Medical institutions and organization of their work

TYPES OF MEDICAL INSTITUTIONS

Treatment and prevention institutions can be divided into two main groups: outpatient clinics and hospitals. An outpatient clinic is a medical institution that provides medical care to incoming patients and patients at home. A hospital is a medical institution in which a patient is treated in a ward on a bed. More than 80% of patients receive outpatient medical care, and about 20% receive inpatient care. Both institutions are engaged not only in treatment, but also in prevention.

Outpatient institutions include outpatient clinics, clinics, medical units, dispensaries, consultations, emergency rooms, and ambulance stations.

In a polyclinic, unlike an outpatient clinic, qualified medical care can be obtained from various specialists (in the outpatient clinic, only doctors of basic specialties receive appointments). The clinics are equipped with all the necessary equipment for recognizing diseases and their treatment, at the same time they are a place for student practice and research activities. If necessary, outpatient clinics refer patients to clinics for consultation.

The medical unit is an outpatient treatment and prevention facility serving workers of the enterprise. The task of the medical unit is to provide first aid, prevent diseases associated with the work process, and treat patients. Large medical units, as a rule, have hospitals.

In factories and factories, agricultural enterprises there are health centers, medical centers, paramedics and paramedic-obstetric stations, which are subordinate to medical units or clinics.

Clinics operate on a local basis, while medical units and health centers operate on a workshop basis. The territory assigned to the clinic is divided into areas with a certain number of adults and children. Each site is served by assigned doctors and nurses. Treatment and preventive work at the site is organized by the local doctor or resident. He supervises nurses and attracts specialists of various profiles to work.

A dispensary is an outpatient medical institution, but with a narrow profile. The scope of work of the dispensary staff includes the treatment and prevention of diseases of any one type. For example, a tuberculosis dispensary deals with the treatment of patients with tuberculosis, the prevention of tuberculosis in people surrounding the patient at home and at work, mass screening of the population to identify early forms of tuberculosis, the prevention of the disease through vaccinations, etc. Accordingly, an oncology dispensary deals with the treatment and prevention of malignant tumors. Etc.

Children's and antenatal clinics, in addition to treating children's and women's diseases, monitor children under 16 years of age and pregnant women throughout the entire period of pregnancy and lactation. Consultations are included in the clinics.

Ambulance stations and emergency rooms at clinics provide medical care to the population in cases of urgent need around the clock.

Ambulance stations are mainly staffed by paramedics, since they often have to go out on their own and provide first aid, attend unexpected births at home, transport seriously ill patients to the hospital, etc. An ambulance doctor goes to the patient together with one or two paramedic assistants .

Inpatient institutions include hospitals, clinics, hospitals, maternity hospitals, and sanatoriums. Depending on their size and subordination, hospitals are divided into republican, regional, city, district and rural. In addition, hospitals are general, with specialized departments, and specialized, designed to treat patients with certain diseases. For example, hospitals for infectious diseases, tuberculosis patients, nervous and mentally ill patients, etc.

A clinic is a hospital where not only inpatient treatment of patients is carried out, but also student training and research work.

A hospital is a hospital for military personnel and retired military personnel.

Sanatoriums are hospitals that primarily provide after-care for patients. Some sanatoriums are located in resorts, that is, in areas with a special climate favorable for the treatment of a particular disease, mineral springs, therapeutic mud, etc.

In addition to outpatient and inpatient medical institutions, there are semi-stationary medical institutions. These include night and day dispensaries at large medical units, tuberculosis dispensaries and hospitals. In these institutions, patients spend part of the day or all of their non-work time, receive treatment under the supervision of medical personnel, eat and rest.

RESPONSIBILITIES OF NURSES

The work of nurses in outpatient clinics and clinics has more independence and responsibility than the work of medical staff in hospitals. This is explained by the nature of the clinic’s work. The doctor at the appointment is required to be prompt, clear and organized, since he must receive a large number of patients: determine the nature of the disease, prescribe treatment, conduct a conversation regarding the recommended regimen and treatment, answer the patient’s questions. The doctor must prescribe the necessary examination, consult with specialists, and record all this information in the outpatient’s medical record. The district nurse should actively assist the doctor during the appointment, freeing him from simple duties so that he can focus all his attention on the patient.

