Original text / Li Zijun 2015-10-13 Source: Health

 

Recently, the Singapore General Hospital suffered from the most serious nosocomial infection in the history of the establishment of the hospital. In the hospital, 22 patients recently suffered from hepatitis C, and 4 of them died due to complications and sepsis. This incident triggered the discussion of nosocomial infection of hepatitis C in the international hospital community.

There is a question behind the incident. Why is there such a serious accident in a country with a relatively complete medical system, such as Singapore? How to avoid this "hospital ghost" in the hospital? Let's hear what experts from the hospital control department in China say.

(The nosocomial infection occurred in the hospital where former Singapore Prime Minister Lee Kuan Yew died.)

Up to 22 of the patients in the Singapore General Hospital suffer from hepatitis C, and 4 of them die due to complications and sepsis! What these patients have in common is that they have lived in the Nephrology Ward of the Singapore General Hospital between April and June this year, and most of them are patients undergoing kidney transplantation.

According to local media reports in Singapore, a total of 8 of the 22 patients died. Four of them died of complications and sepsis that may have been caused by infection with hepatitis C virus. Three of them confirmed that they were not due to hepatitis C virus infection after a thorough evaluation. For death, the cause of death of one patient has not been confirmed. Of the 22 people infected, the youngest is 24 years old, and the rest are between 50 and 60 years old. Initial investigations revealed that the source of the infection may have been intravenous injection.

The Singapore General Hospital stated at a press conference on October 6 that the hospital apologizes unreservedly and will spare no effort to review procedures and investigate all sources of possible infections. The incident is the sole responsibility of the Central Hospital. The hospital will spare no effort to review all procedures and check all possible sources of infection to prevent the accident from happening again. The Ministry of Health in Singapore stated that it has established an independent review committee for this medical malpractice to determine that the Singapore General Hospital has taken all possible measures to investigate the cause of the infection and to remedy the weak links.

Singapore General Hospital is the hospital where former prime minister Li Guangyao was dying. According to people familiar with the matter, the incident initially believed that it might be "blamed on insulin needles", but this is only speculation, and the final investigation results have not been announced.

Why does nosocomial infection occur?

Hepatitis C is mainly spread by blood transfusion, acupuncture, and drug use. The global HCV infection rate is about 3%, about 180 million people are infected, and there are about 35,000 new cases of hepatitis C each year. The initial clinical manifestations of hepatitis C are not obvious, and they are not spread by air and saliva.

Although the incident investigation has not yet "finalized the cause", the industry has begun to discuss this. In an interview with the health community, Lu Lianhe, director of the Department of Sensing and Control of Beijing Ditan Hospital, used the word "incredible" to describe the nosocomial infection in Singapore General Hospital, because as long as it is operated in accordance with modern hospital management methods, no hospital infection will occur. Hepatitis C. Lu joint analysis said that such a large-scale nosocomial infection can only show that there have been mistakes and major omissions in hospital management, of which there are three reasons:

First of all, the most likely nosocomial infection in patients with kidney disease is the incomplete disinfection of the hands of the dialyzer and medical staff during the dialysis process. In this regard, the practice of Ditan Hospital is to separate patients with kidney diseases suffering from infectious diseases such as hepatitis C, hepatitis B, and AIDS from other patients. Each patient has a separate dialyzer. In addition, after performing puncture for the patient, medical staff should use hand decontamination solution to strictly do hand hygiene. During this process, there will be a head nurse and a person in charge of supervision to supervise this. In fact, in order to avoid cross-infection, in Beijing, almost all patients with kidney disease such as hepatitis C and other blood-borne infectious diseases are required to go to the three infectious disease specialties, Youan Hospital, Ditan Hospital and 302 Hospital for dialysis.

Second, repeated use of the needle causes infection. However, the needles of modern hospitals are basically disposable consumables, and it is not possible to reuse the needles.

Finally, it is not ruled out that some people use some methods to intentionally spread the hepatitis C virus to patients, but the probability of this happening is extremely small.

Spooky nosocomial infection

Nosocomial infections refer to infections acquired by inpatients in the hospital, and are nightmares that haunt the minds of medical staff, including infections that occur during hospitalization and infections that occur after hospitalization. Infections acquired by hospital staff in the hospital are also hospital infections. Nosocomial infections can be divided into endogenous infections and exogenous infections, those with low immune function, or patients with pathogens in their bodies, which can induce infections under certain conditions. Pneumonia is the most common type of nosocomial infection in lung diseases, which generally accounts for about 30% of nosocomial infections.

