..

2557

1.1

1.2

1.3 /

1.4

2
-
-

5
6
7
7

3.1
3.2
3.3

16

4
-
-

- (Standard Precaution)
-
-

23
23
24

16
16
20

28
31
36

 ()

43

5.1

43

5.2

43

5.3

45

5.4

45

5.5

46

14

22

42

53

1. (Protective Equipment)
2.

3. /
4.
5. /

54
55
69
72
94
95

1
2 HIV oPEP HIV oPEP
3 HIV oPEP*
4
5
6
7

8 CIE
(International Commission on Illumination)
9

.. 2549

3
39
40
66
66
67
69
70
71

1.1

289
143 .. 2550 - 2552
27.3
72.7 25-34 40.5 18-24
30.8 35 28.7
21 18.2
33.6 18.9
15.4
77.6
22.4 anti-HIV
67.8 28.7 3.5
anti-HIV anti-HIV
51 45.5 2.1
0.7
anti-HIV 61.5
22.5 13.3 anti-HIV
35.7 21.7
4.2
Zidouvudine + Lamivudine 47.6
Zidovudine + Lamivudine + Indinavir 13.3 Zidouvudine + Lamivudine +
Nelfinavir 10.5 13.3

.. 2547 2549
52.6 17.2 30.2
37.63
19.35 15.05
28.97 72.05
27.951

Julian Gold and Maggy Tomdins

4.4 (0.8 18.5)
( occupational injuries)
2




0.3 ( 95 : 0.2 0.5)3
( mucous membrane) 0.09 (
95 : 0.006-0.5) 4

5,6,7

HBsAg
23-62 HBsAg
anti-HCV seroconversion
1.8 ( 95:0 7)8

(Nosocomial Infection)

1.2
1

10,000 *

**

9,000

0.95

67

0.0067

Receptive anal intercourse

50

0.005-0.032

30

0.0032

Receptive penile-vaginal intercourse

10

0.001-0.003

Insertive and intercourse

6.5

Insertive penile-vaginal intercourse

0.0003-0.0009

Receptive oral intercourse

Insertive oral intercourse

0.5

0.13-0.45

0.00001-0.00004

*CDC 2005
**American Academy of Pediatric PEP in Children and Adolescents for Non-occupational
Exposure to Virus 2003
1.3 /
1.3.1

1.3.2

9
1.4
(hepatitis A virus)
(hepatitis B virus) (hepatitis C virus) ( human
immunodeficiency virus, HIV)

1. Kantipong P. Management of HCWs exposure to HIV and post-exposure prophylaxis

(PEP). Chiangrai: Chiangrai Regional Hospital;2007
2. World Health Organization. Post-exposure prophylaxis to prevent HIV
infection;2005
3. Bell DM. Occupational risk of human immunodeficiency virus infection in
healthcare workers: an overview. AmJMed1997; 102(5B):915.
4. Ippolito G, Puro V, De Carli G; Italian Study Group on Oc-cupational Risk of HIV
infection. The risk of occupational hu-man immunodeficiency virus infection in
health care workers: Italian multicenter study. Arch Intern Med1993;153(12):1451
1458.
5. .
RV144 RV152
:
6. .
. :;
7.
; 2547.
8. .
2547.
9. /
2557

1000 1 (Nursing
home) (43%) (28%)
(15%) (41%)
(40%) (15%) 4%

2550
2

(Hospital accreditation)

4
II
, II-1



-

-

/
-
-
- ( root cause)

III III-4.2
(Working environment)

.

25551 14
5


1-4

2557

2 1)
2)
1.

.. 2554

6

2556

2557

.. 25497
8
( 2) ..2553

14

(1)
(2)
(3)

(4)
(1) (2) (3) (
)
2.

