Nurse's algorithm for identifying OOI. Tactics of a paramedic when identifying a particularly dangerous infection

In order to reduce the risk of infection of medical personnel working in laboratories, hospitals, isolation wards, and in field conditions with microorganisms I-II groups pathogenicity and patients suffering from the diseases they cause, use protective clothing- so-called anti-plague suits, insulating suits such as KZM-1, etc.

There are 4 main types of anti-plague suits, each of which is used depending on the nature of the work performed.

First type suit(full suit) includes pajamas or overalls, a long “anti-plague” robe, a hood or a large scarf, a cotton-gauze bandage or an anti-dust respirator or a filter gas mask, canned glasses or disposable cellophane film, rubber gloves, socks, slippers, rubber or tarpaulin boots (shoe covers), oilcloth or polyethylene apron, oilcloth sleeves, towel.

This suit is used when working with material suspected of being contaminated with a plague pathogen, as well as when working in an outbreak where patients with this infection have been identified; when evacuating to a hospital those suspected of having pneumonic plague, carrying out ongoing or final disinfection in plague foci, conducting observation of persons in contact with the patient pulmonary form plague; when autopsying the corpse of a person or animal that died from the plague, as well as from the Crimean-Congo, Lassa, Marburg, and Ebola hemorrhagic fevers; when working with experimentally infected animals and a virulent culture of the plague microbe, pathogens of glanders, melioidosis, and deep mycoses; carrying out work in pulmonary foci anthrax and glanders, as well as diseases caused by viruses classified as pathogenicity group 1.

The duration of continuous work in a type 1 anti-plague suit is no more than 3 hours, in the hot season - 2 hours.

The modern equivalent of the first type of anti-plague suit is an insulating suit (“spacesuit”), consisting of a sealed synthetic overalls, a helmet and an insulating gas mask or a set of replaceable back oxygen cylinders and a reducer that regulates the pressure of the gas supplied to the suit. Such a suit can, if necessary, be equipped with a thermoregulation system, which allows a specialist to work for a long time at uncomfortable temperatures. environment. Before removing the suit, it can be completely treated with a chemical disinfectant in the form of a liquid or aerosol.

Type 2 suit(lightweight anti-plague suit) consists of overalls or pajamas, anti-plague robe, cap or large headscarf, cotton-gauze bandage or respirator, boots, rubber gloves and towels. Used for disinfection and disinsection in the outbreak of bubonic plague, glanders, anthrax, cholera, coxiellosis; when evacuating a patient with secondary plague pneumonia, bubonic, cutaneous or septic forms of plague to a hospital; when working in the laboratory with viruses classified as pathogenicity group I; working with experimental animals infected with pathogens of cholera, tularemia, brucellosis, anthrax; autopsy and burial of the corpses of people who died from anthrax, melioidosis, glanders (in addition, an oilcloth or plastic apron, the same sleeves and a second pair of gloves are put on).

Type 3 suit(pajamas, anti-plague robe, cap or large scarf, rubber gloves, deep galoshes) are used when working in a hospital where there are patients with bubonic, septic or cutaneous forms of plague; in outbreaks and laboratories when working with microorganisms classified as pathogenicity group II. When working with the yeast phase of pathogens of deep mycoses, the suit is supplemented with a mask or respirator.

Type 4 suit(pajamas, anti-plague robe, cap or small scarf, socks, slippers or any other light shoes) are used when working in an isolation ward where there are persons who have interacted with patients with bubonic, septic or cutaneous forms of plague, as well as in the territory where such a patient has been identified , and in areas threatened by plague; in outbreaks hemorrhagic fever Crimea-Congo and cholera; in clean departments of virological, rickettsial and mycological laboratories.

The anti-plague suit is put on in the following order:

1) work clothes; 2) shoes; 3) hood (kerchief); 4) anti-plague robe; 5) apron; 6) respirator (cotton-gauze mask); 7) glasses (cellophane film); 8) sleeves; 9) gloves; 10) a towel (place it in the apron belt with right side).

Remove the suit in reverse order, immersing gloved hands in the disinfectant solution after removing each component. First, remove the glasses, then the respirator, robe, boots, hood (scarf), overalls, and lastly, rubber gloves. Shoes, gloves, and apron are wiped with cotton swabs, generously moistened with a disinfectant solution (1% chloramine, 3% Lysol). Clothes are folded with the outer (“infected”) surfaces turned inward.

Responsibilities medical workers when a patient has been identified as having OAI (or if OAI is suspected)

Responsibilities of a resident physician medical institution:

1) isolate the patient inside the ward and notify the head of the department. If you suspect a plague, request an anti-plague suit for yourself and necessary medications for treating skin and mucous membranes, placement for taking material for bacteriological research and disinfectants. The doctor does not leave the room and does not allow anyone into the room. The doctor performs treatment of mucous membranes and putting on a suit in the ward. To treat mucous membranes, use a solution of streptomycin (250 thousand units in 1 ml), and 70% ethyl alcohol to treat hands and face. To treat the nasal mucosa, you can also use a 1% solution of protargol, for instillation into the eyes - a 1% solution of silver nitrate, for rinsing the mouth - 70% ethyl alcohol;

2) provide care for patients with acute infectious diseases in compliance with the anti-epidemic regime;

3) collect material for bacteriological research;

4) start specific treatment sick;

5) transfer persons who had contact with the patient to another room (transferred by personnel dressed in a type 1 anti-plague suit);

6) before moving to another room, contact persons undergo partial sanitization with disinfection of the eyes, nasopharynx, hands and face. Complete sanitary treatment is carried out depending on the epidemic situation and is appointed by the head of the department;

7) carry out ongoing disinfection of the patient’s secretions (sputum, urine, feces) with dry bleach at the rate of 400 g per 1 liter of secretions with an exposure of 3 hours or pour a double (by volume) amount of 10% Lysol solution with the same exposure;

8) organize protection of the premises where the patient is located from flies, close windows and doors and destroy flies with a firecracker;

9) after the final diagnosis has been established by a consultant - an infectious disease specialist, accompany the patient to the infectious diseases hospital;

10) when evacuating a patient, provide anti-epidemic measures to prevent the spread of infection;

11) after delivering the patient to the infectious diseases hospital, undergo sanitary treatment and go into quarantine for preventive treatment.

