it is considered sterile during the working day. Features of organizing the reception of patients with increased risk infections.

Stuck with a needle? Have you provided first aid without gloves? Were you involved in a fight? And you worry: could you have gotten HIV? Fairly standard situations. Do they require emergency prevention of HIV infection? Let's discuss it in this article.

Possibilities of HIV transmission in everyday life

First, you need to decide on the answer to the question: how is HIV transmitted? Read about this in detail in the articles on our website. The second question concerns the risks of HIV infection in everyday situations. We do not discuss the risks of HIV transmission, read about this.

Is infection possible at home? IN Methodical recommendations MP 3.1.0087-14 “Prevention of HIV infection” states “potential risk of infection from syringe needles of unknown origin.”

To prevent infection in this and other cases, it is possible to prescribe emergency drug prophylaxis.

“Possible use in persons who had a potential risk of infection (sexual contact or rape by a person with unknown HIV status, injury from needles from syringes of unknown origin, etc.).”

Is emergency prevention necessary for needle sticks? The MR states that “the epidemiological effectiveness of the latter measure has not yet been studied, but it has psychotherapeutic significance.” This is understandable: the likelihood of HIV transmission from a single needle prick is extremely low. !

First aid

The provision introduced into the Guidelines MU 3.1.3342-16 “Epidemiological surveillance of HIV infection”. This document states:

“Isolated cases of HIV transmission have been recorded when the blood of an HIV-infected person comes into contact with damaged skin and mucous membranes of an uninfected person, for example, when providing first aid and treatment wound surface without the use of gloves or other barrier means.”

The MU also states that “transmission through close household contact with a source of HIV has not been identified” . But why is it not possible for blood to come into contact with damaged skin and mucous membranes in everyday life? The algorithm of actions after an emergency when providing assistance to a victim at home or as a result of an accident in the municipality is not described.

And the treatment of the wound surface is more likely to concern medical workers, do you think? What if you have to stop the bleeding? open injury? It would be a good idea to find out how health workers behave in such situations.

Actions of a health worker in an emergency

The actions of health workers in situations that could lead to HIV infection are regulated by SanPin 3.1.5 2826-10 “Prevention of HIV infection.”

If there is reason to suspect the presence of contact that entails a risk of HIV infection, preventive chemoprophylaxis is prescribed (clause 8.1.3.3.). What are these reasons? For example, a cut with a scalpel during surgery, or a fountain of blood splashing into the face from a cut vessel (no one is immune from accidents).

What should healthcare workers do in such cases?

"8.3.3.1. Actions of a medical worker in an emergency:

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

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

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

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

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

HIV infection or hepatitis? Who is more dangerous?

The scalpel cut is definitely related to high risk transmission of HIV infection and “hygienic” procedures in this case are not enough - chemoprophylaxis and prescription of drugs for prophylactic purposes are needed. Such situations cannot occur in everyday life. But a broken nose and fists are common; what’s a wedding without a fight?

Broken noses and fists are extremely unlikely events for HIV transmission. But for parenteral hepatitis it is more likely. The infectious dose of the virus for parenteral hepatitis is 100 times less than for HIV. Read about it.

Unlike HIV infection, there is a vaccine against hepatitis B, and hepatitis C is curable. IN Russian documents regulating the prevention of hepatitis, a list emergency measures not specified.

In any case, washing the mucous membranes and skin will not harm. To do this, you can use not only water, but also disinfectants sold in pharmacies. It’s good when such disinfectants based, for example, chlorhexidine, are in home or car first aid kits. There are quite a lot of such drugs.

Remember!

1. The basic rule for preventing infection with blood-borne infections is to reduce the infecting dose. Suitable for this hygiene procedures– washing the wound surface or mucous membranes with water.
2. Offered at emergency situations Hygienic measures are more “psychotherapeutic” than preventive in nature. At least for HIV infection. But hygiene is never superfluous.
3. In cases where you are seriously concerned about possible infection, do not limit yourself to reading this article - contact medical organization. Specialists know what to do in such cases. The main thing is don’t delay!

