Despite recent advances in the healthcare system, hospital-acquired 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.

Hospital-acquired infection: definition

Various kinds of diseases of microbial origin resulting from visits to a medical institution for the purpose of obtaining medical care, examination, or performing certain duties (work), have a single name - "nosocomial infection".

The definition of the World Health Organization (WHO) emphasizes that an infection is considered nosocomial (nosocomial) if its first manifestation took place at least two days after being in a medical institution. If symptoms are present at the time of admission and the incubation period is excluded, the infection is not considered hospital-acquired.

Origin

The main causative agents of nosocomial infections are:

1. Bacteria:

• staphylococcus;
• gram-positive coccal flora;
• intestinal and Pseudomonas aeruginosa;
• spore-bearing non-clostridial anaerobes;
• gram-negative rod-shaped flora (eg, Proteus, Salmonella, Morganella, Enterobacter Citrobacter, Yersinia);
• others.

2. Viruses:

• rhinoviruses;
• rotaviruses;
• viral hepatitis;
• flu;
• measles;
• chickenpox;
• herpes;
• respiratory syncytial infection;
• others.

• conditionally pathogenic;
• pathogenic.

4. Pneumocysts.

5. Mycoplasmas.

• pinworms;
• others.

Classification

There is a generally accepted classification of this type of infection. The main criteria in it are:

1. Ways of transmission of nosocomial infection:

• airborne (aerosol);
• water-alimentary;
• contact and instrumental (post-injection, operating, transfusion, endoscopic, transplant, dialysis, hemosorption, postpartum);
• contact and household;
• post-traumatic;
• others.

2. The nature and duration of the course:

• long-lasting;
• subacute;
• sharp.

3. Complexity of clinical treatment:

• lungs;
• medium;
• heavy.

4. Degree of infection spread:

4.1. Distributed throughout the body (septicemia, bacteremia, and others).

4.2. Localized:

• respiratory (eg, bronchitis);
• eye;
• infections of the skin and subcutaneous tissue (for example, associated with burns, etc.);
• ENT infections (otitis media and others);
• pathology of the digestive system (gastroenterocolitis, hepatitis, abscesses, etc.);
• infections of the reproductive system (for example, salpingo-oophoritis);
• urological (cystitis, urethritis, etc.);
• joint and bone infections;
• dental;
• infections of the cardiovascular system;
• diseases of the central nervous system.

Sources of nosocomial infections

Distributors of nosocomial infection are:

1) patients (especially those who are in the hospital for a long time), patients of a surgical hospital with chronic or acute forms of purulent-septic diseases;

2) health workers (patients and carriers of bacteria), this includes both doctors and nursing staff.

Visitors to the hospital are insignificant sources of nosocomial infections, but at the same time they can be sick with ARVI, and also be carriers of enterobacteria or staphylococci.

Propagation paths

How is nosocomial infection transmitted? Its distribution routes are as follows:

Airborne, or aerosol;

Contact and household;

Food grade;

Through the blood.

A nosocomial infection in a healthcare facility can also be transmitted through:

1. Objects that are directly associated with moisture (washstands, infusion fluids, drinking tanks, tanks containing antiseptics, disinfectants and antibiotics, water in flowerpots and pot holders, air conditioner humidifiers).
2. Contaminated instruments, various medical equipment, bedding, furniture in the ward (bed), items and materials for patient care (dressings, etc.), staff uniforms, hands and hair of patients and medical staff.

In addition, the risk of infection increases if a persistent source of nosocomial infections is present (for example, an unrecognized infection in a patient undergoing long-term treatment).

What is the reason for the increase in nosocomial infections?

In recent years, nosocomial infection has been gaining momentum: the number of registered cases in the Russian Federation has grown to sixty thousand per year. The reasons for such an increase in hospital infections can be both objective (which do not depend on the management and medical workers of medical institutions), and subjective. Let's 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 bacteriological doctors;
• there are no effective methods of treating a staphylococcal carrier, as well as conditions for hospitalization;
• contacts between patients and staff are becoming more frequent;
• an increase in the frequency of seeking medical help;
• increasing the number of people with low immunity.

Subjective causes of infection:

• there is no unified epidemiological approach to the study of nosocomial infections;
• insufficient level of preventive measures, as well as training of doctors and nurses;
• there are no ways of high-quality sterilization of certain types of equipment, insufficient control over the procedures being carried out;
• an increase in the number of undiagnosed carriers among healthcare workers;
• there is no complete and reliable record of nosocomial infections.

Risk group

Despite the level and qualifications of the medical institution, the personnel working there and the quality of the preventive measures carried out, almost everyone can become a source or target of nosocomial infection. But there are certain segments of the population, the body of which is most prone to infection.

