What does an operating room look like in a hospital? Operating block of surgical departments. Administering a cleansing enema to a patient

An important role in the prevention of postoperative complications and the successful outcome of the operation is played by proper organization operation unit, where most of the surgical interventions are carried out.

Operating unit device.

The surgical hospital has an operating unit, each department of the surgical profile is assigned an operating room that meets European standards in terms of equipment. The operation of the operating unit is based on the following provisions:

Operating block - a complex of specially equipped rooms for performing operations and providing support

their activities. The operating unit should be located in a separate room or wing of the building, connected by a corridor to the surgical departments, or located on a separate floor of a multi-storey surgical building. It distinguishes separated operating rooms for performing clean and purulent operations. In addition to operating rooms, the following specially equipped rooms are provided in the operating block:

preoperative room, sterilization room, blood transfusion room, anesthetic room, material room, plaster room, manager's office, staff rooms, sanitary checkpoint, etc.

General requirements for a modern operating unit:

Its premises should have sufficient cubic capacity, illumination, be convenient for cleaning and washing;

Finishing materials of the premises must be resistant to repeated sterilization with chemical antiseptics and UV rays;

Heating and ventilation should provide optimal conditions for the work of staff and the health of patients;

The equipment must meet the modern requirements of surgery and anesthesiology and, if possible, be located outside the operating room;

Reliable communication of the operating unit with the departments of the medical institution is required using a telephone, an alarm system and an elevator system.

The organization of work of the operating block and the rules of behavior of the personnel in it are strictly regulated. Organizes the work of the operating unit its head (surgeon) and senior operating room nurse. Access to the operating block is strictly limited; persons not belonging to its staff are admitted only when accompanied by responsible persons. Persons with acute respiratory diseases and purulent-inflammatory processes are not allowed to be in the operating room. Entrance to the operating room in woolen or synthetic clothing is prohibited. For all members of the operating team, special clothes are used (hat, shirt, trousers, shoe covers, apron and mask), which differ in color from the accepted clothes of other departments of the medical institution, including the purulent operating room. In the operating room for planned operations, first of all, clean operations are performed (on the thyroid gland, blood vessels, joints, for hernias, etc.) and only then are operations associated with possible microbial contamination (cholecystectomy, stomach resection, etc.). Some additional requirements are imposed on the order of work in a purulent operating room. Surgical instruments, dressings and underwear are stored separately and under no circumstances are used for aseptic operations. The combination of work of personnel (nurses, orderlies) in a clean and purulent operating room is excluded.

To ensure the sterility regime in the operating unit

allocate special functional areas. General regime zone: here are the offices of the head, the head nurse, rooms for storing and sorting linen and tools.

The restricted zone, or technical zone, combines production facilities to ensure the operation of the operating unit. Here are the air conditioning equipment.

air, vacuum installations, installations for supplying the operating room with oxygen and narcotic gases, a battery substation for emergency lighting, a darkroom for developing X-ray films.

The strict regime zone consists of such premises as a sanitary inspection room, where there is a room for undressing personnel, showers, cabins for putting on sterile clothes. These rooms are arranged in series, and the staff leaves the dressing booth directly or through the corridor to the preoperative room.

The same zone includes rooms for storing surgical instruments and apparatus, anesthesia equipment and medicines, a blood transfusion room, rooms for the duty team, a senior operating nurse, and a sanitary unit for the personnel of the operating unit.

The sterile regime area combines the operating room, preoperative room and sterilization room. In the premises of this zone, operations are carried out directly - in the operating room, the preparation of the surgeon's hands for the operation - in the preoperative room and the sterilization of instruments that will be needed during the operation or are used repeatedly - in the sterilization room.

Cleaning the operating room is carried out in several stages:

1. before surgery - pre-cleaning: 1% chloramine, 1% solution of incrasept R (PE), 3% H2O2 with 0.5% detergents;

2. current cleaning (during the operation): wiping blood, pus from the floor, cleaning up fallen objects;

3. postoperative cleaning: table treatment, change of sheets, cleaning from the basins of material with pus and blood;

4. final cleaning (at the end of the operating day): cleaning of all items using antiseptics; washing the wall at the height of the nurse);

5. general cleaning (walls, ceiling… - once a week).

Prevention of air infection.

Masks are used to reduce the contamination of the operating room air and reduce the transmission of infection by airborne droplets.

In order to reduce the microflora in the operating room, wet cleaning is carried out (1% chloramine solution, 1% incrasept B solution, 3% hydrogen peroxide solution with 0.5% detergent solution).

Bactericidal lamps are used for more complete sanitation of the air.

Disinfection and sterilization of instruments, gloves, syringes, dressings, monitoring of instruments for occult blood and washing solution, treatment of surfaces of tables, bedside tables, walls and care items, sterility control, preoperative preparation of the surgeon's hands, preparation of the surgical field are carried out in accordance with the order of the Ministry of Health of the Republic of Belarus No. 165 of December 25, 2002 "On disinfection and sterilization in healthcare facilities", instructions No. 351 of December 16, 1998 "Instructions for the prevention of nosocomial infection with HIV infection and the prevention of occupational infection of health workers", order of the Ministry of Health of the Republic of Belarus No. 66 of April 20, 1993 " On measures to reduce the incidence of viral hepatitis in the Republic of Belarus”.

During the postoperative period, a set of measures is carried out aimed at preventing and treating complications, as well as contributing to the processes of reparation and adaptation of the body to the new anatomical and physiological ratios of organs and tissues created by the operation. These include: adequate pain relief, careful care, rest, breathing exercises, exercise therapy, massage, bowel decompression, regular dressings, wound drainage.

Prevention of nosocomial purulent infection.

One of the important sections of the work of a surgeon is to take measures to prevent nosocomial purulent infection.

Nosocomial infection - infectious diseases acquired by patients in medical facilities, manifested mainly by suppuration syndrome and septic lesions. The source of infection in the surgical department are patients with acute and chronic forms of purulent-septic diseases and asymptomatic carriers among patients and staff. The spread of infectious agents occurs in two ways: contact and airborne.

To prevent postoperative purulent complications, a set of sanitary and hygienic measures is organized and carried out aimed at identifying and isolating the source of infection, and interrupting transmission routes. The complex includes: timely detection and isolation in special departments (sections, wards) of patients whose postoperative period was complicated by purulent-septic diseases, timely detection of carriers of pathogenic staphylococcus and their sanitation, the use of highly effective methods for disinfecting the hands of medical staff and the skin of the surgical field, organizing centralized sterilization of linen, dressings, syringes, instruments, the use of disinfection methods and means for processing various environmental objects (bedding, shoes, clothing, soft equipment, etc.) that are of epidemic importance in the transmission of nosocomial infection. The main documents regulating the implementation of these measures are order No. 720 of July 31, 1978 “On improving medical care for patients with purulent surgical diseases and strengthening measures to combat nosocomial infection”, Appendix No. 1 to order No. 720 of July 31, 1978 “Instructions for organization and implementation of sanitary and hygienic measures for the prevention of nosocomial infection in health care facilities in surgical departments, wards and intensive care units ", Order of the Ministry of Health of the Republic of Belarus No. 165 dated December 25, 2002 "On disinfection and sterilization in healthcare institutions". Responsibility for carrying out comprehensive measures to combat postoperative complications rests with the chief physician, heads of surgical departments.

The operating block is a complex of special premises surgical departments designed to perform operations and carry out activities to ensure them. The operating block is the "holy" place of the surgical hospital, it is here that the main stage of treatment of a surgical patient (operation) is carried out, and the result of the entire treatment largely depends on the quality of its implementation. Therefore, special requirements are imposed on this subdivision of the surgical department. When organizing the work of the operating unit, it should be remembered that its main purpose is to create the most favorable environment for performing operations while minimizing the risk of introducing an exogenous infection into the surgical wound. Therefore, the main requirement for its device is maximum isolation from other departments of the medical institution.

