Home Orthopedics What actions are prohibited when a patient is identified? Tactics of a nurse in identifying especially dangerous infections and features of work in an epidemiological outbreak

Orthopedics

What actions are prohibited when a patient is identified? Tactics of a nurse in identifying especially dangerous infections and features of work in an epidemiological outbreak

Algorithm for the actions of medical staff when identifying a patient suspected of having an acute respiratory infection

If a patient suspected of having an acute infectious disease is identified, a doctor organizes work in the outbreak. Nursing staff are required to know the scheme for carrying out anti-epidemic measures and carry them out as directed by the doctor and the administration.

Scheme of primary anti-epidemic measures.

I. Measures to isolate the patient at the place where he is identified and work with him.

If a patient is suspected of having acute respiratory infections, health workers do not leave the room where the patient was identified until the consultants arrive and perform the following functions:

1. Notification of suspected OI by phone or through the door (knock on the door to attract the attention of those outside the outbreak and verbally convey information through the door).
2. Request all settings for the general public health inspection (package for prophylaxis of medical staff, packing for collecting material for research, packing with anti-plague suits), disinfectant solutions for yourself.
3. Before receiving emergency prevention treatment, make a mask from available materials (gauze, cotton wool, bandages, etc.) and use it.
4. Before the installation arrives, close the windows and transoms using available means (rags, sheets, etc.), and close the cracks in the doors.
5. When receiving the instructions to prevent your own infection, carry out emergency infection prevention, put on an anti-plague suit (for cholera, a lightweight suit - a robe, an apron, or possibly without them).
6. Cover windows, doors, and grilles with adhesive tape (except for cholera outbreaks).
7. Provide emergency assistance to the patient.
8. Collect material for research and prepare records and referrals for research to the bacteriological laboratory.
9. Conduct routine disinfection of the premises.

II. Measures to prevent the spread of infection.

Head department, the administrator, upon receiving information about the possibility of identifying DUI, performs the following functions:

1. Closes all doors of the floor where the patient is identified and sets up posts.
2. At the same time, organizes the delivery to the patient’s room of all necessary equipment, disinfectants and containers for them, and medications.
3. Admission and discharge of patients is stopped.
4. Notifies the higher administration about the measures taken and awaits further orders.
5. Lists of contact patients and medical staff are compiled (taking into account close and distant contact).
6. Explanatory work is carried out with contact patients in the outbreak about the reason for their delay.
7. Gives permission for consultants to enter the fireplace and provides them with the necessary costumes.

Exit from the outbreak is possible with the permission of the head physician of the hospital in accordance with the established procedure.

Rabies

Rabies - acute illness warm-blooded animals and humans, characterized by progressive damage to the central nervous system (encephalitis), fatal to humans.

The causative agent is a neurotropic virus of the Rabdoviridae family of the Lyssavirus genus. It has a bullet shape and reaches a size of 80-180 nm. The nucleocapsid of the virus is represented by single-stranded RNA. The exceptional affinity of the rabies virus for the central nervous system was proven by the work of Pasteur, as well as by microscopic studies of Negri and Babes, who invariably found peculiar inclusions, the so-called Babes-Negri bodies, in sections of the brains of people who died from rabies.

Source – domestic or wild animals (dogs, cats, foxes, wolves), birds, bats.

Epidemiology. Human infection with rabies occurs as a result of bites by rabid animals or when they salivate the skin and mucous membranes, if there are microtraumas on these covers (scratches, cracks, abrasions).

The incubation period is from 15 to 55 days, in some cases up to 1 year.

Clinical picture. Conventionally, there are 3 stages:

1. Harbingers. The disease begins with an increase in temperature to 37.2–37.5°C and malaise, irritability, and itching at the site of the animal’s bite.

2. Excitement. The patient is excitable, aggressive, and has a pronounced fear of water. The sound of pouring water, and sometimes even the sight of it, can cause convulsions. Increased salivation.

3. Paralysis. The paralytic stage lasts from 10 to 24 hours. In this case, paresis or paralysis develops lower limbs, paraplegia is more common. The patient lies motionless, muttering incoherent words. Death occurs from paralysis of the motor center.

Treatment. Wash the wound (bite site) with soap, treat with iodine, and apply a sterile bandage. Therapy is symptomatic. Mortality – 100%.

Disinfection. Treatment of dishes, linen, and care items with a 2% chloramine solution.

Precautionary measures. Since the patient’s saliva contains the rabies virus, the nurse must work in a mask and gloves.

Prevention. Timely and full implementation vaccinations.

Yellow fever

Yellow fever is an acute viral natural focal disease with transmissible transmission of the pathogen through mosquito bites, characterized by a sudden onset, high biphasic fever, hemorrhagic syndrome, jaundice and hepatorenal failure. The disease is common in tropical regions of America and Africa.

Etiology. The causative agent, yellow fever virus (flavivirus febricis), belongs to the genus flavivirus, family Togaviridae.

Epidemiology. There are two epidemiological types of yellow fever foci - natural, or jungle, and anthropourgic, or urban.
In the case of the jungle form, the reservoir of viruses is marmoset monkeys, possibly rodents, marsupials, hedgehogs and other animals.
The carriers of viruses in natural foci of yellow fever are mosquitoes Aedes simpsoni, A. africanus in Africa and Haemagogus sperazzini and others. Infection of humans in natural foci occurs through the bite of an infected mosquito A. simpsoni or Haemagogus, which is capable of transmitting the virus 9-12 days after the infectious bloodsucking.
The source of infection in urban yellow fever foci is a sick person in the period of viremia. Virus carriers in urban areas are Aedes aegypti mosquitoes.
Currently, sporadic incidence and local group outbreaks are being recorded in the tropical forest zone in Africa (Zaire, Congo, Sudan, Somalia, Kenya, etc.), South and Central America.

Pathogenesis. The inoculated yellow fever virus hematogenously reaches the cells of the macrophage system, replicates in them for 3-6, less often 9-10 days, then re-enters the blood, causing viremia and clinical manifestation infectious process. Hematogenous dissemination of the virus ensures its penetration into the cells of the liver, kidneys, spleen, bone marrow and other organs, where pronounced dystrophic, necrobiotic and inflammatory changes develop. The most typical occurrences are the occurrence of foci of liquefaction and coagulation necrosis in the mesolobular parts of the hepatic lobule, the formation of Councilman's bodies, and the development of fatty and protein degeneration of hepatocytes. As a result of these injuries, cytolysis syndromes develop with an increase in ALT activity and a predominance of AST activity, cholestasis with severe hyperbilirubinemia.
Along with liver damage, yellow fever is characterized by the development of cloudy swelling and fatty degeneration in the epithelium of the renal tubules, the appearance of areas of necrosis, causing the progression of acute renal failure.
At favorable course disease, a strong immunity is formed.

Clinical picture. There are 5 periods during the course of the disease. The incubation period lasts 3-6 days, less often it extends to 9-10 days.
The initial period (hyperemia phase) lasts for 3-4 days and is characterized by sudden increase body temperature up to 39-41 °C, severe chills, intense headache and diffuse myalgia. As a rule, patients complain of severe pain in the lumbar region, they experience nausea and repeated vomiting. From the first days of illness, most patients experience pronounced hyperemia and puffiness of the face, neck and upper chest. The vessels of the sclera and conjunctiva are clearly hyperemic (“rabbit eyes”), photophobia and lacrimation are noted. You can often observe prostration, delirium, psychomotor agitation. The pulse is usually rapid, and bradycardia and hypotension develop in the following days. The persistence of tachycardia may indicate an unfavorable course of the disease. In many, the liver is also enlarged, and at the end of the initial phase, one can notice icterus of the sclera and skin, the presence of petechiae or ecchymoses.
The hyperemia phase is replaced by short-term (from several hours to 1-1.5 days) remission with some subjective improvement. In some cases, recovery occurs in the future, but more often a period of venous stasis follows.
The patient's condition noticeably worsens during this period. Back to more high level the temperature rises, jaundice increases. The skin is pale, in severe cases cyanotic. A widespread hemorrhagic rash appears on the skin of the trunk and limbs in the form of petechiae, purpura, and ecchymoses. Significant bleeding of the gums, repeated vomiting with blood, melena, nasal and uterine bleeding are observed. In severe cases of the disease, shock develops. The pulse is usually rare, weak filling, blood pressure is steadily decreasing; Oliguria or anuria develops, accompanied by. Toxic encephalitis is often observed.
The death of patients occurs as a result of shock, liver and kidney failure on the 7-9th day of illness.
The duration of the described periods of infection is on average 8-9 days, after which the disease enters the convalescence phase with slow pathological changes.
Among local residents In endemic areas, yellow fever may be mild or without jaundice and hemorrhagic syndrome, which makes it difficult to identify patients in a timely manner.

Forecast. Currently, the fatality rate for yellow fever is approaching 5%.
Diagnostics. Recognition of the disease is based on identifying a characteristic clinical symptom complex in individuals belonging to the category high risk infection (unvaccinated people who visited jungle foci of yellow fever within 1 week before the onset of the disease).

The diagnosis of yellow fever is confirmed by the isolation of a virus from the patient’s blood (in the initial period of the disease) or to it (RSK, NRIF, RTPGA) in later periods of the disease.

Treatment. sick yellow fever hospitalized in hospitals protected from mosquitoes; carry out prevention of parenteral infection.
Therapeutic measures include a complex of anti-shock and detoxification agents, correction of hemostasis. In cases of progression of hepatic-renal failure with severe azotemia, hemodialysis or peritoneal dialysis is performed.

Prevention. Specific prophylaxis in foci of infection is carried out with live attenuated 17 D and, less often, with the Dakar vaccine. Vaccine 17 D is administered subcutaneously in a dilution of 1:10, 0.5 ml. Immunity develops in 7-10 days and lasts for six years. Vaccinations are registered in international certificates. Unvaccinated persons from endemic areas are quarantined for 9 days.

General organizational issues. When identifying a patient suspected of having plague, cholera, contagious hemorrhagic viral fevers (Ebola, Lassa and cercopithecus fevers) and monkeypox, all primary anti-epidemic measures are carried out upon establishing a preliminary diagnosis based on clinical and epidemiological data. When a final diagnosis is established, measures to localize and eliminate foci of the infections listed above are carried out in accordance with current orders and guidelines for each nosological form.

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

1) identification of the patient;

2) information about the identified patient;

3) clarification of the diagnosis;

4) isolation of the patient with subsequent hospitalization;

5) treatment of the patient;

6) observational, quarantine and other restrictive measures;

7) identification, isolation, and emergency prophylaxis for persons in contact with the patient;

8) provisional hospitalization of patients with suspected plague, cholera, GVL, monkeypox;

9) identification of those who died from unknown causes, pathological autopsy of the corpse with the collection of material for laboratory (bacteriological, virological) research, with the exception of those who died from GVL, disinfection, proper transportation and burial of corpses. Autopsies of those who died from GVL, as well as collection of material from the corpse for laboratory research, are not performed due to the high risk of infection;

10) disinfection measures;

11) emergency prevention of the population;

12) medical surveillance of the population;

13) sanitary control of the external environment (laboratory research possible factors transmission of cholera, monitoring the number of rodents and their fleas, conducting an epizootological survey, etc.);

14) health education.

