Placement of X-ray machines in a dental clinic. What are the rules and regulations for the new SanPiN for x-rays? Requirements for the premises for the installation of X-ray equipment

We want to focus your attention on the development x-ray room project or as it is also called x-ray project. X-ray design office and all further work with sources of ionizing radiation in dentistry is regulated by Sanitary Rules and Standards SANPIN 2.6.1.1192-03. It also establishes standards and requirements for lighting, ventilation, room area, handling of X-ray equipment, etc.

Project of an x-ray room in dentistry

If you decide to equip your dental clinic x-ray, then you must definitely understand that placement of x-ray machines directly in the treatment room may not always be the best solution, and sometimes even simply unacceptable. Only dental units can be placed directly in the treatment room. But, if you have more than one dental chair in your office, then most likely you will have to organize X-ray protective partitions to prevent exposure of one of two patients simultaneously in this X-ray treatment room. The pursuit of saving space will lead to clutter in the procedural x-ray room, and is unlikely to create coziness, tranquility and a comfortable stay for both patients and staff. And as already mentioned, placing an orthopantomograph in an office with dental chairs is simply unacceptable.

We can list endlessly the requirements for X-ray rooms in dentistry, including design requirements x-ray rooms , To placement of X-ray machines, citing various excerpts from SANPIN, but the best solution is to ask a question X-ray room design to us.

X-ray room project - scope of work

If you are interested, we are ready to assist in obtaining and Sanitary and epidemiological report on the type of activity radiology.

What is included in a dental x-ray project?

I. Medical and technical specifications for the development of a project for an x-ray room in a dental clinic(document base for x-ray room design);

II. Explanatory note:
- 1. General information and requirements for compliance with the design of an x-ray room in dentistry regulatory framework;
- 2. Initial data for design;
- 3. Technological solutions:
- a. Requirements for technological equipment and compliance with standards;
- b. Radiation safety calculation parameters;
- c. Climate requirements separate x-ray room or treatment room with x-ray;
- d. Lighting requirements in x-ray room;
- e. Requirements for water supply and sewerage in X-ray of the procedure room;
- f. Power requirements for x-ray equipment;
-g. Fire safety requirements;
- h. Waste disposal requirements;
- i. Requirements for the organization of x-ray examinations;
- j. Measures to prevent radiation accidents;
- k. Requirements for decommissioning an X-ray machine;
- 4. Conclusions.

III. Office plan with arrangement of technological equipment;

IV. Table for calculating the required additional protection enclosing structures;

V. Schematic diagram of the re-grounding circuit

VI. Plan for arrangement of cable channels and concrete foundations as necessary, depending on the X-ray machine;

VII. List of finishing of dental X-ray rooms;

VIII. Hardware Specification.

X-ray room project for dentistry, cost of work

Price for designing x-ray rooms (x-ray project)

The result of our work is an agreed project for an x-ray room

Additional/related services

In accordance with the Federal Law of March 30, 1999 N 52-FZ "On the sanitary and epidemiological welfare of the population" (Collection of legislation Russian Federation, 1999, N 14, art. 1650; 2002, N 1 (part 1), art. 2; 2003, N 2, art. 167; 2003, N 27 (part 1), art. 2700; 2004, N 35, art. 3607; 2005, N 19, art. 1752; 2006, N 1, art. 10; 2006, N 52 (part 1) art. 5498; 2007, N 1 (part 1), art. 21; 2007, N 1 (part 1) art. 29; 2007, N 27, art. 3213; N 46, art. 5554; 2007, N 49, art. 6070; 2008, N 24, art. 2801; 2008, N 29 (part 1), art. 3418; 2008, N 52 (part 1), art. 6223; 2008, N 30 (part 2) art. 3616; 2008, N 44, art. 4984; 2009, N 1, art. 17, by Decree of the Government of the Russian Federation dated July 24, 2000 N 554 “On approval of the Regulations on the State Sanitary and Epidemiological Service of the Russian Federation and the Regulations on State Sanitary and Epidemiological Standardization” (Collected Legislation of the Russian Federation, 2000, N 31, Art. 3295; 2004, N 8, Art. 663; 2004, N 47, Art. 4666; 2005, N 39, Art. 3953) I decree:

1. Make change 2 to SanPiN 2.1.3.1375-03 " Hygienic requirements to the placement, arrangement, equipment and operation of hospitals, maternity hospitals and other medical hospitals."*

State in the mentioned sanitary rules “Sanitary and hygienic requirements for dental medical organizations” in a separate chapter (appendix).

G. Onishchenko

* Registered by the Ministry of Justice of Russia on June 18, 2003, registration N 4709.

Application

Sanitary and hygienic requirements for dental medical organizations

Amendment 2 to SanPiN 2.1.3.1375-03

Sanitary and epidemiological rules and regulations SanPiN 2.1.3.2524-09

1. General provisions and scope

1.1. The sanitary rules were developed in accordance with the Federal Law “On the Sanitary and Epidemiological Welfare of the Population” dated March 30, 1999 N 52-FZ, the Regulations on State Sanitary and Epidemiological Standards (approved by Decree of the Government of the Russian Federation dated July 24, 2000 N 554).

1.2. Sanitary rules and regulations (hereinafter referred to as the Rules) are intended for legal entities, regardless of their organizational and legal form and form of ownership, and individual entrepreneurs carrying out activities to provide dental care.

1.3. These Rules are mandatory for execution throughout the Russian Federation by legal entities and individual entrepreneurs carrying out activities in the design, construction, reconstruction of buildings and premises intended for the provision of dental care and operation of equipment, medical equipment and medical devices.

1.4. The rules establish requirements for the placement, design, equipment, maintenance, sanitary and anti-epidemic regime and working conditions of medical personnel in dental medical organizations.

1.5. The design and construction of new, reconstruction and redevelopment of existing dental medical organizations must be carried out in accordance with the requirements of these Rules.

1.6. A dental medical organization must have a sanitary-epidemiological conclusion on compliance with sanitary rules of the conditions for carrying out the types of medical activities, works and services applied for licensing in the manner established by the legislation of the Russian Federation.

1.7. State sanitary and epidemiological supervision over the implementation of sanitary rules is carried out by bodies authorized to carry out state sanitary and epidemiological supervision.

1.8. Each dental medical organization must have an officially published copy of these Rules.

1.9. Responsibility for compliance with the requirements of the sanitary and anti-epidemic regime rests with individual entrepreneurs, legal entities, their managers and other officials.

1.10. Medical equipment, medical supplies, construction and Decoration Materials, as well as the medical technologies used must be permitted for use on the territory of the Russian Federation in in the prescribed manner.

1.11. In order to comply with the anti-epidemic regime, the doctor must work accompanied by nursing staff who carry out the processing of workplaces, disinfection, and also, in the absence of a centralized sterilization facility, pre-sterilization cleaning and sterilization of medical equipment and medical devices.

1.12. Dental medical organizations that include a hospital, including a day hospital, must comply with these sanitary rules, as well as sanitary rules establishing hygienic requirements for the placement, design, equipment and operation of hospitals, maternity hospitals and other medical hospitals.

2. Requirements for the location of dental medical organizations

2.1. Dental medical organizations can be located in separate buildings, in adapted premises, built-in (built-in and attached) to residential and public buildings, subject to compliance with the requirements of sanitary rules and regulations.

2.2. In residential buildings it is allowed to place dental offices, dental outpatient clinics, including those with day hospitals. It is allowed to place dental medical organizations in the basement floors of residential buildings.

2.3. Dental medical organizations located in residential buildings must have a separate entrance from the street.

2.4. Dental medical organizations are located in premises equipped with systems of domestic and drinking cold and hot water supply and water disposal (sewerage).

2.5. The placement and operation of X-ray rooms and devices (including radiovisiographs) are regulated by the current regulatory documents and section 7 of these rules.

2.6. The design, equipment and operation of physiotherapy rooms, the use of lasers must comply with current regulatory documents.

2.7. IN basements, having natural or artificial lighting, it is allowed to place sanitary facilities (dressing rooms, showers, storage rooms, etc.), ventilation chambers, compressor units, sterilization - autoclave rooms.