The responsibility of the outpatient nurse is to organize the appointment and assist the doctor during the appointment.

Arriving 15–20 minutes before the doctor, the nurse should prepare the appointment: interview those waiting for the doctor in order to ensure faster appointment of weak, febrile patients suspected of infectious diseases (requiring urgent isolation) and workers; check and prepare the office for reception (give appropriate instructions to the nurse); prepare outpatient records, laboratory tests and other documents for a doctor’s appointment.

During the appointment, the nurse calls the patients, explains to them how to get tested, tells them where this or that office is located, and, if necessary, accompanies the patients. The nurse writes out prescriptions, referrals to laboratories, to the X-ray room and for consultations with specialists, makes extracts from the medical record and draws up other documentation, and arranges, if necessary, for the patient to be admitted to a hospital.

Doctors' appointments in the clinic's treatment rooms are carried out by experienced nurses. At the patient’s home, the district nurse, following the doctor’s instructions, must check whether the patient complies with the prescribed regimen and teach relatives or neighbors the rules of care.

The nurse must inform the doctor about the slightest changes in the patient’s condition.

Nurses help clinic doctors conduct medical examinations, call patients, organize preventive appointments, draw up documentation, etc.

The participation of nurses in sanitary educational work is expressed in organizing lectures in the clinic and at the site, assisting the doctor during lectures, conducting conversations, reading and distributing leaflets, preparing sanitary bulletins and other documentation related to this work.

In carrying out sanitary and anti-epidemic work at the site, the doctor is assisted by a district nurse or a special nurse - an assistant to an epidemiologist. She monitors the source of the infectious disease, carries out ongoing disinfection, measures the temperature of persons in contact with the patient, carries out vaccinations, etc.

The responsibilities of dispensary and consultation nurses, in addition to regular outpatient work, include patronage of patients.

For example, a visiting nurse at a tuberculosis dispensary regularly visits patients with active tuberculosis and checks whether they have a separate bed, whether their dishes and linen are stored, washed and disinfected separately, whether they properly wash and disinfect their spittoon, how the room is cleaned and ventilated . The nurse brings medications to the patient,, if necessary, invites the patient’s relatives for a follow-up examination, and talks with them about the rules of personal hygiene.

The patronage nurse of the antenatal clinic visits pregnant women and checks whether they have a separate bed, follow a diet, and whether they get enough fresh air. She teaches pregnant women how to maintain good hygiene and prepare for motherhood.

The patronage nurse of the children's clinic begins to visit the family before the birth of the child in order to get acquainted with living conditions and prepare the environment for the unborn child. 1–2 days after the mother is discharged from the maternity hospital, the sister visits the newborn. She examines the child and teaches the mother how to care for him.

In addition, the visiting nurse of the children's clinic visits children of preschool and school age, checks the conditions in which they live, and helps to establish the correct regime, and in case of illness, teaches the mother how to properly care for a sick child.

The nurse on duty at the emergency room receives calls by telephone, transfers them to the doctor, provides first aid to patients in the absence of the doctor, and goes to the patients to carry out the doctor’s orders. She supplies the doctor’s suitcase with medicines and instruments and maintains documentation.

SETUP OF MEDICAL INSTITUTIONS

District, city and rural hospitals are usually located in the center of the service area and away from large enterprises that pollute the air and are a source of noise. Specialized hospitals are located depending on the profile. For example, it is better for an ambulance station to be located in the center of the district, but a hospital for tuberculosis patients should be built on the outskirts of the city or outside the city.

Hospitals are built using various systems. With the pavilion system, small (1–3 floors) separate buildings are located on the hospital premises. This type of layout is convenient for infectious diseases hospitals. In a centralized system, the hospital is located in one or more large buildings connected into one by covered above-ground or underground corridors. With a mixed system, a large building is built to house the main medical non-infectious departments, and several small buildings to house infectious departments, economic services, etc.

