Medical institutions and organization of their work. Lecture on the topic: “Structure of healthcare facilities. The device and functions of the hospital software. hospitalization routes. Medical documentation of the admission department

Medical facilities of a stationary type (hospitals, hospitals) are the main link in the treatment and preventive care of the population. At present, the following types of hospitals are distinguished: combined (they include a hospital and a polyclinic), multi-profile and single-profile, or specialized (cardiology, tuberculosis, etc.).

Hospitals of stationary type have the following approximate organizational structure.

· Management: office, medical statistics room, accounting, medical archives, library.

Medical part: admission department, medical departments (therapeutic, surgical, urological, etc.), treatment and diagnostic departments and rooms (X-ray, endoscopic ultrasound), physiotherapy department, pathoanatomical department, laboratories (biochemical, bacteriological).

Auxiliary part: catering department, pharmacy, warehouses, garages, etc.

Arrangement and organization of work of the reception department

The reception department is the most important medical and diagnostic department. Here the first acquaintance of the patient with the staff of the medical institution takes place. And often, by the reception department, by the way its work is organized, patients judge the organization of the treatment process in the institution as a whole.

Distinguish between centralized and decentralized hospital planning system. With a centralized layout, almost all medical and diagnostic departments are concentrated in one building, and the admission department is also located there. With a decentralized (pavilion) system, the admission department is located either in a separate building or in one of the medical buildings, usually in the one where the intensive care unit, therapeutic or surgical is located. Almost all patients enter the hospital through the admission department. Patients who need emergency medical attention are sometimes taken directly to the intensive care unit, bypassing the emergency department.

The admission department consists of a waiting room, an office of a nurse on duty, one or more examination rooms (for examination by a therapist, a surgeon), a treatment room, a dressing room, and sometimes a small operating room, an isolation room, a sanitary inspection room, an X-ray room, a laboratory, a sanitary unit.

The waiting room is intended for patients and their relatives. There should be a sufficient number of chairs and armchairs. Information about the working hours of medical departments is posted on the stands, a list of products allowed for transfer to patients, and the telephone number of the hospital's information service is given. The days and hours in which you can visit patients should also be indicated here.

Next to the waiting room there is a duty nurse post (registration), where incoming patients are registered and the necessary documentation is processed.

Depending on the capacity of the hospital, one or more examination rooms are equipped in the admission department, in which the doctor on duty examines patients.

The treatment room, or small operating room, is designed to provide emergency medical care. Sanitary treatment of incoming patients is carried out in the sanitary inspection room. In addition, there are several boxes in the admission department, in which patients with an unexplained diagnosis or suspected infectious disease are placed.

In the Russian Federation, there is a developed system of organizations providing medical care to the population. Such institutions are called health care facilities - medical and preventive institutions. They carry out diagnostics, therapy and measures to prevent the occurrence of various diseases. In the last few years in Russia there has been a tendency towards an increase in mortality and a decrease in the birth rate and life expectancy. This is due to the difficult economic situation in the country. Citizens of Russia, of course, need to provide quality medical services. It is for this purpose that organizations such as LPU are created.

Classification of institutions

This article discusses the types of health facilities and their description. These organizations are divided into several types according to the nature of the medical services they provide.

There are the following types:

• Outpatient clinics.
• Stations.
• Sanatoriums, dispensaries and resorts.

This classification does not include emergency stations, organizations providing medical services to pregnant women and women in childbirth (maternity hospitals, antenatal clinics), as well as institutions whose task is to prevent diseases. In addition, institutions for the provision of medical care to children and blood transfusion points are considered separately.

Types of medical facilities (stationary) and their brief description

There are specialized hospitals that treat patients with only a certain group of diseases. A stationary institution, on the territory of which, in addition to diagnosis and treatment, research work is carried out, is called a clinic. A hospital that provides medical services to the military and combatants is called a military hospital.

Outpatient health facilities

This type of organization includes dispensaries. In such institutions, diagnostics and therapy of patients with certain groups of pathologies (mental, cancerous, tuberculosis, skin) are carried out. At the same time, the well-being of patients does not require hospitalization in a hospital. Employees of this type of healthcare facility monitor the condition of patients, provide medical services, and carry out the prevention of various diseases among the population.

Outpatient organizations also include polyclinics, whose employees provide medical care to the population of nearby territories. The list of health facilities includes institutions located in villages and villages. They are called outpatient clinics. In addition, there are feldsher-midwife stations. Employees of such institutions provide emergency care and carry out the prevention of various diseases.

health centers

Health centers do not belong to the types of medical institutions described above. They are usually part of other medical organizations. Such institutions carry out emergency measures in cases of intoxication, bodily injury, and infectious diseases. Preventive work is also carried out by employees of health centers. Often these facilities are part of health units that are attached to enterprises and provide medical services to their staff. The Ministry of Emergency Situations is a complex organization that includes not only a health center, but also a polyclinic, a hospital, and sanatorium-resort institutions.

First aid points

These organizations carry out urgent medical measures in situations where there is a real threat to the patient's life or in the presence of chronic pathologies in the acute phase. EMS stations carry out hospitalization of people who need treatment in a hospital setting.

This usually happens in the following situations:

1. Burns.
2. Intoxication.
3. Injuries.
4. severe infections.
5. terminal states.
6. Childbirth.
7. Acute diseases of various organs and systems.

Hospitalization

The above term refers to the placement of a patient in a hospital. Hospitalization is urgent when the patient's condition requires urgent medical care, so he is taken to a medical institution in a special car. With a planned hospitalization, a doctor is sent to the hospital for the purpose of diagnostics and therapy, which is difficult to carry out on an outpatient basis. In some cases, the doctor transfers the patient from one medical institution to another. If a person is injured or feels a sharp deterioration in his physical condition on the street, he can go to any hospital or emergency station.

