Infectious boxed department was opened in 1986. The department is located in a separate standard building, has 30 Meltzer boxes and a number of auxiliary rooms, which makes it possible to fully autonomize the diagnostic and treatment process. The department has 60 beds.
The overhaul carried out in the department in 2005 and the complete re-equipment with new modern equipment and inventory made it possible to optimize the treatment and diagnostic process and improve the quality of medical services for the flow of patients from the regions of the Russian Federation.
The department is intended for isolation and treatment of sick children with nosocomial infection, contacts for infectious diseases. The department hospitalizes children with fever of unknown etiology, hepatosplenomegaly, lymphadenopathy, intrauterine infections from clinics in the regions who cannot be provided with specialized medical care at the place of residence due to the lack of appropriate equipment or specialists.
During the year, an average of 1,100 sick children are treated in the department. While in the infectious boxing department, patients continue to receive treatment according to the profile of the underlying disease.
The main tasks of the department:
- Providing assistance to children transferred from other departments of the hospital with the addition of infectious diseases that complicate the course of the underlying disease: airborne infections, intestinal infections, hepatitis, septic complications;
- Providing assistance to children transferred from various regions of Russia who are admitted to the hospital with diseases of unknown etiology;
- Introduction into practice of new methods of treating infectious diseases together with the staff of the Department of Children's Infectious Diseases of the Russian State Medical University;
- Implementation into practice of new methods of examination of both infectious and somatic patients, together with the staff of the departments of the RSMU, based in the RCCH;
- Introduction into practice of alternative methods of treatment.
The department is the base of the Department of Infectious Diseases in Children of the Pediatric Faculty of the State Budgetary Educational Institution of Higher Professional Education of the Russian National Research Medical University. N.I. Pirogov of the Ministry of Health of Russia. Head of the department - Doctor of Medical Sciences, Professor Shamsheva O.V.
Doctor of Medical Sciences, Professor A.V. Smirnov; Doctor of Medical Sciences, Associate Professor S.B. Chuelov. On the basis of the department, residents of the departments of pediatric infections and pediatrics are trained.
The staff of the department is represented by highly qualified specialists, certified.
Over the years of work, the employees of the department have accumulated unique experience treatment of chronic hepatitis and congenital cytomegalovirus infection, as well as combined somatic and infectious pathology.
The concentration within the walls of the department of children with various pathologies, combined with a highly developed medical and diagnostic infrastructure, creates the necessary conditions for the implementation of full medical and diagnostic care for children from all regions of the Russian Federation.
Medical staff
Volkova Galina Ilyinichna
Head department - infectious disease specialist
Ignatova Daria Alexandrovna
Infectious disease physician
Ierusalimskaya Daria Viktorovna
Pediatrician
- Education: higher medical education, graduated from Russian National Research Medical University named after N.I. N.I. Pirogov in 2012
- Certificate in Pediatrics, valid until 2018 inclusive
Finogenova Tatyana Anatolyevna
Infectious disease physician
- Education: higher medical, graduated from the 2nd MOLGMI named after N.I. Pirogov in 1974
- Diploma specialty: "Pediatrics", qualification: "Doctor"
- Certificate in Pediatrics, valid until 2017 inclusive
- Certificate in the specialty "Infectious Diseases", until 2021 inclusive
Infectious patients are hospitalized in the infectious diseases department not only for treatment, but also for isolation. Therefore, the infectious disease department is always located in a separate building. The internal layout and sanitary regime of this department in order to prevent nosocomial infections have a number of features.
Infectious patients are admitted to the reception-examination box. After thermometry and examination, the patient undergoes sanitary treatment, and his clothes are sent for disinfection.
Infectious department should have two entrances: one for patients, the other for medical personnel, food delivery and clean linen. The internal layout of the infectious diseases department should provide for dividing it into several independent sections for patients with different diseases. Each section should have its own airlock to prevent the transmission of airborne infection. For greater reliability, the gateway can be equipped with a bactericidal lamp at the rate of 4-5 W per 1 m2. Each section is equipped with a separate sanitary unit.
