Application of drug-resistant bacteria in emergency internal medicine

IntroductionAs one of the main units in the hospital, the emergency internal unit receives patients with various acute illnesses. The complexity and mobility of patients and the frequent use of antibacterial drugs make emergency internal medicine a high-risk area for drug-resistant infections. The emergence and spread of drug-resistant bacteria not only make the treatment of patients extremely difficult, but also increases medical costs and social burdens. Strengthening drug-resistant microbacterial control in emergency care is therefore of critical importance.II. Status and hazards of drug-resistant bacteria(i) Status of drug-resistant bacteriaAt present, the variety and number of drug-resistant bacteria is increasing globally. In emergency medicine, the most common resistance bacteria include methooxysilin-coloured grapepluccus (MRSA), VRE-resistant carcinogen intestinal fungus, bacteria that produce ultra-wide β-Nemamines (ESBLs), multi-resistant copper-green cystasy and bacterium. The emergence of these resistant bacteria makes traditional antibacterial treatments less effective and even less effective.(ii) Hazards of drug-resistant bacteria1. Making treatment more difficult and painful for patientsDrug-resistant bacteria infections are often severe and difficult to treat and require the use of higher-level antibacterial drugs or combinations. This not only prolongs the patient ‘ s stay in hospital, increases the cost of medical care, but may also result in complications and even endangerment of life.2. Impact on quality and safety of careThe spread of drug-resistant bacteria can lead to outbreaks of infection in hospitals, affecting the treatment and rehabilitation of other patients. At the same time, drug-resistant infections also pose greater work stress and occupational risks for medical personnel.3. Increasing health costs and social burdensTreatment of drug-resistant bacterial infections requires the use of expensive antibacterial drugs and advanced treatment techniques, which significantly increases medical costs. In addition, the spread of drug-resistant bacteria can pose a threat to public health and increase the social burden.III. Reasons for internal resistance in emergency cases(i) Unreasonable use of antibacterial drugsEmpirical drugsIn the field of emergency care, due to the urgency of the patient ‘ s condition, doctors tend to treat experiential antibacterial drugs without identifying pathogens. While this can control infection to some extent, it can also lead to the abuse of antibacterial drugs and increase the risk posed by drug-resistant bacteria.2. Overuse of broad spectrum antibacterial drugsIn order to improve the effectiveness of the treatment, doctors may choose to treat the broad spectrum of antibacterial drugs. However, overuse of broad-spectral antibacterial drugs undermines the normal micro-ecological balance of the human body and promotes the production and dissemination of resistant bacteria.3. Excessive use of medicationFor some infected patients, doctors may prolong the use of antibacterial drugs to prevent recurrence. However, the prolonged use of anti-bacterial drugs increases the opportunities created by drug-resistant bacteria.(ii) Patient factor1. Most basic diseasesPatients in emergency medical care often suffer from a variety of underlying diseases, such as diabetes, chronic obstructive pulmonary disease and cardiovascular diseases. These underlying diseases reduce the immune capacity of patients and increase the risk of infection, while they can also lead to the creation of drug-resistant bacteria.2. Multiple intrusive operationsPatients in emergency medical care are frequently required to perform various intrusive operations, such as bronchial tube intubation, central intravenous tube and catheter holding. These operations can destroy the natural barriers to the human body and increase the chance of bacterial infection, while also contributing to the spread of drug-resistant bacteria.(iii) Hospital environmental factors1. High mobilityThe emergency internal medicine is one of the most frequently mobile units in hospitals, and patients, family members, medical personnel, etc. are constantly in and out, which can easily cause the spread of drug-resistant bacteria.2. Inadequate clean sterilizationIf a hospital is not properly cleaned, there may be a large amount of drug-resistant bacteria in the environment, increasing the risk of infection.IV. Application of drug-resistant microbacterial control in emergency care(i) Enhanced management of antibacterial drugs1. Establishment of antibacterial drug management systemsHospitals should establish a sound anti-bacterial regime, with clear principles for the use of