Academician Vadim Pokrovsky. Photo: the-village.ru

In March, in the Moscow region, for the first time in Russia, the use of reusable glass capillaries for sampling blood from a finger was banned. This was done after the regional AIDS center was able to prove the connection between the nosocomial infection of a child with HIV infection using a capillary. Various cases of transmission of infection through non-sterile instruments are recorded in other regions of the country. The head of the Federal Scientific and Methodological Center for Prevention and Control of AIDS, Academician of the Russian Academy of Sciences Vadim Pokrovsky told MedNovosti why there is still a chance of contracting HIV in the hospital and what is needed to bring it to zero..

According to Rospotrebnadzor, in 2007-2014 in Russia (excluding cases of infection through blood transfusion), 20 cases of HIV infection were registered in hospitals. Children were injured in 14 of them. Is this data comprehensive?

As for the children, I think so. Basically, all cases of nosocomial HIV infection are recorded in children. This is because, given the multifactorial nature of HIV transmission, it is much more difficult to prove nosocomial infection in adults than in children. When investigating cases involving adults, it is very difficult to exclude the sexual route of infection or the result of drug use. Therefore, they are all automatically attributed to these factors. And children do not have such risk factors. And if the mother of the child is healthy, a suspicion of nosocomial infection immediately arises. But the presence of cases of infection of children tells us that they are among adults. We simply cannot identify them.

The first emergency that shook the whole country happened 25 years ago, when people knew little about HIV at all. After that, it would seem, the situation was taken under control. But, as it turned out, not for long. What happened?

An outbreak of nosocomial HIV infection, which we managed to uncover in 1989, began in Elista and then spread to Rostov and Volgograd. Then 200 children suffered. After that, the doctors were very scared. And in the country for 15 years there were no cases of infection associated with the provision of medical care. And then the generation of medical workers changed, other people came, and laxity began. In addition, our media stopped talking about HIV infection. On the contrary, there were continuous victorious reports that the spread of HIV in our country is only decreasing.

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A million Russians are infected with HIV. The head of the Federal Scientific and Methodological Center for the Prevention and Control of AIDS of the Central Research Institute of Epidemiology of Rospotrebnadzor, Vadim Pokrovsky, said that “on January 20, introduced the millionth patient with HIV ”.

And here is the result: the number of HIV-infected in the country is dramatically increasing, and the alertness is dropping. Therefore, I strongly urge our doctors to strengthen control over the conduct of all parenteral procedures. This the only way avoid the maximum number of infections. Especially when it comes to children who, unlike adults, cannot notice that they are being injected with a non-sterile syringe and make a comment.

But nowadays, disposable syringes are almost universally used.

It is not at all necessary to use only disposable instruments. The main thing is that all disinfection rules are followed. Moreover, plastic syringes are not actually disposable. You can use them several times, but you cannot sterilize them - they will melt. Therefore, it turned out that plastic tools did not fundamentally solve the problem. It got to the point of ridiculousness: somewhere in the 90s, I received a letter, the author of which was indignant that plastic syringes could not be sterilized, since when heated they immediately deform. So, the devastation is not in the syringes, but in the heads.

Photo: bikeriderlondon / Shutterstock.com

In addition to syringes, there are other tools, and not all of them are disposable.

There is. The same capillary tubes are available in glass and plastic. But for reusable, there are sterilization rules. By the way, by themselves, these tubes are less dangerous in terms of transmission of infection, all cases of transmission of infection are associated mainly with injections. The fact is that the tubes only collect blood that flows from the finger. Cut wounds are generally less dangerous, since blood flows out, and itself plays a certain protective role. And with puncture wounds, blood does not flow, and when injected with a non-sterile syringe, the infectious material is brought inside. That is why the syringes that were used to inject a person with HIV or hepatitis are so dangerous.

At one time there was a lot of talk about infection through dental instruments. True, it was about hepatitis.

Such an infection cannot be denied either, it is quite possible if the tool used does not change. In addition, the hepatitis B virus is more resistant than HIV. But I don’t know a single case of HIV infection in the world through the fault of a dentist that could be proved.

But even if a disposable toolkit does not guarantee against infection, how can this problem be solved?

