Sanitary and hygienic regime in medical institutions. Sanitary and hygienic regime of medical institutions - an important point

Hospitals and obstetric institutions should be provided with a strict protective regime (keeping silence in the wards: no loud conversations, noisy games, TV shows, timely elimination of external and internal noise sources, including noise from equipment, elevators, ventilation systems, refrigerators, faulty plumbing cranes, fixtures, etc.). In each medical institution, the established daily routine should be strictly observed, mandatory patient rest after lunchtime ("quiet time") should be carried out. Transfers and visits to patients should be carried out at the scheduled time. Hospital rooms should be subjected to daily thorough wet cleaning at least 2 times, and more often if necessary. The use of disinfectants should be determined by the specificity of the mode of the premises and the profile of the institution (unit).

Airing chambers should be carried out at least 4 times a day. The premises of operating rooms, hospital rooms and wards of newborns should be irradiated with germicidal lamps.

In medical institutions, personal hygiene by patients should be strictly observed (hygienic baths and linen change at least 1 time in 10 days, which should be noted in the history of the disease); if necessary, the laundry needs to be changed more often (as it gets dirty). Periodically, haircuts and shaving patients should be organized. Smoking and drinking alcohol in medical institutions is strictly prohibited. Hospital linen, clothes should be clean and ironed, should not be defective, be a fixed form and strictly selected in size. Patients should have individual dishes and other personal care products.

1. Requirements to working conditions, life and personal hygiene of medical personnel

Medical institutions must have the necessary composition and area of ​​sanitary facilities for medical personnel in accordance with the current SNiP (BCH). The following requirements must be met:

a) the number of cabinets in the dressing rooms should be taken equal to 100% of the list of personnel (except for the staff of the reception departments of children's and infectious diseases hospitals);

b) the number of showers should be taken from the calculation:

1 shower stall for 10 people in infectious and tuberculosis departments, and in the rest departments - 1 shower stall for 15 people working in the largest shift of middle and junior staff;

c) the number of sanitary appliances for staff should be taken from the calculation: 1 device for 50 people in men's dressing rooms and 1 device for 30 people in women's dressing rooms;

d) the area of ​​wardrobe clothes should be taken from the calculation of 0.8 square meters. m per 1 coat hanger (hook) for a dressing room, and the number of places for a dressing room is 60% of the list of personnel;

e) the wardrobe area for home and work wear should be taken from the calculation of 0.4 square meters. m 1 cabinet. Wardrobes, as a rule, should be provided with double-wing closed ventilated cabinets, providing separate storage of home and work (sanitary) clothes, shoes and hats.

When the number of women working in the most numerous shift is more than 100, there should be a room for women's personal hygiene in accordance with the SNiP "Auxiliary buildings and premises of industrial enterprises", which includes treatment cabins equipped with hygienic showers with individual mixers of cold and hot water, sinks , places to undress. The size of the treatment cabin should be at least 1.8 x 1.2 m. Cabs should have hooks for clothes and linen.

When the number of women working in a hospital is less than 100, a cabin with a hygienic shower of at least 2.4 x 1.2 m in size should be provided, placed in the women's dressing room.

To provide staff with hot meals in hospitals, dining rooms or buffets should be provided. The number of seats in them, as well as the composition and area of ​​production and auxiliary premises should be taken in accordance with the head of the SNiP on the design of catering enterprises.

In the structural subdivisions of medical institutions (departments, laboratories, etc.) for medical staff, rest rooms and meals should be allocated and equipped.

Sanitary facilities should be kept clean. Wet cleaning of the premises should be carried out at least 2 times a day with the use of anti-sludge solutions. Once a month it is necessary to carry out general cleaning.

The nursing staff should be provided with at least 3 sets of working (sanitary) clothes: gowns, kerchiefs, slippers, and replaceable shoes (slippers). A robe and kerchief (cap) must always be available for a change in case of pollution. Sanitary clothing should be uniform (established for the institution) form, as a rule, white, perfectly clean and ironed. Hair should be matched under the kerchief (cap, cap). It is not allowed to wear rings, earrings and other jewelry and foreign objects in the pockets of dressing gowns while working.

Each employee entering the workplace must undergo a medical examination, including an examination by an otolaryngologist, a dentist, and a venereal and venereologist (for women by a gynecologist) with bacteriological tests for the presence of pathogenic and conditionally pathogenic microorganisms.

Decreed contingents (staff of children's hospitals, maternity hospitals and departments that are directly related to the care and nutrition of children, etc.) should be subject to prior (on admission) and further periodic medical examinations in accordance with the approved instruction on the order of medical examinations of these contingents working.

In order to prevent occupational diseases, medical personnel working with harmful (toxic and other) substances or exposed to adverse factors (X-ray and ionized radiation, electromagnetic fields, high humidity, etc.) should, upon admission to work and subsequently to established timing to undergo a medical examination in accordance with the Order of the Ministry of Health of the Republic of Belarus "On the conduct of compulsory prior examinations for admission to work and periodic medical examinations of workers I am exposed to harmful and unfavorable working conditions. "

The staff of the operating units, intensive care units, intensive care and surgery, participating in operations, dressings and serving postoperative patients, as well as staff of maternity homes (departments), newborn units, should be examined once a quarter for a pathogenic staphylococcus.

In order to improve the air environment of operating theaters (rods), in addition to organizing the necessary air exchange, you should remove or absorb drug vapors entering the air space of operating theaters with exhaled air using absorbing filters with activated carbon or absorber and discharge hoses.

In the departments of hospitals, maternity hospitals and other units (especially operating units and rodblokov) to continuously monitor the state of the air environment and the microclimate of the premises, to have indoor thermometers in the rooms to measure the temperature.

In order to reduce the neuro-emotional overvoltage of personnel, it is recommended to form brigades participating in operations and reanimation measures taking into account psychological compatibility. Prevent the inclusion in the surgical team to perform planned operations of staff after night duty, as well as to ensure the alternation of operating and non-operating days.

The sanitary and hygienic conditions in the hospital largely depend on the sanitary maintenance of the premises and the compliance of the patient with the rules of personal hygiene. With a long stay in the premises of people there is a gradual change in the microclimate of the air environment.

The air increases the content of water vapor, dust, increases its temperature, there are unpleasant odors due to the release and decomposition of sweat and organic matter on the skin. All these changes adversely affect the health of patients. In addition, man is a source of bacterial air pollution.

