On approval of the procedure for the presentation and composition of information provided by the executive authorities of the subjects Russian Federation, to be included in the state water register

In accordance with paragraph 13 of the Regulations on the maintenance of the state water registry, approved by Decree of the Government of the Russian Federation of April 28, 2007 N 253 "On the procedure for maintaining the state water registry" (Sobraniye zakonodatelstva Rossiyskoy Federatsii, 2007, N 19, art. 2357), I order :

Approve:

The procedure for the submission by the executive authorities of the constituent entities of the Russian Federation of information for inclusion in the state water register ();

The composition of the information provided by the executive authorities of the constituent entities of the Russian Federation for inclusion in the state water register ().

Minister Yu.P. Trutnev

Registration N 10473

* Collection of Legislation of the Russian Federation, 2007, N 19, art. 2357 ** Regulations on maintaining the state water register, approved by Decree of the Government of the Russian Federation of April 28, 2007 N 253 "On the procedure for maintaining the state water register", clause 26 Annex 2 The composition of the information provided by the executive authorities of the constituent entities of the Russian Federation for inclusion in the state water register 1. Information about water bodies owned by the constituent entities of the Russian Federation Name and type of water body (pond, flooded quarry) Belonging to a hydrographic unit, water management area (code) Location of the water body (geographical coordinates, locality) Cadastral number of the land plot owned by the subject of the Russian Federation, within whose boundaries the water body is located Purpose of the water body Characteristics of the water body Normal retaining level (NSL) (for ponds), m; Surface area of ​​a water body, km2; Total volume of the water body*, million m3; Length, width of the water body, m Average and maximum depth of a water body, m _____________________________ * for ponds at FSL, for flooded quarries - during the period of maximum filling 2. Information on hydraulic and other structures at water bodies owned by the constituent entities of the Russian Federation N p / p Name of the building Location, coordinates Owner balance holder Operating organization Identification codes Purpose, parameters, characteristics Special marks* Structures Belonging to the agricultural plot _____________________________ * - in this column, including the date of commissioning, details of the acts establishing the form of ownership, the balance holder and the operating organization, the rights to the land plot under the structure. 3. Information about fishing grounds Name of the water body An identification number water body Details of the act, which established the fishing area * Options Special marks* Coordinates width, area, km2 Code (00.) and name of the basin district Code (00.00.00.) and name of the hydrographic unit Code (00.00.00.000) of the water management area _____________________________ * Information about fishing grounds is formed on the basis of data from the list of fishing grounds, approved in the prescribed manner ** This column also reflects information on the provision of a fishing area for use and the conditions for using the site. 4. Information on the regimes of districts of sanitary (mountain and sanitary) protection established for medical and recreational areas and resorts of regional and local significance, within the boundaries of which water bodies are located Name of the health-improving area or resort, meaning (regional or local) and location The name and details of the regulatory legal act, on the recognition of the territory as a medical and recreational area or a resort of regional or local significance General information about the district of sanitary (mountain-sanitary) protection Name of water bodies located on the territory of the district of sanitary (mountain and sanitary) protection Regime of the sanitary (mountain and sanitary) protection district, established for the medical and health-improving area or resort, within the boundaries of which water bodies are located

Order of the Minister of National Economy of the Republic of Kazakhstan dated March 17, 2015 No. 215. Registered with the Ministry of Justice of the Republic of Kazakhstan on April 28, 2015 No. 10827. Minister of Health of the Republic of Kazakhstan dated October 4, 2019 No. ҚР ДСМ-135.

Footnote. Lost force by order and.about. Minister of Health of the Republic of Kazakhstan dated 04.10.2019 (shall be enforced after ten calendar days after the day of its first official publication).

3) community-acquired abortions;

7) animal bites;

vaccinations

	immune status		PSCH or PSS	Further vaccinations
			One of the drugs is administered
		Not entered		Scheduled vaccinations according to the vaccination calendar
			One of the drugs is administered	Scheduled vaccinations according to the vaccination calendar
		Enter ADS-M	One of the drugs is administered
			Apply in case of contamination
				According to the vaccination schedule every 10 years - a single revaccination of ADS-M

Note:

The dose of PSCI drug is doubled in the following cases:

lacerated or infected wounds;

later (more than 24 hours after injury) the introduction of PSCI;

in adults who are overweight.

2) persons who do not have documentary evidence of received vaccinations;

3) persons who have passed more than 10 years after the last age-related revaccination.

6. Immunization of persons who have recovered from diphtheria is carried out before discharge from the hospital. Previously unvaccinated individuals are given one dose of ADS-M, followed by a primary course of vaccination (3 doses with an interval of 4 weeks) and a first booster (4th dose with an interval of 6 months). Partially vaccinated individuals receive a course of vaccination of 2 doses 4 weeks apart and the first booster 6 months apart. In the future, immunization is carried out according to the terms of preventive vaccinations in accordance with No. 2295. Fully immunized persons are given one dose of ADS-M if the last dose was administered more than 5 years ago.

