Hygiene of medical establishments, their

planning and equipment. Modern problems in

hospital building. Hygienic measures of

optimization of terms of stay of patients are in

medical establishments.

A hospital is an institution for health care providing patient treatment by specialised staff and equipment, and often but not always providing for longer-term patient stays.

TypesSome patients in a hospital come just for diagnosis and/or therapy and then leave ('outpatients'); while others are 'admitted' and stay overnight or for several weeks or months ('inpatients'). Hospitals are usually distinguished from other types of medical facilities by their ability to admit and care for inpatients.

GeneralGeneralThe best-known type of hospital is the general hospital, which is set up to deal with many kinds of disease and injury, and typically has an emergency department to deal with immediate threats to health and the capacity to dispatch emergency medical services. A general hospital is typically the major health care facility in its region, with large numbers of beds for intensive care and long-term care; and specialized facilities for surgery, plastic surgery, childbirth, bioassay laboratories, and so forth. Larger cities may have many different hospitals of varying sizes and facilities.

Specialized Specialized

Types of specialized hospitals include trauma centers, rehabilitation hospitals, children's hospitals, seniors' (geriatric) hospitals, and hospitals for dealing with specific medical needs such as psychiatric problems (see psychiatric hospital), certain disease categories, and so forth.

TeachingTeaching

A teaching hospital (or university hospital) combines assistance to patients with teaching to medical students and is often linked to a medical school.

ClinicsClinics

A medical facility smaller than a hospital is generally called a clinic, and is often run by a government agency for health services or a private partnership of physicians (in nations where private practice is allowed). Clinics generally provide only outpatient services.

The patient care institution site development area is selected taking into account several reasons- a distance from the farthest settlements of the population service zone: land plot must be connected with population service zone favorably (patient must be taken to the hospital in no more than 30 minutes);

- a distance from the possible air or soil pollution sources; the sources of noise, vibration, the emission of the industries, airports, railway stations, speed motorways and other, taking into account their sanitary and protection zones and “wind rose”;

- usage of the existing green area (park, wood);

- a flat countryside or a flank of hill towards the Southern points and others.

The most suitable form of the hospital group of buildings land site is a rectangular one – with the sides’ ratio 1:2 or 2:3. The long axis should be oriented from the East to the West or from the North-East to the South-West (it provides the hospital constructions wards’ orientation towards the Southern points, but the operating rooms, delivery rooms, laboratories and X-ray departments – towards the Northern points (to prevent dazzling and overheating by solar rays).

Selecting the area, one should take into consideration the possibility of the hospital constructions joining the existing systems of water, sewerage, electricity, gas and heat supply, passages and drive conveniences.

Number of beds

Area norm per 1 bed, m2

Number of beds

Area norm per 1 bed, m2

up to 50 300 > 400 to 800 100-80

> 50 to 100 300-200 > 800 to 1 000

80-60

> 100 to 200 200-140 > 1 000 60

>200 to 400 140-100

The site land area depends on the power, specialization and system of the hospital group of

buildings site development

Systems of hospital site Systems of hospital site development are:development are:

decentralized (pavilion), centralized, mixed, centralized-blocked – the best system of hospital

Decentralized (pavilion) type of hospital

each department is situated in the separate building;

The positive feature of the decentralized system is the possibility of patients to stay more outdoors;

the drawback is the difficulty during the usage of the diagnostic, physiotherapeutic measures or their doubling, which increases the capital expenditure.

Centralized system

all departments are situated in one (semidetached) building;

The drawback of the centralized system is the difficulty of nosocomial infections prevention,

Decreased time or impossibility of the patients to stay outdoors.

Noise

Mixed system of hospital mixed, when the majority of departments

are situated in the central building but some separate ones (infectious diseases, children’s, psychiatric departments and so on) – in the isolated buildings.

Centralized-blocked system of hospital

Such version ensures both centralization of medical processes and using of equipment and realization of a principle of isolation of separate medical departments.

The site land project of the patient care institution includes the following zones:•a zone of the patient care buildings for non-infectious patients;•a zone of the patient care building with infectious diseases;•a polyclinic zone;•a zone of morbid anatomical department;•a household zone;•a landscape zone.

•The infectious, obstetric, children’s, tuberculosis and psychiatric departments should have separate landscape zone of their own.