When talking, sneezing and coughing into the air enters a huge number of droplets of saliva, which may contain pathogens of infectious diseases. Therefore, diseases such as influenza, seasonal catarrh of the upper respiratory tract, scarlet fever, measles, whooping cough, chicken pox, cerebrospinal epidemic meningitis, etc. can be transmitted through the air.

Large droplets of saliva quickly settle to various surfaces, small ones soar in the air for a long time. Drops of saliva with microorganisms, settled on the floor, bed and other furnishings of the medical institution, dry up, and if the premises are not properly cleaned, the microorganisms in viruses may, together with the dust, again be airborne.

It should be remembered that such microorganisms as streptococci, diphtheria bacillus, tuberculous mycobacteria, remain viable, being in the dust for tens of days. Therefore, the prevention of air pollution in the premises of medical institutions is of great hygienic importance.

All hospital premises should be cleaned daily at certain hours. In the wards and corridors, cleaning is done after lifting the patients: sweeping the floor in a wet way, wiping furniture, doors, handles, panels, etc. with a damp, clean cloth. Cleaning is completed by washing the floor or rubbing it with, for example, some kind of dust-binding solution.

After the final cleaning, the chambers must be aired by opening windows (in the warm season) or air vents (in winter). Bedtime patients wet cleaning and airing chambers are required. In winter, it is necessary to air the corridors several times during the night. Daily toilet bowls, urinals, wash basins are washed with hot water with soap and disinfectant solution (solution of chloramine). Bath after each patient is thoroughly washed with warm water and soap, followed by rinsing with a disinfectant solution.

The younger nurse should immediately take out from the chamber of the vessel, urinals and other dishes with discharge of patients. Bedpans are washed and disinfected after each use. Disinfection is performed using a 0.2% bleach solution.

Do you know what :: + + + + +   TRAUMATOLOGY (from trauma and ... logia), a section of clinical medicine that studies injuries: their causes, types, course, methods of prevention and treatment. Together with the orthopedics of traumatology in the Russian Federation is a single medical specialty.
  TOILET SPONGES, large (usually up to 20-50 cm) sponges from the order kremnerogovye. The skeleton consists of a dense porous network of elastic fibers. The object of fishing in the Mediterranean, Red, Caribbean and other seas. Used for hygienic, medical and technical purposes.
  TIAZOL, colorless liquid, boil of 116.8 ° C. Structural fragment of coenzyme thiamine (vitamin B. 1) and many drugs. The thiazole hydrogenated core is incorporated into the structure of penicillins.
  TAMPONADA (from French tampon - stopper, plug), filling wounds and body cavities, for example, with strips of gauze (tampons), to stop bleeding, to delimit the infected part of the wound during the operation, to remove purulent effusion.
  TECHNOLOGICAL EQUIPMENT, a set of devices for installing and securing blanks and tools, performing assembly operations, transportation of blanks, parts or products.
  TREATMENT (from the French. Trepan - drill), the operation of opening a bone cavity (eg, skull).

21.06.2013

The maintenance of the sanitary and hygienic regime in the hospital has a huge impact on the work of the institution and the treatment and prevention process. Standards and rules established by the Department of State Sanitary and Epidemiological Surveillance of the Ministry of Health of Russia should be strictly observed and monitored by medical personnel to prevent the development and spread of nosocomial infection.

Failure to comply with the sanitary and hygienic regime leads to an increase in the risk of the spread of nosocomial infections, that is, infections that occur in medical personnel associated with the treatment and care of patients, due to violation of the rules of antisepsis and asepsis, or in patients. Nosocomial infections include flu, hepatitis B, scarlet fever, measles, chicken pox, etc. Violation of the rules and requirements of the sanitary and hygienic regime leads to pollution of the premises, the spread of pathogenic microbes and the spread of insects and rodents.

Poor room ventilation contributes to increased levels of bacterial contamination of the air. Windows and transom are used for natural ventilation, and in some rooms, such as the operating room, laboratories, special air conditioners are used. Cleaning in the premises of the medical institution must be necessarily wet, using disinfectants. Chlorine-containing preparations are most often used for disinfection.

General cleaning is carried out once a week. All inventory must be marked (for example, “for washing the corridor”) and used strictly for its intended purpose. Wet cleaning is done daily and repeated as needed. It is unacceptable to wear outdoor shoes in the premises of the medical institution. Visitors should wear sturdy shoe covers or removable shoes. When identifying rodents or insects, it is mandatory for the SES staff to conduct pest control or disinfestation.

Equally important for maintaining the sanitary regime is given sufficient lighting of the premises, respect for silence, and the organization of heating (the optimum temperature in the premises in winter should be +20 ° C ..., and in summer + 23-24 ° C ...). Particularly stringent requirements are placed on the personal hygiene of kitchen and coffee shop employees. Wet cleaning in canteens and buffets is carried out after each meal, and the dishes undergo a process of disinfection with bleach.

The necessary maintenance of the sanitary and hygienic regime in medical institutions is largely dependent on the strict implementation of the personal hygiene rules of patients and medical personnel. Administrative, disciplinary and criminal liability is established for non-compliance and violation of the sanitary and hygienic regime prescribed by law.

Under the hygienic regime understand the scientifically-based system of rules governing the proper communal conditions in the premises of hospitals. Hygienic regime is ensured by sanitary improvement of hospitals.

The hospital is for the patient a school of personal hygiene, and raising the hygiene skills of patients contributes to securing the results of treatment after discharge from the hospital.

The hygienic regime in the hospital is ensured by the creation of an optimal microclimate, lighting comfort, an adequate insolation regime, a clean air environment, and sanitary maintenance of the rooms.

Favorable conditions should be created for patients and medical personnel in hospitals to fulfill the rules of personal hygiene.

These topics will be devoted to specific topics of practical training.

Sanitary regime and sanitary content. Cleanliness is a necessary element of a proper hygienic regime of a medical institution.

The atmosphere of absolute purity in combination with other parties of the hospital regime creates the best conditions for the implementation of the treatment process. It inspires the patient confidence in the hospital staff, creates a favorable impression of the hospital, contributes to the well-being of the patient.

The value of the frequency of the hospital in the implementation of the treatment process and the prevention of nosocomial infections can be illustrated by the following examples.