All further measures (anti-epidemic and disinfection) are organized by an epidemiologist.

Responsibilities of the head of the hospital department:

1) clarify clinical and epidemiological data about the patient and report to the chief physician of the hospital. Request anti-plague clothing, equipment for collecting material for bacteriological examination from the patient, disinfectants;

4) organize the identification of persons who were in contact with the patient or who were in the department at the time of detection of acute respiratory infections, including those transferred to other departments and those discharged due to recovery, as well as medical and service personnel of the department, and hospital visitors. Lists of persons who were in direct contact with patients must be reported to the head doctor of the hospital in order to take measures to search for them, call them and isolate them.;

5) vacate one ward of the department for an isolation ward for contact persons;

6) after the arrival of ambulance transport, evacuation and disinfection teams, ensure control over the evacuation from the department of the patient, persons who interacted with the patient, and the final disinfection.

Responsibilities of the doctor on duty at the admission department:

1) by telephone, inform the chief physician of the hospital about the identification of a patient suspected of having AIO;

2) stop further admission of patients, prohibit entry and exit from the emergency department (including service personnel);

3) request stowage with protective clothing, stowage to take material for laboratory research, medicines for treating the patient;

4) change into protective clothing, collect material for laboratory testing from the patient and begin his treatment;

5) identify persons who were in contact with a patient with acute infectious diseases in reception department, and make lists according to the form;

6) after the arrival of the evacuation team, organize final disinfection in the reception department;

7) accompany the patient to the infectious diseases hospital, undergo sanitary treatment there and go into quarantine.

Responsibilities of the hospital chief physician:

1) set up a special post at the entrance to the building where a patient with acute respiratory infection has been identified, prohibit entry into and exit from the building;

2) stop access of unauthorized persons to the hospital territory;

3) check with the head of the department for clinical and epidemiological data about the patient. Report to the chief doctor of the Central State Hygiene Center of the district (city) about the identification of a patient suspected of having an acute infectious disease, and ask to refer an infectious disease specialist and (if necessary) an epidemiologist for consultation;

4) send to the department where the patient is identified (at the request of the head of the department) sets of protective anti-plague clothing, equipment for taking material from the patient for bacteriological examination, disinfectants for ongoing disinfection (if they are not available in the department), as well as medications necessary for treating the patient;

5) upon arrival of the infectious disease specialist and epidemiologist, carry out further measures according to their instructions;

6) ensure the implementation of measures to establish a quarantine regime in the hospital (under the methodological guidance of an epidemiologist).

Responsibilities of a local clinic physician conducting outpatient visits:

1) immediately stop further admission of patients, close the doors of your office;

2) without leaving the office, by phone or through visitors waiting for an appointment, call one of the medical workers of the clinic and inform the chief physician of the clinic and the head of the department about the identification of a patient suspected of having an acute infectious disease, demand an infectious disease consultant and the necessary protective clothing, disinfectants, medications , installation for taking material for bacteriological examination;

3) change into protective clothing;

4) organize protection of the office from flies, immediately destroy flying flies with a firecracker;

5) compile a list of persons who were in contact with the patient with acute infectious diseases at the reception (including while waiting for the patient in the corridor of the department);

6) carry out ongoing disinfection of the patient’s secretions and water after washing dishes, hands, care items, etc.;

7) on the instructions of the chief physician of the clinic, upon arrival of the evacuation team, accompany the patient to the infectious diseases hospital, then undergo sanitary treatment and go to quarantine.

Responsibilities of a local clinic physician visiting patients at home:

1) by hand or by telephone, inform the chief physician of the clinic about the identification of a patient suspected of having an acute respiratory infection, and take measures to protect yourself (put on a gauze mask or respirator);

2) prohibit the entry and exit of unauthorized persons from the apartment, as well as the communication of the patient with those living in the apartment, except for one caregiver. The latter must be provided with a gauze mask. Isolate the patient’s family members in the free areas of the apartment;

3) before the arrival of the disinfection team, prohibit the removal of things from the room and apartment where the patient was;

4) allocate individual dishes and patient care items;

5) compile a list of persons who were in contact with the sick person;

6) prohibit (prior to current disinfection) pouring patient’s excretions and water into sewers or cesspools after washing hands, dishes, household items, etc.;

7) follow the instructions of the consultants (epidemiologist and infectious disease doctor) who arrived at the outbreak;

8) on the instructions of the chief physician of the clinic, upon arrival of the evacuation team, accompany the patient to the infectious diseases hospital, then undergo sanitary treatment and go to quarantine.

Responsibilities of the chief physician of the clinic:

1) clarify the clinical and epidemiological data about the patient and report to the district administration and the chief physician of the regional Center for Hygiene and Epidemiology about the identification of a patient suspected of OI. Call an infectious disease specialist and an epidemiologist for consultation;

2) give instructions:

– close the entrance doors of the clinic and post a post at the entrance. Prohibit entry and exit from the clinic;

– stop all movement from floor to floor. Place special posts on each floor;

– place a post at the entrance to the office where the identified patient is located;

3) send to the office where the identified patient is located, protective clothing for the doctor, equipment for taking material for laboratory testing, disinfectants, medications necessary for treating the patient;

4) before the arrival of the epidemiologist and infectious disease specialist, identify persons who had contact with the patient from among the visitors to the clinic, including those who left it by the time the patient was identified as having an acute respiratory infection, as well as the medical and service personnel of the outpatient clinic. Compile lists of contact persons;

5) upon the arrival of the infectious disease specialist and epidemiologist, carry out further activities in the clinic according to their instructions;

6) after the arrival of the ambulance transport and disinfection team, ensure control over the evacuation of the patient, persons who were in contact with the patient (separately from the patient), as well as the final disinfection of the clinic premises.

