Measures to prevent outbreaks of hospital infections

On the basis of the analysis of 69 outbreaks of hospital infections registered in the USSR in 1986-1989, as well as additional observations made by the authors, a number of factors which determined the present state of the problems concerning this kind of morbidity in the USSR were established: an insufficient level (in cases of enteric infections) or a low level (in cases of purulent septic infections) of etiological diagnosis; poor efficiency of the epidemiological investigation of outbreaks; defects in the work on the prophylactic detection of potential sources of infection among medical staff, parturient women or mothers taking care of their infants. Some possible solutions on these aspects were proposed. Cases of outbreaks of hospital infections among newborns were used as an example demonstrating that such outbreaks were caused mainly by breaches of antiepidemic and sanitary rules in respective hospitals; thus, in one-third of the cases of outbreaks such breaches were observed in maternity clinics with insufficient material and technical equipment. The prevention of these breaches is considered to be the main road to the solution of the whole problem of the prevention of epidemic outbreaks in hospitals.     

The epidemic spread of the influenza A and B viruses in the USSR in 1985-1986

The data on the spread of influenza A and B in the autumn and winter of 1985-1986 are given. Three epidemics caused by all presently circulating viruses, B, A (H3N2) and A (H1N1), were registered in the USSR. Of these, the greatest one was the epidemic of influenza B; morbidity rate among the adult population during this epidemic was at the level with the morbidity rate characteristic of the epidemics registered at the period of 1962-1972, and morbidity rate among children, especially school children, was even higher.     

The epidemiological characteristics of meningococcal infection in the USSR

The epidemiological analysis of morbidity in meningococcal infection in the USSR in the period of 1969-1987 showed that the second rise of the morbidity level occurred in 1984 and was followed by its decrease in most of the regions of the USSR. This study also revealed that the characteristic feature of the second rise of morbidity in meningococcal infection was a considerable involvement of young children (aged up to 3 years), as well as the increased etiological role of group B meningococci in cases of meningococcal infection and the circulation of these microorganisms among the population. Besides, the preservation of the etiological importance of group A meningococci in many regions of the USSR, especially among adults, was noted. In this connection, the use of Soviet group A meningococcal polysaccharide vaccine on epidemiological indications was considered to be epidemiologically substantiated.     

Water-borne outbreaks of rotavirus infections

The clinico-epidemiological characteristics of group rotavirus infection observed in one settlement in March-April is presented. 173 cases of infection were registered in all age groups (children under 7 years constituted only 10.4% of the patients). In most of the apartments found to be the foci of infection only one patient was registered. The virological study of fecal samples from 24 patients showed the presence of human rotaviruses in the feces of 10 patients (41.7%). Neutralizing antibodies in titers of 1:4 to 1:64 were detected in all taken paired sera (21). THe clinical study of 53 hospitalized patients showed that in all cases the infectious process had acute beginning. In most patients the disease took mild forms. The peculiarities of the distribution of the patients in different age groups, the location of the foci of infection and its seasonal character, as well as some objective data on the presence of pollutions in the water mains, indicated that this infection could spread through water via the system of centralized water supply.     

Epidemiological characteristics of postoperative wound infections in a trauma center hospital

The occurrence of cross infections in osteomyelitis patients has been proved by clinical, microbiological, and epidemiological methods. The patients are infected mainly in the dressing room for patients with purulent processes; the working conditions in this dressing room do not preclude the possibility of cross infections.     

Vntr-genotyping of Francisella tularensis strains isolated in the former USSR territory and some European countries during epizootics in 1988 - 1989

Retrospective VNTR-analysis of 159 Francisella tularensis subsp. holarctica strains isolated in December 1988 - February 1989 in former USSR and some European countries was carried out. Analysis of heterogenic genotypes of strains allow to subdivide them into 30 groups of variants by individual genotypes, while cluster analysis--to subdivide them in 7 clusters with different number of compositions. The predominance of genotype C1 strains isolated on the Rostov and Archangelsk regions and the Crimea was established. F. tularensis strains isolated in winter time 1988 - 1989 in different geographic regions were supposed to be resident cultures typical for their biotope in natural focus of disease.     

The molecular epidemiology of poliomyelitis: the characteristics of the strains isolated from patients in Moscow in 1973-1986

Eleven virus strains isolated from poliomyelitis patients in Moscow in 1973-1986 were analyzed by the method of oligonucleotide mapping of RNA. The genome of the isolates showed considerable similarity to the genomes of Sabin's vaccine strains and mainly to the vaccine strain of antigenic type 2. The conclusion was made that the sporadic cases of poliomyelitis registered in this region were etiologically linked with the vaccine strains of poliomyelitis virus. Only in one case the disease appeared in the recipient of the vaccine, in all other cases the patients were infected through contacts.     

