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"Approved" on a methodical conference department of infectious diseases and epidemiology " " __________ 2008 Protocol № Сhief of dept, professor V.D. Moskaliuk METHODOLOGICAL INSTRUCTIONS To a fifth year student of the Faculty of Medicine On independent preparation for practical training Topic: Epidemiology inspection of infectious focus and measures on his liquidation. Prophylactic and antiepidemic role of polyclinic. Subject: epidemiology Major: Medicine Educational degree and qualification degree: Specialist Year of study: 5 Hours: 6 Prepared by Sydorchuk A.S., MD. PhD. 1 1. Theme: Epidemiology inspection of infectious focus and measures on his liquidation. Prophylactic and antiepidemic role of polyclinic. 2. Lesson duration: 4 hours. 3. Educational purpose: 3.1. A Student must know: - Concept "focus" of the infectious disease; - Sequence of leadthrough of inspection of infectious disease focus; - Features of collection of epidemiology anamnesis at the different groups of infections (anthroponotic, antropozoonotic, zoonotic); - Possible ways of transmission, terms, and factors, that distributed of infection; - Measures, in relation to liquidation of infectious disease focus, depending on the category of exciter; - Basic functions of an infectionist in polyclinic. 3.2. - - 3.3. - A student must be able: to collect epidemiology anamnesis; to define the territorial scopes of nidus; to conduct antiepidemic measures in nidus of infectious diseases; to work out a plan of disease measures on localization of nidus infection; to carry out the review of nidus; to collect material (water, pieces of suspicious food products, tests of soil, material from a patient, and others like that) for diagnostic and sanitary-hygenic researches; to make a conclusion and design a medical document in relation to the results of epidemiology inspection of focus. To posses practical skills: collection of epidemiology anamnesis; registration of medical document (urgent report, map of epidemiology inspection of focus); collection of material for bacteriological, virologic, parasitologic, immunological and sanitary-hygienic researches. 4. Advices to the student: At the study of method of epidemiology inspection of infectious focus, to pay a regard to that inspections begin with questioning a patient in permanent establishment (on houses), setting the date of disease, entering time permanent establishment, possible reasons, place, circumstances, which an infection, type of epidemic process (domestic, food, parenterally), possible source of infection, happened at, here. 2 To pay a regard to sequence and care of filling of map of epidemiology inspection. Inspecting a cell, to estimate the sanitary state of apartment, point out the exposed defects, presence of terms for inhibition of rules of the personal hygiene. A role of sanitary education, sanitary-educational work, is in the focus of infection. Features of prophylactic and anti epidemic work of policlinic infectionist. Preventive measures aimed to control infectious diseases taken by medical personnel are divided into preventive and anti-epidemic. Preventive measures are carried out regardless of the presence or absence of infectious diseases at a given time and locality. These measures are aimed at prevention of infectious diseases. Anti-epidemic measures are necessary when an infectious disease develops. It has already been said that the following three basic factors are necessary for development of an epidemic: the source of infection, transmission mechanism, and susceptibility of population. Exclusion of any of these factors terminates the spread of an epidemic process. Prophylactic and antiepidemic measures are therefore aimed at control of the source of infection, disruption of the route by which infection spreads, and strengthening of nonsusceptibility of population. Control of infection source. Patients with some infectious diseases, e. g. measles, pertussis, dysentery or cholera, liberate the pathogenic microorganisms into the environment during the last days of the incubation period or during the first day of the disease. Timely revealing of the sick is thus very important. Active detection of the sick is performed by medical personnel at hospitals, polyclinics, medical posts and the like. Health education of population by medical personnel promotes early attendance of the sick for medical aid and thus helps timely detection of infectious patients. Examination of population in outpatient conditions (in residential districts) is helpful in this respect. An infectious disease is diagnosed on the basis of findings, epidemiologic anamnesis and laboratory tests. All patients with the diagnosis of an infectious disease should be entered into a special record. The record should be made by a physician or a medical nurse. All cases of infectious diseases or suspected cases should be entered into the record, and higher epidemiologic authorities should be informed not later than within 24 hours. In cases of plague, cholera or other disease that requires quarantine measures, local medical personnel must inform higher authorities of the health system. The infectious