The hospital territory is divided into three zones: the zone of medical and treatment-and-prophylactic buildings (buildings for the medical and medical-auxiliary departments of the hospital, the pathology department, a park with sports grounds and a solarium); utility yard area (kitchen, laundry, vegetable storage, garage, etc.); a protective green zone with a width of at least 15 m, and in front of medical buildings at least 30 m. The medical and economic zones must have separate entrances.

The united hospital consists of: a hospital with specialized departments and wards and a clinic with specialized rooms; auxiliary departments (X-ray, pathology) and laboratories; pharmacies; kitchens; laundry; administrative and other premises.

During the construction of the main treatment and prophylactic buildings of the hospital, a corridor system with two-sided or one-sided construction was adopted. With one-sided construction, the corridor is well lit and well ventilated; doors of chambers or offices open into it. The width of corridors in hospitals should be 2.2 m, and in clinics - 3.2 m. In children's and tuberculosis hospitals, in addition to corridors, there are also closed and open verandas and balconies intended for patients to stay outdoors.

The walls in offices, chambers and corridors are painted in light colors. The lower parts of the walls (panels) are covered with oil paint, the upper parts - with glue. Moldings for walls and ceilings are not used. In operating rooms and dressing rooms, in sanitary facilities and catering units, the entire walls and ceilings are covered with oil paint, but it is better to line the walls of these rooms with glazed tiles. Transitions from walls to ceiling and from wall to wall should be rounded. Floors in medical facilities should be easy to clean, impervious to moisture and should not have cracks.

In the wards, it is advisable to cover the floors with linoleum; tightly fitting and well-painted wooden floors are also acceptable. Parquet floors should not have gaps. In rooms that require frequent cleaning, the floors are covered with Metlakh tiles. Such floors are required in operating rooms and labor rooms.

ORGANIZATION OF WORK OF THE ADMISSION DEPARTMENT

Patients referred for hospitalization are admitted primarily to the emergency department of the hospital. It receives and registers patients, draws up appropriate medical documentation, conducts a medical examination to determine the nature and severity of the disease, determines the department for subsequent hospitalization of patients, provides emergency medical care if necessary, and sanitizes it.

As a rule, hospitals have one emergency department; a number of hospital buildings (infectious diseases, maternity, etc.) have their own emergency departments. In large multidisciplinary hospitals, there may be several emergency departments equipped in specialized blocks and buildings (therapeutic, surgical, etc.).

During planned hospitalization, patients enter the emergency department with a referral for hospitalization and an extract from the outpatient medical record. In emergency situations, patients can also be transported by ambulance. In some cases, feeling unwell, patients go to the hospital on their own.

For each patient admitted to a hospital, a medical history (inpatient card) is created, which is the main primary medical document in hospitals. In the admission department, a cover page of the medical history is drawn up, where the following data about the patient is entered: last name, first name and patronymic, year of birth, home address, passport number and series, place of work and position, office and home telephone numbers (if necessary, telephone numbers of close relatives ), exact time of admission, diagnosis of the referring institution. If the patient is in serious condition, he is first provided with the necessary medical care and only then is registered. If the patient is unconscious, the necessary information is recorded from the words of those accompanying him. In addition to filling out the medical history, a corresponding entry is also made in the hospitalization log.

In the emergency department, the patient’s body temperature is measured and a thorough examination of the skin and hairy parts of the body is carried out in order to identify pediculosis (lice). The results obtained are entered into the medical history.

The next stage is an examination of the patient by a doctor from the emergency department, usually carried out in an examination room. In small hospitals or in the absence of emergency hospitalization of patients, the functions of the emergency department doctor are performed by the hospital doctor on duty. To clarify the diagnosis, the emergency department doctor may invite specialists (surgeon, gynecologist, neurologist, etc.) for consultation. If necessary, urgent laboratory and instrumental tests are carried out (blood tests, urine tests, electrocardiograms, X-ray studies).

