Functional responsibilities of a nurse in the infectious diseases department. Organization of the work of an infectious diseases hospital, rules for compliance with the anti-epidemic regime Construction of a children's infectious diseases department

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DEVICE, PURPOSE AND REGIME OF INFECTIOUS HOSPITAL AND DEPARTMENTS
Infectious diseases hospitals and departments are designed to isolate infectious patients for the entire period of infectiousness, as well as diagnose and treat them. Hospitalization is required for the following infectious diseases: typhoid fever, paratyphoid fevers A and B, typhus, diphtheria, tuberculosis (bacillary form), polio, smallpox, plague, cholera, anthrax, viral hepatitis, etc. Isolation at home is permitted for influenza, scarlet fever, measles, whooping cough, chicken pox and other diseases, taking into account the epidemiological situation and the severity of the course.
The infectious diseases hospital consists of treatment and diagnostic, organizational and methodological and administrative parts.
The diagnostic and treatment unit includes the following units: specialized departments, a boxed department (diagnostic), an intensive care and resuscitation department (or wards), surgical, X-ray diagnostic and physiotherapy departments, clinical, bacteriological, serological, virological and biochemical laboratories. central sterilization room, pathology department with morgue.
The work of the organizational and methodological department is aimed at organizing and carrying out, together with the rooms of infectious diseases of polyclinic institutions, measures for the timely detection, hospitalization, treatment of patients, monitoring of convalescents, and carrying out preventive measures.
The administrative and economic part of an infectious diseases hospital consists of an office, a catering unit with a dairy kitchen, a disinfection chamber and a laundry for washing infected linen, storage and utility rooms, a garage, sanitary facilities, etc. In the absence of an infectious diseases hospital, specialized care for infectious patients is provided in infectious diseases departments city and regional somatic hospitals.
Patients admitted to an infectious diseases hospital or departments pass through the emergency department or emergency room, which is served by specially assigned personnel. The reception department consists of several reception boxes. Each box has a separate entrance and a gateway connecting the box with a service corridor, an examination room, a dressing room, a shower room with a bathtub and a dressing room (Fig. 9).

Reception of patients should be individual. It is advisable to assign each receiving box to patients with a specific infection (box for receiving patients with intestinal infections, scarlet fever, etc.).

Rice. 9. Reception department of an infectious diseases hospital (with several departments).

In the emergency room or department, it is necessary to ensure the following activities are carried out: clarify the diagnosis, fill out documentation, prescribe treatment, take material for laboratory testing, carry out sanitary treatment of the patient, as well as disinfection of transport (0.5-1% chloramine solution), with which the patient was brought in. After sanitary treatment, the patient is sent to the appropriate department of the hospital, and disinfection is carried out in the box where the patient was admitted.
Patients with mixed infections, a questionable diagnosis of an infectious disease, or if there are indications of contact with an infectious patient, are isolated in boxes, specially designated wards or Meltzer-type boxes. The Meltzer box has a separate entrance with a vestibule and an internal airlock (pre-box) connected to the service room. Each box is equipped with a sanitary unit, a bathroom and everything necessary for sanitary treatment and care of the patient. The patient remains in the Meltzer box until recovery, the end of quarantine or the diagnosis being clarified.
In order to prevent nosocomial infections, it is most rational to place infectious disease departments in isolated buildings - pavilions. Patients with similar infections are hospitalized in each of these departments. When placing an infectious diseases hospital or department in a large two- or three-story building, departments intended for hospitalization of similar infectious patients must be located in such a way that patients with airborne infections are located on the top floor. Each department should have an average of 20-40 beds. The possibility of separating it, if necessary, into two isolated sections should be taken into account. In each of these sections, it is desirable to have single and three-bed wards for isolating seriously ill patients, two boxes, a sanitary checkpoint for patients, a checkpoint for staff, a pantry, linen rooms for clean and dirty linen, rooms for doctors, paramedical and junior medical personnel, a separate room for washing ships, sanitary facilities for patients and staff (separately). Departments for young children are arranged with no more than 10-20 beds, and in such a way that it can be divided into two halves, where children are placed in half-boxes or behind glass partitions.
Patients are grouped based on the severity of the disease and the period of its development, in order to reduce cross-infection.

