OBJECTIVES, GOALS AND DEFINITION OF SANITARY AND EPIDEMIC PROVISION OF THE POPULATION IN EMERGENCY SITUATIONS

In case of accidents, catastrophes and natural disasters, the sanitary-hygienic and epidemiological situation in the emergency area (ES) is significantly complicated. This is due to the following reasons:

Destruction of residential and public buildings;

Failure of water supply, sewerage and treatment facilities, public utilities and industrial enterprises;

Intensive migration of various contingents of people;

Changes in people's susceptibility to infections;

Failure of sanitary-epidemiological and medical institutions that found themselves in the disaster zone;

The presence of a large number of corpses of people and animals;

The mass reproduction of rodents, the emergence of epizootics among them and the activation of natural foci of zoonotic infections.

All of the above reasons significantly worsen the sanitary and hygienic situation and significantly exacerbate the epidemic situation for many infectious diseases.

For this reason, sanitary-hygienic and anti-epidemic measures are one of the constituent parts of the national system of disaster medicine, an important section of medical support for the population and elimination of the consequences of emergencies.

Sanitary and anti-epidemic provision in emergency situations includes a set of organizational, legal, medical, hygienic and anti-epidemic measures aimed at preventing the occurrence and elimination of infectious diseases, maintaining the health of the population and maintaining its ability to work.

In the process of eliminating the medical and sanitary consequences of emergencies, sanitary and epidemiological support of the population is carried out in three directions:

Sanitary and hygienic measures;

Anti-epidemic measures;

Control environment.

To determine specific sanitary-hygienic and anti-epidemic measures, it is necessary to take into account the characteristics of various types of disasters, natural disasters and the influence of the whole complex of factors and consequences of emergencies both on the nature of the sanitary-epidemic situation and on the dynamics of the epidemic process in a particular nosological form of an infectious disease.

The solution of these problems has great importance and is entrusted to the territorial centers of the State Sanitary and Epidemiological Supervision and institutions of the sanitary and epidemiological service.

Sanitary-hygienic and anti-epidemic measures are one of the most important activities of the authorities, health care and other services, both in everyday life and in the event of an emergency in peacetime and wartime. They aim to address the following goals:

Preservation and strengthening of public health, disease prevention;

Occurrence warning infectious diseases among the population;

Rapid elimination of infectious diseases in case of their occurrence.

ORGANIZATION OF SANITARY AND HYGIENE MEASURES IN EMERGENCY SITUATIONS

Sanitary and hygienic measures- a set of measures carried out in the emergency zone in order to preserve the health of the population and participants in the elimination of the consequences of emergency situations. The main ones are:

Medical control of the state of health;

Sanitary supervision of accommodation conditions;

Sanitary supervision of food and water supply;

Sanitary supervision of bath and laundry services;

Control of the sanitary condition of the territory. The Sanitary and Epidemiological Service organizes and conducts

the following sanitary and hygienic measures in the emergency area:

Organization and assessment of the sanitary and hygienic state of the territory and determination of harmful factors affecting public health and the environment;

Organization and participation in sanitary supervision over the conditions of accommodation of the population in the emergency area, its food, water supply, bath and laundry services;

Organization of sanitary and hygienic measures to protect the personnel of emergency facilities, participants in the liquidation of the consequences of the accident, as well as the population;

Organization of sanitary supervision at hygienically significant facilities that ensure the vital activity of the population in the emergency area;

Medical control of the state of health of the personnel of formations and institutions involved in the elimination of the consequences of emergencies, their provision with special clothing and protective equipment, their correct use;

Participation in the control of the sanitary condition of the territory, its timely cleaning, disinfection and supervision of the burial of dead and dead people and animals;

Organizational and explanatory work on the regime and rules of conduct for the personnel of emergency facilities, participants in the liquidation of the consequences of the accident and the population in the emergency zone.

In case of failure of water supply facilities and networks, measures are determined to provide the population with good-quality water. If it is impossible to restore the centralized water supply, the issue of organizing its delivery to the emergency zone is decided. Specialists take part in the choice of a water source, give permission to use vehicles for water supply, if necessary, organize water disinfection in tankers, carry out selective control of the content of residual chlorine in drinking water and its quality.

In case of failure of sewerage, treatment facilities and networks, the flow of sewage into land areas and open reservoirs, emergency measures are determined to carry out repair and restoration work and stop the discharge of untreated wastewater, conduct daily bacteriological control of the water quality of the reservoir at control points.

At food facilities, events are organized to exclude the possibility of food contamination. In agreement with the specialists of the sanitary and epidemiological teams, they organize temporary food stations in the emergency zone and carry out their improvement.

Particular attention is paid to the implementation of measures among the population to prevent acute intestinal diseases transmitted by water and food.

In places of temporary resettlement of residents and personnel of formations, preventive measures are taken to create appropriate conditions for living, drinking regime, and public services.

ORGANIZATION OF ANTI-EPIDEMIC MEASURES IN EMERGENCY SITUATIONS

Anti-epidemic measures in the zone of action and nearby areas should be aimed at neutralizing the sources of infection, disrupting the pathways and mechanisms for the transmission of pathogens, increasing the immunity of residents, reducing the possibility of developing certain forms of infectious diseases, and reducing the impact on people of various extreme factors. Depending on climatic and geographical conditions, time of year, type of accident, catastrophe or natural disaster among the population, one can expect the spread of viral hepatitis, typhoid fever, dysentery and other acute intestinal infections, as well as natural focal diseases (plague, anthrax, tularemia, leptospirosis and etc.). The possibility of occurrence of other diseases, for the prevention of which special measures are necessary, is not excluded.

Anti-epidemic measures- a set of measures to prevent the occurrence and spread of infectious diseases and the fastest elimination in the event of their occurrence.

Anti-epidemic measures are divided into two groups:

Measures to prevent the occurrence and spread of infectious diseases;

Measures aimed at eliminating epidemic foci among the population in the emergency area.

Main anti-epidemic measures are:

Sanitary and epidemiological reconnaissance of the proposed areas of dispersal and accommodation of evacuated residents in the suburban area;

Epidemiological observation, including the study of the sanitary and epidemiological state of settlements;

Timely detection of infectious patients, their isolation and hospitalization;

Accounting and sanitation of carriers of pathogens and persons suffering from chronic forms of infectious diseases;

Prevention of infectious diseases through the use of vaccines, sera, antibiotics and various chemicals;

Control of vector-borne diseases and rodents.

The most difficult situation in terms of health consequences of emergencies occurs when epidemic foci of infectious diseases appear among the population. They are characterized by the following features:

The presence of infectious patients among the victims and the possibility of an accelerated spread of infection;

Activation of mechanisms for the transmission of infectious agents in emergency zones;

The duration of the contaminating effect of unidentified sources and the appearance of long-acting foci;

The complexity of the indication and diagnosis of infectious foci;

The presence of a minimum incubation period as a result of constant contact with unidentified sources of infection, a decrease in resistance and a large infectious dose of pathogens.

To assess the degree of epidemic danger of infectious diseases in emergency zones, a methodology is proposed that takes into account the most significant factors:

The pathogenicity of the infectious agent;

Mortality;

Contagiousness (expressed by the contagious index);

The number of cases and the number of expected sanitary losses;

The number of contact persons and the need for their isolation (observation);

The size of the epidemic zone (levels: local, local, territorial, regional, federal).

The main anti-epidemic measures in the event of an epidemic outbreak are as follows:

Registration and notification;

Epidemiological survey and sanitary-epidemiological reconnaissance;

Identification, isolation and hospitalization of sick people;

Regime-restrictive measures;

General and special emergency prevention;

Disinfection of the epidemic focus (disinfection, disinsection, deratization);

Identification of bacteria carriers and enhanced medical monitoring of the affected population;

Sanitary explanatory work.

Registration and notification. All identified sick and suspicious persons are taken to a special account. The chief doctor of the center of state sanitary and epidemiological supervision of the district (city) must be immediately notified of the identification of infectious patients. Upon receipt of data on the occurrence of highly contagious infections, the population of the disaster area and adjacent territories is also notified with an explanation of the rules of conduct.

Epidemiological survey and sanitary-epidemiological reconnaissance. Each case of an infectious disease must be subjected to a thorough epidemiological examination in order to identify the alleged source of infection and to carry out basic measures aimed at preventing the spread of infection. Epidemiological examination of the outbreak includes the following work sections:

Analysis of the dynamics and structure of morbidity according to epidemiological characteristics;

Clarification of the epidemiological situation among the remaining population in the disaster zone, their locations;

Questioning and examination of sick and healthy people;

Visual and laboratory examination of the external environment;

Identification of objects that economically worsen the sanitary and epidemiological situation in the disaster area;

Survey of medical (veterinary) workers, representatives of the local population;

Inspection of the sanitary condition of settlements, water sources, communal and food facilities, etc.;

Processing of the collected materials and establishing causal relationships in accordance with the available data on the type of epidemic in a particular infection.

Sanitary and epidemiological intelligence- collection and transmission of information about the sanitary-hygienic and epidemiological situation in the emergency zone. IN tasks sanitary and epidemiological intelligence includes the following:

Identification of the presence and localization of patients, the nature of the outbreak and the prevalence of infectious diseases;

Establishment of the presence and activity of natural focal infections in emergency zones, epizootics among wild and domestic animals;

Examination of the sanitary and hygienic state of the emergency zone, its constituent settlements and water sources, economic facilities, communal and sanitary household, medical and sanitary and epidemiological institutions;

Assessment of the possibility of using for work in epidemic outbreaks the forces and means of local health authorities that have been preserved in emergency zones.

The sanitary and epidemiological intelligence group includes a hygienist, an epidemiologist (or an infectious disease specialist), a bacteriologist, a laboratory assistant, and a driver.

Sanitary and epidemic state of the region. Based on the data obtained, an assessment of the state of the area is made. It can be assessed as prosperous, unstable, dysfunctional and emergency.

Good condition:

Absence of quarantine infections and group outbreaks of other infectious diseases;

The presence of single infectious diseases that are not related to each other and have appeared over a period exceeding the incubation period of this disease;

The epizootic situation does not pose a danger to people;

Satisfactory sanitary condition of the territory, water supply facilities;

Communal amenities.

Unstable state:

An increase in the level of infectious morbidity or the emergence of group diseases without a tendency to further spread;

The appearance of single infectious diseases that are interconnected or have a common source of disease outside the given territory, with a satisfactory sanitary condition of the territory and the high-quality implementation of a set of measures for anti-epidemic support.

