Hospital infection is one of the most difficult problems that occurs in many countries of the world. The social and economic damage caused by hospital pathogens is enormous. Paradoxically, despite the tremendous achievements in the field of therapeutic and diagnostic technologies and, in particular, inpatient treatment, this problem remains one of the most acute.
What is nodule?
Nosocomial or hospital infection (NI) is a disease of microbial etiology that occurs in patients during their stay in hospitals, or when patients visit a medical institution for the purpose of treatment. They are found in all countries of the world and represent a serious problem for medical and preventive health care institutions. Diseases associated with the provision of medical services denote the terms iatrogenic (from Greek, iatros, doctor) or nosocomial (from Greek nosokomeion, hospital) infection.
Types of nosocomial infections (types of pathogens)
Approximately 90% of all hospital infection pathogens are of bacterial origin. Viruses, fungi and protozoa, as well as ectoparasites are less common. Grouping of pathogenic microorganisms, taking into account epidemiology:
- The first group of causative agents 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 manifested to a greater extent precisely in the conditions of a medical institution (salmonellosis, colienteritis).
- The third group is opportunistic microorganisms that develop exclusively in a hospital setting (purulent-septic infections).
Hospital stamps
The circuit in hospitals of infectious agents of nosocomial infections gradually forms the so-called hospital strains, i.e., microorganisms that are 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 special adaptability to drugs (antibiotics, antiseptics, disinfectants, etc.).
Causes of nosocomial infections
The reasons are divided into objective, independent from the managers and personnel of the medical institution, and subjective, depending on the management and personnel of the specialized department, hygienic principles for the prevention of hospital infection, which are not observed.
The main objective reasons are: the lack of an effective treatment method, poor provision of laboratories, the widespread use of antibiotics, an increase in the number of patients with low immunity, and the insufficient number of laboratories. Subjective reasons include: lack of patient records, poor quality of instrument sterilization, lack of hospital control by CEC, increased contact between patients with infectious diseases.
Microbiological diagnosis
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 in a hospital, and the results of laboratory tests.
Upon detection of nosocomial infections caused by opportunistic flora, the length of stay in the hospital and all other aggravating factors (patient age, severity of the underlying disease, deterioration in general health) are taken into account.
In the bacteriological diagnosis of hospital infection caused by UPM, the mass growth of re-sowing 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 that the disease can occur during inpatient treatment, while the patient is already infected in a community-acquired setting.
Routes of transmission of nosocomial infection
In medical and preventive institutions, the classic ways of transmitting hospital infection are:
- airborne droplet;
- fecal-oral;
- contact household.
At the same time, transmission of nosocomial infections is possible at different stages of medical care. Any parenteral intervention (injection, medical history, vaccination, surgery, etc.) using medical equipment that has not been properly handled poses a risk of infection. So hepatitis B, C, syphilis, delta infection, purulent-inflammatory diseases caused by various bacterial agents can be transmitted.
Therefore, it is necessary to limit blood transfusion as much as possible, or conduct them 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 Legionellosis infection when taking whirlpool baths and a hygienic shower. It is highly likely that patients become infected with hospital infections in hospitals through liquid medications (isotonic solution, glucose solution, albucid, etc.), in which gram-negative bacteria multiply rapidly.
Sources of transmission
Sources of infection with nosocomial infections can be:
- nurses and visitors to a medical institution suffering from infectious diseases (flu, diarrhea, pustular skin lesions with less severe symptoms) that continue to be with patients;
- patients with erased forms of the disease;
- patients with wounds treated with antiseptics that are carriers of bacteria of virulent staphylococcus strains;
- young children with pneumonia, otitis media, chickenpox, tonsillitis, etc., which produce pathogenic strains of Escherichia coli (Escherichia coli).
Nosocomial infection can also be caused by microbes in the environment, for example, some types of gram-negative bacteria. In such cases, the source of infection is soil in flowerpots, water, or any humid environment in which conditions exist for bacterial activity.
VBI 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;
- the length of stay in the hospital (70% of such infections appear in patients who are in hospital for more than 18-20 days);
- excessive use of antibiotics that change the intestinal biocenosis, reduce the body's immune resistance, promote the development of antibiotic-resistant strains (a single administration of drugs reduces the content of lysozyme, complement, perperdine and antibody production);
- widespread use of corticosteroids, which reduces the body's resistance;
- hospitalization of people in old age, especially with chronic diseases that are the source of nosocomial infections;
- finding on treatment of children at a young age, and especially up to one year;
- the accumulation of a large number of people who are being treated in a hospital in hospitals.
Measures to prevent nodal drift
Prevention of hospital infection in the hospital is carried out by all departments. Even before the hospitalization of the victim, the doctor who prescribes treatment for the patient, in addition to examination and diagnosis, identifies the following risk factors for the development of nosocomial infections:
- the presence or absence of contact with people who suffer from infectious diseases;
- previously transmitted infectious diseases that are prone to carriage (tuberculosis, viral hepatitis, typhoid paratyphoid diseases, etc.);
- reveal if the patient was outside his or her place of residence.
The first anti-epidemic barrier to the hospital infection prevention and control system is the admission department. When a patient is admitted to hospital, they are taken to prevent infection from entering the ward. Hygienic principles for the prevention of hospital infection:
- individual patient reception;
- careful collection of epidemiological history;
- examination of a person, which includes not only clarification 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 purulent surgery department confirms the rule: "There are no trifles in surgery."