Infectious diseases department mode.

Each ward of the infectious diseases department should have no more than 4 beds. This requirement especially applies to the wards of children's hospitals. The area of the room is calculated so that there are 6-7 m2 per patient. The distance between beds must be at least 1.5 m.
If there is no supply and exhaust ventilation in the rooms, ventilation is carried out through transoms or vents. In winter you need to open it for 10-15 minutes every 2 hours, and in summer you need to leave it open around the clock.
In addition to systematic ventilation, ultraviolet irradiation with a mercury-quartz lamp with a reflector directed upward is recommended. Irradiation (40 min) is performed 3 times a day.
The wards are cleaned using a wet method at least 3 times a day using a 0.5% clarified solution of bleach or chloramine. Restrooms, toilet seats and toilets must be kept clean and washed at least 4 times a day with a 0.5% clarified bleach solution (and immediately if dirty).
After each meal, all dishes are boiled in a 2% sodium bicarbonate solution for 15-30 minutes, depending on the resistance of the pathogens, or disinfected in a chloramine solution or a clarified bleach solution, then washed and doused with boiling water. Leftover food is covered with dry bleach at the rate of 1/5 of the food volume.
In children's infectious diseases hospitals and departments, children are allowed to play only with rubber or celluloid toys that are easily disinfected. Medical staff ensures that patients observe personal hygiene rules.
Visits by relatives are not allowed, with the exception of seriously ill patients and infants (with the permission of the head of the department). Among the products, it is allowed to give cookies, marmalade, etc. in sealed form, as well as fruits to patients.
To serve certain wards, several nursing stations are allocated, connected by a light alarm to the patients' beds. Seriously ill patients are provided with individual round-the-clock supervision by a nurse.
Patients who have recovered from infectious diseases are discharged according to clinical indications, depending on how many days have passed since the temperature dropped to normal and the end of the course of treatment, as well as the results of laboratory tests for carrier status.
Before discharge, the patient takes a hygienic bath or shower, after which he puts on clean linen and disinfected personal clothing.
The room from which the patient was discharged undergoes final disinfection. The patient's dirty linen is sent in a special bag to the laundry, bedding - for treatment in a steam-formalin chamber. The room where the patient was located and household items are treated with a chloramine solution, the concentration of which depends on the resistance of the pathogen.
Convalescents receive an extract from the medical history with a detailed description of the course of the disease, treatment, examination results, etc. It can be sent by mail to a medical institution. In addition, upon discharge, convalescents receive the necessary advice about their regimen and diet for the next 2-3 weeks.

Sanitary and hygienic measures for personnel.

For all employees of infectious diseases hospitals or departments, outer clothing is stored in a wardrobe, and work clothes are stored in individual closets. Operating personnel are required to wear special clothing, keep it clean, and observe personal hygiene rules. Nails should be cut short. Hands should be washed as often as possible with warm water and “Hygiene” soap and a brush.
Taking blood, urine, feces, vomit, and cerebrospinal fluid from patients for examination and delivering the material to the laboratory must be done in such a way that these materials cannot cause infection of personnel or other patients.
After examining patients, caring for them, performing therapeutic or diagnostic procedures, it is necessary to disinfect your hands with a 0.5% chloramine solution or wash them with Hygiene soap.
Personnel involved in the preparation and distribution of food, as well as medicines, are tested for carrier status and are subject to a medical examination upon entry to work. Thereafter every 6 months. An examination is carried out by a gynecologist and once every 3 months. - from a therapist and venereologist. If hospital staff become ill, their access to the department is immediately suspended until recovery, and, if necessary, until repeated negative carrier results are obtained.

Prevention of nosocomial (nosocomial) infections.

