Features of work with HIV infected. HIV and work

In society, people with HIV-positive status still cause mistrust and fear. At the same time, people also want to get a job and be useful. After all, the virus could be acquired not only through sexual contact or a syringe. However, infected people are professionally limited in a sense. They cannot reach their full potential.

There are a number of professions in which a medical examination and approval from a therapist is required. The list of specialties is approved by the Government of the Russian Federation. Representatives of some types of activity annually undergo a medical examination. It will not be possible to conceal the status during the implementation of one of the activities. Employment of an infected applicant will be impossible only for certain positions.

To defend their right to work, any applicant has the right to go to court. In the absence of additional requirements, the applicant for the position is not required to inform his employer about. Accordingly, the manager cannot demand the results of the analyzes for review. There are cases in which employees of the team learn about the infection of an employee. There are misunderstandings. The employee has conflict situations, which affects his performance and self-esteem. Without reliable information, colleagues may refuse to interact with the employee, citing this as a source of infection. It is a myth.

• Through handshakes and touching, healthy people will not become infected with HIV.

People with AIDS can successfully implement labor activity.

Like any employee, a person with a positive status will need to undergo a medical examination. Health workers are not allowed to report an infection to work. If the test results are positive, they can only report to the clinic at the place of registration. The preservation of medical secrecy in Russia has not been canceled.

Even if the employer found out about the infection of the employee, he has no right to fire him. In this regard, the legislation is vague. However, there is no article that provides for the suspension of an employee with an HIV-positive status. Workers with HIV have the same rights as healthy workers. The reverse side of collective behavior, when a person with a positive status is forced to quit. Often status persons are subject to psychological pressure. With growing tension in the team, a person will have to change his workplace. This will help maintain his mental health and adequate self-esteem.

Where HIV carriers are prohibited from working

The list of professions where HIV-infected people are prohibited from working is fixed in the legislative act. The list of professions is agreed at the state level:

• doctors and nurses;
• employees whose activities are related to the collection and transfusion of blood and liquid biomaterials;
• applicants who want to get into service in the Ministry of Internal Affairs and the Armed Forces, as well as in military or civil aviation;
• specialists who develop and manufacture immune preparations.

Vacancies for infected persons are not marked with any benefits or privileges. They willingly hire people who can tell about the disease in the first person as consultants at AIDS centers. Their assistance is especially effective at the stage of counseling those who have just learned about their status or their relatives.

In the said List, the requirements for the applicant are clearly and in detail spelled out. Passage of a medical examination is provided by law at least once a year. Due to the peculiarities of the profession, medical workers are constantly at risk of contracting various infections, including HIV.

Blitz Q&A on frequently asked questions on employment of HIV carriers

Is it possible to work as a doctor with HIV?

The profession of a doctor is included in the List, which was indicated in the Government Decree of October 13, 1995 No. 1017. However, if infected with HIV in the course of performing their duties, an infected doctor cannot be fired. The management of the healthcare institution is obliged to report such a fact to a higher authority. If infection is confirmed at the stage of hiring, then the manager can legally refuse the applicant. A person with a positive status may have a question: is it possible to work as a pathologist with HIV infection. Based on the definition, a pathologist is a doctor. The profession of a doctor is included in the specified List. This means that with a vacant position, a person with a positive status will be denied employment on legal grounds.

Is it possible for an HIV-positive person to carry out activities in the public catering system?

An applicant with an immunodeficiency cannot work in the catering system or be a cook. If such an employee is injured, the likelihood of infecting colleagues or visitors increases. The federal law “On the Prevention of the Spread in the Russian Federation of a Disease Caused by the Human Immunodeficiency Virus (HIV)” clearly defines the disease. It has an infectious nature. At the same time, Article 23 of the Federal Law of January 2, 2000 N 29-FZ (as amended on July 19, 2011) “On the Quality and Safety of Food Products” states that an employee is not allowed to work related to products. If the employer refers to the specified act, then his refusal will be very legitimate. However, the right to work can always be proven or challenged in court.

Is it possible for HIV-positive people to work in trade?

The answer is ambiguous. If the activity of an employee is directly related to the packaging of products or their preparation, then such an employee should be removed from the activity. And the applicant is denied on legal grounds. At the same time, it is not prohibited by law to be a seller of household goods or clothing.

Does a person infected with HIV have the right to work in a kindergarten?

At the legislative level, working in the system of preschool education is not prohibited. The ban only applies to kitchen workers. They are not allowed to work in a preschool institution, which involves direct contact with food. When communicating with children and adults, the infection is not transmitted. The requirement of a mandatory medical examination when applying for a job remains relevant for applicants with HIV. Refusal to undergo a medical examination may be grounds for removal from duty.

