COVID-19: documentation in LPU in questions and answers
In the context of constantly changing regulations, orders, guidelines and other administrative documents on the new coronavirus infection COVID-19, it is important to rationally organize the forces and means of the medical organization.
To begin with, all anti-epidemic measures should be divided into three groups:
1) measures regarding the source of infection;
2) measures targeting the mechanism of transmission;
3) activities regarding the susceptible host.
Each group of measures is regulated by local regulations. Consider their.
- for the storage of foodstuffs
- wine and other alcoholic beverages
- fur products
- in cafes and restaurants
And in other enterprises, where there is a question of short-term or long-term storage of products.
The instructions address the following issues:
- Frequency, schedule of decontamination cleaning for refrigeration equipment
- indications for disinfection
- recommended processing aids
- cleaning equipment
- Procedure for use, modes of application of disinfectants
- Who must carry out the procedure
- Safety rules, protection of the employee’s health when in contact with disinfectants
- peculiarities of preparation and completion of the disinfection process
- guidelines for complying with all SanPin regulations regarding the quality of refrigeration equipment
How to properly care for a professional refrigerator
Sanitary rules for catering (including the maintenance of refrigerators) have changed at the beginning of 2021. Food processing companies must now be more vigilant in monitoring their operations to prevent harm to consumer health.
The main principle of the new version of the document is to provide the population with better nutrition, which requires preserving the nutritional value of food as much as possible.
Refrigeration equipment used in the catering industry must meet the requirements:
- Separate storage of food raw materials and ready products;
- compliance with the temperature regime and its control;
- Sanitary cleaning with professional detergents.
Here are the rules for cleaning and what cleaning agent is used to clean a refrigerated room.
New GOST for cleaning in medical organizations
As of October 1, 2019. GOST R 58393-2019 Professional cleaning services has been put into effect. Cleaning in medical organizations. General requirements. Let’s consider the main provisions of the document.
GOST R 58393-2019 establishes requirements for the provision of professional cleaning services (cleaning services) in organizations carrying out medical activities.
A medical organization is a legal entity engaged in medical activity as its primary (statutory) type of activity on the basis of an appropriate license (clause “medical activity”). 3.1 GOST R 58393-2019).
The document applies to professional cleaning services provided by legal entities and individual entrepreneurs. When carrying out cleaning in medical institutions the requirements of current legislation governing: medical activities and the performance of professional cleaning services must be met (p. 3). 4.1 GOST R 58393-2019).
General requirements for the premises for storage of medicines and organization of their storage
Storage of medicinal products shall be carried out in the premises designated for this purpose. The design, composition, size of storage areas, their operation and equipment should provide proper storage conditions for various groups of drugs.
The complex of storage facilities shall include:
Specified medicinal products and their storage areas should be clearly marked.
The storage area is allocated in a common storage room in the absence of a separate isolated room.
The finishing of the premises for the storage of medicines must meet current hygiene requirements, the inner surfaces of walls and ceilings should be smooth, allowing for wet cleaning.
In each storage room, it is necessary to maintain the climatic conditions, observing the temperature and humidity of the air, established by the pharmacopoeial article or regulatory documentation for medicines. The necessary air exchange in the premises for storage is created by air conditioners, supply and exhaust ventilation or other equipment. Natural and artificial lighting in the storage rooms must ensure accurate and safe execution of all operations performed in the room. If necessary, the protection of drugs from solar radiation should be ensured.
The premises for storage of medicines must be equipped with the necessary number of duly certified measurement devices (thermometers, hygrometers, psychrometers, etc.).) to monitor and record temperature and humidity at least once a day. Measuring instruments shall be placed at least 3 m away from doors, windows and heaters in a readable place at a height of 1.5-1.7 m from the floor. It is recommended that they be located where there is the greatest likelihood of temperature and humidity fluctuations, or where there are the most frequent deviations from the required parameters.
Records should show the temperature and humidity conditions specified for the premises and, if these conditions are not met, records should be kept. corrective actions.
