The microclimate in the hospital premises and the systems that provide it (ventilation and heating). Treatment and prevention institutions
Microclimate - a complex of physical factors of the internal environment of the premises, influencing the heat exchange of the body and human health. Microclimatic indicators include temperature, humidity and air velocity, surface temperature of enclosing structures, objects, equipment, as well as some of their derivatives (air temperature gradient along the vertical and horizontal of the room, the intensity of thermal radiation from internal surfaces).
The impact of a complex of microclimatic factors is reflected in the human sensation of heat and determines the characteristics of the physiological reactions of the body. Temperature effects that go beyond neutral fluctuations cause changes in muscle tone, peripheral vessels, sweat gland activity, and heat production. At the same time, the constancy of the heat balance is achieved due to the significant tension of thermoregulation, which negatively affects the well-being, human performance, and his state of health.
The thermal state in which the stress of the thermoregulatory system is negligible is defined as thermal comfort. It is provided in the range of optimal microclimatic conditions, within which the least stress of thermoregulation and comfortable sensation of heat are noted. The optimal microclimate standards have been developed, which must be ensured in medical and prophylactic institutions, residential, administrative buildings, as well as at industrial facilities, where optimal conditions are necessary for technological requirements. The sanitary norms of the optimal microclimate are differentiated for the cold and warm seasons ( tab. 1 ).
Table 1
Optimal norms of temperature, relative humidity and air velocity in residential, public, administrative premises
|
Indicators |
Period of the year |
|
|
cold and transient |
||
|
Temperature |
||
|
Relative humidity,% |
||
|
Air speed, m / s |
No more than 0.25 |
No more than 0.1-0.15 |
For the premises of medical institutions, the calculated air temperature is normalized, while for premises for various purposes (wards, offices and treatment rooms), these standards are differentiated. For example, in wards for adult patients, rooms for mothers in children's departments, wards for tuberculosis patients, the air temperature should be 20 °; in wards for burn patients, postpartum wards - 22 °; in wards for premature, injured, infants and newborns - 25 °.
In cases where, for a number of technical and other reasons, the optimal microclimate standards cannot be ensured, they are guided by the permissible standards ( tab. 2 ).
table 2
Permissible norms of temperature, relative humidity and air velocity in residential, public, administrative and household premises
|
Indicators |
Period of the year |
|
|
cold and transient |
||
|
Temperature |
Not more than 28 ° |
|
|
for areas with a design air temperature of 25 ° |
Not more than 33 ° |
|
|
Relative humidity,% |
||
|
in areas with an estimated relative humidity of more than 75% |
||
|
Air speed, m / s |
No more than 0.5 |
No more than 0.2 |
The permissible sanitary standards of the microclimate in residential and public buildings are ensured with the help of appropriate planning equipment, thermal and moisture-protective properties of the enclosing structures.
When carrying out the current sanitary supervision in residential, public, administrative and medical institutions, the air temperature is measured at the level of 1.5 and 0.05 m from the floor in the center of the room and in the outer corner at a distance of 0.5 m from the walls; relative humidity is determined in the center of the room at a height of 1.5 m from the floor; air speed is set at 1.5 and 0.05 m from the floor in the center of the room and at a distance of 1.0 m from the window; the temperature on the surface of enclosing structures and heating devices is measured at 2-3 points on the surface. When carrying out sanitary supervision in multi-storey buildings, measurements are made in rooms located on different floors, in end and row sections with one-sided and two-sided orientation of apartments at an outside air temperature close to the calculated one for given climatic conditions.
The air temperature gradient along the height of the room and horizontally should not exceed 2 °. The temperature on the surface of the walls can be lower than the air temperature in the room by no more than 6 °, the floor - by 2 °, the difference between the air temperature and the temperature of the window glass during the cold season should not exceed an average of 10-12 °, and the thermal effect on human body surface of infrared radiation flux from heated heating structures - 0.1 cal / cm 2 × min.
Industrial microclimate ... The microclimate of industrial premises is significantly influenced by the technological process, the microclimate of workplaces located in open areas is influenced by the climate and weather of the area.
