III. Measures in case of emergencies

(Order of the Ministry of Health SO No. 116-p dated February 16, 2012)

All medical workers who carry out any manipulations, as well as junior medical personnel of medical institutions, regardless of their form of ownership, must be vaccinated against hepatitis B(vaccination complex, consisting of 3 vaccinations and revaccination 1 time in 5-7 years).

Primary Care medical workers injured in emergencies associated with the risk of HIV infection on working days are in medical institution at the place of work.

Each medical worker must be familiarized with the order against signature and pass technical training on the prevention of occupational infection with passing a test with an entry in the journal of technical training.

Medical workers, Those who have not completed training are not allowed to work.

In the event of a medical emergency:

1) handle damage depending on the type of accident(the processing procedure is described in section 4);

2) examine the patient for antibodies to HIV and hepatitis B and C(with pre- and post-test counseling and informed consent). Examination for antibodies to HIV is carried out by the method of rapid testing, with the obligatory sending of a sample from the same portion of blood for standard testing for HIV in ELISA.

3) report the emergency to the person in charge for the prevention of occupational infection with blood-borne infections;

4) register an accident in the Logbook accidents at work and in the Journal of emergency situations during medical procedures;

5) test an injured healthcare worker for antibodies to HIV and viral hepatitis B and C (ELISA method) with pre- and post-test counseling and informed consent.

Blood plasma (or serum) samples of a person who is a potential source of infection, and a contact person, are transferred for storage for 12 months to the laboratory of the RC AIDS and IZ;

6) if the victim health worker - woman, necessary take a pregnancy test and find out if you are breastfeeding;

7) with positive(doubtful) result of the patient's examination for HIV infection - start antiretroviral drugs as soon as possible for post-exposure prophylaxis of HIV infection;

8) in case of a negative result in the rapid test, it is necessary to assess the degree of danger of the patient as a source of infection according to the anamnesis. At high

the likelihood of the patient being in the seronegative window and a negative test result, it is necessary to start taking antiretroviral drugs for the purpose of post-exposure prophylaxis of HIV infection.

If the patient is infected with HIV, find out if he is receiving antiretroviral therapy.

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 start chemoprophylaxis; if a full HAART regimen cannot be started immediately, one or two available drugs other than nevirapine and abacavir are started.

Starting antiretroviral prophylaxis as early as possible is recommended(in the first 2 hours after the emergency). If from the moment of possible infection has passed more than 72 hours, it is not advisable to start prophylaxis.

All antiretroviral drugs are used within 30 days.

9) personnel who have come into contact with material infected with hepatitis B virus are simultaneously injected with specific immunoglobulin (no later than 48 hours) and hepatitis B vaccine in different parts of the body according to the scheme 0-1-2-6 months. followed by monitoring of hepatitis markers (not earlier than 3-4 months after the administration of immunoglobulin). If the contact occurred in a previously vaccinated health worker, it is advisable to determine the level of anti-HBs in the blood serum. 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, it is advisable to simultaneously administer 1 dose of immunoglobulin and a booster dose of the vaccine;

9) draw up an "Act on an accident at work" (form H-1, approved by Decree of the Government of the Russian Federation No. 279 dated 11.03.1999);

10) in order to organize dispensary observation and adjust HIV chemoprophylaxis schemes, victims on the day of treatment should be referred to the State Budgetary Institution of Healthcare "OC AIDS and IZ" and its branches in the administrative districts (in case of their absence, to the infectious disease specialist of the infectious disease cabinet of the polyclinic at the place of residence)

Injured medical worker must be warned that it may be a source of infection during the entire observation period (the maximum possible incubation period) and therefore he must take precautions, to avoid possible transmission of HIV (in within 12 months he cannot be a donor, he must have only protected sexual contacts).

