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, intensity of thermal radiation from internal surfaces).
The impact of a complex of microclimatic factors is reflected in a person's heat sensation and determines the characteristics of the physiological reactions of the body. Temperature influences 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, performance of a person, 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 according to 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 |
Not 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 those cases when, for a number of technical and other reasons, the optimal microclimate standards cannot be ensured, they are guided by allowable norms (tab. 2 ).
table 2
Permissible norms of temperature, relative humidity and air velocity in residential, public, administrative and amenity 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 |
Allowable sanitary standards microclimate in residential and public buildings is provided with the help of appropriate planning equipment, heat and moisture protection 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 air 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; temperature on the surface of the enclosing structures and heating appliances 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 in cold period years should not exceed an average of 10-12 °, and the thermal effect on the surface of the human body of the flow of infrared radiation from heated heating structures is 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 industry documents agreed with the state sanitary inspection authorities, an optimal production microclimate... In cabins, on consoles and control stations of technological processes, in halls computing technology, as well as in other rooms in which operator-type work is performed, optimal microclimate values must be ensured: air temperature 22-24 °, humidity - 40-60%, air speed - 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 the 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 indicator of the microclimate, 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 followed, people who work for a long time in a heating microclimate may experience dystrophic changes in the myocardium, arterial hypertension, hypotension, asthenic syndrome, decrease the immunological reactivity of the body, 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 of temperature and speed of air movement in the working area of 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 temperature air, for example, in separate preparatory workshops of the food industry), mainly radiation (low temperature of fences in cold rooms) 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 period there is an opportunity frostbite, difficult to use funds individual protection(freezing of respirators when breathing).
Sanitary standards provide for the provision of optimal or permissible parameters of the microclimate of industrial premises, taking into account 5 categories of work, characterized by different levels energy consumption ( tab. 3 ). The standards regulate the temperature, humidity, air speed and intensity of thermal radiation of workers (taking into account the area of the irradiated body surface), the temperature of the internal surfaces enclosing the working area of structures (walls, floor, ceiling) or devices (for example, screens), the temperature of the external surfaces of the technological equipment, air temperature differences 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 surface of the glass of window openings (during the cold season) and heating from direct sunlight (during 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. 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 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 for warming the inhaled air are used.
Bibliography: Hygienic regulation of the 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 principles of microclimate conditioning for 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.
2. Hygiene requirements to 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 gas and electric 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;
- features 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. | Adult wards | 20 ° |
|
| 2. | Hypothyroid wards | 24 ° |
|
| 3. | Wards for patients with thyrotoxicosis | 15 ° |
|
| 4. | Burn patients, postpartum wards | 22 ° |
|
| 5. | Wards for children | 22 ° |
|
| 6. | Premature, newborn and | 25 ° |
|
| infants | |||
| 7. | Operating rooms, intensive care wards | 22 ° |
|
| 8. | Halls physiotherapy exercises(Exercise therapy) | 18 ° |
Let's analyze the data in the table.
The temperature in most wards of multidisciplinary 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 wards for the sick
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 °.
The relative humidity of the air should be no higher than 60%, the speed of air movement should be no more than 0.15 m / s.
^ Air environment premises: the chemical composition of the air and bacterial contamination are normalized.
Hygienic assessment of hospital air purity. The presence of people and animals in closed rooms leads to air pollution by metabolic products (anthropotoxins and other chemicals). A person in the process of life emits more than 400 different connections-ammonia, ammonium compounds, hydrogen sulfide, volatile fatty acid, 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 air 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 in the air - CO 2. 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 contamination increase. This adversely affects the well-being of people, worsens recovery, and contributes to the appearance of nosocomial infections.
^ Acceptable levels bacterial contamination of the air in hospitals
Bacterial contamination rates depend on functional purpose and the class of cleanliness of the premises. Three types of sanitary-bacteriological indicators are monitored: before the start of 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 dm 3 of air
P. Clean rooms (class B): procedural, dressing, preoperative, intensive care wards, children's wards. Total amount microbes should not exceed 500 per 1 m before starting 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 and during 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 regime hospital premises.
