Hygienic requirements for hospital departments. Sanitary regime of hospitals What should the temperature be in a hospital

Temperature changes should not exceed:

In the direction from the inner to the outer wall - 2°C

In the vertical direction - 2.5°C per meter of height

During the day with central heating - 3°C

Relative humidity air should be 30-60% Air speed- 0.2-0.4 m/s

To provide patients with fresh and clean air a sufficient area and cubic capacity of the chamber, as well as good ventilation, are required.

The minimum volume of ventilation for one patient should be at least 40-50 m 3 of air, and the optimal volume is 1.5-2 times more, therefore, when air conditioning in a hospital, up to 100 m 3 per patient per hour is recommended. Based on the minimum, then with a double air exchange within an hour, the required cubic capacity of the room for one patient should be 20-25 m 3. With a ward height of 3-3.2 m, a similar cubic capacity is achieved with a floor area of 7-7.5 m2, so design standards allocate 7 m2 per patient in a multi-bed ward.

Double air exchange in the room can be achieved if there is mechanical ventilation or by ventilating the room multiple times throughout the day using amplification means natural ventilation(windows, transoms).

State air environment should be subject to systematic control. Sanitary indicators air in the room must meet the following standards:

a) no odor;

c) the total air contamination is no more than 3000-4000 microbes per 1 m 3; the presence of hemolytic and viridans streptococci no more than 15-20 per 1 m 3 ;

d) air oxidability is not more than 5-6 mg O 2 in 1 m 3.

The microclimate of the wards is of considerable importance. In winter and cool times comfortable temperature is 19-22 °C, and in summer the upper limit of the comfort zone increases to 24 °C. In rooms where the patient is naked (bathroom), the air temperature should be no lower than 24-25 °C.

Due to physiological, thermal and bacteriological effects solar radiation a necessary condition a healthy environment in the ward is good daylight. The best orientation of the windows of chambers in southern latitudes is south; in the northern - southern, southeastern, southwestern; in the middle - southern and southeastern.

Some of the wards, medical-auxiliary and utility rooms are oriented with windows facing northern and other unfavorable directions.

The luminous coefficient in the ward is desirable 1:5-1:6; KEO - at least 1. Sources general lighting must provide illumination in the room with incandescent lamps of at least 30 lux, with fluorescent lamps (white light lamps) - at least 100 lux. Lamps of reflected or semi-reflected light are used. It's better to apply Wall lights, located above the head of each bed at a height of 1.6-1.8 m from the floor. The lamp should provide light to the upper and lower hemispheres. The lower flow should create the illumination necessary for reading and performing simple medical procedures (150-300 lux).

Heating - central water and radiant.

In large hospitals there is supply and exhaust mechanical ventilation.

Water supply via piped water (250-400 liters per bed).

52. Ensuring microclimate standards, air exchange, lighting, air purity, water supply quality as therapeutic factors

Heating. IN medical institutions V cold period year, the heating system must ensure uniform heating of the air throughout the entire heating period, eliminate contamination by harmful emissions and unpleasant odors indoor air, do not create noise. The heating system should be easy to operate and repair, linked to ventilation systems, and easily adjustable. With a view to more high efficiency Heating devices should be placed near external walls under windows. In this case, they create uniform heating of the air in the room and prevent the appearance of cold air currents above the floor near the windows. It is not allowed to place heating devices in rooms near interior walls. From a hygienic point of view, radiant heating is more favorable than convective heating. It is used for heating operating rooms, preoperative, intensive care, anesthesia, maternity, psychiatric departments, as well as intensive care and postoperative wards. In this case, the average temperature on the heated surface should not exceed: for ceilings with a room height of 2.5...2.8 m - 28 ° C; for ceilings with a room height of 3.1...3.4 m - 33 °C, for walls and partitions at a height of up to 1 m above floor level - 35 °C; from 1 to 3.5 m from the floor level - 45 °C.

Water with a maximum temperature of heating devices 85 °C. The use of other liquids, solutions and steam as a coolant in heating systems of medical institutions is prohibited.

Natural and artificial lighting of hospitals. All main premises of hospitals, maternity hospitals and other medical hospitals must have daylight. Secondary lighting or only artificial lighting is allowed in storerooms, sanitary facilities near wards, hygienic baths, enema rooms, personal hygiene rooms, showers and dressing rooms for staff, thermostatic, microbiological boxes, preoperative and operating rooms, equipment rooms, anesthesia rooms, darkrooms and some other rooms, the technology and operating rules of which do not require natural light.

The corridors of ward sections (departments) must have natural lighting through windows in the end walls of buildings and in the halls (light pockets). The distance between light pockets should not exceed 24 m and to the pocket - 36 m. The corridors of treatment, diagnostic and auxiliary units should have end or side lighting.

The best orientation for hospital rooms is south, southeast; acceptable - southwest, east; unfavorable - west, northeast, north, northwest; orientation to the northeast and northwest is allowed for no more than 10% of the total number of beds in the department. Operating rooms, resuscitation rooms, dressing rooms, and treatment rooms should be oriented to the north, northeast, east and northwest to avoid overheating and glare.

Artificial lighting must correspond to the purpose of the premises, be sufficient, adjustable and safe, not have a glare or other adverse effect on humans and internal environment premises.

General artificial lighting must be provided in all rooms without exception. For lighting individual functional zones and workplaces, in addition, local lighting is arranged.

Artificial lighting of hospital premises is carried out fluorescent lamps and incandescent lamps. To illuminate wards (except for children's and psychiatric departments), wall-mounted combined lamps for general and local lighting should be used, installed at each bed at a height of 1.7 m from the floor level. In addition, each room must have a special night lighting lamp installed near the door at a height of 0.3 m from the floor. In children's and psychiatric departments, night lighting lamps for wards are installed above doorways at a height of 2.2 m from the floor level.

