Nosocomial infection: ways of spreading and prevention
Despite recent advances in the health care system, nosocomial infection remains an acute medical and social problem. Indeed, in the case of joining the main disease, it worsens the course and prognosis of the disease.
Nosocomial infection: definition
All sorts of diseases of microbial origin, resulting from a visit to a medical institution with the aim of receiving medical care, examinations or performing certain duties (work), are all called “nosocomial infections”.
The definition of the World Health Organization (WHO) stresses that the infection is considered nosocomial (nosocomial) if its first manifestation took place no less than two days after being in a medical institution. In the event of symptoms at the time of admission of the patient and exclusion of the probability of incubationthe period of infection is not considered hospital.
The main causative agents of nosocomial infections are:
- gram positive coccal flora;
- intestinal and blue pus bacillus;
- sporiferous nonclostridial anaerobes;
- gram-negative rod-shaped flora (for example, Proteus, Salmonella, Morganella, Enterobacter Citrobacter, Yersinia);
- conditionally pathogenic;
There is a generally accepted classification of such infections. The main criteria for it are:
1. Ways of nosocomial infection transmission:
- airborne (aerosol);
- contact-instrumental (post-injection, operating, transfusion, endoscopic, transplant, dialysis, hemosorbtion, postpartum);
- household contact;
2. The nature and duration of the flow:
3. The complexity of the clinical treatment:
4. The degree of spread of infection:
4.1.Distributed throughout the body (septicemia, bacteremia and others).
- respiratory (for example, bronchitis);
- infections of the skin and subcutaneous tissue (for example, associated with burns, etc.);
- ENT infections (otitis and others);
- pathologies of the digestive system (gastroenterocolitis, hepatitis, abscesses, etc.);
- infections of the reproductive system (for example, salpingo-oophoritis);
- urological (cystitis, urethritis, etc.);
- infections of the joints and bones;
- cardiovascular infections;
- diseases of the central nervous system.
Sources of nosocomial infection
Distributors of nosocomial infections are:
1) patients (especially those who are in the hospital for a long time), patients of the surgical hospital with chronic or acute forms of purulent-septic diseases;
2) health workers (patients and bacteria carriers), this includes both doctors and nursing staff.
Visitors to the hospital are minor sources of nosocomial infection, but they can also be sick with ARVI, as well as carriers of enterobacteria or staphylococci.
Ways to spread
How is nosocomial infection transmitted? The ways of its distribution are the following:
- airborne, or aerosol;
- contact and household;
- through the blood.
Nosocomial infection in hospitals can also be transmitted through:
- Objects that are directly related to moisture (hand washing facilities, infusion fluids, drinking tanks, tanks containing antiseptics, disinfectants and antibiotics, water in flower pots and pot stands, air conditioners humidifiers).
- Contaminated instruments, various medical equipment, bed linen, furniture in the ward (bed), patient care items and materials (dressing material, etc.), staff uniforms, hands and hair of patients and medical staff.
In addition, the risk of infection increases if a persistent source of nosocomial infection is present (for example, an unrecognized infection in a patient undergoing long-term treatment).
What is the reason for the increase in nosocomial infections?
Nosocomial infection in recent years is gaining more and more speed: the number of registered cases in the Russian Federation has grown to sixty thousand a year. The reasons for this increase in hospital infections can be as objective (which are not dependent on the management and medical staff of medical institutions),so subjective. Briefly dwell on each of the options.
Objective causes of nosocomial infection:
- there are a number of medical institutions that do not meet modern requirements;
- large hospital complexes with a peculiar ecology are being created;
- bacteriological laboratories are poorly equipped and equipped;
- there is a shortage of bacteriologists;
- there are no effective treatment methods for staphylococcal carrier, as well as conditions for hospitalization;
- contacts of patients and staff are becoming more frequent;
- increase in the frequency of seeking medical help;
- increasing the number of people with low immunity.
Subjective causes of infection:
- there is no single epidemiological approach to the study of hospital infections;
- insufficient level of preventive measures, as well as training of doctors and nursing staff;
- there are no methods for qualitative sterilization of certain types of equipment, insufficient control over the procedures performed;
- increasing the number of undiagnosed carriers among health care workers;
- there is no complete and reliable account of nosocomial infections.
Despite the level and qualifications of the medical institution, the personnel working there and the quality of the preventive measures taken, almost everyone can become a source or goal of nosocomial infection. But there are certain segments of the population whose organism is most prone to infection.
