STATE INSTITUTION O.M. MARZEIEV INSTITUTE FOR PUBLIC HEALTH NAMSU

APRIL, 26 - 27

CONFERENCE HISTORY OF MEDICAL SCIENCE, PRACTICE AND EDUCATION"
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ASSESSMENT OF SOCIAL AND ECONOMIC CONSEQUENCES (HEALTH IMPACT) OF UNSOUND BIOCIDES MANAGEMENT. Summary of the Pilot Study


    The consequence of unsound management of disinfectants (D) can affect the countrys biological and chemical safety through an increased rate of hospital-acquired infections (HAI), environmental pollution, the occurrence of occupational diseases and allergies in workers that are in contact with disinfectants.
    Much less attention is paid to the problem of the impact of the antiseptic drugs on the medical staffs health in the hospital departments, which causes the allergy in medical workers and, sometimes, becomes the main reason for changing their profession.
    The issue of using biocides in households, restaurants, food trade remains unresolved which also needs a clear definition because the current documents do not regulate the group of disinfectants or disinfection facilities, nor the frequency of their application, although the risk of contracting intestinal infections at restaurants is high.
    Despite the urgency of using disinfectants, the issue of occupational disease, the occurrence of allergic reactions and poisoning of workers being in contact with disinfectants has not been addressed. The degree of the environmental pollution with disinfectants is also not registered properly in Ukraine.
    Studies conducted in Ukraine have shown that unsound use of biocides leads to the development of nosocomial infections, occupational diseases, including allergic manifestations, and poses a threat of environmental pollution. Multidisciplinary hospitals, public catering establishments, public service establishments (275 facilities) were surveyed.
    According to the national statistics, viral hepatitis A (VGA) morbidity occupies one of the leading places in terms of health and social implications and economic losses due to the infectious pathology. With regard to VGA morbidity, Ukraine occupies one of the first places among European countries. Acute enteroideas are caused by unspecified causative agents and identified as food toxic infections, over 30,000people are infected annually. In Kyiv, in 2007, the acute enteroideas morbidity grew up to 42,8 %, including shigellosis - 10 times growth, salmonellosis - 1,6 times, leptospirosis - 2 times.
    Monitoring infectious morbidity testifies that every 2-3 outbreaks of enteroideas are related to the use of poor quality potable water. In respect of the registration of hospital-acquired infections (HAI), in the developed countries up to 10% of the hospitalised patients are registered, in developing countries, their number makes up 25% and more. In Ukraine, in 2010, less than 4,000 cases of HAI were registered during the year; in 2010-2012, the number of the registered cases of HAI increased two times; in 2011, there were 7,448 cases of HAI.
    HAI structure in Ukraine is as follows: in post-surgical patients - 49,6, in newborns with acute septic infections - 23,2%, in parturient women with acute septic infections - 16,2%, in patients with the urinary tract infections - 5,6%, patients with acute enteroideas - 5,4%. The in-hospital strains of microorganisms are characterised by high virulence, polyresistance to antibiotics, disinfectants (DS). The number of the strains resistant to DS distinguished in hospitals varied from 3,6% to 18,2% depending on the type of the substance.
    The studies showed high mortality that can reach in different nosologic forms of HAI from 14 to 58,6%, and occasionally up to 82,2%. Official statistics on lethal outcomes is absent in the Ministry of Health, the estimated number of lethal cases is 111,716 persons.
    The analysis of microbiological investigations at the establishments of domestic consumer services during 2008-2011 with regard to opportunistic pathogens on the annual basis showed that the percentage in 2008 was 1,64%, in 2011 - 4,53%. The spectrum was presented by both gram-positive and gram-negative microorganisms. Thus, gram-positive microorganisms were found in 65,7% of the cases (<0,05), gram-negative - in 25,7%, Candida yeast-like fungi- in 11,4% of the cases. The analysis of these studies at food enterprises showed that in 2008 the presence of opportunistic pathogens in tests made 5,44%; in 2009 there was 2,91%; in 2010 the percentage of opportunistic pathogens reduced in 4,83% of the tests; in 2011 the number of rejections was 8,87%. When estimating the outcomes, it is possible to establish that during the analysed period no positive dynamics in the improvement of the sanitary-epidemic condition of food enterprises was detected. The achieved outcomes demonstrate the insufficient efficiency of disinfection and possibility of infecting visitors to these facilities.
    The economic damage from the IHI is enormous and amounts 4.5 - 7.0 billion dollars in civilized countries. The registration of the HAI and the estimation of economic losses from them in Ukraine are not carried out, but only the theoretical calculation of them shows that the amount is about 323 million dollars.
    The presented data testify that the inefficient use of biocides results in large social and economic losses.
    The issue of creating and introducing the new model of organization of HAI surveillance at the state level is urgent. This corresponds to the recommendations worked out in the developed countries and by the WHO. The regulatory documents that allow the expert laboratories to use standard methods of unbiased estimation of the specific action of biocides are missing in Ukraine. The issue of applying biocides in the establishments of domestic consumer services, restaurants, food trade remains open; this also requires the clear determination as neither the groups of disinfectant substances nor the objects of disinfection are regulated, although the risk of infection at such establishments is high. Taking into account the above-mentioned, scientific research in the field of effective application of biocides in health care, other public services remains relevant at present and needs to be intensified which will promote its introduction in the public health system.
    Taking into account the above-indicated, the studies on the substantiation of the effective use of biocides in health care and in other public facilities still remain urgent and require intensification, which will facilitate their implementation in the public health system.

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