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. Microclimate parameters determine the heat exchange of the human body and have a significant impact on the functional state of various body systems, well-being, performance and health.
High temperatures have a negative impact on human health. Working in conditions high temperature accompanied by intense sweating, which leads to dehydration of the body, loss of mineral salts, causes permanent changes in the activity of the cardiovascular system, attention is weakened, reactions slow down, etc.
When exposed to the human body negative temperatures there is a narrowing of the vessels of the fingers and toes, the metabolism changes. Prolonged exposure to these temperatures leads to persistent diseases. internal organs.
The parameters of the microclimate depend on the heat physical features technological processes, climate, season, heating and ventilation conditions in healthcare facilities.
The fight against the adverse effects of the industrial microclimate is carried out using technological, sanitary and medical and preventive measures.
Technological measures include: replacement of old and introduction of new technological processes and equipment, automation and mechanization of processes, remote control.
Sanitary and technical measures are aimed at localization of heat releases and thermal insulation, i.e. sealing of equipment, installation of ventilation systems, use of protective equipment, etc.
Medical and preventive measures include: organizing a rational regime of work and rest, undergoing medical examinations, etc.
Requirements for heating, ventilation, microclimate and indoor air are established by the Sanitary and Epidemiological Rules and SanPiN 2.1.3.1375-03 "Hygienic requirements for the location, arrangement, equipment and operation of hospitals, maternity hospitals and other medical hospitals."
Heating, ventilation and air conditioning systems must 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, incl. in day hospitals, are given in Appendix No. 5 to SanPiN 2.1.3.1375-03.
Heating appliances must be smooth surface, allowing easy cleaning, they should be placed at the outer walls, under the windows, without fences. It is not allowed to place heating devices in the chambers near internal walls.
In operating rooms, preoperative, resuscitation rooms, anesthesia, delivery, electric lighting and rooms of 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, excluding adsorption, should be used as heating devices. dust and accumulation of microorganisms.
When installing fences heating appliances in administrative and utility rooms, in children's hospitals, materials are used that are approved for use in in due course. At the same time, free access for the current operation and cleaning of heating devices should be provided.
As a heat carrier in the central heating systems of hospitals and maternity hospitals, water is used with a limiting temperature of heating appliances 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 supply and exhaust ventilation with mechanical impulse and natural exhaust without mechanical impulse.
In infectious diseases, 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 infectious diseases departments supply and exhaust ventilation with mechanical stimulation, 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. The outdoor air supplied by the supply units must be cleaned with coarse and fine filters in accordance with the current regulatory documentation.
The air supplied to operating rooms, anesthesia, delivery, resuscitation, postoperative wards, intensive care wards, as well as to wards for patients with skin burns, AIDS patients and other similar medical premises should be treated with air disinfection devices that ensure the effectiveness of inactivation of microorganisms and viruses that are in the processed air not less than 95% (filters high efficiency H11-H14).
Premises of operating rooms, intensive care wards, resuscitation, delivery, procedural and other rooms in which it is accompanied by release into the air harmful substances, must be equipped with local exhausts or fume hoods.
Content medicines in the air of operating rooms, delivery wards, intensive care wards, resuscitation, procedural, dressing rooms and other similar premises of medical institutions should not exceed the maximum permissible concentrations given in Appendix No. 6 to SanPiN 2.1.3.1375-03.
The levels of bacterial contamination of the air environment of the premises, depending on their functional purpose and cleanliness class, should not exceed the permissible ones given in Appendix No. 7 to SanPiN 2.1.3.1375-03.
Air conditioning should be provided in operating rooms, anesthesia, delivery, postoperative wards, intensive care wards, oncohematological patients, AIDS patients, those with skin burns, resuscitation rooms, as well as in wards for newborns, infants, premature, injured children and other similar medical facilities. In the wards, which are fully equipped with incubators, air conditioning is not provided.
Air ducts of supply ventilation (air conditioning) systems after high-efficiency filters (H11-H14) are provided from stainless steel.
The use of split systems is allowed in the presence of high efficiency filters (H11-H14) only if the rules of routine maintenance are observed. Split - systems installed in the institution must have a positive sanitary and epidemiological conclusion issued in the prescribed manner.
The air exchange rate is selected on the basis of calculations to ensure the specified purity and maintain the gas composition of the air. Relative Humidity air should be no more than 60%, the speed of air movement - no more than 0.15 m / s.
