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Algorithm for the actions of a medical worker in case of cuts and injections





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

In order to avoid infection with parenteral viral hepatitis, HIV infection, the rules for working with pricking and cutting tools should be followed.
In case of cuts and injections, immediately treat and remove gloves, squeeze blood from the wound, wash hands with soap under running water, treat hands with 70% alcohol, grease the wound with 5% iodine solution.
If blood or other biological fluids get on the skin, this place is treated with 70% alcohol, washed with soap and water and re-treated with 70% alcohol.
If blood enters the mucous membranes of the eyes, they are immediately washed with water or a 1% solution of boric acid; if it enters the nasal mucosa, it is treated with a 1% solution of protargol; on the oral mucosa - rinse with 70% alcohol solution or 0.05% potassium permanganate solution or 1% boric acid solution.
The mucous membranes of the nose, lips, and conjunctiva are also treated with a solution of potassium permanganate in a dilution of 1: 10000 (the solution is prepared ex tempore).
For emergency HIV prevention, azidothymidine is prescribed for 1 month. The combination of azidothymidine (retrovir) and lamivudine (elivir) enhances antiretroviral activity and overcomes the formation of resistant strains.
If there is a high risk of HIV infection (deep cut, visible blood getting on damaged skin and mucous membranes from HIV-infected patients), you should contact the regional AIDS Centers for the purpose of chemoprophylaxis.
Persons at risk of HIV infection are under the supervision of an infectious disease specialist for 1 year with a mandatory examination for the presence of a marker of HIV infection.
Personnel who come into contact with material infected with hepatitis B virus are given both a specific immunoglobulin (no later than 48 hours) and a hepatitis B vaccine in different parts of the body according to the schedule 0 - 1 - 2 - 6 months. with subsequent monitoring of hepatitis markers (not earlier than 3-4 months after the introduction of immunoglobulin).
If contact has occurred with a previously vaccinated health care provider, it is advisable to determine the level of anti-HBs in serum. If there is a concentration of antibodies in the titer of 10 IU / L or higher, vaccination is not carried out, in the absence of antibodies, it is advisable to simultaneously administer 1 dose of immunoglobulin and a booster dose of the vaccine.

Option 2: Actions of a medical worker in an emergency (Decree 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 ”).


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- in case of cuts and injections, immediately remove gloves, wash hands with soap under running water, treat hands with 70% alcohol, grease the wound with 5% alcohol solution of iodine;
- when blood or other biological fluids get on the skin, this place is treated with 70% alcohol, washed with soap and water and re-treated with 70% alcohol;
- if the patient’s blood and other body fluids get on the mucous membranes of the eyes, nose and mouth: rinse the mouth with plenty of water and rinse with 70% ethanol, rinse the nose and eyes with water (do not rub);
- if the patient’s blood and other body fluids get on a dressing gown, clothing: remove work clothing and immerse in a disinfectant solution or in a can (tank) for autoclaving;
- As soon as possible, start taking antiretroviral drugs for the purpose of postexposure prophylaxis of HIV infection.

It is necessary to examine as soon as possible after contact the person who may be a potential source of infection for HIV and viral hepatitis B and C, and the person who has contacted him. HIV testing of the potential source of HIV infection and the contacting person is carried out by rapid testing for antibodies to HIV after an emergency with the obligatory sending of a sample from the same portion of blood for routine HIV testing in ELISA. Samples of the plasma (or serum) of the blood of a person who is a potential source of infection, and the contact person are transferred for storage for 12 months to the AIDS center of the subject of the Russian Federation.
The victim and the person who may be a potential source of infection should be interviewed about carriage of viral hepatitis, STIs, inflammatory diseases of the genitourinary sphere, other diseases, and counseling regarding less risky behavior. If the source is infected with HIV, find out if he received antiretroviral therapy. If the victim is a woman, it is necessary to conduct a pregnancy test and find out if she is breast-feeding a child. In the absence of clarifying data, post-exposure prophylaxis is started immediately, when additional information appears, the scheme is corrected.



Postexposure prophylaxis of HIV infection with antiretroviral drugs:
Antiretroviral drugs should be started within the first two hours after the accident, but no later than 72 hours.
The standard postexposure prophylaxis for HIV infection is lopinavir / ritonavir + zidovudine / lamivudine. In the absence of these drugs, any other antiretroviral drugs may be used to initiate chemoprophylaxis; if it is not possible to immediately prescribe a full-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 chemoprophylaxis is prescribed. If chemoprophylaxis is started using abacavir, you should conduct a study on the hypersensitivity reaction to it as soon as possible or replace abacavir with another NRTI.

Registration of an emergency is carried out in accordance with the established requirements:
- LPO employees must immediately report each emergency to the unit manager, his deputy, or senior manager;
- injuries received by health workers should be recorded in each health care facility and act as an accident at work with the preparation of the Act on an accident at work;
- you should fill out the Register of accidents at work;
- it is necessary to conduct an epidemiological investigation of the cause of the injury and to establish a connection between the cause of the injury and the performance by the health worker of official duties.

All healthcare facilities should be provided or, if necessary, have access to rapid HIV tests and antiretroviral drugs. The stock of antiretroviral drugs should be stored in any healthcare facility at the choice of the public 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 the emergency.
The authorized healthcare institution should determine the specialist responsible for the storage of antiretroviral drugs, their storage location with access, including at night and on weekends.

Dental Instrument Processing Sequences Used dental instruments and materials are decontaminated after each patient is admitted. If tools and materials are disposable, the safety of their disposal must be ensured. Before cotton swabs, plastic saliva ejectors, etc., are sent to the city landfill, they should be disinfected by immersing for 1 hour in a 1% solution of chloramine, or in a 6% solution of hydrogen peroxide, or in a 3% solution of bleach, or for 30 minutes in a solution of intrascept. The tips of drills, vacant lots, air and water guns, ultrasonic devices for removing dental deposits after each patient are twice treated with 70 ° alcohol and at the end of the shift they are treated with 3% chloramine for 60 minutes or with Intracept solution for 30 minutes. Instruments in contact with the patient’s mucous membrane and contaminated with biological fluids (dental hand tools, glasses, mirrors, burs) and gloves are immediately disinfected after use, then they undergo pre-sterilization treatment and sterilization. Disinfection is carried out by completely immersing the used tools for 30 minutes in a container with an inject solution (3% chloramine for 60 minutes or a 6% hydrogen peroxide solution for 60 minutes, or a 2% vircons solution for 10 minutes, or a solution can also be used sidex for 15 minutes, or 0.1% chlorsept solution for 60 minutes). The disinfectant solution is used six times, after which it changes. Further, the instruments undergo pre-sterilization treatment: the instruments are immersed in another container with an inject solution at t = 20–45 °, where each instrument is washed with a ruff for 15 s; rinse instruments with running water; rinse with distilled water; check the quality of cleaning: from blood - with an azapiran test (with a positive test, repeat all pre-sterilization treatment); from alkali - phenolphthalein breakdown (with a positive test repeat paragraphs 2 and 3); wipe the instruments with dry towels or dry them with hot air until moisture disappears. Glass, metal, silicone rubber products 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 scalers and burs are treated in the same way as tools. Dental mirrors are subjected to disinfection, then pre-sterilization treatment (paragraphs 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 biks by the autoclaving method in two modes: at t = 120 °, pressure 1 atm. for 45 min or at t = 132 °, pressure 2 atm. within 30 minutes The shelf life of sterility of instruments in sealed packaging (in a bix, in a kraft paper bag) is three days, after opening the bix the material in it is considered sterile during the working day. Features of the organization of patients with an increased risk of infection.





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