Healthcare-Associated Infections: State of the Problem and Prospects

Cover Page


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

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

Full Text

Restricted Access

About the authors

Vasily G. Akimkin

Central Research Institute of Epidemiology

Email: vgakimkin@yandex.ru
ORCID iD: 0000-0003-4228-9044
SPIN-code: 4038-7455

MD, PhD, Professor, Academician of the RAS

Россия, Moscow

Elena B. Brusina

Кemerovo State Medical University

Email: brusina@mail.ru
ORCID iD: 0000-0002-8616-3227
SPIN-code: 6976-2551

MD, PhD, Professor, Corresponding Member of the RAS

Россия, Kemerovo

Nikolay I. Briko

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: nbrico@mail.ru
ORCID iD: 0000-0002-6446-2744
SPIN-code: 2992-6915

MD, PhD, Professor, Academician of the RAS

Россия, Moscow

Alexey V. Tutelyan

Central Research Institute of Epidemiology

Author for correspondence.
Email: bio-tav@yandex.ru
ORCID iD: 0000-0002-2706-6689
SPIN-code: 8150-2230

MD, PhD, Corresponding Member of the RAS]

Россия, Moscow

References

  1. Miller TS. The Birth of the Hospital in the Byzantine Empire. Baltimore, MD: The Johns Hopkins University Press; 1985. 288 p.
  2. Blot S, Ruppé E, Harbarth S, et al. Healthcare-associated infections in adult intensive care unit patients: Changes in epidemiology, diagnosis, prevention and contributions of new technologies. Intensive Crit Care Nurs. 2022;70:103227. doi: https://doi.org/10.1016/j.iccn.2022.103227
  3. Arabi YM, Azoulay E, Al-Dorzi HM, et al. How the COVID-19 pandemic will change the future of critical care. Intensive Care Med. 2021;47(3):282–291. doi: https://doi.org/10.1007/s00134-021-06352-y
  4. Тутельян А.В., Шулакова Н.И. Фундамент и горизонты профилактики ИСМП // Эпидемиология и инфекционные болезни. Актуальные вопросы. — 2023. — № 2. — С. 21–27. [Tutelian AV, Shulakova NI. The foundation of and horizons for prevention of healthcare-associated infections. Epidemiology and Infectious Diseases. Current Items. 2023;2:21–27. (In Russ.)] doi: https://doi.org/10.18565/epidem.2023.13.2.21-7
  5. Allegranzi B, Kilpatrick C, Storr J, et al. Global Infection Prevention and Control Network. Global infection prevention and control priorities 2018–22: a call for action. Lancet Glob Health. 2017;5(1):e1178–e1180. doi: https://doi.org/10.1016/S2214-109X(17)30427-8
  6. Профилактическая медицина в основных терминах и определениях / под ред. акад. РАН В.В. Зверева. — М.: Наука, 2024. — 798 с. [Profilakticheskaya medicina v osnovnyh terminah i opredeleniyah / Pod red. akad. RAN V.V. Zvereva. Moscow: Nauka; 2024. 798 s. (In Russ.)]
  7. Munier-Marion E, Bénet T, Vanhems P. Definition of healthcare-associated influenza: A review and results from an international survey. Influenza Other Respir Viruses. 2017;11(5):367–371. doi: https://doi.org/10.1111/irv.12460
  8. Puro V, Coppola N, Frasca A, et al. Pillars for prevention and control of healthcare-associated infections: an Italian expert opinion statement. Antimicrob Resist Infect Control. 2022;11(1):87. doi: https://doi.org/10.1186/s13756-022-01125-8
  9. The NHSN standardized infection ratio (SIR). A Guide to the SIR. National Center for Emerging and Zoonotic Infectious Diseases (U.S.). Division of Healthcare Quality Promotion; 2024. 50 p.
  10. Suetens C, Latour K, Kärki T, et al. Healthcare-Associated Infections Prevalence Study Group. Prevalence of healthcare-associated infections, estimated incidence and composite antimicrobial resistance index in acute care hospitals and long-term care facilities: results from two European point prevalence surveys, 2016 to 2017. Euro Surveill. 2018;23(46):1800516. doi: https://doi.org/10.2807/1560-7917.ES.2018.23.46.1800516