Due to the specificity of the contingent of patients and to ensure maximum internal isolation in the infectious diseases departments, most patients are placed in boxes and semi-boxes. To do this, 50% of the beds are allocated in the boxes of the children's infectious diseases departments, 25% in the semi-boxes, and 25% in the wards for 2 beds. In infectious diseases departments for adults up to 100 beds, 20 individual and 5 double boxes are equipped, and for 30 beds - 3 individual and 1 double box.
Full box, which guarantees against nosocomial infection, was proposed by the St. Petersburg engineer E.F. Meltzer, therefore it is also called Meltzer. The structure of the box includes: a vestibule with access to the street, through which the patient is hospitalized and discharged; WC; ward and gateway at the entrance from the ward corridor. The box area for 1 bed should be at least 22 m2, for 2 beds - 27 m2. The entrance of medical personnel from the conditionally "clean" corridor to the box is provided through the gateway, where they change their overalls, wash and disinfect their hands. Therefore, the gateway is equipped with a washstand and a hanger for bathrobes. There should be a window in the airlock for passing food to the patient. The sanitary unit should have a bath, a washstand and a toilet. In the wall that isolates the box from the corridor of the department, a window is made to monitor the patient. Patients are sent to the box only after a thorough wet disinfection.
half box also intended for individual hospitalization of the patient, but it differs from boxing in that it does not have an entrance from the street. Therefore, patients enter the semi-box from the general corridor of the department through the sanitary checkpoint. At the same time, contamination of the corridor air with pathogenic microflora is possible, which can penetrate into the wards from here. Semi-boxes are also designed for 1-2 beds.
It should be remembered that when opening the doors of the box and half-box, which lead to the corridor of the department, polluted air can enter the corridor, as well as other rooms. Therefore, the doors must be tightly closed, and if some doors are open, then others must be closed.
Boxed chambers(1 -, 2-seater and maximum - 4-seater) differ from semi-boxes in that they do not have a bath, as well as the entrance to the sanitary unit from the gateway.
All rooms should have a water tap with a washbasin.
In children's infectious diseases hospitals use boxed wards to prevent airborne infections. They are created by installing wooden, metal, glass (stationary or mobile) partitions 2-2.5 m high between the beds. In such wards there are patients with one profile of diseases. A gateway will be installed near the entrance to the ward. The use of boxed rooms is limited because they do not prevent the spread of airborne infections.
All patients infected with infectious diseases must be hospitalized in specialized departments. The exceptions are illnesses such as influenza or measles, which can be treated at home. The purpose of hospitalization in the infectious diseases department is not only treatment, but also complete isolation of the patient, preventing further spread of the infection.
How are patients admitted?
Reception and placement of patients are carried out in accordance with the flow-through system, according to which patients from the moment of admission until the very discharge do not come into contact with other people suffering from other infectious diseases. Each patient delivered to the infectious diseases department on a special vehicle, is received in an isolated box. Some large hospitals provide separate rooms for patients with various infections. So, in one of the boxes, patients with typhoid fever are admitted, in the other - with meningitis, and in the third - with dysentery. Minors are hospitalized in the children's infectious diseases department.
The doctor of the admission department must check the diagnosis, which is indicated in the accompanying card, and only after that he sends the patient to the hospital. The nurse of the infectious department places patients, guided by the nosological sign and taking into account the mechanisms of transmission of the disease.
Requirements for wards and boxes in which patients are admitted
Any infectious department is divided into separate boxes, excluding possible contacts between patients. They must be equipped with gowns for employees, vials of preservative mixture for taking tests for intestinal pathogens, sterile swabs for taking smears for diphtheria and an emergency kit. Medical workers enter the boxes through the internal entrance.
Infectious wards where patients are kept must comply with certain sanitary and hygienic standards. So, the distance between adjacent beds should not be less than 1 m, and the cubic capacity of the room should be at least 18 cubic meters per patient. All rooms must be equipped with a supply and exhaust ventilation system.