Military hospital

Employees of this institution provide medical services to the military, reserve officers, combatants and, if necessary, their relatives. Military hospitals treat viral, surgical, neurological, mental pathologies. Also, on the territory of these organizations, complex therapy, operations, care for injuries, transportation and hospitalization of victims, isolation of patients with various infectious diseases and severe nervous disorders are carried out.

health care facilities for children

A significant decrease in the number of underage citizens who do not have any chronic pathologies occurred due to shortcomings in the work of pediatric medical institutions. After all, these organizations are responsible for the health of future generations. To preserve it, the staff of polyclinics is obliged to conduct regular examinations, as well as diagnostic and preventive measures among minors.

Unfortunately, today the system of work of many organizations of this type needs to be reformed. One of these institutions, the children's outpatient clinic, is engaged in the provision of medical services to minors. A pediatric general practitioner working in this organization can, if necessary, refer his patients to the consultations of other specialists.

Types of healthcare facilities for children are also hospitals and sanatoriums. The hospital provides emergency medical care to persons under the age of fourteen who are diagnosed with acute diseases, pathologies requiring surgical intervention, conditions that require constant monitoring and control by doctors. A sanatorium for children is an institution that aims to rehabilitate a child after illness, surgery or injury.

Polyclinics

There are institutions that provide therapy and prevention of various diseases and provide medical care at home. This type of medical facility is called a polyclinic. This organization is distinguished by a large number of departments, it employs many specialists of various profiles.

In polyclinics there are rooms for diagnostics, laboratory tests, physiotherapy, consultations, vaccinations. Patients can come for procedures or doctor's appointments during certain opening hours. These institutions can also give referrals to a hospital or sanatorium if patients need them. In addition, employees of polyclinics conduct preventive examinations.

Sanatoriums

These organizations are established in places with natural and ecological conditions that are best suited for restoring health. The main characteristics of this type of LPU are as follows:

1. They are aimed not only at treatment, but also at rehabilitation, as well as strengthening the immune system with the help of special procedures.
2. Assume the creation of favorable conditions for the restoration of the body: physiotherapy, exercise therapy, therapeutic nutrition, mild climate.
3. There are sanatoriums for adults, for children with parents and for teenagers.

These institutions can be specialized, that is, provide their services to patients with certain pathologies (diseases of the lungs, heart, gastrointestinal tract, endocrine glands, and so on). Contraindications for treatment in such health facilities are complications during childbearing, late pregnancy, breastfeeding, and viral diseases. However, there are specialized sanatoriums for expectant mothers, sometimes doctors send women there. Persons of transitional age who have pathologies that have arisen against the background of hormonal changes in the body can also undergo therapy in a health facility of a sanatorium type.

Dispensaries

This type of institution is slightly different from the previous one. It has its own characteristics. What is the difference between two types of health facilities - sanatoriums and dispensaries? The second, unlike the first, are located next to factories, factories and agricultural institutions. In dispensaries, medical and rehabilitation measures are carried out for employees of the above-mentioned organizations. Unlike sanatoriums, people can visit these health resorts not during the holidays, but after the end of the working day.

Therapeutic dispensary is also aimed at diagnosing, treating and preventing diseases associated with certain work activities (for example, work in industry, in chemical production). These organizations can provide medical services to patients who do not require hospitalization or visits to sanatoriums and resorts.

Hospices

Sometimes the condition of patients is so severe that they cannot be helped either in the hospital or at home. This can be associated with serious, incurable pathologies (for example, cancerous tumors at the last stage), accompanied by severe pain, which can only be reduced in a specialized hospital. Hospices are such institutions.

In addition to oncology, they also provide assistance with severe brain diseases, dementia, and the consequences of serious bodily injuries. If the doctors of the local polyclinic cannot provide their services to the patient, and he needs constant care and procedures aimed at alleviating the condition and reducing pain, he can be referred to a hospice. Also, this organization accepts people who, due to the difficult situation in the family, cannot be provided with proper medical care at home.

The first hospices were built in France in the 19th century. Now in our country there are many such institutions. The most famous hospices in Moscow are the European Clinic and the First Moscow Hospice. V. V. Millionshchikova. The first organization was created to provide palliative services to patients with malignant neoplasms in the case when the doctor confirmed the fact that the pathology is incurable. In addition to specialists who help patients cope with pain, this institution employs psychotherapists who support the relatives of a person suffering from cancer.

Unfortunately, many public institutions of this type cannot provide enough free places, and the quality of medical services offered there leaves much to be desired. Therefore, some hospices in Moscow work on a paid basis. Thanks to the help of qualified medical personnel, the quality of life of even terminally ill people can be significantly improved.

Medical care for the population is a complex system both in terms of the types of preventive and curative services provided and the types of institutions. In addition, non-profit and commercial healthcare organizations operate in the healthcare system of the Russian Federation.

The main form of non-profit healthcare organizations are institutions, the nomenclature of which is approved by the federal healthcare authority. Non-profit health care organizations also include non-profit partnerships and autonomous non-profit organizations that began to be created in recent years with the adoption in 1995 of the Federal Law "On Non-Profit Organizations".

The main forms of commercial healthcare organizations are state and municipal unitary enterprises, as well as business partnerships (general and limited) and business companies (joint-stock, with limited or additional liability).

The nomenclature of healthcare institutions was approved by Order No. 627 of October 7, 2005 of the Ministry of Health and Social Development of the Russian Federation "On Approval of the Unified Nomenclature of State and Municipal Healthcare Institutions".

