Cleaning Sewage of Medical Establishments

Sewage of infectious, tuberculous and some other departments before dumping into the city sewerage system pass additional disinfecting by chlorination.

Sewage from radiological departments is collected in special precipitation tanks until the decrease of radioactivity to permissible levels, and then get into the city sewerage system.

Recommendations for Practical Classes on the Theme

Key Questions:

1.What is soil?The hygienic significance of soil.

2.Concept of soil pollution.

3.Protection of soil from pollution.

4.Limiting attributes of harmful action of substances in the soil.

5.Hygiene of populated areas. Urbanization and its main hygienic consequences.

6.The town-forming factors (in the past and nowadays).

7.Urbanization and its consequences.

8.Functional zones in cities.

9.Hygienic characteristics of types of city layout.

10.Hygienic characteristics of types of residential quarter layout.

11.Protection of the city environment from pollution.

12.Hygienic requirements to living premises.

13.Hygienically proved methods of removal and neutralization of solid and liquid wastes in the populated areas.

14.Methods of removal and destruction of solid household wastes.

15.Methods of removal of solid industrial wastes.

16.Methods of cleaning household sewage.

Learning Objectives and Their Concrete Definition

1. To know the scheme of sanitary inspection of living premises.

2. A technique of drawing up the act of sanitary inspection of living premises. To draw up the act of sanitary inspection of a flat, room, hostel room, etc.

 

Appendix 1

Scheme of the Act of Sanitary Inspection of Apartment

1. General information: name of building, year of construction, address.

2. Topography of locality: a hill, plain, open or closed for winds.

3. The characteristics of environmental territory: green plantations, location of plants and factories and pollution of atmospheric air by them, availability of noisy, dusty streets, etc.

4. A territory improvement round the building: the total area, percent of a built-up area, percent of green area, system and condition of its cleaning.

5. The characteristics of building: its location in a quarter (with a stitch, continuous, perimeter type of layout), microdistrict. The distance from the neighbouring buildings is ________ meters. The long axis of the building is located (from the south to the north; from west to east, etc.). Number of floors, number of flats on each floor and in the whole house. Building materials (ferro-concrete, stone, wood).

6. A sanitary improvement of building: system of removal of liquid and solid wastes. A sanitary condition of yard, staircases, work of lift.

7. The floor, on which the flat is located, number of rooms ____, including those oriented to the street _______, to the yard __________. Overshadowing by the neighbouring buildings (present, absent).

8. Total area of flat ______ m2, height of ceiling ______ m, living space _______ m2, cubic capacity _______ m3.

9. Number of people living in the flat, including children under 14 years _______.

10. The living space per 1 person ______ m2.

11. Walls: brick, wooden, the dampness (present or not). Sound insulation, material and condition of floors, windows, doors.

12. Heating: central, furnace. Air temperature _____ ºС.

13. Ventilation: central (functioning or not). Window leaves, through airing (possible or not).

14. Illumination: light coefficient in living premises _______. Artificial illumination with incandescent lamps, luminescent lamps, type of light fixture.

15. Area of rooms in m2, whether they are encumbered with things or not.

16. Kitchen: a condition of walls, ceiling, floor. A cooker (gas, electric). A sanitary condition of kitchen.

17. Water pipe (present or not), bathroom (present or not), where clothes are washed.

18. A lavatory is canalized (or not), its sanitary condition _________.

19. Availability of insects in the flat (present or not).

20. Noise in the flat (present or not), its origin.

21. Dampness in rooms (observed or not). Reasons of its occurrence.

22. Complaints of residents.

23. General conclusion about a sanitary state of object.

24. Measures on sanitary improvement of object state.

 

Date of inspection ___________ Signature ________________

Appendix 2

Scheme of Sanitary Inspection of Students’ Hostel

1. General information: name of building, whether specially constructed or adapted to the present purpose, year of construction, address, who resides (students, workers), total number of single _______, married _______, married are accommodated separately.

2. Topography of area: hills, plain, marshland, open or closed for winds.

3. The ground area: total area _____ m2, green plantations (present or not), clean or not.

4. Environmental territory: the inhabited quarter, industrial enterprises, dusty roads and air polluted by them (present or not).

5. The hostel occupies _________ buildings.

6. Building: stone, ferro-concrete, ____ floors, year of construction _________, dry, damp, the walls are whitewashed (or not), floors are wooden, painted (yes, no), covered with linoleum (yes, no), concrete (yes, no), the scheduled repair was last made in ___________ year, complete overhaul in ___________ year.

7. The size of basic premises (bedrooms): width, length, height (in meters). The floor space and cubic capacity per man.

8. Heating: central, local; sufficient or not; air temperature _______ ºС.

9. Ventilation: window leaves, transoms, conditioners, through airing, possible or not, applied or not, complaints of residents on temperature-humidity conditions and smells.

