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The general concept of HIV infection and HIV prevention in surgery

AIDS virus

A virus from the group of retroviruses. Parasitic in human cells having a cell receptor DM-4 (mainly cells of the lymphoid series). The virus is little resistant to the effects of active environmental factors, for example, at a temperature of 56 degrees C, it is inactivated for half an hour, at a temperature of 100 degrees C, for 1 to 2 minutes. At the same time, frozen HIV can persist for several years. In dried blood on needles and syringes, as well as in solutions of psychotropic drugs (drugs), they can remain active for up to 3 weeks or more (at room temperature), and in some cases, probably up to a month, which is one of the most important factors that caused its distribution among drug users.

Long-term epidemiological observations have shown that HIV spreads through sexual contact, transfer of infected blood from an infected person to an uninfected (transfusion of blood or blood components, organ transplants, parenteral interventions performed by tools contaminated with infected blood), from an infected mother to the fetus during pregnancy, passage of the child through the birth canal and breastfeeding.

For HIV transmission, it is necessary not only to have a source of infection and a susceptible subject, but also the emergence of special conditions that ensure this transmission. On the one hand, the release of HIV from an infected organism in natural situations occurs in limited ways: with sperm, secretions of the male and female genital tract, with female milk, and in pathological conditions - with blood of various exudates. On the other hand, as we noted, in order to become infected with HIV and the subsequent development of HIV infection, it is necessary for the pathogen to enter the internal environment of the body, that is, it requires a violation of the integrity of the integument.

The coincidence of both conditions occurs during sexual intercourse, accompanied by micro- or macrodamages, and mechanical rubbing of infectious material (HIV penetration from the seminal fluid into the blood, from physiological excreta of the genital tract — into the blood or from the blood into the blood). The presence of HIV in the seminal fluid, in terms of the volume and dose of the pathogen that exceeds the discharge from the female genital tract, causes a higher probability of HIV transmission from man to woman. Foci of inflammatory diseases or dysplosive processes (cervical erosion) on the lining of the genital tract increase the level of HIV transmission in both directions, being the exit or entrance gate for HIV. On the one hand, cells affected by HIV may be concentrated in these foci, on the other hand, traumatization is easier in inflammatory and destructive foci, which opens the way for HIV. Such physiological aspects as menstruation, with previous changes in the structure of the epithelium, naturally increase the risk of transmitting HIV in both directions if vaginal intercourse occurs shortly or during menstruation. During the year of sexual intercourse with an HIV-infected partner, the probability of infection is 30–40%. Various urinary tract inflammatory processes in men and women, often associated with sexually transmitted infections, play the role of a powerful factor supporting heterosexual transmission of HIV in developing countries. The disproportionately higher level of prevention and treatment of sexually transmitted diseases in economically developed countries is one of the factors responsible for the relatively low level of heterosexual transmission of HIV in North America, Western Europe and Australia. Prevention of HIV infection in surgery includes the identification of virus carriers with HIV infection, strict adherence to safety measures for medical personnel and changes in the rules for sterilizing instruments. Any patient, especially in emergency surgery, can potentially be HIV-infected, so you should carefully follow the precautions when working with him.

In order to prevent HIV infection, all surgical patients should be tested for HIV (form No. 50), the medical staff of the surgical department takes a blood test for HBs antigen, Wasserman reaction, antibodies to HIV infection once every 6 months. To ensure the safety of medical personnel, all manipulations in which contact with blood is possible should be carried out only with gloves.

When carrying out manipulations or operations, a patient with HIV infection must work in special masks (glasses), mail or double gloves; transfer tools only through the tray; have an emergency first aid kit with a full set of medicines; perform manipulations in the presence of a second specialist, who can continue to perform it in the event of rupture of gloves or a cut; treat the skin of the phalanxes with iodine before putting on gloves.