In the emergency departments of large multidisciplinary hospitals there are special diagnostic wards and isolation wards in which patients are examined for several days to clarify the nature of the disease. They also have small operating rooms and dressing rooms for carrying out small-scale surgical interventions and manipulations, and intensive care wards.

After completing the examination, the doctor fills out a medical history, makes a diagnosis of the patient upon admission, notes the need for sanitary treatment, determines the department where the patient will be hospitalized and the method of transportation.

If upon examination it turns out that there is no need for inpatient treatment, then after medical care is provided, the patient is sent home with the appropriate documents and recommendations for outpatient treatment. A record of such a visit is made in a special journal.

ANTHROPOMETRY

When a patient is admitted to a hospital, anthropometry is performed - measuring a number of constitutional characteristics, i.e., certain features of the patient’s physique. Anthropometric studies include, for example, measuring the circumference of the chest, measuring the longitudinal and transverse dimensions of the pelvis, which is of great importance in obstetrics, etc.

For all patients upon admission, it is customary to determine height (body length), which is measured with the patient sitting or standing with a special stadiometer, as well as body weight. Patients are weighed using special medical scales, on an empty stomach, after preliminary emptying of the bladder and emptying the intestines.

Measuring anthropometric data, primarily height and body weight, is of great importance for clinical practice, in particular, for the diagnosis of certain diseases: obesity, nutritional dystrophy (exhaustion due to prolonged malnutrition), dysfunction of the pituitary gland, etc. Measurement of chest circumference ( during quiet breathing, deep inhalation and exhalation) plays a role in the diagnosis of lung diseases. Regularly weighing the patient is a fairly reliable method of controlling edema.

SANITARY TREATMENT OF PATIENTS

When a patient is admitted to the emergency department, they conduct a thorough examination to identify lice. In such cases, head, body and pubic louse may be found.

Body lice are carriers of typhus and louse-borne relapsing fever, the pathogens of which penetrate through damaged skin when the lice are crushed and subsequently scratched. The spread of pediculosis is observed under unfavorable sanitary and hygienic conditions and indicates, first of all, poor bath and laundry management.

If lice are detected, sanitary treatment is carried out, which can be complete (washing the patient with soap and a washcloth in the bath or under the shower, destroying microorganisms and insects in linen, clothing, shoes, bedding and living quarters, i.e. disinfection and disinfestation) or partial, implying only washing of people and disinfection (disinsection) of linen, clothes and shoes.

To combat PEDICULOSIS, THERE ARE MANY SPECIAL PRODUCTS CURRENTLY THAT ARE NON-TOXIC AND DO NOT REQUIRE STYLE AND HAIR. The product is applied to the scalp and covered with wax paper, a scarf is tied on top of the head or a cap is put on, or simply the hair is washed with a special shampoo. To remove nits, comb the hair again for several days with a fine-toothed comb and cotton wool moistened with a hot 10% solution of table vinegar.

To kill pubic lice, the affected hair is shaved off, after which washing the body again with hot water and soap is usually sufficient.

The linen and clothes of patients are disinfected in disinsection chambers (steam-air, hot-air, etc.). Medical personnel treating patients with head lice must use special long clothing made of rubberized fabric or thick canvas.

Prevention of lice consists of regular body washing and timely change of underwear and bed linen.

Upon admission to the hospital, if necessary, patients take a hygienic bath or shower, and patients who need outside help are lowered into the bath on a sheet or placed on a stool placed in the bath and doused with a shower.

All patients must take a hygienic bath or shower in the emergency department (sometimes not quite correctly called sanitization), then they change into hospital clothes. In practice, this rule is not always observed, which is due to several reasons. On the one hand, patients admitted for hospitalization as planned usually take a shower or bath at home. On the other hand, the hospital emergency department often does not have enough space and medical personnel to organize a bath or shower for all incoming patients.

As for hospital linen (pajamas and gowns), it is often of low quality, and patients change into clothes they took from home. Therefore, patients take a bath in the emergency department and change into hospital clothes, usually only for certain indications (in infectious diseases hospitals, when the skin is heavily contaminated, etc.).