Hospital workers most often encounter sources of infection with infectious and viral diseases. And it is dangerous not only for the employee himself. Infected personnel can transmit the infection to the patient they are working with. For this reason, the prevention of HIV infection among health workers is one of the most relevant. According to the Ministry of Health, HIV and other infections are constantly occurring in hospitals, despite the fact that prevention of occupational infection is carried out very often. There are a number of actions designed to protect personnel from infection and further spread of the disease. The reason for the frequent cases of infection is the negligence of the workers themselves, the violation of the algorithm for performing a particular procedure.

Medical staff is always at risk of contracting HIV infection. Professions that are constantly in contact with the blood of patients are especially susceptible to this, for example, surgeons, procedural nurses, gynecologists, and so on.

In infectious diseases, public health has identified possible risk factors - tools or procedures through which infection can occur.

These include:

1. Direct contact with the liquid tissues of the patient (blood, lymph, saliva);
2. Syringe needles;
3. Medical scalpels, tweezers.

Hospitals periodically monitor epidemiological safety and prevent HIV infection among staff to prevent infection and reduce the risk of infection for health workers and patients.

The importance of the biological safety of medical institutions is spelled out in the law of the Ministry of Health of the Russian Federation "On biological safety" dated August 16, 2017.

Routes of HIV infection

HIV infection has a short period of life outside the human body, so it is impossible to get infected with this virus through clothing, dishes or through communication. Infection can occur only through direct contact with the patient's blood.

The medical worker directly works with the material: biological and infectious. The medical business requires fresh, non-disinfected body fluids. Thus, the following routes of infection can be distinguished:

1. In case of accidental needle prick after the patient during blood sampling or performing medical procedures;
2. When blood gets on the surface of the mucous membranes or if biological fluids get into open wounds of the skin;

With the correct implementation of actions during such an incident, further development of the disease can be avoided. But HIV is a specific disease, the developmental features of which do not allow you to quickly notice the infection. As a result, until the first symptoms appear, the infected person is unaware of the infection.

If the patient is sick

If the attending physician is aware that the patient has HIV infection, regardless of the main course of treatment, he is prescribed antiretroviral prevention therapy. Precaution protects both healthcare workers and the patient. Also, similar therapy is prescribed to all people who are in direct contact with the patient.

Important! HIV is an intracellular virus that affects the immune system, so drugs in tablet form do not work on it.

After an intramuscular injection, a course is prescribed for the rehabilitation of the body, since the medicine itself greatly affects the patient's condition. During these procedures, there is the highest risk of infection for a medical worker, since sharp needles are used, as well as droplets of the patient's blood are released onto the surface of the skin. For safety reasons, health workers are advised not to perform such procedures if they feel unwell or if there are scratches and wounds on the skin of the hands.

Treatment of HIV diseases does not imply a complete cure for the disease, but only suppression of its development for a while. This means that if you come into contact with the blood of a person who has completed a full course of rehabilitation, you can still get infected. It is important to understand that infection occurs through contact with blood, serum. The latter does not contain blood cells, but may contain HIV proteins.

After completing the course of treatment, each patient is assigned a number in the Federal Register of HIV-infected with the corresponding records. In order for the disease not to develop, it is necessary to periodically, in accordance with its number, undergo repeated courses of treatment.

If a healthcare worker is sick

Despite the fact that in medical institutions the prevention of occupational HIV infection of medical workers is constantly carried out, there are still many cases of occupational infection. Unscrupulous employees and personnel are periodically revealed. AIDS is not getting smaller thanks to people like this. In order to protect patients like workers, they are required to be tested for HIV once a year, and some even more often. When carrying out various manipulations with cutting devices, additional and repeated briefings are carried out daily, for which both the instructing and the instructed are required to sign. Disinfection is constantly carried out above the working surface in laboratory rooms and at blood sampling points. Also, after working with reusable instruments that come into contact with the mucous membranes of patients, they are placed in a disinfectant solution.

If a medical worker is found to be infected with HIV, his fate depends on the type of activity: cosmetologists and dentists lose the right to work in their profession. Doctors of other positions are required to transfer to a department where there is no risk of infecting the patient (therapist, paramedic).

What to do when diagnosed with HIV

Due to the negligence of medical personnel in hospitals, there is a problem of HIV infection of inpatients. At the same time, a person does not find out about the disease until the next scheduled examination, since such tests are not carried out at discharge.

