Laying for especially dangerous infections sanpin. Tactics of a nurse in identifying especially dangerous infections and features of work in an epidemiological focus

REMINDER

TO THE MEDICAL WORKER WHEN CARRYING OUT THE PRIMARY ACTIVITIES IN THE FOCUS OF THE AE

In the case of a patient suspected of being infected with plague, cholera, GVL or smallpox, it is necessary, on the basis of the clinical picture of the disease, to suggest a case of hemorrhagic fever, tularemia, anthrax, brucellosis, etc., it is necessary first of all to establish the reliability of its connection with the natural focus of infection.

Often the decisive factor in establishing the diagnosis is the following data of the epidemiological history:

Arrival of a patient from an area that is unfavorable for these infections within a time period equal to the incubation period;
Communication of the identified patient with a similar patient along the way, at the place of residence, study or work, as well as the presence of any group diseases or deaths of unknown etiology;
Stay in areas bordering with the parties, unfavorable for the indicated infections or in a territory exotic for plague.

During the period of the initial manifestations of the disease, OOI can give pictures similar to a number of other infections and non-communicable diseases:

With cholera- with acute intestinal diseases, toxic infections of various nature, poisoning with pesticides;

With the plague- with various pneumonia, lymphadenitis with fever, sepsis of various etiologies, tularemia, anthrax;

For monkeypox- with chickenpox, generalized vaccine and other diseases accompanied by rashes on the skin and mucous membranes;

With fever Lasa, Ebola, b-ni Marburg- with typhoid fever, malaria. In the presence of hemorrhages, it is necessary to differentiate from yellow fever, Dengue fever (see clinical and epidemiological characteristics of these diseases).

If a patient is suspected of having one of the quarantine infections, the medical worker must:

1. Take measures to isolate the patient at the place of detection:

Prohibit entry and exit from the hearth, isolate communication with a sick person of family members in another room, and in the absence of the possibility to take other measures - to isolate the patient;
Before the patient is hospitalized and the final disinfection is carried out, it is forbidden to pour the patient's secretions into the sewer or cesspool, water after washing hands, dishes and care items, the removal of things and various objects from the room where the patient was located;

2. The patient is provided with the necessary medical care:

if plague is suspected in a severe form of the disease, streptomycin or tetracycline antibiotics are administered immediately;
in severe cholera, only rehydration therapy is performed. Cardiovascular agents are not administered (see evaluation of dehydration in a patient with diarrhea);
when conducting symptomatic therapy for a patient with GVL, it is recommended to use disposable syringes;
depending on the severity of the disease, all transportable patients are sent by ambulance to hospitals specially designated for these patients;
on-site assistance to non-transportable patients with the call of consultants and an ambulance equipped with everything necessary.

3. By phone or through a courier, notify the head physician of the outpatient clinic about the identified patient and his condition:

Request appropriate medicines, packing of protective clothing, personal protective equipment, packing for material collection;
Before receiving protective clothing, a medical worker in case of suspected plague, GVL, monkeypox should temporarily close his mouth and nose with a towel or mask made from improvised material. For cholera, measures of personal prevention of gastrointestinal infections should be strictly observed;
Upon receipt of protective clothing, they put it on without taking off their own (except for heavily contaminated by the secretions of the patient)
Before putting on PPE, carry out emergency prophylaxis:

A) in case of plague - the nasal mucosa, treat the eye with a solution of streptomycin (100 distilled water per 250 thousand), rinse the mouth with 70 gr. alcohol, hands - alcohol or 1% chloramine. Introduce IM 500 thousand units. streptomycin - 2 times a day for 5 days;

B) with monkeypox, GVL - as with the plague. Anti-small gammaglobulin metisazon - in isolation;

C) In cholera - one of the means of emergency prevention (tetracycline antibiotic);

4. If a patient with plague, GVL, monkeypox is detected, the medical worker does not leave the office, apartment (in case of cholera, if necessary, he can leave the room after washing his hands and removing the medical gown) and stay until the arrival of the epidemiological - decontamination team.

5. Persons who were in contact with the patient are identified among:

Persons at the place of residence of the patient, visitors, including those who left by the time the patient was identified;
Patients who were in this institution, patients transferred or referred to other medical institutions, discharged;
Medical and service personnel.

6. Take material for bakiistudy (before the start of treatment), fill in a simple pencil referral to the laboratory.

7. Carry out current disinfection in the outbreak.

8. after the departure of the patient for hospitalization, carry out a complex of epidemiological measures in the outbreak until the arrival of the disinfectant epidemiological team.

9. Further use of a health worker from the outbreak of plague, GVL, monkeypox is not allowed (sanitation and isolation). With cholera, after sanitization, the health worker continues to work, but he is under medical supervision at the place of work for the duration of the incubation period.

BRIEF EPIDEMIOLOGICAL CHARACTERISTICS OF OOI

Name of the infection	Source of infection	Transmission route	Incub. period
Smallpox	Sick person		14 days
Plague	Rodents, human	Transmissible - through fleas, Airborne, possibly others	6 days
Cholera	Sick person	water, food	5 days
Yellow fever	Sick person	Transmissive - Aedes-Egypti mosquito	6 days
Lasa fever	Rodents, sick man	Airborne, airborne, contact, parenteral	21 days (from 3 to 21 days, more often 7-10)
Marburg disease	Sick person		21 days (from 3 to 9 days)
Ebola	Sick person	Airborne, contact through the conjunctiva of the eye, parapteral	21 days (usually up to 18 days)
monkeypox	Monkeys, sick person before 2nd contact	Airborne, airborne dust, household contact	14 days (from 7 to 17 days)

MAIN SIGNALS OF OOI

PLAGUE- acute sudden onset, chills, temperature 38-40 ° C, a sharp headache, dizziness, impaired consciousness, insomnia, conjunctival hyperemia, agitation, the tongue is coated (chalky), the phenomena of increasing cardiovascular insufficiency develop, after a day, characteristic for each forms of symptoms of the disease:

Bubonic form: the bubo is sharply painful, dense, soldered to the surrounding subcutaneous tissue, motionless, its maximum development is 3-10 days. The temperature lasts 3-6 days, the general condition is severe.

Primary pulmonary: against the background of the listed signs, chest pains, shortness of breath, delirium, cough appear from the very beginning of the disease, sputum is often foamy with streaks of scarlet blood, a discrepancy between the data of an objective examination of the lungs and the general serious condition of the patient is characteristic. The duration of the disease is 2-4 days, without treatment, 100% mortality;

Septicemia: early severe intoxication, a sharp drop in blood pressure, hemorrhage on the skin, mucous membranes, bleeding from internal organs.

CHOLERA- mild form: loss of fluid, loss of own weight occurs in 95% of cases. The onset of the disease is acute rumbling in the abdomen, loosening of the stool 2-3 times a day, maybe 1-2 times vomiting. The patient's well-being is not disturbed, working capacity is maintained.

Medium form: fluid loss of 8% of its own weight, occurs in 14% of cases. The onset is sudden, rumbling in the abdomen, indefinite intense pain in the abdomen, then loose stools up to 16-20 times a day, which quickly loses its fecal character and smell, green, yellow and pink in color of rice water and diluted lemon, uncontrollable defect without urge (for 500-100 ml is allocated 1 time, an increase in stool with each defect is characteristic). Vomiting appears with diarrhea, it is not preceded by nausea. A sharp weakness develops, an unquenchable thirst appears. General acidosis develops, diuresis decreases. The blood pressure drops.

Severe form: algid develops with a loss of fluid and salts over 8% of body weight. The clinic is typical: severe emaciation, sunken eyes, dry sclera.

YELLOW FEVER: sudden acute onset, severe chills, headache and muscle pain, high fever. Patients are safe, their condition is severe, nausea, painful vomiting occurs. Pain under the stomach. After 4-5 days after a short-term drop in temperature and improvement in the general condition, a secondary rise in temperature occurs, nausea, vomiting of bile, and nosebleeds appear. At this stage, three signal signs are characteristic: jaundice, hemorrhage, and a decrease in urine output.

LASS FEVER: in the early period, symptoms: - the pathology is often not specific, a gradual increase in temperature, chills, malaise, headache and muscle pain. In the first week of the disease, severe pharyngitis develops with the appearance of white spots or ulcers on the mucous membrane of the pharynx, tonsils of the soft palate, then nausea, vomiting, diarrhea, pain in the chest and abdomen join. During the 2nd week, diarrhea resolves, but abdominal pain and vomiting may persist. Often there is dizziness, decreased vision and hearing. A maculopapular rash appears.

In severe form, the symptoms of toxicosis increase, the skin of the face and chest becomes red, the face and neck are swollen. The temperature is about 40 ° C, consciousness is confused, oliguria is noted. Subcutaneous hemorrhages may appear on the arms, legs, and abdomen. Frequent hemorrhages in the pleura. The feverish period lasts 7-12 days. Death often occurs in the second week of illness from acute cardiovascular failure.

Along with severe, there are mild and subclinical forms of the disease.

MARBURG DISEASE: acute onset, characterized by fever, general malaise, headache. On the 3-4th day of illness, nausea, abdominal pain, severe vomiting, diarrhea appear (diarrhea can last several days). By the 5th day, in most patients, first on the trunk, then on the arms, neck, face, a rash appears, conjunctivitis develops, hemorrhagic diathesis develops, which is expressed in the appearance of pitechia on the skin, emaptema on the soft palate, hematuria, bleeding from the gums, in places of syringe stakes, etc. The acute febrile period lasts about 2 weeks.

Ebola: acute onset, temperature up to 39 ° C, general weakness, severe headaches, then pain in the neck muscles, in the joints of the muscles of the legs, conjunctivitis develops. Often dry cough, sharp pains in the chest, severe dryness in the throat and throat, which interfere with eating and drinking and often lead to cracks and ulcers on the tongue and lips. On the 2nd-3rd day of illness, abdominal pain, vomiting, diarrhea appear, after a few days the stool becomes tar-like or contains bright blood.

Diarrhea often causes varying degrees of dehydration. Usually on the 5th day, patients have a characteristic appearance: sunken eyes, emaciation, weak skin turgor, the oral cavity is dry, covered with small ulcers similar to aphthous ones. On the 5-6th day of illness, first on the chest, then on the back and limbs, a spotty-potulous rash appears, which disappears after 2 days. On the 4-5th day, hemorrhagic diathesis develops (bleeding from the nose, gums, ears, injection sites, hematemesis, melena) and severe tonsillitis. Often there are symptoms indicating involvement in the CNS process - tremor, convulsions, paresthesia, meningeal symptoms, lethargy, or vice versa excitation. In severe cases, cerebral edema, encephalitis develops.

MONKEY POX: high temperature, headache, pain in the sacrum, muscle pain, hyperemia and swelling of the mucous membrane of the throat, tonsils, nose, rashes are often observed on the mucous membrane of the oral cavity, larynx, nose. After 3-4 days, the temperature drops by 1-2°C, sometimes to subfebrile, general toxic effects disappear, and the state of health improves. After a decrease in temperature for 3-4 days, a rash appears first on the head, then on the trunk, arms, legs. The duration of the rash is 2-3 days. Rashes on separate parts of the body occur simultaneously, the predominant localization of the rash on the arms and legs, simultaneously on the palms and soles. The nature of the rash is papular - vedic. The development of the rash - from spots to pustules slowly, within 7-8 days. The rash is monomorphic (at one stage of development - only papules, vesicles, pustules and roots). Vesicles do not collapse during puncture (multi-chamber). The base of the elements of the rash is dense (the presence of infiltrates), the inflammatory rim around the elements of the rash is narrow, clearly defined. Pustules form on the 8-9th day of illness (day 6-7 of the rash). The temperature again rises to 39-40°C, the condition of the patients deteriorates sharply, headaches, delirium appear. The skin becomes tense, swollen. Crusts are formed on the 18-20th day of illness. There are usually scars after the crusts fall off. There is lymphadenitis.

