Now in medicine there are technologies that can only be called fantastic. It would seem that against the general background of the triumph of medical genius, the death of a patient due to non-compliance with sanitary standards in a medical institution should be long forgotten. Why is the artifact pathway of infection gaining momentum in our safe time? Why are staphylococcus, hepatitis, HIV still “walking” in hospitals and maternity hospitals? Dry statistics say that the frequency of purulent-septic infections in hospitals in recent years has increased by 20%, and their share in intensive care units is 22%, in surgery up to 22%, in urology over 32%, in gynecology 12%, in maternity hospitals ( 33%).
To clarify, the artifact transmission route of infection is the so-called artificial infection of a person in medical institutions, mainly with invasive procedures. How is it that people who have been admitted to the hospital to treat one disease are additionally ill with others there?
Natural infection
With all the variety of opportunities to catch an infection, there are only two mechanisms of transmission of microbes from a patient to a healthy one:
1. Natural, depending on the observance by the person himself of the norms and rules of hygiene.
2. Artificial or medically artifactal transmission of infection. This is a mechanism that is almost entirely dependent on the observance of their duties by medical staff.
In a natural way, the introduction of pathogenic microorganisms can occur when a person comes into contact with a pathogenic environment. Ways of infection:
- airborne droplets, that is, when sneezing, coughing, talking (flu, tuberculosis);
-fecal-oral, that is, through dirty hands, water and products (infectious diseases of the gastrointestinal tract);
-contact household (a very wide range of infections, including sexually transmitted, skin, helminthiasis, typhoid, diphtheria and dozens of others).
Unbelievable, but that’s how you can pick up any ailment by entering a hospital for treatment.
Artificial infection
In medical institutions, there are two main ways of infection of patients, characterized as an artifact transmission route of infection. It:
1. Parenteral, that is, associated with a violation of the skin of the patient.
2.Enteral, possible with some types of examination of patients, as well as with certain therapeutic procedures.
In addition, the same natural mechanism of transmission of infection is flourishing in hospitals, exacerbating the condition of patients many times. It turns out that you can catch the infection during medical manipulations of doctors and nurses, as well as just staying in the hospital.
Causes of infection of patients in medical facilities
Where do the conditions for the infection of patients from naturally occur in hospitals, and how it affects the artifactal mechanism of transmission The reasons are as follows:
1. In hospitals there are always a lot of infected people. In addition, about 38% of the population, including health workers, is a carrier of various pathogens, but people do not suspect that they are carriers.
2. An increase in the number of patients (old people, children) who have significantly lowered their body resistance threshold.
3. The unification of highly specialized hospitals into large complexes where a specific ecological environment is created voluntarily or involuntarily.
In some cases, the patient becomes artificially infected during dressings, if the nurse who is the carrier does not do her job in a protective mask and gloves. Conversely, a patient can infect a health worker if he performs medical procedures (blood sampling, dental treatment, and more) without a protective mask, gloves, and special glasses.
Nursing staff
In many ways, the infection of patients depends on the work of the junior staff. All the same statistics say that only in Russia nosocomial infection with shingellosis increased to 26%, opportunistic parasites up to 18%, and salmonellosis up to 40%!
What in this case determines the artifactal transmission of the infection? This is primarily a complete or insufficient compliance with sanitary standards. Spot checks showed that in many hospitals, nurses clean rooms, handling rooms, and even operating rooms of poor quality. Namely, all surfaces are treated with a single rag, disinfecting solutions for cleaning the premises are prepared at a lower concentration than is required by the standards, quartz lamps are not treated in the chambers and offices, even if they are in good condition.
The situation is especially sad in maternity hospitals. Artifical infection of the fetus or woman in childbirth, for example, purulent-septic infections, can occur due to a violation of the rules of antiseptics during the processing of the umbilical cord, during obstetric care and further care. The reason may be the elementary absence of a mask on the face of a nurse or nurse who are carriers of pathogenic microbes, not to mention poorly sterilized instruments, diapers and so on.
