The topic of the pandemic of the new coronavirus infection became a key topic during the VIII Congress with international participation “Control and prevention of infections associated with the provision of medical care (HAI-2020)”. What lessons has this pandemic taught us? What urgently needs to be changed in the health care system and attitude? One of the sessions of the Congress was devoted to these questions.
Throughout history, epidemics and pandemics have repeatedly changed the map of the world, wars have begun; they contributed to colonial conquest and democratic transformation. However, in recent years, viruses have been declared generally defeated, and the possibility of a pandemic has been considered a fantasy.
But it did happen. And, according to experts, we underestimated the historical experience, the risk of large-scale epidemics and exaggerated the capabilities of antimicrobial drugs, which are rapidly losing their effectiveness today.
A group of scientists led by the chief epidemiologist of the Russian Ministry of Health, academician of the Russian Academy of Sciences, Nikolai Briko presented an analysis of the situation in Russian medicine as a result of the pandemic. According to the head of the Department of Epidemiology, Professor Elena Brusina, Russia met the pandemic in the conditions of a sharply reduced and poorly equipped infectious diseases service. For many years, infectious diseases hospitals have been diligently liquidated in our country, and in universities they have reduced training in the specialties “infectious disease” and “epidemiologist”. “The lessons that we have received and are receiving indicate that today it is necessary to consider the infectious disease service in the context of the country’s national security. We see a serious lack of knowledge in the field of infections among doctors of other specialties, therefore it is necessary to introduce the principles of treatment and diagnosis of infections for general practitioners into the curricula of medical universities, ”says Professor Brusina.
The inappropriateness was demonstrated by the algorithms adopted in the country for working with patients with suspected serious infections. In fact, they are targeted at a small number of people, mainly with an oral-fecal type of infection (for example, cholera). The system turned out to be sorely unprepared for a massive influx of patients with respiratory viruses.
It would seem a trifle, but the system for recording and registering infections in a situation of epidemic spread has failed: the transmission time of information about new cases detected instead of 20 minutes in fact is on average 4 hours, which makes it impossible to respond quickly.
“The architectural and planning solutions of our medical institutions do not take into account the risk of infections and do not allow to quickly divide blocks for infectious patients and others; the premises are not isolated by airlocks and are therefore unsafe for both patients and staff. Our hospital complexes are not considered at all from the point of view of the risk of the introduction of aerogenic infections; in our hospitals, the priority is given to mega-buildings instead of pavilion-type buildings; they either have too few or no isolated boxes, and not all organizations have sanitary facilities in patient rooms. We do not have centralized descent systems in intensive care units. There are serious problems with the disinfection of class B waste – there is simply no special equipment. The pandemic has made it obvious that it is mandatory to equip the laboratory services of hospitals with analyzers, ”says Elena Brusina.
Another problem posed by epidemiologists: the poor quality of biosecurity suits for doctors. For example, there is simply no winter form of protection, which creates problems for ambulance workers today.
In many regions, in recent years, on the waves of optimization, they have eliminated … disinfection chambers. The pandemic showed that they were in a hurry Experts note that the disinfection stations in the country need to be urgently restored.
Scientists have come to the conclusion that the use of cell phones should be strictly prohibited in the “red” zones. The creation of covid departments in the same buildings where other patients lie was also called serious mistakes of this pandemic; the wearing of shields by doctors instead of glasses and the isolation of sick employees in the workplace, which became popular after the infection of Dr. Protsenko.
WHO expert on the programs “Cleanliness increases the safety of health care”, the head of the epidemiological service of the University Hospital of Geneva, Professor Didier Pite shared his experience of managing covid patients in his institution. A huge role here is given to the use of alcohol-based liquid disinfectants (they kill encapsulated viruses like SarsCov2 in 15 seconds). “Numerous international studies have shown that the SarsCov2 virus does not survive in aerosols. One of the most important measures to prevent infection is hand hygiene. We completely changed the work of our hospital in the context of a pandemic: we opened 600 beds for covid patients, divided the flows of patients and doctors, introduced strict social distance everywhere, even in the corridors, in the dining room, tables were allocated so that no one came close to each other, they changed the elevator schedule, opened tents for diagnostics on covid, closed places for doctors to rest. And introduced the daily recycling of the used bottles. As a result, our hospital has become completely different, ”said Professor Pite.