HYGIENE OF MEDICAL ESTABLISHMENTS, THEIR PLANNING AND EQUIPMENT.
MODERN PROBLEMS IN HOSPITAL BUILDING. HYGIENICAL MEASURES OF OPTIMIZATION OF TERMS OF STAY OF PATIENTS ARE IN MEDICAL ESTABLISHMENTS. PROPHYLAXIS OF HOSPITAL INFECTIONS. HYGIENE OF LABOUR OF DOCTORS OF DIFFERENT SPECIALITIES.
The conditions and nature of labor activity of the doctors and other specialists of medical area require constant attention to protection of their health, because 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,Ionizing radiation),
c) Biological (promoters of ifection illnesses, parasite - insect, helminths,Etc.),
d) Chemical (medical drugs, drug facilitiess and other).
Hygienic features of the working conditions and state of health of the doctors of surgical specialties.
Surgical specialties are: the general surgery, thoracic surgery, urinology traumathology and orthopedics, neurosurgery, obstetrics and gynecology, ophthalmology, oncology, facial surgery, surgical odontology, reanimation and anesthesiology. Except for enumerated, to surgical specialties referred anatomy, pathological anatomy, forensic medicine, surgical dermatology and other.The professional feature of activity of the surgeons is multicomponent character of their working process. Except doing operations, as main activity of the doctors of a surgical profile, the considerable endurance of operating time is spent for inspecting patients, diagnostic, postoperative routines, morning conferences, planning how to do operations, filling in documentation (case history, protocols of operations), talking with the relatives of the patients, for the manager of departments, hospitals - administrative duties, and so on.Operational loading of the doctors of a surgical profile, by countings of the explorers, compound: in communal surgery – more than 150 operations for one year, more than 3 for one week; in otolaryngology, accordingly, - more than 170 and to 4; in an obstetrics and gyneacology - 370 and 7 (including abortions, abrasions - 230 and 5). With improvement of professional skill of the surgeon increase both amount, and complication of operations. Operational, rentgenodiagnostical and reanimational loading increase also at daily duties of the emergency.By physiological feature of work activity of the surgeon in operational is obliged working pose, with static stress of the muscle system. Is established, that 37,6 % of all period of the operation a trunk of the surgeon pitched forward and 27 % - with additional rotation in one or other side, and only 26 % of time its trunk is in vertical position. The blood pressure in legs is increased in 2 times, in the field of a basin - on 50 %. Takes place lack of blood supply of brain. From here - headaches,
The working area of the surgeon, occupies up to 60 cm in diameter, which causes to hold arms forward in one position, thus the angle of a brachium from a trunk oscillates from 35 up to 1800. Among the unfavorable factors of the physical nature is warming microclimate. For example, at 3 hourly operations in conditions of absence of a forced ventilation are created such conditions, that temperature of air is increased till 26-28 ", relative humidity till 70-80 of %. The level of an infrared radiation of the nonshadowing lighting above an operating table reaches up to 442 W / м2, all this results in a stress of dodges of thermal control, reinforced sweating (up to 700 mls and will go away for the operation). Considerable sweating is also by high psycho-emotional stress for the surgeons and character of used clothes (cotton costume (suit) and sterile dressing gown, hat, gauze mask).
At conducting operations in conditions of hyperbaric oxigenation the surgeons and their helpers will experience the effect of warming microclimate, heightened atmospheric pressure and heightened infiltration into an organism of azote. The pressure in hyperbaric operational room reaches З and more atmospheres, that is considered predrug, in relation to azote. But the poor cubage in an barocamera, sometimes necessity of pressure increase up to 7-8 atmospheres, can condition of nitrogen narcosis for terms of operational team. The unfavorable operating constructs also process of a compression and, in particular, decompressions. Under operating of azote for terms of operational crew occur euphoria, the behavior (groundless laughter, slowing-down of motive reactings, decrease of attention, clearness of manipulations) is inflected.The feature of a compression is the rise of air temperature in barocamera from original, for example 20С, up to 27 and even 37 degrees. At a decompression, on the contrary, temperature is slashed till 17-15 C and even 12С.The relative humidity at a compression is increased from 40-60% till 70-84%. At a radiodiagnosis, radiognostics, surgical manipulations in traumatology the doctors and their helpers will experience the influence of ionizing radiation.