2.8. Separate rooms are allocated for organizing dental appointments for children. It is not permitted to use adult reception rooms to receive children on a scheduled basis. To organize the reception of children, if possible, a separate compartment with a waiting area and a bathroom should be allocated.

2.9. Medical care for pregnant women is provided in medical dental organizations for adults or in dental offices of antenatal clinics.

2.10. In dental offices, the area for the main dental unit must be at least 14 sq.m. additional installation- 10 sq.m (for a dental chair without a drill - 7 sq.m), the height of the rooms is at least 2.6 m.

2.11. Surgical interventions, for which medical activities in anesthesiology and resuscitation are carried out, are carried out in the conditions of the operating room. At the same time, a room is equipped for the patient’s temporary stay after surgery. In the operating room, if necessary, a supply of medical gases is provided.

2.12. The work of the surgical dentistry office is organized taking into account the separation of flows of “clean” (planned) and “purulent” interventions. Planned interventions are carried out on specially designated days with preliminary general cleaning.

2.13. The set of premises is determined by the capacity of the dental medical organization and types of activities. The minimum area of ​​premises and their minimum set are presented in Appendix 1.

3. Requirements for interior decoration

3.1. All used for interior decoration premises materials must have sanitary and epidemiological certificates in accordance with the area of ​​application.

3.2. The walls of dental offices, corners and junctions of walls, ceilings and floors must be smooth, without cracks.

3.3. To decorate the walls in offices, finishing materials are used that are approved for use in rooms with damp, aseptic conditions and are resistant to disinfectants. The walls of the operating room, dental surgery and sterilization rooms are finished to their full height with glazed tiles or other materials approved for these purposes.

3.4. The walls of the main premises of the dental laboratory are painted or lined with panels having a smooth surface; The seams are hermetically sealed.

3.5. The ceilings of dental offices, operating rooms, preoperative rooms, sterilization rooms and dental laboratories are painted with water-based or other paints. It is possible to use suspended ceilings if this does not affect the standard height of the room. Dropped ceilings must be made of slabs (panels) having a smooth, non-perforated surface that is resistant to the action of detergents and disinfectants.

3.6. Floors in dental offices must have a smooth surface made of materials approved for these purposes.

3.7. The color of wall and floor surfaces in dental offices and dental laboratories should be neutral light tones that do not interfere with the correct color discrimination of mucous membranes, skin, blood, teeth (natural and artificial), filling and denture materials.

3.8. When finishing dental offices in which mercury amalgam is used:

Walls and ceilings should be smooth, without cracks or decorations; plastered (brick) or rubbed (panel) with the addition of 5% sulfur powder to bind mercury vapor into a durable compound (mercury sulphide) and painted with paints approved for dental offices;

The floors must be laid with rolled material, all seams must be welded, the plinth must fit tightly to the walls and floor;

Tables for working with amalgam must be covered with mercury-proof material and have edges at the edges. There should be no open drawers under the working surface of the tables;

It is allowed to use only amalgam produced in hermetically sealed capsules.

4. Equipment requirements

4.1. In rooms with one-way natural light, dental chairs are installed in one row along a light-carrying wall.

4.2. If there are several dental chairs in the office, they are separated by opaque partitions no less than 1.5 m high.

4.3. The absence of a sterilization facility in a dental medical organization is permitted if there are no more than 3 chairs. In this case, installation of sterilization equipment is possible directly in the offices.

4.4. Dental offices are equipped with separate or two-section sinks for washing hands and processing instruments. If there is a sterilization room and it organizes centralized pre-sterilization processing of instruments in the offices, the presence of one sink is allowed. In the operating room, sinks are installed in the preoperative room. Elbow or touch mixers are installed in surgical rooms, sterilization rooms, and preoperative rooms.

4.5. The premises of dental laboratories and dental offices in which work with gypsum is carried out must have equipment for sedimentation of gypsum from wastewater before being discharged into the sewer (gypsum traps, etc.).

4.6. Cabinets are equipped with bactericidal irradiators or other air disinfection devices permitted for this purpose in accordance with the established procedure. When using irradiators open type switches must be located outside the work premises.

5. Requirements for microclimate, heating, ventilation

5.1. Heating, ventilation and air conditioning systems must comply with the standards for the design and construction of residential and public buildings and provide optimal parameters of the microclimate and air environment, including microbiological indicators.

5.2. The surface of heating devices must be smooth, allowing easy cleaning and preventing the accumulation of microorganisms and dust.

5.3. In operating rooms, preoperative, anesthesia, and postoperative rooms, heating devices with a smooth surface that is resistant to daily exposure to detergents and disinfectants should be used.

5.4. At permanent workplaces where medical personnel are present more than 50% of the working time or more than 2 hours of continuous work, microclimate parameters must be provided in accordance with Table 1.

5.5. For places of temporary residence of workers (special premises of the dental laboratory), the microclimate parameters are presented in Table. 2.

5.6. The design and operation of ventilation systems must prevent the flow of air masses from “dirty” areas to “clean” ones.

5.8. To ensure standard microclimate parameters in industrial premises, air conditioning is allowed, including the use of split systems intended for use in medical institutions. Fine filters must be replaced at least once every 6 months, unless otherwise provided by the manufacturer.

5.9. In dental medical organizations with no more than 3 dental chairs (except for operating rooms), located including on non-residential floors of residential and administrative buildings, unorganized air exchange is allowed due to ventilation of rooms through opening transoms or natural exhaust ventilation.

5.10. In dental medical organizations with more than 3 chairs, air exchange in offices is supported by general supply and exhaust ventilation systems with mechanical air stimulation and an air exchange rate (2 for inflow and 3 for exhaust). The ventilation system from the production premises of medical organizations located in residential buildings must be separate from the residential building, in accordance with the sanitary and epidemiological requirements for residential buildings and premises.

5.11. Autonomous systems ventilation should be provided for the following rooms: operating rooms with preoperative rooms, sterilization rooms, X-ray rooms (separate), production premises of dental laboratories, bathrooms.

5.12. In the premises of dental laboratories, local suction and general exhaust ventilation may be combined into one exhaust system, within the laboratory premises or in the ventilation chamber. It is allowed to install a general exchange supply ventilation for laboratory premises and other premises of a dental medical organization, while the supply of fresh air to the laboratory premises should be provided through a separate air duct passing from the ventilation chamber, with a check valve installed on it within the ventilation chamber.

5.13. In dental offices that do not have autonomous ventilation ducts, it is allowed to remove exhaust air from general exhaust ventilation systems at outer wall buildings, through devices that purify the air from harmful chemicals and odors (photocatalytic filters, etc.).

5.14. The technological equipment of dental laboratories, which includes sections for cleaning the exhaust air from this equipment, as well as closed-circuit equipment, does not require additional local suction.

5.15. In dental laboratories, depending on the technological part of the project, local suction is provided from the workplaces of dental technicians, from grinding motors, in the foundry above the furnace, in the soldering room, above heating devices and work tables in the polymerization room. The air released into the atmosphere should be purified in accordance with the technological characteristics of the equipment and materials. Local suction systems should be designed autonomous from the general exhaust ventilation systems of dental medical organizations.

5.16. Dental laboratories for 1 or 2 workplaces, in which work is performed that is not accompanied by the release of harmful substances (for example: applying and firing ceramic mass, turning and other work) are allowed to be located in residential and public buildings. Unorganized air exchange in the room is allowed by ventilation through transoms or using natural exhaust ventilation with 2-fold air exchange through an autonomous ventilation duct with access to the roof or external wall without light openings.

5.17. In rooms equipped with X-ray equipment (including radiovisiographs), the requirements for ventilation and air exchange rates are met according to the technological section of the design documentation, agreed upon in the prescribed manner.

5.18. In premises that require aseptic conditions, it is provided hidden gasket air ducts, pipelines, fittings.

5.19. Regardless of the presence of forced ventilation systems, all offices and rooms, with the exception of operating rooms, must be provided with easily opening transoms.

5.20. In premises, standardized indicators of microbial contamination of the air must be observed.

5.22. Maintenance of ventilation and air conditioning systems and preventive repairs are carried out by a responsible person or under an agreement with a specialized organization.

