Hospital-acquired infection. Hospital infection Synonym for hospital-acquired infections

A nosocomial infection (or nosocomial infection for short) is any infection or viral disease, the infection of which occurred during a long stay in a medical facility, as well as immediately after the patient was discharged from it. Joining the underlying disease, a nosocomial infection can greatly harm the patient. First, it can reduce the effectiveness of previous treatments aimed at treating the underlying disease. And, secondly, it can increase the duration of the treatment process and the recovery period after it.

What viruses cause nosocomial infections?

The bulk of all nosocomial infections studied to date are the result of the activity of such opportunistic pathogens as: staphylococcus aureus, salmonella, streptococcus, E. coli, enterococcus and candida. In the same way, in the hospital, you can get infected with the influenza virus, rota-, adeno-, enterovirus infections, chickenpox, paratitis, measles, diphtheria, hepatitis, stomatitis, sinusitis, angina, diphtheria, tuberculosis, cystitis, meningitis, gastritis and any other infectious disease ...

Why is nosocomial infection becoming more common?

The increase in the incidence of nosocomial infections has several factors and external causes, including:

• general demographic changes towards the aging of our society;
• decrease in the level of well-being of society;
• an increase in the number of people with low social status and leading an immoral lifestyle;
• an increase in the number of people with congenital defects or acquired chronic diseases;
• the introduction of serious and very complex invasive methods of treatment and diagnostics into our healthcare;
• violation of sanitary and hygienic regimes;
• uncontrolled use of antibiotics;
• the use of immunostimulating drugs;
• widespread use of disinfectants and antiseptics.

I would like to talk in more detail about the last three factors provoking the development of nosocomial infections. Many of you will probably say that antibiotics, disinfection and antiseptics should not be the reasons for the development of nosocomial infections, but ways to combat them. Of course, this is true, but .... The fact is that all microorganisms, including pathogenic ones (fungi, bacteria and viruses) can mutate and evolve. The more we come up with various methods of dealing with these organisms, the faster and more strongly they change. With any disease, often even with a common cold, we drink antibiotics and immunostimulating drugs, poison and thereby weaken our body, and viruses only become stronger. We are increasingly using antibacterial and disinfectants, and viruses are spreading more and more. Here is such a "double-edged sword" ...

Hospital-acquired infection. Where can you get infected?

Infection with a nosocomial infection can occur after visiting a medical institution of any type, both outpatient (polyclinics, consultations, dispensaries, ambulance stations) and inpatient (clinics, hospitals, sanatoriums, boarding houses, maternity hospitals, hospitals). However, due to the specifics of implementation diagnostic and therapeutic measures, the most likely spread of nosocomial infections in inpatient medical institutions, especially in the departments of surgery, urology, oncology, gynecology, in burn departments, in intensive care, traumatology and intensive care units, as well as in maternity hospitals and pediatric hospitals.

Dangerous, from the point of view of the high probability of infection with nosocomial infections, are such diagnostic measures as blood sampling, puncture, endoscopy, intubation, vaginal examinations, and so on. Of the therapeutic, the most dangerous are: surgical operations, transplants, transfusions, injections, inhalation, intubation, hemodialysis and similar events.

What are the ways of transmitting nosocomial infections?

Infection of a patient with a nosocomial infection occurs in one of the following ways:

• contact household (non-sterile tools and household items);
• airborne;
• implantation (non-sterile materials, implants and prostheses);
• alimentary (poor quality hospital food and water);
• transmissible (bites of infected insects);
• parenteral (administration of infected blood, solution, or drug);
• vertical (from mother to child during childbirth).

Hospital-acquired infection. Who can become a source of infection?

The source of infection inside the hospital can be:

• the doctors themselves and any of the medical workers who have a latent nature of the disease;
• patients being treated;
• rarely, visitors.

Who is at risk for nosocomial infection?

The risk group includes the following categories of people:

• women in labor and newly born children;
• elderly people;
• people with various chronic diseases;
• people with immunodeficiency and oncopathology.

Susceptibility to nosocomial infections is greatly increased if:

• the patient is in the hospital for a long time;
• he has a need for invasive medical procedures using various devices (drains, catheters, syringes, scalpels, etc.);
• antibiotic treatment is performed;
• immunosuppressive therapy is performed (deliberate suppression of the body's immune response).

Hospital-acquired infection. How to treat?

The complexity of the nosocomial infection process lies in the fact that a nosocomial infection develops against the background of the underlying disease in a strongly weakened organism, partially accustomed to traditional pharmacological drugs, which it has been stuffed with for some time.

Any patient diagnosed with nosocomial infections is immediately isolated. A thorough disinfection is carried out in the room where the patient was previously located. And with the patient himself, the necessary symptomatic and antibiotic therapy is carried out, taking into account the clinical picture of the disease.

Hospital-acquired infection. How can you protect yourself?

The main methods of prevention of nosocomial infections by medical personnel:

• compliance with all anti-epidemic and necessary sanitary and hygienic requirements;
• sterilization of all medical instruments and apparatus;
• disinfection of all premises;
• antiseptic;
• compliance with personal protective measures (wearing gloves, masks, gowns, hand disinfection);
• team vaccination;
• regular scheduled dispensary examination of all honey. workers;
• epidemiological control.

The main methods of prevention of nosocomial infections by the patient:

• compliance with the rules of hospital stay (wearing certain clothes, visiting relatives, going out, etc.);
• compliance with the rules of personal hygiene (constant hand washing);
• compliance with personal protective measures (wearing masks);
• using your own linen and dishes;
• refusal of close contact and communication with other patients;
• close attention to the actions of the medical staff (use of sterile instruments, gloves, devices);
• increasing the resistance of your body (a healthy lifestyle, sports, avoiding antibiotics and not frequent use of disinfectants in your home).

Every year in our country, more than a million people become victims of nosocomial infection. It is surprising that against the background of the overall improvement in the quality of life and the development of medical technologies, the likelihood of infection in medical institutions is very high. However, this is not always the result of poor conditions in hospitals and negligence of the medical staff, it is often a "side effect" of the too progressive modern world.

Nosocomial infection (nosocomial infection) is called any infectious disease, infection of which occurred in a medical institution. Since the middle of the 20th century, nosocomial infections have been a major health problem in various countries of the world. Their causative agents have a number of characteristics due to which they successfully live and reproduce in a hospital environment. According to official data, annually in the Russian Federation, up to 8% of patients become infected with nosocomial infections, which is 2-2.5 million people a year. However, the statistical method of accounting is imperfect and a number of researchers believe that the real incidence is dozens of times higher than the declared one.

