Prevention of nosocomial infections

Prevention of nosocomial infections is not only based on the number of hygienists, hygiene products, a census of hospital-acquired infections, but also on the work of nurses in terms of patient care.

Prevention of nosocomial infections are in a good execution of the medical staff.

Types of VBI

Nosocomial infection NI – types, methods of spread and prevention of hospital-acquired infections of a specific type:

Endogenous infection

The infection occurs under the action of microorganisms, pathogens of nosocomial infection, which are part of the physiological microflora of human organism and necessary for its operation. In the case of depletion of the body due to disease, trauma, excessive physical or mental stress, etc., these organisms can cause infection or disrupt the immune system. This can occur, for example, during intestinal surgery when the infectious agent can penetrate into the abdominal cavity.

To prevent this nosocomial infection prevention supports the immune system of the patient, ensuring sufficient blood supply of tissues and proper selection of antibiotic prophylaxis aimed at inhibition of microbial resistance. The reaction of the microorganisms causing nosocomial infections, with antibiotic treatment is of great importance in the implementation of preventive measures and, especially, in their treatment.

Exogenous infection

These diseases risk factors and methods of prevention of nosocomial infection, there are many. This infection, which the susceptible person comes from outside. Some of these infections are caused by microorganisms that are adapted to the hospital environment. These organisms are very hardy and can survive in unfavorable external environment. They are called hospital strains.

Prevention of hospital infection of this type is in compliance with the measures of the sanitary-epidemiological regime and barrier methods of care. These precautions must adhere to all health workers and other health staff, and visitors.

Currently, the average frequency of nosocomial infections in hospitals in developed countries is in the range of 6-8% hospitalized patients. The higher their frequency in hospitals and in hospitals were registered in the workplace, providing intensive care, conducting surgery and receiving a high number of patients with weakened immune systems. Depending on the type of Department is different and the predominant type of nosocomial infection surgical infection at the surgical ward, urinary tract infection – in patients in long-term hospitalized geriatric pneumonia patients with mechanical ventilation in the ICU, etc.

In accordance with the prevailing clinical manifestations of nosocomial infections, they can be divided into the following categories:

1. Urinary.
2. Infection in region of surgery.
3. Respiratory infections (pneumonia, tracheobronchial disease).
4. Infection of the bloodstream – sepsis.
5. Infections of the gastrointestinal tract.
6. Etc.

In addition, nosocomial infections are divided into specific andnonspecific.

Specific infection

Typical of medical institutions and there are, for example, in therapeutic and diagnostic methods by the introduction of a microorganism from the environment to the organism in susceptible persons, i.e., it is mostly about exogenous infection.

Nonspecific infections

On the contrary, they are not representative of a medical institution and, as a rule, to a greater extent their occurrence depends on the epidemiology of the disease in a given time and in a particular area. These diseases in a medical facility are distributed similarly as in the other place, but can differ by more severe clinical course of patients with weakened. These include common respiratory infections (flu) or food-borne (Salmonella).

Epidemiological measures

Accountability

The law on the protection of public health and amendments to some laws related to it, determines the procedure for detection of infectious diseases. In accordance with the law, leading clinics, departments and other medical facilities must register and report to the epidemiologist on the following phenomena:

1. Mass incidence of nosocomial infection.
2. Nosocomial infection, which led to the death of the patient.
3. Clinically heavy NI, which can lead to serious health damage.

Prevention of nosocomial infection begins during examination of the patient.

Barrier care

It is a preventive "set of actions" aimed at minimizing the risk of nosocomial infections.

Principles and methods of barrier nursing:

• observance of rules of personal hygiene,
• the use of personal cabinets, filters,
• use your own clean PPE and clothing for work place,
• the use of special work clothes and protective workwear for the working processes (working with biological material, etc.),
• adherence to the principles of cross-dressing at the exit from a given Department,
• bandage for the face and gloves should be used wherever impaired skin integrity, there is contact with body cavities,
• adherence to the principles of hand hygiene (washing, disinfection, use of gloves),
• for wiping hands, use disposable material,
• compliance with rules prohibiting food in the workplace.

Requirements for the patient

The patient should observe the rules of the Department. Follow the instructions of doctors and nurses (physical limitations, special preparation before the examination, etc.). He cares about personal hygiene and uses of auxiliary funds that was allocated to it, such as thermometers, urinal, bedpan, etc.

Sanitation of hands in health care

Washing and hand disinfection are an integral part of preventing the spread of nosocomial infections. The importance of this fact is constantly underlined cases of failure to comply with these preventive measures, constituting about 60% of all nosocomial infections.

Hospital bacteria differ from "normal" microorganisms, they are characterized by antibiotic resistance, and some of them are resistant to disinfection.

You should also not forget about the care of nails that must be trimmed, and also that decoration on the hands to reduce the effectiveness of cleansing, germs can also linger on their surfaces.

Hands should be washed before and after each contact with the patient before treatment food and drug administration, after using the toilet, after removing gloves, when hands are visibly dirty, etc.

