III. Measures in case of emergencies

General provisions

This Procedure for the provision of medical care to medical workers and the chemoprophylaxis of HIV infection, the prevention of other blood-borne infections in the event of an emergency in state medical organizations of the Novosibirsk Region regulates the provision of medical care and other measures taken in the event of an emergency in state medical organizations of the Novosibirsk Region, in for the prevention of occupational infection of HIV infection and other blood-borne infections of medical workers.

II. Measures to prevent occupational exposure to HIV infection and blood-borne infections

2.1. The main task of preventing occupational infection of medical workers is the maximum prevention of contact with blood (biological fluids) of any patient. In medical organizations, all patients should be considered as potential sources of infection.

2.2. If the work of medical personnel does not exclude contact with blood, biological fluids and tissues at the workplace, a first aid kit should be stocked. It consists of:

ยท 70% solution of ethyl alcohol (200.0 ml.);

5% alcohol solution of iodine (50.0 ml.);

Adhesive plaster – 1 piece;

Sterile gauze wipes – 10 pcs.;

surgical cotton wool – 50.0 gr.;

sterile gauze bandage – 2 pcs.;

2.3. When carrying out parenteral manipulations, it is necessary to ensure the integrity of the skin. If there are open wounds, it is necessary to protect the damaged skin with waterproof dressings. Medical personnel must be vaccinated against hepatitis “B” without fail.

2.4. If during work contact with the patient’s blood or other biological fluids may occur, personal protective equipment must always be used: mask, goggles (or screen), gown, gloves, cap, if necessary, an apron. Gloves must be worn prior to any parenteral manipulation on the patient.

2.5. When providing medical care, it is prohibited:

a) removing disposable needles with unprotected hands;

b) putting on protective caps on disposable needles after their use;

c) pipetting of biological fluids by mouth is prohibited in laboratories;

d) it is strictly forbidden to rub mucous membranes contaminated with blood or other biological fluids.

2.6. When collecting medical waste, it is prohibited:

a) manually destroy, cut waste of classes B and C, including used systems for intravenous infusion, in order to decontaminate them;

b) manually remove the needle from the syringe after using it, put a cap on the needle after injection;

c) transfer (reload) unpackaged waste of classes B and C from one container to another;

d) compact waste of classes B and C;

e) carry out any operations with waste without gloves or the necessary personal protective equipment and overalls;

f) use soft disposable packaging to collect sharp medical instruments and other sharp objects;

g) install disposable and reusable containers for collecting waste at a distance of less than 1 m from heating devices.

III. Measures in case of emergencies

3.1. Emergencies associated with contact with blood and other biological fluids.

In order to avoid infection with parenteral viral hepatitis, HIV infection, it is necessary to follow the rules for safe work with piercing and cutting instruments.

3.1.1. in case of cuts and injections: immediately remove gloves, wash hands with soap and water under running water, treat hands with 70% alcohol solution, lubricate the wound with 5% iodine solution.

3.1.2. If blood or other biological fluids come into contact with the skin: treat this place with a 70% alcohol solution, wash with soap and water and re-treat with a 70% alcohol solution.

3.1.3. If blood has got on the mucous membranes of the eyes and (or) the mucous membrane of the nose: immediately rinse the mucous membranes with plenty of water, it is strictly forbidden to rub; in case of contact with the mucous membrane of the mouth – rinse the oral cavity with plenty of water and rinse with a 70% solution of ethyl alcohol.

3.2. Emergencies associated with spills and splashing of blood and other biological fluids.

3.2.1. If blood or biological fluids with an admixture of the patient’s blood get on the working clothes of a medical worker, remove the contaminated clothes, following the rules for removing them, immerse them in a disinfectant solution or in a bix (tank) for autoclaving.

3.2.2. When the blood container is destroyed (a test tube is broken or overturned, etc.):

a) put on gloves (if they were not worn);

b) limit the accident site with rags abundantly moistened with a disinfectant solution (concentration according to the regimen provided for the inactivation of bloodborne infection viruses) for the duration of exposure;

c) after exposure, wearing gloves, collect the broken container with a scoop and brush and place it in class B waste;

d) remove gloves, dispose of in accordance with safety requirements into class B waste.

3.2.3. If the blood tube is damaged while the centrifuge is running:

a) open the lid slowly, only 40 minutes after a complete stop;

b) place all centrifuge cups and broken glass in a disinfectant solution (concentration according to the regimen provided for inactivation of bloodborne hepatitis viruses) for the duration of exposure;

c) Treat the inner and outer surface of the centrifuge and the lid with a napkin with a disinfectant solution by wiping twice with an interval of 15 minutes.

3.3. Algorithm of action when registering an emergency.

3.3.1. Carry out anti-epidemic measures in accordance with the situation:

a) first aid in case of emergency situations involving contact with blood and other biological fluids;

b) limiting the impact of a biological agent in emergency situations associated with spills and splashing of blood and other biological fluids.

3.3.2. Immediately notify the head of the unit, his deputy or a higher head.

3.3.3. Examine for HIV and viral hepatitis B and C, STIs a person who may be a potential source of infection and a person who has been in contact with him. In emergency situations, the health worker and the patient are tested for HIV according to code 120 (emergency).

3.3.4. An HIV examination of a potential source of HIV infection and a contact person should be carried out using rapid testing for antibodies to HIV after an emergency with the obligatory sending of a sample from the same portion of blood for standard HIV testing in ELISA, with the obligatory execution of informed consent for HIV testing in 2 copies and conducting pre- and post-test counseling with a note in the medical records (on the informed consent form). Samples of plasma (or serum) of the blood of a person who is a potential source of infection, and a contact person, should be transferred for storage for 12 months to the laboratory of the state budgetary healthcare institution of the Novosibirsk Region “City Infectious Diseases Clinical Hospital N 1” (hereinafter referred to as GBUZ NSO “GIKB N 1 “).

