The microclimate of the premises of therapeutic institutions is determined by the combination of temperature, humidity, air mobility, temperature of the surrounding surfaces and their thermal radiation. The parameters of the microclimate determine the heat exchange of the human body and have a significant impact on the functional state of various organism systems, well-being, efficiency and health.
High temperatures have a negative impact on human health. Work under high temperature is accompanied by intense sweating, which leads to dehydration of the body, loss of mineral salts, causes persistent changes in the activity of the cardiovascular system, weakens attention, the reactions are slowed down, etc.
When exposed to the human body negative temperatures There is a narrowing of the vessels of the fingers and legs, the metabolism changes. The prolonged effect of these temperatures leads to sustainable diseases of the internal organs.
The parameters of the microclimate depend on the thermal physical characteristics of technological processes, climate, season of the year, the conditions of heating and ventilation in health care facilities.
The struggle against the adverse effects of production microclimate is carried out using technological, sanitary and technical and medical and preventive measures.
Technological measures include: replacement of old and introduction of new technological processes and equipment, automation and mechanization of processes, remote control.
Sanitary and technical measures are directed to the localization of heat dissipation and thermal insulation, i.e. Sealing equipment, device of ventilation systems, the use of protective equipment, etc.
Medical and preventive measures include: the organization of the rational regime of labor and recreation, the passage of medical examinations, etc.
Requirements for heating, ventilation, microclimate and air medium of premises are established by sanitary and epidemiological rules and regulations of SanPine 2.1.3.1375-03 "Hygienic requirements for placement, device, equipment and operation of hospitals, maternity houses and other hospitals".
Heating, ventilation and air conditioning systems must provide optimal conditions microclimate and aerial environments of medical institutions.
Settlement temperature parameters, air exchange, categories for the purity of the premises of therapeutic institutions, incl. In day hospitals, given in Appendix No. 5 to Sanpin 2.1.3.1375-03.
Heating appliances should have a smooth surface that allows for light cleaning, they should be placed in outer walls, under windows, without fences. It is not allowed to locate in the warehouses of the heating devices in the inner walls.
In operating, preoperative, resuscitation halls, anesthesia, generic, power supply and premises of psychiatric departments, as well as in the wards of intensive therapy and postoperative chambers as heating devices, heating appliances with a smooth surface should be used, resistant to daily effects of detergent and disinfecting solutions that exclude adsorption. Dust and accumulation of microorganisms.
In the device of the fencing of heating devices in administrative and economic premises, the material is used in children's hospitals allowed to use in the prescribed manner. At the same time, free access must be provided for the current operation and cleaning of heating devices.
As a coolant in the central heating systems of hospitals and maternity hospitals, water is used with a limiting temperature in heating instruments 85 ° C. The use of other liquids and solutions (antifreeze, etc.) as a coolant in the heating systems of medical institutions is not allowed.
The buildings of therapeutic institutions should be equipped with system-exhaust ventilation systems with mechanical motivation and natural exhaust without mechanical motivation.
In infectious, including tuberculous compartments, exhaust ventilation with mechanical motivation is arranged by means of individual channels in each box and semi-fox, which must be equipped with air disinfection devices.
In the absence of a mechanical motivation in infectious compartments, natural ventilation should be equipped with a mandatory equipping of each box and semi-focus device for disinfection of the recycling type air, which ensures the efficiency of inactivating microorganisms and viruses at least 95%.
The design and operation of ventilation systems should exclude the flow of air masses from the "dirty" zones into "clean" rooms.
The premises of therapeutic institutions, in addition to operating, in addition to the supply and exhaust ventilation with mechanical motivation, are equipped with natural ventilation (forms, folding framugs, etc.), equipped with a fixation system.
Outdoor air fence for ventilation and air conditioning systems is made from a pure zone at a height of at least 2 m from the surface of the Earth. The outer air supplied to the intake installations is subject to filter with coarse and thin structure in accordance with the acting regulatory documentation.
Air supplied to operational, anesthesia, generic, resuscitation, postoperative chambers, chambers of intensive therapy, as well as the chamber for patients with skin burns, patients with AIDS and other similar medical premises should be processed by air disinfection devices that ensure the effectiveness of microorganisms and viruses that are inactivating In the processed air at least 95% (high efficiency filters H11-H14).
The premises of the operating, chambers of intensive therapy, resuscitation, generic, procedural and other premises in which are accompanied by excretion in the air of harmful substances, should be equipped with local suctions or exhaust cabinets.
The content of drugs in the air of operating, generic chambers, chambers of intensive therapy, resuscitation, procedural, dressing and other similar premises of therapeutic institutions should not exceed the maximum permissible concentrations given in Appendix No. 6 to Sanpin 2.1.3.1375-03.
The levels of the bacterial displacement of the air of the room, depending on their functional purpose and the class of purity, should not exceed the permissible shown in Appendix No. 7 to Sanpin 2.1.3.1375-03.
Air conditioning should be provided in operating, anesthesis, generic, postoperative chambers, chambers of intensive therapy, oncohematological patients, patients with AIDS, with skin burns, resuscitation, as well as in wards for newborns, chest, prematurely injured children and other similar medical premises. In wards, which are fully equipped with cuevezes, air conditioning is not provided.
Air ducts of supply ventilation (air conditioning) after high efficiency filters (H11-H14) are provided from stainless steel.
The use of split systems is allowed when there are high efficiency filters (H11-H14) only subject to the rules of regulatory work. Split - systems installed in the institution must have a positive sanitary and epidemiological conclusion issued in the prescribed manner.
The multiplicity of the air exchange is selected based on the calculations of the provisional purity and maintenance of the gas composition of the air. The relative humidity of the air should be no more than 60%, the speed of air movement is not more than 0.15 m / s.
