Algorithm of actions of medical staff in the event of an emergency. Prevention of occupational infection of medical personnel with blood-contact infections. Such places include

HIV infection is an anthroponotic chronic infectious disease caused by the human immunodeficiency viruses HIV-1 and HIV-2. The disease occurs in the form of highly specific disturbances in the functioning of the human immune system, leading to its gradual weakening and complete destruction with the formation of AIDS.

The progression of AIDS is accompanied by the development of various infectious complications and secondary malignant tumors.

The sources of the HIV-1 and HIV-2 viruses are infected people. At the same time, a patient with HIV is contagious at all stages of the disease, including the incubation period.

Infection with immunodeficiency viruses can occur:

naturally (sexually, vertically from mother to child, during natural feeding, as well as through contact with wounds and biological fluids);
artificially. This option includes infection through transfusion of blood products, use of donor biological material (sperm, breast milk), invasive medical and non-medical procedures (tattoos, trimmed manicures, injection of narcotic drugs), etc.

People at highest risk for HIV infection include:

taking injecting drugs;
providing intimate services;
non-traditional orientation;
leading a promiscuous sex life, etc.

Comprehensive diagnostics for immunodeficiency viruses is voluntary, with the exception of the category of citizens subject to mandatory examination. Testing is carried out after individual consultations. The results of an HIV test are not communicated over the telephone; they can only be found out in person. After the study, a post-test consultation is carried out.

HIV testing is mandatory:

before starting emergency prevention of HIV infection in an emergency;
when performing screening of pregnant women with unspecified HIV status;
before collecting donor materials;
when submitting documents for admission to medical educational institutions;
when applying for a job in the government. medical institutions and private centers and clinics (all doctors and nurses undergo regular HIV testing);
among researchers or laboratory personnel directly working with biological materials containing HIV-1 and HIV-2 viruses;
when preparing documents for military educational institutions and for service, as well as during conscription or entering service under a contract;
among foreign citizens applying for citizenship or obtaining a residence permit.
when applying for a visa to stay on the territory of the Russian Federation for more than three months.

Is it possible to work with HIV in medicine?

For medical employees, testing for human immunodeficiency viruses is strictly mandatory.

Nurses and doctors with HIV cannot be allowed to work. Also, infected employees should not work at blood transfusion stations.

Medical workers who belong to risk groups for occupational HIV infection (employees of surgical, traumatological, gynecological, dental departments, nurses in manipulation rooms, etc.) undergo mandatory examination once a year.

Also, employees whose skin and mucous membranes have been exposed to biomaterial containing HIV are subject to emergency examination using quick and standard tests.

Prevention of HIV infection among health workers

Infection of these personnel is possible while working with patient biomaterials when performing therapeutic and diagnostic procedures (especially invasive ones), as well as during the disposal of used syringes, when processing instruments, etc.

The leading causes of HIV-related emergencies include violation of safety precautions during the collection and disposal of material, non-compliance with personal safety rules related to the protection of skin and mucous membranes.

In most cases this is due to:

neglect of barrier protective equipment (aprons, gloves, glasses, plastic shields are not used);
violation of personal safety rules when performing invasive procedures;
cleaning workplaces with sharp, unprotected objects left on them;
disposal of needles and their transportation in pierceable containers, etc.

Rules for personal safety and prevention of HIV infection in medical institutions

To ensure personal protection and for preventive purposes, medical personnel must:

Before working with any biomaterials, protect areas of the skin and mucous membranes using special waterproof plasters or bandages;
change gloves before working with each new patient. During work, gloves should be treated with 70% ethyl alcohol. The gloves are then immediately discarded and their reuse is prohibited;
if you are working with blood or biomaterials that may contain HIV, latex gloves should be used;
wash your hands thoroughly with soap after handling biological material;
use protective equipment for the face (gauze bandages) and eyes (protection with glasses or plastic shields);
Immediately treat surfaces of work tables contaminated with blood with detergent and disinfectant solution. Treatment should be carried out twice, maintaining an interval of fifteen minutes;
When collecting capillary blood, use a rubber bulb;
place disposable used equipment (syringe, needle, etc.) in puncture-proof containers for further processing, disinfection and disposal;
ensure that there is always a sufficient amount of cleaning and disinfectants at the workplace.

Nurses and doctors who have skin lesions of an exudative or eczematous nature are excluded from working in manipulation rooms, dressing rooms, etc. until complete recovery.

Emergency situation during HIV infection - algorithm of action

Prevention of infection of personnel is carried out in accordance with (the link is given to download the Order).

In the event of emergencies and emergencies related to HIV, medical personnel:

If gloves are torn or damaged, you must immediately remove them, wash your hands thoroughly with detergents (soap) under a large volume of running water, disinfect your hands with seventy percent alcohol solution, treat the wound with 5% iodine;
On hit:

blood or biomaterials on the skin, disinfect the skin with seventy percent alcohol, wash with soap and water, and re-treat the skin with alcohol;
biomaterials into the oral cavity - the mouth is washed with large volumes of running water and rinsed with 70% alcohol solution;
biomaterials into the eyes or nose - the mucous membranes are washed with large volumes of running water or saline. Rubbing the mucous membrane is prohibited.

If clothing is contaminated with biomaterials, remove work clothes, soak them in disinfectant solutions, and then autoclave them.

The emergency situation should be reported to management immediately. All cases must be recorded in a special journal.

If there is a risk of infection, start taking medications immediately. The medications are taken within the first 2 hours after the accident. The maximum allowable period for starting prevention is the first seventy-two hours after the accident.

The following drugs are used for HIV post-exposure prophylaxis:

lopinavir/ritonavir ® + /
in their absence, use nevirapine ® (single dose) or abacavir ® , then standard prophylaxis according to HAART regimens begins.

New composition of an emergency first aid kit for HIV

According to the protocol, an anti-HIV first aid kit should contain:

bottles with ethyl alcohol (70% - fifty milliliters) and five percent alcohol solution of iodine (ten milliliters);
adhesive plaster, sterile cotton balls (twenty pieces) and gauze napkins (ten pieces);
bandage (sterile).

1. When preparing for manipulations with patients, make sure

integrity of the emergency first aid kit (f.50).

2. Perform manipulations in the presence of a second healthcare worker, who will be able to continue performing them in the event of a glove rupture or cut.

3. Treat the skin of the nail phalanges with iodine before putting on gloves.

4. For a cut or puncture tool in contact with

biological fluids, skin of hands or hands wearing gloves, you must:

Remove gloves and place in a container for disinfection;

Wash your hands with antiseptic soap and lather twice under running water,

Treat the wound with a sterile gauze pad moistened with 70% ethyl alcohol or another alcohol-based antiseptic (at least 30 seconds);

Treat the wound with a sterile gauze cloth moistened with a 5% alcohol solution of iodine,

Cover with bactericidal adhesive tape.

5. If biological fluids come into contact with unprotected skin:

Treat the skin with a sterile gauze pad moistened with 70% ethyl alcohol;

Wash your skin under running water, lathering twice with antiseptic soap;

6. For massive skin contamination blood and other

biological fluids:

Rinse biological fluid from the skin under running water;

Treat with a sterile gauze pad moistened with 70% ethyl alcohol;

Wash the contaminated area of skin with running water and

twice soaping with antiseptic soap;

Dry with a disposable towel or napkin;

Re-treat with a sterile gauze pad moistened with 70% ethyl alcohol.

7. In case of contact with biological fluids into the nose:

in the eyes:

Rinse with plenty of water, you can use a disposable syringe,

Dry your eyes with a sterile gauze pad.

8. In case of contact with biological fluids in the mouth:

Rinse with plenty of water;

Rinse your mouth with 70% ethyl alcohol.

Registration N 20263

In accordance with the Federal Law of March 30, 1999 N 52-FZ “On the sanitary and epidemiological welfare of the population” (Collected Legislation of the Russian Federation, 1999, N 14, Art. 1650; 2002, N 1 (Part 1), Art. 2; 2003, N 2, art. 167; N 27 (part 1), art. 2700; 2004, N 35, art. 3607; 2005, N 19, art. 1752; 2006, N 1, art. 10, N 52 (Part 1), Article 5498; 2007, No. 1 (Part 1), Article 21; No. 1 (Part 1), Article 29; No. 27, Article 3213; No. 46, Article 5554; N 49, Article 6070; 2008, N 24, Article 2801; N 29 (Part 1), Article 3418; N 30 (Part 2), Article 3616; N 44, Article 4984; N 52 ( Part 1), Article 6223; 2009, No. 1, Article 17; 2010, No. 40, Article 4969) and Decree of the Government of the Russian Federation dated July 24, 2000 No. 554 “On approval of the Regulations on the State Sanitary and Epidemiological Service of the Russian Federation and Regulations on state sanitary and epidemiological regulation" (Collected Legislation of the Russian Federation, 2000, N 31, Art. 3295, 2004, N 8, Art. 663; N 47, Art. 4666; 2005, N 39, Art. 3953) I decree:

Approve sanitary and epidemiological rules SP 3.1.5.2826-10 “Prevention of HIV infection” (appendix).

G. Onishchenko

Application

Prevention of HIV infection

Sanitary and epidemiological rules SP 3.1.5.2826-10

I. 0area of application

1.1. These sanitary and epidemiological rules (hereinafter referred to as sanitary rules) establish the basic requirements for a set of organizational, treatment and preventive, sanitary and anti-epidemic measures, the implementation of which ensures the prevention of the occurrence and spread of HIV infection.

