Resolution of the Chief State Sanitary Doctor of the Russian Federation dated May 18, 2010 No. 58 “On approval of SanPiN 2.1.3.2630-10 “Sanitary and epidemiological requirements for organizations engaged in medical activities”

12. Rules for treating the hands of medical personnel and the skin of patients

12.1 In order to prevent nosocomial infections, the hands of medical workers (hand hygiene, disinfection of surgeons’ hands) and the skin of patients (treatment of surgical and injection fields, donor elbows, sanitary treatment of the skin) must be disinfected.

Depending on the medical procedure being performed and the required level of reduction in microbial contamination of the skin of the hands, medical personnel perform hygienic treatment of hands or treatment of the hands of surgeons. The administration organizes training and monitoring of compliance with hand hygiene requirements by medical personnel.

12.2 To achieve effective washing and disinfection of hands, the following conditions must be observed: short-cut nails, no nail polish, no artificial nails, no rings, rings or other jewelry on the hands. Before treating surgeons' hands, it is also necessary to remove watches, bracelets, etc. To dry hands, use clean cloth towels or disposable paper napkins; when treating surgeons' hands, use only sterile cloth ones.

12.3 Medical personnel must be provided with sufficient quantities of effective means for washing and disinfecting hands, as well as hand skin care products (creams, lotions, balms, etc.) to reduce the risk of contact dermatitis. When choosing skin antiseptics, detergents and hand care products, individual tolerance should be taken into account.

12.4 Hand hygiene.

12.4.1 Hand hygiene should be carried out in the following cases:

Before direct contact with the patient;

After contact with the patient's intact skin (for example, when measuring pulse or blood pressure);

After contact with body secretions or excreta, mucous membranes, dressings;

Before performing various patient care procedures;

After contact with medical equipment and other objects located in close proximity to the patient.

After treating patients with purulent inflammatory processes, after each contact with contaminated surfaces and equipment;

12.4.2 Hand hygiene is carried out in two ways:

Hygienic hand washing with soap and water to remove contaminants and reduce the number of microorganisms;

Treating hands with a skin antiseptic to reduce the number of microorganisms to a safe level.

12.4.3 To wash hands, use liquid soap using a dispenser. Dry your hands with an individual towel (napkin), preferably disposable.

12.4.4 Hygienic treatment of hands with alcohol-containing or other approved antiseptic (without prior washing) is carried out by rubbing it into the skin of the hands in the amount recommended by the instructions for use, paying special attention to the treatment of the fingertips, the skin around the nails, between the fingers . An indispensable condition for effective hand disinfection is keeping them moist for the recommended treatment time.

12.4.5 When using a dispenser, a new portion of antiseptic (or soap) is poured into the dispenser after it has been disinfected, washed with water and dried. Preference should be given to elbow dispensers and photocell dispensers.

12.4.6 Skin antiseptics for hand treatment should be readily available at all stages of the diagnostic and treatment process. In departments with a high intensity of patient care and with a high workload on staff (intensive care units, etc.), dispensers with skin antiseptics for treating hands should be placed in places convenient for use by staff (at the entrance to the ward, at the patient’s bedside and etc.). It should also be possible to provide medical workers with individual containers (bottles) of small volumes (up to 200 ml) with skin antiseptic.

12.4.7 Use of gloves.

12.4.7.1 Gloves must be worn in all cases where contact with blood or other biological substrates, potentially or obviously contaminated with microorganisms, mucous membranes, or damaged skin is possible.

12.4.7.2 It is not permitted to use the same pair of gloves when in contact (for care) with two or more patients, when moving from one patient to another, or from a body area contaminated with microorganisms to a clean one. After removing gloves, perform hand hygiene.

12.4.7.3 If gloves become contaminated with secretions, blood, etc. To avoid contamination of your hands during the process of removing them, you should use a swab (napkin) moistened with a solution of a disinfectant (or antiseptic) to remove visible dirt. Remove gloves, immerse them in the product solution, then discard. Treat your hands with an antiseptic.

12.5 Treatment of surgeons' hands.

12.5.1 Surgeons’ hands are sanitized by everyone involved in surgical interventions, childbirth, and catheterization of great vessels. The treatment is carried out in two stages: Stage I - washing hands with soap and water for two minutes, and then drying with a sterile towel (napkin); Stage II - treatment of hands, wrists and forearms with an antiseptic.

12.5.2 The amount of antiseptic required for treatment, the frequency of treatment and its duration are determined by the recommendations set out in the guidelines/instructions for use of a particular product. An indispensable condition for effective hand disinfection is keeping them moist for the recommended treatment time.

12.5.3 Sterile gloves are put on immediately after the antiseptic has completely dried on the skin of the hands.

12.6 Algorithms/standards for all epidemiologically significant therapeutic and diagnostic procedures must include recommended means and methods of hand treatment when performing the relevant manipulations.

12.7 It is necessary to constantly monitor the compliance with hand hygiene requirements by medical workers and bring this information to the attention of personnel in order to improve the quality of medical care.

12.8 Skin antiseptics for hand treatment should be readily available at all stages of the diagnostic and treatment process. In departments with a high intensity of patient care and staff workload (resuscitation and intensive care units, etc.), dispensers with skin antiseptics for hand treatment should be placed in places convenient for use by staff (at the entrance to the ward, at the patient’s bedside, etc. .). It should also be possible to provide medical workers with individual containers (bottles) of small volumes (100-200 ml) with skin antiseptic.

12.9 Disinfection of patient skin

12.9.1 Disinfection of the hands of healthcare workers is of great importance in preventing the transmission of infection to patients and staff. The main methods of hand disinfection are: hygienic treatment of the hands of medical personnel and treatment of the hands of surgeons.

12.9.2 To achieve effective hand disinfection, the following conditions must be observed: short-cut nails, no artificial nails, no rings, rings or other jewelry on the hands. Before treating surgeons' hands, also remove watches and bracelets. To dry your hands, use disposable towels or napkins; when treating surgeons’ hands, use only sterile ones.

12.9.3 It is preferable to treat the patient’s surgical field before surgery and other manipulations associated with violation of the integrity of the skin (puncture, biopsy) with an antiseptic containing a dye.

