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Purpose to lectures
 This lecture is dedicated to particularity to
epydemiology, hygenic base of the preventive
maintenance, the main trends of the control and
checking внутрибольничной to infections (VBI),
questions to desinfections and sterilisations in
medical-preventive institutions, problem VICH
infections, as well as on organizing and methodical
bases to activity сестринской services on preventive
maintenance внутрибольничных infection.
EPYDEMIOLOGY
VNUTRIBOLINICHNYH INFECTION
 Gospitalinaya infection (внутрибольничная infection
VBI) presents itself one of the the most actual
problems of the public health of all countries of the
world. Inflicted by her social-economic damage
enormous and it is difficult yields to определе нию.
Paradoxical, but, in spite of stupendous achievements
in the field of medical-diagnostic technology and, in
particular, technology of the stationary treatment,
problem VBI remains in modern condition one of the
most sharp, gaining all greater medical and social
value.
The Growing of the frequency VBI in modern condition
induced ком плексом factor, the main from which are:
 1. Creation large hospital complex with своеобраз ной
ecology, which define: многочисленность кон
тингента sick (mainly weakened) and медицин ского
of the personnel, constantly and closely
communicating with sick;
 the intensive миграционные processes; lock-in
окружаю щей ambiences (the chambers for sick,
cabinets for diagnostics and medical procedures):
своеобразие микробиологической харак теристики
(the circulation of the row штаммов conditionallypathogenic мик роорганизмов).
2. Shaping powerful artificial (the
артифициального) of the
mechanism of the issue of the
incitants infection, connected with
invalid's interference, medical and
диагностичес кими medical
procedure, use медицин ской
equipments.
3. The Activation natural
mechanism issues возбуди
телей infectious diseases,
particularly air-капельного and
contact-home, in condition of
the close-fitting contact sick,
medical personnel in medical
institutions.
 4. Presence of the constant big array of
the sources воз будителей infection in
the manner of patient, enterring in
стацио нар with нераспознанными
infectious disease, persons, beside ко
торых VBI accumulates on the main
disease in permanent establishment.
 and medical personnel (the carriers,
sick стертыми by forms to infections).
 5. Broad, sometimes uncontrolled
using antibiotic; not always it is enough
thought-out strategy and tactics of the
using in medical and preventive
purpose antibiotic and
химиопрепаратов promote the
appearance to medicinal stability
microorganism.
 6. Shaping beside many microorganism
внутригоспитальных штаммов,
характеризующихся plural medicinal stability,
possessing селективными advantage, high stability to
disadvantage factor surrounding ambiences (the
ultraviolet irradiation, высушиванию, action
disinfecting preparation); ed внутрибольничные
штаммы golden and эпидермального
стафилококков, синегнойной of the stick, протея,
клебсиелл, энтеробактера, row сероваров
salmonellas and others
7. Increase the contingent of the
risk patient, выхаживаемых
and cured due to achievements
of modern medicine. In past
these person were considered
doomed.
 8. Increasing the share very heavy sick,
beside which condition
неспецифических defensive power of
the organism is reduced. Increase the
specific gravity elderly sick reflects
change the age structure of the
population, growth life expectancy.
Presence in permanent establishment
of the large number детей early age is
bound, on the one hand, with
reduction
 9. The Reduction неспецифических defensive power
of the organism beside populations of the globe as a
whole on the strength of his(its) эволюционной
неподготовленности to rapidly changing condition to
lifes in connection with tempestuous research progress
(contamination surrounding ambiences, ecological
crisis, гиподинамия, stress, disadvantage influence on
organism of the noise, vibrations, magnetic flap and
other negative factor).
 10. All are a more broad use for
diagnostics and treatments of the
complex technology, needing for
person method to sterilisations. Using
instrumental medical and диагнос
слизистых shell and skin cover,
shaping "winch" for incitants infection.
 11. The Slow psychological realignment
of a part клиницистов, which as before
consider many VBI (pneumonia,
пиелонефрит, inflammatory diseases
of the skin, subdermal cellulose and
others) as неинфекционную
pathology and at an incorrect time
realize or not at all conduct necessary
preventive and
противоэпидемические of the action.
 In extensive list of the incitants VBI enter the
представи тели of the different taxonomic groups,
referring to bacteria, virus, the most simplest and
mushroom. VBI possible to split into:
 infectious diseases, caused obligate пато генными a
microorganism of the person;
 infectious diseases, caused conditionally-pathogenic
микрофлорой.
 The Epidemic process under festering-septic infection
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has a following particularities:
he runs long, is infected large number sick and
representatives of the medical personnel;
he is realized in closed (hospital) space;
exists probability of the shaping in one centre several
mechanisms of the issue: аэрозольного, contacthome and others;
as reservoir of the incitants to infections alongside
with больны ми and carrier emerges the external
ambience.
