No warning before surgery for an HIV-infected person. Surgery for HIV infection: wrongful refusal, prognosis, indications
»» №4 2001 Dangerous infections
Acquired immunodeficiency syndrome (AIDS) is the most dangerous infectious disease leading to death on average 10-11 years after infection with the human immunodeficiency virus (HIV). According to UN data published in early 2000, the HIV/AIDS pandemic has already claimed the lives of more than 18 million people and today there are 34.3 million HIV-infected people in the world.
As of April 2001, 103,000 HIV-infected people were registered in Russia, and in 2000 alone, 56,471 new cases were detected.
The first reports of patients with HIV infection appeared in the newsletter of the Center for Disease Control (Atlanta, Georgia, USA). In 1982, the first statistics on AIDS cases detected in the United States since 1979 were published. An increase in the number of cases (in 1979 - 7, in 1980 - 46, in 1981 - 207 and in the first half of 1982 - 249) indicated an epidemic the nature of morbidity, and high mortality (41%) spoke of the increasing importance of infection. In December 1982, a case of AIDS associated with blood transfusion was published, suggesting the possibility of a "healthy" carriage of an infectious agent. An analysis of AIDS cases in children has shown that children can receive the agent that causes the disease from an infected mother. Despite treatment, AIDS in children progresses extremely rapidly and inevitably leads to death, which gives reason to consider the problem of extraordinary importance.
Currently, three ways of HIV transmission have been proven: sexual; through parenteral administration of the virus with blood products or through infected instruments; intrauterine - from mother to fetus.
Quite quickly, it was found that HIV is extremely sensitive to external influences, dies when using all known disinfecting agents, and loses activity when heated above 56°C for 30 minutes. Solar, UV and ionizing radiation are detrimental to HIV.
The highest concentration of the AIDS virus was found in blood, semen, and cerebrospinal fluid. In smaller quantities, it is found in saliva, breast milk, cervical and vaginal secretions of patients.
With the increase in the number of HIV-infected and AIDS patients, the demand for medical care, including those requiring both emergency and planned surgical intervention, increases.
Taking into account the peculiarities of the course of HIV infection, it is impossible to deny with certainty that this or that patient does not have it. For medical personnel, each patient should be considered as a possible carrier of a viral infection. In all cases of possible contact with the patient's biological fluids (blood, wound discharge, discharge from drains, vaginal secretions, etc.), it is necessary to use gloves, wash and disinfect hands more often, use a mask, goggles or a transparent screen for the eyes. Do not take part in work with patients in the presence of abrasions on the skin of the hands or superficial skin defects.
The danger of infection of medical personnel really exists if the generally accepted rules of asepsis and hygiene are violated during the performance of medical and diagnostic procedures.
Data have been published where, in order to determine the risk of infection of medical workers, surveys of large groups of doctors (from 150 to 1231 people) were conducted, who did not follow the precautions. The frequency of HIV infection was 0% when the infected material came into contact with intact skin, 0.1-0.9% - with a single hit of the virus under the skin, on damaged skin or mucous membranes.
Glove punctures occur in 30% of operations, wounding the hands with a needle or other sharp object - in 15-20%. When the hands are injured by needles or cutting instruments infected with HIV, the risk of infection does not exceed 1%, while the risk of infection with hepatitis B reaches 6-30%.
Since 1992, on the basis of the Infectious Diseases Clinical Hospital No. 3, there have been beds in the surgical department for providing surgical care to HIV-infected and AIDS patients with concomitant surgical pathology. Over the past period, 600 patients were hospitalized in the department, 250 of them were operated on.
The department provides for a treatment room, a dressing room and an operating room, where assistance and operational benefits are provided only to HIV-infected and AIDS patients.
For all admitted patients, intramuscular injections and any manipulations with blood are carried out by medical personnel only in the treatment room in gowns, hats, and gloves specially provided for these cases. If there is a threat of splashing of blood or other biological fluid, it is necessary to work in a mask and goggles. We use regular latex gloves (two pairs), special goggles and non-woven gowns. Blood during intravenous sampling is collected in test tubes with tightly closed stoppers. All test tubes are necessarily marked with the initials of the patient and the inscription "HIV". Referral sheets to the laboratory when taking blood, urine, biochemical studies are marked with an indication of the presence of HIV infection. These forms are strictly forbidden to be placed in test tubes with blood.
