Guia Preventiva Cortopunzantes

7/17/2019 Guia Preventiva Cortopunzantes

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GUÍA PREVENTIVA DE RECOMENDACIONES PARA TRABAJADORES(AS) SANITARIOSEN MANEJO DE MATERIAL CORTOPUNZANTE

Dra. María Teresa Valen!ela Bra"#D$re%&#ra

Ins&$&!&# 'e Sal!' Pl$%a 'e C*$le

+e%*a



- 1 -

INDICE

1. JUSTIFICACIÓN. .................................................................................................................................... - 3 -

2. OBJETIVOS.............................................................................................................................................. - 3 -

2.1. OBJETIVO GENERAL.......................................................................................................................... - 3 -2.2. OBJETIVOS ESPECÍFICOS. ............................................................................................................... - 3 -

3. CAMPO DE APLICACIÓN. .................................................................................................................... - 3 -

4. TERMINOLOGÍA. ................................................................................................................................... - 3 -

5. PROCEDIMIENTO.................................................................................................................................. - 4 -

5.1. SITUACIONES DE RIESGO: ....................................................................................................................... - 4 -

5.2 CLASIFICACIÓN DEL RIESGO ................................................................................................................ - 4 -

5.3 RIESGO DE INFECCIÓN DESPUÉS DE UN ACCIDENTE POR ELEMENTOS CORTOPUNZANTES .................... - 5 -

5.4 M ANEJO DE M ATERIAL CORTOPUNZANTE: .......................................................................................... - 6 -

5.5. VIRUS DE LA !EPATITIS B "V!B#............................................................................................................. - 8 -

5.$.VIRUS DE LA !EPATITIS C "V!C# ............................................................................................................. - 8 -

5.%. VIRUS DE LA INMUNODEFICIENCIA !UMANA "VI!#.................................................................................... - 9 -

5.&.PREVENCIÓN DE LA TRANSMISIÓN............................................................................................................. - 9 -

5.'. VIGILANCIA DE ACCIDENTES CORTOPUNZANTES EN PERSONAL S ANITARIO ........................................... - 10 -

5.1(. ASPECTOS LEGALES............................................................................................................................ - 10 -

6. REFERENCIAS.......................................................................................................................................... - 11 -

7.PARTICIPANTES....................................................................................................................................... - 13 -

. ANE!OS ..................................................................................................................................................... - 14 -

8.1 ALGORITMO DE MANEJO DE ACCIDENTE CORTOPUNZANTE CON UNA PERSONA O FCAR CON ANTÍGENO DE

SUPERFICIE DE V!B POSITIVO ................................................................................................................ - 14 -

&.2 FLUJOGRAMA: ESTUDIO DE ACCIDENTES CORTOPUNZANTES POR V!C............................................. - 15 -

&.3 CONDUCTA POSTE)POSICIÓN LABORAL A VI! ................................................................................... - 16 -



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3. JUSTI+ICACI4N.

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-+/ ,// 79,++*+ 9,7 07- +;7+/- -,8+/ , 0/-*? //+/ / 0 */0 7 7+ 0/-*7/- 9,-- 7+ /0/6/7- 97+/- 0067- 99*//- 97+7,@/-+*9*06// *9@7- 97 ,-.

2. OBJETIVOS.

2.1. OBJETIVO GENERAL.

E0;7++ , ,< / +/976/9*7/- +/=/*=- 97 /0 8* / *-6*,*+ 99*//-97+7,@/- / /+-70 -*+*7

2.2. OBJETIVOS ESPECÍ+ICOS.

2.2.1. F=7+/9/+ +9*9- -/,+- / /0 6/7 / /0/6/7- 7/9*06// +*/-7-7- /9797 97 80,*7- 97+7+0/- / 07 +*/-7.

2.2.2. I/*8*9+ /0 +*/-7 / ,*+*+ 0- /8/+6//- 6- 8+/9,//- ,*+*- 7+99*//- 97+7,@/-.

2.2.3. D+ 9779/+ 0- +*9*0/- ,- -/,*+ / 9-7 / 99*//- 97+7 ,@/-.

3. CAMPO DE APLICACI4N.

S/ 0*9 /-/ +79/*6*/7 0 /+-70 7/9*06// /,/-7 99*//- 97+7,@/-

4. TERMINOLOGÍA.

a56

4.1. FLUIDOS CORPORALES DE ALTO RIESGO BIOLÓGICO: S/ 97-*/+ 77 80,*7 97+7+0/ 9=*/- /-+*0/- "L<,*7 9/807++,</7 0<,*7 0/,+0 /9.# 7 9,0,*/+ 7+7 80,*7-/9+/9*? 7 /9+/9*? 97 -+/ =*-*;0/