Bad condition:

The emergence of group cases of dangerous infectious diseases in the emergency zone or epidemic foci of especially dangerous infections in neighboring territories, if there are conditions for their further spread;

Numerous diseases of unknown etiology;

The occurrence of single diseases with especially dangerous infections.

Emergency state:

A sharp increase in a short time in the number of dangerous infectious diseases among the affected population;

The presence of repeated or group diseases with especially dangerous infections;

Activation of natural foci of dangerous infections in the emergency zone with the appearance of diseases among people. Identification, isolation and hospitalization of the sick. The team in which the first case of the disease is detected should be the object of careful observation. In case of a number of diseases (dysentery, typhus, scarlet fever, etc.), it is necessary to organize daily rounds and interviews of the contingents served, and in case of suspicion of an infectious disease, isolate and hospitalize the sick.

Timely early removal of the patient from the team is a cardinal measure to prevent the spread of infection.

Regime-restrictive measures. In order to prevent the introduction of infectious diseases and their spread in the event of epidemic foci, a set of regime, restrictive and medical measures are carried out, which, depending on the epidemiological characteristics of the infection and the epidemiological situation, are divided into quarantine and observation. The organization and conduct of these events are entrusted to the responsible heads of administrative territories and the sanitary and anti-epidemic commission.

Quarantine- a system of temporary organizational, regime-restrictive, administrative, legal, therapeutic and preventive, sanitary and hygienic and anti-epidemic measures aimed at preventing the removal of the pathogen of a dangerous infectious disease outside the epidemic focus, ensuring the localization of the focus and their subsequent elimination.

Quarantine is introduced when patients with especially dangerous infections appear among the population, group diseases with contagious infections with their increase in a short time. When establishing even isolated cases of plague, Lassa, Ebola, Marburg disease and some other contagious diseases, as well as mass diseases of anthrax, yellow fever, tularemia, glanders, myeloidosis, typhus, brucellosis, psittacosis, a quarantine regime should be introduced .

Observation- Regime-restrictive measures, which, along with the strengthening of medical and veterinary supervision and the implementation of anti-epidemic, preventive and veterinary and sanitary measures, restrict

the value of movement and movement of people or farm animals in all administrative-territorial formations adjacent to the quarantine zone that create an observation zone.

Observation is introduced in areas with an unfavorable or emergency sanitary-epidemic state, i.e. with the appearance of group non-contagious diseases or isolated cases of contagious infections.

Observation and quarantine are canceled after the expiration of the maximum incubation period of this infectious disease from the moment of isolation of the last patient, after the final disinfection and sanitization of the attendants and the population.

Emergency prevention- a set of medical measures aimed at preventing the occurrence of human diseases in the event of their infection with pathogens of dangerous infectious diseases. It is carried out immediately after establishing the fact of bacterial infection or the appearance among the population of cases of dangerous infectious diseases, as well as mass infectious diseases of unknown etiology.

Unlike vaccination, emergency prophylaxis provides rapid protection for those infected.

Emergency prevention is divided into general and special. Before establishing the type of microorganism that caused the infectious disease, a general one is carried out, and after the type of microbe-causative agent is established, special emergency prophylaxis is carried out.

Broad-spectrum antibiotics and chemotherapy drugs that are active against all or most pathogens of infectious diseases are used as means of general emergency prevention (Table 9.1). The duration of the course of general emergency prophylaxis depends on the time required to identify, identify and determine the sensitivity of the pathogen to antibiotics and averages 2-5 days.

As a means of special emergency prevention, antibacterial drugs are used that have a high etiotropic effect on the pathogen isolated from infectious patients in the epidemic focus, taking into account the results of determining its sensitivity to antibiotics. The duration of the course of special emergency prophylaxis depends on the nosological form of the disease (the incubation period, calculated from the day of infection) and the properties of the prescribed antimicrobial drug.

The order to carry out emergency medical prophylaxis is given by the sanitary and anti-epidemic commissions.

Simultaneously with the start of emergency prophylaxis in the foci of infection, it is recommended to carry out active immunization (vaccination or revaccination) of the population.

Disinfection of foci carried out by the state sanitary and epidemiological service by carrying out the current and final disinfection.

Disinfection- Destruction of pathogens of infectious diseases in the environment. It can be carried out by physical, chemical and combined methods. Disinfection is carried out by disinfection groups. One such group, consisting of a pest control, a disinfector and two orderlies, is able to process 25 apartments with an area of ​​60 m 2 each during the working day.

Disinfection of the territory, buildings and sanitation of the population is carried out by the municipal and technical service.

Disinsection- destruction of insects (carriers of infectious diseases). It is carried out by physical and chemical methods. The main chemical method is considered - the treatment of objects with insecticides.

Deratization- extermination of rodents (as a source of pathogens of infectious diseases). It is carried out by mechanical and chemical methods.

To ensure a quick response and conduct urgent sanitary-hygienic and anti-epidemic measures in the emergency area, on the basis of the institutions of the sanitary-epidemiological service, hygienic and anti-epidemic teams of constant readiness and epidemiological intelligence groups, from which sanitary-epidemiological detachments can be created. The profile and composition of the teams depend on the capabilities of the institution and the nature of the main activity.

Classification of disinfectants.

1.Halogenated- chlorine-containing, boron-containing iodine-containing preparations.

Chlorine-containing preparations - general characteristics- preparations are very active, have a wide spectrum of bactericidal and virucidal action, dissolve well in water, but are aggressive (destroy the material, cause metal corrosion), quickly lose their activity during storage and use, therefore, as a rule, they are used once. It is currently the most widely used group in health care facilities.

Inorganic. Organic.

Hypochlorite SA; - Javel-solid;

Chloramine B; - Javelion;

DP-2E; - Precept; Clorcept;

Anolytes, etc. – Sulfochloratin-M, etc.

Iodine- and boron-containing preparations are mainly used as antiseptics for treating the skin and mucous membranes: iodonate, iodopyrone, aquabor.

2. Oxygen-containing- general characteristics - the preparations are very active, have a wide range of bactericidal and virucidal action, are active against anaerobic microflora, can be used as sterilants, as a rule, are reusable, but aggressive (destroy the material, cause metal corrosion), quickly lose their activity in the light .

Representatives: Hydrogen peroxide, Virkon, Clindesin-oxy, Secusept-pulver, Secusept-Active, Sidex-new (K), Absolucid-oxy, Bibidez-Ultra, etc.

3.Derivatives of peracetic and performic acids- general characteristics - the preparations are very active, have a wide range of bactericidal and virucidal action, have a more gentle effect on materials.

Representatives: Medilox, Sidex-new (K), Pervomur, etc.

4.Quaternary ammonium compounds- general characteristic - a narrow spectrum of antiviral activity, the complete absence of a sporicidal effect, therefore, they are practically not used in their pure form. In practice, drugs are used that combine quaternary ammonium compounds with other cereals of drugs, which provides the necessary bactericidal and virucidal effects. In this case, combined preparations are presented that have a high percentage of the content of the quaternary ammonium group. These preparations have a more gentle effect on materials, combine a disinfecting effect and a washing effect, but to varying degrees they are fixatives of pollution and require a thorough pre-cleaning of the object from biological material before disinfection.

Representatives: Dulbak, Septodor, Lizafin, Samarovka, Deconex, Nika-des, Septabik, Veltolen, Delansin, etc.

Tertiary ammonium compounds- have the same properties as Quaternary ammonium compounds, but do not have a fixing effect.

Representatives: Alminol, Mistral, Incidin extra N, etc.

5.Guanidines(derivatives of chlorhexidine bigluconate) –

Representatives: Lysatol, AHDez-3000, aqueous and alcoholic solutions of chlorhexidine, etc. This group is used as a skin antiseptic.

6.Aldehydes- general characteristics - the preparations are very active, have a wide range of bactericidal, virucidal and sporicidal effects, for the most part they can be used as sterilants, repeated use, but they are strong contact poisons, cause protein denaturation, fixatives of organic contaminants. Can only be used if the treatment process involves thoroughly washing the object in water after disinfection or sterilization.

Representatives: Formalin. Glutaraldehyde - Lysoformin - 3000, Sidex, Sidex-opa, Gigasept, Clindesin-forte, Bianol, Clindesin-3000, Delansal, etc.

7. Alcohol derivatives- represent the main group of skin antiseptics.

Representatives: Isosept, Lizanin, Lizanin OP, Clindesin-elite, Spitaderm, etc. They have a bactericidal, virucidal effect, but do not have a sporicidal effect.

Disinfection measures in healthcare facilities should prevent the formation of hospital strains of microorganisms. To this end, it is necessary to change the disinfectant on a quarterly basis (rotation of disinfectants), but it is necessary to change the group of the drug, and not its name.

Requirements for personnel performing disinfection measures.

Since disinfectants are toxic substances, working with them requires compliance with safety rules.

Persons under the age of 18 are allowed to work with disinfectants.

The health worker must be appropriately trained.

Annually undergo a safety briefing when working with disinfectants, followed by passing the test.

Mandatory use of personal protective equipment (glasses, mask and or respirator, rubber gloves, oilcloth apron) and overalls (robe, cap, change of shoes).

XI. Measures in relation to persons who have been in contact with patients with cholera or vibrio carriers

XVI. Sanitary and anti-epidemic (preventive) measures in the focus of cholera

Preventive measures are aimed at preventing the occurrence of an epidemic process. The basics for the prevention of infectious diseases on a national scale include the following:

Improving the material well-being of the population;

Sanitary protection of the territory from the introduction of especially dangerous infections;

Preventive and current sanitary supervision;

Veterinary and sanitary prophylaxis;

Providing the population with affordable medical care;

Mass immunization of the population;

Preventive disinfection measures;

Anti-epidemic measures in the focus of infection.

Sanitary protection of the territory from the introduction of especially dangerousinfections is carried out in accordance with the "International Health Regulations", pursuant to which a sanitary inspection of vehicles arriving from abroad and an examination of people are carried out. When a patient with a quarantine infection is detected, federal health authorities are urgently notified, followed by operational information from WHO.

Preventive and current sanitary supervision engages in: prevention and elimination of pollution of surface and groundwater, soil and atmosphere; control over compliance with the sanitary and technological regimes of water supply and nutrition of the population; ensuring communal improvement of populated areas, etc.

Veterinary and sanitary prevention is reduced to the prevention and elimination of diseases dangerous to humans among agricultural and domestic animals.

Mass immunization of the population carried out according to plan or according to epidemic indications.