7. In addition to routine immunization against tetanus, emergency specific prophylaxis of this infection is carried out. Indications for emergency specific prophylaxis of tetanus are:

1) injuries, wounds with violation of the integrity of the skin and mucous membranes;

2) frostbite and burns of the second, third and fourth degree;

3) community-acquired abortions;

4) giving birth outside medical organization;

5) birth outside a medical organization;

6) gangrene or tissue necrosis of any type;

7) animal bites;

8) penetrating damage to the gastrointestinal tract.

8. Emergency specific immunization for injuries is carried out in accordance with the table of emergency specific immunization for injuries in accordance with these Sanitary Rules.

For emergency prevention of tetanus, a DTP-containing vaccine, ADS-M, antitetanus human immunoglobulin (hereinafter referred to as PTSI), antitetanus serum (hereinafter referred to as PSS) are used.

9. For immunization of the population against measles, rubella and mumps, a combined measles, rubella and mumps vaccine (hereinafter referred to as MMR) and a single vaccine against measles, rubella and mumps are used.

In case of complication of the epidemiological situation for infectious diseases against which preventive vaccinations are carried out, additional mass immunization is allowed.

10. Persons under the age of 30 who have been in close contact with a patient with measles and rubella and under 25 years of age with a patient with mumps who are not vaccinated, without vaccination records or who do not have a second dose of vaccination against this infection, are given emergency immunization with a single measles vaccine , rubella and mumps, in its absence RCC. Emergency immunization is carried out no later than 72 hours from the moment of contact with the patient.

When registering cases of mumps in an organized team, a single immunization of children under 18 years of age vaccinated against this infection is carried out if more than 7 years have passed since the first vaccination.

11. Preventive vaccinations against hemophilic infection are carried out with combined vaccines, which contain a component against hemophilic infection type B.

12. Prophylactic vaccinations against poliomyelitis are carried out with live or inactivated polio vaccines.

3. Sanitary and epidemiological requirements for carrying out
anti-epidemic measures in the foci of infectious
diseases against which preventive measures are taken
vaccinations

13. Identification of patients or suspected of the disease is carried out medical workers medical organizations, regardless of their departmental affiliation and form of ownership during outpatient appointments, home visits, medical examinations, medical examinations and other visits to healthcare organizations.

Mandatory isolation in the hospital is carried out for patients with diphtheria and poliomyelitis. The rest of the patients are isolated in the hospital on clinical or epidemiological grounds or at home until the complete disappearance of clinical symptoms.

14. For the purpose of timely detection of patients:

1) diphtheria - a single laboratory examination of patients with laryngitis, tonsillitis with pathological plaque, nasopharyngitis is carried out on the day of contacting a medical organization and persons newly admitted to orphanages, children's and adult neuropsychiatric hospitals;

2) poliomyelitis - identification, registration and virological examination of patients with acute flaccid paralysis is carried out;

3) measles and rubella - the identification, registration and laboratory examination of patients with rashes is carried out.

Footnote. Paragraph 15 as amended by the order of the Minister of National Economy of the Republic of Kazakhstan dated 29.08.2016 (shall be enforced upon expiration of ten calendar days after the day of its first official publication).

16. During the epidemiological investigation, the circle of persons who were in contact with the patient (diphtheria, measles, rubella, whooping cough, mumps, poliomyelitis) during incubation period diseases.

17. Persons who have been in contact with the patient are subjected to a clinical examination for the presence of symptoms and signs of the disease and are under daily observation.

18. In the focus of diphtheria, contact persons are observed for 7 days from the moment of the last contact with the patient. On the first day of observation, swabs are taken from contacts from the nose and throat, skin lesions for bacteriological examination for diphtheria bacillus and, without waiting for the results of bacteriological examination, prophylactic antibiotic treatment is carried out.

Identified carriers of toxigenic strains of diphtheria bacilli are isolated for treatment in a hospital and re-examined bacteriologically 2 days after the completion of the course of treatment to ensure abacillation.

19. All items that were in direct contact with a patient with diphtheria are disinfected after isolation of the patient.

20. The admission of persons who have recovered from diphtheria to organized children's groups is carried out with a complete recovery and in the presence of two negative results of bacteriological examinations.

21. Dispensary observation in order to identify late complications, rehabilitation measures are carried out by a district doctor with the involvement (according to indications) of a cardiologist, neuropathologist, ENT doctor. The timing of medical examination is determined by the clinical severity of the form of diphtheria and the presence of complications. Persons with a localized form of diphtheria are observed for 6 months, in the presence of complications - one year.