We make a serious mistake when we use the term "disposable toolbox". We need a self-destructive toolkit. Or one that locks up after a single use so that it cannot be reused (for example, if a syringe gets blocked). Such syringes are already available all over the world. In English, they are called self-destruction.

And many of our domestic inventors have sent me their proposals. But such a toolkit costs a little more in production, and the industry is in no hurry to introduce it until there is a corresponding order from our supervisory authorities. But I think it should be done and gradually move over the years to tools that cannot be used twice.

In addition to tools, there are also the hands of doctors. It is not uncommon to observe how the procedural nurses, who work with gloves, do not change them after changing the patient, at best they rinse under the tap.

This is definitely a violation. And such violations must be fought. The sanitary service cannot keep track of everything. Therefore, it remains on the conscience of health workers and the vigilance of the patients themselves, who must make a comment if something, in their opinion, is being done wrong. Of course, protecting yourself is very important for health workers. But still, their duty is, first of all, to take care of patients.

During a recent discussion of a draft government HIV strategy, some objected to expanding mandatory HIV tests. Motivating this by the fact that the state signs in the absence of a system to protect the patient from infection when performing invasive interventions. At the same time, it should ensure that the biomaterial of one patient under no circumstances can get to another patient or doctor.

These things should not be confused. Population testing is done for early diagnosis, not to protect doctors and other patients from HIV infection in a hospital. Moreover, one of the reasons for nosocomial outbreaks is that doctors think that patients with HIV infection are somewhere in AIDS centers or specialized hospitals. And such patients cannot get to them in gynecology or surgery.

Now we do not hospitalize people for surgery without a certificate of the absence of HIV infection. And they ask for this certificate from some old man who has not thought about sex for 30 years - otherwise we will not take it for a heart bypass operation. We really don't need such testing. It should be carried out among those groups where the infection is most common, and these are now people aged 25 to 40 years. Adult HIV rates sexually active people now it is very high and reaches 2%. This means that everyone can face HIV infection in their own bed.

Source of information: Rospotrebnadzor letter dated 20.06.2013 No. 01 / 6939-13-32 "On increasing the effectiveness of anti-epidemic measures aimed at preventing HIV infection when providing medical care"Signed by G.G. Onischenko.

V last years In the Russian Federation, the problem of HIV infection of patients as a result of the provision of medical care during hospitalization in health care institutions has become topical again. This problem remains relevant for many countries.

Large outbreaks of intra-hospital HIV infection in children have been reported:

• in 2006 in the Republic of Kazakhstan (133 children, 17 mothers were infected),
• in 2006-2008 in the Kyrgyz Republic (191 children, 4 mothers, 2 health workers are infected),
• in 2007-2008 in the Republic of Uzbekistan (147 children are infected).

The most likely causes of infection are the transfusion of infected plasma and blood products, the use of non-sterile medical instruments, and the use of injecting equipment repeatedly and without sterilization.

In the Russian Federation in 1988 - 1989. when the infection was brought into a medical institution within two years, at least 19 nosocomial infection foci were formed in 7 territories of the country, with a total number of victims of more than 290 people, including 270 children.

In recent years, a number of negative factors have been registered in the Russian Federation, indicating increased risk of HIV infection when receiving medical care during hospitalization and health care facilities, including:

• high prevalence of HIV infection in the population of the Russian Federation (0.44% per 100 thousand population in 2012),
• an increase in the prevalence of HIV infection in pregnant women from 0.3% in 2003. up to 0.62% in 2012,
• an increase in hospitalizations of HIV-infected, including for reasons directly related to HIV infection,
• a significant increase in the incidence of HIV infection in children newly diagnosed several years after birth,
• the growth of “accidental findings” of HIV infection in the mothers of such children when examined according to epidemiological indications.

So, for the period from 2007 to May 2013, 15 cases of the formation of foci of nosocomial HIV infection were registered (proven and suspected nosocomial infections), of which in 2012 - 5 foci with suspected nosocomial infections, in the period from January to May 2013 . - 3 lesions. The investigation of 8 outbreaks with suspected nosocomial infections is ongoing.

Foci of nosocomial infection were registered in the Chechen Republic - 8, 1 outbreak was registered in Penza, Rostov regions, Yekaterinburg, 2 outbreaks of nosocomial infections in Moscow and Samara regions.

