Hygienic requirements for the microclimate of the LPU. The microclimate of hospital premises. Heating and ventilation requirements

institutions and pharmacies, with the exception of infectious diseases hospitals (departments), are equipped with mechanically driven supply and exhaust ventilation. In infectious diseases hospitals (departments) exhaust ventilation organized autonomously from each box, semi-box and from each ward section. At the same time, the natural draft hood is equipped with a deflector, and the inflow is equipped with mechanical stimulation and air supply to the corridor.

Air conditioning is organized in operating rooms, anesthesia, delivery, postoperative wards, intensive care units, intensive care units, one- and two-bed wards for patients with burns, in wards designed to accommodate 505 beds, in departments for newborns and infants, as well as in all wards in the departments for premature and injured children.

The air conditioning system should provide in operating rooms, anesthesia, postoperative wards, maternity, resuscitation and intensive care units, relative humidity of 55-60%, air speed of no more than 0.15 m/s.

standalone systems supply and exhaust ventilation provided for operating units (separately for septic and aseptic departments), intensive care units, intensive care units (separately for those entering hospitals from the street and from hospital departments), maternity - separately for the physiological and observational departments; wards of obstetric departments of hospitals (maternity hospitals) - separately for the physiological and observational departments, wards for newborns, premature and injured children; for X-ray rooms, laboratories, mud and hydrotherapy, hydrogen sulfide and radon baths, laboratories for the preparation of radon, sanitary facilities, refrigerators, self-supporting pharmacies.

The outside air supplied by the supply ventilation systems is cleaned in filters. Air recirculation is not allowed.

The air supplied to operating rooms, anesthesia, delivery, postoperative wards, resuscitation rooms, intensive care wards, one- and two-bed wards for patients with skin burns, boards for newborns and infants, for premature and injured children is additionally cleaned in bacteriological filters. In this case, it is not allowed to install oil filters as the 1st stage of air purification and to install air ducts that remove air after bacteriological filters made of galvanized sheet.

Heating. In health and social care institutions, only water heating is used. The heating power of radiators should be calculated so that their surface temperature is not more than 90 ° C, otherwise dust will burn. To facilitate cleaning, radiators should be mounted against the wall, and not in niches. Even better is to use panel radiators, which can be placed one by one

Air-thermal regime of hospitals. Compensatory possibilities of the sick organism are limited, sensitivity to unfavorable factors the external environment is increased. Consequently, the range of fluctuations of meteorological factors in the hospital should be less than in any room for healthy people.

The state of thermal comfort is a combination of four physical factors - air temperature, humidity, air velocity, temperature of the internal surfaces of the room. Normal microclimate parameters take into account: the age of the patient, the characteristics of heat transfer in various diseases, the purpose of the room and climatic conditions.

Air temperature the most important factor microclimate, which determines the thermal state of the body. It is generally accepted that optimum temperature air in the wards of medical institutions should be slightly higher than 20 ° C than in residential premises 18 ° C (Table 6.7).

1. Age characteristics of children determine the highest temperature standards in the wards of premature babies, newborns and infants- 25 o C.

2. Features of heat transfer in patients with impaired thyroid function cause high temperature in the wards for patients with hypothyroidism (24 ° C). On the contrary, the temperature in the wards for patients with thyrotoxicosis should be 15 ° C. Increased heat generation in such patients is the specificity of thyrotoxicosis: the “sheet” syndrome, such patients are always hot.

3. The temperature in the halls of physiotherapy exercises is 18 o C. For comparison: the halls of physical education at school are 15-17 o C. Physical activity is accompanied by increased heat generation.

4. Other functional purpose of the premises: in operating rooms, PITs, the temperature should be higher than in the wards - 22 o.

Composite element indoor microclimate is humidity air with a range of 30 to 70%, and for medical institutions - 40-60%.

Moving air for the body is a light tactile stimulus that stimulates the centers of thermoregulation. Optimal air mobility in the premises of health care facilities is 0.1-0.3 m/s.

