INTRAHOSPITAL INFECTIONS

From Big Medical Encyclopedia

INTRAHOSPITAL INFECTIONS (synonym nozokomialny infections) — the infectious diseases and surgical infections which joined in a hospital a basic disease or damage or the diseases of medics connected with treatment or care of infectious patients. Century and. arise among patients to lay down. institutions owing to inexact diagnosis or violation of the rules of an asepsis and antiseptics, and also isolation of infectious patients, and also transmission of infection by carriers.

In last V. and. owing to the various reasons met often, especially during extensive epidemics.

To the middle of 19 century there was no system of isolation of infectious patients in certain rooms. Statistically the Tranche (J. J. Grancher, 1843 — 190 7), till 1875 in the Parisian hospital of Trusso V.'s number and. in therapeutic department reached 39%, and in surgical — 67%. According to E. E. Gartye, in St. Petersburg mountains. to hospital of

S. P. Botkin V.'s number and. among infectious patients in 1893 — 1896 fluctuated within 26,6 — 38,1%. From the second half of the 70th years of 19 century it began to be applied widely in practice of hospital construction (see) the stage system which provided separate accommodation of patients by types of infectious diseases, played a positive role in V.'s prevention and. In Russia the Children's hospital of St. Vladimir (nowadays Children's city hospital of N ° 2 of I. V. Rusakov) in Moscow was the first hospital of new type. In 1878 at the international exhibition in Paris she was awarded «for consecutive carrying out isolation of patients».

The outstanding role in a rational design of hospitals belongs to the Russian pediatrician K. A. Raukhfus (1835 — 191 5), according to the offer to-rogo hospitals with the isolated departments for surgical, therapeutic and infectious patients were for the first time constructed (separately for each infectious disease). Since the end of the 80th years of 19 century individual isolation of patients in the beginning by means of primitive mesh linen, and then glass partitions between beds, then with the help began to be carried out boxes (see). To the device of boxes, according to some researchers, V. and. struck from 14 to 31% of patients, and during the use of box system — 3 — 4%.

In process of expansion of knowledge in the field of epidemiology and improvement of methods and means of fight against V. and. the last began to be registered less often. Gradually their percent decreased, in noninfectious hospitals and departments they are noted in the form of sporadic cases, and in infectious — hl meet. obr. in children's departments at the expense of respiratory infections. The flu, diseases caused by other viruses, and in children's departments — measles, chicken pox, scarlet fever, a mumps, whooping cough, quinsy, respiratory viral infections have the greatest distribution. Serious danger is constituted by staphylococcal and streptococcal V. and., different pyodermas, consecutive wound fevers, and also the infections caused by a number of conditionally pathogenic microorganisms.

V.'s sources and. can serve: the patients who arrived in an incubation interval of any infectious disease; patients with the mixed infectious diseases; the patients who had recently infectious disease and did not sustain necessary terms of dissociation; carriers of pathogenic microbes (causative agents of diphtheria, meningococcal and intestinal infections, poliomyelitis, etc.) both among the arriving patients, and among personnel; visitors of patients. From intestinal infections as V. and. most often bacterial dysentery meets.

After the mechanism of transfer of sypny, returnable typhus was found out and obligatory disinsection processing of patients, these V. is entered and. began to be registered exclusively seldom.

Emergence and V.'s development and. in to lay down. institutions depend on a variety of reasons: wrong primary diagnoses of diseases; underestimation of importance epidemiol, the anamnesis concerning the postponed earlier infectious diseases at the arriving patients, the wrong distribution of patients in chambers and boxes (without a clinical picture of a disease and epidemiol, data); non-performance necessary dignity. - a gigabyte. the mode and rules of prevention in to lay down. establishment, in particular non-compliance with measures for detection of carriers among patients, unsatisfactory sanitary cleaning of patients, failure to follow rules of the current disinfection, failure to follow of rules of prevention by personnel at patient care, rejection of measures against a drift of any disease from one department (chamber) in another, exceeding of accumulation factors of patients in departments (chambers).

To V.'s development and. decrease in resistance of an organism under the influence of a basic disease promotes.

V.'s prevention and. it is carried out since the moment when the doctor resolved an issue of need of hospitalization of the patient. The doctor sending the patient to a hospital (especially it is important concerning sick children), collects exhaustive data on possible communication of the patient with infectious patients that notes in the accompanying document. In turn the doctor accepting the patient in a hospital at absence epidemiol. data, urgently directs necessary references at the district doctor or in a dignity. - epid, establishment and, being conformed with the received data, carries out the necessary measures for V.'s prevention and. Indispensable condition of prevention of V. and. also individual transportation of patients allowing to exclude infection of the patient in way is. At reception and sanitary cleaning of the patient measures to elimination of contact with other patients (accommodation of patients to reception boxes), and if necessary — disinfection and disinsection actions are taken. Persons at whom two infectious diseases or adjoining to the patient with other infectious disease are suspected are placed in the separate box. In certain cases before transferring the patient to the general chamber, it is placed on the first 48 hours in the box, or the so-called filter. During this time make necessary diagnostic testings and reveal infectious diseases with a short incubation interval.

