Read: Anatomy of the parietal glands of the small intestine. Topography, purpose, species features in domestic animals and birds. Innervation, blood supply, lymph outflow. Anatomy studies the structure of animals in 3 main aspects. b) The history of the development of the main directions of medical science and public health On an industrial scale, 5 main methods of water desalination are used: distillation, freezing, reverse osmosis, electrodialysis, ion exchange. Room ventilation. Air exchange rate in children's groups. Air exchange, microclimate, lighting of the main premises of schools. Question 2. Pyramidal and extrapyramidal systems, their significance, centers and main pathways.

How much air does a person need for a normal existence?

Room ventilation provides timely removal of excess carbon dioxide, heat, moisture, dust, harmful substances, in general, the results of various household processes and people staying in the room.

Types of ventilation.

1) Natural. It consists in natural air exchange between
displacement and the external environment due to the temperature difference between the internal and external
outdoor air, wind, etc.

natural ventilation may be:

Unorganized (by filtering air through cracks)

Organized (through open vents, windows, etc.) - ventilation.

2) Artificial.

Supply - artificial supply of outdoor air into the room.

Exhaust - an artificial extract of air from the room.

Supply and exhaust - artificial inflow and exhaust. Air enters through the supply chamber, where it is heated, filtered and removed through ventilation.

General principle ventilation is that

In dirty rooms, an extractor hood should prevail (to prevent spontaneous intake of dirty air into neighboring rooms)

AT clean rooms inflow should prevail (so that they do not receive air from dirty rooms).

How to determine how much clean air must enter the room per hour per person for adequate ventilation?

The amount of air that needs to be supplied to the room per person per hour is called the ventilation volume.

It can be determined by humidity, temperature, but most accurately determined by carbon dioxide.

Methodology:

The air contains 0.4%<■ углекислого газа. Как уже упоминалось, для помещений, требующих высокого уровня чистоты (палаты, операционные), допускается содержание углекислого газа в воздухе не более 0.7 /~ в обыч­ных помещениях допускается концентрация до 1 Л«.

When people stay indoors, the amount of carbon dioxide increases. One person exhales approximately 22.6 liters of carbon dioxide per hour. How much air must be supplied per person per hour in order to dilute these 22.6 liters so that the concentration of carbon dioxide in the air of the room would not exceed 0.7% ° or 1 /<.. ?

Each liter of air supplied to the room contains 0.4%° of carbon dioxide, that is, each liter of this air contains 0.4 ml of carbon dioxide and thus can still "accept" 0.3 ml (0.7 - 0.4) for clean rooms (up to 0.7 ml per liter or 0.7 /~) and 0.6 ml (1 - 0.4) for normal rooms (up to 1 ml per liter or 1 /~).

Since every hour 1 person releases 22.6 liters (22600 ml) of carbon dioxide, and each liter of air supplied can "accept" the above number of ml of carbon dioxide, the number of liters of air that needs to be supplied to the room per 1 person per hour is

For clean rooms (wards, operating rooms) - 22600 / 0.3 = 75000 l = 75 m 3. That is, 75 m 3 of air per person per hour must enter the room so that the concentration of carbon dioxide in it does not exceed 0.7% *

For ordinary premises - 22600 / 0.6 = 37000 l = 37 m 3. That is, 37 m3 of air per person per hour must enter the room so that the concentration of carbon dioxide in it does not exceed.

If there is more than one person in the room, then the indicated figures are multiplied by the number of people.

Above it was explained in detail how the value of the ventilation volume is found directly on specific figures, in general it is not difficult to guess that the general formula is as follows:

b \u003d (K * M) / (P - P0 \u003d (22.6 l * 14) / (P - 0.4%.)

b - ventilation volume (m)

K - the amount of carbon dioxide exhaled by a person per hour (l)

N is the number of people in the room

P - the maximum allowable carbon dioxide content in the room (/ ")

Using this formula, we calculate the required volume of supplied air (required ventilation volume). In order to calculate the real volume of air that is supplied to the room per hour (real volume of ventilation), it is necessary to substitute the real concentration of carbon dioxide in this room in ppm instead of P (MAC of carbon dioxide - 1 / C 0.7 U ") in the formula:

^ real-

- (22.6 l * 14) / ([C0 2] fact - 0.4 / ~)

L real - real volume of ventilation

[CCVactual - the actual content of carbon dioxide in the room

To determine the concentration of carbon dioxide, the Subbotin-Nagorsky method is used (based on a decrease in the titer of caustic Ba, the most accurate), Rehberg's method (also the use of caustic Ba, express method), Prokhorov's method, photocolorimetric method, etc.

Another quantitative characteristic of ventilation, directly related to the volume of ventilation, is the ventilation rate. The ventilation rate indicates how many times per hour the air in the room is completely exchanged.

Ventilation rate - The volume of the hit (recovered 4) in the chag. air dry I

The volume of the room.

Accordingly, in order to calculate the required ventilation rate for a given room, it is necessary to substitute the required ventilation volume in the numerator in this formula. And in order to find out what is the real ventilation rate in the room, the real ventilation volume is substituted into the formula (see above for the calculation).