MODE OF DISINFECTION OF MAIN OBJECTS IN Cholera

	Method of disinfection	disinfectant	contact time	Consumption rate
1. Room surfaces (floor, walls, furniture, etc.)	irrigation	0.5% solution DTSGK, NGK 1% solution of chloramine 1% solution of clarified bleach	60 min	300ml/m3
2. Gloves	dive	3% solution myol, 1% solution chloramine	120 min
3. Glasses, phonendoscope	2 times wiping with an interval of 15 minutes	3% hydrogen peroxide	30 minutes
4. Rubber shoes, leather slippers	rubbing	See point 1
5. Bedding, cotton pants, jacket	chamber processing	Steam-air mixture 80-90°С	45 min
6. Dishes of the patient	boiling, immersion	2% soda solution, 1% chloramine solution, 3% rmezol solution, 0.2% DP-2 solution	15 minutes 20 minutes
7. Protective clothing of personnel contaminated with secretions	boiling, soaking, autocloning	See point 6 120°С р-1.1 at.	30 minutes	5l per 1 kg of dry laundry
8. Protective clothing for personnel without visible traces of contamination	boiling, soaking	2% solution of soda 0.5% solution of chloramine 3% Mizola solution, 0.1% DP-2 solution	15 minutes 60 min 30 minutes
9. discharge of the patient	fall asleep, mix	Dry bleach, DTSGK, DP	60 min	200 gr. per 1 kg of secretions
10. Transport	irrigation	CM. paragraph 1

ASSESSMENT OF THE DEGREE OF DEHYDRATION BY CLINICAL SIGNS

Symptom or sign	Degrees of disinfection in percent
	I(3-5%)	II(6-8%)	III(10% and above)
1. Diarrhea	Watery stool 3-5 times a day	6-10 times a day	More than 10 times a day
2. Vomiting	None or a small amount	4-6 times a day	Very common
3. Thirst	moderate	Expressed, drinks with greed	Cannot drink or drinks poorly
4. Urine	Not changed	Small amount, dark	Not urinating for 6 hours
5. General condition	Good, upbeat	Bad, drowsy or irritable, agitated, restless	Very drowsy, lethargic, unconscious, lethargic
6. Tears	There is	missing	missing
7. Eyes	Ordinary	Sunken	Very sunken and dry
8. Mucous cavities of the mouth and tongue	Wet	dry	Very dry
9. Breath	Normal	frequent	Very common
10. Tissue turgor	Not changed	Each crease unfolds slowly	Each fold straightened. So slow
11. Pulse	normal	More often than usual	Frequent, weak filling or not palpable
12. Fontanelle (in young children)	Doesn't sink	sunken	Very sunken
13. Average estimated liquid deficit	30-50 ml/kg	60-90 ml/kg	90-100 ml/kg

EMERGENCY PREVENTION IN THE FOCI OF QUARANTINE DISEASES.

Emergency prophylaxis is provided to those who have been in contact with the patient in the family, apartment, at the place of work, study, rest, treatment, as well as persons who are in the same conditions for the risk of infection (according to epidemiological indications). Taking into account the antibiogram of the strains circulating in the focus, one of the following devices is prescribed:

DRUGS	One-time share, in gr.	Frequency of application per day	Average daily dose
Tetracycline	0,5-0,3	2-3	1,0	4
Doxycycline	0,1	1-2	0,1	4
Levomycetin	0,5	4	2,0	4
Erythromycin	0,5	4	2,0	4
Ciprofloxacin	0,5	2	1,6	4
Furazolidone	0,1	4	0,4	4

TREATMENT SCHEMES FOR PATIENTS WITH DANGEROUS INFECTIOUS DISEASES

Disease	A drug	One-time share, in gr.	Frequency of application per day	Average daily dose	Duration of application, in days
Plague	Streptomycin	0,5 - 1,0	2	1,0-2,0	7-10
	Sizomycin	0,1	2	0,2	7-10
	Rifampicin	0,3	3	0,9	7-10
	Doxycycline	0,2	1	0,2	10-14
	Sulfatone	1,4	2	2,8	10
anthrax	Ampicillin	0,5	4	2,0	7
	Doxycycline	0,2	1	0,2	7
	Tetracycline	0,5	4	2,0	7
	Sizomycin	0,1	2	0,2	7
Tularemia	Rifampicin	0,3	3	0,9	7-10
	Doxycycline	0.2	1	0,2	7-10
	Tetracycline	0.5	4	2,0	7-10
	Streptomycin	0,5	2	1,0	7-10
Cholera	Doxycycline	0,2	1	0,2	5
	Tetracycline	0,25	4	1,0	5
	Rifampicin	0,3	2	0,6	5
	Levomecithin	0.5	4	2,0	5
Brucellosis	Rifampicin	0,3	3	0,9	15
	Doxycycline	0,2	1	0,2	15
	Tetracycline	0,5	4	2,0	15

In cholera, an effective antibiotic can reduce the amount of diarrhea in patients with severe cholera, the period of vibrio excretion. Antibiotics are given after the patient is dehydrated (usually after 4-6 hours) and vomiting stops.

Doxycycline is the preferred antibiotic for adults (excluding pregnant women).

Furazolidone is the preferred antibiotic for pregnant women.

When cholerae vibrios resistant to these drugs are isolated in the foci of cholera, the question of changing the drug is considered taking into account the antibiograms of the strains circulating in the foci.

STAYING FOR SAMPLING MATERIAL FROM A PATIENT WITH SUSPECTED CHOLERA (for non-infectious hospitals, ambulance stations, outpatient clinics).

1. Sterile wide-mouth jars with lids or

Ground stoppers at least 100 ml. 2 pcs.

2. Glass tubes (sterile) with rubber

small necks or teaspoons. 2 pcs.

3. Rubber catheter No. 26 or No. 28 for taking material

Or 2 aluminum hinges 1 pc.

4.Polybag. 5 pieces.

5. Gauze napkins. 5 pieces.

7. Adhesive plaster. 1 pack

8. Simple pencil. 1 PC.

9. Oilcloth (1 sq.m.). 1 PC.

10. Bix (metal container) small. 1 PC.

11. Chloramine in a 300g bag, designed to receive

10l. 3% solution and dry bleach in a bag of

calculation 200g. per 1 kg. secretions. 1 PC.

12. Rubber gloves. Two pairs

13. Cotton - gauze mask (anti-dust respirator) 2 pcs.

Laying for each linear brigade of a joint venture, a therapeutic area, a district hospital, a medical outpatient clinic, a FAP, a health center - for everyday work when servicing patients. Items to be sterilized are sterilized once every 3 months.

SCHEME FOR SAMPLING MATERIAL FROM PATIENTS WITH OOI:

Name of the infection	Material under study	Quantity	Material sampling technique
Cholera	A) bowel movements B) vomit B) bile	20-25 ml. por.B and C	The material is taken in a separate ster. The Petri dish placed in the bedpan is transferred to a glass jar. In the absence of secretions - by boat, loop (to a depth of 5-6 cm). Bile - with duonal sounding
Plague	A) blood from a vein B) bubo punctate B) nasopharynx D) sputum	5-10 ml. 0.3 ml.	Blood from the cubital vein - into a sterile test tube, juice from the bubo from the dense peripheral part - a syringe with the material is placed in a test tube. Sputum - in a wide-mouthed jar. Detachable nasopharynx - using cotton swabs.
monkeypox GVL	A) mucus from the nasopharynx B) blood from a vein C) the contents of the rashes of the crust, scales D) from a corpse - brain, liver, spleen (at sub-zero temperatures)	5-10 ml.	Separate from the nasopharynx with cotton swabs in sterile plugs. Blood from the cubital vein - into sterile test tubes, the contents of the rash with a syringe or scalpel are placed in sterile test tubes. Blood for serology is taken 2 times the first 2 days and after 2 weeks.

MAIN RESPONSIBILITIES OF THE MEDICAL STAFF OF THE ENT DEPARTMENT OF THE CRH WHEN DETECTING A PATIENT WITH ASI IN THE HOSPITAL (during a medical round)

Doctor who identified the patient with OOI in the department (at the reception) is obliged:
Temporarily isolate the patient at the place of detection, request containers to collect secretions;
Notify by any means the head of your institution (head of the department, head physician) about the identified patient;
Organize measures to comply with the rules of personal protection of health workers who have identified the patient (request and apply anti-plague suits, treatment of mucous and open areas of the body, emergency prevention, disinfectants);
Provide the patient with emergency medical care according to vital indications.

NOTE: the skin of the hands, face is abundantly moistened with 70 ° alcohol. The mucous membranes are immediately treated with a solution of streptomycin (in 1 ml - 250 thousand units), and in cholera - with a solution of tetracycline (200 thousand mcg / ml). In the absence of antibiotics, a few drops of 1% solution of silver nitrate are injected into the eyes, 1% solution of protargol is injected into the nose, the mouth and throat are rinsed with 70 ° alcohol.

duty nurse, who took part in the medical round, is obliged:
Request laying and take material from the patient for bacteriological examination;
Organize the current disinfection in the ward before the arrival of the disinfection team (collection and disinfection of the patient's secretions, collection of soiled linen, etc.).
Make a list of the closest contacts with the patient.

NOTE: After the patient is evacuated, the doctor and nurse take off protective clothing, pack it in bags and hand it over to the disinfection team, disinfect shoes, undergo sanitization and go to the disposal of their leader.

Head of department, having received a signal about a suspicious patient, is obliged:
Urgently organize the delivery to the ward of packing of protective clothing, bacteriological packing for collecting material, containers and disinfectants, as well as means for treating open areas of the body and mucous membranes, and means of emergency prevention;
Set up posts at the entrance to the ward where the patient was identified and exit the building;
If possible, isolate contacts in wards;
Report the incident to the head of the institution;
Organize a census of the contacts of your department in the prescribed form:
No. p.p., surname, name, patronymic;
was on treatment (date, department);
dropped out of the department on (date);
the diagnosis with which the patient was in the hospital;
place of residence;
place of work.

Head nurse of the department, having received instructions from the head of the department, is obliged:
Urgently deliver to the ward a package of protective clothing, containers for collecting secretions, bacteriological packing, disinfectants, antibiotics;
Divide the patients of the department into wards;
Monitor the work of posted posts;
Conduct a census using the established contact form of your department;
Accept the container with the selected material and ensure the delivery of samples to the bacteriological laboratory.

OPERATIONAL PLAN

activities of the department in case of detection of cases of AIO.

№№ PP	Business name	Deadlines	Performers
1	Notify and assemble department officials at their workplaces in accordance with the existing scheme.	Immediately upon confirmation of the diagnosis	duty doctor, head branch, head nurse.
2	Through the head physician of the hospital, call a group of consultants to clarify the diagnosis.	Immediately if OOI is suspected	duty doctor, head department.
3	Introduce restrictive measures in the hospital: -prohibit unauthorized access to the buildings and the territory of the hospital; - introduce a strict anti-epidemic regime in the hospital departments - prohibit the movement of patients and staff in the department; - set up external and internal posts in the department.	Upon confirmation of the diagnosis	Medical staff on duty
4	Instruct the staff of the department in the prevention of AGI, personal protection measures, and the mode of operation of the hospital.	When gathering personnel	Head department
5	Conduct explanatory work among patients of the department about measures to prevent this disease, adherence to the regimen in the department, measures of personal prevention.	In the first hours	Medical staff on duty
6	Strengthen sanitary control over the work of the distribution, collection and disinfection of waste and garbage in the hospital. Carry out disinfection activities in the department	constantly	Medical staff on duty head department

NOTE: further activities in the department are determined by a group of consultants and specialists from the sanitary and epidemiological station.