An important role in V.'s prevention and. the dignity belongs protivoepid, and. - a gigabyte. to the mode in to lay down. establishment. Early detection of the joining infectious disease, holding observation and quarantine actions in hospital (department) at V.'s emergence is of great importance and., prohibition of visits of patients at epid, trouble (especially concerning droplet infections) this settlement.

In V.'s prevention and. respiratory tracts early isolation of the diseased has the greatest value. Therefore in infectious departments (in nurseries and for adults) it is necessary to have boxes for isolation of patients. A necessary condition of successful prevention of infectious diseases of respiratory tracts is the good ventilation of chambers providing repeated air exchange in them and also disinfecting of air by means of germicidal lamps. Bactericidal ultra-violet lamps (PUFFS) which are suspended in chambers (with a protective visor in order to avoid direct action of beams on eyes), or conditioners of air with special filters are for this purpose used. For group radiation quartz lamps are used. For the purpose of disinfection of air in hospital rooms also chemical desinfectants are applied.

In fight against intrahospital spread of poliomyelitis, viral hepatitis immunoglobulins, for prevention of flu — interferon, interferonogena and immunoglobulin are etc. used. In prevention of a viral hepatitis the correct processing of syringes, needles and other tools has paramount importance if they are reused. Before boiling or other type of sterilization they are killed in the liquids dissolving blood (mix of water, hydrogen peroxide and washing «News» powder, etc.) and carefully wash.

In prevention of intrahospital infection of outside covers implementation of rules of patient care and first of all fight against decubituses has a principal value. At the same time immediate isolation of the diseased, identification and isolation of a source of an infection, the organization of service of patients excluding V.'s distribution is also shown and.

V.'s prevention and. intestinal group the dignity is reached by carrying out a complex. - a gigabyte. the actions allowing to eliminate a possibility of infection of food, water, objects household and a gigabyte. service, to-rymi patients use. Along with it the current and final disinfection, identification of patients and carriers among the arrived patients and personnel is carried out.

Considering monospecificity of postinfectious immunity and cross V.' possibility and., it is recommended to separate in dysenteric departments patients in chambers depending on a look and a serotype of the activator; also separately place patients at whom the diagnosis of dysentery is doubtful. Also separate accommodation of patients with a typhoid and paratyphus is desirable.

Intrahospital infections in surgical departments. Specific conditions of surgical treatment under which patients have open entrance infection atriums in the form of a wound surface cause V.'s emergence and., not observed in other clinics. Century and. the surgical clinic can call various activators: streptococci, pneumococci, proteas, sometimes stick of blue-green pus, diphtheritic stick, etc.; Century and. can arise also at influence of anaerobic microorganisms. Are especially dangerous concerning V.'s development and. causative agents of gas gangrene.

Sources of pathogenic flora in hospitals are patients with the centers hron, infections, trophic ulcers, from trakheostoma, fecal fistulas, etc. However the greatest significance in developing of a nozokomialny surgical infection is attached to service personnel of surgical clinics among which there are possible bacillicarriers, and also is long to the treated patients who also become bacillicarriers.

The raised susceptibility to a hospital infection at surgical patients is explained with weakening of the protective forces operated as a result of an operational injury and blood loss; emergence of antibiotic-resistant strains of the microbes which are constantly living in hospitals and also artificial suppression in a number of patients of immunity with use of immunodepressive agents (X-irradiation, treatment by corticosteroids, AKTG, vinblastine, chloramphenicol, etc.).

Ways of spread of a hospital infection are ways of a usual exogenous infection: airborne, contact and implantation, and the greatest value has airborne. The hospital infection is especially dangerous to patients with major defects of skin (burns, scalped wounds, freezing injuries); for children, old men and weakened; extreme value is gained by a hospital infection for patients after organ transplantation and fabrics.

Prevention of a hospital infection is as follows.