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

All treatment-and-prophylactic and sanitary-epidemiological institutions must have the necessary supply of medications for etiotropic and pathogenetic therapy; installations for collecting material from patients (corpses) for laboratory research; disinfectants and packs of adhesive plaster for sealing windows, doors, ventilation holes in one office (box, ward); means of personal prevention and individual protection (anti-plague suit type I).

The primary alarm about the identification of a patient with plague, cholera, GVL and monkeypox is made to three main authorities: the chief physician of the medical institution, the emergency medical service station and the chief physician of the territorial SES.

The chief doctor of the SES puts into effect the plan of anti-epidemic measures, informs the relevant institutions and organizations about the case of the disease, including territorial anti-plague institutions.

When carrying out primary anti-epidemic measures after establishing preliminary diagnosis it is necessary to be guided by the following incubation periods: for plague - 6 days, cholera - 5 days, Lassa, Ebola and cercopithecus fevers - 21 days, monkeypox - 14 days.

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

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

Further activities are carried out by specialists from the departments of especially dangerous infections of the SES and anti-plague institutions in accordance with current instructions and comprehensive plans.

Doctor's knowledge of various specializations and basic qualifications early manifestations especially dangerous infections, constant awareness and orientation in the epidemic situation in the country, republic, region, district will allow timely diagnosis of these diseases and take urgent anti-epidemic and treatment and preventive measures. In this regard, a health care professional should suspect the disease of plague, cholera, GVL or monkeypox based on clinical and epidemiological data.

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

The procedure for notifying the chief physician of a hospital, clinic or a person replacing him is determined specifically for each institution. Information about an identified patient to the territorial SES, higher authorities, calling consultants and evacuation teams is carried out by the head of the institution or a person replacing him.

If a patient suspected of suffering from plague, cholera, GVL or monkeypox is identified, the following primary anti-epidemic measures are carried out in a clinic or hospital:

1) measures are taken to isolate the patient at the place of his identification before hospitalization in a specialized infectious diseases hospital;

2) transportable patients are delivered by ambulance to a hospital special for these patients. For non-transportable patients, medical care is provided on the spot with a call to a consultant and an ambulance equipped with everything necessary;

3) a medical worker, without leaving the premises where the patient is identified, notifies the head of his institution about the identified patient by telephone or by messenger; requests relevant medications, stowage of protective clothing, means of personal prevention;

4) entry into and exit from a medical facility is temporarily prohibited;

5) communication between floors is stopped;

6) posts are posted at the office (ward) where the patient was, at the entrance doors of the clinic (department) and on the floors;

8) admission, discharge of patients, and visits by their relatives are temporarily suspended;

9) admission of patients for health reasons is carried out in isolated rooms;

10) in the room where the patient is identified, the windows and doors are closed, the ventilation is turned off and the ventilation holes are sealed with adhesive tape;

11) contact patients are isolated in a separate room or box. If plague, GVL or monkeypox is suspected, contacts in rooms connected through ventilation ducts are taken into account. Lists of identified contact persons are compiled (full name, address, place of work, time, degree and nature of contact);

12) before receiving protective clothing, a medical worker who suspects plague, GVL and monkeypox must temporarily cover his nose and mouth with a towel or mask made from improvised materials (bandage, gauze, cotton wool); if necessary, emergency prophylaxis is provided to medical staff;

13) after receiving protective clothing (an anti-plague suit of the appropriate type), they put it on without removing their own, unless it is heavily contaminated with the patient’s secretions;

14) seriously ill patients are provided with emergency medical care before the arrival of the medical team;

15) using a special sampling device, before the arrival of the evacuation team, the health worker who identified the patient takes materials for bacteriological research;

16) in the office (ward) where the patient is identified, ongoing disinfection is carried out;

17) upon the arrival of a team of consultants or an evacuation team, the health worker who identified the patient carries out all the orders of the epidemiologist;

18) if urgent hospitalization of a patient is required for vital reasons, then the health worker who identified the patient accompanies him to a specialized hospital and carries out the orders of the doctor on duty at the infectious diseases hospital. After consultation with an epidemiologist, the health worker is sent for sanitation, and in case of pneumonic plague, GVL and monkeypox - to the isolation ward.

Protective clothing, procedure for using a protective suit. Anti-plague suit provides protection medical personnel from infection with pathogens of plague, cholera, GVL, monkeypox and other pathogens of pathogenicity groups I-II. It is used when serving a patient in outpatient clinics and hospitals, when transporting (evacuating) a patient, carrying out current and final disinfection (disinsection, deratization), when taking material from a patient for laboratory research, during the autopsy and burial of a corpse, door-to-door visits.

Depending on the nature of the work performed, the following types of protective suits are used:

First type - a full protective suit consisting of overalls or pajamas, a hood (large headscarf), anti-plague robe, cotton-gauze mask (dust respirator), goggles, rubber gloves, socks (stockings), rubber or tarpaulin boots and towels. To autopsy a corpse, you must additionally have a second pair of gloves, an oilcloth apron, and oversleeves.

This type of suit is used when working with patients with pneumonic or septic forms of plague, until a final diagnosis is made in patients with bubonic and cutaneous forms of plague and until the first negative result of a bacteriological study is obtained, as well as with GVL.

Second type - a protective suit consisting of overalls or pajamas, an anti-plague robe, a hood (large headscarf), a cotton-gauze mask, rubber gloves, socks (stockings), rubber or tarpaulin boots and a towel. Used in servicing and providing medical care patients with monkeypox.

Third type- a protective suit consisting of pajamas, an anti-plague robe, a large headscarf, rubber gloves, socks, deep galoshes and a towel. It is used when working with patients with bubonic or cutaneous plague who are receiving specific treatment.

Fourth type - a protective suit consisting of pajamas, medical gown, cap or gauze scarf, socks, slippers or shoes. Used in treating cholera patients. When performing the toilet, the patient wears rubber gloves, and when handling discharge, a mask.

Sets of protective clothing (robe, boots, etc.) must be sized and labeled.

How to put on a suit . An anti-plague suit is put on before entering the outbreak area. Costumes must be put on slowly, in a certain sequence, carefully.

The order of putting on is as follows: overalls, socks, rubber boots, hood or large headscarf, anti-plague robe. When using a phonendoscope, it is worn in front of the headscarf. The ribbon 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 ribbon is secured to the sleeves.

The respirator is put on the face so that the mouth and nose are covered, 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 slightly under the chin. The upper straps of the respirator are tied in a loop at the back of the head, and the lower ones - on the crown (like a sling bandage). Having put on a respirator, cotton swabs are placed on the sides of the wings of the nose.

Glasses must fit well and be checked for reliable fastening of the metal frame to the leather part; the glasses must be rubbed with a special pencil or a piece of dry soap to prevent them from fogging. After putting on the glasses, place a cotton swab on the bridge of the nose. Then gloves are put on, previously checked for integrity. For the belt of the robe with right side lay down a towel. During a postmortem examination of a corpse, a second pair of gloves, an oilcloth (rubberized) apron, and oversleeves are additionally put on.

Procedure for removing the suit. The anti-plague suit is removed after work in a room specially designated for this purpose or in the same room in which the work was carried out, after it has been completely disinfected. To do this, the room must have:

1) a tank with a disinfectant solution (Lysol, carbolic acid or chloramine) for disinfecting a robe, headscarf, towel;

2) a basin with hand sanitizer;

3) a jar with 70% ethyl alcohol for disinfecting glasses and a phonendoscope;

4) a pan with a disinfectant solution or soapy water to disinfect cotton-gauze masks (in the latter case, by boiling for 40 minutes).

When disinfecting a suit with disinfectants, all parts of it are completely immersed in the solution.

If the disinfection of the suit is carried out by autoclaving or in a disinfection chamber, the suit is folded, respectively, into bins or chamber bags, which are treated from the outside with a disinfectant solution.

The suit is removed slowly and in a strictly prescribed manner. After removing part of the suit, gloved hands are immersed in a disinfectant solution. The ribbons of the robe and apron, tied with a loop on the left side, make it easy to remove the suit.

Costumes are removed in the following order:

1) thoroughly wash gloved hands in a disinfectant solution for 1-2 minutes;

2) slowly remove the towel;

3) wipe the oilcloth apron with a cotton swab, generously moistened with a disinfectant solution, remove it, rolling it up from the outside inward;

4) remove the second pair of gloves and sleeves;

5) boots and galoshes are wiped with cotton swabs with a disinfectant solution from top to bottom (a separate swab for each boot);

6) without touching open parts skin, remove the phonendoscope;

7) remove the glasses by pulling them forward and upward, backwards with both hands;

8) the cotton-gauze bandage is removed without touching its outer side;

9) untie the ties of the collar, the belt of the robe and, lowering the upper edge of the gloves, release the ties of the sleeves, remove the robe, wrapping the outer part of it inward;

10) remove the scarf, carefully collecting all its ends in one hand at the back of the head;

11) remove gloves, check them for integrity in a disinfectant solution (but not with air);

12) wash the boots again in a tank of disinfectant solution and remove them.

After removing the anti-plague suit, wash your hands thoroughly with warm water and soap. It is recommended to take a shower after work.

Efficiency and quality of anti-epidemic, diagnostic and therapeutic measures when particularly dangerous infections occur, they largely depend on preliminary preparation medical workers. Preparedness is important medical service polyclinic network, since it is most likely that workers at this level will be the first to meet patients with especially dangerous infections.

When identifying a patient suspected of having an acute infectious disease, all primary anti-epidemic measures are carried out when a preliminary diagnosis is established on the basis of clinical and epidemiological data. When a final diagnosis is established, measures to localize and eliminate foci of particularly dangerous infections are carried out in accordance with current orders and 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 followed by hospitalization;
treatment of the patient;
observational, quarantine and others restrictive measures: identification, isolation, laboratory examination, emergency prophylaxis for persons in contact with the patient; provisional hospitalization of patients with suspected AIO; identification of deaths from unknown causes, pathological anatomicalautopsy of corpses with collection of material for laboratory(bacteriological, virological) research, disinfection, proper transportation and burial of corpses; autopsies of those who died from highly contagious hemorrhagic fevers (Marburg, Ebola, JIacca), as well as collection of material from the corpse for laboratory research, are not performed due to the high risk of infection; disinfection measures; emergency prevention of the population; medical surveillance of the population;
sanitary control of the external environment (laboratory researchpossible transmission factors, monitoring the number of rodents, insects and arthropods, conducting an epizootic study);
health education.

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

All treatment-and-prophylactic and sanitary-epidemiological institutions must have the necessary supply of medications for etiotropic and pathogenetic therapy; installations for collecting material from patients suspected of having acute respiratory infections for laboratory testing; disinfectants and packs of adhesive plaster for sealing windows, doors, ventilation holes in one office (box, ward); means of personal prevention and individual protection (anti-plague suit type I).

Primary alarm about identifying a patient, suspected of OI is carried out in three main instances: the chief physician U30, the emergency medical station and the chief physician of the territorial Center for State Examination and 03.

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

A patient with suspected cholera is sampled by a medical professional. 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 Geological Epidemiology Center and 03. Material from patients with GVL is taken only at the place of hospitalization by laboratory workers performing these studies. The collected material is urgently sent for research to a special laboratory.

When identifying cholera patients, only those persons who communicated with them during the period of clinical manifestations of the disease are considered contacts. Medical workers who have been in contact with patients with plague, GVL or monkeypox (if these infections are suspected) are subject to isolation until a final diagnosis is made or for a period equal to the maximum incubation period. Persons who have been in direct contact with a cholera patient

according to the instructions of an epidemiologist, they should be isolated or left under medical supervision.