5.23. Elimination of emerging malfunctions and defects in the ventilation system must be carried out immediately.

6. Requirements for natural and artificial lighting

6.1. All dental offices and dental laboratory premises (permanent workplaces) must have natural light.

6.2. In newly created dental medical organizations, the windows of dental offices, if possible, should be oriented to the northern directions (N, NE, NW) in order to avoid significant changes in brightness in the workplace due to direct sunlight, as well as overheating of the premises in summer time, especially in the southern regions.

6.3. If possible, the main premises and foundries of the dental laboratory should be oriented towards the northern directions to prevent overheating of the premises in the summer.

6.4. In existing dental medical organizations with window orientations that do not correspond to those specified in paragraphs 6.2. and 6.3., it is recommended to use sun protection devices (visors, sun protection films, blinds, etc.). In operating rooms and surgery rooms, sunshades such as blinds are placed between the window frames.

6.5. The coefficient of natural light at permanent workplaces in all dental offices and the main premises of the dental laboratory must comply with the hygienic requirements established by current sanitary standards.

6.7. When installing dental chairs in two rows in existing offices with one-way natural light, artificial light should be used during the work shift, and doctors should periodically change their workstations.

6.8. The location of dental technicians' desks in the main rooms of the dental laboratory should provide left-side natural lighting of the workplace.

6.9. All premises of dental medical organizations must have general artificial lighting made fluorescent lamps or incandescent lamps.

6.10. For general fluorescent lighting In all dental offices and main rooms of the dental laboratory, lamps with an emission spectrum that does not distort color rendition are recommended.

6.11. General lighting lamps should be placed so as not to fall into the field of view of the working doctor.

6.13. Dental offices, main and polishing rooms of a dental laboratory, in addition to general lighting, must also have local lighting in the form of:

dental lamps on dental units;

special (preferably shadowless) reflectors for each surgeon’s workplace;

shadowless reflectors in operating rooms;

lamps at each dental technician’s workplace in the main and polishing rooms.

6.14. The level of illumination from local sources should not exceed the level of general illumination by more than 10 times.

6.15. Lamps for local and general lighting must have appropriate protective fittings that provide for their wet cleaning and protect the eyes of personnel from the glare of the lamps.

7. Ensuring radiation safety during the placement and operation of X-ray machines and rooms

7.1. General requirements to the placement of X-ray machines in dental medical organizations

7.1.1. The basic requirements for the placement and operation of X-ray devices must comply with the provisions of the current sanitary rules, which determine the main criteria for radiation protection, requirements for X-ray equipment and personnel, and the basic requirements for the placement of X-ray devices and their operation. These Rules detail the requirements for the placement and operation of X-ray machines in dental medical organizations.

When conducting X-ray studies, accounting and registration of radiation doses to patients and personnel must be ensured, which must be reflected in the organization’s radiation-hygienic passport and in the forms of state annual statistical reporting.

To conduct X-ray examinations, a license must be issued to carry out activities with a source of ionizing radiation.

7.1.2. At the stage of organizing activities with sources of ionizing radiation (IRS), a choice is made of the premises in which X-ray examinations will be carried out: either in a separate X-ray room, or in a dental office with an installed X-ray machine. At this stage, the number and type of X-ray machines, the area and set of premises for their placement, as well as the necessary additional conditions (lighting, ventilation, power supply, heating, sewerage, etc.) are also determined. The selected layout of the X-ray machine (in a separate X-ray room or in a dental office) is drawn up in the form of a design specification.

7.2. Features of placing X-ray machines in a separate X-ray room

7.2.1. The placement of X-ray machines in X-ray rooms is carried out on the basis of the project. The development of the project is carried out by a design organization that has a license for the corresponding type of activity, based on the customer’s technical specifications. A sanitary and epidemiological report is issued for the project in the prescribed manner. The commissioning and operation of X-ray rooms and devices is carried out in accordance with the hygienic requirements for the design and operation of X-ray rooms, devices and the conduct of X-ray examinations.

7.2.2. The design of the cabinet must ensure compliance with the requirements of technical and regulatory documentation.

7.2.3. The cabinet floor is made of non-conductive electricity materials, natural or artificial (linoleum, natural or artificial stone, ceramic tiles, etc.).

7.2.4. The organization of air exchange in the X-ray room must ensure the maintenance of microclimate indicators (temperature, humidity) in accordance with current hygienic standards and can be ensured by various means (device supply and exhaust ventilation, installation of window fans, air conditioning, etc.).

7.2.5. The X-ray room personnel belongs to group “A” and is subject to special requirements provided for by current sanitary regulations.

7.3. Features of placing X-ray machines in a dental clinic

office

7.3.1. The dental office can accommodate an X-ray machine for targeted images with a digital image receiver that does not require darkroom processing, and with a workload of up to 40 (mAhmin)/week. Placing an orthopantomograph in a dental office is not permitted. The X-ray machine in a dental office is intended only to serve patients in that office. Additional areas for placement of an X-ray machine in a dental office, appropriate sanitary standards, not required. There are also no additional requirements for lighting, ventilation, or heating.

7.3.2. The placement of an X-ray machine in a dental office may be carried out on the basis of design materials containing:

X-ray machine placement diagram;

Calculation of radiation protection of personnel workplaces, adjacent rooms, places of placement of other patients (if there may be other patients in the room during an x-ray examination), and adjacent territory.

7.3.3. Personnel protection can be achieved by distance, time, screens (installation of a protective screen), and the use of personal protective equipment (protective aprons, goggles, etc.).

7.3.4. Workers conducting X-ray examinations of patients belong to group “A” personnel. The remaining employees whose workplaces are located in the dental office, where X-ray examinations are carried out, belong to group “B” personnel. They are subject to personnel requirements established by the basic sanitary rules for ensuring radiation safety.

7.3.5. If during X-ray examinations there may be patients in the dental office who are not participating in them, the dose rate of x-ray radiation in the places where they are located, normalized to the standard operating load of the x-ray machine, should not exceed 1.0 µSv/h. To fulfill this condition, if necessary, stationary or mobile radiation protection equipment can be used.

7.4. The main stages of implementing radiation safety requirements when putting devices into operation, issuing and renewing a license

7.4.1. To implement the requirements of sanitary rules, the administration must ensure a set of measures to comply with radiation safety requirements and prepare documents:

license for activities with sources of ionizing radiation;

sanitary and epidemiological conclusion on activities with sources of ionizing radiation (IRS);

sanitary and epidemiological certificate for the X-ray machine or its certified copy;

a certified copy of the state registration certificate of the x-ray machine;

sanitary and epidemiological conclusion for the project (X-ray room) or design materials (dental office with an X-ray machine);

operational documentation for the X-ray machine;

technical passport for the x-ray room;

protocol for dosimetric measurements at workplaces, in adjacent rooms and in the adjacent territory;

research protocol operational parameters X-ray machine;

test protocol for mobile and personal protective equipment;

grounding inspection reports;

acts of checking the efficiency of ventilation (in the presence of supply and exhaust ventilation systems with mechanical drive);

conclusion of the medical commission on the passage of preliminary and periodic medical examinations by group “A” personnel;

order on the admission of employees to work with radiation sources and classifying them as group “A” personnel;

an order for the person responsible for radiation safety;

documents confirming the accounting of individual radiation doses of patients;

production control program to ensure radiation safety (allowed as a section of the general production control plan of a medical organization);

employees working with the X-ray machine have documents confirming training in the rules of working with the machine;

instructions on labor protection and radiation safety, prevention and elimination of radiation accidents;

on-the-job training log;

cards for recording individual radiation doses of personnel based on the results of individual dosimetric monitoring of group “A” personnel.

8. Sanitary and anti-epidemic measures

8.1. Requirements for the organization and implementation of disinfection and sterilization measures

8.1.1. Responsibility for organizing and conducting disinfection (disinfection, disinfestation, deratization) and sterilization (pre-sterilization cleaning, sterilization) activities, as well as for training personnel on these issues lies with the head of the dental medical organization, who is guided by these sanitary rules and other current regulatory and methodological documents.

8.1.2. To carry out disinfection and sterilization measures, dental medical organizations must be regularly provided with detergents and disinfectants for various purposes, skin antiseptics, means for sterilizing medical products, as well as sterilization packaging materials and control means (chemical indicators, etc.).

8.1.3. Reusable medical devices for dental procedures in patients are subject to the following:

Disinfection;

Pre-sterilization cleaning;

Sterilization;

Subsequent storage under conditions that exclude secondary contamination by microorganisms.

