Nosocomial infections occur as a result. Hospital infection: classification, problem and solutions

State Educational Institution of Higher Professional Education First Moscow State Medical University named after. THEM. Sechenov

Department of Epidemiology

"Epidemiological features of nosocomial infections"

Performed:

Moscow 2010

Nosocomial infections:

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

Nosocomial infection(nosocomial, hospital, hospital) - any clinically significant 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 disease of a hospital employee as a result of 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 healthcare, the problem nosocomial infections remains one of the most pressing modern conditions, acquiring increasing medical and social significance. According to a number of studies, the mortality rate in the group of hospitalized patients who acquired nosocomial infections is 8-10 times higher than that among hospitalized patients without nosocomial infections.

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

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

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

Main The most important pathogens of nosocomial infections are:

gram-positive coccal flora: genus Staphylococcus (Staphylococcus aureus, Staphylococcus epidermidis), genus Streptococcus (Streptococcus pyogenes, Streptococcus pneumoniae, Enterococcus);

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

opportunistic and pathogenic fungi: the genus of yeast-like fungi Candida (Candida albicans), molds (Aspergillus, Penicillium), pathogens of deep mycoses (Histoplasma, Blastomycetes, Coccidiomycetes);

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

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

in large surgical centers, the leading pathogens of postoperative nosocomial infections were Staphylococcus aureus and Staphylococcus epidermidis, streptococci, Pseudomonas aeruginosa, and Enterobacteriaceae;

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

In children's hospitals, the introduction and spread of childhood droplet infections - chickenpox, rubella, measles, mumps - is of great importance.

In neonatal departments, for immunodeficient, hematological patients and HIV-infected patients, herpes viruses, cytomegaloviruses, Candida fungi and Pneumocystis pose a particular danger.

Sources of nosocomial infections are patients and bacteria carriers from among patients and hospital staff, among whom the greatest danger is posed by:

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

staying in prison for a long time hospital patients, which often become carriers of resistant nosocomial strains. The role of hospital visitors as sources of nosocomial infections is extremely insignificant.

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

These are contaminated instruments, breathing and other medical equipment, linen, bedding, mattresses, beds, surfaces of “wet” objects (faucets, sinks, etc.), contaminated solutions of antiseptics, antibiotics, disinfectants, aerosols and other medications, care items patients, dressing and suture material, endoprostheses, drainages, transplants, blood, blood replacement and blood replacement fluids, overalls, shoes, hair and hands of patients and staff.

In the hospital environment, so-called secondary, epidemically dangerous reservoirs of pathogens, in which the microflora survives for a long time and multiplies. Such reservoirs may be liquid or moisture-containing objects - infusion fluids, drinking solutions, distilled water, hand creams, water in flower vases, air conditioner humidifiers, shower units, drains and sewer water seals, hand washing brushes, some parts of medical equipment. diagnostic instruments and devices, and even disinfectants with a low concentration of the active agent.

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

airborne (aerosol);

water and nutritional;

contact and household;

contact-instrumental:

1) post-injection;

2) postoperative;

3) postpartum;

4) post-transfusion;

5) post-endoscopic;

6) post-transplantation;

7) post-dialysis;

8) post-hemosorption.

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 such a division, as noted, is largely arbitrary. Secondly, depending on the nature and duration of the course: acute, subacute and chronic, thirdly, according to the degree of severity: severe, moderate and mild forms 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 (wound infections, 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, 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 (bacteriouria, pyelonephritis, cystitis, urethritis).

2.8 Infections of the reproductive system (salpingoophoritis, endometritis, prostatitis, etc.).

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

2.10 Infection of the central nervous system (meningitis, myelitis, brain abscess, ventriculitis).

2.11 Infections of the cardiovascular system (endocarditis, myocarditis, pericarditis, phlebitis, infections of 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 infection, various forms of candidiasis, influenza and other RVIs , cryptosporidiosis, enteroviral diseases.

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

Prevalence of nosocomial infections

It is generally accepted that there is a pronounced under-registration of nosocomial infections in Russian healthcare; officially, 50-60 thousand patients with nosocomial infections are identified in the country every year, and the rates are 1.5-1.9 per thousand patients. According to estimates, about 2 million cases of nosocomial infections occur in Russia per year.

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

Structure and statistics of nosocomial infections

Currently, purulent-septic infections occupy a leading place in multidisciplinary healthcare facilities (75-80% of all nosocomial infections). Most often, GSIs are recorded in surgical patients. Especially in emergency departments and abdominal surgery, traumatology and urology. For most GSI, 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 are detected in 80% of weakened patients in surgical and intensive care departments. Up to a third of all nosocomial infections of salmonella etiology are registered in pediatric departments and hospitals for newborns. Hospital-acquired salmonellosis tends to form outbreaks, most often caused by S. typhimurium serovar II R, isolated from patients and objects external environment salmonella are highly resistant to antibiotics and external factors.

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

A special risk group is represented by medical personnel whose work involves performing surgical interventions, invasive manipulations and contact with blood (surgical, anesthesiological, intensive care, laboratory, dialysis, gynecological, hematological departments, etc.). 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 make up 5-6% (RVI, hospital-acquired mycoses, diphtheria, tuberculosis, etc.).

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

Causes and factors of 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;

a decrease in the resistance of the patient’s body during increasingly complex procedures;

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

Factors of particular importance today

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

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

If among the population carriers of S. aureus among the population, on average, account for 20-40%, then among the staff of surgical departments - from 40 to 85.7%.

3. The increase in the number of people at risk of developing nosocomial infections, which is largely due to achievements in the field of healthcare in recent decades.

Among hospitalized and outpatient patients, the proportion of:

elderly patients;

children early age with reduced body resistance;

premature babies;

patients with a wide variety of immunodeficiency conditions;

unfavorable premorbid background due to exposure to adverse environmental factors.