In medical examination rooms, it is necessary to install wall-mounted or portable lamps for examining the patient.

Ventilation. The buildings of medical institutions are equipped with systems supply and exhaust ventilation with mechanical drive and natural exhaust ventilation without mechanical drive. In infectious diseases departments, including tuberculosis departments exhaust ventilation mechanically driven, it is arranged from each box and half-box and from each ward section separately through individual channels that prevent vertical air flow. They must be equipped with air disinfection devices.

In all rooms of medical, obstetric and other hospitals, except for operating rooms, in addition to supply and exhaust ventilation with mechanical impulse, natural ventilation must be arranged through vents, folding transoms, sashes in the frames and external walls, as well as ventilation ducts without mechanical air movement. Transoms, vents and other natural ventilation devices must have devices for opening and closing them and be in good condition.

Outdoor air intake for ventilation and air conditioning systems is carried out from a clean area at a height of at least 2 m from the ground surface. Outside air, served air supply units, must be cleaned in coarse and fine structure filters in accordance with current regulatory documentation.

The air supplied to operating rooms, anesthesia rooms, maternity rooms, resuscitation rooms, postoperative wards, intensive care wards, as well as wards for burn patients and AIDS patients, must be treated with air disinfection devices that ensure the effectiveness of inactivation of microorganisms and viruses in the treated air, at least 95 %.

Air conditioning is a set of measures for creating and automatically maintaining an optimal artificial microclimate and air environment in the premises of medical institutions with specified cleanliness, temperature, humidity, ionic composition, and mobility. It is provided in operating rooms, anesthesia rooms, labor and delivery rooms, post-operative resuscitation wards, intensive care wards, oncohematological patients, patients with AIDS, patients with skin burns, in wards for infants and newborns, as well as in all wards of the departments of premature and injured children and other similar medical institutions . Automatic system microclimate adjustment should provide the required parameters: air temperature - 17...25°C, relative humidity- 40...70%, mobility - 0.1...0.5 m/s.

Air exchange in wards and departments is organized in such a way as to limit as much as possible the flow of air between ward departments, between wards, and between adjacent floors. Quantity supply air per room should be 80 m 3 /h per adult and 60 m 3 /h per child.

Architectural and planning solutions of a hospital should exclude the transfer of infections from ward departments and other premises to the operating unit and other premises that require special air purity. Movement air flow are provided from the operating rooms to the adjacent rooms (preoperative, anesthesia, etc.), and from these rooms to the corridor. Exhaust ventilation is required in corridors.

The amount of air removed from the lower zone of the operating rooms should be 60%, from the upper zone - 40%. Fresh air is supplied through the upper zone. In this case, the inflow must prevail over the exhaust by at least 20%.

53. Measures to prevent overheating and hypothermia in the wards.

Prevention of hypothermia:

Installation of heating elements near the window to prevent drafts

·Use of radiant heating method

Moderate air humidity

· Use of warm bed linen, bed rest

Preventing overheating:

Ventilation of premises

· Use of air conditioners

· Walks in the open air

54. Hygienic characteristics placement, layout, equipment and organization of work of hospital catering units and medical control over the organization of nutrition for patients and the health of staff.

The catering unit should be located in a separate building, not interconnected with the main building, with convenient above-ground and underground transport connections (galleries) with buildings, except for infectious diseases. Food products supplied to the food department must comply with the requirements of current regulatory and technical documentation and be accompanied by documents establishing their quality. The diet of patients should be varied and correspond to therapeutic indications in terms of chemical composition, energy value, range of products, and diet.

When developing a planned menu, as well as on days when replacing products and dishes, the chemical composition and calorie content of diets should be calculated. Control for chemical composition actual prepared meals are carried out by sanitary and epidemiological stations quarterly.

Before dispensing food in departments, the quality of finished dishes must be checked by the cook who prepared the dish, as well as by the rejection commission with a corresponding entry in the rejection log. The screening commission includes a nutritionist (in his absence, a nutritionist), a production manager (chef), and a doctor on duty at the hospital. From time to time, the chief physician of a medical institution, at various times and regardless of the sample carried out by members of the rejection commission, also carries out rejection of prepared food.

To take samples in the catering department, separate gowns must be provided for members of the screening commission.

The sample is taken as follows: the prepared food is taken with a ladle from the cauldron (for first courses), with a spoon (for second courses). The person taking the sample, using a separate spoon, takes the prepared food from a ladle or from a plate (for second courses) and transfers it to a spoon, with the help of which he directly samples the food.

The spoon used for taking prepared food should be rinsed after each dish. hot water. After taking the sample, a note is made in the rejection log about the quality of the prepared dish, the time of the rejection is indicated, and permission is given to eat the food. There is no charge for sampling commission members for sample collection.

A daily sample of prepared dishes should be left in the catering unit every day. During the day, for daily testing, the dishes indicated in the layout menu are selected from the most popular diets into cleanly washed sterile glass jars. For a daily sample, it is enough to leave half a portion of the first courses, portioned second courses (cutlets, meatballs, cheesecakes, etc.) are selected entirely in an amount of at least 100 g. The third courses are selected in an amount of at least 200 g.

When serving, first courses and hot drinks must have a temperature of at least 75°C, second courses - not below 65°C, cold dishes and drinks - from 7 to 14°C.

Before serving, the first and second courses can be kept on a hot plate for up to 2 hours.