Vaccines, serums. Even in ancient times, people, describing the epidemic, pointed out: "Whoever suffered the disease was already safe, because no one fell ill twice." Long before civilization, the Indians rubbed crusts from smallpox patients into the skin of their children for prophylactic purposes. In this case, smallpox was usually mild. Since 1980, compulsory vaccination against smallpox in Russia has been canceled due to the complete elimination of this disease in the country.

At present, to prevent infectious diseases by artificially creating human immunity, there is a large number of vaccines and sera.

Vaccines - These are preparations made from microbial cells or their toxins, the use of which is called vaccination. Antibodies appear in the human body 1–2 weeks after the introduction of vaccines, and specific immunity is developed.

artificial acquired immunity occurs as a result of protective vaccinations, when a vaccine is introduced into the body (weakened pathogens of a particular disease - a "live" vaccine) or toxins (waste products of pathogens - a "dead" vaccine). In response to the introduction of the vaccine, a person, as it were, falls ill with this disease, but in a very mild, almost imperceptible form. His body actively produces protective antibodies. And although active artificial immunity does not appear immediately after the introduction of the vaccine (it takes a certain time to produce antibodies), it is quite strong and lasts for many years, sometimes for life. The closer the vaccine immunopreparation is to the natural causative agent of infection, the higher its immunogenic properties and the stronger the resulting post-vaccination immunity. Vaccination with a live vaccine, as a rule, provides complete immunity to the corresponding infection for 5-6 years, vaccination with an inactivated vaccine creates immunity for the next 2-3 years, and the introduction of a chemical vaccine and toxoid provides protection for the body for 1-1.5 years. At the same time, the more purified the vaccine, the less likely it is to cause unwanted, adverse reactions to its introduction into the human body. As an example of active immunity, one can name vaccinations against poliomyelitis, diphtheria, whooping cough.

The bulk of vaccinations are carried out in pre-school and preschool age. At school age, revaccination is carried out, aimed at maintaining the proper level of immunity. There is a special, legally approved immunization calendar for children and adolescents (the general schedule of immunization schemes). The administration of sera is used in cases where the likelihood of a disease is high, as well as in the early stages of the disease, to help the body cope with the disease. For example, vaccinations against influenza in case of an epidemic threat, vaccinations against tick-borne encephalitis before leaving for field practice, after being bitten by a rabid animal, etc.

Vaccination reactions. In response to the introduction of a vaccine into the body, a general, local or allergic reaction (anaphylactic shock, serum sickness) may develop. The general reaction is characterized by chills, fever, general weakness, body aches, and headache. A local reaction is usually observed at the site of injection or inoculation of the immunological drug and is manifested by redness of the skin, swelling and tenderness at the site of the vaccine. Often this is accompanied by itching. Usually vaccination reactions are mild and short-lived. Severe reactions to the vaccine, requiring hospitalization and special medical supervision, are quite rare.

Allergic reactions to vaccinations are manifested by an itchy rash, swelling of the subcutaneous tissue, joint pain, temperature reaction, less often by difficulty breathing.

Vaccination of persons who previously had allergic reactions is allowed only under conditions of special medical supervision.

Indications and contraindications for immunization.The main indication for planned, unscheduled and urgently carried out immunoprophylaxis of infectious diseases is the need to create immunity to infection by stimulating the production of specific immunity by the body's immune system.

Preventive disinfection measures include preventive disinfection, disinsection and deratization.

Disinsection- destruction of insects in places of their mass breeding (mosquitoes, ticks) by using chemical agents and biological methods.

Deratization - measures to prevent and reduce the penetration of rodents into the premises, depriving them of access to water and food. This also includes the organization of measures for the cleaning of populated areas, the timely removal of garbage and the extermination of rodents.

A special role in the prevention of infectious diseases has an increase in the sanitary literacy of the population (education and training in the rules of hygiene in educational institutions, special training of personnel whose activities are related to providing the population drinking water, food, etc.).

Anti-epidemic measures carried out by the medical service are aimed at eliminating the epidemic focus. They suggest:

a) neutralization (elimination) of the source of the infectious agent and disruption of the mechanism of its transmission;

b) increasing immunity to the causative agent of this infection of persons at risk of infection in the outbreak.

The effectiveness of these measures largely depends on the level of sanitary culture of the population.

In the emerging epidemiological focus, the following anti-epidemic measures should be taken:

1) if a disease is suspected, the patient should be isolated before being examined by a doctor (see section 5.3). The decision on hospitalization is made by the doctor;

2) to break the mechanism of transmission of the infectious agent, it is necessary to carry out focal disinfection , consisting of current and final disinfection. The current one is carried out in the presence of the patient in the focus of infection, disinfection with the use of disinfectants is subject to his discharge, care items, as well as the room, dishes and linen.

After disinfection procedures, lice eggs (nits) are removed from the hair with cotton swabs moistened with cranberry juice or a 9% vinegar solution.

After hospitalization of the patient, final disinfection is carried out, aimed at decontaminating the premises and objects located there. In the foci of infections caused by pathogens that are stable in the external environment, for example, with tuberculosis, ringworm, typhus, complete sanitization . Disinfection of bedding and wearable items is carried out using chamber disinfection;

3) for persons who have been in contact with the source of infection (contacts), it is necessary to establish medical supervision for the duration of the maximum duration of the incubation period of this infection. Restrictive separation measures are sometimes applied to persons under medical supervision; this applies most often to children attending preschool and school institutions, as well as adults working in childcare facilities, food industry, public catering, etc.

In case of especially dangerous infections, by decision of the Extraordinary Anti-Epidemiological Commission formed under the administration of the republic (territory, region), a quarantine is established in the focus, from the zone of which entry and exit are prohibited. Persons at risk of infection are subject to observation before leaving the quarantine zone, i.e. isolation in specially adapted rooms for medical observation during the incubation period.

Date added: 2015-02-06 | Views: 1915 | Copyright infringement

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SIBERIAN STATE MEDICAL UNIVERSITY

on "Infectious Diseases"

“Compliance with the anti-epidemic regime

in hospitals as a means of combating nosocomial infection"

Completed by a student of ZFVMSE

groups 59-04

Slesareva S.V.

Anti-epidemic measures and the basics of organizing anti-epidemic work
o Anti-epidemic measures	3
o Organizational structure	3
o Factors of the epidemiological process	5
o Effectiveness of anti-epidemic measures	6
o Regime-restrictive measures	9
o Interventions to disrupt transmission routes	9
o Measures to increase the resilience of the population
o Infectious disease registration system	11
Epidemiological surveillance	12
o Surveillance	12
o Epidemiological diagnosis	14
o Prerequisites	15
o Harbingers	16
hospital infections	17
o Nosocomial infections	17
o Mechanisms, routes and factors of transmission of nosocomial infections	22
o Peculiarities of the epidemic process	24
o Architectural and planning activities	26
o Sanitary and hygiene measures	27
o Prevention of the artifactual mechanism	28
o Organizational work	28
o Prevention of nosocomial infections among medical personnel o List of references

Anti-epidemic measures and the basics of organizing anti-epidemic work

Anti-epidemic measures can be defined as a set of recommendations that are justified at this stage in the development of science, ensuring the prevention of infectious diseases among certain groups of the population, reducing the incidence of the general population and eliminating individual infections. Anti-epidemic measures are carried out in the event of the occurrence (detection) of an infectious disease, preventive measures are carried out constantly, regardless of the presence or absence of an infectious patient.

The basis for the prevention of infectious diseases on a national scale is the increase in the material well-being of the people, the provision of the population with comfortable housing, qualified and affordable medical care, the development of culture, etc.

Medical aspects of the prevention of infectious diseases include systematic sanitary control over the water supply of the population; sanitary and bacteriological control over the quality of food products, the sanitary condition of food industry enterprises and public catering facilities, trade and children's institutions; carrying out planned disinfection, disinfestation and deratization activities; planned specific prevention among the population; implementation of measures for the sanitary protection of borders in order to prevent the introduction of infectious diseases into the country from abroad, etc.

Organizational structure the system of anti-epidemic protection of the population includes medical and non-medical forces and means. An important role in ensuring the anti-epidemic regime is played by non-medical performers. A complex of measures of various nature and direction related to the cleaning of settlements, food, water supply, etc., are carried out by state bodies, institutions, enterprises with the active participation of the population. The implementation of a number of anti-epidemic measures is carried out by medical institutions. The Sanitary and Epidemiological Service mainly manages this activity. It includes diagnostic (epidemiological diagnostics), organizational, methodological and control functions. The executive function of sanitary and epidemiological institutions is limited to carrying out individual measures for immunoprophylaxis and disinfection, anti-epidemic work in the focus of infection. The complexity of the management activities of sanitary and epidemiological institutions lies in the fact that the fight against infectious diseases requires the involvement of forces and means that are not subordinate to institutions.

Legal aspects anti-epidemic activities are enshrined in legislative documents. Thus, in accordance with the Constitution of the Russian Federation (Article 42), every citizen of Russia has the right to a favorable environment and reliable information about its condition. The Civil Code of the Russian Federation (Chapter 59), Fundamentals of the legislation of the Russian Federation on the protection of public health, the law of the RSFSR "On the sanitary and epidemiological well-being of the population of Russia", the Regulations on the state sanitary and epidemiological service of the Russian Federation regulate the rights and obligations of citizens and medical workers in solving problems of sanitary epidemiological well-being and preservation of public health.

The system of the State Sanitary and Epidemiological Service of the Russian Federation includes:

1) Department of Sanitary and Epidemiological Surveillance of the Central Office of the Ministry of Health Russian Federation;

2) centers of state sanitary and epidemiological surveillance in the constituent entities of the Russian Federation, cities and districts, centers of state sanitary and epidemiological surveillance in water and air transport (regional and zonal);

3) research institutions of sanitary-hygienic and epidemiological profile;

4) disinfection stations;

5) state unitary enterprises for the production of medical immunobiological preparations;

6) the sanitary and epidemiological service of the Federal Department of Biomedical and Extreme Problems under the Ministry of Health of the Russian Federation, the centers of state sanitary and epidemiological surveillance subordinate to it;

7) other sanitary and epidemiological institutions.

Bodies and institutions of state sanitary and epidemiological surveillance, in cooperation with health authorities and institutions, develop targeted comprehensive programs of preventive and health-improving measures on the most important problems of protecting public health, make joint decisions on the prevention of human diseases; study the state of health of the population and the demographic situation in connection with the impact of adverse factors of the human environment; organize and control work on the prevention of infectious (parasitic), occupational and mass non-infectious diseases and poisoning of people. Measures to ensure sanitary and epidemiological well-being in the troops and at special facilities of the Ministry of Defense, the Ministry of Railways, the Ministry of Internal Affairs, and state security agencies are carried out by special services of these ministries and departments.

