Option 1: Emergency prevention of parenteral viral hepatitis and HIV infection (Appendix 12 to SanPiN 2.1.3.2630-10)

In order to avoid infection with parenteral viral hepatitis, HIV infection, the rules for working with stabbing and cutting instruments should be observed.
In case of cuts and injections, immediately treat and remove gloves, squeeze blood out of the wound, wash hands with soap and water under running water, treat hands with 70% alcohol, lubricate the wound with 5% iodine solution.
If blood or other biological fluids get on the skin, this place is treated with 70% alcohol, washed with water and soap and re-treated with 70% alcohol.
If blood gets on the mucous membranes of the eyes, they are immediately washed with water or 1% boric acid solution; if it gets on the nasal mucosa, it is treated with a 1% solution of protargol; on the mucous membrane of the mouth - rinse with 70% alcohol solution or 0.05% solution of potassium permanganate or 1% boric acid solution.
The mucous membranes of the nose, lips, conjunctiva are also treated with a solution of potassium permanganate at a dilution of 1: 10000 (the solution is prepared ex tempore).
For the purpose of emergency prevention of HIV infection, azidothymidine is prescribed for 1 month. The combination of azidothymidine (retrovir) and lamivudine (elivir) enhances antiretroviral activity and overcomes the formation of resistant strains.
If there is a high risk of HIV infection (a deep cut, visible blood getting on damaged skin and mucous membranes from HIV-infected patients), you should contact the territorial AIDS Centers for chemoprophylaxis.
Persons exposed to the threat of HIV infection are under the supervision of an infectious disease doctor for 1 year with a mandatory examination for the presence of a marker of HIV infection.
Personnel who have come into contact with material infected with the hepatitis B virus are injected simultaneously with a specific immunoglobulin (no later than 48 hours) and the hepatitis B vaccine in different parts of the body according to the scheme 0 - 1 - 2 - 6 months. with subsequent monitoring of hepatitis markers (not earlier than 3 - 4 months after the administration of immunoglobulin).
If contact has occurred with a previously vaccinated health worker, it is advisable to determine the level of anti-HBs in the serum. If there is a concentration of antibodies in the titer of 10 IU / L and higher, vaccine prophylaxis 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.

Option 2:Actions of a medical worker in an emergency (Resolution of the Chief State Sanitary Doctor of the Russian Federation of 11.01.2011 No. 1 "On the approval of SP 3.1.5.2826-10" Prevention 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 water and soap and re-treated with 70% alcohol;
- if the patient's blood and other biological fluids get on the mucous membranes of the eyes, nose and mouth: rinse the oral cavity with plenty of water and rinse with 70% ethanol solution, 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 gown, clothes: take off work clothes and immerse them in a disinfectant solution or in a bix (tank) for autoclaving;
- start taking antiretroviral drugs as soon as possible for the purpose of post-exposure prophylaxis of HIV infection.

It is necessary, as soon as possible after contact, to test for HIV and viral hepatitis B and C a person who may be a potential source of infection, and a person who has been in contact with him. Testing for HIV of a potential source of HIV infection and the contact person is carried out by the method of rapid testing for HIV antibodies after an emergency with the obligatory direction of a sample from the same portion of blood for standard HIV testing in ELISA. Samples of blood plasma (or serum) of a person who is a potential source of infection and a contact person are transferred for storage for 12 months to the AIDS center of the constituent entity of the Russian Federation.
The victim and the person who may be a potential source of infection should be interviewed about the carriage of viral hepatitis, STIs, inflammatory diseases of the genitourinary system, other diseases, and counseling should be provided regarding less risky behavior. If the source is HIV-infected, check to see if they have received antiretroviral therapy. If the victim is a woman, a pregnancy test should be done to find out if she is breastfeeding. In the absence of clarifying data, post-exposure prophylaxis begins immediately; when additional information appears, the scheme is adjusted.

Post-exposure prophylaxis of HIV infection with antiretroviral drugs:
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 for HIV infection is lopinavir / ritonavir + zidovudine / lamivudine. In the absence of these drugs, any other antiretroviral drugs can be used to initiate chemoprophylaxis; if it is not possible to immediately prescribe a full HAART regimen, one or two available drugs are taken.
Nevirapine and abacavir can only be used in the absence of other drugs. If nevirapine is the only drug available, only one dose of the drug should be prescribed - 0.2 g (repeated administration is unacceptable), then, when other drugs are received, full-fledged chemoprophylaxis is prescribed. If chemoprophylaxis is started with abacavir, a hypersensitivity test should be conducted as soon as possible or the abacavir should be replaced with another NRTI.

Emergency registration is carried out in accordance with the established requirements:
- LPO employees must immediately report each emergency to the head of the unit, his deputy or a higher head;
- injuries sustained by health workers must be accounted for in each health care facility and recorded as an industrial accident with the drawing up of an Industrial Accident Act;
- the Register of occupational accidents should be completed;
- it is necessary to conduct an epidemiological investigation of the cause of the injury and establish a connection between the cause of the injury and the performance of the medical worker's official duties.

All health care providers should be provided with or, if necessary, have access to rapid HIV tests and antiretroviral drugs. The stock of antiretroviral drugs should be kept in any health facility 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 care facility must identify a specialist responsible for the storage of antiretroviral drugs, a storage location with access, including at night and on weekends.

Dental Instrument Processing Sequence Used dental instruments and materials are decontaminated after each patient's appointment. If tools and materials are disposable, ensure that they are safely disposed of. Before cotton swabs, plastic saliva ejectors, etc. are sent to the municipal waste dump, they must be disinfected by immersing them for one hour in 1% chloramine solution, or 6% hydrogen peroxide solution, or 3% bleach solution, or for 30 minutes in a solution of Incept. The tips of drills, wastelands, air and water pistols, ultrasonic devices for removing dental plaque after each patient are treated twice with 70 ° alcohol and at the end of the shift are treated with 3% chloramine for 60 minutes or with an Incept solution for 30 minutes. Instruments in contact with the patient's mucous membrane and contaminated with biological fluids (dental hand instruments, glasses, mirrors, burs) and gloves are disinfected immediately after use, then undergo pre-sterilization treatment and sterilization. Disinfection is carried out by completely immersing the used instruments for 30 minutes in a container with an inccept solution (3% chloramine for 60 minutes or 6% hydrogen peroxide solution for 60 minutes, or 2% Virkons solution for 10 minutes, or a solution sidex for 15 minutes, or 0.1% chlorosept solution for 60 minutes). The disinfectant solution is used six times and then changed. Further, the instruments undergo pre-sterilization treatment: the instruments are immersed in another container with a solution of Incept at t \u003d 20-45 °, where each instrument is washed with a brush for 15 s; wash tools with running water; rinse with distilled water; check the quality of cleaning: from blood - by azapiran test (if the test is positive, repeat the entire pre-sterilization treatment); from alkali - phenolphthalein test (if the test is positive, repeat steps 2 and 3); tools are wiped with dry towels or dried with hot air until moisture disappears. Products made of glass, metals, silicone rubber are sterilized without packaging (in open containers) or in paper packaging by dry heat (dry hot air). Sterilization mode: 60 min at t \u003d 180 °. Polishers, dental scalers and burs are treated in the same way as instruments. Dental mirrors are disinfected, then pre-sterilized (pp. 2, 3 and 4), after which they are sterilized with glass beads at a high temperature: stored in Petri dishes. Rubber gloves, cotton swabs, products made of polymers, textiles, latex are sterilized in bix by autoclaving in two modes: at t \u003d 120 °, pressure 1 atm. within 45 minutes or at t \u003d 132 °, pressure 2 atm. within 30 minutes. The shelf life of the sterility of instruments in a sealed package (in a bix, in a kraft paper bag) is three days, after opening the bix, the material in it is considered sterile during the working day. Features of the organization of admission to patients with an increased risk of infection.

When are the most frequent emergencies associated with the likelihood of infection of health workers?

How to prevent emergencies and occupational infection of healthcare workers?

What personal protective equipment should healthcare workers use?

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

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

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

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

• when performing injections;
• collection of venous blood;
• hand-to-hand transfer of sharp surgical instruments, mishandling of epidemiologically hazardous medical waste;
• cleaning the workplace;
• non-compliance with the requirements of infectious safety during work.

