Requirements for a dental x-ray office. Requirements for the placement, organization of work and equipment of the X-ray room. Requirements for premises for placing X-ray machines

03.02.2018

Basic requirements for the premises of the X-ray room and for placement in it x-ray equipment

The placement of the X-ray room and equipment in it is carried out on the basis of a project completed by an organization that has a license to operate in the placement of ionizing radiation sources (generating) and the design of radiation protection equipment.

An X-ray room, unlike other rooms in medical institutions, is not one room, but several rooms (rooms isolated from each other), each of which has its own purpose and in area meets the established regulatory requirements, and also meets all other sanitary and hygienic requirements. We will dwell on the latter in detail.

Composition and area of ​​the X-ray room/rooms of the X-ray room

The X-ray room includes at least 3 isolated rooms, one of which serves as a treatment room (the room in which work is directly carried out using sources of ionizing radiation), the second is a control room (the room in which the equipment that controls the radiation source is located) and the third is an office doctor Depending on the purpose of the X-ray equipment or the specifics of the medical institution, the X-ray room may include a darkroom, a waiting room, a undressing cabin, a staff room, etc. ( detailed information the types of X-ray rooms are described in the article “Project of an X-ray room”).

Appendix 5 to SanPiN 2.6.1.1192-03 establishes the composition and area of ​​X-ray rooms. Thus, based on the information in Appendix 5 to SanPiN 2.6.1.1192-03, we present below in Table 1 the area of ​​the treatment room with different X-ray machines, in Table 2 the composition and area of ​​the rooms of the X-ray diagnostic room, in Table 3 - the composition and area of ​​the rooms of the X-ray therapy room.

Table 1

Treatment room area with different x-ray machines

table 2

Composition and area of ​​the premises of the X-ray diagnostic room

* Not necessary.
** Not needed when using devices for digital radiography and fluorography.

Table 3

Composition and area of ​​premises of the X-ray therapy room

The use of premises of a smaller area or a reduced set of premises is possible in cases where the equipment used, the organization of work, the number of personnel, etc. ensure compliance with general hygienic requirements (microclimate, bacterial contamination, sanitary and epidemiological regime, etc.).

X-ray room in the building: basic requirements

According to the hygienic requirements of SanPiN 2.6.1.1192-03, it is advisable to place x-ray rooms centrally, as part of the x-ray department, at the junction of the hospital and the clinic. X-ray rooms of infectious diseases, tuberculosis and obstetric departments of hospitals and, if necessary, fluorography rooms of emergency departments and outpatient departments can be located separately.

As a general rule, the X-ray department (office) is not allowed to be located in residential buildings and children's institutions. The exception is X-ray dental rooms (devices), the possibility of placing which in residential buildings is regulated by a special chapter of rules SanPiN 2.6.1.1192-03, as well as the “Basic sanitary rules for ensuring radiation safety (OSPORB-99/2010” SP 2.6.1.2612-10 and Amendment 1 to SP 2.6.1.2612-10. Placement of dental equipment in residential buildings is not allowed. X-ray machines with a film image receiver.

In dental and X-ray rooms adjacent to residential apartments, it is allowed to place X-ray diagnostic devices with digital image processing, the total rated workload of which does not exceed 40 mA-min/week. (detailed information on this issue is described in the article “Placement of X-ray equipment in a dental clinic”).

It is allowed to operate X-ray rooms in clinics built into residential buildings if the vertically and horizontally adjacent rooms are not residential. It is also allowed to place X-ray rooms in an extension to a residential building, as well as in ground floors, if the entrance to the X-ray department (office) is separate from the entrance to the residential building.

As stated in clause 3.3 of SanPiN 2.6.1.1192-03, an X-ray department serving only a hospital or only a clinic should be located in the end parts of the building. In this case, the department should not be a walk-through. Entrances to the X-ray department for inpatient and outpatient department patients are separate.

Important: by virtue of clause 3.4 of SanPiN 2.6.1.1192-03, it is not allowed:

• Place X-ray rooms under rooms where water can leak through the ceiling (swimming pools, showers, restrooms, etc.);
• Place the X-ray treatment room adjacent to the wards for pregnant women and children.