When the chief physician of the clinic receives a signal from the local therapist about identifying a patient with acute respiratory infections at home:

1) clarify clinical and epidemiological data about the patient;

2) report to the chief physician of the regional Center for Hygiene and Epidemiology about the identification of a patient suspected of having AIO;

3) take an order to hospitalize the patient;

4) call consultants to the outbreak - an infectious disease specialist and an epidemiologist, a disinfection team, and ambulance transport for hospitalization of the patient;

5) send protective clothing, disinfectants, medicines, and equipment to the outbreak to collect diseased material for bacteriological examination.

Responsibilities of a doctor line brigade ambulance:

1) upon receipt of an order for the hospitalization of a patient suspected of OI, clarify the expected diagnosis by telephone;

2) when visiting a patient, wear the type of protective clothing that corresponds to the expected diagnosis;

3) a specialized emergency evacuation team must consist of a doctor and 2 paramedics;

4) evacuation of the patient is carried out accompanied by the doctor who identified the patient;

5) when transporting a patient, measures are taken to protect the vehicle from contamination by his secretions;

7) after delivering the patient to the infectious diseases hospital, the ambulance and patient care items are subject to final disinfection on the territory of the infectious diseases hospital;

6) the departure of an ambulance and a team of tow trucks from the territory of the hospital is carried out with the permission of the chief physician of the infectious diseases hospital;

7) members of the evacuation team are subject to medical supervision with mandatory temperature measurement for the entire period of incubation of the suspected disease at the place of residence or work;

9) the doctor on duty at the infectious diseases hospital is given the right, in case of detection of defects in the protective clothing of the medical personnel of the ambulance, to leave them in the hospital for quarantine for observation and preventive treatment.

Responsibilities of the epidemiologist of the Center for Hygiene and Epidemiology:

1) receive from the doctor who discovered the patient with AIO all materials regarding the diagnosis and measures taken, as well as lists of contact persons;

2) conduct an epidemiological investigation of the case and take measures to prevent further spread of the infection;

3) manage the evacuation of the patient to the infectious diseases hospital, and contact persons to the observation department (isolator) of the same hospital;

4) collect material for laboratory diagnostics(samples drinking water, food products, samples of the patient’s secretions) and send the collected samples for bacteriological examination;

5) outline a plan for disinfection, disinfestation and (if necessary) deratization in the outbreak and supervise the work of disinfectors;

6) check and supplement the list of persons who were in contact with the patient with acute infectious diseases, indicating their addresses;

7) give instructions on prohibiting or (as appropriate) permitting the use of enterprises catering, wells, latrines, sewage receptacles and other communal facilities after their disinfection;

8) identify contact persons in the outbreak of acute infectious diseases who are subject to vaccination and phaging, and carry out these activities;

9) establish epidemiological surveillance of the outbreak where a case of acute infectious diseases was detected, and, if necessary, prepare a proposal to impose quarantine;

10) draw up a conclusion about the case of the disease, give its epidemiological characteristics and provide a list of measures necessary to prevent further spread of the disease;

11) transfer all collected material to the head of the local health authority;

12) when working in an outbreak, carry out all activities in compliance with personal protection measures (appropriate special clothing, hand washing, etc.);

13) when organizing and carrying out primary anti-epidemic measures in the outbreak of infectious diseases - be guided by the comprehensive plan for carrying out these measures approved by the head of the regional administration.

General organizational issues. When identifying a patient suspected of having plague, cholera, contagious hemorrhagic viral fevers (Ebola, Lassa and cercopithecus fevers) and monkeypox, all primary anti-epidemic measures are carried out upon establishing a preliminary diagnosis based on clinical and epidemiological data. When a final diagnosis is established, measures to localize and eliminate foci of the infections listed above are carried out in accordance with current orders and guidelines for each nosological form.

The principles of organizing anti-epidemic measures are the same for all infections and include:

1) identification of the patient;

2) information about the identified patient;

3) clarification of the diagnosis;

4) isolation of the patient with subsequent hospitalization;

5) treatment of the patient;

6) observational, quarantine and other restrictive measures;

7) identification, isolation, and emergency prophylaxis for persons in contact with the patient;

8) provisional hospitalization of patients with suspected plague, cholera, GVL, monkeypox;

9) identification of those who died from unknown causes, pathological autopsy of the corpse with the collection of material for laboratory (bacteriological, virological) research, with the exception of those who died from GVL, disinfection, proper transportation and burial of corpses. Autopsies of those who died from GVL, as well as collection of material from the corpse for laboratory research, are not performed due to the high risk of infection;

10) disinfection measures;

11) emergency prevention of the population;

12) medical surveillance of the population;

13) sanitary control for external environment(laboratory research possible factors transmission of cholera, monitoring the number of rodents and their fleas, conducting an epizootological survey, etc.);

14) health education.

All these activities are carried out by local authorities and health care institutions together with anti-plague institutions that provide methodological guidance, advisory and practical assistance.

All treatment-and-prophylactic and sanitary-epidemiological institutions must have the necessary supply of medications for etiotropic and pathogenetic therapy; installations for collecting material from patients (cadavers) for laboratory research; disinfectants and adhesive plaster packages for sealing windows, doors, ventilation holes in one office (box, ward); means of personal prevention and individual protection (anti-plague suit type I).

The primary alarm about the identification of a patient with plague, cholera, GVL and monkeypox is made to three main authorities: the chief physician of the medical institution, the emergency medical service station and the chief physician of the territorial SES.

Chief physician The SES puts into effect a plan of anti-epidemic measures, informs the relevant institutions and organizations about the case of the disease, including territorial anti-plague institutions.