Factors of the epidemiological process are: the source of infection, the mechanism of transmission of the pathogen and the susceptibility of the population. Elimination of one of the factors inevitably leads to the termination of the epidemic process and, therefore, excludes the possibility of the existence of an infectious disease. Therefore, preventive and anti-epidemic measures can be effective if they are aimed at neutralizing (neutralizing) the source of infection, interrupting the pathogen transmission routes and increasing the population's immunity (Table 1).

Table 1. Grouping of anti-epidemic measures according to their focus on the links of the epidemic process

In relation to the source of infection in anthroponoses, diagnostic, isolation, therapeutic and regime-restrictive measures are distinguished, and in zoonoses, sanitary-veterinary and deratization measures.

Measures to break the transmission mechanism of the pathogen are sanitary and hygienic. In an independent group, disinfection and disinfestation measures can be distinguished.

Measures to protect the host population are mainly represented by vaccination of the population, the purpose of which is to create specific immunity (immunity) to individual infectious diseases. A separate group is represented by laboratory research and sanitary and educational work, which cannot be attributed to any direction, but are carried out in the interests of each of them.

Early and complete detection of infectious patients is a prerequisite for timely treatment, isolation and anti-epidemic measures in the outbreak. There are passive and active detection of infectious patients. In the first case, the initiative to seek medical help belongs to the patient or his relatives. The methods of active detection of infectious patients include: identification of patients according to the signals of a sanitary asset, household rounds, identification of patients and carriers during various preventive examinations and examinations (risk groups). So, children are subject to mandatory medical examination and laboratory examination before entering a preschool institution, adults when they are hired by food enterprises. Active detection should also include the identification of infectious patients during medical observation in epidemic foci.

The effectiveness of anti-epidemic measures in relation to sources of infection, it is largely determined by diagnostics, the requirements for which, from an epidemiological standpoint, are mainly due to the choice of reliable and, above all, early methods. The principles of diagnostic errors are associated with the difficulties of differential diagnosis of clinically similar infectious diseases, the polymorphism of the clinical manifestations of many of them, the underestimation of epidemiological data, and the insufficient use of laboratory confirmation capabilities. The quality of diagnostics is significantly improved by combining the use of various methods. In infectious diseases such as measles, mumps, chicken pox, scarlet fever and some others, the diagnosis is almost always made clinically and partly epidemiologically. Laboratory methods for diagnosing widespread use in these infectious diseases have not yet received.

If there is a large set of laboratory diagnostic methods, each of them should be given a correct epidemiological assessment. So, for example, in typhoid fever, early diagnosis of the disease is carried out using the method of isolating the pathogen from the blood (hemoculture) and serological tests (Vidal reaction, Vi-hemagglutination). With retrospective diagnosis, methods of later diagnosis are used, with the help of which the pathogen is isolated from feces, urine, and bile. These methods are used to confirm the diagnosis and identify carriers. The complexity of many laboratory tests limits their wide application. It is for these reasons that adeno- and enterovirus infections are often not diagnosed, although they are found everywhere.

Measures regarding the source of infection in the epidemic focus should be considered effective in cases where, in accordance with the pathogenesis of the disease, the patient is isolated before the onset of the infectious period and for its entire duration (typhoid and typhus). These measures are assessed as ineffective if the patient is isolated at the beginning, at the height or even at the end of the contagious period (viral hepatitis, measles, chicken pox, etc.).

The patient or carrier is isolated, as a rule, placed in an appropriate medical facility until complete clinical recovery or effective sanitation of the carrier is achieved. The terms and conditions of isolation are determined by special instructions. With a number of infectious diseases, isolation of the patient or carrier at home is allowed, subject to conditions that exclude the possibility of infection transmission. There are a number of diseases in which hospitalization is mandatory and provided for by legislative documents. Infectious patients are hospitalized by the forces of health facilities on a special transport that is subject to disinfection.

With zoonoses of wild animals (natural focal diseases), the problem lies in the extermination or reduction in population density, sometimes over large areas, especially when cases of plague, rabies, etc. are detected. These measures are expensive and are carried out according to epidemiological or epizootological indications by specialized institutions of public health and veterinary services . The economic development of territories (plowing the steppes, melioration, afforestation) often leads to the elimination of natural foci of infectious diseases.

The success of anti-epidemic work consists of the quality of the means used, the adequacy of the volume, timeliness and completeness of the measures taken. The effectiveness of anti-epidemic measures is their ability to change the level, structure and dynamics of infectious morbidity, to prevent or reduce the damage to public health associated with morbidity. The effectiveness of anti-epidemic measures is usually considered in three aspects: epidemiological, social and economic.

The epidemiological effect of anti-epidemic measures is understood as the magnitude of the prevented infectious diseases of the population and the phenomena associated with morbidity. The epidemiological effect of changes in the incidence of infectious diseases in the population or its individual groups is characterized and expressed as an efficiency index.

The social effectiveness of anti-epidemic measures is associated with the prevention of population decline in general and the reduction of mortality and disability, in particular of the able-bodied population.

Economic efficiency is closely related to social. It is expressed by the economic effect that is achieved as a result of maintaining the working capacity of the population and preventing society's expenses for the treatment of patients, the maintenance of the disabled, the implementation of measures in epidemic foci, etc.

The epidemiological, social and economic aspects of individual activities in the activities of the anti-epidemic system as a whole are interconnected.

Regime-restrictive measures carried out in relation to persons exposed or at risk of infection. The duration of these measures is determined by the time of danger of infection of persons in contact with the patient or the carrier, plus the maximum incubation period. Three categories of regime-restrictive measures can be distinguished: enhanced medical supervision, observation and quarantine.

Enhanced Medical Surveillance is aimed at actively identifying infectious patients among persons who were in contact with the patient (carrier) at home, at the place of work, study, etc. Among these persons, during the maximum incubation period of the disease, a survey, medical examination, thermometry, laboratory tests, etc. .

Observation (observation)- enhanced medical monitoring of the health of people who are in the quarantine zone and intend to leave it.

Quarantine- a regime-restrictive measure in the system of anti-epidemic services for the population, providing for the complete isolation of contact persons, provided by armed guards, in the event of foci of especially dangerous infections. For less dangerous infections, quarantine means introducing some measures to separate people who have been in contact with the patient, prohibiting the admission of new ones or the transfer of children from the group. in a group in organized groups, preventing people who communicated with the patient in children's groups, food enterprises, limiting their contact with other people.

Character measures to disrupt transmission routes depends on the characteristics of the epidemiology of the disease and the degree of resistance of the pathogen in the external environment. Success is ensured by general sanitary measures that are carried out regardless of the presence of diseases - sanitary control of water supply and food products, cleaning of populated areas from sewage, fighting the breeding of flies, etc. General sanitary measures play a decisive role in the prevention of intestinal infectious diseases. In addition to general sanitary measures, of great importance in preventing further transmission of infection are disinfection , pest control And deratization.

In respiratory tract infections, the transmission factor is air, which is why measures to destroy the transmission mechanism are so difficult, especially in hospital settings and organized groups. The development of methods and devices for air disinfection in such conditions is necessary, and such work is underway. For individual prophylaxis in the focus of infection, it is recommended to wear gauze bandages.

A break in the mechanism of transmission in infections of the external integument is achieved by increasing the general and sanitary culture of the population, improving housing conditions, and the sanitary situation at home and at work. The great importance of measures to interrupt the mechanism of transmission is clearly manifested in diseases of the blood group, in which the transmission factor is a living carrier (lice, mosquitoes, ticks, etc.).

Measures to increase the resilience of the population are reduced both to general strengthening measures that increase the body's nonspecific resistance, and to the creation of specific immunity through preventive vaccinations.

The focus of activities depends on the characteristics of the infection. Along with an integrated approach to anti-epidemic activities, measures aimed at the most vulnerable and accessible link will be decisive. So, with intestinal infections, the basis of prevention is a set of sanitary and hygienic measures aimed at interrupting the transmission of diseases and preventing infection of the population. At the same time, these measures are ineffective in respiratory tract infections, since it is practically impossible to interrupt the aerosol mechanism of transmission of infectious agents, which is extremely active in them. The immunological factor regulates the incidence of respiratory tract infections. In this regard, measures for specific immunization of the population in order to create a high layer of herd immunity play a decisive role in the prevention of this group of infections. Accordingly, those diseases in the fight against which vaccines have been developed are classified as controlled means of immunoprophylaxis. These infections include a number of aerosol anthroponoses (measles, diphtheria, whooping cough, mumps, etc.). Infections managed by sanitary and hygienic measures include anthroponoses with a fecal-oral transmission mechanism (shigellosis, typhoid fever, viral hepatitis A and E, etc.). However, in poliomyelitis, a steady decline in the incidence became possible only after the development and widespread use of a live vaccine. Prevention of the incidence of people with edonosis of domestic animals is provided by sanitary and veterinary measures and vaccinations, and natural focal infections - by regime-restrictive and vaccination measures. The proportion of individual measures is different and depends not only on the nature of the infection, but also on the sanitary and epidemiological situation in which they are carried out.

Registration system for infectious patients adopted in our country provides:

1) timely awareness of sanitary and epidemiological institutions and health authorities about the detection of cases of infectious diseases in order to take all necessary measures to prevent their spread or the occurrence of epidemic outbreaks;

2) correct accounting of infectious diseases;

3) the possibility of conducting operational and retrospective epidemiological analysis.

All medical data on infectious patients are entered into the main medical documentation corresponding to the specifics of a medical institution (HCF): a medical record of an inpatient, a medical record of an outpatient, a child's developmental history, a medical record of a patient with a sexually transmitted disease, etc. In the generally accepted order for each case diseases fill in a statistical coupon for registration of final (refined) diagnoses, an outpatient coupon. For each case of disease (suspicion), unusual reaction to vaccination, bite, saliva by animals, an emergency notification of an infectious disease, food, occupational poisoning, an unusual reaction to vaccination - form No. 58 is filled out. The notice is sent within 12 hours to the territorial center of sanitary and epidemiological supervision registration of the disease (regardless of the place of residence of the patient). A healthcare facility that has clarified or changed the diagnosis is obliged to draw up a new emergency notification and send it to the sanitary and epidemiological supervision center at the place where the disease was detected within 24 hours, indicating the changed diagnosis, the date of its establishment, the initial diagnosis and the results of the laboratory examination.