Room for x-ray equipment

According to clause 2 of Appendix 7 to SanPiN 2.6.1.1192-03, the selection of premises included in the X-ray room (department) is carried out by the administration of the medical institution together with the X-ray and radiological department (RRO) (or another organization similar in function to the RRO) of the region and is consistent with institution of sanitary and epidemiological surveillance. In this case, in relation to individual rooms of the X-ray room, the medical organization must comply with the special requirements established by SanPiN 2.6.1.1192-03. However, in practice, such coordination of the selected premises with Rospotrebnadzor no longer exists and applications for approval of the placement of the X-ray room are no longer submitted.

X-ray room

A treatment room is a specially equipped room in an x-ray room in which an x-ray emitter is located and x-ray examinations or x-ray therapy are carried out.

According to clause 3.11 of SanPiN 2.6.1.1192-03, the height of the X-ray treatment room must ensure the functioning of technical equipment, for example, ceiling mounting of an X-ray emitter, tripod, television monitor, shadowless lamp, etc. X-ray equipment with a ceiling suspension of the emitter, screen-imaging device or X-ray image intensifier requires a room height of at least 3 m (2.6 meters according to newer SanPiN 2.1.3.2630-10). The height of the X-ray treatment room in the case of rotational irradiation must be at least 3 m. The width of the doorway in the X-ray diagnostic room, RCT room and cath lab must be at least 1.2 m with a height of 2.0 m, the size of the rest doorways- 0.9 x 1.8 m.

Requirements for the treatment room area, including depending on the X-ray machine, are given in Tables 1, 2 and 3 above. At the same time, as stated in clause 3.9, the area of ​​the procedural room can be adjusted in agreement with the body exercising federal sanitary and epidemiological supervision, taking into account the following requirements:

• The distance from the personnel workplace behind a small protective screen to the walls of the room is at least 1.5 m;
• The distance from the personnel workplace behind a large protective screen to the walls of the room is at least 0.6 m;
• The distance from the rotating tripod table or from the imaging table to the walls of the room is at least 1.0 m;
• The distance from the photo stand to the nearest wall is at least 0.1 m;
• The distance from the X-ray tube to the viewing window is at least 2 m (for mammography and dental devices - at least 1 m);
• The technological passage for personnel between elements of stationary equipment is at least 0.8 m;
• The area where the gurney is placed for the patient is at least 1.5 x 2 m;
• Additional area in case of technological need to bring a gurney into the treatment room - 6 m 2.

In accordance with clause 3.30 of SanPiN 2.6.1.1192-03, in the treatment room, in addition to the procedure room for fluorography and the X-ray operating room, it is provided for the installation of a sink with a supply of cold and hot water. In a procedural room designed for urological studies, a viduar should be installed.

In the treatment room for the study of children, the presence of toys (washed in a soap and soda solution and disinfected) and distracting design is allowed.

Important: It is not allowed to place equipment in the treatment room that is not included in the project, as well as to carry out work that is not related to x-ray examinations.

X-ray machine placement

The X-ray machine is placed in the treatment room in such a way that the primary beam of radiation is directed towards the main wall, behind which there is a less-visited room. The direct beam of radiation should not be directed towards the viewing window (control room of the protective screen). When the office is located on the first or ground floor, 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's blind area. When the X-ray room is located above the first floor at a distance of less than 30 m from the treatment room to the residential and office premises of the neighboring building, the windows of the treatment room are screened with protective shutters to a height of at least 2 m from the finished floor level.

Information about controlling the X-ray machine is presented in the article “X-ray room project”.

Photo lab

In accordance with clause 3.23 of SanPiN 2.6.1.1192-03, a photo laboratory can consist of one room - a “dark room”. When equipping a laboratory with a developing machine, an additional “light” room should be provided for sorting, marking and trimming dry photographs.

The minimum area of ​​a darkroom (“dark room”) for small-format photographs is 6 m2, for large-format photographs - 8 m2. The minimum width of the passage for personnel between elements of equipment in a dark room is 1.0 m. The width of the doorway is 0.9 - 1.0 m.

The walls of the darkroom are finished with light-colored tiles, primarily at the sink and photo processing device (tiled apron). It is allowed to finish with tiles to a height of 2 m with the overlying finishing materials allowing for repeated wet sanitization.

The door from the darkroom, as well as the treatment room and control room to the corridor, should, for reasons fire safety open “to the exit” (during the evacuation), and from the control room to the treatment room - towards the treatment room.

The window, transfer hatch and entrance door of the darkroom are protected with light-proof curtains to prevent exposure of photographic materials.

