Abstract

According to pediatrics

on the topic:

“The role of a midwife in the prevention of nosocomial infection in newborns and puerpens”

Plan:

1. Investments in newborns. VBI

3. Mechanisms and ways of transmission of pathogens, transmission factors

4. Prevention of nosocomial infections

5. Conclusion

6. References

, their diagnosis, treatment and prevention in maternity hospitals.

Fetus and neonates have a high rate of infection; 1-2% of infants become infected even in the embryonic period, and 10% of newborns - under the age of 2 months. Intrauterine infections cause fetal death and miscarriage, stillbirth or fetal resorption, congenital malformations, prematurity, growth retardation, and numerous complications of chronic postpartum infections. Perinatal infections can lead to severe systemic (sometimes fatal) illness, persistent infections, and long-term chronic sequelae.

According to sample studies, the actual incidence of nosocomial infections in obstetric hospitals reaches 5-18% of newborns and 6 to 8% of puerperas.
Staphylococcus aureus predominates in the etiological structure, in recent years there has been a tendency towards an increase in the importance of various gram-negative bacteria. It is gram-negative bacteria that, as a rule, cause outbreaks of nosocomial infections in maternity wards. Also, the value of St increases. epidermidis.
The "risk" division is the department of premature babies, where, in addition to the above pathogens, diseases caused by fungi of the genus Candida are often found.
Most often, nosocomial infections of the purulent-septic group occur in obstetric departments, outbreaks of salmonellosis are described.
Neonatal HAI is characterized by a variety of clinical manifestations. Purulent conjunctivitis, suppuration of the skin and subcutaneous tissue predominate. Intestinal infections caused by opportunistic flora are often observed. Omphalitis and phlebitis of the umbilical vein are more rare. Up to 0.5-3% in the structure of nosocomial infections in newborns falls on generalized forms (purulent meningitis, sepsis, osteomyelitis).
The main sources of staphylococcal infection are carriers of hospital strains among medical personnel; in infections caused by gram-negative bacteria - patients with mild and erased forms among medical workers, less often - among puerperas. As sources, the most dangerous are resident carriers of hospital strains of St. aureus and patients with sluggish urinary tract infections (pyelonephritis).
Intranatal newborns can be infected from mothers with HIV infection, blood-borne hepatitis, candidiasis, chlamydia, herpes, toxoplasmosis, cytomegaly and a number of other infectious diseases.
In obstetric departments, there are various ways of transmission of nosocomial infections: contact household, airborne droplets, airborne dust, fecal-oral.

Maternity hospitals are the most likely to contract nosocomial infections (HAIs), because a woman's immunity is weakened during pregnancy, and the child's natural defense system has not yet been formed. The main cause of infections are hospital mutant strains of viruses and microorganisms such as streptococci, staphylococci, Escherichia, Klebsiella, Proteus and others. Once settled within the walls of the maternity hospital in a safe concentration for humans, they adapted to disinfectants - weak bacteria died, while strong ones continued to survive.

Currently, some microorganisms are resistant not only to sanitation, but also to antibiotics. Statistics show that staphylococcus infection, which occurred outside the hospital walls, is cured much easier than the hospital one. But, nevertheless, all medical institutions in the world are making every effort that is prescribed by law to ensure the safe conditions for mother and baby. However, from time to time in the medical news there are reports that an infection has been detected in the next maternity hospital. It is extremely wrong to blame doctors for this. The source of infection, of course, can be medical personnel and tools, but in almost 50% of cases, the carriers of the infection are the mothers themselves.

Groups of "risk" for the development of nosocomial infections among newborns are premature babies, newborns from mothers with chronic somatic and infectious pathology, acute infections during pregnancy, with birth trauma, after caesarean section, with congenital anomalies. Among puerperas, the greatest risk is in women with chronic somatic and infectious diseases, aggravated obstetric history, after cesarean section.

The main role as a source of infection in obstetric institutions belongs to medical personnel. As skin antiseptics for disinfecting the hands of medical staff, treating the injection and surgical fields, it is advisable to use products based on alcohols (ethyl, isopropyl, etc. ) with the addition of cationic surfactants

Hospital staff health services should pay special attention to neonatal staff. Serological screening programs to assess immunity to rubella and varicella should be introduced and intensified. Susceptible individuals should be effectively immunized and, if necessary, prevented from coming into contact with sick people. Employees of children's institutions of intensive care who have contact with patients or their blood should be vaccinated against hepatitis B. All employees of children's institutions should be examined annually for tuberculosis; it is necessary to explain to them that in cases of contact with tuberculosis patients or if unusual symptoms of respiratory diseases appear, they should report this to their doctors. Health care workers suffering from streptococcal and staphylococcal infections, infectious diseases of the upper respiratory tract, gastroenteritis, dermatitis, obvious skin lesions or active infections caused by the herpes simplex virus should not come into contact with patients during their illness or during the period stipulated by the relevant regulations. During epidemics of infectious diseases in children's institutions, all their employees should be subjected to clinical and laboratory screening aimed at identifying dermatitis, skin or respiratory infections and all other diseases that lead to the spread of pathogenic microbes that cause epidemics. Ensuring a high level of health education among medical personnel requires active education of issues such as the lack of immunity in newborns, their susceptibility to infection, as well as the need for proper handling of medical instruments and equipment and the importance of thorough handwashing.

