Ordin - nr916 - Din - 2006

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aperw12240\paperh15840\pard\sb0\sl-240{\bkmkstart Pg1}{\bkmkend Pg1}\par\pard\ql
\li1800\sb0\sl-207\slmult0 \par\pard\ql\li1800\sb0\sl-207\slmult0
\par\pard\ql\li1800\sb0\sl-207\slmult0 \par\pard\ql\li1800\sb0\sl-207\slmult0
\up0 \expndtw-2\charscalex100 \ul0\nosupersub\cf1\f2\fs18 Ministerul S\u259?n\u259?
t\u259?\u355?ii Publice \par\pard\ql \li5338\sb0\sl-207\slmult0
\par\pard\ql\li5338\sb46\sl-207\slmult0 \up0 \expndtw-2\charscalex100
\ul0\nosupersub\cf2\f3\fs18 Ordin nr. 916/2006 \par\pard\ql \li5523\sb0\sl-
207\slmult0 \par\pard\ql\li5523\sb6\sl-207\slmult0 \up0 \expndtw-2\charscalex100
\ul0\nosupersub\cf3\f4\fs18 din 27/07/2006 \par\pard\ql \li4219\sb1\sl-
198\slmult0 \up0 \expndtw-2\charscalex100 \ul0\nosupersub\cf1\f2\fs18 Publicat in
Monitorul Oficial, Partea I nr. 759 din \par\pard\ql \li5668\sb3\sl-198\slmult0
\up0 \expndtw-2\charscalex100 06/09/2006 \par\pard\qj \li4253\sb0\sl-200\slmult0
\par\pard\qj\li4253\ri4112\sb21\sl-200\slmult0\fi44 \up0 \expndtw-2\charscalex100
privind aprobarea Normelor de supraveghere, \line \up0 \expndtw-2\charscalex100
prevenire \u351?i control al infec\u355?iilor nosocomiale �n \par\pard\ql
\li5463\sb15\sl-207\slmult0 \up0 \expndtw-2\charscalex100 unit\u259?\u355?ile
sanitare \par\pard\ql \li1799\sb0\sl-210\slmult0 \par\pard\ql\li1799\sb0\sl-
210\slmult0 \par\pard\ql\li1799\sb0\sl-210\slmult0
\par\pard\ql\li1799\ri1781\sb61\sl-210\slmult0\fi201\tx2001 \up0 \expndtw-
1\charscalex100 Av�nd �n vedere prevederile art. 168 alin. (1) din Legea nr.
95/2006 privind reforma �n domeniul s\u259?n\u259?t\u259?\u355?ii \up0 \expndtw-
1\charscalex100 \u351?i ale Hot\u259?r�rii Guvernului nr. 862/2006 privind
organizarea \u351?i func\u355?ionarea Ministerului S\u259?n\u259?t\u259?\u355?ii
Publice, \line\tab \up0 \expndtw-1\charscalex100 v\u259?z�nd Referatul de aprobare
al Autorit\u259?\u355?ii de S\u259?n\u259?tate Public\u259? nr. E.N. 2.476 din 27
iulie 2006, \par\pard\ql \li2000\sb193\sl-207\slmult0 \up0 \expndtw-2\charscalex100
ministrul s\u259?n\u259?t\u259?\u355?ii publice emite urm\u259?torul ordin:
\par\pard\qj \li1798\sb0\sl-200\slmult0 \par\pard\qj\li1798\ri2043\sb19\sl-
200\slmult0\fi151 \up0 \expndtw-1\charscalex100 Art. 1. - Se aprob\u259? Normele de
supraveghere, prevenire \u351?i control al infec\u355?iilor nosocomiale �n
unit\u259?\u355?ile \up0 \expndtw-1\charscalex100 sanitare, prev\u259?zute �n
anexele nr. I-V*) care fac parte integrant\u259? din prezentul ordin.
\par\pard\ql \li1950\sb0\sl-207\slmult0 \par\pard\ql\li1950\sb8\sl-207\slmult0 \up0
\expndtw-2\charscalex100 *) Anexele nr. II-V sunt reproduse �n facsimil.
\par\pard\qj \li1798\sb0\sl-200\slmult0 \par\pard\qj\li1798\ri2023\sb19\sl-
200\slmult0\fi151 \up0 \expndtw-1\charscalex100 Art. 2. - Depistarea/identificarea,
�nregistrarea \u351?i declararea/raportarea infec\u355?iilor nosocomiale de c\u259?
tre \up0 \expndtw-2\charscalex100 orice unitate sanitar\u259? sunt obligatorii.
\par\pard\qj \li1798\ri2183\sb0\sl-220\slmult0\fi151 \up0 \expndtw-1\charscalex100
Art. 3. - Fiecare unitate sanitar\u259? elaboreaz\u259? anual un program propriu de
supraveghere, prevenire \u351?i \up0 \expndtw-2\charscalex100 control al
infec\u355?iilor nosocomiale. \par\pard\qj \li1798\ri1773\sb0\sl-
200\slmult0\fi151 \up0 \expndtw-1\charscalex100 Art. 4. - Fondurile necesare
�ndeplinirii activit\u259?\u355?ilor din programul prev\u259?zut la art. 3 se vor
reg\u259?si distinct �n \up0 \expndtw-2\charscalex100 structura bugetului
unit\u259?\u355?ii. \par\pard\qj \li1798\ri1913\sb0\sl-210\slmult0\fi151 \up0
\expndtw-1\charscalex100 Art. 5. - Costurile aferente activit\u259?\u355?ilor de
supraveghere, prevenire \u351?i control al infec\u355?iilor nosocomiale se \up0
\expndtw-1\charscalex100 vor reg\u259?si �n valoarea serviciilor medicale decontate
de fiecare pl\u259?titor/asigur\u259?tor/finan\u355?ator aflat �n rela\u355?ie \up0
\expndtw-1\charscalex100 contractual\u259? cu unit\u259?\u355?ile sanitare, pentru
fiecare dintre pacien\u355?ii eligibili asista\u355?i. \par\pard\ql
\li1797\ri1943\sb0\sl-208\slmult0\fi151 \up0 \expndtw-1\charscalex100 Art. 6. - �n
toate unit\u259?\u355?ile sanitare activitatea de supraveghere \u351?i prevenire a
infec\u355?iilor nosocomiale face \up0 \expndtw-1\charscalex100 parte din
obliga\u355?iile profesionale ale personalului \u351?i va fi �nscris\u259? �n
fi\u351?a postului fiec\u259?rui salariat. \line \up0 \expndtw-1\charscalex100 Art.
7. - Orice daun\u259? adus\u259? pacien\u355?ilor prin nerespectarea prevederilor
prezentului ordin sau a \line \up0 \expndtw-1\charscalex100 normativelor
profesionale privind asigurarea calit\u259?\u355?ii �ngrijirilor medicale acordate
pacien\u355?ilor �n scopul \up0 \expndtw-1\charscalex100 prevenirii infec\u355?
iilor nosocomiale atrage responsabilitatea individual\u259? sau, dup\u259? caz,
institu\u355?ional\u259?, �n \line \up0 \expndtw-2\charscalex100 condi\u355?iile
prev\u259?zute de legisla\u355?ia �n vigoare. \par\pard\qj \li1797\ri2003\sb0\sl-
210\slmult0\fi151 \up0 \expndtw-1\charscalex100 Art. 8. - Direc\u355?iile de
specialitate din cadrul Ministerului S\u259?n\u259?t\u259?\u355?ii Publice,
unit\u259?\u355?ile sanitare din sistemul \up0 \expndtw-1\charscalex100 public
\u351?i privat, autorit\u259?\u355?ile de s\u259?n\u259?tate public\u259?
jude\u355?ene \u351?i, respectiv, a municipiului Bucure\u351?ti, precum \u351?i
\up0 \expndtw-1\charscalex100 Inspec\u355?ia sanitar\u259? de stat vor duce la
�ndeplinire prevederile prezentului ordin. \par\pard\ql \li1797\ri1873\sb0\sl-
206\slmult0\fi151 \up0 \expndtw-1\charscalex100 Art. 9. - La data intr\u259?rii �n
vigoare a prezentului ordin se abrog\u259? Ordinul ministrului s\u259?n\u259?
t\u259?\u355?ii nr. 994/2004 \up0 \expndtw-1\charscalex100 privind aprobarea
Normelor de supraveghere \u351?i control al infec\u355?iilor nosocomiale �n
unit\u259?\u355?ile sanitare, \line \up0 \expndtw-1\charscalex100 publicat �n
Monitorul Oficial al Rom�niei, Partea I, nr. 1.146 \u351?i 1.146 bis din 3
decembrie 2004. \line \up0 \expndtw-1\charscalex100 Art. 10. - Prezentul ordin va
fi publicat �n Monitorul Oficial al Rom�niei, Partea I. \par\pard\qj
\li4966\ri4827\sb189\sl-200\slmult0\fi221 \up0 \expndtw-2\charscalex100 Ministrul
s\u259?n\u259?t\u259?\u355?ii publice, \line \up0 \expndtw-2\charscalex100 Gheorghe
Eugen Nicol\u259?escu \par\pard\ql \li1998\sb0\sl-200\slmult0
\par\pard\ql\li1998\ri4161\sb21\sl-200\slmult0 \up0 \expndtw-2\charscalex100
Bucure\u351?ti, 27 iulie 2006. \line \up0 \expndtw-2\charscalex100 Nr. 916.
\expndtw-2\charscalex100 ANEXA Nr. I \par\pard\ql \li1948\sb0\sl-207\slmult0
\par\pard\ql\li1948\sb6\sl-207\slmult0 \up0 \expndtw-2\charscalex100 I. Criteriile
de definire a infec\u355?iei nosocomiale \par\pard\ql \li1796\ri1824\sb0\sl-
206\slmult0\fi201 \up0 \expndtw-1\charscalex100 Infec\u355?ia nosocomial\u259? (IN)
este infec\u355?ia contractat\u259? �n unit\u259?\u355?i sanitare cu paturi (de
stat \u351?i private), care se \line \up0 \expndtw-1\charscalex100 refer\u259? la
orice boal\u259? infec\u355?ioas\u259? ce poate fi recunoscut\u259? clinic \u351?
i/sau microbiologic \u351?i pentru care exist\u259? \line \up0 \expndtw-
1\charscalex100 dovada epidemiologic\u259? a contract\u259?rii �n timpul
spitaliz\u259?rii/actului medical sau manevrelor medicale, care \line \up0
\expndtw-1\charscalex100 afecteaz\u259? fie bolnavul - datorit\u259? �ngrijirilor
medicale primite, fie personalul sanitar - datorit\u259? activit\u259?\u355?ii sale
\u351?i \par\pard\sect\sectd\fs24\paperw12240\paperh15840\pard\sb0\sl-
240{\bkmkstart Pg2}{\bkmkend Pg2}\par\pard\qj \li1800\sb0\sl-200\slmult0
\par\pard\qj\li1800\sb0\sl-200\slmult0 \par\pard\qj\li1800\sb0\sl-200\slmult0
\par\pard\qj\li1800\sb0\sl-200\slmult0 \par\pard\qj\li1800\ri1851\sb15\sl-
200\slmult0 \up0 \expndtw-1\charscalex100 \ul0\nosupersub\cf1\f2\fs18 este
legat\u259? prin incuba\u355?ie de perioada asist\u259?rii medicale �n unitatea
respectiv\u259?, indiferent dac\u259? simptomele \up0 \expndtw-2\charscalex100
bolii apar sau nu apar pe perioada spitaliz\u259?rii. \par\pard\qj
\li1800\ri1720\sb21\sl-200\slmult0\fi201 \up0 \expndtw-1\charscalex100 Defini\u355?
ia infec\u355?iei nosocomiale se bazeaz\u259? pe date clinice, epidemiologice, de
laborator, precum \u351?i pe alte \up0 \expndtw-2\charscalex100 tipuri de teste de
diagnostic. \par\pard\ql \li1799\ri2023\sb0\sl-210\slmult0\fi201 \up0 \expndtw-
1\charscalex100 Fiecare caz de infec\u355?ie nosocomial\u259? trebuie dovedit
c\u259? se datoreaz\u259? spitaliz\u259?rii sau �ngrijirilor medico\up0 \expndtw-
1\charscalex100 sanitare ambulatorii �n unit\u259?\u355?i sanitare \u351?i c\u259?
nu era �n incuba\u355?ie sau �n faza de debut/evolu\u355?ie clinic\u259? �n \up0
\expndtw-2\charscalex100 momentul intern\u259?rii/actului medical/manevrei
medicale. \par\pard\qj \li1799\ri1692\sb0\sl-220\slmult0\fi151 \up0 \expndtw-
1\charscalex100 II. Organizarea activit\u259?\u355?ilor de supraveghere \u351?i
control al infec\u355?iilor nosocomiale �n unit\u259?\u355?ile sanitare publice
\up0 \expndtw-2\charscalex100 \u351?i private cu paturi \par\pard\ql
\li1950\sb1\sl-164\slmult0 \up0 \expndtw-1\charscalex100 1. Unit\u259?\u355?ile
sanitare publice cu paturi (spitalul \u351?i alte unit\u259?\u355?i sanitare cu
paturi definite prin art. 172 din \par\pard\qj \li1799\ri1702\sb0\sl-
220\slmult0\fi0 \up0 \expndtw-1\charscalex100 Legea nr. 95/2006 privind reforma �n
domeniul s\u259?n\u259?t\u259?\u355?ii) asigur\u259? organizarea \u351?i func\u355?
ionarea unor servicii de \up0 \expndtw-2\charscalex100 supraveghere \u351?i control
al infec\u355?iilor nosocomiale, dup\u259? cum urmeaz\u259?: \par\pard\qj
\li1799\ri2042\sb0\sl-210\slmult0\fi151 \up0 \expndtw-1\charscalex100 a) la nivelul
spitalelor jude\u355?ene \u351?i al sectoarelor municipiului Bucure\u351?ti,
spitalelor clinice \u351?i universitare, \up0 \expndtw-1\charscalex100 respectiv al
institutelor de asisten\u355?\u259? medical\u259?, se organizeaz\u259? servicii
specializate de supraveghere \u351?i \up0 \expndtw-2\charscalex100 control al
infec\u355?iilor nosocomiale. \par\pard\ql \li2001\sb1\sl-172\slmult0 \up0
\expndtw-1\charscalex100 Activitatea specific\u259? este asigurat\u259? prin
personal propriu, angajat �n acest scop. \par\pard\ql \li1798\ri1672\sb0\sl-
206\slmult0\fi202 \up0 \expndtw-1\charscalex100 Serviciul este organizat cu minimum
7 posturi, din care cel pu\u355?in un medic de specialitate epidemiolog sau \up0
\expndtw-1\charscalex100 microbiolog, cu func\u355?ie de \u351?ef serviciu, 2
clinicieni (specialit\u259?\u355?i chirurgicale \u351?i, respectiv, medical\u259?),
un \line \up0 \expndtw-1\charscalex100 farmacist, 1-2 cadre cu preg\u259?tire
postliceal\u259? de profil asistent medical \u351?i personal cu preg\u259?tire
medie cu o \up0 \expndtw-1\charscalex100 calificare adecvat\u259?
activit\u259?\u355?ilor, o persoan\u259? din serviciul administrativ;
\par\pard\ql \li1798\ri1752\sb15\sl-205\slmult0\fi151 \up0 \expndtw-1\charscalex100
b) la nivelul spitalelor municipale, or\u259?\u351?ene\u351?ti, comunale sau al
altor unit\u259?\u355?i cu paturi de asisten\u355?\u259? medical\u259? \up0
\expndtw-1\charscalex100 definite prin lege (art. 172 din Legea nr. 95/2006), prin
crearea/reorganizarea unui colectiv func\u355?ional cu \line \up0 \expndtw-
1\charscalex100 minimum 3 posturi normate, din care, �n func\u355?ie de num\u259?
rul paturilor din unitate, 0,5-1 norm\u259? de medic \line \up0 \expndtw-
1\charscalex100 specialist, 1-1,5 norm\u259? de cadre medii cu preg\u259?tire de
asistent medical \u351?i o norm\u259? de muncitor cu calificare \up0 \expndtw-
2\charscalex100 adecvat\u259? activit\u259?\u355?ii. \par\pard\ql
\li1797\ri1841\sb15\sl-206\slmult0\fi202 \up0 \expndtw-1\charscalex100 Pentru
coordonarea profesional\u259? a activit\u259?\u355?ii specifice sunt necesare
specialit\u259?\u355?ile de medic specialist \line \up0 \expndtw-1\charscalex100
epidemiolog, microbiolog, boli infec\u355?ioase sau, �n lipsa acestora, medic
specialist pediatru, neonatolog, \line \up0 \expndtw-1\charscalex100 obstetrician-
ginecolog etc., atestat ca absolvent al unui curs de perfec\u355?ionare
profesional\u259? specific\u259?, \line \up0 \expndtw-1\charscalex100 organizat de
autoritatea de s\u259?n\u259?tate public\u259? jude\u355?ean\u259? \u351?i a
municipiului Bucure\u351?ti sau de institutul regional \line \up0 \expndtw-
1\charscalex100 de s\u259?n\u259?tate public\u259?. Pentru posturile de cadre medii
- asisten\u355?i medicali, se vor angaja asisten\u355?i de igien\u259? \line
\up0 \expndtw-1\charscalex100 sau asisten\u355?i �ncadra\u355?i la sta\u355?ia
central\u259? de sterilizare, servicii de neonatologie, ATI, obstetric\u259?-
ginecologie \line \up0 \expndtw-1\charscalex100 etc., cu condi\u355?ia absolvirii
unui curs de perfec\u355?ionare specific\u259? organizat �n condi\u355?ii similare;
\par\pard\ql \li1948\sb0\sl-199\slmult0 \up0 \expndtw-1\charscalex100 c)
unit\u259?\u355?ile sanitare publice cu paturi, altele dec�t cele men\u355?ionate,
unit\u259?\u355?ile sanitare ambulatorii de \par\pard\ql \li1797\sb2\sl-198\slmult0
\up0 \expndtw-1\charscalex100 specialitate \u351?i de asisten\u355?\u259?
medical\u259? primar\u259? cu paturi de zi sau de o zi, unit\u259?\u355?ile
sanitare de asisten\u355?\u259? \par\pard\ql \li1797\ri1855\sb16\sl-206\slmult0
\up0 \expndtw-1\charscalex100 medico-social\u259?, sanatoriile, alte tipuri de
unit\u259?\u355?i sanitare, indiferent de forma de organizare, vor desemna, \up0
\expndtw-1\charscalex100 din personalul propriu, un medic responsabil pentru
activit\u259?\u355?ile specifice de supraveghere \u351?i control al \line \up0
\expndtw-1\charscalex100 infec\u355?iilor nosocomiale, cu activitate de 0,5
norm\u259?, remunerat\u259? ca ore suplimentare sau din venituri proprii, \up0
\expndtw-2\charscalex100 �n conformitate cu legea. \par\pard\ql \li1948\sb0\sl-
199\slmult0 \up0 \expndtw-1\charscalex100 2. Unit\u259?\u355?ile sanitare private
cu paturi vor r\u259?spunde pentru activit\u259?\u355?ile de supraveghere \u351?i
control al \par\pard\qj \li1797\ri2095\sb0\sl-220\slmult0 \up0 \expndtw-
1\charscalex100 infec\u355?iilor nosocomiale, prin asumarea
responsabilit\u259?\u355?ii profesionale \u351?i juridice de c\u259?tre personalul
astfel \up0 \expndtw-1\charscalex100 angajat sau de unitatea astfel
contractat\u259?, �n conformitate cu legisla\u355?ia. \par\pard\ql \li1948\sb1\sl-
176\slmult0 \up0 \expndtw-1\charscalex100 3. Unit\u259?\u355?ile medico-sanitare
care nu pot asigura activitatea de supraveghere \u351?i control al infec\u355?iilor
\par\pard\qj \li1797\ri1665\sb0\sl-210\slmult0 \up0 \expndtw-1\charscalex100
nosocomiale cu personal vor contracta serviciile specifice acestei structuri cu
autoritatea de s\u259?n\u259?tate public\u259? \up0 \expndtw-1\charscalex100
jude\u355?ean\u259? sau a municipiului Bucure\u351?ti, care �\u351?i asum\u259?
responsabilitatea profesional\u259? ori juridic\u259?, dup\u259? caz, \up0
\expndtw-2\charscalex100 pentru serviciile contractate �n prevenirea infec\u355?
iilor nosocomiale. \par\pard\ql \li1797\ri1814\sb10\sl-206\slmult0\fi151 \up0
\expndtw-1\charscalex100 4. �ndrumarea metodologic\u259? a personalului \u351?i a
activit\u259?\u355?ilor desf\u259?\u351?urate �n cadrul structurii de prevenire
\u351?i \line \up0 \expndtw-1\charscalex100 control al infec\u355?iilor nosocomiale
din unit\u259?\u355?ile sanitare publice se realizeaz\u259? de compartimentul de
\line \up0 \expndtw-1\charscalex100 specialitate din cadrul autorit\u259?\u355?ii
de s\u259?n\u259?tate public\u259?. Pentru unit\u259?\u355?ile sanitare private
aceste activit\u259?\u355?i se \line \up0 \expndtw-1\charscalex100 asigur\u259?, la
solicitare, de c\u259?tre autoritatea de s\u259?n\u259?tate public\u259?, pe
baz\u259? de contract de prest\u259?ri servicii. \par\pard\ql
\li1796\ri1776\sb0\sl-206\slmult0\fi151 \up0 \expndtw-1\charscalex100 5.
Interven\u355?ia \u351?i expertiza de specialitate, �n cazul unor focare epidemice
sau situa\u355?ii de risc declarat, sunt \up0 \expndtw-1\charscalex100 asigurate,
la solicitarea unit\u259?\u355?ii ori prin autosesizare, de c\u259?tre
compartimentele specializate ale autorit\u259?\u355?ii de \up0 \expndtw-
1\charscalex100 s\u259?n\u259?tate public\u259? jude\u355?ene \u351?i a
municipiului Bucure\u351?ti, cu titlu de gratuitate, din bugetul de stat, �n cadrul
\up0 \expndtw-2\charscalex100 programelor na\u355?ionale de s\u259?n\u259?tate.
III. Atribu\u355?iile institu\u355?ionale \u351?i individuale �n activitatea de
prevenire \u351?i combatere a infec\u355?iilor nosocomiale �n \up0 \expndtw-
2\charscalex100 unit\u259?\u355?ile sanitare publice \u351?i private
\par\pard\ql \li1947\sb1\sl-169\slmult0 \up0 \expndtw-2\charscalex100 1.
Atribu\u355?iile comitetului director al unit\u259?\u355?ii sanitare:
- solicit\u259? \u351?i aprob\u259? planul anual de activitate pentru supravegherea
\u351?i controlul infec\u355?iilor nosocomiale; \up0 \expndtw-1\charscalex100 -
organizarea \u351?i func\u355?ionarea serviciului de supraveghere \u351?i control
al infec\u355?iilor nosocomiale \u351?i/sau \up0 \expndtw-1\charscalex100
realizarea contractelor de furnizare de servicii necesare prevenirii \u351?i
controlului infec\u355?iilor nosocomiale; \up0 \expndtw-1\charscalex100 -
asigur\u259? condi\u355?iile de implementare �n activitate a prevederilor planului
anual de activitate pentru \line \up0 \expndtw-2\charscalex100 supravegherea \u351?
i controlul infec\u355?iilor nosocomiale;
\par\pard\sect\sectd\fs24\paperw12240\paperh15840\pard\sb0\sl-240{\bkmkstart Pg3}
{\bkmkend Pg3}\par\pard\qj \li1799\sb0\sl-200\slmult0 \par\pard\qj\li1799\sb0\sl-
200\slmult0 \par\pard\qj\li1799\sb0\sl-200\slmult0 \par\pard\qj\li1799\sb0\sl-
200\slmult0 \par\pard\qj\li1799\ri2191\sb15\sl-200\slmult0\fi151 \up0 \expndtw-
1\charscalex100 \ul0\nosupersub\cf1\f2\fs18 - asigur\u259? analiza anual\u259? a
�ndeplinirii obiectivelor planului de activitate, rezultatele ob\u355?inute,
eficien\u355?a \up0 \expndtw-2\charscalex100 economic\u259? a m\u259?surilor \u351?
i investi\u355?iilor finan\u355?ate; \par\pard\ql \li1950\sb15\sl-207\slmult0
\up0 \expndtw-1\charscalex100 - verific\u259? \u351?i aprob\u259? alocarea
bugetului aferent derul\u259?rii activit\u259?\u355?ilor fundamentate prin planul
anual de \par\pard\qj \li1798\ri1683\sb0\sl-210\slmult0\fi0 \up0 \expndtw-
1\charscalex100 activitate pentru supravegherea \u351?i controlul infec\u355?iilor
nosocomiale \u351?i �mbun\u259?t\u259?\u355?irea continu\u259? a condi\u355?iilor
de \up0 \expndtw-1\charscalex100 desf\u259?\u351?urare a activit\u259?\u355?ilor
\u351?i a dot\u259?rii tehnico-materiale necesare evit\u259?rii sau diminu\u259?rii
riscului pentru infec\u355?ie \up0 \expndtw-2\charscalex100 nosocomial\u259?;
- derularea legal\u259? a achizi\u355?iilor \u351?i aprovizionarea tehnico-
material\u259?, prev\u259?zute �n planul de activitate sau \up0 \expndtw-
1\charscalex100 impuse de situa\u355?ia epidemiologic\u259? din unitate, �n vederea
diminu\u259?rii ori evit\u259?rii situa\u355?iilor de risc sau \line \up0 \expndtw-
2\charscalex100 combaterii infec\u355?iilor nosocomiale;
- comitetul director al spitalului va asigura condi\u355?iile de igien\u259?,
privind cazarea \u351?i alimenta\u355?ia pacien\u355?ilor; \up0 \expndtw-
1\charscalex100 - delibereaz\u259? \u351?i decide, la propunerea Colegiului
Medicilor din Rom�nia sau ca urmare a sesiz\u259?rii \line \up0 \expndtw-
1\charscalex100 asista\u355?ilor �n privin\u355?a responsabilit\u259?\u355?ii
institu\u355?ionale ori individuale a personalului angajat/contractat, pentru
\up0 \expndtw-1\charscalex100 fapte sau situa\u355?ii care au dus la lezarea
drepturilor ori au prejudiciat starea de s\u259?n\u259?tate a asista\u355?ilor prin
\up0 \expndtw-2\charscalex100 infec\u355?ie nosocomial\u259? depistat\u259? \u351?i
declarat\u259?; \par\pard\qj \li1798\ri2413\sb0\sl-200\slmult0\fi151 \up0 \expndtw-
1\charscalex100 - asigur\u259? dotarea necesar\u259? organiz\u259?rii \u351?i
func\u355?ion\u259?rii sistemului informa\u355?ional pentru �nregistrarea, \up0
\expndtw-1\charscalex100 stocarea, prelucrarea \u351?i transmiterea informa\u355?
iilor privind infec\u355?iile nosocomiale. \par\pard\ql \li1949\sb2\sl-
195\slmult0 \up0 \expndtw-2\charscalex100 2. Atribu\u355?iile managerului
unit\u259?\u355?ii sanitare: \par\pard\qj \li1797\ri1734\sb21\sl-
200\slmult0\fi151 \up0 \expndtw-1\charscalex100 - r\u259?spunde de organizarea
structurilor profesionale de supraveghere \u351?i control al infec\u355?iilor
nosocomiale �n \line \up0 \expndtw-1\charscalex100 conformitate cu prevederile
prezentului ordin, diferen\u355?iat �n func\u355?ie de �ncadrarea unit\u259?\u355?
ii �n conformitate cu \line \up0 \expndtw-2\charscalex100 legea; \par\pard\qj
\li1797\ri2034\sb21\sl-200\slmult0\fi151 \up0 \expndtw-1\charscalex100 -
particip\u259? la definitivarea propunerilor de activitate \u351?i achizi\u355?ii
cuprinse �n planul anual al unit\u259?\u355?ii pentru \up0 \expndtw-2\charscalex100
supravegherea \u351?i controlul infec\u355?iilor nosocomiale; \par\pard\qj
\li1797\ri2593\sb21\sl-200\slmult0\fi151 \up0 \expndtw-1\charscalex100 - r\u259?
spunde de asigurarea bugetar\u259? aferent\u259? activit\u259?\u355?ilor cuprinse
�n planul anual aprobat pentru \up0 \expndtw-2\charscalex100 supravegherea \u351?i
controlul infec\u355?iilor nosocomiale; \par\pard\ql \li1949\sb2\sl-198\slmult0
\up0 \expndtw-1\charscalex100 - controleaz\u259? \u351?i r\u259?spunde pentru
organizarea \u351?i derularea activit\u259?\u355?ilor proprii ale \par\pard\ql
\li1797\ri1774\sb17\sl-205\slmult0\fi0 \up0 \expndtw-1\charscalex100
compartimentului/serviciului sau, dup\u259? caz, ale responsabilului nominalizat cu
supravegherea \u351?i controlul \up0 \expndtw-1\charscalex100 infec\u355?iilor
nosocomiale, ca structur\u259? de activitate �n direct\u259? subordine \u351?i
coordonare; \line \up0 \expndtw-1\charscalex100 - controleaz\u259? respectarea
normativelor cuprinse �n planul anual de activitate pentru supravegherea \u351?i
\up0 \expndtw-1\charscalex100 controlul infec\u355?iilor nosocomiale de la nivelul
sec\u355?iilor \u351?i serviciilor din unitate, �n colaborare cu responsabilul \up0
\expndtw-2\charscalex100 coordonator al activit\u259?\u355?ii specifice \u351?i cu
medicii \u351?efi de sec\u355?ie; \par\pard\ql \li1948\sb0\sl-199\slmult0 \up0
\expndtw-1\charscalex100 - analizeaz\u259? \u351?i propune solu\u355?ii de
rezolvare, dup\u259? caz, alocare de fonduri, pentru sesiz\u259?rile
compartimentului/serviciului/responsabilului de activitate specific\u259? �n
situa\u355?ii de risc sau focar de infec\u355?ie \up0 \expndtw-2\charscalex100
nosocomial\u259?; \par\pard\qj \li1796\ri1955\sb0\sl-210\slmult0\fi151 \up0
\expndtw-1\charscalex100 - verific\u259? \u351?i aprob\u259? eviden\u355?a
intern\u259? \u351?i informa\u355?iile transmise e\u351?aloanelor ierarhice,
conform legii sau la \up0 \expndtw-1\charscalex100 solicitare legal\u259?, aferente
activit\u259?\u355?ii de supraveghere, depistare, diagnostic, investigare
epidemiologic\u259?, \u351?i \up0 \expndtw-2\charscalex100 m\u259?surile de control
al focarului de infec\u355?ie nosocomial\u259? din unitate; \par\pard\ql
\li1947\sb1\sl-188\slmult0 \up0 \expndtw-1\charscalex100 - solicit\u259?, la
propunerea coordonatorului de activitate specializat\u259? sau din proprie
ini\u355?iativ\u259?, expertize \u351?i \par\pard\qj \li1796\ri1786\sb23\sl-
200\slmult0 \up0 \expndtw-1\charscalex100 investiga\u355?ii externe, consiliere
profesional\u259? de specialitate \u351?i interven\u355?ie �n focarele de
infec\u355?ie nosocomial\u259?; \up0 \expndtw-1\charscalex100 - angajeaz\u259?
unitatea pentru contractarea unor servicii \u351?i presta\u355?ii de
specialitate; \par\pard\ql \li1947\sb2\sl-198\slmult0 \up0 \expndtw-1\charscalex100
- reprezint\u259? unitatea �n litigii juridice legate de r\u259?spunderea
institu\u355?iei �n ceea ce prive\u351?te infec\u355?iile \par\pard\qj
\li1796\ri1706\sb21\sl-200\slmult0 \up0 \expndtw-1\charscalex100 nosocomiale,
respectiv ac\u355?ioneaz\u259? �n instan\u355?\u259? persoanele fizice, �n cazul
stabilirii responsabilit\u259?\u355?ii individuale \up0 \expndtw-2\charscalex100
pentru infec\u355?ie nosocomial\u259?. \par\pard\ql \li1947\sb2\sl-198\slmult0 \up0
\expndtw-2\charscalex100 3. Atribu\u355?iile directorului medical: \par\pard\ql
\li1947\sb15\sl-207\slmult0 \up0 \expndtw-1\charscalex100 - utilizarea �n
activitatea curent\u259?, la toate componentele activit\u259?\u355?ilor medicale de
preven\u355?ie, diagnostic, \par\pard\ql \li1795\sb1\sl-198\slmult0 \up0 \expndtw-
1\charscalex100 tratament \u351?i recuperare, a procedurilor \u351?i tehnicilor
prev\u259?zute �n protocoalele unit\u259?\u355?ii, a standardelor de
sterilizare \u351?i sterilitate, asepsie \u351?i antisepsie, respectiv a normelor
privind cazarea, alimenta\u355?ia \u351?i condi\u355?iile de \up0 \expndtw-
2\charscalex100 igien\u259? oferite pe perioada �ngrijirilor acordate; \par\pard\qj
\li1795\ri1865\sb0\sl-220\slmult0\fi151 \up0 \expndtw-1\charscalex100 - pentru
spitalele care nu �ndeplinesc condi\u355?iile legale de a avea director de
�ngrijiri, func\u355?ia acestuia este \up0 \expndtw-1\charscalex100 preluat\u259?
de directorul adjunct medical, care va avea acelea\u351?i responsabilit\u259?\u355?
i ca acesta. \par\pard\ql \li1947\sb1\sl-176\slmult0 \up0 \expndtw-2\charscalex100
4. Atribu\u355?iile directorului de �ngrijiri: \par\pard\ql \li1947\sb10\sl-
194\slmult0 \up0 \expndtw-1\charscalex100 - r\u259?spunde de aplicarea Precau\u355?
iunilor universale \u351?i izolare special\u259? a bolnavilor; \par\pard\qj
\li1795\ri1925\sb22\sl-200\slmult0\fi151 \up0 \expndtw-1\charscalex100 - r\u259?
spunde de comportamentul igienic al personalului din subordine, de respectarea
regulilor de tehnic\u259? \up0 \expndtw-2\charscalex100 aseptic\u259? de c\u259?tre
acesta; \par\pard\qj \li1795\ri1926\sb0\sl-220\slmult0\fi151 \up0 \expndtw-
1\charscalex100 - urm\u259?re\u351?te circula\u355?ia germenilor �n spital,
men\u355?ine leg\u259?tura cu laboratorul de microbiologie \u351?i
sesizeaz\u259? \up0 \expndtw-2\charscalex100 orice modificare; \par\pard\ql
\li1946\sb1\sl-176\slmult0 \up0 \expndtw-1\charscalex100 - urm\u259?re\u351?te
respectarea circuitelor func\u355?ionale din spital/sec\u355?ie �n func\u355?ie de
specific; \par\pard\qj \li1795\ri2356\sb0\sl-210\slmult0\fi151 \up0 \expndtw-
1\charscalex100 - r\u259?spunde de starea de cur\u259?\u355?enie din sec\u355?ie,
de respectarea normelor de igien\u259? \u351?i antiepidemice; \up0 \expndtw-
1\charscalex100 - propune directorului financiar-contabil planificarea
aprovizion\u259?rii cu materiale necesare prevenirii \up0 \expndtw-2\charscalex100
infec\u355?iilor nosocomiale \u351?i men\u355?inerii st\u259?rii de igien\u259?;
\par\pard\ql \li1946\sb1\sl-193\slmult0 \up0 \expndtw-2\charscalex100 -
controleaz\u259? respectarea m\u259?surilor de asepsie \u351?i antisepsie;
controleaz\u259? igiena bolnavilor \u351?i a �nso\u355?itorilor \u351?i face
educa\u355?ia sanitar\u259? a acestora;
{\bkmkend Pg4}\par\pard\ql \li1951\sb0\sl-207\slmult0 \par\pard\ql\li1951\sb0\sl-
207\slmult0 \par\pard\ql\li1951\sb0\sl-207\slmult0 \par\pard\ql\li1951\sb0\sl-
207\slmult0 \up0 \expndtw-1\charscalex100 \ul0\nosupersub\cf1\f2\fs18 - urm\u259?
re\u351?te efectuarea examenului organoleptic al alimentelor distribuite bolnavilor
\u351?i �nso\u355?itorilor \u351?i le \par\pard\qj \li1799\ri1902\sb0\sl-
220\slmult0\fi0 \up0 \expndtw-1\charscalex100 �ndep\u259?rteaz\u259? pe cele
necorespunz\u259?toare, situa\u355?ie pe care o aduce la cuno\u351?tin\u355?\u259?
medicului \u351?ef de sec\u355?ie \u351?i \up0 \expndtw-2\charscalex100 managerului
spitalului; \par\pard\qj \li1799\ri1841\sb0\sl-200\slmult0\fi151 \up0 \expndtw-
1\charscalex100 - constat\u259? \u351?i raporteaz\u259? managerului spitalului
deficien\u355?e de igien\u259? (alimentare cu ap\u259?, instala\u355?ii
sanitare, \up0 \expndtw-2\charscalex100 �nc\u259?lzire) \u351?i ia m\u259?suri
pentru remedierea acestora; \par\pard\qj \li1799\ri1951\sb1\sl-200\slmult0\fi151
\up0 \expndtw-1\charscalex100 - organizeaz\u259? \u351?i supravegheaz\u259?
preg\u259?tirea saloanelor pentru dezinfec\u355?ii periodice \u351?i ori de c�te
ori este \up0 \expndtw-2\charscalex100 nevoie; \par\pard\ql \li1950\sb2\sl-
198\slmult0 \up0 \expndtw-1\charscalex100 - particip\u259? la recoltarea probelor
de mediu \u351?i testarea eficacit\u259?\u355?ii dezinfec\u355?iei \u351?i
steriliz\u259?rii �mpreun\u259? cu \par\pard\ql \li1798\sb15\sl-207\slmult0
\up0 \expndtw-1\charscalex100 echipa compartimentului/serviciului de
supraveghere \u351?i control al infec\u355?iilor nosocomiale; \par\pard\qj
\li1798\ri1733\sb0\sl-200\slmult0\fi151 \up0 \expndtw-1\charscalex100 - urm\u259?
re\u351?te �n permanen\u355?\u259? respectarea de c\u259?tre personal \u351?i
�nso\u355?itori a m\u259?surilor de izolare \u351?i controleaz\u259? \up0 \expndtw-
2\charscalex100 prelucrarea bolnavilor la internare; \par\pard\qj
anun\u355?\u259? la serviciul de intern\u259?ri locurile disponibile, urm\u259?
re\u351?te internarea corect\u259? a bolnavilor �n func\u355?ie de \up0 \expndtw-
2\charscalex100 grupe de v�rst\u259?, infec\u355?iozitate sau receptivitate;
- urm\u259?re\u351?te aplicarea m\u259?surilor de izolare a bolnavilor cu caracter
infec\u355?ios \u351?i a m\u259?surilor pentru \up0 \expndtw-2\charscalex100
supravegherea contac\u355?ilor; \par\pard\qj \li1798\ri1793\sb0\sl-
200\slmult0\fi151 \up0 \expndtw-1\charscalex100 - instruie\u351?te personalul din
subordine privind autodeclararea �mboln\u259?virilor \u351?i urm\u259?re\u351?te
aplicarea acestor \up0 \expndtw-2\charscalex100 m\u259?suri; \par\pard\qj
semnaleaz\u259? medicului \u351?ef de sec\u355?ie cazurile de boli transmisibile pe
care le observ\u259? �n r�ndul \up0 \expndtw-2\charscalex100 personalului;
- instruie\u351?te \u351?i supravegheaz\u259? personalul din subordine asupra
m\u259?surilor de igien\u259? care trebuie respectate \line \up0 \expndtw-
1\charscalex100 de vizitatori \u351?i personalul spitalului care nu lucreaz\u259?
la paturi (portul echipamentului, evitarea aglomer\u259?rii �n \line \up0 \expndtw-
2\charscalex100 saloane); \par\pard\qj \li1797\ri1865\sb11\sl-200\slmult0\fi151
\up0 \expndtw-1\charscalex100 - instruie\u351?te personalul privind schimbarea la
timp a lenjeriei bolnavilor, colectarea \u351?i p\u259?strarea lenjeriei \up0
\expndtw-1\charscalex100 murdare, dezinfec\u355?ia lenjeriei de la bolnavii
infec\u355?io\u351?i, transportul lenjeriei murdare, transportul \u351?i p\u259?
strarea \up0 \expndtw-2\charscalex100 lenjeriei curate; \par\pard\qj
\li1798\ri2012\sb21\sl-200\slmult0\fi151 \up0 \expndtw-1\charscalex100 - urm\u259?
re\u351?te modul de colectare a de\u351?eurilor infec\u355?ioase \u351?i
neinfec\u355?ioase, a depozit\u259?rii lor, a modului de \up0 \expndtw-
2\charscalex100 transport \u351?i neutralizare a acestora; \par\pard\qj
controleaz\u259? \u351?i instruie\u351?te personalul din subordine asupra \u355?
inutei \u351?i comportamentului igienic, precum \u351?i \up0 \expndtw-
1\charscalex100 asupra respect\u259?rii normelor de tehnic\u259? aseptic\u259?
\u351?i propune medicului \u351?ef de sec\u355?ie m\u259?suri disciplinare �n
\up0 \expndtw-2\charscalex100 cazurile de abateri. \par\pard\ql \li1948\sb1\sl-
188\slmult0 \up0 \expndtw-2\charscalex100 5. Atribu\u355?iile directorului
financiar-contabil: \par\pard\ql \li1948\ri4624\sb23\sl-200\slmult0 \up0 \expndtw-
1\charscalex100 - planificarea bugetar\u259? �n conformitate cu planul de
activitate aprobat; \line \up0 \expndtw-2\charscalex100 - derularea achizi\u355?
iilor \u351?i pl\u259?\u355?ilor �n conformitate cu legisla\u355?ia; \line \up0
\expndtw-1\charscalex100 - evaluarea prin bilan\u355?ul contabil al eficien\u355?ei
indicatorilor specifici. \par\pard\ql \li1949\sb15\sl-207\slmult0 \up0 \expndtw-
2\charscalex100 6. Atribu\u355?iile medicului \u351?ef de sec\u355?ie: \par\pard\qj
organizeaz\u259?, controleaz\u259? \u351?i r\u259?spunde pentru derularea
activit\u259?\u355?ilor proprii sec\u355?iei, conform planului anual \up0 \expndtw-
1\charscalex100 de supraveghere \u351?i control al infec\u355?iilor nosocomiale din
unitatea sanitar\u259?; \par\pard\ql \li1948\sb14\sl-207\slmult0 \up0 \expndtw-
1\charscalex100 - r\u259?spunde de activit\u259?\u355?ile desf\u259?\u351?urate de
personalul propriu al sec\u355?iei. \par\pard\ql \li1948\sb1\sl-198\slmult0 \up0
\expndtw-2\charscalex100 7. Atribu\u355?iile medicului curant (indiferent de
specialitate): \par\pard\qj \li1797\ri2493\sb0\sl-210\slmult0\fi151 \up0 \expndtw-
1\charscalex100 - protejarea propriilor lor pacien\u355?i de al\u355?i pacien\u355?
i infecta\u355?i sau de personalul care poate fi infectat; \up0 \expndtw-
1\charscalex100 - aplicarea procedurilor \u351?i protocoalelor din planul anual de
supraveghere \u351?i control al infec\u355?iilor \up0 \expndtw-2\charscalex100
nosocomiale; \par\pard\ql \li1797\ri2133\sb0\sl-213\slmult0\fi151 \up0 \expndtw-
1\charscalex100 - ob\u355?inerea specimenelor microbiologice necesare atunci c�nd o
infec\u355?ie este prezent\u259? sau suspect\u259?; \line \up0 \expndtw-
1\charscalex100 - raportarea cazurilor de infec\u355?ii intraspitalice\u351?ti
echipei \u351?i internarea pacien\u355?ilor infecta\u355?i; \line \up0 \expndtw-
1\charscalex100 - consilierea pacien\u355?ilor, vizitatorilor \u351?i personalului
�n leg\u259?tur\u259? cu tehnicile de prevenire a transmiterii \line \up0 \expndtw-
2\charscalex100 infec\u355?iilor; \par\pard\qj \li1797\ri2214\sb0\sl-
200\slmult0\fi151 \up0 \expndtw-1\charscalex100 - instituirea tratamentului adecvat
pentru infec\u355?iile pe care le au ei �n\u351?i\u351?i \u351?i luarea de m\u259?
suri pentru a \up0 \expndtw-1\charscalex100 preveni transmiterea acestor
infec\u355?ii altor persoane, �n special pacien\u355?ilor. \par\pard\qj
Atribu\u355?iile medicului \u351?ef de compartiment/serviciu sau medicului
responsabil pentru supravegherea \u351?i \up0 \expndtw-2\charscalex100 controlul
infec\u355?iilor nosocomiale: \par\pard\qj \li1797\ri1663\sb0\sl-
220\slmult0\fi151 \up0 \expndtw-1\charscalex100 - elaboreaz\u259? \u351?i supune
spre aprobare planul anual de supraveghere \u351?i control al infec\u355?iilor
nosocomiale din \up0 \expndtw-2\charscalex100 unitatea sanitar\u259?;
- solicit\u259? includerea obiectivelor planului de activitate aprobat pentru
supravegherea \u351?i controlul infec\u355?iilor \up0 \expndtw-1\charscalex100
nosocomiale, condi\u355?ie a autoriz\u259?rii sanitare de func\u355?ionare,
respectiv component\u259? a criteriilor de acreditare; \up0 \expndtw-
1\charscalex100 - organizeaz\u259? activitatea serviciului de supraveghere \u351?i
control al infec\u355?iilor nosocomiale pentru \line \up0 \expndtw-1\charscalex100
implementarea \u351?i derularea activit\u259?\u355?ilor cuprinse �n planul anual de
supraveghere \u351?i control al infec\u355?iilor \line \up0 \expndtw-
2\charscalex100 nosocomiale al unit\u259?\u355?ii; \par\pard\qj
\li1797\ri1804\sb0\sl-200\slmult0\fi151 \up0 \expndtw-1\charscalex100 - propune
\u351?i ini\u355?iaz\u259? activit\u259?\u355?i complementare de preven\u355?ie sau
de control cu caracter de urgen\u355?\u259?, �n cazul \up0 \expndtw-2\charscalex100
unor situa\u355?ii de risc sau focar de infec\u355?ie nosocomial\u259?;
- r\u259?spunde pentru planificarea \u351?i solicitarea aprovizion\u259?rii
tehnico-materiale necesare activit\u259?\u355?ilor \up0 \expndtw-2\charscalex100
planificate, respectiv pentru situa\u355?ii de urgen\u355?\u259?; \par\pard\ql
\li1948\sb1\sl-172\slmult0 \up0 \expndtw-1\charscalex100 - r\u259?spunde pentru
activitatea personalului subordonat direct din cadrul structurii;
\par\pard\ql\li1798\ri1743\sb174\sl-207\slmult0\fi152 \up0 \expndtw-1\charscalex100
\ul0\nosupersub\cf1\f2\fs18 - asigur\u259? accesibilitatea la perfec\u355?
ionarea/preg\u259?tirea profesional\u259?, r\u259?spunde pentru instruirea
specific\u259? a \line \up0 \expndtw-1\charscalex100 subordona\u355?ilor
direc\u355?i \u351?i efectueaz\u259? evaluarea performan\u355?ei
activit\u259?\u355?ii profesionale a subordona\u355?ilor; \line \up0 \expndtw-
1\charscalex100 - elaboreaz\u259? cartea de vizit\u259? a unit\u259?\u355?ii care
cuprinde: caracterizarea succint\u259? a activit\u259?\u355?ilor acreditate;
\line \up0 \expndtw-1\charscalex100 organizarea serviciilor; dotarea edilitar\u259?
