I APPROVED
deputy Chief of the Main
epidemiological department
Ministry of Health of the USSR
G.G.Onishchenko
dated 04/18/89 N 15-6/12
1. General Provisions
1.1. These Guidelines regulate the organization and implementation of disinfection measures for acute intestinal infections (AEI) of bacterial etiology: salmonellosis, shigellosis, yersiniosis (pseudotuberculosis and intestinal yersiniosis), escherichiosis and other intestinal infections, except for typhoid and paratyphoid fever, disinfection measures for which are regulated by order of the Ministry of Health USSR dated 03/02/89 N 139 "On measures to reduce the incidence of typhoid and paratyphoid fever in the country's population."
1.2. These Guidelines have been developed taking into account the following epidemiological features of the above infections: pathogens are released into the environment with human excreta; the duration of their survival on environmental objects is significant and depends on temperature, humidity, massiveness of infection, the presence of biological contamination, and their resistance to the effects of physical and chemical agents; The importance of contact and household transmission of infection remains significant with the leading main routes (food and water).
1.3. Taking into account the resistance of pathogens to environmental factors and disinfecting agents, recommended disinfection measures are unified for two groups of infections: 1) salmonellosis and intestinal yersiniosis; 2) shigellosis, escherichiosis and pseudotuberculosis.
1.4. For acute intestinal infections, ongoing final and preventive disinfection is carried out.
2. Routine disinfection
2.1. Current disinfection is carried out in the environment of the patient in the outbreak and medical institutions.
2.2. Current disinfection in the outbreak of a patient with acute respiratory infections is organized by a medical institution from the moment an infectious patient is identified until his hospitalization or recovery and is carried out by the patient’s relatives or by the patient himself, and is selectively monitored by employees of sanitary-epidemiological stations (SES) or disinfection stations (DS).
2.3. The doctor (paramedic), who has identified a patient with intestinal diseases, decides on his hospitalization in a hospital. Before hospitalization of the patient or in the case of treating the patient at home, he prescribes treatment and organizes ongoing disinfection, instructing one of the family members about the rules of personal hygiene for the patient and measures to prevent infection of others, which is noted in the outpatient card.
2.4. When organizing ongoing disinfection, attention is paid to:
- isolation of the patient, if possible, with maximum limitation of contact with other family members;
- providing him with individual bed linen, a towel, dishes, a discharge container and care items;
- ensuring separate collection and storage of dirty laundry before washing;
- patient use of easily handled items for everyday needs;
- maintaining cleanliness in the premises, especially in common areas;
- presence of flies for the purpose of subsequent disinfestation measures;
- systematic disinfection of patient secretions and food debris;
- maintenance of out-door toilets and cesspools.
2.5. When carrying out current disinfection, the population uses the simplest methods of disinfection (boiling, wet cleaning, etc.).
2.6. If a patient is identified or suspected of acute intestinal diseases in somatic hospitals, departments for young children and newborns, he should immediately be isolated in a separate ward or isolation ward, where ongoing disinfection is carried out, before being transferred to an infectious diseases hospital.
2.7. In infectious diseases departments of hospitals, personnel carry out ongoing disinfection in accordance with the recommendations of the order of the USSR Ministry of Health dated 04.08.83 N 916.
3. Final disinfection
3.1. Final disinfection is carried out by disinfection stations, disinfection departments of the SES, as well as by the population at home.
3.2. Final disinfection is not carried out after the recovery of a patient with acute respiratory infection treated at home, as well as after the expiration of the incubation period from the moment of identification and isolation of the patient.
3.3. Final disinfection carried out by disinfection stations and disinfection departments of the SES.
3.3.1. Final disinfection is carried out in:
- home hearths, sanitary-poor, crowded communal apartments, in the presence of family focality, with dysentery and other acute intestinal infections;
- households where there are young children (up to two years old), with salmonellosis and intestinal yersiniosis, according to the conclusion of a doctor, paramedic of a healthcare facility or an application from an epidemiologist;
- hostels and hotels;
- well-equipped children's preschools, incl. specialized institutions, boarding schools in the event of group diseases (two or more cases);
- poorly equipped children's institutions for each case;
- schools when group diseases occur (5 or more cases);
- health care facilities, only according to the conclusion of an epidemiologist;
- in catering units of organized groups, public catering establishments, the products of which caused a group incidence (5 or more cases) of salmonellosis, intestinal yersiniosis and pseudotuberculosis.
3.3.2. The disinfection team performs final disinfection of the outbreaks in the following order:
- before entering the outbreak, the entrance door is irrigated from both sides with a hydraulic remote control, then the passage “path” to the room where the patient (bacterium carrier) was located is disinfected, after which the team leader determines the amount of work to be done, prepare a disinfectant solution of the required concentration for disinfecting premises and individual objects ;
- if there are flies in the outbreaks, first, with the windows and doors closed, they are destroyed using insecticides (Table 2);
- after disinsection, open the window (window), begin to disinfect, first of all, the most dangerous objects from an epidemiological point of view (patient excreta, pots, underwear and bed linen, tea and tableware, food debris, door handles, toys, cleaning material , patient care items (Table 1).
3.3.3. Chamber disinfection of things is carried out according to epidemiological indications. To do this, they draw up documentation for things, put them in a bag and take them out of the fireplace, after spraying the bag with a disinfectant solution. After which they begin to disinfect all premises and furniture; common areas are treated: bathroom, corridor, toilet. If there are yard sanitary installations, they are disinfected and disinfested, after which waste bins and the yard area (in places of fecal soil contamination), etc. are disinfected.
In areas of salmonellosis and yersiniosis, special attention should be paid to disinfection of food storage, processing and distribution areas. In areas of intestinal yersiniosis and pseudotuberculosis, according to epidemiological indications and the conclusion of a disinfection doctor, it is necessary to provide for deratization measures, mainly in places where food products are stored and processed.
3.3.4. Upon completion of work in the fireplace, team members change their gowns, pack them for subsequent chamber disinfection, and wash their hands with soap.
3.4. Final disinfection carried out by the public.
3.4.1. Final disinfection is carried out after isolation of a patient with acute respiratory infections or if they are suspected in domestic outbreaks: sanitary, sparsely populated apartments, in the absence of family focality, as well as young children.
3.4.2. The final disinfection by the population is organized by the staff of the medical institution who identified the patient.
The doctor (paramedic) who has identified a patient with ACI instructs him or his family members about the rules and measures to warn others; leaves a memo developed taking into account the specifics of local conditions, gives instructions to the nurse about the timing of final disinfection by the public and recommends disinfection regimes for individual objects.
In the patient’s outpatient card, the local doctor notes the date, hours of diagnosis and the organization of disinfection by the public and its implementation. In the emergency notice (Form 58), he makes a note about the sanitary condition and contents of the fireplace.
If necessary, to organize final disinfection, at the direction of the attending physician, a nurse enters the outbreak.
3.4.3. For institutions operating on the principle of simultaneous hospitalization and disinfection with a significant workload of district nurses during the seasonal rise in the incidence of intestinal infections, the organization of final disinfection by the population is carried out by a nurse for the evacuation of infectious patients from sanitary and epidemiological stations (disinfection stations).
The tow truck instructs the patient’s family member about disinfection and leaves a reminder.
3.4.4. The family member carrying out the disinfection puts on easily washable clothing, a scarf, preferably rubber gloves and begins to disinfect the patient’s room, then treats the common areas. The person carrying out the treatment, after completing it, thoroughly washes his gloves, takes off his work dress and scarf, places them in a tank (basin) for boiling, then washes his hands and takes a shower.
3.4.5. When performing final disinfection, the population uses the simplest methods of disinfection:
- boiling linen, dishes, toys (within 15 minutes from the moment of boiling);
- wet cleaning of premises (floors, window sills, doors, etc.), furniture, kitchens, toilets using household detergents and disinfectants or 2% soap-soda or other cleaning solution.
3.4.6. When performing final disinfection in areas of acute respiratory infection, chamber disinfection is not carried out by the population.
3.4.7. The disinfection department (department) of the sanitary-epidemiological station or the disinfection station annually instructs the personnel of medical institutions on the rules for carrying out final disinfection by the population in outbreaks of infectious diseases.
3.5. Final disinfection in medical institutions.
3.5.1. In infectious diseases hospitals, final disinfection is regulated by order of the USSR Ministry of Health dated 08/04/83 N 916 *.
________________
* On approval of the Instructions on the sanitary and anti-epidemic regime and labor protection of personnel of infectious diseases hospitals (departments).
3.5.2. In somatic hospitals, after isolation of patients with acute respiratory infections, final disinfection is carried out by hospital staff according to the regimes indicated in Table. 1.