The Unified nomenclature of state and municipal health care institutions includes medical institutions (hospitals, dispensaries, outpatient clinics, centers, including scientific and practical ones, emergency medical care institutions and blood transfusion institutions, institutions for the protection of motherhood and childhood, sanatorium spa facilities), health care facilities of a special type, health care institutions for the supervision of consumer protection and human well-being, pharmacies.

Types of medical and preventive institutions (HCI) of health care:

• hospital facilities(city, children's, district, central district, regional hospital, city clinical hospital, city emergency hospital, medical unit);
• specialized hospitals(psychiatric, tuberculosis, ophthalmological, infectious, etc.);
• dispensaries(anti-tuberculosis, oncological, cardiological, neuropsychiatric, narcological, medical and physical education, etc.);
• outpatient clinics(city clinic, outpatient clinic, dental clinic, health centers, feldsher-obstetric stations);
• institutions for the protection of motherhood and childhood(nurseries, kindergartens, orphanage, dairy kitchen, maternity hospital);
• emergency and emergency care and blood transfusion facilities(ambulance stations, blood transfusion stations);
• sanatorium-resort institutions(sanatorium, sanatorium-dispensary, balneological and mud baths).

In addition to this nomenclature, a typical categoricalness is also established depending on the capacity of the institution, which contributes to the rational planning of the network of institutions and states.

Outpatient clinics are divided into five categories according to their capacity, depending on the number of medical visits per shift. The capacity of hospitals is determined by the number of beds.

To calculate the indicator "Capacity of outpatient clinics" by order of the Ministry of Health of the USSR No. 650 dated June 20, 1979, instructions were approved for determining the planned indicator "Capacity of outpatient clinics" for planning a network of healthcare institutions (divisions) providing outpatient and polyclinic care to the population. Since 1980, according to the above order, before submitting a draft health development plan for the next year to the higher authorities, the planned capacity of these institutions (divisions) should be approved, taking into account the depreciation of fixed assets.

Planning a network of medical institutions is necessary to provide quality and equitable medical care, as well as the efficient use of health care resources. For planning, it is necessary to know the need of the population for medical care.

To determine the population's need for medical care, special algorithms for its calculation are used.

General algorithm for calculating the need for medical care

Calculations of the need for medical care are based on:

• population size (current or projected at the end of the planning period)
• estimated norms of time for the provision of medical services (or conventional units of labor)

The product of the population and the frequency of providing medical services gives the number of medical services required in the provision of medical care.

The product of the number of medical services and the calculated norms of time for their provision is the volume of necessary medical care for the population of the municipality, expressed in time required to provide the estimated number of medical services.

Initial data for calculations

Population- taken according to Rosstat.
In order to determine the need for medical care for each municipality, data are needed on the total population, as well as the distribution of the population by age groups (adults, children).

The division of the population into these groups makes it possible to take into account the significant influence of age on the state of health of the population and, accordingly, on its need for the volume and structure of medical care, which should be taken into account when calculating the necessary capacity of the medical care network.

Multiplicity of medical services- per person per year approved

Calculation of the needs of the population in outpatient care.
The unit of account for the volume of outpatient care is a medical visit, during which medical and preventive care is provided.
A general indicator of the volume of outpatient care is the total duration of medical visits (in minutes) required to provide outpatient care to the population.

The population's need for outpatient care (number of medical visits) is calculated taking into account the expected population and the volume of outpatient care per person per year, approved by the Program of State Guarantees for the Provision of Free Medical Care to Citizens of the Russian Federation.

The calculation of the indicator of the required volume of outpatient care is estimated by the total time (in minutes) of medical visits required to provide outpatient care. This indicator is calculated as the product of the number of medical visits and the indicator of the volume of outpatient care per person per year, approved by the Program of State Guarantees for the Provision of Free Medical Care to Citizens of the Russian Federation.

The above calculations are carried out for each municipal district (municipal district). At the same time, it should be borne in mind that the received volumes of medical care for residents of municipalities include medical care provided at all levels of outpatient care.

Calculation of the needs of the population in hospital care.
One day of the patient's stay in bed (bed-day) is taken as the unit of account for the volume of inpatient care.

The need of the population for inpatient care (number of bed-days) is calculated taking into account the expected number of hospitalizations and the standard for the volume of inpatient care in the number of bed-days per person per year, established by the Program of State Guarantees for the Provision of Free Medical Care to Citizens of the Russian Federation, necessary to provide inpatient care.

The expected estimated number of hospitalizations is determined on the basis of the regional forecast indicator of the population of the corresponding municipal district (municipal district).

The above calculations are carried out for each municipal district (municipal district). At the same time, it should be borne in mind that the received volumes of medical care for residents of municipalities include medical care provided at all levels of inpatient care.

Calculation of the needs of the population in emergency medical care.
One ambulance call is accepted as a unit of account for the volume of ambulance.

The population's need for emergency medical care (number of calls) is calculated using the indicator of the volume of emergency medical care in the number of calls per person per year and the expected population.

The calculation of the required volume of emergency medical care is made in the context of the ambulance service teams provided for by the federal classifier.

These calculations are carried out for each municipal district (municipal district). At the same time, it should be borne in mind that the received volumes of medical care for residents of municipalities include medical care provided at all levels of inpatient care.

Calculation of the needs of the population in diagnostic care.
One study is taken as a unit of account for the volume of diagnostic care.
A generalizing indicator of the volume of diagnostic care is the total time (in minutes) required to produce the total estimated number of diagnostic studies.

The population's need for diagnostic assistance (number of examinations) is calculated based on the expected population size and the estimated standard of the average number of examinations per 1 inhabitant.