Epidemiologic analysis morbidity with meningococcal infections in the USSR]

The authors present the analysis of the incidence of epidemic cerebrospinal meningitis in the USSR from 1937 to 1974, and of meningococcus infection from 1965 to 1974. A rise of the meningococcus infection incidence from 1969 to 1974 was recorded 28 years after the elevation of 1940-1942 and was 1.5 times below this latter rise. The rise in 1969-1974 was characterized by marked signs peculiar to the infection with the droplet transmission mechanism; among those who contracted the disease prevalence was seen among children aged under 14 years (63-72%). A marked affection of juveniles was noted. Three types of the dynamic of the meningococcus infection incidence in the republics located in different climatic-geographical zones of the USSR were noted: slow, gradual increase of the level, interrupted and explosive. Such character was determined in the dynamics of the seasonal elevations of morbidity. Antiepidemic measures including a complex of nonspecific measures could not be assessed as sufficiently effective. This finds reflection in the natural course of the epidemic process of the meningococcus infection which remains uncontrolled. From the patients with generalized form of the disease meningococci of group A were isolated in 80-100% of cases, from the number of those typed. The group-specific reference of the nasopharyngeal strains depended on the epidemic situation: strains of serological group A prevailed at the period of the morbidity elevation, and other serological groups (particularly of C and B) increased at its decline.     

The characteristics of 90Sr accumulation and elimination in residents of the Urals region in the period of 1957-1988

A number of radiation accidents occurred at the "Mayak" plutonium production complex (Southern Urals, Russia) in 1950-60s that resulted in environmental contamination of large territories in the Southern and Middle Urals with long-lived radionuclides (90Sr, 137Cs). The results of long-term radiological monitoring were compiled into special databases at the Urals Research Center for Radiation Medicine, which allow the study of 90Sr behaviour in the environment and its accumulation in the human body. Retrospective analysis of the data on postmortem measurements of 90Sr in bones performed on residents of the Urals region over 1957-1988 were conducted for the first time. A time-dependence of 90Sr accumulation in the human body upon its density in soils was observed. Age and gender characteristics of 90Sr retention in bones were studied. It was shown that the levels of 90Sr in residents of large territories north and north-east of Chelyabinsk region, and of bordering territories of Sverdlovsk region were several times higher than the average values for the Russian Federation. Based on the measurements the direct dependence of 90Sr content in the skeleton on 90Sr density in soils was observed 30 years after the 1957 accident (the so called "Kyshtym accident"). However, for individual settlements this dependence may be weakened as a result of the influence of different biological and social factors. No influence of gender on 90Sr accumulation in the skeleton was found in the study. The analysis of age characteristics of 90Sr accumulation in bone, as influenced by skeleton growth and maturation, showed maximal levels of 90Sr from global fallout to be accumulated in bones of the persons born in 1949-1955.     

The characteristics of the epidemic process of hospital infections in maternity hospitals influenced by an operational management system]

As shown in this investigation, the introduction of the algorithmic system of the control of the epidemiological process of hospital infections (HI) in maternity hospitals makes it possible to reduce HI-induced morbidity and mortality rates more than by half, as well as to alter their nosological and age structures, without additional economic expenditures and under the existing material conditions of maternity hospitals. Such success is achieved by the observation of infection precursors indicating the activation of the mechanisms of the transmission of Staphylococcus, Escherichia and Klebsiella infections and the risk factors (preconditions) facilitating this activation with the immediate involvement of all relevant specialists into action at the stage when an increase in the contamination of newborns and puerperal women is noted and not as late as at the stage of morbidity and mortality.     

Detection of enterotoxic strains of Escherichia coli in children with diarrhea treated at the Child Health Center 1986-1988

Studies on detection of enterotoxigenic strains of E. coli were carried in 1986-1988. During this time 2324 rectal swabs from children with diarrhoea symptoms were tested. On the whole 701 E. coli were selected. The ability to produce thermolabile enterotoxin by E. coli strains was evaluated by three methods: Elek test, passive immunohemolysis and ELISA. Among selected E. coli strains enterotoxigenic strains accounted for 21.8% in 1986, 16.3% in 1987 and 28.2% in 1988.     

Surveillance for outbreaks of respiratory tract infections in nursing homes

BACKGROUND: Outbreaks of respiratory tract infections are common in long-term care facilities for older people. The objective of our study was to determine both the frequency of such outbreaks and their clinical and epidemiological features. METHODS: Prospective surveillance for outbreaks of respiratory tract infections and a retrospective audit of surveillance records were conducted in 5 nursing homes in metropolitan Toronto over 3 years. The clinical manifestations of infected residents were identified and microbiological investigations for causal agents were conducted. RESULTS: Sixteen outbreaks, involving 480 of 1313 residents, were identified prospectively during 1 144 208 resident-days of surveillance, for an overall rate of 0.42 infections per 1000 resident-days. Another 30 outbreaks, involving 388 residents, were identified retrospectively. Outbreaks occurred year-round, with no seasonal pattern. Pathogens included influenza virus, parainfluenza virus, respiratory syncytial virus, Legionella sainthelensi and Chlamydia pneumoniae. Multiple pathogens were detected in 38% (6/16) of the prospectively identified outbreaks. Of the 480 residents in the prospectively identified outbreaks 398 (83%) had a cough, 194 (40%) had fever and 215 (45%) had coryza. Clinical findings were nonspecific and could not be used to distinguish between causal agents. Pneumonia developed in 72 (15%) of the 480 residents, and 58 (12%) required transfer to hospital. The case-fatality rate was 8% (37/480). INTERPRETATION: Our findings emphasize the importance of adequate surveillance for outbreaks of respiratory tract infections in nursing homes and of early diagnosis so that appropriate interventions can be promptly instituted.