3.5.3. If a patient with AEI is identified at an outpatient clinic, after isolating the patient, in the office (box), as well as in the rooms where the patient was, final disinfection is carried out by the staff of the institution according to the regimes indicated in Table. 1. If an infectious patient is identified at the reception, the staff must change their gowns and wash their hands twice with warm running water and toilet soap.
4. Preventive disinfection
4.1. Preventive disinfection is carried out to prevent the accumulation of pathogenic and conditionally pathogenic microorganisms on environmental objects, as well as their carriers (insects, rodents, etc.), the occurrence of acute intestinal infections and their spread.
4.2. Preventive disinfection is carried out in:
- medical institutions, kindergartens, schools, boarding schools by staff;
- in public catering establishments, as well as in the production, processing of food products and raw materials of animal origin, working and using disinfection stations or disinfection departments of SES.
4.3. In medical and preventive institutions, the implementation of preventive measures is regulated by Order of the USSR Ministry of Health dated March 23, 1976 N 288 “On approval of the Instructions on the sanitary and anti-epidemic regime of hospitals and on the procedure for the implementation by bodies and institutions of the sanitary and epidemiological service of state sanitary supervision over the sanitary condition of medical and preventive institutions” .
5. Disinfection measures in preschool institutions
5.1. After isolating the patient in the group he attended, final disinfection is carried out, see paragraph 3.3.1.
After the final disinfection in the group for the quarantine period, disinfection measures are carried out according to the regimes indicated in the table. 3.
5.2. While a patient or someone suspected of having acute respiratory infections is in the isolation ward, ongoing disinfection is carried out, and after the patient is removed from it, final disinfection is organized there.
5.3. In the absence of isolation between groups, the scope of disinfection measures is determined by the degree of contact of children visiting these groups.
5.4. Disinfection is carried out in the absence of children at the end of a shift at the child care facility or during children's walks by agreement with the staff of the child care center.
5.5. When carrying out disinfection, bed linen is removed from all beds in the sick group and disinfected by boiling with detergents in a specially designated room (if possible) or soaking in disinfectant solutions. The patient’s linen is disinfected in a separate container.
Bedding from the patient's bed and adjacent beds is disinfected in a disinfection chamber. When storing bedding together, the latter are sent for chamber processing. If there are mattress covers, they are disinfected. In this case, the mattresses are not sent for chamber processing, but are mechanically cleaned with a brush or vacuum cleaner, as well as by shaking out, etc.
When disinfecting objects, use the disinfectants and methods indicated in Table. 1 and 3.
If there are flies in children's institutions, disinsection is carried out before disinfection (Table 2).
5.6. Final disinfection in suburban children's institutions (children's institutions that go out of town for the summer, pioneer camps, etc.) is carried out by the disinfection departments of local sanitary and epidemiological stations.
5.7. Responsibility for organizing and performing ongoing, final disinfection in preschool institutions lies with the administration and medical staff of the institution.
6. Disinfection measures in schools
6.1. In isolated cases of acute intestinal infections, final disinfection is carried out by school staff.
If group diseases occur (5 or more cases), final disinfection is carried out by disinfection teams.
6.2. The following areas are subject to mandatory disinfection: the buffet, dining room and sanitary facilities. At the direction of the epidemiologist, the list of objects can be expanded.
6.3. Responsibility for organizing and performing current, final and preventive disinfection in schools lies with the school administration and medical personnel.
7. Quality control of disinfection measures
7.1. Quality control of disinfection is carried out: visual and laboratory (bacteriological and chemical) methods in accordance with the order of the USSR Ministry of Health dated January 17, 1979 N 60 “On measures to further strengthen and develop disinfection business.”
7.2. Foci of intestinal infections located in unsanitary, crowded communal apartments, dormitories, foci where children under two years of age live, as well as foci as directed by an epidemiologist are subject to mandatory monitoring by medical personnel. When visiting the outbreak, the nurse monitors the correctness of the current disinfection carried out by the population.
7.3. Bacteriological quality control of final disinfection performed by the public is not carried out.
7.4. During bacteriological control, flushing is carried out from an area of at least 200-300 sq.cm in 2-3 adjacent areas of the inspected object. When taking samples from toys, dishes, etc. Swab swabs are performed from the surface of the entire object.
7.5. Accelerated method (one-stage) of bacteriological quality control of disinfection.
This express method using Heifetz medium is based on the ability to count E. coli in crops only by changing the color of the medium without isolating a pure culture and identifying it. Heifetz's medium makes it possible to obtain the final result 18-24 hours after inoculating the swabs. In doubtful cases, use the three-stage method of studying swabs.
Composition of Heifetz medium: 10 g peptone, 5 g mannitol, 5 g table salt, 1 l tap water; after boiling, set the pH of the solution within 7.4-7.6, and then add indicators: 1 ml of a 5% alcohol solution of rosolic acid and 2.5 ml of a 0.1% aqueous solution of methylene blue. At the indicated pH, the color of the medium is red-violet. A red color without a purple tint indicates that the media is highly alkaline and should be discarded.
When producing washes after disinfection with chlorine-containing preparations, 10 g of hyposulfite are added to the proposed recipe. Preparation of indicators:
a) 0.5 g of rosolic acid powder is placed in a small bottle with a ground-in lid and filled with 10 ml of alcohol;
after 24 hours the indicator is ready. The solution is valid for 1 month;
b) 0.1 g of methylene blue is poured into 100 ml of distilled water and heated to a boil; The solution's validity period is unlimited.
The prepared medium is sterilized by boiling or heating in a boiling water bath for 5 minutes.
The medium is poured into test tubes (8-10 ml), heated once with running steam for 20-30 minutes.
The inoculated test tubes are placed in a thermostat at 37 °C for 18 hours. After the specified time, the results are taken into account based on changes in the color of the medium. If the medium is green and has abundant characteristic turbidity, the growth of E. coli is recorded.
7.6. Standard (three-stage) method for studying swabs. For bacterial control of the effectiveness of disinfection in foci of intestinal infections, Eickman or Heifetz nutrient media are used. The latter medium provides a higher inoculability of E. coli in washings than Eikman's medium.
Crops on Eikman's medium are kept in a thermostat at a temperature of 43 °C, on Heifetz's medium - at 37 °C for 18 hours. The next day, from the test tubes in which there is turbidity, a platinum loop is used to inoculate them onto Endo medium in Petri dishes. To obtain isolated colonies, a loop with the collected material is immersed at the edge of a Petri dish into the thickness of the agar, and then the loop is removed and a series of strokes are made in the same place. After this, strokes are applied to the remaining surface of the Endo medium.
The seeded Petri dishes are placed in a thermostat at 37 °C for a day. If there is no growth of colonies on Endo medium, the study ends here. If a colony is present, a smear is made from one half of the colony and stained with Gram stain. The other half of the colony is inoculated by injection into a semi-liquid column with glucose. Since the usual criterion - metallic luster on Endo medium - is not sufficient to recognize E. coli, a smear and inoculation in semi-liquid Hiss medium with glucose are made not only from a colony with a characteristic metallic luster, but also from red and colorless colonies.
Inoculated test tubes with glucose are placed in a thermostat at 43 °C for 2-3 hours. The final result is obtained in the presence of acid and gas formation in a semi-liquid column with glucose and typical gram-negative rods during microscopy of smears.
7.7. Evaluation of the results of studies of samples from the surface of disinfected objects and from linen.
A satisfactory assessment of disinfection is the absence of growth of E. coli in all tested samples.
Unsatisfactory assessment - if E. coli is detected in at least one of them.
