Source: Chu Tianjin News News reporter Xiao Qingqing

 

The hospital is a gathering place for germs and is a "severely affected area" of cross infection. In recent years, news of serious cross-infection in the hospital has been continuously exposed by the media. Events such as neonatal infection death and hepatitis C infection in hemodialysis patients frequently sounded the alarm for nosocomial cross infection. In 2008, eight newborns in the First Affiliated Hospital of Xi'an Jiaotong University died one after another due to severe nosocomial infections. They shocked the Ministry of Health and conducted special inspections on infection control in the hospital. However, not long ago, the Dejiang County People's Hospital of Guizhou Province saw more than a dozen pregnant women's wounds not cured after a cesarean section. Later, the investigation by the health department confirmed that the cause of the incident was due to infection of non-tuberculous mycobacteria in the surgical incision, which was caused by nosocomial infection.

Experts believe that under the current medical conditions in our country, nosocomial infections are inevitable. Moreover, due to various factors such as limited objective conditions of the hospital, insufficient attention from the hospital, and inadequate missionary education, many patients, even some doctors, do not have the awareness of infection prevention, and hospitals at all levels, especially some small hospitals, manage nosocomial infections The investment in control is even less optimistic. In fact, through strengthening monitoring and management, such as strengthening the hand-washing awareness of medical staff, strengthening sterilization and disinfection in key wards, and strictly controlling the use of antibiotics, the infection rate can be controlled below 5%, which can greatly reduce the crossover in the hospital. The chance of infection.

A Why is the hospitalized baby sick?

Ms. Liu’s child was admitted to the neonatal department of the hospital due to jaundice at 42 days of birth. The condition of jaundice was not serious when the child was admitted to the hospital without any discomfort. After a few days in the hospital, the child suddenly had a fever. Mr. Zheng's daughter was hospitalized in the Rehabilitation Department of the hospital for a month. At first, the child showed no signs of catching a cold. He coughed after a week in the hospital, and then repeatedly coughed.

The reporter met Ms. Ma in the interview that her child was hospitalized with bronchopneumonia. The child was originally coughing with fever. From the 4th day of hospitalization, the child pulled eggs and had diarrhea more than ten times a day. Laboratory tests revealed rotavirus infection In order to rehydration treatment, they had to extend the hospital stay. Ms. Ma complained about why her child became more and more serious after hospitalization, and the problems that hadn't existed also appeared. Especially when the baby was infected with rotavirus diarrhea, she was caught by surprise and was very distressed. She questioned reporters: Was the child infected with rotavirus in the hospital? In this case, is there any relevant department that can determine whether it is a nosocomial infection? Does the hospital need to be responsible for nosocomial infection? "In the past, people's understanding of nosocomial infections simply stayed in the areas of hepatitis C and hepatitis B infections. In fact, nosocomial infections refer to infections that patients or staff get in the hospital and produce clinical symptoms. It includes a lot of content. The above cases can be regarded as nosocomial infections." A physician told reporters that taking nosocomial infections in pediatric wards of various general hospitals as an example, the most common nosocomial infections are respiratory infections, followed by digestive tract infections. The younger children have a higher incidence of nosocomial infections. Because there are many escorts in the pediatric ward, the flow of people is large, and the air circulation is poor, and the spread of indoor droplets is often difficult to control and cause cross infection. The second is gastrointestinal infection, which is related to the inadequate development of children's digestive system and poor digestive function; it may also be caused by the transmission of pathogenic microorganisms such as medical staff, parents or children's own hands and objects to the children's gastrointestinal tract infection.

B 10% of the patients had been infected in the hospital

Nosocomial infections generally refer to infections acquired by inpatients in hospitals, including infections that occur during hospitalization and infections that occur after hospitalization. Because hospitals are places where patients are dense, the hospital environment is most susceptible to contamination by pathogenic microorganisms, thereby providing external conditions for the spread of disease and promoting the occurrence of hospital infections. It should be said that the occurrence of nosocomial infections is inevitable, but as long as strict nursing management and preventive measures are implemented, nosocomial infections will be greatly reduced.

The director of the Hospital Infection Management Committee of our province and Professor Deng Min of the Peking Union Medical College Infection Department introduced that hospital infections are divided into exogenous infections and endogenous infections: exogenous infections are mainly caused by outside pathogens, also known as cross-infection. Infections caused by patients with various causes caused by invasion of non-inherent pathogens in hospitals, such as patients with infectious diseases and medical staff who have been in contact with patients; endogenous infections are caused by long-term use of antibiotics to cause normal flora in the body Caused by the disorder. At present, the main causes of hospital infections are: the hand hygiene of medical staff is not up to standard; the abuse of antibiotics has led to the spread of drug-resistant bacteria; unsafe injections. In recent years, the incidence of nosocomial infections has been on the rise. Except for some medical personnel who have not fully complied with medical and health habits, it is mainly related to the widespread existence of drug-resistant bacteria. The data shows that 70% of hospital infections are caused by drug-resistant bacteria.

