Hospital Epidemiology Research Articles

Severity Profile of COVID-19 in Hospitalized Pediatric Patients.

We aimed to describe the clinical characteristics associated with severity in children hospitalized with COVID-19. This was an epidemiological cohort study conducted in two hospitals, one of which was a reference center for the treatment of COVID-19 cases. Data were collected from the reports generated by the hospital epidemiology centers and the medical records of patients aged between 0 and 14 years with a diagnosis of COVID-19, hospitalized between March 2020 and June 2021. To analyze the association between the clinical profile and severity, the cases were classified as severe (severe and critical) and non-severe (asymptomatic, mild, and moderate). Of the 191 children followed up in the cohort, 73.3% developed the severe form. The percentage of children with oxygen saturation below 95% was 46.6%. In the multivariate analysis, a higher risk of severity was estimated among children with uncontrolled asthma (RR = 13.2), who were overweight or obese (RR = 3.21), who had cough symptoms (RR = 2.72), and those aged under one year (RR = 3.23). This result underscores the need to improve healthcare at every level for children and for the management of asthma and nutrition when considering children with this clinical profile who are diagnosed with COVID-19.

Role of Xpert PCR kit in assessing MRSA colonization in medical and surgical units of a tertiary care teaching hospital

Background and rationaleMethicillin resistant Staphylococcus aureus (MRSA) colonization increases the risk of MRSA infection. Detecting MRSA colonization can influence postoperative outcomes and prolong hospital stay. The conventional standard culture method for detecting MRSA colonization has limitations in terms of sensitivity and turnaround time. Hence, we sought out use of Xpert PCR kit for prompt evaluation of MRSA colonization to support MRSA prevention in a tertiary care hospital in Karachi, Pakistan.Materials and methodsDuring 1st April-31st December 2022, 290 nasal and skin swab samples were collected from 257 patients and processed using routine culture (as gold standard method) and PCR-based MRSA detection assay (MRSA Xpert).ResultsA total of two hundred and ninety (290) swab samples from 257 patients were obtained, 33 of which were paired. The overall prevalence of MRSA colonization was 12% by both methods, with 90% of cases classified as community-associated (CA-MRSA) whereas 10% as hospital-acquired (HA-MRSA). The colonized group showed a higher subsequent MRSA infection rate (11% vs. 3.5%) compared to the noncolonized group. Culture identified 11% of screening samples as MRSA positive, Xpert MRSA assay showed 100% sensitivity and 95% specificity. The cost of a single MRSA Xpert assay was $50 while MRSA culture cost around $7.50.ConclusionOur study findings suggest that the presence of MRSA colonization in our cohort of patients is consistent with the existing trends in hospital epidemiology. Both conventional culture and Xpert MRSA methods showed comparable efficacy for detection of MRSA colonization. Larger-scale studies are recommended to validate these findings conclusively.

Linkage of Hospital and Community level records for Epidemiological Research: Experiences from Kagando Health and Demographic Surveillance System in Western Uganda

BackgroundLinkage of census data and hospital records is crucial in conducting epidemiological research to inform public health decisions. In this study, we share our experiences in linking community-level data collected through census with hospital records and highlight the challenges and opportunities from our engagements with stakeholders. MethodologyWe undertook engagements with Uganda Christian University Ethics Research Committee, Hospital Management, and Community Health Volunteers to set up a platform to integrate hospital and census records using key identifiers. Trained data clerks prospectively linked data during patients’ visits following the data protection guidelines. ResultsFrom a population of approximately 30,000 people, we managed to link 1000 records within three months. Lessons learnt and opportunities: It is possible to link data with a set of identifiers, not only relying on common identifiers, especially for communities where ownership of a national identity card or birth certificate is not universal. Building stakeholder partnerships is essential, and frequent meetings with the hospital staff, epidemiologists and data programmers helped to identify problems and solutions. ChallengesLack of local capacity at the health facilities to develop linkage platforms. However, after development they can efficiently run the program. Frequent changes in the versions of the electronic system were later resolved. RecommendationsThere is a need to conduct regular capacity building for stakeholders to help them understand the importance of data linkage. ConclusionPublic engagement is an ethical imperative that enhances the quality, credibility, and long-term impact of research by incorporating the perspectives of the communities being studied.