12.9.4 Treatment of the injection field involves disinfecting the skin using an alcohol-containing antiseptic at the injection site (subcutaneous, intramuscular, intravenous) and drawing blood.

12.9.5 To treat the elbow bends of donors, use the same antiseptics as for treating the surgical field.

12.9.6 For sanitary treatment of patients’ skin (general or partial), use antiseptics that do not contain alcohol and have disinfecting and cleaning properties. Sanitation is carried out on the eve of surgery or when caring for the patient.

Sanitary rules and regulations (SanPiN) are established at the state level and apply to all medical institutions without exception that have a license to carry out medical activities.

They can significantly reduce the risk of free circulation of infection during human contact in hospitals and clinics.

Today, sanitary rules and regulations are implemented at a sufficient level, and this makes it possible to maintain a safe sanitary environment in every medical organization.

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The main thing in the article

SanPiN 2.1 3.2630-10: latest changes

SanPiN 2.1 3.2630-10 “Sanitary and epidemiological requirements for organizations engaged in medical activities” is a regulatory document containing requirements for the functioning of a medical institution, namely:

  1. to location and territory.
  2. For heating, water supply and sewerage, ventilation of hospital buildings and clinics.
  3. Natural and artificial lighting, microclimate, indoor air environment.

Separately, the sanitary and epidemiological features of the organization of treatment and diagnostic units of a medical organization - resuscitation and intensive care units, obstetric and gynecological hospitals, perinatal centers, and emergency departments are given.

Special attention in SanPiN 2.1 3.2630-10 is paid to the requirements for the organization and implementation of sterilization and disinfection measures and the prevention of hospital infections in medical institutions of various profiles.

Last year, changes were made to this document. Paragraph 10.8.4 has been changed - according to the new edition, specialized tuberculosis hospitals and anti-tuberculosis dispensaries, other specialized anti-tuberculosis institutions and their structural units, as well as the separate buildings and structures included in them are repurposed depending on how high the potential risk of infection with Mycobacterium tuberculosis is. territory of the institution and its premises.

According to the degree of possible risk of infection with tuberculosis microbacteria, the following classes of objects are distinguished:

  • class A (non-hazardous) - facilities that are not intended and have not previously been used for diagnosis, treatment, accommodation of persons with confirmed tuberculosis (administrative buildings, catering units, workshops, checkpoints, garages, pharmacies, etc.);
  • class B (potentially dangerous) - facilities in which examination, treatment and placement of patients with extrapulmonary forms of tuberculosis were previously carried out;
  • class B (hazardous) - facilities where examination, treatment and placement of patients with pulmonary forms of the disease, including those caused by drug-resistant microorganisms, were previously carried out (clinical diagnostic and microbiological laboratories, pathology departments, wastewater treatment plants, etc. ).

If a building has several rooms or departments belonging to different hazard classes, the entire building must be classified as the highest of them.

The decision to repurpose organizations involved in the prevention and treatment of tuberculosis is made by the health authorities of the constituent entities of the Russian Federation with the participation of the supervisory authorities of the state sanitary and epidemiological service.

Medical examinations for health workers: when the mandatory minimum of examinations needs to be supplemented

What volume of research includes preliminary and periodic medical examinations of health workers, in which cases the mandatory minimum must be supplemented in order to avoid penalties, read in the journal “Chief Nurse”. Who needs a special examination by a dermatologist? Why can’t a psychiatric examination be replaced by a regular examination by a psychiatrist?

In this case, it is necessary to determine the class of potential danger of infection of an object with Mycobacterium tuberculosis.

Re-profiling work is carried out taking into account the following requirements:

  • class A objects are repurposed only after the final disinfection of the building by an authorized organization;
  • class B objects are repurposed after the final disinfection of the building by an authorized organization and major repairs, during which the ventilation system, as well as wooden doors, floors, window frames, cladding panels and other wooden structures must be completely dismantled; plaster, paint, tile covering are completely removed;
  • class B objects are repurposed after final disinfection and conservation for a period of at least 3 years, after which a major overhaul of the object is carried out with the complete dismantling of ventilation systems and all wooden and porous structures (floors, windows, frames, doors, cladding panels), removal of plaster and paint , tiled covering; After completion of repair work, the building is disinfected again.

After the final disinfection of an object has been carried out, it is necessary to monitor its effectiveness using laboratory methods.

Read about mandatory laboratory tests as part of production control over the management of medical waste in the Chief Nurse System.

Repurposing of class B and C objects located in wooden buildings is unacceptable. These facilities are subject to dismantling and building structures are burned.

When repurposing organizations that provide prevention and treatment of tuberculosis in a hospital setting, it is also necessary to reclaim the soil in the designated area.

The second change in SanPiN concerns the very term “medical and preventive institution” or “therapeutic and preventive organization”. It must be replaced with the term “medical organization” in the appropriate case throughout the entire text of the document.

Also, in the first sentence of paragraph 2.2 of Chapter I, the word “hospitals” must be replaced with the phrase “medical organizations providing medical care in inpatient settings, providing round-the-clock medical observation and treatment (hereinafter referred to as hospitals).”

Requirements for general cleaning

The new SanPiN 2016, intended for medical organizations, imposes special requirements for general cleaning of hospitals and clinics.

They are designed to prevent the spread of infection through contact between people in medical institutions.

According to the new requirements, all premises of a medical organization, as well as equipment and necessary supplies, must be kept clean.

Wet cleaning, which includes washing floors, window sills, doors, equipment and furniture, should be carried out at least 2 times a day using detergents and disinfectant solutions.

The management of the institution organizes preliminary and periodic briefing of the personnel responsible for the cleanliness of the premises on sanitary and hygienic conditions and cleaning technology.

Procedure for general cleaning

We will tell you in the Chief Nurse System which personnel are allowed to perform cleaning, how to carry it out, which mode and method of disinfection to choose, what to base the purchase of disinfectants on and how to control the quality of cleaning.