For transportation food products from bases supplying medical institutions, as well as when delivering ready-made meals to departments, vehicles must be used that have permission from the sanitary and epidemiological station for transporting food products (sanitary passport). To transport prepared food to hospital pantries, thermoses, thermos carts, steam table carts, or containers with tight-fitting lids are used. Bread must be transported in plastic or oilcloth bags, storage of bread in which is not permitted. Periodically, the bags should be washed with water and dried. It is allowed to transport bread in containers closed with a lid (buckets, pans, etc.); it is not allowed to use fabric bags for these purposes.

The buffet departments should have two separate rooms (at least 9 m2) and a dishwashing area (at least 6 m2) with the installation of a 5-cavity bathtub.

Distribution of ready-made food is carried out within 2 hours after its preparation and the time of delivery of food to the department.

Food is distributed to patients by barmaids and nurses on duty in the department. Food distribution must be done in gowns marked “For food distribution.” Control over the distribution of food in accordance with the prescribed diets is carried out by the senior nurse. Juniors are not allowed to distribute food service staff.

Lists of permitted (indicating their maximum quantity) and prohibited products for transfer must be posted at delivery reception areas and departments.

Every day, the nurse on duty of the department must check compliance with the rules and shelf life of food products stored in refrigeration compartments, in the bedside tables of patients.

55. Causes of occurrence and directions for the prevention of nosocomial infections.

The problem of nosocomial infections despite the development of asepsis, antiseptics, and the widespread use of antibiotics And chemotherapy remains one of the most current problems in medicine.

Nosocomial infections- these are the infections that patients become infected with while receiving treatment. medical care(most often when staying in a hospital, as well as when visiting a clinic, etc.).

Sourceinfections in this case, these are patients with airborne, purulent and other infections,” as well as medical personnel who are carriers of opportunistic microorganisms that cause diseases in patients (due to weakened immunity) and usually have a wide range of resistance to antibiotics and chemotherapy .

Some patients become infected while in the hospital from other patients through airborne droplets, contact, as well as during various manipulations using infected instruments or equipment, when using contaminated utensils, etc.

Responsibility for organizing and carrying out a set of sanitary, hygienic and anti-epidemic measures that ensure optimal hygienic conditions in the hospital and preventing the occurrence of nosocomial infections is assigned to the chief physician and hospital epidemiologist. Responsibility for carrying out measures to prevent nosocomial infections lies with the heads of departments. They appoint doctors who, together with the senior nurses of the departments, organize and monitor the implementation of anti-epidemic measures. Nonspecific prevention of nosocomial infections includes:

Architectural and planning measures ensuring rational mutual arrangement in the medical building of ward sections, treatment and diagnostic premises and auxiliary premises; maximum isolation of wards, anesthesiology and intensive care departments, manipulation rooms, operating rooms, etc. For this purpose, it is planned to box the departments, install airlocks at the wards, at the entrance to ward sections, operating blocks on the routes of movement of patients, staff, etc.;

Sanitary measures that exclude the possibility of penetration of air currents, and with it pathogens of nosocomial infections. In this plan great importance has the organization of rational air exchange in the main premises of the hospital, especially in the ward sections and operating blocks;

Sanitary and anti-epidemic measures aimed at improving the sanitary culture of staff and patients, separating the flow of patients, staff, visitors, “clean” and “dirty” materials, monitoring sanitary condition departments, identification, sanitation and treatment of bacteria carriers among patients and staff;

Disinfection and sterilization measures involving the use of chemical and physical methods to destroy possible pathogens of nosocomial infections.

Specific prevention of nosocomial infections involves planned and emergency, active or passive immunization of patients and personnel.

56. Occupational hygiene of surgical doctors and prevention of diseases associated with professional activities.

Surgeons, obstetricians-gynecologists and anesthesiologists are classified as surgical doctors. Their professional activity includes examining patients, preparing them for operations, performing operations, managing patients in the postoperative or postpartum period, rounds, working with documentation, and meeting with relatives.

Obstetricians and gynecologists also work with newborns. Based on the nature of their activities, obstetricians and gynecologists are conventionally divided into three groups:

1. Obstetricians-gynecologists who do not operate on patients, but care for women and newborns

2. a) the same + operations up to 8 hours per week b) the same + operations up to 12 hours per week

3. Gynecological surgeons with more than 12 operating hours per week

The work of a surgical doctor often takes place in unfavorable conditions. All harmful factors, affecting surgeons are divided into the following two groups:

I. Harmfulness associated with the organization of the labor process

1. Significant neuro-emotional and mental stress

2. Static tension of large muscle groups

3. Prolonged forced position of the body

4. Significant stress on analyzers (visual, tactile, auditory)

5. Night work

6. Frequent violation of the work and rest schedule

II. Related to violation of sanitary and hygienic conditions

1. Physical factors- noise, magnetic fields, ultrasound, laser, static electricity, high frequency currents, ionizing radiation (X-ray), high pressure (in a pressure chamber)

2. Unfavorable microclimate

3. Influence chemical substances- analgesics, anesthetics, disinfectants

4. Action of biological agents ( infectious diseases)

5. Disadvantages of layout

6. Defects in lighting, ventilation, heating

Temperature.

Parameter name	Meaning
Article topic:	Temperature regime.
Rubric (thematic category)	Medicine

Temperature changes should not exceed:

‣‣‣ In the direction from the inner to the outer wall - 2°C

‣‣‣ In the vertical direction - 2.5°C per meter of height

‣‣‣ During the day with central heating - 3°C

Relative humidity air should be 30-60% Air speed- 0.2-0.4 m/s

To provide patients with fresh and clean air, sufficient area and cubic capacity of the chamber, as well as good ventilation, are necessary.

