The importance of infection control implementation in medical institutions of therapeutic and surgical profiles: Ukrainian and world experience

Summary. The most common adverse events observed in hospitalized patients are adverse drug reactions, health-care associated infections (HCAIs), and surgical complications. The widespread incidence of HCAIs is reflected in many scientific studies, but data on HCAIs levels are conflicting and depend on the country where the study was conducted, the profile of the hospital or ward, the efficiency and impartiality of the registration system, etc. The aim of the study – to learn the world and Ukrainian experience of the infection control system implementation in medical institutions of therapeutic and surgical profiles by analyzing the available information and literature sources. Materials and Methods. The analysis of information resources of the Internet, international professional publications, medical database MEDLINE/PubMed for the last ten years is carried out. The method of information retrieval and analytical-comparative is applied. Results. Health-care associated infections are infections that first appear 48 hours or more after hospitalization or within 30 days after medical care. Studies conducted in high-income countries have shown that 5–15 %  of hospitalized patients acquire HCAIs, which can affect between 9 and 37 % of those admitted to intensive care units, and in Europe the prevalence of HCAIs in general hospitals profile range from 4.6 to 9.3 %. Prevention of HCAIs depends on careful implementation and adherence to infection control methods. Numerous domestic and foreign researchers point to the importance of implementing an infection control system to improve the quality and safety of medical care in hospitals. Conclusions. Despite the development of many high-tech methods, hand washing with soap or alcohol still remains the most important means of maintaining personal hygiene and preventing HCAIs. However, due to the growing number of antibiotic-resistant bacteria and the reluctance of some health professionals to implement best practices in infection control, HCAIs remain one of the leading causes of death in most countries. It is therefore important that strategic, policy and educational initiatives continue to focus on the treatment and control of these infections. This requires further practical efforts to implement the proposed measures in practice, and research that would provide evidence to justify the introduction of more effective and innovative methods of infection control

health care-associated infections, infection control, prevention, hand hygiene

https://doi.org/10.11603/bmbr.2706-6290.2021.3.12430

[1] Moskalenko VF, editor, Shevchenko OA, Garkavy SI, Derkachev  EA  et  al. Prevention of nosocomial  infections (hygienic, epidemiological and microbiological aspects): textbook. [Профілактика  внутрішньолікарняних  інфекцій (гігієнічні, епідеміологічні та мікробіологічні аспекти): навч. посіб.] Kyiv, Dnipropetrovsk; 2012. Ukrainian.

[2] Marra  AR.  Advances  in  infection  control.  Einstein (Sao  Paulo).  2016;14(1):  108-09.  DOI:  10.1590/S1679-45082016MD3433.

[3] Taran VV. [Analysis of the incidence of nosocomial infections in medical and preventive institutions of Ukraine]. Nauk visn mizhnar human univer. 2014;8: 43-8. Ukrainian.

[4] Osman MF, Askari R. Infection control in the intensive care  unit.  Surg  Clin  North  Am.  2014;94(6):  1175-94. DOI: 10.1016/j.suc.2014.08.011

[5] Menegueti MG, Canini SR, Bellissimo-Rodrigues F, Laus  AM.  Evaluation  of  Nosocomial  Infection  Control Programs in health services. Revista latino-americana de enfermagem. 2015;23 (1): 98-105. Available from: https://doi.org/10.1590/0104-1169.0113.2530

[6] Spatenkova  V,  Bradac  O,  Fackova  D  et  al.  Low incidence  of  multidrug-resistant  bacteria  and  nosocomial infection  due  to  a  preventive  multimodal  nosocomial infection control: a 10-year single centre prospective cohort study in neurocritical care. BMC Neurology. 2018;18(1): 23. Available from: https://doi.org/10.1186/s12883-018-1031-6

[7] Dzhulai OS, Siomak MO, Kiyanitsa VV, Dzhulai OO. [Some  features  of  epidemiology  and  prevention  of nosocomial infections in the Cherkasy region. Military health problems]. 2014;42 (2): 127-32. Ukrainian.

[8] Rega NI, Yastremska SO, Prykhodko VV. [Analysis of the results of bacteriological studies of patients of the intensive  care  unit  of  the  Kharkiv  municipal  health  care institution "Regional Clinical Hospital - Center for Emergency Care and Disaster Medicine" for 2017]. Medsest. 2018;4: 5-9. DOI: https://doi.org/10.11603/2411-1597.2018.4.9848. Ukrainian.

[9] Koval  GM,  Karabinyosh  SO.  [Microbiological monitoring of antibiotic resistance of the main pathogens of nosocomial infections in Transcarpathia in 2013-2014]. Probl klin pediatr. 2015;4: 15-9. Ukrainian.

