Drew out from an order of Public Health Ministry of Ukraine №120 from 25.05.2000

"About improvement of organization of medicare

To the hiv-infection/aids patients"

Any damage of skin, mucous membranes of medical staff, contamination their biomaterial of patients during a grant by him must medicare be characterized as a possible contact with material, containing HIV or other exciter of infectious disease.

In the case of contamination blood or other biomaterials without the damage of skin a victim owes:

1) to process the place of contamination one of disinfectant (3% by solution of hydrogen peroxide, 70% by an ethyl alcohol);

2) to wash water with soap;

3) repeatedly to process 70% by an ethyl alcohol

In the case of contamination blood or other biomaterials with the damage of integrity of skin a victim owes:

1) to take off gloves by a working surface inside;

2) to squeeze out blood from a wound (on cotton wool with an alcohol);

3) to process the damaged place disinfectant;

4) to wash water with soap; to wipe an alcohol;

5) on a wound to impose a plaster, put on finger-stall, new glove.

In the case of hit of biomaterial on mucous membranes:

1) cavities of mouth – to rinse 70% by an alcohol;

2) cavities of nose – to begin to drip 30% solution of albucid;

3) eye – to wash water, to begin to drip 30% solution of albucid.

In all of medical establishments the form of a 108-о "Journal of registration of failures is conducted at a grant medicare of HIV-infecting and work with HIV-infecting material". Therefore at once after a failure it is needed to reveal to guidance of medical establishment about a failure for its registration and to conduct the urgent prophylaxis of HIV-infection.

Composition of medicine chest of "anti-aids"

• an alcohol is ethyl 70% – 50 ml;

• 5% spirituous solution of iodine;

• 3% solution of hydrogen peroxide;

• 30% solution of albucid;

• permanganate of potassium in hinge-plates for 0,05 – 3 items;

• hinge-plates of disinfectants: chloramine 30,0, chlorcine 30,0 for 3 items to each (to keep separately);

• court plaster is a 1 spool;

• scissors are 1 шт.;

• finger-stalls from a calculation 1-2 on every worker;

• sterile gloves are 3 pair;

• promarked capacity (1 l) for breeding of permanganate of potassium;

• promarked capacity (1 l) for breeding of disinfectants.

Surgical instruments after the use at patients it is wet HIV-infection in a 3% solution of chloramine (30 minutes) or 6% solution of hydrogen peroxide (90 minutes) with subsequent ordinary pre-sterilization treatment.

Vі. Tasks for verification of eventual level of knowledges.

Situation tasks for verification of eventual level of knowledges

1. At patient В., to which 3 days operative interference was ago executed concerning the carbuncle of left buttock a temperature of body is 38,2 °С. How to conduct the fence of blood of patient for sowing on sterility?

1. To beginning of antibiotic therapy it is needed to get no less 2th results of the bacteriological sowing. For this purpose it is needed to collect blood from a vein and take in laboratory. The fence of blood needs to be conducted every hour to the receipt of positive result.

2. Sick, 92 years, 2 days was ago operated concerning the deep intermuscular phlegmon of right thigh. At examination the general state of patient is heavy, on questions answers behind time. Temperature of body 38,3 °С, pulse 100 after 1 mines, unrhythmical. Arterial pressure is 80/40 mm Hg. Breathing frequency – 28 after 1 minute. Global analysis of blood: Нb – 50 g/l, leucocytes – 14,3 × 10⁹ /l, red corpuscles – 2,8 × 10⁹ /l, to red cells concretion speed – 34 mm/hour. Kreatine – 260 mcmol/l, bilirubine – 35 mcmol/l. Diuresis 400 ml for day.

Formulate a diagnosis.

2. Deep intermuscular phlegmon of thigh. Sepsis, multiorgan failure.

3. At patient T., 80 years, on 4 days after implementation of resection of sigmoid bowel the symptoms of irritation of peritoneum appeared concerning a shrine, on the survey sciagram of organs of abdominal region is a gas presence under the domes of diaphragm. Concerning postoperative peritonitis on a background insolvency of stitches of anastomosis of patient was executed relaparotomy. A sepsis, kidney insufficiency, developed for a patient.

Name the basic criteria of kidney insufficiency at a sepsis.

3. At a sepsis considered the basic criteria of kidney insufficiency: oliguria, wet less 30 ml/hour, diuresis less 480 ml/day, level of creatine more than 250 mcmol/l.

4. Patient of Ш., 46 years, entered surgical separation for urgent operative treatment concerning оstеоmyelities of stump of right foot at the level of Shopar joint, complicated the phlegmon of right shin. For a patient a sepsis, hepatic insufficiency, is diagnosed.

On what criteria is it possible to testify to the presence of hepatic insufficiency?

4. The basic criteria of hepatic insufficiency at a sepsis are consider the level of bilirubine more than 34 mcmol/l, level of ALT and ASТ higher than norm in 2 times. Normal sizes of ALT 0,1-0,68 mcmol/(hour × l), АSТ – 0,1-0,45 mcmol/(hour × l) at determination the Reytman-Frenkel method.