1.2. Compliance with sanitary rules is mandatory for citizens, individual entrepreneurs and legal entities.

1.3. Monitoring the implementation of these sanitary and epidemiological rules is carried out by the bodies exercising state sanitary and epidemiological supervision.

III. General provisions

3.1. HIV infection is a disease caused by the human immunodeficiency virus - an anthroponotic infectious chronic disease characterized by a specific lesion of the immune system, leading to its slow destruction until the formation of acquired immunodeficiency syndrome (AIDS), accompanied by the development of opportunistic infections and secondary malignant neoplasms.

3.2. The diagnosis of HIV infection is established on the basis of epidemiological, clinical and laboratory data.

3.3. AIDS is a condition that develops against the background of HIV infection and is characterized by the appearance of one or more diseases classified as AIDS-indicative. AIDS is an epidemiological concept and is used for the purposes of epidemiological surveillance of HIV infection.

3.4. The causative agent of HIV infection, the human immunodeficiency virus, belongs to the lentivirus subfamily of the retrovirus family. There are two types of virus: HIV-1 and HIV-2.

3.5. The source of HIV infection is people infected with HIV at any stage of the disease, including the incubation period.

3.6. Mechanism and factors of transmission.

3.6.1. HIV infection can be transmitted through both natural and artificial transmission mechanisms.

3.6.2. The natural mechanism of HIV transmission includes:

3.6.2.1. Contact, which occurs primarily during sexual intercourse (both homo- and heterosexual) and when the mucous or wound surface comes into contact with blood.

3.6.2.2. Vertical (infection of a child from an HIV-infected mother: during pregnancy, childbirth and breastfeeding.)

3.7.3. Artificial transmission mechanisms include:

3.7.3.1. Artificial for non-medical invasive procedures, including intravenous drug administration (use of syringes, needles, other injection equipment and materials), tattooing, and when performing cosmetic, manicure and pedicure procedures with non-sterile instruments.

3.7.3.2. Artificial for invasive interventions in health care facilities. HIV infection can occur through the transfusion of blood, its components, organ and tissue transplantation, the use of donor sperm, donor breast milk from an HIV-infected donor, as well as through medical instruments for parenteral interventions, medical products contaminated with HIV and not processed in accordance with with the requirements of regulatory documents.

3.8. The main factors of transmission of the pathogen are human biological fluids (blood, blood components, sperm, vaginal discharge, breast milk).

3.9. The main population groups vulnerable to HIV infection are: injection drug users (IDUs), commercial sex workers (CSWs), men who have sex with men (MSM). The group at increased risk of contracting HIV includes clients of sex workers, sexual partners of IDUs, prisoners, street children, people with a large number of sexual partners, migrating segments of the population (truck drivers, seasonal workers, including foreign citizens working in rotation and others), people who abuse alcohol and non-injecting drugs, because under the influence of psychoactive substances they are more likely to engage in more risky sexual behavior.

3.10. Clinical course of HIV infection without the use of antiretroviral therapy.

3.10.1. Incubation period

The incubation period for HIV infection is the period from the moment of infection until the body’s response to the introduction of the virus (the appearance of clinical symptoms or the production of antibodies) is usually 2-3 weeks, but can last up to 3-8 months, sometimes up to 12 months. During this period, antibodies to HIV are not detected in the infected person, and therefore the risk of transmission of infection from him in nosocomial foci, including through transfusion of blood and its components, increases.

3.10.2. Acute HIV infection.

In 30-50% of infected people, symptoms of acute HIV infection appear, which is accompanied by various manifestations: fever, lymphadenopathy, erythematous-maculopapular rash on the face, trunk, sometimes on the extremities, myalgia or arthralgia, diarrhea, headache, nausea and vomiting, liver enlargement and spleen, neurological symptoms. These symptoms appear against the background of a high viral load in different combinations and have varying degrees of severity. In rare cases, severe secondary diseases may develop already at this stage, leading to the death of patients. During this period, the frequency of referrals of infected people to healthcare facilities increases; the risk of transmission of infection is high, due to the large amount of virus in the blood.

3.10.3. Subclinical stage.

The duration of the subclinical stage averages 5-7 years (from 1 to 8 years, sometimes more), there are no clinical manifestations other than lymphadenopathy. At this stage, in the absence of manifestations, the infected person remains a source of infection for a long time. During the subclinical period, HIV continues to multiply and the number of CD4 lymphocytes in the blood decreases.

3.10.4. Stage of secondary diseases.

Against the background of increasing immunodeficiency, secondary diseases (infectious and oncological) appear. Diseases with infections of a viral, bacterial, fungal nature initially proceed quite favorably and are stopped by conventional therapeutic agents. Initially, these are predominantly lesions of the skin and mucous membranes, then organ and generalized lesions, leading to the death of the patient.

3.11. Antiretroviral therapy (APT) is the etiotropic treatment of HIV infection. At the present stage, APT does not completely eliminate HIV from the patient’s body, but stops the multiplication of the virus, which leads to the restoration of immunity, the prevention of the development or regression of secondary diseases, the preservation or restoration of the patient’s ability to work and the prevention of his death. Effective antiretroviral therapy is also a preventive measure that reduces the risk of the patient as a source of infection.

IV. Laboratory diagnosis of HIV infection

4.1. Laboratory diagnosis of HIV infection is based on the detection of antibodies to HIV and viral antigens, as well as, in special cases, the detection of HIV proviral DNA and HIV viral RNA (in children in the first year of life).

4.2. Laboratory tests for the diagnosis of HIV infection are carried out in institutions of the state, municipal or private health care system on the basis of a sanitary-epidemiological report and a license provided in the manner established by the legislation of the Russian Federation.

4.3. The standard method for laboratory diagnosis of HIV infection is the determination of antibodies/antigens to HIV using ELISA. Confirmatory tests (immune, line blot) are used to confirm results regarding HIV.

4.4. Diagnostic algorithm for testing for the presence of antibodies to HIV:

4.4.1. At the first stage (screening laboratory).

If a positive result is obtained in the ELISA, the analysis is carried out sequentially 2 more times (with the same serum and in the same test system, the second serum is requested only if it is impossible to send the first serum for further research). If two positive results are obtained from three ELISA tests, the serum is considered primary positive and is sent to the reference laboratory (HIV Diagnostic Laboratory of the Center for Prevention and Control of AIDS) for further research.

4.4.2. At the second stage (reference laboratory).

The initially positive serum is retested by ELISA in a second test system from another manufacturer, which differs from the first in the composition of antigens, antibodies or test format chosen for confirmation. If a negative result is obtained, the serum is retested in a third test system from another manufacturer, which differs from the first and second in the composition of antigens, antibodies or test format. If a negative result is obtained (in the second and third test systems), a conclusion is issued about the absence of antibodies to HIV. If a positive result is obtained (in the second and/or third test system), the serum must be examined in an immune or linear blot. The results obtained in the confirmatory test are interpreted as positive, indeterminate, or negative.

4.4.2.1. In order to ensure control and accounting of research, reference diagnostics should be carried out in the same subject of the Russian Federation where the screening examination was carried out in the laboratory of an authorized specialized healthcare facility that carries out organizational and methodological work on carrying out diagnostic, therapeutic, preventive and anti-epidemic measures for HIV infection and related diseases.

Reference diagnostics can also be carried out at the Federal State Institution, on the basis of which the federal and district centers for the prevention and control of AIDS operate, and at the Federal State Institution Republican Clinical Infectious Diseases Hospital (St. Petersburg).

4.4.3. Tests that contain antibodies to 2 of 3 HIV glycoproteins (env, gag, pol) are considered positive.

4.4.4. Sera are considered negative (negative) in which no antibodies are detected to any of the HIV antigens (proteins) or there is a weak reaction with the p 18 protein.

4.4.5. Sera that contain antibodies to one HIV glycoprotein and/or any HIV proteins are considered undetermined (doubtful). If an indeterminate result is obtained with a protein profile including core proteins (gag) p 25, a test is performed to diagnose HIV-2.

4.4.6. If a negative and questionable result is obtained in an immune or linear blot, it is recommended to examine the serum in a test system to determine the p24 antigen or HIV DNA/RNA. If p24 antigen or HIV DNA/RNA has been detected, re-examination using an immune or line blot is carried out 2, 4, 6 weeks after receiving the first indeterminate result.

4.4.7. If an indeterminate result is obtained, repeated tests for antibodies to HIV are carried out using an immune or linear blot after 2 weeks, 3 and 6 months. If negative ELISA results are obtained, then further research is not required. If, 6 months after the first examination, indeterminate results are again obtained, and the patient does not have risk factors for infection and clinical symptoms of HIV infection, the result is regarded as a false positive. (If there are epidemiological and clinical indications, serological studies are carried out repeatedly as prescribed by the attending physician or epidemiologist).

4.5. To diagnose HIV infection in children under 18 months of age born to HIV-infected mothers, due to the presence of maternal antibodies, other approaches are used.

4.5.1. To diagnose HIV infection in children under 12 months of age born to HIV-infected mothers, methods aimed at identifying HIV genetic material (DNA or RNA) are used. Obtaining positive test results for HIV DNA or HIV RNA in two separate blood samples from a child older than one month is laboratory confirmation of the diagnosis of HIV infection. Receiving two negative test results for HIV DNA or HIV RNA at the age of 1 - 2 months and 4 - 6 months (in the absence of breastfeeding) indicates against the presence of HIV infection in the child, however, the child is removed from the dispensary register due to intranatal and perinatal contact HIV infection can occur after the age of 1 year.