10. Illumination, light coefficient _______, light angle, ventiduct angle.

Natural illumination during ____ hours per day. Artificial illumination, type of lamps. Estimation of natural and artificial illumination.

11. Water supply: centralized (constant, periodically absent); from well. The hot water (present or not).

12. Lavatories: canalized (yes or no), located indoors (or in the yard). Regularly cleaned (yes, no). Quality of its disinfection.

13. Wash-stands, their location, number, sanitary condition.

14. Terms of linen change.

15. Whether washing the linen, cooking food, drying clothes are carried out in bedrooms, corridors.

16. Availability of insects in rooms.

17. The list of additional premises serving the hostel as a whole: a canteen, isolator, reading hall, dryer, etc.

18. System of room cleaning: damp, dry, frequency per week. Containers for garbage (present or not), distance from the hostel. Frequency of garbage evacuation from containers per day.

19. The additional data.

20. The general conclusion about a sanitary condition of hostel.

21. Measures on sanitary improvement of hostel.

Date of inspection ______________ Signature ____________.

 

The Training Instruction.

Hygienic Significance of Habitation

In each inhabited area the most important element is habitation. In uncomfortable accommodation, at high density of people the particularly favourable conditions for spread of respiratory infections, primarily tuberculosis, are created. In dark rooms with insufficient solar and ultraviolet radiation small children are more often ill with rickets.

At preliminary and current sanitary inspection the following requirements to habitation are determined:

The ground area for construction of a house should:

a) be located on a well lighted by the sun and accessible to airing area;

b) have good natural or artificial relief for atmospheric water flow;

c) have dry, not polluted soil; the level of subsoil waters should be not closer than 1.5 m to the ground surface;

d) have the appropriate parameters of a sanitary condition of the ground, namely:

i) the sanitary number should be not less than 0.85.

ii) amount of helminth eggs — up to 10 per 1 kg of ground;

iii) coli titer should be not less than 0.01;

iv) titer of anaerobe microbes (Cl.perfringens). This titer should be not less than 0.001.

6) The hygienic requirements to a building.

Illumination of dwelling depends on orientation of windows to parts of the world. The windows of inhabited rooms should be southern and east in hot areas (the western orientation of a window is not optimal), the windows of additional premises should be oriented to the north. The axis of the building should approach an equatorial direction.

The inhabited rooms should have insolation not less than 3 hours per day.

At insufficient distance between houses a neighbouring building can throw a shadow, due to which the solar irradiation is sharply reduced. Therefore the distance between the neighbouring buildings should be not less than 2 heights of the highest building.

The distance between an inhabited building to a garbage container should be not less than 30 m and not more than 50 m.

7) Types of inhabited buildings:

a) one-storey apartment house (detached house);

b) multi-storey apartment house (cottage);

c) many-room low houses (for 2-8 apartments);

d) many-room multi-storey houses (3 and more floors). Density of population in such houses is considerably higher. In houses higher than 5 floors a lift should be necessarily;

e) a hotel type house — hostel.

8) A flat.

The structure of a flat includes habitable and additional rooms. To habitable rooms a bedroom, a living room, and a study refer.

The additional premises (rooms) are a kitchen, hall, bathroom, lavatory, storeroom, balcony, terrace.

A bedroom should not be with a through-passage, designed for not more than two persons, located far from the kitchen and hall. Its area should be not less than 10 m2.

The room for staying in the daytime (living room, dining room) may be with a through-passage. Its area should be not less than 14-16 m2. Its depth should be not more than double width.

A kitchen should be not less than 7 m2 and should be isolated from habitable rooms.

A hall serves for undressing, storage of the outer clothing and footwear, protecting habitable rooms from penetration of cold, noise. Its width should be not less than 1.2 m.

Internal corridors — their width should be not less than 1.1 m.

9) Hotel-type houses for small families.

At this type of construction the habitable rooms or flats are located on both sides of the central corridor. Each flat of this type has 1-2 habitable rooms, a small kitchen, lavatory, a small hall and a built-in closet. The houses of this type have certain disadvantages: through airing is impossible, the residents often come into contact. Hostels refer to the given type of buildings.

10) Hygienic norms for a students’ hostel are the following:

a) The area of bedrooms should be 6 m2 per one person at a height of bedrooms not less than 2.7 m.

b) The distance between beds should be not less than 0.5 m, from the outer walls to beds — not less than 0.3 m.

c) In one bedroom there should be not more than 4 persons.

d) A common corridor is not more than 40 m in length.

e) The additional rooms should be located at the end of the corridor.

f) In a hostel for more than 300 men a canteen should be provided.

g) The building of a hostel should occupy not more than 25 % of the ground area.

h) The distance from a hostel to the container with garbage should be not less than 30 m and not more than 50 m.

