Mar 17, 2018
Aseptic is a method to prevent the entry of microbes into an operated wound by using organizational measures, physical factors, and chemicals. The only criterion for complete sterility, that is, the death of bacteria, is their inability to reproduce under favorable conditions. This can be judged only by bacteriological control. Among the pathogens of inflammatory and purulent processes, a special place is occupied by staphylococci. Currently, staphylococci more often than other microbes cause suppuration of the skin, subcutaneous tissue, internal organs. They determine the majority of severe complications after trauma. The increasing number of staphylococcal diseases every year is caused not only by the pronounced pathogenicity of the pathogens, resistance to antibiotics and chemotherapy, but also by disorders of aseptic and antiseptic drugs, by non-observance of the current rules for the prevention of purulent complications in everyday surgical practice. Difficulties in the prevention and treatment of purulent surgical infection are exacerbated by the widespread spread of staphylococcal bacilli in the general population, especially medical personnel, and significant air contamination of the air, hospital occupations and patient care in treatment and prevention facilities. In all medical institutions, especially in surgical departments, wards and intensive care units, intensive care measures are carried out to prevent nosocomial infection, observe disinfection regimen. Hospital-acquired infections are infectious diseases received by patients in medical institutions. Modern nosocomial infections in surgical clinics cause various microorganisms. Clinically manifested mainly syndromes of suppuration and septic lesions. The most common pathogens of nosocomial infections are antibiotic-resistant strains of Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, Proteus, Escherichia coli, Klebsiella, Candida fungi. Sources of internal infection in surgical hospitals are patients with acute and chronic forms of purulent-septic diseases and asymptomatic carriers of pathogenic microorganisms among patients and staff. Depending on the location of the pathogen, its excretion from the body of a patient or carrier occurs through various organs and tissues - the respiratory tract, the digestive tract
, the genito-urinary tract. Distribution of pathogens of nosocomial infection occurs in two ways: airborne and contact. The main transmission factors are air, hands, numerous objects of the environment( underwear, dressings, tools, equipment, etc.).
Order No. 215 of the MZRF.
For the prevention and control of postoperative purulent complications, a set of sanitary and hygienic measures is organized and conducted to identify and isolate sources of infection and interrupt transmission routes.
The complex includes:
1. Timely detection and isolation in special wards( sections) of patients in whom the postoperative period was complicated by purulent-septic disease.
2. Timely detection of carriers of pathogenic staphylococcus and their sanation.
3. Application of highly effective methods of disinfecting the hands of medical personnel and the skin of the operating field.
4. Organization of central sterilization of linen, dressings, tools, syringes.
5. Use of methods and means of disinfection for processing various objects of the environment( bedding, soft equipment, clothes, shoes, utensils).
The responsibility for conducting a complex of measures to combat postoperative complications lies with the chief physician and the heads of the surgical departments.
Heads of departments, together with their older sisters, organize and supervise the implementation of instructions for compliance with the deception.
The elder sister instructs the secondary and junior medical staff on the implementation of a complex of antiepidemic measures. Each employee who comes to work in the surgical department passes a full medical examination, including an examination by an otolaryngologist and dentist, a bacteriological study of smears from the mucous nasopharynx for the presence of pathogenic staphylococcus.
All working personnel are taken under clinical supervision for timely detection and cure of carious teeth, chronic inflammatory diseases of the nasopharynx, as well as timely detection of carriers of pathogenic staphylococcus, especially the personnel of the operation unit, chambers and intensive care units.
Sanitation of bacterial carriers of staphylococcus. When conducting routine bacteriological examinations, once every 6 months, compulsory examination is the collection of mucus from the forelegs of the nose. The study can be conducted selectively. The fence of the material is conducted by the senior nurse of the treatment and prophylactic department. To sanitize personnel daily, the following sanitizing agents are used: furacilin 1: 5000, rivanol 1: 5000, 1% boric acid, Lugol's solution, eucalyptus leaf infusion, lysozyme, staphylococcal bacteriophage. To sanitize personnel during epidemiological trouble, it is necessary to use a 1% solution of hexachlorophene, a 3% solution of tribasque, chlorophyllipt. In order to improve the results of sanitation, a change of sanitizing agents should be carried out every 7 days. In the period of epidemiological trouble in the medical institution, all personnel should be sanitized. When sanation can not achieve reduction or complete elimination of the carriage of staphylococcus, it is necessary to properly wear a mask that covers the mouth and nose. In this case, the masks change every three hours. If there are no positive results during the treatment of chronic inflammatory diseases of the upper respiratory tract and the oral cavity, medical workers are transferred to another job. Once a year, mandatory fluorography, once every three months - a blood test for syphilis, a test for the detection of HbsAg( Australian antigen, hepatitis B pathogen), as well as HIV.
In the detection of open inflammatory processes or signs of malaise in medical personnel, they are suspended or work until full recovery.
The head of the department organizes a quarterly inspection of the attendants for the carriage of pathogenic staphylococcus and, in case of detection of carriers, organizes a sanation.
When an intrahospital infection occurs among patients, an extraordinary medical examination of all personnel, departments, an extraordinary bacteriological examination for carriage, as well as a detailed epidemiological investigation, which identify possible sources of infection, ways and factors of transmission, and carry out measures to prevent further spread of the disease.