At a number of industries, the list of which is established by sectoral documents agreed with the state sanitary inspection authorities, an optimal production microclimate... In cabins, on consoles and control stations of technological processes, in computer rooms, as well as in other rooms in which operator-type work is performed, optimal microclimate values \u200b\u200bshould be provided: air temperature 22-24 °, humidity - 40-60%, speed air movement - no more than 0.1 m / s regardless of the period of the year. Optimum rates are achieved mainly through the use of air conditioning systems. However, the technological requirements of some industries (spinning and weaving shops of textile factories, individual shops of the food industry), as well as the technical reasons and economic capabilities of a number of industries (open-hearth, blast furnace, foundry, forging shops of the metallurgical industry, heavy machine building, glass production and food industry ) do not allow to ensure optimal norms of the industrial microclimate. In these cases, at permanent and non-permanent workplaces, in accordance with GOST, permissible microclimate standards are established.
Depending on the nature of heat input and the prevalence of one or another microclimate indicator, shops are distinguished mainly with a convection (for example, food shops of sugar factories, machine rooms of power plants, thermal shops, deep mines) or a radiation heating (for example, metallurgical, glass production) microclimate. The convection heating microclimate is characterized by a high air temperature, sometimes combined with its high humidity (dyeing departments of textile factories, greenhouses, sintering shops), which increases the degree of overheating of the human body (see. Overheating of the body). Radiant heating microclimate is characterized by the predominance of radiant heat.
If preventive measures are not observed, persons who work for a long time in a heating microclimate may experience dystrophic changes in the myocardium, arterial hypertension, hypotension, asthenic syndrome, the immunological reactivity of the body decreases, which contributes to an increase in the incidence of workers with acute respiratory diseases, angina, bronchitis, myositis, neuralgia. When the body overheats, the adverse effect of chemicals, dust, noise increases, and fatigue sets in faster.
Table 3
Optimal values \u200b\u200bof temperature and air velocity in the working area of \u200b\u200bthe production of other premises, depending on the category of work and periods of the year
|
Energy costs, W |
Periods of the year |
||||
|
cold |
cold |
||||
|
Temperature (° C) |
Air speed, ( m / s) |
||||
|
light, Ia |
|||||
|
light, Ib |
|||||
|
moderate, IIa |
|||||
|
moderate, IIb |
|||||
|
heavy, III |
|||||
The cooling microclimate in industrial premises can be predominantly convection (low air temperature, for example, in separate preparatory workshops of the food industry), predominantly radiation (low temperature of enclosures in refrigerating chambers) and mixed. Cooling contributes to the occurrence of respiratory diseases, exacerbation of diseases of the cardiovascular system. With cooling, coordination of movements and the ability to perform precise operations deteriorate, which leads to both a decrease in performance and an increase in the likelihood of industrial injuries. When working in an open area in winter, it becomes possible frostbite, it is difficult to use personal protective equipment (frosting of respirators when breathing).
Sanitary standards provide for the provision of optimal or acceptable parameters of the microclimate of industrial premises, taking into account 5 categories of work, characterized by different levels of energy consumption ( tab. 3 ). The standards regulate temperature, humidity, air velocity and intensity of thermal radiation of workers (taking into account the area of \u200b\u200bthe irradiated body surface), the temperature of internal surfaces enclosing the working area of \u200b\u200bstructures (walls, floor, ceiling) or devices (for example, screens), the temperature of the external surfaces of the technological equipment, air temperature drops along the height and horizontal of the working area, its changes during the shift, and also provide for the necessary measures to protect workplaces from radiation cooling. emanating from the glass surface of window openings (in the cold season) and heating from direct sunlight (in the warm season).
Prevention of overheating of workers in a heating microclimate is carried out by reducing the external heat load by automating technological processes, remote control, using collective and individual protective equipment (heat-absorbing and heat-reflecting screens, air showers, water curtains, radiation cooling systems), regulating the time of continuous stay at the worker place and in the recreation area with optimal microclimatic conditions, organization of the drinking regime.
To prevent overheating of workers in the summer period in the open area, overalls are used made of air- and moisture-permeable fabrics, materials with high reflective properties, and rest is organized in sanitary facilities with an optimal microclimate, which can be provided by using air conditioners or radiation cooling systems. Measures aimed at increasing the body's resistance to thermal effects, including adaptation to this factor, are of great importance.