Scroll

questions for the transfer of information about the patient (vibrio carrier)

Full Name.
Age.
Address (during illness).
Permanent residence.
Profession (for children - a children's institution).
Date of illness.
Date of request for assistance.
Date and place of hospitalization.
Date of material sampling for bacoexamination.
Diagnosis at admission.
final diagnosis.
Accompanying illnesses.
Date of vaccination against cholera and drug.
Epidanamnesis (connection with a reservoir, food products, contact with a patient, vibrio carrier, etc.).
Alcohol abuse.
Use of antibiotics before illness (date of last appointment).
The number of contacts and the measures taken to them.
Measures to eliminate the outbreak and its localization.
Measures to localize and eliminate the outbreak.

SCHEME

specific emergency prophylaxis for a known pathogen

Name of the infection	Name of the drug	Mode of application	single dose (gr.)	Multiplicity of application (per day)	Average daily dose (gr.)	Average dose per course	Average course duration
Cholera	Tetracycline	inside	0,25-0,5	3 times	0,75-1,5	3,0-6,0	4 nights
Cholera	Levomycetin	inside	0,5	2 times	1,0	4,0	4 nights
Plague	Tetracycline	inside	0,5	3 times	1,5	10,5	7 nights
Plague	Olethetrin	inside	0,25	3-4 times	0,75-1,0	3,75-5,0	5 days

NOTE: Extract from the manual,

approved deputy. Minister of Health

Ministry of Health of the USSR P.N. Burgasov 10.06.79

SAMPLING FOR BACTERIOLOGICAL INVESTIGATION DURING OOI.

Picked up material	The amount of material and what it gets into	Property required when collecting material
I. MATERIAL FOR CHOLERA
excreta		Glass Petri dish, sterile teaspoon, sterile jar with ground stopper, tray (sterilizer) for dropping the spoon
Bowel movements without stool	Same	The same + sterile aluminum loop instead of a teaspoon
Vomit	10-15 gr. into a sterile jar with a ground-in stopper, filled 1/3 with 1% peptone water	Sterile Petri dish, sterile teaspoon, sterile jar with ground stopper, tray (sterilizer) for dropping the spoon
II. MATERIAL IN NATURAL SMALLPOX
Blood	A) 1-2 ml. dilute blood into a sterile test tube 1-2 ml. sterile water.	Syringe 10 ml. with three needles and wide lumen
Blood	B) 3-5 ml of blood in a sterile tube.	3 sterile tubes, sterile rubber (cork) stoppers, sterile water in 10 ml ampoules.
	Cotton swab on a stick with immersion in a sterile test tube	Cotton swab in a test tube (2 pcs.) Sterile test tubes (2 pcs.)
Lesions (papules, vesicles, pustules)	Wipe the area with alcohol before taking. Sterile test tubes with ground-in stoppers, defatted glass slides.	96°alcohol, cotton balls in a jar. Tweezers, scalpel, smallpox feathers. Pasteur pipettes, glass slides, adhesive tape.
III. MATERIAL FOR PLAGUE
Punctate from bubo	A) the needle with punctate is placed in a sterile test tube with a sterile rubber peel B) blood smear on glass slides	5% tincture of iodine, alcohol, cotton balls, tweezers, 2 ml syringe with thick needles, sterile test tubes with stoppers, fat-free glass slides.
Sputum	In a sterile Petri dish or a sterile wide-mouthed jar with a ground stopper.	Sterile Petri dish, sterile wide-mouth jar with ground stopper.
Detachable mucous membrane of the nasopharynx	On a cotton swab on a stick in a sterile test tube	Sterile cotton swabs in sterile tubes
Blood for homoculture	5 ml. blood into sterile test tubes with sterile (cork) stoppers.	Syringe 10 ml. with thick needles, sterile tubes with sterile (cork) stoppers.

MODE

Disinfection of various objects infected with pathogenic microbes

(plague, cholera, etc.)
Object to be disinfected	Method of disinfection	disinfectant	Time contact	Consumption rate
1. Room surfaces (floor, walls, furniture, etc.)	Irrigation, wiping, washing	1% solution of chloramine	1 hour	300 ml/m2
2. protective clothing (underwear, gowns, scarves, gloves)	autoclaving, boiling, soaking	Pressure 1.1 kg/cm2. 120°	30 minutes.	¾
		2% soda solution	15 minutes.	¾
		3% Lysol solution	2 hours	5 l. per 1 kg.
		1% solution of chloramine	2 hours	5 l. per 1 kg.
3. Glasses, phonendoscope	rubbing		¾
4. Liquid waste	Fall asleep and stir		1 hour	200gr./l.
5.Slippers, rubber boots	rubbing	3% hydrogen peroxide solution with 0.5% detergent	¾	2-fold wiping with intervals. 15 minutes.
6. Discharge of the patient (sputum, stool, food debris)	Fall asleep and stir; Pour and stir	Dry bleach or DTSGK	1 hour	200 gr. / l. 1 hour of discharge and 2 hours of doses of solution. volume ratio1:2
		5% solution Lyzola A	1 hour
		10% solution Lysol B (naphthalizol)	1 hour
7. Urine	Pour	2% solution of chlorine. Izv., 2% solution of lysol or chloramine	1 hour	Ratio 1:1
8. Dishes of the patient	boiling	Boiling in 2% soda solution	15 minutes.	Full immersion
9. Waste dishes (teaspoons, Petri dishes, etc.)	boiling	2% solution of soda	30 minutes.	¾
		3% solution chloramine B	1 hour
		3% per. hydrogen with 0.5 detergent	1 hour
		3% solution of Lysol A	1 hour
10. Hands in rubber gloves.	Dive and wash	Disinfectants specified in paragraph 1	2 minutes.	¾
Arms	-//-//-wiping	0.5% solution chloramine	1 hour
Arms	-//-//-wiping	70° alcohol	1 hour
11. Bedding accessories	Chamber decontaminated.	Steam-air mixture 80-90°	45 min.	60 kg/m2
12. Synthetic products. material	-//-//- Immersion	Steam-air mixture 80-90°	30 minutes.	60 kg/m2
		1% solution of chloramine	5 o'clock
		0.2% formaldehyde solution at t70°	1 hour

DESCRIPTION OF THE PROTECTIVE ANTIPLAGUE SUIT:

pajama suit
Stocking socks
Boots
Anti-plague medical gown
scarf
fabric mask
Mask - glasses
Oilcloth sleeves
Apron (apron) oilcloth
Rubber gloves
Towel
Oilcloth

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Introduction

Today, despite the successful fight, the relevance of especially dangerous infections remains high. Especially when using anthrax spores as a bacteriological weapon. The priority of the problem of especially dangerous infections (HEI) is determined by their socio-economic, medical and military-political consequences in case of spread in peacetime and wartime. In the absence of an adequate control system, the epidemic spread of HIFs can lead to disorganization not only of the anti-epidemic protection system, but also endanger the existence of the country as a whole.

Plague, anthrax, tularemia and brucellosis are zooanthroponotic natural focal especially dangerous infections, outbreaks of which are constantly recorded in Russia, countries of near and far abroad (Onishchenko G.G., 2003; Smirnova N.I., Kutyrev V.V. , 2006; Toporkov V.P., 2007; Bezsmertny V.E., Goroshenko V.V., Popov V.P., 2009; Popov N.V., Kuklev E.V., Kutyrev V.V., 2008) . In recent years, there has been a tendency to increase the number of diseases in animals and humans caused by these pathogens (Pokrovsky V.I., Pak S.G., 2004; Onishchenko G.G., 2007; Kutyrev V.V., Smirnova N.I. , 2008). This is due to migration processes, the development of the tourism industry, and environmental problems. The possibility of using pathogens of these infections as agents of bioterrorism (Onishchenko G.G., 2005; Afanaseva G.A., Chesnokova N.P., Dalvadyants S.M., 2008;) and the emergence of diseases caused by altered forms of microorganisms ( Naumov A.V., Ledvanov M.Yu., Drozdov I.G., 1992; Domaradsky I.V., 1998). Despite the successes achieved in the prevention of the above infections, the effectiveness of the treatment of late cases of plague and anthrax remains at a low level. The solution of these problems can only be carried out taking into account the expansion of knowledge about their pathogenesis.

The purpose of the course work: to consider the current state of the HEI in Russia, to reveal the main diagnostic methods and algorithms for the action of medical personnel in the event of the detection of HEI, to consider the composition of anti-epidemic packing and their use.

Objectives of the course work: to analyze the scientific literature on OOI, to reveal the main diagnostic methods and algorithms for the action of medical personnel when detecting OOI.

1.1 The concept of OOI and their classification

There is no scientifically substantiated and generally accepted definition of the concept of OOI. The list of these infections is different in various official documents regulating activities related to HFOs and their pathogens.

Familiarization with such lists allows us to state that they include infectious diseases, the mechanisms, the transmission of pathogens of which are capable of ensuring their epidemic spread. At the same time, in the past, these infections were characterized by high mortality. Many of them have retained this property in the present, if they are not recognized in a timely manner and emergency treatment is not started. For some of these infections, there are still no effective therapeutic agents today, for example, for rabies, pulmonary and intestinal forms of anthrax, etc. At the same time, this principle cannot be correlated with all infectious diseases traditionally included in the list of AIOs. Therefore, it can be said that infectious diseases that are usually capable of epidemic spread, covering large masses of the population and/or causing extremely severe individual diseases with high mortality or disability of those who have been ill, are usually considered especially dangerous.

The concept of OOI is broader than the concepts of "quarantine (conventional)", "zoonotic" or "natural focal" infections. So, OOI can be quarantine (plague, cholera, etc.), that is, those that are subject to international sanitary rules. They can be zoonotic (plague, tularemia), anthroponotic (epidemic typhus, HIV infection, etc.) and sapronous (legionellosis, mycoses, etc.). Zoonotic OOI can be natural-focal (plague, tularemia), anthropourgical (sap, brucellosis), and natural-anthropourgical (rabies, etc.).

Depending on the inclusion of pathogens in a particular group, the requirements of the regime (restrictions) when working with them were regulated.

WHO, proclaiming the criteria, proposed to develop a classification of microorganisms based on these principles, as well as to be guided by certain microbiological and epidemiological criteria when developing a classification of microorganisms. They included:

pathogenicity of microorganisms (virulence, infectious dose);

the mechanism and routes of transmission, as well as the range of hosts of the microorganism (the level of immunity, density and migration processes of the hosts, the presence of the ratio of vectors and the epidemiological significance of various environmental factors);

the availability and accessibility of effective means and methods of prevention (methods of immunoprophylaxis, sanitary and hygienic measures to protect water and food, control over animals - hosts and carriers of the pathogen, over the migration of people and / or animals);

Availability and access to effective means and methods of treatment (emergency prevention, antibiotics, chemotherapy, including the problem of resistance to these means).

In accordance with these criteria, all microorganisms are proposed to be divided into 4 groups:

I - microorganisms representing low both individual and social danger. It is unlikely that these microorganisms are able to cause disease in laboratory personnel, as well as the public and animals (Bacillus subtilis, Escherichia coli K 12);

II - microorganisms representing a moderate individual and limited public danger. Representatives of this group can cause individual diseases in humans and/or animals, but under normal conditions they do not represent a serious public health and/or veterinary problem. Limiting the risk of the spread of diseases caused by these microorganisms may be associated with the availability of effective means of their prevention and treatment (the causative agent of typhoid fever, viral hepatitis B);

III - microorganisms representing a high individual, but low social danger. Representatives of this group are capable of causing severe infectious diseases, but cannot spread from one individual to another, or there are effective means of prevention and treatment for them (brucellosis, histoplasmosis);

IV - microorganisms representing a high both social and individual danger. They are capable of causing severe, often untreatable disease in humans and/or animals and can easily spread from one individual to another (foot-and-mouth disease).