Children are infected with HIV in 11 foci, and adults in 4. The total number of infected people is 2 people, incl. 6 adults, 22 children.

In addition, in one outbreak (the Chechen Republic), a child was identified who contracted HIV infection through breastfeeding from a mother: presumably infected while in a health care facility. Epidemiological investigations carried out by the departments of Rospotrebnadzor in the constituent entities of the Russian Federation established that in 5 foci a potential source of infection was a couple: an HIV-infected mother and her child. Moreover, in 4 out of 5 cases, chemoprophylaxis of vertical transmission of HIV to pregnant women and newborns was not carried out. In one case of an HIV-infected pregnant woman with a long-term illness, chemoprophylaxis was carried out with one drug, only during 6 weeks of pregnancy, her three newborn children, also infected with HIV and hepatitis C virus, served as a source of infection for a child who was with them in the same ward. In all cases, nosocomial infection foci were identified retrospectively during an epidemiological investigation of HIV infection in children with HIV - negative parents or adults who had a negative HIV status prior to admission to the medical facility.

The presence of HIV infection in contact children was revealed after 4-5 years or more from birth, after repeated hospitalizations for somatic diseases. In the list of diagnoses established for such children, the most common are: bronchitis, polysegmental bilateral pneumocystis pneumonia with obstructive syndrome, chronic broncho-obstructive disease, destructive bronchitis, inflammatory diseases of the ENT organs, including bilateral mouth recurrent purulent otitis, candida overgrowth oral cavity, cancer (hemoblastosis ?, non-Hodgins lymphoma ?, suspected thrombocytopenic purpura, acute leukemia, etc.).

In 2011, 2 cases of HIV infection were registered in children who were initially diagnosed with tuberculosis and HIV infection was revealed only during hospitalization in a specialized medical institution. During the epidemiological investigation, HIV infection was detected in a mother who had not previously been registered. Children have also been treated in various hospitals on several occasions. A multistage “vertical” route is noted for redirecting such children to treatment from federal municipal institutions in Moscow (from 4 to 10 health care facilities), or treatment in different departments (pulmonary, surgical, ENT - department) of a multidisciplinary children's hospital.

In 50% of cases, children are diagnosed with HIV only when hospitalized in federal medical institutions. Due to the lack of specific antiretroviral therapy in children with undetected HIV infection, the treatment of somatic diseases in such patients does not give the desired effect and, as a rule, is accompanied by an increase in the volume of diagnostic and therapeutic procedures, parenteral interventions, incl. intramuscular injections and intravenous infusions using venous peripheral catheters, which increases the risk of nosocomial infection in case of violation of the sanitary and epidemiological regime in the LPO.

In the mentioned cases, the infectious diseases department of the children's clinical hospital, the department of pathology of premature babies, the department of the AEI of the children's clinical hospital, the observational department of the maternity hospital, the surgical department of the children's clinical hospital, the regional perinatal center, and municipal medical institutions became the places of probable infection. The period of joint stay in a ward or department with a potential source of infection is from several days to 2-3 weeks.

Of particular concern is the situation with the increase in cases of late diagnosis of HIV infection in children who were previously considered healthy.

In 2012, when verifying the data, the Federal Scientific and Methodological Center for the Prevention and Control of AIDS received information from 28 constituent entities of the Russian Federation about 73 HIV-infected children with unknown cause of infection... The number of cases of infection of children during breastfeeding is not decreasing.

For the period 1987-2010, according to personalized registration data, 107 such children were registered among Russians in the Russian Federation, including 10 in 2008, in 2009-12, in 2010 -16, in 2011-22, in 2012 - 11 children ( Perm Territory(5), Astrakhan region (2), Lipetsk region (1), Krasnoyarsk region (1), Saratov region (1), Republic of Mordovia (1).

During the epidemiological investigation, it was found that the identified cases of HIV infection in children are associated with infection of women in late pregnancy or after the birth of a child. During pregnancy, women were reportedly tested negative for HIV infection.

In recent years, stable the number of refusals of HIV-infected pregnant women from chemoprophylaxis is increasing mother and child (up to 8% in areas with a large number of HIV-infected pregnant women).