3
2.1 ..2545 9
..2545 3

..2545 18 (4)
3/2556

..2556

..2556 10 4

3
.. 2545

1


11
2.2
.. 254612
.. 254713
. 0403/.128 30 2510
14
( 7) ..255215

10

.. 2546

.. 2547 . 0403/.128 30
2510

2 .. 2537

( 7) ..2552


2.3
2.3
..2540 16
( 2) ..2542 17
( 3) ..255018

11

(1)
1.5
(2) (1)
5
(3) (1)
3


24

72

..2540
2.4 ..2537
..253719 5

.. 2537 14 20
3
... (3)

12

..2537

.. 2537 13



48

21
1.
2. (.44)
2

3. (.44 )
(.16)


1.

2.
(.16)
3. 1

13

4.

5.
(.16) 2

..

.. 2549
( 2) ..2553

..2556

..2537

..2540

..2537

14

CDC Preventing Needlesticks and Other Sharps Injuries Everything You Need to
Know. [Internet]. 2014 [cited 2014 Feb 2]. Available from:
http://www.cdc.gov/sharpssafety/PPT/2PreventingNeedlesticksPartI.ppt
2

( .. 2554)
3
.
, 2554.
4
..
.
[Internet]. 2014 [cited 2014 Feb 2]. Available from
http://www.isosmartpro.com/private_folder/Law_April_pdf55/1502.pdf
5
. (Key Performance Indicator).
[Internet]. 2014 [cited 2013 April 28]. Available from
http://healthdata.moph.go.th/kpi/index.php
6
. ..
. [Internet]. 2014 [cited 2014 Feb 2]. Available from:
http://www.labour.go.th/th/doc/law/safety-statute-2554.pdf
7

.. . [Internet]. 2014 [cited 2014 Feb 2]. Available from:

http://www.labour.go.th/th/index.php/labour-laws/6284-2556-12-23-08-12-22
8

( 2) ..2553. [Internet]. 2014 [cited 2014 Mar 24]. Available from:
http://www.labour.go.th/th/webimage/images/law/doc/safty_work_environment_2553 _2.p
df
9
.. / /
/
10

.. /
/ / /
11
,
../
12
..
2546

15
13

..2547
14
. 0403/.128 30 2510

15

( 7) ..2552
16
..

17

( ) ..
18
(
) .. / / /
19
.. / / /

20

/ / / /
21
[Internet]. 2014 [cited 2014 Mar 24]. Available from:
http://www.sso.go.th/wpr/category.jsp?media=print&lang=th&cat=943

16

3



3.1


(
)





/

3.2

17

3.2.1 (Physical health hazards)



3.2.1.1

3
3
1)



2).

3) ( Direct glare)
(Reflected glare)

18

CIE (International Commission on Illumination)

.. 2549

500
1,000
600 800
3.2.1.2 (Heat)

/

3.2.1.3 (Noise)
/

1)
(Decibel)

Cardiovascular Endocrine Neurological ( Noise)

19

2)


60

(Time Weighted Average-TWA)

85

3.2.2 (Ergonomics)





3.2.3 (Psychosocial health hazards)
(
)




( Work performance) ( Job satistaction)

20

3.3

(ILO convention 161, 1985)

(National Institute for

Occupational Safety and Health: NIOSH)

1)
2)
3)
4)
5) /
6)
7)
8)
9)

.. 255 0


835

21

.. 2556
103
0.1
1,851 2.0 1,365
1.5 Hepatitis B C HIV

22

1.
. 2549
2. /
. 2557
3. ( .. 2554)

4. Service profile 2554

5. . . . , 2 .. 2545.
6. . - & . 1. :
, 2545.
7. . .

23

-
-
-


-
-
-
-
-

1. (Standard Precaution)


( Blood or body fluid) (mucous membrane)

24

(non - intact skin)

/
2.
(cerebrospinal fluid)
(ascitic fluid) (pleural fluid) (pericardial fluid)
(amniotic fluid) (synovial fluid) (semen) (vaginal
secretion)
3.
3.1. (cap)
3.2. (eye ware)
3.3. - (mask)
3.4. (glove)
3.5. (gown)
3.6. (apron)
3.7. (footware)

1.

1.1
1.1.1

1.1.2
1.1.3
1.1.4

1.1.5
-
1.1.6

1.2

25

1.2.1

1.2.2

1.2.3


1.2.4

Intranet
1.2.5 (
Personal
Protective Equipment: PPE)
PPE
1.2.6
/
/

1.2.7

1.3
1.3.1
1.3.2

1.3.3

1.3.4
/ -
//
1.3.5

1.3.6

26

2.


