The COVID-19 pandemic has produced its effects on functioning of all the state institutions, the public healthcare system being a peculiar one among them. Medical personnel have become an unprotected population group that was actively involved into the epidemic process. Results produced by several studies indicate that relative risks to become infected with COVID-19 are by up to 11.6 times higher for medical personnel than in population at large. A share of medical personnel among patients with COVID-19 varies in different countries, from 4.2 % in China to 17.8 % in the USA. According to official statistics, in 2020 a share of medical personnel who became infected with COVID-19 in in-hospital foci amounted to 68.6 % in the RF regions located in the Urals and Siberian Federal Districts. High epidemic potential of the virus and intensive mass contacts between medical personnel and their patients make for rapid SARS-CoV-2 spread and infection among them. It is vital to examine all the range of risk factors that cause SARS-CoV-2 infection among medical personnel. The present study involved using “The map of epidemiological investigation focused on the incidence of the new coronavirus infection (COVID-19) in medical personnel”. The map was located on Google Cloud Platform. Overall, 613 medical workers from different medical organizations took part in the research. We applied sociological, epidemiological and statistical research techniques. We established that work in an infectious diseases hospital increased a relative risk of SARS-CoV-2 infection by 1.8 times (RR = 1.78; 95 % CI [1.65–1.93]). The total risk of SARS-CoV-2 infection was insignificant for workers employed at a medical organization that provided scheduled medical assistance to population (RR = 1.02; 95 % CI [1.00–1.04]). However, certain factors created elevated risks of infection. Any contacts with COVID-19 patients who were close relatives, friends or neighbors were established to be significant (RR = 1.13; 95 % CI [1.04–1.228]). The research results should be used when organizing work procedures and anti-epidemic activities in infectious diseases hospitals and medical organizations providing scheduled assistance to population. The focus should be on providing medical personnel with personal protective equipment as well as on calculating relevant duration of a work shift relying on the risk-based approach.
Purulent-septic infections (PSI) of puerperas are one of the leading medical and social problems of modern health care. A significant prevalence, an upward trend, insufficient completeness of their identification and registration, along with a high degree of obstetric aggression — these are the modern features of this group of infections.To study the prevalence of PSI in the postpartum period (sepsis, peritonitis, endometritis, mastitis, and surgical site infections), identify risk factors, and assess the effectiveness of epidemiological surveillance of these infections, the analysis of publications on this topic has been carried out on several information resources: eLibrary, Google Scholar, PubMed, NCBI .Postpartum endometritis was found to be the most common form of PSI in puerperas, accounting for 3 to 20% PSI cases, and up to 40.0–54.3% among patients with postpartum inflammatory complications.Surgical intervention is one of the leading risk factors for the development of PSI after childbirth. For example, a cesarean section increases the risk of PSI by 5–20%.The systems of epidemiological surveillance for PSI of puerperas in different countries differ in the approach both to identifying, recording and registering cases, and to collecting information about the place and time of their highest risk.PSI of puerperas is a dynamically changing interdisciplinary problem at the intersection of obstetrics, gynecology and epidemiology. Despite the data on the prevalence of certain nosologies and their risk factors, there are a number of issues that can be discussed and need to be addressed.
Despite the improvement of the obstetric care system, purulent-septic infections (PSI) of puerperas and the associated maternal mortality do not lose relevance at the present time. This study analyzed publications on the following information resources: eLibrary, Google Scholar, PubMed, NCBI on the clinical and pathogenetic characteristics of postpartum GSI (sepsis, peritonitis, endometritis, mastitis, and surgical site infections (SSI)) and their leading pathogens. It should be said that the clinical picture of PSI in the postpartum period does not always correspond to the degree of activity of the infectious process, which leads to late diagnosis of the local focus of infection and, in the future, to its generalization. A modern feature of the PSI of puerperas is their polyetiology, with a predominance of opportunistic microorganisms, the role of individual representatives of which is far from unambiguous and requires discussion. In recent years, the etiological and epidemiological significance of gram-negative microorganisms of the Enterobacteriaceae family, including those with multidrug resistance, has been increasing. Thus, despite a sufficient amount of information on the etiology and clinical and pathogenetic features of PSI in the postpartum period, an interdisciplinary approach is needed to study this problem with the participation of different specialists: obstetricians-gynecologists, microbiologists, clinical pharmacologists and epidemiologists.
