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The general concept of HIV infection and the prevention of HIV infection in surgery

AIDS virus

Virus from the group of retroviruses. Parasitizes in human cells that have the cellular receptor of SD-4 (mainly cells of the lymphoid series). The virus is not resistant to the influence 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, in the frozen state, HIV can persist for several years. In dried blood on needles and syringes, as well as in solutions of psychotropic drugs (drugs), it 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 consumers of narcotic drugs.

Long-term epidemiological observations have shown that HIV spreads during sexual intercourse, when infected blood is transferred from an infected person to an uninfected person (transfusion of blood or its components, organ transplantation, parenteral interventions performed by contaminated blood-contaminated instruments), from an infected mother to the fetus during pregnancy, during passing the child through the birth canal and breastfeeding.

For the transmission of HIV, 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 transfer. On the one hand, the isolation of HIV from an infected organism in natural situations occurs in limited ways: with sperm, secretions of the male and female reproductive tract, with human milk, and in pathological conditions - with blood by various exudates. On the other hand, as we noted, infection of HIV with the subsequent development of HIV infection requires the entry of a pathogen into the internal environment of the body, that is, a breach of the integrity of the integument is necessary.

The coincidence of both conditions occurs during sexual intercourse, accompanied by micro- or macro damage, and by mechanical rubbing of the infectious material (penetration of HIV from the seminal fluid into the blood, from the physiological excreta of the genital tract - into the blood or from the blood - into the blood). The presence of HIV in the semen, in volume and in the dose of the causative agent exceeding the allocation from the female genital tract, causes a higher probability of HIV transmission from a man to a woman. Foci of inflammatory diseases or dysplastic processes (cervical erosion) on the covers of the genital tract increase the level of HIV transmission in both directions, being the output or input gateway for HIV. On the one hand, HIV-infected cells can concentrate in these foci, on the other hand, in traumatic events, inflammatory and destructive foci are more likely to cause HIV. Such physiological moments as menstruation, with previous changes in the structure of the epithelium, naturally increase the risk of HIV transmission 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 inflammatory processes of the urogenital tract in men and women, often associated with sexually transmitted infections, play the role of a powerful factor supporting heterosexual HIV transmission in developing countries. The incomparably 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 HIV transmission in North America, Western Europe and Australia. Prevention of HIV infection in surgery includes the identification of virus carriers infected with HIV infection, strict adherence to safety regulations for medical personnel and a change in the rules for sterilization of instruments. Any patient, especially in emergency surgery, can potentially be HIV-infected, so care must be taken when working with it.

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

When carrying out manipulations or operations, a patient with HIV infection should work in special masks (glasses), chain or double gloves; tools to transfer only through the tray; Have a first aid kit with a full set of medicines; perform manipulation in the presence of a second specialist, who can, in the event of a rupture of gloves or cut, continue its implementation; Handle the skin of the nail phalanx with iodine before putting on gloves.

If the infected liquid gets on the skin, treat it with 70% alcohol, wash it with soap and water and re-disinfect 70% with alcohol; on the mucous membrane - treated with 0.05% solution of potassium permanganate; in the mouth and throat - rinse with 70% alcohol or 0.05% solution of potassium permanganate; with pricks and cuts - squeeze blood from the wound and treat it with 5% iodine solution. Within 30 days, for the prevention of thymazide at a dose of 800 mg / day. When biological fluids get on tables and apparatus, their surface is disinfected. For the prevention of the maximum use of disposable syringes, instruments, systems for intravenous infusion.
Tools after use are disinfected in 3% chloramine solution for 60 minutes or in 6% hydrogen peroxide solution for 90 minutes.

Security measures for the spread of HIV infection in medical institutions.

A nosocomial infection is any clinically recognizable disease that affects a patient as a result of his admission to a hospital or seeking treatment, or an employee's illness as a result of his work in the institution, regardless of the onset of symptoms before or during hospitalization. Therefore, elementary safety measures can not be neglected: • protective equipment (gloves, gowns, glasses, mask respirators) when working with disinfectants. • use of universal precautions when working with biological fluids (gown, mask, gloves, apron).

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

Medical instruments in contact with blood or serum should be carefully disinfected, then disassembled, rinsed and rinsed strictly in rubber gloves.

In time, clean the surfaces of tables and the floor from the blood with rags soaked in a 3% solution of chloromyl, carefully conduct preliminary and final cleaning of the premises and perform general cleaning once a week. It is necessary to strictly observe the rules of personal hygiene, since many microorganisms are transmitted through the hands from this it follows that washing hands is a serious measure of prevention of nosocomial infection. Hand treatment should avoid frequent use of disinfectant, as they can cause skin irritation and dermatitis, which facilitates penetration of the pathogen.

The nurses of the procedural room and the operating room are suspended from work if they have abnormalities in the integrity of the skin. During work, all damage must be covered with a fingertip or an adhesive plaster. In cases of blood on the skin, mucous membranes, pricks or cuts, a first aid kit should be used to prevent HIV infection, in which there is: • 5% iodine solution (storage 1 day after opening); • An adhesive plaster; • potassium permanganate solution of manganese 0,05% (shelf-life 10 days); • bandage; • cotton wool; • tweezers for eyes and nose 4 pcs.

In the event of an injury, it must be recorded (documented in a medical and preventive institution within 12 hours). Health workers who have contact with blood should be examined for the presence of Australian antibodies at least once a year. Persons with the presence of Australian antibodies prior to work are not allowed with blood and its drugs. They must comply with the rules of personal hygiene aimed at preventing infection of the patient.

The role of various health facilities in HIV prevention A currently used HIV / AIDS prevention resource is educating the population about how to prevent HIV infection among people who seek help from medical facilities, which are traditionally called "treatment and prevention institutions", but relatively 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 monitor.

Given the frequency of treatment for medical care by the population, it is advisable to involve the largest possible number of 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 by guidance materials prepared by the territorial health authorities.

Activities carried out by organizations of different profiles should be clearly defined by policy documents and provided with guidance materials. Organization of events is assigned to the administration of the medical institution. Treatment and prophylactic institutions of general profile

In all treatment and prevention institutions, regardless of departmental subordination, there must be people responsible for carrying out preventive measures for HIV infection and training of personnel and clients of the institution that have been trained accordingly. Institutions should have visual advocacy on prevention of sexual transmission of HIV and prevention of drug use in accessible places for patients and visitors, containing information on the possibility of transmitting HIV and hepatitis viruses, including when taking drugs, about methods of preventing infection. It is recommended to provide visitors with free access the same information sheets and booklets of the appropriate content.

In case of detection of persons belonging to vulnerable groups of the population, for example, persons suspected of using psychotropic drugs, the person responsible for HIV prevention activities should hold a consultation (counseling) with such a patient about the prevention of HIV- infection. Consultation should be recorded in the current documentation (outpatient cards, medical history).
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The general concept of HIV infection and the prevention of HIV infection in surgery

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