Transcript Лікувально-профілактичні заклади

Hygiene of medical and dentistry
establishments, their planning
and equipment. Modern
problems in hospital building.
Hygienic measures of
optimization of terms of stay of
patients are in medical
establishments.
A hospital
is an institution for
health care providing
patient treatment by
specialised staff and
equipment, and often
but
not
always
providing for longerterm patient stays.
Types
Some patients in a hospital come just for
diagnosis and/or therapy and then leave
('outpatients'); while others are 'admitted' and
stay overnight or for several weeks or months
('inpatients'). Hospitals are usually distinguished
from other types of medical facilities by their
ability to admit and care for inpatients.
General
The best-known type of hospital is the general hospital, which
is set up to deal with many kinds of disease and injury, and
typically has an emergency department to deal with immediate
threats to health and the capacity to dispatch emergency
medical services. A general hospital is typically the major
health care facility in its region, with large numbers of beds
for intensive care and long-term care; and specialized facilities
for surgery, plastic surgery, childbirth, bioassay laboratories,
and so forth. Larger cities may have many different hospitals
of varying sizes and facilities.
Specialized
Types of specialized hospitals include trauma centers,
rehabilitation hospitals, children's hospitals, seniors' (geriatric)
hospitals, and hospitals for dealing with specific medical needs
such as psychiatric problems (see psychiatric hospital), certain
disease categories, and so forth.
Teaching
A teaching hospital (or university hospital) combines assistance
to patients with teaching to medical students and is often linked
to a medical school.
Clinics
A medical facility smaller than a hospital is generally called a
clinic, and is often run by a government agency for health
services or a private partnership of physicians (in nations where
private practice is allowed). Clinics generally provide only
outpatient services.
The patient care institution site development area
is selected taking into account several reasons
- a distance from the farthest settlements of the population
service zone: land plot must be connected with population
service zone favorably (patient must be taken to the
hospital in no more than 30 minutes);
- a distance from the possible air or soil pollution sources;
the sources of noise, vibration, the emission of the
industries, airports, railway stations, speed motorways
and other, taking into account their sanitary and protection
zones and “wind rose”;
- usage of the existing green area (park, wood);
- a flat countryside or a flank of hill towards the Southern
points and others.
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
Systems of hospital site development
are:
decentralized (pavilion),
centralized,
mixed,
centralized-blocked – the best system of
hospital
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 is the difficulty during the usage of
the diagnostic, physiotherapeutic measures or
their doubling, which increases the capital
expenditure.
Centralized system
 all departments
are situated in
one
(semidetached)
building;