Epidemiology and Outcomes of Hepatitis E Virus-Associated Hospitalisations in the United States With a Focus on Pregnancy: A Nationwide Population Study, 1998-2020.

Hepatitis E virus (HEV) is typically asymptomatic in developed countries but can be more severe in certain populations. We aim to describe the epidemiology of HEV-associated hospitalisations from 1998 to 2020 in the United States, investigate risk factors for inpatient mortality and describe outcomes in pregnant women. We utilised the National Inpatient Sample and extracted cases of HEV-associated hospitalisations using ICD-9/10 diagnostic codes. Demographic, clinical and pregnancy data were extracted and analysed by chi-square and logistic regression. We identified 3354 cases of HEV-associated hospitalisations; 1689 (50.4%) were female and 1425 (42.5%) were non-Hispanic White. The median age was 50 (IQR: 37-59) years. Hospitalisation rates for HEV ranged from 2.5 per 10,000,000 in 2008 to a peak of 9.6 per 10,000,000 people in the general U.S. population in 2004. The mortality rate was 5.2%. Age ≥ 40 years (OR: 7.73; 95% CI: 1.57-38.09; p = 0.012), HIV infection (OR: 4.63; 95% CI: 1.26-16.97; p = 0.021), and coagulopathy (OR: 7.22; 95% CI: 2.81-18.57; p < 0.001) were associated with increased odds of mortality within the HEV cohort. There were 226 pregnant women with HEV. Rates of maternal death, stillbirth and preterm birth were similar between HEV and non-HEV pregnant cohorts. Hepatitis B and hepatitis C co-infection were significantly more common in the HEV pregnant cohort (p < 0.05). HEV-associated hospitalisations are uncommon in the United States, but likely underdiagnosed. Certain risk factors can be used to predict prognosis of these hospitalised patients. Pregnant women with HEV appear to have favourable maternal and fetal outcomes despite hepatitis B and C co-infection.

Perspectives and Awareness of Environmental Sustainability in the Infection Prevention and Control Community Nationally

Background: Healthcare contributes significantly to waste production and greenhouse gas emissions. This became especially apparent during the COVID-19 pandemic. Yet there is modest recognition of this issue, particularly within decision-making in Infection Prevention and Control (IPC). The aim of our study was to gauge general knowledge and attitudes of hospital epidemiologists (HEs) and infection preventionists (IPs) around the intersection of environmental sustainability and IPC, and to identify related institutional practices. Methods: An online survey, composed of ten questions related to environmental sustainability in IPC, was created and emailed to members of the SHEA Research Network (SRN), a national consortium of healthcare facilities collaborating on IPC research, from August - October 2023. Survey answers were collated via Redcap© and descriptive results were obtained. Results: Forty-two individuals (33 HEs, 7 directors of IPC, and 2 IPs) from unique institutions completed the survey. Thirty (71.4%) were from academic medical centers, 5 (11.9%) were from VA medical centers and 7 (16.7%) were from community hospitals. Over half of participants correctly estimated the amount of waste and carbon emissions produced annually by the US healthcare system (6 million tons and 8.5% of national emissions, respectively). However, only 42.9% considered environmental sustainability concerns important or very important when making IPC decisions. Fifteen (34.9%) had an environmental sustainability committee at their institution and of these, 8 had an established relationship with the IPC department. The most common techniques to promote sustainability amongst institutions were water/energy conservation (59.5%), reusable personal protective equipment (52.4%) and Leadership in Energy and Environmental Design (LEED) certification (47.6%). When asked which efforts they would support at their institution, 28.6% would eliminate the use of single-use endoscopes and one third would avoid use of ethylene oxide for sterilization. In deciding whether to support environmental sustainability measures, key considerations participants articulated were patient safety concerns, knowledge about effectiveness and costs, and administrative support. Conclusion: Although there is growing awareness around the contribution of the healthcare industry to carbon emissions and waste production, IPC professionals have not yet universally adopted measures to promote environmental sustainability. In our survey, many participants acknowledged the importance of balancing patient safety and sustainability concerns. Our study demonstrates the need for more research and education to inform decisions around environmentally sustainable efforts in IPC that also preserve patient safety. Additionally, professional and regulatory bodies must acknowledge and promote the importance of environmental sustainability in IPC decision-making.