Detergents and disinfectants must be stored in the manufacturer’s packaging, equipped with a label, in specially designated storage areas outside of work rooms. Working solutions of disinfectants for processing objects are stored in separate containers. They are used:

  • for disinfection, pre-sterilization cleaning and sterilization of medical devices;
  • for disinfection of surfaces, equipment, devices and devices;
  • for disinfection of cleaning material, as well as class B and C waste.

Containers with working solutions of disinfectants must have a tight-fitting lid, as well as a clear inscription or label indicating the name of the solution, its concentration, date of preparation, expiration date, and purpose.

When working with these products, all precautions must be taken, including the use of personal protective equipment.

Approximate form of a log of the organization’s consolidated estimated need for disinfectants, sterilants, pre-sterilization cleaning products, skin antiseptics

Name

Name

Demand in the billing period

disinfectants

divisions of the organization

half year

Cleaning equipment (mops, rags, containers, carts) must be labeled or color-coded based on the purpose of the room and the type of cleaning in it, and must have storage space.

There should be a color coding scheme in the inventory storage area. Washing machines should be located in areas where cleaning carts are assembled.

Windows are washed as needed, but at least 2 times a year. General cleaning of wards and other rooms and offices in departments of a medical organization is carried out according to a schedule at least once a month. It should include washing floors, treating walls, inventory, equipment, and lamps.

In the operating unit, dressing rooms, treatment rooms, manipulation rooms, maternity rooms and other rooms that maintain aseptic conditions, general cleaning is carried out at least once a week. On the day of general cleaning, no operations are carried out in the operating unit.

Cleaning personnel must have personal protective equipment, and all necessary equipment must be labeled.

General cleaning can be carried out unscheduled - for epidemiological reasons or as a result of unsatisfactory results of microbial contamination of the external environment.

Templates for cleaning documents in medical organizations

So that in conditions of shortages and staff turnover, the chief nurse can ensure uninterrupted and high-quality cleaning of premises in a medical organization, the editors of the magazine “Chief Nurse” have prepared a selection of local document templates, a selection of local document templates, which were approved by an expert from Rospotrebnadzor.

The disinfection solution is used to irrigate or wipe the walls of rooms at a height of at least 2 meters, and in operating rooms and maternity rooms - to the entire height to the ceiling. Floors, window sills, doors, furniture, and equipment are also treated.

At the end of the disinfection time, personnel should change protective equipment and wipe surfaces with clean cloth wipes moistened with water. Lastly, the air in the room is disinfected.

Equipment used for cleaning is soaked in a disinfectant solution, then rinsed with water and dried. Equipment for walls and floors must be separate and labeled.

Separate equipment is also used for bathrooms, corridors, and offices. If it is not possible to use disposable cloth napkins every time you clean, reusable napkins must be washed. Inventory should be stored in a specially designated closet or room, but not in the office.

How to choose a disinfectant

Active substance

Activity

Advantages

Flaws

Quaternary ammonium compounds (QAC)

Efficacy against gram-positive and gram-negative vegetative forms of bacteria, fungi, and some viruses

Effective in low concentrations, do not damage treated surfaces, are of little danger if inhaled

There is no sporicidal or tuberculocidal effect, selective action against viruses.

Long-term use leads to the development of microbial resistance

Guanidines

Effective against gram-positive and gram-negative vegetative forms of bacteria, fungi, some viruses, mold

Low-toxic compounds due to inhalation with prolonged antimicrobial action

No sporicidal or tuberculocidal effect, selective action against viruses

Chloroactive compounds

Effective against bacteria (including mycobacteria), fungi, viruses, bacillus spores

Low cost, high activity, speed of action

Causes corrosion of metals and destruction of tissues; irritating effect on the mucous membranes of the eyes and upper respiratory tract

Hydrogen peroxide

Wide spectrum of activity against microorganisms, including bacilli spores

Removes organic contaminants. Without smell. Safe for the environment

Incompatible with metals: brass, zinc, copper, nickel

Peracetic acid

Broad spectrum of activity against microorganisms, including bacilli spores

High level disinfection. Fast acting at low concentrations

Unstable during long-term storage, has a pungent odor and irritating effect on the mucous membranes of the eyes and upper respiratory tract

SanPiN 2.1 3.2630-10: requirements for organizing the work of the treatment room

SanPiN 2.1 3.2630-10 as amended in 2016 imposes a number of requirements for organizing the work of the treatment room.

This applies, in particular, to its zoning, the presence of fume hoods and a computer, and the conduct of inhalations and vaccinations.

Zoning the treatment room: instructions

In order to ensure infection safety in the treatment room, the System expert Chief Nurse developed working instructions for dividing the room into functional zones - aseptic, working and utility.

On a note: The current sanitary legislation does not regulate the requirements for the zoning of treatment rooms.

Allocation of zones in the treatment room

Zoning of treatment rooms in medical organizations is not regulated by law. However, SanPiN 2.1 3.2630-10 contains hygienic requirements for the structure, architectural, planning and design solutions of premises intended for various manipulations, including treatment rooms.

Fulfilling these requirements allows you to:

  • to provide the best conditions for the treatment process, compliance with the sanitary and anti-epidemic regime and the work of medical workers;
  • put technological processes on stream and eliminate the possibility of crossing streams with varying degrees of epidemiological danger.

Zoning in the treatment room allows you to fulfill these requirements.

Conventionally, several zones can be distinguished:

  1. Area for storing drugs and sterile materials (“clean”).
  2. Area for performing manipulations and maintaining medical records (working).
  3. Area for disinfection of reusable medical products, collection and disinfection of medical waste (“dirty”).

In the “clean” area, it is recommended to install a medical cabinet with medications and packaged sterile materials, as well as a manipulation table. The “work” area usually contains a patient couch, a refrigerator, a work table and a second manipulation table.

The “dirty” area is equipped with a sink for tools and a sink for washing hands. There is also a place for storing disinfectant solutions and a container for collecting medical waste.

You need to organize your workspace based on the principles of ergonomics. The procedural nurse must have free access to the patient, and the premises as a whole and inventory, tools and equipment must be available for cleaning, operation and maintenance, taking into account sanitary and hygienic standards, which are given in the appendices to SanPiN 2.1 3.2630-10 (area, number sq. m per employee, microclimate, lighting, noise, etc.).