Insufficiently clean maintenance of the surgical department and the operating unit, increasing the dustiness and contamination of air, adversely affects the creation of sterile conditions necessary for the production of operations and storage of sterile material and instruments.

Poor quality of cleaning floors, furniture in wards and other places where patients are staying, accumulation of dust behind cabinets and radiators of heating leads to air pollution and creates a direct threat of infections, in the transmission of which dust plays an important role.

Among the most important elements of the sanitary regime of medical institutions are those that are aimed at maintaining clean air in the hospital premises. Among these, the exchange of indoor air and dust control are of paramount importance.

The fight against dust in hospital premises is done by:

a) systematic cleaning of premises, combined with airing them;

b) systematic cleaning of soft inventory in the open air:

c) dust fixation by covering the floors and impregnating bathrobes.

Cleaning of all premises of the hospital department is carried out daily.

In the wards, corridors and offices cleaning is done in the morning after lifting the patients.

After the morning toilet of the patients, the reshuffling of the beds and the arrangement of the bedside tables, the floor is wet swept, the furniture is swept away with furniture with a damp cloth and the doors, panels, window sills, heating surfaces, etc. are wiped off. Cleaning is completed by floor cleaning.

Odorless dust-binding substances that cover the floor can also be used to reduce dust. To do this, use special formulations containing oils that keep dust deposited on the floor.

The study of bacterial contamination of air showed that it is minimal until the patients get up.

The number of microorganisms in the air increases by 2-4 times when moving in the patients' room and staff, 2-5 times - when beds are being retired and 2-10 times when the floors are dry swept. With a well-conducted wet cleaning of wards, the number of microorganisms in the air does not increase. This contributes to the ventilation of the chambers after cleaning. In the warmer months, wards should have windows and transom open as long as possible.

When severe frosts air the corridors behind closed chambers.

Cleaning should be repeated throughout the day as needed to ensure constant cleanliness of the room. Dining and buffets are cleaned after each meal. Before the patients go to bed, they re-bed, sweep the floor, air the room of the ward. In the winter time, the corridors are aired several times at night. Bed linen must be changed once every 7-10 days, as well as when it is contaminated for certain patients.

The most complete removal of dust in the hospital is achieved with the help of vacuum cleaners. Vacuum cleaners can be portable and stationary. The disadvantage of portable vacuum cleaners is the noise they generate with a volume of 70-80 dB. This disadvantage does not have a central vacuum station, which equip the hospital during construction.

Mattresses, bedding, walkways and other soft material are an important source of air pollution from wards with dust, volatile odors and microorganisms. Cleaning and knocking out of the listed items is carried out periodically outdoors (verandas are used). The number of microorganisms after cleaning and knocking out is reduced by 10-15 times, and the number of dust particles is 2-3 times.

In order to prevent air pollution in some foreign countries in hospitals, changing of mattresses and bedding in wards does not produce, but completely replaces the beds. Changing mattresses, bedding and, if necessary, disinfection of beds are made in a special room.

Some researchers recommend impregnating bedding and linen with dust-binding compounds. The most affordable product is a 3-5% aqueous solution of emulsol, which contains spun oil (72.5%), asidol (18%), ethylene glycol (20%), caustic soda (1%), water (6.5% ). The linen is immersed in the emulsol solution for 2–3 minutes, then squeezed and dried.

The hygienic properties of the impregnated linen (including smell and color) do not change. A 30% aqueous solution of emulsol (30 ml per 1 m3) is used to cover the floors.

Using rational cleaning methods and systematic aeration, it is possible to significantly reduce the microbial contamination and dust content of the air in hospital rooms. However, the growing proportion of drip infections and the ever increasing requirements for asepsis dictate that measures should be taken to further reduce the microbial contamination of air in the wards of children's infectious diseases wards, in operating rooms, dressing rooms, generic, etc. To this end, in recent years, various methods of disinfecting indoor air have been studied.

The greatest practical application received ultraviolet radiation. Ultraviolet radiation is a powerful and fast-acting bactericidal agent in the irradiation of air or the surface of various objects. The bactericidal effect of ultraviolet rays decreases with increasing dust and humidity.

There are two sources of artificial ultraviolet radiation: high-pressure mercury-quartz lamps (of the PRK type) and low-pressure bactericidal ultraviolet lamps (of the BUV type). Mercury-quartz lamps can be of high power (up to 1000 watts), but they have less output of bactericidal rays per unit of power.

Therefore, PPH type lamps are currently recommended to be used in hospitals for the irradiation of various objects and indoor air in the absence of patients.

Bulb-type lamps are of lower power than PPH (15 and 30 watts), but they have a significantly higher yield of bactericidal rays per unit of power.

The emission spectrum of these lamps is 80% of the most bactericidal rays, so their side effects (ozone formation) are much less.

There are three known methods of applying ultraviolet radiation:

1) direct exposure,

2) indirect irradiation - reflected rays,

3) the irradiation of fresh air in the ventilation or circulation devices.

Direct irradiation is carried out using lamps suspended from the ceiling and directing a direct stream of rays downwards. It can also be carried out with lamps mounted on walls or special stands on the floor. A power of 1.5-2 W per 1 m 3 of room is required. This method can achieve a high degree of disinfection of furniture and air.

So, after 1-2 hours of irradiation of the dressing room during operation, the total number of bacteria in the air decreased by 60-70%, while without irradiation, the contamination of air continuously increased.

However, the direct flux of ultraviolet rays of lamps of the type of PPH and even of the type of a CCV has an adverse side effect and therefore direct irradiation can take place only in the absence of people (in the intervals, before starting work) or in providing them with special glasses for eye protection.

The most widespread indirect ultraviolet irradiation of premises. For this, the ultraviolet radiation source is suspended at a height of 1.8-2 m from the floor with a reflector facing upwards so that the flow of direct radiation falls into the upper zone of the room; the lower area of ​​the room is protected from direct rays by the lamp reflector.

The air passing through the upper area of ​​the room is actually exposed to direct radiation. In addition, ultraviolet rays reflected from the ceiling and the upper part of the walls (for better reflection of the wall should be painted white) irradiate the lower zone of the room in which people can be.

Ultraviolet radiation reflected from the ceiling and walls at the correct dosage has not only bactericidal, but also a favorable biological effect (formation of vitamin D, improvement of the body’s immunological reactivity, stimulation of blood formation), since the intensity of reflected radiation is 20-30 times less than direct.