When working in a cooling microclimate, preventive measures include the use of overalls first of all (see. clothing), shoes (see. Footwear), hats and mittens, the heat-protective properties of which must correspond to meteorological conditions, the severity of the work performed. The time of continuous stay in the cold and rest breaks in sanitary facilities, which are included in working hours, are regulated. These rooms are additionally equipped with devices for warming hands and feet, as well as devices for drying overalls, shoes, gloves. To prevent the respirators from freezing, devices are used to warm the inhaled air.
Bibliography: Hygienic regulation of factors of the working environment and labor process, ed. N.F. Measured by A.A. . Kasparov, p. 71, M., 1986; Provincial Yu . D. and Korenevskaya E.I. Hygienic bases of microclimate conditioning of residential and public buildings, M., 1978, bibliogr .; Occupational Health Guide, ed. N.F. Izmerova, vol. 1, p. 91, M., 1987, Shakhbazyan G.Kh. and F.M. Shleifman. Hygiene of industrial microclimate, Kiev, 1977, bibliogr.
Air value:
Participation in oxidative processes in the body
Heat production and heat regulation
In health-improving activities, it is aimed at preventing certain diseases
Negative Impact:
Chemical contamination
Unfavorable physical factors
Unfavorable weather conditions
Microclimate regulation
The indoor microclimate is determined by temperature, humidity, air speed. Weather - the state of the atmosphere or the state of the physical properties of air in a given place at a given time.
Temperature in the wards - 20 degrees C
The temperature in the doctor's office is 20 degrees C
Temperature in the doctor's office - 20degrees C
Premature baby ward and burn ward - 25 degrees C
Dressing and operating room - 22 degrees C
Residential apartments -18 degrees C
Bathroom - at least 22 degrees C
The assessment of the bacterial composition of the air is carried out according to 2 indicators:
1. The total number of microorganisms contained in 1 m 3 of air.
2. The number of pathogenic microorganisms.
Clean air is considered if in the summer season it contains 1500 microorganisms and no more than 16 streptococci.
Air pollution in summer - not\u003e 2500 microorganisms and not\u003e 30 streptococci.
Clean air in winter up to 4500 microorganisms and up to 36 streptococci. Contaminated - not\u003e 7000 and containing streptococci not\u003e 124.
For health care facilities, in addition to the season, the purpose of the premises is taken into account.
Operating room: not\u003e 500 before surgery; after surgery not\u003e
Resuscitation:not\u003e 750; pathogenic should not be
Maternity (operating): not\u003e 1000; pathogenic should not be
Delivery room (after childbirth): not\u003e 2500; pathogenic should not be
Wards for newborns:not\u003e 1500; streptococci - not\u003e 12
Postpartum:not\u003e 2000; streptococci - not\u003e 16
Methods for determining bacterial air pollution:
1) Aspiration;
2) Sedimentary.
Air purification methods
1. Irradiation with bactericidal lamps (calculation per room volume).
2. Treatment with chemical bactericidal substances
Neutralizing air by improving room ventilation.
No. 64 Hygienic requirements for lighting hospital premises for various purposes
Rational organization of natural lighting, both parties are interested in this: staff (quality of performance of duties), patients (improvement of hygienic conditions of stay, as well as increased mood.
II ???(daylight)
1. Sufficient intensity for staff. The light intensity is divided into 8 categories and classes
accuracy, based on the division of the dimensions of parts and a contrasting background (for each class its own indicators, for example:
operating room - grade 1, registry - grade 6).
2. Should be uniform
3. Do not have a blinding effect
4. Don't create glitter
III (??? artificial lighting)
1. The spectrum should be close to natural
2. Should not give shadows
3. Should be constant in time
Factors determining the level of natural light
1.Factors due to light climate
Geographic latitude
Sun height
Cloudiness
- presence of contamination
2. External factors - time of year and day
Orientation of the light-carrying wall to the cardinal points
- the presence of shading buildings and trees
3. Internal factors
The size of window openings
Configuration of window openings
Frame construction
Placement of windows on a light-carrying wall (the distance from the upper edge of the window to the ceiling should not be\u003e 30 cm.
Painting of internal surfaces (walls and ceiling should be in light colors)
Glass cleanliness
Layout of premises
Methods for assessing natural light
Geometrically - are laid during the design and to determine them we use geometric functions
1. Light coefficient (SK) - the ratio of the area of \u200b\u200bthe glazing to the area of \u200b\u200bthe room, while
glazing area is taken as a unit, for doctors' offices 1/4, 1/5, corridors, stairs 1/12, 1/15.