The concept of nosocomial infection combines a large number of different diseases, which leads to difficulties in its classification. The generally accepted approaches to the division of nosocomial infections are etiological (according to the pathogen) and localization of the process:

Causative agents

Nosocomial infections are caused by bacteria, viruses and fungi. Only a small part of them belong to pathogenic microorganisms, much more important are opportunistic microorganisms. They live on the skin and mucous membranes of a person normally, and they acquire disease-causing only when the immune defense is reduced. Immunity reacts weakly to the presence of conditionally pathogenic flora in the body, since its antigens are familiar to it and do not cause a powerful production of antibodies. Often, pathogens form various associations of several types of bacteria, viruses, fungi.

The list of causative agents of nosocomial infections is constantly growing, today the following types are of greatest importance:

Conditionally pathogenic microflora:	Pathogenic microflora:
(golden, epidermal);	Hepatitis B, C viruses;
(groups A, B, C);	;
Enterobacteriaceae;	;
E. coli;	;
;	;
Proteus;	(for people who have not had chickenpox in childhood and children);
(pseudomonad);	Salmonella;
Acinetobacters;	Shigella;
Pneumocyst;	Clostridia;
Toxoplasma;	;
Cryptococcus;	.
Candida.

The listed microorganisms have one of the mechanisms of wide distribution and high infectivity. As a rule, they have several transmission routes, some are able to live and reproduce outside of a living organism. The smallest particles of viruses are easily carried throughout the hospital through ventilation systems and in a short time infect a large number of people. Overcrowding, close contact, weakened patients - all these factors contribute to the onset of an outbreak and maintain it for a long time.

Bacteria and fungi are less contagious, but they are extremely resistant in the external environment: not amenable to the action of disinfectants, ultraviolet radiation. Some of them form spores that do not die even after prolonged boiling, soaking in disinfectants, or freezing. Free-living bacteria successfully multiply in humid environments (on sinks, in humidifiers, containers with disinfectants), which for a long time maintain the activity of the nosocomial infection focus.

The causative agents of nosocomial infections are usually called the "hospital strain". Such strains periodically replace each other, which is associated with the antagonistic relations of bacteria (for example, Pseudomonas aeruginosa and staphylococcus), a change in disinfectants, equipment renewal, and the introduction of new treatment regimens.

Epidemiological process

Sources of infection are sick people and asymptomatic carriers of the pathogen. Most often they are found among patients, somewhat less often among staff, and very rarely hospital visitors become a source. The role of the latter is insignificant due to the restriction of hospital visits, the organization of meeting places in the foyer, and not in hospital wards. The transmission of pathogens occurs in various ways:

a) Natural ways of spread:

• Horizontal:
  1. fecal-oral;
  2. contact;
  3. airborne;
  4. air-dust;
  5. food.
• Vertical - across the placenta from mother to fetus.

b) Artificial (artifical) ways of distribution:

• Associated with parenteral interventions (injections, blood transfusions, organ and tissue transplants).
• Associated with medical and diagnostic invasive procedures (artificial ventilation of the lungs, endoscopic examination of body cavities, laparoscopic intervention).

In terms of the frequency of outbreaks of nosocomial infection, the leaders are:

1. Maternity;
2. Surgical hospitals;
3. Intensive care and intensive care units;
4. Therapeutic hospitals;
5. Children's departments.

The morbidity structure depends on the hospital profile. So, in surgery, purulent-septic infections come out on top, in therapy - in urological hospitals - infections of the urinary system (due to the use of catheters).

The infectious process develops when the patient has diseases that aggravate his condition. There are groups of patients susceptible to nosocomial infections:

• Newborns;
• Elderly people;
• Emaciated;
• Patients with chronic pathology (diabetes mellitus, heart failure, malignant tumors);
• Long-term receiving antibiotics and antacids (reducing the acidity of gastric juice);
• HIV-infected;
• People who have undergone a course of chemotherapy / radiation therapy;
• Patients after invasive procedures;
• Patients with burns;
• Alcoholics.

The incidence of nosocomial infections is outbreak or sporadic, that is, one or more cases of the disease occur at the same time. The sick are connected by being in the same room, using common instruments, sharing hospital food, using a common sanitary room. Outbreaks have no seasonality; they are recorded at any time of the year.

Prevention of nosocomial infections

Prevention of nosocomial infections is the most effective way to solve the problem. For the treatment of nosocomial infection, the most modern antibiotics are needed, to which microorganisms have not had time to develop resistance. Thus, antibiotic therapy turns into an endless race, in which the possibilities of humanity are very limited.

The state of affairs was understood by the doctors of the last century, in connection with which in 1978 the USSR Ministry of Health issued, which fully regulates the prevention of nosocomial infections and operates on the territory of the Russian Federation to this day.

The most important link in preventing the spread of hospital strains is nursing certification. The nursing staff is directly involved in patient care, invasive manipulations, disinfection and sterilization of objects in the hospital environment. Only strict observance of sanitary rules in medical institutions significantly reduces the frequency of outbreaks of nosocomial infection.

Prevention measures include:

With the development of the pharmaceutical and chemical industries, the problem of nosocomial infections has become incredible. Inadequate prescription of antibiotics, the use of more and more powerful disinfectants in excessive / insufficient concentrations lead to the emergence of super-resistant strains of microorganisms. There are cases when, due to an aggressive and resistant strain of staphylococcus, entire hospital buildings were indulged in fire - there were no more gentle ways to cope with the bacteria. The problem of nosocomial infection is a kind of reminder to mankind of the power of microorganisms, their ability to adapt and survive.

Video: how do nosocomial infections develop?

The concept of nosocomial infection (nosocomial infection). The emergence of antibiotic-resistant forms of microorganisms both in the macroorganism and in the external environment led to the emergence of the problem of nosocomial hospital infection in clinical surgery.

Definition. Nosocomial (nosocomial) infection is an infectious disease that arose as a result of infection in a hospital, regardless of the period of onset of symptoms of the disease (during treatment or after discharge); as well as illness of medical workers resulting from infection in a hospital. A nosocomial infection is an infection that was contracted in a health care facility.

