An Important Step in Infection Prevention: Control
In this study, the extent to which the materials such as stretchers and tables in the health centers are the source of infection and the extent to which the controls to be performed on this subject can be investigated.
As a result of the evaluation of swab samples taken from tables and stretchers used in health centers and emergency service vehicles, the number of bacteria reproduction materials was 78.3% before unannounced inspection and 30.4% after informed inspection. The difference was statistically significant (p <0.01). When these bacteria were examined, S. aureus (34.3%), E. coli (15.2%), coagulase negative staphylococci (11.1%) and Klebsiella sp. (11.1%).
Keywords: Control, Infection.
We know that there are plenty and variety of microorganisms in every environment we live. In healthy people, microorganisms in the skin, upper respiratory tract, intestinal and genital systems are called normal flora. Some microorganisms are more susceptible to disease and are called pathogenic microorganisms and when infected, they cause disease. All microorganisms can cause infection when they find the appropriate environment.
It is impossible to create a fully sterile environment to prevent infection. However, it is possible to put protective barriers between the individual and microorganisms. A protective barrier is a physical, mechanical or chemical process that prevents infection from person to person, from healthcare workers or from contaminated tools and equipment. These processes are divided into three main categories: cleaning, disinfection and sterilization. Cleaning; removal of organic and inorganic substances with the help of water, soap and detergent. Sterilization; It is the complete removal of all microorganisms from the environment by using pressurized steam, dry hot, liquid or gas chemicals and gamma radiation. Disinfection; cleaning and sterilization. In high level disinfection, all bacteria, fungi and viruses in the environment are removed except for resistant bacterial spores. In low level disinfection, vegetative forms of many viruses and bacteria die, while spores, M. tuberculosis and some viruses remain alive.
Table: Distribution of Infection Sources by Risk Groups
Risk group Object Required action
High-grade risk Instrument, equipment, liquid Sterilization
Moderate risk In contact with solid skin, disinfection
tools, equipment, bedding surgery
and inspection tables, sliders, bathtubs
Low-grade risk Constant cleaning without contact with patient
surfaces, commode, ground, wall,
It is only possible to decide when and to which objects to perform for the correct application, only by knowing the risk levels of the sources of infection. Table 1 shows the differentiation of infection sources by risk groups. As can be seen in the table, some of the materials used in health centers are at risk for infection.
In-service trainings are provided within health centers to prevent infection in both resident and mobile health units. In our country, the duties related to the prevention of infection are mostly performed by non-physician health workers and assistants. The best way to measure the effectiveness of training on infection prevention is to conduct an audit. From this point of view, we planned to perform inspection of patient examination tables, gynecological tables and injection tables in the middle-risk group. As a result of this audit, we aimed to determine the bacterial species that can be transmitted to the patients from the health center and to determine how the informed and unannounced inspections affect the flora in the environment.
Materials and Methods
On 29.12.1998, swab samples were taken from the patient stretchers in Hızır Emergency Service vehicles and injection, dressing, examination tables and gynecological tables in 10 health centers and examined on blood and EMB media. The same transactions were repeated on 24.2.1999 with prior notice. Results were evaluated by chi-square test in dependent groups.
Results
In this study, swab samples were taken from 46 places, five of which were stretchers of Hızır Emergency Service ambulances and 41 of which were used in various jobs (injection, dressing, examination) in health centers. At least one bacterial growth was observed in 36 (78.3%) of the materials according to the results of the swab samples taken in the unannounced inspection and 14 (30.4%) of the materials taken in the informed inspection. There was a statistically significant difference between the two control results at different times (p <0.01). When the bacteria isolated before the control were evaluated, S. aureus (32.9%), E. coli (14.5%) and Klebsiella sp. (14.5%), S. aureus (39.2%), coagulase negative staphylococci (26.1) and Bacillus cereus (17.5%) were isolated.
Discussion
The service provided in health centers is a team service where all health workers take part. The person in charge of this service is the physician. When this is the case, the supervision of the service provided in the health center is among the duties of the physician and the health directorate. The main purpose of the audit is to find out the deficiencies in the service provision, to determine the reasons for this and to take the necessary precautions for these reasons. The health center physician should give the necessary importance to the cleaning of the place where he / she works as well as the services provided. Otherwise, it will endanger the health of both the patients coming to the health center and the staff of the health center.
In this study, dressing, examination, injection tables and swab samples taken from Hızır Emergency Department stretchers were evaluated in two different times, unannounced and informed. In the unannounced inspection, 78.3% of the tables and stretchers were smeared, while the frequency of bacterial isolation decreased to 30.4%. According to this, bacterial contamination was detected in health centers and Hızır Emergency Department tables and stretchers. The reason for this can be explained by the lack of importance given to cleaning, the lack of sufficient number of servants to do the cleaning work, or the lack of adequate training on this subject, and the responsible physician's failure to perform the audit duties.
S. aureus was the most frequently isolated bacteria in the study. More studies on this subject
It is very related to hospital and operating room environments. Staphylococci have been shown to be among the main causes of nosocomial infections, especially in recent studies.
An important feature of staphylococci is that they are common in the community and develop resistance to most antibiotics.
Since it is known that washing with water and detergent removes 80% of the microorganisms from the environment, a simple cleaning process in the health center environment will be effective in fighting infection. The most important task in this regard falls to the health center physician. The physician must first be knowledgeable about the subject. In a study conducted by Naçar et al., They reported that the knowledge of physician candidates about preventing infection was insufficient. Physicians who do not have sufficient knowledge at the time of graduation cannot show the necessary interest in their working life and do not inform their staff enough. However, according to the results of the study, it is sufficient to reduce the bacterial contamination by more than half, even if only the control work is given importance. The decrease in bacterial contamination in the pre-informed inspection can be explained by the fact that health center employees do not perform their duties more than their ignorance.
According to these findings, it is of great benefit to prevent infection in the health center environment by educating our physicians on the subject before graduation, educating physicians with in-service trainings and monitoring them regularly.
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