The drawback of the centralized system is
the difficulty of nosocomial infections
prevention,
Decreased time or impossibility of the
patients to stay outdoors.
Noise
Mixed system of hospital
 mixed, when the majority of departments
are situated in the central building but some
separate ones (infectious diseases,
children’s, psychiatric departments and so
on) – in the isolated buildings.
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 site land project of the patient care
institution includes the following zones:
•a zone of the patient care buildings for noninfectious patients;
•a zone of the patient care building with
infectious diseases;
•a polyclinic zone;
•a zone of morbid anatomical department;
•a household zone;
•a landscape zone.
•The
infectious,
obstetric,
children’s,
tuberculosis and psychiatric departments
should have separate landscape zone of their
own.
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.
The distances between the
hospital buildings should
be the following:
between the walls with wards and doctors’ rooms
windows – 2.5 of the opposite building height but not
less than 25 m;
 between the radiological building and other ones –
25 m;
 the morbid anatomical building and a household one
– at the distance of 30 m from other buildings,
residential including;
 between the buildings’ flanks – not less than 30 m,
from the polyclinic, women’s consulting center and
health centre – not less than 15 m.
Bars of the green planting must be located between the
functional areas of hospitals and to make 15 m. the Sanitary
break between medical corps and food bloc, by a path
anatomical corps and defense zonal of the green planting not less than 30 m. the Path anatomical department with a
morgue is placed in the isolated place which not evidently
from the windows of hospital.
Wall an operation must be smooth and shiny, easily to wash
and added irrigation disinfection solutions. All of types of
wiring and heater devices are assembled in walls. It is
recommended to dye walls and ceiling a light mat oily waxen
paint which removes light reflections and does not tire the eyes
of surgeon. A floor is inlaid a tile with small inclination to the
ladder. In an operating-room it is desirable to have two doors:
one - for an import patient with an operation, and second, in a
lateral wall, - for an export operated.
The windows of operatingroom orient on north rhombs.
A light coefficient must make
1:3 -1:4. Operating-room it is
needed densely to push an a
door to.
It is needed, that a microclimate answered the requirements
of comfort. Temperature of air in summer in an operatingroom must be +20-22 °C (in winter -19 -20 °C) at humidity
50-55 %, the rate of movement of air must not exceed 0,1
m/sec It is better to arrange heating of operating-room
aquatic radiation with the location of panels on ceiling or to
the floor.
All of equipment which enters operating-room is needed
preliminary disinfected, and instruments and materials for
bandaging - sterilized. Very perspective is a method of gas
disinfection, for example by the oxide of etalon, however
much he lasts a few hours. After the operation of apartment
with application take away, ventilate carefully, a floor and
panels is washed disinfection solution and hot water.
Surgical department
The operating block of a surgical department
should be situated in the blind-ended
projection or in the separate outhouse of the
hospital
In the operating block
there should be
following rooms: the
operating room – 30
m2 (on the basis of 3050 surgical beds in the
department; for the
complex operations –
40-45 m2)
•the pre-operating room – 10-12 m2,
•the sterilizing room
(one for two operating ones),
•the anesthetic room – 15 m2,
•the instrumental room,
•the surgeon’s room (for protocols),
•the laboratory of the express tests,
•the plaster dressing room,
•the room of the mobile diagnostic,
resuscitative apparatuses and
the anesthetic equipment,
the premises for the sterile and used operating
linen,
the washing and shower room for the operating
brigade,
the postoperative resuscitative wards,
the lavatories for personnel,
the operating nurse’s room and others depending
on the surgical department type.
Illumination of an operational table has great importance.
Devices in operational lamps allow to change direction of
light rays. Due to dispersion of heat with the help of system
of glasses and presence of air layer between them, these
lamps do not get heated. If it is necessary to have additional
illumination of lateral surfaces of the operational field,
mobile and portable lamps are used. The illumination is
duplicated by emergency network working from a battery.
The special group of hospital establishments is made by
radiological separations.
Them there are six types:
are X-Ray and diagnostic
controlled from distance radial therapy
radial therapy by the closed X-Ray nuclides, radial therapy by
the opened X-Ray diagnostic with the use of the closed X-Ray
nuclides separations are mixed.
The most widespread radiological establishments
are X-Ray and diagnostic cabinets or are X-Ray
and diagnostic separations. Work in them must
provide radiation safety an auxiliary personnel
and people which are in contiguous apartments.
The average daily dose of irradiation for
doctors-X-Ray diagnostic must make 3,5 Ber on
a year, and for laboratory assistants - 3 (at GDD5 Ber).
The radiological separations of other types place in
the isolated annex or separate house. Their
planning foresees four groups of apartments: for
diagnostics of ionizing radiations the opened
sources, radial therapy opened and closed,
controlled from distance radial therapy.
Hygienic
requirements
concerning of the
hospital 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.
Except the wards in the ward sector there should be
• a room for patients’ day-time stay (area of 25 m2),
•glazed verandah (30 m2) and medical accessory
premises:
• the doctor’s room (8-9 m2),
•the procedure and manipulation room (12-15 m2),
•the medical nurse’s station (4 m2), and
• in the surgical departments sections – dressing rooms
(pure and purulent).
•Dinner room (for two ward sections with the area of 18
m2),
• a room for clean and dirty linen (each of 4 m2)
• a lavatory with a bathroom (10 m2),
• a lavatory for patients and for personnel,
• a sanitary room (6-8 m2), and
• a corridor.
The optimal ward
windows orientation in
the Northern
hemisphere is the
South-East or South.
But there should be 1-2 wards with the
orientation towards the Northern points for
severely ill patients or patients with fever. Beds
should be located to the light conductive wall
for a patient to be able to turn back from the
dazzling effect of the direct solar radiation.
Natural ward lighting should provide the
daylight factor (DF) of not less than 1%, the
lighting coefficient (LC) 1:5 – 1:6; in the
procedure,
manipulating,
dressing
and
operating – DF respectively is 1.5 – 2 %, LC –
1:3 – 1:5.
The artificial lighting should be
general, 30-60 lx, and the night light – 1015 lx with lamps in the lower part of the
walls.
Artificial
illumination by the
incandescent lamps
should be not less
than 30 lx in the
wards, 100 – 150 lx
in
the
procedure,
manipulating
and
dressing rooms, 200 –
1 000 lx in the
operating rooms.
The optimal air temperature in the wards in
winter and during the transitional period should
range from 19 to 22°C, the relative humidity
should be 40-60 %, the air movement speed within
the limits of 0.05-0.1 m/sec.
In the nursery, post-operative wards, burns units
and in case of fever of the infectious patients the
air temperature should be a bit higher – 22 – 25°C.
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 air-conditioners.
A sanitary knot must be equipped washing room, by bath,
dressing-room and auxiliary apartment. Three dressingrooms are needed: masculine with an urinal, womanish with
an ascending shower and for a medical personnel. That
smells from a sanitary knot did not get to the chamber
corridor, he is provided drawing ventilation, but not
ventilate through small hinge window pane or windows are
opened. The apartments of sanitary knot must have natural
illumination, floors lay out a tile, panels in high not a less
than 1,8 m code draw an oily paint, but yet better lay out a
facing tile.
For efficient patient treatment and the
medical personnel labor the air clearness in the
wards, operating, dressing, procedure rooms and
others is of great importance. The allowable CO2
concentration in the hospital premises being an
index of air pollution by the vital functions
products of the patients and personnel, excreted
by skin and during breathing, also with dust and
microorganisms, should range within the limits of
0.07 – 0.1 %.
Indices of hospital air pollution, such as air
oxygenation (20 – 24 mg O2/ m3 ) and the microbial
figure (500 – 1 000 per m3 in the operating room,
up to 3 500 per m3 in the wards), also have been
calculated and scientifically substantiated.
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.
DENTISTRY
DENTISTRY Cabinets
Digital ortopantomograph
utilized for the receipt of panoramic picture of teeth, necessity in
surgical dentistry
for the exposure of breaks, cysts, tumors, for the estimation of
the state of bone