5. To sick P., 79 years, which is in a clinic with a diagnosis phlegmon of crotch, sepsis, in connection with instability of hemodynamics arterial pressure is supported at the level of 120/80 mm Hg by permanent intravenous tiny infusion 10 ml 4% dopamine on 200 ml of physiological solution.

You will transfer the basic criteria of insufficiency of the cardiovascular system.

5. The basic criteria of failure of the cardiovascular system at a sepsis is: arterial pressure less 90 mm Hg, necessity of introduction of sympathomimetics, tachycardia, РаСО₂ ≤ 49 mm Hg.

6. In a reanimation separation there is patient with destructive pancreatitis, complicated a retroperitoneal phlegmon and sepsis at which on 3 days after operative interference the signs of organ insufficiency appeared outside central nervous system. You will transfer the basic criteria of organ insufficiency outside central nervous system.

6. By the basic criteria of organ failure outside central nervous system is dormancy, soporose state, sum of marks on the scale of Glasgow less than 6 (without antianxiety therapy).

7. To the young man was 18 years executed laser phlebectomy. In 1 days after an operation the state the sick was sharply worsened, pain appeared in area of postoperative wound, a temperature rose to 39,1 °С. A patient has tachycardia (a pulse is 130 shots after 1 minute), breathing frequency – 30 after 1 minute. In a grave condition he was delivered in the induction centre of hospital an ambulance. On what criteria is it possible to draw a conclusion about a presence at patient of organ insufficiency from the side of the system of blood?

7. The basic criteria of organ failure from the side of the system of blood is: is there an amount of leucocytes anymore after 10×10⁹ /l, there is less than thrombocytes 20 000 /mcl, hematocrit value less than 18 %.

8. To the patient S. operative interference is executed concerning the poured out purulent inflammation of the checked spaces of pelvis. Wounds on next days are washed solutions of antiseptics, drain adequately, fabrics of bottom of wound are dim, achromatic color. The temperature of body sticks to at the level of 38,0-38,5 °С, there are tachycardia (105 shots after 1 minute), leucocytosis (12,4 × 10⁹ /l), bilirubinemia (level of bilirubin of 36 mcmol/l).

Why without regard to adequate dissection and drain of purulent hearth does hyperthermia proceed for a patient? What criteria of syndrome of system answer for inflammation are observed for this patient?

8. Increase of temperature at patient on condition of valuable drain of purulent wound testifies to distribution of infectious process outside a primary hearth and development of general suppurative infection – sepsis. This patient have 3 signs of systemic inflammatory response syndrome: hyperthermia, tachycardia, leucocytosis.

9. Patient In., 70 years, hospitalized with a diagnosis abscessed furuncle of right forearm. Objectively: temperature of body 38,1 °С, frequency of cardiac reductions – 102 after 1 minute, breathing vesicular, hepar, spleen not megascopic.

What treatment is shown sick? In what case is it possible to assert about a presence at patient of sepsis?

9. A patient is show implementation of surgical operation: dissection and drain of furuncle. If in a postoperative period on condition of valuable drain of purulent wound sore there will be 2 and more signs of systemic inflammatory response syndrome, it is possible to assert that at sick sepsis.

10. During a fight 4 days ago a man got the wound of right brush after a blow to the teeth of man which, as turned out then, HIV- infected. What stage of HIV- infected at injured and what method can a diagnosis be confirmed?

10. Stage of incubation which lasts from a moment an infection to appearance of antibodies. A diagnosis can be confirmed the method of polymerase chain reaction at the exposure of antigen of НIV-RNA (ribonucleic acid).

11. After the injection of narcotic matter a syringe which contained tailings of blood of HIV- infected of patient, infecting of other man happened. After this time passed 2. What stage of HIV- infection at infected and what is it characterized?

11. ІІ stage of HIV-infection: primary displays. Characterized a relative equilibrium between the immune response of organism and action of virus. Duration from 2-3 to 10-15 years.

12. At patient the post-injection phlegmon of left lower extremity (after introduction of narcotic matter in area of inguinal fold) is mark an increase and sickliness of practically all of groups of outward lymph nodes.

What stage of HIV- infection at infected and what is it characterized? What difference from the stage of incubation?

12. II In the stage of HIV-infection: persistent infection. Persistent generalized lymphadenopathy is characterized, which is a clinical display on this stage. Unlike the stage of incubation antibodies are determined to the antigens of HIV.

13. At patient HIV-infection there is a loss of weight less 10%, mycotic, viral defeats of mucous and skin covers. What stage of HIV-infection at infected?

13. III A the stage of HIV-infection.

14. At patient HIV- infection is a loss of weight less 5% and noncommunicative sarcoma of Kaposhi. What stage of HIV- infection at infected?

14. ІІІ B the stage of HIV-infection.

15. At patient which used injection drugs, furunculosis and phenomena of subsharp encephalitis developed. Antibacterial therapy which was conducted was adequately ineffective and a patient perished during a month. Why did a patient have such defect of the immune system? What disease is it characteristic for?

15. Terminal stage of HIV-infection. Characterized the irreversible defeat of organs and systems. Even therapy of the second diseases, which is conducted adequately ineffective and a patient perishes during a few months.