When carrying out primary anti-epidemic measures after establishing a preliminary diagnosis, it is necessary to be guided by the following incubation period periods: for plague - 6 days, cholera - 5 days, Lassa, Ebola and Cercopithecus fevers - 21 days, monkeypox - 14 days.

From a patient with suspected cholera, material is collected by the medical worker who identified the patient, and if plague is suspected, by the medical worker of the institution where the patient is located, under the guidance of specialists from the departments of particularly dangerous infections of the SES. Material from patients with GVL is taken only at the place of hospitalization by laboratories performing these studies. The collected material is urgently sent for research to a special laboratory.

When identifying cholera patients, only those persons who communicated with them during the period are considered contacts. clinical manifestations diseases. Medical workers who have been in contact with patients with plague, GVL or monkeypox (if these infections are suspected) are subject to isolation until a final diagnosis is made or for a period equal to the incubation period. Persons who have been in direct contact with a cholera patient, as directed by an epidemiologist, must be isolated or left under medical supervision.

Further activities are carried out by specialists from the departments of especially dangerous infections of the SES and anti-plague institutions in accordance with current instructions and comprehensive plans.

Doctor's knowledge of various specializations and basic qualifications early manifestations especially dangerous infections, constant awareness and orientation in the epidemic situation in the country, republic, region, district will allow timely diagnosis of these diseases and take urgent anti-epidemic and treatment and preventive measures. In this regard, a health care professional should suspect the disease of plague, cholera, GVL or monkeypox based on clinical and epidemiological data.

Primary measures in medical institutions. Anti-epidemic measures in all medical institutions are carried out according to a single scheme in accordance with the operational plan of the institution.

The procedure for notifying the chief physician of a hospital, clinic or a person replacing him is determined specifically for each institution. Information about an identified patient to the territorial SES, higher authorities, calling consultants and evacuation teams is carried out by the head of the institution or a person replacing him.

If a patient suspected of suffering from plague, cholera, GVL or monkeypox is identified, the following primary anti-epidemic measures are carried out in a clinic or hospital:

1) measures are taken to isolate the patient at the place of his identification before hospitalization in a specialized infectious diseases hospital;

2) transportable patients are delivered by ambulance to a hospital special for these patients. For non-transportable patients, medical care is provided on the spot with a call to a consultant and an ambulance equipped with everything necessary;

3) a medical worker, without leaving the premises where the patient is identified, notifies the head of his institution about the identified patient by telephone or by messenger; requests relevant medicines, stowage of protective clothing, means of personal prevention;

4) entry into and exit from a medical facility is temporarily prohibited;

5) communication between floors is stopped;

6) posts are set up near the office (ward) where the patient was, entrance doors clinics (departments) and on floors;

8) admission, discharge of patients, and visits by their relatives are temporarily suspended;

9) admission of patients for health reasons is carried out in isolated rooms;

10) in the room where the patient is identified, the windows and doors are closed, the ventilation is turned off and the ventilation holes are sealed with adhesive tape;

11) contact patients are isolated in a separate room or box. If plague, GVL or monkeypox is suspected, contacts in rooms connected through ventilation ducts are taken into account. Lists of identified contact persons are compiled (full name, address, place of work, time, degree and nature of contact);

12) before receiving protective clothing, a medical worker who suspects plague, GVL and monkeypox must temporarily cover his nose and mouth with a towel or mask made from improvised materials (bandage, gauze, cotton wool); if necessary, emergency prophylaxis is carried out for medical staff;

13) after receiving protective clothing (an anti-plague suit of the appropriate type), put it on without removing your own, unless it is heavily contaminated with the patient’s secretions;

14) seriously ill patients are provided with emergency medical care before the arrival of the medical team;

15) using a special sampling device, before the arrival of the evacuation team, the health worker who identified the patient takes materials for bacteriological research;

16) in the office (ward) where the patient is identified, ongoing disinfection is carried out;

17) upon the arrival of a team of consultants or an evacuation team, the health worker who identified the patient carries out all the orders of the epidemiologist;

18) if urgent hospitalization of a patient is required for vital reasons, then the health worker who identified the patient accompanies him to a specialized hospital and carries out the orders of the doctor on duty at the infectious diseases hospital. After consultation with an epidemiologist, the health worker is sent for sanitation, and in case of pneumonic plague, GVL and monkeypox - to the isolation ward.

Protective clothing, procedure for using a protective suit. The anti-plague suit protects medical personnel from infection by pathogens of plague, cholera, GVL, monkeypox and other pathogens of pathogenicity groups I-II. It is used when serving a patient in outpatient clinics and hospitals, during transportation (evacuation) of a patient, carrying out current and final disinfection (disinsection, deratization), when taking material from a patient for laboratory testing, during autopsy and burial of a corpse, and door-to-door visits.

Depending on the nature of the work performed, the following types of protective suits are used:

First type - a full protective suit consisting of overalls or pajamas, a hood (large headscarf), anti-plague robe, cotton-gauze mask (dust respirator), goggles, rubber gloves, socks (stockings), rubber or tarpaulin boots and towels. To autopsy a corpse, you must additionally have a second pair of gloves, an oilcloth apron, and oversleeves.

This type of suit is used when working with patients with pneumonic or septic forms of plague, until a final diagnosis is made in patients with bubonic and cutaneous forms of plague and until the first negative result of a bacteriological study is obtained, as well as with GVL.

Second type - a protective suit consisting of overalls or pajamas, an anti-plague robe, a hood (large scarf), a cotton-gauze mask, rubber gloves, socks (stockings), rubber or tarpaulin boots and a towel. Used in servicing and providing medical care patients with monkeypox.

Third type- a protective suit consisting of pajamas, an anti-plague robe, a large headscarf, rubber gloves, socks, deep galoshes and a towel. Used when working with patients with bubonic or cutaneous form plague receiving specific treatment.

Fourth type - a protective suit consisting of pajamas, medical gown, cap or gauze scarf, socks, slippers or shoes. Used in treating cholera patients. When performing the toilet, the patient wears rubber gloves, and when handling discharge, a mask.

