Infections related to the provision of medical care: species and classification

Infections associated with the provision of medical care are regularly found in clinical practice. And do not blame the doctors, they are trying to do everything possible to delay the occurrence of these complications. Unfortunately, few people succeed in avoiding them.

Definition

What is included in the concept of "infection associated with the provision of medical care"? The definition is as follows: these are any manifestations of the microbial nature that are observed in the patient after treatment in the hospital, or visits to the hospital for treatment, or within a month after discharge from the hospital.

Another name for this group of diseases is nosocomial infection, or VBI. It is believed that the infection appeared in the patient already in the hospital, if the first symptoms of the disease appeared no earlier than two days after the date of admission. An obligatory condition is the absence of a manifestation of this infection in a patient before being placed in a medical institution.

Hospital infections must be distinguished from iatrogenic and opportunistic ones, since they are similar enough to be confused. Iatrogenic is an infection that appears through the fault of medical personnel during treatment or diagnosis. Opportunistic, however, appears in humans, than immunity is not able to contain opportunistic pathogens in check.

Prevalence

The epidemiology of infections associated with the provision of medical care, judging by the estimates of the Center for Disease Control (CDC), is disappointing. In the United States, of a million and a half million people a year, more than half died. In Europe, this figure is twenty-five thousand, in Russia - thirty thousand. But such low figures do not speak about the quality of medical care, but about the low quality of statistical research.

For nosocomial infections, there are different dissemination principles that distinguish them from other diseases of this kind. These differences are the mechanism and factors of transmission, the specific nature of the infection, the role of hospital staff in maintaining and increasing the number of cases. Also, these infections are difficult to treat, since microorganisms that live in a health facility are resistant to the effects of drugs.

Etiology

The causative agents of infections associated with the provision of medical care are spread all over the globe. To date, more than two hundred microbial agents are known that can induce VBI. Before the era of antibiotics, these were anaerobic sticks, streptococci and staphylococci. It has now been established that the cause of the infection can be rotavirus, cytomegalovirus, hepatitis viruses and even HIV.

Being a long time in the territory of a medical institution, the microorganism undergoes a natural selection and mutation, as a result of which there are stable strains, which are disinfected with disinfectants, quartz and antibiotics. In each separate hospital, department and even the operating room there live their "unique" bacteria.

Sources and mechanism of transmission of infection

The concept of "infection associated with the provision of medical care" implies the presence of three whales of the epidemiological process:

- source;

- the mode of transmission;

- a receptive person.

Sources of VBI can be sold to patients who are in the hospital for a long time and are contaminated with its microflora, as well as medical workers, daily contacting the same bacteria. Visitors to day hospitals and relatives play a secondary role in the spread of hospital infections.

The mechanism of transmission can be practically any: fecal-oral, air-drip, contact or transmissible. Transmission factors are instruments, apparatus for breathing and circulation, bed and underwear, beds, bandages and sutures, prostheses, drains and wet objects. These include taps and sinks, plums, infusion solutions, purified water, antiseptic solutions, water in flower vases, condensation in the air purification system and so on.

Risk groups

Infections associated with the provision of medical care to patients are most often found in people with weakened immunity. Of course, all patients have somehow reduced the protective functions of the body, but there are people who are most susceptible. These include:

- aged people;

Premature babies and newborns;

- Patients with oncological, autoimmune, allergic diseases;

- patients who have undergone long-term operations;

- people who lived in an ecologically unfavorable territory.

The enumerated contingent has the most chances of getting sick while in a medical institution, so it requires increased care from the medical staff.

Classification

What are the types of infections associated with the provision of medical care? It all depends on the nature of their classification. For example, if we take the transmission routes, we distinguish: aerosol, alimentary, contact-household, instrumental, post-transplant, infection after injections, blood transfusions, surgeries, endoscopic procedures, and others. Adrift, like other diseases, VBI can be acute, subacute and chronic, as well as severe, moderate and light forms.

There is also a difference in the prevalence of infection associated with the provision of medical care. Classification begins with severe cases:

- Generalized form: bacteremia, septicemia, septicopyemia, bacterial shock.

- Localized form.

- Infections of the skin and subcutaneous fat.

- Infections of the respiratory system.

- Dental forms.

- Infections of the digestive system.

- Infections of the genital and urinary system.

- Infections of the musculoskeletal system.

- Infections of the nervous system.

- Infections of the cardiovascular system.