\u351?i tehnic\u259? a unit\u259?\u355?ii �n ansamblu \u351?i a subunit\u259?\u355?
ilor din structur\u259?; \line \up0 \expndtw-1\charscalex100 facilit\u259?\u355?ile
prin dot\u259?ri edilitar-comunitare de aprovizionare cu ap\u259?, �nc\u259?lzire,
curent electric; prepararea \u351?i \line \up0 \expndtw-1\charscalex100
distribuirea alimentelor; starea \u351?i dotarea sp\u259?l\u259?toriei;
depozitarea, evacuarea \u351?i neutralizarea, dup\u259? caz, a \line \up0 \expndtw-
1\charscalex100 reziduurilor menajere, precum \u351?i a celor rezultate din
activit\u259?\u355?ile de asisten\u355?\u259? medical\u259?; circuitele organice
\u351?i \line \up0 \expndtw-1\charscalex100 func\u355?ionale din unitate etc., �n
vederea caracteriz\u259?rii calitative \u351?i cantitative a riscurilor pentru
infec\u355?ie \line \up0 \expndtw-2\charscalex100 nosocomial\u259?; \par\pard\qj
�ntocme\u351?te harta punctelor \u351?i segmentelor de risc pentru infec\u355?ie
nosocomial\u259? privind modul de sterilizare
\up0 \expndtw-1\charscalex100 \u351?i men\u355?inerea sterilit\u259?\u355?ii �n
unitate, decontaminarea mediului fizic \u351?i cur\u259?\u355?enia din unitate,
zonele "fierbin\u355?i" cu \up0 \expndtw-1\charscalex100 activitate de risc sau cu
dotare tehnic\u259? \u351?i edilitar\u259? favorizant\u259? pentru infec\u355?ii
nosocomiale; \par\pard\qj \li1798\ri2245\sb0\sl-200\slmult0\fi151 \up0 \expndtw-
1\charscalex100 - elaboreaz\u259? "istoria" infec\u355?iilor nosocomiale din
unitate, cu concluzii privind cauzele facilitatoare ale \up0 \expndtw-
2\charscalex100 apari\u355?iei focarelor; \par\pard\ql \li1797\ri1662\sb6\sl-
206\slmult0\fi151 \up0 \expndtw-1\charscalex100 - coordoneaz\u259? elaborarea
\u351?i actualizarea anual\u259?, �mpreun\u259? cu consiliul de conducere \u351?i
cu \u351?efii sec\u355?iilor de \up0 \expndtw-1\charscalex100 specialitate, a
ghidului de prevenire a infec\u355?iilor nosocomiale, care va cuprinde:
legisla\u355?ia �n vigoare, \line \up0 \expndtw-1\charscalex100 defini\u355?iile de
caz pentru infec\u355?iile nosocomiale, protocoalele de proceduri, manopere \u351?i
tehnici de �ngrijire, \up0 \expndtw-1\charscalex100 precau\u355?ii de izolare,
standarde aseptice \u351?i antiseptice, norme de sterilizare \u351?i men\u355?inere
a sterilit\u259?\u355?ii, norme \up0 \expndtw-1\charscalex100 de dezinfec\u355?
ie \u351?i cur\u259?\u355?enie, metode \u351?i manopere specifice sec\u355?iilor
\u351?i specialit\u259?\u355?ilor aflate �n structura unit\u259?\u355?ii, \up0
\expndtw-1\charscalex100 norme de igien\u259? spitaliceasc\u259?, de cazare \u351?i
alimenta\u355?ie etc. Ghidul este propriu fiec\u259?rei unit\u259?\u355?i, dar
utilizeaz\u259? \up0 \expndtw-2\charscalex100 defini\u355?iile de caz care sunt
prev\u259?zute �n anexele la ordin; \par\pard\qj \li1797\ri1964\sb0\sl-
220\slmult0\fi151 \up0 \expndtw-1\charscalex100 - colaboreaz\u259? cu \u351?efii de
sec\u355?ie pentru implementarea m\u259?surilor de supraveghere \u351?i control al
infec\u355?iilor \up0 \expndtw-1\charscalex100 nosocomiale �n conformitate cu
planul de ac\u355?iune \u351?i ghidul propriu al unit\u259?\u355?ii;
verific\u259? respectarea normativelor \u351?i m\u259?surilor de prevenire;
organizeaz\u259? \u351?i particip\u259? la sistemul de autocontrol privind
evaluarea eficien\u355?ei activit\u259?\u355?ilor derulate; \par\pard\ql
particip\u259? \u351?i supravegheaz\u259? - �n calitate de consultant - politica de
antibiotico-terapie a unit\u259?\u355?ii \u351?i sec\u355?iilor; \up0 \expndtw-
1\charscalex100 - supravegheaz\u259?, din punct de vedere epidemiologic,
activitatea laboratorului de diagnostic etiologic \line \up0 \expndtw-
2\charscalex100 pentru infec\u355?iile suspecte sau clinic evidente;
- colaboreaz\u259? cu medicul laboratorului de microbiologie pentru cunoa\u351?
terea circula\u355?iei microorganismelor \up0 \expndtw-1\charscalex100 patogene de
la nivelul sec\u355?iilor \u351?i compartimentelor de activitate \u351?i a
caracteristicilor izolatelor sub aspectul \up0 \expndtw-2\charscalex100
antibiocinotipiilor; \par\pard\qj \li1797\ri1993\sb21\sl-200\slmult0\fi151 \up0
\expndtw-1\charscalex100 - solicit\u259? \u351?i trimite tulpini de microorganisme
izolate la laboratoarele de referin\u355?\u259?, at�t �n scopul ob\u355?inerii \up0
\expndtw-1\charscalex100 unor caracteristici suplimentare, c�t \u351?i �n cadrul
auditului extern de calitate; \par\pard\qj \li1797\ri2104\sb0\sl-
220\slmult0\fi151 \up0 \expndtw-1\charscalex100 - supravegheaz\u259? \u351?i
controleaz\u259? buna func\u355?ionare a procedurilor de sterilizare \u351?i
men\u355?inere a sterilit\u259?\u355?ii \up0 \expndtw-1\charscalex100 pentru
instrumentarul \u351?i materialele sanitare care sunt supuse steriliz\u259?rii;
- supravegheaz\u259? \u351?i controleaz\u259? efectuarea decontamin\u259?rii
mediului de spital prin cur\u259?\u355?are chimic\u259? \u351?i \up0 \expndtw-
2\charscalex100 dezinfec\u355?ie; \par\pard\ql \li1797\ri1703\sb2\sl-
200\slmult0\fi151 \up0 \expndtw-1\charscalex100 - supravegheaz\u259? \u351?i
controleaz\u259? activitatea blocului alimentar �n aprovizionarea, depozitarea,
prepararea \u351?i \up0 \expndtw-1\charscalex100 distribuirea alimentelor, cu
accent pe aspectele activit\u259?\u355?ii la buc\u259?t\u259?ria dietetic\u259?,
lactariu, biberonerie etc.; \up0 \expndtw-1\charscalex100 - supravegheaz\u259?
\u351?i controleaz\u259? calitatea presta\u355?iilor efectuate la sp\u259?l\u259?
torie; \par\pard\qj \li1796\ri1834\sb21\sl-200\slmult0\fi151 \up0 \expndtw-
1\charscalex100 - supravegheaz\u259? \u351?i controleaz\u259? activitatea de
�ndep\u259?rtare \u351?i neutralizare a reziduurilor, cu accent fa\u355?\u259?
de \up0 \expndtw-2\charscalex100 reziduurile periculoase rezultate din activitatea
medical\u259?; \par\pard\ql \li1947\sb2\sl-198\slmult0 \up0 \expndtw-
1\charscalex100 - supravegheaz\u259? \u351?i controleaz\u259? respectarea
circuitelor func\u355?ionale ale unit\u259?\u355?ii, circula\u355?ia asista\u355?
ilor \u351?i \par\pard\qj \li1796\ri1806\sb21\sl-200\slmult0\fi0 \up0 \expndtw-
1\charscalex100 vizitatorilor, a personalului \u351?i, dup\u259? caz, a
studen\u355?ilor \u351?i elevilor din �nv\u259?\u355?\u259?m�ntul universitar,
postuniversitar \up0 \expndtw-2\charscalex100 sau postliceal; \par\pard\ql
supravegheaz\u259? \u351?i controleaz\u259? respectarea �n sec\u355?iile
medicale \u351?i paraclinice a procedurilor profesionale \up0 \expndtw-
1\charscalex100 de supraveghere, triaj, depistare, izolare, diagnostic \u351?i
tratament pentru infec\u355?iile nosocomiale; \line \up0 \expndtw-1\charscalex100 -
supravegheaz\u259? \u351?i controleaz\u259? corectitudinea �nregistr\u259?rii
suspiciunilor de infec\u355?ie la asista\u355?i, derularea \up0 \expndtw-
1\charscalex100 investig\u259?rii etiologice a sindroamelor infec\u355?ioase,
operativitatea transmiterii informa\u355?iilor aferente la structura \up0 \expndtw-
2\charscalex100 de supraveghere \u351?i control al infec\u355?iilor nosocomiale;
- r\u259?spunde prompt la informa\u355?ia primit\u259? din sec\u355?ii \u351?i
demareaz\u259? ancheta epidemiologic\u259? pentru toate \up0 \expndtw-
2\charscalex100 cazurile suspecte de infec\u355?ie nosocomial\u259?;
- dispune, dup\u259? anun\u355?area prealabil\u259? a directorului medical al
unit\u259?\u355?ii, m\u259?surile necesare pentru limitarea \line \up0 \expndtw-
1\charscalex100 difuziunii infec\u355?iei, respectiv organizeaz\u259?, dup\u259?
caz, triaje epidemiologice \u351?i investiga\u355?ii paraclinice necesare; \line
\up0 \expndtw-1\charscalex100 - �ntocme\u351?te \u351?i definitiveaz\u259? ancheta
epidemiologic\u259? a focarului, difuzeaz\u259? informa\u355?iile necesare
privind \line \up0 \expndtw-1\charscalex100 focarul, �n conformitate cu
legisla\u355?ia, �ntreprinde m\u259?suri \u351?i activit\u259?\u355?i pentru
evitarea riscurilor identificate �n \line \up0 \expndtw-2\charscalex100 focar;
- solicit\u259? colabor\u259?rile interdisciplinare sau propune solicitarea
sprijinului extern conform reglement\u259?rilor �n \up0 \expndtw-2\charscalex100
vigoare; \par\pard\ql \li1946\sb1\sl-194\slmult0 \up0 \expndtw-1\charscalex100 -
coordoneaz\u259? activitatea colectivului din subordine �n toate
activit\u259?\u355?ile asumate de \par\pard\qj \li1795\ri3007\sb22\sl-
200\slmult0 \up0 \expndtw-1\charscalex100 compartimentul/serviciul sau colectivul
de supraveghere \u351?i control al infec\u355?iilor nosocomiale. \up0 \expndtw-
1\charscalex100 - �ntocme\u351?te, pentru subordona\u355?i, fi\u351?a postului
\u351?i programul de activitate;
\ul0\nosupersub\cf1\f2\fs18 - raporteaz\u259? \u351?efilor ierarhici problemele
depistate sau constatate �n prevenirea \u351?i controlul infec\u355?iilor \line
\up0 \expndtw-1\charscalex100 nosocomiale, prelucreaz\u259? \u351?i difuzeaz\u259?
informa\u355?iile legate de focarele de infec\u355?ii interioare investigate, \line
\up0 \expndtw-1\charscalex100 prezint\u259? activitatea profesional\u259?
specific\u259? �n fa\u355?a consiliului de conducere, a direc\u355?iunii \u351?i a
consiliului de \up0 \expndtw-2\charscalex100 administra\u355?ie; \par\pard\qj
�ntocme\u351?te rapoarte cu dovezi la dispozi\u355?ia managerului spitalului, �n
cazurile de investigare a \up0 \expndtw-2\charscalex100 responsabilit\u259?\u355?
ilor pentru infec\u355?ie nosocomial\u259?. \par\pard\ql \li1950\sb1\sl-175\slmult0
\up0 \expndtw-2\charscalex100 9. Atribu\u355?iile \u351?efului laboratorului de
microbiologie: \par\pard\qj \li1799\ri1892\sb0\sl-210\slmult0\fi151 \up0 \expndtw-
1\charscalex100 - implementarea sistemului de asigurare a calit\u259?\u355?ii, care
reprezint\u259? un ansamblu de ac\u355?iuni prestabilite \u351?i \up0 \expndtw-
1\charscalex100 sistematice necesare pentru a demonstra
faptul c\u259? serviciile oferite (analize medicale) satisfac cerin\u355?ele
\up0 \expndtw-2\charscalex100 referitoare la calitate; \par\pard\qj
\li1799\ri2242\sb0\sl-220\slmult0\fi151 \up0 \expndtw-1\charscalex100 - elaborarea
ghidurilor pentru recoltarea, manipularea, transportul \u351?i prezervarea
corect\u259? a probelor \up0 \expndtw-1\charscalex100 biologice, care vor fi
�nso\u355?ite de cererea de analiz\u259? completat\u259? corect; \par\pard\qj
\li1799\ri2001\sb0\sl-210\slmult0\fi151 \up0 \expndtw-1\charscalex100 - elaborarea
manualului de biosiguran\u355?\u259? al laboratorului, utiliz�nd recomand\u259?rile
din Ghidul na\u355?ional de \up0 \expndtw-1\charscalex100 biosiguran\u355?\u259?
pentru laboratoarele medicale (edi\u355?ia 1/2005 sau cea mai recent\u259?
edi\u355?ie) �n scopul evit\u259?rii \up0 \expndtw-2\charscalex100 contamin\u259?
rii personalului \u351?i a mediului; \par\pard\ql \li1950\sb0\sl-162\slmult0
\up0 \expndtw-1\charscalex100 - �ntocmirea \u351?i derularea programului de
instruire a personalului din subordine �n domeniul specific al \par\pard\ql
\li1799\sb13\sl-190\slmult0 \up0 \expndtw-2\charscalex100 prevenirii \u351?i
controlului infec\u355?iilor nosocomiale; \par\pard\ql \li1950\sb16\sl-
207\slmult0 \up0 \expndtw-1\charscalex100 - identificarea corect\u259? a
microorganismelor patogene; �n cazul suspiciunii de infec\u355?ie nosocomial\u259?
va \par\pard\ql \li1799\sb1\sl-198\slmult0 \up0 \expndtw-1\charscalex100 asigura
identificarea c�t mai rapid\u259? a agentului etiologic al infec\u355?iilor
nosocomiale, �n colaborare cu \par\pard\ql \li1799\sb3\sl-198\slmult0 \up0
\expndtw-1\charscalex100 epidemiologul \u351?i medicul clinician (membri ai
serviciului de supraveghere \u351?i control al infec\u355?iilor \par\pard\qj
\li1798\ri1723\sb21\sl-200\slmult0\fi0 \up0 \expndtw-1\charscalex100 nosocomiale),
din produsele patologice recoltate de la bolnavi/purt\u259?tori (dac\u259? este
necesar, p�n\u259? la nivel de \up0 \expndtw-2\charscalex100 tipare
intraspecie); \par\pard\ql \li1950\sb15\sl-207\slmult0 \up0 \expndtw-
1\charscalex100 - furnizarea rezultatelor test\u259?rilor �ntr-o form\u259?
organizat\u259?, u\u351?or accesibil\u259?, �n cel mai scurt timp; \par\pard\ql
testeaz\u259? sensibilitatea/rezisten\u355?a la substan\u355?e antimicrobiene a
microorganismelor cu semnifica\u355?ie clinic\u259?, \up0 \expndtw-1\charscalex100
utiliz�nd metode standardizate; �\u351?i va selecta seturile de substan\u355?e
antimicrobiene adecvate pe care le va \up0 \expndtw-1\charscalex100 testa, �n
func\u355?ie de particularit\u259?\u355?ile locale/regionale ale rezisten\u355?elor
semnalate �n ultima perioad\u259? de timp, \u351?i \up0 \expndtw-1\charscalex100
antibioticele utilizate, cu respectarea integral\u259? a recomand\u259?rilor
standardului aplicat; \par\pard\qj \li1798\ri1762\sb0\sl-210\slmult0\fi151 \up0
\expndtw-1\charscalex100 - furnizeaz\u259? rezultatele test\u259?rii c�t mai rapid,
pentru �mbun\u259?t\u259?\u355?irea calit\u259?\u355?ii actului medical, prin
adoptarea \up0 \expndtw-1\charscalex100 unor decizii care s\u259? conduc\u259? la
reducerea riscului de apari\u355?ie a unor infec\u355?ii cauzate de bacterii
rezistente la \up0 \expndtw-2\charscalex100 antibiotice, dificil sau imposibil de
tratat; \par\pard\ql \li1949\sb1\sl-179\slmult0 \up0 \expndtw-1\charscalex100 -
realizeaz\u259? baza de date privind rezisten\u355?a la antibiotice, preferabil pe
suport electronic; \par\pard\qj \li1797\ri1693\sb24\sl-200\slmult0\fi151 \up0
\expndtw-1\charscalex100 - monitorizeaz\u259? rezultatele neobi\u351?nuite \u351?i
semnaleaz\u259? riscul apari\u355?iei unui focar de infec\u355?ie nosocomial\u259?
pe \up0 \expndtw-1\charscalex100 baza izol\u259?rii repetate a unor microorganisme
cu acela\u351?i fenotip (mai ales antibiotip), a unor microorganisme \up0 \expndtw-
1\charscalex100 rare ori prin izolarea unor microorganisme �nalt patogene
sau/\u351?i multirezistente; \par\pard\ql \li1949\sb15\sl-207\slmult0 \up0
\expndtw-1\charscalex100 - raporteaz\u259?, �n regim de urgen\u355?\u259?,
aspectele neobi\u351?nuite identificate prin monitorizarea izol\u259?rilor de
\par\pard\ql \li1797\ri1776\sb0\sl-210\slmult0 \up0 \expndtw-1\charscalex100
microorganisme \u351?i a rezisten\u355?ei la antibiotice \u351?i periodic,
trimestrial, serviciului de supraveghere \u351?i control al \up0 \expndtw-
1\charscalex100 infec\u355?iilor nosocomiale rezultatele cumulate privind izolarea
microorganismelor patogene \u351?i evolu\u355?ia \line \up0 \expndtw-
2\charscalex100 rezisten\u355?ei la antibiotice; \par\pard\qj
monitorizeaz\u259? rezultatele tratamentului pentru fiecare pacient, la
recomandarea clinicianului \u351?i medicului \up0 \expndtw-2\charscalex100
epidemiolog; \par\pard\ql \li1797\ri1834\sb4\sl-208\slmult0\fi151 \up0 \expndtw-
1\charscalex100 - monitorizeaz\u259? impactul utiliz\u259?rii de antibiotice \u351?
i al politicilor de control al infec\u355?iilor la nivelul spitalului; \up0
\expndtw-1\charscalex100 - spitalele care primesc finan\u355?are pentru controlul
infec\u355?iilor nosocomiale asigur\u259? �n cadrul programului \up0 \expndtw-
1\charscalex100 na\u355?ional de supraveghere a infec\u355?iilor nosocomiale �n
sistem santinel\u259? izolarea, identificarea \u351?i testarea \up0 \expndtw-
1\charscalex100 rezisten\u355?ei la antibiotice a microorganismelor patogene,
conform metodologiei transmise de Centrul pentru \up0 \expndtw-1\charscalex100
Prevenirea \u351?i Controlul Bolilor Transmisibile, \u351?i colaboreaz\u259? la
nivel na\u355?ional pentru aplicarea protocoalelor \up0 \expndtw-2\charscalex100
Sistemului european de supraveghere a rezisten\u355?ei la antibiotice; \par\pard\ql
\li1948\sb1\sl-198\slmult0 \up0 \expndtw-1\charscalex100 - stocheaz\u259? tulpini
microbiene de importan\u355?\u259? epidemiologic\u259? �n vederea studiilor
epidemiologice \par\pard\ql \li1797\sb3\sl-198\slmult0 \up0 \expndtw-
1\charscalex100 comparative, cu respectarea reglement\u259?rilor legale privind
biosecuritatea \u351?i biosiguran\u355?a (de exemplu, \par\pard\ql
\li1797\ri1674\sb16\sl-206\slmult0 \up0 \expndtw-1\charscalex100 Legea nr. 339/2005
privind regimul juridic al plantelor, substan\u355?elor \u351?i preparatelor
stupefiante \u351?i psihotrope); \up0 \expndtw-1\charscalex100 - trimite tulpini
microbiene, conform metodologiei de supraveghere �n sistem santinel\u259? a
infec\u355?iilor \line \up0 \expndtw-1\charscalex100 nosocomiale \u351?i
protocoalelor EARSS \u351?i/sau �n orice suspiciune de infec\u355?ie
nosocomial\u259?, pentru identificare \up0 \expndtw-1\charscalex100 prin tehnici de
biologie molecular\u259? \u351?i aprofundarea mecanismelor de rezisten\u355?\u259?
la antibiotice. \par\pard\ql \li1948\sb0\sl-199\slmult0 \up0 \expndtw-
2\charscalex100 10. Atribu\u355?iile farmacistului: \par\pard\qj
\li1797\ri2495\sb0\sl-220\slmult0\fi151 \up0 \expndtw-1\charscalex100 - ob\u355?
inerea, depozitarea \u351?i distribuirea preparatelor farmaceutice, utiliz�nd
practici care limiteaz\u259? \up0 \expndtw-2\charscalex100 posibilitatea
transmisiei agentului infec\u355?ios c\u259?tre pacien\u355?i; \par\pard\qj
distribuirea medicamentelor antiinfec\u355?ioase \u351?i \u355?inerea unei
eviden\u355?e adecvate (poten\u355?\u259?, incompatibilitate, \up0 \expndtw-
2\charscalex100 condi\u355?ii de depozitare \u351?i deteriorare); \par\pard\qj
\li1948\ri3425\sb2\sl-200\slmult0 \up0 \expndtw-1\charscalex100 - ob\u355?inerea
\u351?i depozitarea vaccinurilor sau serurilor \u351?i distribuirea lor �n mod
adecvat; \up0 \expndtw-1\charscalex100 - p\u259?strarea eviden\u355?ei
antibioticelor distribuite departamentelor medicale; \par\pard\qj
\li1797\ri1824\sb0\sl-220\slmult0\fi151 \up0 \expndtw-1\charscalex100 - �naintarea
c\u259?tre serviciul de supraveghere \u351?i control al infec\u355?iilor
nosocomiale a sumarului rapoartelor \u351?i \up0 \expndtw-2\charscalex100
tendin\u355?elor utiliz\u259?rii antibioticelor;
207\slmult0 \up0 \expndtw-1\charscalex100 \ul0\nosupersub\cf1\f2\fs18 - p\u259?
strarea la dispozi\u355?ie a urm\u259?toarelor informa\u355?ii legate de
dezinfectan\u355?i, antiseptice \u351?i de al\u355?i agen\u355?i \par\pard\ql
\li1799\ri1830\sb0\sl-208\slmult0\fi0 \up0 \expndtw-1\charscalex100 antiinfec\u355?
io\u351?i: propriet\u259?\u355?i active �n func\u355?ie de concentra\u355?ie,
temperatur\u259?, durata ac\u355?iunii, spectrul antibiotic, \line \up0 \expndtw-
1\charscalex100 propriet\u259?\u355?i toxice, inclusiv senzitivitatea sau iritarea
pielii \u351?i mucoasei, substan\u355?e care sunt incompatibile cu \up0 \expndtw-
1\charscalex100 antibioticele sau care le reduc poten\u355?a, condi\u355?ii fizice
care afecteaz\u259? �n mod negativ poten\u355?a pe durata \line \up0 \expndtw-
1\charscalex100 depozit\u259?rii (temperatur\u259?, lumin\u259?, umiditate),
efectul d\u259?un\u259?tor asupra materialelor; \line \up0 \expndtw-1\charscalex100
- participarea la �ntocmirea normelor pentru antiseptice, dezinfectan\u355?i \u351?
i produse utilizate la sp\u259?larea \u351?i \line \up0 \expndtw-2\charscalex100
dezinfectarea m�inilor; \par\pard\ql \li1951\sb1\sl-189\slmult0 \up0 \expndtw-
1\charscalex100 - participarea la �ntocmirea normelor pentru utilizarea
echipamentului \u351?i materialelor pacien\u355?ilor; \par\pard\qj
participarea
la controlul calit\u259?\u355?ii tehnicilor utilizate pentru sterilizarea
echipamentului �n spital, inclusiv \up0 \expndtw-1\charscalex100 selectarea
echipamentului de sterilizare (tipul dispozitivelor) \u351?i monitorizarea.
Atribu\u355?iile asistentei/sorei medicale responsabile de un salon:
implementeaz\u259? practicile de �ngrijire a pacien\u355?ilor �n vederea
controlului infec\u355?iilor; \par\pard\qj \li1799\ri2213\sb0\sl-
200\slmult0\fi151 \up0 \expndtw-1\charscalex100 - se familiarizeaz\u259? cu
practicile de prevenire a apari\u355?iei \u351?i r\u259?sp�ndirii infec\u355?
iilor \u351?i aplicarea practicilor \up0 \expndtw-2\charscalex100 adecvate pe
toat\u259? durata intern\u259?rii pacien\u355?ilor; \par\pard\ql \li1951\sb14\sl-
207\slmult0 \up0 \expndtw-1\charscalex100 - men\u355?ine igiena, conform
politicilor spitalului \u351?i practicilor de �ngrijire adecvate din salon;
monitorizeaz\u259? tehnicile aseptice, inclusiv sp\u259?larea pe m�ini \u351?i
utilizarea izol\u259?rii; \par\pard\qj \li1799\ri1811\sb0\sl-220\slmult0\fi151 \up0
\expndtw-1\charscalex100 - informeaz\u259? cu promptitudine medicul de gard\u259?
�n leg\u259?tur\u259? cu apari\u355?ia semnelor de infec\u355?ie la unul dintre
\up0 \expndtw-2\charscalex100 pacien\u355?ii afla\u355?i �n �ngrijirea sa;
- ini\u355?iaz\u259? izolarea pacientului \u351?i comand\u259? ob\u355?inerea
specimenelor de la to\u355?i pacien\u355?ii care prezint\u259? semne \up0 \expndtw-
1\charscalex100 ale unei boli transmisibile, atunci c�nd medicul nu este momentan
disponibil; \par\pard\qj \li1798\ri1802\sb2\sl-200\slmult0\fi151 \up0 \expndtw-
1\charscalex100 - limiteaz\u259? expunerea pacientului la infec\u355?ii provenite
de la vizitatori, personalul spitalului, al\u355?i pacien\u355?i sau \up0 \expndtw-
2\charscalex100 echipamentul utilizat pentru diagnosticare; \par\pard\qj
\li1798\ri2153\sb21\sl-200\slmult0\fi151 \up0 \expndtw-1\charscalex100 - men\u355?
ine o rezerv\u259? asigurat\u259? \u351?i adecvat\u259? de materiale pentru salonul
respectiv, medicamente \u351?i alte \up0 \expndtw-2\charscalex100 materiale
necesare �ngrijirii pacientului; \par\pard\ql \li1949\sb2\sl-198\slmult0 \up0
\expndtw-2\charscalex100 - identific\u259? infec\u355?iile nosocomiale;
\par\pard\qj \li1949\ri3793\sb21\sl-200\slmult0\fi0 \up0 \expndtw-1\charscalex100 -
investigheaz\u259? tipul de infec\u355?ie \u351?i agentul patogen, �mpreun\u259? cu
medicul curant; \up0 \expndtw-2\charscalex100 - particip\u259? la preg\u259?tirea
personalului; \par\pard\ql \li1949\sb2\sl-198\slmult0 \up0 \expndtw-2\charscalex100
- particip\u259? la investigarea epidemiilor; \par\pard\ql \li1949\sb15\sl-
207\slmult0 \up0 \expndtw-1\charscalex100 - asigur\u259? comunicarea cu
institu\u355?iile de s\u259?n\u259?tate public\u259? \u351?i cu alte
autorit\u259?\u355?i, unde este cazul. \par\pard\ql \li1949\sb1\sl-198\slmult0 \up0
\expndtw-1\charscalex100 12. Atribu\u355?iile autorit\u259?\u355?ii de s\u259?
n\u259?tate public\u259? jude\u355?ene, respectiv a municipiului Bucure\u351?ti:
- desemneaz\u259? din compartimentul de specialitate persoane care asigur\u259?
suport tehnic profesional pentru \up0 \expndtw-1\charscalex100 organizarea \u351?i
func\u355?ionarea planului de supraveghere a infec\u355?iilor nosocomiale, la
solicitare; \line \up0 \expndtw-1\charscalex100 - Inspec\u355?ia sanitar\u259? de
stat verific\u259? existen\u355?a \u351?i modul de aplicare a planului propriu al
spitalului de \line \up0 \expndtw-1\charscalex100 prevenire \u351?i control al
infec\u355?iilor nosocomiale, respectarea normelor de igien\u259?, func\u355?
ionalitatea circuitelor, \up0 \expndtw-1\charscalex100 dezinfec\u355?ia,
sterilizarea, respectarea prevederilor privind managementul de\u351?eurilor
medicale \u351?i dac\u259? sunt \up0 \expndtw-1\charscalex100 respectate m\u259?
surile serviciului de supraveghere \u351?i control al infec\u355?iilor
nosocomiale \u351?i/sau ale \line \up0 \expndtw-1\charscalex100 coordonatorului
programului/subprogramului de supraveghere a infec\u355?iilor nosocomiale din
compartimentele \up0 \expndtw-2\charscalex100 de specialitate ale
autorit\u259?\u355?ii de s\u259?n\u259?tate public\u259? jude\u355?ene.
\par\pard\ql \li9388\sb187\sl-207\slmult0 \up0 \expndtw-2\charscalex100 ANEXA Nr.
II \par\pard\ql \li3728\sb0\sl-200\slmult0 \par\pard\ql\li3728\ri3386\sb19\sl-
200\slmult0\tx3937 \up0 \expndtw-2\charscalex100 DEFINI\u354?IILE DE CAZ PENTRU
INFEC\u354?IILE NOSOCOMIALE: \line\tab \up0 \expndtw-2\charscalex100 Grupele de
Infec\u355?ii Nosocomiale cu frecven\u355?\u259? crescut\u259?: \par\pard\ql
\li5643\sb0\sl-207\slmult0 \par\pard\ql\li5643\sb8\sl-207\slmult0 \up0 \expndtw-
2\charscalex100 CAPITOLUL I \par\pard\ql \li4893\sb13\sl-207\slmult0 \up0 \expndtw-
2\charscalex100 INFEC\u354?IILE C\u258?ILOR URINARE \par\pard\ql \li1948\sb193\sl-
207\slmult0 \up0 \expndtw-2\charscalex100 a) Infec\u355?iile simptomatice ale
c\u259?ilor urinare \par\pard\ql \li1999\sb13\sl-207\slmult0 \up0 \expndtw-
1\charscalex100 Prezen\u355?a obligatorie a cel pu\u355?in unul din cele 2 criterii
de diagnostic: \par\pard\qj \li1948\ri1664\sb0\sl-200\slmult0\fi50 \up0 \expndtw-
1\charscalex100 Criteriul 1: Dintre simptomele de mai jos, �n absen\u355?a altor
cauze, prezen\u355?a a cel pu\u355?in una din urm\u259?toarele: \up0 \expndtw-
2\charscalex100 - la bolnavul �n v�rst\u259? de peste un an \par\pard\qj
\li1797\ri2449\sb20\sl-200\slmult0\fi151 \up0 \expndtw-1\charscalex100 \u8226?
febr\u259? (peste 38�C), senza\u355?ie acut\u259? de mic\u355?iune, mic\u355?iuni
frecvente, disurie, senza\u355?ie de tensiune \up0 \expndtw-2\charscalex100
suprapubian\u259?; \par\pard\ql \li1948\sb2\sl-198\slmult0 \up0 \expndtw-
2\charscalex100 - la copilul de un an sau sub un an v�rst\u259? \par\pard\qj
\li1948\ri2818\sb21\sl-200\slmult0 \up0 \expndtw-1\charscalex100 \u8226? febr\u259?
(peste 38�C) sau hipotermie (sub 37�C), apnee, bradicardie, disurie, apatie,
v\u259?rs\u259?turi \line \up0 \expndtw-2\charscalex100 \u351?i \par\pard\ql
\li1948\sb2\sl-198\slmult0 \up0 \expndtw-1\charscalex100 \u8226? bacteriurie
semnificativ\u259? (10\ul0\super\cf4\f5\fs18 5\ul0\nosupersub\cf1\f2\fs18
germeni/ml sau mai mare) cu cel mult dou\u259? specii microbiene izolate.
\par\pard\ql \li2001\sb15\sl-207\slmult0 \up0 \expndtw-1\charscalex100 Criteriul 2:
�n absen\u355?a altor cauze eviden\u355?iate, dintre simptomele men\u355?ionate la
criteriul anterior (1) \par\pard\qj \li1799\ri1762\sb0\sl-200\slmult0\fi151 \up0
\expndtw-1\charscalex100 - prezen\u355?a a cel pu\u355?in dou\u259? simptome pentru
bolnavul peste v�rsta de un an \u351?i cel pu\u355?in a unui simptom la \up0
\expndtw-2\charscalex100 copilul de un an, sau sub aceast\u259? v�rst\u259?;
\par\pard\ql \li2001\sb14\sl-207\slmult0 \up0 \expndtw-2\charscalex100 \u351?i
\par\pard\ql \li2001\sb1\sl-198\slmult0 \up0 \expndtw-2\charscalex100 cel pu\u355?
in una din condi\u355?iile de mai jos:
1\charscalex100 \ul0\nosupersub\cf1\f2\fs18 - piurie (10 sau peste 10
leucocite/mm\ul0\super\cf4\f5\fs18 3\ul0\nosupersub\cf1\f2\fs18 urin\u259? sau cel
pu\u355?in 3 leucocite pe c�mp microscopic - putere de \up0 \expndtw-
2\charscalex100 m\u259?rire 1000x) \par\pard\ql \li1951\sb15\sl-207\slmult0 \up0
\expndtw-1\charscalex100 - eviden\u355?ierea bacteriuriei prin examen direct \u351?
i colora\u355?ia Gram din sedimentul urinar \par\pard\qj \li1799\ri2052\sb0\sl-
200\slmult0\fi151 \up0 \expndtw-1\charscalex100 - urocultur\u259? pozitiv\u259?
pentru acelea\u351?i bacterii uropatogene (gram negative sau S. saprophyticus), �n
cel \up0 \expndtw-2\charscalex100 pu\u355?in dou\u259? probe, cu un num\u259?r
minim de 10\ul0\super\cf4\f5\fs18 3\ul0\nosupersub\cf1\f2\fs18 germeni/ml
urin\u259? \par\pard\ql \li1799\ri1901\sb20\sl-200\slmult0\fi151 \up0 \expndtw-
1\charscalex100 - urocultur\u259? pozitiv\u259? pentru bacterii uropatogene dintr-o
singur\u259? prob\u259?, cu bacterii Gram negative sau S. \up0 \expndtw-
1\charscalex100 saprophyticus, cu un num\u259?r de germeni de </=
10\ul0\super\cf4\f5\fs18 5\ul0\nosupersub\cf1\f2\fs18 /ml urin\u259?, dac\u259?
bolnavul a primit o antibioticoterapie \up0 \expndtw-2\charscalex100 eficient\u259?
anterioar\u259? \par\pard\ql \li1951\sb15\sl-207\slmult0 \up0 \expndtw-
2\charscalex100 - medicul curant a emis diagnosticul de infec\u355?ie
urinar\u259? \par\pard\ql \li1951\sb1\sl-198\slmult0 \up0 \expndtw-1\charscalex100
- dac\u259? medicul curant a recomandat o antibiotico-terapie adecvat\u259? pentru
infec\u355?ie urinar\u259? \par\pard\qj \li1799\ri1751\sb0\sl-220\slmult0\fi201
\up0 \expndtw-1\charscalex100 Cultura pozitiv\u259? prelevat\u259? de pe v�rful
cateterului urinar nu este relevant\u259? pentru diagnosticul unei injec\u355?ii
\up0 \expndtw-2\charscalex100 urinare nosocomiale. \par\pard\qj
\li1799\ri2041\sb0\sl-200\slmult0\fi201 \up0 \expndtw-1\charscalex100 Recoltarea
probei de urin\u259? pentru examen microbiologic se efectueaz\u259? obligatoriu �n
condi\u355?ii aseptice \up0 \expndtw-2\charscalex100 (proba de urin\u259?
curat\u259? din jetul mijlociu) sau prin cateter. \par\pard\qj
\li1799\ri2162\sb2\sl-200\slmult0\fi200
\up0 \expndtw-1\charscalex100 �n cazul sugarului recoltarea probei pentru
urocultur\u259? se efectueaz\u259? prin cateterism sau prin punc\u355?ie \up0
\expndtw-2\charscalex100 suprapubian\u259?. \par\pard\qj \li1799\ri2111\sb0\sl-
220\slmult0\fi201 \up0 \expndtw-1\charscalex100 Cultura pozitiv\u259?
recoltat\u259? din interiorului recipientului de colectare a urinii poate fi
acceptat\u259? numai �n \up0 \expndtw-1\charscalex100 cazul corel\u259?rii pozitive
cu urocultur\u259? recoltat\u259? �n condi\u355?ii aseptice sau prin cateter.
\par\pard\ql \li1949\sb1\sl-176\slmult0 \up0 \expndtw-2\charscalex100 b)
Infec\u355?iile subclinice ale c\u259?ilor urinare \par\pard\ql \li2000\sb10\sl-
194\slmult0 \up0 \expndtw-1\charscalex100 Pentru diagnostic este nevoie de
prezen\u355?a a cel pu\u355?in unul din cele 2 criterii de mai jos: \par\pard\qj
\li1798\ri2403\sb22\sl-200\slmult0\fi201 \up0 \expndtw-1\charscalex100 Criteriul 1:
Bolnavul are un cateter urinar permanent, montat cu cel pu\u355?in 7 zile �naintea
efectu\u259?rii \up0 \expndtw-2\charscalex100 uroculturii \par\pard\ql
\li2000\sb15\sl-207\slmult0 \up0 \expndtw-2\charscalex100 \u351?i \par\pard\qj
\li2000\ri1745\sb0\sl-200\slmult0 \up0 \expndtw-1\charscalex100 urocultura este
pozitiv\u259? cu cel pu\u355?in 10\ul0\super\cf4\f5\fs18
5\ul0\nosupersub\cf1\f2\fs18 germeni/ml, nu cu mai mult de dou\u259? specii de
germeni identifica\u355?i \line \up0 \expndtw-2\charscalex100 \u351?i
bolnavul nu are o simptomatologie clinic manifest\u259? (febr\u259?, senza\u355?ie
de mic\u355?iune, disurie, mic\u355?iuni frecvente \up0 \expndtw-2\charscalex100
sau tensiune dureroas\u259? suprapubian\u259?). \par\pard\qj \li2001\ri2171\sb0\sl-
220\slmult0\fi0 \up0 \expndtw-1\charscalex100 Criteriul 2: Bolnavul nu are un
cateter permanent, montat cu 7 zile �naintea primei uroculturi pozitive \line
\up0 \expndtw-2\charscalex100 \u351?i \par\pard\qj \li1800\ri2294\sb0\sl-
200\slmult0\fi201 \up0 \expndtw-1\charscalex100 bolnavul are cel pu\u355?in
dou\u259? uroculturi pozitive cu cel pu\u355?in 10\ul0\super\cf4\f5\fs18
5\ul0\nosupersub\cf1\f2\fs18 germeni/ml urin\u259?, cu aceea\u351?i specie \up0
\expndtw-2\charscalex100 microbian\u259? sau cel mult cu dou\u259? specii
bacteriene izolate, \par\pard\ql \li2001\sb2\sl-199\slmult0 \up0 \expndtw-
2\charscalex100 \u351?i \par\pard\ql \li2001\sb2\sl-198\slmult0 \up0 \expndtw-
2\charscalex100 bolnavul nu are acuze \u351?i/sau senine clinice manifeste
Cultura pozitiv\u259? prelevat\u259? de pe v�rful cateterului urinar nu este
relevant\u259? pentru diagnosticul unei infec\u355?ii \up0 \expndtw-2\charscalex100
urinare nosocomiale. \par\pard\qj \li1799\ri2041\sb0\sl-200\slmult0\fi201 \up0
\expndtw-1\charscalex100 Recoltarea probei de urin\u259? pentru examen
microbiologic se efectueaz\u259? obligatoriu �n condi\u355?ii aseptice \up0
\expndtw-2\charscalex100 (proba de urin\u259? curat\u259? din jetul mijlociu) sau
prin cateter. \par\pard\qj \li1799\ri2603\sb2\sl-200\slmult0\fi151 \up0 \expndtw-
1\charscalex100 c) Alte infec\u355?ii ale c\u259?ilor urinare (rinichi, ureter,
vezica urinar\u259?, uretra \u351?i \u355?esuturile perirenale sau \up0 \expndtw-
2\charscalex100 retroperitoneale) \par\pard\ql \li2001\sb2\sl-198\slmult0 \up0
\expndtw-1\charscalex100 Din cele trei criterii de mai jos prezen\u355?a a cel
pu\u355?in unuia este obligatorie: \par\pard\qj \li1799\ri2182\sb21\sl-
200\slmult0\fi201 \up0 \expndtw-1\charscalex100 Criteriul 1: Din probele recoltate
(exclusiv urin\u259?) din teritoriul infectat sau din prelevatele histologice, \up0
\expndtw-2\charscalex100 cultivarea este pozitiv\u259? pentru microorganisme
Criteriul 2: Intraoperator este observat abcesul sau probele histopatologice
demonstreaz\u259? prezen\u355?a unui \up0 \expndtw-2\charscalex100 proces
inflamator-infec\u355?ios \par\pard\qj \li1950\ri4792\sb0\sl-220\slmult0\fi50
\up0 \expndtw-2\charscalex100 Criteriul 3: Simptomatologia de mai jos, cu
excluderea altor cauze: \line \up0 \expndtw-2\charscalex100 - febr\u259? (peste
38�C) \u351?i durere sau sensibilitate �n regiunea afectat\u259?; \par\pard\ql
\li1950\sb0\sl-162\slmult0 \up0 \expndtw-2\charscalex100 \u8226? este prezent\u259?
la bolnavul de un an sau mai mare de un an; \par\pard\ql \li1950\sb12\sl-
184\slmult0 \up0 \expndtw-1\charscalex100 - febr\u259? (peste 38�C) sau hipotermia
(sub 37�C), apneea, bradicardia, apatie, febra; \par\pard\ql \li1950\sb17\sl-
207\slmult0 \up0 \expndtw-2\charscalex100 \u8226? sunt prezente la copilul de 1 an
sau mai mic de un an. \par\pard\ql \li2000\sb1\sl-198\slmult0 \up0 \expndtw-
2\charscalex100 dintre criteriile de mai jos este prezent cel pu\u355?in unul:
\par\pard\ql \li1950\sb15\sl-207\slmult0 \up0 \expndtw-2\charscalex100 - eliminare
de puroi pe tubul de dren din teritoriul incriminat; \par\pard\qj
hemocultur\u259? pozitiv\u259? cu microorganisme acceptabile �n
concordan\u355?\u259? cu caracteristicile infec\u355?iei \up0 \expndtw-
2\charscalex100 suspectate; \par\pard\qj \li1950\ri5415\sb20\sl-200\slmult0 \up0
\expndtw-2\charscalex100 - dovada imagistic\u259? (Rx, CT sau MR) a procesului
infec\u355?ios; \line \up0 \expndtw-2\charscalex100 - infec\u355?ia este sus\u355?
inut\u259? de observa\u355?ia medicului curant; \par\pard\ql \li1950\sb2\sl-
198\slmult0 \up0 \expndtw-1\charscalex100 - medicul curant a prescris tratament
antimicrobian adecvat infec\u355?iei suspectate. \par\pard\ql \li5619\sb0\sl-
CAPITOLUL II \par\pard\ql \li4858\sb1\sl-198\slmult0 \up0 \expndtw-2\charscalex100
INFEC\u354?IILE POSTOPERATORII \par\pard\ql \li1950\sb0\sl-207\slmult0
\par\pard\ql\li1950\sb8\sl-207\slmult0 \up0 \expndtw-2\charscalex100 a) Infec\u355?
iile pl\u259?gii operatorii superficiale (de incizie)
207\slmult0 \up0 \expndtw-2\charscalex100 \ul0\nosupersub\cf1\f2\fs18 Cele 3
criterii care trebuie sa fie realizate sunt urm\u259?toarele: \par\pard\ql
\li2001\sb1\sl-198\slmult0 \up0 \expndtw-1\charscalex100 Criteriul 1: Infec\u355?ia
apare �ntr-un interval de 30 zile de la interven\u355?ia chirurgical\u259?
Criteriul 2: Infec\u355?ia cointereseaz\u259? numai \u355?esutul cutanat \u351?i
subcutanat din zona interven\u355?iei (inciziei) \up0 \expndtw-2\charscalex100
Criteriul 3: Este prezent\u259?, cel pu\u355?in una, din urm\u259?toarele
condi\u355?ii: \par\pard\ql \li1951\sb2\sl-198\slmult0 \up0 \expndtw-
1\charscalex100 - secre\u355?ie purulent\u259? la nivelul inciziei superficiale cu
sau f\u259?r\u259? confirmarea laboratorului; \par\pard\qj \li1799\ri1882\sb21\sl-
200\slmult0\fi151 \up0 \expndtw-1\charscalex100 - din prelevatul secre\u355?iei sau
prelevatul tisular recoltate �n condi\u355?ii aseptice de la nivelul inciziei
operatorii \up0 \expndtw-2\charscalex100 superficiale prin cultur\u259? pot fi puse
�n eviden\u355?\u259? germeni patogeni; \par\pard\qj \li1799\ri1891\sb0\sl-
210\slmult0\fi151 \up0 \expndtw-1\charscalex100 - din simptomele infec\u355?iei
sunt prezente cel pu\u355?in unu: durere sau sensibilitate, tumefiere local\u259?,
ro\u351?cat\u259? \up0 \expndtw-1\charscalex100 sau senza\u355?ie de c\u259?
ldur\u259? local\u259? respectiv cazul �n care chirurgul a redeschis plaga,
except�nd situa\u355?ia unui \up0 \expndtw-2\charscalex100 rezultat microbiologic
negativ; \par\pard\ql \li1950\ri3553\sb0\sl-210\slmult0 \up0 \expndtw-
1\charscalex100 - chirurgul sau medicul curant a diagnosticat infec\u355?ia
pl\u259?gii superficiale de incizie. \up0 \expndtw-1\charscalex100 Nu pot fi
considerate infec\u355?ie a inciziei superficiale urm\u259?toarele situa\u355?
ii: \line \up0 \expndtw-1\charscalex100 Abcesul de fir (inflama\u355?ie \u351?i
secre\u355?ie punctiform\u259? la nivelul pl\u259?gii de fir); \line \up0 \expndtw-
1\charscalex100 Infec\u355?ia la nivelul episiotomiei sau la nivelul pl\u259?gii de
circumcizIe al nou n\u259?scutului; \up0 \expndtw-2\charscalex100 Infec\u355?ia
pl\u259?gilor �n\u355?epate; \par\pard\ql \li1999\sb1\sl-177\slmult0 \up0 \expndtw-
2\charscalex100 Infec\u355?ia pl\u259?gilor de arsur\u259?; \par\pard\ql
\li1999\sb9\sl-194\slmult0 \up0 \expndtw-1\charscalex100 Infec\u355?ia pl\u259?
gilor de incizie penetrante �n fascie sau \u355?esutul muscular, \par\pard\ql
\li1950\sb16\sl-207\slmult0 \up0 \expndtw-2\charscalex100 b) Infec\u355?iile
pl\u259?gii operatorii profunde \par\pard\ql \li2000\sb1\sl-198\slmult0 \up0
\expndtw-2\charscalex100 Cele 3 criterii care trebuie realizate sunt urm\u259?
toarele: \par\pard\ql \li2000\sb3\sl-198\slmult0 \up0 \expndtw-1\charscalex100
Criteriul 1: Infec\u355?ia apare �n treizeci de zile de la interven\u355?ia
chirurgical\u259?; \par\pard\qj \li1798\ri2212\sb21\sl-200\slmult0\fi201 \up0
\expndtw-1\charscalex100 Excep\u355?ie constituie implantul, c�nd infec\u355?ia
ap\u259?rut\u259? p�n\u259? la un an de la aplicare semnific\u259? o infec\u355?
ie \up0 \expndtw-2\charscalex100 nosocomial\u259?; \par\pard\qj
Infec\u355?ia intereseaz\u259? \u355?esuturile profunde (ex. fascia sau
musculatura) de la nivelul
pl\u259?gii \up0 \expndtw-2\charscalex100 operatorii \par\pard\ql \li1999\sb2\sl-
198\slmult0 \up0 \expndtw-1\charscalex100 Criteriul 3: Cel pu\u355?in una din
urm\u259?toarele situa\u355?ii trebuie s\u259? fie prezent\u259?: \par\pard\qj
secre\u355?ie purulent\u259? din \u355?esuturile profunde ale pl\u259?gii
operatorii dar f\u259?r\u259? cointeresarea organelor sau \up0 \expndtw-
2\charscalex100 cavit\u259?\u355?ilor atinse prin interven\u355?ia
chirurgical\u259?; \par\pard\ql \li1797\ri1853\sb0\sl-206\slmult0\fi151 \up0
\expndtw-1\charscalex100 - dehiscen\u355?a spontan\u259? a pl\u259?gii operatorii
sau redeschiderea acesteia de c\u259?tre chirurg �n cazul �n care cel \up0
\expndtw-1\charscalex100 pu\u355?in una din urm\u259?toarele simptome sunt
prezente: febr\u259? peste 38�C, durere sau sensibilitate local\u259? cu \line \up0
\expndtw-1\charscalex100 condi\u355?ia unei culturi pozitive din prelevatul de
secre\u355?ie sau \u355?esut din plaga interesat\u259? (�n cazul culturii \line
\up0 \expndtw-2\charscalex100 negative, nu este cazul); \par\pard\qj
\li1797\ri2224\sb15\sl-200\slmult0\fi151 \up0 \expndtw-1\charscalex100 - examenul
clinic direct �n cazul reinterven\u355?iei, sau prin examen histologic sau
radiologie, se pune �n \up0 \expndtw-2\charscalex100 eviden\u355?\u259? abcedarea
sau semnele clare ale unei infec\u355?ii; \par\pard\ql \li1948\sb2\sl-
198\slmult0 \up0 \expndtw-1\charscalex100 - chirurgul sau medicul curant sus\u355?
ine un diagnostic de infec\u355?ia pl\u259?gii operatorii profunde. \par\pard\qj
\li1797\ri2574\sb21\sl-200\slmult0\fi201 \up0 \expndtw-1\charscalex100 Dac\u259?
infec\u355?ia cointereseaz\u259? concomitent structurile superficiale \u351?i
profunde ale pl\u259?gii operatorii \up0 \expndtw-2\charscalex100 diagnosticul va
fi de plag\u259? operatorie profund\u259?; \par\pard\qj \li1796\ri2015\sb0\sl-
220\slmult0\fi200 \up0 \expndtw-1\charscalex100 Infec\u355?ia organului sau
cavit\u259?\u355?ii operate care se dreneaz\u259? prin plag\u259?, este
considerat\u259? infec\u355?ie de plag\u259? \up0 \expndtw-2\charscalex100
operatorie profund\u259?. \par\pard\ql \li1947\sb1\sl-176\slmult0 \up0 \expndtw-
1\charscalex100 c) Infec\u355?iile postoperatorii ale organelor sau
cavit\u259?\u355?ilor instrumentate \par\pard\qj \li1796\ri1995\sb0\sl-
220\slmult0\fi201 \up0 \expndtw-1\charscalex100 Aceste infec\u355?ii pot apare pe
orice teritoriu al organismului care a fost instrumentat �n timpul interven\u355?
iei \up0 \expndtw-2\charscalex100 chirurgicale (excep\u355?ie \u355?esutul cutanat,
fascia \u351?i musculatura) \par\pard\qj \li1796\ri1814\sb0\sl-200\slmult0\fi201
\up0 \expndtw-1\charscalex100 Pentru infec\u355?iile incluse �n aceast\u259?
subgrup\u259? este necesar\u259? localizarea topografic\u259? mai exact\u259? a
infec\u355?iei \up0 \expndtw-2\charscalex100 dup\u259? clasificarea
recomandat\u259? mai jos: \par\pard\ql \li1997\sb3\sl-203\slmult0 \up0 \expndtw-
2\charscalex100 Infec\u355?iile c\u259?ilor urinare \par\pard\ql \li1996\sb1\sl-
199\slmult0 \up0 \expndtw-2\charscalex100 Infec\u355?iile c\u259?ilor respiratorii
superioare, faringita \par\pard\qj \li1996\ri5568\sb21\sl-200\slmult0\fi0 \up0
\expndtw-2\charscalex100 Infec\u355?ia c\u259?ilor respiratorii inferioare
(excep\u355?ie pneumonia) \up0 \expndtw-2\charscalex100 Infec\u355?ia
arterial\u259? sau venoas\u259? \par\pard\ql \li1997\ri4172\sb0\sl-220\slmult0 \up0
\expndtw-2\charscalex100 Miocardita \u351?i pericardita \line \up0 \expndtw-
2\charscalex100 Endocardita \par\pard\ql \li1997\sb1\sl-176\slmult0 \up0 \expndtw-
2\charscalex100 Mediastinita \par\pard\ql \li1996\ri3557\sb0\sl-220\slmult0 \up0
\expndtw-2\charscalex100 Infec\u355?iile ochiului, excep\u355?ie conjunctivita
\line \up0 \expndtw-2\charscalex100 Infec\u355?iile urechii \u351?i mastoidei
Infec\u355?iile cavit\u259?\u355?ii bucale (stomatit\u259?, glosit\u259?,
parodontit\u259?) \up0 \expndtw-2\charscalex100 Sinuzitele \par\pard\ql
\li1996\ri3792\sb6\sl-200\slmult0 \up0 \expndtw-2\charscalex100 Infec\u355?iile
tractului gastro-intestinal \line \up0 \expndtw-2\charscalex100 Infec\u355?iile
cavit\u259?\u355?ii intraabdominale \par\pard\ql \li1996\ri3131\sb0\sl-
220\slmult0 \up0 \expndtw-2\charscalex100 Infec\u355?iile intracraniene ale \u355?
esutului nervos \u351?i durei \line \up0 \expndtw-2\charscalex100 Meningita sau
ventriculita \par\pard\ql \li1997\sb1\sl-176\slmult0 \up0 \expndtw-2\charscalex100
Abcesul spinal f\u259?r\u259? meningit\u259? \par\pard\qj \li1996\ri5818\sb0\sl-
220\slmult0 \up0 \expndtw-2\charscalex100 Infec\u355?iile organelor reproductive
feminine \u351?i masculine \up0 \expndtw-2\charscalex100 Infec\u355?iile
vaginului \par\pard\ql \li1997\sb1\sl-181\slmult0 \up0 \expndtw-2\charscalex100
Abcesul mamar \u351?i mastita
207\slmult0 \up0 \expndtw-2\charscalex100 \ul0\nosupersub\cf1\f2\fs18
Endometrita \par\pard\ql \li2000\ri3714\sb0\sl-220\slmult0 \up0 \expndtw-
2\charscalex100 Infec\u355?iile intraarticulare \u351?i ale bursei \line \up0
\expndtw-2\charscalex100 Osteomielita \par\pard\ql \li2000\sb1\sl-175\slmult0
\up0 \expndtw-2\charscalex100 Infec\u355?iile meniscului intraarticular
\par\pard\ql \li2001\sb10\sl-194\slmult0 \up0 \expndtw-1\charscalex100 Cele 3
criterii obligatorii pentru diagnosticul situa\u355?iilor de mai sus sunt:
Infec\u355?ia apare �n intervalul de p�n\u259? la 30 zile de la interven\u355?ia
chirurgical\u259?. \par\pard\ql \li1799\ri1829\sb0\sl-
206\slmult0\fi202\tx2001\tx2001 \up0 \expndtw-1\charscalex100 Excep\u355?ie
constituie implantul, c�nd infec\u355?ia ap\u259?rut\u259? p�n\u259? la un an are
semnifica\u355?ia infec\u355?iei nosocomiale. \line\tab \up0 \expndtw-
1\charscalex100 Criteriul 2: Infec\u355?ia poate ap\u259?rea cu orice localizare
topografic\u259? �n func\u355?ie de organul sau cavitatea \line \up0 \expndtw-
1\charscalex100 interesat\u259? �n interven\u355?ia chirurgical\u259?, except�nd
\u355?esutul cutanat, fascia \u351?i musculatura. \line \tab \up0 \expndtw-
1\charscalex100 Criteriul 3: Din condi\u355?iile urm\u259?toare cel pu\u355?in una
trebuie s\u259? fie prezent\u259?: \line \up0 \expndtw-1\charscalex100 -
secre\u355?ie purulent\u259? eliminat\u259? prin drenul implantat �n organul sau
cavitatea operat\u259?; \line \up0 \expndtw-1\charscalex100 - rezultat pozitiv �n
cultur\u259? microbiologic\u259? dintr-o prob\u259? de secre\u355?ie sau prelevat
histologic de la nivelul \up0 \expndtw-2\charscalex100 organului sau
cavit\u259?\u355?ii vizat\u259? prin interven\u355?ia chirurgical\u259?;
- examenul clinic direct �n timpul reinterven\u355?iei, sau examenul histologic sau
radiologie pune �n eviden\u355?\u259? un \up0 \expndtw-1\charscalex100 proces de
abcedare sau semnele clare ale unei infec\u355?ii la nivelul organelor sau
cavit\u259?\u355?ilor atinse prin \line \up0 \expndtw-2\charscalex100
interven\u355?ia chirurgical\u259?; \par\pard\ql \li1949\sb1\sl-179\slmult0 \up0
\expndtw-1\charscalex100 - chirurgul sau medicul curant emite diagnosticul de
infec\u355?ie la nivelul organului sau cavit\u259?\u355?ii operate \par\pard\ql
\li1798\ri1782\sb19\sl-206\slmult0\fi201 \up0 \expndtw-1\charscalex100 Este posibil
ca infec\u355?ia organului sau cavit\u259?\u355?ii operate s\u259? se dreneze prin
plaga operatorie. Aceste infec\u355?ii \up0 \expndtw-1\charscalex100 de obicei nu
necesit\u259? reinterven\u355?ie operatorie \u351?i de cele mai multe ori pot fi
considerate ca o complica\u355?ie a \up0 \expndtw-1\charscalex100 pl\u259?gii de
incizie profund\u259?. Din acest motiv ele \u355?in de grupa infec\u355?iilor
pl\u259?gii operatorii profunde. Secre\u355?ia \line \up0 \expndtw-1\charscalex100
recoltat\u259? din organe sau cavit\u259?\u355?i este secre\u355?ie de plag\u259?
operatorie profund\u259?. \par\pard\ql \li5593\sb0\sl-207\slmult0
\par\pard\ql\li5593\sb7\sl-207\slmult0 \up0 \expndtw-2\charscalex100 CAPITOLUL
III \par\pard\ql \li4929\sb1\sl-198\slmult0 \up0 \expndtw-2\charscalex100 PNEUMONIA
NOSOCOMIAL\u258? \par\pard\ql \li1999\sb0\sl-207\slmult0
\par\pard\ql\li1999\sb8\sl-207\slmult0 \up0 \expndtw-1\charscalex100 Pentru
sus\u355?inerea diagnosticului sunt necesare realizarea a cel pu\u355?in unuia din
urm\u259?toarele 4 criterii: \par\pard\qj \li1797\ri1923\sb0\sl-
200\slmult0\fi201 \up0 \expndtw-1\charscalex100 Criteriul 1: La examinarea
fizic\u259? \u351?i stetacustic\u259? a bolnavului sunt prezente raluri crepitante
sau zon\u259? de \up0 \expndtw-2\charscalex100 matitate �n aria pulmonar\u259?