4.2. PRECAUCIONES UNIVERSALES CON SANGRE FLUIDOS CORPORALES: S/ /8*/9767 /0 97,7 / 6/*- /-*- 6**6*@+ /0 +*/-7 / +-6*-*? / *8/99*7/-/+/ /0 /+-70 > 9*//- ,/ -/ +-6*/ 7+ /0 9797 97 -+/ 7 80,*7-976*7- 97 -+/. S/ */*8*97 *=/+-7- 6*9+77+*-67- ,/ -/ +-6*/ 7+ /- =< /+7 07- ,/ +/=*-/ 6>7+ *67+9* /*/6*70?*9 -7: V*+,- / 0 !/**- B"V!B# V*+,- / 0 !/**- C "V!C# V*+,- / 0 I6,7/8*9*/9* !,6 "VI!#

4.3. MATERIAL CORTOPUNZANTE: S/ /76* -< 0- ,- 9,0- ;+,0- 9/+/-7- / ;*-,+< 6700- / =*+*7 +7- ,@7/- / ;*7-* 7 9,0,*/+ *-,67 7/++6*/ ,/ ,*/-/ +7,9*+ , /+* 7+ 97+/ 7 ,9*?.

4.4. PERSONA FUENTE7 P/+-7 9,> -+/ 7 80,*7- 97+7+0/- /- *=70,9+7- / ,/7-*9*? 0;7+0.

4.5. E)POSICIÓN OCUPACIONAL A FCARB: C797 +=- / 0 6,97- "79,0+ ;,90 7+#7 */0 /+7-*7 > 9797 +//+0 97 -+/ -/6/ -/9+/9*7/- =*0/- 7+7-0<,*7- 97+7+0/- ,/ 97/ -+/ =*-*;0/ L<,*7 C/807++,</7 -*7=*0 0/,+06*?*97 -,-/-*7/- =*+0/-. O9,++*7 ,+/ 0 //9,9*? / 9*=*/- 0;7+0/-.

4.$. LUMEN: C=* 7 90 /+7 / , ,;7 7 , ?+7 97 87+6 / ,;7H 7+ //607 ,=-7 -,</7 /0 */-*7 ,.



4.%. ANTICUERPOS: S7 +7/<- / 87+6 / +7,9*- 7+ /0 -*-/6 *6,70?*97 +*/*8*9+ > /,+0*@+ 0- -,-9*- *- > /+- 0 9,/+7 006- </7-.

4.&. INMUNIDAD ADUIRIDA: P+/-/9* / *9,/+7- 07 ,/ -/ -*6*0 *6,*+7/97+ ,*+* 7+ *8/99*? 7 =9,.

5. PROCEDIMIENTO.

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• P/+9,/7: S*/7 /0 6- 8+/9,// > 97 6>7+ +*/-7 / +-6*-*? +=- / ,99*// 97+7,@/ / /0 ,/ /-/ *=70,9+7 -+/ 7 80,*7 97+7+0 / 07+*/-7 ;*70?*97.

• M,97-- :E-/9*06// 79,0+

• P*/0 7 *9

5.1. S$&!a%$#nes 'e R$es2#7

E- ,/00 97,9 ,/ 79-*7 6>7+ +7;;*0* / 99*// 9767:

• R/9-,0+ ,- 7-/+*7+ -, ,-7• C6;*7 / ,-• P+79/*6*/7- 97 9*// *+,*07• F0 / ,-7 / /0/6/7- / +7/99*? /+-70• U-7 / /0/6/7- / +7/99*? /+-70 */9,7-

• U-7 / *-7-**=7- 6*97- / 67 */9,7" E. ,/-#• M0- +9*9- 0;7+0/-.

5.2 Clas$8$%a%$0n 'el R$es2#3

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Exposición con riesgo:

# !/+* +78, ,/ 9,- -+6*/7 +7=79 7+ , *-+,6/7 97 0,6/

00/7 / -+/ 7 80,*7 97+7+0 / +*/-7 7 -*60/ =*- 976* 97 -+/ 780,*7 97+7+0 / +*/-7.

;# E7-*9*? / 6,97-- 7 /+* -+/ 7 80,*7 97+7+0 -*60/ =*- 976*797 -+/

9# D/++6/ / -+/ 7 80,*7 97+7+0 97 +*/-7 / , -70,9*? / 97*,* / 0 */00/- 9767 /+* /+67-*- 7 /9@/6.