[10] Salmanov  AG.  [Infection  control  in  health  care facilities].  Zhurn  holovn  med  sestry.  2012;2:  29-37. Ukrainian.

[11] Salmanov  AG.  [Infectious  safety  of  medical personnel].  Prakt  upravl  zalkad  okhoron  zdorov.  2013;1: 52-60. Ukrainian.

[12] Salmanov  AG.  [Training  of  medical  staff  in  the system  of  infection  control.  The  practice  of  personnel management in the system of infection control]. 2014;5-6: 53-59. Ukrainian.

[13] Friedman  C,  Newsom  W,  editors.  IFIC  Basic Concepts  of  Infection  Control  (Previously  published  as Infection Control: Basic Concepts and Training : 2nd edition. Northern Ireland, UK: International Federation of Infection Control; 2011.

[14] Haque  M,  Sartelli  M,  McKimm  J,  Abu  Bakar  M. Health care-associated infections – an overview. Infection and Drug Resistance. 2018;11: 2321-33. DOI: https://doi.org/10.2147/IDR.S177247

[15] Ustinov OV. [The number of nosocomial infections in Ukraine is underestimated]. Ukr med zhurn. 2016. Available from: https://www.umj.com.ua/article/94849/pokaznik-kilkosti-vnutrishnolikarnyanix-infekcij-v-ukraini-zanizhenij [Accessed October 2021]. Ukrainian.

[16] Danasekaran R, Mani G, Annadurai K. Prevention of healthcareassociated infections: protecting patients, saving lives. Int J Community Med Public Health. 2014;1(1): 67-8.

[17] Revelas  A.  Healthcare-associated  infections:  A public health problem. Niger Med J. 2012;53(2): 59-64.

[18] Multimodal strategies for successful implementation of  infection  prevention  and  infection  control.  State Institution "Public Health Center of the Ministry of Health of Ukraine". 2020 Available from: https://phc.org.ua/kontrol-zakhvoryuvan/infekciyniy-kontrol-u-zakladakh-oz/dlya-fakhivciv [Accessed October 2021]. Ukrainian.

[19] Garrouste-Orgeas M, Philippart F, Bruel C, Max A, Lau N, Misset B. Overview of medical errors and adverse events. Ann Intensive Care. 2012;2(1): 2.

[20] Johnson  NB,  Hayes  LD,  Brown  K,  Hoo  EC, Ethier  KA.  Centers  for  Disease  Control  and  Prevention (CDC).  CDC  National  Health  Report:  leading  causes  of morbidity and mortality and associated behavioral risk and protective factors-United States, 2005-2013. MMWR Suppl. 2014;63(4): 3-27.

[21] Nuvials X, Palomar M, Alvarez-Lerma F. Health-care associated infections. Patient characteristics and influence on the clinical outcome of patients admitted to ICU. Envin-Helics registry data. Intensive Care Med Exp. 2015;3(Suppl 1): A82.

[22] McLaws  ML,  Taylor  PC.  The  Hospital  Infection Standardised Surveillance (HISS) programme: analysis of a two-year pilot. J Hosp Infect. 2003;53(4): 259-67.

[23] Gandra  S.,  Ellison  R.  T.  3rd.  Modern  trends  in infection control practices in intensive care units. Journal of Intensive Care Medicine. 2014;29(6): 311-26. DOI: https://doi.org/10.1177/0885066613485215

[24] Head MG, Fitchett JR, Holmes AH, Atun R. Funding healthcareassociated  infection  research:  a  systematic analysis of UK research investments, 1997-2010. J Hosp Infect. 2014;87(2): 84-91.

[25] Martin  ET,  Kaye  KS,  Knott  C.  Diabetes  and  risk of  surgical  site  infection: A  systematic  review  and  meta-analysis. Infect Control Hosp Epidemiol. 2016;37(1): 88-99.

[26] Atilla A, Doğanay Z, Kefeli Çelik H, Demirağ MD, S Kiliç S. Central line-associated blood stream infections: characteristics and risk factors for mortality over a 5.5-year period. Turk J Med Sci. 2017;47(2): 646-52.

[27] Fu  C,  Wang  S.  Nosocomial  infection  control  in healthcare settings: Protection against emerging infectious diseases.  Infectious  diseases  of  poverty.  2016;5:  30. DOI: https://doi.org/10.1186/s40249-016-0118-9

[28] Lin KY, Cheng A, Chang YC. Central line-associated bloodstream infections among critically-ill patients in the era of bundle care. J Microbiol Immunol Infect. 2017;50(3): 339-48.

