}

Fighting hospital infections

2007/03/01 Kortabitarte Egiguren, Irati - Elhuyar Zientzia Iturria: Elhuyar aldizkaria

Few think that it can be cured in the hospital and that there you can get sick from an infection. But sometimes this happens, and it is important to become aware of the need to reduce these infections. These infections make the patient's health worse. They are also considered indicators of hospital quality. On the other hand, it is cheaper to implement surveillance systems to prevent hospital infections than to spend on subsequent healing.
Fighting hospital infections
01/03/2007 | Kortabitarte Egiguren, Irati | Elhuyar Zientzia Komunikazioa

(Photo: Cruces Hospital)
Hospital infections are not current, they have always existed and have caused several deaths. However, by the 1960s, large hospitals in the United States became specialized groups to monitor and control hospital or nosocomial infections. Its only objective is to reduce, as far as possible, hospital infections.

Also in the Autonomous Community of the Basque Country, little by little, working groups on infections and preventive medicine were organized. Measures were taken to reduce urinary tract infections and strict aseptic measures were taken to reduce respiratory infections in intensive care units, studying air and water circuits and testing appropriate surgical techniques, among others. All this reduced the number of nosocomial infections.

Take action, essential

To reduce hospital infections there is an infection committee in each hospital. The work of this Commission is to monitor the issue and guide the general policy or regulations. On the other hand, the services of hospital microbiology and preventive medicine carry out the monitoring of all the procedures, of the anti-infectious measures adopted and, of course, of all the microorganisms that are isolated.

(Photo: Archive)

These types of commissions establish the procedures and norms of each of the tasks, adopting anti-infectious measures in all areas: where and how to wash hands, the state of the operating rooms, how to work in special care units, etc.

In addition, they establish the policy of use of antibiotics, since it is not possible to use any antibiotic, since microorganisms generate resistance. Finally, a maintenance policy is also established, such as air conditioning or water circulation.

This group of experts monitors the microorganisms that are isolated in hospitals. The reasons are analyzed and found. For example, if there are 20 patients in a high-surveillance unit, a study of the infections that occur in that unit is performed. And if, for example, they see that eight patients are infected with the same microorganism, they take measures: they do more cleaning than normal, see if the antibiotics selected to kill this microorganism are suitable or not, etc. In addition, both nurses and doctors in this unit receive training and advice on universal preventive measures.

They also analyze the state of the facilities: air filtration, water channeling, etc. Among other things, the pipe should be clean. To do this, they hyperchlorine the water or raise the water temperature. If the water temperature rises to about 60 degrees, the microorganisms present in the water die. All these measures, as well as many others, are adopted by groups of infection experts who establish criteria, procedures and standards.

Why?

Yes, measures are taken. In any case, the reflection to be made on a subject of these characteristics is: Why do infections occur in hospitals? Mikel Álvarez, manager of the Cruces Hospital, points out that for several reasons. "On the one hand, keep in mind that the hospitalized population in general is not healthy, that is, it is not in a healthy immune state. And in most cases they are more at risk of getting an infection than others."

Mikel Álvarez, Manager of Cruces Hospital.
I. Kortabitarte

"On the other hand, hospitals attack the patient's body, so to speak. For example, if the patient's skin is cut for intervention, the risk of a microorganism taking its nest and becoming infected will be higher. Undoubtedly, hospital equipment, pipe, etc. they also have a lot to say. Finally, another aspect to consider is that of drugs or antibiotics."

Many of the drugs used in hospitals weaken the person's immune system. That is, they weaken the person and, consequently, it is easier to get an infection. In addition, antibiotics cause selection. In fact, antibiotics kill microorganisms and help natural immunity to act against them, but only kill the weaker microorganisms, so to speak, while the rest -- the most powerful -- stay in the body itself. It can be said that the most evil flora survives and that hurts. In fact, this flora develops resistance and often adapts to the drugs or antibiotics used. With one example it is better understood: a few years ago penicillin served for everything and today it serves little because microorganisms have adapted.

Therefore, according to Mikel Álvarez, "antibiotics should be used rationally, because otherwise it is useless because microorganisms have the capacity to develop a defense system."

Infectious sources

The microorganisms that cause nosocomial infections depend on the patient, hospital and geographic environment. Hospital infectious causes are bacteria, fungi, viruses and parasites. In this order, the most infections cause the least.

Bacteria Staphylococcus aureus (left) and Legionella neumophila.
(Photo: C. Janice Kv/CDC; CDC/PHIL)

The most dangerous and perhaps the best known are gram-positive and gram-negative bacteria. Gram-positive bacteria, such as Staphylococcus aureus, are found in the human body. Half of the infections that occur in high-surveillance units are due to gram-positive microorganisms. Pneumonia caused by mechanical breathing and catheter infections are the most common. The gram-negative (Acinetobacter baumannii, Legionella neumophila) can be found both in the human body and in the environment. The species Acinetobacter baumannii is especially related to respiratory and urinary infections and posterior septicemias. Causes pneumonia and other infectious processes in special care rooms. These infections are often caused by respiratory devices and other monitoring systems. It has very effective mechanisms for antibiotic resistance.

As for fungi, they predominate over people who take a lot of antibiotics. The genus Candida, for example, is found in the human mouth and in the digestive tract. Known fungi of the genus Aspergillus are found in the air. They do not live in the human being, but among them. The spores of the Aspergillus mushroom are everywhere, at home, at school, in the hospital... because the air carries them with dust. In hospitals they can become a serious problem due to increased sensitivity to infections.

