Recommendations for occupational safety and health in a biological laboratory. Safety rules when working with biological material Properly organize the workplace to ensure maximum safety when working with used tools

These occupational safety instructions have been developed specifically for safe work with blood and other biological fluids of patients.

1. GENERAL OCCUPATIONAL SAFETY REQUIREMENTS

1.1. TO independent work where contact with blood and other biological fluids of patients is possible, persons over 18 years of age who do not have medical contraindications trained in safe working methods, who have undergone introductory and initial workplace safety briefings, internships and testing of knowledge of labor safety requirements.
1.2. When working, staff should be guided by the principle that all patients are potentially infected.
1.3. When working with blood and other biological fluids of patients, mechanical damage to the skin is possible:
- puncture wounds due to careless handling of syringes and other piercing instruments (objects);
- cuts on the hands (when opening bottles, vials, tubes with blood or serum; when working with HIV-contaminated instruments);
— bites of mental patients when attacking staff.
1.4. Personnel must perform work in sanitary clothing specified by industry standards: a cotton gown, a medical cap, medical gloves worn over the sleeves of the medical gown.
1.5. For invasive procedures, it is recommended to wear two pairs of gloves, a waterproof gown, and an apron.
1.6. If there is a risk of splashing blood and other biological fluids, work should be carried out wearing masks, safety glasses, and, if necessary, use protective screens, oilcloth aprons.
1.7. When working in a morgue, personnel must have: a robe, oversleeves, a waterproof apron, 2 pairs of rubber gloves, a 4-ply gauze mask, shoe covers, safety glasses, boots or galoshes.
1.8. In the office of the unit, where personnel may come into contact with biological fluids of patients, there must be an emergency first aid kit “Anti-AIDS2”, which includes: 70% ethanol, cotton-gauze swabs; 0.05% solution of potassium permanganate or a weighed portion of the drug in dry form with the required amount of distilled water to prepare the solution; 5% alcohol solution of iodine; bactericidal patch; eye pipettes, disposable syringe; dressing.
1.9. Smoking is permitted only in designated areas. Prohibited use alcoholic drinks at work, as well as going to work under the influence of alcohol or drugs.
1.10. When performing work, you must be attentive, not be distracted by extraneous matters and conversations, and not distract others from work.
1.11. The employee is responsible in accordance with current legislation for compliance with the requirements of instructions, industrial injuries and accidents that occurred through his fault.

2. OCCUPATIONAL SAFETY REQUIREMENTS BEFORE STARTING WORK

2.1. Put on sanitary clothing, fasten the cuffs and hem of the robe, put on a cap and tuck your hair under it. Put on replacement shoes on your feet.
2.2. Prepare and check necessary funds personal protection.
2.3. Cover any damaged skin on your hands, if any, with a band-aid or put on finger pads.
2.4. Make sure that the Anti-AIDS first aid kit is complete.
2.5. Personnel are not allowed to perform invasive procedures in the following cases:
- extensive damage to the skin;
- exudative skin damage;
- weeping dermatitis.

3. OCCUPATIONAL SAFETY REQUIREMENTS DURING WORK

3.1. Medical staff must strictly observe personal protective measures, especially when performing invasive procedures that involve contamination of hands with blood and other biological fluids of patients:
- work in rubber gloves, if there is an increased risk of infection - in two pairs of gloves;
— use masks, glasses, screens;
— use masks and gloves when processing used clothing and tools;
— handle sharp medical instruments carefully;
- do not put a cap on a used needle;
— after disinfection, dispose of used disposable sharp instruments in solid containers;
- collect needles that have fallen on the floor with a magnet, brush and dustpan;
— cover microtraumas on the hands with an adhesive plaster or fingertip. Before and during work, you should check whether the gloves are moisture-proof and whether they are damaged;
- Replace damaged gloves immediately. Gloves treated after use are less durable than new ones and are damaged much more often. The use of fat-based creams and fatty lubricants destroys gloves;
— taking blood from patients or performing other procedures where a healthcare worker may accidentally injure themselves with a used needle must be done with latex gloves, because they reduce the amount of blood inoculum that is transferred during the injection;
— after removing the gloves, soak them in a disinfectant solution for 1 hour, wash your hands with soap and dry with an individual towel;
- remove gloves carefully so as not to contaminate your hands;
— rubber gloves, once removed, should not be reused due to the possibility of contamination of hands.
3.2. To protect themselves from infection through the skin and mucous membranes, medical staff must follow the following rules:
— avoid rubbing movements when using a paper towel, because this damages the surface epithelium;
— use alcohol-based hand disinfection solutions; hand disinfection should never be preferred over the use of disposable gloves; hands must be washed with soap and water each time after removing protective gloves;
- after any procedure, you must thoroughly wash your hands twice in running water and soap;
— hands should be dried only with an individual towel, changed daily, or disposable napkins;
- avoid frequent hand treatment with disinfectants that irritate the skin, do not use hard brushes;
- never eat in a workplace where there may be blood or secretions from the patient;
— get vaccinated against hepatitis B;
— to protect the mucous membranes of the mouth and nose, use a 4-layer gauze mask. The mask should fit tightly to the face;
- wear a robe or apron, or both a robe and an apron, to provide reliable protection against contact with body fluids. Protective clothing should cover the skin and clothing of medical staff, keep liquids out, and keep the skin and clothing dry.
3.3. It is almost impossible to transmit a large infectious dose through clothing.
3.4. It is necessary to use barrier protective equipment not only when working with infected patients; every patient is considered potentially dangerous in relation to infectious diseases.
3.5. When providing medical care HIV-infected and AIDS patients in medical documents and directions, manipulations with parenteral interventions indicate chronic carriage of Hbs Ag with appropriate labeling.
3.6. All diagnostic tests, treatment procedures, and surgical interventions for HIV-infected patients must be carried out last; all biological material is disinfected and destroyed, which is noted in the medical history.
3.7. Medical instruments undergo three-stage processing in accordance with OST 42-21-2-85.
3.8. An HIV-positive patient should perform manipulations in the presence of a second specialist, who, in the event of a rupture of gloves or a cut, can continue to perform them.
3.9. During surgical procedures, double gloves should be used if possible; transfer all sharp instruments during the operation through the intermediate tray, and not from hand to hand, eliminate the use of fingers to guide the needle, it is advisable to use a needle holder.
3.10. In a clinical diagnostic laboratory, when working with blood, serum or other biological fluids, the following is prohibited:
- pipette with your mouth, use a rubber bulb;
- transfuse blood, serum over the edge of the tube;
— use adhesive tape labels to label test tubes. Test tubes should be marked with a pencil on the glass.
3.11. When centrifuging the test material, the centrifuge must be closed with a lid until the rotor stops completely.
3.12. When transporting blood and other biological fluids, the following rules must be observed:
— containers with blood and other biological fluids should be tightly closed with rubber or plastic stoppers immediately at the point of collection;
— it is prohibited to place referral forms or other documentation into the test tubes;
— to ensure disinfection in case of accidental leakage of liquid, transport blood and other biological fluids in racks placed in containers, bins or pencil cases, on the bottom of which a four-layer dry napkin is placed;
— if there is a possibility of splashing blood or biological fluids, wear protective clothing (gowns, aprons) and facial protection (masks covering the mouth and nose, goggles or eye protection);
- if the robe and apron are contaminated with biological fluids, you should change clothes as quickly as possible; When changing clothes, wear gloves and take them off last.
3.13. Disassembly, washing and rinsing of medical instruments that have come into contact with blood or serum should be carried out after preliminary disinfection. Work with rubber gloves.
3.14. Disposable items: syringes, dressings, gloves, masks must be disinfected after use and then disposed of.