22. Children who have been ill with diphtheria are admitted to preschool and educational organizations with a localized form after 2-3 weeks, with complications - after 4-8 weeks.

23. In the epidemiological investigation of cases of poliomyelitis, measles and rubella:

1) an identification number is assigned to each case of the disease;

2) Contacts are interviewed to obtain demographic and clinical information, vaccination status, possible pregnancy, and recent travel history;

3) a laboratory study of the material from patients and persons in contact with the patient is carried out.

24. Observation of persons in contact with a patient with measles, rubella and mumps is carried out within 21 days, with a patient with poliomyelitis within 30 days from the date of detection of the last case of the disease. In the focus of poliomyelitis after hospitalization, the final disinfection is carried out.

Table of emergency specific immunization for injuries

	immune status		PSCH or PSS	Further vaccinations
	Primary complex (3 or more doses)	Enter after 10 years or more from the last vaccination (with extensive wounds, contaminated wounds, frostbite, burns, injuries - 5 years or more)	Administered for contaminated wounds, frostbite, burns and injuries after 5 years or more from the last vaccination	Scheduled vaccinations according to the vaccination calendar
	Partial vaccination (less than 3 doses)	Administered if 1 month or more has passed since the last vaccination	One of the drugs is administered in case of contamination of the wound	Receives the next vaccination in the vaccination cycle and in the future must complete the primary vaccination complex (at least 3 doses) in a territorial medical organization. The choice of drug depends on the age of the person being vaccinated.
	Unvaccinated or unknown vaccination status	An anti-tetanus drug is administered, chosen according to age	One of the drugs is administered	Subsequently, a full course of immunization is carried out (at least 3 doses, taking into account the first dose administered) in a territorial medical organization
	Newborns born outside a healthcare facility and infants less than 2 months of age who are injured	Not entered	One of the drugs is given to the child if the mother is unvaccinated, partially vaccinated, or has an unknown vaccination status. The drug is not administered if the mother is fully vaccinated	Scheduled vaccinations according to the vaccination calendar
	Unvaccinated children over 2 months of age	Administer DPT-containing vaccine according to the vaccination schedule	One of the drugs is administered	Scheduled vaccinations according to the vaccination calendar
	Women (for out-of-hospital births or abortions) in cases where they are not vaccinated or there is no data on vaccinations	Enter ADS-M	One of the drugs is administered	With an interval of 1 month, the second vaccination, after 6 months - revaccination with ADS-M, then every 10 years - a single revaccination
	Women (for out-of-hospital births or abortions), if previously partially vaccinated (less than 3 doses)	ADS-M is administered if more than 1 month has passed since the last vaccination	Apply in case of contamination	According to the vaccination schedule every 10 years - a single revaccination of ADS-M
	Women (for out-of-hospital births or abortions) who have previously received a complete primary complex (3 or more doses)	ADS-M is administered after 10 years or more from the last vaccination (with contaminated wounds - 5 years or more)	Administer after 10 years or more from the last vaccination (with contaminated wounds - 5 years or more)	According to the vaccination schedule every 10 years - a single revaccination of ADS-M

Note:

The anti-tetanus drug is chosen according to age.

Before each administration of the drug, you should carefully read the instructions attached to the drug and strictly follow it.

The dose of PSCI drug is doubled in the following cases.

STATE CUSTOMS COMMITTEE

THE REPUBLIC OF BELARUS

(Extract)

ON THE APPROVAL OF THE "REGULATION ON THE PROCEDURE

CUSTOMS CLEARANCE OF GOODS IMPORTED

TO THE TERRITORY OF THE FREE CUSTOMS ZONE

AND EXPORTED FROM ITS TERRITORY *

In accordance with the Decree of the President of the Republic of Belarus of March 20, 1996 N 114 "On Free Economic Zones on the Territory of the Republic of Belarus" I order:

1. Approve the attached "Regulations on the procedure for customs clearance of goods imported into the territory of the free customs zone and exported from its territory".

Chairman of the Committee P.V. KRECHKO

* Comes into force from the moment of State registration of the Regulations approved by him

POSITION

ABOUT THE ORDER OF CUSTOMS CLEARANCE

GOODS IMPORTED INTO THE TERRITORY

FREE CUSTOMS ZONE AND EXPORTED FROM

ITS TERRITORIES

Registered in the register State registration 07/26/96, reg. N 1519/12.

1. General Provisions

1.1. Free customs zone -- a customs regime in which foreign goods are placed and used within the relevant territorial boundaries without charging customs duties, taxes, as well as without the application of economic policy measures to these goods, and domestic goods are placed and used on the terms applicable to export outside the customs territory of the Republic of Belarus.

1.2. Goods imported into the territory of the free customs zone and exported from its territory are subject to mandatory customs clearance.