Air ducts, air-dispersion and air intake grilles, ventkamera, annotation and other devices should be kept clean, should not have mechanical damage, corrosion traces, tightness disorders.
Fans and electric motors should not create outsiders.
No less often 1 time per month should be controlled by the degree of contamination of filters and efficiency of air disinfection devices. The replacement of filters should be carried out as it is contaminated, but not less often than recommended by the manufacturer.
Community supply and exhaust and local exhaust installations Should be included 5 minutes before starting work and turn off 5 minutes after the end of work.
In the operating and preoperative initial, the air ventilation systems are included, then exhaust, or at the same time supply and exhaust.
In all rooms, air is supplied to the upper area of \u200b\u200bthe room. In sterile rooms, air is supplied with laminar or weaklyrubular jets (air velocity< = 0,15 м/сек).
Air ducts of the supply and exhaust ventilation (conditioning) must have an inner surface, eliminating the removal of the duct or protective coating particles. The inner coating should be non-bound.
To accommodate equipment of ventilation systems, special rooms should be allocated, separate for supply and exhaust systems and not adjacent vertical and horizontally to the cabinets of doctors, operating, chambers and other premises of permanent stay of people.
In the premises for exhaust systems, it is necessary to provide exhaust ventilation with a single air exchange in 1 hour, for supply systems - inlet ventilation with twofold air exchange.
The premises of the ventilation equipment should be used only for its intended purpose.
In the premises to which the requirements of aseptic conditions are presented, the hidden gasket of air ducts, pipelines, reinforcement is provided. In the rest of the premises, air ducts can be placed in closed boxes.
Natural exhaust ventilation is allowed for separately standing buildings The height of no more than 3 floors (in the receiving offices, celades, departments of hydrotherapy, infectious corps and compartments). In this case, the supply ventilation is envisaged with a mechanical motivation and air supply to the corridor.
Exhaust ventilation with a mechanical motivation without a device of an organized inflow is provided from the premises: autoclave, miles, shower, restrooms, sanitary rooms, dirty linen facilities, temporary storage of waste and storerooms for storing disinfectants.
The air exchange in the wards and branches should be organized so as to maximize the flow of air between the celades, between the chambers, between the adjacent floors.
The amount of supply air in the ward should be 80 m 3 / hour per patient.
To create an isolated air regime chambers, they should be designed with a gateway with a message with a bathroom, with a predominance of drawing in the latter.
When entering the department, a gateway with an exhaust ventilation device with an independent channel should be equipped with an exhaust ventilation (from each gateway).
To eliminate the possibility of entering the contaminated air from flight-lift halls to the ward compartments, it is advisable to the device between them of the transition zone with the provision of air support in it.
Architectural and planning solutions and the hospital air exchange systems should exclude the transfer of infections from the ward offices and other premises in the operating unit and other rooms requiring particular air purity.
To eliminate the possibility of receipt of air masses from ward offices, flight-lift halls and other rooms in the operating unit, a device is needed between the specified rooms and the operating unit of the gateway with the rendering of the air.
The movement of air flows should be provided from the operating rooms in the adjacent rooms (preoperative, anesthesia, etc.), and from these premises in the corridor. In the corridors, a device for exhaust ventilation is needed.
The amount of air removed from the lower area of \u200b\u200boperating zone should be 60%, from the upper zone - 40%. The supply of fresh air is carried out through the upper zone, while the inflow must prevail over the exhaust.
It is necessary to provide for separate (isolated) ventilation and air conditioning systems for pure and purulent operating, maternity blocks, resuscitation, oncohematological, burn branches, dressing, individual celades, X-ray and other special tag.
Preventive inspection and repair of ventilation and air conditioning systems must be carried out according to the schedule approved, at least 2 times a year. Eliminating current faults, defects should be carried out without delay.
The administration of the medical institution is organized control over the parameters of the microclimate and the contamination of the chemicals of the air, the operation of the ventilation systems and the multiplicity of air exchange in the following rooms:
- in the main functional premises of operating, postoperative, generic, chambers of intensive therapy, oncohematological, burn branches, FTo, premises for storing potent and poisonous substances, pharmacy warehouses, premises for the preparation of medicines, laboratories, separation of therapeutic dentistry, special premises of radiological offices and in other premises, in the cabinets, using chemical and other substances and compounds that can adversely affect the human health - 1 time in 3 months;
- infectious, incl. tuberculosis hospitals (departments), bacteriological, viral laboratories, radicals - 1 time in 6 months; - In the rest of the premises - 1 time in 12 months.
To disinfect air and surfaces of premises in medical institutions, ultraviolet bactericidal radiation should be used using bactericidal irradiators allowed to use in the prescribed manner.
Methods for using ultraviolet bactericidal radiation, the rules of operation and safety of bactericidal settings (irradiators) must comply with hygienic requirements and instructions for the use of ultraviolet rays.
The assessment of the microclimate is based on the measurements of its parameters (temperature, air humidity, the speed of its movement, thermal radiation) at all places of stay of the employee during the shift.
Temperature changes should not exceed:
Towards the internal to outdoor Wall - 2 ° C
Vertical direction - 2.5 ° C for each meter of height
During the day with central heating - 3 ° C
Relative humidityair should be 30-60% Air speed- 0.2-0.4 m / s
Hygienic requirements for natural and artificial lighting.
Daylight.
The intensity of natural lighting is influenced by: geographical latitude, time of year, time of day, cloudiness, dustiness of the atmosphere, the orientation of the building, the proximity and size of the shadowing facilities, the area, location and shape of the windows, the color of the walls, the ceiling, Iola, furniture, the depth of the room, the room area and etc.
