Detailed explanation of medical staff career exposure process (HBV, HCV, TP, HIV)

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Detailed explanation of medical staff career exposure process (HBV, HCV, TP, HIV)

2021-11-26 00:17:53 7 ℃

How to deal with medical staff occupational exposure?

We specifically introduce the treatment of hepatitis B, hepatitis C, syphilis, and more occupational exposure.

Occupational exposure report

1

After the occupational exposure, emergency treatment measures were implemented as soon as possible, and reported to the nurse within 30 minutes, the nurses were reported within 2 hours, and the exposed source was HIV positive or suspected patients, should be reported within 1 hour after exposure.

2

The content reported to the superior department, including damage time, location, what is damaged, most wounds, on-site treatment measures, medical treatment measures, recording, and medication records.

3

Registration after professional exposure, requiring the parties to report to the departments of the department and the head nurse, and fill in the occupational exposure registration form, tripartite. (The department, the hospitalology, the medical department or the care department).

4

After receiving the corresponding item inspection, the test department is reported to report the test results, and pay attention to the preservation of samples and materials.

Hepatitis B occupational exposure

Extrusion and disinfection

After exposure, don't panic, you should immediately squeeze from the wound near the heart, try to extrude the blood, and flush the wound with flow water, and use 0.5% iodophor to disinfect the wound, then coat the waterproof dressing. If the mucosa is exposed, it is repeatedly rinsed with a large number of physiological saline.

Blood test

After preliminary treatment, it is necessary to take a test of hepatitis B after preliminary treatment: HBV DNA, HBsAg, anti-HBS, HBeag, anti-HBE, anti-HBC and liver function, discretion, for 3 months and 6 months.

Special treatment

1. It is known that the exposed HBsAg is positive or anti-HBS positive, and may not be specially treated, such as the low anti-HBS titer (<10iU / mi), which is required to enhance the hepatitis B vaccine (5 ug).

2, known to the exposed HBsAg and anti-HBS is negative, and the exposed muscles are injected into hepatitis B immunoglobulin (HBIG) 200U and hepatitis B vaccine as soon as possible, and the hepatitis B vaccination is performed according to the No. 0 - J201, and Immediately after exposure, two and a half of hepatitis B and a half, 12 weeks were detected, and abnormal conditions were reported to report to preventive health care.

3, unclear exposed HBSAG positive or anti-HBS is positive, immediately blood test core HBSAG and antigen HBS, and to introduce hepatitis B immunoglobulin (HBIG) 200U as soon as possible, and refer to the above principles according to the above principle according to the above principles deal with.

Hepatitis C vocal exposure

Extrusion and disinfection

Blood examination and treatment

If the exposed source (patient) is HCV infection (anti-HCV positive, HCV-RNA positive), it is recommended to expose medical personnel to the anti-HCV test immediately, and pay anti-HCV funds;

If the medical personnel anti-HCV positive should further detect HCV-RNA, HCV-RNA positive recommendations suggest that interferon + ribavirin's standard antiviral treatment;

If the medical personnel anti-HCV negative, the anti-HCV is detected again 12 weeks after exposure, and the anti-HCV positive will further detect HCV-RNA, HCV-RNA positive, suggest that interferon antiviral treatment; HCV RNA negative Monitor anti-HCV and Alt 24 weeks after exposure, and track management.

Medical exposure

Extrusion and disinfection

The exposed mucosa is applied with a large amount of water, including eye diameters. If there is a stabbed wound, after the exposure occurs, it should be extruded next to the wound. The squeezing should be from the near heart; then flush the exposed wound or non-intact skin with flow water, and then use disinfectant ( Iodophor or alcohol) disinfect the wound.

Blood examination and treatment

➀ If the source (patient) RPR (or VDR) is positive, TPHA should be added, if it is still positive, the needle should receive penicillin drug treatment as soon as possible, early treatment, the lower the chance of syphilis. It is recommended that long-acting penicillin is 2.4 million units, once a week, each side of the buttocks injection 1.2 million units / time, continuous injection for two weeks. Penicillin allergies can use erythromycin or the like. 1 month after stopping the drug, syphilis antibody detection was carried out for 3 months.

➁ If the patient TPHA is negative, the needle is still subject to regular tracking.

