Hygiene of medical-preventive
institutions
Hospital hygiene, as a branch of hygienic science:
history, content, tasks, principles and modern problems
Hygienic bases of hospital construction and
land plot arrangements
Hygienic requirements for the inner layout
of hospital department
Features of internal planning of specialized
departments of hospitals
Hospital’s hygiene
comes from that the hospital is a basic
medico-prophylactic institution of the health
protection system
Hospitals hygiene
is a section of hygienic science, which studies the factors of hospital
environment, heir influence on sick organism and on medical
personnel, develops measures for their optimization and
normalization by development and introduction of hygienic norms
and recommendations on creation and maintenance of the medicalprotective regimen for patients and safe conditions for medical
personnel.
Hospital
Environment
a set of all factors of
physical, chemical,
biological
and
information nature,
which carries out
influence on the
organism of the
patient
during
treatment
Tasks of hospitals hygiene
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1. Study of hospital and environment interaction.
2. Research of hospital environment influence on the patient’s
organism and personnel.
3. Hygienic standartization of the factors of hospital environment.
4. Development of hygienic recommendations on making healthy
conditions for patients and medical personnel.
5. Control after observance of hygienic norms and requirements at
designing, building and exploitation of hospitals.
6. Prophylaxis of hospital infections.
7. Development and observance of requirements and
recommendations on for medical personnel hygiene.
Categories of hospitals:
I. Multisectoral medical-prophylactic
institution
–for
adult or specialized medicalII. One-field
–for children
prophylactic institution
-infectious diseases hospitals
-tubercular dispensaries
-out-patient psychiatric facilities
-ophthalmologic hospitals
-physiotherapeutic hospitals
-rehabilitation hospitals
-emergency hospitals
Hospital functions:
- inpatient care
- polyclinic care
- medical care at home
- prophylactic - at home
- organizational-methodical work
- performs tasks of health care administration within the area health care
Primary theoretical principles and hygienic bases of
medical-prophylactic institutions
 Creation of optimum conditions for the most fast recovery of patients
 Prevention of nosocomial infections
 Preservation of health personnel
 Scientific organization of labor of personnel
 Hospitals should be safe for the environment and public
 The modern hospital should be a school of hygienic education of
patients
 Modern clinics are a school of training and education of medical
personnel
Hygienic requirements to the hospital area
Situated in the city (specialized hospitals -psychiatric, tuberculosis) - in a
suburb zone, with 1,000 m sanitary space from residential territories
In a distance from the possible air or soil pollution sources, according
to the “wind rose”
Usage of the existing green area (park, wood)
In an optimal distance from the farthest settlements of the population
service zone: patient must be taken to the hospital less than 30 minutes
Rectangular form of the hospital territory with the sides’ ratio 1:2 or 2:3.
The long axis orients from the East (North-East) to the West (South-West)
The ground in hospital area must be clean, dry, optimal gradient of relief –
10 %, underground waters situated more than 1,5 m from the surface.
The area of green plantings must be more than 60%, territory for building –
12-15%, territory must be divided into several zones
Systems of hospital
building
Centralized
Decentralized
Block
Mixed
Centralized-block
Hospital complexes
Medical centers
Centralized system
of building supposes placing of all functional departments of
hospital – therapy departments, policlinic and offices in one
multi-storeyed building.
This system gives possibly of rationally using all treating and
diagnostic premises, conditions of external sanitary devices
and equipment operation are facilitated, the routes of patients
and staff motion become shorter (for example, a nurse walks
about 15 km during one duty), food delivery from a nutrition
unit in rooms is accelerated, expenditures for build-operating
are reduced.
The centralized system has some failings, namely: creation of
the treating and protective regimen and prevention of the
hospital infections become difficulty, possibility of walks for
patients is worsened. The failings of the centralized building
system led to new composition decisions of hospital, one of
which is the mixed system of building.
Decentralized system (pavilion)
supposes placing of the separate structures and departments
of MPI in separate low-rise buildings. On the face of it such
building has the number of advantages: the best prevention of
hospital infections, optimum zoning of area, large possibilities
for patients walks. It is an ideal variant for seismically
dangerous regions, rural locality, for the specialized hospitals –
psychiatric, infectious, tubercular, children’s and other.
However this system is very expensive from economic point of
view, because the area of lot is increased, there is a necessity
of duplication of diagnostic and auxiliary rooms, food cooling,
its quality and taste worsening during delivery, the specialized
medical care is difficult etc.
