改进注射后感染并发症监测系统

Y. I. Sisin, A. .. Golubkova, I. Kozlova, N. A. Ostapenko, R. R. Ahmaletdinov
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摘要

相关性。随着医疗机构治疗和诊断过程的高强度化,患者的操作负荷也随之增加,注射后感染并发症的风险也相应增加。在俄罗斯联邦,与医疗相关的感染结构中,注射后并发症在新型冠状病毒感染大流行前的过去十年中占 7.0-11.0%[1]。在 COVID-19 大流行期间,医疗护理条件的变化对注射后并发症发病率的影响问题仍有待讨论和研究。本研究的目的是对医疗机构中注射后感染并发症的流行病学特征进行描述,确定其在患者健康损失结构中的位置,以改进与医疗护理相关的感染监测系统。材料和方法分析了 1994-2022 年期间第 1、2 号 "传染病和寄生虫病发病率信息 "统计观察表和第 30 号 "医疗机构信息 "表,以及 2015-2022 年期间 101 份注射后并发症病例流行病学调查表。工作中使用了流行病学和统计学研究方法。得出结论。在研究期间,汉特-曼西民族自治区-尤格拉地区综合医院门诊机构的注射后并发症发病率为每10万人次0.10例,医院治疗为每10万人次3.85例。注射后并发症的高危人群是老年人,高危地点是手术室、疫苗接种室和神经科。脓肿在注射后并发症的结构中占主导地位(85.4%),注射后并发症最常见的部位是臀部(47.7%)。在对材料进行实验室检查时,72.9%的病例从感染灶中分离出革兰氏阳性微生物,其中比例最大的是金黄色葡萄球菌(74.3%),包括 MRSA。80.5%的注射后并发症病例需要手术治疗,其中77.8%的病例需要住院治疗。发生注射后并发症的先决条件是操作量过大、向患者开具超过 5 种药物的处方以及不遵守注射说明(占 4.8%)。监测注射后并发症之所以复杂,是因为大多数病种缺乏标准定义、故意隐瞒感染性并发症病例以及实验室诊断不完善。
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Improvement the Monitoring System for Post-Injection Infectious Complications
Relevance. The high intensity of the therapeutic and diagnostic process in medical organizations is accompanied by an increase in the manipulation load on patients and, accordingly, an increase in the risk of post-injection infectious complications. In the Russian Federation, in the structure of infections associated with medical care, post-injection complications in the last ten years before the pandemic of a new coronavirus infection occupied 7.0–11.0% [1]. The question of the impact on the prevalence of post-injection complications of medical care conditions that changed during the COVID-19 pandemic remains open for discussion and study. The purpose of this study is to give an epidemiological characterization of post–injection infectious complications in medical organizations, to determine their place in the structure of patient health losses in order to improve the monitoring system for infections associated with medical care. Materials and methods. The forms of statistical observation No. 1, 2 «Information on infectious and parasitic morbidity», No. 30 «Information on medical organizations» for the period 1994–2022, 101 forms of epidemiological investigation of cases of post-injection complications for the period 2015–2022 are analyzed. Epidemiological and statistical research methods were used in the work. Conclusions. During the study period, the prevalence of post-injection complications in outpatient polyclinic organizations of the Khanty–Mansiysk autonomous okrug – Ugra was 0.10 per 100 thousand visits and 3.85 per 100 thousand treated in hospital. The risk groups for post–injection complications were persons of older age groups, and the place of risk was procedural, vaccination rooms, and neurological departments. Abscesses prevailed in the structure of post-injection complications (85.4%), with the most frequent localization of post-injection complications in the gluteal region (47.7%). During laboratory examination of the material, gram-positive microorganisms were isolated from the focus of infection in 72.9% of cases, the largest proportion of which was Staphylococcus aureus (74.3%), including MRSA. In 80.5% of cases of post-injection complications, surgical intervention was required, including 77.8% in a hospital setting. The prerequisites for the occurrence of post-injection complications were excessive manipulation load, prescribing more than 5 drugs to patients and non-compliance with the instructions for injections in 4.8%. The complexity of monitoring post-injection complications is due to the lack of a standard definition of the case in most nosological forms, deliberate concealment of cases of infectious complications and imperfection of laboratory diagnostics.
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