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

4. Activation of artificial (artificial) mechanisms of transmission of nosocomial infections, which is associated with the complication of medical equipment, 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 manipulations from the point of view of transmission of nosocomial infections are:

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

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

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

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

insufficient material and technical supplies with equipment, instruments, dressings, medications;

insufficient set and area of ​​premises;

disturbances in the operation of supply and exhaust ventilation;

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

7. Shortage of medical personnel and unsatisfactory training of hospital staff 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. Nonspecific prophylaxis

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

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

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

rational placement of departments on floors;

correct zoning of the territory.

2. Sanitary measures:

effective artificial and natural ventilation;

creation of regulatory conditions for water supply and sanitation;

correct air supply;

air conditioning, use of laminar flow units;

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

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;

introduction of a hospital epidemiologist service;

laboratory monitoring of the state of the anti-epidemic regime in health care facilities;

identification of bacteria carriers among patients and staff;

compliance with patient placement standards;

inspection and clearance of personnel to work;

rational use of antimicrobial drugs, primarily antibiotics;

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

sanitary educational work among patients.

4. Disinfection and sterilization measures:

use of chemical disinfectants;

the use of physical disinfection methods;

pre-sterilization cleaning of instruments and medical equipment;

ultraviolet bactericidal irradiation;

chamber disinfection;

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

carrying out disinsection and deratization.

II. Specific prevention

1. Routine active and passive immunization.

2. Emergency passive immunization.

Maternity hospitals

According to sample studies, the actual incidence of nosocomial infections in obstetric hospitals reaches 5-18% of newborns and 6 to 8% of postpartum women.

Staphylococcus aureus predominates in the etiological structure; 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 are usually responsible for outbreaks of nosocomial infections in maternity wards. Also, the value of St. increases. epidermidis.

The “risk” department 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, nosocomial infections of the purulent-septic group occur in maternity departments; outbreaks of salmonellosis have been described.

HAIs in newborns are characterized by diversity clinical manifestations. Purulent conjunctivitis, suppuration of the skin and subcutaneous tissue predominate. Intestinal infections caused by opportunistic flora are often observed. Omphalitis and phlebitis of the umbilical vein are more rare. Up to 0.5-3% of the structure of nosocomial infections in newborns are generalized forms (purulent meningitis, sepsis, osteomyelitis).

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

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

In obstetric departments, there are a variety of transmission routes for nosocomial infections: contact-household, airborne, airborne-dust, fecal-oral. Among the transmission factors, dirty hands of personnel, oral liquid dosage forms, infant formula, donor breast milk, and unsterile diapers are of particular importance.

Groups at “risk” for the development of nosocomial infections among newborns are premature infants, newborns from mothers with chronic somatic and infectious pathologies, acute infections during pregnancy, with birth trauma, after cesarean section, and with congenital developmental anomalies. Among postpartum women, the greatest risk is in women with chronic somatic and infectious diseases, aggravated by obstetric history, after cesarean section.

Pediatric somatic hospitals

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

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

In all children's departments, the introduction and nosocomial spread of respiratory tract infections, for the prevention of which vaccines are either absent or used in limited quantities (varicella, rubella, etc.), are of particular relevance. The introduction and emergence of group foci of infections, for which mass immunoprophylaxis is used (diphtheria, measles, mumps), cannot be ruled out.

Sources of infection are: patients, medical personnel, and less commonly, caregivers. Patients, as primary sources, play the main role in the spread of nosocomial infections in nephrology, gastroenterology, pulmonology, and pediatric infectious diseases departments.

Children with activation 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 indolent forms of infectious pathology: 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 droplet mechanism is characteristic of the nosocomial spread of influenza, RVI, measles, rubella, streptococcal and staphylococcal infections, mycoplasmosis, diphtheria, and pneumocystis. During the spread of intestinal infections, both contact and household routes and nutritional transmission routes are active. Moreover, the nutritional route is most often associated not with infected foods and dishes, but with orally administered dosage forms (saline solution, glucose solutions, infant formula, etc.). The artificial route is usually associated with injection equipment, drainage tubes, dressing and suture material, and breathing equipment.

Among children over one year of age, the “risk” groups include children with blood diseases, cancer processes, chronic pathologies of the heart, liver, lungs and kidneys, receiving immunosuppressants and cytostatics, and receiving repeated courses of antibacterial treatment.

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

organization of a reliable supply and exhaust ventilation system;

organizing high-quality work in the emergency department in order to prevent joint hospitalization of children with somatic pathologies and children with foci of infections;

compliance with the principle of cyclicity when filling wards, timely removal of patients with signs of infectious diseases from the department;

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

Surgical hospitals

General surgical departments should be considered as departments at increased “risk” for the occurrence of nosocomial infections, which is determined by the following circumstances:

the presence of a wound, which is a potential entry gate for pathogens of nosocomial infections;

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, indications for surgical interventions have expanded significantly;

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

with a significant number of surgical interventions, microorganisms from nearby parts of the body may enter the wound in quantities 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:

majority urological diseases accompanied by a disturbance in the normal dynamics of urine, which is a predisposing factor for infection of the urinary tract;

the main contingent of patients are 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, increasing the likelihood of microorganisms entering the urinary tract;

In a urological hospital, patients with severe purulent processes (pyelonephritis, renal carbuncle, prostate abscess, etc.) are often operated on, in whom microflora is detected in the urine 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 departments.

Main clinical forms of UTI:

pyelonephritis, pyelitis;

urethritis;

• orchiepidedimitis;

  suppuration of postoperative wounds;

  asymptomatic bacteriouria.

The main etiological factors of UTI are Escherichia coli, Pseudomonas aeruginosa, Proteus, Klebsiella, streptococci, enterococci and their associations. In 5-8% anaerobes are detected. The widespread use of antibiotics for UTIs has led to the emergence of L-forms of microorganisms, the identification of which requires special research techniques. The release of a normally sterile urine monoculture of one microorganism in combination with a high degree of bacteriouria is characteristic of an acute inflammatory process, while an association of microorganisms is characteristic of 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 during various diagnostic transurethral manipulations, the introduction of microorganisms into the bladder is possible. Frequent stagnation of urine leads to the proliferation of microorganisms in it.

Exogenous nosocomial infections occur from patients with acute and chronic UTIs and from hospital environmental objects. The main places of UTI infection are dressing rooms, cystoscopic manipulation rooms, wards (if dressings of patients are carried out in them and when open drainage systems are used).

