Nosocomial infections occur due to a meeting of the source of infection with the susceptible organism of a sick person in the presence of conditions for transmission of the pathogen. Infection prevention measures are regulated by order 720 on the prevention of nosocomial infection, issued by the USSR Ministry of Health 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.
The medical instructions are still used by the order. Order 720 helps employees of medical institutions and sanitary-epidemiological stations organize and control actions for the non-specific prevention of nosocomial infections.
Cancellation of orders and instructions
Orders of the Ministry of Health of the Russian Federation have greater legal force in comparison with SanPiNs, which are periodically introduced and canceled. A resolution of the Chief Sanitary Doctor of the Russian Federation in 2010 approved the SanPiN with sanitary and epidemiological requirements for organizations that carry out medical activities. The document replaced SanPiN 2.1.3.1375-03 on hygienic requirements for the operation of hospitals, maternity hospitals and hospitals.
Sanitary rules 3.1.2485-09 on the prevention of nosocomial infections in surgery hospitals and the corresponding SanPiN 2.1.3.2524-09 on dentistry are also registered.
On the territory of Ukraine, order 720 on the prevention of nosocomial infection was canceled on the basis of the Ministry of Health Order No. 179 of 1998. However, it can be considered valid on the basis of the order of the Ministry of Health No. 229, where the document is not used regarding the organization of the sanitary-anti-epidemic regime in obstetric hospitals.
The main provisions of the document
An infectious disease obtained in a medical facility is a nosocomial infection. Order 720 details the 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 distributed by airborne droplets or through contact with linen, hands, tools.
Prevention methods include:
- isolation of the source of infection;
- interruption of transmission paths.
Pathogens and patients with infection are promptly detected and isolated, hands are decontaminated, clothes and instruments are sterilized. The old order 720 on the prevention of nosocomial infection briefly describes the features of the surgical department, sanitation measures, methods of bacteriological examination and detection of staphylococcal infection.
Rules for the prevention of infection
Responsible for the fight against nosocomial complications are the head physician and the heads of the surgical department. They, together with the nurses, organize and supervise the implementation of events. Order 720 regulates the conduct of medical examinations, cure of caries, check for staph infections once a quarter, instructing employees. The detection of infection is an occasion for an extraordinary check.
Soviet Order 720 on the prevention of nosocomial infection acts as an instruction for organizing a sanitary-hygienic regimen. Activities in the departments affect the disinfection of spatulas, couches, hands of doctors in contact with patients and purulent-septic skin lesions. The instructions apply to the use of disinfectant solutions, changing and handling washcloths, brushes and towels for medical staff.
The instructions apply to wet cleaning twice a day, the use of disinfectants for the detection of nosocomial infections and in wards with purulent complications and diseases. The requirements for eating in stationary units, storing food from home transmissions, and also checking them in accordance with the requirements for the patient’s diet are outlined.
Instructions and hygiene in surgery
Order 720 "Prevention of nosocomial infection" contains requirements for the organization and disinfection in the surgical department instead of SanPin. The operation unit together with resuscitation, 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, tools, items directly from the wards.
In the departments of surgery, a strict sanitary-hygienic regimen is provided:
- patients with purulent-septic lesions are isolated;
- care items, bed and bedside table are disinfected;
- in chambers include ultraviolet irradiators;
- inspection and care takes place in robes, masks and hats, which are always changing;
- patients should not be allowed to enter other wards and departments freely;
- Be sure to change bed and underwear once a week;
- the footwear of patients after discharge is subject to processing.
Patients with purulent-septic foci are prescribed in a separate room.
Sanitary rules for the operating unit
The organization of the operating unit allows you to reduce the risk of nosocomial infections:
- mandatory presence of a vestibule with an ultraviolet irradiator ;
- installation of ventilation systems with bacterial filters;
- the use of mobile recirculation air purifiers;
- separation of operating rooms for purulent and clean operations or thorough disinfection after purulent processes on a separate day;
- the red line rule for sterile underwear, gauze dressing and shoe covers is respected.
The following sanitary-hygienic rules apply in operating units and intensive care units, postoperative wards and dressing rooms:
- processing of wheelchairs, instruments and devices with a disinfectant solution;
- preparation of a 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 requirements for cleaning the operating unit, chambers.
Rules for preparing for surgery and instrument sterilization
The completeness of the rules demonstrates the role that order 720 “Prevention of nosocomial infection” plays. The document has been canceled or not - the guidelines are carried out by medical personnel, avoiding infections. The rules for surgical departments remain unchanged as they relate to:
- processing the hands of personnel involved in the operation and preparing a disinfectant solution;
- pre-sterilization processing of instruments and quality control;
- sterilization of instruments, dressings, gloves and surgical underwear;
- sterilization of heart-lung machines.
Order 720 separately sets out the rules of hygiene in a room with patients with gas gangrene.
The modes and methods of sterilization are considered in detail:
- steam;
- air (heating);
- chemical (hydrogen peroxide and deocone), as well as using ethylene oxide.
Describes the stages of pre-sterilization cleaning, methods of preparing solutions and features of disinfection of various objects of the surgical department. More information about the disinfection of mechanical ventilation apparatus and inhalation solution are given in Appendix No. 4 to this resolution.
Bacteriological control
Appendices 2 and 3 are devoted to bacteriological control carried out by laboratories and disinfection stations. The methodology of bacteriological research is described in detail, a list of objects to be studied, the rules for conducting crops and taking into account their results are given.
Appendix No. 3 is devoted to the detection of staphylococcal nosocomial infection, sanitation by order of 720. Methods of investigation of the upper respiratory tract, bacteriosis and sanitation of the causative agents of infection are described. Particular attention is paid to Staphylococcus aureus, 40% of the strains of which are not sensitive to treatment. The methods of antibioticogram are described.
Order Status 720
Order 720 "Prevention of nosocomial infection", the status of which raises many questions, is used in practice by senior nurses for several purposes:
- helps prevent nosocomial infections;
- allows you to prove your case when disputes arise;
- It is the basis for drawing up instructions for nursing staff;
- replaces the work of a hospital epidemiologist for nurses.
Order 720 was still issued by the USSR Ministry of Health, and 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 illegality of its cancellation. Materials regarding the methods used, solutions and disinfection objects are out of date. But the order describes in most detail the processing of anesthesia-respiratory equipment, which is not in later documents.
Is it worth it to refer to the order legally
If you look at the legal intricacies of the release of new legislative acts, then order 720 "Prevention of nosocomial infection" was canceled by the decision of the Chief State Sanitary Doctor of the Russian Federation back in 2009, when the new sanitary and epidemiological rules of SP 3.1.2485-09 were approved. In 2010, a collision occurred, since the decree was invalidated 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.