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GHID

DE SUPRAVEGHERE I CONTROLN INFECIILE NOSOCOMIALE

EDIIA I

Editarea lucrrii a fost realiat cu suportul acordat de ctre poporul american prin

intermediul Ageniei Statelor Unite pentru Devoltare Internaional (USAID).Ministerul Sntii i Proiectul Prevenirea HIV/SIDA i Hepatitelor Virale B i C poartresponsabilitate pentru coninutul acestui Ghid.Ghidul nu reflect opiniile USAID sau ale Guvernului Statelor Unite ale Americii.

Chiinu - 2008

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Ministerul sntii al republicii Moldovaproiectul usaid prevenirea Hiv/sida

i Hepatitelor virale b i c

GHID

DE SUPRAVEGHERE I CONTROLN INFECIILE NOSOCOMIALE

EDIIA I

c : V. PRISACARI,f. ., h, om m

ch 2008

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cZu 616.9-022G 49

GHIDUL DE SUPRAVEGHERE I CONTROL N INFECIILE NOSOCOMIALEa fost aprobat de ctre Consiliul de Eperi al Ministerului Sntii al Republicii Moldova,

proces-verbal nr. 5 din 28 noiembrie 2008.Coordonator tiinic principal:

v p h m, f , om m,f emg u s M Fm n tm, mg M s r M,

Consultant internaional:

lm Z h m, f , m am n r, f emg am

s i. Mh sk pg, mg g n v F r.

Receneni ociali:

v b h m, f px c n - p M p M s r M

vm cz m, f chg . 2 u s M Fm n tm,s hg M s r M

Responsabili de editarea lucrrii:

v p h m, f , om m,f emg u s M Fm n tm, s mg M s r M,

c rm m, f Mg dmc if p ag s u dz i p Hiv/sida H v b c

v a c if p ag s

u dz i p Hiv/sida H v b c

isbn 978-9975-106-19-1

Descrierea CIP a Camerei Naionale a Crii

Gh gh f m/ . .: v. p. ch.: e-v.i.srl., 2008 . 248 .

isbn 978-9975-106-19-11000 x.

616.9-022

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Gh m , m m- mg, mg, hg, mg, -gg,, g, m m .

e f z m m ag

s u dz i (usaid).M s p p Hiv/sida H v b c Gh.

Gh usaid G s u am.

e - z g G h M s rM dz . 234 29.05.2007 . 84 04.03.2008

b G vm ,

sg r vm v p s mg Ms, f emg

u s M Fm n tm,f , h m,

M amh s d m ,

l v f d s M p M s

sg og f j d p s M p M s

v s f d ag s M sf Ghgh s Ms gh f Hiv/sida,

pm- c n -p M p

c s s Ms g mg,

c n -p Mp, f , h m

f pg s mg, f Mg,img vg usMF n tm, f

, mv F s Ms gg,

f o Gg u s M Fm ,, n tm, f , h m

i o v cm n ag M

c rm Mg dm c if, p usaid /p Hiv/sida H v b c

p usaid pHH, 2008

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GHID DE SUPRAVEGHERE I CONTROL N INFECIILE NOSOCOMIALE

LISTA ABREVIERILOR

BAAR --zCDC c c b s u (a)

CMP c M pCNPMP c n -p M pDRAM z mGDAM g mHIV m mHVB h bHVC h cIMS m-IN f mISP f -ISPN f - mITU f NNIS n nm if s (sua)OMS ogz M sPDI PMD m PU SA TB zTBA zTBL z UV VHB h bVAC h cCSSIN m gh f mCS cm DS

zf z

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capitolul 1.POLITICA I STRATEGIA DE ORGANIzARE

A CONTROLULUI INFECIILOR N INSTITUIILE MEDICALE ..............9

1.1. c gh f m m- r M (v. p) ................................................9

1.2. p g gz f m (v. p) ............. 16

1.3. em gz f m. (l.v, s. og, e. b) .......................................................................................................................... 18

1.3.1DirijareasistemuluiCI...............................................................................................................................................18

1.3.2Organizareasistemuluidesupraveghereepidemiologic,studiereafactorilor deriscielaborareaplanuluidemsuri............................................................................................................19

1.3.3AsigurareaCIcuserviciidelaboratormicrobiologic...................... ...................... ....................... .................... 19

1.3.4 Implementareamsurilordeprolaxieicombatereconcrete................... ................... ................... ................... .... 19

1.3.5Suportuladministrativ..............................................................................................................................................19

1.4. cm n. s . (v.p, s.og) .................................................19

1.5. cm . s . (v. p, l. v, e.b)........... ...... ....... ....... .. 20

1.6. F mg . (v. p) ............................................................................................. 21

capitolul 2.

EPIDEMIOLOGIA INFECIILOR NOSOCOMIALE .................................... 252.1. d z f m. (v. p) ................................................................. 25

2.2. p g f m. (. pg) ........................................................... 25

2.3. emg f g m ................................................................................................. 29

2.3.1.InfeciacuHIV(t.Gheorghi)...................... ....................... ...................... ....................... ....................... ............. 29

2.3.2.Hepatiteleviraleparenterale(C.Spnu,P.Iarovoi,C.Rmi).................... ...................... ....................... .......... 36

2.4. if . ............................................................................................................................... 48

2.4.1.Infeciachirurgical.(V.Prisacari)...................... ....................... ...................... ....................... ....................... .......... 48 2.4.2.Infeciacilorrespiratoriiinferioare.(V.Prisacari)..................... ....................... ....................... ...................... ..... 57

2.4.3.Infeciacilorurinare.(V.Prisacari)....................... ....................... ...................... ....................... ...................... ....... 61

2.4.4.Infecianounscuilorialuzelor.(V.Prisacari)...................... ....................... ...................... ....................... . 65

2.5. a f m ...................................................................................................................................... 69

2.5.1.Infeciapediatric.(A.Cotelea)....................... ...................... ....................... ....................... ...................... .............. 69

2.5.2.Tuberculoza(A.Melnic,V.Crudu).................... ...................... ....................... ....................... ...................... .............. 73

2.6. e . .................................................................................................................................................. 77

2.6.1.Procedeeledeprevenieaexpuneriilarisc.(C.Spnu,P.Iarovoi,M.Apostol)..................... ...................... . 77

2.6.2.Tipuriledeaccidente(t.Gheorghia,Ec.Rotaru)...................... ...................... ....................... ....................... .... 79

2.6.3.Prevenireaaccidentelorialtortipurideexpunereprofesional(C.Spnu,P.Iarovoi,L.Iarovoi).......... 80

Cuprins

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capitolul 3.ASIGURAREA REGIMULUI SANITARO-ANTIEPIDEMIC ......................... 83

3.1. s j m m. (a. M) .................................................................... 83

3.2. dzf (m hm). (v. , e. b,) ...... ....... ....... ....... ...... ....... ....... ....... ....... ...... ..... 88

3.3. sz. (e. b, v. ) ................................................................................................................ 101

3.4. G z m. (v. p, e.lh) ...............................115

3.5. ag z m f. (v.H) ................................................132

3.6. Mz gm -m. (v. ) ....... ....... .133

capitolul 4.REzISTENA AGENILOR CAUzALI LA PREPARATELE ANTIVIRALE,ANTIBIOTICE I DEzINFECTANTE ......................................................... 151

4.1. rz . (c. s) .............................................................................................151

4.2. rz . (v. p) .............................................................................................................. 155

4.3. rz zf. (v. ) ......................................................................................................... 166

capitolul 5.IGIENA PERSONALULUI MEDICAL ......................................................... 19

5.1. ig m ( ). (e. b, v.) ....... ....... ...... ....... ....... ....... ....... ...... 169

5.2. p (pu) (e. r, Ghgh) ..........................................................177

5.3. imz m Hvb. (p.i, l. i) ....... ...... ....... ....... ....... ....... ...... ....... ... 179

5.4. M x x (l. i, e. r) ....................................................................180

5.5. c m z x (.Ghg, i.cmh) ........................182

5.6. Mz m f (c. s, t. H) ............ ..... 185

capitolul 6.CIRCUMSTANE SPECIFICE ....................................................................... 189

6.1. p gz f hg. (v.p) ..................189

6.2. p gz f gg. (v. F, v. a).................................................................................................................194

6.3. p gz f hmz. (v.p) .............200

6.4. p gz f . (.Ghgh, . pg) .............201

6.5. p gz f mg. (p. i) ....... ...... 207

6.6. p gz f f. (t. H) ....... ...... 214

6.7. p gz f . (v.p, v. a)...........................................................................................................215

6.8. p gz f m . (v. p, e. l) ................................................................................221

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capitolul 7.SUPRAVEGHERE EPIDEMIOLOGIC ........................................................ 225

7.1. s -mg s m f . (v. p, a. M)...............................................225

7.2. g, f m. (v.p) ............................................2267.3. exm m m m. (v.p) ...............................................227

7.4. og m f m (v.p, v. a) ...............................................................................................................229

ANExE ............................................................................................................. 235

ax 1. F g m m z x f Hiv h b c .......................235

ax 2. ah f m f Hiv .................................237ax 3. Fm mm fm f fx

- f Hiv ..........................................................................................................238

ax 4. Fm mm fm Hiv z z .................................................................................................................239

ax 5. F gh mg f hg .............................240

ax 6. ah mg f m ..................................................241

ax 7. p m z f m ........................243

ax 8. F gh ( m) .................................................................................................244

ax 9. F gh mg z f m ..................................................................................................245

ax 10. F gh mg z f m z ....................247

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capitolul i.POLITICA I STRATEGIA DE ORGANIzARE

A CONTROLULUI INFECIILOR

N INSTITUIILE MEDICALE

1.1 Conceptul cu privire la supravegherea i controlulinfeciilor nosocomiale n cadrul instituiilor medico-sanitaredin Republica Moldova

Acualiaea

g m f m (in) . e g, mj m, -m g m, m z m mj m (6, 7, 8, 10, 29).

cfm x oMs f m g m f, fz z z m, m f fz m m g f,

f mm mm m .cfm x oMs, f 14 m, g f

m g 8,0% - 21,0% m . e mj m m z ; 75,0%

hg (3, 4, 5, 11, 23).o m g z h b

c, f Hiv/sida, z, mz .d m m m m mx g f -

, , m, , , f . e gj f gz 300-350 z j.

r M f m m . t, m m f m -

g 66,6% hg, 16,6% - m 14,5% - (10).

fm r M m f m 2006 : hg 1,8 1000 , f g - 2,9 1000 -, z 3,9 1000 , - 6,7 1000-.

t, oMs- g m r M m f m. u f m m hg 83,16 1000 (13).

p z g f m m, g z, z fm fm.

o g, m f m m, f,

m , g f z, g m m. m, e v suam g m f (27).