Heating. In hospitals, during the cold period of the year, the heating system must ensure uniform heating of the air throughout heating season, exclude contamination with harmful emissions and unpleasant odors indoor air, do 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 heating of the air 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 interior walls. Optimal system there 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, it is more favorable than convective. It is used to heat operating rooms, preoperative, intensive care, anesthesia, childbirth, psychiatric wards, as well as intensive care wards and postoperative wards.
As a heat carrier in systems central heating hospitals use water 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 should 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 area atmospheric air at a height of at least 2 m from the surface of the earth. Outside air served supply units, cleaned with coarse and fine filters.
The air supplied to operating rooms, anesthesia, birth, resuscitation, 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, delivery, postoperative wards, intensive care units, intensive care units, 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. Automatic system microclimate regulation should provide the required parameters: air temperature - 15 - 25 ° С, relative humidity - 40 - 60%, mobility - no more than 0.15 m / sec.
Air exchange in wards and departments should be organized in such a way as to limit as much as possible the flow of air between ward rooms, between wards, between adjacent floors. Quantity supply air in the ward should be 80m / 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 ward. The air exchange rate is how many times the air will be exchanged during an 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, anesthetic and others), and from these rooms to the corridor. A device is needed in the corridors exhaust ventilation... 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%. Innings fresh air is carried out through the upper zone. In this case, the inflow should prevail by at least 20% over the exhaust. The latter requirement applies to aseptic intensive care wards, recovery wards, intensive care units, delivery rooms, as well as wards for premature babies, 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.
^ Microclimate control and chemical pollution air
Wednesday
The administration of the medical institution organizes this type of control in all rooms from time to time. Serviceability ventilation systems and the frequency of air exchange is checked at the same time.
Table 3
1st group - high-risk premises - once every 3 months. 2nd group - premises high risk- Once every 6 months. 3rd group - all other rooms and, above all, wards - once a year.
Any room, including a hospital ward, is designed to create artificial microclimatic conditions, more favorable than the natural climate existing in a given area. The internal climate (microclimate) of the premises provides big influence on the human body, determines his health, affects human health, sometimes causing him pathological conditions or exacerbation of existing diseases. Under the microclimate it is customary to understand the thermal state of the air environment of the room, which determines the effect of heat sensation of the human body, and is formed from the combined effect of the temperature of the air and surrounding surfaces, humidity and air movement.
Hygienically important:
1) that each of these components does not go beyond physiologically acceptable limits;
2) so that during the day in different points the room microclimate remained even and constant, did not give sharp fluctuations that disrupt normal heat sensation in a person and adversely affect his health;
3) that the difference in temperature horizontally at the outer and inner walls of the room does not exceed 2 ° C, and vertically at a height of 1.5 m and at the floor - 2.5 ° C in order to prevent thermal imbalance and one-sided cooling;
4) so that the difference between the air temperature of the premises and the temperature of the cooled surfaces (outer walls) is not more than 5 ° C in order to avoid negative radiation, which contributes to the disruption of heat exchange in the body, unilateral cooling of the body, the appearance of a feeling of chilliness, deterioration of heat sensation and the development of colds;
5) so that the humidity of the room does not exceed 40-60%, otherwise it will contribute to the disruption of heat exchange in the body (the skin temperature rises and the moisture yield of the skin decreases) and the appearance of dampness in the room;
6) so that the speed of air movement is in the range of 0.1-0.15 m / s, because sedentary air leads to difficulty in heat transfer, and, conversely, mobile air helps to blow over the body, is a useful tactile stimulus that stimulates skin-vascular reflexes that improve thermoregulation.
The indicators for assessing the complex effect of microclimate meteorological factors on the body are the cooling capacity of the air and the equivalent effective temperature. It is extremely difficult to directly determine the amount of heat loss by the body depending on the temperature and speed of air movement, therefore, an indirect method is used to determine the cooling capacity of the air using a spherical catathermometer or Hill's catathermometer. Since this physical device will not be able to reproduce the conditions of heat loss from the skin surface, which depend not only on the cooling capacity of the air, but also on the operation of thermoregulatory centers, the catathermometry method is conventional and indicates that the optimal thermal well-being in persons of the so-called sedentary professions with ordinary clothes is observed with the amount of cooling catathermometer 5-7 Mcal / cm 2, at higher readings a person will feel cold, and at lower readings - stuffiness.
