Instructions for labor protection when working with blood and other biological fluids of patients

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OCCUPATIONAL SAFETY AND HEALTH
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Instructions on labor protection when working with blood and other biological fluids of patients. Full document

Occupational Safety and Health

Occupational Safety and Health / Standard instructions for labor protection

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Safe Operation

1. General requirements for labor protection

1.1. For independent work, in which contact with blood and other biological fluids is possible, persons are allowed at least 18 years old, who do not have medical contraindications, who have been trained in safe working methods and who have been instructed in the scope of this instruction.

1.2. When working, staff should be guided by the principle that all patients are potentially infected.

1.3. When performing work with blood and other biological fluids of patients, mechanical damage to the skin is possible:

1.3.1. stab wounds due to careless handling of syringes and other stabbing instruments (objects);

1.3.2. hand cuts:

when opening bottles, vials, test tubes with blood or serum;
when working with contaminated HIV instruments;

1.3.3. bites of mental patients when attacking personnel.

1.4. Personnel must perform work in personal protective equipment specified by industry standards: a cotton gown, a medical cap, medical gloves worn over the sleeves of a medical gown.

For invasive procedures, it is recommended to wear two pairs of gloves, a waterproof gown and an apron.

If there is a threat of splashing of blood and other biological fluids, work should be done in masks, goggles, if necessary, use protective screens, oilcloth aprons.

1.5. When working in the morgue, the staff must have a type 1 suit:

bathrobe, sleeves, waterproof apron;
2 pairs of rubber gloves;
4-layer gauze mask, shoe covers;
protective glasses;
boots or galoshes.

1.6. In the office of the unit, where personnel may come into contact with biological fluids of patients, there must be an emergency first aid kit "Anti-AIDS", which includes:

70% ethyl alcohol, cotton-gauze swabs;
0,05% solution of potassium permanganate or a sample of the drug in dry form with the necessary amount of distilled water to prepare the solution;
5% alcohol solution of iodine;
bactericidal plaster;
eye droppers, disposable syringe;
dressing.

1.7. The medical staff is obliged to comply with the requirements of this instruction.

2. Labor protection requirements before starting work

2.1. Put on and tidy up work clothes: a cotton robe, fasten the cuffs and skirts of the robe, put on a hat and tuck your hair under it. Put on changeable shoes on your feet.

2.2. Prepare and test personal protective equipment.

2.3. Damage to the skin on the hands, if any, seal with a plaster or put on fingertips.

2.4. Make sure that the "Anti-AIDS" first aid kit is complete.

2.5. Invasive procedures are not allowed, personnel in case of:

extensive damage to the skin;
exudative skin lesions;
weeping dermatitis.

3. Labor protection requirements during work

3.1. Medical staff must strictly observe personal protective measures, especially when carrying out invasive procedures, accompanied by contamination of hands with blood and other biological fluids:

work in rubber gloves, with an increased risk of infection - in two pairs of gloves;
use masks, glasses, screens;
use masks and gloves when handling used clothing and tools;
handle sharp medical instruments with care;
do not put a cap on a used needle;
after disinfection, dispose of the used disposable sharp instruments in solid containers;
collect needles that have fallen to the floor with a magnet, brush and shovel;
cover microtraumas on the hands with adhesive tape, lifusol or the boss. Before and during work, you should check whether the gloves are waterproof, whether they are damaged;
Replace damaged gloves immediately. Gloves that have been treated after use are less durable than new ones and are much more likely to be damaged. The use of fat-based creams, fatty lubricants destroys gloves;
taking blood from patients or performing other procedures, when the health worker may accidentally injure himself with a used needle, must be done with latex gloves, because. they reduce the amount of blood inoculum that is transferred by injection;
after removing gloves, soak them in a disinfectant solution for 1 hour, wash your hands with soap and water and dry with an individual towel;
remove gloves carefully so as not to contaminate hands;
rubber gloves removed once, do not reuse due to the possibility of hand contamination.

3.2. To protect themselves from infection through the skin and mucous membranes, medical staff must observe the following rules:

avoid rubbing motions when using a paper towel, as at the same time, the surface epithelium is damaged;
use alcohol disinfectant solutions for hands; hand disinfection should never be preferred to the use of disposable gloves; hands should be washed with soap and water after each removal of protective gloves;
after any procedure, it is necessary to thoroughly wash your hands twice in running water with soap;
hands should be wiped only with an individual towel, changed daily, or disposable wipes;
avoid frequent hand treatment with skin-irritating disinfectants, do not use hard brushes;
never take food in the workplace, where there may be blood or discharge of the patient;
get vaccinated against hepatitis B;
to protect the mucous membranes of the oral cavity and nose, use a 4-layer gauze mask. The mask should fit snugly to the face;
wear a robe or an apron, or both a robe and an apron, to provide reliable protection against contact of body fluids with body fluids. Protective clothing should cover the skin and clothing of medical staff, keep liquids out, and keep the skin and clothing dry.

It is almost impossible to transmit a large infectious dose through clothing.

3.3. The use of barrier protective equipment is necessary not only when working with infected patients, every patient is considered potentially dangerous in relation to infectious diseases.

3.4. When providing medical care to HIV-infected and AIDS patients, in medical documents and referrals, manipulations with parenteral interventions indicate chronic carriage of Hbs Ag with appropriate labeling.

3.5. All diagnostic tests, treatment procedures, and surgical interventions for HIV-infected patients must be carried out last; all biological material is disinfected and destroyed, which is noted in the medical history.

Medical instruments are subjected to 3-stage processing in accordance with OST 42-21-2-85.

3.6. Manipulations for an HIV-positive patient should be performed in the presence of a second specialist, who, in the event of a rupture of gloves or a cut, can continue to perform them.

