Types of cleaning rooms in hospitals.

There are the following types of cleaning:

· Wet cleaning;

· General cleaning;

· Cleaning by type of final disinfection.

Wet cleaning of chambers (floor, furniture, equipment, window sills, doors) should be at least 2 times a day (window frames, furniture, wipe with a damp cloth, floor wash): 1st time with the addition of detergent (50 g of product per 10 l of water), the 2nd time using a disinfectant of approved concentration.

General cleaning of the chambers of departments, functional areas and classrooms with the use of disinfectants is performed 1 time per month and on epidemiological indications with processing of walls, floors, equipment, inventory, fixtures. In the premises of the operational unit, dressing, maternity halls, treatment, handling, sterilization, intensive care, General cleaning is conducted once a week.

During carrying out General cleaning of ceilings, walls, beds, tables, desks and other furniture and equipment may be processed.

a) 0,5% detergent solution (50 g of powder per 10 l of water or des. means with washing effect) and washed with clean water;

b) method of irrigation or wiping with a cloth dampened with a disinfectant of approved concentration.

After processing, the room is closed for a certain exposure disinfecting solution, after exposure, the room is well-ventilated. All surfaces are washed with water and dried (walls, ceiling, furniture, apparatus, equipment) with a clean cloth.

Final disinfection is performed after discharge, transfer, death of a patient, in the vacant chamber is performed by type of final disinfection.

Cleaning according to the type of final disinfection is carried out by method of irrigation or wiping ceilings, walls, beds, cabinets, tables and other furniture, moistened with disinfectant, wet rags of approved concentration for the final cleaning.

Cleaning is terminated by washing the floor with a disinfectant, then held quartz with subsequent airing. After cleaning rags are disinfected in disinfectant spray, washed under running water until no odor of disinfectant and dried (table 1)

Table 1. Disinfection of cleaning equipment

Name of disinfectants	Concentration	Exposition
Chloramine B	1%, 3%	120 min. 60 min.
Desactin	0,2 %	60 min.
Chloride lime	3% 1 %	60 min. 120 min.
Hydrogen peroxide 6% with 0,5% detergent		60 min.

All cleaning in secure offices is held in conjunction with the nurse: the nurse starts cleaning with clean zone, i.e. manipulation table, dressing table, medical cabinets, fridge, couch, Desk nurse, and the nurse wiping the window sill, chair, door, door handles, toilets and finishes washing the floor.

In the chambers hospital cleaner starts with beds, window sills, door handles, then cleaned sanitary and ends the cleaning by washing the floor. Dining tables, bedside tables and a fridge for the products are processed by dispenser.

Washing the window glass is conducted not less than 1 time per month inside, not less than 1 time in 3 months on the outside and on the extent of contamination. Ventilating the chamber must be at least 4 times a day. Once a year, and more frequently if necessary, should be carried out cosmetic repairs in the premises.

2.2 Personal hygiene of staff members

To personal hygiene practices are included: daily shower or bath, washing coats and other personal service; protection of the mouth and nose (wearing disposable masks); turning away from people nearby when coughing and sneezing, washing hands.

The staff of the hospitals should have a set of replacement work clothing: robe (surgical suit, cap, disposable gloves, and masks. Edges of medical clothing should completely cover the personal clothing. Hair should be completely covered by the cap. Shoes should be made of non-woven material available for disinfection, comfortable and quiet (without heels). It is unacceptable to wear slippers at work. Being in work clothes and in second shoes outside of hospitals is prohibited. Makeup should be moderate, as close to natural. It is undesirable to use scented deodorants and perfumes, as they may cause the patient's allergic reaction. A health care worker should not smell like sweat, stale clothes, and tobacco. Personnel caring infectious patients must take off personal clothes and shoes and wear protective clothing and footwear provided by the sanitary norms. Upon completion of the work should be processed in sanitary inspection (take a shower). Store home clothing and clothing in different cabinets and periodically disinfect their individual wardrobes in the dressing room. Change of robes, caps (head scarves) must be performed at least 2 times a week. At contamination with secretions of patients clothing changes immediately. Housekeeping staff (caretaker, plumber, carpenter, and others), entering the Department, must wear sanitary robe and, departing, leave it in the office. At sanitary treatment of patients in the sink dining, medical, pharmaceutical glassware, and pots and washer vessels for patients’ discharge to wear a rubber apron. With the support of the patient being transferred from one Department to another, workers (nurse, hospital cleaner) should be wear second coat over coat, which is given for disinfection after.