According to the WHO, nosocomial infection (nosocomial infection) occurs on average in 8.4% of patients. According to various authors in Russia and Ukraine, it ranges from 2.9 to 10.2%. The most vulnerable are children under one year old and people over 65 years of age. In the structure of nosocomial infections of surgical hospitals, in the first place is wound infection (postoperative purulent-septic complications), then respiratory tract infections (bronchitis, pneumonia), especially in intensive care units, and urinary tract infections. In the United States, surgical wound infections account for 29% of hospital infections, urinary tract infections 45%, and pneumonia 19%.

VBI is divided into two groups:

• I - caused by obligatory pathogenic microorganisms and associated with the introduction of the pathogen into the hospital (carrier of bacteria), or infection of personnel when working with infectious material (childhood infections - measles, rubella, chickenpox; intestinal diseases - salmonellosis, dysentery; hepatitis B, C). Their share is 15%.
• Group II of diseases caused by opportunistic microorganisms is 85%. Among the pathogens, Staphylococcus, Streptococcus, Klebsiella, Proteus, Escherichia coli, Candida fungi dominate.

Nosocomial infections, as a rule, are caused by hospital strains of microorganisms with multiple drug resistance, high virulence and resistance to unfavorable factors - drying, the action of ultraviolet rays, disinfectants. In the departments of purulent surgery, cross-infection with certain pathogens is possible.

It should be noted that for each hospital, the isolation of the causative agent of a nosocomial infection is strictly specific and is not constant (after a while it changes under the influence of antibiotics, preventive measures taken, compliance with the rules of asepsis and antiseptics).

WBI transmission ways:

• 1 - airborne (spread of staphylococcus, streptococcus through aerosols in physiotherapy rooms, through air conditioners with humidification, ventilation systems, as well as through pillows, bedspreads, mattresses);
• 2 - the contact-household route is carried out through bed linen, breathing apparatus, wet brushes, expressed breast milk, infected hands of staff. It is important in the transmission of gram-negative bacteria.
• 3 - food (violation of food preparation technology, personnel carrying bacteria, infected expressed milk when feeding)
• 4 - artificial or artifactual pathway associated with diagnostic interventions (placement of intravenous, urinary, gastric catheters, fibrogastroscopy, colonoscopy, etc.)
• 5 - parenteral - through contaminated blood products.

The most susceptible to the disease are procedural nurses, employees of the intensive care unit, hemodialysis, blood transfusion stations, personnel associated with pre-sterilization cleaning and sterilization of instruments and linen contaminated with blood or other secrets. The economic damage caused by nosocomial infections is large and consists of the costs of auxiliary treatment, diagnostics, and an increase in the duration of treatment. Social losses - in an increase in mortality and disability.

An important role in the prevention of nosocomial infections is played by nursing staff, whose duties include:

• - Compliance with the rules of asepsis at work;
• - Use of changeable clothes and shoes;
• - Work in dressing masks, hats, gloves;
• - Treatment of the dressing table after each patient;
• - Pre-sterilization processing of instruments;
• - Sterilization of patient care items;
• - Compliance with the order of dressings (first "clean", and then purulent);
• - Work in gloves with blood products and when taking blood;
• - Compliance with the rules of asepsis when caring for catheters;
• - Checking the correct storage of food in refrigerators and nightstands daily.

Violation of the rules of sanitary hygiene and patient care in the department of purulent surgery confirms the rule: "There are no trifles in surgery."

GOU VPO First MGMU im. THEM. Sechenov

Department of Epidemiology

"Epidemiological features of nosocomial infections"

Performed:

Moscow 2010

Hospital-acquired infections:

(concept, prevalence, ways and factors of transmission, risk factors, prevention system)

Nosocomial infection (nosocomial, hospital, hospital) - any clinically expressed disease of microbial origin that affects the patient as a result of his admission to the hospital or seeking medical help, as well as the illness of a hospital employee due to his work in this institution, regardless of the appearance of symptoms of the disease during stay or after discharge from hospital (WHO Regional Office for Europe, 1979).

Despite advances in health care, the problem of nosocomial infections remains one of the most acute in modern conditions, gaining more and more medical and social significance. According to a number of studies, the mortality rate in the group of hospitalized and acquired nosocomial infections is 8-10 times higher than that among those hospitalized without nosocomial infections.

Damage, associated with nosocomial morbidity, consists of the lengthening of the patient's stay in the hospital, an increase in mortality, as well as purely material losses. However, there is also social damage that cannot be estimated by value (disconnection of the patient from the family, work, disability, deaths, etc.). In the United States, the economic damage associated with nosocomial infections is estimated at $ 4.5-5 billion annually.

Etiological nature VBI is determined by a wide range of microorganisms (more than 300), which include both pathogenic and opportunistic flora, the border between which is often quite blurred.

Nosocomial infection is due to the activity of those classes of microflora, which, firstly, is found everywhere and, secondly, a pronounced tendency to spread is characteristic. Among the reasons explaining this aggressiveness are the significant natural and acquired resistance of such microflora to damaging physical and chemical factors of the environment, simplicity in the process of growth and reproduction, close relationship with normal microflora, high contagion, the ability to form resistance to antimicrobial agents.

The mainthe most important causative agents of nosocomial infections are:

gram-positive coccal flora: genus Staphylococcus (Staphylococcus aureus, epidermal staphylococcus), genus Streptococcus (pyogenic streptococcus, streptococcus pneumoniae, enterococcus);

gram-negative bacilli: a family of enterobacteria of 32 genera and the so-called non-fermenting gram-negative bacteria (NGOB), the most famous of which is Pseudomonas aeruginosa (Ps. aeruginosa);

opportunistic and pathogenic fungi: genus of yeast-like fungi Candida (Candida albicans), molds (aspergillus, penicilli), causative agents of deep mycoses (histoplasm, blastomycetes, coccidiomycetes);

viruses: causative agents of herpes simplex and chickenpox (herp viruses), adenovirus infection (adenoviruses), influenza (orthomyxoviruses), parainfluenza, mumps, RS infections (paramyxoviruses), enteroviruses, rhinoviruses, reoviruses, rotaviruses, causative agents of viral hepatitis.

Currently, the most relevant are such etiological agents of nosocomial infections as staphylococci, gram-negative opportunistic bacteria and respiratory viruses. Each medical institution has its own spectrum of leading nosocomial pathogens, which can change over time. For example, in:

in large surgical centers, the leading pathogens of postoperative nosocomial infections were aureus and epidermal staphylococci, streptococci, Pseudomonas aeruginosa, enterobacteria;

burn hospitals - the leading role of Pseudomonas aeruginosa and Staphylococcus aureus;

in children's hospitals, the drift and spread of children's droplet infections - chickenpox, rubella, measles, mumps, are of great importance.

