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General Practice 2023

Infecç&hospital activity: what é, types and how é done the control

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Infecç&hospital activity: what é, types and how é done the control
Infecç&hospital activity: what é, types and how é done the control

Hospital infection, or He alth Care-Related Infection (HAI) is defined as any infection acquired while the person is hospitalized, and may manifest during hospitalization or after discharge, as long as it is related to with hospitalization or procedures performed at the hospital.

Acquiring an infection in the hospital is not uncommon, as this is an environment where many people are sick and on antibiotic treatment. During the period in a hospital, some of the main factors that cause the infection are:

  • Imbalance of bacterial flora of the skin and body, usually due to the use of antibiotics;
  • Decreased defense of the immune system of the hospitalized person, both due to illness and medication use;
  • Performing invasive procedures such as catheter insertion, insertion of probes, biopsies, endoscopies or surgeries, for example, that break the skin's protective barrier.

Generally, the microorganisms that cause nosocomial infections do not cause infections in other situations, as they take advantage of the environment with few harmless bacteria and the drop in the patient's resistance to settle. Despite this, nosocomial bacteria often develop serious and difficult-to-treat infections, as they are more resistant to antibiotics, so, in general, it is necessary to use more potent antibiotics to cure this type of infection.

Types of nosocomial infections

Infections related to the he althcare environment can be classified into some types according to the microorganism and way of entry into the body. Thus, HAIs can be classified as:

  • Endogenous, in which the infection is caused by the proliferation of the person's own microorganisms, being more frequent in people with a more compromised immune system;
  • Exogenous, where the infection is caused by a microorganism that is not part of the person's microbiota, being acquired through the hands of he alth professionals or as a consequence of procedures, contaminated medication or food;
  • Cruzada, which is common when there are several patients in the same ICU, favoring the transmission of microorganisms between hospitalized people;
  • Inter-hospital, which are infections carried from one hospital to another. That is, the person acquires an infection in the hospital where he was discharged, but was admitted to another.

It is important that the type of hospital infection is identified so that the hospital's Infection Control Commission can design measures for the prevention and control of microorganisms in the hospital.

How to control

The control of HAIs is carried out by the Hospital Infection Control Commission (CCIH), which corresponds to a group formed by he alth professionals whose function is to study the epidemiological characteristics of the hospital and to elaborate a program to control nosocomial infection with the objective of reducing as much as possible the number of infections acquired in the hospital, as well as the rate of multidrug-resistant microorganisms.

The CCIH is suitable according to the characteristics of the hospital and its needs, and the main activities carried out by this committee are:

  • Development of rules and routines for cleaning and disinfection of environments, establishing the frequency, type of disinfectant and disinfection, especially in critical areas, such as nurseries, surgical centers or ICU, for example;
  • Determining rules for patients, visitors and professionals to reduce the risk of infections, such as limiting the number of visitors, establishing standards and training for hygiene, collection of exams, application of medication, dressing or preparing food, for example;
  • Stimulation of hygiene measures, especially of the hands,which are one of the main vehicles for the transmission of microorganisms, with frequent washing, or with the use of alcohol gel. Hand washing measures should be implemented both for patient companions and for the medical team, and monitoring this practice is important;
  • Guidelines for the correct use of antibiotics, preventing patients from being treated with unnecessary antibiotics or with broad-spectrum antimicrobials, thus preventing the development of multidrug-resistant bacteria;
  • Guidance on the use of chemical products to eliminate microorganisms, such as germicides, disinfectants, antiseptics, cleaning agents;
  • Surveillance of cases of infection, to understand the causes and develop ways of prevention.

To decrease a hospital's infection rate, basic care must be taken with all patients, regardless of their diagnosis and treatment.In addition, it is important to encourage hospital discharge whenever possible, avoiding staying too long in the hospital, as the chances of infection increase over time.

The activities performed by the CCIH are carried out with the main objective of promoting patient safety through measures aimed at reducing the risk of patient infection, such as raising awareness of companions and medical staff about correct hand hygiene, since the hands are considered the main routes of transmission and contagion by microorganisms. Learn how to wash your hands properly.

Most frequent infections

Infections acquired in the hospital can lead to the appearance of signs and symptoms that vary according to the microorganism responsible for the infection and route of entry into the body. The most frequent infections in the hospital environment are:

1. Pneumonia

Hospital-acquired pneumonia is usually severe and is more common in people who are bedridden, unconscious, or have difficulty swallowing, due to the risk of aspiration of food or saliva. In addition, people who use devices that help breathing are more likely to acquire nosocomial infections.

Some of the most common bacteria in this type of pneumonia are Klebsiella pneumoniae, Enterobacter sp., Pseudomonas aeruginosa, Acinetobacter baumannii, Staphylococcus aureus, Legionella sp., in addition to some types of viruses and fungi.

Main symptoms: The main symptoms associated with nosocomial pneumonia are chest pain, cough with yellowish or bloody discharge, fever, tiredness, lack of appetite and shortness of breath.

2. Urinary tract infection

Hospital urinary tract infection is facilitated by the use of a tube during the hospitalization period, although anyone can develop it.Some of the bacteria most involved in this situation include Escherichia coli, Proteus sp., Pseudomonas aeruginosa, Klebsiella sp., Enterobacter sp., Enterococcus faecalis and fungi such as Candida sp.

Main symptoms: Urinary tract infection can be identified by pain or burning sensation when urinating, abdominal pain, presence of blood in the urine and fever.

3. Skin infection

Skin infections are very common due to injections and venous access for medication or exams, surgery or biopsy scars or the formation of bedsores. Some of the microorganisms involved in this type of infection are Staphylococcus aureus, Enterococcus, Klebsiella sp., Proteus sp., Enterobacter sp., Serratia sp., Streptococcus sp. and Staphylococcus epidermidis, for example.

Main symptoms: In the case of a skin infection, there may be an area of ​​redness and swelling in the region, with or without the presence of blisters. Usually, the site is painful and hot, and there may be production of purulent and foul-smelling secretion.

4. Blood infection

Infection of the bloodstream is called septicemia and usually arises after infection of some place in the body, which spreads through the bloodstream. This type of infection is serious, and if not treated quickly it can quickly lead to organ failure and life-threatening. Any of the microorganisms of infections can spread through the blood, and some of the most common are E. coli, Staphylococcus aureus, Staphylococcus epidermidis or Candida, for example.

Main symptoms: The main symptoms related to blood infection are fever, chills, drop in blood pressure, weak heartbeat, drowsiness. Learn how to identify blood infection.

There are also several other less common types of nosocomial infections, which affect different regions of the body, such as the oral cavity, digestive tract, genitals, eyes or ears, for example. Any hospital infection must be identified quickly and treated with appropriate antibiotics, to prevent it from becoming serious and putting the person's life at risk.

Who is most at risk

Anyone can develop a nosocomial infection, however those with a greater fragility of immunity are at greater risk, such as:

  • Elderly;
  • Newborns;
  • People with compromised immunity, due to diseases such as AIDS, post-transplantation or using immunosuppressive drugs;
  • Poorly controlled diabetes mellitus;
  • People who are bedridden or with altered consciousness, as they are at greater risk of aspiration;
  • Vascular diseases, with impaired circulation, as it makes tissue oxygenation and healing difficult;
  • Patients requiring the use of invasive devices, such as urinary catheterization, insertion of a venous catheter, use of ventilation with devices;
  • Performance of surgeries.

Furthermore, the longer the hospital stay, the greater the risk of acquiring a nosocomial infection, as there is a greater chance of exposure to the risks and responsible microorganisms.

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