transcript

1 Algorithm of actions in the event of an emergency The health facility should keep records and analyze all cases of emergency situations with 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 such a development of events, it is recommended to evaluate the effectiveness of the implemented safety measures at the workplace. If the blood and biological fluids of HIV-infected people get on the skin and mucous membranes of a medical worker, it is necessary to take a set of measures to prevent HIV infection at the workplace, including first aid, prescribing antiretroviral drugs as soon as possible, examination and registration of an emergency. Actions of a medical worker in an emergency if there is a risk of HIV infection: - in case of cuts and injections, immediately remove gloves, wash hands with soap and water under running water, treat hands with 70% alcohol, lubricate the wound with 5% alcohol solution of iodine; - if blood or other biological fluids get on the skin, this place is treated with 70% alcohol, washed with soap and water and re-treated with 70% alcohol; - in case of contact with blood and other biological fluids of the patient on the mucous membrane of the eyes, nose and mouth: oral cavity rinse with plenty of water and rinse with a 70% solution of ethyl alcohol, rinse the nasal mucosa and eyes with plenty of water (do not rub); - if blood and other biological fluids of the patient get on the dressing gown, clothes: remove work clothes and immerse in a disinfectant solution or in a bix (tank) for autoclaving; - start taking antiretroviral drugs as soon as possible for post-exposure prophylaxis of HIV infection. 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 a person who has come into contact with him. An HIV examination of a potential source of HIV infection and a contact person is carried out by 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. Samples of plasma (or serum) of 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 subject's AIDS center Russian Federation. The victim and the person who may be a potential source of infection should be asked about the carriage of viral hepatitis, STIs, inflammatory diseases genitourinary system, other diseases, counseling on less risky behavior. 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 is started immediately, with the appearance of additional information, the scheme is adjusted. Conducting post-exposure prophylaxis of HIV infection with antiretroviral drugs: Taking antiretroviral drugs should be started within the first two hours after the accident, but no later than 72 hours. 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 start chemoprophylaxis; if it is impossible to immediately prescribe a full-fledged HAART regimen, one or two available in

3 Age form "List of persons affected in emergency situations and persons in contact with HIV, deregistered"; Informed consent form for HIV testing. The material used: SP "Prevention of HIV infection" MU "Epidemiology. Prevention of infectious diseases. Epidemiological surveillance of HIV infection. Guidelines" (approved by the Chief State Sanitary Doctor of the Russian Federation) Order of the Ministry of Health of the Republic of Tajikistan dated "On the prevention of occupational infection of medical workers with the human immunodeficiency virus" . Approved by the Order of the Ministry of Health of the Republic of Tajikistan Journal of emergency situations during medical procedures * in (name of department, institution) Started: "..." d Finished: "..." g p / p Full name of the injured medical worker Place of work, position Date and time “AS” Circumstances and nature of “AS” Availability of PPE Full name patient, address, medical history N, date and result of testing for HIV, HBV, HCV, stage of HIV infection. ARVT Amount of assistance provided to victims in "AS" the head who was informed about the "AS" Dates and results of ELISA and IB during medical examination * Next, an Act on a medical accident in a medical organization is drawn up.

4 Approved by the Order of the Ministry of Health of the Republic of Tajikistan I APPROVE / (signature, surname, initials of the head) " " 20 m.p. ACT N ON A MEDICAL ACCIDENT IN THE INSTITUTION 1. Date and time of the medical accident (day, month, year and time of the medical accident) 2. Institution where the victim is an employee (full name, actual address, legal address, surname, initials of the head) 3. Name of the structural unit where the emergency occurred and in which structural unit the injured employee works 4. Information about the injured employee: last name, first name, patronymic sex (male, female) date of birth " " year of full years 5. Presence of pregnancy weeks or breast 6. Position held in the specified medical organization Length of service in the organization, including in this position 7. Persons responsible for investigating a case of a medical accident (head of a structural unit, other officials) 8. Information about briefings (training and testing knowledge) on labor protection by profession (position) or type of work, in the performance of which an emergency occurred (day, month, year) Briefing at the workplace / primary, repeated, unscheduled, target / (underline as appropriate) by profession or type of work during which a medical accident occurred (day, month, year) Security training labor by profession or type of work, during the performance of which a medical accident occurred: from "" 20 to "" 20 (if not carried out - specify) Testing knowledge on labor protection by profession or type of work, during which a medical accident occurred

