In the article, we briefly consider the prevention of nosocomial infections in hospitals. What do these concepts mean?
Any clinically recognized disease that has a microbial origin in a patient or medical professional may be associated with his stay, therapy, seeking medical help or examination at a medical institution. Such an ailment is considered a nosocomial infection (i.e. abbreviated nosocomial infection ). In hospitals, the prevention of such diseases should be carried out without fail.
The identification of pathogens of nosocomial infections is carried out using laboratory diagnostic methods (microscopic, microbiological, serological, molecular biological). In treatment, antibiotics, antiseptics, immunostimulants, physiotherapy, extracorporeal hemocorrection , etc. are used.
Description
One of the most important, and at the same time, urgent tasks is the prevention of nosocomial infections in hospitals.
For the development of infectious pathology, the presence of three links is necessary:
- The source of infection, that is, a biological object in the body of which the causative agents of the disease live, multiply and are released into the environment. The source of infection is a patient or a carrier.
- Pathogen transmission factor from an infected patient to a healthy one.
- Susceptible organism.
Comprehensive measures related to the prevention of nosocomial infections are divided into two groups:
- Nonspecific, which are aimed at eliminating or reorganizing the sources of infection, factors and transmission pathogens.
- Specific, which are aimed at increasing the resistance of the body of patients and staff to the causative agents of nosocomial infections.
Requirements
As part of non-specific prophylaxis, three important requirements must be met:
- Minimizing the possibility of introducing pathogenic pathogens into the hospital.
- Maximum reduction of the risks of nosocomial infection.
- The exception is the removal of the pathogen outside the healthcare facility.
A specific focus on the prevention of hospital infection includes measures to detect an immunodeficiency state along with an adequate adjustment, as well as the use of specific serum, bacteriophages and toxoids for prophylactic purposes.
Order on the prevention of nosocomial infections in health facilities
Disinfection in a medical institution is carried out on the basis of order No. 720 of the Ministry of Health “On improving medical care for patients with purulent surgical diseases and strengthening measures to combat nosocomial infection”.
Key events
The main measures for the prevention of nosocomial infections in healthcare facilities involve non-specific measures. They include the following four groups:
- Carrying out architectural planning actions.
- Implementation of sanitary measures.
- Implementation of sanitary and anti-epidemic actions.
- Disinfection sterilization measures.
Next, we consider them in more detail.
Architectural Planning Activities
Such measures for the prevention of nosocomial infections in hospitals are aimed at preventing the subsequent spread of the pathogen by distance or the so-called black-and-white division of the planning sectors of hospitals.
The distance principle is realized through functional zoning of both the hospital as a whole and all its units with the isolation of one or another zone of varying degrees of purity. In this regard, the infectious, obstetric, children's hospital and various departments must be placed in separate buildings. There are relevant requirements regarding the functional zoning of such units and departments of hospitals. For example, it is extremely important that the operating unit, infectious, pediatric, maternity wards, sectors for the treatment of patients with immunodeficiency, burns, and so on are extremely isolated.
Zoning efficiency
In this case, a positive result is closely related to the presence of the necessary set of rooms of a certain unit, for example, rooms for patients and auxiliary medical rooms. The area of any room must be sufficient and comply with established standards. The set of requirements for the planning and organization of the hospital area is set out in the sanitary epidemiological requirements for organizations that carry out medical activities.
Sanitary technical events
Such measures for the prevention of nosocomial infections in hospitals include a rational arrangement of the ventilation system. Organization of proper air exchange of the building is of great importance. The following important components are distinguished in the complex of effective methods for the prevention of nosocomial infection:
- Maintaining optimal air balance, taking into account the cleanliness of the room.
- Climate conditioning.
- Carrying out air purification, which is supplied to operating rooms and other premises equated to those in medical buildings.
- The use of a laminar installation to create a sterile zone.
In addition, the epidemiological well-being within the hospital is possible only if the sewage and water supply systems are uninterrupted, as well as the organization of energy supply and lighting parameters. Equally important is the proper condition of building structures.