Fume hoods in the treatment room

When working with cytostatics, methyl methacrylates, psychotropic drugs, organic solvents, phenols and formaldehydes, aniline dyes and other reagents, accompanied by the release of toxic substances, treatment rooms are equipped with local exhaust devices.

If work accompanied by the release of toxic substances into the air is not performed in the treatment room, local fume hoods are not required, and air exchange is organized in accordance with the requirements of Section 6 of Chapter I of SanPiN 2.1 3.2630-10.

20 cleaning violations for which the head nurse can be punished

Carrying out vaccinations and inhalations in the treatment room

The treatment room, vaccination room and inhalation room are treatment rooms that differ in functionality and degree of epidemiological risk. Therefore, their placement should be separate.

The inhalation facility is part of the department of physiotherapy and rehabilitation treatment and must meet the requirements set out in paragraph 10.10 of Chapter I of SanPiN 2.1 3.2630-10.

The inhalation room must be separated from other premises. It must contain:

  • supply and exhaust ventilation, which will provide air exchange in the room up to 10 times per hour and help maintain a constant air temperature at +20°C;
  • an additional box for the preparation of medical procedures, sterilization and disinfection of medical devices, equipped with a fume hood, a sink with two compartments and a rotary tap with cold and hot water supply, disinfection boilers.

To carry out vaccination prophylaxis, a medical organization must have a separate vaccination room, equipped in accordance with the requirements of paragraph 6.4 of MU 3.3.1891-04 “Organization of the work of the vaccination room of a children's clinic, the immunoprophylaxis room and vaccination teams.”

Vaccination room: 5 misconceptions about organizing your workspace

Misconception: Furniture in the office should be placed around the entire perimeter.

To eliminate movement losses, make the work cell more compact. Reduce the working perimeter as much as possible, move it towards the entrance to the office. Detailed recommendations from an expert from the journal “Chief Nurse”.

Computer in the vaccination room

Current healthcare legislation does not contain direct prohibitions on the installation of office equipment in the treatment room. That is, it is possible to equip a nurse’s workplace with a computer, but subject to the flow of the technological process of work and the exclusion of crossing flows with varying degrees of epidemiological danger.

When organizing your workspace and placing equipment and machinery, you should adhere to the principles of ergonomics. The standardized area of ​​the treatment room (12 sq. m) should be increased taking into account the number of workstations equipped with computers. The area of ​​one user's workplace should be:

  • 6 sq. m - for users of computers with VDT based on a cathode ray tube;
  • 4.5 sq. m - for users of computers with VDT based on flat discrete screens (LCD, plasma).

These standards for increasing the area are given without taking into account auxiliary devices - printers, scanners, copiers.

Office equipment should be placed based on the requirements of the sanitary and anti-epidemic regime. A computer is a potential source of air and surface pollution in a room, so it must be thoroughly cleaned in a timely manner using disinfectants.



The procedure for wearing and changing a gown when working in a treatment room

The procedure for wearing and changing medical clothing is dictated by the requirements of distinguishing flows with varying degrees of epidemiological risk. It is also necessary in order to prevent contamination of the production environment of premises with different cleanliness classes.

Requirements for staff uniforms and their replacement, depending on the level of contamination of indoor air with microorganisms (operating unit, wards, dressing room, procedure and vaccination rooms, infectious diseases department) and the type of manipulation performed (surgical and parenteral interventions, cleaning, changing linen, etc.) defined in SanPiN 2.1 3.2630-10.

According to the rules, medical personnel are required to put on special clothing before starting work and when entering a sterile room and change it when moving from one type of manipulation to another.

GOST R ISO 14644-5-2005 prohibits the removal of protective clothing from the “clean” room area, however, the typical procedure for medical workers wearing and leaving the “clean” room is described in the reference appendix to this document.

Operating time with sterile tray

Instruments sterilized in unpackaged form are used for their intended purpose immediately or stored on a sterile table for no more than 6 hours.

Open storage of such instruments is strictly prohibited. If necessary, it is allowed to store sterilized, unpackaged instruments in bactericidal chambers for the period specified in the operating instructions for medical equipment.

If a small or large instrumental work table is covered in the treatment room, the periods of storage and use of sterile medical products are determined by the terms of its covering.

✪ Methods of working with sterile materials after opening the package: step-by-step algorithm in the Chief Nurse System.✪

Products and instruments that were not used during the procedure must be re-sterilized.

As for the tray, during operation it is laid out on the manipulation table immediately before use for a particular patient. The number of sterile trays and other products and instruments must be sufficient to ensure uninterrupted operation of the treatment room.

Technique for collecting venous blood in the daily practice of a treatment room nurse

Test results may be affected by provider errors during blood collection. Check whether your employees perform this manipulation correctly.

In the journal “Chief Nurse” we present a protocol that describes step-by-step the actions of a nurse during a blood draw using Greiner Bio-One materials as an example:

1. Remove the gray protective cap from the valve part of the reversible needle. An intact perforated label is an indicator of the sterility and integrity of the needle. If the perforation is torn or damaged, discard the needle and get another one.

2. Screw the double-ended needle perpendicularly into the holder. Failure to screw the needle into the holder correctly may result in damage to both the holder and the needle, and subsequent needle fallout.

The full algorithm of actions is available to clients of the “Chief Nurse” magazine.

Separate table for blood collection in the treatment room

The requirements for the equipment of the treatment room are determined by the provisions of the Procedure for the provision of medical care, developed for its individual types, profiles, diseases or conditions (in accordance with Federal Law No. 323-FZ of November 21, 2011 “On the fundamentals of protecting the health of citizens in the Russian Federation”).

However, not a single order contains a requirement for a separate table for blood collection. It cannot be found either in the Resolution of the Chief State Sanitary Doctor of the Russian Federation No. 58 dated May 18, 2010 “On approval of SanPiN 2.1.3.2630-10 “Sanitary and epidemiological requirements for organizations engaged in medical activities”, nor in the Resolution of the Chief State Sanitary Doctor of the Russian Federation No. 1 dated 01/11/2011 “On approval of SP 3.1.5.2826-10 “Prevention of HIV infection”.