Taking into account the above criteria, it seems appropriate and scientifically justified to call especially dangerous those infectious diseases whose pathogens are classified as pathogenicity I and II in accordance with the above-mentioned sanitary rules.

1.2 Current state of the problem

As described above, at present there is no such concept of "OOI" in world medicine. This term continues to be common only in the CIS countries, while in the world practice, OOI are “infectious diseases that are included in the list of events that may constitute an emergency in the health care system on an international scale.” The list of such diseases is now significantly expanded. According to Appendix No. 2 of the International Health Regulations (IHR), adopted at the 58th World Health Assembly, it is divided into two groups. The first group is "diseases that are unusual and may have a serious impact on public health": smallpox, poliomyelitis caused by wild poliovirus, human influenza caused by a new subtype, severe acute respiratory syndrome (SARS). The second group is "diseases, any event with which is always considered dangerous, since these infections have shown the ability to have a serious impact on the health of the population and spread rapidly internationally": cholera, pneumonic plague, yellow fever, hemorrhagic fevers - fever Lassa, Marburg, Ebola, West Nile. The IHR 2005 also includes communicable diseases “that present a particular national and regional problem”, such as dengue fever, Rift Valley fever, meningococcal disease (meningococcal disease). For example, for the countries of the tropical zone, dengue fever is a serious problem, with the occurrence of severe hemorrhagic, often fatal forms among the local population, while Europeans endure it less severely, without hemorrhagic manifestations, and in European countries this fever cannot spread due to lack of carrier. Meningococcal infection in Central African countries has a significant prevalence of severe forms and high mortality (the so-called "African meningitis belt"), while in other regions this disease has a lower prevalence of severe forms, and therefore lower mortality.

It is noteworthy that WHO included in the IHR-2005 only one form of plague - pneumonic, implying that with this form of damage, the spread of this terrible infection is extremely fast from a sick person to a healthy person by airborne transmission mechanism, which can lead to very the rapid defeat of many people and the development of a huge epidemic in terms of volume, if adequate anti-epidemics are not taken in time -

cal activities. A patient with pneumonic plague, due to the constant cough inherent in this form, releases many plague microbes into the environment and creates a “plague” curtain around him from droplets of fine mucus, blood, containing the pathogen inside. This circular curtain with a radius of 5 meters, droplets of mucus and blood settle on the surrounding objects, which further increases the epidemic danger of the spread of the plague bacillus. Entering this "plague" veil, an unprotected healthy person will inevitably become infected and fall ill. In other forms of plague, such airborne transmission does not occur and the patient is less infectious.

The scope of the new IHR 2005 is now no longer limited to communicable diseases, but covers “a disease or medical condition, regardless of origin or source, that poses or may pose a risk of causing significant harm to humans”.

Although in 1981 the WHO 34th World Health Assembly removed smallpox from the list due to its eradication, in the IHR 2005 it returned it again in the form of smallpox, implying that the world may have left smallpox virus in the arsenal of biological weapons of some countries, and the so-called monkeypox, described in detail in Africa in 1973 by Soviet researchers, can potentially spread naturally. It has clinical manifestations. comparable to those in smallpox and can also hypothetically give high mortality and disability.

In Russia, anthrax and tularemia are also included in the AGI, because on the territory of the Russian Federation, the presence of natural foci of tularemia and anthrax is determined.

1.3.Measures taken when identifying a patient suspected of having an OOI and the tactics of a nurse

If a patient suspected of having an OOI disease is identified in a polyclinic or hospital, the following primary anti-epidemic measures are taken (Appendix No. 4):

Transportable patients are delivered by sanitary transport to a special hospital.

For non-transportable patients, medical care is provided on the spot with a consultant's call and an ambulance equipped with everything necessary.

Measures are taken to isolate the patient at the place of his detection, before hospitalization in a specialized infectious diseases hospital.

The nurse, without leaving the room where the patient was identified, notifies the head of her institution about the identified patient by phone or through a courier, requests appropriate medications, protective clothing, and personal prophylaxis.

If plague, contagious viral hemorrhagic fevers are suspected, the nurse, before receiving protective clothing, must cover her nose and mouth with any bandage (towel, scarf, bandage, etc.), having previously treated her hands and exposed parts of the body with any antiseptic agents and assist the patient, wait for the arrival an infectious diseases doctor or a doctor of another specialty. After receiving protective clothing (anti-plague suits of the appropriate type), they put it on without taking off their own, except for heavily contaminated with the patient's secretions.

The arriving infectious disease specialist (therapist) enters the room where the patient is identified in protective clothing, and the employee accompanying him near the room must dilute the disinfectant solution. The doctor who identified the patient removes the dressing gown, the bandage that protected his respiratory tract, places them in a tank with a disinfectant solution or a moisture-proof bag, treats shoes with a disinfectant solution and moves to another room where he undergoes a complete sanitization, changing into a spare set of clothes (personal items are placed in an oilcloth bag for disinfection). Open parts of the body, hair are treated, the mouth and throat are rinsed with 70 ° ethyl alcohol, antibiotic solutions or a 1% solution of boric acid are instilled into the nose and eyes. The issue of isolation and emergency prophylaxis is decided after the conclusion of the consultant. If cholera is suspected, personal prevention measures for intestinal infections are observed: after examination, the hands are treated with an antiseptic. If the discharge of the patient gets on clothes, shoes are replaced with spare ones, and contaminated things are subject to disinfection.

The arriving doctor in protective clothing examines the patient, clarifies the epidemiological history, confirms the diagnosis, and continues the treatment of the patient according to indications. It also identifies persons who have been in contact with the patient (patients, including those discharged, medical and attendant personnel, visitors, including those who have left the medical institution, persons at the place of residence, work, study.). Contact persons are isolated in a separate room or box or subject to medical supervision. If plague, GVL, monkeypox, acute respiratory or neurological syndromes are suspected, contacts are taken into account in rooms connected through ventilation ducts. Lists of identified contact persons are compiled (full name, address, place of work, time, degree and nature of contact).

It is temporarily prohibited to enter and leave a medical facility.

The communication between floors stops.

Posts are posted at the office (ward) where the patient was, at the entrance doors of the polyclinic (department) and on the floors.

It is forbidden for patients to walk inside the department where the patient was identified, and exit from it.

Reception, discharge of patients, visits to their relatives are temporarily stopped. Prohibit the removal of things until the final disinfection

Reception of patients according to vital indications is carried out in isolated rooms with a separate entrance.

In the room where the patient is identified, windows and doors are closed, ventilation is turned off, and ventilation openings, windows, doors are sealed with adhesive tape, and disinfection is carried out.

If necessary, emergency prophylaxis is carried out for medical staff.

Severely ill patients receive medical care until the arrival of the medical team.

Before the arrival of the evacuation team, the nurse who identified the patient takes the material for laboratory examination with the help of a sampling kit.

In the office (ward) where the patient is identified, current disinfection is carried out (disinfection of secretions, care items, etc.).

Upon the arrival of a team of consultants or an evacuation team, the nurse who identified the patient follows all the orders of the epidemiologist.

If urgent hospitalization of the patient is required for health reasons, then the nurse who identified the patient accompanies him to the hospital and follows the instructions of the doctor on duty of the infectious diseases hospital. After consultation with an epidemiologist, the nurse is sent for sanitation, and in case of pneumonic plague, GVL and monkeypox - to the isolation ward.

Hospitalization of patients in an infectious diseases hospital is provided by emergency medical services by evacuation teams consisting of a doctor or paramedical worker, an orderly familiar with the biological safety regime of work and a driver.

All persons involved in the evacuation of people suspected of being infected with plague, CVGL, pneumonic glanders - type I suits, cholera patients - type IV (in addition, it is necessary to provide surgical gloves, an oilcloth apron, a medical respirator of at least 2 protection class, boots) .

When evacuating patients suspected of diseases caused by other microorganisms of the pathogenicity group II, use protective clothing provided for the evacuation of infectious patients.

Transport for hospitalization of patients with cholera is equipped with a lining oilcloth, dishes for collecting the patient's secretions, disinfectant solutions in a working dilution, stacks for collecting material.

At the end of each flight, the personnel serving the patient must disinfect shoes and hands (with gloves), aprons, undergo an interview with the person responsible for the biological safety of the infectious diseases hospital to identify violations of the regime, and sanitize.

In a hospital where there are patients with diseases classified as group II (anthrax, brucellosis, tularemia, legionellosis, cholera, epidemic typhus and Brill's disease, rat typhus, Q fever, HFRS, ornithosis, psittacosis), an anti-epidemic regime is established, provided for related infections. Cholera hospital according to the regime established for departments with acute gastrointestinal infections.

The device, procedure and mode of operation of the provisional hospital are set the same as for the infectious diseases hospital (patients suspected of this disease are placed individually or in small groups according to the timing of admission and, preferably, according to clinical forms and severity of the disease). Upon confirmation of the alleged diagnosis in the provisional hospital, patients are transferred to the appropriate department of the infectious diseases hospital. In the ward, after the transfer of the patient, the final disinfection is carried out in accordance with the nature of the infection. The remaining patients (contacts) are sanitized, linen is changed, and preventive treatment is carried out.

Allocations of patients and contacts (sputum, urine, feces, etc.) are subject to mandatory disinfection. Decontamination methods are applied in accordance with the nature of the infection.

In a hospital, patients should not use a shared toilet. Bathrooms and toilets must be locked with a key kept by the biosecurity officer. Toilets are opened to drain decontaminated solutions, and baths to process those discharged. With cholera, the patient is sanitized with I-II degrees of dehydration in the emergency department (they do not use a shower), followed by a system for disinfecting flush water and the room, III-IV degrees of dehydration are carried out in the ward.

The patient's belongings are collected in an oilcloth bag and sent for disinfection in a disinfection chamber. In the pantry, clothes are stored in individual bags folded into tanks or plastic bags, the inner surface of which is treated with an insecticide solution.

Patients (vibrio carriers) are provided with individual pots or bedpans.

The final disinfection at the place of detection of the patient (vibrio carrier) is carried out no later than 3 hours from the moment of hospitalization.

In hospitals, current disinfection is carried out by junior medical personnel under the direct supervision of the head nurse of the department.

Personnel carrying out disinfection should be dressed in a protective suit: removable shoes, anti-plague or surgical gown, supplemented with rubber shoes, oilcloth apron, medical respirator, rubber gloves, towel.

Food for the sick is delivered in the dishes of the kitchen to the service entrance of the uncontaminated unit, and there it is poured and transferred from the dishes of the kitchen to the dishes of the pantry of the hospital. The dishes in which the food entered the department are disinfected by boiling, after which the tank with the dishes is transferred to the pantry, where they are washed and stored. The dispenser should be equipped with everything necessary for the disinfection of food residues. Individual dishes are disinfected by boiling.

The nurse responsible for the observance of the biological safety of the infectious diseases hospital conducts, during the epidemiological period, the control of the disinfection of the wastewater of the hospital. Disinfection of wastewater from a cholera and provisional hospital is carried out by chlorination in such a way that the concentration of residual chlorine is 4.5 mg/l. Control is carried out by daily obtaining information from laboratory control, fixing data in a journal.