When establishing a preliminary diagnosis and carrying out primary anti-epidemic measures, one should be guided by the following incubation period periods:
plague - 6 days;
cholera - 5 days;
yellow fever - 6 days;
Crimea-Congo, monkeypox - 14 days; Ebola fever, Marburg, Lasa, Bolivian, Argentine - 21
day;

Further activities are carried out by specialists from the departments of especially dangerous infections TsGE and 03, anti-plague institutions in accordance with current instructions and comprehensive plans.

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

Procedure for notifying the chief physician of the hospital, clinic or person replacing him, is determined specifically for each institution.

Information about an identified patient (suspicious of an acute infectious disease) to the territorial Central State Examination Center and 03, higher authorities, calling consultants and evacuation teams is carried out by the head of the institution or a person replacing him.

When a patient suspected of having an acute infectious disease is identified in a clinic or hospital, the following primary anti-epidemic measures are carried out:

Transportable patients are delivered by ambulance to a special hospital.

For non-transportable patients health care turns out to be in place with calling a consultant and an ambulance equipped with everything necessary.

Measures are being taken to isolate the patient at the place where he is identified., before hospitalization in a specialized infectious diseases hospital.

Medical worker without leaving the premises where a patient is identified, notifies the head of his institution about the identified patient by telephone or by messenger, requests appropriate medications, protective clothing, and personal preventative means.

If plague is suspected, contagious viral hemorrhagic fevers, before receiving protective clothing, the health worker must cover the nose and mouth with any bandage (towel, scarf, bandage, etc.), having previously treated the hands and open parts of the body with any antiseptic agents and provide assistance to the patient, wait for the arrival of an infectious disease specialist or doctor of another specialty. After receiving protective clothing (anti-plague suits of the appropriate type), it is put on without removing your own, unless it is heavily contaminated with the patient’s secretions.

An arriving infectious disease doctor (general practitioner) enters the room, where a patient was identified in protective clothing, and the employee accompanying him was about premises must be diluted with a disinfectant solution. The doctor who identified the patient takes off the robe and bandage that protected him Airways, 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 they undergo complete sanitary treatment, change into a spare set of clothes (personal items are placed in an oilcloth bag for disinfection). Exposed parts of the body, hair are treated, the mouth and throat are rinsed with 70° ethyl alcohol, antibiotic solutions or a 1% solution are instilled into the nose and eyes boric acid. The issue of isolation and emergency prophylaxis is decided after the conclusion of a consultant. If cholera is suspected, personal prevention measures for intestinal infections are observed: after examination, hands are treated antiseptic. If the patient's discharge gets on clothes or shoes, they are replaced with spare ones, and contaminated items are subject to disinfection.

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

Entry is temporarily prohibited medical institution and a way out of it.

Communication between floors stops.

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

It is prohibited for patients to walk inside the department where the patient is identified, and the way out.

Reception is temporarily suspended, discharge of patients, visits by their relatives. It is prohibited to remove items until final disinfection has been carried out.

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

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

If necessary, emergency prophylaxis is provided to medical staff.

Seriously ill patients receive medical care until the medical team arrives.

Using a sampling device, before the evacuation team arrives, the health worker who identified the patient takes material for laboratory examination.

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

Upon arrival of the consultant team or evacuation team, the health worker who identified the patient carries out all the orders of the epidemiologist.

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

Hospitalization of patients to the infectious diseases hospital is provided by the Emergency Medical Service by teams of tow trucks consisting of a doctor or paramedical worker, an orderly, familiar with the biological safety regime and a driver.

Patients with degree III-IV dehydration are hospitalized by resuscitation teams with rehydration systems and oral rehydration solutions.

All persons taking part in the evacuation of those suspected of having the plague, KVGL, pulmonary form of glanders - suits of type I, patients with cholera - type IV (in addition, it is necessary to provide surgical gloves, an oilcloth apron, a medical respirator of at least protection class 2, boots).

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

Transport for hospitalization of cholera patients is equipped with an oilcloth lining, utensils for collecting patient secretions, disinfecting solutions in working dilution, packing for collecting material.

The driver of the evacuation team, if there is an isolated cabin, must be dressed in overalls, if not, in the same type of suit as the rest of the evacuation team members.

After the patient is delivered to the hospital, the transport and items used during transportation are disinfected at a specially equipped site by a team of evacuators or a disinfectant from the cholera hospital, the territorial Center for Geology and Epidemiology.

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.

When transporting a patient with pneumonic plague and glanders, CVHF or suspected of these diseases, evacuators change protective clothing after each patient.

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 corresponding infections. Cholera hospital according to the regime established for departments with acute gastrointestinal infections.

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

The design and regime of the isolation ward is the same as in an infectious diseases hospital.

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

In hospital, patients should not use a shared toilet. Bathrooms and toilets must be locked with a key kept by the biosafety officer. Toilets are opened to drain disinfected solutions, and baths are opened to process those discharged. In case of cholera, sanitary treatment of a patient with I-II degrees of dehydration is carried out in the emergency department (no shower is used), followed by a disinfection system for 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.

Final disinfection at the place where the patient (vibration carrier) is identified is carried out no later than 3 hours from the moment of hospitalization.

At 03:00, upon detection of a cholera patient (vibrio carrier), personnel, V functional responsibilities which this includes, carries out ongoing disinfection of the patient’s secretions, the doctor’s office and other premises where the patient was (vibration carrier), common areas, uniforms of the personnel involved in the reception and examination of the patient, and instruments.

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

Personnel carrying out disinfection must wear protective clothing: replacement shoes, anti-plague or surgical gown, complemented by rubber shoes, oilcloth apron, medical respirator, rubber gloves, towel.

Food for patients is delivered in kitchen utensils to the service entrance uninfected block and there they are poured and transferred from the kitchen dishes to the hospital pantry dishes. 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 dispensing room must be equipped with everything necessary for disinfecting leftover food. Individual dishes are disinfected by boiling.

Algorithm for the actions of medical staff when identifying a patient suspected of having an acute respiratory infection

Scheme of primary anti-epidemic measures.

I. Measures to isolate the patient at the place where he is identified and work with him.

1. Notification of suspected OI by phone or through the door (knock on the door to attract the attention of those outside the outbreak and verbally convey information through the door).
2. Request all settings for the general public health inspection (package for prophylaxis of medical staff, packing for collecting material for research, packing with anti-plague suits), disinfectant solutions for yourself.
3. Before receiving emergency prevention treatment, make a mask from available materials (gauze, cotton wool, bandages, etc.) and use it.
4. Before the installation arrives, close the windows and transoms using available means (rags, sheets, etc.), close the cracks in the doors.
5. When receiving the instructions to prevent your own infection, carry out emergency infection prevention, put on an anti-plague suit (for cholera, a lightweight suit - a robe, an apron, or possibly without them).
6. Cover windows, doors, and ventilation grilles with adhesive tape (except for cholera outbreaks).
7. Provide emergency assistance to the patient.
8. Collect material for research and prepare records and referrals for research to the bacteriological laboratory.
9. Conduct routine disinfection of the premises.

^ II. Measures to prevent the spread of infection.

Head department, the administrator, upon receiving information about the possibility of identifying DUI, performs the following functions:

Exit from the outbreak is possible with the permission of the head physician of the hospital in accordance with the established procedure.

Rabies

Rabies- spicy viral disease warm-blooded animals and humans, characterized by progressive damage to the central nervous system (encephalitis), fatal to humans.

^ Rabies agent neurotropic virus of the Rabdoviridae family of the Lyssavirus genus. It has a bullet shape and reaches a size of 80-180 nm. The nucleocapsid of the virus is represented by single-stranded RNA. The exceptional affinity of the virus rabies to the central nervous system was proven by the work of Pasteur, as well as by microscopic studies of Negri and Babes, who invariably found peculiar inclusions, the so-called Babes-Negri bodies, in sections of the brains of people who died from rabies.

Source – domestic or wild animals (dogs, cats, foxes, wolves), birds, bats.

Epidemiology. Human infection rabies occurs as a result of bites by rabid animals or when they salivate on the skin and mucous membranes, if there are microtraumas on these covers (scratches, cracks, abrasions).

The incubation period is from 15 to 55 days, in some cases up to 1 year.

^ Clinical picture. Conventionally, there are 3 stages:

1. Harbingers. The disease begins with an increase temperature up to 37.2–37.5°C and malaise, irritability, itching at the site of the animal bite.

2. Excitement. The patient is excitable, aggressive, and has a pronounced fear of water. The sound of pouring water, and sometimes even the sight of it, can cause convulsions. Increased salivation.

3. Paralysis. The paralytic stage lasts from 10 to 24 hours. In this case, paresis or paralysis of the lower extremities develops, and paraplegia is more often observed. The patient lies motionless, muttering incoherent words. Death occurs from paralysis of the motor center.

Treatment. Wash the wound (bite site) with soap, treat with iodine, and apply a sterile bandage. Therapy is symptomatic. Mortality – 100%.

Disinfection. Treatment of dishes, linen, and care items with a 2% chloramine solution.

^ Precautionary measures. Since the patient’s saliva contains the rabies virus, then nurse It is necessary to work in a mask and gloves.

Prevention. Timely and complete vaccinations.

Yellow fever

Etiology. The causative agent, yellow fever virus (flavivirus febricis), belongs to the genus flavivirus, family Togaviridae.

Epidemiology. There are two epidemiological types of yellow fever foci - natural, or jungle, and anthropourgic, or urban.
In the case of the jungle form, the reservoir of viruses is marmoset monkeys, possibly rodents, marsupials, hedgehogs and other animals.
The carriers of viruses in natural foci of yellow fever are mosquitoes Aedes simpsoni, A. africanus in Africa and Haemagogus sperazzini and others in South America. Infection of humans in natural foci occurs through the bite of an infected mosquito A. simpsoni or Haemagogus, which is capable of transmitting the virus 9-12 days after the infectious bloodsucking.
The source of infection in urban yellow fever foci is a sick person in the period of viremia. Virus carriers in urban areas are Aedes aegypti mosquitoes.
Currently, sporadic incidence and local group outbreaks are being recorded in the tropical forest zone in Africa (Zaire, Congo, Sudan, Somalia, Kenya, etc.), South and Central America.

Pathogenesis. The inoculated yellow fever virus hematogenously reaches the cells of the macrophage system, replicates in them for 3-6, less often 9-10 days, then re-enters the blood, causing viremia and clinical manifestation of the infectious process. Hematogenous dissemination of the virus ensures its penetration into the cells of the liver, kidneys, spleen, bone marrow and other organs, where pronounced dystrophic, necrobiotic and inflammatory changes develop. The most typical occurrences are the occurrence of foci of liquefaction and coagulation necrosis in the mesolobular parts of the hepatic lobule, the formation of Councilman's bodies, and the development of fatty and protein degeneration of hepatocytes. As a result of these injuries, cytolysis syndromes develop with an increase in ALT activity and a predominance of AST activity, cholestasis with severe hyperbilirubinemia.
Along with liver damage, yellow fever is characterized by the development of cloudy swelling and fatty degeneration in the epithelium of the renal tubules, the appearance of areas of necrosis, causing the progression of acute renal failure.
With a favorable course of the disease, stable immunity is formed.