Going Commando as Part of a Multifaceted Intervention to Reduce CAUTIs in Critically Ill Children

Background and Objectives: Catheter associated urinary tract infections (CAUTIs) are a source of preventable harm in children. Insertion and maintenance bundles have significantly reduced CAUTIs, but infections still occur. Starting in mid-2019, we experienced an increase in CAUTIs in our pediatric intensive care unit (PICU). The objective was to identify preventable causes of CAUTI and develop and test interventions to reduce them. Methods: This quality improvement project was initiated in the PICU of a large tertiary children’s hospital. Interdisciplinary rounds led by the hospital epidemiologist and unit nursing leader with the bedside nurse occurred weekly (starting October 2019) for patients with urinary catheters in place for greater than three days. Discussions included strategies to optimize maintenance of the urinary catheter and identify catheters that could be removed. Additional interventions included no diapers for patients with a urinary catheter (starting March 2021) and use of a urine collection device that prevented both urine stasis in the drainage tube and retrograde flow of urine into the bladder (starting August 2021). Hand hygiene and CAUTI prevention bundle compliance was measured by direct observation of staff. CAUTIs were identified by prospective surveillance by infection prevention using standard definitions. The rate of CAUTIs over time was analyzed using statistical process control charts. Results: The baseline CAUTI rate (January 2017 - June 2019) was 0.5 infections/1000 catheter days with an average of 349 days between CAUTIs. Between July 2019 and February 2021, the CAUTI rate increased to 3.3 with an average of 88 days between CAUTIs. Annual compliance with hand hygiene and the CAUTI prevention bundle elements remained above 90% throughout all time periods. No improvement was seen after the institution of weekly interdisciplinary rounds. Starting in March 2021 after removal of diapers and implementation of the urine collection device that prevented retrograde flow, the CAUTI rate decreased to 0.9 and an average of 200 days between CAUTIs. Currently, it has been 512 days since the last CAUTI. Conclusion: CAUTIs decreased after removing diapers in children with urinary catheters and use of the urine collection device. Removal of diapers likely reduced stool contamination around the catheter and urethral opening. The urine collection device prevented inadvertent retrograde flow of urine into the bladder. These interventions could augment current CAUTI prevention strategies.

Can Artificial Intelligence Support Infection Prevention and Control Consultations?

Background: Artificial intelligence (AI) tools have demonstrated success in US medical licensing examinations; however, their utility in infection prevention and control (IPC) remains unknown. Methods: The program of hospital epidemiology handles consultation calls and records each question and answer. Using 2022 data, we selected 31 frequently asked questions. We utilized four AI tools, including Chat GPT-3.5 and 4.0, Bing AI, and OpenEvidence, to generate answers. We predefined scales (Table 1) to capture responses by three reviewers, including two hospital epidemiologists and one infection preventionist. The mean score of ≥ 3 and ≥ 4 was considered acceptable in accuracy and completeness, respectively. We reported the percentage of responses with acceptable accuracy and completeness out of assessed questions for each category. Results: Among 31 questions, 16 were associated with isolation duration, 9 with healthcare personnel (HCP) exposure, 4 with cleaning contaminated rooms, and 2 with patient exposure. Regarding accuracy, most AI tools performed worse in questions about isolation duration, ranging between 75% and 93.8%. All AI tools, except OpenEvidence, had a 100% accuracy rate for HCP and patient exposure. All AI tools had a 100% accuracy rate for contaminated room handling. The highest overall acceptable accuracy rate was observed in Chat GPT-3.5. Regarding completeness, most AI tools performed worse in questions about isolation duration, ranging between 44% and 75%. All AI tools, except OpenEvidence, had a 100% completeness rate for contaminated rooms and patient exposure. The highest overall acceptable completeness rate was observed in Bing AI (Table 2). Conclusions: All AI tools provided reasonable answers to commonly asked IPC-related questions, although, there were variations among different tools used. AI could be used to supplement the infection control program, especially if resources are limited.

