Etiology and epidemiological features
The development of nosocomial infectious complications is always associated with the presence of a source. In a surgical inpatient setting, patients already suffering from purulent diseases act as the primary source of infection. Pathogenic microorganisms constantly circulate in the department, passing from patient to patient.
The following main routes of transmission of infection are distinguished:
- via surrounding objects;
- via contaminated air;
- via bed and personal linen.
The spectrum of main pathogens is quite specific. These include staphylococci (Staphylococcus), Escherichia coli, Proteus, Klebsiella, and Pseudomonas aeruginosa. A key and most dangerous characteristic of these microorganisms is their extremely high resistance to antibacterial agents.
Pathogenesis and types of infection
Hospital infection poses a huge threat to debilitated and surgical patients whose defense mechanisms are depleted. The introduction of microorganisms leads to the development of severe purulent complications, and when anti-epidemic rules are violated, to mass outbreaks of infection in the department.
Depending on the source of the pathogenic microflora, two types of infection are distinguished:
- Exogenous. The pathogen enters the patient's body directly from the external environment of the surgical hospital.
- Endogenous. Activation of the hospital flora occurs, which had previously gotten onto the patient's skin, throat, or nasopharynx during their stay in the hospital, and then caused a purulent process against the background of decreased immunity.
Control and prevention measures
To prevent the spread of hospital infection, strict adherence to a whole complex of measures at all stages of treatment is required:
- Organizational measures. The basis of prevention is maintaining a strict sanitary regime in the surgical department.
- Actions during outbreaks. In the event of a mass spread of infection, departments are subject to mandatory closure for thorough sanitization.
- Patient logistics. The risk of infection increases over time, so it is necessary to minimize the duration of pre-operative and post-operative hospital stay for patients.
- Antibacterial therapy. The use of antibiotics must be rational. Rotation (changing) of antibacterial agents is mandatory to prevent the development of resistance, and the effectiveness of treatment is confirmed by regular bacteriological monitoring.
- Surgical methods. Combined antiseptic methods are used during operations and dressings. Exclusively closed methods are used for draining wounds and cavities.
Briefly: answers to topical questions
Which microorganisms are the main causative agents of hospital infection?
The main causative agents of hospital infection in a surgical inpatient facility are representatives of the bacterial flora that possess high resistance to antibacterial agents. These include the following microorganisms:
- Staphylococcus (Staphylococcus) is a frequent causative agent of purulent-inflammatory complications, including methicillin-resistant strains (Staphylococcus aureus).
- Escherichia coli (Escherichia coli).
- Proteus (Proteus) are gram-negative rods causing purulent inflammation with putrefactive destruction of soft tissues.
- Klebsiella (Klebsiella).
- Pseudomonas aeruginosa (Pseudomonas aeruginosa) is one of the main causative agents of nosocomial infection that suppresses tissue regeneration.
What are the main routes of transmission of hospital infection in a surgical inpatient facility?
In a surgical inpatient facility, the realization of transmission mechanisms of hospital infection occurs via several main routes:
- Contact route — transmission via care items, medical instruments, dressing materials, surgical linen, as well as via contaminated hands of medical personnel and caregivers.
- Airborne route (airborne droplet / aerosol) — transfer of infection through the air and secretion droplets, which is especially critical in the presence of open wound surfaces and in patients with major defects in integumentary tissues.
- Implantation route — introduction of infection through suture material, implanted drains, metal hardware, and joint endoprostheses during prolonged contact with tissues.
Who is the primary source of hospital infection in the surgical department?
The primary source of hospital infection in the surgical department is patients with purulent diseases. Additional sources of infection also include bacterial carriers and patients with mild or subclinical forms of purulent-inflammatory diseases from the immediate environment.
What risk factors contribute to the development of hospital infection in a patient?
The development of hospital infection is promoted by a weakened state and surgical interventions, as the infection affects debilitated and operated patients. For hospital-acquired pneumonia, risk factors include mechanical ventilation, ICU stay, abdominal surgery, COPD, and diabetes mellitus.
To memorize the main pathogens of hospital infection, use the acronym SKPKS: Staphylococcus, Escherichia coli, Proteus, Klebsiella, Seudomonas aeruginosa.
Class and exam questions
What is the cause of hospital infection?
Its occurrence is associated exclusively with the infection of patients directly within the surgical hospital (from other patients with purulent diseases).
What is the main difficulty in treating nosocomial infections?
Nosocomial microflora possesses extremely high resistance to antibacterial agents.
What is done in case of a mass outbreak of infection in surgery?
During an outbreak, the surgical department is completely closed for thorough sanitization.
What else to study on this topic
- Organization of a strict sanitary regime in the surgical department
- Principles of antibacterial agent rotation
- Closed drainage methods in surgery
- Combined antiseptic methods
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Other topics in the section "CHAPTER 2. ASEPSIS AND ANTISEPSIS"
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