The ventilation rate can be calculated by the inflow (the rate by the inlet), then the volume of air supplied per hour is substituted into the formula and the value is indicated with a (+) sign, or it can be calculated by the exhaust (the rate by the hood), then the volume of air extracted per hour is substituted into the formula and the value is specified with a (-) sign.

For example, if in the operating room the ventilation rate is indicated as +10, -8, then this means that every hour ten times the volume of air enters this room, and eight times the volume of air is extracted in relation to the volume of the room.

There is such a thing as an air cube.

The air cube is the volume of air required per person.

The norm of the air cube is 25-27 m. But as it was calculated above, for one person per hour, it is required to supply an air volume of 37 m 3, that is, at a given norm of the air cube (a given volume of the room), the required air exchange rate is 1.5 = 1.5).

The microclimate of hospital premises.

Temperature regime.

Temperature changes must not exceed:

In the direction from the inner to the outer wall - 2°С

In the vertical direction - 2.5°C per meter of height

During the day with central heating - 3 ° С

Relative humidity should be 30-60%

Air speed - 0.2-0.4 m/s

6. The problem of nosocomial infections; nonspecific prevention measures, purpose and content.

HOSPITAL INFECTIONS - any clinically recognizable disease caused by microorganisms that occurs in patients as a result of being in a medical and preventive organization or seeking medical help, as well as that has arisen in medical personnel as a result of their professional activities (World Health Organization).

nonspecific prophylaxis.

Architectural and planning activities

Construction and reconstruction of inpatient and outpatient clinics in compliance with the principle of rational architectural and planning solutions:

isolation of sections, chambers, operating blocks, etc.;

observance and separation of flows of patients, personnel, “clean” and “dirty” flows;

Rational placement of departments on floors;

Correct zoning of the territory

Sanitary measures

effective artificial and natural ventilation;

creation of normative conditions for water supply and sanitation;

Proper air supply

air conditioning, use of laminar installations;

Creation of regulated parameters of the microclimate, lighting, noise mode;

Compliance with the rules of accumulation, neutralization and disposal of waste from medical institutions.

Sanitary and anti-epidemic measures

· epidemiological surveillance of nosocomial infections, including analysis of the incidence of nosocomial infections;

control over the sanitary and anti-epidemic regime in medical institutions;

introduction of the service of hospital epidemiologists;

· laboratory control of the state of the anti-epidemic regime in medical facilities;

detection of bacteria carriers among patients and staff;

Compliance with the rules of accommodation of patients;

Inspection and admission of personnel to work;

rational use of antimicrobial drugs, primarily antibiotics;

· training and retraining of personnel on the issues of regimen in health facilities and prevention of nosocomial infections;

Sanitary and educational work among patients.

Disinfection and sterilization measures.

the use of chemical disinfectants;

application of physical methods of disinfection;

pre-sterilization cleaning of instruments and medical equipment;

ultraviolet bactericidal irradiation;

chamber disinfection;

steam, dry air, chemical, gas, radiation sterilization;

Carrying out disinfection and deratization.

Air-thermal regime of hospitals. The compensatory capabilities of the sick organism are limited, sensitivity to adverse environmental factors is increased. Consequently, the range of fluctuations of meteorological factors in the hospital should be less than in any room for healthy people.

The state of thermal comfort is a combination of four physical factors - air temperature, humidity, air velocity, temperature of the internal surfaces of the room. Normal microclimate parameters take into account: the age of the patient, the characteristics of heat transfer in various diseases, the purpose of the room and climatic conditions.

Air temperature is the most important microclimate factor that determines the thermal state of the body. It is generally accepted that the optimal air temperature in the wards of medical institutions should be slightly higher than 20 ° C than in residential premises 18 ° C (Table 6.7).

1. The age characteristics of children determine the highest temperature standards in the wards of premature babies, newborns and infants - 25 ° C.

2. Features of heat transfer in patients with impaired thyroid function cause high temperature in the wards for patients with hypothyroidism (24 ° C). On the contrary, the temperature in the wards for patients with thyrotoxicosis should be 15 ° C. Increased heat generation in such patients is the specificity of thyrotoxicosis: the “sheet” syndrome, such patients are always hot.

3. The temperature in the halls of physiotherapy exercises is 18 o C. For comparison: the halls of physical education at school are 15-17 o C. Physical activity is accompanied by increased heat generation.

4. Other functional purpose of the premises: in operating rooms, PITs, the temperature should be higher than in the wards - 22 o.

An integral element of the indoor microclimate is humidity air with a range of 30 to 70%, and for medical institutions - 40-60%.

Moving air for the body is a light tactile stimulus that stimulates the centers of thermoregulation. Optimal air mobility in the premises of health care facilities is 0.1-0.3 m/s.

Hygienic requirements for the chemical and bacteriological composition of air in hospitals

When people stay indoors for a long time, waste products of the body accumulate in the air (the concentration of carbon dioxide, the amount of dust and microorganisms increase, the amount of oxygen decreases, etc.). At the same time, people feel worse, mental and physical performance decreases, coordination of movements and reaction speed deteriorate. Therefore, the definition of microclimatic conditions and calculations of the necessary ventilation in a given room are of great importance.