Urinalysis is given in a container with a tight-fitting lid and is also marked with a message indicating the presence of HIV infection. Transportation is carried out in a closed box marked "HIV".
In case of contamination of gloves, hands or exposed areas of the body with blood or other biological materials, they should be treated for 2 minutes with a swab abundantly moistened with an antiseptic solution (0.1% deoxone solution, 2% hydrogen peroxide solution in 70% alcohol, 70% alcohol ), and 5 minutes after treatment, wash in running water. If the surface of the table, hand pads during intravenous infusion, tourniquet are contaminated, they should be immediately wiped with a rag moistened with a disinfectant solution (3% chloramine solution, 3% bleach solution, 4% hydrogen peroxide solution with 0.5% detergent solution). ).
After use, the needles are placed in a container with a disinfectant solution. This container must be in the workplace. Before immersing the needle, the cavity is washed with a disinfectant solution by sucking it with a syringe (4% hydrogen peroxide solution with 0.5% detergent solution - 3% chloramine solution). Used syringes and gloves are collected in a separate container specially designed for them and disinfected.
We use analyte solutions or 3% chloramine solution. Exposure 1 hour.
If there is a suspicion that the infected material has entered the mucous membranes, they are immediately treated: the eyes are washed with a stream of water, a 1% solution of boric acid, or a few drops of a 1% solution of silver nitrate are injected. The nose is treated with a 1% solution of protargol, and if it gets into the mouth and throat, it is additionally rinsed with 70% alcohol or a 0.5% solution of potassium permanganate, or a 1% solution of boric acid.
If the skin is damaged, you must immediately remove the gloves, squeeze out the blood, and then thoroughly wash your hands with soap and water with running water, treat them with 70% alcohol and lubricate the wound with 5% iodine solution. If infected blood gets on your hands, you should immediately treat them with a swab moistened with a 3% solution of chloramine or 70% alcohol, wash them with running warm water and soap and dry them with an individual towel. Start prophylactic treatment with AZT.
At the workplace, an accident report is drawn up, this fact is reported to the center dealing with the problem of HIV infection and AIDS. For Moscow, this is infectious diseases hospital No. 2.
The treatment room is cleaned at least 2 times a day with a wet method using a disinfectant solution. Cleaning rags are disinfected in a 3% solution of chloramine, an analyte, for an hour. Washes and dries. Gastric and intestinal probes used in preparation for surgery and diagnostic manipulations after the studies are also processed in an analyte solution or 3% chloramine solution with an exposure of 1 hour. Dried and handed over to autoclaving for further use.
The operating field in patients is prepared using individual disposable razors.
Special precautions must be observed during operations. Medical personnel who have lesions on the skin (cuts, skin diseases) should be exempted from direct treatment of patients with HIV infection and the use of equipment in contact with them. As protection during the operation in our department, surgeons, anesthesiologists and operating nurses use plastic aprons, shoe covers, oversleeves, disposable gowns made of non-woven material.
Goggles are used to protect the mucous membrane of the eyes, double masks are used to protect the nose and mouth, and two pairs of latex gloves are put on the hands. During operations of HIV-infected and AIDS patients, instruments are used that are used only for this category of patients and are labeled "AIDS". Sharp and cutting instruments during the operation are not recommended to be transferred from hand to hand. The surgeon himself must take the instruments from the table of the operating nurse.
After the operation, the instruments are washed from biological contaminants in a closed container with running water, then disinfected with a 5% solution of lysetol with an exposure of 5 minutes, a 3% solution of chloramine with an exposure of 1 hour. Next, the instruments are washed with running water and rinsed with distilled water, followed by drying, after which they are handed over for autoclaving.
Dressing gowns are disposable. After the operation, the gowns are kept in an analyte solution, 3% chloramine solution with an exposure of 1 hour, after which they are destroyed. Plastic aprons, shoe covers, sleeves are processed in an analyte solution, 3% solution of chloramine, alaminol with an exposure of 1 hour, washed with running water, dried and reused.
The operating room is processed after the performed manipulations: current cleaning is carried out with analyte solutions, 3% hydrogen peroxide solution.