Sanitary anti-epidemic measures
These methods include maintaining proper sanitary condition along with the observance of the anti-epidemic regime in all rooms of the medical hospital and control over the correctness of their implementation. Among other things, these preventive measures suggest the following:
- Identification of pathogens and carriers of infection among staff (for example, during hiring, conducting periodic preventive examinations and according to relevant epidemiological indications).
- Reorganization.
- Identification of carriers of the disease and patients among patients during their admission to the hospital and during their stay in the department.
Of great importance in the framework of measures to prevent nosocomial infections in hospitals is the control of bacterial contamination of the hospital environment. At the same time, attention is paid to the air and working surfaces of the premises, materials, devices, tools.
Educational work
One of the aspects of sanitary anti-epidemic measures is the systematic implementation of educational work for staff. In this regard, briefings are held on the rules for admitting patients, filling treatment rooms, cleaning rooms, using disinfectants, using a bactericidal lamp, observing personal hygiene rules and treating hands and so on. It is worth noting that, first of all, managers are responsible for ensuring the sanitary epidemiological regime in a hospital facility.
Disinfection and sterilization measures
These methods of prevention of nosocomial infections are aimed at the destruction of pathogens within the nosocomial environment. Disinfection destroys many pathogenic microscopic organisms on various surfaces (floors, walls, door handles, switches, window sills, and so on). Rigid furniture, surfaces of various appliances, apparatus and equipment are cleaned.
It is very important to maintain fresh air in the room, clean dishes along with linen, medical supplies and patient care items. Sanitary technical equipment, the surface of the surgical field and the hands of personnel are also subject to disinfection. Thus, sterilization is the destruction of all types of microscopic organisms, spores, including on medical devices.
Disinfection sterilization measures for the prevention of nosocomial infections are carried out using mechanical treatment (we are talking about washing, wet cleaning, washing, vacuuming, ventilation, ventilation). The tools are chemical agents and physical methods that have a bactericidal effect (for example, high temperatures along with water vapor under excessive pressure, ultraviolet radiation, ultrasound, a microwave field) and their combination (wet cleaning followed by disinfection).
It is worth noting that medical devices that are used for manipulations and invasive procedures, in which there is a risk of damage to the mucous membranes, are subjected to a three-stage treatment after each use: disinfection, pre-sterilization preparation (cleaning) and sterilization, the last two actions being carried out in the sterilization department of each hospitals.
Carrying out specific prevention of nosocomial infections for the patient
Such prophylaxis, along with immunization, is aimed at increasing the resistance of the body of patients and clinical personnel to nosocomial infections. It is usually divided into two forms: planned and emergency.
The planned type of measures for the prevention of nosocomial infections or vaccination (active immunization) is carried out starting from birth. In this case, healthy newborns are vaccinated against hepatitis B and tuberculosis, and then, after reaching a certain age, children are vaccinated in the clinic from diseases such as poliomyelitis, whooping cough, diphtheria, measles and other infections according to the vaccination calendar.
Thus, the younger generation develops persistent lifelong immunity against these diseases. In order to prevent nosocomial infections of medical personnel, routine vaccination against hepatitis B and diphtheria is carried out.
Remediation of carriers of a toxigenic strain of staphylococcus from the number of HCI employees is considered appropriate in situations when they have the same phagovar released within six months. Instead of using broad-spectrum antibiotics, anti-staphylococcal bacteriophages or a two-percent oil solution of the drug called “Chlorophyllipt” are used.
Emergency prevention, as a rule, includes measures that are aimed at preventing the development of pathology in people in case of infection. The goal is to create the immunity of the individual during the incubation period of the disease.
Depending on the nature of the means used, emergency prevention is divided into specific (passive immunization) and general. For the passive form, targeted drugs are used that contain ready-made antibodies along with bacteriophages - antistaphylococcal hyperimmune plasma, measles and antistaphylococcal globulin, staphylococcal bacteriophage. In the framework of emergency prevention, antibiotics of a wide spectrum of exposure (such as penicillins or cephalosporins) are used. The drug "Metronidazole" is also used if the presence of an anaerobic infection is assumed.
We briefly reviewed the prevention of nosocomial infections in health facilities.