Air temperature in a hospital room. Microclimate of medical institutions. Hospital sanitary regime

table 2

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

2.1.1.1. Rules for measuring air temperature

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

Resolution of the Chief State Sanitary Doctor of the Russian Federation dated May 18, 2010 N 58
"On approval of SanPiN 2.1.3.2630-10 "Sanitary and epidemiological requirements for organizations engaged in medical activities"

With changes and additions from:

3. From the moment of entry into force of sanitary and epidemiological rules and regulations SanPiN 2.1.3.2630-10 “Sanitary and epidemiological requirements for organizations engaged in medical activities” SanPiN 2.1.3.1375-03 shall be considered invalid Hygienic requirements to the placement, arrangement, equipment and operation of hospitals, maternity hospitals and other medical hospitals", approved by the resolution of the Chief State Sanitary Doctor Russian Federation dated 06.06.2003 N 124 (registered with the Ministry of Justice of Russia on 06.18.2003, registration N 4709); SanPiN 2.1.3.2195-07, amendment No. 1 to SanPiN 2.1.3.1375-03, approved by Decree of the Chief State Sanitary Doctor of the Russian Federation dated April 25, 2007 No. 19 (registered with the Ministry of Justice of Russia on June 5, 2007, registration No. 9597); SP 3.1.2485-09 "Prevention of nosocomial infections in surgical hospitals (departments) medical organizations", Addendum No. 1 to SanPiN 2.1.3.1375-03, approved by Resolution of the Chief State Sanitary Doctor of the Russian Federation dated 02/13/2009 No. 9 (registered with the Ministry of Justice of Russia on March 20, 2009, registration No. 13548); SanPiN 2.1.3.2524-09 "Sanitary hygienic requirements for dental medical organizations", change No. 2 to SanPiN 2.1.3.1375-03, approved by Decree of the Chief State Sanitary Doctor of the Russian Federation dated July 7, 2009 No. 48 (registered with the Ministry of Justice of Russia on August 20, 2009, registration No. 14581); SanPiN 3.5.2528-09 "Organization of disinfection and sterilization measures in medical and preventive organizations", addendum No. 2 to SanPiN 2.1.3.1375-03, approved by Resolution of the Chief State Sanitary Doctor of the Russian Federation dated 08/06/2009 N 51 (registered with the Ministry of Justice of Russia on 08/26/2009, registration No. 14624); SanPiN 2.1.3.2576-10 amendment No. 3 to SanPiN 2.1.3.1375-03, approved by Resolution of the Chief State Sanitary Doctor of the Russian Federation dated 03/04/2010 No. 18 (registered with the Ministry of Justice of Russia on 04/27/2010, registration No. 17017).

Registration N 18094

Sanitary and epidemiological requirements for entrepreneurs and organizations engaged in medical activities have been determined (SanPiN 2.1.3.2630-10).

They replace SanPiN 2.1.3.1375-03 “Hygienic requirements for the placement, design, equipment and operation of hospitals, maternity hospitals and other medical hospitals” (including additions and changes).

It has been established where treatment and prevention organizations (HPOs) should be located. Thus, psychiatric and infectious diseases hospitals are located at a distance of at least 100 m from residential buildings (previously - at least 500 m). In residential buildings, medical facilities for providing assistance to persons with alcohol or drug addiction, microbiological laboratories, and magnetic resonance imaging departments cannot be located.

Requirements for buildings, structures and premises have been established, interior decoration, water supply and sewerage, heating, ventilation, lighting, inventory and equipment.

It is recommended to ventilate the rooms at least 4 times a day for 15 minutes. They should also have cabinets to store patients' belongings. Window glass need to be washed at least 2 times a year. Previously - at least once a month from the inside and once every 3 months from the outside (spring, summer, autumn).

For cleaning, it is allowed to hire professional cleaning companies working around the clock. The exception is class A premises.

The rules of personal hygiene, as well as the organization of nutrition for patients, have been determined.

It has been established how preventive, anti-epidemic, disinfection and sterilization measures are carried out. Requirements for working conditions of medical staff, etc. have been established.