Sets of protective clothing (robe, boots, etc.) must be sized and labeled.

How to put on a suit . An anti-plague suit is put on before entering the outbreak area. Costumes must be put on slowly, in a certain sequence, carefully.

The order of putting on is as follows: overalls, socks, rubber boots, hood or large headscarf, anti-plague robe. When using a phonendoscope, it is worn in front of the headscarf. The ribbon at the collar of the robe, as well as the belt of the robe, are tied in front on the left side with a loop, after which the ribbon is secured to the sleeves.

The respirator is put on the face so that the mouth and nose are covered, for which the upper edge of the mask should be at the level of the lower part of the orbits, and the lower edge should go slightly under the chin. The upper straps of the respirator are tied in a loop at the back of the head, and the lower ones - on the crown (like a sling bandage). Having put on a respirator, cotton swabs are placed on the sides of the wings of the nose.

Glasses must fit well and be checked for reliable fastening of the metal frame to the leather part; the glasses must be rubbed with a special pencil or a piece of dry soap to prevent them from fogging. After putting on the glasses, place a cotton swab on the bridge of the nose. Then gloves are put on, previously checked for integrity. A towel is placed in the waistband of the robe on the right side. During the pathological autopsy of a corpse, a second pair of gloves, an oilcloth (rubberized) apron, and oversleeves are additionally put on.

Procedure for removing the suit. The anti-plague suit is removed after work in a room specially designated for this purpose or in the same room in which the work was carried out, after it has been completely disinfected. To do this, the room must have:

1) a tank with a disinfectant solution (Lysol, carbolic acid or chloramine) for disinfecting a robe, scarf, towel;

2) a basin with hand sanitizer;

3) jar with 70% ethyl alcohol for disinfecting glasses and phonendoscope;

4) a pan with a disinfectant solution or soapy water for disinfection of cotton-gauze masks (in the latter case- boiling for 40 minutes).

When decontaminating the suit disinfectants all parts of it are completely immersed in the solution.

If the disinfection of the suit is carried out by autoclaving or in a disinfection chamber, the suit is folded, respectively, into bins or chamber bags, which are treated from the outside with a disinfectant solution.

The suit is removed slowly and in a strictly established order. After removing part of the suit, gloved hands are immersed in a disinfectant solution. The ribbons of the robe and apron, tied with a loop on the left side, make it easy to remove the suit.

Costumes are removed in the following order:

1) thoroughly wash gloved hands in a disinfectant solution for 1-2 minutes;

2) slowly remove the towel;

3) wipe the oilcloth apron with a cotton swab, generously moistened with a disinfectant solution, remove it, rolling it up from the outside inward;

4) remove the second pair of gloves and sleeves;

5) boots and galoshes are wiped with cotton swabs with a disinfectant solution from top to bottom (a separate swab for each boot);

6) without touching the exposed parts of the skin, remove the phonendoscope;

7) remove the glasses by pulling them forward and upward, backwards with both hands;

8) the cotton-gauze bandage is removed without touching its outer side;

9) untie the ties of the collar, the belt of the robe and, lowering the upper edge of the gloves, release the ties of the sleeves, remove the robe, wrapping outer part him inside;

10) remove the scarf, carefully collecting all its ends in one hand at the back of the head;

11) remove gloves, check them for integrity in a disinfectant solution (but not with air);

12) wash the boots again in a tank of disinfectant solution and remove them.

After removing the anti-plague suit, wash your hands thoroughly with warm water and soap. It is recommended to take a shower after work.

Efficiency and quality of anti-epidemic, diagnostic and therapeutic measures in the event of particularly dangerous infections, they largely depend on the preliminary training of medical workers. Great importance is attached to the readiness of the medical service of the polyclinic network, since it is most likely that workers at this level will be the first to encounter patients with particularly dangerous infections.

Regional state budgetary institution health

"Center medical prevention city ​​of Stary Oskol"

Restrictions on entry and exit, removal of property, etc.

Removal of property only after disinfection and permission from the epidemiologist,

Strengthening control over food and water supply,

Normalization of communication between separate groups of people,

Carrying out disinfection, deratization and disinsection.

Prevention of especially dangerous infections

1. Specific prevention of especially dangerous infections is carried out with a vaccine. The purpose of vaccination is to induce immunity to the disease. Vaccination can prevent infection or significantly reduce it negative consequences. Vaccination is divided into planned and epidemic indications. It is carried out for anthrax, plague, cholera and tularemia.

2. Emergency prevention for persons who are at risk of contracting a particularly dangerous infection is carried out antibacterial drugs(anthrax).

3. For prevention and in cases of disease, immunoglobulins (anthrax) are used.

Prevention of anthrax

Application of the vaccine

A live vaccine is used to prevent anthrax. Workers involved in livestock farming, meat processing plants and tanneries are subject to vaccination. Revaccination is carried out every other year.

Use of anthrax immunoglobulin

Anthrax immunoglobulin is used to prevent and treat anthrax. It is administered only after an intradermal test. When using the drug with therapeutic purpose anthrax immunoglobulin is given as soon as the diagnosis is made. For emergency prophylaxis, anthrax immunoglobulin is administered once. The drug contains antibodies against the pathogen and has an antitoxic effect. For seriously ill patients, immunoglobulin is administered for therapeutic purposes for health reasons under the guise of prednisolone.

Use of antibiotics

If necessary for emergency indications as preventative measure antibiotics are used. All persons who have contact with patients and infected material are subject to antibiotic therapy.

Anti-epidemic measures

Identification and strict accounting of disadvantaged settlements, livestock farms and pastures.

Establishing the time of the incident and confirming the diagnosis.

Identification of the contingent with high degree disease risk and establishing control over emergency prevention.

Medical and sanitary measures for plague

Plague patients and patients suspected of having the disease are immediately transported to a specially organized hospital. Patients with the pneumonic form of plague are placed one at a time in separate rooms, and patients with the bubonic form of plague are placed several in one room.