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e f z f z f z m , , , m , ,j.

t, fm g in z m, g m, m j in, f m

(mj g , g m z, f , m m m , m -, m m , fm,, h .).

cm - g z 5,6 35,4 z, f , m 14,07z (9, 10, 12, 13, 22, 24), , , g m m. sua, xm, g z 5 m $ (27).

u (12) m , g m m ispn m .ch m 16-23 m , f z , mm m , m f m in . r z

f 3-4 m m.

Particularitile epidemiologice

if m fm, mg g f m m m f .

m m f f m z gg, f (j, f, f xm, g, mz,ghz, h , f Hiv .), f m -.

o z mg fm m gh mg, m m g m, mxm

f, f , in, - .d g f m g

z h b c. f m g xm F r

1997-2001 h b 3%, Hvc 0,8%, mz 2,7% (28). g s m - g (1999) f h m 84

, 61 Hvb 23 Hvc. .. . (2003) m hg f hz h b, c -mg b fm 22,343,3% .

d f - (isp) m m m mx g

m, - (4). r M m - (2002) f g 214 z m - (1). cfm .. . (2002) fm gz 3,5% f -- m (ispn).

o zz isp mm g, g . l gz 140-150 mf isp, fz -m f gm, m f m, ,gg, m, m . (10).

t, f - z gm g mgm. cfm v. p, v. s (1999) m - g , isp f 27 mgm, gmz (62,3%), gmg (34,7%), (2,8%).

o g xm isp , g z m mgm -z , g, m , m s. m, s. hy, e. , mgm g pm, K, e-

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, e, a, c, s, p, p, e, Mg. (5, 20, 25, 29).

rz g (9, 14) m fm. d 132 mgm z m - hg m 29,5% z e. , 12,9% - s. m, 9,8% - s. , 9,8% - p. g-

, 8,3% - K. m, 6,8% - s. f, 4,5% - p. m, 3,8% s. m, 1,5% a mgm.o m mj z f m z (z) -

mgm f zf.cfm m m g f fm p-

m g, xm, - 50% z z f , 75%z f gm 42% f x, mgm g a- . f z f 88% z, f fxm - 96%, fxm

88%, fx 94%, fz 78%, gm 91%, x 53%, c-tmxz 88% (23).

u f l if g emg

usMF n tm m 57,0% - z , f 70,8%, 58,7%, m 66,8%, zm 55,0%, mgz 51,0%, f 41,4%.o z f p. g. t p. g ispn - z f 97,9%, f 58,1%, mgz 69,2%, 94,1%, m

100,0%, 84,0% z. d K. m - z- 82,0%, p. g 80,0%, c 75,0%, e. 64,0%, p. m

60,0%, s. m 52,0% (15).rz (z) f g

mm hz z m, mgm , z g, , hm zf.

cfm x m 50,0% z g z m.M m g m f, z fm z x g (23).

s- r M m 33,2% f - m g g m gm, iMs gg m g 5,0 15,0%.

t, 80,0% ispn m . a, m jm ispn mz f gm.

s m 20 z f zf (E.. , 1999).

d m, r M, m, , fz m z f zf.t, g mg f mz

m mgm g z f m (Gh.c ., 2003).

am z m x z hm fm , m h hm zf.

c m g m f m f .

cfm g (2) mg z f -

f h, m mm g, hg m (14). u f m 45% m g m (15).

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f m m m m f f (m, ,h) 40,0%, (f, ) 36,5%, f m () 12,5%, f g () 10,0% mg (mz) 0,1% (22).

cfm 1500 m 17 fm 20,8-45% (27). hmg in z m, m f -

m g m (.. ., 2003). if mm f m z (17).

m, m f in - j, m, mf,, m (1).

u m hz h b c z hmz. .. . (2003) m Hvb Hvc 67,2 48,5%, -, hmz m 6 , .. . (2003) m (=0,790,66) f hmfz m

h b c hmz s.-pg.cfm m m mj in m g mg. d xm gs, fm .. . (2002) m Hvb mg 40,0%, Hvc 39,0%.

.. . (2002) m z zg m j 3,5 m m mg .

u m, z m m -- m. ch f f cMp ch. s- (2002) m 6,8%, hg 5,7%, m 6,6% mg 8,8%.

a, m - mg in. gm m f:

- m mg mg m in m g;

- m mg, . am r M fz 11 406 mg 257 mg ;

- m m mg, g .

c - x z m in m. az m, h, - f g , f hg z m,m, g , . z -gm g m, hg g,m f, mjz m z in.

o m , z, m f m g m, f. p z m . d m m f gm m m.

a fm x f in f j m m.

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g ch (F r) 5945 z h b c, g 2000-2002, 306 , 5,1%, f m(.. ., 2003).

cfm (65) m f m mHvb 77,3%, Hvc 3,3%, z 5,5%, m 1,9%, m 8,2%

g 1,8%... . (2002) 61 g 3 (1999-2001) g m Hiv. vm - 35% z f m, 25% - m, 12% f 7%- fm.

a, m z m z in mg (Hvb, Hvc, f Hiv).

t, j g f m m rM f . 2008, f, m z mg in. e m g , zf, g, z m

f m . t fm g (27) 2 4% f h .p mm g m oMs . 2005

g u m g m m g. i G gmfm z gm m m m m m g . m f, r M m 30 2006 ogz M s m f m mm g m, m hmm, f f m-, g z m.

o m r M m , f - m m f m, m f m-g , m .

d o Ms n 140 30.04.98 d f m m -x f m m mg g gz gh mg fm , z x f m mg iMs, x scr, inn, iMs c ugh.

come exene n ne anare ror a raegherea onro nfeor no-

oomae n azre e nfe nooomae. proeee erae a eneor omormeae mrre fa n ar or e n ea neeaea n meamene,nrmenar mea, aaere aare n zn e gen a e a, energe eer, a-ene n emee e anazare a aee e. n nee iMs raonae n ome reee nn n ea cMp enr eaarea azror exeonae n e ooeaz earna a Ms.

a, gz m f gh f m (iMs) m m m.

tm g g iMs m, (/ z) m .

r f iMs f : x g f, f g f g.

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p m g f zz m -m :

- g m;

- ;

- gj -;

- ;- ;

- mz z x;

- mm gm j;

- g fz g ;

- g zf z m m;

- z z m f;

- z m.

d m m f m m, f iMs g. af mm gm f m z mx m m m, h.

i x z c z z Gh gh f m M s p- usaid p Hiv/sida h b c M , - perfecionareadocumentelornaionalevizndpracticilemedicalepentruareducerisculdecontractareainfeciilornosocomialeninstituiilemedicaleisusinereaimplementri iaces-torpractici.

p z m f m:

1. e mm gm gh mg f m r M.

2. rz mz m m f m, fm .

3. imm Gh gh f m m- r M.

4. i m mg .

5. pf m mg mgm f m gz m m h.

6. ifm mg iMs cMp f mg f m, gz x m m .

7. ogz hm x m gh f m z m.

8. c z h f m f m.

9. pf mg mg mg, f , g, z g z, g . Mg mg m g z , zf z z , g z in.

10. a g mg g fm fm .

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11. imm hg hg m g g m. s- , z m hgmz m in m h.

12. pf m g , zf z m gh .

13. e z f m, mg, m z f m.

Bibliograe

1. a v., s c., Mg M. . M. cg v ig, emg M-g r M. 26-27 m, 2003. v. 2b. ch, 2003. p. 139-142.

2. v. b, v. nhf, i. c, i. pgz. c m. 1997. n 4. p. 54-55.3. ch Y.s. ug s.W., Wg c.J., l s.s. Mgm f m f f wh -

mg g qfg // J f tm. 1998. 45 (4). p. 758-764.

4. e p., r b. r M s rm. 1993. 11 b (11). p. 901-908.5. G i., v c., M i. agg. 1990. v. 31 (8 s. n). p. 529-531.6. i a. bg, g, zg, mg. 1994. v. 39. n 3-4. p.

161-167.7. Jg Z., a c., M p. . pg. bg. 1991. n 5. p. 561-564.8. M M. b lam n M. 1993. n 5. p. 719-726.9. p t, p v. a usMF n tm.v.2. pm

(g, mg mgm). ch, 2001, . 211-215.10. p v. pm f m. c m, 2005, n 3, . 47-52.11. p v., b s., p t. sgh mg m r-

M. ch, 2000. p. 29-32.12. p v., Gh p., a c., p t. cg iv g, emg, M-

g pzg r M. ch, 1997. p. 227-229.13. p v., ph a., Jh c. b am M. m,

2005, n 2, . 73-86.14. p v., p t. M. cf. usMF n

tm, 21-22 m 1998. ch, 1998. p. 180.14.p v., r e. p mg f hg. b aM.

m, 2008, 2, . 13-22.15. p v., s s. b am M. m, 2006, n

3(7), . 261-270

16. .. . , 2002, . 9-13.17. .., .. ,

. ., 2003. . 175-176.

18. .. . ,

. .-, 2003, . 55-57.

19. .., .., .., ..

. ., 2002. .30-34

20. .., .. // . . 1993.

228 .

21. .., .., . ,

. . , 2003. . 182-185.

22. .., .., .. . . .,2002, . 43-50.

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23. . // . . Ame-

rican International Health Aliance, 2003.

24. .. , ,

, . _ ., 1999. . 196-197.

25. .., .., .. ,

. . , 2003. . 97-98.26. .., .. , .. . . .,

2002, . 50-53.

27. .., .., .. . //

. ., 2002., . 53-58.

28. .., .., .. . .,

2002., . 69-73.

29. .., .. . . ,

1989. 168 .

1.2 Politica i strategia de organizare a controlului infeciilorn instituiile medicale

c m f m jm XX m gm , m , f. pmgm m f m, s u am 1950-1960, m m, g f.

f u s, r M, m pgm fm f mj 80- . t f cm m f m, 1988 f m m Ms ussp p

g f . r M g z f m --

1989, m Ms rM n 242 08.02.89 p g f , m m gz f g z m m g, m m z hzf m f. p m fm g m (fm fm n 058/) g z f z f -.

t, f 90- (v. p ., 1997) m f cMp m m 10% f m-.

u mm gh f m r M g m o Ms n 140 30.04.1998 d fm m x f m, j , mg f m, m f m, g g f m, m xm z in, g m () m z.

px, f z f m- . d m , 30%,

(a. ph, 2004), 70% z m . e j m, 2006 14 - z f m, m m m 2 10 z in .