4. OCCUPATIONAL SAFETY REQUIREMENTS IN EMERGENCIES

4.1. Emergency situations include:
- tearing of gloves;
- punctures and cuts from piercing and cutting instruments;
— contact of blood and other biological fluids with mucous membranes and skin;
— splashing of blood during centrifugation, etc.
4.2. To manipulations that can lead to emergency situation, in particular, include:
— invasive procedures;
— contact with mucous membranes (intact and damaged);
— contact with damaged skin of patients;
- contact with surfaces contaminated with blood or other body fluids.
4.3. If your hands are contaminated with blood or other biological fluids, you should thoroughly wipe them with a swab moistened with a skin antiseptic, and then wash them with running water and soap.
4.4. If hands protected with gloves become dirty, treat the gloves with a napkin, then wash them with running water, remove the gloves with the working surface inward, wash your hands and treat them with a skin antiseptic.
4.5. If your hands are contaminated with blood or biological fluids, you should immediately treat them for at least 30 seconds with a swab moistened with a skin antiseptic, wash them twice with soap and water and wipe dry with a clean towel (napkin).
4.6. If contact with blood, other biological fluids or biomaterials is accompanied by a violation of the integrity of the skin (injection, cut), then the following measures must be taken:
- wash your hands without removing gloves with running water and soap;
— remove the gloves with the working surface facing inward and throw them into the disinfectant solution;
- squeeze blood out of the wound;
- wash your hands with soap;
- treat the wound with 70% alcohol, then the skin around the wound with a 5% alcohol solution of iodine;
- Apply a bactericidal plaster to the wound, put on a finger guard, and if necessary, continue working - put on new rubber gloves.
4.7. If blood or liquids get on the nasal mucosa, drip a 0.05% solution of potassium permanganate, immediately rinse your mouth and throat with 70% alcohol or 0.05% solution of potassium permanganate.
4.8. If biological fluids get into your eyes, you should immediately rinse them with running water, then rinse them with a solution of potassium permanganate using a disposable syringe in a ratio of 1:10000.
4.9. The solution is prepared from a sample of 0.01 g of potassium permanganate and 100 ml of distilled water until the crystals are completely dissolved (3 minutes).
4.10. If biological material gets on a gown or clothing, do the following:
- remove clothes and soak in one of the disinfectant solutions;
- the skin of the hands and other parts of the body if they are contaminated, through clothing, after removing clothing, wipe with a 70% solution of ethyl alcohol;
— wash the surface with soap and water and wipe again with alcohol;
- Wipe contaminated shoes twice with a swab dipped in a solution of one of the disinfectants.
4.11. In the event of an accident during operation of a centrifuge, disinfection measures begin no earlier than after 40 minutes. after the rotor stops, i.e. after aerosol deposition. After 40 min. open the centrifuge lid and immerse all centrifuge beakers and broken glass in the disinfectant solution.
4.12. If infected material gets on the surfaces of walls, floors, equipment, wipe them with 6% hydrogen peroxide, 3% chloramine or other recommended disinfectants, twice with an interval of 15 minutes.
4.13. After treating the victim’s mucous membranes and skin, you must:
— make an entry in the microtrauma log of the institution (department);
- notify the head nurse and the head of the department (office) about the accident. The head nurse notifies the deputy chief physician for epidemiology (or assistant epidemiologist), the chief nurse, and the dispensary doctor about the incident;
- make entries in medical card the victim, about the microtrauma received, indicating the preventive measures taken.
4.14. In the event of a fire or fire, personnel should immediately call fire brigade by calling 101, inform management and begin extinguishing the fire using available fire extinguishing means.
4.15. In case of injury, first of all, free the victim from the traumatic factor, provide first aid to the victim, notify management and, if possible, maintain the situation until the causes of the incident are investigated.

5. LABOR SAFETY REQUIREMENTS AFTER COMPLETION OF WORK

5.1. Place disposable syringes and instruments in a leak-proof container after use.
5.2. Place sharps to be reused in a durable container for reprocessing.
5.3. Do not break used needles by hand, do not bend them, or re-cap them.
5.4. Treat gloves contaminated with blood with a swab containing a disinfectant solution, remove them and immerse them in a container with a disinfectant solution for 60 minutes (3% chloramine solution or 6% hydrogen peroxide solution with 0.06% NHA) or boil in distilled water for 30 minutes.
5.5. Treat work table surfaces at the end of the working day disinfectants, which have a virucidal effect.
5.6. Put in order workplace.
5.7. Remove, inspect, put in order and put away sanitary clothing in specially designated areas.
5.8. You must notify your immediate supervisor of any labor safety deficiencies discovered during work.

Biological hazard or a risk to human health or the environment may be posed by infected organisms or biological material containing microorganisms or biological toxins.