Disposable products must be disinfected and subsequently disposed of after use during dental procedures on patients. Their reuse is prohibited.

8.1.4. In dental medical organizations, when carrying out disinfection and sterilization measures, it is allowed to use only those approved in accordance with the established procedure for use in the Russian Federation:

Disinfectant chemicals (disinfectants, including skin antiseptics; products for pre-sterilization cleaning and sterilization);

Disinfection and sterilization equipment (bactericidal irradiators and other equipment for disinfection of indoor air, disinfection chambers, disinfection units and washing machines, including ultrasonic; sterilizers);

Auxiliary equipment and materials (spraying devices, bacterial filters, chambers with UV radiation for storing sterile instruments, processing containers, sterilization boxes and packaging materials, chemical and biological indicators, etc.).

8.1.5. Disinfectants must be stored in manufacturer's containers (packaging) equipped with a label, on racks, in specially designated places.

8.1.6. It is necessary to have separate containers with working solutions of disinfectants used to treat various objects:

For disinfection, for pre-sterilization cleaning and for sterilization of medical devices, as well as for their preliminary cleaning (when using products with fixing properties);

For disinfection of indoor surfaces, furniture, apparatus, devices and equipment;

For disinfection of cleaning material, for disinfection of waste of classes “B” and “C”.

Containers with working solutions of disinfectants must be equipped with tight-fitting lids and have clear labels indicating the product, its concentration, purpose, date of preparation, and expiration date of the solution.

8.1.7. When working with disinfectants, all precautions must be observed, including the use of personal protective equipment specified in the instructions for use.

8.1.8. Quality control of disinfection, cleaning and sterilization is carried out in accordance with current regulatory and methodological documents.

8.1.9. Quality control of disinfection, pre-sterilization cleaning and sterilization is carried out by responsible persons within the framework of production control, as well as by institutions and bodies carrying out state sanitary and epidemiological supervision.

8.1.10. All dental offices must be provided with medical equipment and medical devices in quantities sufficient for uninterrupted operation, taking into account the time required for their processing between manipulations with patients: for each dentist’s workplace - at least 6 handpieces (of which two angled , two straight, two turbine), for each visit - an individual dental examination kit, consisting of a set of instruments (tray, dental mirror, dental tweezers, dental probe), a bag with cotton swabs, a bag with tweezers (for working with sterile instruments necessary for each patient). If necessary, the set can be completed with other instruments (dental button probe, periodontal graduated probe, smoothers, spatula, excavators, etc.).

8.1.11. Sterile products are placed on the doctor’s dental table (on a sterile tray or sterile napkin) immediately before manipulations on a particular patient.

Under the working surface of the table (on a shelf, in a drawer) it is allowed to place instruments and apparatus for various dental procedures and filling materials.

8.1.12. Breast napkins must be changed after each patient. Disposable napkins are disposed of, reusable ones are washed.

8.1.13. To rinse the mouth with water, disposable or reusable glasses are used individually for each patient.

8.2. Requirements for sanitary maintenance of premises

8.2.1. Wet cleaning of premises is carried out at least twice a day (between shifts and after work) using detergents and disinfectants (according to disinfection regimes for bacterial infections) using irrigation and/or wiping methods. Window glass should be washed at least once a month from the inside and at least once every 3 months from the outside (spring, summer and autumn).

8.2.2. Disinfection of the surfaces of objects located in the treatment area (instrument table, control buttons, keyboard, air gun, lamp, spittoon, headrest and armrests of the dental chair) is carried out after each patient. For these purposes, disinfectants are used that are approved for use in the presence of patients and have a wide spectrum of antimicrobial (virucidal, bactericidal, fungicidal - with activity against fungi of the genus Candida) action. The choice of disinfection modes is carried out according to the most resistant microorganisms - between viruses or fungi of the genus Candida (in tuberculosis medical organizations - according to mycobacterium tuberculosis).

8.2.3. Once a week, general cleaning of the premises is carried out in the operating unit, surgical room, and sterilization (autoclave) room. For disinfection, disinfectants are used that have a wide spectrum of antimicrobial (virucidal, bactericidal, fungicidal - with activity against fungi of the genus Candida) action. The choice of disinfection modes is carried out according to the most resistant microorganisms - between viruses or fungi of the genus Candida (in tuberculosis medical organizations - according to mycobacterium tuberculosis).

In other departments, general cleaning is carried out once a month, using disinfectants according to regimes that are effective against vegetative forms of bacteria.

8.2.4. The general cleaning schedule is drawn up monthly and approved by the manager. Outside the schedule, general cleaning is carried out in case of unsatisfactory results of microbial contamination of the external environment and for epidemiological indications.

8.2.5. To carry out general cleaning, staff must have special clothing and personal protective equipment (robe, cap, mask, rubber gloves, rubber apron, etc.), labeled cleaning equipment and clean cloth napkins.

8.2.6. When carrying out general cleaning, a disinfectant solution is applied to the walls by irrigation or wiping them to a height of at least two meters (in operating units - to the entire height of the walls), windows, window sills, doors, furniture and equipment. At the end of the disinfection time (the staff must change their overalls), all surfaces are washed with clean cloth napkins moistened with tap (drinking) water, and then the air in the room is disinfected.

8.2.7. Used cleaning equipment is disinfected in a disinfectant solution, then rinsed in water and dried. Cleaning equipment for floors and walls must be separate, clearly marked, and used separately for offices, corridors, and bathrooms.

If it is not possible to use disposable cloth napkins, reusable napkins must be washed.

8.2.8. Cleaning equipment must be stored in a specially designated room or cabinet outside the office premises.

8.2.9. To disinfect the air in the premises of dental medical organizations, equipment and/or chemicals approved for this purpose should be used.

Treatment technology and air disinfection modes are set out in the relevant regulatory and methodological documents and instructions for the use of specific disinfection equipment and disinfectants.

In order to reduce air contamination to a safe level, the following technologies can be used:

Impact ultraviolet radiation with the help of open and combined bactericidal irradiators used in the absence of people, and closed irradiators, including recirculators, which allow air disinfection in the presence of people, the required number of irradiators for each room is determined by calculation in accordance with current standards;

Exposure to aerosols of disinfectants in the absence of people using special spraying equipment (aerosol generators) during final disinfection and during general cleaning;

Exposure to ozone using ozone generator installations in the absence of people during final disinfection and during general cleaning;

The use of antimicrobial filters, including electrostatic precipitators, as well as filters operating on the principles of photocatalysis and ionic wind and others.

8.3. Disinfection, pre-sterilization cleaning and sterilization of medical equipment and medical devices

8.3.1. Products of medical equipment and medical purposes are subject to disinfection after use, regardless of their further use (single-use and multiple-use products). Disinfection can be carried out using physical and chemical methods. The choice of method depends on the characteristics of the product and its purpose.

8.3.2. To disinfect medical equipment and medical devices, disinfectants are used that have a wide spectrum of antimicrobial (virucidal, bactericidal, fungicidal - with activity against fungi of the genus Candida) action. The choice of disinfection modes is carried out according to the most resistant microorganisms - between viruses or fungi of the genus Candida (in tuberculosis medical organizations - according to mycobacterium tuberculosis).

8.3.3. When carrying out disinfection, pre-sterilization cleaning and sterilization with solutions of chemical agents, medical devices are immersed in a working solution of the product (hereinafter referred to as the “solution”) to fill the channels and cavities. Detachable products are immersed disassembled, tools with locking parts are soaked open, making several working movements with these tools in the solution.

8.3.4. The volume of the container for treatment and the volume of the product solution in it must be sufficient to ensure complete immersion of medical products in the solution; the thickness of the mortar layer above the products must be at least one centimeter.

8.3.5. Disinfection by wiping may be used for those products of medical equipment and medical purposes that do not come into direct contact with the patient or the design features of which do not allow the use of the immersion method (handpieces, adapters from a turbine hose to handpieces, a micromotor to mechanical handpieces, a handpiece to a scaler for removing dental deposits, light guides of light-curing lamps). It is not recommended to use aldehyde-containing products for these purposes. Treatment of handpieces after each patient can be carried out as follows: the handpiece channel is washed with water, cleaning with special devices(mandrins, etc.), and blow with air; the tip is removed and its surface is thoroughly wiped (once or twice - until visible contaminants are removed) with cloth napkins moistened with drinking water, after which it is treated with one of the disinfectants approved for use for this purpose (taking into account the recommendations of the manufacturer of the tip), and then in steam sterilizer.

