Ministry of Health of the Russian Federation

GOU VPO Tyumen State

Orders on asepsis and antisepsis

Compiled by: Professor Tsiryatieva S.B., Professor Kecherukov A.I., Associate Professor Gorbachev V.N., Associate Professor Aliev F.Sh., Ph.D. Chernov I.A., assistant Baradulin A.A., assistant Komarova L.N.

Approved by the Central Committee for Medical Education of Tyumen State Medical Academy as an educational and methodological aid

(protocol No. 3 dated 12/16/04

The main provisions of orders No. 408 of the USSR Ministry of Health dated July 12, 1989 “On measures to reduce the incidence of viral hepatitis in the country”, No. 170 dated August 16, 1994 “On measures to improve the prevention and treatment of HIV infection in the Russian Federation” are outlined in brief form. , No. 720 dated 07/31/1978 “On improving medical care for patients with purulent surgical diseases and strengthening measures to combat nosocomial infections”, No. 288 dated 03/23/1975 “On the sanitary-epidemiological regime in a medical and preventive institution”, No. 320 dated 05.03 .1987 “Organization and implementation of measures to combat pediculosis.”

The development of asepsis and antisepsis began in the 30s of the 19th century, when the work of the English surgeon Joseph Lister revolutionized surgery and marked the beginning of a new stage in the development of surgery. Since then, human knowledge about microorganisms that cause the development of purulent complications of wounds, the routes of their transmission, methods of treatment and prevention have changed significantly. Great progress in the study of infections with the parenteral mechanism of pathogen transmission was achieved in the 80s – 90s of the twentieth century. The human immunodeficiency virus has been isolated and identified, the properties of parenteral hepatitis B, C, D, G have been studied. New knowledge requires legally established methods for preventing the spread of these infections in medical and preventive institutions.

1. Order 408 of the USSR Ministry of Health dated July 12, 1989 “On measures to reduce the incidence of viral hepatitis in the country.”

2. Order of the Ministry of Health and MP of the Russian Federation No. 170 of August 16, 1994 “On measures to improve the prevention and treatment of HIV infection in the Russian Federation.”

3. Order No. 720 of July 31, 1978 “On improving medical care for patients with purulent surgical diseases and strengthening measures to combat nosocomial infections.”

4. Order of the USSR Ministry of Health No. 288 of March 23, 1975 “On the sanitary and epidemic regime in medical and preventive institutions.”

5. Order 320 of 03/05/1987 “Organization and implementation of measures to combat pediculosis.”

Order 408 of the USSR Ministry of Health dated July 12, 1989 “On measures to reduce the incidence of viral hepatitis in the country.”

The main reasons for the high incidence of viral hepatitis B and C (parenteral hepatitis) are the lack of provision of medical institutions with disposable instruments, sterilization equipment and disinfectants, reagents and test systems for examining blood donors. There are rude medical personnel handling medical and laboratory instruments and rules for using instruments. For this purpose, appendices to Order 408 have been developed - Guidelines “Epidemiology and prevention of viral hepatitis with parenteral transmission of the pathogen” (Appendix 2) and “Means and methods of disinfection and sterilization” (Appendix 3).

Hepatitis B is an independent infectious disease caused by the DNA-containing hepatitis B virus. A feature of the disease is the formation of chronic forms. Hepatitis D (delta) is caused by an RNA containing a defective virus that can replicate only with the mandatory participation of the hepatitis B virus. Infection with the hepatitis B virus occurs through transfusion of infected blood and/or its components, or during therapeutic and diagnostic procedures. Infection is possible during tattoos, piercings, manicures performed with shared instruments; intravenous drug addiction plays a leading role in the spread of parenteral hepatitis. To become infected with hepatitis B, it is enough to inject a minimum amount of infected blood - 10 -7 ml.

The high occupational risk group includes staff of hemodialysis centers, surgeons, obstetricians and gynecologists, laboratory assistants in clinical and biochemical laboratories, operating rooms and procedural nurses.

In order to reduce the incidence of viral hepatitis, the following measures are taken:

Constant screening of blood donors.

Constant examination of recipients of hemotherapy drugs.

Protection and treatment of the hands of medical personnel in contact with blood.

Compliance with pre-sterilization cleaning and sterilization regimes for all medical instruments.

Examination of personnel of medical institutions (at-risk groups) for the presence of HBsAg upon entry to work and then once a year.

__________________________________________________

Order N 408 of the USSR Ministry of Health dated July 12, 1989 on measures to reduce the incidence of viral hepatitis in the country. The current version of the document has legal force, although it focuses on the situation with hepatitis in the republics of the USSR, and most often uses guidelines for the prevention of various forms of hepatitis.

Russian Federation

ORDER of the USSR Ministry of Health dated July 12, 1989 N 408 "ON MEASURES TO REDUC THE INCIDENCE OF VIRAL HEPATITIS IN THE COUNTRY"

The main directions for the development of public health protection and the restructuring of healthcare in the USSR in the twelfth five-year plan and for the period until 2000 provide for a reduction in the incidence of viral hepatitis.

The incidence of viral hepatitis in the country remains at a high level. Particularly unfavorable rates of incidence of viral hepatitis are observed in the republics of Central Asia, where they are 3-4 times higher than the Union average and account for almost half of the total number of cases of viral hepatitis in the country. A significant increase in the incidence of viral hepatitis in recent years in a number of territories of the Turkmen SSR, Uzbek SSR, Kirghiz SSR and Tajik SSR is due to non-A, non-B hepatitis with a fecal-oral transmission mechanism.

The main reasons for the high incidence of viral hepatitis A and non-A, non-B with the fecal-oral transmission mechanism of the pathogen remain: contamination of drinking water and the environment due to serious deficiencies in water supply, sewerage and sanitary cleaning of populated areas; unsatisfactory sanitary and technical condition and maintenance of preschool institutions and schools, their significant overcrowding; insufficient level of communal improvement of the housing stock; low level of hygienic culture of the population; gross violations of sanitary and anti-epidemic norms and rules; low level of hygienic and professional knowledge of workers in public utilities, public catering, children's and adolescent institutions.

A serious health problem is the incidence of viral hepatitis B. In recent years, there has been an increase in the incidence of this nosological form. The high proportion of hepatitis B infections in medical institutions during diagnostic and treatment procedures, blood transfusions and its components is primarily due to serious shortcomings in the provision of medical institutions with syringes, needles, including disposable ones, and other instruments; sterilization equipment, disinfectants, reagents and diagnostic test systems, primarily for examining donors. There are gross violations by medical personnel of the disinfection treatment and sterilization regimes for medical and laboratory instruments and the rules for their use.

The low level of differential diagnosis of viral hepatitis is associated with insufficient production and practical use of test systems for diagnosing hepatitis A, B and delta using highly sensitive methods.

The development of etiotropic therapy is progressing slowly. In many territories, the issue of treating patients with chronic forms of hepatitis B (HBsAg-positive) in infectious diseases hospitals has not been resolved.

In order to improve the diagnosis, treatment and prevention of viral hepatitis,

I affirm:

1. Guidelines "Epidemiology and prevention of viral hepatitis A and non-A, non-B viral hepatitis with a fecal-oral transmission mechanism", appendix 1.