Professor Deng said that the Ministry of Health stipulates that the hospital infection control rate should be below 10%. But in fact, at least 10% of patients increase hospital stays and costs every year due to additional infections in the hospital. In accordance with the requirements of infection control, doctors and nurses must wash their hands every time they come into contact with patients, but medical staff in large hospitals can't do it at all if they touch hundreds of patients every day. The Ministry of Health requires that antibiotics used in hospitals should not exceed 50% of the total dose, but now almost all hospitals exceed 50%, and some hospitals even reach 80%. Antibiotic abuse makes antibacterial control very difficult.

C Nosocomial infection three major high-risk departments

According to reports, for general hospitals, the high-risk departments of nosocomial infection are the intensive care unit (ICU), the operating room, and the artificial kidney (hemodialysis). ICU patients have many basic diseases, long treatment time, and low immunity. The ICU also has invasive operations such as tracheotomy and intubation. Therefore, ICUs in major hospitals restrict visits, mainly to prevent patients from passing bacteria to visitors, and on the other hand, to prevent visitors from transmitting virus bacteria outside. Brought in and infected severely ill patients who were already very resistant. Once the ICU detects drug-resistant bacterial infections, it is necessary to immediately do contact and isolation and hand hygiene protection of medical personnel.

The management of nosocomial infections is complicated and has a lot of content, but it mainly focuses on disinfection and isolation, the rational use of antibacterial drugs, and infection monitoring for pathogen sampling. Taking the pediatric respiratory ward as an example, to prevent cross-infection, in addition to reducing visits and daily cleaning and disinfection, hospitalized children should also be separated by disease type. For example, children with pneumonia should not live with children with enteritis. Between wards and wards, the number of extra beds should be reduced as much as possible, and the feces of the children should be treated. However, due to the shortage of medical resources, the pediatric wards, including many general hospital pediatric wards, are often in full operation. In such a intensive children's environment, bedside isolation must be done, and the medical staff should infect the parents in the hospital on the day of admission Preventive education. However, in the busy medical work, medical staff often fail to preach one by one and ignore this seemingly "insignificant" link.

D National hospital incidence rate is more than 8%

According to statistics from the Ministry of Health, the incidence of nosocomial infections in the country is close to 8% or even higher. The average length of hospitalization for each hospitalized patient is 14 days longer, and the cost is increased by nearly 6542 yuan. It is estimated that the direct loss caused by hospital infection in China is 150 yuan per year More than 100 million yuan.

Some of the hospital’s relevant practitioners felt a lot about the management of infection prevention in the hospital. Everyone thinks that preventing hospital feelings is a very expensive thing, other investment is not counted, only the cost of hand sanitizer and disposable paper towels used in hospitals will need hundreds of thousands of yuan a year, if you clean them once or twice a year Air conditioning, the cost of investment is greater. But I thought about it: the infection management department is actually a profitable department. If the hospital sense is not properly managed or it causes an outbreak of hospital sense, the hospital will have more economic losses.

It is understood that nosocomial infection management has existed abroad for a long time. my country started this work in 1986 and gradually paid attention to nosocomial infection management after the SARS incident in 2003. However, some people in the industry still lament that hospital management is too complicated and professional, and needs to communicate and coordinate with various departments of the hospital. Although they describe this work as a conscience project, many hospitals still do not invest in hospital management at this stage. Optimistic, especially in some small and medium-sized hospitals, infection management is only for coping with inspections, and some large hospitals have introduced various expensive endoscopic medical equipment from abroad, but the most basic disinfection and sterilization methods have not been introduced, which is to rebuild With light maintenance, they will all become potential hidden dangers of nosocomial infections. "We found these risks, and the undetected infection risk still exists because hospital management is really complicated." Industry insiders said that reducing hospital infections is responsible for the lives of patients, and hospitals really need to vigorously strengthen the monitoring of nosocomial infections. And management.

E Improving self-immunity is key

The reporter was informed in the interview that if the hospital’s medical equipment is not strictly sterilized, such as endoscopy, dialysis treatment and other shared equipment, if there is an evidence of blood transmission and other infections, patients can pass Medical accident handling procedures require the hospital to make compensation. However, at present, there is no provision for hospitals to pay for the inevitable cross-infection caused by exogenous cross-infection in hospitals. For example, cases of contracted pneumonia and rotavirus infection in the hospital, the additional medical expenses paid are basically It is the patient who pays for it.

Experts remind patients that even if they are not hospitalized and see a doctor in an outpatient clinic, if infusion treatment is needed, the injection room of a large hospital is often overcrowded and endless, if the patient's resistance is very poor, the risk of cross infection is still not small. In order to reduce the occurrence of diseases, prevent cross-infection, and improve your own resistance is the key. Each of us lives in an environment with bacteria. A large number of bacteria are attached to people. As long as people are healthy and resistant, these bacteria have no chance of making waves. If it is a minor disease, it is best to choose a community hospital or a small and medium-sized hospital with relatively few people for treatment.

The experts also called for, in addition to hospitals to standardize the use of antibiotics to prevent the emergence and spread of drug-resistant bacteria, ordinary citizens must also have a sense of protection against misuse of antibiotics, wash hands frequently, ensure hand hygiene, cultivate good living habits, and improve Your own immunity.