(на примере проектов соматических больниц)»

Tashkent Medical Academy
COMMUNAL AND LABOUR HYGIENE DEPARTMENT
CHAIR: COMMUNAL HYGIENE
SUBJECT: "METHOD OF SANITARY EXAMINATION
PROJECTS OF THE TREATMENT PROFILACTIC AGENCY
(on the example of somatic hospitals)"
.
The purpose of the activity:
To familiarize
students with
the basic
hygienic
requirements
for the land
plot allocated
for the
construction of
hospitals;
To introduce
students to
design
materials
for the
allotment of
land, the
construction
of health
care
facilities;
•To
introduce
students to
the protocol
to enter into
the project.
The student
should know:
• the value of the legal rules
governing the relationship
of man to man, society and
the environment;
• apply the main provisions of
each document in its
significance;
• features of the organization
and conduct of sanitary and
epidemiological measures to
mitigate the adverse effects
of risk factors on health and
the environment.
The student should
be able to:
• to the current sanitary
supervision on controlled
municipal facilities;
• justify your actions to solve
the problem TSN for health;
• carry out sanitary inspection
of supervision and make the
appropriate accounting and
reporting documentation.
The content of lessons.
• Health care is placed
in a residential, green
and suburban areas on
land, the most favorable
for sanitation, away
from the main streets
and roads.
The size of land plots
hospitals up to 400
beds is allowed to
increase by 25%. The
size of land plots for
hospitals, located in a
suburban area, should
be increased:
• infectious
and
oncological
- 15%;
•
Tuberculosis
- 25%;
•
restorative
treatment
for adults 20%;
There are areas of medical building, health center,
gardens and parks, shopping; between the zones
provided strip of green space with a minimum width
of 15 m. The inputs and outputs of the body
pathology, as well as access roads and parking
funeral cars should not be provided from the
windows of buildings with being sick and out of the
garden and park area.
In the area hospitals provide
platforms for climate,
occupational therapy, solarium
area is determined on the basis
of 4,5m², aeration- 3.5 m² per
patient.
Enclosures with chambers and clinics with
hospitals placed at a distance of not less
than 30m from the red line of the building
and housing without chambers, building
clinics, antenatal clinics and hospitals
without -on a minimum distance of 15 m.
• On the perimeter areas
of hospitals provide strip
of green space width 15m,
the perimeter areas of
clinics and dispensaries –
a width of 10m.
Lots of health facilities
and landscaped shield
fence.
• Premises of medical institutions must have
natural lighting. Light allowed coverage of
lavatories for patients and staff, warehouses,
darkroom, enema, hygienic baths, showers,
women's personal hygiene room, anesthesia,
preoperative, hardware, umyvalen, pot, weight,
thermostat, boxes of material for centrifuge
facilities, sanitary inspection rooms.
In buildings, health care facilities, built in IV
construction climatic zone, the windows of
buildings with long-term stay of patients,
doctors' offices and premises of the medical
personnel provide shading devices. For chambers
of hospitals and sanatoriums define permissible
noise levels: daytime - 36 dB at night - 25 dBA.
• Placement under the windows of the chambers
from the garden entrances and entrances to the
emergency room, in receiving and viewing boxes,
emergency station, emergency department and
other services, which are sources of noise are
not allowed.
In the operating room, the generic
ceiling surface should be matte.
The surfaces of walls, partitions
and ceilings of buildings of medical
institutions and pharmacies should
be smooth, admitting dry and wet
cleaning them from dust.
• Modern medical facilities are
equipped with an effective means
of diagnosis and treatment,
providing a comfortable
environment for patients, using
light, sun and air for recreational
purposes, have nothing to do with
the old hospitals-casemates.
• Wall cladding with glazed tiles
include the following areas:
operating, labor and
reanimatsionnyh- to the height of
premises.
Currently, the hospital is a complex consisting
of various departments, performing
therapeutic, preventive, educational and
research functions, and numerous facilities of
administrative and service-economic purpose.
There are three
types of bolnitscentralized,
decentralized and
mixing:
• The centralized system characterized by
placing all hospital departments in one
building or several semi-detached houses.
• Hospitals, built on the decentralized
system, composed of a number of separate,
comparatively large buildings of 1-3 floors,
each building has its purpose. Patient
department in different specialties, clinics,
physical therapy department, administrative
and economic life. In a decentralized
system, it becomes possible to arrange an
isolated garden for every body.
• In mixed hospitals these disadvantages are
eliminated to a considerable extent. All somatic
separation can be combined in the main
building with 4-5 floors and eliminates
centralized, well-equipped offices - X-ray,
physiotherapy, clinical diagnostic, emergency
room. Mixed base from the hygienic point of
view of a rational. It became widespread in
Uzbekistan.
In addition, a
decentralized hospital is
conveniently built in
seismic regions. The
disadvantages include:
• 2. transporting food from
the central kitchen in all of
the outer shell paths;
• 1. the need for duplication of
special medical building medicaldiagnostic cabinets of
physiotherapy, functional
diagnostics, operational and
others;
• 3. increase the area of land
required for the construction,
in connection with this price
increase and improvement of
underground communications.
The advantage of the centralized system is
the rational use of all the branches of special
facilities for diagnosis and treatment, the
possibility of mutual consultation of specialists
in different branches, with convenient
internal communication between
departments.
• monohull hospital inherent and serious
shortcomings: the clinics, offices and
administrative buildings contributes more
visit people. Creates difficulties in
relation to sanitary mode.
