Topic of Independent Students’ Work: Sanitary-Hygienic Inspection of Hospitals

The student should be able to:

· carry out sanitary inspection of hospital;

· make the act of sanitary inspection of hospital.

Purpose of independent students’ work:

· To acquire the skills of estimating the location of a hospital site, system of building a hospital complex, lay-out and equipment: reception wards, therapeutical, surgical, obstetrics, infectious, children departments (children's hospitals), ward sections, polyclinics.

· To master the technique of estimation and realization of sanitary inspection of projects and construction of hospitals and departments of different type and hygienic estimation of conditions of medical personnel work, substantiate the necessary measures for struggle against intrahospital infections.

Algorithm of Practical Independent Work of students

The firststage. Independent sanitary inspection of hospital, department and ward of Simferopol hospital according to the scheme (see Appendix).

The second stage. Presenting the project of act of sanitary inspection to the teacher.

The third stage. Preparation of act of sanitary inspection.

The fourth stage. Handing in the act of sanitary inspection of Simferopol medical preventive establishment to the teacher.

Appendix

Scheme of Sanitary Inspection of Hospital

Name, capacity, address, type of medical establishment.

Hygienic estimation of location of a hospital site.

Functional zoning of a hospital site, hygienic estimation.

Area of a hospital site (per 1 cot).

Presence of polyclinic, radius of its service.

Lay-out of hospital building up.

Estimation of measures providing medical protective regimen.

Structure of premises of the reception ward, equipment, sanitary condition.

Description of one of the basic departments:

Name, amount of ward sections;

Structure of premises of ward section;

Sanitary condition of department.

 Description of ward in the department:

№ of ward;

number of cots, area per 1 cot;

microclimate, ventilation, illumination, colouring of walls;

sanitary condition;

interrogation of patients in the ward about a sanitary condition of hospital, convenience of its location;

estimation of measures providing medical protective regimen (administrative, hygienic, economic).

The basic drawbacks revealed at inspection of hospital as a whole, and of department and ward in particular.

Suggestions to their elimination.

General conclusion on possibility to provide medical protective regimen in the hospital.

Date of inspection _____________________

Signature (group, full name)___________________________________

 

Note: the inspection and drawing up the act of sanitary inspection is made according to the scheme: one hospital per 1 group, 3-5 students per one department, one student per one ward.

 

Hygiene of Nutrition

Theme No.

Principles of Sanitary Examination of Foodstuff.

Topicality of the Theme

A doctor of any speciality should know the rules of estimation of foodstuff quality with the purpose of improvement and maintaining a human health. The biological and nutrient value of foodstuff is preserved under the condition of their high quality meeting the demand of standard. During reception, storage, transportation or processing the foodstuff can spoil, become contaminated by chemical substances, microorganisms, etc. Therefore it is necessary to carry out a thorough sanitary inspection of foodstuffs at all stages of their production and realization.

To determine the quality of foodstuff, a sanitary examination is carried out. The doctor of any speciality should be able to reveal changes of parameters of food quality: organoleptic properties, presence of harmful impurity and reasons of foodstuff spoiling, and also to establish the order of its realization.

Methods of Analysis of Food Quality

· Organoleptic — colour, taste, smell and consistence;

· Physical — density, temperature, etc;

· Chemical — content of proteins, fats, carbohydrates and others nutrients;

· Microscopic — finding foreign substances, ova of helminths, etc. in foodstuff under microscope;

· Bacteriological — finding microorganisms in the food;

· Biological — biological test of dangerous foodstuff on the laboratory animal;

· Radiometric — the level of radioactivity of the foodstuff.

The obtained data are compared with standards of foodstuffs.

For this purpose the following documents regulating the quality of foodstuffs exist:

· The State Standard of a food product. This is a document defining the necessary value of main parameters of the given foodstuff and including the unified, standard procedures of its definition.

· Temporal Technical Conditions of a food product. It is designed for new products and includes main parameters of the given product.

Classification of Foods by Quality

v A good-quality product:

Ø Standard — a product, which parameters correspond to the requirements of the State Standard, e. g. milk with a 3.2 % fat content)

Ø Non-standard — a product having 1-2 unessential non-standard parameters, e.g. milk containing fat lower than 2.5 %)

v Conditionally suitable product demands the preliminary processing before usage (acidic milk is subjected to processing for kefir, curd, cheese and other milk products).

v A bad quality product has parameters making its usage impossible for man’s nutrition, e.g. milk with high contamination by pesticides). The further perspective of such products is destruction or utilization as forage for cattle, etc.

v Falsified products. (Falsificatio from Latin means deception). Properties of such products are changed specially for deceiving the cus­tomer (for example, milk diluted with water). Falsification of products is prosecuted.