It is necessary to mark, that on the participants of surgical crews, except the indicated physical factors, the toxiferous chemical agents affect. It, first of all, chemicals, which are used foringalation narcosis: dioxide of azote (Mine), Ftorotanum (fluotane, halotane), Aether ethanol, Chloroformium (three - chlorethanum), three-clorethilenum, cyclopropane, chlorethyl and other.
Among chronic diseases of the surgeons, gyneacologists, which are discovered by results of the deepened medical browses, the greatest specific weight is borrowed by the diseases of the system of blood circulation, by nervosisms, which are interlinked with high psycho-emotional and physical stress. In them most often the pains are localized in the field of heart, high arterial pressure, considerable changes of ECG, dissonances of the nervous system. The high case rate on gyneacological diseases, failure of pregnancy are discovered in the women - surgeons, which is interlinked, except of a psycho-emotional stress, with effect of anestetics and drugs.
The greatest amount of occupational diseases of the medical workers recorded for the doctors, including surgeons, in age of the highest working activity - 25-50 years. Behind frequency the greatest amount of cases of occupational diseases of the medical workers beloongs to zymotic illnesses, of which one most often are sick, except for infectionists and ftiziatres, also surgeons, pathologists, stomatologists, otolaryngologists, doctors - laboratory assistants. In Ukraine, on a statistician, the tuberculosis of a professional genesis among medical staff occupies 23 %, hepatitis A, B - 15,4 %. In Ukraine among occupational diseases of the surgeons of chemical ethyology the medicamental allergy occupies 15,0 %, urticaria - 15,0 %, dermatitises - 8,0 %.The considerable and continuous loading on a nervous - emotional and intellectual orb of the doctor - surgeon assists forming for him(it) of an idiopathic hypertensia, ischemic illness of heart, neurotic dissonances. A veheto-vascular dystonia, nervosism are discovered in the anaesthesiologists in 30 %. The series of occupational diseases of the doctors is occupied by illnesses, which one are developed from a forced position of a body, stress of separate muscle groups; a radiculitis, osteochondrosis, discynesias, epicondylites - for the orthopedist - traumatologists.
Among reasons of progressing of occupational diseases for the doctors - surgeons select: a hypersensibility of an organism, absence or inefficiency of individual means of protection, non-compliance of the safety regulations, sanitary regulations, irregularity and deterioration of medical engineering, instruments, rigging.
Among diseases, which one has reduced in physical inability, 60 % are necessary on destiny of illnesses of chemical ethyology, 20 % - on illnesses conditioned by the biological factors, and till 10 % - on illnesses aroused by the physical factors and an overstrain of organs and systems.As a result of originating professional disease the doctors were forced to inflect a place of operation through illnesses of chemical ethyology in 80 % of cases, through illnesses aroused by the biological factors in 11 % of cases and in 9 % through a functional overstrain.
Hygienic features of the working conditions and state of health of the doctors of a therapeutic profile.
To specialities of a therapeutic profile are referred: therapy with its derivation (gastroenterology, pulmonology, cardiology), phthisiology, zymotic illnesses, dermatovenerology, neurology, psychiatry, pedonosology, emergency. From the point of view of features of operation and influencing of the unfavorable factors on the doctors of the enumerated specialities it is necessary to arrange on polyclinical, with a local principle of service ill, and on working in a hospital.
Among unfavorable psycho-emotional factors, the influencings will experience one of the divisionals theraputists, the carrying role belongs to excessive physical loading, which one depends on a season of year (amount of calls), sizes of a medical lease, such as building (one – multistore building, availability or absence of lifts).
