Infections associated with the provision of medical care are regularly found in clinical practice. And do not blame the doctors, they are trying to do everything possible to delay the onset of these complications. Unfortunately, few people manage to avoid them.
Definition
What does the concept of “infection related to the provision of medical care” mean? The definition is as follows: this is any manifestation of a disease of a microbial nature that is observed in a patient after treatment in a hospital, or visiting a hospital for treatment, or within a month after discharge from the hospital.
Another name for this group of diseases is nosocomial infection, or nosocomial infection. It is believed that the infection appeared in the patient already in the hospital if the first symptoms of the disease appeared no earlier than two days from the time of admission. A prerequisite is the patient’s absence of manifestations of this infection before being placed in a medical institution.
Hospital infections must be distinguished from iatrogenic and opportunistic infections , since they are similar enough to be confused. Iatrogenic infection is considered to be an infection that appeared due to the fault of medical personnel during treatment or diagnosis. The opportunistic one appears in people, which is why immunity is not able to restrain conditionally pathogenic bacteria in check.
Prevalence
The epidemiology of infections associated with the provision of medical care, judging by the estimates of the Center for Disease Control (CDC), is disappointing. In the United States, more than half of the one and a half million cases a year died. In Europe, this figure is twenty-five thousand, in Russia - thirty thousand. But such low numbers do not speak about the quality of medical care, but about the low quality of statistical studies.
For nosocomial infections, there are distribution principles that distinguish them from other diseases of this kind. These differences are the mechanism and transmission factors, the specifics of the course of infection, the role of hospital staff in maintaining and increasing the number of patients. Also, these infections are difficult to treat, since the microorganisms that live in the medical facility are resistant to drugs.
Etiology
The causative agents of medical-related infections are common throughout the world. To date, more than two hundred microbial agents are known that are able to cause nosocomial infections. Before the era of antibiotics, these were anaerobic bacilli, streptococci and staphylococci. It has now been established that the cause of infection can be rotavirus, cytomegalovirus, hepatitis viruses and even HIV.
Being a long time in the territory of the medical institution, the microorganism undergoes natural selection and mutation, as a result of which there are resistant strains, which can not be disinfectants, quartz and antibiotic therapy. Each individual hospital, ward, and even the operating room has its own unique bacteria.
Sources and transmission mechanism of infection
The concept of "infection associated with the provision of medical care" implies the presence of three whales of the epidemiological process:
- source;
- transmission method;
- a susceptible person.
The sources of nosocomial infections can be sold by patients who have been in the hospital for a long time and are contaminated by its microflora, as well as medical workers who are in daily contact with the same bacteria. Visitors to day hospitals and relatives play a secondary role in the spread of hospital infections.
The transmission mechanism can be almost any: fecal-oral, airborne, contact or transmissible. Transmission factors include instruments, apparatus for breathing and circulation, bedding and underwear, beds, dressings and sutures, prostheses, drains and wet objects. These include faucets and sinks, plums, infusion solutions, purified water, antiseptic solutions, water in flower vases, condensate in the air cleaning system, and more.
Risk groups
Infections associated with the provision of medical care to patients are most often found in people with weakened immune systems. Of course, in all patients, the protective functions of the body are reduced to one degree or another, but there are people who are most susceptible. These include:
- aged people;
- premature babies and newborns;
- patients with cancer, autoimmune, allergic diseases;
- patients who have undergone lengthy operations;
- people who lived in ecologically unfavorable territories.
The listed contingent is most likely to get sick while in a medical institution, so it requires increased care from the medical staff.
Classification
What are the types of infections associated with health care? It all depends on what grounds they are classified. For example, if you take the transmission routes, then they distinguish: aerosol, alimentary, contact-household, instrumental, post-transplant, infection after injections, blood transfusions, operations, endoscopic procedures, and others. With the course, like other diseases, nosocomial infections are acute, subacute and chronic, as well as severe, moderate and mild.
There are also different degrees of prevalence that infections associated with health care can take. Classification begins with severe cases:
- Generalized form: bacteremia, septicemia, septicopyemia, bacterial shock.
- Localized form.
- Infections of the skin and subcutaneous fat.
- Respiratory infections.
- Dental forms.
- Digestive infections.
- Infections of the genital and urinary system.
- Infections of the musculoskeletal system.
- Infections of the nervous system.
- Infections of the cardiovascular system.
