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Infections - Intrahospital infections

Table of contents
Intrahospital infections
Page 2
Prevention
Directions of measures of fight
Inspection
Infections


The infections transmitted from patients to health workers

The risk of infection of medical personnel from patients is not identical at various infections. On a risk degree of infection of medical personnel in the course of professional activity and need of carrying out these or those preventive actions it is obviously possible to divide all infections into the following groups schematically:

1. Especially dangerous infections constituting high epidemiological danger to medical personnel.

2. Especially dangerous infections constituting considerable danger to medical personnel.

3. Especially dangerous infections which are not constituting essential epidemiological danger to medical personnel.

4. The infections constituting considerable epidemiological danger to medical personnel at infection through blood.

5. The infections constituting epidemiological danger
for health workers, and infections concerning which the personnel have to be protected by vaccination.

6. Infections at which the emergency prevention (preventive treatment) of a himiopreparatama at real danger of infection from patients is shown to health workers.

1. Especially dangerous infections constituting high epidemiological danger to medical personnel

The highest danger of infection is observed at a pulmonary form of plague. In the CIS countries plague cases at people are absent for many years, but as the natural centers differ in firmness and epizootic process in them continues, vigilance has to remain. Drift of an infection and from abroad is possible. At a bubonic form of plague (before opening of a bubo) the medical personnel giving help to the patient practically cannot catch. But as at any time the bubonic form can be complicated by pneumonia, all precautionary measures have to be observed as if at the patient the phenomena of plague pneumonia at which the infection extends under the laws characteristic of respiratory infections were already noted.

At a pulmonary form of plague owing to small dispersion of an aerosol the infection quickly extends also a possibility of infection of the personnel which are looking after patients is very big.

High epidemiological danger to people around is constituted also sick with the hemorrhagic fevers (HF), especially Ebola, Marburg, Lassa, it is dangerous also by HL of Congo-Crimea. In Sudan during flash of HL Ebola in hospital from 230 health workers ached 76, 41 died. In 1995 in Zaire 3 instrument nurses and 2 anesthesiologists and several ward sisters caught Lass's fever.

Table 2 of the Infection, the constituting high epidemiological danger to medical personnel, and a prevention measure

Infections

Transfer mechanism

Prevention measures

Measures of the emergency prevention

Plague

 

 

 

Pulmonary form
Bubonic form

Airborne
Through blood, contents of the opened bubo

Individual protection: the second dressing gown, rubber gloves, boot covers, masks with glasses-lens, a kerchief. Work in an antiplague suit of 1 type

The emergency prevention by antibiotics at care of patients, regardless of emergencies

Septic form

Through blood

 

 

HL of Congo-Crimea of HL Lassa GL
Marburg HL Ebola

Through blood, at its hit on mucous membranes of a mouth, a nose, eyes, the damaged integuments

The second dressing gown, rubber gloves, masks with glasses-lens, boot covers. The Protivochumny suit 1 - go type

Measures of chemoprophylaxis are not developed. For the emergency prevention of HL Ebola heterological immunoglobulin is received

At emergence in medical institution of a case of plague, hemorrhagic fever of Lass, Marburg, Ebola on hospital is imposed quarantine. Patients cannot be taken out out of limits of the struck zone.

2. Especially dangerous infection constituting considerable danger to medical personnel

Cholera is carried to especially dangerous infections, the risk of infection of personnel is considerable therefore all developed measures of individual protection should be observed strictly.

Table 3 Especially dangerous infection constituting considerable epidemiological danger to medical personnel, and a measure and prevention.

 

Infection

Transfer mechanism

Prevention measures

Measures of the emergency prevention at emergencies

Cholera

Fecal and oral

Gloves for an average and junior staff, it is desirable for junior staff to put on an apron. Strict observance of sanitary and hygienic requirements. In an accident ward at reception of patients with vomiting it is desirable to put on a mask.

Emergency prevention by antibiotics

3. Especially dangerous infections which are not constituting epidemiological danger to medical personnel

In our country a number of infectious diseases which the person under natural conditions catches only from animals is carried to especially dangerous infections. Work with causative agents of these infections in laboratories demands special conditions, the special mode.

The patient does not constitute epidemiological danger to medical personnel, people from the person does not catch. Let's call the main of them: a malignant anthrax, hemorrhagic fever with a renal syndrome, a brucellosis, a tularemia, rage, leptospirosis.

Do not constitute epidemiological danger to medical personnel sick with KU fever (exceptional cases of infection in the world literature are described casuistic), tetanus, a pseudotuberculosis, a tick-borne encephalitis, borreliosis. Cases of infection of the person from the person are not observed and at a sapronosis — a legionelleza.

4. The infections constituting considerable epidemiological danger to medical personnel at infection through blood

The medical personnel are exposed to risk of infection through blood at more than 30 infections. Among them a specific place is held by a viral hepatitis and HIV infection. Each patient hypothetically should be considered potentially dangerous concerning blood infections, and at contact with blood and other biological liquids the personnel should use means of individual protection.

HIV infection as VBI meets infrequently. In the world about 100 professional infections are known. It is explained by low stability of a virus out of a human body. But HIV infection can be carried to number of the infections constituting considerable epidemiological danger to medical personnel as in case of effective infection in modern conditions it is incurable.

5. Infections concerning which the personnel have to be protected by vaccination

A number of an infection against which inoculations are provided by a national inoculative calendar belongs to the infections constituting epidemiological danger to health workers.

Since the childhood each person has to be imparted against tuberculosis, diphtheria, whooping cough, tetanus, poliomyelitis, measles, epidemic parotitis in the terms determined by a calendar of preventive inoculations, the Inoculative calendar provided also rubella and hepatitis B inoculations.

The carried-out inoculations create protection against an infection, but as immunity against diphtheria and tetanus is limited in time, it is recommended all adults, first of all health workers, to impart each 10 years of ADS-M or AD-M vaccines.

At absence at the health worker of data on inoculations (or the postponed disease) against measles, parotitis, diphtheria, hepatitis B, a rubella inoculations are carried out. Alternative is screening of serum on existence of antibodies (antitoxin) and the solution of a question of inoculations on the basis of the obtained data.
It is reasonable to stop especially on specific prevention of GV — inoculations a recombinant barmy vaccine and passive prevention by immunoglobulin.

The rubella which virus possesses teratogenic action belongs to number of the infections constituting danger to health workers, especially young women.

Rubella inoculations are carried out to 90% of the industrial countries and 28% of developing countries.
In economically developed countries impart usually MMR trivaccine against a rubella, parotitis and measles.
In a number of the countries impart health workers a chicken pox vaccine. In our country the vaccine is not issued.

6. Infections at which the emergency prevention (preventive treatment) of a himiopreparatama at real danger of infection from patients is shown to health workers

The emergency prevention (preventive treatment) aims to interrupt infectious process at an early stage, in an incubation interval, before emergence of symptoms of an illness. It is shown at such infections as plague, cholera, HIV infection, toxoplasmosis when the risk of infection of medical staff is high.

It is necessary to remember that prevention of VBI of medical personnel is not only preservation of health of those who spare life to others, it and prevention of VBI at patients.