These people include:

Mature patients;

Children under ten years of age (most often premature and immunocompromised);

Patients who have decreased immunobiological protection as a result of diseases associated with blood pathologies, oncology, autoimmune, allergic, endocrine diseases, as well as after prolonged operations;

Patients whose psychophysiological status has changed due to the ecological disadvantage of the territory of their residence and work.

In addition to the human factor, there are a number of dangerous diagnostic and therapeutic procedures, the implementation of which can provoke an increase in the number of nosocomial infections. As a rule, this is due to improper use of equipment and tools, as well as neglect in relation to the quality of implementation of preventive measures.

Surgical wound infections

Nosocomial surgical infection (CSI) occupies the lion's share of 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 rooms and dressing rooms through the hands of personnel and medical instruments.

The main risk factors for infection in surgical departments are:

The existence of a centralized operating unit;

Frequent use of invasive procedures;

Long-term operations;

Patients who are in a supine position for a long time after heavy operations.

Preventive measures

To reduce the risk of infection and the increase in hospital infections, multilateral preventive measures are needed. They are quite difficult to carry out for organizational, epidemiological, scientific and methodological reasons. To a greater extent, the effectiveness of the planned and carried out measures aimed at combating hospital infections depends on the planning of the healthcare facility 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 and hygienic and anti-epidemic measures.

These measures are associated with compliance with the conditions for the implementation of the sanitary maintenance of the entire medical institution, the equipment and tools used, compliance with the rules of personal hygiene of patients and medical workers.

General cleaning of wards and functional areas is performed once a month or more often if there are reasons for this. It includes thorough cleaning and disinfection of floors, walls, medical equipment, as well as dusting furniture, lighting fixtures, blinds and other possible items.

Wet cleaning of all rooms must be carried out at least twice a day, always using detergents, disinfectants and cleaning equipment, which has a special marking.

As for the general cleaning of premises such as the operating unit, maternity and dressing room, it must 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 operating time, it is necessary to disinfect the premises using stationary or mobile ultraviolet bactericidal lamps (1 W of power per 1 m 3 of the room).

In general, the prevention of nosocomial infections should provide one of the most important measures - a daily disinfection procedure. Its purpose is to destroy possible microorganisms in wards, equipment and instruments.

Hospital-acquired infections - order concerning the prevention of nosocomial infections

The governing bodies have always faced the problem of hospital infections. Today 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.

The system for tracking and preventing nosocomial infections has been developed over the years. And the service of epidemiologists of the Russian Federation was legalized only after the nineties (in 1993) simultaneously with Order No. 220 "On measures to develop and improve the infectious service in the Russian Federation." This document fixes the rules that are aimed at the development of infectious services and the prospects for improving the activities of medical institutions for this course.

At the moment, there are developed recommendation documents describing the necessary actions for the prevention of airborne and implantation infections.

Supervision of nosocomial infections

Infection control of nosocomial infections is epidemiological surveillance at the level of the country, city, district and in the conditions of individual medical institutions. That is, the process of constant monitoring and implementation, based on epidemiological diagnostics, 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 a nosocomial infection control program, it is necessary to properly develop:

The structure of management and distribution of functional responsibilities for control, which should include representatives of the administration of the medical institution, leading specialists, and the middle level of medical personnel;

The system of complete registration and accounting of nosocomial infections, which is focused on the timely detection and accounting of all purulent-septic pathologies;

Microbiological support of infection control on the basis of bacteriological laboratories, where high-quality research can be carried out;

The system of organizing preventive and anti-epidemic actions;

The current flexible system of training medical workers in infection control tasks;

Personnel health protection system.

Nosocomial infection, nosocomial infection (hospital, nosocomial) is any disease of viral, bacterial or fungal etiology that develops in a patient who is in a medical facility for inpatient or outpatient treatment, as well as within a month from the moment of discharge from the hospital.

The causative agents of nosocomial infections also affect medical personnel, the specifics of whose work involves contact with a potential pathogenic microorganism.

↯ More articles in the journal

What is a nosocomial infection, what are its causative agents, mechanisms and routes of transmission? What activities must be organized in a medical facility for the prevention of nosocomial infections?

See the article for ready-made algorithms and instructions.

A new approach to the definition of nosocomial infections

The concept of nosocomial infections has now changed. Today, most regulatory documents use the term Health Care Infections (HAI) instead of “nosocomial infections”.

It is specified in GOST R 56994-2016 “Disinfectology and disinfection activities. Terms and definitions ", which entered into force on January 1, 2017.

Samples and special collections of standard procedures for nurses available for download.