Storage rooms must be equipped with a sufficient number of cabinets, safes, shelving, racks, pallets. The equipment must be in good condition and must be clean.
Racks, cabinets and other equipment should be installed so as to provide access to medications, free passage of personnel and, if necessary, availability of loading and unloading operations, as well as accessibility to equipment, walls, floor of the room for cleaning.
Proper sanitary regime should be maintained in the premises where medicines are stored. The frequency and methods of cleaning the premises should comply with the requirements of regulatory documents. Sanitary and disinfectants used should be safe, the risk of contamination of drugs in storage by these agents should be excluded.
Special instructions should be developed for the cleaning of spilled or scattered drugs in order to completely eliminate and prevent contamination of other drugs.
When working in the rooms for the storage of medicines, employees should wear special clothes and shoes, follow the rules of personal hygiene.
In the premises for storage, medicinal products are placed in accordance with the storage conditions specified in the pharmacopoeial article or regulatory documentation for medicinal products, taking into account their physical, chemical and hazardous properties, pharmacological and toxicological effect, type of dosage form of the drug and method of its use, the aggregate state of the drug. If computer technology is used, drugs may be arranged alphabetically, by codes.
Racks, cabinets, shelves designed for storage of medicines must be identified. It is also necessary to identify stored medications with a rack card, when using computer technology. with the help of codes and electronic devices.
If the manual method of unloading and loading is used, the stacking height of drugs must not exceed 1.5 m. If mechanized devices are used for unloading and loading operations, drugs should be stored in several tiers. The total height of drugs on the racks should not exceed the capacity of loading and unloading mechanisms.
Medicines in storage rooms should be placed in cabinets, on racks, racks, pallets, etc. Drugs may not be placed on the floor without a pallet. Pallets may be arranged on the floor in a single row or on racks in several tiers, depending on the height of the rack. It is not allowed to place pallets with medicines in several rows by height without using racks.
When creating storage conditions for individual medicinal products it is necessary to follow the requirements specified in the pharmacopoeial article or regulatory documentation for this medicine established by the manufacturer (developer) of the medicinal product based on the stability study results in accordance with the SPS “Stability and shelf life of medicinal products”.
Storage of medicinal products is carried out in a package (consumer, group) corresponding to the requirements of the normative documentation for the medicinal product.
Storage of medicines is carried out at a relative humidity of no more than 65%, depending on the relevant climatic zone (I, II, III, IVA, IVB), unless special storage conditions are not specified in the regulatory documentation.
Medicines should be stored to prevent contamination, commingling and cross-contamination. Extraneous odors in the storage rooms should be avoided.
The system of registration of medicines with a limited shelf life established in the organization should be implemented. If several series of the same drug are in storage, the drug with the expiration date earlier than the others should be taken first for use.
Discarded medications must be identified and stored in an appropriate room (area) under conditions that prevent unauthorized use.
Sanitary. Epidemiological requirements for the working conditions of medical personnel.
Sanitary. epidemiological requirements for working conditions of medical personnel.
According to SanPiN 22.214.171.124 Sanitary and epidemiological requirements for organizations conducting medical activities in working places of medical and other personnel shall ensure compliance with relevant hygienic standards (parameters of microclimate, levels of lighting, ionizing and non-ionizing radiation, purity of workplace air, as well as noise, ultrasound, vibration, electromagnetic fields, ultraviolet, laser radiation).
