Protection against HIV infection in the workplace and. Chemoprophylaxis regimens for parenteral HIV transmission

APPROVE
Deputy Minister
health and
social development
Russian Federation
R.A.KHALFIN
August 6, 2007 N 5961-РХ

These guidelines have been prepared by the Ministry of Health and Social Development of the Russian Federation in accordance with the terms of the Agreement between the Russian Federation and the International Bank for Reconstruction and Development on a loan to finance the project "Prevention, diagnosis, treatment of tuberculosis and AIDS" N 4687-RU as part of the preparation of legal and regulatory acts and methodological documents on diagnostics, treatment, epidemiological and behavioral surveillance of HIV / AIDS and concomitant diseases (Order of the Ministry of Health and Social Development of Russia dated April 1, 2005 N 251 "On the establishment of a Working Group for the preparation of regulatory legal acts and methodological documents on diagnostics, treatment , epidemiological and behavioral surveillance of HIV / AIDS and concomitant diseases)") with the participation of the Federal State Institution "Federal Scientific and Methodological Center for the Prevention and Control of AIDS of Rospotrebnadzor" (Narsia R.S.).

Introduction

The HIV epidemic is an additional factor that creates undue burdens on public health.
Budgetary investments are needed in infrastructure, human resources, equipment and supplies to provide adequate services to patients and to effectively protect health workers.

Prevention and control of occupational HIV-related risk factors can be achieved through ongoing on-the-job training in health services.

The implementation of the national program for the organization of activities to prevent HIV infection in the workplace should be directed to:

• to develop changes legislative framework;
• development of human resources for the health service;
• training of qualified medical personnel;
• creation of conditions guaranteeing safety in the workplace.

The scale of the spread of HIV infection corresponds to the global epidemic. In the world, the most common mode of HIV transmission is through heterosexual contact. In Russia, HIV transmission is common through injecting drug use. There have been cases of transmission of the virus to persons performing their official duties. Protective measures should primarily concern the prevention of HIV transmission through the blood.

HIV transmission in health care facilities is possible:

• from patient to health worker;
• from a healthcare worker to a patient using invasive procedures;
• from patient to patient.

The rapid growth in the number of HIV-infected people in the world and in Russia entails the risk of occupational infection with the human immunodeficiency virus for medical workers. In 2001 alone, in one of the regions of Russia, there were more than 500 cases of emergency contact with biological fluids infected with various viruses, including 10 cases when providing care to HIV-infected people.

In 1997, the CDS (Centers for Disease Control, USA) received reports of 52 documented cases of HIV seroconversion in healthcare workers working with HIV-infected patients.

Another 114 cases of occupational HIV infection were previously registered by SFS. Given the fact that the highest concentration of HIV in biological fluids is contained in the blood, infection most often occurs through contact with HIV-infected blood. Of 6498 cases of skin damage among medical workers with instruments contaminated with HIV-infected blood, the development of infection was observed in 21 cases.
This corresponds to an average probability of infection of 0.3%.

In the Russian Federation, in accordance with the order of the Ministry of Health of the Russian Federation N 275, annual testing for AT to HIV is carried out for medical workers who care for HIV-positive patients and work with materials containing HIV.

For the entire survey period from 1987 to 2006. more than 300 HIV-positive health workers were identified, but only two of them were infected while on duty. The causes of infection of the rest of the doctors were sexual contacts and parenteral drug use.

Almost all cases of HIV infection of medical workers are due to a needle stick while providing care to an HIV-infected person. This occurs when performing blood sampling from a vein, intravenous injections and transfusion of infusion drugs.

In Russia, the most frequently exposed to occupational risk of HIV infection are:

• Average medical staff- procedural nurses working in hospitals and departments providing care to HIV-infected patients.
• Operating surgeons and operating nurses.
• Obstetrician-gynecologists.
• Pathologists.

Body fluids that can infect HIV when exposed to:

• blood;
• sperm;
• vaginal discharge;
• any liquids with an admixture of blood;
• cultures and culture media containing HIV;
• synovial fluid;
• cerebrospinal fluid;
• pleural fluid;
• pericardial fluid;
• amniotic fluid.