2. Guidelines "Epidemiology and prevention of viral hepatitis B, delta and non-A, non-B with parenteral transmission of the pathogen", Appendix 2.

3. Guidelines "Means and methods of disinfection and sterilization", Appendix 3.

4. Guidelines "Clinicology, diagnosis, treatment and outcomes of viral hepatitis in adults and children", Appendix 4.

I order:

1. To the ministers of health of the union and autonomous republics, heads of departments and heads of health departments of territories and regions, heads of the Main Health Departments of the cities of Moscow and Leningrad:

1.1. To develop, taking into account specific conditions, and approve comprehensive action plans to reduce the incidence of viral hepatitis for 1991 - 1995. Strictly monitor the progress of their implementation, annually hear the implementation of these plans at the boards of the ministries of health of the union, autonomous republics, departments and health departments of territories and regions.

1.2. Carry out during 1990 - 1991. training of laboratory doctors in clinical diagnostic, virology laboratories of city and central district hospitals, sanitary and epidemiological stations, blood transfusion stations on the method of staging a reaction to HBs antigen using highly sensitive methods (ROPGA, ELISA, RIA) on the basis of research institutes, virology laboratories of the republican, regional , city SES and blood transfusion stations, large clinical and infectious diseases hospitals.

1.3. Ensure the organization and conduct of examinations with highly sensitive methods for HBsAg of all pregnant women in hepatitis B hyperendemic areas with a high level of HBsAg carriage. For the hospitalization of mothers who are “carriers” of HBsAg, allocate special maternity hospitals or isolated departments (wards) with strict implementation of anti-epidemic measures in them.

1.4. Provide in 1990 - 1995 coverage of centralized sterilization of medical devices for parenteral use in all medical and preventive institutions, increase the responsibility of the heads of these institutions for compliance with disinfection regimes, pre-sterilized cleaning and sterilization of medical and laboratory instruments and equipment.

1.5. Ensure hospitalization of patients with chronic hepatitis B (HBsAg-positive) adults and children in infectious diseases hospitals.

1.6. Oblige republican health centers to strengthen the promotion of a healthy lifestyle, taking into account national and age characteristics; develop methodological materials for lectures and discussions, make extensive use of the media.

2. To the chief state sanitary doctors of the union and autonomous republics, territories and regions:

2.1. Exercise strict control over the provision of epidemic-safe drinking water to the population, the implementation of measures for the sanitary protection of sources of domestic and drinking water use, ensuring the effective operation of treatment facilities in accordance with the norms and rules provided for by the documents of water legislation, the implementation by heads of departments (water and utility departments) economy) and medical institutions to ensure proper sanitary conditions and communal improvement of territories, as well as in preschool institutions, schools, medical and health institutions, and food industry enterprises.

2.2. Strictly monitor compliance in medical institutions with the anti-epidemic regime, disinfection regimes, pre-sterilization cleaning and sterilization of instruments and the rules for their use. All cases of group infection with hepatitis B in medical institutions should be considered at meetings of the emergency anti-epidemic commission.

2.3. To promptly inform about the occurrence of group diseases of viral hepatitis among the population and prompt measures to investigate and eliminate them in accordance with Order N 1025 of the USSR Ministry of Health “On extraordinary reports submitted to the USSR Ministry of Health” dated 09/04/84.

2.4. To organize, since 1990, laboratory monitoring of drinking water based on indicators of viral contamination: GA antigen, coliphages, enteroviruses in accordance with the “Methodological recommendations for the control and assessment of viral contamination of environmental objects” dated September 24, 1986 N 4116-86.

3. To the Head of the Main Epidemiological Directorate, Comrade M.I. Narkevich. and Director of the Institute of Virology named after D.I. Ivanovsky Academy of Medical Sciences of the USSR Comrade D.K. Lvov during 1989 - 1990 organize and conduct regional seminars on diagnostics, treatment and prevention of viral hepatitis for doctors (infectious disease specialists, pediatricians, epidemiologists, virologists, etc.).

4. Head of the Main Epidemiological Directorate, Comrade M.I. Narkevich, Head of the Main Directorate for the Protection of Motherhood and Childhood, Comrade V.A. Alekseev, Head of the Main Directorate for the Organization of Medical Care to the Population, Comrade V.I. Kalinin. to provide, from the moment of development of industrial production of vaccines against hepatitis B, vaccination in accordance with the instructions for use of these vaccines.

5. The Institute of Poliomyelitis and Viral Encephalitis of the USSR Academy of Medical Sciences (Comrade Drozdov S.G.) to ensure the industrial production of a diagnostic solution for determining anti-HAV class lgM and type-specific diagnostic enteroviral sera by ELISA in 1991.

6. The Gorky Institute of Epidemiology and Microbiology of the Ministry of Health of the RSFSR (Comrade I.N. Blokhin) to ensure the industrial production of diagnostic kits for determining the antigen-HAV since 1990 and since 1991 for total anti-HAV using the ELISA method.

7. Institute of General and Communal Hygiene named after A.N. Sysin of the USSR Academy of Medical Sciences (comrade G.I. Sidorenko) together with the N.F. Gamaleya Institute of Epidemiology and Microbiology of the USSR Academy of Medical Sciences (comrade S.V. Prozorovsky), Institute of Virology named after D.I. Ivanovsky of the USSR Academy of Medical Sciences (comrade D.K. Lvov), Institute of Poliomyelitis and Viral Encephalitis (comrade S.G. Drozdov) to carry out in 1989 - 1991. Research to improve methods of water treatment and treatment, water disinfection regimes aimed at increasing the effectiveness of the barrier role of water supply facilities against the hepatitis A pathogen.

8. The All-Union Scientific Research Institute of Preventive Toxicology and Disinfection (Comrade Yu.I. Prokopenko) should submit in the IV quarter of 1989 to the USSR Ministry of Health for approval “Methodological recommendations for the organization of centralized sterilization in medical institutions.”

9. The Institute of Virology named after D.I. Ivanovsky of the USSR Academy of Medical Sciences (T.Lvov D.K.) to develop a genetic engineering test system for diagnosing delta infection during 1989 - 1990.

10. The Institute of Poliomyelitis and Viral Encephalitis of the USSR Academy of Medical Sciences (Comrade S.G. Drozdov), together with NPO "Vector" of the USSR Ministry of Medical Industry, will ensure the production of experimental production series of cultural inactivated vaccine against hepatitis A in 1989 and its industrial production since 1991.

11. General Director of V/O "Soyuzpharmacy" Comrade A.D. Apazov take measures to fully satisfy the needs of the union republics in single-use systems, diagnostic kits for the determination of HBsAg by the methods of ROPGA, ELISA, and reagents, ensuring priority satisfaction of requests from the republics of Central Asia and the Moldavian SSR.