Air ducts, air-distributing and air-inlet grilles, ventilation chambers, ventilation units and other devices must be kept clean, must not have mechanical damage, traces of corrosion, leakage.
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/сек).
Supply and exhaust ventilation (conditioning) air ducts must have an inner surface that prevents particles of the air duct material or protective coating from being carried into the premises. The inner lining must be non-absorbent.
To accommodate the equipment of ventilation systems, special rooms should be allocated, separate for supply and exhaust systems and not adjacent vertically and horizontally to doctors' offices, operating rooms, wards and other premises for permanent residence of people.
In rooms for exhaust systems, exhaust ventilation should be provided with a single air exchange every 1 hour, for supply systems- supply ventilation with double air exchange.
Ventilation equipment rooms should only be used for their intended purpose.
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 linen, temporary storage of waste and pantries for storing 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.
The amount of fresh air in the ward should be 80 m 3 /hour per 1 patient.
To create an isolated air regime of the chambers, they should be designed with a gateway that has a connection with the bathroom, with a predominance of the hood in the latter.
At the entrance to the department, a lock must be equipped with an exhaust ventilation device in it with an independent channel (from each lock).
To exclude the possibility of polluted air from entering the stair-lift halls into the ward departments, it is advisable to arrange a transition zone between them with the provision of air overpressure in it.
Architectural and planning solutions and air exchange systems of the hospital should exclude the transfer of infections from ward departments and other rooms to the operating block and other rooms that require special air purity.
To exclude the possibility of air masses from entering the ward departments, stair-lift halls and other rooms into the operating block, it is necessary to install a lock with air overpressure between these rooms and the operating block.
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 and air conditioning systems for clean and purulent operating rooms, maternity units, resuscitation, oncohematological, burn departments, dressing rooms, separate ward sections, X-ray and other special rooms.
Preventive inspection and repair of ventilation and air conditioning systems of air ducts must be carried out according to the approved schedule, at least 2 times a year. Elimination of current malfunctions, defects should be carried out without delay.
The administration of the medical institution organizes control over the parameters of the microclimate and pollution of the air with chemicals, the operation of ventilation systems and the frequency of air exchange in the following rooms:
- in the main functional premises operating rooms, postoperative, delivery, intensive care wards, oncohematological, burn departments, PTO, storage rooms for potent and toxic substances, pharmacy warehouses, premises for the preparation of medicines, laboratories, department of therapeutic dentistry, special rooms of radiological departments and in other rooms, in offices, using chemical and other substances and compounds that can have harmful effect on human health - 1 time in 3 months;
- infectious, incl. tuberculosis hospitals (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 that are approved for use in the prescribed manner.
Methods of application of ultraviolet germicidal radiation, rules of operation and safety bactericidal installations(irradiators) must comply with hygienic requirements and instructions for the use of ultraviolet rays.
The assessment of the microclimate is carried out on the basis of measurements of its parameters (temperature, air humidity, speed of its movement, thermal radiation) at all places of stay of the employee during the shift.
Read:
|
How much air does a person need for a normal existence?
Room ventilation provides timely removal of excess carbon dioxide, heat, moisture, dust, harmful substances, in general, the results of various household processes and people staying in the room.
Types of ventilation.
1) Natural. Is in natural air exchange between by
displacement and external environment due to the temperature difference between the inside and outside
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 supply of outdoor 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)
AT clean rooms inflow should prevail (so that they do not receive air from dirty rooms).
How to determine how much clean air should enter the room per hour per person in order for ventilation to be sufficient?
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 "take" 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 air supplied 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), Rehberg's method (also the use of caustic Ba, express method), Prokhorov's method, 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
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 (inlet rate), 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 (exhaust rate), 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 staying in a medical and preventive organization or seeking medical help, as well as arising from 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.
Microclimate Control Systems in Medical Institutions
A. P. Borisoglebskaya, Candidate of Engineering
keywords: medical and preventive treatment facility, air distribution, microclimate
Controlling of microclimate in Medical and Preventive Treatment Facilities is a complex task requiring special knowledge, experience and regulatory documents, since the same building includes rooms of different cleanness category and regulated air bacterial loads. Therefore, the design process requires serious discussions, studying of the best national practices and foreign experience.