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

In 70% of UTIs of pseudomonas etiology, exogenous infection occurs; the pathogen is able to persist for a long time and multiply on environmental objects (sinks, containers for storing brushes, trays, antiseptic solutions).

Risk factors for developing UTI:

invasive therapeutic and diagnostic procedures, especially in the presence of inflammatory phenomena in the urinary tract;

the presence of patients with indwelling catheters;

formation of hospital strains of microorganisms;

massive antibiotic therapy for patients in the department;

violation of the processing regime for endoscopic equipment;

use of open drainage systems.

Features of organizing the prevention of nosocomial infections:

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

in the presence of permanent catheters, remove them as early as possible; in the area of ​​the external urethral opening at least 4 times a day it is necessary to treat catheters with an antiseptic solution;

organization of epidemiological surveillance in hospitals with microbiological monitoring of circulating strains; use of adapted bacteriophages;

different tactics of antibiotic therapy in patients with compulsory study sensitivity of circulating strains to antibiotics;

strict adherence to the processing regime for endoscopic equipment;

use of closed drainage systems;

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

Reanimation and intensive care units

Resuscitation and intensive care units (ICU) are specialized high-tech medical departments 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 body systems that ensure the process of human existence as a biological object.

the need to concentrate severely ill patients and personnel constantly working with them in a limited space;

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

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

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

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

Factors that increase the likelihood of death:

ICU-acquired pneumonia;

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: enterobacteriaceae - 35%, Staphylococcus aureus - 30% (of which 60% are methicillin-resistant), Pseudomonas aeruginosa - 29%, coagulase-negative staphylococci - 19%, fungi - 17%.

Features of organizing the prevention of nosocomial infections:

architectural and design solutions for the construction of new ICUs. The main principle is the spatial separation of the flow of patients who enter the department at 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 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 antisepsis when carrying out invasive methods of treatment and examination, using disposable devices, materials and clothing;

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

Ophthalmological hospitals

The ophthalmology hospital follows the same principles as other surgical hospitals. The main pathogens of nosocomial infections are Staphylococcus aureus and Staphylococcus epidermidis, Enterococci, Pneumococci, Group A and B streptococci, and Pseudomonas aeruginosa.

The peculiarities lie, on the one hand, in the 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 electron-optical design of diagnostic and surgical instruments, classical methods of washing, disinfection and sterilization are excluded.

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

Leading routes 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 developing an nosocomial infection increases if:

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

anti-epidemic regime when conducting diagnostic and therapeutic procedures for patients;

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

rules and schedule for visiting patients by visitors;

instilled in the acceptance of transmissions and conditions for their storage

schedule and flow of patients during treatment and diagnostic procedures;

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

Features of organizing the prevention of nosocomial infections:

1. The wards of the ophthalmology department should have 2-4 beds. It is also necessary to provide for the presence in the department of a single room for isolation of a patient with suspected nosocomial infections.

2. Ophthalmic operating rooms have a number of differences from ordinary operating rooms. Most operations are performed under local anesthesia, the operation time does not exceed 20–30 minutes, the number of operations performed during a working day is at least 20–25, which increases the likelihood of violation 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 must 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 ​​the surgical wound.

The thorough preoperative treatment of surgeons' hands is of great importance, since most ophthalmologists currently operate without gloves.

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

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

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

6. In matters of preventing the occurrence of nosocomial infections, you should pay attention to Special attention on patients.

First of all, it is necessary to select 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 procedures: preoperative bacteriological examination, use of protective surgical cut films on the surgical field, discharge from the hospital only for medical reasons.

7. In their design, most ophthalmic diagnostic devices have a chin rest and a support for the upper part of the head.

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

When conducting a diagnostic examination of patients, it is necessary to follow a certain sequence: first of all, examinations are carried out using non-contact methods (determining 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 blenorrhea is suspected, staff should wear protective eyewear.

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

Therapeutic hospitals

The features of the therapeutic departments are:

The majority of patients in these departments are elderly people with chronic pathologies of the cardiovascular, respiratory, urinary, nervous systems, hematopoietic organs, gastrointestinal tract, with cancer;

violations of the local and general immunity of patients due to the long course of the disease and the courses of non-surgical treatment used;

an increasing number of invasive therapeutic and diagnostic procedures;

among patients in therapeutic departments, patients with “classical” infections (diphtheria, tuberculosis, RVI, influenza, shigellosis, etc.) are often identified, who are admitted to the hospital in incubation period or as a result of diagnostic errors;

there are frequent cases of infections that have intrahospital 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 for infection with nosocomial infections are gastroenterological patients, among whom up to 70% are people with gastric ulcer (GUD), 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 ulcers, DU and chronic gastritis It is necessary to take a different approach to the requirements of the sanitary and anti-epidemic regime in gastroenterological departments.

In stationary conditions, the spread of helicobacteriosis can be facilitated by the use of insufficiently cleaned and sterilized endoscopes, gastric tubes, pH meters and other instruments. In general, per patient in gastroenterology departments there are 8.3 studies, including 5.97 instrumental (duodenal intubation - 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 processing and storage methods are violated, microorganisms from contaminated instruments penetrate through damage to the mucosa. In addition, given the fecal-oral mechanism of transmission of helicobacteriosis, the quality of hand cleaning of medical personnel is of great importance.

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

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

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

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

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

strict adherence to personal hygiene by staff and patients;

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

Bibliography:

IN AND. Pokrovsky, S.G. Pak, N.I. Brico, 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

Lecture No. 1

1. Definition of nosocomial infections

2. Definition of the concept of “infectious process”

3. Methods of transmission of infection

4. Factors influencing host susceptibility to infection

Currently, issues of the nurse’s health, her safety at work, and the health of patients have acquired particular importance. The term “safe hospital environment” has appeared in the scientific literature.

Safe hospital environment is an environment that most fully provides the patient and medical worker with conditions of comfort and safety that allow them to effectively meet all their vital needs. A safe hospital environment is created by the organization and implementation of certain activities. Such events include:

1. The infectious safety regime (disinfection, sterilization, disinsection, deratization) is carried out in order to prevent nosocomial infections.