What are emergency situations in the work of medical personnel? What should be done if they occur? You will find answers to these and other questions in the article. An emergency situation means, for example, contamination of the skin, mucous membranes, as well as equipment, uniforms of medical workers, floor surfaces, tables with blood and other secretions of the sick person.

Such an incident can happen to any employee during the performance of his direct duties. What this means for a healthcare worker and how to protect yourself from such unpleasant situations, we will find out below.

Circumstances of occurrence

Why at work medical personnel Are emergencies occurring? It is known that every health worker performs many different manipulations every day, such as, for example:

• disinfection of instruments;
• medical waste management;
• performing injections;
• operation of medical products;
• carrying out general and routine cleaning;
• accounting, storage and use of disinfectants;
• air disinfection and so on.

What can happen?

What types of emergency situations occur in the work of medical personnel? When performing the above duties, anything can happen to a health worker. For example, these could be the following cases:

1. Cuts and punctures with cutting and stabbing instruments.
2. Contamination of the skin and mucous membranes of workers with blood and other biological fluids of patients.
3. Destruction of lamps or thermometers containing mercury (mercury contamination).
4. Spilling (scattering) of class B/C medical waste.
5. Electric shock or other emergencies associated with working with medical equipment, for example, with installations for the neutralization of medical waste.
6. Critical conditions when working with antiseptics ( chemical burn, accidental poisoning with a disinfectant, other negative situations).
7. Bad influence ozone on health workers.
8. Electric shock or other emergencies during cleaning.
9. Harmful effects of radiation on health workers.
10. Breakdown of bactericidal lamps (mercury contamination).

Rules for the work of medical staff

Few people know what emergency situations arise in the work of medical personnel. In order to avoid them, you should follow the rules of work and safety precautions when performing various types of activities. The employer must introduce local instructions into the work of the staff with a clear algorithm for action in various situations.

So, for example, the Department of Health Protection of Moscow, in its notification dated October 26, 2006 No. 44-18-3461, obliged its subordinate health care centers to create in each institution a manual on occupational safety when carrying out work with blood and other biological fluids of patients to be carried out on site training services for “at-risk” employees. The Department also attached sample instructions to this letter.

The basic canons of the work of medical staff include the following:

1. Each health worker must maintain personal hygiene (work using personal protective equipment, wash hands on time, etc.).
2. Health care workers must be careful when working with needles, piercing, and cutting devices.
3. It must be assumed that every patient is potentially dangerous due to infectious diseases.
4. In offices where medical staff may come into contact with patients' biological fluids, there should be an Anti-HIV first aid kit.
5. In emergency situations, emergency prevention is carried out.

Upon completion of the work, the following manipulations are carried out:

• disposable instruments are placed in a puncture-resistant container;
• table surfaces are treated with disinfectants;
• Items to be further used are placed in containers for processing.

Personal protective equipment

Each employee must study emergency situations in the work of medical personnel and the algorithm of actions when they occur. In health care settings, all patients should be considered as likely to be infected with HIV, so when providing medical care It is necessary to comply with all canons and safety requirements at the place of work.

When performing medical research activities, as well as when working with biological fluids (sperm, blood, vaginal secretions, any solutions containing blood, synovial, pleural, cerebrospinal, amniotic, pericardial), personnel must use personal protective equipment:

• doctor's caps;
• medical gowns or suits;
• masks;
• medical gloves;
• protective glasses;
• oilcloth aprons (if necessary);
• protective screens (if necessary).