In the departments of newborns, for immunodeficient, hematological patients and HIV-infected patients, herpes viruses, cytomegaloviruses, candida fungi and pneumocysts are especially dangerous.

Sources of nosocomial there are patients and bacteria carriers from among patients and personnel of medical institutions, among which the greatest danger is:

medical personnel belonging to the group of long-term carriers and patients with erased forms;

long-term inpatients, who often become carriers of resistant nosocomial strains. The role of hospital visitors as sources of nosocomial infections is extremely insignificant.

Ways and factors of transmission of nosocomial infections are very diverse, which significantly complicates the search for the causes of occurrence.

These are contaminated instruments, respiratory and other medical equipment, linen, bedding, mattresses, beds, surfaces of “wet” objects (taps, sinks, etc.), contaminated solutions of antiseptics, antibiotics, disinfectants, aerosols and other drugs, care items patients, dressing and suture material, endoprostheses, drains, transplants, blood, blood substitutes and blood substitutes, overalls, shoes, hair and hands of patients and staff.

In the hospital environment, the so-called. secondary, epidemically dangerous reservoirs of pathogens, in which the microflora survives for a long time and multiplies. These reservoirs can be liquid or moisture-containing objects - infusion fluids, drinking solutions, distilled water, hand creams, water in flower vases, humidifiers for air conditioners, showers, drain drains and water seals, handwashing brushes, some parts of medical diagnostic devices and devices, and even disinfectants with an underestimated concentration of the active agent.

Depending on the ways and factors of transmission of nosocomial infections classify in the following way:

airborne (aerosol);

water-alimentary;

contact and household;

contact-instrumental:

1) post-injection;

2) postoperative;

3) postpartum;

4) post-transfusion;

5) post-endoscopic;

6) post-transplant;

7) post-dialysis;

8) post-hemisorption.

post-traumatic infections;

other forms.

Clinical classifications of nosocomial infections suggest their division, firstly, into two categories depending on the pathogen: diseases caused by obligate pathogenic microorganisms, on the one hand, and opportunistic pathogens, on the other, although this division, as noted, is largely arbitrary. Secondly, depending on the nature and duration of the course: acute, subacute and chronic, thirdly, in terms of severity: severe, moderate and mild forms of the clinical course. And finally, fourthly, depending on the extent of the process:

1. Generalized infection: bacteremia (viremia, mycemia), sepsis, septicopyemia, infectious toxic shock.

2. Localized infections:

2.1 Infections of the skin and subcutaneous tissue (infections of wounds, post-infectious abscesses, omphalitis, erysipelas, pyoderma, paraproctitis, mastitis, dermatomycosis, etc.).

2.2 Respiratory infections (bronchitis, pneumonia, pulmonary abscess and gangrene, pleurisy, pleural empyema, etc.).

2.3 Eye infection (conjunctivitis, keratitis, blepharitis, etc.).

2.4 ENT infections (otitis media, sinusitis, rhinitis, tonsillitis, pharyngitis, epiglottitis, etc.).

2.5 Dental infections (stomatitis, abscess, alveolitis, etc.).

2.6 Infections of the digestive system (gastroenterocolitis, cholecystitis, peritoneal abscess, hepatitis, peritonitis, etc.).

2.7 Urological infections (bacteriuria, pyelonephritis, cystitis, urethritis).

2.8 Infections of the reproductive system (salpingo-oophoritis, endometritis, prostatitis, etc.).

2.9 Infection of bones and joints (osteomyelitis, arthritis, spondillitis, etc.).

2.10 CNS infection (meningitis, myelitis, brain abscess, ventriculitis).

2.11 Infections of the cardiovascular system (endocarditis, myocarditis, pericarditis, phlebitis, infections of the arteries and veins, etc.).

Of the “traditional” infectious diseases, the greatest danger of nosocomial spread is diphtheria, whooping cough, meningococcal infection, escherichiosis and shigellosis, legionellosis, Helicobacteriosis, typhoid fever, chlamydia, listeriosis, Hib infection, rotavirus and cytomegalovirus infections, viral infections and various forms of candidiasis , cryptosporidiosis, enteroviral diseases.

At present, the danger of transmission of blood-borne infections in health care facilities is of great importance: viral hepatitis B, C, D, HIV infection (not only patients but also medical personnel suffer). The special significance of blood-borne infections is determined by the unfavorable epidemic situation for them in the country and the growing invasiveness of medical procedures.

Prevalence of nosocomial infections

It is generally recognized that there is a pronounced under-registration of nosocomial infections in Russian health care; officially, 50-60 thousand patients with nosocomial infections are detected annually in the country, and the indicators are 1.5-1.9 per thousand patients. It is estimated that about 2 million cases of nosocomial infections actually occur in Russia per year.

In a number of countries where the registration of nosocomial infections has been established satisfactorily, the general incidence rates of nosocomial infections are as follows: USA - 50-100 per thousand, the Netherlands - 59.0, Spain - 98.7; indices of urological nosocomial infections in patients with urinary catheter - 17.9 - 108.0 per thousand catheterizations; indicators of postoperative nosocomial infections - from 18.9 to 93.0.

VBI structure and statistics

Currently, the leading place in multidisciplinary healthcare facilities is occupied by purulent-septic infections (75-80% of all nosocomial infections). Most often, GSI is recorded in patients with a surgical profile. Especially in the departments of emergency and abdominal surgery, traumatology and urology. For the majority of GSIs, the leading transmission mechanisms are contact and aerosol.

The second most important group of nosocomial infections is intestinal infections (8-12% in the structure). Nosocomial salmonellosis and shigellosis in 80% are detected in debilitated patients of the surgical and intensive care unit. Up to a third of all nosocomial infections of salmonella etiology are registered in pediatric departments and hospitals for newborns. Nosocomial salmonellosis tend to form outbreaks, most often caused by S. typhimurium serovar II R, while salmonella secreted from patients and from environmental objects is highly resistant to antibiotics and external factors.

The share of blood-borne viral hepatitis (B, C, D) in the structure of nosocomial infections is 6-7%. Patients who undergo extensive surgical interventions with subsequent blood transfusions, patients after hemodialysis (especially chronic programmatic), patients with massive infusion therapy are most at risk of infection. During serological examination of patients of various profiles, markers of blood-borne hepatitis are detected in 7-24%.