2. Angle of incidence - formed by two lines, one of which is drawn horizontally from the point of the working
places to the window frame, and the other from the same point to the upper edge of the window (not< 27 градусов)
3. Angle of the hole - is determined in cases where there are shading buildings or trees and light
the flow does not enter the room through the entire window area. Formed by two lines, one of which goes from a point
workplace to the upper edge of the window, and the second from the same point to the projection point of the highest point
the opposite building on the plane of the window (not< 5 градусов)
4. The length of the laying - the ratio of the depth of the room (the distance from the light-carrying wall to
opposite) to the height of the upper edge of the window to the floor. Not\u003e 2.
Lighting engineering -
KEO - the coefficient of natural light inside the room, to the simultaneously measured lighting outside the room (1% for wards and doctors' offices, 2.5% for operating blocks)
67. Hygienic requirements for the placement, planning, equipment and organization of work of hospital
2. Hygienic requirements for the improvement of hospital premises
Microclimate and systems providing it - ventilation and
heating
The internal environment of the premises acts on the body with a complex of factors: thermal, air, light, color, acoustic and others. Together, these factors determine the well-being and performance of a person indoors.
Let's consider 3 priority factors in the lecture: thermal, air and light.
Heat factor it is a combination of four physical indicators: air temperature, humidity, air velocity and the temperature of the interior surfaces of the room (ceiling, walls).
Airwednesday premises are the gas and electrical composition of air, dust (mechanical impurities), anthropogenic chemicals and microorganisms
Optimization of the microclimate in large rooms contributes to a favorable course and outcome of the disease. The patient's compensatory capabilities are limited, the sensitivity to adverse environmental factors is increased.
The microclimate standards for wards and other premises of the hospital should take into account:
- the patient's age;
- peculiarities of heat exchange in patients with various diseases;
- functional purpose of the premises;
- climatic features of the area.
Table 1
| Indoor air temperature | hospitals | ||
| 1. | Wards for adults | 20 ° |
|
| 2. | Hypothyroid wards | 24 ° |
|
| 3. | Wards for patients with thyrotoxicosis | 15 ° |
|
| 4. | Burn rooms, postpartum | 22 ° |
|
| 5. | Wards for children | 22 ° |
|
| 6. | Premature, newborn and | 25 ° |
|
| infants | |||
| 7. | Operating rooms, intensive care wards | 22 ° |
|
| 8. | Halls of physiotherapy exercises (LFK) | 18 ° |
Let's analyze the table data.
The temperature in most wards of general hospitals is 20 °. For comparison: in the living quarters of the apartment - 18 °.
The age characteristics of children determine the highest standards
temperatures in the wards of premature babies, newborns and infants -
25 °
Features of heat exchange in patients with functional impairments
the thyroid gland cause a high temperature in the wards - for
patients with hypothyroidism (24 °). On the contrary, the temperature in the patient rooms
thyrotoxicosis should be 15 °. Increased heat generation in such
patients - this is the specificity of thyrotoxicosis: the "sheet" syndrome, such
patients are always hot.
physical rooms Cultures at school - 15 - 17 °. Physical activity
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 °.
Relative air humidity should not exceed 60%, air speed should not exceed 0.15 m / s.
^ Air environment premises: the chemical composition of the air and bacterial pollution are normalized.
Hygienic assessment of hospital air purity. The presence of people and animals in enclosed spaces leads to air pollution by metabolic products (anthropotoxins and other chemicals). A person in the process of vital activity releases more than 400 different compounds - ammonia, ammonium compounds, hydrogen sulfide, volatile fatty acids, indole, mercaptan, acrolein, acetone, phenol, butane, ethylene oxide, etc. The exhaled air contains only 15-16% oxygen and 3, 4-4.7% carbon dioxide, saturated with water vapor and has a temperature of about 37 °. As a result, the indoor temperature rises. Pathogenic microorganisms (staphylococci, streptococci, mold and yeast fungi, etc.) enter the air. The number of light ions decreases, heavy ions accumulate. Unpleasant odors appear in wards, reception rooms, medical and diagnostic departments. This is due to the use of various drugs (ether, gaseous anesthetic substances, vapors of various drugs, etc.). Unpleasant odors can be associated with building materials (polymer materials for interior decoration, furniture), as well as with specific food. The content of under-oxidized substances in the air increases. All this has an adverse effect on both patients and staff. Therefore, control over the chemical composition of the air and its bacterial contamination is of great hygienic importance (Table 2).
