Chambers, their structure and equipment. Temperature regime Optimal air temperature in the room

Hospital sanitary standards include the following provisions.

1) Each adult patient should be provided with 25 m3 of air, which is achieved by an area of ​​7 m2 per bed with 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 the evening, the lighting is electric with a matte shade so that the 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 to the outer wall with windows at a distance of 1 m from each other, which creates convenience for patient care, examination and transfer.

1) Beds used in hospitals should be nickel-plated or oil-painted 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, and cardiovascular disorders, functional beds are used. 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.

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) Particular attention is paid 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 undergo 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 by 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.

According to the standards for hospital wards all year round a sanitary standard of external air supply must be supplied to specific quantity 80 m 3 /(h-person) at specific rate filling a hospital room 5 m 2 /person. Let us assume that the hospital ward measures 5 m in width and 6 m in depth. Floor area of ​​the room F floor = 5 x 6 = 30 m2. The ward has beds to accommodate patients in the number L = 30/5 = 6 people. The room must be provided with an influx of outside air in the amount of l day = 6 x 80 = 480 m 3 /h.

The hospital is located in Moscow, the estimated outside air temperature during the cold season is t nx = -28 °C with a heating period duration of 214 days, the average outside air temperature during the heating period is t n.av.ot = -3.1 °C.

In the hospital ward all year round it is necessary to maintain air parameters at the level of thermal comfort for a person, which are standardized by temperature and air humidity in the human habitation area t in [°C], the air temperature in the cold season should be t in = 20-22 ° C, and in summer t = 23-25 ​​°C. Relative air humidity in the human habitation area can vary from φin = 30% in winter to φin = 60% in summer.

For gas pollution, the determining factor affecting human health is the content of carbon dioxide in the air in the area where people live, which should exceed the concentration of carbon dioxide in the outside air by no more than:

C. gas = C. gas + 1250 mg/m3.

In the outdoor air of large cities, Сn.gas = 1000 mg/m2.

To maintain the required normalized air parameters in the habitable area of ​​hospital wards in the area where people are located in terms of temperature, relative humidity, cleanliness and gas pollution, it is necessary to use mechanical supply and exhaust ventilation.

At rest, one adult male at tin = 20 °C emits: sensible heat 90 W/(h-person); water vapor 40 g/(h-person). For the ward under consideration with an area of ​​30 m2, the number of discharges from patients will be:

q tl.out = 6 x 90 = 540 W/h;

w steam = 6 x 40 = 240 g/h.

Sensible heat released from people enters the room at human body temperature, which at normal thermal comfort is t person = 36.6 °C. This temperature is higher than the temperature of the air surrounding a person, and therefore sensible heat rises by convective flow to the ceiling of the room.

In most hospital room ventilation system designs, supply air from central air supply units is supplied to the upper zone of the room. This scheme for organizing air exchange is called “mixed ventilation”

Likewise, water vapor emitted from a person has a temperature of at least 36.6 °C, and it is lighter than the water vapor contained in the air around a person, and therefore rises to the ceiling. When a person exhales, carbon dioxide enters the surrounding air, which also rises by convective currents to the ceiling of the room.

Unfortunately, in most hospital room ventilation system designs, supply air from central air supply units is supplied to the upper zone of the room. This leads to the fact that, descending into the living zone, the supply air mixes with convective flows of harmful substances and returns some of these harmful substances to the human habitation zone. This scheme for organizing air exchange is called “mixed ventilation”.

Significantly better and more comfortable conditions for the air microclimate in the area where people live indoors are provided when using the so-called scheme. "displacement ventilation". The air prepared in the central supply unit is supplied through special floor air distributors directly into the living area of ​​people in the room.

According to the conditions of thermal comfort, the temperature of the supply external air hpn should not be lower than the following values: in winter at t in = 20 °C inflow t pnh = 20 - 3 = 17 °C; in summer at t in = 25 °C, inflow t in = 25 - 5 = 20 °C. Arrival rate supply air into the room from floor air distributors should not be higher than v pn = 0.3 m/s.

For the ward in question, floor-mounted supply air distributors must have a supply cross-sectional area of ​​the following size:

The outer wall has an area of ​​5 x 3 = 15 m2. It contains a window with an area of ​​2.5 x 2 = 5 m2. According to modern standards for thermal protection of buildings, walls in the Moscow climate should have a thermal resistance R st = 3.5 m 2 *s/W, windows - R approx = 0.6 m 2 *s/W. Let's calculate the estimated transmission heat losses.

