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УДК: 614.446.2 DOI:10.33920/med-08-2304-02

Гармонизация комплекса мероприятий по профилактике инфекций, связанных с оказанием медицинской помощи родильницам и новорожденным, требованиям ВОЗ

Орлова Оксана Анатольевна доктор медицинских наук, начальник отдела эпидемиологии — врач-эпидемиолог, ФГБУ «Национальный медико-хирургический центр имени Н.И. Пирогова» Минздрава России, ведущий научный сотрудник лаборатории инфекций, связанных с оказанием медицинской помощи, ФБУН «ЦНИИ эпидемиологии» Роспотребнадзора, старший научный сотрудник лаборатории оппортунистических инфекций, ФГБУ «Научно-исследовательский центр эпидемиологии и микробиологии имени Н. Ф. Гамалеи» Минздрава России, г. Москва, Россия, e-mail: оksana_orlova@bk.ru, http://orcid.org/0000-0002-6701-1252
Абрамов Юрий Евгеньевич аспирант, ФБУН «ЦНИИ эпидемиологии» Роспотребнадзора, г. Москва, Россия, e-mail: abramoffye@gmail.com, http://orcid.org/0000-0002-1972-4581
Тутельян Алексей Викторович доктор медицинских наук, член-корреспондент РАН, заведующий лабораторией инфекций, связанных с оказанием медицинской помощи, ФБУН «ЦНИИ эпидемиологии» Роспотребнадзора, профессор кафедры эпидемиологии ФГАОУ ВО «Первый Московский государственный медицинский университет имени И.М. Сеченова» Минздрава России, г. Москва, Россия, e-mail: bio-tav@yandex.ru, http://orcid.org/0000-0002-2706-6689

В статье представлен комплекс мероприятий по профилактике инфекций, связанных с оказанием медицинской помощи (ИСМП) родильницам и новорожденным, разработанный в соответствии с рекомендациями ВОЗ. Предложенный комплекс профилактики ИСМП позволит минимизировать риски развития ИСМП, а соответственно, улучшит качество оказываемой медицинской помощи родильницам и новорожденным.

Литература:

1. Improving infection prevention and control at the health facility: interim practical manual supporting implementation of the WHO guidelines on core components of infection prevention and control programmes. Geneva: World Health Organization; 2018 (https://apps.who.int/iris/handle/10665/279788, accessed 10 March 2023).

2. Interim practical manual: supporting national implementation of the WHO guidelines on core components of infection prevention and control programmes. Geneva: World Health Organization; 2017 (https://apps.who.int/iris/ handle/10665/330073, accessed 10 March 2023).

3. Slawomirski L, Auraaen A, Klazinga N. The economics of patient safety: strengthening a value-based approach to reducing patient harm at national level. OECD Health Working Papers No. 96. Paris: Organisation for Economic Cooperation and Development; 2017 (https://doi. org/10.1787/5a9858cd-en, accessed 10 March 2023).

4. Jha AK, Larizgoitia I, Audera-Lopez C, Prasopa-Plaizier N, Waters H, Bates DW. The global burden of unsafe medical care: analytic modelling of observational studies. BMJ Qual Saf. 2013; 22 (10):809–15.

5. Allegranzi B, Bagheri Nejad S, Combescure C, Graafmans W, Attar H, Donaldson L, et al. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet. 2011; 377 (9761): 228–241.

6. Health Organization, 2011 (https://apps.who.int/iris/handle/10665/80135, accessed 10 March 2023).

7. Ling ML, Apisarnthanarak A, Madriaga G. The burden of healthcare-associated infections in Southeast Asia: A systematic literature review and neta-analysis. Clin Infect Dis. 2015; 60 (11): 1690–9.

8. Alothman A, Al Thaqafi A, Al Ansary A, Zikri A, Fayed A, Khamis F, et al. Prevalence of infections and antimicrobial use in the acute-care hospital setting in the Middle East: Results from the first point-prevalence survey in the region. Int J Infect Dis. 2020; 101: 249–58.

9. Suetens C, Latour K, Kärki T, Ricchizzi E, Kinross P, Moro ML, et al. Prevalence of health-care associated infections, estimated incidence and composite antimicrobial resistance index in acute care hospitals and long-term care facilities: results from two European point prevalence surveys, 2016 to 2017. Eurosurveillance: Eur Comm Dis Bul. 2018; 23 (46).