Table 1. Methods and means of disinfecting objects during current and final disinfection
Table 1
An object | Way | Facilities | Name of infection |
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salmonellosis, | dysentery, |
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Time | Norm | Time | Norm |
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Allocations | Falling asleep | Bleaching powder, | 150 g/kg | 150 g/kg |
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Urine, opo- | Falling asleep | Bleaching powder | 5 g/l | 5 g/l |
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Dishes made from | Submersible | 1% solution | ||||||||||||
The patient's dishes (tea, | Boiling Immersion in disinfectant solution | 2% baking soda solution 0.5% chloramine solution | 30 | 2 liters per person 2 l per person -"- 2 l per person | 30 | 2 liters per set of dishes -"- |
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________________ * From the moment of boiling. |
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The patient's dishes (tea, | Boiling Submersible | 2% solution of baking soda | 15* | 2 liters per set of dishes -"- | 15* | -"- 2 liters per set of dishes |
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________________ * From the moment of boiling. |
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Leftovers | Boiling Falling asleep | Bleaching powder | 200 g/kg | 200 g/kg |
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________________ * From the moment of boiling. |
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Premises, | At current Upon closing | 0.5% solution 1% solution 0.5% clarified 0.1% solution of sulfochlorantine 3% hydrogen peroxide solution with 0.5% | 60 | -"- -"- 300 ml/sq.m 200 ml/sq.m | 60 | 200 ml/sq. m 300 ml/sq. m |
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________________ * From the moment of boiling. |
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Linen without visible marks | Boiling Soaking- | 2% soda solution or solution of any detergent | - | -"- 4 l/kg | 30 | 4 l/kg -"- |
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________________ * From the moment of boiling. |
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Linen contaminated with excretion | Boiling Soaking- | 2% soda solution | 90 | 4 l/kg -"- | 60 | 4 l/kg -"- |
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________________ ** Products of electrolysis of sodium chloride solution (used for ongoing disinfection in health care facilities). |
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Boiling | 2% soda solution 0.25% lightened 0.5% chlorcinine solution | 60 | Full immersion Full immersion | 30 | Full immersion or |
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________________ ** Products of electrolysis of sodium chloride solution (used for ongoing disinfection in health care facilities). |
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Bed sheets | Obezzara- | Steam-air at a temperature of 80- | 60 kg/sq.m | 60 kg/sq.m chamber floor area |
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Cloth, | Obezzara- | Steam-formalino- | 30 kg/sq.m chamber floor area |
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Flush water after washing the patient, after washing dishes | Falling asleep after- | Bleaching lime or heat-resistant bleaching lime, | ||||||||||||
Orderly | Double anti- Wiping with a rag on which a detergent is applied | Disinfectants used for disinfecting premises Dichlor-1, Belka, Blesk-2, Sanita, PCHD Desus and others | 60 | 500 ml/ sq.m | 60 | 500 ml/sq.m |
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________________ **** During final disinfection, irrigate twice or wipe with a rag with a disinfectant solution at intervals of 15 minutes. |
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Burning Fill with one of the disinfectant solutions | 10% clarified solution of bleach or heat-resistant bleaching lime 5% solution of NGK 20% bleach milk | 120 | In proportion to | 120 | In proportion to |
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Out-door toilets, cesspools and garbage bins | Irrigate with one of the disinfectant solutions | 10% solution of bleaching lime or bleaching lime | 500 ml/sq.m | 500 ml/sq.m |
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Table 2. Measures to combat flies
table 2
Name | Means and methods of controlling flies |
Fighter: a) destruction b) destruction c) destruction | Use of aqueous emulsions of larvicides: 0.2% trolene; 1% karbofos, 0.5% DDVF, diaphos, dicresyl; 1% Diphocarb dust. The surface of the waste is evenly poured (covered) at the rate of 2-5 liters per 1 sq.m. with a waste layer thickness of up to 0.5 m. The dust consumption rate is 300 g/sq.m. The frequency of treatments is once every 5-10 days. Use of chemicals: 2-3% aqueous solutions of chlorophos, insecticidal paper, baits of 1% chlorophos or a mixture of 0.5% aqueous solution with 0.5% dry ammonium carbonate with fly-attracting substances (sugar waste); bait Riapan-M and Alfacid, aerosol cans designed to kill flying insects. Use of mechanical means: sticky tapes, fly traps. Using a mixture of 2% aqueous chlorophos with 0.2% aqueous emulsion of DDVF (10:1); 0.5% water emulsion DDVF; bait from a 1% aqueous solution of chlorophos with 0.5% dry ammonium carbonate with the addition of fly-attracting substances ( fish or meat waste). |
Table 3. Sanitary and disinfection regime in children's institutions during quarantine
Table 3
Object name | Disinfection method and time |
Spatulas (metal) Thermometers (maximum) Dishes freed from food residues Leftover food Rags for washing dishes and tables Dining tables Toys Bed dress Cleaning Cleaning equipment: Discharge Outbuildings | After single use, boil for 15 minutes from the moment of boiling. Store clean and used spatulas in separate, marked containers. Disinfect by complete immersion in a 2% chloramine solution or another solution indicated in Table 1 for disinfecting toys with an exposure of 5 minutes. See table 1. Do not wipe washed dishes, but dry them on wire racks. See table 1. After each removal of food waste, the container is washed (at least three times a day) with water and disinfectant detergents. After washing the dishes, wash, then boil for 15 minutes from the moment of boiling, dry and store dry in a closed, labeled container, or after washing, keep in a 1% solution of chloramine, a clarified solution of bleach or calcium hypochlorite - 60 minutes. Change the solution after each use of the rag. After disinfection, rinse with running water, dry, and store in a closed, labeled container. See table 1. After disinfection, rinse off the disinfectant solution with hot water and wipe the surface dry. See Table 1. Clean twice with a brush soaked in a 1% chloramine solution and ventilate after one hour. See table 1. If the epidemiological situation is complicated, carry out wet cleaning using one of the solutions indicated in Table 1. If the epidemiological situation becomes complicated, disinfect according to the regimens indicated in Table 1. See Table 1. See Table 1. Discharge Dishes. Wash toilet seats with warm soapy water. Wash toilets with kvacha. Treat the surfaces with a 10% solution of bleach and cover it with dry bleach once a week (at the rate of 1 kg per 1 sq.m). Wash the interior surfaces of the yard toilet and door handles daily using 1% chloramine or 1% solutions of clarified bleach. Used kvachas are immersed in a 0.5% solution of clarified bleach or calcium hypochlorite for 30 minutes. Store clean and used kvacha in separate, marked containers. Have at least 6 kvacha per group. Change the disinfectant solution after the organized drop-off of children. |
Note.
prohibited:
- treat pots with a disinfectant solution in the presence of children;
- store kvacha for washing pots and toilets outside the utility closet;
- disinfect linen in group rooms;
- place the tank for disinfecting dishes on a table, stool, or children’s chair;
- store jars of disinfectant solutions for rags in places accessible to children.
The guidelines are intended for medical personnel of sanitary-epidemiological and disinfection stations, treatment-and-prophylactic and preschool institutions, organized groups (schools, etc.).
The Instructions for organizing and carrying out disinfection for dysentery, approved. Ministry of Health of the USSR 09.09.71 N 934-71.
The text of the document is verified according to:
"Chief Nurse"
N 6, 2001
Disinfection- this is the disinfection of environmental agents from pathogenic agents that ensure the transmission of infectious disease agents.
In practice, a distinction is made between focal and preventive disinfection. Focal disinfection is carried out in foci of infection near the patient’s bed (at home, in the hospital) - “current disinfection” (the patient’s secretions, his underwear, things near him, a vessel, dishes are disinfected), as well as at home after hospitalization or death of the patient, in the hospital after his extracts - “final disinfection” (disinfection of an apartment, dorm room, hospital room, mattresses, pillows, blankets).
Routine disinfection in the infectious diseases department is the main activity in the hospital regime. It is of particular importance for intestinal and other bacterial infections. Current disinfection is carried out by hospital workers, nurses, and orderlies. The head nurse, head of the department, and chief physician of the hospital are responsible for the organization and high-quality implementation of current disinfection. The final disinfection is carried out by specially trained disinfectors under the guidance of epidemiologists, assistant epidemiologists, disinfectants of disinfection stations and sanitary and epidemiological stations. During current disinfection, the patient's urine and feces, dishes for food and excreta, linen, patient care items, leftover food, the patient's room, toilet, and furnishings are disinfected. Personal hygiene of the patient and those who look after him is of great importance. The patient's discharge is disinfected in the toilet, in bedpans, and pots. After disinfection and draining of secretions, vessels and pots are disinfected in special tanks with tightly closed lids, then they are washed. The wards, corridors, and premises are wet cleaned daily using detergents and disinfectants. Cleaning material for wards, corridors, and toilets is disinfected separately. The linen of patients is collected in bags or metal bins with a lid, stored in a special room and, after disinfection, sent to the laundry. After discharge, the patient’s bed is disinfected in a disinfection chamber. After eating, dishes are collected on a separate table, freed from food debris, disinfected and washed. Leftover food is collected in a special tank with a lid and disinfected by filling it with a disinfectant solution. A table for dirty dishes, sponges, and brushes are disinfected after each use. Disinfection of sanitary transport requires special attention. Disinfection of vehicles after admission of an infectious patient to the hospital is carried out by the reception department staff. Disinfection begins with the treatment of the external handles of the cabin door, then the floor, ceiling, stretcher, walls and again the floor are irrigated. Irrigation can be carried out using a hydraulic remote control or can be replaced by wiping the surfaces twice with a rag soaked in a disinfectant solution. Chloramine 1%, Lysol 3%, DTSGC 0.5% are used. For aerosol infections, one of the effective methods is ultraviolet irradiation of rooms and wards where patients are located. Medical personnel in such departments must wear gauze respirators.