8.3.6. After disinfection, reusable medical devices must be washed from residual disinfectant in accordance with the recommendations set out in the instructions for use of a particular product.

8.3.7. Disinfection of dental impressions and denture blanks is carried out after use on patients before sending them to the dental laboratory and after receiving them from the dental laboratory immediately before use. The choice of disinfectant depends on the type of impression material. After disinfection, the products are washed with drinking water to remove any remaining disinfectant.

8.3.8. Disinfection of dental suction systems is carried out after completion of work, for which a solution of a disinfectant recommended for these purposes is pumped through the system; The system filled with solution is left for the time specified in the instructions for use of the product. After the disinfection period is completed, the solution is drained from the system and washed with running water.

8.3.9. Polishing attachments, carborundum stones, glass slides are subject to disinfection, cleaning, and sterilization.

8.3.10. In the physiotherapeutic department, removable gingival and point electrodes, tubes for the KUF apparatus (short-wave ultraviolet irradiator), laser light guides, and glass electrodes for the darsonvalization apparatus are disinfected. For applications in the mouth, sterile material is used.

8.3.11. If there are more than three dental chairs in a dental medical organization, pre-sterilization cleaning and sterilization are carried out in specially designated rooms - sterilization (autoclave) rooms, with the allocation of “clean” and “dirty” zones and compliance with flow.

In other cases, pre-sterilization cleaning and sterilization of medical devices can be carried out in offices, for which the necessary equipment must be installed in them.

Pre-sterilization cleaning of products is carried out after disinfection or when combined with disinfection in one process (depending on the product used): manual or mechanized (in accordance with the operating instructions attached to the specific equipment) method.

8.3.12. The quality of pre-sterilization cleaning of products is assessed by performing an azopyram or amidopyrine test for the presence of residual amounts of blood, as well as by performing a phenolphthalein test for the presence of residual amounts of alkaline components of detergents (only in cases of using products whose working solutions have a pH of more than 8.5) in accordance with current methodological documents and instructions for the use of specific products.

8.3.13. Quality control of pre-sterilization cleaning is carried out daily. The following are subject to control: in the sterilization room - 1% of each item of product processed per shift; for decentralized processing - 1% of simultaneously processed products of each item, but not less than three units. The control results are recorded in a journal.

8.3.14. All instruments and products that come into contact with the wound surface, blood or injectable drugs, as well as certain types of medical instruments that during operation come into contact with the mucous membrane and can cause damage to it, are subject to sterilization:

Dental instruments: tweezers, probes, spatulas, excavators, fillers, smoothers, crown removers, skellers, dental mirrors, burs (including diamond-coated) for all types of tips, endodontic instruments, pins, dental discs, cutters, separating metal plates, matrix holders, trays for taking impressions, instruments for removing dental plaque, periodontal surgical instruments (curettes, hooks of various modifications, etc.), instruments for filling tooth canals (pluggers, spreaders), carpule syringes, various types of forceps and nippers for the orthodontic office, vacuum cleaners;

Ultrasonic handpieces and attachments for them, handpieces, removable micromotor sleeves for mechanical handpieces, cannulas for a dental plaque removal device;

Surgical instruments: dental forceps, curettage spoons, elevators, chisels, instrument sets for implantology, scalpels, forceps, scissors, clamps, surgical smoothers, suture needles;

Trays for sterile medical products, tools for working with sterile material, including tweezers and containers for storing them.

8.3.15. Sterilization of medical products used in dentistry is carried out by physical (steam, air, infrared, use of heated glass beads) or chemical (use of chemical solutions, gas, plasma) methods in accordance with current documents, using appropriate sterilizing agents and types of equipment. , approved for use in accordance with the established procedure. The choice of an adequate sterilization method depends on the characteristics of the products being sterilized. Sterilization is carried out according to the modes specified in the instructions for use of a specific product and in the operating instructions for a sterilizer of a specific model.

When sterilizing using the air method, the use of laboratory equipment (ShSS type cabinets) is prohibited.

8.3.16. Handpieces, including ultrasonic ones and attachments for them, endodontic instruments with plastic shanks are sterilized only by steam.

8.3.17. It is possible to sterilize burs in glasperlene sterilizers various types and other small instruments when they are completely immersed in the environment of heated glass beads. It is not recommended to use this method for sterilizing larger dental instruments to sterilize their working parts.

8.3.18. The infrared method is used to sterilize metal products: dental forceps, dental microsurgical instruments, carbide burs, diamond heads and discs, drills, channel fillers, etc.

8.3.19. The chemical method of sterilization using solutions of chemical agents can be used to sterilize only those products in the design of which thermolabile materials are used that do not allow the use of other sterilization methods.

For chemical sterilization solutions of aldehyde- or oxygen-containing agents, or some chlorine-containing components that have a sporicidal effect, are used.

To avoid dilution of working solutions, especially those used repeatedly, products immersed in them must be dry.

When sterilizing with chemical solutions, all manipulations are carried out strictly observing the rules of asepsis; use sterile containers to sterilize and wash products with sterile drinking water from product residues. Products are washed according to the recommendations set out in the instructions for use of a particular product.

8.3.20. With steam, air, gas and plasma methods, products are sterilized in packaged form, using sterilization packaging disposable materials or reusable containers (sterilization boxes with filters) permitted for a specific sterilization method in the prescribed manner.

Products sterilized in packaged form are stored in cabinets and work tables. Shelf life is indicated on the packaging and is determined by the type of packaging material and instructions for its use.

8.3.21. Sterilization of unpackaged products is permitted only with a decentralized processing system in the following cases:

When using solutions of chemicals to sterilize products in the design of which thermolabile materials are used;

When sterilizing dental metal instruments using thermal methods (glasperlene, infrared, air, steam) in portable sterilizers.

It is advisable to immediately use all products sterilized in unpackaged form for their intended purpose. It is prohibited to move them from office to office.

If necessary, instruments sterilized in unpackaged form by one of the thermal methods, after completion of sterilization, may be stored in bactericidal chambers (equipped with ultraviolet lamps) approved for use in the established manner for the period specified in the equipment operation manual, and in the absence of such chambers - on a sterile table for no more than 6 hours.

Medical products sterilized in sterilization boxes can be used for no more than 6 hours after opening them.

8.3.22. Germicidal chambers equipped with ultraviolet lamps may only be used for the purpose of storing instruments to reduce the risk of secondary contamination with microorganisms in accordance with the operating instructions. It is prohibited to use such equipment for the purpose of disinfection or sterilization of instruments.

8.3.23. When sterilizing unpackaged products using the air method, storing sterilized products in an air sterilizer and using them the next day after sterilization is not allowed.

8.3.24. When sterilizing by a chemical method using solutions of chemical agents, sterilized products washed with sterile water are used immediately for their intended purpose or placed for storage in a sterile sterilization box with a filter, lined with a sterile sheet, for a period of no more than 3 days.

8.3.25. All manipulations to set the sterile table are carried out in a sterile gown, mask and gloves, using sterile sheets. Be sure to make a note about the date and time of covering the sterile table. The sterile table is set for 6 hours. Materials and instruments not used during this period from the sterile table are sent for re-sterilization.

8.3.26. The use of sterilized medical devices that have expired after sterilization is not allowed.

8.3.27. Records of sterilization of medical devices are kept in a journal.

8.4. Sterilization control

8.4.1. Sterilization control includes monitoring the operation of sterilizers, checking the parameters of sterilization modes and assessing its effectiveness. The operation of sterilizers is monitored in accordance with current instructions/methodological documents by physical (using instrumentation), chemical (using chemical indicators) and bacteriological (using biological indicators) methods.

The operation of sterilizers using physical and chemical methods is monitored during each sterilization cycle.

8.4.2. Sterilizers are subject to bacteriological control after their installation (repair), as well as during operation at least twice a year.

8.4.3.Maintenance, warranty and Maintenance sterilizers are carried out by service specialists in accordance with contracts.

