Nosocomial infection and its prevention. Nosocomial infection: ways of spread and prevention

– various infectious diseases contracted in a medical facility. Depending on the degree of spread, generalized (bacteremia, septicemia, septicopyemia, bacterial shock) and localized forms of nosocomial infections (with damage to the skin and subcutaneous tissue, respiratory, cardiovascular, urogenital system, bones and joints, central nervous system, etc.) are distinguished. . Identification of pathogens of nosocomial infections is carried out using laboratory diagnostic methods (microscopic, microbiological, serological, molecular biological). In the treatment of nosocomial infections, antibiotics, antiseptics, immunostimulants, physiotherapy, extracorporeal hemocorrection, etc. are used.

General information

Nosocomial (hospital, nosocomial) infections are infectious diseases of various etiologies that arose in a patient or medical employee in connection with their stay in a medical institution. An infection is considered nosocomial if it develops no earlier than 48 hours after the patient’s admission to the hospital. The prevalence of nosocomial infections (HAIs) in medical institutions of various profiles is 5-12%. The largest share of nosocomial infections occurs in obstetric and surgical hospitals (intensive care units, abdominal surgery, traumatology, burn trauma, urology, gynecology, otolaryngology, dentistry, oncology, etc.). Nosocomial infections represent a major medical and social problem, since they aggravate the course of the underlying disease, increase the duration of treatment by 1.5 times, and the number of deaths by 5 times.

Etiology and epidemiology of nosocomial infections

The main causative agents of nosocomial infections (85% of the total) are opportunistic microorganisms: gram-positive cocci (epidermal and Staphylococcus aureus, beta-hemolytic streptococcus, pneumococcus, enterococcus) and gram-negative rod-shaped bacteria (Klebsiella, Escherichia, Enterobacter, Proteus, Pseudomonas, etc. .). In addition, in the etiology of nosocomial infections, the specific role of viral pathogens of herpes simplex, adenovirus infection, influenza, parainfluenza, cytomegaly, viral hepatitis, respiratory syncytial infection, as well as rhinoviruses, rotaviruses, enteroviruses, etc., is great. Nosocomial infections can also be caused by conditionally pathogenic and pathogenic fungi (yeast-like, mold, radiata). A feature of intrahospital strains of opportunistic microorganisms is their high variability, drug resistance and resistance to environmental factors (ultraviolet radiation, disinfectants, etc.).

The sources of nosocomial infections in most cases are patients or medical personnel who are bacteria carriers or patients with erased and manifest forms of pathology. Research shows that the role of third parties (in particular, hospital visitors) in the spread of nosocomial infections is small. Transmission of various forms of hospital infection is realized through airborne droplets, fecal-oral, contact, and transmissible mechanisms. In addition, a parenteral route of transmission of nosocomial infection is possible during various invasive medical procedures: blood sampling, injections, vaccinations, instrumental manipulations, operations, mechanical ventilation, hemodialysis, etc. Thus, in a medical institution it is possible to become infected with hepatitis, purulent-inflammatory diseases, syphilis , HIV infection. There are known cases of nosocomial outbreaks of legionellosis when patients took medicinal showers and whirlpool baths.

Factors involved in the spread of nosocomial infection may include contaminated care items and furnishings, medical instruments and equipment, solutions for infusion therapy, overalls and hands of medical staff, reusable medical products (probes, catheters, endoscopes), drinking water, bedding, suture and dressing material and many others. etc.

The significance of certain types of nosocomial infections largely depends on the profile of the medical institution. Thus, in burn departments, Pseudomonas aeruginosa infection predominates, which is mainly transmitted through care items and the hands of staff, and the main source of nosocomial infection is the patients themselves. In maternity care facilities, the main problem is staphylococcal infection, spread by medical personnel carrying Staphylococcus aureus. In urology departments, infections caused by gram-negative flora dominate: intestinal, Pseudomonas aeruginosa, etc. In pediatric hospitals, the problem of the spread of childhood infections - chickenpox, mumps, rubella, measles - is of particular importance. The emergence and spread of nosocomial infection is facilitated by violation of the sanitary and epidemiological regime of health care facilities (failure to comply with personal hygiene, asepsis and antiseptics, disinfection and sterilization regime, untimely identification and isolation of persons who are sources of infection, etc.).

The risk group most susceptible to the development of nosocomial infections includes newborns (especially premature babies) and young children; elderly and frail patients; persons suffering from chronic diseases (diabetes mellitus, blood diseases, renal failure), immunodeficiency, oncology. A person's susceptibility to hospital-acquired infections increases with the presence of open wounds, abdominal drainages, intravascular and urinary catheters, tracheostomy and other invasive devices. The incidence and severity of nosocomial infections are influenced by the patient's long stay in the hospital, long-term antibiotic therapy, and immunosuppressive therapy.

Classification of nosocomial infections

According to the duration of their course, nosocomial infections are divided into acute, subacute and chronic; according to the severity of clinical manifestations - into mild, moderate and severe forms. Depending on the degree of prevalence of the infectious process, generalized and localized forms of nosocomial infection are distinguished. Generalized infections are represented by bacteremia, septicemia, bacterial shock. In turn, among the localized forms there are:

infections of the skin, mucous membranes and subcutaneous tissue, including postoperative, burn, and traumatic wounds. In particular, these include omphalitis, abscesses and phlegmon, pyoderma, erysipelas, mastitis, paraproctitis, fungal infections of the skin, etc.
infections of the oral cavity (stomatitis) and ENT organs (tonsillitis, pharyngitis, laryngitis, epiglottitis, rhinitis, sinusitis, otitis media, mastoiditis)
infections of the bronchopulmonary system (bronchitis, pneumonia, pleurisy, lung abscess, lung gangrene, pleural empyema, mediastinitis)
infections of the digestive system (gastritis, enteritis, colitis, viral hepatitis)
eye infections (blepharitis, conjunctivitis, keratitis)
infections of the urogenital tract (bacteriuria, urethritis, cystitis, pyelonephritis, endometritis, adnexitis)
infections of the musculoskeletal system (bursitis, arthritis, osteomyelitis)
infections of the heart and blood vessels (pericarditis, myocarditis, endocarditis, thrombophlebitis).
CNS infections (brain abscess, meningitis, myelitis, etc.).

In the structure of nosocomial infections, purulent-septic diseases account for 75-80%, intestinal infections - 8-12%, blood-contact infections - 6-7%. Other infectious diseases (rotavirus infections, diphtheria, tuberculosis, mycoses, etc.) account for about 5-6%.

Diagnosis of nosocomial infections

The criteria for thinking about the development of a nosocomial infection are: the appearance of clinical signs of the disease no earlier than 48 hours after admission to the hospital; connection with invasive intervention; establishing the source of infection and transmission factor. The final judgment on the nature of the infectious process is obtained after identifying the pathogen strain using laboratory diagnostic methods.