During the final disinfection, the same items are processed in the outbreak as during the current disinfection. However, chemical disinfectants are more widely used. In addition, chamber disinfection of things is often carried out. The time frame for final disinfection should be as short as possible (no more than 12 hours in rural areas). The final disinfection begins with irrigation of the door to the patient’s room and the floor. Then they disinfect the patient’s dishes, underwear, excretions, pots, select things for chamber disinfection and put them in bags. For aerosol infections, irrigate all the walls of the room up to the ceiling; for intestinal infections, spray the walls around the bed to a height of 2 meters. Surfaces that are painted with oil paint after treatment with a hydraulic remote control are wiped with a rag soaked in a disinfectant solution. Polished items and paintings are cleaned mechanically with a dry cloth. After disinfecting the walls and furniture, the floor is thoroughly irrigated again. In addition to the patient's room, the corridor, bathroom, toilet, and kitchen are treated. If flies or lice are detected in the apartment, disinfestation is also carried out. Not only the patient’s belongings, but also those of persons who were in contact with the sick (outerwear, pillow, mattress, blanket) are subject to chamber disinfection.
Preventive disinfection is carried out constantly, regardless of the presence of infectious diseases, its goal is to prevent the emergence and spread, accumulation of pathogens of infectious diseases or their carriers. For this purpose, drinking water and wastewater are systematically disinfected, milk is pasteurized, animal whey is disinfected, and mosquitoes, ticks, and rodents are destroyed. Preventive disinfection is widely used in agricultural practice, the food and dairy industries, and in the production of vaccines and serums.
All disinfection methods, depending on their nature, are divided into 3 groups:
1. Physical.
2. Chemical.
3. Biological.
The action of physical disinfection methods is based on the destruction or mechanical removal of pathogenic pathogens from the surface of objects, disinfection through the action of a number of physical factors. Mechanical techniques include: shaking, washing, wiping, vacuuming, ventilation, water and air filtration. The action of high temperature is used when boiling linen, dishes, toys, patient care items, and medical instruments. You can add soda or milk to the water to enhance the disinfecting effect. Boiling continues for 15-30 minutes. Hot air at a temperature of - 180°C is used for frying laboratory and pharmaceutical glassware and instruments in a drying cabinet. Hot dry air in disinfection chambers is used to disinfect clothes, gowns, and linen. Ironing with a hot iron at a temperature of 200°C also frees linen from microflora and insects. Moist hot air and water vapor are widely used for chamber disinfection. A disinfection chamber is an installation in which various objects and things are disinfected and disinfested using physical, physical and chemical means. Chambers can be steam or steam-formalin, dry-heat, stationary and mobile. Stationary cameras are installed in disinfection stations, disinfection departments, hospitals, and sanitary inspection rooms. Mobile cameras are located on cars and go directly to the source of infection and work in the field. An effective bactericidal and sporicidal agent is saturated water vapor. Its effectiveness is due to high humidity and temperature. The higher the pressure of saturated water vapor, the higher its temperature. At normal atmospheric pressure (760 mm Hg), the temperature of water vapor is 100 ° C, at a pressure with the addition of 0.5 atm. - 112°C, 1 atm. - 120°C, 2 atm. -132°C. This allows you to increase the effectiveness of disinfection and reduce its time. Moist heat, high temperature and water vapor under pressure are used in autoclaves to disinfect and sterilize glassware, instruments, linen, dressings, rubber products (120°C, 1 atmosphere, 20 min.). Incineration is used to destroy low-value items: paper, garbage, excrement, carcasses of animals that died from particularly dangerous infections. Combustion is carried out in special ovens, pits or on a fire. Pasteurization - heating a liquid, including dairy products, to 70-80°C for 30 minutes. In this case, most vegetative forms of pathogens die. To destroy spore forms, fractional pasteurization is used - 2-3 times for 30 minutes. in a day.
Sunlight causes the death of many microorganisms, especially sensitive pathogens of dysentery, typhoid fever, and cholera. Ultraviolet rays are used to disinfect air in order to destroy microflora and prevent nosocomial infections in hospitals, maternity hospitals, microbiological laboratories, operating rooms, and dentists' offices. Ultraviolet lamps come in different radiation powers. The bactericidal effect is caused by rays with a wavelength of 200-450 nm. Duration of action from several minutes to several hours.
Ultrasound - acoustic vibrations with a frequency from 2 * 10 4 to 2 * 10 6 Hz - is used to disinfect medical instruments, pharmaceutical and laboratory glassware.
Radioactive radiation affects all types of microorganisms and their spores. Ionization is used for the purpose of sterilization and disinfection.
Chemical method of disinfection is the most common. Chemicals used must meet the following requirements:
1) quickly and completely dissolve in water or mix well with it until stable emulsions are obtained;
2) provide a disinfectant effect at low concentrations and in a short time;
3) have a bactericidal effect;
4) be stable during storage.
Various chemicals are used: phenol, cresol, Lysol, alcohols, various alkalis and acids. The most commonly used are chloride compounds (bleach, chloramine, Ca hypochlorite, DTSGC - two-tertiary basic salt of calcium hypochlorite, dichlorhydantoin, dichlorodimethylhydantoin, chlorhexidine, chlorantoin, neochlor, chlorane, clorsept). Recently, compositional agents (Desaktin, Bacylocide, Batsilol, Sokrena, Microbak, Dezefect, Deconex, Korzolex, Dismozan, Septodor and others) have been widely used, which contain various chemical compounds. They are more effective, do not have a strong odor, do not irritate the skin and mucous membranes, do not spoil the surfaces to which they are applied, are used in low concentrations, many of them exceed bleach and chloramine in disinfection activity.
Hydrogen peroxides and its preparations act on microorganisms as oxidizing agents and are used to disinfect surfaces, clothing, and treat wounds. In practice, 6% hydrogen peroxide is widely used together with detergents (0.5% washing powder solution) in a 1:1 ratio for pre-sterilization treatment of instruments. Hydrogen peroxide solutions are prepared from 33% perhydrol with the addition of water. Can be used to disinfect sanitary equipment, dishes, care items - 4%, 60 min.; 3%, 30 min. - for disinfection of linen not contaminated with blood.
The drug dezoxon-0.1 is prepared on the basis of 5-8% peracetic acid. Dezoxon-0.1 is used to disinfect premises, sanitary equipment (2%, 60 min.), dishes, linen (2%, 30 min.) for viral hepatitis. Dezoxon-0.1 is also used for tuberculosis and fungal infections in the form of 0.1-0.5-0.2% solutions, 30-60-120 minutes.
Aldehydes: formaldehyde and glutaraldehyde, effective against bacteria, viruses, fungi and spores. Formaldehyde is highly soluble in water and has a pungent odor. Formalin (40% aqueous solution of formaldehyde) is used for disinfection in steam-formalin chambers. Aldehydes are included as an integral part in composite disinfectants, such as lysoformin-3000, desoform, descozal, descoton-forte, aerodesin-2000.
Quaternary ammonium compounds (QACs) are water-soluble surfactants that have a weak bactericidal effect. But due to their pronounced cleaning properties, they can cause protein swelling, dissolve it and create conditions for more effective action of disinfectants. Sodium bicarbonate, soaps, and various compositions of synthetic detergents and laundry detergents are used as auxiliary agents. Based on QAS, many composite preparations have been created: descosept AF, clinisept, descosoft, descozal, which are used for final and ongoing disinfection in healthcare institutions, in foci of intestinal and droplet infections of bacterial and viral etiology. At the same time, examination rooms, operating rooms (chairs, beds, operating tables,) mattresses, pillows, stretchers, baths, toilets are processed.
Guanidine (chlorhexidine) is used in the form of 0.05% aqueous or alcohol solutions to disinfect surfaces and treat hands. The efficiency approaches that of quaternary ammonium compounds. It is included in lysoformin-special, gembara (1-2%), which act bactericidal (including salmonella), fungicidal, and inactivate pathogens of viral hepatitis B, HIV/AIDS.
Chlorantoin is a composite disinfectant with a cleaning effect. The composition of the drug includes dichloratine, 5,5 - dimethylhydantoin, surfactants, corrosion inhibitor, alkaline detergents. Active chlorine in this preparation is not less than 13.5%. The disinfecting properties are 5 times greater than bleach and chloramine. Chlorantoin is a light-colored free-flowing powder with a noticeable odor of chlorine, is highly soluble in water, and has bactericidal, antiviral and fungicidal effects. Solutions of chlorantoin are used to disinfect medical products made of metals, glass, and rubber, patient care items, linen, dishes, toys, premises, furnishings, sanitary equipment and other items. Prepare 0.1-0.2-0.5-1-2.5-3% solutions by diluting the dry substance in hot water, exposure time is 60-120 minutes. The activity of the solutions remains for 24 hours. Used in medical institutions for current and final disinfection and in foci of intestinal and droplet infections, as well as for preventive disinfection in sanatoriums, food industry enterprises, hotels, schools, public toilets.