However, it is worth noting that a darkroom is necessary when using film X-ray machines, which have actually already been replaced by modern digital technology.

Other requirements for X-ray room premises

SanPiN 2.6.1.1192-03 contains a number special rules in relation to the X-ray room premises. Thus, the floor of the treatment room, control room, except for the X-ray operating room and darkroom, is made of natural or artificial electrical insulating materials. The use of artificial coverings and floor structures is possible if they have a certificate on their electrical safety. In the X-ray operating room, preoperative room, and darkroom, the floors are covered with waterproof materials that are easy to clean and allow frequent washing and disinfection. The floor of the cath lab must be antistatic and spark-free. When making a floor from antistatic linoleum, it is necessary to ground the base of the linoleum.

The surfaces of the walls and ceilings in the treatment room and control room should be smooth, easy to clean and allow wet cleaning. Finishing materials must have a sanitary and epidemiological certificate allowing their use in residential and public buildings.

The walls in the X-ray operating room are finished with materials that do not produce light reflections, for example, matte tiles.

The orientation of the windows of the X-ray room for fluoroscopy and the control room is preferable to the north-west directions.

The treatment room window for fluoroscopy, if necessary, is equipped with light-protective devices to darken it from natural light (direct sunlight).

An important requirement to comply with is the requirement to place a light sign (signal) “Do not enter!” white-red color, automatically lighting up when the anode voltage is turned on, at the entrance to the procedure room of the X-ray diagnostics, fluorography room and to the control room of the X-ray therapy room at a height of 1.6 - 1.8 m from the floor or above the door. In this case, it is allowed to apply a sign to the light signal radiation hazard.

The regulated air exchange rate, calculated values ​​of illumination and temperature in the premises of the X-ray department (room) are given in Appendix 6 to SanPiN 2.6.1.1192-03. The inflow should be carried out into the upper zone, the exhaust - from the lower and upper zones in a ratio of 50 +/- 10%.

Ventilation of X-ray rooms in newly constructed buildings general purpose must be autonomous. In existing departments, it is allowed to have a non-autonomous general exchange supply system exhaust ventilation, with the exception of computed tomography departments and x-ray departments of infectious diseases hospitals. It is allowed to equip X-ray rooms (departments) with air conditioners.

Start and end of work in the X-ray room

In accordance with clause 3.32 of SanPiN 2.6.1.1192-03, before starting work, personnel check the serviceability of equipment and reagents with mandatory registration of the results in a technical control log. If malfunctions are detected, it is necessary to suspend work and call a representative of the organization carrying out Maintenance and equipment repair.

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. Wet cleaning of the treatment room and control room of the X-ray room is not allowed immediately before and during X-ray examinations.

Necessary formalities

According to the general rule, enshrined in clause 3.31 of SanPiN 2.6.1.1192-03, an institution that has an X-ray room or an X-ray machine must have the following documentation related to the premises of the X-ray room and the placement of X-ray equipment in it:

• Sanitary and epidemiological conclusion on the type of activity (operation, storage, etc.) (see also “Sanitary and epidemiological conclusion on types of activity”);
• technical passport for the X-ray room (more details in the article “Technical passport for the X-ray room”);
• Design documentation for the placement of X-ray equipment;
• The act of putting the X-ray machine into operation, signed by representatives of the organization carrying out commissioning work, and medical organization(for newly supplied devices) and an act for hidden work.

The work of a modern hospital cannot be imagined without a specially equipped X-ray room. The X-ray room can be one of the following types:

• diagnostic x-ray room – fluorographic, mammographic,
• dental, computed tomography room, radiographic;
• therapeutic x-ray room;
• operating x-ray room;
• stationary, portable and portable x-ray machines.

In the article we will consider the basic requirements for X-ray rooms as sources of increased danger in accordance with the requirements of the current SanPiN.

The dangers of X-ray machines

X-ray machines are sources of increased danger because they project ionizing radiation, which is generated when the high voltage is turned on. In this regard, owners of X-ray machines must exercise special caution and caution when using them. All X-ray rooms belong to radiation hazard class 4, so they are subject to special requirements in order to protect patients, medical staff and the environment from ionizing radiation.

Licensing of activities

One of the conditions for compliance with radiation safety is the licensing of activities related to the operation of sources of ionizing radiation. In a general sense, licensing is the process of obtaining special permission to carry out a certain activity from a regulatory authority.