Reason for refusals connected:

• with the reluctance of HIV-infected pregnant women to register with medical institutions, antisocial behavior,
• religious motives,
• information obtained on the Internet about the dangers of chemoprophylaxis and HIV treatment.

As a result, in 2011. chemoprophylaxis was not carried out in 558 HIV-infected pregnant women, in 2012 - 599.

Until now, despite the efforts made and the large volume of examinations of contact persons, it was not possible to establish the source of infection in 4 foci of nosocomial infections of children in the Chechen Republic. All of the above factors increase the likelihood of patients, especially children's hospitals, with a potential source of HIV infection. Since 2011, in the Russian Federation, cases have been registered in the hospital for HIV infection in adults during the provision of medical care to them in public health care facilities and private clinics (Yekaterinburg - 3 people, Samara Region - 2 people, Chechen Republic - 1 person).

Causal relationships have been established and one case of nosocomial infections (Yekaterinburg) has been deciphered. The reason for the infection of 3 women - clients of a private perinatal center in Yekaterinburg was a gross violation of clause 8.4.2.4. and p. 8.4.5.1 SP 3.1.5.2826-10 "Prevention of HIV infection", namely the infusion of a suspension of lymphocytes from donors not examined for the presence of pathogens of blood-borne infections. As part of the epidemiological investigation, the fact of substitution of information about the donor in medical documents was established, and an HIV-infected donor was identified, which served as a source of infection.

Seven departments of Rospotrebnadzor in the constituent entities of the Russian Federation, whose residents were clients of the clinic, took part in the epidemiological investigation. At the same time, an HIV-infected pregnant woman living in the Chelyabinsk region was identified, and chemoprophylaxis was prescribed in a timely manner.

In the Samara region, a suspicion of nosocomial HIV infection was registered in two patients over 60 years old who had repeatedly received surgical care in various hospitals in the city. HIV infection was detected retrospectively, in one case during the examination for HIV in connection with suspected lymphogranulomatosis, in the second - during the examination before the next hospitalization.

It should be noted that, despite a significant increase in the registration of HIV infection among people over the age of 60 and 70 years (more than 700 cases in 2011), reports from the territory of suspected HIV infection during the provision of medical care, with the exception of the mentioned cases, in Rospotrebnadzor was not received. During the development of the HIV epidemic in the Russian Federation, 79 cases of HIV infection were registered in health care facilities during blood transfusion of fresh frozen plasma and blood products. Since 2010, two such cases have been reported annually. In 2012-2013. the main cause of infection during hemotransfusion was the transfusion of erythrocyte suspension from personnel donors in the seronegative period (Smolensk, Kemerovo regions).

In March of this year. In St. Petersburg, a case of transfusion of erythrocyte suspension into a child was registered before the results were obtained confirming the absence of HIV infection in the donor. Epidemiological investigation on this case is ongoing. In the Republic of Buryatia, a case of HIV infection was registered at the Republican Clinical Hospital named after V.I. ON THE. Semashko during blood transfusion for medical reasons. HIV infection was detected during examination of the patient by code 118 (recipient), the transmission factor was the erythrocyte mass received from a personnel donor.

The cause of infection is an error when the doctor-laboratory assistant read the results of the study. The introduction of new modern molecular genetic research methods has made it possible to reduce the number of undeciphered foci of nosocomial HIV infection. In 7 out of 15 foci of nosocomial infection, molecular genetic studies carried out by the Southern District Center for the Prevention and Control of AIDS on the basis of FGUN RostovNIIMP of Rospotrebnadzor and FGUN Central Research Institute of Epidemiology of Rospotrebnadzor most likely confirm the formation of foci of nosocomial infection.

Presumptive factor in the transmission of HIV infection:

• parenteral medical interventions with violation of the integrity of the skin when re-using non-sterile medical instruments: parenteral procedures (test for phenylketonuria, BCG vaccination, blood sampling), intravenous and intramuscular injections, intravenous infusions using peripheral venous catheters "Vasofix";
• HIV contamination of saline solutions used to flush intravascular catheters; - use of medical instruments processed in violation of the requirements for disinfection and sterilization; reuse of the scarifier when taking blood from a finger;
• alkaline inhalations, trauma to the oral mucosa when using a general electric pump to suck mucus from the oral cavity with candidiasis in an HIV-infected and contact child;
• non-observance of the rules for processing the umbilical wound in newborns.