Determination of effective temperatures allows you to indirectly determine the total effect on the body of temperature, humidity and air movement. The assessment of meteorological conditions is carried out on the basis of comparing certain combinations of temperatures, humidity and air movement with the subjective thermal sensations of a person.
The microclimate of the premises can be comfortable, when the physiological mechanisms of thermoregulation of the human body are not tense, and uncomfortable, in which there is tension in the processes of thermoregulation and poor sensation of heat. An uncomfortable microclimate, in turn, can be overheating (acute and chronic hyperthermia) and cooling (acute and chronic hypothermia). Considering that microclimatic factors affect a person jointly, the physiological effect of air temperature is most of all associated with humidity and air speed. The same temperature is felt differently depending on the degree of humidity and air movement. So, if the temperature of the ambient air is higher than the body temperature and the air is saturated with water vapor, then the movement of air does not give a cooling effect, but causes an increase in body temperature. In the case of low relative humidity, the cooling effect of the moving air, despite the high temperature, persists, because in this case, the possibility of heat transfer by evaporation remains.
At a high temperature and humidity of the air and a low speed of its movement, a state of overheating of the body occurs, which can manifest itself in the form of acute hyperthermia, heatstroke or convulsive illness. At low air temperature, high humidity and speed of movement hypothermia develops: local (frostbite) or general.
Changes in weather conditions can cause the development of meteopathic reactions. These reactions can be in both sick and healthy people, in the former they are more often manifested by an exacerbation of chronic diseases, in the latter - a deterioration in well-being and a decrease in working capacity. The largest number of diseases and their exacerbations are associated with abrupt change weather during the passage of synoptic fronts. At the moment of passing this front, all meteorological conditions change sharply. The most significant change in temperature, air velocity and atmospheric pressure... Moreover, it is not the absolute values of these factors that play a significant role, but the fluctuations between the previous and next days. In this regard, the following types of weather are distinguished according to Fedorov:
1.Optimal
Dt not more than 2 ° С
DР not more than 4 mbar
DV no more than 3 m / s
2. Annoying
Dt not> 4 ° С
DP not> 8 mbar
DV not> 9 m / s
Dt is more than 4 ° С
DP> 8 mbar
The meteotropic reactions that occur when the weather changes differ from the exacerbation of the underlying disease due to other reasons, and have the following symptoms:
A) occur simultaneously and massively in patients with the same type of disease under adverse weather conditions;
B) short-term deterioration of the state simultaneously with the deterioration of the weather;
C) the relative stereotypicity of repeated violations in the same patient under abnormal weather conditions.
According to the severity, meteotropic reactions are divided into mild and pronounced.
Most often meteotropic reactions occur in patients with essential hypertension, coronary artery disease, bronchial asthma, glaucoma, peptic ulcer stomach and duodenal ulcer, renal and cholelithiasis.
Microclimate parameters determine the heat exchange of the human body and have a significant effect on functional state 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, the temperature of the 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 placement, arrangement, equipment and operation of hospitals, maternity hospitals and other medical hospitals."
Heating and ventilation systems must provide optimal conditions microclimate and air environment in hospitals.
The parameters of the design temperature, the frequency of air exchange, the category for the cleanliness of the premises of medical institutions regulated by SanPiN 2.1.3.1375-03 are shown in Table 3.1.
Table 3.1 - Temperature, air exchange rate, cleanliness category in the premises of the central hospital and medical unit
|
Name of premises |
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 of heating systems should have a smooth surface that allows easy cleaning, they should be placed against external walls, under windows, without fences. It is not allowed to 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 without mechanical impulse.
In infectious diseases, including tuberculosis departments, mechanical exhaust ventilation is arranged through individual ducts in each box and semi-box, which must be equipped with air disinfection devices.
