1. Chair of General Hygiene and Ecology HYGIENIC REGUIREMENT TO CONSTRUCTION OF MODERN HOSPITALS

2. PLAN OF LECTURE 1. Importance of optimum conditions of hygiene in hospital for successful treatment of patients. 2. Hygienic requirements to construction of modern hospitals. 3. Hygienic characteristic of various systems of hospital planning.

3. ENTER It is well – known that result of treatment of the patient depends not only on medical measures, but also on nursing and hygienic conditions in the hospital. Unfavorable influence of external environment on the organism of the ill person is more negative than on healthy people. Each doctor of medical establishment must known well hygienic requirements, concerning construction, internal planning and maintenance of hospitals and to be able to organize sanitary-hygienic and treatment - and -protective regimen and carry out measures for prophylaxis of hospital infections.

4. IMPORTANCE OF OPTIMUM CONDITIONS OF HYGIENE IN HOSPITAL FOR SUCCESSFUL TREATMENT OF PATIENTS. Main peculiarities of modern design of hospitals are construction of large polypro file hospitals with polyclinic, improvement of out-patient polyclinic help for population, enlargement of specialized medical establishments (tubercular hospitals, mental hospitals, department for recovery treatment, and so on), creation of specialized preventive establishments.

6. PROBLEMS IN THE FIELD OF HYGIENE FOR MEDICAL- PREVENTIVE ESTABLISHMENTS: 1)Hygienic study of hospital environment and its influence on the organism of patients and personnel. 2)Substantiation of permissible number of stories in hospitals and sanatorium-health-resort complexes and substantiation of optimum number of beds in medi cal-preventive establishments.

7. 3)Working out optimum parameters of microclimate and the air environment in wards for patients with different forms of pathology. 4)Grounding optimum parameters of insolation and lighting of medical establishments. 5)Working out recommendations on prevention of noise nuisance concerning treatment-and- protective regimen in hospital. 6)Working out effective measures for nonspecific prophylaxis of hospital infections.

8. FUNCTIONS OF HOSPITALS 1. The main function of a hospital is treatment of patients. 2. At the same time, a hospital provides preventive measures for health protection of people, prophylaxis of diseases, prevention of relapses and complications of diseases. 3. It carries out large work on medical and social rehabilitation of patients. 4. Large work is done by a hospital on examination of capacity for work. 5. Training of medium-level medical personnel and students. 6. Improvement of qualification of medical workers and research work is conducted in hospital.

10. HYGIENIC REQUIREMENTS TO CONSTRUCTION OF MODERN HOSPITALS Requirements to the choice of the plot of land 1. General somatic hospital must be situated on the territory of the living zone of city. 2. Specialized hospitals with long-term stay of patients should be placed on the edge of the city or even outside the city. 3. They should be placed on a high and well-aired territory.

11. 4. The ground should be dry and porous. 6. Construction of hospitals on a place of former cemeteries and burial grounds of cattle is forbidden. 7. The site of the hospital should be removed from sources of noise and air pollution. 8. Hospitals should not be built near industrial enterprises, railways, noisy sports constructions, airports, markets and other sources of noise. 9. In medical building the level of noise should not exceed permissible parameters (30 dBA at night and 40 dBA in a day time). 5. The level of subsoil water must be at least 1.5 m from foundation of building.

12. THE REQUIREMENTS TO THE GENERAL PLAN OF MEDICAL ESTABLISHMENT The site of the hospital should have rectangular form with a ratio of the sides as 1:2 or 2:3. It should be large enough. The site of the general plan depends on the number of beds in the hospital and the system of building up.

13. THE SIZES OF AREA The sizes of area must provide possibility of the optimum placing of hospital complexes from hygienical and medical- technological positions and to answer the amounts of beds. NUMBERS OF BEDS IN A HOSPITAL SIZE OF A HOSPITAL PLOT PER BED (M 2 ) To 50300 50-100300-200 100-200200-140 200-400140-100 400-800100-80 800-100080-60 More than 100060 Sizes of land for different hospitals in Ukraine (SNaR 2.07.01-89)

14. GENERAL PLAN OF A HOSPITAL General plan of a hospital has functional division. There are the following zones on the territory of the site of the hospital: A zone of non-infectious medical building A zone of a policlinic An economic zone A pathologic and anatomic zone A zone of a garden and park A zone of infectious medical building

15. 1 2 1 3 4 5 6 7 8 9 10 1.The school 2.The village 3.The living houses 4.The bread bakery 5.The garages 6.The market 7.The clothing factory 8.The factory of chemical equipment 9. The hospital 10. Green plantation

16. Medical buildings should be situated on a distance at least 30 m from a "red line". Sanitary distance between an in-patient department, a morgue and an economic zone should be not less than 30 m. The same can be said about the distance between a kitchen and a morgue.

