Closely related to the development of the healthcare system is the trend toward an increase in medical waste. Updating the indicative standards for the generation of class B medical waste is necessary for the correct operation of all sequential processes for handling medical waste. Predicting the amount of class B waste generation makes it possible to optimize work in medical organizations and reduce risks to the health of staff and patients. In this work, we noted a significant increase in the generation of medical waste of class B in multidisciplinary hospitals and Outpatient clinics in St. Petersburg and the Leningrad Region, as well as an increase in the fraction of plastic in the composition of medical waste, a statistical evaluation of the results was carried out and indicative standards for the formation of medical waste of class B were proposed. data on indicative standards for waste generation in departments are extremely relevant due to the different fractional and morphological composition of waste, an extremely high potential infectious risk (including the spread of multidrug-resistant strains) in a number of them, for example, in intensive care units, hemodialysis, and surgery.

Achieving the required level of herd immunity against a new coronavirus infection (COVID-19) in order to protect the population is an urgent issue in preventive and practical medicine around the world. Herd immunity is an indirect indicator of protection against COVID-19 disease and is made up of the immunity of individuals in a particular group. Epidemiological monitoring of the structure, formation, and dynamics of herd immunity will make it possible to correctly and timely adjust approaches to anti-epidemic measures, both in individual risk groups, in particular among medical workers, and in society as a whole. The required level of herd immunity against a new coronavirus infection can be achieved naturally, after a disease, or artificially, through mass immunization of the population. To date, vaccination is the safest, most effective, and most cost-effective method. Serological research methods (detection of IgG) indicate the effectiveness of vaccination — the formation of post-vaccination immunity or a past disease. Determining the period of time at which a stable antibody titer is determined, as well as their level, is essential for predicting morbidity.

The article presents information about circulating isolates Klebsiella pneumoniae in a hospital megapolis with properties of hypervirulence and simultaneous multiresistance. The resulting K. pneumonia isolates are of particular importance due to the emergence of resistance to almost all β-lactams due to the presence of carbapenemase metal-β-lactamase. Furthermore, the isolated strains producing carbapenemases possess mechanisms of resistance to a wide range of antimicrobial preparations, and the types of infectious process caused by carbapenemazo-producing enterobacteries are characterized by a high lethality level. Microbiological, biochemical, biophysical, molecular-genetic, biological, bioinformational and statistical methods of research were used in the work. A prospective method was used to identify the source of the infections. In the first stage, a microbiological study was carried out on biomaterials obtained from patients treated in a hospital in Saint Petersburg. After a microbiological study, 52 isolates of K. pneumoniae were obtained, 53.8 % of isolates had a hypermucoid phenotype and 98 % had carbapenemases:blaNDM type — 49 (92 %), blaNDM+OXA-48-like — 3 (8 %). Isolates with two new phenotypes have been isolated (no. 2511 and no. 2512). Isolates of no. 2512 LD50 had 10*2 BAC/ml, and plasmids such as Incfib(Mar), Inchi1b, and Incr were also found, with Incr-A plasmid emitted encoding resistance to fluoroquinolone: aac(6’)-Ib-cr and to β-lactam antibiotics: blaTEM-1B. The described data confirm the opinions of the researchers about the possible formation of a new “super pathogen” — instantaneously hypervirulent and plural resistant strain of K. pneumoniae.

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Health-care-related infections are becoming more relevant today. The difficulty and largely of diagnosis increased impact of adverse effects (postoperative period, increase of bed-days, use of irrational antibacterial therapy, use of excessive methods of disinfection) factors of the hospital environment on the human body, contributing to the development of severe postoperative complications, among them, sternomediastinitis occupies a special place in cardiac surgery. The clinical case we represent clearly demonstrates the atypical flow of sternominetite caused by the hypervirulent strain Klebsiella pneumoniae blaNDM-Type. Generally, sternomediastinitis causes Staphylococcus epidermidis, Staphylococcus haemolyticus. Every week the patient stays in the cardiothoracic ward of the hospital is associated with a 15 % increase in the risk of mediastinitis development. The data indicate the need for continuous epidemiological monitoring of the relevant microorganisms that are potential agents of nosocomial infections. Thus, adequate diagnosis, choice of rational treatment tactics and effective antibacterial therapy significantly improve the prognosis of the current of a given severe disease. Early epidemiological diagnosis will help to reduce the risk of the development and spread of hospital-acquired infections in the post-operative period.