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Reasons and prophylactic. in - hospital infections.
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REASONS AND PROPHYLACTIC
IN - HOSPITAL INFECTIONS.
Concept In hospital infection (II) by the definition of the WHO:
It is any clinically expressed disease microbe aetyology, amazing the patient during hospitalization or visiting medical establishments, and also medical staff during his professional work, irrespective, are shown or are not shown symptoms of this disease during presence of the given persons in medical establishment or after 3 days after leaving of the hospital.
The spreading of II is now registrated in all countries of the world, it is very actual problem for the health servise, so at WHO it is the special Committee for investigation and struggle with II.
Structure activators of II in 20 century:
1) Till 50th years the leading position in structure II was occupied the sharp infectious diseases caused by pathogenic microorganisms (scarlet fever, diphtheria, chicken pox, gas gangrene, tetanus etc. ).
2) The main place and original " plague" of many hospitals in 50-60-е years became a staphylococcal infection.
3) Thanks to wide use of antybiotic therapy since 70-th years at first place become the gramm - negative flora – proteus, esherixia coli, enterobacter, etc. (are very stable to antybiotics and it is very difficult to deliver from it by the help of antybiotics).
Danger of appearance of II for the patient:
- Current of the basic disease is made heavier;
- Morbidity patients at generalized form II is up to 60 %;
- There can be new illnesses during treatment in hospital.
Danger of II for public health services:
- Violation work of a hospital, down to time closing hospital or it department for desinfection;
- Increase time of stay of the patient in a hospital (on the average one case of II extends term of stay of the patient in hospital for 13-17 days);
- Additional economic charges for treatment patients, work of the personnel.
Basic sources of II:
- Initial sourses: it is patients, medical staff, visitors (less often)
- Secondary sourses (objects of the intra hospital environment): tools; linen, furniture; air, food.
Categories of intra hospital subjects on danger of transfer II:
1) Critical (are most dangerous, the most strict requirements to it disinfection) - surgical toolkit, needles, endoscopes, cateters;
2) Half-critical (the equipment for inhalations and anesthesia, utensils);
3) Not critical (linen, furniture).
Basic ways of transfer II:
- Inhalation way (air - drop and air - dust);
- Contact (through tools, linen, furniture);
- Injection (at introduction of medicines);
- Fecal-oral (intestital infections throwing by dirty hands);
- Alimentary (through food).
Structure of II (frequency rate in different departments of hospital): Infections of renal ways - 15-40 %; Surgical and dentist infection - 10-30 %; Infections of respiratory ways - 15-20 %; Intestinal infections - 10-20 %
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Reasons of growing II now in any countries:
- Growth among hospitalized patients amount of persons from groups of the increased risk - patients with various chronic diseases (cardiovascular, oncological, illnesses of blood, a diabetes), immunodepressive conditions; old patients,
- Easing of natural immunity and allergization the population owing to an adverse ecological situation;
- " Urbanization" of the intra hospital environment, concentration a plenty of patients and the personnel in multi-storey buildings;
- Complication operative interventions, increase it duration and traumatic, wide application endoscope equipment which are badly giving in to sterilization;
- Excessive, sometimes insufficiently proved application antibiotics, formation intra hospital kinds activators II, polyresistant to antibiotics, used in a hospital;
- Insufficiently careful disinfecting injection and other toolkit;
- Increase duration stay of the patient in a hospital, connected to many functional - diagnostic researches;
- Easing attention to strict observance of the hygienic and sanitary - antyepidemical modes in hospitals.
System prevention II in hospital:
1) Strict observance sanitary - antyepidemical mode:
- Good ventilation, sanitation air of premises, optimum microclimate;
- Realization medical control personnel;
- Qualitative disinfection and sterilization the equipment, linen etc.;
- Regular bacteriological control tools, linen, air, food, hands;
- Revealing and isolation infectious patients;
- Observance rules of personal hygiene by the personnel and patients.
2) Architectural actions:
- Rational accommodation and zoning hospital site;
- Interposition branches and divisions on buildings and floors for isolation ward sections, branches, operational, studies, wards;
- Observance hygienic norms of the area, volume of hospital premises.
3)Increase resistancy patients and the personnel:
- optimum mode of work and rest;
- rational balanced diet;
- sufficient stay on fresh air;
- scheduled and emergency immunization of the patients.
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