Factors that affect the risk of contracting HIV:

• HIV status of the patient and the stage of the disease. If the patient has an acute infection or advanced disease (AIDS), then there is more virus in the blood and the risk of infection is higher.
• Whether the patient is receiving antiretroviral therapy; if it does, then the risk of infection is lower.
• The presence of treatment-resistant strains of HIV in the patient (in this case, antiretroviral therapy may not be effective).
• The degree of contamination of the instrument with infectious material. A needle prick after drawing blood from a vein is more dangerous than a needle prick after an intramuscular injection.
• The degree of violation of the integrity of the skin and mucous membranes in case of injury to a health worker.
• Treatment of the wound surface. Immediate extrusion of blood, washing with an antiseptic solution reduces the risk of infection.
• Timely chemoprophylaxis of HIV infection by antiretroviral drugs to a healthcare worker prevents infection.

Prevention of transmission of infection in healthcare facilities:

• Eliminate the risk of contact with infected objects by using protective equipment such as goggles, gloves, masks and protective clothing.
• Safe organization of work.
• Continuous training of staff in infection prevention methods.

Actions in case of occupational infection:

1. Promptly report all cases of possible occupational HIV infection to the head of the organization.
2. Send an operational report to the Federal Center for the Prevention and Control of AIDS in case of infection.

The administration of medical institutions should develop a program that includes the following elements:

• assess risk in the workplace;
• determine the priorities and nature of preventive measures;
• find ways to meet the protection needs of personnel;
• provide appropriate funding;
• apply workplace safety standards and protocols;
• ensure optimal workload for staff;
• train new employees in infection prevention practices;
• analyze cases of injuries when working with needles and other sharp instruments;
• constantly monitor and identify emerging risks of infection;
• familiarize employees with modern sources of information on risk factors for injuries when working with traumatic tools, infectious substrates, with examples of successful combating these risks;
• constantly train medical staff in the safe handling of traumatic and infectious substrates, including their neutralization and adequate disposal.

• Attend parenteral infection prevention classes and follow appropriate recommendations, including hepatitis B vaccinations.
• Before any work with traumatic tools, plan your actions in advance, including those related to their disposal.
• Try not to use dangerous medical equipment if you can find a safe and reasonably effective replacement for it.
• Do not cap used needles.
• Throw away used needles in a special (non-piercing) waste container in a timely manner.
• Immediately report all cases of injury when working with needles, other sharp objects, infected substrates. This will help you get the medical attention you need on time.
• Notify management of any observed factors that increase the risk of injury in the workplace.
• Provide assistance to the administration in the selection of devices (blood sampling systems, etc.). Give preference to devices with protective devices.
• Training of medical workers at all levels: managers, doctors, nurses, social workers, consultants and other professionals.
• Provide complete and accurate information about transmission and risk factors for infection.
• Teach methods to combat discrimination and stigmatization.
• Develop, implement and strengthen confidentiality measures.

Actions in case of emergency situations

In case of damage to the skin (cut, injection), if bleeding occurs from the damaged surface, it does not need to be stopped within a few seconds. If there is no bleeding, then you need to squeeze out the blood, treat the skin with 70 degrees. alcohol, then iodine solution.

If infectious material comes into contact with the face and other open areas of the body:

• wash thoroughly with soap, then wipe the skin 70 deg. alcohol.

• rinse with water.

If infectious material enters the oral cavity:

• rinse 70 deg. alcohol.

If infectious (or suspicious for HIV infection) material gets on a dressing gown, clothes:

• immediately treat the place with one of the disinfectant solutions;
• disinfect gloves;
• remove the bathrobe and soak in one of the solutions;
• put in sterilization boxes for autoclaving.

Skin of the hands and other areas of the body under contaminated clothing:

• wipe 70 deg. alcohol.

Shoes are treated with a double wipe 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: pour any disinfectant solution over the contaminated area with an exposure time of 30 minutes, then wipe it.

Chemoprophylaxis of parenteral transmission of HIV

Principles of chemoprevention of parenteral transmission of HIV

1. V medical institution there should be a clear and simple instruction on when and how to carry out chemoprophylaxis:
   Stage I - the beginning of chemoprophylaxis;
   Stage II - conducting a detailed study of the risk of infection and the causes of the accident, preparing reports.
2. If there is a threat of parenteral infection: damage to the skin with an HIV-contaminated instrument, contact of HIV-infected material with mucous membranes or damaged skin, chemoprophylaxis with antiretroviral drugs is recommended.
3. It is very important to start chemoprophylaxis as early as possible, preferably within the first two hours after a possible infection. If it cannot be started immediately on a high-intensity therapy regimen, it is necessary to start taking the drugs available as soon as possible.
4. After 72 hours, the start of chemoprophylaxis or the expansion of its scheme is meaningless, but with the urgent desire of the victim, chemoprophylaxis can be prescribed.