18. Pathologic and anatomic zone and roads to it should be placed so that they would not be visible from windows of wards and from garden and park zone. The area occupied by construction should not exceed 12-15 %. The general area of green space should make up not less than 60 % from the common area of the hospital (not less than 25m 2 for 1 bed).

19. The site of the hospital should have a protective green zone not less than 15 m wide on perimeter. In front of medical- diagnostic establishments its width is increased up to 30 m.

20. HYGIENIC CHARACTERISTIC OF VARIOUS SYSTEMS OF HOSPITAL PLANNING I.The first system is decentralized system of construction. II.The second system is centralized system of construction. III.The third system is mixed system of construction. IV.The fourth system is centralized-block system. There are 4 systems of hospital planning:

21. DECENTRALIZED SYSTEM OF CONSTRUCTION The first system of planning is used for infectious, children's, mental hospitals. Hygienic advantages of this system consist of the following: planning guarantees favorable and safe conditions in department for isolation of patients, antiepidemic mode and prophylaxis of hospital infections; in this case there are favorable conditions for treatment-and-protective regimen; it creates optimum microclimate in wards, because the building is well insolated and ventilated.

22. Disadvantages of this system of planning are: medical service of patients is difficult; duplication of medical diagnostic rooms is necessary, consultation of patients is impeded; additional problems are connected with nutrition of patients.

23. CENTRALIZED SYSTEM OF CONSTRUCTION It is characterized by an arrangement of all medical departments, polyclinic and administrative rooms in one multi-storied, multi-beyond building. This system is: convenient for medical- diagnostic service and consultation of patients; ways of movement of patients and personnel from wards to diagnostic and physiotherapeutic rooms are short; delivery of food from kitchen to wards is improved.

24. Disadvantages of this system in hygienic aspect is: a danger of spreading hospital infections due to contacts of patients from different departments; keeping of antiepidemic regimen is difficult. It is more difficult to create treatment-and-protective regimen.

25. EXAMPLE OF GENERAL PLAN OF DISTRICT HOSPITAL 1.The main medical building for 240 beds 2.Medical building for 60 beds 3.Infectious building for 20 beds 4.Administrative building 5.Food department 6.Morgue Scale 1 :1000 6 1 5 4 3 2

26. MIXED SYSTEM OF CONSTRUCTION Mixed system of construction combines positive features of both systems and has the following hygienic characteristics: the basic somatic departments are situated in one multi-storied building (4-5 floors). Other departments, such as maternity, children's department are placed in a separate building with isolated garden.

27. CENTRALIZED -BLOCK SYSTEM Centralized -block system is isolated blocks in multi-storied buildings: a block of wards, a medical-diagnostic block, a block of material and technical service. They are joined with warm transitions. The following alternatives of the centralized-block system of planning are possible: X-form, T- form, H- form, etc. XTH

29. CONCLUSION Optimum condition in hospitals is very important for recovery of health and forces of patients. Creation in hospital optimum hygienic conditions and treatment-and-protective regimen increases adaptation of the organism of patients and promotes successful treatment of them.

33. THANKS FOR ATTEINTION

34. Ministry of Public Health of Ukraine Ivano-Frankivsk National Medicine University Chair of Ceneral Hygiene and Ecology HYGIENIC REGUIREMENT TO CONSTRUCTION OF MODERN HOSPITALS The interior design of hospitals AS. PROF. NELLI KRUTIKOVA

35. PLAN OF LECTURE 1. Admission department. 2. Hygienic requirements to the interior design of hospitals. 3. Sanitary-hygienic and treatment-and- protective regimen in specialized departments of hospitals. 4. Prophylaxis of hospital infections.