10. Global guidelines for the prevention of surgical site infection, 2nd ed. Geneva: World Health Organization; 2018 (https://apps.who.int/iris/handle/10665/277399, accessed 10 March 2023).

11. van Dillen J, Zwart J, Schutte J, van Roosmalen J. Maternal sepsis: epidemiology, etiology and outcome. Curr Opin Infect Dis. 2010; 23 (3): 249–54.

12. Global report on the epidemiology and burden of sepsis: current evidence, identifying gaps and future directions. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/ handle/10665/334216, accessed 10 March 2023).

13. Guidelines on core components of infection prevention and control programmes at the national and acute health care facility level 2016 (https://apps.who.int/iris/bitstream/handle/10665/251730/9789241549929-eng.pdf?sequence = 1&isAllowed = y, accessed 10 March 2023).

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15. Сметанин В.Н. Гигиена рук в медицинских организациях: реализация концепции — эффективная мера профилактики ИСМП. Санитарный врач. 2022; 11: 833–839. doi: 10.33920/med-08-2211-04

16. Нешатаев А.Н., Лукьяненко Н.В., Лукьяненко Н.Я. Эпидемиологическая оценка факторов риска инфекций, связанных с оказанием медицинской помощи (ИСМП) в онкогинекологической практике среди пациентов, получивших и не получавших химио- и радиоизотопную терапию. Санитарный врач. 2019; 6: 21–29.

17. Сурсякова К.И., Сафьянова Т.В., Дронов С.В., Козлов Д.Ю. Оценка влияния факторов риска развития инфекций мочевыводящих путей как формы ИСМП на примере крупных многопрофильных стационаров Алтайского края. Санитарный врач. 2022; 1: 20–31. doi: 10.33920/med-08-2201-03

18. Global report on infection prevention and control 2022 (https://www.who.int/publications/i/item/9789240051164, accessed 10 March 2023).

19. Haley RW, Culver DH, White JW, Morgan WM, Emori TG, Munn VP, et al. The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol. 1985; 121 (2): 182–205.

20. Mermel LA, Jefferson J, Blanchard K, Parenteau S, Mathis B, Chapin K, et al. Reducing Clostridium difficile incidence, colectomies, and mortality in the hospital setting: a successful multidisciplinaryapproach. Jt Comm J Qual Patient Saf. 2013; 39 (7): 298–305.

21. O’Boyle C, Jackson, M., Henly, SJ. Staffing requirements for infection control programs in US health care facilities: Delphi project. Am J Infect Control. 2002; 30: 321–33.

22. Larson EL, Quiros D, Lin SX. Dissemination of the CDC’s hand hygiene guideline and impact on infection rates. Am J Infect Control. 2007; 35 (10): 666–75.

23. Rosenthal VD, Guzman S, Safdar N. Effect of education and performance feedback on rates of catheter-associated urinary tract infection in intensive care units in Argentina. Infect Control Hosp Epidemiol. 2004; 25 (1): 47–50.

24. Rosenthal VD, McCormick RD, Guzman S, Villamayor C, Orellano PW. Effect of education and performance feedback on handwashing: the benefit of administrative support in Argentinean hospitals. Am J Infect Control. 2003; 31 (2): 85–92.

25. Rosenthal VD, Guzman S, Safdar N. Reduction in nosocomial infection with improved hand hygiene in intensive care units of a tertiary care hospital in Argentina. Am J Infect Control. 2005; 33 (7): 392–7.

26. Rubinson L, Wu AW, Haponik EE, Diette GB. Why is it that internists do not follow guidelines for preventing intravascular catheter infections? Infect Control Hosp Epidemiol. 2005; 26 (6): 525–33.

27. Quiros D, Lin S, Larson EL. Attitudes toward practice guidelines among intensive care unit personnel: a cross-sectional anonymous survey. Heart Lung 2007; 36 (4): 287–97.

28. Hugonnet S, Chevrolet JC, Pittet D. The effect of workload on infection risk in critically ill patients. Crit Care Med. 2007; 35 (1): 76–81.

29. Hugonnet S, Uckay I, Pittet D. Staffing level: a determinant of late-onset ventilatorassociated pneumonia. Crit Care. 2007; 11 (4): R80.

30. Mark BA, Harless DW, Berman WF. Nurse staffing and adverse events in hospitalized children. Policy Polit Nurs Pract. 2007; 8 (2): 83–92.

