Prevention of healthcare-associated infections associated (HAI) is an important part of the activities of a medical organization (MO), focused on the quality and safety of medical services. Epidemiological safety of the profile infectious MO requires strict adherence to the sanitary and anti-epidemic regime. An example of such a MO is the State Budgetary Institution of the Republic of Mari El, Republican Tuberculosis Health Center (RATHC). The analysis of sanitary and epidemiological well-being on the example of the RATHC used the methods of retrospective and operative epidemiological analysis of cases among staff and patients, as well as data of microbiological monitoring. Based on the results of the analysis for the period of 2002-2016, there were 7 cases of HAI among the staff, which are tuberculosis processes, 116 cases of HAI were found among the patients, not associated with tuberculosis. According to the microbiological monitoring (MBM) of the RATHC, there has been a decrease in studies aimed at detecting coliform bacteria (CB) (1.5 times), S. aureus from the surfaces of the RATHC objects (1.5 times), pathogenic flora (1.5 times), and working solutions of disinfectants for the activity of the active substance (ASA) (1.2 times). At the same time, there has been an increase in research aimed at determining microbial contamination of air (a total microbial number by 8.6 times, S. aureus by 8.6 times), a degree of sterility of medical products (MP) by 2.4 times and the pre-sterilization quality control of medical products (MPPSQC) by 1.5 times. Epidemiologically significant structural subdivisions (children’s department, surgical and therapeutic departments, clinical diagnostic and bacteriological laboratories) have been established. The obtained results indicate the need for staff motivation to comply with the established instructions and protocols to ensure the sanitary and epidemiological well-being of the medical organization.
HAI occupy an actual place in the modern healthcare system in terms of hygiene and epidemiology, the quality management system in medical organizations, since epidemiological safety is one of the tools for targeting to the consumer of medical services with the involvement of medical personnel to achieve this goal [1,2,3,4,5,6].
The Russian Federation in 2011 enacted “The National Concept for the Prevention of Healthcare-Associated Infections”, approved by the Chief State Sanitary Doctor of the Russian Federation on November 6, 2011, which fully identifies the demographic, economic, medical aspects of this issue and ways to solve this problem. Economic analysis according to the national concept is one of the criteria for assessing the prevention of HAI [7,8,9,10].
Prevention of HAI in medical organizations is the main activity of the departmental epidemiological service, which requires close monitoring in surgical hospitals, perinatal centers, and in specialized health centers. A tuberculosis health center is an example of a medical organization, where the risk of developing nosocomial tuberculosis is great both among patients and its employees due to the peculiarities of the transmission mechanism of this pathogen .
Despite the fact that in the Russian Federation there is a tendency to reduce the incidence of tuberculosis, this nosology remains one of the most socially significant infectious diseases, including in the structure of occupational diseases, which indicates the existing risk of tuberculosis development as HAI among medical staff. In 2016, in the territory of the Russian Federation, the dominant in the structure of occupational diseases and poisonings (with the biological factor of the production environment as the key factor in the pathogenesis of the development of occupational disease) among medical personnel and other employees of organizations classified as “Healthcare” in accordance with the all-Russian classifier of economic activities, are respiratory tuberculosis – 85.5% (2015 – 88.7%), and tuberculosis of other organs – 8.6% (2015 – 4.1%). The investigations of occupational diseases have revealed the following main factors and conditions for the emergence of pathologies: contact with the infectious agent during labor activity – 42.7% of cases, imperfect workplace arrangement – 13.1%, improper use of personal protective equipment (PPE) – 12.6 %, and imperfect technological processes – 8.0% .
In 2016, the Republic of Mari El (RME) had no cases of nosocomial tuberculosis registered in the structure of the HAI of the RATHC, which is explained by strict observance of the sanitary legislation in the field of epidemiological safety, and the understanding by the medical personnel of the internal instructions for compliance with the sanitary and anti-epidemic regime. This study analyzes the results of implementing risk management from the standpoint of ensuring sanitary and epidemiological well-being in the conditions of the RATHC [13,14, 15].
There has been a decrease in the incidence of HAI among the RATHC employees and patients, which indicates compliance with the sanitary and anti-epidemic regime in the MO, and also reflects the quality of medical care provided to the population. The MBM serves as a tool that allows for timely response to various violations of internal instructions and protocols for ensuring sanitary and epidemiological well-being by medical personnel. At the same time, despite the fact that the number of studies has decreased, this has not affected the quality of compliance with the sanitary and anti-epidemic regime, as evidenced by the absence of nosocomial cases of tuberculosis since 2012, as well as a decrease in the number of other HAI in the organization
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