4.5.2. Removal from dispensary registration for HIV infection at the age of 18 months is carried out if:

Two or more negative test results for HIV antibodies using ELISA;

Absence of pronounced hypogammaglobulinemia at the time of blood testing for antibodies to HIV;

Absence of clinical manifestations of HIV infection.

4.5.3. Diagnosis of HIV infection in children born to HIV-infected mothers and reaching the age of 18 months is carried out in the same way as in adults.

4.6. Laboratory diagnosis of HIV infection can only be carried out using certified standardized diagnostic test systems (kits) approved for use on the territory of the Russian Federation in accordance with the established procedure.

In order to carry out incoming quality control of the test systems used to identify persons infected with the human immunodeficiency virus, standard serum panels (industry standard samples) approved for use in the prescribed manner are used.

4.7. The document issued by the laboratory based on the results of the study indicates the name of the test system, its expiration date, series, ELISA result (positive, negative), immunoblot result, linear blot (list of identified proteins and conclusion: positive, negative, indeterminate). For confidential research, the document must contain passport data: full name, full date of birth, address of residence, contingent code. During an anonymous examination, the document is marked with a specially established code.

4.7.1. If a questionable result is obtained in a confirmatory test (immune, linear blot), a conclusion is issued about the uncertain result of the study and it is recommended to repeat the examination of the patient until the status is determined (after 3,6, 12 months).

4.8. Simple/rapid HIV specific antibody tests are tests that can be performed without special equipment in less than 60 minutes. Blood, serum, blood plasma and saliva (scraping from the gum mucosa) can be used as test material.

4.8.1. Application areas for simple/quick tests:

Transplantology - before collecting donor material;

donation - blood examination, in case of emergency transfusion of blood products and the absence of donor blood tested for HIV antibodies;

vertical prevention - testing pregnant women with unknown HIV status in the prenatal period (to prescribe drug prevention of HIV infection during childbirth);

HIV post-exposure prophylaxis - HIV testing in case of emergency.

4.8.2. Each HIV test using simple/quick tests must be accompanied by a mandatory parallel study of the same portion of blood using the classical methods of ELISA and IB.

4.9. Issuing a conclusion about the presence or absence of HIV infection based solely on the results of a simple/quick test is not permitted. The results of simple/quick tests are used only for timely decision-making in emergency situations.

V. Procedure for testing for HIV infection

5.1. The main method of detecting HIV infection is testing for HIV antibodies with mandatory pre- and post-test counseling. The presence of HIV antibodies is evidence of HIV infection. A negative HIV antibody test result does not always mean that a person is not infected, since there is a “seronegative window” period (the time between HIV infection and the appearance of antibodies, which is usually about 3 months).

5.2. Testing for HIV infection is carried out voluntarily, except in cases where such testing is mandatory.

The following are subject to mandatory medical examination for HIV infection:

Donors of blood, blood plasma, sperm and other biological fluids, tissues and organs (including sperm), as well as pregnant women in the case of abortive and placental blood collection for the production of biological products each time donation material is taken;

The following employees are subject to mandatory medical examination to detect HIV infection upon entry to work and during periodic medical examinations:

Doctors, paramedical and junior medical personnel of centers for the prevention and control of AIDS, health care institutions, specialized departments and structural divisions of health care institutions, engaged in direct examination, diagnosis, treatment, service, as well as conducting forensic medical examinations and other work with persons infected with human immunodeficiency virus, having direct contact with them;

Doctors, paramedical and junior medical personnel of laboratories (groups of laboratory personnel) who screen the population for HIV infection and study blood and biological materials obtained from persons infected with the human immunodeficiency virus;

Scientists, specialists, employees and workers of research institutions, enterprises (productions) for the production of medical immunobiological preparations and other organizations whose work is related to materials containing the human immunodeficiency virus.

Medical workers in surgical hospitals (departments) upon entry to work and subsequently once a year;

Persons undergoing military service and entering military educational institutions and military service under conscription and contract, when conscripted for compulsory military service, when entering service under a contract, when entering military universities of ministries and departments that establish restrictions for the admission of persons to service with HIV infection;

Foreign citizens and stateless persons when applying for a citizenship permit or residence permit, or work permit in the Russian Federation, when foreign citizens enter the territory of the Russian Federation for a period of more than 3 months.

5.3. At the request of the person being examined, voluntary HIV testing can be anonymous.

5.4. Health care providers should recommend that individuals at high risk of HIV infection regularly undergo HIV testing for early detection of HIV infection, counseling on HIV infection, and timely initiation of treatment in the event of infection.

5.5. Examination for HIV infection (including anonymous) is carried out in medical institutions of all forms of ownership with the informed consent of the patient in conditions of strict confidentiality, and in the case of examination of minors under the age of 14 years - at the request or with the consent of his legal representative.

5.6. Testing for HIV infection is carried out with mandatory pre- and post-test counseling on HIV prevention issues.

5.7. Consultation should be conducted by a trained specialist (preferably an infectious disease doctor, epidemiologist or psychologist) and include basic provisions regarding HIV testing, the possible consequences of testing, determining the presence or absence of individual risk factors, assessing the awareness of the person being examined on issues of HIV prevention, providing information about routes of HIV transmission and methods of protection against HIV infection, types of assistance available to those infected with HIV.

5.8. When conducting pre-test counseling, it is necessary to fill out an informed consent form for HIV testing in two copies, one form is given to the person being examined, the other is kept in the health care facility.

5.9. A referral for an enzyme-linked immunosorbent assay (ELISA) of a blood sample for HIV infection is filled out by all health care organizations, regardless of their legal form and form of ownership.

5.9.1. During confidential testing, personal data on the patient is provided without abbreviations (according to the passport or a substitute identification document of the person being examined): full name, full date of birth, citizenship, address of residence, contingent code.

5.9.2. During anonymous testing (without a passport), only a digital code is indicated, including the serial number of the person being examined, year of birth, place of residence (subject of the Russian Federation). The last name, first name and patronymic of the person being examined is not indicated.

5.10. A response about the examination result is issued upon completion of the testing algorithm. The issuance of an official document confirming the presence or absence of HIV infection in the person being examined is carried out only by institutions of the state or municipal health care system.

5.11. The results of HIV testing are communicated to the person being examined by a consultant during post-test counseling; If possible, the same specialist provides pre- and post-test counseling to the patient.

5.11.1. Counseling for any HIV test result should include a discussion of the meaning of the result, taking into account the risk of HIV infection for the person being examined; explanation of the routes of transmission of HIV and methods of protection against HIV infection for the person being examined; types of care available for those infected with HIV, and recommendations for further testing tactics.

5.11.1.1. Counseling for an indeterminate HIV test result, in addition to a set of standard information, should contain a discussion of the possibility of HIV infection, the need to take precautions to prevent the spread of HIV infection, guarantees of medical care, treatment, and respect for the rights and freedoms of HIV-infected people. The person being tested is sent to the Center for Prevention and Control of AIDS.

5.11.1.2. A person diagnosed with HIV infection is notified by a consultant of the test results. The specialist communicates the positive test result in a clear and concise manner, provides time to absorb this news, and answers the patient’s questions. Explains the need to take precautions to prevent the spread of HIV infection, guarantees of medical care, treatment, respect for the rights and freedoms of HIV-infected people, as well as criminal liability for putting in danger of infection or infecting another person. The person being tested is sent to the Center for the Prevention and Control of AIDS to establish a diagnosis of HIV infection and provide medical care.

5.11.2. Study results are not communicated over the phone.

5.11.3. The diagnosis of a disease caused by the human immunodeficiency virus is established by a doctor at the Center for the Prevention and Control of AIDS or an authorized physician at a medical facility based on a set of epidemiological data, the results of a clinical examination and laboratory tests. The diagnosis of HIV infection is communicated to the patient by a doctor (preferably an infectious disease specialist, epidemiologist or psychologist) during consultation with the patient at the Center for the Prevention and Control of AIDS or an authorized healthcare facility. The patient is notified in writing about the detection of HIV infection, and he is provided with information on this problem. If HIV is detected in minors under the age of 18, their parents or legal representatives are notified.

VI. Organization of dispensary observation of patients with HIV infection

6.1. The goal of clinical monitoring of HIV-infected patients is to increase the duration and maintain the quality of their life. The main objectives are to form adherence to dispensary observation, timely identify their indications for antiretroviral therapy, chemoprophylaxis and treatment of secondary diseases, ensure the provision of timely medical care, including psychological support and treatment of concomitant diseases.

6.2. HIV-infected persons are subject to invitation to primary and periodic examinations, but their right to refuse examination and treatment, as well as the right to be observed in a medical institution of their own choice, expressed in writing, must not be violated.

6.3. Persons with an established diagnosis of HIV infection should be taken for clinical observation for HIV infection. Dispensary observation is carried out by healthcare facilities authorized by an administrative act of the health care management body of a constituent entity of the Russian Federation.

Dispensary observation can also be carried out at the Federal State Institution, on the basis of which the federal and district centers for the prevention and control of AIDS operate, and at the Federal State Institution Republican Clinical Infectious Diseases Hospital (St. Petersburg).

6.4. For each case of HIV infection (including when a positive laboratory test result for HIV infection is detected on sectional material), an epidemiological investigation is carried out by specialists from the AIDS center and, if necessary, by specialists from the bodies carrying out state epidemiological surveillance. Based on the results of the epidemiological investigation, a conclusion is given about the causes of the disease, sources of infection, leading routes and factors of transmission of HIV infection that determined the occurrence of the disease. Taking into account this conclusion, a set of preventive and anti-epidemic measures is being developed and implemented, including training of HIV-infected people and contact persons, and the prescription of specific and non-specific prevention means.