Bandaging of patients in the postoperative period, as well as manipulations that do not require anesthesia, are carried out in a dressing room specially designed for this category of patients. The surgeon and dressing nurse dress in the same way as for the operation. The instruments are marked "HIV" and are only used for bandaging HIV/AIDS patients. Handling of used material, instruments and cabinet is carried out in the same way as in the operating room.
With the increase in the number of HIV-infected and AIDS patients, the number of requests for medical care by this category of patients is growing.
When contacting a patient, one should proceed from the premise that all incoming patients are HIV-infected, and strictly implement appropriate preventive measures.
Effective prevention of HIV infection is possible only with the daily training and education of medical personnel. This will allow you to overcome the fear of contact with an HIV-infected patient, to act competently and confidently.
This is the key to the professional safety of medical workers.
T.N. BULISKERIA, G.G. SMIRNOV, L.I. Lazutkina, N.M. VASILIEVA, T.N. SHISHKARVA
Infectious Clinical Hospital No. 3, Moscow
Surgery for HIV helps prolong the lives of infected patients, as well as make the course of comorbidities less problematic. AIDS itself is not an indication for surgery. Surgically, this disease cannot be cured. This kind of intervention is necessary when the disease reaches a certain stage and causes various complications in the body. It is important to know that HIV is operated on, but there are a number of special security measures.
Can a patient be denied surgery for HIV?
This question is the most acute, so it should be answered first. Medical professionals do not have the right to refuse surgical intervention to an infected patient if it does not directly threaten his life. In emergency situations, surgical operations for HIV infection are also carried out. Doctors in such cases observe increased security measures. The same applies to cases where a person with an unconfirmed immunodeficiency virus needs emergency help. Before planned procedures, an express or routine analysis for the presence of this disease is carried out without fail. If there is a direct threat to the patient's life, then the intervention is carried out without the results of an AIDS test, but with increased security measures.
Elective surgery for HIV detection may be delayed, but cannot be cancelled. The postponement of its terms occurs due to the need for additional clinical and laboratory studies.
Surgery for HIV infection: in what cases is indicated, planned activities
Preparation for this procedure in people with immunodeficiency virus is carried out in the standard mode. Specialists collect anamnesis and conduct the necessary clinical and laboratory studies. This is all done taking into account the fact that this disease can be fraught with a lot of threats. We are talking about opportunistic infections and other concomitant diseases, which at certain stages are asymptomatic. Some of them may cause the transfer of surgical intervention for a more optimal period of time for this. Before performing an operation in HIV-infected patients, special attention is paid to tests that reveal the quantitative composition of CD4 cells. They help determine the stage at which the immunodeficiency virus is currently located, as well as the general state of the patient's immunity.
Is it possible to do surgery for HIV, if the disease is not caused by this virus. Some pathologies and conditions of patients with immunodeficiency syndrome are not directly related to it. They can appear in patients both before infection and after it. In these cases, interventions are also carried out, however, they also require increased security measures and consideration of the general condition of the infected person.
There are situations when patients have a number of contraindications that are not related to this dangerous virus. Do operations make HIV-infected in this case? There is no single answer to this question. After all, if the intervention is planned, then it can be postponed for medical reasons. We are talking about problems with the kidneys, liver, cardiovascular system or gastrointestinal tract. In emergency cases, doctors always compare the possible threat to the patient's life. And if it really exists, then the operation is performed even if there are contraindications.
Is HIV surgery performed on patients with bowel obstruction? This issue also often worries patients. Such a problem, for reasons dependent on the immunodeficiency virus, occurs in about ten percent of patients. The rest of their number falls on diseases that are in no way connected with this dangerous disease. Operations in such cases are carried out, since this condition carries a direct threat to the life of the patient. After all, intestinal obstruction for a short period of time leads to general intoxication of the body.
Surgery for HIV: how does it affect the body, what are the prognosis?
People with the immunodeficiency virus at the time when they only learned to diagnose it, practically did not undergo surgical interventions. After all, the forecasts at that time were disappointing. Such patients did not live long, and abdominal incisions strongly festered and became the cause of a high percentage of mortality. In modern medicine, much attention has been paid to this issue. Techniques have been developed for surgical and laparoscopic interventions in infected people, as well as maintenance therapy regimens after such procedures. As a result, mortality after extensive surgical interventions among HIV-infected people has decreased. Today it is about ten percent in the initial stage and thirty-three percent in the acute phase. In most cases, various interventions have a productive effect on the state of the body and allow prolonging the life of patients, as well as alleviating the symptoms of concomitant diseases.