2.1
Standard
precautions
2.2
/

2.3

(hand washing or hand antisepsis) 2

2.3.1 ( Plain/non - antimicrobial soap)


Colonize

non - infectious
material
2.3.2 (Antiseptic soaps) 7.5% Povidone
iodine, 4% chlorhexidinegluconate, Triclosan



chlorhexidinegluconate
Povidone iodine

27

3 - 5
7

1.

2.

3.

4.

28

5.

6.

7.

2.4

2.5
(Non Touch Technique)
4.3 (Standard Precaution)

(Standard Precautions)
1.

-
- ,
-
-
-

29

(Standard Precautions)
2. 2.1

2.2 -

2.3
-

-

2.4 (Gown)

2.5

3.

4.

(One - handed technique)

30

(Standard Precautions)
4. ()

-

O( ne - handed technique)


(Two - handed technique)

- Clamp Holder

- Syringe
- Mouth piece, Resuscitation Bag
(Resuscitation)
-

5.

6.

7. Respiratory Hygiene/Cough
Etiquette

7.1
-
-
7.2

7.3
7.4 3
- Aseptic technique
- multiple-dose vial or solution container

8. Safe Injection Practice

9. -
Spinal and Epidural
procedure

31

3. /

3.1
3.1.1

3.1.2
Syringe, Suction catheter, Slip joint,
Three- way /

3.1.3
/

3.1.4
/
(Forceps)

3.1.5


3.2


4.4
..2556
26.77
7.2 6.9 7.6
5.1 2,490
466 2,024
19.9 2 103
50,481 75
142 2,352
37,000

32

4
1.

2.



3.


3.1
( medicut, scalp vein)
( blood lancet)


3.2 /

//

4. ( re-cycle)

1. (7 ) /
/
2. -

3.
4.
(ICN)
5.

33

1.
-
- /
- -
-
-
-
-
-
2.
-
-
- /
-
- //
-
-
3. 3 4
4.

34

(: www.pcd.go.th)
1. ( Chemical Disinfection)
(sodium hypochlorite)
0.1-0.5%

2. (Incineration) 90-95 %


600-1,000 C

35

3. (Steam Sterilization / Autoclaving)

Steam Sterilizer autoclave retort

4. (Thermal inactivation)



4.1

4.2
(dry heat)
160 170 C 2-4
5. ( Gas /Vapor Sterilization)
(ethylene oxide) (formaldehyde)



6. ( Microwave)
( Shredder)


95C 20
7. ( Sterilization by irradiation)

1.
1.
2.
2.
3.
3.
4.
4.

36

4.5

(Post Exposure Prophylaxis: PEP)

1. (Exposed person)
2
1.1 (Occupational exposed group)


1.2 (Non - occupational exposed group)


(PEP)
occupational Post Exposure Prophylaxis (oPEP) non - occupational Post Exposure Prophylaxis
(nPEP)
2. (Source or source person)

(Potentially HIV - infected material)
- (blood and body fluids)
- (specific body fluids)

(Occupational exposures)

- (percutaneous injury)
- (Contact of mucous membrane)
- (Contact of non - intact skin)
dermatitis

37

- 0.3 ( 95
0.2 - 0.5)
- 0.09 (95 0.006 - 0.5)
- 0.09
-

1.
1.1
4% Chlorhexidine 70% Alcohol 10% Iodophore

1.2
4% Chlorhexidine
70% Alcohol 10% Iodophore
1.3 0.9% NSS



2.

2.1. (Source Assessment)

(Anti - HIV)
( CD4)
( HIV RNA)

(Window period)

38

HBsAg)
(
(Anti - HCV)

2.2.

2.2.1.
(1)
(2) Ant - HIV, HBsAg, Anti - HCV

(3)
2.2.2.