Clinical picture. There are 5 periods during the course of the disease. The incubation period lasts 3-6 days, less often it extends to 9-10 days.
The initial period (hyperemia phase) lasts for 3-4 days and is characterized by a sudden increase in body temperature to 39-41 ° C, severe chills, intense headache and diffuse myalgia. As a rule, patients complain of severe pain in the lumbar region, they experience nausea and repeated vomiting. From the first days of illness, most patients experience pronounced hyperemia and puffiness of the face, neck and upper chest. The vessels of the sclera and conjunctiva are clearly hyperemic (“rabbit eyes”), photophobia and lacrimation are noted. Prostration, delirium, and psychomotor agitation can often be observed. The pulse is usually rapid, and bradycardia and hypotension develop in the following days. The persistence of tachycardia may indicate an unfavorable course of the disease. Many people have an enlarged and painful liver, and at the end of the initial phase one can notice icterus of the sclera and skin, the presence of petechiae or ecchymoses.
The hyperemia phase is replaced by short-term (from several hours to 1-1.5 days) remission with some subjective improvement. In some cases, recovery occurs in the future, but more often a period of venous stasis follows.
The patient's condition noticeably worsens during this period. The temperature rises again to a higher level, and jaundice increases. The skin is pale, in severe cases cyanotic. A widespread hemorrhagic rash appears on the skin of the trunk and limbs in the form of petechiae, purpura, and ecchymoses. Significant bleeding of the gums, repeated vomiting with blood, melena, nasal and uterine bleeding are observed. In severe cases of the disease, shock develops. The pulse is usually rare, weak filling, blood pressure is steadily decreasing; Oliguria or anuria develops, accompanied by azotemia. Toxic encephalitis is often observed.
The death of patients occurs as a result of shock, liver and kidney failure on the 7-9th day of illness.
The duration of the described periods of infection is on average 8-9 days, after which the disease enters the convalescence phase with a slow regression of pathological changes.
Among local residents of endemic areas, yellow fever can occur in a mild or abortive form without jaundice and hemorrhagic syndrome, which makes timely identification of patients difficult.

Forecast. Currently, the fatality rate for yellow fever is approaching 5%.
Diagnostics. Recognition of the disease is based on identifying a characteristic clinical symptom complex in individuals classified as high risk of infection (unvaccinated people who visited jungle foci of yellow fever within 1 week before the onset of the disease).

The diagnosis of yellow fever is confirmed by the isolation of the virus from the patient’s blood (in the initial period of the disease) or antibodies to it (RSK, NRIF, RTPGA) in later periods of the disease.

Treatment. Patients with yellow fever are hospitalized in hospitals protected from mosquitoes; carry out prevention of parenteral infection.
Therapeutic measures include a complex of anti-shock and detoxification agents, correction of hemostasis. In cases of progression of hepatic-renal failure with severe azotemia, hemodialysis or peritoneal dialysis is performed.

Prevention. Specific prophylaxis in foci of infection is carried out with the live attenuated 17 D vaccine and, less often, with the Dakar vaccine. Vaccine 17 D is administered subcutaneously in a dilution of 1:10, 0.5 ml. Immunity develops in 7-10 days and lasts for six years. Vaccinations are registered in international certificates. Unvaccinated persons from endemic areas are quarantined for 9 days.

Smallpox

Smallpox is an acute, highly contagious viral disease that occurs with severe intoxication and the development of vesicular-pustular rashes on the skin and mucous membranes.

Etiology. Pathogen smallpox– orthopoxvirus variola from the genus orthopoxvirus, family Poxviridae – is represented by two varieties: a) O. variola var. major – the actual causative agent of smallpox; b) O. variola var. minor is the causative agent of alastrima, a benign form of human smallpox in South America and Africa.

The causative agent of smallpox is a DNA-containing virus with a size of 240-269 x 150 nm; the virus is detected in a light microscope in the form of Paschen bodies. The smallpox causative agent is resistant to various physical and chemical factors, at room temperature it does not lose viability even after 17 months.

Epidemiology. Smallpox is a particularly dangerous infection. The reservoir and source of viruses is a sick person who is infectious with last days incubation period up to full recovery and crusts falling off. Maximum infectivity is observed from the 7-9th day of illness. Smallpox infection occurs through airborne droplets, airborne dust, household contact, inoculation and transplacental routes. The most important is the airborne transmission of pathogens. Human susceptibility to smallpox is absolute. After an illness, strong immunity remains.

Pathogenesis. After penetration into the human body, the virus replicates in regional lymph nodes, then spreads through the blood internal organs(primary viremia), where it replicates in the elements of the mononuclear phagocyte system (within 10 days). Subsequently, the infection generalizes (secondary viremia), which corresponds to the onset of clinical manifestation of the disease.
Having a pronounced tropism for tissues of ectodermal origin, the virus causes swelling, inflammatory infiltration, ballooning and reticular degeneration in them, which is manifested by rashes on the skin and mucous membranes. In all forms of the disease, parenchymal changes develop in the internal organs.

Clinical picture. The following forms of the disease are distinguished: severe - hemorrhagic smallpox (smallpox purpura, pustular hemorrhagic, or black smallpox) and confluent smallpox; moderate severity – scattered smallpox; lungs - varioloid, smallpox without rash, smallpox without fever.
The clinical course of smallpox can be divided into a number of periods. The incubation period lasts on average 9-14 days, but can be 5-7 days or 17-22 days. The prodromal period lasts 3-4 days and is characterized by a sudden increase in body temperature, pain in the lumbar region, myalgia, headache, and often vomiting. Within 2-3 days, half of the patients develop a prodromal measles-like or scarlet-like rash, localized mainly in the area of Simon's femoral triangle and thoracic triangles. Towards the end of the prodromal period, body temperature decreases: at the same time, a smallpox rash appears on the skin and mucous membranes.
The period of the rash is characterized by a repeated gradual increase in temperature and a staged spread of the smallpox rash: first it appears on the linden tree, then on the torso, on the extremities, affecting the palmar and plantar surfaces, condensing as much as possible on the face and extremities. On one area of the skin the rash is always monomorphic. Elements of the rash look like spots Pink colour, quickly turning into papules, and after 2-3 days into smallpox vesicles, having a multi-chamber structure with an umbilical cord in the center of the element and surrounded by a zone of hyperemia.
From the 7-8th day of illness, suppuration of smallpox elements develops, accompanied by a significant rise in temperature and a sharp deterioration in the patient’s condition. Pustules lose their multi-chamber structure, collapse when punctured, and are extremely painful. By the 15-17th day, the pustules open, dry out with the formation of crusts, while the pain decreases, and unbearable skin itching appears.
During the 4-5th week of illness against the background normal temperature The body is marked by intense peeling, falling off of crusts, in the place of which deep whitish scars remain, giving the skin a rough (pockmarked) appearance. The duration of the disease in an uncomplicated course is 5-6 weeks. Hemorrhagic forms of smallpox are the most severe, often accompanied by the development of infectious-toxic shock.

Forecast. With an uncomplicated course of the disease, mortality reached 15%, with hemorrhagic forms - 70-100%.

Diagnostics. Based on epidemiological history data and the results of a clinical examination. Specific diagnostics involves the isolation of the virus from the elements of the rash ( electron microscopy), infection of chicken embryos and detection of antibodies to the smallpox virus (using RNGA, RTGA and the fluorescent antibody method).

Treatment. Applies complex therapy, including the use of anti-smallpox immunoglobulin, metisazon, antibiotics wide range actions and detoxification agents.

Prevention. Patients should be isolated, and contact persons should be observed for 14 days and vaccinated. Quarantine measures are being implemented in full.

anthrax

Anthrax is an acute bacterial zoonotic infection characterized by intoxication, the development of serous-hemorrhagic inflammation of the skin, lymph nodes and internal organs and occurs in the form of a cutaneous (with the formation in most cases of a specific carbuncle) or septic form.

Etiology. Pathogen anthrax– bacillus anthracis – belongs to the genus Bacillus, family Bacillaceae. It is a large spore-forming gram-positive rod measuring (5-10) x (1-1.5) microns. Anthrax bacilli grow well on meat-peptone media. They contain capsular and somatic antigens and are capable of secreting exotoxin, which is a protein complex consisting of causing swelling protective and lethal components. Vegetative forms of anthrax bacillus quickly die when exposed to conventional disinfectants and boiling. Disputes are incomparably more stable. They persist in the soil for decades. When autoclaving (110 °C) they die only after 40 minutes. Activated solutions of chloramine, hot formaldehyde, and hydrogen peroxide also have a sporicidal effect.

Epidemiology. The source of anthrax is sick domestic animals: cattle, horses, donkeys, sheep, goats, deer, camels, pigs, in which the disease occurs in a generalized form. It is most often transmitted by contact, less often by nutrition, airborne dust and transmission. In addition to direct contact with sick animals, human infection can occur through the participation of a large number of transmission factors. These include excretions and skins of sick animals, their internal organs, meat and other food products, soil, water, air, objects environment, contaminated with anthrax spores. In the mechanical inoculative transmission of the pathogen, blood-sucking insects (horseflies, jet flies) are important.
Susceptibility to anthrax is related to the route of infection and the magnitude of the infectious dose.
There are three types of anthrax foci: professional-agricultural, professional-industrial and household. The first type of outbreaks is characterized by summer-autumn seasonality, the others occur at any time of the year.

Pathogenesis. The entry point for anthrax pathogens is usually damaged skin. In rare cases, it enters the body through the mucous membranes of the respiratory tract and gastrointestinal tract. At the site of penetration of the pathogen into the skin, an anthrax carbuncle appears (less commonly, adematous, bullous and erysipeloid forms of skin lesions) in the form of a focus of serous-hemorrhagic inflammation with necrosis, edema of adjacent tissues, and regional lymphadenitis. The development of lymphadenitis is caused by the introduction of the pathogen by mobile macrophages from the site of introduction to the nearest regional The lymph nodes. The local pathological process is caused by the action of anthrax exotoxin, individual components of which cause severe microcirculation disorders, tissue edema and coagulative necrosis. Further generalization of anthrax pathogens with their breakthrough into the blood and the development of a septic form occurs extremely rarely in the cutaneous form.
Anthrax sepsis usually develops when the pathogen enters the human body through the mucous membranes of the respiratory tract or gastrointestinal tract. In these cases, disruption of the barrier function of the tracheobronchial (bronchopulmonary) or mesenteric lymph nodes leads to generalization of the process.
Bacteremia and toxinemia can cause the development of infectious-toxic shock.

