No matter how ideal a medical institution is, no matter how well the sanitary standards are observed there, there is still a risk of getting an infection - a nosocomial infection. This is a rather unpleasant event in a person’s life and can carry negative consequences, so it is important to diagnose it in time and start therapy. And for starters, learn more about this infection in order to recognize it in time and carry out prevention.
What is a disease?
Nosocomial infection is otherwise called nosocomial infection. This is a clinically expressed pathology of microbial origin that affects a person during his hospitalization or visit to a medical institution in order to undergo therapy.
A nosocomial infection is considered as such if the symptoms of the disease appear two days after the patient's admission to the hospital. Some types of pathologies may develop after the patient returns home from the hospital.
Distribution factors
The main cause of nosocomial infection is the unfavorable conditions created inmedical institution. The chance of getting infected increases if:
- Departments or entire hospitals do not meet sanitary standards.
- Staph carriers do not receive adequate treatment.
- The number of staff-patient contacts has increased.
- Laboratories are under-equipped.
- The patient was prescribed large-scale antibiotic therapy.
- Microbial resistance to antibacterial agents is increasing.
- Weakened immunity due to complications after surgery.
Transmission routes
Today, doctors distinguish several ways of transmission of nosocomial infection - these are:
- airborne;
- household;
- contact-instrumental;
- postoperative and post-injection;
- infections that appear after injury.
The importance of the problem lies in the fact that the ways of transmission of nosocomial infection are diverse, so finding the causes is quite difficult.
Classification
If we consider them according to the duration of the course, then conditionally the diseases can be divided into three main groups:
- spicy;
- subacute;
- chronic.
According to clinical manifestations, they are mild, moderate and severe. Two forms are distinguished from the degree of spread of infection: generalized and localized.
In the first case, infection is manifested by bacteremia, septicemia and bacterial shock. As for localforms, then the following types of infection can be distinguished:
- Injury to the skin, mucosal and subcutaneous tissue, which include abscesses, cellulitis, erysipelas, mastitis, paraproctitis, skin fungus and others.
- Diseases of the oral cavity and ENT organs: stomatitis, tonsillitis, pharyngitis, otitis media, sinusitis and others.
- Penetration of pathogenic microorganisms into the lungs and bronchi, which causes the development of pneumonia, bronchitis.
- Gastrointestinal tract injury.
- Conjunctivitis and other eye infections.
- Urinary tract infections.
- Nervous and cardiovascular system damage.
- Infection of soft and bone tissues.
Most of all existing types of nosocomial infections are purulent-septic diseases, about 12% of patients become infected with intestinal infections.
Who is at risk?
The following categories of patients are most often susceptible to infection:
- migrant or homeless people;
- people with long-term progressive chronic infections;
- patients who have been prescribed immunosuppressive therapy, including immunosuppressants;
- patients after surgery followed by blood replacement therapy, hemodialysis, infusion treatment;
- parturient women and newborns, especially those born prematurely or late;
- newborns with birth trauma or birth defects;
- medicalhe alth facility staff.
What contributes to the spread of nosocomial infection?
Pathogens can circulate between different sources. For example, one of the common chains is "patient-he alth-care worker-patient". Thus, an epidemic of nosocomial infections may break out in any of the medical institutions.
Summary of what contributes to the spread of hospital-acquired nosocomial infections:
- gram-positive microorganisms: enterococci or staphylococci;
- gram-negative bacteria: E. coli, aerobic microorganisms;
- pseudomonas;
- mushrooms;
- viruses;
- Koch's stick and salmonella.
In most cases, and this is about 90% according to statistics, nosocomial infection is caused by bacteria. This is facilitated by the resistance of microorganisms to external influences, many of them do not die even during boiling or disinfection.
Urinary Tract Diseases
Bacterial complications of the excretory system are leading in the structure of nosocomial infections. The urinary tract is in most cases affected during catheterization of the bladder, and only a small proportion falls on other manipulations on the organs of the genitourinary system. Most often, such diseases lead to an extension of treatment. The patient has to stay longer in the medical facility.