For hygienic assessment of natural lighting, I use the following indicators:
| Indicator | Characteristic | Norm |
| Light coefficient | The ratio of the glazed surface of the windows to the floor area | Living spaces- 1:8 - 1:10.School classes- 1:4 -1:5 |
| Angle of incidence. | The angle of falling the ray of light relative to the horizontal plane | 27 ° |
| Angle of hole | The angle between the upper boundary of the window and the roof of the opposing building (visible from the window of the sky) | 5 ° |
| The depth coefficient of the attachment | The ratio of length (depths) of the room to the height of the window | At least 2.5 |
| Natural Light Coefficient (CEO) ■ | The illumination ratio at this room point to simultaneous outer illumination (in the shade), expressed as a percentage. | IN residential premises -not less than 0.5% in 1 m. The walls opposite to the windows. IN classes -at least 1%. |
Artificial lighting.
Requirementsto artificial lighting:
1) Sufficiency
2) proximity to the spectrum to the natural light
3) uniform distribution
4) no blind
5) no side effects
6) economy
Sources of artificial light:
1) Fluorescent lamps.The spectrum is close to the natural light, economical, give uniform lighting. Disadvantages - small noise, stroboscopic effect (luminous flux pulsation)
2) Incandescent lamps.Less economical, not close on the spectrum to natural light, but do not have flaws of fluorescent lamps. Used more often, especially in domestic conditions.
Lighting systems:
1) General lighting.It is carried out due to the luminaires attached to the ceiling. Luminaires can be
1. Direct light.All light goes straight down, creating shadows, uneven lighting, having a blinding effect.
2. Reflected light.The light goes to the ceiling (due to the lampshar) and it is reflected from it down. The most favorable (soft, uniform light) is economically disadvantageous.
3. Scattered (semi-limited) light- Most common. Give uniform lighting in all directions, meet economic requirements.
2) Local lighting.Creates illumination (on the illuminated surface), which should exceed the total illumination of the surrounding space (no more than 10 times, since with a strong contrast of the eye during the interruptions in the work do not have time to adapt to less illumination and fatal comes).
3) Combined lighting(local + total)
4) Mixed- (artificial + natural) - the most common and favorable.
Norms of general artificial lighting:
Normated illumination.At the same time, the norms of illumination for luminescent lamps in2 times lower than for incandescent lamps.
Light norms in various (non-hospital) premises:
Naturally, the norms are compared with real illumination. Real illumination can be defined in two ways.
1. By measuringwith the help of a special device - luxometer
2. Settlement:
Lighted b \u003d number of lamps * power of one lamp* E room area E \u003d 2.5 for incandescent lamp E \u003d 12 for luminescent lamps
Aerial reservation.
The air of closed rooms with a large cluster of people has the greatest practical importance.
Cleaning and disinfection (sanitation) of the air environment of closed places is made using special cleaners and bactericidal lamps.
Mobile recirculation air cleaners are used (VSPR-0.9, VSPR-1.5).
Bactericidal lamps are sources of ultraviolet short-wave radiation. The most comfortable lamp boiled.
Perhaps two ways to use BUV bactericidal lamps:
More convenient and effective is the irradiation of the air in the presence of people. At the same time, the lamps are located at an altitude of 2.5 m in the places of the most powerful convection flow of air (above heating devices, doors, etc.). The required number of boiled lamps depends on the size of the room and the power of the lamps. When calculating the number of lamps proceed from the fact that each meter cubic air should have 0.75-1 W power, according to the lamp required. Air irradiation time should not exceed 8 hours per day. It is better to carry out irradiation 3-4 times a day with interruptions to ventilate the room.
When serving air in the absence of people(Operational, dressing, etc.) The lamps are uniformly or with a predominance over the working surfaces. At the same time, the cubic meter of air requires a consumption of no less than 1.5 W, and the minimum irradiation time is 15-20 mi nut.
In addition to the lamps, the BUVs also use lamps of the PC.
Standards:
Some degrees reduce the microbial air pollution of the air, properly organized ventilation, regular ventilation.
Sources of air pollution of hospital rooms.
The main component polluting the air room surgical
hospital and operational block, is the dust of the smallest dispersion, on
which is sorbed by microorganisms. Sources of dust are, the main
way, ordinary and special clothing of patients and personnel, bed
accessories, the flow of soil dust with air flows, etc.
4. Sanitary improvement elements of hospitals Heating, ventilation, water supply, sewage. Sanitary rules for the descent and cleaning of hospital wastewater, collecting and removing solid waste.
Requirements for heating, ventilation
The heating, ventilation and air conditioning systems should provide the normalized parameters of the microclimate and the air of the rooms in which medical activities are carried out.
Heating devices must have a smooth surface that excludes the adsorption of dust and resistant to the effects of detergent and disinfecting solutions. They should be placed in outer walls, under the windows. The location of the heating devices in the inner walls in the wards is not allowed.
With the device for the fencing of heating devices, free access must be provided for current operation and cleaning.
In the central heating systems of LPOs, water is used as a coolant with a temperature in heating devices 70-85 o C. The use of other liquids and solutions in heating systems is not allowed.
LPO buildings must be equipped with systems of supply and exhaust ventilation with mechanical and / or natural motivation.
Mechanical supply and exhaust ventilation systems must be passported. Operation (maintenance) of mechanical supply and exhaust ventilation and air conditioning is carried out by a responsible person of the organization or another specialized organization. Once a year, the effectiveness of work is conducted, current repairs (If necessary), as well as cleaning and disinfection of mechanical supply and exhaust ventilation and air conditioning systems.
Ventilation system production premises Lights placed in residential buildings should be separate from the ventilation of a residential building.