The Hygienic Regulations are given in the Annexes to SanPiN 2, Hygienic Regulations for Children and Adolescents, and Hygienic Regulations for Children and Adolescents.1.3.2630-10:
Appendix 3, “Cleanliness class, reqThe air exchange rate, the permissible andthermostat and the temperatures should be clearly set forth in the annexes to SanPiN 2;
Appendix 4 “Maximum allowable concentrations (MAC) and hazard classes of leThe “Sanitary and Epidemiological Standards in the Air of the Premises of Medical Organizations”;
Hygienic specifications are set out in Annexes to SanPiN 2 and 2 of SanPiN 2natural, artificial, and combinedThe “light of the main premises of medical organizations”;
Appendix 8 “Maximum permissible levels (MPL) of electromagnetic radiation at the working places of medical personnel”;
6 Hygienic requirements for working 9 conditions of medical workers, occupational 9 “Permissible levels of sound6 Hygienic requirements for working conditions of medical workers performing 9 Annex 9 “Permissible levels of sound in medical equipment on the premises of medicalof the medical and prophylactic organizations”;
Appendix 10 “Maximum permissible sound levels and equivalent sound levels at workplaces for work activities of different categories of severity and intensity, dB”;
Appendix 11 “Maximum permissible levels of airborne ultrasound in working places”.
Hygienic requirements to working conditions of medical workers, performingThe following are the most important elements of theThe guidelines of the same name (R 2.2.4/126.96.36.1996-07), approved on. 10.08.2007 by the Chief State Sanitary Doctor
Hygienic requirements for working conditions of the personnel of radiotherapy departments, X-ray departments and radionuclide departments are contained in SanPiN 188.8.131.522-03 “Hygienic requirementsThe safety requirements for the construction and operation of the X-ray unitof new rooms, apparatuses and carrying out radiological researches” 2. Radiation safety standards (NRB-99/2009) 3. SP 184.108.40.20612-10 “Basic Sanitary Rules for Radiation Safety”Radiation safety rules (NRB-99/2010) 4. thanDetailed requirements for working conditions of personnelThe requirements for personal electron microcomputers and personal computers in X-ray departments, radiotherapy departments, and radionuclide departments see. chapter with the same title.
When using computer technologyThe requirements of sanitary regulations must be observedPiN 2.2.2/2.4.1340-03 “Hygienic requirements forThe requirements for personal electronic calculators are as followsThe “Electronic Control and Organization of Work” (eds. of 03.09.2010).
Working conditions of medical workers who work at laser ovens and other ophthalmologic equipmentIf the boiler has been filled with water and turned on, the liquid begins to expandThe following are some examples of how to use and operate lasers.
It is not allowed to use medicalThe use of local fume hoods or absorbent filters is subject to the use of local fume hoods for the removal of hazardous chemicals (cytostatics, psychotropics, drugs, and chemical reagents) The use of local exhaust ventilation systems for the removal of hazardous substances, without exhaust ducts (air suction devices) or absorption filters, is not permitted. RaThe use of hazardous chemicals (cytostatics, psychotropics, chemical toxins, ozone depleting substances, and toxic chemicals) is not permitted in areas with high concentrations of toxic chemicalsChemical equipment, including anesthesia equipment that emits harmful reagents) in the treatment, inhalation, laboratory and recuperation laboratoriesThe purpose of the ventilation system is to prevent the health effects of the biological agents on the personnel of the existing medical and prevent the health effects of the staffIf local exhaust units are used.
In order to prevent the adverse effects of biological factors on the health of medicalIn order to prevent the adverse effects of the biological factor on the health of the medical personnel in the existing medical and health care facilitiesThe use of poisonous substances in the treatment of chronic painful lesionsIn the case of a mechanical supply and exhaust ventilation system, the following devices should be providedrecirculation air disinfection devicemedical labs.
Gloves should be worn before any parenteral manipulations to prevent blood-borne infectionsPatient information. After removal of gloves hygienic hand treatment should be performed. All personnel shall be equipped with insecticide resistant masks, face shields, respirators, aprons, etcThe number of lockers should be adequate for the number of gloves removedThe number and size of gloves to be treated should be equal to 100% of the medical personnel on the payrollAll personnel shall wear protective clothing, masks, face shields, respirators, aprons, etc.The necessary protective equipment (aprons, mask, etc.) must be worn according to the profile of the department and the type of work performed.
