Nosocomial infections are what? What promotes the spread of nosocomial infection?
. No matter how ideal the medical institution, no matter how well the health standards are observed, there is still a risk of getting an infection - a nosocomial infection. This is a rather unpleasant event in a person's life and can carry negative consequences, so it's important to diagnose it in time and start therapy. And to get started, - learn more about this infection, in time to recognize it and carry out prevention.
What is a disease?
Nosocomial infection is also called nosocomial infection. This is a clinically pronounced pathology of microbial origin that affects a person during his hospitalization or a visit to a medical institution in order to undergo therapy.
Intrahospital infection is considered as such if the symptoms of the disease manifest themselves two days after the patient's admission to the hospital. Some types of pathologies can develop even after the patient returns home from the hospital.
Distribution factors of
The main cause of nosocomial infection is unfavorable conditions created in a medical institution. The probability of infection increases if:
- Branches or entire hospitals do not meet sanitary standards.
- Staphylococcus carriers do not receive adequate treatment.
- The number of staff and patient contacts has increased.
- The laboratories have insufficient equipment.
- The patient is prescribed a large-scale antibiotic therapy.
- Microbes increase resistance to antibacterial agents.
- Weakened immunity due to complications after surgery.
Today, physicians identify several ways of transmission of nosocomial infection:
- contact and tool;
- postoperative and post-injection;
- infections that appear after trauma.
The importance of the problem lies in the fact that the transmission routes of the nosocomial infection vary widely, so it is rather difficult to find the reasons.
If we consider them by the duration of the current, then the conditional diseases can be divided into three main groups:
In clinical manifestations, they are mild, moderate and severe. Two forms are distinguished from the extent of infection: generalized and localized.
In the first case, infection is manifested by bacteremia, septicemia and bacterial shock. With regard to local forms, then you can distinguish such types of infection:
- The defeat of the skin, cellulose mucous and subcutaneous, which include abscesses, phlegmon, erysipelas, mastitis, paraproctitis, skin fungus and others.
- Diseases of the oral cavity and ENT organs: stomatitis, tonsillitis, pharyngitis, otitis, sinusitis and others.
- Penetration of pathogenic microorganisms into the lungs and bronchi, which causes the development of pneumonia, bronchitis.
- Lesion of the gastrointestinal tract.
- Conjunctivitis and other infectious diseases of the eye.
- Infections of the genitourinary sphere.
- The defeat of the nervous and cardiovascular system.
- Infection of soft and bony tissues.
Most of all existing types of nosocomial infections are purulent-septic diseases, about 12% of patients are infected with intestinal infections.
Who is at risk?
Most often, such categories of patients are susceptible to infection:
- a migratory population or persons without a fixed place of residence;
- people with long-term progressive chronic infections;
- patients to whom the therapy was prescribed, suppressing immunity, including immunosuppressants;
- patients after surgery with subsequent blood replacement therapy, hemodialysis, infusion therapy;
- maternity wards and newborns, especially those who were born before or after;
- newborns with trauma during birth or congenital malformations;
- medical personnel of the facility.
What promotes the spread of nosocomial infection?
Pathogens can circulate between different sources. For example, one of the most common chains is "patient-health worker-patient".Thus, in any of the hospitals, an epidemic of nosocomial infections can erupt.
A short list of what promotes the spread of nosocomial infections:
- Gram-positive microorganisms: enterococci or staphylococci;
- Gram-negative microbes: Escherichia coli, aerobic microorganisms;
- stick of Koch and Salmonella.