Indications for starting chemoprophylaxis

If contact occurred with biological material taken from a patient with HIV infection, it is recommended to start chemoprophylaxis of parenteral HIV infection.

If the HIV status of a patient whose blood has been exposed is unknown, it is recommended that they be tested for antibodies to HIV using approved express tests.

If a positive result is obtained, the appointment of chemoprophylaxis of HIV infection is recommended. Further examination of the patient in order to confirm or exclude the diagnosis of HIV infection is carried out in the prescribed manner.
If the HIV status of a potential source of infection is unknown and cannot be established, chemoprophylaxis may be prescribed according to epidemiological indications by the decision of the responsible physician.

Chemoprophylaxis regimens for parenteral HIV transmission

With the advent of highly active antiretroviral therapy regimens (treatment with multiple antiretroviral drugs different groups) they began to be used in regimens for chemoprophylaxis of parenteral and sexual HIV infection, since theoretically they should be more effective than monotherapy (treatment with a single drug) chemoprophylaxis, the effectiveness of which has been proven. In particular, the effectiveness of the following chemoprophylaxis scheme has been proven (the risk of infection is reduced by 70%): Zidovudine - orally 0.2 g 3 times a day for 4 weeks. Recommended in accordance with the order of the Ministry of Health of the Russian Federation N 170 of 08/16/94. This chemoprophylaxis regimen can be used as an alternative if it is impossible to use a more intensive regimen or if the victim does not want to use it. If zidovudine is intolerant or the hemoglobin level is below normal, it is recommended to replace it with Phosphazid (0.4 g 2 times a day).

Highly active antiretroviral therapy regimens recommended for chemoprophylaxis of parenteral and sexual HIV infection

Main scheme:

Lopinovir/ritonovir 3 capsules 2 times a day + zidovudine 0.3 2 p. per day + lamivudine 0.15 2 times a day (it is preferable to use a combined form of zidovudine / lamivudine).

If it is impossible to start the main regimen in time (including intolerance to the drugs included in the main regimen, or the presence of contraindications to them), alternative regimens are used. As an alternative, any highly active antiretroviral therapy regimen including HIV protease inhibitors can be used.
With the development of intolerance to one of the drugs, it is replaced in accordance with general rules described in the guidelines for antiretroviral therapy for HIV infection.

For regimens that include non-nucleoside inhibitors of HIV reverse transcriptase, there are some limitations.

Features of the use of efavirenz.

Because efavirenz is teratogenic, it is contraindicated in the first trimester of pregnancy. It is not recommended for pregnant women and women of childbearing age.

Features of the use of nevirapine.

Since repeated use of nevirapine in people with normal CD4 counts in the blood can lead to the development of life-threatening side effects (necrosis of liver tissue), its use in chemoprevention regimens for parenteral and sexual HIV infection is not recommended. If no other antiretroviral drugs are available, a single dose of nevirapine followed by a different regimen may be considered.

When prescribing chemoprophylaxis, blood tests of a health worker are carried out for possible subsequent correction of the therapy regimen:

• biochemical (creatinine, urea, bilirubin, ALT, ACT);
• clinical (hemoglobin, erythrocytes, platelets, neutrophils, leukocyte formula);
• pregnancy test.

Since the timing of chemoprophylaxis can be critical, if not all the drugs needed to complete the treatment regimen are available, it is preferable to prescribe at least one drug and add the rest later.

After an episode of emergency contact with a source of infection, a medical worker must be observed for at least 12 months.

Registration of emergency situations

• Each emergency must be immediately reported to the head of the unit or his deputy.
• Injuries received by medical workers should be taken into account in each health facility and acted as an accident at work.
• On the fact of the injury, the journal "On Injury Recording" is filled in and an "Epidemiological Investigation Act" of the cause of the injury and the connection between the cause of the injury and the performance of one's official duties is drawn up.
  Recommendations on chemoprophylaxis can be obtained from a specialist at the AIDS Center by phone. At night, weekends and holidays The decision to start antiretroviral therapy is made by the responsible hospital doctor.
• The fact of injury should be reported to the AIDS Center and the Central State Sanitary and Epidemiological Service.
• Registration of an emergency is carried out in accordance with the laws and regulations adopted at the level of the federal government and the subjects of the Federation.