According to GOST, nosocomial infections are any microbial pathologies that arise:

• in patients while in hospital, outpatient treatment or at home;
• from employees of health care facilities in the course of performing their professional duties.

Prevention of nosocomial infection includes measures aimed at preventing outbreaks and spread of infectious pathologies. This work is carried out by a commission specially created by the head of the medical institution.

It includes the head nurse of the institution as an official and member of the commission for the prevention of nosocomial infections.

Download instructions

1. Styling for emergency personal prevention of OOI.
2. Universal styling for biomaterial collection.
3. Emergency alert scheme for identifying a patient with AOI.
4. A message about the detection of OOI.
5. How to use a protective suit.

Epidemiology and etiology of nosocomial infections

The following sources are distinguished by origin:

• patients with manifest forms (considered the most dangerous sources of infections);
• carriers of various strains of pathogenic and opportunistic microorganisms, including those resistant to antimicrobial drugs;
• employees of medical institutions with infectious diseases.

Medical personnel must clearly know what the main causes of infectious diseases exist - this will allow more effective planning and implementation of preventive measures.

Mechanisms and ways of transmission of nosocomial infections

VBI classification

1. Taking into account the mechanisms and ways of spreading the infection agent, there are:
   • aerosol (airborne);
   • introductory alimentary (food);
   • contact and household;
   • contant and instrumental (postoperative, postpartum, postdialysis, posttransfusion, postendoscopic and others).
   • post-traumatic;
   • other forms.
2. Taking into account the nature and duration of the course:
   • sharp;
   • chronic;
   • subacute.
3. Taking into account the severity of the course:
   • lungs;
   • medium-heavy;
   • heavy.
4. Taking into account the degree of spread of the pathological process:
   • generalized (bacteremia, mycemia, viremia, septicemia, septicopyemia, infectious toxic shock, etc.):
   • localized (skin and subcutaneous fat, eyes, urogenital area, ENT organs, gastrointestinal tract, central nervous system, heart and blood vessels, musculoskeletal system, etc.).

We have prepared a tutorial for you that explains how to monitor the epidemiological situation in the hospital.in the journal Head Nurse.

They also described the reference points of the current control, on which it is necessary to make management decisions.

Factors participating in the development and spread of nosocomial infections can be:

• deficiency of immunity;
• the spread of strains of pathogenic and opportunistic microbes that are resistant to antibiotics;
• age, an increase in the number of elderly and debilitated patients;
• neglect of safety rules during medical procedures and patient care.

Types of causative agents of nosocomial infections

According to the World Health Organization, it is hospital infections that pose a serious threat to the health and life of the population, since they are characterized by a high degree of resistance to antimicrobial drugs, which significantly complicates treatment.

Microorganisms that can cause nosocomial infection belong to different groups. The main ones are presented in the table.

The types of pathogens are diverse, but 90% of them are infectious agents of bacterial origin. Fungi, viruses and protozoa are much less common.

The types of infectious agents largely depend on the profile of the hospital. So, in the burn department, the Pseudomonas aeruginosa, transmitted through the hands of medical workers and environmental objects, is a particular danger. The source in this case is people.

In maternity hospitals, Staphylococcus aureus infection predominates, the main source of which is medical personnel. The route of transmission of Staphylococcus aureus is airborne.

In surgical hospitals, the causative agent of infection - Escherichia coli (E. coli) prevails, and hospitals of the urological profile amaze with a variety of pathogenic microflora - here you can find Escherichia coli, Klebsiella, Chlamydia, and Proteus.

The same can be said about trauma departments - there is a Pseudomonas aeruginosa, Staphylococcus aureus, Proteus, etc.

The admission department of the hospital should prevent the admission of patients with signs of an infectious disease to the ward.

Harbingers

This allows you to minimize the risk for both patients and health care personnel.

Diseases related to hospital-acquired

The risk group includes such nosological forms in which the development of nosocomial infection is most likely:

• purulent-inflammatory processes of the subcutaneous tissue, mucous membranes and skin (phlegmon, abscess, mastitis, erysipelas);
• defeat of the ENT organs (pharyngitis, laryngitis, tonsillitis);
• infections of the bronchopulmonary tree (aspiration and congestive pneumonia);
• damage to the gastrointestinal tract (toxic and injection hepatitis);
• infectious diseases of the eyeball;
• purulent-inflammatory lesions of the bone and articular system;
• infections of the genitourinary system;
• damage to the meninges and brain matter;
• Infectious genesis of the membranes of the heart and great vessels.

LECTURE No. 4. Hospital-acquired infections.

Topic: Fundamentals of prevention of nosocomial infections.

Lecture plan:

The concept of nosocomial infections, classification.

Characteristics of sources of nosocomial objects.

The mechanisms of transmission of hospital infections.