The main criterion for assessing the degree of indoor air pollution and calculating ventilation is the concentration of carbon dioxide in the air. The amount of carbon dioxide (CO 2 ) in indoor air increases as a result of people's breathing, during the processes of combustion, fermentation, and decay. The content of CO 2 in the atmospheric air is within 0.04% (0.03-0.05%). The maximum permissible concentration of CO 2 in residential and public buildings is not higher than 0.1%.

The air in hospitals contains chemicals that accumulate during the work of medical personnel. There are hygienic standards for the content of these substances in the air of hospital premises - the maximum allowable concentrations (table 6.2).

The administration of the medical institution organizes control over the microclimate and chemical pollution of the air in all rooms periodically: 1st group - high-risk rooms - 1 time in 3 months. 2nd group - high-risk premises - 1 time in 6 months. 3rd group - all other premises and, first of all, wards - once a year.

Microclimate- a complex of physical factors of the internal environment of the premises, influencing the heat exchange of the body and human health. Microclimatic indicators include temperature, humidity and air velocity, the temperature of the surfaces of enclosing structures, objects, equipment, as well as some of their derivatives (air temperature gradient along the vertical and horizontal of the room, the intensity of thermal radiation from internal surfaces).

The impact of a complex of microclimatic factors is reflected in the heat sensation of a person and determines the characteristics of the physiological reactions of the body. Temperature effects that go beyond neutral fluctuations cause changes in the tone of muscles, peripheral vessels, the activity of sweat glands, and heat production. At the same time, the constancy of the heat balance is achieved due to the significant stress of thermoregulation, which negatively affects the well-being, working capacity of a person, and his state of health.

The thermal state in which the tension of the thermoregulatory system is negligible is defined as thermal comfort. It is provided in the range of optimal microclimatic conditions, within which there is the least stress of thermoregulation and comfortable heat sensation. Optimal norms of M. have been developed, which should be provided in medical and preventive and children's institutions, residential, office buildings, as well as at industrial facilities where optimal conditions are necessary for technological requirements. Sanitary norms for optimal M. are differentiated for the cold and warm periods of the year ( tab. one ).

Table 1

Optimal norms for temperature, relative humidity and air velocity in residential, public, administrative premises

Indicators	Period of the year
		cold and transitional
Temperature
Relative humidity, %
air speed, m/s	Not more than 0.25	Not more than 0.1-0.15

For the premises of medical institutions, the design air temperature is normalized, while for premises for various purposes (wards, rooms and treatment rooms), these standards are differentiated. For example, in wards for adult patients, rooms for mothers in children's departments, wards for tuberculosis patients, the air temperature should be 20 °; in wards for new patients, postpartum wards - 22°; in wards for premature, injured, infants and newborns - 25 °.

In those cases when, for a number of technical and other reasons, the optimal norms of M. cannot be ensured, they are guided by permissible norms ( tab. 2 ).

table 2

Permissible standards for temperature, relative humidity and air velocity in residential, public, administrative and amenity premises

Indicators	Period of the year
		cold and transitional
Temperature	Max 28°
for areas with an estimated air temperature of 25°	Max 33°
Relative humidity, %
in areas with an estimated relative air humidity of more than 75%
air speed, m/s	Not more than 0.5	Not more than 0.2

Permissible sanitary norms of M. in residential and public buildings are provided with the help of appropriate planning equipment, heat-shielding and moisture-proof properties of enclosing structures.

When conducting current sanitary supervision in residential, public, administrative and medical institutions, the air temperature is measured at the level of 1.5 and 0.05 m from the floor in the center of the room and in the outer corner at a distance of 0.5 m from the walls; relative humidity is determined in the center of the room at a height of 1.5 m from the floor; air speed is set at 1.5 and 0.05 m from the floor in the center of the room and at a distance of 1.0 m from the window; the temperature on the surface of enclosing structures and heating devices is measured at 2-3 points on the surface.

When carrying out sanitary supervision in multi-storey buildings, measurements are made in rooms located on different floors, in end and ordinary sections with one-sided and two-sided orientation of apartments at an outside air temperature close to the calculated one for these climatic conditions.

The air temperature gradient along the height of the room and horizontally should not exceed 2°. The temperature on the surface of the walls can be lower than the air temperature in the room by no more than 6 °, the floor - by 2 °, the difference between the air temperature and the temperature of the window glass in the cold season should not exceed an average of 10-12 °, and the thermal effect on the surface of the human body of the flux of infrared radiation from heated heating structures-0.1 cal/cm 2 × min.

Industrial microclimate. The industrial premises are significantly affected by the technological process, while the workplaces located in open areas are significantly affected by the climate and weather of the area.

At a number of industries, the list of which is established by industry documents agreed with the state sanitary supervision authorities, an optimal production microclimate is provided. In booths, on consoles and control posts for technological processes, in computer rooms, as well as in other rooms in which operator-type work is performed, optimal M values ​​\u200b\u200bshould be provided: air temperature 22-24 °, humidity - 40-60%, air speed - no more than 0.1 m/s regardless of the period of the year. Optimal standards are achieved mainly through the use of air conditioning systems. However, the technological requirements of some industries (spinning and weaving shops of textile factories, individual food industry shops), as well as technical reasons and economic opportunities for a number of industries (open-hearth, blast furnace, foundry, forge shops of the metallurgical industry, heavy engineering enterprises, glass production and food industry ) do not allow to ensure the optimal norms of the production microclimate. In these cases, at permanent and non-permanent workplaces, in accordance with GOST, permissible norms of M.