table 2
The chemical composition of indoor air
An important indicator of the air environment is the content of carbon dioxide - CO 2 in the air. Indoors, the CO 2 content should not exceed 0.1%. In the atmospheric air - 0.03-0.04%. The content of 0.1% CO 2 is not toxic to humans. However, all indicators of the air-thermal environment deteriorate at this concentration of CO 2: the temperature, relative humidity, anthropogenic impurities and microbial pollution increase. This adversely affects the well-being of people, worsens recovery, and contributes to the emergence of nosocomial infections.
^ Permissible levels of bacterial contamination of the air in hospitals
The standards for bacterial contamination depend on the functional purpose and class of cleanliness of the premises. Three types of sanitary and bacteriological indicators are monitored: before starting work and during work.
The total number of microorganisms in 1 m Air (CFU m)
The number of Staphylococcus aureus colonies in 1 m 3 of air
The amount of mold and yeast in 1 dm3 of air
P. Clean rooms (class B): procedural, dressing, preoperative, intensive care wards, children's wards. The total number of microbes should not exceed 500 per 1 m before the start of work, during work - no more than 750 / m.
III. Conditionally clean (class B): wards of surgical departments,
corridors adjacent to operating rooms, maternity rooms, boxes and wards of infectious wards, etc. The total number of microbes should not exceed 750 / m 3 before starting work, during work - no more than 1000. Staphylococcus aureus and microfungi should be absent in all rooms of classes A , B and C both before the start and during the work. IV. Dirty (class D): corridors and premises of administrative
buildings, stairs, toilets, etc. Microbial contamination is not standardized.
Hygienic requirements for heating and ventilation.
Heating, ventilation and air conditioning systems provide air-thermal conditions in hospital premises.
Heating. In hospitals, during the cold period of the year, the heating system must ensure uniform heating of the air throughout the entire heating period, exclude pollution with harmful emissions and unpleasant odors of the air in the premises, and not create noise. The heating system should be easy to operate and repair, linked to ventilation systems, and easily adjustable. The heaters should be placed against the outer walls under the windows for higher efficiency. In this case, they create uniform air heating in the room and prevent the appearance of cold air currents above the floor near the windows. It is not allowed to place heating devices in chambers near internal walls. The optimal system is central heating. Only water with a temperature limit of 85 ° is allowed. Smooth surface heaters are only permitted in hospital rooms. Devices must be resistant to daily exposure to cleaning and disinfecting solutions, not to adsorb dust and microorganisms.
Heating devices in children's hospitals are fenced off. Radiant heating from a hygienic position is more favorable than convective heating. It is used to heat operating rooms, preoperative, intensive care, anesthesia, childbirth, psychiatric wards, as well as intensive care and postoperative wards.
As a heat carrier in central heating systems of hospitals, water is used with a maximum temperature in heating devices of 85 ° C. The use of other liquids and solutions as a heat carrier in heating systems of hospitals is prohibited.
Ventilation . Hospital buildings must be equipped with three systems:
supply and exhaust ventilation with mechanical induction;
natural exhaust ventilation without mechanical induction;
conditioning
Outside air intake for ventilation and air conditioning systems is made from a clean zone of atmospheric air at a height of at least 2 m from the ground surface. Outside air supplied by air handling units is cleaned with coarse and fine filters.
The air supplied to operating rooms, anesthesia, childbirth, intensive care, postoperative wards, intensive care wards, as well as to wards for patients with burns, AIDS patients, should be treated with air disinfection devices that ensure the effectiveness of inactivating microorganisms and viruses in the processed air. less than 95%.
^ Air conditioning ~ this is a set of measures for the creation and automatic maintenance of the optimal artificial microclimate and air environment in the premises of medical institutions with a given clean, temperature, humidity, ionic composition, and mobility. It is provided in operating rooms, anesthesia, birth, postoperative wards, intensive care units, intensive care wards, hematological patients with AIDS, with skin burns, in wards for infants and newborns, as well as in all wards of departments of premature and injured children and other similar medical institutions. The automatic microclimate control system must provide the required parameters: air temperature - 15 - 25 ° С, relative humidity - 40 - 60%, mobility - no more than 0.15 m / s.