Reasons for the spread of nosocomial infections in hospitals.

Fundamentals of the direction of prophylaxis of nosocomial infections.

The problem of nosocomial infections (nosocomial infections) arose with the advent of the first hospitals. In the years that followed, it became extremely important for all countries of the world.

VBI occurs in 5-7% of patients admitted to medical institutions. Of 100,000 patients infected with nosocomial infections, 25% die. Hospital infections increase the length of hospital stay.

Hospital-acquired infections Is any clinically recognizable disease of microbial etiology that affects a patient as a result of his stay in a medical institution (hospital) or seeking medical help (regardless of the onset of symptoms of the disease during or after a hospital stay), or a hospital employee due to his work in this institution.

Thus, the concept of nosocomial infections includes:

diseases of hospital patients;

diseases of patients receiving assistance in polyclinics and at home;

cases of nosocomial infection of personnel.

By etiology, 5 groups of nosocomial infections are distinguished:

bacterial;

viral;

1. infections caused by protozoa;

   diseases caused by ticks.

At the present stage, the main causative agents of nosocomial infections in hospitals are:

staphylococci;

gram-negative opportunistic enterobacteriaceae;

respiratory viruses.

In most cases, the causative factor of nosocomial infections, especially purulent-septic infections, are opportunistic microorganisms that are capable of forming "hospital strains".

A "hospital strain" is understood as a type of microorganism adapted to living in a hospital setting.

Distinctive properties of hospital strains are:

high resistance (insensitivity) to antibiotics;

resistance to antiseptics and disinfectants;

increased virulence 1 for humans.

In hospitals, the following groups of nosocomial infections are most common:

Group 1 - diarrheal (intestinal);

Group 2 - airborne (measles, flu, rubella);

Group 3 - purulent-septic.

The first and second groups of nosocomial infections account for only 15% of all diseases, the third - 85%.

In epidemiology, there are 3 links of the epidemiological process:

sources of infection;

transmission mechanism;

susceptible organism.

Sources vbi.

The source Nosocomial infections in hospitals are patients, medical staff,much less often facesimplementing nursing and visitors.They can all be carriers infections as well be ill (usually in a mild or latent form), in the recovery stage or in the incubation period. The source of infection can be animals (rodents, cats, dogs).

The patientsare the main source of hospital infections. The role of this source is especially great in urological, burns and surgical departments.

Medical staff,as a rule, it acts as a source of nosocomial infections in infections caused by Staphylococcus aureus (purulent-septic nosocomial infections), sometimes - with salmonellosis (intestinal), sometimes - with infections caused by opportunistic flora.

In this case, the medical staff identifies - "hospital" strains of pathogens.

The role of visitors and caregivers in the spread of nosocomial infections is very limited.

Vbi transmission mechanisms.

With nosocomial infections, transmission mechanisms can be divided into two groups: naturaland artifactual (artificially created).

Naturalmechanisms of transmission of nosocomial infections are divided into 3 groups:

horizontal:

fecal-oral (intestinal infections);

airborne (respiratory tract infections);

transmissible (through blood-sucking insects, blood infections);

contact and household (infection of the outer integument).

vertical (from mother to fetus during intrauterine development);

during the act of childbirth (from the mother).

Artificaltransmission mechanisms of nosocomial pathogens are mechanisms created in the conditions of medical institutions:

infectious;

transfusion (with blood transfusion);

associated (associated) with operations;

associated with medical procedures:

intubation;

catheterization.

inhalation;

associated with diagnostic procedures:

taking blood;

sounding of the stomach, intestines;

scopy (bronchoscopy, tracheoscopy, gastroscopy, etc.);

punctures (spinal, lymph nodes, organs and tissues);

manual examination (with the help of a doctor's hands).

The third link in the epidemic process is susceptible organism.

The high susceptibility of the body of hospital patients to nosocomial infections is due to the following features:

a) children and the elderly prevail among the patients of medical institutions;

b) the weakening of the body of patients with the underlying disease;

c) a decrease in the immunity of patients through the use of certain drugs and procedures.

Factors contributing to the spread of wbw in hospitals.

Formation "Hospital" drug-resistant microorganism strains.

Availability a large number sourcesVBI in the form of patients and staff.

Availabilityconditions for the implementation natural transmission mechanisms VBI:

high population density (patients) in medical institutions;

close contact of medical personnel with patients.

Formation powerful artificial transmission mechanism VBI.

Increased patient susceptibility VBI, which has several reasons:

the predominance of children and the elderly among patients;

the use of drugs that reduce immunity;

damage to the integrity of the skin and mucous membranes during medical and diagnostic procedures.

Despite recent advances in the healthcare system, hospital-acquired 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.

