Major orders in force in surgery , emergency departments , intensive care units

August 12, 2017 17:50 | Paramedic

1. Order of the USSR Ministry of Health number 408 of 1989 "On measures to reduce the incidence of viral hepatitis in the country."

epidemiology, clinical features, diagnosis, treatment, outcomes, clinical examination of patients with viral hepatitis A, B, Delta and others.

Hepatitis A. Hepatitis A (HA) belongs to the family of picornaviruses, similar to enterovirus.HA virus may persist for several months at 4 ° C, a few years - at a temperature of -20 ° C for several weeks - at room temperature.The virus is inactivated by boiling.

Known only one serotype of the virus HA.From defined specific markers of the most important is the presence of antibodies to the virus HA class Ig M (anti-virus HA IgM), which appear in the serum at the beginning of the disease and persist for 3-6 months.Detection of anti-HAV IgM indicative of hepatitis A and is used to diagnose the disease and identify the sources of infection in the outbreak.

GA virus antigen is detected in the stool of patients for 7-10 days before c

linical symptoms, and is used to identify the sources of infection.

Anti-HA IgG detected with the 3-4th week of illness and lasts long.

source of infection are patients with any form of acute infectious process.

disease forms: icteric, anicteric, subclinical, inaparantnaya.

transmission mechanism - fecal-oral.Its implementation occurs through factors inherent intestinal infections: water, "dirty hands", food, household items.The susceptibility of people to infection general.Immunity after suffering a long illness, perhaps a lifetime.

incubation period of 7 to 50 days, an average of 15-30 days.

predzheltushnogo period (the period of prodrome) - acute onset, fever up to 38 ° C or higher, chills, headache, weakness, loss of appetite, nausea, vomiting, abdominal pain.There is a feeling of heaviness in the right upper quadrant.Language is imposed, bloating, liver reacts with abdominal palpation.The length of this period - for 5-7 days.By the end of the period predzheltushnogo urine becomes dark, the color of beer.Feces discolored.It appears subikterichnost sclera.Starts Phase II icteric disease.

Jaundice is growing rapidly, a number of symptoms of weakening, retained a feeling of heaviness in the right hypochondrium, weakness, loss of appetite.Dimensions of the liver increases, it has a smooth surface, it is sealed.Increased spleen.In the blood - leukopenia, moderate increase in bilirubin, AST, and increased AlAT.Icteric period lasts 7-15 days.

convalescence period characterized by the rapid disappearance of clinical and biochemical evidence of hepatitis.

chronic forms of HA exist.

anicteric forms of viral hepatitis A have the same clinical (except jaundice) and biochemical (except for an increase in bilirubin) signs.

Erased form - those in which all of the clinical signs of minimally expressed.

Inaparantnye form - asymptomatic carriage, which is detected by the appearance of ALT in blood serum and the presence of anti-IgM and IgG.

Diagnosis is based on clinical data, as well as detection of serum antibodies to GA class immunoglobulin M (anti-HAV IgM) and class G (anti-HAV IgG) and increasing the activity of ALT and AST and bilirubin in the blood.

patients are hospitalized in the infectious department of the hospital.Recovery occurs usually within 1 - 1.5 months after discharge from hospital.

Convalescents CAA observed in the study of infectious diseases where medical examinations are held 1 time per month.Removed from the register after 3 months in the absence of complaints, normalization of liver function tests, and sizes.

treatment, prevention

Mild forms of hepatitis A do not require medical treatment.Enough dieting, polupostelnogo mode, plentiful drink;at medium-severe detoxification added introduction means: intravenously administered 5% glucose solution, Ringer's solution

500 ml with 10 ml of 5% but th ascorbic acid.

Severe forms are rare: you may need to conduct a more intensive infusion therapy.

Preventive measures - intravenous immunoglobulin on epidemiological indications to 3.0 ml.Data on the prevention of immunoglobulin-entered in the accounts of the form № 063 / y and 26 / u.Administered drug is allowed no more than 4 times at intervals of not less than 12 months.

For persons that were in contact with patients with CAA, established surveillance (1 time per week for 35 days).

Hepatitis B (HB) - an independent disease caused by the hepatitis B virus, which belongs to the family gepadnavirusov.It is extremely stable in the environment.