2. Measures to ensure personal hygiene of the patient and medical staff. Patient personal hygiene includes care of the skin, natural folds, care of the mucous membranes, timely change of underwear and bed linen, prevention of bedsores and provision of a bedpan and urinal. Personal hygiene of medical personnel includes the use of appropriate special clothing, replacement shoes, and keeping hands and body clean. These activities are carried out to prevent nosocomial infections.

3. Therapeutic protective regime (providing a regime of emotional safety for the patient, strict adherence to the rules of hospital routine and performing manipulations, ensuring a regime of rational motor activity).

In the problem of protecting the health of medical personnel, the focus is “ pain points» modern healthcare. Doctors, saving millions of human lives, trying to prevent hospital-acquired infections in patients, find themselves insufficiently protected. According to statistics, the incidence of a number of infections among medical personnel is much higher than in other groups of the population.

1. Definition of nosocomial infections.

The problem of nosocomial infections (HAIs) in last years has acquired exceptionally great importance for all countries of the world. The rapid growth of medical institutions, the creation of new types of medical (therapeutic and diagnostic) equipment, the use the latest drugs, having immunosuppressive properties, artificial suppression of immunity during organ and tissue transplantation - these, as well as many other factors, increase the threat of the spread of infections among patients and staff of medical institutions.

Currently nosocomial infections (HAIs) are one of the main causes of morbidity and mortality in hospitalized patients. The addition of nosocomial infections to the underlying disease often negates the results of treatment, increases postoperative mortality and the length of the patient’s hospital stay. According to research data, the number of cases of nosocomial infections is up to 10% of the number of hospitalized patients during the year; of these, about 2% die.

nosocomial infection (nosocomial, hospital, hospital)- any clinically significant infection which affects the patient as a result of his admission to the hospital or treatment for medical assistance, or an infectious disease of an employee as a result of his work in this institution.

The increase in the incidence of nosocomial infections is due to a number of reasons:

1) demographic changes in society, primarily an increase in the number of older people who have reduced body defenses;

2) an increase in the number of people belonging to high-risk groups (patients with chronic diseases, premature newborns, etc.);

3) widespread use of antibiotics; frequent use of antibiotics and chemotherapy drugs contributes to the emergence of drug-resistant microorganisms that are characterized by higher virulence and increased resistance to environmental factors, including disinfectants;

4) the introduction of more complex surgical interventions into healthcare practice, the widespread use of instrumental (invasive) methods of diagnosis and treatment;

5) wide distribution of congenital and acquired immunodeficiency conditions, frequent use of drugs that suppress the immune system;

6) violation of sanitary-hygienic and anti-epidemic regimes.

Factors contributing to the occurrence of nosocomial infection:

Underestimation of the epidemic danger of intra-hospital sources of infection and the risk of infection through contact with a patient;
- overload of medical facilities;
- the presence of undetected carriers of nosocomial strains among medical staff and patients;
- violation by medical staff of the rules of asepsis and antiseptics, personal hygiene;
- untimely implementation of current and final disinfection, violation of the cleaning regime;
- insufficient equipment of health care facilities with disinfectants;
- violation of the disinfection and sterilization regime of medical instruments, devices, devices, etc.;
- outdated equipment;
- unsatisfactory condition of catering facilities and water supply;
- lack of filtration ventilation.

The risk of developing an HAI varies greatly depending on the profile of the healthcare facility. Highest risk departments are intensive care units, burn departments, oncohematology departments, hemodialysis departments, trauma departments, urology departments and other departments in which the intensity of invasive and aggressive medical procedures is high and/or in which highly susceptible patients are hospitalized.

Inside hospital departments places of increased risk of infection with nosocomial infections are the rooms in which the most risky manipulations are performed (operating rooms, dressing rooms, endoscopic rooms, procedural rooms, examination rooms, etc.).

Leading forms of nosocomial infections There are four main groups of infections:

Urinary tract infections,

Infections in the area surgical intervention,

Lower respiratory tract infections,

Bloodstream infections.

Sources of nosocomial infections (nosocomial infections):

Medical personnel;
- carriers of latent forms of infection;
- patients with acute, erased or chronic form inf. diseases, including wound infection;
- dust, water, food;
- equipment, tools.

Risk groups for nosocomial infections (nosocomial infections):

1) patients:
- without a fixed place of residence, migrating population,
- with long-term untreated chronic somatic and infectious diseases,
- unable to receive special medical care;
2) persons who:
- therapy that suppresses the immune system (irradiation, immunosuppressants) is prescribed
- complex diagnostic and surgical interventions are carried out;
3) postpartum women and newborns, especially premature and post-term;
4) children with congenital anomalies development, birth trauma;
5) medical staff of health care facilities (medical and preventive institutions).

Nosocomial infection can occur both during the patient's stay in a health care facility and after discharge from it. In the latter case, the question of whether the disease belongs to an nosocomial infection is decided collectively. The etiological structure and features of the epidemiology of nosocomial infections depend on the profile of health care facilities, the age of patients, the specifics of methods, means of treatment and examination of patients and a number of other factors.

An important role in prevention nosocomial infection plays nursing staff. Control Nosocomial infections are monitored by various specialists, including doctors, epidemiologists, pharmacists, while in many countries this aspect of activity (infection control) is entrusted specifically to specialists from among the nursing staff.

The current epidemic of acquired immunodeficiency syndrome (AIDS), caused by a specific virus (HIV), has challenged infection control nurses to develop a containment system to prevent the spread of this and other often unrecognized infections in health care settings and the community. It is specialists involved in infection control who have developed general (universal) precautions for contact with all biological fluids.

2. Definition of the concept of “infectious process”

All infectious diseases are the result of sequential events, and noxious infections are no exception. For proper organization For preventive measures and control, it is important to understand the essence of the infectious process.

Infectious process– the process of interaction between a pathogen and a microorganism under certain external and internal environment, which includes developing pathological protective-adaptive and compensatory reactions.