2. MAIN TREND of the CONTROL And CHECKING
VNUTRIBOLINICHNOY INFECTIONS
 The Difficulty of the fight with госпитальной infection is
defined that that her(its) level, structure and track record
are conditioned действи ем and interaction many factor.
This dictates необходи мость complex approach to her(its)
preventive maintenance. Regardless of profile of the
medical permanent establishment must be executed three
важ нейших requirements: information to minimum
possibility snowdrift to infections;
 exception внутригоспитального contamination;
 exception stand;bear infections for limits of the medical
institution.
 Epide miologicheskiy control for VBI this system of
the monitoring for track record of the epidemic
process внутрибольничных ин фекций (the disease,
носительство, летальность), фактора ми and
condition, influencing upon their spreading, analysis
and generalization to got information for development
scientifically motivated systems of the measures of the
fight and preventive maintenances.
The Purposes of the
epydemiological control:
 give the objective conclusion about epydemiological ситуа
ции on VBI in medical-preventive institution and his(its)
subdivisions and on this base to develop scientifically
обосно ванные recommendations on checking VBI;
 in good time install the trends of the epidemic process,
change этиологии VBI, connection factor risk for operative
contributing correction in established system of the
measures of the fight and preventive maintenances;
 promote the optimization preventive and противо
эпидемических action.
 Discovery sick VBI promote the following методи
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ческие acceptance:
participation (seasonly) in pass-by of the physicianклинициста;
interview with physician and nurses;
regular observation for warm-up graph;
familiarization with given antibiotic about using for
вы явления patient, getting course
антибиотикотерапии (information from drugstore,
from branch, applications for antibiotics, reception
their);
предоперационное shaving.
 The Component part of control is a spying for
sanitary-hygenic and противоэпидемическим cut in
LPU. In USA, the country of the Europe and Asia work
on preventive maintenance VBI name infectious
checking. Checking for VBI осуще ствляют the
different specialists, including physicians of the
medical profile, эпидемиологи, pharmacists while in
many country infectious checking is entrusted exactly
on высоко квалифицированный сестринский
personnel.
 The Component part of control is a spying for
sanitary-hygenic and противоэпидемическим cut in
LPU. In USA, the country of the Europe and Asia work
on preventive maintenance VBI name infectious
checking. Checking for VBI осуще ствляют the
different specialists, including physicians of the
medical profile, эпидемиологи, pharmacists while in
many country infectious checking is entrusted exactly
on высоко квалифицированный сестринский
personnel.
 The General approaches of the preventive maintenance VBI
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beside persons with иммунодефицитами discovery
possible factor risk of the development VBI before begin
main treatment; absolute observance of the general
measures of the preventive maintenance; the
reinforcement of defensive power of the organism of the
master, for what are conducted following measures:
вакцинация patient with observance corresponding to
schemes of the inoculations and evidences: vaccines
against Rzeiyotopaz aegi to5a are shown Ozhegovym sick;
вакцинация against hepetitis In sick, residing on
treatment in branch гемодиализа;
passive immunization with use иммуноглобулина at
contact with sick hepetitis А or measles;
purpose corresponding to diets;
use эубиотиков, бактериофагов;
антигеннеспецифическая иммунопрофилактика
(иммуномодуляторы).
3. HYGENIC BASE of the PREVENTIVE MAINTENANCE
VNUTRIBOLINICHNYH INFECTION
 The Preventive maintenance внутрибольничных infection
(VBI) in лечеб но-preventive institution (LPU) depends on
many factor, the most significant of them is observance ги
гиенических requirements, which are presented both to
проведе нию different manipulate, and to LPU as a whole.
The Questions of the origin and spreading VBI indissoluble
are connected with hygenic problem. So successfully
осуществ лять preventive maintenance VBI possible only
by decisions both эпи демиологических, and hygenic
problems, costing before medical-preventive institution.
Sanitary-epydemiological control for VBI be conditionally
divided: on эпиде миологический and hygenic blocks,
mutually complementing each other (refer to scheme).
PREVENTIVE INSTITUTIONS
 Protivoepidemicheskie actions in medical-профилак
тических institutions (LPU), directed on preventive
maintenance внутрибольничной to infections,
provide the desinfection an object surrounding
ambiences, counting for распро странения infectious
diseases, and sterilisation изде лий medical purpose.
 Under desinfection understand destruction
pathogenic and ус ловно-pathogenic microorganism
on surface in помеще ниях (the floor, wall, handles of
the doors, breakers, windowsill and etc), on hard
furniture, surface device, instrument, equipment,
midair premiseses, on the dishes, linen, product of the
medical purpose and subject of the care for sick,
sanitary-technical equipment, in separations sick, био
логических liquid and etc. The Sterilisation provides
destruction all type microorganism, including their
dispute, on product and in product of the medical
purpose.
