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       Nosocomial infections, the full name "healthcare-related infections", refer to infections obtained by doctors and patients in hospitals. Nosocomial infections can be divided into four categories according to different infection routes: surgical infections, blood infections, respiratory tract infections, and urinary tract infections. The highest mortality rate is due to respiratory tract infections caused by the use of respirators, and the most common is urinary tract infections caused by the use of catheters. It is not only related to the hospital, it is related to everyone, medical staff, patients and escorts. Surgery, puncture, acupuncture, vaccination, blood transfusion, dialysis, minimally invasive, and injection can cause infections. Dental clinics, plastic surgery hospitals, and nursing homes are all at risk of infection. This report popularizes concepts, standards, and related laws and regulations on hospital infection control.

Status of hospital infections worldwide

       In recent years, with the widespread and large-scale use of hormones, immunosuppressants, and broad-spectrum antibacterial drugs, a large number of drug-resistant strains and variant strains have emerged, resulting in the selection of antibiotics in patients with higher and higher levels, and the use of more and more, which also As a result, the global hospital infection rate is increasing year by year.

       According to relevant data, there are 2 million nosocomial infections in the United States each year, and the economic loss is as high as 7.5 billion U.S. dollars. In the United Kingdom, there are 100,000 nosocomial infections each year, resulting in a loss of 4.5 billion U.S. dollars. China has 4 million cases each year. The Ministry of Health of my country stipulates that the incidence of nosocomial infections is: <7% for primary hospitals; <8% for secondary hospitals; <10% for tertiary hospitals; and the rate of underreporting for all levels of hospitals is ≤20%. According to 2015 data from China Medical Infectology, the direct economic loss caused by each hospital infection patient in China General Hospital is 11229-33187 yuan.

       1.4 million people worldwide are suffering from nosocomial infections at all times. In fact, many patients' hospital complications are caused by infections, and 70% of hospital infections can be avoided through sensory control measures. Medical incidents caused by out-of-control hospital infection control occur frequently.

Epidemic characteristics of nosocomial infection

        The occurrence of nosocomial infections seriously affects the prognosis of patients' diseases, increases the suffering of patients and the workload of medical staff, and seriously causes the death of patients; at the same time, it also causes huge economic losses to patients, and also affects the economic and social benefits of hospitals.

Multiple studies have shown that the top 5 nosocomial infections are Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae, and Candida albicans;

       

       Nosocomial infections are mainly caused by lower respiratory tract infections, followed by upper respiratory tract and surgical incision infections. The main causes of respiratory tract infections are the application of various invasive procedures and the small room space. The spread of indoor droplets is often not easy to control, causing cross-infection, which is another reason why respiratory tract infections account for the highest incidence of hospital infections.

        At present, there are significant differences in the proportion of nosocomial infections among various departments in Chinese hospitals. Some studies have indicated that the susceptible departments for nosocomial infections are surgical ICU, hematology, emergency department, respiratory medicine and neurology. The age of the infected patients is V-shaped, mainly for infants younger than two years old and elderly patients over 60 years old. The immune system of infants and young children is not yet mature, the elderly patients are critically ill, the immune function is relatively low, the invasive procedures are more, and they are often associated with underlying diseases. Therefore, these two populations are currently at high risk of hospital infection.

Transmission routes and influencing factors

       Of the 7 common types of nosocomial infections, 6 can be transmitted by contact and 5 can be transmitted by air.

       1. Hepatitis C (HCV) and Hepatitis B (HBV), diseases that are mainly transmitted by blood. Occupational exposure caused by the use of unstandardized endoscopes, dental instruments, syringes, needles, hemodialysis machines, and medical personnel during the use and handling of medical instruments.

       2. Enterovirus infection is mainly transmitted through fecal-oral transmission and through direct contact between people. Indirect contact through the hospital environment contaminated by the virus, medical facilities, daily necessities, and hands contaminated by medical personnel. Enteroviruses can also spread through the respiratory tract.