1.3. The presentation of goods imported into the territory of the free customs zone and exported from its territory is carried out at customs clearance points located in such a zone.

1.4. The procedure for declaring goods imported into the territory of the free customs zone and exported from its territory is determined by other regulations State Customs Committee of the Republic of Belarus.

1.5. The territory of the free customs zone is subject to fencing. The limits of the free customs zone, as well as entrances and exits are under customs control.

1.6. Customs the right to carry out inventory and operations customs control in relation to goods located in the territory of the free customs zone.

1.7. Goods that are dangerous, capable of damaging other goods or requiring special equipment are allowed to be placed in the free customs zone only in places specially designed for their placement.

1.8. The legislation of the Republic of Belarus may impose restrictions on certain types of activities carried out in the territory of the free customs zone by business entities registered in such a zone, and operations performed with goods imported into the zone.

2. Import of goods into the territory of the free customs zone

2.1. Goods imported into the territory of the free customs zone are subject to customs clearance in the customs regime of the free customs zone. An applicant for a free customs zone regime may be a business entity registered in a free customs zone in accordance with the procedure established by the legislation of the Republic of Belarus.

2.2. Goods imported into the customs territory of the Republic of Belarus for the purpose of placement in a free customs zone are subject to customs clearance under the customs regime of transportation under customs supervision.

2.3. Goods exported from the customs territory of the Republic of Belarus to the territory of the free customs zone may be declared under the customs regimes associated with their temporary or permanent placement outside the customs territory of the Republic of Belarus.

3. Export of goods from the territory of the free customs zone

3.1. Goods exported from the territory of the free customs zone are subject to customs clearance in the customs regime of the free customs zone. At the same time, customs duties and taxes are not levied and economic policy measures are not applied. An applicant for a free customs zone regime may be a business entity registered in a free customs zone in accordance with the procedure established by the legislation of the Republic of Belarus.

3.2. The movement of goods through the customs territory of the Republic of Belarus, exported from the territory of the free customs zone, for the purpose of placement outside the customs territory of the Republic of Belarus, is carried out in the customs regime of transportation under customs supervision.

3.3. Goods imported into the customs territory of the Republic of Belarus from the territory of the free customs zone may be declared under the customs regimes associated with their temporary or permanent placement in the customs territory of the Republic of Belarus, while the collection of customs duties and taxes, as well as the application of economic policy measures are carried out in depending on the origin of goods, or classifying them as produced in a free customs zone and the declared customs regime.

On approval of the procedure for submission and composition of information submitted by the executive authorities of the constituent entities of the Russian Federation for inclusion in the state water register

In accordance with paragraph 13 of the Regulations on the maintenance of the state water registry, approved by Decree of the Government of the Russian Federation of April 28, 2007 N 253 "On the procedure for maintaining the state water registry" (Sobraniye zakonodatelstva Rossiyskoy Federatsii, 2007, N 19, art. 2357), I order :

Approve:

The procedure for the submission by the executive authorities of the constituent entities of the Russian Federation of information for inclusion in the state water register ();

The composition of the information provided by the executive authorities of the constituent entities of the Russian Federation for inclusion in the state water register ().

Minister Yu.P. Trutnev

Registration N 10473

* Collection of Legislation of the Russian Federation, 2007, N 19, art. 2357 ** Regulations on maintaining the state water register, approved by Decree of the Government of the Russian Federation of April 28, 2007 N 253 "On the procedure for maintaining the state water register", clause 26 Annex 2 The composition of the information provided by the executive authorities of the constituent entities of the Russian Federation for inclusion in the state water register 1. Information about water bodies owned by the constituent entities of the Russian Federation Name and type of water body (pond, flooded quarry) Belonging to a hydrographic unit, water management area (code) Location of the water body (geographical coordinates, settlement) Cadastral number of the land plot owned by the subject of the Russian Federation, within whose boundaries the water body is located Purpose of the water body Characteristics of the water body Normal retaining level (NSL) (for ponds), m; Surface area of ​​a water body, km2; Total volume of the water body*, million m3; Length, width of the water body, m Average and maximum depth of a water body, m _____________________________ * for ponds at FSL, for flooded quarries - during the period of maximum filling 2. Information on hydraulic and other structures at water bodies owned by the constituent entities of the Russian Federation N p / p Name of the building Location, coordinates Owner balance holder Operating organization Identification codes Purpose, parameters, characteristics Special marks* Structures Belonging to the agricultural plot _____________________________ * - in this column, including the date of commissioning, details of the acts establishing the form of ownership, the balance holder and the operating organization, the rights to the land plot under the structure. 3. Information about fishing grounds Name of the water body Identification number of the water body Details of the act, which established the fishing area * Options Special marks* Coordinates width, area, km2 Code (00.) and name of the basin district Code (00.00.00.) and name of the hydrographic unit Code (00.00.00.000) of the water management area _____________________________ * Information about fishing grounds is formed on the basis of data from the list of fishing grounds, approved in the prescribed manner ** This column also reflects information on the provision of a fishing area for use and the conditions for using the site. 4. Information on the regimes of districts of sanitary (mountain and sanitary) protection established for medical and recreational areas and resorts of regional and local significance, within the boundaries of which water bodies are located Name of the health-improving area or resort, meaning (regional or local) and location The name and details of the regulatory legal act, on the recognition of the territory as a medical and recreational area or a resort of regional or local significance General information about the district of sanitary (mountain and sanitary) protection Name of water bodies located on the territory of the district of sanitary (mountain and sanitary) protection Regime of the sanitary (mountain and sanitary) protection district, established for the medical and health-improving area or resort, within the boundaries of which water bodies are located