In departments where the risk of such an incident is high, there is a prevention of nosocomial HIV infection. It is based on the precautionary measures established for hospital staff, as well as a set of rules for inpatients. The text of the SanPin on the prevention of nosocomial HIV infection contains the following provisions:

1. Each patient is considered as a potential source of infection, regardless of status, age and gender.
2. Hospitals should be equipped with all necessary equipment and disinfectants for laboratory equipment;
3. If a virus infection is suspected, a set of measures is taken to identify and prevent the spread of the disease;
4. An extraordinary investigation is underway to further prevent. Immunodeficiency is infected by viruses. A special set of measures establishes the route of infection and stops further spread;
5. An emergency situation in case of HIV infection is recorded in a special log.

It should be understood that not all hospital departments have the same infection risk ratio. For example, dentistry is more dangerous than therapeutic. Also, the risk of infection is high in unlicensed private clinics, as disinfection there can be carried out with other drugs that are not recommended for use in hospitals that do not work on HIV. Such procedures can be carried out incorrectly, without technology.

When contacting a private clinic, you should proceed as follows:

1. Ask for a license to provide the requested services;
2. Check the disinfection log and the name of the preparations;
3. Check the time of the last procedure;
4. Make sure that the doctor uses all the necessary personal hygiene products (gloves, sterile wipes, etc.).

You can find out all the necessary requirements in SanPin, which is freely available in any clinic.

If infection has occurred

If an emergency situation occurs, it is necessary to take all measures to prevent the development of the disease and its spread. In medicine, there is a strict subordination among medical workers and there is a law on the security of personal information, an employee with whom an incident has occurred is obliged to report this only to his immediate superior. He decides on the further fate of his subordinate (in accordance with the requirements of the law).

If further work is required, all damage must be thoroughly disinfected to prevent blood or lymph from entering the working tool.

Important! If an employee notifies the supervisor of the fact that he has been infected and continues his work, the responsibility for the further spread of HIV will be borne by the supervisor.

If biological fluids get on mucous membranes, infection may not occur immediately, so the employee must immediately treat with alcohol or an alcohol-based skin antiseptic (lowering the concentration so that there is no burn). After a few days, you need to conduct an HIV test to make sure that there is no disease.

Skin lesions are the most likely route of infection. Vessels approach the surface of the wound, blood circulation increases, so it is impossible to quickly neutralize the source of HIV infection. A similar situation is often noted in the surgical department, since it is almost impossible to quickly replace a surgeon.

According to the statistics of HIV infections, more than 73 cases are recorded annually at work. More than half of them occur due to incorrect actions in the first minutes of infection. For example, if a source of infection gets on the eye, many people treat the wound with plenty of water, while it is necessary to rinse with a solution of potassium permanganate.

Often, patients themselves do not inform the doctor about the disease, and he does not conduct the necessary analysis.

Prevention of HIV infections in health care settings, including outpatient clinics and hospitals

The main measure to combat HIV in hospitals is the prevention of occupational exposure. Measures for the prevention of HIV infection in medical institutions are established in the SanPin and have been listed above. The actions carried out in medical institutions are mainly preventive. Infections in health facilities are less common, so measures are relaxed here.

But the used tools are always disinfected, and compliance with safety regulations is also required:

1. The use of tools for other purposes is prohibited;
2. When working with biological fluids, treat before and after procedures;
3. The requirements of the charter must be met by all employees of the institution, regardless of the type of activity;
4. Neglect of protective equipment is punishable by a fine and a reprimand with entry in the work book;
5. All actions, the result of which may lead to the spread of HIV, are equated with negligence or breach of duty;
6. Employees are required to use gloves, goggles to prevent infection through mucous membranes and accidental injuries;
7. The treatment of the instrument is carried out in the morning and in the evening, as well as after each procedure. To do this, they are placed in special containers with a working solution.

Advice! In order not to burn the skin of the hands during processing, it is necessary to use personal protective equipment (for example, gloves).

Performing procedures using syringes also requires a number of actions:

1. The use of syringes is only allowed once;
2. Unpacking the instrument is carried out immediately before the procedure.

In accordance with Article 22 of the Federal Law of the Russian Federation dated March 30, 1995 No. 38-FZ “On Preventing the Spread of Disease Caused by the Human Immunodeficiency Virus (HIV) in the Russian Federation” to employees of healthcare institutions and organizations that diagnose and treat HIV -infected, bonuses to the official salary are paid, a reduced working day is established, additional leave is provided for work in especially dangerous working conditions.
In accordance with the Guidelines for the organization of medical and diagnostic care and dispensary observation of patients with HIV infection and AIDS, approved by order of the Ministry of Health and Medical Industry of the Russian Federation dated August 16, 1994 No. 170 and the Guidelines for the Prevention of Parenteral Viral Hepatitis and HIV infections in medical personnel of health care institutions”, HIV infection is an infectious disease with a rather limited number of possible transmission routes, the knowledge of which must be taken into account when working with patients.
During a routine physical examination, no additional protective measures are required if there is no damage to the skin of the hands. If there are any, they must be sealed with a plaster or put on fingertips.