When operating ventilation systems should be provided regulatory requirements To noise and vibration levels.
Design and operation of ventilation systems should exclude the flow of air masses from "dirty" rooms in "clean".
Regardless of the availability of systems forced ventilation In all therapeutic and diagnostic premises, with the exception of the cleanliness of class A, the possibility of natural ventilation should be provided.
Independent ventilation systems are provided for the premises of operating, resuscitation, radiopabinets, laboratories. General systems of supply and exhaust ventilation for a group of rooms of one or several structural units, except for the purity of class A.
In all rooms, the air is fed to the upper zone. According to the medical task for designing operational, chambers for burn and other immunocomplete patients of under construction and reconstructed medical organizations, air is recommended to apply on top of the unidirectional air flow into the operating table zone (bed).
Air removal is provided from the upper zone, except for operating, anesthesia, intensive, generic and x-ray-processed, in which the air is removed from two zones: 40% of the upper zone and 60% from the lower zone (60cm from the floor).
When working with liquid nitrogen and other heavy gases, aerosols, the extractor is organized only from the bottom zone. Premises for storing biomaterials in liquid nitrogen should be equipped independent system Exhaust ventilation and emergency ventilation, which is automatically included in the gas analyzer signal.
In aseptic premises, the inflow must prevail over the hood. In the premises of the infectious profile, the extractor prevails above the influx.
In order to provide permanent indicators of the specified air parameters, the supply and exhaust system of ventilation of the class A Class A should operate in continuous mode.
Shut-off devices (including check valves) should be installed on the supply and exhaust ventilation systems in section, laboratories of pathologists and departments of forensic examination, as well as in other premises, to eliminate unauthorized air flow.
In infectious, including tuberculous compartments, exhaust ventilation systems are equipped with air disinfection devices or fine cleaning filters.
Boxes and boxed chambers are equipped autonomous systems Ventilation with a predominance of air exhaust over the influx and installation of air disinfection devices or fine cleaning filters. When installing disinfecting devices directly at the outlet of the room, it is possible to combine the air ducts of several boxes or bauxed chambers into one exhaust ventilation system.
In existing buildings, in the absence of a mechanical motivation in infectious compartments, natural ventilation should be equipped with a mandatory equipping of each box and an airborne chamber of air disinfection devices that ensure the effectiveness of inactivation of microorganisms at least 95% at the output.
Insulation of patients with infectious diseases that can lead to emergency situations in the field of sanitary and epidemiological well-being of the population and require activities on sanitary protection of the territory (plague, cholera, yellow fever, viral hemorrhagic fever and others) is allowed only in boxes with a mechanical ventilation system .
In LPO, a total area of \u200b\u200bno more than 500 sq. M, in the rooms of class B and B (except for the x-ventilation, cabinets of computer and magnetic resonance tomography) is allowed to be allowed.
Outdoor air fence for ventilation and air conditioning systems is made from a pure zone at a height of at least 2 m from the surface of the Earth. The outer air supplied to the intake installations is to be clean with coarse and fine filters.
The exhaust air release is envisaged above the roof by 0.7m. It is allowed to release air to the facade of the building after cleaning the filters of the appropriate destination.
The air supplied to the cleanliness of classes A and B is purified and disinfected, devices that ensure the effectiveness of the inactivation of microorganisms at the output from the installation at least 99% - for class A and 95% for class B, as well as filtering efficiency corresponding to the high filters Efficiency (H11-H14). High cleaning filters are subject to replacement at least once every six months, unless otherwise provided by the instruction manual.
To ensure the normalized temperature and humidity of air in the cleanliness of classes A and B, it is necessary to provide air conditioning using systems and equipment allowed for these purposes in the prescribed manner. On the task of design, it is possible to equip the air conditioning systems of the class V.
The air exchange in the wards and offices should be organized so as to prevent air flow between the celades between the chambers, between the adjacent floors. When entering the ward compartment / section, the operating unit, the resuscitation compartment provides a gateway with a ventilation device.
In the wards with nanosals, the hood is organized from the bathroom.
In order to maintain a comfortable air temperature in the cabinets of doctors, wards, administrative and auxiliary premises, the use of split systems is allowed, provided that cleaning and disinfection of filters and heat exchanger cameras are allowed in accordance with the manufacturer's recommendations, but at least once every 3 months. The use of radiant heat panel (cooling) is also allowed.
Exhaust ventilation with mechanical motivation without a device of an organized inflow is provided from the premises: shower, sanitary assemblies, dirty linen premises, temporary storage of waste and storerooms for storing disinfectants, reagents and other substances with a sharp odor.
The levels of the bacterial displacement of the air of the room, depending on their functional purpose and the purity class, should not exceed the permissible shown in Appendix 3
Workplaces in the premises where work is carried out, accompanied by the release of harmful chemicals (work with cytostatics, psychotropic substances, methyl methacrylates, phenols and formaldehydes, organic solvents, aniline dyes and others) should be equipped with local exhaust devices.
The release of exhaust air from local exhaust devices is carried out by independent channels. Local outpass removing air from different roomsBut with the same harm can be combined into one exhaust ventilation system.
To accommodate the equipment of ventilation systems, special premises are allocated, separate for supply and exhaust systems. Channel ventilation equipment It is possible to post behind the tail ceiling in the corridors and in the premises without permanent stay of people.
Air ducts of the supply ventilation and air conditioning should have an inner unbagging surface, eliminating the removal of air ducts or protective coatings.
Air ducts of supply ventilation systems (air conditioning) after high efficiency filters (H11-H14) are provided from stainless steel or other materials with a smooth, corrosion-resistance, not dusting surface.