1.4 Incidence statistics

According to the Ministry of Health of the Russian Federation on the territory of Russia, the presence of natural foci of tularemia is determined, the epizootic activity of which is confirmed by the sporadic incidence of people and the isolation of the causative agent of tularemia from rodents, arthropods, from environmental objects or by the detection of an antigen in the pellets of birds and the droppings of predatory mammals.

According to the Ministry of Health of Russia, in the last decade (1999 - 2011), mainly sporadic and group morbidity has been recorded, which annually fluctuates between 50 - 100 cases. In 1999 and 2003 an outbreak was recorded, in which the number of patients in the Russian Federation was 379 and 154, respectively.

According to Dixon T. (1999), for many centuries, the disease was registered in at least 200 countries of the world, and the incidence of people was estimated from 20 to 100 thousand cases per year.

According to WHO data, about 1 million animals die from anthrax every year in the world and about 1 thousand people fall ill, including with a frequent fatal outcome. In Russia, over the period from 1900 to 2012, more than 35,000 permanently unfavorable sites for anthrax and more than 70,000 outbreaks of infection were registered.

With untimely diagnosis and the absence of etiotropic therapy, lethality in anthrax infection can reach 90%. Over the past 5 years, the incidence of anthrax in Russia has somewhat stabilized, but still remains at a high level.

In the 90s of the last century, according to the Ministry of Health in our country, from 100 to 400 cases of human disease were diagnosed annually, while 75% were in the Northern, Central and West Siberian regions of Russia. In 2000-2003 the incidence in the Russian Federation decreased significantly and amounted to 50–65 cases per year, but in 2004 the number of cases increased again to 123, and in 2005 several hundred people fell ill with tularemia. In 2010, 115 cases of tularemia were registered (in 2009 - 57). In 2013, more than 500 people were infected with tularemia (as of September 1) 840 people as of September 10 1000 people.

The last recorded non-epidemic case of cholera death in Russia is February 10, 2008, the death of 15-year-old Konstantin Zaitsev.

2.1 Educational and training activities carried out to provide medical care and carry out preventive measures when a patient with ASI is identified

Due to the fact that cases of AIO are not registered in the Chuvash Republic, the research part of this course work will be devoted to training activities carried out to improve the skills of medical personnel in providing medical care and taking preventive measures when a patient with AIO is identified.

Comprehensive plans are developed by the centers of the State Sanitary and Epidemiological Supervision and health departments (departments, committees, departments - hereinafter referred to as health authorities) in the constituent entities of the Russian Federation and territories of regional subordination, coordinate with interested departments and services and submit for approval to the local administration with annual adjustments in accordance with the emerging sanitary and epidemiological situation on the ground

(MU 3.4.1030-01 Organization, provision and assessment of the anti-epidemic readiness of medical institutions to take measures in case of especially dangerous infections). The plan provides for the implementation of measures with an indication of the deadline, the persons responsible for their implementation in the following sections: organizational measures, training, preventive measures, operational measures when a patient (suspicious) with plague, cholera, CVHF, other diseases and syndromes is detected.

For example, on May 30, a patient with cholera was conditionally identified in the Kanashsky MMC. All entrances and exits from the medical facility were blocked.

A training session on providing medical care and taking preventive measures when a patient is diagnosed with a particularly dangerous infection (cholera) is conducted by the Regional Directorate No. 29 of the Federal Medical and Biological Agency (FMBA) of Russia together with the Kanash MMC and the Center for Hygiene and Epidemiology (TsGiE) No. 29 in as close to real conditions as possible. In advance, the medical staff is not warned about the identity of the "sick" person, as well as about which general practitioner he will turn to. At the appointment, the doctor, having collected an anamnesis, should suspect a dangerous diagnosis and act in accordance with the instructions. In addition, in accordance with the guidelines, the administration of the medical institution does not have the right to warn the population in advance about the passage of such an exercise.

In this case, the patient was a 26-year-old woman who, according to legend, arrived in Moscow from India on May 28, after which she went by train to the city of Kanash. At the railway station, her husband met her in a private vehicle. A woman fell ill on the evening of the 29th: severe weakness, dry mouth, loose stools, vomiting. On the morning of the 30th, she went to the reception desk of the polyclinic to get an appointment with a therapist. In the office, her health deteriorated. As soon as the doctor suspected a particularly dangerous infection, he began working out an algorithm of actions in case of its detection. An infectious disease doctor, an ambulance brigade and a disinfection group from the Center for Hygiene and Epidemiology were urgently called; informed the management of the institutions involved. Further along the chain, the entire algorithm of actions of the medical staff to provide medical care in identifying a patient with AIO was worked out: from collecting biological material for bacteriological examination, identifying contact persons to hospitalizing the patient in an infectious diseases hospital.

In accordance with the guidelines on the organization and implementation of primary anti-epidemic measures in the event of a patient suspected of contracting infectious diseases that cause emergencies in the field of sanitary and epidemiological welfare of the population, the doors of the polyclinic were blocked, posts from the medical staff were posted on the floors, entrances and exits. An announcement was posted at the main entrance announcing the temporary closure of the polyclinic. The “hostages” of the situation were the patients who were at the polyclinic at that time, and to a greater extent those who came to see doctors - people were forced to wait about an hour outside, in windy weather, until the exercises were over. Unfortunately, the staff of the polyclinic did not organize explanatory work among the patients who were on the street, and they did not inform about the approximate time for the end of the exercises. If someone needed urgent help, it had to be provided. In the future, during such training sessions, more complete information will be provided to the population about the time of their completion.

At the same time, classes on especially dangerous infections are urgently needed. Due to the fact that a large number of citizens go on vacation to tropical countries, it is possible to import especially dangerous infections from there. Kanash medical institutions should be ready for this, and, first of all, the city polyclinic, to which 45,000 citizens are attached. If the disease actually happened, the risk of infection and the scale of the spread of infection would be very high. The actions of the medical staff should ideally be brought to automaticity, and patients who are at the time of the danger of infection in the clinic should also act without panic, show tolerance and understanding of the situation. Annual trainings allow you to work out the interaction of specialists from the Kanash Medical Center, Regional Directorate No. 29 of the FMBA of Russia, Center for Hygiene and Epidemiology No. 29 and be as prepared as possible for real cases of detection of patients with AIO.

2.2 Anti-epidemic packings and their composition

Epidemiological stacks are designed for primary anti-epidemic measures:

Taking material from the sick or dead and from environmental objects in medical and preventive institutions (HCF) and at checkpoints across the state border;

Pathological anatomical autopsy of dead people or animal corpses, carried out in the prescribed manner for diseases of unclear etiology, suspected of a particularly dangerous infectious disease;

Sanitary and epidemiological examination of the epidemic focus of especially dangerous infections (DOI);

Timely implementation of a complex of sanitary and anti-epidemic (preventive) measures for the localization and elimination of the epidemic focus of AIO.

The UK-5M epidemiological stack is designed to collect material from people for testing for especially dangerous infectious diseases (DOI).

The UK-5M universal laying is equipped on the basis of MU 3.4.2552-09 dated 1.11.2009. approved by the Head of the Federal Service for Supervision of Consumer Rights Protection and Human Welfare, Chief State Sanitary Doctor of the Russian Federation G.G. Onishchenko.

The epidemiological package available at the Kanash MMC includes 67 items [App. No. 5].

Description of styling for special treatment of the skin and mucous membranes before putting on protective clothing:

A medical worker who has identified a patient with plague, cholera, contagious hemorrhagic infection or other dangerous infections, before putting on an anti-plague suit, must treat all exposed parts of the body. For these purposes, each medical center, medical institution should have a packing containing:

* weighed chloramine 10 gr. for preparation of 1% solution (for skin treatment);

* chloramine weighings of 30 gr. for the preparation of 3% solution (for the treatment of medical waste and medical instruments);

* 700 ethyl alcohol;

* antibiotics (doxycycline, rifampicin, tetracycline, pefloxacin);

* drinking water;

* beakers, scissors, pipettes;

* weights of potassium permanganate for the preparation of a 0.05% solution;

* distilled water 100.0;

* sodium sulfacyl 20%;

* napkins, cotton wool;

* containers for the preparation of disinfectants.

Rules for taking material for laboratory testing from a patient (corpse) in case of suspected illness with plague, cholera, malaria and other especially dangerous infectious diseases according to the operational folder for carrying out activities upon detection of a patient (corpse) suspected of having an OOI: collection of clinical material and its packaging carried out by a medical worker of a medical institution who has been trained in the organization of work in the conditions of registration of especially dangerous infections. The sampling is carried out in sterile disposable vials, test tubes, containers, sterile instruments. Packaging, labeling, storage and transportation of material for laboratory diagnostics in case of suspected especially dangerous infections must comply with the requirements of SP 1.2.036-95 "Procedure for accounting, storage, transfer and transportation of microorganisms of pathogenicity groups I-IV".

Sampling of clinical material by trained medical personnel is carried out in personal respiratory protection equipment (respirator type ShB-1 or RB "Lepestok-200"), goggles or face shields, shoe covers, double rubber gloves. After the material selection procedure, gloves are treated with solutions of disinfectants, hands, after removing gloves, are treated with antiseptics.

Before taking the material, it is necessary to fill out a referral form and place it in a plastic bag.

The material is taken before the start of specific treatment with sterile instruments in a sterile dish.

General requirements for sampling biological material.

To protect against infection, when taking samples of biomaterial and delivering them to the laboratory, a medical worker must comply with the following requirements:

* do not contaminate the outer surface of the dishes during sampling and delivery of samples;

* do not pollute the accompanying documents (referrals);

* minimize the direct contact of the biomaterial sample with the hands of the medical worker who takes and delivers the samples to the laboratory;

* use sterile disposable or approved containers (containers) for the collection, storage and delivery of samples in accordance with the established procedure;

* transport samples in carriers or stacks with separate nests;

* observe aseptic conditions in the process of performing invasive measures to prevent infection of the patient;

* take samples in a sterile container that is not contaminated with biomaterial and does not have defects.

As mentioned above, the research part of the course work is devoted to educational and training activities carried out to improve the skills of providing medical care when detecting AEs, as well as the use of anti-epidemic packing. This is due to the fact that no cases of infection with especially dangerous infections were recorded on the territory of Chuvashia.

When writing the research part, I came to the conclusion that classes on especially dangerous infections are urgently needed. This is due to the fact that a large number of citizens go on vacation to tropical countries, from where it is possible to import especially dangerous infections. In my opinion, medical institutions in Kanash should be ready for this. If the disease actually happened, the risk of infection and the scale of the spread of infection would be very high.

During periodic exercises, the knowledge of the medical staff is improved and their actions are brought to automatism. Also, these trainings teach medical staff to interact with each other, serve as an impetus for the development of mutual understanding and cohesion.

In my opinion, anti-epidemic packing is the basis for providing medical care to a patient with ASI and the best protection against the spread of infection and, of course, for the health worker himself. Therefore, the correct packaging of the styling and their correct use is one of the most important tasks when a particularly dangerous infection is suspected.

Conclusion

In this course work, the essence of the OOI and their current state in Russia, as well as the tactics of the nurse in case of suspicion or detection of OOI, were considered. Therefore, it is relevant to study the methods of diagnosis and treatment for AIO. In the course of my research, tasks related to the detection of especially dangerous infections and the tactics of a nurse were considered.

When writing a term paper on the research topic, I studied special literature, including scientific articles on AIO, textbooks on epidemiology, methods for diagnosing AIO, and algorithms for the actions of a nurse in case of suspicion or detection of especially dangerous infections.

Due to the fact that in Chuvashia cases of ASI were not registered, I studied only the general statistics of morbidity in Russia, and considered educational and training measures to provide medical care in case of detection of ASI.