The hospital site housing density depending on the amount of beds should not exceed 10 – 15 %. Up to 60 – 65 % of the area should be occupied by all kinds of green area; 20 – 25 % - a household zone, passages and passageways. The size of the landscape zone should be not less than 25 m2 per one bed.

Hospital consist from next Hospital consist from next department:department:

1. Reception department;

2. Treatment and surgery department, genecology , children, infection, emergency, radiology department and other

3) Policlinic ;

The building of the policlinic must be location on distance 30—50 m from hospital. Entrance must be separate.

4) Treat mentally and diagnostically departments with department functionally diagnostic, x-ray diagnostic, physiotherapy and rehabilitation department;

5) Pathological department;

6) Sterilization department and garage and other

7) Administration department, library, addition department and economical department.

between the walls with wards and doctors’ rooms windows – 2.5 of the opposite building height but not

less than 25 m; between the radiological building and other ones – 25 m; the morbid anatomical building and a household one – at the distance of 30 m from other buildings, residential including; between the buildings’ flanks – not less than 30 m, from the polyclinic, women’s consulting center and health centre – not less than 15 m.

The distances between the hospital buildings should be the following:

Bars of the green planting must be located between the functional areas of hospitals and to make 15 ì. the Sanitary break between medical corps and харчоблоком, by a pathoanatomical corps and defence zonal of the green planting - not less than 30 ì. the Pathoanatomical department with a morgue is placed in the isolated place which not evidently from the windows of hospital.

Before main included in a hospital it is necessary to foresee modern grounds for visitors from the calculation of 0,2 м2 on a 1 bed, but not less than 50 м2, and also for the motor transport of employees and visitors – not nearer 100 m codes from chamber corps

From a leeward and below after a hypsography, in the distance 30-40 m codes from hospital houses, dispose an economic yard with a central boiler room, laundry, disinfection chamber, garages, storage facilities, vegetable store. An economic yard is insulated from other areas the bar of the green planting in 8—10 ì. a width

A policlinic consists of to the vestibule-locker room, hall and medical cabinets. For expectation corridors are utilized in not less than 3,2 m codes a width, which well light up and get some fresh air.The low-limit of medical cabinet make 12 м2, and the specialized cabinets – 15-18 м2. Windows must not go out of noisy doors and north rhombs.

Wall an operation must be smooth and shiny, easily to wash and added irrigation disinfection solutions. All of types of wiring and heater devices are assembled in walls. It is recommended to dye walls and ceiling a light mat oily waxen paint which removes light reflections and does not tire the eyes of surgeon. A floor is inlaid a tile with small inclination to the ladder. In an operating-room it is desirable to have two doors: one - for an import patient with an operation, and second, in a lateral wall, - for an export operated.

The windows of operating-room orient on north rhumbs. A light coefficient must make 1:3 -1:4. Operating-room it is needed densely to push an a door to.

It is needed, that a microclimate answered the requirements of comfort. Temperature of air in summer in an operating-room must be +20-22 °C(in winter -19 -20 °C) at humidity 50-55 %, the rate of movement of air must not exceed 0,1 m/sec It is better to arrange heating of operating-room aquatic radiation with the location of panels on ceiling or to the floor.

All of equipment which enters operating-room is needed preliminary disinfected, and instruments and materials for bandaging - sterilized. Very perspective is a method of gas disinfection, for example by the oxide of etalon, however much he lasts a few hours. After the operation of apartment with application take away, ventilate carefully, a floor and panels is washed disinfection solution and hot water.

An obstetric separation plugs in the structure maternity and post-natal physiology observation separations, separations pathologies pregnant, and also separations for new-born. Chamber sections are here designed in obedience to requirements to the common somatic separations for adults.

Infections department has two entrance: the first-for patients; the second-for personal.

In the infectious diseases units the following rooms should be equipped: box wards (with every bed isolation), semi-boxes (the isolated wards with common lavatory and bathroom), and absolute boxes (the isolated wards with lavatory and bathroom).

Infections department

Isolator consist of ward, lock, tambours and restroom. Square of box is 22 m2.

Surgical department

The operating block of a surgical department should be situated in the blind-ended projection or in the separate outhouse of the hospital

In the operating block there should be following rooms: the operating room – 30 m2 (on the basis of 30-50 surgical beds in the department; for the complex operations – 40-45 m2)

•the pre-operating room – 10-12 m2, •the sterilizing room (one for two operating ones), •the anesthetic room – 15 m2, •the instrumental room, •the surgeon’s room (for protocols), •the laboratory of the express tests,•the plaster dressing room, •the room of the mobile diagnostic,

resuscitative apparatuses and the anesthetic equipment, the premises for the sterile and used operating linen, the washing and shower room for the operating brigade, the postoperative resuscitative wards, the lavatories for personnel, the operating nurse’s room and others depending on the surgical department type.