The calculation of the general indicator of the required volume of medical care is estimated by the total time (in minutes) for the production of all studies necessary for the diagnosis of diseases. This indicator is calculated based on the estimated number of diagnostic studies and the estimated time standards for the production of diagnostic studies.

The total volume of diagnostic studies consists of the estimated number of studies performed in the provision of medical care on an outpatient basis and in a hospital setting.

Calculation tables are used to calculate the volume of diagnostic care separately for each type of diagnostic studies (bacteriological, biochemical, histological, immunological, general clinical, cytological, radiological, radiological, ultrasound, functional, endoscopic).

The above calculations are carried out for each municipal district (municipal district). At the same time, it should be borne in mind that the received volumes of diagnostic assistance for residents of municipalities include diagnostic assistance provided at all levels of medical care.

The proposed methodology for determining the needs of the population in the volume of medical care involves the use of calculated technological standards. At the same time, most of the necessary technological standards are currently missing. Under these conditions (up to the completion of the process of developing a complete set of necessary standards that has begun), it seems appropriate to calculate the need for medical care and the capacity of the medical care network based on the calculated indicators of the federal Program of State Guarantees of Medical Care adapted for the region. The expediency and admissibility of such an approach is based on the fact that, in terms of the main performance indicators, medical organizations in the absolute majority of the constituent entities of the Russian Federation still lag behind the indicators of the Program of State Guarantees of Medical Care.

It is assumed that as the design technological standards are developed, the necessary clarifications will be introduced into the schemes of the prospective medical care network, based on calculations that use the methodology described above in full.

Medical institutions are medical institutions of various forms of ownership that provide medical and preventive care to the population.

Treatment and preventive care is a state system of universal provision of the population with all types of qualified medical care, including a full range of treatment, diagnostic and preventive measures.

In recent decades, there has been a marked deterioration in the health status of the population of our country: the level of morbidity and mortality is steadily increasing, the average life expectancy is decreasing against the backdrop of a falling birth rate. The population is aging, the demographic crisis is growing, which is largely due to the difficult economic situation. The situation is aggravated by the practically uncontrolled influx of migrants from neighboring countries, since these people are not registered with medical institutions and are often carriers of dangerous infections. Nevertheless, in all conditions, medical workers should make the most of all their knowledge and skills to provide qualified medical care to the population.

Chapter 1. Types of medical institutions

Depending on the type of medical and preventive care provided, medical institutions are divided into outpatient, inpatient and sanatorium-resort institutions. The following institutions stand out:

1) ambulance stations, hospitals or emergency departments;

2) specialized medical institutions for the provision of obstetric and gynecological care, which include antenatal clinics, maternity hospitals, maternity and specialized gynecological departments and hospitals;

3) medical and pediatric institutions (children's clinics and hospitals);

4) sanatorium and sanatorium-prophylactic institutions.

The existing range of medical institutions also includes institutions of a special type (leprosarium) and blood transfusion stations.

Basic principles of organization of medical care

The general principles of organizing medical and preventive care are the same both in cities and in rural areas, but certain geographical and economic features of specific areas make their own adjustments to the organization of qualified medical care for the population.

The provision of medical care to the population is carried out by outpatient clinics, hospitals and sanatorium-resort institutions, as well as institutions of emergency and emergency care, maternal and child health, etc. Medical care can be provided both at the place of residence, in outpatient clinics, clinics and hospitals, and directly at the place of work, in the medical units of organizations, which include medical units and health centers. The organization of medical care is carried out according to the territorial and district principle.

In the structure of organizing medical care for employees of industrial enterprises, construction and transport, the main institution is the medical and sanitary unit, which is a complex that includes a polyclinic, a hospital, as well as health centers located directly on the territory of the enterprise. A separate link in this complex are sanatorium-prophylactic institutions.

In rural areas, the main feature of the provision of medical care is its phasing. At the first stage, assistance is provided in the conditions of a rural medical district - in an independent medical outpatient clinic, feldsher-obstetric station, nursery-kindergartens and feldsher stations of local enterprises. The second stage includes medical institutions organized in district centers. The main institution of this level is the central district hospital, where it is possible to provide basic types of specialized medical care. The third stage is the provision of any kind of specialized assistance in regional (territorial, republican) medical and preventive institutions. A certain part of the population in rural areas has the opportunity to receive medical care (including inpatient care) in medical institutions of the nearest cities.

There are mobile medical outpatient clinics, clinical diagnostic laboratories, fluorography units, dental offices and entire trains, including a number of departments for providing specialized assistance to the population of remote areas.

Treatment and preventive care in medical institutions of outpatient type

Out-of-hospital assistance to the urban population is provided in district clinics and departments of dispensaries. Polyclinics are multidisciplinary outpatient treatment and prophylactic institutions. Dispensaries are specialized medical and preventive institutions that treat and monitor patients with certain groups of diseases.

Residents of rural areas are provided with medical assistance in feldsher-obstetric stations (mid-level medical personnel), outpatient clinics and polyclinic departments of district, regional and republican hospitals.

Medical institutions of the outpatient type provide medical care to those categories of patients whose health condition does not require emergency or planned hospitalization. Such patients are examined and treated at the reception, and if necessary, they are provided with the appropriate amount of skilled care at home. Inspection, diagnosis and appointment of a complex of therapeutic measures in this case are carried out by the local doctor. Institutions of the outpatient type, among other things, also carry out medical examinations of the population.

The concept of clinical examination implies the active monitoring of the medical personnel of these institutions over the health status of certain population groups that are registered.

At the moment, specialized consultative and diagnostic centers are widespread, organized on the basis of a number of medical and research institutes and large multidisciplinary hospitals. They are intended for outpatient examination and treatment of patients of various profiles.