It is advisable to draw up documentation in the event of an accident according to the attached scheme:

Registration of an accident in the accident log:

Form N 1

Date ___/___/____/, time _____ h. _____ min.
FULL NAME. health worker ______________________________________________
Position of health worker ___________________________________________
Manipulation carried out ____________________ short description
accidents ___________________________________________ measures taken
__________________________________________________________________

head's signature units (at night duty and
responsible doctor) ____________________________________

signature of senior medical officer sisters ___________________________________

Form N 2

Details of the patient in whose care the accident occurred:

FULL NAME. _______________________________________________________________
Date of Birth ___/___/____/
the address ____________________________________________________________
telephone __________________________________

HIV status:

1. HIV diagnosis confirmed
   - confirmation date
   - stage of HIV infection
   - whether the patient is on antiretroviral therapy
   - Plasma RNA level
   - number of CD4, CD8 lymphocytes, their ratio
2. HIV status unknown
   - blood for antibodies to HIV was taken, but the result was not received
   - blood for antibodies to HIV was not taken (specify the reason)
3. HIV antibody rapid test result positive
4. A negative rapid test result was obtained.

Viral hepatitis B and C:

1. - blood for the presence of HBsag
2. - blood for the presence of total antibodies to hepatitis C.

Routine laboratory testing for HIV antibodies/antigen of a healthcare worker and patient is performed:

• On the day of registration of the emergency;
• in 3 months;
• 6 months;
• 12 months; after an episode of emergency contact with a source of infection.

The victim must be warned that he can serve as a source of HIV infection during the entire period of observation, and therefore he must take precautions to avoid possible transmission of HIV.

Taking into account the consequences of occupational infection in the performance of their duties, guarantees have been adopted in the Federal Law N 38 "On the prevention of the spread in the Russian Federation of a disease caused by the human immunodeficiency virus (HIV infection)" article 4, guarantees in the field of labor article 22.

V modern medicine Much attention is paid to the issue of preventing the most terrible disease of recent decades. Of course, we are talking about immunodeficiency virus. A dangerous disease, unfortunately, has not yet been cured. Therefore, scientists are concerned not only with the development of vaccines and drugs, but also with the safety that is necessary in order to reduce the spread of the disease. Everyone should take care of individual safety. However, there are other, more stringent measures. HIV prevention in the workplace allows you to protect not only those whose professional duty is directly related to the potential for infection, but also patients who may become infected, for example, when visiting a treatment room. What should be the HIV prevention in an emergency, and where should it be followed?

Individual personal HIV prevention: what should you know about it?

Primary HIV prevention should be carried out by everyone who cares about their own health, as well as the safety of loved ones. That is why every person should know about the ways of transmitting a terrible disease. Most often, the virus passes from the carrier to a healthy person through sexual contact. In order to protect yourself from this scenario, you should definitely use barrier contraception. This applies not only to traditional intercourse, but also to oral and anal sex. If possible, you should refrain from promiscuity and ask the new partner for a certificate of his health in terms of sexually transmitted infections. After all, personal prevention of HIV infection is a great opportunity to maintain your health. Therefore, there should be no embarrassment in questions about the state of health of a partner.

The second most popular way of transmitting a terrible virus is injecting drugs. There is no need to talk about security measures in this case, however, drug addicts are still advised to refrain from using a common syringe.

Prevention of HIV infection and AIDS among healthcare workers: basic safety measures

Particular attention is also paid to the safety of medical personnel, in official duties which includes surgery. Prevention of HIV infection and AIDS in surgery includes the use of increased security measures when working with infected patients. In operating units, as well as in treatment rooms, anti-AIDS first-aid kits are placed on a mandatory basis.

The role of the midwife and nurse in the prevention of HIV infection is invaluable. Especially when it comes to taking delivery from an infected woman. After all, it depends on them whether the virus will be transmitted from mother to baby or not. Junior medical personnel in such cases must act quickly and smoothly. Only a baby born into the world is treated according to epidemic standards and requirements, due to which it is often possible to prevent infection.

Prevention of HIV infection in any enterprise that pays due attention to personnel safety is limited to regular briefings and the availability of an anti-AIDS first aid kit.

First aid kit anti-HIV
The immunodeficiency virus is a terrible disease that, over the long years of research, has not learned how to cure. That is why each person must take care of himself ...

"HIV AIDS" - Middle East and North Africa. Caribbean. Women and children. The main factors hindering the achievement of the goals. Africa south of the Sahara. Action Plan to Achieve MDG-6 by 2015. UNAIDS Report for World AIDS Day | 2011 Faster. Latin America. Western and Central Europe.