  11. Ministry of Health. Igiene delle mani può ridurre del 30% le infezioni ospedaliere. 2019. Available from: https://www.salute.gov.it/portale/news/p3_2_1_1_1.jsp?lingua=italiano&menu=notizie&p=null&id=3736
  12. Report on the Burden of Endemic Health Care-Associated Infection Worldwide. A systematic review of the literature. WHO; 2011. 40 p.
  13. Huerta-Gutiérrez R, Braga L, Camacho-Ortiz A, et al. One-day point prevalence of healthcare-associated infections and antimicrobial use in four countries in Latin America. Int J Infect Dis. 2019;86:157–166. doi: https://doi.org/10.1016/j.ijid.2019.06.016
  14. Metsini A, Vazquez M, Sommerstein R, et al. The Swissnoso Network. Point prevalence of healthcare-associated infections and antibiotic use in three large Swiss acute-care hospitals. Swiss Med Wkly. 2018;148:w14617. doi: https://doi.org/10.4414/smw.2018.14617
  15. Haque M, Sartelli MО, McKimm J, et al. Health care-associated infections — an overview. Infect Drug Resist. 2018;11:2321–2333. doi: https://doi.org/10.2147/IDR.S177247
  16. Su CH, Chang SC, Yan JJ, et al. Excess mortality and long-term disability from healthcare-associated staphylococcus aureus infections: a population-based matched cohort study. PLoS One. 2013;8(9):e71055. doi: https://doi.org/10.1371/journal.pone.0071055
  17. Kopp MA, Watzlawick R, Martus P, et al. Long-term functional outcome in patients with acquired infections after acute spinal cord injury. Neurology. 2017;88(9):892–900. doi: https://doi.org/10.1212/WNL.0000000000003652
  18. De Montmollin E, Ruckly S, Schwebel C, et al. Pneumonia in acute ischemic stroke patients requiring invasive ventilation: Impact on short and long-term outcomes. J Infect. 2019;79(3):220–227. doi: https://doi.org/10.1016/j.jinf.2019.06.012
  19. Forrester JD, Maggio PM, Tennakoon L. Cost of Health Care-Associated Infections in the United States. J Patient Saf. 2022;18(2):e477–e479. doi: https://doi.org/10.1097/PTS.0000000000000845
  20. Покровский В.И., Акимкин В.Г., Брико Н.И., и др. Национальная концепция профилактики инфекций, связанных с оказанием медицинской помощи, и информационный материал по ее положениям. — Н. Новгород: Ремедиум. Приволжье, 2012. — 84 с. [Pokrovskij VI, Akimkin VG, Briko NI, i dr. Nacional’naya koncepciya profilaktiki infekcij, svyazannyh s okazaniem medicinskoj pomoshchi, i informacionnyj material po ee polozheniyam. Nizhnij Novgorod: Remedium. Privolzh’e; 2012. 84 s. (In Russ.)]
  21. Покровский В.И., Акимкин В.Г., Брико Н.И., и др. Внутрибольничные инфекции: новые горизонты профилактики // Эпидемиология и инфекционные болезни. — 2011. — № 1. — С. 4–7. [Pokrovsky VI, Akimkin VG, Briko NI, et al. Nosocomial infections: new vistas in their prevention. Epidemiology and Infectious Diseases. Current Items. 2011;1:4–7. (In Russ.)]
  22. Здравоохранение в России. 2023: стат. сб. — М.: Росстат, 2023. — 179 с. [Zdravoohranenie v Rossii. 2023: stat. sb. Moscow: Rosstat; 2023. 179 s. (In Russ.)]
  23. Бокерия Л.А., Ступаков И.Н., Гудкова Р.Г., и др. Хирургическое лечение болезней системы кровообращения в Российской Федерации (2010–2014 гг.) // Вестник Росздравнадзора. — 2016. — № 1. — С. 63–69. [Bokeria LA, Stupakov IN, Gudkova RG, et al. Surgical treatment of circulatory system diseases in the Russian Federation (2010–2014). Bulletin of Roszdravnadzor. 2016;1:63–68. (In Russ.)]
