HYGIENE OF MEDICAL ESTABLISHMENTS, THEIR PLANNING AND EQUIPMENT.
MODERN PROBLEMS IN
The activity of the medical worker bound with influencing both unfavorable working conditions, and dangerous factors of manufacturing environment on a workstation. These factors encounter a broad spectrum of manufacturing harmful factors.
а) Psychophysiological (psycho-emotional stress, specific work pose, excessive stress of analisator systems and other),
b) Physical (noncomfortable microclimate, poor illuminance of workstations, noise, chattering, ultrasonics, laser, radioirradiations,
c) Biological (promoters of ifection illnesses, parasite - insect, helminths,
d) Chemical (medical drugs, drug facilitiess and other).
The stress of the visual evaluator can result in to a spastic stricture of accommodation and originating of a so-called artificial myopia, and the operation with photopolymeric valves can invoke a photo-ophthalmia, combustions of a cornea, clouding of crystalline. In this connection the characteristic complains on tiredness of vision, feel of “sand in eyes ", discomfort.
The operation with mercurial amalgams can be the reason originatings for the doctors - stomatologists, medical sisters, tooth techniques of micromercuralism.
The greater 25 zymotic diseases, including HIV, prion illness, hepatitises B and C passed through a saliva, tissue an opened wound.
Measures on environmental sanitation of the working conditions of the medical workers.
The sanitary regulations and norms - stipulate creations of optimal microclimatic conditions in separate functional buildings of hospital entities, ventilating system, conditioning of air, natural and synthetic lighting, sanitary - hardware (cold and ardent water facilities, communal and special water drain).
It is necessary to conduct systematic laboratory check of concentration of anestetics in operational with the purpose of debarment overflow them GDK: for a Aether - 300 мг/м3, Ftorotanum - 20 мг/м3, inhalanum - 200 мг/м3, Chloroformium - 5 мг/м3, cloraethilum - 50 мг/м3, Trilenum - 10 мг/м3.
To security of shortening of operating time for this category of the medical workers is from time to time referred also.
Security of spacing interval most effective, as the radiation dose is slashed proportionally to quadrate of spacing interval, and is reached by definition of zones of inaccessibility for sources X-ray and gamma-ray, usage of positioning devices by operation with enclosed and opened sources of ionizing radiation, rational budgeting of buildings and sufficiency of their sizes.
The security by screening is reached by operation with X-ray and gammas - radiatings with the help of lead screens by the way of pods, screens, antiradiation rubber skirts, etc. Shields for sources of a beta radiation are aluminum, organic glass. For security of terms of surgical crew against X-ray beaming at traumatological, orthopedic operations will be provided by new rentgenodiagnostical staff, roving defensive screens.
In Ukraine waste strong statutiry and normative base on protection of operation. Since 1992 gated in I shall do the progressive Law of Ukraine " About protection of operation ". The constitution of Ukraine has locked behind each medical worker the right on safe operation.
With the purpose of preservation of health of the medical workers and pharmacists working in parasitic conditions, the legislation establishes(installed) the abbreviated working day:
- Hourly - in zymotic, tubercular separations of hospitals, children's entities, in psychiatric, psychoneurological, narcological entities and separations, in physico-theraputical, radon, balneal separations, in sanitary - epidemiological departments both separations and labs, which one work with the parasitic factors (doctors - bacteriologists, epidemiologists, hygienists, parasitologists, toxicologists, sanitarian doctors, desinfectors) etc.
The night duties of the doctors and medical sisters, duty on days off, according to the legislation should to be countervailed: by operation without the right of dream hour in an hour, and with the right of dream - 0,5 hours in an hour. By the legislation is stipulated also limitations of norms loading of the doctor at the rate of on 1 business hour; out-patient reception - surgeons - 9 ill, ophthalmologists, otolaringologists, dermatovenerologists - 8, traumatolog-orthopedist - 7, theraputist, infectionist, endocrinologist, hematologist, urologist , oncologist, pediatrist, surgeon - stomatologist - 5 ill, children's psychiatrist - 2,5, theraputist-stomatologist - 3, prosthetic odontology, forensic psychiatry - 2 ill.
- 5,5-hour the working day is established for the doctors out-patient - polyclinical entities, LSEC, LKK. Psychoneurological tubercular dispancers, stomatologists , doctors and nurses, working with oscillators a UHF, or irradiation in polyclinics.
- 5-hour the working day is established for medical staff, immediately working in rentgenodiagnostics, rentgenophotography, on rotatory roentgen - therapeutic, hamma theraputical installations, for the pathologists, prosectors, anatomists, other specialists working with a corpse material, for medical workers, handling children's entity for mentally retarded children, with a defect of CNS.