[29] Skrupky  LP,  Mcconnell  K,  Dallas  J,  Kollef  MH. A comparison  of  ventilator-associated  pneumonia  rates  as identified  according  to  the  National  Healthcare  Safety Network and American College of Chest Physicians criteria. Crit Care Med. 2012;40(1): 281-84

[30] Mathai AS, Phillips A, Isaac R. Ventilator-associated pneumonia:  A  persistent  healthcare  problem  in  Indian Intensive Care Units! Lung India. 2016;33(5): 512-16.

[31] Leelakrishna P, Karthik Rao B. A study of risk factors for catheter associated urinary tract infection. Int J Adv Med. 2018;5(2): 334-39.

[32] Tenke  P,  Mezei  T,  Bőde  I,  Köves  B.  Catheter-associated  Urinary  Tract  Infections.  Euro  Urol  Suppl. 2017;16(4): 138-43.

[33] Dudkina  OL,  Haliyash  NB.  [Principles  of  infection control  in  nursing  practice].  Medsestryn.  2016;2:  41-4. DOI: https://doi.org/10.11603/2411-1597.2016.2.7427 Ukrainian.

[34] Uralbayeva TS. [Experience in organizing infection control  in  a  children's  hospital].  Medsestryn.  2019;  2:12-5.  DOI:  https://doi.org/10.11603/2411-1597.2019.2.10191 Ukrainian.

[35] Hsu  V.  Prevention  of  health  care-associated infections. Am Fam Physician. 2014 Sep 15;90(6):377-82. Erratum in: Am Fam Physician. 2015 May 15;91(10): 676. PMID: 25251230.

[36] Ferrelliand  J,  Di  Cuccio  MH.  Sustainable  hand hygiene  efforts;  a  review  of  a  successful  campaign. Infectious  Disorders  –  DrugTargets.  2013;13(3):  169-76. DOI: https://doi.org/10.2174/1871526511313030004

[37] Yarmak  TV.  [The  practice  of  hand  hygiene  in treatment and prevention facilities - a guarantee of safety and health of patients and health professionals]. Mizhnar zhurn osvity i nauky. 2019;2(2): 60. Available from: http://nbuv.gov.ua/UJRN/intjeds_2019_2_2_47 [Accessed October 2021]. Ukrainian.

[38] Masroor  N,  Doll  M,  Tevens  M,  Bearman  G. Approaches to hand hygiene monitoring: From low to high technology approaches. Int J Infect Dis. 2017;65: 101-04. https://doi.org/10.1016/j.ijid.2017.09.031

[39] Good  hand  hygiene  by  health  workers  protects patients  from  drug  resistant  infections.  World  Health Organization. Geneva, 2014. Available from: https://www.who.int/news/item/02-05-2014-good-hand-hygiene-by-health-workers-protects-patients-from-drug-resistant-infections [Accessed October 2021].

[40] Querido MM, Aguiar L, Neves P, Pereira CC, Teixeira JP. Self-disinfecting  surfaces  and  infection  control.  Colloids Surf  B  Biointerfaces.  2019;1;178:  8-21.  DOI: 10.1016/j.colsurfb.2019.02.009

[41] Cleaning and disinfection of environmental surfaces in  the  context  of  COVID-19.  World  Health  Organization. Geneva, 2020 Available from: https://apps.who.int/iris/rest/bitstreams/1277966/retrieve [Accessed October 2021].

[42] Hagel S, Ludewig K, Frosinski J. Effectiveness of a hospitalwide educational programme for infection control to reduce the rate of health-care associated infections and related  sepsis  (ALERTS)–  methods  and  interim  results. Dtsch Med Wochenschr. 2013;138(34-35): 1717-22.

[43] Graveto J, Rebola R, Fernandes EA, Costa P. Hand hygiene: nurses' adherence after training. Revista brasileira de  enfermagem.  2018;71(3): 1189-93.  DOI:  https://doi.org/10.1590/0034-7167-2017-0239

[44] Martos-Cabrera MB, Mota-Romero E, Martos-García R. Hand  hygiene  teaching  strategies  among  nursing  staff  : А  systematic  review.  Int  J  Environ  Res  Public  Health. 2019;16(1):  3039. Available  from:  https://doi.org/10.3390/ijerph16173039

[45] Bahadur  S,  Jan  J, Younas A, Ahmad  I,  Javed  S, Amaar S, et al. Infection prevention and control practices observed by students of a medical college. J Rehman Med Inst. 2017;3(1-2): 39-46.

[46] Guidelines for infection control in health care facilities. Odessa,  2020.  Available  from:  https://healthcenter.od.ua/wp-content/uploads/2020/10/nastanova.pdf [Accessed October 2021]. Ukrainian.

[47] Diamond F. Nurse manager oversight helps maintain hand  hygiene  standards.  Infection  Control  Today.  2020 Available from: https://www.infectioncontroltoday.com/view/nurse-manager-oversight-helps-maintain-hand-hygiene-standards [Accessed October 2021].