In the absence of mechanical forced ventilation in infectious diseases wards, natural ventilation must be equipped with the obligatory equipment of each box and semi-box with a recirculation-type air disinfection device, ensuring the inactivation efficiency of microorganisms and viruses is at least 95%.
The 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 documents.
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 inactivating microorganisms and viruses in the treated air at least 95% (filters high efficiency H11-H14).
Operating rooms, intensive care units, resuscitation rooms, treatment rooms and other rooms in which there is a release into the air harmful substances must be equipped with local suction or fume hoods.
The levels of bacterial contamination of the indoor air 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 the premises of medical institutions
|
The substance to be determined |
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 provided from 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 electric motors must be free of abnormal noise.
At least once a month, the degree of filter contamination and the efficiency of air disinfection devices should be monitored. The filters should be replaced as soon as it becomes dirty, but at least as often as recommended by the manufacturer.
General exchange supply and exhaust and local exhaust units should be switched on 5 minutes before the start of work and off 5 minutes after the end of work.
In operating rooms and preoperative rooms, supply ventilation systems are first switched on, then exhaust systems, or supply and exhaust systems at the same time.
In all rooms, air is supplied to the upper area of the room. Air is supplied to sterile rooms in laminar or weakly turbulent jets (air velocity< = 0,15 м/с).
Supply and exhaust ventilation (air conditioning) ducts must have inner surface, excluding the removal of particles of the material of the air duct or protective coating into the premises. Internal coating must be non-absorbent.
In the premises, which are subject to the requirements of aseptic conditions, it is provided hidden gasket air ducts, pipelines, fittings. 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). Wherein forced ventilation 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 in such a way as to limit as much as possible the overflow 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 operating rooms 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 should be carried out urgently.
Control over the microclimate parameters and chemical contamination of the air environment, the operation of ventilation systems and the frequency of air exchange should be carried out in the following premises:
In the main functional rooms operating rooms, postoperative wards, 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 other rooms, in offices, using chemical 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 premises - once every 12 months.
To disinfect the 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 for the 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.
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 high temperature conditions is accompanied by intense sweating, which leads to dehydration of the body, loss of mineral salts, causes persistent changes in the activity of the cardiovascular system, weakens attention, slows down reactions, 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.
Microclimate parameters depend on the thermal and physical characteristics of technological processes, climate, season, heating and ventilation conditions in healthcare institutions.
The fight against the unfavorable influence of the industrial microclimate is carried out using technological, sanitary-technical and medical-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 localizing heat generation and thermal insulation, i.e. sealing of equipment, arrangement of ventilation systems, use of protective equipment, etc.
Medical and preventive measures include: the organization of a rational regime of work and rest, medical examinations, etc.
Requirements for heating, ventilation, microclimate and air environment of premises are established by the Sanitary and Epidemiological Rules and Norms SanPiN 2.1.3.1375-03 "Hygienic Requirements for the Location, Arrangement, Equipment and Operation of Hospitals, Maternity Hospitals and Other Treatment Facilities".
Heating, ventilation and air conditioning systems must 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 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 devices should have a smooth surface that allows easy cleaning and 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, childbirth, electric glow and rooms of psychiatric departments, as well as in intensive care and recovery wards, heating devices with a smooth surface that are resistant to daily exposure to washing and disinfecting solutions, excluding adsorption, should be used as heating devices. dust and the accumulation of microorganisms.
When installing fences for heating devices in administrative and utility rooms, in children's hospitals, a material is used that is allowed for use in the prescribed manner. At the same time, free access must be provided for the current operation and cleaning of heating devices.
Water with a maximum temperature in heating devices of 85 ° C is used as a heat carrier in central heating systems of hospitals and maternity hospitals. The use of other liquids and solutions (antifreeze, etc.) as a heat carrier 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 without mechanical impulse.
In infectious diseases, including tuberculosis departments, mechanical exhaust ventilation is arranged through individual ducts in each box and semi-box, which must be equipped with air disinfection devices.