· Service personnel are prohibited from:

· siting on the patients bed;

· to appear in the office or workplace without clothing;

· leaving the work wearing work clothing beyond the infectious diseases Department or to wear clothes on the work clothing, but also using work clothing at home for any purpose;

· to appear in the dining room or buffet in work clothing;

· to use the lavatory for patients, utensils and other things which patients use;

· to eat in the wards, corridors and laboratories;

· Smoking in rooms, corridors and laboratories;

• to move from one department to another or to enter in the boxes and the house without a special need.

2.3 Hand decontamination (processing)

Decontamination of hands is the most important procedure for preventing nosocomial infections. To ensure efficient processing of the hands you must comply with the following conditions: trimmed nails, no nail polish, no artificial nails, no jewelry and watches on hands.

The goal of decontamination of hands is to:

1 - remove the decay products and microorganisms;

2 -to provide patient infectious safety;

3 - to provide a high level of cleanliness and personal hygiene;

4 - to delay the development of microorganisms.

Medical personnel must wash their hands before examining each patient, before and after procedures, after cleaning, change of linen, toilet and so on.

There are three levels of decontamination of hands: the social, hygiene, surgical.

Ø The social level (normal hand washing) - washing of not heavily contaminated hands with soap and water (antiseptics are not applied), allows you to remove most transient microorganisms from skin. Social processing hands is held before eating, after visiting the toilet, before and after patient care, by contamination of the hands.

The processing rules of the hands. Remove all jewelry, watches from hands, because they make difficult removing microorganisms. It is necessary to make forearms free from smock sleeves, then to check skin for damage (scratch, chap), which should be sticked by adhesive plaster. Hands are soaped from periphery to the center by energetic movements of palms during 10 seconds, then palms are rinsed with warm running water and everything starts anew. It is believed that the first soaping and rinsing with warm water provides washing off of microbes from the skin of hands. Under the influence of warm water and massage the pores of the skin open, so when you re-soap and rinse wash off the germs from the open pores. Warm water promotes more effective exposure of soap, while the hot water removes the hand surface protective layer of fat. In this regard, you should avoid using too hot water for washing hands.

Hygiene standards - washing with antiseptic funds; this is a more effective method of removal and destruction of microorganisms.

Hygienic treatment of hands is performed before performing invasive procedures, before caring the patient with a weakened immune system, before and after wound care and urinary catheter, before donning and after removing gloves, after contact with biological liquids of an organism or after a possible microbial contamination.

Hygienic treatment of hands consists of two stages: mechanical cleaning and disinfection of hands by skin antiseptic.

It is more preferable to use liquid soap in dosers with one-time flasks for washing (mechanical cleaning). You should not add the soap into partly-voided flask of doser because of possible contamination. If you use the soap in pieces, you need use small pieces, in order to keep big pieces out of wet environment, supported rise of microorganisms. It is recommended to use soap-box which allows the soap to dry between washing hands.

The sequence of movements during the processing of the hands must conform to European standard EN 1500. Each movement is repeated at least 5 times. Hands processing is carried out for 30 seconds - 1 minute.

(Fig. 2).

Figure 2. Hygienic handwashing procedure.

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Hands should be dried paper (ideally) with a towel, by which then to close the faucet. In the absence of paper towels can be used pieces of cloth about the size of 30 x 30 cm for individual use. After each use these towels should be dropping in a specially designed storage containers to send to the laundry. Electric dryer are not effective enough, because they dry the skin too slowly.

After the mechanical cleaning (twice soaping and rinsing) antiseptic is applied to the hands in an amount of not less than 3 ml. In the case of hygienic disinfection for washing hands used drugs, contained antiseptic detergents, as well as hands are disinfected with alcohol (in the absence of adequate conditions for washing hands or in the absence of the necessary time for washing). Using antiseptic soaps and detergents hands are moistened, after which the skin is treated with 3 ml of alcohol-containing preparation (for example, "Isocat", "Spitters", "AHD-2000 special", "Lisanin", "Biosense", "Monoprint") and carefully rubbed into the skin until dry (wipe hands should).

Staff should warn against wearing rings and using nail polish because of rings and cracked polish complicate the removal of microorganisms. Manicure (especially manipulation in the area of the nail bed can cause microtrauma, which can be easily infected. Equipment for washing hands must be conveniently located throughout the hospital. In particular, it should be installed directly in the room where are diagnostic or penetrating treatments, as well as in each chamber or exit.

Surgical level is in any surgical interventions involving the violation of the integrity of the skin of the patient, to prevent the introduction of microorganisms into the surgical wound and the occurrence of postoperative infectious complications.

Processing rules:

1. In contrast to the above-described method of mechanical treatment on surgical level in the processing includes forearm, at blotting use sterile wipes, and hand washing lasts at least 2 minutes(Fig. 2).

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Figure 2.