To exclude or confirm bacteremia, bacteriological blood cultures are performed for sterility, preferably at least 2-3 times. In localized forms of nosocomial infection, microbiological isolation of the pathogen can be carried out from other biological environments, and therefore culture of urine, feces, sputum, wound discharge, material from the pharynx, swab from the conjunctiva, and from the genital tract is performed for microflora. In addition to the cultural method for identifying pathogens of nosocomial infections, microscopy, serological tests (RSC, RA, ELISA, RIA), virological, molecular biological (PCR) methods are used.

Treatment of nosocomial infections

The difficulties of treating nosocomial infections are due to its development in a weakened body, against the background of the underlying pathology, as well as the resistance of hospital strains to traditional pharmacotherapy. Patients with diagnosed infectious processes are subject to isolation; The department undergoes thorough ongoing and final disinfection. The choice of antimicrobial drug is based on the characteristics of the antibiogram: for nosocomial infections caused by gram-positive flora, vancomycin is most effective; gram-negative microorganisms – carbapenems, IV generation cephalosporins, aminoglycosides. Additional use of specific bacteriophages, immunostimulants, interferon, leukocyte mass, and vitamin therapy is possible.

If necessary, percutaneous blood irradiation (ILBI, UVB), extracorporeal hemocorrection (hemosorption, lymphosorption) are performed. Symptomatic therapy is carried out taking into account the clinical form of nosocomial infection with the participation of specialists of the relevant profile: surgeons, traumatologists, pulmonologists, urologists, gynecologists, etc.

Prevention of nosocomial infections

The main measures to prevent nosocomial infections come down to compliance with sanitary, hygienic and anti-epidemic requirements. First of all, this concerns the disinfection regime of premises and care items, the use of modern highly effective antiseptics, high-quality pre-sterilization treatment and sterilization of instruments, strict adherence to the rules of asepsis and antiseptics.

Medical personnel must observe personal protective measures when performing invasive procedures: work in rubber gloves, goggles and a mask; handle medical instruments carefully. Vaccination of health workers against hepatitis B, rubella, influenza, diphtheria, tetanus and other infections is of great importance in the prevention of nosocomial infections. All health care facility employees are subject to regular scheduled dispensary examinations aimed at identifying the carriage of pathogens. To prevent the occurrence and spread of nosocomial infections will be possible by reducing the length of hospitalization of patients, rational antibiotic therapy, the validity of invasive diagnostic and therapeutic procedures, and epidemiological control in health care facilities.

When caring for patients, prevention of nosocomial infections is possible by following general precautions:

Wash hands immediately after contact with contaminated material and patients (blood and other body fluids contaminated by a person or personal care items);

If possible, do not touch infected material;

Wear gloves when in contact with blood, working with contaminated materials and biological fluids;

Wash your hands immediately after removing gloves;

Immediately clean up any spilled or spilled infected material;

Disinfect care equipment immediately after use;

Burn used dressing material.

The primary objectives of the VBI include the following activities:

1. Specific prevention. Vaccination is a strategic direction in the fight against hepatitis B, diphtheria, tetanus, etc.

2. In the premises of medical institutions it is necessary to: regularly carry out wet cleaning, observe the ventilation regime of the rooms (4 times a day).

3. Carry out sanitary treatment of patients upon admission to the hospital every 7 days with a simultaneous change of bed linen and a note in the medical history. Bed linen is changed for postpartum women once every 3 days, underwear and towels are changed daily, and patients undergo an extraordinary change of linen after surgery. In operating rooms, maternity units, and newborn wards, only sterile linen should be used. Used linen can be stored in a separate compartment in a special room for no more than 12 hours. After patients are discharged, bedding (mattress, blanket, pillow) must be sent to the disinfection room, which is especially important in surgical and obstetric units, where there is a risk of wound infection.

4. Compliance with the procedure for receiving patients (examination, treatment and measurement of body t, taking swabs from the throat and nose for staphylococcus).

5. Properly organize the patient care system, excluding the possibility of both transmission of infection by service personnel and its introduction from the outside.

6. Cleaning, use, disinfection of cleaning equipment in accordance with MR Order No. 288.

7. Strict compliance with the requirements of current guidelines for the prevention of nosocomial infections:

A). Disinfection, pre-sterilization cleaning and sterilization of medical devices OSB 42-21-02-88;

b). Order of the USSR Ministry of Health dated July 12, 1989. No. 408 “On measures to reduce the incidence of viral hepatitis in the country.”

V). Order of the Ministry of Health of the Russian Federation dated June 16, 1997. No. 184 “On approval of guidelines for cleaning, disinfection and sterilization of endoscopes and instruments for them used in health care facilities.”

G). Order of the Ministry of Health of the Russian Federation dated November 26, 1997. No. 345 “On improving measures to prevent nosocomial infections in obstetric hospitals.”

8. Active identification of infectious patients, compliance with the terms of observation of contact patients.

9. Timely isolation of patients with suspected infectious disease.

10. Compliance with the diet: equipping dispensers, selling products, the procedure for collecting and disposing of food waste, handling dishes.

11. Compliance with the rules for the collection and disposal of waste from healthcare facilities.

12. Monitoring the health status of medical staff.

13. Advanced training of medical staff (staff must know the clinical picture of infectious diseases, sources, ways of their spread).

14. Compliance with the sanitary and epidemiological regime and improving the sanitary culture of medical staff.

Sanitary and Epidemic Regime (SER) is a set of measures carried out in a hospital with the aim of preventing nosocomial infections and creating optimal hygienic conditions for patients and speeding their recovery.

If you interrupt the chain of infection in any of the three links above, the epidemic process can be stopped.

Impact on parts of the epidemiological process:

Implementation of effective control over nosocomial infections (infection control)4

Isolation of the source of infection;

Destruction of infectious agents (disinfection, sterilization);

Interruption of transmission routes;

Increasing the body's resistance.

At the head of all this multifaceted work is a nurse who organizes, implements and is responsible for compliance with measures for the prevention of nosocomial infections, and the correctness of the actions will depend on her knowledge and practical skills.

Any diseases that a person develops in connection with his stay in a medical institution are classified in medicine as nosocomial infections. But such a diagnosis will be made only if a pronounced clinical picture was noted no earlier than 48 hours after the patient entered the hospital.

In general, nosocomial infections are considered quite common, but most often this problem appears in obstetric and surgical hospitals. Nosocomial infections are a huge problem, as they worsen the patient’s condition, contribute to a more severe course of the underlying disease, automatically prolong the period of treatment and even increase the mortality rate in departments.

Major nosocomial infections: pathogens

The pathology in question has been very well studied by doctors and scientists; they have accurately identified those opportunistic microorganisms that belong to the group of main pathogens:

Viral pathogens play a fairly large role in the occurrence and spread of nosocomial infections:

respiratory syncytial infection;

In some cases, pathogenic fungi take part in the occurrence and spread of infections in this category.

Note:A distinctive feature of all opportunistic microorganisms that are involved in the occurrence and spread of this category of infections is resistance to various influences (for example, ultraviolet rays, medications, powerful disinfectant solutions).

