Hygienic Requirements to the Admission Department of Hospital

Table 35

FUNCTIONS AND STRUCTURE OF HOSPITAL ADMISSION DEPARTMENT

FUNCTIONS	TYPES of PREMISES
Admission of patients and reception of visitors	Entrance hall with registry
Physical examination, establishing or confirmation of diagnosis	Doctor’s consulting room, room for patient’s examination, express laboratory
Rendering emergency care	Room for patient’s examination
Cleansing patients	Cloakroom, bathroom, dressing room

 

The admission department is intended for registration, physical examination, establishing or confirmation of diagnosis, cleansing patients and if necessary - rendering emergency medical aid. Patients with doubtful diagnosis are placed at reception wards.

The structure of admission department includes the following premises: entrance hall (for waiting), registration and inquiry office, room for patients’ examination, sanitary inspection room (a cloakroom, bathroom, room for dressing), room for medical procedures, dressing room, laboratory for urgent analyses, X-ray room, wards per 1-2 cots, consulting room of doctor on duty, toilet for personnel.

Hygienic Requirements to the Infectious Department

The infectious patients are admitted to the infectious departments not only for treatment but also for isolation. Therefore, the interior planning and sanitary regimen of this department are arranged with the purpose of prevention of intrahospital infections.

The infectious department should have two entrances: one for patients, the second - for personnel, for delivery medicines, food, etc.

Sewage from infectious department before dumping into city sewerage system is disinfected (norm of residual chlorine in it is 3 mg/l).

Types of wards.Isolation of patients is realized in boxes, half-boxes and isolation wards.

A box is a premise with total area of 22 m2 (per cot) or 27 m2 (per 2 cots) in which there is a ward external, entrance for admission of patients, bathroom, internal entrance which is connected with a hospital corridor. In boxes patients with doubtful diagnosis and particularly dangerous infections, such as cholera, etc. are placed.

Half-boxes differ from boxes only in absence of external eutrance. Patients get into a half-box through a hospital corridor.

Isolation wards are usual wards, cots in which are separated by partitions 2–2.5 m high to prevent contact of infectious patients. It is impossible to place patients with respiratory infections there, as there is common air exchange in such wards.

                  Causes and Prevention of Intrahospital Infections

According to WHO’s definition the intrahospital infection (II) is any clinically expressed disease of a microbe etiology affecting the patient during hospitalization or visiting medical establishments, as well as medical staff during its professional work, irrespective of the fact, whether the symptoms of this disease are manifested or not during presence of the given persons in medical establishment or up to 3 days after discharging from the hospital.

 

The spread of intrahospital infection is now registered in all countries of the world, it is a very topical problem for public health services, therefore there is a special Committee in WHO for investigation and struggle with intrahospital infection.

 

Structure of causative agents of intrahospital infection in the 20-21 century:

· Till 1950s a dominant position in the structure of intrahospital infections belonged to acute infectious diseases caused by pathogenic microorganisms (scarlet fever, diphtheria, chicken pox, whooping cough, gas gangrene, tetanus, etc.).

· A real "plague" of many hospitals in 50-60s of the 20 century became a staphylococcal infection.

· Beginning with 1970s due to wide use of antibiotic therapy the leading place is occupied by gram-negative flora – proteus, E.coli, enterobacter, etc. which are very stable to antibiotics and it is very difficult to eliminate them with the help of antibiotics.

 

Danger of occurrence of intrahospital infection for the patient consists in the following:

· the course of the basic disease is exacerbated;

· lethality of patients at generalized form of intrahospital infection is up to 60 %;

· new diseases during treatment in hospital can occur.

 

Danger of intrahospital infection for public health services is as follows:

· disorganization of hospital work, down to temporary closing of hospital or its department for disinfection;

· increase of duration of patient’s stay in hospital (on average one case of intrahospital infection increases the term of patient’s stay in hospital up to 13-17 days);

· additional economic expenses for treatment of patients, work of personnel.

 

Basic sources of intrahospital infection are subdivided into:

· primary, including patients, medical staff, visitors (less often)

· secondary, including objects of the intrahospital environment, i.e instruments; linen, furniture; air, food.

 

Categories of intrahospital objects according to the danger of transmission of intrahospital infection are as follows:

· critical, which are the most dangerous, requiring the most careful disinfection; they include surgical toolkit, needles, endoscopes, catheters;

· half-critical, including the equipment for inhalation and anesthesia, kitchen utensils;

· non-critical, i.e. linen, furniture.

 

 

The basic ways of transmission of intrahospital infection are the following:

· aerosol (a respiratory and air-dust way);

· contact (through tools, linen, furniture);

· parenteral (at injecting medicines);

· fecal-oral (through dirty hands);

· alimentary (through food).

 

Structure of intrahospital infection according to localization includes:

· infections of the urinary tract - 15-40 %;

· wound (surgical) infection - 10-30 %;

· infections of respiratory ways - 15-20 %;

· intestinal infections - 10-20 %

 

Causes of intrahospital infection growth nowadays in different countries are the following:

· a considerable increase of intrahospital infectionamong hospitalized patients of risk groups, i.e. patients with various chronic diseases (cardiovascular, oncological, blood diseases, diabetes mellitus), immunodepressive states; aged patients;

· weakening of natural immunity and allergization of population due to unfavourable ecological situation;

· "urbanization" of intrahospital environment, concentration of great number of patients and staff in multi-storey buildings;

· complicating the operative interventions, increase of their duration and traumatism, wide application of endoscope equipment which badly yields to sterilization;

· an excessive, sometimes insufficiently grounded application of antibiotics, the formation of intrahospital strains of causative agents of intrahospital infection, polyresistant to antibiotics used in a hospital;

· insufficiently careful disinfecting of injection and other instruments;

· increase of duration of patient’s stay in hospital due to numerous functional-diagnostic researches;

· insufficient attention to strict observance of hygienic and sanitary-antiepidemic regimen in hospitals.

 

System of prevention of intrahospital infection includes the following:

v Strict observance of sanitary-antiepidemic regimen:

Ø good ventilation, air sanitation of premises, optimal microclimate;

Ø realization of medical control of personnel;

Ø high-quality disinfection and sterilization of equipment, linen etc.;

Ø regular bacteriological control of instruments, linen, air, food, hands;

Ø revealing and isolation of infectious patients;

Ø observance of rules of personal hygiene by personnel and patients.

v Architectural measures:

Ø rational location and zoning of hospital site;

Ø rational interposition of departments and subdivisions in buildings and on floors in order to provide disconnection of ward sections, departments, operating rooms, offices, wards;

Ø observance of hygienic norms of area, volume of hospital premises.

v Increase of resistance of patients and personnel:

Ø optimal regimen of work and rest;

Ø rational nutrition;

Ø sufficient staying in the open air;

Ø scheduled and emergency immunization of patients.

Occupational Hygiene of Medical Personnel

The sickness rate of medical workers as compared to other professions is marked to be rather high, especially of surgeons, anesthesiologists, infectionists, phthisiatricians, roentgenologists, radiologists, etc.