Surgical processing level of hands

After drying nail bed and nail walls are processed additionally by disposable sterile wooden watered in solution antiseptics. If the brushes are still applied, you should apply sterile soft disposable brushes or capable of withstanding autoclaving, at that you should use brushes only for processing periungual areas and only for the first treatment during the work shift.

2. After the mechanical treatment there is antiseptic applied onto hands ("Allsat Pro", "Spitters", "Sterillium", "Attenders" and so on) in portions of 3 ml and, without drying, is rubbed into the skin, strictly observing the sequence of movements of the scheme EN-1500. The procedure for the application of skin antiseptics is repeated at least two times, the total consumption of antiseptic is 10 ml, the total treatment time is 5 minutes.

3. Sterile gloves are worn only on dry hands. At duration of work with gloves is more than 3 hours processing is repeated with change of gloves (Fig. 3-4).

4. After removing the gloves hands are again wiped with a moistened skin antiseptic, then are washed with soap and moistened by emollient cream.

1. How to put on sterile gloves:

2. How to remove sterile gloves:

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Figure 3-4.

How to put on and remove sterile gloves

Procedure:

1. Hand washing

2-3. Place sterile packaging in a clean, dry surface without touching the surface. Open the packaging.

4. Using your thumb and index fingers of the left hand, carefully take the glove for a folded cuff of gloves (fingers should not touch the inner surface of the glove). Close the fingers of right hand and enter glove.

5.Put on the glove in one motion, holding folded cuffs at the wrist level.

6-7. Take the glove for the left hand by II, III, IV fingers of your right hand for cuff so that the fingers did not touch the inner surface of the gloves.

8-10. Put on the second glove in one motion on your left hand, at that avoid contact of the hand in glove with the surfaces except the surface of the second wore gloves.

11. If necessary, after putting on both gloves, correct fingers and interdigital space while the glove will not sit conveniently on hand.

12-13. Unscrew the cuff of the first glove, easily slipping the fingers of the other hand on the crease, avoiding any contact with any surfaces except the surface of the gloves.

14. Hands in gloves should touch solely to sterile devices, or pre-disinfected parts of the patient's body.

15-17. Take the fingers of the left hand in glove for cuff on the right glove, touching its outside. Remove the glove and turn it inside out up to the second knuckle of the fingers (not completely remove).

18. Take the cuff by fingers of right hand in glove on the left glove, touching its outside. Remove the other glove, pulling its outer edge on the tips of the fingers with partially removed glove.

19. Remove the glove on the left hand, twisting it completely inside out, to make sure that the skin of health worker resides solely in contact with the inner surface of the glove.

20. Throw away gloves.

21. Process hands.

The main elements of sanitary and anti-epidemic regime are disinfection and sterilization.

Disinfection

Disinfection (disinfection) is the process of destroying pathogenic human microorganisms on objects in the external environment, with the exception of bacterial spores; this term is applied only in those cases when it comes to inanimate objects, for biological tissues is used the term "antiseptic".

3.1 Types of disinfection are:

ü the preventive

ü focal: the current and final

Preventive disinfection is carried out in the absence of the sources of infection, but assumes their presence. The goal of preventive disinfection is to reduce dissemination of objects contacted with patients, through the systematic disinfection of objects, thereby reducing the risk of human infection.

Focal disinfection is carried out in epidemic foci. Objective of focal disinfection is the prevention of contamination of people surrounding the patient, and preventing removal of the pathogen beyond the hearth. Depending on conditions there are current (at presence source of infection) and final (after removal of the source) disinfection.

Current disinfection is performed continuously during the entire infectious period at the bedside, in the insulators of medical centers, medical institutions with the aim of preventing the spread of infectious diseases beyond the hearth. The objective of the current disinfection is the destruction and prevention of the dispersion of infection pathogens on transmission ways in hearth itself and beyond. Epidemiological value of current disinfection is determined by destruction of each new portion of secretions or by destruction of pathogens released into the environment in a different way. The current disinfection is organized by health worker of health organization and is conducted by a person caring for the sick, convalescent himself or bacillicarrier. Current disinfection is carried out systematically, in contrast to the final, which is usually performed only once.

Final disinfection is carried out in the foci of infection during days after hospitalization, isolation, recovery or death of the patient. At final disinfection they make an effort to achieve complete disinfection of objects in the hearth (facilities, kitchenware, linen, furnishing, and others), which could be inseminated by agents of this infectious disease and serve as factors of transmission. Final disinfection is more effective when intervals of time between the removal of the source of infection of the lesion and its implementation are smaller. Final disinfection is carried by disinfection station or by disinfection departments (offices) of the departments of sanitary-epidemiological service, in rural areas it’s conducted by the organization of primary health care.

Methods of disinfection:

ü mechanical

ü physical

ü chemical

ü combined

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