31. Nijssen S, Bonten MJ, Franklin C, Verhoef J, Hoepelman AI, Weinstein RA. Relative risk of physicians and nurses to transmit pathogens in a medical intensive care unit. Arch Intern Med. 2003; 163 (22): 2785–6.

32. Pittet D, Simon A, Hugonnet S, Pessoa-Silva CL, Sauvan V, Perneger TV. Hand hygiene among physicians: performance, beliefs, and perceptions. Ann Intern Med. 2004; 141 (1): 1–8.

33. Yokoe D, Casper C, Dubberke E, Lee G, Muñoz P, Palmore T, et al. Infection prevention and control in health-care facilities in which hematopoietic cell transplant recipients are treated. Bone Marrow Transplant. 2009; 44: 495–507.

34. Sehulster L, Chinn RY; CDC; HICPAC. Guidelines for environmental infection control in health-care facilities. Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). MMWR Recomm Rep. 2003; 52: 1–42.

35. Benet T, Nicolle MC, Thiebaut A, Piens M-A, Nicolini F-E, Thomas X, et al. Reduction of invasive aspergillosis incidence among immunocompromised patients after control of environmental exposure. Clin Infect Dis. 2007; 45: 682–686.

36. Орлова О.А., Юмцунова Н.А., Семененко Т.А., Карпов О.Э., Русакова Е.В., Зотова А.А., Русаков Н.В., Кузин С.Н. Новые технологии в комплексе мероприятий по неспецифической профилактике инфекций, связанных с оказанием медицинской помощи. Гигиена и санитария. 2020; 99 (10): 1055–1060.

37. Marra AR, Schweizer ML, Edmond MB. No-touch disinfection methods to decrease multidrug-resistant organism infections: a systematic review and meta-analysis. Infect Control Hosp Epidemiol. 2018; 39: 20–31.

38. McGinigle KL, Gourlay ML, Buchanan IB. The use of active surveillance cultures in adult intensive care units to reduce methicillin-resistant Staphylococcus aureus — related morbidity, mortality, and costs: a systematic review. Clin Infect Dis. 2008; 46 (11): 1717–1725. doi: 10.1086/587901.

39. Muto CA, Jernigan JA, Ostrowsky BE, Richet HM, Jarvis WR, Boyce JM et al. SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and enterococcus. Infect Control Hosp Epidemiol. 2003; 24: 362–386.

40. Орлова О.А., Юмцунова Н.А., Никитина Г.Ю., Семененко Т.А. Результаты проспективного эпидемиологического наблюдения за реципиентами костного мозга Эпидемиология и инфекционные болезни. Актуальные вопросы. 2022; 4: 45–51.

41. Cocanour CS, Peninger M, Domonoske BD, Li T, Wright B, Valdivia A, et al. Decreasing ventilator-associated pneumonia in a trauma ICU. J. Trauma. 2006; 61 (1): 122–9; discussion 9–30.

42. Fisher D, Tambyah PA, Lin RT, Jureen R, Cook AR, Lim A, et al. Sustained meticillin-resistant Staphylococcus aureus control in a hyperendemic tertiary acute care hospital with infrastructure challenges in Singapore. J Hosp Infect. 2013; 85 (2):141–8.

43. Charrier L, Allochis MC, Cavallo MR, Gregori D, Cavallo F, Zotti CM. Integrated audit as a means to implement unit protocols: a randomized and controlled study. J Eval Clin Pract. 2008; 14 (5): 847–53.

44. Moongtui W, Gauthier DK, Turner JG. Using peer feedback to improve handwashing and glove usage among Thai health care workers. Am J Infect Control. 2000; 28 (5): 365–9.

45. Yinnon AM, Wiener-Well Y, Jerassy Z, Dor M, Freund R, Mazouz B, et al. Improving implementation of infection control guidelines to reduce nosocomial infection rates: pioneering the report card. J Hosp Infect. 2012; 81 (3): 169–76.

1. Improving infection prevention and control at the health facility: interim practical manual supporting implementation of the WHO guidelines on core components of infection prevention and control programmes. Geneva: World Health Organization; 2018 (https://apps.who.int/iris/handle/10665/279788, accessed 10 March 2023).

2. Interim practical manual: supporting national implementation of the WHO guidelines on core components of infection prevention and control programmes. Geneva: World Health Organization; 2017 (https://apps.who.int/iris/ handle/10665/330073, accessed 10 March 2023).