Losses through the wall:

losses through the window:

General heat loss

With an apparent heat gain of 540 Wh from six sick people in the room under consideration, the calculated transmission heat losses of 537 Wh are fully compensated. The heating system is left with heat compensation for reheating the supply external air from t pnx = 17 °C to t inp = 20 °C:

Much more quality conditions according to the created air microclimate in the area where people live in the room are ensured when using the “displacement ventilation” scheme

Currently, in many hospitals in our country, it can be observed that the systems built according to the project supply ventilation are not used by the operation service due to the desire to save heat on heating the supply air. The wards create stuffiness, odors, and gas pollution. Therefore, patients open the transoms, and cold outside air enters the room. To heat cold air in sanitary norm quantities, the system must consume heat:

The specific design load on the heating system of the room in the absence of a supply ventilation system and the entry of sanitary norms of outside air through the open transom in the window is:

A significant reduction in the estimated heat consumption for heating and ventilation of hospital wards can be achieved by using energy-saving technology for operating EQA systems, described in detail in.

The simplest and most economical energy-saving FOC system is carried out by installing domestic heat exchangers of the KSK model made of bimetallic rolling finned tubes in the supply and exhaust units after the air filters, which ensures their high thermal efficiency and low aerodynamic resistance. The heat exchangers in the supply and exhaust units are connected to each other by pipelines on which the pump and sealed expansion tank.

Assembled system disposal is washed with water, dried and filled with antifreeze with a freezing point 5 °C below the design temperature of the cold outside air. In the climate of Moscow, the concentration of antifreeze should be selected for freezing temperature conditions no higher than:

The thermal efficiency of this energy saving system with pump circulation of antifreeze is assessed by an indicator that has the form:

where t Нx2 is the temperature of the supply external air after the heat exchangers in the supply unit, °C; t y1 is the temperature of the air removed from the ceiling of the rooms [°C], with a mixing ventilation scheme (supply and exhaust under the ceiling) t y1 = t in = 20 °C, with a displacement ventilation scheme we take the values ​​t y1 = 23 °C and Θ t .yy = 0.4.

NPF Khimkholodservice has developed an original adiabatic air cooling device. The required number of sheets made of hygroscopic material is installed along the cross-section of the apparatus

Let us transform the indicator according to formula (1) to the form of calculating the temperature value t nx2:

The required heat for heating the sanitary system is l pn = 480 m 3 / h in the supply unit, which implements an energy-saving system with pump circulation of antifreeze:

Estimated flow Thanks to the use of an energy-saving ventilation system, heat loss is reduced by:

The paper provides a calculation of reducing the annual heat consumption in the supply and exhaust system in the Moscow climate using an energy-saving system with pump circulation of antifreeze. A specific indicator for reducing heat consumption during the heating period of 20 kW/(year-m3) and a formula for calculating the amount of heat saved per year were obtained:

Let us assume that the hospital has 400 beds in wards for treating patients. These wards are served by a supply ventilation system, the capacity of which is: l pn = 400 x 80 = 32,000 m 3 /h.

Supply and exhaust ventilation systems in hospital wards operate 24 hours a day, i.e. t wok = 24. Using formula (2) we obtain:

According to 2011 tariffs, the cost of 1 kW of heat from a heat supply system from a fuel cell is 1.4 rubles/kW. Cost of heat saved per year:

Q t.yy = 640,000 x 1.4 = 896,000 rub.

The cost of a recycling system with pump circulation for supply and exhaust systems with a capacity of 32 thousand m 3 /h is estimated at 600 thousand rubles. So, the use of a recycling unit in supply and exhaust systems in hospitals pays for itself in less than one year.

The recent summer of 2010 was very hot and dry. At midday, the outside air temperature increased to t nm1 = 34 °C, with a wet-bulb temperature not exceeding t nm1 = 18 °C. In hot and dry climates, it is effective and economical to use the simplest and most economical method of adiabatic cooling of incoming outdoor air, the effectiveness of which is assessed by the indicator:

where t H2 is the temperature value of adiabatically humidified supply external air.

The original adiabatic air cooling device was developed at the research and production company Khimkholodservis. The required number of sheets made of hygroscopic material is installed along the cross-section of the apparatus. The number of canvases depends on the required value of the E a indicator. For E a = 0.8, it is necessary to sequentially install eight blades along the air flow, which are moistened through slots in the upper tension pipe for a tape of two blades. To achieve E a = 0.8, four tapes and four tension pipes. The depth of the apparatus along the air flow is no more than 0.3 m.