Operating unit placement

The operating unit should be located on a separate floor or in a separate wing of the building, connected by a corridor with surgical department. The best option is if it is located in an isolated annex or a separate building connected to the main building by a passage. To avoid the influence of adverse environmental factors (noise, air pollution, etc.), the operating unit should be located on the upper floors - not lower than the second. Allows you to avoid, firstly, the sun's rays, which, reflected from the shiny walls, floor and instruments, complicate the work of surgeons, and secondly, overheating of the premises in the summer months.

Operating blocks for “clean” and “purulent” operations must be placed separately. medical institution With one operating unit, it is necessary to allocate operating rooms for performing clean and purulent operations, while dividing and removing them as much as possible. They should employ different personnel and use different equipment, surgical instruments, underwear. Despite the fact that operations are performed in purulent operating rooms for patients with already developed purulent-septic diseases, the requirements for their layout, equipment and regimen are the same as for clean ones.

Despite the desire for maximum isolation of the operating unit, it should be ensured good communication with a resuscitation and intensive care unit, specialized medical and diagnostic departments.

Operating block layout

For the normal functioning of the operating unit, the following groups of rooms are required:

1. Operating rooms (operating rooms, anesthetic rooms, equipment rooms, preoperative rooms, awakening wards);

2. Premises for personnel (sanitary inspection room, rooms for surgeons, nurses, anesthesiologists, senior operating sister, protocol room);

3. Utility rooms (linen, material);

4. Industrial premises (premises for the preparation of dressings, instrumental, autoclave, sterilization, central sterilization department).

The sterile regime in the operating room is ensured primarily by preventing the entry of microorganisms into the operating room from other rooms and their spread in the operating room. To ensure aseptic conditions during the performance of surgical interventions, to prevent pollution of the air and rooms in the immediate vicinity of the surgical wound, the principle of zoning is observed when planning the operating unit. It involves the division of premises into special functional areas. There are 4 zones of sterility in the operating unit:

1. Zone of the sterile mode.

2. High security zone.

3. Restricted zone.

4. General hospital regime area (not sterile).

The sterile regime zone (zone 1) includes the premises in which operations are performed, surgical instruments are sterilized: operating rooms, sterilization rooms. In the premises of this zone, the most stringent requirements for asepsis are imposed.

The strict regime zone (zone 2) includes premises directly connected with the operating room by a door: preoperative, anesthesia. They communicate with the premises of the third zone through an internal corridor.

The restricted regime zone (zone 3) includes all other premises inside the clean zone of the sanitary inspection room (instrumental, material, urgent analysis laboratory, patient awakening room, rooms for nurses, surgeons, protocol room, etc.)

The zone of general hospital regime (zone 4) includes premises located outside the sanitary inspection room or a special vestibule (gateway) - the office of the head, the office of the senior medical sisters, rooms for dirty laundry.

Purpose of the main premises of the operating block

Operating room. Designed to perform operations. In the operating room, the operating team is dressed in sterile clothing. There are also zones in the operating room. In the most remote part of the entrance to the premises, there is a working room for an operating room nurse. There is a “large” operating table for sterile instruments and dressings, tables for solutions and suture material, stands for bixes with sterile linen and material. Employees not dressed in sterile clothing are not allowed into this area during the operation. In the working area of the sister, the operating team puts on sterile gowns and gloves before the operation, the operating sister completes the “small” instrument table.

In the central zone there is an operating table, which is installed so that access to the patient is provided from all sides. Anesthesiological equipment is placed in the area adjacent to the exit. On the wall where the door is located, a centralized supply of medical gases (oxygen, nitrous oxide) is carried out.

Sterilization. In the sterilization room there are dry-heat cabinets for sterilization of instruments. The sterilization room communicates with the operating room through a transfer window.

Preoperative. Designed to prepare the operating team for the operation. Washing hands, putting on aprons, goggles is carried out here. In the preoperative removed after operations sterile clothes, gloves, masks.

Anesthesia. It is designed to prepare anesthesiologists for work in the operating room, introducing the patient into anesthesia. In the operating blocks of the old layout, anesthetics are not provided, therefore, the introduction of the patient into anesthesia is carried out directly in the operating room.

Protocol. In the protocol room, doctors write down the protocols of surgical interventions, fill out the necessary medical documentation.

Personnel checkpoint. Here, the operating team is undergoing sanitization. There are "dirty" and "clean" zones in the sanitary inspection room. In the “dirty” area, staff undress and leave clothes in individual lockers. Personnel can enter the “clean” zone only through the shower cabin. After taking a shower, the staff puts on clean linen, special suits and shoes. There are no sanitary checkpoints in the operating rooms of the old layout. The separating function is performed by the vestibule.

Finishing of the premises of the operating block

The walls and floors of the operating room must be slit-free, smooth, waterproof, impervious to dust, insects and rodents. In operating rooms, the joints between walls, floors and ceilings should be rounded and covered with materials that allow repeated washing and disinfection. Most often, tiles are used for this, but marble is considered the best material. The best colors are green-blue, gray-green, as they are less tiring for the eyesight. Their surface should be matte. A mandatory requirement for all finishing materials, in order to prevent possible explosions of gas mixtures, is their antistatic properties.

Equipment

There should be no unnecessary furniture and equipment in the operating room. The less equipment and furniture, the easier it is to keep it clean. Furniture should be light, simple in design, portable, with a well-washable surface.

operating mode

The fundamental principle of the organization of work in the operating room is the strictest observance of asepsis rules. Compliance with the regime begins with the planning of the operating day. In accordance with the degree of infection of the operation, the operating rooms are determined, where the surgical intervention will be performed and its sequence. Operations are performed in order from less infected to more infected.

The operation mode of the operating block provides for the restriction of visits to it. No one should be in the operating room during non-working hours. Workers of the operating room, operating teams, anesthesia teams are allowed into the operating room. It is forbidden to enter the operating room unnecessarily. Before the operation, the staff goes through a sanitary inspection room, changes into special underwear that differs in color from the clothes of employees of other departments, puts on shoe covers or special shoes, hats, masks. Currently, instead of masks, special plastic caps have appeared on the face, from under which the exhaled air is sucked out by a special system. Patients are also preparing for the operation, washing, changing linen, shaving the hair in the area of the surgical field, and putting on a cap on the head. Access by unauthorized persons (students, observers) is minimized as much as possible. Television is used to monitor the operation in modern operating rooms. During the operation, the movement of personnel in the operating room should be limited. Talk needs to be limited. A person in 1 hour at rest when breathing releases 10-100 thousand microbial bodies * and when talking - up to 1 million.

In the operating room, it is necessary to maintain a certain microclimate (temperature, humidity, air purity). Violations of the temperature regime and air exchange can adversely affect the patient's condition and lead to the development of complications. The optimal temperature in the operating room is considered to be 22-25°C with a humidity of 50? 7 o. Higher temperatures cause increased sweating in surgeons and the patient, a decrease in temperature can lead to cooling of the patient.

An important element in maintaining an appropriate microclimate and preventing airborne infection is proper ventilation of the operating room. According to the requirements, ventilation should provide air exchange up to 3-4 times per hour. To ensure sufficient ventilation, operating rooms are equipped with air conditioners. Operating rooms are equipped with supply ventilation, not exhaust. During its operation, air is supplied from the street and forced through the filters into the room. Together with the dust deposited on the filters, the microorganisms fixed on it are removed. Air leaves the operating room through doors and windows. The use of forced ventilation avoids the ingress of polluted air from adjacent premises.