In the absence of mechanical forced ventilation in infectious diseases wards, natural ventilation must be equipped with the obligatory equipping of each box and semi-box with a recirculation-type air disinfection device, ensuring 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 intake for ventilation and air conditioning systems is made 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, birth, intensive care, 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 inactivating microorganisms and viruses located in the processed air at least 95% (high efficiency filters H11-H14).
The rooms of operating rooms, intensive care wards, resuscitation rooms, delivery rooms, treatment rooms and other rooms in which harmful substances are released into the air must be equipped with local suction or fume hoods.
The content of medicines in the air of operating rooms, delivery rooms, intensive care units, intensive care units, procedural rooms, 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 levels 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, hematological patients with AIDS, with skin burns, intensive care units, as well as in wards for newborns, infants, premature, injured children and other similar treatment facilities. Air conditioning is not provided in wards that are fully equipped with incubators.
Air ducts of supply ventilation (air conditioning) systems after high efficiency filters (H11-H14) are made of stainless steel.
The use of split - systems is allowed with high efficiency filters (H11-H14) only subject to the rules of routine maintenance. Split - systems installed in an institution must have a positive sanitary and epidemiological conclusion issued in accordance with the established procedure.
The air exchange rate is selected based on calculations to ensure the specified purity and maintain the gas composition of the air. Relative air humidity should be no more than 60%, air speed - no more than 0.15 m / s.
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 electric motors must be free of abnormal noise.
At least once a month, the degree of filter contamination and the efficiency of air disinfection devices should be monitored. 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 should be switched on 5 minutes before the start of work and switched off 5 minutes after the end of work.
In operating rooms and preoperative rooms, supply ventilation systems are first switched on, then exhaust systems, or supply and exhaust systems at the same time.
In all rooms, air is supplied to the upper area of the room. Air is supplied to sterile rooms in laminar or weakly turbulent jets (air velocity< = 0,15 м/сек).
Air ducts of supply and exhaust ventilation (air conditioning) must have an internal surface that excludes the removal of particles of the duct material or protective coating into the premises. The inner cover must be non-absorbent.
To accommodate the equipment of ventilation systems, special rooms should be allocated, separate for supply and exhaust systems and not vertically and horizontally adjacent to doctors' offices, operating rooms, wards and other premises of permanent residence of people.
In rooms for exhaust systems, exhaust ventilation with a single air exchange per 1 hour should be provided, for supply systems - supply ventilation with a double air exchange.
Ventilation equipment rooms should only be used for their intended purpose.
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 in such a way as to limit as much as possible the overflow of air between the ward departments, between the wards, between adjacent floors.
The amount of air supplied to the ward should be 80 m 3 / hour per 1 patient.
To create an isolated air mode of the chambers, they should be designed with a gateway that has a connection with a bathroom, with a predominance of an exhaust hood in the latter.
At the entrance to the department, a gateway with an exhaust ventilation device with an independent channel (from each gateway) must be equipped.
To exclude the possibility of contaminated air entering from the staircase-elevator halls into the ward offices, it is advisable to arrange a transition zone between them with the provision of air pressure 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 unit and other rooms that require special air purity.
To exclude the possibility of air masses entering from the ward rooms, staircase-elevator halls and other rooms into the operating unit, a device is required between the indicated rooms and the operating unit of a sluice with air pressure.
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 operating rooms 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 and air conditioning systems for clean and purulent operating rooms, maternity units, intensive care, 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 should be carried out according to the approved schedule, at least 2 times a year. Elimination of current malfunctions, defects should be carried out urgently.
The administration of the medical institution organizes control over the microclimate parameters and chemical pollution of the air environment, the operation of ventilation systems and the frequency of air exchange in the following rooms:
- in the main functional rooms of operating rooms, postoperative, delivery rooms, intensive care wards, oncohematological, burn departments, FTO, 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 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 hospitals (departments), bacteriological, viral laboratories, X-ray rooms - once every 6 months; - in other premises - once every 12 months.
To disinfect the 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 for the 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 measurements of its parameters (temperature, air humidity, speed of its movement, thermal radiation) at all places of the employee's stay during the shift.