The sources of the infections in question are most often medical personnel, or the patients themselves who have undiagnosed pathologies - this is possible if their symptoms are hidden. The spread of nosocomial infections occurs through contact, airborne droplets, vector-borne or fecal-oral routes. In some cases, pathogenic microorganisms are also spread parenterally, that is, during various medical procedures - administering vaccines to patients, injections, blood sampling, artificial ventilation, surgical interventions. In this parenteral way, it is quite possible to become infected with inflammatory diseases with the presence of a purulent focus.

There are a number of factors that are actively involved in the spread of nosocomial infections - medical instruments, uniforms of medical personnel, bedding, medical equipment, reusable instruments, dressings and, in general, anything, any item that is located in a particular hospital.

Hospital-acquired infections do not happen all at once in one department. In general, there is some differentiation of the problem under consideration - a specific inpatient department in a medical institution has its own “own” infection. For example:

urological departments - or;
burn departments - Pseudomonas aeruginosa;
maternity wards - ;
pediatric departments - and other childhood infections.

Types of nosocomial infections

There is a rather complex classification of nosocomial infections. Firstly, they can be acute, subacute and chronic - this classification is carried out only according to the duration of the course. Secondly, it is customary to distinguish between generalized and localized forms of the pathologies under consideration, and thus they can be classified only taking into account the degree of prevalence.

Generalized nosocomial infections are bacterial shock, bacteremia and septicemia. But the localized forms of the pathologies under consideration will be as follows:

Pyoderma, skin infections of fungal origin, mastitis, and others. These infections most often occur in postoperative, traumatic and burn wounds.
, mastoiditis, and other infectious diseases of the ENT organs.
Lung gangrene, mediastinitis, pleural empyema, lung abscess and other infectious diseases that affect the bronchopulmonary system.
, and other diseases of infectious etiology that occur in the organs of the digestive system.

In addition, localized forms of the pathologies under consideration include:

keratitis/ / ;
/ / ;
myelitis/brain abscess/;
/ / / ;
/pericarditis/.

Diagnostic measures

Medical personnel can only assume that there is a nosocomial infection if the following criteria are met:

The patient's clinical picture of the disease appeared no earlier than 48 hours after admission to a hospital-type hospital.
There is a clear connection between the symptoms of infection and the implementation of an invasive type of intervention - for example, a patient with symptoms after admission to the hospital underwent an inhalation procedure, and after 2-3 days he developed severe symptoms. In this case, hospital staff will talk about nosocomial infection.
The source of infection and the factor of its spread are clearly established.

It is imperative that for accurate diagnosis and identification of a specific strain of the microorganism that causes the infection, laboratory/bacteriological studies of biomaterials (blood, feces, throat swab, urine, sputum, discharge from wounds, and so on) are carried out.

Basic principles of treatment of nosocomial infections

Treatment of nosocomial infection is always complex and lengthy, because it develops in the patient’s already weakened body. After all, a patient in an inpatient department already has an underlying disease, plus an infection is superimposed on it - the immune system does not work at all, and given the high resistance of nosocomial infections to drugs, the recovery process can take a long time.

Note:As soon as a patient with a nosocomial infection is identified, he is immediately isolated, a strict quarantine is declared in the department (exit/entry of patients and their relatives, medical personnel from other departments is strictly prohibited) and complete disinfection is carried out.

When identifying the pathologies in question, it is first necessary to identify the specific causative agent of the infection, since only this will help to correctly select an effective one. For example, if a nosocomial infection is caused by gram-positive strains of bacteria (staphylococci, pneumococci, streptococci and others), then it would be appropriate to use Vancomycin in treatment. But if the culprits of the pathologies in question are gram-negative microorganisms (Escherichia, Pseudomonas and others), then cephalosporins, carbapenems and aminoglycosides will predominate in doctors’ prescriptions . The following are used as additional therapy:

bacteriophages of a specific nature;
vitamin and mineral complexes;
leukocyte mass.

It is mandatory to carry out symptomatic therapy and provide patients with nutritious, but dietary nutrition. It is not possible to say anything specifically about symptomatic therapy, since all drug prescriptions in this case are carried out on an individual basis. The only thing that is prescribed to almost all patients is antipyretics, since any infectious diseases are accompanied by an increase in body temperature.

Prevention of nosocomial infections

The pathologies in question cannot be predicted, and the spread of nosocomial infections throughout the department cannot be stopped. But it is quite possible to take some measures to prevent even their occurrence.

Firstly, medical personnel must strictly comply with anti-epidemic and sanitary-hygienic requirements. This applies to the following areas:

use of high-quality and effective antiseptics;
regularity of disinfection measures in the premises;
strict adherence to the rules of antiseptics and asepsis;
ensuring high quality sterilization and pre-sterilization treatment of all instruments.

Secondly, medical personnel are obliged to comply with the rules for conducting any invasive procedures/manipulations. It is understood that medical workers carry out all manipulations with patients only wearing rubber gloves, goggles and a mask. There must be extremely careful handling of medical instruments.

Thirdly, medical workers must be vaccinated, that is, be participants in the program of vaccination of the population against and other infections. All employees of a medical institution must undergo regular medical examinations, which will allow timely diagnosis of the infection and prevent its spread throughout the hospital.

It is believed that medical personnel should reduce the length of hospitalization of patients, but not to the detriment of their health. It is very important to select only rational treatment in each specific case - for example, if therapy is carried out with antibacterial agents, then they should be taken by the patient in strict accordance with the prescriptions of the attending physician. All diagnostic or invasive procedures must be carried out reasonably; it is unacceptable to prescribe, for example, endoscopy “just in case” - the doctor must be sure of the need for manipulation.

Nosocomial infections are a problem for both hospitals and patients. Preventive measures, if they are strictly followed, in most cases help prevent their occurrence and spread. But despite the use of modern, high-quality and effective disinfectants, antiseptics and aseptics, the problem of infections in this category remains relevant.

Tsygankova Yana Aleksandrovna, medical observer, therapist of the highest qualification category

Speaking about the importance of preventing nosocomial infections, it should be noted that this problem is certainly complex and multifaceted. Each of the areas of prevention of nosocomial infections provides for a number of targeted sanitary-hygienic and anti-epidemic measures aimed at preventing a certain route of transmission of the infectious agent within the hospital. We will discuss the issues of disinfection and sterilization in more detail.

The effectiveness of the fight against nosocomial infections is determined by whether the design of the health care facility building complies with the latest scientific achievements, as well as the modern equipment of the health care facility and strict compliance with the requirements of the anti-epidemic regime at all stages of the provision of medical care.

In health care facilities, regardless of profile, three most important requirements must be met:

-minimizing the possibility of infection;
-exclusion of nosocomial infections;

Preventing the spread of infection outside the health care facility.

Prevention of nosocomial infections is divided into:

specific

nonspecific

Specific prevention of nosocomial infections.

