Nurses could be trained to prevent nosocomial infections. At least, that's what a draft submitted for consultation by the Ministry of Health says
Courses for nosocomial infections. Photo: Shutterstock
An order project aimed at obtaining skills in “supervision, prevention and limitation of infections associated with medical care” was put into consultation by the Ministry of Health. It is addressed to healthcare assistants from healthcare-associated infection prevention services (HCAI).
The duration of the courses will be 16 weeks, of which 5 weeks of theoretical training and 11 weeks of practice. More precisely, 192 hours, of which 60 hours of theoretical training and 132 hours of practical training. An exam will be taken to complete the course. It contains a written assessment test and a skills test – project by solving practical situations. Proposed for accreditation are five training centers in Bucharest, Iasi, Cluj-Napoca, Târgu Mureș and Timisoara.
The objective of the Ministry of Health program is to educate medical assistants so that they can apply and monitor infection prevention and control measures during their current activities.
Medical assistants with the right to practice freely, with completed studies both with a license exam and without a license exam, respectively with a professional qualification certification exam, are eligible for this program. After finishing the course, they can carry out activities within the specialized departments/services of hospitals or other medical units, coordination actions (director of care, coordinators of health programs in the field), training and participation in research teams .
The manager of the “Matei Balș” Institute, Cǎtǎlin Apostolescu, applauds the initiative, but points out that assistants cannot coordinate intrahospital infection prevention programs, this being the attribute of epidemiologists and infectious disease doctors.
“Every person who works in a hospital must be trained. There are some norms that are generally valid, issued by DSP and that must be applied in all hospitals. And there is the internal control that must be done by each individual unit. Permanent training and control programs must be made“, conveys the doctor Cătălin Apostolescu.
Clean hospitals only on paper
Even though our country reports far fewer nosocomial infections than other countries in Europe, things are not as they appear on paper. And the reality of these infections associated with the medical act hit us when the hospitals had to treat the victims of the fire at the Collective Club. Perhaps, because of this, the victims of the Crevedia explosions were sent abroad for treatment.
Romania reported an average of 1% of cases of nosocomial infections, while the European average is 7%, in 2023. And the year before, a rate of 2% was reported, while the average in the European Union was 8%
However, we will not get rid of these infections anytime soon, they will even multiply, warns the manager of the “Matei Balș” Institute.
“They are an integral part of the medical record. This societal hysteria that you go to the hospital and leave with an infection is greatly exaggerated and logic tells us that, in the future of medicine, there will be even more nosocomial infections. There are three main reasons why there will be more and more. First, thanks to advances in medicine, an increasing number of immunosuppressed patients are surviving. For example, 50 years ago, a patient who was diagnosed with kidney failure was dead in a few months, if he had diabetes, he was dead in 2-3-4 years, but now such patients survive 30-40 years from the moment of diagnosis, but there are some years burdened with some risks. Then medicine is becoming more and more invasive, basically any hole that our body has, we can now go in with an instrument, and if we don't have a hole, we do. All kinds of surgeries are done, we fit prostheses of all possible kinds, there are some foreign bodies that remain in our body and which the body tries to reject. Many times, patients with prostheses or transplants are voluntarily subjected to immunosuppressive therapies. The third reason is antimicrobial resistance, which is on the rise. Anywhere in the world, at any time, a patient admitted to a hospital can get a nosocomial infection“, the doctor explained to “Adevărul”.
“Nosocomial infection is not malpractice”
The underreporting of this type of infection is also caused by the association with malpractice, doctors say.
“Nosocomial infection does not mean malpractice, although there are many lawyers who campaign for it. You can get nosocomial infection with your own germs without taking them from the hospital. Underreporting is, unfortunately, a reaction of the medical body to these accusations that are brought to them in the public space. The EU average of 7-8% means that one in 12 people admitted to a hospital get a nosocomial infection. The problem is at the level of society, to decriminalize nosocomial infection and to see it as a complication of the medical act, but which does not necessarily imply fault. I am not campaigning against those doctors or nurses who, by not following some protocols, lead to the appearance of nosocomial infections, because then we can talk about malpractice. The fact that these infections exist, and we accept this reality, does not mean that we should not make efforts to limit the rate of nosocomial infections. This is an ongoing, permanent process. It's a daily activity”adds the manager of “Matei Balș” Hospital.
Long nails – sources of infections
On the other hand, there have been cases where medical staff did not follow the rules that say long, false, nail polish and jewelry have no place in a hospital, because the risk of nosocomial infections is higher.
In 2022, 18 medical staff from the Marius Nasta Institute gave explanations in the disciplinary committee because of long nails, painted with nail polish or gel. These are nurses, nurses and resident doctors. And not only at this hospital are there problems related to hand hygiene.
The latest hand hygiene study, 2022, shows that “the hands of healthcare professionals are still the main route of transmission of pathogens responsible for such infections”.
Jeffrey Kaplan, professor of biology at American University, states: “The longer the nail, the more surface there is for microorganisms to adhere to. The studies found 32 different bacteria and 28 different fungi under the anglei”, according to USA Today.
This is because decontamination is more difficult for people with long nails.
The “Matei Balș” Institute had a partnership with the Norwegian Government to limit the spread of nosocomial infections, and in mid-February a new European program will start: EU-JAMRAI 2. This joint action of EU actors aims to “develop and implement implementation of effective unique health policies to combat antimicrobial resistance and reduce healthcare-associated infections”.
What does nosocomial infection mean?
A nosocomial infection or an infection associated with the medical act is any infectious disease that affects the patient, following hospitalization or after seeking medical assistance, or any infectious disease that affects the worker in the medical field of the health institution following the fulfillment of work obligations, regardless of the time of onset of symptoms, during or after hospitalization, according to the World Health Organization (WHO).