Patient First Strategies for Reducing Inequities in HAI Prevention

Background: Inequities in healthcare-associated infections (HAI) incidence and prevention measures are critically important to understand (Chen,2021). While evaluations are beginning to characterize these disparities by infection type (Gettler, 2023), our work expands this by characterizing disparities by prevention strategies. By better understanding how evidence-based prevention strategies are implemented at the patient level, infection preventionists and hospital epidemiologists can better design strategies that provide equitable care to all patients. Methods: Beginning January 2023, gender, race, ethnicity, spoken language, and age group fields were added to daily chlorhexidine gluconate (CHG) treatment and C. difficile test order compliance data captured via electronic medical record. In July 2023, fields on recorded race, ethnicity, and gender were added to well-established foley and vascular access real-time peer audit tools that are used by infection preventionists (IPs). Each prevention strategy variable was summarized by demographic variables and differences in compliance were measured using chi-square tests. Results: 899 vascular audits and 420 foley audits were completed by IPs between July – December 2023. In 2023, there were 114,066 opportunities for CHG Treatment and 1,991 C. difficile test orders. Missing data varied by metric but ranged from 0-60%. Statistically significant differences by race were found in 3 of 8 components (i.e., intact seal, secured catheter and absence of dependent loop) in the foley audit (p &lt; 0 .01) and compliance with C. difficile test ordering (p &lt; 0 .01). No differences in race were found in vascular access audits or CHG treatment. No differences in gender or ethnicity were noted in foley, vascular access audits, CHG treatment compliance, or C. difficile testing. Differences in gender and age were found in CHG treatment compliance (p &lt; 0 .001). Conclusions: By focusing more on patient level process measures rather than only presenting stratified outcomes data, we can identify targeted opportunities for improvement in health equity before our patients develop an HAI. Further evaluations should also focus on assessing the clinical relevance of statistical findings to better inform intervention strategies. Separately, efforts are needed to improve completeness and integrity of demographic data in the electronic medical record.

30th International Conference on Hospital Epidemiology and HygieneHospital hygiene, epidemiology and sustainability

30th International Conference on Hospital Epidemiology and HygieneHospital hygiene, epidemiology and sustainability

Hospital hygiene and epidemiology - the future of physician and non-physician education

Hospital hygiene and epidemiology - the future of physician and non-physician education

Automation and digitalization in hospital hygiene and epidemiology: QUO VADIS?

Automation and digitalization in hospital hygiene and epidemiology: QUO VADIS?

Comparison of COVID-19 Infection in Operating Room Staff During Two COVID-19 Waves Using Different Preventive Strategies in a Tertiary Care Hospital in Pakistan.

To assess if limiting elective surgeries during specific pandemic phases significantly affected COVID-19 incidence among operating room (OR) staff. Retrospective cohort study. Place and Duration of the Study: Operation Theatre (OT), The Aga Khan University Hospital, Karachi, Pakistan, from May 2020 to 2021. This retrospective study compared two pandemic waves: Wave 1, during which elective surgeries were restricted (REL), and Wave 2, during which elective surgeries were continued routinely (EL). Exposure levels were measured based on OR activity. Incidence rates were calculated per 100 OR staff, per 100 ORs, and per 100 surgeries for both Groups. No statistically significant difference emerged in COVID-19 incidence among OR staff between REL (13.8 per 100 staff) and EL (14.4 per 100 staff) Groups (p = 0.825). However, the EL Group exhibited a significantly lower incidence risk per running OR (5.6 per 100 ORs vs. REL's 12 per 100 ORs, p <0.001). Additionally, the EL Group showed a lower incidence per 100 surgeries (1.5 vs. REL's 2.9, p <0.002). Restricting elective surgeries during the early pandemic phase did not significantly reduce COVID-19 incidence among OR staff. Infections were primarily linked to interactions with colleagues and the community, emphasising the need for a balanced pandemic response considering patient care and the consequences of surgery restrictions. COVID-19 infection, Operating room staff, COVID-19 waves, COVID-19 transmission, Hospital epidemiology, Pandemic response.