Patients with serious illnesses (hypertensive crisis, acute myocardial infarction, acute cerebrovascular accident, severe circulatory failure, active tuberculosis, etc.), certain skin diseases, diseases requiring emergency surgical intervention, as well as women in labor. Usually in such cases, the patient’s skin is wiped with a swab moistened with warm water and soap, then with clean water and wiped dry.

For wiping, you can also use warm water with the addition of cologne or alcohol. Patients' nails are trimmed short.

TRANSPORTATION OF PATIENTS

The method of transporting the patient to the department is usually determined by the doctor examining him. The choice of transportation method in some cases is very important. For example, even minimal physical activity of a patient with internal bleeding or an acute stage of myocardial infarction can seriously worsen their condition.

Patients who are in satisfactory condition are sent to the department on foot, accompanied by a nurse or orderly. Weakened patients, disabled people, elderly and senile patients are often transported on a special wheelchair, while avoiding sudden jolts and jerks. Seriously ill patients are transported on a gurney or carried on a stretcher.

A stretcher with a patient can be carried by two or four people, and they walk out of step, in short steps. When going up the stairs, the patient is carried head first, when going down, feet first, lifting the foot end of the stretcher in both cases. To make it easier to carry the stretcher, special sanitary straps are used.

Carrying the patient in his arms and shifting him can be carried out by one, two or three people. If one person carries the patient, then with one hand he clasps the patient’s chest at the level of the shoulder blades, and brings the other hand under his hips, while the patient, in turn, clasps the carrier by the neck.

When transferring a patient from a stretcher to a bed, it is better to position the stretcher at a right angle to the bed, so that the foot end of the stretcher is closer to the head end of the bed; after lifting the patient, he is brought half-turned to the bed and laid on the bed. If such an arrangement of the stretcher for some reason turns out to be impossible, then the stretcher is placed in parallel, with the personnel located between the stretcher and the bed in series, or, in extreme cases, close to it. Before shifting the patient, be sure to check the readiness of the bed and the availability of necessary care items.

Currently, special devices are used to make it easier to carry and shift patients.

ORGANIZATION OF WORK OF THE THERAPEUTIC DEPARTMENT

Inpatient treatment of therapeutic patients is carried out in general therapeutic departments. In multidisciplinary hospitals, there are specialized therapeutic departments (cardiology, gastroenterology, etc.) intended for the examination and treatment of patients with certain diseases of internal organs (cardiovascular system, digestive organs, kidneys, etc.).

The department is headed by a director, who is usually appointed from among the most experienced doctors. He organizes timely examination and treatment of patients, controls the work of medical personnel, and is responsible for the rational use of the department’s bed capacity, medical equipment and medicines.

The staffing schedule for employees of therapeutic departments provides for the positions of ward doctors (hospital residents) who directly examine and treat patients; senior nurse who organizes and supervises the work of ward nurses and orderlies; sister-housekeeper, responsible for the timely provision of the department with soft and hard equipment, as well as underwear and bed linen; ward nurses working at the post and carrying out the appointments of attending physicians for the examination and treatment of patients; a procedural nurse performing certain manipulations in the treatment room; junior nurses, barmaids and cleaners providing care for patients, their nutrition, and maintaining the necessary sanitary condition in the department.

The therapeutic department can have a different number of beds. In turn, each department is divided into so-called ward sections, usually numbering 30 beds each.

In addition to the wards, the therapeutic departments include the office of the head of the department, the doctors’ office (resident’s room), the rooms of the head nurse and the housewife, a treatment room, a pantry, a dining room, a bathroom, an enema room, a room for washing and sterilizing vessels and storing cleaning supplies, storage space for gurneys and mobile chairs, toilets for patients and medical personnel. Each department has premises for daytime stay of patients - halls, verandas, etc.