Hygienic requirements for the chemical and bacteriological composition of air in hospitals

When people stay indoors for a long time, waste products of the body accumulate in the air (the concentration of carbon dioxide, the amount of dust and microorganisms increase, the amount of oxygen decreases, etc.). At the same time, people feel worse, mental and physical performance decreases, coordination of movements and reaction speed deteriorate. Therefore, the definition of microclimatic conditions and calculations of the necessary ventilation in a given room are of great importance.

The main criterion for assessing the degree of indoor air pollution and calculating ventilation is the concentration of carbon dioxide in the air. The amount of carbon dioxide (CO 2 ) in indoor air increases as a result of people's breathing, during the processes of combustion, fermentation, and decay. The content of CO 2 in atmospheric air is within 0.04% (0.03-0.05%). The maximum permissible concentration of CO 2 in residential and public buildings– no more than 0.1%.

Hospital air contains chemicals that accumulate during work medical personnel. There are hygienic standards for the content of these substances in the air of hospital premises - the maximum allowable concentrations (table 6.2).

The administration of the medical institution organizes control over the microclimate and chemical pollution of the air in all rooms periodically: 1st group - high-risk rooms - 1 time in 3 months. 2nd group - high-risk premises - 1 time in 6 months. 3rd group - all other premises and, first of all, wards - once a year.

Microclimate parameters determine the heat exchange of the human body and have a significant impact on the functional state various systems body, well-being, performance and health.

The microclimate of the premises of medical institutions is determined by a combination of temperature, humidity, air mobility, the temperature of the surrounding surfaces and their thermal radiation.

The requirements for the microclimate and air environment of the premises are established by SanPiN 2.1.3.1375-03 "Hygienic requirements for the placement, arrangement, equipment and operation of hospitals, maternity hospitals and other medical hospitals."

Heating and ventilation systems should provide optimal conditions microclimate and air environment of premises of medical institutions.

The parameters of the design temperature, the frequency of air exchange, the category for the cleanliness of the premises of medical institutions regulated by SanPiN 2.1.3.1375-03 are shown in Table 3.1.

Table 3.1 - Temperature, air exchange rate, cleanliness category in the premises of the central hospital and medical unit

Name of premises	Estimated air temperature, О С	Air exchange rate, m3/h	Extraction ratio with natural air exchange
	Extract, %
Chambers for adult patients		80 for 1 bed

Chambers for patients with tuberculosis		80 for 1 bed

	Extract, %
Chambers for patients with hypothyroidism		80 for 1 bed

Chambers for patients with thyrotoxicosis
Postoperative wards, intensive care wards		By calculation, but not less than 10-fold exchange	Not allowed

Doctors' offices		Inflow from the corridor
Cabinet of functional diagnostics
Cabinet of microwave and ultrahigh-frequency therapy, thermotherapy, ultrasound treatment				Not allowed

Relative air humidity should be no more than 60%, air speed - no more than 0.15 m / s.

Heating appliances of heating systems should have a smooth surface that allows easy cleaning, they should be placed against external walls, under windows, without fences. It is not allowed to place heating devices near the inner walls in the chambers.

In operating rooms, preoperative, resuscitation rooms, anesthesia rooms, electrotherapy and psychiatric departments, as well as in intensive care and postoperative wards, heating devices with a smooth surface that is resistant to daily exposure to detergents and disinfectants should be used as heating devices, excluding adsorption of dust and accumulation of microorganisms.

As a heat carrier in systems central heating hospitals use water with a limiting temperature in heating devices of 85 ° C. The use of other liquids and solutions (antifreeze, etc.) as a heat carrier in the heating systems of medical institutions is not allowed.

Buildings of medical institutions should be equipped with systems of supply and exhaust ventilation with mechanical stimulation and natural exhaust ventilation without mechanical stimulation.

