Order No. 720: prevention of nosocomial infection( briefly).Status of Order No. 720

Intrahospital infections occur due to a meeting of the source of infection with the susceptible organism of the patient in the presence of conditions for the transmission of the pathogen. Measures to prevent infections are regulated by Order 720 on the prevention of nosocomial infection, issued by the Ministry of Health of the USSR back in 1978.The document was intended to improve the provision of medical care to patients with purulent surgical lesions and to intensify measures against nosocomial infections.

The instructions to the order of medical workers are still used. Order 720 helps employees of medical and preventive institutions and sanitary epidemiological stations organize and monitor actions for nonspecific prevention of nosocomial infections.

Cancellation of orders and instructions

Orders of the Ministry of Health of the Russian Federation have greater legal force compared to SanPiNs, which are periodically introduced and canceled. Decree of the Chief Sanitary Doctor of the Russian Federation in 2010 approved 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 homes and hospitals.

Sanitary rules 3.1.2485-09 on the prevention of nosocomial infections in the 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 abolished on the basis of the Order of the Ministry of Health No. 178 of 1998.However, it can be considered acting on the basis of the order of the Ministry of Health No. 229, where the document is not used for the organization of the sanitary-antiepidemic regime in obstetric hospitals.

Key points of document

An infectious disease obtained in a health facility is an intrahospital infection. Order 720 describes in detail cases of infection in surgery, which manifest suppuration and sepsis. The main pathogens: Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, Protea, Candida, Klebsiella, Serratia - have not changed, but have become more resistant to antibiotics. Sources of infection become patients with purulent-septic diseases or personnel with a latent form of infection. Pathogens spread by airborne droplets or through contact with laundry, hands, tools.

Methods of prevention include:

• isolation of the source of infection;
• break transmission paths.

Pathogens and patients with infection are timely identified and isolated, hand disinfection, sterilization of linen, tools are carried out. The old order 720 on the prevention of nosocomial infection briefly describes the features of the surgical department, measures for sanitation, methods of bacteriological examination and detection of staphylococcal infection.

Rules for preventing infection

The head physician and the head of the surgical department are responsible for the fight against nosocomial complications. Together with nurses, they organize and monitor the implementation of activities. Order 720 regulates the conduct of medical examinations, the treatment of caries, testing for staphylococcal infections once a quarter, instructing employees. Identifying the infection is an occasion for an extraordinary check.

The Soviet order 720 on the prevention of nosocomial infections acts as an instruction for the organization of a sanitary and hygienic regime. Activities in the departments affect the disinfection of spatulas, couches, hands of doctors, in contact with patients and purulent-septic skin lesions. The instruction concerns the use of disinfectant solutions, the replacement and treatment of loofers, brushes and towels for medical staff.

The instruction concerns wet cleaning twice a day, the use of disinfectants in the detection of nosocomial infections and in wards with purulent complications and diseases. The requirements for food intake in stationary departments, storage of food from home transfers, as well as their verification in accordance with the requirements for the patient's diet, are set forth.

Instruction and hygiene in surgery

Order 720 "Prevention of nosocomial infection" contains requirements for organization and disinfection in the surgical department instead of SanPin. The operating unit together with the resuscitation, postoperative wards are areas of special attention from the perspective of the spread of infections. Sources of infection are also incoming patients and their care items, dressings, tools, things directly from the chambers.

In the surgical departments a strict sanitary and hygienic regime is envisaged:

• patients with purulent-septic lesions are isolated;
• care items, bed and bedside table are disinfected;
• in wards include ultraviolet irradiators;
• inspection and care takes place in dressing gowns, masks and hats, which must change;
• patients can not freely go to other chambers and offices;
• always change bed and underwear once a week;
• treatment is subject to the shoes of patients after discharge.

Patients with pyo-septic foci in a separate room are prescribed.

Sanitary rules of operating unit

The organization of the operating unit allows to reduce the risk of nosocomial infections:

• necessarily presence of a vestibule with an ultraviolet irradiator;
• installation of ventilation systems with bacterial filters;
• using mobile recirculation air cleaners;
• division of the operating room for purulent and clean operations or thorough disinfection after carrying out purulent processes on a single day;The
• complies with the red line rule regarding sterile underwear, gauze bandages and shoe covers.

In the operation and intensive care units, postoperative departments and dressings, the following sanitary and hygienic rules apply:

• treatment of gurneys, devices and devices with a disinfectant solution;
• preparation of the table with sterile tools;
• collection of used dressings in separate containers, their separation is clean and purulent;
• use and disinfection of the oilcloth apron by nurses during dressing of patients with purulent processes.

The instruction contains the requirements for cleaning the operating unit, chambers.

Rules for preparation for operation and sterilization of the

tool The completeness of the rules demonstrates the role played by order 720 "Prevention of nosocomial infection".Whether or not the document has been revoked is carried out by medical personnel, thus avoiding infection. The rules for the surgical departments remain unchanged, since they concern:

• of handling the hands of personnel involved in the operation, and preparing a disinfectant solution;
• pre-sterilization processing tools and control its quality;
• sterilization tools, dressings, gloves and surgical underwear;
• sterilization apparatus for artificial circulation.

Order 720 separately identifies the rules of hygiene in the ward with patients who have gas gangrene.

The regimes and methods of sterilization are considered in detail:

• steam;
• air( heating);
• chemical( hydrogen peroxide and dezocon), and also with the help of ethylene oxide.

The stages of pre-sterilization cleaning, methods of solution preparation and the features of disinfection of various objects of the surgical department are described. More details on disinfection of artificial lung ventilation units and inhalation solution are given in Appendix No. 4 to this Resolution.

Bacteriological control of

Annexes 2 and 3 are devoted to bacteriological control performed by laboratories and disinfection stations. The method of bacteriological researches is described in detail, a list of objects to be studied, the rules for carrying out the crops and recording their results are given.

Appendix № 3 is devoted to the detection of staphylococcal nosocomial infection, sanitation at the order of 720. Methods for studying the upper respiratory tract, carrying out bacteriosov and sanation of infectious agents are described. Particular attention is paid to staphylococcus aureus, 40% of the strains of which are not sensitive to treatment. The methods of the 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:

• contributes to the prevention of nosocomial infections;
• allows you to prove your case in case of controversial situations;
• is the basis for the preparation of instructions for junior nurses;
• replaces the work of a hospital epidemiologist for nurses.

Order 720 is still issued by the Ministry of Health of the USSR, but canceled in practice by the issuance of new sanitary regulations. Although the order, as a legislative act, is above the rules, which indicates the incompetence of its cancellation. Materials regarding the methods, solutions and disinfection facilities used are obsolete. But the order describes in more detail the treatment of anesthesia and respiratory equipment, which is not in the later documents.

Whether it is necessary to refer to the order legally

If to understand legal subtleties of new legislative acts, then order 720 "Prevention of hospital infection" was abolished 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 were approved.2485-09.In 2010, there was a conflict, because the ruling was declared invalid because of the appearance 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.