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

Potentially hazardous body fluids from patients include:

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

At high risk of contracting blood-borne infections are:

• nurses performing invasive manipulations, including procedural, sentry, ward, operating nurses;
• doctors of surgical specialties performing surgical interventions;
• obstetricians-gynecologists;
• anesthesiologists-resuscitators;
• pathologists;
• dentists and dentists;
• laboratory staff;
• ambulance staff;
• junior medical personnel involved in the processing of medical devices for single and multiple use, medical waste management.

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

• shortage of working time;
• work at night;
• professional inexperience of a medical worker;
• lack of infectious alertness.

MEASURES FOR PREVENTION OF EMERGENCY SITUATIONS AND PROFESSIONAL INFECTION OF MEDICAL PROFESSIONALS

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

Instructing medical workers on occupational safety issues, including in the areas of prevention of occupational infection and safe handling of medical waste, is conducted by the head of the structural unit at least once a year.

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

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

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

If there are cuts, scratches, abrasions, etc. on the skin of the hands, before starting work, the damaged areas are carefully sealed with adhesive plaster, if necessary, use fingertips.

Important!

Regardless of the use of gloves, before any contact with the patient or objects of his environment, as well as after such contact, the medical worker must perform hygienic treatment of hands, and, if necessary, treatment of the hands of surgeons.

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

• do not resort to frequent washing of hands with soap, when carrying out hygienic treatment of hands, give preference to alcohol-containing skin antiseptics;
• avoid using hot water while washing your hands;
• do not use hard brushes for washing hands;
• when using towels, do not rub the skin of the hands in order to avoid the formation of microcracks;
• do not wear gloves after handling hands until they are completely dry;
• regularly use creams, lotions, balms and other hand care products.

Medical instruments and medical devices contaminated with patient body fluids may only be disassembled, washed and rinsed after preliminary disinfection.

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

It is forbidden to direct the point of the instrument into the area of \u200b\u200byour own non-dominant hand or the hands of an assistant during operations.

When transferring medical instruments, use the tray (Fig. 3) or the neutral zone on the operating table (Fig. 4).

It is advisable to use magnetic mats for transporting contaminated instruments in the operating unit.

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

All departments of a medical organization, in which staff contact with the blood of patients is possible, must be provided with packs for emergency prevention of parenteral infections (first-aid kits "Anti-AIDS"; Fig. 5), as well as reminders with an algorithm for post-exposure measures in emergency situations.

Composition of packing for emergency prevention of parenteral infections:

70% ethyl alcohol;

5% alcohol solution of iodine;

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

bactericidal adhesive plaster (not less than 1.9 cm × 7.2 cm) - 3 pcs.;

sterile medical gauze napkin (no less than 16 × 14 cm, No. 10) - 1 pack;

As a rule, the responsibility for the availability and complete set of pads is assigned to the senior nurses of the institution.

Note:

1. Packing for emergency prevention of parenteral infections is placed in a cover or container with strong locks (clamps). The material and construction of the container must ensure the possibility of disinfection.

2. The styling should be completed with medical devices registered in the Russian Federation. After the expiration date, drugs and medical devices are subject to write-off and disposal in accordance with applicable law.

PERSONAL PROTECTION MEANS FOR MEDICAL WORKERS

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

As additional means of protection with a high risk of infection, moisture-proof armbands and aprons can be used.

When performing medical procedures, during which splashing of blood and other biological fluids may occur, personnel should use special face shields or safety glasses (Fig. 6).

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

Washing of overalls is carried out in a centralized manner, it is prohibited to wash overalls at home.

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

• double gloves, including those with puncture indication (fig. 7);

• gloves with an inner antibacterial coating (fig. 8);

• "Chain mail" gloves (Fig. 9).

If the integrity of the gloves is violated, they must be removed as soon as possible and hand hygienic.

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

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

Important!

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

MEDICAL EXAMINATIONS AND VACCINATION OF PERSONNEL

Upon admission to work, all healthcare workers must be vaccinated in accordance with the current vaccination schedule, including against viral hepatitis B.

Vaccination of medical workers against viral hepatitis B is carried out without regard to age. With a decrease in the tension of post-vaccination immunity, revaccination against viral hepatitis B is carried out, which is subject to medical workers who have contact with blood and / or its components, including:

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

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

An examination for the presence of HBsAg by the ELISA method and Anti-HCV IgG in the blood serum during employment and further is annually subject to medical workers of the following institutions and departments of medical organizations:

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

Medical workers of the following institutions and departments of medical organizations are subject to mandatory testing for HIV infection by the ELISA method when hiring and further on annually:

• aIDS Prevention and Control Centers;
• healthcare institutions, specialized departments and structural units of institutions engaged in direct examination, diagnosis, treatment, service, as well as conducting forensic medical examination and other work with persons infected with HIV, who have direct contact with them;
• surgical hospitals and departments;
• laboratories that screen the population for HIV infection and study blood and biological materials obtained from persons infected with the human immunodeficiency virus.

MEDICAL WASTE HANDLING

Collection, accumulation, storage, disinfection (neutralization) of medical waste should be carried out in accordance with the requirements of SanPiN 2.1.7.2790-10 "Sanitary and Epidemiological Requirements for the Management of Medical Waste".

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

Persons who handle medical waste, when hiring and then annually, must undergo mandatory training on safety when working with waste.

The personnel working with medical waste is provided with overalls and personal protective equipment.

For the collection of sharp medical waste, use non-puncture, moisture-resistant containers equipped with needle scrapers and lids that prevent spontaneous opening (Fig. 10).

The containers for the collection of acute medical waste must be changed at least once every 72 hours, in operating rooms - after each operation.

When handling medical waste, it is prohibited:

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

RULES FOR WORKING WITH BIOLOGICAL MATERIAL

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

An absorbent material (gauze napkin, cloth, cotton wool, etc.) is placed on the bottom of the container for transportation. The container must be labeled and have an international sign "Biohazard".

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

All delivered containers with liquid materials must be closed with plugs (lids), excluding the possibility of spontaneous opening during transportation. Tubes with biological fluids are additionally placed in a rack.

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

The containers are placed on a tray or tray covered with a multi-layer gauze cloth soaked in a disinfectant solution.

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

When working with biological material, it is not allowed to use tubes with broken edges, it is forbidden to pipet with the mouth (it is necessary to use automatic pipettes, pears), it is forbidden to pour liquid material over the edge of the tube (bottle).

Centrifugation of biological fluids and other operations with a high probability of aerosol formation should be carried out in biological safety boxes or in separate boxed rooms. Do not remove non-disinfected blood clots from tubes by shaking them out.

For disinfection, tubes with blood clots should be dipped in the disinfectant solution in an inclined position using tweezers.

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

After finishing work with biological material, the staff conducts mandatory hygienic treatment of hands.

ACTIONS OF MEDICAL PERSONNEL IN THE OCCURRENCE OF EMERGENCY SITUATIONS

Algorithm of actions of medical personnel in case of emergencies:

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

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

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

4. In case of contamination of work clothes with biological fluids potentially dangerous in relation to infection with blood-borne infections, it must be removed and immersed in a working solution of a disinfectant (for example, "Abacteril", "Alaminol", "Wendelin", "Hexaquart Forte", "Lisarin", "Mistral", etc.) or autoclave; treat shoes with a working solution of a disinfectant in accordance with the instructions attached to it.

DOCUMENTATION OF EMERGENCY SITUATION

In the event of an emergency, the medical worker is obliged to inform his immediate supervisor or the head of the structural and functional unit about the incident. Information about an emergency is recorded in the Journal of Emergency Situations during medical procedures.

An act on a medical accident in the institution is drawn up.

VICTIM AND PATIENT EXAMINATION

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

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

Plasma (or serum) samples from the patient who is a potential source of infection and the injured healthcare professional are transferred for storage for 12 months at the Center for Prevention and Control of AIDS.

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

POST-CONTACT PREVENTION AND DIPANCER OBSERVATION AFTER EMERGENCY SITUATION

Post-exposure chemoprophylaxis of HIV infection

The optimal timing for starting chemoprophylaxis of HIV transmission is the first 2 hours after the emergency.

Prophylactic drug intake must be started no later than 72 hours after the contact of the injured health worker with biological material.

Post-exposure chemoprophylaxis of HIV transmission to a medical worker injured in an emergency is started when a patient who is a potential source of infection:

• HIV infected;
• when examined by express testing for HIV antibodies, it has a positive result;
• not known;
• belongs to risk groups (a user of injecting drugs or psychoactive substances, casual sex, sexually transmitted diseases, etc.).