Nosocomial is considered a disease that developed in the hospital after a longer period (counting from the day of admission) than the incubation period of this infection, or appeared after discharge from the hospital in a period shorter than the incubation period for this infection.
Community-acquired cases include cases of infection before hospitalization, when the patient is admitted to the hospital in the incubation or prodromal period (introduction). Among nosocomial infectious diseases, the first place in frequency is occupied by airborne droplets: influenza, acute respiratory diseases, chicken pox, rubella, mumps, scarlet fever, measles, etc.
The most common source of nosocomial infection are patients with infectious diseases that were not recognized upon admission and patients admitted during the incubation period.
When referring a patient to a hospital, doctors at treatment and preventive institutions are required, along with a thorough examination of the patient, to collect accurate information about the infectious diseases he or she has suffered, the presence and possibility of contact in an apartment, house, child care facility, etc. All this data is included in the referral for hospitalization. In the emergency room or department, an admitted infectious patient is carefully examined in order to clarify the diagnosis and identify a mixed infection, collect a detailed epidemiological history, and check for information about contacts with infectious patients or carriers.
When a nosocomial infection occurs, anti-epidemic measures are taken to prevent the spread of the disease and, if necessary, quarantine is declared. During the quarantine period, only patients who have previously had this infection are admitted to the department.
The first patient with a nosocomial infection is transferred from the department to a box or isolation ward, or to a mixed department, and then the room and all things that were used by him are disinfected.
Persons in contact with this patient are monitored for the maximum incubation period. Depending on the disease, a carrier examination, preventive treatment, gamma globulin, etc. are administered. The sanitary-epidemiological station is immediately notified of the case of the disease.

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Design and operating mode of an infectious diseases hospital

To prevent the spread of infectious diseases, patients are isolated in an infectious diseases hospital according to clinical and epidemiological indications. In an infectious diseases hospital, not only the patient is fully treated, but also his reliable isolation ensures the cessation of further spread of the infection. The main requirement for an infectious diseases hospital is protection of patients and medical staff from nosocomial infection. The infectious diseases hospital is different from other hospitals. It includes an emergency department, a ward-type department and a box-type department, an intensive care unit, an X-ray department, a diagnostic laboratory, a catering unit, a disinfection chamber, a central sterilization room, physiotherapy rooms, ultrasound examination, endoscopy.

The principle of operation of an infectious diseases hospital - flow-through - ensures the separation of patients upon their admission and placement in the hospital, depending on the type of pathogen. From the moment of admission until discharge, patients should not have contact with other infectious patients; therefore, each patient is sent to the appropriate departments, for example, the department for intestinal infections, upper respiratory tract infections, etc.

The admission department of infectious diseases hospitals has a box structure for individual admission of each patient. These boxes are intended for receiving and sorting patients with various pathologies. An infectious patient enters a separate box in the emergency department, where he is examined by doctors and nurses and undergoes thorough sanitary treatment, after which the patient is admitted to the appropriate medical department.

Sanitary treatment of admitted patients includes taking a shower or bath for seriously ill patients - wiping the skin and disinfestation if lice is detected. Examination for lice is mandatory for all those admitted to the hospital. The admissions department nurse carefully examines the clothes, hair on the head and skin of the incoming patient. The patient's personal clothing is sent to a disinfection chamber for processing. The patient receives his clothes only after discharge from the hospital. In the hospital he is in hospital clothes.

After examining the patient and transferring him to the medical department, the nurse disinfects the affected ward in the emergency department. From the emergency department, the patient is admitted to the appropriate department of the hospital without contact with other patients. When diagnosing an airborne infection, the patient is placed in a box office, which is located on the highest floors. Departments for airborne infections are located on the top floor so that pathogens are not carried by the ascending air flow from the lower floors to the upper ones. The boxes can be open if they are placed inside a large ward, isolating from each other by a partition 22-2 m high. Such boxes are intended for patients with scarlet fever, whooping cough, diphtheria, etc. Closed boxes are separated from each other by a full partition up to the ceiling and have a door and a separate bathroom. However, patients enter and leave them through a common corridor, in which it is possible to become infected with measles, chickenpox and other airborne infections.

Each infectious diseases department has two exits: one for patients and the other for medical staff and visitors. When placing infectious patients in wards, a nurse in a medical department must follow a strict rule to prevent nosocomial infection: a patient in the acute phase of the disease should not be placed in a ward with recovering patients. It is important for the nurse to monitor the numbering of hospital beds and ensure that the number of each of them corresponds to the number of items related to it: dishes, which must be individual. Patients are prohibited from moving their beds in the room; the distance between them must be at least 1 m.

