Guidelines. Prevention of infection, including medical workers, with the human immunodeficiency virus in the workplace. Prevention of infection, including medical workers, with the human immunodeficiency virus in the workplace Special

Prevention of HIV transmission during parenteral interventions in medical institutions is primarily based on compliance with the sanitary and anti-epidemic regime, safe work organization and constant training of personnel in prevention methods. The main principle of the work of medical staff to prevent nosocomial transmission of HIV is the use in each health care facility of precautionary measures in relation to each patient as potentially infected with HIV. Since even when examining people entering medical institutions, it is not possible to identify all those infected with HIV due to the existence of a “seronegative window” period, and in addition, the test result often becomes known after the provision of medical care. In any emergency situation when there is a risk of HIV infection, it is necessary to act in compliance with the rules of the Sanitary and Epidemiological Regulations and the instructions of the Ministry of Health and Social Development of the Russian Federation. Post-exposure chemoprophylaxis

does not guarantee 100% protection against HIV infection and, therefore, these measures should be part of an overall strategy to prevent occupational HIV infection, based on standard precautions. In addition to standard precautions to prevent exposure to infectious material, workplace safety procedures should be established and strictly followed. To prevent occupational HIV infection of medical workers, the following rules must be observed:

All health care workers should undergo regular training on preventive measures
occupational infection and nosocomial transmission of HIV infection.
Health care workers and other employees who may be exposed to HIV
should receive appropriate information about the availability of contact
prevention and institutions to contact in case of an emergency.

When performing any medical manipulations, a health care facility employee must
observe barrier protection measures. Medical personnel must be provided and
trained in the use of personal protective equipment when caring for patients.
The medical worker must be dressed in a gown, cap, disposable mask (and if
if necessary - goggles or protective shields, special medical work clothes),
replacement shoes. All manipulations that may lead to contamination of hands with blood,
blood serum or other biological fluids must be carried out in
rubber medical gloves. Rubber gloves, once removed, cannot be used again.
are used. During work, gloves are treated with 70% alcohol or other
regulated disinfectants.

Workers of all medical specialties must apply epidemiological
safe technologies for performing therapeutic and diagnostic procedures. Necessary
observe precautions and safety rules when performing
manipulations with cutting and piercing instruments (needles, scalpels, burs, etc.);
Injections and cuts to gloves and hands should be avoided. Used needles immediately
are disposed of (without putting a protective cap on them) in hard waterproof
containers. Containers are disposed of without overfilling.

If there are wounds on the hands, exudative skin lesions or weeping dermatitis,
the health worker is removed from patient care and contact with patients during illness
items to care for them. If work needs to be done, all damaged
areas should be covered with finger pads, adhesive tape, etc.

All workplaces must be provided with disinfectants, emergency
first aid kit and instructions for post-exposure prophylaxis and staff rules
in case of emergency.

All healthcare facilities should be provided with rapid tests for HIV and, if necessary, have
access to antiretroviral drugs. The stock of antiretroviral drugs should be
stored in any institution of the choice of the subject of the Russian Federation, but in such a way that in the event
in the event of an emergency, each health facility must have access to rapid tests and
antiretroviral drugs to prescribe PEP within 1-2 hours after an emergency
situations. Each health care facility must appoint a specialist by order of the chief physician.
responsible for storing ARVs, the storage location of ARVs must be determined (in
depending on the specifics of the region: emergency room, ambulance, etc.) with
ensuring their availability around the clock, including at night and on weekends.

When preparing for manipulation, a patient with HIV infection must
make sure the emergency first aid kit is intact. All manipulations are carried out in the presence
a second specialist who can, in the event of a rupture of gloves or a cut, continue them
performance.

If infectious biological liquids infected with HIV come into contact with
skin with trauma or microtrauma, and especially under the skin and mucous membranes
medical worker, it is necessary to carry out a set of measures to

preventing HIV infection in the workplace, including first aid, prescribing antiretroviral drugs as soon as possible, examination and registration of an emergency.

After use, all medical products must be disinfected with
subsequent pre-sterilization cleaning and sterilization. Product processing
medical purposes is carried out in accordance with SanPiN 2.1.7.2527-09 “Rules
collection, storage and disposal of waste from medical institutions" and the order
No. 408 of July 12, 1989 “On measures to reduce the incidence of viral hepatitis in
country”, OST 42-21-2-85 and other specialized instructions of the Ministry of Health of the SSR of the Russian Federation. For
disinfection should be used registered by the Ministry of Health of the SR RF and recommended for
use in medical institutions of disinfectants in concentrations and
exposure times specified in the relevant recommendations for their use.

For medical workers to prevent occupational infections
vaccination against hepatitis B is carried out in accordance with SP 3.1.958-00 “Prevention
viral hepatitis. General requirements for epidemiological surveillance of viral
hepatitis."

The health care facility must keep records and analyze all cases of emergency situations involving medical staff,
associated with the risk of nosocomial transmission of infections.

