The role of layout in infection prevention
Architectural and layout solutions are the first barrier to the spread of infections. The building of a paramedic and midwife station (FAP) must be divided into paramedic and midwifery units, each having its own set of basic rooms (vestibule, waiting area for 10–12 people, admission and examination room).
To prevent cross-infection, special zones are provided:
- Isolation ward (at the paramedic station). Designed for the temporary accommodation of infectious patients. The main rule is having a separate entrance. Includes a boxed ward for 2 beds (or up to 4 beds with a catering unit in remote areas), a sanitization room, and a toilet.
- Delivery suite. Consists of a room for the sanitization of women in labor, the delivery room, and a toilet. The windows of such wards must face strictly south or southeast.
In a rural maternity hospital with 3 beds, the routing is organized as follows: the patient passes through the reception into the examination room for sanitization, and then into the specialized department, where mother and child room-in accommodation is arranged. A second, separate entrance is provided for the consultation room and the catering unit.
Sanitary and hygienic regulations of premises
Absolutely all premises, equipment, and medical devices must be kept in impeccable cleanliness.
Routine cleaning (washing floors, wiping furniture and doors) is carried out:
- At least 2 times a day;
- Using soap-soda solutions and disinfectants;
- Important: the use of powdered synthetic detergents is strictly prohibited.
General cleaning with disinfection is organized once a week in operating rooms, dressing rooms, and delivery suites. In this process, the room is completely cleared of furniture and equipment. Window glass is washed from the inside at least once a month, and from the outside every 4–6 months.
All cleaning equipment (buckets, mops, rags) must be clearly labeled indicating the room. It must be stored separately and used strictly for its intended purpose. Trash cans are placed in corridors, and pedal bins are placed in treatment rooms.
Air asepsis and patient sanitization
In special-regime areas (intensive care units, delivery suites, laboratory boxes, newborn wards), regular air disinfection is carried out. Stationary or mobile UV lamps are used for this purpose. Irradiation is turned on after cleaning, as well as during the ongoing operation of the room.
Sanitization upon admission: Every patient admitted to the hospital (in the absence of medical contraindications) undergoes sanitization in the admission department. It includes:
- Taking a shower or bath.
- Nail trimming.
- Issuance of individual soap and washcloth.
- Changing into clean undergarments, pajamas (or a robe), and slippers.
Hospital linen management
Proper handling of linen is critical for preventing nosocomial outbreaks. The department must always have a daily supply of clean linen, which is strictly labeled.
Frequency of linen change:
- Standard — as it gets soiled, but at least once a week.
- For postpartum women — bed linen is changed every 3 days, while undergarments and towels are changed daily.
- For postoperative patients — systematically, until wound discharge ceases.
- In obstetric hospitals, only sterile linen is used.
Dirty linen is collected in dense containers (oilcloth bags) and transported on carts. Temporary storage in closed bins is allowed for no more than 12 hours. Staff are required to wear protective clothing (mask, gloves, gown). Laundering infected linen requires prior disinfection. After a patient's discharge, mattresses, pillows, and blankets are sent for mandatory chamber disinfection.
Briefly: answers to topical questions
What are the main groups of microorganisms that act as causative agents of nosocomial infections?
The main causative agents of nosocomial infections are hospital strains of opportunistic microorganisms, as well as bacteria, viruses, fungi, and protozoa.
- Bacteria — gram-negative aerobic rods are among the leading pathogens.
- Eukaryotes — fungi and protozoa capable of developing resistance.
- Viruses — also adapt to the aggressive factors of the hospital environment.
Pathogens are characterized by increased virulence, multiresistance to antibiotics, and resistance to disinfectants.
What are the main routes and transmission factors of nosocomial infections in a surgical department?
In surgical departments, the sources and transmission factors of nosocomial infections can involve aerosol, contact, and alimentary routes; the risk is also associated with medical manipulations and instruments.
The main transmission factors include:
- Medical instruments and equipment — medical instruments, as well as equipment for mechanical ventilation of the lungs.
- Personnel hands — dirty hands of medical workers.
- Solutions — contaminated solutions.
The risk of infection is associated with urinary bladder catheterization, endoscopic examinations, mechanical ventilation, wound care, and dressings.
What methods and regimes exist for air disinfection in special-regime premises of healthcare facilities?
To disinfect air in special-regime premises, ultraviolet irradiation, the aerosol method, and ventilation are used.
- UV irradiation — carried out using bactericidal lamps at the rate of 1 W of power per 1 m³ of room volume; irradiation is performed after cleaning and during ongoing operation. In the absence of people and patients, open bactericidal irradiators can be used, while in the presence of people, closed UV irradiators (recirculators) are used. According to cited sources, one lamp sterilizes up to 30 m³ of air in 2 hours.
- Aerosol method — spraying a mixture of a 3% hydrogen peroxide solution and a 0.5% lactic acid solution using the "Desinfal" apparatus. Treatment is carried out on the eve of surgery or at least 2 hours before it.
- Ventilation and airing — premises are aired at least 4 times a day; ventilation is among the measures to combat airborne infection.
What chemical tests are used to evaluate the quality of pre-sterilization cleaning of medical instruments?
The quality of pre-sterilization cleaning of medical instruments is evaluated using the azopiram test.
This chemical test is used to detect residues of "hidden" blood on the surfaces of items. Cleaning is considered ineffective and the test is considered positive if a purple color appears within one minute after the reagent contacts the treated area of the instrument.
Class and exam questions
Can washing powder be used to wash floors in a hospital?
No, the use of powdered synthetic detergents for wet cleaning in healthcare facilities is strictly prohibited. Soap-soda solutions and disinfectants must be used.
How often is general cleaning performed in operating rooms?
General cleaning with washing and disinfection in operating units, dressing rooms, and delivery suites is carried out once a week with the room completely cleared of equipment.
Where and for how long is dirty laundry allowed to be stored in the department?
Dirty linen can be temporarily stored in utility rooms for no more than 12 hours. It must be kept in tightly closed containers (barrels or boxes), which are then subject to disinfection.
What are the specific features of an isolation room in a rural health post (FAP)?
The main mandatory requirement for an isolation ward is having a separate entrance from the street to prevent infectious patients from crossing paths with other visitors.
What else to study on this topic
- Explication of premises of obstetric and paramedic stations of the FAP
- Organization of a midwife's apartment at a rural maternity hospital
- Requirements for engineering infrastructure of healthcare facility grounds
- Regulations for transporting infected laundry to the laundry facility
Master the entire topic in the "Hygiene" course
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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.