After discharge, patients are subject to 3-month observation.

Contact persons are observed for 6 days. In contact with patients with pneumonic plague contact persons prophylaxis with antibiotics is carried out.

Prevention of plague(vaccination)

Preventive immunization of the population is carried out when a massive spread of plague among animals is detected and a particularly dangerous infection is introduced by a sick person.

Routine vaccinations are carried out in regions where natural endemic foci of the disease are located. A dry vaccine is used, which is administered intradermally once. Maybe reintroduction vaccines in a year. After vaccination with an anti-plague vaccine, immunity lasts for a year.

Vaccination can be universal or selective - only for the threatened population: livestock breeders, agronomists, hunters, food processors, geologists, etc.

Re-vaccinate after 6 months. persons at risk of re-infection: shepherds, hunters, workers agriculture and employees of anti-plague institutions.

Maintenance personnel are given preventive antibacterial treatment.

Anti-epidemic measures for plague

Identification of a plague patient is a signal for the immediate implementation of anti-epidemic measures, which include:

Carrying out quarantine measures. The introduction of quarantine and the definition of a quarantine territory are carried out by order of the Extraordinary Anti-Epidemic Commission;

Contact persons from the plague outbreak are subject to observation (isolation) for six days;

Carrying out a set of measures aimed at destroying the pathogen (disinfection) and destroying pathogen carriers (deratization and disinfestation).

When a natural outbreak of plague is identified, measures are taken to exterminate rodents (deratization).

If the number of rodents living near people exceeds the 15% limit for getting into traps, measures are taken to destroy them.

There are two types of deratization: preventive and exterminatory. General sanitary measures, as the basis for rodent control, should be carried out by the entire population.

Epidemic threats and economic damage caused by rodents will be minimized if deratization is carried out in a timely manner.

Anti-plague suit

Work in a plague outbreak is carried out in an anti-plague suit. An anti-plague suit is a set of clothing that is used medical personnel when carrying out work in conditions possible infection especially dangerous infections - plague and smallpox. It protects the respiratory organs, skin and mucous membranes of personnel involved in medical and diagnostic processes. It is used by sanitary and veterinary services.

Medical, sanitary and anti-epidemic measures for tularemia

Epidemic surveillance

Epidemic surveillance of tularemia is the continuous collection and analysis of information about episodes and vectors of the disease.

Prevention of tularemia

A live vaccine is used to prevent tularemia. It is intended to protect humans in areas of tularemia. The vaccine is administered once, starting at age 7.

Anti-epidemic measures for tularemia

Anti-epidemic measures for tularemia are aimed at implementing a set of measures, the purpose of which is the destruction of the pathogen (disinfection) and the destruction of carriers of the pathogen (deratization and disinfestation).

Preventive measures

Anti-epidemic measures, carried out on time and in full, can lead to a rapid cessation of the spread of especially dangerous infections, localize and eliminate epidemic focus as soon as possible. Prevention of especially dangerous infections - plague, cholera, anthrax and tularemia is aimed at protecting the territory of our state from the spread of especially dangerous infections.

Basic literature

1. Bogomolov B.P. Differential diagnosis infectious diseases. 2000

2. Lobzina Yu.V. Selected issues in the treatment of infectious patients. 2005

3. Vladimirova A.G. Infectious diseases. 1997

Identification and implementation of primary measures for particularly dangerous infections (plague, cholera, yellow fever, anthrax). When identifying a patient suspected of having a particularly dangerous infection, the paramedic is obliged to:
notify the manager medical institution and regional sanitary and epidemiological surveillance authorities;
call ambulance and, if necessary, consultants;
isolate family members and neighbors (at home); prohibit them from leaving, close windows and ventilation ducts;
stop the appointment, close the windows and doors (in outpatient settings), inform the manager by phone or by express;
prohibit the use of sewerage and water supply;
carry out the necessary emergency assistance in accordance with the diagnosis;
upon receiving the package, change into protective clothing (anti-plague suit type I or IV);
compile lists of persons who were in contact with the patient, identify a possible source of infection;
carry out necessary examination sick;
report to the former consultants and emergency physician basic information about the patient, epidemiological history;
upon confirmation of the diagnosis, issue a referral to a hospital;
carry out routine disinfection (disinfection of feces, vomit, rinsing water after washing hands).

When reporting information about a suspected particularly dangerous infection, you must provide the following:
date of illness;
preliminary diagnosis, who made it (last name, first name, position, name of institution), on the basis of what data it was made (clinical, epidemiological, pathological);
date, time and place of identification of the patient (corpse);
current location (hospital, clinic, first aid station, train);
last name, first name, patronymic of the patient (corpse);
name of the country, city, region (where the patient (corpse) came from);
what type of transport arrived (number of train, bus, car), time and date of arrival;
address of permanent residence;
whether you received chemoprophylaxis or antibiotics;
did you receive preventive vaccinations against this infection;
measures taken to eliminate and localize the outbreak of the disease (number of contacts), carry out specific prevention, disinfection and other anti-epidemic measures;
what kind of help is needed (consultants, medications, disinfectants, transport);
signature under this message (last name, first name, patronymic, position);
the name of the person who transmitted and received this message, the date and hour of transmission of the message.

Hospitalization of patients is mandatory, isolation of contacts is carried out by order of the epidemiologist. In exceptional cases, when the infection is widespread, a quarantine is established in the area of ​​the outbreak with isolation of contacts. In other cases, the terms of observation of contacts are determined by the incubation period: for cholera - 5 days, for plague - 6 days, for anthrax - 8 days. With everyone especially dangerous disease activities are carried out by order of the epidemiologist.

Task No. 2

Review the material from the disciplines “Fundamentals of Microbiology and Immunology” and “Infectious Diseases with a Course in Epidemiology” on a given topic.