(Percutaneous or mucous membrane exposure, severe or less severe, small volume or

large volume)

3. (Post Exposure Prophylaxis: PEP)

(Occupational exposed group)
1 occupational post exposure prophylaxis for HIV
(HIVoPEP) HIV oPEP 1
72 .
anti-HIV 4 3 6 anti - HIV 3rd
generation ( HCV anti - HIV
12 )
/
Complete blood count
(CBC) Blood urea nitrogen (BUN) Creatinine Lever function test (LFT)
/

39

3.1 (Serology)
Anti - HIV, HBsAgAnti - HCV

3.2 Anti - HIV Anti - HIV

24

3.3 HBsAg Anti - HBs 24

3
( 10mIU/ml
) /hepatitis B immunoglobulin (HBIG)
3.4 Anti - HCV Anti - HCV Alanine
Animotransferase (ALT) 24
HCV
3.5
3.2, 3.3 3.4
2 HIV oPEP HIV oPEP

Anti-HIV (rapid test) 2

CBC, BUN, Cr, LFT3
HIV-PCR or viral load
HBsAg
AntiHBs6
AntiHCV
HCV RNA

Yes
No
Y/ N4
Yes
No
Yes
Y9/N

1
Baseline
4
3
Yes
Yes
Yes
Yes
No
Yes
Yes
Yes
No
Yes
No
No
5
Yes
Yes
No
Y5/N
Yes
No
Y/N7
No
Yes
No
No
Y/N8
No
Yes
No
No

1.
acute HIV infection

2. Anti-HIV 4thgeneration Anti-HIV 3rd generation 6
1 source patient HCV co - infection 12 1
3. 1 2

40

4. source patient HIV 2

acute HIV infection
5. source HBsAg anti-HBs
6.
7. vaccine 3 baseline

8. source patient HCV infection

9. source patient anti HCV

occupational post exposure prophylaxis for HIV: HIVoPEP

( 1 - 2 ) 72 (
72 unknown source
HIV oPEP )
2 HIV oPEP 4
1
3 HIV oPEP*

TDF + 3TC or FTC + Lopinavir/ritonavir**

TDF + 3TC or FTC + Rilpivirine

B

TDF + 3TC or FTC + Raltegravir

TDF + 3TC or FTC + Atazanavir/ritonavir**
TDF + 3TC or FTC+ Darunavir/ritonavir**

C
AZT TDF A B

estimated
glomerular filtration rate (eGFR)
< 60./

: TDF = tenofovir, 3TC = lamivudine, FTC = emtricitabine, AZT = zidovudine

41

:
TDF
= 300 1
AZT
= 200-300 12 ()
3TC
= 300 1 150 12
Rilpivirine
= 25 1
Raltegravir = 400 12
Lopinavir/ritonavir = 400 Lopinavir/100 ritonavir 12
Atazanavir/ritonavir = 300 Atazanavir/100 ritonavir 1
Darunavir/ritonavir = 800 Darunavir/100 ritonavir 1
600 Darunavir /100 ritonavir 12
* source patient HIV drug - resistant

** drug drug interaction

1.
2.
3.
4.

42

1. Kuhar DT, Henderson DK, Kimberly KA, et al. Updated US Public Health Service
Guidelines for the Managementof Occupational Exposures to Human
Immunodeficiency Virusand Recommendations for Postexposure Prophylaxis. Infect
Control Hosp Epidemiol 2013;34(9):875-892.
2. New YorkState Department of Health AIDS Institute. HIV prophylaxis following
occupational exposure. 2012 [cited 2014, May 16]. Available from
http://www.hivguidelines.org/clinical-guidelines/post-exposure-prophylaxis/hivprophylaxis-following-occupational-exposure
3. Landovitz RJ, Currier JS. Postexposure Prophylaxis for HIV Infection. N Engl J Med
2009; 361:1768-1775.
4. Cardo DM, Culver DH, Ciesielski CA, et al.A case-control study of HIV
seroconversion in health care workers after percutaneous exposure. Centers for
Disease Control and Prevention Needlestick Surveillance Group. N Engl J Med.
1997;337(21):1485-90.
5. Ippolito G, Puro V, De Carli G.The risk of occupational human immunodeficiency
virus infection in health care workers. Italian Multicenter Study. The Italian Study
Group on Occupational Risk of HIV infection. Arch Intern Med 1993;153(12):1451-8.
6. Henderson DK, Fahey BJ, Willy M, et al. Risk for occupational transmission of
human immunodeficiency virus type 1 (HIV-1) associated with clinical exposures. A
prospective evaluation.Ann Intern Med. 1990;113(10):740-6.
7. Postexposure Prophylaxis to Prevent Hepatitis B Virus Infection. MMWR 2006: 55
(RR16);30-31.
8. Updated U.S. Public Health Service Guidelines for the Management of
Occupational Exposures to HBV, HCV, and HIV and Recommendations for
Postexposure Prophylaxis. MMWR 2001: 50(RR11);1-42