Very great importance microclimatic conditions have a therapeutic factor, and in the winter and transitional periods of the year the temperature in the wards should be in the range of 18 - 21 ° C, and in the summer the upper limit of the comfort zone should not exceed 24 ° C. To do this, the heating devices located there must have devices for their regulation. In particular, have already been developed special devices to conventional radiators that automatically maintain the set air temperature.

To prevent overheating in the hot summer months, the only radical remedy is to install air conditioners, which should first of all be installed in wards for patients suffering from severe disorders of the cardiovascular system.

As a palliative measure, it is advisable to use the correct orientation of windows according to the cardinal directions, painting the external walls in White color, vertical gardening, installation of shutters, blinds and curtains, application special types heat-retaining glass, increasing air speed using room fans, etc.

Considering the beneficial biological and psychophysiological effects solar radiation, it is necessary to ensure sufficient insolation of the ward premises, and their best orientation is considered to be southern. It has been established that even weakened ultraviolet irradiation, penetrating through ordinary glass, can have a detrimental effect on pathogenic flora. At the same time, the rays of the sun penetrating into the ward lift the mood of the patients to some extent and improve their well-being.

Finally, proper orientation of windows is one of the prerequisites for sufficiency natural light, the indicators of which for ward premises are equal to light coefficient 1:5 - 1:6 and EEC no less than 1.0.

The sections for drip and intestinal infections have specific features, where boxes, half-boxes and boxed wards should be equipped. Of these, the first ones have an external entrance with a vestibule, a bath, a toilet, a room with 1 bed, a locker for staff and a transfer locker for transferring dishes and food. Semi-boxes usually consist of two compartments, united by a common bath and shower room.

As for boxed chambers, they only have glass partitions between the beds, which to a certain extent protect against infection.

“Hygiene”, V.A. Pokrovsky

See also:

Indoor microclimate medical institutions is determined by a combination of temperature, humidity, air mobility, the temperature of surrounding surfaces and their thermal radiation. Microclimate parameters determine the heat exchange of the human body and have a significant impact on the functional state of various body systems, well-being, performance and health.
High temperatures have a negative impact on human health. Working in conditions high temperature accompanied by intense sweating, which leads to dehydration of the body, loss of mineral salts, causes persistent changes in the activity of the cardiovascular system, weakened attention, slow reactions, etc.
When exposed to the human body negative temperatures There is a narrowing of the blood vessels in the fingers and toes, and the metabolism changes. Prolonged exposure to these temperatures leads to persistent diseases of internal organs.
Microclimate parameters depend on heat physical features technological processes, climate, season of the year, heating and ventilation conditions in healthcare institutions.
The fight against the unfavorable influence of the industrial microclimate is carried out using technological, sanitary and technical and medical and preventive measures.
Technological measures include: replacement of old and introduction of new technological processes and equipment, automation and mechanization of processes, remote control.
Sanitary and technical measures are aimed at localizing heat emissions and thermal insulation, i.e. sealing equipment, installing ventilation systems, using protective equipment, etc.
Medical and preventive measures include: organizing a rational work and rest regime, undergoing medical examinations, etc.
Requirements for heating, ventilation, microclimate and air environment of premises are established by Sanitary and Epidemiological Rules and Standards SanPiN 2.1.3.1375-03 “Hygienic requirements for the placement, design, equipment and operation of hospitals, maternity hospitals and other medical hospitals.”
Heating, ventilation and air conditioning systems must provide optimal conditions microclimate and air environment premises of medical institutions.
Parameters of the design temperature, air exchange rate, categories for cleanliness of the premises of medical institutions, incl. in day hospitals, are given in Appendix No. 5 to SanPiN 2.1.3.1375-03.
Heating devices must have smooth surface allowing easy cleaning, they should be placed near external walls, under windows, without fences. It is not allowed to place heating devices in rooms near interior walls.
In operating rooms, preoperative, intensive care rooms, anesthesia, labor and delivery rooms, electric lighting and premises of psychiatric departments, as well as in intensive care wards and postoperative wards, heating devices with a smooth surface, resistant to daily exposure to cleaning and disinfecting solutions, eliminating adsorption should be used as heating devices dust and accumulation of microorganisms.

