Specific and non-specific prevention of nosocomial infections in ICU of Burn Centre and their place in multimodal control system

Abstract

The aim of the study is to evaluate the effectiveness of a number of technologies for controlling purulent-septic infections in a multi-modal system for the prevention of ICP in the ICU of a burn center. Materials and methods . Research on the basis of the ICU of burn center of City Clinical Hospital No. 40 (Yekaterinburg, Russia). To evaluate the effectiveness of the Pseudovac vaccine, a single-center, pilot, prospective, randomized, and parallel study was performed. The observation group consisted of 48 patients, of which 24 patients were included in the experimental group, and 24 – in the control group. The effectiveness was evaluated based on the frequency of hospital infections and colonization caused by P. aeruginosa. We also evaluated the characteristics of antimicrobial therapy with an assessment of the duration of antimicrobial therapy, the number of days free from antibiotic therapy, and the consumption of antibiotics. In order to evaluate the effectiveness of using detergents with probiotic effect and aerosol high-dispersion aerosol of the air-cleaning agent, the number of positive seeding of microorganisms, including pathogens with altered biochemical characteristics before and after treatment of air and hospital environment objects was analyzed. The McNemar test was used to compare relative indicators that characterize related populations. Results and discussions . In the group of unvaccinated patients, there were more hospital infections (83.0 %) than in the experimental group (70.8 %), p = 0.4936. Patients in the control group were infected and colonized with P. aeruginosa strains – 62.5 %, while in the experimental group there were 37.5 %; p = 0.1489. The need to prescribe antibiotics in the groups occurred with approximately the same frequency and was 75.0 and 79.2 % respectively; p = 1.0000. The need for prescribing anti-sinus medications was lower in the experimental group (20.8 %) compared to the control group (41.7 %); p = 0.2129. The consumption of drugs aimed at treating Pseudomonas infection in the experimental group was significantly lower and amounted to 103 compared to 190 NDDD per 1,000 bed days in the control group; p < 0.001. After aerosolization, the number of positive findings on ICU environmental objects decreased by more than two times; p < 0.001. The percentage of microorganisms with altered biochemical characteristics on the significant objects of the Department before treatment was 11.8 % (4), after treatment such microorganisms were not sown. After general cleaning with the use of cleaning probiotics, the share of positive findings in flushes from the Department’s external environment decreased by three times, or from 27 (45.8 %) to 11 (17.2 %), p < 0.001; and the share of microorganisms with altered biochemical characteristics almost four times, or from 9 (15.3 %) to 1 (1.6 %), p = 0.275. Conclusions . 1. In the system of epidemiological control of ICP in the ICU, indoor air aerosolization and cleaning of the hospital environment with the use of probiotics showed high efficiency in reducing the microbial load in the Department. 2. The Pseudovac vaccine did not significantly affect the prevalence of hospital infections in the experimental group. Most notable was a decrease in the consumption of antibacterial drugs and reduce the intake of antibiotics with antidiagonal activity in the vaccinated patients.