In infectious departments, including tuberculosis departments, mechanically driven exhaust ventilation is arranged through individual channels in each box and semi-box, which must be equipped with air disinfection devices.

In the absence of supply and exhaust ventilation with mechanical stimulation in the infectious departments, natural ventilation must be equipped with the obligatory equipment of each box and half-box with a recirculation-type air disinfection device that ensures the efficiency of inactivation of microorganisms and viruses of at least 95%.

Design and operation ventilation systems should exclude the overflow of air masses from "dirty" areas to "clean" rooms.

The premises of medical institutions, except for operating rooms, in addition to supply and exhaust ventilation with mechanical stimulation, are equipped with natural ventilation (windows, folding transoms, etc.), equipped with a fixation system.

The intake of outdoor air for ventilation and air conditioning systems is carried out from a clean area at a height of at least 2 m from the ground. Outside air supplied air handling units, is subject to cleaning with coarse and fine filters in accordance with the current regulatory documentation.

The air supplied to operating rooms, anesthesia, resuscitation, postoperative wards, intensive care wards, as well as to wards for patients with skin burns, AIDS patients and other similar medical premises must be treated with air disinfection devices that ensure the effectiveness of inactivation of microorganisms and viruses located in the treated room. air at least 95% (filters high efficiency H11-H14).

The premises of operating rooms, intensive care wards, resuscitation, procedural and other rooms in which harmful substances are released into the air must be equipped with local exhausts or fume hoods.

The levels of bacterial contamination of the indoor air environment depend on their functional purpose and cleanliness class and are also regulated by the requirements of SanPiN 2.1.3.1375-03.

Table 3.2 - Maximum Permissible Concentration and Hazard Classes medicines in the air of the premises of medical institutions

Substance to be determined	MAC, mg/m3	Hazard Class
Ampicillin
Aminazine (demethylaminopropyl 3-chlorophenothiazine hydrochloride)
Bebzylpenicillin
diethyl ether
Ingalan (1,1-difluoro-2, 2-dichloroethyl methyl ether)
Nitrous oxide (in terms of 02)	5 (in terms of 02)
Oxacillin
Streptomycin
Tetracycline
Fluorotan
Florimycin
Formaldehyde
Ethyl chloride

Air ducts of supply ventilation systems after high-efficiency filters (H11-H14) are made of stainless steel.

Split - systems installed in the institution must have a positive sanitary and epidemiological conclusion.

Air ducts, air-distributing and air-inlet grilles, ventilation chambers, ventilation units and other devices must be kept clean, must not have mechanical damage, corrosion, or leaks.

Fans and electric motors must not create extraneous noise.

At least once a month, the degree of contamination of filters and the efficiency of air disinfection devices should be monitored. Filter replacement should be carried out as it gets dirty, but not less often than recommended by the manufacturer.

General exchange supply and exhaust and local exhaust units should turn on 5 minutes before the start of work and turn off 5 minutes after the end of work.

In operating rooms and preoperative rooms, supply ventilation systems are first switched on, then exhaust, or both supply and exhaust.

In all rooms, air is supplied to the upper zone of the room. In sterile rooms, air is supplied by laminar or slightly turbulent jets (air velocity< = 0,15 м/с).

Air ducts for supply and exhaust ventilation (air conditioning) must have an inner surface that excludes the removal of air duct material particles into the premises or protective coating. Internal coating must be non-absorbent.

In rooms that are subject to the requirements of aseptic conditions, hidden laying of air ducts, pipelines, fittings is provided. In other rooms it is possible to place air ducts in closed boxes.

Natural exhaust ventilation is allowed for separate buildings with a height of no more than 3 floors (in reception departments, ward buildings, hydrotherapy departments, infectious diseases buildings and departments). Wherein forced ventilation provided with mechanical stimulation and air supply to the corridor.

Exhaust ventilation with mechanical stimulation without an organized inflow device is provided from the premises: autoclaves, sinks, showers, latrines, sanitary rooms, rooms for dirty laundry, temporary storage of waste and pantries for the storage of disinfectants.