\par\pard\ql \li1999\sb1\sl-198\slmult0 \up0 \expndtw-2\charscalex100 din urm\u259?
toarele este prezent cel pu\u355?in un simptom: \par\pard\qj \li1948\ri3804\sb0\sl-
220\slmult0 \up0 \expndtw-1\charscalex100 - apari\u355?ia unei expectora\u355?ii
sau schimbarea caracterului expectora\u355?iei anterioare; \up0 \expndtw-
2\charscalex100 - hemocultura pozitiv\u259? cu flor\u259? microbian\u259?
patogen\u259?; \par\pard\qj \li1797\ri2463\sb0\sl-210\slmult0\fi151\tx1999 \up0
\expndtw-1\charscalex100 - demonstrarea agentului patogen din aspiratul
transtraheal, prelevat bronhoscopic sau bioptic. \line\tab \up0 \expndtw-
1\charscalex100 Criteriul 2: Examenul radiologie pulmonar al bolnavului
eviden\u355?iaz\u259? un infiltrat
pulmonar nou sau \line \up0 \expndtw-1\charscalex100 progresiv, o condensare sau
forma\u355?iune cavitar\u259? pulmonar\u259? sau o cointeresare pleural\u259?
prezen\u355?a a �nc\u259? cel pu\u355?in unul din urm\u259?toarele semne: \line
\up0 \expndtw-2\charscalex100 - secre\u355?ie purulent\u259? pe drenul aplicat al
teritoriului atins; \par\pard\ql \li1948\sb1\sl-183\slmult0 \up0 \expndtw-
1\charscalex100 - hemocultura pozitiv\u259? cu flor\u259? microbian\u259?
concordant\u259? cu aspectul infec\u355?iei suspicionate; \par\pard\ql
\li1948\sb8\sl-195\slmult0 \up0 \expndtw-1\charscalex100 - infec\u355?ia
demonstrat\u259? prin explor\u259?ri de imagistic\u259? (CT, MR, sau
Echografie); \par\pard\ql \li1948\sb16\sl-207\slmult0 \up0 \expndtw-1\charscalex100
- izolarea unui virus sau demonstrarea antigenului specific viral din secre\u355?
iile tractusului respirator; \par\pard\qj \li1796\ri1755\sb0\sl-
200\slmult0\fi151 \up0 \expndtw-1\charscalex100 - determinarea serologic\u259? a
unui anticorp IgM specific sau cre\u351?terea de cel pu\u355?in 4 ori a titrului
anticorpilor \up0 \expndtw-2\charscalex100 IgG specific din probe de seruri
perechi; \par\pard\ql \li1948\sb14\sl-207\slmult0 \up0 \expndtw-2\charscalex100 -
histologie relevant\u259? pentru pneumonie. \par\pard\qj \li1948\ri1943\sb0\sl-
220\slmult0\fi50 \up0 \expndtw-1\charscalex100 Criteriul 3: La copilul de un an sau
sub un an prezen\u355?a obligatorie a cel pu\u355?in 2 semne din urm\u259?
toarele: \up0 \expndtw-1\charscalex100 - apnee, tahicardie sau bradicardie,
detres\u259? respiratorie, tuse, wheezing \par\pard\ql \li1998\sb1\sl-
175\slmult0 \up0 \expndtw-2\charscalex100 \u351?i \par\pard\ql \li1998\sb10\sl-
194\slmult0 \up0 \expndtw-2\charscalex100 cel pu\u355?in una din urm\u259?toarele
condi\u355?ii: \par\pard\ql \li1948\sb16\sl-207\slmult0 \up0 \expndtw-
2\charscalex100 - secre\u355?ii mai abundente la nivelul c\u259?ilor
respiratorii; \par\pard\ql \li1948\sb1\sl-198\slmult0 \up0 \expndtw-2\charscalex100
- expectora\u355?ie nou ap\u259?rut\u259? sau schimbarea caracterelor
expectora\u355?iei; \par\pard\qj \li1796\ri2052\sb0\sl-210\slmult0\fi151 \up0
\expndtw-1\charscalex100 - izolarea prin hemocultura pozitiv\u259? a agentului
patogen sau eviden\u355?ierea serologic\u259? a anticorpilor IgM \line \up0
\expndtw-1\charscalex100 specifice sau cre\u351?terea de cel pu\u355?in 4 ori a
titrului anticorpilor IgG specifici �n probe de seruri perechi; \line \up0
\expndtw-1\charscalex100 - izolarea agentului patogen din aspiratul transtraheal,
prelevat bronhoscopic sau prob\u259? bioptic\u259?; \par\pard\ql \li1947\sb1\sl-
189\slmult0 \up0 \expndtw-2\charscalex100 - demonstrarea antigenelor virale din
secre\u355?ia c\u259?ilor respiratorii; \par\pard\ql \li1947\sb17\sl-207\slmult0
\up0 \expndtw-2\charscalex100 - histologie relevant\u259? pentru pneumonie.
\par\pard\ql \li1796\ri1933\sb0\sl-210\slmult0\fi201\tx1997 \up0 \expndtw-
1\charscalex100 Criteriul 4: La copilul de un an sau sub un an examenul radiologie
eviden\u355?iaz\u259? un infiltrat pulmonar nou \line \up0 \expndtw-1\charscalex100
sau progresiv, o imagine cavitar\u259? sau de condensare pulmonar\u259? sau o
cointeresare pleural\u259?. \line \tab \up0 \expndtw-2\charscalex100 \u351?i
in una din urm\u259?toarele: \par\pard\ql \li1947\sb6\sl-196\slmult0 \up0 \expndtw-
2\charscalex100 - secre\u355?ii mai abundente la nivelul c\u259?ilor
respiratorii; \par\pard\ql \li1947\sb15\sl-207\slmult0 \up0 \expndtw-
2\charscalex100 - expectora\u355?ie nou ap\u259?rut\u259? sau schimbarea
caracterelor expectora\u355?iei;
\ul0\nosupersub\cf1\f2\fs18 - izolarea prin hemocultur\u259? pozitiv\u259? a
agentului patogen sau eviden\u355?ierea serologic\u259? a anticorpilor IgM \line
\up0 \expndtw-1\charscalex100 specifice sau cre\u351?terea de cel pu\u355?in 4 ori
a titrului anticorpilor IgG specifici �n probe de seruri perechi; \line \up0
\expndtw-1\charscalex100 - izolarea agentului patogen din aspiratul transtraheal,
prelevat bronhoscopic sau prob\u259? bioptic\u259?; \par\pard\ql \li1950\sb1\sl-
197\slmult0 \up0 \expndtw-2\charscalex100 - demonstrarea antigenelor virale din
secre\u355?ia c\u259?ilor respiratorii; \par\pard\ql \li1950\sb3\sl-198\slmult0
\up0 \expndtw-2\charscalex100 - histologie relevant\u259? pentru pneumonie.
Examenul microbiologic prin cultur\u259? efectuat\u259? din secre\u355?iile
expectorate nu sunt de prea mare utilitate �n \up0 \expndtw-1\charscalex100
diagnosticul etiologic dar pot fi utilizate pentru orientarea etiologic\u259?
respectiv evaluarea sensibilit\u259?\u355?ii la \line \up0 \expndtw-2\charscalex100
antibioticele chimioterapice. \par\pard\ql \li2001\sb15\sl-207\slmult0 \up0
\expndtw-1\charscalex100 Examin\u259?rile radiologice seriate pot avea o utilitate
net superioar\u259? fa\u355?\u259? de imaginile unice. \par\pard\ql
\li5585\sb193\sl-207\slmult0 \up0 \expndtw-2\charscalex100 CAPITOLUL IV
\par\pard\ql \li3299\sb13\sl-207\slmult0 \up0 \expndtw-2\charscalex100 INFEC\u354?
IILE NOSOCOMIALE ALE \u354?ESUTULUI SANGVIN (S�NGELUI) \par\pard\ql
\li1950\sb193\sl-207\slmult0 \up0 \expndtw-2\charscalex100 a) Septicemia
dovedit\u259? etiologic prin examene de laborator \par\pard\ql \li2000\sb13\sl-
207\slmult0 \up0 \expndtw-1\charscalex100 Din cele 2 criterii de mai jos cel
pu\u355?in unul trebuie s\u259? fie �ndeplinite: \par\pard\qj
Una sau mai multe hemoculturi ale bolnavului este pozitiv\u259? pentru
microorganisme \line \up0 \expndtw-2\charscalex100 \u351?i \par\pard\ql
\li2000\ri2092\sb20\sl-200\slmult0 \up0 \expndtw-1\charscalex100 microorganismul
izolat din hemocultur\u259? nu este �n rela\u355?ie de cauzalitate cu alte
infec\u355?ii ale pacientului \up0 \expndtw-1\charscalex100 Criteriul 2: Din
simptomele de mai jos prezen\u355?a a cel pu\u355?in unul este obligatorie:
\line \up0 \expndtw-2\charscalex100 La bolnavul peste v�rsta de un an: \par\pard\ql
\li1950\ri3398\sb16\sl-206\slmult0 \up0 \expndtw-2\charscalex100 - febr\u259?
(peste 38�C), frisoane, hipotensiune. \line \up0 \expndtw-2\charscalex100 La
copilul de un an sau sub un an: \line \up0 \expndtw-2\charscalex100 - febr\u259?
(peste 38�C) apnee, bradicardie. \line \up0 \expndtw-2\charscalex100 \u351?i
\par\pard\ql \li2000\sb0\sl-199\slmult0 \up0 \expndtw-1\charscalex100 din cele trei
situa\u355?ii de mai jos cel pu\u355?in una trebuie s\u259? fie
�ndeplinit\u259?: \par\pard\ql \li1950\sb15\sl-207\slmult0 \up0 \expndtw-
1\charscalex100 - flora bacterian\u259? comensual\u259? (de ex. difteromorfii,
Bacillus sp. Propionibacterium sp., stafilococi \par\pard\qj \li1798\ri1743\sb0\sl-
200\slmult0\fi0 \up0 \expndtw-1\charscalex100 coagulazo negativi, etc.) trebuie
s\u259? fie prezent\u259? �n hemocultur\u259? �n cel pu\u355?in dou\u259? probe
recoltate la intervale \up0 \expndtw-2\charscalex100 de timp diferite; \par\pard\qj
\li1798\ri1713\sb20\sl-200\slmult0\fi151 \up0 \expndtw-1\charscalex100 - flora
comensual\u259? mai sus citat\u259? este �n hemocultur\u259? pozitiv\u259? a unui
pacient cu cateter vascular montat \u351?i \up0 \expndtw-2\charscalex100 medicul
curant recomand\u259? antibioticoterapie adecvat\u259?; \par\pard\qj
\li1798\ri1692\sb0\sl-220\slmult0\fi151 \up0 \expndtw-1\charscalex100 - testele
directe de eviden\u355?iere a unor antigenele specifice din s�nge sunt pozitive (de
ex. H. influenzae, S. \up0 \expndtw-2\charscalex100 pneumoniae, N. meningitidis,
streptococi grup B, etc.) \u351?i \par\pard\qj \li1797\ri2575\sb0\sl-
200\slmult0\fi200 \up0 \expndtw-1\charscalex100 toate aceste simptomatologii \u351?
i probe pozitive de laborator nu sunt �n rela\u355?ie cu o alt\u259? infec\u355?ie
a \up0 \expndtw-2\charscalex100 pacientului. \par\pard\qj \li1797\ri2445\sb2\sl-
200\slmult0\fi200 \up0 \expndtw-1\charscalex100 Flebita purulent\u259?,
confirmat\u259? prin cultur\u259? pozitiv\u259? din recoltarea de pe cateterul
vascular dar f\u259?r\u259? \up0 \expndtw-2\charscalex100 hemocultur\u259?
pozitiv\u259? este considerat\u259? infec\u355?ie local\u259? vascular\u259?.
Hemocultur\u259? pozitiv\u259? care nu poate fi corelat\u259? cu alt\u259?
infec\u355?ie a bolnavului este considerat\u259? infec\u355?ie \up0 \expndtw-
2\charscalex100 bacteriologic confirmat\u259? a \u355?esutului sangvin.
Pseudobacteriemiile (bacteriemiile tranzitorii sau prin suprainfectarea probei
recoltate) nu sunt \up0 \expndtw-2\charscalex100 considerate infec\u355?ii
nosocomiale ale \u355?esutului sangvin. \par\pard\ql \li1948\sb2\sl-199\slmult0
\up0 \expndtw-2\charscalex100 b) Septicemia clinic\u259? (Starea toxico-
septic\u259? clinic\u259?) \par\pard\ql \li1998\ri3605\sb0\sl-210\slmult0\fi0
\up0 \expndtw-1\charscalex100 Pentru confirmarea diagnosticului sunt necesare
realizarea urm\u259?toarelor 4 criterii: \up0 \expndtw-1\charscalex100 Criteriul 1:
Din simptomatologia de mai jos prezen\u355?a a cel pu\u355?in unui simptom: \up0
\expndtw-2\charscalex100 La bolnavul cu v�rst\u259? peste un an: \par\pard\qj
\li1796\ri1863\sb0\sl-220\slmult0\fi151
\up0 \expndtw-1\charscalex100 - febr\u259? (peste 38�C), hipotensiune cu presiunea
sistolic\u259? de 90 mm Hg sau sub aceast\u259? valoare, oligurie \up0 \expndtw-
2\charscalex100 cu 20 ml/or\u259? excre\u355?ie sau sub aceast\u259? valoare.
\par\pard\ql \li1998\sb1\sl-164\slmult0 \up0 \expndtw-2\charscalex100 La copilul de
un an sau sub aceast\u259? v�rst\u259?: \par\pard\qj \li1947\ri4782\sb0\sl-
220\slmult0 \up0 \expndtw-2\charscalex100 - febr\u259? (peste 38�C) sau hipotermie
(sub 37�C), apnee, bradicardie. \line \up0 \expndtw-2\charscalex100 \u351?i
Criteriul 2: Hemocultura nu a fost recoltat\u259? sau are o hemocultur\u259?
negativ\u259? \line \up0 \expndtw-2\charscalex100 \u351?i \par\pard\qj
cu excep\u355?ia simptomatologiei amintite la criteriul 1, nu sunt alte semne
relevante pentru o alt\u259? \up0 \expndtw-2\charscalex100 infec\u355?ie
Medicul curant a dispus un tratament adecvat pentru septicemie. \par\pard\qj
\li1796\ri2255\sb0\sl-200\slmult0\fi201 \up0 \expndtw-1\charscalex100 Septicemia
care se confirm\u259? prin hemocultur\u259? pozitiv\u259? este considerat\u259?
septicemie confirmat\u259? prin \up0 \expndtw-2\charscalex100 examene de laborator.
Septicemia nosocomial\u259? prin cateterism central - defini\u355?ie
epidemiologic\u259? \par\pard\qj \li1796\ri2024\sb0\sl-210\slmult0\fi201 \up0
\expndtw-1\charscalex100 Defini\u355?ia se bazeaz\u259? pe prezen\u355?a unui
cateter cu cap\u259?tul terminal �n apropierea inimii sau este montat \up0
\expndtw-1\charscalex100 �ntr-o arter\u259? sau ven\u259? central\u259?. Cateterul
montat la nivelul arterei sau venei ombilicale este considerat \line \up0 \expndtw-
2\charscalex100 cateter central.
\ul0\nosupersub\cf1\f2\fs18 Infec\u355?ia sanguin\u259? se consider\u259?
nosocomial\u259? �n rela\u355?ie cu folosirea cateterului, dac\u259? infec\u355?ia
apare la 48 \up0 \expndtw-1\charscalex100 ore de la aplicare. Dac\u259? infec\u355?
ia apare peste 48 ore de la montarea cateterului \u351?i nu sunt depistate alte
\up0 \expndtw-1\charscalex100 cauze pentru septicemie, defini\u355?ia de mai sus
poate fi acceptat\u259? \u351?i �n acest caz. \par\pard\ql \li1950\sb1\sl-
197\slmult0 \up0 \expndtw-2\charscalex100 d) Septicemia nosocomial\u259? prin
cateterism central - defini\u355?ie clinic\u259? \par\pard\qj
\li1798\ri2011\sb0\sl-210\slmult0\fi202 \up0 \expndtw-1\charscalex100 Defini\u355?
ia se bazeaz\u259? pe eviden\u355?ierea bacteriemiei/fungemiei la cel pu\u355?in o
hemocultur\u259? efectuat\u259? la un \up0 \expndtw-1\charscalex100 bolnav cu
cateter vascular care prezint\u259? o simptomatologie clinic\u259? compatibil\u259?
cu starea septic\u259? (febr\u259?, \up0 \expndtw-2\charscalex100 frison,
hipotensiune) \par\pard\ql \li2000\sb1\sl-189\slmult0 \up0 \expndtw-2\charscalex100
\u351?i \par\pard\qj \li2000\ri4623\sb22\sl-200\slmult0 \up0 \expndtw-
2\charscalex100 cu excep\u355?ia cateterului nu are alte cauze depistate pentru
septicemie \line \up0 \expndtw-2\charscalex100 sau \par\pard\ql \li2000\sb2\sl-
198\slmult0 \up0 \expndtw-2\charscalex100 oricare din situa\u355?iile de mai
jos: \par\pard\qj \li1798\ri2012\sb21\sl-200\slmult0\fi151 \up0 \expndtw-
1\charscalex100 - rezultatul unei culturi semnificativ pozitive de pe cateterul
central (semicantitativ peste 15 colonii/unit. \line \up0 \expndtw-1\charscalex100
cateter sau cantitativ peste 10\ul0\super\cf4\f5\fs18 3\ul0\nosupersub\cf1\f2\fs18
microorganisme/unitate de cateter) cu microorganisme izolate identice \line \up0
\expndtw-1\charscalex100 (specie \u351?i antibiocinotipie) cu microoganismele
izolate din hemocultur\u259? recoltat\u259? din circula\u355?ia periferic\u259?;
- rezultatul culturilor microbiene recoltate concomitent din vasele centrale \u351?
i periferic sunt pozitive \u351?i \up0 \expndtw-2\charscalex100 raportul
exprim\u259?rii cantitative central/periferic este peste 5/l; \par\pard\qj
\li1799\ri2191\sb0\sl-220\slmult0\fi151 \up0 \expndtw-1\charscalex100 - rezultatele
culturilor microbiene recoltate �n timpi diferi\u355?i (peste 2 ore diferen\u355?a)
de la nivelul vaselor \up0 \expndtw-2\charscalex100 centrale \u351?i periferice
demonstreaz\u259? identitate de patogen izolat. \par\pard\ql \li3914\sb175\sl-
207\slmult0 \up0 \expndtw-2\charscalex100 Grupele de Infec\u355?ii nosocomiale cu
frecven\u355?\u259? mai sc\u259?zut\u259?: \par\pard\ql \li5610\sb0\sl-
CAPITOLUL V \par\pard\ql \li3135\sb13\sl-207\slmult0 \up0 \expndtw-2\charscalex100
INFEC\u354?IILE NEPNEUMONICE ALE C\u258?ILOR RESPIRATORII INFERIOARE
\par\pard\ql \li1950\sb193\sl-207\slmult0 \up0 \expndtw-2\charscalex100 a)
Bron\u351?ita-, traheobron\u351?ita-, bron\u351?iolita-, traheita- nosocomial\u259?
Pentru definirea infec\u355?iilor traheobron\u351?ice prezen\u355?a a cel pu\u355?
in unuia din urm\u259?toarele criterii sunt \up0 \expndtw-2\charscalex100
obligatorii: \par\pard\qj \li2000\ri4383\sb0\sl-220\slmult0\fi0 \up0 \expndtw-
1\charscalex100 Criteriul 1: Bolnavul nu are semne clinice sau radiologice de
pneumonie \line \up0 \expndtw-2\charscalex100 \u351?i \par\pard\ql \li2000\sb1\sl-
176\slmult0 \up0 \expndtw-1\charscalex100 din cele de mai jos sunt prezente cel
pu\u355?in dou\u259? simptome, f\u259?r\u259? o alt\u259? cauz\u259?:
- febr\u259? (peste 38�C), tuse, expectora\u355?ie nou ap\u259?rut\u259? sau cu
cre\u351?tere cantitativ\u259? progresiv\u259? a acesteia, \up0 \expndtw-
2\charscalex100 stridor, respira\u355?ie superficial\u259? \par\pard\ql
\li2000\sb1\sl-181\slmult0 \up0 \expndtw-2\charscalex100 \u351?i \par\pard\ql
\li2000\sb8\sl-195\slmult0 \up0 \expndtw-2\charscalex100 realizarea a cel pu\u355?
in unuia din cele de mai jos: \par\pard\qj \li1950\ri3973\sb21\sl-
200\slmult0\fi0 \up0 \expndtw-1\charscalex100 - cultur\u259? pozitiv\u259? din
aspiratul traheal profund sau din prelevatul bronhoscopic \up0 \expndtw-
2\charscalex100 - detectarea antigenelor specifice din secre\u355?ia tractului
respirator. \par\pard\qj \li2000\ri2391\sb0\sl-220\slmult0\fi0 \up0 \expndtw-
1\charscalex100 Criteriul 2: La copilul de un an sau sub un an nu sunt semne
clinice sau radiologie de pneumonie \line \up0 \expndtw-2\charscalex100 \u351?i
\par\pard\ql \li2000\sb1\sl-176\slmult0 \up0 \expndtw-2\charscalex100 din
simptomele de mai jos sunt prezente cel pu\u355?in dou\u259? semne: \par\pard\qj
\li1798\ri2080\sb0\sl-220\slmult0\fi151 \up0 \expndtw-1\charscalex100 - febr\u259?
(peste 38�C), tuse, expectora\u355?ie nou ap\u259?rut\u259? sau cu cre\u351?tere
cantitativ\u259? progresiv\u259? a acesteia, \up0 \expndtw-2\charscalex100 stridor,
detres\u259? respiratorie, apnee sau bradicardie. \par\pard\ql \li2000\sb1\sl-
195\slmult0 \up0 \expndtw-2\charscalex100 este �ndeplinit\u259? cel pu\u355?in una
din urm\u259?toarele situa\u355?ii: \par\pard\qj \li1949\ri3923\sb21\sl-
200\slmult0\fi0 \up0 \expndtw-1\charscalex100 - cultur\u259? pozitiv\u259? din
aspiratul traheal profund sau din prelevatul bronhoscopic; \up0 \expndtw-
2\charscalex100 - detectarea antigenelor specifice din secre\u355?ia tractului
respirator; \par\pard\qj \li1798\ri2084\sb21\sl-200\slmult0\fi151 \up0 \expndtw-
1\charscalex100 - apari\u355?ia anticorpilor IgM specifice sau cre\u351?terea de
cel pu\u355?in 4 ori a litrului anticorpilor IgG specifici la \up0 \expndtw-
2\charscalex100 investigarea sero-etiologic\u259?, pe probe de seruri perechi.
Nu sunt incluse bron\u351?itele cronice ale bolnavilor cu tuberculoz\u259?
pulmonar\u259?, cu excep\u355?ia cazurilor �n care \up0 \expndtw-2\charscalex100
suprainfec\u355?ia acut\u259? poate fi demonstrat\u259? etiologic. \par\pard\qj
\li1949\ri5626\sb0\sl-200\slmult0 \up0 \expndtw-2\charscalex100 b) Alte infec\u355?
ii nosocomiale ale tractului respirator inferior \line \up0 \expndtw-
2\charscalex100 Din criteriile de mai jos trebuie �ndeplinite cel pu\u355?in
unul: \par\pard\qj \li1999\ri3992\sb2\sl-200\slmult0 \up0 \expndtw-1\charscalex100
Criteriul 1: Cultur\u259? microbian\u259? pozitiv\u259? din \u355?esutul pulmonar
sau lichid pleural \line \up0 \expndtw-1\charscalex100 Criteriul 2: Intraoperator
sau histopatologic se observ\u259? abces sau empiem \line \up0 \expndtw-
2\charscalex100 Criteriul 3: Examenul radiologie pulmonar prezint\u259? imagine de
abces \par\pard\qj \li1797\ri2584\sb21\sl-200\slmult0\fi201 \up0 \expndtw-
1\charscalex100 Concomiten\u355?a pneumoniei \u351?i a infec\u355?iei acute a
c\u259?ilor respiratorii inferioare cu aceea\u351?i etiologic \up0 \expndtw-
2\charscalex100 identificat\u259?, oblig\u259? la �ncadrarea patologiei la
"Pneumonie". \par\pard\ql \li1999\sb2\sl-198\slmult0 \up0 \expndtw-1\charscalex100
Abcesul pulmonar sau empiemul f\u259?r\u259? pneumonie se �ncadreaz\u259?
la infec\u355?ii ale tractului respirator inferior. \par\pard\ql \li5583\sb0\sl-
CAPITOLUL VI \par\pard\ql \li3433\sb1\sl-198\slmult0 \up0 \expndtw-2\charscalex100
INFEC\u354?IILE CUTANATE \u350?I ALE \u354?ESUTURILOR MOI SUBCUTANE \par\pard\ql
2\charscalex100 a) Infec\u355?iile pielii
207\slmult0 \up0 \expndtw-2\charscalex100 \ul0\nosupersub\cf1\f2\fs18 Din
criteriile de mai jos prezen\u355?a a cel pu\u355?in unul este obligatorie:
Prezen\u355?a unei secre\u355?ii purulente, pustul\u259?, vezicul\u259? sau
furuncul la nivelul pielii bolnavului. \par\pard\qj \li1799\ri1821\sb21\sl-
200\slmult0\fi201 \up0 \expndtw-1\charscalex100 Criteriul 2: Din simptomele de mai
jos sunt prezente cel pu\u355?in dou\u259? \u351?i acestea nu sunt �n leg\u259?
tur\u259? cu alte \up0 \expndtw-2\charscalex100 infec\u355?ii ale organismului:
\par\pard\qj \li1951\ri2531\sb0\sl-220\slmult0 \up0 \expndtw-1\charscalex100 -
durere sau sensibilitate, tumefac\u355?ie, ro\u351?ea\u355?\u259? sau senza\u355?ie
de c\u259?ldur\u259? la nivelul regiunii afectate \line \up0 \expndtw-
2\charscalex100 din situa\u355?iile de mai jos este prezent\u259? cel pu\u355?in
una: \par\pard\qj \li1799\ri1922\sb0\sl-210\slmult0\fi151 \up0 \expndtw-
1\charscalex100 - din aspiratul regiunii afectate sau din prelevatul secre\u355?iei
prezente cultura microbiologic\u259? este pozitiv\u259?. \up0 \expndtw-
1\charscalex100 Dac\u259? microorganismul identificat face parte din flora
normal\u259? a pielii (de ex. stafilococ coagulazo-negativ, \up0 \expndtw-
1\charscalex100 micrococi, difteroides, etc.) izolatul trebuie s\u259? fie
monoetiologic �n cultur\u259? pur\u259?; \par\pard\ql \li1950\sb1\sl-193\slmult0
\up0 \expndtw-2\charscalex100 - hemocultur\u259? pozitiv\u259? f\u259?r\u259? o
alt\u259? cauz\u259? depistat\u259?; \par\pard\qj \li1798\ri1871\sb22\sl-
200\slmult0\fi151 \up0 \expndtw-1\charscalex100 - �n prelevatul tisular din
regiunea afectat\u259? sau la un examen serologic se pune �n eviden\u355?\u259? un
antigen \line \up0 \expndtw-1\charscalex100 specific (de ex. ale virusurilor herpes
simplex, Varicella zoster sau ale H. influenzae, N. meningitidis, etc.); \line \up0
\expndtw-1\charscalex100 - la examenul histologic provenit din regiunea
afectat\u259? se pun �n eviden\u355?\u259? macrofage polinucleare; \par\pard\qj
\li1798\ri2284\sb21\sl-200\slmult0\fi151 \up0 \expndtw-1\charscalex100 - rezultat
serologic pozitiv pentru anticorpii specifici IgM sau cre\u351?terea de cel
pu\u355?in 4 ori a IgG-urilor \up0 \expndtw-2\charscalex100 specifici �n probe de
seruri perechi. \par\pard\ql \li1798\ri1784\sb0\sl-210\slmult0\fi200 \up0 \expndtw-
1\charscalex100 Infec\u355?ia nososcomial\u259? a pielii poate rezulta din variate
situa\u355?ii ca urmare a activit\u259?\u355?ii de �ngrijiri din spitale. \line
\up0 \expndtw-1\charscalex100 Infec\u355?iile pl\u259?gii superficiale de incizie,
pustulele nou-n\u259?scutului, decubitele \u351?i pl\u259?gile post combustie \line
\up0 \expndtw-1\charscalex100 suprainfectate, abcesul mamar \u351?i mastita nu fac
parte din subgrupa infec\u355?iilor nosocomiale ale pielii. \par\pard\qj
\li1798\ri2363\sb0\sl-220\slmult0\fi151 \up0 \expndtw-1\charscalex100 b)
Infec\u355?iile \u355?esuturilor moi subcutane (fasceita necrozant\u259?, gangrena,
celulita necrozant\u259?, miozita, \up0 \expndtw-2\charscalex100 limfadenita,
limfangita) \par\pard\ql \li1999\ri2383\sb0\sl-210\slmult0 \up0 \expndtw-
1\charscalex100 Pentru sus\u355?inerea diagnosticului sunt necesare realizarea a
cel pu\u355?in unul din urm\u259?toarele criterii: \up0 \expndtw-1\charscalex100
Criteriul 1: din \u355?esuturile sau secre\u355?iile regiunii afectate cultivarea
microbiologic\u259? este pozitiv\u259?. \up0 \expndtw-1\charscalex100 Criteriul 2:
prezen\u355?a unei secre\u355?ii purulente la nivelul regiunii afectate.
intraoperator sau la examenul histopatologic sunt observate abces sau alte semne
relevante \par\pard\ql \li1798\sb14\sl-207\slmult0 \up0 \expndtw-2\charscalex100
pentru un proces infec\u355?ios. \par\pard\qj \li1797\ri1713\sb0\sl-
200\slmult0\fi201 \up0 \expndtw-1\charscalex100 Criteriul 4: din simptomele de mai
jos, f\u259?r\u259? o leg\u259?tur\u259? depistat\u259? cu o alt\u259? infec\u355?
ie, sunt prezente durerea \u351?i \up0 \expndtw-1\charscalex100 ro\u351?
ea\u355?\u259? local\u259?, tumefierea \u351?i senza\u355?ia de arsur\u259? la
nivelul regiunii afectate. \par\pard\ql \li1999\sb14\sl-207\slmult0 \up0 \expndtw-
2\charscalex100 \u351?i \par\pard\ql \li1949\ri3656\sb0\sl-200\slmult0\fi50 \up0
\expndtw-2\charscalex100 cel pu\u355?in una din urm\u259?toarele situa\u355?ii:
\line \up0 \expndtw-2\charscalex100 - hemocultur\u259? pozitiv\u259?;
- depistarea unor antigene specifice din s�nge sau urin\u259? (de ex. H.
influenzae, S. pneumoniae, N. \up0 \expndtw-2\charscalex100 meningitidis,
streptococi de grup B, Candida sp., etc.); \par\pard\qj \li1797\ri2325\sb0\sl-
220\slmult0\fi151 \up0 \expndtw-1\charscalex100 - rezultat serologic pozitiv pentru
anticorpi specifici IgM sau cre\u351?terea de cel pu\u355?in 4 ori a IgG-urilor
\up0 \expndtw-2\charscalex100 specifici �n probe de seruri perechi. \par\pard\qj
\li1797\ri2063\sb0\sl-200\slmult0\fi201 \up0 \expndtw-1\charscalex100 Nu fac parte
din subgrup: infec\u355?iile pl\u259?gii care afecteaz\u259? concomitent pielea
\u351?i \u355?esuturile moi profunde \up0 \expndtw-1\charscalex100 (fascia, \u355?
esutul muscular), infec\u355?iile pl\u259?gii de decubit, infec\u355?iile \u355?
esuturilor profunde ale bazinului. \par\pard\ql \li1948\sb2\sl-199\slmult0 \up0
\expndtw-2\charscalex100 c) Infec\u355?ia pl\u259?gilor de decubit \par\pard\ql
\li1999\sb2\sl-198\slmult0 \up0 \expndtw-2\charscalex100 Pentru diagnostic sunt
necesare urm\u259?toarele criterii: \par\pard\qj \li1797\ri1843\sb0\sl-
220\slmult0\fi201 \up0 \expndtw-1\charscalex100 Criteriul 1: Prezen\u355?a, f\u259?
r\u259? leg\u259?tur\u259? cu o alt\u259? infec\u355?ie, a cel pu\u355?in dou\u259?
din urm\u259?toarele simptome: ro\u351?ea\u355?a \up0 \expndtw-2\charscalex100
pielii, sensibilitate sau edem la nivelul buzei pl\u259?gii de decubit \par\pard\ql
\li1999\sb10\sl-194\slmult0 \up0 \expndtw-2\charscalex100 Din condi\u355?iile de
mai jos �ndeplinirea a cel pu\u355?in unu: \par\pard\qj \li1948\ri3714\sb22\sl-
200\slmult0\fi0 \up0 \expndtw-1\charscalex100 - din secre\u355?ia sau \u355?esutul
local recoltat corespunz\u259?tor cultur\u259? microbian\u259? pozitiv\u259?;
\up0 \expndtw-2\charscalex100 - hemocultur\u259? pozitiv\u259? f\u259?r\u259? o
alt\u259? cauz\u259? depistat\u259?. \par\pard\ql \li1998\sb15\sl-207\slmult0
\up0 \expndtw-2\charscalex100 Prezen\u355?a numai a secre\u355?iei purulente nu
confirm\u259? infec\u355?ia. \par\pard\ql \li1998\sb1\sl-198\slmult0 \up0 \expndtw-
1\charscalex100 Simpla prezen\u355?\u259? a microorganismelor din prelevatul de pe
suprafa\u355?a decubitului nu este suficient. \par\pard\qj \li1796\ri1785\sb0\sl-
220\slmult0\fi200 \up0 \expndtw-1\charscalex100 �n cazul decubitelor recoltarea
trebuie s\u259? cuprind\u259? �ns\u259?m�n\u355?area aspiratului de la nivelul
marginilor pl\u259?gii \up0 \expndtw-2\charscalex100 sau ale prelevatelor tisulare
din plag\u259?. \par\pard\ql \li1947\sb1\sl-176\slmult0 \up0 \expndtw-
2\charscalex100 d) Infec\u355?iile pl\u259?gii de arsur\u259? \par\pard\ql
\li1997\sb10\sl-194\slmult0 \up0 \expndtw-1\charscalex100 Pentru diagnostic sunt
necesare prezen\u355?a a cel pu\u355?in unuia din urm\u259?toarele criterii:
1\charscalex100 Criteriul 1: Apari\u355?ia sau schimbarea caracterului pl\u259?gii
de arsur\u259? cu deta\u351?area brusc\u259? a crustei, \line \up0 \expndtw-
1\charscalex100 schimbarea culorii crustei �n brun �nchis, negru sau mov-violet,
apari\u355?ia edemului la marginile pl\u259?gii \line\tab \up0 \expndtw-
2\charscalex100 \u351?i \par\pard\ql \li1794\ri2085\sb16\sl-
206\slmult0\fi202\tx1996\tx1996 \up0 \expndtw-1\charscalex100 Examenul histologic,
confirm\u259? p\u259?trunderea microorganismelor �n \u355?esuturile s\u259?n\u259?
toase din vecin\u259?tate. \line\tab \up0 \expndtw-1\charscalex100 Criteriul 2:
Apari\u355?ia sau schimbarea caracterului pl\u259?gii de arsur\u259? cu deta\u351?
area brusc\u259? a crustei, \line \up0 \expndtw-1\charscalex100 schimbarea culorii
crustei �n brun �nchis, negru sau mov-violet, apari\u355?ia edemului la marginile
pl\u259?gii \line \tab \up0 \expndtw-2\charscalex100 \u351?i \par\pard\ql
\li1996\sb0\sl-199\slmult0 \up0 \expndtw-2\charscalex100 Apari\u355?ia a cel
pu\u355?in una din urm\u259?toarele condi\u355?ii: \par\pard\ql \li1946\sb2\sl-
198\slmult0 \up0 \expndtw-2\charscalex100 - hemocultur\u259? pozitiv\u259? f\u259?
r\u259? alte cauze determinante; \par\pard\qj \li1794\ri2087\sb21\sl-
200\slmult0\fi151 \up0 \expndtw-1\charscalex100 - prezen\u355?a virusului herpetic
demonstrat\u259? prin cultur\u259? sau examen electronomicroscopic sau prezen\u355?
a \up0 \expndtw-1\charscalex100 evident\u259? a incluziunilor
virale la examenul electronomicroscopic din prelevatul bioptic tisular.
\par\pard\ql\li1799\ri1851\sb180\sl-206\slmult0\fi201\tx2001 \up0 \expndtw-
1\charscalex100 \ul0\nosupersub\cf1\f2\fs18 Criteriul 3: La bolnavul cu arsur\u259?
sunt prezente cel pu\u355?in dou\u259? din condi\u355?iile de mai jos, f\u259?
r\u259? o alt\u259? cauz\u259? \line \up0 \expndtw-1\charscalex100 cunoscut\u259?:
febr\u259? (peste 38�C) sau hipotermie (sub 36�C), hipotensiune, oligurie (sub 20
ml/or\u259?), \line \up0 \expndtw-1\charscalex100 hiperglicemie sub dieta
glucidic\u259? anterior tolerat\u259? sau semne de confuzie mintal\u259? \line \tab
\up0 \expndtw-2\charscalex100 \u351?i \par\pard\ql \li2000\sb0\sl-199\slmult0
\up0 \expndtw-2\charscalex100 �ndeplinirea a cel pu\u355?in una din urm\u259?
toarele condi\u355?ii: \par\pard\qj \li1950\ri1741\sb21\sl-200\slmult0\fi0 \up0
\expndtw-1\charscalex100 - examenul histopatologic confirm\u259? p\u259?trunderea
microorganismelor �n \u355?esuturile s\u259?n\u259?toase din vecin\u259?tate;
\up0 \expndtw-2\charscalex100 - hemocultur\u259? pozitiv\u259?; \par\pard\ql
\li1950\sb2\sl-198\slmult0 \up0 \expndtw-1\charscalex100 - prezen\u355?a virusului
herpetic demonstrat\u259? prin cultur\u259? sau examen electronomicroscopic sau
prezen\u355?a \par\pard\ql \li1798\sb15\sl-207\slmult0 \up0 \expndtw-
1\charscalex100 evident\u259? a incluziunilor virale la examenul
electronomiscroscopic din prelevatul bioptic tisular. \par\pard\ql
\li1798\ri1832\sb0\sl-206\slmult0\fi201\tx2000\tx1999 \up0 \expndtw-1\charscalex100
Numai prezen\u355?a unei secre\u355?ii purulente de la nivelul pl\u259?gii nu este
criteriu de certitudine prin posibilitatea \up0 \expndtw-1\charscalex100
apari\u355?iei acesteia \u351?i �n cadrul deficien\u355?elor de �ngrijire
corespunz\u259?toare a pl\u259?gii. \line \tab \up0 \expndtw-1\charscalex100
Prezen\u355?a singular\u259? a sindromului febril la bolnavul cu arsur\u259? nu
este argument conving\u259?tor. \line \tab \up0 \expndtw-2\charscalex100 Febra
poate fi de resorb\u355?ie, �n urma distrugerii tisulare. \par\pard\ql
\li1950\sb1\sl-191\slmult0 \up0 \expndtw-2\charscalex100 e) Abcesul mamar sau
mastita \par\pard\ql \li2000\sb16\sl-207\slmult0 \up0 \expndtw-2\charscalex100 Sunt
necesare prezen\u355?a a cel pu\u355?in unuia din urm\u259?toarele criterii:
Criteriul 1: Prelevatele recoltate intraoperator prin aspirare sau bioptic sunt
pozitive pentru \up0 \expndtw-2\charscalex100 microorganisme �n cultur\u259?.
Criteriul 2: Intraoperator sau prin examen histopatologic sunt observate abces sau
semne patognomonice \up0 \expndtw-2\charscalex100 pentru un proces infec\u355?
ios. \par\pard\qj \li2000\ri4092\sb0\sl-220\slmult0\fi0 \up0 \expndtw-
1\charscalex100 Criteriul 3: febr\u259? (peste 38�C) \u351?i sindrom inflamator
local la nivelul mamelei. \line \up0 \expndtw-2\charscalex100 \u351?i
\par\pard\ql \li2000\sb1\sl-176\slmult0 \up0 \expndtw-2\charscalex100 Medicul
curant a emis diagnosticul de abces mamar. \par\pard\qj \li1798\ri2002\sb25\sl-
200\slmult0\fi201 \up0 \expndtw-1\charscalex100 Abcesul mamar apare de cele mai
dese ori post partum. Abcesele mamare care apar �n primele 7 zile \up0 \expndtw-
2\charscalex100 dup\u259? na\u351?tere sunt considerate infec\u355?ii
nosocomiale. \par\pard\ql \li1950\sb2\sl-198\slmult0 \up0 \expndtw-2\charscalex100
f) Infec\u355?ia ombilical\u259? (omphalita) \par\pard\qj \li1999\ri2342\sb21\sl-
200\slmult0\fi0 \up0 \expndtw-1\charscalex100 Pentru sus\u355?inerea diagnosticului
prezen\u355?a a cel pu\u355?in unuia din criteriile de mai jos sunt obligatorii:
\line \up0 \expndtw-1\charscalex100 Criteriul 1: La nivelul bontului ombilical al
nou-n\u259?scutului apare ro\u351?ea\u355?\u259? local\u259? \u351?i secre\u355?ie
seroas\u259? \line \up0 \expndtw-2\charscalex100 \u351?i \par\pard\ql
\li1999\sb15\sl-207\slmult0 \up0 \expndtw-2\charscalex100 Din situa\u355?iile de
mai jos se realizeaz\u259? cel pu\u355?in una: \par\pard\qj \li1949\ri5005\sb0\sl-
200\slmult0 \up0 \expndtw-2\charscalex100 - din secre\u355?ia sau aspiratul local
cultura microbian\u259? este pozitiv\u259?; \up0 \expndtw-2\charscalex100 -
hemocultur\u259? pozitiv\u259?. \par\pard\ql \li1798\ri2013\sb15\sl-
206\slmult0\fi201\tx1998\tx1999 \up0 \expndtw-1\charscalex100 Criteriul 2: La
nivelul bontului ombilical al nou-n\u259?scutului apare ro\u351?ea\u355?\u259?
local\u259? \u351?i secre\u355?ie purulent\u259?. \line\tab \up0 \expndtw-
1\charscalex100 Infec\u355?iile care apar dup\u259? cateterismul arterei sau venei
ombilicale sunt considerate infec\u355?ii vasculare. \line \tab \up0 \expndtw-
1\charscalex100 Sunt considerate ca infec\u355?ii nosocomiale \u351?i infec\u355?
iile bontului ombilical care apar �n primele 7 zile de la \line \up0 \expndtw-
2\charscalex100 externarea nou-n\u259?scutului. \par\pard\ql \li1949\sb0\sl-
199\slmult0 \up0 \expndtw-2\charscalex100 g) Pustuloza nou n\u259?scutului
Din criteriile de mai jos realizarea a cel pu\u355?in unuia este obligatorie: \line
\up0 \expndtw-2\charscalex100 Criteriul 1: Nou-n\u259?scutul are una sau mai multe
pustule \line \up0 \expndtw-2\charscalex100 \u351?i \par\pard\ql \li1999\sb1\sl-
188\slmult0 \up0 \expndtw-2\charscalex100 Medicul curant emite diagnosticul de
infec\u355?ie a pielii. \par\pard\qj \li1999\ri5705\sb23\sl-200\slmult0\fi0 \up0
\expndtw-2\charscalex100 Criteriul 2: Nou-n\u259?scutul are una sau mai multe
pustule \line \up0 \expndtw-2\charscalex100 \u351?i \par\pard\ql \li1999\sb2\sl-
198\slmult0 \up0 \expndtw-2\charscalex100 Medicul curant aplic\u259? o antibiotico-
terapie adecvat\u259?. \par\pard\ql \li1999\sb15\sl-207\slmult0 \up0 \expndtw-
1\charscalex100 Nu sunt incluse �n acest subgrup: eritema toxic\u259? \u351?i
sindroamele pustuloase neinfec\u355?ioase. \par\pard\qj \li1797\ri1943\sb0\sl-
220\slmult0\fi201 \up0 \expndtw-1\charscalex100 Sunt considerate nosocomiale \u351?
i pustulele infec\u355?ioase care apar �n primele 7 zile de la externarea
nou\up0 \expndtw-2\charscalex100 n\u259?scutului. \par\pard\ql \li5558\sb174\sl-
207\slmult0 \up0 \expndtw-2\charscalex100 CAPITOLUL VII \par\pard\ql
\li4733\sb13\sl-207\slmult0 \up0 \expndtw-2\charscalex100 INFEC\u354?IILE CARDIO-
VASCULARE \par\pard\ql \li1948\sb193\sl-207\slmult0 \up0 \expndtw-2\charscalex100
a) Infec\u355?ia arterial\u259? \u351?i venoas\u259? \par\pard\qj
\li1998\ri3845\sb19\sl-200\slmult0\fi0 \up0 \expndtw-1\charscalex100 Pentru
diagnostic sunt necesare realizarea a cel pu\u355?in unuia din cele 5 criterii:
\line \up0 \expndtw-1\charscalex100 Criteriul 1: Din artera sau vena excizat\u259?
chirurgical, cultur\u259? microbian\u259? pozitiv\u259? \line \up0 \expndtw-
2\charscalex100 Hemocultura nu a fost efectuat\u259? sau a fost negativ\u259?.
