Hospital-Acquired Infections

HOSPITAL-ACQUIRED INFECTIONS, infectious diseases that arise among patients in medical institutions. The most frequent source of hospital-acquired infections is patients admitted to the hospital during the incubation period. This is especially true for patients with mixed forms of infectious diseases. Depending on the time of entry of each infectious agent, their nature, and the duration of their incubation periods, there is either a simultaneous combination of signs characteristic of different infections, or the symptoms of each disease appear with a certain interval. Hospital-acquired infections are most often observed in pediatric departments, with the forms transmitted by the so-called droplet infection predominating. An example can be the most common hospital-acquired disease for pediatric departments—measles. The incubation period of measles is about 10–12 days, after which the prodromal period begins, lasting 3–4 days, during which the temperature starts to rise, catarrhs of the mucous membranes become noticeable, and the patient can already disseminate the infection. The initial symptoms mentioned are also characteristic of other diseases, for example, influenza, and cannot serve as a basis for transferring this patient to the appropriate department before the diagnosis is precisely established. However, isolating the patient in a separate ward, while keeping the same staff for his care, and even transferring him, after the diagnosis is clarified, to a measles department, does not save the situation. The same can be said about other forms of "droplet infections"; the difference will lie only in the duration of incubation, the contagiousness and persistence of the infectious agent, and the greater or lesser possibility of early recognition of the disease. Other forms of infections occur less frequently as hospital-acquired infections and can also occur by transferring the infection from patients admitted during the incubation period or who are carriers of some infection. For pediatric departments, especially for young children, the spread of purulent skin infections (pyodermia) in the form of pustulosis, furunculosis, multiple abscesses, or finally in the form of impetigo contagiosa, which obtains wide distribution among weakened children and often leads to severe consequences, with complications in internal organs and general sepsis, is of great importance. Etiologically, these diseases are associated with pathogenic staphylococci, which further increase their virulence as they pass from one child to another. Diseases spreading by parasites can occur if incoming patients are not sufficiently sanitized. Personnel working in hospital departments can also transmit an infection to patients if they have contracted some infection themselves. Transmission of infection is also possible from healthy personnel if they are carriers of the infection or infected parasites. Insufficient qualification of personnel, heavy workload, overcrowding of hospital departments, or a lack of care items especially favor the transfer of the infectious agent. Visitors infected with some disease, carriers of infections, or infected insects can also serve as a source of infection for inpatients. The possibility of introducing the infectious agent with products brought by visitors is not excluded. In summer, mosquitoes can introduce malaria, and flies can be vectors of infections, especially intestinal ones. The extent to which hospital-acquired infections are widespread is evident from the following numerical data for Paris hospitals: before 1875, these diseases in the Trussot hospital reached 67% in the surgical department and 39% in the somatic department. According to Rubinet's data, they constituted 16% in 1902 and 12% in 1905. According to statistics of Russian medical institutions: in the children's clinic of the Military Medical Academy for 1896–1903, hospital-acquired infections fluctuated from 0 to 10.5%; in Moscow children's hospitals: in the Rusakov Hospital (formerly Vladimirskaya) for 1902–08, on average 12.24%; in the Filatov Hospital (formerly Sofiyskaya) for 1897–1905, 19%; and in the Obraztsovaya (formerly Morozovskaya) children's hospital in 1910, in therapeutic departments from 2.7 to 3.29%, in surgical departments 13%, and in scarlet fever departments from 7.07 to 15.65%. In Moscow hospitals for adults, where children are admitted only to infectious departments, the figures for diseases are as follows: in Sokolnicheskaya in 1908, 3.3%; in 1909, 6.9%; and in 1910, 6.8%; in Staro-Ekaterininskaya in 1909, 2%; in Shcherbatovskaya in 1910, 2.5%. With overcrowding of hospitals, which leads to crowding and deterioration of sanitary-hygienic conditions, the number of hospital-acquired diseases increases. Thus, according to data from the Botkin Hospital (formerly Soldatenkovskaya) in Moscow for 1913, hospital-acquired diseases were 6.8% (in the scarlet fever and diphtheria departments), and in 1924, 12.7%; in 1925, 13.7%; in 1926, 13%; and in 1927, 6.7% (the department was occupied by scarlet fever patients during these years). On the contrary, in medical institutions where conditions for combating hospital-acquired infections were favorable and special measures were taken for this purpose, a definite difference in numerical data can be noted. Thus, according to Renault's statistics, for 1890–99 the number of hospital-acquired infections fluctuated from 14 to 31%, and with the installation of wards (see), it decreased to 3–4%. Martin considers that with a proper ward system, a decrease to 3% should be considered a good result. At the Pasteur Hospital in Paris, with the implementation of a system of isolating patients and due to the high discipline of the personnel, the percentage of hospital-acquired infections was no more than 0.2 per 30,000 infectious patients from 1900 to 1926. The significance of mixed infections, and consequently, hospital-acquired infections, is sufficiently evident from the mortality figures from these forms: in the Botkin Hospital in Moscow in 1924, mortality from scarlet fever was 6%, and from scarlet fever with another infection added was 21%. According to data from the Obraztsovaya Children's Hospital (formerly Morozovaya), from 1907 to 1924, 12.9% died from scarlet fever, 22.9% from measles, and 37.5% from scarlet fever + measles. In order to combat the introduction of any infection into hospitals, it is first necessary to eliminate the possibility of a newly admitted patient becoming infected during transport, for which institutions managing the transport of patients must be provided with transport means capable of being disinfected in a timely manner. Receiving wards of children's hospitals and those with infectious departments, as well as outpatient clinics, must have separate entrances and waiting rooms for acutely febrile and rash patients, and a sufficient number of isolation wards for admitting and discharging infectious patients. When developing new hospital construction, infectious departments must be built and equipped according to modern sanitary engineering requirements (see Hospital, Wards), it is necessary to combat overcrowding of hospitals and have a reserve space for isolating suspected patients in all departments. One of the important points in the fight against hospital-acquired infections is the proper organization of hospital affairs and the conscious attitude towards their duties by all personnel. All incoming patients undergo thorough sanitary processing, and their belongings pass through a disinfection chamber. A thorough inquiry is necessary to find out if the patient has been in contact with any infection, and in the affirmative case, corresponding isolation is required. Hospital premises and patients themselves must be maintained according to the strictest sanitary-hygienic requirements. The fight against ectoparasites must occupy a firm place in hospital life. After the discovery and discharge of an infectious patient, the premises and items that were in contact with him are subjected to appropriate disinfection or disinsection. Care items for patients, depending on the nature of transmission of the infectious agent, should be individual; if this possibility is not available, then care items and dishes, which by necessity pass from one patient to another, must be subjected to disinfection after each use. In the event of the introduction of measles infection, passive immunization according to Degkwitz should be performed for all who have not had this disease (see Measles). Personnel caring for patients must be qualified, in sufficient numbers, and especially strictly selected for infectious and pediatric departments; they must be provided with special clothing and after work have the opportunity, after taking a bath or shower, to change into their own clothing in a special room. When visiting patients by their relatives (which may be permitted in exceptional cases), the rules developed for this purpose must be strictly followed (see Contagious Hospital).