3.3.5. Informed consent forms, with a note about the conduct before and after test counseling, should be stored with a package of documents (a certificate of a medical accident in a medical organization, the results of an HIV, VH, STI examination of an injured medical worker and a potential source of infection) in a medical organization with a responsible person.

3.3.6. Commissions for the investigation of cases of an emergency in a medical organization (hereinafter referred to as the Commission) to conduct:

a) epidemiological investigation:

– the causes of the injury and the establishment of a connection between the cause of the injury and the performance of the health worker’s official duties;

– the possibility of infection of the injured medical worker;

b) control of the completeness and timeliness of emergency measures, the appointment of post-exposure prophylaxis and the execution of documents for an emergency in a medical organization in accordance with the current legislation of the Russian Federation;

3.3.7. During the epidemiological investigation, clarify with a potential source about the carriage of viral hepatitis, STIs, inflammatory diseases of the urogenital area, other diseases, about immunization against hepatitis B, if the source is infected with HIV, find out if he received antiretroviral therapy.

If the victim is a woman, a pregnancy test should be done to see if she is breastfeeding. In the absence of clarifying data, post-exposure prophylaxis should be started immediately; if additional information appears, the scheme is adjusted.

3.3.8. Conducting consultations with epidemiologists of the GBUZ NSO “GIKB N 1” by phone 218-20-17 on the appointment of post-exposure prophylaxis and execution of documents for an emergency and a medical organization.

3.3.9. Post-exposure prophylaxis of HIV infection with antiretroviral drugs should be started within the first two hours after the accident, but no later than 72 hours.

3.4. Emergency post-exposure prophylaxis of HIV infection with antiretroviral drugs.

3.4.1. The decision to start chemoprophylaxis is made by the Commission, taking into account all the features of a registered case in a medical organization.

3.4.2. Indications for starting chemoprophylaxis:

a) if contact occurred with the biological material of a patient with HIV infection;

b) if the HIV status of the patient whose blood was in contact is unknown, and the result of the examination for antibodies to HIV using express tests approved for use is positive;

c) in the absence of express tests for rapid diagnosis, post-exposure prophylaxis should be started immediately; if additional information appears, the scheme is adjusted.

3.4.3. The standard regimen for post-exposure prophylaxis of HIV infection is lopinavir/ritonavir + zidovudine/lamivudine.

In the absence of these drugs, use any other antiretroviral drugs to start chemoprophylaxis; if it is not possible to start a full HAART regimen immediately, start one or two available drugs.

3.4.4. For post-exposure prophylaxis of HIV infection, use:

a) nucleoside reverse transcriptase inhibitors (hereinafter referred to as NRTIs): azidothymidine (retrovir 100 mg); combivir (lamivudine 150 mg + zidovudine 300 mg);

b) protease inhibitors (PI): kaletra (lopinavir 200 mg + ritonavir 50 mg).

3.4.5. To reduce the risk of occupational HIV infection, apply a standard chemoprophylaxis regimen, regardless of the degree of risk:

combivir N 60 – 1 tab. x 2 times a day (per os) + kaletra N 120 – 2 caps. x 2 times a day (per os) – 4 weeks.

3.4.6. In the absence of these drugs, to start chemoprophylaxis, use azidothymidine 200 mg x 3 times a day or combivir – 1 tab. x 2 times a day.

The use of nevirapine and abacavir is possible only in the absence of other drugs. If the only available drug is nevirapine, prescribe only one dose of the drug – 0.2 g (it is not allowed to take it again), then, when other drugs are received, prescribe full chemoprophylaxis.

If abacavir is started on chemoprophylaxis, testing for abacavir hypersensitivity reaction or switching from abacavir to another NRTI should be done as soon as possible.

3.4.7. In order to carry out chemoprophylaxis in a timely manner, it is necessary to have an irreducible supply of antiretroviral drugs per person in the amount of:

combivir tab. N 60 – (1 pack);

Kaletra capsules N 120 – (1 pack);

3.4.8. For the period of holidays and weekends, emergency provision of drugs for post-exposure chemoprophylaxis is carried out in the state budgetary organization of the Novosibirsk Region “City Clinical Infectious Diseases Hospital N 1”: Novosibirsk, st. S. Shamshinykh, 40, around the clock by the doctor of the emergency department (tel.: 218-17-79).

3.5. Post-exposure prophylaxis of viral hepatitis B

3.5.1. A healthcare worker (unvaccinated against hepatitis B) who has had contact with an infected material should be vaccinated against hepatitis B. Vaccination should be carried out according to the scheme 0 – 1 – 2 – 6 months, followed by monitoring of hepatitis B markers.

3.5.2. If contact occurs in a previously vaccinated health care worker, determine serum levels of anti-HBs. In the presence of an antibody concentration in the titer of 10 IU / l and above, vaccination is not carried out; in the absence of antibodies, a booster dose of the vaccine should be administered.

3.6. Making an emergency.

3.6.1. Injuries or emergencies should be recorded in the register of emergencies during medical procedures, which is stored in each structural unit of the medical organization. The journal is kept in the form approved by the Decree of the Chief State Sanitary Doctor of the Russian Federation dated 07/21/16. No. 95.

3.6.2. Each medical accident in a medical organization is documented by an Act on a medical accident in an institution in 2 copies, drawn up in the form approved by the decision of the Chief State Sanitary Doctor of the Russian Federation dated 07/21/16. N 95. One copy is sent to the AIDS Center epidemiologist, the second copy remains in the medical organization where the emergency occurred.

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