Biological safety – procedures for carrying out laboratory research and special equipment for microbiological laboratories that protect laboratory personnel and the environment when working with potentially infectious microorganisms.

Biosafety level– the level of precautions required when working with potentially hazardous biological agents. There are 4 levels of biosafety (Table 1). In foreign countries, a higher biosafety level number means an increased risk when performing laboratory tests.

Table 1

Characteristics of biosafety levels

Biosafety level dangers	Description	Laboratory equipment	Microorganisms
(lowest)	Biological agents that pose minimal risk to personnel and the environment.	No special equipment required.	There should be hand washing facilities, easily disinfected work surfaces, durable furniture, windows with mosquito nets, no automatic ventilation, personal protective clothing (gloves, gowns), automatic dispensers, eye and face protection, autoclaves, safe centrifuges. Agrobacterium radiobacter Bacillus thuringiensis Escherichia coli K12 Lactobacillus acidophilus Micrococcus leuteus Pseudomonas fluorescens Serratia marcescens Aspergillus
	niger	Equipment is classified as Class 1. Strict precautions are required when performing procedures that may generate infectious aerosol or splashes. Special precautions are taken for sharp and cutting objects.	Bacillus subtilis Borrelia burgdorferi Clostridium difficileMycobacterium other than tuberculosis Salmonella Staphylococcus aureus(MRSAAndVRSA) Streptococcus pneumonia V. hepatitisA, B, C V. fluA V. measles V. mumps prions genetically modified organisms
	Biological agents that can cause serious or potentially fatal disease through inhalation for which vaccines and treatments are available.	Class 2 safety boxes	Bacillus anthracis Coxiella burnetii Mycobacterium tuberculosis Rickettsia rickettsii Salmonella typhi V. atypical pneumonia (SARS) V. Venezuelan equine encephalomyelitis V. yellow fever V. Rift Valley fever V. West Nile fever V. Spotted Mountain fever V. smallpox Plasmodium falciparum Trypanosoma cruzi
4(highest)	Dangerous and exotic agents causing serious illnesses, for which no vaccines or treatments have been developed.	Class 3 safety boxes or “cosmonaut suits” with an autonomous air supply system.	Y. pestis hemorrhagic fever viruses (V. Crimean hemorrhagic fever (Congo virus), V. Lassa, V. dengue fever, V. Marburg, v. Machupo, V. Junin, V. Ebola, Hantaviruses) V. bird flu (H5 N1)

In the Republic of Belarus and Russia according to the degree of danger to humans and the environment is also highlighted 4 groups pathogens of infectious diseases, however, on the contrary, a lower group number means an increased risk when performing laboratory tests.

Group I – pathogens of acute infectious diseases: plague, smallpox, hemorrhagic fevers (Lassa, Ebola, etc.).

Group II – pathogens of highly contagious bacterial, fungal and viral infections: anthrax, brucellosis, tularemia, cholera, typhus, blastomycosis, rabies, AIDS, hepatitis B and C, etc., botulinum toxins and tetanus toxin.

Group III – pathogens of other infections: whooping cough, tetanus, botulism, tuberculosis, trichomoniasis, malaria, leishmaniasis, influenza, polio, herpes viruses, etc.

Group IV - opportunistic (causative agents of gas gangrene, Klebsiella, staphylococci, streptococci, Pseudomonas aeruginosa, some candida and aspergillus, amoebiasis, adenoviruses, rotaviruses, enteroviruses, etc.) and non-pathogenic microorganisms.

Attenuated strains of pathogens of groups I–II belong to microorganisms of pathogenicity group III, and attenuated strains of groups III–IV belong to pathogenicity group IV.

Working with material containing microorganisms of pathogenicity groups I–II requires adherence to strict safety measures to prevent cases of intra-laboratory infection, transfer of infection outside the laboratory and prevent contamination of the environment, therefore research is carried out in specially equipped high-security microbiological laboratories by specially trained and vaccinated personnel (if there are vaccines).

Work with material containing microorganisms of III–IV pathogenicity groups is regulated by the Sanitary Rules “Safety of working with microorganisms of III–IV pathogenicity groups and helminths,” which were adopted for execution on the territory of the Republic of Belarus by Resolution of the Chief State Sanitary Doctor No. 40 of July 27, 2000.

Research is carried out in bacteriological laboratories at medical institutions and at hygiene and epidemiology centers.

Depending on the research performed, microbiological laboratories are divided into diagnostic, production and research. In accordance with the types of microorganisms studied in microbiological laboratories, bacteriological, virological, mycological and protozoological laboratories are distinguished.

Depending on the level of safety when working with microorganisms, microbiological laboratories are divided into four risk groups.

Group I – special regime laboratories (maximum isolated) with high individual and public risk.

Group II – sensitive laboratories (isolated) with high individual and low public risk.

Group III – basic (main) laboratories with moderate individual and limited public risk.

Group IV – basic (main) laboratories with low individual and public risk. In practical classes, students work with microorganisms of pathogenicity group IV. The educational workshop of the Department of Microbiology is considered an educational microbiological laboratory, where

1. You cannot enter the premises of the bacteriological laboratory without special clothing - a medical gown and cap; it is prohibited to bring outer clothing to the workshop.

It is prohibited for outsiders to visit students working in the laboratory. Each student must work at his assigned workplace. While working in the laboratory, silence, order and cleanliness should be maintained. 2. In the premises of the bacteriological laboratory, strictly prohibited

eat, smoke, use cosmetics. Daily thorough cleaning of the premises is carried out wet using disinfectant liquids.

3. Each group is assigned a permanent student on duty who monitors the maintenance of cleanliness and order by the students of the group at their workplaces.

4. Students take everything necessary for work in class (cups, test tubes, pipettes, bacterial loops) on a special table, and the work done in class is also placed there. Test tubes and cups with infected material must be signed (nature of the material, name of the culture, date, group number, full name of the researcher). After finishing work, the workplace must be put in complete order.

5. Before performing work and after completion, you must wash your hands with soap. All material entering the laboratory must be considered contaminated. Work with biomaterials is carried out using rubber gloves. Prohibited

touch biomaterial and microbial cultures with your hands.