This is a system of comprehensive measures aimed at preventing the emergence, limiting the spread and eliminating certain (specific) infectious diseases by creating immunity (immunity) to them in animals, as well as carrying out special measures, diagnostic studies and the use of therapeutic and prophylactic agents.

Population immunization

The entry of pathogenic microorganisms into the human body causes a natural protective reaction. Special antibodies are produced that attack microbes. After overcoming the disease, these substances remain in the body. This is how immunization occurs. This is the process by which a person becomes resistant to certain diseases.

There are three types of immunization:

Active immunization

It can be either natural or artificial. Natural immunization occurs after an illness. The second is carried out through the introduction of vaccines. Vaccines can be live, dead microorganisms, chemical, created using genetic engineering, multicomponent, with microbial DNA fragments. Thus, active immunization promotes a long-term effect, protecting the body from acute infections. The vaccine can be administered in various ways: intravenously, into a muscle, under the skin or intradermally (the most effective). With active immunization, correct calculation of the drug dose is necessary. If the norm is exceeded, a relapse of the disease is possible. If it decreases, vaccination will be ineffective.

A live virus, multiplying in the body, stimulates cellular, secretory, humoral immunity. However, this method of immunization has its drawbacks. First of all, the possible progression of the disease. Also, such single-component vaccines, since their combination with other microorganisms can give an unpredictable reaction.

Active immunization is a method that is not suitable for people with immunodeficiency, patients with leukemia, lymphoma, or those undergoing radiotherapy. The administration of such vaccines to pregnant women is also prohibited.

Passive immunization

Temporary immunity is created through passive immunization. In this case, antibodies to certain antigens are introduced. As a rule, this method is used, provided that active immunization has not been carried out, to treat spider and snake bites. Thus, passive immunization is a method that provides only a short-term effect (albeit instantaneous) and is usually applied after exposure to the pathogen. In this case, drugs such as human immunoglobulin (normal and specific) and special serums are used. Indications for the use of immunoglobulins are the prevention of hepatitis, measles, immunodeficiency, prolonged inflammatory processes and infections. Immunoglobulin is obtained from the blood plasma of an adult. She is pre-tested for infection. Such drugs are administered intramuscularly. The maximum amount of antibodies is observed already on the second day. After about 4 weeks they disintegrate. Sometimes the injection may cause pain. Therefore, experts recommend injecting drugs deeply enough.

Active-passive immunization

a combined (mixed) method of creating artificial passive-active immunity, based on the introduction of serum and the corresponding vaccine into the body simultaneously (simultaneously) or sequentially: first the serum is administered, and then the vaccine. This method, like passive immunization, is used to create immediate immunity.

Typically used for emergency tetanus prophylaxis

It is subject to persons with a violation of the integrity of the skin or mucous membranes, with burns and frostbite of II § III degree, operations on the gastrointestinal tract, animal bites, childbirth at home without medical assistance and out-of-hospital abortions.

Nonspecific prevention of nosocomial infections:

Nonspecific prevention is prevention methods aimed at increasing the body's protective (reactive) forces to counteract respiratory viruses that penetrate the human body.

This prevention is carried out both in the pre-epidemic period and directly during the period of epidemic rise in incidence.

Nonspecific prevention includes:

Architectural and planning measures are aimed at preventing the spread of the pathogen by isolating ward sections from operating units.

in accordance with SanPiN 5179-90 “Sanitary rules for the design, equipment, operation of hospitals, maternity hospitals and other health care facilities” include:

-maximum separation of patients up to the creation of boxed wards;
-separation of “purulent” and “clean” flows of patients;
- installation of operating airlocks with bactericidal “locks”;
- introduction of quarantine measures for epidemiological indications;
-planning a sufficient number of premises with a large set of utility rooms;
-creation of “aseptic” operating rooms with effective ventilation and air conditioning;
-planning a centralized sterilization department;
- allocation of 4-5 operating rooms for every 100 surgical beds.

Sanitary and hygienic measures are ensured by the fulfillment of all requirements, the sanitary culture of patients and staff, the correct establishment of bacteriological control, the identification of carriers of pathogenic bacteria among staff and patients and the sanitization of these persons.

-hand washing by staff;
-treatment of the surgical field, skin, birth canal;
-use of disposable medical instruments, overalls, toiletry and care items, disposable consumables and linen;
-regular change of underwear and bed linen;
-proper storage and disposal of dirty linen and dressings;
-proper sanitary maintenance of premises;
-control over the use of sterile materials and instruments (taking sanitary and bacteriological samples).

Sanitary and epidemiological measures - organizational, administrative, engineering, technical, medical, sanitary, veterinary and other measures aimed at eliminating or reducing the harmful effects on humans and the environment of harmful factors arising from various types of activities, preventing the occurrence and spread of infectious and mass diseases non-infectious diseases (poisonings), as well as organizing measures to eliminate them.

Disinfection measures include:

- metrological control of disinfection and sterilization installations;
-disinfection and sterilization of bedding and care items after each patient;
- quality control of disinfection, pre-sterilization cleaning and sterilization;
-control of the activity of disinfection solutions;
-wide and correct use of ultraviolet emitters.

Regulatory framework for the sanitary and anti-epidemic regime (list of fundamental documents):

· Order No. 123 of April 17, 2002 On approval of the industry standard “Protocol for the management of patients. Pressure sores”
· Order No. 170 of August 16, 1994 “On measures to improve the prevention and treatment of HIV infection in the Russian Federation.”
· Order No. 288 of March 23, 1976 “On approval of instructions on the sanitary anti-epidemic regime of hospitals and on the procedure for the implementation by bodies and institutions of the sanitary-epidemiological service of state sanitary supervision over the sanitary condition of medical institutions.”
· Order No. 342 of November 26, 1998 “On strengthening measures to prevent epidemic typhus and combat lice.”
· Order No. 408 of July 12, 1989 “On measures to reduce the incidence of viral hepatitis in the country.”
· Order No. 475 of August 16, 1989 “On measures to further improve the prevention of acute intestinal infections in the country.” _ Guidelines for organizing and carrying out disinfection for intestinal bacterial infections No. 15-6/12 dated April 18, 1989. _
· Order No. 720 of July 31, 1978 “On improving medical care for patients with purulent surgical diseases and strengthening measures to combat nosocomial infections.” _
· Order No. 770 of June 10, 1985 “On the implementation of the industry standard OST No. 42-21-2-85 “Sterilization and disinfection of medical devices. Methods, means and modes"" _
· San Pin 2.1.3.2630-10 “Sanitary and epidemiological requirements for organizations engaged in medical activities.”
· San.Pin 2.1.3.2826-10 “Prevention of HIV infection”

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Introduction

1. Relevance of the problem

2. Objectives of the work

3. Object of study

4. Working hypothesis

5. Practical significance

7. Research methods

11. Interpretation of results

Application

Introduction

One of the components characterizing the “health index” of a nation is the level of infectious morbidity, in the formation of which hospital-acquired infections (hereinafter referred to as nosocomial infections) play an important role. The incidence of nosocomial infections to a certain extent reflects the quality of medical care provided to the population and significantly affects the level of economic costs. Currently, the problem of nosocomial infections has attracted the attention of medical workers of various specialties: health care managers, hygienists, epidemiologists and clinicians. Issues of preventing nosocomial infections are considered a priority area of scientific research.