During inspections of the sanitary and epidemiological regime in health care facilities in connection with suspicion of nosocomial infection, a number of violations:

• conducting parenteral interventions in a hospital setting for unidentified outpatients;
• discrepancy between the volumes of used disposable and sterile medical instruments and medical prescriptions;
• no entry in the journal: about the name and amount of the sterilized material, as well as the autoclavable dressing material;
• lack of a register of small operations, including bronchoscopy and gastroscopy;
• lack of medical documentation for sterilization of bronchoscopes;
• misuse of sterilization tests (tests to control the inside of packages are used with an open method of sterilization);
• the sterilization time of the sterile tray coincides with the time of its use;
• holders for vacutainers are not disinfected;
• reduced control over pre-sterilization cleaning (there is no setting of the azopyram sample on the blades after the next disinfection);
• the storage terms of sterile instruments are violated (instruments are stored in the Panmed installation for more than 7 days), there are no dates for opening and laying on bixes with sterile material;
• the control logs for pre-sterilization cleaning and sterilization do not contain data on the processing of reusable needles and a syringe for puncture;
• the requirements for disinfection of used capillaries are violated (they are disinfected with incomplete immersion in a disinfectant solution);
• requirements for the organization of observation of medical personnel injured in emergency situations are violated;
• the time frames for medical specialists to undergo an examination for HIV infection are violated.

In the course of the epidemiological investigation, HIV infection was detected by an anesthesiologist who had not been tested for HIV infection for more than a year.

In the MBUZ "Podolsk Children's City Hospital" an unacceptable situation of prolonged, more than two years, residence in the infectious diseases ward of a young HIV-infected child was registered.

The issue of sending a child to the Republican Scientific and Practical Center for such children was not resolved.

In the same institution, the fact of using an ultrasound room in the infectious diseases ward as a ward for isolation while treating another HIV-infected child was noted. As part of an epidemiological investigation using the genotyping method, it was established that this particular child was the source of infection during the formation of the nosocomial infection focus.

A common violation in the maintenance of medical records is the lack of information about the number of the ward, bed, movement of patients within the department, indicating inaccurate residential addresses.

The lack of this information reduces the speed and efficiency of the epidemiological investigation.

Marked facts of failure requirements:

• Technical Regulations on the safety requirements of blood, its products, blood-substituting solutions and technical means used in transfusion-infusion therapy, approved by the Decree of the Government of the Russian Federation dated 26.01.2010 No. 29;
• SP 2.13.2630-10 "Sanitary and Epidemiological Requirements for Organizations Performing Medical Activities";
• SP 3.5.1378-03 "Sanitary and Epidemiological Requirements for the Organization and Implementation of Disinfection Activities";
• SP 3.1.5.2826-10 "Prevention of HIV infection";
• SP 3.11275-03 "Prevention of infectious diseases during endoscopic manipulations".

Shortcomings in the organization of work to identify HIV infection in pregnant women, failure to provide measures for chemoprophylaxis of vertical transmission of HIV infection from mother to child, unacceptable negligence in the implementation of anti-epidemic measures in health care facilities, unsatisfactory control by hospital epidemiologists and deputy heads of the institution for epidemiological questions, contribute to the formation of foci of nosocomial HIV infection.

Attention should be paid to the insufficient quality of the ongoing epidemiological investigations:

• submission by the departments of Rospotrebnadzor by subjects Russian Federation the final report is delayed indefinitely, from several months to a year;
• the reports do not contain information about the approved plan of measures for the investigation;
• information on contact persons, dates and the list of medical procedures performed is not summarized in tables and diagrams;
• there is practically no data on full compliance (non-compliance) with the sanitary and epidemiological regime at the site of the alleged infection;
• there are no instructions for eliminating the identified deficiencies in the sanitary and epidemiological regime and recommendations for organizational and technical solutions for their elimination.

Together with the main fighter against AIDS in the Russian Federation, the site analyzed how you can get infected with HIV in hospitals.

Infection of a child with HIV, which happened in the Moscow region, made them say that medical institutions in this regard, unfortunately, are more unsafe.