MINISTRY OF HEALTH OF THE RSFSR
ORDER
April 14, 1979
N 215
ON MEASURES TO IMPROVE ORGANIZATION AND INCREASE QUALITY
SPECIALIZED MEDICAL CARE FOR PATIENTS
PURULENT SURGICAL DISEASES
In recent years, health authorities and institutions, medical and research institutes of the Russian Federation have carried out certain work to develop and improve the quality of medical care for patients with purulent surgical diseases.
As of January 1, 1978, 29,933 beds were deployed for these patients in the Russian Federation, which is 17.1% of the total number of surgical beds. On the basis of surgical hospitals of large hospitals, 169 purulent departments were created with a total number of 7,260 beds, i.e. 24% of the total number of beds allocated for the treatment of purulent surgical diseases. In the polyclinics of the republic, 200 rooms have been organized for the treatment of this category of patients.
In a number of administrative territories of the republic, purposeful work is being carried out to improve medical care patients with purulent-inflammatory diseases.
So, in Moscow, a differentiated treatment of purulent surgical diseases is carried out. Specialized departments have been created for the treatment of mastitis, osteomyelitis, peritonitis, and measures are being taken to prevent post-injection abscesses and phlegmon. As a result of the work carried out, mortality from purulent diseases in the city of Moscow decreased from 3.4% in 1976 to 2.9% in 1977. The number of purulent infections in maternity hospitals has decreased. The number of post-injection abscesses is reduced.
In surgical departments of hospitals Altai Territory, Astrakhan, Orenburg and other regions, a significant reduction in the frequency of suppuration after emergency and planned operations.
In general, in the RSFSR in 1977, compared with 1975, the incidence of purulent infections of the skin and subcutaneous tissue decreased by 4.6%. At the same time, the number of days of temporary disability per 100 employees decreased by 3.7%.
The urgency of the problem of prevention and treatment of surgical infection is determined by the current prevalence of this pathology. About 1.3% of all surgical patients are patients with purulent diseases.
Every year, more than 2 million patients with purulent-inflammatory diseases are treated in the clinics of the Russian Federation, the loss of labor from which is over 15 million working days.
In the structure of purulent-inflammatory diseases with which patients go to the clinic, 26.15% are phlegmon and soft tissue abscesses, 22.35% are panaritiums, 20.09% are boils and carbuncles, 4.17% are mastitis, 18. 02% - other purulent diseases, 9.22% - patients discharged from the hospital for aftercare after suffering purulent-inflammatory diseases.
Annually, the loss of labor among the insured is 13.6% for patients with phlegmon and abscesses of the total number of days of temporary disability from all purulent diseases, felons - 15.6%, boils and carbuncles - 13.9%, mastitis - 2.2%, other purulent diseases - 40.3%, discharged from the hospital for aftercare - 14.4%.
In surgical hospitals of the Russian Federation, patients with purulent diseases account for 14-15%. Of these, 38.67% - with purulent diseases of the skin and subcutaneous tissue, 7.5% - with post-injection phlegmon, 13% - with felons and phlegmon of the hand, 10% - with purulent mastitis, 8.3% - with osteomyelitis and arthritis, 22.6% - with other purulent-inflammatory diseases.
Among the causative agents of inflammatory and purulent processes, a special place is occupied by staphylococci, which in 65.5% of cases are the cause of suppuration of the surgical wound. Currently, staphylococci more often than other microbes cause suppurative processes of the skin, subcutaneous tissue and internal organs. They cause the majority of severe complications after trauma, as well as after various infectious diseases.
Such an infection poses a great danger to debilitated patients and children. The increasing number of staphylococcal diseases every year is explained by the pronounced pathogenicity of pathogens, their increasing resistance to antibiotics and chemotherapy drugs, in connection with which antibiotic therapy of septic diseases of staphylococcal nature often turns out to be ineffective, as well as significant violations of the rules of asepsis and antisepsis in hospitals, non-compliance with the current rules for the prevention of possible purulent complications in daily surgical practice.
The difficulties in the prevention and treatment of purulent surgical infection are exacerbated by the widespread staphylococcal bacillus carriage among the population, especially medical personnel, and significant microbial contamination of the air, hospital supplies and patient care in medical institutions.
The checks carried out reveal that the sanitary and anti-epidemic regime is violated almost everywhere in the general surgical departments. Most of the beds (17.292 or 58%) allocated for patients with purulent surgical infection are located in general surgical hospitals, without taking measures to prevent the possible spread of infection.
From 71 republican ASSR, regional and regional hospitals, purulent surgical departments are available only in 21. Of the 2,822 city and children's hospitals, emergency hospitals, only 112 (4%) have purulent surgical departments. Reliable isolation of purulent surgical departments from the rest of the hospital in most cases is not ensured.