Air ducts, air-chipping and air intake grilles, ventilation chambers, ventilation plants and other devices should be kept clean, not have mechanical damage, corrosion traces, tightness disorders. The use of ventilation chambers is not for direct purposes. The cleaning of the premises of the ventilation cameras should be carried out at least 1 time per month, and air intake mines are not less than once every six months. MaintenanceCleaning and disinfection of ventilation systems is provided at least once a year. Elimination of current faults, defects are carried out without delay.
In all the cleanliness of class A, there is a hidden gasket of pipelines, reinforcement. In the rest of the premises, air ducts can be placed in closed boxes.
Support and exhaust grilles must be maximally removed from each other within the same room.
Through the thoughtful I. basement Must be protected from penetration of rodents, birds and synanthropic insects.
Regardless of the adopted ventilation system, it is recommended to ventilating the chambers at least 4 times a day to 15 minutes.
The administration of LPOs is organized control over the parameters of the microclimate and the microbial semination of the air environment with frequency at least 1 time in 6 months and the contamination of the air-environment chemicals, at least 1 time per year.
Air recirculation is allowed for one room under the installation of high efficiency filter (H11-H14) with the addition of external air by calculation to ensure the regulatory parameters of the microclimate and air purity.
In the presence of centralized air conditioning and air humidification systems in order to prevent medical-headed legionelosis, microbiological control of these systems for the presence of Legionelle is carried out 2 times a year. Sampling is performed in accordance with current requirements. . Air-conditioning low-power installations without humidification of air and split-system control over legionellas are not subject to.
Requirements for water supply and sewage
5.1 All newly under construction, reconstructed and existing medical institutions must be equipped with water supply, sewage, centralized hot water supply. Water quality for economic and drinking destination must comply with the requirements of sanitary rules.
In the presence of its own source of water supply, water consumption is possible in the presence of sanitary and epidemiological conclusion on this source.
5.2 Cleaning and disinfection of wastewater from LPO should be carried out on citywide or other sewage treatment plants that guarantee effective cleaning and disinfection of wastewater. In the absence of citywide or other sewage treatment plants, wastewater LPOs must be complete biological cleaning and disinfection on local facilities.
5.3 In order to prevent clogging sewage systems Buildings in premises for the preparation of plaster should be provided for the installation of a gymstone.
Wastewater removal from the premises of mud procedures, mud cuisine and other places of the mud agent should be carried out through special lathes in the precast mudovenary.
To clean the production wastewater from the food building in hospitals for 500 beds and more should be provided for the installation (outside the building) of the grease traps.
5.4 For newly under construction and reconstructed LGOs in case of failure or preventive repair of hot water supply, centralized backup hot water supply should be provided. For existing institutions - water heating devices are installed as a backup source.
5.5 In medical offices, rooms and staff cabinets, in toilets, in mother-in-room services, washbasins with liner hot and hot and auxiliary premises must be installed, procedural, dressings and auxiliary rooms. cold waterequipped with mixers. Temperature hot water At the disclaimers of children's and psychiatric chambers, shower, bathrooms for patients should not exceed 37 ° C.
In wards, gateways under the ward, washbasins are installed in accordance with the design task.
5.6 Preoperative, Dressing, Generic Halls, Resuscitation, Procedural Cabinets, Nursing Posts with Newborns Chambers, Honey Sisters Posts (in Building and Designed LGOs) and other rooms requiring compliance with the special mode and cleanliness of the serving medical staff should be equipped with washbasins with installation of mixers With the elbow (contactless, pedal and other non-cycle) control and dispensers with liquid (antiseptic) soap and solutions of antiseptics.
The same cranes and dispensers are installed in infectious, tuberculous, skin-venereological, purulent, burn, hematological departments, clinical and diagnostic and bacteriological laboratories, as well as in the sumps, in gateways-boxes, semi-fox and bathrooms for staff.
5.7 In the wards of newborns, shells with a wide bowl and high mixers are installed.
5.8 In the cabinets, where the processing of the tools is carried out, it is necessary to provide for a separate shell for washing hands or a cough sink (washing).
5.9 Bathrooms are provided with toilet paper, handwashing agents.
5.10 Sanitary rooms of the ward branches must be equipped with devices for processing and drying the ship, oilcloth.
5.11 For the convenience of patients in sanitary nodes under the chambers, the design of shower cabins can provide a drain without installing shower pallets or shower pallets without sideboards.
5.12 In order to prevent the prevention of mineralized legionellazes in departments (wards) for the treatment of immunocompromverted patients (transplantology, oncohematology, burns, etc.) at hot water temperature at the parsing points (shower grids) below 60 degrees it is recommended to use additional protection tools (special filters) . Microbiological control for Legionell in these institutions is carried out 2 times a year, the selection point is before entering the distribution network. At hot water temperature above 65 degrees and cold water below 20 degrees, microbiological control is not carried out.
-Sapt, storage and removal of LPU waste.
There are 5 classes of LPU waste. "A" - non-hazardous (waste non-contact with biological fluids of patients, infectious patients, non-toxic). - Food waste of all LPUs, except infectious, TB, leather veins, etc. hospitals; - inventory and equipment not containing toxic and radioactive elements; - construction trash, etc. Collection → Disposable packages having a white color → Reusable tanks → Interconnected containers for collecting waste class A.
