Transcript 08. Hygiene of medical establishments

Hygiene of medical establishments, their
planning and equipment. Modern
problems in hospital building. Hygienic
measures of optimization terms of stay
patients in medical establishments.
Prophylaxis of hospital infections.
Hygiene of labor doctors and different
specialties.
A hospital
is an institution for health
care providing patient
treatment by specialised
staff and equipment. But
not always providing for
longer-term patient stays.
The site land area depends on the power, specialization and
system of the hospital group of buildings site development
Number of
beds
Area norm
per 1 bed, m2
Number of
beds
Area norm per
1 bed, m2
up to 50
300
> 400 to 800
100-80
> 50 to 100
300-200
80-60
> 100 to 200
200-140
> 800 to
1 000
> 1 000
>200 to 400
140-100
60
Decentralized (pavilion) type of
hospital
each department is situated in the separate
building;
The positive
feature of the
decentralized
system is the
possibility of
patients to stay
more outdoors;



The drawback of the centralized system is the difficulty of
nosocomial (intrahospital)infections prevention,
Decreased time or impossibility of the patients to stay
outdoors.
Noise
Centralized-blocked system of hospital
Such version ensures
both centralization
of medical processes
and using of
equipment and
realization of a
principle of isolation
of separate medical
departments.
The hospital site housing density depending on the amount
of beds should not exceed 10 – 15 %. Up to 60 – 65 % of the
area should be occupied by all kinds of green area; 20 – 25
% - a household zone, passages and passageways. The size
of the landscape zone should be not less than 25 m2 per one
bed.
Hospital consist from next department:
1. Reception department;
2. Treatment and surgery department, genecology ,
children, infection, emergency, radiology
department and other
3) Policlinic ;
The building of the
policlinic must be
location on distance
30—50 m from hospital.
Entrance must be
separate.
4) Treat mentally and diagnostically
departments with department functionally
diagnostic, x-ray diagnostic, physiotherapy
and rehabilitation department;
5) Pathological
department;
6) Sterilization department
and garage and other
7) Administration department, library, addition
department and economical department.
Isolator consist of ward, lock, tambours and restroom.
Square of box is 22 m2.
Surgical department
Children’s departments
Each hospital department is intended for patients with similar
diseases.
It should include:
ward sections for 30 beds, with
6 wards for 4 beds with the area of 7 m2 per bed,
2 wards for 2 beds with the area of 7 m2 per bed wards
2 wards for 1 bed with the area of 9-12 m2 for severe somatic
and infectious patients, with the cubic capacity of 20-25 m3 for
each patient and the ventilation volume – 40-45 m3/hour.
There can be two types of the corridor: a side one
with windows facing towards the Northern points,
or a central – with light gaps (halls).
The nurse workplace is located in the
corridor in order to supply a good
review of the wards.
Natural ward lighting should provide the
daylight coefficient (DC) of not less than 1%, the
lighting coefficient (LC) 1:5 – 1:6; in the
procedure, manipulating, dressing and operating
– DC respectively is 1.5 – 2 %, LC – 1:3 – 1:5.
The wards ventilation should be achieved by
means of exhaust ventilation ducts, presence of
window leaves and windows which can be opened;
the modern hospitals should be equipped with airconditioners.
The treatment protective mode of permanent
establishment includes the followings elements:
providing of the mode is a thrift of psyche
of patient;
 adherence of rules of internal order of day;
 providing of the mode rational physical
(motive) to activity.

Hospitalism
Be are what physical, psychical, infectious
disorders of health of man, conditioned the
features of medical service.
Hospitalism
Physical
Accident
Psychical
Hospital
infection
Hospital cultures are
adapted
sporadic
Accident
Hospital cultures are no
adapted
endemic
epidemic
Exciters of intrahospital (nosocomial, hospital)
infections
Staphylococcus, streptococci,
blue pear stick, coli bacillus,
salmonella, enter bacteria,
enter cocas and other de bane
ease pathogenic
microorganisms.
 And also viruses of flu,
adenovirus, enter virus,
exciters of viral hepatitis

ESCHERICHIA COLI
Distribution of certain exciter in
development of infection can be related to
the type of medical establishment
In permanent
establishments of
general surgical type are
gram-negative bacteria,
in particular blue pear
 in urology separations is
a coli bacillus, enter
cocas and others like
that.

ESCHERICHIA COLI
Distribution of certain exciter in
development of infection can be related to
the type of medical establishment
 Blue
pear sticks
prevail in
separations.
 in separations newborn find
staphylococcus, enter
cocas.
STAPHYLOCOCCUS
AUREUS
Sources of infection:






patients
personnel
visitors
apparatus
instruments
linen et cetera
Patients can be infected pathogenic factors both from an
external environment and own in the case of hyposthenic
immunity
Ways of transfer of intrahospital
infections
PATIENT
Objects
materials
animals and others
like that
Personnel
visitors
patients
Except for control after the observance of sanitary-hygienic
requirements in relation to apartments, personal hygiene it is
necessary to conduct:
-
timely exposure and
sanitation of transmitters of
pathogenic staphylococcus:
one time in a quarter
obligatory inspection of
employees on the transmitter
of pathogenic staphylococcus
for the medical staff of
surgical separations and
maternity hospital, and at
origin of infection – on the
measure of necessity;

- safety measures at AIDS and disease mode,
measures of infection;
 - observance of rules of asepsis and antiseptic;
Prophylaxis of in-hospital infections
Technical
measures
Sanitary
disease
measures
Disinfection and
sterilization
IMMUNISATION
Emergency
Architectonically
plan measures
Specific prophylaxis
Planned
Un specific prophylaxis
Measures of architectural plan
A rational location of
separations is on floors
Isolation of sections,
chambers, operating
blocks but other
Observance of streams
sick, personnel
Zoning of territory
Technical measures
Ventilation:
(reveal, drawing, mixed, condition)
Sanitary disease measures
Sanitary
educational work
is among a
personnel and
patients
Control is after
the sanitary state
and mode of
permanent
establishments
An exposure of
transmitters is
among a
personnel and
patients
Control is after the bacterial semi nation of in-hospital
environment
Disinfection and sterilization measures
Tooling
Use
chemical facilities
Use
physical methods
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