As a result of the project created and carried out to study the state of the problem, I found that the incidence of AIO remains at a fairly high level. For example, in 2000-2003. the incidence in the Russian Federation decreased significantly and amounted to 50–65 cases per year, but in 2004 the number of cases increased again to 123, and in 2005 several hundred people fell ill with tularemia. In 2010, 115 cases of tularemia were registered (in 2009 - 57). In 2013, more than 500 people were infected with tularemia (as of September 1) 840 people as of September 10, 1000 people.

In general, the Ministry of Health of the Russian Federation notes that over the past 5 years, the incidence in Russia has somewhat stabilized, but still remains at a high level.

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Epidemiological surveillance of tularemia. Methodical instructions. MU 3.1.2007-05

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Adnagulova A.V., Vysochina N.P., Gromova T.V., Gulyako L.F., Ivanov L.I., Kovalsky A.G., Lapin A.S. Epizootic activity of natural and anthropourgical foci of tularemia on the territory of the Jewish Autonomous Region and in the vicinity of Khabarovsk during the flood on the Amur River 2014-1(90) pp.:90-94

Alekseev V.V., Khrapova N.P. The current state of diagnosis of especially dangerous infections 2011 - 4 (110) pages 18-22 of the journal "Problems of especially dangerous infections"

Belousova, A.K.: Nursing in infectious diseases with a course of HIV infection and epidemiology. - Rostov n/a: Phoenix, 2010

Belyakov V.D., Yafaev R.Kh. Epidemiology: Textbook: M.: Medicine, 1989 - 416 p.

Borisov L.B., Kozmin-Sokolov B.N., Freidlin I.S. Guide to laboratory studies in medical microbiology, virology and immunology - M., "Medicine", 1993

Briko N.I., Danilin B.K., Pak S.G., Pokrovsky V.I. Infectious diseases and epidemiology. Textbook - M.: GEOTAR MEDICINE, 2000. - 384 p.

Bushueva V.V., Zhogova M.A., Kolesova V.N., Yushchuk N.D. Epidemiology. - account. allowance, M., "Medicine", 2003 - 336 p.

Vengerov Yu.Ya., Yushchuk N.D. Infectious diseases - M .: Medicine 2003.

Vengerov Yu.Ya., Yushchuk N.D. Infectious human diseases - M .: Medicine, 1997

Gulevich M.P., Kurganova O.P., Lipskaya N.A., Perepelitsa A.A. Prevention of the spread of infectious diseases in temporary accommodation during the flood in the Amur Region 2014 - 1(19) pp. 19-31

Ezhov I.N., Zakhlebnaya O.D., Kosilko S.A., Lyapin M.N., Sukhonosov I.Yu., Toporkov A.V., Toporkov V.P., Chesnokova M.V. Management of the epidemiological situation at a biologically hazardous facility 2011-3(18) pp. 18-22

Zherebtsova N.Yu. etc. Disinfection case. - Belgorod, BelSU, 2009

Kamysheva K.S. Microbiology, fundamentals of epidemiology and methods of microbiological research. - Rostov n/a, Phoenix, 2010

Lebedeva M.N. Guide to practical exercises in medical microbiology - M., "Medicine", 1973

Ozeretskovsky N.A., Ostanin G.I. disinfection and sterilization modes of polyclinics - St. Petersburg, 1998, 512 p.

Povlovich S.A. Medical microbiology in graphs - Minsk, Higher School, 1986

Titarenko R.V. Nursing in infectious diseases - Rostov n / a, Felix, 2011

Application No. 1

Description of the protective anti-plague suit:

1. Pajama suit;

2. Socks-stockings;

4. Anti-plague medical gown;

5. Kerchief;

6. Fabric mask;

7 Mask - glasses;

8. Oilcloth oversleeves;

9. Apron - oilcloth apron;

10. Rubber gloves;

11. Towel;

12. Oilcloth

Application No. 2

The procedure for using a protective (anti-plague) suit

The protective (anti-plague) suit is designed to protect against infection by pathogens of especially dangerous infections during all their main types of transmission.

The order of putting on the anti-plague suit is: overalls, socks, boots, hood or large scarf and anti-plague robe. The ribbons at the collar of the robe, as well as the belt of the robe, are tied in front on the left side with a loop, after which the ribbons are fixed on the sleeves. The mask is put on the face so that the nose and mouth are closed, for which the upper edge of the mask should be at the level of the lower part of the orbits, and the lower one should go under the chin. The upper ribbons of the mask are tied with a loop at the back of the head, and the lower ones - at the crown of the head (like a sling-like bandage). Putting on a mask, cotton swabs are placed on the sides of the wings of the nose and all measures are taken to ensure that air does not get in addition to the mask. Spectacle glasses must be rubbed with a special pencil or a piece of dry soap to prevent them from fogging. Then put on gloves, after checking them for integrity. A towel is placed behind the belt of the dressing gown on the right side.

Note: if it is necessary to use a phonendoscope, it is put on in front of a hood or a large scarf.

Procedure for removing the anti-plague suit:

1. Thoroughly wash gloved hands in a disinfectant solution for 1-2 minutes. Subsequently, after removing each part of the suit, gloved hands are immersed in a disinfectant solution.

2. Slowly remove the towel from the belt and drop it into a basin with disinfectant.

3. Wipe the oilcloth apron with a cotton swab abundantly moistened with disinfectant, remove it, turning the outer side inward.

4. Remove the second pair of gloves and sleeves.

5. Without touching the exposed parts of the skin, take out the phonendoscope.

6. Glasses are removed with a smooth movement, pulling them forward, up, back, behind the head with both hands.

7. The cotton-gauze mask is removed without touching the face with its outer side.

8. Untie the ties of the collar of the robe, the belt and, lowering the upper edge of the gloves, untie the ties of the sleeves, take off the robe, wrapping its outer part inside.

9. Remove the scarf, carefully gathering all its ends in one hand at the back of the head.

10. Remove gloves, check them for integrity in a disinfectant solution (but not with air).

11. The boots are wiped from top to bottom with cotton swabs, abundantly moistened with disinfectant (a separate swab is used for each boot), removed without the help of hands.

12. Remove socks or stockings.

13. They take off their pajamas.

After removing the protective suit, wash hands thoroughly with soap and warm water.

14. Protective clothing is disinfected after a single use by soaking in a disinfectant solution (2 hours), and when working with anthrax pathogens - autoclaving (1.5 atm - 2 hours) or boiling in a 2% soda solution - 1 hour.

When disinfecting the anti-plague suit with disinfectant solutions, all its parts are completely immersed in the solution. Take off the anti-plague suit slowly, without haste, in a strictly prescribed manner. After removing each part of the anti-plague suit, gloved hands are immersed in a disinfectant solution.

Application No. 3

Alert scheme when detecting OOI

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Application No. 4

dangerous infection anti-epidemic

Algorithm of actions of medical staff in case of detection of a patient suspected of having OOI

When a patient suspected of having an AIO disease is identified, all primary anti-epidemic measures are carried out when a preliminary diagnosis is established on the basis of clinical and epidemiological data. When establishing the final diagnosis, measures to localize and eliminate foci of especially dangerous infections are carried out in accordance with the current orders and instructive guidelines for each nosological form.

The principles of organizing anti-epidemic measures are the same for all infections and include:

* Identification of the patient;

*information (message) about the identified patient;

*clarification of the diagnosis;

*isolation of the patient with subsequent hospitalization;

* treatment of the patient;

*observational, quarantine and other restrictive measures: detection, isolation, laboratory examination, emergency prophylaxis for persons in contact with the patient; provisional hospitalization of patients with suspected AIO; identification of those who died from unknown causes, pathological and anatomical autopsy with the collection of material for laboratory (bacteriological, virological) research, disinfection, proper transportation and burial of corpses; autopsy of those who died from highly contagious hemorrhagic fevers (Marburg, Ebola, JIacca), as well as sampling from a corpse for laboratory research, is not performed due to the high risk of infection; disinfection measures; emergency prevention of the population; medical supervision of the population; * sanitary control of the external environment (laboratory study of possible

transmission factors, monitoring the number of rodents, insects and arthropods, conducting an epizootic study);

*health education.

All these activities are carried out by local health authorities and institutions together with anti-plague institutions that provide methodological guidance and practical assistance.

All medical and preventive and sanitary and epidemiological institutions must have the necessary supply of medicines for etiotropic and pathogenetic therapy; stacks for taking material from patients suspected of having OOI for laboratory testing; disinfectants and adhesive plaster packages based on gluing windows, doors, ventilation openings in one office (box, ward); means of personal prevention and individual protection (type I anti-plague suit).

Primary signaling about the identification of a patient suspected of having an OOI is carried out in three main instances: the chief physician of U30, the ambulance station and the chief physician of the territorial CGE and 03.

The chief physician of the CGE and 03 puts into action the plan of anti-epidemic measures, informs the relevant institutions and organizations about the case of the disease, including territorial anti-plague institutions.

From a patient with suspicion of cholera, material is taken by a medical worker who identified the patient, and if plague is suspected, by a medical worker of the institution where the patient is located, under the guidance of specialists from the departments of especially dangerous infections of the Central State Examination and 03. Material from patients is taken only at the place of hospitalization by laboratory workers performing these studies. The collected material is urgently sent for analysis to a special laboratory.

When identifying patients with cholera, only those persons who communicated with them during the period of clinical manifestations of the disease are considered to be contacts. Medical workers who have been in contact with patients with plague, HVL or monkeypox (if these infections are suspected) are subject to isolation until the final diagnosis is established or for a period equal to the maximum incubation) period. Persons who have been in direct contact with a cholera patient, as directed by an epidemiologist, should be isolated or left under medical supervision.

When establishing a preliminary diagnosis and conducting primary anti-epidemic measures, one should be guided by the following terms of the incubation period:

* plague - 6 days;

* cholera - 5 days;

*yellow fever - 6 days;

*Crimea-Congo, monkeypox - 14 days;

* Ebola, Marburg, Lasa, Bolivian, Argentinean - 21 days;

*syndromes of unknown etiology - 21 days.

Further activities are carried out by specialists from the Departments of Particularly Dangerous Infections of the CGE and 03, anti-plague institutions in accordance with the current instructions and comprehensive plans.

Anti-epidemic measures in medical institutions are carried out according to a single scheme in accordance with the operational plan of this institution.

The procedure for notifying the head doctor of a hospital, polyclinic or the person replacing him is determined specifically for each institution.

Informing about the identified patient (suspicious for the disease of the OOI) to the territorial CGE and 03, higher authorities, calling consultants and evacuation teams are carried out by the head of the institution or a person replacing him.