HIV occupation exposure

1. When the following circumstances occur, it is determined as a primary exposure:

(1) Exposure to body fluids, blood or medical equipment, items containing body fluids, blood;

(2) The exposure type is exposed to the defective skin or mucosa, which is small in exposure and short exposure.

2. When the following cases occur, it is determined to be secondary exposure:

(1) Exposure to body fluids, blood or medical equipment, items containing body fluids, blood;

(2) The exposure type is exposed to the defective skin or mucous membrane, the exposure is large and the exposure time is long; or the type of exposure is exposed to the stab or cut the skin, but the degree of damage is lighter, it is rubbed or Needle stab.

3. When the following cases occur, it is determined to be a three-level exposure:

(1) Exposure to body fluids, blood or medical equipment, items containing body fluids, blood;

(2) The exposure type is exposed to stab or cut the skin, but the degree of damage is heavier, and there is a significant visible blood for deep wounds or cuts.

The viral load level of the exposed source is divided into three types of mild, severe and exposed sources (1) Test, exposed source is positive for HIV, but the titer is low, and there is no clinical symptom of HIV infection, CD4 is normal , For mild type.

(2) Test, exposed source is the positive of HIV, but the titer is high, and HIV-infected people have clinical symptoms, and the CD4 count is low, which is a gravity type.

(3) It is not possible to determine whether the exposed source is a positive of HIV, which is unknown for exposure.

Partial emergency treatment measures

(1) Immediately use soap and flow water to clean the skin with a physiological saline.

(2) If there is a wound, it should be gently squeezed by the side of the wound, and the blood of the damage is extruded, and then rinse with soap and flow water. A partial extrusion of the wound is prohibited.

(3) After the wound in the injured site, the disinfecting liquid such as 75% ethanol or 0.5% iodophor is disinfected, and the wound is covered.

(4) Clothing pollution: take off the contaminated clothing as soon as possible to disinfect the treatment.

(5) Splash of pollutants: When a small splashing accident occurs, the disinfection treatment should be performed immediately. When a large-scale splash accident occurs, the laboratory leadership and safety person in charge should be notified to the scene, find out the situation, and determine the sterilization range and procedures.

Treatment after HIV occupation exposure

1. The Academy of Academy and the Laboratory are evaluated and determined on the exposed level and the viral loading level of the exposed source.

2. Implement preventive medication.

(1) Time for medication

Preventive medication should begin as early as possible after HIV occupation exposure, preferably within 4 hours, no more than 24 hours; more than 24 hours, it should also be implemented.

(2) Principle of medication

➀ When the level of exposure is low, the exposed source viral load level can be mild, and preventive medication may not be used; the level of exposure of the exposed source viral load is severe or the level of exposure of the exposed source viral load is Mild time, use basic medication procedures.

➁ The level of exposure of the secondary exposure and exposing the source viral load is severe, and the three-stage exposure is used, and the exposed source viral load level is mild or severe, and the reinforcement procedure is used.

➂ When exposed source viral load levels, basic medication procedures can be used.

(3) medication program

Preventive medication regimen: divided into basic drug procedures and enhanced medication procedures.

Basic medication procedures: Two reverse transcriptase inhibitors, use routine therapeutic dosage, continuously take 28 days. Such as two-term (AZT and 3TC combined formulation) 300mg / time, 2 times a day, continuously taking 28 days or reference antiviral treatment guidelines.

Strengthening the medication procedure: The reinforced treatment procedure is based on the basic medication procedures, and also adds a protease inhibitor, such as good-rate or ritanavir, uses a routine therapeutic dose, and serves for 28 days.

3. The exposure should be tested immediately after exposure, 6 weeks, 12 weeks, 6 months, 12 months, and monitoring and handling the toxicity of drugs, and discovers abnormal conditions report to prevent health care.

4, the exposed person should fill in the "case registration form for AIDS professional exposure", complete the post-information exchange prevention and health care.

Conclusion:

In the past, the survey showed that medical staff self-protection is weak, and the knowledge of protection knowledge is prevalent is more common, and it is particularly lacking on relevant treatment knowledge and skills after occupational exposure.

The career protection knowledge training of medical staff should be strengthened, enhance the awareness of prevention and control of medical staff, thereby reducing the occupational exposure in work. While strengthening the occupational safety protection and safeguards of medical personnel, the government department should also improve the compensation mechanism of infectious disease staff.

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