6.4.1. If nosocomial infection is suspected, an epidemiological investigation is carried out by specialists from the bodies carrying out state epidemiological surveillance, together with specialists from AIDS Centers and/or specialists from the Federal State Institution, on the basis of which the federal and district centers for the prevention and control of AIDS, the Federal State Institution Republican Clinical Infectious Diseases Hospital (city of Moscow) operate. St. Petersburg), with the involvement of the necessary experts.

For each case of nosocomial infection, a set of preventive and anti-epidemic measures is carried out to localize the outbreak and prevent further spread of the infection, and an “Epidemiological Investigation Report” is drawn up.

6.4.2. Epidemiological investigations into sexual partners and drug-using partners are carried out using the “partner notification” method (if an HIV-infected person is detected, contact persons are identified and they are provided with individual counseling on HIV prevention issues). An HIV-infected person is given the opportunity to either independently inform their partners about the risk of HIV infection and invite them to counseling at the AIDS center, or provide the consultant with contact information about their partners (usually the partner’s name and phone number) for an invitation to counseling. The consultant must strictly follow the principle of anonymity of information and guarantee complete confidentiality to the first and all subsequent participants in the notification.

6.5. Dispensary observation of children is carried out by a pediatrician at the AIDS Center together with a pediatrician at the medical education facility.

6.6. During the appointment, the doctor carries out psychological adaptation of the patient, determines the completeness of the examination and treatment, evaluates and forms adherence to therapy.

6.7. Counseling on HIV infection issues is carried out during each examination of a patient with HIV infection as part of his dispensary observation.

6.7.1. When observing HIV-infected children, the persons caring for the child and those legally responsible for the child are consulted. Child counseling on HIV infection is carried out in accordance with age characteristics.

6.8. During dispensary observation, counseling and routine examinations are carried out before prescribing antiretroviral therapy, and during antiretroviral therapy, in accordance with existing standards, recommendations and protocols. It is necessary to ensure regular screening of HIV-infected people for tuberculosis (at least once every 6 months) and opportunistic infections, as well as prevention of tuberculosis and Pneumocystis pneumonia for all those in need in accordance with the requirements of regulatory documents.

6.9. Treatment of patients with HIV infection is carried out on a voluntary basis and includes the following areas: psychosocial adaptation of the patient, antiretroviral therapy, chemoprophylaxis of secondary diseases, treatment of secondary and concomitant diseases.

6.9.1. Antiretroviral therapy is an etiotropic treatment for HIV infection and is carried out for life. Its appointment and control of effectiveness and safety is carried out by the Center for the Prevention and Control of AIDS of a constituent entity of the Russian Federation. This function can be performed by the Federal State Budgetary Institutions, on the basis of which the federal and district centers for the prevention and control of AIDS operate; Federal State Institution Republican Clinical Infectious Diseases Hospital (St. Petersburg), as well as health care facilities under the methodological guidance of the AIDS Center.

6.9.2. To assess the effectiveness and safety of APT, regular studies of viral load, CD4 lymphocyte levels, clinical and biochemical blood tests, instrumental and clinical studies are carried out as part of clinical observation. The main criterion for the effectiveness of APT is the reduction of the viral load to an undetectable level.

6.9.3. Effective (with the achievement of an undetectable level of viral load) antiretroviral therapy is also a preventive measure that reduces the risk of the patient as a source of infection.

6.10. When identifying people infected with HIV who are undergoing hospital treatment, it is necessary to ensure that they undergo consultation with an infectious disease specialist at the AIDS Center, laboratory tests necessary to clarify the stage of the disease and decide on the prescription of antiretroviral therapy.

6.11. In order to increase the effectiveness of clinical observation and formation of adherence to antiretroviral therapy, a multiprofessional approach should be used with the involvement of the attending physician, nurse, specialized medical specialists, psychologists, social workers, and trained consultants from among HIV-infected people. The formation of patient adherence to dispensary observation is carried out on the basis of counseling technology within the framework of a patient-centered approach.

VII. State sanitary and epidemiological surveillance of HIV infection

7.1. Epidemiological surveillance of HIV infection is a system of constant dynamic and multidimensional monitoring of the dynamics and structure of morbidity (infection) of this infectious disease that occurs in the human population due to the peculiarity of the pathogenic agent (biological factor) that caused the infectious process, and various socio-demographic and behavioral characteristics of people.

7.2. The purpose of state sanitary and epidemiological surveillance of HIV infection is to assess the epidemiological situation, trends in the development of the epidemic process; monitoring the coverage of the population with prevention, clinical observation, treatment and support for HIV infection, the effectiveness of ongoing activities for making management decisions and the development of adequate sanitary and anti-epidemic (preventive) measures aimed at reducing the incidence of HIV infection; prevention of the formation of group diseases of HIV infection, severe forms and deaths.

7.3. State sanitary and epidemiological surveillance of HIV infection is carried out by bodies exercising state sanitary and epidemiological surveillance.

7.4. Identification, recording and registration of HIV-infected patients and HIV examinations are carried out in accordance with established requirements.

7.4.1. Each case of HIV infection (positive immunoblot test result) is subject to registration and registration at the place of detection in the health care facility, regardless of departmental affiliation and form of ownership. Records are kept at the patient’s place of residence to organize dispensary observation and treatment.

7.4.2. Information about a positive result of a blood test for HIV in immune blotting from the reference laboratory is transmitted to the screening laboratory and/or health care facility that sent the material for testing, as well as to the territorial bodies carrying out state sanitary and epidemiological supervision, the Federal Scientific and Methodological Center for Prevention and fight against AIDS. When HIV infection is detected in non-residents of the Russian Federation, information is transferred to the territorial center for the prevention and control of AIDS at the place of permanent registration of the patient.

7.4.3. Upon receipt of a positive test result for HIV from a donor of blood, organs and tissues, information from the reference laboratory is transmitted within 24 hours by telephone to blood service institutions (blood transfusion stations, blood transfusion departments) and to territorial bodies carrying out state sanitary and epidemiological supervision .

7.4.4. An extraordinary report on each case of HIV infection in treatment and prevention organizations or suspicion of it is transmitted to the bodies exercising state sanitary and epidemiological supervision in a constituent entity of the Russian Federation, to the Federal body exercising sanitary and epidemiological supervision in the Russian Federation and the Federal Scientific and Methodological Center for Prevention and the fight against AIDS.

Upon completion of the epidemiological investigation, the Epidemiological Investigation Report is sent to the Federal Authority for Sanitary and Epidemiological Surveillance in the Russian Federation and the Federal Scientific and Methodological Center for the Prevention and Control of AIDS.

7.4.5. The healthcare facility that has changed or clarified the diagnosis submits a secondary report on the patient with HIV infection to the Federal Scientific and Methodological Center for the Prevention and Control of AIDS and the territorial center for the Prevention and Control of AIDS at the place of permanent registration of the patient, indicating the changed (clarified) diagnosis, date its establishment in the case of:

Determining the causes of infection of an HIV-infected person,

Making a diagnosis of AIDS,

Determining the death of an HIV-infected or AIDS patient,

Change of patient's place of residence,

Removing the diagnosis of HIV infection,

Conclusions about the presence or absence of HIV infection in a child born to an HIV-infected mother.

7.5. Health care facilities that have laboratories conducting HIV research, regardless of organizational and legal forms, forms of ownership and departmental affiliation, including the Federal State Institution, on the basis of which the federal and district centers for the prevention and control of AIDS, the Federal State Institution "Republican Clinical Infectious Diseases Hospital" operate provide information on the results of a blood test for antibodies to HIV (monthly form N4 of the federal state statistical surveillance) to the center for the prevention and control of AIDS of the constituent entity of the Russian Federation on whose territory HIV testing is carried out.

7.6. Bodies carrying out sanitary and epidemiological supervision in the constituent entities of the Russian Federation, health authorities of the constituent entities of the Russian Federation ensure monitoring and evaluation of the effectiveness of measures for the prevention and treatment of HIV infection in the constituent entities of the Russian Federation in accordance with approved indicators, and send the monitoring results to the Federal authority, carrying out sanitary and epidemiological supervision in accordance with established requirements.

7.7. Providing information about the diagnosis of HIV infection without the consent of a citizen or his legal representative is permitted in cases provided for by the legislation of the Russian Federation:

For the purpose of examining and treating a citizen who is unable, due to his condition, to express his will;

If there is a threat of the spread of infectious diseases, mass poisonings and injuries;

At the request of the bodies of inquiry and investigation, the prosecutor and the court in connection with an investigation or trial;

At the request of military commissariats or military medical services;

In the case of providing assistance to a minor under the age of 18, to inform his parents or legal representatives;

If there are grounds to believe that harm to a citizen’s health was caused as a result of illegal actions.

With the written consent of a citizen or his legal representative, it is permitted to transfer information constituting medical confidentiality to other citizens, including officials, in the interests of examining and treating the patient, for conducting scientific research, publishing in scientific literature, using this information in the educational process and in for other purposes.

VIII. Sanitary and anti-epidemic (preventive) measures for HIV infection

Prevention of HIV infection must be carried out comprehensively in relation to the sources of the virus, mechanisms, routes and factors of transmission, as well as susceptible populations, including persons from vulnerable groups of the population.