Exposición sin riesgo:

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# !/+* -,/+8*9*0 ,/ 7 9,- -+6*/7 /-9+*8*99*?

;# !/+* 97 *-+,6/7 ,/ 7 /- -*60/ =*- 976*7 97 -+/ 7 80,*797+7+0 97 +*/-7.

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Nacional para la e!,ridad al,d *c,pacional.



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T7- 0- /7-*9*7/- 80,*7- / ;7 +*/-7 7 -* +*/-7 9779*7 / -/+797=/+-*? -/97-*/+ -* +*/-7.

5.3 R$es2# 'e $n8e%%$0n 'es/!-s 'e !n a%%$'en&e /#r eleen&#s%#r&#/!nan&es.

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# A// *=70,9+7

;# C7*9*? *6,70?*9 /0 +;7+

9# P+78,* / 0 0/-*?

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L N7+6 / M/7 P7-/7-*9*? L;7+0 S+/ / /0 C7/7 / 0 P+/=/9*? /0 I8/99*? 7+ VI! S/K 0 NIOS! "I-*,7 N9*70 + 0 S/,+* > S0,O9,9*70# /-9+*;/ 9767 res/#nsa$l$'a' 'el e/lea'#r /+/ 7+- / /- +/ :

• A0*@+ 0- 0/-*7/- +7,9*- 7+ /0/6/7- 97+7,@/- +7,9*7- / 6/+

/ */*8*9+ 07- /0*+7- > *7- / 0/-*7/-.

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• A-/,++-/ ,/ 07- +;7+/- +/9*; 0 /;* 99*9*? / 6/7 ,-7 >/0*6*9*? / /0/6/7- 97+7,@/-.

• R/=*-*? /+6// 7 67*8*99*? / +9*9- / +;7 ,/ 0/ /0*+7 /0/-*7/- 7+ /0/6/7- 97+7,@/-.

• E-;0/9/+ +79/*6*/7- + /0 +/7+/ 77+,7 / 99*//- 7+ /-7- /0/6/7-

• O9,+-/ /0 -/,*6*/7 /0 9,60*6*/7 / **99*7/- / 07- +;7+/-99*/7-.

A 0 =/@ 07- &raa9a'#res + +7//+-/ -* 6*-67- > -,- 976/+7- / +;7 /0- 0/-*7/- 97+7,@/- /;/:

• E=*+ /0 ,-7 / ,- 9,7 /*- 0/+*=- -/,+- > /8/9*=-

• S,/+*+ 0 -/0/99*? > /=0,9*? / *-7-**=7- 97 6/9*-67- / -/,+*

• U*0*@+ 07- *-7-**=7- 97 6/9*-67- / -/,+* -* -/ *-7/ / /007-

• N7 +/9-,0+ ,- /-,- / -, ,-7

• P+/++ 97 /+*7+* +79/*6*/7- ,/ *=70,9+/ /0 ,-7 > /0*6*9*? //0/6/7- 97+7,@/-

• D/-/9+ *6/*6// /-,- / -, ,-7 07- /0/6/7- 97+7,@/-



• I87+6+ / 87+6 *6/*6// /9+7 / 9,0,*/+ 99*// 97 /0/6/7-97+7,@/- -/K +779707 7 7+6*= /0 -/+=*9*7

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• R/9*;*+ 99*9*? / ;*7-/,+* > 6/7 / 6/+*0 97+7,@/ -/K+779707 7 7+6*= /0 -/+=*9*7.

• A0 *+/-7 0 +;7 +/9*;*+ /0 /-,/6 / =9,9*? 97+ /**- B

5.4 Mane9# 'e Ma&er$al %#r&#:/!nan&e7

• C7+ 97 , 79*? -,8*9*// / 9- + /0*6*9*? / 6/+*0 97+7,@/

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/0*6*+ / 87+6 *6/* /0 /0/6/7 97+7,@/

• L- 9- / 97+7,@/ */06// /;/ /-+ 97/*- 7+ -77+/- / 9+<0*97-7 6/0

• L /0*6*9*? / 6/+*0 97+7,@/ /;/ -/+ *6/*6// /-,- /+/0*@7 /0 +79/*6*/7

• L 9 / /0*6*9*? / 6/+*0 97+7,@/ -/ /;/ /-/9+ 9,7 /-79,7 / +/- 9,+7- / -, 99* ;

• A0 +/*++ 0 9 / 97+7,@/- /0 /+-70 /9+7 /;/ -/00+0 97 9*

/76 / /0 > +7,++0 > /7-*+0 / /0 +/ -,9* + -, +/*+7 / 9++7/-/9*0 /-*7 /90,-*=6// /-/ ,-7 ;

• N7 -/ /;/ /0*6*+ 0<,*7- 0*;+/- / 0 9 + 97+7,@/-

• C7+ 97 9 / 9+? 97 0-*97 / -, */+*7+ + 0 /0*6*9*? / =*+*7- >76700- 7 976*-

S/0*9 +*/-7- ;*70?*97-2 C 97+7 ,@/

/ e&erencia arci$o sección de ries!os bioló!icos.