Clinical picture. The duration of the incubation period of anthrax ranges from several hours to 14 days, most often 2-3 days. The disease can occur in localized (skin) or generalized (septic) forms. The cutaneous form occurs in 98-99% of all cases of anthrax. Its most common variety is the carbunculous form; Edematous, bullous and erysipeloid are less common. Predominantly exposed parts of the body are affected. The disease is especially severe when carbuncles are localized on the head, neck, mucous membranes of the mouth and nose.
Usually there is one carbuncle, but sometimes their number reaches 10-20 or more. At the site of the entrance gate of infection, a spot, papule, vesicle, and ulcer develop successively. A spot with a diameter of 1-3 mm is reddish-bluish in color, painless, and resembles marks from an insect bite. After a few hours, the spot becomes a copper-red papule. Local itching and burning sensation increase. After 12-24 hours, the papule turns into a vesicle with a diameter of 2-3 mm, filled with serous fluid, which darkens and becomes bloody. When scratched or spontaneously, the vesicle bursts, its walls collapse, and an ulcer with a dark brown bottom, raised edges and serous-hemorrhagic discharge is formed. Secondary (“daughter”) vesicles appear along the edges of the ulcer. These elements undergo the same stages of development as the primary vesicle and, merging, increase the size of the skin lesion.
After a day, the ulcer reaches 8-15 mm in diameter. New “daughter” vesicles that appear at the edges of the ulcer cause its eccentric growth. Due to necrosis central part After 1-2 weeks, the ulcer turns into a black, painless, dense scab, around which a pronounced red inflammatory ridge forms. In appearance, the scab resembles a coal on a red background, which was the reason for the name of this disease (from the Greek anthrax - coal). In general, this lesion is called a carbuncle. The diameter of the carbuncles ranges from a few millimeters to 10 cm.
The tissue swelling that occurs along the periphery of the carbuncle sometimes covers large areas with loose tissue. subcutaneous tissue, for example on the face. Hitting the area of edema with a percussion hammer often causes gelatinous trembling (Stefansky's symptom).
Localization of the carbuncle on the face (nose, lips, cheeks) is very dangerous, since swelling can spread to the upper respiratory tract and lead to asphyxia and death.
Anthrax carbuncle in the necrosis zone is painless even when pricked with a needle, which serves as an important differential diagnostic sign. The lymphadenitis that develops with the cutaneous form of anthrax is usually painless and does not tend to suppurate.
The edematous variety of cutaneous anthrax is characterized by the development of edema without the presence of a visible carbuncle. In later stages of the disease, necrosis occurs and a large carbuncle is formed.
With the bullous variety, blisters with hemorrhagic fluid form at the site of the entrance gate of infection. After opening of the blisters or necrotization of the affected area, extensive ulcerative surfaces are formed, taking the form of a carbuncle.
A peculiarity of the erysipeloid type of cutaneous anthrax is the development of a large number of blisters with clear liquid. After opening them, ulcers remain that undergo transformation into a scab.
The cutaneous form of anthrax occurs in mild to moderate severity in approximately 80% of patients, and in severe form in 20% of patients.
In mild cases of the disease, the intoxication syndrome is moderately expressed. Body temperature is normal or subfebrile. By the end of the 2-3rd week, the scab is rejected with the formation (or without it) of a granulating ulcer. After it heals, a dense scar remains. The mild course of the disease ends with recovery.
In moderate and severe cases of the disease, malaise, weakness, headache. By the end of 2 days, body temperature may rise to 39-40°C, activity is impaired of cardio-vascular system. At favorable outcome After 5-6 days of illness, the temperature drops critically, general and local symptoms reverse, swelling gradually decreases, lymphadenitis disappears, the scab disappears by the end of the 2-4th week, the granulating ulcer heals with the formation of a scar.
The severe course of the cutaneous form may be complicated by the development of anthrax sepsis and have an unfavorable outcome.
The septic form of anthrax is quite rare. The disease begins acutely with tremendous chills and an increase in temperature to 39-40 ° C.
Already in the initial period, pronounced tachycardia, tachypnea, and shortness of breath are observed. Patients often experience pain and a feeling of tightness in the chest, a cough with the release of foamy, bloody sputum. Physically and radiologically, signs of pneumonia and effusion pleurisy (serous-hemorrhagic) are determined. Often, especially with the development of infectious-toxic shock, hemorrhagic pulmonary edema occurs. The sputum secreted by patients coagulates in the form of cherry jelly. A large number of anthrax bacteria are found in the blood and sputum.
Some patients experience sharp cutting pain in the abdomen. They are accompanied by nausea, bloody vomiting, and loose bloody stools. Subsequently, intestinal paresis develops, and peritonitis is possible.
With the development of meningoencephalitis, the consciousness of patients becomes confused, meningeal and focal symptoms appear.
Infectious-toxic shock, edema and swelling of the brain, gastrointestinal bleeding and peritonitis may be the cause fatal outcome already in the first days of the disease.

Forecast. In the cutaneous form of anthrax it is usually favorable, in the septic form it is in all cases serious.

Diagnostics. It is carried out on the basis of clinical, epidemiological and laboratory data. Laboratory diagnostics includes bacterioscopic and bacteriological methods. In order to early diagnosis sometimes the immunofluorescent method is used. Allergological diagnostics of anthrax are also used. For this purpose, an intradermal test with anthraxin is performed, giving positive results already after the 5th day of illness.
The material for laboratory research in the cutaneous form is the contents of vesicles and carbuncles. In the septic form, sputum, vomit, feces, and blood are examined. Research requires compliance with work rules, as for especially dangerous infections, and is carried out in special laboratories.

Treatment. Etiotropic therapy for anthrax is carried out by prescribing antibiotics in combination with anti-anthrax immunoglobulin. Penicillin is used at a dose of 6-24 million units per day until the symptoms of the disease subside (but not less than 7-8 days). In case of septic form, it is advisable to use cephalosporins 4-6 g per day, chloramphenicol sodium succinate 3-4 g per day, gentamicin 240-320 mg per day. The choice of dose and combination of drugs is determined by the severity of the disease. Immunoglobulin is administered in a dose of 20 ml for mild forms, and 40-80 ml for moderate and severe cases. Course dose can reach 400 ml.
In the pathogenetic therapy of anthrax, colloid and crystalloid solutions, plasma, and albumin are used. Glucocorticosteroids are prescribed. Treatment of infectious-toxic shock is carried out in accordance with generally accepted techniques and means.
For the skin form, local treatment is not required, but surgical interventions can lead to generalization of the process.

Prevention. Preventive actions carried out in close contact with the veterinary service. Of primary importance are measures to prevent and eliminate morbidity in farm animals. Identified sick animals should be isolated and their corpses burned; contaminated objects (stalls, feeders, etc.) must be disinfected.
To disinfect wool and fur products, the steam-formalline method of chamber disinfection is used.
Persons who have been in contact with sick animals or infectious material are subject to active medical supervision within 2 weeks. If the development of the disease is suspected, antibacterial therapy is carried out.
Vaccination of people and animals is important, for which dry live vaccine is used.

Cholera

Cholera is an acute, anthroponotic infectious disease caused by Vibrio cholerae, with a fecal-oral transmission mechanism, occurring with the development of dehydration and demineralization as a result of watery diarrhea and vomiting.

Etiology. The causative agent of cholera - vibrio cholerae - is represented by two biovars - V. cholerae biovar (classical) and V. cholerae biovar El-Tor, similar in morphological and tinctorial properties.

Cholera vibrios have the appearance of small, sized (1.5-3.0) x (0.2-0.6) microns, curved rods with a polarly located flagellum (sometimes with 2 flagella), providing high mobility of pathogens, which is used for their identification, do not form spores or capsules, are gram-negative, stain well with aniline dyes. Toxic substances have been found in Vibrio cholerae.

Vibrios cholerae are highly sensitive to drying, ultraviolet irradiation, and chlorine-containing preparations. Heating to 56 °C kills them in 30 minutes, and boiling kills them instantly. They can be preserved for a long time at low temperatures and in the organisms of aquatic organisms. Vibrios cholerae are highly sensitive to tetracycline derivatives, ampicillin, and chloramphenicol.

Epidemiology. Cholera is an anthroponotic intestinal infection prone to pandemic spread. The reservoir and source of pathogens is an infected person who releases cholera vibrios with feces into the external environment. Vibrio excretors are patients with typical and erased forms of cholera, cholera convalescents and clinically healthy vibrio carriers. The most intense source of pathogens are patients with pronounced clinical picture cholera, which in the first 4-5 days of illness release up to 10-20 liters of feces into the external environment per day, containing 106 - 109 vibrios per ml. Patients with mild and erased forms of cholera excrete a small amount of feces, but remain in the group, which makes them epidemically dangerous.

Convalescent vibrio carriers release pathogens on average for 2-4 weeks, transient carriers - 9-14 days. Chronic carriers of V. cholerae can shed pathogens for a number of months. Lifelong carriage of vibrios is possible.

The mechanism of cholera infection is fecal-oral, realized through water, nutritional and contact-household routes of infection. The leading route of transmission of cholera pathogens, leading to the epidemic spread of the disease, is water. Infection occurs both when drinking contaminated water and when using it for household purposes - for washing vegetables, fruits and when swimming. Due to urbanization processes and insufficient levels of wastewater treatment and disinfection, many surface water bodies can become an independent contaminating environment. Facts have been established of repeated isolation of El Tor vibrios after exposure to disinfectants from sludge and mucus of the sewer system, in the absence of patients and carriers. All of the above allowed P.N. Burgasov to come to the conclusion that sewer discharges and infected open water bodies are the habitat, reproduction and accumulation of El Tor vibrios.

Foodborne cholera outbreaks usually occur among a limited number of people who consume contaminated food.

It has been established that the inhabitants of various bodies of water (fish, shrimp, crabs, mollusks, frogs and other aquatic organisms) are capable of accumulating and preserving El Tor cholera vibrios in their bodies for quite a long time (acting as a temporary reservoir of pathogens). Eating hydrobionts (oysters, etc.) without careful heat treatment led to the development of the disease. Food epidemics are characterized by an explosive onset with immediately emerging foci of the disease.

Infection with cholera is also possible through direct contact with a patient or vibrio carrier: the pathogen can be brought into the mouth by hands contaminated with vibrios, or through objects infected with the secretions of patients (linen, dishes and other objects household items). The spread of cholera pathogens can be facilitated by flies, cockroaches and other household insects. Outbreaks of the disease caused by contact and household infection are rare and are characterized by slow spread.

There is often a combination of various transmission factors causing mixed outbreaks of cholera.

Cholera, like other intestinal infections, is characterized by seasonality with an increase in the incidence rate in the summer-autumn period of the year due to the activation of pathogen transmission routes and factors (drinking large amounts of water, an abundance of vegetables and fruits, bathing, “fly factor”, etc. .).

Susceptibility to cholera is general and high. The transferred disease leaves behind a relatively stable species-specific antitoxic immunity. Repeated cases of the disease are rare, although they do occur.

Pathogenesis. Cholera is a cyclic infection that leads to significant loss of water and electrolytes with intestinal contents due to the predominant damage to the enzyme systems of enterocytes. Cholera vibrios entering through the mouth with water or food partially die in the acidic environment of the gastric contents, and partially, bypassing the acid barrier of the stomach, enter the lumen small intestine, where they multiply intensively due to the alkaline reaction of the environment and the high peptone content. Vibrios are localized in the superficial layers of the mucous membrane of the small intestine or in its lumen. Intensive reproduction and destruction of vibrios is accompanied by the release of large amounts of endo- and exotoxic substances. The inflammatory reaction does not develop.

Clinical picture. The clinical manifestations of cholera caused by Vibrio species, including classical Vibrio El Tor, are similar.

The incubation period ranges from several hours to 5 days, averaging about 48 hours. The disease can develop in typical and atypical forms. In a typical course, mild, moderate and severe forms of the disease are distinguished according to the degree of dehydration. With an atypical course, erased and fulminant forms are distinguished. With El Tor cholera, a subclinical course of the infectious process in the form of vibrio carriage is often observed.