8.5. Hand treatment rules

8.5.1. Depending on the medical procedure being performed and the required level of reducing microbial contamination of the skin of the hands, hygienic treatment hands of medical personnel or treatment of the hands of surgeons.

8.5.2. For achievement effective washing and hand disinfection must be observed following conditions: short-cut nails, no nail polish, no artificial nails, no rings, rings or other jewelry on the hands. Before treating surgeons' hands, it is also necessary to remove watches, bracelets, etc. To dry hands, use cloth or paper towels or disposable wipes; when treating surgeons' hands - only sterile fabric ones.

8.5.3. When choosing skin antiseptics, detergents and hand skin care products, one should take into account their skin tolerance, the intensity of skin coloring, the presence of fragrance, etc.

8.5.4. Medical staff should be provided with sufficient quantities of effective means for washing and disinfecting hands, as well as hand skin care products (creams, lotions, balms, etc.) to reduce the risk of contact dermatitis.

8.6. Hand hygiene

8.6.1. Hand hygiene includes two methods:

Washing hands with soap and water (hygienic handwashing) to remove contaminants and reduce microorganisms;

Treating hands with a skin antiseptic (hand hygiene) to reduce the number of microorganisms to a safe level.

The choice of hand treatment method depends on the degree and nature of contamination.

8.6.2. Used for hand washing liquid soap using a dispenser (dispenser) or solid (bar), placed in magnetic or other soap dishes, the design of which does not allow the soap to get wet.

Dry your hands with an individual disposable towel (napkin).

8.6.3. Alcohol-containing and other approved antiseptics are used to disinfect hands.

8.6.4. Hand hygiene with an antiseptic should be carried out in the following cases:

Before direct contact with the patient;

After contact with intact skin of the patient (for example, when measuring pulse or blood pressure and so on.);

After contact with body secretions or excreta, mucous membranes, dressings;

When performing various manipulations to care for a patient after contact with areas of the body contaminated with microorganisms;

After contact with medical equipment and other objects located in close proximity to the patient;

After treating patients with purulent inflammatory processes (periodontitis, gangrenous pulpitis), curettage of periodontal pockets, opening of periodontal abscesses, after each contact with contaminated surfaces and equipment;

After removing gloves, wash your hands under running water.

8.6.5. Hygienic treatment of hands with an antiseptic (without prior washing) is carried out by rubbing it into the skin of the hands in the amount recommended in the instructions for use, paying special attention to the treatment of the fingertips, the skin around the nails, and between the fingers. An indispensable condition for effective hand disinfection is keeping them moist for the recommended treatment time.

8.6.6. When using a dispenser, a new portion of antiseptic (or soap) is poured into the dispenser after it has been disinfected, washed with water and dried. Preference should be given to elbow dispensers and photocell dispensers.

8.6.7. In the absence of dispensers or the possibility of using them, antiseptics (including gels) are used in individual packaging (small-volume bottles), which are disposed of after use.

8.6.8. If your hands are contaminated with blood, saliva or other body fluids, you should:

Remove dirt with a swab or napkin moistened with an antiseptic,

Treat your hands with antiseptic twice,

Wash your hands with soap and water,

Dry your hands thoroughly with a disposable towel.

Treat with an antiseptic.

8.6.9. Gloves must be worn before performing any manipulation on the patient.

After removing gloves, perform hand hygiene.

Gloves must be changed after each patient. Reuse gloves are prohibited.

8.7. Treatment of surgeons' hands

8.7.1. The treatment of the hands of surgeons and other specialists involved in surgical interventions and other manipulations associated with violation of the integrity of the skin and mucous membranes is carried out in two stages:

Stage I - washing hands with soap and water for two minutes, and then drying with a sterile towel (napkin);

Stage II - treatment of hands, wrists and forearms with an antiseptic.

8.7.2. The amount of antiseptic required for treatment, the frequency of treatment and its duration are determined by the recommendations set out in the guidelines/instructions for use of a particular product. An indispensable condition for effective hand disinfection is keeping them moist for the recommended treatment time.

Sterile gloves are put on immediately after the antiseptic has completely dried on the skin of the hands.

9. Occupational hygiene and personal hygiene rules for personnel

9.1. The administration of a dental medical organization is obliged to ensure safe conditions labor of medical personnel. Preliminary upon employment and periodic medical examinations of personnel are carried out on the basis of a medical organization that has a license to conduct such examinations in the prescribed manner. Personnel of dental medical organizations are subject to immunization in accordance with the national calendar of preventive vaccinations and the vaccination calendar for epidemiological indications.

9.2. Medical personnel must be provided with sets of replacement clothing: gowns or medical suits, caps, masks, and replacement shoes. Changes of clothing are stored separately from personal clothing in individual two-section lockers outside reception rooms (dressing room, staff room, administrative premises, wall cabinets etc.). Outerwear personnel is stored in the wardrobe or in cabinets outside the production premises.

9.3. Change of sanitary clothing (gowns, work suits, caps) is carried out daily, regardless of the profile of the room; in case of contamination with blood - immediately. The number of sets must be at least 3 for each worker.

9.4. Washing of sanitary clothing is carried out centrally under contracts with laundries or in the laundry of the medical organization itself. Washing sanitary clothing at home is prohibited.

9.5. In the operating room, doctors and other persons involved in the operation must work in sterile gowns, gloves and masks. Replaceable shoes should be made of non-woven material.

9.6. In order to prevent the spread of parenteral infections, it is necessary to form epidemiological alertness of staff towards the patient as a potential source of blood-borne infections.

When carrying out medical procedures, personnel must strictly observe personal protective measures:

To work in medical gowns(suits), hats, glasses (shields), masks, replaceable shoes, gloves;

If there are microtraumas, scratches, or abrasions on the hands, cover the damaged areas with adhesive tape;

Follow the rules for hand hygiene (see sections 8.5.- 8.7).

9.7. While treating a patient, you must not take notes, touch the telephone receiver, etc. Eating food and using cosmetics is prohibited in the workplace.

9.8. If the skin is damaged (accidental puncture, cut, etc.), it is necessary to immediately treat the gloves with disinfectant solutions, remove them, wash your hands with soap, squeeze out blood from the damaged surface, treat the skin with 70 alcohol, then with iodine. If the patient's biological fluid gets on the mucous membrane of the oropharynx, immediately rinse your mouth and throat with 70% ethyl alcohol. If biological fluid gets into your eyes or nose, you must rinse them with water or a solution of potassium permanganate in a ratio of 1:10000.

9.9. If there is a high risk of contracting HIV infection (deep cut, visible blood on damaged skin and mucous membranes from patients infected with HIV), you should contact the territorial AIDS Control and Prevention Centers to prescribe chemoprophylaxis.

The first private dental offices and clinics appeared in Russia in the early 1990s, and today most Russians turn to them. Patients are attracted by the quality of medical services and the use of the latest treatment and diagnostic methods. Even in a small dental office located in a residential building, you can find a dental apparatus, which, by the way, is a source of X-ray radiation, which means that during its operation it is necessary to comply with radiation safety standards. Read the article about what requirements dental offices and clinics that conduct X-ray examinations must meet.

In accordance with clause 3.30 of SanPiN 2.6.1.1192-03 “Hygienic requirements for the design and operation of X-ray rooms, devices and the conduct of X-ray examinations” To install and operate X-ray dental equipment, the institution must collect the following documents:

Sanitary and epidemiological conclusion on the type of activity: operation, storage, testing, etc. of an X-ray machine (devices) in an X-ray room (rooms);

Sanitary and epidemiological certificate for the X-ray machine as a product that poses a potential danger to humans;

Sanitary and epidemiological report on the X-ray room project;

Technical passport for the X-ray room;

Instructions for labor protection, including requirements for radiation safety, for the prevention and elimination of radiation accidents;

Sanitary rules, other regulatory and instructional documents regulating radiation safety requirements.

X-ray machines are permitted for use in medical practice provided they are registered by the Russian Ministry of Health and have a sanitary-epidemiological report on their compliance with sanitary rules in the field of radiation safety. The data bank on registered X-ray devices is located in the Center for Standardization and Certification of the Russian Ministry of Health. Often, private clinics use exclusive copies of X-ray diagnostic equipment that are not included in the data bank of the Center for Standardization and Certification. Such equipment must undergo radiation-hygienic tests with the involvement of specialists from an organization accredited in the prescribed manner.