One of the basic principles of building a network of health care
institutions is their approach to the population served.
Hospitals, having in its composition clinic, women's clinic are
placed evenly in the district of the village. This is convenient
for health care: monitoring of patients, their care at home,
organization of preventive and promotive efforts.
• Hospital useful to have on the periphery of
the area due to the lack in most cases the
requirements of hygienic areas. This applies in
particular to hospitals for 400, 600 or more
beds, which require 5-10 hectares of land
For health care institutions are assigned the most favorable natural
conditions for their land, located on higher ground, possibly with a
southern slope, well-ventilated and rich vegetation. The area should
be good, beautiful near the hospital to have lakes, rivers, gardens,
parks and others. There, because of their beneficial effect on air
regime and microclimate. Seals and industrial developments should
be avoided. The site should not be on the leeward side in relation to
production, the area should be removed from the sources of noise
and air pollution, soil and water.
• Optimal orientation south, southeast,
southwest, depending on climate zone
areas. By relief area should be quiet,
convenient for construction.
When choosing a site it is necessary to consider
the possibility of acceding to the existing
networks water supply, sewerage, electrification,
telephones and gasification. It is particularly
important to ensure clean water and sewage
descent. In addition, consider the possibility of
expanding the hospital.
• The proper placement of the hospital buildings
is very hygienic value.
At the hospital there
are the following areas:
• Zone hospital
buildings with the
release of a special
group of infectious
cases. For this area
is given the best
territory.
• Zone Clinic with
administrative and
economic office,
pharmacy and
laboratory.
To ensure favorable conditions of insolation and aeration
hospital buildings need to keep sufficient gaps between
them.
• In SanPin №0054-96, the following health gaps between office buildings: at the height of 1-2 floors
of 25 m .; at a height of 3-4 floors - 30 m; at a height of over 4 floors - at least the height of the
highest buildings. Between medical and residential buildings and public buildings need a break of at
least 2 m, height of the highest building, but not less than 30 m.
• Outpatient area should be separated from the stationary zone. Postmortem body located
downwind to the hospital building.
• In a centralized system, the construction of hospitals area is divided into two areas: medical and
economic. Residential buildings occupy about 10-15% of hospital grounds, driveways, roads 15-20%.
In the design
section of
the hospital
have to
solve a few
questions:
• on the
capacity of
the
compartment;
• size of the
chambers;
• On auxiliary
facilities.
Tools for the disinfection of surfaces in premises of health
facilities must meet the following requirements:
• ensure destruction of pathogens of nosocomial infections,
bacteria, viruses, fungi, at room temperature;
• possess good detergency or combined with detergents;
• have relatively low toxicity and be harmless to the
environment;
• be compatible with various types of materials;
• non-flammability be stable, easy to handle;
• do not have a locking effect on organic pollution.
Health care setting regardless of its profile and the bed capacity as a result of its
activities on the various forms and degrees of fractional composition of hazardous
waste. All healthcare waste separated according to their epidemiological,
toxicological and radiological hazards in the five classes of danger:
• Class A - non-hazardous waste of medical institutions.
• Class B - hazardous waste.
• Class B - extremely hazardous wastes hospitals.
• Class D - waste LPU, the composition close to the industry.
• Class D - radioactive waste health facilities.
The requirements for in-situ facilities for temporary storage of
medical waste:
Gender rooms laid with ceramic tiles.
Walls of premises with glazed tiles are laid over the entire
height.
Covering the ceiling waterproof paint.
Window units.
Internal door frames.
The room must be equipped with:
a. - Sink;
b. - Irrigation faucet;
c. - Water flow;
d. - Bactericidal irradiator;
e. - Ventilated.
The method of "Round Table"
• Divide the group into small groups of 2-3 people, each
MG offer sheet with the issue and ask for 1-2 minutes to
write down the answer, then pass another piece of MG
and MG to take from another the next question and so
on Thus, if the 5 mg to organize, the teacher hands out 5
questions, and ultimately each piece should be 5 replies.
After 12 minutes, the teacher collects all sheets and
analyzes the quality of the answers aloud and exposes
the evaluation of each 5 mg in which the correct
answers, "choir" 4 replies, "Satisfactory" 3 replies,
"unsatisfactory" at least two correct answers.
Option suggested questions:
• Placement of the hospital in the village.
• Hygiene requirements for the site selection.
• Requirements for territory planning clinic.
• Requirements for greening hospitals.
• Planning and equipment of the hospital building.
• Admissions Office.
Control questions:
• Hygienic bases of the modern construction
of health facilities.
• Site selection, planning and construction of
hospitals.
• The internal layout and sanitary equipment
of medical institutions.
• microclimatic conditions and noise control
in hospitals.
• Hygiene requirements for the hospital site.
• What is the section of the hospital and its structure.
• Specify the types of chambers, hygienic requirements
for their equipment.
• Functional zoning of the hospital.
• Features of planning of children's hospitals.
• Features planning clinics.
Recommended reading:
Key:
"Hygiene", edited by prof. Demedenko NM 2002.
KI Akulov, Bushtuevoy KA "Communal Hygiene"
m. 1986
Guide to laboratory zaniyatiyam of communal
hygiene Goncharuk EI .. M. 1982.
T. Sh Otabaev, T.I.Iskandarov. "Communal
Hygiene" T.1994.
Additional information:
- Training - program kontroliruschaya
- Lecture materials
- Abstracts from the Internet
- SanPin, guests, guidance