Hospital-acquired infection: definition

Various kinds of diseases of microbial origin resulting from visits to a medical institution for the purpose of obtaining medical care, examination, or performing certain duties (work), have a single name - "nosocomial infection".

The definition of the World Health Organization (WHO) emphasizes that an infection is considered nosocomial (nosocomial) if its first manifestation took place at least two days after being in a medical institution. If symptoms are present at the time of admission and the incubation period is excluded, the infection is not considered hospital-acquired.

Origin

The main causative agents of nosocomial infections are:

1. Bacteria:

• staphylococcus;
• gram-positive coccal flora;
• intestinal and Pseudomonas aeruginosa;
• spore-bearing non-clostridial anaerobes;
• gram-negative rod-shaped flora (eg, Proteus, Salmonella, Morganella, Enterobacter Citrobacter, Yersinia);
• others.

2. Viruses:

• rhinoviruses;
• rotaviruses;
• viral hepatitis;
• flu;
• measles;
• chickenpox;
• herpes;
• respiratory syncytial infection;
• others.

• conditionally pathogenic;
• pathogenic.

4. Pneumocysts.

5. Mycoplasmas.

• pinworms;
• others.

Classification

There is a generally accepted classification of this type of infection. The main criteria in it are:

1. Ways of transmission of nosocomial infection:

• airborne (aerosol);
• water-alimentary;
• contact and instrumental (post-injection, operating, transfusion, endoscopic, transplant, dialysis, hemosorption, postpartum);
• contact and household;
• post-traumatic;
• others.

2. The nature and duration of the course:

• long-lasting;
• subacute;
• sharp.

3. Complexity of clinical treatment:

• lungs;
• medium;
• heavy.

4. Degree of infection spread:

4.1. Distributed throughout the body (septicemia, bacteremia, and others).

4.2. Localized:

• respiratory (eg, bronchitis);
• eye;
• infections of the skin and subcutaneous tissue (for example, associated with burns, etc.);
• ENT infections (otitis media and others);
• pathology of the digestive system (gastroenterocolitis, hepatitis, abscesses, etc.);
• infections of the reproductive system (for example, salpingo-oophoritis);
• urological (cystitis, urethritis, etc.);
• joint and bone infections;
• dental;
• infections of the cardiovascular system;
• diseases of the central nervous system.

Sources of nosocomial infections

Distributors of nosocomial infection are:

1) patients (especially those who are in the hospital for a long time), patients of a surgical hospital with chronic or acute forms of purulent-septic diseases;

2) health workers (patients and carriers of bacteria), this includes both doctors and nursing staff.

Visitors to the hospital are insignificant sources of nosocomial infections, but at the same time they can be sick with ARVI, and also be carriers of enterobacteria or staphylococci.

Propagation paths

How is nosocomial infection transmitted? Its distribution routes are as follows:

Airborne, or aerosol;

Contact and household;

Food grade;

Through the blood.

A nosocomial infection in a healthcare facility can also be transmitted through:

1. Objects that are directly associated with moisture (washstands, infusion fluids, drinking tanks, tanks containing antiseptics, disinfectants and antibiotics, water in flowerpots and pot holders, air conditioner humidifiers).
2. Contaminated instruments, various medical equipment, bedding, furniture in the ward (bed), items and materials for patient care (dressings, etc.), staff uniforms, hands and hair of patients and medical staff.

In addition, the risk of infection increases if a persistent source of nosocomial infections is present (for example, an unrecognized infection in a patient undergoing long-term treatment).

What is the reason for the increase in nosocomial infections?

In recent years, nosocomial infection has been gaining momentum: the number of registered cases in the Russian Federation has grown to sixty thousand per year. The reasons for such an increase in hospital infections can be both objective (which do not depend on the management and medical workers of medical institutions), and subjective. Let's 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 bacteriological doctors;
• there are no effective methods of treating a staphylococcal carrier, as well as conditions for hospitalization;
• contacts between patients and staff are becoming more frequent;
• an increase in the frequency of seeking medical help;
• increasing the number of people with low immunity.

Subjective causes of infection:

• there is no unified epidemiological approach to the study of nosocomial infections;
• insufficient level of preventive measures, as well as training of doctors and nurses;
• there are no ways of high-quality sterilization of certain types of equipment, insufficient control over the procedures being carried out;
• an increase in the number of undiagnosed carriers among healthcare workers;
• there is no complete and reliable record of nosocomial infections.

Risk group

Despite the level and qualifications of the medical institution, the personnel working there and the quality of the preventive measures carried out, almost everyone can become a source or target of nosocomial infection. But there are certain segments of the population, the body of which is most prone to infection.