To organize the full treatment of patients and care for them, the correct equipment of the rooms in which patients spend most of their time is of great importance. From the point of view of providing the necessary medical and protective regime, the ideal situation is when 60% of the wards in the department are equipped with 4 beds each, 20% - with 2 beds, and 20% - with one. In other words, in a ward section with 30 beds there should be 6 four-bed wards, two double and two single, with the condition that there should be 7 m2 per patient in the general ward 2 area, and in a single room - 9 m 2 . A smaller area has a negative impact on the organization of treatment and care for patients.

The wards are equipped with the necessary medical equipment and furniture: medical (functional) beds, bedside tables or bedside tables, a common table and chairs.

In general wards, it is advisable to use special portable screens, which allow, in necessary cases (performing some manipulations, fulfilling physiological needs, etc.) to protect the patient from outside observation. For this purpose, stationary screens in the form of a curtain attached to a special frame are also used. Such a curtain can easily be closed around the patient and then opened again.

In the wards, individual night lamps and radio points are equipped near each bed. It is advisable to install an alarm at each bed so that any patient, if necessary, can call medical personnel.

In the ward section (in the corridor) a nurse's station is installed, which is her direct workplace. At the post there is a table with sliding and locking drawers for storing necessary medical documentation, a desk lamp and a telephone. It is better to store medical histories in a separate box or cabinet, divided into compartments (according to the room numbers), which allows you to quickly find the required medical history.

The nurse's station should also have a cabinet (or several cabinets) for storing medications. In this case, it is necessary to allocate locked compartments in which there are drugs of groups A (poisonous) and B (potent). Medicines for external and internal use, as well as drugs for injection, are placed on special shelves. Store instruments, dressings, and flammable substances (alcohol, ether) separately. Medicines that quickly lose their properties during storage (infusions, decoctions, serums and vaccines) are placed in a special refrigerator. They store patient care items (thermometers, heating pads, jars, etc.) separately, as well as utensils for taking tests. Next to the post there are scales for weighing patients.

A treatment room will also be installed here. It is staffed by a specially trained procedural nurse.

In the treatment room, various diagnostic and therapeutic procedures are performed: subcutaneous, intramuscular and intravenous injections, drawing blood for clinical and biochemical tests, determining blood group, pleural puncture to remove fluid from the pleural cavity, puncture of the abdominal cavity for ascites, diagnostic puncture of the liver, measurement of venous pressure and blood flow speed, gastric and duodenal intubation.

In the treatment room, systems for intravenous drip administration of drugs are assembled, syringes and needles are sterilized by boiling (if the hospital does not have a central sterilization room).

Since many manipulations performed in the treatment room are invasive in nature (i.e., associated with the danger of microbial flora entering the patient’s body), great demands are placed on the sanitary condition of this room; in particular, regular air disinfection is carried out using a bactericidal lamp.

The functioning of the therapeutic department also includes maintaining the necessary medical records. Its list is quite extensive and includes many items. Documents that are mainly prepared by doctors include, for example, a medical history, a hospital discharge card, a certificate of incapacity for work, etc.

A number of medical documents in the department are filled out and maintained by guard nurses. This is a notebook (journal) of medical prescriptions, where, when checking medical histories, the nurse enters the prescriptions made by the doctor, patient records of the department, which reflects data on the movement of patients (i.e. admission, discharge, etc.) for the day, temperature sheets , portion tables indicating the number of patients receiving a particular table.

One of the main documents that a nurse constantly maintains at the post is the duty handover log. It notes data on the movement of patients during a shift, indicates appointments regarding the preparation of patients for research, and focuses attention on the condition of seriously ill patients who need constant monitoring.

Reception and transfer of duty is a responsible event, and requires great composure from nurses. Formally carried out, crumpled reception and transfer of duties lead, as a rule, to various kinds of omissions, unfulfilled assignments, etc.