It is obtaining a license when organizing an X-ray room that is the main requirement for admission to activity. This is due to the fact that the operation of an X-ray room in a medical institution should bring maximum benefit from the procedure, but at the same time guarantee radiation safety to the patient and medical staff. This is guaranteed by obtaining the appropriate license.

Algorithm for organizing the work of the X-ray room

In order to make the procedure for organizing the work of the office clear, let’s imagine this process in the form of several stages:

• choosing an X-ray machine that is suitable for work in a medical institution;
• development and implementation of a project for the future office;
• obtaining a sanitary and epidemiological certificate for carrying out activities;
• obtaining a license for activities with sources of ionizing radiation;

Let's consider these stages in detail.

Choosing an X-ray machine
First of all, the management of a medical institution must determine the tasks that are of primary importance to the radiology department of the hospital, determine the composition of the studies performed and the purpose of the device. Based on this, the technical characteristics of the future device are determined, as well as the possibility of its placement in the hospital. There are a number of general requirements that apply to X-ray machines for medical use. In particular, they must have:

• registration certificate from the Ministry of Health of the Russian Federation;
• sanitary and epidemiological conclusion that the device complies with SanPiN 2.6.1.1192-03 (X-ray rooms), as well as radiation safety requirements;
• certificate of compliance with regulatory and technical documents.

Let us note that the sanitary-epidemiological report must contain an indication of whether the device must be equipped with a means for changing the individual radiation dose during research. This requirement is contained in SapPiN 2.1.6.1192-03.

In addition, the use of fluoroscopy machines is not permitted unless the machine is equipped with an X-ray image intensifier.

After the required model of the device has been selected, its documentation has been studied, it is necessary to coordinate its purchase with the authorized organization - the territorial governing body of the State Sanitary and Epidemiological Supervision.

Coordination will subsequently help you correctly draw up medical and technical specifications for the installation and design of an X-ray room and avoid problems when coordinating many other details: choosing a room, approving a project, etc.

After purchasing an X-ray machine, the medical institution must ensure its safety, as well as monitor compliance with the conditions for its receipt, use, storage, and write-off. The conditions must be such that the possibility of damage, loss and uncontrolled use of devices is completely excluded.

If the X-ray machine is not yet in use, it must be stored in a specially equipped room (storage) in which their safety will be ensured and access by third parties will be excluded.

Development of an X-ray room project
The project must be developed in the following cases:

• during the construction of a new hospital, department, etc.;
• when organizing a new X-ray room in a hospital;
• during major repairs, refurbishment or redevelopment of an existing office;
• when changing examination technology and replacing equipment.

If a new hospital or department is being built, the design of the X-ray room is developed as part of the overall project of the hospital according to the medical and technical specifications. Institutions that have a license giving the right to design sources of ionizing radiation may be allowed to create a project. The administration of the medical institution issues a medical project to a specialized organization. terms of reference, on the basis of which the cabinet design is developed. The assignment from the medical institution must contain the following information:

• for which object it is necessary to draw up a project;
• what area is allocated for the project;
• what equipment is planned to be placed in the X-ray room;
• what technological procedures will be used in the work of the office.

Requirements for the placement of an X-ray room
When drawing up technical specifications, it is necessary to take into account the requirements for the placement of the office, the area of ​​the premises, etc.

The premises for the X-ray room are selected by the hospital management in agreement with the authorized organization (State Sanitary and Epidemiological Supervision).
X-ray rooms cannot be placed in children's institutions and residential buildings, but the operation of the office is permissible in clinics that are built into residential buildings. In this case, the premises adjacent to the office should not be residential or located on the ground floor or in an extension to a residential building.
In this case, the entrance to the X-ray room must be separate.
Let us note that SanPiN 2.6.1.1192-03 and SNiP 31-01-2003 contain contradictory norms: the first document says that X-ray and dental rooms can be placed in residential buildings, and the second document says that any X-ray rooms.
Please note that the requirements for X-ray rooms contained in these documents must, in any case, be carefully studied before drawing up the project.
Therefore, we believe that the decision on the location of an x-ray and dental office should be made by the controlling organization. Cabinets should not be placed under rooms with high levels of humidity, which include swimming pools, bathrooms, toilet rooms, bathhouses.
X-ray treatment rooms should not be adjacent to wards for pregnant women and newborns.

Office area and set of premises
All requirements for X-ray rooms in terms of their area and set of premises are set out in Appendix No. 5 to SanPiN No. 2.6.1.1192-03.

