1. Kharkov National Medical University Department of Hygiene and Ecology №1 Special problems of hospital hygiene

2. Main problems of lecture 1. 1. Occupational Health and Safety Hazards for Medical and Surgical Staff 2. 2. Hospital-acquired infection and their prophylaxis 3. 3. Peculiarities of internal design and hygienic regimen in specialized departments of hospitals

3. Structure of doctor’ morbidity essential hypertension essential hypertension myocardial ischemia myocardial ischemia diseases of musculoskeletal system diseases of musculoskeletal system gynecologic diseases, complications of pregnancy and puerperal period gynecologic diseases, complications of pregnancy and puerperal period diseases of liver, gallbladder and pancreas diseases of liver, gallbladder and pancreas

4. Physical hazards Ionizing radiation Ionizing radiation Laser beams Laser beams Microwave or radiofrequency radiation Microwave or radiofrequency radiation Unfavorable microclimate Unfavorable microclimate Inadequate lighting Inadequate lighting Noise Noise

5. Accident hazards Cuts from sharp instrument Cuts from sharp instrument Burns and scalds Burns and scalds Electrical shock Electrical shock Cryogenic agents Cryogenic agents Asphyxiation in confined spaces Asphyxiation in confined spaces Heat and cold stresses Heat and cold stresses Associated with slips, trips and falls Associated with slips, trips and falls

6. Chemical hazards disinfectants disinfectants mercury mercury latex latex a variety of cleaning agents a variety of cleaning agents scented products scented products ethylene oxide ethylene oxide anesthetic gases anesthetic gases methyl methacrylate methyl methacrylate hydrogen peroxide hydrogen peroxide vehicle exhaust from ambulances vehicle exhaust from ambulances chemicals used in terrorist activities chemicals used in terrorist activities

7. Сontactant dermatitis

8. Biological hazards bloodborne pathogens bloodborne pathogens airborne biological agents airborne biological agents droplets containing infectious biological agents droplets containing infectious biological agents environmental biological contaminants environmental biological contaminants

9. Ergonomic hazards associated with patient handling associated with patient handling associated with computer use associated with computer use associated with material handling of equipment, furniture and supplies including lifting, carrying, pushing, pulling, etc. associated with material handling of equipment, furniture and supplies including lifting, carrying, pushing, pulling, etc. associated with positioning and holding limbs, equipment, etc. associated with positioning and holding limbs, equipment, etc.

10. Nervous-emotional strain

11. Occupational Hazards in the Operating Room

12. Hazards of surgeon work Unfavorable microclimate Unfavorable microclimate Contaminated air Contaminated air High risk of trauma High risk of trauma

13. Hazards of surgeon work A break of work and rest regimen A break of work and rest regimen Working upright posture Working upright posture Hard physical work Hard physical work

14. Overstrain of a working hand

15. The increased strain of vision

16. Hospital acquired infections Hospital acquired infection is also called Nosocomial infection or Healthcare- associated infection nosocomial “nosus” = disease “komelion” = to take care of

17. Condition of HAI spreading Presence of microorganisms in hospital environment Immuno- compromised patient Transmission of pathogens between staff and patients and among patients

18. Prevalence of HAI   diseases of upper respiratory organs, children’s infections   staphylococcal and streptococcal infections of the skin, hypodermic cellular tissue, mucous membranes, post-operative suppurative inflammatory complications, septic diseases   intestinal infections

19. Sources of HAI

20. Сost of HAI treatment

21. Risk factors of HAI with multiresistant pathogens   Advanced age   Underlying disease   Severity of illness   Transplantation   Gastrointestinal surgery   Exposure to medical devices   Heavy exposure to antimicrobial therapy   Prolonged hospital stay   Interinstitutional transfer of patient

22. Prevention of HAI transmission Nonspecific measures : architectural planning, sanitary and technical, sanitary and antiepidemic, disinfection and sterilization measures. Specific measures : planned and urgent specific prophylaxis

23. General Recommendations for Control and Prevention of HAI transmission Regular hand washing after contact with patients or surfaces in a hospital Regular hand washing after contact with patients or surfaces in a hospital Regular disinfection of potentially contaminated surfaces and equipment Regular disinfection of potentially contaminated surfaces and equipment Surveillance cultures necessary for infection control purposes for specific organisms such as VRE Surveillance cultures necessary for infection control purposes for specific organisms such as VRE Alcohol-based hand washing liquids Alcohol-based hand washing liquids Antibiotic formulary intervention or restriction Antibiotic formulary intervention or restriction

24. ADMISSION DEPARTMENT

25. SURGICAL DEPARTMENT

26. FUNCTIONAL AREAS OF OPERATIONAL UNIT I zone I zone II zone III zone III zone IV zone IV zone Operating rooms Washing roomSterilization Preopera- tional Anaesthetic Equipment room Artificial blood circulation apparatus and other devices Disassembly and cleaning of instruments Portable equipment Clean linen A mobile X-ray apparatus The protocol room Instrumental material Pantry of gypsum Pantry of cleaning equipment Photo- laboratory Gypsum room Sanitary- Inspection room for personnel Premises of personnel Storage areas Rest room of personnel Premises of personnel

27. Sterile zone operating room

28. Especially clean zone Sterilization room Preoperating room Anaesthetic room Equipment room Artificial blood circulation apparatus and other devices Washing room

29. Clean zone  Disassembly and cleaning of instruments  Clean linen  Portable equipment  A mobile X-ray apparatus  The protocol room  Instrumental material  Pantry of cleaning equipment  Gypsum room  Pantry of gypsum  Photo-laboratory

30. Zone of general hospital regimen Sanitary inspection room for personnel Sanitary inspection room for personnel Premises of personnel Premises of personnel Rest room of personnel Rest room of personnel Storage Storage

31. INFECTIOUS DEPARTMENT

32. Box for 2 beds 1. Entrance from street 2. Tambour 3. Ward 4. Bath 5. Wash basin 6. Entrance from сorridor 7. Sluice 8. Bed

33. Semibox 1. Ward 2. Sanitary room 3. Wardrobe for change white coat 4. Sluice 5. Entrance from сorridor

34. Thank for your attention!