There are observations about the positive effect of indirect exposure in wards for newborns and premature babies (better weight dynamics, less aerogenic diseases, easier course of the disease).

Ultraviolet irradiation in wards with children with scarlet fever reduced the incidence of complications 3 times. In the irradiated wards of the children's infection ward, several times less were sown from the air of diphtheria bacilli, hemolytic streptococcus, and pyogenic staphylococcus.

It is advisable to irradiate the chambers in autumn and winter and in early spring 3-4 times a day for 1 hour.

Artificial ultraviolet radiation, even indirect, is contraindicated in children with an active form of tuberculosis, nephrosis nephritis, a feverish state and a sharp depletion.

Disinfection of premises and care products is as follows.

In infectious wards, with daily cleaning, wipe the surface with a cloth. Wiping with a rag increases its contamination and is ineffective in disinfecting wiped surfaces. Therefore, it is recommended that three rags in a solution of chloramine and periodically wipe them when wiping surfaces.

After washing, tableware is disinfected by boiling or washing in a 0.2% bleached bleach solution followed by rinsing.

In the infectious diseases department, the duration of the disinfection of dishes with bleach must be at least 1 hour. Toilets, urinals, bathrooms, sinks are thoroughly cleaned of dirt (kerosene, acids or detergent), and then washed with hot water and soap. Bathrooms after each patient are washed with warm water.

The wooden parts of the toilet bowls are washed with a 5% bleach solution. Bedpans are washed and disinfected after each use. Disinfection is carried out with steam or in a 0.2% bleach solution for one hour.

It is necessary to introduce everywhere devices for washing and thermal sterilization of bed-pans and urinals, working on electricity or on water from a connected hot-water system. This refers to such devices as "Purifax", the Czech apparatus of the company "Hirana" and others.

The procedure for neutralization of items for the care of seriously ill patients in these preparations takes 7-8 minutes.

Toys are neutralized by washing in a 3% solution of chloramine or using a brush dipped in it, as well as ultraviolet radiation (15 minutes at a distance of 30 cm from the lamp to the surface of the toy).

It is advisable to whitewash rooms in hospitals at least once a year. After whitewashing, which is combined with careful cleaning of the hospital premises, the content of microorganisms in the air of the chambers for a long time keeps within the lower bounds, and after a few months, even with unchanged sanitary regime, it begins to increase.

Another important condition for ensuring hygienic regime is the organization of timely collection, disinfection and disposal of waste generated during the operation of hospitals.

Personal hygiene of medical personnel. A neat, collected and cultural appearance, meticulous implementation of personal hygiene rules by medical personnel are essential conditions for patient care.

Medical personnel should serve as a model for patients in personal hygiene.

In addition, the implementation of personal hygiene by staff is of great importance for the prevention of nosocomial infections, both among health care workers and among patients.

All employees who come to work in the hospital are subject to mandatory medical examination. Subsequently, the staff of the food unit and the younger staff directly serving the patients are subjected to a monthly medical examination, and once every six months, they are examined for bacilli carrying. Employees who become ill with diseases dangerous in relation to the possibility of transferring them to the sick are not allowed to work.

When a medical worker arrives at work, he should take off his outerwear, wash his hands thoroughly with soap and then put on the installed protective clothing (bathrobe, kerchief, gauze bandage on the mouth and nose, etc.). Overalls must be immaculately clean, ironed, appropriate size.

After dirty work, staff must wash their hands thoroughly with hot water with a brush and soap, and, if necessary, treat them with a disinfectant solution, such as a 0.2% bleached bleach solution or a 1% bleach solution. This should be done after serving infectious patients, as well as before and after various manipulations. Hand washing brushes should be stored in a disinfectant solution.

It is necessary that the nails of employees were cut short. Technical staff engaged in cleaning the room is not allowed to the distribution of food.

Every hospital should have the ability for staff to take a shower after work. For staff of infectious and disinfecting departments, shower-type permits are arranged.

Objective control over the sanitary condition of the hospital. Objective and reliable assessment of the sanitary condition of the hospital is impossible without systematic hygienic studies of the external environment.

The most important of them are: instrumental studies of microclimatic factors (temperature, humidity and air velocity, temperature of external walls), air examination for bacterial contamination, oxidation and carbon dioxide content, noise intensity study, research on the sterility of surgical instruments and dressings, research washes from the hands of staff and patients, from clothes, furniture, household items and the degree of contamination with E. coli; the study of food on caloric and nutrient content, including vitamins; drinking water research, etc.

It is recommended that all data describing the sanitary condition of the environment in a hospital be recorded in a special sanitary journal.

Analysis of the results of these studies helps to uncover the causes of deficiencies and find effective measures to eliminate them.

Hygienic conditions are an important prerequisite for the prevention of hospital (nosocomial) infection. The fight against hospital infection is relevant not only for infectious, pediatric, surgical, maternity, but also for all other departments. In recent years, hospitals have seen an increase in hospital diseases, especially due to staphylococcal infection, which has even been called the “plague of 20th century hospitals”. So, in the US, hospital infections suffer from up to 6.3% of all those treated in hospitals. In England during the year, about 1 million additional bed-days accounted for postoperative purulent-septic and other complications. At the same time, all researchers invariably emphasize that the basis for the prevention of nosocomial infection is a hygienically rational device, equipment and hospital maintenance.

Hospital hygiene should ensure healthy working conditions for all staff. Medical personnel may be exposed to a range of occupational hazards. These include: neuropsychic tension (surgeons, resuscitators, anesthesiologists, obstetricians-gynecologists, personnel of psychiatric hospitals, etc.), stress on skeletal muscles (surgeons, dentists, etc.), night work (staff on duty), chemical (anesthesiologists, and others) and physical agents (personnel of radiological, physiotherapeutic, barooperative, and other departments), nosocomial infection (influenza and other drip infections), etc.

A particularly high level of hygienic support is necessary when introducing the latest scientific achievements into medicine. So, for example, without the development and implementation of appropriate hygienic measures, it is impossible to use radioisotopes and other sources of ionizing radiation, electron microscopes, lasers, barooperative, newest physiotherapeutic installations. Conducting a complex system of hygienic measures is necessary for organ transplants. The use of various polymeric materials, bactericidal paints, disinfectants, detergents and cleaning products in the hospital also requires hygienic competence. Exemplary hygiene in the hospital helps her become a school of hygiene skills for patients. Taking into account the increased importance of hospital hygiene, a new post “hospital hygienist” is being introduced into the staffs of hospitals in several countries. In Russia - "hospital epidemiologist."