Air exchange in the wards and departments should be organized in such a way as to limit as much as possible the flow of air between the ward departments, between the wards, and between adjacent floors. The amount of air supplied to the ward should be 80 m3 / hour per patient. The volume of air in wards with minimum dimensions (7m - area, 3m - height) is 21 m 3 per patient. The provision of a sufficient standardized volume of air (80 m3 per hour) is achieved by changing the air 4 times in the room. The air exchange rate is the number of times the air is exchanged per hour in the room.
The architectural and planning solutions of the hospital should exclude the transfer of infections from ward departments and other rooms to the operating unit and other rooms that require special air purity. The movement of air flows must be ensured from the operating rooms to the adjacent rooms (preoperative, anesthesia and others), and from these rooms to the corridor. An exhaust ventilation device is required in the corridors. This is ensured by the correct ratio of supply and exhaust.
The amount of air removed from the lower zone of operating rooms should be 60%, from the upper zone - 40%. Fresh air is supplied through the upper zone. In this case, the inflow must prevail by at least 20% over the exhaust. The latter requirement applies to aseptic intensive care wards, recovery wards, intensive care, delivery boxes, as well as wards for premature, infants, newborns and injured children. At the same time, in the wards for tuberculosis hospitals for adults, the extract should prevail over the inflow. This prevents contamination of the corridor and other rooms of the ward section. In infectious diseases, including tuberculosis departments, mechanical exhaust ventilation is arranged from each box and semi-box and from each ward section separately, through individual channels that exclude vertical air flow, they must be equipped with air disinfection devices.
^ Control over microclimate and chemical air pollution
wednesday
The administration of the medical institution organizes this type of control in all premises periodically. The serviceability of ventilation systems and the frequency of air exchange are checked at the same time.
Table 3
1st group - high-risk premises - once every 3 months. 2nd group - high-risk premises - once every 6 months. 3rd group - all other rooms and, above all, wards - once a year.
As a result of the introduction of new services to patients of dental clinics, the activity of any medical institution requires a qualitatively different approach to compliance with sanitary standards of the microclimate. We will understand in the article what the microclimate in medical institutions affects and what work should be done to optimize it.
Microclimate in a medical institution
All sanitary rules and norms in dentistry that enterprises in the medical field must follow are specified in the Decree of the Chief State Sanitary Doctor of the Russian Federation of 05/18/2010 No. 58 (Decree “On the approval SanPiN 2.1.3.2630-10 "Sanitary and Epidemiological Requirements for Organizations Carrying Out Medical Activities"). The microclimate requirements are described in chapter 6 "Requirements for heating, ventilation, microclimate and indoor air".
The formed market of medical services is wide enough, and constant interaction both between patients and between patients and dentists leads to the appearance of two unfavorable moments:
- cross-infection of clinic clients
- occupational infection of dental workers who carry out the appropriate manipulations
The influence of the microclimate in a medical institution affects the productivity of the clinic staff. First of all, it is an indicator of the quality of the hospital environment for the patient.
The corresponding requirements are formed depending on the layout of buildings of medical institutions. If it meets all the requirements, then the microclimate is satisfactory in terms of microbiological indicators. To comply with these requirements, pay attention to the properties of the room. Let us clarify that if clinic employees spend half their time in this building or more than two hours from their work activities (that is, constantly), this room is called a workplace.
Requirements for creating a microclimate in rooms with a regular presence of an employee
Requirements for creating a microclimate in rooms where clinic staff are periodically
In addition, the excess of hazardous and harmful substances is not allowed in the clinics, respectively, ventilation systems are working properly. Moreover, the sanitary rules and regulations of the Russian Federation indicate that if they break down, urgent repair is required. Finally, the ventilation systems in dentistry offices need preventive repairs in order to avoid their unexpected failure.
The spread of infections in the medical business is largely due to the general epidemiological situation in Russia; thus, an increase in morbidity in people living in the country also increases the risk of infection of dental patients in medical institutions.
At the same time, we 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 among individual dental clinics.
