METHODICAL INSTRUCTION FOR STUDENTS OF THE 6 COURSE
MEDICAL FACULTY
LESSON № 1 (PRACTICAL – 6 HOURS)
Themes: 1. Basics lows and tasks of the hygiene. Evaluation of the medical-prophylactic establishments. Sanitary-hygienic requirements for the planning and building of the medical-prophylactic establishments.
2. Modern problems of intrahospital infection and principles of it prophylactic. Hygienic estimation of working conditions of the medical personnel in medical-prophylactic establishments.
Aim: 1. To know on the hygienic conditions and harmful factors influencing the efficacy of patients’ treatment and medical workers’ health.
2. Become familiar with the legislative and organizational measures of the provision of the optimal regime, hygienic conditions for patients of the in-patient departments and the medical workers’ labour protection.
Master the general scheme and methods of subjective (sanitary inspection) and objective sanitary control of the conditions of patients’ stay and the conditions of medical personnel labour at the hospital.
3. To know the general scheme and methods of subjective (sanitary inspection) and objective sanitary control of the conditions of patients’ stay and the conditions of medical personnel labour at the hospital.
PROFESSIONAL ORIENTATION OF STUDENTS
One of the most important parts of the preliminary sanitary inspection is the examination of the projects. Especially great significance has sanitary examination of hospital projects the aim of which is achieving of further improving of public medical service, ensuring of medical protection regimen, infection warning in hospitals.
Hygienic standards concerning planning creation and organization the work of medical-prophylactic establishments. The process of creation optimal hygienic conditions in medical-prophylactic establishments are defined by the peculiarities of planning and building on the plot regulation and inside planning of the buildings, their sanitary-technical improvements, and also sanitary condition during maintenance.
Improving the conditions for the patients in hospital, medical service for the population; providing treatment-security regimen, preventing nosocomial (hospital) infections – depend upon the conformity of the hospital design with the hygienic requirements. Work of medical workes and doctors as particular is characterized of big intellectual loading, demand a lot volume of operative and lasting memory and demands a lot of responsibility for the life and health of patients. The occupational exercise load and hazards of the surgical specialties doctors include: - the number of surgical interventions – up to 150 per year in general surgery, 170 – in otorhinolaryngology, 370 – in obstetrics and gynecology. The number and complexity of the operations increase with the raising the level of the surgeon’s skill; - the forced body position with the trunk frontal bending and the prolonged static tension of muscles of the shoulder girdle, back and stretched forward arms; - the hot microclimate of the operating room with high streams of the radioactive heat from the artificial lighting sources (shadowless lamp); - the ionizing radiation during the X-ray examinations, especially in traumatology, vascular surgery, neurosurgery; - the toxic effect of the narcosis agents (nitrous oxide, halothane, chloroform, diethyl ether) and anesthetics; - high mental and nervous-emotional exertion, connected with the complexity and duration of the surgical intervention, possible post-operative complications and responsibility for patient’s life.
Among the diseases afflicting the surgical specialties doctors with temporary disability the most widespread are the diseases of nervous system, cardio-vascular system, digestive system and acute respiratory diseases. A considerable amount of peoples uses food in establishments of catering, to which also hospitals nutritional sections, schools, child gardens and other founding. That's why to doctors of very different professions must to know organization principles of catering and to have by practical acquired habits from control for observance hygienic of demands to their work.
It is known, that more than a half of professional diseases of the doctors - (59,8 % and more) is caused by physical and mental overstrain, and also the influence of the chemical factors.
METHODOLOGY OF PRACTICAL CLASS (900-1200 hour).
I. Theme № 1. “Evaluation of the medical-prophylactic establishments. Sanitary-hygienic requirements for the planning and building of the medical-prophylactic establishments”
1. To acquaint with main symbolic signs in building drawings.
2. To examine situational plan of locality, direction of dominant winds, level of isolation from residential areas, existence of enterprises which pollute air on the territory of a hospital with dust and gases, existence of noisy streets and roads, railroads, aerodromes.
3. To examine general plan of a hospital, to determine harmony of sizes with hygienic standards building and planting trees and shrubs percentage on the plot, approaches to separate blocks zoning of the plot, rational arrangement of hospital blocks managerial buildings on the plot and gaps between them.
4. To give the conclusion on the typical project of hospital, accordance of hygienic norms. To mark failing and dates concrete and grounded suggestions on the improvement of project.
5. To written the act of sanitary inspection of the general plan of hospital
II. Theme № 2. “Modern problems of intrahospital infection and principles of it prophylactic. Hygienic estimation of working conditions of the medical personnel in medical-prophylactic establishments”.
1. Estimate working conditions of the medical personnel and a sanitary condition of hospital establishment (according to inspection of treatment-and-prophylactic establishment). To prepare the laconic report by results of sanitary inspection of hospital and operating conditions of the medical personnel in it.
