Nosocomial infections occur due to the meeting of the source of infection with a susceptible organism of a sick person in the presence of conditions for the transmission of the pathogen. Infection prevention measures are regulated by order 720 on the prevention of nosocomial infection, issued by the USSR Ministry of He alth back in 1978. The document was intended to improve the provision of medical care to patients with purulent surgical lesions and to strengthen measures against nosocomial infections.
Instructions for the order are still used by medical workers. Order 720 helps employees of medical institutions and sanitary and epidemiological stations organize and control actions for non-specific prevention of nosocomial infections.
Cancellation of order and instructions
Orders of the Ministry of He alth of the Russian Federation have greater legal force compared to SanPiNs, which are periodically introduced and canceled. The Decree of the Chief Sanitary Doctor of the Russian Federation in 2010 approved SanPiN with sanitary and epidemiological requirements for organizations thatcarry out medical activities. The document replaced SanPiN 2.1.3.1375-03 on hygienic requirements for the operation of hospitals, maternity hospitals and hospitals.
Also registered are sanitary rules 3.1.2485-09 on the prevention of nosocomial infections in surgical hospitals and the corresponding SanPiN 2.1.3.2524-09 on dentistry.
On the territory of Ukraine, order 720 on the prevention of nosocomial infection was canceled on the basis of the Order of the Ministry of He alth No. 179 of 1998. However, it can be considered valid on the basis of the order of the Ministry of He alth No. 229, where the document is not used regarding the organization of the sanitary and anti-epidemic regime in obstetric hospitals.
Document highlights
An infectious disease obtained in a medical institution is a nosocomial infection. Order 720 describes in detail cases of infection in surgery, which are manifested by suppuration and sepsis. The main pathogens: Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, Proteus, Candida, Klebsiella, Serrations - have not changed, but have become more resistant to antibiotics. Sources of infection are patients with purulent-septic diseases or personnel with a latent form of infection. Pathogens are spread by airborne droplets or through contact with linen, hands, tools.
Prevention methods include:
- isolation of the source of infection;
- breaking transmission paths.
Pathogens and patients with infection are detected and isolated in a timely manner, hands are disinfected, linen and tools are sterilized. The old order 720 for the prevention of nosocomial infection briefly describes the features of the surgical department, sanitization measures, methods of bacteriological examination and detection of staph infection.
Infection prevention rules
Responsible for the fight against nosocomial complications are the head physician and heads of the surgical department. Together with the nurses, they organize and supervise the implementation of activities. Order 720 regulates the conduct of medical examinations, the cure of caries, testing for staphylococcal infections once a quarter, and instructing employees. Identification of an infection is a reason for an extraordinary check.
Soviet order 720 for the prevention of nosocomial infection acts as an instruction for the organization of the sanitary and hygienic regime. Activities in the departments affect the disinfection of spatulas, couches, hands of doctors in contact with patients and purulent-septic skin lesions. The instruction concerns the use of disinfectant solutions, changing and processing washcloths, brushes and towels for medical staff.
The instruction refers to wet cleaning twice a day, the use of disinfectants in case of nosocomial infection and in wards with purulent complications and diseases. The requirements for eating in stationary departments, storing food fromhome transmissions, as well as their verification in accordance with the requirements for the diet of the patient.
Instruction and hygienic regime in surgery
Order 720 "Prevention of nosocomial infection" contains requirements for the organization and disinfection in the surgical department instead of SanPins. The operating block, together with intensive care and postoperative wards, are areas of special attention from the point of view of the spread of infections. Sources of infection are also incoming patients and their care items, dressings, instruments, things directly from the wards.
Surgery departments have a strict sanitary and hygienic regime:
- patients with purulent-septic lesions are isolated;
- care items, bed and bedside table are disinfected;
- in the wards turn on ultraviolet irradiators;
- examination and care takes place in dressing gowns, masks and caps, which must be changed;
- patients cannot freely go to other wards and departments;
- be sure to change bed and underwear once a week;
- Shoes of patients after discharge are subject to processing.
Discharge patients with purulent-septic lesions in a separate room.
Sanitary rules of the operating unit
The organization of the operating unit reduces the risk of nosocomial infections:
- mandatory presence of a vestibule with an ultraviolet irradiator;
- installation of ventilation systemswith bacteria filters;
- use of mobile recirculating air cleaners;
- separation of operating rooms for purulent and clean operations or thorough disinfection after purulent processes on a separate day;
- redline rule respected regarding sterile underwear, gauze bandage and shoe covers.
The following sanitary and hygienic rules apply in operating theaters and intensive care units, postoperative wards and dressing rooms:
- processing gurneys, instruments and apparatus with a disinfectant solution;
- preparing the table with sterile instruments;
- collecting used dressings in separate containers, separating them clean and purulent;
- use and disinfection of oilcloth apron by nurses during dressing of patients with purulent processes.
The instruction contains the requirements for cleaning the operating unit, wards.
Rules of preparation for surgery and instrument sterilization
The completeness of the rules demonstrates the role played by Order 720 "Prevention of Nosocomial Infection". Canceled or not the document - guidelines are carried out by medical personnel, avoiding infections. The rules for surgical departments remain unchanged as they relate to:
- cleaning the hands of the personnel involved in the operation and preparing a disinfectant solution;
- pre-sterilization processing of instruments and its controlquality;
- sterilization of instruments, dressings, gloves and surgical linen;
- sterilization of heart-lung machines.
Order 720 separately highlights the rules of hygiene in the ward with patients with gas gangrene.
The modes and methods of sterilization are considered in detail:
- steam;
- air (by heating);
- chemical (hydrogen peroxide and deocon) and ethylene oxide.
Describes the stages of pre-sterilization cleaning, methods of preparation of solutions and features of disinfection of various objects of the surgical department. More information about the disinfection of ventilators and inhalation solution is given in Appendix No. 4 to this resolution.
Bacteriological control
Appendices No. 2 and 3 are devoted to bacteriological control carried out by laboratories and disinfection stations. The methodology of bacteriological studies is described in detail, a list of objects to be studied, the rules for conducting crops and recording their results are given.
Appendix No. 3 is devoted to the detection of staphylococcal nosocomial infection, sanitation by order 720. Methods for examining the upper respiratory tract, carrying out bakposev and sanitation of infectious agents are described. Particular attention is paid to Staphylococcus aureus, 40% of strains of which are not sensitive to treatment. Antibiogram techniques are described.
Status of order 720
Order 720"Prevention of nosocomial infection", the status of which raises many questions, is used in practice by chief nurses for several purposes:
- helps prevent nosocomial infections;
- allows you to prove your case in case of disputable situations;
- is the basis for the preparation of instructions for junior medical staff;
- replaces the job of a hospital nurse epidemiologist.
Order 720 was still issued by the USSR Ministry of He alth, but was canceled in practice by the release of new sanitary rules. Although the order, as a legislative act, is above the rules, which indicates the incompetence of its cancellation. Materials regarding the methods used, solutions and objects of disinfection are outdated. But the order describes in more detail the processing of anesthesia and respiratory equipment, which is not in later documents.
Should I invoke the order legally
If you understand the legal intricacies of the release of new legislative acts, then order 720 "Prevention of nosocomial infection" was canceled by a decree of the Chief State Sanitary Doctor of the Russian Federation back in 2009, when new sanitary and epidemiological rules SP 3.1.2485-09 were approved. In 2010, there was a conflict, since the decree was declared invalid due to the emergence of a new one. The current SanPiN 2.1.3.2630-10 and SanPiN 2.1.3.2630-10 are now a replacement for order 720.