Valid Editorial from 12.07.1989

ORDER of the USSR Ministry of Health dated July 12, 1989 N 408 "ON MEASURES TO REDUC THE INCIDENCE OF VIRAL HEPATITIS IN THE COUNTRY"

DISINFECTION, PRE-STERILIZATION CLEANING AND STERILIZATION OF MEDICAL DEVICES

Medical products used for patients with viral hepatitis with parenteral mechanisms of transmission of the pathogen or carriers of the HBs antigen, after disinfection, are subjected to pre-sterilization cleaning and sterilization if during use they come into contact with the wound surface, come into contact with blood or injectable drugs, and also come into contact with the mucous membrane casing and may cause damage to it.

1. Disinfection of medical products.

1.1. When disinfecting products that have internal channels, a disinfectant solution in a volume of 5-10 ml is passed through the channel to remove residual blood, serum and other biological fluids immediately after use, after which the product is completely immersed in the solution for the required disinfection time (Table 2). If the solution is contaminated with blood, its disinfecting properties are reduced, and therefore it is necessary to have a second container for disinfection after preliminary rinsing in the disinfectant solution.

1.2. If the product is made of corrosion-resistant metal and cannot withstand contact with a disinfectant, then it is washed in a container with water. Wash water is disinfected by boiling for 30 minutes or covered with dry bleach, heat-resistant bleaching lime, neutral calcium hypochlorite in a ratio of 200 g per 1 liter, mixed and left to disinfect for 60 minutes. in a container with a lid, then the product is disinfected using the boiling or air method.

After disinfection, the product is thoroughly washed with running water.

2. Pre-sterilization cleaning.

2.1. Pre-sterilization cleaning involves removing protein, fat, mechanical contaminants and residual quantities of medications from products.

2.2. Pre-sterilization cleaning is carried out manually or mechanically using washing solutions.

2.3. As washing solutions, solutions of the Biolot detergent are used, as well as washing solutions containing hydrogen peroxide with synthetic detergents “Progress”, “Marichka”, “Astra”, “Aina”, “Lotos”, “Lotos-automatic” ( the last two with and without a corrosion inhibitor).

To reduce corrosion of metal instruments, it is more advisable to use solutions of the Biolot detergent and washing solutions containing hydrogen peroxide with the synthetic detergent “Lotus” or “Lotus-automatic” and the corrosion inhibitor sodium oleate (0.14%)<*>.

<*>- Note: the preparation of the washing solution is described in OST 42-21-2-85 "Sterilization and disinfection of medical devices. Methods, means and modes" (Table 2).

2.4. Pre-sterilization cleaning is carried out manually in the sequence outlined in Table 3.

2.5. Mechanized pre-sterilization cleaning is carried out using special equipment using the jet, rotational method, brushing or using ultrasound.

The method of performing mechanized cleaning must comply with the operating instructions supplied with the equipment.

When using a mechanized cleaning method, the cleaning solutions specified in clause 2.3 are used.

2.6. Pre-sterilization cleaning of endoscopes and medical instruments for flexible endoscopes is carried out in accordance with the instructions and methodological documents on disinfection, pre-sterilization cleaning and sterilization of these products.

2.7. The quality of pre-sterilization cleaning of products is assessed for the presence of blood by performing an azopyram and amidopyrine test and a phenolphthalein test - for the presence of residual amounts of alkaline components of the detergent.

2.8. Quality control of pre-sterilization cleaning is carried out by sanitary-epidemiological and disinfection stations once a quarter.

Self-monitoring in medical institutions is carried out at least once a week, organized and supervised by the head nurse (midwife) of the department.

2.9. 1% of simultaneously processed products of the same name, but not less than 3-5 units, are subject to control.

2.10. The description of the samples is given in the relevant instructional and methodological documents: azopyram - in the guidelines "Quality control of pre-sterilization cleaning of medical products using the azopyram reagent" N 28-6/13 dated May 26, 1988, amidopyrine and phenolphthalein - in the "Guidelines for pre-sterilization cleaning of medical products" N 28-6/13 dated June 8, 1982

2.11. If a test for blood or detergent is positive, the entire group of controlled products from which the control was taken is subjected to repeated processing until negative results are obtained.

3. Sterilization.

3.1. Sterilization ensures the death of vegetative and spore forms of pathogenic and non-pathogenic microorganisms in sterilized products.

3.2. Sterilization is carried out using various methods: steam (Table 4), air (Table 5), chemical: using solutions of sterilizing agents (Table 6) and gases (Tables 7 and 8).

The choice of one or another sterilization method depends on the characteristics of the product being sterilized.

3.3. Products made of metals, polymeric materials, rubber, including parts made of corrosion-resistant metals, are subjected to sterilization with solutions.

3.4. Products to be sterilized with solutions are laid out freely in containers with the solution and straightened out; if the product is long, it is laid out in a spiral. The products are completely immersed in the solution, and the channels and cavities are filled with the solution.

3.5. After the end of the sterilization period, the products are immersed twice (when sterilizing with hydrogen peroxide) or three times (when sterilizing with dezoxon-1 and glutaraldehyde) for 5 minutes in sterile water, changing it each time, then the products are transferred with a sterile forceps to a sterile sterilization box lined with a sterile sheet .

3.6. The hydrogen peroxide solution can be used within 7 days from the date of preparation when stored in a closed container in a dark place. Further use of the solution can only be carried out if the content of the active substance is controlled.

Dezoxon-1 solution is used for one day.

3.7. For the gas sterilization method, ethylene oxide, a mixture of OB (a mixture of ethylene oxide and methyl bromide in a weight ratio of 1:2.5, respectively), as well as vapors of a solution of formaldehyde in ethyl alcohol are used.

3.8. Gas sterilization is carried out in portable devices (microanaerostat MI, with a volume of 2.7 and 3.2 cubic dm (l), a Minutka pressure cooker of three sizes: maximum capacity according to the passport (before the sealing gasket), cubic dm, 8.0; 6.0; 4.5; total volume, cubic dm, respectively 8.5; 6.6; 5.0).

Microanaerostats are used without modification.

The Minutka pressure cooker is equipped in accordance with the recommendations set out in the “Methodological recommendations for disinfection, pre-sterilization cleaning and sterilization of medical instruments for flexible endoscopes” N 28-6/3 dated 02/09/88 (clause 4.3.3.).

3.9. The methodological recommendations specified in clause 3.8. include: preparation of a solution of glutaraldehyde (clause 2.3), a method for determining the concentration of glutaraldehyde in a solution (Appendix 1), a method for introducing a solution of formaldehyde in ethyl alcohol into portable sterilizers (clause 4.3 .4.), preparation of a solution of formaldehyde in ethyl alcohol and the method of analyzing this method (Appendix 2).

Table 1

METHODS AND MEANS OF DISINFECTING OBJECTS FOR VIRAL HEPATITIS

Notes:

<*>- The secretions of a patient with hepatitis B and a carrier of the HBs antigen, dishes from under the secretions are disinfected only in case of bleeding from the gastrointestinal tract and urinary tract;

<**>- The consumption rate depends on the brand of GKT: 200 g/kg - for brand A, 250 g/kg - for brand B.

<***>- Activated chloramine solutions are used only for final disinfection;

<****>- Clarified solutions of bleach, heat-resistant bleaching lime, NGK, GKT are used to disinfect premises in the absence of other disinfectants.