Both in the event of an emergency, and in the presence of prerequisites and
In such a development, it is recommended to conduct an assessment of the effectiveness
safety measures in place at the workplace, and, if necessary, tighten
available standards. Particular emphasis must be placed on the importance of primary
prevention of HIV infection wherever possible contact with HIV.

Registration of an emergency situation

Any emergency must be reported to the supervisor immediately
unit or his deputy. Employees of the organization must immediately
notify your immediate or superior manager about each
an accident or a deterioration in your health due to
manifestations of signs of acute illness when performing actions,
conditioned by labor relations with the employer.

Injuries received by medical workers must be taken into account in each health care facility and acted upon
like an industrial accident. Forms of documents to be executed
regulated by Decree of the Ministry of Labor of the Russian Federation dated October 24, 2002 No. 73 “On approval
forms of documents necessary for the investigation and recording of accidents on
production, and provisions on the specifics of investigating accidents in
production in certain industries and organizations." Based on the fact of injury directly
after an emergency, fill in:

1. Journal of industrial accidents (Appendix 1)

2. Report on an industrial accident (Appendix 2)

In accordance with Article 229.2. “The procedure for conducting an investigation of accidents
cases" of the Labor Code of the Russian Federation No. 197-FZ investigation materials
accidents include:

1. order (instruction) on the creation of a commission to investigate the accident
case;

2. plans, sketches, diagrams, protocol for examining the scene of the incident, and if
necessary - photo and video materials;

3. documents characterizing the state of the workplace, the presence of dangerous and
harmful production factors;

4. extracts from logs of registration of labor safety briefings and protocols
checking the victims’ knowledge of labor protection requirements;

5. protocols of interviews with eyewitnesses of the accident and officials,
explanations of the victims;

6. expert opinions of specialists, results of technical calculations,
laboratory research and testing;

7. medical report on the nature and severity of the injury,
caused to the health of the victim, or the cause of his death, while
the victim was intoxicated at the time of the accident,
drug or other toxic intoxication;

8. copies of documents confirming the issuance of special aid to the victim
clothing, special footwear and other personal protective equipment in
in accordance with current regulations;

9. extracts from previously issued to the employer and related to the subject
investigation of orders of state labor inspectors and officials
persons of the territorial body of the corresponding federal body
executive power, exercising control and supervision functions in
established field of activity (if the accident occurred in
organization or at a facility controlled by this body), as well as extracts from
representations of trade union labor inspectors on the elimination of identified
violations of labor protection requirements;

10. other documents at the discretion of the commission.

The fact of injury should be reported to the territorial Center for the Prevention and Control of AIDS and the territorial department of Rospotrebnadzor. In accordance with the Decree of the Chief State Sanitary Doctor of the Russian Federation dated February 24, 2009 No. No. 11 “On the submission of extraordinary reports on emergency situations in the field of public health of a sanitary and epidemiological nature” for each case of detection of HIV infection in medical institutions or the death of an infected person HIV emergency reports are submitted to the Federal Service for Surveillance in the Sphere of Consumer Rights Protection and Human Welfare. At the same time, the health care facility, regardless of the form of ownership, sends an extraordinary report within 2 hours after establishing the fact of an emergency situation to the territorial bodies of Rospotrebnadzor, and informs the municipal (departmental) health authority. The Rospotrebnadzor office for a constituent entity of the Russian Federation sends an extraordinary report to the Federal Service for Supervision of Consumer Rights Protection and Human Welfare no later than 24 hours after the fact of an emergency is established.

Acute occupational diseases, for which there is reason to believe that their occurrence is due to exposure to harmful production factors, are subject to investigation in accordance with the Regulations on the investigation and recording of occupational diseases, approved by Decree of the Government of the Russian Federation of December 15, 2000 No. 967 “On approval of the regulations on the investigation and recording of occupational diseases."

At the end of the temporary disability of the victim, the employer sends a message to the relevant state labor inspectorate, and, if necessary, to the relevant territorial federal supervisory authority, about the consequences of the industrial accident and the measures taken. About accidents at work, which over time have become the category of serious accidents or fatal accidents, the employer, within 24 hours after receiving information about this, sends a notice in the prescribed form to the relevant state labor inspectorates, trade union bodies and territorial bodies of the federal, controlled by territorial federal supervisory authorities), information about insured events is sent to the insurance company.

If a nosocomial case of HIV transmission is detected, a copy of the epidemiological investigation map for this case is sent to the Federal Scientific and Methodological Center for the Prevention and Control of AIDS in accordance with the methodological recommendations of the Ministry of Health of the SR RF No. 6963-РХ dated September 20, 2007 “Epidemiological investigation of a case of HIV-infection” infections and anti-epidemic measures" and methodological recommendations of the Ministry of Health of the Slovak Republic of the Russian Federation No. 5962-РХ "Organization of work to collect information on cases of HIV infection and AIDS."