These people include:

Mature patients;

Children under ten years of age (most often premature and immunocompromised);

Patients who have decreased immunobiological protection as a result of diseases associated with blood pathologies, oncology, autoimmune, allergic, endocrine diseases, as well as after prolonged operations;

Patients whose psychophysiological status has changed due to the ecological disadvantage of the territory of their residence and work.

In addition to the human factor, there are a number of dangerous diagnostic and therapeutic procedures, the implementation of which can provoke an increase in the number of nosocomial infections. As a rule, this is due to improper use of equipment and tools, as well as neglect in relation to the quality of implementation of preventive measures.

Surgical wound infections

Nosocomial surgical infection (CSI) occupies the lion's share of 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 rooms and dressing rooms through the hands of personnel and medical instruments.

The main risk factors for infection in surgical departments are:

The existence of a centralized operating unit;

Frequent use of invasive procedures;

Long-term operations;

Patients who are in a supine position for a long time after heavy operations.

Preventive measures

To reduce the risk of infection and the increase in hospital infections, multilateral preventive measures are needed. They are quite difficult to carry out for organizational, epidemiological, scientific and methodological reasons. To a greater extent, the effectiveness of the planned and carried out measures aimed at combating hospital infections depends on the planning of the healthcare facility 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 and hygienic and anti-epidemic measures.

These measures are associated with compliance with the conditions for the implementation of the sanitary maintenance of the entire medical institution, the equipment and tools used, compliance with the rules of personal hygiene of patients and medical workers.

General cleaning of wards and functional areas is performed once a month or more often if there are reasons for this. It includes thorough cleaning and disinfection of floors, walls, medical equipment, as well as dusting furniture, lighting fixtures, blinds and other possible items.

Wet cleaning of all rooms must be carried out at least twice a day, always using detergents, disinfectants and cleaning equipment, which has a special marking.

As for the general cleaning of premises such as the operating unit, maternity and dressing room, it must 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 operating time, it is necessary to disinfect the premises using stationary or mobile ultraviolet bactericidal lamps (1 W of power per 1 m 3 of the room).

In general, the prevention of nosocomial infections should provide one of the most important measures - a daily disinfection procedure. Its purpose is to destroy possible microorganisms in wards, equipment and instruments.

Hospital-acquired infections - order concerning the prevention of nosocomial infections

The governing bodies have always faced the problem of hospital infections. Today 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.

The system for tracking and preventing nosocomial infections has been developed over the years. And the service of epidemiologists of the Russian Federation was legalized only after the nineties (in 1993) simultaneously with Order No. 220 "On measures to develop and improve the infectious service in the Russian Federation." This document fixes the rules that are aimed at the development of infectious services and the prospects for improving the activities of medical institutions for this course.

At the moment, there are developed recommendation documents describing the necessary actions for the prevention of airborne and implantation infections.

Supervision of nosocomial infections

Infection control of nosocomial infections is epidemiological surveillance at the level of the country, city, district and in the conditions of individual medical institutions. That is, the process of constant monitoring and implementation, based on epidemiological diagnostics, 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 a nosocomial infection control program, it is necessary to properly develop:

The structure of management and distribution of functional responsibilities for control, which should include representatives of the administration of the medical institution, leading specialists, and the middle level of medical personnel;

The system of complete registration and accounting of nosocomial infections, which is focused on the timely detection and accounting of all purulent-septic pathologies;

Microbiological support of infection control on the basis of bacteriological laboratories, where high-quality research can be carried out;

The system of organizing preventive and anti-epidemic actions;

The current flexible system of training medical workers in infection control tasks;

Personnel health protection system.

According to the WHO definition, “nosocomial infection (nosocomial infection) is any clinically recognizable infectious disease that affects a patient as a result of his admission to a hospital or seeking treatment, or an infectious disease of a hospital employee due to his work in this institution, regardless of the onset of symptoms illness during or after hospital stay. " Nosocomial infections also include cases of the disease that have arisen not only as a result of a patient's stay in the hospital, but also as a result of infection during diagnostic and treatment procedures by medical personnel in outpatient clinics, as well as at home. hospital nos. Nosocomial infections all over the world, including our country, are an urgent problem of modern medicine. At least 5% of patients admitted to hospitals are exposed to nosocomial infection. In hospitals of various profiles, epidemic outbreaks of nosocomial infections periodically occur.

Etiology... Pathogens, depending on the degree of pathogenicity, are divided into obligate pathogenic and conditionally pathogenic. The role of obligate pathogenic microorganisms in the emergence of nosocomial infections is small. So, in non-infectious hospitals, several nosological forms caused by this group of pathogens are recorded - viral hepatitis B, C, D, HIV infection, influenza and other ARVI, herpes infection, acute intestinal viral infections. The most common causative agents of nosocomial infections are conditionally pathogenic microbes: aureus and epidermal staphylococcus, streptococcus, enterococcus, klebsiella, escherichia, enterobacter, proteus, etc.