The patient's dishes must be boiled with 2% soda after use. Spatulas, beakers, pipettes, etc. are subject to mandatory sterilization after use. Discharge from patients with intestinal infections is disinfected in vessels or pots with bleach or chloramine before being discharged into the sewer. The nurse must thoroughly wash her hands before each procedure, as well as when moving from one patient to another. Staff gowns should be hung at the doors of isolation rooms and a basin with a disinfectant solution for hand treatment should be placed. Sterilization of reusable syringes and other medical instruments is carried out centrally in autoclaves.

Nurses play a major role in the prevention of hospital infections when they monitor the sanitary and hygienic condition of the wards and other premises of the infectious diseases hospital. Independent nursing interventions include regular ventilation and quartzing of rooms, monitoring ongoing disinfection, changing bed and underwear in cases of contamination with vomit, feces, urine and other biological fluids of the patient. After the patient is discharged, final disinfection is carried out in the ward. The most perfect isolation of an infectious patient is in the so-called boxed department, consisting of Meltzer boxes, in which the possibility of contracting any infectious disease is eliminated.

The Meltzer box consists of: 1) a vestibule - a prebox; 2) chambers; 3) a sanitary unit with a bath; 4) gateway for personnel.

Rules for the work of medical staff in the Meltzer box:

1) Medical personnel serving patients in the boxed department are located in the internal corridor, into which patients are prohibited from entering.

2) When visiting a patient, medical workers enter the airlock from the corridor, wash their hands, put on a gown, then go into the room.

3) When leaving the patient, the process is repeated in the reverse order: the gown is removed, then the hands are disinfected. It is necessary to ensure that when the door from the room to the airlock is opened, the door from the airlock to the corridor is tightly closed to prevent the spread of infectious diseases such as measles and chicken pox through the air.

Patients are hospitalized in the boxed department: a) with mixed diseases; b) with an unknown diagnosis; c) who were in contact with patients with particularly dangerous infections.

As a rule, there is one patient in the Meltzer (individual) box. After the patient is discharged, the room is thoroughly disinfected. For each box, items necessary for servicing the patient and cleaning the room are assigned with markings. Dirty laundry and garbage, previously disinfected with bleach, are taken out of the box in special bags, in which they are sent for further processing (washing, boiling) or burning.

Hospital for Infectious Disease

For the entire infectious period, infectious patients are hospitalized in infectious diseases hospitals or specially adapted departments. When hospitalizing patients, the nurse monitors the sanitary treatment and ongoing disinfection.

The design of an infectious diseases hospital is based on the principle of a flow-through system: upon admission, a patient passes through the system of hospital premises without returning to those where he has already been.

In the reception department, primary sanitary treatment, disinfection and disinsection of things, and neutralization of secretions are carried out. In the infectious diseases department, treatment and final disinfection and control of bacterial carriage are carried out before discharge.

In addition to the reception department and treatment rooms, each infectious diseases hospital has a sanitary checkpoint (in large hospitals there are several of them), a disinfection chamber and a laundry room. The sanitary facilities of the food block and outbuildings are located at a sufficient distance from the medical buildings. Infectious diseases departments can be located in separate independent buildings (pavilion system) or in two- and multi-story buildings. An infectious diseases hospital must have at least 3 isolated departments designed for various infections. Each of them is equipped with one ward for the isolation of patients with an unclear diagnosis or with mixed infections. Infectious diseases hospitals with 100 beds or more are required to have a special diagnostic department.

The premises in the infectious diseases hospital should be bright, clean, with mesh windows (for the warm season). The area per patient is on average 7-8 m2. Each infectious diseases hospital must have a clinical bacteriological laboratory and a morgue.

First of all, the patient is admitted to the emergency department, isolated from the treatment department. Patients delivered by ambulance are admitted in boxes designed for certain diseases (typhoid fever, scarlet fever, diphtheria, meningitis, etc.). Transport is disinfected. The box has a separate entrance and double glazed doors lead from the box to the corridor of the reception department. All box doors are locked with a key. The doctor examines the patient directly in the box and establishes a preliminary diagnosis, after which the patient is sent to the appropriate department.

The box design prevents one patient from meeting another. The box should contain gowns for staff, a couch, a desk, chairs, a set of emergency medications, syringes with needles, a sterilizer, sterile tubes with swabs for taking throat swabs for diphtheria, a preservative mixture in tubes for taking stool for intestinal pathogens.