Illumination of an operational table has great importance. Devices in operational lamps allow to change direction of light rays. Due to dispersion of heat with the help of system of glasses and presence of air layer between them, these lamps do not get heated. If it is necessary to have additional illumination of lateral surfaces of the operational field, mobile and portable lamps are used. The illumination is duplicated by emergency network working from a battery.

Children’s departments

The special group of hospital establishments is made by radiological separations. Them there are six types:are X-Ray and diagnostic controlled from distance radial therapy radial therapy by the closed X-Ray nuclides, radial therapy by the opened X-Ray diagnostic with the use of the closed X-Ray nuclides separations are mixed.

The most widespread radiological establishments are X-Ray and diagnostic cabinets or are X-Ray and diagnostic separations. Work in them must provide radiation safety an auxiliary personnel and people which are in contiguous apartments. The average daily dose of irradiation for doctors-X-Ray diagnostic must make 3,5 Ber on a year, and for laboratory assistants - 3 (at GDD-5 Ber).

The radiological separations of other types place in the isolated annex or separate house. Their planning foresees four groups of apartments: for diagnostics of ionizing radiations the opened sources, radial therapy opened and closed, controlled from distance radial therapy.

Hygienic requirements

concerning hospital departments

Each hospital department is intended for patients with similar diseases. It should include: ward sections for 30 beds, with 6 wards for 4 beds with the area of 7 m2 per bed, 2 wards for 2 beds with the area of 7 m2 per bed wards2 wards for 1 bed with the area of 9-12 m2 for severe somatic and infectious patients, with the cubic capacity of 20-25 m3 for each patient and the ventilation volume – 40-45 m3/hour.

Except the wards in the ward sector there should be• a room for patients’ day-time stay (area of 25 m2), •glazed verandah (30 m2) and medical accessory premises:• the doctor’s room (8-9 m2), •the procedure and manipulation room (12-15 m2), •the medical nurse’s station (4 m2), and• in the surgical departments sections – dressing rooms (pure and purulent). •Dinner room (for two ward sections with the area of 18 m2), • a room for clean and dirty linen (each of 4 m2)• a lavatory with a bathroom (10 m2), • a lavatory for patients and for personnel, • a sanitary room (6-8 m2), and • a corridor.

There can be two types of the corridor: a side one with windows facing towards the Northern points, or a central – with light gaps (halls).

The nurse workplace is located in the corridor in order to supply a good review of the wards.

But there should be 1-2 wards with the orientation towards the Northern points for severely ill patients or patients with fever. Beds should be located parallelly to the light conductive wall for a patient to be able to turn back from the dazzling effect of the direct solar radiation.

The optimal ward windows orientation in the Northern hemisphere is the South-East or South.

Natural ward lighting should provide the daylight factor (DF) of not less than 1%, the lighting coefficient (LC) 1:5 – 1:6; in the procedure, manipulating, dressing and operating – DF respectively is 1.5 – 2 %, LC – 1:3 – 1:5.

The artificial lighting should be general, 30-60 lux, and the night light – 10-15 lux with lamps in the lower part of the walls.

Artificial illumination by the incandescent lamps should be not less than 30 lx in the wards, 100 – 150 lx in the procedure, manipulating and dressing rooms, 200 – 1 000 lx in the operating rooms.

The optimal air temperature in the wards in winter and during the transitional period should range from 19 to 22°C, the relative humidity should be 40-60 %, the air movement speed within the limits of 0.05-0.1 m/sec. In the nursery, post-operative wards, burns units and in case of fever of the infectious patients the air temperature should be a bit higher – 22 – 25°C, and for patients with thyrotoxicosis – lower – 18 – 22°C.

The wards ventilation should be achieved by means of exhaust ventilation ducts, presence of window leaves and windows which can be opened; the modern hospitals should be equipped with air-conditioners.

A sanitary knot must be equipped умивальнею, by bath, dressing-room and auxiliary apartment. Three dressing-rooms are needed: masculine with an urinal, womanish with an ascending shower and for a medical personnel. That smells from a sanitary knot did not get to the chamber corridor, he is provided drawing ventilation, but not ventilate through small hinge window pane or windows are opened. The apartments of sanitary knot must have natural illumination, floors lay out a tile, panels in high not a less than 1,8 mcode draw an oily paint, but yet better lay out a facing tile.