  24. Голухова Е.З., Семенов В.Ю., Милиевская Е.Б., и др. Обеспеченность высокотехнологичной медицинской помощью по профилю «сердечно-сосудистая хирургия» жителей субъектов Российской Федерации в 2021 году // Комплексные проблемы сердечно-сосудистых заболеваний. 2023;12(2):77–87. [Golukhova EZ, Semenov VYu, Milievskaya EB, et al. Provision of high-tech cardiovascular care to residents of the Russian Federation regions in 2021. Complex Issues of Cardiovascular Diseases. 2023;12(2):77–87. (In Russ.)] doi: https://doi.org/10.17802/2306-1278-2023-12-2-77-87
  25. Surgical operation and procedures statistics (Eurostat Statistics Explained), 2022. Available from: https://ec.europa.eu/eurostat/statistics-explained/index.php?title
  26. Готье С.В., Хомяков С.М. Донорство и трансплантация органов в Российской Федерации в 2022 году. XV сообщение регистра Российского трансплантологического общества // Вестник трансплантологии и искусственных органов. — 2023. — Т. 25. — № 3. — С. 8–30. [Gautier SV, Khomyakov SM. Organ donation and transplantation in the Russian Federation in 2022. 15th Report from the Registry of the Russian Transplant Society. Russian Journal of Transplantology and Artificial Organs. 2023;25(3):8–30. (In Russ.)] doi: https://doi.org/10.15825/1995-1191-2023-3-8-30
  27. Чикина О.Г., Благонравова А.С. Риски развития инфекций, связанных с оказанием медицинской помощи, при выхаживании новорожденных с экстремально низкой и очень низкой массой тела // Медицинский альманах. — 2017. — № 4 (49). — С. 46–53. [Chikina OG, Blagonravova AS. Riski razvitiya infekcij, svyazannyh s okazaniem medicinskoj pomoshchi, pri vyhazhivanii novorozhdennyh s ekstremal’no nizkoj i ochen’ nizkoj massoj tela. Medicinskij al’manah. 2017;4(49):46–53. (In Russ.)]
  28. Единая база частной системы здравоохранения Statprivat. Available from: https://statprivat.ru (accesed: 09.07.2024).
  29. Распоряжение Правительства РФ от 28.12.2022 № 4296-р. Available from: http://publication.pravo.gov.ru/document/0001202212290079?ysclid=lziprkjrmi549868457
  30. Peter S, Bang JY, Varadarajulu S. Single-use duodenoscopes: where are we and where are we going? Curr Opin Gastroenterol. 2021;37(5):416–420. doi: https://doi.org/10.1097/MOG.0000000000000755
  31. Jacobs P, Akpinar I. Single-use medical devices: economic issues. Heart Asia. 2018;10(2):e011034. doi: https://doi.org/10.1136/heartasia-2018-011034
  32. Суворов С.Г., Лекманов А.У., Ярошецкий А.И., и др. Национальное эпидемиологическое исследование РуВен: применение искусственной вентиляции легких в отделениях реанимации и интенсивной терапии у детей // Анестезиология и реаниматология. — 2015. — № 2. – C. 27–32. [Suvorov SG, Lekmanov AU, Yaroshetskiy AI, et al. Russian national epidemiological study RuVen: the use of artificial lung ventilation in the intensive therapy in children. Anesteziologiya i reanimatologiya. 2015;60(2):27–32. (In Russ.)]
  33. Брико Н.И., Брусина Е.Б., Зуева Л.П., и др. Госпитальный штамм — непознанная реальность // Эпидемиология и вакцинопрофилактика. — 2013. — № 1 (68). — С. 30–35. [Briko NI, Brusina EB, Zueva L, et al. Phospital strain — mysterious reality. Epidemiology and Vaccinal Prevention. 2013;1(68):30–35. (In Russ.)]
  34. Авдеев С.Н., Адамян Л.В., Алексеева Е.И., и др. Профилактика, диагностика и лечение новой коронавирусной инфекции (COVID-19). Временные методические рекомендации. Версия 18 от 26.10.2023. — М., 2023. — 260 с. [Avdeev SN, Adamyan LV, Alekseeva EI, i dr. Profilaktika, diagnostika i lechenie novoj koronavirusnoj infekcii (COVID-19). Vremennye metodicheskie rekomendacii. Versiya 18 ot 26.10.2023. Moscow; 2023. 260 s. (In Russ.)]
  35. Asghar R, Rasheed M, Hassan J, et al. Advancements in Testing Strategies for COVID-19. Biosensors (Basel). 2022;12(6):410. doi: https://doi.org/10.3390/bios12060410