According to Section 15 of SanPiN 220.127.116.1130-10 “Requirements for working conditions of medical personnel” for staff of the herdThe unit should have a minimum of one shower cubicle per 10 persons working in the infection and tuberculosis wardsWashrooms with showers and toilets. The number of closets in the dressing rooms should be taken equal to 100% of the listed medical personnelThe main principle of the new version of the document is to ensure the safety of the employees, their working and technical personnel, the checkroom and the control roomWashrooms must be provided with two-pieceThe number and size of gloves to be treated should be equal to 100% of the medical personnelThe hygienic requirements for the separate storage of household and work clothing. The area of outdoor checkrooms should be taken on the basis of at least 0.08 m2 per coat hanger (hook) of the checkroom. other wardsThe area of checkrooms for personal and work clothes should be based on thenot less than 0.5 m2 per ward.
The number of shower cubicles in the inpatient units is based on the following calculation: no less than 1 shower cubicle for 10 people working in the departmentThe unit shall have an infectious disease ward and a tuberculosis wardin other wards; in other wards. not less than 1 duThe maximum occupancy for a 15-person maximum-shift wardrobe should be 4 cubicles. In a smaller number of perat least one shower cabin should be envisaged for the personnel of the telephone service.
The number of shower cubicles in the unit shall be as followsmatrix lavatories for the personnel. Washing of the clothes of the staff should be done by one personIt is allowed to provide for the number of men and women workingThe following guidelines are approved by the Ministry of Health.
Depending on the capacity of the treatment facilities, the following should be envisaged by the design assignmentcanteens, refreshment rooms or eating rooms for personnel. In each structural subdivision, rooms are allocated for personnel in which there must beThe conditions for eating.
Medical personnel should be provided with a change of clothes: gowns, caps, and a change of shoes in a centralized locationThe equipment must be in accordance with the table of equipment, but not less than 3 sets of protective clothing per jobFor more information, see. In the operating room, physicians and others involved in surgery must work in sterile gowns, gloves, and masks. Replacement shoes should be made of non-woven fabric and non-wovenof the material.
Staff clothes must be washed and kept cleanThe changeable clothing sets: gowns, caps, shoe covers and shoes should be provided centrally and separately from the patients’ undergarments. Changing clothes in the unitThe doctor should have a change of footwear for 1 year, with mandatory testing for HIV marker 2 times a weekThe service is performed on a daily basis and is carried out as perdirtying. In therapeutic facilities. Infectious disease marker testing is mandatory, twice a week and as soon asdirtying. The changing shoe of the personnel working in theIn a general practitioner’s office in a room with asepticThe fluid used in this test must be of a non-woven disinfectant-available material. The changeable clothing and shoes shall also be provided for the medical personnel of the other units, providing theThe preventive measures are to be avoided by staff not to take notesNo food should be eaten by the staff.
In the course of the manipulation of the patientThe staff should not take notes, orderthe hands to a telephone handset, etc.
Employees eat in specially designated rooms, on the racks of the building or on the kitchen tableeating is forbidden in the middle of the room.
Wearing medical clothing and shoesDo not use blood or other paraphernalia outside the hospital.
Prophylactic measures in case of infectionthe employee’s skin and mucous membranes contaminated with blood or other body fluids, as well as in case of punctures and cuts (according to SanPiN 2L.3.2630-10)
In case of skin contamination the hands are emitted from theThe staff should not take any notes, make orders, or assist in any other way.п. soap and water; dry hands thoroughly with a disposable towel; treat them twiceUse antiseptic.
Hands while wearing gloves should be washed with a tissue dampened with disinfectant, then washed under running water, gloves off, hands should be washed with soap and water, hands should be dried thoroughlyWash and treat with skin antiseptic.
In case of contact with the body fluids of theIf the patient’s mucous membranes in the oropharynx are immediatelyRinse mouth and throat immediately with 70% alcohol or 0.05% manganese solutionliquids.
In case of contact with biological fluidsIf swallowed, wash the eyes with manganese solutionPotassium permanganate in water at a ratio of 1:10,000.