<*****>- Solutions of hydrogen peroxide, Dezoxon-1, NGK, GKT in the required concentrations are prepared according to the active substance, the rest - according to the drug.

<******>- Disinfection of toys in the presence of a patient with hepatitis B or a carrier of the HBs antigen is carried out according to epidemiological indications.

table 2

DISINFECTION OF MEDICAL DEVICES

Notes:

1. Disinfection of medical instruments can be carried out with medical hydrogen peroxide and technical grades A and B, followed by washing of the instruments.

2. The concentration of the disinfectant agent: chloramine, sulfochloranthine, DP-2 is given according to the drug, the rest - according to the active substance.

3. For products and their parts that are not in direct contact with the patient, wiping should be done with a napkin soaked in a disinfectant solution and wrung out to prevent the disinfectant solution from getting into the inside of the product.

4. After disinfection by immersion, the products must be washed in running water until the smell of the disinfectant is completely removed.

5. The disinfectant solution should be used once.

6. When disinfecting by boiling and steam, products made of polymeric materials must be packaged in gauze.

7. The method for preparing a solution of glutaraldehyde is given in the “Methodological recommendations for disinfection, pre-sterilization cleaning and sterilization of medical instruments for flexible endoscopes”, approved. Ministry of Health of the USSR 02/09/88 N 28-6/3.

8. Disinfection of disposable medical products made from plastics is carried out in accordance with the "Instructions for the collection, storage and delivery of scrap disposable medical products made from plastics", approved. Ministry of Health of the USSR 03/24/89

Table 3

PRE-STERILIZATION CLEANING

Note: the temperature of the solution is not maintained during the washing process.

Table 4

STEAM STERILIZATION METHOD (SATURATED WATER STEAM UNDER EXCESSIVE PRESSURE)

Table 6

CHEMICAL STERILIZATION METHOD (SOLUTIONS OF CHEMICALS)

Notes:

1. The temperature of the hydrogen peroxide solution is not maintained during the sterilization process.

2. The concentrations of sterilizing solutions are given based on the active substance (in the case of Dezoxon-1 - peracetic acid).

Table 7

CHEMICAL METHOD OF STERILIZATION (GAS) WITH A MIXTURE OF OB AND ETHYLENE OXIDE

Note:

Products sterilized by the gas method (ethylene oxide or OB mixture),

used after keeping them in a ventilated room at an air speed of 20 cm/s for:

1 day - for glass and metal products;

5-13 days - for plastic and rubber products with short-term contact (up to 30 minutes);

specific ventilation periods must be specified in the technical specifications for specific products;

14 days - for all products that have prolonged contact (over 30 minutes) with mucous membranes, tissues, blood;

21 days - for products made of polymer materials with prolonged contact (over 30 minutes) used for children.

Table 8

CHEMICAL METHOD OF STERILIZATION (GAS) WITH FORMALDEHYDE VAPOR IN ETHYL ALCOHOL

Note:

After sterilization with vapors of a solution of formaldehyde in ethyl alcohol, degassing of products made of polymeric materials (rubber, plastics), metals and glass is not required, with the exception of products made of plastics and rubber in contact with blood, which require 2-day degassing at room conditions.

Boss
Chief Epidemiological
Department of the USSR Ministry of Health
M.I.NARKEVICH

GOU VPO Tyumen State

medical Academy

Department of General Surgery

Orders on asepsis and antisepsis

Compiled by: Professor Aliev F.Sh., Associate Professor Gorbachev V.N., Associate Professor Chernov I.A., Associate Professor Baradulin A.A., Ph.D. Komarova L.N.

Approved by the Central Committee for Medical Education of Tyumen State Medical Academy as an educational and methodological aid

The main provisions of orders No. 408 of the USSR Ministry of Health dated July 12, 1989 “On measures to reduce the incidence of viral hepatitis in the country”, No. 170 dated August 16, 1994 “On measures to improve the prevention and treatment of HIV infection in the Russian Federation” are outlined in brief form. , No. 720 dated 07/31/1978 “On improving medical care for patients with purulent surgical diseases and strengthening measures to combat nosocomial infections”, No. 288 dated 03/23/1975 “On the sanitary and epidemic regime in a medical and preventive institution”, No. 320 dated 05.03 .1987 “Organization and implementation of measures to combat pediculosis.”

The development of asepsis and antisepsis began in the 30s of the 19th century, when the work of the English surgeon Joseph Lister revolutionized surgery and marked the beginning of a new stage in the development of surgery. Since then, human knowledge about microorganisms that cause the development of purulent complications of wounds, the routes of their transmission, methods of treatment and prevention have changed significantly. Great progress in the study of infections with the parenteral mechanism of pathogen transmission was achieved in the 80s – 90s of the twentieth century. The human immunodeficiency virus has been isolated and identified, the properties of parenteral hepatitis B, C, D, G have been studied. New knowledge requires legally established methods for preventing the spread of these infections in medical and preventive institutions.

Topic study plan

Order 408 of the USSR Ministry of Health dated July 12, 1989 “On measures to reduce the incidence of viral hepatitis in the country.”

Order of the Ministry of Health and the Ministry of Health of the Russian Federation No. 170 of August 16, 1994 “On measures to improve the prevention and treatment of HIV infection in the Russian Federation.”

Order No. 720 of July 31, 1978 “On improving medical care for patients with purulent surgical diseases and strengthening measures to combat nosocomial infections.”

Order of the USSR Ministry of Health No. 288 of March 23, 1975 “On the sanitary and epidemic regime in medical and preventive institutions.”

Order 320 of 03/05/1987 “Organization and implementation of measures to combat head lice.”

Order 408 of the Ministry of Health of the USSR dated July 12, 1989 “on measures to reduce the incidence of viral hepatitis in the country.”

The main reasons for the high incidence of viral hepatitis B and C (parenteral hepatitis) are the shortcomings in providing medical institutions with disposable instruments, sterilization equipment and disinfectants, reagents and test systems for examining blood donors. There are rude medical personnel handling medical and laboratory instruments and rules for using instruments. For this purpose, appendices to Order 408 have been developed - Guidelines “Epidemiology and prevention of viral hepatitis with parenteral transmission of the pathogen” (Appendix 2) and “Means and methods of disinfection and sterilization” (Appendix 3).

Hepatitis B is an independent infectious disease caused by the DNA-containing hepatitis B virus. A feature of the disease is the formation of chronic forms. Hepatitis D (delta) is caused by an RNA containing a defective virus that can replicate only with the mandatory participation of the hepatitis B virus. Infection with the hepatitis B virus occurs through transfusion of contaminated blood and/or its components, or during therapeutic and diagnostic procedures. Infection is possible during tattoos, piercings, manicures performed with shared instruments; intravenous drug addiction plays a leading role in the spread of parenteral hepatitis. To become infected with hepatitis B, it is sufficient to inject a minimum amount of infected blood - 10 -7 ml.

The high occupational risk group includes staff of hemodialysis centers, surgeons, obstetricians - gynecologists, laboratory assistants in clinical and biochemical laboratories, operating rooms and procedural nurses.