- The 4-hourly working day is established for the doctors, mean and low medical staff immediately which was taken up with opened radionuclides.
At transferring for 5-day's working week the week uptime is saved by reallocating working hours of 6-th day 5 day working week.
Tasks of hospital hygiene:
Ø Preference to acceleration of recovery the patient, achievement of indemnification of functions, medical and psychological rehabilitation.
Ø Achievement for psychological and somatic comfort for the patients during stay in hospital institutions.
Ø Prevention of nosocomial infection
Ø Maintenance of epidemic and radiologic safety.
Ø Maintenance of healthy occupational environment for the medical personnel.
Ø A regulation of use of new disinfectants, detergents, polymeric materials, newest equipment and technologies in medical institutions.
Ø Formation of bases of a healthy life style at the personnel and patients MPI.
Ø Minimization of influence on an environment for construction and operation of medical institutions.
The main characteristic of all medical-preventive institutions is presence so called "hospital environment ". Hospital environment is a set of all factors of physical, chemical, biological and information nature, which carries out influence on an organism of the patient during treatment. There are microclimate of hospital premises, various radiation end wave influences, medicines, antiseptics and polymer material, special hospital strains of bacteria. These factors define dynamics of medical rehabilitation and health of patient and staff.
When they develop the general plans of medical-preventive institutions it is necessary to take into account local climatic conditions and to provide measures on protection of building and nearby area from the adverse external factors. A choice of the ground area for an arrangement of houses of hospitals, maternity houses and others in-patient institutions should be agreed with local authorities and institutions of environmental health service. General hospitals and maternity houses should be placed outside of the centre of cities and settlements, the hospitals of emergency care have to be under construction in view of the maximal approximation to groups of the population, which they are served. The specialized hospitals or complexes with capacity for over than on 1000 beds for the patient stay during long time, and also special hospitals (psychiatric, tuberculosis and other) is necessary to place in a suburb zone, with 1000 m sanitary space from residential territories. In a choice of a site for health facility it is necessary to remember an environmental sanitary situation and prevailing direction of winds ("wind rose").
The ground in hospital area must be clean, dry, without sharp differences a relief. The hospital area should be placed in aerodynamic shadow, so that the velocity of air movement did not exceed 5 m/s. They electrify the area, supply it with waterpipes and water drain, border on perimeter and protect by a strip of green plantings with width not less than 15 meters (2-3 lines of trees with low schtamb and rich crone).
Hospitals and maternity houses should be remoted from the railways, airports, high-speed highways and other powerful sources of pollution.
At an arrangement medical and maternity institutions in residential zone it is necessary to place them not closer than 30 m from a red line of building and 30-50 m from apartment houses, depending on the number of floors in houses of medical-preventive institutions..
Bush it is necessary to place not closer than 5 m from a hospital house, trees - not closer than 10 m. Trees and the bushes with poisonous fruits, sharp hooks, allergic-dangerous (give a lot of pollen) plants are not used for gardening.
Hygienic meaning of vegetations:
v Protection against wind, dust and noise
v Optimization of microclimatic conditions: they give a shadow, normalize a humidity of air and make an aerodynamic shadow
v Bactericide influence of phytoncides on bacterial pollution of air
v Oxygenation of air
v Fixing of dust by a grassy lawn
v Architectural-planning meaning
v Aesthetic and psychohygienic meaning
v They can be a potential source of allergens
v Some plants are poisonous
v Danger of traumatisation with sharp and rigid stalks of plants, with heavy fruits etc
v Adsorption of dust particles by plants surface
In the territory of hospitals there should be the following zones:
1. Zone of medical departments: for the infectious patient, medical departments for noninfectious patient, for pediatric departments, for patrimonial houses and maternity departments, psychosomatic departments, dermato-veneralogical departments, radiologic departments
2. OPD and administrative zone
3. Garden zone
4. Zone of court yard
Separate entrances to the various hospital zones should be provided. For emergencies they provide “Ambulance Road” – the entrance and exit for ambulance should create one-flow driving in and out of the hospital department area.
The patologo-anatomic departments with a funeral zone should be isolated from ward departments and they should not be looked through windows of the departments, from the hospital garden, and also through windows of inhabited and public houses.
Distance between houses with windows of chambers has to make 2,5 heights of opposite house, but not less than 24.
Infectious, maternity, psychosomatic, dermatovenerologic and the children's departments of hospitals should be placed in the separate houses. If hospital has the out-patient department, the last should situate close to periphery of a site.