However, it is impossible to provide sanitation of air in the operating room only with ventilation. Therefore, bactericidal ultraviolet lamps are used for air disinfection. Operating rooms can be equipped with ceiling, wall, floor lamps. A bactericidal lamp creates a "sterile zone" around itself with a diameter of (2 Gm). They are placed in the direction of convection air flow. Be sure to install a lamp above the entrance, so that the air entering the operating room is subjected to bactericidal radiation. It is not allowed to place lamps closer than 2 m from the operating table. Air disinfection with bactericidal lamps is carried out during breaks between work, at night or at a specially allotted time. Be sure the lamps must be lit during the cleaning and at least an hour after it is over, since when it is carried out, a large number of microorganisms rise into the air along with the dust. The operation of germicidal lamps is allowed in the presence of people, only when using aluminum reflective screens. A bactericidal lamp sterilizes 30 m 3 of air for 2 hours, while simultaneously destroying microorganisms on open surfaces. Air irradiation for an hour can reduce the amount of microflora in the air by 75-90%.

When working in the operating room around heated bodies (equipment, lamps, etc.), turbulent air flows occur, which can contribute to the entry of microorganisms into the operating room area wounds. Therefore, for the production of a number of operations (organ transplantation, implantation of prostheses, etc.), ultra-clean operating rooms with a laminar flow of sterile conditioned air are being created. In them, the air that has passed through the bacterial filter is supplied to the operating room at a pressure of 0.2 - 0.3 atm. through the ceiling and out through the holes in the floor. Thus, a rectilinear (laminar) movement of sterile air is created. A constant vertical flow carries away from the operating room microorganisms that have entered the air from the patient or from the medical staff. Air exchange in such operating rooms reaches 500 times per hour.

The operating room must be kept clean and tidy at all times.

For this, several types of cleaning are provided: preliminary, current, postoperative, final and general.

Preliminary. In the morning, before starting operations, wipe horizontal surfaces (floor, tables, window sills) with a damp cloth to remove dust that has settled overnight from the air.

Current cleaning. Produced during operations. During the operation, fallen napkins, balls, instruments are removed, removed organs are taken out of the operating room, pollution is eliminated.

Postoperative. Between operations, waste materials are taken out of the operating room, the operating table is wiped with an antiseptic solution, and linen is changed.

Final. It is carried out after the end of the working day. Wet cleaning is carried out using disinfectant solutions of the ceiling, walls, window sills, all items and equipment, the floor. After its completion, bactericidal lamps are turned on.

General. It is performed according to the plan once a week, no operations are performed on this day. When performing general cleaning, the ceiling, windows, walls and floor are washed hot water with soap and antiseptics. All mobile equipment is removed from the operating room and processed in another room. General cleaning is unscheduled when the operating room is heavily contaminated, for example, after surgery in patients with an anaerobic infection - gas gangrene.

Control over the state of the operating room is assigned to the senior operating sister. She carries out day-to-day monitoring of the condition and operation of the operating unit, its timely cleaning and proper maintenance, and organizes bacteriological studies in the operating room. Control over the sterility regime is carried out by bacteriological studies of the operating room air, washings from the walls, ceiling, apparatus and instruments. Such studies are performed once a month.

Similar principles are followed when organizing the work of dressing rooms. All the rules adopted for the operating unit apply to the dressing rooms.

Operating block - a complex of specially equipped rooms designed for surgical operations. About. placed not lower than the second floor of the building and isolated from other departments and services of the hospital while maintaining convenient connections with the surgical departments, as well as intensive care and anesthesiology departments. About. for purulent and "clean" operations are planned separate. In O.'s structure. includes: an operating room, a preoperative room, an anesthesia room, a sterilization room, a hardware room, a material room, a room for operating sisters, an office for the head of the operating unit, a sanitary inspection room and other rooms.

Premises O. b. should be convenient for wet cleaning, inaccessible to rodents and insects. Floors, walls and ceilings in O.'s rooms. must be covered with a water-resistant inorganic material that can withstand clean handling with disinfectant solutions. The windows of the operating room are oriented to the northeast or northwest. The ratio of window area to floor area should be 1:3. The floors in the operating room are covered with antistatic material to prevent the occurrence of sparks when metal objects fall on it. The walls are tiled with matte gray-green or gray-blue tiles, the ceiling is painted with oil paint ( rice .) The air temperature in the operating room is maintained within 22-23 °, relative humidity - 50-60%. Operating rooms designed for training and demonstration sessions are equipped with transmitting television cameras mounted to the operating lamp, or viewing windows in the ceiling of the room.

5 m from each other. It is recommended to additionally install stationary or mobile air cleaners (VOPR-0.9 or VOPR-1.5M), capable of 15 min work to reduce the dust content of the air and the number of microorganisms in it by 7-10 times. Artificial lighting of the operating room is carried out by panel fluorescent lamps or incandescent lampshades with a total power of 500 Tue at 50 m 2. The illumination of the surgical field should be within 3000-5000 OK. This is ensured by shadowless ceiling lamps installed above the operating table.

Compliance with the sanitary and hygienic regime in O. b. provides for strict adherence to the rules asepsis . The whole territory of O. b. divided into zones: the first zone (sterile) includes rooms in which the most stringent asepsis requirements are observed (operating room, sterilization room); the second zone (strict regime) includes rooms directly connected with the operating room (preoperative, anesthetic); the third zone (restricted mode) - room for operating nurses,

control room, laboratory of urgent analyzes, clean zone of the sanitary inspection room, etc.; the fourth zone (general hospital regime) has an entrance that is not connected with the passage through the sanitary inspection room. The first zone is separated from the second and third by a wide red strip applied to the floor, which the medical staff should not cross without special clothing. During non-working hours, the doors of the operating room must be locked. Medical personnel not participating in the operation are not allowed to be in the operating room. Enter O. b. in linen shoe covers, clean gowns, a cap and a four-layer gauze mask. It is strictly forbidden to be in the operating room in street shoes. All items brought in or imported into O. b. (wheelchairs, gas cylinders, etc.) should be treated with disinfectant solutions.

In the operating room, 5 types of cleaning are carried out: preliminary - daily at the beginning of the working day they wipe the dust that has settled overnight on horizontal surfaces (on the floor, window sills, tables, etc.); current - during the operation, fallen objects are lifted (instruments, balls, tampons, etc.), and they also wipe the floor with antiseptic solutions when an accidentally spilled liquid (pus, exudate, bile, etc.) gets on it; cleaning after the end of the next operation - the floor in the central area of the operating room is treated with disinfectant solutions,

INTRODUCTION…2

SOME ELEMENTS OF PLANNING SURGICAL DEPARTMENTS…3

REQUIREMENTS FOR EQUIPMENT OF OPERATING UNITS…4

LIGHTING AND ELECTRICAL SUPPLY OF SURGICAL HOSPITALS AND OPERATING ROOMS…7

ROOM VENTILATION…8

OPERATING ROOM MICROCLIMATE…10

AIR CLEANING…10

FIGHTING NOISE…13

CONCLUSION…14

LIST OF USED LITERATURE…15

Introduction

Medical institutions in which surgical care is provided to patients are divided into two types: outpatient and inpatient. Outpatient clinics include polyclinics in which there are surgical rooms or departments, as well as ambulance and emergency care. Among the hospitals, there are multidisciplinary and specialized ones.