Reusable packaging → Wash and disinfection. "B" - hazardous (potentially infected waste and materials contaminated with purulent discharge, blood, discharge of patients; pathoanatomy and postoperative waste (organs and tissues); biol waste of vivarius and microbiological laboratories working with microbes 3-4 pathogenic groups; all infectious waste etc. offices). Collect → Yellow Packages and Marking "Hazardous Waste, Class B" + LPU code and division, date and surname of a responsible person. Filled on ¾, sealing. Sorting without sealing is prohibited. Delivery to the collection site of Class B. "B" is extremely dangerous (materials in contact with patients with particularly dangerous infections; microbiological laboratories working with microbes of 1-2 hazard classes; waste of phthisiatric, micrological hospitals and with patients with anaerobic infection). Collection → Red Packages + - // - Waste Containers Class B → Separate rooms with deposit water, ventilation, bactericidal emitters, moisture-resistant coatings. !!! The joint layout of containers in and other classes is categorically prohibited. !!! B + B is prohibited to sort without gloves and move from one package to another. "G" - close to industrial (overdue drugs and desiccation; mercury containing objects and equipment; chemotherapy; cytostatics). Storage → Auxiliary rooms. Exportation → Special enterprises on contractual conditions. "D" - radioactive. Storage: a + b + B \u003d no more than a day (n.) Week (temperature< 5 градусов). Пищ отходы = температура < 5 градусов. ВЫВОЗ: А → вывозятся простым автотранспортом для бытового мусора. Б, В → только специальный транспорт, утилизируется на специальных установках. В отделениях → старшая сестра (ответственная).
5. Hygienic aspects of the prevention of nosocomial infections. Planning, sanitary and disinfective measures. Sanitary and hygienic and anti-epidemic regulations, hospitals.
institutions and pharmacies, with the exception of infectious hospitals (offices) are equipped with a supply-exhaust ventilation with mechanical motivation. In infectious hospitals (compartments), exhaust ventilation is organized autonomously from each boxing, semi-fox and from each storeroom. At the same time, the hood on a natural traction is equipped with a deflector, and the inflow is a mechanical motivation and air supply to the corridor.
Air conditioning is organized in operating, anesthesis, generic, postoperative chambers, resuscitation departments, intensive therapy, single and double chambers for patients with burns, in wards intended for accommodating 505 beds, in departments for newborns and breastfeeding, as well as All chambers in departments for premature and injured children.
The air conditioning system should provide in operating, anesthesis, postoperative wards, generic, resuscitation and intensive care departments, relative air humidity 55-60%, air movement speed not more than 0.15 m / s.
Independent systems of supply and exhaust ventilation are provided for operating blocks (separately for septic and aseptic compartments), resuscitation departments, intensive therapy (separately for hospitals from the hospital and from hospitals), generic - separately for physiological and observational departments; Chambers of obstetric departments of hospitals (maternity houses) - separately for physiological and observational departments, chambers for newborns, premature and injured children; For X-ray cabinets, laboratories, dirt and dirty, hydrogen sulfide and radon baths of laboratories of the preparation of radon, sanitary nodes, refrigeration chambers, and sensitive pharmacies.
The outer air supplied to the supply ventilation systems is cleaned in filters. Air recycling is not allowed.
Air supplied to operational, anesthesia, generic, postoperative chambers, resuscitation, chambers of intensive therapy, in single and double-minded chambers for patients with skin burns, fees for newborns and breast-age, for premature and injured children is additionally purified in bacteriological filters. In this case, it is not allowed to install oil filters as the 1st stage of air purification and the device of air ducts, removing air after bacteriological filters from galvanized tin.
Heating. In health and social security institutions is used exclusively water heating. The power of radiators should be calculated so that their surface temperature is not more than 90 ° C, otherwise dust will burn. To facilitate cleaning, radiators need to be mounted at the wall, and not in niches. Even better to use panel radiatorswhich can be placed one one
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The inner room of the premises acts on the body with a complex of factors: thermal, air, light, color, acoustic. Acting in aggregate, these factors determine the well-being and performance of a person in a closed room.
Thermal factor this combination of four physical indicators: air temperature, humidity, air speed and temperature of indoor surfaces (ceiling, walls).
Airfront
premises are a gas and electric air composition, dust (mechanical impurities), anthropogenic chemicals and microorganisms
Microclimate Optimization B. large rooms Promotes favorable course and outcome of the disease. Compensatory capabilities of the patient are limited, sensitivity to adverse environmental factors is raised.
The norms of the microclimate of the chambers and other hospitals should consider:
- the age of the patient;
Features of the heat exchange of patients with different diseases;
Functional purpose of premises;
Climatic features of the terrain.
Temperature in most patrols of multi-profile hospitals - 20 °; The ageal features of children determine the highest temperatures in the wards of premature, newborns and infants -25 °; Features of the heat exchange of patients with impaired thyroid functions determine high temperature In the ward, for patients with hypothyroidism (24 °). In contrast, the temperature in the wards for patients with thyrotoxicosis should be 15 °. Increased heat generation in such patients is the specificity of thyrotoxicosis: "Sheets" syndrome, so patients are always hot; The temperature in the halls of therapeutic physical culture is 18 °.
Air environment Premises: The chemical composition of air and bacterial contamination is normalized.
Chemical composition of indoor air
The normatives of the bacterial dissemination depend on the functional purpose and the class of cleanliness of the premises. Control three types of sanitaryobacteriological indicators: before the start of work and during operation.
The total number of microorganisms in 1 m of the air ( m.)
Number of colonies staphylococcus aureus in 1 m 3 air
Number of mold and yeast mushrooms in 1 dm of air
Heating. In medical institutions cold period The heating system should ensure uniform heating of air throughout the heating period, exclude contamination with harmful discharges and unpleasant smells Air of premises, not to create noise. The heating system should be convenient to operate and repair, linked to ventilation systems, easily adjustable. Heating devices should be placed in outer walls under windows, which ensures their higher efficiency. In this case, they create uniform heating of air indoors and prevent the appearance of cold air over the floor near the windows. It is not allowed to accommodate the heating devices in the inner walls. The optimal system is central heating. Only water with a maximum temperature of 85 ° is allowed. Heating appliances are allowed only with a smooth surface in hospitals. The devices must be resistant to the daily effects of detergent and disinfecting solutions, do not adsorb dust and microorganisms.