It enters the pipes tap water drinking quality, which moisturizes the fabric material. All moisture absorbed by the material of the canvases evaporates into the air passing through them. Therefore, there is no water recirculation, as is typical for traditional adiabatic humidifiers with pumped circulation of water irrigating a nozzle made of corrugated plastic sheets. Therefore, the new pumpless adiabatic humidifier does not pollute the air with bacteria that can develop in the warm water of the trays of traditional adiabatic humidifiers.

The authors have developed a scheme for two-stage evaporative cooling of supply external air, which can be quite simply built into existing supply and exhaust units in hospitals. The first stage uses a recycling installation with pump circulation of antifreeze, discussed in detail above in operating mode during the cold season. After air filter in exhaust units, an adiabatic exhaust air humidifier with an indicator E a = 0.8 is added. An adiabatic humidifier E a = 0.6 is installed in the supply unit after the heater.

In Fig. 1 shows the construction in an i-d diagram humid air mode of two-stage evaporative cooling of the supply outside air, which at midday has a dry-bulb temperature of t нм = 34 °C and a wet-bulb temperature of t Нм1 = 18 °C, and the exhaust air has a dry-bulb temperature of t у1 = 28 °C and wet thermometer t um1 = 19 °C. Let us transform expression (3) to the form of finding the air temperature after adiabatic humidification:

We use expression (4) to calculate the temperature of the exhaust air after adiabatic humidification in an apparatus with E a = 0.8:

Passing through the heat exchanger recovery installations, the exhaust air with tу2 = 20.8 °C through the walls of the finned tubes will cool the antifreeze passing through the tubes to a temperature taf = 23 °C, from which the pump will supply cooled antifreeze into the heat exchanger tubes in the air supply unit. The thermal efficiency of a heat exchanger is determined by:

where t H2 is the outside air temperature after the heat exchanger, °C. Let us transform expression (5) to the form of calculating the temperature t nx2 at Θ t = 0.7:

On the i-d diagram (Fig. 1) we find the value t nm2 = 15.6 °C. An adiabatic humidifier with E a = 0.6 is installed in the supply unit. We calculate the temperature of the supply outside air after adiabatic humidification:

IN supply fan and air ducts, air with t H3 = 19.9 °C will be heated by 1 °C and with a temperature t pn = 20.9 °C will enter the area of ​​the beds with patients through the floor air distributor, displacing the generated excess heat, water vapor and gases to the ceiling, where the temperature of the displaced air will increase to t у1 = 28 °С and t ум1 = 19 °С (see construction in Fig. 1).

The calculations carried out and plotted on the i-d diagram in Fig. 1 showed that adiabatic humidification can ensure the maintenance of a comfortable temperature tb = 25 °C in hospital wards. Currently, hospital wards generally do not have air cooling facilities. This leads to the fact that in a hot summer, when t H = 34 °C increases and such heat persists for more than two months, the temperature in the premises will rise to t ≈ 30-34 °C. This creates extremely difficult conditions for people in these premises. This especially adversely affects the physical condition of people with various diseases of cardio-vascular system.

Complementing traditional ventilation systems with adiabatic humidifiers and recycling systems with pump circulation of antifreeze will pay for itself in less than a year due to a reduction of up to 50% of heat consumption in the cold season and improvement comfortable conditions presence of patients in wards on hot summer days.

Temperature conditions.

Temperature changes should not exceed:

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

‣‣‣ 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 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. 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 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 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 room 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 in the cold season of the 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.

As a coolant in systems central heating hospitals and maternity hospitals use 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, hardware 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. 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, 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. For lighting individual functional zones and workplaces, in addition, local lighting is arranged.

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 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. 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 premises 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 supplied 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. 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. Movement air flow are provided 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.

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.

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 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 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 - at least 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.” Control over the distribution of food in accordance with the prescribed diets is carried out 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 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 drugs.

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.
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 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-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. Influence chemical substances- 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 conditions. - concept and types. Classification and features of the category "Temperature." 2017, 2018.

← + Ctrl + →
Personal hygiene of the patient

Hospital sanitary regime

Maintaining required sanitary regime in hospital premises plays a huge role in the work of the hospital, the organization of the treatment process and patient care, as well as in the prevention of many diseases. Violations of the requirements and rules of the sanitary regime leads to contamination of premises, the proliferation of pathogenic microorganisms, the spread various insects. Thus, poor ventilation of wards leads to an increase in the level of bacterial contamination of the air, and the preservation of food residues in the buffet and untimely removal food waste promote the appearance of cockroaches. Poor care of soft equipment, furniture, mattresses, cracks in walls and baseboards contribute to the spread of bed bugs, and untimely removal of garbage from the hospital premises causes the spread of flies. Violations of food storage rules in the catering unit lead to the appearance of rodents.