How hospital cases of HIV transmission occur and what an ordinary patient can do here, said Academician Vadim Pokrovsky, head of the Federal Scientific and Methodological Center for the Prevention and Control of AIDS.

Sampling of analyzes. The case that occurred in a hospital near Moscow was presumably related to the collection of tests: according to official data, blood was taken from a 9-month-old girl from a finger using Panchenkov's capillary - a glass pipette into which blood droplets are collected to determine ESR (erythrocyte sedimentation rate) ... After the emergency, the regional health ministry banned the use of glass equipment for blood sampling. Although, according to Vadim Pokrovsky, the transmission mechanism is not exactly established: blood is taken into the capillary, which flows out, and for HIV transmission, the virus must enter the wound - which is why cut wounds rarely lead to infection, unlike stab wounds.

Injections. The most dangerous equipment in terms of HIV is syringes and needles. According to Vadim Pokrovsky, old glass and metal can at least be sterilized. But the safety of disposable ones depends on the actions of doctors: if one of them, in violation of all instructions, uses one syringe for two patients (this, unfortunately, happens), infection is possible.

Blood transfusion. By law, donors must be screened for all dangerous infections, so theoretically the possibility of getting HIV through blood transfusion is excluded. But in practice, this is possible if the donor himself became infected quite recently and the test system does not yet show this. But this, fortunately, is very rare.

Vadim Pokrovsky / Still from Channel One

Operations. If the operation is performed not in the field, but in a hospital, infection is impossible - all instruments are always sterilized. On this score, one can be calm: epidemiologists have not registered such cases of HIV infection.

Teeth treatment. Usually in terms of HIV, people are most afraid of dentistry. And in principle, it is really possible to get infected in a dentist's chair, as in any other situation when there is contact of instruments with blood. However, in practice, people are more likely to be infected with hepatitis than with HIV. According to the Federal AIDS Center, over the past 30 years there has not been a single such case, at least officially recorded.

At the end of last year in Yekaterinburg, there was another case of HIV infection during a blood transfusion. So far, it has not entered the official statistics, and there are already new reports about 4 cases in other regions of the country about possible HIV infection through blood transfusion, and about 4 more - when using non-sterile medical instruments.

Specialists from the Federal AIDS Center say that nosocomial infection continues.

In general, as soon as the blood began to be sent to quarantine, it seemed that an end to HIV infection through blood transfusion was put. However, sending blood to quarantine is just storing plasma for a period of 6 months until the donor is checked again. Moreover, blood elements such as erythrocytes and lymphocytes are generally not stored for a long time. In short, it is possible to prevent infection, but by the very end of the "verification period" the donor may have time to become infected.

The first cases of HIV infection in hospitals became known in 1988-1989, when 22 adults and 270 children in southern Russia were affected. Since 2008, the registration of new cases has begun again, usually 1-2 per year. In 2014, 10 infections happened at once: in the Bashkir, Sverdlovsk, Novosibirsk, Kaluga, Chelyabinsk, Pskov, Moscow regions, the Chechen Republic, Krasnoyarsk Territory and in the Khanty-Mansi Autonomous Okrug-Yugra region. Last year, 8 cases were registered and this figure is not final.

Disease and investigation

It is very difficult to investigate such cases of infection. Usually, medical institutions hide this information, and infected people most often refuse to undergo testing. Therefore, it is necessary to check up to one and a half thousand patients who were in the hospital at the time of infection. Moreover, such checks can take a very long time.

Compensation for contamination

Nosocomial infections can be divided into 2 groups: massive infections in the late 80s and almost 40 infections in the last 10 years.

The only case of HIV infection during kidney transplantation occurred in Sverdlovsk region in 2000. After, other cases of infection were recorded during the provision of medical care in 40 regions of the country. Most of the victims were children infected in kindergarten hospitals.

Infection of adults began in 2011, when 3 people were infected in Yekaterinburg, 2 in the Samara region and 1 in Chechnya.

Three patients from Yekaterinburg were undergoing a three-year trial, which ended quite recently. In the Preobrazhenskaya clinic in the city of Yekaterinburg, three women were immunized with lymphocytes during infertility treatment. The infection occurred through blood donated by a clinic employee. According to the court, the clinic is obliged to pay each victim 5 million rubles.