3. Slawomirski L, Auraaen A, Klazinga N. The economics of patient safety: strengthening a value-based approach to reducing patient harm at national level. OECD Health Working Papers No. 96. Paris: Organisation for Economic Cooperation and Development; 2017 (https://doi. org/10.1787/5a9858cd-en, accessed 10 March 2023).

4. Jha AK, Larizgoitia I, Audera-Lopez C, Prasopa-Plaizier N, Waters H, Bates DW. The global burden of unsafe medical care: analytic modelling of observational studies. BMJ Qual Saf. 2013; 22(10):809-15.

5. Allegranzi B, Bagheri Nejad S, Combescure C, Graafmans W, Attar H, Donaldson L, et al. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet. 2011; 377(9761):228-241.

6. Report on the burden of endemic health care-associated infection worldwide. Geneva: World Health Organization, 2011 (https://apps.who.int/iris/handle/10665/80135, accessed 10 March 2023).

7. Ling ML, Apisarnthanarak A, Madriaga G. The burden of healthcare-associated infections in Southeast Asia: A systematic literature review and neta-analysis. Clin Infect Dis. 2015; 60(11):1690-9.

8. Alothman A, Al Thaqafi A, Al Ansary A, Zikri A, Fayed A, Khamis F, et al. Prevalence of infections and antimicrobial use in the acute-care hospital setting in the Middle East: Results from the first point-prevalence survey in the region. Int J Infect Dis. 2020; 101: 249-58.

9. Suetens C, Latour K, Kärki T, Ricchizzi E, Kinross P, Moro ML, et al. Prevalence of health-care associated infections, estimated incidence and composite antimicrobial resistance index in acute care hospitals and long-term care facilities: results from two European point prevalence surveys, 2016 to 2017. Eurosurveillance: Eur Comm Dis Bul. 2018;23(46).

10. Global guidelines for the prevention of surgical site infection, 2nd ed. Geneva: World Health Organization; 2018 (https://apps.who.int/iris/handle/10665/277399, accessed 10 March 2023).

11. van Dillen J, Zwart J, Schutte J, van Roosmalen J. Maternal sepsis: epidemiology, etiology and outcome. Curr Opin Infect Dis. 2010; 23(3):249-54.

12. Global report on the epidemiology and burden of sepsis: current evidence, identifying gaps and future directions. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/ handle/10665/334216, accessed 10 March 2023).

13. Guidelines on core components of infection prevention and control programmes at the national and acute health care facility level 2016 https://apps.who.int/iris/bitstream/handle/10665/251730/9789241549929-eng.pdf?sequence=1&isAllowed=y, accessed 10 March 2023).

14. Zhukova E.V., Burova A.A., Mirskaya M.A., Nikitina G.Yu., Semenenko A.V. Structure and antibiotic resistance of bacterial pathogens in high-risk ISMP departments under the COVID-19 pandemic. Sanitarnyj vrach (Sanitary doctor). 2022;11: 821-832. (in Russian) doi: 10.33920/med-08-2211-03

15. Smetanin V.N. Hand hygiene in medical organizations: the implementation of the concept is an effective measure for the prevention of ISMP. Sanitarnyj vrach (Sanitary doctor).2022;11: 833-839. (in Russian) doi: 10.33920/med-082211-04

16. Neshataev A.N., Lukyanenko N.V., Lukyanenko N.Ya. Epidemiological assessment of risk factors for infections associated with the provision of medical care (ISMP) in oncogynecological practice among patients who received and did not receive chemo- and radioisotope therapy. Sanitarnyj vrach (Sanitary doctor). 2019;6: 21-29. (in Russian)

17. Sursyakova K.I., Safyanova T.V., Dronov S.V., Kozlov D.Yu. Assessment of the influence of risk factors for urinary tract infections as a form of ISMP on the example of large multidisciplinary hospitals of the Altai Territory. Sanitarnyj vrach (Sanitary doctor). 2022;1:20-31. (in Russian) doi: 10.33920/med-08-2201-03

18. Global report on infection prevention and control 2022 https://www.who.int/publications/i/item/9789240051164, accessed 10 March 2023).

19. Haley RW, Culver DH, White JW, Morgan WM, Emori TG, Munn VP, et al. The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol. 1985; 121 (2):182–205.