For personal accounting of infectious patients and subsequent control of the completeness and timing of the transfer of information to the center of sanitary and epidemiological supervision, information from an emergency notification is entered into a special register of infectious diseases - form No. 60

Epidemiological surveillance

Epidemiological surveillance represents an information system for providing health authorities with the information necessary for the implementation of measures to prevent and reduce the incidence of the population. Abroad, it is called public health supervision. Being a purely information system, epidemiological surveillance serves as the basis for the development of strategies and tactics, rational planning, implementation, adjustment and improvement of the activities of the sanitary and anti-epidemic service to combat and prevent infectious diseases. The main provisions of epidemiological surveillance (collection, analysis, interpretation and transmission of information about the state of health of the population) can be extended to non-communicable diseases. With regard to infectious diseases, epidemiological surveillance, according to B.L. Cherkassky (1994) can be defined as a system of dynamic and integrated tracking (observation) of the epidemic process of a specific disease in a certain area in order to rationalize and increase the effectiveness of preventive and anti-epidemic measures.

Monitoring- part of epidemiological surveillance, responsible for diagnosing the situation and developing direct tactical actions of the sanitary and epidemiological service. The ultimate goal of epidemiological surveillance - the development of a scientifically based set of strategic management decisions and the subsequent assessment of the effectiveness of the entire system - goes beyond epidemiological monitoring. When dynamically assessing the epidemiological situation, it is necessary to take into account both biological (the state of the pathogen population, hosts, their interaction with each other and the environment through a specific mechanism of transmission), and natural and social components (working, living and recreational conditions of the population) of the epidemic process. The effectiveness of epidemiological surveillance should not be assessed by the degree of its influence on the level, structure and dynamics of infectious morbidity. Only a rational system of prevention and control of infection can influence these manifestations of the epidemic process. The effectiveness of epidemiological surveillance can only be assessed by the ability to provide information necessary and sufficient for making rational management decisions and their optimal implementation. The influence of the epidemiological surveillance system on the epidemic process can only have an indirect effect and depend on the timeliness and expediency of using its results in planning, improving and implementing preventive and anti-epidemic measures.

The tasks of epidemiological surveillance include (B.L. Cherkassky, 1994):

o assessment of the extent, nature of the prevalence and socio-economic significance of an infectious disease;

o identifying trends and assessing the pace of dynamics of the epidemic process of this infectious disease over time;

o zoning of territories, taking into account the degree of real and potential epidemiological distress for this infectious disease;

o identification of contingents of the population at increased risk of disease due to the characteristics of their production, household or other living conditions;

o identifying the causes and conditions that determine the observed nature of the manifestations of the epidemic process of this infectious disease;

o determination of an adequate system of preventive and anti-epidemic measures, planning the sequence and timing of their implementation;

o control of the scale, quality and effectiveness of ongoing preventive and anti-epidemic measures in order to rationally adjust them;

o development of periodic forecasts of the epidemiological situation.

Epidemiological surveillance is carried out in accordance with complex targeted programs specially developed for each nosological form of infectious diseases. Surveillance programs include interrelated, independent sections (subsystems): information-analytical and diagnostic. The information-analytical subsystem is the basic section of epidemiological surveillance. Within the framework of this subsystem, all forms of manifestation of diseases are taken into account and recorded, as well as the dynamics of carriage, morbidity, mortality and mortality are monitored. The volume of necessary information in each case is determined by the characteristics of the epidemiology of the disease, as well as the real possibilities of the anti-epidemic system for the necessary information support in specific conditions of place and time. Differences in surveillance tasks for individual infectious diseases determine the set of necessary information for a full study of the epidemiological situation. So, along with information support common to all surveillance programs for monitoring the level, structure and dynamics of morbidity (mortality) in infections controlled by means of immunoprophylaxis, information is needed on the immune status of the population (immunological control) with an assessment of the intensity of immunity in risk groups. At the same time, in diphtheria, it is important to monitor the circulation of the pathogen among the population (bacteriological control, including data on the structure, breadth of circulation, and biological properties of the pathogen). For measles, this information is not needed. Epidemiological surveillance for intestinal infections should be based on sanitary and hygienic control of the external environment, compliance with the sanitary and epidemiological regime at food facilities, etc. In case of zoonoses, a comprehensive multifaceted epizootologo-epidemiological surveillance is required, carried out jointly by the sanitary-epidemiological and veterinary services.

The starting point for developing an epidemiological surveillance program is a retrospective analysis of the local epidemiological situation for the previous period. Its purpose is determined by the priority areas of epidemiological surveillance of the infectious disease under study in specific conditions. The logical continuation of the retrospective epidemiological analysis is the operational epidemiological analysis, i.e. study of the dynamics of the epidemiological situation for making operational decisions on the management of the epidemic process.

Epidemiological diagnosis involves an assessment of the current situation and its causes in a particular territory, among certain groups of the population in the studied period of time. Socio-economic analysis is important, allowing to assess the economic and social damage caused by a particular infectious disease,

Similar to the concept of “prenosological diagnostics” used in clinical practice, i.e. recognition of the borderline states of the body between health and disease, norm and pathology, in epidemiological practice there is the concept of "pre-epidemic diagnosis", i.e. timely detection of prerequisites and precursors possible complication epidemiological situation and the development on their basis of recommendations for the operational correction of the plan of preventive and anti-epidemic measures (B.L. Cherkassky, 1994).

The range of components of the natural environment and the specifics of their influence on the epidemic process are determined for each infectious disease by the mechanism of transmission of pathogens. Thus, in infections of the respiratory tract, the causative agents of which mainly live in the body of the biological host, natural factors act mainly on the host population (resistance of the macroorganism). In intestinal infections, the pathogens of which can be in the external environment for a long time, natural factors affect both pathogens and the activity of infection transmission routes. The social conditions of the population's life affect the biological basis of the epidemic process through all 3 of its links, but with different intensity in different infections. With respiratory tract infections, the dynamics of the epidemic process is determined by the renewal of the composition of the teams, which contributes to the introduction of pathogens, an increase in the non-immune layer and the activation of the transmission mechanism. In intestinal infections, the main prerequisites for the complication of the epidemiological situation are those phenomena of social life that can activate the leading pathways of pathogen transmission (water and food).

Harbingers complications of the epidemiological situation in respiratory tract infections can serve as the emergence of a source of infection in combination with an increase in the non-immune layer of the population, as well as a change in the landscape of circulating pathogens. Thus, a prognostic sign of a probable increase in the incidence of meningococcal infection can be an increase in specific gravity serogroup A or C meningococci in adolescents and adults, as well as a sharp increase in detected serogroup B meningococci in young children. Changes in the antigenic characteristics of the influenza virus can also serve as a predictor of a possible rise in the incidence. An unfavorable moment in the development of the epidemic process of diphtheria and streptococcal (group A) infection is a redevelopment in the serological and typical structure of the population of the circulating pathogen, an increase in its toxigenicity. A harbinger of a complication of the epidemiological situation in intestinal infections can be a deterioration in the bacteriological parameters of water and food, a change in the properties of the circulating pathogen.

Information on the movement of infectious diseases is distributed in the form of periodic reports, reports on outbreaks, information letters, bulletins, methodological documents, etc. Analytical materials ors on the sanitary and epidemiological state of individual regions and the country as a whole are published in the monthly bulletin "Population Health and Habitat" , the annual State report on the sanitary and epidemiological situation in Russia, etc. In accordance with the Constitution of Russia and legislative documents in the field of healthcare, data on sanitary and epidemiological well-being are communicated to the population of the country through the mass media.

Comprehensive targeted surveillance programs for individual infectious diseases being developed and implemented in healthcare practice are included in the system of state sanitary and epidemiological surveillance. The information subsystem of the latter is social and hygienic monitoring (SHM). The legal basis for the preparation of the concept, organizational structure and principles for the creation and implementation of the SHM system was the law of the Russian Federation "On the sanitary and epidemiological well-being of the population", according to which "observation, assessment and forecasting of the state of health of the population in connection with the state of its habitat" are defined as leading elements of state sanitary and epidemiological supervision. The creation and implementation of the SHM system at the federal and regional levels will be an important stage in the development of the preventive direction in protecting the health of the population of the Russian Federation.

hospital infection

hospital infections(hospital-acquired infections - nosocomial infections) are one of the most urgent health problems in all countries of the world. The socio-economic damage they cause is enormous and difficult to determine. Paradoxically, despite the colossal achievements in the field of diagnostic and treatment technologies and, in particular, inpatient treatment technologies, the problem of nosocomial infections remains one of the most acute and is becoming increasingly medical and socially significant. Among the factors determining the growth trend of nosocomial infections, one should mention the widespread use of invasive (damaging and penetrating) diagnostic and therapeutic manipulations, immunosuppressants, the widespread, sometimes uncontrolled use of antibiotics and, as a result, the spread of antibiotic-resistant strains of microorganisms in the hospital, as well as a certain shift in the structure hospitalized (increase in the proportion of elderly people, debilitated children, patients with long-term, previously incurable diseases), etc.

For a long time, only diseases of patients resulting from infection in the hospital were attributed to HAI. It was this part of the nosocomial infection, of course, the most noticeable and significant, that first of all attracted the attention of the public and medical workers. Today, according to the WHO definition, nosocomial infections include “any clinically recognizable infectious disease that affects a patient as a result of his admission to a hospital or seeking treatment for it, or hospital employees as a result of their work in this institution, regardless of the onset of symptoms of the disease during hospital stay or after discharge.

From this definition, it follows that the concept of "nosocomial infection" includes both diseases of patients who received medical care in hospitals and clinics, medical units, health centers, at home, etc., and cases of infection of medical personnel in the course of their professional activity. In certain types of hospitals, personnel are at high risk of contracting various infectious diseases, including hepatitis B and C, HIV infection (intensive care units and purulent surgery, HIV infection and hemodialysis units, blood transfusion stations, etc.). Among nurses, the most susceptible to infection are procedural sisters, as well as personnel who carry out pre-sterilization cleaning and sterilization of instruments and equipment contaminated with blood and other secrets. There is evidence that 63% of the medical staff of purulent surgical departments fall ill with various forms of purulent-inflammatory infections during the year, in maternity hospitals this figure is 15%. In 5-7% of the staff, repeated illnesses are possible.