This requirement is provided only for the equipment of polyclinic consultative and diagnostic centers for examining citizens who live and work in event zones established around chemical weapons storage facilities and chemical weapons destruction facilities in accordance with Order No. 400 of November 5, 1999 “On measures to implement the Government Resolution Russian Federation dated September 22, 1999 No. 1082.”

Object of control

Subject of control

Responsible

Executor

Periodicity

Indoor surfaces, honey. furniture, equipment

(including ventilators, anesthesia and respiratory equipment, hemodialysis,
artificial
blood circulation, dosing equipment, incubators)

Compliance with the frequency of preventive

disinfection (routine and general cleaning)

Head nurse of the department

Middle and junior
medical staff of the departments

Monthly Weekly (selected)

The effectiveness of preventive

disinfection

Head nurse of the department

LPO Laboratory(*)

2 times a year (select premises according to schedule)

Efficiency of focal and final disinfection

Head nurse of the department

LPO Laboratory(*)

In every case of infectious disease and
according to epidemiological indications

Indoor air

The effectiveness of preventive disinfection (bacterial contamination of the air, CFU, Staphylococcus aureus) in operating rooms, maternity rooms, treatment rooms, dressing rooms, surgical rooms (including urological, dental,

gynecological,

endoscopic, procedural),

blood transfusion departments, hemodialysis

Head nurse

LPO Laboratory(*)

2 times per year

Ensuring compliance with the requirements of operational documentation for installations

Responsible person

Nursing staff of departments

Annually

Maintaining a log of registration and control of air disinfection installations

Elder sister

Responsible person

Constantly

Chemicals for disinfection/sterilization

Availability of registration certificates, certificates of conformity for the disinfectants used and instructions for their use

chief nurse (responsible person for storing disinfectants
funds)

On admission
each batch

Availability of a minimum monthly supply of disinfectants

chief nurse

Head nurse of the department

Monthly

Determination of the concentration of working solutions of disinfectants and sterilants using chemical indicators

Head nurse of the department

Nursing staff working with disinfectants

Weekly (at least one sample of each type)

Laboratory control

(physico-chemical and analytical) DW

chief nurse (responsible person for storage of disinfectants)

chief nurse (responsible person for storage of disinfectants)

At the stage of acceptance of each batch (if there are means of quantitative control of the content of the active substance), in case of unsatisfactory results of chemical control of the concentration of working solutions

Compliance with the storage conditions of the product and its working solutions, compliance with the values ​​of the mode parameters
application (specified concentration, temperature of the working solution and holding time)

Head nurse of the department

Nursing staff of departments

Daily with each treatment

(disinfection, sterilization)

(*) In the absence of a laboratory in a health care facility, the performer of the work is determined under an agreement with an organization accredited in the “System of accreditation of laboratories carrying out sanitary epidemiological research and testing”

(**) work is carried out under a contract by an analytical laboratory accredited by the accreditation body for analytical laboratories in the system of accreditation of analytical laboratories (SAAL).

Annex 1

To SanPiN 2.1.3.2630-10

Minimum area of ​​premises (appr. resolution

p/p

Name of premises

Area, m2)

1. Areas per bed in wards of various purposes and capacities

1.1. Single bed rooms

Intensive care, including for burn patients

Individual delivery room with a transformable bed

Individual delivery room

For newborns (isolator)

For children under 7 years old with 24-hour mothers' stay

For adults or children over 7 years old with an accompanying person

1.2. Wards with two beds or more

For adults and children over 7 years old

Neurosurgical, orthopedic traumatological, radiological, burns (except intensive care units), rehabilitation treatment, medical and social (including in hospices), diagnostic wards, wards for patients using wheelchairs

General psychiatric and narcological

Psychiatric supervisory

Others, including prenatal

For children under 7 years old

Intensive care, resuscitation

With mothers' day stay

With 24-hour stay of mothers

Neurosurgical, orthopedic traumatological, radiological, burns (except intensive care units), rehabilitation treatment, medical and social (including in hospices), diagnostic wards, wards for patients using wheelchairs

Infectious diseases, including tuberculosis

Psychiatric general type

Psychiatric supervisory

Others

For children under 1 year, including newborns

Intensive care for newborns

For children with 24-hour mothers

For children with day care mothers

In wards without mothers:

For 1 bed

For 1 couvez

2. Consultative, medical, diagnostic rooms, rooms for rehabilitation treatment, common to different structural units

Office-office for receiving patients without examination (psychologist, lawyer, social worker, etc.)

Doctor's (paramedic) office for receiving adult patients (without specialized chairs, hardware diagnostic methods, treatment and parenteral interventions), pre-trip/post-trip examination room

Doctor's (paramedic's) office for receiving children (without specialized chairs, hardware diagnostic methods, treatment and parenteral interventions)

Doctor's office with a specially equipped workplace (gynecologist, urologist, proctologist, ophthalmologist, otorhinolaryngologist, geneticist, etc.)

Manipulation, examination room with hardware diagnostic and treatment methods, including in the office of a specialist doctor

Dressing room

Treatment room for intravenous infusions, venous blood sampling, intramuscular, intradermal injections, extracorporeal hemocorrection, vaccination room, treatment room for a cosmetologist with parenteral interventions

Small operating room

Preoperative for minor operating room

Gateway for small operating room

Room (with toilet) for temporary stay of a patient after outpatient surgery

6 for 1 place, but not less than 9

Allergen preparation room

39.1

Room for storage and dilution of BCG vaccine, storage of hepatitis B vaccine in an obstetric hospital

Room for small (up to 5 people) groups (speech therapy, psychotherapy, etc.)

Rooms for electrolight therapy, heat therapy, laser therapy, magnetotherapy, oxygen therapy, acupuncture, electrosleep therapy, etc.

6 per 1 place, but not less than 12

Room for classes of groups of more than 5 people (speech therapy, psychotherapy, hypnotherapy, etc.)