 The Hydrogen peroxide (PV) and
preparations on her(its) base have a
row attractive quality absence of the
scent, ecological purity, possibility of
the using for desinfection not only, but
also for предстерилизационной
peelings and sterilisations изде лий
medical purpose. However
ингаляционное воздей ствие PV on
person is characterized 2-m class to
dangers;
 The Disinfecting facilities on base альдегидов, представ
ляющие itself ready solutions to using or fluid concoctions
("Glutaral" and "Glutaral N" Russia, "Saydeks" USA,
"Steranios 20% concentrated" France and others), use for
desinfection and sterilisations product медицин ского of the
purpose, since they possess the high activity in respect of all
type bacteria, virus, mushroom and dispute мик
роорганизмов and do not change the functional characteristic
обраба тываемых object. Because of ability альдегидов to fix
organic contamination necessary before desinfection уда лять
with surfaces product blood and other organic суб страты.
More are broadly used facility, containing, кро ме альдегидов,
четвертичные ammonium join (the HOUR), гуанидины,
неионогенные SUNG and the other components, снижаю
щие toxicity дезинфектантов and adding him washing свой
ства ("Alaminol", "Bianol" Russia, "Lizoformin 3000"
Germany, "Dekoneks 50ФФ" Switzerland).
ISSUE, CLINIC, PREVENTIVE
MAINTENANCE
 VICH-infection viral disease, caused one of the
representatives family ретровирусов. It can проте
кать and бессимптомно, and with development of the
heavy complications.
 THE AIDS DISEASE (the syndrome gained
иммунодефицита) is a terminal phase VICHinfections and is characterized выра женным by
reduction иммунитета that brings about development
оп портунистических infection, malignant
новообразова ний, defeats CNS, кахексии.
 Begin epoches of the spreading VICH-infections possible
от нести to 1981, when american centre on checking
заболе ваемости has registered the unusual growing of the
consumption препа рата for treatment pneumonia, caused
пневмоцистой. Such pneumonia it is enough rare
disease, usually she встре чается beside people with
иммуносупрессией. Then, was installed that basically
disease strikes the mans-гомосексуалис тов, drug addict,
sick hemophilia. Consequently, возбуди тель infections
can be in any liquid and экссуда тах, in composition which
enter the plasma shelters and лимфоциты, this blood,
семенная liquid, влагалищный secret, breast milk.
 The incitant disease was discovered In 1983 virus,
назван ный virus иммунодефицита person (VICH).
VICH RNA-containing virus, which particularity is
presence in him ferment inverse транскриптазы,
allowing on base RNA virus to synthesize DNK-copy,
which then внедряет ся in gene Т-хелперов and
макрофагов key hutches, from кото рых depends
protection of the organism from чужеродных
microorganism. The Mechanisms of this process
before the end not clear, however установле но that
gradual disappearance Т-хелперов and макрофагов
brings about destruction whole иммунной systems
and development mortal оппортунистических
infection and tumors.
 For issue VICH-infections particularly great importance of
the inflammation слизистых shell. So, was proved that on
фо не different infection, sending sexual by way (сифи
лиса, герпеса and etc), probability of the contamination
VICH-infection sharply increases. Modern epydemiological
иссле дованиями is installed that under casual prick by
needle зараже ние VICH occurs in 0,5% events, but risk
sharply increases under deep prick. Specifically follows to
note extremely low ве роятность contamination VICHinfection under home contact. In modern scientific
literature no nor one proved event инфицирования VICH
in family, which members пользова лись same home
subject and the dishes, as sick, helped sick under
одевании, bathing, receiving the food and etc.
CLINIC
 In Russia acts the clinical categorization VICH-инфек ции, offered by V. I.
Pokrovskim (1989). In accordance with her, I stage of the disease this
инкубационный period i.e. ла тентная phase, when some clinical
manifestations отсутст вуют moreover no and laboratory sign
инфицирования (the ан тител). Length to this stage from several months
before several years. All this time virus multiplies so медлен но that does not
recognize the иммунной system, find him(it) on this stage possible only by
means of полимеразной chain ре акции (PCR). In some cases during 2 4 ned.
after зара жения develops 3 14-days sharp, мононуклеозоподобный
syndrome, being accompanied fever, malaise, rash, артралгиями and quickly
appearing полилимфоаденопатией; in this case already through 1 3 knead i.e.
much early, происхо дит сероконверсия, all manifestations will grow still
(except полилимфо-аденопатии).