At the first stage, the patient encounters outpatient clinics. In the polyclinic, conservative treatment of a number of diseases, dressings and even minor operations (removal of benign soft tissue tumors, opening of panaritium, etc.) are carried out. Recently, outpatient surgery centers have been organized at polyclinics, where somewhat more complex operations are performed (for hernia, limbs and other diseases). In more complex cases, patients are sent to hospitals for special examinations and operations.

Hospitals can be designed to provide emergency care (teams of specialists are on duty around the clock) and to provide assistance in a planned manner.

The success of inpatient treatment of patients largely depends on the optimization of the hospital environment. This includes optimal ward hygienic conditions that contribute to the fastest recovery of patients. Hygienic conditions prevent the emergence and spread of nosocomial infections, as the most formidable factor affecting the sanitary and hygienic comfort of hospital departments. Hospital hygiene should provide optimal conditions for the work of medical personnel, protect them from the effects of occupational hazards (such as neuropsychic overwork, skeletal muscle tension, night shifts, chemical and physical agents, nosocomial infection, etc.). The introduction of new technologies in medicine is inextricably linked with the achievements of hygienic science, the norms and rules of which make it possible to ensure the proper level of technology and safety during complex procedures (working with radionuclides, lasers, barooperative, organ transplantation).

These optimal conditions can only be provided by an integrated approach to the design, construction and operation of hospital buildings, taking into account modern scientific developments and the requirements of various fields of science. And most importantly, hygiene plays one of the most important roles in this task.

In modern multidisciplinary hospitals, the number of surgical beds is approximately 25-45% of the total bed fund. The surgical department consists of wards and an operating block, which, having acquired autonomy in recent years, has undoubtedly become one of the most complex functional elements of the clinic.

Some elements of the planning of surgical departments

Currently, two main options for organizing operating units are used.

The first option, which has been used for a long time, provides for the presence of an operating unit at each surgical department. At the same time, in order to prevent air pollution, the operating unit is placed in the dead-end zone of the department or in a separate wing of the building. According to the second option, the operating units of several surgical departments are combined into one operating complex, for which a separate wing of the ground or underground floor is allocated or placed in a specialized annex that is connected to the hospital directly or through a closed passage. In the latter case, the height and dimensions of the rooms in the operating rooms will not depend on the layout of the main building where the hospital is located. The second option is optimal, as it provides complete isolation of operating rooms from the hospital.

As part of the operating unit, two completely separate, carefully isolated departments are provided: aseptic and septic, connected with the hospital by sluice passages. A purulent dressing room should be placed in the purulent department next to the purulent operating room. If the block consists of only two operating rooms, then they are divided into clean and purulent; in this case, the purulent operating room should be strictly isolated from the clean one. The following set of rooms can be recommended: operating room, preoperative room, sterilization room, anesthesia room, equipment room, cardiopulmonary bypass room, ancillary rooms, staff rooms, locks with the necessary equipment.

In a surgical hospital with a small number of beds (up to 50), the operating unit can be located on the same floor as the hospital.

At the same time, it is necessary to ensure careful isolation between the operating unit and the hospital. Such isolation is achieved by the installation of gateways, in which the processing of persons moving from the hospital to the operating unit is carried out.

The area of the lock rooms depends on the capacity of the surgical department, the number of operating tables, the intensity of personnel traffic, etc. The lock room must have an entrance and exit arranged on opposite sides and be separated by a partition with a passage door. In the dirty part of the airlock, dirty overalls (boot covers, bathrobe, underwear, mask, hat) are removed, which are immediately put into a special container (polyethylene bag). In the clean part of the lock put on clean overalls.

Above the entrance and exit from the lock, as well as in the middle part of the room under the ceiling, a source of UV radiation is placed. A washbasin is installed in the dirty part of the gateway. In the locks between the clean operating room and the hospital, an air exchange system with a positive air balance should be arranged (the inflow is greater than the exhaust), in the locks between the purulent department and the hospital - with a negative air balance, i.e. the exhaust should be greater than the inflow. The sterilization room should be located separately, in an isolated place.

When designing new or reconstructing existing buildings, in which operating units are supposed to be installed, it is necessary to provide for strict zoning in order to ensure aseptic conditions. In the first zone of the operating block, operating rooms and sterilization rooms should be located, in the second - preoperative and anesthetic rooms, in the third - all auxiliary rooms, as well as a sanitary checkpoint for personnel.

All personnel working in the operating unit are sent to their workplaces after passing through the sanitary checkpoint. Moreover, it is necessary to strictly observe the ways of movement according to the destination: surgeons - through the preoperative room to the operating room, and after the end of the operation - to the auxiliary rooms, the anesthesiologist and anesthetist nurses - to the anesthesia room (if it is separate) and then to the operating room, after the operation - to the auxiliary rooms, operating nurses - through the preoperative room to the operating room, and then to the auxiliary rooms.

It is impossible to allow maintenance of clean and purulent operating rooms by the same auxiliary (auxiliary) personnel. Upon completion of work in the purulent department, personnel can enter the premises of the hospital only after appropriate treatment in the lock rooms.

A patient entering an operation from a hospital passes through the gateway, then goes to the anesthesia room (if it is separate), and from there to the operating room.

In the operating room, if possible, should be placed. 1 operating table (area 36-48 m2 with a height of at least 3.5 m). The number of tables is taken at the rate of 1 table for 30-40 surgical beds.

For complex operations, taking into account a large operating team, it is necessary to have an operating room with an area of at least 45-50 m2.

The walls of the operating room should be smooth, easy to clean, and have the possibility of irrigation with disinfectant solutions. All types of wiring and heating devices are mounted in the walls, which are recommended to be painted with matte oil-wax paint of bright gray or greenish-gray color, which removes light glare and favorably affects the surgeon's visual apparatus. If possible, the walls are laid with ceramic tiles.

In the same way, the floor of the operating room is laid and the ceiling is painted with oil paint. In the operating room, it is desirable to have two doors: one for the transport of the patient to the operation, and the second for the removal of the operated. The windows of the operating room should be oriented to the northern points. A light ratio of 1:3 - 1:4 is sufficient. Operating room doors must be tightly closed.

In some countries, in order to organize stable working conditions for the surgeon (relative to lighting and microclimate), operating rooms without windows appeared, located on the underground floors of the building.

The most important functional element of the hospital is the ward department. Each department consists of typified sections with 20 beds.

Departments are calculated, as a rule, for 60 beds (in some cases, for 90-120 beds). Each ward section provides for 60% of the wards for 4 beds, 20% for 2 and 20% for 1 bed. The norm of the area for 1 bed is 7 m2; in postoperative wards, in wards for patients with skin burns and rehabilitation treatment for adults - 10 m2. The ward for 1 bed should have 9 m2 (with a gateway-12m2).

The department provides for a dressing room, a room for storing portable equipment, a place for wheelchairs and mobile chairs, a manager's office, an intern's room, a head nurse's room and other rooms.

The ratio of the area of the wards and auxiliary premises should be 1:1 or more in favor of auxiliary premises, which allows maintaining proper general sanitary and anti-epidemic regimes in the section. In hospitals where the surgical department is located in a separate building, an emergency department is arranged in it, the size and structure of which depend on the capacity of the department. It is highly desirable to have an intensive care unit and an outpatient operating room as part of the emergency department.

Requirements for equipment of operating units

The standard operating room consists of three functional rooms: the preoperative room for the surgeon, the preoperative room for the patient, and the operating room itself. The specificity of these rooms makes the highest demands on their equipment.

A well-equipped operating room is a help to the surgeon and a certain confidence that everything possible will be done during the operation.