5 (day, month, year, protocol N) 9. Brief description of the place where the medical accident occurred 10. Circumstances of the medical accident, date of registration in the medical accident log deep abrasion, puncture with a contaminated needle, contamination of damaged skin and mucous membrane with infected blood or other biological fluids): 12. Information on the use of issued personal protective equipment at the time of the emergency (overalls, gloves, goggles, mask, apron) 13. Decontamination measures accident site, prevention of HIV infection of the victim 14. Causes of the medical accident (indicate the main and concomitant causes) 15. Eyewitnesses of the accident 16. Characteristics of the alleged source of infection: results of HIV testing: express diagnostics (date, result) ELISA (date, result ) IB (date, result) HIV status of the patient, registration N HIV, date of detection of HIV infection antiretroviral therapy immune status viral load HBV test results (date, result) HCV test results (date, result) epidemiological data indicating a high probability of the patient being in the "seronegative window" of the victim, including express diagnostics HIV test results (date, result) HBV test results (date, result) HCV test results (date, result) 18. Vaccination against hepatitis B in the victim (indicating date of vaccination, vaccine name, batch number, expiration date): V1 V2 V3 RV immunity to hepatitis B 19. Date and time of start, end of antiretroviral drugs, name of drugs

6 " " 20 y. AS: 1.1. FULL NAME. Date of birth 1.2. Address: - registration - residence 1.3. Contact phone 1.4. Place of work and position 1.5. Date and time "AS": 1.6. Date of circulation: 1.7. Short description"AS" 1.8. Measures taken: 1.9. Date of HIV testing when registering: Scheme of prescribed treatment: 2. Source “AC” data: 2.1. Full name Date of birth 2.3. Address: - registration - residence 2.4. Place of work and position: 2.5. Risk group (underline): HIV-infected (VP-), drug addict, CSW, CVHB, CVHC Rapid test (date and result): 2.7. If not examined, indicate the reason:

7 Responsible doctors: Infectionist: (full name) signature phone: Epidemiologist: (full name) signature phone: Date of completion: 20 Approved by Order of the Ministry of Health of the Republic of Tajikistan Notice of deregistration of the victim in the "AS" (to be submitted within 72 hours from the date of removal of the victim from the register by fax (843)) 1. Full name. 2. Date of birth 3. Address: - registration - residence 4. Place of work 5. Date of registration 6. Date of deregistration 7. Reason for deregistration (end of observation period, departure to another region, death, written refusal to observe , detection of HIV infection) 8. Results of laboratory observation: Dates of examination Dates and results of laboratory examination 3 months 6 months after "AS" after "AS" when registering 12 months after "AS" According to the schedule Actually

8 Responsible doctors: Infectionist: (full name) signature phone: Epidemiologist: (full name) signature phone: Date of completion: 20 Approved by the Order of the Ministry of Health of the Republic of Tajikistan Informed consent to an examination for HIV infection I , (last name, first name, patronymic) of the year of birth, I hereby confirm that, based on the information provided to me, freely and without coercion, reporting on the consequences of the examination, I decided to be tested for antibodies to HIV. For this purpose, I agree to take a blood test. I certify that it has been explained to me why it is important to get tested for HIV, how the test is carried out, and the consequences of testing for HIV. I am informed that: - HIV testing is carried out at the AIDS Center and other medical institutions. Testing at my voluntary choice can be voluntary anonymous (without presenting documents and indicating the name) or confidential (upon presentation of a passport, the result will be known to the examinee and the attending physician). In public health facilities, HIV testing is free of charge; - Evidence of the presence of HIV infection is the presence of antibodies to HIV in the blood of the examined person. However, during the period between infection and the appearance of antibodies to HIV (the so-called "seronegative window, usually 3 months), no antibodies to HIV are detected during testing and the person being examined can infect others. - HIV infection is transmitted only in three ways: - parenteral - most often through drug use, but can also be transmitted through the use of non-sterile medical instruments, transfusion of blood components, tattooing, piercing with a contaminated instrument, use of other people's shaving and manicure accessories; - sexual intercourse without a condom; - from an HIV-infected mother to a child during during pregnancy, childbirth and breastfeeding. Signature of subject for HIV: Date:

9 Approved by Order of the Ministry of Health of the Republic of Tajikistan municipality) n / p Full name Year of birth Address Registration category: contact with HIV, "AS" Type of registration: Contact: - sexual, - IV "AS": - medical, - household, - ISO. Date of registration Period of dispensary observation until: Date and result of the examination for the reporting period * Submitted by the 5th day of the month following the reporting quarter (by hand). Responsible doctors: Infectionist: (full name) signature phone: Epidemiologist: (full name) signature phone: Date of completion: 20

10 Approved by the Order of the Ministry of Health of the Republic of Tajikistan List* of persons affected in the “Emergency situation” and persons in contact with HIV, deregistered for the quarter of 20 (indicate the municipality) n/a Full name Year of birth Address Type of registration: “AS »: medical, household, ISO Contact: - sexual; - intravenous (indicate with whom the VP is in contact) Date of registration Dispensary observation period until: Date and result of the HIV test before deregistration Reason for deregistration Submitted by the 5th day of the month following the reporting quarter (by hand). Responsible doctors: Infectionist: (full name) signature phone: Epidemiologist: (full name) signature phone: Date of completion: 20

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ATTACHMENT 1

Models of emergency situations and their liquidation

An emergency situation means contamination of the skin, mucous membranes, as well as overalls of medical workers, equipment, table surfaces, floors with blood and other secretions of the patient. .

Blood is the strongest source of infection with the hepatitis B virus or HIV in the workplace. Therefore, protection against hepatitis B virus and HIV infection primarily consists of preventing their transmission through the blood, as well as hepatitis B vaccination. Although the modes of transmission of hepatitis B virus and HIV are the same, the risk of exposure to hepatitis B virus in the workplace is higher than HIV infection (this is due to the fact that the concentration of the virus in the blood of HIV-infected patients is much less).

Emergency Model #1:
damage to the skin (cut, prick)

The probability of contracting HIV when puncturing or cutting the skin with instruments contaminated with HIV-infected blood is 0.3-0.5%. The probability of infection with the hepatitis B virus in this emergency is 6-30%.

If a cut or injection occurs, remove gloves immediately or expose the area of ​​the wound. Squeeze out the blood from the wound; wipe off the blood with a swab dipped in 70% alcohol. Then, if the wound allows, thoroughly wash your hands under running water with soap twice. Lubricate the wound with 5% iodine solution. After 15 minutes, repeat the treatment with alcohol; cover with bactericidal plaster.

Emergency Model #2:
blood spilled onto exposed parts of the body

The probability of contracting HIV when infected blood comes into contact with intact skin is estimated at 0.05%.

If blood (or other biological fluid) has got on intact skin, it should be immediately treated with a swab moistened with a disinfectant solution or 70% alcohol solution for 0.5-1 minute. Do not rub! Then wash twice with warm running water and soap and dry with a disposable cloth or individual towel. After 15 minutes, repeat the treatment with alcohol (for more information, see the Hand treatment file).

Emergency Model #3:
blood has entered the eyes, nasal mucosa or oral cavity

The probability of contracting HIV when infected blood enters the mucous membranes is estimated at 0.09%.

If blood gets into the eyes, immediately rinse them with distilled water from the first aid kit for the prevention of HIV infection (or with a freshly prepared 0.05% solution of potassium permanganate - dilute 100 mg of potassium permanganate in 200 ml of distilled water). To wash the eyes, use glass baths: fill them with water or a solution, apply to the eyes and rinse, blinking for 2 minutes. Instill 2-3 drops of a 20% solution of albucid into each eye.

If blood gets on the nasal mucosa, immediately rinse the nose for 2 minutes in a freshly prepared 0.05% solution of potassium permanganate (dissolve 100 mg in 200 ml of water). Drop into each nasal passage 2-3 drops of a 20% solution of albucid.

If blood gets on the oral mucosa, immediately rinse your mouth with 70% ethyl alcohol or freshly prepared 0.05% potassium permanganate solution (dissolve 100 mg in 200 ml of water) for 2 minutes.

Emergency Model No. 4:
blood got on a dressing gown or other overalls

If blood gets on the dressing gown, the overalls are carefully removed (rolled up with the contaminated side inward) and immersed in the disinfectant solution for the required time (5 liters of disinfectant solution are used per 1 kg of dry laundry). Then it is rinsed in water and washed in the usual way. The skin under contaminated clothing is treated as indicated in paragraph "2" of this manual. Shoes are wiped twice with a disinfectant solution (at the same time, hands are protected with gloves, wiping rags are disposed of after disinfection).

