Topic relevance and detection of infected patients
The widespread prevalence of AIDS poses a serious occupational hazard for medical personnel. In surgical practice, the risk of infection is particularly high because physicians, operating room nurses, and ward nurses are in constant contact with the blood of infected patients during their work.
The foundation of infection safety is the timely identification of virus carriers. For this purpose, strict preventive measures are applied in surgery:
- Total screening: Absolutely all patients admitted for treatment to surgical departments routinely undergo mandatory HIV testing.
- Emergency diagnostics: If, in urgent surgery settings, there is a need to urgently confirm or rule out a diagnosis, an emergency blood test for the HIV antigen is performed.
Clinical markers of AIDS
Medical personnel must maintain a high level of alertness and be able to recognize patients with a potential HIV status based on external and clinical manifestations. This is necessary for their timely detection and, if necessary, isolation and implementation of additional precautions.
Key clinical markers of the disease include:
- Respiratory system lesions: Development of severe pneumonia and specific pneumocystosis, as well as respiratory candidiasis.
- Oncological manifestations: Kaposi sarcoma (a specific vascular tumor disease).
- Systemic reactions: Presence of a pronounced immunodeficiency syndrome and generalized lymphadenopathy (enlarged lymph nodes).
- General disorders: Chronic diarrhea refractory to standard treatment and progressive, sharp weight loss.
Surgeon personal safety rules
In accordance with orders from the Russian Ministry of Health, the protection of medical personnel is based on the mandatory use of barrier protection and strict adherence to safety protocols.
Use of personal protective equipment:
- Rubber gloves. These are an absolute mandatory and basic element of gear. They must be used when performing any procedures in the hospital setting, as well as at the slightest risk of contact with blood or any biological fluids.
- Special masks and goggles. During surgical interventions in HIV-infected patients, the surgical team must use additional protection. Special masks and safety goggles prevent infected biological fluids from getting onto mucous membranes.
Actions in emergency situations: An emergency situation is defined as the accidental contact of blood or other biological fluids with the skin or mucous membranes of personnel, as well as surrounding objects. In such cases, immediate and thorough treatment of the contaminated areas with antiseptic agents is required.
Surgical instrument processing and consumables
Instrument safety is ensured by multi-stage processing protocols. After use, instruments must be soaked in concentrated disinfectant solutions.
The use of one of two main disinfection regimens is permitted:
- Soaking in a 3% chloramine solution with an exposure time of strictly 30 minutes.
- Soaking in a 6% hydrogen peroxide solution with an exposure time of 90 minutes.
Only after the complete completion of this decontamination stage can the instruments undergo subsequent standard pre-sterilization cleaning.
Furthermore, the most important aspect of preventing the spread of infection in a hospital setting is the widest possible use of disposable consumables. These include syringes, intravenous infusion sets (drips), and other single-use instruments that are disposed of immediately after use.
Briefly: answers to topical questions
What is the exact algorithm of actions for a surgeon if a patient's blood gets onto intact skin?
If blood gets onto intact hand skin, the contaminated area must be immediately treated with a skin antiseptic. The action algorithm includes the following stages:
- Antiseptic treatment — wipe for 30 seconds with a swab soaked in 70% ethanol, 3% chloramine solution, actiniderm, actiniset, or chlorhexidine (treatment with 96% ethanol solution with an exposure time of 5 minutes is also allowed).
- Hand washing — wash twice with warm running water and soap.
- Drying — dry thoroughly with an individual towel.
How to properly treat eye mucous membranes in case of accidental contact with infected blood?
In case of accidental contact of infected blood with the eyes, they should be rinsed immediately. The following agents are used to treat eye mucous membranes:
- Water — copious rinsing with running water.
- Boric acid solution — use of a 1% or 2% solution for rinsing.
What is the regimen for post-exposure prophylaxis (PEP) of HIV for medical personnel?
The regimen for post-exposure prophylaxis of HIV for medical personnel is based on taking antiretroviral drugs. The basic principles of prophylaxis are:
- Choice of drugs — antiretroviral agents are prescribed (e.g., zidovudine), while the specific volume and regimen depend on the stratification of parenteral infection risk.
- Duration of the course — the basic rule establishes a drug intake duration of 4 weeks (1 month) for any risk level.
- Monitoring — the affected employee is placed under medical dispensary observation for a period of 1 year.
To memorize the clinical markers of AIDS, use the mnemonic PLISKA: P — Pneumonia/Pneumocystosis, L — Lymphadenopathy, I — Immunodeficiency, S — Weight loss (slimming)/diarrhea, K — Respiratory candidiasis, A — Angiosarcoma (Kaposi sarcoma).
Class and exam questions
Do all surgical patients need to be screened for HIV?
Yes, total HIV screening is mandatory for all patients admitted for treatment to surgical departments.
In which solutions must instruments be soaked after surgery in an HIV-infected patient?
Instruments must be soaked either in a 3% chloramine solution for 30 minutes or in a 6% hydrogen peroxide solution for 90 minutes.
What additional protective equipment is needed when operating on an HIV-positive patient?
In addition to mandatory rubber gloves, special surgical masks and safety goggles must be used when operating on HIV-positive patients.
What to do in an emergency (blood contact with skin)?
If blood or biological fluids get onto the skin, mucous membranes, or objects, immediate treatment of the contaminated area with antiseptics is required.
What else to study on this topic
- Features of the clinical course of Kaposi sarcoma
- Differential diagnosis of pneumocystosis
- Algorithm of standard pre-sterilization cleaning
- Procedure for recording emergency situations in surgery
Master the entire topic in the "General Surgery" course
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Other topics in the section "CHAPTER 2. ASEPSIS AND ANTISEPSIS"
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