PREVENTION OF NOSOCOMIAL PNEUMONIAS IN A SURGICAL INTENSIVE CARE UNIT
Abstract
Nosocomial pneumonia on average occurs in 8–20% of patients in the Intensive care unit (ICU) and in 27% of patients under mechanical ventilation (ventilator). The pnemonia prevalence depends on the duration of respiratory support, and is an independent predictor of adverse outcome in critically ill patients requiring mechanical ventilation. The study objective is to develop measures to prevent nosocomial ventilator-associated pneumonias (VAP) in surgical intensive care units. We analyzed the measures to prevent ventilator-associated respiratory tract infections in the surgical intensive care department (ICU) for 10 years (2004–2013). The prevalence of ventilator-associated respiratory tract infections is the highest (87.65±11.76%) in the stucture of health care-associated infections. The improved surveillance system produced the reliable data on the incidence density (increase from 3.9±0.8 in 2004 and 11.7±1.4 in 2007, per 1 000 ALV/day). Pathogens VAP were characterized by multiple drug resistance. The greatest resistance was found to aminoglycosides in the isolated microorganisms (69.5±6.8%). The percentage of desinfectant resistant strains ranged from 1.1±0.6% (chlorine-based disinfectants) to 13.13±4.8% (to quarternary ammonium based disinfectants). VAP prevention in the surgical ICU should be comprehensive and include a hospital-wide preventive measures.
About the Authors
O. A. Orlova
МБУЗ Городская клиническая больница № 8
Russian Federation
Russian Federation
Oksana Orlova - Cand. med. Sciences, head. epidemiological Department Medical Budget Organization Clinical Hospital № 8.
2A-22, Dneprovskaja str., Chelyabinsk, 454024 Tel.: + 7 922 230-68-90
V. G. Akimkin
First Sechenov Moscow State Medical University; Research Institute of Desinfectology of Federal Service on Customers’ Rights Protection and Human Well-Being Surveillance
Russian Federation
Russian Federation
Corresponding member cor. Russian Academy of Sciences, Dr. med. Sciences, Professor, head. the Department of Disinfectology of the First Sechenov Moscow SMU, leading scientific. Researcher Central Research Institute of Epidemiology of Federal Service on Customers’ Rights Protection and Human Well-Being Surveillance, Deputy Director RID Federal Service on Customers’ Rights Protection and Human Well-Being Surveillance
References
1. Akimkin V.G., Tutelian A.V., Brusinа E.B. Prospects for research in the field of prevention of infections associated with medical care // Disinfection Affairs. 2014; 3: 5-11 (in Russian).
2. Pokrovsky V.I., Akimkin V.G., Briko N.I., Brusinа E.B. et al. Nosocomial infections: new horizons for prevention // Epidemiology and Infectious Diseases. 2011; 1: 4-7 (in Russian).
3. Pokrovsky V.I., Akimkin V.G., Briko N.I., Brusina E.B. et al. The National Concept of prevention of infections associated with medical care and information material on its provisions. Nizhny Novgorod: Publishing Remedium Povolzh'e; 2012 (in Russian).
4. Mitrofanova N.N., Melnikov V.L., Babaev S.Y., Zhuravlev R.V. Analysis of environmental, clinical and epidemiological characteristics of nosocomial infections in the intensive care general hospital in Penza // Medical almanac. 2014; 2 (32): 39-42 (in Russian).
5. Orlova O.A., Akimkin V.G. Clinical and epidemiological characteristics of hospital-acquired respiratory tract infections among patients department of surgical intensive care unit // Epidemiology and Vaccinal Prevention. 2013; 2: 73 – 79 (in Russian).
6. State report On the state sanitary and epidemiological welfare of the population in the Russian Federation in 2013. // Available at: www.rospotrebnadzor.ru (in Russian).
7. Gelfand B.R., Belotserkovskii B.Z., Milyukova I.A., Gelfand E.B. et al. Epidemiological monitoring of nosocomial infections. Part II. The study of the epidemiology of nosocomial infections in Intensive care unit // Infection in surgery. 2013; 2 (11): 44-50 (in Russian)
8. Gelfand B.R., Belotserkovskii B.Z., Protsenko D.N., Rudnоv V.A. et al. Nosocomial pneumonia in surgery. Methodical recommendations // Infection and antimicrobial therapy. 2003; 5-6: 124-129 (in Russian).
9. Orlova O.A., Akimkin V.G. Assessment of the intensity of the epidemic process ventilator-associated respiratory tract infections among patients department of surgical intensive care unit // Public health and environment. 2014; 10 (259): 38-41 (in Russian).]
10. Sinopalnikov A.I., Romanov A.G. Recommendations for the management of adult patients with lower respiratory tract infections // Vrach (The Doctor). 2012; 4: 11-18 (in Russian).
11. Lobacheva G.V., Popov D.A., Rahimov A.A., Kolesnikova E.A. Ventilator-associated pneumonia in the Cardiac Intensive Care Unit // Clinical physiology of blood circulation. 2014; 3: 71-75 (in Russian).
12. Chernenkaja T.V., Borisova L.A., Aleksandrova I.V., Kosolapov D.A. Pathogens septic nosocomial infections in intensive care units hospital ambulance // Medical alphabet. 2013; 2 (12): 30-33 (in Russian).
13. Zhuravkov Ju.L., Koroleva A.A., Valjuzhenich Ja.I., Sokolov A.S. Monitoring of nosocomial infections in patients on mechanical ventilation // Military medicine. 2013; 3 (28): 41-43 (in Russian).
14. Pimenova I.V., Baharev A.V. Early diagnosis of nosocomial pneumonia in patient’s intensive care units // Medical alphabet. 2012; 1 (5): 11-16 (in Russian).
15. Nomikoz I.V., Ignatova G.L., Duhin V.A. Feature causes of ventilator-associated pneumonia in patients after neurosurgical operations // Bulletin of the Chelyabinsk Regional Clinical Hospital. 2012; 1: 65-66 (in Russian).
16. WHO Guidelines on Hand Hygiene in Health Care. World Health Organization. Geneva. 2013 // Available at: www.who.int.
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