Particularly great in the etiology of nosocomial infections is the role of hospital pathogens, which differ from non-hospital pathogens by high pathogenicity, multi-resistance to antibiotics and chemotherapy drugs, higher resistance to adverse environmental factors (drying, exposure to ultraviolet rays, disinfectants). The emergence of antibiotic-resistant pathogen strains is facilitated by their irrational use.

Epidemiology... Sources of nosocomial infection can be:

Medical personnel and carriers of hospital strains of pathogens suffering from certain infectious diseases (influenza, diarrhea, pustular skin lesions), who continue to work;

Patients with erased forms of diseases;

Patients with clean wounds, who are bacterial carriers of virulent strains of staphylococcus;

Babies with somatic pathology, emitting pathogenic strains of E. coli.

In the conditions of medical institutions, natural ("classic") mechanisms of transmission of infection operate: airborne, fecal-oral, contact and blood contact (viral hepatitis B, C, D, HIV infection).

The artifactual route of transmission of pathogens to health care facilities is due to a violation of the sterilization and disinfection regime of medical instruments, devices, non-observance of aseptic rules by personnel, and the administration of infected blood products to patients.

In connection with the widespread use of invasive interventions in the examination and treatment of patients, cases of infection of patients as a result of damage to the integrity of the mucous membranes and skin integuments when using contaminated instruments and equipment have become more frequent.

The spread of nosocomial infections is facilitated by:

Creation of large multidisciplinary hospital centers with a high density of patients and medical personnel who constantly and closely communicate with each other;

Formation of a powerful artificial (artifactual) factor of infection transmission associated with invasive interventions, medical and diagnostic procedures;

The constant presence of sources of infection (patients and medical staff - carriers of pathogens, as well as patients with erased forms of diseases);

Formation of hospital strains of pathogens with high pathogenicity and polyantibiotic resistance;

Congenital and acquired immunodeficiency in patients.

The most accessible and complete clinical and epidemiological characteristics of nosocomial infections are presented by A.P. Krasilnikov and A.I. Kondrusev (1987)

Classification of nosocomial infections

Clinic... Nosocomial infections caused by obligate pathogenic agents (viral hepatitis, dysentery, influenza, measles, etc.) have an appropriate ("classical") clinical picture, are quite easily recognized by practitioners and are hospitalized after their detection in infectious hospitals.

The main problem of modern practical medicine is nosocomial infections caused by conditionally pathogenic microorganisms.

The predisposing factors of nosocomial infections are:

Weakening of the macroorganism by the underlying disease, various diagnostic procedures, complex surgical interventions;

Long stay of patients in the hospital;

Excessive use of antibiotics, which alter the intestinal biocenosis, reduce the immunological resistance of the organism, contribute to the formation of antibiotic-resistant strains;

The widespread use of glucocorticosteroids, which reduce the body's resistance;

Hospitalization of a large number of elderly people, especially chronic patients, who are the source of nosocomial infections;

Hospital stay for children under one year old.

Depending on the prevalence of the pathological process, localized and generalized forms of nosocomial infections are distinguished.

Localized forms - infections of the skin and subcutaneous tissue, respiratory diseases (bronchitis, pneumonia), eye infections (conjunctivitis, keratitis), ENT infections (otitis media, rhinitis, sinusitis), infections of the digestive system (gastroenteritis, enteritis, colitis), uroinfections (pyelonephritis, cystitis , urethritis), etc.

Generalized forms, accompanied by bacteremia and viremia, most often occur in the elderly, as well as in infants and are atypical. So, premature infants and infants suffer from acute intestinal infections caused by enteropathogenic E. coli, staphylococci, salmonella, Pseudomonas aeruginosa. The association of conditionally pathogenic microbes (staphylococcus + Proteus + Pseudomonas aeruginosa) is especially dangerous, which causes the development of very severe destructive-necrotizing enterocolitis with intestinal paresis and symptoms of dynamic obstruction. Of the group of respiratory tract infections in hospitals, the most common are influenza, ARVI, staphylococcal lung lesions.

The elderly are particularly prone to developing pneumonia. The clinical picture of pneumonia in them can vary widely from typical symptoms such as fever, chills, cough with phlegm, to weaker and more vague symptoms such as malaise and confusion. Sputum production, like fever, may be absent or minimal at the height of the disease. The physical examination also sometimes fails.