Treatment and preventive care in medical institutions of stationary type

Inpatient medical care is provided in specialized inpatient facilities, mainly for conditions requiring complex diagnostics and treatment, the use of special equipment, major surgical interventions, constant monitoring by medical personnel and intensive care.

Inpatient medical care is provided to patients whose state of health requires constant monitoring and the use of methods of diagnosis and therapeutic or surgical treatment that are not feasible in a polyclinic. Inpatient treatment is carried out in district, district, city, regional and republican hospitals, military medical units, hospitals, inpatient departments of dispensaries, as well as in clinics at educational and research medical institutes. The need for hospitalization of a patient in a hospital is determined by the local doctor of the outpatient clinic or polyclinic, and if the patient develops emergency conditions, the doctor of the ambulance or the emergency department of the hospital.

Therapeutic and preventive care in medical institutions of the sanatorium type

A sanatorium is a type of medical institution in which for the therapeutic treatment of certain diseases and general strengthening of the body, mainly natural factors and conditions are used in combination with physiotherapy, therapeutic and dietary nutrition and exercise therapy. Sanatoriums are organized in resort areas and suburban areas with the most favorable natural conditions. For employees of large industrial enterprises, special sanatoriums and dispensaries are being opened. There are sanatoriums for children, adults and parents with children. These medical institutions can be subdivided according to the medical profile. There are special sanatoriums for tuberculosis patients, with diseases of the cardiovascular system, digestive tract, respiration, nervous system, etc. Sanatoriums can be one- or multi-profile.

Women with pathology of pregnancy, regardless of the term, with a normal pregnancy for more than 26 weeks, nursing mothers and people with infectious diseases cannot be sent to the sanatorium.

Medical institutions providing medical care to children

The system of providing medical and preventive care to children, adopted in the Russian Federation, consists of three closely interconnected links - a children's clinic, a children's hospital, and a children's sanatorium.

In addition, the necessary medical care is provided to pediatric patients in specialized departments of hospitals and polyclinics for adults, maternity hospitals, consultative and diagnostic centers, etc.

A certain amount of medical care, mainly preventive, is provided to children in medical offices organized at nursery schools, orphanages, educational institutions and children's health camps.

The Children's Hospital is a medical institution for patients under the age of 14 inclusive, whose health condition requires constant monitoring by a doctor, intensive care or specialized, such as surgical, care. Such hospitals are divided into multidisciplinary and specialized, and according to the system of general organization, they can be combined with a polyclinic and non-united.

The main task of a modern children's hospital is the complete restoration of the health of a sick child. Assistance involves four main stages - the diagnosis of the disease, the adoption of urgent therapeutic measures, the main course of treatment and rehabilitation, including the necessary social assistance.

Medical institutions and organization of their work

TYPES OF HOSPITALS

Treatment-and-prophylactic 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 who are at home. Hospital - a medical institution in which the patient is treated in a ward on a bed. More than 80% of patients receive outpatient medical care, about 20% in the hospital. Both those and other institutions are engaged not only in treatment, but also in prevention.

Ambulatory-type institutions include outpatient clinics proper, polyclinics, medical units, dispensaries, consultations, emergency rooms, ambulance stations.

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

The medical and sanitary unit is an outpatient-type medical and preventive institution serving the 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. As a rule, there are hospitals at large medical and sanitary units.

Factories and factories, agricultural enterprises have health posts, medical posts, feldsher and feldsher-obstetric stations, which are subordinate to medical and sanitary units or polyclinics.

Polyclinics work according to the district principle, medical units and health centers work according to the shop principle. The territory assigned to the clinic is divided into sections with a certain number of adults and children. Each site is serviced by assigned doctors and nurses. Therapeutic and preventive work at the site is organized by the district doctor or intern. He supervises nurses, attracts specialists of various profiles to work.

A dispensary is a medical and preventive institution of an outpatient type, but of a narrow profile. The scope of work of the dispensary staff includes the treatment and prevention of diseases of any one kind. For example, a tuberculosis dispensary is engaged in the treatment of tuberculosis patients, the prevention of tuberculosis in people around the patient at home and at work, a mass examination of the population to detect early forms of tuberculosis, the prevention of the disease through vaccination, etc. Accordingly, the oncological dispensary is engaged in the treatment and prevention of malignant tumors. Etc.

Children's and women's clinics, in addition to treating children's and women's diseases, monitor children under the age of 16 and pregnant women during the entire period of pregnancy and lactation. Consultations are part of the polyclinics.

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

Paramedics mainly work at ambulance stations, since they often have to travel on their own and provide first aid, take births that suddenly occur at home, transport seriously ill patients to the hospital, etc. The ambulance doctor goes to the patient together with one or two paramedics - assistants .

Institutions of stationary type include hospitals, clinics, hospitals, maternity hospitals, sanatoriums. Depending on the 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 patients, tuberculosis patients, for nervous and mental patients, etc.

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

The hospital is a hospital for military personnel and retirees of former military personnel.

Sanatoriums are hospitals in which mainly aftercare of patients is carried out. Some of the 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 medical institutions of outpatient and inpatient type, there are medical institutions of semi-stationary type. These include night and day dispensaries at large medical and sanitary units, tuberculosis dispensaries and hospitals. In these institutions, patients spend part of the day or all the time not busy with work, receive treatment under the supervision of medical personnel, eat and rest.