The minimum volume of ventilation for one patient should be at least 40-50 m 3 of air, and the optimal volume is 1.5-2 times more; therefore, when air conditioning in a hospital, up to 100 m 3 per patient per hour is recommended. If we proceed from the minimum, then with a double air exchange within an hour, the required cubic capacity of the room for one patient should be 20-25 m 3. With a ward height of 3-3.2 m, a similar cubic capacity is achieved with a floor area of 7-7.5 m 2, in connection with this, design standards allocate 7 m 2 per patient in a multi-bed ward.

Double air exchange in the room should be achieved in the presence of mechanical ventilation or by ventilating the room multiple times during the day using means of enhancing natural ventilation (window windows, transoms).

The state of the air environment must be the object of systematic monitoring. The sanitary parameters of the air in the ward must comply with the following standards:

a) no odor;

c) the total air contamination is no more than 3000-4000 microbes per 1 m 3; the presence of hemolytic and viridans streptococci no more than 15-20 per 1 m 3;

d) air oxidability is not more than 5-6 mg O 2 in 1 m 3.

The microclimate of the wards is of considerable importance. In winter and cool times, the comfortable temperature is 19-22 °C, and in summer the upper limit of the comfort zone increases to 24 °C. In rooms where the patient is naked (bathroom), the air temperature should be no lower than 24-25 °C.

Due to the physiological, thermal and bacteriological effects of solar radiation, good natural lighting is a necessary condition for a healthy environment in the ward. The best orientation of the windows of chambers in southern latitudes is south; in the northern - southern, southeastern, southwestern; in the middle - southern and southeastern.

Some of the wards, medical-auxiliary and utility rooms are oriented with windows facing northern and other unfavorable directions.

The luminous coefficient in the room is desirable 1:5-1:6; KEO - at least 1. Sources of general lighting must provide illumination in the room with incandescent lamps of at least 30 lux, with fluorescent lamps (white light lamps) - at least 100 lux. Lamps of reflected or semi-reflected light are used. It is better to use wall lamps located above the head of each bed at a height of 1.6-1.8 m from the floor. The lamp should provide light to the upper and lower hemispheres. The lower flow should create the illumination necessary for reading and performing simple medical procedures (150-300 lux).

Heating - central water and radiant.

In large hospitals there is supply and exhaust mechanical ventilation.

Water supply via piped water (250-400 liters per bed).

52. Ensuring microclimate standards, air exchange, lighting, air purity, water supply quality as therapeutic factors

Heating. In medical institutions during the cold period of the year, the heating system must ensure uniform heating of the air throughout the entire heating period, eliminate contamination of the indoor air with harmful emissions and unpleasant odors, and not create noise. The heating system should be easy to operate and repair, linked to ventilation systems, and easily adjustable. For higher efficiency, heating devices should be placed near external walls under windows. In this case, they create uniform heating of the air in the room and prevent the appearance of cold air currents above the floor near the windows. It is not allowed to place heating devices near internal walls in rooms. From a hygienic point of view, radiant heating is more favorable than convective heating. It is used for heating operating rooms, preoperative, intensive care, anesthesia, maternity, psychiatric departments, as well as intensive care and postoperative wards. In this case, the average temperature on the heated surface should not exceed: for ceilings with a room height of 2.5...2.8 m - 28 ° C; for ceilings with a room height of 3.1...3.4 m - 33 °C, for walls and partitions at a height of up to 1 m above floor level - 35 °C; from 1 to 3.5 m from the floor level - 45 °C.

Water with a maximum temperature in heating devices of 85 ° C is used as a coolant in central heating systems of hospitals and maternity hospitals. The use of other liquids, solutions and steam as a coolant in heating systems of medical institutions is prohibited.

Natural and artificial lighting of hospitals. All main premises of hospitals, maternity hospitals and other medical hospitals must have daylight. Lighting with second light or only artificial lighting is allowed in storerooms, sanitary units in wards, hygienic baths, enema rooms, personal hygiene rooms, showers and dressing rooms for staff, thermostatic, microbiological boxes, preoperative and operating rooms, hardware rooms, anesthesia rooms, darkrooms and some others premises, the technology and operating rules of which do not require natural lighting.

The corridors of ward sections (departments) must have natural lighting through windows in the end walls of buildings and in the halls (light pockets). The distance between light pockets should not exceed 24 m and to the pocket - 36 m. Corridors of treatment, diagnostic and auxiliary units should have end or side lighting.

Artificial lighting must correspond to the purpose of the premises, be sufficient, adjustable and safe, and not cause glare or other adverse effects on humans and the internal environment of the premises.

General artificial lighting must be provided in all premises without exception. In addition, local lighting is installed to illuminate individual functional areas and workplaces.

Artificial lighting of hospital premises is carried out with fluorescent lamps and incandescent lamps. To illuminate wards (except for children's and psychiatric departments), wall-mounted combined lamps for general and local lighting should be used, installed at each bed at a height of 1.7 m from the floor level. In addition, each room must have a special night lighting lamp installed near the door at a height of 0.3 m from the floor. In children's and psychiatric departments, night lighting lamps for wards are installed above the doorways at a height of 2.2 m from the floor level.

In medical examination rooms, it is extremely important to install wall-mounted or portable lamps for examining the patient.

Ventilation. Buildings of medical institutions are equipped with supply and exhaust ventilation systems with mechanical drive and natural exhaust ventilation without mechanical drive. In infectious diseases, incl. In tuberculosis departments, mechanically driven exhaust ventilation is arranged from each box and half-box and from each ward section separately through individual channels that prevent vertical air flow. They must be equipped with air disinfection devices.

