»» №4 2001 Dangerous infections
Acquired Immune Deficiency Syndrome (AIDS) is the most dangerous infectious disease leading to death on average 10-11 years after infection with the human immunodeficiency virus (HIV). According to UN data published in early 2000, the HIV/AIDS pandemic has already claimed the lives of more than 18 million people and today there are 34.3 million HIV-infected people in the world.
As of April 2001, 103,000 HIV-infected people were registered in Russia, and in 2000 alone, 56,471 new cases were detected.
The first reports of patients with HIV infection appeared in the newsletter of the Center for Disease Control (Atlanta, Georgia, USA). In 1982, the first statistics on AIDS cases detected in the United States since 1979 were published. An increase in the number of cases (in 1979 - 7, in 1980 - 46, in 1981 - 207 and in the first half of 1982 - 249) indicated an epidemic the nature of morbidity, and high mortality (41%) spoke of the increasing importance of infection. In December 1982, a case of AIDS associated with blood transfusion was published, suggesting the possibility of a "healthy" carriage of an infectious agent. An analysis of AIDS cases in children has shown that children can receive the agent that causes the disease from an infected mother. Despite treatment, AIDS in children progresses extremely rapidly and inevitably leads to death, which gives reason to consider the problem of extraordinary importance.
Currently, three ways of HIV transmission have been proven: sexual; through parenteral administration of the virus with blood products or through infected instruments; intrauterine - from mother to fetus.
Quite quickly, it was found that HIV is extremely sensitive to external influences, dies when using all known disinfecting agents, and loses activity when heated above 56°C for 30 minutes. Solar, UV and ionizing radiation are detrimental to HIV.
The highest concentration of the AIDS virus was found in blood, semen, and cerebrospinal fluid. It is found in lesser amounts in saliva. breast milk, cervical and vaginal secretions of patients.
With the increase in the number of HIV-infected and AIDS patients, the demand for medical care, including those requiring both emergency and planned surgical intervention, increases.
Taking into account the peculiarities of the course of HIV infection, it is impossible to deny with certainty that this or that patient does not have it. For medical personnel, each patient should be considered as a possible carrier of a viral infection. In all cases of possible contact with the patient's biological fluids (blood, wound discharge, discharge from drains, vaginal secretions, etc.), gloves must be used, hands should be washed and disinfected more often, a mask, goggles or a transparent eye shield should be used. Do not take part in work with patients in the presence of abrasions on the skin of the hands or superficial skin defects.
The danger of infection of medical personnel really exists if the generally accepted rules of asepsis and hygiene are violated during the performance of medical and diagnostic procedures.
Data published where surveys were conducted to determine the risk of infection of medical workers large groups doctors (from 150 to 1231 people) who did not follow the precautionary measures. The frequency of HIV infection was 0% when the infected material came into contact with intact skin, 0.1-0.9% - with a single hit of the virus under the skin, on damaged skin or mucous membranes.
Glove punctures occur in 30% of operations, wounding the hands with a needle or other sharp object - in 15-20%. When the hands are injured by needles or cutting instruments infected with HIV, the risk of infection does not exceed 1%, while the risk of infection with hepatitis B reaches 6-30%.
Since 1992, on the basis of the Infectious Clinical Hospital No. 3, there have been beds in the surgical department for providing surgical care to HIV-infected and AIDS patients with concomitant surgical pathology. Over the past period, 600 patients were hospitalized in the department, 250 of them were operated on.
The department provides for a treatment room, a dressing room and an operating room, where assistance and operational benefits are provided only to HIV-infected and AIDS patients.
For all admitted patients, intramuscular injections and any manipulations with blood are carried out by medical personnel only in the treatment room in gowns, hats, and gloves specially provided for these cases. If there is a threat of splashing of blood or other biological fluid, it is necessary to work in a mask and goggles. We use regular latex gloves (two pairs), special goggles and non-woven gowns. Blood during intravenous sampling is collected in test tubes with tightly closed stoppers. All test tubes are necessarily marked with the initials of the patient and the inscription "HIV". Referral sheets to the laboratory when taking blood, urine, biochemical studies are marked with an indication of the presence of HIV infection. These forms are strictly forbidden to be placed in test tubes with blood.
Urinalysis is given in a container with a tight-fitting lid and is also marked with a message indicating the presence of HIV infection. Transportation is carried out in a closed box marked "HIV".
