Hospital infections are one of the most difficult problems that arise in many countries of the world. The social and economic damage caused by hospital pathogens is enormous. Paradoxically, despite huge advances in therapeutic and diagnostic technologies and, in particular, hospital care, this problem remains one of the most acute.
What is WBI?
Accompany-acquired or hospital-acquired infection (HAI) is a disease of microbial etiology that occurs in patients during their stay in hospitals or when patients visit a he althcare facility for treatment. They are found in all countries of the world and represent a serious problem for medical and preventive he alth care institutions. Diseases associated with the provision of medical services,denote the terms iatrogenic (from Greek, iatros, doctor) or nosocomial (from Greek nosokomeion, hospital) infections.
Types of nosocomial infection (types of pathogens)
Approximately 90% of all hospital infections are of bacterial origin. Viruses, fungi and protozoa, as well as ectoparasites, are less common. Grouping of pathogens based on epidemiology:
- The first group of pathogens of traditional infections are those that do not have a special characteristic (shigellosis, rubella, hepatitis, influenza, HIV infection, viral hepatitis, etc.).
- The second group or obligate parasites, the pathogenicity of which is more pronounced in the conditions of a medical institution (salmonellosis, colienteritis).
- The third group is conditionally pathogenic microorganisms that develop exclusively in hospital conditions (purulent-septic infections).
Hospital stamps
The circulation of infectious agents of nosocomial infections in hospitals gradually forms the so-called hospital strains, i.e. microorganisms most effectively adapted to the local conditions of a particular department of a medical institution.
The main feature of a hospital infection is increased virulence, as well as a special adaptability to drugs (antibiotics, antiseptics, disinfectants, etc.).
Causes of HAI
Reasons are divided intoobjective, independent of the managers and staff of the medical institution, and subjective, depending on the management and staff of the profile department, hygienic principles for the prevention of hospital infections that are not observed.
The main objective reasons are: lack of an effective method of treatment, poor availability of laboratories, widespread use of antibiotics, an increase in the number of patients with low immunity, insufficient number of laboratories. Subjective reasons include: lack of patient records, poor quality of sterilization of instruments, lack of control of hospitals by the CEC, increased contacts between patients with infectious diseases.
Microbiological diagnostics
A hospital infection caused by pathogenic microorganisms is diagnosed on the basis of the clinical picture, epidemiological history, analysis of contacts with patients who are being treated at the hospital, and laboratory test results.
When detecting nosocomial infections caused by opportunistic flora, the length of stay in the hospital and all other aggravating factors (age of the patient, severity of the underlying disease, deterioration in general he alth) are taken into account.
In the bacteriological diagnosis of nosocomial infection caused by UPM, the mass growth of re-inoculation microorganisms is important, as well as the study of several cultures of each species. It is difficult enough to distinguish nosocomial infections from infections acquired in the external environment. This can be explained by the fact thatthe disease can occur during inpatient treatment, at a time when the patient is already infected in the community.
Routes of nosocomial infection transmission
In medical and preventive institutions, the classic ways of transmission of nosocomial infection are:
- airborne;
- fecal-oral;
- contact household.
At the same time, the transmission of nosocomial infections is possible at different stages of medical care. Any parenteral intervention (injection, history taking, vaccination, surgery, etc.) using medical equipment that has not been properly cleaned poses a risk of infection. This is how hepatitis B, C, syphilis, delta infection, purulent-inflammatory diseases caused by various bacterial agents can be transmitted.
Therefore, it is necessary to limit blood transfusions as much as possible, or to carry them out only according to strict indications. Various medical procedures lead to the transmission of infection, for example, catheterization of blood vessels, urinary tract. There have been cases of infection with legionellosis while taking whirlpool baths and hygienic showers. It is more likely that patients acquire nosocomial infections in hospitals through liquid medicines (isotonic solution, glucose solution, albukid, etc.) in which gram-negative bacteria multiply rapidly.
Sources of infection transmission
Sources of HBI infection can be:
- nurses and visitors to a medical institution suffering from infectious diseases (flu, diarrhea, pustular skin lesions, with mild symptoms) who continue to be close to patients;
- patients with erased forms of diseases;
- patients with antiseptic wounds who carry virulent strains of staphylococcus bacteria;
- young children with pneumonia, otitis, chickenpox, tonsillitis, etc. who produce pathogenic strains of Escherichia coli (E. coli).
Nosocomial infections can also be caused by microbes found in the environment, such as certain types of Gram-negative bacteria. In such cases, the source of infection is the soil in flowerpots, water, or any moist environment in which there are conditions for the life of bacteria.
AFI development factors
The following factors directly affect the development of nosocomial infection:
- weakening of the patient's body by the underlying disease, all kinds of diagnostic procedures and surgical interventions;
- length of hospital stay (70% of these infections occur in patients who stay in hospital for more than 18-20 days);
- excessive use of antibiotics that change the intestinal biocenosis, reduce the body's immune resistance, contribute to the development of antibiotic-resistant strains (single administration of drugs reducescontent of lysozyme, complement, properdin and antibody production);
- widespread use of corticosteroids, which reduces the body's resistance;
- hospitalization of elderly people, especially those with chronic diseases that are the source of nosocomial infections;
- treatment of children at a young age, and especially up to one year;
- congestion of a large number of people who are being treated at a hospital in hospitals.
Measures to prevent the drift of HBI
Prevention of nosocomial infection in the hospital is carried out by all departments. Even before the hospitalization of the victim, the doctor who prescribes treatment to the patient, in addition to examination and diagnosis, identifies the following risk factors for the development of nosocomial infections:
- presence or lack of contact with people who suffer from infectious diseases;
- previously transferred infectious diseases that are prone to carriage (tuberculosis, viral hepatitis, typhoid and paratyphoid diseases, etc.);
- detect if the patient has been away from their place of residence.
The first anti-epidemic barrier of the system of prevention and control of hospital infection is the reception department. When a patient is admitted for inpatient treatment, they are taken to prevent infection from entering the department. Hygiene principles for the prevention of nosocomial infection:
- individual patient appointment;
- careful collection of epidemiological history;
- examination of a person, which includes not onlyclarification of the diagnosis, but also the timely identification of those who suffer from infectious diseases, being in close proximity to the patient.
Violation of the rules of sanitary hygiene and recommendations for patient care in the department of purulent surgery confirms the rule: "There are no trifles in surgery."