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

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

Post-exposure prophylaxis of viral hepatitis

In case of positive test results for viral hepatitis B and C of the patient, with the biological fluids of which there was contact, the injured medical worker is referred for consultation with an infectious disease specialist. In the presence of epidemiological indications, emergency immunoprophylaxis of hepatitis B is performed.

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

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

Dispensary observation of medical workers injured in emergency situations

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

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

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

After 12 months, with negative results of laboratory tests, the victim is removed from dispensary observation.

Note!

If a positive result is obtained during the examination of the victim, an investigation is carried out of the circumstances and reasons for the occurrence of an occupational disease in the employee in the manner prescribed by the legislation of the Russian Federation.

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

The medical organization should keep records and analysis of emergencies associated with the risk of infection of medical personnel. Accounting and analysis is carried out by an epidemiologist of a medical organization, chief nurse or other specialist in accordance with the order of the institution.

In the course of retrospective epidemiological studies, the responsible specialist assesses the frequency of emergencies in the medical organization as a whole, as well as in the context of departments, identifies risk factors, risk groups among medical personnel.

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

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

Note!

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

In order to prevent accidents and occupational infection, regular training of medical personnel is carried out. The most effective are trainings, business and educational role-playing games, and visual aids.

An assessment of the level of knowledge of medical personnel on the prevention of emergencies should be carried out annually.

P. Ye. Sheprinsky, chief physician, BUZ VO "Vologda City Hospital No. 1"
E. V. Dubel, head. epidemiological department - doctor-epidemiologist BUZ VO "Vologda City Hospital No. 1"

Transcript

1 Algorithm of actions in the event of an emergency In a medical facility, a record and analysis of all cases of emergency situations by medical personnel associated with the risk of nosocomial transmission of infections should be kept. Both in the event of an emergency, and in the case of prerequisites and such a development of events, it is recommended to assess the effectiveness of the safety measures taken at the workplace. If 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 in the workplace, including first aid, prescribe 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 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 water and soap and re-treated with 70% alcohol; - if blood and other biological fluids of the patient get on the mucous membrane of the eyes, nose and mouth: rinse the oral cavity with plenty of water and rinse with 70% ethanol solution, 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 gown, clothes: take off work clothes and immerse them in a disinfectant solution or in a bix (tank) for autoclaving; - start taking antiretroviral drugs as soon as possible for the purpose of post-exposure prophylaxis of HIV infection. It is necessary, as soon as possible after contact, to test for HIV and viral hepatitis B and C a person who may be a potential source of infection and a person who has been in contact with him. Testing for HIV of a potential source of HIV infection and the person in contact is carried out by the method of rapid testing for HIV antibodies after an emergency with the obligatory direction of a sample from the same portion of blood for standard testing for HIV in ELISA. Samples of blood plasma (or serum) of a person who is a potential source of infection and a contact person are transferred for storage for 12 months to the AIDS center of the subject of the Russian Federation. The victim and the person who may be a potential source of infection should be interviewed about the carriage of viral hepatitis, STIs, inflammatory diseases of the genitourinary system, other diseases, and counseling should be provided regarding less risky behavior. If the source is HIV-infected, check to see if they have received antiretroviral therapy. If the victim is a woman, a pregnancy test should be performed to find out if she is breastfeeding. In the absence of clarifying data, post-exposure prophylaxis begins immediately; when additional information appears, the scheme is adjusted. Post-exposure prophylaxis of HIV infection with antiretroviral drugs: 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 for HIV infection is lopinavir / ritonavir + zidovudine / lamivudine. In the absence of these drugs, any other antiretroviral drugs can be used to initiate chemoprophylaxis; if it is impossible to immediately prescribe a full-fledged HAART regimen, one or two of the

3 Age form “List of persons affected by emergencies and persons in contact with HIV, removed from the register”; form "Informed consent for testing for HIV infection". The material used: JV "Prevention of HIV infection" MU "Epidemiology. Prevention of infectious diseases. Epidemiological surveillance of HIV infection. Methodological Instructions "(approved by the Chief State Sanitary Doctor of the Russian Federation) Order of the Ministry of Health of the Republic of Tatarstan from" On the prevention of professional infection of medical workers with the human immunodeficiency virus " ... Approved by the Order of the Ministry of Health of the Republic of Tatarstan. Journal for recording emergencies during medical procedures * in (name of department, institution) Started: "..." g Finished: "..." 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 rendered to victims in the “AS” Full name the head who was informed about the "AS" Dates and results of IFA and IB during clinical examination * Further, 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 RT APPROVED / (signature, surname, initials of the head) "" 20 M.P. ACT N ABOUT THE MEDICAL ACCIDENT AT THE INSTITUTION 1. Date and time of the medical accident (date, month, year and time of the medical accident) 2. The institution, the employee of which is the victim (full name, actual address, legal address, surname, initials of the head) 3. The name of the structural unit where the emergency occurred, and in which structural unit the injured worker works 4. Information about the injured worker: last name, first name, patronymic gender (male, female) date of birth "" year of full years 5. Presence of pregnancy weeks or breast feeding a child 6. Position held in the specified medical organization work experience in the organization, including in this position 7. Persons responsible for investigating the case of a medical accident (head of the structural unit, other officials) 8. Information on briefings (training and verification) knowledge) on labor protection by profession (position) or type of work, in the performance of which th emergency situation occurred (day, month, year) Instruction at the workplace / initial, 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, indicate) Checking knowledge of labor protection by profession or type of work during which a medical accident occurred

5 (date, month, year, protocol No.) 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 11. The nature of the injuries received and the organ affected: (puncture wound, superficial or deep abrasion, puncture with a contaminated needle, contamination with infected blood or other biological fluids of damaged skin and mucous membranes): 12. Information on the use of the issued personal protective equipment at the time of the emergency (overalls, gloves, glasses, 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 HIV infection detection antiretroviral therapy immune status viral load HBV test results (date, result) HCV test results (date, result) Epidemiological data indicating a high likelihood of the patient being in the "seronegative window" 17. Test results of the victim, including express diagnostics results of testing for HIV infection (date, result) results of testing for HBV (date, result) results of testing for HCV (date, result) 18. Presence of vaccinations against viral hepatitis B in the victim (indicating dates of vaccination, name of vaccine, batch number, expiration date): V1 V2 V3 RV Strength of immunity to hepatitis B 19. Date and time of start and end of antiretroviral drugs intake, name of drugs (if ARVT was not carried out, indicate the reason

6 "" 20, full name, position Signature Approved by the Order of the Ministry of Health of the Republic of Tatarstan Notice of the registration of the victim in the "AS" (submitted within 72 hours from the moment the victim is identified by fax (843)) 1. Data of the victim in "AS": 1.1. FULL NAME. Date of birth 1.2. Address: - registration - accommodation 1.3. Contact phone 1.4. Place of work and position 1.5. Date and time "AS": 1.6. Date of access: 1.7. Brief description of "AS" 1.8. Measures taken: 1.9. Date of HIV testing at registration: Scheme of prescribed treatment: 2. Data of the source "AS": 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, sex worker, CVHV, 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 filling: 20 year Approved by the Order of the Ministry of Health of the Republic of Tatarstan Notice of deregistration of the victim in "AS" (submitted within 72 hours from the moment the victim was removed 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: Terms of examination Dates and results of laboratory examination after 3 months 6 months after "AS" after "AS" when registering 12 months after "AS" On schedule Actually

8 Responsible doctors: Infectious disease specialist: (full name) signature telephone: Epidemiologist: (full name) signature telephone: Date of filling: 20 year Approved by the Order of the Ministry of Health of the Republic of Tajikistan Informed consent to HIV testing I , (surname, name, patronymic) year of birth, I hereby confirm that on the basis of the information provided to me, freely and without coercion, giving a report on the consequences of the examination, I decided to be tested for HIV antibodies. For this purpose, I agree to take a blood test. I acknowledge that it has been explained to me why it is important to get tested for HIV, how the test is done, and what the consequences of testing for HIV can have. 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 presentation of documents and indication of the name) or confidential (upon presentation of a passport, the result will be known to the examined and attending physician). In public health facilities, HIV testing is free; - evidence of HIV infection is the presence of antibodies to HIV in the blood of the examined person. However, in 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 in only 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 an infected instrument, the use of other people's shaving and manicure accessories; - through sexual intercourse without a condom; - from an HIV-infected mother to a child during time of pregnancy, childbirth and breastfeeding Signature of the subject for HIV: Date:

9 Approved by the Order of the Ministry of Health of the Republic of Tatarstan List * of persons affected by the "Emergency" and persons in contact with HIV, tested for HIV infection for the quarter of the year 20 (indicate the municipality) n / a Full name Year of birth Address Category of registration: contact with HIV, "AS" Type of registration: Contact: - sexual, - I / O "AS": -medical, - household, - ISO. Date of registration Period of dispensary observation until: Date and result of examination for the reporting period * Submitted by the 5th day of the month following the reporting quarter (by courier). Responsible doctors: Infectionist: (full name) signature telephone: Epidemiologist: (full name) signature telephone: Date of completion: 20

10 Approved by the Order of the Ministry of Health of the Republic of Tatarstan List * of persons affected by the "Emergency" and persons contacting with HIV deregistered in the quarter of 20 (indicate the municipality) n / a Full name Year of birth Address Registration type: "AS »: Medical, household, ISO Contact: - sex; - IV (indicate with whom the VP contact) Date of registration Period of dispensary observation until: Date and result of HIV testing before deregistration Reason for deregistration Submitted by the 5th day of the month following the reporting quarter (by courier). Responsible doctors: Infectionist: (full name) signature telephone: Epidemiologist: (full name) signature telephone: Date of completion: 20

Prevention of nosocomial HIV infection in medical workers N.N. Ladnaya Federal Scientific and Methodological Center for the Prevention and Control of AIDS FBSI TsNIIE Rospotrebnadzor November 24

"Prevention of HIV infection" Sanitary Epidemiological Rules SP 3.1.5.2826-10. Approved by the Resolution of the Chief State Sanitary Doctor of the Russian Federation 1 January 11, 2011 with amendments and additions

MINISTRY OF HEALTHCARE OF THE RYAZAN REGION PR IK AS 11.02.2013 149 On improving measures to prevent occupational HIV infection of medical workers "In the Russian

DONOR'S APPLICATION FULL NAME donor Year of birth Gender A GENERAL STATE OF HEALTH YES NO 1 Is your general health currently good? 2 Do you now have fever, headache, sore throat, runny nose, cough?

Kaliningrad Regional Center for the Prevention and Control of AIDS and Infectious Diseases POST-CONTACT PREVENTION OF PROFESSIONAL HIV INFECTION IN HEALTH WORKERS Due to the high circulation rate

HIV infection: concept, transmission routes, prevention. HIV legislation. GKUZ "Volgograd Regional Center for the Prevention and Control of AIDS and Infectious Diseases", Volgograd HIV-Infe

Department of Health, Moscow GBUZ Infectious Clinical Hospital 2 Regional public organization of nurses of the city of Moscow "Prevention of occupational HIV infection" Speaker:

ABOUT MANAGEMENT OF A PREGNANT WOMAN WITH HIV INFECTION IN A MEDICAL ORGANIZATION PROVIDING PRIMARY MEDICAL AND SANITARY CARE. Ryabtseva Natalya Sergeevna BUZ UR "URC AIDS and IZ" Izhevsk November 21, 2017 KEY

"Algorithm of actions in emergency situations in medical institutions, post-exposure prophylaxis." Head of the Epidemiological Department of the GBUZ NO "REC AIDS" NOSOVA NATALYA VLADIMIROVNA Nizhny Novgorod Region 2017

REGIONAL STATE BUDGETARY PROFESSIONAL EDUCATIONAL INSTITUTION "BARNAUL BASIC MEDICAL COLLEGE" Diary of industrial practice PM 01 "Medical and medico-social assistance

Informed consent to conduct voluntary screening for HIV antibodies HOT LINE 47-03-35, Khabarovsk, Pilotov lane 2 For what purpose is testing for HIV antibodies: Timely

REGIONAL STATE BUDGETARY PROFESSIONAL EDUCATIONAL INSTITUTION "BARNAUL BASIC MEDICAL COLLEGE" Diary of industrial practice PM07 Performing work in the profession junior medical

Prevention of occupational HIV infection Today, in the context of a generalized HIV epidemic, healthcare workers increasingly have to provide care to HIV-infected patients.

1 Appendix 2 "Informed consent to chemoprophylaxis of HIV transmission from mother to child during pregnancy, childbirth and newborn" I, (Last name, First name, Full patronymic) year

Prevention of HIV infection in healthcare facilities in Krasnodar region Moscow, 2014 Relevance of the problem 11000 10000 9000 8000 7000 6000 5000 6614 121 5409 8050 125 6535 8666 146 6778 10018 136 7393 160 140 120 100 80 4000

Republic of Kalmykia Order of July 23, 2012 1001PR / 111 P / 133 PR On measures to prevent occupational infection of medical workers with human immunodeficiency viruses (HIV), hepatitis B and C

MINISTRY OF HEALTH OF THE SVERDLOVSK REGION ORDER of February 16, 2012 N 116-p ON IMPLEMENTATION IN THE WORK OF HEALTH CARE INSTITUTIONS OF THE SVERDLOVSK REGION OF METHODOLOGICAL RECOMMENDATIONS "ALGORITHM OF ACTION

Methodology of post-exposure prophylaxis of HIV infection 1 Method of post-exposure prophylaxis of HIV infection In the Russian Federation, the number of emergencies that entail the risk of infection increases annually

Regulations on the procedure for identifying contact persons, their dispensary observation in the CDC and KIZ of healthcare institutions of the Sverdlovsk region 1. General provisions Based on the known routes of transmission of the pathogen

On the organization of interaction between state medical organizations for the identification and dispensary observation of HIV-infected patients T.A. Sorokina, head of the department of preventive and anti-epidemic

Regulatory legal support of the sanitary and anti-epidemic regime in medical organizations Chief Nurse of GBUZ SO "OC AIDS" Reneva Elena Alekseevna LOGO List of sanitary rules, methods

M INISTRY OF HEALTH OF THE UDM OF THE URT REPUBLIC BUDGETARY INSTITUTION OF HEALTH OF THE UDMURT REPUBLIC "UDMURT REPUBLICAN CENTER FOR THE PREVENTION AND CONTROL OF SOCIETY WITH AIDS AND INFECTION"

Head of the Health Department of the Administration of Yekaterinburg GOVERNMENT OF THE SVERDLOVSK REGION MINISTRY OF HEALTH OF THE SVERDLOVSK REGION Vayner, 34-B Yekaterinburg, 620014 Phone (343)

Epidemiological situation on HIV infection in the Republic of Bashkortostan. Prevention of occupational infection with HIV infection 1 Epidemiologist GBUZ RCPH with AIDS and IZ Ivanova I.A. Ufa, 2016 1987

YOU NEED TO KNOW TO LIVE! HIV Infection Brief 2019 WHAT YOU NEED TO KNOW ABOUT HIV / AIDS HIV infection is a chronic infectious disease caused by the Human Immunodeficiency Virus (HIV) characterized by

Prevention of HIV infection HIV infection is a slowly progressive infectious disease resulting from infection with the human immunodeficiency virus (HIV), which affects the immune system, as a result

Infectious safety in the work of a nurse in the dressing room of the KGBUZ DKKB them. A.K. Piotrovicha Gora Yulia Valentinovna Dressing nurse of the urological department Sukholovskaya

HIV infection is a slowly progressive infectious disease resulting from infection with the human immunodeficiency virus. The disease affects the immune system, causing the body to become,

Prevention of occupational HIV infection among medical workers of the State Budgetary Healthcare Institution of Health Care "OC AIDS" M.Ye. Konovalova 2015 Today, in the context of a generalized HIV epidemic, all health workers

What a negative HIV test means This booklet is for people who have tested negative for HIV. It cannot replace a doctor's consultation. The purpose of the brochure is to remind

Budgetary health care institution of the Udmurt Republic "Udmurt Republican Center for the Prevention and Control of AIDS and Infectious Diseases" PREVENTION of the occupational route of infection

BASIC REGULATORY LEGAL ACTS AND NEW DOCUMENTS IN THE CONTEXT OF HIV / AIDS Deputy chief physician for organizational, methodological and preventive work NN Sidorova Founding document on

TEST CONTROL in the specialty "Hygienic education", second qualification category 1. To what level does the prevention, aimed at eliminating the risk factors of diseases, belong? 2. To what

About the awareness of senior nurses on the problem of HIV infection O.S. Starodubtseva, L.R. Tsygvintseva, E.E. Tsypushkina, I.I. Oran "Ural State Medical Academy" (GBOU VPO UGMA