Air exchange in the wards and departments should be organized in such a way as to maximally limit the flow of air between the ward departments, between the wards, between adjacent floors.

Quantity supply air to the ward should be 80 m3/h per 1 patient.

The movement of air flows should be provided from operating rooms to adjacent rooms (preoperative rooms, anesthetic rooms, etc.), and from these rooms to the corridor. Exhaust ventilation is required in the corridors.

The amount of air removed from the lower zone of the operating rooms should be 60%, from the upper zone - 40%. The supply of fresh air is carried out through the upper zone, while the inflow should prevail over the exhaust.

It is necessary to provide separate (isolated) ventilation systems for clean and purulent operating rooms, resuscitation, oncohematological, burn departments, dressing rooms, separate ward sections, X-ray and other special rooms.

Preventive inspection and repair of ventilation systems and air ducts must be carried out according to the approved schedule, at least twice a year. elimination current faults, defects should be carried out without delay.

Monitoring of microclimate parameters and air pollution with chemicals, the operation of ventilation systems and the frequency of air exchange should be carried out in the following rooms:

In the main functional rooms of operating rooms, postoperative rooms, intensive care wards, oncohematological, burn, physiotherapy departments, storage rooms for potent and toxic substances, pharmacy warehouses, medicine preparation rooms, laboratories, the department of therapeutic dentistry, special rooms of radiological departments and in other premises, in offices, using chemicals and other substances and compounds that can have a harmful effect on human health - 1 time in 3 months;

Infectious, incl. tuberculosis departments, bacteriological, viral laboratories, X-ray rooms - 1 time in 6 months; - in other rooms - 1 time in 12 months.

To disinfect the air and surfaces of rooms in medical institutions, ultraviolet bactericidal radiation should be used using bactericidal irradiators approved for use in the prescribed manner.

Methods for the use of ultraviolet germicidal radiation, the rules for the operation and safety of germicidal installations (irradiators) must comply with hygiene requirements and instructions for the use of ultraviolet rays.

The assessment of the microclimate is carried out on the basis of instrumental measurements of its parameters (temperature, air humidity, speed of its movement, thermal radiation) at all places of stay of the employee during the shift.

How much air does a person need for a normal existence?

Room ventilation ensures the timely removal of excess carbon dioxide, heat, moisture, dust, harmful substances, in general, the results of various household processes and people staying indoors.

Types of ventilation.

1) Natural. It consists in natural air exchange between
displacement and the external environment due to the temperature difference between the internal and external
outdoor air, wind, etc.

natural ventilation may be:

Unorganized (by filtering air through cracks)

Organized (through open vents, windows, etc.) - ventilation.

2) Artificial.

Supply - artificial feed outside air into the room.

Exhaust - an artificial extract of air from the room.

Supply and exhaust - artificial inflow and exhaust. Air enters through the supply chamber, where it is heated, filtered and removed through ventilation.

General principle ventilation is that

In dirty rooms, an extractor hood should prevail (to prevent spontaneous intake of dirty air into neighboring rooms)

V clean rooms inflow should prevail (so that they do not receive air from dirty rooms).

How to determine how much clean air must enter the room per hour per person for adequate ventilation?

The amount of air that needs to be supplied to the room per person per hour is called the ventilation volume.

It can be determined by humidity, temperature, but most accurately determined by carbon dioxide.

Methodology:

The air contains 0.4%<■ углекислого газа. Как уже упоминалось, для помещений, требующих высокого уровня чистоты (палаты, операционные), допускается содержание углекислого газа в воздухе не более 0.7 /~ в обычных помещениях допускается концентрация до 1 Л«.

When people stay indoors, the amount of carbon dioxide increases. One person exhales approximately 22.6 liters of carbon dioxide per hour. How much air must be supplied per person per hour in order to dilute these 22.6 liters so that the concentration of carbon dioxide in the air of the room would not exceed 0.7% ° or 1 /<.. ?