When examined in the emergency department, a mixed infection may be detected. In this case, the patient is also placed in a separate room or box.

For each patient in the emergency department, a medical history is created according to the established template. Note the home and office phone numbers of relatives or neighbors. On a special form, the nurse on duty indicates a list of the patient’s belongings left in the hospital, informing the patient himself (if he is conscious) or the person accompanying him about this. A request is sent to the kitchen indicating the table assigned to the patient.

The patient's personal linen is sent to disinfection chambers in a tightly closed bag with a number corresponding to the medical history number. When infested with lice, the linen is subjected to special treatment.

In the emergency department, the issue of how to transport the patient to the department is decided (on a stretcher on a gurney on foot).

After examining the patient, the doctor on duty or the emergency department paramedic makes the first emergency treatment appointments and instructions for the necessary urgent tests. For all children admitted to hospital in the emergency department, smears of mucus from the nasopharynx are taken for diphtheria bacillus. In patients with intestinal diseases, stool culture for intestinal pathogens.

From the emergency department, patients are admitted to medical treatment, and in unclear cases, to the provisional departments of the hospital. From here, after the diagnosis is clarified, they are transferred to the appropriate ward according to the disease.

In case of a very serious condition and pronounced psychomotor agitation, the patient is sent to the appropriate department of the hospital or to the intensive care unit without examination in the emergency room. In this case, all documentation is filled out by the nurse in the department with notification to the emergency room.

In each infectious diseases department, 1-2 rooms are allocated for especially severe patients; If necessary, an individual nurse post is established.

Sanitary treatment of the patient includes: washing in the bathtub under the shower, treating the scalp with insecticidal solutions if lice are detected. Removed hair during pediculosis is burned. Fingernails and toenails are trimmed. After each patient, washcloths and sponges are placed in special labeled pots, disinfected and thoroughly boiled. Baths are washed with hot water and treated with disinfectants. In weakened patients, sanitary treatment is limited to wet wiping.

Infection wards must meet certain hygienic requirements: the cubic capacity per patient must be 18-22 m3; distances between beds - at least 1 m; air temperature 18-20 °C with supply and exhaust ventilation (transoms should open every 2-3 hours even in winter); the chambers should be bright.

Regular cleaning of wards and other hospital premises is carried out only using the wet method using disinfectant solutions. If health conditions permit, each patient is washed weekly in a bath or shower with a mandatory change of underwear and bed linen. Seriously ill patients are wiped down, linen is often changed, the condition of the skin and mucous membranes is monitored, bedsores are prevented.

The department must have a constant supply of insecticidal preparations (dusts, soaps, DDT, chlorophos) and disinfectants (bleach, chloramine), the activity of which is regularly tested in the laboratory.

Wiping the floors in wards and corridors must be done at least 2 times a day.

Dirty dishes are poured into solutions of bleach or chloramine, boiled and not wiped, but dried. Leftover food is covered with bleach and then thrown into a sewer or cesspool.

The patient's underwear soiled with feces and urine is soaked in a chloramine solution. Then it is boiled and washed. Patient care items (beds, heating pads, circles, pots) must be individual.

Toys in the children's department can only be rubber or plastic, which are easy to disinfect and boil. Soft toys are strictly prohibited in infectious diseases departments.

In the restrooms there should be tanks with a 10% bleach solution to disinfect vessels, pots, shelves and nests for pots.

The head nurse of the department must ensure that the department always has a sufficient supply of linen. Mattresses from beds of discharged patients are sent to a disinfection chamber and used only after disinfection.

The nurse must remember that nutrition of a patient, especially weakened by intoxication with fever and dyspeptic symptoms, is the most important method of restoring his health. It is necessary to monitor transfers to patients so that they do not receive products that are absolutely contraindicated for this disease (for example, smoked dairy products for typhoid fever, etc.).

The department allocates several nursing positions and clearly distributes job responsibilities. It is recommended to assign a procedural nurse whose responsibilities include performing subcutaneous intramuscular intravenous injections and preparing systems for drip and jet infusions. The most qualified nurses work in the intensive care wards.