The so-called "heart" of any operating room is the operating table. It can be a universal table or a special-purpose operating table. Depending on the functions, the tables may differ in characteristics, but at the same time they must necessarily meet some general criteria:

The design of the table should provide easy access to the patient for both the surgeon and assistants;

Table management should be as easy and fast as possible;

The design of the table should provide for the possibility of using additional equipment;

The design of the table must take into account all possible configurations that may be required for different types and stages of the operation;

For the manufacture of the table, only high-quality materials intended for use in aggressive conditions should be used.

Operating tables are available in the following configurations:

Proctology (knee supports, proctological device, etc.);

Gynecology (intravenous infusion stand, knee and arm supports, bedpan, arch for anesthesiologist);

Traumatology (devices for fixing the patient in different positions: side supports, shoulder supports, etc.);

Neurosurgery (head supports, surgeon's hand supports, etc.);

General surgery;

Endoscopy.

Adjustments of operating tables can be mechanical, hydraulic and electrical.

In addition to the operating table, the obligatory elements of the operating room equipment are a rack for appliances (if it is not included with the table), a lamp, an anesthesiologist's trolley, an instrumental table of the "Goose" type, a step, a Bobrov table, a stool or chair for an anesthesiologist, a display cabinet, a basin on a stand, stands for bixes, watches.

In the preoperative room for the surgeon, a sterilizer, a general-purpose cabinet and a surgeon's hand wash (single, double or triple) should be installed.

The requirements for equipping the preoperative room for the patient include a gurney and a general-purpose cabinet.

One of the main requirements for furniture for operating units is its functionality and versatility. This is due to the variety of procedures carried out. As a rule, these tasks are solved through the use of a modular principle in the construction of furniture and equipment, which makes it possible to arrange sets of the necessary, based on specific conditions.

Sterility requirements are decisive for operating units. This fully applies to the furniture located in these rooms. This important requirement can be ensured by the use of special materials for the manufacture of medical furniture that can withstand repeated processing using aggressive chemicals containing alkalis, alcohols and chlorine solutions. Naturally, at the same time, these materials must be absolutely safe for human health - they must not emit harmful substances, they must not cause allergic reactions.

One of the most common materials that fully meet these requirements is stainless steel. The high manufacturability of stainless steel, its ability to successfully withstand increased loads, withstand aggressive environments and high humidity have made it the main material for the production of medical furniture and medical equipment for various purposes. This includes surgical tables, surgical sinks, chairs for medical personnel, couches, surgical and procedure chairs and much more that is included as standard in operating rooms.

Stainless steel furniture produced by well-known manufacturers has high reliability, durability, good ergonomic performance, high functionality and sufficient versatility to ensure comfortable and safe medical procedures for various purposes. Resistance to high humidity and exposure to chemical elements makes such furniture suitable for repeated cleaning and wet cleaning without losing its performance and neat appearance.

Another important requirement for the materials from which medical furniture for operating units is made is their ability to withstand the harmful effects of ultraviolet radiation used for bacterization. Stainless steel is able to meet these important requirements.

More than others, austenitic stainless steels are adapted to aggressive environments. Austenitic steels (mostly AISI 304) are an ideal material for use in places where strict adherence to sanitary and hygienic conditions is necessary.

The main manufacturers also offer other modern materials used in the manufacture of furniture for equipping operating units. Among them are stone surfaces, ceramics and chemically resistant plastics. This allows you to choose the best option that combines the main qualities and an affordable level of cost.

Lighting and electrical supply of surgical hospitals and operating rooms

A sufficient level of natural illumination in the wards, in the rooms for the daytime stay of patients, manipulation, sterilization is achieved with a ratio of glazing area and floor area of 1:5, 1:6, while the minimum coefficient of natural illumination (KEO) should not be lower than 1%. In operating rooms, dressing rooms / staff rooms, laboratories, the light factor is 1:4, 1:5.

Windows should be glazed with so-called enriched glass, which transmits a greater amount of long-wave ultraviolet radiation. If the windows are not oriented to the north, then it is advisable to use glass that delays thermal radiation.

Artificial lighting should be provided in all rooms of the surgical department: general, local, bedside and night, as well as installations for UV air sanitation.

The illumination of the premises of the surgical hospital and the operating unit is provided by incandescent lamps and fluorescent lamps. The latter should be preferred. In preoperative, operating, anesthesia, resuscitation, dressing, anti-shock rooms, it is advisable to install closed-type lamps with solid diffusers in a splash-proof design. In these rooms, the illumination created by general lighting fixtures should be 150 lux (in operating rooms 200-500 lux). In operating rooms, special lighting is provided to ensure a gradual change in brightness from a highly lit operating table to lower levels of illumination in the rest of the room. The illumination of the surgical field should not exceed the optical limit so that there is no blinding (from surgical linen, instruments) and no shadows.

To illuminate the wards, it is advisable to use fluorescent lamps such as LHBTs, LB, LDTs-1. These luminaires must have a noiseless ballast: for example, a starter device with an especially low noise level for fluorescent lamps with a power of 20-40 W.

Local bedside lighting should provide convenient clinical examination and classes of the lying patient. Illumination from a local lamp (on a book in the hands of a lying patient) with an incandescent lamp should be at least 100 lux and with a fluorescent lamp - at least 200 lux. Local lighting should be carried out with direct light fixtures (they are installed at a height of 1.6-1.8 m from the floor).

Particular attention should be paid to lighting in operating rooms.

Exceptionally favorable lighting conditions, maximally facilitating the rapid implementation of the most complex operations, should be created on the surgical field. At the same time, in order to reduce eye strain, discrepancies between the brightness of the surgical field, its background and surroundings should be avoided.

In practice, three main ways of lighting the surgical field are used: by means of mobile lamps, by means of lamps built into the design of the operating room (walls, ceiling); with suspended lighting.

The first and third methods are more commonly used, but the second method reduces heat generation, increases lighting flexibility, significantly reduces the number of dust-collecting surfaces, allows lighting installations to be compactly placed and combined with ventilation.

To reduce visual fatigue, it is necessary to ensure that the brightness of the immediate surroundings of the surgical field is somewhat lower than the brightness of the field itself and is related to it approximately as 1:2. This can be achieved by painting the surrounding surfaces (linen) in colors (green, blue, green-blue, dark gray, etc.) that have a low reflectivity. Moreover, the ratio of the brightness level of the remaining surfaces of the operating room to the brightness of the operating field should be no more than 1:10.

Lighting must be arranged in such a way as to avoid the occurrence of brilliance. This is achieved by closing light sources for viewing from the operation site and using lamps with matte screens.

In operating rooms, as well as in other main rooms of the operating and dressing unit, fluorescent lighting should be used, which improves color rendering on the operating field, limits the formation of shadows, creates the required lighting conditions on the surface and in the depth of the operated cavity, and prevents the operating head from heating up.

When monitoring the lighting conditions in operating rooms, pay attention to the following:

1) the illumination of the wound surface should be at least 3000-10000 lux;

2) on the surgical field, on the surface of the wound in its depth there should be no shadows;

3) there should be no direct and reflected glare in the field of view;

4) the color of lighting should be close to the spectrum of daylight;

5) the increase in air temperature due to lighting at a height of 0.5 m from the surgical field should not exceed 2–3 °;

6) the uninterrupted operation of the lighting installation must be ensured.

During the operation of lighting installations, one should: a) use lamps of the designed power; b) systematically wipe the surfaces of fixtures; c) timely change aging (long-burning) lamps; d) use general light fixtures with shaders; e) compliance with the height of the suspension of fixtures; e) do not use unprotected lamps;

The premises of the surgical dressing unit must be equipped with emergency lighting.

Turning on and off the lighting of operating rooms, dressing rooms, anesthesia, extraction rooms should be made from corridors or other rooms.

The electrical wiring is hidden, the sockets are installed flush with the wall surface.

