Ministry of Education and Science of Ukraine
Kharkiv National University of V. N. Karazin
Medical faculty
«Hygienic assessment of the conditions of stay of patients and
occupational hygiene of medical workers in treatment and prevention
facilities»
Prepared by:
3rd year student,
group 322
Hamidreza Rahmani
Kharkiv – 2020
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Hygienic requirements for wards. To provide patients with fresh and
clean air, a sufficient area and volume, as well as adequate ventilation of the
ward, are necessary. The minimum volume of air flow per patient should be 4050 square meters, and the optimal one is 2 times more. If we proceed from the
minimum ventilation volume, then with a two-fold air exchange within an hour,
the required room volume per patient should be 20-25 sq.m. With a chamber
height of 3-3.2 m, this volume is achieved with a floor area of 7-7.5 sq.m. The
current design standards for one patient in a multi-room ward are allocated 7
square meters, in infectious and tuberculosis departments 7.5 square meters, in
intensive care wards 13 square meters. m, in radiological departments 10 sq. m.
The minimum size of a single-bed room without a sluice is 9 sq. m, with a
sluice 12 sq. m, with a sluice and a toilet 14 sq. m. The beds in the wards should
be located parallel to the windows, at a distance of 0.9-1 m from the outer wall,
between the beds it is 0.8-1 m.
The state of comfort to the patient is felt with a certain combination of
such indicators as temperature, humidity, air movement. In the wards, it is
necessary to provide an optimal microclimate, air temperature 18-20 degrees,
humidity 40-60%, air speed 0.1-0.2 m / sec. It is necessary to provide maximum
insolation, the orientation of the chambers should be south and southeast.
The coefficient of natural light (KEO) is 1.5 ‒ 2%, the light coefficient
(SK) in wards, doctor's offices and treatment rooms is 1:4, 1:6, and in operating
rooms 1: 4 ‒ 1:5, in other rooms 1:6 ‒ 1:7.
Artificial lighting of wards should contribute to the creation of
psychophysiological comfort for patients and optimal working conditions for
medical personnel. Artificial lighting should create comfort, be uniform and
constant, without shine and harsh light and shade. These requirements are met
by incandescent lamps with diffused light fittings («milk ball», «Lucetta»), lowpressure gas-discharge lamps which are called «fluorescent lamps». In each
ward, a special night lamp should be provided, in a niche near the door. For
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offices of surgeons, obstetrician-gynecologists, traumatologists, pediatricians,
infectious
disease
specialists,
dermatovenerologists,
allergists,
dentists,
examination and examination boxes ‒ 500 lux. When examining a patient by a
doctor or performing medical procedures, the local minimum illumination is
300 lux.
Ventilation should be natural or artificial, the air exchange rate is 1.5-2
times per hour. The required double air exchange is achieved by repeated
ventilation or by means of artificial ventilation. If this requirement is not met,
air stagnation, its pollution and the appearance of specific hospital odors are
observed, and the possibility of infection with airborne infections increases.
The post of a nurse is located near the treatment room and single-bed
wards intended for seriously ill patients. From the post, the corridor, entrances
to the chambers and auxiliary rooms should be visible. The distance from the
post to the serviced wards should not exceed 15 m. The post must have the
necessary equipment: a table, a cabinet, a sterilizer, a refrigerator, a washbasin,
a telephone, an alarm unit consisting of equipment for a signal from the ward to
call
the
medical
staff
and
two-way
intercom
(video
conversation)
communication sister and patient.
Hygienic requirements for the corridor. All these rooms should be
connected by a ward corridor, since the hygienic conditions in the section, the
convenience of servicing patients largely depends on the method of building the
ward corridor, it can be with one-sided building of premises (side), with twosided buildings (central) and with partially two-sided buildings. Hygienic
advantages It has an easy-to-move, well-ventilated side corridor, is a reservoir
of clean air for the wards, through which through-ventilation of the wards can
also be carried out. However, with a side corridor, the section, and therefore the
department (hospital), is stretched in length, which makes it difficult to serve
patients. The two-sided building of the corridor significantly shortens the length
of the section, therefore it is advisable not to build up one of the corridor sides
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by more than 60-75% of its length. For free turning of beds, gurneys or
stretchers, the width of the corridor must be at least 2.4 square meters. In
addition, this floor contributes to high-quality cleaning and disinfection. The
walls of the corridor should be painted with light oil paint. The floor of the
corridor should be lined with linoleum, which reduces the noise that occurs
when using small mechanization (wheelchairs, wheelchairs, etc.).