Before front entrances to the hospitals, polyclinics, SES, dispensaries and the maternity houses they are provided grounds for the visitors by the account 0,2 m2 per one bed or per one visit on duty, but not less than 50 m2. Parking area for a vehicle of institutions, employees and visitors should be placed not closer than 100 from ward departments. The temporary parking of a vehicle of individual usage should be placed on distance not closer than 40 m from the entrance to the hospital. Buildings of out-patient institution as rule do not have more than 5 floors.
The departments of children's hospitals for children till 3 years with the mothers should be placed not above than fifth floor, the chambers for infants and children's psychiatric departmentes - are not higher than the second floor.
Cleaning of territory has to be carried out daily. For collecting of wastes and household dust they establish containers with covers. These containers should be disinfected and washed properly. Distance between a ground for dust container and ward and medical-diagnostic departments should be not less than 25 m. They should dispose waste from containers every day. Specific (postoperation, patologo-anatomic and other) medical waste should be incinerated in special furnaces.
Planning of medical and maternity hospitals have to provide optimum sanitary - hygienic and antiepidemic modes and conditions of patient stay, work and rest of the personnel.
Structure of institutions and planning of its premises have to exclude an opportunity of crossing or another contact of "clean" and "dirty" flows.
Maternity houses - specialized stationary institutions, which provide health care for pregnant women in childbirth, recently delivered women, newborns, to the gynecologic patients (at presence of gynecological department).
They offer to place in basement of medical-diagnostic departments warehouses, sanitary - household premises for the personnel (wardrobes, shower-room), sanitary care unit, buffets and restaurants for the personnel, central laundry, premises for collecting and sorting of a dirty linen, premises for desinfecting of bad pans, oil-clothes and beds, premises of preservation, regeneration and heating of a medical muds; storehouse of radioactive dross and linen polluted with radioactive substances.
It’s forbidden to place medical-diagnostic departments, workshops using hazardous materials and reception wards in basement of hospital.
X-ray rooms and laboratories of radiodiagnostic should not be adjacent on a horizontal or vertical with chambers for the pregnant woman and children. It is forbidden to place x-ray studies under premises of shower, lavatories and other possible sources of water.
Premises of hospitals, maternity houses and others should be illuminated by day light. The illumination by the second light or only artificial illumination is used in premises of barns, toilets, bathrooms, enema room, rooms of personal hygiene, shower and wardrobe rooms for the personnel, thermostate, microbiological banks, preparation and operational, apparatus, narcosis, photolaboratories and some other premises which do not require natural illumination. Operation room projected with natural illumination, it is necessary to focus on the north.
The corridors of ward sections (departments) should have natural illumination. Distance between light pockets should not exceed 24 m, and between the first light pocket and window in the dead end of the corridor – 30 m.
For protection from blinding actions and overheating in summer time from direct solar rays in medical stationary located in 3 and 4 climatic areas aperture wrapped up on sector of horizon 70-240º of northern latitude they have to use solar protection equipment.
The artificial illumination should answer assignment of a premise, be sufficient, regulated and safe, to prevent the dazzling and other adverse influence on the human organism and internal hospital environment.
The general artificial illumination is necessary stipulated in everything, without exclusions, premises. For illumination of separate functional zones and workplaces, they use local illumination.
The artificial illumination of hospital premises is provided with luminescent and bulb lamps.
We use combined lighting (general and local illumination) in the hospital wards. In one-bed chambers the general illumination is provided. In chambers of children's and psychiatric departments, intensive therapy, the reanimation, in postoperation chambers they provide only ceiling fixtures of general illumination. For night shifts they use lamps in niches near doors
The emergency illumination is provided at dressing, manipulation, procedural, ATS, assistant, drugstores, reception wards, laboratories of the urgent analysis, X-ray-operation room, and on the nurse stations.
For waste treatment from hospital catering service in hospitals they establish fat-catching device. The treatment of waste from hospitals including infectious is carried out by municipal sewer system. At absence of municipal sewege systemthey use system of local waste treatment.
For all health facilities should be provided reserve (emergency) hot water supply. They could use electrical boilers or second input of hot water supply. For heating it’s used water heating system with maximal water temperature in heating devices 85oC (Using water steam heating in the hospitals is prohibited).
The heating radiating concrete panels can be used in following premises: operation, preoperation, resuscitation wards, narcosis, delivery, premises of electrolight treatment, psychiatric departments of hospitals, therapy rooms, rooms for premature babies, injured children, little children and newborns infection wards, combustiological wards, complete and incomplete boxes, premises of blood bank, storerooms for sterile materials and medications, x-ray rooms, laboratories and experimental - biological clinics (vivaria).