Aguja hueca o instrumentos con lumen

Aguja sólida Bisturí Vidrio

Profunda: Punción o herida profundacon sangramiento

Moderada: Penetración de la piel con aparición de sangre

Supercial: Rasguño supercial sin sangramiento

MS BA!" R#$S%"

RIESGO SEG;N INSTRUMENTO DEL ACCIDENTE<

M=S ALTO RIESGO

MAS BAJO RIESGO

SEVERIDAD DE LA 1ERIDA

M=S ALTO RIESGO

L- *8/99*7/- 6- 8+/9,//- -/K /0 CDC "C/+7 + /0 C7+70 > 0 P+/=/9*? /E8/+6//-# / ,*+*+ -7:

L ,*-*9*? / //- +-6**7- 7+ =< -,</ / /0 /+-70 / -0, /- ,

-*,9*? +*/-7 /-+ / 0 ; +/=0/9* / V!B V!C > VI! / 0 7;09*? ///+0 .L7- 99*//- 97+7,@/- //+ , /-7 / ,-* / /0 8/97. L0*/+,+ 978*+6 ,/ 0 =/+/+ *9*/9* / /-7- /97- /- /-9779* 7+,/ 777- 07- /=/7- -7 7*8*97- 0+//7+ / 3(5( / 07- /*-7*7-4

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L- 9*8+- /+/- 7+ 0 O+*@9*? M,*0 / 0 S0, /-*6 ,/ /0 7 2(((79,++*/+7 / /0 6,7 $5.((( *8/99*7/- 7+ V!B 1$.4(( 7+ V!C > 1.((( 7+ VI! / /0

/+-70 / -0, +*;,*;0/- , 99*// 97+7,@/%.

5.5. V$r!s 'e la 1e/a&$&$s B (V1B)

E0 V!B /- */@ =/9/- 6- +-6*-*;0/ ,/ /0 V!C > -/ -, =/@ 6- ,/ /0 VI! .E0+*/-7 / +-6*-*? / 0 *8/99*? /- / 3( / /0 /+-70 / -0, /,/-7 > -*=9,9*?& "1&$#

E0 V!B ,// -/+ +-6**7 7+ =< +//+0 "+-8,-*70# /+9,/ -/,0 >=/+*90. L =< +//+0 > /+9,/ -7 0- 6- 8+/9,//-. L -+/ /- /0 =/<9,07 /+-6*-*? 6- /8*9@. E0 V!B /- 9@ / -7;+/=*=*+ , -/6 / -+/ -/9 /-,/+8*9*/- 0 6/*7 6;*//'. L +/=0/9* / ,/-+7 <- /- / (%1(

5.$. V$r!s 'e la 1e/a&$&$s C (V1C)

L /**- C /- , /8/+6/ ,/ //+ , 07 *697 *=/0 6,*0 /;*7 ,/-,- +*9*0/- 97-/9,/9*- -7: 9*++7-*- /*9 > 9+9*76 /79/0,0+. S/K/-*69*7/- / 0 O+*@9*? M,*0 / 0 S0, -7 ,/ 9,06// 3 / 07;09*? //+0 6,*0 /- *8/9 7+ /0 =*+,-11.

E C*0/ 0- /8/+6//- /*9- //+6* , +77+9*? *67+/ / 067+0* //+0. L - / 67+0* 7+ 9*++7-*- / ,/-+7 <- /- , / 0- 6-0- /0 6,7 "23 7+ 1((.((( ;*/- /0 7 2(((2(('#12.

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S/K /-,*7- 0*6*7- /0 +*/-7 / *8/99*? /-,- / , /7-*9*? "7+ ,*9@7 / , 7 97+/# -+/ *8/9 97 V*+,- / 0 !/**- C /-+7*66// 1.&. N7 -/ -;/ /0 +*/-7 /-,- / , -0*9,+ 97 -+/. S/

5 Lei! >P7 ?ia#ro@s<i ?>7 Ailen M7 #eenland N:. "arac#eris#ics o& persons and job @i# needles#ic< inj,ries in a na#ional da#a se#.2m > %n&ec# "on#rol.

