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Hospitals are patient-intensive places, and the hospital environment is most likely to be contaminated by pathogenic microorganisms, thus providing external conditions for the spread of disease and promoting the occurrence of hospital-acquired infections. Hospital-acquired infections bring serious harm to both society and individuals. A large amount of information proves that as long as the nursing management is strict and preventive measures are implemented, the occurrence of hospital-acquired infections will be less. For this reason, we must take comprehensive measures to ensure that every disinfection, sterilization and isolation meets the predetermined requirements in order to prevent and control the occurrence of hospital-acquired infections. At the same time, it is our responsibility to publicize to the community that everyone should be hygienic and take time to protect the environment.
I. Definition of hospital-acquired infections
Hospital-acquired infections are infections acquired by patients or staff in the hospital and produce clinical symptoms. Because infections have a certain incubation period, hospital-acquired infections also include patients who become infected in the hospital and develop the disease only after they are discharged.
Second, the classification of hospital infections
Based on the different sources of infection, hospital infections are divided into:
(a) endogenous infection (autoinfection) refers to the immunocompromised patients by their own normal flora caused by infection. That is, the patient in the occurrence of hospital infections have been carriers of pathogens, when the body's resistance is reduced to cause self-infection.
(2) exogenous infection refers to infections caused by exogenous flora brought by others in the environment. Including:
1. cross-infection in the hospital or others (patients, carriers, staff, visitors, chaperones) to obtain and cause direct infection.
2. Environmental infections Infections caused by contaminated environment (air, water, medical equipment and other items). Such as due to the operating room, air pollution caused by the patient's postoperative incision infection, syringe sterilization caused by the epidemic of hepatitis B and so on.
Three common hospital infections
(A) lung infection lung infection often occurs in some chronic serious impact on the patient's defense mechanism of the disease, such as cancer, leukemia, chronic obstructive pulmonary disease, or tracheotomy, tracheal catheterization and other patients. Judgment of lung infection is mainly based on clinical manifestations and X-ray fluoroscopy or photographs, and its incidence accounts for about 23.3% to 42% of hospital-acquired infections. Lung infections are a threat to critically ill patients, immunosuppressed patients, and patients with weakened immunity, with a mortality rate of 30%-50%.
(2) urinary tract infection Patients who have no symptoms of urinary tract infection when they are admitted to the hospital and develop symptoms (fever, difficulty urinating, etc.) after 24 hours during their hospitalization, and have bacterial growth in urine culture, or have no symptoms, but the leukocytes in the urine specimen are more than 10 / ml, and the bacteria are more than 105 / ml, all of them can be judged to be urinary tract infections. China's statistics, the incidence of urinary tract infections in hospital infections accounted for about 20.8% to 31.7%, 66% to 86% of the occurrence of urinary tract infections related to the use of catheters.
(3) Wound infection Wound infection includes wound infection in surgical and traumatic events, and the judgment of wound infection mainly depends on whether there is an inflammatory reaction or pus in the wound and nearby tissues, and more precisely, the bacterial culture. It is estimated that the incidence of wound infections accounts for about 25% of hospital-acquired infections.
(4) viral hepatitis Viral hepatitis can be transmitted not only in healthy people, but also in patients. Viral hepatitis can be categorized into five types: type A, type B, type C, type D, and type E. The virus can be transmitted to the patient by a single person.
The source of hepatitis A and hepatitis E is the patient and asymptomatic infected people, transmitted through the digestive tract. The patient discharges feces with virus, which is not sterilized and contaminated with water or food, and people are infected by accidentally consuming unboiled water or uncooked food, i.e. fecal-oral transmission.
Hepatitis B, hepatitis C, hepatitis D, the source of infection is patients and carriers of the virus, the virus exists in the blood and various body fluids, infectious blood can be infected through the skin, mucous membranes of the tiny damage, but also through the vertical transmission from mother to child, or through the transfusion of blood products, close sexual contact and infection.
(E) skin and other parts of the infection Patients in the hospital during the skin or subcutaneous tissue suppuration, various dermatitis, bedsore infection, bacteremia, intravenous catheter and needle puncture site infection, endometrial infection, intra-abdominal infection.
Hospitalized patients who have endotracheal intubation, multiple surgeries or prolonged surgery, indwelling catheterization, the application of chemotherapy, radiotherapy, immunosuppressive agents, as well as geriatric patients should be considered as the key object of the prevention of hospital-acquired infections.
Four, hospital infection factors
(I) subjective factors Medical personnel of hospital infections and its harmful effects of insufficient knowledge; can not strictly implement the aseptic technology and disinfection and isolation system; the hospital rules and regulations are incomplete, there is no sound outpatient and emergency pre-screening, triage system, inpatient hospitals do not have a hospital hygiene and disposal system, resulting in the spread of infectious agents. In addition, there is a lack of monitoring of the effectiveness of disinfection and sterilization, which does not effectively control the occurrence of hospital-acquired infections.
(B) objective factors
1. invasive means of diagnosis and treatment increased According to statistics, the United States each year due to the use of medical equipment and infection accounted for 45% of hospital infections. Such as endoscopes, urinary catheters, arterial catheters, tracheotomy, tracheal intubation, inhalation devices, organ transplantation, dental drills, blood collection needles, suction vessels, monitoring instrument probes and other invasive diagnostic and treatment means, not only the outside world of microorganisms imported into the body, but also damage the body's defense barriers, so that pathogens are easy to invade the body.
