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Epidemiological control of the medics who had contact with blood of HIV-positive people

Table of contents
Epidemiological control of the medics who had contact with blood of HIV-positive people
Appendix 1
Appendix 2
Literature

 

 

 

Methodical instructions on epidemiological control of the medics who had contact with blood of HIV-positive people and patients with AIDS

Methodical instructions made:
Neshcheret E.N.
Candidates of Medical Science. Grazhdanov N. P.
Candidates of Medical Science. Stepanets V. Y.
Blakitny L. A.
dots. Slyusarev L. I.
Cuoshengko I. I.

Now in the world many researches for the purpose of identification of transfer of HIV from patients of the medical institutions infected with HIV and patients with AIDS to health workers are conducted. This option of intrahospital transfer gains special importance as leads to professional infection of health workers.

In September, 1988 within the Global program for AIDS of WHO implementation of the project which purpose is gathering of all the data on cases of transfer of HIV which are available in the different countries from painful to the health worker was begun.

The most important aspect of professional infection is their frequency. Available facts demonstrate low risk of such infections.

In the table No. 1 the most part of results of the corresponding examinations of health workers conducted in the different countries of the world is summed up.

Table No. 1.

Authors: Number of the contacting medics

From them caught: HIV

Frequency of infection (%)

Weiss et.al. (1985) 2245

4

0.18

MsMahon. Sutterer 2557 (1988)

4

0.15

Marcus et.al. (1989) 2880

3

0.1

Ippolito et.al. (1990) 2520

0

0

Henderson (1993) 3916

8

0.2

Frequency of infection of health workers at contact with HIV-positive blood.
Apparently, infection frequency at contacts with HIV-positive blood does not exceed 0.2%. At contact with blood of patients with hepatitis B the frequency of infection of health workers reaches 7-30% that exceeds that at HIV infection by 20-100 times.

Among the factors promoting HIV infection. on the first place put the dose of an infekt caused by the volume of the injected blood and concentration of HIV in it. The low infektivnost of HIV in comparison with a virus of hepatitis B is explained by its perhaps low concentration in blood. 1 ml of blood of the patient with hepatitis B contains about 100 million infectious units of the activator, and at the patient with AIDS - only 10-1000 units. Syringe needles bear on themselves the bigger volume of blood, than sutural needles. Contacts with blood at pricks and cuts it is much more dangerous, than at hit on skin and mucous. The greatest risk group is procedural nurses and clinical laboratory assistants.

The center for control of diseases (USA) offers the following definition of a case of documentary professional infection "The health worker who was not exposed to the known risk factors of infection of HIV in which serum taken soon after professional contact there was no AT to HIV, but they appeared at repeated inspections, despite the absence of during supervision of other sources of infection".

It should be noted, however, that the concept "professional broadcast of HIV" is defined in various states differently, and there is no standard definition. Specialists of WHO of R.Marcus, K.Kay. J.M.Mann consider that seroconversion is really connected with professional contact if:

1. At this health worker at inspection soon after contact (it is preferable not later than in 30 days) antibodies to HIV were not revealed.
2. Signs of an acute retrovirus syndrome in temporary communication with contact were noted (on the basis of clinical supervision in 2-3 weeks after contact with characteristic symptoms: fever, rash on stomach skin to a trunk, increase in lymph nodes, weakness, a mialgiya, an arthralgia).
3. Seroconversion during the supervision period after contact is found.

Besides, only when the health worker denied any other possibility of contact with HIV, except professional are carried to cases of the established (documentary) or possible infection.

CONTACTS WITH BLOOD are called all contacts of the blood with mucous membranes damaged by skin or a prick the used tool and also hit of blood on the unimpaired skin. A.Kontakt with blood, the representing high risk:
- skin puncture use by sharp instrument.
- hit of splashes of blood on mucous membranes and on the injured skin.
B. The contact with blood representing low risk:
- any contact with the small volume of blood (for example, damage by a firm surgical needle, etc.),
- contact at the unimpaired skin.
C. Does not constitute epidemiological danger:
- skin puncture unused sharp instrument.
- blood traces on clothes.
- splashes of not bloody substance.

When carrying out researches with registration of all cases of contacts with blood it is necessary to define important epidemiological factors, such as anatomic localization of wound and circumstance at which most often there are wounds, category of the injured medic. In this regard the log-book of contacts with blood of patients when carrying out invasive manipulations is offered it is not dependent on the immune status of the patient (N 1 appendix).

In case of contact with the patient's blood by the health worker certain actions for prevention of professional infection have to be taken.

A) THE OFFERED PRINCIPLES OF ACTIONS OF HEALTH WORKERS. THE PATIENTS WHO WERE AFFECTED BY BLOOD:

a) To the health worker:
- at hit of blood in his face diligently wash with soap, eyes wash out water or solution of permanganate potassium in cultivation 1:10000;
- at hit of blood, other biological substances in a mouth. to rinse an oral cavity 70 C alcohol;
- at disturbance of integrity of skin (cuts, pricks) from the injured surface to squeeze out blood, to process leather 70-degree alcohol, then iodine;
- skin of hands and other parts of a body under the clothes contaminated by blood is wiped with 70-degree alcohol;
- the footwear is processed double wiping by the rags moistened in one of disinfecting solutions;
- to inform administration, b) actions of hospital administration:
- to estimate and register in a log-book of contacts with blood a type of influence, for example, an injury a needle, a cut sharp instrument, hit of splashes on a mucous membrane or the damaged skin sites;
- in case of professional contact with HIV-positive blood to draw up the statement of the regime commission of treatment-and-prophylactic establishment;
- to provide the copy of the act in OBLUZO and the regional center for prevention and fight against AIDS and territorial SES (N2 appendix);
- to inform the medic concerning the subsequent risk for people around. To advise to apply safe methods of the sexual relations, to postpone pregnancy;
- to suggest the victim to pass test for HIV (code 115) in time in actions for determination of initial level and then in 6 weeks, 12 weeks. 6 months and 12 months after influence to establish medical supervision over the injured health worker, to carefully note this period all signs of an illness (F 025U);
- medical supervision is carried out by the doctor of department (office) on delivery of health care by the HIV-positive;
- upon termination of supervision to send to the Donetsk regional center for prevention and fight about AIDS and territorial SES information on results of medical supervision over the health worker contacting to blood the HIV-positive patient (N 3 appendix).