Industry insiders said that nosocomial infections are more resistant than common infections outside the hospital, and treatment with antibiotics is likely to be unsuccessful. Not only that, nosocomial infections are more harmful than ordinary infections, which can cause patients to last longer and even increase mortality.

General hospitals use these methods to prevent nosocomial infections

Doing a good job in hospital infection prevention and infectious disease prevention is the key to avoiding hospital infections. For general hospitals, the high-risk departments of nosocomial infections are the intensive care unit (ICU), the operating room, and the dialysis room. Lin Jinlan, a member of the Disease Control and Sensing Office of Beijing Tsinghua Changgeng Hospital, shared the experience of this tertiary hospital with the health community.

First, establish a three-level infection management organizational structure. The hospital has an independent hospital infection management department, which is equipped with full-time staff according to the number of beds, regularly receives professional training, and formulates infection control rules and regulations to train and evaluate all staff to increase awareness of infection control. Full-time staff should repeatedly supervise and rectify the building layout and operation process to comply with the principle of control;

Second, strictly implement hand hygiene measures, equipped with complete hand washing and sanitation hand disinfection facilities, regularly detect the cleanliness of the hands of clinical staff, medical staff closely monitor the infection status of inpatients, and report the infection status of hospitals to higher administrative units, and Informatization of monitoring can promptly discover the clustering events of hospital infection;

Third, implement the centralized supply of multiplexed disinfection and sterilization of medical devices and articles, and implement the monitoring of indicators for the effects of disinfection or sterilization;

Fourth, formulate standard operating procedures for environmental cleaning, supervise the implementation of cleaning, regularly sample and cultivate environmental hygiene, and purchase and supply of sterile medical items in line with national requirements to ensure the use of qualified products;

Fifth, multi-department linkage, timely detection of patients with multi-drug resistant bacteria and timely isolation.

Several major nosocomial infections in my country in recent years

Just when a serious nosocomial infection occurred in Singapore not far away, we found that in recent years, there have also been too many serious nosocomial infections in our country. Only by drawing lessons from this can we achieve the alarm bell of nosocomial infection.

1. Eight children died in an affiliated hospital of Xi'an Jiaotong University

From September 3, 2008, 9 neonates of the First Affiliated Hospital of Xi'an Jiaotong University School of Medicine successively developed clinical symptoms such as fever and increased heart rate. Among them, 8 neonates died of disseminated intravascular coagulation and 1 newborn Pediatric treatment in the hospital improved. The investigation concluded that the incident was caused by a hospital infection. Afterwards, the post of the dean of the hospital and the deputy dean in charge of the hospital were abolished; the post of the head of the relevant functional departments such as the medical department and the nursing department was removed; the post of director of the neonatal department and the head nurse of the hospital were removed; The family members of the children were 180,000 yuan.

2. The pain of hospital infection management of "eyeball incident" in Suzhou, Anhui

On December 11, 2005, doctors from the Department of Ophthalmology of Suzhou City Hospital of Anhui Province and Xu Mou, the chief ophthalmologist from Shanghai, and others performed phacoemulsification surgery on 10 patients. The next day, the nurse found that 10 patients had eye infections! Nine patients should undergo eyeball removal surgery, and the other patient should undergo vitrectomy.

The processing results include: the cancellation of the title of the second-class first-class hospital in Suzhou City Hospital; the dean Hao Chaochun was removed from all functions inside and outside the party and transferred from the health system; the deputy dean Shao Zhengming was sentenced to a serious warning within the party and the administrative record was excessively punished; Persons in charge of ophthalmology were given warnings and notes until they stayed with the party to check the punishment and ceased practicing for 9 months to 1 year.

3. Atypical pneumonia (SARS)

It was first discovered in February 2003 that SARS spread to Hong Kong and other places after Guangdong, and quickly spread to 27 countries and regions in the world. As of 12:00 on May 18, 2003, a total of 4698 cases of atypical pneumonia were reported in the mainland of China, including 917 medical staff and 224 deaths. 17 medical personnel died in SARS prevention and control. Out-of-control SARS is closely related to hospital infection, and the final control of SARS is also due to good hospital infection control measures! At that time, the Minister of Health was removed from office, and the Beijing Mayor was removed from office. The relevant persons in charge of governments and hospitals in various places were punished or dealt with to varying degrees.