A special risk group is represented by medical personnel whose work is associated with the performance of surgical interventions, invasive manipulations and contact with blood (surgical, anesthetic, resuscitation, laboratory, dialysis, gynecological, hematological units, etc.). The carriers of markers of these diseases in these units are from 15 to 62% of the personnel, many of them suffer from chronic forms of hepatitis B or C.

Other infections in the structure of nosocomial infections account for 5-6% (RVI, hospital mycoses, diphtheria, tuberculosis, etc.).

In the structure of the incidence of nosocomial infections, a special place is occupied by outbreaks these infections. Outbreaks are characterized by the massiveness of diseases in one healthcare facility, the action of a single pathway and common transmission factors in all patients, a large percentage of severe clinical forms, high (up to 3.1% mortality, and frequent involvement of medical personnel (up to 5% among all cases). outbreaks of nosocomial infections were detected in obstetric institutions and departments of neonatal pathology (36.3%), in psychiatric adult hospitals (20%), in somatic departments of children's hospitals (11.7%). By the nature of pathology, intestinal infections predominated among outbreaks (82.3 % of all outbreaks).

Causes and factors of the high incidence of nosocomial infections in medical institutions.

Common reasons:

the presence of a large number of sources of infection and conditions for its spread;

decrease in the resistance of the patient's body with complicating procedures;

shortcomings in the location, equipment and organization of the health care facility.

Factors of particular importance at the present time

1. Selection of multidrug-resistant microflora, which is due to irrational and unreasonable use of antimicrobial drugs in health care facilities. As a result, strains of microorganisms with multiple resistance to antibiotics, sulfonamides, nitrofurans, disinfectants, skin and therapeutic antiseptics, and UV radiation are formed. The same strains often have altered biochemical properties, colonize the external environment of medical facilities and begin to spread as hospital strains, mainly causing nosocomial infections in a particular medical institution or medical department.

2. Formation of bacteria carriers. In the pathogenetic sense, carriage is one of the forms of the infectious process in which there are no pronounced clinical signs. It is now believed that carriers of bacteria, especially among medical personnel, are the main sources of nosocomial infections.

If among the population carriers of S. aureus among the population, on average, make up 20-40%, then among the personnel of surgical departments - from 40 to 85.7%.

3. An increase in the number of contingents at risk of nosocomial infections, which is largely due to advances in healthcare in recent decades.

Among hospitalized and outpatient patients, the share of:

elderly patients;

young children with reduced body resistance;

premature babies;

patients with a wide variety of immunodeficiency states;

unfavorable premorbid background due to the influence of unfavorable environmental factors.

As the most significant reasons for the development of immunodeficiency states distinguish: complex and prolonged operations, the use of immunosuppressive medications and manipulations (cytostatics, corticosteroids, radiation and radiotherapy), long-term and massive use of antibiotics and antiseptics, diseases leading to a violation of immunological homeostasis (lesions of the lymphoid system, oncological processes, tuberculosis, diabetes mellitus, collagenoses, leukemia, hepatic renal failure), old age.

4. Activation of artificial (artifactual) mechanisms of transmission of nosocomial infections, which is associated with the complication of medical technology, a progressive increase in the number of invasive procedures using highly specialized devices and equipment. Moreover, according to WHO, up to 30% of all procedures are not justified.

The most dangerous in terms of transmission of nosocomial infections are the following manipulations:

diagnostic: blood sampling, probing of the stomach, duodenum, small intestine, endoscopy, puncture (lumbar, sternal, organs, l / nodes), biopsies of organs and tissues, venesection, manual examinations (vaginal, rectal) - especially if there are erosions on the mucous membranes and ulcers;

therapeutic: transfusion (blood, serum, plasma), injections (from subcutaneous to intravenous), tissue and organ transplantation, operations, intubation, inhalation anesthesia, mechanical ventilation, catheterization (vessels, bladder), hemodialysis, inhalation of medicinal aerosols , balneological treatment procedures.

5. Incorrect architectural and planning decisions of medical institutions, which leads to the intersection of “clean” and “dirty” flows, lack of functional isolation of units, favorable conditions for the spread of strains of nosocomial pathogens.

6. Low efficiency of medical and technical equipment of medical institutions. Here the main things are:

insufficient material and technical equipment with equipment, instruments, dressings, medicines;

insufficient set and area of \u200b\u200bpremises;

disturbances in the supply and exhaust ventilation;

emergency situations (on the water supply system, sewerage system), interruptions in the supply of hot and cold water, disruptions in heat and power supply.

7. Lack of medical personnel and unsatisfactory training of health care personnel on the prevention of nosocomial infections.

8. Failure by the staff of medical institutions to comply with the rules of hospital and personal hygiene and violation of the regulations of the sanitary and anti-epidemic regime.

System of measures for the prevention of nosocomial infections.

I. Non-specific prevention

1. Construction and reconstruction of inpatient and outpatient polyclinic institutions in compliance with the principle of rational architectural and planning solutions:

isolation of sections, wards, operating units, etc .;

observance and separation of flows of patients, personnel, “clean” and “dirty” flows;

rational placement of departments on floors;

correct zoning of the territory.

2. Sanitary and technical measures:

effective artificial and natural ventilation;

creation of regulatory conditions for water supply and wastewater disposal;

correct air supply;

air conditioning, laminar flow systems;

creation of regulated parameters of microclimate, lighting, noise regime;

compliance with the rules for the accumulation, neutralization and disposal of waste from medical institutions.

3. Sanitary and anti-epidemic measures:

epidemiological surveillance of nosocomial infections, including analysis of the incidence of nosocomial infections;

control over the sanitary and anti-epidemic regime in medical institutions;

the introduction of a hospital epidemiologist service;

laboratory control of the state of the anti-epidemic regime in medical institutions;

identification of bacteria carriers among patients and staff;

compliance with the norms of accommodation of patients;

inspection and admission of personnel to work;

rational use of antimicrobial drugs, primarily antibiotics;

training and retraining of personnel on the regime in health care facilities and prevention of nosocomial infections;

sanitary and educational work among patients.

4. Disinfection and sterilization measures:

the use of chemical disinfectants;

application of physical methods of disinfection;

pre-sterilization cleaning of instruments and medical equipment;

ultraviolet bactericidal irradiation;

chamber disinfection;

steam, dry air, chemical, gas, radiation sterilization;

pest control and deratization.

II. Specific prevention

1. Routine active and passive immunization.

2. Emergency passive immunization.

Obstetric hospitals

According to selective studies, the real incidence of nosocomial infections in obstetric hospitals reaches 5-18% of newborns and from 6 to 8% of puerperas.