Criteriul 2: Intra-operator sau la examenul histopatologic al arterelor sau venelor
exist\u259? constatarea \up0 \expndtw-2\charscalex100 semnelor unei infec\u355?
ii. \par\pard\ql \li1796\ri1734\sb20\sl-200\slmult0\fi201\tx1998 \up0 \expndtw-
1\charscalex100 Criteriul 3: Din semnele de mai jos trebuie s\u259? fie prezent cel
pu\u355?in unul, �n absen\u355?a altor cauze infec\u355?ioase \line \up0 \expndtw-
1\charscalex100 depistate: febr\u259? peste 38�C, durere, ro\u351?ea\u355?a pielii
sau senza\u355?ie de c\u259?ldur\u259? la nivelul regiunii afectate. \line \tab
\up0 \expndtw-2\charscalex100 \u351?i \par\pard\qj \li1796\ri2425\sb21\sl-
200\slmult0\fi201 \up0 \expndtw-1\charscalex100 au crescut mai mult de 15 colonii
microbiene din proba semicantitativ\u259?, �ns\u259?m�n\u355?at\u259? de pe
v�rful \up0 \expndtw-2\charscalex100 materialului endovascular
207\slmult0 \up0 \expndtw-2\charscalex100 \ul0\nosupersub\cf1\f2\fs18 \u351?i
\par\pard\ql \li2001\sb1\sl-198\slmult0 \up0 \expndtw-2\charscalex100 hemocultura
nu a fost efectuat\u259? sau a avut un rezultat negativ. \par\pard\qj
Secre\u355?ie purulent\u259? la nivelul vasului din teritoriul afectat \line
\up0 \expndtw-2\charscalex100 hemocultura nu a fost efectuat\u259? sau a avut un
rezultat negativ. \par\pard\qj \li1800\ri2030\sb21\sl-200\slmult0\fi201 \up0
\expndtw-1\charscalex100 Criteriul 5: la copilul de un an sau sub un an sunt
prezente, �n absen\u355?a altor cauze depistate, cel pu\u355?in \up0 \expndtw-
2\charscalex100 unul din urm\u259?toarele semne: \par\pard\qj
\li1799\ri2008\sb0\sl-220\slmult0\fi200 \up0 \expndtw-1\charscalex100 febr\u259?
(peste 38�C) sau hipotermie (sub 37�C), apnee, bradicardie, letargie sau ro\u351?
ea\u355?\u259? dureroas\u259? sau \up0 \expndtw-2\charscalex100 senza\u355?ie de
c\u259?ldur\u259? la nivelul regiunii afectate \par\pard\ql \li2001\sb1\sl-
176\slmult0 \up0 \expndtw-2\charscalex100 \u351?i \par\pard\qj
\li1799\ri2422\sb0\sl-220\slmult0\fi201 \up0 \expndtw-1\charscalex100
au crescut mai mult de 15 colonii microbiene din proba semicantitativ\u259?,
�ns\u259?m�n\u355?at\u259? de pe v�rful \up0 \expndtw-2\charscalex100 materialului
endovascular \par\pard\ql \li2001\sb1\sl-181\slmult0 \up0 \expndtw-
2\charscalex100 hemocultura nu a fost efectuat\u259? sau a avut un rezultat
negativ. \par\pard\qj \li1799\ri2243\sb21\sl-200\slmult0\fi200 \up0 \expndtw-
1\charscalex100 Infec\u355?ia intravascular\u259? unde hemocultura este
pozitiv\u259? se consider\u259? infec\u355?ie sangvin\u259? microbiologic \up0
\expndtw-2\charscalex100 dovedit\u259?. \par\pard\qj \li1799\ri2103\sb0\sl-
220\slmult0\fi200 \up0 \expndtw-1\charscalex100 Infec\u355?iile vasculare din zona
graftului, shuntului, fistulei sau canulei �n cazul �n care hemocultura este
\up0 \expndtw-1\charscalex100 negativ\u259? sunt considerate infec\u355?ii sangvine
�n rela\u355?ie cu cateter vascular central. \par\pard\ql \li1950\sb1\sl-
176\slmult0 \up0 \expndtw-2\charscalex100 b) Endocardita de valv\u259?
(natural\u259? sau artificial\u259?) \par\pard\ql \li2000\sb10\sl-194\slmult0
\up0 \expndtw-2\charscalex100 Din criteriile de mai jos cel pu\u355?in unul trebuie
s\u259? fie prezent: \par\pard\ql \li2000\sb16\sl-207\slmult0 \up0 \expndtw-
1\charscalex100 Criteriul 1: Cultur\u259? microbian\u259? pozitiv\u259? din proba
recoltat\u259? de pe valve sau vegeta\u355?ii cardiace. \par\pard\ql
\li2000\sb1\sl-198\slmult0 \up0 \expndtw-1\charscalex100 Criteriul 2: La bolnav
sunt prezente, far\u259? o alt\u259? cauz\u259? cunoscut\u259?, dou\u259? sau mai
multe semne din \par\pard\ql \li1798\ri1761\sb21\sl-200\slmult0\fi0 \up0 \expndtw-
1\charscalex100 urm\u259?toarele: febr\u259? (peste 38�C), sufluri cardiace noi sau
modificarea suflurilor cardiace, semne de embolie, \up0 \expndtw-1\charscalex100
sindroame cutanate (pete\u351?ii, echimoze, noduli subcutana\u355?i durero\u351?i,
insuficien\u355?\u259? cardiac\u259? congestiv\u259? sau \up0 \expndtw-
2\charscalex100 tulbur\u259?ri de ritm cardiac) \par\pard\ql \li1999\sb15\sl-
207\slmult0 \up0 \expndtw-2\charscalex100 \u351?i \par\pard\ql
\li1949\ri3069\sb0\sl-200\slmult0\fi50 \up0 \expndtw-2\charscalex100 Din urm\u259?
toarele situa\u355?ii este prezent\u259? cel pu\u355?in una: \line \up0 \expndtw-
2\charscalex100 - dou\u259? sau mai multe hemoculturi pozitive; \par\pard\qj
\li1797\ri2085\sb20\sl-200\slmult0\fi151 \up0 \expndtw-1\charscalex100 - prelevatul
recoltat de pe valve confirm\u259?, prin examen direct \u351?i colora\u355?ie Gram,
prezen\u355?a bacteriilor �n \up0 \expndtw-2\charscalex100 absen\u355?a sau �n
cazul negativit\u259?\u355?ii hemoculturilor; \par\pard\ql \li1948\sb2\sl-
198\slmult0 \up0 \expndtw-1\charscalex100 - intraoperator sau la necropsie sunt
observate direct vegeta\u355?ii pe valvele cardiace; \par\pard\qj
\li1797\ri2673\sb21\sl-200\slmult0\fi151 \up0 \expndtw-1\charscalex100 - examenul
serologic sau urinar pune �n eviden\u355?\u259? antigene microbiene/de ex. H.
influenzae, S. \up0 \expndtw-2\charscalex100 pneumoniae, N. meningitidis,
streptococi grup B, etc.); \par\pard\qj \li1948\ri4625\sb0\sl-220\slmult0 \up0
\expndtw-2\charscalex100 - examenul echografic depisteaz\u259? apari\u355?ia unor
vegeta\u355?ii valvulare noi \line \up0 \expndtw-2\charscalex100 \u351?i
\par\pard\ql \li1999\sb1\sl-176\slmult0 \up0 \expndtw-2\charscalex100 antemortem,
medicul dispune un tratament antimicrobian adecvat. \par\pard\ql
la copilul de un an sau sub un an sunt prezente dou\u259? sau mai multe din semnele
de mai jos: \up0 \expndtw-1\charscalex100 febr\u259? (peste 38�C) sau hipotermie
(sub 37�C), apnee, bradicardie, sufluri cardiace noi sau schimbarea \up0 \expndtw-
1\charscalex100 caracteristicilor suflurilor, embolie, sindroame cutanate
(pete\u351?ii, echimoze, noduli subcutana\u355?i durero\u351?i), \up0 \expndtw-
1\charscalex100 insuficien\u355?\u259? cardiac\u259? congestiv\u259?, tulbur\u259?
ri de ritm cardiac (de conducere) \par\pard\ql \li1999\sb14\sl-207\slmult0 \up0
\expndtw-2\charscalex100 \u351?i \par\pard\ql \li1999\sb1\sl-198\slmult0 \up0
\expndtw-2\charscalex100 Cel pu\u355?in una din urm\u259?toarele situa\u355?ii:
\par\pard\ql \li1948\sb3\sl-198\slmult0 \up0 \expndtw-2\charscalex100 - dou\u259?
sau mai multe hemoculturi pozitive; \par\pard\qj \li1797\ri2125\sb21\sl-
200\slmult0\fi151 \up0 \expndtw-1\charscalex100 - prelevatul recoltat de pe valve
confirm\u259?, prin examen direct \u351?i colora\u355?ie gram, prezen\u355?a
bacteriilor �n \up0 \expndtw-2\charscalex100 absen\u355?a sau �n cazul
negativit\u259?\u355?ii hemoculturilor; \par\pard\ql \li1948\sb15\sl-207\slmult0
\up0 \expndtw-1\charscalex100 - intraoperator sau la necropsie sunt observate
direct vegeta\u355?iuni pe valvele cardiace; \par\pard\qj \li1797\ri2614\sb0\sl-
200\slmult0\fi151 \up0 \expndtw-1\charscalex100 - examenul serologic sau urinar
pune �n eviden\u355?\u259? antigene microbiene (de ex. H. influenzae, S. \up0
\expndtw-2\charscalex100 pneumoniae, N. meningitidis, Streptococi grup B, etc.);
examenul echografic depisteaz\u259? apari\u355?ia unor vegeta\u355?ii valvulare noi
\line \up0 \expndtw-2\charscalex100 \u351?i \par\pard\ql \li1999\sb2\sl-198\slmult0
\up0 \expndtw-2\charscalex100 antemortem, medicul dispune un tratament
antimicrobian adecvat. \par\pard\ql \li1948\sb15\sl-207\slmult0 \up0 \expndtw-
2\charscalex100 c) Miocardita sau pericardita \par\pard\ql \li1999\sb1\sl-
198\slmult0 \up0 \expndtw-1\charscalex100 Pentru diagnostic este necesar cel
pu\u355?in unul din urm\u259?toarele criterii: \par\pard\qj \li1797\ri1764\sb0\sl-
220\slmult0\fi201 \up0 \expndtw-1\charscalex100 Criteriul 1: Cultur\u259?
microbian\u259? pozitiv\u259? din prelevatul de \u355?esut pericardic sau aspirat
din lichidul pericardic \up0 \expndtw-2\charscalex100 recoltate intraoperator.
Criteriul 2: Din semnele de mai jos, f\u259?r\u259? o leg\u259?tur\u259?
evident\u259? cu o alt\u259? cauz\u259?, sunt prezente cel pu\u355?in dou\u259?:
\up0 \expndtw-1\charscalex100 febr\u259? (peste 38�C), durere toracic\u259?, puls
paradox sau arie cardiac\u259? m\u259?rit\u259?. \par\pard\ql \li1998\sb2\sl-
198\slmult0 \up0 \expndtw-2\charscalex100 Cel pu\u355?in una din situa\u355?iile
urm\u259?toare: \par\pard\ql \li1947\sb3\sl-198\slmult0 \up0 \expndtw-
2\charscalex100 - simptomatologie ECG relevant\u259? pentru miocardit\u259? sau
pericardit\u259?; \par\pard\qj \li1796\ri1834\sb21\sl-200\slmult0\fi151 \up0
\expndtw-1\charscalex100 - serologie sangvin\u259? pozitiv\u259? pentru antigene
microbiene specifice (de ex. H. influenzae, S. pneumoniae, \line \up0 \expndtw-
2\charscalex100 etc.);
2\charscalex100 \ul0\nosupersub\cf1\f2\fs18 - examenul histopatologic confirm\u259?
miocardita sau pericardit\u259?; \line \up0 \expndtw-2\charscalex100 - echografia,
CT sau MR confirm\u259? existen\u355?a lichidului pericardic. \par\pard\qj
La copilul de un an sau sub un an sunt prezente cel pu\u355?in dou\u259? semne,
f\u259?r\u259? leg\u259?tur\u259? cu o alt\u259? \up0 \expndtw-1\charscalex100
cauz\u259? depistat\u259?, din urm\u259?toarele: febr\u259? (peste 38�C) sau
hipotermie (sub 37�C), apnee, bradicardie, puls \up0 \expndtw-2\charscalex100
paradox sau arie cardiac\u259? m\u259?rit\u259?. \par\pard\ql \li2000\sb15\sl-
198\slmult0 \up0 \expndtw-2\charscalex100 Cel pu\u355?in una din situa\u355?iile de
mai jos: \par\pard\ql \li1950\sb3\sl-198\slmult0 \up0 \expndtw-2\charscalex100 -
simptomatologie ECG relevant\u259? pentru miocardit\u259? sau pericardit\u259?;
- serologie sangvin\u259? pozitiv\u259? pentru antigene microbiene specifice (de
ex. H. influenzae, S. pneumoniae, \line \up0 \expndtw-2\charscalex100 etc.);
examenul histopatologic confirm\u259? miocardita sau pericardita; \line \up0
\expndtw-2\charscalex100 - echografia, CT sau MR confirm\u259? existen\u355?a
lichidului pericardic. \par\pard\qj \li1798\ri1892\sb0\sl-200\slmult0\fi201 \up0
\expndtw-1\charscalex100 Pericarditele dup\u259? opera\u355?iile de chirurgie
cardiac\u259? sau dup\u259? infarctul miocardic de cele mai multe ori nu \up0
\expndtw-2\charscalex100 sunt de cauz\u259? infec\u355?ioas\u259?. \par\pard\ql
\li1949\sb2\sl-199\slmult0 \up0 \expndtw-2\charscalex100 d) Mediastinita
\par\pard\ql \li2000\sb2\sl-198\slmult0 \up0 \expndtw-1\charscalex100 Pentru
diagnostic prezen\u355?a a cel pu\u355?in unul din criteriile de mai jos trebuie
s\u259? fie prezent: \par\pard\qj \li1798\ri1893\sb0\sl-220\slmult0\fi201 \up0
\expndtw-1\charscalex100 Criteriul 1: Cultur\u259? microbian\u259? pozitiv\u259?
din �ns\u259?m�n\u355?area prelevatelor de \u355?esut miocardic sau aspirat din
\up0 \expndtw-2\charscalex100 situsul mediastinal recoltate intraoperator.
\par\pard\ql \li2000\sb1\sl-176\slmult0 \up0 \expndtw-1\charscalex100 Criteriui 2:
Intraoperator sau prin examen histopatologic sunt observate
semnele mediastinitei. \par\pard\qj \li1798\ri1872\sb0\sl-220\slmult0\fi201
\up0 \expndtw-1\charscalex100 Criteriul 3: Sunt prezente cel pu\u355?in una,
f\u259?r\u259? o alt\u259? cauz\u259? evident\u259?, din urm\u259?toarele semne:
febr\u259? (peste \up0 \expndtw-2\charscalex100 38�C), durere toracic\u259? sau
instabilitate sternal\u259? \par\pard\ql \li1999\sb1\sl-181\slmult0 \up0 \expndtw-
2\charscalex100 Cel pu\u355?in una din urm\u259?toarele situa\u355?ii: \par\pard\ql
\li1949\sb1\sl-198\slmult0 \up0 \expndtw-2\charscalex100 - evacuarea unei
secre\u355?ii purulente din regiunea mediastinal\u259?; \par\pard\qj
\li1949\ri4624\sb0\sl-220\slmult0\fi0 \up0 \expndtw-1\charscalex100 - hemocultura
sau cultur\u259? microbian\u259? din lichidul mediastinal pozitiv\u259?; \up0
\expndtw-2\charscalex100 - imaginea radiologic\u259? a unei umbre mediastinale mult
l\u259?rgit\u259?. \par\pard\ql \li1797\ri1882\sb0\sl-210\slmult0\fi201 \up0
\expndtw-1\charscalex100 Criteriul 4: la copilul de un an sau sub un an sunt
prezente cel pu\u355?in una, f\u259?r\u259? o alt\u259? cauz\u259? evident\u259?,
din \line \up0 \expndtw-1\charscalex100 urm\u259?toarele semne: febr\u259? (peste
38�C) sau hipotermie (sub 37�C), apnee, bradicardie sau instabilitate \line \up0
\expndtw-2\charscalex100 sternal\u259? \par\pard\ql \li1999\sb1\sl-165\slmult0 \up0
\expndtw-2\charscalex100 \u351?i \par\pard\ql \li1999\sb13\sl-192\slmult0 \up0
\expndtw-2\charscalex100 Cel pu\u355?in una din urm\u259?toarele situa\u355?ii:
\par\pard\ql \li1948\sb16\sl-207\slmult0 \up0 \expndtw-2\charscalex100 - evacuarea
unei secre\u355?ii purulente din regiunea mediastinal\u259?; \par\pard\qj
\li1948\ri4625\sb0\sl-200\slmult0\fi0 \up0 \expndtw-1\charscalex100 - hemocultura
sau cultur\u259? microbian\u259? din lichidul mediastinal pozitiv\u259?; \up0
\expndtw-2\charscalex100 - imaginea radiologic\u259? a unei umbre mediastinale mult
l\u259?rgit\u259?. \par\pard\qj \li1796\ri1794\sb20\sl-200\slmult0\fi201 \up0
\expndtw-1\charscalex100 Mediastinita \u351?i osteomielita concomitent\u259?,
ap\u259?rute dup\u259? opera\u355?iile de chirurgie cardiac\u259? se
�ncadreaz\u259? la \up0 \expndtw-2\charscalex100 subgrupa mediastinitei.
\expndtw-2\charscalex100 CAPITOLUL VIII \par\pard\ql \li4211\sb1\sl-198\slmult0
\up0 \expndtw-2\charscalex100 INFEC\u354?IILE OSOASE \u350?I ALE ARTICULA\u354?
IILOR \par\pard\ql \li1947\sb0\sl-207\slmult0 \par\pard\ql\li1947\sb8\sl-
207\slmult0 \up0 \expndtw-2\charscalex100 a) Osteomielita \par\pard\ql
\li1998\sb1\sl-198\slmult0 \up0 \expndtw-2\charscalex100 Din criteriile de mai jos
prezen\u355?a a cel pu\u355?in unu este obligatorie: \par\pard\ql \li1998\sb3\sl-
198\slmult0 \up0 \expndtw-1\charscalex100 Criteriul 1: Din prelevatul de \u355?esut
osos al bolnavului cultura microbian\u259? este pozitiv\u259?. \par\pard\qj
Examenul direct intraoperator sau examenul histopatologic pune �n
eviden\u355?\u259? semne clare de \up0 \expndtw-2\charscalex100
osteomielit\u259?. \par\pard\qj \li1795\ri1874\sb21\sl-200\slmult0\fi202 \up0
\expndtw-1\charscalex100 Criteriul 3: Sunt prezente cel pu\u355?in una, f\u259?
r\u259? o alt\u259? cauz\u259? evidente, din urm\u259?toarele semne: febr\u259?
(peste \up0 \expndtw-1\charscalex100 38�C), tumefiere local\u259? dureroas\u259?,
senza\u355?ie de c\u259?ldur\u259? local\u259? sau prezen\u355?a unei secre\u355?ii
la nivelul locului \line \up0 \expndtw-2\charscalex100 osteomielitei
Cel pu\u355?in una din urm\u259?toarele situa\u355?ii: \line \up0 \expndtw-
2\charscalex100 - hemocultura bolnavului pozitiv\u259?; \par\pard\qj
\li1947\ri3296\sb20\sl-200\slmult0 \up0 \expndtw-1\charscalex100 - serologie
pozitiv\u259? pentru antigene microbiene (de ex. H. influenzae, S. pneumoniae);
\up0 \expndtw-1\charscalex100 - exist\u259? dovezi de imagistic\u259? (radiologie,
CT sau MR) pentru osteomielit\u259?. \par\pard\ql \li1947\sb2\sl-198\slmult0
\up0 \expndtw-2\charscalex100 b) Infec\u355?iile articula\u355?iilor \u351?i ale
bursei \par\pard\ql \li1997\sb15\sl-207\slmult0 \up0 \expndtw-2\charscalex100 Din
criteriile de mai jos prezen\u355?a a cel pu\u355?in unu este obligatorie:
Din lichidul intraarticular sau biopsie sinovial\u259?, cultur\u259?
microbian\u259? pozitiv\u259?. \par\pard\qj \li1795\ri1825\sb0\sl-220\slmult0\fi201
\up0 \expndtw-1\charscalex100 Criteriul 2: Observa\u355?ia direct\u259?
intraoperatorie sau examenul histopatologic pune �n eviden\u355?\u259? semne
clare \up0 \expndtw-2\charscalex100 de artrit\u259? sau bursit\u259?.
Criteriul 3: Sunt prezente cel pu\u355?in dou\u259?, f\u259?r\u259? o alt\u259?
cauz\u259? evident\u259?, din urm\u259?toarele semne: durere \up0 \expndtw-
1\charscalex100 articular\u259?, tumefiere local\u259? dureroas\u259?, senza\u355?
ie de c\u259?ldur\u259? local\u259? \u351?i lichid intraarticular demonstrat cu
\up0 \expndtw-2\charscalex100 limitarea mobilit\u259?\u355?ii articulare
207\slmult0 \up0 \expndtw-2\charscalex100 \ul0\nosupersub\cf1\f2\fs18 Cel pu\u355?
in una din urm\u259?toarele situa\u355?ii: \par\pard\qj \li1800\ri2112\sb0\sl-
220\slmult0\fi151 \up0 \expndtw-1\charscalex100 - prin colora\u355?ie gram la
examenul microscopic direct al lichidului intraarticular sunt prezente bacterii
\u351?i \up0 \expndtw-2\charscalex100 leucocite; \par\pard\ql \li1951\sb1\sl-
175\slmult0 \up0 \expndtw-1\charscalex100 - prezen\u355?a unor antigene microbiene
�n s�nge, urin\u259? sau lichidul sinovial; \par\pard\qj \li1800\ri1970\sb0\sl-
220\slmult0\fi151 \up0 \expndtw-1\charscalex100 - frotiul preparat din lichidul
sinovial \u351?i examenul chimic al acestuia sunt relevante pentru prezen\u355?a
unei \up0 \expndtw-2\charscalex100 infec\u355?ii, �n absen\u355?a unei patologii
reumatologice; \par\pard\ql \li1951\sb1\sl-181\slmult0 \up0 \expndtw-
1\charscalex100 - semnele imagistice ob\u355?inute (radiologie, CT, MR) sunt
concludente pentru procesul infec\u355?ios. \par\pard\ql \li1951\sb8\sl-195\slmult0
\up0 \expndtw-2\charscalex100 c) Infec\u355?iile meniscului intraarticular
\par\pard\ql \li2001\sb16\sl-207\slmult0 \up0 \expndtw-2\charscalex100 Din
criteriile de mai jos prezen\u355?a a cel pu\u355?in unu este obligatorie:
Criteriul 1: Cultur\u259? microbian\u259? pozitiv\u259? rezultat\u259? prin
�ns\u259?m�n\u355?area \u355?esutului chondroid (meniscal) recoltat \up0 \expndtw-
2\charscalex100 intra-operator. \par\pard\qj \li1800\ri1720\sb20\sl-
200\slmult0\fi201 \up0 \expndtw-1\charscalex100 Criteriul 2: Intra-operator prin
examen direct sau prin examen histopatologic sunt puse �n eviden\u355?\u259?
semne \up0 \expndtw-2\charscalex100 de infec\u355?ie al meniscului
intraarticular. \par\pard\qj \li2001\ri4110\sb0\sl-220\slmult0\fi0 \up0 \expndtw-
1\charscalex100 Criteriul 3: Sunt prezente semnele febrei (peste 38�C) sau ale
durerii locale \line \up0 \expndtw-2\charscalex100 \u351?i \par\pard\ql
\li2001\sb1\sl-176\slmult0 \up0 \expndtw-2\charscalex100 Exist\u259? dovezi
radiologice sau CT, MR de infec\u355?ie. \par\pard\qj \li2001\ri4110\sb0\sl-
220\slmult0\fi0 \up0 \expndtw-1\charscalex100 Criteriul 4: Sunt prezente semnele
febrei (peste 38�C) sau ale durerii locale \line \up0 \expndtw-2\charscalex100
\u351?i \par\pard\qj \li1800\ri1979\sb0\sl-200\slmult0\fi201 \up0 \expndtw-
1\charscalex100 La examenul serologie sau din urin\u259? sunt puse �n
eviden\u355?\u259? antigene specifice (de ex. H. influenzae, S. \up0 \expndtw-
2\charscalex100 pneumoniae, N. meningitides, streptococi de grup B).
\par\pard\ql \li5586\sb200\sl-207\slmult0 \up0 \expndtw-2\charscalex100 CAPITOLUL
IX \par\pard\ql \li4709\sb13\sl-207\slmult0 \up0 \expndtw-2\charscalex100
INFEC\u354?IILE TRACTULUI DIGESTIV \par\pard\ql \li1951\sb193\sl-207\slmult0
\up0 \expndtw-2\charscalex100 a) Gastroenterite \par\pard\ql \li2001\sb13\sl-
207\slmult0 \up0 \expndtw-2\charscalex100 Dovada a cel pu\u355?in unui criteriu din
cele de mai jos este necesar\u259?: \par\pard\ql \li2001\sb1\sl-198\slmult0 \up0
\expndtw-1\charscalex100 Criteriul 1: Bolnavul prezint\u259? un tranzit intestinal
accelerat cu scaune diareice apoase, cu o durat\u259? mai \par\pard\qj
\li1799\ri1803\sb0\sl-210\slmult0 \up0 \expndtw-1\charscalex100 mare de 12 ore,
v\u259?rs\u259?turi, cu sau f\u259?r\u259? febr\u259?, situa\u355?ie �n care
etiologia neinfec\u355?ioas\u259? este pu\u355?in probabil\u259? (de \line \up0
\expndtw-1\charscalex100 ex. teste diagnostice, procedur\u259? terapeutic\u259?,
exacerbarea unei st\u259?ri cronice sau diaree psihic\u259? prin stress, \line \up0
\expndtw-2\charscalex100 etc.). \par\pard\qj \li1799\ri1811\sb0\sl-
220\slmult0\fi201 \up0 \expndtw-1\charscalex100 Criteriul 2: Din semnele de mai jos
sunt prezente cel pu\u355?in dou\u259?, f\u259?r\u259? o alt\u259? cauz\u259?
depistat\u259?: senza\u355?ie de \up0 \expndtw-2\charscalex100 vom\u259?, v\u259?
rs\u259?tur\u259?, durere abdominal\u259?, cefalee \par\pard\ql
\li2001\sb13\sl-192\slmult0 \up0 \expndtw-2\charscalex100 Din situa\u355?iile de
mai jos cel pu\u355?in una este prezent\u259?: \par\pard\ql \li1950\sb16\sl-
207\slmult0 \up0 \expndtw-1\charscalex100 - coprocultura sau prelevatul rectal este
pozitiv pentru patogene enterale; \par\pard\qj \li1799\ri2942\sb0\sl-
200\slmult0\fi151 \up0 \expndtw-1\charscalex100 - la examenul electronomicroscopic
al prelevatului din materii fecale pot fi puse �n eviden\u355?\u259? \up0 \expndtw-
2\charscalex100 microorganisme enteropatogene; \par\pard\qj \li1799\ri2472\sb20\sl-
200\slmult0\fi151 \up0 \expndtw-1\charscalex100 - prin din materii fecale sau
examen serologic sunt puse �n eviden\u355?\u259? antigene, respectiv anticorpi \up0
\expndtw-2\charscalex100 microbieni specifici; \par\pard\qj \li1798\ri1811\sb0\sl-
220\slmult0\fi151 \up0 \expndtw-1\charscalex100 - prezen\u355?a enteropatogenului
este dovedit\u259? pe cultur\u259? celular\u259? (efect citopatogen, eviden\u355?
ierea de toxine, \line \up0 \expndtw-2\charscalex100 etc.); \par\pard\qj
\li1799\ri1932\sb0\sl-200\slmult0\fi151 \up0 \expndtw-1\charscalex100 - apari\u355?
ia anticorpilor IgM sau cre\u351?terea de cel pu\u355?in patru ori a titrului
anticorpilor IgG �n probe de seruri \up0 \expndtw-2\charscalex100 perechi.
Infec\u355?iile esofagului, stomacului, intestinului sub\u355?ire \u351?i gros,
rectului \par\pard\qj \li1798\ri1772\sb0\sl-220\slmult0\fi201 \up0 \expndtw-
1\charscalex100 Pentru definirea infec\u355?iilor tractului gastro-intestinal -
exclusiv gastroenterita \u351?i apendicita - sunt necesare \up0 \expndtw-
2\charscalex100 a fi �ndeplinite cel pu\u355?in unul din urm\u259?toarele criterii:
Criteriul 1: Intraoperator sau prin examen histopatologic sunt demonstrate
prezen\u355?a abcesului sau ale \up0 \expndtw-2\charscalex100 altor semne clare de
infec\u355?ie. \par\pard\qj \li1798\ri2184\sb2\sl-200\slmult0\fi201 \up0 \expndtw-
1\charscalex100 Criteriul 2: Dintre semnele de mai jos sunt prezente cel pu\u355?in
dou\u259? \u351?i nu pot fi depistate alte cauze \up0 \expndtw-1\charscalex100
generatoare respectiv semnele pot fi �ncadrate �n diagnosticul infec\u355?iei
segmentului digestiv dat: febr\u259?, \up0 \expndtw-2\charscalex100 vomismente,
vom\u259?, durere abdominal\u259? sau sensibilitate abdominal\u259? \par\pard\ql
\li2000\sb1\sl-198\slmult0 \up0 \expndtw-2\charscalex100 Din situa\u355?iile de mai
jos cel pu\u355?in una este �ndeplinit\u259? \par\pard\qj \li1798\ri1822\sb0\sl-
220\slmult0\fi151 \up0 \expndtw-1\charscalex100 - din secre\u355?iile recoltate
intraoperator sau endoscopic sau, din prelevatul recoltat pe tubul de dren
montat \up0 \expndtw-2\charscalex100 post-operator, cultura microbian\u259? este
pozitiv\u259?; \par\pard\qj \li1798\ri1822\sb0\sl-210\slmult0\fi151 \up0 \expndtw-
1\charscalex100 - din secre\u355?iile recoltate intraoperator sau endoscopic sau,
din prelevatul recoltat pe tubul de dren montat \up0 \expndtw-1\charscalex100 post-
operator prin microscopie extemporanee cu colora\u355?ie Gram \u351?i prin proba
hidroxidului de potasiu se \up0 \expndtw-2\charscalex100 pune �n eviden\u355?\u259?
prezen\u355?a bacteriilor; \par\pard\ql \li1950\sb1\sl-165\slmult0 \up0 \expndtw-
2\charscalex100 - hemocultura este pozitiv\u259?; \par\pard\ql \li1950\sb13\sl-
192\slmult0 \up0 \expndtw-2\charscalex100 - la examenul radiologie pot fi
eviden\u355?iate modific\u259?ri patognomonice; \par\pard\qj
\li1798\ri2422\sb22\sl-200\slmult0\fi151 \up0 \expndtw-1\charscalex100 - la
examenul endoscopic sunt puse �n eviden\u355?\u259? modific\u259?ri patognomonice
(esofagit\u259? sau proctit\u259? \up0 \expndtw-2\charscalex100
candidozic\u259?). \par\pard\sect\sectd\fs24\paperw12240\paperh15840\pard\sb0\sl-
240{\bkmkstart Pg18}{\bkmkend Pg18}\par\pard\ql \li1951\sb0\sl-207\slmult0
\ul0\nosupersub\cf1\f2\fs18 c) Hepatitele \par\pard\ql \li2001\sb1\sl-
198\slmult0 \up0 \expndtw-1\charscalex100 Pentru sus\u355?inerea diagnosticului
sunt necesare �ndeplinirea urm\u259?toarelor criterii: cel pu\u355?in dou\u259? din
\par\pard\ql \li1799\sb15\sl-207\slmult0 \up0 \expndtw-1\charscalex100 semnele -
febr\u259?, anorexie, senza\u355?ie de vom\u259?, v\u259?rs\u259?tur\u259?, durere
sau senza\u355?ie de plenitudine �n hipocondrul \par\pard\qj \li1799\ri1673\sb0\sl-
200\slmult0 \up0 \expndtw-1\charscalex100 drept cu sau f\u259?r\u259? sindrom
icteric sau subicteric, transfuzie �n antecedentele personale �ntr-o perioad\u259?
de sub \line \up0 \expndtw-2\charscalex100 3 luni, \par\pard\ql \li2001\sb14\sl-
198\slmult0 \up0 \expndtw-2\charscalex100 din situa\u355?iile de mai jos cel
pu\u355?in una este prezent\u259?: \par\pard\qj \li1950\ri3521\sb0\sl-
220\slmult0\fi0 \up0 \expndtw-1\charscalex100 - test pozitiv pentru antigenele sau
anticorpii de faz\u259? acut\u259? ale hepatitei A, B sau C; \up0 \expndtw-
2\charscalex100 - probe hepatice alterate; \par\pard\qj \li1799\ri1942\sb0\sl-
200\slmult0\fi151 \up0 \expndtw-1\charscalex100 - test pozitiv din urin\u259? sau
secre\u355?ie faringian\u259? pentru citomegalovirus sau teste serologice de
faz\u259? acut\u259? \up0 \expndtw-2\charscalex100 (IgM) pentru CMV, HSV, EBV,
etc.). \par\pard\qj \li1950\ri4372\sb2\sl-200\slmult0\fi50 \up0 \expndtw-
1\charscalex100 Urm\u259?toarele st\u259?ri patologice nu pot fi considerate
hepatit\u259? nosocomial\u259?: \up0 \expndtw-2\charscalex100 - hepatita
neinfec\u355?ioas\u259? sau icter neinfec\u355?ios; \par\pard\ql \li1950\sb2\sl-
198\slmult0 \up0 \expndtw-1\charscalex100 - hepatita toxic\u259? post
alcoolic\u259? sau alte substan\u355?e cu toxicitate hepatic\u259?; \par\pard\ql
\li1949\sb15\sl-207\slmult0 \up0 \expndtw-1\charscalex100 - patologia
obstructiv\u259? de c\u259?ile biliare sau hepatita \u351?i icterul urmare a
colecistitei sau angiocolitei. \par\pard\ql \li1949\sb1\sl-198\slmult0 \up0
\expndtw-1\charscalex100 d) Infec\u355?iile intraabdominale neclasificate �n alte
locuri (vezicula biliar\u259? \u351?i ficat - excep\u355?ie hepatita sau
localiz\u259?ri la nivelul splinei, pancreasului, peritoneului, cavit\u259?\u355?ii
subfrenice sau subdiafragmatic \u351?i alte \u355?esuturi \up0 \expndtw-
2\charscalex100 intraabdominale). \par\pard\ql \li2000\sb1\sl-176\slmult0 \up0
\expndtw-1\charscalex100 Pentru diagnostic sunt necesare �ndeplinirea a cel
pu\u355?in unul din urm\u259?toarele criterii: \par\pard\qj \li1798\ri2563\sb0\sl-
220\slmult0\fi201 \up0 \expndtw-1\charscalex100 Criteriul 1: Din secre\u355?ia
purulent\u259? recoltat\u259? intra-operator sau din aspirat intraabdominal cultura
\up0 \expndtw-2\charscalex100 microbiologic\u259? este pozitiv\u259?
Criteriul 2: Intraoperator sau prin examen histopatologic sunt observate abces sau
semne clare pentru un \up0 \expndtw-2\charscalex100 proces infec\u355?ios
Din semnele de mai jos sunt prezente cel pu\u355?in dou\u259?: febr\u259?,
anorexie, senza\u355?ie de vom\u259?, \par\pard\ql \li1797\sb13\sl-188\slmult0 \up0
\expndtw-2\charscalex100 v\u259?rs\u259?tur\u259?, durere abdominal\u259? sau
sindrom icteric \par\pard\ql \li1999\sb17\sl-207\slmult0 \up0 \expndtw-
2\charscalex100 Din situa\u355?iile de mai jos cel pu\u355?in una este
prezent\u259?: \par\pard\ql \li1949\sb3\sl-198\slmult0 \up0 \expndtw-
1\charscalex100 - din con\u355?inutul drenului aplicat intraoperator cultura
microbian\u259? este pozitiv\u259?; \par\pard\qj \li1797\ri1744\sb21\sl-
200\slmult0\fi151 \up0 \expndtw-1\charscalex100 - din secre\u355?iile
intraabdominale recoltate intraoperator sau din prelevatul histopatologic prin
colora\u355?ie gram \up0 \expndtw-2\charscalex100 la examinare microscopic\u259?
sunt puse �n eviden\u355?\u259? bacterii; \par\pard\qj \li1797\ri2365\sb0\sl-
220\slmult0\fi151 \up0 \expndtw-1\charscalex100 - hemocultura este pozitiv\u259?
\u351?i semnele investiga\u355?iei imagistice (radiologie, echografic, CT, MR
sau \up0 \expndtw-2\charscalex100 investigare cu izotopi) pledeaz\u259? pentru o
infec\u355?ie intraabdominal\u259?. \par\pard\ql \li1999\sb1\sl-176\slmult0 \up0
\expndtw-1\charscalex100 Pancreatita acut\u259? nu se �ncadreaz\u259? �n subgrup
dec�t cu condi\u355?ia originii infec\u355?ioase ale acestuia. \par\pard\ql
\li1948\sb10\sl-194\slmult0 \up0 \expndtw-2\charscalex100 e) Enterocolita
necrozant\u259? \par\pard\ql \li1999\sb16\sl-207\slmult0 \up0 \expndtw-
1\charscalex100 Pentru diagnosticul enterocolitei necrozante la sugar sunt necesare
prezen\u355?a urm\u259?toarelor: \par\pard\qj \li1796\ri1924\sb0\sl-
200\slmult0\fi201 \up0 \expndtw-1\charscalex100 Cel pu\u355?in dou\u259? din
urm\u259?toarele semne, f\u259?r\u259? o alt\u259? cauz\u259? determinat\u259?:
v\u259?rs\u259?tur\u259?, distensie abdominal\u259?, \up0 \expndtw-2\charscalex100
resturi alimentare �n stomac \par\pard\ql \li1998\sb14\sl-207\slmult0 \up0
\expndtw-2\charscalex100 \u351?i \par\pard\qj \li1998\ri4556\sb0\sl-200\slmult0\fi0
\up0 \expndtw-2\charscalex100 prezen\u355?a macroscopic\u259? sau microsopic\u259?
a s�ngelui �n materiile fecale \line \up0 \expndtw-2\charscalex100
\u351?i \par\pard\ql \li1948\ri3205\sb20\sl-200\slmult0\fi50 \up0 \expndtw-
2\charscalex100 cel pu\u355?in una din urm\u259?toarele semne radiologice \line
\up0 \expndtw-2\charscalex100 - pneumoperitoneu; \par\pard\ql \li1948\sb2\sl-
198\slmult0 \up0 \expndtw-2\charscalex100 - pneumatoz\u259? intestinal\u259?;
\par\pard\ql \li1948\sb15\sl-207\slmult0 \up0 \expndtw-1\charscalex100 - imagini
nemodificate \u351?i rigide la nivelul anselor intestinului sub\u355?ire.
\expndtw-2\charscalex100 CAPITOLUL X \par\pard\ql \li5211\sb1\sl-198\slmult0
\up0 \expndtw-2\charscalex100 INFEC\u354?IILE GENITALE \par\pard\ql \li1947\sb0\sl-
207\slmult0 \par\pard\ql\li1947\sb8\sl-207\slmult0 \up0 \expndtw-2\charscalex100 a)
Endometrita \par\pard\ql \li1998\sb1\sl-198\slmult0 \up0 \expndtw-2\charscalex100
Din criteriile de mai jos prezen\u355?a a cel pu\u355?in unu: \par\pard\ql
\li1998\sb3\sl-198\slmult0 \up0 \expndtw-1\charscalex100 Criteriul 1: Din
prelevatul intraoperator, aspirat endocavitar sau biopsie, cultur\u259?
microbian\u259? pozitiv\u259? \par\pard\ql \li1796\ri1821\sb17\sl-
205\slmult0\fi202\tx1997 \up0 \expndtw-1\charscalex100 Criteriul 2: Din semnele de
mai jos, f\u259?r\u259? o alt\u259? cauz\u259? determinat\u259?, sunt prezente cel
pu\u355?in dou\u259?: febr\u259? \line \up0 \expndtw-1\charscalex100 (peste 38�C),
durere abdominal\u259?, sensibilitate uterin\u259? sau secre\u355?ie purulent\u259?
din cavitatea uterin\u259? \line \tab \up0 \expndtw-1\charscalex100 Endometrita
post partum este considerat\u259? infec\u355?ie nosocomial\u259? cu excep\u355?ia
situa\u355?iilor �n care lichidul \line \up0 \expndtw-1\charscalex100 amniotic a
fost infectat �naintea intern\u259?rii �n spital sau preluarea gravidei �n spital a
avut loc dup\u259? 48 ore de \up0 \expndtw-2\charscalex100 la ruperea
membranelor. \par\pard\ql \li1947\sb0\sl-199\slmult0 \up0 \expndtw-2\charscalex100
b) Infec\u355?iile episiotomiei \par\pard\ql \li1997\sb15\sl-207\slmult0 \up0
\expndtw-2\charscalex100 Pentru diagnostic sunt necesare realizarea urm\u259?
toarelor criterii: \par\pard\ql \li1997\ri2765\sb0\sl-210\slmult0\fi0 \up0
\expndtw-1\charscalex100 Criteriul 1: Dup\u259? na\u351?tere vaginal\u259? la plaga
de episiotomie este prezent\u259? o secre\u355?ie purulent\u259? \up0 \expndtw-
1\charscalex100 Criteriul 2: Dup\u259? na\u351?tere vaginal\u259? pe locul pl\u259?
gii episiotomiei apare abcesul \line \up0 \expndtw-2\charscalex100 Dup\u259? unele
opinii episiotomia nu este interven\u355?ie chirurgical\u259?. \par\pard\ql
\li1946\sb1\sl-186\slmult0 \up0 \expndtw-2\charscalex100 c) Infec\u355?iile �n
situsul bontului vaginal
207\slmult0 \up0 \expndtw-1\charscalex100 \ul0\nosupersub\cf1\f2\fs18 Pentru
diagnostic sunt necesare cel pu\u355?in unul din urm\u259?toarele criterii:
Criteriul 1: De la nivelul bontului vaginal dup\u259? histerectomie se elimin\u259?
o secre\u355?ie purulent\u259? \up0 \expndtw-1\charscalex100 Criteriul 2: La
nivelul bontului vaginal dup\u259? histerectomie apare un abces \par\pard\qj
Din secre\u355?iile de la nivelul bontului vaginal dup\u259? histerectomie, cultura
microbiologic\u259? este \up0 \expndtw-2\charscalex100 pozitiv\u259?
\par\pard\ql \li1999\sb2\sl-198\slmult0 \up0 \expndtw-1\charscalex100 Infec\u355?ia
bontului vaginal se �ncadreaz\u259? �n subgrupa infec\u355?iei de organ.
1\charscalex100 d) Alte infec\u355?ii ale organelor genitale (epididimit\u259?,
prostatit\u259?, vaginit\u259?, ooforit\u259?, metrita \u351?i alte infec\u355?
ii \up0 \expndtw-1\charscalex100 profunde ale \u355?esuturilor din micul bazin), cu
excep\u355?ia endometritei \u351?i ale infec\u355?iei bontului vaginal.
\line\tab \up0 \expndtw-2\charscalex100 Din criteriile de mai jos cel pu\u355?in
una trebuie s\u259? fie prezent\u259?: \par\pard\ql \li1798\ri1742\sb0\sl-
210\slmult0\fi201\tx2000 \up0 \expndtw-1\charscalex100 Criteriul 1: Cultur\u259?
microbian\u259? pozitiv\u259? din secre\u355?ia sau prelevatul histologic recoltat
din regiunea afectat\u259? \line\tab \up0 \expndtw-1\charscalex100 Criteriul 2:
Intraoperator sau prin examen histopatologic pot fi observate semne relevante
pentru un \line \up0 \expndtw-2\charscalex100 proces infec\u355?ios sau abces
Criteriul 3: Dintre semnele de mai jos sunt prezente cel pu\u355?in dou\u259?
f\u259?r\u259? o alt\u259? cauz\u259? depistat\u259?: febr\u259? peste \up0
\expndtw-2\charscalex100 38�C, senza\u355?ie de vom\u259?, v\u259?rs\u259?
tur\u259?, durere, sensibitate sau disurie \par\pard\ql \li1999\sb3\sl-
201\slmult0 \up0 \expndtw-2\charscalex100 \u351?i \par\pard\ql
\li1949\ri3655\sb0\sl-200\slmult0\fi50 \up0 \expndtw-2\charscalex100 cel pu\u355?in
una din urm\u259?toarele situa\u355?ii: \line \up0 \expndtw-2\charscalex100 -
hemocultur\u259? pozitiv\u259?; \par\pard\ql \li1949\sb15\sl-207\slmult0 \up0
\expndtw-2\charscalex100 - procesul patologic a fost diagnosticat de medic.
XI \par\pard\ql \li4267\sb13\sl-207\slmult0 \up0 \expndtw-2\charscalex100
INFEC\u354?IILE SISTEMULUI NERVOS CENTRAL \par\pard\qj \li1949\sb0\sl-
200\slmult0 \par\pard\qj\li1949\ri4565\sb19\sl-200\slmult0 \up0 \expndtw-
1\charscalex100 a) Infec\u355?ii intracraniene (abcesul, infec\u355?ia sub- \u351?i
epi-dural\u259?, encefalita) \line \up0 \expndtw-2\charscalex100 Din criteriile de
mai jos prezen\u355?a a cel pu\u355?in unu este obligatorie: \par\pard\ql
\li1999\sb2\sl-198\slmult0 \up0 \expndtw-1\charscalex100 Criteriul 1: Din
prelevatul de \u355?esut nervos intracranian sau dura mater cultur\u259?
microbian\u259? pozitiv\u259? \par\pard\qj \li1798\ri1792\sb21\sl-200\slmult0\fi201
\up0 \expndtw-1\charscalex100 Criteriul 2: Intraoperator sau prin examen
histopatologic se eviden\u355?iaz\u259? semnele unui abces sau ale unui \up0
\expndtw-2\charscalex100 proces infec\u355?ios \par\pard\qj \li1798\ri2062\sb0\sl-
220\slmult0\fi201 \up0 \expndtw-1\charscalex100 Criteriul 3: Din semnele de mai
jos, �n absen\u355?a unei alte cauze, sunt prezente cel pu\u355?in dou\u259?:
cefalee, \up0 \expndtw-1\charscalex100 vertij, feb\u259? peste 38�C, semne de
focar, tulburare senzorial\u259? sau confuzie \par\pard\ql \li1999\sb1\sl-
\li1798\ri1693\sb0\sl-220\slmult0\fi151 \up0 \expndtw-1\charscalex100 - din
prelevatul de \u355?esut nervos intracranian sau abces, recoltate prin aspirare,
intraoperator sau necroptic, \up0 \expndtw-2\charscalex100 cultura microbian\u259?
este pozitiv\u259?; \par\pard\ql \li1949\sb1\sl-181\slmult0 \up0 \expndtw-
2\charscalex100 - prezen\u355?a antigenului specific �n s�nge sau urin\u259?;
\par\pard\ql \li1949\sb8\sl-195\slmult0 \up0 \expndtw-1\charscalex100 - infec\u355?
ia are semne imagistice evidente (radiologie, CT, MR sau arteriografic);
- anticorpi specifici de faz\u259? acut\u259? (IgM) sau cre\u351?terea anticorpilor
specifici IgG de cel pu\u355?in 4 ori din probe \up0 \expndtw-2\charscalex100 de
seruri perechi \par\pard\ql \li1999\sb2\sl-198\slmult0 \up0 \expndtw-
1\charscalex100 �n diagnosticul ante-mortem medicul a dispus terapia
antimicrobian\u259? adecvat\u259?. \par\pard\ql \li1798\ri1882\sb0\sl-
210\slmult0\fi201\tx1999 \up0 \expndtw-1\charscalex100 Criteriul 4: La copilul de
un an sau sub un an din semnele de mai jos sus prezente cel pu\u355?in dou\u259?:
febr\u259? \line \up0 \expndtw-1\charscalex100 (peste 38�C) sau hipotermie (sub
37�C), apnee, bradicardie, semne de focar sau tulbur\u259?ri senzoriale \line
\tab \up0 \expndtw-2\charscalex100 \u351?i \par\pard\ql \li1999\sb1\sl-
186\slmult0 \up0 \expndtw-2\charscalex100 cel pu\u355?in una din situa\u355?iile de
mai jos: \par\pard\qj \li1797\ri1694\sb0\sl-220\slmult0\fi151 \up0 \expndtw-
1\charscalex100 - din prelevatul de \u355?esut nervos intracranian sau abces,
recoltate prin aspirare, intraoperator sau necroptic, \up0 \expndtw-2\charscalex100
cultura microbian\u259? este pozitiv\u259?; \par\pard\ql \li1949\sb1\sl-178\slmult0
\up0 \expndtw-2\charscalex100 - prezen\u355?a antigenului specific �n s�nge sau
urin\u259?; \par\pard\ql \li1949\sb19\sl-207\slmult0 \up0 \expndtw-1\charscalex100
- infec\u355?ia are semne imagistice evidente (radiologie, CT, MR sau
arteriografic); \par\pard\qj \li1797\ri1834\sb0\sl-200\slmult0\fi151 \up0 \expndtw-
1\charscalex100 - anticorpi specifici de faz\u259? acut\u259? (IgM) sau cre\u351?
terea anticorpilor specifici IgG de cel pu\u355?in 4 ori pe probe \up0 \expndtw-
2\charscalex100 de seruri recoltate �n dinamic\u259? (seruri perechi). \par\pard\qj
\li1797\ri2395\sb20\sl-200\slmult0\fi200 \up0 \expndtw-1\charscalex100 �n cazul
prezen\u355?ei concomitente a meningitei \u351?i abcesului intracranian infec\u355?
ia este considerat\u259? \u351?i \up0 \expndtw-2\charscalex100 �ncadrat\u259? ca
infec\u355?ie intracranian\u259?. \par\pard\ql \li1948\sb2\sl-198\slmult0 \up0
\expndtw-2\charscalex100 b) Meningit\u259? sau ventriculit\u259? \par\pard\ql
\li1998\sb15\sl-207\slmult0 \up0 \expndtw-2\charscalex100 Din criteriile
de mai jos prezen\u355?a a cel pu\u355?in unul este obligatorie: \par\pard\ql
\li1998\sb1\sl-198\slmult0 \up0 \expndtw-1\charscalex100 Criteriul 1: din lichidul
cefalorahidian recoltat cultura microbian\u259? este pozitiv\u259? \par\pard\ql
din semnele de mai jos, �n absen\u355?a altor cauze, cel pu\u355?in unul este
prezent: febr\u259? (peste 38�C), \up0 \expndtw-1\charscalex100 cefalee, redoarea
cefei, semne de irita\u355?ie meningeal\u259?, semne patognomonice la nivelul
nervilor cranieni, \line \up0 \expndtw-2\charscalex100 iritabilitate
situa\u355?iile de mai jos cel pu\u355?in una este realizat\u259?: \par\pard\qj
\li1796\ri2295\sb0\sl-200\slmult0\fi151 \up0 \expndtw-1\charscalex100 - �n LCR
num\u259?rul elementelor celulare albe este crescut\u259?, albuminorahia
crescut\u259? \u351?i/sau glicorahia \up0 \expndtw-2\charscalex100 sc\u259?
zut\u259?; \par\pard\qj \li1947\ri3256\sb20\sl-200\slmult0\fi0 \up0 \expndtw-
1\charscalex100 - colorarea Gram \u351?i examenul microscopic direct, confirm\u259?
prezen\u355?a bacteriilor �n LCR; \up0 \expndtw-2\charscalex100 - hemocultur\u259?
pozitiv\u259?; \par\pard\sect\sectd\fs24\paperw12240\paperh15840\pard\sb0\sl-
\ul0\nosupersub\cf1\f2\fs18 - examinarea antigenelor din LCR, s�nge sau urin\u259?
este pozitiv\u259?; \par\pard\qj \li1799\ri1892\sb0\sl-220\slmult0\fi151 \up0
\expndtw-1\charscalex100 - prezen\u355?a anticorpilor specifici de faz\u259?
acut\u259? (IgM) sau cre\u351?terea anticorpilor specifici IgG de cel pu\u355?in
4 \up0 \expndtw-2\charscalex100 ori din probe seruri perechi \par\pard\ql
\li2000\sb10\sl-194\slmult0 \up0 \expndtw-1\charscalex100 �n cazul diagnosticului
ante-mortem medicul a prescris antibioticoterapie adecvat\u259? cazului.