20. Mermel LA, Jefferson J, Blanchard K, Parenteau S, Mathis B, Chapin K, et al. Reducing Clostridium difficile incidence, colectomies, and mortality in the hospital setting: a successful multidisciplinaryapproach. Jt Comm J Qual Patient Saf. 2013;39 (7):298–305.

21. O’Boyle C, Jackson, M., Henly, SJ. Staffing requirements for infection control programs in US health care facilities: Delphi project. Am J Infect Control. 2002;30:321–33.

22. Larson EL, Quiros D, Lin SX. Dissemination of the CDC’s hand hygiene guideline and impact on infection rates. Am J Infect Control. 2007;35 (10):666–75.

23. Rosenthal VD, Guzman S, Safdar N. Effect of education and performance feedback on rates of catheter-associated urinary tract infection in intensive care units in Argentina. Infect Control Hosp Epidemiol. 2004; 25 (1):47–50.

24. Rosenthal VD, McCormick RD, Guzman S, Villamayor C, Orellano PW. Effect of education and performance feedback on handwashing: the benefit of administrative support in Argentinean hospitals. Am J Infect Control. 2003; 31 (2):85–92.

25. Rosenthal VD, Guzman S, Safdar N. Reduction in nosocomial infection with improved hand hygiene in intensive care units of a tertiary care hospital in Argentina. Am J Infect Control. 2005; 33 (7):392–7.

26. Rubinson L, Wu AW, Haponik EE, Diette GB. Why is it that internists do not follow guidelines for preventing intravascular catheter infections? Infect Control Hosp Epidemiol. 2005; 26 (6):525–33.

27. Quiros D, Lin S, Larson EL. Attitudes toward practice guidelines among intensive care unit personnel: a cross-sectional anonymous survey. Heart Lung 2007; 36 (4):287–97.

28. Hugonnet S, Chevrolet JC, Pittet D. The effect of workload on infection risk in critically ill patients. Crit Care Med. 2007; 35 (1):76–81.

29. Hugonnet S, Uckay I, Pittet D. Staffing level: a determinant of late-onset ventilatorassociated pneumonia. Crit Care. 2007; 11 (4): R80.

30. Mark BA, Harless DW, Berman WF. Nurse staffing and adverse events in hospitalized children. Policy Polit Nurs Pract. 2007;8 (2):83–92.

31. Nijssen S, Bonten MJ, Franklin C, Verhoef J, Hoepelman AI, Weinstein RA. Relative risk of physicians and nurses to transmit pathogens in a medical intensive care unit. Arch Intern Med. 2003; 163 (22):2785–6.

32. Pittet D, Simon A, Hugonnet S, Pessoa-Silva CL, Sauvan V, Perneger TV. Hand hygiene among physicians: performance, beliefs, and perceptions. Ann Intern Med. 2004; 141 (1):1–8..

33. Yokoe D, Casper C, Dubberke E, Lee G, Muñoz P, Palmore T, et al. Infection prevention and control in health-care facilities in which hematopoietic cell transplant recipients are treated. Bone Marrow Transplant. 2009; 44: 495- 507.

34. Sehulster L, Chinn RY; CDC; HICPAC. Guidelines for environmental infection control in health-care facilities. Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). MMWR Recomm Rep. 2003; 52: 1- 42.

35. Benet T, Nicolle MC, Thiebaut A, Piens M-A, Nicolini F-E, Thomas X, et al. Reduction of invasive aspergillosis incidence among immunocompromised patients after control of environmental exposure. Clin Infect Dis. 2007; 45: 682- 686.

36. Orlova O.A., Yumtsunova N.A., Semenenko T.A., Karpov O.E., Rusakova E.V., Zotova A.A., Rusakov N.V., Kuzin S.N. New technologies in the complex of measures for the nonspecific prevention of infections associated with the provision of medical care. Gigiena-i-sanitariya (Hygiene and sanitation). 2020; 99 (10): 1055-1060. (in Russian)

37. Marra AR, Schweizer ML, Edmond MB. No-touch disinfection methods to decrease multidrug-resistant organism infections: a systematic review and meta-analysis. Infect Control Hosp Epidemiol. 2018; 39: 20-31.

38. McGinigle KL, Gourlay ML, Buchanan IB. The use of active surveillance cultures in adult intensive care units to reduce methicillin-resistant Staphylococcus aureus–related morbidity, mortality, and costs: a systematic review. Clin Infect Dis. 2008;46 (11):1717–1725. doi:10.1086/587901.