Svetlana Smirnova, deputy chief physician of the regional AIDS Center, says that infected women were identified within a year after undergoing the procedure. Then they were prescribed antiretroviral therapy, thanks to which one of the patients successfully gave birth to a healthy child. The women are now taking the necessary medications.

Another trial ended the other day in Yekaterinburg. In 2014, in a hospital in the Sverdlovsk Region, a man received blood transfusions from five donors, two of whom were infected with HIV. The court awarded compensation to the victim in the amount of 800 thousand rubles. At the end of 2015, in the same regional hospital, a 25-year-old girl was infected during a blood transfusion.

At the same time, according to employees of the Federal AIDS Center, the situation in the Sverdlovsk region is not the worst, because investigations are carried out there quickly.

Svetlana Smirnova states that in the Sverdlovsk region the epidemic has generalized and the prevalence of HIV already exceeds 1% of the total population. The problem is, most people consider themselves healthy. If infection occurs in the coming days before donating blood, then it is impossible to detect the virus using standard methods. There must be a 3 month "seronegative window" before the virus is detected.

The real number of carriers of the infection is unknown

For example, in the Sverdlovsk region, from 60 to 100 donors with HIV are identified every year. If it is not the first time they donate blood, an investigation begins and a search for all patients who received blood from them.

According to Svetlana Smirnova, it is very easy to trace the blood path. The medical institution is checked and the donor himself receives a letter with a request to undergo examination. After the start of quarantine (2004), all donors who have come to donate blood up to this point are at risk.

The case of infection in the Preobrazhenskaya clinic in Yekaterinburg turned out to be very secret. 103 women underwent lymphocyte immunization, 3 of whom were officially infected. Another 100 women have become inaccessible to AIDS Center services and may also become infected.

If we talk about compensation, then 5 million rubles is the largest amount so far. Until now, it has not been possible to obtain compensation from the Moscow Regional Perinatal Center, in which the child was infected with HIV and hepatitis C.

At the end of January 2015, one million HIV-infected residents were registered in our country. However, according to unofficial data, there are much more of them.

The routes of HIV infection are drugs through injections (57.3%) and unprotected sexual intercourse (40.3%).

In March 2017, clinics near Moscow banned the use of glass capillaries, which are designed to take blood from a finger.

This decision was made after the specialists of the regional center dealing with the fight against AIDS proved the existence of a link between the use of a reusable capillary and the infection in the walls of the child's hospital with the immunodeficiency virus.

Infection cases due to the use of non-sterile instruments were also recorded in other regions of the Federation.

Head of the Scientific and Methodological Center of the Federation, which deals with the fight against AIDS, academician Russian Academy Science Pokrovsky Vadim talked about why the country is still likely to contract HIV in a hospital, and how to minimize these risks.

According to information provided by Rospotrebnadzor, during 2007-2014, 20 cases of HIV infection were registered in the Federation in the walls of hospitals. This statistic does not include data on infection following blood transfusion. Moreover, 14 out of 20 infected are children. The scale of the problem is clear.

Mostly, cases of infection are recorded in hospitals for children. This situation is due to the fact that adults can get an infection in another way. It is almost impossible to prove nosocomial infection of adult citizens who are sexually active.

When investigating cases of infection in adults, the possibility of infection from a sexual partner or due to the introduction of drugs cannot be ruled out. Everything is automatically written off for the indicated reasons. But in children, these risk factors are excluded. If the mother of the child is healthy, then first of all, they study the likelihood of nosocomial infection. But if children become infected due to non-sterile instruments, then there is a likelihood of infection in adults. It is just that it is much more difficult to identify such cases.

The first incident that shook the whole country happened more than 25 years ago. At the time, information about HIV was not widely disseminated. After the emergency, they began to control the situation. But this did not help to avoid problems.

In 1989 there was an outbreak of HIV infection in hospitals. It began in Elista, and then spread to Volgograd and Rostov-on-Don. The injured were 200 children. This situation scared the doctors. After that, for 15 years, there was not a single case of infection with the immunodeficiency virus associated with the provision of medical care.

Over time, the generation of medical workers changed and, for some reason, they began to forget about the precautions. At the same time, the media could only hear triumphant speeches about the reduction in the rate of HIV spread.