Relevance. Due to the COVID-19 pandemic a infectious diseases hospitals nationwide network has been deployed to treat patients infected with SARSCoV-2. The principles of their formation with a strict division into «infectious» and «clean» zones, despite the epidemiological justification, lead to the formation of a dynamic artificially created closed ecosystem. In such an ecosystem, on the one hand, patients who undergo a wide range of invasive and aggressive therapeutic and diagnostic manipulations, and medical personnel stay for a long time, on the other hand, pathogens of a viral and bacterial nature that can adapt to hospital conditions and form resistant strains circulate. As a result, high risks of contamination of environmental objects of hospitals and patients themselves are created, which can lead to the development of exogenous nosocomial infection.Aims. To study the features of viral and bacterial contamination of objects in the hospital environment of the infectious diseases hospital for the treatment of patients infected with SARS-CoV-2 during the COVID-19 pandemic.Materials and methods. A study was conducted on 343 samples from the external environment of the infectious diseases hospital for COVID-19 patients’ treatment during its planned work. Sample collection was performed during three days (Tuesday, Thursday, Sunday) at 20 unified sampling points: in the area where patients general hospital area as well as from the outer surface of personal protective equipment for medical personnel (overalls, gloves). The study used epidemiological (descriptiveevaluative and analytical), molecular genetic (SARS-CoV-2 PCRRT, sequencing), bacteriological (isolation, cultivation and MALDITOF identification of bacterial cultures) methods. Statistical significance of differences was assessed by Fisher's point test (φ). Differences were considered significant at p≤0.05. Statistical data processing was carried out using the Microsoft Office 2010 application package, the online resource https://medstatistic. ru/, ST Statistica 10.Results. The study demonstrated a high level of viral and bacterial contamination of environmental objects in the intensive care unit of the infectious diseases hospital for COVID-19 patients treatment – 11.1%, incl. objects of the general hospital environment – 9.3% (doctor's workplace – 16.7%); patient location area – 13.9% (electric pump – 27.8%, mechanical ventilation, manipulation table – 16.7% each); the outer surface of personnel gloves – 21.1–38.9%; the outer surface of protective overalls for personnel – 44.4–50.0%. SARS-CoV-2 isolated from the objects of the external environment of the hospital belonged to the genetic variant B.1.617.1 DELTA, which corresponded to the epidemiological situation at sampling collection period. The opportunistic microflora structure was dominated by Enterococcus faecalis (38.1%), Klebsiella pneumoniaе (21.4%) and Escherichia coli (16.7%), which demonstrated a high level of resistance (to 3 or more groups of antibiotics).Conclusion. Initially, the main sources of the infectious diseases hospital environmental objects contamination with SARS-CoV-2 are most likely patients. Further contamination of the infectious diseases hospital environmental objects with viruses and opportunistic microflora occurs with the medical personnel direct participation. The current situation requires a review of approaches to the rules for disinfection, the PPE use and employees hands antiseptic treatment in infectious diseases hospital during the COVID-19 pandemic, as well as the length of staff work period length.
Introduction: One of the key elements of the infectious disease surveillance system is microbiological monitoring of contamination of environmental objects and health care personnel hands. In the context of the COVID-19 pandemic, virology testing of swabs from hospital objects and personal protective equipment of workers of infectious disease hospitals for patients with COVID-19 has acquired special importance. According to the current regulatory documents, however, greater priority in microbiological monitoring is given to determination and identification of bacterial pathogens, thus necessitating the development and implementation of an advanced technique of a simultaneous assessment of viral and bacterial contamination. Objective: To compare different environmental surface sampling techniques used to assess viral and bacterial contamination. Materials and methods: Samples for environmental swab testing were collected in accordance with the “Scheme for sampling environmental swabs for simultaneous assessment of viral and bacterial contamination” patented by the authors (Industrial Design Patent No. 132971 of September 5, 2022). We applied bacteriological, molecular genetic, and statistical methods in the study. Results: Overall, 343 wipe samples were tested, of which 68 were atypical (two 38-swab portions, 11.1 % each, contained SARS-CoV-2 RNA and opportunistic microorganisms). Among the opportunistic microorganisms, 42 bacterial strains were identified, including 16 strains of Enterococcus faecalis (38.1 %), 9 strains of Klebsiella pneumoniae (21.4 %), 7 strains of Escherichia coli (16.7 %), 3 strains of Enterococcus faecium (7.1 %), 3 strains of Staphylococcus aureus (7.1 %), 2 strains of Pseudomonas aeruginosa (4.9 %), and 2 strains of Pantoea agglomerans (4.9 %). Eleven variants of viral and bacterial associations were identified. The comparison of environmental swabbing performed by the technique under study with that performed by the standard method, based on test results, indicated a significant 11.1 and 12.3-fold difference in the proportion of non-standard findings for SARS-CoV-2 and opportunistic microorganisms, respectively. Conclusions: The study results prove that our technique of environmental swabbing meets all modern requirements and facilitates an objective assessment of the level of viral and bacterial contamination of the study objects. This approach can be used for laboratory testing within state and industrial control at institutions of various specialties (healthcare, food industry, childcare facilities, etc.).
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