Aspergillus fungus often causes irreversible damage.
A. Umaran

The ventilation of operating rooms, for example, is very controlled and numerous studies have been carried out on the relationship between the operation of ventilation systems of operating rooms and acquired aspergillosis and other infectious diseases. However, there are many and varied fungi and, when they reach the right time, they are able to cause infection.

Viruses, in general, cause infections in people who have been transplanted into the hospital. This is because the immune system of these patients is weakened to prevent transplant recusal, resulting in infections with various viruses. They appear or predominate for mechanical or immune reasons. Parasite infections are minor.

In hospitals, most infections are not transmitted by air, although it is often believed to be the same. The transmission of microorganisms from one patient to another is done mainly by contact. On the other hand, many hospital diseases are endogenous. That is, each one has a series of microorganisms that, in case the immunity decreases, prevails. Therefore, it is not necessary to transmit it. It can spread with food or water. For example, Legionella bacteria, which inhabits the water, by breathing unconsciously along with water vapor, in some cases infections occur.

High risk areas

Four main types of infections can be distinguished: urinary, respiratory, surgical, and asepsis or blood.

The most common infections are those of the respiratory system after surgery.
Archive

At one time the urinary tract was widespread, according to Mikel Alvarez. Today, in most cases, surgical infections occur, which occur in operative wounds. In 2006, the number of hospital infections in Cruces Hospital was 7.63%, of which approximately 2% were surgical.

As for respiratory infections, according to 2006 data, this type of infection represented 1.8% of cases. Most of them occur in large surveillance units. In fact, patients in these rooms are in critical condition and should normally be connected to a respiratory system.

The number of infections is not the same in all parts of the body and the risk is not the same in all hospital units. Very few infections occur in the units in which mothers come to have children. In these cases people are healthy. Even if it seems to be a lie, the risk in high-surveillance units is higher. In these units, in general, one in four people is infected.

Children's units are the areas of least risk for infection. The most dangerous are large surveillance units.
Archive

They are the units of greater cleaning and special surveillance, as the name suggests. These units take stricter measures. Normally the air is filtered to ensure that the possible microorganisms present in the air have not crossed the filter. Just in case, the sick are in different rooms, more separated from each other. However, due to the poor condition of patients, it is in this unit that most infections occur. In the words of Mikel Alvarez "it is a normal process, they will be cured."

It is clear that no one will go to the hospital, but sometimes you have to go. However, after reading, do not think that this is a worrying situation. In fact, infections only occur if they are given the opportunity and work is being done to prevent options in hospitals, reducing the pathways of infection. In addition, statistical data show that hospital infections are declining year after year.

Acinetobacter baumannii, hospital opportunist
One of the microorganisms that cause hospital infections is the bacterium Acinetobacter baumannii. This is what is being investigated in the Faculty of Medicine and Dentistry of the UPV.
Acinetobacter baumannii is an opportunistic bacteria that causes serious hospital infections, such as pneumonia. It is opportunistic for attacking weakened patients. The number of patients infected with A. baumannii is not high, but the mortality of these infections is high, both because they are affected and because they are resistant to many A. baumannii antibiotics. In addition, by applying a treatment, the bacteria are able to develop their resistance to it.
In the face of this problem, it is very important to keep track of the new resistance obtained by the bacteria to know which antibiotics patients should be treated with. To carry out this study it is necessary, on the one hand, to locate and highlight the gene of the new resistance and, on the other, to know if integrones exist or not.
(Photo: LWW'S Organism Central)
Integrons are chains of resistance genes in which much of the new resistances obtained by A. baumannii are stored. The bacteria have other pathways, but the most integral is the most effective way to capture and transmit resistances. The integrons have a great mobility, all the resistances achieved by an A. baumannii are easily transmitted to others, so the species is constantly renewed and becomes more resistant.
UPV/EHU researchers have isolated and analyzed various types of A. baumannii from hospitals and found that 90% of strains have integrons. Appearance of strains resistant to current antibiotics. Researchers are now trying to detect these cases and find ways to follow up. It is about finding ways to detect early the characteristics of the resistances of these strains and to standardize and make practical these methods so that they can be used in clinics.
The current alternative is to improve control, hardening measures to prevent hospital infections. At the moment no antibiotics have been found to treat these strains of different resistance. However, they use antibiotics when possible. To achieve this, it is necessary to detect the infection in time and know the bacterial strain that has produced it. In addition, it is necessary to know the resistances of the strain causing the infection. In this sense, it is intended to implement control systems to control mortality by A. baumannii.
EPINE Research
In all hospitals there is a team of experts responsible for the daily monitoring of hospital infections. In addition, each year a specific study or follow-up is carried out, the EPINE study. This is a study on the development of the prevalence of nosocomial infections in Spanish hospitals.
The EPINE study is conducted at the end of May each year. For this research, experts choose a day when they analyze the clinical history of patients hospitalized in the hospital and extract a series of data. In short, this research serves to know the rate of hospital infection, the microorganisms responsible for these infections, where infections are located, etc. It allows comparing the interannual data of each hospital and checking whether or not the improvement measures implemented have had results. In this one-day study a kind of picture of the hospital situation is made. It also allows comparing data with other hospitals. According to all of them, local measures are then adopted.
Data on prevalence of hospital infections in Spain. EPINE 1990-2005.
According to the EPINE report, the number of hospital infections in Cruces Hospital was 8.21% in 2005. A total of 816 patients were analyzed. This data may indicate that stricter measures are adopted year after year and more attention is paid: In 2006 this value was 7.63% after 839 patients.
In hospitals in the Autonomous Community of the Basque Country the average percentage of hospital infections is 5-7%.
Kortabitarte Egiguren, Irati
Services
229
2007
Services
035
Microbiology
Article
Services

Gai honi buruzko eduki gehiago

Elhuyarrek garatutako teknologia