6 MendoBa "7 arrien#os7 'CsD,eB 7 PaniBBa '. xposición laboral a san!re &l,idos corporales. xperiencia en ,n ospi#al pediC#rico. e$

"il %n&ec#ol /001.E Fi#Bimons 7Francois A7 e "arli A 7o,$al 7PrG-Hs#In 2 7P,ro ' e# al.(epa#i#is $ir,s7epa#i#is " $ir,s and o#er blood-bornein&ec#ions in eal#care @or<ers;!,idelines &or pre$en#ion and mana!amen# in ind,s#rialised co,n#ries.*cc,p n$iron Med.8 el#rami M7?illiams % 7 apiro "N e# al.is< and mana!emen# o& blood-borne in&ec#ions in eal# care @or<ed ."lin Microbiol e$ /008.

9 ond ?? 7Fa$ero M7 Pe#ersen N>7Ara$elle "7ber# >? 7 Manard >.,r$i$al o& epa#i#is $ir,s a&#er drn! and s#ora!e &or one @ee<

+Le##er.Lance# 1981.



10 Minis#erio de al,d. A,a "lnica. Manejo ra#amien#o de la %n&ección por 'ir,s de la (epa#i#is +'(.erie A,as "lnicas./010.

11 oBa 27 LópeB L Marcelo. (epa#i#is " in "ile; ,rden o& #e disease. e$ MJd "ile /006.

1/ epar#amen#o de s#ads#ica e %n&ormación en al,d Minis#erio de al,d. 2n,ario de s#ads#icas 'i#ales./009.

13 Minis#erio de al,d. A,a "lnica. Manejo ra#amien#o de la %n&ección por 'ir,s de la (epa#i#is " +'(".erie A,as "lnicas./010.



9+// ,/ /- 6,> ;7 /+7 -/ +/7+7 *8/99*? / V*+,- / !/**- C /-,- /0 /7-*9*?

E0 +*/-7 / +-6*-*? /0 V!C 7+ , 99*// 97+7,@/ 97 -+/ 976*,// =+*+ /+/ 1 %.E C*0/ /0 +*/-7 / +-6*-*? / , 8,// /-9779*

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5.%. V$r!s 'e la In!n#'e8$%$en%$a 1!ana (VI1)

E0 +*/-7 +76/*7 / *8/99*? / VI! /-,- / , /7-*9*? "7+ , *9@7 /, 7 97+/# 97 -+/ *8/9 97 VI! /- +7*66// (.3 "3 / 1(((#. E-/9*+ ,/ /0 ''.% / 0- /7-*9*7/- 7+ *9@7- > 97+/- 7 79-*7 *8/99*?.

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E ,/-+7 <- -/ /-*6 ,/ /+/ /0 1 > /0 24 / 0- /7-*9*7/- 0;7+0/- -+/ >

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No se puede solicitar el examen de detección de anticuerpos para el VIH como

C7,9 7+ 99*// 7+ /0/6/7 97+7,@/ 97 -7-/9 / /7-*9*? VI!:

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L 90=/ / 0 +/=/9*? /- 0 =9,9*? -/ +/976*/ 6//+ 97;/+,+- 6>7+/- &5 / /0 /+-70 / -0,1$.



14 "". ecommenda#ions &or pre$en#in!.ransmission o& ,man inm,node&icienc $ir,s and epa#i#is $ir,s #o pa#ien# ,rin! expos,re Kprone

in$asi$e procederes.199115 Minis#erio de al,d. A,a "lnica ndrome de %nm,node&iciencia 2dD,irida. '%(-%2. /009

16 Minis#erio de al,d. A,a "lnica. Manejo ra#amien#o de la %n&ección por 'ir,s de la (epa#i#is +'(.erie A,as "lnicas./010.



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$. RE+ERENCIAS

1ELe 16.E444;Parra&o / 2r# /9.

18 N 40; i#,lo '%; e las *bli!aciones de %n&ormar de los ies!os Laborales. 2r# /1.

19 Le 16.E444; i#,lo 'i Pre$ención de ies!os Pro&esionales; 2r# 68.

/0 Le 16.E444 ;i#,lo 'i Pre$ención de ies!os Pro&esionales; 2r# 66.



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Documents

Guia Preventiva Cortopunzantes