37. 1. ADMISSION DEPARTMENT Each hospital should have admission department. RECEPTION MEDICAL EXAMINATION SANITARY TREATMENT OF PATIENTS REGISTRATION

39.  possibility of outbreak of hospital infections;  stimulate improvement of medical diagnostic process.

42. The admission department of hospitals of centralized and mixed system of construction should be situated in main hospital building whereas in decentralized hospitals - in the building with the greatest number of beds. While planning of admission department principle of constant circulation of entering and discharging patients must be kept.

43. THE STRUCTURE OF ADMISSION DEPARTMENT INCLUDES THE FOLLOWING ROOMS: 1.a hall (waiting room) with a registry and cloak-room; 2.an inquiry office at the rate of 1.2 m 2 for one entering patient; 3.a room for examining patients (sanitary examination or sick inspection room), its area should be 12 m 2 ; 4.a sanitary treatment room with a cloak-room; 5.a bath-room and a shower for patients; 6.a manipulation room with a dressing room; 7.a room for doctor-in-charge (if a hospital has 300 beds and more); 8.a box (diagnostic ward) for patients with unknown diagnosis; toilets for personnel and patients.

44. 2. HYGIENIC REQUIREMENTS TO THE INTERIOR DESIGN OF HOSPITALS The structure of rooms in a department should correspond to the specific character of diseases and age of patients. To improve hygienic conditions in wards it is necessary, namely to create a comfortable microclimate, rational illumination and optimum color of walls. The ward department of the hospital is designed for 60 beds. It consists of two ward sections for 30 beds and a neutral zone.

46. The first principle of the ward section planning is isolation. It means that seriously ill patients must be placed in one-bed wards (they are 20% of all wards); relative isolation in two-bed wards for patients, whose condition is not very serious (20% of wards), other patients should stay in four-bed wards (60% of total wards in ward section).

48. 1. In terapy-7 m 2 per bed 2. In infections department and for tubercular patients for children -7,5 m 2 per bed -6,5 m 2 per bed 3. In department for patients with burns, radiologicals patients -10 m 2 per bed 4. In intensive terapy-10 m 2 per bed 5. For children with non-infections diseases -6 m 2 per bed

51. Examples of internal design of ward section a - the ward section with a corridor of two-side building; b - the ward section with a two-way corridor; 1 - the sanitary treatment room; 2 - the room for daily stay of patients; 3 - the dressing room; 4 - the wards for 4 beds; 5 - the post for the nurse on duty; 6 - the wards for 1 bed; 7 - the clysters room; 8 - the room for keeping the portable equipment; 9 - the bathroom; 10 - the room for dirty linen; 11 - the sanitary room; 12 - the wards for 2 beds; 13 - the doctor's room; 14 - the head's room; 15 - the room for endoscope; 16 - the refreshment room; 17 - the dining room; 18 - the room for personnel; 19 - the chief-nurse's room; 20 - the nurse-manager's room; 21 - the room for daily stay of patients; 22 - the doctor's room.

54. THERE ARE THREE TYPES OF CORRIDORS 1)The first type is a lateral corridor (unilateral building). This corridor is convenient for patients and personnel movement, it is well ventilated and insolated; but at the same time the department is extended in length, that worsens the service of patients. 2)A central corridor (bilateral building) is the second type of corridor design. In this case the corridor is badly insolation and badly ventilated. 3)The third type of a corridor is semi-bilateral system of building. In this case building-up one of the sides of a corridor should not exceed 60-75 %.

56. 3. SANITARY-HYGIENIC AND TREATMENT-AND-PROTECTIVE REGIMEN SURGICAL DEPARTMENT. Functions of this department are: A.Reception of patients; B.Specification of diagnosis; C.Surgical help for patients.

57. The main peculiarity of surgical department is the presence of the operating block. For creation of aseptic conditions during the operation in operating block should be 3 zones:  sterile zone;  especially clean zone;  clean zone.

59. In the first zone there are to which strict aseptic requirements are specified. The sterile zone includes: I.Operating room; II.Room for sterilization of surgical materials and instruments.

61. The second zone is called especially clean zone. It includes: 1. Preoperating room; 2. Room for narcosis. These rooms are connected directly with operating room.