If contaminated liquid gets on the skin, treat it with 70% alcohol, wash with soap and water and re-disinfect with 70% alcohol; on the mucous membrane - to process a 0.05% solution of potassium permanganate; in the mouth and throat - rinse with 70% alcohol or 0.05% potassium permanganate solution; for injections and cuts - squeeze blood from the wound and treat it with 5% iodine solution. Within 30 days take for the prevention of thymazid at a dose of 800 mg / day. When biological fluids come into contact with tables and devices, their surface is disinfected. In order to prevent the maximum use of disposable syringes, tools, systems for intravenous infusion.
After use, the instruments are disinfected in a 3% solution of chloramine for 60 minutes or in a 6% solution of hydrogen peroxide for 90 minutes.

Security measures for the spread of HIV in medical institutions.

A nosocomial infection is any clinically recognizable disease that affects a patient as a result of his admission to the hospital or seeking medical help, or the illness of an employee as a result of his work in this institution, regardless of the onset of symptoms of the disease before or during his stay in the hospital. safety measures should not be neglected: • protective equipment (gloves, gowns, goggles, respirator mask) when working with disinfectants. • use of universal precautions when handling biological fluids (bathrobe, mask, gloves, apron).

In order to prevent infection with viral hepatitis, HIV infection should use disposable tools, for each patient separate, and then subjected to disinfection, thorough presterilization treatment.

Medical instruments in contact with the blood or serum of people must be thoroughly disinfected, then disassembled, rinsed and rinsed strictly in rubber gloves.

Timely clean the surfaces of the tables and the floor of the blood with a cloth moistened with a 3% chloromoryl solution, thoroughly carry out a preliminary, final cleaning of the room and once a week carry out a general cleaning. The rules of personal hygiene should be strictly observed, since a multitude of microorganisms are transmitted through the hands from this it follows that hand washing is a serious measure to prevent nosocomial infection. When handling your hands, you should avoid frequent use of a disinfectant, as they can cause skin irritation and dermatitis, which facilitates penetration of the pathogen.

Nurses of the treatment room and the operating room are suspended from work if they have a violation of the integrity of the skin. While working, all damages should be covered with a fingertip or adhesive plaster. In cases of blood on the skin, mucous membranes, injections or cuts, use the first-aid kit for HIV prevention, which has: • 5% iodine solution (storage 1 day after opening); • adhesive plaster; • potassium manganese solution 0.05% (shelf life 10 days); • bandage; • cotton wool; • tweezers for eyes and nose 4 pcs.

When injured, it must be recorded (documented at a medical institution within 12 hours). Medical workers who have contact with blood are subject to inspection for the presence of an Australian antibody at least once a year. Persons with the presence of Australian antibodies are not allowed to work with blood and its preparations. They must follow the rules of personal hygiene aimed at preventing infection of the patient.

The role of various medical institutions in the prevention of HIV infection The currently little-used resource for preventing the spread of HIV / AIDS is teaching the population how to prevent HIV infection among people who seek medical help, which are traditionally called “treatment-and-prophylactic institutions”, but comparatively rarely participate in preventive activities. This work is carried out within the framework of one medical department, therefore it is relatively easy to organize and control.

Considering the frequency of the population seeking medical assistance, it is advisable to involve as many as possible institutions and organizations in preventive work in order to create a reliable information barrier to the spread of HIV.

Activities carried out by organizations of different profiles, should be clearly defined guidance materials prepared by the territorial health authorities.

Activities carried out by organizations of various profiles should be clearly defined by legislative documents and provided with guidance materials. The organization of events is entrusted to the administration of the medical institution. General health care facilities

In all medical institutions, regardless of departmental subordination, there should be persons responsible for carrying out preventive measures for HIV infection and training personnel and clients of the institution who have received appropriate training. Institutions should have a publicly accessible campaign for the prevention of sexual transmission of HIV and the prevention of drug use, containing information about the possibility of transmitting HIV and hepatitis viruses, including when taking drugs, and methods of preventing infection. It is recommended to provide visitors with free access to the same information sheets and booklets of relevant content.

In the event that people belonging to vulnerable groups of the population are found, for example, people suspected of using psychotropic drugs, the person responsible for HIV prevention measures should conduct an interview with the patient on HIV prevention issues. infections. Consultation should be recorded in current documentation (outpatient cards, medical records).
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The general concept of HIV infection and HIV prevention in surgery

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