  36. Hung PJ, Chen CC. Diagnostic accuracy of rotavirus antigen tests in children: A systematic review and meta-analysis. Trop Med Int Health. 2023;28(2):72–79. doi: https://doi.org/10.1111/tmi.13846
  37. Беляков В.Д., Колесов А.П., Остроумов П.Б., и др. Госпитальная инфекция. — Л.: Медицина; 1976. — 231 с. [Belyakov VD, Kolesov AP, Ostroumov P.B., i dr. Gospital’naya infekciya. Leningrad: Medicina; 1976. 231 s. (In Russ.)]
  38. Afshinnekoo E, Bhattacharya C, Burguete-García A, et al. MetaSUB Consortium COVID-19 drug practices risk antimicrobial resistance evolution. Lancet Microbe. 2021;2(4):e135–e136. doi: https://doi.org/10.1016/S2666-5247(21)00039-2
  39. Fresia P, Antelo V, Salazar C, et al. Urban metagenomics uncover antibiotic resistance reservoirs in coastal beach and sewage waters. Microbiome. 2019;7(1):35. doi: https://doi.org/10.1186/s40168-019-0648-z
  40. Mulani MS, Kamble EE, Kumkar SN, et al. Emerging Strategies to Combat ESKAPE Pathogens in the Era of Antimicrobial Resistance: A Review. Front Microbiol. 2019;10:539. doi: https://doi.org/10.3389/fmicb.2019.00539
  41. Navidinia M. The clinical importance of emerging ESKAPE pathogens in nosocomial infections. J Paramed Sci. 2016;7(3):43–57. doi: https://doi.org/10.22037/jps.v7i3.12584
  42. Global Bacterial Antimicrobial Resistance Burden Estimates. Institute for Health Metrics and Evaluation (IHME), University of Oxford; 2019. Seattle, United States of America: Institute for Health Metrics and Evaluation (IHME); 2022. doi: https://doi.org/10.6069/DBG1-V028
  43. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Antimicrobial Resistance Collaborators. Lancet. 2022;399(10325):62900655. doi: https://doi.org/10.1016/S0140-6736(21)02724-0
  44. Weiner-Lastinger LM, Abner S, Edwards JR, et al. Antimicrobial-resistant pathogens associated with adult healthcare-associated infections: Summary of data reported to the National Healthcare Safety Network, 2015–2017. Infect Control Hosp Epidemiol. 2020;41(1):1–18. doi: https://doi.org/10.1017/ice.2019.296
  45. Шмакова М.А., Штернис Т.А., Желнина Т.П., и др. Распространенность бактерий рода Acinetobacter в медицинских организациях Кемеровской области // Эпидемиология и вакцинопрофилактика. — 2018. — Т. 17. – № 3. — С. 27–31. [Shmakova MA, Shternis TA, Zhelnina TP, et al. Prevalence Acinetobacter spp. in Kemerovo Region Healthcare Settings. Epidemiology and Vaccinal Prevention. 2018;17(3):27–31. (In Russ.)] doi: https://doi.org/10.31631/2073-3046-2018-17-3-27-31
  46. Serra-Burriel M, Keys M, Campillo-Artero C, et al. Impact of multi-drug resistant bacteria on economic and clinical outcomes of healthcare-associated infections in adults: Systematic review and meta-analysis. PLoS One. 2020;15(1):e0227139. doi: https://doi.org/10.1371/journal.pone.0227139
  47. ВОЗ обновила список лекарственно-устойчивых бактерий, представляющих наибольшую угрозу для здоровья человека. Available from: www.who.int/ru/news/item/17-05-2024-who-updates-list-of-drug-resistant-bacteria-most-threatening-to-human-health
  48. Powell LM, Choi SJ, Chipman CE, et al. Emergence of Erythromycin-Resistant Invasive Group A Streptococcus, West Virginia, USA, 2020–2021. Emerg Infect Dis. 2023;29(5)898–908. doi: https://doi.org/10.3201/eid2905.221421
  49. Распоряжение Правительства РФ от 30 марта 2019 г. № 604-р «Об утверждении плана мероприятий на 2019–2024 гг. по реализации Стратегии предупреждения распространения антимикробной резистентности в Российской Федерации на период до 2030 г. Available from: https://www.garant.ru/products/ipo/prime/doc/72116668/
