Hygienic requirements for the planning and organization of the internal environment of the hospital Made by: Bolatov A.K., 339-GM Checked by: Zeinoldina. - презентация

1 Hygienic requirements for the planning and organization of the internal environment of the hospital Made by: Bolatov A.K., 339-GM Checked by: Zeinoldina A.S. JSC "Medical University Astana Department of Ecology and General Hygiene

2 Hospital hygiene Hospital hygiene is a branch of hygiene that studies the influence of factors related to conditions of patients ' stay in hospitals, and developing regulations and requirements, eliminating the adverse effects of these factors. Hospital hygiene is developing standards and requirements for placing, planning and sanitary- technical support of medical institutions. The main objective of the hygiene of hospitals the creation of optimal conditions of stay of patients, effective therapeutic process and favourable working conditions for medical staff.

3 Hospital building systems A. Decentralized, B. Mixed, C. Centralized

4 Sanitary and epidemiological requirements for the design, construction, reconstruction, re-profiling of health facilities buildings Projected no more than 9 floors. Ward departments of children's hospitals are located not higher than the 5 floor, chambers for children under the age of seven and children's psychiatric departments (chambers) not higher than the 2 floor. It is not allowed to place in a residential and public building: a hospital with a round-the-clock stay of patients, a microbiological (virologic, parasitological) laboratory, a department of magnetic resonance imaging. Infectious, psychiatric, skin-venereal, tuberculosis departments, which are part of multi-profile hospitals, are located in separate buildings. When planning isolation and the availability of autonomous ventilation systems, it is allowed to place these compartments in the same building with other offices, except for antituberculous.

5 Pathoanatomical department Is located in a separate building or in an annexed building to a building located in the economic zone, with the exception of the food unit. The distance from the department to the chambers and the kitchen should not be less than 30 m. In the pathoanatomical department should be at least three entrances (two for separate reception and delivery of corpses, the third for the staff). The premises for opening infected corpses are isolated and have a separate entrance from the outside. The building of the pathoanatomical department should not be viewed from the windows of medical and maternity facilities, residential and public buildings located near the territory of the organization.

6 The minimum area in wards from two beds and more ОтделенияПлощадь, м 2 на 1 койку (не менее) Инфекционные и туберкулезные для взрослых Инфекционные и туберкулезные для детей: 7,5 - без мест матерей6,5 - с дневным пребыванием матерей8 - с круглосуточным пребыванием матерей10 Ортопедотравматологические (в т.ч. Восстановительного лечения), ожоговые, радиологические: - для взрослых и в палатах для детей с дневным пребыванием Матерей 10 - для детей с круглосуточным пребыванием матерей13 Интенсивной терапии, послеоперационные13 Детские неинфекционные: - без мест матерей6 - с дневным пребыванием матерей7,5 - с круглосуточным пребыванием матерей9,5 Психоневрологические и наркологические: - общего типа6 - инсулиновые и наркологические7 Психиатрические для детей: - общего типа5 - надзорные6 Для новорожденных6 Прочие палаты на 2 и более коек7 Палаты на 1 койку7 В палатах дневных стационаров: - для детей;4,5 - для взрослых 6

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8 Sanitary and epidemiological requirements for water supply, sewage of health facilities In the wards, offices, toilets, treatment rooms, dressings and ancillary rooms, wash basins with hot and cold water supply are installed through the mixers. The temperature of hot water in the distribution network in children's and psychiatric wards should not exceed 37 ° C. Pre-operative, dressing rooms, birth halls, treatment rooms, nurses' posts in newborn wards, surgical, gynecological offices, lock boxes, semi-boxes, laboratories are equipped with shells with the installation of elbow valves, ulnar dispensers with liquid antiseptic soap and solutions of antiseptics. In the wards of newborns, sinks with a wide bowl and hot and cold water are installed through the faucets to wash the children. In infectious and anti-tuberculosis hospitals (departments) there must be local treatment facilities.

9 Sanitary-epidemiological requirements for natural and artificial illumination of health facilities

10 Sanitary and epidemiological requirements for ventilation of health facilities

11 The maximum permissible concentration and hazard classes of drugs in the air Определяемое веществокласс опасностиПДК в мг/м 3 АмпициллинII А0,1 Аминазин (ДиметиламинопропилII А0,3 3-хлорфенотиазинхлоргидрат - ) БензилпенициллинII А0,1 Диэтиловый эфирIV300 (1,1-дифтор-2,2-дихлорэтилмети-IV200 ловый эфир) Закись азота (в пересчете на 5 (в пересчете на О2)О2)O2)O2) ОксациллинIA0,05 СтрептомицинIA0,1 ТетрациклинII А0,1 Трихлорэтилен 10 Фторотан (1,1#III20 1-Трифтор-2-хлорбромэтан) ФлоримицинII A0,1 ФормальдегидII A0,5 Хлористый этилIV50

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13 Sanitary and epidemiological requirements for the collection, neutralization, transportation, storage and disposal of medical waste The medical waste of the organization (hereinafter referred to as waste) is divided into five classes according to the degree of danger: Class A - non-hazardous, like solid household waste; Class B - moderately dangerous; Class C - extremely dangerous; Class D - wastes of composition similar to industrial wastes; Class E - radioactive. 1) waste collection and disposal; 2) temporary storage of waste in containers in the territory (class A) and in specially designated premises (classes B, C, D, D) 3) transportation of containers to the place of neutralization or destruction of waste.