1. Relevance of the problem

Nosocomial infections remain one of the pressing problems of modern medicine. An nosocomial infection is any clinically recognizable infectious disease that affects a patient as a result of his hospitalization or visit to a medical institution for the purpose of treatment, as well as hospital staff due to their activities, regardless of whether or not symptoms of this disease appear while these persons are in the hospital.

In recent years, factors have emerged that contribute to an increase in the incidence of nosocomial infections:

Operation of healthcare facilities under conditions of limited funding (lack of medicines, antiseptics, detergents, disinfectants, medical instruments, linen, sterilization equipment);

Significant increase in the number of hospital strains resistant to antibiotics and disinfectants;

The difficulty of disinfecting and sterilizing modern expensive medical equipment.

It should also be noted that a large number of new foreign and domestic disinfectants have appeared on the Russian market, insufficient and contradictory information about which creates certain difficulties for healthcare institutions in choosing effective drugs. In addition, numerous publications on the use of antibiotics and immunomodulators to prevent hospital infections are also contradictory, which does not allow clinicians to widely include them in the complex of preventive measures. Of no less importance is the lag in the development of regulatory documentation at the federal level that determines the activities of health care facilities and the prevention of nosocomial infections at the present stage.

The previously mentioned factors for the occurrence of nosocomial infections remain relevant at the moment:

Creation of large hospital complexes with a unique ecology and intensive migration processes;

The presence of a large array of sources of infection;

Increasing role of artificial and activation of natural mechanisms of infection transmission;

Irrational use of antibiotics;

Increase in high-risk groups in the population (elderly people, premature babies, patients with chronic diseases);

Reduced nonspecific defenses of the body;

Non-compliance with the standards for the area and set of main and auxiliary premises in health care facilities and violation of sanitary-anti-epidemic and sanitary-hygienic regimes in them;

Insufficient competence of medical workers, especially nursing staff, who play the main role in the prevention of nosocomial infections.

2. Objectives of the work

Collect data on the development of nosocomial infections in the Russian Federation and other countries and analyze them, prove the relevance of this issue, find out about the prevalence of nosocomial infections in medical institutions in the city of Vyborg, study various methods of preventing nosocomial infections.

3. Object of study

The object of our research work was the following medical and preventive institutions in the city of Vyborg: Vyborg Central Regional Hospital (therapeutic, surgical, traumatological, neurological, ophthalmological departments), Vyborg Children's City Hospital, Vyborg Military Hospital, Vyborg Psychoneurological Dispensary.

4. Working hypothesis

Based on the statistics presented below, as well as on the basis of observations of the work of nursing staff during practical training in medical institutions in the city of Vyborg, we have put forward a working hypothesis, which is that nursing and junior medical staff (more than 50%) does not comply with the rules of asepsis and antisepsis, does not know the rules of sanitary and epidemiological regulations and does not take measures to prevent the occurrence of nosocomial infections.

5. Practical significance

The practical significance of this research work includes both social and economic efficiency.

Social efficiency is determined by improving the working conditions of medical workers and the lives of the population, and improving healthcare.

Economic efficiency lies in the possibility of saving material and financial resources for healthcare.

To achieve the goals of our work, we have set ourselves the following tasks:

1. Find out about the prevalence of nosocomial infections in medical institutions from information sources available to us.

2. Analyze the development of nosocomial infections in the Russian Federation and other countries.

3. Conduct surveys among medical workers of medical institutions in the city of Vyborg.

4. Analyze the results of the survey. Draw conclusions.

5. Study methods of preventing nosocomial infections.

7. Research methods

The main research methods in our work are conducting interviews and surveys among medical workers of medical institutions, as well as monitoring the performance of their work.

8. Research design and organization

1. Collect all possible data regarding the concept of nosocomial infections.

2. Find out the statistics of the occurrence of nosocomial infections, the frequency of occurrence of certain types of nosocomial infections in our country and European countries

3. Conduct a survey on the topic “HAI” among the medical personnel of the city of Vyborg.

4. Process the survey data and draw a conclusion.

5. Suggest methods for preventing the occurrence of nosocomial infections.

9. Nosocomial infections: problems and solutions

According to official statistics, from 50 to 60 thousand cases of nosocomial infections are registered annually in the Russian Federation, however, according to estimates, this figure is 40-50 times higher. According to sample studies, in the Russian Federation up to 8% of patients suffer from nosocomial infections, i.e. about 2-2.5 million people. in year.

The incidence rates of nosocomial infections, according to official data, range from 0.7 to 1.9 per 1000 patients. At the same time, it should be noted that this indicator in Czechoslovakia is at the level of 163, the USA - 50-100, Belgium - 29.

In surgical hospitals in Russia, according to official registration materials, the frequency of nosocomial infections is 0.2-0.3%, while according to special studies - 15-18%.

Consequently, the recorded incidence rate of nosocomial infections in the Russian Federation does not reflect its true value.

Nosocomial infections are predominantly registered in maternity institutions (34.1%) and surgical hospitals (28.7%). This is followed by therapeutic hospitals (18.7%) and children's hospitals (10.5%). 8.0% of nosocomial infections cases were registered in outpatient clinics. There are no data on cases of nosocomial infections in the emergency medical service in the sources available to us.

In the structure of nosocomial infections, the leading place is occupied by purulent-septic infections (hereinafter - PSI), the share of which ranges from 60 to 85%. Surgical hospitals account for about 92% of GSI cases.

The frequency of nosocomial infections varies widely and depends on the type of hospital, the degree of invasion and aggression of the diagnostic and treatment process, the nature of the underlying pathology, the tactics of using antibacterial drugs, disinfectants and other factors.

The main causative agents of nosocomial infections in hospitals of various profiles are staphylococci (primarily Staphylococcus aureus, followed by epidermal and saprophytic staphylococci), gram-negative bacteria (Escherichia coli, Proteus, Klebsiella, irrations, Enterobacteriaceae, Pseudomonas aeruginosa, etc.), respiratory viruses, yeast-like fungi of the genus Candida and molds of the genus Aspergillus.

Analysis of available data shows that in the structure of nosocomial infections detected in large multidisciplinary health care facilities, purulent-septic infections (PSI) occupy a leading place, accounting for up to 75-80% of their total number. Most often, purulent-septic infections are recorded in surgical patients, especially in the departments of emergency and abdominal surgery, traumatology and urology. The main risk factors for the occurrence of purulent-septic infection are: an increase in the number of carriers of resident-type strains among employees, the formation of hospital strains, an increase in the contamination of the air, surrounding objects and the hands of personnel, diagnostic and therapeutic manipulations, non-compliance with the rules for placing patients and caring for them, etc. .