8.1. Activities in epidemic foci of HIV infection

8.1.1. Activities carried out regarding the source of HIV infection

In relation to the identified source of HIV infection, measures are taken to reduce the likelihood of transmission of the virus:

8.1.1.1. Timely detection and diagnosis of HIV infection.

8.1.1.2. Specific therapy with antiretroviral drugs as prescribed by a doctor (including preventive chemotherapy in pregnant women) reduces the viral load in an HIV-infected person and reduces the risk of transmitting HIV infection.

8.1.1.3. Referring someone infected with HIV for STI testing and treatment reduces the risk of sexual transmission.

8.1.1.4. Referring injection drug users to drug dependence treatment reduces the source of drug-related virus transmission.

8.1.1.5. The ban on entry and deportation of HIV-infected foreign citizens in the manner established by the legislation of the Russian Federation reduces the number of sources of infection in the country.

8.1.2. Measures regarding mechanisms, routes and factors of transmission

8.1.2.1. Disinfection and sterilization of medical instruments and equipment in medical institutions, as well as equipment and instruments in hairdressing salons, beauty salons, piercing and tattoo salons, the use of disposable instruments.

8.1.2.2. Ensuring and monitoring the safety of medical manipulation practices and the use of barrier methods of protection.

8.1.2.3. Examination of blood donors and any other donated materials for the presence of antibodies to HIV at each donation of donated material, quarantine of blood products and rejection of infected donated material. Lifelong exclusion of HIV-infected and ELISA-positive persons during reference research from donating blood, plasma, organs and tissues.

8.1.2.4. Conducting an epidemiological investigation of HIV infection.

8.1.2.5. Consulting/training the population - both susceptible populations and sources of infection - on safe or less dangerous behavior.

8.1.2.6. Preventive work with vulnerable groups of the population (IDUs, sex workers, MSM, etc.).

8.1.2.7. Preventing the child’s contact with the mother’s biological fluids should be combined with the administration of ARV drugs and is achieved:

During childbirth with a planned cesarean section in HIV-infected women;

After childbirth, by replacing breastfeeding of a child of an HIV-infected mother with artificial feeding.

8.1.2.8. At the request of an HIV-infected woman, she can be provided with assistance to prevent unwanted pregnancy.

8.1.3. Measures for susceptible populations

8.1.3.1. Contact persons for HIV infection are considered to be persons who had the opportunity to become infected based on known mechanisms, routes and factors of transmission of the infectious agent. Establishing the fullest possible circle of people who had contact with an HIV-infected person makes it possible to inform about methods and means of protection against HIV infection during pre-test counseling and examination for HIV infection.

8.1.3.2. Teaching safe behavior regarding HIV infection is the main measure for preventing HIV infection among contact persons and the population.

8.1.3.3. Carrying out preventive chemoprophylaxis. For emergency prevention of the disease, antiretroviral drugs are prescribed to persons at risk of contracting HIV infection, including: newborns of HIV-infected mothers, health workers and other persons injured while providing care to HIV-infected persons, citizens in respect of whom there is reason to believe the presence of contact resulting in a risk of HIV infection.

8.2. Prevention of hospital-acquired HIV infection

8.2.1. The basis for the prevention of nosocomial HIV infection is compliance with the anti-epidemic regime in medical institutions in accordance with established requirements (SANPIN 2.1.3.2630-10 “Sanitary and epidemiological requirements for organizations engaged in medical activities”, registered with the Ministry of Justice of Russia on August 9, 2010. N18094). Preventive measures are carried out on the basis that each patient is regarded as a potential source of blood-borne infections (hepatitis B, C, HIV and others).

8.2.2. Monitoring and assessment of the state of the anti-epidemic regime in healthcare facilities is carried out by bodies exercising state sanitary and epidemiological supervision.

8.2.2.1. In order to prevent nosocomial transmission of HIV infection, it is necessary to ensure:

8.2.2.1.1. Compliance with established requirements for disinfection, pre-sterilization cleaning, sterilization of medical devices, as well as for the collection, disinfection, temporary storage and transportation of medical waste generated in medical facilities.

8.2.2.1.2. Equipping with the necessary medical and sanitary equipment, modern atraumatic medical instruments, means of disinfection, sterilization and personal protection (special clothing, gloves, etc.) in accordance with regulatory and methodological documents. Single-use products must be decontaminated/decontaminated after use during manipulations on patients; their reuse is prohibited.

8.2.2.1.3. If a case of nosocomial HIV infection is suspected, a set of preventive and anti-epidemic measures is carried out in health care facilities:

8.2.2.1.4. An unscheduled sanitary and epidemiological investigation is carried out with the aim of identifying the source, transmission factors, establishing a circle of contact persons, both among staff and among patients who were in equal conditions, taking into account the risk of possible infection, and implementing a set of preventive and anti-epidemic measures to prevent infection in conditions LPO.

8.3. Prevention of occupational HIV infection

In order to prevent occupational HIV infection, the following is carried out:

8.3.1. A set of measures to prevent emergency situations when performing various types of work.

8.3.2 Accounting for cases of injuries, microtraumas received by personnel of health care facilities and other organizations during the performance of professional duties, emergency situations involving contact of blood and biological fluids with the skin and mucous membranes.

8.3.3. If an emergency situation occurs at the workplace, a medical worker is obliged to immediately take a set of measures to prevent HIV infection.

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 clothing: 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.

8.3.3.2. It is necessary, as soon as possible after contact, to examine for HIV and viral hepatitis B and C a 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. Samples of plasma (or serum) from the blood of a person who is a potential source of infection and a contact person are transferred for storage for 12 months to the AIDS center of a constituent entity of the Russian Federation.

The victim and the person who may be a potential source of infection must be interviewed about the carriage of viral hepatitis, STIs, inflammatory diseases of the genitourinary tract, and other diseases, and counseled 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; if additional information becomes available, the regimen is adjusted.

8.3.3.3. Carrying out post-exposure prophylaxis of HIV infection with antiretroviral drugs:

8.3.3.3.1. Antiretroviral medications should be started within the first two hours after the accident, but no later than 72 hours.

8.3.3.3.2. 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.

8.3.3.3.3. 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;

8.3.3.3.4. 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 storing antiretroviral drugs, a storage location with access, including at night and on weekends.

8.4. Prevention of HIV infection during transfusion of donor blood and its components, organ and tissue transplantation and artificial insemination

8.4.1. Prevention of post-transfusion HIV infection, HIV infection during organ and tissue transplantation and artificial insemination includes measures to ensure safety during the collection, procurement, storage of donor blood and its components, organs and tissues, as well as when using donor materials.

8.4.2. Preparation of donor blood and its components, organs and tissues.

8.4.2.1. Donors of blood, blood components, organs and tissues (including sperm) are allowed to take donor material after studying documents and the results of a medical examination confirming the possibility of donation and its safety for medical use.

8.4.2.2. When carrying out activities to promote blood plasma donation, it is necessary to explain the need for re-examination of the donor 6 months after donation.

8.4.2.3. The safety of donor blood, its components, donor organs and tissues is confirmed by negative results of laboratory testing of donor blood samples taken during each collection of donor material for the presence of pathogens of blood-borne infections, including HIV, using immunological and molecular biological methods.

8.4.2.4. Sampling of donor blood to determine markers of blood-borne infections is carried out during the procedure of donating blood and blood components directly from the blood system (without compromising the integrity of the system) or a special satellite container for samples included in this system, into vacuum-containing (vacuum-forming) disposable tubes , corresponding to the applied research methods. When collecting organs and tissues (including sperm), donor blood samples are taken to determine markers of blood-borne infections in parallel with the procedure for collecting donor material (at each donation of donor material).

8.4.2.5. When examining a donor's blood sample, the presence of antibodies to HIV-1, 2 and HIV p24 antigen is simultaneously determined. The first immunological test (ELISA) is carried out in a single setting. If a positive test result is obtained, the corresponding test (ELISA) is repeated twice using the reagents used in the first test. If at least one positive result is obtained during repeated testing for HIV markers, the donor material is disposed of, and the sample is sent for reference research.

8.4.2.6. It is prohibited to use test systems with lower sensitivity and specificity for re-analysis of seropositive blood samples, as well as test systems or methods of a lower generation than those used in the initial analysis.

8.4.2.7. Molecular biological studies (PCR, NAT) are carried out in addition to mandatory immunological tests (ELISA) for markers of blood-borne infections in accordance with the requirements of regulatory documentation and have an auxiliary value.

8.4.2.8. The first molecular biological study is carried out in a single setting. If a positive test result is obtained, the corresponding study is repeated twice using the reagents used in the first test. If at least one positive result is obtained during repeated testing, the donor blood sample is considered positive, and the donor material is disposed of.

8.4.2.9. Health care institutions that procure donated blood and its components are required to develop a system of good manufacturing practices that guarantee the quality, effectiveness and safety of blood components, including the use of modern methods for identifying markers of HIV-1, 2 and viral hepatitis and participation in an external quality control system.

8.4.2.10. Donor blood and its components are transferred to medical institutions for transfusions only after repeated (at least 6 months) examination of the donor for the presence of markers of HIV-1, 2 viruses and other blood-borne infections to exclude the possibility of undetected infection during the seronegative window (quarantine) . Quarantine of fresh frozen plasma is carried out for a period of at least 180 days from the moment of freezing at a temperature below minus 25 C. Upon expiration of the quarantine period for fresh frozen plasma, a re-examination of the donor's health status and laboratory testing of the donor's blood are carried out in order to exclude the presence of pathogens of blood-borne infections in it.