43

5.1

( Collection of Data)

1. ( Consolidation)

2. (Interpretation)

3. ( Dissemination) (
)

4.

5.2
.. 1987

Zidovudine (AZT)

.. 1990 Center of Diseases Control and Prevention(CDC)
(Guideline for Occupational Post Exposure Prophylaxis)
.. 1995 Morbidity and Mortality Weekly Report (MMWR)

.. 1996
( Non-occupational Post Exposure Prophylaxis)
(sexual assault and consensual sex)
US Public Health Service (PHS) PEP
()

44

.. 1998 CDC
2-3
72 28


.. 2000
.. 1998 CDC

.. 1999
.. 2001 US PHS
( 2)
.. 2003
.. 2004
(Refugees)
.. 2005 CDC

.. 2005 US PHS
( 3)
.. 2005 US PHS

PEP Food and Drug Administration (FDA)
.. 2013 US PHS

( 4)

45

5.3

/
5.4

1.
2.
3. (

) ( )

46

4.

5.

6.
5.5
/ /
1

/ /
- ()
........................................................................................................
........................
1. B ()
2. // (//)
3. 08.30 16.30 . 16.30 24.00 . 00.01 08.30 .
1. .............................................. HN.HIV
5. ( ) ( .. Staff Resident Intern Extern)
( ) ( ) (..RN TN) ( ) . ( )
( ) .......................................... .................................................
6. ()...........................................................................................
7.

1.

2.

47

8. P( PE)
( )
( )
( ) /
(1
( )
2 ( ) ( ) mask ( ) ( )
( ) ( ) ( ) () ....................................................
9 17, 27 29
15
29
9. (, ,............... )................................................................
10. ...................................................................................................................................
11.
1.
2.
3.
4.
5. ..................................................
12. ().......................................................
...................................................................................................................................................................
13. ().......................
14.
( )
( 5 , )
( ) ( 5 , )
( ) ( 50 )
15. /
( )
( )
( )
( ) //
( ) /
( )
( )
( ) /
( ) ...................................................................................................................................

48

/
( ) /ward ( )
( ) LR & Delivery room
( ) Treatment

OR
( ) ER
( ) ICU
( ) OPD
( ) .....................................................................

16.
( )
( ) ( )
17. ............................................................
18. /
( )
( )
( )
( )
( ) IV catheter
( ) ......................................................................................................................................
19.
( )
1.
( ) 2.
19.1
( )
1.
( ) 2.
20. (, )....................................................................
21. (, , )....................
...................................................................................................................................................................
22. ()..................................................................
23.
(Safety Design)
( ) 1.
( ) 2.
24.
( ) 1.
( ) 2. ( ) 3.
25.
( ) 1. 1 ( ) 2. 2 ( ) 3.
26.
( ) 1.

) 2.

49

27. /

28. /
.................................................................................................................................................................................
.................................................................................................................................................................................
.................................................................................................................................................................................
.................................................................................................................................................................................
.................................................................................................................................................................................
...............................................................................................................................................................................
..
.................................................................................................................................................................................
29. : ( ) ( )
( ) stat dose ............. ...............
( ) TDF 300 mg + 3TC 150 mg
( ) .....................................................................................................
( ) stat dose 72 .........................................................
..
..
..
...........................................
(.............................................................)
......................................................
(..............................................................)
. ............./................../.....................