1\charscalex100 Criteriul 3: La copilul de un an sau sub un an din semnele de mai
jos sunt prezente cel pu\u355?in unul, f\u259?r\u259? o \line \up0 \expndtw-
1\charscalex100 alt\u259? cauz\u259? evident\u259?: febr\u259? (peste 38�C) sau
hipotermie (sub 37�C), apnee, bradicardie, redoarea cefei, \line \up0 \expndtw-
1\charscalex100 semne de irita\u355?ie meningeal\u259?, semne patognomonice pentru
nervi cranieni, iritabilitate \line \tab \up0 \expndtw-2\charscalex100 \u351?i
in una din situa\u355?iile de mai jos: \par\pard\qj \li1798\ri2293\sb0\sl-
220\slmult0\fi151 \up0 \expndtw-1\charscalex100 - �n LCR num\u259?rul elementelor
celulare albe este crescut\u259?, albuminorahia crescut\u259? \u351?i/sau
glicorahia \up0 \expndtw-2\charscalex100 sc\u259?zut\u259?; \par\pard\qj
\li1949\ri3324\sb0\sl-200\slmult0 \up0 \expndtw-1\charscalex100 - colora\u355?ia
Gram \u351?i examenul microscopic direct, confirm\u259? prezen\u355?a bacteriilor
�n LCR; \up0 \expndtw-2\charscalex100 - hemocultur\u259? pozitiv\u259?;
\par\pard\ql \li1949\sb2\sl-199\slmult0 \up0 \expndtw-2\charscalex100 - examinarea
antigenelor din LCR, s�nge sau urin\u259? este pozitiv\u259?; \par\pard\qj
prezen\u355?a anticorpilor specifici de faz\u259? acut\u259? (IgM) sau cre\u351?
terea anticorpilor specifici IgG de cel pu\u355?in ori \up0 \expndtw-
2\charscalex100 din probe seruri perechi \par\pard\ql \li1999\sb15\sl-
198\slmult0 \up0 \expndtw-1\charscalex100 �n cazul diagnosticului ante-mortem
medicul a prescris antibioticoterapie adecvat\u259? cazului. \par\pard\qj
\li1798\ri2232\sb0\sl-220\slmult0\fi201 \up0 \expndtw-1\charscalex100 Meningita nou
n\u259?scutului se consider\u259? nosocomial\u259? cu excep\u355?ia situa\u355?iei
�n care sunt dovezi pentru \up0 \expndtw-2\charscalex100 transmiterea
tranplacentar\u259?; \par\pard\ql \li1999\sb1\sl-176\slmult0 \up0 \expndtw-
2\charscalex100 Meningoencefalita este considerat\u259? meningit\u259?;
\par\pard\ql \li1999\sb19\sl-207\slmult0 \up0 \expndtw-2\charscalex100 Abcesul
spinal asociat cu meningit\u259? este �ncadrat ca meningit\u259?; \par\pard\ql
\li1998\sb1\sl-198\slmult0 \up0 \expndtw-1\charscalex100 Infec\u355?ia dup\u259?
shunt se consider\u259? infec\u355?ie de plag\u259? cu condi\u355?ia s\u259?
apar\u259? �ntr-un interval de un an. \par\pard\ql \li1948\sb3\sl-198\slmult0
\up0 \expndtw-2\charscalex100 c) Abces spinal f\u259?r\u259? meningit\u259?
\par\pard\ql \li1999\sb15\sl-207\slmult0 \up0 \expndtw-1\charscalex100 Pentru
diagnostic necesit\u259? prezen\u355?a a cel pu\u355?in unui criteriu din urm\u259?
toarele: \par\pard\ql \li1999\sb1\sl-198\slmult0 \up0 \expndtw-1\charscalex100
Criteriul 1: Din abcesul subdural sau epidural cultura microbian\u259? este
pozitiv\u259? \par\pard\qj \li1797\ri2013\sb0\sl-220\slmult0\fi201 \up0 \expndtw-
1\charscalex100 Criteriul 2: Intraoperator sau necroptic, respectiv la examenul
histopatologic sunt observate semne de \line \up0 \expndtw-2\charscalex100 abces
Din semnele de mai jos sunt prezente cel pu\u355?in unu \u351?i nu exist\u259?
alt\u259? rela\u355?ie de cauzalitate \par\pard\qj \li1797\ri1943\sb0\sl-
220\slmult0\tx1998 \up0 \expndtw-1\charscalex100 cunoscut\u259?: febr\u259? peste
38�C, durere, sensibilitate local\u259?, semne de radiculit\u259?, paraparez\u259?
sau paraplegie \line\tab \up0 \expndtw-2\charscalex100 \u351?i \par\pard\ql
\li1948\ri3656\sb0\sl-200\slmult0\fi50 \up0 \expndtw-2\charscalex100 cel pu\u355?in
una din situa\u355?iile de mai jos: \line \up0 \expndtw-2\charscalex100 -
hemocultur\u259? pozitiv\u259?; \par\pard\qj \li1948\ri1905\sb6\sl-200\slmult0 \up0
\expndtw-1\charscalex100 - exist\u259? dovezi (radiologice, CT, MR, mielografie,
echografie, explorare cu izotopi) pentru abcesul spinal \line \up0 \expndtw-
2\charscalex100 ante-mortem medicul a dispus tratamentul antimicrobian adecvat.
\par\pard\ql \li1998\sb15\sl-207\slmult0 \up0 \expndtw-1\charscalex100 Abcesul
spinal concomitent cu meningit\u259? se �ncadreaz\u259? �n subgrupa meningit\u259?.
XII \par\pard\ql \li3266\sb13\sl-207\slmult0 \up0 \expndtw-2\charscalex100
INFEC\u354?IILE OCHIULUI, URECHII, FARINGELUI \u350?I CAVIT\u258?\u354?II BUCALE
\par\pard\ql \li1947\sb193\sl-207\slmult0 \up0 \expndtw-2\charscalex100 a)
Conjunctivita \par\pard\ql \li1998\sb13\sl-207\slmult0 \up0 \expndtw-
2\charscalex100 Cel pu\u355?in unul din criteriile de mai jos trebuie
�ndeplinite: \par\pard\ql \li1796\ri1874\sb0\sl-206\slmult0\fi201\tx1997\tx1998
\up0 \expndtw-1\charscalex100 Criteriul 1: Din proba de secre\u355?ie
purulent\u259? recoltat\u259? de la nivelul conjunctivei oculare sau ale \u355?
esuturilor \line \up0 \expndtw-1\charscalex100 din vecin\u259?tate (pleoap\u259?,
cornee, glande lacrimale) cultura microbiologic\u259? este pozitiv\u259? \line \tab
\up0 \expndtw-1\charscalex100 Criteriul 2: La nivelul conjunctivei oculare sau ale
zonelor oculare �nvecinate apare durerea \u351?i ro\u351?ea\u355?a \line \tab
\up0 \expndtw-2\charscalex100 din semnele de mai jos cel pu\u355?in unul este
prezent \par\pard\qj \li1947\ri2766\sb0\sl-200\slmult0\fi0 \up0 \expndtw-
1\charscalex100 - �n secre\u355?ia conjunctival\u259?, la examenul nativ colorat
gram sunt observate leucocite \u351?i bacterii \up0 \expndtw-2\charscalex100 -
exist\u259? o secre\u355?ie purulent\u259? �n zona afectat\u259?; \par\pard\qj
investigarea secre\u355?iei este pozitiv\u259? pentru antigene specifice (ELISA sau
IF pentru Chlamidydia \up0 \expndtw-2\charscalex100 trachomatis, Herpes simplex,
Adenovirus, etc.); \par\pard\qj \li1947\ri3905\sb0\sl-220\slmult0\fi0 \up0
\expndtw-1\charscalex100 - la examenul microscopic al secre\u355?iei sunt prezente
macrofagele polinucleare; \up0 \expndtw-2\charscalex100 - cultura viral\u259? este
pozitiv\u259?; \par\pard\qj \li1795\ri1726\sb0\sl-200\slmult0\fi151 \up0 \expndtw-
1\charscalex100 - sunt detecta\u355?i anticorpi specifici de faz\u259? acut\u259?
(IgM) sau cre\u351?terea anticorpilor specifici IgG de cel pu\u355?in 4 \up0
\expndtw-2\charscalex100 ori �n probe de seruri perechi. \par\pard\ql
\li1996\sb2\sl-199\slmult0 \up0 \expndtw-2\charscalex100 Infec\u355?iile globului
ocular nu fac parte din aceast\u259? subgrup\u259?. \par\pard\ql \li1997\sb2\sl-
198\slmult0 \up0 \expndtw-1\charscalex100 Conjunctivita iritativ\u259? (de ex.
dup\u259? instila\u355?iile cu nitrat de argint) nu sunt nosocomiale.
Conjunctivitele �n cadrul infec\u355?iilor virale sistemice (rujeola, rubeola,
etc.) fac parte din patologia \up0 \expndtw-2\charscalex100 specificat\u259?.
Infec\u355?iile ochiului
\ul0\nosupersub\cf1\f2\fs18 Pentru diagnostic este necesar\u259? realizarea a cel
pu\u355?in unuia din urm\u259?toarele criterii: \par\pard\qj \li1799\ri1941\sb0\sl-
220\slmult0\fi201 \up0 \expndtw-1\charscalex100 Criteriul 1: Probele recoltate de
la nivelul camerei anterioare sau posterioare sau din umoarea apoas\u259?, \up0
\expndtw-2\charscalex100 �ns\u259?m�n\u355?area microbiologic\u259? rezult\u259?
cultur\u259? pozitiv\u259? \par\pard\ql \li1799\ri2001\sb0\sl-
210\slmult0\fi202\tx2000 \up0 \expndtw-1\charscalex100 Criteriul 2: Dintre semnele
de mai jos sunt prezente cel pu\u355?in dou\u259?, f\u259?r\u259? o alt\u259?
cauz\u259? depistat\u259?: durere \line \up0 \expndtw-1\charscalex100 ocular\u259?,
tulburare de acuitate vizual\u259?, hipopion (secre\u355?ie purulent\u259? �n
camera anterioar\u259?) \line \tab \up0 \expndtw-2\charscalex100 \u351?i
in una din situa\u355?iile de mai jos: \par\pard\ql \li1950\sb14\sl-192\slmult0
\up0 \expndtw-2\charscalex100 - medicul specialist a diagnosticat o infec\u355?ie
ocular\u259?; \par\pard\qj \li1950\ri3462\sb22\sl-200\slmult0 \up0 \expndtw-
1\charscalex100 - sunt detectate antigene specifice din s�nge (de ex. H.
influenzae, S. pneumoniae); \up0 \expndtw-2\charscalex100 - hemocultur\u259?
pozitiv\u259?. \par\pard\ql \li1950\sb2\sl-198\slmult0 \up0 \expndtw-
2\charscalex100 c) Infec\u355?iile urechii, mastoidei \u351?i apofizei mastoidei
Pentru diagnosticul infec\u355?iei sunt utilizabile urm\u259?toarele criterii:
\line \up0 \expndtw-2\charscalex100 Pentru otita extern\u259? cel pu\u355?in unul
din criteriile de mai jos: \par\pard\ql \li2000\sb2\sl-198\slmult0 \up0 \expndtw-
1\charscalex100 Criteriul 1: Din secre\u355?ia purulent\u259? a conductului
auditiv, cultur\u259? microbian\u259? pozitiv\u259? \par\pard\qj
Dintre semnele de mai jos prezen\u355?a a cel pu\u355?in unu, f\u259?r\u259? o
alt\u259? acuz\u259? determinat\u259?: febr\u259? peste \up0 \expndtw-
1\charscalex100 38�C, durere \u351?i criterii local sau secre\u355?ie
purulent\u259? la nivelul conductului auditiv \par\pard\ql \li1999\sb2\sl-
\li1999\ri1733\sb21\sl-200\slmult0 \up0 \expndtw-1\charscalex100 din secre\u355?ia
purulent\u259?, examenul microscopic colorat gram pune �n eviden\u355?\u259?
prezen\u355?a microorganismelor. \up0 \expndtw-2\charscalex100 Pentru otita
intern\u259? cel pu\u355?in unul din criteriile de mai jos: \par\pard\qj
Din secre\u355?ia urechii interne, recoltat\u259? intraoperator, cultura a fost
pozitiv\u259?. \up0 \expndtw-2\charscalex100 Criteriul 2: Medicul a emis
diagnosticul de otit\u259? medie. \par\pard\ql \li1999\sb1\sl-176\slmult0 \up0
\expndtw-2\charscalex100 Pentru mastoidit\u259? cel pu\u355?in unul din criteriile
de mai jos: \par\pard\ql \li1999\sb19\sl-207\slmult0 \up0 \expndtw-1\charscalex100
Criteriul 1: Din secre\u355?ia purulent\u259?, de la nivelul mastoidei,
cultur\u259? microbian\u259? pozitiv\u259?. \par\pard\qj \li1797\ri2053\sb0\sl-
200\slmult0\fi202 \up0 \expndtw-1\charscalex100 Criteriul 2: Dintre semnele de mai
jos este prezent cel pu\u355?in unul, f\u259?r\u259? o alt\u259? cauz\u259?
determinat\u259?: febr\u259? \up0 \expndtw-1\charscalex100 peste 38�C, durere,
sensibilitate \u351?i eritem local, cefalee sau parez\u259? facial\u259?
\par\pard\ql \li1998\sb1\sl-198\slmult0 \up0 \expndtw-2\charscalex100 prezen\u355?a
a cel pu\u355?in uneia din situa\u355?iile de mai jos: \par\pard\qj
eviden\u355?ierea bacteriilor �n preparatul microscopic colorat Gram, din
prelevatul secre\u355?iei purulente de la \up0 \expndtw-2\charscalex100 nivelul
mastoidei; \par\pard\ql \li1948\sb1\sl-176\slmult0 \up0 \expndtw-2\charscalex100 -
examenul serologic eviden\u355?iaz\u259? prezen\u355?a antigenelor specifice.
\par\pard\ql \li1948\sb10\sl-194\slmult0 \up0 \expndtw-2\charscalex100 d)
Infec\u355?iile din cavitatea bucal\u259? (stomatita, glosita \u351?i
parodontita) \par\pard\ql \li1998\sb16\sl-207\slmult0 \up0 \expndtw-1\charscalex100
Pentru diagnostic este necesar realizarea a cel pu\u355?in unul din urm\u259?
toarele criterii: \par\pard\ql \li1998\sb1\sl-198\slmult0 \up0 \expndtw-
1\charscalex100 Criteriul 1: Din secre\u355?ia purulent\u259? a \u355?esuturilor
din cavitatea bucal\u259? cultur\u259? pozitiv\u259? \par\pard\qj
La examenul cavit\u259?\u355?ii bucale (examen fizic, intraoperator sau
histopatologic) abcesul sau \up0 \expndtw-2\charscalex100 semnele clare ale
infec\u355?iei sunt prezente \par\pard\ql \li1796\ri2034\sb0\sl-
210\slmult0\fi201\tx1997 \up0 \expndtw-1\charscalex100 Criteriul 3: Cel pu\u355?in
unul din urm\u259?toarele semne sunt prezente, f\u259?r\u259? o alt\u259?
cauz\u259? determinat\u259?: abces, \line \up0 \expndtw-1\charscalex100
exulcera\u355?ii, pete albe proeminente pe mucoas\u259? inflamat\u259? sau pl\u259?
ci/depozite pe mucoasa cavit\u259?\u355?ii bucale \line\tab \up0 \expndtw-
2\charscalex100 Cel pu\u355?in una din urm\u259?toarele situa\u355?ii: \par\pard\qj
\li1947\ri2516\sb0\sl-220\slmult0 \up0 \expndtw-1\charscalex100 - la examenul
microscopic al prelevatului recoltat, colorat Gram, se observ\u259? prezen\u355?a
bacteriilor; \up0 \expndtw-2\charscalex100 - prob\u259? pozitiv\u259? cu hidroxid
de potasiu; \par\pard\ql \li1947\sb1\sl-183\slmult0 \up0 \expndtw-1\charscalex100 -
la examenul microscopic al prelevatului recoltat sunt observate macrofage
polinucleare; \par\pard\qj \li1795\ri2106\sb0\sl-220\slmult0\fi151 \up0 \expndtw-
1\charscalex100 - apari\u355?ia anticorpilor specifici de faz\u259? acut\u259?
(IgM) sau cre\u351?terea de cel pu\u355?in 4 ori a titrului anticorpilor \up0
\expndtw-2\charscalex100 specifici IgG, la examenul serologic, pe probe de seruri
perechi; \par\pard\qj \li1796\ri2125\sb0\sl-220\slmult0\fi151 \up0 \expndtw-
1\charscalex100 - medicul a stabilit diagnosticul de infec\u355?ie a
cavit\u259?\u355?ii bucale \u351?i a aplicat un tratament local sau peroral \up0
\expndtw-2\charscalex100 antifungic adecvat. \par\pard\ql \li1996\sb0\sl-
162\slmult0 \up0 \expndtw-1\charscalex100 Infec\u355?ia herpetic\u259?, caz nou, cu
manifestare la nivelul cavit\u259?\u355?ii bucale poate fi nosocomial\u259?, dar
infec\u355?ia \par\pard\ql \li1796\sb13\sl-187\slmult0 \up0 \expndtw-
1\charscalex100 recidivant\u259?/reacutizat\u259? nu se �ncadreaz\u259? �n
aceast\u259? categorie de infec\u355?ii. \par\pard\ql \li1946\sb17\sl-
207\slmult0 \up0 \expndtw-2\charscalex100 e) Sinuzitele fronto-maxilare
\par\pard\ql \li1997\sb1\sl-198\slmult0 \up0 \expndtw-1\charscalex100 Din
criteriile de mai jos realizarea a cel pu\u355?in unul este obligatorie pentru
diagnostic: \par\pard\ql \li1997\sb3\sl-198\slmult0 \up0 \expndtw-1\charscalex100
Criteriul 1: Din secre\u355?ia purulent\u259? a cavit\u259?\u355?ilor paranazale
\u351?i maxilare cultur\u259? microbian\u259? pozitiv\u259? \par\pard\qj
Dintre semnele de mai jos cel pu\u355?in unul este prezent, f\u259?r\u259? o
alt\u259? cauz\u259? depistat\u259?: febr\u259? peste \up0 \expndtw-1\charscalex100
38�C, durere sau sensibilitate la suprafa\u355?a zonei sinusului afectat, cefalee,
rinoree cu secre\u355?ie purulent\u259? sau \up0 \expndtw-2\charscalex100
obstruc\u355?ie nazal\u259? \par\pard\ql \li1996\sb15\sl-207\slmult0 \up0 \expndtw-
2\charscalex100 cel pu\u355?in una din urm\u259?toarele situa\u355?ii: \par\pard\ql
\li1946\ri3456\sb0\sl-220\slmult0 \up0 \expndtw-2\charscalex100 - rezultat
edificator la examenul radiologie; \line \up0 \expndtw-2\charscalex100 - imagine
radiografic\u259? relevant\u259?. \par\pard\qj \li1946\ri4568\sb0\sl-200\slmult0
\up0 \expndtw-1\charscalex100 f) Infec\u355?iile c\u259?ilor respiratorii
superioare (faringita, laringita \u351?i epiglotita) \up0 \expndtw-2\charscalex100
Din criteriile de mai jos cel pu\u355?in unul este realizat: \par\pard\qj
Dintre semnele de mai jos sunt prezente cel pu\u355?in dou\u259?, f\u259?r\u259? o
alt\u259? cauz\u259? depistat\u259?: febr\u259? \up0 \expndtw-1\charscalex100 peste
38�C, eritemul mucoaselor, durere �n g�t, tuse, disfagie, secre\u355?ie
purulent\u259? faringian\u259?
207\slmult0 \up0 \expndtw-2\charscalex100 \ul0\nosupersub\cf1\f2\fs18 \u351?i
situa\u355?iile de mai jos este realizat\u259? cel pu\u355?in una: \par\pard\qj
\li1951\ri5313\sb21\sl-200\slmult0\fi0 \up0 \expndtw-2\charscalex100 - din
prelevatele regiunii afectate cultura microbian\u259? pozitiv\u259?; \up0 \expndtw-
2\charscalex100 - hemocultur\u259? pozitiv\u259?; \par\pard\ql \li1950\sb2\sl-
198\slmult0
\up0 \expndtw-1\charscalex100 - examenul s�ngelui sau secre\u355?iei tractului
respirator este pozitiv pentru antigene specifice; \par\pard\qj
prezen\u355?a anticorpilor specifici de faz\u259? acut\u259? (IgM) sau cre\u351?
terea de cel pu\u355?in 4 ori a titrului anticorpilor \up0 \expndtw-2\charscalex100
IgG specifici �n probe de seruri perechi; \par\pard\ql \li1950\sb2\sl-
198\slmult0 \up0 \expndtw-2\charscalex100 - medicul a emis diagnosticul de
infec\u355?ie respiratorie acut\u259?. \par\pard\ql \li2000\sb15\sl-207\slmult0
\up0 \expndtw-1\charscalex100 Criteriul 2: La examenul fizic, intra-operator sau
histopatologic se constat\u259? prezen\u355?a abcesului \par\pard\qj
La copilul de un an sau sub un an sunt prezente cel pu\u355?in dou\u259? din
semnele de mai jos, f\u259?r\u259? o \up0 \expndtw-1\charscalex100 alt\u259?
cauz\u259? depistat\u259?: febr\u259? (peste 38�C) sau hipotermie (sub 37�C),
apnee, bradicardie, rinoree sau secre\u355?ie \up0 \expndtw-2\charscalex100
purulent\u259? la nivelul faringelui \par\pard\ql \li2000\sb1\sl-186\slmult0
\up0 \expndtw-2\charscalex100 cel pu\u355?in una din situa\u355?iile de mai jos
este realizat\u259?: \par\pard\qj \li1950\ri4774\sb21\sl-200\slmult0 \up0 \expndtw-
1\charscalex100 - din prelevatele regiunii afectate, cultura microbian\u259? a fost
pozitiv\u259?; \up0 \expndtw-2\charscalex100 - hemocultur\u259? pozitiv\u259?;
\par\pard\ql \li1950\sb2\sl-198\slmult0 \up0 \expndtw-1\charscalex100 - examenul
s�ngelui sau secre\u355?iei tractului respirator este pozitiv pentru antigene
specifice; \par\pard\qj \li1798\ri1993\sb21\sl-200\slmult0\fi151 \up0 \expndtw-
1\charscalex100 - prezen\u355?a anticorpilor specifici de faz\u259? acut\u259?
(IgM) sau cre\u351?terea de cel pu\u355?in 4 ori a titrului anticorpilor \up0
\expndtw-2\charscalex100 IgG specifici �n probe de seruri perechi; \par\pard\ql
\li1949\sb2\sl-198\slmult0 \up0 \expndtw-2\charscalex100 - medicul a emis
diagnosticul de infec\u355?ie respiratorie acut\u259?. \par\pard\ql \li5534\sb0\sl-
CAPITOLUL XIII \par\pard\ql \li5283\sb13\sl-207\slmult0 \up0 \expndtw-
2\charscalex100 INFEC\u354?II SISTEMICE \par\pard\ql \li1949\sb193\sl-
207\slmult0 \up0 \expndtw-2\charscalex100 a) Infec\u355?iile diseminate
Sunt infec\u355?ii care cointereseaz\u259? mai multe organe sau sisteme f\u259?
r\u259? o localizare regional\u259?/teritorial\u259? \up0 \expndtw-1\charscalex100
caracteristic\u259?. De cele mai multe ori sunt de etilogie viral\u259?
(rubeol\u259?, rujeol\u259?, infec\u355?ia urlian\u259?, varicela, \up0 \expndtw-
2\charscalex100 eriterma infectiosum, infec\u355?ia HIV, etc.). \par\pard\qj
\li1798\ri2012\sb21\sl-200\slmult0\fi201 \up0 \expndtw-1\charscalex100 Diagnosticul
de cele mai multe ori se bazeaz\u259? pe simptomatologia clinic\u259? \u351?i probe
de laborator pentru \up0 \expndtw-2\charscalex100 diagnosticul etiologic.
Febra de origine necunoscut\u259? (FUO) \u351?i starea toxico-septic\u259? a nou
n\u259?scutului nu sunt �ncadrate �n acest \up0 \expndtw-2\charscalex100 grup de
patologie. \par\pard\ql \li1999\sb1\sl-176\slmult0 \up0 \expndtw-2\charscalex100
Exantemele virale \u351?i eruptive fac parte din acest grup de patologie.
\par\pard\ql \li5523\sb0\sl-207\slmult0 \par\pard\ql\li5523\sb12\sl-207\slmult0
\up0 \expndtw-2\charscalex100 CAPITOLUL XIV \par\pard\ql \li2421\sb1\sl-198\slmult0
\up0 \expndtw-1\charscalex100 INFEC\u354?II NOSOCOMIALE LA BOLNAVII CU SPITALIZARE
CRONIC\u258?, DE LUNG\u258? DURAT\u258? \par\pard\ql \li1949\sb0\sl-207\slmult0
\par\pard\ql\li1949\sb8\sl-207\slmult0 \up0 \expndtw-2\charscalex100 1) Infec\u355?
iile urinare \par\pard\ql \li1949\sb1\sl-198\slmult0 \up0 \expndtw-2\charscalex100
a) Infec\u355?iile urinare la bolnavii necateteriza\u355?i \par\pard\qj
\li1948\ri4280\sb0\sl-220\slmult0\fi50 \up0 \expndtw-1\charscalex100 Sunt necesare
pentru diagnostic realizarea a trei din semnele de mai jos: \up0 \expndtw-
2\charscalex100 - febr\u259? peste 38�C \u351?i/sau frison \par\pard\ql
\li1948\ri4365\sb0\sl-210\slmult0 \up0 \expndtw-1\charscalex100 - apari\u355?ia sau
accentuarea unei jene dureroase la mic\u355?iune \u351?i/sau disurie; \up0
\expndtw-2\charscalex100 - apari\u355?ia sau accentuarea unei senza\u355?ii
dureroase suprapubiene; \line \up0 \expndtw-2\charscalex100 - modificarea
caracteristicilor urinii emise; \par\pard\ql \li1948\sb1\sl-165\slmult0 \up0
\expndtw-1\charscalex100 - deteriorarea st\u259?rii fizice \u351?i/sau mentale,
eventual incontinen\u355?\u259? urinar\u259?. \par\pard\ql \li1948\sb21\sl-
207\slmult0 \up0 \expndtw-2\charscalex100 b) Infec\u355?iile urinare la bolnavii cu
cateter urinar \par\pard\qj \li1948\ri4004\sb0\sl-200\slmult0\fi50 \up0 \expndtw-
1\charscalex100 Sunt necesare pentru diagnostic realizarea a cel pu\u355?in
dou\u259? din urm\u259?toarele: \up0 \expndtw-2\charscalex100 - febr\u259? peste
38�C \u351?i/sau frison; \par\pard\qj \li1948\ri5315\sb20\sl-200\slmult0 \up0
\expndtw-2\charscalex100 - apari\u355?ia senza\u355?iei dureroase sau de tensiune
suprapubian\u259?; \up0 \expndtw-2\charscalex100 - modificarea caracteristicilor
urinii emise; \par\pard\ql \li1948\sb2\sl-198\slmult0 \up0 \expndtw-2\charscalex100
- deteriorarea st\u259?rii fizice \u351?i/sau mintale. \par\pard\ql
\li1948\sb15\sl-207\slmult0 \up0 \expndtw-2\charscalex100 2) Infec\u355?iile
respiratorii \par\pard\ql \li1948\sb1\sl-198\slmult0 \up0 \expndtw-2\charscalex100
a) Faringit\u259? \u351?i r\u259?ceal\u259? simpl\u259? \par\pard\qj
\li1948\ri4745\sb0\sl-220\slmult0\fi50 \up0 \expndtw-2\charscalex100 Dintre semnele
\u351?i simptomeie de mai jos prezen\u355?a a cei pu\u355?in dou\u259?: \up0
\expndtw-2\charscalex100 - rinoree \u351?i/sau str\u259?nut; \par\pard\ql
\li1948\sb1\sl-176\slmult0 \up0 \expndtw-2\charscalex100 - congestie \u351?i/sau
obstruc\u355?ie nazal\u259?; \par\pard\qj \li1948\ri5756\sb0\sl-220\slmult0 \up0
\expndtw-2\charscalex100 - durere faringian\u259?, disfonie \u351?i/sau
degluti\u355?ie dureroas\u259?; \up0 \expndtw-2\charscalex100 - tuse
neproductiv\u259?; \par\pard\ql \li1948\sb1\sl-181\slmult0 \up0 \expndtw-
2\charscalex100 - micro-limfadenopatie latero-cervical\u259? dureroas\u259?.
Viroz\u259? asem\u259?n\u259?toare st\u259?rii gripale \par\pard\qj
\li1796\ri2072\sb21\sl-200\slmult0\fi202 \up0 \expndtw-1\charscalex100 Prezen\u355?
a st\u259?rii febrile (peste 38�C) \u351?i cel pu\u355?in trei din urm\u259?
toarele: frison, cefalee sau durere ocular\u259? \up0 \expndtw-2\charscalex100
retrobulbar\u259?, mialgie, astenie
207\slmult0 \up0 \expndtw-2\charscalex100 \ul0\nosupersub\cf1\f2\fs18 sau
\par\pard\ql \li2001\sb1\sl-198\slmult0 \up0 \expndtw-2\charscalex100
inapeten\u355?\u259?, durere �n g�t, apari\u355?ia sau accentuarea tusei uscate.
Bron\u351?it\u259? \u351?i traheobron\u351?it\u259? \par\pard\qj
\li1800\ri1671\sb0\sl-200\slmult0\fi200 \up0 \expndtw-1\charscalex100 �n
prezen\u355?a unui examen radiologie toracic negativ sau �n absen\u355?a acestuia
este obligatorie prezen\u355?a a cel \up0 \expndtw-2\charscalex100 pu\u355?in trei
semne din urm\u259?toarele: \par\pard\ql \li1799\ri1753\sb15\sl-
206\slmult0\fi151 \up0 \expndtw-1\charscalex100 - apari\u355?ia tusei sau
accentuarea ei, apari\u355?ia expectora\u355?iei sau accentuarea ei, febr\u259?
(peste 38�C), durere \up0 \expndtw-1\charscalex100 toracic\u259? pleural\u259?,
apari\u355?ia sau accentuarea unor semne stetacustice pulmonare (raluri ronflante,
inspir \line \up0 \expndtw-1\charscalex100 zgomotos, etc.) apari\u355?ia sau
accentuarea disfunc\u355?iei respiratorii (tahipnee, respira\u355?ie
superficial\u259?, etc.), stare \up0 \expndtw-2\charscalex100 general\u259?
fizic\u259? \u351?i/sau mental\u259? alterat\u259?. \par\pard\ql \li1950\sb0\sl-
199\slmult0 \up0 \expndtw-2\charscalex100 d) Pneumonie \par\pard\ql \li2001\sb2\sl-
198\slmult0 \up0 \expndtw-2\charscalex100 Prezen\u355?a a cel pu\u355?in dou\u259?
semne din urm\u259?toarele: \par\pard\ql \li1950\sb15\sl-207\slmult0 \up0 \expndtw-
1\charscalex100 - apari\u355?ia tusei sau accentuarea ei, apari\u355?ia
expectora\u355?iei sau accentuarea ei, febr\u259? (peste 38�C), durere \par\pard\ql
\li1799\ri1670\sb0\sl-210\slmult0\fi0 \up0 \expndtw-1\charscalex100 toracic\u259?
pleural\u259?, apari\u355?ia sau accentuarea unor semne stetacustice pulmonare
(raluri ronflante \u351?i crepitante, \up0 \expndtw-1\charscalex100 inspir
zgomotos, dispnee, etc.), apari\u355?ia sau accentuarea disfunc\u355?iei
respiratorii (tahipnee, respira\u355?ie \line \up0 \expndtw-2\charscalex100
superficial\u259?, etc.), stare general\u259? fizic\u259? \u351?i/sau mental\u259?
alterat\u259?. \par\pard\qj \li1798\ri2583\sb0\sl-200\slmult0\fi200 \up0 \expndtw-
1\charscalex100 �n prezen\u355?a unui rezultat radiologie care eviden\u355?
iaz\u259? pneumonia sau probabilitatea pneumoniei \up0 \expndtw-1\charscalex100
(condensare) sau un infiltrat pulmonar, accentuarea desenului hilar \u351?i/sau
perihilar. \par\pard\ql \li1950\sb5\sl-207\slmult0
\up0 \expndtw-2\charscalex100 e) Otit\u259? \par\pard\qj \li1798\ri1892\sb0\sl-
200\slmult0\fi201 \up0 \expndtw-1\charscalex100 Dac\u259? otita este
diagnosticat\u259? de medic sau exist\u259? o secre\u355?ie otic\u259? uni- sau
bilateral\u259?. Durerea otic\u259? sau \up0 \expndtw-1\charscalex100 prezen\u355?a
unei ro\u351?e\u355?e congestive local\u259? este edificatoare dac\u259? otorea nu
este cu secre\u355?ie purulent\u259?. \par\pard\ql \li1949\sb14\sl-207\slmult0 \up0
\expndtw-2\charscalex100 f) Sinuzit\u259? \par\pard\ql \li2000\sb1\sl-
198\slmult0 \up0 \expndtw-2\charscalex100 Este diagnostic clinic emis de un
medic. \par\pard\ql \li1949\sb15\sl-207\slmult0 \up0 \expndtw-2\charscalex100 g)
Infec\u355?iile gurii \u351?i cavit\u259?\u355?ii bucale \par\pard\ql
\li1999\sb1\sl-198\slmult0 \up0 \expndtw-2\charscalex100 Este un diagnostic clinic
stabilit de medic sau medic stomatolog \par\pard\ql \li1949\sb3\sl-198\slmult0 \up0
\expndtw-2\charscalex100 3) Infec\u355?iile primare ale \u355?esutul sanghin
(s�ngelui) \par\pard\qj \li1798\ri1673\sb21\sl-200\slmult0\fi201 \up0 \expndtw-
1\charscalex100 Prezen\u355?a a dou\u259? sau mai multe hemoculturi pozitive din
care au fost identificate microorganisme identice \up0 \expndtw-1\charscalex100 sau
o hemocultur\u259? pozitiv\u259? ia care poate fi acceptat\u259? c\u259? nu
exist\u259? doar o suprainfec\u355?ie a probei recoltate sau \up0 \expndtw-
2\charscalex100 a mediului de cultur\u259? \par\pard\ql \li1999\sb15\sl-207\slmult0
\up0 \expndtw-2\charscalex100 \u351?i \par\pard\ql \li1949\ri3100\sb0\sl-
200\slmult0\fi50 \up0 \expndtw-2\charscalex100 este prezent cel pu\u355?in unul din
urm\u259?toarele semne: \line \up0 \expndtw-2\charscalex100 - febr\u259? peste
38�C; \par\pard\ql \li1949\sb14\sl-207\slmult0 \up0 \expndtw-2\charscalex100 -
hipotermie nou ap\u259?rut\u259? (sub 35�C); \par\pard\qj \li1949\ri4495\sb0\sl-
200\slmult0\fi0 \up0 \expndtw-1\charscalex100 - presiune sistolic\u259? cu cel
pu\u355?in 30 mmHg mai mic\u259? fa\u355?\u259? de cel obi\u351?nuit; \up0
\expndtw-2\charscalex100 - deteriorarea func\u355?iei fizice \u351?i mintale.
\par\pard\ql \li1949\sb14\sl-207\slmult0 \up0 \expndtw-2\charscalex100 4)
Gastroenterite \par\pard\ql \li1999\sb1\sl-198\slmult0 \up0 \expndtw-
2\charscalex100 Prezen\u355?a a cel pu\u355?in unul din urm\u259?toarele
semne/simptome: \par\pard\qj \li1949\ri4744\sb0\sl-220\slmult0 \up0 \expndtw-
2\charscalex100 - dou\u259? sau mai multe scaune apoase peste cele obi\u351?nuite
�n 24 ore; \up0 \expndtw-2\charscalex100 - dou\u259? sau mai multe
vomismente/vom\u259? �n 24 ore; \par\pard\qj \li1948\ri2074\sb0\sl-200\slmult0 \up0
\expndtw-1\charscalex100 - coprobacteriologie pozitiv\u259? pentru Salmonella sp.
Shigella sp., E. coli O157:H7, Camphylobacter sp. \line \up0 \expndtw-
2\charscalex100 sau \par\pard\qj \li1999\ri4095\sb2\sl-200\slmult0\fi0 \up0
\expndtw-1\charscalex100 rezultate pozitive pentru toxine microbiene specifice (de
ex. C. difficile, etc.) \line \up0 \expndtw-2\charscalex100 \u351?i \par\pard\qj
\li1797\ri1823\sb0\sl-220\slmult0\fi201 \up0 \expndtw-1\charscalex100 semne
relevante pentru gastroenterit\u259? infec\u355?ioas\u259? (grea\u355?\u259?,
v\u259?rs\u259?turi, scaune diareice, jen\u259? sau durere �n \up0 \expndtw-
2\charscalex100 regiunea abdominal\u259?.) \par\pard\ql \li1948\sb1\sl-
176\slmult0 \up0 \expndtw-2\charscalex100 5) Infec\u355?iile cutanate \u351?i
ale \u355?esuturilor moi \par\pard\ql \li1948\sb19\sl-207\slmult0 \up0 \expndtw-
2\charscalex100 a) Celulita \u351?i infec\u355?ia pl\u259?gii cutanate/subcutane
Prezen\u355?a secre\u355?iei purulente la nivelul pl\u259?gii, pielii sau \u355?
esuturilor moi subiacente \line \up0 \expndtw-2\charscalex100 \u351?i
\par\pard\ql \li1999\sb14\sl-207\slmult0 \up0 \expndtw-2\charscalex100 Prezen\u355?
a unuia din semnele de mai jos: \par\pard\ql \li1948\ri4553\sb0\sl-
206\slmult0\fi0 \up0 \expndtw-1\charscalex100 - febr\u259? peste 38�C sau
schimbarea defavorabil\u259? a st\u259?rii mentale/fizice; \line \up0 \expndtw-
2\charscalex100 - senza\u355?ie de c\u259?ldur\u259? \u351?i ro\u351?ea\u355?\u259?
la nivelul trunchiului sau membrelor; \line \up0 \expndtw-2\charscalex100 -
tumefiere \u351?i sensibilitate sau durere la nivelul regiunii afectate; \line \up0
\expndtw-1\charscalex100 - exacerbarea secre\u355?iilor la nivelul leziunii sau a
teritoriului afectat. \par\pard\ql \li1948\sb1\sl-191\slmult0 \up0 \expndtw-
2\charscalex100 b) Infec\u355?ii micotice cutanate \par\pard\ql \li1998\sb16\sl-
207\slmult0 \up0 \expndtw-2\charscalex100 Realizarea urm\u259?toarelor dou\u259?
criterii: \par\pard\ql \li1948\sb1\sl-198\slmult0 \up0 \expndtw-2\charscalex100 -
prezen\u355?a unei erup\u355?ii maculo-papuloase; \par\pard\ql \li1948\sb3\sl-
198\slmult0 \up0 \expndtw-2\charscalex100 - diagnosticul micozei de c\u259?tre un
medic sau prin probe de laborator. \par\pard\ql \li1948\sb15\sl-207\slmult0 \up0
\expndtw-2\charscalex100 c) Infec\u355?ie cutanat\u259? herpetic\u259? \u351?i
herpes zoosterian\u259? \par\pard\ql \li1997\sb1\sl-198\slmult0 \up0 \expndtw-
2\charscalex100 �n ambele situa\u355?ii realizarea urm\u259?toarelor dou\u259?
criterii: \par\pard\ql \li1948\sb3\sl-198\slmult0 \up0 \expndtw-2\charscalex100 -
prezen\u355?a unei erup\u355?ii veziculare pe o suprafa\u355?\u259?
segmentar\u259?; \par\pard\ql \li1948\sb15\sl-207\slmult0 \up0 \expndtw-
1\charscalex100 - diagnosticul de c\u259?tre medic sau prin laborator a unei
infec\u355?ii specifice. \par\pard\ql \li1948\sb1\sl-198\slmult0 \up0 \expndtw-
2\charscalex100 d) Scabie cutanat\u259?
2\charscalex100 \ul0\nosupersub\cf1\f2\fs18 Pentru diagnostic este necesar\u259?
realizarea a dou\u259? criterii: \line \up0 \expndtw-2\charscalex100 - prezen\u355?
a unor erup\u355?ii maculo-papulare pruriginoase; \par\pard\ql \li1951\sb15\sl-
207\slmult0 \up0 \expndtw-1\charscalex100 - diagnosticul scabiei de c\u259?tre un
medic cu sau f\u259?r\u259? confirmarea prin examene de laborator. \par\pard\ql
\li1951\sb1\sl-198\slmult0 \up0 \expndtw-2\charscalex100 e) Conjunctivit\u259?
\par\pard\ql \li2001\sb3\sl-198\slmult0 \up0 \expndtw-2\charscalex100 Din cele
dou\u259? criterii realizarea a cel pu\u355?in unul: \par\pard\ql \li1951\sb15\sl-
207\slmult0 \up0 \expndtw-1\charscalex100 - apari\u355?ia unei secre\u355?ii
purulente la nivelul ochiului sau la ambii ochi de cel pu\u355?in 24 ore;
- apari\u355?ia unei ro\u351?e\u355?e noi sau accentuarea celei existente la
nivelul conjunctivei oculare, senza\u355?ie \up0 \expndtw-2\charscalex100
dureroas\u259? sau durere local\u259?, cu sau f\u259?r\u259? prurit, de cel
pu\u355?in 24 ore. \par\pard\ql \li1951\sb14\sl-207\slmult0 \up0 \expndtw-
2\charscalex100 6) Perioade febrile probabil infec\u355?ioase de cauz\u259?
neelucidat\u259?/incert\u259? \par\pard\ql \li1799\ri1768\sb0\sl-
210\slmult0\fi201\tx2001 \up0 \expndtw-1\charscalex100 Stare febril\u259? (peste
38�C) �n mai multe episoade, cu intervale afebrile de cel pu\u355?in 12 ore, stare
care este \up0 \expndtw-1\charscalex100 prezent\u259? cel pu\u355?in 3 zile \u351?i
nu sunt demonstrate cauze evidente infec\u355?ioase sau neinfec\u355?ioase.
\line \tab \up0 \expndtw-2\charscalex100 Medicul emite diagnosticul de stare
febril\u259? de cauz\u259? neelucidat\u259?. \par\pard\ql \li5551\sb184\sl-
207\slmult0 \up0 \expndtw-2\charscalex100 CAPITOLUL XV \par\pard\ql
\li2985\ri2741\sb19\sl-200\slmult0\tx3178 \up0 \expndtw-2\charscalex100 INFEC\u354?
II CU MICROORGANISME GENETIC MODIFICATE ARTIFICIAL \u350?I CU \line\tab \up0
\expndtw-2\charscalex100 TRANSMITERE ACCIDENTAL\u258? SAU PRIN AC\u354?IUNI DE
BIOTERORISM \par\pard\ql \li1799\sb0\sl-206\slmult0
Orice simptom sau sindrom infec\u355?ios care apare sub form\u259? de caz nou
\u351?i acut, este prezent la o persoan\u259? \up0 \expndtw-1\charscalex100 sau
afecteaz\u259? mai mul\u355?i bolnavi \u351?i/sau personal medico-sanitar \u351?i
epidemiologie este demonstrat\u259? leg\u259?tura \up0 \expndtw-1\charscalex100 de
cauzalitate cu activitatea \u351?i/sau produsele \u351?i materialele unui laborator
de microbiologie sau, este \line \up0 \expndtw-1\charscalex100 suspicionat\u259?
r\u259?sp�ndirea inten\u355?ionat\u259? a agentului etiologic patogen infec\u355?
ios. \par\pard\ql \li9340\sb0\sl-207\slmult0 \par\pard\ql\li9340\sb7\sl-207\slmult0
\up0 \expndtw-2\charscalex100 ANEXA Nr. III \par\pard\ql \li3239\sb193\sl-
207\slmult0 \up0 \expndtw-2\charscalex100 SUPRAVEGHEREA EPIDEMIOLOGIC\u258? A
INFEC\u354?IILOR NOSOCOMIALE \par\pard\ql \li1950\sb0\sl-207\slmult0
\par\pard\ql\li1950\sb6\sl-207\slmult0 \up0 \expndtw-2\charscalex100 1.
Considera\u355?ii generale. \par\pard\qj \li1798\ri2412\sb0\sl-210\slmult0\fi202
\up0 \expndtw-1\charscalex100 Supravegherea epidemiologic\u259? este activitatea
sistematic\u259? \u351?i/sau continu\u259? de colectare, analiz\u259?, \up0
\expndtw-1\charscalex100 prelucrare, interpretare a datelor, necesar\u259? pentru
cunoa\u351?terea frecven\u355?ei infec\u355?iilor nosocomiale \u351?i \up0
\expndtw-2\charscalex100 identificarea factorilor de risc. \par\pard\ql
\li2000\sb1\sl-186\slmult0 \up0 \expndtw-2\charscalex100 Rezultatul analizei
datelor este difuzat sistematic. \par\pard\ql \li2000\sb17\sl-207\slmult0 \up0
\expndtw-1\charscalex100 Datele ob\u355?inute
folosesc pentru elaborarea, planificarea, implementarea \u351?i evaluarea
\par\pard\ql \li1798\sb1\sl-198\slmult0 \up0 \expndtw-1\charscalex100 ac\u355?
iunilor/programelor de ac\u355?iuni, av�nd ca scop prevenirea \u351?i controlul
infec\u355?iilor nosocomiale, \par\pard\ql \li1950\sb3\sl-198\slmult0 \up0
\expndtw-2\charscalex100 2. Obiective: \par\pard\ql \li1950\sb15\sl-207\slmult0
\up0 \expndtw-1\charscalex100 2.1. S\u259? determine inciden\u355?a infec\u355?
iilor nosocomiale pe baza defini\u355?iilor de caz. \par\pard\ql \li1950\sb1\sl-
198\slmult0 \up0 \expndtw-1\charscalex100 2.2. S\u259? determine tendin\u355?a
evolu\u355?iei precum \u351?i modific\u259?rile caracteristicilor infec\u355?iilor
nosocomiale. \par\pard\ql \li1949\sb3\sl-198\slmult0 \up0 \expndtw-2\charscalex100
2.3. S\u259? identifice factorii de risc. \par\pard\ql \li1949\sb15\sl-
207\slmult0 \up0 \expndtw-1\charscalex100 2.4. S\u259? determine promovarea
ac\u355?iunilor/programelor de prevenire \u351?i control. \par\pard\ql
\li1949\sb1\sl-198\slmult0 \up0 \expndtw-2\charscalex100 2.5. S\u259? evalueze
activit\u259?\u355?ile/programele de prevenire \u351?i control. \par\pard\ql
\li1949\sb3\sl-198\slmult0 \up0 \expndtw-2\charscalex100 3. Defini\u355?iile
infec\u355?iilor nosocomiale. \par\pard\qj \li1797\ri2253\sb21\sl-200\slmult0\fi201
\up0 \expndtw-1\charscalex100 Supravegherea epidemiologic\u259? a infec\u355?iilor
nosocomiale se bazeaz\u259? pe defini\u355?iile clinice de caz ale \up0 \expndtw-
2\charscalex100 infec\u355?iilor nosocomiale prev\u259?zute �n prezentul ordin.
Popula\u355?ia supravegheat\u259?: \par\pard\ql \li1999\sb15\sl-207\slmult0 \up0
\expndtw-1\charscalex100 Reprezint\u259? num\u259?rul total de persoane aflate la
risc pentru dob�ndirea unei infec\u355?ii nosocomiale (ex.: \par\pard\qj
\li1797\ri1685\sb0\sl-220\slmult0 \up0 \expndtw-1\charscalex100 pacien\u355?ii
interna\u355?i �n sec\u355?iile de chirurgie, pacien\u355?ii interna\u355?i �n
sec\u355?ia de pediatrie, sugarii alimenta\u355?i artificial �n \up0 \expndtw-
2\charscalex100 sec\u355?ia de pediatrie, etc.). \par\pard\ql \li1948\sb1\sl-
175\slmult0 \up0 \expndtw-2\charscalex100 5. Colectarea datelor. \par\pard\qj
\li1797\ri1715\sb0\sl-210\slmult0\fi151 \up0 \expndtw-1\charscalex100 5.1.
