Prevention of nosocomial infections
Any diseases that a person has in connection with his stay in a medical institution are classified in medicine as nosocomial infections.But such a diagnosis will be made only in the event that a pronounced clinical picture was noted no earlier than 48 hours after the patient had entered the hospital.
In general, nosocomial infections are considered quite common, but most often a similar problem appears in obstetric and surgical hospitals. Intrahospital infections are a huge problem, as they worsen a patient's condition, contribute to a more severe course of the underlying disease, automatically prolong the period of treatment and even increase the level of deaths in the departments.Table of contents: Pathogens of nosocomial infections Types of nosocomial infections Diagnostic measures Basic principles of the treatment of nosocomial infections Prevention of nosocomial infections
The main hospital infections: causative agents
The pathology examined is very well studied by physicians and scientists, they precisely identified those opportunistic microorganisms,Which belong to the group of the main pathogens:
- Staphylococcus - can be golden and epidermal;
- streptococcus( beta-hemolytic);
Viral pathogens play an important role in the emergence and spread of nosocomial infections:
- adenovirus infection;
- parainfluenza and influenza;
- herpes simplex;
- viral hepatitis;
- respiratory syncytial infection;
In some cases, the involvement in the occurrence and spread of infections of the category considered take pathogenic fungi.
Note: is a distinguishing feature of all conditionally pathogenic microorganisms that are involved in the emergence and spread of this category of infections is resistance to various effects( for example, ultraviolet rays, drugs, powerful disinfectant solutions).
The sources of these infections are most often the medical staff, or the patients themselves, who have unrecognized pathologies - this is possible if the symptoms are hidden.The spread of nosocomial infections occurs contact, airborne, transmissible or fecal-oral route. In some cases, pathogenic microorganisms also spread parenterally, that is, during various medical manipulations - the introduction of vaccines to patients, injections, blood sampling, artificial ventilation, surgical interventions.In this way, it is possible to get infected with hepatitis, HIV infection, inflammatory diseases with the presence of a purulent focus, syphilis.
There are a number of factors that actively participate in the spread of nosocomial infections - medical instruments, medical equipment, bedding, medical equipment, reusable tools, dressing materials and in general everything, any item that is in a specific hospital.
Intrahospital infections do not happen all at once in one department of .In general, there is some differentiation of the problem under consideration - for a specific inpatient department, there is an inherent "infection" in the medical institution.For example:
- urological units - Pseudomonas aeruginosa or Escherichia coli;
- burns branches - Pseudomonas aeruginosa;
- birth departments - staphylococcal infection;
- pediatric departments - rubella, mumps, measles, chicken pox and other childhood infections.
Types of nosocomial infections
There is a rather complex classification of nosocomial infections.First, they can be acute, subacute and chronic - this classification is carried out only by the duration of the course.Secondly, it is customary to distinguish between generalized and localized forms of the pathologies under consideration, and so to classify them will be obtained only taking into account the prevalence.
Generalized nosocomial infections are bacterial shock, bacteremia and septicemia. And here the localized forms of the examined pathologies will be as follows:
- Piodermia, omphalitis, infections of the skin of fungal origin, mastitis, paraproctitis and others.These infections most often occur in postoperative, traumatic and burn wounds.
- Stomatitis, laryngitis, mastoiditis, tonsillitis, rhinitis, pharyngitis and other infectious diseases of the ENT organs.
- Gangrene lung, mediastinitis, pneumonia, pleural empyema, lung abscess and other infectious diseases that affect the bronchopulmonary system.
- Viral hepatitis, enteritis, gastritis and other diseases of infectious etiology that occur in the organs of the digestive system.
In addition, the localized forms of the pathologies under consideration include :
- keratitis / conjunctivitis / blepharitis;
- osteomyelitis / bursitis / arthritis;
- myelitis / brain abscess / meningitis;
- Cystitis / adnexitis / urethritis / pyelonephritis;
- thrombophlebitis / pericarditis / endocarditis.