If contact with blood or other biological fluids occurs in violation of the integrity of the skin (injection, cut), the victim must:

– remove gloves with the working surface facing inward;

– squeeze blood out of the wound;

– treat the damaged area (70% alcohol, or 5% iodine, or 3% hydrogen peroxide solution, or other approved antiseptic);

– wash your hands under running water and soap;

– apply a plaster to the wound;

– put on a finger guard;

– if necessary, continue working by wearing new gloves. When suctioning liquid material, it is necessary to use rubber bulbs, and the pipettes must be covered with cotton swabs.

Pipetting by mouth is strictly prohibited!

6. Inoculations are carried out in an alcohol lamp, while flaming the edges of the test tubes, loops, and spatulas! keep flammable materials and substances near working alcohol lamps, and leave working alcohol lamps unattended. Before lighting the alcohol lamp, you need to make sure that its body is in good condition, the wick is set to the required height and loosened, and the neck and wick holder are dry. The wick must fit tightly into the guide tube of the holder (otherwise a flash of vapor inside the alcohol lamp and an explosion may occur). A lit alcohol lamp it is forbidden move about, it is forbidden light one alcohol lamp from another. You need to extinguish the alcohol lamp by covering the flame of the wick with a cap; if this is not possible, fill it with water. Blow out the flame prohibited.

7. When working with biomaterials, it is necessary to use tools (loops, spatulas, tweezers, needles). Instruments that have had contact with infected material are flamed in the flame of an alcohol lamp, or completely immersed in containers with a disinfectant solution.

At the end of the work, the used glassware and cotton-gauze plugs are dumped into separate bins. Every day, dishes that contained infected material are sent to the sink after preliminary sterilization by autoclaving.

8. Staining of preparations is carried out in specially designated areas. The used glass slides are placed in a desiccator.

9. A microscope is a precise optical instrument that requires strict adherence to the rules for working with it:

– raise the condenser to the level of the stage;

– open the diaphragm;

– adjust the brightness of the built-in illuminator or illuminate the field of view using a mirror (in low light conditions a concave mirror is used, in sufficient light conditions a flat mirror is used);

– a drop of immersion oil is applied to a slide with a colored preparation, into which the lens is carefully immersed under eye control;

– lifting the tube, look into the eyepiece and first use a macro-screw, and then use a micro-screw to establish a clear image of the object;

– at the end of the work, lift the tube, remove the preparation, and remove the immersion oil from the front lens of the lens with a gauze cloth;

- The microscope is placed in the closet.

9. In case of an accident with utensils containing infected material, or spilling of liquid infected material, the teacher must be informed. Contaminated surfaces and objects are immediately disinfected:

– glass fragments are placed in a bix,

– a disinfectant solution is applied to the accident site, exposure time is 5–10 minutes,

– then wipe the disinfectant solution with a moisture-absorbing cloth.

Carry out antiseptic treatment of contaminated parts of the body - washing with soap.

10. When working with electrical equipment and electrical appliances, it is forbidden to check the presence of voltage with your fingers, carry switched-on energized devices, or use faulty electrical equipment and wiring. Violation of the rules for working with electrical equipment and electrical appliances may result in electric shock and fire.

11. At the beginning of each semester, the teacher provides safety instructions when working with microbial cultures, biomaterials, alcohol lamps and electrical appliances. The instruction is recorded in the journal with the personal signature of the student and certified by the signature of the teacher.

ATTENTION! To prevent nosocomial infections 2. In the premises of the bacteriological laboratory, strictly attending classes at clinical sites in the robe in which the student worked in the microbiology laboratory!

THE GOVERNMENT OF MOSCOW

DEPARTMENT OF HEALTH

To prevent occupational infection medical workers dangerous infectious diseases, the administration of health care institutions is obliged to organize training of personnel on precautionary methods at work, rules of use, personal protective equipment and first aid measures in emergency situations.

Therefore, each institution must develop instructions on labor protection when performing work with blood and other biological fluids of patients for conducting workplace training with “at-risk” employees.

As practical guide The Department of Health sends sample instructions on labor protection, including basic safety requirements when working with blood and other biological fluids.

Head of logistics department

V. I. ZYKOV

Application

to the Department's letter

health care of the city of Moscow

dated 01/01/2001 N

SAMPLE INSTRUCTIONS

OCCUPATIONAL SAFETY WHEN WORKING WITH BLOOD AND

OTHER BIOLOGICAL FLUIDS OF PATIENTS

1. General requirements labor protection

1.1. Persons at least 18 years of age who have no medical contraindications, have been trained in safe work methods and have been instructed in the scope of this instruction are allowed to perform independent work that may involve contact with blood and other biological fluids.

1.2. When working, staff should be guided by the principle that all patients are potentially infected.

1.3. When working with blood and other biological fluids of patients, mechanical damage to the skin is possible:

1.3.1. puncture wounds due to careless handling of syringes and other piercing instruments (objects);

1.3.2. cuts on hands:

When opening bottles, vials, tubes with blood or serum;

When working with HIV-contaminated instruments;

1.3.3. bites of mental patients when attacking staff.

1.4. Personnel must perform work in personal protective equipment specified by industry standards: a cotton gown, a medical cap, medical gloves worn over the sleeves of a medical gown.

If there is a risk of splashing blood and other biological fluids, work should be carried out wearing masks, safety glasses, and, if necessary, using protective screens and oilcloth aprons.

1.5. When working in a morgue, personnel must have a type 1 suit:

Robe, sleeves, waterproof apron;

2 pairs of rubber gloves;

4-layer gauze mask, shoe covers;

Protective glasses;

Boots or galoshes.

1.6. In the office of the unit, where personnel may come into contact with biological fluids of patients, there must be an emergency first aid kit "Anti-AIDS", which includes:

70% ethyl alcohol, cotton gauze swabs;

0.05% solution of potassium permanganate or a weighed portion of the drug in dry form with the required amount of distilled water to prepare the solution;

5% alcohol solution of iodine;

Bactericidal patch;

Eye pipettes, disposable syringe;

Dressing.

1.7. Medical personnel are required to comply with the requirements of this instruction.

2. Labor protection requirements before starting work

2.1. Put on and put in order your work clothes: a cotton robe, fasten the cuffs and hems of the robe, put on a cap and match your hair under it. Put on replacement shoes on your feet.