Requirements for inventory and technological equipment. All rooms are
equipped with a set of standard furniture providing good conditions for patient
care. The outer and inner surfaces of medical furniture must be smooth and
made of materials resistant to detergents, disinfectants and medicines.
The presence of pathogenic staphylococci and streptococci in the air
indicates air pollution with secretions from sick people. For the premises of
medical institutions requiring aseptic conditions, indicators of the permissible
content of microflora in the air have been developed, which show the levels of
bacterial contamination of the air environment of the premises of medical
institutions, depending on their functional purpose and class of cleanliness.
Ventilation should be supply and exhaust, centralized heating.
The uninterrupted supply of the hospital with good-quality water is a
guarantee against the occurrence of gastrointestinal diseases. It is best to join
the health care facility to the city water supply system, then the water
consumption per bed can be increased to 400 liters per day. In rural areas, where
there is no centralized water supply, those artesian wells are recommended that
are characterized by a relatively constant composition of water that meets
sanitary and hygienic requirements. Water consumption for 1 bed can be about
100 liters per day if there is a local sewage system.
The hospital generates a significant amount of wastewater that should be
treated as infected even in general hospitals. Better to connect to the citywide
floatable sewer. If there is no city-wide sewerage system, then the so-called
small sewerage system is used ‒ underground filtration fields, where soil-based
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wastewater treatment methods are used (by filtration into the soil). Wastewater
from infectious and tuberculosis medical institutions (departments) must be
decontaminated before being discharged into the external sewerage system.
Each medical institution develops and approves a system for the
collection, temporary storage and disposal of waste of various hazards, in this
regard, the hospital must be provided with the necessary number of
technological equipment (racks ‒ carts, transport inner-body carts, dock seals,
etc.), disposable packaging and transport containers. For the disinfection of
solid waste (now called «medical waste»), it is recommended to install ovens,
incinerators, composts and biothermal chambers. Only the incineration of these
wastes, if they do not contain polymeric materials, guarantees personnel,
patients and the population from the spread of infectious diseases.
Sanitary maintenance of premises, equipment, inventory. All premises,
equipment, medical and other equipment must be kept clean. Wet cleaning of
premises. Washing of floors, furniture, equipment, window sills, doors should
be carried out at least 2 times a day, using detergents and disinfectants approved
for use in accordance with the established procedure. Window glass should be
washed at least 1 time per month from the inside and at least 1 time per 3
months outside (in spring, summer, autumn). General cleaning of the premises
of ward departments and other functional rooms and offices should be carried
out according to the schedule at least once a month, with the processing of
walls, floors, equipment, inventory, lamps. General cleaning (washing and
disinfection) of the operating unit, dressing rooms, delivery rooms, treatment
rooms, manipulation rooms, sterilization rooms is carried out once a week with
the processing and disinfection of equipment, furniture, inventory. It is
necessary to carry out disinfection, disinsection, deratization monthly in
accordance with sanitary rules.
In the main premises of medical institutions, cosmetic repairs of premises
should be carried out annually. Elimination of current defects (leaks on ceilings
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and walls, traces of dampness, mold, repair of cracks, potholes, restoration of
exfoliated tiles, flooring defects, etc.) should be carried out immediately. During
the period of current and major repairs, the functioning of the premises is
prohibited.
Disposable products after disinfection are disposed of in the prescribed
manner. Reusable medical devices are subject to disinfection and sterilization.
Patients should change linen regularly as they become dirty, at least once
a week. In operating rooms, maternity wards, and in wards for newborns, sterile
linen should be used. After the patient is discharged, as well as as they become
dirty, mattresses, pillows, blankets are disinfected in the chamber. Bedding must
be renewed every five years. Linen is washed in special laundries or as part of a
medical institution. You can store dirty laundry in the department only for 12
hours.
Litter bins installed every 50 meters for collecting garbage at the
entrances to the building, in recreation areas and on the territory should be
cleared of garbage daily and kept clean. Containers for collecting solid
household waste should be provided with lids, cleaned regularly, washed and
disinfected after each emptying.
Occupational health medical staff. Literature on the health status of
medical workers has appeared in the last 20-25 years. The work of medical
workers is very diverse and differs significantly in the type of professional
actions. In recent years, there have been significant changes in the treatment
process, new specialties have appeared, the specialty has been divided into
narrow areas, the most complex medical and diagnostic equipment has been
used, the methods of monitoring the health of patients have become more
complicated.