1. Improvement of methods of an asepsis: for reduction of air pollution in the operating room special antimicrobic surgical masks, air conditioning with its bacterial cleaning, UF-radiation of air and rooms are offered; for prevention of a contact infection improve a technique processings of hands (see) and surgery field (see), applying various poverkhnostnoaktivny substances to washing — detergents (see); for the purpose of prevention of an implantation infection the suture material, prostheses are implemented into practice, nails and other objects subjected to sterilization by gamma-rays directly in packaging to-ruyu are removed only at the time of use, physical are improved. and chemical methods sterilizations (see), devices disposable are implemented (syringes, systems for hemotransfusion).

2. Organizational actions are directed to modernization of surgical departments with their profiling, division, a special design, a boxing, creation of so-called superpure operating rooms, etc. The great value is given to the correct organization of operating sequence and bandagings (pure in the beginning, then infected). Important organizational action — identification of bacillicarriers among personnel. The revealed bacillicarriers are subject to sanitation, and in case of its unsuccessfulness shall be discharged of work in surgical departments.

3. To lay down. - professional, actions are directed to increase in immunobiological forces of an organism by administration of serums by the patient, vaccines, immune globulins, hemotransfusions, etc. Preventive use of antiseptic drugs including new antibiotics is important. At the choice of a method of treatment of burns, scalped wounds bigger preference is given to the closed methods of treatment. Treatment of hospital surgical infections is made by the general principle of treatment of pyoinflammatory diseases at which special attention is paid to increase in protective forces of an organism. Patients with a hospital surgical infection are subject to transfer in purulent departments, and in some cases and to the placement to isolation centers.

Intrahospital infections in children's hospitals have special value since children in comparison with adults are more susceptible to various infectious diseases and first of all to those which are transferred in the airborne way. Century and. can arise in children's hospitals of any profile.

In connection with considerable improvement of systematically carried out prevention of infectious diseases, improvement of improvement of children's hospitals V.'s frequency and. it was sharply reduced; also their etiological structure changed. The intrahospital outbreaks of measles, whooping cough, diphtheria became rare. It was a consequence of falloff of the general incidence of the listed infectious diseases in connection with high performance mass immunoprevention (see). The first place among V. and. occupy acute respiratory diseases (flu, adenoviral, enteroviral, mycoplasmal infections) which played not less important role earlier, but were considered very badly. Chicken pox, scarlet fever, intestinal infections (dysentery if - an infection, a viral hepatitis) kept the value.

M. G. Danilevich in the forties considerably expanded 20 century the concept «intrahospital infections». It showed that in the conditions of a children's hospital various complications developing at patients (otitises, stomatitises, colitis, pneumonia, pyodermas etc.) are a consequence of intrahospital infection. For the same reason in infectious departments superinfections and reinfections are often observed. Danilevich called all this group of the diseases arising in hospital «cross infections». They burden the course of basic process and worsen an outcome of the disease not in a smaller measure, than those infectious diseases which it was accepted to call V. and.

From 50th years 20 century great value got staphylococcal V. and. (especially in departments for newborns and in surgical hospitals). The general increase of staphylococcal diseases happens also at the expense of nozokomialny infections. Excessive and quite often chaotic use of the antibiotics oppressing a normal bacterial flora and breaking natural balance between antagonistic components of a microbic biocenosis of a human body promotes development of resistant highly virulent strains of staphylococcus. The last can widely circulate in hospital department. It is established that the overwhelming mass of staphylococcal V. and. it is connected with exogenous infection, but not with activation of own bacterial flora as assumed earlier. It belongs as well to other nozokomiya — intestinal if - the infection which is found it is almost exclusive at children of the earliest age.

Such V.' source and., as measles and chicken pox, are almost exclusively sick children. Cases of infection with chicken pox from patients are described the surrounding herpes (see) with the subsequent development of flash. Both sick children, and adults from among the personnel and mothers left for service of the children can be a source of acute respiratory infectious diseases. It is important to note that acute pneumonias in most cases arise in connection with various acute respiratory infections. Therefore the room of the child with an acute pneumonia in children's somatic department creates threat of a drift of an infection.

Intrahospital infection with intestinal infections, «a staphylococcal disease», a viral hepatitis comes both from children, and from personnel and the looking after mothers. At these infections patients can is long to keep contageousness; the big role in a drift and spread of infectious diseases in department is played by carriers of contagiums (see. Carriage of contagiums ).

The most important and only way of transfer of acute respiratory diseases (measles, chicken pox, diphtheria, scarlet fever, epidemic parotitis) is airborne, and at staphylococcal infections which causative agent has considerable firmness — and an air and dust way. At penetration into hospital departments of some infections which are transmitted in the airborne way (e.g., flu), emergence of considerable epidemic flashes is possible. At a drift of such droplet infections as measles, whooping cough, diphtheria against which systematic immunization of children on the first year of life is carried out secondary cases arise rather seldom or at all and e are observed. Intestinal infections extend through ware, various hospital stock, bathrooms, vessels. In transfer of intestinal infections hands of personnel are of great importance. At a viral hepatitis, (hl. obr. at hepatitis A), in addition to a fecal and oral way, transfer is not excluded in the airborne way; transfer of serumal hepatitis at various medical manipulations (hemotransfusion and plasmas, injections) is possible.