8.4.2.11. Blood components with a short shelf life (up to 1 month) should be taken from regular (repeat) donors and used within the expiration date. Their safety must be further confirmed by PCR and other NAT technology methods. In this case, blood plasma (serum) from the same and the next donation is used as the object of study.

8.4.2.12. As an additional measure that increases the viral safety of blood and its components without replacing them, the use of methods for inactivating pathogenic biological agents is allowed.

8.4.2.13. Donor blood and its components that do not meet safety requirements or are unused are isolated and subjected to disposal, including disinfection with disinfectant solutions or the use of physical disinfection methods using equipment approved for these purposes in accordance with the established procedure, as well as disposal of generated waste.

8.4.2.14. Data on donors of blood and its components, procedures and operations performed at the stages of procurement, processing, storage of donor blood and its components, as well as on the results of the study of donor blood and its components are registered on paper and (or) electronic media. Registration data is retained for 30 years and must be available for regulatory review.

8.4.3. When an organization donating blood and its components receives information about the possible infection of a recipient with blood-borne infections, it is necessary to identify the donor (donors) from whom the infection may have occurred and take measures to prevent the use of donor blood or its components received from this donor (donors).

8.4.3.1. If information is received about the possible infection of a recipient with blood-borne infections, an analysis of previous cases of donation for a period of at least 12 months preceding the last donation is carried out, the documentation is re-analyzed, and the organization processing blood (plasma) assesses the need to recall manufactured blood products, taking into account type of disease, time interval between donation and blood testing and product characteristics.

8.4.4. In the production of blood products, the safety of donor blood in accordance with general principles is confirmed by negative results of laboratory testing of donor blood samples taken during each collection of donor material for the presence of pathogens of blood-borne infections, including HIV, using immunological and molecular biological methods.

8.4.4.1. Additionally, when processing plasma to obtain blood products, it is necessary to examine the plasma combined into the technological load for the presence of pathogens of blood-borne infections.

8.4.4.2. At all stages of production, measures must be in place to track the donation of blood plasma included in the boiler load, production waste (disposed of or transferred to other production) and the finished medicinal product.

8.4.4.3. All plasma rejected during entry control for fractionation is subject to mandatory disposal.

8.4.5. Carrying out transfusions of donor blood and its components, organ and tissue transplantation and artificial insemination.

8.4.5.1. Transfusion of donor blood and its components, transplantation of organs and tissues and artificial insemination from donors who have not been examined for the presence of pathogens of blood-borne infections, including HIV, using immunological and molecular biological methods are prohibited.

8.4.5.2. The physician prescribing blood transfusions of blood products must explain to the patient or his relatives the existence of a potential risk of transmission of viral infections, including HIV, through blood transfusion.

8.4.5.3. All manipulations for the administration of blood transfusion media and blood products must be carried out in accordance with the instructions for use and other regulatory documents.

8.4.5.4. It is prohibited to administer blood transfusion media and drugs from human blood from one package to more than one patient.

8.4.6. In case of transfusion of donor blood, its components, transplantation of donor organs and tissues from an HIV-infected donor, post-exposure chemoprophylaxis for HIV infection with antiretroviral drugs must be carried out immediately (but no later than 72 hours after the transfusion/transplant).

8.5. Prevention of vertical transmission of HIV infection

8.5.1. Detection of HIV infection in a pregnant woman is an indication for prevention of mother-to-child transmission of HIV.

8.5.2. Infection of a child from an HIV-infected mother is possible during pregnancy, especially in the later stages (after 30 weeks), during childbirth and during breastfeeding.

8.5.3. The probability of HIV transmission from mother to child without preventive measures is 20 - 40%.

8.5.4. The use of preventive medical interventions can reduce the risk of infection of a child from the mother to 1 - 2%, even in the later stages of HIV infection.

8.5.5. The maximum effectiveness of preventive measures aimed at preventing the transmission of HIV infection from mother to child is achieved by reducing the viral load in the mother’s blood to an undetectable level (during pregnancy and childbirth) and preventing the child’s contact with the mother’s biological fluids (during and after childbirth - blood, vaginal discharge, breast milk).

8.5.6. To reduce the amount of virus in the blood of a pregnant woman, it is necessary to provide counseling and prescribe antiretroviral drugs.

8.5.7. In order to prevent contact of blood and other tissues of the mother and child, it is necessary:

8.5.7.1. Carry out delivery when the mother's viral load is more than 1,000 copies of HIV RNA / ml of plasma, or, if it is unknown, by planned cesarean section: upon reaching the 38th week of pregnancy, before the onset of labor and rupture of amniotic fluid. During natural childbirth, reduce the anhydrous period to 4-6 hours.

8.5.7.2. Motivate an HIV-infected woman to refuse breastfeeding and latching on her newborn.

8.5.8. Drug prevention of mother-to-child transmission of HIV infection (chemoprophylaxis) involves prescribing antiretroviral drugs to mother and child. Antiretroviral drugs (ARVs) are prescribed to a woman from the 26-28th week of pregnancy (if the woman does not have indications for continuous antiretroviral therapy), during childbirth and to the child after birth.

8.5.8. 1. Indications for prescribing ARVs for women and children:

Presence of HIV infection in a pregnant woman;

A positive result of testing for antibodies to HIV in a pregnant woman, including using rapid tests;

Epidemiological indications in a pregnant woman (if the test result is negative for HIV and there is a risk of HIV infection in the last 12 weeks).

8.5.8.2. To prevent mother-to-child transmission of HIV during pregnancy and childbirth, a regimen of three antiretroviral drugs is prescribed: 2 nucleoside reverse transcriptase inhibitors + 1 non-nucleoside reverse transcriptase inhibitor or 1 boosted protease inhibitor. In the process of chemoprophylaxis with antiretroviral drugs, comprehensive monitoring of the effectiveness and safety of therapy is carried out according to a standard regimen.

8.5.8.3. Chemoprophylaxis is prescribed to all children of HIV-infected mothers from the first hours of life, but no later than 72 hours after birth or from the moment of the last breastfeeding (subject to its subsequent abolition). The choice of antiretroviral prophylaxis regimen for a child is determined by the completeness and quality of chemoprophylaxis in the mother during pregnancy; the regimen includes 1 or 3 drugs.

8.6. Prevention of HIV infection in public service organizations

8.6.1. Prevention of HIV infection in domestic service organizations (hairdressers, manicures, pedicures, beauty salons, offices, etc.), regardless of departmental affiliation and forms of ownership, is ensured in accordance with the requirements of SanPiN 2.1.2. 2631-10 “Sanitary and epidemiological requirements for the location, design, equipment, maintenance and operating hours of public utility organizations providing hairdressing and beauty services”, registered by the Ministry of Justice of the Russian Federation on 07/06/2010, registration number 17694.

8.6.2. The organization and conduct of production control is entrusted to the head of the organization.

IX. Hygienic education of the population

9.1. Hygienic education of the population is one of the main methods of preventing HIV infection. No single activity can prevent or stop the HIV epidemic in the region. A comprehensive, targeted program of prevention, treatment and care should be carried out for different groups of the population.

9.2. Hygienic education of the population includes: providing the population with detailed information about HIV infection, measures of nonspecific prevention of HIV infection, the main symptoms of the disease, the importance of timely identification of sick people, the need to register them with a dispensary and other activities using the media, leaflets, posters, newsletters, carrying out individual work aimed at developing behavior that is less dangerous in relation to HIV infection.

9.3. Public education should include coverage of all approaches to safe and less dangerous behavior in terms of contracting HIV infection: safe sexual behavior, safety of parenteral interventions, professional safety.

9.4. Preventive work among the population is carried out by bodies and institutions of Rospotrebnadzor in the constituent entities of the Russian Federation, health authorities and institutions, including: centers for the prevention and control of AIDS, drug treatment clinics and drug rehabilitation centers, dermatovenerological clinics, antenatal clinics and perinatal centers, centers medical prevention, health centers, employers, non-governmental and other organizations under the methodological guidance of the AIDS Center.

9.5. Health care facilities, regardless of departmental subordination, must have in a place accessible to patients and visitors visual propaganda on the prevention of HIV infection, drug use, information about the activities of medical institutions and public organizations providing assistance to HIV-infected people who use psychoactive substances, persons who provide sexual services for a fee, victims of violence, and helpline numbers.

9.6. The curricula of educational institutions (municipal educational institutions, higher educational institutions, secondary specialized educational institutions, initial vocational training institutions, vocational schools) must include issues of HIV prevention.

9.7. It is necessary to ensure the implementation of HIV prevention programs in the workplace.

9.8. It is necessary to ensure the implementation of HIV prevention programs among population groups at high risk of HIV infection (injecting drug users, men who have sex with men, commercial sex workers).

– 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,nasal mucosa and eyes are washed generously with water (do not rub);

– if blood or other biological fluids of the patient get on the gown or clothes: remove work clothes and immerse 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.

8.3.3.2. It is necessary, as soon as possible after contact, to test for HIV and viral hepatitis B and C a 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. Samples of plasma (or serum) from the blood of a person who is a potential source of infection and a contact person are transferred for storage for 12 months to the AIDS center of a constituent entity of the Russian Federation.

8.3.3.3. Carrying out post-exposure prophylaxis of HIV infection with antiretroviral drugs:

8.3.3.3.1. Antiretroviral medications should be started within the first two hours after the accident, but no later than 72 hours.

When do emergencies involving the likelihood of infection of healthcare workers most often occur?

How to prevent emergencies and occupational infections of medical workers?

What personal protective equipment should healthcare workers use?

What is the algorithm of actions in case an emergency does occur?