In typical cases, the disease develops acutely, often suddenly: at night or in the morning, patients feel an imperative urge to defecate without tenesmus and abdominal pain. Discomfort, rumbling and transfusion around the navel or lower abdomen are often noted. The stool is usually copious, the stools initially have a fecal character with particles of undigested food, then become liquid, watery, yellow color with floating flakes, later lighten, taking on the appearance of odorless rice water, with the smell of fish or grated potatoes. In case of mild disease, there may be from 3 to 10 bowel movements per day. The patient's appetite decreases, thirst and muscle weakness. Body temperature usually remains normal; a number of patients develop low-grade fever. Upon examination, you can detect increased heart rate and dry tongue. The abdomen is retracted, painless, rumbling and fluid transfusion along the small intestine are detected. With a favorable course of the disease, diarrhea lasts from several hours to 1-2 days. Fluid loss does not exceed 1-3% of body weight (I degree of dehydration). Physico Chemical properties blood are not disturbed. The disease ends in recovery. As the disease progresses, there is an increase in the frequency of stools (up to 15-20 times a day), the bowel movements are copious, watery in the form of rice water. Usually accompanied by repeated profuse vomiting “fountain” without nausea and pain in the epigastrium. Vomit quickly becomes watery with a yellowish discoloration due to the admixture of bile (Greek chole rheo - “flow of bile”). Profuse diarrhea and repeated profuse vomiting quickly, over several hours, lead to severe dehydration (II degree of dehydration) with a loss of fluid amounting to 4-6% of the patient’s body weight.

The general condition is deteriorating. Muscle weakness, thirst, and dry mouth increase. Some patients experience short-term seizures calf muscles, feet and hands, diuresis decreases. Body temperature remains normal or low-grade. The skin of patients is dry, its turgor is reduced, and unstable cyanosis is often observed. The mucous membranes are also dry, and hoarseness often occurs. Characterized by increased heart rate and decreased blood pressure, mainly pulse pressure. Disturbances in the electrolyte composition of the blood are not permanent.

In the absence of rational and timely therapy, fluid loss often reaches 7-9% of body weight within a few hours ( III degree dehydration). The condition of the patients progressively worsens, signs of pronounced exicosis develop: facial features become sharper, the eyes become sunken, the dryness of the mucous membranes and skin increases, it wrinkles on the hands (“washerwoman’s hands”), the muscular relief of the body also increases, aphonia is expressed, tonic spasms of individual muscle groups appear . There are sharp arterial hypertension, tachycardia, widespread cyanosis. Oxygen deficiency in tissues aggravates acidosis and hypokalemia. As a result of hypovolemia, hypoxia and loss of electrolytes, glomerular filtration in the kidneys decreases and oliguria occurs. Body temperature is normal or reduced.

With the progressive course of the disease in untreated patients, the amount of fluid lost reaches 10% of body weight or more (IV degree of dehydration), and decompensated dehydration shock develops. In severe cases of cholera, shock may develop during the first 12 hours of illness. The condition of patients is steadily deteriorating: profuse diarrhea and repeated vomiting, observed at the beginning of the disease, are reduced or completely stopped during this period. Characterized by pronounced diffuse cyanosis, often the tip of the nose, ears, lips, marginal edges of the eyelids acquire a purple or almost black color. Facial features become even more sharpened, cyanosis appears around the eyes (symptom of “dark glasses”), eyeballs are deeply sunken, turned upward (symptom of “setting sun”). The patient’s face shows suffering and a plea for help – facies chorelica. The voice is silent, consciousness is preserved for a long time. Body temperature drops to 35-34 °C. The skin is cold to the touch, easily gathers into folds and does not straighten out for a long time (sometimes within an hour) - “cholera fold”. The pulse is arrhythmic, weak in filling and tension (thread-like), almost not palpable. Tachycardia is pronounced, heart sounds are almost inaudible, blood pressure is practically undetectable. Shortness of breath increases, breathing is arrhythmic, shallow (up to 40-60 breaths per minute), ineffective. Patients breathe quickly open mouth due to suffocation, muscles are involved in the act of breathing chest. Tonic cramps spread to all muscle groups, including the diaphragm, which leads to painful hiccups. The abdomen sinks, is painful during muscle cramps, and is soft. Anuria usually occurs.

Dry cholera occurs without diarrhea and vomiting and is characterized by an acute onset, rapid development of dehydration shock, a sharp drop in blood pressure, increased breathing, aphonia, anuria, cramps of all muscle groups, meningeal and encephalitic symptoms. Death occurs within a few hours. This form of cholera is very rare in weakened patients.

In the fulminant form of cholera, a sudden onset and rapid development of dehydration shock with severe dehydration of the body are observed.

Forecast. With timely and adequate therapy, the mortality rate is favorable and close to zero, but it can be significant in the fulminant form and delayed treatment.

Diagnostics. The diagnosis is based on a combination of anamnestic, epidemiological, clinical and laboratory data.

Treatment. Patients with all forms of cholera are subject to mandatory hospitalization in hospitals (specialized or temporary), where they receive pathogenetic and etiotropic therapy.

The main focus of treatment is the immediate replenishment of water and electrolyte deficiency - rehydration and remineralization using saline solutions.

Simultaneously with rehydration measures, patients with cholera are given etiotropic treatment - tetracycline is prescribed orally (for adults, 0.3-0.5 g every 6 hours) or chloramphenicol (for adults, 0.5 g 4 times a day) for 5 days. In severe cases of the disease with vomiting, the initial dose of antibiotics is administered parenterally. While taking antibiotics, the severity of diarrhea syndrome becomes less severe, and therefore the need for rehydration solutions is almost halved.

Patients with cholera do not need a special diet and, after vomiting stops, should receive regular food in a slightly reduced volume.

Patients are usually discharged from the hospital on the 8-10th day of illness after clinical recovery and three negative results of bacteriological examination of stool and a single examination of bile (portions B and C).

Prevention. The system of measures for the prevention of cholera is aimed at preventing the introduction of this infection into our country from disadvantaged areas, implementing epidemiological surveillance and improving the sanitary and communal condition of populated areas.

For the purpose of specific prevention, cholerogen is used - an toxoid, which in vaccinated people in 90-98% of cases causes not only the production of vibriocidal antibodies, but also antitoxins in high titers. Vaccinations are performed once with a needleless injector in a dose of 0.8 ml of the drug for adults. Revaccination according to epidemiological indications can be carried out no earlier than 3 months after primary vaccination. A more effective oral vaccine has been developed.

Plague

Plague - acute natural focal vector-borne disease, caused by Y. pestis, is characterized by fever, severe intoxication, serous-hemorrhagic inflammation in the lymph nodes, lungs and other organs, as well as sepsis. It is a particularly dangerous quarantine (conventional) infection, which is subject to the International Health Regulations. Carrying out scientifically based anti-plague measures in the 20th century. made it possible to eliminate plague epidemics in the world, but sporadic cases of the disease are recorded annually in natural foci.

Etiology. The causative agent of plague yersinia pestis belongs to the genus yersinia of the family Enterobacteriaceae and is a stationary ovoid short rod measuring 1.5-0.7 microns. The stability of the causative agent of plague outside the body depends on the nature of the factors affecting it external environment. As the temperature decreases, the survival time of bacteria increases. At a temperature of –22 °C, bacteria remain viable for 4 months. At 50-70 °C the microbe dies after 30 minutes, at 100 °C - after 1 minute. Conventional disinfectants in working concentrations (sublimate 1:1000, 3-5% Lysol solution, 3% carbolic acid, 10% milk of lime solution) and antibiotics (streptomycin, chloramphenicol, tetracyclines) have a detrimental effect on Y. pestis.

Epidemiology. There are natural, primary (“wild plague”) and synanthropic (anthropurgic) foci of plague (“city”, “port”, “ship”, “rat”). Natural foci of diseases developed in ancient times. Their formation was not connected with man and his economic activities. The circulation of pathogens in natural foci of vector-borne diseases occurs between wild animals and blood-sucking arthropods (fleas, ticks). A person entering a natural focus can become infected with the disease through the bites of blood-sucking arthropods that carry the pathogen, or through direct contact with the blood of infected commercial animals. About 300 species and subspecies of rodents carrying the plague microbe have been identified. In rats and mice, plague infection often occurs in a chronic form or in the form of asymptomatic carriage of the pathogen. The most active carriers of plague pathogens are the rat flea, the flea of human dwellings and the marmot flea. Infection of humans with plague occurs in several ways: transmissible - through the bites of infected fleas, contact - when skinning infected commercial rodents and cutting the meat of infected camels; nutritional – when eating foods contaminated with bacteria; aerogenic – from patients with pneumonic plague. Patients with pneumonic plague are the most dangerous to others. Patients with other forms may pose a threat if there is a sufficient flea population.

Pathogenesis is largely determined by the mechanism of infection transmission. Primary affect at the site of implementation is usually absent. With the flow of lymph, plague bacteria are carried to the nearest regional lymph nodes, where they multiply. Serous-hemorrhagic inflammation develops in the lymph nodes with the formation of a bubo. Loss of the lymph node's barrier function leads to generalization of the process. Bacteria are hematogenously spread to other lymph nodes and internal organs, causing inflammation (secondary buboes and hematogenous foci). The septic form of plague is accompanied by ecchymoses and hemorrhages in the skin, mucous and serous membranes, and the walls of large and medium-sized vessels. Severe degenerative changes in the heart, liver, spleen, kidneys and other internal organs are typical.

Clinical picture. The incubation period of the plague is 2-6 days. The disease, as a rule, begins acutely, with severe chills and a rapid increase in body temperature to 39-40 °C. Chills, feeling of heat, myalgia, painful headache, dizziness are the characteristic initial signs of the disease. The face and conjunctiva are hyperemic. The lips are dry, the tongue is swollen, dry, trembling, covered with a thick white coating (as if rubbed with chalk), enlarged. Speech is slurred and unintelligible. Typically toxic damage nervous system, expressed to varying degrees. Damage to the cardiovascular system is detected early, tachycardia (up to 120-160 beats per minute), cyanosis and pulse arrhythmia appear, and blood pressure decreases significantly. Seriously ill patients experience bloody or coffee-ground-colored vomit, loose stool with mucus and blood. An admixture of blood and protein is found in the urine, and oliguria develops. The liver and spleen are enlarged.

Clinical forms of plague:

A. Mainly local forms: cutaneous, bubonic, cutaneous-bubonic.

B. Internally disseminated, or generalized forms: primary septic, secondary septic.

B. Externally disseminated (central, often with abundant external dissemination): primary pulmonary, secondary pulmonary, intestinal.

The intestinal form is not recognized as an independent form by most authors.

Erased, mild, subclinical forms of plague are described.

Skin form. At the site of pathogen penetration, changes occur in the form of necrotic ulcers, boils, and carbuncles. Necrotic ulcers are characterized by a rapid, sequential change of stages: spot, vesicle, pustule, ulcer. Plague skin ulcers are characterized by a long course and slow healing with the formation of a scar. Secondary skin changes in the form of hemorrhagic rashes, bullous formations, secondary hematogenous pustules and carbuncles can be observed in any clinical form of plague.