Description:
Providing a microclimate in medical buildings or medical institutions is a complex task that requires special knowledge, experience and regulatory documents due to the presence in the volume of one building of premises of various purity classes and normalized levels of bacterial contamination of the air. Therefore, the design process requires serious discussion, study of the best domestic practices and foreign experience.
A. P. Borisoglebskaya, cand. tech. Sci., editor of the issue on the topic "Organization of the microclimate of health care facilities"
Ensuring a microclimate in medical buildings or medical and preventive treatment facilities (HCF) is a complex task that requires special knowledge, experience and regulatory documents due to the presence in the volume of one building of rooms of various cleanliness classes and normalized levels of bacterial contamination of the air. Therefore, the design process requires serious discussion, study of the best domestic practices and foreign experience.
Development of the domestic regulatory framework
Having analyzed the history of the design of healthcare facilities, it can be seen that until the beginning of the 90s, there was a production of projects for hospital buildings, the main share of which belonged to standard design. Medical technologies of the treatment process almost did not develop and did not require the modernization of architectural and planning and, accordingly, engineering solutions. Therefore, the projects were rather monotonous, the typification of planning decisions led to the typification of decisions in the field of engineering systems design, such as ventilation and air conditioning. So, for a long time, planning decisions were made in projects for such basic structures as hospital wards without locks with direct access to the corridor of the ward section. And only at the very end of the 70s - the beginning of the 80s did the first projects appear with the installation of lock rooms at the wards, which led to a novelty in the adoption of sanitary and technical solutions. The design technology was based on the relevant regulatory documentation. In 1970, SNiP 11-L.9-70 “Hospitals and polyclinics. Design standards”, which for 8 years has been the main standard for designers in the narrow specialization “medical institutions”. It has not yet traced the requirement for the layout of wards with a lock, with the exception of wards for newborns and boxes, semi-boxes of infectious diseases hospitals. It was replaced in 1978 by SNiP 11-69-78 "Treatment and preventive care institutions", in which there is a reasonable requirement for the need to equip the wards with a gateway. Thus, a fundamentally new approach to the design of wards and ward sections arose. Moreover, joint architectural-planning and sanitary-technical solutions are recommended as the main way to ensure the required microclimate. Also by 1978, “Instructive and methodological guidelines for organizing air exchange in ward departments and operating blocks of hospitals” were developed, where the requirement was voiced to create an isolated air regime of the wards through planning decisions - the creation of gateways in the wards. Both documents were the result of new research in the field of organization of air exchange in hospital premises. Later, in 1989, SNiP 2.08.02–89 “Public Buildings and Structures” was published, which included requirements for the design of healthcare facilities as types of public buildings, and in 1990, an addition to it in the form of a manual for the design of healthcare facilities. This document provided indispensable assistance to designers until 2014. , despite the prescription of origin, until it was replaced by SP 158.13330.2014 “Buildings and premises of medical organizations”. Then came out sequentially in 2003 and 2010, replacing each other, SanPiN 2.1.3.1375-03 "Hygienic requirements for the placement, arrangement, equipment and operation of hospitals, maternity hospitals and other medical hospitals" and SanPiN 2.1.3.2630-10 "Requirements for organizations engaged in medical activities. Thus, an overview of the main regulatory documents that have accompanied project activities in the field of medicine for several decades to the present is presented.
The outbreak of interest in the hygienic aspects of the air environment was especially acute in the 70s. Not only specialists in the design of engineering systems, but also specialists in the field of sanitation and hygiene began to intensively study the quality of the air environment in medical facilities, the state of which was considered unsatisfactory. A large number of publications have appeared on the topic of organizing measures to ensure clean air in the premises of healthcare facilities. Among epidemiologists, it has long been believed that the quality of the air environment is determined by the quality of anti-epidemic measures. There is a concept of specific and non-specific infection prevention. In the first case, these are disinfection and sterilization (anti-epidemic measures), in the second case, ventilation and architectural and planning measures. Over time, studies have shown that against the background of specific prevention, current medical and technological processes in health facilities continue to be accompanied by the growth and spread of nosocomial infections. The emphasis began to be placed on sanitary and architectural and planning solutions, which among hygienists began to be considered the main method of non-specific prevention of nosocomial infection (HAI), and they began to play a dominant role.
Design features of health care facilities
During the entire period, especially from the mid-1990s to the present, there has been a development in technologies to ensure clean air, starting from the sterilization of air and surfaces of rooms and up to the use of modern technical solutions and the introduction of the latest equipment in the field of microclimate. Modern technologies have appeared that make it possible to provide and maintain the required conditions of the air environment.