Studies conducted under WHO programs have shown that nosocomial infections occur on average in 8.4% of patients. In European countries, this figure was 7.7%, in the western part Pacific Ocean- 9%, regions of Southeast Asia and the Eastern Mediterranean - 10-11% respectively, in the USA - about 5%. The most affected were children under 1 year of age and persons over 65 years of age. In the United States, up to 2 million diseases are registered annually in hospitals, in Germany - 500-700 thousand, which is approximately 1% of the population of these countries. In Russia, the problem of nosocomial infections is no less relevant. According to selective studies conducted based on WHO recommendations on the basis of 58 healthcare facilities in 8 regions of the CIS, the incidence rate was 6.7% of the number of hospitalized patients. In absolute terms, the estimated annual incidence of patients in hospitals is 2-2.5 million people. In children's surgical hospitals, nosocomial infections were detected in 21.9% of operated patients; in adult surgical hospitals, the proportion of postoperative purulent-septic complications is 12-16%. The relevance of the problem of nosocomial infections for our country is also confirmed by constantly recorded outbreaks of diseases in medical facilities. A significant achievement of recent years has been the introduction in Russia since 1990 of the registration of nosocomial infections within the framework of state statistical reporting. The analysis of these materials makes it possible to assess the incidence of nosocomial infections in last years, including by territories, the structure of morbidity - by nosological forms and hospitals of various profiles. At the same time, the recorded incidence of nosocomial infections in Russia does not fully reflect its true level.

The problem of nosocomial infections is studied and considered in various aspects, including economic and social ones. The economic damage caused by nosocomial infections consists of direct and additional costs, at least associated with an increase in the length of the patient's stay in the hospital, laboratory examinations, and treatment (antibiotics, immunopreparations, etc.). According to American authors, the cost of additional hospital stay due to nosocomial infections is annually from 5 to 10 billion dollars.

The social aspect of damage concerns harm to the health of the victim, up to disability in some nosological forms, as well as an increase in the mortality of patients with nosocomial infections. According to WHO, the mortality rate among those hospitalized with nosocomial infections was 10 times higher than that among those without infection. An analysis of nosocomial outbreaks in obstetric institutions in our country showed that mortality among affected newborns averaged 16.2%, and sometimes reached 46.6% in neonatal pathology departments.

An extensive list of nosocomial pathogens includes representatives of various taxonomic groups related to bacteria, viruses, protozoa and fungi. VBI can be divided into 2 large groups infectious diseases caused by:

obligate human pathogens;

Conditionally pathogenic human microflora.

The 1st group includes all cases of "traditional" (classic) infectious diseases - such as childhood infections (measles, diphtheria, scarlet fever, rubella, mumps, etc.), intestinal infections (salmonellosis, shigellosis, etc.), hepatitis B and C and many other diseases. The occurrence of these diseases in a hospital can significantly complicate the course of the underlying disease, especially in children's hospitals and obstetric institutions. This group of diseases accounts for approximately 15% of nosocomial infections. The emergence and spread in hospitals of infectious diseases caused by obligate pathogenic microorganisms, as a rule, is associated with the introduction of the pathogen into medical institutions or infection of personnel when working with infectious material. The introduction of pathogenic pathogens into a non-infectious hospital can occur:

o upon admission to the hospital of patients who are in the incubation period of the disease, or carriers of a pathogenic agent;

o from hospital staff who are carriers of the pathogen;

o from visitors to hospitals, especially during epidemics of influenza and other acute respiratory infections, as well as through donated food and other items.

When pathogenic microorganisms are introduced into a hospital, single or multiple cases of infectious diseases occur, registered simultaneously or sequentially, which is determined by the activity of the existing transmission mechanism. The epidemiological manifestations of these diseases, with rare exceptions (hospital salmonellosis with airborne dust infection, aerogenic infection with brucellosis, etc.), are well known, and the situation in hospitals is largely determined by the general epidemiological situation. As the incidence of a particular infection increases, the frequency of introducing diseases into hospitals also increases. The success of the fight against nosocomial infections depends on the competent and conscientious implementation of the recommended anti-epidemic and preventive measures.

The 2nd group (approximately 85% of nosocomial infections) includes diseases caused by opportunistic pathogens. This group represents a set of infectious diseases of different clinical manifestations and etiology, which are in a causal relationship with the diagnostic and treatment process. The structure of these diseases is determined by purulent-inflammatory diseases (purulent-septic), manifested by local inflammatory processes with or without suppuration and tending to generalization and the development of sepsis. Staphylococci, streptococci, gram-negative bacteria (E. coli, Klebsiella, Proteus, serrations, etc.) dominate among pathogens. Cases of nosocomial infection with pseudomonas, legionella, rotaviruses, cytomegaloviruses, etc. are not uncommon. The importance of fungi of the genus Candida, nocardia, cryptococci, etc. has increased. The role of pneumocystis, cryptosporidium, and other representatives of protozoa has been proven. The etiological role of different pathogens changes over time. Thus, in recent years there has been a tendency towards an increase in the role of gram-negative bacteria and a decrease in the role of gram-positive bacteria in hospital pathology. The proportion of participation of various microorganisms is determined by a number of factors: the localization of the pathological process, the profile of the hospital, the nature and level of laboratory examination, etc. Thus, the pathology of the urinary tract is caused almost exclusively by gram-negative microorganisms, with infections of the lower respiratory tract Pseudomonas aeruginosa and pneumococci dominate. In obstetric hospitals, gram-positive microflora (staphylococcus, streptococcus) predominates, in psychiatric hospitals - intestinal infections (typhoid fever, shigellosis), in gastroenterological - helicobacteriosis, in surgical departments - gram-negative microflora and staphylococcus, etc.

It should be noted such a feature of the course of the infectious process in purulent surgery as a possible cross-infection with the pathogen. Patients with staphylococcal and Pseudomonas aeruginosa infections in the same ward exchange pathogens. In abdominal surgery, in more than 50% of cases, infection of the abdominal cavity is of a polymicrobial nature, which also indicates the prevalence of the phenomenon of cross-infection and superinfection in healthcare facilities.

Nosocomial diseases are usually caused by nosocomial strains of microorganisms with multidrug resistance, higher virulence and resistance to adverse environmental factors - drying, exposure to ultraviolet rays and disinfectants. It should be remembered that in solutions of some disinfectants, hospital strains of pathogens can not only persist, but also multiply. A number of pathogens, such as Klebsiella, Pseudomonas, Legionella, can multiply in a humid environment - air conditioners, inhalers, showers, liquid dosage forms, on the surface of washbasins, in wet cleaning equipment, etc. .

One of the reasons for the incomplete registration of nosocomial infections in Russia is the lack of clear definitions and criteria for identifying these infections in regulatory documents. In this regard, the experience of foreign countries, in particular the United States, where the principles and provisions of the “definitions of nosocomial infections” have been developed and are currently in force, is of undoubted interest. A number of Western European countries use these "definitions" in their work, giving the document its value as a possible international standard. The definition is based on a combination of clinical signs, as well as the results of laboratory and other types of diagnostic studies. The list of nosocomial infections includes definitions of surgical wound infections, blood and urinary tract infections, and pneumonia. Other types of infections are classified on the basis of organ-system localization. Surgical wound infections account for approximately 29% of hospital infections in the United States, urinary tract infections 45%, pneumonia 19%, and contain the greatest threat of death. According to the literature, 15% of deaths in hospitalized patients are associated with pneumonia, which often occurs in surgical hospitals, intensive care units and intensive care units. Blood infections are more often secondary. Skin infections, infections of soft tissues, gastrointestinal tract, reproductive system, cardiovascular system, bone tissues and combined infections are rare and account for less than 6%. Assessing the socio-economic significance of each hospital infection, it should be noted that wound infections absorb 42% of the additional costs and explain half of the additional hospital stay of the total number of nosocomial infections. Pneumonia ranks second and requires 39% of additional costs. In third place are urinary tract infections (13% of costs),

blood infections account for 3% of costs.

Fig.1 Mechanisms and ways of transmission of nosocomial infections.

The polyetiology of nosocomial infections and the variety of sources of pathogens of various nosological forms predetermine the diversity mechanisms, ways and factors of transmission(Fig. 1), which have their own specifics in hospitals of different profiles. However, there are a number of common points that contribute to or hinder the spread of pathogens. First of all, this is the layout of hospital premises, sanitary and hygienic conditions of the hospital, treatment and diagnostic rooms.

Airborne (aerosol) transmission route infection plays a leading role in the spread of staphylococcal and streptococcal infections. Infected air causes outbreaks of Legionnaires' disease, registered in hospitals in several countries around the world. At the same time, air conditioners with humidifiers played a large role in the spread of infection. ventilation systems, more rarely, diseases were associated with the inhalation of water or dust aerosol during physiotherapeutic procedures or earthworks carried out near the hospital. It should be borne in mind that bedding - mattresses, mattresses, blankets, pillows - can also become factors in the transmission of staphylococci, enteropathogenic and other pathogens.

Contact household transmission characteristic mainly of infections caused by gram-negative bacteria. At the same time, it is necessary to take into account the possibility of intensive reproduction and accumulation of these microorganisms in a humid environment, in liquid dosage forms, in expressed breast milk, on wet brushes for washing the hands of personnel and wet rags. Contaminated instruments, respiratory equipment, linen, bedding, the surface of wet objects (faucet handles, the surface of sinks, etc.), infected hands of personnel can also serve as infection transmission factors. Household transmission is also realized with staphylococcal infection, especially in cases where it is caused by epidermal staphylococcus aureus.

Food way of transmission can be realized in infections caused by various etiological agents. Babies who are breastfed may become infected with staphylococci when fed or supplemented with expressed milk or when fed by a mother with mastitis. Violations of food preparation technology, the presence of unrecognized sources of infection among food workers lead to outbreaks of intestinal infections in hospitals. However, the artificial, or artificial, transmission mechanism plays the main role in the spread of nosocomial infections. The value of the artifactual mechanism is growing. In fact, we are dealing with a real "aggression" of diagnostic and therapeutic medical technologies. In addition, according to WHO, about 30% of invasive interventions are performed unreasonably. Parenteral transmission of pathogens is possible when using non-disinfected syringes and needles, with the introduction of infected blood products. Non-compliance with the rules of asepsis and antisepsis by the personnel, violations of the sterilization and disinfection of medical instruments and devices lead to the implementation of an artificial way of infection transmission. At the same time, in each type of hospitals, it is important to identify risk factors and contingent, the likelihood of nosocomial infections in which is especially high.