2. Estimate working conditions of the doctor according to a situational task.
3. To calculate the basic indexes of health of population.
To risk factors of developemtn of hospital infection belong:
(1) time of operation
(2) infication of the wound
(3) length of incision
(4) usage of drenages
(5) old age of patients
(6) time of hospotalization before the operation
(7) usage of antibiotics
(8) presence of diabetes mellitus
(9) malignant formations.
INDIVIDUAL STUDENTS PROGRAM
I. Theme № 1. “Evaluation of the medical-prophylactic establishments. Sanitary-hygienic requirements for the planning and building of the medical-prophylactic establishments”
Control questions:
1. Kinds of sanitary inspection .
2. Main stages of preliminary sanitary inspection (set aside a building plot, consideration of design documentation, building attendance).
3. Hospital building systems, their advantages and disadvantages.
4. Sanitary examination of hospital building, the analysis of projects.
5. Circumstances for choosing a building plot for medical-prophylactic establishments.
6. Main materials for sanitary examination of designs for building hospitals (explanatory note, general plan, situational plan, plans of story and sketches of facade plan).
7. Functional zones of hospitals territory.
8. Hygienic requirements concerning the planning, sanitary appliance, optimal regime of exploitation of the therapeutic, surgical departments, the operating block .
9. Hygienic peculiarities of planning, sanitary appliance, optimal regime of exploitation of the infectious, children’s, phthisiatric and other specialized departments.
10. Hygienic requirements to a sanitary regime of the basic departments and rooms in hospital.
11. Hygienic requirements to the organization of doctor’s work of different profile (the surgeon, the gynecologist, the pediatric, the therapist, the family doctor) and nurse.
12. Occupational hazards, hygiene and labour protection of different medical departments (surgical, therapeutic, infectious diseases, psychoneurological and others) medical personnel.
II. Theme № 2. “Modern problems of intrahospital infection and principles of it prophylactic. Hygienic estimation of working conditions of the medical personnel in medical-prophylactic establishments.”
Control questions:
1. Hygienic requirements to internal planning therapeutic, surgical, obstetrics and gynecologic, children's and infectious departments of hospital.
2. Hygienic requirements to a sanitary regime of the basic departments and rooms in hospital.
3. Hygienic requirements to the organization of doctor”s work of a different profile (the surgeon, the gynecologist, the pediatrist, the therapist, the family doctor) and nurse.
4. Preventive maintenance of the diseases which connected with professional work of the doctor and nurse.
5. Preventing nosocomial (hospital) infections in specialty departments of a hospital.
6. Sanitary culture of patients and medical staff,
7. Correct providing of bacteriologic control, revealing among the.
8. Hygienic and Sanitary regime in surgical profile.
9. Delivery of patients is provided in separate room
10. Diseases of Hospital infection
11. Ways of transmittance of hospital infections
12. Sources of hospital infection.
SEMINAR DISCUSSION OF THEORETICAL ISSUES (1230 – 1400 hour).
1. Kinds of sanitary inspection .
2. Main stages of preliminary sanitary inspection (set aside a building plot, consideration of design documentation, building attendance).
3. Hospital building systems, their advantages and disadvantages.
4. Sanitary examination of hospital building, the analysis of projects.
5. Circumstances for choosing a building plot for medical-prophylactic establishments.
6. Main materials for sanitary examination of designs for building hospitals (explanatory note, general plan, situational plan, plans of story and sketches of facade plan).
7. Functional zones of hospitals teritory.
8. Hygienic requirements concerning the planning, sanitary appliance, optimal regime of exploitation of the therapeutic, surgical departments, the operating block .
9. Hygienic peculiarities of planning, sanitary appliance, optimal regime of exploitation of the infectious, children’s, phthisiatric and other specialized departments.
10. Hygienic requirements to a sanitary regime of the basic departments and rooms in hospital.
11. Hygienic requirements to the organization of doctor’s work of different profile (the surgeon, the gynecologist, the pediatric, the therapist, the family doctor) and nurse.
12. Occupational hazards, hygiene and labour protection of different medical departments (surgical, therapeutic, infectious diseases, psychoneurological and others) medical personnel.
13. Hygienic requirements to internal planning therapeutic, surgical, obstetrics and gynecologic, children's and infectious departments of hospital.
14. Hygienic requirements to a sanitary regime of the basic departments and rooms in hospital.
15. Hygienic requirements to the organization of doctor”s work of a different profile (the surgeon, the gynecologist, the pediatrist, the therapist, the family doctor) and nurse.