The design of engineering systems in health care facilities has always been and is a difficult task compared to the design of a number of other objects related, like health care facilities, to public buildings. Features of the technology for designing heating, ventilation and air conditioning systems in these buildings are directly related to the features of the health facilities themselves. Features of LPU are as follows. The first feature of LPU should be considered a wide range of their names. These are general hospitals and specialized hospitals, maternity hospitals and perinatal centers. The complex of healthcare facilities includes: infectious diseases hospitals, polyclinics and dispensaries, treatment and diagnostic and rehabilitation centers, medical centers for various purposes, dental clinics, research institutes and laboratories, dispensaries and sanatoriums, ambulance substations and even dairy kitchens and sanitary and epidemiological stations. This entire list of institutions of completely diverse purposes implies the same set of various medical technologies that accompany the operation of buildings. In recent years, medical technologies have been growing rapidly: new and incomprehensible processes are being carried out in operating rooms, laboratories and other premises, sophisticated modern equipment is being used. For design engineers, misunderstood names and abbreviations in the explication of premises become frightening, which cannot be understood without qualified technologists, with the presence of which, as a rule, there are difficulties. On the other hand, the improvement of medical and technological solutions requires new, directly related, engineering solutions, often unknown without the support of technologists or their lack of proper qualifications. All this adds difficulties in the production of design work, and often even for an engineer with a long experience in the field of medicine, each new building being designed presents newly set, sometimes research, technological and engineering tasks.
The second feature of LPU should be considered a feature of the sanitary and hygienic state of the indoor air environment, which is characterized by the presence in the indoor air of not only mechanical, chemical and gas pollution, but also microbiological contamination of the air. The standard criterion for the cleanliness of indoor air in public buildings is the absence of excess heat, moisture and carbon dioxide in it. In healthcare facilities, the main indicator for assessing air quality is nosocomial infection (HAI), which is of particular danger, the source of which is the staff and the patients themselves. It has the peculiarity, regardless of the planned disinfection measures, to accumulate, grow rapidly and spread throughout the premises of the building, and in 95% of cases by air.
The next feature is the nature of the architectural and planning solutions of medical facilities, which have changed qualitatively. There was a time when the hospital building assumed the presence of a group of different buildings located at a distance from each other and separated, respectively, by air from each other. This made it possible to isolate clean and dirty medical and technological processes and patient flows. Clean and dirty rooms were located in separate buildings, which helped to reduce the transmission of infection. In modern times of saving building space in the design, there is a tendency to increase the number of storeys, compactness in terms of and capacity of hospitals, which leads to a reduction in the length of communications and, of course, more economically. On the other hand, this leads to a close mutual arrangement of rooms with different cleanliness classes and the possibility of contamination from dirty rooms to clean rooms both vertically and in floor plan.
To justify the recommended requirements for the design of engineering systems in health facilities, it is necessary to dwell on the air regime of buildings (VRZ). Here it is necessary to consider the boundary value problem of VRZ regarding the nature of air movement through openings in the external and internal enclosures of buildings, which directly affects the sanitary and hygienic state of the air environment and can be considered as one of the features of health facilities. The air regime of the health care facility, as in any multi-storey building, is unorganized (chaotic) in nature, that is, it occurs spontaneously due to natural forces. Under VRZ in this case, one should understand the nature of the movement of air flows through the enclosing structures of the building. On fig. 1 shows a schematic section of the building. The section shows a stairwell (elevator shaft), which, as a single high room, is a vertical connection between the floors of the building and is of particular danger, since it is a channel through which air flows are transferred. Through the leakage of external fences (windows, transoms) there is an unorganized movement of air due to the difference in pressure outside and inside the premises of the building. As a rule, the movement of air at the level of the lower floors occurs from the street into the building, and as the number of storeys increases, the amount of incoming air gradually decreases and approximately at the middle of the height of the building changes its direction to the opposite, and the amount of outgoing air increases and on the top floor becomes maximum. In the first case, this phenomenon is called infiltration, in the second - ex-filtration. The same patterns are valid for the movement of air through the openings or their leaks in the internal enclosures of the building. As a rule, on the lower floors of the building, air flows move from the corridor of the floor to the volume of the staircase, and on the upper floors, on the contrary, from the staircase to the floors of the building. That is, the air coming from the premises of the lower floors of the building rises up and is distributed through the stairwell to the upper floors. Thus, there is an unorganized flow of air between the floors of the building, and, consequently, the transfer of WFI with its flows. As the number of storeys increases, air pollution in the stair-elevator units increases, which, if the air exchange is not properly organized, leads to an increase in bacterial contamination of the air in the rooms of the upper floors.