When working with biological substances of patients with HIV infection or performing manipulations, it is necessary to apply the appropriate rules:
- a medical worker should use personal protective equipment (gown, cap, disposable mask, gloves, etc.) to avoid direct contact with wounds and tissues, blood, cerebrospinal fluid, secretory and excretory secretions of patients or environmental objects contaminated with these biological fluids;
- the unit must have an "Anti-HIV" first aid kit;
- to protect against the possible ingress of virus-containing material during work, it is recommended to use goggles, screens or other protective equipment that is subject to disinfection;
- when performing medical procedures, during which the formation of splashes of blood and other biological fluids may occur, the personnel must be dressed in disposable aprons;
- delivery of blood samples is carried out in containers with closing lids, from a material that does not deteriorate during disinfection. Transportation of materials in bags, briefcases and other personal items is not allowed.
The most real danger of infection occurs when gloves are torn and punctured, which can lead to contact with contaminated material on the skin, possibly with microtraumas, and especially with pricks and cuts. To reduce the likelihood of infection in such cases, it is recommended:
- in preparation for the manipulation of a patient with HIV infection, make sure the integrity of the emergency kit;
- perform manipulations in the presence of a second specialist, who, in the event of a rupture of gloves or a cut, can continue its implementation;
- treat the skin of the nail phalanges with iodine before putting on gloves.
Consider as an emergency any damage to the skin, as well as the ingress of blood and other biological fluids on the mucous membranes of the oropharynx, nose and eyes:
- in case of damage to the skin: it is necessary to treat the gloves with a disinfectant solution and remove them. Squeeze out the blood from the wound, then wash your hands thoroughly with soap and water, treat them with 70% ethyl alcohol. Lubricate the wound with 5% iodine solution, apply a bactericidal patch to the injury site. Don't rub!
If blood gets on the mucous membranes of the eyes, oropharynx, nose: rinse the mucous membrane of the eye with distilled water and drip a 0.05% solution of potassium permanganate. Treat the mucous membranes of the oropharynx and nose with a 0.05% solution of potassium permanganate. Rinse mouth and throat with 79% ethanol solution or 0.05% potassium permanganate solution.
Prophylactic thymoside (AZT) 800 mg/day for 3 days is recommended.
The injured medical worker is under medical observation by an infectious disease doctor.

Organization of anti-epidemic support for HIV infection differs significantly from the established practice of working to combat the spread of other infectious diseases.

The need to keep medical secrecy not only about AIDS patients, HIV carriers, but also about persons in contact with them who are suspected of being infected with HIV, dictates a completely different tactic of work.

Anti-epidemic work begins with the detection of seropositivity for antibodies to HIV. Depending on the results of laboratory studies, its implementation is modified by levels (from institutional to republican), ensuring continuity, completeness, and confidentiality.

1. The procedure for information on HIV-infected, AIDS patients and their registration.

1.1. the serum of the person being examined in the ELISA in the screening laboratory in the returned copy of the F.264 / y-88 direction, the entry “repeat the analysis” is made.

1.2. In the arbitration laboratory or in the laboratory of the regional CGE or 03 received material is recorded in a separate journal. Upon receipt of a positive or doubtful result in the ELISA, information about this is transmitted to the epidemiological department of the CGE and 03, and the sample is sent to the reference laboratory Republican CGE and 03. The medical facility reported that the sample was left for further research.

1.3. In the epidemiological department of the regional CGE and 03, sero-positive persons in the ELISA are recorded in a special journal and the progress of further testing for HIV infection.

1.4. In case of a negative result the laboratory issues a response to the health facility that sent the sample.

1.5. Upon receipt of a positive test result in ELISA and negative in immunoblotting, the information is transmitted to the epidemiological department of the RCGE and 03, which, after entering it into a computer filing cabinet, reports this to the OCGE and 03 at the place of residence to organize dispensary observation.

1.6. In the event of an uncertain, doubtful or positive result in immunoblotting, the reference laboratory promptly (by phone) reports to the epidemiological department of the RCGE and 03 and within 24 hours sends a written conclusion according to F.264 / U-88. If necessary, laboratory tests are carried out in laboratories upon request. The blood of HIV-infected people is sent by the Republican Center HE and 03 to BelNIIEM for scientific research. Material for research is sent only in coded form. All the obtained research results are transferred to the epidemiological department of the RCGE and 03 with strict confidentiality. Based on the messages received, the epidemiological department of the RCGE and 03 determines the tactics for further information about the seropositive patient. In RCGE and 03, OTsGE and 03 and KIZah, accounting is carried out according to F.60 / U-88.