Epidemiology of Respiratory Syncytial Virus Hospitalizations in Poland: An Analysis from 2015 to 2023 Covering the Entire Polish Population of Children Aged under Five Years.

Respiratory syncytial virus (RSV) is an important cause of childhood hospitalizations. The aim of the study was to estimate the rates of RSV-related hospitalizations in children aged less than 5 years in Poland. This retrospective observational cohort study was based on data obtained from the National Health Fund in Poland regarding all acute respiratory tract infections and RSV-coded admissions of children (age < 5 years) to public hospitals between July 2015 and June 2023. Patients were stratified based on the following age groups: 0-1 month, 2-3 months, 4-6 months, 7-12 months, 13-24 months, and 25-60 months. The number of RSV-related hospitalizations increased every season, both before and through the ending phase of the coronavirus disease 2019 (COVID-19) pandemic. The COVID-19 pandemic was associated with a shift in the seasonality pattern of RSV infection. Hospitalization rates per 1000 inhabitants were the highest for children aged 0-12 months, reaching 47.3 in the 2022/23 season. Within this group, the highest hospitalization rate was observed for children aged 2-3 months-94.9 in the 2022/23 season. During the ending phase of the COVID-19 pandemic, the observed increase in admission rates was 2-, 4-, and 5-fold the pre-COVID rate for children aged <12 months, 12-24 months, and 25-60 months, respectively. In Poland, RSV infections cause a significant burden in hospitalized children aged less than 5 years. RSV-related hospitalizations were most frequent in children aged less than 1 year. The COVID-19 pandemic was associated with a shift in the seasonality pattern of RSV infections. After the pandemic, more RSV-related hospitalizations were observed in older children (aged 13 months and older) vs. the pre-pandemic phase.

IJCM_41A: Epidemiology of intussusception hospitalization and its potential risk with Rotasiil among vaccinated children admitted in a tertiary care hospital in South India

Background: There is an established well reported link of intussusception with the use of rotavirus vaccines. Little is known about the newly introduced rotasiil vaccine causing intussusception. So, this study has been undertaken to study the epidemiology of intussusception and its potential risk among children vaccinated with Rotasiil vaccine. Methodology: A hospital based cross-sectional study was conducted for a period of 2 years among children &lt;2 years admitted with confirmed intussusception. A predesigned semi structured questionnaire was used to capture sociodemographic data by interviewing parents and clinical data was collected from hospital records. Vaccination details was extracted from vaccination cards. Data was expressed in percentages and proportions. Results: Out of 80 confirmed cases of intussusception 64 (80%) children received rotasiil vaccine. The mean age of the study participants was 12+ 6 months and 67.5% of them were males. Out of the vaccinated children 82.8% and 98.4% of them had received all the doses and only two doses respectively. The median age (IQR) of receiving first, second and third doses was 7.6 (6.9-9.4), 12.9 (11.9-15.4), and 17.9 (16.4-21.8) weeks, respectively. Among them 95.3% of participants had ileocolic type of intussusception and 89% of it was resolved by non-surgical procedures. Within a risk period of 1-21 days postvaccination 1 and 8 cases of intussusception were reported after second and third dose respectively Conclusion: There were more number of cases of intussusception observed in the high risk period of 1-21 days after the third dose as compared to that of first and second dose of rotasiil vaccine

Clinical and economic burden of respiratory syncytial virus in children aged 0–5 years in Italy