50

2
........./........../.......... ..................... .
/
(* : expose /
)
Percutaneous
// /
1
injury*
/(mucous membrane /(non-intact skin
exposure)*2
exposure)*3
( ) Less severe
( ) Small volume
( ) Small volume
( ) More severe ( ) Large volume
( ) Large volume
1 =
2 = Mucous
Percutaneous injury membrane exposure
0.3% 0.9%

3 = Non-intact skin
exposure
< 0.9%

( )
( )
( ) (
28 ) ..
Vaccine Hepatitis B
( ) ......................................................................
( )
( )
HBIG ...... / ...... / .......( ) Hepatitis B VaccineDay 0 ...... /........ / .......
1 ....... /......../ .......
6 ....... /......../........
( )
( )
( )
( ) Anti HIV ( ) HBsAg ( ) Anti-HBs
( ) CBC, UA ()
( ) SGOT, SGPT, BUN, Cr ()
/ .............................................
..

(............................................)
.... / ............ / ..........

51

3 ICN

( ) ( ) ( )

( ) ( ) ( )

( )

( ) S/E ( )
( ) ( )

( )

( ) :
( ) ( )

(Day 0)
Hemoglobin .mg% Hematocrit mg% Neutrophil .%

Anti-HIV ( )

Lymphocyte %
Red cell morphology ..
WBC count . Per cu.mm.

Monocyte %

( )
HBsAg

( )

Basophil %

( )

Eosinophil%

Anti-HB ( )

Band form ..%

( )

SGOT ....... SGPT ....... BUN ....... Cr ....... UA .

( ) 1* ( 2 ) ......./......../.........
( ) 2* ( 4 ) ......./........./.........
* CBC, SGOT, SGPT,
BUN, Cr, UA
( ) 3 ( 6) ......../......../..........
( ) 4 ( 3 ..... .../......./..........
( ) 5 ( 6 .... ..../......../.........

52

( ) ..... /
4

) (

..............................................................................................................................................................................
( ) 4
( )
( )
/
/ ..............................

2 WBC count per cu,. mm.

Hematocrit mg% Neutrophil

4 .%
Lymphocyte %

Red cell morphology ....

Monocyte %
Basophil %

Hemoglobin . Mg% Hematocrit.. mg%

Eosinophil%
Band form ..%

SGOT ....... SGPT ....... BUN ....... Cr ....... UA .

4 WBC count per cu,. mm.

Red cell morphology ....

Anti-HIV ( )
( )
3
Anti-HIV ( )
( )
6

Anti-HIV ( )
Hematocrit mg% Neutrophil .%
( )
Lymphocyte %
Monocyte %
Basophil %

Hemoglobin . Mg% Hematocrit.. mg%

Eosinophil%
Band form ..%

SGOT ....... SGPT ....... BUN ....... Cr ....... UA .

ICN / ....................................
......./................/..........

53

1. Guidelines for POST-EXPOSURE PROPHYLAXIS TO PREVENT HIV INFECTION Joint

WHO/ILO guidelines on post-exposure prophylaxis (PEP) to prevent HIV infection,
World Health Organization, 2007 Focusing on Occupational post - exposure
prophylaxis : 4.3 Clinical management of occupational HIV exposure.
Page 38 - 47
2. Guidelines for POST-EXPOSURE PROPHYLAXIS TO PREVENT HIV INFECTION Joint
WHO/ILO guidelines on post-exposure prophylaxis (PEP) to prevent HIV infection,
World Health Organization, 2007 Focusing on Occupational post -exposure
prophylaxis : Patient information sheet 4: post-exposure prophylaxis
medicine. Page 80 - 81
3. Guidelines for POST-EXPOSURE PROPHYLAXIS TO PREVENT HIV INFECTION Joint
WHO/ILO guidelines on post-exposure prophylaxis (PEP) to prevent HIV infection,
World Health Organization, 2007 Focusing on Occupational post -exposure
prophylaxis : Annex 5 Sample checklists for the clinical management of HIV
post -exposure prophylaxis. Page 85 - 87
4. Guidelines for POST-EXPOSURE PROPHYLAXIS TO PREVENT HIV INFECTION Joint
WHO/ILO guidelines on post-exposure prophylaxis (PEP) to prevent HIV infection,
World Health Organization, 2007 Focusing on Occupational post -exposure
prophylaxis : Annex 7 Sample documentation templates. Page 89 - 91
5. .
; 2547 .
; 2549/2550.