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For punctures and cuts wash your hands with soap and running water without taking off your gloves, remove gloves, squeeze blood from the wound, wash your hands with soap and water and treat the wound with 5% alcohol iodine tincture. If there are micro-injuries, scratches, abrasions on the hands, seal the injured areas with adhesive tape.
Emergency prophylaxis against hepatitis B and HIV infection according to Annex 12 of SanPiN 18.104.22.16830-10 (refer to. Appendix).
In case of injuries, including microIf there is any risk of infection from bodily fluids (puncture wounds, cuts), the person in charge of the prophylacticThe medical personnel who carry out parenteral infections prevention in LPU shall organize the registration in the logbook of traumas and prepare the act according to the legislation of the Republic of Kazakhstan on the prevention of parenteral infections in LPUIf any blood or other biologic contaminants come into contact with your hands, they should be washed with soap and water.
Softening and protective creams are used for hand skin care, providingKeeping the skin supple and firm.
Emergency prevention of parenteral viral hepatitis
To avoid infection with parenteralIf you are infected with viral hepatitis or HIV, you should follow the rules for working withUse water with soap and water for re-cutting with cutting tools and utensils.
In case of cuts and punctures, immediately treatWork and remove gloves, squeeze blood from the wound, wash hands with soap and water under running water, treat with 70% alcohol, lubricateIf a patient is infected with viral hepatitis or HIV infection.
If blood or other biologically active substances get into the skin, the wound should be cleaned with 70% alcoholIf any of these liquids comes into contact with the skin, the area should be washed with 70% alcohol, and the gloves should be removedUse soap and water to clean the wound and re-treatUse 70% alcohol.
If blood gets on the eye mucous membranes, rinse immediately with water or a 1% solution of boric acid; if the nose gets on the mucous membranes, the. are treated with 1% protargol solution; on the mucous membrane of the mouth. gargle with 70% alcohol or 0.05% potassium permanganate solution or 1% boric acid solution.
The mucous membranes on the nose, lips, conjunctivaeThe mucous membranes on the nose, lips, and conjunctivae are also treated with a solution of potassium permanganate at a dilution of 1:10,000 (to be prepared extempore).
For the purpose of emergency prophylaxis of HIV infection azidotimidine is administered forFor emergency prophylaxis of HIV-infection azidothidine is given for 1 month. The combination of azidothymidine (retrovir) and lamivudine (elivir) increases antiretroviral activity and overcomesThe following measures should be taken in order to prevent infections. In case of a high risk of HIV infection, theThe combination of azidothidine (retrovir) and lavudine (elivir) enhances antiretroviral activityThe importance of chemoprophylaxis should be taken into account in the design of the antiretroviral treatment regimenThe use of chemoprophylaxis in patients with HIV/AIDS is a prerequisite for a proper diagnosis of HIV infection.
Individuals at risk of HIV infection are placed under observation by the Ministry of HealthThe institution should be checked by an infectious disease doctor for 1 year with obligatory testing for HIV marker.
Personnel in whom an infection has occurredhepatitis virus-infected material is injected at the same timeThe hepatitis B vaccine is administered simultaneously with thecyphic immunoglobulin (not later than 48 hours) is administered at the same time.) and hepatitis B vaccine at different sitesThe body’s stiffness according to the 0-1-2-6-month pattern. If no antibodies are present, the vaccine should not be administered to any of the following health care workersIf the contact has been preceded by monitoring for hepatitis markers (not earlier than 3-4 months). After administration of immunoglobulina). If the contact occurred in a previously vaccIf no antibodies are present afterwards, it is advisable tobut determine the level of anti. HBs in serum. No vaccine prophylaxis is given in the presence of antibody concentration of 10 IU/l or higher, in the absence of antibodies.It is reasonable to give 1 dose of immunoglobulin and a booster dose of hepatitis vaccine at the same time.
The area of responsibility for interventions.