Failure to comply with the sanitary regime increases the risk of the spread of nosocomial infections - infectious diseases that arise in patients in hospitals, or in medical workers associated with the treatment and care of patients, as a result of violations of the rules of asepsis and antisepsis, i.e. measures aimed at fight against pathogens of various infections. Among these diseases spreading in hospital conditions, include influenza, infectious (serum) hepatitis B, infection of which occurs due to poor sterilization of syringes and needles, and in children's departments - measles, scarlet fever, chicken pox, etc.

When organizing a sanitary regime in a hospital, significant requirements are placed on lighting, ventilation and heating, i.e., the creation of a certain microclimate in hospital premises.

Equal importance should be given to the lighting of the chambers. It must be remembered that direct sunlight has a bactericidal effect, that is, it helps reduce the level of bacterial air pollution. At the same time, it is necessary that the lighting be of sufficient intensity, uniform, and biologically complete in its spectrum. For these reasons, for example, ward windows are usually oriented to the south and southeast, and operating room windows to the north. For best use daylighting It is advisable to place the beds in the wards parallel to the wall with windows. To avoid the blinding effect of direct sunlight and overheating of the rooms, windows must be equipped with visors, curtains or have blinds.

When organizing artificial lighting, take into account that fluorescent lamps provide the patient with greater comfort than conventional incandescent lamps. Some departments (operating rooms, maternity units, etc.) also provide emergency lighting.

A prerequisite for maintaining a sanitary regime in hospitals is adequate ventilation, that is, removing polluted air from the premises and replacing it with clean air. Natural ventilation is achieved by regularly opening windows or transoms. Systematic failure to ventilate rooms leads to air stagnation and a significant increase in bacterial contamination, which facilitates the spread of nosocomial infections. In a number of rooms, for example in operating rooms, they use automatic maintenance of cleanliness, composition, humidity and air speed using air conditioners.

When organizing heating in hospitals, it is assumed that the optimal indoor temperature for a person is +20 °C in winter, and +23-24 °C in summer. The hygienic requirement is best met by radiant heating (with heated surfaces located in the walls, floor, ceiling), which prevents a significant difference between the temperature of the heat source and the temperature of the human body.

Maintaining a sanitary regime involves regular thorough cleaning of the premises and territory of the hospital. Garbage from buildings and compartments is taken out into metal bins with tight-fitting lids and removed in a timely manner.

Cleaning hospital premises must be wet, since washing reduces microbial contamination of the premises and surfaces of objects.

Disinfection can be achieved different ways. Thus, boiling is widely used to disinfect dishes, linen, and patient care items. Ultraviolet radiation mercury-quartz and mercury-uviol lamps are used to disinfect air in wards, treatment rooms, operating rooms.

For disinfection, chlorine-containing compounds are most often used ( bleach, chloramine, calcium, sodium and lithium hypochlorite, etc.). The antimicrobial properties of chlorine preparations are associated with the action of hypochlorous acid, which is released when chlorine and its compounds are dissolved in water.

The bleach solution is prepared according to certain rules. 1 kg of dry bleach is diluted in 10 liters of water, thereby obtaining the so-called 10% bleach-lime milk, which is left in a special room in a dark container for 1 day. Then the clarified bleach solution is poured into an appropriate dark glass container, the date of preparation is marked and the container is stored in a darkened room, since active chlorine is quickly destroyed in the light. In the future for wet cleaning use a 0.5% clarified bleach solution, for which, for example, take 9.5 liters of water and 0.5 liters of a 10% bleach solution. Chloramine solution is most often used in the form of a 0.2-3% solution (mostly 1%).

But such products are almost a thing of the past, and only a chronic lack of funding does not allow us to completely switch to new generation disinfectants, which are less toxic, more effectively destroy microorganisms, and are much more convenient to use. Modern disinfection means are differentiated - for, for processing instruments, for treating premises and for treating linen and secretions of patients.

Wet cleaning of hospital premises is carried out daily. In wards, corridors and offices - in the morning, after patients get up. During cleaning, pay attention to the sanitary condition of bedside tables and bedside tables, where it is not allowed to store perishable foods that can cause food poisoning.

Furniture, window sills, doors and door handles, and also (last) wipe the floor with a damp cloth. Wet cleaning must be completed by ventilating the rooms, since the walking of patients and medical staff and the changing of beds are accompanied by an increase in bacterial air pollution.