patients must be isolated in proper time. Patients with plague, cholera, viral hepatitis, typhoid and paratyphoid fever, diphtheria, and similar contagious diseases should be immediately hospitalized. The patients should be handled 3 in special ambulance cars that should be disinfected after transportation of each patient. The patient delivered to the hospital must be given appropriate sanitary treatment before placing in the appropriate ward or an isolated room, if the diagnosis is not clear, or infection is mixed by its character. Special measures should be taken in order to prevent spread of infection within the hospital. In order to remove the danger of spreading infection, the patient should be given appropriate therapy. Patients with scarlet fever, escherichiasis, dysentery and the like diseases can remain at home where they must be isolated from the other family. The family must be instructed how to prevent infection and to disinfect the household utensils. Observation of the patient by the medical personnel must be constant. Persons cured from infectious diseases should be discharged from hospital after alleviation of all clinical symptoms, and examination for the carrier state, specific for each particular infection; for example, person who sustained diphtheria, can be discharged from hospital after a complete clinical cure and two negative bacteriological tests of the faucial and nasopharyngeal smears. Persons who recovered from typhoid fever, paratyphoid, salmonellosis, dysentery should be observed in outpatient conditions. The term of observation depends on each particular disease. Carriers of infection should be revealed and isolated for medical examination and treatment. Since it is impossible to screen the entire population, only those who can be a danger for the surrounding people (personnel of children's institutions, food catering, and the like establishments) should be inspected. If the epidemiologic situation requires, the following groups of people should be examined for the carrier state: (a) persons who can be in contact with typhoid fever patients, patients with dysentery, paratyphoid, diphtheria, and meningococcal infection; (b) persons with a history of sustained typhoid fever, paratyphoid, and dysentery; (c) persons suspected for being a source of infection in the focus of infection. The carriers must be immediately withdrawn from their occupation at food catering or children's institutions till they are completely cured and given multiple tests for the absence of the carrier state. Chronic carriers should be moved to other jobs that are not connected with food or children. Infection carriers must be regularly treated and observed according to special instructions. If animals are the source of infection, measures differ. Veterinary measures should be taken with respect to domestic animals. Animals with brucellosis should be slaughtered. Horses with glanders should also be killed. Food and materials obtained from diseased animals must be given special treatment. Farms where infection is revealed, must be disinfected and quarantine established. Wild animals that are not the object of quarry must be destroyed, and measures for their isolation from man should be taken. 4 Disruption of infection transmission pathways. The pathways by which infection can be transmitted are disrupted by acting on the transmission factors. Since intestinal infections are transmitted by the faecal-oral route, all preventive measures are aimed to preclude contact of the infected material with water, food, or hands. General sanitary measures should be taken constantly and universally, regardless of the presence or absence of infection in a given locality. Community hygiene is very important in prevention of infection spread. Layout of settlements, housing conditions, the presence or absence of water supply and sewage systems are important factors in this respect. Permanent control of water supply system, a correct selection of water body and the site of water intake, protection of the water intake zone, purification and decontamination of water are important preventive measures. Soil protection from contamination with domestic wastes and sewage and timely cleaning of settlements are decisive measures against flies. 5. Control questions: 1. Name the epidemic factors and characterize them briefly. 2. Name the phases of transmission of pathogenic microbes from one macroorganism to another. 3. What major factors are involved in the transmission of pathogenic microorganism s? 4. What measures are necessary to control the source of infection and to disrupt the route of infection transmission? 5. What measures are taken to strengthen insusceptibility of population to infectious diseases? 6. Name anti-epidemic measures that should be taken in a focus of infection. 7. Name the measures that should be taken to persons who were in contact with the diseased? 6. LITERATURE A. Basic: 1. Lecture. 2. Epidemiology and Fundamentals of Infectious Diseases. M.L. Volovskaya. Mir Publisher. Moscow. B. Additional: 1. A Lange Medical book. Medical Epidemiology. Second Edition. Raymond S.Greenberg, Stephen R.Daniels. – Aplleton, Stamford, Connecticut. – 1996. – P.195. 5