In operating rooms, anesthesia, sterilization, hardware, laboratory rooms that are part of the blocks, there must be a sufficient number of sockets for connecting devices, instruments and other current consumers.

In addition, sockets with three-phase current are placed in these rooms, as well as sockets with a grounding contact (two-pole sockets).

Room ventilation

One of the most effective measures to improve the working conditions of personnel, as well as those used to combat air pollution in the premises of surgical departments and to ensure its cleanliness, is artificial ventilation.

In the premises of surgical hospitals built according to modern standard projects, air conditioning and mechanical supply and exhaust ventilation are arranged. The supply of fresh air should be carried out from top to bottom, and the location of the supply and exhaust openings should be such that there is no possibility of the formation of unventilated places in the room.

The supply air intake is carried out not lower than 2.5 m from the ground level through a specially arranged brick shaft. It is necessary to arrange an umbrella over the mine. It is advisable to plant spruce or other tall shrub plantings around the mine.

The supply air supplied to the premises of the surgical hospital must be processed (mechanical cleaning on filters, heating or cooling, humidification or drying) and disinfection.

Bacteriological air purification is carried out by supplying it to antibacterial purification filters.

It is recommended to install a source of UV radiation in the outlet of the air duct (channel), by flowing around which the air can be additionally disinfected before entering the room.

Special requirements are imposed on the ventilation of the premises of the operating unit and individual operating rooms. Here it is necessary to arrange an independent system of supply and exhaust ventilation with mechanical stimulation, if there is no possibility of using air conditioning.

The air exchange rate and the design temperature in the rooms of the operating unit should be as follows. At an estimated temperature of 22 ° C in all rooms, the air exchange rate per 1 hour for the inflow is determined by calculation, for the exhaust - 8-10; in dressing rooms, manipulation rooms, preoperative rooms - 1, 5 and 2, respectively.

When ventilating the premises of the operating unit, as well as during air conditioning, it is necessary to predominate the inflow over the exhaust, i.e., a little more supply air should flow. This is done in order to prevent air from entering the operating room from the hospital and other rooms.

In addition, it is necessary to pay attention to the organization of air flows. From operating rooms that have their own supply and exhaust ventilation system with or without air conditioning, air flows should enter the preoperative, anesthesia and other rooms, and from there into the corridor. Removal of air from the corridors should be carried out through the exhaust ducts and the shaft of the staircase and elevator assembly.

Particular attention is paid to the ventilation of operating rooms. The ventilation scheme depends on the number of operating tables. With 1 table, it is advisable to supply air from top to bottom through a perforated panel and side supply slots. The supply unit is located under the ceiling above the operating table. The outflowing supply air jets, descending, create an air curtain around the operating table. This supply eliminates the increased air pollution in the operating area. At the same time, in the center of the hall, the air exchange rate reaches 60 or more in 1 hour. With a different ventilation scheme, the supply devices are located in the upper part of the walls at the corner points of the room so that the jet leaving the hole has an angle of 15 ° to the vertical plane and is directed mainly way, on operating tables. In this case, laminar air flows are created and hygienic conditions are provided.

Removal of exhaust air in both ventilation schemes is carried out from the upper and lower zones through exhaust slots arranged in the walls around the perimeter of the room, and at least half of the air (60% of the total flow) should be removed through the lower slots, since vapors of some anesthetics (halothane), heavier in relative density.

Sources of UV radiation are installed in the supply openings for additional air disinfection before entering it. room. Their installation does not replace bacterial filters and is an additional measure of air neutralization. When ventilating operating rooms, relative humidity should be maintained in the range of 50–60%, air mobility of 0.15–0.2 m / s and a temperature of 19–21 ° C during the warm period and 18–20 ° C during the cold period.

The most effective and up-to-date method of ventilating operating rooms, in terms of combating dust and bacterial air pollution, is to equip operating rooms with laminar air flow, which can be supplied in a horizontal or vertical direction. Vertical flow is preferable, as it allows, at normal air speeds, to achieve 500-600-fold exchange in 1 hour.

The microclimate of operating rooms

The condition of the operated person and the efficiency of the surgeon depend on the creation of an optimal stable microclimate in the operating room. Naturally, the requirements for the parameters of the microclimate for an undressed immobile patient and a surgeon are different.

If the air temperature rises more than +26 ° C, the patient has a thermoregulatory tension. If the temperature drops below + 17 ... + 15 ° C, patients develop signs of hypothermia. For most surgeons, the optimum temperature is around +20 °C.

It has been proven that the air temperature in the operating room in summer should be +20…+22 °С (+19…+20 °С in winter) at a humidity of 50–55% and an air velocity of up to 0.1 m/s.

Creating a stable and optimal microclimate can only be achieved by supplying conditioned air to the operating room, which is especially important in warm climate zones. Naturally, it is desirable to be able to adjust the operating room microclimate parameters.

Heating of the operating room is better to organize water, radiation with panels on the ceiling, walls or built into the floor.

Ensuring clean air

In the spread of nosocomial infection, the airborne route is of the greatest importance, and therefore, great attention should be paid to constantly ensuring the cleanliness of the air in the premises of the surgical hospital and the operating unit.

The main component that pollutes the air in the room of the surgical hospital and the operating unit is dust of the smallest dispersion, on which microorganisms are sorbed. Sources of dust are mainly ordinary and special clothing of patients and staff, bedding, soil dust ingress with air currents, etc.

Therefore, measures aimed at reducing the contamination of the operating room air primarily involve reducing the influence of contamination sources on the air.

Persons with septic wounds and any purulent contamination of the skin are not allowed to work in the operating room. It is recommended to use aseptic hand creams.

Before the operation, the staff must take a shower. Although studies have shown that in many cases the shower was ineffective. Therefore, many clinics began to practice taking a bath with an antiseptic solution.

At the exit from the sanitary inspection room, the staff puts on a sterile shirt, pants and shoe covers. After processing the hands in the preoperative room, put on a sterile gown, gauze bandage and sterile gloves.

The sterile clothing of the surgeon loses its properties after 3–4 hours and is desterilized. Therefore, during complex aseptic operations (such as transplantation), it is advisable to change clothes every 4 hours. The same requirements apply to the clothing of staff serving patients after transplantation in intensive care units.

A gauze dressing is an insufficient barrier to pathogenic microflora, and studies have shown that about 25% of postoperative purulent complications are caused by a strain of microflora sown both from a festering wound and from the oral cavity of the operating surgeon.

The barrier function of the gauze bandage is improved after treatment with vaseline oil prior to sterilization.

Patients themselves can be a potential source of contamination, so they should be prepared appropriately before surgery.

Among the activities aimed at ensuring clean air great importance has a correct and constant air exchange in the premises of the hospital, which practically excludes the development of nosocomial infections.

Along with artificial air exchange, it is necessary to create conditions for aeration and ventilation of the premises of the surgical department. Particular preference should be given to aeration, which allows for many hours and even around the clock in all seasons of the year to carry out natural air exchange, which is a decisive link in the chain of measures that ensure air purity.

In-wall ventilation ducts contribute to increasing the efficiency of aeration. The effective functioning of these channels is especially necessary during the winter and transitional periods, when the air in hospital rooms is largely polluted with microorganisms, dust, carbon dioxide, etc. Studies show that the more air is removed through the exhaust ducts, the more bacteriologically clean outdoor air enters through transoms and various leaks. In this regard, it is necessary to systematically clean the ventilation ducts from dust, cobwebs and other debris. The efficiency of in-wall ventilation ducts is increased if deflectors are installed on their upper end part (on the roof).

Airing must be carried out during wet cleaning of the premises of the hospital (especially in the morning) and the operating unit after work.