Except for above mentioned categories of foodstuff quality there is another concept — a product substitute — a substitute of a natural product officially produced by the state at lack of natural products, e.g. margarine is a substitute for cow butter). It is estimated according to the State Standard and may belong to one of the categories of foodstuff quality.

 

Sanitary-Hygienic Characteristics of Foods

Fishis rich in proteins of high biological value. The proteins of fish have a satisfactory amino acid balance. The fish oils are rich in unsaturated fatty acids of the omega–3 family having an antisclerotic action and A and D vitamins. Fish liver oils are the richest source of calcium, phosphorus and A, D vitamins. Fish is less rich in iron (Table 3). Sea fish contains iodine, while fresh water fish does not.

But fish may be a source of some diseases — fish-borne diseases, such as:

· Helminthiasis: Dibothriocephalus latus, opisthorchiasis

· Bacterial infections: salmonellosis, botulism

· Viral infections: Hepatitis A Virus.

Eggs. Egg contains all the nutrients except for carbohydrates and vitamin C (Table 3). But in eggs cholesterol is contained in a dose of 250 mg per egg. Cholesterol promotes hypercholesterolemia and the risk of atherosclerosis. Elderly people can eat only 2 eggs a week.

Egg-borne diseases include bacterial infections, e.g. salmonellosis.

Meat. Meat contains 15 to 20 % of protein. Meat proteins are a good source of essential amino acids. The energy provided by meat depends upon its fat content. Iron is contained in meat in a dose of 2 to 4 mg per 100 g (Table 9). Iron from meat is more easily absorbed than iron from plants and it is another major quality of meat. Meat contains some vitamins (A, B6, B2, and PP), minerals, such as phosphorus, iron, zinc. It is poor in calcium and carbohydrates.

Liver is extremely rich in many nutrients.

All meat should be examined by veterinary inspector before sale. It is necessary to exert a strict sanitary control over places of sale and conditions of keeping fresh meat. Fresh meat must be wet, of pink colour, elastic and have an agreeable smell. It must be clear from pathogenic bacteria. If in a slice (40 cm2) of meat not more than 3 cysts are found out, a special cooking is necessary.

Meat-borne diseases:

· Helminthisms: Taenia saginata, Taenia soliumand, Trichinella spiralis

· Bacterial infections: tuberculosis, anthrax, brucellosis, salmonellosis

· Viral infections: spongy encephalitus

Table 9

Nutritive Value of Meat, Fish, and Eggs (g/100 g)

	Proteins (g)	Fats (g)	Carbohydrates (g)	Iron (mg)
Meat	21.4	3.6	-	2-4
Fish	19.5	2.4	-	0.7-3.0
Eggs*	10.0	10.0	-	2.5
* Two large eggs weighing about 100g

Sanitary-Hygienic Characteristics of Milk and Dairy Products

Milk is the most valuable foodstuff with high nutrition value. It is an ideal food for infants and children. The milk proteins contain casein, lactatalbumin and lactoglobulin; milk fat is easily digestible. Carbohydrates are present in milk as lactose. Milk contains vitamins, but vitamin С is present only in very small quantities. Human and animal milk is compared in Table 10.

Table 10

Nutritive Value of Milk
(Food Value per 100 ml)

Nutrients		Buffalo milk	Cow milk	Goat milk	Human milk
Fat	g	6.5	4.1	4.5	3.4
Protein	g	4.3	3.2	3.3	1.1
Lactose	g	5.1	4.4	4.6	7.4
Calcium	mg	210	120	170	28
Iron	mg	0.2	0.2	0.3	0.5
Vitamin C	mg	1	2	1	3
Minerals	g	0.8	0.8	0.8	0.1
Water	g	81.0	87	86.8	88
Energy	kcal	117	67	72	65

Milk Products

Vegetable milk is produced from certain vegetable foods (soyabean, groundnut). It may be used as a substitute for animal milk.

Cheese — proteins 12-16%, calcium — 8OO mg, phosphorus — 400 mg, fats — 25%.

Sour cream — fats up to 36%.

Curds (cottage cheese) — fats — 9-20%, proteins -12-16%.

Kefir is slightly alcoholic and acidic, produced by fermenta­tion of milk with yeasts and lactobacilli.

Curd. Fresh curd must be white or creamy without sour smell. Fats — 9-18%, water — 65-80 %, acidity — 20-27° Тerner.

Milk-Borne Diseases (FAO/WHO)

These can be divided into:

v Animal infections that can be transmitted to man including those of:

Ø primary importance, i.e. tuberculosis, brucellosis, streptococcal infections, staphylococcal poisoning, salmonellosis, Q fever

Ø lesser importance, i.e. cowpox, foot and mouth diseases, anthrax, leptospirosis, tick-borne encephalitis.

v Infections primary to man that can be transmitted through milk, such as typhoid and paratyphoid fevers, shigellosis, cholera, enteropathogenic Escherichia coli (EPEC), non-diarrheal diseases including streptococcal infections, staphylococcal food poisoning, diphtheria, tuberculosis, enteroviruses, viral hepatitis.