Features of the epidemic process purulent-septic infections are:

o the epidemic process is ongoing, it involves a large number of patients and medical personnel;

o the epidemic process takes place in a closed (hospital) space;

o there is a possibility of the formation of several transmission mechanisms in one focus: aerosol, contact-household, etc.;

o as a reservoir of infectious agents, along with patients and carriers, the external environment acts.

Since most nosocomial infections are caused by opportunistic pathogens, it is important to clearly define risk factors and risk groups in each type of hospital. The complexity of the fight against hospital infection is determined by the fact that its level, structure and dynamics are the result of the action and interaction of many factors. This dictates the need for an integrated approach to their prevention. The traditionally established system of prevention and control of infections (influence on all three links of the epidemic process) is also applicable to nosocomial infections, but needs to be corrected taking into account their general characteristics, as well as the characteristics of the etiology and epidemiological manifestations of diseases in a particular type of health facility.

Of great importance is the development of an epidemiological surveillance system designed both for an objective assessment of the epidemiological situation in a hospital, and for forecasting and scientific substantiation of control and prevention measures. Epidemiological surveillance includes registration, registration of diseases, deciphering the etiological structure, the study of the circulation of pathogenic and opportunistic microorganisms. This work includes monitoring the health of medical personnel (morbidity and carriage). An integral part of supervision is monitoring the sanitary-hygienic and anti-epidemic regime in health facilities. In the United States, Europe and Asia, work on the prevention of nosocomial infections is called infection control. The control of nosocomial infections is carried out by various specialists, including medical specialists, epidemiologists, pharmacists, while in many countries infection control is assigned to highly qualified nursing personnel. The active participation of the nursing service in the prevention of nosocomial infections is one of the main prerequisites for success.

First of all, efforts should be directed to active and early detection of diseases, full accounting and registration of all cases. Morbidity should be analyzed not only by the localization of the pathological process, but also by etiology with a detailed description of the isolated strains. The analysis of lethal outcomes is important (sometimes the number of lethal outcomes exceeds the number of registered diseases).

The importance of microbiological monitoring of the latitude and biological properties of circulating pathogens should be emphasized, since one of the reasons for the increase in the incidence of nosocomial infections is the formation of hospital strains. Timely detection of the fact of the appearance and circulation of hospital strains in a hospital indicates an impending complication of the epidemiological situation and prompts appropriate measures. Given the high number of antibiotic-resistant strains of the pathogen among them, an important and urgent task is to develop in each medical institution strategies and tactics of chemoprophylaxis and chemotherapy. These issues should be dealt with by trained professionals. The need for such an approach is dictated by the huge volume of existing drugs and their widespread use in clinical medicine.

Among the measures aimed at the source of infection, one can single out: timely detection and isolation of patients upon admission to the hospital and during their stay in special wards (boxes), taking into account the etiological factor, and epidemiological investigation of each case of nosocomial infections. Thus, the further spread of the infection is prevented, and it is carried to other health facilities.

In recent years, the inexpediency of a wide examination of medical personnel of hospitals for the carriage of opportunistic microflora has been shown. In our country, a decision has been made to stop routine examinations of medical workers for carriage of Staphylococcus aureus, which are justified only in a particularly difficult epidemiological situation. Quarterly sanitation with broad-spectrum drugs led to disruption of the normal microbial biocenosis of the nasopharyngeal mucosa, which plays an important role in protecting the body from pathogenic microorganisms. It is considered expedient to sanitize only long-term carriers that excrete the pathogen of the same fagovar for more than 6 months. In this case, it is recommended to use drugs with a narrow spectrum of action - a 2% oil solution of chlorophyllipt or a staphylococcal bacteriophage.

The group of measures aimed at breaking the transmission mechanism includes architectural and planning activities, sanitary-hygienic and disinfection modes. Architectural and planning measures are aimed at ensuring a strict separation of "purulent" and "clean" flows of patients. For this, a sufficient number of premises and their rational placement are planned. The operating unit should have the entire set of production, household and auxiliary premises and be maximally isolated from other hospital premises. It must have 2 isolated non-passage compartments: septic and aseptic. When placing operating rooms on top of each other, the septic compartment should be located above the aseptic one. "Purulent" surgical departments should be located on the upper floors of buildings to exclude the possibility of polluted air entering other rooms. It is desirable to remove the "purulent" department with a septic operating unit in a separate building.

In the buildings of health care facilities, as a rule, supply and exhaust ventilation with mechanical stimulation is provided. Ventilation in buildings should exclude air flows from "dirty" zones (premises) to "clean" ones. Departments or groups of premises between which air flows are not allowed are isolated with locks. Departments or groups of premises that have one sanitary and hygienic regime are usually equipped with one centralized system supply and exhaust ventilation. Basic principle: in rooms with an aseptic regime, the air supply prevails over the exhaust (clean operating rooms, childbirth, resuscitation, procedural, dressing rooms, etc.); in "dirty" rooms (purulent operating room, storage room for dirty linen, boxes for working with infectious material, etc.), the air extract prevails over the inflow. Fresh air is supplied through the upper zone, while the inflow must prevail over the exhaust by at least 20%. The frequency of air exchange in operating rooms is taken at least 10 times per hour.

Intensive care units and intensive care units also pose an increased risk. One of the methods of transmission of infection in these departments is airborne, the other is contact, both direct and through care items, underwear, dressings, instruments, and medical and diagnostic equipment.

Of great importance in the fight against nosocomial infections belongs to sanitary and hygienic measures: observance by medical personnel of the rules of personal hygiene, careful processing of hands and disinfection regimen. Of particular note is the role of sterilization measures, the violation of which can lead to the emergence of not only purulent-inflammatory diseases, but also viral hepatitis B and C, HIV infection, etc. One should strive to use disposable instruments (syringes, blood transfusion systems, etc.). .). The use of disposable underwear is effective.

Of great importance in the transfer of infection from one patient to another play the hands of the staff. According to available data, in 40% of cases, the development of infections caused by opportunistic microflora is associated with the presence of these microorganisms on the hands of personnel, and more often enterobacteria. In this regard, in any case, medical personnel should wash their hands before and after performing all manipulations for patients allocated in the high-risk group for developing nosocomial infections. Washing hands and using gloves are not mutually exclusive. Moreover, washing hands after removing gloves is also necessary, as they can be imperceptibly torn or contain invisible cracks or damage. For the prevention of nosocomial infections, it is necessary to comply with other sanitary and hygienic requirements:

o do not shake in the air or throw patients' bedding on the floor;

o correctly remove solid and liquid waste from the treatment department;

o strictly comply with the requirements for disinfection of care items and medical devices, pre-sterilization cleaning and sterilization;

o observe the mode of ventilation of the premises;

to carry out washing of floors and wet cleaning of surfaces (furniture, equipment, apparatus) in accordance with the requirements, using disinfectants.

The sanitary and hygienic regime, its rational organization and maintenance is the function of the heads of the hospital and department, and first of all the senior and chief nurses. It is they who should educate the nursing staff with a sense of responsibility for high quality of the work performed, to monitor the sanitary and hygienic condition of all objects and compliance with the rules of asepsis and antisepsis. The head nurse conducts marketing research of disinfectants, sterilization equipment and medical instruments, draws up applications for their purchase.

Prevention of the artifactual mechanism the transfer is facilitated by the reduction in the use of invasive procedures, the widespread use of non-invasive methods for obtaining material for research, the creation of centralized sterilization departments, and the use of disposable instruments. Invasive interventions should be carried out only when absolutely necessary. In this case, conditions must be observed that guarantee safety. Abroad, vascular catheterization is treated as a very serious operation, carrying it out in a mask, gloves, and sterile gowns.

Neither epidemiologically nor economically planned studies of environmental objects are justified. They are expensive and rarely effective. Rational are only episodic targeted studies to control the sanitary and hygienic state of a particular object and during outbreaks of nosocomial infections. In our country, in a number of cities, up to 50-70% of microbiological studies of clinical laboratories are directed to the external environment and only 30-50% to patients. Therefore, the etiology and causes of outbreaks of nosocomial diseases are often not deciphered. This does not exclude the need for bacteriological control over the sterility of instruments, dressings, solutions, milk mixtures, etc.

The experience gained in our country and abroad indicates that progress in the field of prevention of nosocomial infections largely depends on organizational work. Prospects for the active prevention of nosocomial infections are opened for public health by the order of the Ministry of Health of the Russian Federation No. 220 dated 17.09.93. This order introduced the positions of doctors - clinical epidemiologists, and in large hospitals - the deputy chief physician for sanitary and epidemiological issues, formulated new tasks and provided new organizational opportunities for creating an effective system for the prevention of nosocomial infections. In the centers of the State Sanitary and Epidemiological Supervision, groups (departments) for the control of nosocomial infections have been created. Their main task is the methodological guidance of the work on the prevention of nosocomial infections, licensing of health facilities, analysis of the epidemiological situation in various health facilities, participation in the investigation of outbreaks and minimal "punitive" sanctions against the heads of health facilities. There is experience in creating commissions in health care facilities to combat nosocomial infections, headed by the deputy chief physician. The commission, in addition to a representative of the hospital administration, includes heads of departments (go doctors of medical departments), a chief nurse (or an infection control specialist), a hospital epidemiologist, laboratory workers, and, finally, representatives of engineering and technical services. In the prevention of nosocomial infections, such organizational forms of activity of health facilities as:

o organization of work of maternity hospitals according to the mother-child principle (their advantage has been proven in 12 parameters). As observations have shown, in maternity hospitals operating on the principle of mother-child, the colonization of the newborn organism is carried out mainly by maternal rather than hospital strains, the intensity of circulation of intra-hospital strains among staff and at environmental objects decreases;

o creation of departments (wards) in obstetric hospitals for day care of pregnant women from high-risk groups with prenatal pathology;

o change in the ratio of pre-hospital and hospital care towards pre-hospital care;

o conducting diagnostic studies in specialized centers;

o reduction in hospital admissions;

o Minimize the time spent in the hospital. In surgical hospitals during planned operations, this is possible due to examination in outpatient settings without duplication of tests in the hospital.

In maternity hospitals, early attachment of the newborn to the breast is recommended for the formation of a normal biocenosis and immune system, early discharge - on the 2nd-4th day, termination of treatment for infectious patients, their timely transfer to hospitals, permission for relatives to be present before, during and after childbirth. The use of combined antibacterial prophylaxis in the pre-, intra- and postoperative periods can reduce the number of complications by an average of 30%. However, chemo- and antibiotic prophylaxis should be justified and carried out strictly according to indications.