When installing fences heating devices in administrative and utility rooms, in children's hospitals, material is used that is approved for use in in the prescribed manner. At the same time, free access must be provided for routine operation and cleaning of heating devices.
Water with a maximum temperature of heating devices 85° C. The use of other liquids and solutions (antifreeze, etc.) as a coolant in heating systems of medical institutions is not allowed.
The buildings of medical institutions must be equipped with systems supply- exhaust ventilation with mechanical urge and natural exhaust without mechanical urge.
In infectious diseases departments, including tuberculosis departments, mechanical exhaust ventilation is arranged through individual channels in each box and half-box, which must be equipped with air disinfection devices.
In the absence of mechanically driven supply and exhaust ventilation in infectious diseases departments, natural ventilation must be equipped with the mandatory equipping of each box and half-box with a recirculation-type air disinfection device, ensuring an efficiency of inactivation of microorganisms and viruses of at least 95%.
Design and operation ventilation systems should prevent the flow of air masses from “dirty” areas to “clean” rooms.
The premises of medical institutions, except for operating rooms, in addition to supply and exhaust ventilation with mechanical impulse, are equipped natural ventilation(window windows, folding transoms, etc.), equipped with a fixation system.
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 by air supply units, must be cleaned with coarse and fine structure filters in accordance with the 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 patients with skin burns, AIDS patients and other similar medical premises must be treated with air disinfection devices that ensure the effectiveness of inactivation of microorganisms and viruses located in the treated air at least 95% (filters high efficiency H11-H14).
Operating rooms, intensive care wards, resuscitation rooms, labor and delivery rooms, treatment rooms and other rooms in which the release into the air is accompanied by harmful substances, must be equipped with local suction or fume hoods.
Content medicines in the air of operating rooms, maternity wards, intensive care wards, resuscitation rooms, treatment rooms, dressing rooms and other similar rooms of medical institutions should not exceed the maximum permissible concentrations given in Appendix No. 6 to SanPiN 2.1.3.1375-03.
Levels of bacterial contamination of the indoor air, depending on their functional purpose and cleanliness class, should not exceed the permissible limits given in Appendix No. 7 to SanPiN 2.1.3.1375-03.
Air conditioning should be provided in operating rooms, anesthesia, delivery, postoperative wards, intensive care wards, oncohematological patients, patients with AIDS, patients with skin burns, intensive care units, as well as in wards for newborns, infants, premature babies, injured children and other similar medical premises. In wards that are fully equipped with incubators, air conditioning is not provided.
Air ducts of supply ventilation (air conditioning) systems after high efficiency filters (H11-H14) are made of stainless steel.
The use of split systems is allowed in the presence of high efficiency filters (H11-H14) only if the rules of routine maintenance are observed. Split systems installed in an institution must have a positive sanitary and epidemiological certificate issued in the prescribed manner.
The air exchange rate is selected based on calculations to ensure a given purity and maintain the gas composition of the air. Relative humidity air should be no more than 60%, air movement speed should be no more than 0.15 m/sec.
Air ducts, air distribution and air intake grilles, ventilation chambers, ventilation units and other devices must be kept clean and must not have mechanical damage, traces of corrosion, leakage.
Fans and electric motors should not create extraneous noise.
At least once a month, the degree of contamination of filters and the efficiency of air disinfection devices should be monitored. Filters should be replaced as they become dirty, but no less frequently than recommended by the manufacturer.
General supply and exhaust and local exhaust units should be turned on 5 minutes before the start of work and turned off 5 minutes after the end of work.
In operating rooms and preoperative rooms, supply ventilation systems are first turned on, then exhaust, or simultaneously supply and exhaust.
In all rooms, air is supplied to the upper zone of the room. Air is supplied to sterile rooms using laminar or slightly turbulent jets (air speed< = 0,15 м/сек).
Air supply and exhaust ventilation (air conditioning) ducts must have inner surface, excluding the removal of particles of air duct material or protective coating into the premises. The inner coating must be non-absorbent.
To accommodate the equipment of ventilation systems, special rooms should be allocated, separate for supply and exhaust systems and not vertically or horizontally adjacent to doctors’ offices, operating rooms, wards and other premises where people permanently reside.
In rooms for exhaust systems, exhaust ventilation should be provided with a single air exchange every 1 hour, for supply systems- supply ventilation with double air exchange.
Ventilation equipment rooms should be used only for their intended purpose.