In all premises of medical, obstetric and other hospitals, except for operating rooms, in addition to supply and exhaust ventilation with mechanical stimulation, natural ventilation must be arranged through vents, folding transoms, sashes in the frames and external walls, as well as ventilation ducts without mechanical stimulation of air. Transoms, vents and other natural ventilation devices must have devices for opening and closing them and be in good condition.

Outdoor air intake for ventilation and air conditioning systems is carried out from a clean area at a height of at least 2 m from the ground surface. External air supplied by air supply units must be cleaned in coarse and fine structure filters in accordance with current regulatory documentation.

Air conditioning is a set of measures for creating and automatically maintaining an optimal artificial microclimate and air environment in the premises of medical institutions with specified cleanliness, temperature, humidity, ionic composition, and mobility. It is provided in operating rooms, anesthesia rooms, labor and delivery rooms, post-operative resuscitation wards, intensive care wards, oncohematological patients, patients with AIDS, patients with skin burns, in wards for infants and newborns, as well as in all wards of the departments of premature and injured children and other similar medical institutions. An automatic microclimate control system must provide the required parameters: air temperature - 17...25°C, relative humidity - 40...70%, mobility - 0.1...0.5 m/s.

Air exchange in wards and departments is organized in such a way as to limit as much as possible the flow of air between ward departments, between wards, and between adjacent floors. The amount of supply air into the room should be 80 m3/h per adult and 60 m3/h per child.

Architectural and planning solutions for a hospital must prevent the transfer of infections from ward departments and other premises to the operating unit and other premises that require special air purity. The movement of air flows is ensured from the operating rooms to the adjacent rooms (preoperative, anesthesia, etc.), and from these rooms to the corridor.
Posted on ref.rf
Exhaust ventilation is extremely important in corridors.

53. Measures to prevent overheating and hypothermia in the wards.

Prevention of hypothermia:

Installation of heating elements near the window to prevent drafts

·Use of radiant heating method

Moderate air humidity

· Use of warm bed linen, bed rest

Preventing overheating:

Ventilation of premises

· Use of air conditioners

· Walks in the open air

54. Hygienic characteristics of the placement, layout, equipment and organization of work in hospital catering units and medical control over the organization of nutrition for patients and the health of staff.

When developing a planned menu, as well as on days when replacing products and dishes, the chemical composition and calorie content of diets should be calculated. Control over the chemical composition of actually prepared dishes is carried out by sanitary and epidemiological stations on a quarterly basis.

It is important to note that in order to take a sample in the catering department, separate gowns must be allocated for members of the rejection commission.

The spoon used for taking prepared food should be rinsed with hot water after each dish. After taking the sample, a note is made in the rejection log about the quality of the prepared dish, the time of the rejection is indicated, and permission is given to eat the food. There is no charge for sampling commission members for sample collection.

A daily sample of prepared dishes should be left in the catering unit every day. During the day, for the daily sample, the dishes indicated in the layout menu are selected from the most popular diets into cleanly washed sterile glass jars. It is important to note that for a daily sample it is enough to leave half a portion of the first courses; portioned second courses (cutlets, meatballs, cheesecakes, etc.) are selected entirely in an amount of at least 100 ᴦ. The third courses are selected in quantities of at least 200 ᴦ.

When serving, first courses and hot drinks must have a temperature of at least 75°C, second courses - not below 65°C, cold dishes and drinks - from 7 to 14°C.

Before serving, the first and second courses can be kept on a hot plate for up to 2 hours.

To transport food products from bases supplying medical institutions, as well as when delivering ready-made meals to departments, vehicles must be used that have permission from the sanitary and epidemiological station for transporting food products (sanitary passport). To transport prepared food to hospital pantries, thermoses, thermos trolleys, food warmer trolleys or containers with tight-fitting lids are used. Bread must be transported in plastic or oilcloth bags, storage of bread in which is not permitted. Periodically, the bags should be washed with water and dried. It is allowed to transport bread in containers closed with a lid (buckets, pans, etc.); it is not allowed to use fabric bags for these purposes.

In the buffet departments there should be two separate rooms (at least 9 m2) and a dishwashing area (at least 6 m2) with the installation of a 5-cavity bathtub.

Distribution of ready-made food is carried out within 2 hours after its preparation and the time of delivery of food to the department.

Food is distributed to patients by barmaids and nurses on duty in the department. Food distribution must be done in gowns marked “For food distribution.” The distribution of food in accordance with the prescribed diets is monitored by the senior nurse. Junior staff are not allowed to serve food.

Lists of permitted (indicating their maximum quantity) and prohibited products for transfer must be posted at delivery reception areas and departments.

Every day, the nurse on duty of the department must check compliance with the rules and shelf life of food products stored in the refrigerated sections in the bedside tables of patients.

55. Causes of occurrence and directions for the prevention of nosocomial infections.

The problem of nosocomial infections despite the development of asepsis, antiseptics, and the widespread use of antibiotics And Chemotherapy remains one of the most pressing problems in medicine.

Nosocomial infections- these are those infections that patients become infected with while receiving medical care (most often while in a hospital, as well as when visiting a clinic, etc.).

Sourceinfections in this case, these are patients with airborne, purulent and other infections, as well as medical personnel who are carriers of opportunistic microorganisms that cause diseases in patients (due to weakened immunity) and usually have a wide range of resistance to antibiotics and chemotherapy drugs.