       3. Infection in the surgical site, after contact and transmission, bacteria directly enter the surgical field through the hands, instruments, gauze, irrigation fluid, etc. of the operator; instruments, dressings, disinfectants, and bandages contaminated with bacteria can directly introduce bacteria into the incision. It can also be spread by air. Dander, droplets, and bacteria on the hair enter the incision through the flowing air and contaminated media.

       4. Newborn infections are mainly spread through direct or indirect contact with hands contaminated by medical personnel. Infection can be obtained through the inhalation of contaminated amniotic fluid during labor. Infection can be caused by contact with the mother after birth and the indirect transmission of the polluted environment, medical equipment, and household goods. Indoor air pollution, as well as indoor medical equipment and certain fixed devices such as catheters, cannulas, nebulizers, face masks, warm boxes, blue light boxes, treatment vehicles, cribs, and air conditioners.

       5. Bloodstream infection, the pathogen directly enters the bloodstream or spreads through indirect contact. Arteriovenous indwelling catheter, hemodialysis, and interventional treatment, etc.; or caused by uncleanness of intravascular injection of drugs, fluids, blood, plasma.

       6. Burn infection is mainly spread through contact. Some living equipment in the environment, such as faucets, bed linens and treatment equipment, etc., cause the spread of pathogens after the staff hands are contaminated. It can also be spread through the air. The burned skin is open and susceptible to bacterial viruses in the air.

       7. Respiratory tract infections are mainly transmitted by air and droplets. The droplet nuclei with pathogenic microorganisms are suspended in the air for a long time and in a large area, causing the spread of the disease or the infection of the infected persons when coughing, sneezing and talking The infection occurs when the foam enters the eyes, mouth, nasopharyngeal mucosa of susceptible people. It can also be spread through contact, and pathogens can contaminate medical personnel's hands, medical equipment, gauze, rinse fluid, etc.

       

Medical staff hand hygiene is the most critical, simple and economical method for preventing and controlling hospital infections. Many studies have found that the microbial infections in the hands of medical staff are very serious and often become the vector of infectious diseases. Infections caused by direct or indirect hand-borne pathogens account for more than 30.0% of hospital infections.

        The hospital is a place where pathogenic microorganisms gather. The pathogenic bacteria are dispersed in the air in the form of aerosol, which is an important factor leading to various iatrogenic infections such as respiratory tract infections, skin infections of burn patients, and surgical incision infections. Pathogenic bacteria and susceptible people coexist in the hospital environment, and pathogenic microorganisms spread diseases through the air or other transmission media. Therefore, hospital air disinfection is an important measure to prevent and control hospital infections.

 

Nosocomial infection management related policy scan

       

1 "Hospital Infection Management Measures"

       On July 25, 2006, the Ministry of Health issued the "Administrative Measures on Hospital Infection." The policy stipulates: all kinds of medical instruments used for invasive operations such as injection, puncture, and blood collection must be sterilized one by one. Disinfecting medical equipment, disposable medical equipment and utensils used by medical institutions shall comply with relevant state regulations. Medical devices and appliances that are used once cannot be reused.

       Medical institutions shall formulate specific measures to ensure that the hand hygiene of medical personnel, the environmental conditions of diagnosis and treatment, aseptic operation techniques and occupational health protection work meet the requirements of the regulations, and control the risk factors of hospital infection.

 

       2 "Safety Management Standards for Clinical Use of Medical Devices"

       On January 18, 2010, the Ministry of Health issued the “Management Standards for the Safety of Clinical Use of Medical Devices (Trial)”. The policy regulates the safety management of clinical use of medical devices, including the safety management of medical device product safety, personnel, systems, technical specifications, facilities, and environment involved in medical services of medical institutions.

 

       3 "Regulations on the Biosafety Management of Pathogenic Microbiology Laboratory"

       On May 27, 2014, the 69th Executive Meeting of the State Council adopted the Regulations on the Biosafety Management of Pathogenic Microbiology Laboratories.