Bleach contains 25% active chlorine. In dry form, it is used for disinfection of liquid feces, urine, vomit, food debris, urine, pus, sputum, for filling toilets, cesspools (1 kg per 1 m2). Bleaching lime, which contains active chlorine, is unsuitable for use.< 15%. Из порошка хлорной извести изготовляют хлорно-известковое молоко в виде 10-20% водной взвеси (1 кг на 10 л воды). Только что изготовленное хлорно-известковое молоко используют для побелки помещений, обеззараживания выделений больного, обработки деревянных частей туалетов и в ветеринарной практике. Осветленные растворы хлорной извести получают после фильтрации или отстаивания хлорно-известкового молока на протяжении 3 дней. Осветленные растворы 10-20% хлорной извести сохраняют не больше 5 дней в закупоренной таре темного стекла и в прохладном месте, из них изготовляют рабочие растворы (0,2,-0,5-1-3-5%) (берут соответственно 200-500-1000-3000-5000 мл 10% раствора, добавлением воды до 10 л). Их применяют для обеззараживания судов, горшков, тряпок, щеток, посуды, для дезинфекции ванн, унитазов. Допускается обработка стен, пола, предметов обстановки в жилых домах, больницах, в теплый период года в хорошо проветриваемых помещениях. Хлорная известь имеет неприятный запах, вызывает раздражение слизистых оболочек глаз и дыхательных путей, обесцвечивает ткань, вызывает коррозию металлов, поэтому шире применяется хлорамин и его растворы. Он более стойкий, хорошо растворяется в воде, не имеет тех недостатков, которые есть у хлорной извести. Растворы хлорамина можно использовать на протяжении 10-15 дней. Хлорамин применяют при кишечных и капельных инфекциях в виде 0,2-0,5-1-3% водных и активированных растворов. В 0,2-3% концентрации применяют для обеззараживания белья, посуды, игрушек, предметов ухода за больными, обстановки в очагах кишечных и капельных инфекций, в жилых и больничных помещениях, детских и школьных учреждениях, местах сосредоточения людей. При туберкулезе концентрацию хлорамина увеличивают до 5 %. Сроки хранения хлорамина >3 years. Preparation of chloramine solutions from powder or from a basic 10% solution (0.2% - 2 g per 1 liter of water; 1% - 10 g per 1 liter of water or 200-1000 ml of a 10% solution up to 10 liters of water, respectively).
Phenol or carbolic acid is used in the form of soap-phenolic solutions (5% phenol, 3% soap, 92% water) or (3% phenol, 2% soap, 95% water) for intestinal infections, diphtheria.
Lysol (3-10%) is used to disinfect linen, treat floors, and pour over the corpses of people and animals who died from the plague.
The effectiveness of disinfection measures depends on the timeliness and quality of their implementation. A message about the need for final disinfection at the site is submitted to the sanitary and epidemiological or disinfection stations within 1 hour. after hospitalization of the patient. Current disinfection should begin no later than after 3 hours. from the time the patient was identified. The quality of disinfection is determined selectively by visual, chemical and bacteriological control methods. Visual inspection allows you to assess the sanitary condition of the facility, select the method and scope of final and ongoing disinfection. Chemical control is used to check the correct preparation of disinfectant solutions (concentration of the solution, its activity). For bacteriological quality control of final and ongoing disinfection, at least 10 control swabs are taken in residential outbreaks, and at least 30 swabs are taken in healthcare facilities and preschool institutions. Bacteriological control in foci of intestinal infections is carried out by identifying E. coli, and in foci of respiratory tract infections - staphylococcus, in foci of tuberculosis - staphylococcus and mycobacterium tuberculosis. Disinfection is considered satisfactory if, after the final disinfection, microflora is inoculated in no more than 0.5% of the swabs, and after the current one - in no more than 3% of the swabs. If pathogenic microflora is inoculated, the final disinfection is considered unsatisfactory.
QUESTIONS FOR SELF-CHECK:
1. What is the difference between artificial active and passive immunity?
2. At what age is vaccination against whooping cough carried out?
3. When is revaccination against tuberculosis carried out?
4. What toxoids are used for routine immunization?
5. Based on what data is the vaccination plan drawn up?
6. What is the difference between routine vaccinations and vaccinations for epidemic indications?
7. What is the side effect of the live polio vaccine?
8. What part of the epidemic process is disinfection aimed at?
9. What requirements must chemical disinfectants meet?
10. What chlorine-containing preparations are used for disinfection in residential premises?
11. What disinfectants are used for disinfection in medical institutions?
12. What types of disinfection chambers do you know based on the nature of the active bactericidal agent?
And public catering, stations, carriages, entertainment institutions, etc.).
The main objects of preventive disinfection are:
- clinics, children's clinics and other similar institutions (disinfection is carried out after appointments or in between);
- children's preschool institutions;
- (cinemas, hostels, markets, etc.);
- food industry enterprises (,),;
- hairdressing salons, baths, showers, swimming pools, etc.;
- enterprises where they are stored and processed.
Preventive disinfection, depending on the nature of the object, is carried out either by the business organizations themselves, or by preventive disinfection centers (disinfection departments of the territorial centers of hygiene and epidemiology of Rospotrebnadzor).
Business organizations are engaged in carrying out preventive disinfection measures in cases where their constant and continuous implementation is required (pasteurization of milk and dairy products, gyms, and so on).
Disinfection institutions of the sanitary-epidemiological service in these cases carry out methodological and control functions.
In some cases, when preventive disinfection is one-time or periodic in nature, it is carried out using the forces and means of preventive disinfection centers or disinfection departments of territorial centers of hygiene and epidemiology (disinfection of industrial premises after major repairs, periodic, etc.).
The effectiveness of preventive disinfection is largely determined by the sanitary and communal improvement of the settlement, the sanitary and technical condition of the facility, the quality of implementation of preventive recommendations of the sanitary and epidemiological service at the facilities, and the degree of participation of the population in the implementation of preventive measures.
Current disinfection
Current disinfection- carried out at the patient’s bedside (in the outbreak) in his presence, in isolation wards of medical centers, medical institutions, aimed at destroying pathogens as they are released by the patient or carrier, in order to prevent the spread of infectious diseases beyond the outbreak.
The most common indications for routine disinfection are:
- the presence of the patient in the outbreak before hospitalization;
- treatment of an infectious patient at home until recovery;
- the presence of a bacteria carrier in the outbreak until it is completely sanitized;
- the presence of convalescents in the outbreak before removal from the dispensary register.
Current disinfection in apartment foci of infectious diseases is organized by the medical worker who identified the infectious patient.
In some cases, the organization of ongoing disinfection is carried out by employees of the sanitary and epidemiological service, however, this approach is considered unpromising, since it delays the start of disinfection measures and is poorly controlled in the future.
The organizational role of a medical worker (most often a local doctor) during ongoing disinfection is that he explains and teaches the patient (or caregivers) how to carry out ongoing disinfection.
It should be especially emphasized that current disinfection includes two groups of measures:
- Disinfection of environmental objects and patient secretions.
Current disinfection in apartment epidemic foci is carried out by the sick themselves (bacteria carriers) or by persons caring for the sick.
Sanitary and hygienic measures in the apartment fireplace as part of ongoing disinfection include:
- isolation of the patient in a separate room or a fenced off part of it ( the patient's room is wet cleaned and ventilated 2-3 times a day), avoiding contact with children, limiting the number of objects with which the patient can come into contact, observing personal hygiene rules;
- allocation of a separate bed, towels, care items, utensils for food and drink;
- Dishes and care items for the patient are stored separately from the utensils of family members;
- separate maintenance and collection of the patient’s dirty laundry from the laundry of family members;
- maintaining cleanliness in rooms and common areas, using separate cleaning equipment for the patient’s room and other rooms;
- in the summer, flies are systematically controlled;
- the family member caring for the patient must wear a robe or an easy-to-clean dress; there should be a scarf on the head; In areas of aerosol infections, it is necessary to wear a cotton-gauze bandage. When leaving the patient's room, overalls should be removed, hung separately and covered with a sheet.
In outbreaks at home, it is advisable to use physical and mechanical methods of disinfection, as well as use household chemicals. At the same time, it is widely used soda, soap, boiling and hot water, clean rags, washing, ironing, airing, etc.