In addition, when drawing up a project for operating X-ray rooms, it is also necessary to take into account the requirements of SanPiN No. 2.1.3.2630-10, SNiP 06/31/2009. The following requirements are imposed on the X-ray room:

• the distance from the walls of the room to the medical staff’s workplace behind a small screen should be at least 1.5 meters;
• at least 0.6 meters should be the distance from the walls of the room to the medical staff’s workplace behind a large screen;
• The distance from the walls of the room to the image table or tripod table must be at least 1 meter;
• The distance from the nearest wall to the photo stand must be at least 10 centimeters;
• The distance from the viewing window to the X-ray tube must be at least 2 meters;
• the distance from the equipment elements to the technological passage for the medic must be at least 80 centimeters;
• gurneys must be placed in an area of ​​at least 1.5-2 meters;
• the additional area required to bring the gurney into the treatment room must be at least 6 square meters. m.

The design proposals of the equipment manufacturer, which are contained in the technical documentation for the devices, should be taken into account, but they do not replace the development of your own design.

• prevention of possible radiation accidents;
• calculation of stationary radiation protection.

Further finished project must undergo a sanitary-epidemiological examination, which decides whether its content meets the requirements of sanitary standards.
Such an examination is carried out by a special body - the territorial center of hygiene and epidemiology.

More information about sanitary and epidemiological examination
The essence of the examination is to establish compliance of design and other documentation, products, services, works (Federal Law “On the Sanitary and Epidemiological Welfare of the Population”) with state rules, standards and technical regulations.
Experts are given 2 months to review the project and document the results of the examination, after which they accept a positive or negative expert opinion.
If the experts’ decision is negative, it should list the complete deficiencies that the medical institution must eliminate in the project.
If the terms of the examination are violated, the medical institution has the right to file a complaint with a higher organization.
After approval of the project, the authorized organization issues a “Sanitary and Epidemiological Conclusion” on the compliance of the project sanitary requirements. After this, the project can be implemented.

Equipment installation
As we have already said, after receiving a positive sanitary and epidemiological conclusion for the X-ray room project, the medical institution can carry out all the necessary measures.
In particular, the premises are being repaired or reconstructed, and other activities provided for by the project are being implemented. After this, you can begin installing the equipment. Installation activities are carried out by a specialized organization or representatives of the equipment manufacturer.
Please note that equipment that was not provided for in the design documentation cannot be placed in the office.
All organizations that are involved in construction and installation work, must have appropriate licenses and other permits provided for by law.

Commissioning of the X-ray room
Before accepting an X-ray room, it is necessary to check the compliance of ventilation systems, sewage systems, lighting, noise, microclimate systems, radiation control of the room and other systems with sanitary rules.
Such checks are carried out by organizations that are accredited to conduct such studies. They carry out the necessary research and measurements, after which they draw up the appropriate act.
After all the work is completed, it is necessary to assemble a commission that will commission the X-ray room into operation. The commission includes:

• representatives of the medical institution (chief physician, his deputies, etc.);
• representatives of the State Sanitary and Epidemiological Supervision Service;
• representatives of the X-ray center;
• representatives of the construction and installation organization.

The commission establishes the compliance of the actual work performed with the content of the project, examines the acts and protocols of the studies and measurements carried out, and establishes the availability of all the necessary documents listed in Appendix No. 7 to SanPiN No. 2.6.1.1192-03. After a successful inspection, the commission signs an acceptance certificate for the x-ray room in triplicate (for the medical institution, x-ray center and authorized organization).

Obtaining a technical passport for the office
The medical institution must obtain a technical passport for the office. This document certifies the technical condition of all equipment located in the X-ray room.
In addition, it confirms that staff workplaces and premises comply with legal requirements.
A passport must be obtained for each room for tomography, diagnostics, x-ray therapy, osteometry, etc. It is filled out by the chief X-ray radiologist of the territory, after which it is certified by his signature and seal.
The passport has a validity period of 3 years, which can be renewed no more than three times.
If insignificant deviations of the devices from the passport data are identified, it can be issued from six months to a year.
If serious violations are detected in the operation of the equipment, the work of the office and equipment is suspended until completion. repair work or replacement of equipment.
In addition, the technical passport can be replaced before the expiration date if the complete set of the device changes, if the design of the X-ray room changes, as well as in case of wear and tear of the equipment and the emergency condition of the room.