Depending on the nature of the heat input and the prevalence of one or another indicator of M., shops are distinguished mainly with a convection (for example, food shops of sugar factories, machine rooms of power plants, thermal shops, deep mines) or radiation heating (for example, metallurgical, glass production) microclimate. Convection heating M. is characterized by high air temperature, sometimes combined with its high humidity (dye departments of textile factories, greenhouses, sinter shops), which increase the degree of overheating of the human body (see. Overheating of the body ). Radiation heating M. is characterized by the predominance of radiant heat.

If preventive measures are not observed in people who work for a long time in heating M., dystrophic changes in the myocardium, asthenic syndrome, the immunological reactivity of the body decreases, which contributes to an increase in the incidence of workers with acute respiratory diseases, tonsillitis, bronchitis, om, mi. When the body overheats, the adverse effect of chemicals, dust, noise increases, and fatigue sets in faster.

Table 3

Optimal values ​​of temperature and air velocity in the working area of ​​the production of other premises, depending on the category of work and periods of the year

	energy consumption, Tue	Periods of the year
		cold		cold
		Temperature (°C)		Air velocity, ( m/s)
light, ia
light, Ib
moderate, IIa
moderate, IIb
heavy, III

Cooling M. in industrial premises can be predominantly convection (low air temperature, for example, in separate preparatory shops for the food industry), predominantly radiation (low temperature of the enclosures in cold rooms), and mixed. Cooling contributes to the occurrence of respiratory diseases, exacerbation of diseases of the cardiovascular system. When cooling down, coordination of movements and the ability to perform precise operations deteriorate, which leads to both a decrease in performance and an increase in the likelihood of work injuries. When working in an open area in winter, it becomes possible frostbite, the use of personal protective equipment is difficult (freezing of respirators when breathing).

Sanitary standards provide for the provision of optimal or acceptable parameters of M. industrial premises, taking into account 5 categories of work, characterized by different levels of energy consumption ( tab. 3 ). The norms regulate the temperature, humidity, air velocity and intensity of thermal exposure of workers (taking into account the area of ​​the irradiated body surface), the temperature of internal surfaces, enclosing the working area structures (walls, floors, ceilings) or devices (for example, screens), the temperature of the outer surfaces of the technological equipment, air temperature fluctuations along the height and horizontal of the working area, its changes during the shift, and also provide for the necessary measures to protect workplaces from radiation cooling. emanating from the glass surface of window openings (during the cold season) and heating from direct sunlight (during the warm season).

Prevention of overheating of those working in heating M. is carried out by reducing the external heat load by automating technological processes, remote control, the use of collective and individual protective equipment (heat-absorbing and heat-reflecting screens, air showers, water curtains, radiation cooling systems), regulation of the time of continuous stay on the workplace and in the recreation area with optimal microclimatic conditions, the organization of the drinking regime.

To prevent overheating of those working in the summer in an open area, overalls made of air- and moisture-permeable fabrics, materials with high reflective properties are used, and rest is organized in sanitary facilities with optimal temperature, which can be ensured by using air conditioners or radiation cooling systems. . Of great importance are measures aimed at increasing the body's resistance to thermal effects, including adaptation to this factor.

When working in a cooling M., preventive measures include the use of overalls in the first place (see. clothing ), shoes (see Shoes ), hats and mittens, the heat-shielding properties of which must correspond to meteorological conditions, the severity of the work performed. The time of continuous stay in the cold and breaks for rest in sanitary facilities, which are included in working hours, are regulated. These rooms are additionally equipped with devices for heating hands and feet, as well as devices for drying overalls, shoes, and mittens. To prevent freezing of respirators, devices for heating the inhaled air are used.

Bibliography: Hygienic regulation of factors of the working environment and the labor process, ed. N.F. Measured and A.A . Kasparov, p. 71, M., 1986; Provincial Yu . D. and Korenevskaya E.I. Hygienic bases of microclimate conditioning of residential and public buildings, M., 1978, bibliogr.; Occupational Health Guide, ed. N.F. Izmerova, vol. 1, p. 91, M., 1987, Shakhbazyan G.X. and Shleifman F.M. Hygiene of industrial microclimate, Kyiv, 1977, bibliogr.

Microclimate Control Systems in Medical Institutions

A. P. Borisoglebskaya, Candidate of Engineering

keywords: medical and preventive treatment facility, air distribution, microclimate

Controlling of microclimate in Medical and Preventive Treatment Facilities is a complex task requiring special knowledge, experience and regulatory documents, since the same building includes rooms of different cleanness category and regulated air bacterial loads. Therefore, the design process requires serious discussions, studying of the best national practices and foreign experience.

Description:

Providing a microclimate in medical buildings or medical institutions is a complex task that requires special knowledge, experience and regulatory documents due to the presence in the volume of one building of rooms of various cleanliness classes and normalized levels of bacterial contamination of the air. Therefore, the design process requires serious discussion, study of the best domestic practices and foreign experience.