GW source are patients of any form of acute and chronic hepatitis B and chronic "carriers" of the virus.The latter are the main sources of infection.The patient may already be infectious for 2-8 weeks before the appearance of symptoms of the disease.

incubation period - 6-120 days.

predzheltushnogo period.The disease begins gradually.Patients complain of loss of appetite, nausea, vomiting, constipation alternating with diarrhea.Often concerned about pain in the joints, itchy skin, increased

transmission mechanism - parenteral:

• through broken skin and mucous membranes;

• tranplatseptarno;

• in blood transfusions;

• sexually.

size of the liver, sometimes spleen.In the blood leukopenia.Activity of test enzymes ALT and AST in serum increased.The duration of the period of one day up to 3-4 weeks.

prolonged jaundice period, characterized by the severity and resistance of clinical symptoms of the disease tends to increase.Jaundice reaches a maximum of 2-3 weeks.There prolonged pain in the right upper quadrant, the liver is smooth and extended.In the blood: leukopenia, lymphocytosis, a significant increase in the level of bilirubin, increased ALT and AST in the serum.

Usually acute hepatitis B occurs in moderate shape, often severe.

fulminant (lightning) are rare form.

Complications: hepatic coma, encephalopathy.

chronic forms of hepatitis B often occur

rekovalestsentsii period is longer than the CAA, clinical and biochemical symptoms persist for a long time.

specific methods of laboratory diagnostics - the presence of the antigen HBs (HBSAg), which appears in the blood long before the onset of the clinic.

for distinguishing HBsAg carrier state of active infection is a necessary study of serum anti-HBsIgM, the absence of such antibodies is typical for carriage.

Extract convalescent hepatitis B is carried out by the same clinical indications as hepatitis A. About the statement of convalescents who-HBs-antigen continues to be detected for a long time, you need to inform the clinic doctor and infectious diseases in the area of ​​sanitary and epidemiological station.

outcomes of acute viral hepatitis:

• recovery;

• residual effects:

• prolonged convalescence;

• postgepatitnaya hepatosplenomegaly.

continued during the infection process:

• prolonged hepatitis;

• chronic persistent hepatitis;

• asymptomatic carriers of HBs-antigen;

• chronic active hepatitis;

• cirrhosis of the liver;

• primary liver cancer.

After discharge from the hospital made the patient examination no later than 1 month.Then it was inspected after 3, 6, 9 and 12 months after discharge.Removal from the register held in the absence of chronic hepatitis B and the double negative study on HBsAg, held at intervals of 10 days.


• detoxification therapy, depending on the severity of the condition;

• reaferon (recombinant interferon alfa-2);

• symptomatic treatment.

Prevention is aimed at actively identifying sources of infection, it is necessary to conduct a survey of the population in the medium-tion of hepatitis B, and first of all to examine risk groups.

risk groups

1. Donors.

2. Pregnant.

3. Recipients of blood and its components.

4. Staff Blood Service institutions, hemodialysis departments, surgery, biochemical laboratories, stations "Ambulance", intensive care units.

5. Patients with a high risk of infection of the staff of hemodialysis centers, kidney transplantation, cardiovascular and pulmonary surgery, hematology.

6. Patients with any chronic pathologies, long being hospitalized.

7. Patients with chronic liver disease.

8. Contingent Substance Abuse and STI clinics.

Prevention of occupational exposure:

• all manipulations, during which the contamination of hands with blood or serum may occur held in rubber gloves.During operation, all damage at the hands plastered with plaster.To avoid splattering blood work should be masked;

• frequent use of disinfectants should be avoided during treatment arms.Surgery for hand washing should not use hard brushes;

• in the case of blood contamination of hands should treat them immediately with a disinfectant solution (1% solution of chlorine bleach) and wash them twice with warm soapy water, wipe dry with a napkin individual single use;

• surface desktops in the case of blood contamination immediately handle a 3% solution of chlorine bleach;

• health care workers who have by the nature of professional activity into contact with blood, to be examined for the presence of HBsAg when applying for a job, and then - at least 1 time per year.

1. In order to prevent hepatitis B in all the health facilities:

• should be possible to use single-use instruments;

• strictly observe the disinfection rules, pre cleaning and sterilization of medical equipment;

• histories of people - HBsAg carriers should be marked.

2. OST USSR Ministry of Health 1985 42-21-2-85

Sterilization and disinfection of medical devices.

methods, means, modes:

• Disinfection (methods, tools);

• presterilizing processing (steps);

• Sterilization (methods, modes, tools);

• cleaning products from corrosion.