4 per place, but not less than 24

Gateway at doctor's offices

Ophthalmologist's dark room

Audiometric cabin (except for cabins supplied as a finished product)

Procedural endoscopy

Room for washing and processing endoscopes

Individual conditioned reflex therapy room

Group conditioned reflex therapy room

6 per 1 place, but not less than 20

Mud treatment room, bathroom

8 per 1 place (bath), but not less than 12

Inhalation therapy room

3 for 1 place, but not less than 10

Procedural halotherapy, speleotherapy, etc.

6 for 1 place, but not less than 18

Solarium vertical

3 for 1 place, but not less than 12

Solarium horizontal

4 per 1 place, but not less than 12

Physical therapy room for group classes, gym

5 per 1 place, but not less than 20

Walking training hall

Mechanotherapy and occupational therapy rooms

4 per 1 place, but not less than 12

Massage and manual therapy rooms

8 per 1 couch, but not less than 10

Shower room with pulpit (area to be determined depending on the number of showers)

Premises for underwater shower-massage, whirlpool, vibration baths, four-chamber baths

Placement of contrast baths

Treatment room for magnetic resonance imaging

25 (to be specified by the technical requirements of the equipment)

Magnetic resonance imaging control room

Patient preparation in the magnetic resonance imaging room

3. Specific premises of individual structural divisions

3.1. Reception departments

Filter box for children's clinics, reception and examination box for hospitals

Sanitary pass for patients

8 (with shower)

12 (with bath)

Room (place) for storing gurneys and wheelchairs

2 per gurney

1 per wheelchair, but not less than 6

Filter for receiving women in labor and pregnant women

Temporary storage room for patients' belongings

0.3 per 1 bed, but not less than 6

Pre-resuscitation

Reanimation room

Birth box:

Street vestibule

Room for sanitary treatment of women in labor

Individual delivery room with a transformable bed

Individual delivery room

Toilet

Preparatory room with shower for staff

3.2. Other premises of ward departments

Children's playroom, day care room for children and adults

0.8 per bed, but not less than 12

Charge nurse post

Pantry with equipment for washing tableware

Dining room for patients

for 1 seat

Canteen for patients in wheelchairs

for 1 seat

Gateway to the ward

Toilet with washbasin in the room

Shower in the ward

Bathroom (toilet, washbasin, shower)

Bathroom with lift

Enema

3.3. Operating units, resuscitation and intensive care units

General operating room (including endoscopic and laparoscopic)

Operating room for orthopedic, traumatological and neurosurgical operations

Operating room for performing heart surgeries using an artificial cardiopulmonary bypass, cath lab

Preoperative room for one general operating room

Preoperative room for two general (one specialized) operating rooms

Patient preparation room, anesthesia room

Instrumental and material room, storage rooms for sterile, suture materials, solutions

4 for each operating room, but not less than 10

Sterilization room for emergency sterilization

Room for disassembling and washing instruments, including endoscopic equipment

10, plus 2 for each operating room over 4

Room for washing and disinfecting anesthesia and respiratory equipment

12, plus 2 for each operating room above 4

Storeroom for anesthesia and respiratory equipment

8, plus 2 for each operating room over 4

Room for storing and preparing blood and blood substitutes for transfusion

Protocol (provided for if there are more than 4 operating rooms)

Storage room for post-operative waste

Storage and preparation room for plaster and plaster bandages

Dressing room with bath and lift for burn patients

Psychological relief room

Temporary storage room for corpses

3.4. Hemodialysis and detoxification departments

Dialysis room with duty nurse station

14 per dialysis bed

Water treatment room

Salt warehouse

2 per dialysis place, but not less than 8

Storeroom solutions

1.5 for each dialysis place, but not less than 8

Dialysis machine repair room

Procedure room for peritoneal dialysis

3.5. Diagnostic laboratories

Laboratory assistant (including hematological, biochemical, embryological, histological, etc.)

6 for each workplace, but not less than 12

Room for reception and registration of biomaterial for laboratory research

Capillary blood sampling room

4 for each workplace, but not less than 9

Urgent analysis laboratory

Autoclave for disinfection

3.6. Departments of industrial transfusiology

Treatment room for 1 chair with a gateway for donated blood collection and plasmapheresis

4 per seat, but not less than 14+2

Box (with pre-box) for blood fractionation

10 + 4

Procedure room (with gateway) for autoplasmapheresis

14+2

Room for plasma quarantine, storage room for untested blood components, storage of blood substitutes, temporary storage and distribution of blood and its substitutes

Donor rest room

3.7. Laboratory of in vitro fertilization (IVF)

Small operating room

Preoperative

Patient Entry Gateway

Manipulation room for egg retrieval and implantation of a fertilized egg (provided for in the absence of an operating room)

Embryology laboratory with genetics office

18+12

Sperm donation room

Cryostorage

3.8. Pathological and anatomical departments and forensic medical examination bureaus

Reception room for corpses

Pantry for storing the belongings of the deceased

Corpse storage room with cassette refrigeration cabinet

determined by the dimensions of the equipment, but not less than 12

Sectional for 1 table

18 per table and 12 for each subsequent one

Presection

Room for reception and registration of biopsy and autopsy material

Preparatorskaya

Fixation

Archive of wet autopsy and biopsy material

Archive of microslides and biopsy blocks

Corpse dressing room

Storerooms for preservative solutions, poisons and volatile substances

Funeral supplies storage room

Funeral hall

Storage area for corpses before being sent for cremation

Storage area for urns with ashes until they are released to relatives

Clergyman's quarters

Medical examination rooms for living persons

by area of ​​patient reception rooms

Office for working with documents

Storage room for evidence and valuables

Archive of histological material

4. Auxiliary, service and household premises common to all structural units

Office of the head of the department

Staff room

Head nurse's room

Staff room

6 per doctor, but not less than 12

Doctor's office

Room for students*

Teachers' quarters*

Room of the sister-owner of the department

Storage room for clean linen and bedding

Storage room for consumables and medicines

Storage room for narcotic drugs and psychotropic substances

Medical archive

0.3 per bed, 4 per 100 visits per shift, but not less than 12

Conference room (including stage and chairs equipped with music stands)

0.9 per seat

Pantry of sick things

0.2 per bed

Staff street clothes dressing room

0.08 per hook

Dressing room for home and work clothes of staff

0.5 per individual cabinet

Lobby-dressing room for visitors

0.5 per visitor

Changing room for patients in treatment and diagnostic rooms

1.3 per seat, but not less than 2

Staff toilet with sink

Staff shower

Temporary storage room for dirty linen

Storage area for cleaning supplies and disinfectant solutions

Temporary storage room for medical waste

Sanitary room (temporary storage of dirty linen, medical waste, vessel washing)

Storage room for a mobile X-ray machine, portable equipment

Drain room

______________________________

* In case these are educational bases or clinics of higher and secondary educational institutions.