These people include:
- patients of mature age;
- Children up to ten years (most often premature and with a weakened immune system);
- patients who have reduced immunobiological protection as a result of diseases associated with blood pathologies, oncology, autoimmune, allergic, endocrine diseases, as well as after prolonged operations;
- patients who have changed their psycho-physiological status due to the ecological distress of the territory of the place of residence and work.
In addition to the human factor, there are a number of hazardous diagnostic and therapeutic procedures that can lead to an increase in nosocomial infections. As a rule, this is due to improper use of equipment and tools, as well as disregard for the quality of preventive measures.
Procedures at risk
Transplantation of tissues and organs
Manual gynecological examination
Catheterization of the urinary tract and blood vessels
Manual Rectal Studies
Surgical wound infections
Nosocomial surgical infection (CRI) occupies the lion's share in the total mass of hospital infections - an average of 5.3 per hundred patients.
Such pathologies are divided into superficial (skin and subcutaneous tissue are affected), deep (muscles and fascia are affected), and cavity / organ infections (any anatomical structures are affected).
Infection occurs both for internal reasons and for external factors. But more than eighty percent of infections are associated with internal infection, which occurs in operating and dressing rooms through the hands of staff and medical instruments.
The main risk factors for infections in surgical units are:
- the existence of a centralized operating unit;
- frequent use of invasive procedures;
- carrying out long operations;
- patients who are in a supine position for a long time after heavy operations.
To reduce the risk of infection and the growth of hospital infections, multilateral preventive measures are needed. They are quite difficult to carry out for organizational, epidemiological and scientific and methodological reasons. To a greater degree, the effectiveness of the planned and carried out measures aimed at combating hospital infection depends on the planning of health facilities in accordance with modern equipment, the latest scientific achievements and strict adherence to the anti-epidemic regime.
Prevention of nosocomial infections is carried out in several directions, each of which necessarily includes sanitary-hygienic and anti-epidemic measures.
These activities are related to the observance of the conditions for the implementation of the sanitary maintenance of the entire medical institution, the equipment and tools used, the observance of personal hygiene rules for patients and medical workers.
General cleaning of chambers and functional premises is carried out once a month or more often, if for good reason. It includes thorough washing and disinfection of floors, walls, medical equipment, as well as wiping furniture, lighting fixtures, blinds and other possible objects from dust.
At least twice a day should be carried out wet cleaning of all premises, always with the use of detergents, disinfectants and cleaning equipment, which has a special marking.
As for the general cleaning of such premises as the operating unit, the delivery room and the dressing room, it should be done there once a week. At the same time, it is necessary to completely remove equipment, inventory and furniture from the hall. Also, after cleaning and during the operational time, it is necessary to disinfect the premises using stationary or mobile ultraviolet germicidal lamps (1 W of power per 1 m3premises).
In general, the prevention of nosocomial infections should provide one of the most important activities - a daily disinfection procedure.Its purpose is to destroy possible microorganisms in the wards, on equipment and tools.
Nosocomial infections - an order for the prevention of nosocomial infection
Government has always had the problem of nosocomial infections. To date, there are about fifteen orders and other regulatory documents of the Ministry of Health of the USSR, the RSFSR and the Russian Federation. The very first were published in 1976, but their meaning is relevant to this day.
A system for tracking and preventing nosocomial infections has been developed for many years. And the service of epidemiologists of the Russian Federation was legalized only after the ninetieth years (in 1993) simultaneously with the Order No. 220 "About measures for development and improvement of infectious services in the Russian Federation". This document fixes the rules that are aimed at the development of the infectious service and the prospects for improving the activities of medical institutions in this course.
At the moment, there are developed reference documents describing the necessary actions for the prevention of airborne and implant infections.
Infectious control of nosocomial infections is the epidemiological surveillance at the country, city, district, and in the conditions of individual medical institutions. That is, the process of continuous monitoring and implementation on the basis of epidemiological diagnosis of actions aimed at improving the quality of medical care, as well as ensuring the safety of the health of patients and staff.
To fully implement the nosocomial infection control program, it is necessary to properly develop:
- management structure and distribution of functional duties of control, which should include representatives of the administration of the medical institution, leading specialists, middle-level medical personnel;
- a system of complete registration and recording of nosocomial infections, which is focused on the timely detection and registration of all purulent-septic pathologies;
- microbiological support of infection control on the basis of bacteriological laboratories in which high-quality studies can be conducted;
- the system of organization of preventive and anti-epidemic actions;
- the current flexible system of training health care workers in infection control;
- personnel health protection system.