For efficient patient treatment and the medical personnel labour the air clearness in the wards, operating, dressing, procedure rooms and others is of great importance. The allowable CO2 concentration in the hospital premises being an index of air pollution by the vital functions products of the patients and personnel, excreted by skin and during breathing, also with dust and microorganisms, should range within the limits of 0.07 – 0.1 %.

Indices of hospital air pollution, such as air oxygenation (20 – 24 mg O2/ m3 ) and the microbial figure (500 – 1 000 per m3 in the operating room, up to 3 500 per m3 in the wards), also have been calculated and scientifically substantiated.

The treatment protective mode of permanent establishment includes the followings elements:

providing of the mode is a thrift of psyche of patient; adherence of rules of internal order of day; providing of the mode rational physical (motive) to activity.

HospitalismBe are what physical, psychical,

infectious disorders of health of man, conditioned the features of medical

service.

Physical Psychical

Accident Hospital infection

Hospital cultures are adapted

Hospital cultures are unadapted

sporadic endemic epidemic

Hospitalism

Intrhospital (nosocomial, hospital) infection

any clinically recognized disease of microbial etiology is related to the stay, treatment, inspection or appeal of man for medical help in hospital.

Exciters of intrahospital (nosocomial, hospital) infections

Staphylococcuss, streptococci, blue pear stick, proteus, клебсела, collibacillus, salmonella, enterobacteria, enterococcus and other de bane ease pathogenic microorganisms.

And also viruses of flu, adenoviruss, rotaviruss, enteroviruss, exciters of viral hepatitis et al

ESCHERICHIA COLI

Distribution of certain exciter in development of infection can be related to the type of medical establishment

In permanent establishments of general surgical type are gram-negative bacteria, in particular blue pear

in urology separations is a coli bacillus, enterococcus and others like that.

ESCHERICHIA COLI

Distribution of certain exciter in development of infection can be related to the type of medical establishment

Blue pear sticks prevail in ambustial separations.

in separations new-born find staphylococcus, enterococcuss.

STAPHYLOCOCCUS AUREUS

Sources of infection: patients personnel visitors apparatus instruments linen et cetera

Patients can be infected pathogenic factors both from an external environment and own in the case of hyposthenic immunity

Ways of іinfection`s patients

air-dustborne; - (through the articles of examination, linen, medical

instruments, apparatus, hands of medical personnel);

- (at introduction of medicinal preparations, solutions and others like that);

-alimentary (products, water and others like that).

Ways of transfer of intrahospital infections

PATIENT

Objects materials

animals and others like that

Personnel visitors patients

Except for control after the observance of sanitary-hygenic requirements in relation to apartments, personal hygiene it is

necessary to conduct: - timely exposure and

sanation of transmitters of pathogenic staphylococcus: one time in a quarter obligatory inspection of employees on the transmitter of pathogenic staphylococcus for the medical staff of surgical separations and maternity hospital, and at origin of infection – on the measure of necessity;

- safety measures at AIDS and disease mode (order ¹ 486), measures of infection(order ¹ 120);

- observance of rules of asepsis and antiseptic;

control after patients with an exposure in them of pediculosis and them

Pediculosis treatments (order ¹ 410), teniosisу, infectious diseases, to hepatitis and others like that;

Heterospecific prophylaxis Specific prophylaxis

Prophylaxis of in-hospital infections

Architectonically plan measures

Tekhnichni measures

Sanitary disease

measures

Dezinfekciyno-sterilizaciyni

measures

Pla

nn

ed

Ekstr

en

na

IMMUNISATION

Architectonically plan measures

Isolation of sections, chambers, operating blocks but other

Observance of streams sick, personnel

A rational location of separations is on floors

Zonuvannya of territory

Tekhnichni measures

Ventilation: (reveal, drawing, mixed, кондиціювання, equipments of ламінарні and others like that)

Sanitary disease measures

An exposure of transmitters is among a personnel and patients

Control is after the sanitary state and mode of permanent establishments

Sanitary educational work is among a personnel and patients

Control is after the bacterial semination of in-hospital environment

Dezinfekciyno-sterilizaciyni measures

Usephysical methods Use

chemical facilities

Tooling

д