In order to reduce the incidence of viral hepatitis, the following measures are taken:

Constant screening of blood donors.

Constant examination of recipients of hemotherapy drugs.

Protection and treatment of the hands of medical personnel in contact with blood.

Compliance with pre-sterilization cleaning and sterilization regimes for all medical instruments.

Examination of personnel of medical institutions (at-risk groups) for the presence of HBsAg upon entry to work and then once a year.

ORDER. 07.12.89 No. 408. “On measures to reduce the incidence of viral hepatitis in the country”

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“On measures to reduce the incidence of viral hepatitis in the country”

The main directions for the development of public health protection and the restructuring of healthcare in the USSR in the twelfth five-year plan and for the period until 2000 provide for a reduction in the incidence of viral hepatitis.

The incidence of viral hepatitis in the country remains at a high level. Particularly unfavorable rates of incidence of viral hepatitis are observed in the republics of Central Asia, where they are 3-4 times higher than the Union average and account for almost half of the total number of cases of viral hepatitis in the country. A significant increase in the incidence of viral hepatitis in recent years in a number of territories of the Turkmen SSR, Uzbek SSR, Kirghiz SSR and Tajik SSR is due to non-A, non-B hepatitis with a fecal-oral transmission mechanism.

The main reasons for the high incidence of viral hepatitis A and non-A, non-B with the fecal-oral transmission mechanism of the pathogen remain: contamination of drinking water and the environment due to serious deficiencies in water supply, sewerage and sanitary cleaning of populated areas; unsatisfactory sanitary and technical condition and maintenance of preschool institutions and schools, their significant overcrowding; insufficient level of communal improvement of the housing stock; low level of hygienic culture of the population; gross violations of sanitary and anti-epidemic norms and rules; low level of hygienic and professional knowledge of workers in public utilities, public catering, children's and adolescent institutions.

A serious health problem is the incidence of viral hepatitis B. In recent years, there has been an increase in the incidence of this nosological form. The high proportion of hepatitis B infections in medical institutions during diagnostic and treatment procedures, blood transfusions and its components is primarily due to serious shortcomings in the provision of medical institutions with syringes, needles, including disposable ones, and other instruments; sterilization equipment, disinfectants, reagents and diagnostic test systems, primarily for examining donors. There are gross violations by medical personnel of the disinfection treatment and sterilization regimes for medical and laboratory instruments and the rules for their use.

The low level of differential diagnosis of viral hepatitis is associated with insufficient production and practical use of test systems for diagnosing hepatitis A, B and delta using highly sensitive methods.

The development of etiotropic therapy is progressing slowly. In many territories, the issue of treating patients with chronic forms of hepatitis B (HBsAg-positive) in infectious diseases hospitals has not been resolved.

In order to improve the diagnosis, treatment and prevention of viral hepatitis, I affirm:

Guidelines “Epidemiology and prevention of viral hepatitis A and non-A, non-B viral hepatitis with a fecal-oral transmission mechanism”, Appendix 1.

Guidelines "Epidemiology and prevention of viral hepatitis B, delta and non-A, non-B with parenteral transmission of the pathogen", Appendix 2.

Guidelines “Means and methods of disinfection and sterilization”, Appendix 3.

Carry out during 1990-1991. training of laboratory doctors in clinical diagnostic, virology laboratories of city and central district hospitals, sanitary and epidemiological stations, blood transfusion stations on the method of staging a reaction to HBs antigen using highly sensitive methods (ROPGA, ELISA, RIA) on the basis of research institutes, virology laboratories of the republican, regional , city SES and blood transfusion stations, large clinical infectious diseases hospitals.

Ensure the organization and conduct of examinations with highly sensitive methods for HBsAg of all pregnant women in hepatitis B hyperendemic areas with a high level of HBsAg carriage. For the hospitalization of pregnant women carrying HBsAg, allocate special maternity hospitals or isolated departments (wards) with strict implementation of anti-epidemic measures in them.

Provide in 1990-1995. coverage of centralized sterilization of medical devices for parenteral use in all medical and preventive institutions, increase the responsibility of the heads of these institutions for compliance with disinfection regimes, pre-sterilization cleaning and sterilization of medical and laboratory instruments and equipment.

Oblige republican health centers to strengthen the promotion of a healthy lifestyle, taking into account national and age characteristics; develop methodological materials for lectures and discussions, make extensive use of the media.

2. To the chief state sanitary doctors of the union and autonomous republics, territories and regions:

Exercise strict control over the provision of epidemic-safe drinking water to the population, the implementation of measures for the sanitary protection of sources of domestic and drinking water use, ensuring the effective operation of treatment facilities in accordance with the norms and rules provided for by the documents of water legislation, the implementation by heads of departments (water and utility departments) economy) and medical institutions to ensure proper sanitary conditions and communal improvement of territories, as well as in preschool institutions, schools, medical and health institutions, and food industry enterprises.

Strictly monitor compliance in medical institutions with the anti-epidemic regime, disinfection regimes, pre-sterilization cleaning and sterilization of instruments and the rules for their use. All cases of group infection with hepatitis B in medical institutions should be considered at meetings of the emergency anti-epidemic commission.

Timely inform about the occurrence of group diseases of viral hepatitis among the population and prompt measures to investigate and eliminate them in accordance with Order No. 1025 of the USSR Ministry of Health “On extraordinary reports submitted to the USSR Ministry of Health” dated 09/04/84.

To organize, since 1990, laboratory monitoring of drinking water based on indicators of viral contamination: GA antigen, coliphages, enteroviruses in accordance with the “Methodological recommendations for the control and assessment of viral contamination of environmental objects” dated September 24, 1986 No. 4116-86.

To the Head of the Main Epidemiological Directorate, Comrade M.I. Narkevich. and director of the Institute of Virology named after. DI. Ivanovsky Academy of Medical Sciences of the USSR to Comrade D.K. Lvov, during 1989-1990. organize and conduct regional seminars on diagnostics, treatment and prevention of viral hepatitis for doctors (infectious disease specialists, pediatricians, epidemiologists, virologists, etc.).

Head of the Main Epidemiological Directorate, Comrade M.I. Narkevich, Head of the Main Directorate for the Protection of Motherhood and Childhood, Comrade V.A. Alekseev, Head of the Main Directorate for the Organization of Medical Care to the Population, Comrade V.I. Kalinin. to provide, from the moment of development of industrial production of vaccines against hepatitis B, vaccination in accordance with the instructions for use of these vaccines.

The Institute of Poliomyelitis and Viral Encephalitis of the USSR Academy of Medical Sciences (Comrade Drozdov S.G.) provided industrial production of diagnostic kit for determining anti-HAV class IgM and type-specific diagnostic enteroviral sera by ELISA in 1991.

The Gorky Institute of Epidemiology and Microbiology of the Ministry of Health of the RSFSR (T. Blokhin I.N.) to ensure the industrial production of diagnostic kits for determining the antigen-HAV since 1990 and since 1991 for total anti-HAV using the ELISA method.