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p z z in g g z fm f (m), - g m m .

t n 140 g f m 400 m m mg g -gz gh mg f m , f g z m m f m. mm xm . n m- f m-mg. t, x (sua, M b, a, Fr ( nzk sk-pg), .) m m f m-mg m- gz m m in. m csi j z m- -mg, gz -gh f m .

u xm iMsp icdosM c s g -

gh -mg f m, z f g gm m .n m gz m m in,

gz m fz. cm x m z in. n m cMp - z x.

ig g f - m . t, , m isp , m 2/3 z f gm, f mz m, z/z f z, z 80-90%.

p m r M f mm m- gm m f m, m :

1. H cg Ms 24.06.2000 p gz m gh fm.

2. o Ms n 53 21.03.2000 d f rM(i m , zf z m.

3. H cg Ms 26.06.2001 p gz g m iMs.

4. o Ms n 327 04.10.2005 c mm hg f m m f m

m fm.5. i m Ms n 06-4/777 24.05.1991 d gz gm -

m zf m m mg.

6. H m f r M n 18 04.09.2006 d mm i f Hiv/sida m.

7. s sgh mg f Hiv/sida Ms n 20, 19.01.2007.

M m m z, Ms n 140 30.04.1998 d f m m x

f m. e pgm gh f m m m , z m.

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rz m g m, gmm , :

gm g m ;

g m, g m;

hm m;

g z m, j.t m m.d m f 30 2006 . M gz oMs

m M s rM, m i a m d oMs , f g - m.

l 29.06.2007 c M s c c gh f m m- r M, f m . 2007-2009, m m :

e mm m gh mg f

m, , m; rz mz m, Ms n 140 30.04.1998 m f m.

e mm gh gh f m m- r M.

ogz m z m f m. i, f m mg mgm

f m. ag hm x m gh f m

. imm gm gh mg f m.

e m mm pf m.

e z f m, .

1.3 Elemente de organizare a controlului infeciilor (CI)n instituiile medico-sanitare

iMs f m , g , m- .. f . p m, gz ci iMs, fm . t, x mmf g m ci iMs.

1.3.1 Dirijarea sistemului CIog j gh in iMs Comitetul

despital(CS). i g z . cm f cs z mm 1.5.

1.3.2 Organizarea sistemului de supraveghere epidemiologic,studierea factorilor de risc i elaborarea planului de msuri

Fg h ci mg . F z mg z mm 1.6.

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1.3.3 Asigurarea CI cu servicii de laborator microbiologics gm ci g mg

gm. e f m - mg -mg. mg.p z m z g

m, m z zf. p mm m fm.

1.3.4 Implementarea msurilor de prolaxie i combatere concretecmx m ci z z mg

m m m z z . iMs m-m m g m, m m mg; m z, z zf; m .p x m f g mm , ,

f .1.3.5 Suportul administrativ

s pgm ci m, m , mmg, m gj. e m - gm ci, . d , gm gh mg m z in.n m in m - gj z f z f m. z z z .

1.4 Comitetul naional de supraveghere i control n infeciilenosocomiale. Structura i responsabilitile

j m g f m gh mg f m m , g M s z cm , :

f m in;

Ms g f, m hg,

gg, .; gh mg in.cm f m f m.

Responsabiliti

1. cz gh mg f -m.

2. ez gh f m.3. ez gm gh mg f -

m.4. ez fz m, m gh gh

f m.

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5. ez m mz z gm g-h f m.

6. ez gm z m gh f m.

7. az z () m, z f m.

1.5 Comitetul de spital. Structura i funciile

cm gh f m cs - iMs z .

m cs : (m f j m ), mmg m mg, f, g, f, hg,, , mfg. cm cs m f -g mg. e m -m g, x j m.

cs iMs.

F cm : gzz gh in iMs,

m ;

m gh mg iMs mmg, m, m, h, .;

z m cMp m g g z in;

z z IMS cMp gh in z , g z ,gzz ghz in, gm m;

zz z c m , , , mg in iMs;

z iMs, zzz , z m mg c M z ;

gzz fz m m gh mg, m x in gj ;

z f in, z z fm f;

, z z gm in iMs, , m / , g f.

imm gm in j m mg: z x iMs z in, h g -

mg g;

m , h, f mg m iMs;

m m .

cs m iMs g, fm, m hg fm, hz m-, m h, m, m.

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1.6 Funciile epidemiologului de spital

s mg in z m f emg .

c z m mm f mg iMs

Ms n 140 30.04.1998 d f m m x in. d-m , g m m in, f mg , gm, , f .

i f mg m mg -m .

s m mg , gz z m m in.

f mg m m mg.emg g mg, , gz

gh m in . ogz ,

mg .a m mg : g gh mg in , , , g,

z, m g in; z m in; fz mg m, m -m in; fz h mg z in, f z gm

m , m ; z m mg

in;

m g , g m, g ,m z m m j, f x m ;

gzz m m f, z f ;

z in, m fm cs in; gzz m in; zz m m f zf

z; cMp, m z m;

m g m ; gzz g f z m; gzz m g gh in; fz z z in , m

, f , m m z ; fz mkg zf, j g,

z ; fz m z mg z m

mz gm m m mg f;

d mg, m, f z mg :

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Dediagnosticepidemiologic,careinclude- m g mg;

- fm m f in;

-f z mg mg (gmg) mx m m in;

- g mg z in;- mg f f

;

-m g f;

- , f m g g;

-z mg z g g ;

-z m m f fm;

- fm z mg z fm cs gh in;

-f m m m in;-m m z g z .

Organizatoric gz mm mx m x f

;

z m x f ;

gzz f f m m ;

z g g;

fmz m-f m gh in;

gzz x f ; z m m x f

;

gzz mm hg in.

Metodic- m m x in,

m ;

- m x in;

-

mm mj m m x in;-fz, m , z z m g;

-g m f mg x in.

Decontrol

-fz m gm m ;

-fz xz m in, g z in;

-z m g z cs;

-fz m m , z g in;-fz m g g, z

, .;

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-fz gh mg m g- .

p m in m mg z z - (g mg) m , g f . r-z m x , m mg .

u mg g fm , , mg. rz g mg h gm m f z m in, f , -m, mg mg z m, .

a gz mg m g fm m m gm m, gz m

in, m , gz zf z ., f m in, z m m z, g m gm m .

r m f z m in m mg m g j m mg.s j m mg zz m g gh , m m mh, z f- m gm m.

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capitolul 2.EPIDEMIOLOGIA INFECIILOR NOSOCOMIALE

2.1 Denie de caz standard de infecie nosocomial

Infecienosocomial (f ) - m () f, fz z z m, m f fz m - m gf, f mm mmg, x, m .

Meniuni:1. cz f m , m

m, z mz .

2. cz mf f z , mgm z, x z m , m.

3. z f , , z mf 72 gm mm, f .

4. z , f m m 72 , x gm m , z f m.

5. if m z g g fm mgm :

z ;

z zf; m g, z.

2.2 Particularitile etiologice ale infeciilor nosocomialei caracteristica lor

s g f m z m gmz gmg, , f- fm g. u m f g , m

z.ag g f m z g:i. Mgm g (Msp) m f

m , z f m g f.

ii. Mgm g (Mcp) z f m mm, z z.

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Infecii nosocomiale i agenii cauali mai frecvent iolai

I N F E C I I A G E N I C A U z A L I

I. Infecii respiratorii (fg, ,

m, , m ..)

s. , H. z, s. yg,

s. m, p. g, M. m

K. m, lg ., ..

2. Infecii ORL (, z, , g,g, g)

v, s. yg, s. ,

s. m, p .,

H. z, M. m, c. hh

3.Infecii oculare (j, k,f)

s. , H. z, s. yg,

s. m, p. g, chmy,h, , fg

4. Infecii ale sistemului digestiv (,, g, , ha, e ..) H b, c, d, G

e. , g e,cmy, sm , s. , s. f, c. fg, b. ,

v. hmy, Y. .. h a, e, , h b, c, d, G

5. Uroinfecii (gmf, f,, )

e. , p .,p. g, s. , s. hy, e. f, s. yg, b., c, um

6. Infecii ale sistemului nervos central(mg, f, )

n. mg, s. m, H. z, M. , l. myg,

s. , , h, fg

7. Infecii inamatorii purulente(f, , , gm,m ..)

s. yg, s. , s. m, e. , p.g,

8. Infecii genitale(gf, m, g )

n. gh, chmy, p .,

e. , s. , p, umym, Fm, h,thm g, G g,

M. hm

9. Infecii de plag i combustii shy, p, pm,b ., e

10. Infecii generaliate(m, m)

s. , s. yg, s. m,

p. g, e. f, e. ., c,

H. z, p .

11. Micobacterioe(m, xm)

M. m, M. k, M. fm,

M.

12. Micoe s g ag, M, pm

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s g f m g z m- , , m m m g m z f.

Mgm g, g f zm f g: x.

v g z x m m f- m m : z g , m m m -gm , g mgm , .. dz f m.

v g x z h gm h m m. M f g g. p m m g m m. dz f mm m.

Mj mgm g z f.

Mcp m f g . F h

m , gm gz, g .p mgm g x

m m, m x g, m,, , g m, mm z.

Mj gm m m z f (z).

Mm m gz mf m m g m h m Mcp. ex m g, m m m g mgm.

dz f m f mgm, gm m m m, mz f m, z m f g, hg - m mz, gm mm m ,z z mgm, m , z m f m f g.

d m, mgm g z m m f g , , z, g (K88, cFa/i, cFa/ii..), , gx, a, g z, - xx, zm g- (z, hz, z, mgz, ffz ..). m mg-

m g hm m f g mf g gm z z, mmm, mm, hg g m m.

ex gmg f g mgm g m z g z m m m .l x x , m f m x m f z .

pg f z g m mm g g mgm, j, zm f ,z f.

pzm g f m, g

, fm fm l m mgm, a g, fg, mm. M g g (m, , , m, hg,

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, hh ..) f g m f m- (mm g) g mgm. u mx g f f z m. F m z z, zzm, mg, mm, f.

ag g zz f m m f m g. u z f fm g (, m,mm, , , mg, m, , f, j, f g, .). t g fm g: m,mg, f .. z mgm g.

t m m m-zg g f g g; xm f z m, e. , e ., -, k, f , g g.

a f z f mx; m f -h m h . if mx

gz z g m f, , f mj z s. , s. m, e. , p ., p. g, .

e f x mm, , mg g mj mgm g, z .

if m z fm z z oculuibacterian. a g z z f- f m g, f g , hg

g f, fz g h m m z z xg . x g z m

m x (x gmg, x-x x ..) z x m, mgm x zm , hm, g m , g g m m g m hx, z. smm f, h, h, z, g h . p -f.

p m mgm g h gm m g mf - .

v xm hg (m f m m m m m ) m m m . a hg xm mgm g - m m m m m mgm g.