Biofluid contamination

So what should you do if there is an emergency situation in the work of medical personnel? What is the algorithm of actions? If an emergency occurs with biomaterial at the workplace, the victim is obliged to stop work and carry out disinfection measures depending on its type:

1. If biological fluid gets on the skin, you need to moisten the area with 70% alcohol, wash with soap and re-moisten with 70% alcohol.
2. If biological fluid gets into your eyes, rinse them immediately clean water or boric acid 1%.
3. If biological fluid gets on hands protected with gloves, the gloves must be cleaned with a cloth soaked in a disinfectant, then washed with water. Next, you need to remove them inside the work surface, wash your hands and lubricate them with an antiseptic.
4. If biological fluid gets on the nasal mucosa, you will need to treat it with 1% protargol.
5. If biological fluid gets on the mucous membrane of the oropharynx, you should immediately rinse your mouth with 70% alcohol or 0.05% potassium permanganate solution or boric acid 1 %.

Skin damage

What should be the action in an emergency? nurse, if there was contact with blood, other biological fluids or biomaterials, accompanied by a violation of the integrity of the skin (cut, injection)? Here you need to take the following measures:

• Without removing gloves, wash your hands with soapy water;
• remove gloves with the work surface inward and place them in a disinfecting solution;
• if blood comes from the wound, do not stop it for a couple of minutes, otherwise squeeze the blood out of the wound;
• wash your hands with soapy water;
• treat the wound with 70% alcohol, then with an alcohol solution of iodine 5% and cover with a bactericidal plaster, if necessary, put on a fingertip;
• do not use adhesive antiseptics (BF-6 and others) that interfere with wound drainage.

Contaminated clothing

Let's consider the algorithm of actions in an emergency situation when biomaterial gets on clothes or a robe. Here take the following measures:

• remove clothes and soak in a disinfectant solution;
• Treat the skin of your hands and other areas of the body if they are contaminated through clothing after removing it with 70% alcohol;
• wash the surface with soap and water and re-treat with 70% alcohol;
• If biomaterial gets on your shoes, wipe them twice with a swab soaked in a disinfectant solution.

Other actions

Health care workers should also know the following:

• If biomaterial gets on the surface of the floor, walls, equipment, it is necessary to wipe them twice, with an interval of 15 minutes, with hydrogen peroxide 5% or chloramine 3% or another disinfectant solution.
• In case of an emergency that arises during the operation of the centrifuge, you can open the lid of the device and carry out disinfection measures only after 40 minutes. after the rotor stops (during this time the aerosol will settle). After you have opened the centrifuge lid, place the broken glass and centrifuge beakers in the disinfectant solution, inner and outer surface Wipe the device twice with a rag soaked in disinfectant.

Blood

Blood emergencies are considered very dangerous. After all, blood is the most powerful source of infection in the workplace with hepatitis B or HIV. Therefore, measures to protect against such infections consist, first of all, in preventing their transmission through blood and vaccination against hepatitis B.

It is known that the methods of transmission of HIV and hepatitis B virus are identical. And yet, the risk of contracting hepatitis at the place of work is higher than HIV infection (this is due to the fact that the density of the virus in the blood of HIV-infected patients is less).

Emergency version No. 1. In case of a cut or puncture of the skin

Let's consider the algorithm of actions in an emergency situation with HIV. The chance of contracting this virus from a cut or puncture of the skin with devices contaminated with HIV-contaminated blood is 0.5%. The probability of infection with hepatitis B is 6-30%.

Emergency version No. 2. In case of contact with skin

The probability of contracting HIV when contaminated blood comes into contact with intact skin is estimated at 0.05%. If blood (or other biological fluid) appears on your intact skin, immediately treat it with a swab soaked in 70% alcohol or a disinfectant solution for 1 minute. You can't rub it!

Then wash twice with running warm water and soap and wipe dry with a disposable cloth. After 15 minutes, repeat the treatment with alcohol.

Emergency version No. 3. In case of contact with mucous membranes

When contaminated blood comes into contact with mucous membranes, the probability of HIV infection is estimated at 0.09%. If blood gets into your eyes, you should immediately rinse them with distillate from the first aid kit (or with a freshly prepared solution of potassium permanganate - dilute 100 mg of potassium permanganate in 200 ml of distillate).