The peculiarity of a doctor’s work is characterized by the presence of
daily and night shifts, the absence of fixed lunch breaks, and a heavy workload
of the working day. Special requirements are imposed on the intellectual, neuro-
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emotional capabilities of the body, physical endurance, and health. For example,
a therapist in a polyclinic, hospital, sanatorium performs various professional
duties, carries various physical and neuro-emotional stress. The work of a
surgeon differs in content, scope of activity. In recent years, there have been
significant changes in the treatment process ‒ these are ionizing, laser radiation,
ultrasound, work in pressure chambers.
Work in pressure chambers. This work is associated with the activities of
surgeons during operations on the heart, lungs, blood vessels, obstetrics. In
these conditions, negative aspects are excessive atmospheric pressure, unusual
microclimate, isolation and limited habitat, the possibility of nitrogen action.
Sometimes surgeons may experience euphoria, a decrease in pulse rate, a
decrease in systolic blood pressure, a decrease in cardiac output, and
psychomotor changes are noted. Therefore, constant medical supervision,
preliminary medical supervision is necessary, to restrict the work of women in
pressure chambers.
The work of an anesthesiologist. The professional actions of an
anesthesiologist require dedication, prolonged tension, attention, quick
assessment of information relevant to the situation. His duties include preparing
the patient for anesthesia, conducting anesthesia, maintaining and normalizing
the functions of the patient’s body during the operation and in the postoperative
period. In this case, the doctor must be collected and neat. With an increase in
the length of service, the doctor complains of headaches, increased fatigue,
conjunctivitis. During pregnancy, there can be various types of pathology if
they work more than 25 hours a week.
The work of surgeons. The work is very diverse, it makes high demands
on the professional qualities, physical endurance and neuro-emotional sphere of
the doctor. The surgeon must be able to make quick decisions, be consistent and
have a sense of responsibility for the life and health of the patient. Surgeons
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often develop hypertension, hypotension, varicose veins, and in the age group
over 50, coronary heart disease, atherosclerosis.
The work of obstetrician-gynecologists. The obstetrician-gynecologist is
in constant neuro-emotional stress associated with responsibility for the health
of the mother and child, which requires precise coordination of sensory and
motor functions. It should be noted that 93% in this area are women. Labor is
characterized by a high degree of fatigue, which leads to some changes in
functional indicators, the speed of information processing decreases, and
memorization worsens. In the structure of morbidity, cardiovascular diseases
prevail, as in surgeons and anesthesiologists.
Personal hygiene of medical personnel. Medical personnel should be
provided with special clothing (gowns, hats, slippers). Personal hygiene must be
observed ‒ wash hands before examining the patient and after examining.
Monitor the condition of the hands (no cracks, pustules). Overalls must not be
carried outside the hospital and must not go outside the hospital in medical
gowns. Workwear should be washed in special laundries.
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CONCLUSIONS
Medical institutions are often neglected by the sanitary supervision
authorities, which negatively affects the order and completeness of sanitaryhygienic and anti-epidemic measures in them. In some cases, the weakening of
sanitary supervision leads to a deterioration in the indicators of the treatment
process, the formation of favorable conditions for the development of hospital
infections. At the same time, advances in modern science and technology make
it possible to optimize the conditions for treating patients and shorten the time
and improve the indicators of medical work.
Hygiene of medical staff includes three main elements ‒ personal
hygiene, hygiene of professional clothing and workplace, hygiene of medical
manipulations. Dispensary monitoring of medical staff is important, which is
aimed at timely detection and remediation of foci of chronic infection (carious
teeth, diseases of the right respiratory tract and oral cavity, carriers of
staphylococci).
Due to the risk of infection of medical personnel with
infections involving the transmissible route of transmission (HIV, hepatitis), as
blood and body fluids in some patients are potentially infected, there are
universal precautions:
• use of gloves in direct contact with a patient or possibly infected fluid;
• instant washing of hands or skin surface after accidental contact with
blood;
• prevention of injuries by sharp objects (needle, scalpel, tools, bone
fragments, etc.) that contain potentially contaminated biological fluids;
• wearing a mask and goggles to prevent contamination of the mucous
membranes of the eyes and mouth with sprays of biological fluids;
• wearing water-repellent robes and aprons during the procedure due to
the possibility of soaking them with potentially contaminated liquids.
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3. Rumyantsev G.I. et al., «General Hygiene». M., 1985. p. 230-328.
4. Pivovarov Yu. P. and other Guide to laboratory studies, M., 1983, p. 90135.
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Melnichenko P.I.
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