Diagnosis of nosocomial infectionscaused by obligate pathogenic microorganisms is carried out taking into account the clinical picture, epidemiological anamnesis (contact with patients, group nature of diseases) and laboratory data. When identifying nosocomial infections caused by conditionally pathogenic flora, the length of hospital stay and other aggravating factors (patient age, severity of the underlying disease, deterioration of the patient's condition against the background of prolonged ineffective therapy) should be taken into account. For bacteriological confirmation of the diagnosis, the massive growth of the microorganism and repeated seeding are important.

Treatment... Therapy with nosocomial infections presents great difficulties, since the disease develops in a weakened organism, burdened by an underlying pathology. In each case, there must be an individual approach to treatment. The choice of antibacterial drugs and their combinations are carried out taking into account the sensitivity of microbes to them. Much attention must be paid to the patient's immune status and, if necessary, to use immunostimulants (thymogen, thymalin, T-activin, methyluracil, sodium nucleonate, etc.)

Prevention... Responsibility for the organization and implementation of a complex of sanitary and anti-epidemic measures in nosocomial infections rests with the chief physician of a medical and preventive institution (LPU). To coordinate the work in each hospital, a permanent commission is created under the leadership of the deputy chief physician for medical affairs. The main function of this commission is to control the registration and accounting of hospital infections, and to carry out measures to prevent them. This commission works in contact with the Sanitary and Epidemiological Service.

Measures to prevent the introduction of nosocomial infections into the hospital are carried out by all departments of the healthcare facility. When sending a patient to a hospital, the doctor, in addition to the diagnosis and passport data, must reflect the following information:

Contact with infectious patients;

Information about infectious diseases transferred in the past;

Information about the patient's stay outside the permanent place of residence.

In the admission department, it is necessary to observe measures to prevent the introduction of infection into the hospital, namely:

Individual reception of the patient;

Thorough collection of epidemiological anamnesis;

Full examination of the patient to establish a diagnosis;

If necessary, the use of paraclinical methods of examination of the patient.

After establishing the diagnosis of an infectious disease or suspicion of it, the patient must be immediately isolated and an emergency notification must be filled in according to F. No. 058y.

When children are hospitalized, the main attention should be paid to preventing the introduction of volatile airborne infections into the hospital (measles, chickenpox, mumps infection, etc.). Therefore, it is imperative to find out information about the above listed infections, which rarely recur, about preventive vaccinations made earlier, the presence of contact with infectious patients at the place of residence and in children's groups.

Even with the ideal operation of the admission department, infections can be brought into any hospital by patients with diseases during the incubation period, carriers of infection, patients with erased forms of the disease. In this regard, treatment departments should be ready to organize measures to localize the focus and prevent the spread of an infectious disease in the hospital.

In order to prevent the introduction of infections into the hospital, the personnel working in it, especially nurses, take the following measures:

Examination and laboratory examination of newcomers to work;

Periodic medical and laboratory control of permanent employees;

Change of home clothes and footwear by personnel to work clothes before starting work in the department;

Briefing on the implementation of the sanitary and anti-epidemic regime with the periodic delivery of the standards of the sanitary minimum;

Strict assignment of personnel to the department;

Carrying out preventive vaccinations according to indications (against viral hepatitis, diphtheria).

To eliminate the artifactual route of transmission of nosocomial pathogens, it is of particular importance to thoroughly disinfect medical instruments, dressings, etc. in the CSO. Disposable instruments (syringes, needles, systems for transfusion of blood and solutions) should be used whenever possible. When carrying out parenteral manipulations, a nurse, in addition to working clothes, must use rubber gloves and a mask. If the hands are contaminated with blood or other biological fluid, the nurse should treat them with disinfectants and wash them with soap and water (see "HIV infection").

Nurses who, by the nature of their work, have contact with blood or its components, are subject to examination for HB S Ag and anti-HCV and vaccination against viral hepatitis B with the Engerix B vaccine

The spread of infectious diseases in the hospital is also hindered by the observance of the sanitary and epidemiological regime, the careful implementation of disinfection and sterilization measures. An important role in the prevention of nosocomial infections is played by measures to reduce the number of medical invasive interventions and blood transfusions.

A comprehensive approach to the prevention of nosocomial infections should be determined by close cooperation between clinicians and epidemiologists.

test questions

1. What does the concept of nosocomial infections include?

2. What pathogens are caused by nosocomial infections?

3. Who is the source of infection in nosocomial infections?

4. The mechanism of infection with nosocomial infections.

5. What contributes to the spread of nosocomial infections?

6. Predisposing factors of nosocomial infections.

7. Clinical manifestations of nosocomial infections.

8. Measures for the prevention of nosocomial infections at the prehospital and hospital stages.

9. Measures of prophylaxis of nosocomial infections by medical staff.