Hg mgm g mf mj g, z , , zf, f f z, fg . a mgm m hg - g z m m z. hg g m m.

p mgm g m hg, ,

m m. a m m , hm m , m ( m m ).

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M m m m f z h m h; z m -m x.

cm m m m mf hm z, x

.v mgm g mf f-m g z f f m z m f m fm z gm m.

2.3 Epidemiologia infeciilor sanguin transmisibile

2.3.1 Infecia HIV/SIDAsm m hz (sida) z z f f m g

m, z z m f z, m mg.sida f g 1981 g

m m m m m K hmx sua.ag g sida m m (Hiv) 1983 l M-

g (F, i p) r G (sua, i n c). z m m: Hiv-1 Hiv-2. if Hiv-2 m m m m m g Hiv-1.

z, m f Hiv f m: sida f Hiv. p msida f, z z m f g, -m f , m.

sida m f m m - f m-. ag g f g , fm , g g m f - mf g m g.p Hiv, f z , adn- g, adn- m, mg adn- m z . a Hiv m f f.

ag g f Hiv, t-mf, Htlv-3. e mx, fm f, m 85220 m. x z mm g- x. , mm . p , f gm m z

, m , m m 18 25 k, z 18 25, x, g g m g, g41 g120, m fm 34, 52 68. f , m , g z , 40, 55 g160. F g-m m , zz g fHiv/sida. p Hiv m, , gg, f g f g.

l z g f Hiv f m m f z mg, . c f g m. dg mf cd4 t-h, g m m, z g g

m m. if Hiv fz , f cd4: m,mfg g m, m m , g .

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if Hiv sida mf . t zz -m , m, , Hiv f f , z f m f, , mgm g. d m m g f mgm g f g gg m.

Perioada de incubaie f Hiv ( f m mm ) 10 m m. axm 50% z, f, 24 m f, z -m f , z fm g gh. a z z 2 m, m m . t g f. d mz , , m , .

p stadiul limfoadenopatiei generalizate persistente (LGP).p mm mf m. e m mf 2 m m z, m 2 m m m, m h 2 m m. lmf- gz m f m mm f Hiv z.

s m m z m, m complexul asociat SIDA.p g.if z , , f m. s m g, 3 m m, m m 3839, f , z m, m, m m , 10% g m m. g, , m mf,m t-h/t-.

Stadiul de SIDA propriu-zis m f Hiv z z- -m m f sida- sida-, f fm f m g. d m f ( mm 170 mgm g) sida- f 13 zg, g f f (. 1).

if sida zz - g, , z -m , m .

Tabelul 1. Clasicarea agenilor infecioi SIDA indicatori

Protooare Fungi Bacterii Virusuri

txm g

i

cym

pmy

c

cy fm

Hm m

c mm

sm

Mym m mx

Mym

H mx

cymg

hm

d m mg, m sida m K. sida m zz z , f m, mg,z gz, mz. sida z mfm , mm, .

Mz sida mz g fm f g g. f m f m m, g m fm sida mf m :

1. Pulmonar:m m, gz m, m ;2. Intestinal: z, g z, fg;

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3. Cerebral: (xmz), mg (), f (),m (mfm), m ;

4. Diseminat: m K, mz, z, f mg,xmz, hz;

5. Nedifereniat: f , g, z .

19901993, ogz M s c m sua f Hiv f z z m mm mf tcd4 g (. 2).

Tabelul 2. Clasicarea stadiilor infeciei HIV la adolesceni i aduli

Cantitatea (%)de limfociteCD4 n snge

Stadiul clinic

A

Asimptomatic,acut

(primar) sau AGP

BManifest

nici A nici C

CMaladiile

SIDA -indicatoare1 500(29%)

2. 200499 (1428%)

3.

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p f Hiv m. mz mg m f- f f z f h. v m fg, , z .

r f, f m g f. l f m g (udi), , x , -

x z, g .Evoluia procesului epidemic.- , f Hiv f m, m z . pm f Hiv/sida z m m, m. cfm pgm onu/sida, m Hiv/sida 40,3 m, 38 m ( 17,5 m fm) 2,3 m . nm 2005 f 4,9 m f, 4,2 m - 700 m - 15. d m sida 25 m m, 3,1 m 2003. pm m fm f Hiv/sida.

r M f Hiv/sida m , 2007 f g 731 z f Hiv (7,41 100000 ),

2006 681 (14,72 100000 ). 19872008 f 4145 f, 1192 z e . m f ,

. c m f - g m b (685,6 100000 ) mg: G (105,34), F (58,26), sg (66,28). s- -z m c (66,31), d (66,31), rz (44,94) ..

g n f f g . t(325,66) r (339,59).

d . 2000 f f udi, m x m. af, . 2001 udi 77 % m f , - f x 20 %, 2007 udi 30,37 %, m x 68,67 %.

m m fm f 26,72% 2001 41,58 % 2007. . 2002, xm 4586 g z gh -mg m b ch, f g g Hiv f. 2003, 10863 g f g 12 fm z. d 2003 fmm g, fz : jm . rz m fm f: 2004 m f 52, 2005 71, 2006 84,2007 81. c fm mg f m f mm z. 20012007

g f Hiv f 42 .c , f Hiv fz . p f 1524 20012007 26,3 - 24,26 % m f.

c , Hiv f gz . 20012007 sida-z f g 528 f. c m z f z, Mym z, z g g, m. a sida 155 .

mg m f Hiv/sida, z- f z, f m -. cm m sida m

m.M m m sida

g gm . p m f z gm

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19952000 20012005. z zz m -z pgm n x f Hiv/sida f -m x 20062010, H G r M . 948 05.09.2005. pgm f z z m mg z gm . e m m , m m , g , x f mm f, m f, m gmz m, g , g fz g m .

2007 f f g, pm lg c xf Hiv/sida.

dg f Hiv zz -Hiv. l 90-95% f -Hiv m 3 f, 5-9%- 6 , 0,5-1% - m z. c m m 2 m f. l m sida f z, m.p mm f g g m

f g g, , j f, m. a m , m hmfz. m sida z , m.

p g z - m mj z mh -g z g f f (g. 1).

Fig. 1. Marcherii serologici ai HIV la diferite stadii ale infeciei

1 2 3 5

Incu-baie

Infeciarecent Perioada asimptimatic

Manifestriclinice

ViremiaHIV

Seroconversia complet Viremia HIV

a-Hiv igG

a-Hiv igM

ag Hiv

a-Hiv igGc ag Hiv

if Hiv

Sptmni Luni Ani

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l f, f g, mh g fHiv z g Hiv igM. m- z , z igG, g . m g g .

M g z g z mzm aiF,

elisa eia (ezym lk im ay). r M g f Hiv fz - z g, hm m, g m m. fz 14 f ,mj m . t m -fm, mxm m- .l gz fz g (4).

f m m oMs/unaids, m j f Hiv , f f g f Hiv.

Prima strategie zz g . p g xmz

g , z mzm fz . M z- g () z mh Hiv. M z z() mh Hiv. u z g z.

Strategia a doua zz gh mg, , f- g gh mg , z m g . z m g z m mzm.M z g () z mh Hiv. M z z () g - , , , mzm , m z . a , , g f, m

m. d z z, m z mh Hiv. l z g, f m g, m z mh Hiv z , f z m. l z g z xm.

Strategia a treia zz g f Hiv. agm g z . 4.

dg f Hiv mj z zz g -Hiv1 -Hiv2, , m, -Hiv1, -Hiv2 -g Hiv1. z ( 1,5-3 , z .) g zz g m-g z Hiv. g- m g zz g mg m.

c g zz : m - de screening - deconrmare. l g m g zm -Hiv. ig m z g, , m, m z z, g.

l g zz elisa m m -Hiv1 -Hiv2, , z m - m -Hiv1,-Hiv2 g Hiv1.

M g g mzm . l z g, f z m - -Hiv. p m z g mh Hiv. l

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z g m g , f, , elisa . c m f m . l z z, m g z z mh Hiv elisa. l z g - , z m z (). M g z . r

, f z z m g (z, g,, ).

Tabelul 4. Algoritmul testrii sngelui la marcherii serologici ai HIV n diagnosticulindividual al infeciei HIV/SIDA

Prima proba de snge

Negativ:Se face concluzia privind

lipsa marcherilor HIV

Prima investigaie ELISA

Pozitiv:Mostra se cerceteaz

a doua oar

A doua investigaie ELISA

Negativ:Mostra se testeaz

a treia oar

Pozitiv:Mostra se apreciaz ca

coninnd marcherii HIV.Se testeaz a II prob de

snge

Negativ:Se face concluzia

privind lipsamarcherilor HIV

Pozitiv:Mostra se apreciaz

ca coninnd marcheriai HIV. Se testeaz a II

prob de snge

A doua prob de snge

Negativ:De a eclude greelile.

La necesitate a investigaa III prob de snge

Testare ELISA

Pozitiv:Persoana se evalueaz capozitiv n ELISA, proba

se cerceteaz n testul deconrmare

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p x g, - m m g, m- , m m ., m g mzm.

z m g, m , z z, g m.

d - f z g, mjz m g g m, zz - .

M z elisa xmz m. z z z f z f Hiv.

t g , m, fz g f sida c n -p M p, csida. cz f Hiv sida m gh m mg.

2.3.2 Epidemiologia hepatitelor virale nosocomialeAcualiaea

H (Hv) m g .u m z Hv m m mm g m. sg Hv iMs m: f mxm fz-, g m , m m-m j m g m ,

, m.r m m f x Hiv, Hvb Hvc

0,3%, 10-35% 2,7% 1.

Epidemiologia hepatitelor virale n plan global

H m m m m m-. c f z m mg m XX m m m fh m mj . d h z m, h z, m g g / m, m gm oMs -

h a b, h c m g , m m z h.cfm m ogz M s (oMs) 2 m g

f h b (vHb), 350-400 m f , f h d (vHd) z f . c 170 m f h c m m 10 m h d (vHd). , f gg, 100 m z h fm, 400 m h (Hc), 700 m z h (cH) xm 300 m z m h m (cpH). af m h b (Hvb)m 500 m 1,2 m , z 9- z m 2- z m .

