Temperature regime. Hospital: organization of work and mode Monitoring the air temperature in the ward

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, warmed, and then distributed throughout the room. Thus, in winter, jets of cold air reach patients already warmed.

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

Hospitals usually 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.

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

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

Temperature changes should not exceed:

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

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

During the day with central heating - 3°C

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

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

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

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

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

a) no odor;

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

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

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

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

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

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

Heating - central water and radiant.

In large hospitals there is supply and exhaust mechanical ventilation.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Prevention of hypothermia:

Installation of heating elements near the window to prevent drafts

·Use of radiant heating method

Moderate air humidity

· Use of warm bed linen, bed rest

Preventing overheating:

Ventilation of premises

· Use of air conditioners

· Walks in the open air

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I. Harmfulness associated with the organization of the labor process

1. Significant neuro-emotional and mental stress

2. Static tension of large muscle groups

3. Prolonged forced position of the body

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

5. Night work

6. Frequent violation of the work and rest schedule

II. Related to violation of sanitary and hygienic conditions

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

2. Unfavorable microclimate

3. Influence chemical substances- analgesics, anesthetics, disinfectants

4. Action of biological agents ( infectious diseases)

5. Disadvantages of layout

6. Defects in lighting, ventilation, heating

7. Hygienic requirements for microclimate

hospital premises. Methods of integrated

assessing the influence of microclimate on the body.

Microclimate of hospital premises.

Temperature.

Temperature changes should not exceed:

• In the direction from the inner to the outer wall - 2°C
• In the vertical direction - 2.5°C per meter of height
• During the day with central heating - 3°C

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

Methods for comprehensive assessment of the influence of microclimate on the body.

A separate consideration of microclimate factors does not allow an objective assessment of the influence of the microclimate on the body, since all factors are interconnected and can weaken or strengthen each other (temperature and air speed, temperature and humidity, etc.).

There are methods for a comprehensive assessment of the microclimate and its effect on the body:

1) Evaluation cooling capacity of air. The cooling capacity is determined using a catathermometer and is measured in μcal/cm"s. The norm (thermal comfort) for a sedentary lifestyle is 5.5-7 μcal/cm 2 s. For an active lifestyle - 7.5-8 μcal/cm 2 s. For large premises, where heat transfer is higher and the cooling capacity is approximately 4-5.5 µcal/cm s.

2) Determination of EET (equivalent effective temperature), radiation temperature and RT (resultant temperature).

1. Equivalent effective temperature (EET) determined from the table taking into account air speed and relative humidity.

1. Average radiation temperature characterizes the thermal effect of solar radiation. It is determined using a ball thermometer. The average radiation temperature can be used as an independent indicator characterizing thermal radiation, and can be used to determine the resulting temperature.
2. 3. Resultant temperature (RT) allows you to determine the total thermal effect on a person of temperature, humidity, air speed and radiation. RT is determined using nomograms after the values ​​of all four of the above microclimate factors (humidity, air speed, air temperature, radiation temperature) have been determined. There are nomograms for determining RT during light and heavy physical labor. Comfortable RT at rest is 19°C, for light physical work - 16-17°C

3) Objective methods:

1 ..Detection of skin temperature

1. Study of sweating intensity
2. Pulse rate study, blood pressure etc.
3. Cold test - study of the body's adaptation to cold. The principle is that the temperature is measured on a selected area of ​​the skin with an electric thermometer, then ice is applied for 30 seconds, after which the skin temperature is measured every 1-2 minutes for 20-25 minutes. After this, adaptation to cold is assessed:

• Normal - temperature returns to original level after 5 minutes
• Satisfactory adaptation - after 10 minutes
• Negative result - 15 minutes or more.

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 the sanitary and epidemiological rules and regulations SanPiN 2.1.3.2630-10 “Sanitary and epidemiological requirements for organizations engaged in medical activities” are put into effect, SanPiN 2.1.3.1375-03 “Hygienic requirements for placement, arrangement, equipment and operation of hospitals, maternity hospitals and other medical hospitals", approved by Decree of the Chief State Sanitary Doctor of the 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 should 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.