Computer tomography in hundred one times
more effective than ordinary x-ray
photography vehicle, as processes all of the
got information, and ordinary x-ray
photography setting – only about 1%.
The use of conical ray of computer
tomography allows to get the gone into a
detail image of high-res of the probed
area/cylinder diameter 40 mm and in high
30mm. Three-dimensional kind – axial,
coronal and sagital – allow to carry out the
supervision of certain area. Possibility of
layer cuts is under any corner for an
optimum visual reflection.
PLAN OF THE DENTRISTRY CLINIC
Artificial illumination
General illumination levels of horizontal workings
surfaces by lamps (bulb and luminescent) :
Name of the rooms:
 Doctors, procedural, manipulation, basic apartments
of laboratory room for dental technical- 200 and 500.
 Storage room- 200and 400 lx
 Cabinets of the nurses, junior nurses, washing rooms
– 150 and 300 lx
 Soldering, cabinets of X-ray for teeth, apartment for
preparation of surgery instruments to sterilized –
100 and 200 lx
 Registration rooms of expectations, corridors,
sterilization room – 751and 50 lx
 Sanitary rooms – 30 and75 lx
Hospitalism Be are what physical, psychical, infectious
disorders of health of man, conditioned the features of medical
service.
Hospitalism
Physical
Psychical
Hospital
infection
Accident
Hospital cultures are
adapted
sporadic
endemic
Hospital cultures
are un adapted
epidemic
Intrhospital (nosocomial,
hospital) infection

any clinically recognized disease of
microbial etiology is related to the stay,
treatment, inspection or appeal of man for
medical help in hospital.
Exciters of intrahospital (nosocomial, hospital)
infections
Staphylococcuss,
streptococci, blue pear
stick, proteus, collibacillus,
salmonella, enterobacteria,
enterococcus and other de
bane ease pathogenic
microorganisms.
 And also viruses of flu,
adenoviruss, rotaviruss,
enteroviruss, exciters of
viral hepatitis et al

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 gramnegative bacteria, in
particular blue pear
in urology separations is a
coli bacillus, enterococcus
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
ambustial
separations.
 in separations
new-born find
staphylococcus,
enterococcuss.

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 infection's patients




air-dust borne;
- (through the articles of examination, linen,
medical instruments, apparatus, hands of
medical personnel);
- (at introduction of medicinal preparations,
solutions and others like that);
-alimentary (products, water and others like
that).
Ways of transfer of intrahospital
infections
PATIENT
Objects
materials
animals and others
like that
Personnel
visitors
patients
Except for control after the observance of sanitaryhygienic requirements in relation to apartments,
personal hygiene it is necessary to conduct:
-
timely exposure and
sanation 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;
control after patients with an
exposure in them of
pediculosis and them
 Pediculosis treatments (order
¹ 410), teniosis, infectious
diseases, to hepatitis and
others like that;


- safety measures at AIDS and disease
mode (order ¹ 486), measures of
infection (order ¹ 120);
 - observance of rules of asepsis and
antiseptic;
Prophylaxis of in-hospital infections
Tekhnichni
measures
Sanitary
disease
measures
Dezinfekciynosterilizaciyni
measures
IMMUNISATION
Ekstrenna
Architectonically
plan measures
Specific prophylaxis
Planned
Heterospecific prophylaxis
Architectonically plan measures
A rational location of
separations is on floors
Isolation of sections,
chambers, operating
blocks but other
Observance of streams
sick, personnel
Zonuvannya of
territory
Technical measures
Ventilation: (reveal, drawing, mixed, кондиціювання,
equipments of ламінарні and others like that)
Sanitary disease measures
Sanitary
educational work
is among a
personnel and
patients
Control is after the
sanitary state and
mode of
permanent
An exposure of
transmitters is
among a personnel
and patients
establishments
Control is after the bacterial semi nation of in-hospital
environment
Disinfection-sterilization measures
Tooling
Use
chemical facilities
Use
д
physical methods