To perform various diagnostic and therapeutic procedures, special rooms are allocated (for example, for sigmoidoscopy of spinal punctures, etc.). As a rule, a specially designated nurse works in the sigmoidoscopy room. She prepares patients for this procedure, helps the doctor during its implementation and keeps rectoscopes, rheostats, light bulbs, etc. in perfect order. The same nurse usually conducts treatment with microenemas.

The nurse in the infectious diseases department quickly informs the doctor about changes in the patients’ condition; closely monitors changes in doctor's orders; carries them out without delay; timely pastes the obtained test results into the medical history. The nurse transfers the therapeutic and diagnostic prescriptions indicated by the doctor in the medical history to the appropriate notebooks or to individual prescription cards accepted in this department.

The department nurse constantly instructs incoming patients about the regimen in the department, sanitary and hygienic skills and proper nutrition for this infectious disease.

Discharge of patients is possible no earlier than the mandatory isolation period if clinical symptoms of the disease disappear and the results of bacteriological examination are negative. The frequency of the latter depends on the specialty and place of work of the patient.

The patient leaves the department with his clothes pre-treated in the hospital's disinfection chamber.

Visiting patients with relatives or friends in infectious diseases departments is, as a rule, not allowed.

infectious diseases hospital box

Isolation of infectious patients

Isolation of infectious patients is an anti-epidemic measure aimed at separating patients with infectious diseases, as well as persons suspected of these diseases or who have had contact with patients, from the people around them to prevent further spread of the infection.

Patients are isolated for the entire period of infectiousness; if an infectious disease is suspected - depending on the specified diagnosis; communicated with the patient - for a period equal to the maximum duration of the incubation period. The following forms of isolation are used: hospitalization, isolation at home, placement in an isolation ward, observation. For some infectious diseases, hospitalization is mandatory; for others, it is carried out according to epidemiological and clinical indications.

A referral for hospitalization is issued by doctors at the clinic or ambulance service. The referral contains information about communication with infectious patients about travel to countries where a suspected infectious disease is registered in children - information about routine vaccinations. Hospitalization is carried out by special transport for emergency indications - the ambulance service. After transporting the patient, the vehicle is sanitized.

Patients with quarantine diseases are hospitalized in specially equipped hospitals. Patients with predominantly droplet infectious diseases with an unspecified diagnosis (for example, suspected measles, rubella), with a mixed infection, contact with a patient with another infectious disease (a patient with viral hepatitis had contact with a patient with chickenpox) and also in the absence of an appropriate specialized department are subject to isolation in individual boxes. In other cases, hospitalization is carried out in departments profiled according to nosological principles (for example, departments for patients with hepatitis, dysentery, and influenza). The design and regime of the infectious diseases department (hospital) must ensure the prevention of nosocomial infection of personnel, as well as the spread of the infectious agent outside the hospital. To avoid nosocomial infections, diagnostic isolation wards are organized within the department. Patients with an infectious disease caused by different serotypes (subtypes) of the pathogen (for example, viral hepatitis, dysentery) are placed in different rooms.

In order to prevent reinfection, the principle of simultaneously filling the wards is used (for example, with scarlet fever).

The timing of discharge from the hospital, in addition to clinical indications, is determined by the duration of the infectious period for a given infectious disease or is established on the basis of bacteriological studies of feces, urine, bile, throat swabs, sputum.

When isolating at home, the patient should be allocated a separate room or part of the room separated by a screen with dishes and other household items, carry out routine disinfection, and ventilate the premises. Persons caring for the patient are informed about the necessary measures to prevent possible infection (wearing a gauze mask, washing hands after contact with the patient and his secretions, etc.).

Placement in an isolation ward is a temporary measure of isolation of the patient before hospitalization or isolation at home, used in groups (for example, in children's institutions) as well as in clinics. Specially equipped or adapted premises are used for isolators.

Persons who have had contact with patients with quarantine diseases are subject to observation. In case of other infectious diseases, workers in contact with the patient involved in the production, storage and sale of food products, as well as workers in child care institutions and some public services (water supply, hairdressing salons, etc.) are suspended from work; children are prohibited from visiting child care institutions; For the purpose of early diagnosis, bacteriological, serological and other studies are carried out and medical supervision is established, including clarification of complaints, examination, and thermometry.

