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