Effect of sanitary-epidemiological conclusion
This document gives the right to operate and store X-ray equipment and is issued for the first time on the basis of the act of acceptance of the X-ray room into operation. This document is valid for 5 years from the date of its issuance; after expiration of the validity period, the medical institution is required to issue a new conclusion. In order to obtain a new conclusion, the medical institution contacts the Center for Hygiene and Epidemiology so that the agency conducts a new sanitary and epidemiological examination. One conclusion is issued per medical institution. It indicates all X-ray rooms and devices (stationary and mobile) to which it applies. The annex to the sanitary-epidemiological report specifies the restrictive conditions for the use of equipment and the conditions for its operation. If control organizations subsequently reveal a violation of the requirements of sanitary and epidemiological rules, the current conclusion must be revoked.

Obtaining a license to operate with sources of ionizing radiation
After passing all the previous stages (not earlier), the medical institution must obtain a license to carry out activities related to sources of ionizing radiation.
Such a license is issued by executive authorities authorized to carry out state sanitary and epidemiological supervision.
To obtain a license, a medical institution submits a package of documents to the licensing authority:

• application for a license. The application must indicate: the name of the medical institution, its location and other contact information;
• copies of the constituent documents of the medical institution;
• copies of medical institution licenses to carry out medical activities;
• a list of specific sources of radiation that are planned to be used in a medical institution. This list is accompanied by copies of documents for these sources, as well as a sanitary and epidemiological certificate for working with such sources;
• copies of educational documents of medical workers that confirm their qualifications to work with sources of radiation;
• receipt of payment of the license fee for consideration of the application for issuance of a permit.

All provided copies must be notarized.

License terms

• compliance with the legislation of the Russian Federation and SanPiN requirements;
• the presence in the medical institution of structures and premises that meet the requirements for placing X-ray rooms in them;
• compliance of design and other documentation, operating conditions, storage and operation of ionizing radiation sources with radiation safety requirements;
• the presence of employees who have the appropriate qualifications to carry out work in the field of using ionizing radiation sources;
• conducting radiation safety certification for all employees who work with radiation sources;
• existence of an action plan aimed at protecting medical institution employees and citizens in the event of a radiation accident.

The licensing authority reviews the documents, conducts the necessary studies, examinations and other activities, after which, within a period not exceeding 60 days, it makes a decision to issue a license. A license for a medical institution is issued for a period of 5 years, after which it, in the absence of changes in licensing conditions and requirements, can be extended. If a medical institution has violated licensing requirements, the licensing authority has the right to suspend the license to eliminate these violations or go to court to cancel it.

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The equipping of the X-ray room and the placement of equipment in it is carried out according to a project developed by an organization that has a license that allows it to design radiation protection equipment and place generating sources of ionizing radiation.

An X-ray room is a complex of rooms, each of which has a specific purpose. All premises and the equipment placed in them are subject to a number of regulatory and technical requirements, which will be discussed further.

Requirements for premises for placing X-ray machines

X-ray rooms (other than x-ray and dental rooms) are not allowed to be installed in residential buildings, as well as in the buildings of children's institutions. X-ray rooms are allowed to be located in clinics that operate in residential buildings, if the adjacent premises are non-residential. Also, the X-ray room can be located in an annex or in the basement of a residential building if it has a separate entrance.

Rooms with X-ray equipment are located, if possible:

• centrally - in the form of x-ray units or departments at the junction of the clinic and the hospital (with the exception of x-ray rooms for tuberculosis, infectious diseases and obstetrics, and sometimes fluorography rooms);
• in the end parts of the building;
• isolated from rooms from which water can flow (showers, swimming pools, treatment rooms);
• isolated from wards for children and pregnant women.

The X-ray room should not be walk-through. The entrance to it is equipped separately from the entrance to the clinic or hospital.

Requirements for the composition and area of ​​the X-ray room

The X-ray room includes at least 3 isolated rooms:

• the procedural room, where the X-ray machine is located and work is performed with it;
• X-ray equipment control room;
• doctor's office.

The office may also include a darkroom, undressing and waiting rooms, a staff room, etc.

Requirements for the area of ​​certain types of X-ray room premises are set out in Appendix 5 to SanPiN 2.6.1.1192-03.

This table presents the area requirements for treatment rooms depending on the type of X-ray machine used.