In the etiological structure, Staphylococcus aureus predominates; in recent years, there has been a tendency towards an increase in the importance of various gram-negative bacteria. It is gram-negative bacteria that, as a rule, cause outbreaks of nosocomial infections in maternity wards. Also, the value of St. epidermidis.

The division of “risk” is the department of premature babies, where, in addition to the above pathogens, diseases caused by fungi of the genus Candida are often found.

Most often in obstetric departments there are nosocomial infections of the purulent-septic group, outbreaks of salmonellosis are described.

For nosocomial infections of newborns, a variety of clinical manifestations is characteristic. Purulent conjunctivitis, suppuration of the skin and subcutaneous tissue predominate. Intestinal infections caused by opportunistic flora are often observed. More rarely omphalitis and phlebitis of the umbilical vein are found. Generalized forms (purulent meningitis, sepsis, osteomyelitis) account for up to 0.5-3% in the structure of nosocomial infections of newborns.

The main sources of staphylococcal infection are carriers of hospital strains among medical personnel; with infections caused by gram-negative bacteria - patients with mild and erased forms among medical workers, less often among women in childbirth. The most dangerous sources are resident carriers of the hospital strains of St. aureus and patients with indolent urinary tract infections (pyelonephritis).

Intra-natally, newborns can be infected from mothers with HIV, blood-borne hepatitis, candidiasis, chlamydia, herpes, toxoplasmosis, cytomegaly and a number of other infectious diseases.

In obstetric departments, there are various ways of transmission of nosocomial infections: contact-household, airborne, air-dust, fecal-oral. Dirty hands of staff, oral liquid dosage forms, baby milk sweeteners, donated breast milk, and non-sterile diapers are of particular importance among transmission factors.

The “risk” groups of nosocomial infections among newborns are premature babies, newborns from mothers with chronic somatic and infectious pathology, acute infections during pregnancy, with birth trauma, after cesarean section, with congenital malformations. Among puerperas, the greatest risk is in women with chronic somatic and infectious diseases, aggravated by an obstetric history, after cesarean section.

Pediatric somatic hospitals

According to American authors, nosocomial infections are most often found in the intensive care and intensive care units of pediatric hospitals (22.2% of all patients who passed through this department), pediatric oncology departments (21.5% of patients), in pediatric neurosurgery departments (17.7%). 18.6%). In cardiological and general somatic pediatric departments, the frequency of nosocomial infections reaches 11.0-11.2% of hospitalized patients. In Russian hospitals for young children, the incidence of nosocomial infections in children ranges from 27.7 to 65.3%.

In children's somatic hospitals, a variety of etiological factors of nosocomial infections (bacteria, viruses, fungi, protozoa) are noted.

In all children's departments, the drift and nosocomial spread of respiratory tract infections are of particular relevance, for the prevention of which vaccines are either absent or are used in limited quantities (chickenpox, rubella, etc.). Skidding and the emergence of group foci of infections, for which mass immunoprophylaxis is used (diphtheria, measles, mumps), is not excluded.

Sources of infection are: patients, medical personnel, less often caregivers. Patients, as primary sources, play the main role in the spread of nosocomial infections in nephrological, gastroenterological, pulmonological, infectious pediatric departments.

Children with activation of endogenous infection against the background of an immunodeficiency state also pose a threat as a source of infection.

Among medical workers, the most common sources of infection are persons with sluggish forms of infectious pathology: the urogenital tract, chronic pharyngitis, tonsillitis, rhinitis. In case of streptococcal infection, carriers of group B streptococci (pharyngeal, vaginal, intestinal carriage) are of no small importance.

In children's somatic departments, both natural and artificial transmission routes are important. The airborne mechanism is typical for the nosocomial spread of influenza, RVI, measles, rubella, streptococcal and staphylococcal infections, mycoplasmosis, diphtheria, pneumocystosis. With the spread of intestinal infections, both contact and household routes and alimentary transmission routes are active. Moreover, the alimentary pathway is more often associated not with infected foods and dishes, but with oral dosage forms (saline, glucose solutions, milk mixtures, etc.). The artifactual pathway is usually associated with injection equipment, drainage tubes, dressings and sutures, and breathing apparatus.

Among children over one year old, children with blood diseases, oncological processes, chronic pathologies of the heart, liver, lungs and kidneys, receiving immunosuppressants and cytostatics, receiving repeated courses of antibacterial treatment, are referred to the “risk” contingents.

planning box-type wards for young children and accommodating older children in single or double wards;

organization of a reliable supply and exhaust ventilation system;

organization of high-quality work of the admission department in order to prevent joint hospitalization of children with somatic pathology and children with foci of infections;

adherence to the principle of cyclicity when filling the wards, timely withdrawal of patients with signs of infectious diseases from the department;

giving the status of infectious wards for young children, nephrology, gastroenterology and pulmonology.

Surgical hospitals

General surgical departments should be considered as units of increased "risk" of nosocomial infections, which is determined by the following circumstances:

the presence of a wound, which is a potential gateway for nosocomial pathogens;

among those hospitalized in surgical hospitals, about 1/3 are patients with various purulent-inflammatory processes, where the risk of wound infection is very high;

in recent years, the indications for surgical interventions have significantly expanded;

up to half of surgical interventions are carried out for emergency indications, which contributes to an increase in the frequency of purulent-septic infections;

with a significant number of surgical interventions, it is possible for microorganisms to enter the wound from the nearest parts of the body in an amount that can cause a local or general infectious process.

Urological hospitals

Features of urological hospitals that are important for the spread of nosocomial infections in these departments:

most urological diseases are accompanied by a violation of the normal dynamics of urine, which is a predisposing factor for infection of the urinary tract;

the main contingent of patients is elderly people with reduced immunological reactivity;

frequent use of various endoscopic equipment and instruments, the cleaning and sterilization of which is difficult;

the use of multiple transurethral manipulations and drainage systems that increase the likelihood of microorganisms entering the urinary tract;

in a urological hospital, patients with severe purulent processes (pyelonephritis, kidney carbuncle, prostate abscess, etc.) are often operated on, in whom microflora in the urine is found in a clinically significant amount.

The leading role in the pathology of patients in these hospitals belongs to urinary tract infections (UTIs), which account for 22 to 40% of all nosocomial infections, and the frequency of UTIs is 16.3-50.2 per 100 patients in urological units.

