Transcript 03. Hygiene of medical establishments

Hygiene of medical
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 most suitable form of the hospital group
of buildings land site is a rectangular one –
with the sides’ ratio 1:2 or 2:3. The long axis
should be oriented from the East to the West
or from the North-East to the South-West (it
provides the hospital constructions wards’
orientation towards the Southern points, but
the
operating
rooms,
delivery
rooms,
laboratories and X-ray departments – towards
the Northern points (to prevent dazzling and
overheating by solar rays).
Selecting the area, one should take into
consideration the possibility of the hospital
constructions joining the existing systems of
water, sewerage, electricity, gas and heat
supply, passages and drive conveniences.
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.
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.
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 ì. the Sanitary
break between medical corps and харчоблоком, by a
pathoanatomical corps and defence zonal of the green
planting - not less than 30 ì. the Pathoanatomical
department with a morgue is placed in the isolated place
which not evidently from the windows of hospital.
Before main included in a hospital it is necessary to foresee
modern grounds for visitors from the calculation of 0,2 м2 on a
1 bed, but not less than 50 м2, and also for the motor
transport of employees and visitors – not nearer 100 m codes
from chamber corps
From a leeward and below after a
hypsography, in the distance 30-40 m
codes from hospital houses, dispose an
economic yard with a central boiler
room, laundry, disinfection chamber,
garages, storage facilities, vegetable
store. An economic yard is insulated
from other areas the bar of the green
planting in 8—10 ì. a width
A policlinic consists of to the
vestibule-locker room, hall and
medical cabinets. For
expectation corridors are utilized
in not less than 3,2 m codes a
width, which well light up and
get some fresh air.
The low-limit of medical cabinet
make 12 м2, and the specialized
cabinets – 15-18 м2. Windows
must not go out of noisy doors
and north rhombs.
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 rhumbs.
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 5055 %, 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.
An obstetric separation plugs in the structure maternity and
post-natal physiology observation separations, separations
pathologies pregnant, and also separations for new-born.
Chamber sections are here designed in obedience to
requirements to the common somatic separations for adults.
Infections department
Infections department has two entrance: the
first-for patients; the second-for personal.
In the infectious diseases units the following
rooms should be equipped: box wards (with every
bed isolation), semi-boxes (the isolated wards with
common lavatory and bathroom), and absolute
boxes (the isolated wards with lavatory and
bathroom).
Isolator consist of ward, lock, tambours
and restroom. Square of box is 22 m2.
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.
Children’s departments
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 XRay 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 GDD-5
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 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.
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.
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 parallelly 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 lux, and the night light – 1015 lux 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,
and for patients with thyrotoxicosis – lower – 18 –
22°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 умивальнею, 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 mcode draw an oily paint, but yet better lay out a
facing tile.
For efficient patient treatment and the
medical personnel labour 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.
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 unadapted
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, клебсела,
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 іinfection`s patients




air-dustborne;
- (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 sanitary-hygenic 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), teniosisу, 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
Tekhnichni 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 semination of in-hospital
environment
Dezinfekciyno-sterilizaciyni measures
Tooling
Use
chemical facilities
Use
д
physical methods