Self Test

1. Identify the type of state sanitary supervision over habitation.

*A. current

*B. preliminary

C. precautionary

D. every ten-day

E. single at approval of a building

2. The depth of underground water at construction of buildings should make up not more than

A. 1 m

*B. 1.5 m

C. 2.2 m

D. 2.5 m

E. 3 m

3. Time of insolation of habitable rooms should make up:

A. 60 min/day

*B. 180 min/day

C. 240 min/day

D. 300 min/day

Problem Solving

1. For construction of shielding building (from noise) a shop is chosen 110m in length, 5.5 m in height for protection of neighbouring house № 4. A highway passes nearby. An equivalent noise level in apartments of the house at present makes up 50.5 dB, on habitable territory — 65.5 dB. Make the conclusion on expediency of screen construction.

2. In a room of a student's hostel there are 4 persons. Frequency of ventilation is 3 times/hour, СО2concentration — 0.2 %. Light coefficient — 1:5. Temperature is 20º C, air humidity -55 %. General illumination by incandescent lamps -150 lux, local illumination — 50 lux. What diseases or deviations in a physiological condition of students can occur?

3. A two-room flat is located on the 6th floor, the lift does not work. The windows are southeast. The kitchen is next to a living room. A bathroom and lavatory are combined. The total area of the apartment is 45m2, 5 persons live in it. Noise at night is 25 dB. The walls of the bedroom are of light-green colour. The relative humidity is 66 %. The air temperature is 18º C. The walls of the sitting room are pink. The temperature is 20ºС. Frequency of ventilation in the kitchen is 1.5 times/hour. Make a hygienic estimate.

Standard Answers

1. The length of a noise-protecting screen is 120 m, its height — 5 m. The height of house № 4 is not specified. We can assume that at the expense of shielding at a height a noise level will decrease by 10 dB (ratio of 110 to 50.5 = 2, that reduces a noise level by 10 dB), that will exceed the norm. Hence the shop should be built higher.

2. There may be decrease of capacity for work, headache because of exceeding MPC of СО2.

3. Hygienic conditions are satisfactory with the exception of the kitchen which should not be combined with a habitable room. It is necessary to put a partition, to change the door lay-out.

 

 

Hospital Hygiene

Theme No 11.

Hygienic Requirements to Hospitals

The hospitals are built for implementation of medical protective regimen.

The Medical-Protective Regimen and Its Main Components

The medical protective regimen is a complex of medicodiagnostic, hygienic, administrative and economic measures directed at the fastest restoration of work capacity or health of a person.

The medical diagnostic measures include:

· Diagnostic and medical procedures. They are considered to be the main factor, but without carrying out other measures of medical protective regimen their efficiency decreases.

Hygienic measures include:

· An optimal choice of hospital location, the observance of requirements to hospital site and its functional zones;

· Providing sanitary-antiepidemic regimen in hospitals, prevention of nosocomial infections (NI);

· Creation of optimal hygienic conditions of location, lay-out, isolation and functional connection of premises in hospital;

· Providing hygienic requirements to microclimate, bacterial contamination of the hospital environment, illumination, ventilation, water supply, hospital heating;

· Providing rational and dietetic nutrition of patients, prevention of food poisonings;

· Observance of personal hygiene by patients and staff;

· Creation of optimal working conditions for medical staff and prevention of occupational diseases in personnel.

Administrative measuresare as follows:

· The establishment of schedule and routine of work of hospital and polyclinic;

· Providing staff of personnel;

· Estimation of work efficiency of personnel, etc.

Economic measuresare:

· Supply with medicines, linen and equipment, foodstuffs; transport supply of hospital.

Hygienic Requirements to Hospital Location

While choosing place for location of hospital of general type (central regional hospital, municipal hospital with polyclinic, etc.), two basic demands should be made:

· Providing optimal hygienic conditions for hospital site - preferably out of town.

· Accessibility to the served population (radius of polyclinic service in town is 3-5 km) – hospital should be in the town center, where the hygienic conditions are bad.

It is rather difficult to combine both of these requirements, as they are inconsistent. Nowadays the problem is solved by construction of hospital in the suburbs, and polyclinic - in the town center.

For specialized hospitals (phthisical, oncological, psychoneurological, infectious, venereologic) the first requirement is priority, the second one is not essential.

The Area of Hospital Site

The size of ground areas for hospitals of all types is regulated by sanitary norms and depends on capacity of hospital:

· at hospital capacity up to 50 cots (beds) it is 300 m2 per 1 cot,

· up to 100 cots - 200 m2,

· from 200 up to 400 cots - 140-100 m2,

· from 400 up to 800 cots - 100 - 80 m2,

· from 800 up to 1000 cots - 80 - 60 m2.

For specialized hospitals in the suburbs the area is increased:

· for infectious and oncological hospitals by 15 %,

· for phthisical and psychiatric - by 25 %,

· for pediatric by 40 %.

The area site of maternity hospital makes up 0.7 of norms for typical hospital.