In the Russian Federation, blood-borne infections occupy second place (more than 30%) in the overall structure of occupational morbidity among medical personnel, second only to tuberculosis. In this regard, healthcare institutions should implement a system of preventive measures aimed at preventing the occurrence of medical accidents and occupational infections of personnel.

Medical workers can become infected with blood-borne infections in the event of emergency situations, which include injuries and microtraumas from contaminated sharp medical instruments, contact with blood and other biological fluids on mucous membranes and unprotected skin.

Emergency situations associated with the likelihood of infection of health care workers most often occur:

when performing injections;
collection of venous blood;
transfer of sharp surgical instruments from hand to hand, improper handling of epidemiologically hazardous medical waste;
cleaning the workplace;
failure to comply with infection safety requirements during work.

The risk of contracting HIV infection when pricked with a contaminated needle is 0.3%, hepatitis B - from 1 to 30%, hepatitis C - up to 7%.

Potentially hazardous patient fluids include:

blood;
sperm;
vaginal discharge;
lymph;
synovial fluid;
cerebrospinal fluid;
pleural fluid;
pericardial fluid;
amniotic fluid.

The following are at high risk of contracting bloodborne infections:

nurses performing invasive procedures, including procedural, guard, ward, operating room nurses;
doctors of surgical specialties performing surgical interventions;
obstetricians-gynecologists;
anesthesiologists-resuscitators;
pathologists;
dentists and dentists;
laboratory service staff;
emergency medical personnel;
junior medical personnel involved in the processing of single-use and reusable medical products, and the management of medical waste.

The following factors contribute to the occurrence of emergencies among medical workers:

shortage of working time;
night work;
professional inexperience of the medical worker;
lack of infectious alertness.

MEASURES TO PREVENT EMERGENCIES AND OCCUPATIONAL INFECTION OF MEDICAL WORKERS

Medical workers are allowed to work in which contact with infected biological material is possible only after appropriate instruction at the workplace, which must be noted in the instruction logbook.

Instruction of medical workers on occupational safety issues, including the prevention of occupational infections and safe handling of medical waste, is carried out by the head of the structural unit at least once a year.

The administration of a medical organization is obliged to organize the work and rest regime of medical workers in accordance with labor legislation, provide staff with the necessary personal protective equipment, hand hygiene products, safe medical products (including vacuum tubes for collecting venous blood (Fig. 1), blunt-ended suture surgical needles, scalpels with protective caps (Fig. 2), etc.).

When performing professional duties, personnel of medical organizations must consider each patient as a potential source of infection, including HIV infection and viral hepatitis. During manipulations involving contact with biological fluids, a medical worker must strictly observe precautions and use the necessary personal protective equipment.

Medical workers with exudative lesions of the skin of the hands are excluded from performing invasive manipulations for the duration of the disease.

If there are cuts, scratches, abrasions, etc. on the skin of the hands, carefully seal the damaged areas with adhesive tape before starting work, and use finger pads if necessary.

Important!

Regardless of the use of gloves, before any contact with the patient or objects in his environment, as well as after such contact, the medical worker is required to perform hand hygiene, and, if necessary, disinfect the hands of surgeons.

To prevent the development of dermatitis and skin trauma, medical personnel must follow a number of recommendations:

do not resort to frequent hand washing with soap; when performing hand hygiene, give preference to alcohol-containing skin antiseptics;
Avoid using hot water when washing your hands;
do not use hard brushes to wash your hands;
When using towels, do not rub the skin of your hands to avoid the formation of microcracks;
do not put on gloves after treating your hands until they are completely dry;
regularly use creams, lotions, balms and other hand skin care products.

Medical instruments and medical devices contaminated with biological fluids of patients can be disassembled, washed and rinsed only after preliminary disinfection.

During surgical interventions and other invasive procedures, special care must be taken when using sharp medical instruments, especially when applying sutures during suturing of wounds and blood vessels.

Do not point the tip of the instrument at your own non-dominant hand or the hands of an assistant during operations.

When transferring medical instruments, use a tray (Figure 3) or a neutral area on the operating table (Figure 4).

To transport contaminated instruments in the operating room, it is advisable to use magnetic mats.

If blood and other epidemiologically dangerous biological fluids of patients get on the floor, walls, furniture, equipment and other surrounding objects, it is necessary to treat the contaminated area with a disinfectant solution that is active against pathogens of blood-borne infections.

All departments of a medical organization in which personnel may come into contact with the blood of patients must be provided with emergency prevention kits for parenteral infections (Anti-AIDS first aid kits; Fig. 5), as well as leaflets with an algorithm for post-contact measures in emergency situations.

Composition of the pack for emergency prevention of parenteral infections:

70% ethyl alcohol;

5% alcohol solution of iodine;

sterile medical gauze bandage (5 m × 10 cm) - 2 pcs.;

bactericidal adhesive plaster (at least 1.9 cm × 7.2 cm) - 3 pcs.;

sterile medical gauze napkin (at least 16×14 cm, No. 10) - 1 pack;

Responsibility for the availability and configuration of equipment is usually assigned to the senior nurses of the institution.

Note:

1. The emergency prevention kit for parenteral infections is placed in a case or container with strong locks (fasteners). The material and design of the container must allow disinfection.

2. The equipment should be equipped with medical devices registered in the Russian Federation. After expiration dates, medicines and medical devices are subject to write-off and disposal in accordance with current legislation.

PERSONAL PROTECTION EQUIPMENT FOR MEDICAL WORKERS

All manipulations in which there is a risk of transmitting blood-borne infections must be performed using barrier protective equipment, which includes a medical gown or suit (overalls), closed shoes, a cap (cap), a mask, and gloves.

Waterproof sleeves and aprons can be used as additional means of protection in case of a high risk of infection.

When performing medical procedures that may result in splashing of blood or other body fluids, personnel should use special face shields or safety glasses (Figure 6).

In rooms where invasive procedures are performed, there should be a spare set of medical clothing.

Washing of workwear is carried out centrally; washing of workwear at home is prohibited.

When performing invasive manipulations with a high level of epidemiological risk, gloves are used that reduce the likelihood of infection of a medical worker:

double gloves, including those with puncture indicator (Fig. 7);

gloves with internal antibacterial coating (Fig. 8);

“chainmail” gloves (Fig. 9).

If the integrity of the gloves is compromised, they must be removed as soon as possible and hand hygiene performed.

Even if only one of the gloves is damaged, both must be replaced. A new pair of gloves should be put on hands that are completely dry after treatment in order to prevent adverse reactions from the skin.

If gloves are contaminated with patient blood or secretions, remove them using a swab or napkin moistened with a disinfectant or antiseptic solution to avoid contamination of hands during removal of gloves.

Important!

Reuse of gloves is strictly prohibited. It is not recommended to treat gloves with alcohol-containing or other antiseptic agents - in this case, the porosity and permeability of the material increases.

MEDICAL EXAMINATIONS AND VACCINATIONS OF STAFF

Upon entering work, all medical workers must be vaccinated in accordance with the current schedule of preventive vaccinations, including against viral hepatitis B.

Vaccination of medical workers against viral hepatitis B is carried out regardless of age. When the intensity of post-vaccination immunity decreases, revaccination against viral hepatitis B is carried out, which is subject to medical workers who have contact with blood and/or its components, including:

staff from blood service departments, hemodialysis departments, kidney transplant departments, cardiovascular and pulmonary surgery departments, burn centers and hematology;
personnel of clinical diagnostic and biochemical laboratories;
doctors, nursing and junior medical staff of surgical, urological, obstetric-gynecological, anesthesiological, resuscitation, dental, oncological, infectious diseases, therapeutic, including gastroenterological hospitals, departments and clinics;
medical staff of emergency stations and departments.

Serological studies of the intensity of post-vaccination immunity to hepatitis B are recommended to be carried out every 5-7 years.

Medical workers of the following institutions and departments of medical organizations are subject to examination for the presence of HBsAg by ELISA and Anti-HCV IgG in blood serum upon hiring and annually thereafter:

institutions for donating blood and its components;
centers, departments of hemodialysis, organ transplantation, hematology;
clinical diagnostic laboratories;
surgical, urological, obstetric-gynecological, ophthalmological, otolaryngological, anesthesiological, resuscitation, dental, infectious diseases, gastroenterological hospitals, departments and offices (including dressing rooms, treatment rooms, vaccination rooms);
dispensaries;
perinatal centers;
ambulance stations and departments;
disaster medicine centers;
FAPs, health centers.

Medical workers of the following institutions and departments of medical organizations are subject to mandatory screening for HIV infection using the ELISA method upon hiring and annually thereafter:

centers for the prevention and control of AIDS;
healthcare institutions, specialized departments and structural divisions of institutions engaged in direct examination, diagnosis, treatment, service, as well as forensic medical examination and other work with persons infected with HIV, having direct contact with them;
surgical hospitals and departments;
laboratories that screen the population for HIV infection and study blood and biological materials obtained from persons infected with the human immunodeficiency virus.

MEDICAL WASTE HANDLING

Collection, accumulation, storage, disinfection (neutralization) of medical waste must be carried out in accordance with the requirements of SanPiN 2.1.7.2790-10 “Sanitary and epidemiological requirements for the management of medical waste.”

Persons at least 18 years of age who are immunized against hepatitis B are allowed to work with medical waste.

Persons handling medical waste, upon hiring and then annually, must undergo mandatory safety training when working with waste.

Personnel working with medical waste are provided with special clothing and personal protective equipment.