Knowledge of a source of contagiums and the mechanism of its transfer defines an orientation and efficiency of anti-epidemic measures. For V.'s prevention and. in children's hospital has special value the correct design of the building of hospital, the structure of reception, boxes, semi-boxes, an order of reception and accommodation of patients on chambers, the correct mode of their service etc. (see. Children's hospital ). Special attention shall be paid also to careful collecting at the arriving children of the anamnesis which if necessary is supplemented with data from child care facilities and a dignity. - epid, stations.

From measures of specific prevention at intestinal diseases the fagoprofilaktika is applied (see. Fagoprofilaktika , a phagotherapy), at respiratory viral infectious diseases — interferon (see); an important role is played by a seroimmunity — administration of human immunoglobulin to the children who were in contact with patients with measles, viral hepatitis (see. Immunoglobulins ). Administration of immunoglobulin for the purpose of prevention of measles is carried out only to the children who were not ill and are not vaccinated against this disease.

Intrahospital infections in maternity homes. In maternity homes conditions for emergence and V.'s distribution can appear and. Newborns (especially premature) children with a defective immunoreactivity and the women in labor weakened by childbirth are very sensitive to pathogenic microorganisms. In obstetrical institutions special value as V. and. get acute respiratory, staphylococcal and intestinal infections. Among the last plays the main role if - the infection caused by pathogenic strains of colibacillus (see. Kolya infection ). At unsatisfactory a dignity. - a gigabyte. the mode there can be considerable epidemic flashes. Primary sources of an infection are women in labor and medical staff (both patients, and carriers), newborns become secondary sources. The special attention is required to itself by a carriage of pathogenic stafilokokk among medical staff of maternity homes. In V.'s prevention and. in maternity homes the main role is played by observance strict a dignity. - a gigabyte. the mode (see. Maternity home ). The special attention is deserved by inspection of personnel, and also the arriving women in labor on a carriage of a pathogenic indestinal flora and staphylococcus; the personnel shall use often replaced sterilized gauze masks, systematically wash and disinfect hands.

At the first symptoms of a disease (including at emergence of skin pustulous diseases) the service personnel shall be discharged of work, and newborns are immediately isolated. The difficult task is represented by sanitation of carriers of pathogenic stafilokokk. Topical administration of antibiotics for this purpose is inexpedient. Use of active immunization against a staphylococcal infection of pregnant women is recommended: staphylococcal anatoxin in a dose of 0,5 ml is entered on 32 — the 34th, then on 37 — 38th week of pregnancy and at receipt into a maternity home. This measure does not affect the frequency of a carriage, but considerably reduces incidence.

See also Isolation of infectious patients , Infection , Karantin, karantinization .


Bibliography: Ashatkin V. A. Antimicrobic gauze surgical mask, Surgery, No. 1, page 89, 1971, bibliogr.; Baroyan O. V., Shaginyan I. A. and Zueva B.C. Drug resistant staphylococcus in surgical departments, in the same place, N ° 9, page 58, 1972, bibliogr.; Bogdanov of II. L. Intrahospital infections and their prevention, Kiev, 1963, bibliogr.; To Danila-vich M. G. Acute children's infections, page 45, L., 1960; L and about in A. L. Mistakes and dangers at treatment of infectious diseases at children, page 53, L., 1966, bibliogr.; S. D noses. The general doctrine about infectious diseases at children, Mnogotomn, the management on pediat., under the editorship of Yu. F. Dombrovskaya, t. 5, page 7, M., 1963, bibliogr.; P about r t of N about in F. G. and To about r N of e e in V. N. Superpure operating rooms with a laminar air flow, Surgery, No. 4, page. From, 1973; V.P's Pods. Urgent problems of an infection in surgery, Vestn, hir., t. 108, No. 5, page 9, 1972; Purely - in and the p G. N. Epidemiology and prevention of staphylococcal infections, L., 1969, bibliogr.; Best man I. I. and Ashatkin V. A. Ways of prevention of infection of operational wounds, Vestn, hir., t. 104, No. 5, page 9, 1970, bibliogr.; Infection in hospital, ed. by G. L. Gibson, Edinburgh — L., 1974.

I. L. Bogdanov; S. D. Nosov (academician, ped.), V. I. Struchkov, V. A. Sakharov (hir.).

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