"Teacher's Work Program" - Library EER. The timing of the program. Structure of the Program. The work program of the teacher. Requirements for the level of training of students. Adjustment work program. Rationale. The author's program is characterized by an original concept and content construction. What is the Author Program? To write a working program.

"HIV infection" - Kaposi's sarcoma. From an infected donor. I do exercise or sports every day. I never do drugs. HIV INFECTION = disease ending in AIDS!!! The duration of clinical manifestations of acute HIV infection is usually 2-3 weeks. AIDS. Acceptance of your sexuality.

"HIV" - I don't drink alcohol. I follow the daily routine. Treatment. I do exercise or sports every day. Once in the body, the virus destroys the immune system gradually. I can deal with stress. Damage period: from three months. The history of development. HIV infection-. When having sex, I use a condom. 14.

"Working program" - The main functions of the curriculum. School Administration: Curriculum -. Exemplary Curriculum -. Curriculum and thematic plan: Working curriculum -. Regulatory; Purposeful; informative; procedural; Estimated; Meeting for deputy directors for water resources management February 2009 Content of the subject.

"Certification of workplaces" - RESPONSIBILITY for the reliability of measurements and assessments rests with the employer and the certification organization. The employer is obliged: by Rospotrebnadzor on July 29, 2005). Certification procedure. You should pay attention to the proposed cost of the work. The specified period is counted from the date of completion of the previous certification.

APPROVE
Deputy Minister of Health and
social development of the Russian Federation
R.A. Khalfin
August 6, 2007 N 5961-РХ

Prevention of infection, including healthcare workers,
human immunodeficiency virus in the workplace

These guidelines have been prepared by the Ministry of Health and Social Development of the Russian Federation in accordance with the terms of the Agreement between the Russian Federation and the International Bank for Reconstruction and Development on a loan to finance the project "Prevention, diagnosis, treatment of tuberculosis and AIDS" N 4687-RU as part of the preparation of legal and regulatory acts and methodological documents on the issues of diagnosis, treatment, epidemiological and behavioral surveillance of HIV / AIDS and concomitant diseases (Order of the Ministry of Health and Social Development of Russia dated April 1, 2005 N 251 "On the establishment of a Working Group for the preparation of regulatory legal acts and methodological documents on diagnostics, treatment, Epidemiological and Behavioral Surveillance of HIV/AIDS and Concomitant Diseases") with the participation of the Federal State Institution "Federal Scientific and Methodological Center for the Prevention and Control of AIDS of Rospotrebnadzor" (Narsia R.S.).

Introduction

The HIV epidemic is an additional factor that creates undue burdens on public health. Budgetary investments are needed in infrastructure, human resources, equipment and supplies to provide adequate services to patients and to effectively protect health workers. Prevention and control of occupational HIV-related risk factors can be achieved through ongoing on-the-job training in health services.

The implementation of the national program for the organization of activities to prevent HIV infection in the workplace should be aimed at: developing changes in the legislative framework; development of human resources for the health service; training of qualified medical personnel; creation of conditions guaranteeing safety in the workplace. The scale of the spread of HIV infection corresponds to the global epidemic. In the world, the most common mode of HIV transmission is through heterosexual contact. In Russia, HIV transmission is common through injecting drug use. There have been cases of transmission of the virus to persons performing their official duties. Protective measures should primarily concern the prevention of HIV transmission through the blood.

HIV transmission in health care facilities is possible: from a patient to a healthcare worker; from a healthcare worker to a patient using invasive procedures; from patient to patient.

The rapid growth in the number of HIV-infected people in the world and in Russia entails the risk of occupational infection with the human immunodeficiency virus for medical workers. In 2001 alone, in one of the regions of Russia, there were more than 500 cases of emergency contact with biological fluids infected with various viruses, including 10 cases when providing care to HIV-infected people.

In 1997, the CDS (Centers for Disease Control, USA) received reports of 52 documented cases of HIV seroconversion in healthcare workers working with HIV-infected patients.

Another 114 cases of occupational HIV infection were previously registered by SFS. Given the fact that the highest concentration of HIV in biological fluids is contained in the blood, infection most often occurs through contact with HIV-infected blood. Of 6498 cases of skin damage among medical workers with instruments contaminated with HIV-infected blood, the development of infection was observed in 21 cases.

This corresponds to an average probability of infection of 0.3%

In the Russian Federation, in accordance with the order of the Ministry of Health of the Russian Federation N 275, annual testing for AT to HIV is carried out for medical workers who provide care to HIV-positive patients and work with materials containing HIV.