Today, X-ray machines that record images on film are being replaced by more modern systems in which data is recorded digitally. For example, when using a radiophysiograph - one of the types of digital dental radiographic systems - studies are carried out by introducing solid-state X-ray sensitive detectors into the oral cavity, which makes it possible to reduce the patient’s radiation dose by 2-4 times.

Requirements for the arrangement of the office and placement of the X-ray diagnostic apparatus

A dental apparatus that works with ordinary film without an intensifying screen is installed in a room of at least 8 m2 only in the X-ray department (room) of a general medical or dental treatment institution. To accommodate a device operating with a highly sensitive film and (or) digital image receiver, including a radiovisiograph, the area of ​​the room must be at least 6 m2. The radiovisiograph can also be installed in the premises of a dental institution located in a residential building, including in areas adjacent to residential premises. At the same time, radiation safety standards for the population within the premises in which X-ray dental examinations are carried out must be observed. The area of ​​the dental office equipped with a radiovisiograph must be at least 14 m2. According to clause 7.3.1 of SanPiN 2.1.3.2630-10, panoramic devices (orthopantomographs) cannot be placed in the dental office, as well as in the premises of the dental clinic adjacent to residential premises.

If the X-ray dental diagnostic room is located on the first or basement floors, then the windows of the treatment room are screened with protective shutters to a height of at least 2 m from the level of the building blind area. If the X-ray room is located above the first floor at a distance from the treatment room to residential and office premises neighboring building is less than 30 m, the windows of the treatment room are screened with protective shutters to a height of at least 2 m from the finished floor level.

The X-ray machine is placed in such a way that the radiation beam falls in the direction of the wall behind which there is a less visited room. If a dental clinic has several rooms, and an X-ray machine is installed in only one of them, then it must be stationary in order to exclude the possibility of its transfer to other rooms that do not have appropriate stationary or mobile radiation protection equipment.

The range of modern building materials and the capabilities of private dental clinics make it possible to choose for the manufacture of stationary radiation protection those materials that provide reliable protection. Lead equivalents of building materials used for protection against X-ray radiation are listed in Table. 3-6 appendices 9 SanPiN 2.6.1.1192-03. When using materials not listed in the tables, it is necessary to have data on their protective properties or determine protective characteristics in accredited organizations using control samples.

Stationary radiation protection facilities The x-ray room (walls, floor, ceiling, protective doors, observation windows, shutters, etc.) must ensure attenuation of x-ray radiation to a level at which the main dose limit (PD) for the relevant categories of exposed persons will not be exceeded. The calculation of radiation protection is based on determining the attenuation factor (K) of the absorbed dose rate ( D 0) X-ray radiation in the air at a given point in the absence of protection up to the value of the permissible absorbed dose rate (ADR) in the air:

K = D 0 / DMD = 10 3 × KR × W × N/ (30 × r 2 × DMD),

where 10 3 is the conversion factor from mGy to μGy;

KR- radiation output - the ratio of the power of the air kerma in the primary X-ray beam at a distance of 1 m from the focus of the tube, multiplied by the square of this distance, to the strength of the anode current, mGy × m 2 / (mA × min.);

W— workload of the X-ray machine (mA × min.)/week;

N— radiation directivity coefficient, relative unit;

30 - the value of the normal operating time of the X-ray machine per week during single-shift work of group A personnel (30-hour work week), h/week;

r— distance from the focus of the X-ray tube to the calculation point, m.

When equipping an X-ray diagnostic room in a room adjacent to residential, it is necessary to adhere to the requirements of radiation safety standards for the population within the X-ray dental office. Therefore, when calculating radiation protection in this case, the points located:

Close to the inner surfaces of the walls of the X-ray room, located horizontally adjacent to the living quarters;

At the floor level of the X-ray room - when the living space is located under the room;

At the ceiling level of the X-ray room - when the living space is located above the room.

It should be noted that the materials used today for the manufacture of protective fences and interfloor ceilings, in most cases, provide the necessary attenuation factor for X-ray radiation, so residents of apartments located adjacent to the X-ray room are not exposed to doses exceeding the dose limit for the population. Moreover, the calculation of radiation protection is carried out in such a way that the requirements of radiation safety standards for the population living in rooms adjacent to the rooms in which X-ray examinations are carried out are met with a significant margin. Often, part of the residential premises adjacent to the X-ray room of a private dental clinic is occupied by its owners, which for the population serves as a strong argument in favor of the reliability of radiation safety.

When planning to equip an X-ray room in a dental clinic located in a residential building, you need to make sure that it interfloor ceilings are not made of wood, which is not a barrier to x-rays. Wooden floors have been preserved in many old houses. In this case, it becomes necessary to create a special protective ceiling in the X-ray room.

Radiation protection of personnel and patients

The office where X-ray dental examinations are carried out must have a set mobile And individual funds protection of staff and patients. If the control panel and the treatment room are located in the same room, it is necessary to install large protective screen with viewing window. It is possible to move the X-ray machine control panel (anode voltage switch button) to a separate room (control room). In any case, it must be possible to monitor the patient through the viewing window. The office can also be equipped with a television camera. If the power button is located outside the office, it is necessary to exclude the possibility of access to it by random persons.

To protect personnel, the X-ray room must be equipped with an apron protective one-sided lung and collar protective. The patient is provided with a protective dental apron or cape (cape) protective and apron to protect gonads.

According to NRB-99/2009, persons working with man-made radiation sources are defined as Group A personnel. In our case, these are employees who work directly with dental devices. Persons working at a radiation facility or on the territory of its sanitary protection zone and located in the sphere of influence of man-made sources are defined as Group B personnel. This includes employees who do not work with an x-ray diagnostic apparatus, but are exposed to x-ray radiation. The main dose limits and permissible exposure levels for group B personnel are equal to 1/4 of the values ​​for group A personnel.

The effective dose for personnel should not exceed over a period of labor activity(50 years) 1000 mSv, and for the population over a lifetime - 70 mSv. Planned increased exposure (above established dose limits) is allowed only for men over 30 years of age with their voluntary written consent after being informed of the possible radiation doses and health risks. The main radiation dose limits for personnel of groups A, B and the population, established by NRB-99/2009, are given in the table.

The International System of Units (SI) measures absorbed dose in grays (Gy). 1 Gy is equal to the absorbed energy of 1 J per 1 kg of mass of the substance. To take into account the biological effect of the absorbed dose, an equivalent absorbed dose of ionizing radiation was introduced, equal to the product of the absorbed dose and the biological effectiveness coefficient. In the SI system, the effective and equivalent absorbed dose is measured in sieverts (Sv).

In order to prevent unnecessary re-exposure of patients at all stages of medical care, the results of previously conducted x-ray studies and the doses received during the year are taken into account. When referring a patient for an x-ray examination, consultation or hospital treatment, when he is transferred from one hospital to another, the results of X-ray studies (description, pictures) are transferred along with an individual card. The established standard for annual preventive radiation exposure during preventive medical X-ray examinations and scientific research for practically healthy individuals is 1 mSv. Radiation dose limits for patients for diagnostic purposes are not established.

Requirements for personnel working with X-ray dental equipment

Persons at least 18 years of age who have a document confirming appropriate training, who have been instructed and tested their knowledge of safety rules, documents and instructions in force in the institution are allowed to operate an X-ray machine. Training of specialists involved in X-ray examinations is carried out according to programs that include the section “Radiation Safety” in institutions licensed to educational activities. X-ray examinations are carried out radiologist And x-ray technician. For dental clinic best option when X-ray diagnostics are carried out by a radiologist with a higher education professional education in the specialty "Dentistry" and postgraduate professional education (internship and (or) residency) in the specialty "Radiology", as well as a radiographer who has received secondary vocational education in the specialty "Dentistry", "Preventive Dentistry", "Orthopedic Dentistry" and a specialist certificate in specialty "Radiology".