Emergency Model No. 5:
blood got on the equipment, table surfaces, floor

If drops of blood get on the equipment or furniture surfaces, wipe them immediately with a cloth soaked in a disinfectant solution. Repeat the treatment after 15 minutes. The tissue is then disinfected and disposed of.

In the presence of large amounts of blood and liquids containing blood (for example, vomit), on the floor, put on gloves, soak a rag in a disinfectant solution and collect the blood in a container. Then add disinfectant solution to the container in the ratio of 1:4. Exposure according to the instructions for the disinfectant. The contaminated area is repeatedly wiped with disposable wipes soaked in a disinfectant solution. The treatment is repeated after 15 minutes. If there are large pools of blood on the floor, the use of disposable waterproof shoe covers should be considered, and if there is a risk of splashing, goggles and a waterproof apron should be used. Wear gloves when removing soiled shoe covers and apron.

Contaminated cleaning material should be soaked in a disinfectant solution (concentration and exposure time - see instructions for the disinfectant) in a ratio of 1:4, and then disposed of in accordance with the instructions for class B waste disposal.

APPENDIX 2

First aid kit for HIV prevention

Composition of the first aid kit:

Additionally, it is necessary to provide for the presence in the department:

• emergency instructions preventive measures in case of emergencies;
• working disinfectant solutions in the disinfection corner, an irreducible supply tap water for washing hands in a 5-liter container, toilet soap, individual wipes for getting your hands wet.

To clean up large pools of blood, you may need: disposable waterproof shoe covers, rubber gloves, rags. If there is a risk of blood splashing, goggles or a protective face shield, waterproof apron.

The first aid kit for the prevention of HIV infection should be stored in a separate labeled box in treatment room. Responsibilities for monitoring the storage and replenishment of the first-aid kit are assigned to the head nurse of the department.

Before removing clothes, gloves are disinfected.

In case of minor contamination with biological fluid, clothing is removed, placed in a plastic bag and sent to the laundry without pre-treatment, disinfection.

In case of significant contamination, clothing is soaked in water from the disinfectants used in the institution (except for 6% hydrogen peroxide and neutral calcium hydrochloride, which destroy tissues).,

Personal clothing contaminated with biological fluid is washed in hot water (70 °C) with detergent.

The skin of the hands and other parts of the body under the place of contaminated clothing is wiped with 70% alcohol. After that, it is washed with soap and wiped again with alcohol.

Contaminated shoes are wiped twice with a rag soaked in a solution of one of the disinfectants used in the institution.

• 17. In case of contact with mucous membranes

The oral cavity - rinse with a 70% solution of ethyl alcohol.

Nasal cavity - drip a 20-30% solution of albucid.

Eyes - rinse with water, then drip a 20-30% solution of albucid.

• 18. In case of contact with blood and other fluids with intact skin

urgently treat the site of contamination with one of the disinfectants (70% alcohol solution, 3% hydrogen peroxide solution, 3% chloramine solution);

then wash with soap and water and re-treat with alcohol

• 19. When skin is damaged

remove gloves with a working surface inside;

squeeze blood out of a wound, injection;

treat the affected area with one of the disinfectants (70% ethyl alcohol, 5% iodine solution - for cuts, 3% hydrogen peroxide solution - for injections);

wash your hands thoroughly with soap and running water, and then wipe them with a 70% solution of ethyl alcohol, apply a plaster on the wound, put on a fingertip;

if necessary, continue work - put on new gloves

• 20. Principles of chemoprevention of parenteral HIV transmission

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

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

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

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

Features of the use of efavirenz.

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

Features of the use of nevirapine.

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

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

Biochemical (creatinine, urea, bilirubin, ALT, AST);

Clinical (hemoglobin, erythrocytes, platelets, neutrophils, leukocyte formula);

Pregnancy test.

An emergency situation may occur with an employee during the performance of his immediate duties. What this means for a healthcare worker and how to avoid such unpleasant situations will be discussed in this article.