39. Muto CA, Jernigan JA, Ostrowsky BE, Richet HM, Jarvis WR, Boyce JM et al. SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and enterococcus. Infect Control Hosp Epidemiol. 2003; 24: 362- 386.

40. Orlova O.A., Yumtsunova N.A., Nikitina G.Yu., Semenenko T.A. Results of prospective epidemiological surveillance of bone marrow recipients. Еhpidemiologiya-i-infekcionnye-bolezni-aktualnye-voprosy (Epidemiology and infectious diseases. Current issues.) 2022; 4:45-51. (in Russian)

41. Cocanour CS, Peninger M, Domonoske BD, Li T, Wright B, Valdivia A, et al. Decreasing ventilator-associated pneumonia in a trauma ICU. J. Trauma. 2006; 61 (1):122–9; discussion 9–30.

42. Fisher D, Tambyah PA, Lin RT, Jureen R, Cook AR, Lim A, et al. Sustained meticillin-resistant Staphylococcus aureus control in a hyperendemic tertiary acute care hospital with infrastructure challenges in Singapore. J Hosp Infect. 2013; 85 (2):141–8.).

43. Charrier L, Allochis MC, Cavallo MR, Gregori D, Cavallo F, Zotti CM. Integrated audit as a means to implement unit protocols: a randomized and controlled study. J Eval Clin Pract. 2008;14 (5):847–53.

44. Moongtui W, Gauthier DK, Turner JG. Using peer feedback to improve handwashing and glove usage among Thai health care workers. Am J Infect Control. 2000;28 (5):365–9.

45. Yinnon AM, Wiener-Well Y, Jerassy Z, Dor M, Freund R, Mazouz B, et al. Improving implementation of infection control guidelines to reduce nosocomial infection rates: pioneering the report card. J Hosp Infect. 2012; 81 (3):169–76.

Инфекции, связанные с оказанием медицинской помощи (ИСМП), относятся к числу наиболее частых осложнений у пациентов, получающих медицинскую помощь в стационарных условиях. ИСМП, большинство из которых вызваны штаммами микроорганизмов с множественной лекарственной устойчивостью (МЛУ), наносят вред пациентам, посетителям и медицинским работникам и ложатся значительным бременем на системы здравоохранения, включая связанные с этим повышенные расходы. Из каждых 100 пациентов в больницах неотложной помощи семь пациентов в странах с высоким уровнем дохода и 15 пациентов в странах с низким и средним уровнем дохода заболевают по крайней мере одной инфекцией, связанной с оказанием медицинской помощи, во время пребывания в больнице [1, 2].

На основе данных за 2016–2017 гг. Европейский центр по профилактике заболеваний и контролю (ECDC) подсчитал, что 4,5 млн эпизодов ИСМП ежегодно возникали у пациентов, поступающих в больницы неотложной помощи в странах Европейского союза и Европейской экономической зоны [3]. Смертность среди пациентов, инфицированных резистентными микроорганизмами, по меньшей мере в два-три раза выше, чем среди пациентов, инфицированных чувствительными микроорганизмами [3–9].

Отдельные компоненты системы профилактики ИСМП и стратегии борьбы с МЛУ разрабатываются во многих странах мира, однако их реализация часто вызывает затруднения как на национальном уровне, так и на уровне медицинских организаций (МО) в связи с недостаточным финансированием, отсутствием поддержки на государственном уровне, недостаточным уровнем специалистов и отсутствием программ мониторирования [10, 11]. В большинстве отчетов прослеживается четкая корреляция между внедрением программ профилактики ИСМП и уровнем дохода в стране [12].

В 2016 г. Всемирной организацией здравоохранения (ВОЗ) разработано руководство по основным компонентам программ профилактики инфекций и инфекционного контроля на национальном уровне и уровне медицинских учреждений экстренной помощи, где декларированы минимальные требования к профилактике ИСМП для предупреждения инфицирования пациентов, медицинских работников и посетителей и обеспечения эпидемиологической безопасности [13].

Для Цитирования:
Орлова Оксана Анатольевна, Абрамов Юрий Евгеньевич, Тутельян Алексей Викторович, Гармонизация комплекса мероприятий по профилактике инфекций, связанных с оказанием медицинской помощи родильницам и новорожденным, требованиям ВОЗ. Санитарный врач. 2023;4.
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