Thus, the registration of an emergency situation is carried out in accordance with the laws and regulations of the federal and regional levels.

Legal aspects

Medical examination for antibodies to HIV of citizens of the Russian Federation is carried out with
preliminary and subsequent counseling on HIV prevention issues
infections in accordance with Article 7 of Federal Law No. 38-F3 “On Prevention
human immunodeficiency."

Employees of enterprises, institutions and organizations of state and municipal
healthcare systems that diagnose and treat HIV-infected people, and
also persons whose work involves materials containing the immunodeficiency virus
person, in case of infection with the human immunodeficiency virus while performing their
official duties have the right to receive state one-time
benefits in accordance with Articles 21, 22 of Federal Law No. 38-F3 “On
preventing the spread in the Russian Federation of a disease caused by
human immunodeficiency virus."

In accordance with Article 5 of Federal Law No. 38-F3 “On Prevention
spread of the disease caused by the virus in the Russian Federation
Human Immunodeficiency" HIV-infected - citizens of the Russian Federation
have all rights and freedoms on its territory and bear responsibilities in accordance with
with the Constitution of the Russian Federation, the legislation of the Russian Federation and
legislation of the constituent entities of the Russian Federation. Rights and freedoms of citizens
Russian Federation may be restricted due to the presence of HIV infection
only by federal law. In accordance with Article 11 of Federal Law No. 38-F3
Citizens of the Russian Federation, if they are diagnosed with HIV infection, cannot be
donors of blood, biological fluids, organs and tissues.

In accordance with Article 17 of Federal Law No. 38-F3 “On Prevention
spread of the disease caused by the virus in the Russian Federation
human immunodeficiency”, dismissal from work, refusal of admission to
work, refusal of admission to educational institutions and institutions providing
medical care, as well as restriction of other rights and legitimate interests of HIV-
infected on the basis of their HIV infection, as well as restriction
housing and other rights and legitimate interests of family members of HIV-infected people.
HIV-infected healthcare workers providing parenteral
manipulations in the performance of professional duties may be suggested
a position that does not involve parenteral interventions, without reduction in size
wages.

In accordance with Article 22, 209, 210 of the Labor Code of the Russian Federation No. 197-FZ
the employer is obliged to ensure safety and working conditions appropriate
state regulatory requirements for labor protection; provide workers
equipment, tools, technical documentation and other means,
necessary for the performance of their labor duties; implement mandatory
social insurance of employees in the manner established by federal laws;

compensate for harm caused to employees in connection with the performance of their labor duties, as well as compensate for moral damage in the manner and under the conditions established by the Labor Code, other federal laws and other regulatory legal acts of the Russian Federation.

Articles 219 and 220 of Section 10 “Labor Safety” of the Labor Code of the Russian Federation No. 197-FZ contain information about the employee’s right to work in conditions that meet labor protection requirements. And, among other things, every employee has the right to: o a workplace that meets labor protection requirements; o compulsory social insurance against accidents at work and

occupational diseases in accordance with federal law; o obtaining reliable information from the employer, relevant government bodies and public organizations about labor conditions and safety in the workplace, about the existing risk of damage to health, as well as about measures to protect against exposure to harmful and (or) hazardous production factors; o refusal to perform work if a danger to his life and health arises due to violation of labor protection requirements, except for cases provided for by federal laws, until such danger is eliminated; o provision of personal and collective protective equipment in accordance with

labor protection requirements at the expense of the employer;

o training in safe labor methods and techniques at the expense of the employer; o professional retraining at the expense of the employer in the event

liquidation of a workplace due to violation of labor protection requirements; about compensation, etc.

In accordance with Article 227 of the Labor Code of the Russian Federation No. 197-FZ, accidents that occur with employees and other persons involved in the production activities of the employer during the performance of their labor duties or performing any work on behalf of the employer (his representative) are subject to investigation and recording. ), as well as when carrying out other lawful actions determined by labor relations with the employer or performed in his interests.

In accordance with Article 228 of the Labor Code of the Russian Federation dated No. 197-FZ, the employer’s responsibilities in the event of an accident are:

o immediate organization of first aid to the victim and, if necessary,

delivering it to a medical organization; o taking urgent measures to prevent the development of emergency or other

emergency situation and the impact of traumatic factors on other persons; o preserving the situation as it was at the time of the incident until the investigation of the accident begins, if this does not threaten the life and health of other persons and does not ■ lead to a catastrophe, accident or other emergency circumstances, and if it is impossible to preserve it, record the current situation; o immediately inform the authorities and organizations specified in the Labor Code, other federal laws and other regulatory legal acts of the Russian Federation about the accident;

o take other necessary measures to organize and ensure a proper and timely investigation of the accident and registration of investigation materials.