The infectious process is the essence of an infectious disease. An infectious disease itself is an extreme degree of development of the infectious process.

Scheme No. 1. Chain of infectious process

The development of any infectious disease begins with the penetration of the pathogen into the human body. In this case, a number of conditions are necessary: ​​the state of the macroorganism (the presence of receptors to which the microbe will attach; the state of immunity, etc.) and the state of the microorganism.

The most important properties of the infectious agent are taken into account: pathogenicity, virulence, toxigenicity, invasiveness.

Pathogenicity is the ability, genetically fixed, of a microorganism to cause a certain disease. It is a species characteristic, and bacteria are capable of causing only certain clinical symptoms. Based on the presence or absence of this sign, all microorganisms are divided into pathogenic, opportunistic (cause disease under any unfavorable conditions) and non-pathogenic.

Virulence the vital capacity of a microorganism is the degree of pathogenicity. For each colony pathogenic microbes this property is individual. Virulence is judged by the severity and outcome of the disease that this pathogen causes. In laboratory conditions, it is measured by the dose that causes either the development of disease or death in half of the experimental animals. This property is not stable, and virulence can change among different colonies of bacteria of the same species, for example, during treatment with an antibiotic.

Invasiveness and adhesiveness– the ability of microbes to penetrate human tissues and organs and spread into them.

This is explained by the presence of various enzymes in infectious agents: fibrinolysin, mucinase, hyaluronidase, DNase, collagenases, etc. With the help of them, the pathogen penetrates all natural barriers of the human body (skin and mucous membranes), promotes its vital activity under the influence of the body’s immune forces.

The above enzymes are present in many microorganisms - causative agents of intestinal infections, gas gangrene, pneumococci, staphylococci, etc. - and ensure further progression of the infectious process.

Toxigenicity– the ability of microorganisms to produce and secrete toxins. There are exotoxins (protein) and endotoxins (non-protein).

Another one of important characteristics the causative agent of an infectious disease is tropism- its sensitivity to certain tissues, organs, systems. For example, the causative agent of influenza affects the cells of the respiratory tract, dysentery – the intestinal epithelium, mumps, or “mumps” – the tissue of the salivary glands.

2. Reservoir of infection– place of accumulation of the pathogen. There are living and non-living reservoirs. Alive– staff, patients, visitors (skin, hair, nasal cavity, oral cavity, gastrointestinal tract and genitourinary system); mechanical carriers. Inanimate– solutions, equipment, tools, care items, products, water, dust.

3. Exit gate. Depends on the location of the reservoir of infection: Respiratory tract, Digestive tract, Genitourinary tract, Skin (mucous membranes), Transplacental vessels, Blood.

– various infectious diseases contracted in a medical facility. Depending on the degree of spread, generalized (bacteremia, septicemia, septicopyemia, bacterial shock) and localized forms of nosocomial infections (with damage to the skin and subcutaneous tissue, respiratory, cardiovascular, urogenital system, bones and joints, central nervous system, etc.) are distinguished. . Identification of pathogens of nosocomial infections is carried out using laboratory diagnostic methods (microscopic, microbiological, serological, molecular biological). In the treatment of nosocomial infections, antibiotics, antiseptics, immunostimulants, physiotherapy, extracorporeal hemocorrection, etc. are used.

General information

Nosocomial (hospital, nosocomial) infections are infectious diseases of various etiologies that arose in a patient or medical employee in connection with their stay in a medical institution. An infection is considered nosocomial if it develops no earlier than 48 hours after the patient’s admission to the hospital. The prevalence of nosocomial infections (HAIs) in medical institutions of various profiles is 5-12%. Largest specific gravity Nosocomial infections occur in obstetric and surgical hospitals (intensive care units, abdominal surgery, traumatology, burn trauma, urology, gynecology, otolaryngology, dentistry, oncology, etc.). Nosocomial infections represent a major medical and social problem, since they aggravate the course of the underlying disease, increase the duration of treatment by 1.5 times, and the number of deaths by 5 times.

Etiology and epidemiology of nosocomial infections

The main causative agents of nosocomial infections (85% of the total) are opportunistic microorganisms: gram-positive cocci (epidermal and Staphylococcus aureus, beta-hemolytic streptococcus, pneumococcus, enterococcus) and gram-negative rod-shaped bacteria (Klebsiella, Escherichia, Enterobacter, Proteus, Pseudomonas, etc. .). In addition, in the etiology of nosocomial infections, the specific role of viral pathogens of herpes simplex, adenovirus infection, influenza, parainfluenza, cytomegaly, viral hepatitis, respiratory syncytial infection, as well as rhinoviruses, rotaviruses, enteroviruses, etc., is great. Nosocomial infections can also be caused by conditionally pathogenic and pathogenic fungi (yeast-like, mold, radiata). A feature of intrahospital strains of opportunistic microorganisms is their high variability, drug resistance and resistance to environmental factors (ultraviolet radiation, disinfectants, etc.).

The sources of nosocomial infections in most cases are patients or medical personnel who are bacteria carriers or patients with erased and manifest forms of pathology. Research shows that the role of third parties (in particular, hospital visitors) in the spread of nosocomial infections is small. Broadcast various forms Nosocomial infection is realized through airborne droplets, fecal-oral, contact, and transmissible mechanisms. In addition, a parenteral route of transmission of nosocomial infection is possible during various invasive medical procedures: blood sampling, injections, vaccinations, instrumental manipulations, operations, mechanical ventilation, hemodialysis, etc. Thus, in a medical institution it is possible to become infected with hepatitis, purulent-inflammatory diseases, syphilis , HIV infection. There are known cases of nosocomial outbreaks of legionellosis when patients took medicinal showers and whirlpool baths.

Factors involved in the spread of nosocomial infection may include contaminated care items and furnishings, medical instruments and equipment, solutions for infusion therapy, overalls and hands of medical staff, products medical purposes reusable (probes, catheters, endoscopes), drinking water, bedding, suture and dressing material and much more. etc.

