Professional Documents
Culture Documents
28 Aprilie
Munca in conditii decente, siguranta la locul de
munca,
Celebrata in intreaga lume
7 Aprilie
• Resurse umane pentru sanatate
• Sustinerea si protectia “health workers”
• Realizarea de conditii de munca sigure si suportive
prin salarii, resurse si management imbunatatit
• Celebrata in intreaga lume
HCW - Lucratorii in sanatate -
OMS
Nici o persoana nu ar trebui sa suporte injurii
sau alte prejudicii la locul de munca;
respectarea drepturilor omului este principiul
fundamental pe baza caruia se defineste
sanatatea ocupationala
Tobacco
Alcohol
Cholesterol
Overweight
Physical inactivity
Environmental risks
Occupational risks
Illicit drugs
0 2 4 6 8 10 12 14 16 18 20
DALYs %
20,000 17,000
16,000
12,000
Mandatarea vaccinarii HBV
8,000
4,000 800
0
1983 1991 1995
Aceasta reglementare a avut cel mai mare impact in
eliminarea transmiterii VHB intre lucratorii in sanatate
Mahoney F et al. Archives of Int Med 157 (1997): 2601-2603
DAR . . . aprox. 80% dintre lucratorii in
sanatate raman neimunizati in multe parti
ale globului
In ciuda
eficacitatii
de 95% a
vaccinarii
VHB
Attributable fraction of HCV, HBV and HIV infections in healthcare w orkers due to injuries
w ith contaminated sharps, ages 20-65
100% HCV
HBV
80% HIV
60%
Percentage
40%
20%
0%
Regions
HBV, HCV
Activitati care se constituie in
situatii de risc :
Indepartarea materialului contaminat cu sange sau
APPI
Sânge, Secreţii
fluide genitale, LCR,
HIV lichid de Saliva, urină,
biologice
ascită, materii fecale,
care conţin
amniotic, lacrimi
sânge lapte matern
Risc de transmitere a HIV, VHB, VHC
Virus Evoluţie Risc după Încărcătură Vaccin Px.
cronică accident virală nespec
percutan plasmatică ifică
HIV 100% 0,3% 10-104 NU DA
VHC 60-80% 3%
NU DA
106-109
Riscul transmiterii virusurilor HIV, VHB,
VHC dupa leziune percutana
Virus
HBV 6 – 30Chance of HCW
din 100 persoane
Infection
HCV 3 – 10 din 100 persoane
riscurilor
Documentari anuale cu
• instrument fara ac
sau cu ac in siguranta
printr-o modalitate
Self-sheathing syringe
care reduce efectiv Seringa cu auto
riscul expunerii acoperire
Alte exemple
In use
After use
Seriga cu ac retractabil
Lanceta retractabila
Nurse 24 35
Laboratory worker, clinical 16 17
Physician, nonsurgical 6 12
Laboratory technician, nonclinical 3 -
Housekeeper/maintenance worker 2 13
Technician, surgical 2 2
Embalmer/morgue technician 1 2
Health aide/attendant 1 15
Respiratory therapist 1 2
Technician, dialysis 1 3
Dental worker, including dentist - 6
Emergency medical technician/paramedic - 12
Physician, surgical - 6
Other technician/therapist - 9
Other healthcare occupation - 5
Total 57 139
Occupational human immunodeficiency virus (HIV) infections in U.S. health care
workers reported to the Centers for Disease Control and Prevention, by year of
report, 1985 to 2001. (Modified from Henderson DK, Gerberding JL. Healthcare
worker issues, including occupational and nonoccupational postexposure
management. In: Dolin RM, Masur H, Saag MS, eds. AIDS Therapy. 2nd ed. New
York: Churchill Livingstone; 2002:327; and Do AN, Ciesielski CA, Metler RP, et al.
Occupationally acquired human immunodeficiency virus [HIV] infection: national case
surveillance data during 20 years of the HIV epidemic in the United States. Infect
Injuring device
used in artery or 3.6 1.3-11 4.3 1.7-12
vein
Terminal illness in
8.5 2.8-28 5.6 2.0-16
source patient[§]
Postexposure use
0.14 0.03-0.47 0.19 0.06-0.52
of zidovudine
From Cardo DM, Culver DH, Ciesielski CA, et al. A case-control study of HIV seroconversion in health care workers after percutaneous exposure. Centers for
Disease Control and Prevention Needlestick Surveillance Group. N Engl J Med. 1997;337:1485-1490. Copyright © 1997 Massachusetts Medical Society. All
rights reserved.
Factori de risc pentru transmiterea HIV
Tipul de AES
expunere percutana > permucoasa
Factori legati de Expunere cutanata>cutaneo-
mucoasa
tipul de AES
• T exp lung>scurt
• Accident cutaneo- • Prezenta de leziuni>absente
mucos
• Leziune profunda>leziune
• Accident percutan superficiala
• Ac cu lumen “gol”> “plin”
• Dispozitiv intravascular>s.c.
sau i.m.
• Prezenta sangelui
vizibil>absent
• Ac de calibru mare>mic
• Absenta manusilor>cu manusi
Factori legati de sursa
Stadiul SIDA>stadii precoce HIV
1 μl sange contine
Limfocite CD4 sub
200/mm3
103 HIV/ml- 1 virus
Incarcatura virala
104 HIV/ml- 10 virusuri
mare> nedetectabila 105 HIV/ml- 100 virusuri
sau mica
4. Investigarea persoanei asistate si a
personalului medical pentru HIV cu adoptarea
unei atitudini corespunzatoare
DHS/Occupational /PP
sursa: NEJM 1997;337:1485-90.
Determinarea codului de expunere CE
Tip de expunere cu
risc de infectie
Severitate SEVERITATE
Mic Moderat
scazuta mare
Picaturi
Cateva multiple
ac chirurgical ac cu lumen,
sau zgarietura
picaturi sange vizibil
Nu
Nivel Nivel
necesita
redus de crescut
PPE
expunere de
expunere
80
70
60
50
40
30
20
10
0
Nausea Fatigue Headache Vomiting Diarrhea Myalgias
6
5
5
4
4
3
2
1
0
1997 1998 1999 2000
Year
MMWR 2001;49(51):1153-6.
Profilaxie post expunere EACS European
AIDS Clinical Society-2007
Schema de baza
• 4 saptamani
• ZDV 600 mg/zi in doua prize
• 3TC (lamivudina) 300 mg/zi in doua prize sau
tenofovir si emtricitabina
Schema extinsa
• 4 saptamani
• ZDV 600 mg/zi in doua prize
• 3TC (lamivudina) 300 mg/zi in doua prize sau
tenofovir si emtricitabina si
• Lopinavir sau saquinavir
Adverse Effects:
Basic vs Expanded Regimens
60
2 NRTI
50
2 NRTI + 1 PI
% of individuals
40
30
20
10
0
General Lower GI Upper GI elevated hyperbili- 2x ALT
TG rubinemia
Nelfinavir
Efavirenz
Recomandari actualizate
Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis,
September 26, 2005 / 54(RR-9);1-17. http://aidsinfo.nih.gov/guidelines/default_db2.asp?id=67
CDC Post-Exposure Prophylaxis Guidelines