16. Preventive maintenance of the diseases which connected with professional work of the doctor and nurse.
17. Preventing nosocomial (hospital) infections in specialty departments of a hospital.
18. Sanitary culture of patients and medical staff,
19. Correct providing of bacteriologic control, revealing among the.
20. Hygienic and Sanitary regime in surgical profile.
21. Delivery of patients is provided in separate room
22. Diseases of Hospital infection
23. Ways of transmittance of hospital infections
24. Sources of nosocomial infection.
TEST EVALUATION AND SITUATIONAL TASKS
TEST QUESTIONS:
1. What are the kinds of sanitary inspection?
A - precautionary
B - current
C – mixed
D- external
E-internal
2. The area of hospital building must be :
A - 12-15%,
B– 15-30%,
C– 40-60%
D- 20-70%
E- 50-90%
3. What kind of the main systems of building hospital complexes is not presents
A. decentralized,
B. centralized,
C. mixed;
D. decentralized- industrialized housing construction;
E. centralized-industrialized housing construction.
4.The minimum quantity of entrances to hospital territory.
A. One.
B. Two.
C. Three.
D. Four.
E. Five.
5. Who one of the following pregnant women is not reception in observation department of the maternity house
A. acute respiratory disease
B. at absence of the medical documentation
C. skin diseases of infectious ethyology
D. long waterless interval
E. Fe-deficient anemia.
SITUATION TASKS
City hospital consists of main corps (surgical
and therapeutic separations) and a few corps for the infectious, maternity,
child's separations. The therapeutic and surgical separation is had on two ward
sections, in each are 40 beds In every section are 10
wards for 4 beds. An area on one bed is
To define the type of building of hospital, to give hygienical estimation to planning. To indicate, which still indexes are needed for estimation of work conditions of medical personnel.
CORRECT ANSWERS OF TEST EVALUATIONS AND SITUATIONAL TASKS:
1 - A, 2-B, 4 - A , 4 -D, . 5 – B
Answer on situation task:
Type of
building of hospital is mixed. Ward sections have more of beds (it is
recommended to 30), absent to flame for seriously sicking
on 1-2 beds, area for 1 bed insufficient (it is to be not less than
Individual student work (1415-1500 hour) are checked by solving situational tasks for each topic, answers in test evaluations and constructive questions (the instructor has tests & situational tasks).
INITIAL LEVEL OF KNOWLEDGE AND SKILLS
The student must know:
1. Kinds of sanitary inspection.
2. Preventive sanitary inspection of the patient care institutions’ project and building; its main stages. Constituents of the project.
3. Hygienic requirements concerning the location of the hospital within the settlement taking into account the adjacent objects and “wind rose”.
4. Hygienic requirements concerning the hospital area general plan, the territory functional zoning, accomplishment, density of housing and green area.
5. Modern systems of the hospitals site development, their comparative characteristics, influence on the exploitation and equipment conditions.
6. Hygienic significance of the hospital constructions and departments’ internal planning for the provision of the personnel labour and patient treatment hygienic conditions.
7. Hygienic requirements concerning the planning of the hospital admission departments; its significance for the exploitation regime and the hospital nosocomial infections prevention.
8. Hygienic requirements concerning the planning and the work regime of the therapeutic, surgical and infectious diseases departments.
9. Hygienic characteristics of the ward sections, the requirements for these sections rooms at different departments.
The student should how:
1.To estimate conformity of internal planning of hospitals to hygienic requirements.
2.Using the construction drawings of the situational and general layout to determine and assess the project patient care institutions’ location and territory zoning, taking into account objects, adjacent to the land parcel, “wind rose”, correspondence with the site development, percentage of green area and the constructions’ orientation
3.Using the constructions’ plans and slits to determine and assess the correspondence of the hospital premises’ area, cubic capacity and sanitary accomplishment to hygienic standards; their correspondence to the functional purpose.
REFERENCES:
1. Practical classes materials
2. Hygiene and human ecology. Manual for the students of higher medical institutions/ Under the general editorship of V.G. Bardov. – K., 2009. – 668 p.
3. Kozak D.V., Sopel O.N., Lototska O.V. General Hygiene and Ecology. – Ternopil: TSMU, 2008. – 248 p.
4. William P. Cunningham, Barbara Woodworth Saigo. Environmental Science: A Global Concern / third edition. – Wm. C. Brown Publishers..
5.
6.
Health Hazards Of The Human
Environment. – World Health Organization,
7. A hand book of Preventive and Social Medicine. – Yash Pal Bedi / Sixteenth Edition, 2003 – p. 26-36, 92-97.
8. Lecture on hygiene.
Methodical instruction has been worked out by: ass-prof. Sopel O.M.
Methodical instruction was discussed and adopted at the Department sitting
30 august 2011, Minute № 1
Methodical instruction was adopted and reviewed at the Department sitting
28 august 2013, Minute № 1