Healthcare-associated infections: state of the problem and prospects

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Currently, the epidemic process of healthcare-associated infections (HAI’s) has a number of features, including a decrease in the intensity of manifestations of the epidemic process of HAI’s in surgery with a simultaneous increase in the proportion of severe forms of infections with loss of function or organ, a high risk of developing HAI’s in children with low and extremely low body weight, the spread of HAI’s pathogens with high epidemic potential: bacteria multiresistant to antimicrobial drugs, a decrease in the frequency of exogenous infection and an increase in infections associated with the formation of a hospital clone. At the same time, it should be noted that there are clear trends in the development of medical technologies, primarily in surgery, concerning the intensification of surgical treatment methods, a decrease in the aggression of medical technologies, an increase in the use of various implants, as well as organ and tissue transplantations. At the same time, the epidemic process of HAI predominantly involves microorganisms from the group of ESKAPE pathogens, which have the ability to “escape” the biocidal action of antimicrobial drugs and a high epidemic potential, necessary and sufficient for their epidemic spread in the hospital environment. In this regard, a mandatory condition for combating the formation of a “hospital” strain (clone) and the further development of group diseases of patients and employees of a medical organization is the introduction of systemic genetic monitoring of microorganisms circulating in the hospital environment using a risk-oriented approach based on systematically organized epidemiological diagnostics. This approach is determined by the need for timely identification of groups and risk factors, both in the context of individual units and the medical organization as a whole, in order to develop effective preventive and anti-epidemic measures.