Each liter of air supplied to the room contains 0.4%° of carbon dioxide, that is, each liter of this air contains 0.4 ml of carbon dioxide and thus can still "accept" 0.3 ml (0.7 - 0.4) for clean rooms (up to 0.7 ml per liter or 0.7 /~) and 0.6 ml (1 - 0.4) for normal rooms (up to 1 ml per liter or 1 /~).

Since every hour 1 person emits 22.6 liters (22600 ml) of carbon dioxide, and each liter of supplied air can "accept" the above number of ml of carbon dioxide, the number of liters of air that needs to be supplied to the room per 1 person per hour is

For clean rooms (wards, operating rooms) - 22600 / 0.3 = 75000 l = 75 m 3. That is, 75 m 3 of air per person per hour must enter the room so that the concentration of carbon dioxide in it does not exceed 0.7% *

For ordinary premises - 22600 / 0.6 = 37000 l = 37 m 3. That is, 37 m3 of air per person per hour must enter the room so that the concentration of carbon dioxide in it does not exceed.

If there is more than one person in the room, then the indicated figures are multiplied by the number of people.

Above it was explained in detail how the value of the ventilation volume is found directly on specific figures, in general it is not difficult to guess that the general formula is as follows:

b \u003d (K * M) / (P - P0 \u003d (22.6 l * 14) / (P - 0.4%.)

b - ventilation volume (m)

K - the amount of carbon dioxide exhaled by a person per hour (l)

N is the number of people in the room

P - the maximum allowable carbon dioxide content in the room (/ ")

Using this formula, we calculate the required volume of supplied air (required ventilation volume). In order to calculate the real volume of air that is supplied to the room per hour (real volume of ventilation), it is necessary to substitute the real concentration of carbon dioxide in this room in ppm instead of P (MAC of carbon dioxide - 1 / C 0.7 U ") in the formula:

^ real-

- (22.6 l * 14) / ([C0 2] fact - 0.4 / ~)

L real - real volume of ventilation

[CCVactual - the actual content of carbon dioxide in the room

To determine the concentration of carbon dioxide, the Subbotin-Nagorsky method is used (based on a decrease in the titer of caustic Ba, the most accurate), the Rehberg method (also the use of caustic Ba, express method), the Prokhorov method, the photocolorimetric method, etc.

Another quantitative characteristic of ventilation, directly related to the volume of ventilation, is the ventilation rate. The ventilation rate indicates how many times per hour the air in the room is completely exchanged.

Ventilation rate - The volume of the hit (recovered 4) in the chag. air dry I am

The volume of the room.

Accordingly, in order to calculate the required ventilation rate for a given room, it is necessary to substitute the required ventilation volume in the numerator in this formula. And in order to find out what is the real ventilation rate in the room, the real ventilation volume is substituted into the formula (see above for the calculation).

The ventilation rate can be calculated by the inflow (the rate by the inlet), then the volume of air supplied per hour is substituted into the formula and the value is indicated with a (+) sign, or it can be calculated by the exhaust (the rate by the hood), then the volume of air extracted per hour is substituted into the formula and the value is specified with a (-) sign.

For example, if in the operating room the ventilation rate is indicated as +10, -8, then this means that every hour ten times the volume of air enters this room, and eight times the volume of air is extracted in relation to the volume of the room.

There is such a thing as an air cube.

The air cube is the volume of air required per person.

The norm of the air cube is 25-27 m. But as it was calculated above for one person per hour, it is required to supply an air volume of 37 m, that is, at a given norm of the air cube (a given volume of the room), the required air exchange rate is 1.5 = 1.5).

The microclimate of hospital premises.

Temperature regime.