1.7. About all cases of HIV seropositivity, starting with a double positive result in ELISA, OCGE and 03 (for the city of Minsk and the Minsk region RCGE and 03) in writing (with a stamp of DSP) reports to a single donor center (in its absence, to the regional blood transfusion station) prohibition of blood donation from the respective persons without specifying the reason for the suspension.

1.8. RCGE and 03 submits information to the Ministry of Health of the Republic about identified HIV-infected and AIDS patients and carried out anti-epidemic measures (without indicating the name, address, place of work).

Population to be tested for HIV.

Examination of citizens of the Republic of Belarus, foreign citizens and stateless persons residing or staying on the territory of the republic, for the detection of infection with the human immunodeficiency virus (AIDS disease) is carried out in accordance with the “Rules for Medical Examination ...”, approved by the Minister of Health of the Republic of Belarus on March 12, 1993. and coordinated with the ministries concerned (Ministry of Internal Affairs of the Republic of Belarus, Ministry of Justice of the Republic of Belarus, Ministry of Foreign Affairs of the Republic of Belarus, Prosecutor General of the Republic of Belarus). These rules have been drawn up taking into account the recommendations of WHO and amended in 1994.

1. Subject to verification:

1.1. Donors of blood, blood plasma and other biological fluids and tissues at each collection;

1.2. Foreign citizens and stateless persons who arrived in the republic for study (over three months) within 10 days after arrival and after 6 months, but no more than twice a year.

Foreign citizens and stateless persons who arrived from countries whose certificates of testing for antibodies to HIV are recognized by the Republic of Belarus are examined 3 months after arrival;

1.4. Patients with suspected or confirmed diagnosis:

• Kaposi's sarcoma;
• brain lymphomas;
• T-cell leukemia;
• pulmonary and extrapulmonary tuberculosis, patients with unmotivated progression of tuberculosis, as well as with early severe complications of the tuberculosis process at diagnosis and after 6 months;
• parenteral viral hepatitis, persistent HBs antigenemia, as well as viral hepatitis of undeciphered etiology (at diagnosis and 9 months after discharge);
• diseases caused by cytomegalovirus;
• generalized or chronic form of infection caused by the herpes simplex virus;
• recurrent lichen in persons younger than 60 years;
• aseptic meningoencephalitis (at diagnosis and after 6 months);
• mononucleosis (adults and children over 13 years of age at diagnosis and
• in 6 months);
• pneumocystosis (pneumonia);
• toxoplasmosis (central nervous system);
• cryptococcosis (extrapulmonary);
• cryptosporidiosis;
• isosporosis;
• histoplasmosis;
• strongyloidiasis;
• candidiasis of the esophagus, trachea, bronchi or lungs;
• deep mycoses;
• atypical mycobacteriosis;
• progressive multifocal leukoencephalopathy;
• newborns with developmental anomalies, intrauterine toxoplasmosis infection, listerillosis, low birth weight in urgent delivery at 39-41 weeks (weighing less than 2500.0).

1.5. Patients who are systematically transfused with blood and its preparations (hemophilia, Werlhof's disease, von Willebrand's disease, anemia of various origins, etc.) - every 6 months.

1.5.1. Recipients of blood, other biological fluids and tissues are examined according to epidemiological indications.

1.6. Placental blood sent for processing.

1.7. Children:

1.7.1. Born from HIV-infected mothers: at 12, 18 months;

1.7.2. Issued for adoption, as well as in orphanages, orphanages, boarding schools.

1.8. Persons suffering from venereal diseases and sexually transmitted diseases are examined upon detection.

1.9. Drug addicts, homosexuals and bisexuals, persons involved in prostitution - if identified.

1.10. Persons entering pre-trial detention centers are examined upon admission, and those in correctional labor institutions, according to clinical and epidemiological indications.

1.11. Medical workers in case of contact with the patient's biological material resulting from an emergency - immediately after the accident and after 6 months.

1.12. Medical workers and patients of medical and preventive organizations and other citizens who have been in contact with HIV-infected persons (as directed by specialists from the GE I 03 centers).

1.13. Persons whose need for examination is determined during the epidemiological investigation of the focus of HIV infection.

2. The cadaveric material from the deceased with signs that do not exclude the diseases listed in paragraphs 1.3, 1.4 is examined.

3. Citizens of the Republic of Belarus, foreign citizens and stateless persons who have expressed a desire to undergo an examination, including anonymously, are examined.

epidemiological investigation.

The aim of the epidemiological investigation of HIV cases is to limit its further spread.

Upon detection of HIV-infected among residents of the Republic of Belarus serving sentences in places of deprivation of liberty or service in the ranks of the Armed Forces of the Republic of Belarus, registration is carried out at the place of residence, and epidemiological investigation - at the place of detection within 10 days. When HIV-infected foreign citizens from this category of persons are identified, registration and epidemiological investigation are carried out at the place of detection.

