Healthcare facilities have always played an important role in transmission of bloodborne infections. Procedures involving blood and blood fluids pose a risk of transmitting hepatitis B, hepatitis C and HIV not only to healthcare workers, but also to patients. To assess the role of healthcare facilities in transmission of bloodborne infections and to identify risk groups among patients as well as transmission factors, a total of 75 outbreaks of hepatitis B, hepatitis C and HIV have been analyzed with reference to the data published in different countries in 2008–2020. The comparative analysis was conducted for the outbreaks in the United States during 1992–2008 and 2008–2019. Most of the outbreaks of bloodborne infections at healthcare facilities were caused by non-adherence to standard precautions among healthcare workers: Reusing disposable items; improper handwashing; reusing gloves; non-disinfecting surfaces, reusable equipment and devices; non-sterilizing reusable instruments. In terms of bloodborne infections, high-risk facilities include hemodialysis centers, oncohematology clinics, outpatient clinics, nursing homes, residential care facilities, and diabetes treatment centers. High-risk groups include patients undergoing hemodialysis, oncohematological patients, and patients with diabetes. Diagnosis of bloodborne infections on a regular basis, hepatitis B vaccination among high-risk patients, investigation of outbreaks, adoption of rules and procedures combined with training and compliance control of healthcare workers contribute to solution of the problem associated with nosocomial transmission of bloodborne infections.
Objective. To analyze the incidence of HCV in patients of the «Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology» (Center), to compare with the overall population incidence of HCV, to identify risk factors and risk groups of HCV infection in the Center’s patients. Materials and Methods. A retrospective analysis of the HCV incidence of HCV patients of the Center who were admitted to the Center between 01.07.2014 and 31.12.2020 was carried out. The study included patients aged 0 to 18 years, from all regions of the country, who had previously received therapy at their place of residence. Patient profile: hematological, oncological, immunological and surgical. The indications for testing for HCV were: hospitalization at the Center, stay at the center for 4–6 months, clinical indications. To assess risk factors and identify risk groups for HCV incidence, the main epidemiological aspects (age, sex, disease characteristics, geographical prevalence) were analyzed. Results. The incidence of HCV in the Center’s patients was 1.7%, which is 5 times higher than the incidence of the entire population of the country, and 50 times higher than that of the pediatric population. The highest incidence rate was observed in children aged 1 to 2 years – 2.8%. When comparing the risks of infection of the Center’s patients with the children’s population of the country in age groups under 1 year, from 1 to 14 years, and from 14 to 19 years, an excess of 29, 24 and 9 times was revealed, respectively. When analyzing nosological forms, it was found that the highest HCV incidence was in patients with primary immunodeficiencies – 3.2%, while in patients with malignant neoplasms – 1.8%. The region with the highest prevalence of HCV in our study was the Far Eastern Federal District (9%), namely the Amur Region (14%). Conclusions. Thus, the morbidity of patients with oncological and hematological profiles and patients with primary immunodeficiencies clearly demonstrates the problem of implementing the artificial mechanism of HCV transmission, which requires taking measures regarding the safety of invasive manipulations.
Objective. To investigate a candidemia outbreak caused by C. parapsilosis in a clinical unit of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology (NMRC PHOI). Materials and Methods. A total of 35 isolates of C. parapsilosis obtained from clinically significant specimens and swabs, including hands of nursing staff of the NMRS PHOI, over the 2018-2020 were genotyped in this retrospective study. Identification of C. parapsilosis isolates was performed by microbiological methods. The clonal structure of C. parapsilosis isolates was investigated by polymerase chain reaction followed by fragment analysis of microsatellite repeats (short tandem repeats, STR markers). Results. The results of the study showed genetic diversity of the population of C. parapsilosis isolates over the 2018–2020 in the NMRC PHOI. A total of 27 genotypes were identified, one of which caused candidemia in 6 patients. Conclusions. The study results confirmed the nosocomial candidemia outbreak and showed the fragment analysis of STR-markers may be used for epidemiological investigations of outbreaks in hospital settings.
Patients with oncological and hematological diseases are at high risk of acquiring bloodborne infections due to multiple blood transfusions and frequent parenteral exposure. In order to evaluate the prevalence of bloodborne infections (i. e., hepatitis B, hepatitis C, and human immunodeficiency virus (HIV)), we analyzed data on the seroprevalence of these viruses in patients admitted to the D. Rogachev NMRCPHOI from 2014 to 2020. We also performed a comparative analysis between these data and the prevalence of these infections in the total child population in Russia. The study was approved by the Independent Ethics Committee and the Scientific Council of the D. Rogachev NMRCPHOI. Among patients admitted to the D. Rogachev NMRCPHOI, the mean seroprevalence was 1.7% for hepatitis C, 0.2% for hepatitis B, and 0.1% for HIV. The seroprevalence of hepatitis B and C among our patients was 6 and 50 times higher than the prevalence among Russian children and adolescents, respectively. The prevalence of HIV among patients treated at the D. Rogachev NMRCPHOI was 3 times higher than that among the child and adolescent population in Russia. In patients with oncological and immunological diseases, the detection of HBV DNA, HCV RNA, and Anti-HBc is considered clinically useful and plays an important role in the diagnosis of occult hepatitis infections which cannot be identified with routine diagnostic tests. Our study with pediatric patients with oncological, hematological, and immunological diseases highlights the problem of nosocomial transmission of bloodborne pathogens. HCV transmission in medical facilities is the most pressing issue that requires the implementation of healthcare programs aimed at preventing parenteral transmission and at ensuring the safety of donated blood.
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