Typically, in residential epidemic outbreaks, chemical disinfectants are used only to disinfect secretions.
Current disinfection measures in an infectious diseases hospital should be carried out throughout the entire period of patients’ stay in the hospital, from their admission to discharge.
After examining each patient, the rooms in which patients are received are subjected to wet disinfection in accordance with the nature of the infection.
Particular attention should be paid to the disinfection of objects that patients came into contact with during the appointment.
Dishes, in which food for infectious patients is transferred from home, must be returned to relatives only after disinfection.
Linen and other washable soft items, used by patients, are collected in tanks with lids or bags moistened with disinfectant solutions and sent to the laundry. In cases where it is not possible to store contaminated linen separately in the laundry, it is collected in a compartment in an isolated room and subjected to wet disinfection before being sent to the laundry.
Toys must be individual and must be disinfected after use by a sick child. Toys of low value must be burned. For disinfection discharge and the dishes made from them should be used more widely in practice, special devices.
If they are not available in the hospital toilet, to collect secretions from patients with intestinal infections, it is necessary to use galvanized tanks with a lid and a mark of 5, 10, 20 liters.
After filling the tank to a certain height fecal matter the latter are subjected to disinfection in the specified way, and a spare tank is put out for use.
Medical personnel caring for patients are obliged to strictly observe the rules of personal prevention (thorough washing and disinfection of hands after finishing caring for the patient, before distributing food, feeding bedridden patients, children, etc.).
It is mandatory to use respirators in departments for patients with aerosol infections. Eating by staff in the wards and corridors is prohibited.
In infectious diseases hospitals and on their territory, systematic control of flies, other insects and rodents and ensure that hospital areas and outbuildings are maintained in complete sanitary conditions.
The disinfection squad is delivered to the outbreak along with all disinfection equipment by transport intended for evacuation of an infectious patient, if it is not possible to allocate a separate vehicle for these purposes.
Upon arrival at the outbreak, the disinfectant determines a place to place the outerwear of the disinfection squad, puts on special clothing, examines the outbreak and finds out all the circumstances that determine the scope and content of disinfection measures, according to which he outlines a plan for the final disinfection.
The main stages of final disinfection in an epidemic outbreak are:
- according to indications, extermination of flies with closed windows, vents and doors;
- treating the door to the room where the patient was, and the floor in the patient’s room with a disinfectant solution;
- disinfection of underwear and bed linen in a disinfectant solution or by boiling;
- disinfection of the patient’s leftover food using disinfectants or boiling;
- disinfection of food utensils using a disinfectant solution or boiling;
- disinfection of secretions and dishes for secretions using a disinfectant solution or boiling;
- disinfection of toys using a disinfectant solution or boiling;
- collecting items for chamber disinfection;
- preparing walls and individual objects for disinfection;
- disinfection of paintings, figurines and polished objects;
- , packing work clothes, washing hands.
In addition to observing the above sequence of disinfection actions, disinfection should begin from more distant parts of the room and corners, sequentially moving towards the exit, after which the corridors, kitchen, and toilet are disinfected.
For chamber disinfection, things are taken from foci of the following infectious diseases: plague, cholera, relapsing fever, epidemic typhus, Brill disease, Q fever (pulmonary form), anthrax, viral hemorrhagic fevers, typhoid fever, paratyphoid fever, tuberculosis, leprosy, diphtheria , fungal diseases of hair, skin and nails (microsporia, trichophytosis, rubrophytosis, favus), scabies.
Chamber disinfection should be carried out on the belongings of not only the patient, but also those who were in contact with him. Items subject to chamber disinfection are sorted and placed in bags separately for steam-air, steam and steam-formalin disinfection. For all things sent to the cell, a receipt is drawn up in two copies, one of which is left with the owners of the things, and the second is sent to the cell along with the things.
Things placed in bags are taken out and loaded into an ambulance immediately after they are collected. Bags with things must be sprayed with a disinfectant solution on the outside before being removed from the fire.
When working on hospitalization and focal disinfection, doctors, nursing and junior medical personnel who come into contact with infectious patients, material contaminated with pathogens and premises, when coming to work, must leave all personal clothing, underwear and shoes in individual closets and put on clean overalls.
When working in outbreaks, disinfection personnel should not use the hangers available in the outbreak. Clothes removed by personnel should be stored in a special case or placed in a pre-disinfected place. Working in fires without special clothing is prohibited.
When working with disinfectants, personnel must wear a respirator and ensure that the products used do not come into contact with the skin; before taking rubber gloves, you need to wash your hands (with gloves) with soap, wipe dry and carefully remove the gloves from your hands; disinfection equipment must be stored in a special room - cabinets, covers, containers, etc.
The final disinfection of the transport on which the infectious patient was evacuated is carried out by the disinfector of the hospital reception department, and the transport that delivered things from the outbreak for chamber disinfection and communicating people for sanitary treatment is disinfected by the personnel who brought the things and people.
The disinfectant solution for treating vehicles is taken at the same concentration as for disinfection in the outbreak.
To disinfect vehicles, the hospital reception department must have disinfectant solutions and the necessary equipment.
Dermantin upholstery and oilcloth covers are wiped with rags, and soft sofas are wiped with brushes soaked in a disinfectant solution.
In the most common low-pressure lamps, almost the entire radiation spectrum falls at a wavelength of 253.7 nm, which is in good agreement with the peak of the bactericidal efficiency curve (that is, the efficiency of ultraviolet absorption by DNA molecules). This peak is located around the wavelength of radiation equal to 253.7 nm, which has the greatest effect on DNA, but natural substances (for example, water) delay the penetration of UV.
Germicidal UV radiation at these wavelengths causes dimerization of thymine in DNA molecules. The accumulation of such changes in the DNA of microorganisms leads to a slowdown in the rate of their reproduction and extinction. Ultraviolet lamps with a bactericidal effect are mainly used in devices such as bactericidal irradiators and bactericidal recirculators.
The incineration installation is used for the timely disposal of various industrial and biological waste generated in various enterprises.
Waste disposal in the incinerator occurs at high temperatures, which ensures the decomposition of organic compounds into inorganic ones and destroys all pathogenic microflora.
The incinerator is not used to destroy harmful substances and waste that do not decompose at high temperatures or that form harmful substances at high temperatures.
Special burners used in the incineration plant ensure reliable and safe destruction of biological and industrial residues. Thanks to them, the temperature in the tank where waste is destroyed can be above a thousand degrees, which allows you to burn any waste and kill all microorganisms.
When destroyed in an incinerator, the volume of waste is reduced tens of times and a small amount of practically sterile ash is obtained.
Depending on the type and properties of food raw materials, different pasteurization modes are used. There are long (at a temperature of 63-65 C for 30-40 minutes), short (at a temperature of 85-90 C for 0.5-1 minute) and flash pasteurization (at a temperature of 98 C for several seconds).
When a product is heated for a few seconds to a temperature above 100 C, it is customary to speak of ultra-pasteurization.
During pasteurization, vegetative forms of microorganisms in the product die, but the spores remain in a viable state and, when favorable conditions arise, begin to develop intensively. Therefore, pasteurized products (milk, beer, etc.) are stored at low temperatures for a limited period of time.
It is believed that the nutritional value of products remains virtually unchanged during pasteurization, since the taste and valuable components (vitamins, enzymes) are preserved.
Pasteurization does not mean sterilization of the product. Mostly killed during pasteurization psychrotrophic and mesophilic lactic acid bacteria (S. lactis, S. cremoris etc.), while thermophilic lactic acid streptococci and enterococci, used to produce fermented milk products, reduce activity.
The effectiveness of pasteurization (the nature of the microflora in milk after pasteurization) is largely determined by the storage conditions of milk before pasteurization (in particular, the temperature of its cooling after milking).
Pasteurization cannot be used when canning food, since a hermetically sealed container is a favorable environment for the germination of spores of anaerobic microflora (see botulism).
For the purpose of long-term preservation of products (especially those initially contaminated with soil, for example, mushrooms, berries), as well as for medical and pharmaceutical purposes, fractional pasteurization is used - tindalization.
It is impossible to sterilize aqueous solutions in bottles in drying cabinets, since water turns into steam at high temperatures and the bottle can be torn.
In practice, moist heat sterilization is carried out at a temperature of 50-150 C and is carried out in the following ways.
Disinfection chambers provide reliable disinfection or disinfestation clothing, bedding, wool, carpets, salvage materials, books and other items.
All other methods of disinfecting soft items, except boiling, do not guarantee complete disinfection and disinsection, and disinfection by boiling is unacceptable for outerwear, bedding (pillows, blankets, mattresses) and some other soft items.
Disinfection chambers use physical (water steam, steam-air mixture, dry hot air), chemical (formaldehyde, etc.) or both disinfectants at the same time.