The problem of urinary tract infections has recently been actively studied, and the peculiarities of the epidemic process in patients of different profiles also remain unclear. That is why it is important to conduct a series of studies:
- to study the intensity of manifestations of urinary tract infection in the hospital;
- identify all risk factors for disease;
- to establish the ways and factors of transmission of the pathogen;
- develop a prevention system;
- take steps to prevent urinary tract infection in the hospital if possible.
In maternity hospitals
Infection of newborns has its own characteristics, so the relevance of nosocomial infections in obstetrics and neonatology is not reduced. Babies, especially those who were born before the appointed time, have low immunological resistance. This circumstance, as well as other risk factors, cause a high risk of getting a nosocomial infection during a hospital stay.
There are several main causes of nosocomial infection in newborn babies:
- low gestational age, especially in babies born before 32 weeks;
- morphofunctional immaturity and the presence of perinatal pathology;
- prolonged hospital stay;
- use of non-sterile medical equipment and instruments;
- complex drug treatment;
- congenital pathologies;
- enteral nutrition disorders;
- surgicalinterference
- jaundice in newborns.
To reduce the percentage of infection with nosocomial infections that occur in maternity hospitals, it is necessary to carry out preventive measures as often as possible. First of all, allow only verified personnel to work and use only processed and sterile tools. This is the only way to reduce the infection rate of newborns during the hospital stay after birth.
Diagnostic measures
The relevance of nosocomial infection is great. To determine the type of pathogen, the doctor should pay attention to the characteristics of the symptoms, conduct an examination and refer the patient for diagnosis. When taking blood, bacteremia (pathogenic microorganisms) in the bloodstream or septicemia can be detected - a generalization of the infection, after which an analysis for bakposev should be taken to determine the type of pathogen. Therefore, blood for research is taken in all cases of hospital fever, except:
- primary episode of fever after surgery;
- situations, if the doctor is sure that these are manifestations of drug fever;
- clinical manifestations of deep vein thrombosis.
The number of series of blood sampling depends on the estimated probability of detecting bacteremia. After a course of antibiotic treatment, it is again recommended to carry out manipulation and carry it out within two days. It is impossible to take blood for bacteriological examination through an indwelling catheter. In the hands of medical staffgloves must be present.
The norm is when pathogenic microorganisms are not found in the blood. Persistent or recurrent bacteremia is a sign of a serious infection.
Prevention
The urgency of nosocomial infection forces us to look for effective methods to solve the problem. The most effective and reliable is prevention, which, as you know, is better than therapy with modern antibiotics, to which bacteria have not yet had time to develop resistance.
It has long been known about how serious complications a patient's infection in a medical institution can turn into. Back in Soviet times, in the 70s of the last century, it was published, which has not lost its force to this day, and therefore regulates the prevention of nosocomial infection.
That is why it is important to take preventive measures in a timely manner, which include:
- detection of nosocomial infection carriers;
- isolation of patients with clear signs of an infectious disease from the moment of admission to the institution;
- strict adherence to the sanitary and epidemiological regime;
- hospital use of hoods with antibacterial filters;
- careful treatment of tools, equipment and all surfaces with any of the substances for disinfection;
- rational use of antibiotics.
Antibacterial treatment
Having learned what it is - nosocomial infections, you should give a few words to the features of the treatment of such a disease. In most cases, empirical oretiotropic technique. Choosing the right drugs is quite difficult, because it all depends on the structure of antibiotic resistance in a particular medical facility, as well as on the presence of concomitant ailments in the patient, mono- and polymicrobial etiology of the infection and its localization.
The main principle of empirical treatment is the selection of drugs that are active against most types of pathogens. That is why it is recommended to resort to combination therapy and the use of a broad-spectrum drug.
Thus, the following drugs are recommended for the treatment of nosocomial infections:
- fluoroquinolones Levofloxacin or Ciprofloxacin;
- combinations of β-lactams with beta-lactamase inhibitors;
- drugs with antipseudomonal activity, such as carbapenems, 3rd-4th generation cephalosporins and others.
Etiotropic therapy depends on the phenotype of antibiotic resistance of pathogens and a number of other factors.
The attending physician should select the type of treatment for each individual case after all tests have been taken and the causative agent of the infection has been identified. Constant monitoring will allow you to quickly get rid of the disease without consequences for the patient.
After discharge from the hospital, the patient should observe his condition for a few more days and retake tests to be sure that the treatment has given good results and the disease will not return again.