For purulent operations, special operating rooms are allocated only in those medical institutions that have specialized departments. In many surgical departments, in which beds are allocated for patients with purulent surgical infection, operations for these patients are usually performed in general surgical operating rooms.
Permanent medical, middle and junior medical personnel for managing patients with purulent surgical diseases and caring for them are available only in specialized purulent departments.
In general surgical departments, where beds are allocated for patients with purulent surgical infection, they are treated by doctors who simultaneously supervise other patients who do not have purulent complications, which poses a threat to nosocomial infection. Conducted studies have established that the staff of surgical departments, especially purulent ones, in 87% of cases is a carrier of staphylococci, the isolated strains of which are resistant to antibiotics in 64.6%.
At the same time, the projects of newly constructed medical institutions do not always provide for the necessary premises and conditions for the sanitary and hygienic treatment of personnel.
Rooms for the treatment of purulent surgical diseases in polyclinics are available only in 22 administrative territories. Their number is only 4.8% in relation to the total number of surgical rooms. Outpatient operations for purulent diseases are often performed without following the principle of sequence, along with "clean" operations. The sensitivity of the flora to antibiotics in most cases is not determined. Proteolytic enzymes for the treatment of purulent wounds are used extremely rarely. Early secondary, delayed primary, and secondary sutures are not used.
The fact that 3.4% of patients with panaritiums (31.463 out of 924.160 in 1977) were hospitalized in hospitals after unsuccessful treatment testifies to the incorrect tactics of managing patients with purulent-inflammatory diseases in polyclinics. The indication for hospitalization was the development of complicated forms of panaritium and the worsening of the course of the disease. As a rule, the appearance of complicated forms of panaritium was directly dependent on the errors in the treatment of its superficial forms.
The rapidly advancing adaptation of microorganisms to the antibacterial drugs used requires a timely change of antibiotics. However, the survey showed that the determination of antibiotic resistance of the flora is not always carried out even in large republican ASSRs, regional, regional and city hospitals.
An unfavorable effect on the development of purulent complications has an excessively wide, and in some cases unreasonable, use of antibiotics. Active immunization of patients with staphylococcal toxoid in order to increase specific anti-staphylococcal immunity, as well as passive immunization (hyperimmune plasma, gamma globulin) are used extremely rarely.
Surgeons in polyclinics commit serious violations of generally accepted requirements for the treatment of hands. In most medical institutions of the Dagestan Autonomous Soviet Socialist Republic, Ivanovo, Penza, Saratov and Sakhalin regions, surgeons treat their hands only with alcohol, in the Kuibyshev region they treat only rubber gloves with sublimate.
According to the SES of the Vladimir region, out of 2392 samples from surgical material taken in medical institutions, 156 (5.5%) turned out to be non-sterile.
Non-compliance with the rules of asepsis and antisepsis in the treatment of hands, sterilization of instruments and dressings causes the occurrence of purulent complications, which complicates the treatment of patients, lengthens their stay in the hospital, the period of temporary disability and negatively affects the outcome of treatment.
In the Kabardino-Balkar ASSR, suppuration of wounds after emergency operations in 1977 occurred in 22.3% of cases, in the Krasnoyarsk Territory - in 0.5%, in Tomsk region- 9.2%, in general in the RSFSR - 4.3%.
Purulent complications in medical institutions of the RSFSR in 1977 were the cause of deaths in emergency operations in 28.29% of cases, in planned ones - in 16.79%. In the Vladimir region, out of 130 deaths after emergency operations, 95 patients (73%) died from purulent complications, and out of 13 who died after elective operations, in all cases, death occurred as a result of purulent complications.
Serious violations of the basics of asepsis and antisepsis during injections are evidenced by the fact that 7.5% of patients with purulent surgical infections who are hospitalized are patients with post-injection phlegmon and abscesses. An even greater number of patients with these complications are on outpatient treatment.
The heads of a number of medical institutions, as well as sanitary-epidemiological and disinfection stations, do not ensure the strict implementation of a set of sanitary and hygienic measures in surgical departments, in wards and intensive care and intensive care units.
Beds and mattresses, on which there were patients with purulent diseases, are not disinfected in a number of hospitals. Measures to prevent crowding of patients in the wards are not taken. Laundry of patients with purulent-inflammatory diseases is often carried out together with the rest of the linen.
Work on the prevention of purulent infections among workers in industrial enterprises, construction, transport and Agriculture carried out by medical and sanitary units, polyclinics, health centers, sanitary and epidemiological stations, skin and venereal dispensaries and offices, in many cases is ineffective and does not give tangible results.