Besides the divisionals theraputists and pediatrists, ER doctors, doctors - psychiatrists, the neuropathologists score constant psycho-emotional stress. It is conditioned by gravity of illness of the patients, complication of diagnostic, boundedness of possibilities of the doctor to help ill, feature of contacts of the doctor with ill and their with close. The particular unfavorable operating on the doctors of a therapeutic profile is done by modern facilitiess of a hardware of medical entities - X-ray equipments, source of a radoactive radiation, electronic, ultrahigh-frequency, superhigh-frequency, ultrasonics, laser sets, source of ultraviolet radiation, chemical factors - pharmacological drugs, which one operate on medical staff by the way of solutions, gases, vapors and aerosolums.
For the doctors of leprosoriums, infectionists, dermato-venerologists, helmintologists, laboratory assistants antiplague, bacteriological, virologic, helmintological labs, desinfectors, epidemiologists particular professional unfavorable factors – exciters of the applicable zymotic diseases.
Among diseases of the doctors - theraputists with a temporary disability on the main place the acute respiratory diseases, influenza, illnesses of organs of blood circulation, digestion, nervous system. Thus the doctors - theraputists are sick considerably frequently and lengthy in matching with the doctors - surgeons, which work in a hospital (accordingly 103,4 cases and 128 dawned and 48,4 cases and 76,9 dawned disabilities on 100 working).
In pattern of chronic diseases trough theraputists the main rank places occupied by illnesses of digestion organs - (chronic cholecystitis, gastrityes, peptic ulcer of a stomach, duodenum), illness of the nervous system and sense organs. Are then routed: an ischias, radiculites conditioned by often variation of stay in building and outdoor at service or at home. It is necessary to note, that the considerable proportion of the doctors are engaged in services of the colleagues without the applicable decor of disease in medical documents. This feature essentially influences quality and endurance of treatment, entirety of the registration and, accordingly on an index of a case rate, that is why officially, of taking medical advices up to 600 cases on 1000 working, and on retrospective interrogation - up to 1500 on 1000 register.
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.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). . It is forbidden to construct hospital institutions in places which were earlier used for landfills, field of assenization (irrigation, filtration), cemetery, etc., and also that have polluted soil. 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. The hospital area should be gardened and comfortable. The area of green plantings and lawns has to make not less than 60 % of the general area and area of garden zone - 25 sq. m. on a bed.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.
Now they use 3 basic systems of building of medical institutions. They are distinguished by a various degree of centralization and isolation of functional departments.
The centralized system of building of hospitals is characterized by the maximal concentration of medical service. Usually the hospital house represents a multi-storeyed structure the separate departmentes and services situated at various levels in general architectural space. In Ukraine the hospital could not have more than 9 floors.
The basic advantages of the centralized system is:
Ø Economy. At the expense of the small area and absence of duplication of the basic building volumes, functional departments, and engineering networks, the charges on construction and technical equipment of hospital decrease.
Ø The reduction of the vertical and horizontal ways of movement of the personnel and patients allows to raise efficiency of medical process.
Ø The large concentration of scientific and technical resources allows to develop departrments on the basis of this centralized type hospitals, which give the qualified and specialized medical care.
In the same time for this system has some drawback:
Ø The raised risk of nosocomial infections. Difficulty of isolation of departments with a various structure, presence of ascending flows of bacterial aerosols, intensification of loading on hospital environment lead to increased risk of disease.
Ø Deterioration of conditions of hospital environment. High concentration of technical equipment makes excessing of noise level. The microclimate of the top floors could be overcooling because of power wind drafts.
Ø The architectural flexibility of the centralized system is low usually.
The decentrilized system is characterized by organization of various functional departments in separate houses.
The essence of pavilion system is the arrangement of separate functional departments in 2-3 floor-houses. The basic advantage of this system is:
· Good isolation of various departments, that allows to prevent occurrence of nosocomial infections,
· Good conditions for observance medical care regimen
However, nowadays they were compelled to refuse decentralized system. It is connected with:
· The large expenses on building works and technical equipment
· Reduction of garden zone
· Increase of the length of movement for the personnel and patients. There are some technical decisions for reduction of the routes of the personnel, in particular underground type of communication, but it does not solve a problem
Presently most perspective is the mixed system of construction. It unites features of centralized and decentralized system. It has the most flexible architectural planning.