To maintain cleanliness in the rooms, wet cleaning is repeated as necessary during the day, as well as before bedtime.

Wet cleaning of dining rooms and pantries is carried out after each meal. Food waste is collected in closed buckets or bins with lids and taken out.

It is very important to follow the rules for washing dishes. The operation includes washing dishes twice with hot water using soda, mustard or other detergents, subsequent disinfection with a 0.2% clarified solution of bleach and rinsing.

Particularly strict requirements are imposed on the personal hygiene of kitchen and buffet workers, their regular and timely medical examination and bacteriological examination.

Wet cleaning of bathrooms (bathtubs, sinks, toilets) is carried out several times a day as they become dirty. To clean toilets, use a 0.5% clarified solution of bleach. Baths are washed after each patient with warm water and soap, and then rinsed with a 0.5% solution of bleach or 1-2% solution of chloramine.

General cleaning of all premises, including washing the floor, sweeping walls and ceilings, is carried out at least once a week. The equipment used in this case (mops, buckets, etc.) must be appropriately marked (for example, for washing the toilet, for washing corridors, etc.).

If bedbugs or cockroaches are found in hospital premises, measures are taken to destroy them (disinsection). A set of special measures (deratization) is also carried out when rodents are identified. Since disinsection and deratization are associated with the use of toxic substances, these activities are carried out by staff members of sanitary and epidemiological stations (SES).

Preventing the spread of flies, bedbugs, cockroaches and rodents in hospitals consists of maintaining cleanliness in the premises, timely removal of garbage and food waste, carefully sealing cracks in the walls, and storing food products in places inaccessible to rodents.

Note that maintaining the necessary sanitary condition in hospitals involves not only strict implementation medical personnel and patients with sanitary standards and the regime of wet cleaning of various premises, but also with the observance of personal hygiene rules by medical personnel and patients.

← + Ctrl + →
Organization of the work of the therapeutic departmentPersonal hygiene of the patient

What are the requirements for artificial lighting??
Electric lighting used in the evening and at night should not be too bright. At the same time, in doctors’ offices, laboratories, treatment rooms, especially in operating rooms and dressing rooms, the lighting, on the contrary, should be very powerful. In operating rooms and dressing rooms, special shadowless lighting systems are used.

What should the air temperature be in the hospital premises?
In the wards, the air temperature should be +20 "C, in dressing rooms and bathrooms - +22-25 "C, in operating rooms and labor rooms - +25 "C. The temperature in the room should be uniform.

What is the hygienic air standard in a hospital per patient?
The composition of the air in the room where people are is constantly changing. Dust in the indoor air plays a large role in the spread of germs and viruses and thereby contributes to the occurrence of diseases such as influenza, catarrh of the upper respiratory tract, measles, scarlet fever, etc.
Hygienic standards for air in hospital ward per patient is 27-30 m3, and this air must be replaced with fresh air every hour. Replacement of indoor air with outdoor clean air is carried out using natural and artificial ventilation.

How is the ventilation of rooms in a hospital carried out?
Ventilation of hospital premises through vents and transoms cannot be regulated and depends on climatic and meteorological conditions. In hospitals, it is necessary to install artificial supply and exhaust ventilation to purify the air, warm it or cool it. Operating rooms, boxes, isolators must have independent supply and exhaust systems. Installed for each room hygiene standards exchange of air in the supply and exhaust.

What are the care items in the hospital?
Care items include sippy cups, heating pads, ice packs, glass, enamel and rubber Esmarch mugs, bedpans, urinals, beakers, thermometers for measuring body temperature, water and air, rubber cushions, mattresses for the prevention of bedsores, headrests, benches for legs, etc. All these items must be in places specially designated for them.

How are patient care items sterilized and disinfected?
Before serving to the patient, vessels and urinals are rinsed with hot water to keep them warm. After use, they are washed with soap or powder ("Lotus", "Hygiene", etc.) and disinfected with a 0.5% bleach solution or 1% chloramine solution. Used enema tips should be kept in special glass jars labeled "dirty", and clean ones - in sterilizers, where they are boiled after washing with soap. In infectious diseases departments, each patient has his own care items until discharge from the hospital.

What are hospital supplies?
Hospital equipment includes beds, bedside tables, stretchers, chairs, trestle beds, and cabinets. The host sister is responsible for the safety of hospital equipment. Sanitary condition equipment is provided by a nurse, and a nurse supervises her work.