Emergencies in the work of medical personnel - description, features and algorithm of actions

What are emergency situations in the work of medical personnel? What should be done if they occur? You will find answers to these and other questions in the article. An emergency is understood, for example, to contaminate the skin, mucous membranes, as well as equipment, medical clothing, floor surfaces, tables with blood and other unexplained secretions.

With each employee during the performance of their direct duties, such an incident can occur. What does this mean for the healthcare provider and how to protect yourself from such unpleasant situations, we will find out below.

Circumstances of occurrence

Why do emergencies appear in the work of medical personnel ? It is known that every health worker performs many different manipulations every day, such as, for example:

• disinfection of tools;
• medical waste management;
• execution of injections;
• operation of medical products;
• carrying out general and current cleanings;
• accounting, storage and use of disinfectants;
• air disinfection and so on.

What can happen?

What are the emergencies in the work of medical personnel? When implementing the above duties, anything can happen to the health worker. For example, these may be such incidents:

1. Cuts and injections with cutting and stitching tools.
2. Contamination of the skin and mucous membranes of workers with blood and other biological fluids of patients.
3. Destruction of lamps or thermometers containing mercury (mercury pollution).
4. Spill (scattering) of medical waste of B / V classes.
5. Electric shock or other emergency circumstances associated with working with medical equipment, for example, with installations for the neutralization of medical waste.
6. Critical conditions when working with antiseptics (chemical burn, accidental poisoning with a disinfectant, other negative situations).
7. The harmful effects of ozone on health workers.
8. Electric shock or other emergency during cleaning.
9. The harmful effects of radiation on health workers.
10. Failure of bactericidal lamps (mercury pollution).

Rules of work of medical staff

Few people know what emergencies arise in the work of medical personnel. In order to avoid them, the canons of work and safety precautions must be observed when performing various kinds of events. The employer must implement local instructions with a clear algorithm of action in various situations in the work of the personnel.

Thus, for example, the Moscow Health Department in its notification dated 26.10.2006 No. 44-18-3461 ordered the health centers subordinate to it to create a labor safety manual for each institution when working with patients with blood and other bi-fluids to be carried out on site briefing services with employees of the “risk group”. The Department also attached sample instructions to this letter.

The basic canons of the work of medical staff include the following:

1. Each health care provider must observe personal hygiene (work using personal protective equipment, treat hands and other on time).
2. Health workers should be careful when working with needles, pricking, cutting devices.
3. We must proceed from the fact that each patient is possibly dangerous regarding infectious ailments.
4. In rooms where medical personnel may contact patients' biofluids, an Anti-HIV first-aid kit should be provided.
5. In emergency situations, emergency prevention is carried out.

At the end of the work, the following manipulations are carried out:

• one-time tools are placed in a puncture-proof container;
• table surfaces are treated with disinfectants;
• items to be used further are placed in containers for processing.

Personal Protective Equipment

Each employee should study emergency situations in the work of medical personnel and the algorithm of actions in case of their occurrence. In medical institutions, all patients should be considered as likely to be infected with HIV, therefore, when providing medical care, it is necessary to comply with all the canons and safety requirements at the place of work.

When performing medical research activities, as well as when working with biofluids (semen, blood, vaginal secretions, any solutions mixed with blood, synovial, pleural, cerebrospinal, amniotic, pericardial) personal protective equipment should be used:

• medical caps;
• medical gowns or suits;
• masks;
• medical gloves;
• protective glasses;
• oilcloth aprons (if necessary);
• protective screens (if necessary).

Biofluid pollution

So what should you do if there is an emergency in the work of medical personnel? What is the algorithm of actions? If there is an emergency situation with biomaterial at the workplace, the victim must stop working and carry out disinfecting measures, depending on its type:

1. If biofluid enters the skin, moisten this place with 70% alcohol, wash with soap and re-moisten with 70% alcohol.
2. If bio-fluid gets into the eyes, immediately rinse them with clean water or 1% boric acid.
3. If bio-fluid gets on hands protected by gloves, it is necessary to clean the gloves with a cloth moistened with a disinfectant, then wash with water. Next, you need to remove them inside with a working surface, wash your hands and grease with an antiseptic.
4. If a biofluid gets on the nasal mucosa, you will need to treat it with 1% protargol.
5. If a biofluid enters the mucous membrane of the oropharynx, immediately rinse the mouth with alcohol 70% or a solution of potassium permanganate 0.05% or boric acid 1%.

Skin damage

What should be the actions in an emergency situation for a nurse if there is contact with blood, other biofluids or biomaterials, accompanied by a violation of the integrity of the skin (cut, prick)? Here you need to take such measures:

• without removing gloves, wash hands with soapy water;
• remove gloves inside with a working surface and send them to a disinfecting solution;
• if blood comes from the wound, do not stop it for a couple of minutes, otherwise squeeze blood from the wound;
• wash hands with soapy water;
• treat the wound with 70% alcohol, then 5% iodine alcohol solution and seal with a bactericidal patch, put on a fingertip if necessary;
• Do not use adhesive antiseptics (BF-6 and others) that interfere with drainage of the wound.

Clothing contamination

Consider the algorithm of actions in case of emergency, when the biomaterial fell on clothes, a bathrobe. Here take the following measures:

• remove clothes and soak in a disinfecting solution;
• the skin of the hands and other areas of the body when they are contaminated through the garment after removing it, treat it with 70% alcohol;
• wash the surface with soap and water and re-treat with 70% alcohol;
• if biomaterial gets on the shoe, wipe it twice with a swab dipped in a disinfectant solution.