 Such a image disease reveals itself beside 15% VICH-
инфицированных and, since clinical picture gangplank with
such at mononucleosis, all sick, перенесшим this ин фекцию,
regardless of age necessary through 3 knead after begin diseases
to fix the examination on antibodies to VICH. r' II stage
продромальная, or stage primary проявле ний. The Disease
runs wave-like bright clinical signs are replaced full their
disappearance. In this stage can appear the so-called AIDS
DISEASE-associated complex set constant симптомов
developing beside VICH инфицированных; typical of AIDS
DISEASE оппортунис тические to infections and tumors are
absent. In list these ти пичных for AIDS DISEASE cliniclaboratory sign enter:
infections
 V.I.POKROVSKIY, 1989
 International categorizations, 1994
 I stage incubation Primary VICH-infection.
 The Incubation (before appearance antibody), clinical бессимптомная in 80% events.
Mononukleozopodobnyy syndrome in 15% sluchaev.
 II stage primary manifestations
 Phase А quiping infection (мононуклеозоподобный syndrome)
 phase B бессимптомная (latent)
 Phase V генерализованная лимфаденопатия
 Chronic VICH-infection
 III stage secondary diseases Subdivision on
 phase on the grounds of clinical симптомокомплекса
 phase A
 phase B
 phaseV
 VICH-infection on stage of the unrolled AIDS DISEASE.
 Antibodies cease be worked out
 IV stage terminal
LABORATORY DIAGNOSTICS
 Finding beside patient one of enumerated вы ше
clinical manifestations or instructions on contact with
VICH инфицированным allow заподозрить VICHinfection.
 Exact her(its) diagnostics possible at determination in
shelters most virus or his(its) antigen. But these
methods in consequence of сво ей дороговизны have
not got while spreading though their ис пользование
and could help discovery VICH инфицированных
already in latent phase of the disease.
 The Determination antibody to VICH is sensitive and не
дорогим method that promotes his(its) broad using. Two tests
are Used on antibodies to VICH. One of them твердофазный
иммуноферментный analysis IFA (EYZA-test), dousing high
sensitivity and specificity, од нако possible and
ложноположительные results, in connection with than at the
reception positive result analysis необ ходимо their additional
acknowledgement by means of специфи ческого of the method
Vestern-блот. Vestern-блот иммуноэлектрофоретическая
reaction, allowing reveal the antibodies, working out in organism
to squirrel VICH only. Under по лучении positive result in IFA
these tests shelters are checked back by method вестерн-блот
i.e. they are confirmed, and only after this patient consider
инфицированным VICH. Use EYZA-test for obligatory
examination донорской shelters has sharply reduced the risk of
the contamination under перелива нии shelters, but not has
quite excluded him(it) so, in accordance with recommendation
carry, blood transfusion and her(its) дериватов must be
produced on life evidences only.
TREATMENT
 While drastic remedies of the fight with VICH no. The
Majority противовирусных preparation, using in
different combination, only reduces the amount of the
viral particles in ор ганизме sick and slows the
development a disease. The Special значе ние has a
well-timed discovery оппортунистических ин
фекций and tumors that possible only in specialized
centre.
PREVENTIVE MAINTENANCE
 In Republic Uzbekistan legal base of the fight with VICH-
infection is a law About warning распростране ния in
Republic Uzbekistan diseases, caused виру сом
иммунодефицита person (VICH-infection) , establishing
confidentiality in work with VICH инфицированными by
persons and sick AIDS DISEASE. Without fall под лежат
the examination on antibodies to VICH donors shelters,
semens and organ, pregnant, patients with diseases,
передающи мися the sexual by way. All are a foreign
people, arriving in Uzbekistan more then on 3 knead, are
obliged to present the certificates about checking for VICH
at registration of the exit visa.
 Protivoepidemicheskiy mode in medical учреждени
ях is provided integer beside order, directed on
provision of safety medical manipulate, обез
вреживание biological liquids, organ and fabric. Lich
naya preventive maintenance медперсонала is
concluded in using disposable toolbox, keeping used
ма териала in special container with толстыми wall.
In no event it is impossible put on the cap on
disposable needles по сле their use. The Careful
desinfection in accordance with instruction subjects to
the toolbox an многоразового дейст вия (the surgical
instruments, эндоскопы and etc), necessary also use
the systems of the safe fence shelters.
ORGANIZING And METHODICAL BASE to ACTIVITY SESTRINSKOY
SERVICES ON PREVENTIVE MAINTENANCE VNUTRIBOLINICHNYH
INFECTION
 The Particularities of the development of the epidemic
process in condition of the permanent establishment
and value of the problem VBI for public health have
brought about making the new branch of medicine
госпитальной to epydemiology. Foreign and domestic
experience on fight with VBI witnesses: for making
efficient профилак тических programs necessary to
use scientifically обоснован ные methods and use the
knowledges and facility of all services and под
разделений LPU.