The main clinical forms of UTI:

pyelonephritis, pyelitis;

urethritis;

• orchiepidenedymitis;

  suppuration of postoperative wounds;

  asymptomatic bacteriuria.

The main etiological factors of UTI are Escherichia coli, Pseudomonas aeruginosa, Proteus, Klebsiella, streptococci, enterococci and their associations. Anaerobes are detected in 5-8%. The widespread use of antibiotics for UTI has led to the emergence of L-forms of microorganisms, the identification of which requires special research methods. Isolation of their sterile normal urine monoculture of one microorganism in combination with a high degree of bacteriuria is characteristic of an acute inflammatory process, the association of microorganisms - for a chronic one.

Endogenous infection of the urinary tract is associated with the presence of natural contamination of the external parts of the urethra, and with various diagnostic transurethral manipulations, the introduction of microorganisms into the bladder is possible. Frequent stagnation of urine leads to the multiplication of microorganisms in it.

Exogenous nosocomial infections occur from patients with acute and chronic UTIs and from the hospital environment. The main places of infection with UTI are dressing, cystoscopic manipulation, wards (in the case of bandaging patients and using open drainage systems).

The leading factors in the transmission of nosocomial infections are: open drainage systems, hands of medical personnel, catheters, cystoscopes, various specialized instruments, solutions contaminated with microorganisms, including antiseptic solutions.

With UTI of Pseudomonas aeruginosa etiology, exogenous infection occurs in 70%, the pathogen can persist and multiply for a long time in environmental objects (shells, containers for storing brushes, trays, antiseptic solutions).

Risk factors for developing UTI:

invasive medical and diagnostic manipulations, especially in the presence of inflammation in the urinary tract;

the presence of patients with indwelling catheters;

the formation of hospital strains of microorganisms;

massive antibiotic therapy for patients in the department;

violation of the processing mode of endoscopic equipment;

use of open drainage systems.

Features of the organization of prevention of nosocomial infections:

the use of catheterization only according to strict indications, the use of single-use catheters, training of medical staff in the rules of working with catheters;

in the presence of indwelling catheters - their early withdrawal; in the area of \u200b\u200bthe external opening of the urethra at least 4 times a day, it is necessary to treat the catheters with an antiseptic solution;

organization of epidemiological surveillance in a hospital with microbiological monitoring of circulating strains; the use of adapted bacteriophages;

different tactics of antibiotic therapy in patients with a mandatory study of the sensitivity of circulating strains to antibiotics;

strict adherence to the processing mode of endoscopic equipment;

the use of closed drainage systems;

bacteriological examination of planned patients at the prehospital stage and dynamic bacteriological examination of patients in urological departments.

Reanimation and intensive care units

Reanimation and intensive care units (ICUs) are specialized high-tech treatment units of hospitals for hospitalization of the most severe patients with various types of life-threatening conditions.

A distinctive feature of the departments is the control and “prosthetics” of the functions of the body systems that ensure the process of human existence as a biological object.

the need to concentrate in a limited space of seriously ill patients and constantly working with him;

the use of invasive research and treatment methods associated with possible contamination of conditionally sterile cavities (tracheobronchial tree, bladder, etc.), violation of intestinal biocenosis (antibacterial therapy);

the presence of an immunosuppressive state (forced starvation, shock, severe trauma, corticosteroid therapy, etc.);

are important factors contributing to the occurrence of nosocomial infections in these departments.

The most significant risk factors in ICU patients are: the presence of intravascular and urethral catheters, tracheal intubation, tracheostomy, mechanical ventilation of the lungs, the presence of wounds, chest drains, peritoneal dialysis or hemodialysis, parenteral nutrition, administration of immunosuppressive and anti-stress drugs ... The incidence of nosocomial infections increases significantly if the ICU stay for more than 48 hours.

Factors that increase the likelihood of death:

pneumonia acquired in the ICU;

bloodstream infection or sepsis confirmed by blood culture.

According to studies, about 45% of ICU patients had various types of nosocomial infection, including 21% - an infection acquired directly in the ICU.

The most common types of infection were: pneumonia - 47%, lower respiratory tract infections - 18%, urinary tract infections - 18%, bloodstream infections - 12%.

The most common types of pathogens are: enterobacteria - 35%, Staphylococcus aureus - 30% (of which 60% are methicillin-resistant), Pseudomonas aeruginosa - 29%, coagulase-negative staphylococci - 19%, fungi - 17%.

Features of the organization of prevention of nosocomial infections:

architectural and design solutions for the construction of new OIT. The basic principle is the spatial separation of the flows of patients who enter the department for a short time, and patients who will be forced to stay in the department for a long time;

the main mechanism of contamination is the hands of the staff, it would be ideal to follow the principle: “one nurse - one patient” when serving patients who are in the department for a long time;

strict adherence to the principles of asepsis and antiseptics when carrying out invasive methods of treatment and examination, while using devices, materials and clothing for single use;

the use of clinical and microbiological monitoring, which makes it possible to maximize the possibilities of targeted antibiotic therapy, and to avoid the unjustified use of empirical therapy, including antifungal therapy.

Ophthalmic hospitals

In the ophthalmological hospital, the same principles are adopted as in other surgical hospitals. The main causative agents of nosocomial infections are Staphylococcus aureus and epidermalis, enterococci, pneumococci, group A and B streptococci, Pseudomonas aeruginosa.

The peculiarities are, on the one hand, in a large number of patients, and on the other hand, in the need to examine patients with the same instruments. Due to the complex and delicate mechanical-optical and electro-optical design of diagnostic and surgical instruments, the classical methods of their washing, disinfection and sterilization are excluded.

The main sources of infection are patients and the carrier (patients and medical personnel) who are in the hospital.

Leading ways and factors of transmission of nosocomial infections:

direct contact with patients and carriers;

indirect transmission through various objects, objects of the external environment;

through common transmission factors (food, water, medicines) infected by a sick person or carrier.

The risk of nosocomial infections increases if:

the frequency and technology of daily wet cleaning of hospital wards, examination rooms and other rooms;

anti-epidemic regimen during diagnostic and treatment procedures for patients;

systematic filling of hospital wards (preoperative and postoperative patients);

rules and schedule for visiting patients by visitors;

instilled in the reception of transmissions and conditions of their storage

schedule and flow of patients during medical and diagnostic procedures;

quarantine and isolation measures in identifying a patient with an infectious lesion of the organs of vision.

Features of the organization of prevention of nosocomial infections:

1. The wards of the ophthalmological department should be designed for 2-4 beds. It is also necessary to provide for the presence in the department of a single ward to isolate a patient with suspected nosocomial infections.