       The Regulations stipulate that the collection of pathogenic microorganism samples should meet the following conditions:

(1) Have equipment that is compatible with the level of biological safety protection required to collect pathogenic microorganism samples;

(2) Staff with relevant professional knowledge and operation skills;

(3) Effective measures to prevent the spread and infection of pathogenic microorganisms;

       The containers of highly pathogenic pathogenic microbial (toxic) species or samples should be sealed, and the containers or packaging materials should also meet the requirements of waterproofing, breakage prevention, leakage prevention, high (low) temperature resistance, and high pressure resistance.

 

       4 "Guidelines for Hospital Infection Outbreak Control WS/T 524-2016"

       On August 2, 2016, the National Health and Family Planning Commission released the 2016 Chinese Health Industry Standard-Guidelines for Outbreak Control of Nosocomial Infections (WS/T524-2016). The "Guide" states:

       Medical institutions should establish a responsibility system for reporting hospital infection outbreaks, clarify that the legal representative or main person in charge is the first person responsible, and formulate and implement the rules and regulations, working procedures, and disposal plans for hospital infection outbreaks during monitoring, reporting, investigation, and disposal To clarify the responsibilities of the relevant departments of the hospital in reporting and handling of hospital infection outbreaks.

 

Establish a hospital infection monitoring system and implement measures to detect outbreaks of hospital infections in a timely manner.

       Medical observations were made on other patients, hospital staff, escorts, and visiting staff who were in close contact with infected patients until the longest incubation period of the disease or no new cases of infection. Stop using suspiciously contaminated items, or use them after passing strict disinfection and sterilization treatment and testing.

       If new cases of nosocomial infections continue to occur, the reasons for the ineffectiveness of control measures should be analyzed, other risk factors that may lead to infection outbreaks should be evaluated, and control measures adjusted. If the situation is particularly serious, measures should be taken to stop the consultation by itself or after reporting to the competent health and family planning administrative department.

 

Specific methods of hospital infection management

       The first is to raise the level of medical staff's awareness of hospital infection

       The occurrence of any hospital infection is directly or indirectly related to medical personnel, and no matter whether doctors, nurses, medical technicians, or logistics, training and internship personnel in the hospital may affect the hospital infection work. Although China has made a lot of publicity and training on hospital infection in recent years, with the development of hospital modernization and the continuous updating and development of knowledge, various new types of disinfectants, disinfection methods and monitoring technologies have emerged in an endless stream. Various chemical and physical disinfection methods and hospital infection rules and regulations are still not comprehensive.

       The study pointed out that 80.0% of medical staff can wash hands before and after aseptic operation and rescue critical patients before and after wearing resuscitators; 60.0% cannot do six-step handwashing, wear masks in wards, access medical records and patient items Wash your hands afterwards. In actual medical work, no matter whether doctors, nurses or medical technicians have irregular operations, therefore, medical personnel should improve self-protection awareness and actively prevent and control nosocomial infections.

 

       Second, improve the air quality of the hospital

       Studies have shown that the quality of hospital air quality is closely related to hospital infection. According to reports, there are 14 airborne infectious diseases, ranking first among various transmission media. When the total number of bacteria in the air in the hospital operating room is 1000-1800cfu/m3, the risk of infection caused by airborne transmission increases significantly. If the total number of bacteria drops to 180cfu/m3 or less, this risk is significantly reduced.

       Disinfection and sterilization is one of the main measures to prevent and control nosocomial infections. Strengthening and perfecting disinfection and sterilization work plays a very important role in controlling exogenous infections. Conventional physical and chemical disinfection is prone to secondary air pollution and certain toxic side effects. More importantly, these disinfection methods are terminal disinfection, which does not have bacteriostatic effect. Once disinfection is stopped, the number of pathogenic bacteria in the environment is very fast Will pick up. And some disinfection methods are corrosive to indoor equipment and have a certain side effect on the human body, and personnel must leave during use. Therefore, it is necessary to introduce the concept of dynamic disinfection. On the basis of air disinfection, the concepts of clean air and green disinfection must also be introduced. This is the development trend of hospital air disinfection today and in the future.

 

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