In addition to these measures, to ensure the purity of the air and the destruction of microorganisms, disinfection is used using ultraviolet radiation and, in some cases, chemicals. For this purpose, indoor air (in the absence of personnel) is irradiated with bactericidal lamps such as DB-15, DB-30 and more powerful, which are placed taking into account convection air currents. The number of lamps is set at the rate of 3 W per 1 m3 of the irradiated space. In order to mitigate the negative aspects of the effect of lamps, instead of direct irradiation of the air environment, diffuse radiation should be used, i.e., irradiation of the upper zone of the premises, followed by reflection of radiation from the ceiling, for which ceiling irradiators can be used, or simultaneously with bactericidal light fluorescent lamps.

To reduce the possibility of microflora spreading throughout the premises of the operating unit, it is advisable to use bactericidal light curtains created in the form of radiation from lamps above doors, in open passages, etc. In this case, the lamps are mounted in metal soffit tubes with a narrow slot (0.3-0 .5cm).

Neutralization of air with chemicals is carried out in the absence of people. For this purpose it is allowed to use propylene glycol or lactic acid. Propylene glycol is sprayed with a spray gun at the rate of 1.0 g per 5 m3 of air. Lactic acid used for food purposes is used at the rate of 10 mg per 1 m3 of air.

The asepticity of the air in the rooms of the surgical hospital and the operating unit can also be achieved by using materials that have a bactericidal effect. These substances include derivatives of phenol and trichlorophenol, oxydiphenyl, chloramine, sodium salt of dichloroisocyanuric acid, naphthenylglycine, cetyloctadecylpyridine chloride, formaldehyde, copper, silver, tin and many others. They are impregnated with bed and underwear, dressing gowns, dressings. In all cases, the bactericidal properties of materials persist from several weeks to a year. Soft tissues with bactericidal additives retain bactericidal action for more than 20 days.

It is very effective to apply films or various varnishes and paints to the surface of walls and other objects, in which bactericidal substances are added. For example, oxydiphenyl in a mixture with surfactants is successfully used to give the surface a residual bactericidal effect. It should be borne in mind that bactericidal materials do not have a harmful effect on the human body.

In addition to bacterial pollution, the air pollution of operating units with narcotic gases is also of great importance: ether, halothane, etc.

Studies show that in the process of operating in the operating room air contains 400-1200 mg/m 3 of ether, up to 200 mg/m3 or more of halothane, up to 0.2% of carbon dioxide. Very intense air pollution with chemicals is an active factor contributing to the premature onset and development of surgeons' fatigue, as well as the occurrence of adverse changes in their health status.

In order to improve the air environment of operating rooms, in addition to organizing the necessary air exchange, it is necessary to capture and neutralize drug gases that enter the airspace of the operating room from the anesthesia machine and with exhaled diseased air. For this, activated carbon is used. The latter is placed in a glass vessel connected to the valve of the anesthesia machine. The air exhaled by the patient, passing through a layer of coal, is deprived of narcotic residues and comes out purified.

The equipment of modern operating rooms with an autonomous supply and exhaust ventilation system has made it possible to significantly reduce the contamination of the air environment. Thus, the organization of such ventilation with an air exchange rate of +10–8 and the organization of air inflow under the ceiling on one side of the operating room, and the exhaust hood on the opposite side, can reduce air contamination by 2-4 times; microbial count even at the end of the day does not exceed 1500-2000 in 1 m3, and the percentage of suppuration after surgery is significantly reduced.

But these indicators do not satisfy modern surgery. So, during the transplantation of vital organs, it is desirable that the air contamination does not exceed 2-10 per 1 m3, and pathogenic staphylococci or hemolytic streptococci are not detected when 250-500 liters of air are sown.

Therefore, in recent years, they have been trying to organize such a system of supply and exhaust ventilation, in which air is supplied to the operating room over a large area through a perforated panel (3x3m in area), and is removed through exhaust openings located near the floor and under the ceiling near one of the walls.

During the operation, with normal air supply, the air exchange rate reaches 15 per hour. If a long-term and traumatic operation is performed, the air is supplied at a higher speed, as a result of which the exchange rate can increase up to 30-90 per hour. This creates almost sterile conditions around the operating table. Operating theaters have been built abroad, providing an air exchange rate around the operating table of 500–700 per hour. This made it possible to reduce air contamination to 2–4 saprophytes per 1 m3, i.e. operations became really aseptic.

Another way to create aseptic conditions during the operation involves the presence of individual airtight plastic suits with individual air supply. The head of the patient and the anesthesiologist with equipment are isolated from the operating field with a plastic screen. This method allows to reduce the frequency of septic complications in any operation to 0.3%.

Noise control

The permissible noise level in the premises of a surgical hospital should not exceed 35 dBA for daytime and 25 dBA for night time, for operating rooms - 25 dBA.

Ensuring silence in the premises of the hospital and the operating unit should be provided at the design stages of the hospital: when allocating a site, developing a master plan, designing buildings and constructing them, as well as during the reconstruction of buildings and structures, and ensured during operation.

Particular attention is paid to the protection of the operating unit from various noise impacts. In this regard, it should be placed in an isolated extension to the main building with the implementation of anti-noise measures or located on the upper floors of the hospital in a dead end zone.

Significant noise is generated by ventilation devices. When developing and implementing anti-noise measures during the reconstruction of hospitals, their overhaul, etc., it is necessary to take into account the ways of noise propagation: a) through the air inside the air ducts through the supply and exhaust grilles; b) through the walls of transit air ducts to the room through which they are laid; c) through the air environment surrounding the ventilation unit, to the enclosing structures of the chamber and through them to adjacent rooms.

All air handling units should be placed in the basement or basement, necessarily under the secondary premises, or in extensions to the main building or on the attic floors. It is advisable to place exhaust chambers and devices in the attic (technical floor), placing them above the auxiliary rooms. Placing exhaust chambers in the basement floors requires an increase in appropriations and the volume of construction work.

To muffle noise, it is necessary to carry out thorough sound insulation by using various silencers (tubular, honeycomb, plate, chamber, etc.), vibration-isolating bases, inserts made of soft materials, and sound-absorbing linings. Noise from transit ducts passing through the premises can be reduced by lining the inner surface of the ducts with sound-absorbing material or by increasing the massiveness of the walls of the ducts (if other conditions permit) and applying soundproofing materials to them.

In order to reduce noise in wards, corridors, halls, pantry and other rooms, sound-absorbing lining should be used, which should also meet sanitary and hygienic requirements for wet cleaning.

To improve the sound insulation of ceilings from air and impact sound, it is necessary to use the design of "floating floors", and from impact sound - soundproof soft rolled floor coverings.

Noise generator is also sanitary-technological equipment of hospitals. The wheels of wheelchairs and wheelchairs for patients should have rubber or pneumatic tires, rubber mats should be laid on tableware carts. Refrigerators should be installed on special rubber shock absorbers, elevator winches should be installed on spring or rubber shock absorbers, elevator doors should be sliding, shaft walls should be double (air gap of 5-6 cm).

Conclusion

The complex of therapeutic measures taken before surgery to transfer the underlying disease to the most favorable phase, the treatment of concomitant diseases and the preparation of vital organs and systems for the prevention of postoperative complications is called the preparation of patients for surgery.

The main task of preoperative preparation is to reduce operational risk and create optimal conditions for a favorable outcome.

Preoperative preparation is carried out for all patients. In the minimum volume, it is carried out only for patients operated on for emergency and urgent indications.