RESPONSIBILITIES OF NURSES

There is more independence and responsibility in the work of nurses in outpatient clinics and polyclinics than in the work of medical personnel in hospitals. This is explained by the nature of the work of the clinic. Efficiency, clarity and organization are required from the doctor at the reception, as he must accept a large number of patients: determine the nature of the disease, prescribe treatment, conduct a conversation about the recommended regimen and treatment, answer the patient's questions. The doctor must prescribe the necessary examination, consult with specialists, write down all this information in the outpatient's medical record. The district nurse should actively help the doctor at the appointment, freeing him from simple duties so that he can focus all his attention on the patient.

The duty of the polyclinic nurse is to organize the appointment and help the doctor during the appointment.

Arriving 15–20 minutes earlier than the doctor, the nurse must prepare the appointment: conduct a survey of the waiting doctor in order to ensure faster admission of weak, feverish, suspected infectious diseases patients (requiring urgent isolation) and workers; check and prepare the office for the reception (give appropriate instructions to the nurse); prepare outpatient cards, laboratory tests and other documents for a doctor's appointment.

During the reception, the nurse calls the patients, explains to them how to take tests, tells them where this or that office is located, and, if necessary, escorts the patients. The nurse writes out prescriptions, referrals to the laboratory, to the X-ray room and for consultations with specialists, makes extracts from the medical record and draws up other documentation, organizes, if necessary, the placement of the patient in the hospital.

The appointments of doctors in the treatment rooms of the polyclinic are performed by experienced nurses. At the patient's home, the district nurse, following the instructions of the doctor, must check whether the patient is complying with the prescribed regimen, teach relatives or neighbors the rules of care.

The nurse is obliged to inform the doctor about the slightest changes in the patient's condition.

Nurses help the doctors of the polyclinic to carry out medical examinations, call patients, organize preventive appointments, draw up documentation, etc.

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

In carrying out sanitary and anti-epidemic work at the site, the district nurse or a special sister - assistant epidemiologist helps the doctor. She monitors the focus of an infectious disease, conducts current disinfection, measures the temperature of persons in contact with the patient, vaccinates, etc.

The duties of the nurses of the dispensary and consultation, in addition to the usual outpatient work, include patronage of patients.

For example, the patronage nurse of 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 wash and disinfect their spittoon correctly, how the room is cleaned and ventilated . The nurse brings medicines 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, whether they follow a diet, whether they get enough fresh air. She teaches pregnant women to follow the rules of 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 the 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 patronage 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 regimen, 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 phone, passes them to the doctor, in the absence of a doctor provides first aid to patients, goes to the patients to fulfill the doctor's prescriptions. She completes the doctor's suitcase with medicines and instruments, maintains documentation.

DEVICE 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, ambulance stations should be located in the center of the district, and a hospital for tuberculosis patients should be built on the outskirts of the city or outside the city.

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

The territory of the hospital is divided into three zones: a zone of medical and treatment-and-prophylactic buildings (buildings for medical and medical-auxiliary departments of the hospital, a pathoanatomical department, a park with sports grounds and a solarium); utility yard area (kitchen, laundry, vegetable store, 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 joint hospital consists of: a hospital with specialized departments and wards and a polyclinic with specialized rooms; auxiliary departments (X-ray, pathoanatomical) and laboratories; pharmacies; kitchens; laundry; administrative and other premises.

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

The walls in offices, wards and corridors are painted in light colors. The lower parts of the walls (panels) are covered with oil paint, the upper parts are glued. Stucco decorations for walls and ceilings are not used. In operating rooms and dressing rooms, in the premises of sanitary units and catering units, walls and ceilings are completely covered with oil paint, but it is better to line the walls of these rooms with glazed tiles. Wall-to-ceiling and wall-to-wall transitions must be rounded. Floors in medical facilities should be easy to clean, impermeable to moisture and should not have gaps.

In the wards, it is advisable to cover the floors with linoleum; wooden, tightly fitting and well-painted floors are also acceptable. Parquet floors should not have gaps. In rooms that need frequent washing, the floors are covered with metlakh tiles. Such floors are obligatory in operating rooms, generic.

ORGANIZATION OF THE WORK OF THE RECEPTION DEPARTMENT

Patients referred for hospitalization are admitted, first of all, to the emergency department of the hospital. It admits and registers patients, draws up relevant 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.

As a rule, one admission department is organized in hospitals, in a number of hospital buildings (infectious, maternity, etc.) their own admission departments are allocated. 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 entering the hospital, a medical history (inpatient card) is recorded, which is the main primary medical document in hospitals. In the admission department, a title page of the medical history is drawn up, where the following information 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, and telephone numbers of close relatives ), exact time of admission, diagnosis of the referring institution. If the patient is in a serious condition, then first he is provided with the necessary medical care and only then is he registered. If the patient is unconscious, the necessary information is recorded from the words of the persons accompanying him. In addition to filling out the medical history, an appropriate entry is also made in the hospitalization log.

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

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

In the emergency departments of large multidisciplinary hospitals there are special diagnostic wards and isolation rooms 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 small-scale surgical interventions and manipulations, as well as resuscitation wards.

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

If during the examination it turns out that there is no need for inpatient treatment, then after the provision of medical care, the patient is allowed to go home with the relevant documents and recommendations for outpatient treatment. A record of such a visit is made in a special journal.

ANTHROPOMETRY

Upon admission of the patient to the hospital, anthropometry is carried out - the measurement of a number of constitutional characteristics, i.e., certain features of the patient's physique. Anthropometric studies include, for example, the measurement of the circumference of the chest, the measurement of the longitudinal and transverse dimensions of the pelvis, which is of great importance in obstetrics, etc.

In all patients, upon admission, it is customary to determine the height (body length), which is measured in the patient's position sitting or standing with a special stadiometer, as well as body weight. Weighing of patients is carried out with the help of special medical scales, on an empty stomach, after preliminary emptying of the bladder and emptying the intestines.