All-Russian action "Stop HIV / AIDS" starts in the Volgograd region In order to draw public attention to the problems of the spread of HIV infection in the Russian Federation from 15 to 21 May 2017

HIV Prevention "Behave with prudence Among thousands of people, only one dies a natural death, the rest die from a reckless manner of life." Maimonides the medieval philosopher Prevention

HIV Prevention in Brief Where is HIV? HIV is found in many body fluids, including blood, semen, vaginal secretions, and breast milk. How is HIV transmitted? HIV is transmitted through:

DECISION OF THE MINISTRY OF HEALTH OF THE REPUBLIC OF BELARUS November 8, 2017 93 On approval of the Instruction on the procedure for organizing the provision of medical care to persons infected with the immunodeficiency virus

MINISTRY OF HEALTH OF THE RUSSIAN FEDERATION ORDER September 16, 2003 N 442 ON APPROVAL OF REGISTRATION FORMS FOR REGISTRATION OF CHILDREN BORN TO HIV-INFECTED MOTHERS In order to organize monitoring

MINISTRY OF HEALTH OF THE AMUR REGION PR IK A Z 31.03.2014 379 Blagoveshchensk On the procedure for providing antiviral drugs In accordance with the order of the Ministry of Health and Social Development of the Russian Federation dated 05.12.2005

~ Ministry of Health of the Republic of Bashkortostan (Ministry of Health of the Republic of Bashkortostan) Department of Rospotrebnadzor in the Republic of Bashkortostan and ORDER of the city of Ufa on the conducted examinations for HIV infection in the Republic of Bashkortostan

1. Natural mechanisms of transmission of nosocomial infections: 2. Artificial mechanisms of transmission of nosocomial infections: 3. Meetings of the commission for the prevention of nosocomial infections are held: 4. Medical workers performing manipulations are examined for hepatitis B:

1 On measures to prevent HIV infection There are more than 60 million HIV-infected people in the world. Cases of HIV infection are detected in all constituent entities of the Russian Federation. Recently, there has been an increase in the incidence

Organization of measures to prevent occupational HIV infection in medical labor collectives V.I. Kharchenko, A.A. Malinovsky. GBUZ "IKB 2 DZM" MGC AIDS Definition: Professional

Epidemic situation on HIV infection in the Republic of Belarus as of September 1, 2016 As of September 1, 2016 in the Republic of Belarus 21,336 cases of HIV infection were registered, the number of people

Appendix 1 Reliable protection against hepatitis B. Dear parents, please be aware that your children are at risk of contracting hepatitis B if they are not vaccinated. Hepatitis B is a widespread viral disease characterized by

Page 1 of 9 1. Scope of application The instruction defines the labor protection and safety requirements at the workplace of employees when working with blood and other biological fluids. 2. Regulatory

HIV infection that you need to know about. HIV is further away than you think, but closer than you expect. The presentation was provided by N.V. Vasilyeva, a psychologist from the AIDS office. HIV infection is a disease caused by a virus

OBUZ Ivanovo region "Center for the prevention and control of AIDS and infectious diseases" SBEE HPE IvGMA Ministry of Health of Russia RESULTS OF TESTING OF MEDICAL STAFF OF CHILDREN'S POLYCLINICS ON ISSUES

HIV infection: concept, transmission routes, prevention. Epidemiological situation on HIV infection in the Volgograd region. Legal aspects of HIV testing. Prevention of occupational HIV infection

HIV Prevention Educational Program Core Module: What Everyone Should Know About HIV / AIDS? Definitions of HIV: Human Immunodeficiency Virus AIDS: Acquired Immunodeficiency Syndrome

MINISTRY OF HEALTH OF THE AMUR REGION PR IK A Z 03.02.2014 125 Blagoveshchensk On improving measures to prevent perinatal transmission of HIV infection in the Amur Region

The facts about HIV HIV / AIDS is the greatest challenge facing the world. Over the past 20 years, the pandemic has claimed the lives of more than 25 million people. More than 40 million currently live with

To your health! Newsletter State Institution "Svetlogorsk Zonal Center for Hygiene and Epidemiology" 7-2019 E-mailing Parenteral viral hepatitis. Source of infection, ways

REPUBLICAN AIDS PREVENTION CENTER MINISTRY OF HEALTH, REPUBLIC OF ARMENIA Main directions of prevention of vertical transmission of HIV infection and their effectiveness in Armenia Speaker: Manukyan

Order of the Ministry of Health of Russia dated 09.16.03. 442 On approval of registration forms for registration of children born to HIV-infected mothers In order to organize monitoring of children born to HIV-infected

INTERNATIONAL SCIENTIFIC AND PRACTICAL CONFERENCE "CURRENT ISSUES OF PREVENTION OF TRANSMISSION OF HIV INFECTION FROM MOTHER TO CHILD" Observation of pregnant women with HIV infection. Experience of interagency interaction

1 HIV, HIV INFECTION, AIDS. WAYS OF TRANSMISSION HIV infection is a disease caused by the Human Immunodeficiency Virus (HIV). Once in the body, HIV gradually suppresses the immune system and makes it incapable

HIV / AIDS B- I-IMMUNODEFICIENCY VIRUS H- HUMAN This is a virus that is transmitted from person to person, it gradually destroys its protective (immune) system, making it defenseless against various infections

Evaluation of the results of work on the provision of medical care to women. Assessment of perinatal prevention of mother-to-child transmission of HIV. Interaction with medical organizations. Video Selector Protocol

Patient's School Activity 4.1 Living with HIV Plan Risk Factors for HIV Transmission Discordant couples, HIV and pregnancy Alternative treatment Healthy lifestyle Properties of HIV Unstable in the environment Cannot withstand

In memory of Sergei S., who contracted HIV,
giving birth to some drug addict on the train

APPENDIX 1

Emergency models and their elimination

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

Blood is the most potent source of hepatitis B virus or HIV infection in the workplace. Therefore, protective measures against hepatitis B virus and HIV infection consist primarily of preventing their transmission through blood, as well as vaccination against hepatitis B. Although the modes of transmission of hepatitis B virus and HIV are the same, the risk of contracting 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 lower).

Emergency Model No. 1:
damage to the skin (cut, injection)

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

If a cut or injection occurs, gloves should be removed immediately or the wound area should be exposed. Squeeze blood out of the wound; wipe off the blood with a swab dipped in 70% alcohol. Then, if the wound permits, wash your hands thoroughly under running water with double soaping. Lubricate the wound with 5% iodine solution. After 15 minutes, repeat the treatment with alcohol; seal with a bactericidal plaster.

Emergency Model No. 2:
blood has spilled onto exposed parts of the body

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

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

Emergency Model No. 3:
blood has got into the eyes, nasal mucosa or oral cavity

The likelihood of HIV infection when infected blood gets on the mucous membranes is estimated at 0.09%.

If blood gets into your eyes, you should 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 solution, apply to the eyes and rinse, blinking for 2 minutes. Instill into each eye 2-3 drops of a 20% solution of albucide.

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). Instill 2-3 drops of a 20% solution of albucid into each nasal passage.

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 has spilled on a robe or other workwear

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

Emergency Model No. 5:
blood has spilled onto equipment, table surfaces, floor

If drops of blood get on equipment or furniture surfaces, they should be immediately wiped off with a cloth soaked in disinfectant solution. Repeat the treatment after 15 minutes. The napkin is then disinfected and disposed of.

In the presence of large amounts of blood and fluids containing blood (for example, vomit) on the floor, wearing gloves, moisten a cloth with a disinfectant solution and collect the blood in a container. Then add disinfectant solution to the container in a ratio of 1: 4. Exposure according to the instructions for the disinfectant. The contaminated area is re-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, consider the use of disposable waterproof shoe covers, and if there is a risk of splashing, glasses and a waterproof apron. Remove contaminated shoe covers and apron with gloves.

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

APPENDIX 2

First Aid Kit for HIV Prevention

The composition of the first aid kit:

Appointment	Name and quantity
For the treatment of wound surfaces	25 ml of 5% alcohol solution of iodine in a bottle - 1 pc.
For disinfection of material on skin	50 ml 70% ethyl alcohol in a bottle - 1 pc.
For disinfection of material on mucous membranes	hinge in dark pasting of dry manganese-sour potassium, 100 mg - 2 pcs. bottle with 200 ml of distilled water (for preparation of 0.05% solution of potassium permanganate) - 2 pcs. bottle with 5 ml of 20% albucid solution - 1 pc.
For instilling medicine in the eyes and nose	pipettes - 2 pcs.
For washing eyes with 0.05% solution of potassium permanganate	glass eye baths - 2 pcs.
To stop bleeding	rubber band - 1 pc.
Dressing	Sterile bandage 7x14 - 3 pcs. Sterile cotton wool 100 g - 1 pack bactericidal plaster g - 5 pcs.