In sanitary - household premises for the attendants it is necessary to accept:
1. Quantity of sanitary devices for the medical staff - not less than 2 devices for the women and 1 device for the men; but not less than 1 sanitary unit on each department
2. Quantity of shower cabins - 1 shower cabin per 10 employees in infectious and phthysiatric departments, in other departments - 1 shower cabin on 15 employees in the largest shift. If less number of the personnel it is necessary to provide 1 shower cabin on department.
Lavatory for the patient in ward departments for hundicapped patients should have special equipment (racks, folding ), that the seriously ill patient can use of sanitary devices.
The houses of medical and patrimonial houses should be equipped with systems of balanced ventilation, except for infectious departments.
Reception ward of hospital has following functional tasks:
· Reception, registration and distribution of patients
· Previous diagnostics
· The decision of a question about necessity of in-patient or out-patient treatment
· Sanitary treatment of patients
· Prevention of communicable diseases
· Shifting needed patients to other health facilities
· Discharging the patient and distribution of an information.
The number of patients are receipted by the reception ward depend on the number of beds in the hospital and its specialization::
· 2 % of beds number - in TB, mental and rehab hospitals
· 15 %- in emergency hospitals and maternity houses
· 10 %- in other hospitals.
The number of the patient flows should be accepted from the ratio:
· 1 flow per 800 beds- TB and rehab hospitals
· 1 flow on 600 beds- in mental hospitals
· 1 flow on 150 beds- in emergency care facilities
· 1 flow on 200 beds- others hospitals.
In infectious hospitals and infectious departments of general hospitals they provide reception wards with examination boxes, their quantity depends on quantity of beds in department:
· up to 60 beds - 2 boxes.
· 100 -3 boxes
· more then 100 beds-by the formula X=3*x, where x - 1 additional box for every 50 beds of department.
The similar boxes are organized in children hospitals.
In obstetric departments the reception premises (examination room, sanitary treatment unit) should be provided as combined for physiological department and department of a pathology of pregnancy and separately for observation and gynecologic departments. The movements the patient of all departments, including stairs and elevators, should be isolated one from one.
If it’s necessary they organize traumatological shifts, their offices should be placed on the ground floors of houses.
For reception of the infectious patient they provide isolator room which connected to examination room of the ward.
Ward department is the basic functional structural element of in-patient medical institutions. The basic types of ward departments is: noninfectious department (for adult and children) and infectious departments, maternity department
If children departments has 60 or more beds they should be placed in separate buildings. Infectious and TB departments are placed only in separate buildings.
Ward department consists of ward sections and general premises located between the sections. The general premises include the medical and diagnostic offices, catering service premises etc.
The ward section represents the isolated complex of rooms and medical-auxiliary premises providing care for patients with homogeneous diseases. The quantity of beds in ward section, as a rule, is not less 20 and no more than 30 (except for psychiatric).
The quantity of 1 bed rooms in observation obstetric department, department of a pregnancy pathology and also in hematological, neurosurgical and urologic departments for adult persons and children should be not less than 15 %, and in others departments - not less than 7 % of quantity of beds in department.
The quantity of 2 beds rooms in the specified departments has to make not less than 15 %. In all other departments project not less than two 3 bed rooms in each section.
The best ratio is 20%of one-bed, 20% for two-bed and 80% for three and four-bedrooms.
In infectious stationary basic structural unit of ward department could be not a ward, but complete or uncompleted box or boxed room. Boxes provide a complete isolation of the patient. There are 1-2 bed boxes using in Ukraine.
The operational block.
The operational block has such functional zones:
І. The sterile zone: an operational room
ІІ. A zone of restrictions
· group of premises for preparation to operation: preoperation, wardrobe for overalls, narcosis room,
· group of premises for the equipment: apparatus room (AABC, hypotemia)
· group of premises of postoperation wards
· group of auxiliary premises, which contain also sluice at an entrance to operational room
ІІІ. A zone of the limited access:
· group of premises for diagnostic researches
· group of premises for preparation tools and equipment for operation: sterilization, instrumental-material (instrumental-financially)
· group of premises of the personnel: offices of the surgeons, office of the doctor - anaesthesiologist, room of the nurses-anaesthesiologists, room of attendants
· auxiliary premises: sluices at an entrance in septic and aseptic of department, room to the central board, plasters і and that similar
· warehouse premises: blood bank etc
MAJOR FUNCTIONS OF THE ADMINISTRATIVE SERVICE
1. Provide service related to accounting, billing, budget, cashiering, housekeeping, laundry, personnel, property and supply, security, transport, engineering, and maintenance; and
2. Render support services to hospital care providers, clients, other government, and private agencies, and professional groups.