Application No. 5

List of items included in the epidemic packing of BU "KMMTS":

1. Case for packing items

2. Latex gloves

3. Protective suits: (Tykem C and Tyvek overalls, A RTS boots)

4.Full respiratory protection mask and respirator

5. Instructions for taking material

7. Sheet paper for writing A4 format

8. Simple pencil

9. Permanent marker

10. Adhesive plaster

11. Oilcloth lining

14. Plasticine

15 Spirit lamp

16. Anatomical and surgical forceps

17.Scalpel

18. Scissors

19Bix or container for transportation of biological material

20Sterilizer

Items for blood sampling

21. Disposable sterile scarifiers

22. Syringes with a volume of 5.0, 10.0 ml disposable

23. Venous hemostatic tourniquet

24. Tincture of iodine 5-%

25. Rectified alcohol 960 (100 ml), 700 (100 ml)

26.Vacuum tube for obtaining blood serum with needles and holders for sterile vacuum tubes

27. Vacuum tube with EDTA for blood collection with needles and holders for sterile vacuum tubes

28. Slides

29. Fixer (Nikiforov's mixture)

30. Nutrient media for blood cultures (vials)

31. Alcohol gauze wipes

32. Sterile gauze wipes

33. Sterile bandage

34. Sterile cotton wool

Items for sampling biological material

35. Polymeric (polypropylene) containers for collection and transportation of samples with screw caps, volume not less than 100 ml, sterile

36. Containers with a spoon for collecting and transporting feces with a screw cap, polymeric (polypropylene) sterile

37. Plastic bags

38. Tongue spatula straight bilateral polymer disposable sterile

39Swabs swabs without transport media

40. Polymer loops - sterile samplers

41. Loop (probe) rectal polymer (polypropylene) direct sterile

42. Disposable sterile catheters No. 26, 28

43. Nutrient broth pH 7.2 in a bottle (50 ml)

44. Nutrient broth pH 7.2 in 5 ml tubes

45. Physiological solution in a vial (50 ml)

46. Peptone water 1% pH 7.6 - 7.8 in a 50 ml bottle

47. Petri dishes disposable polymer sterile 10

48. Microbiological disposable polymer test tubes with screw caps

Items for PCR diagnostics

60. Microtubes for PCR 0.5 ml

61. Tips for automatic pipettes with filter

62.Tip stand

63. Rack for microtubes

64. Automatic dispenser

Disinfectants

65. A sample of chloramine, calculated to obtain 10 liters of a 3% solution

66.30% hydrogen peroxide solution to make a 6% solution

67. Capacity for the preparation of a disinfectant solution with a volume of 10 l

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Cholera

This infection belongs to the group of intestinal. It differs from other diseases in this category in that it causes a very severe diarrheal syndrome and severe dehydration. As a result, the patient develops hypovolemic shock.

The penetration of the microbe into the body occurs through contaminated water. The bacterium damages the intestinal wall. As a result, the reverse absorption of water stops, and it begins to leave the body. The patient develops frequent loose stools, resembling rice water.

Mortality depends on the timeliness of diagnosis and initiation of treatment.

Death can occur from cardiovascular failure. The disease requires immediate implementation of a set of measures to rehydrate the patient.

Black (natural) smallpox

This is a particularly dangerous infection of viral origin. It is characterized by a pronounced intoxication syndrome and typical skin rashes. To date, this infection is considered defeated, and the virus can only be detected in a microbiological laboratory.

The source of the black pox virus is a sick person. The route of transmission of this infection is airborne or airborne. In addition, it is possible for the virus to penetrate through damaged skin, and in pregnant women, infection of the fetus through the placenta.

Susceptibility to the virus is extremely high. After the disease, stable immunity is formed, but 0.1% of those who have been ill can get sick again. The infection was registered earlier in the countries of Africa and Asia. In 1977, the last case of smallpox was noted. In 1980, the World Health Organization declared victory over smallpox.

The disease lasts about one and a half months with a change of four periods. The elements of the rash go through several stages of development. First, a spot is formed that transforms into a papule and a vesicle. Then a purulent vesicle is formed, which is soon covered with a crust. Erosions and ulcers form on the mucous membranes. Severe intoxication is characteristic. After two weeks, the recovery period begins. Mortality in different types of smallpox ranged from 28% to 100%.

Yellow fever

This is a disease of viral origin, natural focal, with an acute course. The infection causes liver damage and hemorrhagic syndrome. Laboratories distinguish two types of virus: endemic, causing disease in the wild; epidemic - provoking a disease in an urban area.

The source of the virus is monkeys, less often rodents. It is spread by mosquitoes. A person becomes infected by the bite of an infected insect. People can get sick regardless of gender and age. Susceptibility to infection is extremely high, and there is no innate immunity. After illness, a stable defense is formed.

Most often, pathology is recorded in the countries of South America and Africa. However, individual cases can occur in any area where mosquitoes live. The spread of the disease is facilitated by infected people and animals that move from country to country.

By itself, an infected person cannot excrete the pathogen and is not dangerous to other people. The circulation of the virus begins when the carrier, the mosquito, appears.

According to the nature of the flow, three degrees of severity and a lightning-fast form are distinguished. The disease begins acutely, with a sharp rise in temperature. The high fever lasts for about three days.

A characteristic symptom is redness of the skin of the face and upper neck. Injected sclera, edematous eyelids and lips are observed. The tongue is thickened, red. Photophobia and lacrimation are characteristic. Significantly enlarged and painful liver and spleen. After a few days, icteric staining of the skin and mucous membranes is formed. The patient's condition is deteriorating. Bleeding from the nose, gums and stomach develops.

Mild to moderate infections usually result in recovery. With a severe degree, death occurs on the sixth day, with a lightning-fast form, a person dies after three days. The cause of death is multiple organ failure.

anthrax

Particularly dangerous infections are anthrax. A disease of bacterial origin. Due to its danger, it is considered as a biological weapon of mass destruction.

The causative agent is the immobile bacillus Bacillus anthracis. It lives in the soil, from where domestic animals can become infected. They become a source of infection for a person - he becomes infected while working with them. The infection enters the human body through airborne and alimentary routes (with food).

Allocate skin and generalized forms of the disease. In the cutaneous form, a characteristic carbuncle is formed, which is covered with a black scab. The generalized form affects almost all internal organs. Mortality in the cutaneous form is almost zero, in the generalized form it is very high.

Tularemia

This is a bacterial zoonotic infection. It is characterized by natural focality. The source of the bacteria are all kinds of rodents, cattle and sheep.

The pathogen can enter the human body in the following ways: contact, when direct contact with infected rodents occurs; alimentary, when a person consumes infected foods and water; aerosol, when dust with bacteria is inhaled; transmissible - when bitten by infected insects.

Depending on how the infection occurred, clinical forms of infection develop. When the bacteria is inhaled, the pulmonary form of tularemia begins. If the infection occurred through food and water, a person becomes ill with anginal-bubonic and alimentary forms. After a bite, an ulcer-bubonic form develops.

Particularly dangerous infections caused by this bacterium are recorded mainly in our country.

The disease proceeds cyclically with a change of four periods. Characterized by an acute onset, high fever, malaise. A typical symptom is pain in the lower back and calf muscles. The feverish period can last up to a month.

The features of the appearance of the patient are noted: the face is puffy, hyperemia and cyanosis of the skin; sclera injected; the patient is in euphoria. After the third day of illness, a patchy or petechial rash develops in some patients.

A specific symptom is the defeat of the lymph nodes. This is most clearly seen in the bubonic form. The nodes increase several times, solder with the surrounding tissues. The skin over them is inflamed. The prognosis for tularemia is favorable, deaths are observed in 1% of cases.

Flu

This infection is also of viral origin. It is characterized by seasonality, damage to the respiratory tract and a high incidence of complications. The common human influenza caused by the H1N1 virus is not included in the group of quarantine infections.

The list of especially dangerous infections includes the avian influenza virus - H5N1. It causes severe intoxication, lung damage with the development of respiratory distress syndrome. The source of infection is migratory waterfowl.

A person becomes infected when caring for such birds, as well as when eating infected meat. In addition, the virus shows the ability to circulate among people.

The disease begins acutely, with a high fever. It can last up to two weeks. Three days after infection, a catarrhal syndrome develops. It is manifested by bronchitis and laryngitis. In the same period, most patients develop viral pneumonia. Lethality reaches 80%.

Prevention measures

Prevention of especially dangerous infections is carried out jointly by all countries belonging to the World Health Organization. In addition, each state individually implements a set of preventive measures.

The problems of particularly dangerous infections lie in the fact that due to the developed transport capabilities, the risk of importing pathogens of these diseases to different countries increases. For prevention, control is carried out at all borders of countries: land, air, sea.

Employees of international vehicles, airports, train stations undergo special training in recognizing quarantine infections and measures to take.

With any suspicion of a dangerous infection in a person, he is placed in an isolated room and medical assistance is called. Additionally, an emergency notification is sent to the SES. Employees who came into contact with the sick person are also isolated. Everyone is prescribed drugs for emergency prophylaxis.

Dangerous infections during pregnancy - most often this is an indication for its termination. All viruses are able to cross the placenta and infect the fetus. He usually dies in utero.

For the treatment of especially dangerous infections, a person is placed in a separate box of an infectious diseases hospital. Medical personnel should not leave the hospital for the entire duration of treatment. For medical manipulations and other work with the patient, it is mandatory to use special protective suits. They are used to protect personnel from infection.

Modern treatment consists in the use of appropriate antibacterial and antiviral drugs. Pathogenetic and symptomatic agents are also used for treatment.

These infections are dangerous with high mortality, so it is very important to observe preventive measures. To reduce the incidence, specialized laboratories are working on the creation of new highly effective drugs.

Regional State Budgetary Institution of Healthcare

"Center for Medical Prevention of the City of Stary Oskol"

Restriction of entry and exit, export of property, etc.,

Export of property only after disinfection and permission of the epidemiologist,

Strengthening control over food and water supply,

Normalization of communication between separate groups of people,

Disinfection, deratization and disinfestation.

Prevention of especially dangerous infections

1. Specific prevention of especially dangerous infections is carried out by a vaccine. The purpose of vaccination is to induce immunity to the disease. Vaccination can prevent infection or significantly reduce its negative consequences. Vaccination is divided into planned and epidemic indications. It is carried out with anthrax, plague, cholera and tularemia.

2. Emergency prophylaxis for persons who are at risk of contracting a particularly dangerous infection is carried out with antibacterial drugs (anthrax).

3. For prevention and in cases of illness, immunoglobulins (anthrax) are used.

Anthrax Prevention

Vaccine use

A live vaccine is used to prevent anthrax. Vaccinations are subject to workers associated with animal husbandry, workers in meat processing plants and tanneries. Revaccination is carried out in a year.

The use of anthrax immunoglobulin

Anthrax immunoglobulin is used to prevent and treat anthrax. It is administered only after an intradermal test. When using the drug for therapeutic purposes, anthrax immunoglobulin is given as soon as the diagnosis is established. In emergency prophylaxis, anthrax immunoglobulin is administered once. The drug contains antibodies against the pathogen and has an antitoxic effect. For seriously ill patients, immunoglobulin is administered for therapeutic purposes for health reasons under the cover of prednisolone.

Use of antibiotics

Antibiotics are used as a prophylactic measure when necessary for emergency indications. All persons who have contact with sick and infected material are subject to antibiotic therapy.

Anti-epidemic measures

Identification and strict accounting of disadvantaged settlements, livestock farms and pastures.

Establishing the time of the incident and confirming the diagnosis.

Identification of a contingent with a high degree of risk of disease and the establishment of control over the conduct of emergency prevention.

Medical and sanitary measures for plague

Plague patients and patients with suspected disease are immediately transported to a specially organized hospital. Patients with pneumonic plague are placed one at a time in separate wards, with bubonic plague - several in one ward.

After discharge, patients are subject to a 3-month follow-up.

Contact persons are observed for 6 days. In case of contact with patients with pneumonic plague, prophylaxis with antibiotics is carried out for contact persons.

Plague Prevention(vaccination)

Preventive immunization of the population is carried out when a mass spread of plague among animals is detected and a particularly dangerous infection is imported by a sick person.

Scheduled vaccinations are carried out in regions where there are natural endemic foci of the disease. A dry vaccine is used, which is administered once intradermally. It is possible to re-administer the vaccine after a year. After vaccination with the anti-plague vaccine, immunity persists for a year.

Vaccination is universal and selective - only to the threatened contingent: livestock breeders, agronomists, hunters, purveyors, geologists, etc.