Epidemiological investigation methods:

Study of medical records, familiarization with the social status of the patient, laboratory examination.

An epidemiological investigation is carried out with the involvement of specialists from RCGE and 03, OCGE and OZ, and, if necessary, other specialists.

During the epidemiological investigation determine the ways and factors of HIV infection. The information received is specified by studying the documentation in the relevant medical or other institution and conducting an inspection directly at the facility. The epidemiological form 357/y-AIDS is filled in by the doctor conducting the epidemiological investigation.

The information entered into it is not subject to disclosure and is used only for official use. The epidemiological card is filled in for all HIV-infected and is maintained throughout the life of an HIV-infected person or the duration of his stay in the territory of the Republic of Belarus.

The complex of epidemiological measures includes:

• conducting epidemiological work directly with the infected;
• identification of persons who could become infected or be infected in the same conditions;
• carrying out activities to break transmission routes;
• implementation of organizational measures;
• HIV prevention measures.

Working with HIV-infected.

After establishing the fact of infection of the patient with the human immunodeficiency virus, he is notified in writing by the doctor conducting the epidemiological investigation about the presence of the immunodeficiency virus in his body and the need to comply with measures to prevent the spread of this disease. In the future, monitoring of the focus is carried out.

Prevention of infection in the home. Explanatory work is carried out with relatives, especially those caring for an HIV-carrier with AIDS, on how to protect themselves from infection when providing medical care (wound dressing, stopping nosebleeds, etc.), service, and care.

Rules of conduct for medical personnel in the care of HIV-sick and infected. Prevention of cases of occupational infection of healthcare workers.

In the context of the increasing spread of HIV infection among the population, the introduction of the human immunodeficiency virus into medical organizations is an everyday reality. Therefore, everyone who seeks medical help should be considered as a potential carrier of the human immunodeficiency virus. Accordingly, measures must be taken in every workplace to prevent the transmission of the virus. human immunodeficiency from a possible virus carrier or AIDS patient to other patients, medical and technical personnel.

1. General provisions

1.1. By order of organization, work on the prevention of parenteral HIV infection is assigned to the commission on nosocomial infections, a responsible person is appointed in each department for ensuring security issues, a system is defined for monitoring the work of staff in the evening and at night, and monitoring the quality of instrument processing.

1.2. Workplaces are provided with extracts from instructive and methodological documents, first-aid kits for emergency prevention in emergency situations.

1.3. All medical instruments (as well as dishes, underwear, apparatus, etc.) contaminated with blood, biological fluids, and also in contact with mucous membranes, immediately after use, are subject to disinfection in accordance with Order M3 of the Republic of Belarus No. 66 dated April 2, 1993. “ On measures to reduce the incidence of viral hepatitis in the Republic of Belarus” and other regulatory documents. The modes of disinfection are similar to those used for the prevention of infection with hepatitis B, C, D.

1.4. When carrying out manipulations related to the violation of the integrity of the skin, mucous membranes, and also not excluding splashing of biological fluids during the autopsy, laboratory research, processing of instruments, linen, cleaning, etc., medical workers and technical personnel must use personal protective equipment (surgical gown, mask, goggles or screen, waterproof apron, sleeves, gloves) to avoid contact of the patient's blood, tissues, biological fluids with the skin and mucous membranes of the personnel. The approach to the use of protective clothing should be differentiated, taking into account the degree of risk of infection with HIV infection.

1.5. Medical workers with injuries (wounds) on their hands, exudative skin lesions, weeping dermatitis are suspended for the duration of the disease from medical care of patients, contact with items of care for them.

2. Precautions when providing medical care, servicing patients, working with biomaterial:

2.1. Health workers must take precautions when handling cutting and stabbing instruments (needles, scalpels, scissors, etc.).

2.2. Emergency medical teams should have puncture-resistant containers for collecting used syringes.

2.3. To avoid injuries, it is not allowed to use glass objects with broken edges when taking blood and other biological fluids.

2.4. It is unacceptable to take blood from a vein through a needle directly into a test tube.

2.5. All manipulations for taking blood and serum should be performed using rubber pears, automatic pipettes, dispensers.

2.6. To avoid emergency situations, any containers with blood, other biological fluids, tissues, pieces of organs should be tightly closed with rubber or plastic stoppers immediately at the sampling site and placed in a container.

2.7. In medical hospitals, blood and other biomaterials should be transported in racks placed in containers, bixes or canisters, on the bottom of which a 4-layer dry napkin is placed (in case of damage to dishes or accidental tipping over).