Sanitary and hygienic regime of the infectious department
The staff is obliged to regularly carry out wet cleaning of the wards and other premises. Each patient should be bathed weekly in the shower or bath. Seriously ill patients are regularly wiped and preventive measures are taken against the appearance of bedsores. Mandatory change of underwear and bed linen should occur at least once a week.
In addition, the department must have a stock of disinfectants and insecticides. The staff is obliged to wipe the floors at least twice a day, not only in the wards where the patients are located, but also in the corridors. All dirty dishes are first treated with a solution of chloramine or bleach, and then boiled and dried thoroughly. Uneaten food is covered with bleach and thrown into a cesspool or sewer.
How is disinfection carried out?
The work of the infectious diseases department is built on certain rules. Regular disinfection is required. Dirty linen of patients is first soaked in a solution of chloramine, and then boiled and washed. The children's infectious diseases department without fail processes linen, care items for small patients and their toys. The latrines contain containers filled with a 10% solution of bleach, designed to disinfect shelves, pots and vessels. Mattresses from the beds of recovered patients must be sent to the disinfection chamber.
How are food transfers controlled?
The phone number of the infectious diseases department, by which you can find out the list of allowed products, is easily recognized in the city certificate. The medical staff must remember that the speedy recovery of the patient directly depends on his nutrition. Therefore, some products cannot be transferred to the infectious diseases departments. For example, patients diagnosed with typhoid fever are strictly forbidden to consume dairy products and smoked meats.
What are the responsibilities of nurses?
The infectious department implies a clear distribution of official and functional duties of the staff. The department must have a procedural nurse who prepares systems for jet and drip infusions. In addition, her responsibilities include performing intravenous and intramuscular injections. Nurses should monitor the condition of patients and immediately report to the doctor about any changes that occur. They are obliged to strictly fulfill all medical prescriptions and timely paste the results of laboratory tests in the medical history. The nurse should regularly instruct incoming patients about the regime established in the department.
How are recovered patients discharged?
Patients do not have the right to leave the infectious diseases department before the expiration of the mandatory period of isolation. Discharge of recovered patients becomes possible only after the complete disappearance of the clinical symptoms of the disease and after receiving negative results of bacteriological examination. The patient leaves the infectious diseases department in his own clothes, which have been pre-treated in the hospital disinfection chamber.
— implementation of organizational and methodological work on the prevention, diagnosis and treatment of patients with infectious diseases;
– study of the dynamics of infectious morbidity and mortality, development of measures to reduce morbidity, improve the quality of diagnosis and treatment efficiency.
In infectious clinics are:
— organizational and methodological work;
– medical-diagnostic and advisory work;
– analysis of the work of the clinic for servicing infectious patients and preparation of cabinet reports.
The work of an office doctor is complex, diverse, very significant in scope, it is carried out in close connection with district doctors, other specialist doctors, doctors of infectious diseases hospitals, and specialists from Rospotrebnadzor. An infectious disease doctor in a polyclinic should be a good organizer. Prevention of infectious diseases, their timely detection, treatment and post-treatment using all possibilities are the links of a single chain.
Features of its device and mode of operation.
There are 3 types of medical departments:
Departments with boxed-type wards.
It consists of wards that have their own sanitary room for patients (toilet, bath, hand and face wash), a bedroom and a vestibule for medical workers in which there is a wash for washing hands, replaceable gowns and disinfectants.
Department with chambers of semi-boxed type.
They differ from the previous ones in that a sanitary room for sick patients is not available in every ward, but is intended for several wards.
Branches of the general type.
It has a structure similar to other therapeutic departments. The sanitary room is one, but separated, for male and female patients.
Treatment departments of infectious diseases hospitals of modern construction most often have boxed-type wards. It is advisable to fill the ward-boxes with patients with similar diseases, or if it is difficult to make a diagnosis, in order to avoid nosocomial superinfection, with similar syndromes. Usually the method is used simultaneous filling of chambers. The ward is filled with patients only within one working day. If the hospital is multi-storey, then it is desirable that the departments for patients with an airborne mechanism of disease transmission be located on the upper floors, because. pathogens with streams of warm rising air rise up and seeding of the upper floors occurs.