In case of contamination of gloves, hands or exposed areas of the body with blood or other biological materials, they should be treated for 2 minutes with a swab abundantly moistened with an antiseptic solution (0.1% deoxone solution, 2% hydrogen peroxide solution in 70% alcohol, 70% alcohol ), and 5 minutes after treatment, wash in running water. If the surface of the table, hand pads during intravenous infusion, tourniquet are contaminated, they should be immediately wiped with a rag moistened with a disinfectant solution (3% chloramine solution, 3% bleach solution, 4% hydrogen peroxide solution with 0.5% detergent solution). ).
After use, the needles are placed in a container with a disinfectant solution. This container must be in the workplace. Before immersing the needle, the cavity is washed with a disinfectant solution by sucking it with a syringe (4% hydrogen peroxide solution with 0.5% detergent solution - 3% chloramine solution). Used syringes and gloves are collected in a separate container specially designed for them and disinfected.
We use analyte solutions or 3% chloramine solution. Exposure 1 hour.
If there is a suspicion that the infected material has entered the mucous membranes, they are immediately treated: the eyes are washed with a stream of water, a 1% solution of boric acid, or a few drops of a 1% solution of silver nitrate are injected. The nose is treated with a 1% solution of protargol, and if it gets into the mouth and throat, it is additionally rinsed with 70% alcohol or a 0.5% solution of potassium permanganate, or a 1% solution of boric acid.
In case of damage to the skin, immediately remove gloves, squeeze out blood, and then running water wash your hands thoroughly with soap, treat them with 70% alcohol and lubricate the wound with 5% iodine solution. If infected blood gets on your hands, you should immediately treat them with a swab moistened with a 3% solution of chloramine or 70% alcohol, wash them with running warm water and soap and dry them with an individual towel. Start prophylactic treatment with AZT.
At the workplace, an accident report is drawn up, this fact is reported to the center dealing with the problem of HIV infection and AIDS. For Moscow, this is infectious diseases hospital No. 2.
The treatment room is cleaned at least 2 times a day with a wet method using a disinfectant solution. Cleaning rags are disinfected in a 3% solution of chloramine, an analyte, for an hour. Washes and dries. Gastric and intestinal probes used in preparation for surgery and diagnostic manipulations after the studies are also processed in an analyte solution or 3% chloramine solution with an exposure of 1 hour. Dried and handed over to autoclaving for further use.
The operating field in patients is prepared using individual disposable razors.
Special precautions must be observed during operations. Medical personnel who have skin lesions (cuts, skin diseases) should be exempted from direct treatment of patients with HIV infection and the use of equipment in contact with them. As protection during the operation in our department, surgeons, anesthesiologists and operating nurses use plastic aprons, shoe covers, oversleeves, disposable gowns made of non-woven material.
Goggles are used to protect the mucous membrane of the eyes, double masks are used to protect the nose and mouth, and two pairs of latex gloves are put on the hands. During operations of HIV-infected and AIDS patients, instruments are used that are used only for this category of patients and are labeled "AIDS". Sharp and cutting instruments during the operation are not recommended to be transferred from hand to hand. The surgeon himself must take the instruments from the table of the operating nurse.
After the operation, the instruments are washed from biological contaminants in a closed container with running water, then disinfected with a 5% solution of lysetol with an exposure of 5 minutes, a 3% solution of chloramine with an exposure of 1 hour. Next, the instruments are washed with running water and rinsed with distilled water, followed by drying, after which they are handed over for autoclaving.
Dressing gowns are disposable. After the operation, the gowns are kept in an analyte solution, 3% chloramine solution with an exposure of 1 hour, after which they are destroyed. Plastic aprons, shoe covers, sleeves are processed in an analyte solution, 3% solution of chloramine, alaminol with an exposure of 1 hour, washed with running water, dried and reused.
The operating room is processed after the performed manipulations: current cleaning is carried out with analyte solutions, 3% hydrogen peroxide solution.
Bandaging of patients in the postoperative period, as well as manipulations that do not require anesthesia, are carried out in a dressing room specially designed for this category of patients. The surgeon and dressing nurse dress in the same way as for the operation. The instruments are marked "HIV" and are only used for bandaging HIV/AIDS patients. Handling of used material, instruments and cabinet is carried out in the same way as in the operating room.
With the increase in the number of HIV-infected and AIDS patients, the number of requests for medical care by this category of patients is growing.
When contacting a patient, one should proceed from the premise that all incoming patients are HIV-infected, and strictly implement appropriate preventive measures.
Effective prevention of HIV infection is possible only with the daily training and education of medical personnel. This will overcome the fear of contact with HIV-infected patient act smartly and confidently.
This is the key to the professional safety of medical workers.