On the eve of a planned surgical operation, general preoperative preparation is carried out. Her goal:

1. Eliminate contraindications to surgery by examining the vital organs and systems of the patient.

2. Preparation of the patient psychologically.

3. Prepare as much as possible the systems of the patient's body, on which the intervention will have the greatest load during the operation and in the postoperative period.

4. Prepare the operating field.

Each patient entering the surgical hospital for surgical treatment must be undressed and examined the skin of all parts of the body. In the presence of weeping eczema, pustular rashes, boils or fresh traces of these diseases, the operation is temporarily postponed and the patient is sent for outpatient aftercare. The operation of such a patient is performed a month after a complete cure, because the infection can manifest itself at the site of surgical intervention in a patient weakened by an operating injury.

On the day of the operation, the surgeon should pay maximum attention to the patient, encourage him, ask about his well-being, examine how the surgical field is prepared, listen to the heart and lungs, examine the pharynx, and calm him down.

If the patient is taken to the operating room ahead of time, order and silence should be established in the operating room.

The main role in the normalization of the patient's psyche is played by the patient's trust in the doctor of the department and all the attending staff, the authority and competence of the surgeon.

The maximum preparation eliminates the possibility of complications, prepares the vital organs of the patient for surgical intervention, creates a favorable psychological background, raises the system, and all these factors contribute to the speedy recovery of the patient.

Bibliography

Akzhigitov G.N. Organization and work of the surgical hospital. – M.:

Medicine, 1978. - 288 p.

Guidelines for the organization of air exchange in ward departments and operating blocks of hospitals. - M., 1987.

Krechkovsky E.A., Matyashin I.M., Nickberg I.I. Sanitary and hygienic provision of surgical departments of hospitals. - K .: Zdorov "I", 1981. -112 p.

Loshondi D. Nosocomial infections. - M.: Medicine, 1978. - 456 p.

SanPiN 5179-90 "Sanitary rules for the design, equipment and operation of hospitals, maternity hospitals and other medical institutions"

Skobareva Z.A. Modern rationing of artificial lighting in residential and public buildings. - M., 1970. p. 87.

Wheeler I.T. design of hospitals (translated from English) - M., 1972. - p.83-

Device and equipment operating rooms blocks surgical departments
Abstract >> Medicine, health
Hernia repair - appendectomy - venectomy - amputation B operational block there is a system of interchangeability. I perform the functions ... of the rules of asepsis and antisepsis in operational block. 22 7. Staff operational block It is forbidden to work on faulty...
operating room system (1)
Abstract >> Informatics
Structure: |name |initial block|final block| | | | | | | | | | | | | "Elementary block" refers to some relative... - it is single user. Second level operating rooms systems is operating rooms systems that allow you to register ...
Operating systems of modern computing complexes
Abstract >> Informatics
subject areas. 1.3. Classification operating rooms systems Operating systems can differ in features ... within some block this text. With sufficient ... length

Operating block I Operating block

a complex of specially equipped rooms designed for surgical operations. About. are placed not lower than the second floor of the building and isolate other departments and services of the hospital while maintaining convenient connections with the surgical departments, as well as intensive care and anesthesiology departments. About. for purulent and "clean" operations are planned separate. In O.'s structure. includes: an operating room, an anesthetic room, a hardware room, a material room, a room for operating sisters, a head of the operating unit, a sanitary inspection room and other rooms.

Premises O. b. should be convenient for wet cleaning, inaccessible to rodents and insects. Floors, walls and ceilings in O.'s rooms. must be covered with a water-resistant inorganic material that can withstand clean handling with disinfectant solutions. The windows of the operating room are oriented to the northeast or northwest. The ratio of window area to floor area should be 1:3. The floors in the operating room are covered with antistatic material to prevent the occurrence of sparks when metal objects fall on it. The walls are tiled with matte gray-green or gray-blue tiles, the ceiling is painted with oil paint ( rice .) The air temperature in the operating room is maintained within 22-23 °, relative humidity - 50-60%. Operating rooms intended for conducting training and demonstration sessions are equipped with transmitting television cameras mounted to the operating room, or viewing windows in the ceiling of the room.

O.'s equipment about. should be convenient for work, easy to move or carry, not have areas inaccessible for processing, not deteriorate from contact with disinfectant solutions. The operating room and anesthetic room are equipped with air conditioners or supply and exhaust ventilation with a predominance of air inflow, providing 10-20 times in 1 h. The air in the operating room should be supplied after cleaning in special bacterial filters through grilles installed at a height of at least 2.5 m from the floor, and the outflow is carried out through gratings built into the wall at a height of 0.4 m. The operating room is also equipped with wall-mounted (OBN-150, OBN-200) and ceiling-mounted (OBP-300, OBP-350) bactericidal irradiators, which are located at a distance of 2.5 m from each other. It is recommended to additionally install stationary or mobile air cleaners (VOPR-0.9 or VOPR-1.5M), capable of 15 min work to reduce the dust content of the air and the number of microorganisms in it by 7-10 times. Artificial operating room is carried out by panel fluorescent lamps or incandescent lampshades with a total capacity of 500 Tue at 50 m 2. The illumination of the surgical field should be within 3000-5000 OK. This is ensured by shadowless ceiling lamps installed on the operating table.

Compliance with the sanitary and hygienic regime in O. b. provides for strict adherence to the rules of asepsis (Asepsis). The whole territory of O. b. divided into zones: the first zone (sterile) includes rooms in which the most stringent asepsis requirements are observed (operating room, sterilization room); the second zone (strict regime) includes rooms directly connected with the operating room (preoperative, anesthetic); the third zone (restricted regime) - room for operating nurses, control room, emergency tests, clean zone of the sanitary inspection room, etc .; the fourth zone (general hospital regime) has, not associated with the passage through the sanitary checkpoint. The first zone is separated from the second and third by a wide red stripe applied on it, which the medical staff should not cross without special clothing. During non-working hours, the doors of the operating room must be locked. Medical personnel not participating in the operation are not allowed to be in the operating room. Enter O. b. in linen shoe covers, clean gowns, a cap and a four-layer gauze mask. It is strictly forbidden to be in the operating room in street shoes. All items brought in or imported into O. b. (wheelchairs, gas cylinders, etc.) should be treated with disinfectant solutions.

In the operating room, 5 types of cleaning are carried out: preliminary - daily at the beginning of the working day they wipe it, which has settled overnight on horizontal surfaces (on the floor, window sills, tables, etc.); current - during the operation, fallen objects (instruments, tampons, etc.) are lifted, and the floor is also wiped with antiseptic solutions when an accidentally spilled liquid (pus, exudate, bile, etc.) gets on it; cleaning after the end of the next operation - the floor in the central area of the operating room is treated with disinfectant solutions, the used one is put in special containers and taken out of the operating room; daily cleaning at the end of the working day - they wash window sills, walls, doors, floors, wipe the surfaces of all appliances and apparatus, turn on bactericidal lamps; general cleaning or disinfection (performed once at the end of the week) - ceilings, walls, windows, doors, as well as all items in the operating room are washed with hot water and soap or synthetic detergents and treated with disinfectant solutions.

operating room type

General view of the operating room.

II Operating block

a complex of premises of a medical institution, specially equipped for surgical operations; except operating O. b. includes preoperative, sterilization, anesthesia, blood transfusion room, etc.

1. Small medical encyclopedia. - M.: Medical Encyclopedia. 1991-96 2. First aid. - M.: Great Russian Encyclopedia. 1994 3. Encyclopedic dictionary of medical terms. - M.: Soviet Encyclopedia. - 1982-1984.

What does an operating room look like in a hospital? Operating block of surgical departments. Administering a cleansing enema to a patient

Device and equipment operating rooms blocks surgical departments

operating room system (1)

Operating systems of modern computing complexes