The main objectives of its activities:

1) Improving hospital hygiene;

2) Systematic monitoring of hospital sanitary conditions;

3) Minimizing the risk of nosocomial infection.

The creation of hygienic conditions depends on the system of hospital construction, the properties of the land plot and the location of the hospital in the village, the design and internal planning of hospital buildings, sanitary engineering infrastructure, equipment and sanitary maintenance.

LOGICAL STRUCTURE OF THE SECTION« HYGIENE OF MEDICAL AND PROPHYLACTIC INSTITUTIONS» (in the aspect of the work of a medical profile doctor)

1. Assessment of the location of hospitals in populated areas, planning of the land plot taking into account the creation of a treatment and protection regime, protection of hospital premises from noise, pollution, creation of a favorable insolation regime, the possibility of using the site for patients to stay in the fresh air. 2. Assessment of compliance with hygienic requirements for the planning of departments of admission and discharge of patients, taking into account the possibility of providing a medical-protective regime and prevention of nosocomial infections. 3. Assessment of the features of the layout of the various departments of the hospital (pediatric, surgical, obstetric-gynecological, infectious, etc.). 4. Assessment of the sanitary and hygienic regime in the department.

Theme 1. HYGIENIC REQUIREMENTS FOR THE PLACEMENT, PLANNING AND EQUIPMENT OF MEDICAL AND PREVENTION INSTITUTIONS (sanitary examination of the hospital project)

PRACTICAL SIGNIFICANCE OF THEME:

The creation of optimal hygienic conditions in hospitals is determined by the characteristics of the layout and development of the hospital site, the design and internal planning of buildings, their sanitary and technical improvement, and the sanitary condition during operation.

OBJECTIVES:

To study the basic hygienic requirements for the placement and internal planning of medical institutions using the example of a typical hospital design.

QUESTIONS OF THEORY:

1. Modern hygiene problems of hospital construction.

2. Hygienic requirements for the placement of hospitals and the planning of the land.

3. Hospital building systems, land zoning.

4. Hygienic requirements for admission department, ward section and other structural units of hospitals.

5. Planning and mode of operation in the therapeutic, surgical, children's, obstetric and infectious departments of hospitals.

PRACTICAL SKILLS:

To master the technique of hygienic examination of projects of medical institutions.

LITERATURE:

Main: 1. Rumyantsev G.I. et al. General hygiene. -M., - 1986.-C.230-253, 289-300. 2. Gabovich RD, Poznansky S.S., Shakhbazyan, G.Kh. Hygiene. Kiev .- 1984.-C.277-304. 3. Pivovarov, Yu.P.Goeva, O.E. Velichko, A.A. Guide to laboratory hygiene. M.Meditsina.-1983.-C.59-92.

Additional: 1. Bystrov TA Hygiene of medical institutions. -M.-1971. 2. Sakhnovskaya N.N., Manenko A.K. Hygiene of medical institutions. - Kiev. -1982. 3. Hospital hygiene. Translation from German. -Minsk. -1984.

TASK TO THE INDEPENDENT WORK OF STUDENTS:

Based on the literature and educational material provided

I. To study the sanitary and hygienic principles of the planning of medical institutions.

Ii. To study the hygienic requirements for the location of medical institutions in the settlements and the layout of the hospital site, taking into account the creation of a favorable treatment-and-protection and anti-epidemic regime.

Iii. To study the hygienic requirements for the planning of the department for admission and discharge of patients and the characteristics of admission and discharge in various departments of hospitals.

Iv. Learn the hygienic requirements for the ward section (for example, the layout of the therapeutic department). Features of the layout of the children's, obstetric-gynecological, surgical and infectious diseases departments of hospitals.

V. Understand the hygienic requirements for the layout of the outpatient department.

Vi. To master the program of sanitary examination of the hospital project.

EDUCATIONAL MATERIAL FOR INDEPENDENT PREPARATION

1.1. Hygienic principles of placement of medical institutions and planning of land plots.

A modern hospital is a medical center intended for treatment-and-prophylactic services for the population. Considering the fact that most hospitals provide services not only to hospitalized patients, but also to the population of the area of ​​location, it is necessary to provide for the location of the hospital directly in the residential (residential) zone or in the center of the area served (somatic profile). Specialized departments or complexes with a capacity of over 1000 beds, for patients to stay for a long time (psychiatric, tuberculosis, rehabilitation treatment, etc.) must be located in the suburban area or marginal areas, possibly in green areas or in close proximity, observing gaps in 1000 m from the residential area, for the use of natural conditions as an additional therapeutic factor. Female consultations, dental clinics and other outpatient facilities can be placed in residential and public buildings within walking distance (1.5-2 km), near streets and roads with public transport. Medical institutions, according to SNiP-69-78 "Medical-preventive institutions" should be located in accordance with the general plan and the draft detailed planning of the settlement, taking into account its functional zoning.

The territory of the hospital should be removed from noise sources (airfields, railways, main urban highways) and air, soil and water pollution (citywide landfills, dumping fields, cattle burial grounds and industrial enterprises) with a sanitary protection zone from 50 to 1000 m depending on the degree of harmfulness of the object, on the windward side - from sources of air pollution. The site is placed on a well insolable, aerated and rich vegetation soil, with a natural or organized slope (0.5-10 0) to insolate and drain atmospheric water. Soils should allow the use of natural grounds without additional measures, have unpolluted, filtering soil. The low standing of groundwater (no closer than 1.5 m from the ground and 1 m from the foot of the foundation) should allow construction without work on artificially lowering the level and construction of complex waterproofing. The site should not be flooded, swamp, it should not be karst and landslide phenomena.

The calculation of the needs of the population in health care facilities and the size of land plots is made in accordance with the SNiP "Planning and development of cities, towns and rural settlements". Green areas, most favorable in their natural conditions, located on elevated dry terrain, are well ventilated for a medical institution. When choosing a site, you should consider the possibility of connecting the hospital building to the existing water supply, sewerage, electrification, district heating and gasification networks.

Everything said about the design, layout and sanitary equipment of hospitals is a necessary prerequisite for creating the most favorable hygienic conditions in the hospital.