Over the entire period of the survey from 1987 to 2006, more than 300 HIV-positive health workers were identified, but only two of them were infected while on duty. The causes of infection of the rest of the doctors were sexual contacts and parenteral drug use.

Almost all cases of HIV infection of health care workers are due to a needle stick while caring for an HIV-infected person. This occurs when performing blood sampling from a vein, intravenous injections and transfusion of infusion drugs.

In Russia, the most frequently exposed to occupational risk of HIV infection are:

- Nursing staff - procedural nurses working in hospitals and departments providing care to HIV-infected patients.

- Operating surgeons and operating nurses.

- Obstetrician-gynecologists.

- Pathologists.

Biological fluids, upon contact with which HIV infection is possible: blood; sperm; vaginal discharge; any liquids with an admixture of blood; cultures and culture media containing HIV; synovial fluid; cerebrospinal fluid; pleural fluid; pericardial fluid; amniotic fluid.

Factors that affect the risk of contracting HIV:

- HIV status of the patient and the stage of the disease. If the patient has an acute infection or advanced disease (AIDS), then there is more virus in the blood and the risk of infection is higher.

- Is the patient receiving antiretroviral therapy; if it does, then the risk of infection is lower.

- The presence of treatment-resistant strains of HIV in the patient (in this case, antiretroviral therapy may not be effective).

- The degree of contamination of the tool with infectious material. A needle prick after drawing blood from a vein is more dangerous than a needle prick after an intramuscular injection.

- The degree of violation of the integrity of the skin and mucous membranes in case of injury to a health worker.

- Treatment of the wound surface. Immediate extrusion of blood, washing with an antiseptic solution reduces the risk of infection.

- Timely chemoprophylaxis of infection with HIV-antiretroviral drugs to a health worker prevents infection.

Prevention of infection transmission in healthcare facilities

Eliminate the risk of contact with infected objects by using protective equipment such as goggles, gloves, masks and protective clothing.

- Safe organization of work.

- Continuous training of staff in infection prevention methods.

Actions in case of occupational infection

1. Promptly report all cases of possible occupational HIV infection to the head of the organization.

2. Send an operational report to the Federal Center for the Prevention and Control of AIDS in case of infection.

The administration of medical institutions should develop a program that includes the following elements:

assess risk in the workplace; determine the priorities and nature of preventive measures; find ways to meet the protection needs of personnel; provide appropriate funding; apply workplace safety standards and protocols; ensure optimal workload for staff; train new employees in infection prevention practices; analyze cases of injuries when working with needles and other sharp instruments; constantly monitor and identify emerging risks of infection; familiarize employees with modern sources of information on risk factors for injuries when working with traumatic tools, infectious substrates, with examples of successful combating these risks; constantly train medical staff in the safe handling of traumatic and infectious substrates, including their neutralization and adequate disposal.

Attend parenteral infection prevention classes and follow appropriate recommendations, including hepatitis B vaccinations.

- Before any work with traumatic tools, plan your actions in advance, including those related to their disposal.

- Try not to use dangerous medical equipment if you can find a safe and reasonably effective replacement for it.

- Do not cap used needles.

- Throw away used needles in a special (non-piercing) waste container in a timely manner.

- Immediately report all cases of injury when working with needles, other sharp objects, infected substrates. This will help you get the medical attention you need on time.

- Report to the administration about all noticed factors that increase the risk of injury in the workplace.

- Assist the administration in the selection of devices (blood sampling systems, etc.). Give preference to devices with protective devices.

- Training of medical workers at all levels: managers, doctors, nurses, social workers, consultants and other specialists.

- Provide complete and accurate information on transmission and risk factors for infection.

- Teach methods to combat discrimination and stigmatization.

- Develop, implement and strengthen confidentiality measures.

Actions in case of emergency situations

In case of damage to the skin (cut, injection), if bleeding occurs from the damaged surface, it does not need to be stopped within a few seconds. If there is no bleeding, then you need to squeeze out the blood, treat the skin with 70 degrees. alcohol, then iodine solution.

If infectious material comes into contact with the face and other open areas of the body:

- wash thoroughly with soap, then wipe the skin with 70 degrees. alcohol.

Eyes:

- rinse with water.

If infectious material enters the oral cavity:

- rinse with 70 degrees, with alcohol.