Sanitary Examination of Milk

Sanitary-Hygienic Expertise of Milk

Evaluation of Organoleptic Properties of Milk

· Colour of milk is evaluated in a cylinder made of colourless glass, which contains 50-60 ml of milk.

Normal colour of milk is white with a yellowish shade.

Skim milk has a bluish shade.

Diluted with water milk has a bluish shade.

Impurity of blood in milk (cow¢s diseases) is of pinkish shade.

If an animal eats some plants, shade of its milk may be: orange, yellow — at eating carrots, pinkish — at eating beet, etc.

· Consistence of milk is determined by a trace remained on walls of a flask after its churning.

Normal consistence has a white trace

Watery consistence of milk (milk diluted with water) has no white trace.

Mucous or viscous consistence of milk (in case of development of bacteria in milk) leaves a dragging trace on walls.

· Smell. For evaluation of smell 100 ml of milk are poured in a conic flask. Milk is shaken and after that smell is evaluated.

Fresh milk has a milk specific smell.

Sour milk has a specific acidic smell.

Putrefactive microorganisms of milk add the smell of ammonia, hydrogen sulfide, etc., to it.

If milk is improperly stored or transported, it can acquire different smells, e.g. of petroleum, soap, fish, perfume, etc.

· Taste. For evaluation of taste an oral cavity is rinsed by a small amount of milk (5-10 ml).

Good-quality milk has a slightly sweet taste.

Diluted with water milk or skim milk has a watery taste.

Other tastes (bitter, salty, styptic, fishy) are caused by a forage animal, its illness, extraneous impurities, incorrect taking and storage of milk.

Evaluation of Physical Properties of Milk

· A dry residueis determined as quantity of organic substance and salts which are found in 1 liter of milk. A dry residue is determined by boiling down of water. A normal dry residue makes up 11–12.5%.

· Density of milk is evaluated with the help of a device called a lactodensimeter (Fig. 7).

A lactodensimeter is immersed in a cylinder with milk and the density of milk is determined by level of milk. For example, point 20 designates the density of 1.020, point 30 — 1.030, etc. The indications of lactodensimeter are added to the number 1.0. For example, the level of milk indicates point 30 of a lactodensimeter scale; it means that the density of milk is equal to the following:

1.0 + 0.030 = 1.030.

The density also depends on temperature of milk. For this purpose there is a thermometer in lactodensimeter showing the temperature of milk. If temperature of milk is lower than 20ºС, for each degree below 20ºС it is necessary to subtract 0.0002 from the readings of lactodensimeter.

If temperature of milk is higher than 20ºС, for each degree above 20ºС it is necessary to add 0.0002.

The normal density of milk at 20°C is 1.028 — 1.034.

 

Fig. 7. Lactodensimeter

Evaluation of Chemical Properties of Milk

· Fat content is determined by a butyrometer (Fig. 8). This is a glass vessel of a cylindrical form. Into the device 10 ml of milk, sulfuric acid, amyl spirit are poured. Then butyrometer is placed in a centrifuge. The device is centrifugated for 5 minutes and after that the fat content of milk is observed. The isoamyl alcohol containing milk fats is concentrated at the neck of butyrometer with points, each major scale point corresponds to 1% of fat, each small — to 0.1 % of fat. The normal fat content is 2.5 — 3.2 %

Fig. 8. Butyrometer

 

· The acidity is measured by Turner’s degrees (T). It is the quantity of 1 ml of decinormal caustic soda (0.1 N solution of Na2CO3), which is used for titration of lactic acid in 100 ml of milk at addition of 3-4 drops of 1% phenolphthalein (10 ml of milk + 20 ml of water + phenolphthalein + titration by 0.1 N solution of Na2CO3 up to a weak-pink staining). The obtained result is multiplied by 10 times.

Normal acidity is 16-22°T (16-19°T is fresh milk, 20-22°T — fresh enough, over 23°T — not fresh milk). Milk diluted with water has acidity below 16°T.

Tests onFalsification of Milk

· Test for definition of starch. It is necessary to pour 10 ml of milk,add 1 ml of iodine solution. The appearance of a blue colour demonstrates the presence of starch in milk.

· T est for definition of soda (addition of rosolic acid). It is necessary to pour 5 ml of milk + 4-5 drops of a 0.2 % solution of rosolic acid in 96 % alcohol. If milk contains soda, its colour becomes crimson (+ Test ). The milk which does not contain soda becomes yel­low-pink (-Test).