Institute of General and Communal Hygiene named after. A.N. Sysin of the USSR Academy of Medical Sciences (comrade G.I. Sidorenko) together with the Institute of Epidemiology and Microbiology named after. N.F. Gamaleya Academy of Medical Sciences of the USSR (t. Prozorovsky S.V.), Institute of Virology named after. DI. Ivanovsky Academy of Medical Sciences of the USSR (t. Lvov D.K.), Institute of Poliomyelitis and Viral Encephalitis (t. Drozdov S.G.) to be carried out in 1989-1991. Research to improve methods of water treatment and treatment, water disinfection regimes aimed at increasing the effectiveness of the barrier role of water supply facilities against the hepatitis A pathogen.

The All-Union Scientific Research Institute of Preventive Toxicology and Disinfection (T. Prokopenko Yu.I.) to submit in the IV quarter of 1989 to the USSR Ministry of Health for approval “Methodological recommendations for the organization of centralized sterilization in medical institutions.”

The Institute of Poliomyelitis and Viral Encephalitis of the USSR Academy of Medical Sciences (Comrade S.G. Drozdov), together with NPO “Vector” of the USSR Ministry of Medical Industry, ensured the production of experimental production series of cultural inactivated vaccine against hepatitis A in 1989 and its industrial production from 1991.

General Director of V/O "Soyuzpharmacia" T. Apazov A.D. take measures to fully satisfy the needs of the union republics in single-use systems, diagnostic kits for the determination of HBsAg by the methods of ROPGA, ELISA, and reagents, ensuring priority satisfaction of requests from the republics of Central Asia and the Moldavian SSR.

General Director of V/O Soyuzmedtekhnika, T. Zinovtsov N.A. take measures to satisfy requests for medical and laboratory instruments, including disposable ones, equipment for disinfection and sterilization of medical products. Ensure priority satisfaction of applications for these products from the Ministries of Health of the Republics of Central Asia and the Moldavian SSR.

The All-Union Scientific Research Center for Preventive Medicine (T. Oganov R.G.) to prepare materials for the population on the prevention of viral hepatitis, to carry out a coordinating function over the work of republican, regional, regional health education houses.

The chief specialists of health care authorities should take personal control over the validity of prescribing blood transfusions, blood products, and injection therapy by doctors in hospitals, dispensaries, medical units, with a view to their maximum reduction and replacement with blood substitutes and oral medications, taking into account indications.

Consider the orders of the Minister of Health of the USSR No. 300 of 04/08/77 “On strengthening measures to prevent serum hepatitis in medical institutions” and No. 752 of 07/08/81 “On strengthening measures to reduce the incidence of viral hepatitis” to be considered invalid.

Minister

E.I. Chazov

Annex 1

To the order of the USSR Ministry of Health

Guidelines

Etiology

Hepatitis A (HA). The GA virus belongs to the picornavirus family and is similar in its physicochemical characteristics to enteroviruses. In the external environment, it is more stable than typical picornaviruses. The HA virus can survive for several months at a temperature of +4 °C, for several years at a temperature of -20 °C, and for several weeks at room temperature. The virus is inactivated by boiling. Partial death of the virus in water occurs within 1 hour at a residual chlorine concentration of 0.5-1.5 mg/liter, complete inactivation occurs when exposed to 2.0-2.5 mg/liter for 15 minutes, with ultraviolet irradiation ( 1.1 watt) - in 60 seconds. The virus is stable to acids and fat solvents.

Only one serological type of HA virus is known. Of the currently determined specific markers, the most important is the presence of antibodies to the HA virus of the IgM class (HAV IgM antibodies), which appear in the blood serum at the onset of the disease and persist for 3-6 months. Detection of anti-HAV IgM clearly indicates hepatitis A and is used to diagnose the disease and identify sources of infection in foci. GA virus antigen (AgHAV) is detected in the feces of patients 7-10 days before clinical symptoms and in the first days of the disease, which is also used for early diagnosis and identification of sources of infection. Determination of anti-HAV IgG, which are detected from 3-4 weeks of the disease, characterizes the immunostructure of the population and the dynamics of specific humoral immunity.

Non-A, non-B hepatitis (NANV) - with a fecal-oral transmission mechanism. The antigenic and biological properties, physicochemical characteristics of the virus that causes GNANV are currently insufficiently studied.

Epidemiology

Hepatitis A. The source of infection are patients with any form of acute infectious process (icteric, anicteric, subclinical, inparant). Patients with anicteric and asymptomatic forms, as well as patients in the pre-icteric phase of the disease, are of greatest epidemiological importance. The most massive release of the virus in feces occurs in the last 7-10 days of incubation and in the pre-icteric period of the disease. At this time, patients are most contagious. With the appearance of jaundice in the vast majority, the release of the virus stops or sharply decreases; the danger of persons in this phase of infection to others is low; hospitalization of patients in this case has no epidemiological significance. In rare cases, virus shedding may take up to 2-3 weeks. Viremia is short-lived and has no epidemiological significance. Chronic virus carriage has not been established.

The mechanism of transmission of the pathogen is fecal-oral. Its implementation occurs through factors inherent in intestinal infections: water, food, “dirty” hands and household items. In children's and other organized groups, the contact and household route of transmission of the pathogen is of greatest importance. The spread of infection is facilitated by overcrowding, failure to isolate groups in children's institutions, the formation of “combined” round-the-clock and extended-day groups, violation of the sanitary and anti-epidemic regime, and late identification and isolation of patients. The waterborne route of transmission of the pathogen occurs when using poor-quality drinking water, swimming in contaminated water bodies, with intensive contamination of water sources near water intakes with the GA virus, the absence or periodic violation of water treatment and disinfection regulated by GOST, supplied to the population, when using technical water pipelines, violation of sanitary conditions distributing water supply network in combination with water shortages and suction of sewage or groundwater, poor sanitary and communal amenities of the territory.

Contamination of food products with the virus at food enterprises, public catering and trade establishments can occur from personnel with undiagnosed forms of GA who do not comply with personal hygiene rules. Food can also become contaminated with the virus when poor-quality water is used for processing, cooking or washing dishes. Berries and vegetables become contaminated with the virus when they are grown in irrigated fields or in gardens fertilized with the contents of toilets.

Human susceptibility to infection is universal. Immunity after an illness is long-lasting, possibly lifelong. Asymptomatic forms form a less intense immune system than clinically expressed ones. The level of collective immunity of the population is one of the factors influencing the course of the epidemic process. There is a tendency for immune individuals to increase with age. In areas with high incidence (Central Asia, Kazakhstan), most people acquire anti-HAV by the age of 4-6 years, and in areas with average and low rates - by 20-30 years.

The epidemic process of GA is characterized by a number of features: widespread distribution; uneven intensity in certain areas; cyclical long-term dynamics, expressed by autumn-winter seasonality; predominantly affecting preschool children, adolescents and young adults; low familial frequency. Periodic increases in incidence are observed at intervals from 3 to 10 years and vary in different territories and in certain age groups of the population. At intervals of 15-20 years, synchronous rises occur, covering all territories of the country.

In areas with high incidence rates, the most affected population group is toddlers. Children who attend preschool institutions tend to get sick more often than those who do not attend. In recent years, there has been an equalization of morbidity rates among the population of cities and villages. The greatest intensity of development of the epidemic process in certain territories also depends on the action of socio-demographic factors (fertility, age structure, the proportion of large families and the “organization” of children, population density, migration activity, etc.).