The mixed system
of building of hospital lots is presented by placing of receiving
centers and all of basic somatic, treating and diagnostic
departments (X-ray department and physiotherapeutic ward,
clinical and diagnostic laboratory, pharmacy) in a main corps,
and policlinic, maternity, children’s, infectious departments – in
separate buildings. Administrative offices and postmortem
department are placed separately. Consequently, the mixed
system of building rationally combines dignities of the
centralized and decentralized systems, minimizing their
failings.
Functional zones at the hospital area
І. Main zones:
polyclinic
the patient care buildings
а) for non-infectious patients
б) for patients with infectious diseases
landscape
household zone
pathanatomy
ІІ. Additional:
radiological zone
zone of training pavillions
•The zone of policlinic is placed nearer to the boundaries of
the lot to the central entrance, isolated from medical
pavilions, on distance 30-50 m.
•The entrance in a zone of policlinic must be individual.
•The pathoanatomical department with a morgue is placed
in a separate place, which is not visible from the windows of
medical pavilions.
•The economic zone is located from the leeward side and
below on lay of land, on the distance of 30-40 m from the
hospital pavilions.
•Nutrition unit, boiler-house, laundry with sterilizer room,
garage, storehouses, vegetable storage facility are placed
here.
•The functional zones are separated from each other by
green belt with width of 10-15 m.
• On periphery it is also need to create the protective threelayer zone from the green planting with width of 10-15 m,
protecting hospital from noise, dust, harmful gases and
strong winds.
The inner layout of medical institution, regardless of the
system of building, must corresponds certain requirements.
Among them the fundamental principle, designated in
international practice by the term “spacing”, and suppose
dividing all of flows and processes on «clean» and «dirty»,
providing functional spacing, boxing and locking, and if it
necessary - using of quarantine and disposable articles.
Architectural and structural decisions of buildings and
premises of medical and obstetric hospitals, regardless of the
name of zones and set of premises, must provide the
optimum sanitary and hygienic, antiepidemic regimens and
conditions for patients staying, realization all necessary
sanitary-epidemic measures and the best conditions for
professional activity of personnel.
The main structurally-functional unit of the
inner layout of hospitals is a hospital
department.
Hospital department is a set of basic and
auxiliary premises, joined by general
corridor, occupying a separate floor, having
two entrances and intended for diagnostics
and treatment of the patients with
homogeneous diseases.
Ward section, which is presented by the
complex of basic and auxiliary premises,
jointed by a common corridor with one
entrance with a sluice (deadlock planning),
intended for patients with homogeneous
diseases
Types of ward departments
1. Noninfectious:
a) therapeutic profile;
b) surgical;
c) specialized (ophthalmological, dermato-,
neurological, etc.)
2. Infectious
3. Obstetrical - gynecological
General principles of internal planning of ward
departments
1. Occupy separate (full) floor.
2. Be diversified
3. Correctly positioned on the floors, taking into account:
a) the urgency of aid;
b) b) easy transport of patients;
c) c) the spread of infection from the air flow upward
4. consist of several sections of the ward
The main rooms of departments are
the rooms of different modifications:
- wards for 1, 2, 3 and 4 beds;
- wards with sluice;
- isolated wards;
- semiisolated wards;
- boxes.
The medical purpose wards (consulting
room, procedural, post of duty sister
and other), utility wards (pantry,
dining-room), bathroom unit (lavatory,
bathroom, dirty and clean linen store
room, rooms for washing and
sterilization of ships and other),
corridor are put to the auxiliary
premises.
Types of internal planning of hospital
departments
1. Line:
a) unnilateral one corridor
b) one corridor partially double-sided (with a dashed
double-sided layout)
c) two corridor (forbidden for surgical departments and
infectious profile).
2. Centric:
the location of the wards along the perimeter,
There should be a gateway at the entrance to the
departments section: specialized, obstetric, neonatal,
infectious
Number of beds in the ward section:
not less than 20
not more than 30
Hygienic requirements to the internal
planning of hospital departments and
sections:
a) a complete set of basic premises, diagnostic and treatment,
sanitary and administrative facilities;
b) the sufficiency of the area of the main and auxiliary buildings,
their height and laying depth;
c) zoning of sections (zone wards and auxiliary premises area);
d) presence of only one entrance into section (a dead-end
planning);
e) the rational distribution of main and auxiliary premises in
accordance with:
- orientation of diagnostic and treatment process;
- the route of movement of patients;
- flow of sterile and contaminated of tools, clothes, equipment;
- minimization of charts of medical personnel movement
In every section of department 7% of
wards are designed for 1 bed, not less than
two wards for 2 beds, other – not more,
than for 4 beds. In such specialized
departments, as obstetrical pathology,
hematologic, burns, neurosurgical, urology
there are 15% of wards for 1 bed, 15% - for
2 beds and 70% - for 3-4 beds.