Identificarea infec\u355?iilor nosocomiale constituie sarcina permanent\u259? a
medicilor din spitale/ambulatoriu, \line \up0 \expndtw-1\charscalex100 din sistemul
sanitar de stat \u351?i privat. Diagnosticul de infec\u355?ie nosocomial\u259? se
va men\u355?iona �n actele medicale \line \up0 \expndtw-1\charscalex100 cu care
lucreaz\u259? medicul (ex.: foaia de observa\u355?ie clinic\u259?, fi\u351?a de
consulta\u355?ie, registrul de consulta\u355?ie, etc.). \par\pard\ql
\li1948\sb1\sl-194\slmult0 \up0 \expndtw-1\charscalex100 5.2. �nregistrarea \u351?i
declararea infec\u355?iilor nosocomiale se face pe Fi\u351?a cazului de infec\u355?
ie nosocomial\u259? \par\pard\qj \li1797\ri1705\sb22\sl-200\slmult0\fi0 \up0
\expndtw-1\charscalex100 (model prezentat �n Figura 1), de c\u259?tre asistenta
desemnat\u259? (asistenta \u351?ef\u259?) din fiecare sec\u355?ie sau directorul
\up0 \expndtw-2\charscalex100 de �ngrijiri din unitatea sanitar\u259?
respectiv\u259?. \par\pard\qj \li1797\ri2354\sb0\sl-220\slmult0\fi151 \up0
\expndtw-1\charscalex100 5.3. Responsabilitatea corectitudinii datelor �nregistrate
revine medicului �n �ngrijirea c\u259?ruia se afl\u259? \up0 \expndtw-
2\charscalex100 pacientul. \par\pard\qj \li1797\ri2305\sb0\sl-200\slmult0\fi151
\up0 \expndtw-1\charscalex100 5.4. Fi\u351?ele cazurilor de infec\u355?ii
nosocomiale vor fi transmise imediat compartimentului/serviciului de \up0 \expndtw-
2\charscalex100 supraveghere \u351?i control al infec\u355?iilor nosocomiale.
\par\pard\ql \li1948\sb2\sl-199\slmult0 \up0 \expndtw-1\charscalex100 6. Controlul
�nregistr\u259?rii \u351?i declar\u259?rii cazurilor de infec\u355?ie
nosocomial\u259? \par\pard\ql \li1948\sb2\sl-198\slmult0 \up0 \expndtw-
1\charscalex100 6.1. Compartimentul/serviciul de supraveghere \u351?i control al
infec\u355?iilor nosocomiale stabile\u351?te un ritm de \par\pard\qj
\li1796\ri1756\sb0\sl-220\slmult0 \up0 \expndtw-1\charscalex100 control pentru
depistarea cazurilor nediagnosticate, ne�nregistrate \u351?i neanun\u355?ate (ritm
recomandat: minim la \up0 \expndtw-2\charscalex100 2 zile, maxim la 7 zile).
210\slmult0 \par\pard\qj\li1799\sb0\sl-210\slmult0
\ul0\nosupersub\cf1\f2\fs18 6.2. Compartimentul/serviciul de supraveghere \u351?i
control al infec\u355?iilor nosocomiale �nregistreaz\u259? \u351?i declar\u259?
\up0 \expndtw-1\charscalex100 cazurile de infec\u355?ie nosocomial\u259?
descoperite la verific\u259?rile pe care le face la nivelul sec\u355?iilor,
dup\u259? consult cu \up0 \expndtw-2\charscalex100 medicul care �ngrije\u351?te
pacientul. \par\pard\qj \li1799\ri2181\sb0\sl-200\slmult0\fi201 \up0 \expndtw-
1\charscalex100 6.3 Centralizarea datelor se face de c\u259?tre asistenta
compartimentului/serviciului de supraveghere \u351?i \up0 \expndtw-1\charscalex100
control al infec\u355?iilor nosocomiale pentru spitalul pe care �l deserve\u351?te.
Unit\u259?\u355?ile sanitare private �nregistreaz\u259? \u351?i declar\u259?
cazurile de infec\u355?ii nosocomiale �n acela\u351?i regim ca \u351?i \up0
\expndtw-2\charscalex100 unit\u259?\u355?ile sanitare de stat. \par\pard\ql
\li1950\sb2\sl-198\slmult0 \up0 \expndtw-2\charscalex100 7. Analiza datelor.
7.1. Datele se prelucreaz\u259? \u351?i se analizeaz\u259? s\u259?pt\u259?m�nal de
c\u259?tre compartimentul/serviciul de \up0 \expndtw-2\charscalex100
supraveghere \u351?i control al infec\u355?iilor nosocomiale. \par\pard\qj
Validarea datelor se face de compartimentul/serviciul de supraveghere \u351?i
control al infec\u355?iilor \up0 \expndtw-1\charscalex100 nosocomiale care poate
solicita �n acest sens medicul care are �n �ngrijire pacientul. \par\pard\qj
Calculul \u351?i interpretarea indicilor se face de c\u259?tre
compartimentul/serviciul de supraveghere \u351?i control al \up0 \expndtw-
2\charscalex100 infec\u355?iilor nosocomiale cu un ritm s\u259?pt\u259?m�nal
- Inciden\u355?a infec\u355?iilor nosocomiale reprezint\u259? num\u259?rul de
cazuri noi de infec\u355?ii �ntr-o s\u259?pt\u259?m�n\u259?, raportate \up0
\expndtw-1\charscalex100 la popula\u355?ia asistat\u259? �n acela\u351?i interval
de timp. Pentru intervale de timp lunare, trimestriale sau anuale, �n \up0
\expndtw-1\charscalex100 unit\u259?\u355?ile sanitare cu paturi, se va utiliza ca
numitor popula\u355?ia de pacien\u355?i externa\u355?i. \par\pard\qj
Prevalen\u355?a la un moment dat reprezint\u259? num\u259?rul de cazuri de
infec\u355?ii nosocomiale existente �n evolu\u355?ie la \up0 \expndtw-
2\charscalex100 un moment dat (o zi, o s\u259?pt\u259?m�n\u259?, etc.) �ntr-o
popula\u355?ie analizat\u259?. \par\pard\ql \li1949\sb2\sl-198\slmult0 \up0
\expndtw-2\charscalex100 9. Diseminarea datelor. Datele interpretate sunt
diseminate c\u259?tre: \par\pard\ql \li1949\sb15\sl-207\slmult0 \up0 \expndtw-
2\charscalex100 9.1. sec\u355?ii, pentru informare \u351?i completarea m\u259?
surilor; \par\pard\qj \li1798\ri2052\sb0\sl-220\slmult0\fi151 \up0 \expndtw-
1\charscalex100 9.2. Consiliul de administra\u355?ie, care prin analiz\u259? ia
decizii legate de obiectivele men\u355?ionate �n prezenta \up0 \expndtw-
2\charscalex100 Anex\u259?, �n leg\u259?tur\u259? direct\u259? cu asigurarea
actului medical; \par\pard\ql \li1797\ri1844\sb0\sl-210\slmult0\fi151 \up0
\expndtw-1\charscalex100 9.3. Compartimentul/serviciul de supraveghere \u351?i
control al infec\u355?iilor nosocomiale are obliga\u355?ia �ntocmirii \up0
\expndtw-1\charscalex100 "D\u259?rii de seam\u259? statistice trimestriale" \u351?i
transmiterea acesteia c\u259?tre Autoritatea de S\u259?n\u259?tate Public\u259?
\line \up0 \expndtw-2\charscalex100 jude\u355?ean\u259?, respectiv a municipului
Bucure\u351?ti. \par\pard\ql \li1948\sb1\sl-163\slmult0 \up0 \expndtw-
2\charscalex100 10. Atitudinea �n caz de izbucnire epidemic\u259?. \par\pard\qj
Izbucnirea epidemic\u259? reprezint\u259? �nregistrarea unui num\u259?r de cazuri
de infec\u355?ie nosocomial\u259? �n exces \up0 \expndtw-2\charscalex100 net
fa\u355?\u259? de num\u259?rul de cazuri a\u351?teptat. \par\pard\qj
Responsabilitatea pentru izbucnirea unui episod epidemic revine �n exclusivitate
unit\u259?\u355?ii care l-a \up0 \expndtw-2\charscalex100 generat. \par\pard\ql
Compartimentul/serviciul de supraveghere \u351?i control al infec\u355?iilor
nosocomiale stabile\u351?te din punct de \line \up0 \expndtw-1\charscalex100 vedere
tehnic conduita �n rezolvarea izbucnirii epidemice. Odat\u259? cu informarea
operativ\u259? a Autorit\u259?\u355?ii de \line \up0 \expndtw-1\charscalex100
S\u259?n\u259?tate Public\u259? Jude\u355?ean\u259?,
conform reglement\u259?rilor Ministerului S\u259?n\u259?t\u259?\u355?ii
Publice, \line \up0 \expndtw-1\charscalex100 Compartimentul/serviciul de
supraveghere \u351?i control al infec\u355?iilor nosocomiale poate solicita
colaborarea \line \up0 \expndtw-2\charscalex100 acesteia. \par\pard\qj
Sec\u355?iile la nivelul c\u259?rora se �nregistreaz\u259? izbucniri epidemice sunt
responsabile de ducerea la \up0 \expndtw-1\charscalex100 �ndeplinire a m\u259?
surilor stabilite de Compartimentul/serviciul de supraveghere \u351?i control al
infec\u355?iilor \up0 \expndtw-2\charscalex100 nosocomiale �n vederea rezolv\u259?
rii episodului epidemic, \par\pard\qj \li1796\ri2795\sb0\sl-220\slmult0\fi151
\up0 \expndtw-1\charscalex100 10.5. Comitetul director al unit\u259?\u355?ii
sanitare este abilitat s\u259? stabileasc\u259? m\u259?surile administrative
\up0 \expndtw-2\charscalex100 corespunz\u259?toare �n cazul unei izbucniri
epidemice. \par\pard\ql \li9777\sb164\sl-207\slmult0 \up0 \expndtw-2\charscalex100
Figura 1 \par\pard\ql \li4261\sb0\sl-207\slmult0 \par\pard\ql\li4261\sb6\sl-
207\slmult0 \up0 \expndtw-2\charscalex100 FI\u350?A CAZULUI DE INFEC\u354?IE
NOSOCOMIAL\u258?
*)\par\pard\sect\sectd\sbknone\cols2\colno1\colw4079\colsr60\colno2\colw7961\colsr1
60\ql \li1799\sb0\sl-115\slmult0 \par\pard\ql \li1799\sb0\sl-115\slmult0
\par\pard\ql \li1800\sb99\sl-115\slmult0\tldot\tx3114 \up0 \expndtw-
4\charscalex86 \ul0\nosupersub\cf5\f6\fs10 �N SEC\u354?IA ...\tab \up0 \expndtw-
4\charscalex88 .. SPITALUL ...\par\pard\ql \li1800\sb0\sl-112\slmult0 \up0
\expndtw-4\charscalex89 Bolnavul: Nume ...\par\pard\qj \li1799\ri271\sb17\sl-
95\slmult0\fi0 \up0 \expndtw-4\charscalex90 Data na\u351?terii
(zz/ll/aa): ... \line \up0 \expndtw-4\charscalex91 Data intern\u259?rii
(zz/ll/aa): ... \line \up0 \expndtw-4\charscalex89 Diagnostic la
internare ...\par\pard\ql \li1799\sb0\sl-114\slmult0 \up0 \expndtw-4\charscalex84
Diagnostic la 72 de ore ...\par\pard\column \ql \li1799\sb0\sl-115\slmult0
\par\pard\ql \li1799\sb0\sl-115\slmult0 \par\pard\ql \li800\sb99\sl-115\slmult0
\up0 \expndtw-4\charscalex89 .. Data complet\u259?rii (zz/ll/aa):
...\par\pard\ql \li20\sb0\sl-112\slmult0\tldot\tx2125 \up0 \expndtw-
4\charscalex87 .. Prenume ...\tab \up0 \expndtw-4\charscalex84 . Sexul
...\par\pard\ql \li320\sb0\sl-114\slmult0 \up0 \expndtw-4\charscalex86 ... V�rsta
la data intern\u259?rii ...\par\pard\ql \li800\sb0\sl-112\slmult0 \up0 \expndtw-
4\charscalex80 .. Nr. FO ... \par\pard\sect\sectd\sbknone \li1799\sb1\sl-
113\slmult0\fi0\tx2699 \up0 \expndtw-4\charscalex86 Salon Nr. ..\tab \up0
\expndtw-4\charscalex87 . Dac\u259? a fost mutat se specific\u259?
salonul \u351?i data mut\u259?rii: ...\par\pard\sect\sectd\sbknone
\li1799\sb1\sl-114\slmult0\fi0 \up0 \expndtw-4\charscalex86 �n sec\u355?iile cu
profil chirurgical:\par\pard\ql \li1799\sb0\sl-106\slmult0 \up0 \expndtw-
4\charscalex91 Denumirea opera\u355?iei ... \par\pard\ql \li2399\sb1\sl-
98\slmult0 \up0 \expndtw-4\charscalex91 data interven\u355?iei
(zz/ll/aa): ... \par\pard\ql \li1799\sb0\sl-115\slmult0
\par\pard\ql\li1799\sb13\sl-115\slmult0 \up0 \expndtw-4\charscalex95 Infec\u355?ie
nosocomial\u259?: \par\pard\ql \li1799\sb5\sl-115\slmult0 \up0 \expndtw-
3\charscalex100
\u9484?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u947
2?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u94
72?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9
472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u
9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\
u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?
\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9488
? \par\pard\li1799\sb1\sl-112\slmult0\fi0\tldot\tx7018 \up0 \expndtw-4\charscalex96
\u9474?Diagnostic clinic: ...\tab \up0 \expndtw-4\charscalex96 .
debut\u9474?\par\pard\li1799\sb0\sl-112\slmult0\fi0\tx7439 \up0 \expndtw-
4\charscalex96 \u9474?(zz/ll/aa): ...\tab \up0 \expndtw-4\charscalex96
\u9474?\par\pard\li1799\sb1\sl-114\slmult0\fi0 \up0 \expndtw-4\charscalex97
\u9492?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u947
2?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u94
72?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9
472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u
9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\
u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?
\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9496
?\par\pard\li1798\sb113\sl-115\slmult0\fi0 \up0 \expndtw-4\charscalex95 Examene
microbiologice centru diagnosticul de infec\u355?ie
nosocomial\u259?:\par\pard\li1798\sb0\sl-113\slmult0\fi0 \up0 \expndtw-
4\charscalex95
\u9484?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u947
2?\u9472?\u9516?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u94
72?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9
472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9516?\u9472?\u9472?\u9472?\u9472?\u
9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\
u9472?\u9472?\u9472?\u9472?\u9516?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?
\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9488
?\par\pard\li1798\sb1\sl-113\slmult0\fi0\tx3598\tx5039\tx6298\tx6598\tx7438 \up0
\expndtw-4\charscalex86 \u9474? Data recolt\u259?rii probei \u9474?\tab \up0
\expndtw-4\charscalex94 Denumirea examenului\tab \up0 \expndtw-4\charscalex85
\u9474? Germeni izola\u355?i\tab \up0 \expndtw-4\charscalex94 \u9474?\tab
\up0 \expndtw-4\charscalex94 Diagnostic\tab \up0 \expndtw-4\charscalex94
\u9474?\par\pard\li1798\sb1\sl-
114\slmult0\fi0\tx2278\tx3298\tx3958\tx5038\tx6298\tx7438 \up0 \expndtw-
4\charscalex94 \u9474?\tab \up0 \expndtw-4\charscalex94 (zz/ll/aa)\tab \up0
\expndtw-4\charscalex94 \u9474?\tab \up0 \expndtw-4\charscalex94 efectuat\tab
\up0 \expndtw-4\charscalex94 \u9474?\tab \up0 \expndtw-4\charscalex94
\u9474?\tab \up0 \expndtw-4\charscalex94 \u9474?\par\pard\qj \li1798\ri4603\sb0\sl-
90\slmult0 \up0 \expndtw-3\charscalex100
\u9500?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u947
2?\u9472?\u9532?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u94
72?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9
472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9532?\u9472?\u9472?\u9472?\u9472?\u
9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\
u9472?\u9472?\u9472?\u9472?\u9532?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?
\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9508
? \line \up0 \expndtw-3\charscalex100
\u9500?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u947
2?\u9472?\u9532?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u94
72?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9
472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9532?\u9472?\u9472?\u9472?\u9472?\u
9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\
u9472?\u9472?\u9472?\u9472?\u9532?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?
\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9508
\u9500?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u947
2?\u9472?\u9532?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u94
72?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9
472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9532?\u9472?\u9472?\u9472?\u9472?\u
9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\
u9472?\u9472?\u9472?\u9472?\u9532?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?
\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9508
\u9492?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u947
2?\u9472?\u9524?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u94
72?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9
472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9524?\u9472?\u9472?\u9472?\u9472?\u
9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\
u9472?\u9472?\u9472?\u9472?\u9524?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?
\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9496
? \par\pard\ql \li1798\sb113\sl-115\slmult0 \up0 \expndtw-4\charscalex94
Antibiograma: ... \par\pard\sect\sectd\fs24\paperw12240\paperh15840\pard\sb0\sl-
\par\pard\ql\li1800\sb0\sl-90\slmult0
\par\pard\ql\li1800\sb0\sl-90\slmult0 \par\pard\ql\li1800\ri4290\sb56\sl-90\slmult0
\up0 \expndtw-4\charscalex91 \ul0\nosupersub\cf5\f6\fs10 Data extern\u259?rii
(zz/ll/aa): ... \line \up0 \expndtw-4\charscalex88 Nr. total zile spitalizare:
... \par\pard\qj \li1799\ri5622\sb0\sl-90\slmult0\fi0 \up0 \expndtw-4\charscalex91
Starea la externare (vindecat, ameliorat, sta\u355?ionar, transferat,
decedat): ... \up0 \expndtw-4\charscalex89 Diagnosticul la externare (sau
deces): ... \par\pard\ql \li1799\sb0\sl-90\slmult0 \up0 \expndtw-4\charscalex88
Nr. zile de tratament pentru infec\u355?ia nosocomial\u259?: ...
\par\pard\ql \li1799\sb0\sl-90\slmult0 \up0 \expndtw-4\charscalex86 Factori de
risc ... \par\pard\ql \li6418\sb0\sl-115\slmult0 \par\pard\ql\li6418\sb0\sl-
Semn\u259?tura \par\pard\qj \li1799\sb0\sl-220\slmult0
\ul0\nosupersub\cf1\f2\fs18 *) Se completeaz\u259? pentru fiecare caz nou de
infec\u355?ie nosocomial\u259? (dac\u259? un bolnav a avut dou\u259? sau mai
\up0 \expndtw-1\charscalex100 multe infec\u355?ii nosocomiale, se completeaz\u259?
c�te o fi\u351?\u259? pentru fiecare �mboln\u259?vire). \par\pard\ql
\li9321\sb191\sl-207\slmult0 \up0 \expndtw-2\charscalex100 ANEXA Nr. IV
\par\pard\ql \li5015\sb0\sl-200\slmult0 \par\pard\ql\li5015\ri4671\sb19\sl-
200\slmult0\tx5934 \up0 \expndtw-2\charscalex100 PRECAU\u354?IUNI UNIVERSALE
\line\tab \up0 \expndtw-2\charscalex100 (PU) \par\pard\ql \li5520\sb111\sl-
115\slmult0 \up0 \expndtw-4\charscalex90 \ul0\nosupersub\cf5\f6\fs10 SCOPUL
aplic\u259?rii PU: \par\pard\ql \li3269\sb5\sl-115\slmult0 \up0 \expndtw-
3\charscalex100
\u9484?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u947
2?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u94
72?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9
472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u
9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\
u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?
\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9488
? \par\pard\li3268\sb5\sl-115\slmult0\fi1\tx8909 \up0 \expndtw-4\charscalex91
\u9474?Prevenirea transmiterii infec\u355?iilor cu cale de transmitere
sanguin\u259?, la locul de munc\u259? al\tab \up0 \expndtw-4\charscalex90
\u9474?\par\pard\li3268\sb0\sl-113\slmult0\fi1\tx8909 \up0 \expndtw-
4\charscalex90 \u9474?personalului.\tab \up0 \expndtw-4\charscalex90
\u9492?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u947
2?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u94
72?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9
472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u
9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\
u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?
\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9496
?\par\pard\li3268\sb0\sl-113\slmult0\fi1 \up0 \expndtw-4\charscalex91
\u9484?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u947
2?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u94
72?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9
472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u
9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\
u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?
\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9488
?\par\pard\li3268\sb1\sl-114\slmult0\fi1\tx8909 \up0 \expndtw-4\charscalex90
\u9474?CONCEPTUL de PU se refer\u259? la:\tab \up0 \expndtw-4\charscalex90
4\charscalex87 \u9474?- m\u259?surile care se aplica �n vederea prevenirii
transmiterii HIV, VHB, VHC \u351?i al\u355?i agen\u355?i\tab \up0 \expndtw-
4\charscalex90 \u9474?\par\pard\li3268\sb1\sl-113\slmult0\fi0\tx8909 \up0 \expndtw-
4\charscalex91 \u9474? microbieni cu cale de transmitere sanguin\u259?, �n
timpul actului medical.\tab \up0 \expndtw-4\charscalex90
\u9474?- s�nge, alte fluide biologice \u351?i \u355?esuturile tuturor
pacien\u355?ilor se consider\u259? a fi poten\u355?ial
4\charscalex86 \u9474? infectate cu HIV, VHB, VHC \u351?i al\u355?i
agen\u355?i microbieni cu cale de transmitere parenteral\u259?\tab \up0
\expndtw-4\charscalex90 \u9474?\par\pard\li3268\sb1\sl-
114\slmult0\fi0\tx3449\tx8909 \up0 \expndtw-4\charscalex90 \u9474?\tab \up0
\expndtw-4\charscalex90 (sanguin\u259?)\tab \up0 \expndtw-4\charscalex90
4\charscalex91 \u9474?- to\u355?i pacien\u355?ii se consider\u259? poten\u355?
ial infecta\u355?i cu HIV, VHB, VHC sau cu al\u355?i agen\u355?i\tab
\up0 \expndtw-4\charscalex90 \u9474?\par\pard\li3268\sb1\sl-
113\slmult0\fi0\tx8908 \up0 \expndtw-4\charscalex90 \u9474? microbieni cu cale
de transmitere sanguin\u259?, deoarece:\tab \up0 \expndtw-4\charscalex90
4\charscalex91 \u9474?- cei mai mul\u355?i dintre purt\u259?torii de HIV,
VHB, VHC \u351?i al\u355?i agen\u355?i microbieni sunt\tab \up0 \expndtw-
4\charscalex90 \u9474? asimptomatici \u351?i nu-\u351?i cunosc propria
stare de portaj;\tab \up0 \expndtw-4\charscalex90 \u9474?\par\pard\li3268\sb1\sl-
114\slmult0\fi0 \up0 \expndtw-4\charscalex91
\u9492?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u947
2?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u94
72?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9
472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u
9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\
u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?
\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9496
?\par\pard\li3266\sb1\sl-112\slmult0\fi1231 \up0 \expndtw-4\charscalex91 REGULI de
baz\u259? �n aplicarea Precau\u355?iunilor Universale:\par\pard\li3266\sb1\sl-
113\slmult0\fi1 \up0 \expndtw-4\charscalex92
\u9484?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u947
2?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u94
72?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9
472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u
9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\
u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?
\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9488
\u9474?1. Consider\u259? to\u355?i pacien\u355?ii poten\u355?ial infecta\u355?
i;\tab \up0 \expndtw-4\charscalex91 \u9474?\par\pard\li3266\sb0\sl-
113\slmult0\fi1\tx8907 \up0 \expndtw-4\charscalex92 \u9474?2. Consider\u259?
c\u259? s�ngele, alte fluide biologice \u351?i \u355?esuturile sunt
contaminate\tab \up0 \expndtw-4\charscalex91 \u9474?\par\pard\li3266\sb1\sl-
114\slmult0\fi1\tx8907 \up0 \expndtw-4\charscalex91 \u9474? cu HIV, HBV,
HCV.\tab \up0 \expndtw-4\charscalex91 \u9474?\par\pard\li3266\sb0\sl-
113\slmult0\fi0\tx8907 \up0 \expndtw-4\charscalex88 \u9474?3. Consider\u259?
c\u259? acele \u351?i alte obiecte folosite �n practica medical\u259? sunt
contaminate dup\u259?\tab \up0 \expndtw-4\charscalex91
4\charscalex91 \u9474? utilizare.\tab \up0 \expndtw-4\charscalex91
\u9492?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u947
2?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u94
72?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9
472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u
9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\
u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u94
72?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9
496?\par\pard\li3266\sb0\sl-113\slmult0\fi0 \up0 \expndtw-4\charscalex92
\u9484?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u947
2?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u94
72?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9
472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u
9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\
u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?
\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9488
\u9474?CONTACTUL\tab \up0 \expndtw-4\charscalex91 \u9474?\par\pard\li3266\sb0\sl-
113\slmult0\fi0\tx8907 \up0 \expndtw-4\charscalex92 \u9474?tegumentelor \u351?i
mucoaselor cu urm\u259?toarele produse TREBUIE considerat LA RISC:\tab
\up0 \expndtw-4\charscalex91 \u9474?\par\pard\li3266\sb1\sl-
113\slmult0\fi0\tx8907 \up0 \expndtw-4\charscalex91 \u9474?- s�nge;\tab \up0
\expndtw-4\charscalex91 \u9474?\par\pard\li3266\sb1\sl-114\slmult0\fi0\tx8907
\up0 \expndtw-4\charscalex92 \u9474?- lichid amniotic, lichid pericardic,
lichid peritoneal, lichid pleural, lichid sinovial,\tab \up0 \expndtw-
4\charscalex91 \u9474? lichid cefalo-rahidian;\tab \up0 \expndtw-4\charscalex91
4\charscalex91 \u9474?- sperma, secre\u355?ii vaginale;\tab \up0 \expndtw-
4\charscalex91 \u9474?- \u355?esuturi;\tab \up0 \expndtw-4\charscalex91
4\charscalex91 \u9474?- orice alte fluide organice vizibil contaminate cu
s�nge;\tab \up0 \expndtw-4\charscalex91 \u9474?\par\pard\ql \li3266\sb0\sl-
106\slmult0 \up0 \expndtw-3\charscalex100
\u9492?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u947
2?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u94
72?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9
472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u
9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\
u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?
\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9496
? \par\pard\ql \li3606\sb0\sl-207\slmult0 \par\pard\ql\li3606\sb24\sl-
207\slmult0 \up0 \expndtw-2\charscalex100 \ul0\nosupersub\cf1\f2\fs18 APLICAREA
PRECAU\u354?IUNILOR UNIVERSALE SE REFER\u258? LA: \par\pard\ql \li1951\sb0\sl-
207\slmult0 \par\pard\ql\li1951\sb6\sl-207\slmult0 \up0 \expndtw-2\charscalex100 I.
UTILIZAREA ECHIPAMENTULUI DE PROTEC\u354?IE ADECVAT, COMPLET, CORECT;
1.1. DEFINI\u354?IE "ECHIPAMENT DE PROTEC\u354?IE": bariera �ntre lucr\u259?tor
\u351?i sursa de infec\u355?ie, utilizat\u259? �n \up0 \expndtw-2\charscalex100
timpul activit\u259?\u355?ilor care presupun risc de infec\u355?ie. \par\pard\ql
\li1951\sb14\sl-207\slmult0 \up0 \expndtw-1\charscalex100 1.2. CATEGORII DE BARIERE
utilizate pentru aplicarea precau\u355?iunilor universale: \par\pard\ql
\li1951\sb1\sl-198\slmult0 \up0 \expndtw-2\charscalex100 1.2.1. M\u258?NU\u350?I
\par\pard\ql \li1951\sb3\sl-198\slmult0 \up0 \expndtw-2\charscalex100 a) TREBUIE
UTILIZATE �n urm\u259?toarele situa\u355?ii: \par\pard\qj \li1800\ri1971\sb21\sl-
200\slmult0\fi151 \up0 \expndtw-1\charscalex100 - anticiparea contactului m�inilor
cu s�nge, lichide biologice contaminate, alte lichide biologice cu urme \up0
\expndtw-2\charscalex100 vizibile de s�nge, \u355?esuturi umane; \par\pard\ql
\li1951\ri4098\sb0\sl-220\slmult0 \up0 \expndtw-2\charscalex100 - abord venos sau
arterial; \line \up0 \expndtw-2\charscalex100 - recoltare de LCR; \par\pard\qj
\li1951\ri2398\sb0\sl-200\slmult0 \up0 \expndtw-1\charscalex100 - contact cu
pacien\u355?i care s�ngereaz\u259?, au pl\u259?gi deschise, escare de decubit, alte
leziuni cutanate; \line \up0 \expndtw-1\charscalex100 - manipularea, dup\u259?
utilizare a instrumentarului contaminat, �n vederea cur\u259?\u355?irii,
decontamin\u259?rii. \par\pard\ql \li1951\sb2\sl-199\slmult0 \up0 \expndtw-
2\charscalex100 b) FELUL M\u258?NU\u350?ILOR \par\pard\ql \li1951\sb2\sl-
198\slmult0 \up0 \expndtw-2\charscalex100 - de uz unic sterile: \par\pard\ql
\li1951\sb3\sl-198\slmult0 \up0 \expndtw-2\charscalex100 \u8226? chirurgie
\par\pard\ql \li1951\sb15\sl-207\slmult0 \up0 \expndtw-2\charscalex100 \u8226?
examinare intern\u259? \par\pard\qj \li1799\ri2059\sb0\sl-200\slmult0\fi151 \up0
\expndtw-1\charscalex100 \u8226? interven\u355?ii care implic\u259? un contact cu
regiuni ale corpului �n mod normal sterile; uneori sunt necesare \up0 \expndtw-
2\charscalex100 m\u259?nu\u351?i duble; \par\pard\ql \li1951\sb14\sl-207\slmult0
\up0 \expndtw-2\charscalex100 \u8226? abord vascular prin punc\u355?ie;
tegument pacient cu solu\u355?ii de continuitate; \par\pard\ql
\li1951\ri3088\sb21\sl-200\slmult0 \up0 \expndtw-2\charscalex100 \u8226?
manipularea unor materiale poten\u355?ial contaminate; \line \up0 \expndtw-
2\charscalex100 - nesterile curate: \par\pard\ql \li1951\sb2\sl-198\slmult0 \up0
\expndtw-1\charscalex100 \u8226? examin\u259?ri curente, care implic\u259? un
contact cu mucoasele, dac\u259? nu exist\u259? o recomandare contrar\u259?;
manipularea de materiale contaminate; \par\pard\ql \li1950\sb1\sl-198\slmult0
\up0 \expndtw-2\charscalex100 \u8226? cur\u259?\u355?enie, �ndep\u259?rtare de
produse biologice contaminate;
207\slmult0 \up0 \expndtw-2\charscalex100 \ul0\nosupersub\cf1\f2\fs18 - de uz
general, menaj, de cauciuc: \par\pard\qj \li1800\ri2298\sb0\sl-220\slmult0\fi151
\up0 \expndtw-1\charscalex100 \u8226? activit\u259?\u355?i de �ntre\u355?inere,
care implic\u259? un contact cu s�nge \u351?i alte produse biologice considerate a
fi \up0 \expndtw-2\charscalex100 contaminate; \par\pard\qj \li1799\ri2179\sb0\sl-
200\slmult0\fi151 \up0 \expndtw-1\charscalex100 \u8226? colectare materiale
contaminate, cur\u259?\u355?ire \u351?i decontaminare instrumentar, material moale,
suprafe\u355?e \up0 \expndtw-2\charscalex100 contaminate. \par\pard\ql
\li1951\sb2\sl-198\slmult0 \up0 \expndtw-2\charscalex100 \u8226? manipularea de
materiale contaminate; \par\pard\ql \li1951\sb3\sl-198\slmult0 \up0 \expndtw-
2\charscalex100 \u8226? cur\u259?\u355?enie, �ndep\u259?rtare de produse
biologice \par\pard\ql \li1950\sb3\sl-198\slmult0 \up0 \expndtw-2\charscalex100 c)
MOD DE FOLOSIRE: \par\pard\ql \li1950\sb15\sl-207\slmult0 \up0 \expndtw-
2\charscalex100 - schimbare dup\u259? fiecare pacient; \par\pard\ql \li1950\sb1\sl-
198\slmult0 \up0 \expndtw-1\charscalex100 - dup\u259? folosire se spal\u259? mai
�nt�i m�inile cu m\u259?nu\u351?i, dup\u259? care acestea se �ndep\u259?
rteaz\u259?, prinz�nd \par\pard\ql \li1798\ri1821\sb0\sl-210\slmult0\fi1 \up0
\expndtw-1\charscalex100 marginea primei prin exterior arunc�nd-o �n containerul
pentru colectare \u351?i apoi prinz�nd-o pe cealalt\u259?, cu \up0 \expndtw-
1\charscalex100 m�na liber\u259? prin interior, sco\u355?�nd-o cu grij\u259? \u351?
i arunc�nd-o �n acela\u351?i container aflat Ia �ndem�n\u259?; \line \up0 \expndtw-
1\charscalex100 - dup\u259? �ndep\u259?rtarea m\u259?nu\u351?ilor m�inile se
spal\u259? din nou, 10-15 secunde, chiar dac\u259? m\u259?nu\u351?ile nu
prezint\u259? \up0 \expndtw-1\charscalex100 semne vizibile de deteriorare �n timpul
activit\u259?\u355?ii �ncheiate; m\u259?nu\u351?ile de unic\u259? utilizare nu se
reutilizeaz\u259?, \up0 \expndtw-2\charscalex100 deci nu se cur\u259?\u355?\u259?,
dezinfecteaz\u259?; \par\pard\qj \li1798\ri2513\sb0\sl-200\slmult0\fi151 \up0
\expndtw-1\charscalex100 - m\u259?nu\u351?ile de uz general se pot decontamina
\u351?i reutiliza, dac\u259? nu prezint\u259? semne de deteriorare \up0 \expndtw-
2\charscalex100 (perforare, �mb\u259?tr�nire cauciuc, etc.) \par\pard\ql
\li1949\sb7\sl-207\slmult0 \up0 \expndtw-2\charscalex100 1.2.2. HALATE OBI\u350?
NUITE \par\pard\ql \li1949\sb1\sl-198\slmult0 \up0 \expndtw-2\charscalex100 - �n
timpul tuturor activit\u259?\u355?ilor din unit\u259?\u355?ile medicale.
1.2.3. \u350?ORTURI, BLUZE IMPERMEABILE - completeaz\u259? portul halatelor atunci
c�nd se anticipeaz\u259? \up0 \expndtw-1\charscalex100 producerea de stropi,
pic\u259?turi, jeturi cu produse biologice poten\u355?ial contaminate, protej�nd
tegumentele \up0 \expndtw-2\charscalex100 personalului medical din: \par\pard\ql
\li1948\ri4085\sb12\sl-200\slmult0 \up0 \expndtw-2\charscalex100 - sec\u355?ii cu
profil chirurgical; \line \up0 \expndtw-2\charscalex100 - laboratoare; \par\pard\ql
\li1948\ri3161\sb0\sl-220\slmult0 \up0 \expndtw-2\charscalex100 - servicii de
anatomie patologic\u259?, medicin\u259? legal\u259?;
\line \up0 \expndtw-2\charscalex100 - unele activit\u259?\u355?i
administrative; \par\pard\ql \li1948\sb1\sl-176\slmult0 \up0 \expndtw-
2\charscalex100 - servicii de urgen\u355?\u259?. \par\pard\ql
\li1948\ri4081\sb0\sl-220\slmult0\fi0 \up0 \expndtw-2\charscalex100 1.2.4. MASCA,
protejeaz\u259?: \line \up0 \expndtw-2\charscalex100 - tegumentele; \par\pard\ql
\li1948\sb1\sl-181\slmult0 \up0 \expndtw-2\charscalex100 - mucoasele bucal\u259?,
nazal\u259? ale personalului medical. \par\pard\ql \li1948\ri3316\sb0\sl-
220\slmult0\fi0 \up0 \expndtw-2\charscalex100 1.2.5. PROTECTOARE FACIALE,
protejeaz\u259?: \line \up0 \expndtw-2\charscalex100 - tegumentele; \par\pard\ql
\li1948\ri3680\sb0\sl-210\slmult0 \up0 \expndtw-2\charscalex100 - mucoasele
bucal\u259?, nazal\u259?, ocular\u259?. \line \up0 \expndtw-2\charscalex100 Tipuri
de protectoare faciale: \line \up0 \expndtw-2\charscalex100 - OCHELARI \par\pard\ql
\li1948\sb1\sl-168\slmult0 \up0 \expndtw-2\charscalex100 - ECRAN PROTECTOR, etc.
1.2.6. ECHIPAMENTE DE RESUSCITARE, protejeaz\u259? mucoasa bucal\u259? �n timpul
instituirii respira\u355?iei \up0 \expndtw-2\charscalex100 artificiale.
\par\pard\ql \li1948\sb1\sl-183\slmult0 \up0 \expndtw-2\charscalex100 1.2.7. BONETE
- simple (textile), sau impermeabile \par\pard\ql \li1948\sb8\sl-195\slmult0
\up0 \expndtw-2\charscalex100 1.2.8. CIZME DE CAUCIUC \par\pard\ql \li1948\sb16\sl-
207\slmult0 \up0 \expndtw-2\charscalex100 2. SP\u258?LAREA M�INILOR \u351?i a altor
p\u259?r\u355?i ale tegumentelor \par\pard\ql \li1948\sb1\sl-198\slmult0 \up0
\expndtw-2\charscalex100 \u8226? IMPORTAN\u354?A \par\pard\ql \li1948\sb3\sl-
198\slmult0 \up0 \expndtw-1\charscalex100 - cel mai important \u351?i uneori
singurul mod de prevenire a contamin\u259?rii \u351?i disemin\u259?rii agen\u355?
ilor microbieni. \par\pard\ql \li1948\sb15\sl-207\slmult0 \up0 \expndtw-
2\charscalex100 \u8226? C�ND? \par\pard\qj \li1948\ri5757\sb0\sl-220\slmult0
\up0 \expndtw-2\charscalex100 - la intrarea �n serviciu \u351?i la p\u259?r\u259?
sirea locului de munc\u259?; \up0 \expndtw-2\charscalex100 - la intrarea \u351?i la
ie\u351?irea din salonul de bolnavi; \par\pard\qj \li1948\ri3595\sb0\sl-200\slmult0
\up0 \expndtw-1\charscalex100 - �nainte \u351?i dup\u259? examinarea fiec\u259?rui
bolnav; aten\u355?ie bolnavii cu mare receptivitate; \up0 \expndtw-2\charscalex100
- �nainte \u351?i dup\u259? aplicarea unui tratament; \par\pard\qj
\li1948\ri5095\sb1\sl-200\slmult0 \up0 \expndtw-2\charscalex100 - �nainte \u351?i
dup\u259? efectuarea de investiga\u355?ii \u351?i proceduri invazive; \up0
\expndtw-2\charscalex100 - dup\u259? scoaterea m\u259?nu\u351?ilor de protec\u355?
ie; \par\pard\ql \li1948\sb2\sl-198\slmult0 \up0 \expndtw-2\charscalex100 -
dup\u259? scoaterea m\u259?\u351?tii folosit\u259? la locul de munc\u259?;
�nainte de prepararea \u351?i distribuirea alimentelor \u351?i a medicamentelor
administrate per os; \up0 \expndtw-2\charscalex100 - dup\u259? folosirea
batistei; \par\pard\ql \li1948\sb2\sl-198\slmult0 \up0 \expndtw-2\charscalex100 -
dup\u259? folosirea toaletei; \par\pard\ql \li1947\sb15\sl-207\slmult0 \up0
\expndtw-2\charscalex100 - dup\u259? trecerea m�inii prin p\u259?r; \par\pard\ql
\li1947\sb1\sl-198\slmult0 \up0 \expndtw-2\charscalex100 - dup\u259?
activit\u259?\u355?i administrative, gospod\u259?re\u351?ti. \par\pard\ql
\li1947\sb3\sl-198\slmult0 \up0 \expndtw-2\charscalex100 \u8226? CUM?
\par\pard\ql \li1947\ri3126\sb21\sl-200\slmult0 \up0 \expndtw-2\charscalex100 -
�ndep\u259?rtarea bijuteriilor (inele, br\u259?\u355?\u259?ri), ceasurilor;
\line \up0 \expndtw-2\charscalex100 - unghii �ngrijite, t\u259?iate scurt;
utilizare de ap\u259? curent\u259? \u351?i s\u259?pun pentru sp\u259?larea
obi\u351?nuit\u259?; \up0 \expndtw-2\charscalex100 - dou\u259? s\u259?puniri
consecutive; \par\pard\ql \li1946\sb1\sl-176\slmult0 \up0 \expndtw-1\charscalex100
- �n cazuri de urgen\u355?\u259? este permis\u259? utilizarea de antiseptice ca
�nlocuitor al sp\u259?latului, dar nu ca rutin\u259?;
207\slmult0 \up0 \expndtw-2\charscalex100 \ul0\nosupersub\cf1\f2\fs18 - �n unele
situa\u355?ii sp\u259?larea este completat\u259? de dezinfec\u355?ia m�inilor:
\par\pard\ql \li1951\sb1\sl-198\slmult0 \up0 \expndtw-1\charscalex100 - dup\u259?
manipularea bolnavilor septici, a bolnavilor contagio\u351?i \u351?i a celor cu
imunodepresie sever\u259?; \par\pard\qj \li1799\ri2061\sb21\sl-200\slmult0\fi151
\up0 \expndtw-1\charscalex100 - �nainte \u351?i dup\u259? efectuarea tratamentelor
parenterale (�n abordurile vasculare \u351?i efectuarea de punc\u355?ii \up0
\expndtw-1\charscalex100 lombare este obligatoriu portul m\u259?nu\u351?ilor),
schimbarea pansamentelor (aten\u355?ie m\u259?nu\u351?i), termometrizare \up0
\expndtw-2\charscalex100 intrarectal\u259?, clisme, toaleta lehuzei (aten\u355?ie -
m\u259?nu\u351?i); \par\pard\ql \li1950\ri3192\sb21\sl-200\slmult0\fi0 \up0
\expndtw-2\charscalex100 - dup\u259? efectuarea toaletei bolnavului la
internare; \line \up0 \expndtw-2\charscalex100 - dup\u259? manipularea \u351?i
transportul cadavrelor; \par\pard\ql \li1798\ri1862\sb0\sl-210\slmult0\fi151
\up0 \expndtw-1\charscalex100 - �nainte \u351?i dup\u259? efectuarea examenelor
\u351?i tratamentelor oftalmologice, ORL, stomatologice \u351?i �n general \up0
\expndtw-1\charscalex100 �nainte \u351?i dup\u259? orice fel de manevr\u259? care
implic\u259? abordarea sau producerea unor solu\u355?ii de continuitate \line
\up0 \expndtw-2\charscalex100 (aten\u355?ie-m\u259?nu\u351?i), \par\pard\qj
\li1949\ri2244\sb0\sl-220\slmult0\fi0 \up0 \expndtw-1\charscalex100 - sp\u259?
larea, dezinfec\u355?ia m�inilor \u351?i portul m\u259?nu\u351?ilor: - \u350?
TERGEREA, USCAREA este OBLIGATORIE \up0 \expndtw-2\charscalex100 - cu h�rtie
prosop; \par\pard\ql \li1949\sb1\sl-164\slmult0 \up0 \expndtw-2\charscalex100 -
prosop de unic\u259? �ntrebuin\u355?are. \par\pard\ql \li1949\sb13\sl-
192\slmult0 \up0 \expndtw-2\charscalex100 3. PREVENIREA ACCIDENTELOR \u350?I A
ALTOR TIPURI DE EXPUNERE PROFESIONAL\u258? \par\pard\ql \li1949\sb16\sl-207\slmult0
\up0 \expndtw-2\charscalex100 3.1. EXPUNEREA PROFESIONAL\u258? \par\pard\ql
\li1949\sb1\sl-198\slmult0 \up0 \expndtw-2\charscalex100 - prin inocul\u259?ri
percutane: \par\pard\ql \li1949\sb3\sl-198\slmult0 \up0 \expndtw-2\charscalex100
\u8226? �n\u355?epare; \par\pard\ql \li1949\sb15\sl-207\slmult0 \up0 \expndtw-
2\charscalex100 \u8226? t\u259?iere. \par\pard\qj \li1949\ri4975\sb0\sl-200\slmult0
\up0 \expndtw-2\charscalex100 - contaminarea tegumentelor care prezint\u259?
solu\u355?ii de continuitate; \up0 \expndtw-2\charscalex100 - contaminarea
mucoaselor. \par\pard\ql \li1949\sb14\sl-207\slmult0 \up0 \expndtw-2\charscalex100
- �n timpul: \par\pard\ql \li1949\sb1\sl-198\slmult0 \up0 \expndtw-
1\charscalex100 \u8226? efectu\u259?rii de manopere medicale invazive cu ace \u351?
i instrumente ascu\u355?ite; \par\pard\ql \li1949\sb15\sl-207\slmult0 \up0
\expndtw-2\charscalex100 \u8226? manipul\u259?rii de produse biologice poten\u355?
ial contaminate; \par\pard\qj \li1798\ri2270\sb0\sl-200\slmult0\fi151 \up0
\expndtw-1\charscalex100 \u8226? manipul\u259?rii instrumentarului \u351?i a altor
materiale sanitare, dup\u259? utilizarea �n activit\u259?\u355?i care au dus la
\up0 \expndtw-2\charscalex100 contaminarea cu produse biologice poten\u355?ial
infectate. \par\pard\ql \li1949\sb14\sl-207\slmult0 \up0 \expndtw-2\charscalex100 -
prin intermediul: \par\pard\ql \li1949\sb1\sl-198\slmult0 \up0 \expndtw-
2\charscalex100 \u8226? instrumentelor ascu\u355?ite; \par\pard\ql \li1949\sb3\sl-
198\slmult0 \up0 \expndtw-2\charscalex100 \u8226? materialului moale;
suprafe\u355?elor, altor materiale utilizate �n activitatea din unit\u259?\u355?ile
sanitare; \par\pard\ql \li1949\sb1\sl-198\slmult0 \up0 \expndtw-2\charscalex100
\u8226? reziduurilor din activitatea medical\u259?; \par\pard\ql
\li1949\ri3889\sb0\sl-220\slmult0 \up0 \expndtw-2\charscalex100 3.2. METODE DE
PREVENIRE \line \up0 \expndtw-2\charscalex100 - obiecte ascu\u355?ite: \par\pard\ql
\li1949\sb1\sl-176\slmult0 \up0 \expndtw-2\charscalex100 \u8226? reducerea de
manevre parenterale la minimum necesar; \par\pard\qj \li1798\ri1800\sb0\sl-
220\slmult0\fi151 \up0 \expndtw-1\charscalex100 \u8226? colectarea imediat
dup\u259? utilizare �n containere rezistente la �n\u355?epare \u351?i t\u259?iere,
amplasate la �ndem�n\u259? \u351?i \up0 \expndtw-2\charscalex100 marcate
corespunz\u259?tor conform reglement\u259?rilor MSP pentru: \par\pard\ql
\li1998\sb1\sl-181\slmult0 \up0 \expndtw-2\charscalex100 > preg\u259?tire �n
vederea utiliz\u259?rii; \par\pard\ql \li1998\sb8\sl-195\slmult0 \up0 \expndtw-
2\charscalex100 > distrugere; \par\pard\ql \li1998\sb16\sl-207\slmult0 \up0
\expndtw-2\charscalex100 > evitarea recapi\u351?on\u259?rii, �ndoirii, ruperii
acelor utilizate. \par\pard\ql \li1949\ri3361\sb0\sl-200\slmult0 \up0 \expndtw-
2\charscalex100 \u8226? de evitat scoaterea din seringile de uz unic. \line \up0
\expndtw-2\charscalex100 - lenjerie: \par\pard\qj \li1798\ri1749\sb20\sl-
200\slmult0\fi151 \up0 \expndtw-1\charscalex100 \u8226? manipularea lenjeriei
contaminate cu s�nge \u351?i alte produse biologice poten\u355?ial contaminate c�t
mai pu\u355?in \up0 \expndtw-2\charscalex100 posibil; \par\pard\ql \li1949\sb2\sl-
198\slmult0
\up0 \expndtw-1\charscalex100 \u8226? sortare \u351?i prelucrare cu echipament de
protec\u355?ie potrivit, �n spa\u355?ii special destinate; \par\pard\ql
\li1949\sb15\sl-207\slmult0 \up0 \expndtw-1\charscalex100 \u8226? colectare �n saci
impermeabili, la nevoie dubli, marca\u355?i �n mod corespunz\u259?tor; \par\pard\ql
\li1949\sb1\sl-198\slmult0 \up0 \expndtw-2\charscalex100 \u8226? evitarea p\u259?
str\u259?rii lor �ndelungate, �nainte de prelucrare; \par\pard\ql \li1949\sb15\sl-
207\slmult0 \up0 \expndtw-1\charscalex100 \u8226? asigurarea unui ciclu corect
\u351?i complet de prelucrare - decontaminare. \par\pard\ql \li1949\sb1\sl-
198\slmult0 \up0 \expndtw-2\charscalex100 \u8226? cur\u259?\u355?enie \u351?i
decontaminare: \par\pard\ql \li1998\sb3\sl-198\slmult0 \up0 \expndtw-
1\charscalex100 > folosirea m�nu\u351?ilor la �ndep\u259?rtarea urmelor de s�nge,
alte lichide biologice sau \u355?esuturi; \par\pard\qj \li1798\ri1677\sb21\sl-
200\slmult0\fi200 \up0 \expndtw-1\charscalex100 > decontaminarea ini\u355?ial\u259?
cu substan\u355?e clorigene, �ndep\u259?rtarea cu h�rtie absorbant\u259? care se
colecteaz\u259? �n \up0 \expndtw-2\charscalex100 containere sau saci de plastic
marca\u355?i; \par\pard\ql \li1998\ri3768\sb0\sl-220\slmult0\fi0 \up0 \expndtw-
2\charscalex100 > dezinfec\u355?ie cu solu\u355?ie germicid\u259?; \line \up0
\expndtw-2\charscalex100 > uscarea suprafe\u355?ei prelucrate; \par\pard\qj
\li1797\ri1743\sb0\sl-210\slmult0\fi200 \up0 \expndtw-1\charscalex100 > folosirea
de tehnici standard �n vederea efectu\u259?rii cur\u259?\u355?eniei, steriliz\u259?
rii, decontamin\u259?rii echipamentului \up0 \expndtw-1\charscalex100 medical, a
pavimentelor, pere\u355?ilor, mobilierului, veselei, sticl\u259?riei, tac�murilor,
conform reglement\u259?rilor MSP. \up0 \expndtw-2\charscalex100 - reziduuri
infectante \par\pard\ql \li1949\sb1\sl-165\slmult0 \up0 \expndtw-2\charscalex100
\u8226? neutralizare prin ardere sau autoclavare \par\pard\qj
colectare - recipiente impermeabile, marcate pentru diferen\u355?ierea clar\u259?
prin culoare \u351?i etichetare. \up0 \expndtw-2\charscalex100 - igiena
personal\u259?: \par\pard\ql \li1948\sb1\sl-183\slmult0 \up0 \expndtw-
2\charscalex100 \u8226? sp\u259?larea m�inilor (pct. 2); \par\pard\qj
sp\u259?larea altor p\u259?r\u355?i ale corpului care au venit �n contact cu
produse biologice poten\u355?ial contaminate sau \up0 \expndtw-2\charscalex100 cu
materiale poten\u355?ial contaminate; \par\pard\ql \li1948\sb1\sl-180\slmult0
\up0 \expndtw-2\charscalex100 \u8226? evitarea activit\u259?\u355?ilor cu risc de
expunere: \par\pard\sect\sectd\fs24\paperw12240\paperh15840\pard\sb0\sl-
\ul0\nosupersub\cf1\f2\fs18 > existen\u355?a de leziuni cutanate; \line \up0
\expndtw-2\charscalex100 > prezen\u355?a unui deficit imunitar; \line \up0
\expndtw-2\charscalex100 > graviditate; \par\pard\ql \li1951\sb1\sl-197\slmult0
\up0 \expndtw-2\charscalex100 - asisten\u355?a de urgen\u355?\u259?, principii:
via\u355?a pacientului este pre\u355?ioas\u259?; \par\pard\ql \li1950\sb15\sl-
207\slmult0 \up0 \expndtw-2\charscalex100 \u8226? obligatorie aplicarea
precau\u355?i un i lor universale; \par\pard\qj \li1799\ri2440\sb0\sl-
200\slmult0\fi151 \up0 \expndtw-1\charscalex100 \u8226? chiar \u351?i �n
situa\u355?ii imprevizibile se vor asigura cele necesare respect\u259?rii
principiilor precau\u355?iunilor \up0 \expndtw-2\charscalex100 universale.