The anti-epidemiological regime of the infectious diseases department includes mandatory wet cleaning of the premises, at least 2 times a day using disinfectants. Once every 7-10 days, general disinfection of the wards is carried out, the same disinfection is carried out when the last patient is discharged from the ward. Cleaning material is marked separately for each type of premises. Dishes of patients after each meal must be thoroughly disinfected. Disinfection and sterilization of medical equipment and instruments must be carried out strictly according to existing instructions and orders.
In order to prevent the spread of infection outside the department and hospital, the following measures are taken:
1. Food waste should be removed from the compartment only after preliminary disinfection.
2. All excretions of sick patients and waste water are discharged into the general sewer after preliminary disinfection
3. The admission of visitors to departments is prohibited or limited, books, letters and other personal belongings of patients are taken out of the department only after disinfection.
4. Medical workers must strictly follow the rules of infectious safety in infectious diseases departments.
5. The discharge of convalescents is carried out according to certain rules.
Boxing device.
The admission department should have special treatment boxes or one-two-bed rooms, well isolated from other rooms and designed to isolate patients with mixed infections.
Patients are hospitalized in the boxed department: a) with mixed diseases; b) with an unidentified diagnosis; c) who were in contact with patients with especially dangerous infections.
Meltzer type boxing device
Children suffering from infectious diseases are examined upon admission to the hospital in special "through" boxes of the Meltzer system. Meltzer's box consists of: 1) vestibule - pre-box; 2) chambers; 3) sanitary unit with bath; 4) lock for personnel.
Through the inner waiting room, which communicates with the corridor through tightly closed, partially glazed doors, attendants enter and exit, serve food to the sick person, etc. , medical instruments, etc.
In addition to receiving newly arriving patients, Meltzer boxes can also serve for individual hospitalization of patients with drip or other most contagious infections. In such cases, the patient remains in the box until discharge. The convalescent person leaves the box through the outer door (into the courtyard of the hospital), and the final disinfection is done in the box.
Indications for placement flax to the boxed compartment
The correct arrangement of the admission department, strict isolation of patients in accordance with the diagnosis and proper sanitization, the presence of boxes for the isolation of patients with mixed infection ensure effective fight against nosocomial infections.
Rules for the work of medical staff in the Meltzer box:
1) The medical staff serving patients in the boxed department is located in the inner corridor, into which patients are not allowed to enter.
2) When visiting a patient, medical workers enter the gateway from the corridor, wash their hands, put on a gown, then go to the ward.
3) When leaving the patient, the process is repeated in reverse order: the gown is removed, then the hands are disinfected. It is necessary to ensure that at the time of opening the door from the ward to the airlock, the door from the airlock to the corridor is tightly closed to prevent the spread of infectious diseases such as measles and chickenpox through the air.
In the Meltzer (individual) box, as a rule, there is one patient. After the patient is discharged, the room is thoroughly disinfected. Behind each box, items necessary for servicing the patient and cleaning the room are assigned with the help of marking. Dirty linen and garbage, previously disinfected with bleach, are taken out of the box in special bags, in which they are sent for further processing (washing, boiling) or incineration.
With a thorough examination, it is possible to identify patients suffering from mixed infections, such as measles and diphtheria, chicken pox and whooping cough. Patients with signs of mixed infections are placed in boxes (better - like Meltzer's) or in small wards - insulators.
Boxes are rooms for isolation of patients with infectious diseases and people suspected of infectious diseases, as well as for isolation in order to prevent nosocomial infections.