2.2. Prepare and check personal protective equipment.

2.3. Cover any damaged skin on your hands, if any, with a band-aid or put on finger pads.

2.4. Make sure that the Anti-AIDS first aid kit is complete.

2.5. Personnel are not allowed to perform invasive procedures if:

Extensive damage to the skin;

Exudative skin damage;

Weeping dermatitis.

3. Labor protection requirements during work

3.1. Medical personnel must strictly observe personal protective measures, especially when performing invasive procedures that involve contamination of hands with blood and other biological fluids:

Work with rubber gloves; if there is an increased risk of infection, use two pairs of gloves;

Use masks, glasses, screens;

use masks and gloves when handling used clothing and tools;

Handle sharp medical instruments with care;

Do not cap a used needle;

after disinfection, dispose of used disposable sharp instruments in solid containers;

Collect needles that have fallen on the floor with a magnet, brush and dustpan;

Cover microtraumas on the hands with an adhesive plaster, Lifusol or boss. Before and during work, you should check whether the gloves are moisture-proof and whether they are damaged;

Replace damaged gloves immediately. Gloves treated after use are less durable than new ones and are damaged much more often. The use of fat-based creams and fatty lubricants destroys gloves;

Drawing blood from patients or performing other procedures where a healthcare worker may accidentally injure themselves with a used needle should be done with latex gloves, as they reduce the amount of blood inoculum that is transferred during the injection;

After removing the gloves, soak them in the disinfectant solution for 1 hour, wash your hands with soap and dry with an individual towel;

Remove gloves carefully so as not to contaminate your hands;

Rubber gloves, once removed, should not be reused due to the possibility of contamination of hands.

3.2. To protect themselves from infection through the skin and mucous membranes, medical staff must follow the following rules:

Avoid rubbing movements when using a paper towel, as this damages the surface epithelium;

Use alcohol-based hand disinfection solutions; hand disinfection should never be preferred over the use of disposable gloves; hands must be washed with soap and water each time after removing protective gloves;

After any procedure, you must thoroughly wash your hands twice in running water and soap;

Hands should be dried only with an individual towel, changed daily, or disposable wipes;

Avoid frequent hand treatment with disinfectants that irritate the skin, and do not use hard brushes;

Never eat in a workplace where there may be blood or secretions from a patient;

Get vaccinated against hepatitis B;

To protect the mucous membranes of the mouth and nose, use a 4-layer gauze mask. The mask should fit tightly to the face;

Wear a robe or apron, or both a robe and an apron, to ensure reliable protection from contact with body fluids. Protective clothing should cover the skin and clothing of medical staff, keep liquids out, and keep the skin and clothing dry.

It is almost impossible to transmit a large infectious dose through clothing.

3.3. It is necessary to use barrier protective equipment not only when working with infected patients; every patient is considered potentially dangerous in relation to infectious diseases.

3.4. When providing medical care to HIV-infected and AIDS patients, medical documents and referrals, manipulations with parenteral interventions indicate chronic carriage of Hbs Ag with appropriate labeling.

3.5. All diagnostic tests, treatment procedures, and surgical interventions for HIV-infected patients must be carried out last; all biological material is disinfected and destroyed, which is noted in the medical history.

Medical instruments undergo a 3-stage processing in accordance with OST.

3.6. An HIV-positive patient should perform manipulations in the presence of a second specialist, who, in the event of a rupture of gloves or a cut, can continue to perform them.

3.7. During surgical procedures, double gloves should be used if possible; transfer all sharp instruments during the operation through the intermediate tray, and not from hand to hand, eliminate the use of fingers to guide the needle, it is advisable to use a needle holder.

3.8. In a clinical diagnostic laboratory, when working with blood, serum or other biological fluids, the following is prohibited:

Pipetting by mouth, use a rubber bulb;

Transfuse blood and serum over the edge of the tube;

Use adhesive tape labels to label tubes. Test tubes should be marked with a pencil on the glass.

3.9. When centrifuging the test material, the centrifuge must be closed with a lid until the rotor stops completely.

3.10. When transporting blood and other biological fluids, the following rules must be observed:

Close containers with blood and other biological fluids immediately at the collection site tightly with rubber or plastic stoppers;

Do not place referral forms or other documentation into the tubes;

To ensure disinfection in case of accidental leakage of liquid, transport blood and other biological fluids in racks placed in containers, bins or pencil cases, on the bottom of which a four-layer dry napkin is placed;

If there is a risk of splashing blood or body fluids, wear protective clothing (gowns, aprons) and facial protection (face masks, goggles or eye protection);

If the robe and apron are contaminated with body fluids, change clothes as quickly as possible; When changing clothes, wear gloves and take them off last.

3.11. Disassembly, washing and rinsing of medical instruments that have come into contact with blood or serum should be carried out after preliminary disinfection. Work with rubber gloves.

3.12. Disposable items: syringes, dressings, gloves, masks must be disinfected after use and then disposed of.

4. Occupational safety requirements in emergency situations

4.1. Emergency situations include:

Glove tearing;

Punctures and cuts from piercing and cutting instruments;

Contact of blood and other biological fluids with mucous membranes and skin;

Spattering of blood during centrifugation, etc.

4.2. Manipulations that can lead to an emergency situation, in particular, include:

Invasive procedures;

contact with mucous membranes (intact and damaged);

Contact with damaged skin of patients;

contact with surfaces contaminated with blood or other body fluids.

4.3. If your hands are contaminated with blood or other biological fluids, you should thoroughly wipe them with a swab moistened with a skin antiseptic, and then wash them with running water and soap.

If hands protected with gloves become dirty, treat the gloves with a napkin, then wash them with running water, remove the gloves with the working surface inward, wash your hands and treat them with a skin antiseptic.

4.4. If your hands are contaminated with blood or biological fluids, you should immediately treat them for at least 30 seconds with a swab moistened with a skin antiseptic, wash them twice with soap and water and wipe dry with a clean towel (napkin).