Cameras are installed in medical and preventive and sanitary-epidemiological institutions, as well as in industrial enterprises.
Varnishes and paints have been developed based on guanidines. Disadvantage: the “film” (at high concentrations) is sticky.
List of legislative documents on sterilization and disinfection issues
- ST SEV 3188-81 "Medical products. Methods, means and regimes of sterilization and disinfection. Terms and definitions."
- GOST 25375-82 "Methods, means and modes of sterilization and disinfection of medical products. Terms and definitions."
- OST 64-1-337-78 "Resistance of medical metal instruments to means of pre-sterilization cleaning, sterilization and disinfection. Classification. Selection of method."
- Temporary instructions for sterilization of packaged disposable plastic magazines for surgical draining devices (approved by the USSR Ministry of Health 09.11.72 N 995-72).
- Methodological recommendations for the sterilization of artificial blood circulation devices with ethylene oxide gas (approved by the USSR Ministry of Health 03.26.73 N 1013-73).
- Temporary instructions for washing and sterilizing surgical instruments and plastic products with hydrogen peroxide and a mixture of ethylene oxide and methyl bromide (approved by the USSR Ministry of Health on August 25, 1972 N 988-72).
- Guidelines for the control of steam sterilizers (autoclaves) in medical institutions (types "AV", "AG", AP" and "AOB") (approved by the USSR Ministry of Health on November 28, 1972 N 998-72).
- Methodological recommendations for sterilization in a portable gas apparatus (approved by the USSR Ministry of Health on March 26, 1972 N 1014-73).
- Guidelines for pre-sterilization treatment and sterilization of rubber products and components for medical purposes (approved by the USSR Ministry of Health 06.29.76 N 1433).
- Guidelines for sterilizing dressings, surgical linen, surgical instruments, rubber gloves, glassware and syringes in steam sterilizers (approved by the USSR Ministry of Health on August 12, 1980 N 28-4/6).
- Methodological recommendations for the use of dezoxon-1 for disinfection and sterilization (approved by the USSR Ministry of Health on December 24, 1980 N 28-15/6).
- Guidelines for pre-sterilization cleaning of medical products (approved by the USSR Ministry of Health 06/08/82 N 28-6/13).
- Order of the USSR Ministry of Health N 720 of July 31, 1978 “On improving medical care for patients with purulent surgical diseases and strengthening measures to combat nosocomial infections.”
- Order of the USSR Ministry of Health N 1230 of December 6, 1979 “On the prevention of diseases in obstetric hospitals.”
- Order of the USSR Ministry of Health N 752 of July 8, 1981 “On strengthening measures to reduce the incidence of viral hepatitis.”
- Order of the Ministry of Health of the USSR N 916 of August 4, 1983 “On approval of instructions on the sanitary and anti-epidemic regime and labor protection of personnel of infectious diseases hospitals (departments).”
- Guidelines for the classification of foci of tuberculosis infection, implementation and quality control of disinfection measures for tuberculosis (approved by the USSR Ministry of Health on May 4, 1979 N 10-8/39).
- Guidelines for the use of chloramine for disinfection purposes (approved on October 21, 1975 N 1359-75).
- Instructions for the use of hydrogen peroxide with detergents for disinfection purposes (approved by the USSR Ministry of Health on August 29, 1970 N 858-70).
- Guidelines for the use of sulfochlorantine for disinfection purposes (approved by the USSR Ministry of Health on June 23, 1977 N 1755-77).
- Guidelines for the use of chlorpin for disinfection (approved by the USSR Ministry of Health on December 24, 1980 N 28-13/5).
- Guidelines for the use of desam for disinfection (approved by the USSR Ministry of Health on December 24, 1980 N 28-14/6).
- Guidelines for sterilization in a formaldehyde sterilizer.
- Guidelines for the use of gibitan for disinfection 08.26.81 N 28-6/4.
- Order of the USSR Ministry of Health No. 60 dated January 17, 1970 “On measures to further strengthen and develop disinfection business.”
- Methodological recommendations for the chemical cleaning of surgical instruments made of stainless steel (approved by the USSR Ministry of Health on March 14, 1983 N 28/6-6).
- Instructions for disinfection and disinsection of clothing, bedding, shoes and other objects in steam-air-formalin, steam and combined chambers and disinsection of these objects in air disinfection chambers (08.20.77).
Links, literature, dissertations, books
- The list of all chemical disinfectants that have a certificate of state registration is given on the Rospotrebnadzor website
Disinfection is a set of measures aimed at destroying pathogenic microorganisms in the external environment. In a broad sense, disinfection also includes the destruction of arthropods - carriers of infections (see Disinsection) and rodents - carriers and vectors of infections (see Deratization).
Disinfection is part of a complex of anti-epidemic and sanitary-preventive measures.
Disinfection is divided into current, final and preventive.
Routine disinfection is carried out before hospitalization of an infectious patient, in case of leaving him at home, as well as in infectious, anti-tuberculosis and outpatient institutions. At the same time, the patient’s secretions, dishes, linen and other items that were used by the patient are systematically disinfected, and the premises are wet cleaned daily using disinfectants. Ongoing disinfection is accompanied by strict adherence to personal hygiene rules for patients and nursing staff. The simplest and most accessible methods of current disinfection are boiling, wet cleaning of premises using disinfectant solutions, the use of chemical disinfectants to disinfect patient secretions, soaking linen, etc.
Current disinfection is organized by the staff of medical institutions or an assistant at the epidemiological and sanitary station. Control and methodological guidance over the correct implementation of current disinfection is assigned to disinfection stations or disinfection departments of sanitary and epidemiological stations. The direct performers of current disinfection are specially trained nursing staff in medical institutions or people caring for the sick at home. Current disinfection is stopped after hospitalization or recovery of the patient as directed by the attending physician.
Final disinfection is carried out after removing the patient from the outbreak (in case of hospitalization, recovery or death). The purpose of final disinfection is to completely free the source of infection from pathogens. Final disinfection is of particularly great epidemiological importance due to the fact that many infectious agents are able to remain viable for a long time on environmental objects. The effectiveness of final disinfection is determined by the timing and completeness of its implementation after removing the patient from the outbreak. In cities it is carried out in the first 6 hours. after hospitalization of the patient, and in rural areas - no later than 12 hours. Final disinfection is carried out by disinfection stations, disinfection departments of sanitary and epidemiological stations and medical areas. Disinfection work in the outbreak is completed with the preparation of the relevant documents.
Preventive disinfection is carried out in order to prevent the spread of infectious diseases mainly in crowded places (in children's groups, catering establishments, medical institutions).
The most common methods of preventive disinfection are: boiling, timely cleaning with removal of garbage and other waste, chlorination of water, etc. Preventive measures also include the fight against insects and rodents.
All chemical disinfectants are toxic to people and animals, so precautions must be taken when working with them.
Features of disinfection for some infectious diseases:
- Adenoviral infections
- Typhoid fever, paratyphoid fever, cholera
- Flu
- Epidemic hepatitis (Botkin's disease), enteroviral infections (poliomyelitis, Coxsackie infection, ECHO infection)
- Dermatomycosis (trichophytosis, microsporia, scab, epidermophytosis)
- Dysentery, salmonellosis
- Diphtheria
- Q fever
- Ornithosis
- Smallpox natural
- anthrax
- Staphylococcal infections (disinfection in maternity hospitals)
- Typhus
- Tuberculosis
- Scabies
- Disinfection business
Disinfection. Methods, types and methods of disinfection
Disinfection(from the Latin “de” - deliverance and “infectio” - infection) or disinfection - the destruction of pathogens of infectious diseases in the human environment using special means.
Disinfection and sterilization in healthcare institutions is regulated by the Order of the Ministry of Health of the Republic of Belarus dated November 25. 2002, No. 165 “On disinfection and sterilization in healthcare institutions.”
Disinfection (disinfection) of objects can be carried out in the following ways:
1. Irrigation, treatment of surfaces of premises, equipment, furniture, vehicles and others with aerosols of disinfectant solutions.
2. Wiping with a rag soaked in a disinfectant solution the surfaces of furniture, equipment, toys, medical products, patient care items and others.
3. Immersion in a disinfectant solution of dishes, linen, toys, medical products, patient care items and others.
4. Treatment with disinfectants in the form of powders, granules or their concentrated solutions of secretions, food debris, corpses, garbage containers, soil and others.
5. Treatment with a steam-air mixture, steam, a steam-formalin mixture, hot air in the chambers of clothing, shoes, bedding, soft toys and others.
6. Irradiation of air and surfaces with ultraviolet rays.
The choice of disinfection method is determined by the characteristics of the object being disinfected.