14 The main structural units of the hospital Admission department; Ward offices; Medical-diagnostic department; Laboratory; Central sterilization department; pharmacy; Service of cooking; Pathoanatomical department; Administrative and economic service.

15 Admissions department The planning of the admissions department should exclude the possibility of cross-contamination of patients. In order to prevent nosocomial infections, the admission departments of the children's, obstetric, tuberculosis, infectious, skin-venereal departments should be independent and located at each of these departments. With centralized and mixed hospital construction systems, the reception compartment is located in the main building, with the decentralized system in the housing with the largest number of beds. In all cases, the admissions office should be located near the entrance to the hospital. The ambulance from the street to the waiting room should be short, not to intersect with the internal roads of the hospital.

16 Ward section The main structural unit of the hospital is the ward section. The section is an isolated complex of chambers, medical-auxiliary and household premises, a corridor and sanitary units. The hospital section is provided for patients with the same type of diseases. A ward section of beds is considered the most suitable for providing favorable conditions for patients to stay. Two ward sections make up a department that has a general staff of medical personnel. Ward department - the main functional element of a hospital.

17 Surgery department

18 Surgical block Ward section

19 Basic variants of the organization of operational blocks The presence of an operation block in each surgical department. To achieve maximum isolation of the operating unit, it is placed in the dead-end zone of the compartment or in a separate wing of the building. Operational blocks of several surgical departments are combined into one operating complex.

20 The premises of the operating unit are conventionally divided into 4 groups depending on the degree of correlation of aseptic rules The most stringent requirements are imposed on operational, Preoperative and anesthetic, Premises for storage of blood, equipment, Premises for staff (nursing, laboratory and "clean" zone of the sanitary inspection for personnel).

21 The operating unit The operating unit must have two isolated non-conductor compartments - septic and aseptic. When placing operating one on top of the other, septic surgery should be placed above aseptic

22 Operating room

23 S > 36 m2 With the participation of a large operating team S = m2 H = 3,5 m The walls of the operating room should be smooth, with rounded corners. They are lined at full height with glazed tiles or other moisture-resistant materials that are easy to wash and withstand disinfectant treatment. The ceiling is painted with oil paint, and the floor is made of tiles with a slight inclination to the ladder. Floors must be non-sparkling, antistatic. The operating room doors must be tightly closed.

24 Operating room lighting The light factor in the operating room should be 1: 4-1: 5, KNL - at least 1.5% The illumination with a total coverage of fluorescent lamps should not be less than 400 lux. For local illumination of the operating field, special shameless, suspended or mobile lamps are used. The illumination created by the shameless lamps reaches 10, lux

25 Microclimate of the operating room The air temperature in the summer is ° C (in the winter of ° C) at a humidity of 50-55% and the speed of air movement up to 0.1 m / s. The air must be cleaned with bactericidal filters, natural ventilation is not allowed. Multiplicity of air exchange should be not less than 10, moreover, an inflow of at least 20% should prevail over the hood. For good air exchange in the operating room, the supply air holes are located under the ceiling at one operating room wall, and the exhaust openings at the opposite side near the floor.

26 Obstetric department

27 In the reception and inspection rooms, a filter is arranged, through which the woman in childbirth passes from the lobby. There are two examination rooms – one for those entering the family physiological department and the department of pregnancy pathology and the second for those entering the observatory department. After the examination in the filter room, where thermometry is carried out, an anamnesis is collected, an outbreak of pustular diseases is detected, the woman in labor enters the examination room. From it - to the room for sanitation and then to the department. Both the physiological and the observational departments have a common planning scheme - prenatal chambers, ancestral block, intensive care chambers, postpartum chambers, wards for newborns. Each department has its own set of medical diagnostic and auxiliary facilities.

28 Infection department. The infectious department should have its own reception compartment, which consists of reception and observation boxes, as well as diagnostic boxes for patients with an unclear diagnosis. The infection compartment should consist of boxes, half-boxes and chambers. The children's infectious departments are provided with boxed wards. To prevent nosocomial infections, the most reliable boxing complex of rooms (entrance vestibule, bathroom with bathtub, ward, gateway between the room and the corridor). The patient enters the box from the street through the entrance tambour. Staff enters the patient through the gateway. Poluboks consists of the same premises as boxing, but does not have an entrance from the street. Patients enter the half-boxes from the corridor of the department. In the section consisting of half-boxes, there can be patients only with the same diseases. In the boxed chambers of children's infectious divisions, between the beds there are partitions m high, the upper part of which is glazed. This ensures a partial isolation of children in the same ward. In each infectious disease ward, a neutral zone should be provided, where doctors and nurses' offices are located. The best option for planning is fully boxed offices.

29 INFECTIOUS STATIONARY EQUIPPED WITH BOXES

30 List of references Приказ Главного государственного санитарного врача Республики Казахстан от 24 июня 2002 года N 23. Зарегистрирован в Министерстве юстиции Республики Казахстан 8 июля 2002 года N Утратил силу приказом и. о. Министра здравоохранения Республики Казахстан от 23 июля 2010 года N 533 Об утверждении санитарных правил и норм " Требования к устройству и содержанию больничных организаций и организаций охраны материнства и детства "