There are now about 350 different pathogens; they can cause an infectious process in a patient and provoke illness of medical personnel when providing services.
You might be interested
- Dental clinic production control program
Hospital-acquired infections and air purification technologies
Informing about the peculiarities of the spread of nosocomial infections in various medical institutions is very inactive, however, there are a lot of patients who get to the dentists in the maxillofacial departments with typical 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 with 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 dentist's face and hands, end up on the mucous membrane of the nasopharynx and eyes. Finally, they are also deposited on the surface of the equipment in the cabinet.
On average, 1 ml of saliva can contain up to 5 billion microorganisms; 1 gram of dental 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, we need innovative ways to purify the air.
Now on the market there are devices that almost completely solve the problem of microbiological air purity. These are devices based on Bioinactivation technology, they disinfect, disinfect and carry out fine filtration indoor air, and also reduce microbial contamination of various surfaces.
The unit can be used to prepare a local “clean” area (for example, an operating table) or treat the entire room - on average, one such mobile unit covers 40-50 m 3.
This technology is based on the phenomenon of electroporation of the cell membrane, that is, the formation of pores in the cell membrane under the influence of an electric field. The electroporation process 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 tension, which destroys it. Now this technology has become actively used in the medical business, including in dentistry, including surgery.
Thank you for your help Olga Konina, Ph.D., doctor of the 2nd category
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.
The microclimate of the premises of medical institutions is determined by a combination of temperature, humidity, air mobility, temperature of surrounding surfaces and their thermal radiation.
Requirements for the microclimate and air environment of the premises are established by SanPiN 2.1.3.1375-03 "Hygienic requirements for the location, arrangement, equipment and operation of hospitals, maternity hospitals and other medical hospitals."
Heating and ventilation systems should provide optimal conditions for the microclimate and air environment in the premises of medical institutions.
The parameters of the design temperature, the frequency of air exchange, the category of 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 |
Design air temperature, О С |
Air exchange rate, m3 / h |
Exhaust multiplicity with natural air exchange |
||
|
Exhaust,% |
|||||
|
Wards for adult patients |
80 for 1 berth |
||||
|
Tuberculosis wards |
80 for 1 berth |
||||
|
Exhaust,% |
|||||
|
Hypothyroid wards |
80 for 1 berth |
||||
|
Wards for patients with thyrotoxicosis |
|||||
|
Postoperative wards, intensive care wards |
By calculation, but not less than 10 times the exchange |
Not allowed |
|||
|
Doctor's offices |
Inflow from the corridor |
||||
|
Functional diagnostics room |
|||||
|
Cabinet of microwave and ultra-high-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 devices for 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 locate heating devices in chambers against internal walls.
In operating rooms, preoperative, resuscitation rooms, anesthesia, electrotherapy and psychiatric wards, as well as in intensive care and postoperative wards, heating devices with a smooth surface that are resistant to daily exposure to washing and disinfecting solutions, excluding the adsorption of dust and accumulation of microorganisms.
Water with a maximum temperature in heating devices of 85 ° C is used as a coolant in central heating systems of hospitals. The use of other liquids and solutions (antifreeze, etc.) as a coolant in heating systems of hospitals is not allowed.
Buildings of medical institutions should be equipped with supply and exhaust ventilation systems with mechanical impulse and natural exhaust ventilation without mechanical impulse.
In infectious diseases, including tuberculosis departments, mechanical exhaust ventilation is arranged by means of individual channels in each box and semi-box, which must be equipped with air disinfection devices.
In the absence of mechanical forced ventilation in infectious wards, natural ventilation must be equipped with the obligatory equipping of each box and semi-box with a recirculation-type air disinfection device that ensures the inactivation efficiency of microorganisms and viruses is at least 95%.
Design and operation of ventilation systems should exclude the overflow of air masses from "dirty" areas to "clean" rooms.
Premises of medical institutions, except for operating rooms, in addition to supply and exhaust ventilation with mechanical induction, are equipped with natural ventilation (vents, folding transoms, etc.), equipped with a fixation system.
Outside air for ventilation and air conditioning systems is taken from a clean area at a height of at least 2 m from the ground. Outside air supplied by air handling units must be cleaned 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 treatment rooms should be treated with air disinfection devices that ensure the effectiveness of inactivation of microorganisms and viruses in the treated air at least 95% (high efficiency filters H11-H14).