Responsibility for organizing and implementing a set of sanitary, hygienic and anti-epidemic measures that ensure optimal hygienic conditions in the hospital and prevent the occurrence of nosocomial infections rests with the chief physician and hospital epidemiologist. Responsibility for carrying out measures to prevent nosocomial infections lies with the heads of departments. They appoint doctors who, together with the senior nurses of the departments, organize and monitor the implementation of anti-epidemic measures. Nonspecific prevention of nosocomial infections includes:

‣‣‣ architectural and planning measures ensuring rational relative arrangement of ward sections, treatment and diagnostic premises and auxiliary premises in the medical building; maximum isolation of wards, anesthesiology and intensive care departments, manipulation rooms, operating rooms, etc.
Posted on ref.rf
For this purpose, it is planned to box the departments, install airlocks at the wards, at the entrance to the ward sections, operating blocks on the routes of movement of patients, staff, etc.;

‣‣‣ sanitary and technical measures that exclude the possibility of penetration of air currents, and with it pathogens of nosocomial infections. In this regard, the organization of rational air exchange in the basic premises of the hospital, especially in the ward sections and operating blocks, is of great importance;

‣‣‣ sanitary and anti-epidemic measures aimed at improving the sanitary culture of staff and patients, separating the flow of patients, staff, visitors, “clean” and “dirty” materials, monitoring the sanitary condition of departments, identifying, sanitizing and treating bacteria carriers among patients and staff;

‣‣‣ disinfection and sterilization measures involving the use of chemical and physical methods to destroy possible pathogens of nosocomial infections.

Specific prevention of nosocomial infections involves planned and emergency, active or passive immunization of patients and personnel.

56. Occupational hygiene of surgical doctors and prevention of diseases associated with professional activities.

Surgeons, obstetricians-gynecologists and anesthesiologists are classified as surgical doctors. Their professional activities include examining patients, preparing them for operations, performing operations, managing patients in the postoperative or postpartum period, making rounds, working with documentation, and meeting with relatives.

Obstetricians-gynecologists also work with newborns. Based on the nature of their activities, obstetricians and gynecologists are conventionally divided into three groups:

1. Obstetricians-gynecologists who do not operate on patients, but care for women and newborns

2. a) the same + operations up to 8 hours per week b) the same + operations up to 12 hours per week

3. Gynecological surgeons with more than 12 operating hours per week

The work of a surgical doctor often takes place in unfavorable conditions. All harmful factors, affecting surgeons are divided into the following two groups:

I. Harmfulness associated with the organization of the labor process

1. Great neuro-emotional and mental stress

2. Static tension of large muscle groups

3. Prolonged forced position of the body

4. High voltage analyzers (visual, tactile, auditory)

5. Night work

6. Frequent violation of the work and rest schedule

II. Related to violation of sanitary and hygienic conditions

1. Physical factors - noise, magnetic fields, ultrasound, laser, static electricity, high frequency currents, ionizing radiation (X-ray), high pressure (in a pressure chamber)

2. Unfavorable microclimate

3. The influence of chemicals - analgesics, anesthetics, disinfectants

4. Action of biological agents (infectious diseases)

5. Disadvantages of layout

6. Defects in lighting, ventilation, heating

Harmfulness associated with the organization of the labor process.

Nervous-emotional tension due to responsibility for the life and health of the patient. Moments that can increase neuro-emotional stress include complications during operations and childbirth, unusual operations, the extreme importance of resuscitation, etc.

Long-term forced position makes excursions difficult chest and breathing becomes rapid and shallow. Vital capacity during surgery is 75% of preoperative values. The mask lengthens the duration of inhalation by 60% and exhalation by 20%. This is reflected in blood oxygen saturation: during surgery it decreases by 8-10%. During the operation, the surgeon's body is tilted by 45°, and the head by 60-80° (normally about 10°). A large load falls on lower limbs: swelling of the lower leg increases, the foot flattens by 4-5 cm. The movement of blood to the extremities causes ischemia of organs and the brain, which can lead to dizziness and headaches. Working posture during surgery contributes to organ compression abdominal cavity. During the operation there is overvoltage analyzers: visual, tactile. The tactile analyzer is especially strained by gynecologists who perform abortions.

Temperature regime. - concept and types. Classification and features of the category "Temperature." 2017, 2018.

table 2

Premises	Temperature, degrees C	Temperature fluctuations
		horizontally	vertically
Living room apartments or dormitories
Wards for adult therapeutic patients, rooms for mothers children's departments, hypothermia rooms
Wards for tuberculosis patients (adults, children)
Wards for patients with hypothyroidism
Postoperative wards, resuscitation rooms, intensive care wards, maternity wards, boxes, operating rooms, anesthesia rooms, wards with 1-2 beds for burn patients, pressure chambers.
Postpartum wards
Wards for premature, infant, newborn and injured children.
Boxes, half-boxes, filter boxes, preboxes.
Ward sections of the infectious diseases department.
Prenatal, filters, reception and examination boxes, dressing rooms, manipulation rooms, preoperative rooms, procedural rooms, rooms for feeding children under one year of age, rooms for vaccinations.
Sterilization in operating rooms.