Temperature changes must not exceed:

In the direction from the inner to the outer wall - 2°С

In the vertical direction - 2.5°C per meter of height

During the day with central heating - 3 ° С

Relative humidity should be 30-60%

Air speed - 0.2-0.4 m/s

6. The problem of nosocomial infections; nonspecific prevention measures, purpose and content.

HOSPITAL INFECTIONS - any clinically recognizable disease caused by microorganisms that occurs in patients as a result of being in a medical and preventive organization or seeking medical help, as well as that has arisen in medical personnel as a result of their professional activities (World Health Organization).

nonspecific prophylaxis.

Architectural and planning activities

Construction and reconstruction of inpatient and outpatient clinics in compliance with the principle of rational architectural and planning solutions:

isolation of sections, chambers, operating blocks, etc.;

observance and separation of flows of patients, personnel, “clean” and “dirty” flows;

Rational placement of departments on floors;

Correct zoning of the territory

Sanitary measures

effective artificial and natural ventilation;

creation of normative conditions for water supply and sanitation;

Proper air supply

air conditioning, use of laminar installations;

Creation of regulated parameters of the microclimate, lighting, noise mode;

Compliance with the rules of accumulation, neutralization and disposal of waste from medical institutions.

Sanitary and anti-epidemic measures

· epidemiological surveillance of nosocomial infections, including analysis of the incidence of nosocomial infections;

control over the sanitary and anti-epidemic regime in medical institutions;

introduction of the service of hospital epidemiologists;

· laboratory control of the state of the anti-epidemic regime in medical facilities;

detection of bacteria carriers among patients and staff;

Compliance with the rules of accommodation of patients;

Inspection and admission of personnel to work;

rational use of antimicrobial drugs, primarily antibiotics;

· training and retraining of personnel on the issues of regimen in health facilities and prevention of nosocomial infections;

Sanitary and educational work among patients.

Disinfection and sterilization measures.

the use of chemical disinfectants;

application of physical methods of disinfection;

pre-sterilization cleaning of instruments and medical equipment;

ultraviolet bactericidal irradiation;

chamber disinfection;

steam, dry air, chemical, gas, radiation sterilization;

Carrying out disinfection and deratization.

Microclimatic conditions are very important as a healing factor, and in the winter and transition periods of the year, the temperature in the wards should be in the range of 18-21 ° C, and in summer the upper limit of the comfort zone should not exceed 24 ° C. To do this, the heating devices located there must have devices for their regulation. In particular, special devices have already been developed for conventional radiators, which automatically maintain the set air temperature.

To prevent overheating in the hot summer months, the only radical remedy is the installation of air conditioners, which should first of all be equipped in wards for patients suffering from severe disorders of the cardiovascular system.

As palliative measures, it is advisable to use the correct orientation of windows according to the cardinal points, painting the outer walls white, vertical gardening, installing shutters, blinds and curtains, using special types of heat-retaining glass, increasing the speed of air movement with the help of room fans, etc.

Given the beneficial biological and psycho-physiological effects of solar radiation, it is necessary to ensure sufficient insolation of the ward rooms, and their best orientation is considered to be south. It has been established that even a weakened ultraviolet irradiation that has penetrated ordinary glass can have a detrimental effect on pathogenic flora. At the same time, the rays of the sun penetrating the ward raise the mood of patients to some extent and improve their well-being.

Finally, the proper orientation of windows is one of the prerequisites for the sufficiency of natural light, the indicators of which for ward rooms are equal to the light coefficient 1:5 - 1:6 and KEO not less than 1.0.

Sections for drip and intestinal infections are distinguished by specific features, where boxes, semi-boxes and boxed wards should be equipped. Of these, the first have an external entrance with a vestibule, a bath, a toilet bowl, a ward for 1 bed, a gateway for staff and a transfer locker for transferring dishes and food. Semi-boxes usually consist of two compartments, united by a common bath-shower room.

As for the boxed wards, they have only glass partitions between the beds, which to a certain extent protect against infection.

"Hygiene", V.A. Pokrovsky