To wash your eyes, use glass baths: fill them with solution or water, apply to your eyes and rinse, blinking for a couple of minutes. Place three drops of Albucid 20% into each eye.

If there is blood on the nasal mucosa, immediately rinse your nose with a freshly prepared 0.05% solution of potassium permanganate for 2 minutes. Then drop 3 drops of a 20% albucid solution into each nostril.

If there is blood on the oral mucosa, rinse it immediately with 70% alcohol or a freshly prepared 0.05% solution of potassium permanganate for 2 minutes.

The processing of clothing and premises in this case is identical to the above algorithms.

First aid kit

So, you already know what it is urgent Care in emergency situations. In order to provide it on time, you should always have a first aid kit on hand to prevent HIV infection. It usually contains the following drugs:

Purpose	Name and quantity
For treating wounds
To disinfect material that comes into contact with the skin	one bottle of 70% ethyl alcohol
For disinfection of material found on mucous membranes	· weighed in a dark paste of dry potassium permanganate 100 mg - two pieces; · one bottle with 20% albucide solution; · two bottles with 200 ml of distillate (for making a 0.05% solution of potassium permanganate).
For instillation of medication into the nose and eyes	two pipettes
For washing eyes with 0.05% solution of potassium permanganate	two glass eye baths
Additional raw materials	spare pair of gloves, sterile gauze wipes, finger pads
To stop bleeding	one rubber band
Dressing raw materials	· three sterile bandages with parameters 7X14; · 1 package of sterile cotton wool (100 g); · five bactericidal patches.

Additionally, the department must have:

• working disinfecting solutions in the disinfection corner, an unlimited supply of water for washing hands (5 l), toilet soap, individual napkins for blotting hands;
• instructions for carrying out preventive emergency measures in case of emergency situations.

To clean up large pools of blood you may need: rubber gloves, waterproof disposable shoe covers, rags. If there is a risk of blood spraying, you should wear a face shield or goggles or a waterproof apron.

The first aid kit should be kept in a marked separate box in treatment room. The head nurse of the department is responsible for monitoring this storage and replenishing the first aid kit.

Logbook

How are emergency situations recorded during medical manipulations? All these cases are recorded in the log of emergency situations that occurred at work. The health care provider indicates the date and time of the occurrence of special circumstances. It describes the emergency and the measures taken to resolve it. The record is certified by the responsible person with his signature. The log table contains the following vertical columns:

1. No.
2. Date, time (day, month, hours, minutes).
3. Description of the incident.
4. Taken measures.
5. Signature of the responsible person.

This magazine measures 210 x 297 mm (A4 format, vertical). On title page The name of the institution and unit in which emergency cases are recorded, the start date and end date of the journal must be indicated. The pages of the document are numbered, the last page indicating the number of laced and numbered pages. The journal must be sealed with the signature of the accountable person and the seal of the organization.

Nurse tactics

What is the nurse's tactics in an emergency? She should do the following:

• accident log;
• act of official inquiry upon occurrence emergency;
• write a personal explanatory note in any form, describing in detail the reasons for what happened and the circumstances.

1. Immediately after the accident, he donates blood for HIV and markers of hepatitis B and C.
2. If the patient is HIV-infected, she must arrive at the AIDS Center within 72 hours to prescribe ART therapy.
3. Next, dispensary patronage is carried out with blood donation for markers of hepatitis B and C and HIV after 3, 6 and 12 months from the date of the accident.

Risk

So, you now know how emergency care is provided in emergency situations in medical institutions. Midwives and nurses are at risk of contracting HIV, hepatitis B and C, just like everyone else. But the risk is significantly reduced if they are careful both in their professional activities and in their personal lives.

It should be noted how great the role of nurses is not only in preventing the spread of HIV and other infections in hospitals, but also in reducing personnel risk and social issues. consequences of the disease.