Here you can see the requirements for the composition and area of ​​the X-ray diagnostic room.

* Not necessary.

** Not required when using equipment for digital fluorography and radiography.

And this table presents data on the composition and area of ​​​​the premises of the X-ray therapy room.

Requirements for the X-ray room procedure

A procedure room is an X-ray room in which a source of ionizing radiation is located and X-ray procedures and studies are performed.

When designing a procedure room for an x-ray diagnostic or x-ray therapy room, the following requirements must be taken into account:

• The distance between the walls of the room and the employee’s workplace behind a protective screen (small) should be 1.5 meters.
• The distance between the walls of the room and the employee’s workplace behind the protective screen (large) should be from 0.6 meters.
• There should be a distance of at least 1 meter between the turntable-tripod or imaging table and the walls of the room. There should be at least 10 centimeters from the photo stand to the nearest wall.
• The minimum distance between the viewing window and the X-ray tube is 2 meters. For dental and mammography machines, this figure is reduced to 1 meter.
• Between the elements of the stationary equipment of the office there must be a technical passage for personnel with a width of at least 0.8 meters. A space of at least 1.5x2 meters is allocated for placing gurneys for patients. For the import of gurneys and other technological needs There must be at least 6 m2 of free space in the treatment room.

The treatment room must have a sink with hot and cold water supply (the requirements do not apply to treatment rooms fluorography and X-ray operating). For rooms where urological X-ray examinations are carried out, there is also a requirement for the mandatory placement of visual instruments.

Requirements for a photo lab

The X-ray laboratory must have a “dark room”. If it has a developing machine, it is also necessary to equip a “light room” where dry photographs will be cropped, sorted and labeled.

Requirements for the minimum area of ​​the “dark room” of the darkroom:

• for small format photographs ---- 6 m2;
• for large format photographs ---- 8 m2.

Between the equipment of the “dark room” there must be passages for personnel at least 1 meter wide. The doorway should have a width of 0.9-1 meter.

Light tiles are used to decorate the walls of the darkroom next to the sink and photo processing device. Height tiled apron- at least 2 meters from the floor. The remaining sections of the walls should be finished with materials that are subject to repeated wet cleaning.

The entrance door, window and transfer hatch in the darkroom should be protected with light-proof curtains (so that photographic materials are not exposed to light).

The use of digital equipment eliminates the need to set up a darkroom in the X-ray room.

Other requirements for premises and equipment of X-ray rooms

The floor of the darkroom premises should be made of artificial or natural materials with electrical insulating properties.

The floor in the preoperative, X-ray operating room, and darkroom must be waterproof, spark-free, and antistatic (when using linoleum, its base must be grounded).

The doors from the darkroom, as well as from the control room and the treatment room, open “towards the exit”; from the control room to the treatment room - towards the treatment room (to facilitate evacuation).

The ceiling and walls of the X-ray room must be smooth, resistant to frequent washing, and free of light reflections.

All materials used in the decoration of the X-ray room must have sanitary and epidemiological certificates authorizing their use in public and residential buildings.

It is advisable to orient the windows in the X-ray room to the northwest. Darkening systems are installed on the window of the fluoroscopy room to protect from sunlight.

When the anode voltage is turned on at the entrance to the treatment room and the control room of the X-ray room, the “Do not enter!” sign should automatically light up. white-red color. It is located above the door or at a height of 1.6-1.8 meters from the floor.

The air flow into the X-ray room should be in the upper zone, and the exhaust should be 50% (+-10%) from below and from above.

When constructing new X-ray rooms, the design includes autonomous ventilation. In premises that are already in use (except for computed tomography departments and x-ray departments of infectious diseases hospitals), it is possible to use general supply and exhaust ventilation systems. Air conditioning may be installed in rooms with X-ray equipment.

Detailed requirements for air exchange, temperature conditions, illumination of X-ray diagnostic and X-ray therapy rooms are set out in Appendix 6 to SanPiN 2.6.1.1192-03.