The procedure for insurance against industrial accidents and occupational diseases is determined by the current regulatory legal acts. At the federal level, insurance is regulated by Federal Law No. 125-FZ “On compulsory social insurance against accidents at work and occupational diseases and Federal Law No. 217-FZ “On insurance tariffs for compulsory

social insurance against industrial accidents and occupational diseases for 2009 and for the planning period of 2010 and 2011.”

Article 6.3. The Code of the Russian Federation on Administrative Offenses establishes liability for violation of legislation in the field of ensuring the sanitary and epidemiological well-being of the population, expressed in violation of current sanitary rules and hygienic standards, failure to comply with sanitary, hygienic and anti-epidemic measures.

Article 6.1. The Code of the Russian Federation on Administrative Offenses establishes liability for concealment by a person suffering from HIV infection or a venereal disease of the source of infection, as well as persons who had contact with this person that creates a risk of contracting these diseases. Article 143 of the Criminal Code of the Russian Federation No. 63-F3 provides for punishment for violation of labor protection rules.

Article 122 of the Criminal Code of the Russian Federation No. 63-F3 establishes criminal liability for contracting HIV infection or putting another person at risk of contracting HIV infection.

Annex 1

JOURNAL of registration of accidents at work<*>

(name of the organization, last name, first name, patronymic of the employer - individual, his registration data)

<*> Note. Magazine registration of accidents at work must be stored in the organization for 45 years.

Appendix 2 Form N-1 APPROVED

Signature, full name employer

"_"_____________ 200_ g.

ACT No.

about an accident at work

1. Date and time of the accident______________________________________________________________

(day, month, year and time, number of full hours from the start of work)

2. Organization (employer) of which the victim is (was) an employee

(name, location, legal address, departmental and industry affiliation (OKONKH main type of activity);

(last name, initials of the employer - individual)

Name of structural unit_______________________________________________

3. The organization that sent the employee_________________________________________________

(name, location, legal address, industry affiliation)

4. Persons who conducted the accident investigation:

(surnames, initials, positions and place of work)

5. Information about the victim:

Full Name______________________________________________________

gender (male, female)_______________________________________________________________

Date of Birth_____________________________________________________________

professional status
profession (position)___

length of work during which the accident occurred ______________________________

(number of complete years and months)

including in this organization_______________________________________________________________

(number of complete years and months)

6. Information on briefings and training on labor protection
Introductory briefing/initial, repeated,_____________________________________________

(day month Year)

Instruction at the workplace (unscheduled, targeted / underline as necessary) in the profession or type of work during which the accident occurred, if not carried out, indicate)

(day month Year)

Internship: from "__ "____________ 200_ to "___ "__________ 200_

Occupational safety training in the profession or type of work during which the accident occurred
accident: from "__ "___________ 200_ to "___ "___________ 200_

(if not carried out, indicate)

Check of knowledge_____________________________________________________________________

(day, month, year, protocol number) 7. Brief description of the place (facility) where the accident occurred

(brief description of the scene of the incident indicating dangerous and (or) harmful

Equipment the use of which resulted in an accident

(name, type, brand, year of manufacture, manufacturer) 8. Circumstances of the accident

(brief summary of the circumstances preceding the accident, description of events

And the actions of the victim and other persons associated with the accident, the presence of barrier protective equipment during the accident (working clothes, gloves, goggles, mask, apron and other information)

8.1. Type of incident ^_________________________________________________________________

(puncture wound, superficial or deep abrasion, puncture with a contaminated needle, contamination
infected blood or other biological fluids of damaged skin and mucous membranes
shells, etc.)______________________________________________________________

8.2. The nature of the injuries received and the organ damaged medical report
about the severity of health damage

8.3. The victim is under the influence of alcohol or drugs
(no, yes - indicate the state and degree of intoxication in accordance with the conclusion on

The results of the examination carried out in accordance with the established procedure)

8.4. Eyewitnesses of the accident______________________________________________________________

(last name, initials, permanent place of residence, home telephone)
9. Causes of the accident__________________________________________

(indicate the main and associated reasons

10. Persons who violated labor protection requirements:

(surnames, initials, positions (professions) indicating the requirements of legislative, other regulatory legal and local regulations providing for their responsibility for violations that were the causes of the accident specified in paragraph 9 of this act, when establishing the fact of gross negligence of the victim, indicate the degree of his guilt in percentage) Organization (employer) whose employees are these persons (name, address)

11. Measures to eliminate the causes of the accident, deadlines

Signatures of the persons conducting the accident investigation

(Full name) 200 g.

One copy is sent to the victim or his authorized representative

"AIDS HIV" - Middle East and North Africa. Caribbean. Women and children. The main factors hindering the achievement of set goals. Sub-Saharan Africa. Action plan to achieve MDG-6 by 2015. UNAIDS World AIDS Day Report | 2011 Faster. Latin America. Western and Central Europe.

“Teacher’s work program” - library electronic educational resources. Program acceptance deadlines. Structure of the Program. Teacher's work program. Requirements for the level of training of students. Adjustment of the work program. Rationale. The author's program is characterized by an original concept and structure of content. What is the Author Program? To write a working program.