The effectiveness of treatment of patients in a hospital depends to a large extent on the organization of the necessary medical and protective regime in the department. Creating such a regime involves protecting the patient from various negative emotions (associated, for example, with pain), providing conditions for sufficient and complete sleep and rest (rational placement of patients in the wards, silence in the department), allowing walks in the warm season and visits to patients by relatives , providing patients with fresh newspapers and magazines, organizing a buffet in the hospital with a fairly wide range of products necessary for dietary nutrition, which is of certain importance, for example, for out-of-town patients, etc.

In hospitals, there is still often a fairly large number of factors that significantly violate the principles of the medical and protective regime. These include cases of incorrect or untimely fulfillment of necessary prescriptions, rudeness and inattention to patients on the part of medical personnel (for example, insufficient pain relief for patients during painful manipulations). Disturbances that sometimes occur in the work of medical staff in departments (for example, knocking doors and clanking buckets, accompanied by exclamations from medical staff in the early morning hours, irregular wet cleaning, difficulties with timely change of bed linen, poorly prepared food), problems with sanitary facilities have a negative impact on patients. technical support (interruptions in the supply of hot water, breakdowns in heating, faulty telephones, etc.). The list of such costs could be continued. The listed “little things” adversely affect the condition of patients and reduce the authority of the medical institution. Creating an optimal medical and protective regime in a hospital is a task in which all services of a medical institution must actively participate.

SANITARY REGIME OF THE HOSPITAL

Maintaining the required sanitary regime in hospital premises plays a huge role in the work of the hospital, the organization of the treatment process and patient care, as well as in the prevention of many diseases. Violations of the requirements and rules of the sanitary regime lead to contamination of premises, the proliferation of pathogenic microorganisms, and the spread of various insects. Thus, poor ventilation of wards leads to an increase in the level of bacterial contamination of the air, and the preservation of leftover food in the buffet and untimely disposal of food waste contribute to the appearance of cockroaches. Poor care of soft equipment, furniture, mattresses, cracks in walls and baseboards contribute to the spread of bed bugs, and untimely removal of garbage from the hospital premises causes the spread of flies. Violations of food storage rules in the catering unit lead to the appearance of rodents.

Failure to comply with the sanitary regime increases the risk of the spread of nosocomial infections - infectious diseases that arise in patients in hospitals, or in medical workers associated with the treatment and care of patients, as a result of violations of the rules of asepsis and antisepsis, i.e. measures aimed at fight against pathogens of various infections. Such diseases that spread in hospital settings include influenza, infectious (serum) hepatitis B, infection of which occurs due to poor sterilization of syringes and needles, and in children's departments - measles, scarlet fever, chicken pox, etc.

When organizing a sanitary regime in a hospital, significant requirements are placed on lighting, ventilation and heating, i.e., the creation of a certain microclimate in hospital premises.

Equal importance should be given to the lighting of the chambers. It must be remembered that direct sunlight has a bactericidal effect, that is, it helps reduce the level of bacterial air pollution. At the same time, it is necessary that the lighting be of sufficient intensity, uniform, and biologically complete in its spectrum. For these reasons, for example, ward windows are usually oriented to the south and southeast, and operating room windows to the north. To make better use of daylight, it is advisable to place the beds in the wards parallel to the wall with windows. To avoid the blinding effects of direct sunlight and overheating of the rooms, windows must be equipped with visors, curtains or have blinds.

When organizing artificial lighting, it is taken into account that fluorescent lamps provide the patient with greater comfort than conventional incandescent lamps. Some departments (operating rooms, maternity units, etc.) also provide emergency lighting.

A prerequisite for maintaining a sanitary regime in hospitals is adequate ventilation, that is, removing polluted air from the premises and replacing it with clean air. Natural ventilation is achieved by regularly opening windows or transoms. Systematic failure to ventilate rooms leads to air stagnation and a significant increase in bacterial contamination, which facilitates the spread of nosocomial infections. In a number of rooms, for example in operating rooms, they use automatic maintenance of cleanliness, composition, humidity and air speed using air conditioners.

When organizing heating in hospitals, it is assumed that the optimal indoor temperature for a person is +20 °C in winter, and +23–24 °C in summer. The hygienic requirement is best met by radiant heating (with heated surfaces located in the walls, floor, ceiling), which prevents a significant difference between the temperature of the heat source and the temperature of the human body.