The territory of hospitals, maternity houses and other in-patent institutions should have convenient access roads with a firm covering. Internal roads and foot paths should be covered by the concret or asphalt.
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.
In territory of infectious hospital (department) should be allocated a "clean" and "dirty" zone isolated by one from one strip of green plantings. On departure from a "dirty" zone there should be stipulated platforms for desinfection of transport.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. All hospitals should be equipped by centralized water supply, ssewege system, ventilation (if it’s necessary - by systems of air conditioning), rubbish-collector with rubbish chamber, elevators as needed, electrical and telephone networks. If necessary they use centralized vacuum rubbish collectors and other equipment.
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 houses of medical and patrimonial houses should be equipped with systems of balanced ventilation, except for infectious departments. In the last should be established the exhausting ventilation. The exhausting ventilation from chambers has to be carried out through individual channels, which prevents of air movement by the vertical.
They use exhausted from operational, narcosis, resuscitation, patrimonial and X-ray rooms, as a rule, from two zones: 40 %- from upper zone (10 cm. from a ceiling), 60 %- from the bottom zone (on 60 cm from a floor) in view of allocation in these premises of gases and steams, which can form explosive mixes, or difficult positively charged ions.
Ventilation systems in operation, narcosis, resuscitation, maternity and other wards with severe sanitary should be equipped with bacterial filters.
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.
The operational block
The operational block is structural unit of hospital using for surgical operations.
The operational blocks are divided into general and specialized (traumatologic, cardiologic, neurosurgical). By an attribute of presence one department (aseptic) or two (aseptic and septic) operation room are divided on aseptic and combined.
The operational block has such functional zones:
І. The sterile zone: an operational room
ІІ. A zone of restrictions
ІІІ. A zone of the limited access:
Nosocomial infections (i.e., infections acquired in the hospital) have become acute problem in human medicine because of increases in drug-resistant microbial strains and increases in the use of invasive procedures for patient support and monitoring. Compliance with handwashing protocols is perhaps the most important means of preventing nosocomial infection. Careful attention to aseptic technique and judicious use of antibiotics are also essential.
Nosocomial infections (NI) -infectious diseases connected to stay, inspection and treatment in medical-preventive institutions or reference (manipulation) in these for the help.
The concept "hospitalismus", which quite often use as a synonym of the term "hospital infection ", is wider and unites all diseases caused by specificity of environment of medical institutions. There are traumatic hospitalismus, mental (psychogenic) and infectious hospitalismus (NI). Joining to the basic disease, nosocomial infections worsen its decursus and prognosis.
The transfer of microorganisms can occur:
1. by an aerogenic way.
2. by fecal-oral way
3. by parenteral introduction
4. by the contact
Among directions of preventive maintenance of NI it is possible to allocate two basic:
· Unspecific preventive maintenance - covers architectural - planning measures, sanitary - antiepidemic measures, sanitary - technical measures;
· Specific prevention (immunization) - will be carried out in the scheduled order. It’s used an active immunization (vaccine, anatoxines less often; more often - passive immunization (immunoglobulini).
You know that on the hospital area they provide some functional zones. The infectious departments should be isolated from non-infectious. The currents of movement for "pure" and "dirty" (suspicious for communicable diseases) patient should be also isolated from each other according to a principle of one-way flow. It’ very important how departments are distributed by the floors. Departments requiring aseptic conditions (surgical, maternity, neonatological) should be placed on the first floors of a hospital building. At the arrangement of operation - reanimation complex septic operations have to be placed above aseptic. In infectious cases of departments intended for hospitalization of the homogeneous patients they place them by the floors, thus the most contagious patients (with aerial infections) are placed in the top floors.