To collect sharps medical waste, use puncture-proof, moisture-resistant containers equipped with needle removers and lids that prevent spontaneous opening (Fig. 10).

Containers for collecting sharp medical waste must be changed at least once every 72 hours, in operating rooms - after each operation.

When handling medical waste it is prohibited:

manually destroy and cut waste of classes B and C, including used systems for intravenous infusions, hemacons with residual amounts of blood, in order to disinfect them;
manually remove the needle from the syringe after using it, put the cap on the needle after injection;
pour and reload unpackaged waste of classes B and C from one container to another;
compact waste of classes B and C;
carry out any operations with waste without gloves or the necessary personal protective equipment and protective clothing;
use soft disposable packaging to collect sharp medical instruments and other sharp objects;
install disposable and reusable waste collection containers at a distance of less than 1 m from heating devices.

RULES FOR WORKING WITH BIOLOGICAL MATERIAL

Biological materials should be delivered to the laboratory in closed containers or cooler bags, the design of which allows them to be washed and treated with disinfectants (Fig. 11).

An absorbent material (gauze pad, fabric, cotton wool, etc.) is placed at the bottom of the container for transportation. The container must be marked and have the international “Biohazard” sign.

Delivery of material in shopping bags, suitcases, briefcases and other personal items is not allowed.

All delivered containers with liquid materials must be closed with stoppers (lids) to prevent spontaneous opening during transportation. Test tubes with biological fluids are additionally placed in a rack.

When receiving and disassembling material delivered to the laboratory, precautions must be observed.

The containers are placed on a tray or tray covered with a multi-layer gauze napkin moistened with a disinfectant solution.

Laboratory personnel, when accepting and disassembling biological material, must use personal protective equipment - masks and rubber gloves.

When working with biological material, it is not allowed to use test tubes with broken edges, it is forbidden to pipette with your mouth (it is necessary to use automatic pipettes, bulbs), and it is forbidden to pour liquid material over the edge of a test tube (bottle).

Centrifugation of biological fluids and other operations with a high potential for aerosol generation should be carried out in biological safety cabinets or separate cubicles. It is prohibited to remove undisinfected blood clots from test tubes by shaking them out.

To disinfect, tubes with blood clots must be immersed in a disinfectant solution in an inclined position using tweezers.

All work with biological material is carried out using personal protective equipment: gloves, masks, caps, medical gown or suit, medical shoes.

After finishing work with biological material, personnel perform mandatory hand hygiene.

ACTIONS OF MEDICAL STAFF IN THE EVENT OF EMERGENCY SITUATIONS

Algorithm of actions of medical personnel in emergency situations:

1. In case of injections and cuts with instruments contaminated with biological fluids of patients, it is necessary to immediately treat and carefully remove gloves, wash your hands with soap under running water, then treat them with a 70% ethyl alcohol solution, lubricate the wound with a 5% alcohol solution of iodine . If necessary, cover the damaged area of skin with a bactericidal adhesive plaster or apply an aseptic bandage.

2. If blood or other biological fluids come into contact with the skin, it is necessary to treat the area of skin at the site of contact with biological material with a 70% ethyl alcohol solution, then wash with soap and water, and re-treat with an alcohol solution.

3. If blood and other biological fluids get on the mucous membranes of the mouth, eyes and nose: rinse the oral cavity with plenty of water and rinse with a 70% solution of ethyl alcohol, immediately rinse the mucous membranes of the nose and eyes with plenty of water (do not rub!).

4. In case of contamination of work clothes with biological fluids that are potentially dangerous in relation to bloodborne infections, they must be removed and immersed in a working solution of a disinfectant (for example, “Abacteril”, “Alaminol”, “Wendelin”, “Hexaquart Forte”, “Lizarin”, "Mistral", etc.) or autoclave; Treat shoes with a working solution of disinfectant in accordance with the instructions supplied with it.

DOCUMENTING AN EMERGENCY

If an emergency occurs, the medical worker is obliged to inform his immediate supervisor or the head of the structural and functional unit about the incident. Information about the emergency situation is entered into the Emergency Situations Logbook during medical procedures.

A report on a medical accident in the institution is drawn up.

EXAMINATION OF THE VICTIM AND PATIENT

To resolve the issue of the need for emergency chemoprophylaxis, the injured healthcare worker and the patient, who is a potential source of infection, are immediately examined using rapid testing for antibodies to HIV with the obligatory sending of samples from the same portions of blood for testing for HIV using the standard ELISA method.

If a medical organization does not have its own laboratory, rapid tests for HIV antibodies can be performed by a trained medical professional who has been instructed in accordance with the order of the institution. Store rapid tests in accordance with the conditions specified in the instructions for their use.

Plasma (or serum) samples from the blood of the patient, who is a potential source of infection, and the injured medical worker are transferred to the Center for Prevention and Control of AIDS for storage for 12 months.

As soon as possible after an emergency, a person who may be a potential source of infection and a medical worker who has been exposed to the risk of infection are examined for markers of viral hepatitis B and C. If the medical worker injured in the emergency is a woman, a pregnancy test must be performed and find out if she is breastfeeding the baby.

POST-EXPOSURE PREVENTION AND FOLLOW-UP MONITORING AFTER AN EMERGENCY

Post-exposure chemoprophylaxis of HIV infection

The optimal time to begin chemoprophylaxis of HIV transmission is the first 2 hours from the moment of the emergency.

Prophylactic medication must be started no later than 72 hours after the injured healthcare worker comes into contact with biological material.

Post-exposure chemoprophylaxis for the transmission of HIV infection to a medical worker injured in an emergency situation begins to be carried out in cases where the patient, who is a potential source of infection:

HIV positive;
when examined using rapid testing for antibodies to HIV, has a positive result;
unknown;
belongs to risk groups (user of injecting drugs or psychoactive substances, has casual sexual contacts, sexually transmitted diseases, etc.).

To carry out anti-epidemic measures and chemo-prevention of HIV transmission in emergency situations, each medical organization must have a stock of antiretroviral drugs. Access of medical personnel to drugs for chemoprophylaxis should be unhindered at any time of the day, including on weekends and holidays.

To correct the chemoprophylaxis regimen, the victim is sent to the Center for Prevention and Control of AIDS on the next working day.

Post-exposure prophylaxis of viral hepatitis

If the examination results for viral hepatitis B and C are positive for the patient with whose biological fluids there was contact, the injured medical worker is referred for consultation with an infectious disease specialist. If there are epidemiological indications, emergency immunoprophylaxis of hepatitis B is carried out.

Unvaccinated medical workers are given the hepatitis B vaccine and, if possible, specific immunoglobulin within 48 hours of the emergency. The hepatitis B vaccine and specific immunoglobulin are administered simultaneously, but in different areas of the body. Immunoglobulin is administered in a dose of 0.06-0.12 ml (at least 6 IU) per 1 kg of body weight once, emergency vaccination is carried out according to the scheme 0-1-2-6 months.

In medical workers vaccinated against hepatitis B, the strength of immunity is determined (if possible). If the titer of protective antibodies at the time of contact is more than 10 mIU/ml, then hepatitis B prophylaxis is not carried out; if the antibody concentration is less than 10 mIU/ml, then the victim in an emergency is given a booster dose of the vaccine and 1 dose of immunoglobulin.

Dispensary observation of medical workers injured in emergency situations

The period of clinical observation is determined by the maximum duration of the incubation period of HIV infection and is 1 year.

During observation, the injured medical worker is examined for HIV infection using the ELISA method after 3, 6, 12 months from the moment of the emergency. If markers of viral hepatitis B and/or C are detected in a patient who is a potential source of infection, then the injured medical worker must be examined for these infections 3 and 6 months after the emergency.

The affected medical worker should be warned that, despite negative examination results, he may be a source of infection for others during the entire observation period due to the existence of a seronegative (seroconversion) window. For 12 months, a medical worker involved in an emergency cannot have unprotected sex or become a donor.

After 12 months, if laboratory test results are negative, the victim is removed from dispensary observation.

Note!

If a positive result is obtained during the examination of the victim, an investigation is carried out into the circumstances and causes of the employee’s occupational disease in the manner established by the legislation of the Russian Federation.

ORGANIZATIONAL AND METHODOLOGICAL MEASURES FOR PREVENTION OF EMERGENCIES IN A MEDICAL ORGANIZATION

A medical organization must keep records and analyze emergency situations associated with the risk of infection of medical personnel. Accounting and analysis are carried out by a medical organization's epidemiologist, chief nurse or other specialist in accordance with the order of the institution.

In the course of retrospective epidemiological studies, the responsible specialist assesses the frequency of emergency situations in a medical organization as a whole, as well as by department, and identifies risk factors and risk groups among medical personnel.

When carrying out the analysis, it is necessary to calculate the proportion of emergency situations in which post-exposure preventive measures were carried out in accordance with the algorithms developed in the medical organization.

Based on the results of the study, measures are being developed to reduce the risk of infection among medical workers.

Note!

Algorithms for post-exposure prophylaxis in emergency situations, measures to prevent occupational infection, and a list of persons responsible for this section of activity must be set out in an order for the institution, which is approved by the head of the medical organization.

In order to prevent emergency situations and occupational infections, regular training of medical personnel is carried out. Trainings, business and educational role-playing games, and visual aids are most effective.

An assessment of the level of knowledge of medical personnel regarding the prevention of emergency situations should be carried out annually.

P. E. Sheprinsky, chief physician of the Vologda City Hospital No. 1
E.V. Dubel, head. epidemiological department - epidemiologist of the Vologda City Hospital No. 1