Appendix 2

To SanPiN 2.1.3.2630-10

Composition, set and minimum recommended areas of premises of a dental medical organization **
(approved resolution Chief State Sanitary Doctor of the Russian Federation dated May 18, 2010 N 58)

Name of premises

Minimum area, m2

Notes

Lobby area with reception desk, outerwear wardrobe and waiting room

For each adult patient 1.2 m2

For each child, taking into account the stay of one of the parents - 2 m2

Doctor's office (dentist therapist, surgeon, orthopedist, orthodontist, pediatric dentist)

With an increase of 10 m2 for each additional dental unit (7 m2 per additional dental chair without installation)

Doctor's office in educational institutions

Oral hygiene room

Given the limited scope of medical care

Operating block:

In the absence of a central sterilization room, instruments from the operating room are sent for sterilization to the preoperative room, where a sterilization room is provided, and the area of ​​the preoperative room increases by at least 2 m2

preoperative

operating room

temporary room for the patient after surgery

X-ray room for one dental X-ray machine for targeted images

6 *

Reducing the area is possible subject to clauses 7.2.1 of these sanitary rules

Sterilization

The area is accepted in accordance with the technological justification (dimensions of equipment, etc.), but not less than 6 m2

Dental laboratory: room for dental technicians

4 m2 per technician, but no more than 10 technicians in one room

Specialized rooms: polymerization, plaster, polishing, soldering

If there is a dental laboratory for 1-2 full-time dental technicians, it can be located in two rooms - in one of the rooms the processes of plaster casting, polishing, polymerization, and soldering are combined, in the other there is a dental technician’s workplace. In this case, the area of ​​both offices must be at least 14 m2

Foundry

Depending on the technology and dimensions of the equipment, the area may be changed

Physiotherapeutic department:

electrolight therapy, laser therapy room

6 m2 per device

hydrotherapy room

6 m2 per device

UHF, microwave and ultraviolet irradiation room

6 m2 per device

physiotherapy room

6 m2 per device

Administrative, utility and auxiliary premises:

office of the manager (administrator)

1.5 m2 for each worker per shift. Outerwear can be placed in a wardrobe

staff room with wardrobe

head nurse's office

Can be combined with the head nurse’s office, without increasing the area of ​​the head nurse’s office

storage room for medicines and narcotic materials

storage rooms for medical products

Can be placed in wardrobes in corridors and basements

dirty linen closet

clean linen storage room

patient toilet

If the number of dental chairs in a dental medical organization is no more than 3, it is allowed to have one toilet for patients and staff

staff toilet

* Areas for other offices and auxiliary rooms of the X-ray department are in accordance with the current sanitary rules regulating the requirements for sources of ionizing radiation.

** The minimum set of premises for the work of a dental medical organization includes: a lobby group, a dentist’s office, a staff room, a toilet, a storage room.

I. General requirements for organizations engaged in medical activities
1. General provisions and scope
2. Requirements for the location and territory of treatment and prevention organizations (HPO)
3. Requirements for buildings, structures and premises

7. Requirements for natural and artificial lighting
9. General requirements for the organization of preventive and anti-epidemic measures
10. Sanitary and epidemiological features of the organization of units of various profiles
11. Sanitary maintenance of premises, equipment, inventory
12. Rules for treating the hands of medical personnel and the skin of patients
13. Requirements for the rules of personal hygiene of patients
14. Requirements for patient nutrition
15. Requirements for working conditions of medical personnel
II. Organization of disinfection and sterilization measures in organizations engaged in medical activities
1. General Provisions
2. Requirements for disinfection, pre-sterilization cleaning and sterilization of medical devices
3. Ensuring the implementation of disinfection and sterilization measures
III. Prevention of nosocomial infections in surgical hospitals (departments)
1. Organization of measures to prevent nosocomial infections
2. Epidemiological surveillance
3. Basic principles of prevention of nosocomial infections
4. Prevention of nosocomial infections in the operating room and dressing rooms
5. Prevention of nosocomial infections in intensive care units and intensive care units
6. Disinfection and sterilization measures
IV. Prevention of nosocomial infections in obstetric hospitals (departments)
1. Organization of activities for the prevention of nosocomial infections in obstetric hospitals
2. Organization of the anti-epidemic regime
3. Rules for the maintenance of structural units of obstetric hospitals and perinatal centers
4. Organization and implementation of disinfection and sterilization measures
5. Epidemiological surveillance of nosocomial infections
6. Investigation and elimination of group nosocomial diseases among newborns and postpartum women
V. Sanitary and hygienic requirements for dental medical organizations
1. General Provisions
2. Requirements for the location of dental medical organizations
3. Requirements for interior decoration
4. Equipment requirements
5. Requirements for microclimate, heating, ventilation
6. Requirements for natural and artificial lighting
7. Ensuring radiation safety during the placement and operation of X-ray machines and rooms
8. Sanitary and anti-epidemic measures
VI. Sanitary and epidemiological requirements for the design, equipment and operation of medical and obstetric stations and outpatient clinics
1. General Provisions
2. Hygienic requirements for accommodation and territory
3. Hygienic requirements for buildings, structures and premises
4. Requirements for interior decoration
5. Requirements for water supply and sewerage
6. Requirements for heating, ventilation, microclimate and indoor air environment
7. Hygienic requirements for natural and artificial lighting
8. Requirements for inventory and technological equipment
9. Sanitary and anti-epidemic measures
10. Hygienic requirements for working conditions and personal hygiene of medical and service personnel
Appendix 1 Minimum premises areas
Appendix 2 Composition, set and minimum recommended areas of premises of a dental medical organization
Appendix 3 Cleanliness class, recommended air exchange, permissible and design temperature
Appendix 4 Maximum permissible concentrations (MAC) and hazard classes of medicines in the air of premises of medical organizations
Appendix 5 Standardized indicators of natural, artificial and combined lighting of the main premises of medical organizations
Appendix 6 List of medical equipment and medical devices used in medical and pharmaceutical activities and subject to sanitary, epidemiological and hygienic assessment
Appendix 7 Permissible levels of physical factors created by medical equipment products
Appendix 8 Maximum permissible levels (MPL) of electromagnetic radiation at the workplace of medical personnel
Appendix 9 Permissible sound levels of medical equipment in the premises of medical and preventive organizations
Appendix 10 Maximum permissible sound levels and equivalent sound levels in workplaces for work activities of different categories of severity and intensity, dBA
Appendix 11 Maximum permissible levels of airborne ultrasound at workplaces
Appendix 12 Emergency prevention of parenteral viral hepatitis and HIV infection
Appendix 13 List of registered nosological forms of postoperative infections
Appendix 14 The procedure for cleaning the premises of various structural departments of the obstetric hospital
Appendix 15 List of registered nosological forms of infectious diseases in obstetric hospitals
Appendix 16. Terms and definitions
Appendix 17. Recommended procedure for investigating group nosocomial diseases among newborns and postpartum women
Appendix 18. Determination of the need for disinfectants, sterilants, pre-sterilization cleaning products and skin antiseptics
Appendix 19. Work of the administration and specialists of the treatment and prevention organization in organizing and carrying out disinfection and sterilization measures (approximate distribution of responsibilities)
Appendix 20. Approximate plan for production control over compliance with sanitary rules when carrying out disinfection and sterilization measures
Bibliographic data I. General requirements for organizations engaged in medical activities
1. General provisions and scope
2. Requirements for the location and territory of treatment and prevention organizations (HPO)
3. Requirements for buildings, structures and premises