Sanitary - antiepidemic measures provide health promotion activity among the patients and personnel, monitoring of an epidemic situation, including revealing vira- and bacteria carriers. With this purpose the system of the previous and periodic (current) medical surveys is introduced. So, pupils of medical schools, the students of medical high schools during practice should pass obligatory physical examination with participation of physician, dermatovenerologist, they have to make fluorography (if this research was not taken during the previous 6 months), analysis feces on carriage of intestinal infections and helmints eggs, and the persons are more senior than 18 years - on HIV, RW and urethral (for women also vestibular and vaginal) smear on Neisseria gonorrhoeae.
Before practice in maternity houses, newborn wards, children's hospitals (departments), surgical departments etc. it is necessary to pass inspection of stomatologist, otholaringologist with an obligatory capture smears on staphylococci tests (from a nose and fauces)
Prior to the beginning work in maternity houses, children's hospitals and other MPI medical workers should to pass inspection including fluorography (6 months), RV and tests on gonorrhea, analysis on HIV they repeat every year, carriage of pathogenic staphylococcus and RW -too, tests on gonorrhea and analysis on HIV - 1 time per 6 months, on carriage - 1 time per 6 months will be carried out.
All hospitals should be supplied with a linen - accordingly of sheet of equipment at enough. Change of a linen by the patient should be carried out in process of its pollution, regularly, but not less once for one week. Polluted linen should be changed immediately. The change of bed-clothes for delivered women should be carried out 1 time per 3-4 days, body linen and towels - daily, under napkins - by the necessity. Change of a linen by the patient after operation should be carried out regularly to the discontinuance of exudation from wounds.
In maternity hospitals (patrimonial blocks and other premises with aseptic mode for newborn) should be used a sterile linen.
The temporary (not more than 12 hours) preservation of dirty linen in departments could be provided in the shut container (metal, plastic boxes, dense boxes, and other capacities, which are subject of disinfecting). For work with a dirty linen the personnel should be supplied sanitary clothes (dressing gown, cap, mask, glove).
The clean linen should be stored in the special premises, deduced for it. In departments they should have a daily stock of a linen. Linen and container should be marked.
The washing of a hospital linen should be carried out by centralized way in special laundries at the hospitals. The washing of a linen in medical institutions is carried out in conformity with the instruction on technology of processing of a linen of medical establishments at factories – laundries.
The washing of hospital linen in urban municipal laundries on a condition of allocation on them of special technological lines is supposed which exclude an opportunity of contact of hospital linen with not hospital. The linen in infectious, observation and purulent - surgical departments before washing should give in disinfecting in special premises by processing of disinfecting solution in washing machines.
After recovery of the patient, his death, and also for the prevention of pollution a mattress, pillow, the blankets should be changed and a disinfected.
At the reception ward all in-patients will pass special sanitary processing in acceptance branch (acceptance soul or baths, the cutting of nails and other procedures) by the necessity. It depends on results of the examination. They give to each patient soap and wiping bast for personal use. After sanitary care the complete set clean body linen, pajamas, shoes (slippers) is given out to the patient. They keep the personal clothes and the footwear for safety in special container with hangers (polyethylenic bags, covers with a dense fabric etc.) or it is transferred to preservation to its relatives or familiars.
Washing of the patient is carried out not less than 1 time per week with marking in the case history. Hygiene of the seriously ill patients (washing, wiping of a skin of the person, parts of a body, rinsing oral cavity etc.) will carry out constantly after the meal and at pollution of a body. It should be organized a hair dressing and shaving for the patient. Each patient should be supplied with a personal towel and soap.
The serving medical personnel of hospital, patrimonial houses and other medical institutions should be supplied complete sets of the replaceable worker (sanitary) clothes: dressing gowns, caps, replaceable shoes (slippers) in quantities, that provides daily change sanitary clothes. All medical personnel of medical or patrimonial institutions have to be faultlessly tidy and accurate, edge of the worker (sanitary) clothes should completely close personal (home) clothes. The hair should completely be covered with caps. Change of footwear of the personnel of operational, patrimonial blocks, resuscitation, dressing rooms and newborn departments should be with non-fabric material, suitable for desinfecting.
The doctors, nurses should wash hands before the examination of each patient or performance of procedures, and also after "dirty procedures " (cleaning of premises, change of the patient linen, visiting of a lavatory etc).