Another large group of nosocomial infections is intestinal infections. In some cases they constitute up to 7-12% of their total number. Among intestinal infections, salmonellosis predominates. Salmonellosis is recorded mainly (up to 80%) in weakened patients in surgical and intensive care units who have undergone extensive abdominal surgery or have severe somatic pathology. Salmonella strains isolated from patients and from environmental objects are characterized by high antibiotic resistance and resistance to external influences. The leading routes of transmission of the pathogen in health care facilities are household contact and airborne dust.

A significant role in nosocomial pathology is played by blood-contact viral hepatitis B, C, D, constituting 6-7% in its overall structure. Patients who undergo extensive surgical interventions followed by blood replacement therapy, program hemodialysis, and infusion therapy are most at risk of the disease. Examinations carried out on inpatients with various pathologies reveal up to 7-24% of people whose blood contains markers of these infections. A special risk category is represented by hospital medical personnel whose duties include performing surgical procedures or working with blood (surgical, hematological, laboratory, hemodialysis departments). Surveys reveal that up to 15-62% of personnel working in these departments are carriers of markers of blood-borne viral hepatitis. These categories of people in health care facilities constitute and maintain powerful reservoirs of chronic viral hepatitis.

The share of other infections registered in health care facilities accounts for up to 5-6% of the total incidence. Such infections include influenza and other acute respiratory infections, diphtheria, tuberculosis, etc.

Research conducted by WHO in 14 countries, incl. in Russia, showed:

In the European region, the incidence of nosocomial infections is about 7%, in the USA - about 5%;

In Russia, according to estimates, more than 2 million people fall ill with nosocomial infections every year;

In surgical hospitals, for example, in Moscow, nosocomial infections develop in 16% of patients.

The conclusion is that our health workers are still doing everything possible not to know about the real scale of morbidity and damage from nosocomial infections.

According to estimates, in Russia up to half a million patients fall ill with nosocomial infections per year, most of whom are in hospitals.

The length of hospital stay for one such patient increases by 6-7 days. The damage is estimated in hundreds of millions of rubles. Medical staff suffer from nosocomial infections. The study of this “layer” of nosocomial infections in our country has practically not yet begun. Meanwhile, in other states, the incidence of illness among health care workers exceeds the levels among workers in leading industries.

According to WHO research, in Russia the incidence of hepatitis B among surgeons, for example, is 13 times higher, and among intensive care unit personnel 6 times higher than among the population. According to the Russian Federation, in purulent surgery departments, more than 50% of medical staff become ill with various purulent-inflammatory infections during the year. Professions with a particularly high risk of infection include not only surgeons, gynecologists, dentists, clinical laboratory assistants, but also endoscopists, ENT doctors, urologists and many other professions.

Nosocomial infections worsen the general condition of patients and increase the patient's length of stay in the hospital by an average of 6-8 days. According to WHO, the mortality rate in the group of people with nosocomial infections is significantly (10 times or more) higher than the mortality rate among similar groups of patients without nosocomial infections.

Elimination of nosocomial infections occurring in health care facilities and treatment of patients affected by them require significant budget funding. The minimum economic damage caused by nosocomial infections annually in the Russian Federation is about 5 billion rubles.

The importance of preventing hospital infections increases sharply with the transition to the principles of social insurance. This is also facilitated by the licensing of medical institutions, since a license for medical activities places legal responsibility on medical institutions for each case of nosocomial infection.

What can healthcare actually do to prevent in-hospital complications?

Undoubtedly, the most important achievement in the world over the past decades has been the creation of an infection control system for nosocomial infections. The main attention will be paid to hand washing standards, hygienic and surgical antisepsis, the use of standard precautions in the prevention of occupational infections, and the most common errors when sterilizing medical products. It is important to keep in mind that modern requirements for the prevention of nosocomial infections, which will be discussed today, are not based on the personal opinion of several scientific authorities or officials from the Ministry of Health. Existing standards are based on the principles of evidence-based medicine. This was preceded by large-scale studies, the results of which were subjected to careful statistical processing.

These standards are recognized in our country, however, their implementation is extremely slow. Unfortunately, new regulatory documents on the prevention of nosocomial infections in our country have not yet been published. Yes, however, it is difficult to name a country where such things are being implemented in medical institutions with the help of orders from the Ministry of Health. Many medical workers in the region, including healthcare organizers, continue to explain their inaction on the implementation of standard preventive measures by the fact that modern provisions conflict with previously issued orders of the USSR Ministry of Health.

Infection control is a whole system of preventive measures, which has its own specifics for each profile of a hospital’s structural unit. It has been convincingly proven that the most powerful factor in the spread of infection is the hands of personnel, medical clothing, and medical instruments.

10. Results of the survey

74 health workers from various departments and medical institutions in Vyborg took part in the survey. Each of them was presented with an anonymous questionnaire containing a number of questions.

Based on the results of the analysis of the survey conducted on eleven main questions (see Appendix 1), we made the following conclusions:

1. The percentage of cases of nosocomial infections is quite minimal. More than 92% of respondents answered that cases of nosocomial infections occur - rarely.

2. 70% of respondents answered that they Sometimes report cases of nosocomial infections, 24% - Always report cases of nosocomial infections and only 6% not reported.

3. Almost 97% of respondents do Not all sanitary regulations.

4. 74% of respondents are trying follow the rules of asepsis and antisepsis and monitor their implementation, 26% - Always follow these rules and monitor this.

5. 54% of medical personnel change gloves during a work shift as it gets dirty, 36% - after working with several patients, 7% - 1-2 times per shift and 3% - after each manipulation.

6. Almost 99% of respondents carry out ventilation according to schedule.

7. 93.5% - try Always take into account the concentration of disinfectants.

8. Only 74% try to use All individual protection means.

9. High percentage (92%) Always carry out preventive and focal disinfection according to plan.

10. Many medical workers (89%) noted that they lack of equipment.

11. 100% of respondents answered that under no circumstances should cases of nosocomial infections be allowed to occur.

11. Interpretation of results

Based on the survey data, we made the following conclusions:

1. Although absolutely all medical workers surveyed understand the danger of nosocomial infections, not all of them try to take preventive measures.

2. Not all health care workers report cases of nosocomial infections. Consequently, measures to prevent and combat nosocomial infections are also not carried out.

3. Almost all of the respondents do not comply with all the rules of the sanitary and epidemiological regime, which is a contributing factor to the occurrence of nosocomial infections.

4. Most health workers only try to follow the basic rules of asepsis and antisepsis, although these rules relate to the basics of the work of nursing staff and are one of the main factors in preventing the occurrence of nosocomial infections.

5. More than half of the respondents change gloves as they become dirty. It is safe to say that this is how patients become infected at the hands of medical staff.

6. 26% of respondents do not use all personal protective equipment, which contributes to the possibility of self-infection among health workers.

7. Almost all health workers noted that they lack medical equipment. Because of this, many have to use disposable equipment several times, and some do not even disinfect it.