All this led to the fact that the number of infected citizens in the country began to increase rapidly, while the alertness of people continued to decrease. There is a need to strengthen the monitoring procedures for any parenteral procedures. This is the only way to minimize the number of infections. This is especially important when it comes to underage patients. Unlike adults, they may not notice or understand that they are planning to be injected with a non-sterile syringe.

Now plastic syringes are widely used, what about this nuance?

It is not necessary to use disposable instruments, the main thing is to follow all the established disinfection rules. In addition, plastic syringes are not disposable. They can be used many times, but they cannot be sterilized. They melt in the process. Because of this, the appearance of plastic instruments could not fundamentally solve the problem of nosocomial infection.

In the 90s, I even received a letter in which the author was indignant at the fact that it was not possible to sterilize plastic syringes. They are immediately deformed when heated. This indicates that the problem is not in the syringes, but in the heads of the health workers.

In the process of providing medical care, not only syringes are used, but also other medical instruments. Many of them are not disposable.

- For reusable instruments, special sterilization rules have been developed. But almost all cases of infection in hospitals are associated with injections with non-sterile instruments. Blood collection tubes (plastic or glass) are less hazardous. This is due to the fact that with their help they only collect the blood released from the finger.

Cut wounds are considered not dangerous, since blood flows out and has a protective effect. Puncture wounds do not cause heavy bleeding, which can lead to infection during injections with a non-sterile syringe. True, before that, it is necessary that the same untreated syringe give an injection to a person infected with HIV or hepatitis.

There was a time when there was talk of a possible infection through dental equipment. True, it was a question of a possible hepatitis infection.

The possibility of contracting hepatitis cannot be denied if the used instrument is not replaced at the hospital. In addition, the hepatitis B virus is more resistant than the immunodeficiency virus, as, in principle, are many bacterial infections (chlamydia, gardnerellosis, syphilis, gonorrhea). The head of the AIDS Center is not aware of a single proven case of HIV infection in the dentist's office.

Video: "A specialist's view of nosocomial infections"

Methods to deal with the threat

If even the use of disposable instruments does not solve the problem with a probable infection, what is left for doctors and patients to do?

The use of the term "disposable instruments" is erroneous. Instruments are needed that will self-destruct or block after a single use (for example, a plug will form in the syringe). They are already used in all civilized countries: on English language they are called self-destruction.

Russian inventors periodically send their proposals for the development of self-locking tools. But the cost of their manufacture is higher, therefore, such syringes are not yet produced on an industrial scale, they are awaiting the appearance of a corresponding order from officials. According to Pokrovsky, it would be desirable to begin the transition to such instruments right now. In a few years, they would be in widespread use.

But tools aren't the only source of infection. There are also the hands of doctors. For example, when performing medical procedures, nurses do not change gloves when changing patients; they can simply rinse their hands under the tap.

This is a clear violation of sanitary standards, which should be dealt with. Of course, the sanitary service cannot identify all violations. Patients and health workers should be vigilant and hygienic themselves. Health care providers should not only monitor their health, but also think about the safety of patients.

When discussing the state strategy for combating the immunodeficiency virus, some spoke out against expanding the program of mandatory tests for the detection of this virus. They justified this by the fact that the state with such a step confirms the absence of a developed system to protect patients from nosocomial infection. There are no guarantees that biomaterial from one patient will not be able to get to a physician or another patient.

- Extended HIV diagnostics is aimed at early detection of infected patients. This is not related to the protection of physicians and other hospital patients from AIDS. Nosocomial HIV outbreaks are possible due to the widespread belief that infected people are in specialized centers... Some doctors believe that a sick patient cannot get into conventional surgery or gynecology.

Currently, it is impossible to get to hospital for a planned operation without a certificate of the absence of an immunodeficiency virus. Of course, a general survey is not always justified. But a mass screening of a group of people, where infection is most likely, should be mandatory. Most often, people aged 25-40 years encounter HIV. Among sexually active adults, the rate of infected citizens is high, reaching 2%. This means that everyone can face HIV infection.

Hirudotherapist, Therapist

Conducts a complete examination of the body and makes conclusions based on the results. Has extensive experience both in the application of traditional medicine and folk methods... The main direction of non-traditional treatment is hirudotherapy.