Assessing efficiency of epidemiological security system for the medical organization

Abstract

Healthcare workers comprise a high-risk cohort of developing diverse infections caused by opportunistic and pathogenic microbes. Among medical workers of the Russian Federation the first rank place in occupational diseases is held by tuberculosis of respiratory organs accounting for more than half of all registered occupational diseases. Moreover, its high incidence is particularly noted among forensic specialists and medical workers in anti-tuberculosis institutions. The organization of epidemiological surveillance and tuberculosis prevention medical workers so far remains unsolved both scientifically and practically. On one hand, high TB incidence in pattern of clinical TB forms may be due to higher percentage of patients suffering from common, advanced and complicated forms of drug-resistant Mycobacterium tuberculosis infection as well as rise of socially significant co-infections (HIV+tuberculosis) among the population. Specialists from the Regional Bureau of Forensic Medicine were examined during 2009–2018 time period by using molecular genetic approaches to analyze 4948 wash samples (2009–2013 — 3649 samples; 2014–2018 — 1299 swabs) collected from various environmental objects, medical overalls and hands of medical specialists while performing professional duties in autopsy rooms, laboratories as well as facilities housekeeping department. It was demonstrated that M. tuberculosis DNA was detected in 353 and 81 swabs in 2009–2013 and 2014–2018 time period. Based on intensity of contacting with pathogenic biological agents, production technologies applied in the Regional Bureau of Forensic Medicine were divided into two groups. M. tuberculosis contamination in diverse facilities or any item as well as a contamination risk for medical worker hands and medical overalls were evaluated in accordance with professional duties assigned to individual specialists, followed by calculating significant differences in groups exami ned. It was found that some facilities and environmental items most exposed to a high-risk M. tuberculosis contamination were identified, which are involved in pathogen spreading from autopsy rooms outside to the remainder of facilities. It allowed for autho rities to improve performance of activities ensuring epidemiological security for attending specia lists that not only resulted in significantly decreased incidence of M. tuberculosis DNA detection, but also lowered TB incidence rate among them from 292.4 down to 280.9 cases and 46.3 per 10 thousand workers during 2007–2009 and 2017–2018 time period, respectively.

Keywords

• nosocomial tuberculosis
• medical personnel
• molecular-genetic researches
• mycobacteria
• epidemiological safety of medical activity