Re-vaccinated after 6 months. persons at risk of re-infection: shepherds, hunters, agricultural workers and employees of anti-plague institutions.

Maintenance personnel are given prophylactic antibacterial treatment.

Anti-epidemic measures for plague

The identification of a plague patient is a signal for the immediate implementation of anti-epidemic measures, which include:

Carrying out quarantine measures. The introduction of quarantine and the determination of the quarantine territory is carried out by order of the Extraordinary Anti-Epidemic Commission;

Contact persons from the focus of the plague are subject to observation (isolation) for six days;

Implementation of a set of measures aimed at the destruction of the pathogen (disinfection) and the destruction of carriers of the pathogen (deratization and disinsection).

When a natural focus of plague is detected, measures are taken to exterminate rodents (deratization).

If the number of rodents living near people exceeds the 15% limit of their falling into traps, measures are taken to exterminate them.

Deratization is of 2 types: preventive and destructive. General sanitary measures, as the basis for the fight against rodents, should be carried out by the entire population.

Epidemic threats and economic damage caused by rodents will be minimized if derat control is carried out in a timely manner.

Anti-plague suit

Work in the focus of the plague is carried out in an anti-plague suit. The anti-plague suit is a set of clothing that is used by medical personnel when working in conditions of possible infection with a particularly dangerous infection - plague and smallpox. It protects the respiratory organs, skin and mucous membranes of personnel involved in medical and diagnostic processes. It is used by the sanitary and veterinary services.

Medical-sanitary and anti-epidemic measures for tularemia

epidemic surveillance

Tularemia surveillance is the continuous collection and analysis of episode and vector data.

Prevention of tularemia

A live vaccine is used to prevent tularemia. It is designed to protect humans in tularemia foci. The vaccine is administered once, starting from the age of 7 years.

Anti-epidemic measures for tularemia

Anti-epidemic measures for tularemia are aimed at the implementation of a set of measures, the purpose of which is the destruction of the pathogen (disinfection) and the destruction of the carriers of the pathogen (deratization and disinfestation).

Preventive actions

Anti-epidemic measures carried out in time and in full can lead to a rapid cessation of the spread of especially dangerous infections, localize and eliminate the epidemic focus in the shortest possible time. Prevention of especially dangerous infections - plague, cholera, anthrax and tularemia is aimed at protecting the territory of our state from the spread of especially dangerous infections.

Main literature

1. Bogomolov B.P. Differential diagnosis of infectious diseases. 2000

2. Lobzina Yu.V. Selected issues of therapy of infectious patients. 2005

3. Vladimirova A.G. infectious diseases. 1997

Particularly dangerous infections (SDIs) or infectious diseases are diseases that are characterized by a high degree of contagiousness. They appear suddenly and spread rapidly, are characterized by a severe clinical picture and a high degree of mortality. What are these pathologies, and what preventive measures to take in order not to get infected, read on.

What is this list?

Especially dangerous infections include a conditional group of acute contagious human diseases that correspond to two characteristics:

may appear suddenly, quickly and massively spread;
are severe and have a high mortality rate.

The list of HROs was first presented at the 22nd session of the World Health Organization (WHO) on July 26, 1969. In addition to the list, the assembly also established the International Health Regulations (IHR). They were updated in 2005 at the 58th session of the WHO.

According to the new amendments, the assembly has the right to draw conclusions about the state of certain diseases in the country, both according to official state reports and media reports.

WHO has been given considerable authority in the medical regulation of infectious diseases caused by AGI.

It is important to note that today in world medicine there is no concept of "OOI". This term is mainly used in the CIS countries, and in the world practice, AEs mean infectious diseases that are included in the list of events that may pose an excessive danger to the health care system on an international scale.

List of OOI

The World Health Organization has compiled a whole list of more than a hundred diseases that can quickly and massively spread among the population. Initially, according to 1969 data, this list included only 3 diseases:

plague;
cholera;
anthrax.

However, later the list was significantly expanded and all the pathologies that were included in it were conditionally divided into 2 groups:

1. Diseases that are unusual and may affect public health. These include:

smallpox;
polio;
severe acute respiratory syndrome.

2. Diseases, any manifestation of which is assessed as a threat, since these infections can have a serious impact on public health and quickly spread internationally. This also includes diseases that represent a regional or national problem. These include:

cholera
pneumonic plague;
yellow fever;
hemorrhagic fevers (Lassa, Marburg, West Nile fever);
dengue fever;
Rift Valley fever;
meningococcal infection.

In Russia, two more infections have been added to these diseases - anthrax and tularemia.

All these pathologies are characterized by a severe course, a high risk of mortality, and, as a rule, form the basis for biological weapons of mass destruction.

Classification of especially dangerous infections

All OOIs are classified into three types:

1. Convention diseases. Such infections are subject to international sanitary regulations. It:

bacterial pathologies (plague and cholera);
viral diseases (monkeypox, hemorrhagic viral fevers).

2. Infections that require international surveillance, but are not subject to joint activities:

(typhus and relapsing fever, botulism, tetanus);
viral (, poliomyelitis, influenza, rabies, foot and mouth disease);
protozoan (malaria).

3. Not subject to WHO supervision, are under regional control:

anthrax;
tularemia;
brucellosis.

The most common OOI

The most common dangerous infections should be considered separately.

Plague

An acute especially dangerous disease that refers to. The source and spreader of the infection are rodents (mainly rats and mice), and the causative agent is a plague bacillus that is resistant to environmental conditions. Plague is transmitted primarily through transmissible flea bites. Already from the beginning of the manifestation of the disease, it proceeds in an acute form and is accompanied by a general intoxication of the body.

Significant symptoms include:

high fever (temperature can rise to 40 ° C);
unbearable headache;
the tongue is covered with a white coating;
hyperemia of the face;
delirium (in advanced cases, when the disease is not treated correctly);
expression of suffering and horror on the face;
hemorrhagic eruptions.

Plague is treated with antibiotics (streptomycin, terramycin). The pulmonary form always ends in death, as acute respiratory failure occurs - the patient dies within 3-4 hours.

Acute intestinal infection with a severe clinical picture, a high mortality rate and an increased prevalence. The causative agent is Vibrio cholerae. Infection occurs mainly through contaminated water.

Symptoms:

sudden profuse diarrhea;
profuse vomiting;
decreased urination due to dehydration;
dryness of the tongue and oral mucosa;
decrease in body temperature.

The success of therapy largely depends on the timeliness of the diagnosis. Treatment involves taking antibiotics (tetracycline) and intravenous plentiful administration of special solutions to make up for the lack of water and salts in the patient's body.

smallpox

One of the most highly contagious infections on the planet. Refers to anthroponotic infections, only people get sick with it. The transmission mechanism is airborne. The source of the variola virus is considered to be an infected person. The infection is also transmitted from the infected mother to the fetus.

Not a single case of smallpox has been reported since 1977! However, smallpox viruses are still stored in bacteriological laboratories in the United States and Russia.

Symptoms of infection:

sudden increase in body temperature;
sharp pains in the lumbar region and sacrum;
rash on inner thighs, lower abdomen.

Treatment of smallpox begins with the immediate isolation of the patient, the basis of therapy is gamma globulin.

Yellow fever

Acute hemorrhagic transmissible infection. Source - monkeys, rodents. The carriers are mosquitoes. Distributed in Africa and South America.

Symptoms of the course of the disease:

redness of the skin of the face and neck in the first stage of the disease;
swelling of the eyelids and lips;
thickening of the tongue;
lacrimation;
pain in the liver and spleen, an increase in the size of these organs;
redness is replaced by yellowness of the skin and mucous membranes.

If the diagnosis is not made in time, the patient's state of health worsens every day, bleeding from the nose, gums and stomach is noted. Possible death from multiple organ failure. The disease is easier to prevent than to treat, so the population is vaccinated in areas where cases of pathology are frequent.

An infection of a zoonotic nature is considered as a weapon of mass destruction. The causative agent is a motionless bacillus bacillus that lives in the soil, from where animals become infected. The main carrier of the disease is considered to be cattle. The ways of human infection are airborne and alimentary. There are 3 types of the disease, which will depend on the symptoms:

Cutaneous. The patient develops a spot on the skin, which eventually turns into an ulcer. The disease is severe, possibly fatal.
Gastrointestinal. There are such signs: a sudden increase in body temperature, hematemesis, abdominal pain, bloody diarrhea. As a rule, this form is fatal.
Pulmonary. Runs the hardest. There is a high temperature, bloody cough, disturbances in the functioning of the cardiovascular system. A few days later the patient dies.

Treatment consists of taking antibiotics, but more importantly, the introduction of a vaccine that prevents infection.

Tularemia

Bacterial zoonotic infection. Source - rodents, cattle, sheep. The causative agent is a gram-negative rod. The mechanism of penetration into the human body is contact, alimentary, aerosol, transmissible.

Symptoms:

heat;
general malaise;
pain in the lower back and calf muscles;
skin hyperemia;
damage to the lymph nodes;
macular or petechial rash.

Compared to other OOIs, tularemia is 99% treatable.

Flu

The list of AEs includes avian influenza, a severe viral infection. The source of infection is migratory waterfowl. A person can get sick if the infected birds are not properly cared for or if the meat of an infected bird is eaten.

Symptoms:

high fever (may last up to several weeks);
catarrhal syndrome;
viral pneumonia, from which the patient dies in 80% of cases.

quarantine infections

This is a conditional group of infectious diseases, in which quarantine of one degree or another is imposed. It is not equivalent to AIO, but both groups include many infections that require the imposition of strict state quarantine with the involvement of military forces in order to restrict the movement of potentially infected people, protect lesions, etc. Such infections include, for example, smallpox and pulmonary plague.

It is worth noting that recently WHO has made several statements that it is inappropriate to impose strict quarantine when cholera occurs in a particular country.

There are the following methods for diagnosing OOI:

1. Classic:

microscopy - the study of microscopic objects under a microscope;
polymerase chain reaction (PCR);
agglutination reaction (RA);
immunofluorescence reaction (RIF, Koons method);
bacteriophage test;
a bioassay on an experimental animal whose immunity is artificially reduced.

2. Accelerated:

exciter indication;
pathogen antigens (AG);
reverse passive hemagglutination reaction (RPHA);
coagglutination reaction (RCA);
enzyme immunoassay (ELISA).

Prevention

Prevention of OOI is carried out at the highest level in order to prevent the spread of diseases throughout the state. The complex of primary preventive measures includes:

temporary isolation of the infected with further hospitalization;
diagnosis, convening a council;
collection of anamnesis;
providing first aid to the patient;
sampling material for laboratory research;
identification of contact persons, their registration;
temporary isolation of contact persons until their infection is excluded;
carrying out current and final disinfection.

Depending on the type of infection, preventive measures may vary:

Plague. In natural foci of distribution, observations are made of the number of rodents, their examination and deratization. In adjacent areas, the population is vaccinated with a dry live vaccine subcutaneously or cutaneously.
. Prevention also includes work with foci of infection. Patients are being identified, isolated, and all persons in contact with the infected are being isolated. Hospitalization of all suspicious patients with intestinal infections is carried out, disinfection is carried out. In addition, it is required to control the quality of water and food in the area. If there is a real threat, quarantine is introduced. When there is a threat of spread, immunization of the population is carried out.
. Identification of sick animals with the appointment of quarantine, disinfection of fur clothing in case of suspected infection, immunization according to epidemic indicators is carried out.
smallpox. Prevention methods include vaccination of all children from the age of 2, followed by revaccination. This measure virtually eliminates the occurrence of smallpox.

Laying for especially dangerous infections sanpin. Tactics of a nurse in identifying especially dangerous infections and features of work in an epidemiological focus

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