If infectious (or suspicious for HIV infection) material gets on a dressing gown, clothes:

- immediately treat the place with one of the solutions of disinfectants;

- disinfect gloves;

- remove the dressing gown and soak in one of the solutions;

- put in sterilization boxes for autoclaving.

Skin of the hands and other areas of the body under contaminated clothing:

- wipe 70 degrees. alcohol.

Shoes are treated with a double wipe 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: pour any disinfectant solution over the contaminated area with an exposure time of 30 minutes, then wipe it.

Chemoprophylaxis of parenteral transmission of HIV

Principles of chemoprevention of parenteral transmission of HIV

1. The medical institution should have a clear and simple instruction on when and how to carry out chemoprophylaxis:

Stage I - the beginning of chemoprophylaxis;

Stage II - conducting a detailed study of the risk of infection and the causes of the accident, preparing reports.

2. If there is a threat of parenteral infection: damage to the skin with an HIV-contaminated instrument, contact of HIV-infected material with mucous membranes or damaged skin, chemoprophylaxis with antiretroviral drugs is recommended.

3. It is very important to start chemoprophylaxis as early as possible, preferably within the first two hours after a possible infection. If it cannot be started immediately on a high-intensity therapy regimen, it is necessary to start taking the drugs available as soon as possible.

4. After 72 hours, the start of chemoprophylaxis or the expansion of its scheme is pointless, but with the urgent desire of the victim, chemoprophylaxis can be prescribed.

Indications for starting chemoprophylaxis

If contact occurred with biological material taken from a patient with HIV infection, it is recommended to start chemoprophylaxis of parenteral HIV infection.

If the HIV status of a contacted patient is unknown, testing for HIV antibodies using approved rapid tests is recommended.

If a positive result is obtained, the appointment of chemoprophylaxis of HIV infection is recommended. Further examination of the patient in order to confirm or exclude the diagnosis of HIV infection is carried out in the prescribed manner.

If the HIV status of a potential source of infection is unknown and cannot be established, chemoprophylaxis may be prescribed according to epidemiological indications by the decision of the responsible physician.

Chemoprophylaxis regimens for parenteral HIV transmission

With the advent of highly active antiretroviral therapy regimens (treatment with several antiretroviral drugs of different groups), they began to be used in chemoprophylaxis for parenteral and sexual HIV infection, since theoretically they should be more effective than monotherapy chemoprophylaxis (treatment with a single drug), the effectiveness of which has been proven. In particular, the effectiveness of the following chemoprophylaxis scheme has been proven (the risk of infection is reduced by 70%): zidovudine - orally 0.2 g 3 times a day for 4 weeks. Recommended in accordance with the order of the Ministry of Health of the Russian Federation N 170 of 16.08.94. This chemoprophylaxis regimen can be used as an alternative if it is impossible to use a more intensive regimen or the victim is unwilling to use it. If zidovudine is intolerant or the hemoglobin level is below normal, it is recommended to replace it with phosphazide (0.4 g 2 times a day).

Highly active antiretroviral therapy regimens recommended for chemoprophylaxis of parenteral and sexual HIV infection

Main scheme:

Lopinovir/ritonovir 3 capsules 2 times a day + zidovudine 0.3 2 p. per day + lamivudine 0.15 2 times a day (it is preferable to use a combined form of zidovudine / lamivudine).

If it is impossible to start the main regimen in time (including intolerance to the drugs included in the main regimen, or the presence of contraindications to them), alternative regimens are used. As an alternative, any highly active antiretroviral therapy regimen including HIV protease inhibitors can be used.

With the development of intolerance to one of the drugs, it is replaced in accordance with the general rules described in the guidelines for antiretroviral therapy for HIV infection.

For regimens that include non-nucleoside inhibitors of HIV reverse transcriptase, there are some limitations.

Features of the use of efavirenz.

Because efavirenz is teratogenic, it is contraindicated in the first trimester of pregnancy. It is not recommended for pregnant women and women of childbearing age.

Features of the use of nevirapine.

Since repeated use of nevirapine in people with normal CD4 counts in the blood can lead to the development of life-threatening side effects (necrosis of liver tissue), its use in chemoprevention regimens for parenteral and sexual HIV infection is not recommended. If no other antiretroviral drugs are available, a single dose of nevirapine followed by a different regimen may be considered.

When prescribing chemoprophylaxis, a medical worker's blood tests are carried out for possible subsequent correction of the therapy regimen: biochemical (creatinine, urea, bilirubin, ALT, ACT); clinical (hemoglobin, erythrocytes, platelets, neutrophils, leukocyte formula); pregnancy test.