The increase in the incidence of GA usually begins in July-August and reaches a maximum in October-November, followed by a decrease in the first half of the next year. There are unequal timing of the onset and severity of seasonal increases in incidence in different socio-age groups of the population. In areas with average incidence rates, the seasonal rise begins among schoolchildren, and in areas with high incidence rates - among children of younger age groups.

Hepatitis neither A nor B is an independent disease with a fecal-oral transmission mechanism, in which markers of hepatitis A and B are not detected. It is registered mainly in the republics of Central Asia. This infection is characterized by a number of epidemiological signs, which include:

1) pronounced unevenness of the territorial distribution of morbidity;

2) the explosive nature of outbreaks with a high incidence rate in areas with poor water supply;

3) the most common lesion is in adults 15-30 years old;

Low familial focality.

GNANV is characterized by a severe course of the disease and high mortality in pregnant women, usually in the second half of pregnancy. All known epidemic outbreaks of this disease are caused by the action of the water factor. The true extent of this infection is unknown.

The main preventive measures for hepatitis A and non-A, non-B are sanitary and hygienic, aimed at breaking the fecal-oral mechanism of transmission of the pathogen, providing the population with good-quality water and epidemic-safe food products, creating conditions that guarantee compliance with sanitary rules and requirements for procurement, transportation, storage, technology of preparation and sale of food products; ensuring widespread and constant implementation of sanitary, technical and hygienic standards and rules of the sanitary and anti-epidemic regime in children's institutions and educational institutions; observance of personal hygiene rules, hygienic education of the population.

Based on this, sanitary and epidemiological service institutions must carry out the following activities: monitoring the condition of all epidemiologically significant facilities (water supply sources, wastewater treatment plants, water supply and sewerage networks, public catering facilities, trade facilities, children's, educational and other institutions); widespread use of laboratory monitoring of environmental objects using sanitary-bacteriological and sanitary-virological methods (determination of coliphages, enteroviruses, antigen of the GA virus); assessment of epidemiologically significant socio-demographic and natural processes; assessing the relationship between morbidity and sanitary conditions; morbidity forecasting; assessment of the quality and effectiveness of ongoing activities.

The planning of specific measures for the prevention of GA should be based on the results of in-depth retrospective and operational analysis and morbidity forecast data.

The objectives of retrospective epidemiological analysis include:

1) analysis of long-term morbidity dynamics;

2) analysis of seasonal dynamics of morbidity;

3) identification of socio-age groups of the population with high, medium and low levels of morbidity, taking into account their epidemiological significance;

4) identification of individual groups in which morbidity is systematically recorded;

5) assessment of the quality and effectiveness of ongoing anti-epidemic measures;

Identification of patients with viral hepatitis is carried out by doctors and paramedics of all healthcare institutions during outpatient visits, visiting patients at home, during periodic examinations of the population, and monitoring persons who communicated with patients. It is important to take into account the clinical features of the initial period, the presence of erased and anicteric forms, the diagnosis of which requires special attention. In the absence of jaundice and insufficient severity of other symptoms, it is advisable to conduct a blood test to determine the activity of ALT and, if possible, anti-HAV class IgM.

In apartments with good living conditions, in case of suspicion of GA, short-term (no more than 3 days) isolation of the sick at home is allowed to carry out the necessary laboratory tests. Patients with suspected hepatitis who live in unfavorable living conditions (communal apartments, dormitories, etc.), as well as persons with etiologically undifferentiated hepatitis, are subject to mandatory hospitalization.

In hospitals for hospitalization, it is necessary to separately accommodate patients with hepatic and hepatitis B, they must comply with the anti-epidemic regime provided for by the “Instructions on the sanitary and anti-epidemic regime and occupational safety of personnel of infectious diseases hospitals (departments)”, approved by order of the USSR Ministry of Health No. 916 of 04.08.84.

If the indicator is 12 or higher per 1000, a one-time administration of immunoglobulin to preschoolers or primary school students at the beginning of the seasonal rise is justified, with the implementation of this activity within 10-15 days.

Data on IGP are entered into accounting forms No. 63/u and 26/u. Administration of immunoglobulin is allowed no more than 4 times at intervals of at least 12 months. After administration of immunoglobulin, vaccinations can be carried out after 4-8 weeks. Administration of immunoglobulin after vaccinations is allowed after 2 weeks.

Considering that IHP tactics depend on the incidence of hepatitis in specific territories, it is advisable when planning this event to use the results of short-term and long-term forecasts (“Guidelines for forecasting the incidence of viral hepatitis”, Ministry of Health of the USSR, No. 15/6-18, 07/04/89. ).

Cases of viral hepatitis at the place of residence are subject to examination by an epidemiologist or an assistant epidemiologist. In some cases, it is allowed to collect information from hospitalized patients in a hospital, followed by going to the “hotbed” and filling out an epidemiological survey card (f. 357/u). Foci of GA in groups (children's institutions, hospitals, rest homes, sanatoriums, etc.) are examined by an epidemiologist. The results of the examination are documented in the form of a report.

Persons suspected of being the source of infection should be subjected to in-depth clinical and biochemical examination, and, if possible, examination for GA markers. Groups in which the patient could have been at the end of the incubation period and in the first days of the disease (hospitals, sanatoriums, temporary children's groups, etc.) are also identified in order to carry out anti-epidemic measures in them. Persons who have been in contact with patients with HA are subject to systematic (at least once a week) medical observation (thermometry, questioning, examination to determine the size of the liver, spleen, etc.) for 35 days from the date of separation from the patient. If indicated, children in preschool institutions are observed daily, and in schools - weekly. When repeated diseases occur, the observation period increases, the duration of observation is counted from the last case.

Medical personnel of children's institutions or health centers are informed about persons in contact with a patient with HA at the place of residence. Contact persons associated with the preparation and sale of food products are reported to the head of the relevant institution and the departmental sanitary and epidemiological service to strengthen control over such person’s compliance with the rules of personal and public hygiene, and timely removal from work at the first signs of illness.

Laboratory examinations of persons who interacted with patients with HA (determination of alanine aminotransferase in the blood, and, if possible, specific markers of HA) if indicated (the appearance in the team of an increased number of acute respiratory infections, especially accompanied by liver enlargement, the presence of hepatolienal syndrome of unknown etiology, dyspeptic symptoms, fever and etc.) is carried out in preschool institutions as prescribed by a pediatrician and epidemiologist.

If HA is detected in a preschool children's institution, the transfer of children from this institution to others, as well as to another group within this institution, is prohibited within 35 days from the date of isolation of the last patient. Admission of new children to these institutions is allowed with the permission of the epidemiologist, subject to the preliminary administration of immunoglobulin to a child who has not previously been reliably ill with GA. The staff of the child care institution, as well as parents, should be instructed in detail about the first symptoms of the disease and the need to immediately report to medical workers any deviations in the child’s condition.