\par\pard\qj \li1950\ri4944\sb20\sl-200\slmult0 \up0 \expndtw-2\charscalex100 3.3.
SERVICIILE DE STOMATOLOGIE, echipament de protec\u355?ie: \up0 \expndtw-
2\charscalex100 - masc\u259?; \par\pard\ql \li1950\ri4473\sb0\sl-220\slmult0
\up0 \expndtw-2\charscalex100 - ochelari, ecran; \line \up0 \expndtw-
2\charscalex100 - m\u259?nu\u351?i; \par\pard\ql \li1950\sb1\sl-176\slmult0 \up0
\expndtw-2\charscalex100 - \u351?or\u355? impermeabil c�nd se anticipeaz\u259?
producerea de: \par\pard\ql \li1950\sb10\sl-194\slmult0 \up0 \expndtw-
2\charscalex100 \u8226? epan\u351?amente \par\pard\ql \li1950\sb16\sl-
207\slmult0 \up0 \expndtw-2\charscalex100 \u8226? s�nge; \par\pard\ql
\li1950\ri3792\sb0\sl-200\slmult0 \up0 \expndtw-2\charscalex100 \u8226? saliv\u259?
cu urme vizibile de s�nge. \line \up0 \expndtw-2\charscalex100 - alte
recomand\u259?ri: \par\pard\ql \li1950\sb14\sl-207\slmult0 \up0 \expndtw-
2\charscalex100 \u8226? sistem de aspira\u355?ie rapid\u259?; \par\pard\ql
pozi\u355?ia adecvat\u259? a scaunului; \line \up0 \expndtw-2\charscalex100 -
instrumentar: \par\pard\ql \li1950\sb14\sl-207\slmult0 \up0 \expndtw-
2\charscalex100 \u8226? corect utilizat; \par\pard\ql \li1950\sb1\sl-198\slmult0
\up0 \expndtw-2\charscalex100 \u8226? corect colectat, sp\u259?lat, decontaminat
\u351?i/sau dezinfectat. \par\pard\ql \li1950\sb15\sl-207\slmult0 \up0 \expndtw-
2\charscalex100 3.4. SERVICIILE DE ANATOMIE PATOLOGIC\u258?: \par\pard\qj
\li1949\ri3294\sb0\sl-200\slmult0\fi0 \up0 \expndtw-1\charscalex100 - masc\u259?,
ochelari, ecran protector, m\u259?nu\u351?i, halat, \u351?orturi impermeabile,
cizme, bonete; \up0 \expndtw-2\charscalex100 - decontaminare dup\u259? efectuare a
necropsiilor: \par\pard\ql \li1949\sb14\sl-207\slmult0 \up0 \expndtw-
2\charscalex100 \u8226? instrumentar; \par\pard\ql \li1949\sb1\sl-198\slmult0
\up0 \expndtw-2\charscalex100 \u8226? suprafe\u355?e, mobilier. \par\pard\qj
LABORATOARE CLINICE \u350?I DE CERCETARE: regulile generale de aplicare a
precau\u355?iunilor \up0 \expndtw-2\charscalex100 universale trebuie completate cu:
- colectarea flacoanelor care con\u355?in produse biologice �n containere marcate,
care s\u259? �mpiedice \up0 \expndtw-2\charscalex100 r\u259?sturnarea, v\u259?
rsarea, spargerea; \par\pard\qj \li1949\ri4935\sb2\sl-200\slmult0\fi0 \up0
\expndtw-2\charscalex100 - evitarea contamin\u259?rii pere\u355?ilor exteriori ai
flacoanelor colectoare; \line \up0 \expndtw-2\charscalex100 - utilizarea
echipamentului potrivit cu presta\u355?iile laboratorului: \par\pard\ql
\li1949\sb2\sl-198\slmult0 \up0 \expndtw-2\charscalex100 \u8226? m\u259?nu\u351?
i; \par\pard\ql \li1949\sb15\sl-207\slmult0 \up0 \expndtw-2\charscalex100 \u8226?
masc\u259?, ochelari de protec\u355?ie, ecran protector; \par\pard\ql
\li1949\sb1\sl-198\slmult0 \up0 \expndtw-2\charscalex100 \u8226? halat, \u351?
or\u355? impermeabil, bonet\u259?. \par\pard\ql \li1949\sb3\sl-198\slmult0 \up0
\expndtw-2\charscalex100 - sp\u259?larea atent\u259? a m�inilor (pct. 2);
- utilizarea de echipamente de pipetare automate, semiautomate, pentru �nl\u259?
turarea tehnicilor de pipetare \up0 \expndtw-2\charscalex100 cu gura;
aten\u355?ie la utilizarea de material ascu\u355?it �n activitatea de laborator;
\up0 \expndtw-2\charscalex100 - cur\u259?\u355?enia, dezinfec\u355?ia, sterilizarea
�n mod corect, standardizat; \up0 \expndtw-2\charscalex100 - instrumentarul
contaminat, colectare, decontaminare: \par\pard\ql \li1949\sb1\sl-188\slmult0
\up0 \expndtw-2\charscalex100 \u8226? chimic\u259?; \par\pard\ql \li1949\sb17\sl-
207\slmult0 \up0 \expndtw-2\charscalex100 \u8226? fizic\u259?-ardere;
autoclav. \par\pard\ql \li1949\sb15\sl-207\slmult0 \up0 \expndtw-2\charscalex100 -
aparatur\u259? defect\u259?-decontaminare �nainte de reperare; \par\pard\qj
\li1797\ri1924\sb0\sl-200\slmult0\fi151 \up0 \expndtw-1\charscalex100 - la
terminarea activit\u259?\u355?ii, echipamentul utilizat r\u259?m�ne �n laborator
p�n\u259? la colectarea \u351?i �ndep\u259?rtarea �n \up0 \expndtw-2\charscalex100
vederea prelucr\u259?rii; \par\pard\ql \li1948\sb14\sl-207\slmult0 \up0 \expndtw-
2\charscalex100 - amplasarea de afi\u351?e avertizoare asupra riscului de
contaminare. \par\pard\ql \li1797\ri1817\sb0\sl-210\slmult0\fi200 \up0 \expndtw-
1\charscalex100 �NTREAGA ASISTEN\u354?\u258? ACORDAT\u258? PERSOANELOR IMPLICATE �N
EXPUNEREA PROFESIONAL\u258? \up0 \expndtw-1\charscalex100 ("SURS\u258?", PERSONAL
AFECTAT) SE VA DESF\u258?\u350?URA NUMAI PE BAZ\u258? DE CONSIM\u354?\u258?M�NT
\u350?I \line \up0 \expndtw-2\charscalex100 CONFIDEN\u354?IALITATE, CU ASIGURAREA
DOCUMENTELOR LOR MEDICALE. \par\pard\ql \li1949\sb1\sl-186\slmult0 \up0 \expndtw-
2\charscalex100 4. PERSONAL INFECTAT CU HIV: \par\pard\ql \li1949\sb6\sl-
196\slmult0 \up0 \expndtw-2\charscalex100 - respectarea drepturilor omului;
\par\pard\ql \li1949\sb15\sl-207\slmult0 \up0 \expndtw-1\charscalex100 - schimbarea
locului de munc\u259?, av�nd acordul celui infectat, sau la cererea acestuia, c�nd:
\par\pard\ql \li1949\sb1\sl-198\slmult0 \up0 \expndtw-2\charscalex100 \u8226? se
dovede\u351?te c\u259? nu-\u351?i protejeaz\u259? pacien\u355?ii; \par\pard\ql
\li1949\sb3\sl-198\slmult0 \up0 \expndtw-2\charscalex100 \u8226? este necesar\u259?
protec\u355?ia sa medical\u259?. \par\pard\ql \li1948\sb15\sl-207\slmult0 \up0
\expndtw-2\charscalex100 - conducerea unit\u259?\u355?ii va asigura un alt loc de
munc\u259?. \par\pard\ql \li1797\ri2067\sb0\sl-210\slmult0\fi151 \up0 \expndtw-
1\charscalex100 5.
EVALUAREA RISCULUI PE CATEGORII DE LOCURI DE MUNC\u258? \u350?I
ACTIVIT\u258?\u354?I PRESTATE DE \up0 \expndtw-1\charscalex100 PERSONALUL MEDICO-
SANITAR �N FUNC\u354?IE DE CONTACTUL CU S�NGE \u350?I ALTE LICHIDE \line \up0
\expndtw-2\charscalex100 BIOLOGICE. \par\pard\ql \li1998\sb1\sl-186\slmult0 \up0
\expndtw-2\charscalex100 I - contact permanent, inevitabil, consistent;
200\slmult0 \par\pard\ql\li2000\ri3743\sb15\sl-200\slmult0 \up0 \expndtw-
2\charscalex100 \ul0\nosupersub\cf1\f2\fs18 II - contact imprevizibil,
inconstant; \line \up0 \expndtw-2\charscalex100 III - contact inexistent;
PENTRU CATEGORIILE APAR\u354?IN�ND GRUPELOR I \u350?I II SE VOR APLICA PERMANENT
\up0 \expndtw-2\charscalex100 PRECAU\u354?IUNILE UNIVERSALE. \par\pard\ql
\li2001\sb2\sl-198\slmult0 \up0 \expndtw-1\charscalex100 Pentru cele din categoria
a III-a sunt suficiente precau\u355?iunile obi\u351?nuite. \par\pard\ql
2\charscalex100 ANEXA Nr. V \par\pard\qj \li2443\sb0\sl-200\slmult0
METODOLOGIA DE SUPRAVEGHERE \u350?I CONTROL AL ACCIDENTELOR CU EXPUNERE \line
\up0 \expndtw-2\charscalex100 LA PRODUSE BIOLOGICE LA PERSONALUL CARE LUCREAZ\u258?
�N DOMENIUL SANITAR \par\pard\ql \li1951\sb0\sl-207\slmult0
\par\pard\ql\li1951\sb8\sl-207\slmult0 \up0 \expndtw-2\charscalex100 1.
Justificare: \par\pard\ql \li1800\ri1881\sb0\sl-210\slmult0\fi200 \up0 \expndtw-
1\charscalex100 �n prezent, �n Rom�nia nu sunt colectate suficiente informa\u355?ii
pentru a evalua riscul de expunere \u351?i de a \up0 \expndtw-1\charscalex100
estima inciden\u355?a infec\u355?iilor postexpunere la s�nge \u351?i produse
biologice la personalul care lucreaz\u259? �n \line \up0 \expndtw-2\charscalex100
sistemul sanitar. \par\pard\ql \li1799\ri1772\sb0\sl-205\slmult0\fi201 \up0
\expndtw-1\charscalex100 Din datele culese de c\u259?tre Comisia de Lupt\u259? Anti
SIDA a Ministerului S\u259?n\u259?t\u259?\u355?ii (CNLAS), prin intermediul \up0
\expndtw-1\charscalex100 Centrelor Regionale de Monitorizare (CR) reiese c\u259? �n
anul 2003 au fost raportate 94 de expuneri \line \up0 \expndtw-1\charscalex100
profesionale cu risc de infec\u355?ie, la 70 dintre acestea aplic�ndu-se m\u259?
suri profilactice corespunz\u259?toare, �n \line \up0 \expndtw-1\charscalex100 anul
2004 au fost raportate 96 de expuneri, la 75 dintre acestea aplic�ndu-se m\u259?
suri profilactice \line \up0 \expndtw-2\charscalex100 corespunz\u259?toare.
Raport\u259?ri expuneri profesionale culese de CNLAS �n perioada 2003-2004:
\ul0\nosupersub\cf5\f6\fs10
\u9484?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9516?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u947
2?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u94
72?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9516?\u9472?\u9472?\u9472?\u9472?\u9
472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u
9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\
u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9488?
\par\pard\li1799\sb17\sl-115\slmult0\fi0\tx2399\tx4319\tx6539 \up0 \expndtw-
4\charscalex88 \u9474?\tab \up0 \expndtw-4\charscalex88 \u9474? Num\u259?r
expuneri profesionale\tab \up0 \expndtw-4\charscalex84 \u9474? Num\u259?r
profilaxii post-expunere\tab \up0 \expndtw-4\charscalex88
\u9474?\par\pard\li1799\sb0\sl-113\slmult0\fi0\tx2399\tx4319\tx5099\tx6539 \up0
\expndtw-4\charscalex88 \u9474?\tab \up0 \expndtw-4\charscalex88 \u9474?\tab
profesional\u259?\tab \up0 \expndtw-4\charscalex88 \u9474?\par\pard\ql
\li1799\sb1\sl-91\slmult0 \up0 \expndtw-3\charscalex100
\u9500?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9532?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u947
2?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u94
72?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9532?\u9472?\u9472?\u9472?\u9472?\u9
472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u
9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\
u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9508?
\par\pard\li1799\sb22\sl-
3\charscalex100 \u9474?\tab \up0 \expndtw-3\charscalex100 2003\tab \up0 \expndtw-
3\charscalex100 \u9474?\par\pard\ql \li1799\sb1\sl-106\slmult0 \up0 \expndtw-
3\charscalex100
\u9500?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9532?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u947
2?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u94
72?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9532?\u9472?\u9472?\u9472?\u9472?\u9
472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u
9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\
u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9508?
3\charscalex100
\u9500?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9532?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u947
2?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u94
72?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9532?\u9472?\u9472?\u9472?\u9472?\u9
472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u
9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\
u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9508?
\par\pard\li1799\sb14\sl-115\slmult0\fi0\tx2399\tx3299\tx4319\tx5339\tx6539 \up0
\expndtw-4\charscalex79 \u9474? TOTAL\tab \up0 \expndtw-4\charscalex87
\u9474?\tab \up0 \expndtw-4\charscalex87 190\tab \up0 \expndtw-4\charscalex87
\u9474?\par\pard\ql \li1799\sb0\sl-90\slmult0 \up0 \expndtw-3\charscalex100
\u9492?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9524?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u947
2?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u94
72?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9524?\u9472?\u9472?\u9472?\u9472?\u9
472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u
9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\
u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9496? \par\pard\ql
\li1800\sb0\sl-213\slmult0 \par\pard\ql\li1800\ri1911\sb16\sl-
213\slmult0\fi201\tx2001 \up0 \expndtw-1\charscalex100 \ul0\nosupersub\cf1\f2\fs18
La nivelul Institutului de Boli Infec\u355?ioase "Prof. Dr. Matei Bal\u351?" (IBI)
au fost �nregistrate 37 cazuri �n anul \line \up0 \expndtw-1\charscalex100 2003
\u351?i 55 �n 2004. Pentru toate aceste cazuri s-a aplicat Protocolul de Profilaxie
Post-expunere \line \up0 \expndtw-1\charscalex100 Profesional\u259? (PPEP),
incluz�nd vaccinarea anti hepatit\u259? B \u351?i chimioprofilaxia cu
antiretrovirale. \line \tab \up0 \expndtw-1\charscalex100 Categoriile profesionale
expuse accidentelor cu risc de infec\u355?ie, din cazuistica institutului, sunt:
\ul0\nosupersub\cf5\f6\fs10
\u9484?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u947
2?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9516?\u94
72?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9
472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u
9472?\u9472?\u9472?\u9472?\u9516?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\
u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9488?
\par\pard\li1800\sb5\sl-115\slmult0\fi0\tx2159\tx3840\tx5580\tx6539 \up0 \expndtw-
4\charscalex86 \u9474?\tab \up0 \expndtw-4\charscalex86 Categoria
profesional\u259?\tab \up0 \expndtw-4\charscalex86 \u9474? Num\u259?r
cazuri/expuneri\tab \up0 \expndtw-4\charscalex82 \u9474? Procent (%)\tab
\up0 \expndtw-4\charscalex86 \u9474?\par\pard\ql \li1799\sb1\sl-96\slmult0 \up0
\expndtw-3\charscalex100
\u9500?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9
472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u
9532?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\
u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?
\u9472?\u9472?\u9472?\u9472?\u9472?\u9532?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9508?
\expndtw-4\charscalex94 \u9474?medic chirurg\tab \up0 \expndtw-4\charscalex94
\u9474?\tab \up0 \expndtw-4\charscalex94 3,3\tab \up0 \expndtw-4\charscalex94
\u9500?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u947
2?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9532?\u94
72?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9
472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u
9472?\u9472?\u9472?\u9472?\u9532?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\
u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9508?
\expndtw-4\charscalex95 \u9474?medic stomatolog\tab \up0 \expndtw-
4\charscalex95 \u9474?\tab \up0 \expndtw-4\charscalex95 1,1\tab \up0 \expndtw-
3\charscalex100
\u9500?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u947
2?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9532?\u94
72?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9
472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u
9472?\u9472?\u9472?\u9472?\u9532?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\
u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9508?
\expndtw-4\charscalex93 \u9474?medic alte specialit\u259?\u355?i\tab \up0
\expndtw-4\charscalex93 \u9474?\tab \up0 \expndtw-4\charscalex93 32\tab \up0
\expndtw-4\charscalex93 \u9474?\tab \up0 \expndtw-4\charscalex93 34,8\tab \up0
\expndtw-4\charscalex93 \u9474?\par\pard\ql \li1799\sb1\sl-98\slmult0 \up0
\u9500?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u947
2?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9532?\u94
72?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9
472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u
9472?\u9472?\u9472?\u9472?\u9532?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\
u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9508?
\expndtw-4\charscalex94 \u9474?medic rezident\tab \up0 \expndtw-4\charscalex94
\u9500?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u947
2?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9532?\u94
72?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9
472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u
9472?\u9472?\u9472?\u9472?\u9532?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\
u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9508?
\expndtw-3\charscalex100 \u9474?student\tab \up0 \expndtw-3\charscalex100
\u9500?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u947
2?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9532?\u94
72?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9
472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u
9472?\u9472?\u9472?\u9472?\u9532?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\
u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9508?
\expndtw-4\charscalex95 \u9474?student stomatolog\tab \up0 \expndtw-4\charscalex95
\u9500?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u947
2?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9532?\u94
72?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9
472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u
9472?\u9472?\u9472?\u9472?\u9532?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\
u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9508?
\expndtw-4\charscalex96 \u9474?asistent\u259? medical\u259?\tab \up0 \expndtw-
3\charscalex100
\u9500?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u947
2?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9532?\u94
72?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9
472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u
9472?\u9472?\u9472?\u9472?\u9532?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\
u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9508?
\expndtw-3\charscalex100 \u9474?infirmier\u259?\tab \up0 \expndtw-
3\charscalex100
\u9500?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u947
2?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9532?\u94
72?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9
472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u
9472?\u9472?\u9472?\u9472?\u9532?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\
u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9508?
\expndtw-4\charscalex95 \u9474?tehnician dentar\tab \up0 \expndtw-
3\charscalex100
\u9500?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u947
2?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9532?\u94
72?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9
472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u
9472?\u9472?\u9472?\u9472?\u9532?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\
u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9508?
\expndtw-3\charscalex100 \u9474?�ngrijitoare\tab \up0 \expndtw-3\charscalex100
\u9500?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u947
2?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9532?\u94
72?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9
472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u
9472?\u9472?\u9472?\u9472?\u9532?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\
u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9508?
\par\pard\li1798\sb22\sl-115\slmult0\fi0\tx3838\tx4738\tx5578\tx6118\tx6538
\up0 \expndtw-3\charscalex100 \u9474?brancardier\tab \up0 \expndtw-
3\charscalex100
\u9500?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u947
2?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9532?\u94
72?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9
472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u
9472?\u9472?\u9472?\u9472?\u9532?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\
u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9508?
\expndtw-3\charscalex100 \u9474?voluntar\tab \up0 \expndtw-3\charscalex100
\u9500?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u947
2?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9532?\u94
72?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9
472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u
9472?\u9472?\u9472?\u9472?\u9532?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\
u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9508?
\expndtw-3\charscalex100 \u9474?TOTAL\tab \up0 \expndtw-3\charscalex100 \u9474?\tab
\up0 \expndtw-3\charscalex100 92\tab \up0 \expndtw-3\charscalex100 \u9474?\tab \up0
\expndtw-3\charscalex100 100\tab \up0 \expndtw-3\charscalex100
\u9492?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u947
2?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9524?\u94
72?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9
472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u
9472?\u9472?\u9472?\u9472?\u9524?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\
u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9496? \par\pard\qj
\li1800\sb0\sl-200\slmult0 \par\pard\qj\li1800\ri2140\sb60\sl-200\slmult0\fi201
\up0 \expndtw-1\charscalex100 \ul0\nosupersub\cf1\f2\fs18 Nu reiese din datele
culese de CNLAS dac\u259? din cele 190 cazuri de expunere profesional\u259? au
ap\u259?rut \up0 \expndtw-2\charscalex100 seroconversii pentru HIV, HBV sau HCV.
1\charscalex100 La cele 92 cazuri �nregistrate \u351?i asistate �n IBI nu s-a
semnalat nici un caz de infec\u355?ie cu HIV, HBV, HCV. \line\tab \up0 \expndtw-
1\charscalex100 Supravegherea este unul din cele mai importante mijloace de
cunoa\u351?tere a riscului prin expunere \line \up0 \expndtw-1\charscalex100
profesional\u259? la s�nge \u351?i produse biologice \u351?i de dezvoltare a unor
strategii de prevenire \u351?i control. \par\pard\ql \li1951\sb1\sl-188\slmult0
\up0 \expndtw-2\charscalex100 2. Scop \par\pard\qj \li1799\ri1761\sb23\sl-
200\slmult0\fi201 \up0 \expndtw-1\charscalex100 Reducerea riscului de infec\u355?ie
post-expunere la s�nge \u351?i produse biologice la personalul care lucreaz\u259?
�n \up0 \expndtw-2\charscalex100 sistemul sanitar. \par\pard\ql \li1950\sb2\sl-
198\slmult0 \up0 \expndtw-2\charscalex100 3. Obiective:
1\charscalex100 \ul0\nosupersub\cf1\f2\fs18 - estimarea inciden\u355?ei
accidentelor cu expunere la produse biologice la personalul care lucreaz\u259?
�n \up0 \expndtw-2\charscalex100 sistemul sanitar; \par\pard\qj
ierarhizarea factorilor de risc (proceduri, dispozitive, instruire, respectarea
Precau\u355?iilor Universale, \up0 \expndtw-2\charscalex100 statusul sursei,
altele); \par\pard\qj \li1951\ri5893\sb0\sl-220\slmult0 \up0 \expndtw-
2\charscalex100 - evaluarea respect\u259?rii precau\u355?iunilor universale
(PU); \line \up0 \expndtw-2\charscalex100 - ob\u355?inerea de date standardizate la
nivel na\u355?ional; \par\pard\ql \li1800\ri2241\sb0\sl-206\slmult0\fi151 \up0
\expndtw-1\charscalex100 - responsabilizarea personalului medical �n sensul
cunoa\u351?terii riscului expunerii la s�nge \u351?i produse \up0 \expndtw-
1\charscalex100 biologice \u351?i a aplic\u259?rii m\u259?surilor de prevenire a
acestor accidente \u351?i a consecin\u355?elor acestora; \line \up0 \expndtw-
1\charscalex100 - estimarea riscului de infec\u355?ie post-expunere
profesional\u259? cu: HIV, VHB, VHC; \line \up0 \expndtw-2\charscalex100 -
aplicarea corect\u259? a m\u259?surilor profilactice primare \u351?i secundare.
\par\pard\ql \li1951\sb1\sl-169\slmult0 \up0 \expndtw-2\charscalex100 4. Tip de
supraveghere: \par\pard\ql \li1951\ri3694\sb26\sl-200\slmult0 \up0 \expndtw-
2\charscalex100 - modul de colectare a datelor: pasiv \line \up0 \expndtw-
2\charscalex100 - instrumente de colectare a datelor: \par\pard\ql \li1951\sb2\sl-
198\slmult0 \up0 \expndtw-2\charscalex100 \u8226? fi\u351?a de supraveghere tip;
fi\u351?a privind datele despre spital; \par\pard\ql \li1951\sb1\sl-198\slmult0
\up0 \expndtw-1\charscalex100 \u8226? fi\u351?a clinic\u259? de �nregistrare a
expunerii profesionale cu risc de infec\u355?ie HIV. \par\pard\ql \li1951\sb3\sl-
198\slmult0 \up0 \expndtw-2\charscalex100 5. Defini\u355?ii: \par\pard\qj
\li1799\ri1721\sb21\sl-200\slmult0\fi151 \up0 \expndtw-1\charscalex100 - Persoana
care lucreaz\u259? �n sistemul sanitar: orice persoan\u259? (angajat, student,
voluntar) ale c\u259?rei activit\u259?\u355?i \up0 \expndtw-1\charscalex100
implic\u259? contactul cu pacien\u355?i, s�nge sau alte produse biologice provenite
de la pacien\u355?i, �n cabinete, sec\u355?ii, \up0 \expndtw-2\charscalex100
compartimente sau laboratoare. \par\pard\ql \li1950\sb15\sl-207\slmult0 \up0
\expndtw-1\charscalex100 - Expunere cu risc de infec\u355?ie HIV, VHB, VHC, care
necesit\u259? profilaxie post-expunere profesional\u259? \par\pard\ql
\li1799\ri1802\sb0\sl-206\slmult0\fi0 \up0 \expndtw-1\charscalex100 (PPEP):
accidentarea transcutan\u259? (exemplu: �n\u355?ep\u259?tur\u259? cu ac sau t\u259?
ietur\u259? cu un obiect t\u259?ios), contactul \up0 \expndtw-1\charscalex100
mucoaselor sau al pielii, care prezint\u259? leziuni ce-i afecteaz\u259?
integritatea (ex: expunerea pe o piele cu \line \up0 \expndtw-1\charscalex100
excoria\u355?ii, t\u259?ieturi, delabr\u259?ri, flictene, eczeme sau alte
afec\u355?iuni dermatologice) sau contactul cutanat pe o \up0 \expndtw-
1\charscalex100 piele intact\u259?, dar cu o durat\u259? prelungit\u259? (ex.:
c�teva minute \u351?i chiar mai mult) sau implicarea unei suprafe\u355?e \up0
\expndtw-1\charscalex100 �ntinse de contact cu s�nge, \u355?esuturi sau alte
produse biologice contaminate vizibil cu s�nge. \line \up0 \expndtw-1\charscalex100
- Produse biologice: a) sperma, secre\u355?ii vaginale; b) fluide (lichid
cefalorahidian, sinovial, pleural, \line \up0 \expndtw-1\charscalex100 peritoneal,
pericardic, amniotic); c) concentrate de HIV (�n laboratoare). \par\pard\ql
\li1799\ri1711\sb13\sl-200\slmult0\fi200 \up0 \expndtw-1\charscalex100 �n
absen\u355?a s�ngelui vizibil �n saliv\u259?, lacrimi, sudoare, urin\u259?, fecale,
lapte aceste produse biologice nu sunt \up0 \expndtw-1\charscalex100 considerate cu
risc de infec\u355?ie HIV \u351?i nu impun m\u259?suri de profilaxie
antiretroviral\u259? \u351?i de supraveghere \line \up0 \expndtw-2\charscalex100
medical\u259? PPEP. \par\pard\qj \li1798\ri2284\sb21\sl-200\slmult0\fi151 \up0
\expndtw-1\charscalex100 - Caz de expunere profesional\u259?: orice persoan\u259?
care lucreaz\u259? �n sistemul sanitar \u351?i care a suferit o \up0 \expndtw-
1\charscalex100 expunere accidental\u259? cu risc de infec\u355?ie HIV, VHB, VHC
prin contact cu s�nge sau produse biologice \up0 \expndtw-2\charscalex100
considerate cu risc de infec\u355?ie. \par\pard\ql \li1950\sb15\sl-207\slmult0 \up0
\expndtw-2\charscalex100 6. Popula\u355?ia \u354?int\u259?: \par\pard\qj
\li1798\ri3104\sb0\sl-200\slmult0\fi151 \up0 \expndtw-1\charscalex100 - persoanele
care lucreaz\u259? �n sistemul sanitar, respectiv: personalul medico-sanitar \u351?
i de \up0 \expndtw-1\charscalex100 �ngrijire/auxiliar/tehnic, persoane aflate �ntr-
o form\u259? de �nv\u259?\u355?\u259?m�nt, voluntari. \par\pard\ql \li1950\sb14\sl-
207\slmult0 \up0 \expndtw-2\charscalex100 7. Unit\u259?\u355?ile \u354?
int\u259?: \par\pard\ql \li1950\sb1\sl-198\slmult0 \up0 \expndtw-2\charscalex100 A.
unit\u259?\u355?ile sanitare cu paturi; \par\pard\ql \li1950\sb3\sl-198\slmult0
\up0 \expndtw-2\charscalex100 B. unit\u259?\u355?ile sanitare f\u259?r\u259?
paturi. \par\pard\ql \li1950\sb15\sl-207\slmult0
\up0 \expndtw-2\charscalex100 8. Atribu\u355?ii: \par\pard\ql \li1950\sb1\sl-
198\slmult0 \up0 \expndtw-2\charscalex100 A. Atribu\u355?ii �n unit\u259?\u355?ile
sanitare cu paturi \par\pard\ql \li1950\sb3\sl-198\slmult0 \up0 \expndtw-
2\charscalex100 B. Atribu\u355?ii �n unit\u259?\u355?i sanitare f\u259?r\u259?
paturi \par\pard\ql \li1950\sb15\sl-207\slmult0 \up0 \expndtw-2\charscalex100 C.
Atribu\u355?ii ale altor unit\u259?\u355?i sanitare/structuri de s\u259?n\u259?tate
public\u259? \par\pard\ql \li1950\sb0\sl-207\slmult0 \par\pard\ql\li1950\sb6\sl-
207\slmult0 \up0 \expndtw-2\charscalex100 A. Atribu\u355?ii �n unit\u259?\u355?ile
sanitare cu paturi \par\pard\ql \li1950\sb1\sl-198\slmult0 \up0 \expndtw-
2\charscalex100 A.1 . compartimentul/sec\u355?ia �n care a avut loc accidentul
\par\pard\ql \li1950\sb3\sl-198\slmult0 \up0 \expndtw-2\charscalex100 a) persoana
accidentat\u259? \par\pard\ql \li1950\sb15\sl-207\slmult0 \up0 \expndtw-
1\charscalex100 \u8226? aplic\u259? imediat protocolul din "Ghid practic de
management al expunerii accidentale la produse biologice"; \par\pard\qj
\li1798\ri2180\sb0\sl-200\slmult0\fi151 \up0 \expndtw-1\charscalex100 \u8226? �n
prima or\u259? de la accident se prezint\u259? la medicul \u351?ef de sec\u355?
ie/compartiment sau la medicul \u351?ef de \up0 \expndtw-2\charscalex100
gard\u259?; \par\pard\ql \li1949\sb14\sl-207\slmult0 \up0 \expndtw-
1\charscalex100 \u8226? �n termen de 24 de ore se prezint\u259? la responsabilul
serviciului de supraveghere a infec\u355?iilor nosocomiale; \par\pard\ql
\li1949\sb1\sl-198\slmult0 \up0 \expndtw-2\charscalex100 \u8226? anun\u355?\u259?
medicul de medicina muncii pentru luarea �n eviden\u355?\u259?; \par\pard\ql
\li1949\sb3\sl-198\slmult0 \up0 \expndtw-2\charscalex100 b) medicul \u351?ef de
sec\u355?ie/compartiment sau medicul \u351?ef de gard\u259?: \par\pard\ql
\li1949\sb15\sl-207\slmult0 \up0 \expndtw-1\charscalex100 \u8226?
�nregistreaz\u259? accidentul �ntr-un registru de eviden\u355?\u259? a accidentelor
cu expunere la produse biologice; \par\pard\qj \li1798\ri1818\sb0\sl-
200\slmult0\fi151 \up0 \expndtw-1\charscalex100 \u8226? raporteaz\u259? accidentul
responsabilului serviciului de supraveghere a infec\u355?iilor nosocomiale �n maxim
24 \up0 \expndtw-2\charscalex100 de ore de la producerea accidentului; \par\pard\qj
asigur\u259? recoltarea e\u351?antioanelor de s�nge de la pacientul surs\u259?,
respect�nd legisla\u355?ia privind testarea \up0 \expndtw-2\charscalex100
voluntar\u259? cu consiliere; \par\pard\qj \li1797\ri1730\sb0\sl-
220\slmult0\fi151 \up0 \expndtw-1\charscalex100 \u8226? asigur\u259? transportul
e\u351?antioanelor de s�nge provenite de la pacientul surs\u259? la laboratorul
unit\u259?\u355?ii cu paturi \up0 \expndtw-2\charscalex100 �n care a avut loc
accidentul; \par\pard\sect\sectd\fs24\paperw12240\paperh15840\pard\sb0\sl-
200\slmult0\fi151 \up0 \expndtw-1\charscalex100 \ul0\nosupersub\cf1\f2\fs18 \u8226?
asigur\u259? recoltarea e\u351?antioanelor de s�nge de la personalul accidentat,
respect�nd legisla\u355?ia privind \up0 \expndtw-2\charscalex100 testarea
voluntar\u259? cu consiliere. \par\pard\ql \li1951\sb15\sl-207\slmult0 \up0
\expndtw-2\charscalex100 c) Unitatea sanitar\u259? �n care s-a produs accidentul
\par\pard\qj \li1800\ri1697\sb0\sl-200\slmult0\fi151 \up0 \expndtw-
1\charscalex100 \u8226? asigur\u259? prelevarea \u351?i trimiterea e\u351?
antioanelor de s�nge provenite de la pacientul surs\u259?, pentru testare, la
\up0 \expndtw-2\charscalex100 unitatea desemnat\u259? sau asigur\u259? efectuarea
lor �n unitate. \par\pard\ql \li2001\sb14\sl-207\slmult0 \up0 \expndtw-
1\charscalex100 Prelevarea \u351?i trimiterea probelor biologice se va face conform
legisla\u355?iei (standardelor) �n vigoare. \par\pard\ql \li1951\sb1\sl-198\slmult0
\up0 \expndtw-1\charscalex100 \u8226? trimite persoana accidentat\u259? c\u259?tre
serviciul de supraveghere a infec\u355?iilor nosocomiale; \par\pard\qj
asigur\u259? trimiterea persoanei accidentate c\u259?tre sec\u355?ia/spitalul de
boli infec\u355?ioase �n oricare dintre \up0 \expndtw-2\charscalex100 urm\u259?
toarele situa\u355?ii: \par\pard\ql \li1950\ri3873\sb0\sl-200\slmult0 \up0
\expndtw-2\charscalex100 - sursa HIV pozitiv cunoscut\u259?; \line \up0 \expndtw-
2\charscalex100 - sursa HIV cu test rapid pozitiv; \par\pard\qj
\li1950\ri4604\sb2\sl-200\slmult0 \up0 \expndtw-1\charscalex100 - sursa cu status
biologic necunoscut \u351?i cu risc epidemiologie crescut; \up0 \expndtw-
2\charscalex100 - sursa Ag HBs pozitiv/Ac HBs prezen\u355?i; \par\pard\ql
\li1950\sb2\sl-198\slmult0 \up0 \expndtw-2\charscalex100 - sursa Ac HCV pozitiv;
\u8226? asigur\u259? trimiterea accidentatului la Autoritatea de S\u259?n\u259?tate
Public\u259? jude\u355?ean\u259?, �n vederea vaccin\u259?rii \up0 \expndtw-
1\charscalex100 antihepatit\u259? B, �n cazul �n care spitalul/sec\u355?ia de boli
infec\u355?ioase nu a putut asigura vaccinarea. \par\pard\ql \li1950\sb2\sl-
198\slmult0 \up0 \expndtw-2\charscalex100 A.2 . Laboratorul spitalului �n care a
avut loc accidentul \par\pard\ql \li1950\sb15\sl-207\slmult0 \up0 \expndtw-
1\charscalex100 \u8226? efectueaz\u259? �n toate cazurile testul rapid HIV,
dac\u259? acest test este disponibil. \par\pard\qj \li1798\ri1772\sb0\sl-
200\slmult0\fi201 \up0 \expndtw-1\charscalex100 Acest test se va efectua pentru
pacientul surs\u259? �n termen de 2 ore, cu transmiterea rezultatului medicului
\up0 \expndtw-2\charscalex100 c\u259?ruia i s-a raportat evenimentul.
\u8226? prime\u351?te \u351?i trimite e\u351?antioanele de s�nge provenite de la
pacientul surs\u259? c\u259?tre laboratorul desemnat \up0 \expndtw-1\charscalex100
pentru efectuarea testelor ELISA de identificare a: Ac anti-HIV, Ac anti-VHC, Ag
HBs \u351?i Ac HBs sau \up0 \expndtw-2\charscalex100 efectueaz\u259? testele
respective, dac\u259? este autorizat. \par\pard\ql \li1949\sb1\sl-197\slmult0
\up0 \expndtw-1\charscalex100 A.3 . Serviciul de supraveghere \u351?i control al
infec\u355?iilor nosocomiale din spitalul �n care a avut loc accidentul
r\u259?spunde de aplicarea programului de supraveghere: \par\pard\ql
\li1798\ri2151\sb16\sl-206\slmult0\fi151 \up0 \expndtw-1\charscalex100 - �n cazul
�n care spitalul are epidemiolog, acesta va evalua riscul de infec\u355?ie cu HIV,
VHC, VHB; \up0 \expndtw-1\charscalex100 - epidemiologul va asigura consilierea
personalului expus \u351?i recoltarea e\u351?antioanelor de s�nge, cu \up0
\expndtw-1\charscalex100 respectarea legisla\u355?iei privind testarea
voluntar\u259?, �n cazul �n care acestea nu au fost efectuate de c\u259?tre \up0
\expndtw-2\charscalex100 medicul \u351?ef de sec\u355?ie/compartiment sau
medicul \u351?ef de gard\u259?; \par\pard\ql \li1797\ri2264\sb0\sl-
210\slmult0\fi152 \up0 \expndtw-1\charscalex100 - �n cazul �n care riscul de
infec\u355?ie cu HIV \u351?i/sau VHC este absent, iar riscul de infec\u355?ie cu
VHB este \up0 \expndtw-1\charscalex100 prezent, persoana accidentat\u259? va fi
�ndrumat\u259? c\u259?tre Autoritatea de S\u259?n\u259?tate Public\u259? jude\u355?
ean\u259?, la \up0 \expndtw-2\charscalex100 cabinetele de vaccinare desemnate,
pentru vaccinarea anti hepatit\u259? B; \par\pard\qj \li1797\ri2064\sb0\sl-
200\slmult0\fi151 \up0 \expndtw-1\charscalex100 - �n cazul �n care riscul de
infec\u355?ie cu HIV \u351?i/sau VHC este prezent, indiferent de riscul VHB,
persoana \up0 \expndtw-2\charscalex100 accidentat\u259? va fi �ndrumat\u259?
c\u259?tre spitalul/sec\u355?ia de boli infec\u355?ioase; \par\pard\qj
\li1797\ri1674\sb11\sl-200\slmult0\fi151 \up0 \expndtw-1\charscalex100 - persoanele
accidentate care sunt deja cunoscute cu infec\u355?ie cronic\u259? cu VHB \u351?
i/sau VHC, vor fi �ndrumate \up0 \expndtw-1\charscalex100 c\u259?tre
spitalul/sec\u355?ia de boli infec\u355?ioase pentru a se stabili o conduit\u259?
adecvat\u259?; \par\pard\ql \li1948\sb2\sl-198\slmult0 \up0 \expndtw-
2\charscalex100 - anun\u355?\u259? medicul de medicina muncii despre evenimentul
�nregistrat; \par\pard\ql \li1948\sb15\sl-207\slmult0 \up0 \expndtw-1\charscalex100
- completeaz\u259? \u351?i trimite lunar, la Autoritatea de s\u259?n\u259?tate
public\u259? jude\u355?ean\u259?, fi\u351?ele de supraveghere; \par\pard\ql
\li1948\sb1\sl-198\slmult0 \up0 \expndtw-1\charscalex100 - completeaz\u259? \u351?i
trimite semestrial, la Autoritatea de S\u259?n\u259?tate public\u259? jude\u355?
ean\u259?, fi\u351?ele unit\u259?\u355?ii sanitare; \par\pard\qj
\li1796\ri2342\sb0\sl-220\slmult0\fi151 \up0 \expndtw-1\charscalex100 \u8226? va
face analiza semestrial\u259? a cazurilor de expunere accidental\u259?
profesional\u259? \u351?i de seroconversie \up0 \expndtw-2\charscalex100
�nregistrate �n unitate. \par\pard\ql \li1948\sb1\sl-176\slmult0 \up0 \expndtw-
1\charscalex100 \u8226? anun\u355?\u259? medicul de medicina muncii al
unit\u259?\u355?ii sanitare �n care s-a produs accidentul despre \par\pard\qj
\li1796\ri2107\sb0\sl-220\slmult0 \up0 \expndtw-1\charscalex100 seroconversia
pentru HIV \u351?i/sau VHB \u351?i/sau VHC (cu respectarea confiden\u355?
ialit\u259?\u355?ii conform legisla\u355?iei �n \up0 \expndtw-2\charscalex100
vigoare, Legea nr. 584/2002). \par\pard\ql \li1997\sb1\sl-181\slmult0
\up0 \expndtw-1\charscalex100 �n cazul �n care serviciul de supraveghere a
infec\u355?iilor nosocomiale unit\u259?\u355?ii medicale �n care s-a produs
accidentul nu are epidemiolog, evaluarea riscului de infec\u355?ie cu HIV, VHB, VHC
va fi f\u259?cut\u259? de c\u259?tre medicul \up0 \expndtw-1\charscalex100 \u351?ef
de sec\u355?ie sau \u351?ef de gard\u259?, �n colaborare cu medicul epidemiolog de
la Autoritatea de S\u259?n\u259?tate public\u259?, \up0 \expndtw-1\charscalex100
dac\u259? spitalul/sec\u355?ia de boli infec\u355?ioase nu este abordabil sau nu se
consider\u259? necesar\u259? colaborarea cu \line \up0 \expndtw-2\charscalex100
specialistul infec\u355?ionist. \par\pard\ql \li1947\ri3480\sb0\sl-200\slmult0 \up0
\expndtw-2\charscalex100 A.4 . Laboratorul desemnat pentru testare \line \up0
\expndtw-2\charscalex100 Efectueaz\u259?: \par\pard\ql \li1947\sb14\sl-
207\slmult0 \up0 \expndtw-2\charscalex100 - pentru pacientul surs\u259?: Ac HIV
(ELISA), Ag HBs, Ac VHC; \par\pard\ql \li1947\sb1\sl-198\slmult0 \up0 \expndtw-
1\charscalex100 - pentru personalul accidentat: Ac HIV (ELISA), Ag HBs, Ac HBs, Ac
VHC. \par\pard\qj \li1796\ri1713\sb0\sl-220\slmult0\fi201 \up0 \expndtw-
1\charscalex100 Rezultatele vor fi comunicate solicitantului (unitatea
sanitar\u259? �n care s-a produs accidentul) �n maximum o \up0 \expndtw-
1\charscalex100 s\u259?pt\u259?m�n\u259? \u351?i la Autoritatea de S\u259?n\u259?
tate Public\u259? jude\u355?ean\u259? lunar/trimestrial, conform normelor
legale. \par\pard\ql \li1947\sb1\sl-176\slmult0 \up0 \expndtw-2\charscalex100 B.
Unit\u259?\u355?ile sanitare f\u259?r\u259? paturi \par\pard\qj
\li1795\ri1895\sb0\sl-220\slmult0\fi201 \up0 \expndtw-1\charscalex100 Personalul
care lucreaz\u259? �n unit\u259?\u355?ile medicale f\u259?r\u259? paturi se va
adresa celui mai apropiat spital, urm�nd \up0 \expndtw-2\charscalex100 acela\u351?i
circuit. \par\pard\ql \li1997\sb1\sl-181\slmult0 \up0 \expndtw-1\charscalex100
Completarea "Fi\u351?ei de supraveghere" va fi f\u259?cut\u259? de c\u259?tre
medicul epidemiolog din Autoritatea de \par\pard\qj \li1794\ri1775\sb0\sl-
210\slmult0\fi0\tx1996 \up0 \expndtw-1\charscalex100 S\u259?n\u259?tate
Public\u259? jude\u355?ean\u259? ca urmare a raport\u259?rii f\u259?cute de
unitatea sanitar\u259? care a �nregistrat accidentul. \line\tab \up0 \expndtw-
1\charscalex100 Raportarea c\u259?tre Autoritatea de S\u259?n\u259?tate
Public\u259? jude\u355?ean\u259? se va face de c\u259?tre unitatea sanitar\u259? �n
care \line \up0 \expndtw-2\charscalex100 s-a �nregistrat accidentul, �n termen de
24 ore. \par\pard\sect\sectd\fs24\paperw12240\paperh15840\pard\sb0\sl-
\ul0\nosupersub\cf1\f2\fs18 C. Atribu\u355?ii ale altor unit\u259?\u355?i
sanitare/structuri de s\u259?n\u259?tate public\u259? \par\pard\ql \li1951\sb1\sl-
198\slmult0 \up0 \expndtw-2\charscalex100 C.1 . spitalul/sec\u355?ia de boli
infec\u355?ioase \par\pard\ql \li1951\sb15\sl-207\slmult0 \up0 \expndtw-
2\charscalex100 a) Medicul specialist infec\u355?ionist \par\pard\ql
\li1951\sb1\sl-198\slmult0 \up0 \expndtw-2\charscalex100 \u8226? pentru personalul
expus: \par\pard\ql \li1799\ri1973\sb0\sl-206\slmult0\fi151 \up0 \expndtw-
1\charscalex100 - va asigura consilierea \u351?i recoltarea e\u351?antioanelor de
s�nge, cu respectarea legisla\u355?iei privind testarea \up0 \expndtw-
1\charscalex100 voluntar\u259?, �n cazul �n care acestea nu au fost efectuate
anterior, de c\u259?tre medicul \u351?ef de \line \up0 \expndtw-1\charscalex100
sec\u355?ie/compartiment, medicul \u351?ef de gard\u259?, medicul epidemiolog,
serviciului de supraveghere a infec\u355?iilor \up0 \expndtw-2\charscalex100
nosocomiale \u351?i/sau autorit\u259?\u355?ii de s\u259?n\u259?tate public\u259?
jude\u355?ean\u259?; \par\pard\ql \li1950\sb10\sl-207\slmult0 \up0 \expndtw-
2\charscalex100 - evalueaz\u259?/re-evalueaz\u259? riscul de infec\u355?ie cu HIV,
VHB, VHC; \par\pard\ql \li1950\sb1\sl-198\slmult0 \up0 \expndtw-1\charscalex100 -
stabile\u351?te indica\u355?ia/efectueaz\u259? chimioprofilaxia ARV, �n
conformitate cu ghidurile de specialitate; \par\pard\qj \li1799\ri1811\sb0\sl-
220\slmult0\fi151 \up0 \expndtw-1\charscalex100 - stabile\u351?te indica\u355?
ia/efectueaz\u259? chimioprofilaxia infec\u355?iei cu VHB \u351?i/sau VHC, �n
conformitate cu ghidurile \up0 \expndtw-2\charscalex100 de specialitate;
- stabile\u351?te indica\u355?ia/efectueaz\u259? administrarea de imunglobuline
specifice anti-VHB (dac\u259? sunt disponibile); \line \up0 \expndtw-
1\charscalex100 - stabile\u351?te indica\u355?ia/efectueaz\u259? vaccinarea anti
hepatit\u259? B, �n cazul �n care persoana accidentat\u259? a ajuns \line \up0
\expndtw-1\charscalex100 de la �nceput la spitalul/sec\u355?ia de boli infec\u355?
ioase, \u351?i dac\u259? vaccinul este disponibil. Asigur\u259? testarea \line \up0
\expndtw-1\charscalex100 r\u259?spunsului imunologic (titrul Ac HBs) al acesteia
fa\u355?\u259? de vaccinarea antihepatit\u259? B anterioar\u259?; \line \up0
\expndtw-1\charscalex100 - trimite la Autoritatea de S\u259?n\u259?tate
Public\u259? jude\u355?ean\u259?/cabinetul desemnat pentru vaccinare
antihepatit\u259? B, \line \up0 \expndtw-1\charscalex100 �n cazul �n care nu poate
asigura vaccinarea, la nivelul spitalului/sec\u355?iei de boli infec\u355?ioase;
completeaz\u259? "Fi\u351?a clinic\u259? de �nregistrare a expunerii profesionale
cu risc de infec\u355?ie HIV"; \par\pard\qj \li1798\ri1736\sb0\sl-210\slmult0\fi151
\up0 \expndtw-1\charscalex100 \u8226? transmite trimestrial c�te un exemplar din
fiecare "Fi\u351?a clinic\u259? de �nregistrare a expunerii profesionale cu \up0
\expndtw-1\charscalex100 risc de infec\u355?ie HIV", Ministerului S\u259?n\u259?
t\u259?\u355?ii Publice, prin Centrul Regional de Monitorizare, de care apar\u355?
ine, \up0 \expndtw-1\charscalex100 din momentul lu\u259?rii �n
eviden\u355?\u259? \u351?i dup\u259? �ncheierea perioadei de supraveghere
clinic\u259?. \par\pard\ql \li1999\sb11\sl-207\slmult0 \up0 \expndtw-
1\charscalex100 Persoanele accidentate care prezint\u259? seroconversie pentru HIV,
VHB, VHC, ca urmare a expunerii \par\pard\qj \li1798\ri1664\sb0\sl-200\slmult0 \up0
\expndtw-1\charscalex100 profesionale cu risc, vor fi men\u355?inute �n
eviden\u355?a spitalului/sec\u355?iei de boli infec\u355?ioase pentru tratament
specific \up0 \expndtw-2\charscalex100 \u351?i monitorizare. \par\pard\ql
\li1949\sb14\sl-207\slmult0 \up0 \expndtw-1\charscalex100 b) serviciul de
supraveghere \u351?i control al infec\u355?iilor nosocomiale al
spitalului/sec\u355?iei de boli infec\u355?ioase \par\pard\ql \li1949\sb1\sl-
198\slmult0 \up0 \expndtw-2\charscalex100 \u8226? confirm\u259? telefonic
prezentarea tuturor persoanelor accidentate: \par\pard\ql \li1949\sb3\sl-
198\slmult0 \up0 \expndtw-2\charscalex100 - unit\u259?\u355?ii sanitare �n care s-a
produs accidentul cu risc de infec\u355?ie; \par\pard\ql \li1949\sb15\sl-
207\slmult0 \up0 \expndtw-1\charscalex100 - medicului epidemiolog de la autoritatea
de s\u259?n\u259?tate public\u259? jude\u355?ean\u259?. \par\pard\ql
\li1949\sb1\sl-198\slmult0 \up0 \expndtw-2\charscalex100 C.2 . medicul de medicina
muncii \par\pard\ql \li1949\sb3\sl-198\slmult0 \up0 \expndtw-1\charscalex100
\u8226? va lua �n eviden\u355?\u259? persoanele expuse profesional la riscul de
infec\u355?ie cu HIV, VHB, VHC \u351?i va aplica \par\pard\qj
\li1798\ri1914\sb21\sl-200\slmult0 \up0 \expndtw-1\charscalex100 actele normative
�n vigoare privind cercetarea \u351?i declararea accidentelor de munc\u259? \u351?i
a cazurilor de boal\u259? \up0 \expndtw-2\charscalex100 profesional\u259?.