1. To plan, direct and coordinate financial operations of the hospital;
2. To prepare work and financial plan and provide fund estimates for programs and projects;
3. To manage the receipt and disbursement of cash/ collections;
4. To administer personnel development programs, policies and standards;
5. To give advice on matters affecting policies, enforcement and administration of laws, rules and regulations;
6. To procure, store, manage and issue the inventory and disposal of unserviceable hospital equipment and materials; and
7. To provide general services such as repairs and maintenance, housekeeping, laundry, transport and security.
FUNCTIONS OF DIFFERENT DEPARTMENTS UNDER THE ADMINISTRATIVE SERVICE
ADMINISTRATIVE OFFICE – Directs and supervises the activities and functions of administrative units to effectively deliver quality support services.
1. PERSONNEL SECTION - Development and administration of a comprehensive manpower development program which includes recruitment and selection, promotion, training, employee welfare and benefits, manpower planning and research.
2. PROPERTY AND SUPPLY SECTION - Procurement, storage, inventory, distribution and disposition of hospital supplies, materials, and equipment.
3. HOUSEKEEPING SECTION - Develop and maintain clean, safe and sanitary environment for patients and hospital personnel.
4. LINEN AND LAUNDRY SECTION - Ensure adequate supply of clean linens for patients and hospital units.
5. ENGINEERING AND MAINTENANCE SECTION - Installation, operation and maintenance of electrical, mechanical and communication equipment and allied facilities including buildings and vehicles.
6. MOTOR POOL SECTION (TRANSPORT) - Convey transport patients, hospital officials and personnel to their destination.
7. SECURITY FORCE - Ensure safety of hospital patients, facilities and personnel, maintain peace and order, and enforce hospital rules and regulations.
8. MEDICAL SOCIAL SERVICE -The Medical Social Service function Is to see to it that patients attain emotional equilibrium as they are assisted with other needs which interfere in hospitalization and treatment.
9. MEDICAL RECORDS - Process, maintain, analyze and safe keep all medical records created in this hospital; prepares hospital statistical reports; and formulate and develop effective policies, systems and procedures for the efficient operations of the section.
10. PHARMACY SECTION - Ensures continuous supply
of drugs and medicines to patients by maintaining an adequate quantity in
stocks of those approved by the Pharmacy Therapeutic Committee. Dispenses,
compound drugs for in and out patients. Controls the purchasing,
requisitioning, safekeeping and issuing of drugs. Maintains records and files
of dangerous drugs and other pharmaceuticals as required by law. Serves as the
11. DIETARY SERVICE – Maintain or enhances the health of the patients and personnel by providing them with high quality and nutritious food through an efficient Dietary Service; Provides or serves safe, nutritious and attractive food through careful planning, wise procurement and proper preparation of balanced and satisfying meals within budgetary limits; Implements diet prescription in coordination with physician and nurse; Provides nutrition consultation and education services to patients as well as in-service training to both dietary personnel and other related fields; Promotes and maintains cooperation with other department in the hospital towards total patient care.
12. ACCOUNTING SECTION - Systematic recording of all financial transactions, preparation of financial statements and relevant reports, and maintenance and safekeeping of the hospital’s Book of Accounts.
13. BUDGET SERVICE - Prepares the Work and Financial Plan and provision of fund estimates for hospital programs and projects.
14. CASHIER SERVICE - Receipt, deposit, custody and disbursement of cash/collection of the hospital (Cash Management)
15. MEDICARE AND BILLING SECTION - Admits, classifies Pay and Medicare Patients, orients patient with regard to privileges, obligations, responsibilities during the course of confinement. Prepares statement of account on service and bills rendered to patient. File records, bills and statement of account.
16. INFORMATION AND ADMITTING SECTION
Hygienic and Sanitary regime in surgical profile
Dirty clothes are gathered into special bags made of wool or into closable dishes. It is prohibited to put dirty clothes on the floor or directly into gatherers. Sorting of dirty clothes is provided in special buildings out of the department. After clothes change subjects in the ward are treated with desinfecting solution.
Instruments with blood directly after operation or procedure ar put for 60 minutes into solution of corrosium inhibitor in temperature 22±5 oC. After that they are well washed with water and kept for 15 minutes in synthetic washing solution in temperature 40-50oC. Every instrument is washed with the help of brush or cotton ball, washed in water for 3-10 minutes, then in distilled water and dryed by hot air (temperature 85oC) to complete elimination of water.
Surgical instruments from steel after washing in water are kept in solution
of acetic acid (
All instruments that have contact with wound surface, blood, injectional preparations or mucosa and may cause its damage are to sterilized.