2. Ophthalmic operating rooms have a number of differences from conventional operating rooms. Most operations are performed under local anesthesia, the time of operations does not exceed 20-30 minutes, the number of operations performed during the working day is at least 20-25, which increases the likelihood of aseptic conditions in the operating room. As part of the operating unit, it is necessary to have an operating room in which operations are performed on patients with infectious diseases of the organs of vision. This operating room should be equipped with all necessary surgical equipment to avoid the use of equipment from “clean” operating rooms.

In operating rooms, it is preferable to create a unidirectional laminar flow in the area of \u200b\u200bthe wound.

Carefulness of preoperative processing of the hands of surgeons is of great importance, since most of the ophthalmologists now operate without gloves.

3. Organization of efficient ventilation (exchange rate of at least 12 per hour, preventive cleaning of filters at least 2 times a year).

4. Clear organization of the regime of ultraviolet bactericidal irradiation of premises.

5. Use of gas, plasma sterilizers and chemical sterilization techniques for the processing of highly specialized fragile instruments.

6. In matters of prevention of nosocomial infections, special attention should be paid to patients.

First of all, it is necessary to single out from the general flow of patients most susceptible to infection, that is, the “risk group”, directing the main attention to them when carrying out preventive measures: preoperative bacteriological examination, the use of protective surgical cut films on the surgical field, discharge from the hospital only for medical reasons ...

7. Most ophthalmic diagnostic devices are designed with a chin rest and an upper head rest.

To comply with the anti-epidemic regime in diagnostic rooms, it is necessary to regularly, after each patient, wipe the chin rest and the support for the frontal part of the head with a disinfectant solution. You can touch the patient's eyelids only through a sterile napkin. Swabs and cotton ball tweezers must be sterilized.

During the diagnostic examination of patients, a certain sequence must be observed: first of all, examinations are carried out using non-contact methods (determination of visual acuity, visual fields, refractometry, etc.), and then a set of contact techniques (tonometry, topography, etc.).

8. Examination of patients with purulent lesions of the organs of vision must be carried out with gloves. If bleneorrhea is suspected, personnel should wear safety glasses.

9. Particular importance is attached to the strict observance of the technology of disinfection of diagnostic equipment that has contact with the mucous membranes of the eye during use.

Therapeutic hospitals

The features of the departments of the therapeutic profile are:

the majority of patients in these departments are elderly people with chronic pathology of the cardiovascular, respiratory, urinary, nervous systems, hematopoietic organs, gastrointestinal tract, with oncological diseases;

disorders of local and general immunity of patients due to a long course of diseases and the courses of non-surgical treatment used;

an increasing number of invasive diagnostic and treatment procedures;

among the patients of the departments of the therapeutic profile, patients with "classic" infections (diphtheria, tuberculosis, RVI, influenza, shigellosis, etc.) are often detected, which are admitted to the hospital during the incubation period or as a result of diagnostic errors;

there are frequent cases of the occurrence of infections with an in-hospital spread (nosocomial salmonellosis, viral hepatitis B and C, etc.);

An important problem for patients in a therapeutic hospital is viral hepatitis B and C.

One of the leading “risk” groups of nosocomial infections are patients with gastroenterological profile, among whom up to 70% are people with gastric ulcer (PUD), duodenal ulcer (DU) and chronic gastritis. The etiological role of the microorganism Helicobacter pylori in these diseases is now recognized. Based on the primary infectious nature of ulcer, ulcer and chronic gastritis, one should approach the requirements of the sanitary and anti-epidemic regime in gastroenterological departments in a different way.

In stationary conditions, the spread of helicobacteriosis can be facilitated by the use of insufficiently cleaned and sterilized endoscopes, gastric probes, pH meters and other instruments. In general, 8.3 studies per patient in gastroenterology departments, including 5.97 instrumental (duodenal intubations - 9.5%, gastric - 54.9%, endoscopy of the stomach and duodenum - 18.9%). Almost all of these studies are invasive methods, always accompanied by a violation of the integrity of the gastrointestinal mucosa and, if the methods of processing and storage are violated, microorganisms from contaminated instruments penetrate through mucosal damage. In addition, given the fecal-oral mechanism of transmission of helicobacteriosis, the quality of the treatment of the hands of medical personnel is of great importance.

Sources of infection in gastroenterological departments are also patients with chronic colitis, who often excrete various pathogenic and opportunistic microorganisms into the external environment.

high-quality prehospital diagnostics and prevention of hospitalization of patients with “classic” infections;

a full range of isolation-restrictive and anti-epidemic measures for bringing "classic" infections into the department (including disinfection and emergency immunization of contact persons);

strict control over the quality of pre-sterilization processing and sterilization of instruments used for invasive manipulations, reduction of an unreasonably large number of invasive procedures;

use of gloves for all invasive procedures, vaccination of personnel against hepatitis B;

strict adherence to the personal hygiene regime by staff and patients;

prescribing eubiotics to patients (acipol, biosporin, bifidumbacterin, etc.).

Bibliography:

IN AND. Pokrovsky, S.G. Pak, N.I. Briko, B.K. Danilkin - Infectious Diseases and Epidemiology. 2007 "GEOTAR-Media"

Yushchuk N.D., Zhogova M.A. - Epidemiology: textbook. - M .: Medicine 1993

Medical microbiology, virology, immunology, ed. L. B. Borisova, M - 1994

http://revolution.allbest.ru/medicine/c00073053.html

Despite recent advances in the healthcare 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.

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;
• chicken pox;
• 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. Widespread 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.

Hospital visitors are insignificant sources of nosocomial infections, but at the same time they can be sick with ARVI, as well as 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 methods 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 is 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.

Risk group procedures
Diagnostic	Therapeutic
Blood sampling	Operations
Sounding	Various injections
Venesection	Tissue and organ transplant
	Intubation
Endoscopy	Inhalation
Manual gynecological examinations	Catheterization of the urinary tract and blood vessels
Manual rectal examinations	Hemodialysis

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 due to external factors. But more than eighty percent of infections are associated with internal infection that 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

Multilateral preventive measures are needed to reduce the risk of infection and the increase in hospital infections. They are rather difficult to carry out for organizational, epidemiological, scientific and methodological reasons. To a greater extent, the effectiveness of planned and carried out measures aimed at combating hospital infections depends on the planning of the medical 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 that 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 the infectious service 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 to prevent 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.