In addition, the hygienic conditions in the hospital depend on the mode and schedule of the day for patients, the sanitary regime and maintenance of the premises, the observance of personal hygiene rules by staff and patients, etc.

It should be noted that the tasks and content of the hygienic and medical protective regime in the hospital are closely intertwined. Therefore, the treatment and protection regime is unthinkable in the hospital where hygienic treatment is not observed.

Hygienic regime of the patient. Under the hygienic regime, or personal hygiene, the patient is understood as a scientifically based system of rules governing his lifestyle and behavior in order to most effective treatment and the earliest possible recovery of health and disability.

The individual mode, which determines the lifestyle of each patient, is established within the framework of the general hospital mode, but taking into account the individual characteristics of the patient.

The hospital is for the patient a school of personal hygiene, and raising the hygiene skills of patients contributes to securing the results of treatment after discharge from the hospital.

At the heart of the hospital regime is a firm daily routine, mandatory for both patients and staff. The daily routine in the hospital is characterized by a strict alternation in time of the processes of wakefulness, sleep, taking medical procedures, eating, walking, etc.

The activity proceeding in a certain rhythm is most beneficial for the organism, which is especially important for patients.

The rise of patients in most medical institutions is made at 7 o'clock 30 min. in the morning After thermometry, patients perform the morning toilet: brush their teeth, wash their face. Walking patients perform the hardening measures recommended by their doctor and morning exercises.

In the summertime, morning exercises should be held on the terrace or in the garden, in the cold season or in inclement weather - in a pre-ventilated day-stay room. At this time, the staff cleans the wards.

Walking patients can straighten their beds, put in order the bedside tables. After cleaning, the wards are necessarily ventilated, after which medical appointments are made.

From 8.30 am to 9.00 pm, the patients have breakfast, after which they return to the wards, where they stay until the doctor goes around and receive appointments. From 9 o'clock 15 minutes, a doctor round begins. After a detour, patients receive appointments. The rest of the time before lunch, bedridden patients can spend on the veranda or terrace, where they are brought by staff.

Walking patients take walks in the hospital garden. The length of the walk is dosed by the doctor, who records it in the history of the disease, as well as allowing the patient to take air or sun baths. Many patients can take walks in the winter. Even patients remaining in wards should not be deprived of fresh air and sunlight.

They should lie on the beds next to the windows, the wards should be regularly ventilated. At the same time (preferably in the air), physical therapy is carried out. By selecting physical exercises, one can within certain limits manage the cardiovascular system, the respiratory apparatus, influence the metabolism and other functions of the body.

From 13 hours 30 minutes to 14 hours 30 minutes, patients have lunch, and from 14 hours. 30 min. up to 16 hours for them arrange an afternoon rest or sleep. At this time there should be the same silence as at night.

Time after sleep can also be used to stay in the garden. During these hours, it is recommended to perform occupational therapy for those patients for whom it is indicated. Work in the garden is quite suitable work in the garden, drawing, sculpting, needlework.

Indestructible work in the fresh air in the shade increases the overall tone of the body and has a positive effect on blood circulation, digestion, and sleep. Labor therapy has a particularly large impact on the patient's psyche.

The consciousness that he is already allowed to work, causes the patient a sense of cheerfulness, he gains confidence in the restoration of his health and strength, which contributes to recovery. During these hours evening appointments are made and temperature is measured.

From 18 to 19 o'clock the sick eat dinner, after which, those who do not receive appointments can read, play chess, checkers, listen to the radio, watch a television program. At 21 o'clock the sick drink evening tea. Then they make an evening walk through the hospital garden and a toilet (brush their teeth, wash their face, wash their feet).

At 22 o'clock the sick go to bed. The light turns off, in some places there is a duty light. Staying sick in the hallway at this time is not allowed. The staff takes all measures to ensure complete silence in the department.

Thus, the duration of physiological sleep, afternoon and night, totals 10-11 hours.

Sanitary regime and sanitary content. Cleanliness is a necessary element of a proper hygienic regime of a medical institution.

The atmosphere of absolute purity in combination with other parties of the hospital regime creates the best conditions for the implementation of the treatment process. It inspires the patient confidence in the hospital staff, creates a favorable impression of the hospital, contributes to the well-being of the patient.

The importance of hospital cleanliness in the implementation of the treatment process and the prevention of nosocomial infections can be illustrated by the following examples.

Insufficiently clean maintenance of the surgical department and the operating unit, increasing the dustiness and contamination of air, adversely affects the creation of sterile conditions necessary for the production of operations and storage of sterile material and instruments.

Among the most important elements of the sanitary regime of treatment-and-prophylactic institutions are those that are aimed at maintaining clean air in the hospital premises. Among these, the exchange of indoor air and dust control are of paramount importance.

The curve of bacterial contamination of air in poorly ventilated wards rises during the day. Therefore, every hospital should have a well-executed air regime, i.e., the order of ventilation of the chambers and corridors during the cold season,

The fight against dust in hospital premises is done by:

a) systematic cleaning of premises, combined with airing them;

b) systematic cleaning of soft equipment in the open air;

c) fixing dust by covering the floors and impregnating bathrobes, bedding with dust-binding compounds.

Cleaning of all premises of the hospital department is carried out daily. In the wards, corridors, offices cleaning is done in the morning after lifting the patients.

After the morning toilet of the sick, the reshuffling of the beds and the arrangement of the bedside tables, the floor is damply swept, furniture is swept away with a damp cloth and the doors, panels, window sills, heating surfaces are wiped clean, and the floor is cleaned.

You can also use the odorless dust-binding substances that cover the floor. To do this, use special formulations containing oils that keep dust deposited on the floor.

The study of bacterial contamination, air showed that it is minimal until the patients get up.

The number of microorganisms in the air increases by 2-4 times when moving in the patients' room and staff, 2-5 times - when beds are being retired and 2-10 times when the floors are dry swept. With a well-conducted wet cleaning of wards, the number of microorganisms in the air does not increase. This contributes to the ventilation of the chambers after cleaning. In the warmer months, wards should have windows and transom open as long as possible.

When severe frosts air the corridors behind closed chambers.

Cleaning should be repeated throughout the day as needed to ensure constant cleanliness of the room. Dining and buffet clean after each meal.

Before the patients go to bed, they re-bed, sweep the floor, air the room of the ward. In the winter time, the corridors are aired several times at night.