In rooms subject to aseptic conditions, hidden installation of air ducts, pipelines, and fittings is provided. In other rooms it is possible to place air ducts in closed boxes.
Natural exhaust ventilation is allowed for detached buildings with a height of no more than 3 floors (in emergency departments, ward buildings, hydrotherapy departments, infectious diseases buildings and departments). Wherein forced ventilation is provided with mechanical drive and air supply into the corridor.
Exhaust ventilation with mechanical drive without an organized inflow device is provided from the following premises: autoclaves, sinks, showers, latrines, sanitary rooms, rooms for dirty linen, temporary storage of waste and storage rooms for disinfectants.
Air exchange in wards and departments should be organized in such a way as to limit as much as possible the flow of air between ward departments, between wards, and between adjacent floors.
Quantity supply air per room should be 80 m 3 /hour per 1 patient.
To create an isolated air regime in the rooms, they should be designed with an airlock connected to the bathroom, with a predominance of exhaust in the latter.
At the entrance to the department there must be a gateway equipped with an exhaust ventilation device with an independent channel (from each gateway).
To eliminate the possibility of contaminated air entering from the staircase and elevator halls into the ward departments, it is advisable to construct a transition zone between them with provision of air pressure in it.
Architectural and planning solutions and hospital air exchange systems must prevent the transfer of infections from ward departments and other premises to the operating unit and other premises that require special air purity.
To exclude the possibility of air masses entering from the ward departments, staircase-elevator halls and other rooms into the operating unit, it is necessary to install a pressurized airlock between these rooms and the operating unit.
Movement air flow should be provided from the operating rooms to the adjacent rooms (preoperative, anesthesia, etc.), and from these rooms to the corridor. Exhaust ventilation is required in corridors.
The amount of air removed from the lower zone of the operating rooms should be 60%, from the upper zone - 40%. Fresh air is supplied through the upper zone, and the inflow should prevail over the exhaust.
It is necessary to provide separate (isolated) ventilation and air conditioning systems for clean and purulent operating rooms, maternity units, intensive care, oncohematology, burn departments, dressing rooms, separate ward sections, X-ray and other special rooms.
Preventive inspection and repair of ventilation and air conditioning systems must be carried out according to the approved schedule, at least 2 times a year. Elimination of current malfunctions and defects must be carried out immediately.
The administration of the medical institution organizes control over microclimate parameters and air pollution by chemicals, the operation of ventilation systems and the frequency of air exchange in the following premises:
- in the main functional rooms operating rooms, postoperative, maternity, intensive care wards, oncohematology, burn departments, medical and technical departments, rooms for storing potent and toxic substances, pharmaceutical warehouses, premises for the preparation of medicines, laboratories, the department of therapeutic dentistry, special rooms of radiology departments and other premises, in offices, using chemical and other substances and compounds that can have harmful effects for human health - once every 3 months;
- infectious, incl. tuberculosis hospitals (departments), bacteriological, virus laboratories, X-ray rooms - once every 6 months; - in other premises - once every 12 months.
To disinfect the air and surfaces of premises in medical institutions, ultraviolet bactericidal radiation must be used using bactericidal irradiators approved for use in the prescribed manner.
Methods for using ultraviolet bactericidal radiation, operating rules and safety of bactericidal installations (irradiators) must comply with hygienic requirements and instructions for the use of ultraviolet rays.
The microclimate is assessed based on measurements of its parameters (temperature, air humidity, air speed, thermal radiation) at all places where the employee stays during the shift.

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

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

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

Hospitals typically have central heating. At furnace system chambers service staff is obliged to ensure constant monitoring of the correct firing of the stoves and the maintenance of a uniform temperature throughout the day.

The furnishings of the room, in addition to the beds, consist of bedside tables, stools and a linen closet.

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

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

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

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

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

On bedside tables Place only a carafe of water and a glass (the glass should be covered with a clean napkin or turned upside down).

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

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

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

Rice. 1. Change the sheets.

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