Microflora of the hands

The constant microflora of the skin:

1. Located on the surface and in the inner layers of epidermidis, sweat and sebaceous glands, in the vicinity of the nails, if not disturbed the balance of external influence, has a constant composition
2. It is permanent and cannot be removed by mechanical means (6 minute wash removes only about 60% of the microflora), disinfectants or antibiotics
3. 20% of the resident flora are not able to eliminate even the surgical cleansing of the hands
4. As a rule, this microflora does not cause infection except in susceptible individuals, for example, with immune deficiency
5. Includes mainly the following main types of bacteria – coagulase-negative staphylococci (St. Epidermidis, St. Hominis, St. Haemolyticus), Staphylococcus aureus (Staphylococcus Aureate), Corynebacterium (Corynebacterium pseudodiphtericum), etc.

Transient microflora of the skin

1. Microorganisms that contaminate the surface of the skin, their number and the ratio reflects the microbial load of the environment and nature of work – it consists of non-pathogenic, conditionally pathogenic and pathogenic microorganisms.
2. It is created when contact between the patient and physician, a physician with other health care worker with contaminated objects.
3. Microflora is maintained for a limited period of time, sometimes for several hours.
4. It can be removed mechanically with the help of disinfectants.
5. Is a common cause of nosocomial infections.
6. Includes, for example, bacteria of the genus Streptococcus,enterococci, enterobacteria, Escherichia coli, Pseudomonas aeruginosa, and viruses – rotaviruses, reovirus, hepatitis a virus etc.

Mechanical cleansing of the hands

Mechanical cleansing of the hands is directed to the removal of dirt and transient microflora of the skin.

Procedure hand washing: washing is done with warm water and soap for approximately 30 seconds, after which the hands are rinsed and wiped dry with disposable towels.

Hygienic cleansing of the hands

Is done before preparing food, results food, personal hygiene, etc.

The procedure is performed using a detergent with a disinfecting active substance. This cleaning is more effective than the mechanical washing of hands, but less effective than hygienic disinfection.

Hygienic hand disinfection

It is part of the barrier methods of care, prior to invasive procedures, is part of the hygiene filter after accidental contamination of the hands of the biological material, prior to any aseptic operation, when treating a patient with a weakened immune system, in case of rupture of the glove during any operation.

The procedure is performed with a disinfectant intended for disinfection of hands. The disinfectant is rubbed into dry hands for about 30-60 seconds. Hands after the disinfection procedure, not rinsed and not wiped off.

Surgical hand disinfection

Reduces the number of transitional and permanent microflora on the hands and forearms. Is performed before the operation, between operations, in violation of the integrity or changing gloves.

For surgical hand disinfection liquid disinfection alcohol is used a tool. It is rubbed into the skin of the hands and forearms for about 3-5 minutes until dry. Hands after the disinfection procedure, not rinsed and not wiped off.

Preparations for cleansing and disinfecting hands:

1. Disinfectant detergents.
2. Alcohol disinfectants.
3. Soap containing only the usual cleansing material.

The use of gloves

Gloves serve as a personal protective equipment that provides a mechanical barrier between the medical staff and the patient and thus reduces the risk of transmission of microorganisms.

Gloves are chosen depending on activity.

Ordinary disposable gloves are used, for example, in the following cases:

• when selecting or contact with biological material,
• when performing nursing and inspection activities,
• upon contact with the contaminated material, such as used clothing, linen and tool,
• when washing and disinfection of contaminated equipment, where there is a risk of contact with infectious agents.

Sterile gloves are used:

• when handling sterile material,
• in invasive procedures and dressing changes,
• during surgical activities.

When using gloves, should adhere to the principles, which include, for example, replacing them after each activity and after each patient, before and after use of gloves is required for hygienic hand disinfection, in case of violation of the integrity of gloves during the operation, you must perform the hygienic hand disinfection, and then mechanical washing. Used gloves must be disposed of as special medical waste.

Disinfection, sterilization and purification

Medical institutions disinfection and sterilization are key preventive measures of nosocomial infections. Their importance grows with the increasing incidence of resistant strains in the hospital environment. You must disinfect all surfaces and objects that are in contact with patients and medical staff. The frequency of disinfection should consider the type of office and frequency of medical care.

Each hospital institution should have as part of the sanitary-epidemiological regime specific developed and approved the program of disinfection, the existing rules which must be followed.

Disinfection

Disinfection is a set of measures for the destruction or removal of microorganisms from objects and environments with physical, chemical or combined procedures. Thus, the procedure prevents transmission of infection from source to susceptible people.

Sterilization

Sterilization is the destruction of all pathogenic and nonpathogenic organisms, including their spores, all, from a medical point of view, important parasites and their eggs and irreversible inactivation of viruses.

Cleaning

Cleaning the entire space using a disinfectant. Typically, wet cleaning is carried out. Control over the implementation of a cleaning held by the chief physician or head nurse.