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

“HIV” - I don’t drink alcohol. I keep a daily routine. Treatment. I do physical exercise or sports every day. Once in the body, the virus gradually destroys the immune system. I can cope with stress. Damage period: from three months. History of development. HIV infection-. When having sexual intercourse, I use a condom. 14.

“Work program” - The main functions of the training program. Administration of the educational institution: Curriculum -. Sample curriculum -. Educational and thematic plan: Working curriculum -. Regulatory; Goal-setting; Contentful; Procedural; Estimated; Meeting for deputy directors of water management, February 2009. Contents of the subject.

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

In modern medicine, much attention is paid to the issue of preventing the most terrible disease of recent decades. Of course, we are talking about the immunodeficiency virus. Unfortunately, a dangerous disease has not yet been cured. Therefore, scientists are working not only to develop vaccines and medicines, but also to ensure the safety that is necessary to reduce the spread of the disease. Everyone should take care of their personal safety. However, there are other, more stringent measures. HIV prevention in the workplace helps protect not only those whose professional duties are directly related to the potential for infection, but also patients who may become infected, for example, when visiting a treatment room. What should HIV prevention be in an emergency situation, and where should it be implemented?

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

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

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

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

Particular attention is also paid to the safety of medical personnel whose job responsibilities include performing surgical operations. Prevention of HIV infection and AIDS in surgery includes the use of increased safety measures when working with infected patients. Anti-AIDS first aid kits are required to be placed in operating rooms and treatment rooms.

The role of the midwife and nurse in the prevention of HIV infection is invaluable. Especially when it comes to giving birth to an infected woman. After all, it largely depends on them whether the virus will be transmitted from mother to baby or not. Junior medical staff in such cases must act quickly and harmoniously. A baby that has just been born is treated according to epidemic standards and requirements, which often makes it possible to prevent infection.

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

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

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

Introduction

The HIV epidemic is an additional factor creating excessive burdens on health care.
Budgetary investments in infrastructure, human resources, equipment and supplies are required to adequately provide services to patients and effectively protect health workers.

Prevention and control of occupational risks associated with HIV can be achieved through ongoing on-the-job training in health services.

The implementation of a national program for organizing activities to prevent HIV infection in the workplace should be aimed at:

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

The scale of the spread of HIV infection corresponds to a global epidemic. Globally, the most common route of HIV transmission is through heterosexual contact. In Russia, HIV transmission through drug use using syringes is common. There have been cases of transmission of the virus to persons performing their official duties. Protective measures should primarily focus on preventing the transmission of HIV through blood.

HIV transmission in health care facilities is possible:

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

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

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

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

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

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

Almost all cases of HIV infection among medical workers are caused by needle sticks while providing care to an HIV-infected person. This occurs when taking blood from a vein, intravenous injections and transfusion of infusion drugs.

In Russia, the most common occupational risks of HIV infection are:

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

Biological fluids that can cause HIV infection upon contact:

• blood;
• sperm;
• vaginal discharge;
• any fluids mixed with blood;
• HIV-containing cultures and culture media;
• synovial fluid;
• cerebrospinal fluid;
• pleural fluid;
• pericardial fluid;
• amniotic fluid.

Factors that affect the risk of HIV infection:

• Patient's HIV status and stage of disease. If the patient has an acute infection or a late stage of the disease (AIDS), then there is more virus in the blood and the risk of infection is higher.
• Whether the patient is receiving antiretroviral therapy; if it does, the risk of infection is lower.
• The patient has treatment-resistant strains of HIV (in this case, antiretroviral therapy may be ineffective).
• The degree of contamination of the instrument with infectious material. A needle stick after drawing blood from a vein is more dangerous than a needle stick after an intramuscular injection.
• The degree of violation of the integrity of the skin and mucous membranes when a health worker is injured.
• Treatment of the wound surface. Immediate squeezing out of blood and rinsing with an antiseptic solution reduce the risk of infection.
• Timely administration of chemoprophylaxis for HIV infection by health care workers with antiretroviral drugs prevents infection.

Preventing transmission of infection in health care facilities:

• Eliminate the risk of contact with contaminated objects through the use of protective equipment, such as glasses, gloves, masks and protective clothing.
• Safe work organization.
• Continuous training of staff in infection prevention methods.

Actions in case of occupational infection:

1. Promptly report all cases of possible professional HIV infection to the head of the organization.
2. Send a prompt report to the Federal Center for Prevention and Control of AIDS in the event of an infection.