3.7. During surgery, double gloves should be used if possible; transfer all sharp instruments during the operation through the intermediate tray, and not from hand to hand, exclude the use of fingers to guide the needle, it is advisable to use a needle holder.

3.8. In a clinical diagnostic laboratory, when working with blood, serum or other biological fluids, the following is prohibited:

pipetting by mouth, use a rubber bulb;
pour blood, serum over the edge of the test tube;
use adhesive tape labels to label test tubes. Test tubes should be marked with a pencil on the glass.

3.9. When centrifuging the test material, the centrifuge must be closed with a lid until the rotor stops completely.

3.10. When transporting blood and other biological fluids, the following rules must be observed:

containers with blood, other biological fluids immediately at the place of taking tightly close with rubber or plastic stoppers;
it is forbidden to put referral forms or other documentation in the tubes;
to ensure disinfection in case of accidental outflow of liquid, transport blood and other biological fluids in tripods placed in containers, bixes or canisters, on the bottom of which lay a four-layer dry napkin;
if there is a possibility of splashing of blood or body fluids, wear protective clothing (gowns, aprons) and protective equipment for the mucous membranes of the face (masks covering the mouth and nose, goggles or eye shields);
if the robe and apron are contaminated with biological fluids, you should change clothes as quickly as possible; wear gloves when changing clothes and take them off last.

3.11. Disassembly, washing and rinsing of medical instruments that have come into contact with blood or serum should be carried out after preliminary disinfection. Work to carry out in rubber gloves.

3.12. Disposable items: syringes, dressings, gloves, masks after use should be disinfected with subsequent disposal.

4. Labor protection requirements in emergency situations

4.1. Emergency situations include:

rupture of gloves;
punctures and cuts with piercing and cutting tools;
ingress of blood and other biological fluids on the mucous membranes and skin;
spattering of blood during centrifugation, etc.

4.2. Manipulations that can lead to an emergency include, in particular:

invasive procedures;
contact with mucous membranes (whole and damaged);
contact with damaged skin of patients;
contact with surfaces contaminated with blood or other body fluids.

4.3. If hands are contaminated with blood and other biological fluids, wipe them thoroughly with a swab moistened with a skin antiseptic, and then wash them with running water and soap.

If the hands protected by gloves are contaminated, treat the gloves with a napkin, then wash them with running water, remove the gloves with the working surface inside, wash your hands and treat them with a skin antiseptic.

4.4. If hands are contaminated with blood, body fluids, immediately treat them for at least 30 seconds with a swab moistened with a skin antiseptic, wash them twice with soap and water and wipe dry with a clean towel (napkin).

4.5. If contact with blood, other biological fluids or biomaterials is accompanied by a violation of the integrity of the skin (prick, cut), then the following measures must be taken:

wash hands without removing gloves with running water and soap;
remove gloves with a working surface inside and discard them in a disinfectant solution;
squeeze blood out of the wound;
wash your hands with soap;
treat the wound with 70% alcohol, then the skin around the wound with 5% alcohol solution of iodine;
put a bactericidal plaster on the wound, put on a fingertip, and if necessary, continue working - put on new rubber gloves.

4.6. If blood or liquids get on the nasal mucosa - drip a 0,05% solution of potassium permanganate, rinse your mouth and throat immediately with 70% alcohol or a 0,05% solution of potassium permanganate.

4.7. If biological fluids get into the eyes, immediately rinse them with running water, then rinse them with a solution of potassium permanganate using a disposable syringe in a ratio of 1:10000.

The solution is prepared from a sample of 0,01 g of potassium permanganate and 100 ml of distilled water, until the crystals are completely dissolved (3 minutes).

4.8. If biological material gets on a dressing gown, clothes, do the following:

remove clothes and soak in one of the disinfectants;
the skin of hands and other parts of the body, if they are contaminated, through clothing, after removing clothing, wipe with 70% ethyl alcohol solution;
wash the surface with soap and water and wipe again with alcohol;
wipe contaminated shoes twice with a swab dipped in a solution of one of the disinfectants.

4.9. In the event of an accident during operation on the centrifuge, disinfection measures begin to be carried out no earlier than 40 minutes later. after the rotor stops, i.e. after aerosol precipitation. After 40 min. open the centrifuge lid and immerse all centrifuge cups and broken glass in the disinfectant solution.

4.10. If an infected material gets on the surface of walls, floors, equipment, wipe them with 6% hydrogen peroxide, 3% chloramine or other recommended disinfectants, twice with an interval of 15 minutes.

4.11. After treatment of the mucous and skin integuments of the victim, it is necessary:

1) Make an entry in the Register of microtraumas of the institution (department).

2) Notify the head nurse and the head of the department (office) about the accident. The head nurse notifies the deputy head physician for epidemiology (or assistant epidemiologist), the head nurse, and the dispensary doctor about the incident.

3) Make entries in the medical record of the victim about the microtrauma received, indicating the preventive measures taken.

4.12. If a medical worker is suspected of being infected with an infectious disease, an investigation is carried out in accordance with the "Regulations on the investigation and registration of occupational diseases" (approved by Decree of the Government of the Russian Federation of December 15.12.2000, 967 No. XNUMX).

5. Labor protection requirements at the end of work

5.1. Place disposable syringes and instruments after use in a leak-proof container.

5.2. Place sharp objects to be reused in a sturdy container for processing.

5.3. Do not break used needles by hand, do not bend, do not re-cap.

5.4. Treat gloves contaminated with blood with a swab containing a disinfectant solution, remove them and immerse them in a container with a disinfectant solution for 60 minutes (3% chloramine solution or 6% hydrogen peroxide solution with 0,06% NHA) or boil in distilled water for 30 minutes.

5.5. Treat desk surfaces at the end of the working day with disinfectants that have a virucidal effect.

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