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

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

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

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

Registration N 20263

In accordance with the Federal Law of 30.03.1999 N 52-FZ "On the sanitary and epidemiological welfare of the population" (Collected Legislation of the Russian Federation, 1999, N 14, Art. 1650; 2002, N 1 (Part 1), Art. 2; 2003, No. 2, Article 167; No. 27 (part 1), Article 2700; 2004, No. 35, Article 3607; 2005, No. 19, Article 1752; 2006, No. 1, Article 10, No. 52 (part 1), art.5498; 2007, No. 1 (part 1), article 21; No. 1 (part 1), article 29; No. 27, article 3213; No. 46, article 5554; 49, art. 6070; 2008, no. 24, art. 2801; no. 29 (part 1), art. 3418; no. 30 (part 2), art. 3616; no. 44, art. 4984; no. 52 ( Part 1), Art. 6223; 2009, N 1, Art. 17; 2010, N 40, Art. 4969) and the Decree of the Government of the Russian Federation of 24.07.2000 N 554 "On approval of the Regulations on the State Sanitary and Epidemiological Service of the Russian Federation and the Regulation on State Sanitary and Epidemiological Standardization "(Collected Legislation of the Russian Federation, 2000, N 31, Art. 3295, 2004, N 8, Art. 663; N 47, Art. 4666; 2005, N 39, Art. 3953) I decree:

To approve the sanitary and epidemiological rules of SP 3.1.5.2826-10 "Prevention of HIV infection" (attachment).

G. Onishchenko

application

Prevention of HIV infection

Sanitary and Epidemiological Rules SP 3.1.5.2826-10

I. 0 scope

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

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

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

III. General Provisions

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

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

3.3. AIDS is a condition that develops against the background of HIV infection and is characterized by the appearance of one or several diseases referred to as AIDS indicators. AIDS is an epidemiological concept and is used for the epidemiological surveillance of HIV infection.

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

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

3.6. Transmission mechanism and factors.

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

3.6.2. The natural mechanism of HIV transmission includes:

3.6.2.1. Contact, which is realized mainly during sexual intercourse (both with homo- and heterosexual) and with contact of a mucous or wound surface with blood.

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

3.7.3. The artificial transmission mechanism includes:

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

3.7.3.2. Artifical for invasive interventions in LPO. Infection with HIV can be carried out through transfusion of blood, its components, transplantation of organs and tissues, the use of donor sperm, donor breast milk from an HIV-infected donor, as well as through medical instruments for parenteral interventions, medical devices contaminated with HIV and not subjected to treatment in accordance with with the requirements of regulatory documents.

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

3.9. The main population groups vulnerable to HIV infection are: injecting drug users (IDUs), commercial sex workers (CSWs), men who have sex with men (MSM). Clients of sex workers, sexual partners of IDUs, prisoners, street children, persons with a large number of sexual partners, migratory population groups (truck drivers, seasonal workers, including foreign citizens working on a rotational basis, and others) represent a high risk group of HIV infection. people who abuse alcohol and non-injecting drugs, as they are more likely to engage in more dangerous sexual behavior under the influence of psychoactive substances.

3.10. Clinical course of HIV infection without antiretroviral therapy.

3.10.1. Incubation period

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

3.10.2. Acute HIV infection.

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

3.10.3. Subclinical stage.

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

3.10.4. Stage of secondary diseases.

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

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

IV. Laboratory diagnostics of HIV infection

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

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

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

4.4. Diagnostic algorithm for testing for HIV antibodies:

4.4.1. At the first stage (screening laboratory).

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

4.4.2. At the second stage (reference laboratory).

Primarily positive serum is re-examined in ELISA in a second test system of another manufacturer, which differs from the first one in the composition of antigens, antibodies or the format of the tests chosen for confirmation. If a negative result is obtained, the serum is re-examined in a third test system of another manufacturer, which differs from the first and second in the composition of antigens, antibodies or the format of the tests. In case of a negative result (in the second and third test systems), a conclusion is issued on the absence of antibodies to HIV. If a positive result is obtained (in the second and / or third test system), the serum must be examined in an immune or linear blot. Results obtained in a confirmatory test are interpreted as positive, indeterminate, and negative.

4.4.2.1. In order to ensure control and accounting of studies, reference diagnostics should be carried out in the same constituent entity of the Russian Federation, where the screening examination was carried out in the laboratory of an authorized specialized health care professional, carrying out organizational and methodological work on conducting diagnostic, therapeutic, preventive and anti-epidemic measures for HIV infection and related diseases.

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

4.4.3. Positive (positive) samples are those in which antibodies to 2 of 3 HIV glycoproteins (env, gag, pol) are detected.

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

4.4.5. Sera in which antibodies to one HIV glycoprotein and / or to any HIV proteins are detected are considered indeterminate (doubtful). If an uncertain result is obtained with a protein profile including core proteins (gag) p 25, a study is conducted to diagnose HIV-2.

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

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

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

4.5.1. To diagnose HIV infection in children under 12 months of age born to HIV-infected mothers, methods are used to identify the genetic material of HIV (DNA or RNA). Obtaining positive test results for HIV DNA or HIV RNA in two separate blood samples from a child older than one month is laboratory confirmation of the diagnosis of HIV infection. Receiving two negative results of testing for HIV DNA or HIV RNA at the age of 1 - 2 months and 4 - 6 months (in the absence of breastfeeding) testifies against the presence of HIV infection in the child, however, the child's removal from the dispensary for intrapartum and perinatal contact due to HIV infection can be made over the age of 1 year.

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

Two or more negative results of the study for antibodies to HIV by ELISA;

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

Absence of clinical manifestations of HIV infection.

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

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

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

4.7. In the document issued by the laboratory based on the results of the study, the name of the test system, its expiration date, series, ELISA result (positive, negative), the result of an immune, linear blot (a list of identified proteins and a conclusion: positive, negative, undefined) are indicated. In case of confidential research, the document must contain passport data: full name, full date of birth, address of residence, contingent code. In an anonymous examination, the document is marked with a specially set code.

4.7.1. If a questionable result is obtained in a confirmatory test (immune, linear blot), a conclusion is issued about an indefinite study result and it is recommended to repeat the examination of the patient before determining the status (after 3.6, 12 months).

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

4.8.1. Applications for simple / quick tests:

transplantology - before the collection of donor material;

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

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

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

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

4.9. It is not allowed to issue a conclusion on the presence or absence of HIV infection only based on the results of a simple / quick test. The results of simple / quick tests are used only for timely decision making in emergency situations.

V. Procedure for examination for HIV infection

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

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

Compulsory medical examination for HIV infection is subject to:

Donors of blood, blood plasma, sperm and other biological fluids, tissues and organs (including sperm), as well as pregnant women in the case of taking abortion and placental blood for the production of biological products at each donor material collection;

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

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

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

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

Medical workers in hospitals (departments) of the surgical profile upon admission to work and thereafter once a year;

Persons doing military service and entering military educational institutions and military service by conscription and contract, when conscripted for military service, when entering service under a contract, when entering military universities of ministries and departments that establish restrictions on the recruitment of persons with HIV infection;

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

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

5.4. Health-care workers should advise individuals in populations at higher risk of HIV infection to undergo regular HIV screening for early detection of HIV infection, counseling on HIV infection, and timely initiation of treatment in case of infection.

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

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

5.7. Counseling should be carried out by a trained specialist (preferably an infectious disease doctor, epidemiologist or psychologist) and include the main provisions regarding HIV testing, the possible consequences of testing, determining the presence or absence of individual risk factors, assessing the awareness of the examined person on HIV prevention issues, providing information on the ways of HIV transmission and ways of protection against HIV infection, types of care available for an HIV-infected person.

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

5.9. A referral for a study in an enzyme-linked immunosorbent assay of a blood sample for HIV infection is filled in by all health care providers, regardless of the organizational and legal form and form of ownership.

5.9.1. In confidential testing, the patient's personal data is given without abbreviations (according to the passport or a substitute identity document of the subject): full name, full date of birth, citizenship, residence address, contingent code.