The significance of certain types of nosocomial infections largely depends on the profile of the medical institution. Thus, in burn departments, Pseudomonas aeruginosa infection predominates, which is mainly transmitted through care items and the hands of staff, and the main source of nosocomial infection is the patients themselves. In maternity care facilities, the main problem is staphylococcal infection, spread by medical personnel carrying Staphylococcus aureus. In urology departments, infections caused by gram-negative flora dominate: intestinal, Pseudomonas aeruginosa, etc. In pediatric hospitals, the problem of the spread of childhood infections - chickenpox, mumps, rubella, measles - is of particular importance. The emergence and spread of nosocomial infection is facilitated by violation of the sanitary and epidemiological regime of health care facilities (failure to comply with personal hygiene, asepsis and antiseptics, disinfection and sterilization regime, untimely identification and isolation of persons who are sources of infection, etc.).

The risk group most susceptible to the development of nosocomial infections includes newborns (especially premature babies) and young children; elderly and frail patients; persons suffering from chronic diseases (diabetes mellitus, blood diseases, renal failure), immunodeficiency, oncology. A person's susceptibility to nosocomial infections increases if he/she has open wounds, cavity drainages, intravascular and urinary catheters, tracheostomy and other invasive devices. The incidence and severity of nosocomial infections are influenced by the patient's long stay in the hospital, long-term antibiotic therapy, and immunosuppressive therapy.

Classification of nosocomial infections

According to the duration of their course, nosocomial infections are divided into acute, subacute and chronic; according to the severity of clinical manifestations - mild, moderate and severe forms. Depending on the degree of prevalence of the infectious process, generalized and localized forms of nosocomial infection are distinguished. Generalized infections are represented by bacteremia, septicemia, bacterial shock. In turn, among the localized forms there are:

• infections of the skin, mucous membranes and subcutaneous tissue, including postoperative, burn, and traumatic wounds. In particular, these include omphalitis, abscesses and phlegmon, pyoderma, erysipelas, mastitis, paraproctitis, fungal infections of the skin, etc.
• infections of the oral cavity (stomatitis) and ENT organs (tonsillitis, pharyngitis, laryngitis, epiglottitis, rhinitis, sinusitis, otitis media, mastoiditis)
• infections of the bronchopulmonary system (bronchitis, pneumonia, pleurisy, lung abscess, lung gangrene, pleural empyema, mediastinitis)
• infections of the digestive system (gastritis, enteritis, colitis, viral hepatitis)
• eye infections (blepharitis, conjunctivitis, keratitis)
• infections of the urogenital tract (bacteriuria, urethritis, cystitis, pyelonephritis, endometritis, adnexitis)
• infections of the musculoskeletal system (bursitis, arthritis, osteomyelitis)
• infections of the heart and blood vessels (pericarditis, myocarditis, endocarditis, thrombophlebitis).
• CNS infections (brain abscess, meningitis, myelitis, etc.).

In the structure of nosocomial infections, purulent-septic diseases account for 75-80%, intestinal infections - 8-12%, blood-contact infections - 6-7%. For other infectious diseases ( rotavirus infections, diphtheria, tuberculosis, mycoses, etc.) account for about 5-6%.

Diagnosis of nosocomial infections

The criteria for thinking about the development of nosocomial infection are: the occurrence clinical signs illness no earlier than 48 hours after admission to the hospital; connection with invasive intervention; establishing the source of infection and transmission factor. The final judgment on the nature of the infectious process is obtained after identifying the pathogen strain using laboratory diagnostic methods.

To exclude or confirm bacteremia, bacteriological blood cultures are performed for sterility, preferably at least 2-3 times. In localized forms of nosocomial infection, microbiological isolation of the pathogen can be carried out from other biological media, in connection with which a culture of urine, feces, sputum, wound discharge, material from the pharynx, a smear from the conjunctiva, and from the genital tract is performed for microflora. In addition to the cultural method for identifying pathogens of nosocomial infections, microscopy, serological reactions(RSK, RA, ELISA, RIA), virological, molecular biological (PCR) methods.

Treatment of nosocomial infections

The difficulties of treating nosocomial infections are due to its development in a weakened body, against the background of the underlying pathology, as well as the resistance of hospital strains to traditional pharmacotherapy. Patients with diagnosed infectious processes are subject to isolation; The department undergoes thorough ongoing and final disinfection. The choice of antimicrobial drug is based on the characteristics of the antibiogram: for nosocomial infections caused by gram-positive flora, vancomycin is most effective; gram-negative microorganisms – carbapenems, IV generation cephalosporins, aminoglycosides. Additional use of specific bacteriophages, immunostimulants, interferon, leukocyte mass, and vitamin therapy is possible.

If necessary, percutaneous blood irradiation (ILBI, UVB), extracorporeal hemocorrection (hemosorption, lymphosorption) are performed. Symptomatic therapy is carried out taking into account the clinical form of nosocomial infection with the participation of specialists of the relevant profile: surgeons, traumatologists, pulmonologists, urologists, gynecologists, etc.

Prevention of nosocomial infections

The main measures to prevent nosocomial infections come down to compliance with sanitary, hygienic and anti-epidemic requirements. First of all, this concerns the disinfection regime of premises and care items, the use of modern highly effective antiseptics, high-quality pre-sterilization treatment and sterilization of instruments, strict adherence to the rules of asepsis and antiseptics.

Medical personnel must comply with measures personal protection when carrying out invasive procedures: wear rubber gloves, goggles and a mask; handle medical instruments carefully. Great importance in the prevention of nosocomial infections is the vaccination of health workers against hepatitis B, rubella, influenza, diphtheria, tetanus and other infections. All healthcare facility employees are subject to regular scheduled dispensary examination aimed at identifying the carriage of pathogens. To prevent the occurrence and spread of nosocomial infections will be possible by reducing the length of hospitalization of patients, rational antibiotic therapy, the validity of invasive diagnostic and therapeutic procedures, and epidemiological control in health care facilities.