T.N. BULISKERIA, G.G. SMIRNOV, L.I. Lazutkina, N.M. VASILIEVA, T.N. SHISHKARVA
Infectious Clinical Hospital No. 3, Moscow
Given that the incidence of HIV infection in the Krasnodar Territory has taken the form of an epidemic, and indications for examination are limited to certain contingents, non-compliance with protection measures and prevention rules can lead to both professional infection of medical personnel and the spread of infection when providing medical care to patients.
Medical personnel participating in operations, caring for the postoperative period, as well as carrying out any medical manipulations with HIV-infected people, must observe personal safety measures.
Before starting work, medical personnel need to examine the skin of the hands, and if there are abrasions, scratches, rashes, macerations, they must be treated with 70% alcohol or 5% alcohol tincture of iodine, sealed with adhesive tape or some kind of film-forming drug. Do all manipulations with gloves. Treat the skin of the nail phalanges with iodine before putting on gloves. Make sure you have an emergency first aid kit.
Perform manipulations in the presence of a second specialist.
To dump used tools, needles, syringes, use non-piercing containers with a bucket-type handle.
Pour the used instruments, without disassembling, without touching them with hands, into a container for disinfection. Disinfection should be carried out by the most accessible and simple method, excluding additional contact: boiling in a 2% soda solution for 15 minutes from the moment of boiling or in water for 30 minutes from the moment of boiling.
Discard disinfected syringes, needles, disposable systems into non-puncture containers for disposal. Reusable medical instruments are processed in 3 stages.
Anti-epidemic and disinfection measures are carried out according to the regime of servicing patients with viral hepatitis with a parenteral transmission mechanism. The patient's linen is disinfected by boiling in a 0.5% washing solution for 30 minutes or soaked in a 3% chloramine solution for 2 hours. Bedding is handed over for chamber processing. The patient's dishes with food debris are disinfected in a 3% solution of chloramine for 60 minutes. Dishes from under the patient's secretions are disinfected in 0.6% NGK - 2 hours, in 0.2% GKT - 2 hours, or in 3% clarified bleach solution - 1 hour.
Measures in the event of an accident when working with HIV-infected material.
Provide workplaces with a disinfectant solution and a first aid kit, which is used in case of an accident and which includes: 70% alcohol, iodine, dressings, a sample of potassium permanganate (50 mg) and an appropriate amount (100 ml) of distilled water for its dilution, eye droppers, bactericidal patch.
Report any emergency to the supervisor immediately.
If the material suspected of being infected with HIV has got on a dressing gown, clothes, they must be removed and soaked in a 3% chloramine solution for 2 hours.
The skin of the hands and other parts of the body under contaminated clothing is wiped with 70% alcohol. Contaminated shoes are wiped with a rag soaked in a 3% solution of chloramine. If an infected material gets on the floor, walls, equipment, the contaminated places are poured with a 3% solution of chloramine or single drops of blood are removed with a swab dipped in a 3% solution of chloramine, then the contaminated places are wiped with a clean rag soaked in a disinfectant solution of the same concentration with an interval of 30 minutes. Used rags are thrown into a container with a disinfectant solution with an exposure of one hour.
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Although the risk of HIV transmission in the home is very low, there may still be situations where special care may be required from both the infected person and those who care for him. Such cases include contact with the secretions of an infected person, which contain the virus in an amount sufficient to infect others.
Let's look at some of the risk factors and features of caring for people with HIV.
When You Might Need Disinfection
In most cases, maintaining good health and minimizing the chance of transmitting the virus only requires good hygiene and sanitation. For example, it is important to clean regularly, wash hands and body, use gloves, and so on. In most cases, there is no need to use disinfectants during cleaning or washing, except when the patient is ill with other infectious diseases.
In what situations may disinfection be necessary? When you have to deal with the feces of an HIV-positive person, his blood, semen or female secretions. In this case, the contaminated surface must not only be washed or wiped, but also disinfected. It is important to wear gloves to avoid contact with skin that may be damaged. Used wipes, sponges or rags must be wrapped in a plastic bag and discarded, as they are now a source of infection.
Types of disinfectants
When the surface is washed, it is wiped with a disinfectant solution. In finished form, such funds are sold in pharmacies, you need to use them according to the instructions. There are two main types of disinfectants:
- containing chlorine;
- alcohol based.
If you are using a chlorine solution, it must be diluted to the correct concentration. Important warning: chlorine-containing solutions must not be mixed with other detergents or disinfectants, as the evaporation resulting from chemical reactions is very harmful. In any case, when working, you need to ensure good ventilation.