1 c cmm d r. vm: 27s3, sm 2001, isbn 1188-4169, Hh c. a : www.h-.g./h-g

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p f vHb g z f z3 z m. a 45% m g endemicitate nalt Hvb (f mh vHb (agHb) jg 8%, f 60% x mj m ): afsh, a s-e, bz amz.

a 43% g endemicitate medie (f ag Hb z j 2-7%, f 20-60% g : oMj, am s c, a c, e s-e.

r (12 %) endemicitate redus (f ag Hb 2%, f jg 20%: am n, e n-v, a, am s, c.

r M, m, z m , j agHb 8%.

d mg oMs z m, infeciaviralCfz 3% . d gg zz 4 : f j ag, s; j (0,2-1%) e-

, am n, a; m (1,1-5%) e, zM, a, eg. e z xm 5 m m f h c. sua z xm 3,5 m f h c, g- 150.000 z .

v h d gg g, m z gg m (z M M, e e, rm, am-z z af).

r z f h b - 15-20%, c - 85%.

Epidemiologia hepatitelor virale B, C, D n Republica Moldova

p m fm zg , h b (Hvb) g 1966 34,3 z 100.000 .

m m , g 1974 mxm 85,5 /. u 47,9 / 1979, mz fz , 76,6 / 1987. 1988 mz fz m, z, 2007 6,67 / (g.1).

Fig. 1. Dinamica morbiditii prin hepatita viral B n Republica Moldova, anii 1981-2007

v m 17 , m mm- m , f g g,

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m g h b d, 14 . af , Hvb m m 14 - 1002 z 1989 17 z 2007 60 .

a m hm m m 15 m m . d -

m m , m m . g (15 m m ) m - 1836

z 1989 222 z 2007 (17 m m ) 8 . a , m x (), m -x , .

a m , g m f f , m m , m m g f vHb g f.

z , m Hvb, m g

mj ( 0,2 100 m lxmg 1,8 o) m h , z h mh. i m h z h 772,9 1989 1693,7 2005.

Morbiditatea prin HVB acut n Republica Moldova dup vrst i sex.

u f g m f f x , m g . p m Hvb f j m, gm mm Hvb m 1994. z, g 0-2

3-6 13 (1995-2007) z 238 z . p xm m m m Hvb, 55,8% 44,2% x fm.

Hepatita Viral C

p 1989 h c (Hvc) h nanb mm f. az h c, g m f, x g , f h c.

H c, g rM 1991.

d z g 2 mz f m f 1996 1,62 / 7,6 0/, 4,7 . ,

1997, , g 2007 2,9/. z Hvc g 20-50 .

az m Hvc fm f g g m x m 52,7% 47,3% fm,- f m. a, m Hvc m m, , , m, - m m Hvb Hvd.

Hepatita viral D

p mg h d m m m f vHb, f g g h d f -

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f f m z h b M h d (Hvd) gz 1991. p , mm 0,14/ 1991 1,9/ 1997, m 0,6

/ 2007.

Fig. 2. Dinamica morbiditii prin HVC i HVD acute n Republica Moldova, anii 1991-2007

p g m Hvd . c x m f f f, Hvd f f h b c,

m m, 66,3%, 33,7% fm.

Perioada de incubaie

a) Hepatita Viral Bp m - f vHb z 45

180 z. m m Hvb 30-90 z m-m f. a .

b) Hepatita viral C Hvc, fm mj , z 14 110

z, m 28-43 z. dg mz, gm x m m g vHc.

c) Hepatita viral Dp Hvd z 21 90 z, , g, .

receptivitatea populaiei

a) Hepatita Viral Bs f vHb f

h b fm , , mmk h b: agHb, -Hb / -Hb. iz Hb-gm j

f, -Hb z m. p -Hb Hvb ; , z f vHb .

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b) Hepatita viral Cs f vHc Hvc

fm , , -Hvc g.c) Hepatita viral Dp z Hb-gm.

p f vHb vHd h d / b fm . p f vHb vHd - h b, Hb-gm.

Sursa de infecie

a) Hepatita viral Bd f v H b f fm h b

, g f vHb (agHb), - Hb-gm mmm 6 . u f z agHb m g z g vHb

(agHb). p f g 2-8 m m h b, f z f mm m h, x. F , z g, g, m g. m m mg m z udi. b- h b agHb m mg f g . G agHb z z f .

b) Hepatita viral Cd f h c (vHc) f fm h

c , vHc, z-Hcv g. d z m m, m f vHc -

f, , z z, h c, Hvc (fm ) Hvc, z m f.

a f m m m-g Hvc, m m f z -Hcv z, arnz alt . G -Hcv z z f -. b Hvc m mg f g .

c) Hepatita viral Ds f z Hvd vHd,

agHb -Hdv g m-mm 6 .

Mecanismul i cile de transmitere

a) Hepatita Viral Bl h b agHb mediilezio-

logicealeorganismului (z mm ). c m f, f Hvb, 0,00004 m, m m g m xm 0,0001 m 100 z f h b.

rz m h b, g x vHb , m-m f f . nmz g m mg

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m x m f Hvb.

Cile naturale Perinatal ().: m mm f f m ()

( z ).

Orizontal: m z h f m . Seual: m z x f.

Cile articiale Nosocomial m f m

m mj z f m .

Pacient-medic: if m f. Pacient-pacient: if f m

hm m m m m m

m- (manipulaiistomatologice,operaiichirurgicale,hemodializ,transfuziidesngesauderivatesanguine,transplantdeorgane,injecii,colectareaprobelordesngesaualtemediiziologicepentruinvestigaiidelaborator,cercetriinstrumentaleendoscopiceetc.)

Medic-pacient: f g m f. Pacient-societate: if z f m

m m m z , , fm .

Habitual-comunal m g g m h m m m m ( g: , , , mh h,

z m m .)

Caracterizarea cilor naturale de transmitere a virusului hepatitei B

Transmiterea perinataltm vHb mm f m m

m h b m - z f mxm. d fmz z f , , , f m.

p m transmitereperinatal g f g (), f , zz m . axm 98%

z f , 2% - fz g. d- agHb g cz.tm z:1. c fm m Hvb m g, m m;

2. c fm Hb ( agHb).

v m f mg.e h f z hm g 3.

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Figura 3. Evoluia i sechelele infectrii perinatale cu virusul Hepatitei B

im m vHb z m f agHb g- agHb.l f f f ( gj ) z.

Transmiterea orizontalu m z Hvb j agHb g m g- g - m z. g, z m g zg f.

tm z m f m .d m, z z . f f

m h fm agHb.Transmiterea sexualr x Hvb m. tm

z m m m, g g m-

fm , h b. a f m -m hm hx vHb x m, x agHb f b sx tm (bst). F : m hmx, g-, m f m.

Caracterizarea cilor articiale de transmitere a virusului hepatitei B

Transmiterea pacient-medicr m m . p f

vHb m z hm m x f g m m m , f x. c m , 25-30%, f - m hg m . p mm

Mama cu HBs - antigenemie

AgHBe pozitiv

Frecvena infectriiperinatale cu VHB 70-90%

Portajul cronic al VHBse dezvolt la 90%

nou-nscui

AgHBe negativ

Frecvena infectriiperinatale cu VHB 10-30%

Portajul cronic al VHBse dezvolt la 10-15%

nou-nscui

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f vHb f (5-6%). c m f zz m j, g, g ( f), g zf m.

Transmitere pacient-pacientr f m- m m m

m m r M, f h b (vHb) g 8%. if m hmz, fz g , g, m m m- m m , g, gz, , , , m .

Transmiterea medic-pacient m m (mg, gg, hg, .) - g z

m vHb m f . im m m- m m m z m f z m m mm .

z f m agHb agHb z m m ( 41) f g .

Transmiterea pacient-societate f m m f m m m m g zg gm, m z x m, f f mz z m -, m x f m.

im mg m m vHb M : i g m m m

f;

n , , m

gh gm -mg m- , ;

sm j;

tm g ;

p z m.

Calea de transmitere habitual-comunal z f m g mm fm, m , , zm ., zf z m m m z m (fz, mg .).

Factorii de risc asociai cu transmiterea VHB

) H b tfz agHb z; M m ; n mm f vHb; am g; Hmz; am m mm j; c x / h z agHb z;

p x m; exm m m, z m.

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b) Hepatita C tfz f; am g; Hmz; tm f m m m; c x / h z -Hcv z; p x m; n mm f vHc.

Controlul infeciilor cu virusuri hepatice B, C i D

v - g h b d;

sg z agHb -Hcv g, g, m ; r mxm fz gm g j;

t m agHb Hvb; ag z m m

m f; m m f m f; ogz , m, h

f m m z; e g mm x f

g ; ag , m, h m m; tm h .

PersoaneleAgHBsianti-HCVpozitivetrebuie:

s f;

s j z ;

s fm m x;

s fm m , g z;

s fm .

p m agHb -Hcv z m m.

PersoaneleAgHBsianti-HCVpozitivenutrebuie:

s z g, g, m;

s m mm m h f g ( , , , mh h, z m m .);

Prolaxia hepatitelor virale

o m m, g f,

gm, m x .

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Prolaxia specic a HVB i HVD

c m m h b mm .p Hvb :- v Hvb m mm m m z

h , z h m h.

- v Hvb m Hvd.

- Mj z z mg .px Hvb zz m: mz .Imunizarea activ m Hvb.v Hvb f m z : - -

m m g.p x f mg Hvb (HbiG).Vaccinurile derivat plasmatice (VDP) agHb, m

agHb z agHb ( , fm / m), - hx m. a

f, m -Hb(). uz m mm, hmz g.

Vaccinurile recombinant genetice: g g agHb j (shmy ). a gz agHb, hx m hm. thg g f m g gz.

Imunoglobulina specic contra HVB (IGHB) m m, z -Hb (m m 100.000 ui/m). am iGHb m mz -Hb m z x. iGHb m m 48

x vHb, m m z . p m z m3-6 . um z m x(hm x).

Vaccinuri combinate

v Hvb m cm-G (bcG), j, m (ror), Hmh z (H), hh, m (dtp-).

pm z Hvb m g m. v- m f z .

dz 10 mg, 20 mg agHb.t m m 2-8c. cg -

g g j, f mg.

am 95% .s m , m z ( > 40 ),

mm, z fm.d f mg m f : f g, hmz, Hiv,

( f, g -, hm ).

p Hvb x : f > 38,5c, h- m , m m z .ef : , g j .