anti-bacterial drugs, approval processes and oversight mechanisms. Strengthen training and education in the use of anti-micropharmaceutical drugs and improve the level of rational use by medical personnel.2. Antibacterial surveillanceThe use of anti-bacterial drugs in emergency medical units is monitored on a regular basis, including the intensity of use, use, resistance, etc. Based on the results of the monitoring, strategies for the use of antibacterial drugs are adjusted in a timely manner to increase the level of rational use of antibacterial drugs.3. Introduction of individualized treatmentAppropriate antibacterial drugs are selected for individualisation based on patient ‘ s condition, pathogen culture and drug sensitivity test results. Avoid overuse of empirical drugs and broad spectrum antibacterial drugs.(ii) Enhanced infection control measures1. Strict implementation of the hand hygiene systemHandsome is the most basic and effective measure to prevent infection in hospitals. Medical personnel should strictly apply a hand-sanitary system, which washes or disinfects the hands before, after and after contact with the patient, before and after intrusive operations.2. Strengthening environmental cleanlinessThe environment of the emergency internal section is regularly cleaned up, including the ground, walls, equipment, furniture, etc. Emphasis is placed on the disinfection of areas of frequent patient contact, such as bed bars, call buttons, door handles, etc.3. Regulating intrusive operationsInvasive operations, such as bronchial intubation, central veins, catheter retention, etc., are carried out in strict compliance with operational protocols. Attention should be paid to sterile technologies during operations to avoid contamination. Care should be strengthened after operation, and dressings should be periodically replaced to prevent infection.4. Implementation of isolation measuresIn case of drug-resistant infections, quarantine measures such as single-room isolation or concentrated isolation of the same patients should be taken in a timely manner. Segregation markings should be visible and medical personnel should wear appropriate protective supplies to prevent the spread of drug-resistant bacteria when exposed to isolated patients.(iii) Increased patient immunity1. Strengthening nutritional supportProvide reasonable nutritional support to patients, ensure that they receive sufficient nutrients, such as proteins, vitamins and minerals, and increase their immunity.2. Active treatment of basic diseasesFor people with basic diseases, the treatment of basic diseases, control of conditions and improvement of the overall health of the patients should be actively pursued.3. Health educationHealth education is provided to patients and their families to raise awareness and prevent drug-resistant infections. To guide patients to properly wash their hands, cough rituals, personal hygiene, etc. to reduce the risk of infection.(iv) Increased training of medical personnel1. Drug resistance knowledge trainingMedical personnel are regularly trained in drug-resistant bacteria, including the type of drug-resistant bacteria, the means of transmission, hazards, prevention and control measures. (c) Raising awareness and prevention awareness of drug-resistant bacteria among medical personnel.2. Training in infection control skillsStrengthen the skills of medical personnel in infection control, including in the areas of hand hygiene, environmental clean sterilization, isolation measures, intrusive operations, etc. Increased levels of infection control among medical personnel.3. Emergency disposal capacity trainingDevelop emergency preparedness plans for drug-resistant infections and organize regular emergency drills for medical personnel. Improved emergency response capacity of medical personnel in case of outbreaks of drug-resistant infections.ConclusionsDrug resistance prevention and control is an important task for emergency internal medicine. By strengthening the management of anti-bacterial drugs, strengthening infection control measures, increasing the immune capacity of patients and strengthening the training of medical personnel, a wide range of applied measures can be effective in preventing and controlling the production and dissemination of drug-resistant bacteria, improving the quality of care and safety in emergency medical care and ensuring the health of patients. At the same time, the prevention and control of drug-resistant bacteria requires the joint efforts and collaboration of all hospital departments, the establishment of long-lasting mechanisms for the prevention and control of drug-resistant bacteria and the continuous refinement of preventive and control measures to meet the growing challenge of drug-resistant bacteria.