12. The nurse is the main link in the prevention of nosocomial infections

Conventionally, three types of nosocomial infections can be distinguished: - in patients infected in hospitals; - in patients infected while receiving outpatient care; - in medical workers who became infected while providing medical care to patients in hospitals and clinics.

In order to properly understand the main directions of preventing nosocomial infections, it is advisable to briefly characterize their structure.

The problem of preventing nosocomial infections is multifaceted and very difficult to solve for a number of reasons - organizational, epidemiological, scientific and methodological. The effectiveness of the fight against nosocomial infection is determined by whether the design of the health care facility building complies with the latest scientific achievements, as well as the modern equipment of the health care facility and strict compliance with the requirements of the anti-epidemic regime at all stages of the provision of medical care. In health care facilities, regardless of the profile, three most important requirements must be met: minimizing the possibility of introducing infection, excluding intra-hospital infections, and excluding the spread of infection outside the medical institution.

In matters of prevention inside hospitals, junior and nursing staff are assigned the main, dominant role - the role of organizer, responsible executor, and also controller. Daily, thorough and strict compliance with the requirements of the sanitary-hygienic and anti-epidemic regime during the performance of their professional duties forms the basis of the list of activities of the guard nurse, the prevention of nosocomial infections. In this regard, the importance of the role of the senior nurse in the clinical diagnostic department of the hospital should be especially emphasized. Basically, they are nursing staff who have worked in their specialty for a long time, have organizational skills, and are well versed in issues of a security nature.

Speaking about the importance of preventing nosocomial infections, it should be noted that this problem is, of course, complex and multifaceted. Each of the areas of prevention of nosocomial infection provides for a number of targeted sanitary-hygienic and anti-epidemic measures aimed at preventing a certain route of transmission of an infectious agent within a hospital, and is worthy of separate consideration, however, within the framework of this publication we will only note the issues of disinfection and sterilization.

Disinfection is one of the most significant areas of preventing nosocomial infections. This aspect of the activity of medical personnel is multicomponent and aims to destroy pathogenic and opportunistic microorganisms in the external environment of wards and functional premises of hospital departments, medical instruments and equipment. The organization of disinfection work and its implementation by junior medical staff is a complex, labor-intensive daily task.

It is worth emphasizing the special importance of this area of personnel activity in relation to the prevention of nosocomial infections, since in a number of cases (purulent-septic infections, nosocomial intestinal infections, including salmonellosis) disinfection is practically the only way to reduce morbidity in a hospital. It should also be noted that all hospital strains of pathogens of nosocomial infections, along with almost complete antibiotic resistance, have significant resistance to external factors, incl. and disinfectants. For example, the causative agent of nosocomial salmonellosis Salm.typhimurium is insensitive to the concentrations of working solutions of chlorine-containing disinfectants traditionally recommended for current disinfection (0.5-1%), and dies when exposed to only at least 3% chloramine solution and 5% hydrogen peroxide with exposure not less than 30 minutes. Ignorance by medical personnel of these scientific facts and the use of solutions with a lower concentration of the active substance for disinfection sites leads to the appearance in hospitals of hospital strains that are even more resistant to external influences, artificially selected by hospital staff.

From the above example, it is obvious that there are significant differences in the tactics and methods of carrying out preventive and focal (current and final) disinfection in a hospital. It should be remembered that disinfection is carried out taking into account the epidemic danger and the degree of significance of a number of items and equipment as potential risk factors in the implementation of one or another mechanism of transmission of nosocomial infections within the hospital. Taking into account the indicated high percentage of disinfectant solution, sanitary rooms, bedpans, urinals, dishes, secretions, linen and personal belongings of infectious patients, etc. are treated.

It is necessary to know and remember that compliance with the rules of the anti-epidemic regime and disinfection is, first of all, the prevention of hospital-acquired infections and the preservation of the health of medical personnel. This rule applies to all categories of medical workers, and especially to personnel working in operating rooms, dressing rooms, manipulation rooms and laboratories, i.e. having a higher risk of nosocomial infection due to direct contact with potentially infected biological material (blood, plasma, urine, pus, etc.). Working in these functional rooms and departments requires special compliance by staff with the regulations - personal protection and safety rules, mandatory disinfection of gloves, waste material, disposable instruments and linen before their disposal, regularity and thoroughness of routine general cleaning.

We would like to note that in connection with the appearance on the Russian market of a significant number of equipment samples and new disinfectants, the basis has been laid for revising the routine, outdated configuration of disinfection corners and chlorine-containing disinfectants supplied to clinics (chloramine, bleach, etc.). Currently, powdered chlorine-containing disinfectants, which, in our opinion, have only negative aspects (high retail price, difficulties with transportation and storage, poor solubility, loss of activity during storage, aggressiveness towards disinfected materials, toxic effects on personnel, etc.) , an alternative has appeared - concentrated liquid disinfectants based on quaternary ammonium compounds. These preparations do not have the negative qualities inherent in powdered chlorine-containing products and, in addition to disinfecting, also have a pronounced cleaning effect.

In order to prevent HIV infection, viral hepatitis B, C and other nosocomial infections, all medical products used for manipulations that violate the integrity of the skin and mucous membranes or those in contact with the surface of the mucous membranes, as well as during purulent operations or surgical manipulations in an infectious patient after each use they must be subjected to pre-sterilization treatment and sterilization.

Pre-sterilization treatment of medical devices is carried out in clinical diagnostic departments and consists of their disinfection and pre-sterilization cleaning. Disinfection using the chemical method is carried out by immersing instruments, gloves, laboratory glassware, etc. in a 3% chloramine solution for 60 minutes or a 4% hydrogen peroxide solution for 90 minutes. The disinfectant solution is used once.

Pre-sterilization cleaning consists of several stages. At the end of disinfection, the instruments are washed with running water over a sink for 30 s until the smell of the disinfectant is completely removed. Disinfected and washed medical instruments are soaked in a hot (50-55 ° C) solution containing, according to the OST 42-21-2-85 recipe, detergent and hydrogen peroxide for 15 minutes. when the product is completely immersed. After soaking, each product is washed in a detergent solution using a cotton-gauze swab. Then the washed medical instruments are rinsed under running water for 3-10 minutes, and then for 30-40 seconds in distilled water. Washed medical instruments are dried with hot air in a drying cabinet at a temperature of 85°C until the moisture completely disappears.

The quality of cleaning of products is checked by performing benzidine, ortho-toluidine and amidopyrine tests. 1% of simultaneously processed instruments (but not less than 3-5 products of the same name) are subject to control. The presence of residual amounts of detergents on products is determined by performing a phenolphthalein test. Products that test positive for blood or detergent are reprocessed until a negative result is obtained.

The modern development of disinfection allows the use of one working solution of a disinfectant to solve the issues of disinfection and pre-sterilization cleaning of medical instruments.