7. Requirements for natural and artificial lighting

9. General requirements for the organization of preventive and anti-epidemic measures
10. Sanitary and epidemiological features of the organization of units of various profiles
11. Sanitary maintenance of premises, equipment, inventory
12. Rules for treating the hands of medical personnel and the skin of patients
13. Requirements for the rules of personal hygiene of patients
14. Requirements for patient nutrition
15. Requirements for working conditions of medical personnel
II. Organization of disinfection and sterilization measures in organizations engaged in medical activities
1. General Provisions
2. Requirements for disinfection, pre-sterilization cleaning and sterilization of medical devices
3. Ensuring the implementation of disinfection and sterilization measures
III. Prevention of nosocomial infections in surgical hospitals (departments)
1. Organization of measures to prevent nosocomial infections
2. Epidemiological surveillance
3. Basic principles of prevention of nosocomial infections
4. Prevention of nosocomial infections in the operating room and dressing rooms
5. Prevention of nosocomial infections in intensive care units and intensive care units
6. Disinfection and sterilization measures
IV. Prevention of nosocomial infections in obstetric hospitals (departments)
1. Organization of activities for the prevention of nosocomial infections in obstetric hospitals
2. Organization of the anti-epidemic regime
3. Rules for the maintenance of structural units of obstetric hospitals and perinatal centers
4. Organization and implementation of disinfection and sterilization measures
5. Epidemiological surveillance of nosocomial infections
6. Investigation and elimination of group nosocomial diseases among newborns and postpartum women
V. Sanitary and hygienic requirements for dental medical organizations
1. General Provisions
2. Requirements for the location of dental medical organizations
3. Requirements for interior decoration
4. Equipment requirements
5. Requirements for microclimate, heating, ventilation
6. Requirements for natural and artificial lighting
7. Ensuring radiation safety during the placement and operation of X-ray machines and rooms
8. Sanitary and anti-epidemic measures
VI. Sanitary and epidemiological requirements for the design, equipment and operation of medical and obstetric stations and outpatient clinics
1. General Provisions
2. Hygienic requirements for accommodation and territory
3. Hygienic requirements for buildings, structures and premises
4. Requirements for interior decoration
5. Requirements for water supply and sewerage
6. Requirements for heating, ventilation, microclimate and indoor air environment
7. Hygienic requirements for natural and artificial lighting
8. Requirements for inventory and technological equipment
9. Sanitary and anti-epidemic measures
10. Hygienic requirements for working conditions and personal hygiene of medical and service personnel
Appendix 1 Minimum area of ​​premises No. Name of premises Area (m2)
Appendix 2 Composition, set and minimum recommended areas of premises of a dental medical organization** Name of premises Minimum area, m2
Appendix 3 Cleanliness class, recommended air exchange, permissible and design temperature
Appendix 4 Maximum permissible concentrations (MAC) and hazard classes of medicines in the air of premises of medical organizations
Appendix 5 Standardized indicators of natural, artificial and combined lighting of the main premises of medical organizations
Appendix 6 List of medical equipment and medical devices used in medical and pharmaceutical activities and subject to sanitary, epidemiological and hygienic assessment
Appendix 7 Permissible levels of physical factors created by medical equipment products
Appendix 8 Maximum permissible levels (MPL) of electromagnetic radiation at the workplace of medical personnel
Appendix 9 Permissible sound levels of medical equipment in the premises of medical and preventive organizations
Appendix 10 Maximum permissible sound levels and equivalent sound levels in workplaces for work activities of different categories of severity and intensity, dBA
Appendix 11 Maximum permissible levels of airborne ultrasound at workplaces
Appendix 12 Emergency prevention of parenteral viral hepatitis and HIV infection
Appendix 13 List of registered nosological forms of postoperative infections
Appendix 14 The procedure for cleaning the premises of various structural departments of the obstetric hospital
Appendix 15 List of registered nosological forms of infectious diseases in obstetric hospitals