5.9.2. For anonymous testing (without a passport), only the digital code is indicated, including the serial number of the person being examined, year of birth, place of residence (constituent entity of the Russian Federation). The surname, name, patronymic of the examined person is not indicated.

5.10. The answer about the result of the survey is issued at the end of the testing algorithm. The issuance of an official document on the presence or absence of HIV infection in the examined person is carried out only by institutions of the state or municipal health care system.

5.11. The HIV test results are reported to the person being examined by the consultant during the post-test counseling; if possible, the same specialist conducts pre- and post-test counseling of the patient.

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

5.11.1.1. Counseling with an uncertain HIV test result, in addition to a set of standard information, should include a discussion of the possibility of HIV infection, the need to observe precautions to prevent the spread of HIV infection, guarantees of medical care, treatment, and respect for the rights and freedoms of HIV-infected. The test taker is sent to the Center for the Prevention and Control of AIDS.

5.11.1.2. The person diagnosed with HIV infection is notified by the counselor of the test results. The specialist reports a positive test result in a clear and concise form, provides time for the perception of this news, and answers the examinee's questions. Explains the need to comply with precautions to prevent the spread of HIV infection, guarantees the provision of medical care, treatment, observance of the rights and freedoms of HIV-infected, as well as criminal liability for endangering or infecting another person. The test person is sent to the Center for the Prevention and Control of AIDS to establish a diagnosis of HIV infection and provide medical assistance.

5.11.2. The results of the study are not reported by phone.

5.11.3. The diagnosis of the disease caused by the human immunodeficiency virus is established by the doctor of the Center for the Prevention and Control of AIDS or an authorized doctor of the LPO on the basis of a complex of epidemiological data, the results of clinical examination and laboratory tests. The diagnosis of HIV infection is communicated to the patient by a physician (preferably an infectious disease doctor, epidemiologist or psychologist) while consulting the patient at the AIDS Prevention and Control Center or an authorized health care provider. The patient is notified in writing about the detection of HIV infection, and he is provided with information on this problem. In case of HIV detection in minors under the age of 18, their parents or legal representatives are notified.

Vi. Organization of dispensary observation of patients with HIV infection

6.1. The purpose of dispensary observation of HIV-infected patients is to increase the duration and preserve the quality of their life. The main tasks are the formation of adherence to dispensary observation, the timely identification of their indications for the appointment of antiretroviral therapy, chemoprophylaxis and treatment of secondary diseases, ensuring the provision of timely medical care, including psychological support and treatment of concomitant diseases.

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

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

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

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

6.4.1. If there is a suspicion of nosocomial infection, an epidemiological investigation is carried out by specialists of the bodies carrying out state epidemiological surveillance, together with specialists from AIDS Centers and / or specialists from the Federal State University of Education and Science, on the basis of which the federal and district centers for the prevention and control of AIDS function, the Federal State Institution Republican Clinical Infectious Disease Hospital (St. Petersburg), with the involvement of the necessary experts.

For each case of nosocomial infection, a complex of prophylactic and anti-epidemic measures is carried out to localize the focus and prevent further spread of the infection, an "Epidemiological Investigation Act" is drawn up.

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

6.5. Dispensary supervision of children is carried out by a pediatrician of the AIDS Center in conjunction with a pediatrician of the LPO.

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

6.7. Counseling on HIV infection is carried out at each examination of a patient with HIV infection within the framework of dispensary observation of him.

6.7.1. When monitoring HIV-infected children, counseling is provided to caregivers and those who are legally responsible for the child. Counseling of a child on HIV infection is carried out in accordance with age characteristics.

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

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

6.9.1. Antiretroviral therapy is a lifelong etiotropic therapy for HIV infection. Its purpose and control over its effectiveness and safety is carried out by the Center for the Prevention and Control of AIDS of the constituent entity of the Russian Federation. This function can be performed by FGUN, on the basis of which the federal and district centers for the prevention and control of AIDS function; FGU Republican Clinical Infectious Diseases Hospital (St. Petersburg), as well as LPO under the methodological guidance of the AIDS Center.

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

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

6.10. If an inpatient HIV-infected person is identified, it should be ensured that they are consulted by an infectious disease specialist at the AIDS Center, laboratory tests required to clarify the stage of the disease and decide on the appointment of antiretroviral therapy.

6.11. In order to increase the effectiveness of dispensary observation and the formation of adherence to antiretroviral therapy, a multi-professional approach should be used with the involvement of a doctor, a nurse, narrow medical specialists, psychologists, social workers, and trained counselors from among HIV-infected. Formation of patients' adherence to dispensary observation is carried out on the basis of consultation technology within the patient-centered approach.

Vii. State sanitary and epidemiological surveillance of HIV infection

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

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

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

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

7.4.1. Each case of HIV infection (positive result of research in immunoblot) is subject to registration and accounting at the place of detection in the health care facility, regardless of departmental affiliation and ownership. Registration at the place of residence of the patient is carried out to organize dispensary observation and treatment.

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

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

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

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

7.4.5. LPO, which changed or clarified the diagnosis, submits a secondary report on the patient with HIV infection to the Federal Scientific and Methodological Center for the Prevention and Control of AIDS and the Territorial Center for the Prevention and Control of AIDS at the place of permanent registration of the patient, indicating the changed (updated) diagnosis, date its establishment in case:

Establishing the causes of HIV infection,

Establishing a diagnosis of AIDS,

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

Change of the patient's place of residence,

Removing the diagnosis of HIV infection,

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

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

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

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

In order to examine and treat a citizen who, due to his condition, is not able to express his will;

With the threat of the spread of infectious diseases, mass poisoning and injuries;

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

At the request of military commissariats or military medical service;

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

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

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

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

Prevention of HIV infection should be carried out in a comprehensive manner in relation to the sources of the virus, mechanisms, routes and factors of transmission, as well as the susceptible population, including people from vulnerable groups of the population.

8.1. Activities in the epidemic foci of HIV infection

8.1.1. Interventions with regard to the source of HIV infection

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

8.1.1.1. Timely detection and diagnosis of HIV infection.

8.1.1.2. Specific therapy with antiretroviral drugs prescribed by a physician (including preventive chemotherapy in pregnant women) lowers the viral load in the HIV-infected person and reduces the risk of HIV transmission.

8.1.1.3. Referral for STI screening and treatment of an HIV-infected person reduces the risk of sexual transmission.

8.1.1.4. Referral of injecting drug users to drug dependence treatment reduces the source's ability to transmit the virus through drug use.

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

8.1.2. Measures regarding mechanisms, routes and factors of transmission

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

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

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

8.1.2.4. Conducting an epidemiological investigation of HIV infection.

8.1.2.5. Counseling / educating the population - both the susceptible contingent and the sources of infection - on safe or less dangerous behavior.

8.1.2.6. Preventive work with vulnerable groups of the population (IDU, CSW, MSM, etc.).

8.1.2.7. Prevention of contact of the child with the body fluids of the mother should be combined with the appointment of ARV drugs and is achieved by:

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

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

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

8.1.3. Measures for the susceptible population

8.1.3.1. Contact persons for HIV infection are persons who have had the opportunity to become infected based on the known mechanisms, routes and factors of transmission of the pathogen. Establishing the fullest possible circle of people who have had contact with an HIV-infected person makes it possible to inform about the methods and ways of protecting against HIV infection during pre-test counseling and testing for HIV infection.

8.1.3.2. Teaching safe behavior in terms of contracting HIV infection is the main measure for the prevention of HIV infection among contact persons and the population.

8.1.3.3. Preventive chemoprophylaxis. For emergency prevention of the disease, persons at risk of contracting HIV are prescribed antiretroviral drugs, including: newborns of HIV-infected mothers, health workers and other persons affected by the provision of assistance to HIV-infected persons, citizens in relation to whom there is reason to believe that contact with a risk of HIV infection.

8.2. Prevention of nosocomial HIV infection

8.2.1. The basis for the prevention of nosocomial HIV infection is compliance with the anti-epidemic regime in medical institutions in accordance with the established requirements (SANPIN 2.1.3.2630-10 "Sanitary and Epidemiological Requirements for Organizations Carrying out Medical Activities", registered with the Ministry of Justice of Russia on August 9, 2010 No. N18094). Preventive measures are carried out on the basis that each patient is regarded as a potential source of blood-borne infections (hepatitis B, C, HIV and others).