Health authorities and chief surgeons of the ASSR, territories and regions, and Moscow and Leningrad do not pay due attention to the advanced training of medical personnel in purulent surgery.
In the Mordovian, Tuva, Chechen-Ingush, Chuvash, Yakut Autonomous Soviet Socialist Republics, Primorsky Krai, Arkhangelsk, Vladimir, Irkutsk, Kaliningrad, Kaluga, Oryol, Penza, Rostov regions, training in purulent surgery is not carried out at all.
Many surgical and other departments of medical institutes carry out and organize this work poorly.
Employees of the departments of medical institutes and research institutions, as well as most of the chief surgeons of the ASSR, territories, regions pay little attention to the important problem of "purulent surgery".
In order to further improve the organization and improve the quality of medical care for patients with purulent surgical diseases and the prevention of purulent postoperative complications in medical institutions and in pursuance of the order of the Ministry of Health of the USSR N 720 dated July 31, 1978 "On improving medical care for patients with purulent surgical diseases and strengthening measures to combat with nosocomial infection
I ORDER:
1. To the Ministers of Health of the ASSR, heads of regional and regional health departments, heads of the main health departments of the Leningrad City Executive Committee, Moscow City Executive Committee, Moscow Regional Executive Committee:
1.1. During 1979, check the state and organization of specialized medical care for patients with purulent surgical diseases and, on the basis of the materials received, develop action plans aimed at improving the quality of this type of care, as well as measures to prevent purulent-inflammatory diseases and postoperative complications for each medical institution in separately (hospitals, polyclinics, medical units, dermatovenerological dispensaries), meaning:
- further increase in the number of beds and a network of independent departments and offices in polyclinics for the treatment of patients with purulent surgical infection, taking into account the incidence, with the creation of conditions for preventing the spread of purulent infection;
- organization of large departments of purulent surgery (60 or more beds) in multidisciplinary hospitals for the treatment of patients with surgical purulent diseases and complications.
In cities where, due to the size of the population, it is currently not possible to create specialized purulent surgical departments, allocate special wards in general surgical departments with all measures to prevent the spread of infection:
- separation of operating rooms and dressing rooms in the surgical departments for "clean" and purulent operations and dressings and equipping operating rooms with air conditioners;
- ensuring reliable isolation of purulent departments in hospitals and rooms for the treatment of patients with purulent surgical diseases in polyclinics from other departments of the hospital and polyclinic;
- categorical prohibition of the operation in patients with purulent surgical infection in general surgical operating rooms;
- introduction into practice of unified, the highest quality methods for processing the surgical field, hands, surgical gloves, sterilization of surgical instruments, suture and dressing material, surgical linen;
- introduction of a method for express diagnostics of the sensitivity of microbial flora to antibiotics;
- organization and implementation of a complex of sanitary and hygienic measures in departments, offices, hospitals, clinics and surgical institutes, guided by instructions approved by order of the USSR Ministry of Health N 720 of 07/31/78 (Appendices 1, 2, 3, 4);
- organization of centralized sterilization rooms in large medical institutions, taking into account the possibilities of providing them necessary equipment and equipment;
- carrying out a set of preventive measures to reduce the incidence of purulent-inflammatory processes of the skin and subcutaneous tissue among workers in industrial enterprises, construction, transport, and agriculture;
- organization and conduct of qualified control by the sanitary supervision authorities over the sanitary-epidemiological and hygienic regime in medical institutions;
- advanced training of doctors of surgical departments of hospitals and surgical rooms of polyclinics on issues modern methods treatment of purulent-inflammatory diseases, organization and implementation of a complex of sanitary and hygienic measures in the surgical departments of hospitals and surgical rooms in polyclinics;
- advanced training of middle and junior medical personnel of surgical departments of hospitals and surgical rooms of polyclinics and health centers on the organization and implementation of a complex of sanitary and hygienic measures.
Include these activities in comprehensive plans for joint work with medical and research institutions.
1.2. Until June 1979, in each medical institution that has a surgical department, a permanent commission chaired by a deputy chief physician for medical affairs or an experienced clinician to develop and implement a set of sanitary and hygienic measures for the prevention of nosocomial infections is to be created.