There is also an unorganized flow of air between rooms located on the windward and leeward facades of the building, as well as between adjacent rooms in the floor plan or between sections of departments. On fig. 2 shows the plan of the ward section of the hospital and indicates (arrows) the direction of air movement between the rooms. This is how air flows from the rooms of the wards located on the windward facade of the building to the rooms of the wards located on the windward facade, bypassing the ward lock. It is also obvious that there is a flow from the corridor of one ward section to the corridor of another. The circle shows the required organization of the movement of air flows in the ward block, excluding the flow of air from the ward to the corridor, and from the corridor to the ward.
Under the floor plan there is a fragment of the corridor with the image of active locks - additionally provided rooms with supply or exhaust ventilation in them to prevent air from flowing between the corridors of different sections. In the first case, the lock is considered "clean", since clean air flows from it into the corridor, in the second - "dirty": air from neighboring rooms will flow into the lock. Thus, assessing the phenomenon of VRZ as a difficult task, it becomes necessary to solve it, which should be reduced to the organization of flows of overflowing air and their control.
The features of health care facilities buildings are taken into account as a whole, since all the considered parameters are interconnected and interdependent, and affect the requirements for the organization of air exchange, architectural, planning and technical solutions, isolation of ward departments, sections, wards for patients and premises of operating blocks, which should be nosocomial infection prevention and control measures.
When organizing a rational scheme for the distribution of air flows, it is necessary to take into account the purpose of the premises, especially such as ward departments and operating blocks.
Planning and sanitary-technical solutions of ward departments should exclude the possibility of air flows from stair-elevator nodes to departments and, conversely, from departments to stair-elevator nodes, in departments - from one ward section to another, in ward sections - from the corridor to wards for patients and, conversely, from the wards to the corridor. Such solutions in the field of organizing the movement of air flows imply the exclusion of air flow in an undesirable direction and the spread of infectious agents with air flows. On fig. 3 shows a diagram of the organization of air flows, excluding the flow of air between floors.
Thus, the tasks of designing heating, ventilation and air conditioning systems of health facilities should be as follows:
1) maintaining the required parameters of the microclimate of the premises (temperature, speed, humidity, the required sanitary norm of oxygen, the specified chemical, radiological and bacterial purity of indoor air) and eliminating odors;
2) exclusion of the possibility of air overflow from dirty areas to clean ones, creation of an isolated air regime of wards, ward sections and departments, operating and generic blocks, as well as other structural divisions of healthcare facilities;
3) preventing the formation and accumulation of static electricity and eliminating the risk of an explosion of gases used in anesthesia and other technological processes.
Literature
- Borisoglebskaya A.P. Medical and preventive institutions. General requirements for the design of heating, ventilation and air conditioning systems. M.: AVOK-PRESS, 2008.
- Borisoglebskaya A.P. // ABOK. - 2013. - No. 3.
- Borisoglebskaya A.P. // ABOK. - 2010. - No. 8.
- Borisoglebskaya A.P. // ABOK. - 2011. - No. 1.
- // ABOK. - 2009. - No. 2.
- Tabunshchikov Yu. A., Brodach M. M., Shilkin N. V. Energy efficient buildings. M.: AVOK-PRESS, 2003.
- Tabunshchikov Yu. A. // ABOK. - 2007. - No. 4.
Air-thermal regime of hospitals. The compensatory capabilities of the sick organism are limited, sensitivity to adverse environmental factors 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 is the most important microclimate factor that determines the thermal state of the body. It is generally accepted that the optimal air temperature in the wards of medical institutions should be slightly higher than 20 ° C than in residential premises 18 ° C (Table 6.7).
1. The age characteristics of children determine the highest temperature standards in the wards of premature babies, newborns and infants - 25 ° 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.
An integral element of the 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 the atmospheric air is within 0.04% (0.03-0.05%). The maximum permissible concentration of CO 2 in residential and public buildings is not higher than 0.1%.
The air in hospitals contains chemicals that accumulate during the work of 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.