Circumstances of an emergency

It is no secret that every medical worker daily performs dozens of different manipulations during the implementation process, such as:

• Performing injections;
• Disinfection of instruments;
• Operation of medical devices;
• Medical waste management;
• Accounting, storage and use;
• holding;
• and etc.

When performing the above manipulations, the medical An employee may find himself in completely different emergency situations., for example:

• contamination of the skin and mucous membranes of workers with blood and other biological fluids of patients;
• injections and cuts with piercing and cutting tools;
• scattering (spill) of medical waste of B/C classes;
• destruction of mercury-containing lamps or thermometers ( mercury pollution);
• adverse situations when working with disinfectants (accidental poisoning with a disinfectant, chemical burn, other adverse situations);
• electrical shock or other emergencies when working with medical equipment, such as installations for disinfection/ ;
• electric shock or other emergencies during cleaning activities;
• adverse effects of ozone on healthcare workers;
• destruction of germicidal lamps (mercury contamination);
• adverse effects of radiation on healthcare workers.

It is worth remembering that the occurrence of an emergency does not always lead to an accident at work. In order to distinguish between these concepts, we recommend that you read our article "".

In order to avoid such emergencies, you should follow the rules of work and when performing various activities. The employer should introduce local Instructions into the work of personnel with a clear algorithm of action in certain situations (for example, Instructions on the rules for handling medical waste, Instructions on the rules for accounting, storage and use of disinfectants, other instructions).

For example, in his Letter No. 44-18-3461 dated October 26, 2006, he ordered the healthcare institutions subordinate to him to develop in each institution an instruction on labor protection when working with blood and other risk." To this Letter, the Moscow Department of Health attached an exemplary instruction.

The main rules for the work of medical personnel include the following:

1. Each medical worker must observe personal hygiene measures (comply with the standard of hand treatment, work using, etc.);
2. Medical workers must take precautions when working with piercing, cutting instruments, with needles;
3. It must be assumed that each patient is potentially dangerous in relation to infectious diseases;
4. When working in offices where medical personnel can come into contact with patients' biological fluids, there should be an "Anti-HIV" first aid kit.
5. In emergency situations, carry out emergency prophylaxis;
6. At the end of the work, perform the necessary manipulations:
   • Place disposable instruments in a puncture-proof container;
   • Items to be further used should be placed in containers for processing;
   • Treat table surfaces with disinfectants.

The uniform composition of such a first-aid kit has not been established, but taking into account the data reflected in the above Letter, in Appendix 12 to SanPiN 2.1.3.2630-10 "Sanitary and epidemiological requirements for organizations engaged in medical activities", approved Decree of the Chief State Sanitary Doctor of the Russian Federation of May 18, 2010 No. 58 and taking into account the provisions of SP 3.1.5.2826-10 "Prevention of HIV infection", approved by the Decree of the Chief State Sanitary Doctor of the Russian Federation of 11.01.2011 No. 1, it can be concluded that the first-aid kit should include the following:

• 70% ethyl alcohol;
• cotton-gauze swabs;
• 5% alcohol solution of iodine;
• bactericidal plaster;
• dressing.

Article 11 Federal Law No. 52-FZ dated March 30, 1999"On the sanitary and epidemiological well-being of the population" legal entities and individual entrepreneurs are required to take preventive measures.

Very often, in the process of work of medical personnel, injections and cuts occur. In order to avoid possible infection, the employee should follow the rules for working with piercing and cutting tools, as well as know and observe safety precautions, which consist in mandatory preventive measures.

Preventive measures are carried out on the basis that each patient is regarded as a potential source of bloodborne infections (hepatitis B, C, HIV and others).

A plan of preventive measures should be drawn up in each medical organization and approved by the head of this organization. Such a requirement is contained in the "Sanitary and epidemiological requirements for organizations engaged in medical activities" (SanPiN 2.1.3.2630-10), approved by the Decree of the Chief State Sanitary Doctor of the Russian Federation of May 18, 2010 No. 58.