A. P. Borisoglebskaya, cand. tech. Sci., editor of the issue on the topic "Organization of the microclimate of health care facilities"

Ensuring a microclimate in medical buildings or medical and preventive treatment facilities (HCF) is a complex task that requires special knowledge, experience and regulatory documents due to the presence in the volume of one building of premises of various cleanliness classes and normalized levels of bacterial contamination of the air. Therefore, the design process requires serious discussion, study of the best domestic practices and foreign experience.

Development of the domestic regulatory framework

Having analyzed the history of the design of healthcare facilities, it can be seen that until the beginning of the 90s, there was a production of projects for hospital buildings, the main share of which belonged to standard design. Medical technologies of the treatment process almost did not develop and did not require the modernization of architectural and planning and, accordingly, engineering solutions. Therefore, the projects were rather monotonous, the typification of planning decisions led to the typification of decisions in the field of engineering systems design, such as ventilation and air conditioning. So, for a long time, planning decisions were made in projects for such basic structures as hospital wards without locks with direct access to the corridor of the ward section. And only at the very end of the 70s - the beginning of the 80s did the first projects appear with the installation of lock rooms at the wards, which led to a novelty in the adoption of sanitary and technical solutions. The design technology was based on the relevant regulatory documentation. In 1970, SNiP 11-L.9-70 “Hospitals and polyclinics. Design standards”, which for 8 years has been the main standard for designers in the narrow specialization “medical institutions”. It has not yet traced the requirement for the layout of wards with a lock, with the exception of wards for newborns and boxes, semi-boxes of infectious diseases hospitals. In 1978, it was replaced by SNiP 11-69-78 "Treatment and preventive care institutions", in which there is a reasonable requirement for the need to equip the wards with a gateway. Thus, a fundamentally new approach to the design of wards and ward sections arose. Moreover, joint architectural-planning and sanitary-technical solutions are recommended as the main way to ensure the required microclimate. Also by 1978, “Instructive and methodological guidelines for organizing air exchange in ward departments and operating blocks of hospitals” were developed, where the requirement was voiced to create an isolated air regime of the wards through planning decisions - the creation of gateways at the wards. Both documents were the result of new research in the field of organization of air exchange in hospital premises. Later, in 1989, SNiP 2.08.02–89 “Public Buildings and Structures” was published, which included requirements for the design of health facilities as types of public buildings, and in 1990, an addition to it in the form of a manual for the design of healthcare facilities. This document provided indispensable assistance to designers until 2014. , despite the prescription of origin, until it was replaced by SP 158.13330.2014 “Buildings and premises of medical organizations”. Then came out sequentially in 2003 and 2010, replacing each other, SanPiN 2.1.3.1375-03 "Hygienic requirements for the placement, arrangement, equipment and operation of hospitals, maternity hospitals and other medical hospitals" and SanPiN 2.1.3.2630-10 "Requirements for organizations engaged in medical activities. Thus, an overview of the main regulatory documents that have accompanied project activities in the field of medicine for several decades to the present is presented.

The outbreak of interest in the hygienic aspects of the air environment was especially acute in the 70s. Not only specialists in the design of engineering systems, but also specialists in the field of sanitation and hygiene began to intensively study the quality of the air environment in medical facilities, the state of which was considered unsatisfactory. A large number of publications have appeared on the topic of organizing measures to ensure clean air in the premises of healthcare facilities. Among epidemiologists, for a long time it was believed that the quality of the air environment is determined by the quality of anti-epidemic measures. There is a concept of specific and non-specific infection prevention. In the first case, these are disinfection and sterilization (anti-epidemic measures), in the second case, ventilation and architectural and planning measures. Over time, studies have shown that against the background of specific prevention, current medical and technological processes in health facilities continue to be accompanied by the growth and spread of nosocomial infections. The emphasis began to be placed on sanitary and architectural and planning solutions, which among hygienists began to be considered the main method of non-specific prevention of nosocomial infection (HAI), and they began to play a dominant role.

Design features of health care facilities

During the entire period, especially from the mid-1990s to the present, there has been a development in technologies to ensure clean air, starting from the sterilization of air and surfaces of rooms and up to the use of modern technical solutions and the introduction of the latest equipment in the field of microclimate. Modern technologies have appeared that make it possible to provide and maintain the required conditions of the air environment.

The design of engineering systems in health care facilities has always been and still is a difficult task compared to the design of a number of other objects related, like health care facilities, to public buildings. Features of the technology for designing heating, ventilation and air conditioning systems in these buildings are directly related to the features of the health facilities themselves. Features of LPU are as follows. The first feature of LPU should be considered a wide range of their names. These are general hospitals and specialized hospitals, maternity hospitals and perinatal centers. The complex of healthcare facilities includes: infectious diseases hospitals, clinics and dispensaries, treatment and diagnostic and rehabilitation centers, medical centers for various purposes, dental clinics, research institutes and laboratories, dispensaries and sanatoriums, ambulance substations and even dairy kitchens and sanitary and epidemiological stations. This entire list of institutions of completely diverse purposes implies the same set of various medical technologies that accompany the operation of buildings. In recent years, medical technologies have been growing rapidly: new and incomprehensible processes are being carried out in operating rooms, laboratories and other premises, sophisticated modern equipment is being used. For design engineers, misunderstood names and abbreviations in the explication of premises become frightening, which cannot be understood without qualified technologists, with the presence of which, as a rule, there are difficulties. On the other hand, the improvement of medical and technological solutions requires new, directly related, engineering solutions, often unknown without the support of technologists or their lack of proper qualifications. All this adds difficulties in the production of design work, and often even for an engineer with a long experience in the field of medicine, each new building being designed presents newly set, sometimes research, technological and engineering tasks.