63. In the third zone there must be: 1.Room for preparation and keeping blood; 2.Room for portable equipment 3.Rooms for surgeons and nurses; 4.Laboratory for urgent analyses 5.A protocol room; 6.Clean zone for sanitary test of the personnel.

64. ROOMSTHE AREA, m 2 The operting room for general operations36 The orthopedic, traumatologic and neurosurgery operations 42 Heart and vessels operations operating room 48 The preoperating room, if there is one operating room; if there are two operating rooms 15 25 A dressing room22

65. The operating room must face the North or North-East. The light coefficient in operating room must be 1/3 - 1/4, coefficient of natural lighting must be 2%. The level of artificial lighting on the operating field and in the depth of a wound should be 3000-1000 Lx. The spectrum of artificial lighting should be about the spectrum of day light.

66. In operating rooms, rooms for narcosis it is recommended to provide air- conditioning purified with bacterium filters. While air-conditioning should provide domination of air inflow speed over outflow. The ratio of air movement should be 2-3 times per hour, during narcosis ratio of air movement must be 10 times per hour. The temperature in the operating room must be 22-25°C. The relative humidity of air should be up to 60%.

67. THERAPEUTIC DEPARTMENT The main functions of the therapeutic department: RECEPTION OF THERAPEUTIC PATIENTS ESTABLISHING DIAGNOSIS AND PROVIDING CONSERVATIVE TREATMENT

68. 1.wards for patients; 2.an office for head of department; 3.a room for interns; 4.a medical post (more often 2); 5.a manipulation room; 6.a functional diagnostic room; 7.an X-ray room (one X-ray room for 100 beds); 8.a physiotherapy room for electric phores; 9.electric sleep; 10.a laboratory for clinical diagnostic researches, a public catering organization, a toilet and other subsidiary rooms. The therapeutic department consists:

69. Infectious department The functions of infectious department are: 1)reception of the infectious patients; 2)specified diagnosis; 3)isolation of patients; 4)medical treatment of them.

70. Peculiarities of the infectious department design are localization of the infectious department in a separate building, the design of small infectious department should permit dividing it into several independent sections intended for health service of patients with various infections. For improvement of isolation of patients sections are designed for one and two beds, maximum four beds in ward, all wards are equipped with a washstand and a tap. Isolation wards are designed for one or two beds, 22 m 2 and 27 m 2 accordingly.

71. A -, B -, C -, D -.

72. 4. PROPHYLAXIS OF HOSPITAL INFECTIONS Among the hospital infections: I.The first place belongs to the diseases of upper respiratory organs and children's in­fections, namely influenza, measles, chicken pox, scarlet fever, infectious paratitis, quinsy. II.The second place belongs to staphylococcal and streptococcal infections of the skin, hypodermic cellular tissue, mucous membranes, post-operative sup-purative inflammatory complications and septic diseases. III.The third place obtain intestinal infections, i.e. dysentery, salmonnelesis.

73. Sources of hospital infections are patients, who get into hospital in the incubation period of infectious diseases, patients brought to hospital with mixed infection, patients, who have not finished terms of quarantine (somatic patients), carriers of pathogenic staphylococcus, streptococcus, intestinal infections, poliomyelitis are among patients and medical staff, visitors of hospitals carriers of the microbes or visitors with easy forms of infectious diseases.

74. For these purpose it is necessary to create rational accommodation of departments, isolation of wards from the operating block, anesthesiological department, medical diagnostic department, and others.

75. I.Sanitary-technical measures are ventilation of hospital rooms and air-conditioning of hospital premises. II.Sanitary and antiepidemic measures include sanitary: 1. hygienic; 2. sanitary-antiepidemic. III.To provide sanitary culture of personnel and patients. IV.Bacteriological control in department. V.Relieving among the staff and patients bacterial carriers of infectious diseases is also regarded as prophylactic measures.

76. SPECIFIC PROPHYLAXIS INCLUDES PLANNED SPECIFIC PROPHYLAXIS AND URGENT SPECIFIC PROPHYLAXIS.

80. Each hospital should have admission department. The structure of rooms in a department shoud correspond to the specific character of diseases and age of patients. Hospital infections are the get of infectious diseases acquired by patient during their examination or treatment in hospitals. Prophylaxis of hospital infections is achieved by specific and nonspecific measures.

81. THANKS FOR ATTEINTION