The medical personnel can think about the fact that there is a nosocomial infection only if the following criteria are met:
- The clinical picture of the disease in the patient occurred not earlier than 48 hours after admission to hospitalType.
- There is a clear association between the symptoms of the infection and invasive intervention-for example, a patient with signs of bronchitis after the admission to the hospital underwent inhalation, and 2-3 days later he developed severe symptoms of angina.Here in this case, hospital staff will talk about nosocomial infections.
- The source of the infection and the factor of its spread are clearly established.
It is mandatory to conduct laboratory / bacteriological studies of biomaterials( blood, feces, pharyngeal swab, urine, sputum, wounds, etc.) for accurate diagnosis and detection of a specific strain of the pathogen. .
Basic principles of the treatment of nosocomial infections
The treatment of nosocomial infection is always complex and time-consuming, because it develops in the already weakened organism of the patient .After all, the patient of the inpatient department already has a major disease, plus an infection is superimposed on him - the immunity does not work at all, and given the high resistance of hospital-acquired infections to medicines, the recovery process can last for a long time.
Note: as soon as a patient with a nosocomial infection is identified, he is immediately isolated, strict quarantine is announced at the department( exit / entry of patients and their relatives, medical personnel from other departments is strictly prohibited) and perform complete disinfection.
When identifying the pathologies in question, it is first necessary to isolate a particular pathogen of infection, as only this will help to select competently the effective antimicrobial drug .For example, if the nosocomial infection is provoked by gram-positive strains of bacteria( staphylococcus, pneumococcus, streptococcus and others), it will be appropriate to use Vancomycin in the treatment.But if the culprits of the pathologies under consideration are gram-negative microorganisms( escherichia, pseudomonas and others), cephalosporins, carbapenems and aminoglycosides will predominate in prescribing physicians.As additional therapy apply:
- bacteriophages of a specific nature;
- vitamin and mineral complexes;
- leukocyte mass.
Mandatory symptomatic therapy and provide patients with a full, but dietary nutrition .In occasion of symptomatic therapy, something specifically can not be said, since all prescriptions of medications in this case are carried out individually.The only thing that is prescribed to virtually all patients is antipyretic agents, since any infectious diseases are accompanied by an increase in body temperature.
Prevention of nosocomial infections
The pathologies considered can not be predicted, and the spread of nosocomial infections by the department can not be stopped.But to take some measures to prevent even their occurrence is quite realistic.
First, the medical personnel must strictly comply with anti-epidemic and sanitary-hygienic requirements. This applies to the following areas:
- application of quality and effective antiseptics;
- regularity of disinfection in the room;
- clear compliance with the rules of antiseptics and asepsis;
- providing high quality sterilization and pre-sterilization treatment of the entire toolkit.
Secondly, the medical personnel must comply with the rules for carrying out any invasive procedures / manipulations. It is understood that medical personnel do all manipulations with patients only in rubber gloves, goggles and a mask. There should be extreme care with the medical tool.
Thirdly, health workers must be vaccinated, that is, participants in the vaccination program for the population from hepatitis B, diphtheria, influenza and other infections of .All employees of the medical institution should undergo regular medical check-ups, which will allow timely diagnosis of the infection and prevent its spread through the hospital.
It is believed that medical personnel should shorten hospitalization time for patients, but not at the expense of their health .It is very important to select in each specific case only rational treatment - for example, if the therapy is carried out with antibacterial drugs, then they should be taken by the patient in strict accordance with the prescribing physician's appointments.All diagnostic or invasive procedures should be carried out reasonably, it is unacceptable to appoint, for example, endoscopy "just in case" - the doctor should be sure of the need for manipulation.
Intrahospital infections are a problem both for the medical institution and for the patients.Preventive measures, if they are strictly observed, in most cases help prevent their occurrence and spread.But despite the use of modern, high-quality and effective disinfectants, antiseptics and aseptics, the problem of infections of the category under consideration remains relevant.
Tsygankova Yana Aleksandrovna, medical reviewer, therapeutist of the highest qualification category