Antibiotics
As noted above, people with an unclear diagnosis often come to the hospital. The patient is prescribed laboratory examinations, as well as modern diagnostic methods, in which the enteric route of administration (through the mouth) into the body cavity of the corresponding equipment is used. While the test results are being prepared, the practice has been established to prescribe antibiotics with a wide spectrum of action. In a small part, this causes positive dynamics, and in a large part, strains of pathogens are created inside the hospital that do not respond to the effects directed against them (disinfection, quartzization, drug therapy). Due to the natural distribution pathways, these strains are spread throughout the hospital. Unjustified prescription of antibiotics was observed in 72% of patients. In 42% of cases, this was in vain. In the whole country, due to unjustified antibiotic treatment, the infection rate in hospitals reached 13%.
Diagnosis and treatment
It would seem that new diagnostic methods should help to quickly and correctly identify all ailments. Everything is so, but in order to prevent artificial infection of patients, the diagnostic equipment must be correctly processed. For example, a bronchoscope after each patient should be disinfected for ¾ hours according to the norms. Inspections have shown that this is not widely observed, because doctors should not examine 5-8 patients as normal, but 10-15 according to the list. It is clear that they do not have enough time to process the equipment. The same applies to gastroscopy, colonoscopy, catheter placement, puncture, instrumental examination, inhalation.
But the enteric route of drug administration reduces the level of infection. Here, only the duodenal method is dangerous, when the medicine is injected using a probe directly into the duodenum. But oral (taking medicines and tablets by mouth, washing them down or not washing them with water), sublingual (under the tongue) and buccal (gluing special pharmaceutical films to the mucous membranes of the gums and cheeks) are practically safe.
Parenteral route of transmission
This transmission mechanism is a leader in the spread of AIDS and hepatitis. Means the parenteral route - infection through the blood and in violation of the integrity of the mucous membranes, skin. In a hospital, this is possible in such cases:
- transfusion of blood / plasma;
- infection through a syringe during injection;
-surgical intervention;
-conducting medical procedures.
Often, artificial infection occurs in dental clinics and during a visit to a gynecologist due to the fact that doctors use an incorrectly processed instrument to examine their patients' mucous membranes, as well as due to the work of doctors in non-sterile gloves.
Injections
This type of therapy has been used for a long time. When the syringes were reusable, they were subjected to mandatory sterilization before use. In practice, unfortunately it was they who led to the infection of patients with dangerous diseases, including AIDS, due to the blatant negligence of doctors. Now, both for treatment (intravenous and intramuscular injections), and for blood sampling for tests, only disposable syringes are used, therefore, the risk of artifact infection is minimized here. Health workers are required to check the tightness of the syringe packaging before the procedure and under no circumstances to reuse it or the needle for further manipulations. A different situation with instruments for endoscopes (needles, biopsy syringes and others), which in practice are not processed at all. In the best case, they are simply immersed in disinfectants.
Operations
A high percentage of infection occurs during surgery. It is curious that in the 1941-1945s, 8% of infection of the wounded was recorded, and in our time, postoperative indicators of purulent-septic infections have increased to 15%. This happens for reasons:
-use during the operation or after it poorly sterilized dressings;
- insufficient sterilization of cutting or non-cutting tools;
- widespread use of various implants (in orthopedics, in dentistry, in cardiology). Many microorganisms are able to exist inside these structures, in addition, they cover themselves with a special protective film, making them inaccessible to antibiotics.
Disinfection should be carried out in special bix, autoclaves or chambers, which depends on the method of sterilization. Now the operating rooms are trying to use disposable sterile sheets, clothing of surgeons and patients, which should reduce the level of artifact infection. To exclude infection through implants, after surgery, patients receive enhanced antibiotic therapy.
Blood transfusion
It is believed that only blood syphilis, AIDS, and two hepatitis B and C viruses can be caught during a blood transfusion. It is for these pathogens that donor blood is checked at the collection points. But practice shows that even using only disposable syringes, hepatitis D, G, TTV viruses, toxoplasmosis, cytomegalovirus, listeriosis and other infection can be transmitted during blood transfusion. Before donating blood, doctors must check all donors for infection. In fact, often there is not enough time to conduct analyzes, or negligence is simply allowed. Therefore, it is imperative to carefully check the blood taken from the donor. But this is not always done, so to this day, even in Moscow clinics, there are cases of infection of patients with blood transfusion. The second problem is that there are many mutated strains that even the latest test systems do not recognize. The same situation with infection and when transplanting donor organs.