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

SANITATION OF PATIENTS

Upon admission of the patient in the emergency department, a thorough examination is carried out in order to detect pediculosis. In such cases, head, body and pubic louse may be found.

Body lice (body lice) are carriers of typhus and louse relapsing fever, the pathogens of which penetrate through damaged skin when crushing lice and subsequent scratching. The spread of pediculosis is observed under unfavorable sanitary and hygienic conditions and indicates, first of all, the poor organization of the bath and laundry business.

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

CURRENTLY, THERE ARE A LOT OF SPECIAL PRODUCTS THAT ARE NON-TOXIC AND DO NOT REQUIRE STITIZH AND HAIR TO CURE PEDICULOSIS. The product is applied to the scalp and covered with waxed paper, a scarf is tied on top of the head or a cap is put on, or they simply wash their hair with a special shampoo. To remove nits for several days, comb the hair again with a fine comb with cotton wool moistened with a hot 10% solution of table vinegar.

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

Linen and clothes of patients are disinfected in disinfestation chambers (steam-air, hot-air, etc.). Medical personnel handling patients with pediculosis should use special long clothing made of rubberized fabric or thick canvas.

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

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

A sanitary bath or shower in the emergency department (sometimes not quite correctly called sanitization) should be taken by all patients, then they change into hospital gowns. In practice, this rule is not always observed, which is due to several reasons. On the one hand, patients admitted to hospital on a planned basis usually take a shower or bath at home. On the other hand, in the admission department of a hospital, there are often not enough rooms and medical staff to organize a bath or shower for all incoming patients.

With regard to hospital linen (pajamas and gowns), it is often of low quality, and patients change into clothes taken 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, with severe contamination of the skin, etc.).

It is not allowed to take a hygienic bath for patients with serious illnesses (with a hypertensive crisis, acute myocardial infarction, acute cerebrovascular accident, with severe circulatory failure, tuberculosis in the active phase, etc.), some 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 rubbing, you can also use warm water with the addition of cologne or alcohol. Patients' nails are cut short.

TRANSPORTATION OF PATIENTS

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

Patients who are in a satisfactory condition are sent to the department on foot, accompanied by a nurse or nurse. Weakened patients, disabled people, elderly and senile patients are often transported on a special wheelchair, while avoiding sharp shocks 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, with short steps. When climbing the stairs, the patient is carried head first, while descending - feet forward, in both cases raising the foot end of the stretcher. To facilitate the carrying of the stretcher, special sanitary straps are used.

Carrying the patient in the arms and shifting can be carried out by one, two or three people. If the patient is carried by one person, 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 shifting the patient from the stretcher to the bed, it is better to place 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, 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, while the personnel is between the stretcher and the bed in series, or, in extreme cases, close to it. Before shifting the patient, it is imperative to check the readiness of the bed, the availability of the necessary care items.

Currently, special devices are used to facilitate the carrying and shifting of patients.

ORGANIZATION OF THE WORK OF THE THERAPEUTIC DEPARTMENT

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

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

The staff list of employees of therapeutic departments provides for the positions of ward doctors (hospital residents) who directly carry out the examination and treatment of patients; senior nurse organizing and supervising the work of ward nurses and orderlies; a housewife who is 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 fulfilling the appointments of the attending physicians for the examination and treatment of patients; procedural nurse performing certain manipulations in the treatment room; junior nurses, nurses, barmaids and nurses-cleaners who provide care for patients, their food, maintaining the necessary sanitary condition in the department.

In the therapeutic department, a different number of beds can be deployed. In turn, each department is subdivided into the 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 doctor's office (staff's room), the rooms of the head nurse and the housewife, the treatment room, the pantry, the dining room, the bathroom, the enema room, the room for washing and sterilizing ships and storing cleaning items, a place to store wheelchairs and mobile chairs, toilets for patients and medical personnel. In each department, rooms are provided for the daytime stay of patients - halls, verandas, etc.

For the organization of full-fledged treatment of patients and care for them, the correct equipment of the wards, 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, such a situation is considered ideal when 60% of the wards in the department are deployed for 4 beds each, 20% for 2 beds and 20% for one. In other words, in the ward section for 30 beds, 6 four-bed wards should be allocated, two double and two single, and with the condition that one patient in the general ward has 7 m 2 area, and in a single room - 9 m 2 . A smaller area negatively affects the organization of treatment and patient care.

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 that allow, in necessary cases (performing certain manipulations, fulfilling physiological needs, etc.), to protect the patient from outside observation. For this purpose, stationary screens are also used in the form of a curtain attached to a special frame. Such a curtain can be easily drawn around the patient, and then opened again.

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

In the ward section (in the corridor), a nurse's post is equipped, which is her direct workplace. At the post there is a table with retractable and lockable drawers for storing the necessary medical documentation, a table lamp and a telephone. Case histories are best stored in a separate box or locker, divided into compartments (according to room numbers), which allows you to quickly find the desired case history.

There should also be a closet (or several lockers) for storing medicines at the nurse's post. At the same time, lockable compartments are necessarily allocated, in which there are drugs of group A (poisonous) and B (strong). Medicines for external and internal use, as well as drugs for injection are placed on special shelves. Separately store tools, dressings, flammable substances (alcohol, ether). Medicines that quickly lose their properties during storage (infusions, decoctions, serums and vaccines) are placed in a special refrigerator. Separately store items for patient care (thermometers, heating pads, jars, etc.), as well as dishes for taking tests. Next to the post set scales for weighing patients.

There is also a treatment room here. It employs a specially trained procedural nurse.