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Dozajul i schemele recomandate pentru prolaxia de pre-expunere cu vaccinuri contraHVB

v Hvb m m g mh g m. p m- m dtp, , bcG j. M m , m

.d m Hvb mz z (mm) f f m -Hvb.

v m Hvb mz , f.l mm f hm Hvb m 0, 2, 4 , 0, 2, 6

, 0, 1, 5, 6 , 6, 10, 14 m, 0, 1, 2, 12 0, 1, 6 , hm rM.

p f hm 3 , mmm - x f hm 4.

d -Hb 10 mui/m f f m mj a, m f agHb.

z m 3 z m m 10 mui/m m m z m .

z hm f m , m m .

r m z m m m m g .

l mm x f m

m g.

Prolaxia post-expunere

z x f vHb, mz g img Hvb (iGHb).

Prolaxia nespecic a hepatitelor virale B, C i D

px f z x g mx m m m, h.

s x m m g g h b, c d f m, , g m m.

rz :1. t z agHb -Hcv g m, m, ,

, g;

2. r mxm z g;

3. imm fz g;

4. r mxmm m g j gm;

5. c, mj h x j zg m hm m , m ;

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6. d agHb, h mm fm f m h m m ;

7. c , hm g f f b, c, d: udi, f m , h, z, , g,

hm, Hiv/sida .8. ag h , , m, m, m hm z m z;

9. ag m hm , f;

10. tf m agHb z, z agHb , f z, m, f m .

m (fz, m, mh, h, ),x f g j -z g m z.

h, x f f - , z m.

testarea donatorilor de snge i grefe

t g g g agHb m- mzm g mm agHb 0,025- 0,1g/m. s m z g fm ( m )

z M s.s m f m m , z m mm. p -m m m pcr.

Testarea donatorilor de snge i grefe la anti-HCV

p h -Hcv m - agHb. r z 2 g Hcv (ns3 ns4).p m z z, m m.

af 1997 G rM m H .507 pgm

n m h b, c d. a pgm mm x . af - - Hvb g m m m, fm h , hmz, mfzg ..

d m f mm z g m m f, g z agHb -Hcv -m - , m m j, mz zm m f . z - m Hvb,Hvd Hvc m f m m . d m m g m g mj . m f G r M h .

1143 19 m 2007 pgm n m h b, c d 2007-2011. chz z gz x - pgm m m, g

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m , gz h , j h, , .

d x m mj z. o m m m f m.

2.4 Infeciile septico-purulente

2.4.1 Infecia chirurgical f hg f m: f

hg, f hg g, f -, f . o m f hg m f zz m f g- hg (35).

Frecvena infeciilor chirurgicalen m hg m m, f g

hg m g (9, 10, 15, 21, 31, 38).if hg m f g m.

sua, xm, f hg f m 24,0%. m 40% g m m 80% hg (11,35).

u f m m. ch, 1996-2002, f, 1301z ispn g , 66,3% hg (19, 21).

cfm hg m inspz f 5,0% 35% m (1, 7, 8, 12, 20, 22, 31, 32,33, 34, 36, 38).

F f hg m m , , g , m , g , z m.

u oMs f m m o mj a s-e (11,8% 10,0%, z), g g o (7,7 9,0%, z) (17).

sua f f hg 0,5 25,0% m , . M 9,8%, sk-pg 9,0% (35).

u f f hg m f f .. (2002),

gh 45327 hg, 20 (1980-2001) 4002 z f - m. z - f m m g 88,31,65 1000 , m f m - m m 230,8610,78 1000 .

a z m, , m hg- . ch. s- hg m f - hg 83,16 1000 8,31%0,87 ,

mg , , 74,2 7,42%1,05 (23). s- , 45,0% m g m (23, 27).

hg, xm, f z 1,8% 22,2% f

(24, 29).i f hg f hg. u f (23) m hg g m

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f hg z hg (416,66). d zg m - 224,5, hm 133,3, -m 116,2, m 83,76, hm 55,71, m 183,3, hg 58,8.

l mg m - z f z-

m-g m m f , 80,43% m . i f m -- m 130,28. m f ispn

mm 142,85. m, , m f f hg g

hg g (571,4), m x j (333,3), (157,9), -z (120,4).

if m fm mg g f m m m f. t, m g m f m f (21,22, 23).

u f (25, 26) m, mg m /m, hg g g , hg mxf gm. cfm (38) m m f gz m,

g f m , gg m.u m m mm f f a. ph (2006), -

hg m m hg m g hg (45,8%) g hg f (19,9%). d fm mf f hg f : j (10,97%), - m (7,32%), f (3,66%), (2,44%), hmm (2,44%), m g (1,22%), (1,2%).

if m z . r f hg 2% sua g 7 z , 10 z s. pg (35).

z f c r. (4) - 8 z f g 3,3 z gg 9,9 z hg g, 19,8 z hg .

z f m m ch (23) - zf hg g 11-14 z.

pg z in m m mj h m (14, 28). Mj h m g g in m m m . d xm-

M W.J. . (1992) sua m, m z in g 7,3 z, h m 3152 (t.G. em ., 1993), g m 5 10 m .

Criteriile de determinare a infeciei chirurgicale nosocomiale

i f hg g , mg m (), . d z j h m, g in. z m in m.

sm gh f m sua

m f hg.cfm f hg m 2 g: f g f -g/.

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if hg z m g, f, -m m m , f f,

m m f.if hg g m m gm

(g ), x gm g z, f

h f m (35).

Deniii de caz n infeciile chirurgicale*

Infeciachirurgicaldeplagsupercialif m z 30 z g m

g z. l m:1. s z, f m , f m

m.

2. iz mgm h , m z g f.

3. Mf m m mm f: z (), m m (m), hm(), f f g( z z z), z, z m , f z, h g hg.

4. dg f hg g m hg m.

Infeciachirurgicaldeplagprofundif m z 30 z m, m z

z z m ( , , m , z ) m , f g , f m f ( xm f m) g -z, m:

1. s m z, g .

2. dg g h hg, z m m mm f: f (>38c), z , h z z g g.

3. l xm , m , xm hg mg m f z z f.

4. dg f hg f hg m . M:1. if z f, f, gz f hg f. 2. if g/, z, gz f hg f.

Infeciachirurgicalaorganului/cavitiiif m z 30 z m, m z

z m , m f g , f m gm (g ), xz z, f h m m , m:

___________________* l z z f hg f cdc pgm

nnis sua (35)

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1. em j g . M: 1. n f hg g/ m z j g (), f m f fzm.

2. d mgm h , m g f.

3. l xm m , xm hg g, m f g .

4. dg f hg g/ hg m .

o zz insp mzm g, g . l gz 140-150 mf isp, fz -m f gm.

cfm (19) f m m ch z z ing ( 1996-2002), f - m - mf 70 . c m insp f g hg, 45,8% fm g g. a f m g: g , m g, g , , z.

if g hg f - 19,9%, 29 fm g: , , fgm, m, h-, , , , z, zm, m, g, gm , gm ,gm , gm m, , ,mm , hmm , hmm g, , - f, hmm , z, z .

if m 2,53%. d f fm m, m , m j , mm m-, , m f.

if 12,06%, g: m,mm, m, hm, m, , , g , .

if m 13,29% fm g m mj z g m.

if f 3,97% g g xg m m hm m.

if m - m 0,92% z, g

x, m, , .if m - m 0,76% z z m-

g .if h, h z m 0,76% g -

hg, , fm, , g .

Particularitile etiologice n infeciile chirurgicale nosocomiale

s f ispn z g mf , g.

ex (20, 24) mz fm. d 132 m-gm z m - hgm 29,5% z e. , 12,9% - s. m, 9,8% - s. , 9,8% - p. g, 8,3%

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- K. m, 6,8% - s. f, 4,5% - p. m, 3,8% - s. m, 1,5% - a ., 13,1% mgm.

u (27) f mg 138 m, 40% m, m mzm g f g.d 131 z 36,64% s. , 20,68% - s. m, 10,69% - p. g,

8,40% - e. , 7,63% - p. m, 3,82% - p. g, 3,05% s. yg c ., 2,29% - e . e. f, 1,53% - mgm. sua f hg - m .

fm m nnis (3) (. 1990-1996; n=17671) m f f hg z s. (20 %) gzg (14%), e . (12 %), e. (8 %), p. g (8%), e . (7%), p. m (3%),K.m (3%), (3%), c. (2%), mgm gmz (2%), b fg (2%). u z f m f h m-gm , m rhz yz, cm fg, rh h-, n f, lg mh, lg mf pm m.

a, g z f - m

mj mgm -z , g, m .d mj , mgm

z m x. t hzz z f z . am z m x z hm- fm , m , h hm zf.

m m, mj mgm, , m. t, m, z -gm z, g g, .

Patogeneza infeciei chirurgicale

if ( f) z mgm gz m-gm m mgm, f m- g m gm.

cfm c p.J. (1992) z f hg z m f:

Dozamicrobiandecontaminare

Rezistenaorganismuluipacientului=Risculdezvoltriiinfecieichirurgicale

a, z f hg z m m m gm.exm - , z f g

m mgm - gm 105-106 m.c m m zm z , f g oMs-

42 14 , m f : 13% - , 16% - , 29% - m (11, 35).

exm, m , - g z m - f hg 102-105 gm (35), f m gm.

c , f if i (22), m fm.

u mg f m m , 1-2 z hg, hm mg- . dm igM f g 58,5% - 64,0% ; igG - 39,6%-44,0%

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iga - 32,0% - 42,9% (p>0,05). nm fg f 2 mz, f m (58,53,0%) 29,61,4%.

t, , m , , - m --, f 2 m m (56,0%) z , m f m (27,9%) (p

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e m f z g mgm -gm z f . a, m g h g.

u m z g hg, h, f m-, , z z g f hg,

h m. c g z m , h, m m ( ).