The second feature of LPU should be considered a feature of the sanitary and hygienic state of the air environment of the premises, which is characterized by the presence in the air of the premises not only of mechanical, chemical and gas pollution, but also of microbiological contamination of the air. The standard criterion for the cleanliness of indoor air in public buildings is the absence of excess heat, moisture and carbon dioxide in it. In healthcare facilities, the main indicator for assessing air quality is nosocomial infection (HAI), which is of particular danger, the source of which is the staff and the patients themselves. It has the peculiarity, regardless of the planned disinfection measures, to accumulate, grow rapidly and spread throughout the premises of the building, and in 95% of cases by air.

The next feature is the nature of the architectural and planning solutions of medical facilities, which have changed qualitatively. There was a time when the hospital building assumed the presence of a group of different buildings located at a distance from each other and separated, respectively, by air from each other. This made it possible to isolate clean and dirty medical and technological processes and patient flows. Clean and dirty rooms were located in separate buildings, which helped to reduce the transmission of infection. In modern times of saving building space in design, there is a tendency to increase the number of storeys, compactness in terms of and capacity of hospitals, which leads to a reduction in the length of communications and, of course, more economically. On the other hand, this leads to a close mutual arrangement of rooms with different cleanliness classes and the possibility of contamination from dirty rooms to clean rooms both vertically and in floor plan.

To justify the recommended requirements for the design of engineering systems in health facilities, it is necessary to dwell on the air regime of buildings (VRZ). Here it is necessary to consider the boundary value problem of VRZ regarding the nature of air movement through openings in the external and internal enclosures of buildings, which directly affects the sanitary and hygienic state of the air environment and can be considered as one of the features of health facilities. The air regime of the health care facility, as in any multi-storey building, is unorganized (chaotic) in nature, that is, it occurs spontaneously due to natural forces. Under VRZ in this case, one should understand the nature of the movement of air flows through the enclosing structures of the building. On fig. 1 shows a schematic section of the building. The section shows a stairwell (elevator shaft), which, as a single high room, is a vertical connection between the floors of the building and is of particular danger, since it is a channel through which air flows are transferred. Through the leakage of external fences (windows, transoms) there is an unorganized movement of air due to the difference in pressure outside and inside the premises of the building. As a rule, the movement of air at the level of the lower floors occurs from the street into the building, and as the number of storeys increases, the amount of incoming air gradually decreases and approximately at the middle of the height of the building changes its direction to the opposite, and the amount of outgoing air increases and on the top floor becomes maximum. In the first case, this phenomenon is called infiltration, in the second - ex-filtration. The same patterns are valid for the movement of air through the openings or their leaks in the internal enclosures of the building. As a rule, on the lower floors of the building, air flows move from the corridor of the floor to the volume of the staircase, and on the upper floors, on the contrary, from the staircase to the floors of the building. That is, the air coming from the premises of the lower floors of the building rises up and is distributed through the stairwell to the upper floors. Thus, there is an unorganized flow of air between the floors of the building, and, consequently, the transfer of WFI with its flows. As the number of storeys increases, air pollution in the stair-elevator units increases, which, if the air exchange is not properly organized, leads to an increase in bacterial contamination of the air in the rooms of the upper floors.

There is also unorganized air flow between rooms located on the windward and leeward facades of the building, as well as between adjacent rooms in the floor plan or between sections of departments. On fig. 2 shows the plan of the ward section of the hospital and indicates (arrows) the direction of air movement between the rooms. This is how air flows from the rooms of the wards located on the windward facade of the building to the rooms of the wards located on the windward facade, bypassing the ward lock. It is also obvious that there is a flow from the corridor of one ward section to the corridor of another. The circle shows the required organization of the movement of air flows in the ward block, excluding the flow of air from the ward to the corridor, and from the corridor to the ward.

Under the floor plan there is a fragment of the corridor with the image of active locks - additionally provided rooms with supply or exhaust ventilation in them to prevent air from flowing between the corridors of different sections. In the first case, the lock is considered "clean", since clean air flows from it into the corridor, in the second - "dirty": air from neighboring rooms will flow into the lock. Thus, assessing the phenomenon of VRZ as a difficult task, it becomes necessary to solve it, which should be reduced to the organization of flows of overflowing air and their control.

The features of health care facilities buildings are taken into account as a whole, since all the considered parameters are interconnected and interdependent, and affect the requirements for the organization of air exchange, architectural, planning and technical solutions, isolation of ward departments, sections, wards for patients and premises of operating blocks, which should be nosocomial infection prevention and control measures.

When organizing a rational scheme for the distribution of air flows, it is necessary to take into account the purpose of the premises, especially such as ward departments and operating blocks.

Planning and sanitary-technical solutions of ward departments should exclude the possibility of air flows from stair-elevator nodes to departments and, conversely, from departments to stair-elevator nodes, in departments - from one ward section to another, in ward sections - from the corridor to wards for patients and, conversely, from the wards to the corridor. Such solutions in the field of organizing the movement of air flows imply the exclusion of air flow in an undesirable direction and the spread of infectious agents with air flows. On fig. 3 shows a diagram of the organization of air flows, excluding the flow of air between floors.