Heating devices in children's hospitals are protected. Rady heating with hygienic position is more favorable than convective. It is used to heat operating, preoperative, resuscitation, anesthesia, generic, psychiatric departments, as well as chambers of intensive therapy and postoperative chambers.
As a coolant in the central heating systems of therapeutic institutions, water is used with a limiting temperature in the heating instruments 85 ° C. The use of other liquids and solutions as a coolant in heating systems of medical institutions is prohibited.
Ventilation. The buildings of therapeutic institutions must be equipped with three systems:
·
supply-exhaust ventilation with mechanical motivation;
·
Natural exhaust ventilation without mechanical motivation;
·
conditioning
Natural ventilation (aeration) through the velocity, framoufi is required for all therapeutic premises, except for operational.
Outdoor air intake for ventilation and air conditioning systems produce from a clean area of \u200b\u200batmospheric air at a height of at least 2 m from the surface of the Earth. The outer air supplied to the intake installations is purified by coarse and thin structure filters.
Air supplied to operational, anesthesia, generic, resuscitation, postoperative chambers, chambers of intensive therapy, as well as a chamber for patients with burns, patients with AIDS, should be processed by air disinfection devices that ensure the effectiveness of inactivation of microorganisms and viruses in the processed air, less than 95%.
There are methods for a comprehensive assessment of the microclimate and its influence on the body:
1) Evaluation of the cooling capacity of air. The cooling capacity is determined using a catarmometer and is measured in the RUB / cm "C. Norm (thermal comfort) for a sedent lifestyle-5.5-7 mcal / cm 2 s. With a moving lifestyle - 7.5-8 μal / cm 2 -C. For large premises, where heat transfer is higher than the coolant rate is approximately 4-5.5 μal / cm with.
2) Definition of EET (equivalent effective temperature) - an indicator characterizing the integrated effect on the human temperature, humidity and speed of movement
ambient air, as well as infrared (thermal) environmental emission; Determined with help
nomograms or tables in terms of equivalent and efficient and radiation temperatures., radiation temperature and RT (result result).
2. Hygienic requirements for the improvement of hospital premises
The inner room of the premises acts on the body by complex factors: thermal, air, light, color, acoustic and other. Acting in aggregate, these factors determine the well-being and performance of a person in a closed room.
Consider 3 priority factors in the lecture: thermal, air and light.
Thermal factor this combination of four physical indicators: air temperature, humidity, air speed and temperature of indoor surfaces (ceiling, walls).
Airwednesday premises are a gas and electric air composition, dust (mechanical impurities), anthropogenic chemicals and microorganisms
Optimization of microclimate in large rooms contributes to favorable flow and outcome of the disease. Compensatory capabilities of the patient are limited, sensitivity to adverse environmental factors is raised.
The norms of the microclimate of the chambers and other hospitals should consider:
Table 1
| Indoor air temperature | hospitals | ||
| 1. | Chambers for adults | 20 ° |
|
| 2. | Chambers for patients with hypothyroidism | 24 ° |
|
| 3. | Chambers for patients with thyrotoxicosis | 15 ° |
|
| 4. | Chambers for burning patients, postpartum | 22 ° |
|
| 5. | Chambers for children | 22 ° |
|
| 6. | Chambers for premature, newborns and | 25 ° |
|
| baby | |||
| 7. | Operating, Chambers of Intensive Therapy | 22 ° |
|
| 8. | Healing Physical Halls (LFC) | 18 ° |
We will analyze the data of the table.
Temperature in most wards of multi-profile hospitals - 20 °. For comparison: in the residential premises of the apartment - 18 °.
4. Other functional design of premises: in operating, peits
temperature should be higher than in the wards - 22 °.
The relative humidity of the air should be no higher than 60%, the speed of air movement is not more than 0.15 m / s.
^ Air Premises: The chemical composition of air and bacterial contamination is normalized.
Hygienic assessment of hospital air purity. The presence in closed rooms of people and animals leads to air pollution with metabolic products (anthropotoxins and other chemicals). The person in the process of vital activity distinguishes more than 400 different compounds - ammonia, ammonium compounds, hydrogen sulfide, volatile fatty acids, indole, mercaptan, acrolein, acetone, phenol, butane, ethylene oxide, etc. The exhaled air contains only 15-16% oxygen and 3, 4-4.7% carbon dioxide, saturated with water vapors and has a temperature of about 37 °. As a result, the air temperature in the premises increases. Pathogenic microorganisms (staphylococci, streptococci, mold and yeast mushrooms, etc.) are entered into the air. The amount of light ions decreases, heavy ions accumulate. There are unpleasant odors in the wards, adoptive, medical and diagnostic departments. This is due to the use of various drugs (ether, gaseous anesthetic substances, evaporation of various drugs, etc.). Unpleasant odors can be associated with building materials (Polymer materials for decoration, furniture), as well as with specific foods. The content of unsophisticated substances in the air rises. All this has adverse effects, both in patients and personnel. Therefore, control by chemical composition Air and its bacterial disseminance has an important hygienic value (Table 2).
table 2
Chemical composition of indoor air
An important indicator of the air is the content in the air of carbon dioxide - CO 2. In the premises, the content of CO 2 should not exceed 0.1%. In atmospheric air - 0.03-0.04%. The content of 0.1% CO 2 is not toxic for humans. However, all indicators of the air-thermal medium deteriorate at this concentration of CO 2: temperature increases, relative humidity, anthropogenic impurities and microbial contamination. This adversely affects the well-being of people, worsens recovery, contributes to the emergence of nosocomial infections.
