PREVENTION AND CONTROL OF NOSOCOMIAL INFECTIONS IN OBSTETRICAL AND GYNECOLOGICAL PRACTICE - ROLE OF THE MIDWIFE
Hristina Milcheva and Rosalina Yordanova
ABSTRACT: Introduction. The problem of nosocomial infections retains its importance even now in the conditions of modern health care. "Nosocomial" is defined as any infectious process that developed as a result of or in connection with medical care for another disease. Nosocomial infections cause great health damage and significant economic, social and moral losses. A prerequisite for the occurrence and spread of nosocomial infections (intra-hospital infections - IBI) are the increasingly large-scale application of invasive treatment procedures and the mass use of antibiotics in the treatment process, as well as the reduced immune protection of patients.
This applies mostly to the risk sectors in the health care system, which include obstetrics and gynecology and neonatology departments.
Purpose of the study: To analyze the problem of prevention and control of nosocomial infections in obstetrics and gynecology practice on the basis of scientific research, normative documents and national programs and standards, and to highlight the role of the midwife in realizing this process.
Material and methods: systematic review and analysis of scientific literature, normative documents
Results and discussions: Worldwide studies show that nosocomial infections accompany medical activities and, despite all control and prevention measures, their reduction is possible to a minimum of 14% (1). Nosocomial infections account for 7% in developed and 10% in developing countries. These infections depend on the underlying disease of the patient, the availability of invasive devices, the use of antimicrobial therapy, the type of intensive care unit and the workload and training of healthcare workers, monitoring the frequency of infections. (11). According to the WHO, approximately 15% of all hospitalized patients suffer from these infections. During hospitalization, the patient is exposed to pathogens through the environment from various sources, healthcare personnel, and other infected patients (12). One of the causes of VBI is the use of outdated disinfectants, despite the availability of new and more effective ones, due to their lower cost (1). Hospital waste also serves as a potential source of pathogens, and about 20%–25% of hospital waste is classified as hazardous (12). Statistics show that about 70% of BTIs are transmitted by the hands of staff (1).The widespread use of antibiotics leads to the emergence of microorganisms resistant to antimicrobial agents. In the last two years, due to the Covid-19 pandemic, measures regarding hygienic hand washing and disinfection have been strengthened. Hand hygiene is considered a primary, key means of reducing VBI (2). Routine hand hygiene is the most important feature of infection control (6). Despite the accepted medical standard for the prevention and control of VBI, there is a lack of a universally accepted system for reporting these infections.
Conclusions: For the prevention and control of VBI, it is necessary to apply a complex (integrated approach) and the introduction of an effective monitoring and control system, as well as a package of mandatory measures. The role of the midwife (main, senior, ordinary) in carrying out preventive measures and control of VBI is extremely important, in view of the fact that she works in high-risk departments of obstetrics and gynecology practice.
Keywords: prevention, control, nosocomial infections, integrated approach, midwife's role