  50. Tyumentseva M, Mikhaylova Y, Prelovskaya A, et al. CRISPR Element Patterns vs. Pathoadaptability of Clinical Pseudomonas aeruginosa Isolates from a Medical Center in Moscow, Russia. Antibiotics (Basel). 2021;10(11):1301. doi: https://doi.org/10.3390/antibiotics10111301
  51. Лебедева И.Б., Бондаренко Т.Е., Галимова Н.И., и др. Риск ИСМП, вызванных грибами рода Candida, у пациентов госпиталя для лечения больных COVID-19 // Успехи медицинской микологии. — 2023. — Т. 24. — С. 225–227. [Lebedeva IB, Bondarenko TE, Galimova NI, i dr. Risk ISMP, vyzvannyh gribami roda Candida, u pacientov gospitalya dlya lecheniya bol’nyh COVID-19. Uspekhi medicinskoj mikologii. 2023;24:225–227. (In Russ.)]
  52. Report on the burden of endemic health care-associated infection Worldwide. A systematic review of the literature. World Health Organization; 2011. 40 p.
  53. Брусина Е.Б., Зуева Л.П., Ковалишена О.В. и др. Инфекции, связанные с оказанием медицинской помощи: современная доктрина профилактики. Часть 2. Основные положения // Эпидемиология и вакцинопрофилактика. — 2018. — Т. 17. — № 6. – С. 4–10. [Brusina EB, Zuyeva LP, Kovalishena OV, et al. Healthcare-Associated Infections: Modern Doctrine of Prophylaxis. Part II. Basic Concept. Epidemiology and Vaccinal Prevention. 2018;17(6):4–10. (In Russ.)] doi: https://doi.org/10.31631/2073-3046-2018-17-6-4-10
  54. Брико Н.И., Брусина Е.Б., Зуева Л.П., и др. Стратегия обеспечения эпидемиологической безопасности медицинской деятельности // Вестник Росздравнадзора. — 2017. — № 4. — С. 15–21. [Briko NI, Brusina EB, Zueva LP, et al. The strategy of ensuring epidemiological safety of medical activity. Bulletin of Roszdravnadzor. 2017;4:15–21. (In Russ.)]
  55. Брико Н.И., Брусина Е.Б., Зуева Л.П., и др. Эпидемиологическая безопасность — важнейшая составляющая обеспечения качества и безопасности медицинской помощи // Вестник Росздравнадзора. — 2014. — № 3. — С. 27–32. [Briko NI, Brusina EB, Zueva LP, et al. epidemiological safety is the key component for ensuring quality and safety of medical care. Bulletin of Roszdravnadzor. 2014;3:27–32. (In Russ.)]
  56. Найговзина Н.Б., Попова А.Ю., Бирюкова Е.Е., и др. Оптимизация системы мер борьбы и профилактики инфекций, связанных с оказанием медицинской помощи, в Российской Федерации // Эпидемиология и инфекционные болезни. Актуальные вопросы. — 2018. — № 1. — С. 6–14. [Naygovzina NB, Popova AYu, Biryukova EE, et al. Optimization of the system of measures for control and prevention of healthcare-associated infections, in the Russian Federation. Epidemiology and Infectious Diseases. Current Items. 2018;1:6–14. (In Russ.)]
  57. Контроль и профилактика инфекций, связанных с оказанием медицинской помощи (ИСМП-2023) // Cборник тезисов XI конгресса с международным участием (23–24 ноября 2023 г.) / под ред. акад. РАН В.Г. Акимкина. — М.: ФБУН ЦНИИ эпидемиологии Роспотребнадзора, 2023. — 100 с. [Kontrol’ i profilaktika infekcij, svyazannyh s okazaniem medicinskoj pomoshchi (ISMP-2023). Cbornik tezisov XI kongressa s mezhdunarodnym uchastiem (23–24 noyabrya 2023 g.) / pod red. akad. RAN V.G. Akimkina. Moscow: FBUN CNII epidemiologii Rospotrebnadzora; 2023. 100 s. (In Russ.)]
  58. Scardoni A, Balzarini F, Signorelli C, et al. Artificial intelligence-based tools to control healthcare associated infections: A systematic review of the literature. J Infect Public Health. 2020;13(8):1061–1077. doi: https://doi.org/10.1016/j.jiph.2020.06.006

Supplementary files

Supplementary Files
Action
1. JATS XML

Copyright (c) 2025 "Paediatrician" Publishers LLC