Factorii de risc

p g f g, f m z f z fm.

cfm oMs- f m m in g : g m m, mj m hg z, m f, mgm z , m in (oMs).

cfm f sua (35) f z z fhg m:

Factoriasociaicupacientul v

am

d

Fm

oz

if m z

cz mgm im m,

d z

o

Factoriiasociaicupracticachirurgical th hg

i hmz

o m

tmz x

c m hg

Hx

Hm

b

pg m

d

v

sz m

pz z hg

dj hg

G m g

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r m g m f f m.

s- , f m m m m m, m (A.. ., 2003; v. p, e. r, 2008).

hmg in z m, m f -m g m.u mg f (19) insp f

m m f , m gm, (60 m ),g z, z g m, m (g), f -m, hg , m f ( 8.00-18.00), z m-g m, m. d xm,- , m - f m 3 m

g m (z, f , f g) m f g m (20,292,82% 6,190,64%, ). rm ispn 4 m m m g m

m (16,782,18% 4,010,65%, ). d m hg hg g: z f m h-g 2,05 , m - 2,80 . f g hg : z m h 1,45 , ,2,25 , 1,36 1,64 , 1,50 2,23 , g 2,07 3,00 , z 2,09 4,20 , -1,58 2,08 , hz 2,09 2,2 ; mg hg f m f 1,13 , m - 1,52 , : f hm 1,0 2,45 , f- gm 1,22 1,39 , z 1,31 1,5 , mm 1,13 2,05 ,.

d m m 14,85 z fm 24,45 z m -, 11,36 25,43 z hg m 12,33 23,47 z m .

s- m f m z f hg - z 6,050,81% f m z 8,231,20%, fm z f hg - - z 26,323,74% .

sm m f m - -. cfm (29) f g g m , 7.30 24.00, m g . a (2) mz f g

f , 24.00 8.00.p (23), (n=1606), z f hg (ispn) m m f (8.00-12.00) m (12.00-18.00), f 8,080,92% , , 8,461,09%. l 18.00 24.00 f insp 3,942,23%. l ( 24.00 8.00)m - - f .

Bibliograe

1. bj a., ch a. omz m gh mg f-. omz gh mg . e, 2000, .

268-276.2. c M.a. H if c: p p. nw-Y, 1987, . 256-265.3. c f d c p. n nm if s

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(nnis) , mmy fm o 1986 a 1996, My 1996. a fm hn nm if s (nnis) sm. am. J. if c, 1996, 24, . 380-388.

4. c r. . th f f g . JaMa, 1994, 271, . 1598-1601.5. c p.J. sg w f. i: Wwz M.J., . if d. phh:

1975; 130: 579-84.

6. c p.J. sg w f. i: Wwz M.J., if d. phh: W.b.s c, 1992, . 558-564.7. d p., v., ph a. u mg m -

m hg m. ch. M. cg. v ig, em-g Mg r. M. ch, 2003, . 2b, . 142-144.

8. i M., M-d l., c d. . sg f h sgy c f hH c Kgj. M. pg. 57(5-8), 2004, . 369-373.

9. i a. if m: , z . bg, g, zg,mg. 1994, . 39, n 3-4, . 161-167

10. Jg Z., a c., M p. . nm f g m. p-g. bg. 1991, n 5, . 561-564.

11. Hy r.W. . th w m f . a w f . am.J. emgy, 121, 1985, . 159-167.12. Km-Hm t., bk H., t a. . s f h q f

g w dh y h. if c H. em. 24(8), 2003, . 584-590.13. Kh n.n. . cm f w hg f my. M m

. Khg (Mk), 1991, . 119-123.14. Kk K.b. . th m f g f h 1990: my,

x gh f hz x . if. c. H. em., 1999, 20, . 725-730.15. M M. e q s f m. b lam

M. 1993, n 5, . 719-726.16. M W.J. . i f m m m f. i:

b J.v., bhm p.s., . H if. 3 . b: l, bw c, 1992, . 577-596.

17. My-Wh K.t. . a y f h f h-q f.J. H. if., 1988, 11 (sm a), . 43-48.

18. ph a. emg f - m m( m m. ch). tz m. ch, 2006.

19. ph a., p v. a mg f - m m m ch. a usMF n tm. ch, 2003, .1, . 337-342.

20. p t., p v. u mg f - m.

a usMF n tm. v. 2. ch, 2001, . 211-215.21. p v. pm f m. c m, 2005, n 3, . 47-52.22. p v., b s., p t. r f f m

. sgh mg m r M. ch,2000, . 29-32.

23. p v., ph a., Jh c. e mg f f- m. b aM. m. 2005, n 2, . 73-86.

24. p v., p t. s g f m - hgm. M. cf. usMF n tm. ch,1998, . 180.

24.p v., r e. p mg f hg. b a-

m m. 2008, n 2(16), . 13-22.25. p v., s v. c mg f - -

. Xv-m s j m . 1999, . 42-43.

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26. p v., s v., p t. if mg. M. cf. . usMF n tm. ch, 1999, . 195.

27. p v., s s. p mg g m.b aM. m, 2006, n 3(7), . 261-270.

28. Wk d.s. . c f m f: f y, -

, m shy f. am. J. if. c, 1988, 16, .185-192.29. Wenzel V.P. . ., 1990.

30. ..

- . . ., 2002, . 9-13.

31. .., ..

. , ,

, . ., 1999, . 116-117.

32. .., .. . ., 1993, 228 .

33. ..

.

, , , . ., 1999, . 119.34. .., ..

. . ,

, , . ., 1999, . 124-125.

35. . .

. . ., 2- . ., 2003, - 478.

36. ..

. , ,

, . ., 1999, . 196-197.

37. .., .., .. .

. ., 2002, . 53-58.

38. .., .. . ., 1989, 168 .39. .. . . .

., 1999. . 62-67.

2.4.2 Infecia cilor respiratorii inferioarecfm nnis (sua) m m f m

f ( f hg g f ), 13% 18% in (8).

r M, fm g f m

f 3,97% g m x g m hm (2). csi, r M, x f -

m f z g z m f. t m m z m z h-g z, m m,m mg (8).

u (7) f m m m f f 9,7% (. 1999), g m g 42,6%.

t f r M m hg (p v., r e., 2008) f m - f 41,5%.

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.. . (2003) z in m m 76,3% g f m.

cfm .. , .. (1999), m m m: 10 1000 , hg 15 1000, z m 54 1000 . l m m -

m : 3 z 1000, hg 7 z 47 1000 . t.G. M . (1999) 14% -m m m hg g. v m 60 .

l g f m f m, ,h, h, h, m mzm m.

Criteriile de denire a infeciilor, cilor respiratorii inferioareA) Pneumoniile nosocomiale1. pz m xm m:

) , m ;

) mgm z >105 ;

) mgm z hm ;

) z mgm g h, ;

2. l xm g - z g, , h m:) mgm 104-105 gm/m m ;

) mgm z hm ;

) z mgm g 104 -105 h, ;

) z g ;

) g igM ( ) igG ( h );f) hg m.

p , z m m: , h,, whzg, gh, m j .

B) Bronita, traheobronita, traheita (fr semne sau simptome de pneumonie).c:1. m g m z m: f

(>38c), , , m:) mgm z h h (104 105 gm/m);

) z g m .p , f m g m: f (>38c), ,

, , m: ) mgm z m h h (10 4 105 gm/m);

) z g m ;

) (igM), igG h .

C) Alte infecii ale tractului respirator inferior (abces pulmonar, empiem) trebuie sndeplineasc unul din urmtoarele criterii (1, 2 sau 3):

1. mgm f, - z m h

m, h ;2. m mm m hg xm hg;

3. m, g.

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d g g m m g m f , f f f.

cfm c c sua z mm 5,9 z, h m m m m h m in, g mx m

(1).t, fm sua, m m 13-43%. r m m m (8). .. . (1999), , z m jm m m m.

Etiologia pneumoniilor nosocomiale

pm m m f , m mx, f () mgm mz m.

c m g fm m m m-gm gmg (pm g, e ., K m, eh-h , s m, a . .). cfm nnis mg-m m 60% m m (1).

cfm (9), g z m m z K. m 19%, (m ) 19%, p.g 15%, c, e, a 8%, F, e. 4%. m jm z f f mx.

l f , m m mf s m Hmhy z. pm -

m f , m f hg g . m fg, c -

.pm lg . ag g m f

z.pm m m f

g, m f .

Patogeneza pneumoniilor nosocomiale

Mgm m m m m f, m, fg g, xg.

ag z m f f m: m, mgm zz --fg m, h z m m . e mgm hmg f.

e f, z fg mgm gmg z m m . cz m mgm gmg g m , z g

fg g m, g, f, m-gm gmg m m.dz m m m .

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Factorii de risc

Factoriiderisc,dependenidestareaorganismuluigazd: ( - );

g z;

h ; g (z gh);

m gm;

f ;

m hm... , .. (1999) z m m -

h 72,1% m m.Factoriiderisc,dependenidemediulspitalicesc:

m;

z ;

m; zf j mj gj (z , g zg, f m zg , m zg z , m , f j m ).

Factorii,cenlesnescprocesuldeaspiraieamicroorganismelor m;

hm;

h ; f z- g;

m z z;

m;

h m ;

h m -.Factorii,cempiedicevacuareanormalasputei

hg , g, gm m;

;

f z; mz.

pm m 20,8-45,0% z m (3).

Bibliograa

1. c f d c p. n nm if s(nnis) , mmy fm o 1986 a 1996, My 1996. a fm hn nm if s (nnis) sm. am. J. if. c, 1996, 24, . 380-388.

2. ph a. emg f - m m( m m. ch). tz m. ch, 2006.

3. p v., r e. p mg f hg. b aM. m. 2008, n. 2, . 13-22.

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4. .. : .

.: , , ,

. ., 1999, . 83.

5. .., .., .. -

. .:

, . -,2003, . 73-75.

6. .. . . .:

, , , . ., 1999, . 155.

7. .. .

. . ., 2002, . 43-50.

8. . .

. . ., 2- . ., 2003, 478 .

9. .., .., ..

. .: , ,

, . ., 1999, .213.

2.4.3 Infeciile tractului urinarif (itu), fm , m f-

f m r, xm, - 22,0% (5), sua 40,0% (2) f m.

z f .. i .. (2003) . Km, - in m m 25,43,2 100 j z. M f f m f (75,010,8%). m

45,515,0%, gg 30,08,4%, hg g 33,310,2%, m 17,94,7% g 7,54,2%. um m x, x h m f m g.

Mm f m- z f m.

z hz f m z m 4,5 25 z, fm F r (9) 1,0 3,0 z, fm sua. t, h m g m g z fm m 3803$ (1, 9). r M m f f. l f - f , , fm - , m f z z m (9).

Manifestrile clinice principale ale ITU

f

g hg

Criteriile de diagnosticare (deniiile)

tm f , t - m m. b m m f

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z g , g, g, f mm, m f z mm m , z , h. 43,7% z f mf, 56,3% z mm (6).

d itu m, m .if m m m mg:

mgm 105

mgm/m, z mxm 2 mgm.