Given that inflammatory process develops against the background of a reduced immune reactivity of the patient, immunological methods of fighting the infection become important: specific immunoprophylaxis and immunotherapy with the help of vaccines, toxoids, hyperimmune antimicrobial plasmas, targeted immunoglobulins and immunomodulators.

The question of prevention of nosocomial infections among medical personnel. Throughout the world, viral hepatitis B, C and D are considered as occupational diseases of medical workers in contact with the blood of patients. Another important problem of nosocomial infections among medical personnel is HIV infection. As noted, in the departments of purulent surgery, burn departments, there is an increased incidence of purulent-inflammatory diseases among medical personnel. Only a set of measures can prevent infection of medical personnel: for some infections, vaccination (hepatitis B, diphtheria), for others, an increase in nonspecific resistance of the macroorganism (influenza, acute respiratory infections, etc.), for a number of infections, compliance with elementary hygiene rules and use in contact with blood and other biological secrets of personal protective equipment (gloves, goggles, gowns, masks, etc.). It is also important to be very careful with used sharp medical instruments (needles, scalpels, etc.). Such an elementary rule should also be observed: in the presence of microtraumas on the skin, close the entrance gates of infection with adhesive tape or lifusol, which should be in the first-aid kit for medical personnel in each health facility. Regular medical examination of medical workers helps to identify patients and carriers of infection among them, which affects both the prevention of occupational diseases and their neutralization as sources of infection for patients.

To date, enough information has been accumulated on the high economic efficiency of the introduction of nosocomial infections prevention programs. Studies conducted in the United States have shown that a 0.4% reduction in the incidence of nosocomial infections fully pays for the costs of the prevention program and prevents the development of infection in more than 130,000 patients. However, the biggest obstacle to their active use is the "human factor". Until health care workers, from nurses to chief physicians, take an active interest in careful and daily routine of all regulated simple measures, any significant results in the fight against nosocomial infections cannot be obtained. It is still much easier to hide HAI than to prevent it. Close interaction of medical workers of the treatment-and-prophylactic and sanitary-epidemiological services is of great importance in the successful fight against nosocomial infections.

List of used literature:

1. Pokrovsky V.I., Pak S.G., Briko N.I., Danilkin B.K. Infectious diseases and epidemiology. - M.: GEOTAR MEDICINE, 2000.

2. Pokrovsky V.I. Cherkassky B.L., Petrov V.L. Anti-epidemic practice. – M.:-Perm, 1998.

3. Order of the Ministry of Health No. 916-1983 "On approval of instructions on the sanitary and anti-epidemic regime and labor protection of personnel of infectious diseases hospitals (departments)".

4. Guide to the epidemiology of infectious diseases / Ed. IN AND. Pokrovsky, in 2 volumes - M.: 1993.

5. Yafaev R.Kh., Zueva L.P. Epidemiology of nosocomial infections.. - L., 1989.

Lecture 8

Preventive and anti-epidemic measures in the outbreak

Plan

2. The concept of an epidemic focus.

3. Measures to eliminate epidemic outbreaks.

4. Registration and registration of infectious diseases.

5. Quarantine measures.

6. Measures aimed at neutralizing the source of infection.

1) Measures in relation to a sick person.

2) Measures regarding carriers.

3) Measures in relation to animals - sources of infection.

7. Activities aimed at breaking the mechanisms, ways and factors of transmission.

8. Activities aimed at a susceptible organism.

1) Measures in relation to persons in contact with patients.

2) Measures to increase the resistance of the population to infection.

9. Liquidation of the focus.

1. Directions for the prevention of infectious diseases in the country

1) prevention of the emergence and spread of infectious diseases;

2) reduction of infectious morbidity and elimination of some infectious diseases;

3) health education of the population on infectious diseases;

4) prevention of the importation of infectious diseases into the country.

2. The concept of an epidemic focus

The epidemic focus is the location of the source of infection with the territory surrounding it to the extent that it is capable of transmitting the infectious agent in this particular situation with a given disease.

The epidemic focus is a structural cell of the epidemic process and the place where measures should be taken to determine the boundaries of the focus, limit the spread of the epidemic process,

Allocate:

family hearths;

home centers (with multi-family settlement of houses);

collective foci;

hearths in children's institutions;

production centers, etc.

3. Measures to eliminate epidemic outbreaks

Measures to combat infectious diseases are divided into 2 groups:

Preventive measures are taken regardless of the presence or absence of infectious diseases. Their goal is to prevent the occurrence of infectious diseases.

Anti-epidemic measures are carried out in the event of the appearance of an infectious disease - in an epidemic focus.

4. Registration and registration of infectious diseases

1. Identified infectious patients are registered in

"Journal of Infectious Diseases"form No. 60-lech .),

which is carried out in all medical and preventive, children's preschool institutions and schools.

2. Simultaneously fill out the card

"Emergency notification of an infectious disease, food, acute occupational poisoning, unusual reaction to vaccination" (Form No. 58 ).

Not later than 12 hours later, the card must be sent to the CSES at the place where the sick person was detected.

From the moment of receiving a message about the presence of a patient (carrier), the center for sanitary and epidemiological surveillance is included in the work, which should determine the scope of measures necessary to eliminate the outbreak.

This is revealed during the epidemiological survey.

epidemiological survey solves the following tasks:

a) identification of sources and routes of transmission of infection;

b) establishing the boundaries of the outbreak;

c) determination of environmental objects subject to disinfection;

d) identification of persons at risk of infection, subject to medical observation or separation;

e) drawing up an action plan to eliminate the outbreak.

5. Quarantine measures

A set of administrative and health measures that prevent the entry into a safe area (collective) and prevent the spread of infection outside the epidemic focus is calledquarantine.

Quarantines usually prevent the spread of infection from one area to another, but do not completely eliminate this possibility.

6. Measures aimed at neutralizing the source of infection

1) Measures in relation to a sick person

a) early detection;

There are active and passive detection of infectious patients.

active detection:

1) medical workers bypass the apartments of the population,

2) identification of patients during various preventive examinations and examinations,

3) in the process of medical observation in the outbreaks.

Passive detection - the initiative to seek medical help belongs to the patient or his relatives.

B) Early and accurate diagnosis is necessary for the timely isolation of patients.

C) Isolation of patients;

1) isolation at home;

* the patient is given a separate room (or a fenced part of the room);

* separate items of care, separate dishes are allocated;

* caregivers are trained in routine disinfection methods;

* visits to the patient by persons not directly related to his care should be avoided.

2) hospitalizations.

· Indications for hospitalization may be:

1) clinical ( severe course illness, etc.)

2) epidemiological:

a) accommodation of the patient in a hostel,

b) lack of utilities, etc.;

c) intra-family and intra-apartment contact with employees of food enterprises and persons equated to them, as well as with children attending children's institutions;

d) features of the patient's profession - an employee of a food enterprise or a person equated to him.

Isolation of the ill person ends after the cessation of the release of the pathogen.

E) Dispensary observation is established for those who have been ill after recovery from certain infections (typhoid fever and paratyphoid fever, dysentery, viral hepatitis, cholera).

2) Measures regarding carriers

A) discovery.

persons who have had some infectious diseases;

persons who have been in contact with infectious patients;

persons from decreed groups of the population, whose carriage poses the greatest danger to others (those who work in food institutions, children's institutions, etc.) - preventive medical examinations.

Examination for carriage is also carried out according to epidemiological indications.

B) Sanitation of carriers is carried out medications or physiotherapy.

C) Hospitalization of carriers rarely used, for example, with cholera, carriage of toxigenic diphtheria microbes.

D) In ​​acute carriage, the most commonly used measure is separation: carriers are removed from visiting children's groups or public catering establishments. The dissociation is terminated upon the liquidation of the carrier.

E) In case of chronic (multi-month or long-term) carriage of typhoid bacteria, a restrictive regime is applied: chronic carriers are prohibited from working in food enterprises and preschool children's institutions.

E) Sanitary and educational work among carriers and persons from their environment - careful personal hygiene significantly reduces the epidemiological danger of carriers to others.

3) Measures taken in relation to animals - sources of infection

If the sources of infection are farm and domestic animals:

Isolation of infected animals on special farms - insulators;

etiological therapy;

In some casesinfected animals are destroyed;

Meat, organs of slaughtered farm animals under certain conditions (for example, after boiling in boilers under pressure) can be allowed for sale.

Measures to improve the livestock are carried out by the veterinary service.

If the sources of infection are wild animals

measures to combat diseases of wild animals - carried out by forestries

If the sources of infection are rodents, then measures for the control of rodents (deratization) in settlements are carried out by the medical service - the preventive disinfection departments of the Center for Sanitation and Epidemiological Control.

7. Measures aimed at disrupting the mechanisms, routes and factors of transmission of pathogens

public health measures aimed atavoiding hit pathogens into the body with water, food, through dirty hands. Should be carried out constantly and everywhere, regardless of the presence of cases of infectious diseases.

Communal sanitation: improvement of settlements, their layout, housing arrangement, availability of sewerage and water supply.

2) Activities carried out by health authorities

Ensure the implementation of measures to prevent the transmission of infection in the focus through household items and through arthropods:

Disinfection

Sterilization

Disinsection

Improving the sanitary culture of the population. This is achieved by conducting sanitary and educational work by the staff of medical institutions, TsSEN.

8. Activities aimed at a susceptible organism

1) Measures in relation to persons in contact with the patient

A) Medical supervision during the maximum incubation period of the given disease.

B) Laboratory examination to identify carriers or those who have been ill with this disease in the past (serological examination).

C) Dissociation - they are not allowed to work (study, to a children's institution) until they receive laboratory examination data indicating that the person is not a carrier of a pathogenic agent.

Among adults, as a rule, persons working in public catering establishments and in children's institutions are subject to separation.

D) Hospitalization is carried out in case of especially dangerous infections (plague, cholera), contacts with patients in the hospital undergo laboratory examinations.

D) Emergency prevention of the disease:

passive immunization (introduction of sera, immunoglobulin);

active immunization - vaccination (used very rarely in contacts).

The method of emergency prophylaxis is determined by the infection for which it is applied; the covered contingent is determined by the data of the epidemiological survey.

2) Measures to increase the resistance of the population to infections

A) General physiological effects:

rational, vitamin-rich nutrition,

physical education,

hardening of the body.

B) Specific artificial immunity created by the introduction of immunizing drugs.

9. Elimination of the focus

The outbreak is considered eliminated if during the maximum incubation period of the disease from the moment of hospitalization of the patient (or termination of home isolation) and disinfection, no new patients and carriers were detected in the outbreak.