Capacity of wards section depends on its
profile - from 20 to 30 beds, capacity of
department – from 15-45 to 90- 120 beds.
Admission department
Functions:
1. Acceptance and discharge of patients.
2. Distribution of patients according to the departments.
3. Primary health care.
4. Sanitization of patients.
Placement principles, depending on building system:
at decentralized - in a separate building, near the entry, near the x-ray cabinet
and reanimation;
in a centralized - on the 1st floor, near the elevator;
with mixed - in the main building.
For children, obstetrics, tuberculosis, infectious and skin and venereal
departments emergency room should be separate.
A set of admission department premises:
- lobby with a toilet
- reception desk
- reference
- duty doctor's office
- bathing and delousing establishment
- insulating and diagnostic cabinet
- wardrobe
- procedural
Surgery department
Principles of planning:
- Sectional ("clean", "purulent");
availability of the sanitary inspection room for personnel;
in a set of premises - the presence of bandaging, gypsum;
- Ward (preoperative, postoperative, intensive care units);
Placement of the operating
decentralized –
in the department
centralized - operating room for all surgical
departments
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isolation from other departments;
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connection with the reanimation and sterilization;
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at the entrance - sanitary inspection for personnel;
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in an isolated location, an annexe block, connected to
the offices of transitions;
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zonation (sterile area, strict regime zone, restricted area
regime, area of general regime);
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the existence of "pure" and "purulent" operating;
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standard square one operating table (30 beds) - 36 sq.m.
number of beds in the recovery room - 2 operating 1.
Features of maternity department
planning:
strict flowing
- beds: 20% - pathology of pregnant women,
80% - maternity ward;
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availability of receiving- inspection department:
-- distribution of pregnant women;
-- availability of receiving and viewing box, sanitary inspection room,
delivery room, maternity boxing with the gateway; an extract room;
-
-
sanitary inspection for personnel.
Physiological department:
Prenatal
- prenatal (prenatal wards, ICU, postoperating
room)
- patrimonial (delivery room, preparation
of medical staff, small operating?).
Postpartum
- wards for postpartum women (1-2 beds and individual)
- wards for newborns (1-2 beds)
- wards for joint stay postpartum women and newborn
(1-2 beds)
Observational
- individual patrimonial ward (delivery room)
- delivery room
- postnatal wards
– wards for newborns.
Principles of maternity hospital (department)
of planning:
- eliminate the crossing stream of pregnant and
postpartum women;
- a special anti-epidemic regime.
DEPARTMENT OF INFECTIOUS DISEASES
Tasks:
isolation of the patient:
Impediment of infection dissemination .
Features of planning:
reception of patients by receiving and viewing box for each
department;
availability of 2 entrances (for patients and personnel);
availability of the sanitary inspection room for personnel;
equipment of the individual sections with gateways;
a full set of premises in the section;
a special type of wards (boxes, semiboxes, boxed wards, wards
with gateways).
A box is an autonomous
ward for 1 patient with
sanitary unit. Such ward has
an internal entrance (from a
corridor) for personnel and
external
entrance
(from
street) for patients (fig. 9.5).
When patient comes into a
box, he passes through a
tambour and stay in the box
till his total recovering. On
an entrance from a corridor
there is a sluice where
personnel subject to sluicing
(wash
hands,
change
uniform etc); thus, the
maximal isolation of patients,
being in box, from contact
with
other
patients
in
department is attained. Box
are designed for 1 or 2
patients, their area must be
22 and 27m2 accordingly
Note: А – tambour, Б – sanitary unit, В – wards, Г – sluice; 1 – bed, 2 – table, 3 – tabouret, 4 –
rack for personnel's smocks,
5 – foul air flue, 6 – unit for giving food in box, 7 – case
for cleaning equipment, 8 – wash basin, 9 – bath, 10 – lavatory pan.
Layout of box
Children's department
Peculiarities:
 accommodation in a separate building (block);
 ward section of 15-20 beds;
 reception - by receiving and viewing box compartment;
 availability of the sanitary inspection room for personnel.