Persons who have suffered from certain infectious diseases (typhoid fever, dysentery, viral hepatitis, brucellosis, etc.) are also under medical supervision to identify possible relapses, the chronic course of the disease, and chronic carriage of pathogens.

Anti-epidemic directorim working in an infectious diseases hospital

1. Preventing the spread of infection outside the hospital:

· transport processing;

· restriction of visits by relatives;

· strict adherence to the flow-through system;

· processing the patient’s belongings in a disinfection chamber;

· location of the hospital outside the city;

· Discharge of only neutralized waste into the city sewer system;

· prohibition on bringing soft toys and books (only newspapers, magazines, plastic or rubber toys);

· availability of closets for personal and work clothes of medical workers.

2. Prevention of the occurrence of nosocomial infections:

· adherence to the regimen by patients;

· availability of wards and boxes (corresponding structure of the hospital);

· disinfection, disinsection and deratization;

· do not accommodate newly admitted patients with convalescents;

· filling the wards depending on the infection and its transmission routes;

· prohibition of food distribution by a nurse;

· observance of personal hygiene rules by patients;

· use of personal care items;

· undergoing periodic medical examinations by medical personnel and food service workers.

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Design and mode of the infectious diseases department. Responsibilities of medical workers when suspecting or identifying a patient with particularly dangerous infections. Mandatory compliance with sanitary standards for the location of premises and the placement of patients in ward sections.

Educational objective: to familiarize cadets with the organization of the work of an infectious diseases hospital and the complex of anti-epidemic measures carried out in a medical institution during admission, treatment and examination, as well as during discharge of an infectious patient.

Study time: 2 hours. Place of classes: reception and treatment departments of the clinic of infectious diseases (442 OKVG, City Infectious Diseases Hospital named after S.P. Botkin).

Structural and logical sequence of teaching the question. The formation of knowledge, skills and practical skills among cadets in organizing the anti-epidemic regime of an infectious diseases hospital is an important area in teaching infectious diseases.

During the lesson, cadets become familiar with the general principles of the functioning of an infectious diseases hospital using the example of the infectious diseases department of the District Military Hospital, starting with the territory, the location of the buildings and ending with the wards of the medical departments and the intensive care unit.

Assignment for independent study of the topic

Using the textbook and lecture material to acquire the necessary basic knowledge, master the following sections for the practical lesson.

1. The main tasks of the infectious diseases department of the hospital:

Reception, triage of infectious patients, carrying out complete sanitary treatment, disinfection of linen and belongings of patients;

Diagnosis of infectious diseases with the necessary clinical and laboratory tests;

Treatment of patients using the necessary clinical, laboratory and other studies (x-ray, electrocardiographic, sigmoidoscopy, etc.), as well as conducting a military medical examination;

Carrying out measures to prevent intrahospital infection and its spread outside the hospital (department);

Notifying the senior medical commander and unit commanders about the arrival of infectious patients from units;

Participation in preventive and anti-epidemic work, combat training conducted in the hospital, training of military doctors in infectious pathology.

2. Organizational principles of work of an infectious diseases hospital. The design and mode of operation of the infectious diseases department of a hospital should be based on the principle of a access system and complete separation of patients with various infectious diseases. It should be emphasized the need for separate admission of patients with droplet and intestinal infections in separate examination and sanitary passages, as well as the correct implementation of disinfection measures.

Basic principles for deploying an infectious diseases hospital:

Maximum disunity;

Access system;

Preventing nosocomial infections and infection of medical personnel;

The ability to quickly transfer to a strict anti-epidemic regime.

3. Work of the admission department of an infectious diseases hospital. Organization of emergency care for infectious patients upon admission to hospital:

Responsibilities of the medical personnel on duty for receiving patients and the necessary documentation (registration card of an inpatient - form 12, record book of patients undergoing inpatient treatment - form 13);

Using the example of incoming infectious patients, work out the principles of their sorting, types of sanitary treatment, methods of transportation to medical departments;

Construction of a sanitary passage, methods and means of final disinfection of transport and receiving bays;

The contents of the emergency cabinet for incoming patients, the basic principles of its use.

Procedure for receiving infectious patients

1) infectious patients, bypassing the general admission department of the hospital, are sent to the admission department for infectious patients.

Patients are received individually in specially designated isolated examination boxes.

