Intrahospital infections

Description:

Now intrahospital infections (VBI) are one of the main reasons for incidence and mortality of the hospitalized patients. Accession of VBI to a basic disease quite often nullifies results of treatment, increases a postoperative lethality and duration of stay of the patient in a hospital. Growth of incidence of VBI is caused by a variety of reasons:

1) demographic changes in society, first of all increase in number of senior citizens at which protective forces of an organism are reduced;

2) increase in number of the persons belonging to the contingents of the increased risk (patients with chronic diseases, premature newborns, etc.);

3) wide, sometimes uncontrolled use of antibiotics; frequent use of antibiotics and himiopreparat promotes emergence of the drug resistant microorganisms differing in higher virulence and the increased resistance to influence of environmental factors, including to disinfectants;

4) implementation in practice of health care of more difficult surgeries, broad use of tool (invasive) diagnostic methods and treatments;

5) wide circulation of the inborn and acquired immunodeficiency, frequent use of the means suppressing immune system;

6) disturbance of the sanitary and hygienic and anti-epidemic modes.

The most successful and full should consider the definition of VBI offered the European regional offices of WHO. Intrahospital (nozokomialny, hospital) the infection is the any clinically recognized disease of a microbic etiology connected with stay, treatment, inspection or the request of the person for medical care in MPI, or an infectious disease of the employee owing to his work in this establishment.

The intrahospital infection can arise both during stay of the patient in MPI, and after an extract from it. In the latter case the issue of disease belonging to VBI is resolved jointly. The etiological structure and features of epidemiology of VBI depend on a profile of MPI, age of patients, specifics of methods, remedies and inspection of patients and some other factors.

VBI bulk at the present stage is caused by uslovnopatogenny activators: stafilokokka, streptococci, pyocyanic stick, Proteus, klebsiyella, colibacillus, salmonellas, enterobakgeriya, enterococci, serraniye, bacteroids, clostridiums, kandida, etc. microorganisms. The important place in an etiology of VBI is taken by influenza viruses, adenoviruses, rotaviruses, enteroviruses, causative agents of a viral hepatitis, etc. Intrahospital infections can be caused by rare or earlier unknown activators, such as legionella, pneumocysts, aspergilla, etc.

Can be VBI sources having the most important epidemiological value:

- patients with the acute, erased or chronic form of infectious diseases, including a wound fever, and also carriers of different types of pathogenic and opportunistic microorganisms;

- medical personnel: carriers, and also suffering from the forms of infections expressed (manifest) or erased;

- mothers (generally in obstetric hospitals and departments for children of early age): carriers or patients;

- visitors.

Ways and factors of transfer of VBI activators are also diverse.

Infection of patients can happen in clinic the next ways:

- airborne or air and dust;

- contact and household (through objects of patient care, linen, medical tools, the equipment, and also personnel hands);

- parenteral (at introduction of the infected blood preparations, isotonic solutions and other medicines);

- alimentary (through milk, solutions for drink, foodstuff);

- vertical (transplacental — from mother to a fruit or the newborn through a placenta).

The importance of separate ways and factors of transfer of VBI activators depends on a profile of MPI. So, if in obstetrical institutions the staphylococcal infection which main source are carriers of golden staphylococcus among medical personnel, and a major factor of transfer — air prevails, then in burn departments the pyocyanic stick dominates, the main source of an infection are patients, and in the main way of transfer — contact and household (objects of leaving, a personnel hand, etc.). In urological hospitals the infections caused by gram-negative bacteria prevail: enterobakteriya, Proteus, pyocyanic and colibacillus.

Emergence and development of VBI in MPI are promoted:

1) underestimation of epidemic danger of intrahospital sources of an infection and risk of infection at contact with patients it is purulent - septic infections, their untimely isolation;

2) presence of undetected patients and carriers of intrahospital strains among medical personnel and patients;

3) disturbance by personnel of rules of an asepsis and antiseptics, personal hygiene, current and final disinfection, cleaning mode;

4) disturbance of the mode of sterilization and disinfection of medical tools, devices, devices, etc.;

5) disturbance of actions of the restrictive and guarding mode.

Thus, VBI represents a serious problem in the field of safety of the hospital environment. For fight against VBI in MPI the complex of actions, one of which is the organization and performance of preventive measures, is used.