2.8. Transportation of blood samples and other biomaterials from medical institutions to laboratories located outside these institutions should be carried out only in containers (bixes, pencil cases) that exclude spontaneous or deliberate opening of their covers along the way (lock, sealing, sealing the joints with adhesive tape). The outer surface of the containers is treated with a disinfectant solution.

2.9. It is not allowed to transport blood samples and other biomaterials in cardboard boxes, wooden boxes, plastic bags.

2.10. It is not allowed to place referral forms or other documentation inside the container, bix.

2.11. Parts of organs, bones, teeth, crowns of teeth removed during operations, materials used in the provision of medical care (single-use instruments, bandages, cotton wool, gypsum, wax, etc.) are disinfected in accordance with Order M3 of the Republic of Belarus No. 66 dated April 2 1993 and subsequently disposed of.

3. Measures for wounds, contact with blood, other biological materials of patients

Any damage to the skin, mucous membranes, contamination of them with biological materials of patients during the provision of medical care to them should be qualified as a possible contact with material containing HIV or another agent of an infectious disease.

3.1. If contact with blood or other liquids has occurred with a violation of the integrity of the skin (prick, cut), the victim must: remove gloves with a working surface inside; squeeze blood out of the wound; treat the damaged area with one of the disinfectants (70% alcohol, 5% iodine tincture for cuts, 3% hydrogen peroxide solution for injections), wash hands under running water with soap and then wipe with 70% alcohol; put a plaster on the wound, put on fingertips; if necessary, continue work - put on new gloves. It is necessary immediately, without waiting for the examination of a possible source of infection, to start taking azidothymidine 200 mg every 4 hours for 3 days, and subsequently 200 mg every 6 hours for 25 days. If the result of the examination of the source of infection is negative, chemoprophylaxis is stopped. Before taking the drug azidothymidine, the blood serum of a healthcare worker should be taken for seronegativity, in the subsequent examination of a healthcare worker is repeated every 6 months to confirm the absence or presence of seroconversions. During this period, the health worker is advised to note all signs of ill health, refrain from donating, observe safe sex practices, and women avoid pregnancy.

3.2. In case of contamination with blood or other biological fluid without damaging the skin: treat the skin with one of the disinfectants (70% alcohol, 3% hydrogen peroxide, 3% chloramine solution, etc.) - wash the treated area with soap and water and repeat treat with alcohol.

3.3. If the biomaterial gets on the mucous membranes: rinse the mouth with 70 ° alcohol; drip a 20-30% solution of albucid into the nasal cavity; rinse eyes with water (with clean hands), drip with a 20-30% solution of albucid.

3.4. If biomaterial gets on a dressing gown, clothes, shoes:

• gloves are disinfected before removing clothes;
• in case of slight contamination with a biological fluid, the clothes are removed and placed in a plastic bag and sent to the laundry without pre-treatment, disinfection;
• in case of significant contamination, clothing is soaked in one of the disinfectants (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, then washed with soap and rubbed again with alcohol; contaminated shoes are wiped twice with a rag soaked in a solution of one of the disinfectants.

3.5. First aid kit for emergency medical care. To provide emergency medical care in case of an emergency, at the workplace accompanied by a violation of the integrity of the skin, the ingress of biological material on the mucous membranes, you must have a first aid kit with the following set of items and medicines:

• fingertips (or gloves);
• adhesive plaster;
• scissors;
• ethyl alcohol 70°;
• albucid 20-30%;
• tincture of iodine 5%;
• hydrogen peroxide 3%.

3.6. For emergency medical facilities, FAPs, health centers, in addition to a first-aid kit for emergency medical care, protective clothing sets are provided for the number of medical workers providing medical care (surgical gown, mask, goggles or screen, plastic apron, oversleeves, plastic bag for collecting contaminated clothing).

4. Registration of accidents and monitoring of victims

4.1. Emergencies associated with the ingress of a large amount of blood or other biological material onto a large wound surface or mucous membrane are subject to registration in the accident log.

4.2. The following data is recorded in the journal: last name, first name, patronymic of the injured worker; date and time of the accident; type of work performed during the accident; description of the nature of the accident; description of the source of the possible infection and testing for HIV.

4.3. If a healthcare worker is diagnosed with HIV infection, based on these and other data, it will be decided whether the infection is occupational.

4.4. The head of the organization and the chairman of the commission on nosocomial infections are immediately informed about the accident and the measures taken in connection with this. The results of HIV testing of medical workers are strictly confidential.

4.5. The first survey is carried out immediately after the accident. A positive result will indicate that the worker is infected and the accident is not the cause of occupational infection. If the result is negative, a second examination is carried out after 6 months.

4.6. During the observation period, the employee is prohibited from donating blood (tissues, organs), women are advised to avoid pregnancy.

Nosocomial infection.

