The microclimate in the premises of the hospital and the systems that provide it (ventilation and heating). Medical institutions. Air-thermal regime of hospitals Development of domestic regulatory framework

Air value:

Participation in oxidative processes in the body

Heat production and heat regulation

In health measures aimed at the prevention of certain diseases

Negative impact:

Pollution by chemical factors

Adverse physical factors

Adverse weather conditions

Rationing the microclimate

The microclimate of enclosed spaces is determined by temperature, humidity, air velocity. Weather - the state of the atmosphere or state physical properties air in the place in question at a given time.

The temperature in the wards is 20 degrees C

The temperature in the doctor's office is 20 degrees C

The temperature in the doctor's office - 20 degrees C

Ward for premature babies and burns ward - 25 degrees C

Dressing room 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 summer time year it contains 1500 microorganisms and no more than 16 streptococci.

Polluted air in summer - not > 2500 microorganisms and not > 30 streptococci.

Clean air in winter period up to 4500 microorganisms and up to 36 streptococci. Contaminated - not > 7000 and containing streptococci not > 124.

For health facilities, apart from the season, the purpose of the premises is taken into account.

Operating room: before surgery not > 500; after surgery not
Resuscitation: not > 750; should not be pathogenic

Maternity(operating): not > 1000; should not be pathogenic
delivery room(postpartum): not > 2500; should not be pathogenic
Wards for newborns: not > 1500; streptococci - not > 12
Postpartum: not > 2000; streptococci - not > 16

Methods for determining bacterial air pollution:

1) Aspiration;

2) Sedimentation.

Air purification methods

1. Irradiation with bactericidal lamps (calculation per cubic capacity of the room).

2. Treatment with chemical bactericides

Neutralization of air by improving the ventilation of the room.

№ 64 Hygiene requirements for hospital lighting 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 an increase in mood.

II ???(daylight)

1. Sufficient intensity for the staff. Illumination intensity is divided into 8 categories and classes
accuracy, based on the division of the size of the details and the contrasting background (each class has its own indicators, for example:
operating room - class 1, receptionist - class 6).

2. Must be uniform

3. No glare

4. Do not create glitter

III (???artificial lighting)

1. The spectrum should be close to natural

2. Should not give shadows

3. Must be constantly on time

Factors that determine the level of natural light

1. Factors due to light climate

Geographic latitude

Height of the sun

Presence of clouds
- the presence of pollution

2. External factors - time of year and day

Orientation of the light-bearing wall to the cardinal points
- the presence of shading buildings and trees
3. Internal factors

Value window openings

Window opening configuration

Frame design

Placement of windows on a light-bearing wall (the distance from the upper edge of the window to the ceiling should not be > 30 cm.

Coloring internal surfaces(walls and ceiling should be light colors)

Glass cleanliness

Room layout

Methods for assessing natural light

Geometrically- are laid during the projection and for their determination we use geometric functions

1. Light coefficient (SC) - the ratio of the area of ​​​​glazing to the area of ​​\u200b\u200bthe room, while

the 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 window frame, and the other from the same point to the top edge of the window (not< 27 градусов)

3. Opening angle - determined in cases where there are shading buildings or trees and light
the flow does not enter the room through the entire area of ​​​​the window. Formed by two lines, one of which goes from the point
workplace to the upper edge of the window, and the second from the same point to the projection point highest point
of the opposite building onto the plane of the window (not< 5 градусов)

4. Laying length - the ratio of the depth of the room (the distance from the light-bearing wall to
opposite) to the height of the upper edge of the window to the floor. Not > 2.

Lighting -

KEO - daylight factor interior, to simultaneously measured outdoor lighting (1% for wards and doctor's offices, 2.5% for operating rooms)

67. Hygienic requirements for the placement, layout, equipment and organization of work of hospitals

Very great importance how healing factor have microclimatic conditions, and in the winter and transitional periods of the year, the temperature in the wards should be in the range of 18 - 21 ° C, and in summer the upper limit of the comfort zone should not exceed 24 ° C. For this, those who are there heating appliances must have devices for their regulation. In particular, special devices have already been developed for conventional radiators, which automatically maintain the set air temperature.

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

As palliative measures, it is advisable to use the correct orientation of windows according to the cardinal points, the coloring of the outer walls in White color, vertical gardening, installation of shutters, blinds and curtains, application special types heat-retaining glass, increasing the speed of air movement using room fans, etc.

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

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

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

As for boxed wards, they have only glass partitions between beds, to a certain extent protecting from infection.

"Hygiene", V.A. Pokrovsky

See also:

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

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

2. Features of heat transfer in patients with impaired thyroid function determine high temperature in 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 rooms: in operating rooms, PITs, the temperature should be higher than in the wards - 22 o.

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

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

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

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

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 - rooms high risk- 1 time in 3 months. 2nd group - high-risk premises - 1 time in 6 months. 3rd group - all other premises and, first of all, wards - once a year.

Microclimate- 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, the temperature of the surfaces 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 heat sensation of a person and determines the characteristics of the physiological reactions of the body. Temperature influences that go beyond neutral fluctuations cause changes in the tone of muscles, peripheral vessels, the activity of sweat glands, and heat production. At the same time, constancy heat balance It is achieved due to the significant tension of thermoregulation, which negatively affects the well-being, working capacity of a person, his state of health.

The thermal state in which the tension of the thermoregulatory system is negligible is defined as thermal comfort. It is provided in the range of optimal microclimatic conditions, within which there is the least stress of thermoregulation and comfortable heat sensation. Optimal microclimate standards have been developed, which should be provided in medical and preventive and children's institutions, residential, office buildings, as well as at industrial facilities where optimal conditions are necessary for technological requirements. Sanitary standards for the optimal microclimate are differentiated for the cold and warm periods of the year ( tab. one ).