Chlorine solutions must be kept in a dark place and away from children. Never work with this tool without gloves and do not disinfect your hands with it, especially if there are wounds on them. Be aware that chlorine can leave white marks on fabrics and floors.
Alcohol is ineffective in contact with feces or blood, so it is important to clean surfaces before disinfecting them. Alcohol-containing substances should not be used for a long time, as they can burn the skin and ruin artificial materials.
Some other nuances
If you are sick with the flu or acute respiratory infections, then it is advisable to refrain from caring for an HIV-infected person during the acute period of the illness. Although he is no more prone to infection with these viruses than other people, he does not need an “extra” illness. During the period of illness, it is also important to ventilate the room well.
If blood, semen, or vaginal discharge from an HIV-positive person comes into contact with your skin, you will not become infected. You just need to wash the area with soap and water. If there is damage on the skin, the wound is also well washed. Then it must be disinfected with alcohol and stick a bactericidal patch. In this case, there is a risk of contracting HIV, so you will need to see a doctor and get tested.
Injection needles used by an infected person should not be kept in the open or in a plastic bag. After use, they must be placed in a container and thrown away so that no one gets hurt with them.
This is processing which is excl. reinfection
Disinf., Prester, Sterilization. See questions 1.2,
Only the tools and tools necessary for working with this patient should be left in direct access. Before starting treatment, disinfectants should be prepared for the treatment of instruments, surfaces, and suction devices. If the materials from which suction devices and hoses are made are difficult to disinfect or there is a possibility of blood splashing, they should be covered with a film. If blood gets on devices and instruments, they should be immediately thoroughly cleaned with a disinfectant. After the appointment, the doctor and assistant take off their gloves, disposable mask and throw them into a trash bag. The doctor takes off his gown, the assistant puts it in the laundry container. Hygienic hand disinfection is mandatory. All waste from the spittoon and protective films from the installations are placed in special garbage bags. The nurse puts on new gloves and performs hygienic care of all working tools. With the help of special tongs, the used instruments are placed in a disinfectant container, while piercing and cutting objects are placed in a separate disposable container. The tips are disinfected with alcohol, then they are internally cleaned using a special oil spray.
Finally, the handpieces are autoclaved or other effective disinfection of their internal parts. Suction units are cleaned with disinfectants. Thorough disinfection of all surfaces, washing the floor.
6. Quality control of pre-sterilization cleaning. Samples: azopyramic, amidopyrine, phenolphthalein.
All medical devices should be subjected to pre-sterilization treatment in order to remove protein, fat and mechanical contaminants, as well as medicines. The quality of the pre-sterilization treatment of medical instruments is checked by testing for the presence of blood residues and the completeness of washing products from alkaline components.
Quality control of pre-sterilization cleaning is carried out by setting the following samples:
Phenolphthalein - on the quality of washing from synthetic products "Lotos", "Astra", azopyramic or amidopyrine - on the quality of washing from blood and drugs.
Phenolphthalein test - a few drops of a 1% alcohol solution of phenolphthalein are applied to a cotton swab and the test instrument is wiped with this swab. The appearance of a pink color indicates poor-quality cleaning from detergents.
Azopyramic test - contains 10% amidopyrine: 0.10-0.15% aniline hydrochloride, 95% ethyl alcohol. The finished solution can be stored in a tightly closed vial in a dark place in the refrigerator for two months, at room temperature 18-23 ° C for no more than a month. Moderate yellowing of the reagent during storage without precipitation does not reduce its working qualities.
Preparation of a working solution: immediately before checking the quality of cleaning, a working solution is prepared by mixing equal volumes of "azopyram" and a 3% hydrogen peroxide solution. The prepared solution of "azopyram" is applied to the blood stain. If not later than after 1 minute a violet color appears, then turning into a lilac color, the reagent is suitable for use, if the color does not appear within 1 minute, then the reagent cannot be used.
The method of setting the reaction. The test products are treated with a working solution, wiped with swabs moistened with a reagent, various surfaces of apparatus and equipment, apply a few drops to the test object
Reaction features:
1. Staining that occurred later than 1 minute after processing the test items is not taken into account.
2. The objects to be examined must be at room temperature. Hot objects must not be tested.
3. Keep the working solution in bright light or at elevated temperatures is prohibited.
4. Azopyr working solution should be used within 1-2 hours.
5. After checking, regardless of the results, the remains of azopyram should be removed from the test items by washing them with water or wiping with a swab moistened with water or alcohol, and then repeat the pre-sterilization cleaning of these items.