Before starting an X-ray dental examination, personnel must check the serviceability of equipment and reagents with mandatory recording of the results in a control and technical journal. If malfunctions are detected, it is necessary to stop work and call a representative of the organization performing maintenance and repair of equipment. After the end of the working day, the X-ray machine, electrical appliances, desk lamp, electric lighting, ventilation, wet cleaning of walls with washing of floors and thorough disinfection of elements and accessories of the X-ray machine are carried out. Wet cleaning is carried out monthly using a 1-2% solution acetic acid. It is not allowed to carry out wet cleaning procedure room and control room of the X-ray dental room immediately before and during the examination.

The administration of the dental clinic is responsible for organizing preliminary (upon employment) and annual periodic medical examinations of group A personnel. Persons who do not have medical contraindications for working with sources of ionizing radiation are allowed to work. If deviations in the state of health are identified that prevent the continuation of work in the X-ray room, the question of temporary or permanent translation these persons to work outside of contact with radiation in the prescribed manner is decided by the administration of the institution in each individual case individually.

NOTE!

Women are exempt from direct work with X-ray equipment for the entire period of pregnancy and breastfeeding child.

Radiation control

The person responsible for conducting radiation monitoring is appointed by the administration of the dental institution. The implementation of radiation monitoring is part of production control, the program of which is determined taking into account the characteristics and conditions of work performed in the X-ray and dental room, and is agreed upon with the state sanitary and epidemiological inspection body.

In accordance with clause 8.5 of SanPiN 2.6.1.1192-03 radiation monitoring includes:

Monitoring the radiation dose rate at personnel workplaces, in rooms and areas adjacent to the X-ray room. It is carried out during technical certification of the X-ray room, obtaining a sanitary and epidemiological report;

Monitoring the technical condition and protective effectiveness of mobile and personal radiation protection equipment. Conducted at least once every two years;

Individual radiation monitoring of group A personnel. It is carried out continuously with registration of measurement results once a quarter (in agreement with the state sanitary and epidemiological inspection body - once every six months);

Individual radiation monitoring of persons periodically participating in special X-ray examinations (surgeons, anesthesiologists, etc.) is carried out in the same way as for group A personnel; the assessment of radiation doses of a given contingent may be carried out using a calculation method;

Control of patient dose loads. It is carried out with every x-ray examination.

As part of the implementation of the production control program The administration of the institution determines:

List of employees for whom individual or group dosimetry monitoring is required;

The procedure for conducting group dosimetric monitoring, indicating the workplaces where dose rate measurements are required;

The procedure for conducting individual dosimetric monitoring, indicating the number of individual dosimeters and where they are worn on the employee’s body;

The procedure for monitoring the correct wearing of personal dosimeters and the use of personal protective equipment;

List of actions when exceeding control levels is detected.

According to the established practice of dosimetric monitoring in medical organizations, measurements and recording of results are usually carried out by third-party organizations - testing laboratory centers, radiation monitoring laboratories, etc., accredited in the prescribed manner.

For medical personnel who are not in close proximity to the radiation source or X-ray beam (control room, darkroom, adjacent rooms) who are subject to uniform irradiation, one individual dosimeter located on the surface of the body (for example, in the breast pocket of a robe) is enough to indications, using the appropriate transition coefficient, estimate the value of the effective dose. Medical personnel conducting special X-ray examinations under the control of X-ray radiation, by the nature of their work, must be close to the patient, that is, in close proximity to the radiation source or X-ray beam. The exposure of this category of personnel is uneven. According to data from phantom and full-scale measurements on the front surface of the body, such workers have a more than 10-fold excess dose, and the dose gradient in the body is much greater. The distribution of surface and depth doses also depends on additional shielding of the body with a protective apron. In this case, to correctly assess the standardized values, it is necessary to use two individual dosimeters on the surface of the worker’s body.

In accordance with clause 3.13.7 OSPORB-99/2010, in a medical organization that uses sources of ionizing radiation, a card is issued for each employee classified as group A personnel accounting of individual doses. It reflects the following information:

Information about the employee: last name, first name and patronymic, date of birth, gender, home address, telephone number;

Information about the employee’s professional activities: position, nature of work, length of service in radiation hazardous conditions;

Information about radiation doses:

• quarterly radiation doses;
• total annual radiation doses;
• total radiation dose at the time of filling out the card;

• radiation dose received during the period of secondment to other organizations;
• radiation dose received as a result of radiation accidents and planned increased exposure.

If an employee moves to another institution where work with radiation sources is carried out, a copy of the individual dose record card is transferred to the new place of work. The original is stored on same place work for 50 years.

A very common situation occurs when the construction of a clinic, including an X-ray room, begins before the clinic owner finds the right design specialist. Therefore, at a certain stage, many questions arise about what is possible and what is not. Of course, it is better to hire a competent specialist who will calculate radiation protection and develop a design for placing an X-ray machine as early as possible. But if for some reason you started without it, be sure to take into account the requirements that the X-ray room must meet.

All requirements for the premises in which X-ray examinations are carried out are specified in Sanitary regulations and standards, SanPiN 2.6.1.1192-03 “Hygienic requirements for the design and operation of X-ray rooms, devices and the conduct of X-ray examinations.”

Here we draw your attention to the main ones:

1. In dental clinics located in residential buildings, it is allowed to install digital X-ray machines and devices that work with a highly sensitive image receiver (without a darkroom). In this case, the room in which X-ray dental examinations are carried out must comply with the requirements of radiation safety standards.

2. The area of ​​the cabinet for placing a dental sighting device (digital) must be at least 6 sq. m, for an orthopantomograph (digital) - at least 8 sq. m, for two devices - at least 12 sq. m.

3. There should be no rooms with high humidity above the room in which X-ray examinations are carried out. If a residential apartment is located above, then there should be no toilets, showers or bathrooms above the X-ray room. There may be corridors, kitchens and living rooms.

4. The width of the doorway must be at least 0.9 m.

5. The door from the treatment room to the corridor should open towards the corridor.

6. The door from the control room (console) to the treatment room should open towards the treatment room.

7. When there is more than one X-ray diagnostic device in the room, a device is provided to block the simultaneous activation of two or more devices.

8. All open metal devices (in the clinic, most often these are heating radiators) must be insulated using protective screens.

9. The surfaces of the walls and ceiling in the X-ray room must be smooth, easy to clean and allow wet cleaning.

10. It is allowed to use ceramic tiles (ceramic granite) or antistatic linoleum as flooring material.

11. The treatment room must have a sink with hot and cold water supply.

12. The supply and exhaust ventilation system in the X-ray room must be autonomous. The exhaust should be carried out from two zones - upper and lower, in a ratio of 50%; inflow - in the upper zone. The air exchange rate per hour should be at least 3 for exhaust and 2 for inflow.

Please note that this information should in no way be considered as advice to do everything yourself, without resorting to the help of specialists.

X-ray rooms have been used for quite a long time to diagnose many diseases of the human body. The most common branches of medicine in which X-rays are used are surgery, traumatology, therapy, urology, gastroenterology, dentistry and many other fields cannot do without such an important device. X-ray rooms are opened not only in hospitals, so it is important to know what requirements must be met when placing individual X-ray rooms and whether there is a license for an X-ray room.

All requirements are contained in the specialized SNiP “Hygienic requirements for the design and operation of X-ray rooms, devices and the conduct of X-ray examinations.” We will look at them:

The X-ray room can be installed in both residential and non-residential buildings. When placing an office in a residential building, it must have a special finish that will serve to reduce the level of radiation or completely absorb it.

The minimum area of ​​the X-ray room must be at least 6 m2 if a dental sighting device will be used. If an orthopantomograph is installed, a room of more than 8 m2 is required. And if you plan to install several devices, then the area must be calculated taking into account 6 m2 for each device.

When placing the x-ray in multi-storey building One of the main conditions for its placement is the absence of rooms with increased humidity on the floors above. No toilets, bathrooms, etc.

The minimum doorway for entering the X-ray room must be more than 90 cm.

The door must open outward, that is, into the corridor.

There must be a resistor that does not allow all the X-ray equipment in the room to be turned on at the same time, if there are two or more devices.

Absolutely all metal objects in the office, including pipes and radiators, must be protected with protective screens.

The walls of the X-ray room cannot be covered with wallpaper; they must be covered with washable materials.

The floor is covered with tiles or linoleum.

The office must have a sink with cold as well as hot water.

The X-ray room must be equipped with an autonomous hood, which must operate independently of the ventilation of the entire building.

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