Air temperature is essentially the most important microclimate factor that determines the thermal state of the body. Recommended optimal temperature air depends on the season of the year. Thus, in summer the thermal comfort zone shifts towards higher air temperatures than in winter. This is due to the seasonal restructuring of some body functions, including thermoregulatory ones. It is generally accepted to normalize the air temperature in enclosed spaces for the winter period of the year. The most favorable air temperature in residential premises for a person at rest and dressed in ordinary home clothes is 18-20 0 C with optimal humidity (40-60%) and air mobility (0.2-0.3 m/sec) . Air temperatures above 24-25 0 C, and below 14-15 0 C are considered unfavorable, capable of disturbing the thermal balance of the body and causing the development of various diseases. It is generally accepted that the optimal air temperature in the wards of medical institutions should be slightly higher than in residential premises. Since in many pathological conditions the heat exchange of the body with the environment changes to varying degrees, the microclimate standards of the wards and other functional departments of the hospital should take into account the characteristics of the patient’s heat exchange, the characteristics and stage of the pathological process, the patient’s age, time of day, season of the year, and climate of the area. For patients, the optimal air temperature parameters shift: during the day - often towards higher temperatures and at night - towards lower temperatures, due to changes in their heat exchange, imperfect skin-vascular reactions and a decrease in the regulatory role of the limbs in heat exchange. Optimal air temperatures in specialized wards must be differentiated depending on the purpose of the ward and the age of the patients, as well as the characteristics of the form and stage of the disease, which have a primary impact on heat exchange and thermoregulation of the body. When studying the thermal state of a patient, the pathological background of the thermoregulatory reaction should be taken into account, excluding the effect of medications that affect thermoregulation. Optimization of microclimatic conditions in hospital premises plays a significant role in the complex of factors that normalize homeostasis and contributes to favorable treatment, course and outcome of the disease. The optimal air temperature in the wards of a cardiology hospital during the day should be 21-24 0 C, adhering to the lower limit for middle-aged patients light forms illnesses in the summer and the lower limit - for elderly patients of moderate severity during the heating season. At night, for all these patients, the optimal air temperature will be 17-18 0 C. The optimal air temperature in the wards for the pulmonology department should be considered 21-22 0 C during the day and 16-17 0 C at night. For patients in the wards of the burn center , the optimal air temperature is in the range of 24-26 0 C, if the effect of radiant heating on the body surface is excluded. For feverish patients, the optimal air temperature is determined to be 22-23 0 C (daytime) and 17-18 0 C (at night). For other patients in whom thermal metabolism is not impaired, the optimal air temperature is taken to be the same as for cardiac patients. Thus, there is no single optimal air temperature for different patients. The desire to establish an individual optimal air temperature based on the body’s heat exchange is justified. To some extent, it is possible to improve microclimatic conditions to optimal ones by selecting clothes and thus creating the desired microclimate of the under-clothing space. Instruments: depending on the design and device, thermometers are divided into alcohol, mercury, electric, etc. In addition, thermometers are divided into household, aspiration (dry thermometer of the Assmann aspiration psychrometer), minimum and maximum. According to their purpose, thermometers are divided into wall, water, soil, chemical, technical, medical, etc.

2.1.1.1. Rules for measuring air temperature

Measuring air temperature in enclosed spaces, schools, apartments, children's institutions, medical institutions, industrial premises, etc. is carried out in compliance with the following rules: when measuring air temperature, it is necessary to protect the thermometer from the effects of radiant energy from stoves, lamps and other open energy sources. In residential premises, air temperature is measured at a distance of 1.5 m from the floor (breathing height) in the center of the room. For more accurate measurements, thermometers are simultaneously installed in the center of the room, outside and inner corners at a distance of 0.2 m from the walls. In medical institutions, air temperature is additionally measured at a height of 0.7 m from the floor (breathing zone of bed patients). Temperature differences are determined and evaluated vertically and horizontally. To determine vertical temperature differences, thermometers are installed in the center and at the mentioned corners of the room at a height of 0.2; 0.7; 1.5 m from the floor. To determine the horizontal temperature difference, the difference between the maximum and minimum temperature separately for each level (0.2; 0.7; 1.5 m) in all measured areas of the room. The daily temperature difference in the wards is measured using maximum and minimum thermometers, which are installed in the rooms at a level (0.7 and 1.5 m from the floor. To measure the temperature of walls (enclosing surfaces) at a height of 1.5 m from the floor, a wall thermometer is used , the reservoir of which is glued to the wall with plasticine, or an electric thermometer is used. Temperature readings during measurements are taken 5-10 minutes after the start of the measurement. The dynamics of recording the air temperature in the examined room over a certain period of time (day, week) is carried out with a thermograph.

The rooms where patients are accommodated must be clean and well lit. The room temperature should be 20°.

To maintain clean air, the room needs to be ventilated and ventilated as often as possible. The best remedy Transoms are used to ventilate the room. The air entering through the transom is directed to the ceiling, where it is mixed with room air, is warmed up, and then distributed throughout the ward. Thus, in winter, jets of cold air reach patients already warmed.

The flow of fresh air into the room can be ensured artificial ventilation: supply, exhaust, supply and exhaust.

Hospitals typically have central heating. At furnace system Housekeeping personnel are required to ensure constant monitoring of the correct firing of the stoves and the maintenance of a uniform temperature throughout the day.

The furnishings of the room, except the beds, are bedside tables, stools and linen closet.

Wards are cleaned only using the wet method: before cleaning, rags and brushes are moistened with water.

First, they clean the bedside tables and wipe off dust from the furniture and window sills, then they begin to sweep the room from the edges to the middle. The floor in the room is washed once a day, and wet sweeping is carried out several times a day, and care is taken to ensure that no litter is left anywhere.

The patient's bed is usually made of iron - it is easier to disinfect. It is advisable that the bed legs be on wheels.

Bed linen - sheets, pillowcases - are changed at least once a week. The bed is changed every morning.

In order to be able to approach the patient’s bed from any side, it is placed with the head of the bed against the wall. The distance between the beds should be about 1 m, the passage in the middle of the room (the distance between two rows of beds) should be at least 1.5 m. In winter, the beds should not be pushed tightly against the cold outer wall.

Only a carafe of water and a glass are placed on the bedside tables (the glass should be covered with a clean napkin or turned upside down).