Criterii de denire

A)Infeciasimptomatic z z m m:1. F (>38c), h, , 105 /

m , z m m gm ( m f m, ,f h : g, m mjj, z );

2. d m m: f (>38c), h, ,

m:) ( 20 mm3 , >3 /m, >10, 40 (10x40);) z mgm , f m Gm;) z gm ( Gm g ) m 100 gm/m mgm;

) 104 - 105 gm/m g mgm ;) m;f) g m.

p z m m: f (>38c), hm (38c), , m:) j f;

) mgm z hm ;) g m g g , mgmz, z mg, xm z;

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) g m;

) m.p , z m: f (>38c), h-

m (

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3. M m.4. cz m5. cz g. i itu f m. l

z m h, 10- z m, f z 50% z, (9). l 1000 z m 8 10 itu

(6).6. n gm () .7. t g .8. F m j h.9. t z. i itu z f m

1,9 m , z f (38,2 20,1 100 z, , (p

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8. .., .., .., ..

. . . .-.

. , 2006, . 63-68.

9. . .

. . ., 2- . ., 2003, . 167.10. .., .. . ., 1989, 168 .

2.4.4 Infecia nou-nscuilor i luzelorp m f m

m isp m.if g, z - m f m.

z (2, 3, 7) f m z 10,0-18,0 27,8-35,5% m - 6,0-9,9% z. f m m - m (17,5-21,3%), m m 2,7-3,5% z (5, 6, 11). t, F r, fm , f

f m - (. 2000) m 0,66% 6,6 1000 .cfm (6) m - z 34,9 72,5 1000, .

pg m - - z m m fmg.

Lanou-nscui: j m m

mf mg (), veziculita () fz m m , gm mg m m f j f

Laluze: f g m , z m m f j

m , , f f

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d f g m g m - z. cfm m 5% fm z zf g. u m z f fz (10).

o m f m z, g,

, . r f m m z, : 5% z 85% g, m 1-3% (1).

Criterii de diagnosticare

Infeciadeplag (z mm 2.4.1).

Endometritaem m (1 2):) mgm z h m, , ;

) j m: f (>38c), m, .

Infeciaepiziotomiei. c (1 2):) j zm;

) zm.

Infeciapereteluivaginal. c (1 2):) j g;

) g;

) mgm g z h j g,

g.Alteinfeciialetractuluireproductivfeminin (g, , f, x

m f m g). c (1,2 3):) mgm z h f;

) fm mf f m hg xm hg;

) m: f (>38c), g, , , , m:) mgm z hm;

) g m.

Infeciapielii.) , , z, f;

) m z f: , , m, hm m: mgm z , f;

mgm z hm;

z g m f;

gg, m xm m f;

igM , igG, h .

Mastita.) mgm z, mm f h j z j, ;

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) mm f m hg, xm hg;

) f (>38c), m ;

) g m.

Omfalitanou-nscutului. c (1 2):1. em / j g m m:

) mgm z h j ;

) mgm z hm;

2. em j m.

Pustulozacopiluluisubunan. c (1 2):) z m g

) z m m

Infeciacircumcizeisugarului. c (1, 2 3):

1. dj mz;2. em, m, mz mgm z

z;

3. em, m, mz mgm z f ( mgm f m m, ) g m, m m m.

Factori de risc

Pentrunou-nscui

m, g m m 1500 gm mm f hz m m g g hg

Pentruluze m f m g h g z

s- fm g m m 3 m f, mm ; 2 m f f m f mm g ( g, h g, hmg, .) 4 m f z g . c m , x,h, m m j g m 7 m f f m g (7).

f m - m j, 26-30%. m 35,0-40,0%, mf 8-10%, m 5-7%, fm gz (m, m,mg) 4,0-5,0% (11). Fgm 7-8% (7).

cfm (6) isp m fm gz 50,3%z; m h (j, ) 15,3%, mf 15,3%, 17,2%. l z m f (m, mm)

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f hg 30,1%. cfm , m isp f m, z isp 89,7% z f f z.

.. (2003) b m m fm m-f isp . d 2726 m isp m 605 z (22,80,8%). c f f 1,8 m m (390 64,52,0%),

m (215 35,52,0%), p

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Bibliograa

1. Faro S. Postpartum endometritis Infections in Pregnancy. Wiley-Liss, New-York, 1990, p. 45.

2. Genchikov L.A. et al. Current prophylaxis of nosocomial infections of neonates and puerpe-

rae. ZhMEI 3, 103-105 (1996). Cit.: . . . 2- .,

2003, . 229.

3. Musina L-T. Et al. Etiology and nosology of nosocomial pyoinammatory diseases in neonates.Rossiiskii Vestnik Perinatologii i Pediatrii 1, 39-42 (1995) Cit.: .

. . 2- ., 2003, . 229.

4. Prisacari V., Plop T. Unele aspecte epidemiologice n infeciile septico-purulente nosocomiale.

Anale tiinice USMF N. Testemianu, vol. 2, Chiinu, 2001. P. 211-215.

5. .., .., ..

. ,

. -, 2003, . 167-169.

6. .., .., ..

-

. .: ,

. .-, 2003, . 64-66.

7. .., .. . .:

. . .. , .. . ., 1993, . 103-110.

8. .. . . .

. .-. .

. , 2006, . 63-67.

9. . .

. . ., 2- . ., 2003. 478 .

10. .., ..

. .:

, . .-,2003, . 59-61.

11. .. -

. ,

. .-, 2003, . 132-133.

12. .., .., ..

- . .

, , , . .,

1999, . 172-173.

2.5 Alte infecii nosocomiale2.5.1 Infecia pediatric

if m z m z mm. p, m , g z f, z z m, z f. e-g f m z , g gmf f f, g g, , fg,. ag m m m f .

m, f x , z

gm z. c x m m g .d xm, f s m shy m , z m , -

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m. t f f m g f, m f z, f m .

if m mf f fm , f-, m, m, . n f x f . m

fm mf f m . u -mg z h mm m (Hvb, Hvc Hvd).

p f m g m f mf , fz m z z m, f mm mmg, m - f z mm .

c f , gh f m , z m m. M m , m z f m, z g (f x ), mmg m gz

f m, m gm f, . z m m m f m, zg m. p m hg m, f -m. m, f m m f g g, . f m m , z z, m m, , f g , . a, g g f. m m gmf f m. o m mm , z f , .

o g, z f m s -hm, fm m z f m gm. 1950 1960 s g m 1 f g . u, gm-g z mj f m. m m, s.mm 1 2.000 - z f m . sh , g b - f m. F g fz fg z m.

s u am, 2 6% z

f m. r f z , f m -gh . s m m m f m z, m m m g m- m g . p m, f m m . c m g , m gz m m z. r f m g . pm g 500 1.000g m , f x m f x.

F m , z z g z . m, gz-g m , m z m. s g b, s. , m, g

m g. c m gm gm-g : ehh , e . K m. rz m j . t- s. z -mz f m m-z. vm

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z -mz. rz xm z gm-g. F z m z, z f m .u xm z cm f m f m . l mmm, fg ( mg h

) g m g f m. c m m f m h ( g ), m . if m ( g) (-- -). c m m z, m m.l m - m.

p f m f , f g f . m x f m (bda), z m , f , m - m gh gm m . t, m f bda

m z f.if 0,5-5% . c , f m, f z 3, , z , m- f m f. F z f m (f m), g , f , - z, z g, h, hm, m mm gz, , , m z gm z m, m - zh- hmz - z - hm - g, m - m, f m -, m m, m m -, f fg, sida, h, g, z gm-g.

if , , m z m g m. af, sua, 25% m g m m 1.500 gm, z f . if z m -, m m m. m, g zz m m m -z, m, f f . , g g , 40% z h-m g. , m m, f - m m

m. af, gm , , z z m m z, 25% m-z z m, fm, m, m f gm m m.

s m , fm gm, hm z z, mz f , z g, y z, , j.

if - m m m. M z m, xm - g f.

if f m,

z 40% , , m , m g m m. a f m m x : , , f, g g ,

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m , z . p m m j z m g, f z , z f m . ag zz f z f m, f f, f m m. d f z f, . M mj f m g

e, , pm. sg m f z m m j. i mg z m f m.

d m - m m , m f m bda m. g bda m f g g, gehh, sm, shg, mgm g m g K, e-, c, . if e., g, mf f . cfm , f m f z m ( gj, mm, .),z- h m. Fm mf f

m f g, fm g, z . cz f m bda, -m g sm shg, g , f g z f m m (1 6 ). a f m m gm f - m m h.

r m f m m m m mgm . sgh f m g f g m- x gj m. a m , m f m. m mf m z m - f m f . am m- g f m ff , m m f m.

Bibliograe

1. a h mx mg: .WHo. 20 a 1211 G 27 swz

2. a f m http://www.raa.ro/evenimentestiintice/hi-vacademy/resurse/OrdMS994/ANEXAIIATRIBUTII.doc3. bm o. if g//pg, i, 2001, www..m.//.hm

4. s d. n gh mgm m m www.m./_/m//2006/n%20gh%20%20mgm%20%20m%20m.f

5. .., .., .. . -

. //, , 1985, . 3-6.

6. .. .

, , . ., 1994.

7. .. //

. 07/ 2/2005.8. .. //

. .2007.

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2.5.2 Tuberculozan g x m Mycobacteriumtuberculosis m.M.tuberculosis m

m , tb . d g,M.tuberculosis m g f. if

M.tuberculosis , z, - h, jg .

l 2-12 m f, m mz m f, z mg tb z. t, m , m m . a fz tb. p- tb z z m- (ppd), z mm tb g.

axm 5-10% f M.tuberculosis tb , m tb . r tb tb mj m f (1,2,3).

Persoanele expuse riscului major de infectare cu M. tuberculosis f g x f M.tuberculosis

g . p x M.tuberculosis f m concentraiapicturilorinfecioaserspnditenaeridurataexpuneriifadeopersoancuTB.c m g , m m f.

c z - h g ( z m m ) m tb m (4). u tb gz tb - m -tb. g, tb z m m 3 (4,5).

a , m x g x m-j f M.tuberculosis.p g .

t m fm m, m f M.tuberculosis(1). p f Hiv m f f M.tuberculosis x m m hz tb, m - f , Hiv (4,7,8,9).

v bcG fz f x, tb m tb, m f m mg - (10).

Riscul de infectare cu M. tuberculosis n cadrul spitalelor

tm M.tuberculosis mj (12,13,14). p z f , g , tb m, m m mz tb. tm M.tuberculosis f - tb, m z

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