An infectious and inflammatory process that affects lung tissue and develops in a hospital setting, in the classification of nosological names, is defined by the term nosocomial pneumonia. A feature of the disease is a clear connection with the hospitalization of the patient, which takes from 48 to 72 hours in time. This disease is also known under the names of nosocomial or nosocomial pneumonia, and the causative agents of the infection are resistant to the effects of most antibiotics, so it is difficult to eliminate the cause of the inflammation. Often, the development of an infectious process is preceded by a long bed rest or a person being in an intensive care unit with a ventilator connected. In terms of the number of deaths, nosocomial pneumonia accounts for about 30% of all registered deaths of patients, and this problem remains relevant even with the current level of development of medicine.
The reasons
The causative agents of pneumonia are bacteria, viruses and fungi, which, despite the sanitization carried out in hospitals, remain on objects and in the external environment. Hospital pathogens are virtually immune to the effects of antimicrobial agents. They are constantly in contact with disinfectants, as a result of which resistance to antiseptics develops. Hospital infections are considered the most difficult in terms of therapy, since the choice of effective drugs is limited.
The study of the etiology of the disease made it possible to identify the most common types of pathogens that can cause the development of nosocomial pneumonia. The list is headed by the following pathogens:
- Staphylococcus aureus.
- Intestinal and Pseudomonas aeruginosa.
- Proteus.
In debilitated patients or people with immunodeficiency pathologies, pneumonia is caused by viruses of group A and B, as well as cytomegalovirus , a member of the herpes family. Nosocomial mycoplasma pneumoniae is rare and usually affects the elderly or bedridden patients. Infection is possible both through care items and during medical procedures. The presence of a number of provoking factors increases the risk of the disease:
- The presence of a focus of inflammation in the body.
- Stagnation of blood in a small circle with heart failure.
- Chronic respiratory diseases.
- Tracheal intubation, connection to a ventilator.
- Accidental aspiration of stomach contents during tube feeding of bedridden patients.
- Poor quality of hospital sanitation.
- Invasive medical procedures and examinations.
- Uncontrolled intake of antibiotics.
- Postoperative period.
- Bad habits and negative environmental conditions.
The main feature of the disease is infection of a person in a hospital setting, especially if he is forced to comply with strict bed rest for a long time or is in intensive care on mechanical ventilation.
The classification of nosocomial infections, depending on the length of hospitalization, distinguishes two main options:
- Early nosocomial pneumonia. They arise in the first 5 days from the moment of admission to the hospital and are provoked by pathogens that have already been in the human body. The most common causative agent is staphylococcus aureus.
- Late hospital pneumonia. The attachment of pathogenic microflora occurs in a hospital setting. This type of inflammation is usually triggered by Pseudomonas aeruginosa or E.coli.
The definition of the type of nosocomial pneumonia affects the choice of the standard of treatment and affects the prognosis of the disease. The most dangerous type of hospital infections is considered to be inflammatory processes that began after a long stay in the intensive care unit. With such pneumonia, the choice of drugs is limited not only by the resistance of the pathogen, but also by the serious condition of the patient.
Symptoms
The clinical manifestations of the disease depend on the type of pathogen, but the general symptoms of pneumonia remain similar for all types of infections:
- Fever, chills, sweating, decreased appetite, vomiting, aching muscles and joints are signs of growing intoxication.
- Severe chest pain, cough with profuse sputum or unproductive cough, cyanosis of the skin, feeling short of breath or the appearance of signs of asphyxia are the main symptoms of nosocomial pneumonia, the appearance of which indicates the development of a global infectious process in the lungs.
The patient’s condition is rapidly deteriorating, adults may complain of prolonged headaches, and the child develops neurological symptoms. Patients with suspected nosocomial pneumonia are contagious, are placed in a separate box, and further care and treatment is carried out only by medical personnel.
Diagnostics
The first signs of nosocomial pneumonia are similar to the manifestations of diseases caused by tumors, tuberculosis or vascular disorders in the pulmonary circulation. Hospital infections should be diagnosed as soon as possible, which will allow you to quickly begin specific therapy. For pulmonary patients, in order to differentiate various types of pathologies, it is advisable to conduct a diagnostic examination using laboratory tests and instrumental methods:
- Microscopy and bacterial culture of sputum allow you to identify the causative agent of the infection and select an antimicrobial drug.
- Urine and blood tests reveal the level of intoxication and allow you to assess the degree of damage to internal organs.
- The appointment of an X-ray examination of the lungs helps to diagnose diseases at the earliest stages and to assess the damage to the lung tissue.
Timely diagnosis reduces the risk of complications, but since it is rather difficult to choose an antibiotic for the treatment of nosocomial pneumonia, the consequences can be most severe.
Treatment
Nosocomial pneumonia is treated comprehensively. In the therapy regimen, antibiotics are used, which are chosen after determining the sensitivity of the pathogen. For combined infections, the doctor may prescribe up to 3 types of antibacterial agents, which are administered intramuscularly or intravenously. Treatment should be started as early as possible, and before the test results are obtained, it is allowed to use broad-spectrum antibiotics. The obligatory stages of the medical complex are the fight against general intoxication and the provision of support to the internal organs.
Additional measures to help treat nosocomial pneumonia are physiotherapy to cleanse the respiratory system, exercise therapy and massage, which stimulate respiratory function and increase overall resistance to infection.
Forecast
The outcome of nosocomial pneumonia largely depends on the time elapsed from the moment of infection to the start of medical procedures. The most favorable prognosis concerns patients who are conscious and with a mild course of the infectious process. By the time they are discharged, they have completely recovered without complications. The consequences of severe nosocomial pneumonia can be death and disability resulting from extensive damage to the lung tissue.
Prevention
The basis for the prevention of the occurrence of nosocomial or nosocomial pneumonia is compliance with the recommendations of sanitary and epidemiological standards and schemes for the management of severe patients:
- Wet cleaning in a hospital is carried out according to the technical prescription with the use of disinfectant solutions of the required concentration.
- The use of a ventilator and endoscopic examination methods are carried out only if necessary.
- To prevent stagnation, it is recommended to limit the period of stay of patients on strict bed rest, and for bedridden patients to carry out regular physical exercises of a passive type.
- Instruments and materials that come into contact with the human respiratory tract and the oral cavity are processed according to the existing protocol.
- Disinfectants are subject to planned replacement to exclude the development of resistance of pathogens.
Reasonable approach to prevention and timely treatment of nosocomial pneumonia allow to preserve the health of hospital patients.