The most complete removal of dust in the hospital is achieved with the help of vacuum cleaners. Vacuum cleaners can be portable and stationary. The disadvantage of portable vacuum cleaners is the noise they generate with a volume of up to 70-80 dB.

This disadvantage does not have a central vacuum station, which equip the hospital during construction.

Mattresses, bedding, walkways and other soft equipment are an important source of air pollution from wards with dust, volatile odors and microorganisms. Cleaning and knocking out of the listed items is carried out periodically outdoors (verandas are used). The number of microorganisms after cleaning and knocking out decreases by 10-15 times, and the number of dust particles - by 2-3 times.

In order to prevent air pollution, in a number of foreign hospitals, changing mattresses and bedding in the wards does not produce, but completely replaces the beds. Changing mattresses, bedding and, if necessary, disinfection of beds are carried out centrally in a special room.

Some researchers recommend impregnating bedding and linen with dust-binding compounds. The most accessible product is a 3-5% aqueous solution of emulsol, which contains spun oil (72.5%), asidol (18%), ethylene glycol (2%), caustic soda (1%), water (6.5% ). The linen is immersed in the emulsol solution for 2–3 minutes, then squeezed and dried.

The hygienic properties of the impregnated linen (including smell and color) do not change. A 30% aqueous solution of emulsol (30 ml per 1 m 2) is used to cover the floors.

Using rational cleaning methods and systematic aeration, it is possible to significantly reduce the microbial contamination and dust content of the air in hospital rooms. However, the growing proportion of drip infections and the ever increasing requirements for asepsis dictate the implementation of measures to further reduce the microbial contamination of air in the wards of children's infectious diseases wards, in operating rooms, dressing rooms, generic, etc. To this end, various methods of air disinfection have been studied in recent years premises.

The greatest practical application received ultraviolet radiation. Ultraviolet radiation is a powerful and fast-acting bactericidal and virucidal agent in the irradiation of air or the surface of various objects. The bactericidal effect of ultraviolet rays decreases with increasing dust and humidity.

There are two sources of artificial and ultraviolet radiation; mercury-quartz lamps of high pressure (type of PRK) and bactericidal ultraviolet lamps of low pressure (of type BUV). Mercury quartz lamps can be of high power (up to 1000 watts), but they have less output of bactericidal rays per unit of power.

Therefore, lamps of the PPH type are currently recommended to be used in hospitals only for irradiating various objects and indoor air in the absence of patients.

Bulb-type lamps are of lower power than PPH (15 and 30 watts), but they have a significantly higher yield of bactericidal rays per unit of power. The emission spectrum of these lamps is 80% of the most bactericidal rays, so their side effects (ozone formation) are much less.

Three methods of using ultraviolet radiation are known:

1) direct exposure,

2) indirect irradiation - reflected rays,

3) fresh air irradiation in ventilation or recirculation devices. Direct irradiation is carried out using lamps suspended from the ceiling and directing a direct stream of rays downwards. It can also be carried out with lamps mounted on walls or in special stands on the floor. A power of 1.5-2 W per 1 m 3 of room is required. This method can achieve a high degree of disinfection of furniture and air.

So, after 1-2 hours of irradiation of the dressing room during operation, the total number of bacteria in the air decreased by 60-70%, while without irradiation, the contamination of air continuously increased.

However, the direct flux of ultraviolet rays of lamps of the type of PPH and even of the type of CCV has an adverse side effect and therefore direct irradiation can be carried out only in the absence of people taking breaks, before starting work) or while providing them with special glasses for eye protection.

The most widespread indirect ultraviolet irradiation of premises. For this, the ultraviolet radiation source is suspended at a height of 1.8-2 m from the floor with a reflector facing upwards so that the flow of direct radiation falls into the upper zone of the room; the lower area of ​​the room is protected from direct rays by the lamp reflector.

The air passing through the upper area of ​​the room is actually exposed to direct radiation. In addition, ultraviolet rays reflected from the ceiling and the upper part of the walls (for better reflection of the wall should be painted white) irradiate the lower zone of the room in which people can be.

Ultraviolet radiation reflected from the ceiling and walls at the correct dosage has not only bactericidal, but also a favorable biological effect (formation of vitamin D, improvement of the body’s immunological reactivity, stimulation of blood formation), since the intensity of reflected radiation is 20-30 times less than direct.

There are observations about the positive effect of indirect exposure in wards for newborns and premature babies (better weight dynamics, less aerogenic diseases, easier course of the disease).

Ultraviolet irradiation in wards with children with scarlet fever reduced the incidence of complications 3 times. In the irradiated wards of the children's infection ward, several times less were sown from the air of diphtheria bacilli, hemolytic streptococcus, and pyogenic staphylococcus.

It is advisable to irradiate the chambers in autumn and winter and in early spring 3-4 times a day for 1 hour.

Artificial ultraviolet radiation, even indirect, is contraindicated in children with an active form of tuberculosis, nephrosis nephritis, fever and severe exhaustion.

Disinfection of premises and care products is as follows.

In infectious wards, with daily cleaning, wipe the surface with a cloth. Wiping with a rag greatly increases its contamination and is ineffective in disinfecting wiped surfaces. Therefore, it is recommended to have three rags in a solution of chloramine and periodically change them when wiping surfaces.

After washing, tableware is disinfected by boiling or washing in a 0.2% bleached bleach solution followed by rinsing.

In the infectious diseases department, the duration of the disinfection of dishes with bleach must be at least 1 hour. Toilets, urinals, bathrooms, sinks are thoroughly cleaned of dirt (kerosene, acids or detergent), and then washed with hot water and soap. Bathrooms after each patient are washed with warm water.

The wooden parts of the toilet bowls are washed with a 5% bleach solution. Bedpans are washed and disinfected after each use. Disinfection is carried out with steam or in a 0.2% bleach solution for one hour.

It is necessary to introduce everywhere devices for washing and thermal sterilization of bed-pans and urinals, working on electricity or on water from a connected hot-water system. This refers to such devices as Purifax, the Czech apparatus of the firm Hirana, etc.

The procedure for the disposal of items for the care of seriously ill patients in these devices takes 7-8 minutes.

Toys are neutralized by washing in a 3% solution of chloramine or using a brush dipped in it, as well as ultraviolet radiation (15 minutes at a distance of 30 cm from the lamp to the surface of the toy).