As a result of the introduction of new services to patients of dental clinics, the activities of any medical institution require a qualitatively different approach to meeting the sanitary standards of the microclimate. We understand in the article what the microclimate in medical institutions affects and what work should be done to optimize it.
Microclimate in a medical facility
All sanitary rules and norms in dentistry, which enterprises in the medical field are required to follow, are specified in the Decree of the Chief State Sanitary Doctor of the Russian Federation dated May 18, 2010 No. 58 (Resolution "On Approval SanPiN 2.1.3.2630-10"Sanitary and epidemiological requirements for organizations engaged in medical activities"). Microclimate requirements are described in Chapter 6 "Requirements for heating, ventilation, microclimate and indoor air".
The formed market of medical services is quite wide, and constant interaction both between patients and between patients and dentists leads to two unfavorable moments:
- cross-infection of clinic clients
- occupational infection of dental workers who carry out appropriate manipulations
The influence of the microclimate in a medical institution affects the productivity of clinic staff. First of all, it is an indicator of the quality of the hospital environment for the patient.
Relevant requirements are formed depending on the layout of the buildings of medical institutions. If it meets all the requirements, then the microclimate is satisfactory in terms of microbiological indicators. To comply with such requirements, pay attention to the properties of the room. Let us clarify that if the clinic employees spend half of their time in this building or more than two hours from their work activity (that is, constantly), this room is called a workplace.
Requirements for creating a microclimate in rooms with the regular presence of an employee
Requirements for the creation of a microclimate in the premises where the clinic staff is periodically
In addition, the excess of hazardous and harmful substances is not allowed in the clinic, respectively, the ventilation systems also work properly. Moreover, the sanitary rules and norms of the Russian Federation indicate that if they break down, urgent repairs are required. Finally, the ventilation systems of dental offices need preventive maintenance to avoid their unforeseen failure.
The situation of the spread of infections in the medical business is largely due to the general epidemiological situation in Russia; thus, an increase in the incidence among people living in the country also increases the risk of infection of dental patients in medical institutions.
At the same time, we also note the economic losses that accompany the growth of infectious diseases: in European countries, these figures are approximately 7-7.5 billion euros, while in our country these figures are almost twice as high. Objectively, it can be judged that such a situation directly affects the quality of life of Russians, and also forms a negative reputation in individual dental clinics.
Now there are about 350 different pathogens; they can cause an infectious process in the patient and provoke the illness of medical personnel in the provision of services.
You may be interested
- Production control program of the dental clinic
Nosocomial infections and air purification technologies
Informing about the features of the spread of nosocomial infections in various medical institutions is very inactive, however, there are a lot of patients who come to dentists in the maxillofacial departments with characteristic complications. Often, the presence of microorganisms in the air in dental clinics exceeded the standards for the total number of colonies in 58% of cases, and in the autumn-winter period in 67.2% of the total number exceeding the standards.
When a dentist works with a drill, especially during various invasive procedures, the local concentration of pathogens in the air increases several times, at the same time, microorganisms are sprayed from the patient's oral cavity in the form of tiny particles. They settle on the skin of the face and hands of the dentist, end up on the mucous membrane of the nasopharynx and eyes. Finally, they also settle on the surface, equipment in the cabinet.
On average, 1 ml of saliva can contain up to 5 billion microorganisms; 1 gram of plaque contains 10-1000 billion microorganisms. Moreover, if a microorganism has stable antibiotic resistance and resistance to disinfectants, this exacerbates the situation with infectious diseases in dental facilities. Accordingly, innovative ways to purify the air environment are also needed.
Now devices appear on the market that almost completely solve the problems of microbiological air purity. These are devices based on Bioinactivation technology, they disinfect, disinfect and carry out fine filtration indoor air, as well as reduce microbial contamination of various surfaces.
Using the unit, you can prepare a local "clean" area (for example, an operating table) or process the entire room - on average, one such mobile unit covers 40–50 m3.
This technology is based on the phenomenon of cell membrane electroporation, that is, the formation of pores in the cell membrane under the influence of an electric field. The process of electroporation is irreversible, as a result, we observe the inactivation of pathogenic microorganisms. The cell is affected by an electric field of a given orientation and intensity, which destroys it. Now this technology has become actively used in the medical business, including dentistry, including surgery.
We thank Olga Konina, Ph.D., doctor of the 2nd category, for her help
Loading...