^ Permissible levels of bacterial semination of air of premises of medical institutions
The normatives of the bacterial dissemination depend on the functional purpose and the class of cleanliness of the premises. Control three types of sanitaryobacteriological indicators: before the start of work and during operation.
P. Clean rooms (Class b): Procedural, Dressing, Preoperative, Resuscitation Chambers, Children's Chambers. The total number of microbes should not exceed 500 per 1 m before the start of work, during operation - no more than 750 / m.
III. Conditionally clean (Class B): Chambers of surgical departments,
corridors adjacent to operating, maternity hospitals, boxes and chambers of infectious departments, etc. The total number of microbes should not exceed 750 / m 3 prior to work, during operation - no more than 1000. Staphylococcus gold and microhydriba should be absent in all rooms of classes A , B and in both before, and while working. IV. Dirty (class d): corridors and administrative premises
buildings, stairs, toilets, etc. Microbial dissemination is not normalized.
Hygienic requirements for heating and ventilation.
Heating, ventilation and air conditioning systems provide air-thermal hospital mode.
Heating. In medical institutions, the cold period of the year, the heating system should ensure uniform heating of air during the entire heating period, eliminate the contamination of the harmful discharges and unpleasant air smells, not to create noise. The heating system should be convenient to operate and repair, linked to ventilation systems, easily adjustable. Heating devices should be placed in outer walls under windows, which ensures their higher efficiency. In this case, they create uniform heating of air indoors and prevent the appearance of cold air over the floor near the windows. It is not allowed to accommodate the heating devices in the inner walls. The optimal system is central heating. Only water with a maximum temperature of 85 ° is allowed. Heating appliances are allowed only with a smooth surface in hospitals. The devices must be resistant to the daily effects of detergent and disinfecting solutions, do not adsorb dust and microorganisms.
Heating devices in children's hospitals are protected. Rady heating with hygienic position is more favorable than convective. It is used to heat operating, preoperative, resuscitation, anesthesia, generic, psychiatric departments, as well as chambers of intensive therapy and postoperative chambers.
As a coolant in the central heating systems of therapeutic institutions, water is used with a limiting temperature in the heating instruments 85 ° C. The use of other liquids and solutions as a coolant in heating systems of medical institutions is prohibited.
Ventilation . The buildings of therapeutic institutions must be equipped with three systems:
Outdoor air intake for ventilation and air conditioning systems produce from a clean area of \u200b\u200batmospheric air at a height of at least 2 m from the surface of the Earth. The outer air supplied to the intake installations is purified by coarse and thin structure filters.
Air supplied to operational, anesthesia, generic, resuscitation, postoperative chambers, chambers of intensive therapy, as well as a chamber for patients with burns, patients with AIDS, should be processed by air disinfection devices that ensure the effectiveness of inactivation of microorganisms and viruses in the processed air, less than 95%.
^ Air conditioning ~ this is a set of events to create and automatic maintenance In the premises of therapeutic institutions of optimal artificial microclimate and the air environment with a given clean, temperature, humidity, ionic composition, mobility. It is envisaged in operating, anesthetic, generic, postoperative chambers, resuscitation, intensive care chambers, oncohematological patients, patients with AIDS, with skin burns, in chambers for infant and newborn children, as well as in all the wards of departments of premature and injured children and other similar healing institutions. Automatic system Microclimate adjustments should provide the required parameters: air temperature - 15 - 25 ° C, relative humidity - 40 - 60%, mobility - not more than 0.15 m / s.
The air exchange in the wards and branches should be organized so as to maximize the air flow between the celades, between the chambers, between the adjacent floors. The amount of supply air in the ward should be an 80m / hour per patient. Air volume in chambers with minimal dimensions (7m - area, 3m-high) is 21 m 3 per patient. Ensuring a sufficient normalized air volume (80m per hour) is achieved by a 4-h-air shift in the ward. The multiplicity of the air exchange is how many times an exchange of air will occur within an hour in the room.
Architectural and planning solutions of the hospital should exclude the transfer of infections from the celestial offices and other premises in the operating unit and other rooms requiring special purity of air. The movement of air flows should be provided from the operating rooms in the premises adjacent to them (preoperative, anesthesia and others), and from these premises in the corridor. In the corridors, a device for exhaust ventilation is needed. This is ensured by the correct ratio of tributary and exhaust.
The amount of remote air from the lower zone of operating rooms should be 60%, from the upper zone - 40%. Fresh air supply is carried out through the upper zone. In this case, the inflow should prevail at least 20% over the hood. The last requirement applies to the aseptic chambers of intensive therapy, postoperative chambers, resuscitation, generic boxes, as well as to the chambers for premature, chest, newborns and injured children. At the same time, in the wards for tuberculosis hospitals for adult patients, the extract should prevail over the influx. It warns pollution of the corridor and other premises of the chamber section. In infectious, including tuberculous compartments, exhaust ventilation with mechanical motivation is arranged from each box and half-fox and from each storeroom separately, by means of individual channels that exclude air flow vertically, they must be equipped with air disinfection devices.
^ Control over the microclimate and chemical air pollution
environments
The administration of the medical institution organizes this type of control in all rooms periodically. The operation of the ventilation systems and the multiplicity of air exchange is verified on the same time.
Table 3.
1st group - High Risk Rooms - 1 time in 3 months. The 2nd group is an increased risk premises - 1 time in 6 months. The 3rd group is all other rooms and, above all, the chambers - 1 time per year.