During the observation period, the quarantine group of the children's institution should not take part in events held in common premises with other groups; groups are separated during walks. For the quarantine group, the self-service system and cultural events are canceled.

Within 2 months from the date of isolation of the last patient with HA in a child care institution (preschool group, school class), routine vaccinations should not be carried out. The question of the advisability of emergency IGP is decided by an epidemiologist in consultation with the medical service of the institutions. As a rule, IGP is carried out within the quarantine group of a preschool institution, but according to epidemic indications it can be extended to other groups. Conducting IGP among schoolchildren is advisable in case of multiple cases of GA. Disinfection and disinfestation measures in GA outbreaks are carried out in accordance with Appendix 3.

Children who have had contact with GA in the family are allowed into groups with the permission of the epidemiologist, in the case of previous GA, the administration of immunoglobulin and the establishment of regular monitoring of these children for 35 days.

If a case of GA occurs in a somatic children's hospital or sanatorium, the transfer of children from ward to ward and to other departments is stopped. Newly admitted children are recommended to be placed in separate rooms. Supervision over the implementation of anti-epidemic measures and compliance with the sanitary and hygienic regime is being strengthened.

Prevention of outbreaks of GNANV diseases is carried out on the basis of the implementation of sanitary and hygienic measures and is based on an analysis of the territorial and age structure of morbidity, taking into account the epidemiological characteristics of this infection. Particular attention is paid to the state of water supply. The results of a retrospective epidemiological analysis of the incidence of GNANV and the sanitary and hygienic condition of the territories are used to specify preventive and anti-epidemic measures. The greatest importance is attached to measures to improve water supply, sewerage, sanitary and hygienic improvement of territories (Methodological recommendations “Non-A, non-B viral hepatitis with a fecal-oral transmission mechanism (epidemiology, clinic, treatment and prevention)”, Moscow, 1987) . Current decisions are made taking into account morbidity indicators and the characteristics of the development of the epidemic process in GNANV.

Directorates of the USSR Ministry of Health

M.I. Narkevich

Appendix 2

To the order of the USSR Ministry of Health

Guidelines

Etiology

Hepatitis B (HB) is an independent infectious disease caused by the Hepatitis B virus (HBV), which belongs to the hepatovirus family. The virus is extremely stable in the external environment. In the body of people infected with HBV, surface HBsAg, core HBcAg, E-antigen (HBeAg) and antibodies to these antigens, virus-specific DNA can be detected with different frequencies and at different stages. All virus antigens and their corresponding antibodies can serve as indicators of the infectious process, while HBsAg, virus-specific DNA, anti-HBc of the IgM class indicate an actively ongoing infection; the appearance of anti-HBs in combination with anti-HBcor during the period of convalescence may serve as a sign of completed infection. HBeAg accompanying full-fledged viral particles is a direct indicator of active virus reproduction and reflects the degree of infectivity. Long-term HBe- and HBs-antigenemia is an unfavorable sign indicating the formation of a chronic process. Replacement of HBeAg with appropriate antibodies with ongoing HBs antigenemia indicates the likelihood of a benign course of the process. Long-term, possibly lifelong, carriage of the virus is a feature of hepatitis B.

Hepatitis delta. The causative agent of viral hepatitis delta (HD) is an RNA-containing defective virus that can replicate in the host body only with the obligatory participation of a helper virus, the role of which is played by HBV. The delta shell is formed by HBsAg.

Hepatitis is neither A nor B with parenteral transmission of the pathogen. The use of highly sensitive methods for the specific diagnosis of hepatitis A and B, the exclusion of infection with cytomegalovirus and Epstein-Barr virus, made it possible to identify viral hepatitis transmitted by the parenteral route, in which markers of these infections are not determined.

Epidemiology

Hepatitis B. Sources of HB virus infection are patients with any form of acute and chronic hepatitis B (AGB, CHB), as well as chronic “carriers” of the virus, which include persons with a duration of HBs antigenemia for 6 months or more. The latter are the main sources of infection. The greatest epidemic danger is posed by “carriers” of HBsAg, especially those with the presence of HBsAg in the blood. A patient can be contagious as early as 2-8 weeks before signs of the disease appear. Patients with CHB and carriers of the virus can maintain epidemic significance throughout their lives.

In patients with acute and chronic hepatitis B, “healthy” carriers of HBsAg, the virus can be contained in significant concentrations in the blood and semen. It can be detected by sensitive methods (ROPGA, ELISA, RIA) in saliva, urine, bile and other secretions. The real epidemic danger is blood and semen.

The hepatitis B virus spreads through evolutionarily formed natural and artificial routes. The latter currently determine the incidence of hepatitis B in the country. The mechanism of transmission of HB virus infection both in natural and artificial conditions is parenteral.

The implementation of artificial transmission routes occurs when the integrity of the skin and mucous membranes is violated through the blood and its components containing HBV. For HBV infection, the introduction of a minimum amount (10 (-7) ml) of infected blood is sufficient. Infection can occur during transfusions of blood and its components, but most often during a variety of therapeutic and diagnostic procedures in cases of using insufficiently cleaned or laboratory instruments, instruments, apparatus. Infection is also possible during tattoos, ritual ceremonies, and other procedures performed with shared instruments (earlobe piercings, shaving, manicures, etc.).

It has now been established that 6-20% of cases of acute hepatitis B (AGB) are caused by infection through transfusions of blood and its components. In children under one year of age, post-transfusion hepatitis accounts for 70-80% of cases.

In almost half of patients with acute hepatitis B, infection occurs during therapeutic and diagnostic parenteral procedures, and in approximately 30-35% of patients - through natural means in the context of everyday communication and professional activities.

The implementation of natural routes of transmission of HBV occurs when the pathogen penetrates the blood through damaged mucous membranes or skin. Factors for the transmission of HBV can be personal hygiene items (toothbrushes, razors and manicure instruments, washcloths, combs, etc.) used by several family members.

The group at highest risk of hepatitis B infection includes medical workers who, due to their professional activities, have constant contact with blood and its components. This group primarily includes staff of hemodialysis centers, surgeons, obstetricians-gynecologists, hematologists, laboratory assistants in clinical and biochemical laboratories, operating rooms and procedural nurses.

Measures to prevent hepatitis B should be aimed at actively identifying sources of infection and breaking both natural and artificial routes of infection, as well as carrying out specific prevention in risk groups.

In the complex of preventive and anti-epidemic measures, measures aimed at preventing infections with the hepatitis B virus during transfusions of blood and its components, and carrying out therapeutic and diagnostic parenteral interventions are of paramount importance.

In order to identify the sources of HBV infection, it is necessary to conduct a population survey for HBV carriage, primarily among those at risk (table).

All categories of donors for each blood donation are subject to a comprehensive clinical and laboratory examination with a mandatory blood test for the presence of HBsAg using highly sensitive methods of its indication (HBsAg, ELISA, RIA), as well as to determine the activity of alanine aminotransferase (ALAT) in accordance with the “Instructions for medical examination blood donors", Ministry of Health of the USSR, 1978 No. 06-14/13.

Persons who, as a result of examination, have been identified as having:

previous VH, regardless of the duration of the disease;

presence of HBsAg in blood serum;