B) HIMIOPROFILAKTICHESKY TREATMENT AFTER CONTACT WITH HIV-POSITIVE BLOOD.

In relation to HIV the question of post-exposition chemoprophylaxis of effects of possible infection of health workers after contact with HIV-positive blood or biological liquid gains the special importance.

Abroad for a number of years efficiency of a zidovudine (analog azidotimidan, retrovir, timozid) for this purpose is studied and preliminary results of researches allow to recommend the differentiated indications for preventive purpose of a zidovudine depending on contact type. Reception of a zidovudine should be begun as soon as possible after contact (in the first hour, but no later than 12 hours), without waiting for inspection of the patient - a probable source of infection on HIV (table N 2). If the result of inspection on existence of AT to HIV at the patient negative or positive at the medic, then chemoprophylaxis stops.

Prevention by a zidovudine of health workers with potentially professional infection of HIV (to 200 mg there are each 4 hours x 3 days before clarification of the immune status of the patient or the medic if the patient Is HIV-positive 200 mg each 4 hours x 25 days).

Table No. 2.

 

Contact type

Reception of a zidovudine

Massive (transfusion)

it is recommended

Certain parenteral (in/in an injection)

it is approved

Possibly parenteral (p / to or on mucous)

it is encouraged

Doubtfully parenteral (not blood)

it is not supported

Not parenteral (intradermal)

it is not carried out

 

It should be noted that there is also other point of view: against use of a zidovudine. The main argument - high toxicity of drug owing to what its reception becomes for many almost impossible in several weeks after the beginning of prevention. Also a hint of doubt in sufficient efficiency of a zidovudine as prophylactic is dropped.

The zidovudine (AZT.ZDV) in combination with inhibitors of proteases (ZTS and IDV) is an effective remedy of prevention after parenteral contacts with blood of HIV-positive patients (table N3).

Table No. 3.

Temporary recommendations of a health service of the USA about chemoprophylaxis of infection of HIV after professional contacts with blood depending on a type of contact, 1996.

type of contact

substances, soderzh. contagium

anti-retrovirus prevention

scheme of anti-retrovirus prevention

Parenteral

Blood the Greatest risk

It is recommended

ZDV+3TC+IDV

Increases risk

It is recommended

ZDV+3TC+IDV

The risk is not high

It is offered

ZDV+3TC

The liquids containing visible blood other potentially infected liquids or fabrics

It is offered

ZDV+3TC

Other biological liquids (for example urine)

It is not offered

 

Mucous membranes

Blood

It is offered

ZDV+3TC+IDV

The liquids containing visible blood, other potentially infected liquids or fabrics

It is offered

ZDV+3TC

Other biological liquids (for example urine)

It is not offered

 

Skin, risk it is raised

Blood

It is offered

ZDV+3TC+IDV

The liquids containing visible blood other potentially infected liquids or fabrics

It is offered

ZDV+3TC

Other biological liquids (for example urine)

It is not offered

 

Note: ZDV zidovudine (retrovir, azidothymidine, timozid), 3TC-lamivudin. IDV индиновир.

EXPLANATIONS TO THE TABLE.

Parenteral (transdermal) contact with material the containing HIV in high concentration (blood) is considered the highest in exploratory laboratory, laboratory of diagnosis of AIDS. The risk is increased in the following cases:
a) deep damage by the pricking, cutting medical tools contaminated by the patient's blood.
b) damage is put with the tool which was in a vein or an artery of the HIV-positive patient earlier,
c) The HIV-positive patient to whose blood there was a contact died of AIDS within 60 days after contact in this connection it is supposed that it had a high titre of HIV.

The risk is not high if there was no contact with large volume of blood (for example, damage by a firm surgical needle) or blood with a high titre of HIV (the patient with the diagnosis AIDS).
Mean sperm, vaginal allocations by other potentially infectious liquids, cerebrospinal, synovial, pleural, perionatalny, recardial. amniotic liquids.

For skin the risk increases at contacts with the material containing HIV in high credits at long contact, at contact of a big site of skin or a site in which integrity of skin is obviously broken.

Chemoprophylaxis should be recommended to health workers after the professional contact with HIV connected with high or the raised risk of transfer.

At contacts with insignificant risk (urine) of infection chemoprophylaxis is not justified and is not offered as toxicity of drugs exceeds advantage of chemoprophylaxis.

Scheme of preventive treatment: a zidovudine (ZDV) 200 of mg three times a day, lamivudin (3TC) of 150 mg twice a day, indinavir mg (IDY) 800 three times a day (if IDV is not available, it it is possible to replace sakvinaviry - 600 mg three times a day). Preventive treatment is carried out within four weeks. The route of administration of drugs is specified in the accompanying instruction insert.



 
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