Other actions

Healthcare providers should also be aware of the following:

• If biomaterial gets on the surface of the floor, walls, equipment, it is necessary to wipe them twice with an interval of 15 minutes with hydrogen peroxide 5% or chloramine 3% or other disinfectant.
• In case of an emergency during a centrifuge, it is possible to open the lid of the device and carry out disinfection measures only after 40 minutes. after the rotor stops (during this time the aerosol settles). After you open the centrifuge lid, place the broken glass and centrifuge cups in a disinfectant solution; treat the inside and outside of the apparatus twice with a rag soaked in a disinfectant.

Blood

Blood emergencies are considered very dangerous. After all, blood is the most powerful source of infection in the workplace with hepatitis B or HIV. Therefore, measures to protect against such infections are first and foremost to prevent their transmission through the blood and vaccination against hepatitis B.

It is known that the methods of transmission of HIV and hepatitis B virus are identical. Nevertheless, the risk of contracting hepatitis at the place of work is higher than HIV infection (this is because the density of the virus in the blood of HIV-infected infants is lower).

Emergency version No. 1. In case of skin cut or puncture

Consider the algorithm of actions in case of emergency with HIV. The probability of infection with this virus when cut or puncture the skin with devices stained with HIV-infected blood is 0.5%. The probability of infection with hepatitis B is 6-30%.

If you are cut or pricked, immediately remove gloves and squeeze blood from the wound. Next, remove the blood with a swab dipped in 70% alcohol. Then wash your hands under running water, soaping them twice. After lubricating the damage with iodine 5%. After 15 minutes, treat with alcohol again. Next, seal the wound with a bactericidal patch.

Emergency version No. 2. In case of skin contact

The probability of HIV infection when contaminated blood gets on unhurt skin is estimated at 0.05%. If blood (or other biofluid) is on your intact skin, immediately treat it with a swab moistened with 70% alcohol or disinfectant for 1 minute. You can’t rub it!

Then wash twice with running warm soapy water and wipe dry with a disposable towel. After 15 minutes, repeat the treatment with alcohol.

Emergency version number 3. In case of contact with the mucous membrane

If infected blood enters the mucous membrane, the probability of HIV infection is estimated at 0.09%. If blood gets into your eyes, immediately rinse with distillate from the medicine cabinet (or with a freshly prepared solution of potassium permanganate - dilute 100 mg of potassium permanganate in 200 ml of distillate).

To wash your eyes, use glass baths: fill them with a solution or water, attach to your eyes and rinse, blinking for a couple of minutes. In each eye, instill three drops of 20% albucide.

If the blood is on the nasal mucosa, immediately rinse your nose with a freshly prepared 0.05% potassium permanganate solution for 2 minutes. Then instill in each nostril 3 drops of a 20% albucid solution.

If the blood is on the oral mucosa, rinse it immediately with 70% alcohol or a freshly prepared 0.05% potassium permanganate solution for 2 minutes.

The processing of clothes and premises in this case is identical to the above algorithms.

First aid kit

So, you already know what emergency aid is in itself. In order to provide it on time, you should always have at hand a first-aid kit for the prevention of HIV infection. It usually contains the following drugs:

Additionally, the department must have:

• working disinfecting solutions in the disinfection area, an irreplaceable supply of water for washing hands (5 l), toilet soap, individual wipes for wet hands;
• instructions for emergency preventive measures.

To clean large pools of blood, you may need: rubber gloves, waterproof, disposable shoe covers, rags. If there is a risk of blood spraying, you need to wear a front protective shield or glasses, a waterproof apron.

The first-aid kit must be stored in a marked separate box in the treatment room. To control this storage and replenish the first-aid kit is the duty of the head nurse of the department.

Logbook

How are emergency situations recorded during medical procedures? All these cases are recorded in the journal of emergency situations that appeared at the factory. The health worker indicates the date and time of occurrence of special circumstances. It describes an emergency and measures taken to eliminate it. The record certifies the person in charge with its signature. The log table contains the following vertical columns:

1. No. p / p.
2. Date, time (day, month, hours, minutes).
3. Description of the incident.
4. Taken measures.
5. Signature of the responsible person.

This magazine has a size of 210 X 297 mm (A4 format, vertical). The title page should indicate the name of the institution and unit in which emergency cases are kept, the start date and the end date of the journal. The pages of the document are numbered, the last page indicates the number of stitched and numbered pages. The journal must be sealed by the signature of the accountable person and the seal of the organization.

Nurse Tactics

What is the tactics of a medical nurse in an emergency? She must perform the following actions:

1. Take emergency measures to prevent infection (remove biomaterial, perform treatment of the affected area corresponding to the level of the accident).
2. Immediately notify the head nurse of the department, the head of the department, and at the weekend and at night - the doctor on duty.
   

Next, the nurse is required to fill out the registration documents:

• journal of registration medavariy;
• an act of official inquiry in the event of an emergency;
• write a personal explanatory note in any form, describing in detail the reasons for what happened and the circumstances.

Next, the nurse performs the following steps:

1. Immediately after the accident, he donates blood for HIV and hepatitis B and C. markers.
2. If the patient is HIV-infected, she must arrive at the AIDS Center within 72 hours to prescribe ART therapy.
3. Next, a dispensary is carried out with blood donation for markers of hepatitis B and C and HIV 3, 6 and 12 months after the accident.

Risk

So, you now know how emergency assistance is provided in emergency situations in medical facilities. Midwives and nurses are at risk of contracting HIV, hepatitis B and C, like all other people. But the risk is significantly reduced if they are careful both in professional activity and in personal life.

It should be noted how important the role of nurses is not only in preventing the spread of HIV and other infections in hospitals, but also in reducing personnel risk and social benefits. the consequences of the disease.