2. The use of immune-suppressing treatments Because of the need for treatment, the use of hormones or immunosuppressants, chemotherapy, radiotherapy, resulting in a decline in the patient's own immune function and become susceptible.
3. The development and popularization of a large number of antibiotics The application of a variety of antibiotics in the course of treatment or the centralized use of a large number of antibiotics, so that the patient's body of the normal bacterial flora imbalance, drug-resistant strains of bacteria, resulting in prolonged course of the disease, the chance of infection increased.
4. Increase in susceptible patients With the progress of medical technology, some incurable diseases in the past can be cured or prolong the survival time, so the proportion of hospitalized patients with chronic diseases, malignant diseases, the proportion of elderly patients increased, and the resistance of these patients to infection is quite low.
5. Serious environmental pollution hospitals due to infectious agents, so the pollution of the environment is also serious. Among them, the most serious pollution is the infected patient's ward, toilet pollution is also very serious, flush toilet every time the water may provoke a large number of microbial aerosols. Public **** supplies in the ward, such as sinks, bath tubs, commodes, carts, mops and rags, are also often contaminated.
6. Failure to place necessary restrictions on visitors When reasonable and necessary restrictions on visitors are relaxed, the likelihood of pathogenic bacteria being brought into the hospital by visitors or chaperones increases.
V. Prevention and control of hospital-acquired infections
The causes of hospital-acquired infections are many and varied, but as long as management is strengthened and effective measures are taken, nearly 2/3 of hospital-acquired infections can be prevented.
(A) improve the hospital building and layout of the hospital building layout is reasonable or not on the prevention of hospital infections is crucial. Infectious disease rooms, ultra-clean wards, operating rooms, guardianship rooms, observation rooms, visiting reception rooms, supply rooms, laundries, kitchens, etc., from the point of view of infection prevention, in order to prevent the spread of bacteria and the spread of disease, in the equipment and the layout of the special requirements should be.
(2) strict implementation of rules and regulations The system is a summary of people's experience in long-term work practice and the basis for dealing with and checking the work. Including disinfection and isolation system, aseptic technology operating procedures and visitation system. Isolation is aimed at limiting contamination to the smallest possible extent, and is one of the most important measures for preventing hospital infections. Aseptic operating procedures are medical regulations that must be observed by health care workers throughout the process of diagnosis and treatment. Every health care worker should be from the hospital infection, to protect the patient's health from the strict implementation of the system, routine and implementation of the rules, and advise patients and visitors *** with compliance.
(C) good disinfection and sterilization disinfection and sterilization is an effective measure to control hospital-acquired infections.
(4) strengthen the cleanliness and hygiene work Cleanliness and hygiene work includes dust, dirt wiping and removal, but also includes the prevention of mosquitoes, flies, cockroaches, rodents and so on. When carrying out cleaning and sanitation work, care must be taken not to raise dust to avoid spreading pollution. Brooms and dusters should not be used in hospitals, and the heads of mopping cloths should preferably be removed for sterilization. Cleaning of wards should be carried out immediately after contamination. The order should be started by the less contaminated wards, gradually into the more seriously contaminated areas, and finally deal with the patient's public **** activities. Medical staff workplace should also be clean and sanitary cleaning.
(E) to take reasonable diagnostic and therapeutic methods The use of antimicrobial drugs to be targeted, the application of suppression of immunotherapy to take appropriate protective measures, such as the first treatment of chronic foci to prevent self-infection, regular check of white blood cell dynamics and other monitoring, providing drug prevention. Diagnostic treatment that is easy to introduce microorganisms into the body should be effectively disinfected, sterilized, and strictly aseptic technical operation.
(F) timely control of infection prevalence Control of infection prevalence mainly includes the search for sources and ways of infection, take appropriate isolation and sterilization measures.
(7) to carry out monitoring of hospital infections The purpose of hospital infection monitoring is to obtain first-hand information through monitoring, analyze the causes of hospital infections, to find the weak links, to provide a basis for taking effective measures and through monitoring to evaluate the effectiveness of various measures. The main contents of monitoring include: environmental pollution monitoring, sterilization effect monitoring, disinfection pollution monitoring, special ward monitoring (such as burns, urology wards, operating rooms, guardianship rooms, etc.), bacterial strain resistance monitoring, cleanliness and hygiene monitoring, infectious agent monitoring, rules and regulations implementation monitoring. Surveillance should be carried out as a routine, on a regular basis, at regular intervals, and for regular programs. Records of infections are required to be detailed and specific, and are analyzed by regular statistics on a ward-by-ward basis.
(VIII) to improve staff hygiene and health conditions All hospital staff should be regular health checks, if there is discomfort or suspected infectious diseases, should be reported immediately so that appropriate measures can be taken, and according to the need for injection of the relevant vaccines, and if necessary, passive immunization or drug prevention. Health care workers should also do a good job of personal protection, one is to prevent the germs to themselves or take out of the ward; the second is to prevent the germs to the susceptible person in the room. In personal protection, the main thing is to wear personal protective equipment (clothing, hats, shoes, gloves, masks) and hand washing and disinfection.