Bubonic form. The most important feature The bubonic form of plague is bubo - a sharply painful enlargement of the lymph nodes. As a rule, there is only one bubo; less often, two or more buboes develop. The most common locations of plague buboes are the inguinal, axillary, and cervical areas. Early sign the developing bubo - sharp pain, forcing the patient to take unnatural positions. Small buboes are usually more painful than larger ones. In the first days, individual lymph nodes can be felt at the site of the developing bubo; later they become fused with the surrounding tissue. The skin over the bubo is tense, becomes red, and the skin pattern is smoothed out. No lymphangitis is observed. At the end of the stage of bubo formation, the phase of its resolution begins, which occurs in one of three forms: resorption, opening and sclerosis. With timely antibacterial treatment, complete resorption of the bubo occurs more often within 15-20 days or its sclerosis. According to severity clinical course The first place is occupied by the cervical buboes, then the axillary and inguinal ones. The axillary plague poses the greatest danger due to the threat of developing secondary pneumonic plague. In the absence of adequate treatment, mortality in the bubonic form ranges from 40 to 90%. With early antibacterial and pathogenetic treatment fatal outcome occurs rarely.

Primary septic form. It develops rapidly after a short incubation, ranging from several hours to 1-2 days. The patient feels chills, body temperature rises sharply, severe headache, agitation, and delirium appear. Possible signs of meningoencephalitis. A picture of infectious-toxic shock develops, and coma quickly sets in. The duration of the disease is from several hours to three days. Cases of recovery are extremely rare. Patients die due to severe intoxication, severe hemorrhagic syndrome, and increasing cardiovascular failure.

Secondary septic form. Is a complication of others clinical forms infection is characterized by an extremely severe course, the presence of secondary foci, buboes, and pronounced manifestations of hemorrhagic syndrome. Lifetime diagnosis of this form is difficult.

Primary pulmonary form. The most severe and epidemiologically most dangerous form. There are three main periods of the disease: the initial period, the height of the period and the soporous (terminal) period. The initial period is characterized by a sudden rise in temperature, accompanied by sharp chills, vomiting, severe headache. At the end of the first day of illness, cutting pain in the chest, tachycardia, shortness of breath, and delirium appear. The cough is accompanied by the release of sputum, the amount of which varies significantly (from a few “spits” with “dry” plague pneumonia to a huge mass with the “profuse wet” form). At first, the sputum is clear, glassy, viscous, then it becomes foamy, bloody and, finally, bloody. Thin consistency of sputum is a typical sign of pneumonic plague. excreted with sputum great amount plague bacteria. Physical data are very scarce and do not correspond to the general serious condition of the patients. The peak period of the disease lasts from several hours to 2-3 days. Body temperature remains high. Noteworthy are facial hyperemia, red, “bloodshot” eyes, severe shortness of breath and tachypnea (up to 50-60 breaths per minute). Heart sounds are muffled, pulse is frequent, arrhythmic, blood pressure is reduced. As intoxication increases, the depressed state of patients is replaced by general excitement, and delirium appears. The terminal period of the disease is characterized by an extremely severe course. Patients develop a stuporous state. Shortness of breath increases, breathing becomes shallow. Blood pressure is almost undetectable. The pulse is rapid, thread-like. Petechiae and extensive hemorrhages appear on the skin. The face becomes bluish, and then an earthy-gray color, the nose is pointed, the eyes are sunken. The patient experiences fear of death. Later, prostration and coma develop. Death occurs on the 3-5th day of illness with increasing circulatory failure and, often, pulmonary edema.

Secondary pulmonary form. Develops as a complication bubonic plague, clinically similar to primary pulmonary plague. Plague in vaccinated patients. It is characterized by an extension of the incubation period to 10 days and a slowdown in the development of the infectious process. During the first and second days of the disease, the fever is low-grade, general intoxication is mild, and the condition of the patients is satisfactory. The bubo is small in size, without pronounced manifestations of periadenitis. However, the symptom of severe pain in the bubo always persists. If these patients do not receive antibiotic treatment for 3-4 days, then the further development of the disease will be no different from the clinical symptoms in unvaccinated patients.

Forecast. Almost always serious. Methods play a decisive role in recognizing plague laboratory diagnostics(bacterioscopic, bacteriological, biological and serological), carried out in special laboratories operating in accordance with instructions on the operating hours of anti-plague institutions.

Treatment. Plague patients are subject to strict isolation and mandatory hospitalization. The main role in etiotropic treatment belongs to antibiotics - streptomycin, tetracycline drugs, chloramphenicol, prescribed in large doses. Along with antibacterial treatment, detoxification pathogenetic therapy is carried out, including the introduction of detoxification liquids (polyglucin, reopoliglucin, hemodez, neocompensan, albumin, dry or native plasma, standard saline solutions), diuretics (furosemide, or Lasix, mannitol, etc.) - for fluid retention in the body, glucocorticosteroids, vascular and respiratory analeptics, cardiac glycosides, vitamins. Patients are discharged from the hospital with complete clinical recovery and negative results of bacteriological control.

Prevention. In Russia, and earlier in the USSR, the world's only powerful anti-plague system was created, which carries out preventive and anti-epidemic measures in natural plague foci.

Prevention includes the following measures:

a) prevention of human diseases and outbreaks in natural areas;

b) preventing infection of persons working with material infected or suspected of being infected with plague;

c) preventing the importation of plague into the country from abroad.

^ Procedure for using a protective (anti-plague) suit

A protective (anti-plague) suit is designed to protect against infection by pathogens of particularly dangerous infections in all their main types of transmission. An anti-plague suit consists of pajamas or overalls, socks (stockings), slippers, a scarf, an anti-plague robe, a hood (large scarf), rubber gloves, rubber (tarpaulin) boots or deep galoshes, a cotton gauze mask (dust respirator, filtering or oxygen - insulating gas mask), flight-type safety glasses, towels. An anti-plague suit can, if necessary, be supplemented with a rubberized (polyethylene) apron and the same sleeves.

^ The procedure for putting on an anti-plague suit: overalls, socks, boots, hood or large headscarf and anti-plague robe. The ribbons at the collar of the robe, as well as the belt of the robe, must be tied in front on the left side with a loop, after which the ribbons are secured to the sleeves. The mask is put on the face so that the nose and mouth are covered, for which the upper edge of the mask should be at the level of the lower part of the orbits, and the lower edge should go under the chin. The upper straps of the mask are tied with a loop at the back of the head, and the lower ones - at the crown (like a sling bandage). Having put 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 outside the mask. The lenses of the glasses must first be rubbed with a special pencil or a piece of dry soap to prevent them from fogging up. Then put on gloves, having first checked them for integrity. A towel is placed in the waistband of the robe on the right side.

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

^ Procedure for removing the anti-plague suit:

1. Wash your gloved hands thoroughly 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 your belt and dump it into a basin with a disinfectant solution.

3. Wipe the oilcloth apron with a cotton swab, generously moistened with a disinfectant solution, remove it, folding it from the outside inward.

4. Remove the second pair of gloves and sleeves.

5. Without touching the exposed parts of the skin, remove the phonendoscope.

6. The 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. Undo the ties of the collar of the robe, the belt and, lowering the upper edge of the gloves, untie the ties of the sleeves, remove the robe, turning the outer part of it inward.

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

10. Take off gloves and check them for integrity in a disinfectant solution (but not with air).

11. Boots are wiped from top to bottom with cotton swabs, generously moistened with a disinfectant solution (a separate swab is used for each boot), and removed without using hands.

12. Take off socks or stockings.

13. Take off pajamas.

After removing the protective suit, wash your 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 pathogens anthrax– autoclaving (1.5 atm – 2 hours) or boiling in a 2% soda solution – 1 hour.

When disinfecting an anti-plague suit with disinfectant solutions, all its parts are completely immersed in the solution. The anti-plague suit should be removed slowly, without rushing, in a strictly established order. After removing each part of the anti-plague suit, gloved hands are immersed in a disinfectant solution.

In order to reduce the risk of infection of medical personnel working in laboratories, hospitals, isolation wards, in the field with microorganisms of I-II pathogenicity groups and patients suffering from diseases caused by them, they use protective clothing - the so-called. anti-plague suits, insulating suits such as KZM-1, etc.

There are 4 main types of anti-plague suits, each of which is used depending on the nature of the work performed.

First type suit(full suit) includes pajamas or overalls, a long “anti-plague” robe, a hood or a large scarf, a cotton-gauze bandage or an anti-dust respirator or a filter gas mask, canned glasses or disposable cellophane film, rubber gloves, socks, slippers, rubber or tarpaulin boots (shoe covers), oilcloth or polyethylene apron, oilcloth sleeves, towel.

This suit is used when working with material suspected of being contaminated with a plague pathogen, as well as when working in an outbreak where patients with this infection have been identified; when evacuating to a hospital those suspected of having pneumonic plague, carrying out ongoing or final disinfection in plague foci, conducting observation of persons who have been in contact with a patient with pneumonic plague; when autopsying the corpse of a person or animal that died from the plague, as well as from the Crimean-Congo, Lassa, Marburg, and Ebola hemorrhagic fevers; when working with experimentally infected animals and a virulent culture of the plague microbe, pathogens of glanders, melioidosis, and deep mycoses; carrying out work in foci of pulmonary anthrax and glanders, as well as diseases caused by viruses classified as pathogenicity group 1.

The duration of continuous work in a type 1 anti-plague suit is no more than 3 hours, in the hot season - 2 hours.

The modern equivalent of the first type of anti-plague suit is an insulating suit (“spacesuit”), consisting of a sealed synthetic overalls, a helmet and an insulating gas mask or a set of replaceable back oxygen cylinders and a reducer that regulates the pressure of the gas supplied to the suit. Such a suit can, if necessary, be equipped with a thermoregulation system, which makes it possible for a specialist to work for a long time at uncomfortable ambient temperatures. Before removing the suit, it can be completely treated with a chemical disinfectant in the form of a liquid or aerosol.

Type 2 suit(lightweight anti-plague suit) consists of overalls or pajamas, anti-plague robe, cap or large headscarf, cotton-gauze bandage or respirator, boots, rubber gloves and towels. Used for disinfection and disinsection in the outbreak of bubonic plague, glanders, anthrax, cholera, coxiellosis; when evacuating a patient with secondary plague pneumonia, bubonic, cutaneous or septic forms of plague to a hospital; when working in the laboratory with viruses classified as pathogenicity group I; working with experimental animals infected with pathogens of cholera, tularemia, brucellosis, anthrax; autopsy and burial of the corpses of people who died from anthrax, melioidosis, glanders (in this case, they additionally wear an oilcloth or plastic apron, the same sleeves and a second pair of gloves).

Type 3 suit(pajamas, anti-plague robe, cap or large scarf, rubber gloves, deep galoshes) are used when working in a hospital where there are patients with bubonic, septic or cutaneous forms of plague; in outbreaks and laboratories when working with microorganisms classified as pathogenicity group II. When working with the yeast phase of pathogens of deep mycoses, the suit is supplemented with a mask or respirator.

Type 4 suit(pajamas, anti-plague robe, cap or small scarf, socks, slippers or any other light shoes) are used when working in an isolation ward where there are persons who have interacted with patients with bubonic, septic or cutaneous forms of plague, as well as in the territory where such a patient has been identified , and in areas threatened by plague; in foci of Crimean-Congo hemorrhagic fever and cholera; in clean departments of virological, rickettsial and mycological laboratories.

The anti-plague suit is put on in the following order:

1) work clothes; 2) shoes; 3) hood (kerchief); 4) anti-plague robe; 5) apron; 6) respirator (cotton-gauze mask); 7) glasses (cellophane film); 8) sleeves; 9) gloves; 10) a towel (place it behind the apron belt on the right side).