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

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

• Attend classes on the prevention of parenterally transmitted infections and follow appropriate recommendations, including hepatitis B vaccinations.
• Before any work with traumatic instruments, plan your actions in advance, including those related to their neutralization.
• Try not to use dangerous medical instruments if you can find a safe and sufficiently effective replacement for it.
• Do not recap used needles.
• Promptly dispose of used needles in a special (puncture-resistant) waste container.
• Immediately report all cases of injury when working with needles, other sharp objects, or contaminated substrates. This will help you get the necessary medical care on time.
• Inform management of any observed factors that increase the risk of injury in the workplace.
• Provide assistance to the administration in selecting devices (blood sampling systems, etc.). Give preference to devices with protective devices.
• Training of medical workers at all levels: managers, doctors, nurses, social workers, consultants and other specialists.
• Provide complete and accurate information about transmission and risk factors for infection.
• Teach methods to combat discrimination and stigmatization.
• Develop, implement and strengthen privacy practices.

Actions in case of emergency situations

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

If infectious material comes into contact with the face or other exposed areas of the body:

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

• rinse with water.

If infectious material enters the oral cavity:

• rinse 70 degrees. alcohol.

If infectious (or suspected HIV infection) material gets on a gown or clothing:

• immediately treat the area with one of the disinfectant solutions;
• disinfect gloves;
• remove the robe and soak in one of the solutions;
• Place in sterilization boxes for autoclaving.

The skin of the hands and other areas of the body under contaminated clothing:

• wipe 70 degrees. alcohol.

Shoes are treated by wiping twice with a rag soaked in a solution of one of the disinfectants. If infected material gets on the floor, walls, furniture, equipment and other surrounding objects: pour any disinfectant solution onto the contaminated area with an exposure of 30 minutes, then wipe.

Chemoprevention of parenteral transmission of HIV

Principles of chemoprophylaxis of parenteral transmission of HIV

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

Indications for starting chemoprophylaxis

If contact occurs with biological material taken from a patient with HIV infection, it is recommended to begin chemoprophylaxis for parenteral HIV infection.

If the HIV status of the patient whose blood has been contacted is unknown, it is recommended to test him for antibodies to HIV using approved rapid tests.

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

Chemoprophylaxis regimens for parenteral HIV transmission

With the advent of highly active antiretroviral therapy regimens (treatment with several antiretroviral drugs from different groups), they began to be used in chemoprophylaxis regimens for parenteral and sexual HIV infection, since theoretically they should be more effective than chemoprophylaxis using a monotherapy regimen (treatment with one drug), the effectiveness of which has been proven. In particular, the following chemoprophylaxis regimen has been proven effective (the risk of infection is reduced by 70%): Zidovudine - 0.2 g orally 3 times a day for 4 weeks. Recommended in accordance with Order of the Ministry of Health of the Russian Federation No. 170 dated August 16, 1994. This chemoprophylaxis regimen can be used as an alternative if it is impossible to use a more intensive regimen or the victim is unwilling to use it. If zidovudine is intolerant or the hemoglobin level is below normal, it is recommended to replace it with Phosphazide (0.4 g 2 times a day).

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

Basic scheme:

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

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

There are some limitations to regimens that include non-nucleoside HIV reverse transcriptase inhibitors.

Features of the use of efavirenz.

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

Features of the use of nevirapine.

Since repeated use of nevirapine in people with normal levels of CD4 lymphocytes in the blood can lead to the development of life-threatening side effects (liver tissue necrosis), its use in chemoprophylaxis regimens for parenteral and sexual HIV infection is not recommended. If other antiretroviral drugs are not available, a single dose of nevirapine followed by initiation of therapy according to a different regimen is acceptable.

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

• biochemical (creatinine, urea, bilirubin, ALT, AST);
• clinical (hemoglobin, red blood cells, platelets, neutrophils, leukocyte formula);
• pregnancy test.

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

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

Registration of emergency situations

• Each emergency must be immediately reported to the head of the unit or his deputy.
• Injuries sustained by healthcare workers must be recorded in each health care facility and registered as an industrial accident.
• Upon the fact of an injury, the “Accounting for Injuries” journal is filled out and an “Epidemiological Investigation Report” is drawn up on the cause of the injury and the connection between the cause of the injury and the performance of one’s official duties.
  Recommendations on chemoprophylaxis can be obtained from a specialist at the AIDS Center by telephone. At night, weekends and holidays, the decision to start antiretroviral therapy is made by the responsible doctor at the hospital.
• The fact of injury should be reported to the AIDS Center and the Center for Sensitivity and Epidemiology.
• Registration of an emergency situation is carried out in accordance with laws and regulations adopted at the level of the federal government and constituent entities of the Federation.

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

Registration of an accident in the accident log:

Form N 1

Date ___/___/____/, time _____ hours _____ minutes.
FULL NAME. health worker ______________________________________________
Position of health worker _________________________________________________
Manipulation performed __________________________ brief description
accident __________________________________________ measures taken
__________________________________________________________________

manager's signature units (at night duty and
responsible doctor) _____________________________________

senior medical officer's signature sisters ___________________________________

Form N 2

Information about the patient during whose care the accident occurred:

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

HIV status:

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

Viral hepatitis B and C:

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

Standard laboratory testing for HIV antibodies/antigen of a healthcare worker and a patient is carried out:

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

The victim should be warned that he or she may be a source of HIV infection throughout the observation period and should therefore take precautions to avoid possible transmission of HIV.