Establish that the commission, at least once a quarter, analyzes the sanitary and hygienic situation in a medical institution and, on the basis of this analysis and bacteriological control data, submits appropriate proposals to the head physician.
1.3. In order to reduce the likelihood of infection with virulent and antibiotic-resistant microorganisms and to prevent postoperative complications, take measures to organize
polyclinic conditions of the maximum possible examination of patients hospitalized for planned surgical treatment, in order to reduce the length of stay of patients in the hospital before surgery.
1.4. To oblige the heads of medical institutions:
- conduct an epidemiological investigation of each case of post-injection purulent complications in patients and take measures to prevent such complications.
To prevent the development of late suppuration, postoperative infiltrates, patients with such complications should be discharged only after they have been cured.
II. To the chief surgeons of the ministries of health of the ASSR, regional and regional health departments, the main health departments of the Leningrad City Executive Committee, the Moscow City Executive Committee, the Moscow Regional Executive Committee:
II.1. To ensure the implementation of organizational measures and to strengthen control over the prevention of nosocomial infections in surgical departments and over the quality of treatment of patients with purulent surgical diseases in medical institutions.
II.2. Introduce in the surgical departments of hospitals the registration of each case of complications of suppuration, as well as post-injection complications. Introduce a record of post-injection complications in the surgical rooms of polyclinics, analyze the materials of this record and take prompt measures aimed at preventing complications of suppuration and post-injection complications.
II.3. To oblige heads of surgical departments to provide in annual reports detailed information on the frequency and nature of purulent complications after elective operations and injections.
II.4. To organize intensive care units in large hospitals for the treatment of patients with peritonitis and purulent septic diseases.
II.5. To ensure the introduction into the practice of surgeons of the achievements of modern medical science on the prevention and treatment of purulent surgical infections.
III. Assign to the Moscow City Research Institute of Emergency Medicine. N.V. Sklifosovsky functions of the republican scientific and methodological center for purulent surgery and the head scientific institution for the republican scientific problem "Purulent Surgery".
IV. Instruct the director of the research institute. N.V. Sklifosovsky Comrade Komarov B.D. develop and submit for approval by the Ministry of Health of the RSFSR no later than September 1, 1979 methodological recommendations on:
- prevention and treatment of felons;
- prevention and treatment of purulent-septic infections;
- differentiated treatment of patients with purulent-inflammatory diseases.
V. Rectors of medical institutes, directors of research institutes to include in the plans of joint work with health authorities and institutions the issues of organizing and improving the quality of medical care for patients with purulent surgical infections.
VI. To the Head of the Main Directorate of Research Institutes and Coordination of Scientific Research Comrade Velichkovsky B.T.:
- expand scientific research on the problem of "purulent surgery" on:
- Immunity and increased body resistance in purulent surgical infections;
- the role of endogenous infection in the occurrence and course of purulent diseases;
- prevention and treatment of purulent-inflammatory diseases of the skin and subcutaneous tissue in workers of industrial enterprises, construction, transport and agriculture.
VII. Head of the Main Sanitary and Epidemiological Directorate Comrade N.S. Titkov establish strict control over the timely and unconditional fulfillment by sanitary-epidemiological and disinfection stations of the instructions approved by order of the Ministry of Health of the USSR N 720 of July 31, 1978 (appendices NN 1, 2, 3, 4).
VIII. Head of the Main Pharmacy Department Comrade Apazov A.D. take measures to improve the supply of proteolytic enzymes to medical institutions of the republic.
IX. To the Head of the Department of Research Institutes of Epidemiology, Microbiology and the Production of Vaccines and Serums Comrade Bychenko V.D. to take measures to improve the supply of medical institutions with antistaphylococcal gammaglobulin, staphylococcal toxoid and other immune and serum preparations against purulent surgical infections.
X. To the directors of the Leningrad Order of the Red Banner of Labor of the Research Institute of Hematology and Blood Transfusion Comrade Shabalin V.N., the Kirov Research Institute of Blood Transfusion Comrade V.A. Zhuravlev:
- to find ways to increase the supply of medical institutions of the republic with hyperimmune blood products for the treatment of purulent infection (anastaphylococcal, antipseudomonal sera and other polyglobulins).
XI. To the head of the Department for the distribution of material assets and equipment, comrade Khromov B.M. to take measures to ensure in 1979-1980. operating rooms of surgical departments with containers for transportation of linen of patients with purulent diseases.
XII. To impose control over the execution of the order on the Deputy Minister Comrade Trubilin N.T.
Minister
healthcare of the RSFSR
V.V.TROFIMOV