If the fact of nosocomial infection is revealed, a commission is created by order of the Ministry of Health to identify the causes that led to the infection and take measures to eliminate them. It includes members of the regime commission of the Ministry of Health, epidemiologists of the Republican and regional centers of GE and 03, chief specialists of healthcare organizations in accordance with the profiles of the medical hospital, the laboratory where the infection occurred.

Organization of anonymous and voluntary (confidential) testing for HIV infection.

The right to an anonymous and voluntary examination for the presence of antibodies to the human immunodeficiency virus is granted to any citizen, regardless of place of residence, in any medical institution that has a treatment room.

In the lobby of the medical institution, in a prominent place, there should be information about the possibility of an anonymous and voluntary examination, the place of blood sampling, and the office's working hours.

Office workers are required to show maximum tact and attention to the subject. Negative or judgmental attitude is unacceptable.

In the case of an anonymous examination, "anonymous" is entered instead of the surname in the journal of the treatment room. Code 114 is entered in the code column. The subject is informed of the registration number and telephone number, by which he can later learn about the results of the analysis. A voluntary examination is carried out without a referral and is coded 100. At the request of the applicant, pre-test and post-test counseling is carried out.

Diagnosis, treatment, drug prevention of HIV-infected and AIDS patients is carried out in accordance with the instructions of the Ministry of Health of the Republic of Belarus No. 32-0904 dated March 25, 2004.

Response structure. Rules for medical examination for the detection of HIV and the procedure for information on identified patients. Contingents subject to HIV testing. Epidemiological investigation of cases of HIV infection. Rules of conduct for medical personnel in the care of HIV patients and infected. Prevention of cases of occupational HIV infection. Reception department - functions, structure, organization, staff responsibilities, precautions, first aid - 16/08/2012 15:32

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

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

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

Infection with immunodeficiency viruses can be carried out:

• naturally (sexually, vertically from mother to child, with natural feeding, as well as in contact with wounds and body fluids);
• artificially. This option includes infection during the transfusion of blood products, the use of donor biological material (sperm, breast milk), invasive medical and non-medical procedures (tattoos, cropped manicure, drug administration), etc.

Those at highest risk of contracting HIV include:

• taking injecting drugs;
• providing intimate services;
• unconventional orientation;
• promiscuous, etc.

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

An HIV test is mandatory:

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

Is it possible to work with HIV in medicine

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

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

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

Also, an emergency examination using rapid and standard tests is carried out by employees whose skin and mucous membranes have got a biomaterial containing HIV.

Prevention of HIV infection in healthcare workers

Infection of the indicated personnel is possible during work with the patient's biomaterials during therapeutic and diagnostic procedures (especially invasive ones), as well as during the disposal of used syringes, during the processing of instruments, etc.

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

In most cases, this is due to:

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

Personal safety rules and HIV prevention in medical institutions

To ensure personal protection and for preventive purposes, medical staff should:

• before working with any biomaterials, protect areas of the skin and mucous membranes with special waterproof plasters or dressings;
• change gloves before handling each new patient. During operation, gloves should be treated with 70% ethyl alcohol. Then the gloves are immediately thrown away, their reuse is prohibited;
• if you have to work with blood or biomaterials that may contain HIV, latex gloves should be used;
• wash hands thoroughly with soap after handling biological material;
• use protective equipment for the face (gauze bandages) and eyes (protection with glasses or plastic shields);
• immediately treat the surfaces of work tables contaminated with blood with detergent and disinfectant solution. Processing should be carried out twice, with an interval of fifteen minutes;
• when taking capillary blood, use a rubber bulb;
• put disposable used instruments (syringe, needle, etc.) in non-puncture containers for further processing, disinfection and disposal;
• make sure that there is always a sufficient amount of detergents and disinfectants in the workplace.

Nurses and doctors with skin lesions of an exudative or eczematous nature are suspended from work in manipulation rooms, dressing rooms, etc. until full recovery.

Emergency situation in case of HIV infection - algorithm of action

The prevention of infection of personnel is carried out in accordance with (the link is given for downloading the Order).

With the development of emergencies and emergencies associated with HIV, medical staff:

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

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

If clothing is contaminated with biomaterials, work clothing should be removed, soaked in disinfectant solutions, then it is subjected to autoclaving.

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

At the risk of infection, immediately start taking medications. The drugs are taken during the first 2 hours after the accident. The maximum allowable period for the start of prevention is the first seventy-two hours after the accident.

For post-exposure prophylaxis of HIV, drugs are used:

• lopinavir/ritonavir ® + /
• in their absence, nevirapine ® (once) or abacavir ® is used, then standard prophylaxis according to HAART regimens begins.

New composition of the emergency first aid kit for HIV

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

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