Thus, the tasks of designing heating, ventilation and air conditioning systems of health facilities should be as follows:

1) maintaining the required parameters of the microclimate of the premises (temperature, speed, humidity, the required sanitary norm of oxygen, the specified chemical, radiological and bacterial purity of indoor air) and eliminating odors;

2) exclusion of the possibility of air overflow from dirty areas to clean ones, creation of an isolated air regime of wards, ward sections and departments, operating and generic blocks, as well as other structural divisions of healthcare facilities;

3) preventing the formation and accumulation of static electricity and eliminating the risk of an explosion of gases used in anesthesia and other technological processes.

Literature

1. Borisoglebskaya A.P. Medical and preventive institutions. General requirements for the design of heating, ventilation and air conditioning systems. M.: AVOK-PRESS, 2008.
2. Borisoglebskaya A.P. // ABOK. - 2013. - No. 3.
3. Borisoglebskaya A.P. // ABOK. - 2010. - No. 8.
4. Borisoglebskaya A.P. // ABOK. - 2011. - No. 1.
5. // ABOK. - 2009. - No. 2.
6. Tabunshchikov Yu. A., Brodach M. M., Shilkin N. V. Energy efficient buildings. M.: AVOK-PRESS, 2003.
7. Tabunshchikov Yu. A. // ABOK. - 2007. - No. 4.

Microclimate- a complex of physical factors of the internal environment of the premises, influencing the heat exchange of the body and human health. Microclimatic indicators include temperature, humidity and air velocity, the temperature of the surfaces of enclosing structures, objects, equipment, as well as some of their derivatives (air temperature gradient along the vertical and horizontal of the room, the intensity of thermal radiation from internal surfaces).

The impact of a complex of microclimatic factors is reflected in the heat sensation of a person and determines the characteristics of the physiological reactions of the body. Temperature effects that go beyond neutral fluctuations cause changes in the tone of muscles, peripheral vessels, the activity of sweat glands, and heat production. At the same time, the constancy of the heat balance is achieved due to the significant stress of thermoregulation, which negatively affects the well-being, working capacity of a person, and his state of health.

The thermal state in which the tension of the thermoregulatory system is negligible is defined as thermal comfort. It is provided in the range of optimal microclimatic conditions, within which there is the least stress of thermoregulation and comfortable heat sensation. Optimal microclimate standards have been developed, which should be provided in medical and preventive and children's institutions, residential, office buildings, as well as industrial facilities where optimal conditions are necessary for technological requirements. Sanitary standards for the optimal microclimate are differentiated for the cold and warm periods of the year ( tab. one ).

Table 1

Optimal norms for temperature, relative humidity and air velocity in residential, public, administrative premises

Indicators	Period of the year
		cold and transitional
Temperature
Relative humidity, %
air speed, m/s	Not more than 0.25	Not more than 0.1-0.15

For the premises of medical institutions, the design air temperature is normalized, while for premises for various purposes (wards, rooms and treatment rooms), these standards are differentiated. For example, in wards for adult patients, rooms for mothers in children's departments, wards for tuberculosis patients, the air temperature should be 20 °; in wards for burn patients, postpartum wards - 22°; in wards for premature, injured, infants and newborns - 25 °.

In cases where, for a number of technical and other reasons, optimal microclimate standards cannot be ensured, they are guided by acceptable standards ( tab. 2 ).

table 2

Permissible standards for temperature, relative humidity and air velocity in residential, public, administrative and amenity premises

Indicators	Period of the year
		cold and transitional
Temperature	Max 28°
for areas with an estimated air temperature of 25°	Max 33°
Relative humidity, %
in areas with an estimated relative air humidity of more than 75%
air speed, m/s	Not more than 0.5	Not more than 0.2

Permissible sanitary microclimate standards in residential and public buildings are ensured with the help of appropriate planning equipment, heat-shielding and moisture-proof properties of building envelopes.

When conducting current sanitary supervision in residential, public, administrative and medical institutions, the air temperature is measured at the level of 1.5 and 0.05 m from the floor in the center of the room and in the outer corner at a distance of 0.5 m from the walls; relative humidity is determined in the center of the room at a height of 1.5 m from the floor; air speed is set at 1.5 and 0.05 m from the floor in the center of the room and at a distance of 1.0 m from the window; the temperature on the surface of enclosing structures and heating devices is measured at 2-3 points on the surface. When carrying out sanitary supervision in multi-storey buildings, measurements are made in rooms located on different floors, in end and ordinary sections with one-sided and two-sided orientation of apartments at an outside air temperature close to the calculated one for these climatic conditions.

The air temperature gradient along the height of the room and horizontally should not exceed 2°. The temperature on the surface of the walls can be lower than the air temperature in the room by no more than 6 °, the floor - by 2 °, the difference between the air temperature and the temperature of the window glass in the cold season should not exceed an average of 10-12 °, and the thermal effect on the surface of the human body of the flux of infrared radiation from heated heating structures-0.1 cal/cm 2 × min.

Industrial microclimate . The microclimate of industrial premises is significantly influenced by the technological process, the microclimate of workplaces located in an open area is significantly affected by the climate and weather of the area.