2) entry into the box is permitted only to medical personnel directly working in it and persons accompanying the patient. Simultaneous admission of 2 (two) or more patients in one box is prohibited;

3) after each examination of the patient, the office and all furnishings in it are subjected to thorough wet disinfection. Until disinfection is completed, admission to the examination room of a newly arrived patient is prohibited;

4) in the receiving department there should be a thermostat where Petri dishes and liquid nutrient media inoculated with infectious material are delivered if the bacteriological laboratory is not working (evenings, nights, weekends, holidays);

5) the ambulance transport that delivered the infectious patient and the stretcher after handing over the patient are subject to disinfection at the “transport disinfection site” by the personnel of the reception department;

6) at the entrance to the examination room there must be gowns, caps, headscarves, gauze masks for medical personnel and a mat moistened with a disinfectant solution;

7) from the examination room, the patient is sent to the sanitary checkpoint for sanitary treatment, after which the patients dress in clean underwear, pajamas, socks and slippers and are sent to the appropriate treatment departments.

8) clothes, underwear, shoes of patients and uniforms are collected in individual bags and sent for disinfection to a disinfection chamber, from where they are delivered to a warehouse for storage;

9) information about admitted infectious patients by the medical personnel on duty is reported to the unit and to the relevant sanitary and epidemiological institution for carrying out preventive and anti-epidemic measures at the place of duty.

Organization of work of medical departments

Based on the diagnosis, the admitted patient is sent to a specialized department (ward) of the hospital.

If there is a diagnostic department, the patient, in case of a questionable diagnosis, is detained in this department until a final clinical diagnosis is established (up to 3 days), after which he is transferred to a specialized treatment department (ward). If there is no diagnostic department, the patient is placed in a separate room.

Medical triage of infectious patients in specialized departments is carried out in such a way that newly admitted patients are not in the same room with convalescent patients or patients with complications. Patients during the height of the disease (and the greatest epidemic danger) are kept in separate rooms (in one half of the department), where they are provided with appropriate care and regimen. Patients requiring intensive treatment are placed in a special ward. As they recover, patients are transferred to wards for patients in the period of early convalescence.

Feeding of patients during the height of the disease should be carried out in the wards, and feeding of convalescent patients in the dining room. Dishes of patients after each meal are disinfected by boiling or immersing in a disinfectant solution.

All patients are provided with individual marked glasses, and patients with intestinal infections, in addition, are provided with individual marked glasses. Their markings must correspond to the patient’s bed number. The reception and diagnostic department and the airborne infections department are equipped with bactericidal ultraviolet irradiators to disinfect rooms after patients with airborne infections.

In all departments for patients with viral hepatitis, special attention is paid to the peculiarities of the work of medical personnel, sterilization of medical instruments, syringe regimen, which ensures the prevention of viral hepatitis with a parenteral transmission mechanism.

In the department of acute intestinal infections, cadets get acquainted with the main functional departments: wards for patients, a dining room, an office for endoscopic examinations, a sanitary unit, a dressing room, and a treatment room. Attention is drawn to the sorting of patients in the department according to nosological forms and periods of illness. The organization of control over the nature of the stool of patients, their bacteriological examination, final and ongoing disinfection are being studied.

In the department of airborne infections, the emphasis is on measures to prevent intra-hospital infections, as well as infection of medical personnel. Familiarization with the work of functional diagnostic rooms, inhalation rooms, and x-ray rooms. Particular attention is paid to the work of the dental office, mandatory examination of the dentist for all infectious patients and, if necessary, sanitation of the oral cavity.

In the box department, cadets study the design of the box for treating infectious patients, the peculiarities of the work of medical personnel in connection with the box placement of patients.

In the intensive care ward, cadets are familiarized with its equipment and equipment. At the same time, the continuity of emergency care in the unit’s medical center and intensive care in the garrison hospital is emphasized. In the intensive care unit, constant dynamic monitoring is carried out with the maintenance of an intensive care and observation chart, as well as the use of cardiac monitors and other equipment to monitor vital signs.

In conclusion, attention should be paid to the peculiarities of organizing the work of an infectious diseases hospital in terms of equipping it with the necessary equipment for the transition to a strict anti-epidemic operating regime.