1. After disinfection, the instruments are washed under a strong stream of running water for 3-5 minutes.
2. Then completely immerse in a cleaning solution at a temperature of 50 ° C for 15 minutes. The temperature of the washing solution during the washing process is not supported. The unchanged solution can be heated up to 6 times during the day, with the exception of the Biolot detergent. It is used once, because when used again, the enzyme that is part of the detergent is destroyed during the cleaning process.
3. Washing each product in a soapy solution with a brush or cotton-gauze swab for 30 seconds.
4. Rinse under running water for 10 minutes when using the Biolot detergent - for 3 minutes, the Progress detergent - for 5 minutes.
Amidopyrine test is carried out by mixing equal amounts of 5% alcohol solution of amidopyrine and 5% hydrogen peroxide, add a few drops of 30% acetic acid. In the presence of blood, a blue-violet coloration occurs. Conducting self-control! daily, head nurse - 1 time per week, SES - 1 time per quarter.
Pre-sterilization cleaning is carried out manually or mechanically (using special equipment). Inkjet method:
5. Rinsing with distilled water in the tank for 30 seconds.
6. Drying with hot air at a temperature of 85 ° C until the complete disappearance of moisture in the drying cabinet.
7. Then they put samples. If the sample is positive, pre-sterilization cleaning is carried out again. If an instrument contaminated with blood can be washed under running water immediately after it has been used during a particular manipulation, then it is not immersed in a corrosion inhibitor solution - sodium benzoate. If this is not possible, then before pre-sterilization cleaning, instruments contaminated with blood are immersed in a 1% sodium benzoate solution immediately after their use for 60 minutes, the temperature of the solution is 22-27 ° C. If necessary, instruments can be left immersed in sodium benzoate solution for up to 7 hours.
Preparation of cleaning solution.
Detergent 5 g, perhydrol 27.5% - 17 g, 33% - 16 g. Hydrogen peroxide 6% 85 g, 3% - 170 g, water up to 1 liter (978 g) can be used.
Infection safety after caring for an HIV-infected or AIDS patient
After caring for or treating an HIV-infected or AIDS patient, the health care provider should:
1. Treat gloved hands in a container with a 3% solution of chloramine (or other regulated solution).
2. Remove gloves and dip into another container with the same solution, fill the gloves with a disinfectant solution.
3. Put on clean rubber gloves.
4. Fill the removed rubber gloves with a disinfectant solution.
5. Remove the gown and fold it right side in.
6. Place the dressing gown in an oilcloth bag for dirty linen (the bag is marked).
7. Remove gloves.
8. Remove the mask.
9. Change shoes.
10. Wash hands thoroughly with soap under running water twice, dry with a towel.
After performing manipulations in patients with AIDS and HIV-infected, it is necessary to
1. Place the instrument after the manipulation in one of the proposed disinfectant solutions˸
2. Subject to pre-sterilization treatment and sterilization in accordance with OST 42-21-2-35 and ʼʼ Guidelines for disinfection, pre-sterilization cleaning and sterilization of medical suppliesʼʼ, approved by the Ministry of Health of Russia on December 30, 1998 / No. MU - 287-113.
3. After the manipulation, treat the surface of the desktop with a rag moistened with a 3% solution of chloramine twice (or with another agent approved for disinfection by wiping).
4. Remove rubber gloves from hands after washing in a container with a disinfectant solution.
5. Place rubber gloves in a container with a disinfectant solution.
6. Remove the gown, mask and place in a rubber bag for dirty laundry.
7. Wash your hands with soap and water under running water twice, dry your hands with a hair dryer or a clean disposable towel.
Note if the desktop is contaminated with blood during the manipulation, it is necessary to immediately treat the table with a rag soaked in a 6% hydrogen peroxide solution with a 0.5% detergent with an interval of 15 minutes. The surface of the desktops after work is wiped with a rag soaked in a 3% solution of chloramine twice. After treatment, place the rags in a container with a 3% solution of chloramine for 60 minutes (or other regulated disinfectant solution).
Injuries received by medical workers are subject to registration in each health facility.
The victim is observed by an infectious disease specialist for 6-12 months.
ʼʼInfection control and prevention of nosocomial infectionsʼʼ
I option
1. Wet cleaning of the premises of health facilities for the prevention of nosocomial infection is carried out˸
1. 1 time per day
2. 2 times a day
3. 4 times a day
4. 2 times a week
Infectious safety after providing care to an HIV-infected or AIDS patient - concept and types. Classification and features of the category "Infectious safety after providing care to an HIV-infected or AIDS patient" 2015, 2017-2018.