Task No. 3

Answer the following questions:

1. What types of prevention do you know?

2. What is a “focus of infection”?

3. What is disinfection?

4. What types, varieties and methods of disinfection do you know?

5. What measures are taken at the source of infection?

6. When is an emergency notification sent?

8. What is the paramedic’s tactics when identifying a particularly dangerous infection?

Task No. 4

Prepare for a vocabulary dictation on the following terms:

infectious process, infectious disease, incubation period of the disease, prodromal period of the disease, mechanism of transmission of infection, pathogenic microorganisms, virulence, sporadia, epidemic, pandemic, epidemiological process, immunity, acquired artificial active (passive) immunity, sterile and non-sterile immunity, individual prevention, public prevention, vaccines, toxoids, immune sera (heterologous and homologous), bacteriophages, source of infection, zoonoses, anthroponoses, disinfection, deratization, disinfestation, chronic carriage, convalescence, exotoxins, endotoxins, especially dangerous infections.

Task No. 5

Develop a medical and preventive conversation on the topic:

· Prevention of helminthiases (for preschoolers)

· Prevention of spread viral infections(for schoolchildren)

· Prevention infectious diseases(for adults)

· Prevention of diseases caused by protozoa (for adults)

To do this, divide into subgroups, each topic must be voiced, coincidences are not welcome. When conducting a conversation, consider age characteristics your listeners. The conversation should be conducted in a language that the audience can understand (think microbiology seminars). The time allotted for the conversation is 10 minutes.

Task No. 6

Imagine that one of the tour operators invited you to participate in the creation of a “Memo for Tourists” traveling outside the Russian Federation.

Your tactics:

1. Familiarize yourself with the direction of travel of tourists.

2. Find out all the possible information about this country from the Internet.

3. Develop a reminder about next plan:

Preparing for the trip.

Stay in foreign country(catering, living conditions, recreation.)

Returning from a trip.

Suggested countries: Türkiye, Vietnam, Egypt, China, Thailand.

Divide into subgroups and choose one of the directions.

Task No. 7.

Complete a health education newsletter on one of the given topics:

“Wash your hands before eating!”

You can suggest the topic that is of greatest interest to you.

Algorithm for the actions of medical staff when identifying a patient suspected of having an acute respiratory infection

If a patient suspected of having an acute infectious disease is identified, a doctor organizes work in the outbreak. Nursing staff are required to know the scheme for carrying out anti-epidemic measures and carry them out as directed by the doctor and the administration.

Scheme of primary anti-epidemic measures.

I. Measures to isolate the patient at the place where he is identified and work with him.

If a patient is suspected of having acute respiratory infections, health workers do not leave the room where the patient was identified until the consultants arrive and perform the following functions:

1. Notification of suspected OI by phone or through the door (knock on the door to attract the attention of those outside the outbreak and verbally convey information through the door).
2. Request all settings for the general public health inspection (package for prophylaxis of medical staff, packing for collecting material for research, packing with anti-plague suits), disinfectant solutions for yourself.
3. Before receiving the emergency prevention treatment, make a mask from available materials (gauze, cotton wool, bandages, etc.) and use it.
4. Before the installation arrives, close the windows and transoms using available means (rags, sheets, etc.), close the cracks in the doors.
5. When receiving the dressings, to prevent your own infection, carry out emergency infection prevention, put on an anti-plague suit (for cholera, a lightweight suit - a robe, an apron, or possibly without them).
6. Cover windows, doors, and grilles with adhesive tape (except for cholera outbreaks).
7. Provide emergency assistance to the patient.
8. Collect material for research and prepare records and referrals for research to the bacteriological laboratory.
9. Conduct routine disinfection of the premises.

II. Measures to prevent the spread of infection.

Head department, the administrator, upon receiving information about the possibility of identifying DUI, performs the following functions:

1. Closes all doors of the floor where the patient is identified and sets up guards.
2. At the same time, organizes the delivery to the patient’s room of all necessary equipment, disinfectants and containers for them, and medications.
3. The admission and discharge of patients is stopped.
4. Notifies higher administration about measures taken and awaits further orders.
5. Lists of contact patients and medical staff are compiled (taking into account close and distant contact).
6. Explanatory work is carried out with contact patients in the outbreak about the reason for their delay.
7. Gives permission for consultants to enter the fireplace and provides them with the necessary costumes.

Exit from the outbreak is possible with the permission of the head physician of the hospital in accordance with the established procedure.

Rabies

Rabies - acute illness warm-blooded animals and humans, characterized by progressive damage to the central nervous system (encephalitis), fatal to humans.

The causative agent is a neurotropic virus of the Rabdoviridae family of the Lyssavirus genus. It has a bullet shape and reaches a size of 80-180 nm. The nucleocapsid of the virus is represented by single-stranded RNA. The exceptional affinity of the rabies virus for the central nervous system was proven by the work of Pasteur, as well as by microscopic studies of Negri and Babes, who invariably found peculiar inclusions, the so-called Babes-Negri bodies, in sections of the brains of people who died from rabies.

Source – domestic or wild animals (dogs, cats, foxes, wolves), birds, bats.

Epidemiology. Human infection with rabies occurs as a result of bites by rabid animals or when they salivate the skin and mucous membranes, if there are microtraumas on these covers (scratches, cracks, abrasions).

Incubation period from 15 to 55 days, in some cases up to 1 year.

Clinical picture. Conventionally, there are 3 stages:

1. Harbingers. The disease begins with an increase in temperature to 37.2–37.5°C and malaise, irritability, itching at the site of the animal’s bite.

2. Excitement. The patient is excitable, aggressive, and has a pronounced fear of water. The sound of pouring water, and sometimes even the sight of it, can cause convulsions. Increased salivation.

3. Paralysis. The paralytic stage lasts from 10 to 24 hours. In this case, paresis or paralysis develops lower limbs, paraplegia is more common. The patient lies motionless, muttering incoherent words. Death occurs from paralysis of the motor center.