Sterilization can be carried out by steam, air or chemical methods, depending on the technical capabilities and nature of the material being sterilized. In departments where there is no central sterilization room in the hospital, sterilization is carried out in dry-heat ovens in one of the following modes: in the first mode, the sterilization temperature in the chamber is 180°C, time is 60 minutes; according to the second mode, the sterilization temperature in the chamber is 160°C, the sterilization time is 150 minutes.

In conclusion, I would like to note that in health care facilities not only significant therapeutic and diagnostic activities are carried out, but also a very extensive range of sanitary, hygienic and anti-epidemic measures aimed at preventing nosocomial infections, which are a special specificity of categories of human diseases associated with the patient receiving one or another type of infection. medical care and resulting from the patient’s hospital stay. At the head of all this multifaceted work on the prevention of nosocomial infections in health care facilities is a nurse - the main organizer, executor and responsible controller, the correctness of whose activities depends on the knowledge and practical skills acquired during the training process to solve this problem. A conscientious attitude and careful compliance by medical personnel with the requirements of the anti-epidemic regime will prevent occupational illness among employees, which will significantly reduce the risk of nosocomial infection and preserve the health of patients.

The main directions for the prevention of nosocomial infections are defined in the Concept for the Prevention of Nosocomial Infections, approved by the Ministry of Health and Social Development of Russia on December 6, 1999:

Optimization of the epidemiological surveillance system for nosocomial infections;

Improving laboratory diagnostics and monitoring of nosocomial pathogens;

Increasing the efficiency of disinfection and sterilization measures;

Development of strategies and tactics for the use of antibiotics and chemotherapy drugs;

Optimization of measures to prevent nosocomial infections with various modes of transmission and combat them;

Rationalization of the basic principles of hospital hygiene;

Optimization of principles for the prevention of nosocomial infections of medical personnel;

Assessment of the cost-effectiveness of measures to prevent nosocomial infections.

An analysis of the incidence of nosocomial infections according to official data showed the lack of registration of a number of nosological forms of nosocomial infections, a low level of incidence of nosocomial infections compared to the level of the Russian Federation as a whole and its individual territories, and a large range of incidence rates for registered nosological forms during the observation period. The problem of recording postoperative infections is especially acute. All of the above indicates insufficient epidemiological surveillance of nosocomial infections at the level of both health care facilities and Rospotrebnadzor institutions. Under-registration of nosocomial infections is due to the following reasons:

Concealment of cases due to fear of legal sanctions from both Rospotrebnadzor and medical insurance organizations;

Lack of officially approved clinical criteria for nosocomial infections;

Different approaches of clinicians and epidemiologists to the diagnosis of nosocomial infections and, in particular, GSI.

Many clinicians consider some forms of nosocomial infections as a non-infectious pathology, and in surgical hospitals, nosocomial infections are classified as complications at best. The introduction of hospital epidemiologist positions did not change the situation.

The lack of objective data creates the appearance of sanitary and epidemiological well-being and does not contribute to the development and implementation of preventive measures.

Based on the above, it can be argued that in recent decades, nosocomial infections have become an increasingly significant health problem. They significantly aggravate the course of the underlying disease, creating a threat to the patient’s life, and also increase the cost of treatment. Nosocomial infections at the present stage are characterized by high contagiousness, a wide range of pathogens, various routes of transmission, high resistance to antibiotics and chemotherapeutic drugs and represent one of the main causes of mortality in patients in hospitals of various profiles.

In order to improve the situation, we believe that, first of all, it is necessary to ensure objective accounting and registration of nosocomial infections. In this regard, appropriate training should be provided to managers of health care facilities, hospital epidemiologists and all medical personnel. It is advisable to optimize the accounting and reporting forms for maintaining medical records and create a unified system of unified documents.

Monitoring the incidence of nosocomial infections in various types of health care facilities will allow us to identify its specifics and determine the priority of certain preventive measures, and a systematic analysis of the incidence will contribute to their timely adjustment.

It is necessary to create and implement in each health care facility, taking into account its specifics, territorial programs for the prevention of nosocomial infections, including infection control programs. These programs should include standards and algorithms for medical care, algorithms for the use of antibiotics, antiseptics and disinfectants, hygiene standards, standard definitions of nosocomial infections and training programs for medical personnel.

Systematic training of nurses should be organized in health care facilities. Their training should be carried out taking into account the specifics of work in various functional departments of health care facilities.

An essential point in improving the prevention of nosocomial infections is the creation of motivation in the activities of personnel. At present, it is impossible to abandon command-and-administrative and economic methods of management, which involve material rewards and punishments.

We consider it extremely important to develop and improve normative and methodological documentation regulating the implementation of hygienic and anti-epidemic measures in health care facilities, since many provisions of existing documents are outdated and require urgent revision.

It is also necessary to increase the effectiveness of sanitary and epidemiological surveillance of health care facilities.

I would like to hope that the study will help to correctly assess the situation and determine priority measures to combat nosocomial infections in healthcare facilities of various profiles.

nosocomial infection medical pathogen

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Annex 1

Nosocomial infection (HAI)

Highlight your answer option.

1.Do cases of nosocomial infections often occur in your department?

Almost every day

About once a week

Once every few weeks

2. Do you report cases of nosocomial infections?

Yes, always Sometimes No

3. Do you comply with ALL the requirements of the Sanitary and Epidemiological Regulations?

Yes Not all No

4. Do you follow the rules of asepsis and antisepsis? Do you always do them?

Yes, I always do it and keep an eye on it

I try to fulfill them and monitor their implementation

I do it myself, I don’t monitor the work of others

I follow only the basic rules, I don’t follow others.

5.How many times do you change gloves during a work shift?

After each manipulation

After working with several patients

As it gets dirty

1-2 times per shift

6. Do you carry out ventilation in the wards and do you follow the schedule?

I always carry out according to the schedule

I don’t always have time to carry it out

Patients ventilate their rooms themselves

7. Do you take into account the concentration of disinfectants when disinfecting, processing, etc.?

8. Do you use all of the following when working with patients?

Robe/suit, cap, replacement shoes, gloves, mask.

I use absolutely everything I don’t use everything

9. Is preventive and focal (current, final) disinfection carried out in your department?

Always carried out according to plan

Not always carried out

10. Is your department sufficiently equipped with disinfectants? means, honey equipment?

Fully stocked

We don't have enough equipment

We don't have enough mischief. funds

11. Do you think that nosocomial infections pose a serious threat to the patient?

Yes, in no case should cases of nosocomial infections be allowed to occur.

It affects the patient's condition, but there is no serious threat

I don't think it affects his condition at all.

Appendix 2

Posted on Allbest.ru

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Nosocomial infection and its prevention. Nosocomial infection: ways of spread and prevention

General information

Etiology and epidemiology of nosocomial infections

Classification of nosocomial infections

Diagnosis of nosocomial infections

Treatment of nosocomial infections

Prevention of nosocomial infections

Major nosocomial infections: pathogens

Types of nosocomial infections

Diagnostic measures

Basic principles of treatment of nosocomial infections

Prevention of nosocomial infections

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