4.5. If contact with blood, other biological fluids or biomaterials is accompanied by a violation of the integrity of the skin (injection, cut), then the following measures must be taken:

Wash your hands without removing gloves with running water and soap;

Remove gloves with the working surface facing inward and throw them into the disinfectant solution;

Squeeze blood out of the wound;

Wash your hands with soap;

Treat the wound with 70% alcohol, then the skin around the wound with a 5% alcohol solution of iodine;

Apply a bactericidal plaster to the wound, put on a finger guard, and if necessary, continue working - put on new rubber gloves.

4.6. If blood or liquids get on the nasal mucosa, drop in a 0.05% solution of potassium permanganate, immediately rinse your mouth and throat with 70% alcohol or 0.05% solution of potassium permanganate.

4.7. If biological fluids get into your eyes, you should immediately rinse them with running water, then rinse them with a solution of potassium permanganate using a disposable syringe in a ratio of 1: 10,000.

The solution is prepared from a sample of 0.01 g of potassium permanganate and 100 ml of distilled water until the crystals are completely dissolved (3 minutes).

4.8. If biological material gets on a gown or clothing, do the following:

Remove clothes and soak in one of the disinfectants;

If the skin of the hands and other parts of the body is contaminated, through clothing, after removing clothing, wipe with a 70% solution of ethyl alcohol;

Wash the surface with soap and water and wipe again with alcohol;

Wipe contaminated shoes twice with a swab soaked in a solution of one of the disinfectants.

4.9. In the event of an accident during operation of a centrifuge, disinfection measures begin no earlier than after 40 minutes. after the rotor stops, i.e. after aerosol deposition. After 40 min. open the centrifuge lid and immerse all centrifuge beakers and broken glass in the disinfectant solution.

4.10. If infected material gets on the surfaces of walls, floors, equipment, wipe them with 6% hydrogen peroxide, 3% chloramine or other recommended disinfectants, twice with an interval of 15 minutes.

4.11. After treating the victim’s mucous membranes and skin, you must:

1) Make an entry in the microtrauma log of the institution (department).

2) Notify the head nurse and the head of the department (office) about the accident. The head nurse notifies the deputy chief physician for epidemiology (or assistant epidemiologist), the chief nurse, and the dispensary doctor about the incident.

3) Make entries in the victim’s medical record about the microtrauma received, indicating the preventive measures taken.

4.12. If a health worker is suspected of being infected with an infectious disease, an investigation is conducted in accordance with the “Regulations on Investigation and Recording occupational diseases"(approved by Decree of the Government of the Russian Federation dated January 1, 2001 N 967).

5. Labor protection requirements upon completion of work

5.1. Place disposable syringes and instruments in a leak-proof container after use.

5.2. Place sharps to be reused in a durable container for reprocessing.

5.3. Do not break used needles by hand, do not bend them, and do not re-cap them.

5.4. Treat gloves contaminated with blood with a swab containing a disinfectant solution, remove them and immerse them in a container with a disinfectant solution for 60 minutes (3% chloramine solution or 6% hydrogen peroxide solution with 0.06% NHA) or boil in distilled water for 30 minutes.

5.5. Treat desk surfaces at the end of the working day with disinfectants that have a virucidal effect.

To compile this instruction, we used instructions on labor protection when performing work with blood and other biological fluids from City Clinical Hospital No. 23 (occupational safety engineer) and Psychiatric Hospital No. 5 (occupational safety engineer).

1. GENERAL OCCUPATIONAL SAFETY REQUIREMENTS

1.1. Persons over 18 years of age who have no medical contraindications, have been trained in safe work methods, have undergone introductory and initial workplace safety briefings, internships and tests of knowledge of safety requirements are allowed to perform independent work, which may involve contact with blood and other biological fluids of patients. labor.
1.2. When working, staff should be guided by the principle that all patients are potentially infected.
1.3. When working with blood and other biological fluids of patients, mechanical damage to the skin is possible:
- puncture wounds due to careless handling of syringes and other piercing instruments (objects);
- cuts on the hands (when opening bottles, vials, tubes with blood or serum; when working with HIV-contaminated instruments);
- bites of mental patients when attacking staff.
1.4. Personnel must perform work in sanitary clothing specified by industry standards: a cotton gown, a medical cap, medical gloves worn over the sleeves of the medical gown.
1.5. For invasive procedures, it is recommended to wear two pairs of gloves, a waterproof gown, and an apron.
1.6. If there is a risk of splashing blood and other biological fluids, work should be carried out wearing masks, safety glasses, and, if necessary, using protective screens and oilcloth aprons.
1.7. When working in a morgue, personnel must have: a robe, oversleeves, a waterproof apron, 2 pairs of rubber gloves, a 4-ply gauze mask, shoe covers, safety glasses, boots or galoshes.
1.8. In the office of the unit, where personnel may come into contact with biological fluids of patients, there must be an emergency first aid kit “Anti-AIDS2”, which includes: 70% ethyl alcohol, cotton-gauze swabs; 0.05% solution of potassium permanganate or a weighed portion of the drug in dry form with the required amount of distilled water to prepare the solution; 5% alcohol solution of iodine; bactericidal patch; eye pipettes, disposable syringe; dressing.
1.9. Smoking is permitted only in designated areas. It is prohibited to consume alcoholic beverages at work, as well as to go to work under the influence of alcohol or drugs.
1.10. When performing work, you must be attentive, not be distracted by extraneous matters and conversations, and not distract others from work.
1.11. The employee is responsible in accordance with current legislation for compliance with the requirements of instructions, industrial injuries and accidents that occurred through his fault.

2. OCCUPATIONAL SAFETY REQUIREMENTS BEFORE STARTING WORK
2.1. Put on sanitary clothing, fasten the cuffs and hem of the robe, put on a cap and tuck your hair under it. Put on replacement shoes on your feet.
2.2. Prepare and check the necessary personal protective equipment.
2.3. Cover any damaged skin on your hands, if any, with a band-aid or put on finger pads.
2.4. Make sure that the Anti-AIDS first aid kit is complete.
2.5. Personnel are not allowed to perform invasive procedures in the following cases:
- extensive damage to the skin;
- exudative skin damage;
- weeping dermatitis.