Taking into account the consequences of professional infection in the performance of their official duties, guarantees have been adopted in Federal Law No. 38 “On preventing the spread in the Russian Federation of the disease caused by the human immunodeficiency virus (HIV infection)” Article 4, labor guarantees Article 22.

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

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

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

Introduction

The HIV epidemic is an additional factor creating excessive burdens on health care. Budgetary investments in infrastructure, human resources, equipment and supplies are required to adequately provide services to patients and effectively protect health workers. Prevention and control of occupational risks associated with HIV can be achieved through ongoing on-the-job training in health services.

The implementation of a national program for organizing activities to prevent HIV infection in the workplace should be aimed at: developing changes to the legislative framework; development of human resources for the health service; training of qualified medical personnel; creating conditions that guarantee safety in the workplace. The scale of the spread of HIV infection corresponds to a global epidemic. Globally, the most common route of HIV transmission is through heterosexual contact. In Russia, HIV transmission through drug use using syringes is common. There have been cases of transmission of the virus to persons performing their official duties. Protective measures should primarily focus on preventing the transmission of HIV through blood.

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

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

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

Another 114 cases of occupational HIV infection were previously registered by the SDS. Considering the fact that among biological fluids the maximum concentration of HIV is contained in the blood, infection most often occurs through contact with HIV-infected blood. Of the 6,498 cases of skin damage among medical workers with instruments contaminated with HIV-infected blood, the development of infection was observed in 21 cases.

This corresponds to an average probability of infection of 0.3%

In the Russian Federation, in accordance with the order of the Ministry of Health of the Russian Federation N 275, testing for AT to HIV is carried out annually for medical workers providing assistance to HIV-positive patients and working with materials containing HIV.

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

Almost all cases of HIV infection among health care workers are caused by needle sticks while providing care to an HIV-infected person. This occurs when taking blood from a vein, intravenous injections and transfusion of infusion drugs.

In Russia, the most common occupational risks of HIV infection are:

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

- Operating surgeons and operating nurses.

- Obstetricians-gynecologists.

- Pathologists.

Biological fluids that can cause HIV infection upon contact: blood; sperm; vaginal discharge; any fluids mixed with blood; HIV-containing cultures and culture media; synovial fluid; cerebrospinal fluid; pleural fluid; pericardial fluid; amniotic fluid.

Factors that affect the risk of HIV infection:

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

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

- The patient has treatment-resistant strains of HIV (in this case, antiretroviral therapy may be ineffective).

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

- The degree of violation of the integrity of the skin and mucous membrane when a health worker is injured.

- Treatment of the wound surface. Immediate squeezing out of blood and rinsing with an antiseptic solution reduce the risk of infection.

- Timely administration of chemoprophylaxis to HIV infection by health care workers with antiretroviral drugs prevents infection.

Preventing transmission of infection in health care facilities

Eliminate the risk of contact with contaminated objects through the use of protective equipment, such as glasses, gloves, masks and protective clothing.

- Safe work organization.

- Continuous training of personnel in infection prevention methods.

Actions in case of occupational infection

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

2. Send a prompt report to the Federal Center for Prevention and Control of AIDS in the event of an infection.

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

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

Attend classes on the prevention of parenterally transmitted infections and follow appropriate recommendations, including hepatitis B vaccinations.

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

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

- Do not recap used needles.

- Promptly dispose of used needles in a special (puncture-resistant) waste container.

- Immediately report all cases of injury when working with needles, other sharp objects, or contaminated substrates. This will help you get the necessary medical care on time.

- Inform the administration about all observed factors that increase the risk of injury in the workplace.

- Provide assistance to the administration in choosing devices (blood sampling systems, etc.). Give preference to devices with protective devices.

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

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

- Teach methods to combat discrimination and stigmatization.

- Develop, implement and strengthen confidentiality measures.

Actions in case of emergency situations

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

If infectious material comes into contact with the face or other exposed areas of the body:

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

Eyes:

- rinse with water.

If infectious material enters the oral cavity:

- rinse at 70 degrees with alcohol.

If infectious (or suspected HIV infection) material gets on a gown or clothing:

- immediately treat the area with one of the disinfectant solutions;

- disinfect gloves;

- remove the robe and soak in one of the solutions;

- Place in sterilization boxes for autoclaving.

The skin of the hands and other areas of the body under contaminated clothing:

- wipe at 70 degrees. alcohol.

Shoes are treated by wiping twice with a rag soaked in a solution of one of the disinfectants.

If infected material gets on the floor, walls, furniture, equipment and other surrounding objects: pour any disinfectant solution onto the contaminated area with an exposure of 30 minutes, then wipe.