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

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

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

8.2.2.1.2. Equipping with the necessary medical and sanitary equipment, modern atraumatic medical instruments, disinfectants, sterilization and personal protective equipment (special clothing, gloves, etc.) in accordance with regulatory and methodological documents. Disposable products, after being used during manipulations with patients, must be disinfected / neutralized, their reuse is prohibited.

8.2.2.1.3. If there is a suspicion of a case of nosocomial HIV infection, a complex of preventive and anti-epidemic measures is carried out in the health care facility:

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

8.3. Prevention of occupational HIV infection

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

8.3.1. A set of measures for the prevention of emergencies when performing various types of work.

8.3.2 Recording of cases of injuries, microtraumas by the personnel of medical treatment facilities, other organizations, emergency situations with the ingress of blood and biological fluids on the skin and mucous membranes during the performance of professional duties.

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

8.3.3.1. Actions of a medical worker in an emergency:

In case of cuts and injections, immediately remove gloves, wash hands with soap 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 water and soap and re-treated with 70% alcohol;

If the patient's blood and other biological fluids get on the mucous membrane of the eyes, nose and mouth: rinse the oral cavity with plenty of water and rinse with 70% ethanol solution, rinse the nasal mucosa and eyes with plenty of water (do not rub);

If the patient's blood and other biological fluids get on the gown, clothing: take off 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.

8.3.3.2. It is necessary, as soon as possible after contact, to test for HIV and viral hepatitis B and C a person who may be a potential source of infection and a person who has been in contact with him. Testing for HIV of a potential source of HIV infection and the contact person is carried out by the method of rapid testing for HIV antibodies after an emergency with the obligatory direction of a sample from the same portion of blood for standard HIV testing in ELISA. Samples of blood plasma (or serum) of a person who is a potential source of infection and a contact person are transferred for storage for 12 months to the AIDS center of the subject of the Russian Federation.

The victim and the person who may be a potential source of infection should be interviewed about the carriage of viral hepatitis, STIs, inflammatory diseases of the genitourinary system, other diseases, and counseling should be provided regarding less risky behavior. If the source is HIV-infected, check to see if they have received antiretroviral therapy. If the victim is a woman, a pregnancy test should be performed to find out if she is breastfeeding. In the absence of clarifying data, post-exposure prophylaxis begins immediately; when additional information appears, the scheme is adjusted.

8.3.3.3. Post-exposure prophylaxis of HIV infection with antiretroviral drugs:

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

8.3.3.3.2. The standard regimen for post-exposure prophylaxis for HIV infection is lopinavir / ritonavir + zidovudine / lamivudine. In the absence of these drugs, any other antiretroviral drugs can be used to initiate chemoprophylaxis; if it is not possible to immediately prescribe a full HAART regimen, one or two available drugs are taken. Nevirapine and abacavir can only be used in the absence of other drugs. If nevirapine is the only drug available, only one dose of the drug should be prescribed - 0.2 g (repeated administration is unacceptable), then, when other drugs are received, full-fledged chemoprophylaxis is prescribed. If chemoprophylaxis is started with abacavir, it should be tested for hypersensitivity reactions as soon as possible, or abacavir should be replaced with another NRTI.

8.3.3.3.3. Emergency registration is carried out in accordance with the established requirements:

Employees of health care facilities must immediately report each emergency to the head of the unit, his deputy or a higher head;

Injuries sustained by health workers must be recorded in each health care facility and recorded as an occupational accident with the drawing up of an Occupational Accident Act;

The Occupational Accident Register should be completed;

It is necessary to conduct an epidemiological investigation of the cause of the injury and establish a link between the cause of the injury and the performance of the health worker's official duties;

8.3.3.3.4. All health care providers should be provided with or, if necessary, have access to rapid HIV tests and antiretroviral drugs. The stock of antiretroviral drugs should be kept in any health facility 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 care facility must identify a specialist responsible for the storage of antiretroviral drugs, a storage location with access, including at night and on weekends.

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

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

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

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

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

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

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

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

8.4.2.6. It is prohibited to re-analyze seropositive blood samples using test systems with lower sensitivity and specificity, as well as test systems or methods of a lower generation than were used in the primary analysis.

8.4.2.7. Molecular biological studies (PCR, NAT) are carried out in addition to mandatory immunological studies (ELISA) for markers of blood-borne infections in accordance with the requirements of regulatory documents and are of secondary importance.

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

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

8.4.2.10. Donated blood and its components are transferred to medical institutions for transfusion only after repeated (at least 6 months) examination of the donor for the presence of markers of HIV-1, 2 and other blood-borne infections to exclude the possibility of not detecting infection during the seronegative window (quarantine) ... Fresh frozen plasma is quarantined for a period of at least 180 days from the moment of freezing at a temperature below minus 25 C. After the quarantine period of fresh frozen plasma has expired, a repeated examination of the donor's health status and a laboratory study of the donor's blood are carried out in order to exclude the presence of pathogens of blood-borne infections in it.

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

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

8.4.2.13. Donated blood and its components that do not meet safety requirements or are not used are isolated and disposed of, including disinfection with disinfectant solutions or the use of physical disinfection methods using equipment permitted for these purposes in accordance with the established procedure, as well as the disposal of the resulting waste.

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

8.4.3. When an organization for a donation of blood and its components receives information about the possible infection of the recipient with blood-borne infections, it is necessary to identify the donor (s) from whom the infection could occur, and take measures to prevent the use of donated blood or its components obtained from this donor (s).

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

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

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

8.4.4.2. At all stages of production, measures should be provided to trace the donation of blood plasma included in the boiler load, production waste (disposed of or transferred to other industries) and the finished drug.

8.4.4.3. All plasma rejected during the incoming inspection for fractionation is subject to mandatory disposal.

8.4.5. Transfusion of donated blood and its components, organ and tissue transplantation and artificial insemination.

8.4.5.1. It is prohibited to transfuse donor blood and its components, transplant organs and tissues and artificial insemination from donors who have not been tested for the presence of pathogens of blood-borne infections, including HIV, using immunological and molecular biological methods.

8.4.5.2. The physician who prescribes blood transfusion of blood products should explain to the patient or his relatives the potential risk of transmission of viral infections, including HIV through blood transfusion.

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

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

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

8.5. Prevention of vertical transmission of HIV infection

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

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

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

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

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

8.5.6. To reduce the amount of virus in the blood of a pregnant woman, counseling and antiretroviral drugs should be prescribed.

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

8.5.7.1. Conduct delivery with a maternal viral load of more than 1,000 copies of HIV RNA / ml of plasma, or, if it is unknown, by planned caesarean section: upon reaching the 38th week of pregnancy, before the onset of labor and amniotic fluid outflow. For natural childbirth, reduce the anhydrous period to 4-6 hours.

8.5.7.2. To motivate an HIV-infected woman to refuse to breastfeed her newborn and latch on to the breast.

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

8.5.8. 1. Indications for the appointment of ARVP in women and children:

The presence of HIV infection in a pregnant woman;

A positive test result for HIV antibodies in a pregnant woman, including the use of rapid tests;

Epidemiological indications in a pregnant woman (with a negative HIV test and a risk of HIV infection in the last 12 weeks).

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

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

8.6. Prevention of HIV infection in consumer service organizations

8.6.1. Prevention of HIV infection in household service organizations (hairdressing salons, manicure, pedicure, beauty salons, offices, etc.), regardless of departmental affiliation and ownership, is provided in accordance with the requirements of SanPiN 2.1.2. 2631-10 "Sanitary and Epidemiological Requirements for Accommodation, Arrangement, Equipment, Maintenance and Operating Mode of Public Utilities Organizations Providing Hairdressing and Cosmetic Services", registered by the Ministry of Justice of the Russian Federation on July 06, 2010, registration number 17694.

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

IX. Hygienic education of the population

9.1. Hygienic education of the population is one of the main methods of HIV prevention. No single action can prevent or stop the HIV epidemic in the region. There should be a comprehensive, targeted prevention, treatment and care program for different populations.

9.2. Hygienic education of the population includes: providing the population with detailed information about HIV infection, measures for non-specific prevention of HIV infection, the main symptoms of the disease, the importance of timely detection of sick people, the need to take them to dispensary records and other activities using the media, leaflets, posters, bulletins, individual work aimed at creating behavior that is less dangerous in relation to HIV infection.

9.3. Education of the population should include coverage of all approaches of safe and less dangerous behavior in terms of contracting HIV infection: safety of sexual behavior, safety of parenteral interventions, occupational safety.

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

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

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

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

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