In most cases, and this is according to statistics about 90%, the nosocomial infection is caused by bacteria. 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. Urinary tracts in most cases are affected by bladder catheterization, and only a small fraction falls on other manipulations on the organs of the genitourinary system. Most often, such diseases lead to prolongation of treatment. The patient has to stay longer in a medical institution. The problem of urinary tract infections has recently been actively studied, and the features of the epidemic process in patients with different profiles remain unclear. That is why it is important to conduct a number of studies:
- to study the intensity of urinary tract infections in the hospital;
- identify all risk factors for the development of the disease;
- establish pathways and factors of transmission of the pathogen;
- to develop a preventive system;
- , if possible, take measures to prevent infection of the urinary tract 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 who were born before the appointed term, have low immunological resistance. This circumstance, like other risk factors, causes a high degree of risk of getting nosocomial infection during inpatient stay.
There are several main reasons for the development of nosocomial infection in newly born babies:
- is a small gestational age, especially in children born before 32 weeks;
- morphofunctional immaturity and the presence of perinatal pathology;
- long stay in a medical institution;
- use of non-sterile medical equipment and tools;
- is a complex medication;
- congenital pathology;
- disorders of enteral feeding;
- surgical intervention
- jaundice in newborns.
To reduce the percentage of infections with nosocomial infections occurring in maternity hospitals, preventive measures should be taken as often as possible. First of all, allow only proven personnel to work and use an exclusively processed and sterile tool. This is the only way to reduce the infection rate of newborns during their stay in the hospital after birth.
The relevance of nosocomial infection is great. To determine the type of pathogen, the physician should pay attention to the features of the symptomatology, conduct an examination and send the patient to the diagnosis. With blood sampling, bacteremia( pathogenic microorganisms) in the bloodstream or septicemia - generalization of the infection can be detected, after which an analysis for bapsoseva should be performed to determine the type of pathogen. Therefore, blood for research is taken in all cases of hospital fever, except:
- primary fever episode after surgery;
- situation, if the doctor is sure that this is a manifestation of drug fever;
- clinical manifestations of deep vein thrombosis.
The number of blood sampling runs depends on the probable probability of detecting bacteremia. After the course of treatment with antibiotics again recommend to carry out manipulation and carry it out for two days. You can not take blood for bacteriological examination through a permanent catheter. At the hands of medical staff should be present gloves.
The norm is when pathogenic microorganisms are not found in the blood. Persistent or recurrent bacteremia is a sign of serious infection.
The relevance of nosocomial infection forces us to seek effective methods of solving the problem. The most effective and reliable is considered to be prevention, which is known to be better than modern antibiotic therapy, to which the bacteria have not yet developed resistance.
About how serious complications may result in infection of a patient in a medical institution, it is known for a long time. Back in the Soviet times, in the 70s of the last century, was published, which has not lost its power to this day, and therefore regulates the prevention of nosocomial infection.
That is why it is important to take timely preventive measures, which imply:
- detection of carriers of nosocomial infection;
- isolating patients with obvious signs of an infectious disease from the moment of admission to the institution;
- strict adherence to sanitation;
- use in the hospital of extracts with antibacterial filters;
- careful processing of tools, equipment and all surfaces with any of the disinfection substances;
- rational use of antibiotics.
After learning that this is - nosocomial infections, you should give a couple of words to the peculiarities of treating such a disease. In the most cases, empirical or etiotropic techniques are used. It is rather difficult to choose suitable drugs, because everything depends on the structure of antibiotic resistance in a particular medical institution, as well as on the presence of concomitant ailments in the patient, the 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 combined therapy and use of a broad-spectrum drug.
So for the treatment of nosocomial infections, such drugs are recommended:
- fluoroquinolones "Levofloxacin" or "Ciprofloxacin";
- combination of β-lactams with beta-lactamase inhibitors;
- medications with anti-synergic activity, such as carbapenems, cephalosporins 3-4 generations, and others.
Etiotropic therapy depends on the phenotype of antibiotic resistance of pathogens and a number of other factors.
The treatment doctor should select the type of treatment for each individual case after all the tests have been taken and the infectious agent has been identified. Constant monitoring will allow to get rid of the disease in a short time without consequences for the patient.
After discharge from the hospital, the patient has to monitor his condition for several days and re-take tests to be sure that the treatment has yielded good results and the disease will not return.