Types of disinfection
There are focal and preventive disinfection.
Focal disinfection – this is disinfection, which is carried out in an epidemic focus of an infectious disease. Focal disinfection is divided into current And final one.
Current focal disinfection– this is disinfection, which is carried out in the outbreak in the presence of a source of infection and is aimed at destroying pathogens as they are released by the patient or carrier. The most common indications for routine disinfection are:
– keeping the patient at home before hospitalization;
– treatment of the patient at home and in the hospital;
– the presence of a carrier of infection in the outbreak;
– the presence of convalescents (recovering patients) in the outbreak.
Routine disinfection is carried out daily, its frequency is determined by the type of infectious disease. To carry out routine disinfection, disinfectants approved for use by the Ministry of Health of the Republic of Belarus and with approved instructions for their use must be used. The concentration of the working solution of the disinfectant depends on the type of infectious pathology.
Routine disinfection includes wet cleaning of the premises using a disinfectant solution, disinfection of discharge and discharge utensils, food debris, personal hygiene items, and patient care items with disinfectants. One of the methods of ongoing disinfection for infections transmitted by airborne droplets (flu, measles, etc.) is ultraviolet irradiation of rooms where patients are located.
Final focal disinfection- this is disinfection, which is carried out after removing the source of infection from the source in order to completely free the site from pathogens isolated by the patient. Its difference from current disinfection, which is carried out repeatedly, is that it is carried out once and is comprehensive.
The stages of final disinfection are:
– preparation of disinfectants;
– according to indications – disinfestation (extermination of insects);
– treatment of the door to the room where the patient (carrier of infection) was, and the floor in his room with a disinfectant solution;
– disinfection of linen, toys, leftover food of the patient (carrier of infection), dishes, secretions and dishes for secretions;
– collecting things for chamber disinfection;
– disinfection of walls, objects, windows, furniture, floors;
– disinfection of cleaning equipment.
Final disinfection is carried out for typhoid fever, paratyphoid fever, typhus, Brill's disease, anthrax, plague, cholera, contagious viral hemorrhagic fever, Q fever, fungal diseases, scabies, diphtheria, viral hepatitis A, E, acute intestinal infections (dysentery, salmonellosis ), polio, tuberculosis.
For these diseases, final disinfection is carried out either immediately after evacuation of the patient, or within 24 hours after detection of the disease.
For other infectious diseases, final disinfection is carried out depending on the epidemic situation by decision of the chief state sanitary doctor of the administrative territory.
Preventive disinfection – this is disinfection, which is carried out in the absence of an identified source of infection in places where pathogens of infectious diseases are likely to accumulate (health care facilities, educational institutions, catering and retail establishments, train stations, etc.).
Preventive disinfection is carried out using physical, chemical and biological methods.
Physical method of disinfection– this is the destruction or reduction in the population of pathogens under the influence of physical factors (high temperature, ultraviolet radiation, ultrasound, etc.). The destruction of pathogens occurs under the influence of sunlight, drying, water vapor, boiling, calcination, burning, dry hot air, and ironing. Mechanical factors such as washing, cleaning, filtration, ventilation, etc. can be used. The advantages of the method are simplicity and accessibility to implementation; the disadvantages are that it is impossible to achieve complete disinfection.
Biological methods of disinfection involve the use of biological filters, biothermal chambers, and bacteriophages.
Chemical method of disinfection involves the use of chemical disinfectants.
As the first stage of sterilization, disinfection is also carried out to prevent occupational infection of medical workers.
Pre-sterilization treatment
Pre-sterilization treatment (PST) is carried out to remove residual quantities of drugs, reduce the initial contamination with microorganisms, and remove protein, fat and mechanical contaminants.
Most often, pre-sterilization treatment (cleaning) is carried out in 2 ways:
– with soaking the object being treated in a cleaning solution;
– with boiling of the processed object.
Pre-sterilization cleaning with soaking in a washing solution includes the following steps:
Soaking in a cleaning solution while completely immersing the product. The concentration, temperature of the cleaning solution and holding time are determined by the instructions for use.
2. Washing each product in the same solution in which the soaking was carried out, using a brush, a cotton-gauze swab or a cloth, channels - using a syringe. Washing duration is 0.5–1 minute.
3. Rinse with drinking running water for 0.5–1 minute.
Dry with hot air (temperature 85°C) until moisture disappears.
Pre-sterilization cleaning using boiling consists of the following steps:
1. Boiling with approved detergents for 15 minutes.
2. Washing each product in the process of rinsing with running drinking water using a brush, cotton-gauze swab or fabric napkin, channels using a syringe for 0.5–1 minute.
3. Rinse with running drinking water for 5–10 minutes.
4. Rinse with distilled water.
5. Dry with hot air (temperature 85°C) until dry.
Actually sterilization
Physical and chemical methods are used to sterilize products and medical supplies, patient care items, etc. The choice of an adequate sterilization method depends on the characteristics of the products being sterilized.
When sterilizing, as a rule, products are packaged in sterilization packaging materials or in sterilization boxes (boxes).
Packages with sterilized products must contain information about the date of sterilization, and on sterilization boxes - about the dates of sterilization and opening, certified by the signature of a health worker.
For sterilization, only packaging materials that are duly approved for industrial production and use in the Republic of Belarus can be used.
In some cases, it is allowed to sterilize instruments unpackaged (in open trays).
The period of preservation of sterility of products sterilized in sealed paper packages (wet-resistant bag paper, high-strength packaging paper, crepe paper is used) is 20 days. Products sterilized without packaging are placed on a “sterile table” and used during one work shift.
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Disinfection —
Pest control —
Deratization -
Types of disinfection
Purpose of disinfection.
Focal disinfection divided by:
- focal current disinfection
Disinfection methods
These include:
- hand washing.
- pasteurization;
- boiling in distilled water - 30 minutes from the moment of boiling at a temperature of 100°C, and with the addition of sodium bicarbonate (baking soda) - 15 minutes from the moment of boiling at full immersion.
Before boiling, the products are cleaned of organic contaminants in a separate container, washed in compliance with anti-epidemic protection measures, the wash water is disinfected and poured into the sewer.
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Disinfection — This is the destruction (disinfection) of pathogenic and opportunistic microorganisms and their vegetative forms in the human environment.
Pest control — destruction of insects harmful to humans, ticks, lice, fleas (carriers of infectious diseases)
Deratization - destruction of harmful rodents (sources of infection).
Types of disinfection
Purpose of disinfection- destruction of pathogenic and conditionally pathogenic microorganisms in the external environment of wards and functional premises of health care facilities, on medical equipment and instruments.
The following types of disinfection are distinguished::
Ø preventive (in the absence of a lesion)
Ø focal (if there is a focus) disinfection.
Preventive disinfection is carried out to prevent nosocomial infections.
Focal disinfection divided by:
- focal current disinfection , which is carried out at the source of infection, at the bedside of an infectious patient, is carried out repeatedly;
- focal final disinfection , which is carried out once after isolation, hospitalization in the infectious diseases department, recovery or death of the patient in order to completely free the infectious focus from pathogens.
Disinfection methods
There are mechanical, physical, chemical, biological, and combined methods of disinfection.
Mechanical disinfection methods:
These include:
- wet cleaning of premises and furnishings;
- beating of clothes, bed linen and bedding;
- clearing the premises from dust using a vacuum cleaner, whitewashing and painting the premises;
- hand washing.
Physical (thermal) methods of disinfection:
Physical methods of disinfection include the following methods:
- use of sunlight;
- irradiation with ultraviolet emitters to disinfect indoor air and surfaces;
- ironing with a hot iron, firing, calcination;
- burning of garbage and items of no value;
- treatment with boiling water or heating to a boil;
- pasteurization;
- tindalization (fractional pasteurization for 6-7 days at 60°C, exposure - 1 hour);
- boiling in distilled water - 30 minutes from the moment of boiling at a temperature of 100°C, and with the addition of sodium bicarbonate (baking soda) - 15 minutes from the moment of boiling at full immersion. Before boiling, the products are cleaned of organic contaminants in a separate container, washed in compliance with anti-epidemic protection measures, the wash water is disinfected and poured into the sewer.
Scalding with boiling water and bringing to a boil is also used.
- The air disinfection method (without packaging, in a dry-heat oven at T° - 180°C, exposure 60 minutes from the moment the temperature is reached) is used if products made of glass, metals, rubber, latex, heat-resistant polymer metals are not contaminated with organic substances ;
- Steam method. Disinfectant agent: water vapor under an excess pressure of 2 atm.
The physical method is the most reliable and harmless to personnel.
If conditions allow, namely equipment, product range, preference should be given to this method.
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