\par\pard\ql \li1949\sb2\sl-198\slmult0 \up0 \expndtw-1\charscalex100 C.3 .
Autoritatea de s\u259?n\u259?tate public\u259? jude\u355?ean\u259? \u351?i a
municipului Bucure\u351?ti \par\pard\qj \li1798\ri2362\sb21\sl-200\slmult0\fi151
\up0 \expndtw-1\charscalex100 \u8226? centralizeaz\u259? trimestrial Fi\u351?ele de
supraveghere a accidentelor cu expunere la s�nge \u351?i produse \line \up0
\expndtw-1\charscalex100 biologice (anexa 1) din unit\u259?\u355?ile sanitare cu
\u351?i f\u259?r\u259? paturi, precum \u351?i Fi\u351?ele unit\u259?\u355?ii
sanitare (anexa 2) \par\pard\ql \li1949\sb2\sl-198\slmult0 \up0 \expndtw-
1\charscalex100 \u8226? trimite trimestrial aceste fi\u351?e la Institutul de
S\u259?n\u259?tate Public\u259? Regional \par\pard\qj \li1797\ri2320\sb21\sl-
200\slmult0\fi151 \up0 \expndtw-1\charscalex100 \u8226? asigur\u259? vaccinarea
anti-hepatit\u259? B, �n situa\u355?ia �n care spitalul/sec\u355?ia de boli
infec\u355?ioase nu o poate \up0 \expndtw-2\charscalex100 asigura, dar o
recomand\u259?. \par\pard\ql \li1797\ri1940\sb0\sl-206\slmult0\fi151 \up0 \expndtw-
1\charscalex100 \u8226? analizeaz\u259? epidemiologic accidentele cu expunere la
s�nge \u351?i produse biologice ale personalului care \up0 \expndtw-1\charscalex100
lucreaz\u259? �n unit\u259?\u355?i sanitare la nivel jude\u355?ean (num\u259?r de
accidente �nregistrate, rata inciden\u355?ei, num\u259?r de \up0 \expndtw-
1\charscalex100 accidenta\u355?i care s-au pozitivat, rata inciden\u355?ei pe
categorii profesionale, rata inciden\u355?ei pe \line \up0 \expndtw-2\charscalex100
sec\u355?ii/compartimente etc.) \par\pard\ql \li1949\sb10\sl-207\slmult0 \up0
\expndtw-1\charscalex100 \u8226? asigur\u259? feedback-ul datelor c\u259?tre
unit\u259?\u355?ile sanitare din teritoriu,
implicate �n expunerile profesionale. \par\pard\ql \li1949\sb1\sl-198\slmult0 \up0
\expndtw-2\charscalex100 C.4 . Institutele Regionale de S\u259?n\u259?tate
Public\u259? \par\pard\ql \li1948\sb15\sl-207\slmult0 \up0 \expndtw-1\charscalex100
\u8226? primesc de la Autorit\u259?\u355?ile de S\u259?n\u259?tate Public\u259?
arondate Fi\u351?a de supraveghere \u351?i Fi\u351?a unit\u259?\u355?ii
sanitare; \par\pard\ql \li1948\sb1\sl-198\slmult0 \up0 \expndtw-2\charscalex100
\u8226? asigur\u259?: \par\pard\ql \li1948\sb3\sl-198\slmult0 \up0 \expndtw-
1\charscalex100 - introducerea Fi\u351?ei de supraveghere \u351?i a Fi\u351?ei
unit\u259?\u355?ii sanitare �n baza de date (fi\u351?iere EPI-Data) \par\pard\qj
transmiterea trimestrial\u259? a datelor �nregistrate �n baza de date EPI-Data,
c\u259?tre Centrul pentru Prevenirea \up0 \expndtw-2\charscalex100 \u351?i
Controlul Bolilor Transmisibile; \par\pard\ql \li1796\ri1684\sb0\sl-
206\slmult0\fi151 \up0 \expndtw-1\charscalex100 - analiza regional\u259? a
accidentelor prin expunere la s�nge \u351?i produse biologice a personalului care
lucreaz\u259? \up0 \expndtw-1\charscalex100 �n unit\u259?\u355?i sanitare
(num\u259?r de accidente �nregistrate, rata inciden\u355?ei, num\u259?r de
accidenta\u355?i care s-au pozitivat, \up0 \expndtw-1\charscalex100 rata
inciden\u355?ei pe categorii profesionale, rata inciden\u355?ei pe sec\u355?
ii/compartimente, procentul din persoanele \up0 \expndtw-2\charscalex100
accidentate care au respectat precau\u355?iunile universale etc.) \par\pard\ql
\li1948\sb10\sl-207\slmult0 \up0 \expndtw-2\charscalex100 - feedback c\u259?tre
autorit\u259?\u355?ile de s\u259?n\u259?tate public\u259? jude\u355?ene
arondate. \par\pard\ql \li1947\sb1\sl-198\slmult0 \up0 \expndtw-2\charscalex100
\u8226? Colaboreaz\u259? cu Centrul Regional de Monitorizare HIV/SIDA. \par\pard\ql
\li1947\sb3\sl-198\slmult0 \up0 \expndtw-2\charscalex100 C.5 . Centrul regional de
monitorizare HIV/SIDA \par\pard\ql \li1947\sb15\sl-207\slmult0 \up0 \expndtw-
1\charscalex100 \u8226? Colaboreaz\u259? cu Institutul de S\u259?n\u259?tate
Public\u259? regional �n vederea prelucr\u259?rii \u351?i analizei datelor.
1\charscalex100 \u8226? trimite trimestrial, la Institutul de Boli Infec\u355?ioase
Matei Bal\u351?, Fi\u351?ele clinice de �nregistrare a expunerilor \up0 \expndtw-
1\charscalex100 profesionale cu risc de infec\u355?ie HIV, culese de la
spitalele/sec\u355?iile de boli infec\u355?ioase. \par\pard\ql \li1947\sb14\sl-
207\slmult0 \up0 \expndtw-2\charscalex100 C.6 . Institutul de Boli Infec\u355?ioase
Matei Bal\u351? \par\pard\ql \li1947\sb1\sl-198\slmult0 \up0 \expndtw-
2\charscalex100 \u8226? asigur\u259? feedback-ul datelor c\u259?tre Centrele
Regionale HIV SIDA; \par\pard\sect\sectd\fs24\paperw12240\paperh15840\pard\sb0\sl-
200\slmult0\fi151 \up0 \expndtw-1\charscalex100 \ul0\nosupersub\cf1\f2\fs18 \u8226?
analizeaz\u259? trimestrial, �mpreun\u259? cu Centrul pentru Prevenirea \u351?i
Controlul Bolilor Transmisibile datele \up0 \expndtw-1\charscalex100 �nregistrate
�n Fi\u351?a clinic\u259? de �nregistrare a expunerii profesionale cu risc de
infec\u355?ie HIV \par\pard\ql \li1951\sb15\sl-207\slmult0 \up0 \expndtw-
2\charscalex100 C.7 . Centrul pentru Prevenirea \u351?i Controlul Bolilor
Transmisibile \par\pard\ql \li1951\sb1\sl-198\slmult0 \up0 \expndtw-2\charscalex100
\u8226? realizeaz\u259? analiza datelor la nivel na\u355?ional; \par\pard\qj
asigur\u259? feedback-ul datelor c\u259?tre Institutul de Boli Infec\u355?ioase
Matei Bal\u351?, Institutele de S\u259?n\u259?tate public\u259? \up0 \expndtw-
2\charscalex100 regionale, Autorit\u259?\u355?ile de S\u259?n\u259?tate
Public\u259? jude\u355?ene. \par\pard\ql \li1950\sb1\sl-176\slmult0 \up0 \expndtw-
2\charscalex100 9. Indicatori de evaluare a sistemului; \par\pard\ql
\li1950\sb10\sl-194\slmult0 \up0 \expndtw-2\charscalex100 - procentul fi\u351?elor
completate corect; \par\pard\qj \li1950\ri5554\sb22\sl-200\slmult0 \up0 \expndtw-
2\charscalex100 - procentul de accidenta\u355?i investiga\u355?i corect cu
laboratorul; \line \up0 \expndtw-2\charscalex100 - procentul de accidenta\u355?i cu
monitorizare complet\u259?; \par\pard\ql \li1950\sb2\sl-198\slmult0 \up0 \expndtw-
1\charscalex100 - procentul de accidenta\u355?i care au beneficiat de profilaxie
confom metodologiei; \par\pard\ql \li2925\sb0\sl-207\slmult0
\par\pard\ql\li2925\sb8\sl-207\slmult0 \up0 \expndtw-2\charscalex100 FI\u350?A DE
SUPRAVEGHERE A ACCIDENTULUI POST EXPUNERE LA PRODUSE \par\pard\ql \li4403\sb1\sl-
198\slmult0 \up0 \expndtw-2\charscalex100 BIOLOGICE A PERSONALULUI SANITAR
\ul0\nosupersub\cf6\f7\fs12 Nr. Fi\u351?a \par\pard\ql \li1800\sb2\sl-
138\slmult0 \up0 \expndtw-4\charscalex100 JUDE\u354?UL: \par\pard\ql
\li1800\sb1\sl-116\slmult0 \up0 \expndtw-4\charscalex100 LOCALITATEA
\par\pard\li1800\sb17\sl-138\slmult0\fi0\tx5831 \up0 \expndtw-4\charscalex100
UNITATEA SANITAR\u258?\tab \up0 \expndtw-4\charscalex100 SEC\u354?
IA/COMPARTIMENTUL\par\pard\ql \li1800\sb1\sl-127\slmult0 \up0 \expndtw-
4\charscalex100 SPCIN da/nu \par\pard\ql \li1800\sb4\sl-138\slmult0 \up0 \expndtw-
4\charscalex100 medic epidemiolog da/nu \par\pard\li1800\sb1\sl-
138\slmult0\fi0\tx3239 \up0 \expndtw-4\charscalex100 Ini\u355?ialele\tab \up0
\expndtw-4\charscalex100 CNP\par\pard\ql \li1800\sb1\sl-117\slmult0 \up0 \expndtw-
4\charscalex100 CATEGORIA PROFESIONAL\u258? \par\pard\li1800\sb17\sl-
138\slmult0\fi0\tx3167 \up0 \expndtw-4\charscalex100 DATA NA\u350?TERII:\tab
\up0 \expndtw-4\charscalex100 SEX\par\pard\ql \li1800\ri3923\sb0\sl-133\slmult0
\up0 \expndtw-4\charscalex100 Vechimea �n activitatea profesional\u259? \line
\up0 \expndtw-4\charscalex100 Vechimea �n serviciul actual \line \up0 \expndtw-
4\charscalex100 Data \u351?i ora accidentului \line \up0 \expndtw-4\charscalex100
Data \u351?i ora declar\u259?rii \par\pard\li1800\sb9\sl-
138\slmult0\fi0\tx3743\tx6047\tx7918 \up0 \expndtw-5\charscalex100 Statusul
vaccinal HVB:\tab \up0 \expndtw-5\charscalex100 vaccinat complet cu 3 doze;\tab
\up0 \expndtw-5\charscalex100 �n curs de vaccinare;\tab \up0 \expndtw-
5\charscalex100 nevaccinat\par\pard\ql \li1800\sb132\sl-138\slmult0 \up0 \expndtw-
4\charscalex100 CIRCUMSTAN\u354?ELE ACCIDENTULUI \par\pard\ql \li1800\sb1\sl-
116\slmult0 \up0 \expndtw-4\charscalex100 Locul producerii accidentului
\par\pard\ql \li1800\sb6\sl-138\slmult0 \up0 \expndtw-4\charscalex100 Gest de
rutin\u259?/situa\u355?ie de urgen\u355?\u259? \par\pard\ql \li1800\sb2\sl-
138\slmult0 \up0 \expndtw-4\charscalex100 C�te ore a lucrat �nainte de accident
\par\pard\ql \li1800\sb2\sl-138\slmult0 \up0 \expndtw-4\charscalex100 Primele
�ngrijiri de urgen\u355?\u259? aplicate da/nu \par\pard\ql \li1800\sb2\sl-
138\slmult0 \up0 \expndtw-4\charscalex100 Dac\u259? da, timpul scurs de la accident
p�n\u259? la aplicare \par\pard\ql \li1800\sb122\sl-138\slmult0 \up0 \expndtw-
4\charscalex100 NATURA EXPUNERII \par\pard\ql \li1800\ri3960\sb1\sl-140\slmult0
\up0 \expndtw-5\charscalex96 �n\u355?epare ac: da/nu tipul acului ... \line
\up0 \expndtw-5\charscalex97 T\u259?iere da/nu \par\pard\ql \li1800\ri4500\sb0\sl-
108\slmult0\tx2447 \up0 \expndtw-4\charscalex100 Dac\u259? da: superficial
\line\tab \up0 \expndtw-4\charscalex100 profund \par\pard\ql \li1800\sb0\sl-
108\slmult0 \up0 \expndtw-4\charscalex100 Proiec\u355?ie s�nge da/nu
\par\pard\ql \li2519\sb0\sl-108\slmult0 \up0 \expndtw-4\charscalex100 lichide
biologice da/nu, tipul lichidului biologic \par\pard\ql \li1800\sb8\sl-
119\slmult0 \up0 \expndtw-4\charscalex100 Locul proiec\u355?iei: ochi,
fa\u355?\u259?, piele lezat\u259? \par\pard\qj \li1800\ri5605\sb0\sl-
108\slmult0\tx2519 \up0 \expndtw-4\charscalex100 Cantitatea de produs biologic la
care a fost expus accidentatul: \line\tab \up0 \expndtw-5\charscalex89 mic\u259?
(sub 5 ml), medie (sub 50 ml), mare (peste 50 ml). \line \up0 \expndtw-
5\charscalex90 Timpul de contact cu produsul biologic: \par\pard\qj
\li1800\ri4381\sb0\sl-140\slmult0\fi719 \up0 \expndtw-4\charscalex96 mai pu\u355?in
de 5 min., �ntre 5-14 min., �ntre 15 min-1 or\u259? \u351?i peste o or\u259?.
\up0 \expndtw-5\charscalex96 Alt tip de expunere: \par\pard\ql
\li1800\ri3204\sb0\sl-108\slmult0 \up0 \expndtw-4\charscalex100 Denuminrea
procedurii efectuate �n momentul accidentului \line \up0 \expndtw-4\charscalex100
MECANISMUL ACCIDENTULUI: \par\pard\ql \li2015\sb0\sl-108\slmult0 \up0 \expndtw-
4\charscalex100 autoaccidentare \par\pard\ql \li2015\sb0\sl-108\slmult0 \up0
\expndtw-4\charscalex100 accidentare de c\u259?tre un coleg \par\pard\ql
\li2015\ri3996\sb0\sl-140\slmult0 \up0 \expndtw-4\charscalex100 accidentare de
c\u259?tre un pacient \line \up0 \expndtw-4\charscalex100 alte mecanisme
\par\pard\ql \li1800\sb0\sl-108\slmult0 \up0 \expndtw-4\charscalex100 PREVENIREA
\par\pard\ql \li1800\ri3960\sb3\sl-140\slmult0\tx2015 \up0 \expndtw-4\charscalex100
APLICARE PU: DA/NU; DAC\u258? NU, DE CE? \line\tab \up0 \expndtw-4\charscalex100
Echipament de protec\u355?ie: \par\pard\li2231\sb7\sl-138\slmult0\fi0\tx3887
\up0 \expndtw-4\charscalex100 M\u259?nu\u351?i\tab \up0 \expndtw-4\charscalex100
da/nu, nu este cazul nr. perechi utilizate\par\pard\ql \li2231\ri4823\sb0\sl-
108\slmult0 \up0 \expndtw-4\charscalex100 Masc\u259? \line \up0 \expndtw-
4\charscalex100
Halat \par\pard\ql \li2231\sb0\sl-108\slmult0 \up0 \expndtw-4\charscalex100
Protector facial \par\pard\ql \li2231\sb0\sl-108\slmult0 \up0 \expndtw-
4\charscalex100 Alte \par\pard\ql \li1800\sb8\sl-114\slmult0 \up0 \expndtw-
4\charscalex100 Cum crede\u355?i c\u259? acest accident ar fi putut fi prevenit?
INFORMA\u354?II DESPRE SURSA ACCIDENTULUI \par\pard\ql \li1800\sb2\sl-
138\slmult0 \up0 \expndtw-4\charscalex100 NECUNOSCUT\u258? da/nu \par\pard\ql
\li1800\sb2\sl-138\slmult0 \up0 \expndtw-4\charscalex100 CUNOSCUT\u258? da/nu
Pacient (status imunologic confirmat prin date de laborator) \up0 \expndtw-
5\charscalex100 STATUS HIV \par\pard\ql \li1800\sb1\sl-115\slmult0 \up0 \expndtw-
4\charscalex100 \u8226? cunoscut, pozitiv, �n tratament da/nu, dac\u259? da,
preciza\u355?i tratamentul: ... \par\pard\ql \li1800\sb6\sl-138\slmult0 \up0
\expndtw-4\charscalex100 \u8226? negativ \par\pard\qj \li1800\ri5533\sb1\sl-
140\slmult0\tx1943 \up0 \expndtw-4\charscalex100 \u8226? necunoscut, apar\u355?ine
grup de risc da/nu, dac\u259? da ce grup de risc \line\tab \up0 \expndtw-
4\charscalex100 STATUS VHB \par\pard\ql \li1800\sb1\sl-115\slmult0 \up0 \expndtw-
4\charscalex100 \u8226? cunoscut, pozitiv antigen HBs, �n tratament da/nu,
dac\u259? da, preciza\u355?i tratamentul: ... \par\pard\ql \li1800\sb6\sl-
138\slmult0 \up0 \expndtw-4\charscalex100 \u8226? negativ \par\pard\qj
\li1800\ri5605\sb1\sl-140\slmult0\tx1943 \up0 \expndtw-4\charscalex100 \u8226?
necunoscut, apar\u355?ine grup de risc da/nu,dac\u259? da ce grup de risc \line\tab
\up0 \expndtw-4\charscalex100 STATUS VHC \par\pard\ql \li1800\sb2\sl-138\slmult0
\up0 \expndtw-4\charscalex100 \u8226? cunoscut, pozitiv, �n tratament da/nu,
dac\u259? da, preciza\u355?i tratamentul: ... \par\pard\ql \li1800\sb2\sl-
138\slmult0 \up0 \expndtw-4\charscalex100 \u8226? negativ \par\pard\ql
\li1800\sb122\sl-138\slmult0 \up0 \expndtw-4\charscalex100 ATITUDINEA �N CAZ DE
ACCIDENT \par\pard\ql \li1800\ri3780\sb9\sl-130\slmult0\tx2303\tx2303 \up0
\expndtw-4\charscalex100 M\u259?suri imediate: da/nu, dac\u259? nu, de ce?
\line\tab \up0 \expndtw-4\charscalex100 Sp\u259?lare cu ap\u259? \u351?i s\u259?
pun: da/nu \line \tab \up0 \expndtw-4\charscalex100 Antiseptic: da/nu, dac\u259?
da, care: \par\pard\sect\sectd\fs24\paperw12240\paperh15840\pard\sb0\sl-
\ul0\nosupersub\cf6\f7\fs12 Testul HIV rapid: da/nu, dac\u259? nu, de ce? \line
\up0 \expndtw-4\charscalex100 Examene serologice: da/nu \par\pard\ql
\li2303\sb8\sl-138\slmult0 \up0 \expndtw-4\charscalex100 anterior accidentului
da/nu \par\pard\ql \li2303\sb2\sl-138\slmult0 \up0 \expndtw-4\charscalex100
ini\u355?iate cu ocazia accidentului: \par\pard\ql \li2303\sb2\sl-138\slmult0
\up0 \expndtw-4\charscalex100 \u8226? HIV ELISA da/nu \par\pard\ql \li2303\sb2\sl-
138\slmult0 \up0 \expndtw-4\charscalex100 \u8226? Antigen HBs da/nu \par\pard\ql
\li2303\sb1\sl-116\slmult0 \up0 \expndtw-4\charscalex100 \u8226? Anticorpi anti HBs
da/nu \par\pard\ql \li2303\sb6\sl-138\slmult0 \up0 \expndtw-4\charscalex100 \u8226?
Anticorpi anti HV da/nu \par\pard\ql \li2303\sb2\sl-138\slmult0 \up0 \expndtw-
4\charscalex100 \u8226? Altele \par\pard\ql \li1800\ri3456\sb59\sl-108\slmult0 \up0
\expndtw-4\charscalex100 Tratament profilactic: da/nu, dac\u259? da, pentru ce:
\line \up0 \expndtw-4\charscalex100 Data �nceperii tratamentului: \par\pard\ql
\li1800\sb8\sl-138\slmult0 \up0 \expndtw-4\charscalex100 Comentarii:
\par\pard\li1800\sb12\sl-138\slmult0\fi0\tx7199 \up0 \expndtw-5\charscalex100 Cine
a completat fi\u351?a (numele prenumele, func\u355?ia �n clar)\tab \up0 \expndtw-
5\charscalex100 Data:\par\pard\ql \li5144\sb0\sl-207\slmult0
\ul0\nosupersub\cf1\f2\fs18 FI\u350?A UNIT\u258?\u354?II SANITARE \par\pard\ql
\li2001\sb0\sl-200\slmult0 \par\pard\ql\li2001\ri4150\sb19\sl-200\slmult0\fi0
\up0 \expndtw-2\charscalex100 Numele Unit\u259?\u355?ii Sanitare \line \up0
\expndtw-2\charscalex100 Nr. Total paturi \par\pard\ql \li2001\ri4019\sb21\sl-
200\slmult0 \up0 \expndtw-2\charscalex100 Nr. Total pacien\u355?i spitaliza\u355?i/
\line \up0 \expndtw-2\charscalex100 Nr. total consulta\u355?ii: \par\pard\ql
2\charscalex100 Num\u259?r zile de spitalizare \par\pard\qj \li2001\ri5952\sb0\sl-
220\slmult0 \up0 \expndtw-2\charscalex100 Nr. Total personal medico sanitar pe
spital din care: \line \up0 \expndtw-2\charscalex100 pe sec\u355?ii: medici,
asistente, personal auxiliar, tehnic, \par\pard\li1951\sb1\sl-
183\slmult0\fi0\tldot\tx9437 \up0 \expndtw-1\charscalex100 \u8226? medici
reziden\u355?i, eleve/elevi la \u351?coala sanitar\u259? postliceal\u259?,
studen\u355?i, alte ...\tab \up0 \expndtw-2\charscalex100 . SPCIN\par\pard\ql
\li1799\sb6\sl-188\slmult0 \up0 \expndtw-2\charscalex100 da/nu, medic epidemiolog
da/nu \par\pard\ql \li4190\sb0\sl-207\slmult0 \par\pard\ql\li4190\sb10\sl-
207\slmult0 \up0 \expndtw-2\charscalex100 Fi\u351?a clinic\u259? de �nregistrare a
expunerii profesionale \par\pard\ql \li5249\sb1\sl-198\slmult0 \up0 \expndtw-
2\charscalex100 cu risc de infec\u355?ie HIV \par\pard\ql \li1800\sb0\sl-90\slmult0
\par\pard\ql\li1800\sb0\sl-90\slmult0 \par\pard\ql\li1800\ri3630\sb82\sl-90\slmult0
\up0 \expndtw-4\charscalex86 \ul0\nosupersub\cf5\f6\fs10 Spitalul de Boli
Infec\u355?ioase care a asigurat PPE: ... \line \up0 \expndtw-4\charscalex87
Medicul specialist care a asigurat PPE: ... \par\pard\ql \li1800\sb0\sl-
115\slmult0 \par\pard\ql\li1800\sb15\sl-115\slmult0 \up0 \expndtw-4\charscalex89 1.
Persoana expus\u259? \par\pard\li1799\sb0\sl-
115\slmult0\fi0\tldot\tx3119\tldot\tx4799 \up0 \expndtw-4\charscalex89
Numele ...\tab \up0 \expndtw-4\charscalex89 .. Prenumele ...\tab \up0 \expndtw-
4\charscalex89 ..; v�rsta ...... ani; CNP: ...\par\pard\li1799\sb0\sl-
112\slmult0\fi0\tldot\tx4679 \up0 \expndtw-4\charscalex89 LOCUL DE
MUNC\u258? ...\tab \up0 \expndtw-4\charscalex89 ... Locul accidentului
...\par\pard\li1799\sb1\sl-113\slmult0\fi0\tldot\tx4859\tldot\tx7078 \up0 \expndtw-
4\charscalex89 PROFESIA ...\tab \up0 \expndtw-4\charscalex89 ... VECHIMEA
...\tab \up0 \expndtw-4\charscalex89 ... ani\par\pard\li1799\sb113\sl-
115\slmult0\fi0\tldot\tx3719\tldot\tx4919\tldot\tx6179\tldot\tx7258 \up0 \expndtw-
4\charscalex89 Data expunerii\tab \up0 \expndtw-4\charscalex89 ./\tab \up0
\expndtw-4\charscalex89 ./\tab \up0 \expndtw-4\charscalex89 ./\tab \up0 \expndtw-
4\charscalex89 .../\par\pard\li3239\sb1\sl-113\slmult0\fi0\tx4439\tx5759\tx6898
\up0 \expndtw-3\charscalex100 ZZ\tab \up0 \expndtw-3\charscalex100 LL\tab \up0
\expndtw-3\charscalex100 AA\tab \up0 \expndtw-3\charscalex100 ora\par\pard\ql
\li1799\sb105\sl-115\slmult0 \up0 \expndtw-4\charscalex90 Localizarea
anatomic\u259? a expunerii: ... \par\pard\li1799\sb6\sl-
115\slmult0\fi0\tx3899\tx5279\tx6478 \up0 \expndtw-4\charscalex92 Tipul
expunerii:\tab \up0 \expndtw-4\charscalex92 [] Transcutan;\tab \up0 \expndtw-
4\charscalex92 [] Mucoase;\tab \up0 \expndtw-4\charscalex92 []
Cutan\par\pard\ql \li1799\sb104\sl-115\slmult0 \up0 \expndtw-4\charscalex90
Produsul biologic incriminat: [] s�nge \par\pard\ql \li3599\sb5\sl-
115\slmult0 \up0 \expndtw-4\charscalex84 [] alte umori ... \par\pard\ql
\li3599\sb1\sl-96\slmult0 \up0 \expndtw-4\charscalex89 [] produse biologice
con\u355?in�nd s�nge vizibil: \par\pard\ql \li1799\sb0\sl-115\slmult0
\u9484?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u947
2?\u9472?\u9516?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u94
72?\u9472?\u9472?\u9516?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9
472?\u9472?\u9472?\u9472?\u9516?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u
9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9516?\u9472?\u9472?\u9472?\u9472?\u9472?\
u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9516?\u9472?\u9472?\u9472?
\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9488
? \par\pard\li1799\sb12\sl-
115\slmult0\fi0\tx2219\tx3299\tx3599\tx4079\tx4379\tx4859\tx5159\tx5699\tx5999\tx65
39\tx6839\tx7439 \up0 \expndtw-4\charscalex97 \u9474?\tab \up0 \expndtw-
4\charscalex97 Test\u259?ri la:\tab \up0 \expndtw-4\charscalex97 \u9474?\tab
\up0 \expndtw-4\charscalex97 Data\tab \up0 \expndtw-4\charscalex97 \u9474?\tab \up0
\expndtw-4\charscalex97 HIV\tab \up0 \expndtw-4\charscalex97 \u9474?\tab \up0
\expndtw-4\charscalex97 AgHBs\tab \up0 \expndtw-4\charscalex97 \u9474?\tab \up0
\expndtw-4\charscalex97 AcHBs\tab \up0 \expndtw-4\charscalex97 \u9474?\tab \up0
\expndtw-4\charscalex97 AcHCV\tab \up0 \expndtw-4\charscalex97
\u9500?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u947
2?\u9472?\u9532?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u94
72?\u9472?\u9472?\u9532?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9
472?\u9472?\u9472?\u9472?\u9532?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u
9
472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9532?\u9472?\u9472?\u9472?\u9472?\u9472?\u
9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9532?\u9472?\u9472?\u9472?\
u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9508?
115\slmult0\fi0\tx2279\tx3299\tx4079\tx4859\tx5699\tx6539\tx7439 \up0 \expndtw-
4\charscalex90 \u9474?\tab \up0 \expndtw-4\charscalex90 momentul 0\tab \up0
\expndtw-4\charscalex90 \u9474?\tab \up0 \expndtw-4\charscalex90 \u9474?\tab
\u9474?\tab \up0 \expndtw-4\charscalex90 \u9474?\tab \up0 \expndtw-
3\charscalex100
\u9500?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u947
2?\u9472?\u9532?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u94
72?\u9472?\u9472?\u9532?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9
472?\u9472?\u9472?\u9472?\u9532?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u
9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9532?\u9472?\u9472?\u9472?\u9472?\u9472?\
u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9532?\u9472?\u9472?\u9472?
\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9508
4\charscalex91 \u9474?\tab \up0 \expndtw-4\charscalex91 6 s\u259?pt\u259?
m�ni\tab \up0 \expndtw-4\charscalex91 \u9474?\tab \up0 \expndtw-4\charscalex91
\u9474?\tab \up0 \expndtw-4\charscalex91 \u9474?\tab \up0 \expndtw-
4\charscalex91 \u9474?\tab \up0 \expndtw-4\charscalex91 \u9474?\tab \up0 \expndtw-
3\charscalex100
\u9500?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u947
2?\u9472?\u9532?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u94
72?\u9472?\u9472?\u9532?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9
472?\u9472?\u9472?\u9472?\u9532?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u
9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9532?\u9472?\u9472?\u9472?\u9472?\u9472?\
u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9532?\u9472?\u9472?\u9472?
\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9508
4\charscalex85 \u9474?\tab \up0 \expndtw-4\charscalex85 3 luni\tab \up0 \expndtw-
4\charscalex85 \u9474?\tab \up0 \expndtw-4\charscalex85 \u9474?\par\pard\ql
\u9500?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u947
2?\u9472?\u9532?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u94
72?\u9472?\u9472?\u9532?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9
472?\u9472?\u9472?\u9472?\u9532?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u
9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9532?\u9472?\u9472?\u9472?\u9472?\u9472?\
u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9532?\u9472?\u9472?\u9472?
\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9508
4\charscalex85 \u9474?\tab \up0 \expndtw-4\charscalex85 6 luni\tab \up0 \expndtw-
4\charscalex85 \u9474?\tab \up0 \expndtw-4\charscalex85 \u9474?\par\pard\ql
\u9492?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u947
2?\u9472?\u9524?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u94
72?\u9472?\u9472?\u9524?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9
472?\u9472?\u9472?\u9472?\u9524?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u
9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9524?\u9472?\u9472?\u9472?\u9472?\u9472?\
u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9524?\u9472?\u9472?\u9472?
\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9496
? \par\pard\li1798\sb0\sl-115\slmult0\par\pard\li1798\sb5\sl-
115\slmult0\fi0\tldot\tx4557 \up0 \expndtw-4\charscalex91 CONSILIERE PRE-TESTARE
(data): ...\tab \up0 \expndtw-4\charscalex91 .. CONSILIERE POST-TESTARE (data):
...\par\pard\ql \li1798\sb112\sl-115\slmult0 \up0 \expndtw-4\charscalex96
PROFILAXIE ANTIRETROVIRAL\u258?: \par\pard\li2158\sb1\sl-
113\slmult0\fi0\tldot\tx4317\tldot\tx5457\tldot\tx6177 \up0 \expndtw-4\charscalex89
Data ini\u355?ierii:\tab \up0 \expndtw-4\charscalex89 ./\tab \up0 \expndtw-
4\charscalex89 .../\tab \up0 \expndtw-4\charscalex89 ... ora ...\par\pard\ql
\li2158\sb0\sl-105\slmult0 \up0 \expndtw-4\charscalex87 Schema \u351?i
dozele: ... \par\pard\ql \li2157\sb0\sl-115\slmult0 \par\pard\ql\li2157\sb112\sl-
115\slmult0 \up0 \expndtw-3\charscalex100 Durata: \par\pard\ql \li2157\sb5\sl-
115\slmult0 \up0 \expndtw-4\charscalex89 Reac\u355?ii adverse ap\u259?rute
\u351?i rezolvarea lor: \par\pard\ql \li1797\sb105\sl-115\slmult0 \up0 \expndtw-
4\charscalex92 Profilaxie Antihepatit\u259? B: \par\pard\li2337\sb6\sl-
115\slmult0\fi0\tx4617\tx5997 \up0 \expndtw-4\charscalex91 [] Imunoglobuline
specifice:\tab \up0 \expndtw-4\charscalex91 DA/NU\tab \up0 \expndtw-4\charscalex91
DATA:\par\pard\li2337\sb0\sl-112\slmult0\fi0\tx4617\tx5997 \up0 \expndtw-
4\charscalex91 [] Vaccin anti-Hepatit\u259? B\tab \up0 \expndtw-4\charscalex91
DA/NU\tab \up0 \expndtw-4\charscalex91 DATA: 1. ..\par\pard\li1797\sb1\sl-
115\slmult0\fi4559 \up0 \expndtw-4\charscalex87 2. ..\par\pard\li1797\sb0\sl-
112\slmult0\fi4559 \up0 \expndtw-4\charscalex87 3. ..\par\pard\li1797\sb1\sl-
113\slmult0\fi0 \up0 \expndtw-4\charscalex87 Alte tratamente:
...\par\pard\li1797\sb1\sl-114\slmult0\fi0\tldot\tx3957\tldot\tx5637 \up0 \expndtw-
4\charscalex87 Status final HIV: ...\tab \up0 \expndtw-4\charscalex87 .
HBV: ...\tab \up0 \expndtw-4\charscalex87 . HCV: ...\par\pard\li1797\sb113\sl-
115\slmult0\fi0 \up0 \expndtw-4\charscalex87 2. Pacient (SURSA POTEN\u354?
IAL\u258? DE INFEC\u354?IE)\par\pard\li1797\sb111\sl-
115\slmult0\fi0\tldot\tx3477\tldot\tx5637 \up0 \expndtw-4\charscalex88
NUMELE ...\tab \up0 \expndtw-4\charscalex88 . PRENUMELE ...\tab \up0 \expndtw-
4\charscalex88 .. FO ...\par\pard\li1797\sb0\sl-
114\slmult0\fi0\tx2757\tldot\tx3597\tx4557\tldot\tx5457\tx6476 \up0 \expndtw-
4\charscalex88 TEST HIV: ...\tab \up0 \expndtw-4\charscalex88 ./data: ...\tab
\up0 \expndtw-4\charscalex88 .; AgHBs: ...\tab \up0 \expndtw-4\charscalex88
../data: ...\tab \up0 \expndtw-4\charscalex88 ..; AcHCV: ...\tab \up0 \expndtw-
4\charscalex88 ./data: ...\par\pard\li1797\sb0\sl-113\slmult0\fi0\tldot\tx4317
\up0 \expndtw-4\charscalex88 �nc\u259?rc\u259?tura viral\u259? HIV: ...\tab \up0
\expndtw-4\charscalex88 . Rezisten\u355?a viral\u259?: ...\par\pard\ql
\li1797\sb1\sl-112\slmult0 \up0 \expndtw-4\charscalex90 Tratamente ARV
anterioare: ... \par\pard\ql \li1797\sb1\sl-97\slmult0 \up0 \expndtw-
4\charscalex88 Data ini\u355?ierii TARV actuale: ... \par\pard\li1797\sb15\sl-
115\slmult0\fi0\tldot\tx3237\tldot\tx4377 \up0 \expndtw-4\charscalex91 Limfocite
CD4: ...\tab \up0 \expndtw-4\charscalex91 .../data: ...\tab \up0 \expndtw-
4\charscalex91 . Stadiul clinico-imunologic: ...\par\pard\ql \li4029\sb0\sl-
200\slmult0 \par\pard\ql\li4029\ri3684\sb29\sl-200\slmult0\tx4440 \up0 \expndtw-
2\charscalex100 \ul0\nosupersub\cf1\f2\fs18 Protocol de asigurare a �ngrijirilor de
urgen\u355?\u259?, �n caz de \line\tab \up0 \expndtw-2\charscalex100 expunere
accidental\u259? la produse biologice
207\slmult0 \par\pard\ql\li1951\sb167\sl-207\slmult0 \up0 \expndtw-
2\charscalex100 \ul0\nosupersub\cf1\f2\fs18 1. �N CAZ DE EXPUNERE CUTANAT\u258?:
\par\pard\ql \li1951\sb13\sl-207\slmult0 \up0 \expndtw-1\charscalex100 \u8226? se
spal\u259? imediat locul cu ap\u259? \u351?i s\u259?pun \u351?i apoi se cl\u259?
te\u351?te, dup\u259? care \par\pard\qj \li1799\ri2039\sb0\sl-200\slmult0\fi151
\up0 \expndtw-1\charscalex100 \u8226? se utilizeaz\u259? un antiseptic, cu timp de
contact minim 5 minute: solu\u355?ie clorigen\u259? diluat\u259? 1/10, compus
\up0 \expndtw-2\charscalex100 iodat �n solu\u355?ie dermic\u259?, alcool 70� sau
alt dezinfectant cutanat \par\pard\ql \li1950\sb14\sl-207\slmult0 \up0 \expndtw-
2\charscalex100 2. �N CAZ DE EXPUNERE PERCUTAN\u258?: \par\pard\ql \li1950\sb1\sl-
198\slmult0 \up0 \expndtw-1\charscalex100 \u8226? se spal\u259? imediat locul cu
ap\u259? \u351?i s\u259?pun \u351?i apoi se cl\u259?te\u351?te, dup\u259? care
1\charscalex100 \u8226? se utilizeaz\u259? un antiseptic, cu timp de contact minim
5 minute: solu\u355?ie clorigen\u259? diluat\u259? 1/10, compus
\up0 \expndtw-2\charscalex100 iodat �n solu\u355?ie dermic\u259?, alcool 70� sau
alt dezinfectant cutanat \par\pard\ql \li1950\sb1\sl-176\slmult0 \up0 \expndtw-
1\charscalex100 \u8226? interzis\u259? s�ngerarea deoarece poate crea microleziuni
care pot accelera difuziunea virusului \par\pard\ql \li1950\sb10\sl-194\slmult0
\up0 \expndtw-2\charscalex100 3. �N CAZ DE EXPUNERE A MUCOASELOR: \par\pard\ql
\li1950\sb16\sl-207\slmult0 \up0 \expndtw-1\charscalex100 \u8226? sp\u259?lare
abundent\u259? timp de 5 minute cu ser fiziologic sau cu ap\u259? �n cazul
absen\u355?ei acestuia. \par\pard\ql \li3650\ri3304\sb183\sl-220\slmult0\tx4478
\up0 \expndtw-2\charscalex100 Algoritm de circula\u355?ie a informa\u355?ie �n
cazul expunerii profesionale \line\tab \up0 \expndtw-2\charscalex100 accidentale la
s�nge \u351?i produse biologice \par\pard\ql \li3540\sb0\sl-115\slmult0
\par\pard\ql\li3540\sb0\sl-115\slmult0 \par\pard\ql\li3540\sb77\sl-115\slmult0 \up0
\expndtw-3\charscalex100 \ul0\nosupersub\cf5\f6\fs10
\u9484?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9488? \par\pard\ql
\li3539\ri3720\sb0\sl-90\slmult0\fi0\tx4139 \up0 \expndtw-4\charscalex95 \u9474?
Personal accidentat\u9474? \line \up0 \expndtw-3\charscalex100
\u9492?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9516?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9496? \line\tab \up0
\expndtw-3\charscalex100 \u9474? \par\pard\ql \li4139\sb6\sl-115\slmult0 \up0
\expndtw-1\charscalex100 v \par\pard\ql \li3599\ri3750\sb0\sl-90\slmult0\fi0
\up0 \expndtw-3\charscalex100
\u9484?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9488? \line \up0 \expndtw-
4\charscalex86 \u9474? M\u259?suri imediate \u9474? \line \up0 \expndtw-
4\charscalex87
\u9492?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9516?\u9472?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9496? \par\pard\ql \li4139\sb0\sl-
90\slmult0 \up0 \expndtw-1\charscalex100 \u9474? \par\pard\ql \li4139\sb7\sl-
101\slmult0 \up0 \expndtw-1\charscalex100 v \par\pard\li1798\sb11\sl-
115\slmult0\fi1621\tx5399 \up0 \expndtw-4\charscalex95
\u9484?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u947
2?\u9488?\tab \up0 \expndtw-4\charscalex95
\u9484?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9488?\par\pard\li1798\sb0\sl-
114\slmult0\fi1621 \up0 \expndtw-4\charscalex95 \u9474?Medic \u351?ef sec\u355?
ie/gard\u259? \u9500?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?>\u9474?
Laborator desemnat\u9474?\par\pard\li1798\sb0\sl-
113\slmult0\fi1621\tx4859\tx5399\tx6539 \up0 \expndtw-4\charscalex95 \u9474?
Consiliere, recoltare\tab \up0 \expndtw-4\charscalex95 \u9474?\tab \up0 \expndtw-
4\charscalex84 \u9474? pentru testare\tab \up0 \expndtw-4\charscalex95
4\charscalex95
\u9492?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472
?\u9516?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u947
2?\u9496?\tab \up0 \expndtw-4\charscalex95
\u9492?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9496?\par\pard\li1798\sb1\sl-
114\slmult0\fi2340\tx5938 \up0 \expndtw-4\charscalex95 \u9474?\tab \up0 \expndtw-
4\charscalex95 \u9474? ^\par\pard\li1798\sb0\sl-112\slmult0\fi2340\tx5938 \up0
\expndtw-4\charscalex95 v\tab \up0 \expndtw-4\charscalex95 v
4\charscalex95
\u9484?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9488?\tab
\u9484?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9524?\u9472?\u9472?\u9472
?\u9472?\u9472?\u9488?\par\pard\li1798\sb0\sl-
113\slmult0\fi600\tx3838\tx4798\tx5578\tx5938\tx6418 \up0 \expndtw-
4\charscalex95
\u9484?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9508?\tab \up0 \expndtw-4\charscalex95
Responsabil\tab \up0 \expndtw-4\charscalex95 \u9474?\tab \up0 \expndtw-
4\charscalex95 \u9474?\tab \up0 \expndtw-4\charscalex95 DSP\tab \up0 \expndtw-
4\charscalex95 \u9474?\par\pard\li1798\sb1\sl-
113\slmult0\fi600\tx3478\tx4018\tx4798 \up0 \expndtw-4\charscalex95 \u9474?\tab
\up0 \expndtw-4\charscalex95 \u9474?\tab \up0 \expndtw-4\charscalex95 SPCIN\tab
\u9500?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472
?>\u9474? Consiliere, \u9474?\par\pard\li1798\sb1\sl-
114\slmult0\fi600\tx3478\tx5578\tx6418 \up0 \expndtw-4\charscalex95 v\tab \up0
\expndtw-4\charscalex95 \u9474?Consiliere, evaluare,\u9474?\tab \up0 \expndtw-
4\charscalex85 \u9474? evaluare,\tab \up0 \expndtw-4\charscalex95
\u9474?\par\pard\li1798\sb0\sl-
113\slmult0\fi0\tx3478\tx3838\tx4798\tx5578\tx6418 \up0 \expndtw-4\charscalex95
\u9484?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9488?\tab \up0 \expndtw-
4\charscalex95 \u9474?\tab \up0 \expndtw-4\charscalex95 profilaxie\tab \up0
\expndtw-4\charscalex95 \u9474?\tab \up0 \expndtw-4\charscalex92 \u9474?
profilaxie\tab \up0 \expndtw-4\charscalex95 \u9474?\par\pard\li1798\sb1\sl-
114\slmult0\fi0\tx2998\tx3478\tx5578 \up0 \expndtw-4\charscalex85 \u9474?
Medicina muncii\tab \up0 \expndtw-4\charscalex95 \u9474?\tab \up0 \expndtw-
4\charscalex95
\u9492?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9516
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9496?\tab
\u9492?\u9472?\u9472?\u9472?\u9472?\u9472?\u9516?\u9472?\u9472?\u9472?\u9472?\u9472
?\u9472?\u9472?\u9496?\par\pard\li1798\sb0\sl-113\slmult0\fi0\tx4138\tx5938 \up0
\u9492?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9496?\tab \up0 \expndtw-
4\charscalex95 \u9474?\tab \up0 \expndtw-4\charscalex95 \u9474?
^\par\pard\li1798\sb1\sl-113\slmult0\fi599\tx4137\tx5938 \up0 \expndtw-
4\charscalex95 ^\tab \up0 \expndtw-4\charscalex95 v\tab \up0 \expndtw-
4\charscalex95 \u9474? \u9474?\par\pard\li1798\sb1\sl-
\u9484?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9488?\tab
\up0 \expndtw-4\charscalex95 \u9474? \u9474?\par\pard\li1798\sb0\sl-
\up0 \expndtw-4\charscalex90 \u9474? Spital/sec\u355?ie boli\tab \up0 \expndtw-
4\charscalex95 \u9474?\tab \up0 \expndtw-4\charscalex95 \u9474?
\u9474?\par\pard\li1798\sb1\sl-114\slmult0\fi599\tx3837\tx4797\tx5937 \up0
\u9492?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9508?\tab \up0 \expndtw-4\charscalex95
infec\u355?ioase\tab \up0 \expndtw-4\charscalex95 \u9474?\tab \up0 \expndtw-
4\charscalex95 \u9474? \u9474?\par\pard\li3476\sb1\sl-112\slmult0\fi0\tx5936
\up0 \expndtw-4\charscalex92 \u9474?Consiliere, evaluare,\u9474?\tab \up0
\expndtw-4\charscalex92 \u9474? \u9474?\par\pard\li3476\sb0\sl-
\up0 \expndtw-4\charscalex92 profilaxie\tab \up0 \expndtw-4\charscalex92
\u9474?\tab \up0 \expndtw-4\charscalex92 \u9474? \u9474?\par\pard\li3476\sb1\sl-
\u9492?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9516?\u9472
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\up0 \expndtw-4\charscalex92 \u9474? \u9474?\par\pard\li3476\sb0\sl-
113\slmult0\fi600\tx5936 \up0 \expndtw-4\charscalex92 \u9474? ^\tab \up0 \expndtw-
4\charscalex92 \u9474? \u9474?\par\pard\li3476\sb1\sl-114\slmult0\fi599\tx5935
\up0 \expndtw-4\charscalex92 v \u9474?\tab \up0 \expndtw-4\charscalex92 v
4\charscalex92
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?\u9524?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9488?\tab
\u9484?\u9472?\u9472?\u9472?\u9472?\u9472?\u9524?\u9472?\u9472?\u9472?\u9488?\par\p
ard\li3476\sb1\sl-113\slmult0\fi0\tx6296 \up0 \expndtw-4\charscalex84 \u9474?
Centrul Regional de
\u9500?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472
?\u9472?\u9472?>\u9474? ISP\tab \up0 \expndtw-4\charscalex92
\u9474?\par\pard\li3476\sb1\sl-114\slmult0\fi0\tx4796\tx6296 \up0 \expndtw-
4\charscalex86 \u9474? Monitorizare HIV\tab \up0 \expndtw-4\charscalex92
\u9474?
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2?\u9472?\u9508?\tab \up0 \expndtw-4\charscalex92 \u9474?\par\pard\li3476\sb0\sl-
\u9492?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9516?\u9472?\u9472
?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9496?\tab
^\tab \up0 \expndtw-4\charscalex92
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4\charscalex92 v \u9474?\tab \up0 \expndtw-4\charscalex92 v
4\charscalex92
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?\u9472?\u9488?\tab \up0 \expndtw-4\charscalex92
CNLAS - MS
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?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?>\u9474? CNCSBT\tab \up0
\expndtw-4\charscalex92 \u9474?\par\pard\li3476\sb0\sl-
\expndtw-4\charscalex92 \u9474?
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2?\u9472?\u9472?\u9472?\u9472?\u9472?\u9472?\u9508?\tab \up0 \expndtw-
4\charscalex92 \u9474?\par\pard\li3476\sb1\sl-114\slmult0\fi239\tx5696 \up0
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?\u9472?\u9496?\tab \up0 \expndtw-4\charscalex92
ard\sect\sectd\fs24}

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