It is advisable to whitewash rooms in hospitals at least once a year. After whitewashing, which is combined with careful cleaning of the hospital premises, the content of microorganisms in the air of the chambers for a long time keeps within the lower bounds, and after a few months, even with constant sanitary regime, it begins to increase.

An integral element of the sanitary regime in the hospital is the creation of a rest mode, in which the major role is played by noise control.

Noise in the hospital has an external and internal origin. The volume of external noise sources is higher, patients and staff more often complain about it. Fighting with external noise is carried out mainly by the correct choice of the site for the hospital and its rational development.

But there are many own sources of noise in the hospital. Thus, the noise level in decibels is at the closing of the ward doors - up to 80-85, the closing of the elevator doors - up to 80-90, movements of the elevator - up to 60-62, disassembling of the dining room and tea-ware - up to 70-80, in the generic room - up to 70-80, when filling the bath with water - up to 67, running water in the toilet - up to 70, calling a landline - up to 70-74, working an electric scooter - up to 77, moving a chair - up to 60-70, walking on the floor - up to 55- 60, the conversation of two people in the corridor - up to 65-76, etc.

The fight against hospital noise requires many measures. When drafting the internal layout of the hospital building, the rooms are grouped according to the noise level in them.

Chambers operating rooms are located away from noise sources: in hospitals, the requirements for sound insulation from both airborne and shock noise are particularly high. The average airborne soundproofing ability of partitions between chambers and operating rooms on the one hand, and other rooms on the other, should be at least 48 dB, between chambers and medical rooms - at least 44 dB, and sound insulation of doors not less than 30 dB. In rooms that are a source of intense noise, the device is recommended double doors. In the latter case, sealing between the floor and the lower edge of the door is difficult.

The following sealing design is rational. In the doorway, on the floor and above the door, rubber bands are fixed, the edges of which are beveled, and rubber gaskets of the tubular profile are attached to the lower and upper edges of the door.

When the doors are closed, this gasket seals the gap, and when open, it does not touch the floor.

It is estimated that the patient hears the noise of closing doors 500-700 times a day. Therefore, it is imperative to make door closing silently using rubber dampers. To combat the impact of noise flooring must be "floating" design.

Such floors prevent the spread of noise in the lower floor, but do not guarantee the penetration of noise in the adjacent rooms. Therefore, it is necessary to apply a noiseless and elastic floor covering. The coating must be easily washable and well disinfectable. Linoleum and some other coatings made from synthetic materials satisfy these requirements.

In hospitals and clinics should be used as widely as possible to apply fencing trim sound-absorbing materials (well-cleaned, non-dusting). Finishing a single ceiling in the chamber with sound-absorbing materials reduces the noise volume by 2 times. Sound absorbing materials cover the upper parts of the walls.

Modern hospital is saturated with sanitary equipment. Improper device and its operation can lead to the formation of intense noise. Therefore, when installing this equipment in hospitals, it is necessary more carefully than anywhere else to perform conventional measures against noise and vibration. In addition, it is not recommended to lay pipelines from one chamber to another.

With the passage of the pipeline through the fence between them put a strip of cork or mineral wool. In places where the pipe is fastened to the wall, a gasket made of sound-absorbing material is placed between the clamp and the wall. The water supply network of the hospital building should be divided into separate sections in order to prevent the spread of noise (for example, during repairs) throughout the building. To this end, in the pipeline make inserts from rubber or plastic pipes.

Each hospital should consider the most important sources of noise when carrying out specific anti-noise measures.

For example, under phones enclose the microporous rubber reducing noise level by 18-19 dB. Movable beds and tables should be equipped with wheels with rubber tires. The hinged covers of the tanks are provided with rubber gaskets that reduce the noise at closing by 10-15 dB, a rubber tube is placed on the bath tap that reaches the bottom, which reduces the noise by 10-14 dB when filling the bath.

Good lubrication of door hinges, tamping of rubber furniture legs, rubber walkways in the corridors, the use of soft shoes, etc. are important.

For the silence mode, silent light signaling, the behavior of patients and personnel (quiet speech), warning of doors slamming, ringing dishes, etc., are of great importance. In this regard, it is necessary to conduct daily explanatory work.

Personal hygiene of medical personnel. A neat, collected and cultural appearance, meticulous implementation of personal hygiene rules by medical personnel are essential conditions for patient care.

Medical personnel should serve as a model for patients in personal hygiene.

In addition, the implementation of personal hygiene by staff is of great importance for the prevention of nosocomial infections, both among health care workers and among patients.

All employees who come to work in the hospital are subject to mandatory medical examination. Subsequently, the staff of the food unit and the younger staff directly serving the patients are subjected to a monthly medical examination, and once every six months they are examined for bacilli-carrying.

Employees who become ill with diseases dangerous in relation to the possibility of transferring them to the sick are not allowed to work.

When a medical worker arrives at work, he should take off his outerwear, wash his hands thoroughly with soap and then put on the installed protective clothing (bathrobe, kerchief, gauze bandage on the mouth and nose, etc.). Overalls must be immaculately clean, ironed, appropriate size.

After dirty work, staff must wash their hands thoroughly with hot water with a brush and soap, and, if necessary, treat them with a disinfectant solution, for example, a 0.2% bleached bleach solution or 1% bleach solution. This should be done after serving infectious patients, as well as before and after various manipulations. Hand washing brushes should be stored in a disinfectant solution.

It is necessary that the nails of employees were cut short. Technical staff engaged in cleaning the room is not allowed to the distribution of food.

Every hospital should have the ability for staff to take a shower after work. For staff of infectious and disinfecting departments, shower-type permits are arranged.

Objective control over the sanitary condition of the hospital. An objective and reliable assessment of the sanitary condition of the hospital is impossible without systematic hygienic studies of the external environment.

The most important of them are: instrumental studies of microclimatic factors (temperature, humidity and air velocity, temperature of external walls), air examination for bacterial contamination, oxidation and carbon dioxide content, noise intensity study, research on the sterility of surgical instruments and dressings, research washes from the hands of staff and patients, from clothes, furniture, household items on the presence and degree of contamination with E. coli; the study of food on caloric and nutrient content, including vitamins; drinking water research, etc.

It is recommended that all data describing the sanitary condition of the environment in a hospital be recorded in a special sanitary journal.

Analysis of the results of these studies helps to uncover the causes of deficiencies and find effective measures to eliminate them.