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Plan

Introduction

1. The main reasons for the development of nosocomial infections

2. Pathogens of nosocomial infections

3. Human sensitivity

4. Factors contributing to the occurrence and spread of nosocomial infections

5. Mechanisms, ways, factors of transmission of nosocomial infections

6. System of measures to prevent nosocomial infections

Conclusion

Introduction

Nosocomial infection (HAI) is any clinically significant disease of microbial origin that affects a patient as a result of his admission to the hospital or seeking treatment, regardless of the appearance of symptoms of the disease in the patient during his hospital stay or after his discharge, as well as an infectious disease employee of a medical organization as a result of his infection while working in this organization.

Nosocomial infections remain one of the pressing problems of modern medicine.

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

The damage associated with in-hospital morbidity consists of an increase in the length of time patients stay in the hospital, an increase in mortality, as well as purely material losses. However, there is also social damage that cannot be assessed in terms of value (disconnection of the patient from family, work activity, disability, deaths, etc.).

The problem of nosocomial infections has become even more important due to the emergence of so-called hospital-acquired (usually multiresistant to antibiotics and chemotherapy) strains of staphylococci, salmonella, Pseudomonas aeruginosa and other pathogens. They spread easily among children and the weakened, especially the elderly, patients with reduced immunological reactivity, who represent a risk group.

In recent years, factors have emerged that contribute to an increase in the incidence of nosocomial infections: the work of health care facilities under conditions of limited funding (lack of medicines, antiseptics, detergents, disinfectants, medical instruments, linen, sterilization equipment); a significant increase in the number of hospital strains resistant to antibiotics and disinfectants; the difficulty of disinfecting and sterilizing modern expensive medical equipment.

Thus, the relevance of the problem of hospital infections for theoretical medicine and practical healthcare is beyond doubt. It is caused, on the one hand, by the high level of morbidity, mortality, socio-economic and moral damage caused to the health of patients, and on the other hand, nosocomial infections cause significant harm to the health of medical personnel.

1. The main reasons for the development of nosocomial infections

The emergence and development of nosocomial infections in health care facilities is facilitated by:

The presence of undetected patients and carriers of nosocomial strains among medical personnel and patients;

Widespread use of complex equipment requiring special sterilization methods;

Formation and selection of hospital strains of microorganisms with high virulence and multidrug resistance;

The creation of large hospital complexes with their own specific ecology - crowding in hospitals and clinics, the characteristics of the main contingent (mainly weakened patients), the relative enclosure of premises (wards, treatment rooms etc.);

Violation of the rules of asepsis and antisepsis, deviations from sanitary and hygienic standards for hospitals and clinics;

Violation of the sterilization regime for disinfection of medical instruments, devices, devices, etc.;

Irrational use of antibiotics;

Increase in high-risk groups in the population (elderly people, premature babies, patients with chronic diseases);

Non-compliance with the standards for the area and set of main and auxiliary premises in health care facilities and violation of sanitary-anti-epidemic and sanitary-hygienic regimes in them;

Insufficient competence of medical workers, especially nursing staff, who play the main role in the prevention of nosocomial infections.

2. Pathogens of nosocomial infections

Nosocomial infections are caused by a large group of microorganisms, which includes representatives of pathogenic and opportunistic microorganisms.

The bulk of nosocomial infections are on modern stage caused by opportunistic pathogens. These include: staphylococci, streptococci, Pseudomonas aeruginosa, Proteus, Klebsiella, coli, salmonella, enterobacter, enterococcus, serration, bacteroides, clostridia, candida and other microorganisms.

Influenza viruses, adenoviruses, rotaviruses, enteroviruses, pathogens of viral hepatitis and other viruses occupy a significant place in the etiology of nosocomial infections. Nosocomial infections can be caused by rare or previously unknown pathogens, such as Lepunellus, Pneumocystis, Aspergillus and others.

The degree of risk of infection with nosocomial infections largely depends on the etiology of the disease. This makes it possible to classify nosocomial infections depending on the risk of infection of a patient from medical personnel and medical personnel from a patient.

Nosocomial infections are reported everywhere, in the form of outbreaks or sporadic cases. Almost any hospital patient is predisposed to the development of infectious processes. Nosocomial infections are highly contagious, wide range pathogens and various routes of their transmission, the possibility of outbreaks at any time of the year, the presence of patients with increased risk diseases (“risk group”) and the possibility of relapses.

Peculiarities epidemic process depend on the properties of the pathogen, type of institution, patient population, quality of organization medical care, sanitary-hygienic and anti-epidemic regimes.

3. Human susceptibility

A person whose resistance to a particular pathogenic agent is not sufficiently effective is called susceptible.

The development of infection and the severity of clinical manifestations depend not only on the properties of the pathogen, but also on some factors inherent in the host organism:

* age

* accompanying illnesses

* genetically determined immune status

* previous immunization

* presence of immunodeficiency acquired as a result of disease or therapy

* psychological condition

Susceptibility human body to infections increases with:

*presence of open wounds

* presence of invasive devices such as intravascular catheters, tracheostomies, etc.

* basic availability chronic disease, such as diabetes mellitus, immunodeficiency, neoplasmosis, leukemia

* certain therapeutic interventions, including immunosuppressive therapy, radiation or antibiotics.

The entire set of hospital conditions leads to the fact that, along with the possible occurrence and spread of infectious diseases that occur outside hospitals, hospitalized patients are characterized by diseases caused by opportunistic microorganisms.

nosocomial infection pathogen epidemic

4. Factors, contributing to the emergence and spread of nosocomial infections

External factors (specific to any hospital):

Equipment and tools

Food products

Medicines

Linen, bedding, mattresses, beds

Patient's microflora:

Skin

Genitourinary system

Airways

Invasive medical manipulations carried out in a hospital:

Long-term catheterization of veins and bladder

Intubation

Surgical disruption of the integrity of anatomical barriers

Endoscopy

Medical staff:

Constant carriage of pathogenic microorganisms

Temporary carriage of pathogenic microorganisms

Sick or infected employees

For the emergence and spread of any infectious disease (and nosocomial infections are no exception), three main components are required: the source of infection, the route of transmission and the susceptible subject.