Remove the suit in reverse order, immersing gloved hands in the disinfectant solution after removing each component. First, remove the glasses, then the respirator, robe, boots, hood (scarf), overalls, and lastly, rubber gloves. Shoes, gloves, and apron are wiped with cotton swabs, generously moistened with a disinfectant solution (1% chloramine, 3% Lysol). Clothes are folded with the outer (“infected”) surfaces turned inward.

Responsibilities of medical workers when identifying a patient with AIO (or suspected AIO)

Responsibilities of a resident physician medical institution:

1) isolate the patient inside the ward and notify the head of the department. If you suspect a plague, request an anti-plague suit for yourself and necessary medications for the treatment of skin and mucous membranes, installation for taking material for bacteriological research and disinfectants. The doctor does not leave the room and does not allow anyone into the room. The doctor performs treatment of mucous membranes and putting on a suit in the ward. To treat mucous membranes, use a solution of streptomycin (in 1 ml - 250 thousand units), and to treat hands and face - 70% ethanol. To treat the nasal mucosa, you can also use a 1% solution of protargol, for instillation into the eyes - a 1% solution of silver nitrate, for rinsing the mouth - 70% ethyl alcohol;

2) provide care for patients with acute infectious diseases in compliance with the anti-epidemic regime;

3) collect material for bacteriological research;

4) start specific treatment sick;

5) transfer persons who had contact with the patient to another room (transferred by personnel dressed in a type 1 anti-plague suit);

6) before moving to another room, contact persons undergo partial sanitization with disinfection of the eyes, nasopharynx, hands and face. Complete sanitary treatment is carried out depending on the epidemic situation and is appointed by the head of the department;

7) carry out ongoing disinfection of the patient’s secretions (sputum, urine, feces) with dry bleach at the rate of 400 g per 1 liter of secretions with an exposure of 3 hours or pour a double (by volume) amount of 10% Lysol solution with the same exposure;

8) organize protection of the premises where the patient is located from flies, close windows and doors and destroy flies with a firecracker;

9) after the final diagnosis has been established by a consultant - an infectious disease specialist, accompany the patient to infectious diseases hospital;

10) when evacuating a patient, provide anti-epidemic measures to prevent the spread of infection;

11) after delivering the patient to the infectious diseases hospital, undergo sanitary treatment and go into quarantine for preventive treatment.

All further measures (anti-epidemic and disinfection) are organized by an epidemiologist.

Responsibilities of the head of the hospital department:

1) clarify clinical and epidemiological data about the patient and report to the chief physician of the hospital. Request anti-plague clothing, equipment for collecting material for bacteriological examination from the patient, disinfectants;

4) organize the identification of persons who were in contact with the patient or who were in the department at the time of detection of acute respiratory infections, including those transferred to other departments and discharged due to recovery, as well as medical and service personnel of the department, and hospital visitors. Lists of persons who were in direct contact with patients must be reported to the head doctor of the hospital in order to take measures to search for them, call them and isolate them.;

5) vacate one ward of the department for an isolation ward for contact persons;

6) after the arrival of ambulance transport, evacuation and disinfection teams, ensure control over the evacuation from the department of the patient, persons who interacted with the patient, and the final disinfection.

Responsibilities of the doctor on duty at the admission department:

1) by telephone, inform the chief physician of the hospital about the identification of a patient suspected of having AIO;

2) stop further admission of patients, prohibit entry and exit from the emergency department (including service personnel);

3) request a room with protective clothing, a room for collecting material for laboratory testing, and medications for treating the patient;

4) change into protective clothing, collect material for laboratory testing from the patient and begin his treatment;

5) identify persons who were in contact with a patient with acute infectious diseases in the emergency department and compile lists according to the form;

6) after the arrival of the evacuation team, organize final disinfection in the reception department;

7) accompany the patient to the infectious diseases hospital, undergo sanitary treatment there and go into quarantine.

Responsibilities of the hospital chief physician:

1) set up a special post at the entrance to the building where a patient with acute respiratory infection has been identified, prohibit entry into and exit from the building;

2) stop access of unauthorized persons to the hospital territory;

3) check with the head of the department for clinical and epidemiological data about the patient. Report to the chief physician of the district (city) Center for Hygiene and Epidemiology about the identification of a patient suspected of having an acute infectious disease, and ask to refer an infectious disease specialist and (if necessary) an epidemiologist for consultation;

4) send to the department where the patient is identified (at the request of the head of the department) sets of protective anti-plague clothing, equipment for taking material from the patient for bacteriological research, disinfectants for ongoing disinfection (if they are not available in the department), as well as medications necessary for treating the patient;

5) upon the arrival of an infectious disease specialist and an epidemiologist, carry out further measures according to their instructions;

6) ensure the implementation of measures to establish a quarantine regime in the hospital (under the methodological guidance of an epidemiologist).

Responsibilities of a local clinic physician conducting outpatient visits:

1) immediately stop further admission of patients, close the doors of your office;

2) without leaving the office, by phone or through visitors waiting for an appointment, call one of the medical workers of the clinic and inform the chief physician of the clinic and the head of the department about the identification of a patient suspected of having an acute infectious disease, demand an infectious disease consultant and the necessary protective clothing, disinfectants, medications , installation for taking material for bacteriological examination;

3) change into protective clothing;

4) organize protection of the office from flies, immediately destroy flying flies with a firecracker;

5) compile a list of persons who were in contact with the patient with acute infectious diseases at the reception (including while waiting for the patient in the corridor of the department);

6) carry out ongoing disinfection of the patient’s secretions and water after washing dishes, hands, care items, etc.;

7) on the instructions of the chief physician of the clinic, upon arrival of the evacuation team, accompany the patient to the infectious diseases hospital, then undergo sanitary treatment and go to quarantine.

Responsibilities of a local clinic physician visiting patients at home:

1) by hand or by telephone, inform the chief physician of the clinic about the identification of a patient suspected of having an acute respiratory infection, and take measures to protect yourself (put on a gauze mask or respirator);

2) prohibit the entry and exit of unauthorized persons from the apartment, as well as the communication of the patient with those living in the apartment, except for one caregiver. The latter must be provided with a gauze mask. Isolate family members of the patient in the free areas of the apartment;

3) before the arrival of the disinfection team, prohibit the removal of things from the room and apartment where the patient was;

4) allocate individual dishes and patient care items;

5) compile a list of persons who were in contact with the sick person;

6) prohibit (prior to current disinfection) pouring the patient’s secretions and water into sewers or cesspools after washing hands, dishes, household items, etc.;

7) follow the instructions of the consultants (epidemiologist and infectious disease doctor) who arrived at the outbreak;

8) on the instructions of the chief physician of the clinic, upon arrival of the evacuation team, accompany the patient to the infectious diseases hospital, then undergo sanitary treatment and go to quarantine.

Responsibilities of the chief physician of the clinic:

1) clarify the clinical and epidemiological data about the patient and report to the district administration and the chief physician of the regional Center for Hygiene and Epidemiology about the identification of a patient suspected of OI. Call an infectious disease specialist and an epidemiologist for consultation;

2) give instructions:

– close the entrance doors of the clinic and post a post at the entrance. Prohibit entry and exit from the clinic;

– stop all movement from floor to floor. Place special posts on each floor;

– place a post at the entrance to the office where the identified patient is located;

3) send to the office where the identified patient is located, protective clothing for the doctor, equipment for taking material for laboratory testing, disinfectants, and medications necessary for treating the patient;

4) before the arrival of the epidemiologist and infectious disease specialist, identify persons who had contact with the patient from among the visitors to the clinic, including those who left it by the time the patient was identified with acute respiratory infections, as well as medical and service personnel of the outpatient clinic. Compile lists of contact persons;

5) upon the arrival of the infectious disease specialist and epidemiologist, carry out further activities in the clinic according to their instructions;

6) after the arrival of the ambulance transport and disinfection team, ensure control over the evacuation of the patient, persons who were in contact with the patient (separately from the patient), as well as the final disinfection of the clinic premises.

When the chief physician of the clinic receives a signal from the local therapist about identifying a patient with acute respiratory infections at home:

1) clarify clinical and epidemiological data about the patient;

2) report to the chief physician of the regional Center for Hygiene and Epidemiology about the identification of a patient suspected of having AIO;

3) take an order to hospitalize the patient;

4) call consultants to the outbreak - an infectious disease specialist and an epidemiologist, a disinfection team, and ambulance transport for hospitalization of the patient;

5) send protective clothing, disinfectants, medicines, and equipment to the outbreak to collect diseased material for bacteriological examination.

Responsibilities of a line ambulance doctor:

1) upon receipt of an order for the hospitalization of a patient suspected of OI, clarify the expected diagnosis by telephone;

2) when visiting a patient, wear the type of protective clothing that corresponds to the expected diagnosis;

3) a specialized ambulance evacuation team must consist of a doctor and 2 paramedics;

4) evacuation of the patient is carried out accompanied by the doctor who identified the patient;

5) when transporting a patient, measures are taken to protect the vehicle from contamination by his secretions;

7) after delivering the patient to the infectious diseases hospital, the ambulance and patient care items are subject to final disinfection on the territory of the infectious diseases hospital;

6) the departure of an ambulance and a tow truck team from the hospital territory is carried out with the permission of the chief physician of the infectious diseases hospital;

7) members of the evacuation team are subject to medical supervision with mandatory temperature measurement for the entire period of incubation of the suspected disease at the place of residence or work;

9) the doctor on duty at the infectious diseases hospital is given the right, in case of detection of defects in the protective clothing of the medical personnel of the ambulance, to leave them in the hospital for quarantine for observation and preventive treatment.

Responsibilities of the epidemiologist of the Center for Hygiene and Epidemiology:

1) receive from the doctor who discovered the patient with AIO all materials regarding the diagnosis and measures taken, as well as lists of contact persons;

2) conduct an epidemiological investigation of the case and take measures to prevent further spread of the infection;

3) manage the evacuation of the patient to the infectious diseases hospital, and contact persons to the observation department (isolator) of the same hospital;

4) collect material for laboratory diagnostics (samples of drinking water, food products, samples of patient secretions) and send the collected material for bacteriological examination;

5) outline a plan for disinfection, disinfestation and (if necessary) deratization in the outbreak and supervise the work of disinfectors;

6) check and supplement the list of persons who were in contact with the patient with acute infectious diseases, indicating their addresses;

7) give instructions on prohibiting or (as appropriate) permitting the use of public catering establishments, wells, latrines, sewage receptacles and other communal facilities after their disinfection;

8) identify contact persons in the outbreak of acute infectious diseases who are subject to vaccination and phaging, and carry out these activities;

9) establish epidemiological surveillance of the outbreak where a case of acute infectious diseases was detected, and, if necessary, prepare a proposal to impose quarantine;

10) draw up a conclusion about the case of the disease, give its epidemiological characteristics and provide a list of measures necessary to prevent further spread of the disease;

11) transfer all collected material to the manager local authority health management;

12) when working in an outbreak, carry out all activities in compliance with personal protection measures (appropriate special clothing, hand washing, etc.);

13) when organizing and carrying out primary anti-epidemic measures in the outbreak of infectious diseases - be guided by the comprehensive plan for carrying out these measures approved by the head of the regional administration.