At a number of industries, the list of which is established by industry documents agreed with the state sanitary supervision bodies, an optimal production microclimate. In cabins, on consoles and control posts for technological processes, in computer rooms, as well as in other rooms in which operator-type work is performed, optimal microclimate values ​​​​should be provided: air temperature 22-24 °, humidity - 40-60%, speed air movement - no more than 0.1 m/s regardless of the period of the year. Optimal standards are achieved mainly through the use of air conditioning systems. However, the technological requirements of some industries (spinning and weaving shops of textile factories, individual food industry shops), as well as technical reasons and economic opportunities for a number of industries (open-hearth, blast furnace, foundry, forge shops of the metallurgical industry, heavy engineering enterprises, glass production and food industry ) do not allow to ensure the optimal norms of the production microclimate. In these cases, at permanent and non-permanent workplaces, in accordance with GOST, permissible microclimate standards are established.

Depending on the nature of the heat input and the prevalence of one or another indicator of the microclimate, shops are distinguished mainly with a convection (for example, food shops of sugar factories, machine rooms of power plants, thermal shops, deep mines) or radiation heating (for example, metallurgical, glass production) microclimate. The convection heating microclimate is characterized by high air temperature, sometimes combined with its high humidity (dye departments of textile factories, greenhouses, sinter shops), which increases the degree of overheating of the human body (see Fig. Overheating of the body). The radiation heating microclimate is characterized by the predominance of radiant heat.

If preventive measures are not observed in persons working for a long time in a heating microclimate, dystrophic changes in the myocardium, arterial hypertension, hypotension, asthenic syndrome can be observed, the immunological reactivity of the body decreases, which contributes to an increase in the incidence of workers with acute respiratory diseases, tonsillitis, bronchitis, myositis, neuralgia. When the body overheats, the adverse effect of chemicals, dust, noise increases, and fatigue sets in faster.

Table 3

Optimal values ​​of temperature and air velocity in the working area of ​​the production of other premises, depending on the category of work and periods of the year

	energy consumption, Tue	Periods of the year
		cold		cold
		Temperature (°C)		Air velocity, ( m/s)
light, ia
light, Ib
moderate, IIa
moderate, IIb
heavy, III

The cooling microclimate in industrial premises can be predominantly convectional (low air temperature, for example, in separate preparatory workshops for the food industry), predominantly radiative (low temperature of enclosures in cold rooms) and mixed. Cooling contributes to the occurrence of respiratory diseases, exacerbation of diseases of the cardiovascular system. When cooling down, coordination of movements and the ability to perform precise operations deteriorate, which leads to both a decrease in performance and an increase in the likelihood of work injuries. When working in an open area in winter, it becomes possible frostbite, the use of personal protective equipment is difficult (freezing of respirators when breathing).

Sanitary standards provide for the provision of optimal or acceptable parameters of the microclimate of industrial premises, taking into account 5 categories of work, characterized by different levels of energy consumption ( tab. 3 ). The norms regulate the temperature, humidity, air velocity and intensity of thermal exposure of workers (taking into account the area of ​​the irradiated body surface), the temperature of internal surfaces, enclosing the working area structures (walls, floors, ceilings) or devices (for example, screens), the temperature of the outer surfaces of the technological equipment, air temperature fluctuations along the height and horizontal of the working area, its changes during the shift, and also provide for the necessary measures to protect workplaces from radiation cooling. emanating from the glass surface of window openings (during the cold season) and heating from direct sunlight (during the warm season).

Prevention of overheating of workers in a heating microclimate is carried out by reducing the external heat load by automating technological processes, remote control, using collective and individual protective equipment (heat-absorbing and heat-reflecting screens, air showers, water curtains, radiation cooling systems), regulating the time of continuous stay at the work place and in a recreation area with optimal microclimatic conditions, organization of a drinking regime.

To prevent overheating of workers in the summer in an open area, overalls made of air- and moisture-permeable fabrics, materials with high reflective properties are used, and rest is organized in sanitary facilities with an optimal microclimate, which can be provided by using air conditioners or radiation cooling systems. Of great importance are measures aimed at increasing the body's resistance to thermal effects, including adaptation to this factor.

When working in a cooling microclimate, preventive measures include the use of overalls in the first place (see. clothing), shoes (see Shoes), hats and mittens, the heat-shielding properties of which must correspond to meteorological conditions, the severity of the work performed. The time of continuous stay in the cold and breaks for rest in sanitary facilities, which are included in working hours, are regulated. These rooms are additionally equipped with devices for heating hands and feet, as well as devices for drying overalls, shoes, and mittens. To prevent freezing of respirators, devices for heating the inhaled air are used.

Bibliography: Hygienic regulation of factors of the working environment and the labor process, ed. N.F. Measured and A.A . Kasparov, p. 71, Moscow, 1986; Provincial Yu . D. and Korenevskaya E.I. Hygienic bases of microclimate conditioning of residential and public buildings, M., 1978, bibliogr.; Occupational Health Guide, ed. N.F. Izmerova, vol. 1, p. 91, M., 1987, Shakhbazyan G.X. and Shleifman F. M. Hygiene of industrial microclimate, Kyiv, 1977, bibliogr.