Maintaining a sanitary regime involves regular thorough cleaning of the premises and territory of the hospital. Garbage from buildings and compartments is taken out into metal bins with tight-fitting lids and removed in a timely manner.

Cleaning hospital premises must be wet, since washing reduces microbial contamination of the premises and surfaces of objects.

Disinfection can be achieved in various ways. Thus, boiling is widely used to disinfect dishes, linen, and patient care items. Ultraviolet radiation from mercury-quartz and mercury-uviol lamps is used to disinfect air in wards, treatment rooms, and operating rooms.

For disinfection, chlorine-containing compounds (bleach, chloramine, calcium, sodium and lithium hypochlorite, etc.) are most often used. The antimicrobial properties of chlorine preparations are associated with the action of hypochlorous acid, which is released when chlorine and its compounds are dissolved in water.

The bleach solution is prepared according to certain rules. 1 kg of dry bleach is diluted in 10 liters of water, thereby obtaining the so-called 10% bleach-lime milk, which is left in a special room in a dark container for 1 day. Then the clarified bleach solution is poured into an appropriate dark glass container, the date of preparation is marked and the container is stored in a darkened room, since active chlorine is quickly destroyed in the light. Subsequently, for wet cleaning, a 0.5% clarified bleach solution is used, for which, for example, take 9.5 liters of water and 0.5 liters of a 10% bleach solution. Chloramine solution is most often used in the form of a 0.2–3% solution (mostly 1%).

But such products are almost a thing of the past, and only a chronic lack of funding does not allow us to completely switch to new generation disinfectants, which are less toxic, more effectively destroy microorganisms, and are much more convenient to use. Modern disinfectants are differentiated - for treating hands, for treating instruments, for treating premises and for treating linen and patient secretions.

Wet cleaning of hospital premises is carried out daily. In wards, corridors and offices - in the morning, after patients get up. During cleaning, pay attention to the sanitary condition of bedside tables and bedside tables, where it is not allowed to store perishable foods that can cause food poisoning.

Furniture, window sills, doors and door handles, and (last of all) the floor are wiped with a damp cloth. Wet cleaning must be completed by ventilating the rooms, since the walking of patients and medical staff and the changing of beds are accompanied by an increase in bacterial air pollution.

To maintain cleanliness in the rooms, wet cleaning is repeated as necessary during the day, as well as before bedtime.

Wet cleaning of dining rooms and pantries is carried out after each meal. Food waste is collected in closed buckets or bins with lids and taken out.

It is very important to follow the rules for washing dishes. The operation includes washing dishes twice with hot water using soda, mustard or other detergents, subsequent disinfection with a 0.2% clarified solution of bleach and rinsing.

Particularly strict requirements are imposed on the personal hygiene of kitchen and buffet workers, their regular and timely medical examination and bacteriological examination.

Wet cleaning of bathrooms (bathtubs, sinks, toilets) is carried out several times a day as they become dirty. To clean toilets, use a 0.5% clarified solution of bleach. Baths are washed after each patient with warm water and soap, and then rinsed with a 0.5% solution of bleach or 1–2% solution of chloramine.

General cleaning of all premises, including washing the floor, sweeping walls and ceilings, is carried out at least once a week. The equipment used in this case (mops, buckets, etc.) must be appropriately marked (for example, for washing the toilet, for washing corridors, etc.).

If bedbugs or cockroaches are found in hospital premises, measures are taken to destroy them (disinsection). A set of special measures (deratization) is also carried out when rodents are identified. Since disinsection and deratization are associated with the use of toxic substances, these activities are carried out by staff members of sanitary and epidemiological stations (SES).

Preventing the spread of flies, bedbugs, cockroaches and rodents in hospitals involves maintaining cleanliness in the premises, timely removal of garbage and food waste, carefully sealing cracks in the walls, and storing food products in places inaccessible to rodents.

Olga Ivanovna Zhidkova