54

1. (Protective Equipment)
2.
3. /
4.
5. /

55

1. (Protective Equipment)

1.

2.

3.

4.
5.

1. (cap)
2. (eye - ware)
3. - (mask)
4. (glove)
5. (gown)
6. (apron)
7. (foot - ware)

1.
-
-

1.
2.
3.

56

2.

1.
2.
3.

4
1.

2.

3.
4. (face shield)

3. -
-
1.
2.
3.

- (high efficiency particular air - HEPA filter mask)

1.

(bronchoscopy)
2.

57

(fit check)

4.
2
1.
2.

2
1. ( sterile glove) ( disposable)
(reusable) 2
1.1
1.2
2. (non-sterile glove)
2.1 (examination glove)

2.2 ( heavy-duty glove)


1.
2.

1.
1.1 3-5 (surgical
hand washing)


1.2

1.3

58

1.4



1.5 30
(hygienic hand washing)

1.
2.
3. ()

2.
2.1

2.2
2.3

2.4

1.

2.

3.
5.

1.
2.

59

6.
-

7.

1.

2. ()

1.
2.


3.
4.

1.


2.

1) Gown
2) Mask
3) Goggles/face shield
4)
5) Gloves
6) (Booth)/Apron

60

1)
2)
3) (Face shield or goggles)
4) (Gown)
5) Mask

1.

61

2.

3.

62

4.

5.

63

1.

2.

64

3.

4.

65

5.

66

1.
2.
3. -
4.
5.

6.
7.
8.

-/+
+
+
+
+
+
-

+
+

+
-

+
+

+
-

1.

2.
3.
4.
5.
6. Cut Down
7. Ambu bag
8. (CPR)
9.
10.

11.

12.
13.Blood Exchange
14.Hemodialysus
15.
16.

17.
18.
19.
20.

+
-

+
+
+
+
+
+

+
+
+
-

+
+
+
+
-

+
+
+
+
+
+
+

+
+
+
+
+
+
+

+
+
+
+
+
+
+

+
-

+
+
-

+
+
+

+
-

+
+
+
+
+

+
+
+
+
+

+
+
+
+

+
-

+
+
+
-

+
+
-

+
+
+
+

+
+
+
+

+
+
-

+
-/+
-

67

1.
2.
3.
4.

+
+
+
+
+
-/+
+
+
-/+
+
+

-/+
-/+
-

+
-/+
-/+
+
-

1.

1.
2.
3. Body fluids
4.
5.
2.

2.1
2.2
.

non-infectious material

68

2.3 3-5
20 20-30
Clostridium
difficile
nonenveloped virus

3.

3.1
3.2
2 2-5

3.3
Chlorhexidinegluconate
6
2
4.

4.1
4.2
4.3

4.4
4.5
4.6

69

70

8 CIE
(International Commission on Illumination)

71

9

.. 2549

72

73

74

75

76

77

78

79

80

81

82

83

84

85

86

87

88

89

90

91

92

93

94

Occupational Safety and Health Administration
(OSHA) .. 1971
.. 1972 OSHA " national consensus"
( Federal Standards)
OSHA .. 1991
( blood-borne pathogens) HIV
.. 2001 OSHA
CFR1910.1030

standard precautions



CDC guideline

OSHA 300 Log

( EU Commission for Employment, Social Affairs and Inclusion, 2010)
(Council of
the EU, 2010) .. 2013
( Needle
stick injuries)
(safety-engineered medical devices ; SEMDs)

95

. ..
. .

. .

. .

. ...

. ..

. .

/
.
.

. .

. .

. .

. .

. .

. .

.

.

. .

/
. ..

/
.

96