3. Order of the USSR Ministry of Health number 215 of 1979 "On measures to improve the organization and improve the quality of specialized medical care to patients with purulent surgical diseases."

these instructions on the organization and conduct of sanitary and hygienic measures, anti-epidemic regime in surgical departments, intensive care wards.

4. Order of the Ministry of Health of the Russian Federation № 295 of 1995 "On introduction of the rules for mandatory testing for HIV."

list of employees of institutions and organizations that undergo a medical examination for HIV infection during the mandatory upon employment and periodic medical examinations:

• doctors, middle and junior medical staff to prevent and control AIDS, engaged in direct examination, diagnosis, treatment and care of persons infected with HIV;

• doctors, middle and junior medical staff, laboratories;

• scientists, workers of enterprises for the production of immunobiological preparations, whose work is connected with the material containing immunodeficiency virus.

Rules for mandatory testing for HIV infection.

1. compulsory medical examination to be donors of blood, semen and other body fluids, tissues, organs.

2. Investigation of serum for antibodies to Human Immunodeficiency Virus 2 is held in ethane.

I stage - revealed the total spectrum of antibodies against HIV antigens by ELISA.

II stage - performed immunoblotting to identify antibodies to specific proteins of immunodeficiency virus.

3. In the case of HIV infection in workers of individual enterprises (the list of organizations approved by the RF Government), they are subject to transfer to another job, excluding conditions of HIV infection.

list of indications for testing for HIV / AIDS in order to improve the quality of diagnosis.

1. Patients for clinical indications:

• feverish more than one month;

• have swollen lymph nodes of two or more groups with more than one month;

• diarrhea lasting longer than one month;

• with unexplained weight loss;

• protracted and recurrent pneumonia or pneumonia, are not amenable to conventional treatment;

• protracted and recurrent suppurative bacterial parasitic diseases, sepsis;

• with subacute encephalitis;

• with lint leukoplakia language;

• with recurrent pyoderma;

• women with chronic inflammatory diseases of the reproductive system of unknown etiology.

2. Patients with suspected or confirmed diagnosis of the following diseases:

• addiction;

• diseases, sexually transmitted diseases;

• Kaposi's sarcoma;

• lymphoma of the brain;

• T-cell leukemia;

• pulmonary and extrapulmonary tuberculosis;

• Hepatitis B;

• cytomegalovirus infection;

• generalized or chronic forms of herpes simplex;

• recurrent herpes zoster (persons under 60 years of age);

• mononucleosis;

• esophageal candidiasis, bronchial tubes, trachea;

• deep mycosis;

• anemia of various origins;

• pregnant - in the case of abortnoy and placental blood sampling for further use as raw material for the production of Immunopreparat.

Compulsory testing for HIV is prohibited.

Coding patients at the direction of their HIV-examination:

100 - citizens of the Russian Federation;

102 - addicts;

103 - homo- and bisexual;

104 - patients with sexually transmitted diseases;

105 - Persons with promiscuity;

106 - Persons who are abroad longer than one month;

108 - donors;

109 - pregnant women (donor and placental blood abortnoy);

110 - recipients of blood products;

112 - persons who were in detention at risk;

113 - examined but clinically indicated (adults);

115 - medical staff working with AIDS patients or infectious material;

117 - examined clinically indicated (children);

118 - Other (specify contingent);

120 - medical contacts with AIDS patients;

121 - heterosexual partners of HIV-infected;

122 - homosexual partners of HIV-infected;

123 - partners of HIV-infected by intravenous drug use;

126 - VCT;

127 - anonymous survey;

200 - foreign nationals.

5. Order of Ministry of Health of the USSR № 1002 dated 09.04.87 "On measures of prevention of AIDS virus."

of the survey shall be:

• foreigners who arrived in the period of 3 months or more;

• Russian citizens returning from foreign trips lasting more than one month;

• persons at risk who received multiple transfusions of blood and blood products, addicted, homosexuals, prostitutes;

• citizens who have contact with patients or virus carriers;

• wishing to be examined.

6. Order № 286 of Ministry of Health of the Russian Federation from 12.07.93 and an order number 94 dated 02.07.97, the "On improvement of disease control, sexually transmitted."

on the patient for the first time with a diagnosis of active tuberculosis, syphilis, gonorrhea, trichomoniasis, chlamydia, ureaplasma, bacterial vaginosis, urogenital candidiasis, anourogenitalnogo herpes, genital warts, scabies, trachoma, athlete's foot is served notice (Form № 089 / y93).

Notification shall be made in each health care setting.