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 methods treatment and diagnosis. Even in a small dental office located indoors housing stock, you can come across 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 the residential and office premises of the neighboring building of 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 information on their protective properties or determine the 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 is 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 internal surfaces 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 its interfloor ceilings are not made of wood, which is not a barrier to X-ray radiation. Wooden floors 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 observation 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 1000 mSv over a period of working activity (50 years), 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 of 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 a dental clinic, the best option is when X-ray diagnostics are carried out by a radiologist who has a higher professional education in the specialty "Dentistry" and postgraduate professional education (internship and (or) residency) in the specialty "Radiology", as well as a radiologist who has received secondary vocational education in the specialty “Dentistry”, “Preventive Dentistry”, “Orthopedic Dentistry” and a specialist certificate in the 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, table lamps, electric lighting, ventilation are turned off, the walls are wet cleaned, the floors are washed, and the elements and accessories of the X-ray machine are thoroughly disinfected. Wet cleaning is carried out monthly using a 1-2% acetic acid solution. It is not allowed to carry out wet cleaning of the treatment 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 entry to work) and annual periodic medical examinations of group A personnel. Persons who do not have medical contraindications for working with sources are allowed to work ionizing radiation. If deviations in the state of health are identified that prevent the continuation of work in the X-ray room, the issue of temporary or permanent transfer of these persons to work outside 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.

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 radiation monitoring in medical organizations, measurements and recording of results are usually carried out by third-party organizations - testing laboratory centers, radiation control laboratories, etc., accredited in accordance with the established procedure.

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 staff, conducting special X-ray examinations under the control of X-ray radiation, by the nature of his activity 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 at the same place of work for 50 years.

In accordance with Federal law dated 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 for the placement, design, equipment and operation of hospitals, maternity hospitals and other medical hospitals.”*

State in the mentioned sanitary rules ah, “Sanitary and hygienic requirements for dental medical organizations” as 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 order established by law 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 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. Rendering medical care for pregnant women, it is carried out 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 the types of activities. Minimum areas of premises and their minimum set are presented in Appendix 1.

3. Requirements for interior decoration

3.1. All materials used for interior decoration of premises 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 the surfaces of walls and floors 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. Under work surface tables should not have open drawers;

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 open-type irradiators, the 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 design and construction standards for residential and public buildings and provide optimal parameters 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 smooth surface resistant to daily exposure to detergents and disinfectants.

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 (with the exception of operating rooms), located including on non-residential floors of residential and administrative buildings, unorganized air exchange is allowed by ventilating the premises 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). Ventilation system from production premises 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 common exchange system 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 chemical substances and odors (photocatalytic filters, etc.).

5.14. Technological equipment dental laboratories, which includes sections for cleaning the exhaust air from of 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 to an 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 rooms subject to aseptic conditions, hidden installation of air ducts, pipelines, and fittings is provided.

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 any 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 for 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 floor of the office is made of non-conducting materials, natural or artificial (linoleum, natural or artificial stone, ceramic tile and so on.).

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(supply and exhaust ventilation device, 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 stipulated by the current sanitary rules.

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 the dental office is intended for patient use only. of this office. Additional space for placing an X-ray machine in a dental office that meets sanitary standards is 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, glasses, 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 general plan production control 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, instruments 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 responsible persons within the framework of production control, as well as 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 workplace dentist - at least 6 handpieces (of which two are 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 package 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 solution disinfectant, then rinse in water and dry. 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:

Exposure to ultraviolet radiation using open and combined bactericidal irradiators used in the absence of people, and closed irradiators, including recirculators, allowing 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 design features 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 plaque, light guides of light-curing lamps). It is not recommended to use aldehyde-containing products for these purposes. Handpieces can be processed after each patient as follows: the handpiece channel is washed with water, cleaned using special devices (mandrins, etc.), and blown 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, which during operation come into contact with the mucous membrane and can cause damage to it:

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, impression trays, instruments for removing dental plaque, periodontal surgical instruments(curettes, hooks different 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. Glasperlene sterilizers can be used to sterilize various types of burs and other small instruments. full immersion them into a medium 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.

Monitoring the operation of sterilizers by physical and chemical methods carried out 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 of the hands of medical personnel or treatment of the hands of surgeons is carried out.

8.5.2. To achieve effective hand washing and disinfection, it is necessary to observe following conditions: short-cut nails, no nail polish, no artificial nails, no rings, signet rings, etc. jewelry. Before treating surgeons' hands, it is also necessary to remove watches, bracelets, etc. To dry hands, use cloth or paper towels or disposable napkins; when treating surgeons' hands, use 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 personnel 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. To wash hands, use liquid soap using a dispenser or solid soap (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 the patient’s intact skin (for example, when measuring pulse or blood pressure, etc.);

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 of gloves is 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, closets, etc.). Staff outerwear 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.