Causes of High Incidence
Prevention of infections associated with the provision of medical care is aimed at reducing the overall incidence rate. But unfortunately, today all safety precautions are ineffective. The main reason for this is the emergence of multiresistant flora.
First of all, this happens because the bacteria mutate, changing their properties due to the irrational use of antibiotics and disinfectants. These are ideal conditions for creating microflora with secondary multi-resistance.
Primary resistance is the natural ability of this type of microbes to resist aggressive agents. The habit of doctors to prescribe antibiotics for any reason leads to the fact that the effectiveness of treatment is reduced, and bacteria become immune to drugs. But not only the medical staff is to blame. In Russia, people are accustomed to prescribing antibacterial agents on their own, but at the same time do not adhere to the instructions for use.
Fleming Principles
There are three principles of Fleming that are recommended by the international health organization.
The first principle is to prescribe antimicrobials only if the pathogen is sensitive to them. This will limit the use of antibiotics, will force doctors to always conduct studies of the sensitivity of flora to drugs, and will highlight drugs with a narrow, directed spectrum of action.
The second principle of Fleming says that you need to ensure an effective concentration of the drug in the lesion. This rule will reduce the number of locally used antibiotics and drugs prescribed for preventive purposes. In addition, this will make it possible to cancel the medication immediately, and not gradually, as well as adjust the dose and preparation, based on studies of the patient’s body fluids every seven days.
The third principle - it is necessary to prescribe antibiotics at such a dose and administer them in such a way as to minimize negative effects. This will allow more rational use of drugs.
The formation of bacteriocarriers
Infections associated with the provision of medical care cannot exist without a bacterium carrier, the so-called “null patient”, which will be an invisible source of infection for everyone else.
Bacteriocarrier is a form of infection that appears if an equilibrium is established between the host and the parasite against the background of the absence of clinical manifestations. Immunological reactions continue to occur. If the microorganism passed in latent form through five patients, then it changes its properties and becomes more aggressive.
Preventive measures in this case are:
- regular medical examination of medical workers;
- bacteriological examination of hospital staff;
- timely detection and treatment of infected doctors;
- daily monitoring of the health status of doctors.
Hazardous diagnostic and treatment procedures
Infections associated with the provision of medical care (IASP) appear not only after the patient spent some time in hospital, but also after a series of diagnostic and therapeutic procedures that contribute to the contamination of the hospital flora. These include blood transfusions, injections, transplantation of organs and tissues. Among resuscitation measures are intubation, inhalation anesthesia, life support devices, and catheters. Also, infection can occur after hemodialysis, inhalation and balneological procedures.
Spalding Classification
Infections related to the provision of medical care can be transmitted through medical devices. Therefore, Spaulding divided them into three groups, taking the risk of infection with hospital flora as a classification sign.
The first group is critical. These include surgical instruments, catheters, implants, needles and injection fluids.
The second group is semi-critical: endoscopic and inhalation equipment, anesthesia devices, rectal thermometers.
The third group, respectively, is non-critical. These are all other items: ships, tonometers, crutches, dishes, underwear, axillary thermometers.
Prevention
Prevention of infections associated with the provision of medical care is based on the recommendations of the World Health Organization on the prevention of nosocomial infections. Good prevention should include three steps:
- minimizing the appearance of infection from outside the hospital;
- the exclusion of the spread of infection by affecting the links of the epidemic process;
- the exception of the removal of infection outside the hospital.
For this, there is isolation of patients with dangerous infectious diseases in specialized boxes with a separate entrance and exit, which is not connected with the rest of the department. In addition, current and general sanitization of tools and surfaces is carried out in each department. The frequency of these measures depends on the need: in therapeutic departments - less often, in surgical departments, respectively, more often.
Treatment
Infections associated with the provision of medical care, albeit with difficulty, are nevertheless amenable to drug therapy. Ideally, the doctor prescribes a specific antimicrobial drug with a narrow spectrum of action, which is designed for a specific type of pathogen. But in practice, this is hardly possible, because sowing microflora and sensitivity analysis take a week, and the patient needs to be treated now. Therefore, the doctor is forced to prescribe empirical therapy, based on his conclusions. The choice of antibacterial drug depends on the doctor’s knowledge of which microflora prevails in the department.
In order for pathogens to not develop resistance to drugs, it is necessary to adhere to the rotation of drugs, that is, change them every two to three months. This will help reduce resistance and improve treatment outcomes.