Causes of high incidence

Prevention of infections associated with the provision of medical care is aimed at reducing the overall incidence rate. But unfortunately, today all precautions are ineffective. The main reason for this is the appearance of multiresistant flora.

First of all, this happens because bacteria mutate, changing their properties due to irrational use of antibiotics and disinfectants. These are ideal conditions for the creation of microflora with secondary multiresistance.

Primary resistance is the natural ability of a given type of microbes to resist aggressive agents. The habit of doctors on any occasion to prescribe antibiotics leads to the fact that the effectiveness of treatment is reduced, and the bacteria become immune to drugs. But not only the medical staff is to blame for this. In Russia, people are accustomed to self-prescribe antibacterial drugs, but they do not adhere to the instructions for use.

Principles of Fleming

There are three principles of Fleming, which are recommended by the international health organization.

The first principle is to prescribe antimicrobials, only if the causative agent of the infection is sensitive to them. This will limit the use of antibiotics, make doctors always carry out studies of the sensitivity of flora to medicines, will bring to the forefront drugs with a narrow, directed spectrum of action.

The second principle Fleming says that you need to ensure an effective concentration of the drug in the lesion. This rule will reduce the number of locally used antibiotics and drugs prescribed for preventive purposes. In addition, it will make it possible to cancel the medication immediately, rather than gradually, and also adjust the dose and drug, based on the study of the patient's biological fluid cultures every seven days.

The third principle is to prescribe antibiotics in such a dose and introduce them in such a way as to minimize the negative effects. This will allow more rational use of medicines.

Formation of bacterial transport

Infections associated with the provision of medical care can not exist without a carrier bacterium, the so-called "zero patient", which will be an inconspicuous source of infection for everyone else.

Bacteriosis is a form of infection that occurs if an equilibrium is established between the host and the parasite against the background of a lack of clinical manifestations. Immunological reactions continue to occur. If the microorganism has passed in latent form through five patients, then it changes its properties and becomes more aggressive.

Preventive measures in this case are:

- regular medical examination of medical workers;

- bacteriological study of hospital staff;

- timely detection and treatment of infected doctors;

- daily monitoring of the health of doctors.

Dangerous diagnostic and medical procedures

Infections related to the provision of medical assistance (ISMP) appear not only after the patient has spent some time on inpatient treatment, but also after a series of diagnostic and therapeutic manipulations that contribute to the contamination of the hospital flora. These include blood transfusions, injections, organ and tissue transplant surgery. Among the resuscitation measures are intubation, inhalation anesthesia, devices for life support, staging catheters. Also, infection can occur after the procedure of hemodialysis, inhalation and balneological procedures.

Classification by Spaulding

Infections associated with the provision of medical care can be transferred through medical devices. Therefore, Spalding divided them into three groups, taking the risk of infection with the hospital flora as a classifying sign.

The first group is critical. These include surgical instruments, catheters, implants, needles and injectable liquids.

The second group is semi-critical: endoscopic and inhalation equipment, devices for anesthesia, rectal thermometers.

The third group, respectively, are non-critical. These are all other items: ships, tonometers, crutches, dishes, linen, axillary thermometers.

Prevention

Prevention of infections associated with the provision of medical care is based on the recommendations of the World Health Organization for the prevention of HBV. Good prevention should include three stages:

- minimizing the appearance of infection from outside the hospital;

- elimination of the spread of infection, by influencing the links of the epidemic process;

- Exclusion of infection out of the hospital.

For this purpose, there is isolation of patients with dangerous infectious diseases in specialized boxes with a separate entrance and exit, which is not communicated with the rest of the department. In addition, in each department the current and general sanitary treatment of tools and surfaces is carried out. The frequency of these measures depends on the need: in the therapeutic departments - less often, in the surgical departments , respectively, more often.

Treatment

Infections associated with the provision of medical care, although with difficulty, but still succumb to drug therapy. Ideally, the doctor prescribes a specific antimicrobial drug of a narrow spectrum of action, which is designed for a specific type of pathogen. But in practical activities this is hardly possible, because sowing microflora and sensitivity analysis take a week, and the patient needs to be treated now. Therefore, the doctor is forced to prescribe empirical therapy, based on his conclusions. The choice of antibacterial drug depends on the knowledge of the doctor about which microflora prevails in the department.

In order that the pathogens did not develop resistance to the drugs, it is necessary to adhere to the rotation of the preparations, that is, change them every two to three months. This will help reduce resistance and improve the results of treatment.