SAŽETAK
Intrahospitalna ili bolnička infekcija je svaka infekcija nastala za vrijeme boravka bolesnika u stacionarnim zdravstvenim ustanovama. Svaka infekcija koja nije bila prisutna, niti u inkubaciji u vrijeme primanja u bolnicu. Infekcija koja je prisutna u vrijeme primanja u bolnicu, a može se povezati sa prijašnjom hospitalizacijom.
Nastajanje, širenje infekcije u bolničkim sredinama postaje sve veći problem u današnjici. Prenošenje rezistentnih sojeva bakterija putem prljavih ruku zdravstvenih radnika jedan je od osnovnih razloga širenja infekcije. Nepravilna primjena metoda asepse i antisepse samo su neki od uzroka nastanka epidemije intrahospitalnih infekcija. Bolničke pneumonije razvijaju se u oko 15-18 % bolesnika s bolničkim infekcijama ( druga po redu najčešća bolnička infekcija), a u jedinicama intenzivne njege i znatno češća. Smrtnost iznosi 20-50 %, a produžuje hospitalizaciju za 4-9 dana. Rizik za razvoj pneumonije u mehanički ventiliranih bolesnika je 7-10 puta veći nego u bolesnika koji ne trebaju mehaničku ventilaciju. Kod bolesnika na KMV aspiracija mikroorganizama iz predhodno koloniziranih gornjih disajnih puteva najčešći je način nastanka infekcije, ali i izravan ulazak mikroorganizama kroz endotrahealnu cijev jedan je od načina ulaska mikroorganizama u donji respiratorni trakt.Najvažniji rizični faktor za kolonizaciju, gornjih disajnih puteva uključuju i predhodne hirurške zahvate, komu, endotrahealne intubacije, česte aspiracije, pothranjenost i plasiranu nazogastričnu sondu. Izvorište mikroorganizama koji uzrokuju kolonizaciju ili infekciju još nije sasvim utemeljeno. Može biti egzogeno, npr: kontaminirani respiratorni pribor, ruke zdravstvenog osoblja te površine u jedinici intenzivnog liječenja, ili endogeno, npr: gastrointestinalni trakt.
Kod bolesnika na mehaničkoj ventilaciji lokalna odbrana domaćina umanjena je zbog prisustva endotrahealnog tubusa, što ograničava učinkovitost iskašljavanja i dovodi do mukocilijarne disfunkcije. Ako je mukocilijarna funkcija usporena, mukoza respiratornog trakta privlači bakteriju, koja se širi umjesto da se odstrani, što dovodi i do kolonizacije i do infekcije. U radu će biti prikazani podaci o redovnoj prijavi i praćenju bolničkih infekcija na Klinici za neurohirurgiju UKCS od 2009-2014.g.
Ključne riječi: infekcija, kontaminacija, kolonizacija
MODERNIZING AND CONTROL OF REPORTING OF INFECTIONS AT THE CLINIC FOR NEUROSURGERY
SUMMARY
Intra-hospital or hospital infection is any infection occurred during the stay of patients in the health institutions. Each infection which was not present, or in the incubation period at the time of the admission.An infection that is present at the time of admission, and may be associated with previous hospitalization.
The formation, the spread of infection in the hospital environment is becoming an increasing problem at present. Transmission of resistant strains of bacteria through the unclean hands of health care workers is one of the main reasons for the spread of infections. Improper application of methods of asepsis and antisepsis are just some of the causes of the epidemic of intra-hospital infections.
Nosocomial pneumonia develops in approximately 15-18% of patients with nosocomial infections (the second most common hospital infection), in intensive care units and more common. The mortality rate is 20-50%, and prolonged hospitalization for 4-9 days. The risk of developing pneumonia in a mechanically ventilated patients is 7-10 times higher than in patients who do not require mechanical ventilation. In patients at KMV aspiration of microorganisms from previously colonized upper respiratory tracts is the most common type of infection, and direct entry of microorganisms through the endotracheal tube is one way of entry of microorganisms into the lower respiratory tract.
Most important risk factor for colonization of the upper respiratory tract include previous surgical interventions, endotracheal intubation, frequent aspiration, malnutrition and conveyed nasogastric tube. The source of microorganisms that cause colonization or infection is not yet established. It may be exogenous, eg.contaminated respiratory equipment, unclean hands of medical personnel and surfaces in intensive care unit, or endogenous, eg.gastrointestinal tract.
In patients receiving mechanical ventilation local host defense is impaired by the presence of the endotracheal tube, which limits the efficiency of expectoration and leads to mucociliary dysfunction. If the mucociliary function is slowed, respiratory tract mucosa is attracting bacteria, extending rather than removing, which leads to colonization and infection. The paper will present data with regards to reporting and monitoring of hospital infections at the Department of Neurosurgery of the UKCS from 2009-2014.g.
Keywords: infection, contamination, colonization, infection