BackgroundRespiratory syncytial virus (RSV) is among the leading causes of hospitalization due to lower respiratory tract infections (LRTIs) in children younger than 5 years worldwide and the second cause of infant death after malaria. RSV infection occurs in almost all the infants before the second year of life with variable clinical severity, often requiring medical assistance. This analysis investigated patients aged 0–5 years with RSV infection focusing on epidemiology, clinical features, and economic burden of RSV-associated hospitalizations in a setting of Italian real clinical practice.MethodsAn observational retrospective analysis was conducted on administrative databases of healthcare entities covering around 2.6 million residents of whom 120,000 health-assisted infants aged < 5 years. From 2010 to 2018, pediatric patients were included in the presence of hospitalization discharge diagnosis for RSV infections, and RSV-related acute bronchiolitis or pneumonia. Epidemiology, demographics, clinical picture and costs were evaluated in RSV-infected patients, overall and stratified by age ranges (0–1, 1–2, 2–5 years) and compared with an age-matched general population.ResultsOverall 1378 RSV-infected children aged 0–5 years were included. Among them, the annual incidence rate of RSV-related hospitalizations was 175–195/100,000 people, with a peak in neonates aged < 1 year (689–806/100,000). While nearly 85% of infected infants were healthy, the remaining 15% presented previous hospitalization for known RSV risk factors, like preterm birth, or congenital heart, lung, and immune diseases. The economic analysis revealed that direct healthcare costs per patient/year were markedly higher in RSV patients than in the general population (3605€ vs 344€).ConclusionsThese findings derived from the real clinical practice in Italy confirmed that RSV has an important epidemiological, clinical, and economic burden among children aged 0–5 years. While the complex management of at-risk infants was confirmed, our data also highlighted the significant impact of RSV infection in infants born at term or otherwise healthy, demonstrating that all infants need protection against RSV disease, reducing then the risk of medium and long-term complications, such as wheezing and asthma.

A descriptive model featuring expansive clinical microbiology approaches and antimicrobial stewardship to control antimicrobial resistance in low- and middle-income countries

The upsurge and escalation of antimicrobial resistance (AMR) poses a major worry on the global scene. Effective antimicrobial stewardship (AMS) programs are critical to combat this challenge, and applied knowledge in clinical microbiology serves as the cornerstone for the successful implementation. Despite technological advances, many low- and middle-income countries (LMICs) still adopt traditional phenotypic techniques in clinical microbiology laboratories. An expansive implementation of clinical microbiology approaches can bridge this apparent gap. Good laboratory assessment, hospital epidemiology, and infection prevention and control, which are the sub-divisions of the expansive clinical microbiology approaches, can be deployed to implement AMS appropriately in LMICs. In this paper, we describe a model featuring a functional AMS equipped with expansive clinical microbiology approaches to control AMR in LMICs. &amp;nbsp;

Epidemiologic trends, risk factors and outcomes for pediatric myocarditis in the COVID era

BackgroundDuring the peak of the COVID pandemic, there was a high degree of awareness around myocarditis as a potential manifestation. However, it is not very clear if hospitalizations related to myocarditis increased pre- and during the COVID era and if there was an impact on outcomes of the same. ObjectivesThe objective of this study was to assess the epidemiology of hospitalizations for pediatric myocarditis between 2019 and 2022 (COVID era) compared to the prior era. An additional objective was to assess the outcomes for COVID and non-COVID myocarditis for hospitalized patients. MethodsPHIS database was utilized to identify patients diagnosed with myocarditis from 2006 to 2022 using appropriate diagnostic codes. To assess and compare the outcomes, such as in-hospital mortality, ICU hospitalization, and length of stay (LOS), mixed model multivariable logistic regression analysis was performed. ResultsA total of 5084 patients were diagnosed with myocarditis from 2006 to 2022. The incidence of myocarditis patients increased significantly from 4.23 % in 2006 to 15.2 % in 2021 (p < 0.001). Specifically, during the post-COVID era from 2020 to 2022, the incidence of myocarditis (n = 1298, 28.7 %) increased significantly. Out of which, one-third (n = 366, 28.1 %) of the patients were also diagnosed with COVID-19. Patients having COVID-19 along with myocarditis had two times (OR: 2.13 (95 % CI: 1.55–2.92), and patients utilizing mechanical ventilation had 13 times higher odds of ICU hospitalization. In contrast, patients visiting ED had 35 % lower odds of ICU hospitalization. Although patients diagnosed with COVID and myocarditis are twice as likely to be hospitalized in the ICU, there were comparable rates of discharge mortality between COVID era and non-COVID era among pediatric myocarditis cases. ConclusionDespite the increase in the incidences of myocarditis patients and increased hospitalizations during post-COVID era, rates of mortality among these patients were comparable.