According to clause 3 of SanPiN 3 of the directive, the vaccine should be administered without delay. 3.2 SanPiN 3.1.3263-15 each structural subdivision of the medical organization performing endoscopic intervention shall identify persons responsible for the organization and implementation of anti-epidemic measures, including the quality of processing of endoscopic equipment.
The head (doctor) of structural subdivision (office) that performs endoscopic interventions shall develop an operating instruction for the treatment of endoscopes that are available in the equipment of structural subdivision (office), which shall be approved by the head of the medical organization. This instruction shall be prepared based on the provisions of these sanitary rules taking into account the type, brand (model) of endoscopes, operational documentation on them and equipment designed for their processing and storage, instructions for use of chemical cleaning, disinfection and sterilization means (p. 3). 3.3 SanPiN 3.1.3263-15).
Physicians directly involved in conducting endoscopic interventions and processing endoscopic equipment shall undergo advanced training at least once every five years at organizations with a license for educational activity under programs of additional professional education, which include issues of epidemiological safety of endoscopic interventions (par. 3.4 SanPiN 3.1.3263-15).
Each endoscope that is available in the equipment of a structural subdivision where endoscopic interventions are performed is assigned an identification number that includes information about its type, model and serial number. The identification number of the endoscope used during a medical intervention shall be indicated in the protocol of the endoscopic intervention, in the special notes column of the logbook of the studies performed in the endoscopy department, or in the logbook of surgical interventions (p. 3.6 SanPiN 3.1.3263-15).
Order 09 for sanitary regime in a pharmacy has died
Normative documents regulating the sanitary regime of pharmacy organizations have always been among the most important for pharmacists and pharmacists. For almost a quarter of a century the main “regulator” of this topic was the Order of the Ministry of Health of 21.10.1997 09 “On approval of the Instruction on the sanitary regime of the pharmacy organizations (drugstores). This has now been replaced by GHSA Regulation 4.
Let’s note one significant difference. If earlier the topic of sanitary regime in a pharmacy was regulated by the regulatory act, approved by the Ministry of Health, now the source of legislative regulation in this area becomes the Chief Sanitary Doctor of the country, which is the head of Rospotrebnadzor. On what this may mean in terms of the controllability of pharmacy organizations, we will talk below, but for now let’s move on to Regulation 4, under which pharmacies operate.
Routine tidying up
The current one is different from the general cleaning of medical rooms. It has a special algorithm of actions:
- With the onset of a new work shift, all surfaces are cleaned with detergents.
- In the standard scheme use a solution in which 10 liters of water, 50 g of cleaning powder.
- Next, disinfection is carried out.
Special rules must be observed. They are prescribed in accordance with the norms of SanPin:
- The employee must wear special clothes and shoes. The presence of rubber gloves, headgear, bathrobe is sufficient.
- Garbage is collected, packed in special bags, and disposed of.
- All surfaces in the room shall be treated with disinfectants.
- Every surface must be wiped with damp cloth.
- Floors are rinsed thoroughly, especially under couches, behind benches and underneath.
- The quarts shall be performed for one hour. Accompanied by ventilation.
- The utensils are washed, treated, and dried.
- In the schedule of cleaning of medical facilities, data about the employee who performed the work and the time of performance are entered.
The floor is cleaned with 2 containers. Each container is intended for a certain liquid:
First wet the rag in the first bucket, wipe the floor, wet in the second bucket and repeat the rinsing.
It is very important to keep the rooms where people are fed in order. After each meal, wipe down tables, chairs, if necessary, the floor. In addition during the routine cleaning it is necessary to:
- Remove dirt from window sills, furniture, equipment, work surfaces.
- Wash walls and floors with disinfectant solutions.
- Do quarts in the same way as for general cleaning in medical institutions, especially in operating rooms, intensive care wards.
If you keep your clinic clean regularly, it will take less effort and time to do a general cleaning. The current maintenance is enough 2 times per working hours. In operating rooms, cleaning is performed after each procedure.