A bathrobe is a reliable way to interrupt the transmission of microorganisms. An additional measure that helps keep the situation in maternity hospitals under control is air sampling, analyzes from surfaces and instruments. The total number of microorganisms should not exceed 500 per 1 m 2, and Staphylococcus aureus and other pathogenic microorganisms should not be present in the room at all.

Main directions of prevention of nosocomial infections :

optimization of the epidemiological surveillance system for nosocomial infections;

Improving laboratory diagnostics and monitoring of nosocomial pathogens;

Improving the effectiveness of disinfection measures;

Improving the efficiency of sterilization measures;

Development of strategy and tactics for the use of antibiotics and chemotherapy drugs;

Optimization of prevention and control methods for nosocomial infections with different pathogen transmission routes;

rationalization of the basic principles of hospital hygiene;

optimization of HAI prevention for medical personnel;

Evaluation of the economic efficiency of measures for the prevention of nosocomial infections.

The architectural layout of obstetric institutions is of great importance in the prevention of nosocomial infections. The placement of the observational department on the 1st floor, practiced in typical projects, promotes the circulation of microorganisms throughout the building. Warm air rises from the bottom up, therefore, due to "unorganized" air flows along flights of stairs, elevator shafts, etc. there is a movement of microorganisms both horizontally (within the floor) and vertically (between floors). It is advisable to place the observational department in separate buildings or in isolated outbuildings.

One of the factors contributing to the spread of microorganisms in the volume of the building are the defects of the ventilation system, already incorporated in its design. Instead of removing polluted air from the rooms, the supply and exhaust ventilation system allows a significant number of microorganisms to move throughout the building. When monitoring the operation of the ventilation system, it is necessary to pay attention to containers with water for humidifying the air, since some microorganisms (the genus Pseudomonas, etc.) multiply well in humid conditions and subsequently spread with air flow to all floors of the building.

It is advisable to revise the working hours of pregnancy pathology departments. Due to the isolation of obstetric hospitals, favorable conditions have developed in them for the selection of hospital bacterial strains due to the absence of competing microflora. Women stay in these departments for a long time, sometimes the entire period of pregnancy, which contributes to their colonization. By the time of delivery, they receive the entire set of hospital strains circulating in the obstetric facility. Parturient women with pathology of the urogenital tract are of great danger. In the postpartum period, nosocomial infections are most often recorded in such puerperas and newborns.

Prevention of nosocomial infections in newborns is facilitated by a reduction in the number of invasive procedures. It has been shown that if the frequency of vaginal examinations during childbirth is less than 7, then the risk of developing endometritis in puerperas in the postpartum period is 27%, with an increase in the number of studies - 71% or more.

Unlike foreign countries, where caesarean section is performed mainly on a planned basis, in the CIS countries, emergency surgery is most often performed in the second stage of labor. In this case, the contamination of the surgical wound with endometrial microorganisms occurs. If during a planned caesarean section, the incidence of endometritis is 5%, then during emergency operations in women at risk, it is up to 85% (with natural childbirth 1-3%). A promising direction in the prevention of nosocomial infections is the use of disposable equipment and materials.

The benefits of living together after childbirth have long been proven. In a number of obstetric hospitals, due to the reduction in the number of births, it has recently been practiced to unite the mother and child a day after birth, creating a sparing regimen for the puerperal. However, with this approach, one of the advantages of living together is lost, since the child in the first day of life is not colonized by maternal strains of microorganisms, but by bacteria that circulate in children's wards.

Prevention of nosocomial infections includes a set of disinfection measures aimed at the destruction of pathogenic and opportunistic microorganisms at objects in the patient's environment. Compositions based on quaternary ammonium compounds, aldehydes, cationic surfactants and alcohols are considered the best disinfectants for medical devices. With a wide spectrum of action, these compounds have a gentle effect on the material of the product, do not violate its functional characteristics and have detergent properties.

CONCLUSION

Infection control in newborns should be primarily about prevention rather than treatment. This goal is achieved through careful prenatal examination (screening), immunization and early treatment of the mother before and during childbirth. The rules for careful care of the newborn with its immature immunological defense system include thorough handwashing, the availability of the necessary personnel, facilities and conditions for isolation, and reasonable attempts to minimize the use of various monitoring and life support devices and devices. A strong health care program for staff is required to ensure that highly susceptible neonates are not subsequently infected with common viruses (eg, herpes simplex virus, enteroviruses, respiratory syncytial virus) and bacteria (such as staphylococci and streptococci).

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