Hygiene of the surgical unit

Principles of routing in surgery and inpatient settings

To ensure the highest level of epidemiological safety in a healthcare facility, a strict logistics system is implemented. The main goal of such a system is to completely eliminate the physical crossing of various groups of people and materials. To this end, independent movement routes are designed at the planning stage, including separate elevators for different purposes.

Modern hospital hygiene identifies three main categories of routes:

• Sterile flow. This is the most protected and isolated zone, designed specifically for operating surgeons and scrub nurses to access the surgical site directly.
• Clean flow. Intended for the safe transfer of prepared patients to the operating room, entry of anesthesiologists, as well as junior and technical staff. Clean medications and fresh surgical linen are also transported along this safe path.
• Dirty flow. Used for the safe removal and evacuation of used dressings, soiled linen, and various medical and biological wastes.

Epidemiological regime and infection control

Healthcare-associated infections (HAIs) pose a serious threat to both vulnerable patients and medical staff. Basic planning solutions for any inpatient facility are built on the strict isolation of flows. "Clean" routes are used for the movement of medical personnel and recovering patients preparing for discharge. "Dirty" routes cover all movements of infectious patients and processes related to their care and treatment.

In infectious diseases departments, where patients present a high epidemiological hazard, the following architectural placement options are used:

1. Construction of completely standalone buildings within a large multidisciplinary hospital.
2. Organization of independent infectious diseases hospitals (they can be built as ward-based, box-based, or semi-box-based blocks).
3. Construction of multi-story hospital buildings where the golden rule is strictly observed: patients with only one specific infection are allowed to be treated on a single floor.

The sanitary and antiepidemic regime requires mandatory isolation of patients, thorough sanitization, as well as regular and high-quality disinfection of all premises, medical equipment, dishware, bed linen, and patient excretions.

Design of box units and patient admission

The initial examination of patients with suspected infectious diseases is carried out by a physician strictly in a specialized admission-examination box. After each examined patient, the room undergoes mandatory disinfection.

The logistics of the admission-examination box are thought out to the smallest detail:

• Airlock (V). Through this, the patient enters the office directly from the street, bypassing the general corridors of the admission unit.
• Examination room (B). The main working area. It contains a couch, table, stool, stretcher, washbasin, toilet, and a hook for the patient's clothes. Thermometry, registration, and sanitization are performed here.
• Buffer zone (A). A safe entry zone for medical personnel from the internal hospital corridor.

For inpatient treatment, individual boxes and semi-boxes are used. The individual box provides the most reliable protection against the spread of HAIs. It necessarily includes a separate outdoor entrance from the street, an entrance airlock, a ward, a bathroom with a tub, and an airlock. The patient is treated here until full recovery and leaves the premises exclusively through the external door, after which terminal disinfection of the box is performed. Dishwashing is done strictly inside the box, and observation of the patient's condition is carried out through the glassed-in part of the wall from the corridor side. A medical worker enters the patient's room only through the airlock: before returning to the general corridor, they must remove the protective gown, wash their hands, and treat them with a disinfectant solution. Food is passed through a special cabinet.

Patients with mixed infections or an undetermined diagnosis are hospitalized in the box first. The isolation period lasts at least 5 days — this time is required for laboratory and bacteriological tests. After a precise diagnosis is made, the patient is transferred to the department's specialized ward.

The semi-box differs from a full box only in that it lacks an external entrance from the street. Patients enter it from the general corridor. An important rule: in a single section consisting of semi-boxes, it is permitted to house patients with only the same infection.

Hygienic area standards and FAP structure

To ensure adequate air exchange, comfortable placement of equipment, and the ability to carry out thorough cleaning, strict minimum area standards for premises (calculated per adult patient) have been established:

• Standard ward (with its own toilet and airlock) — 7.5 m² per bed.
• Admission-examination box — at least 16 m².
• Individual box for 1 bed — 22 m².
• Individual box for 2 beds — 27 m².

At the rural level, primary healthcare is provided at feldsher-midwife stations (FAPs). According to planning requirements, an FAP must consist of two independent isolated rooms, each with a separate entrance (one of these rooms is allocated directly for the needs of the feldsher station).

Class and exam questions

What else to study on this topic

• Sanitization of patients in the admission unit
• Types and stages of disinfection in healthcare facilities (current and terminal)
• Infection safety rules for medical personnel working in the airlock
• Features of laboratory and bacteriological diagnostics of the hospital environment

Other topics in the section "Chapter 8. Hygiene of Healthcare Facilities"

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.