3. OCCUPATIONAL SAFETY REQUIREMENTS DURING WORK
3.1. Medical staff must strictly observe personal protective measures, especially when performing invasive procedures that involve contamination of hands with blood and other biological fluids of patients:
- work in rubber gloves, if there is an increased risk of infection - in two pairs of gloves;
- use masks, glasses, screens;
- use masks and gloves when processing used clothing and tools;
- handle sharp medical instruments carefully;
- do not put a cap on a used needle;
- after disinfection, dispose of used disposable sharp instruments in solid containers;
- collect needles that have fallen on the floor with a magnet, brush and dustpan;
- cover microtraumas on the hands with an adhesive plaster or fingertip. Before and during work, you should check whether the gloves are moisture-proof and whether they are damaged;
- Replace damaged gloves immediately. Gloves treated after use are less durable than new ones and are damaged much more often. The use of fat-based creams and fatty lubricants destroys gloves;
- taking blood from patients or performing other procedures where a healthcare worker may accidentally injure themselves with a used needle must be done with latex gloves, because they reduce the amount of blood inoculum that is transferred during the injection;
- after removing the gloves, soak them in a disinfectant solution for 1 hour, wash your hands with soap and dry with an individual towel;
- remove gloves carefully so as not to contaminate your hands;
- rubber gloves removed once, do not reuse due to the possibility of contamination of hands.
3.2. To protect themselves from infection through the skin and mucous membranes, medical staff must follow the following rules:
- avoid rubbing movements when using a paper towel, because this damages the surface epithelium;
- use alcohol-based hand disinfection solutions; hand disinfection should never be preferred over the use of disposable gloves; hands must be washed with soap and water each time after removing protective gloves;
- after any procedure, you must thoroughly wash your hands twice in running water and soap;
- hands should be dried only with an individual towel, changed daily, or disposable napkins;
- avoid frequent hand treatment with disinfectants that irritate the skin, do not use hard brushes;
- never eat in a workplace where there may be blood or secretions from the patient;
- get vaccinated against hepatitis B;
- to protect the mucous membranes of the oral cavity and nose, use a 4-layer gauze mask. The mask should fit tightly to the face;
- wear a robe or an apron, or both a robe and an apron, to ensure reliable protection against contact of body fluids with biological fluids. Protective clothing should cover the skin and clothing of medical staff, keep liquids out, and keep the skin and clothing dry.
3.3. It is almost impossible to transmit a large infectious dose through clothing.
3.4. It is necessary to use barrier protective equipment not only when working with infected patients; every patient is considered potentially dangerous in relation to infectious diseases.
3.5. When providing medical care to HIV-infected and AIDS patients, medical documents and referrals, manipulations with parenteral interventions indicate chronic carriage of Hbs Ag with appropriate labeling.
3.6. All diagnostic tests, treatment procedures, and surgical interventions for HIV-infected patients must be carried out last; all biological material is disinfected and destroyed, which is noted in the medical history.
3.7. Medical instruments undergo three-stage processing in accordance with OST 42-21-2-85.
3.8. An HIV-positive patient should perform manipulations in the presence of a second specialist, who, in the event of a rupture of gloves or a cut, can continue to perform them.
3.9. During surgical procedures, double gloves should be used if possible; transfer all sharp instruments during the operation through the intermediate tray, and not from hand to hand, eliminate the use of fingers to guide the needle, it is advisable to use a needle holder.
3.10. In a clinical diagnostic laboratory, when working with blood, serum or other biological fluids, the following is prohibited:
- pipette by mouth, use a rubber bulb;
- transfuse blood, serum over the edge of the tube;
- use adhesive tape labels to label test tubes. Test tubes should be marked with a pencil on the glass.
3.11. When centrifuging the test material, the centrifuge must be closed with a lid until the rotor stops completely.
3.12. When transporting blood and other biological fluids, the following rules must be observed:
- containers with blood and other biological fluids should be tightly closed with rubber or plastic stoppers immediately at the collection site;
- it is prohibited to place referral forms or other documentation into the test tubes;
- to ensure disinfection in case of accidental leakage of liquid, transport blood and other biological fluids in racks placed in containers, bins or pencil cases, on the bottom of which a four-layer dry napkin is placed;
- if there is a risk of splashing blood or body fluids, wear protective clothing (gowns, aprons) and facial protection (mask covering the mouth and nose, goggles or eye protection);
- if the robe and apron are contaminated with biological fluids, you should change clothes as quickly as possible; When changing clothes, wear gloves and take them off last.
3.13. Disassembly, washing and rinsing of medical instruments that have come into contact with blood or serum should be carried out after preliminary disinfection. Work with rubber gloves.
3.14. Disposable items: syringes, dressings, gloves, masks must be disinfected after use and then disposed of.