In the hospital environment, so-called secondary, epidemically dangerous reservoirs of pathogens, in which the microflora survives for a long time and multiplies. Such reservoirs may be liquid or moisture-containing objects - infusion fluids, drinking solutions, distilled water, hand creams, water in flower vases, air conditioner humidifiers, shower units, drains and sewer water seals, hand washing brushes, some parts of medical equipment. diagnostic instruments and devices, and even disinfectants with a reduced concentration of the active agent.

The source of nosocomial infections are: patients, carriers of nosocomial pathogens, medical personnel and persons involved in caring for patients (as well as students), relatives visiting patients in the hospital.

5. Mechanisms, pathways, factors of transmission of nosocomial infections

The polyetiological nature of nosocomial infections and the variety of sources of their causative agents predetermine the variety of mechanisms, routes and factors of transmission, which have their own specifics in hospitals of various profiles.

Pathogens of nosocomial infections can be transmitted by airborne droplets, airborne dust, alimentary routes, transfusion, transplacentally, during the passage of the fetus through the birth canal, genital and other routes.

Aerosol the mechanism plays a leading role in the spread of staphylococcal and streptococcal infections. In the spread of the causative agent of this infection, air conditioners with humidifiers, ventilation systems, and bedding - mattresses, pillows - play a large role - they can also become factors in the transmission of staphylococci.

Through contact and everyday life infections caused by gram-negative bacteria are transmitted. Microorganisms multiply intensively and accumulate in a humid environment, in liquid dosage forms, in expressed breast milk, on damp brushes for washing hands, damp rags. Factors of infection transmission can include: breathing equipment, linen, bedding, the surface of “wet” objects (faucet handles, sink surfaces), infected hands of personnel.

In the spread of purulent-inflammatory diseases important role plays artificial, or artificial transmission mechanism.

Parenteral transmission of pathogens is possible when using non-disinfected syringes and needles, or when administering infected blood products.

Infectious agents can be transmitted:

* through direct person-to-person contact, such as direct

contact of medical personnel with patients or with their secretions, excreta and other liquid secretions of the human body;

* in case of indirect contact of a patient or medical worker with a contaminated intermediate object, including contaminated equipment or medical supplies;

* through droplet contact that occurs when talking, sneezing or coughing;

* during the spread of infectious agents contained in the air through the air

droplet molecules, dust particles or suspended in the air passing through ventilation systems;

*through normal means supplied to medical institutions: Contaminated blood, medications, food or water. Microorganisms may or may not grow on these hospital supplies;

* through a carrier of infection. The infection can be transmitted from person to person

to humans through an animal or insect that plays the role of an intermediate

host or vector of the disease.

Contact is the most common means of transmission of infection in modern hospitals.

6. System of measures for the prevention of nosocomial infections

I. Nonspecific prophylaxis

1. Construction and reconstruction of inpatient and outpatient clinics in compliance with the principle of rational architectural and planning solutions: isolation of sections, wards, operating units, etc.; compliance and separation of flows of patients, personnel, “clean” and “dirty” flows; rational placement of departments on floors; correct zoning of the territory.

2. Sanitary measures: effective artificial and natural ventilation; creation of regulatory conditions for water supply and sanitation; correct air supply; air conditioning, use of laminar flow units; creation of regulated parameters of microclimate, lighting, noise conditions; 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; introduction of a hospital epidemiologist service; laboratory monitoring of the state of the anti-epidemic regime in health care facilities; identification of bacteria carriers among patients and staff; compliance with patient placement standards; inspection and clearance of personnel to work; rational use of antimicrobial drugs, primarily antibiotics; training and retraining of personnel on issues of regime in health care facilities and prevention of nosocomial infections; sanitary educational work among patients.

4. Disinfection and sterilization measures: use of chemical disinfectants; the use of physical disinfection methods; pre-sterilization cleaning of instruments and medical equipment; ultraviolet bactericidal irradiation; chamber disinfection;

steam, dry air, chemical, gas, radiation sterilization; carrying out disinsection and deratization.

Disinfection is the destruction of vegetative forms of microorganisms on environmental objects (or reduction in their numbers).

Pre-sterilization cleaning is the process of removing visible dust, dirt, organic and other foreign materials.

Sterilization is the destruction of all forms of microorganisms (vegetative and spore) on environmental objects.

Asepsis is a set of organizational and preventive measures aimed at preventing the entry of microorganisms into the wound and into the body as a whole.

Antiseptics are a set of therapeutic and preventive measures aimed at destroying microorganisms in the wound and in the body as a whole.

II. Specific prevention

Routine active and passive immunization.

Emergency passive immunization.

The most important ways Reducing the risk of transmission of infection in a health care facility is as follows:

Conscientiousness of staff compliance with all requirements related to hygiene, hand washing and use of protective clothing

Careful adherence to all patient care techniques, which minimizes the spread of infectious agents

Use of sanitation techniques aimed at reducing the number of infectious agents present in the hospital.

Conclusion

Thus, any clinically recognizable infectious diseases that occur in patients after hospitalization or a visit to a medical institution for the purpose of treatment, as well as in medical personnel due to their activities, should be considered as nosocomial infections, regardless of whether symptoms of this disease appear or do not appear during time spent by these persons in a medical institution.

When developing infection control principles, it is very important to carefully study all local needs and develop such a program infection control, which will take into account local capabilities and the characteristics of a given medical institution or department.

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The frequency of nosocomial or hospital infections demonstrates the quality of medical care. Typically, the risk group includes socially disadvantaged sections of the population and premature babies, but any person admitted to a hospital for treatment is not immune from infection.

Nosocomial or hospital-acquired is an infectious disease of various etiologies that a patient becomes infected with after being admitted to a hospital.

Nosocomial infections include illnesses of medical personnel if the infection occurred during their professional activities.

Signs of a hospital infection usually appear two days after admission to the hospital department. Sometimes symptoms occur after the patient has been discharged. Nosocomial infections are a serious problem for the healthcare system.

Outbreaks of diseases are recorded not only in third world countries, but also in highly developed countries of Europe and Asia.

The risk of infection is borne not only by patients in infectious diseases departments, but also by any diagnostic procedures:

• gastroendoscopy
• duodenal intubation
• pulmonoscopy
• cystoscopy
• gastroscopy