The rooms of operating rooms, intensive care wards, resuscitation rooms, treatment rooms and other rooms in which the release of harmful substances into the air is observed should be equipped with local suction or fume hoods.
The levels of bacterial contamination of the air environment of premises depend on their functional purpose and cleanliness class are also regulated by the requirements of SanPiN 2.1.3.1375-03.
Table 3.2 - Maximum permissible concentration and hazard classes of medicines in the air of hospitals
|
Determined substance |
MPC, mg / m3 |
Hazard Class |
|
|
Ampicillin |
|||
|
Aminazine (demytylaminopropyl 3-chlorophenothiazine hydrochloride) |
|||
|
Babzilpenicillin |
|||
|
Diethyl ether |
|||
|
Ingalan (1,1-difluoro-2, 2-dichloethyl methyl ether) |
|||
|
Nitrous oxide (in terms of 02) |
5 (in terms of 02) |
||
|
Oxacillin |
|||
|
Streptomycin |
|||
|
Tetracycline |
|||
|
Ftorotane |
|||
|
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 an institution must have a positive sanitary and epidemiological conclusion.
Air ducts, air distribution and air intake grilles, ventilation chambers, ventilation units and other devices must be kept clean, must not have mechanical damage, traces of corrosion, leakage.
Fans and motors must be free of abnormal noise.
At least once a month, you should check the degree of contamination of filters and the efficiency of air disinfection devices. The filters should be replaced as soon as it becomes dirty, but at least as often as recommended by the manufacturer.
General exchange air handling units and local exhaust units must be switched on 5 minutes before the start of work and switched off 5 minutes after the end of work.
In operating and preoperative rooms, the supply ventilation systems are first switched on, then the exhaust, or simultaneously the supply and exhaust.
In all rooms, air is supplied to the upper area of \u200b\u200bthe room. Air is supplied to sterile rooms in laminar or weakly turbulent jets (air velocity< = 0,15 м/с).
The air ducts of the supply and exhaust ventilation (air conditioning) must have an inner surface that excludes the removal of particles of the air duct material or protective coating into the premises. The inner cover must be non-absorbent.
In the premises to which the requirements of aseptic conditions are imposed, a 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 detached buildings with a height of no more than 3 floors (in reception rooms, ward buildings, hydrotherapy departments, infectious buildings and departments). In this case, supply ventilation is provided with mechanical induction and air supply to the corridor.
Exhaust ventilation with mechanical induction 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 so as to limit as much as possible the flow of air between the ward departments, between the wards, between adjacent floors.
The amount of air supplied to the ward should be 80 m3 / h per 1 patient.
The movement of air flows must be ensured from the operating rooms to the adjacent rooms (preoperative, anesthetic, etc.), and from these rooms to the corridor. An exhaust ventilation device is required in the corridors.
The amount of air removed from the lower zone of the operating room should be 60%, from the upper zone - 40%. Fresh air is supplied through the upper zone, while the supply must prevail over the exhaust.
It is necessary to provide for separate (isolated) ventilation systems for clean and purulent operating rooms, intensive care, oncohematological, burn departments, dressing rooms, separate ward sections, X-ray and other special rooms.
Preventive inspection and repair of ventilation systems and air ducts should be carried out according to the approved schedule, at least twice a year. Elimination of current malfunctions, defects must be carried out urgently.
Control over the microclimate parameters and chemical pollution of the air environment, 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, burns, physiotherapy departments, rooms for storing potent and toxic substances, pharmacy warehouses, rooms for the preparation of medicines, laboratories, the department of therapeutic dentistry, special rooms of radiological departments and in in other rooms, in offices, using chemicals and other substances and compounds that can have a harmful effect on human health - once every 3 months;
Infectious, incl. tuberculosis departments, bacteriological, viral laboratories, X-ray rooms - once every 6 months; - in other rooms - once every 12 months.
For disinfection of air and surfaces of premises in medical institutions, ultraviolet bactericidal radiation should be used with the use of bactericidal irradiators approved for use in accordance with the established procedure.
The methods of application of ultraviolet bactericidal radiation, the rules of operation and safety of 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 instrumental measurements of its parameters (temperature, air humidity, speed of its movement, thermal radiation) at all places of the employee's stay during the shift.