Chemoprevention of parenteral transmission of HIV

Principles of chemoprophylaxis of parenteral transmission of HIV

1. The medical institution must have clear and simple instructions on when and how to carry out chemoprophylaxis:

Stage I - start of chemoprophylaxis;

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

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

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

4. After 72 hours, starting chemoprophylaxis or expanding its regimen is pointless, but if the victim strongly desires, chemoprophylaxis can be prescribed.

Indications for starting chemoprophylaxis

If contact occurs with biological material taken from a patient with HIV infection, it is recommended to begin chemoprophylaxis for parenteral HIV infection.

If the HIV status of the patient whose blood has been contacted is unknown, it is recommended that he be tested for HIV antibodies using approved rapid tests.

If a positive result is obtained, chemoprophylaxis for HIV infection is recommended. Further examination of the patient in order to confirm or exclude the diagnosis of HIV infection is carried out in accordance with the established procedure.

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

Chemoprophylaxis regimens for parenteral HIV transmission

With the advent of highly active antiretroviral therapy regimens (treatment with several antiretroviral drugs from different groups), they began to be used in chemoprophylaxis regimens for parenteral and sexual HIV infection, since theoretically they should be more effective than chemoprophylaxis using a monotherapy regimen (treatment with one drug), the effectiveness of which has been proven. In particular, the following chemoprophylaxis regimen has been proven effective (the risk of infection is reduced by 70%): zidovudine - 0.2 g orally 3 times a day for 4 weeks. Recommended in accordance with Order of the Ministry of Health of the Russian Federation No. 170 dated August 16, 1994. This chemoprophylaxis regimen can be used as an alternative if it is impossible to use a more intensive regimen or the victim is unwilling to use it. If zidovudine is intolerant or the hemoglobin level is below normal, it is recommended to replace it with phosphazide (0.4 g 2 times a day).

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

Basic scheme:

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

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

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

There are some limitations to regimens that include non-nucleoside HIV reverse transcriptase inhibitors.

Features of the use of efavirenz.

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

Features of the use of nevirapine.

Since repeated use of nevirapine in people with normal levels of CD4 lymphocytes in the blood can lead to the development of life-threatening side effects (liver tissue necrosis), its use in chemoprophylaxis regimens for parenteral and sexual HIV infection is not recommended. If other antiretroviral drugs are not available, a single dose of nevirapine followed by initiation of therapy according to a different regimen is acceptable.

When prescribing chemoprophylaxis, blood tests are performed on the health worker for possible subsequent correction of the treatment regimen: biochemical (creatinine, urea, bilirubin, ALT, AST); clinical (hemoglobin, red blood cells, platelets, neutrophils, leukocyte formula); pregnancy test.

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

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

Registration of emergency situations

- Each emergency must be immediately reported to the head of the unit or his deputy.

- Injuries received by healthcare workers must be taken into account in each health care facility and registered as an industrial accident.

- Upon the fact of an injury, the journal “Accounting for Injuries” is filled out and an “Epidemiological Investigation Report” is drawn up on the cause of the injury and the connection between the cause of the injury and the performance of one’s official duties.

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

- The fact of injury should be reported to the AIDS Center and the Center for Sensitivity and Epidemiology.

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

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

Registration of an accident in the accident log:

Form N 1

Form N 2

HIV status:

1. The diagnosis of HIV infection is confirmed

- date of confirmation

- stage of HIV infection

- is the patient on antiretroviral therapy?

- RNA level in plasma

- number of CD4, CD8 lymphocytes, their ratio

2. HIV status unknown

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

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

3. Received a positive result from a rapid test for antibodies to HIV

4. A negative result of the rapid test was received.

Viral hepatitis B and C:

1. - blood for the presence of HBsag

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

Standard laboratory testing for HIV antibodies/antigen of a healthcare worker and a patient is carried out:

- On the day of registration of the emergency;

- in 3 months;

- 6 months;

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

The victim should be warned that he or she may be a source of HIV infection throughout the observation period and should therefore take precautions to avoid possible transmission of HIV. Taking into account the consequences of professional infection in the performance of their official duties, guarantees have been adopted in Federal Law No. 38 “On preventing the spread in the Russian Federation of the disease caused by the human immunodeficiency virus (HIV infection)” Article 4, labor guarantees Article 22.

1. Federal Law “On the Sanitary and Epidemiological Welfare of the Population” dated September 30, 1999 N 52-FZ (amended from December 30, 2001; January 10, June 30, 2003; August 22, 2004).

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

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

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

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

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

7. Sanitary rules and regulations “Rules for the collection, storage and disposal of waste from medical institutions” SanPiN 2.1.7.728-99. FSGSEN of the Ministry of Health of Russia. - Moscow, 1999.
10. Order of the Ministry of Health and Medical Industry of the Russian Federation “On measures to improve the prevention and treatment of HIV infection in the Russian Federation” dated August 16, 1994 N 170.

Electronic document text
prepared by Kodeks JSC and verified against:
Regulatory documents for the chief physician,
N 10, October, 2007