No matter how ideal the medical institution may be, no matter how well the sanitary standards are respected, there is still a risk of getting an infection - a nosocomial infection. This is a rather unpleasant event in a personβs life and can carry negative consequences, therefore it is important to diagnose it in time and start therapy. And for starters - to learn more about this infection in order to recognize it in time and to carry out prevention.
What is a disease?
Nosocomial infection is also called nosocomial infection. This is a clinically pronounced pathology of microbial origin, which affects a person during his hospitalization or visiting a medical institution in order to undergo therapy.
A nosocomial infection is considered such if the symptoms of the disease appear two days after the patient enters the hospital. Some types of pathologies may develop after the patient returns from the hospital home.
Distribution factors
The main cause of nosocomial infection is the adverse conditions created in the medical facility. The probability of infection increases if:
- Departments or entire hospitals do not meet sanitary standards.
- Staphylococcus carriers do not receive adequate treatment.
- The number of contacts between staff and the patient has increased.
- The laboratories have insufficient equipment.
- A large-scale antibiotic therapy is prescribed to the patient.
- In microbes, resistance to antibacterial agents increases.
- Immunity is weakened due to complications after surgery.
Transmission ways
Today, doctors distinguish several ways of transmission of nosocomial infection - these are:
- airborne droplet;
- domestic;
- contact instrumental;
- postoperative and postinjection;
- infections that occur after injury.
The importance of the problem lies in the fact that the transmission routes of nosocomial infection are diverse, so finding the causes is quite difficult.
Classification
If we consider them according to the duration of the course, then conditionally the disease can be divided into three main groups:
According to clinical manifestations, they are mild, moderate and severe. Two forms are distinguished from the degree of spread of infection : generalized and localized.
In the first case, infection is manifested by bacteremia, septicemia and bacterial shock. As for local forms, the following types of infection can be distinguished:
- Damage to the skin, fiber of the mucous membranes and subcutaneous tissue, which include abscesses, phlegmon, erysipelas, mastitis, paraproctitis, skin fungus and others.
- Diseases of the oral cavity and ENT organs: stomatitis, tonsillitis, pharyngitis, otitis media, sinusitis and others.
- The penetration of pathogenic microorganisms into the lungs and bronchi, which causes the development of pneumonia, bronchitis.
- The defeat of the gastrointestinal tract.
- Conjunctivitis and other infectious diseases of the eye.
- Genitourinary infections.
- Damage to the nervous and cardiovascular systems.
- Infection of soft and bone tissues.
Most of all existing types of nosocomial infections are purulent-septic diseases, about 12% of patients become infected with intestinal infections.
Who is at risk?
Most often, these categories of patients are susceptible to infection:
- migratory population or persons without a fixed place of residence;
- people with long-term progressive chronic infections;
- patients who have been prescribed immunosuppressive therapy, including immunosuppressants;
- patients after surgery with subsequent blood replacement therapy, hemodialysis, infusion treatment;
- women in labor and newborns, especially those who were born prematurely or later;
- newborns with trauma during birth or congenital malformations;
- medical personnel of healthcare facilities.
What contributes to the spread of nosocomial infection?
Pathogens can circulate between different sources. For example, one of the common chains is patient-health-care provider-patient. Thus, in any of the medical institutions an epidemic of nosocomial infections can erupt.
A short list of what contributes to the spread of nosocomial nosocomial infections:
- gram-positive microorganisms: enterococci or staphylococci;
- gram-negative microbes: E. coli, aerobic microorganisms;
- pseudomonads;
- mushrooms;
- viruses;
- Koch's wand and salmonella.
In most cases, and this is about 90% according to statistics, bacteria cause a nosocomial infection. This is facilitated by the resistance of microorganisms to external influences; many of them do not die even during boiling or disinfection.
Urinary tract diseases
Bacterial complications of the excretory system are leading in the structure of nosocomial infections. The urinary tract in most cases is affected by catheterization of the bladder, and only a small fraction falls on other manipulations on the organs of the genitourinary system. Most often, such diseases lead to prolonged treatment. The patient has to stay in a medical facility longer.
The problem of urinary tract infections has been actively studied recently, and the features of the
epidemic process in patients of different profiles also remain unexplained. That is why it is important to conduct a series of studies:
- to study the intensity of manifestations of a urinary tract infection in a hospital;
- identify all risk factors for the development of the disease;
- establish ways and factors of transmission of the pathogen;
- develop a system of prevention;
- if possible, take measures to prevent urinary tract infections in the hospital.