4. OCCUPATIONAL SAFETY REQUIREMENTS IN EMERGENCIES
4.1. Emergency situations include:
- tearing of gloves;
- punctures and cuts from piercing and cutting instruments;
- contact of blood and other biological fluids with mucous membranes and skin;
- splashing of blood during centrifugation, etc.
4.2. Manipulations that can lead to an emergency situation, in particular, include:
- invasive procedures;
- contact with mucous membranes (intact and damaged);
- contact with damaged skin of patients;
- contact with surfaces contaminated with blood or other body fluids.
4.3. If your hands are contaminated with blood or other biological fluids, you should thoroughly wipe them with a swab moistened with a skin antiseptic, and then wash them with running water and soap.
4.4. If hands protected with gloves become dirty, treat the gloves with a napkin, then wash them with running water, remove the gloves with the working surface inward, wash your hands and treat them with a skin antiseptic.
4.5. If your hands are contaminated with blood or biological fluids, you should immediately treat them for at least 30 seconds with a swab moistened with a skin antiseptic, wash them twice with soap and water and wipe dry with a clean towel (napkin).
4.6. If contact with blood, other biological fluids or biomaterials is accompanied by a violation of the integrity of the skin (injection, cut), then the following measures must be taken:
- wash your hands without removing gloves with running water and soap;
- remove gloves with the working surface facing inward and throw them into the disinfectant solution;
- squeeze blood out of the wound;
- wash your hands with soap;
- treat the wound with 70% alcohol, then the skin around the wound with a 5% alcohol solution of iodine;
- Apply a bactericidal plaster to the wound, put on a finger guard, and if necessary, continue working - put on new rubber gloves.
4.7. If blood or liquids get on the nasal mucosa, drip a 0.05% solution of potassium permanganate, immediately rinse your mouth and throat with 70% alcohol or 0.05% solution of potassium permanganate.
4.8. If biological fluids get into your eyes, you should immediately rinse them with running water, then rinse them with a solution of potassium permanganate using a disposable syringe in a ratio of 1:10000.
4.9. The solution is prepared from a sample of 0.01 g of potassium permanganate and 100 ml of distilled water until the crystals are completely dissolved (3 minutes).
4.10. If biological material gets on a gown or clothing, do the following:
- remove clothes and soak in one of the disinfectants;
- wipe the skin of the hands and other parts of the body if they are contaminated, through clothes, after removing clothes, with a 70% solution of ethyl alcohol;
- wash the surface with soap and water and wipe again with alcohol;
- Wipe contaminated shoes twice with a swab dipped in a solution of one of the disinfectants.
4.11. In the event of an accident during operation of a centrifuge, disinfection measures begin no earlier than after 40 minutes. after the rotor stops, i.e. after aerosol deposition. After 40 min. open the centrifuge lid and immerse all centrifuge beakers and broken glass in the disinfectant solution.
4.12. If infected material gets on the surfaces of walls, floors, equipment, wipe them with 6% hydrogen peroxide, 3% chloramine or other recommended disinfectants, twice with an interval of 15 minutes.
4.13. After treating the victim’s mucous membranes and skin, you must:
- make an entry in the microtrauma log of the institution (department);
- notify the head nurse and the head of the department (office) about the accident. The head nurse notifies the deputy chief physician for epidemiology (or assistant epidemiologist), the chief nurse, and the dispensary doctor about the incident;
- make entries in the victim’s medical record about the microtrauma received, indicating the preventive measures taken.
4.14. In the event of a fire or fire, personnel must immediately call the fire brigade by calling 101, inform management and begin extinguishing the fire using available fire extinguishing means.
4.15. In case of injury, first of all, free the victim from the traumatic factor, provide first aid to the victim, notify management and, if possible, maintain the situation until the causes of the incident are investigated.

5. LABOR SAFETY REQUIREMENTS AFTER COMPLETION OF WORK
5.1. Place disposable syringes and instruments in a leak-proof container after use.
5.2. Place sharps to be reused in a durable container for reprocessing.
5.3. Do not break used needles by hand, do not bend them, or re-cap them.
5.4. Treat gloves contaminated with blood with a swab containing a disinfectant solution, remove them and immerse them in a container with a disinfectant solution for 60 minutes (3% chloramine solution or 6% hydrogen peroxide solution with 0.06% NHA) or boil in distilled water for 30 minutes.
5.5. Treat desk surfaces at the end of the working day with disinfectants that have a virucidal effect.
5.6. Tidy up your workspace.
5.7. Remove, inspect, put in order and put away sanitary clothing in specially designated areas.
5.8. You must notify your immediate supervisor of any labor safety deficiencies discovered during work.

Instruction and writing in the safety magazine

Methodology of conducting the lesson and guidelines on this topic

Topic 1. Rules for working with virus-containing materials. Virology laboratory setup

Section I. General virology

Purpose of the lesson: get acquainted with the virology laboratory of the department and equipment. Study the rules and safety precautions when working with virus-containing material.

Equipment and materials: tables - diagrams of the structure of a virology laboratory, table box, fluorescent and inverted microscopes, centrifuges, refrigerators, magnetic stirrers, thermostats, alcohol lamps, glassware (peers, test tubes, bottles, mattresses, Petri dishes, pipettes), Takachi apparatus, basic reagents and nutrients environment, registration log of students who received safety instructions, laboratory documentation and basic approved instructions on the rules of work in veterinary institutions, multimedia equipment, presentations MS Office Power Point on the topic of the lesson.

Teacher's explanation: goals and objectives of virology laboratories, equipment, operating hours of virology laboratories, prevention of laboratory infections, methods of storing and destroying viruses in laboratories, canning, documentation in virology laboratories, safety precautions when students work with virus-containing material, with laboratory animals.

Virology laboratory employees and students are required to follow work rules that prevent contamination of virus-containing material with foreign microflora, ensure personal safety and prevent the dispersion of viruses in the external environment.

When working with virus-containing material, the following requirements must be met:

· prevent the dispersion of viruses in the external environment;

· prevent contamination (contamination) of virus-containing material with foreign microflora;

· ensure personal safety.

The operating hours of the virology laboratory are regulated by law Russian Federation, international rules for conducting diagnostic laboratory tests, internal regulations. All laboratory personnel are instructed and trained in safe working methods and are provided with special clothing, safety shoes, and sanitary protection and protective devices in accordance with current regulations. Entry into production premises by unauthorized persons is strictly prohibited. Virology laboratory employees are required to follow work rules that prevent contamination of the test material by bacteria and fungi, the possibility of infecting personnel and the spread of infection.

It is prohibited to leave the laboratory in gowns and special shoes or to put on outerwear over a gown, to smoke, to eat in production premises and to store food in them. In boxing they wear a sterile gown, mask, cap, and in some cases wear goggles and gloves. Be sure to change your shoes. Walking and talking while working is not allowed.

All material entering the laboratory for testing must be considered infected! Infectious material should be handled with extreme caution. When unpacking its jars, you must wipe the outside with a disinfectant solution and place them on a tray or in a ditch. The work area on the table is covered with several layers of gauze moistened with a 3–5% chloramine solution. Liquids containing viruses are poured over cuvettes with a disinfectant solution. When working with a pipette, use a bulb. Pipettes, slides, glassware and rubber products involved in working with infectious material are disinfected by immersion in a 5% solution of chloramine or solutions of phenol, Lysol, sulfuric acid. It is prohibited to remove equipment, supplies, materials, etc. from the laboratory without first disinfecting them. At the end of work, the workplace is cleaned and disinfected. Virus-containing material necessary for further work is stored in a refrigerator and sealed. Hands wearing gloves are washed in a jar with a 5% chloramine solution, then the gloves are removed, disinfected a second time, disinfected and washed.