There are several basic activities and rules that must be organized in a medical organization and must be observed by employees. Therefore, every medical employee should know and observe:

• Standard for processing the hands of staff and the skin of the patient;
• If necessary, carry out sanitization of the patient in the admissions department of a medical organization;
• Meals for medical personnel should be organized in a separate room, and for patients, if possible, in a separate building;
• At the workplace, all the requirements of sanitary standards must be observed;
• Personnel must be provided with personal protective equipment (more on this in the article "");
• If hands are contaminated, they must be washed and treated with an antiseptic;
• In case of injections and cuts, it is necessary to wash your hands with gloves, remove gloves, squeeze blood out of the wound, wash your hands, treat the wound;
• If necessary, carry out emergency HIV prevention. It must be carried out in accordance with Appendix 12 "Emergency prevention of parenteral viral hepatitis and HIV infection" SanPiN 2.1.3.2630-10, but taking into account the provisions of SP 3.1.5.2826-10 "Prevention of HIV infection", in particular, it is not necessary to use permanganate potassium (potassium permanganate). This is permissible due to the fact that SP 3.1.5.2826-10 was approved eight months later than SanPiN 2.1.3.2630-10 and, therefore, have priority in terms of regulatory force.

For reference: potassium permanganate (potassium permanganate) refers to the precursors of narcotic drugs and psychotropic substances and is included in Table III of List IV of the list of narcotic drugs, psychotropic substances and their precursors subject to control in the Russian Federation, approved by Decree of the Government of the Russian Federation of June 30, 1998 No. 681.

• Carry out disinfection measures;
• Conduct prophylactic immunizations.

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According to methodological recommendations“Prevention of infection, including medical workers, with the human immunodeficiency virus at the workplace”, approved by the Ministry of Health and Social Development of Russia on August 6, 2007 No. 5961-РХ, in Russia, the following are most often at occupational risk of contracting HIV:

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

In this regard, it is very important for medical personnel to comply with all necessary measures precautions and implement a whole range of preventive measures, most of them are contained in various regulations, for example, in such as the Decree of the Chief State Sanitary Doctor of the Russian Federation dated January 11, 2011 No. 1 “On Approval of SP 3.1.5.2826-10 “Prevention of HIV Infection” (Together with "SP 3.1.5.2826-10. Sanitary and epidemiological rules..."). Equally important will be the excellent knowledge of medical personnel on how to act in a particular emergency situation associated with the risk of contracting HIV infection.

For emergency prevention of the disease, people at risk of contracting HIV infection are prescribed antiretroviral drugs.

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

All medical organizations should be provided or have access to rapid HIV tests and antiretroviral drugs, if necessary. A stock of antiretroviral drugs should be kept in any medical organization at the choice 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 the emergency. The authorized health facility should identify a specialist responsible for the storage of antiretroviral drugs, a place for their storage with access, including at night and on weekends.

According to the information published in Letter No. 14-1/10/2-2018 of March 22, 2013 of the Ministry of Health of Russia, 65% of medical workers receive microtrauma of the skin every month, but no more than 10% of injuries and emergencies are officially recorded.

It is worth remembering that employees of medical organizations must immediately report each emergency to the head of the unit, his deputy or a higher manager.

A number of methodological documents, and it is prescribed to conduct mandatory accounting and investigation of emergency situations among medical workers performing, and for each case, an entry should be immediately made in the microtrauma register or in the emergency register.

At the same time, there is no unified form of such journals. However, based on the requirements of SanPiN 2.1.3.2630-10 for information to be registered in such a journal, a medical organization can usually easily develop the form of such a journal on its own.

An emergency can happen to any healthcare worker. But it is always worth remembering that the likelihood of its occurrence can be reduced by unquestioning compliance with the requirements and the execution of all job descriptions.

Normative legal acts:

• Federal Law No. 52-FZ of March 30, 1999 “On the Sanitary and Epidemiological Welfare of the Population”;
• Decree of the Chief State Sanitary Doctor of the Russian Federation dated May 18, 2010 No. 58 on the approval of the “Sanitary and epidemiological requirements for organizations engaged in medical activities” (SanPiN 2.1.3.2630-10);
• Decree of the Chief State Sanitary Doctor of the Russian Federation dated 11.01.2011 No. 1 “On approval of SP 3.1.5.2826-10 “Prevention of HIV infection” (together with “SP 3.1.5.2826-10. Sanitary and epidemiological rules ...”).