Transcript Hygiene of medical establishments nova

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.
Types
Some patients in a hospital come just for diagnosis
therapy and then leave ('outpatients'); while others
are 'admitted' and stay overnight for several weeks
or months ('inpatients'). Hospitals are usually
distinguished from other types of medical facilities
by their ability.
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 region, with large numbers of beds for
intensive care and long-term care; and specialized facilities for
surgery, plastic surgery, childbirth, bioassay laboratories.
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 (intrahospital)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 non-infectious 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 m. the Sanitary
break between medical corps and , by the pathological and
anatomical corps and zonal of the green planting - not less
than 30 m. The pathological and anatomical 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 m2 on
a 1 bed, but not less than 50 m2, 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 of the green planting
in 8—10 m
A policlinic consists of to
the vestibule 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 m2, and
the specialized cabinets –
15-18 m2. 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 operatingroom 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 operating-room 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.
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 30-50
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 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 doctorsX-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 parallel 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 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 artificial lighting should be
general, 30-60 lx, and the night light – 10-15
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 airconditioners.
A sanitary knot must be equipped washing room, dressingroom and auxiliary apartment. Three dressing-rooms 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 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.

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
Intrahospital (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
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 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 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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