Since the timing of chemoprophylaxis can be critical, if not all the drugs needed to complete the treatment regimen are available, it is preferable to prescribe at least one drug and add the rest later.

After an episode of emergency contact with a source of infection, a medical worker must be observed for at least 12 months.

Registration of emergency situations

- Every emergency should be immediately reported to the head of the unit or his deputy.

- Injuries received by medical workers should be taken into account in each health facility and acted as an accident at work.

- On the fact of injury, the journal "On Injury Recording" is filled in and an "Act of Epidemiological Investigation" of the cause of the injury and the connection between the cause of the injury and the performance of one's official duties is drawn up.

Recommendations on chemoprophylaxis can be obtained from a specialist at the AIDS Center by phone. At night, weekends and holidays, the decision to start antiretroviral therapy is made by the responsible hospital doctor.

- The fact of injury should be reported to the AIDS Center and the Central State Sanitary and Epidemiological Service.

- Registration of an emergency is carried out in accordance with the laws and regulations adopted at the level of the federal government and the subjects of the Federation.

It is advisable to draw up documentation in the event of an accident according to the attached scheme:

Registration of an accident in the accident log:

Form N 1

FULL NAME. health worker

Health worker position

Conducted manipulation

short description

measures taken

head's signature subdivisions (at night of the duty and responsible doctor)

signature of senior medical officer sisters

Form N 2

Details of the patient in whose care the accident occurred:
Date of Birth

HIV status:

1. HIV diagnosis confirmed

- confirmation date

- stage of HIV infection

- whether the patient is on antiretroviral therapy

- Plasma RNA level

- number of CD4, CD8 lymphocytes, their ratio

2. HIV status unknown

- blood for antibodies to HIV was taken, but the result was not received

- blood for antibodies to HIV was not taken (specify the reason)

3. Positive HIV antibody rapid test result

4. A negative rapid test result has been received.

Viral hepatitis B and C:

1. - blood for the presence of HBsag

2. - blood for the presence of total antibodies to hepatitis C.

Routine laboratory testing for HIV antibodies/antigen of a healthcare worker and patient is performed:

- On the day of registration of the emergency;

- in 3 months;

- 6 months;

- 12 months; after an episode of emergency contact with a source of infection.

The victim must be warned that he can serve as a source of HIV infection during the entire period of observation, and therefore he must take precautions to avoid possible transmission of HIV. Taking into account the consequences of occupational infection in the performance of their duties, guarantees have been adopted in the Federal Law N 38 "On the prevention of the spread in the Russian Federation of a disease caused by the human immunodeficiency virus (HIV infection)" article 4, guarantees in the field of labor article 22.

1. the federal law"On the sanitary and epidemiological well-being of the population" dated September 30, 1999 N 52-FZ (changes dated December 30, 2001; January 10, June 30, 2003; August 22, 2004).

2. Federal Law "On the prevention of the spread in the Russian Federation of a disease caused by the human immunodeficiency virus (HIV infection)" dated March 30, 1995 N 38 (modified on August 22, 2004).

3. Sanitary rules "Safety of working with microorganisms of I-II pathogenicity groups" SP 1.2.011-94. State Committee for Sanitary and Epidemiological Supervision of Russia. - Moscow, 19941.

4. Sanitary rules "Safety of working with microorganisms of 3-4 pathogenicity groups and helminths" SP 1.2.731-99. Ministry of Health of the Russian Federation. - Moscow, 1999 (modified 2.3.5.021-94 dated 12/30/94).

5. Sanitary and epidemiological rules "Prevention of viral hepatitis. General requirements to the epidemiological surveillance of viral hepatitis "SP 3.1.958-00. Ministry of Health of the Russian Federation. - Moscow, 2000.

6. Sanitary rules "Hygienic requirements for institutions, organizations, enterprises and persons engaged in disinfection activities" SP 3.5.675-97. Ministry of Health of Russia. - Moscow, 1998.

7. Sanitary rules and norms "Rules for the collection, storage and disposal of waste from medical institutions" SanPiN 2.1.7.728-99. FTSGSEN of the Ministry of Health of Russia. - Moscow, 1999.
10. Order of the Ministry of Health and Medical Industry of the Russian Federation "On measures to improve the prevention and treatment of HIV infection in the Russian Federation" dated 16.08.94 N 170.

Electronic text of the document
prepared by CJSC "Kodeks" and checked against:
Regulatory documents for the chief physician,
N 10, October, 2007