In maternity hospitals
Infection of newborns has its own characteristics, so the relevance of nosocomial infections in obstetrics and neonatology is not reduced. Infants, especially those born before the appointed time, have low immunological resistance. This circumstance, like other risk factors, causes a high degree of risk of getting a nosocomial infection during a hospital stay.
There are several main reasons for the development of nosocomial infection in newly born babies:
- low gestational age, especially in children born before 32 weeks;
- morphofunctional immaturity and the presence of perinatal pathology;
- prolonged stay in a medical institution;
- use of non-sterile medical equipment and instruments;
- complex drug exposure;
- congenital pathologies;
- enteral nutrition disorders;
- surgical intervention
- jaundice in newborns.
To reduce the percentage of infection with nosocomial infections that occur in maternity hospitals, preventive measures should be taken as often as possible. First of all, allow only trusted personnel to work and use exclusively processed and sterile instruments. This is the only way to reduce the percentage of infections of newborns during hospital stays after birth.
Diagnostic measures
The relevance of nosocomial infection is great. To determine the type of pathogen, the doctor should pay attention to the peculiarities of the symptoms, conduct an examination and refer the patient for diagnosis. When blood sampling can be detected bacteremia (pathogens) in the bloodstream or septicemia - generalization of the infection, after which, to determine the type of pathogen, an analysis should be taken for bacterial seeding. Therefore, blood for examination is taken in all cases of hospital fever, except:
- primary episode of fever after surgery;
- situations if the doctor is sure that these are manifestations of drug fever;
- clinical manifestations of deep vein thrombosis.
The number of blood sampling runs depends on the perceived probability of detecting bacteremia. After a course of antibiotic treatment, it is again recommended that manipulation be carried out and it is carried out within two days. It is impossible to take blood for
bacteriological examination through a permanent catheter. Gloves should be present on the hands of the medical staff.
The norm is when no pathogenic microorganisms are found in the blood. Persistent or recurrent bacteremia is a sign of a serious infection.
Prevention
The relevance of nosocomial infection makes us look for effective methods of solving the problem. The most effective and reliable is prevention, which, as you know, is better than therapy with modern antibiotics, to which bacteria have not yet managed to develop resistance.
About how serious complications a patient's infection in a medical institution can turn into has been known for a long time. Back in Soviet times, in the 70s of the last century, it was published, which has not lost its strength to this day, and therefore regulates the prevention of nosocomial infections.
That is why it is important to take preventative measures in a timely manner, which include:
- identification of carriers of nosocomial infections;
- isolation of patients with clear signs of an infectious disease from the moment they enter the institution;
- strict observance of the sanitary and epidemiological regime;
- hospital use of hoods with antibacterial filters;
- thorough processing of tools, equipment and all surfaces with any of the substances for disinfection;
- rational use of antibiotics.
Antibacterial treatment
Having learned what it is - nosocomial infections, a couple of words should be given to the features of the treatment of such a disease. In a predominant number of cases, empirical or etiotropic techniques are used. It is quite difficult to choose the appropriate drugs, because it all depends on the structure of antibiotic resistance in a particular medical institution, as well as on the presence of concomitant ailments in the patient, mono- and polymicrobial etiology of the infection and its localization.
The main principle of empirical treatment is the selection of drugs that are active against most types of pathogens. That is why it is recommended to resort to combination therapy and the use of drugs with a wide spectrum of action.
So for the treatment of nosocomial infections, the following drugs are recommended:
- fluoroquinolones Levofloxacin or Ciprofloxacin;
- combinations of Ξ²-lactams with beta-lactamase inhibitors;
- drugs with anti-pseudomonas activity, such as carbapenems, cephalosporins of 3-4 generations and others.
Etiotropic therapy depends on the phenotype of the antibiotic resistance of pathogens and a number of other factors.
The type of treatment for each individual case should be selected by the attending physician after all tests have been taken and the causative agent of the infection has been identified. Constant monitoring will allow you to quickly get rid of the disease without consequences for the patient.
After discharge from the hospital, the patient should monitor his condition for several more days and re-take tests to be sure that the treatment has yielded good results and the disease will not return again.