In the treatment room, various diagnostic and therapeutic manipulations are performed: subcutaneous, intramuscular and intravenous injections, blood sampling for clinical and biochemical tests, blood grouping, pleural puncture to remove fluid from the pleural cavity, abdominal puncture for ascites, diagnostic puncture of the liver, measurement of venous pressure and blood flow velocity, gastric and duodenal sounding.

In the treatment room, systems for intravenous drip administration of drugs are assembled, syringes and needles are sterilized by boiling (if there is no central sterilization room in the hospital).

Since many manipulations performed in the treatment room are invasive in nature (i.e., they are associated with the risk 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 provides for the maintenance of the necessary medical documentation. Its list is quite extensive and includes many items. Documents that are mainly drawn up by doctors include, for example, a medical history, a card of a person who left the hospital, a certificate of incapacity for work, etc.

A number of medical documents in the department are filled in and maintained by duty nurses. This is a notebook (journal) of medical appointments, where, when checking the case histories, the nurse enters the appointments made by the doctor, reports on the patients of the department, which reflects data on the movement of patients (i.e. admission, discharge, etc.) per day, temperature sheets , portioners indicating the number of patients receiving a particular table.

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

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

The effectiveness of the treatment of patients in a hospital to a large extent depends on the organization of the necessary medical and protective regimen in the department. The creation of such a regimen involves protecting the patient from various negative emotions (associated, for example, with pain), providing conditions for sufficient and proper sleep and rest (rational placement of patients in the wards, silence in the department), allowing walks in the warm season and visiting sick 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 some importance, for example, for patients from other cities, etc.

In hospitals, quite a large number of factors are still often observed that significantly violate the principles of the medical and protective regimen. These include cases of incorrect or untimely fulfillment of the necessary appointments, rudeness and inattention to patients by medical personnel (for example, insufficient anesthesia of patients during painful manipulations). Disturbances that sometimes occur in the work of the medical staff of the departments (for example, the knocking of doors and the clinking of buckets, accompanied by exclamations of the medical staff in the early morning hours, irregular wet cleaning, difficulties with the timely change of bed linen, poorly prepared food), problems in the sanitary- technical support (interruptions in the supply of hot water, disruptions 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 credibility of the medical institution. Creating an optimal medical and protective regimen in a hospital is a task in which all services of a medical institution should be actively involved.

HOSPITAL SANITATION

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

Non-compliance with the sanitary regime increases the risk of the spread of nosocomial infections - infectious diseases that occur in patients who are in hospitals, or among medical workers associated with the treatment and care of patients, as a result of violations of aseptic and antiseptic rules, i.e. measures aimed at the fight against pathogens of various infections. Among such diseases spreading in hospital conditions are influenza, infectious (serum) hepatitis B, the infection of which occurs due to poor sterilization of syringes and needles, and in children's departments these are measles, scarlet fever, chicken pox, etc.

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

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

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

A prerequisite for maintaining a sanitary regime in hospitals is sufficient ventilation, i.e., the removal of polluted air from the premises and its replacement with clean air. Natural ventilation is carried out by regularly opening windows or transoms. Systematic non-ventilation of wards leads to stagnation of air and a significant increase in its bacterial contamination, which facilitates the spread of nosocomial infections. In a number of rooms, for example, in operating rooms, automatic maintenance of cleanliness, composition, humidity and air velocity is used with the help of air conditioners.

When organizing heating in hospitals, it is assumed that the optimum 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 the location of heated surfaces 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 provides for regular thorough cleaning of the premises and territory of the hospital. Garbage from buildings and compartments is taken out into metal tanks with tight-fitting lids and removed in a timely manner.

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

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

For disinfection, chlorine-containing compounds are most often used (chlorine, chloramine, calcium, sodium and lithium hypochlorite, etc.). 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.

A solution of bleach is prepared according to certain rules. 1 kg of dry bleach is diluted in 10 liters of water, while obtaining the so-called 10% chloride-lime milk, which is left in a special room in a dark bowl for 1 day. Then the clarified solution of bleach 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. In the future, for wet cleaning, a 0.5% clarified bleach solution is used, for which, for example, 9.5 liters of water and 0.5 liters of a 10% bleach solution are taken. A solution of chloramine is most often used in the form of a 0.2-3% solution (mainly 1%).

But such funds are almost yesterday, and only a chronic lack of funding does not allow a complete transition to new generation disinfectants, which are less toxic, more effective at destroying microorganisms, and much more convenient to use. Modern means of disinfection are differentiated - for the treatment of hands, for the treatment of instruments, for the treatment of premises and for the treatment of linen and excretions of patients.

Wet cleaning of hospital premises is carried out daily. In the wards, corridors and offices - in the morning, after the 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 products that can cause food poisoning.

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

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

Wet cleaning of canteens and buffets is carried out after each meal. Food waste is collected in closed buckets or tanks with lids and taken out.

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

Particularly stringent 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 (baths, sinks, toilet bowls) is carried out several times a day as they get dirty. To wash toilet bowls, a 0.5% clarified solution of bleach is used. Bathtubs are washed after each patient with warm water and soap, after which they are rinsed with a 0.5% solution of bleach or a 1-2% solution of chloramine.

General cleaning of all premises with washing the floor, sweeping the walls and ceilings is carried out at least 1 time per week. The inventory used for this (mops, buckets, etc.) must be appropriately marked (for example, for washing the toilet, for washing the corridors, etc.).

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

Prevention of the spread of flies, bedbugs, cockroaches and rodents in hospitals consists in maintaining cleanliness in the premises, timely removal of garbage and food waste, careful sealing of cracks in the walls, and storage of food products in places inaccessible to rodents.

Olga Ivanovna Zhidkova