Treatment. Wash the wound (bite site) with soap, treat with iodine, and apply a sterile bandage. Therapy is symptomatic. Mortality – 100%.

Disinfection. Treatment of dishes, linen, and care items with a 2% chloramine solution.

Precautions. Since the patient’s saliva contains the rabies virus, then nurse It is necessary to work in a mask and gloves.

Prevention. Timely and complete vaccinations.

Yellow fever

Yellow fever is an acute viral natural focal disease with transmissible transmission of the pathogen through mosquito bites, characterized by a sudden onset, high biphasic fever, hemorrhagic syndrome, jaundice and hepatorenal failure. The disease is common in tropical regions of America and Africa.

Etiology. The causative agent, yellow fever virus (flavivirus febricis), belongs to the genus flavivirus, family Togaviridae.

Epidemiology. There are two epidemiological types of yellow fever foci - natural, or jungle, and anthropourgic, or urban.
In the case of the jungle form, the reservoir of viruses is marmoset monkeys, possibly rodents, marsupials, hedgehogs and other animals.
The carriers of viruses in natural foci of yellow fever are mosquitoes Aedes simpsoni, A. africanus in Africa and Haemagogus sperazzini and others. Infection of humans in natural foci occurs through the bite of an infected mosquito A. simpsoni or Haemagogus, which is capable of transmitting the virus 9-12 days after the infectious bloodsucking.
The source of infection in urban yellow fever foci is a sick person in the period of viremia. Virus carriers in urban areas are Aedes aegypti mosquitoes.
Currently, sporadic incidence and local group outbreaks are being recorded in the tropical forest zone in Africa (Zaire, Congo, Sudan, Somalia, Kenya, etc.), South and Central America.

Pathogenesis. The inoculated yellow fever virus hematogenously reaches the cells of the macrophage system, replicates in them for 3-6, less often 9-10 days, then re-enters the blood, causing viremia and clinical manifestation of the infectious process. Hematogenous dissemination of the virus ensures its introduction into the cells of the liver, kidneys, spleen, bone marrow and other organs where pronounced dystrophic, necrobiotic and inflammatory changes develop. The most typical occurrences are the occurrence of foci of liquefaction and coagulation necrosis in the mesolobular parts of the hepatic lobule, the formation of Councilman's bodies, and the development of fatty and protein degeneration of hepatocytes. As a result of these injuries, cytolysis syndromes develop with an increase in ALT activity and a predominance of AST activity, cholestasis with severe hyperbilirubinemia.
Along with liver damage, yellow fever is characterized by the development of cloudy swelling and fatty degeneration in the epithelium of the renal tubules, the appearance of areas of necrosis, causing the progression of acute renal failure.
With a favorable course of the disease, stable immunity is formed.

Clinical picture. There are 5 periods during the course of the disease. The incubation period lasts 3-6 days, less often it extends to 9-10 days.
The initial period (hyperemia phase) lasts for 3-4 days and is characterized by a sudden increase in body temperature to 39-41 ° C, severe chills, intense headache and diffuse myalgia. As a rule, patients complain of severe pain in the lumbar region, they experience nausea and repeated vomiting. From the first days of illness, most patients experience pronounced hyperemia and puffiness of the face, neck and upper sections breasts The vessels of the sclera and conjunctiva are clearly hyperemic (“rabbit eyes”), photophobia and lacrimation are noted. You can often observe prostration, delirium, psychomotor agitation. The pulse is usually rapid, and bradycardia and hypotension develop in the following days. The persistence of tachycardia may indicate an unfavorable course of the disease. In many, the liver is also enlarged, and at the end of the initial phase, one can notice icterus of the sclera and skin, the presence of petechiae or ecchymoses.
The hyperemia phase is replaced by short-term (from several hours to 1-1.5 days) remission with some subjective improvement. In some cases, recovery occurs in the future, but more often a period of venous stasis follows.
The patient's condition noticeably worsens during this period. Back to more high level the temperature rises, jaundice increases. Skin pale, in severe cases cyanotic. A widespread hemorrhagic rash appears on the skin of the trunk and limbs in the form of petechiae, purpura, and ecchymoses. Significant bleeding of the gums, repeated vomiting with blood, melena, nasal and uterine bleeding. In severe cases of the disease, shock develops. The pulse is usually rare, weak filling, blood pressure is steadily declining; Oliguria or anuria develops, accompanied by. Toxic encephalitis is often observed.
The death of patients occurs as a result of shock, liver and kidney failure on the 7-9th day of illness.
The duration of the described periods of infection is on average 8-9 days, after which the disease enters the convalescence phase with slow pathological changes.
Among local residents of endemic areas, yellow fever can occur in a mild form or without jaundice and hemorrhagic syndrome, which makes timely identification of patients difficult.

Forecast. Currently, the case fatality rate for yellow fever is approaching 5%.
Diagnostics. Recognition of the disease is based on identifying a characteristic clinical symptom complex in individuals belonging to the category high risk infection (unvaccinated people who visited jungle foci of yellow fever within 1 week before the onset of the disease).

The diagnosis of yellow fever is confirmed by the isolation of a virus from the patient’s blood (in the initial period of the disease) or to it (RSK, NRIF, RTPGA) in more later periods diseases.

Treatment. sick yellow fever hospitalized in hospitals protected from mosquitoes; carry out prevention of parenteral infection.
Therapeutic measures include a complex of anti-shock and detoxification agents, correction of hemostasis. In cases of progression of hepatic-renal failure with severe azotemia, hemodialysis or peritoneal dialysis is performed.

Prevention. Specific prophylaxis in foci of infection is carried out with live attenuated 17 D and, less often, with the Dakar vaccine. Vaccine 17 D is administered subcutaneously in a dilution of 1:10, 0.5 ml. Immunity develops in 7-10 days and lasts for six years. Vaccinations are registered in international certificates. Unvaccinated persons from endemic areas are quarantined for 9 days.