Table 1

Optimal norms for temperature, relative humidity and air velocity in residential, public, administrative premises

For the premises of medical institutions, the design air temperature is normalized, while for premises for various purposes (wards, rooms 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, optimal microclimate standards cannot be ensured, they are guided by allowable norms (tab. 2 ).

table 2

Permissible standards for temperature, relative humidity and air velocity in residential, public, administrative and amenity premises

Permissible sanitary norms microclimate in residential and public buildings are provided with the help of appropriate planning equipment, heat-shielding and moisture-proof properties of enclosing structures.

When conducting 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 ordinary sections with one-sided and two-sided orientation of apartments at an outside air temperature close to the calculated one for these 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 in the cold season should not exceed an average of 10-12 °, and the thermal effect on the surface of the human body of the flux of infrared radiation 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 an open area is significantly affected by the climate and weather of the area.

At a number of industries, the list of which is established by industry documents agreed with the state sanitary supervision bodies, an optimal production microclimate. In cabins, on consoles and control posts of technological processes, in halls computer science, as well as in other rooms in which operator-type work is performed, optimal microclimate values ​​​​should be provided: air temperature 22-24 °, humidity - 40-60%, air speed - no more than 0.1 m/s regardless of the period of the year. Optimal standards 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 food industry shops), as well as technical reasons and economic opportunities for a number of industries (open-hearth, blast furnace, foundry, forging shops of the metallurgical industry, enterprises heavy engineering, glass production and the food industry) do not allow to provide optimal norms for the production microclimate. In these cases, at permanent and non-permanent workplaces, in accordance with GOST, permissible microclimate standards are established.

Depending on the nature of the heat input and the prevalence of one or another indicator of the microclimate, shops are distinguished mainly with convection (for example, food shops of sugar factories, machine rooms of power plants, thermal shops, deep mines) or radiation heating (for example, metallurgical, glass production) microclimate. The convection heating microclimate is characterized by high air temperature, sometimes combined with its high humidity (dye departments of textile factories, greenhouses, sinter shops), which increases the degree of overheating of the human body (see Fig. Overheating of the body). The radiation heating microclimate is characterized by the predominance of radiant heat.

If preventive measures are not observed in persons working for a long time in a heating microclimate, dystrophic changes in the myocardium, arterial hypertension, hypotension, asthenic syndrome can be observed, the immunological reactivity of the body decreases, which contributes to an increase in the incidence of workers with acute respiratory diseases, tonsillitis, bronchitis, myositis, neuralgia. When the body overheats, the adverse effect of chemicals, dust, noise increases, and fatigue sets in faster.

Table 3

Optimal values ​​of temperature and air velocity in the working area of ​​the production of other premises, depending on the category of work and periods of the year

The cooling microclimate in industrial premises can be predominantly convection ( low temperature air, for example, in separate preparatory workshops of the food industry), mainly radiation (low temperature of the fences in cold rooms) and mixed. Cooling contributes to the occurrence of respiratory diseases, exacerbation of diseases of the cardiovascular system. When cooling down, 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 work injuries. When working in an open area in winter, it becomes possible frostbite, difficult to use funds personal protection(freezing of respirators during 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 norms regulate the temperature, humidity, air velocity and the intensity of thermal exposure of workers (taking into account the area of ​​the irradiated body surface), the temperature of internal surfaces, enclosing the working area structures (walls, floors, ceilings) or devices (for example, screens), the temperature of the outer surfaces of the technological equipment, air temperature fluctuations in height and horizontal 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 (during the cold season) and heating from direct sunlight (during the warm season).

Prevention of overheating of those working in a heating microclimate is carried out by reducing the external heat load through automation technological processes, remote control, the use of collective and individual protective equipment (heat-absorbing and heat-reflecting screens, air showers, water curtains, radiation cooling systems), regulation of the time of continuous stay at the workplace and in the recreation area with optimal microclimatic conditions, organization of the drinking regime.

To prevent overheating of workers in the summer in an open area, overalls made of air- and moisture-permeable fabrics, materials with high reflective properties are used, and rest is organized in sanitary facilities with an optimal microclimate, which can be provided by using air conditioners or radiation cooling systems. Importance have measures aimed at increasing the body's resistance to thermal effects, including adaptation to this factor.

When working in a cooling microclimate, preventive measures include the use of overalls in the first place (see. clothing), shoes (see Shoes), hats and mittens, the heat-shielding properties of which must correspond to meteorological conditions, the severity of the work performed. The time of continuous stay in the cold and breaks for rest in sanitary facilities, which are included in working time. These rooms are additionally equipped with devices for heating hands and feet, as well as devices for drying overalls, shoes, and mittens. To prevent freezing of respirators, devices for heating the inhaled air are used.

Bibliography: Hygienic regulation of factors of the production environment and labor process, ed. N.F. Measured and A.A . Kasparov, p. 71, Moscow, 1986; Provincial Yu . D. and Korenevskaya E.I. Hygienic basics of microclimate conditioning of residential and public buildings, M. , 1978, bibliography; Occupational Health Guide, ed. N.F. Izmerova, vol. 1, p. 91, M., 1987, Shakhbazyan G.X. and Shleifman F. M. Hygiene of industrial microclimate, Kyiv, 1977, bibliogr.

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

Ventilation of the premises ensures the timely removal of excess carbon dioxide, heat, moisture, dust, harmful substances, in general, the results of various household processes and the presence of people in the premises.

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 must enter the room per hour per person for adequate ventilation?

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

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

Methodology:

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

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

Each liter of air supplied to the room contains 0.4%° of carbon dioxide, that is, each liter of this air contains 0.4 ml of carbon dioxide and thus can still "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 releases 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 3, 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 care, 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.