Is it possible to do surgery for HIV infection - the doctor decides, based on the specific case.
Quote
I do not know this order, I wrote it. I only know how everything happens in hospitals in Moscow and the Moscow Region. We (near zamkadye) - separate HIV + from HIV- as they can. In Moscow they are being taken to Sokolinka.
Quote
Yes. angry_alien
Try this situation out for yourself. And let's fantasize - you are not in Moscow ....
Well, I tried it on, so what? At least where - HIV + will be cut only in emergency cases, if it is planned - then only in agreement with the doctors and te de and te pe. I am well aware of this, I can’t say that it pleases me, but such is the reality of our life.
Quote
Yes, they test for hepatitis during elective surgeries?
During planned operations, a huge number of tests are performed. My daughters had an operation - they cut out an ingrown nail, so everything was there - from RW, HIV, hepatitis B and C to blood sugar and prothrombin time. Only during emergency operations there is no time for tests, therefore, when they bring in an ambulance, they do everything and everyone. And when the patient has MONTHS to prepare for the operation, during this time it is quite possible to go to the hospital that has the conditions for the treatment of HIV +. And their own nerves will be safer.
Quote
I can’t say about the tools, but the operblock is the same.
They put it at the end of the day and then carry out an unscheduled general cleaning - don’t attach a room. hepatitis B and a separate one for hepatitis C. And everyone who had them on the tests received their own probes, which were sterilized in a separate container and did not come into contact with others. Reinsurance, yes, but the human factor is almost completely excluded (unless, of course, a person is a complete scumbag).
Quote
But don't you think that in operating and other risky manipulations, doctors must comply with all safety measures, because it is not known what the patient is a carrier of?
And no one says they shouldn't. But one thing is a patient with a SUSPECTED carrier state, and another with a CONFIRMED one. And for the Ministry of Health, a confirmed carrier of something matters.
I, if anything, do not take the side of the Ministry of Health and do not give value judgments. It's just how it happens in our lives and we have to adapt to it. And even if we take to the streets, there is a strong argument against it, we are in the minority, and the Ministry of Health guards the health of HIV and minimizes all the chances of accidental spread of HIV, this is its priority. I'm afraid we are not yet in a position to re-scandal the Ministry of Health ...
Quote ID: 11741 107
Few on this site know that I used to work in a laboratory for the diagnosis of HIV infection, hepatitis and syphilis. Even earlier, when I was studying, I would never have thought that I could go to work there. I didn't want to risk my life without having "tasted it" yet. Although I understand that the ways of infection can be different and it is not necessary to label a person as a drug addict or a prostitute.
There was a case in my life. I've just graduated. Went to work. I first took it in the clinic under the watchful eye of the mentors. Then I was quickly attached to the hospital as well. Well, one day I have a bunch of forms in the intensive care unit and gynecology. Resuscitation always comes first for me, because. it's always hard there. Not only to work, but also to be. People are not always in the recovery stage. It's easier in gynecology. Mostly young, sociable. Positive. ... There is one girl left. In the suitcase, everything is already prepared for blood sampling, the cotton wool is also at the ready. I take a scarifier, I prick, I'm going to throw it off and ..., it sticks to my glove and pierces my finger. The feeling of anxiety did not leave me, but I completed the work. Of course, she treated the wound, squeezed out the blood at the puncture site. But there was panic. I have never run so fast. Rather, for the device and the results of the girl’s blood are already in my hands. She was even healthier than me. Cosmonaut :) Laughter, laughter, but I'm all leading to this: Recently in our country more and more people live with terrible diagnoses - HIV-infected and AIDS.Not just the doomed, but the living. They, like all healthy people, live a full life: work, travel, marry, give birth and raise children. It must be understood that HIV-infected and AIDS patients are different stages of the disease. Their main difference is that the AIDS stage is more severe than the stage of HIV infection, so often an infected person feels quite healthy. It has been proven that from the stage of HIV infection to the development of AIDS, five to fifteen years can pass.How do plastic surgeons treat people with HIV infection and directly with the stage of AIDS? Could you, being in the place of a surgeon, not disdain and with operate on such a patient? Controversial question...