Этические и юридические аспекты назначения антибактериальных препаратов резерва

The article explains what an antibacterial reserve preparation means. It has been shown that the drug belonging to the group is determined by its pharmacological properties only such as a clinically significant (sufficient for empirical application) activity in relation to Pseudomonas aeruginosa or nosocomial (methicillin-resistant) strains of Staphylococcus aureus. It allows to differentiate between two categories of reserve antibiotics, which exert an anti-Gram-negative and anti-Gram-positive activity. There is an exhaustive list of preparations included into each group and available in the Russian market. Meanwhile, no drugs that correspond to inclusion requirements for both groups are available. Possible conflicts that occur during clinical application of antibacterial reserve drugs are comprehensively analyzed. It is based on divergence of interests of a patient and the patient’s representatives, treating physician, management of the clinic, hospital epidemiologists and manufacturers of reserve generics. Economic and general biological (selection of drug-resistant strains in extensively wide application) arguments commonly contradict the legal (compliance with clinical recommendations), moral and ethical (independence of aid quality from the patient’s prognosis) standards. The Legislator’s position in relation to the issue has been reviewed. Imperfect regularity framework and insufficient legal safety of a doctor make it possible to resolve conflicts through concessions and agreements including reserve antibiotics prescribed as per conditionally social indications.

Implementation of contact precautions for multidrug-resistant organisms in the post-COVID-19 pandemic era: An updated national Emerging Infections Network (EIN) survey.

To understand how healthcare facilities employ contact precautions for patients with multidrug-resistant organisms (MDROs) in the post-coronavirus disease 2019 (COVID-19) era and explore changes since 2014. Cross-sectional survey. Emerging Infections Network (EIN) physicians involved in infection prevention or hospital epidemiology. In September 2022, we sent via email an 8-question survey on contact precautions and adjunctive measures to reduce MDRO transmission in inpatient facilities. We also asked about changes since the COVID-19 pandemic. We used descriptive statistics to summarize data and compared results to a similar survey administered in 2014. Of 708 EIN members, 283 (40%) responded to the survey and 201 reported working in infection prevention. A majority of facilities (66% and 69%) routinely use contact precautions for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) respectively, compared to 93% and 92% in 2014. Nearly all (>90%) use contact precautions for Candida auris, carbapenem-resistant Enterobacterales (CRE), and carbapenem-resistant Acinetobacter baumannii. More variability was reported for carbapenem-resistant Pseudomonas aeruginosa and extended-spectrum β-lactamase-producing gram-negative organisms. Compared to 2014, fewer hospitals perform active surveillance for MRSA and VRE. Overall, 90% of facilities used chlorhexidine gluconate bathing in all or select inpatients, and 53% used ultraviolet light or hydrogen peroxide vapor disinfection at discharge. Many respondents (44%) reported changes to contact precautions since COVID-19 that remain in place. Heterogeneity exists in the use of transmission-based precautions and adjunctive infection prevention measures aimed at reducing MDRO transmission. This variation reflects a need for updated and specific guidance, as well as further research on the use of contact precautions in healthcare facilities.

85 years of the Department of Epidemiology and Evidence-Based Medicine of Kazan State ­Medical University: from history to modern times

In 2023, it was 85 years since the founding of the Department of Epidemiology and Evidence-Based Medicine at Kazan State Medical University. The article describes the main stages of the history of the department, from its foundation to the present day. The first head of the department in 1938 was V.I. Popov. In addition to successful work in training specialists, the history of the department was marked by extensive scientific activity and work carried out in the direction of the infectious diseases prevention, including as part of eliminating outbreaks. Employees of the department have carried out scientific research devoted to improving the diagnosis of infectious diseases, improving epidemiological surveillance in order to further reduce the incidence and eliminate current infections, including diphtheria, typhus and typhoid fever, tuberculosis, smallpox, viral hepatitis, infection caused by the human immunodeficiency virus, etc. A significant part of the scientific work carried out by the staff of the department concerned the study of post-infectious and post-vaccination immunity, as well as the study of the influence of environmental risk factors on the immunological reactivity of the body. The change in the paradigm of modern epidemiology and the epidemic situation has necessitated modification of the educational process with the inclusion in the program and expansion of teaching in such areas as clinical epidemiology, hospital epidemiology, and military epidemiology. In 2016, the department was renamed the Department of Epidemiology and Evidence-Based Medicine.