There are several types of boxes:
open boxes(Fig. 1) - part of the room, divided by partitions (movable or fixed) with a height of 1.5 to 2.2 m. The insulation in such boxes is imperfect. Closed boxes - part of the room, separated from the ceiling by a partition. Communication with the boxes is carried out through the corridor of the department. Boxes are equipped with items necessary for patient care. There are also lock chambers. They are rooms with a small compartment - a gateway. There is a washbasin, a second dressing gown, a scarf (cap) for the attendants in the gateway. These chambers also open into the department corridor. Boxing area - 20-25 m 2: ward - 10 m 2, gateway - 1.5-2 m 2, bathroom - 8-9 m 2.
Individual (so-called Meltzer) boxes are the most perfect (Fig. 2). The patient in such a box is completely isolated. He enters the boxes from the yard. In such a box there is also a compartment - a gateway that communicates with the corridor of the boxed compartments, in which there is a washbasin, a second dressing gown, a scarf (cap).
The medical staff enters the boxes through the gateway, where they wash their hands, change their gown or put on a second gown, a scarf (cap). When leaving the box, the staff first removes the gown and cap, and then washes and disinfects their hands (0.2-0.5% solution, etc.). All things, care items, material for research are taken out of the box into the yard. In the boxes there are only the most necessary items for the patient: a bed, a bedside table, a stool, a box with a lid for dirty linen.
Group boxes are used to isolate several patients with the same diagnosis at the same time.
Rice. 1 open boxes
Rice. 2. Meltzer system box: A - staff entrance; B - entrance for the patient; I - lock for personnel; II - gateway for the patient; III - chamber. 1 - bed; 2 - a window for serving food; 3 - sink for washing personnel; 4 - step at the entrance; 5 - front; in - a place for dirty linen and dishes; 7 - ventilation duct; 8 - toilet bowl; 9 - bath; 10 - a sink for washing the patient.
Bacteriological boxes- isolated rooms for holding. These boxes can be large-sized and occupy an area of several square meters and small-sized (desktop). Bacteriological boxes must meet the following basic requirements: have an air system (bactericidal lamps, for example, BUV-15 or BUV-30) or an air supply and exhaust system with the supply of disinfected and heated air to a predetermined temperature. Air disinfection can be carried out by passing it through a system of filters that trap microorganisms. To prevent microbial contamination, the room of the boxes should have a pre-box and, if possible, a vestibule where the staff puts on overalls (gowns, preferably sterile, mask, scarf or cap, slippers). In the bacteriological box there should be no unnecessary things that interfere with cleaning, which is done daily with the use of detergents and disinfectants. When working in a bacteriological box, sterile dishes and sterile or disinfected instruments, etc. are used. All items are brought into the boxes in advance of work from the pre-box, and then bactericidal lamps are turned on. If there is a large pre-box or vestibule, a refrigerator, a centrifuge are installed in it so as not to transfer infected materials to other rooms.
A desktop bacteriological box, designed for one or two workers, is usually made of glass or non-flammable transparent plastics and can be used in camping and field conditions. It has openings for hands, equipped with sleeves made of medical oilcloth or other washable material, ending in rubber or rubber bands, located in the area of \u200b\u200bthe wrists of workers. The table box also has a pre-box, bactericidal lamps or a supply and exhaust system with a supply of disinfected air, a spirit lamp or a gas burner, a gas supply hose; it is desirable to have a water supply and outflow system, an air thermometer, a container with a disinfectant solution, etc.
Radiation boxes- special chambers for working with radioactive substances. There are several types of boxes designed to work with beta or gamma emitters, for one or two workplaces. Work with radioactive substances in the boxes is carried out using special remote tools (see Radiological Instrumentation) - remote tweezers, grippers, ampoule and vial openers, and remote pipettes for pouring solutions of radioactive substances. The boxes are supplied for decontamination, and if necessary, gas. Radiation boxes have their own ventilation system with special filters - traps of volatile radioactive substances. After work, the box is decontaminated by washing it with soap and water. Drainage water is collected in special settling tanks and kept until the concentration drops to the maximum allowable levels for a given isotope. The tightness of the boxes and the efficiency of the filter-traps of the ventilation system should be checked periodically.