In case of diseases of the heart, lungs, with some injuries, as well as after a number of operations, the patient has to be given a semi-sitting position, but in other cases (with swelling, wounds of the legs) his legs must be raised. For this purpose, there are special beds in which the head or foot end is raised using a movable frame. More often, however, you just have to use a headrest. If the patient needs to be given a semi-sitting position, a footrest is created ( hard roller, wooden shield) so that the patient does not move from the headrest.

When cleaning the bed, it is more convenient to transfer the sick or wounded person to a free bed.

All bed dress remove, shake out and, if possible, hang for airing. The mattress is aired at least once a week. To prevent the mattress from becoming dirty, especially in seriously ill patients, oilcloth is placed under the sheets. You can change bed linen without transferring the patient to another bed. To do this, roll a dirty sheet to the middle of the bed, and a clean one, rolled up halfway, is placed next to it along the length, then the patient is slightly lifted and the dirty sheet is pulled out from under him, and a clean one is rolled out in its place (Fig. 1).

Rice. 1. Change the sheets.

For those affected by asphyxiating toxic substances (phosgene, diphosgene, chloropicrin, chlorine), special oxygen chambers are equipped. For those affected by blister-type toxic substances and tear gases, the wards are darkened so that bright light does not irritate the affected mucous membrane of the eyes.

Hospital sanitary standards include the following provisions.

1) Each adult patient should be provided with 25 m3 of air, which is achieved with an area of 7 m2 per bed and a room height of 3.5 m.

2) The maximum number of beds in a ward should not exceed 5-6; and for seriously ill patients there are single or double rooms with a separate bathroom.

3) The windows of the chambers should be oriented to the south or southeast. IN evening time Electric lighting with a matte shade so that bright light does not irritate the eyes of patients. At night, the nurse should use a night light so as not to wake up the other patients.

4) The air temperature in the room should be 18-20 degrees. To ensure air purity and maintain a constant temperature in winter time ventilation should be carried out 2-3 times a day. IN summer time There should be nets on the windows and 24-hour ventilation of the room.

5) Only the most necessary furniture is placed in the wards: beds, bedside tables (bedside tables), chairs and one common table. There is a coat rack and a trash bin by the door. There should also be: a thermometer to monitor the temperature in the room, a bedside alarm and radio headphones.

6) Beds in the ward are placed parallel external wall with windows at a distance of 1 m from each other, which creates convenience for caring for patients, examining and shifting.

1) Beds used in hospitals should be nickel plated or plated oil paint for ease of treatment with disinfectant solutions. The mesh should be stretched tightly, covered with a mattress with oilcloth, and for trauma patients, a shield is required. For severely ill patients, patients with lung diseases, cardiovascular disorders, they are used functional beds. They consist of three parts, which, using handles, change position, giving the patient or victim a functionally advantageous position. For example, in case of heart disease, an elevated position of the head and torso, in case of a fracture of the pelvic bones - the “frog” position, etc. These beds also have a movable table for the convenience of feeding the patient, a stand for a bedpan, a holder for IVs, and a trapezoid for self-lifting.

3) Each medical worker has special clothing, which has the purpose of protecting personnel from possible infection from patients and prevention of nosocomial spread of infection.

To do this, staff and patients must comply with the following rules:

a) store outerwear and special clothing separately;

b) do not go outside the hospital premises in special clothing and do not wear them during off-duty hours;

c) when visiting infectious diseases departments, as well as purulent surgery departments, including burns, change your gown;

d) patient care items must be treated with disinfectant. solutions according to the instructions of the Ministry of Health and stored in closed cabinets;

e) patients who are allowed to walk should not leave the hospital premises;

f) infectious diseases departments must be completely isolated.

10) Fruits and perishable foods should not be stored in patients’ bedside tables or on the windowsills of wards. This is monitored daily by the ward nurse. Products must be labeled with the date they were brought into the hospital and stored in the refrigerator.

11) There should be no rodents, bedbugs, or cockroaches in the departments. When they appear, the sanitary and epidemiological station is called, which carries out treatment of the wards and utility rooms.

12) Special attention pays attention to the cleanliness of toilets, their regular cleaning, proper storage ships in des. solutions.

13) Dressing room, treatment room and others utility rooms are cleaned daily and “generalized” according to a special schedule.

14) The buffet and dining room in the departments is subject to special hygienic treatment. All dishes are washed with disinfectant after each meal. funds according to the instructions of the Ministry of Health. Tables are also washed and rooms are cleaned after each meal. The barmaid must strictly observe the rules of personal hygiene (clean robe, headscarf, short-cut nails). Cleaning equipment must be labeled and assigned to each room in the department, including the buffet.

15) To feed patients, dishes made of earthenware, glass, aluminum and stainless steel are used. Dishes with cracks or broken edges are prohibited from being used due to the risk of damage to hands and mouth.

16) Dishwashing mode:

A) mechanical removal leftover food;

b) washing with a brush in water at a temperature of 45-48 ° C with the addition of detergents, permitted sanitary standards(0.5-2% solution soda ash, 1% trisodium phosphate solution, etc.)

c) boiling brushes before washing dishes in a 1% soda ash solution;

d) washing dishes in water at a temperature of 50 ° C with the addition of a 1% clarified solution of bleach in an amount of 10 ml per 1 liter of water;

e) rinsing the dishes in the third bath with hot water at a temperature not lower than 70 °C, for which the dishes are loaded into special grids and placed on racks;

f) drying dishes on a special shelf or rack, or in a drying cabinet.

Washed dishes are stored in special cabinets or on racks covered with clean gauze or linen.